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TOWN OF BARNSTABLE
Lf>C 9'I'iUN —7'7 M A r P4 SEWAGE #
-)LAGS A -115 ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY l�U nn
LEACHING FACILITY: (type) �X tr4, I''�� (size) GA'•
NO. OF BEDROOMS 3 I
BUILDER OR OWNER G �.1 tC -Ur16NUL
PERMIT DATE: COMPLIANCE DATE:
Separation Distance Between 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) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
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L 0 CATION SEWAGE PERMIT NO.
Lo"r c �CGS Pm*
VILLAGE
N INSTALLER'S NAME a ADDRESS
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Q U I L D E R OR OWNER
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DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED _ Z _
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
--------- .............OF..... ....................................
Apphration for llhipoiial Works Tomitrurtion ramit
Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal
System at:
4112'ez'<5. ..........e.41 .............. .................... 6......................................................
.....................
Location-Address or Lot No.
................................. ............................................................ .................................................................................................
Own.AE:��IIJ A) I-VYWC!�4.. Address
z,.................0-w�.. .................................................. ......................................................................................
Installer Address
Type of Building Size Lot./49....................Sq. feet
Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic Garbage Grinder Wo)
Other—Type of Building ............................ No. of persons-_----------------------- Showers Cafeteria
Otherfixtures ...................................................................................................n..................................................
Design Flow...........,.. .5.......................gallons per person per day. Total daily flow------------X.3R..................gallons.
Septic Tank—Liquid capacity./gPe..gallons Length,8............ Width.!4!.,( '-. Diameter................ Depth_.-5-14..".
x Disposal Trench—No. .................... Width.....__......_...... Total Length.....__......_...... Total leaching area...................sq. ft.
Seepage Pit No-------1------------ Diameter-----!.Z........ Depth below inlet.?_fA?2....... Total leaching area.:gn.g/......sq. ft.
Other Distribution box ( ) Dosing tank ( ) '7 9,�;—
Percolation Test Results Performed by.CA' Date........................................
'2 a Test Pit No. I.............minutes per inch' Depth of Test Pit..../��......... Depth to ground water.... ---Vj__
44 Test Pit No. 2...............minutes per inch Depth of Test Pit___............_.... Depth to' ground water______
'A F
94 ...........................................................W.......................................................................... .. ....A OG E R•
tr
0 Description of Soil .......4Pj5�q ...e-004opf. e. —.3pep" 1�,:�,,
.................................................................................................. MIJ L
3AP.'.,e M_ffqi'�IEVVICZ �
U ....... •. T .... -!..-- z............................. ...4Z_.-a94 20
W CIVI
_ ------------------------- - ---------------------------------
Nature of Repairs or Alterations—Answer when applicable............................................................ ...... -- --------
U T.
..................................................................................................................................................................... ..... A
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System
cordance it
the provision f'L I'!L- 5 f the State Sanit ry Code— The undersigned fu ther agrees not place the sys e in 2/p
<ve�on unt,!�'?",ertificate of Compliance s b issue&-by the board of Ith.
---Eign d..-. ..... . ... . . ..... ... ..... ......._.;�
��.............................................................. ........
Application Approved By.............. c�- ate
Date
Application Disapproved for the following reasons:................................................ ........................................................
............................................................................................................................................................. .........................................
Issued. Date
Permit No.---...
........ ........I----------------------- ............ /.....
D to
No � Fps..::- .
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
........................OF.....Ido"O!L:fl. 7''. +GCr
Appliratinn for Bhipviial Works Tnmtxn.rtion ratnit
Application is hereby made for a Permit to Construct (,ot() or Repair ( ) an Individual Sewage Disposal
System at:
_;4V_A.............. ..•-'-......•'-'__....'--
Location-Address or Lot No.
...................... .e,-_-,.e"pi:;........ ..L.t,...........................................
W I Owner Address
( -------- -.-•`---._---.--••----------•-•------•-------- -------------•------
Ins`alle Address •• •--•-.
Pq
UType of Building Size Lot_ d b :�--.........Sq. feet
I� Dwelling—No. of Bedrooms............................................Expansion Attic ( ) ge Grinder (Ala)
Pk Other—Type of Building ---------------------------- No. of persons............................ Showers ( . ) — Cafeteria ( )
QI Other fixtures --------------------•--.---. _
W Design Flow...........%oT. �.................•.__•._galIons per person per day. Total daily flow----___-__-.:X al...........•...•__gallons.
R; Septic Tank—Liquid capacity_/94o..gallons Length,8'A'...... Width.15 -f/Q"_ Diameter................ Depth..-10 .Q."�.
W Disposal Trench—No..................... Width.................... Total Length............ Total leaching area---------__._....._.sq. ft.
x
Seepage Pit No.......I------------ Diameter-----i?rO-------- Depth below inlet+Z.-fA7..._. Total leaching area.�f*0.....sq. ft.
Z Other Distribution box ( ) Dosing tank
'-' Percolation Test Results Performed ''01 .
!! Date..
-------------------��`
Test Pit No. 1.....';!'.._._minutes per inch Depth of Test Pit..... _ ------ Depth to ground water.._%...?
H-OFM
fs, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........
..................•• ---....._......_........ ......._...... •--_..--••-"...._..........._....•••... {" ....pQGER �G
a ---• ...�� �����3�i�� t n
q ,♦ c � MfCt4it41EWICZ
a!4!.`;}_SGr G ��"'� �/ •�" y.Q/ 7'i.CjG U •'S�r�' _. _. 7.*............................... 1Vi2.30420 y
CIVIL
7/d --•-•---------•"--------------------".----------------------------
U Nature of Repairs or Alterations—Answer when applicable...................................................................... ........
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of.TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
S�gned-•--••-•••-•-•---• ........................................"-..........---•--. •------------••••............
Pate
Application Approved By..........` _. � ' _._F . •----'.y E-
l Da -�
Application Disapproved for the following reasons:---------••-----"--------------•-"-"----------•-------"-"------...-------"-----"-----••-•--------'--'--•--...•
...............••--...........-----'---•-----•-----•---------•'•••••••'•"•-__.._._..."'-•-•-------••••.••-----•-•-----•-•-•-••------••------•-'•----------•---•-•---•-------•-----......----_.__.''''-
Date
Permit No......... S ---------------- Issued-..-----'--.. .._._/5
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
f ..........................................OF.....................................................................................
