HomeMy WebLinkAbout0025 PIRATES WAY - Health 25 PIRATES WAY, W.HY4XNISPORT
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Commonwealth of Massachusetts d65- OS(
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
25 PIRATES WAY
Property Address
RONALD MENARD
Owner Owners Name
information is required for every WEST HYANISPORT MA 02601 8/12/2020
page. Cityrrown State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
Important:When A. General Information
filling out forms
on the computer, I
use only the tab 1. Inspector:
key to move your
cursor-do not KEVIN BURKE
use the return Name of Inspector
key.
THE BUILDING INSPECTOR
Company Name
15 CHESTNUT ST
Company Address
WAREHAM MA 02571
City/Town State Zip Code
508 291 2228 SI 13730
Telephone Number License Number
B. Certification
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 16.000).The system:
® Passes ❑ Conditionally Passes ❑ Fails
❑ Needs Further Evaluation by the Local Approving Authority
I �� � 0
-� 3
Inspectors Signature Date
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 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.
*""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.
t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
M , 25 PIRATES WAY
Property Address
P
RONALD MENARD
Owner Owner's Name
information is required for every WEST HYANISPORT MA 02601 8/12/2020
page. Cityfrown State Zip Code Date of Inspection
B. Certification (cont.)
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
B) System Conditionally Passes(cont.):
❑ 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 ❑ Y ❑ N ❑ ND(Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below):
❑ 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 ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
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
t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
25 PIRATES WAY
Property Address
RONALD MENARD
Owner Owner's Name
information is required for every WEST HYANISPORT MA 02601 8/12/2020
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
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.
Check the box for"yes", "no"or"not determined" (Y, N, ND)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.
❑ Y ❑ N ❑ ND (Explain below):
y
t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17
f
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
M 5 25 PIRATES WAY
Property Address
RONALD MENARD
Owner Owner's Name
information is required for every WEST HYANISPORT MA 02601 8/12/2020
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
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 fecal
coliform bacteria indicates absent 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:
D) System Failure Criteria Applicable to All Systems:
You must indicate"Yes" or"No"to each of the following for all inspections:
Yes No
❑ ® Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ ® 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 Y day flow
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17
Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
25 PIRATES WAY -
Property Address
RONALD MENARD
Owner Owner's Name
information is required for every WEST HYANISPORT MA 02601 8/12/2020
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Yes No
❑ ® 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 fecal coliform bacteria indicates absent 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
and chain of custody must be attached to this form.]
❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd.
❑ ® 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.
For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the
questions in Section D.
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.
t5ins.doc•rev.6/16 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 5 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
r( 25 PIRATES WAY
Property Address
RONALD MENARD
Owner Owner's Name
information is required for every WEST HYANISPORT MA 02601 8/12/2020
page. Cityrrown State Zip Code Date of Inspection
C. Checklist
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:
® ❑ 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(5)]
D. System Information
Residential Flow Conditions:
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 GPD
t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
M '< 25 PIRATES WAY
Property Address
RONALD MENARD
Owner Owner's Name
information is required for every WEST HYANISPORT MA 02601 8/12/2020
page. City/Town State Zip Code Date of Inspection
D. System Information
Description:
THIS SYSTEM IS A 1000 GALLON TANK WITH D BOX AND A 8'X 6' PIT ONLY RECORDS ON
FILE 10/24/1997 BARNSTABLE BOARD OF HEALTH
Number of current residents: 1
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No
information in this report.)
Laundry system inspected? ® Yes ❑ No
Seasonal use? ❑ Yes ® No
Water meter readings, if available(last 2 years usage(gpd)):
Detail:
Sump pump? ❑ Yes ® No
Last date of occupancy: 08/12 2020
Date
Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 15.203): Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
l5ins.doc-rev.6116 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
, 25 PIRATES WAY
Property Address
RONALD MENARD
Owner Owner's Name
information is required for every WEST HYANISPORT MA 02601 8/12/2020
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Last date of occupancy/use: Date
Other(describe below):
General Information
Pumping Records:
Source of information:
Was system pumped as part of the inspection? ❑ Yes ® 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)and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
25 PIRATES WAY
Property Address
RONALD MENARD
Owner Owner's Name
information is
required for every WEST HYANISPORT MA 02601 8/12/2020
page. Cityfrown State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known)and source of information:
THE ONLY THING ON FILE IS ONE PAGE ON FILE AT THE BARNSTABLE BOARD OF HEALTH
DATE 10/24/1997
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
Depth below grade: 22"feet
Material of construction:
❑ cast iron ®40 PVC ❑ other(explain):
Distance from private water supply well or suction line: feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
JOINTS SOILD NO SIGN OF LEAKAGE
Septic Tank(locate on site plan):
16"
Depth below grade: feet
Material of construction:
E concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain)
If tank is metal, list age:
years
Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No
Dimensions: 1000 GALLON �
Sludge depth:
2"
t5ins.doc-rev.6/16 Tdle 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
25 PIRATES WAY
Property Address
RONALD MENARD
Owner Owner's Name
information is required for every WEST HYANISPORT MA 02601 8/12/2020
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Septic Tank(cont.)
