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HomeMy WebLinkAbout0089 WHIP-O-WILL DRIVE - Health 89 Whip-o-will Drive Hyannis F A = 289 135 i i r Commonwealth of Massachusetts ag9, Title 5 Official Inspection Form i, Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r 89 Whip-O-Will Drive u Property Address Anita Hayden Owner Owner's Name / information is required for every Hyannis i/ Ma 02601 9-24-2020 F page. City/Town 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 filling out forms A. Inspector Information S(*P 1,14M) on the computer, . Brett Hickey use only the tab key to move your Name of Inspector cursor-do not B&B Excavation use the return Company Name � ,key. 374 Route 130 Company Address Sandwich Ma 02563 City/Town State Zip Code n�ry (508)477-0653 S113747 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above;the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails Brett Hickey oae'ZOZoo9 51a 6:ai-oaoo' 9-24-2020 Inspector's 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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: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. t51nsp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form - i Subsurface Sewage Disposal System Form -INot for Voluntary Assessments ,�,.. 89 Whip-O-Will Drive Property Address Anita Hayden Owner Owner's Name information is Hyannis Ma 02601 9-24-2020 required for every y page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1,2, 3,or 5 and all of 4 and 6. 1), 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: The system was in working order at the time of inspection. 2) 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 olc*or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or exf.ltration 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): t5insp.doc•rev.7/26/2018 _ Title 1 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 - f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage.Disposal System Form -Not for Voluntary Assessments t. 89 Whip-O-Will Drive Property Address Anita Hayden Owner Owner's Name information is required for every Hyannis Ma 02601 9-24-2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes(cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ 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): 3) 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. a. 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: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 I c Commonwealth of Massachusetts Title 5 Official Inspection Form 1- - Subsurface Sewage Disposal System Form -Not for Voluntary Assessments - 89 Whip-O-Will Drive Property Address Anita Hayden Owner Owner's Name information is Hyannis Ma 02601 9-24-2020 required for every y page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. 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 sail 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. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ 0 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 t5insp.doc-rev.7/26/2018 Tice 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 r Commonwealth of Massachusetts . - Title 5 Official Inspection Form !, Subsurface Sewage Disposal System Form -Not for Voluntary Assessments . �;� 89 Whip-O-Will Drive Property Address Anita Hayden Owner Owner's Name information is Hyannis Ma 02601 9-24-2020 required for every y page. City/Town State Zip Code Date of Inspection C. Inspection Summary (Cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ 0 Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ O Liquid depth in cesspool is less than 6"below invert or available volume is less than %day flow ❑ O Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ O Any portion of the SAS,cesspool or privy is below high ground water elevation. ❑ 0 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 water supply well. ❑ El Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ Fx1 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.] ❑ 0 The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ Q 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. 5) 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 CA. 