Cyr ifirab of Toutphaurr
THIS IS TO CERTIFY, That the Individual e °age Disposal Syste onstructed '^ ) or Repaired ( )
�_ ,
J .-.., lnsta er •
at-•'•-••-�* �'I j ! :,gin ----•------ --------------------"---"-------"-----•-------- "
has been instaiied in accordance with the provisions of T i of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No------- _� �C'�_Y ____-__-__- dated... �l l'`'��-___-_"_-__-_•--
THE ISSUANCE OF THIS CERTIFICATE SHALL.NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILLI FUNC ION SATISFACTORY t n
DATE. ........ z..- --'-•-== Inspector...... 4 �q.............. .
THF- ',d'OMMONWEAIITH,OF MASSACHUSETTS!
BOARD �F" HEALTH
jK, ..`'1
- FEE......:: l
Disposal 10orhig Tnn tr tinn' rnnft
Permission is hereby granted..........r -= ------]:.Z�r"-=..........jZ....'v�-"------ Tz.... ......................................
to Construct ) or Repair ( ) n Indivi ual Sewage Disposal System
atNo........... ..... ttM r..... 441 ...... ---"----•----•---•-"---"•---•---........
Street C,
as shown on the application for Disposal Works Construction Permit ---:j:---_`---____._ Dated
....a��� ! ...............•..
` �, f :.� -
/ p ...•....•1._.....•.... Board of Health
----
DATE--------•-------"----•---•0--'--'•-----•--"-•--"----......
FORM 1255 HOBBS & WARREN, INC., PUBLISHERS
7ou�R1 �2 E P�fLT
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
d DEPARTMENT OF ENVIRONMENTAL PROTECTION
v
TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 44 Marks Path
Hyannis,MA 02601
Owner's Name: Paul Shockley
Owner's Address: Same
Date of Inspection: 2/28/06
Name of Inspector: (please print) Ron Burlingame
Company Name: Ron Burlingame
Mailing Address: 58 Oak Street
West Barnstable,MA 02668
Telephone Number: 508420-2050
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information 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 Section 15.340 of Title 5(310 CMR 15.000). The system:
X Passes
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
Fails
v
Inspector's Signature: / c L a- Date: 3 s 3 - or.
The system inspector shall submit 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 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address:
Owner:
Date of Inspection:
Inspection Summary: Check A B,C,D or E/ALWAYS complete all of Section D
A. System Passes:
X I have not found any information which indicates that any of the failure criteria described in 310 CMR 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 statements. If"not determined"please
explain.
The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally
unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the
existing tank is replaced with a complying septic tank as approved by the Board of Health
*A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance
indicating that the tank is less than 20 years old is available.
ND explain:
Observation of sewage backup or break out or high static water level in the distribution box due to broken or
obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with
approval of Board of Health):
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:
Owner:
Date of Inspection:
C. Further Evaluation is Required by the Board of Health:
Conditions exist which require further evaluation by the Board of 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 Health determines in accordance with 310 CMR 15.303(1)(b)that the
system is not functioning in a manner which will protect public health,safety and the environment:
Cesspool or privy is within 50 feet of a surface water
_ Cesspool or privy is 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 SAS is within a Zone 1 of a public water supply.
The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well.
The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a
private water supply well".Method used to determine distance
"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 are triggered.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:
Owner:
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
X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool
X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool
X Liquid depth in cesspool is less than 6"below invert or available volume is less than''/z day flow
X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Number of times pumped
X Any portion of the SAS,cesspool or privy is below high ground water elevation.
X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
X Any portion of a cesspool or privy is within a Zone 1 of a public well.
X Any portion of a cesspool or privy is within 50 feet of a private water supply well.
X 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
are triggered.A copy of the analysis must be attached to this form.]
NO (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 with a design flow of 10,000 gpd to 15,000
gpd.
You must indicate either"yes"or"no"to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
yes no
the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped
Zone 11 of a public water supply well
If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered
"yes" in Section D 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 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address:
Owner:
Date of Inspection:
Check if the following have been done.You must indicate"yes"or"no"as to each of the following:
Yes No
X _ Pumping information was provided by the owner,occupant,or Board of Health
X Were any of the system components pumped out in the previous two weeks?
X Has the system received normal flows in the previous two week period?
X Have large volumes of water been introduced to the system recently or as part of this inspection?
X _ Were as built plans of the system obtained and examined?(If they were not available note as NIA)
X _ Was the facility or dwelling inspected for signs of sewage back up?
X _ Was the site inspected for signs of break out?
X _ Were all system components,excluding the SAS,located on site?
X _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition
of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum?
X _ 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
X _ Existing information.For example,a plan at the Board of Health.
X _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance
is unacceptable) [310 CNM 15.302(3)(b)]
Page 6 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address:
Owner:
Date of Inspection:
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): 3 Number of bedrooms(actual): 3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330
Number of current residents: 2
Does residence have a garbage grinder(yes or no): No
Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required]
Laundry system inspected(yes or no):No
Seasonal use: (yes or no): No
Water meter readings,if available(last 2 years usage(gpd)):2004—79,750 gals.;2005—80,250gals.
Sump pump(yes or no):No
Last date of occupancy: Currently occupied
COMMERCIALANDUSTRIAL
Type of establishment:
Design flow(based on 310 CMR 15.203): gpd
Basis of design flow(seats/persons/sgfl,etc.):
Grease trap present(yes or no):_
Industrial waste holding tank present(yes or no):
Non-sanitary waste discharged to the Title 5 system(yes or no):_
Water meter readings,if available:
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information: Home owner—2004 Canco
Was system pumped as part of the inspection(yes or no): No
If yes,volume pumped: gallons--How was quantity pumped determined?
Reason for pumping:
TYPE OF SYSTEM
X 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):
Approximate age of all components,date installed(if known)and source of information: 1985
Were sewage odors detected when arriving at the site(yes or no): No
Page 7 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:
Owner:
Date of Inspection:
BUILDING SEWER(locate on site plan)
Depth below grade:
Materials of construction:_cast iron _40 PVC_other(explain):
Distance from private water supply well or suction line:
Comments(on condition of joints,venting,evidence of leakage,etc.):
SEPTIC TANK: X (locate on site plan)
Depth below grade: 3'
Material of construction: X concrete—metal_fiberglass polyethylene
other(explain)
If tank is metal list age:— Is age confirmed by a Certificate of Compliance(yes or no): —(attach a copy of
certificate)
Dimensions: 1000 gallon
Sludge depth: 3"
Distance from top of sludge to bottom of outlet tee or baffle:
Scum thickness: 6"
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or bafflc:
How were dimensions determined: Measuring stick
Comments(on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity,liquid levels
as related to outlet invert,evidence of leakage,etc.):
Tees were present. The liquid level was even with the outlet invert. Recommend pumping.