Distance from top of sludge to bottom of outlet tee or baffle
30"
Scum thickness
Distance from top of scum to top of outlet tee or baffle
7"
Distance from bottom of scum to bottom of outlet tee or baffle
14"
How were dimensions determined? FIELD MEASURED
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
DUE TO THE AGE OF THE SYSTEM IT SHOULD BE PUMP EVERY TWO YEARS INLET AND
OUTLET TEE IN GOOD SHAPE. TANK STRUCTURAL SOUND LIQUID LEVELS AT BOTTOM OF
OUTLET INVERT RIGHT WERE THEY ARE SUPPOSED TO BE
Grease Trap (locate on site plan):
Depth below grade: feet
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: Date
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
25 PIRATES WAY
Property Address
RONALD MENARD
Owner Owner's Name
information is required for every WEST HYANISPORT MA 02601 8/12/2020
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Capacity:
gallons
Design Flow: gallons per day
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments(condition of alarm and float switches, etc.):
"Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
t5ins.doc•rev.6116 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 11 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M , 25 PIRATES WAY
Property Address
RONALD MENARD
Owner Owner's Name
information is required for every WEST HYANISPORT MA 02601 8/12/2020
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Distribution Box(if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert 0
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.):
D BOX LEVEL NO SIGN OF CARRYOVER INSIDE OR OUT
Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No*
Alarms in working order: ❑ Yes ❑ No*
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
*If pumps or alarms are not in working order, system is a conditional pass.
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M , 25 PIRATES WAY
Property Address
RONALD MENARD
Owner Owner's Name
information is required for every WEST HYANISPORT MA 02601 8/12/2020
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Type:
® leaching pits number: 1-8'X6'
❑ 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.):
NO PONDING VEGETATION NORMAL GRASS NO SIGN OF HYDRAULIC FAILURE
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 ❑ No
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17
J-
Commonwealth of Massachusetts
Title 5 Official Inspection Form
o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
M 25 PIRATES WAY
Property Oroperty Address
RONALD MENARD
Owner Owners Name
information is WEST HYANISPORT MA 02601
required for every 8/12/2020
page. CitylTown State Zip Code Date of Inspection
D. System Information (cont.)
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.):
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
,.• 25 PIRATES WAY
Property Address
RONALD MENARD
Owner Owner's Name _
information is WEST HYANISPORT required for every MA 02601 8/12/2020
a C /Town
page. � State Zip Code Date of Inspection
D. System Information (cont.)
Sketch Of Sewage Disposal System: Provide a view 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. Check one of the boxes below:
® hand-sketch in the area below.
❑ drawing attached separately
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t5ins.doc•rev.6r16 Title 5 Official Insp
ection Form:Subsrafaoe Sewage Disposal System•Page 16 or 17
f
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
25 PIRATES WAY
Property Address
RONALD MENARD
Owner Owner's Name
information is required for every WEST HYANISPORT MA 02601 8/12/2020
page. Cityfrown State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
® Check Slope
® Surface water
® Check cellar
® Shallow wells
Estimated depth to high ground water: 10,
feet
Please indicate all methods used to determine the high ground water elevation:
❑ Obtained from system design plans on record
If checked, date of design plan reviewed: Date
❑ Observed site(abutting property/observation hole within 150 feet of SAS)
® Checked with local Board of Health -explain:
SURROUNDING PROPERTYS
❑ Checked with local excavators, installers-(attach documentation)
❑ Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
THE TWO PROPERTIES RIGHT BEHIND 25 PIRATES WAY FIRST ONE IS 21 PRAM ROAD SITE
PLAN DATED 12/19/2019 ALSO SOIL EVALUATION REPORT HAS GROUND WATER AT 10,THE
SECOND ADDRESS IS 26 PRAM ROAD HAS GROUND WATER AT 9.8' PAPER ON FILE
BARNSTABLE BOARD OF HEALTH
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
> 25 PIRATES WAY
Property Address
RONALD MENARD
Owner Owner's Name
information is required for every WEST HYANISPORT MA 02601 8/12/2020
page. Citylrown State Zip Code Date of Inspection
E. Report Completeness Checklist
® Inspection Summary: A, B, C, D, or E checked
® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed
® System Information—Estimated depth to high groundwater
® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17
8/11/2020 ShowAsbuilt(1700x2800)
1P�VSTOWN OF BARNSTABLE
LOCATION/11S _ T ti SEWAGE p s"J3
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V LLAGE1TC� rd / ASSESSOR'S MAP At LOT
INSTALLER'S NAME&PHONE NO. a s f °" 7 S S 7- Z
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SEPTIC TANK CAPACITY
LEACHING FAC LM:(type) /07 /D c e-) (size) 4�
NO.OF BEDROOMS 0—`J
BUILDER OR OWNER C/—-
PERMrrDATE: `'Z 8—9 S COMPLIANCE DATE:/G
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leachi ility Feet
Private Water Supply Well and Leaching Facility (If any w s exist
on site or within 200 fat of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any w¢tl exist
within 300 feet of leaching taci;�(yy Feet
Furnished by
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INSTALLER'S NAME&PHONE NO.��dd ?�'
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) 4. D a (size)
NO.OF BEDROOMS ..