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 t51nsp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �a 89 Whip-O-Will Drive Property Address Anita Hayden Owner Owner's Name information is Hyannis Ma 02601 9-24-2020 required for every y page. City/Town State Zip Code Date of Inspection C. Inspection Summary (Cont.) If you have answered "yes"to any question in Section C.5 the system is considered a significant threat,or answered"yes"to any question in Section CA above the large system has failed.The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes"or"no"for each of the following for all inspections: Yes No X ❑ ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ El Were any of the system components pumped out in the previous two weeks? x Has the system received normal flows in the previous two week ❑ ❑ y p e 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) ❑ 0 Was the facility or dwelling inspected for signs of sewage back up? El ❑ Was the site inspected for signs of break out? El ❑ Were all system components, excluding the SAS, located on site? ED ❑ 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? ❑ El 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: El ❑ 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)] t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 89 Whip-O-Will Drive Property Address Anita Hayden Owner Owner's Name information is required for every Hyannis Ma 02601 9-24-2020 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: . 3 Number of bedrooms(design): Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330/GPD Description: 1 Number of current residents: Does residence have a garbage grinder? ❑ Yes 91 No Does residence have a water treatment unit? ❑ Yes ❑■ No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes F!I No information in this report.) Laundrysystem inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes [0 No Water meter readings, if available(last 2 years usage(gpd)): See below Detail: 2019- 24,684gallons No usage recorded before 2019 Sump pump? ❑ Yes ❑■ No current Last date of occupancy: Date t5lnsp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 Commonwealth of Massachusetts ............,IF Title 5 Official Inspection Form F Subsurface Sewage Disposal System Form -Not for Voluntary Assessments c , 89 Whip-0-Will Drive Property Address Anita Hayden Owner Owner's Name information is Hyannis Ma 02601 9-24-2020 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: NA 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 Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Owner- date of last pump is unknown 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: t5insp.doc-rev.7/26/2018 Title`.Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts - - Title 5 Official Inspection Form Y Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .� 89 Whip-O-Will Drive Property Address Anita Hayden Owner Owner's Name information is Hyannis Ma 02601 9-24-2020 required for every St page. City/Town ate Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: R 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): Approximate age of all components, date installed (if known)and source of information: 2003 per permit Were sewage odors detected when arriving at the site? ❑ Yes ❑■ No 5. Building Sewer(locate on site plan): 31 Depth below grade: feet Material of construction: ❑cast iron ■❑40 PVC ❑other(explain): Town water Distance from private water supply well or suction line: feet Comments (on condition of joints, venting,evidence of leakage, etc.): t5lnsp.doc•rev.7/2612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 L Commonwealth of Massachusetts r Title 5 Official Inspection Form j Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ssi 89 Whip-O-Will Drive Property Address Anita Hayden Owner Owner's Name information is Hyannis Ma 02601 9-24-2020 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): 2' Depth below grade: feet Material of construction: ❑� 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 1 Dimensions: 500gallons 611 Sludge depth: 3011 Distance from top of sludge to bottom of outlet tee or baffle On Scum thickness NS Distance from top of scum to top of outlet tee cr baffle NS Distance from bottom of scum to bottom of outiet tee or baffle measured How were dimensions determined? 