GREASE TRAP:_(locate on site plan)
Depth below grade:_
Material of construction: concrete metal fiberglass—polyethylene—other
(explain). — — —
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
Date of last pumping:
Comments(on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity,liquid levels
as related to outlet invert,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:
Owner:
Date of Inspection:
TIGHT or HOLDING TANK: None (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: gallons/day
Alarm present(yes or no):
Alarm level: Alarm in working order(yes or no):
Date of last pumping:
Comments(condition of alarm and float switches,etc.):
DISTRIBUTION BOX: X (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: Even
Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of
leakage into or out of box,etc.):
The D-Box was level. There were no signs of solids.
PUMP CHAMBER: None (locate on site plan)
Pumps in working order(yes or no):
Alarms in working order(yes or no):
Comments(note condition of pump chamber,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:
Date of Inspection:
SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required)
If SAS not located explain why:
Type
X leaching pits,number: 4'X 6'—600 gallon
leaching chambers,number:
leaching galleries,number:
leaching trenches,number,length:
leaching 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.):
The leach pit had approximately 20"of water on the bottom. The scum line was at the same level. The were
no signs of failure. The bottom to grade was approximately 9'. The cover was approximately 2'below grade.
CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan)
Number and configuration:
Depth—top of liquid to inlet invert:
Depth of solids layer:
Depth of scum layer:
Dimensions of cesspool:
Materials of construction:
Indication of groundwater inflow(yes or no):
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
PRIVY: (locate on site plan)
Materials of construction:
Dimensions:
Depth of solids:
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
Page 10 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:
Owner:
Date of Inspection:
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.
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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:
Date of Inspection:
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water feet
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: -o Po&9AP 141 G 4 Q4 r r 11,4R5
Checked with local excavators,installers-(attach documentation)
Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
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Town of Barnstable Health Inspector
oFtHF tpk, Office Hours
. do Regulatory Services 8:30-9:30
Thomas F.Geiler,Director 1:00—2:00
BARNSTABLE,
1639. Public Health Division
�0
ArEo �A Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
AMNESTY PROGRAM APPLICANT — SEPTIC QUESTIONNAIRE
1. General Information: Size of Property: 'a3
Address: h9,, Map d -71_Parcel - Q0 t
Name: Phone #:
2a. How many bedrooms exist at your property now?
2b. Are you planning to add any bedrooms? kA-d If yes, how many?
2c. How many bedrooms total are proposed at this property (including the amnesty unit)?
2d. Please include a copy of the floor plans for the entire property- showing the existing
rooms in the home plus the proposed amnesty apartment and/or addition. Please label
each room clearly on the plans.
3. Is the dwelling connected to public sewer? YES or CNO)
If the dwelling is connected to public sewer,skip questions#4 through#9 below.
4. Location of dwelling is INSIDE or OUTSIDE a Zone of Contribution to public supply wells? W p
5. Is the dwelling connected to an ONSITE WELL or to PUBLIC WATER?
6. Is a disposal works construction permit on file? YES or NO
6a. If yes,how many bedrooms were approved according to this permit? Bedrooms.
0
7. Were any building permits obtained for construction of additional bedrooms? YES or NO
8. Is there an engineered septic system plan on file at the Health Division? YES or NO
9. Has the septic system been inspected by a DEP certified inspector within the last two years? YES or NO
-------------------------------------------------------------------------------------------------------------------
FOR OFFICE USE ONLY
The Public Health Division has no objection to bedrooms at this property. .
Special Conditions-
Signed: - Date:
Q;/health/wpfiles/amnestyapp
l
Message Page 1 of 1
McKean, Thomas
From: McKean, Thomas
Sent: Wednesday, July 19, 2006 9:20 AM
To: Taylor, Madeline
During our staff meeting held yesterday, we reviewed the three applications. The following comments and
questions were received:
7 Thach Lane- Question: What is the floor-to-ceiling height at the"second floor loft?" Is this a sleeping
loft? The septic system appears to be adequate for three bedrooms.
45 Uncle Al's Way- If the two storage rooms are finished rooms, more work needs to be done to remove
these rooms (also reference email dated July 12th). A revised floor plan was received
however, these rooms have doors and there is privacy provided between the apartment and
these rooms.
44 Mark's Path (Three level home)- The submitted sketch is inadequate. Please ask the applicant to
submit a neatly drawn floor plan using a straight edge, labeling every room, along with dimensions and
doorway widths. The submitted floor plan shows an unlabeled room adjacent to the"dining room" in the
basement. What is it? There weren't any dimensions provided to the doorways, including to the"family
room." Where is the staircase on the basement pla,,n? It isn't shown. The applicant has another option:
eliminate a bedroom from the first or second floors of the home by providing a five feet wide opening within
a another doorway or wall between rooms (also reference emails dated May 3, 2006) .
-----Original Message-----
From: Taylor, Madeline
Sent: Monday, July 17, 2006 10:27 AM
To: McKean,Thomas
Subject: Septic Approvals
Hi Tom
I need to get things finalized for the August Hearing and was hoping you could send me over approval
notices for 44 Marks Path, Hyannis (conditional upon the family room doorway being widened to four feet)
and 45 Uncle Al's Way (conditional upon opening up the 3rd bedroom in the main house to five feet and
removing two bedrooms from the lower level). Also Thach Lane would be great too- I know you said you
found something on file for it. I really appreciate your assistance.
Thanks
Madeline
'� 7/19/2006
McKean, Thomas
From: McKean, Thomas
Sent: Wednesday, May 03, 2006 3:54 PM
To: Taylor, Madeline
Subject: RE:44 Marks Path
The applicant will have to address the minimum 5'feet doorway opening policy of the Board of Health. Otherwise, the TV
room will be considered as a"bedroom" due to the fact that three feet is less than five feet.
The applicant has one other option: eliminate another bedroom from the home by providing a minimum five feet wide
opening within a doorway or wall between rooms.
-----Original Message-----
From: Taylor, Madeline
Sent: Wednesday, May 03,2006 2:47 PM
To: McKean,Thomas
Subject: RE:44 Marks Path
-----Original Message-----
From: McKean,Thomas
Sent: Wednesday, May 03,2006 10:39 AM
To: Taylor,Madeline
Subject:44 Marks Path
I am in receipt of an amnesty septic questionnaire application for 44 Marks Path.