BUILDER OR OWNER ayt A
PERMITDATE: e°a' — COMPLIANCE DATE:/6
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leachi acility Feet
Private Water Supply Well and Leaching Facility (If any w s exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wytl exist
within 300 feet of leaching faci Feet
Furnished by A
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THE COMMONWEALTH OF MASSACH@l. ETTS
BOAR® OF HEALTH
TOWN OF BARNSTABL E
Appliration for Bi-tipooal Workii Towilrurtion Famit
Application is hereby made for a Permit to Construct ( ) or Repair (b4 an Individual Sewage Disposal
System at:
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W Owner 74� ///[►�A^d/dress ,//w�/
a .. .... .............
....••-•---•---------- -- ...------ -----------------.................. ................I-------- ---------""'"...... -__ --------
Installer Address
d Type of Building Size Lot............................Sq. feet
Dwelling— No. of Bedrooms-----------------------------------------._.Expansion Attic ( ) Garbage Grinder
aOther—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( )
Q' Other fixtu es .
d
g -----------------gallons per person per day. Total daily flow._.------------.-.--..� -----------
Design Flow------------------ --------
-------...........gallons.
--
W -
WSeptic Tank—Liquid capacity./O.0--gallons Length---------------- Width.--..----------- Diameter____..-_.-.---- Depth................
x Disposal Trench—No. .................... Width.................. Total Length.................. Total leaching area....................sq. ft.
Seepage Pit No-----------/....... Diameter------/0.-_----- Depth below inlet.....6........... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
.-.4 Percolation Test Results Performed by------------ ------------------------------------------------------------- Date........................................
0.7
Test Pit No. I----------------minutes per inch Depth of Test Pit.........----------- Depth to ground water........................
r4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
W -----------------------------------------•-----------------•-------------...................................................................................
0 Description of Soil.........................................................................................................................................................................
x
U --------------------------------------------------------•-----------------------•-------------------------•--------------------------------------•--------------------------------•.....----••-•--------
W
U Nature of Repairs or Alteratioty�—Answer when appllic0able-----.-J_AJ _.. .....lG9n .... �T'-C----...
-T-ityi.l JL )------- tS �--- F3 ----I.....-- ..... T---- `J c .....................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System.in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a C ificate of Compliancee be n issue t oard of health.
j~- Signed - � �J
Application.Approved By .. .. � ----- ----- -- .``..�b�. f'.`... .:
Application Disapproved for the following reasons- ------------------------------------------........................_-----------------------------------------
............. ...._.................................. .. ...__....._._...._. . . ..... ......._...... ------------------ ........................................
Darer.
Permit No. .... ......'1. ..`-..� ------- Issued ....... - __Z5 .
Dace
r
THE COMMONWEALTH OF MASSACH .SETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliratiott for Diilipw tl Workii Tomitrnrtion jinmit
Application is hereby made for a Permit to Construct ( ) or Repair (b< an Individual Sewage Disposal
System at:
....��;" �i/lam-i2,s GJ�'% GJ
Location-Address or Lot No.
G.0 L /w1.4..J / !'N US.Lf�i---- ---✓i; ---•-> aZz_�.J...--:=--- ..-----••--..........
,� 0 saner L Address
........6
.........
..................
Installer Address
U ' Type of Building 3 Size Lot............................Sq. feet.
.. Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder {—�/vU
aOther—Type of Building -----------------------_-- No. of persons-_-----..-_.-..--.---------- Showers ( ) — Cafeteria ( )
d 'Other fixtures --------------------------------------------------------------------------------------- -----------------
•-----
W Design Flow.................��....-.-.---_...gallons per person per day. Total daily flow...-----_-_-3-.�. U_____-____________gallons.
