HomeMy WebLinkAbout0081 OLD TOWN ROAD - Health 81 Old Town Road
Hyannis
----------------------------
A = 268 070
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TOWN OF BARNSTABLE c
LOCATION V OLD —fO Ly& 4,o
SEWAGE # ®O o 0/f
VILLAGE f Jefi A/VAA--&I ,PoRf ASSESSOR'S MAP & LOT 2 -7c'
INSTALLER'S NAME&PHONE NO. 110 Add C U Al !��ii o � �'10Al
SEPTIC TANK CAPACITY A. ,S'eJ 0
LEACHING FACILITY: (type) Z)RX we (size) 3
NO.OF BEDROOMS
BUILDER OR OWNER
PERMIT DATE: I d COMPLIANCE DATE: a `V-)—
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
Furnished by
.6' �Q � s 3
�G�/ TOWN OF BAR/N�S(TABLE
LOCATION � �� Tom- 0/C� �W^ IBC• SEWAGE #
/e
VILLAGE &A JAk5 ASSESSOR'S MAP & LOT v1C4� 010
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY CUf,,)n
LEACHING FACILITY: (type) CrZwo (size)
NO.OF BEDROOMS
BUILDER OR OWNER
PERMITDATE: 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 leachingacility) Feet
Furnished by ern f/h.C4;ao" or-;
Cif
ua
Fee$5 0 .0 0
` THE COMMONWEALTH OF MASSACHUSETTS Entered in computer-
- J
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
01pplication for Mfigpooar Opgtem Conotruction 3pCrmit
Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( )Xtkcomplete System 11 Individual Components
Location Address or Lot No. 81 Old Town Road Owner's Name,Address and Tel.No. T o n i L e n c i
West Hyan nisport,Mass. 81 Old Town Road
Assessor'sMap/Parcel v / D West Hyannisport,Mass.
Installer's Name,Address,and Tel.No.5 0 8—7 7 5—3 3 3 8 Designer's Name,Address and Tel.No.rj'Q 8- 8 3 3=21 7 7-
J.P.Macomber & Son Inc. David B.Mas:�r "�`` '"'"1-t=Y
Box 66 Centerville,Mass.02632 �DBC Environmental Designs ✓
Type of Building:
Dwelling XX No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder(NO)
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 3 4 0 G PD gallons per day. Calculated daily flow 3 3 0 r p n gallons.
Plan Date 1 2/2 6/01 Number of sheets Revision Date
Title
Size of Septic Tank 1 5 0 0 + Box Type of S.A.S. 2-5 0 0 ' s 2 5 'X 1 3 'X 2 '
Description of Soil Fill-loamy sand-medium sand. -
Nature of Repairs or Alterations(Answer when applicable) Omit t i nq two c e s o o l s_ T n s t a 1 1 i n g
1 -1500 gallon septic tank, 1 -Distribution box and two 500 gallon
leaching chambers packed in 4 ' of 12 stone. 25 'X13 'X2 '
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued by B d o ealth.
Signed Date 1 2 2/0 2
Application Approved by Date
Application Disapproved for the following reasons
f
Permit No. - Date Issued
Fee 5 0.0 0
stir :� '. •�?,.� �
C THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes
' }4,RkJBLIC HEALTH DIVISION TOWN OF BARNSTABLE., MASSACHUSETTS$.
Zipphration for 33t000al 'bp6tem Congtruction Permit
Application for a Permit to Construct( )Repair( )Up`grade(� )Abandon( )X"` omplete System ❑Individual Components
4?
Location Address or Lot No. 81 Old Town Roar " `„ Owner's Name,Address and Tel.No. ToniLenci
West Hyan nisport,NPass. A'> 8.1' Old Town Road
Assessor's Map/Parcel C5 > C . -- 'West.�.•�J( 7S V West Hyannisport,Mass.
Installer's Name,Address,and Tel.No.5 0 8—7 7 5—3 3 3 8 Designer's Name,Address and Tel.No}0 8—0 1_1_9.119
J.P.Macomber & Son Inc. ®dFAabombdgO& Son Inc.
Box 66 Centerville,Mass.02632
s Type of Building:
Dwelling XX No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder(NO)
)Other �.... Type of Building No.of Persons Showers( ) Cafeteria(
Other Fixtures %
Design Flow 3 4 0GPD gallons per day. Calculated daily flow 3 3 0 GPD gallons.
Plan Date 1 2/2 6/01 Number of sheets Revision Date
Title
Size of Septic Tank 1 500 + Box Type of S.A.S. 2-500 s 25 'X13 'X2 '
Description of Soil:Fill—loamy sand—medium sand.
Nature of Repairs or Alterations(Answer when applicable) Omitting two cesspools. Installing
171500 gallon septic tank, 1—Distribution box and two 500 gallon
leaching c ambers .packed in 4 of 1 stone. 25 'X131X2 '
Date last inspected: } +
y Agreement: '
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation untilla Certifi-
cate of Compliance has been issu`yd by t wZrWoealth.4d .
Signed Date 1 /c 2 2/0 2
Application Approved by Date c74�/ 0/7�_
Application Disapproved for the following reasons `
Permit No. Date Issued r-
- ------- ------------------------ ------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded(XX)
Abandoned( )by J.P.Maeomber & Son Inc.
at 81 Old Town Road West HYannisport,Mass. has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No.�%�12)- �S dated /25 f/0 2�,' .
Installer J.P.Maeomber & Son Inc. DesignerDavid B." Mason
The issuance of this permit shall not be construed as a guarantee that the syst will f hnctionAasesigned.