The submitted floor plan is not adequate.
- No dimensions were provided for the"TV Room" .
-The width of the doorway to the TV room is not noted. It is a regular doorway with no door. There is no way they
can put in a five foot opening there as the staircase to the upstairs is against the wall.
- Is there a door provided at the TV room doorway? no
-A room is not labeled on the"ground"floor. What is it? If it's on the left bottom corner of the ground floor sketch,
it's the outside of the building. The left wall of the dining room is actaully an external wall. They must have drawn a
rectangle and not erased that line.
- Room size dimensions are not provided. If you need room dimensions for each individual room let me know and I
will call the owners. Thanks.
Therefore, the application is denied at this time.
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AJUL?Oy?Obb6 $ �3t1 M BARNSTABLE BOARD OF HEALTH NO, 4893
a r ; Town of Barnstable HealthlwPector
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Office Hours
Regulatory Services 9:30-9:30
Thomas F.Geiler,Director 1:00—2:00
i t XA Public Health Division
A ;639'k
Thomas McKean,Director
200 Maui Street,Hyannis,MA 02601
Office: 508.862-4644 Fax: $08-790-6304
AMNESTY PROGRAM APPLI AUNT - SEPTIC QUESTIONNAIRE
1. General Information: Size of Property' ';L3
Address: 19 Parcel 0 (4 - 00 b
Name:_k_ V Phone#:
2a, How many bedrooms exist at your property now? 3
2b. Are you planning to add any bedrooms? PII If yes, how many?
2c. How many bedrooms total are proposed at this property(including the amnesty unit)?
2d.Please include a copy-of the floor plans for the a Lire property-showing the existing
rooms in the home plus the proposed amnesty apvtment andlor additfon. Please label
each room clearly on the plans,
3, Is the dwelling connected to public sewer? YES or NO
If the dwelling is connected to publio sewer,skip questions 04 through#9 below.
4. Location of dwelling is INS1D& or I OUTSIDE a Zone of Contribution to public supply wells? W P
S. Is the dwelling connected to an ONSrTE WELL or to PUBLIC WATER?
6. Is a disposal works construction permit on file? YES or NO
6a. If yes,how malty bedrooms were approved according to this pennit? Bedrooms.
7. Were any building permits obtained for construction of additional bedrooms? YES or NO
$. Is there an engineered septic system plan on file at the Hcalth Division? YES or NO
9. Has the septic system been inspcctcd by a DPP certified inspector within the lase two years? YES or NO
�. ..,---------------------
------------------......,,..,,,..___�—........�....�—_� ..._..,,---------
FOR OFFICE USE ONLY
The Public Health Division has no objection to � bedrooms at this property,
Special Condition
Lint "^
Signed; Date: I1.0
�;/headEh/wpf ler/arr�sestY�P
APR, 20, 2007 8: 54AM Bk 2:L635 P9.NO, 489 2,bs
DEED RESTRICTION
WHEREAS, we Kerry A. Casey and Paul E. Shockley are the owners of 44 Marks
Path, Hyannis, MA as further described in deed recorded at the Barnstable County
Registry of Deeds in Book 16019, Page 258;
WHEREAS, we Kerry A. Casey and Paul E. Shockley, as the owners of said property
have agreed with the Town of Barnstable Board of Health to a restriction as to the
number of bedrooms which can be included in the property located at 44 Marks Path,
Hyannis, MA;
WHEREAS, the Town of Barnstable Board of Health, is requiring that the agreement
for the restriction on the number of bedrooms which can be included in the property be
put on record -with the -Barnstable County Registry of Deeds by recording this
docurment,
NOW, THEREFORE, we Kerry A. Casey and Paul E. Shockley do hereby place the
following restriction on the above-referenced property in accordance with our
agreement with the Town of Barnstable Board of Health, which restriction shall run
with the land and be binding upon all successors in title;
1. The property located at 44 Marks Path, Hyannis, MA may contain no more
than 3 bedrooms,
2, Kerry A. Casey and Paul E. Shockley agree that this shall be a permanent
deed restriction affecting the property located at 44 Marks Path, Hyannis,
MA.
ExZecutes a sealed instrument this s� dayof , 2006.
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OMMMONVV-EA T OF IViASSACHUSE FTS
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Then personally appeared the above-named d lmovva- 12
the person who executed the foregoinginstrument a owledged the same , 4 ?
free act and deed,before me, J! �® ,'�
Notary Publicd'•-•--
��s9tic�.r,/�
My commission expires:
MADELINE=
Comm_ onnv att hus0s
My Commission Expires
December 4,2009
APR. 20, 2001 8: 54AM N0, 489 P. 3
Paul A. S c
COMMONWEALTH,OF MASSACHUSETTS
ss �3" : L� , 2006
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Then personally appeared the above-named G J known toy` Dyi ~ •��..:,;
the person who executed the fo egoin i tnmient and ac owledged the same to
free act and deed,before me,
Notary c Publi •
_ _ _ ... .. ', . _ _ _ '�% Off;�•::....`-`C ��.
My commission'e � :
DELINE P
Commonwealth of MassachuszZ
My Commission Expires
December a_
BARNSTABLE REGISTRY OF DEEDS
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Crocker, Sharon
From: Crocker, Sharon
Sent: Tuesday, April 24, 2007 10:56 AM
To: O'Connell, Timothy
Cc: Barry, Lois
Subject: Sign-off 44 Marks Path, Hyannis
The customer for above address was following up with Lois in Building for the signoff.
This is the customer approved by Tom for Amnesty and we had Madeline fax us a copy of the Amnesty
Application.
If this is all set, can you sign off on it in the computer this afternoon (during inspection hours) and return the
application to myself or Lois in Building.
THE HEALTH FOLDER AND BUILDING APPLICATION WILL BE UP AT THE COUNTER NEXT TO MONITOR.
Thank you.
Bk 21635 P058 JD79668
z
12-21-2006 a 1 1 m 41 cx
DEED RESTRICTION
WHEREAS, we Kerry A. Casey and Paul E. Shockley are the owners of 44 Marks
Path, Hyannis, MA as further described in deed recorded at the Barnstable County
Registry of Deeds in Book 16019, Page 258;
WHEREAS, we Kerry A. Casey and Paul E. Shockley, as the owners of said property
have agreed with the Town of Barnstable Board of Health to a restriction as to the
number of bedrooms which. can be included in the property located at 44 Marks Path,.