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 tank was in working order at the time of inspection. The tank is not in need of pumping at this time but should be pumped every two years for maintenance. t5insp.doc-rev.7/26/2018 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 „�'\ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 89 Whip-O-Will Drive Property Address Anita Hayden Owner Owner's Name information is Hyannis Ma 02601 9-24-2020 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): NA 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 Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): NA Depth below grade: Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): ` Dimensions: I Capacity: gallons Design Flow: gallons per day t5lnsp.doc•rev.7/26/2018 TiBe 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 16 Commonwealth of Massachusetts ---- -=_ Title 5 Official Inspection Form 0 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments t 89 Whip-O-Will Drive Property Address Anita Hayden Owner Owner's Name information is Hyannis Ma 02601 9-24-2020 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) 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 9. Distribution Box(if present must be opened)(locate on site plan): 0" 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.): The - w d box as in workingorder at the time of inspection. p t5insp.doc-rev.7/26/2018 Title°Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments J� 89 Whip-O-Will Drive Property Address Anita Hayden Owner Owner's Name information is Hyannis Ma 02601 9-24-2020 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. 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.): NA * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS)(locate on site plan,excavation not required): If SAS not located,explain why: Type: ❑ leaching pits number: (2)500 gallon chambers El leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number,dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5lnsp.doc-rev.7/26/2018 Title 5 Offidal Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts a - : Title 5 Official Inspection Form t- Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 89 Whip-O-Will Drive Property Address Anita Hayden Owner Owner's Name information is Hyannis Ma 02601 9-24-2020 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS)(cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil,condition of vegetation,etc.): The SAS was in working order at the time of inspection. Chambers were dry when viewed. 12. Cesspools (cesspool must be pumped as part of inspection)(locate on site plan): NA 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 Comments (note condition of soil, signs of hycraulic failure, level of ponding,condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form v - Subsurface Sewage Disposal System Form -Not for Voluntary Assessments L� 89 Whip-O-Will Drive Property Address Anita Hayden Owner Owner's Name information is Hyannis Ma 02601 9-24-2020 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: NA Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 15insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 . e t • 1 Commonwealth of Massachusetts +y ,p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 89 Whip-O-Will Drive Property Address Anita Hayden Owner Owner's Name infonnation is Hyannis Ma 02601 9-24-2020 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. 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 l TOWN OF 13A"sTABLE E LOCATYOtif _ 1 'it r SEwACE# -700 t S k V1LI:.A1G8 HXd&a C ASSE,SSQR-S MAP de LOT`242 t uasTALtaswsWAmE&Ptim4E-No. &.6; SEP= TA.INIX CAPACrry LRACMMG FACUAW.,(Wipe) 7- No.o�.ssfsx�yalr�s 3 BMWER0RC3WPIM C4 x tad FERMrrDATE: tf -Z 1rUl�tPLr�,1�cE:DATZ. 7ICS 3 r separation Yyiatnaca Botvteate tltc; Mautintutu Adjusted QuundwaterTable to the Bottom ofLeac hingftcifity Eat Ptivate[tow supply�Vva aqd Licking Pacitity. Many'circub.exist an site e<•Wi triit x00 f t Of leaching fora u$y) Edgo�aaf Wadan d and L—hing AHW of any wetlands etXigt within 300 feet 4 hwdiirag'facility) Ftitnisked kY i . -k y t / 0 l5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form 4y� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments � .; 89 Whip-O-Will Drive Property Address Anita Hayden Owner Owner's Name information is required for every Hyannis Ma 02601 9-24-2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑■ Check Slope ❑■ Surface water ❑■ Check cellar Shallow wells No GW F below SAS Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: F-I Obtained from system design plans on record 4-7-2003 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: ❑ Checked with local excavators, installers-(attach documentation) f ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: A plan on file at the local Board of Health was used to determine high groundwater. