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HomeMy WebLinkAbout0176 DROMOLAND LANE - Health 176 DRONOLAND LANE, BARNSMPLE A= 335-08Z 0 � o V c O 6 o Commonwealth of Massachusetts At Title 5 Official Inspection Form y Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 176 Dromoland Lane, Cummaquid • * �'1 - 33S'- n-8�- Property Address f _ Nancy.Bethune c/o Karen Weston Hanesian POA Owner Owner's Name information is 700 Attucks Lane Suite 1C Hyannis MA .� required for every � 02601 Y ; April 22, 2014 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. " a Important:When filling out forms A. General Information on the computer, use only the tab 1. Inspector: 5V key to move your ..` °',. . . cursor-do not Troy Williams y use the return Name of Inspector key. Troy Williams Septic Inspections' �-�► Company Name 19 Hummel Drive Company Address y ~ • ' •'i � South Dennis MA ,;- "; 02660 Cltyrrown State Zip Code (508)385- 1300 S1682 Telephone Number s' _ License Number B. Certification y . 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 pursuanjRq Sectiorij,6 346f . Title 5(310 CMR 16.000).The system:' 3 :-0= 1 ® Passes { 0 Conditionally Passes ", El° dils ❑,Needs Further Evaluation by the Local Approving Authority " S April 22, 2014 ` n ' Inspector's Signatur 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., ""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. E � t5ins•3/13 Title 5 Official Inspecti Fo Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments yr� 176 Dromoland Lane, Cummaguid Property Address Nancy Bethune c/o Karen Weston Hanesian POA Owner Owner's Name information is 700 Mucks Lane Suite 1C Hyannis MA 02601 A nl 22 2014 required for every y p + page. Cityrrown 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: System meets minimum standards set by Massachusetts DEP at the time of inspection only.This inspection is not a guarantee or warranty on the future working conditions of leaching, pipes, components or the future structural integrity of said components and only represents conditions found at the time of inspection only. 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): t5ins-3113 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 2 of 17 t Commonwealth of Massachusetts Title 5 Official Inspection Form. Subsurface Sewage Disposal System Form-Not for Voluntary Assessments '< 176 Dromoland Lane, Cummaquid _- Property Address Nancy Bethune c/o Karen.Weston Hanesian POA Owner Owner's Name information is 700 Attucks Lane Suite 1C Hyannis * MA 02601 t required for every - � April 22, 2014 • page. Cityrrown 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): Ell-.„ + broken pipe(s)are replaced 0 Y ❑ N 0-ND (Explain below): ' ❑ obstruction is removed " ❑ Y '❑ N ❑- ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y. ❑ N` ❑ ND(Explainbelow): ❑ 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 .Y ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 4. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 176 Dromoland Lane, Cummaquid Property Address Nancy Bethune c/o Karen Weston Hanesian POA" Owner Owner's Name information is required for every 700 Attucks Lane Suite 1C, Hyannis MA 02601 April 22, 2014 page. Cityrrown 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 El ® Liquid depth in.cesspool is less than 6" below invert or available volume is less than %day flow t5ins-3113 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 . 176 Dromoland Lane, Cummaquid 7 . Property Address Nancy Bethune c/o Karen Weston Hanesian POA Owner Owner's Name ' information is 700 Mucks Lane Suite 1C, Hyannis MA 02601 #. -April 22, 2014t required for every n ' page. CltylTown State Zip Code Date of Inspection B. Certification (cont.j - 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. L s ❑ ® 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 50feet 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.Alcopy 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-. a 10,000gpd: The system fails.I have determined'tliat 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 tnecessary 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 16,000 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 El El ',-the system is within 400 feet of a surface•drinking water supply _ E] El 'the system is within 200 feet of a tributary to a surface drinking water supply ❑' 0 the system is located in a nitrogen sensitive area(Interim Wellhead Protection t 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. w t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts Title 5 officiadl Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments "t 176 Dromoland Lane, Cummaquid Property Address Nancy Bethune c/o Karen Weston Hanesian POA Owner Owner's Name information is 700 Attucks Lane Suite 1C Hyannis MA 02601 April 22 required for every Y p �il , 2014 page. Cityfrown 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? N ❑ 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 t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 6 of 17 t Commonwealth of Massachusetts Title 5 official inspection Form' 't Subsurface Sewage Disposal System Form-Not for Voluntary.Assessments 176 Dromoland Lane, Cummaquid Property Address ` Nancy Bethune c/o Karen Weston Hanesian POA Owner Owner's Name r information is required for every 700 Mucks Lane Suite 1 C, Hyannis r MA 02601 ., __ April 22, 2014 page. Cityrrown r t State '-Zip Code` Date of Inspection D. System Information ; Description: I i Number of current residents: "'° 0 Does residence have a garbage.grinder? ❑ Yes .