Hyannis, MA;
WHEREAS, the Town of Barnstable Board of Health, is requiring that the agreement
for the restriction on the number of.bedrooms which can be included in the property be
put on record with the . Barnstable County Registry of Deeds by recording this
document;
NOW, THEREFORE, we Kerry A. Casey and Paul E. Shockley do hereby place the
following restriction on the above-referenced property in accordance with our
agreement with the Town of Barnstable Board of Health, which restriction shall run
with the land and be binding upon all successors in title;
1. The property located at 44 Marks Path, Hyannis, MA may contain no more
than 3 bedrooms.
2. Kerry A. Casey and Paul E. Shockley agree that this shall be a permanent
deed restriction affecting the property located at 44 Marks Path, Hyannis,
MA.
Executed s a sealed J Mp,4-
instrument this � day of , 2006.
rry asey
OMMONWEA T OF MASSACHUSE-fTS A /
ss ,v !�� �� , 2006
Then personally appeared the above-named &2n .C/ knowr.`to rn to be
the person who executed the foregoin instrum/ t a owledged the same to be
free act and deed, before me,
Notary Public
My commission expires:
MADELINE P.TA LOR
�i6�a Pnhlir
Commonwealth o Massachusetts
My Commission Expires
December 4,2009
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Paul A. Sid c.IAX
COMMONWEAL OF MASSACHUSETTS
i3 �A-) , ss Al 52006
Then personally appeared the above-named pAA/4 C ,S C known to m to be
the person who executed the foregoin in trument and ac owledged the same to be_�
free act and deed, before me, M � � �G
Notary Public.
My commission expires:
DELINI�H.
is
Commonwealth of Massachuseits�
My Commission Expires i
December,?. 2t ^,9
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COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
RECEIVED
SEP 2 5 2002
TOWN OF BARNSTABLE
TITLE 5 HEALTH DEPT.
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 44 Marks Path _
Hyannis,AM 02601
Owner's Name: Claire Donahue
Owner's Address: Same
Date of Inspection: September 19, 2002
Name of Inspector:(Please Print) James M. Ford
Company Name: James M. Ford
Mailing Address: P.O. Box 49 Map:271
Osterville,MA 02655-0049 Parcel.094
Telephone Number: (508)862-9400 Lot: 6
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information 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 Section 15.340 of Title 5(310 CMR 15.000). The system:
✓ Passes
Conditionally Passes
Needs her Evaluation by the Local Approving Authority
Fails
Inspector's Signature: Date: September 22, 2002
The system inspector shall sub rccopy 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.
Title 5 Inspection Form 6/15/2000 page 1
• Page 2 of 1 l
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 44 Marks Path
Hyannis, MA
Owner: Claire Donahue
Date of Inspection: September 19, 2002
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes:
✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR
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 statements. If"not determined",please
explain.
The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally
unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the
existing tank is replaced with a complying septic tank as approved by the Board of Health.
*A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance
indicating that the tank is less than 20 years old is available.
ND explain:
Observation of sewage backup or break out or high static water level in the distribution box due to broken or
obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with
approval of Board of Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
ND explain:
The system required pumping more than 4 tunes 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:
2
Page 3 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 44 Marks Path
Hyannis, MA
Owner: Claire Donahue
Date of Inspection: September 19, 2002
C. Further Evaluation is Required by the Board of Health:
Conditions exist which require further evaluation by the Board of 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 Health determines in accordance with 310 CMR 15.303(1)(b)that the
system is not functioning in a manner which will protect public health,safety and the environment:
Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is 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 SAS is within a Zone 1 of a public water supply.
The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well.
_ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a
private water supply well". Method used to determine distance
"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 are triggered. A copy of the analysis must be attached to this form.
3. Other:
I
3
Page 4 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 44 Marks Path
Hyannis,MA
Owner: Claire Donahue
Date of Inspection: September 19, 2002
D. System Failure Criteria applicable to all systems:
You must indicate either"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
✓ 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
✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than 'h day flow
✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number
of times pumped_.
✓ 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
water supply.
✓ Any 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
are triggered. A copy of the analysis must be attached to this form.]
No (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 System:
To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000
gpd-
You must indicate either"yes"or"no"to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
Yes No
the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped
Zone 11 of a public water supply well
If you have answered`yes"to any question in Section E the system is considered a significant threat,or answered
"yes"in Section D 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.
4
I
Page 5 of 11
OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 44 Marks Path
Hyannis, MA
Owner: Claire Donahue
Date of Inspection: September 19, 2002
Check if the following have been done: You must indicate"yes"or"no"as to each of the following:
Yes No
✓ Pumping information was provided by the owner,occupant,or Board of Health
✓ Were 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?
✓ Were 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?
✓ 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 the 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)].
5
Page 6 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 44 Marks Path
Hyannis, MA
Owner: Claire Donahue
Date of Inspection: September 19, 2002
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): 3 Number of bedrooms(actual): 3
DESIGN flow based on 310 CMR 15.203 (for example:110 gpd x#of bedrooms): 330
Number of current residents: 2
Does residence have a garbage grinder(yes or no): No
Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required]
Laundry system inspected(yes or no): No
Seasonal use(yes or no): , No
Water meter readings,if available(last 2 years usage(gpd)): 2000-81,750 gals.;2001 -80,250 gals.
Sump Pump(yes or no): No ti
Last date of occupancy: Currently occupied
COMMERCIAL/INDUSTRIAL
Type of establishment:
Design flow(based on 310 CMR 15.203): gpd
Basis of design flow(seats/persons/sgft,etc.):
Grease trap present(yes or no):
Industrial waste holding tank present(yes or no)
Non-sanitary waste discharged to the Title 5 system(yes or no):
Water meter readings,if available:
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information: None on file-per treatment plant
Was system pumped as part of the inspection(yes or no): No
If yes,volume pumped: gallons--How was quantity pumped determined?
Reason for pumping:
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):
Approximate age of all components,date installed(if known)and source of information;
Unknown
Were sewage odors detected when arriving at the site(yes or no): No
6
r -
Page 7 of l I
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 44 Marks Path
Hyannis, MA
Owner: Claire Donahue
Date of Inspection: September 19, 2002
BUII.DING SEWER(locate on site plan)
Depth below grade:
Materials of construction: _cast iron 40 PVC _other(explain):
Distance from private water supply well or suction line:
Comments(on condition of joints,venting,evidence of leakage,etc.):
SEPTIC TANK: ✓ (locate on site plan)
Depth below grade: Approx. 3'
Material of.construction.: ✓ concrete _metal _fiberglass _polyethylene
_other(explain)
If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of
certificate)
Dimensions: 1000 gal.