WSeptic Tank—Liquid capacity./GM---gallons Length................ Width----------------,Diameter..-------------- Depth----------------
x Disposal Trench—No. .................... Width.................... Total Length----------------.-.- Total leaching area...........:........sq. ft.
Seepage Pit No........../_...... Diameter.......e��.-_--._. Depth below inlet......6........... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank
~" Percolation Test Results Performed b 4--------------------------------- Date...------.------.--..-----__-•--..•--...
Y 1 -- ----
.a _Test Pit No. 1................minutes per inch Depth of Test Pit....._-.---_------_ Depth to ground water...._--....------------
fX Test Pit No. 2.........:_'....minutes per inch Depth-of Test Pit-------------------- Depth to ground water........................
---- ------------------------•---- --------------------•-----------•----•-•-•-••---•----.-...•--.........................................................
0 r Description of Soil--; t `---------------------------------------------••--------•--------------"--.---.-----------•---------------•-•-----------------•----------------•....--••------
U. .......................------------=-------••---------------------•-•--•----•------------•-••-•------... --
W ,, -
--- --------- - ------- --------- ...........=---'----=='----- --- -
11�
U Nature of.-Repairs or Alteratio — when applicable._.....I/U_ ..... ....-_14"t) -------------------------------------
Answer
7:-'4�:1..L 1-------D'`---T`------�G---�----;--- �IJQU rSt'Q----- -..------. ----=SrvNc--------------------------------
Agreement:f ,.N I ,r '
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in oper tion until a Ce ificate of Compliance has be n issued t oard of health.
)) J 1 Signed .............r...............-... .--- ..._..._.................... --------------- ---- ----------------------------
I
Applcation.Approved By -__... �' ��-- -� .... ... --------------------- ...............
'^..�r✓Z
Date
Application Disapproved for the following reasons- --------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------................-----------------...._..................-------------------------------------------[�-, ------- ....... ...................
Permit No. .... ...`. -------_ Issued V% ......
-----i5a...
Daze
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE t�
(�Ertifirate of C11ompli ncie
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired
by .. -
"
has been installed in accordance with the provisions of TI'I I_E of he State Environmental Code as described in
the application for Disposal Works Construction Permit I --- . ` . . dated � '.r...��_ f=._. ..<�
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE ..----------.._ .. .f. 7---- ------------------------- Inspector ------------ --- ----------- --------------.------
U
THE COMMONWEALTH OF MASSACHUSETTS Z� Q✓ /
BOARD OF HEALTH
TOWN OF BARNSTABLE
No. ................ FEE........................
Dispooal IVorkn Tomitrnrt an ranfit
Permission is hereby granted = -------------- ..................
to Construct ( ) or Repair an Individual Sewage Disposal System
atNo.------....-•..............•-----•-• --- -_ ......-
Street
as shown on the application for Disposal Works Construction Permit Zqffated--- ........ ....
47
Board of Health
DATE........
FORM 36508 HOBBS 6 WARREN.INC.,PUBLISHERS
TOWN OF BARNSTABLE
I;E7CpTION S r»c �S 4J SEWAGE # 3 7
V LLAGE2''U ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO. �d d °" ' ? a 7 7 Z
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) L` �. /D a (size)
NO OF BEDROOMS _ `3
A
B ILDER OR OWNER
PER"'MITDATE: �� `°� — 9 COMPLIANCE DATE:/6 "r �! S /
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leachi acility Feet
Private Water Supply Well and Leaching Facility (If any w s exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wgtl exist
:;:w.ithin 300 feet of leaching faci Feet
Furiushed by
a � s
\r
n�
asc)o vl
\ COMMONWEALTH OF MASSACHUSETTS
Y'
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: 25 Pirates Way
W Hyannisport
Owner's Name: Al Gilman
Owner's Address: 15 Musket Dr.
Acton, MA
Date of Inspection: ,.-7—0 f
Name of Inspector: (please print) W i 1 1 i am R_ . Robinson Sr.
Company Name: William E. Robinson Septic Service
Mailing Address: P O Box 1089
Centerville, MA
Telephone Number: ( 5 0 8) 7 7 5—8 7 7 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 toSection 15.340 of Title 5(310 CMR 15.000). The system:
® V/Passes
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
Fails
C
Inspector's Signature: 20 U Date!
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.
Title 5 Inspection Form 6/15/2000 page 1
Page 2 of 11
v
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 25 Pirates Way
W Hyannisport
Owner:
Date of Inspection: e-.%3-o
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. Sy tem 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:
AL
System Conditionally Passes:
One or more system components as described in the"Conditional Pass"section need to be replaced or %t
rep a' ed.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass.