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 , Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 . Commonwealth of Massachusetts - -_ Title 5 Official Inspection Form — Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,11 89 Whip-O-Will Drive Property Address Anita Hayden Owner Owner's Name information is H annis Ma 02601 9-24-2020 required for every y page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: A. Inspector Information: Complete all fields in this section. ❑■ B. Certification: Signed&Dated and 1,2, a, or 4 checked ❑■ C. Inspection Summary: 1,2, 3, or 5 completed as appropriate 4(Failure Criteria)and 6(Checklist)completed �■ D. System Information: For 8:Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc-rev.7/26/2018 Title 501ficial Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 TOWN OF BARNSTABLE 1� �C- LOCATION q W " O ice; 1Deiu% SEWAGE # g®©3 " 1 S� VILLAGE 1444ww! c ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. Ro 6,J S M0 S(a kC 7 75-27'7 L SEPTIC TANK CAPACITY I S n U LEACHING FACILITY: (type) Z D2rIr.�G- 5 (size) 9 x NO. OF BEDROOMS 3 BUILDER OR OWNER 'PERMITDATE: COMPLIANCE DATE: Y LL716 3 Separation Distance Between the: Maximum Adjusted Gioundwater 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 c F �y c c d C;7 o d m r Jar No. - THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pprication for 30i5p0al *pgtem Congtrurtion Permit Application for a Permit to Construct( . )Repair(A)"Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. � � Owner's Name,Address and Tel.No. 95 k/hnao 4lii/ Ar Assessor's Map/Parcel age- 13� _ Installer's Name,Address,and Tel.No. Designer's Nam Address and Tel.No. 3/0 ' ,No b�--v e7 SWw Se/W1G e— �Co- T�G� po /o*F 3 7f-iAn �E Cr�c/ems sq�Or��c,G� Type of Building: 2q Dwelling No.of Bedrooms V Lot Size sq.ft. Garbage Grinder(17C4 Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) JA1,5 IP411 1r 30b/&1 54S7fi m _W e` oco ?¢chi ETA"-13 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 issu d b of Health. Sig Date f�—/0 -0- Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued Wlo7o, 3 t 4 - No. 3 Fee,0 61 _ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZippYication for Mizvo!6al *pg;tem Congtruction Permit Application for a Permit to Construct( . )Repair( Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location�ddress or Lot No. Ow er's Name,Address and Tel.No. sq 4/fili40 4//%/ 01- N y4`!n1 S u Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name)/Address and Tel.No. 3&q l.(J.C . J10 b I--'v t7 SP/4A; SC,-I/ _co- -re-c- f.o ,&,It /015�y CQ14110//- 1-13 T•iAn 1F_ Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(n( �- Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil ' Nature of Repairs or Alterations(Answer when applicable) 7v4> Date last inspected: , Agreement: 1 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 issud b + B arofHealth. Sig �oN� Date /;/—_/D '0� Application Approved by \ Date +yk Application Disapproved for the following reasons Permit No. 3 ( Date Issued y /o o 3 u�ecirw THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY thq the On-site Sewage Disposal Sastem Constructed( )Repaired (,I"")Upgraded( k*) Abandoned( )by w E. j�0 b 1rlSd.-) at S `r k n J id O V, // or y�.o f7 n/ s has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. G 3 1' 1 dated 41 t° G 3 Installer Designer The issuance,of this permit shall not be construed as a guarantee that the system wi, functio as si n ed.C Date I I t� Inspector it".. 1w, (`>, No. � _I s l — Fee 5CA�('� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS 3Di9;po9;a1 *proem Construction Permit Permission is hereby granted to onstruct( )Re air(Upgrade( )Abandon( ) System located at 8 O tot, Or/Ve-- 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 must be completed within three years of the date f�t is nr. Date: �11 O�C/ Approved b .