Sludge depth: S"
Distance from top of sludge to bottom of outlet tee or baffle: 26"
Scum thickness: 10"
Distance from top of scum to top of outlet tee or baffle: 8"
Distance from bottom of scum to bottom of outlet tee or baffle: 7"
How were dimensions determined: Measuring stick
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,liquid levels
as related to outlet invert,evidence of leakage,etc.):
Tees were present. The liquid level was even with the outlet invert. Recommend pumping
GREASE TRAP: None (locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _fiberglass _polyethylene _other
(explain):
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
Date of last pumping:
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels
as related to outlet invert,evidence of leakage,etc.):
7
Page 8 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 44 Marks Path
Hyannis, MA
Owner: Claire Donahue
Date of Inspection: September 19, 2002
TIGHT or HOLDING TANK: None (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: gallons/day
Alarm present(yes or no):
Alarm level: Alarm in working order(yes or no):
Date of last pumping:
Comments(condition of alarm and float switches,etc.):
DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: Even
Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of
leakage into or out of box,etc.):
The D-box was level. There were no signs of solids.
PUMP CHAMBER: None (locate on site plan)
Pumps in working order(yes or no):
Alarms in working order(yes or no)
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
8
Page 9 of l 1
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 44 Marks Path
Hyannis, MA
Owner: Claire Donahue
Date of Inspection: September 19, 2002
SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required)
If SAS not located explain why:
Type
✓ leaching pits,number: 4'x 6'-600 gal.
leaching chambers,number:
leaching galleries,number:
leaching trenches,number,length:
leaching 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.):
The leach pit had approximately 2'of water on the bottom. The scum line was at the same level. There were no signs offailure.
The bottom to grade was approximately 9'. The cover was approximately 2'below grade.
CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan)
Number and configuration:
Depth-top of liquid to inlet invert:
Depth of solids layer:
Depth of scum layer:
Dimensions of cesspool.:
Materials of construction:
Indication of groundwater inflow(yes or no):
Comments (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
PRIVY: None (locate on site plan)
Materials of construction:
Dimensions:
Depth of solids:
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
9
Page 10 of 11
OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 44 Marks Path
Hyannis, MA
Owner: Claire Donahue
Date of Inspection: September 19, 2002
Map:271
Parcel: 094
SKETCH OF SEWAGE DISPOSAL SYSTEM Lot.6
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.
An r
�4
10 0 a
f �
I
I 3 A B
l /y yi.6
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-3 S6 33
10
f
Page I of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 44 Marks Path
Hyannis,MA
Owner: Claire Donahue
Date of Inspection: September 19, 2002
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water 30' +/- feet
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: topographic and water contours maps
Checked with local excavators,installers-(attach documentation)
Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
The bottom of the leach pit to grade was approximately 9. Using the Barnstable topographic map and the Cape Cod
Commission water contours map the maps were showing approximately 30'+/-to ground water at this site.
This report has been prepared and the system inspected and passed as of the date of inspection. This report is
not a warranty or guarantee that the system will function properly in the future. There have been no warranties
or guarantees, either expressed,written or implied, relating to the system, the inspection and/or this report.
11
g
V
r`y
Commonwealth of Massachusetts
Executive Office of Environmental Affairs
Department of
Environmental Protection
Wllllam F.Weld Trudy Coxe
Gommor gay
Argeo Paul Celluccl Davld B.Struhs,
U.Gowmor C-nmhwbmr
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM_
PART A
CERTIFICATION
Property Address: 44 Mark' s Path, Hyannis Address of owner. Edgar Levesque
Date of Inspection: 12-1 3-9 6 (If different) 7 743 E. Neville .Av e
Name of Inspector. W.E. Robinson SR Mesa, Arizona 85208
Company Name,Address and Telephone Number. ( 5 0 8) 7 7 5-8 7 7 6
W.E. Robinson Septic Service .
P.O. Box 1089 Centerville MA
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate
and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sedisposal systems. The system:
_ Passes ge
_ Conditionally Passes
_ Needs Further Evaluation By the Local Approving Authority
_ Fails / 1
Inspector's Signature:A,/ b Date: /�
The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(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 Department of Environmental Protection.
The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority.
INSPECTION SUMMARY:
Check A,B, C,or D:
A) SYS PASSES:
7ve not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303.
Any failure criteria not evaluated are indicated below.
B) TEM CONDITIONALLY PASSES:
ne or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes
on.
Indicate ,no,or not determined(Y,N,or ND). Describe basis of determination in all instances. If"not determined",explain why not)
_ The septic tank is metal, cracked,structurally unsound, shows substantial infiltration or exfiltration,.or tank failure is
imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved
I
y the Board of Health.
(revised 11/03/95) 1
One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 • Telephone(617)292-UN
�A1 Printed on Recycled Paper
i
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 44 Marks Path, Hyannis,
Owner. Edgar Levesque
Date of Inspection: 1 2—1 3—9 6
Bl SYSTEM CONDITIONALLY PASSES(continued)
Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)
or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of
Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is levelled or replaced
The system required pumping more than four 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
Cl FUR ER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
onditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the
p blic health,safety and the environment.
1) S STEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A
WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
_ Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh.
2) YSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER.SUPPLIER,IF APPROPRIATE)
ETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND
AFETY AND THE ENVIRONMENT:
The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a
surface water supply.
_ The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well.
The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well.
The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water
supply well, unless a well water analysis 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.
3) OTHER
(revised 11/03/95) 2
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(oontinued)
Property Address: 44 Marks Path, Hyannis
Owner. Edgar Levesque
Date of Inspection: 1 2—1 3—9 6
D] YSTEM FAILS:
I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for
this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the
Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool.
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.
Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow.
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Number of times pumped
Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation.
Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
Any portion of a cesspool or privy is within a Zone I 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. If the well has been analyzed to be acceptable,attach copy of well water analysis for
coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen.
E]LARGE YSTEM FAILS:
e following criteria apply to large systems in addition to the criteria above:
system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public
ealth and safety and the environment because one or more of the following conditions exist:
the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area(IWPA)or a mapped Zone II of a public
water supply well)
The owae or operator of any such system shall bring the system and facility into Hill compliance with the groundwater treatment program.
requireme to of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information..