® No ' Is laundry on a separate sewage system? (Include laundry system inspection [I Yes ® No information in this report.) >_: Laundry system inspected? - ® Yes ❑ No Seasonal use? - f ❑'`Yes ® No Water meter readings, if available last'2 ears usage 13=32,000 gals. 9 ( Y 9 (gpd)) 12=45,000 gals. Detail: Sump pump? C` ❑ 'Yes ® No Last date of occupancy: occasional use Date Commercial/Industrial Flow Conditions: Type of Establishment:' N/A Design flow(based on 310 CMR 15.203): N/A Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft.,'etc.): N/A Grease trap.present? :,;o ❑. 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: N/A t5ins-3/13 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 Y 176 Dromoland Lane, Cummaquid Property Address Nancy Bethune c/o Karen Weston Hanesian POA Owner Owner's Name information is 700 Attucks Lane Suite 1C, Hyannis MA 02601 April 22 2014 required for every p page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: ` N/A Date Other(describe below): N/A General Information Pumping Records: Source of information: No pumping info was available. Was system pumped as part of the inspection? ❑ Yes Z 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•3113 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 176 Dromoland Lane, Cummaguid Property Address Nancy Bethune c/o Karen Weston,Hanesian POA Owner Owner's Name f information is 02601 required for every 700 Attucks Lane Suite 1 C, Hyannis• � p 22, 2014 April " page. Cityfrown MA A State ` Zip Code,. Date of Inspection D. System Information (cont.)_ , Approximate age of all components, date installed (if known)and source of information: Tank, d-box and leaching were installed 66'10/10/95 per compliance. ti Were sewage odors detected.when arriving at the site? > - ❑ Yes ® No Building Sewer(locate on site plan): , Depth below grade: feet Material.of construction: H, ❑ cast iron 040 PVC ❑ other(explain):' Distance from private water supply well or suction line: feet Comments(on conditionof joints, venting, evidence of leakage; .- Lines were found clear at the time of inspection. Septic Tank(locate on site plan): Depth below 9 rade: • .+ 1' • Meet Material.of construction: ®concrete ❑ metal ❑ fiberglass ❑ polyethylene ':' ' ❑other(explain) • ` °r a - < ' If tank is metal, list age: _ r years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No 6'X10.5'X6' 1500 gallon Dimensions: „ • ,t 4„ Sludge depth: F t5ins•3/13 Title 5 Official Inspection Porte:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 176 Dromoland Lane, Cummaquid Property Address Nancy Bethune c/o Karen Weston Hanesian POA Owner Owner's Name information is 700 Attucks Lane Suite 1C Hyannis MA 02601 Aril 22 2014 required for every � y P , 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 2' 8" - Scum thickness thin layer Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? probe/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.): Pvc inlet and outlet tees were found present and in working order. No evidence of leakage or damage was found. Tank was not in need of pumping at this time. Grease Trap(locate on site plan): Depth below grade: N/A feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): 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 Date t5ins-3/13 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 .'l 176 Dromoland Lane, Cummaquid Property Address 4 Nancy Bethune c/o Karen Weston Hanesian POA y - Owner Owner's Name information is 700 Attucks Lane'Suite 1C, Hyannis MA 02601, April 22 2014 required for every p page. Citylrown State Zip Code Date of Inspection D. System Information (cont.), t f.k 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: - N/A Material of construction: ❑ concrete ❑ metal ❑ fiberglass n ❑polyethylene ,❑ other(explain): Dimensions: �J N/A Capacity: N/A gallons Design Flow: N/A , 4 . gallons per day ' Alarm present: ❑ Yes ❑ No Alarm level: N/A Alarm in working order:. ❑ Yes ❑ No N N/A° Date of last pumping:; _ Date ; Comments(condition of alarm and float switches-, etc.): N/A "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-3113 Title 5 Official Inspection Form: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 176 Dromoland Lane, Cummaquid Property Address Nancy Bethune c/o Karen Weston Hanesian POA Owner Owners Name y information is 700 Attucks Lane Suite 1C Hyannis MA 02601 j April 22, 2014 required for every � Y p page. CitylTown State Zip Code t 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 level 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 was found level and in working order with equal distribution to outlet lines. No evidence of solid carry-over or backu in the past was found rY p p u d at the time of Inspection. I Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* I Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): N/A fr } i * 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•3/13 Title 5 Official Inspection Form:Subsurface Sawage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form,` Subsurface Sewage Disposal System Form-Not for Voluntary Assessments . 