Ans er yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please
expla .
The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally
unso d,exhibits substantial infiltration or exfiltration or tank failure is imminent.System will pass inspection if the
exist' g tank is replaced with a complying septic tank as approved by the Board of Health...
*A tal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance
indi ting that the tank is less than 20 years old is available.
N explain:
Observation of sewage backup or break out or high static water level in the distribution box due to broken or
o structed pipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection if(with
ap roval of Board of Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
explain:
The system required pumping more than 4 times a year due to broken or obsttttcted pipe(s).The system will
ass inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
explain:
a
Page 3 of l I
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 25 Pirates Way
W Hyannisport
Owner: Gilman
Date of Inspection: 3a
C. urther 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 fail' g to protect public health,safety or the environment.
1. yytem will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the
stem 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
sys em 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 l 1
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 25 Pirates way
W Hyannisport
Owner:
Date of Inspection: C 0 3—O
D. System Failure Criteria applicable to all systems:
Y must indicate"yes"or"no"to each of the following for all inspections:
Yes No
Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
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 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 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. [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/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.
Large Systems:
o 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)
es 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 drinldng 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 ou have answered"yes"to any question in Sertiain E the system is considered a significant threat,or answered
ti'es" n Section D above the large system bas fmkd.The owner or operator of any large system considered a
ant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR
.The system owner should contact the appropriate regional office of the Department.
4
Page 5 of 1 I
Y
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: rA:qVS, ' Hay
Hyannis yannisport
Owner: Gilman
Date of Inspection: G 3~6�
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?
VHave 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)
zz _ Was the facility or dwelling inspected for signs of sewage back up
Was the site inspected for signs of break out?
jz_ 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 o
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)]
t
5
Page 6 of 11
G
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 25 Pirates Way
yannispor
Owner: 1 man
Date of Inspection: 4C —;-3 eQ
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): Number of bedrooms(actual): 2
DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): G�
Number of current residents:
Does residence have a garbage grinder(yes or no):/L O
Is laundry on a separate sewage system(yes or no):_ [if yes separate inspection required]
Laundry system inspected(yes or no): A-0
Seasonal use:(yes or no):
Water meter readings,if available(last 2 years usage(gpd)): 2 0 0 0-01 44, 250 gal.
Sump pump(yes or no):2-0 1 9 9 9-0 0 50, 250 gal.
Last date of occupancy: !!�' W
COMM ERCIAL/INDUSTRIAL
Typ of establishment:
Desi n flow(based on 310 CMR 15.203): gpd
Basis of design flow(seats/persons/sgft,etc.):
Gre a trap present(yes or no):
Indus ial waste holding tank present(yes or no):
Non- anitary waste discharged to the Title 5 system(yes or no):
Wat meter readings,if available:
Las date of occupancy/use:
OT ER(describe):
GENERAL INFORMATION
Pumping Records
Source of information:
Was system pumped as part of the inspection(yes or no):/L 0
If yes,volume pumped:_gallons--How was quantity pumped determined?
Reason for pumping:
TYP F 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 componepts, datstalled(if known)and source of information:
�� 9 � '73 Were sewage odors detected when arriving at the site(yes or no):
6
Page 7 of I I
r OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 25 Pirates Way
W Hyannisport
Owner: Gilman
Date of Inspection:
B LDING SEWER(locate on site plan)
Dep below grade:
Mate 'als of construction:_cast iron _40 PVC_other(explain):
Dista ce from private water supply well or suction line:
Co ents(on condition of joints,venting,evidence of leakage,etc.):
SEPTIC TANK:_(locate on site plan)
Depth below grade: �
Material of construction:_Vcconcrete_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:
Sludge depth: 3 —Sy-
Distance from top of sludge to bottom of outlet tee or baffle:`!