•_._. TOWN OF BARNSTABLE �L LOCATION 22 t76 QL SEWAGE # goo3 l S� VILLAGE 14ai'4wi-o C ASSESSOR'S MAP& LOT��S� a INSTALLER'S NAME&PHONE NO. 1ZQ 6-J S 0 i,J — I SEPTIC TANK CAPACITY 1 Sno i - • j LEACHING FACILITY: (type) Z. Dgywe 1,5 (size) NO. OF BEDROOMS ' BUILDER OR OWNER J30 ds PERMTTDATE: I'lic to COMPLIANCE DATE:1117 063 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 • � � US��hk NHS wff r� COMMONWEALTH OF MASSACHUSETTS ExECUTIVE OI.FICE' OF ENVIRONMENTAL AFFA17Z.S DEPARTMENT OF ENVIRONMENTAL PROTECTION --i) INSPECTION 0 TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARI ASSL'SSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM Rv'- 1V D PART A CERTIFICATION JAN 2 9 2003 ,;perty Address: 89 WI-IIP O WILL DR HYANNIS 02601 TOWN OF I'A' TABLE •�ner's Name: RICHARD BUREAU HEALTH DEP1. Owner's Address: 1003 OCEAN MARENA BLVD. FLAGER BEACH FLORIDA 32136 <�k T 1© 3 Date of inspection: 1/8/03 Name of Inspector: (please print) JOHN GRACI Company Name: SEPTIC INSPECTIONS rZ�� Mailing Address: P.O. BOX 2119 TEAT.ICKET, MA. 02536 MAP Telephone Number: 508-564-6813 FAX 508-564-7270 PARCEL LOT _ CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: _ Pa1IF"Urr _ Coes _ Neluation by the Local Approving Authority X Fatspector's Signature: Date: 1.18103 he system inspector shall subm a copy of this inspection report to the Approving Authority(Board of Health or DEP)within ;0 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 gent to the"system owner and copies sent to the buyer, if applicable,and the approving authority. I )tes and Comments i HE SYSTEM FAILS TITLE V INSPECTION.THE LEACH PIT WAS FULL AND PONDING AT THE TIME OF THE 1SPECTION.TI-IE PIT NEEDS TO BE UPGRADED. '**This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 89 WHIP O WILL DR HYANNIS 02601 Owner: RICHARD BUREAU Date of Inspection: 1/8/03 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: THE SYSTEM FAILS TITLE V INSPECTION.THE LEACH PIT WAS FULL AND PONDING AT THE TIME OF THE INSPECTION. THE PIT NEEDS TO BE UPGRADED. 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. n/a 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: n/a n/a 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: n/a n/a 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: n/a Page 3 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 89 WHIP O WILL DR HYANNIS 02601 P Y Owner: RICHARD BUREAU Date of Inspection: 1/8/03 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 n/a "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: n/a Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 89 WHIP O WILL DR HYANNIS 02601 Owner: RICHARD BUREAU Date of Inspection: 1/8/03 D. System Failure Criteria applicable to all systems: You must indicate"yes" or"no"to each of the following for all-inspections: Yes No X _ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than '/2 day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed'pipe(s).Number of times pumped nLa. X Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone 1 of a public well. _ X Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] X _ (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply _ X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone 11 of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CM 15.304. The system owner should contact the appropriate regional office of the Department. A Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 89 WHIP O WILL DR HYANNIS 02601 Owner: RICHARD BUREAU Date of Inspection: 1/8/03 Check if the following have been done.You must indicate "yes" or"no" as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health X Were any of the system components pumped out in the previous two weeks X _ Has the system received normal flows in the previous two week period? X Have large volumes of water been introduced to the system recently or as part of this inspection? X Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up`? X _ Was the site inspected for signs of break out? X _ Were all system components,excluding the SAS, located on site? X _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions, depth of liquid, depth of sludge and depth of scum X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no X Existing information. For example,a plan at the Board of Health. X _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] S Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 89 WHIP O WILL DR HYANNIS 02601 Owner: RICHARD BUREAU Date of Inspection: 1/8/03 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 1 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)):tt�r Sump pump(yes or no): NO Last