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Home My WebLink About0022 ARROWHEAD DRIVE - Health 224 Arrowhead Drive Hyannis IF _. 271�050 �L� o i o e o ° o a o • h ° j o ° rr 1 . r` L0 Cr-AT10N SEWAGE PERMIT NO. ?�Z V I L c IN LLIR'S NAME A+ ADDRESS i a L o E R o owaAj DATE PERMIT ISSUED DAT E C0MPLIANCE ISSUED �� - -- -- f � L _ d� � � � o �_ � V �0 C _ �. Y _ .l(�� MjNl3f . TOViN OF B U LF LOCATION K /� SEWAGE # -t!ILLAGE H:�°1 v1 A l ASSESSOR'S MAP & LOT AlJ' � INSTALLER'S NAME&PHONE NO. V f�L'LA�n /� / — M 4 1 1 (eSS ed0 t_ SEPTIC TANK CAPACITY ,p e� LEACHING FACILrrY: (type) �1�� 0�✓ / (size) NO. OF BEDROOMS 3 BUILDER OR OWNER y nod PERMIT DA : U n to COMPLIANCE DATE: Se ara on istance Betw n the. Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) A/ A Feet Edge of Wetland and Leaching Facility(If any wetlands exist M Feet within 300 feet of leaching facility) Ae04YePC,14*J(—Furnished by � /�A/WAJ-5 d i I I y \ QQ r6 f. ► `► -� { ". COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS a DEPARTMENT OF ENVIRONMENTAL PROTECTION , t7 1 PARCEL - LOTY- TITLE S OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: f0� head Mf+- Owner's Name: A9a�ka V . #owa(rd I-A / anc omp5or Owner's Address: 6 dt I— , lI hvlrs I St Dd l-04 S/P i3 2- Date of Inspection: /Z Q (J., " Name of Inspector: (please print) Joseph M.Martins Company Name: Accu Sepcheck co Mailing Address: 17 Northside Dr., S.Dennis,MA 02660 Telephone Number: 508-385-5891 ry v CERTIFICATION STATEMENT M I certify that I have personally inspected the sewage disposal system at this address and that the info ation reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section15.340 of Title 5(310 CMR 15.000} The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails 4 Inspector's Signature Date: �� d The system inspector shall s Lit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments: ""This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Page 2 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 22 Arrowhead Drive, Hyannis, MA Owner: Thompson Date of Inspection: 7/23/04-8/2/04 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D 2:e Passes: not found any information which indicates that any of the failure criteria described in 310 CUR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statem f"not determined"please explain. The septic tank is metal and over 20 years old*or the sep ' (whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or ilure is imminent.System will pass inspection if the existing tank is replaced with a complying septic tank pproved by the Board of Health. *A metal septic tank will pass inspection if it is Ily sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years of ' available. ND explain: Observation of sewage ckup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due t broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of th): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 22 Arrowhead Drive, Hyannis, MA Thompson Owner: 7/23/04-8/2/04 Date of Inspection: C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Bo f Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Healt termines in accordance with 310 CMR 15.303(1)(b)that the system'is not functioning in a man which will protect public health,safety and the environment: Cesspool or privy is m 50 feet of a surface water _ Cesspool or pri ' within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SASEof 1 of a public water supply. _ The system has a septic tank and SAS and the SA a private water supply well. The system has a septic tank and SAS e SASeet but 50 feet or more from a private water supply well". Method us o determine distance "This system passes if the w�ej ater analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organ' Compounds indicates that the well is free from pollution from that facility and the presence of ammo ' nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are red.A copy of the analysis must be attached to this form. 3. Other: Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 22 Arrowhead Drive, Hyannis, MA Thompson Owner: 7/23/04-8/2/04 Date of Inspection: D. System Failure Criteria applicable to all systems: You must indicate"yes"or`no"to each of the following for all inspections: Yes No Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool T Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or ,clogged SAS or cesspool ./ Static liquid level in the distribution box above outlet invert-due to an overloaded or clogged SAS or /cesspool ✓ squid depth in cesspool is less than 6"below invert or available volume is less than %2 day flow _Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number /of times pumped _ J Any portion of the SAS,cesspool or privy is below high ground water elevation. _ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface Zwater supply. _ XAny portion of a cesspool or privy is within a Zone 1 of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water .supply well with no acceptable water quality analysis.[This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria Al are triggered.A copy of the analysis must be attached to this form.] /• (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility wit design flow of 10,000 gpd to 15,000 gpd- You must indicate either`yes"or"no"to each of the followin (The following criteria apply to large systems in addition t e criteria above) yes, no _ the system is within 400 feet of a s ce drinking water supply the system is within 200 f of a tributary to a surface drinking water supply the system is locat a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a pub ' water supply well If you have answer 'yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Secti above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. Page 5 of I 1 OFFICIAL INSPECTION FORM-NOT FOR'VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 22 Arrowhead Drive, Hyannis, MA Owner: Thompson Date of Inspection: 7/23/04-8/2/04 Check if the following have been done. You must indicate`yes"or"no"as to each of the following: Yes o Pumping information was provided by the owner,occupant,or Board of Health jZWere any of the system components pumped out in the previous two weeks _ Has the system received normal flows in the previous two week period? Have large volumes of water been introduced to the system recently or as part of this inspection? NWere as built plans of the system obtained and examined?