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:
How were dimensions determined: ($ zr J�
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels
as related to outlet invert,evidence of.leakage,etc.):
GRE SE TRAP:_(locate on site plan)
Depth elow grade:_
Materi 1 of construction:_concrete_metal_fiberglass polyethylene_other
(expla ):
Dime sions:
Scu thickness:
Dis ce from top of scum to top of outlet tee or baffle:
Dis nce from bottom of scum to bottom of outlet tee or baffle:
Dat of last pumping:
C ents(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels
as elated to outlet invert,evidence of leakage,etc.):
I
7
II
Page 8 of l 1 '
- F
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 25 Pirates Way
W Hyannispor
Owner: Gilman
Date of Inspection: C °-7, 3-ex 7
TIG or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan)
Depth bel w grade:
Material o construction: concrete metal fiberglass_polyethylene other(explain):
Dimension
Capacity: gallons
Design Flo gallons/day
Alarm pres nt(yes or no):
Alarm lev 1: Alarm in working order(yes or no):
Date of 1 t pumping:
Comme (condition of alarm and float switches,etc.):
DISTRIBUTION BOX:Z(if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: 8
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.): b
PUMP HAMBER: (locate on site plan)
Pumps in working order(yes or no):
Alarms i working order(yes or no):
Commen s(note condition of pump chamber,condition of pumps and appurtenances,etc.):
8
Page 9of11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 25 Pirates Way
W Hyannisport
Owner: Gilman
Date of Inspection: lam. 3-0 -'
SOIL ABSORPTION SYSTEM(SAS): V (locate on site plan,excavation not required)
If SAS not located explain why:
Type
leaching pits,number: I
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.):
Xe CASE 5 )b ecy Z / ,
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)
Material of construction:
Dimens' ns:
Depth f solids:
Co nts(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: 25 Pirates Way
W Hyannisport
Owner: Gilman
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.
UA
10
r
Page 11 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 25 Pirates Way
W Hyannisport
Owner: Gilman J
Date of Inspection: 'a
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells je,
Estimated depth to groundwater 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 withi }50 feet of SAS)
Checked with local Board of Health-explain: 969 7�b,.6 alb _9'
Checked with local excavators, installers-(attach documentation)
Accessed USGS database-explain:
You must describe how you estab)lii he/d the high$round water elevation:
11
`._'�-'�++:.•,,..ti,..-+r.•a-,.»y-�:ti-..t".,...,.. .,-•�- - .`.'-'..,.--,.,�-„*-s.n-.-�',+*^.�+�r'Asa..�w.-+ar.-»...,,rv,,�r..r�u""x^fi�---2^.. ,.,-... .. . r-.r�+,•-..^-�'1�•'�S.t.....-.n.-<..--.rs'�nr.y,-iNns�-Y+.+"".,,.
TOWN OF BARNSTABLE BAR-W ( 3281
Ordinance or Regulation
WARNING NOTICE
Name of Offender/Manager QU ok*, _ /'�Py1 fr
Address of Offender tor fAkr 'AJ&, (.r MV/MB Reg.#
I�
Village/State/Zip ��,�„ ��' _ ,� t) p/
Business Name 1P ,,yam/ , on 'F-/-21 200/
-V-
Business Address )I '`
S%4nature .of Enforcing Officer
Village/State/Zip
Location of Offense ' tr lr) LNA%-/ o v
-�'" { -Enforcing DepEt�/Division
Offense [o ✓! O _ � n � � � ` �llr.a►rI. relit A P CIvw!Pl3r
Facts o') 0'. 1)0,01eV,*k fm(p r 1 t
0kn inn
4V^ k� �0�1
This will serve'only as' a warning. At this time no legal action has been/taken.
It is the goal of Town agencies to achieve voluntary compliance of Town
Ordinances, Rules and Regulations. Education efforts and warning notices are
attempts to gain voluntary compliance. Subsequent violations will result in
appropriate legal action ,by the Town.
WHITE-OFFENDER CANARY ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT.
TOWN OF BARNSTABLE BAR-W 3281
Ordinance or Regulation
WARNING NOTICE
Name of Offender/Manager t�.a�^at . ' tt`�'
Address of Offender s t01 z,�14 t J MV/MB Reg.#
Village/State/Zip P"#tll:.vs7/1,. f
r
Business Name .` 4) /am/ on. l'121120�Ll_
Business Address
Signature .of Enf`dreing Officer
Village/State/Zip
Location of Offense { '�° � ( ,, a'/44
""j'" ! Enforcing Deppy/Division
offense �
Facts JF Ix, 1 0 f.r 1.14le 44 r J41, t.Fi" "t.. rkl(P
" This will serve-only as' a warning. At this time no legal action has been/taken.
It is the goal of Town agencies to achieve voluntary compliance of Town
` Ordinances, Rules a d Regulations. Education efforts and warning notices are
attempts to gain voluntary compliance. Subsequent violations will result in
appropriate legal action,by the Town.
WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT.
F
` COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
RECEIVED
[JAY 3 2005
TITLE 5 TOWN OF BARNSTABLE
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY—AS SS P�VIEN-TS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 25 Pirates Way
Hyannisport
Owner's Name: Alden Gilman
Owner's Address: 1907 Le Gare Court
Will mi nq on, NC 28403-5354
Date of Inspection:
Name of Inspector:(please print) Wi 1 1 i am E_ Robi nson Sr.
Company Name: William E. Robinson Septic Service
Mailing Address: P O Box 1089
Centerville, MA
Telephone Number: (5081 775-8776.