date of occupancy: n/a 0 \ COMMERCIAL/INDUSTRIAL 60 S0� Type of establishment: n/a Design flow(based on 310 CMR 15.203): n/agpd Basis of design flow(seats/persons/sqft,etc.): n/a Grease trap present(yes or no): NO Industrial waste holding tank present(yes or no): NO Non-sanitary waste discharged to the Title 5 system(yes or no): NO Water meter readings, if available: n/a Last date of occupancy/use: n/a OTHER(describe): n/a GENERAL INFORMATION Pumping Records Source of information: n/a Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: n/agallons--How was quantity pumped determined? n/a Reason for pumping: n/a TYPE OF SYSTEM X Septic tank,distribution box, soil absorption system _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records, if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank Attach a copy of the DEP approval Other(describe): n/a Approximate age of all components,date installed(if known)and source of information: 30 YEARS INFO FROM OWNER Were sewage odors detected when arriving at the site(yes or no): NO C, Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 89 WHIP O WILL DR HYANNIS 02601 Owner: RICHARD BUREAU Date of Inspection: 1/8/03 BUILDING SEWER(locate on site plan) Depth below grade: n/a Materials of construction:_cast iron =40 PVC other(explain): n/a Distance from private water supply well or suction line: n/a Comments(on condition of joints, venting,evidence of leakage,etc.): TOWN SEPTIC TANK: X(locate on site plan) Depth below grade: 14 Material of construction: Xconcrete_metal_f fiber- - _polyethylene other(explain)n/a If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: 1000 GALLONS" Sludge depth: 3" Distance from top of sludge to bottom of outlet tee or baffle: 31" Scum thickness: 3" Distance from top of scum to top of outlet tee or baffle: 0" Distance from bottom of scum to bottom of outlet tee or baffle: n/a How were dimensions determined: 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.): THE LIQUID LEVEL IS OVER THE TEE IN THE TANK.THE TANK IS STRUCTURALLY SOUND. RECOMMEND MAINTAINING SEPTIC SYSTEMS EVERY TWO YEARS. GREASE TRAP: _(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping: n/a Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): n/a 7 Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 89 WHIP O WILL DR HYANNIS 02601 Owner: RICHARD BUREAU Date of Inspection: 1/8/03 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Capacity: n/a gallons Design Flow: n/a gallons/day Alarm present(yes or no): N/A Alarm level: N/A Alarm in working order(yes or no): NO Date of last pumping: n/a Comments(condition of alarm and float switches,etc.): n/a plan) site DISTRIBUTION BOX: _(if present must be opened)(locate on p ) Depth of liquid level above outlet invert: n/a 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.): n/a PUMP CHAMBER: _(locate on site plan) Pumps in working order(yes or no): NO Alarms in working order(yes or no):NO Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): n/a R Page 9 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 89 WHIP O WILL DR HYANNIS 02601 Owner: RICHARD BUREAU Date of Inspection: 1/8/03 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: n/a Type 1000 GAL 6' X 6' leaching pits, number: 1 n/a leaching chambers, number: n/a n/a leaching galleries, number: n/a n/a leaching trenches, number, length: n/a n/a leaching fields, number: n/a n/a overflow cesspool, number: n/a n/a innovative/alternative system Type/name of technology: n/a Comments(note condition of soil, signs of hydraulic failure, level of ponding,damp soil, condition of vegetation,etc.): THE LEACH PIT IS PAST THE EFFECTIVE DEPTH OF LEACHING. AT THE TIME OF THE INSPECTION THE PIT WAS PONDING AND IN HYDRAULIC FAILURE. CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: n/a Depth—top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer: n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater inflow(yes or no): NO Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.): n/a PRIVY: (locate on site plan) Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.): n/a A Page 10 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 89 WHIP O WILL, DR HYANNIS 02601 Owner: RICHARD BUREAU Date of Inspection: 1/8/03 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch or 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. in f Wage I I of I I • �r OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 89 WHIP O WILL DR HYANNIS 02601 Owner: RICHARD BUREAU Date of Inspection: 1/8/03 SITE EXAM Slope Surface water Check cellar Shallow wells I stimated depth to ground water 10+feet Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record- If checked,date of design plan reviewed: n/a YES Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a NO Checki:d with local excavators, installers-(attach documentation) NO Acces.:ed USGS database-explain: n/a You must describt: how you established the high ground water elevation: GROUNDWATER WAS DETERMINED BY HAND AUGER- 10' NO WATER ENCOUNTERED. ' I FLOW PROFILE y TOP OF FOIJPDATION RAISE COVERS TO WITHIN EL - 4120 6 in OF FINAL GRADE -RAISE ONE COVER ON GALLERY ��Q�V 2- LAYER OF 1/8- D-BOX 1/2" STONE �3' DROP FLOW LINE 3/4"-I I/4" 10' & ' 14 STONE 48' GAS--" PRECAST� DRYWELL BAFFLE 37.35 6 in BOTTOM OF 38.45 STONE \.37J, LEACHING SOIL ABSORPTION BASE SYSTEM 37.60r 6 1n STONE BASE 37.30 37.00 GALLERY 1500 GALLON (END VIEW) 3s.00 s.00 r�+ l I r' SEPTIC TANK rr CI 3.5 r► b) IS_5 r► V ESTIMATED SEASONAL HOH OROUNDWATER m � o m 85.00 ftw . w - _ . v J =� I w � 13 m o EXIS TING WA o m � N< z `� BEDROOM 4 D Z N Z > -n AWE < N ca z Dom„ n LLING -� m o 0 TOP F/v o m m a N" 3ZO EL - 420 +_ m D Z y o y K) Tl 3 -+O -0Ln m o . 3 N)__4 _ —� w o> m z u't°m z '�. o i m o � _ 78,55 fr m , --- 3 m — — TRAVELLED WAY Z x WHIP o WIL >z o L DRIVE 0 , z z , C _ rm 00 _ � Q) =z>N m W co n m 4�> '� X m o � �� -� n _ '� � m o mom, w �o , c11?9 yA Ay Z pv Z �_y X ny�r mv o � 70 � — o � 0 9W? m fTl _ 8T z$ iv 0) m z Lo< z y�9 0 v y O r v m _ �cM> I C z Z ► O O (. o p -4 = y o � 3 m m _ WHIP O WILL DR o 3 24 3 m z C r 3 n o > x Z�p m m 9 z N (,Z� (� m PITCNERS WA y y -t vvrn� NLn 0) r- D C z m 3 SOIL TEST LOG DESIGN CALCULATIONS # DATE OF TEST: MARCH 10. 2003 SOIL EVALUATOR: DAVID D. COUGHANOWR. IRS DESIGN FLOW: 3 BEDROOMS X 110 GPD - 330 GPD WITNESSED BY: WITNESS REQUIREMENT WAIVED - NO VARIANCES REQUIRED $ SEPTIC TANK: 330 GPD X 2 DAYS - 660 GALLONS NO GROUNDWATER ENCOUNTERED TEST PIT I PARENT MATERIAL: PROGLACIAL OUTWASH INSTALL 1500 GALLON SEPTIC TANK (MINIMUM ALLOWED) ELEVATION - 40.40 ;- PERC AT 62 in : 2 MIN/INCH IN C SOILS DISTRIBUTION BOX: USE 3 OUTLET D-BOX. DEPTH SOL USDA SOL SOL COLOR SOIL OTHER SOIL ABSORBTION SYSTEM: A 29 ft x 10 ft x 2 ft •LEACHING GALLERY CAN LEACH (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING Abot - ( 29 x 10 ) - 290 sf 0-9 Ap SANDY LOAM 10 YR 3/3 NONE FRIABLE A s d w - ( 29 - 29 10 • 10 ) x 2 - 15 6 s f Atot - 446 sf 9-38 Bw LOAMY SAND 10 YR 5/6 NONE FRIABLE V t 0,74 x 446 - 330.04 G P D 38-144 C MEDIUM SAND 10 YR 6/4 NONE LOOSE. 5i STONES USE A 29 ft x 10 ft x 2 ft GALLERY. Vi - 330.04 GPD > 330 GPD REQUIRED GROUNDWATER _ ADJUSTMENT LEACHING GALLERY EXISTING GROUNDWATER LEVEL BASED ON BARNSTABLE GIS DEPARTMENT RECORDS CONSTRUCTION DETAIL OBSERVED GW: 10.0 INDEX WELL: MIW-29 DRYWELL UNIT STONE ZONE: C 8'-6'x 4'-10'x 2'-9' READING: FEB 2003 2 t, EFF, DEPTH LEVEL: 7.4 29.0 ft ADJUSTMENT: 2.3 fi \ ADJUSTED GW: 18.3 N � O N 0 � a�E S o � o 1) GARBAGE- GRINDER NOT ALLOWED WITH THIS DESIGN C'4 2) ALL LINES 'TO BE SCH 40 PVC AND PITCH AT 1/8 INCH PER FOOT MINIMUM. 4 ft 8.5 4 ft 8.5' 4 ft 3) ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM REQUIREMENTS 29.0 ft NOT TO OF MASSACHUSETTS TITLE 5 SEPTIC CODE (310 CMR 15) SCALE 4) INSTALLER TO VERIFY LOCATIONS OF ALL UNDERGROUND UTILITIES BEFORE EXCAVATING FOR SYSTEM. 5) EXISTING CESSPOOLS TO BE PUMPED. COLLAPSED, AND FILLED, OR REMOVED 6) ALL STONE TO BE DOUBLE WASHED AND FREE OF IRON, FINES AND DUST IN PLACE 7) LINES EXITING D-BOX TO RUN LEVEL FOR 2'-0' BEFORE PITCHING DOWN 8) ECO-TECH ENVIRONMENTAL RECOMMENDS THE INSTALLATION OF LOW FLOW FIXTURES SEWAGE DISPOSAL SYSTEM PLAN AND APPLIANCES. AND BIANNUAL PUMPING OF THE SEPTIC TANK 9) SYSTEM IS NOT DESIGNED TO WITHSTAND VEHICULAR LOADING. DO NOT TO SERVE EXISTING DWELLING PARK OR DRIVE VEHICLES OVER SEPTIC SYSTEM. 10) INSTALLER TO OBTAIN DISPOSAL WORKS PERMIT BEFORE STARTING WORK. RICHARD & JENNIFER BUREAU 11) SEPTIC TANKS SHALL BE INSTALLED LEVEL AND TRUE TO GRADE ON A LEVEL a 89 WHIP-0-WILL DRIVE HYANNIS. MA STABLE BASE THAT HAS BEEN MECHANICALLY COMPACTED AND ON TO WHICH SIX INCHES OF CRUSHED STONE HAS BEEN PLACED TO MINIMIZE UNEVEN SETTLING ECO-TECH ENVIRONMENTAL 43 TRIANGLE CIRCLE SANDWICH MA 02563 ETE-1365 I APRIL 7. 2003 2/2