Date � "��`U�. . Inspector `1 �4✓ y
1
No. -------------------------Fee $50.00 _
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
lisspoal *pgteni, Congtructton Permit
Permission is hereby ranted to Construct( )Repair( )Upgrade.( X}'Abandon( )
System located at Sf Old Town Road West Hyanni sport,Mass.
and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
Provided: Construction T ust be completed within three years of the date of this pemut. /
Date: C Approved by
TOWN OF BARNSTABLE'
LOCATION 040 0 T O WAI X O SEWAGE # 0 0/4
VILLAGE w e s% &y A Al A1®5,�!QA'f ASSESSOR'S MAP & LOT .1 -6 7 c'
INSTALLER'S NAME&PHONE NO. /� Add C U A /9
SEPTIC TANK CAPACITY S
LEACHING FACILITY: (type) A- /7fE'Y �e�ZV S (size)
NO.OF BEDROOMS _
BUILDER OR OWNER r93�t� Lei c '
PERMIT DATE: I—d;1- 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
Furnished by
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COMMONWEALTH OF MASSACHUSE-TTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
TITLE 5
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
'CERTIFICATION
Property Address: 154 Old Town Road RECEIVED
Hyannis, MA 02601
Owner's Name: Joan Birch SEP 2 5 2001
Owner's Address: Same
TOWN OF BARNSTABLE
Date of Inspection: September 19, 2001 HEALTH DEPT.
Name of Inspector: (Please Print)James M. Ford
Company Name: James M. Ford
Mailing Address: P.O.Box 49
Osterville,MA 02655-0049 Map: 268
Telephone Number: (508)862-9400 - Parcel: 070- _
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 CAM 15.000). The system:
Passes
Conditionally Passes
Need rther Evaluation by the Local Approving Authority
✓ Fails
Inspector's Signature: Date: September 20, 2001
The system inspector sh)submra 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
DER 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 I
Page 2 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
_ PART A
CERTIFICATION (continued)
Property Address: 154 Old Town Road
Hyannis, AM
Owner: Joan Birch
Date of Inspection: September 19, 2001
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:
T
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:
2
A
Page 3 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 154 Old Town Road
Hyannis, AM
Owner: Joan Birch
Date of Inspection: September 19, 2001
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:
3
Page 4 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
'CERTIFICATION (continued)
Property Address: 154 Old Town Road.
Hyannis,AM
Owner: Joan Birch
Date of Inspection: September 19, 2001
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.]
Yes (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 II 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
Page 5 of 11
OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 154 Old Town Road
Hyannis, AM
Owner: Joan Birch
Date of Inspection: September 19, 2001
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?
n/a 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: 154 Old Town Road,
Hyannis, AM
Owner: Joan Birch
Date of Inspection: September 19, 2001
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): n/a 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)): 2000-41,250 Qals.; 1999-33,000 Qals.
Sump Pump(yes or no): No
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: Pumped approximately 2 years aQo-per owner
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
Page 7 of 11
OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
- PART C
SYSTEM INFORMATION (continued)
Property Address: 154 Old Town Road
Hyannis, AM
Owner: Joan Birch
Date of Inspection: September 19, 2001
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: ✓ (locate on site plan) Cesspool acting as a septic tank
Depth below grade: 10"
Material of construction: _concrete _metal fiberglass _polyethylene
✓ other(explain) cesspool block
If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): `(attach a copy of
certificate)
Dimensions: 5'W x 4'T x 7'bottom to grade
Sludge depth: 5"
Distance from top of sludge to bottom of outlet tee or baffle: --
Scum thickness: 6" a
Distance from top of scum to top of outlet tee or baffle: —
Distance from bottom of scum to bottom of outlet tee or baffle:
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.):
The liquid level was above the outlet tee, backing up from the overflow. The cover was 10"below grade.
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.):
Page 8 of 1 l
' OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 154 Old Town Road
Hyannis, AM
Owner! Joan Birch
Date of Inspection: September 19, 2001
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: Qallons/day
Alarm presenf(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: None (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert:
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.):
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 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C ,
SYSTEM INFORMATION (continued) „
Property Address: 154 Old Town Road
Hyannis, MA
Owner: Joan Birch
Date of Inspection: September 19, 2001
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:
leaching fields,number,dimensions:
✓ overflow cesspool,number: 1
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 overflow cesspool was 5'Wx 6'Tx 8'6"bottom to Qrade. Liquid was approximately 10"above the inlet pipe. The overflow
cesspool was in hydraulic failure. The cover was 12"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.):
t
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: 154 Old Town Road
Hyannis, AM
Owner: Joan Birch
Date of Inspection: September 19, 2001
Map: 268
Parcel: 070
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.
f3 i - 31
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Page i l of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 154 Old Town Road
Hyannis, AM
Owner: Joan Birch
Date of Inspection: September 19, 2001
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water 29'+/- feet (Adjusted High Ground Water Level is 25.1)
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 overflow cesspool to grade was approximately 816". Using the Barnstable topographic map and the Cape Cod
Commission water contours map, the maps were showing approximately 29,+/-to groundwater at this site. Using the Cape Cod
Commission Technical Bulletin, the high ground water adjustment for this site(MI W 29, Zone C, 8/01)was 3.9'.
This report has been prepared and the system inspected and failed 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
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TEST HOLE LOGS
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PARCEL: — .- 70
FLOOD ZONE:
/✓o/ �-- SOIL EVALUATOR:
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DAV I D B . MASON DATE:/ Z
DBC ENVIRONMENTAL DESIGNS
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EAST SANDWICH . MA
3 ( 508 ) 833- 2177
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