.CERTIFICATION STATEMENT
1 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 Sect' n 15.340 of Title 5(310 CMR 15.000). The system:
asses
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
Fails
Inspector's Signature: �<j „ �. Date:
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Heattlt of
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 I
Page 2 of l 1 '
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 25 Pirates Way
Hyannisport
Owner. Alden Gilman
Date of Inspection: 41,
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. Syst 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. Sy em Conditionally Passes:
e or more system components as described in the"Conditional Pass"section need to be replaced or
repaired. he system,upon completion of the replacement or repair,as approved by the Board of Health,will pass.
Answer ye ,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,cKhibits substantial infiltration or cAltration or tank failure is imminent.System will pass inspection if the -
existing tai ik is replaced with a complying septic tank as approved by the Board of Health.
•A metal eptic 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 expl
bservation of sewage backup or break out or high static water level in the distribution box due tabroken or _
obstru ed pipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection if(with
appro 1 of Board of Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
explain:
The system required pumping more than 4 times a year due to broken or obsmxlcd pipe(s).The system will
p s inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
N explain: _ I
OV
f
• Page 3 of I I
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 25 Pirates Way
yannispor
Owner: Alden Gliman
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 fa ling to protect public health,safety or the environment.
I. System will pass unless Board of Health determines in ccordanc with 310 CMR 15.303(1)(b)that the
system is not functioning in a manner which will pr ect public h alth,safety and the environment:
Cesspool or privy is within 50 feet of a surf a water
Cesspool or privy is within 50 feet of a bo ering vegetated./etland or a salt marsh
2, Nystem will fail unless the Board o Health(and Public Water Supplier,if any)determines that the
Sys( m is functioning in a manner that protects the public health,safety and environment'.
The system has a septic �d 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 , and SAS and the SAS is within a Zone 1 of a public water supply.
_ The system has a sep�c 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 front a
private water supply w�,l" Method used to determine distance
"This system passeyif the well water analysis,performed at a DEP certified laboratory, for coliforrn
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. (her:
3
Page 4 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 25 Pirates Way
Hyannisport
Owner: Alden Gilman
Date of Inspection:
D. System F ilure Criteria applicable to all systems:
You must indi to"yes"or"no"to each of the following for all inspections:
Yes No
_ Bac p of sewage into facility or system component due to overloaded or clogged SAS or cesspool
Disc ge or ponding of effluent to the surface ofthe ground or surface waters due to an overloaded or
clog d SAS or cesspool
_ Stati liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cessp of
Liqui depth in cesspool is less than 6"below invert or available volume is less than'/I day flow
Requ ed pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number
of ti es pumped
Any ortion of the SAS;cesspool or privy is below high ground water elevation.
Any ortion of cesspool or privy is within I00.feet of a surface water supply or tributary to a surface
wat r supply. ,
An portion of a cesspool or privy is within a Zone 1 of a public well.
An portion of a cesspool or privy is within 50 feet of a private water supply well.
y portion of a cesspool or privy is less than 100 feet but greater than 50 f^_et from a private eater
pply well with no acceptable water quality analysis.(This system passes if the well water analysis,
erformed 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/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. L rge Systems:To be c nsidcrcd a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000
gpd•
You mu indicate either"yes"or"no"to each of the following:
(The foil wing criteria apply to large systems in addition to the criteria above)
yes no
to system is within 400 feet of a surface drinking water supply
e 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 li of a public water supply well
if you ave answered"yes"to any question in Section E the system is considered a significant threat,or answered
" cs"m Section D above the large s stem has fatted.The owner or or of large system considered a
Y �Y g y
y �
sig ficant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR
15 04.The system owner should contact the appropriate regional office of the Department.
4
Page 5 of l l
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART�B
CHECKLIST
Property Address: 25 Pirates Way
Hyannispor
Owner: Alden Gilman
Dale of Inspection: �
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
'V Were any of the system components pumped out in the previous two weeks?
_ _I/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.
L/— Determined in the field(if any of the failure criteria related to Part C is at issue approximation.of distance.
is unacceptable)[310 CIAR I5.302(3)(b))
5
Page 6 of i 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 25 Pirates Way_
HyannisAort
Owner: Alden Gilm n
Date of Inspection: -- (3
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design):.,3 Number of bedrooms(actual):
DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms):26.6
Number of current residents:
Does residence have a garbage grinder(yes or no): /t'd
Is laundry on a separate sewage system(yes or no);,�,6[if yes separate inspection required]
Laundry system inspected(yes or no):LZi�
Seasonal use:(yes or no)-,&O
Water meter readings,if available(last 2 years usage(gpd)): 3/0.4-3/0 5 78, 750
Sump pump(yes or no):A 31U3-31UT-7-22, 250
Last date of occupancy:
COMMERCIA NDUSTRRIAV L
Type of establis ent:
Design flow( ed on 310 CMR 15.203): gpd
Basis of desi flow(seatslpersonsJsgft,etc.):
Grease trap resent(yes or no):_
Industrial aste holding tank present(yes or no):_
Non-san' waste discharged to the Title 5 system(yes or no):_
Water eter readings,if available:
Last to of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information:
Was system pumped as padof the inspection(yes or no):_
If yes,volume pumped:_gallons--How was quantity pumped determined?