(revised 11/03/95) 3
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
PmpertyAddresw 44 Marks Path;. Hyannis, MA
Owner. Edgar Levesque
Date of Inspection: 1 2-1 3-9 6
Check if the following have been done:
70,
ping information was requestedof the owner, occupant,and Board of Health.
e of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates
during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection.
_L/As built plans have been obtained and examined. Note if they are not available with N/A.
ZThe facility or dwelling was inspected for signs of sewage back-up.
v The system does not receive non-sanitary or industrial waste flow
�he site was inspected for signs of breakout.
_.Le AU system components, excluding the Soil Absorption System, have been located on the site.
_L The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or
tees, material of construction,dimensions,depth of liquid,depth of sludge,depth of scum.
!/The size and location of the Soil Absorption System on the site has been determined based on existing information or
zvximated by non-intrusive methods.
I/Zhep
facility owner(and occupants, if different from owner)were provided with information on the
maintenance of Sub-
Surface properSurface Disposal System.
(revised 11/03/95) 4
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Addreaw 44 Marks Path, Hyannis
Owner. Edgar Levesque
Date of Inspection: 1 2—1 3_9 6
FLOW CONDITIONS
RESIDENTIAL-
Design flow +yQ�ns
Number of bedrooms:y�°/
Number of current reside-La i 0
Garbage grinder(yes or no):��
Laundry connected to system(yes or no):YL�-S
Seasonal use(yes or no):.,�O 1 9 9 4 — 17 , 300 cubic f t.
Water meter readings,if available:
1995 - 1 5, 900 nuhi n ftt _ Nnv 96 _ 8 . 700 cu—ft.
Last date of occupancy:
CO RERCIAI. NDUSTRIAU
Type o establishment:
Design ow: gallons/day
Grease p present: (yes or no)_
Indust ' Waste Holding Tank present: (yes or no)_
Non- 'tary waste discharged to the Title 5 system: (yes or no)_
Water eter readings,if available:
Last of occupancy:
OTH •(Describe)
Last to of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and of information:
a��:� 0 —1,d -bL 1,73
System pumped as part of inspection: (yes or no)A, o
If yea,volume pumped: gallons
Reason for pumping:
TYPE OF YSTEM
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)
Other(explain)
APPROXIMATE AGE of all components,date installed(if known)and source of information: ? S
Sewage odors detected when arriving at the site: (yes or no) ✓C)
(revised 11/03/95) 6
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
propertyAddre= 44 Marks Path, Hyannis
Owner. Edgar Levesque
Date of Inspection: 1 2—1 3—9 6
SEPTIC TANK_✓
(locate on site plan)
Depth below grade:44
Material of constriction:_concrete_metal_F _other(e:plain)
C:
Dimensions:
Sludge depth: 'S=�
Distance from top of alud$e to bottom of outlet tee or baffle: C/0,
Scum thickness: =�
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle: I�,
Comments:
(recommendation for pumping,conditio of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert,structural integrity,
evidence of leakage,etc.) Fi �� i�- o A
G E TRAP:_
(locate site plan)
Depth belo grade:
Material of nstruction:_concrete_metal_FRP_other(e:plain)
Dimensions:
Scum ess:
Distance m top of scum to top of outlet tee or baffle:
Distance m bottom of scum to bottom of outlet tee or baffle:
Comments:
(reco, en tion for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,
evidence of ,etc.)
(revised 11/03/95) 6
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 44 Marks Path, Hyannis
owner. Edgar Levesque
Date of Inspection: 12—1 3—9 6
TIGH OR HOLDING TANK:_
(kxate site plan)
Depth be grade:
Material construction:tion:_concrete_metal_FRP_other(explam)
Dime no:
Ca gallons
Design ow: gallons/day
Alarm`1 1:
Commen :
(conditi of inlet tee,condition of alarm and float switches,etc.)
DISTRIBUTION BOX:
(locate on site plan)
Depth of liquid level above outlet invert:_
Comments:
(note if level and distribution is equal, evidence of solids carryover,evidence of leakage into or out of box,etc.)
PUMP C BER:_
(locate on ' plan)
Pumps in'or
' order:(yes or no)
Continents:
(note condition o pump chamber,condition of pumps and appurtenances,etc.)
k
(revised 11/03/95) 7
r
i
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 44 Marks Path, Hyannis
Owner. Edgar Levesque
Date of Inspection: 1 2—1 3—9 6
SOIL ABSORPTION SYSTEM(SAS):
(locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods)
If not determined to be present,explain:
Type:
leaching pits,number:
leaching chambers,number:_
leaching galleries,number:
leaching trenches, number,length:
leaching fields,number,dimensions:
overflow cesspool,number:—
Comments:
(note condition of so' ei of h ulic failure, level of ponding,condition of vegetation etc.)
Gb n
a Ga4-
CESSPOOLS:_
Goes: on site plan)
Numbs and configuration:
Depth- p of liquid to inlet invert:
De of solids layer.
De of scum layer:
no of cesspool:
riels of construction:
n of groundwater:
inflow(cesspool must be pumped as part of inspection)
Comme : (note condition of soil,sign of hydraulic failure,level of ponding, condition of vegetation,etc.)
P
(locate on 'te plan)
Materials o constnu ion: Dimensions:
Depth of so'
Comments:(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.)
(revised 11/03/95) 8
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
PropertyAddresw 44 Marks Path, Hyannis
Owner. Edgar Levesque
Date of Inspection: 1 2—1 3—9 6
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100'
YV
ti t
L
G 3
DEPTH TD GROUNDWATER
Depth to groundwater: 1 V-'x feet
method of determination or approximation: 6
/cam
(revised 11/03/95) 9
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PERC TEST APPLICATION NO. F 4i �-�_
_ REVISIONS:
TEST PIT DA TA DATE OF TESTING:� 6 _ PERC. TEST DA TA e SEPTI C TANK DETAIL siZE- _ _ GAS. DIST. BOX DETAIL : LEACHING FACILITY DETAIL NO DATE
TEST BY T,rT
- DATE OF TEST/NGf I � 4�__ T4NK TO CONFORM Tc? TITLE 5 REC�U/REMEh•'Tj. TO CONFORM TO LE ,S REOU/REMENTS
P 'DE'PTi•� -r r- I £t. v WITNESSED BY 7}M__� --- -
___ TEST BY _ �I _ .��L�Q _ . _ _ NO. OF OUTLETS, ---= ------ ---
r, _ , -- WITNESSED BY L4.*�1� -.__ �t :; Ht,� �,,;"'�,�, �� ,.