(If they were not available note as N/A) Was the facility or dwelling inspected for signs of sewage back up? Was the site inspected for signs of break out? v Were all system components,excluding the SAS,located on site? Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no _✓Existing information.For example,a plan at the Board of Health. Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)J Page 6 of 1 I OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 22 Arrowhead Drive, Hyannis, MA Owner: Thompson Date of Inspection: 7/23/04-8/2/04 FLOW CONDITIONS RESIDENTIAL 2 v Q ' /�O�nl/1 =3 Number of bedrooms(design):Nh Number of bedrooms(actual): /- � DESIGN flow based on 310 CMR 15 203(for example: 110 gpd x#of bedrooms): 33� Number of current residents: e)-y Does residence have a garbage grinder(yes or no):Na Is laundry on a separate sewage system(yes or no);0 [if yes separate inspection required] Laundry system inspected(yes Qr no)�l/1�' O 4 3 Y��U D Seasonal use: (yes or no):�U Water meter readings,if available(last 2 years usage(gpd)): Sump pump(yes or no): NIP _/ p 9 Last date of occupancy,,Q �P,T/y COMMERCIALANDUSTRIAL J Type of establishment: Design flow(based on 310 CMR 15.203): pd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank r es or no): Non-sanitary waste dis ed to the Title 5 system(yes or no):_ Water meter r ' s,if available: Last occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records y/0 /Lspie q A f �)&Ipov/ fD � �Source of information: N �'[( (/ Was system pumped as part of the inspection(yes or no): /QS If yes,volume pumped: allon�--How was tity pumped determin � _{� Reason for pumping: d� TYPE OF SYSTEM _Septic tank,distribution box,soil absorption system Single cesspool $Overflow cesspool —Privy Shared system(yes or no)(if yes,attach previous inspection records,if any) Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank _Attach a copy of the DEP approval _Other(describe): Appr ate age of all components, t installed(if wn)and so f information: Were sewage odors detected when arriving at the site(yes or no :,F Page 7 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 22 Arrowhead Drive, Hyannis, MA Owner: Thompson Date of Inspection: 7/23/04-8/2/04 BUILDING SEWER(locate on site plan) Depth below grade: PP 2- Materials of construction:_cast iron _40 PVC_other(explain): Distance from private water supply well or suction line: > /D 1 Comments(on condition of joints,v nting,evidence of leakage,etc.): c/ D ro ..eve eA D e96� SEPTIC TANK:_(locate on site plan) Depth below grade: Material of construction:_concrete metal_fiberglass_po ethylene _other(explain) If tank is metal list age:_ Is age confirmed by a Ce ' sate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: Sludge depth: Distance from top of sludge to om of outlet tee or baffle: Scum thickness: Distance from top o um to top of outlet tee or baffle: Distance from om of scum to bottom of outlet tee or baffle: How were ensions determined: Commen s(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): GREASE TRAP:_(locate on site plan) Depth below grade: Material of construction:_concrete metal_fibergl polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of o tee or baffle: Distance from bottom of scum to om of outlet tee or baffle: Date of last pumping: Comments(on pumpm mmendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet ' ert,evidence of leakage,etc.): Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 22 Arrowhead Drive, Hyannis, MA Owner: Thompson Date of Inspection: 7/23/04-8/2/04 TIGHT or HOLDING TANK: (tank,must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass_polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallon y Alarm present(yes or no): Alarm level: Al working order(yes or no): Date of last pumping: Comments(conditi of alarm and float switches,etc.): DISTRIBUTION BOX: (if present be opened)(locate on site plan) Depth of liquid level above outlet' ert: Comments(note if box is lev d distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of,bo c.): PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump ch ,condition of pumps and appurtenances,etc.): Page 9 of 11 OFFICIAL INSPECTION FORM— NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: 22 Arrowhead Drive, Hyannis, MA Date of Inspection: Thompson 7/23/04-8/2/04 SOIL,ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number:_ leaching chambers, number: leaching galleries,number: leaching trenches,number,length: thing fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation, etc.): / �� .7 &�tY1 IS . 3 , DL�c CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: ! "!A to Ck Depth—top of liquid to inlet invert: 0 11 Depth of solids layer: rc�6G 7 7 V'e— e elo7 Depth of scum layer: /•D ' S t�, Dimensions of cesspool: X D Materials of construction: ead ] Indication of groundwater inflow(yes or no): —AW Comments(note condition of soil,signs of hydraulic failure,lev I of ponding,condition of vegetation, t / / ��'� l.e✓e/ �✓o ��tv �P1� tee PRIVY: (locate on site plan) Materials of construction: Dimensions: s , Depth of solids: Comments(note condition>soils of hydraulic failure,level of ponding,condition of vegetation,etc.): Y Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 22 Arrowhead Drive, Hyannis, MA Owner: . Thompson . Date of Inspection: 7/23/04-8/2/04 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. B � *4 l 2-�Z 13 = 3 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: 22 Arrowhead Drive, Hyannis, MA Date of Inspection: Thompson 7/23/04-8/2/04 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 3I 'l � D PPa& P ( r gom Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system.design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach do umentation) /� ✓Accessed USGS database-explain: O Q r�s �`//e, pvQ 7`er Cdn-fa/,r In& You must describe how you established the high ground water elevation: 74-, 6 r.0 t./Vt 4)dle.,% Ce�i bv v- W 4--51 L 36-y-d -ID &Hem- P�-i 023f6 - 30 q. aL l