Reason for pumping:
TYP OF SYSTEM
eptic 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 o[information:
K 3 j a-71
Were sewage odors detected when arriving at the site(yes or no): 1v Q
6
f
1'agc 7 of I I
OFFICIAL INSPECTION FORM—NOT FOIL VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOIAI
PART C
SYSTEM INI:ORIIIATION(continued)
Troperty Address: 25 Pirates Way
_Hyanni sport
Owner: Alden Gilman
Da it orInspeclion:
BUILDING SE ER(locate on site plait)
Depth below adc.
Materials o construction:_cast iron _40 PVC_other(explain):
Distance ont private water supply well or suction lint:
Comme is(on condition of juu,Ls,venting,evidence of leakage,etc.):
SEPTIC TAN
K;/(locale on site plan)
Depth below grade: I �/
Material of construction: concrete metal fiberglass J,ol)•ethylene
_othcr(explain)
If tank is metal list age:_ Is age confinned•by a Certificate of Compliance(yes or no):_(attach a copy of
certificate) �
Dimensions:_(.
Sludge depth:
Distance Gom top of sludge to bottom of outlet Ice or bafllc:,Z—
Scum thickness: �l
Distance from top of stunt to top of outlet tee or baffle: r
Distance Gorn bottom of scull,to bottom of outlet tee or battle:
Ilow were dimensions determined:_C3 �t'� �-0 e✓ irs 3
Comments(on pumping recommendations,inlet and outlet Ice or Garlic condition,structwal integrity,liquid levels
as related to outlet invert,evidence of leakage,etc.):
'e; 'C tdd
GREASE TRAP:_(Iocat on site plan) -
Dcpdn below grade:
Material of eonstrueti :-concrete metal fiberglass_pol)-cdiyIene—other
(explain): —
Dimensions:
Scum III ickness:
Distance fro op of scuinlo top of outlet Ice or bathe:
Distance Go bottom of scum to butium of outlet tee or baffle:
Dale of las pumping:
ConUttcn (on pumping recommendations,inlet and outlet tee or battle condition,structural integrity,liquid levels
as relat to outlet inverl,evidence of leakage,etc.):
7
'age S of I 1 -
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM 1NFOR -IATION(continued)
Properly Address: 25 Pirates Way
Hyannisnnrt
Owner: Al.dAn ri l man
Wit of Inspecllon:
9
TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locale on site plan)
Depth below grade:
Material of construction: concrete_metal fiberglass_pulyethylene other(explaut):
Dimensions:_
Capacity: allons
Design Flow: gallons/day
Alarm present(yes r no):
Alarm level: Alann in working order(yes or no):—
Dale of last pu ing:
Comrnents(co dition of alarm and float switches,etc.):
DIST111 UTION BOX: (if present must be opencd)(locate on site plan)
Depth of liquid level above outlet invert:
Conunents(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.):
PUAIP CHAMBER: (locate on site plan)
Pumps in working rdcr(yes or no):—
Alarms in worki order(yes or no):—
Conunents(no condition of pump chamber,condition of pumps and appurtenances,etc.):
Page 9 of 1 I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 25 Pirates Way
Hyannisport
Owner: Alden Gilman
Date of Inspection:
SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required)
If SAS not located explain why:
i T'reachtng pits,number: �
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.):
.e 7v,.`— 40,
CESSPOOLS: (cess of must be pumped as part of inspection)(locate on site plan) /J
Number and configurati n: _
Depth—top of liquid t inlet invert:
Depth of solids layer-
Depth of scum laye
Dimensions of ce pool:
Materials of con traction:
Indication of gr dwatcr inflow(yes or no):
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
PRIVY: (locate o site plan)
Materials of constru ion:
Dimensions:
Depth of solids:
Comments(not 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: 25 Pirates Way
Hyannisport
Owner: Alden Gilman
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.
.� Lk
10
Page 11 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 25 Pirates Way
Hyannisport
Owner. Alden Gilman
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:
Checked with local excavators,installers-(attach documentation)
Accessed USGS database-explain:
You must describe how yo established the high ground water elevation:
` l 40 cu 1LsrG
11