— -- - -- -- WI TNES , ]M ,,,,� - � REMQVEABLE COVER _
MANHOL BROUGHT TO
�'lt2d i > •,:. :.• •• o FINISH GRADE. . •• r.• 2"PEASTOAU LQAMaFILL /2"Mi.N.
I
— _- - - SAS, _.___ 3 C(EAR 3"CLEARw r- P -
7z- — --- -- , , �j OUTLET IPES ._
�}- - - t — 6 MrN. 3' MIN. 6"MIN, ° ._ ` ' I AS REQU/RED t
! DEPTH OF TEST:
INLET �
1
�T{tt 1 =) RA TE� - - `---' ����7—`-"�—- -_— �'� /O"M/N. _ E 1 I
I i Q/ST.
- IN rEE -OUTLET TEE j t11 �X
----- -- - Q --- - AL;"
L
I INLET AND OUTLET 4' 0" MIN/MUM .: OUT,.ET TEE DEPTH SEPTJC TANK I• . • ---
f 2" 6" / PRECAST OR BLOCK 'Ml�!' 1
TEES TO BE CAST L IOU/D DEPTH i4 AT UOUlD GEPTH OF 4 !" CONCRETE SEEPAGE PIT
-} —_-. -- r-- -4--- ---- _ -- .-._. _ ..____. _ — - IRON, SCHED. 40 ; l9 5 ".s CONS \ '
•: I2 ��( DEPTH OF TEST T 24" �' o s /o' i. .
L _-__ -- _ _ P.VC. OR CAS, IN
PLACE CONCRETE 29 •.. , ..`'. . o M/N. .
CONCRETE a 34 ' " B' BOTTOM ON LEVEL STABLE8ASE
RATE'
CONS R(/G /pN
-- — -- (WA TER T/GHT)
.. _Feb,'
/NLET TEE PROVIDED WHERE SLOPE FOUNDATION i.
K�f ht�lpilt •.��,; .+ •. ., .. ,. !. •.:,• • OF INLET PIPE EXCEEDS ODB % OR r• ---
- )K TANK TO 8EABLE TO WlTHSTANG i
BOTTOM OF TANK ON LEVEL STABLE BASE /N A PUMPED SYSTEM. 20 MIN t t
Wf-��i'�, _ - -- _ ------ -- ---- ------ -- _-- -- --- H-lDLOAD/NG UNLESS UNDER ----- ------------ --_-- - --� WASHED STONE` i
- -- PAVEMENT OR/N OR/VE. H-20 -
I
• 5 A T i;1� L OA D/NG UNDER PAVEMEN'T OR
DRIVE.
O TES PLAN VET /N VER T EL E VA T/ONSo - —
I. THIS PLAN IS FOR THE DESIGN AND CONSTRUCTION OF THE `,£WAGE
DISPOSAL FACILITY ONLY. SCALE I '�=
INV. AT BUILDING
c'. ALL CONSTRUCT/ON METHODS AND MATERIALS SHALL CONFORM TO - 1 IN AT SEPTIC TANK(IN) 5� �3_ ;'�" ' •` '` < '� ''
MASS. D.E.C/.E TITLE 5 AND THEaN BOARD OF
D�, ` �' - --- �3
. 1� � /NV AT SEPTIC TANK(CUT)
.HEAL TH RFGU/ A TIONS. ��7� I 9 r s►� a tag ss dii inn
3, "N FRONT OF HOUSE FINISH GRADE TO SLOPE AWAY AT �fv 0/,Q �� i Q/
LEAST 314 " FOR /5 ' � s
f /NV. AT D/ST. BOX(/NJ
°4 DR/VE'WAY TO PITCH }r'OWARDS ,STREET FOR THE FIRS T INV ATDISTeox(OUT)
/O ' FROM BUILDING
AT LEACHING FACILITY --
?'"0�:,tom! GuA Tt Wit' /�_ /5',4/ r� /4 L3,C,,G 77�,Y/. f�.' f BOSTON, MASS. WORCESTER, MASS.
AT BOTTOM OFPIT- 4 •Q`� HALIFAX, MASS. NORWELL, MASS.
BEDFORD, MASS. LEXINGTON, MASS.
r HYANNIS, MASS. MANSFIELD, MASS.
CRANSTON, R.I. DERRY, N.H.
i
kt.A(-c)U`T C Al,L.CUL 10�j
150 = Z4 z 0 '
DESIGN DA A
DESIGN FLOW-
Q Y
�c .P11 £
E3 1E1 IC::
c.,iCRV iC£. + .� � REQUIRED SEPTIC TANK
�r _ ►v_K + , - - 49f _ GAL.
SEPTIC TANK PROVIDED r 1 ' _ GAL CAPE COD SURVEY
C C)N S U LTA N T S
op% REQUIRED SIZE LEACHING FACILITY,
. �O' __ ---__--_— 326? Main Street Route 6A
, i! Barnstable Village. Massachusetts 02630
Number. (617)3 e 8133
Adf
DIVISION OF
BOSTON SURVEY CONSULTANTS INC.
SIZE OF LEACHING FACILITY PROVIDED: i ENGINEERING • SURVEYING PLANNING
o N^^ �.. . .°., L �T ..,,, ` $ / TYPE OF SYSTEM: TITLE:
�'-� V r, nw... ,w► 'r► '`e. �• 1 � Cr�" •� .,, _ � ..^� F � �/(��T /4,/T�3 !��TT`"'�'l��""". .------
ot
._.. -- _ . ., •. - �} , � s� x SEWAGE DISPOSAL SYSTEM
31 ---�--_ _...�,. � -.. "" .�,, �' -,..._ .� -- �q � '����,� x ��� �,��r.� ��,� � ,�_�: - .�.�._ DESIGN
-Its- 'e;
L OCUS PLA IV:
Aq- )Q$TA'gLrQ H A NN ►5 MA,
FOR:
vL
SCALE: AS SHOWN
/ METERS
hNUMMIZ
FEET 0
DATE: o2
COMP./DESIGN:
CHECK: C P ll1
DA TUM•• ;�Y ; DRAWN:
/.. .c .
FIELD:
FILE NO:
DWG. NO: = JOB NO: ,_-',
SHEET: I OF: I