176 Dromoland Lane Cummaquid Property Address Nancy Bethune c/o Karen Weston Hanesian POA Owner Owner's Name information is 700 Attucks Lane Suite 1C, Hyannis MA 02601- April 22, 2014 required for every Zip Code Date of Inspection page. City/Town State `, D. System Information (cont.),,, °. t Type. ❑ leaching pits number: : ® sers leaching chambers number: 3 with 4flow'fustone . with 4'of stone ❑ leaching galleries 1 number: 32'X 12'X 2' - ❑ leaching trenches number, length: 112"stone under) ❑ ' 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.): ' Soil was sandy. Flows were dry on inspection. Checked stone and found dry and clean. No evidence of hydraulic failure or problems in the past were found at the time of inspection. Cesspools'(cesspool must be pumped as part of inspection)a(locate'on siteplan): Number and configuration - N/A Depth—top of liquid to inlet invert t N/A - Depth of solids layer N/A Depth of scum layer N/A N ti Dimensions of cesspool N/A N/A Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 176 Dromoland Lane, Cummaguid Property Address Nancy Bethune c/o Karen Weston Hanesian POA Owner Owner's Name information is 700 Attucks Lane Suite 1C, Hyannis MA 02601 April 22 required for every p �il , 2014 page. Cityfrown 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.): 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 15ins-3/13 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- .�' 176 Dromoland Lane, Cummaguid Property Address Nancy Bethune Go Karen Weston Hanesian POA Owner Owner's Name information is 700 Attucks Lane Suite 1C, Hyannis `MA. '' 02601 "April 22 2014 required for every p page. Cityrrown 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 13 K, ❑ O 371 a 60 { t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17° Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ..�'< 176 Dromoland Lane, Cummaquid Property Address Nancy Bethune c/o Karen Weston Hanesian POA Owner Owner's Name information is 700 Attucks Lane Suite 1C, Hyannis MA 02601 April 22 2014 _ required for every P , page. Cityrrown 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: 12.0+ 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: 8/15/95 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) ® Accessed USGS database-explain: AIW 247 Zone B 23.4' 2.7' adjustment You must describe how you established the high ground water elevation: Test hole recorded on plan showed no water found at 12.0'. Hand augered 4' below bottom of leaching with no water found at a depth of 10.5'. Groundwater adjustment at the time of inspection was 27. Bottom of leaching at 6.5'was found not to be located in the high groundwater elevation at the time of inspection. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3113 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 y� 176 Dromoland Lane, Cummaguid Property Address J , Nancy Bethune c/o Karen Weston Hanesian POA Owner Owner's Name ' information is 700 Mucks Lane Suite 1C, Hyannis MA - 02601 Aril 22, 2014 required for every P page. Citylrown State Zip Code Date of Inspection.,, E. Report Completeness Checklist ® Inspection Summary: A,}B,�C, D, or E checked 4 ® 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 `< r 4. < • ' ..< ` ".. J i�x L { � • is � �;-. (, .. .� .. .. - t ,, •A .. . . , 'Ins.[ r • ' J t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 r f. T VN OF BARNSTABLE LOCATION ]' 6 to n SEWAGE# 7W VILLAGE EC�v�/'°)aO�yld �I� ASSESSOR'S MAP&LOT INSTALLER'S NAME&PHONE NO. 736d6 /6-h5 SEPTIC TANK CAPACITY Ili© :7:.w 5 LEACHING FACILITY: (type)lfd' O�'�Ulcr-S (size) 'Z. Z X Z NO.OF BEDROOMS BUILDER OR OWNER Ae,< iz�, PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 2�' 2 �� � �� , � � a �. i .� .�. ASSESSORSMAPNa for N01 � PARRCELIdO' a,�= 4 FRic `. J THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Di�5pmiul Murky Tontitrnrtinn Frrmit Application is hereby made for a Permit to Construct (te S or Repair ( ) an Individual Sewage Disposal System at: --L4*?v Cs� r Location-:\ddress or.Lot No.......... ................. .. . .. ----- -�j#-� ---- •-•---------• ��! �'f/�/� Owner - - .....••--- Address �7J jiY'Qt �S o'*i Installer - Address UType of Building Size Lot_�.g�l.._..__..Sq. feet Dwelling—No. of Bedrooms.____-_-_-_�___________________________Expansion Attic ( ) Garbage Grinder ( ) a Other—Type of Building _ _________________________ No. of persons-------- .------------------- Showers ( ) — Cafeteria ( ) d Other fixtures W Design Flow._._.___.__S-�r______ __________________gallons per person per day. Total daily flow_.__:___._.3-��.........__...,......gallons. 9 Septic Tank—Liquid capacity/sd_galIons Length_/®_w-`_�._ Width-'.`_-_�0 f�___ Diameter.---_-___._.•._- DeQth.S'.6" Disposal Trench—No. .......�_......... Width------ Total Length....-3Z_.______ Total leaching area....._..___.P....sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) `-' Percolation Test Results Performed by....s7&7S0Ae __./0- 11 --/ny, -_-_ ._��5-4� r --------------- ..a Test Pit No. 1.... __z---minutes per inch Depth of Test Pit-_ �_-`-�.--- Depth to ground water__________________•__..- (4 Test Pit No. 2...4%.z____minutes per inch Depth of Test Pit Depth to ground water------__ ____________ _ Ix ........-•------------------- ---•--------•------•-•----•---...._.......---••--•----......-•-•-----------------•---------------••-•-----•.........----...... O Description of Soil_...a��--�N s !a`�[ �'' '`7_._..-G i�-3S" o�/Lo - 3S"-45'" _1ye-alv, ... c -- --- U ......... -••-•-..._..--••----------•-----•-•------....-•-----•--•--------•------•...................................•-- W U Nature of Repairs or Alterations=Answer when applicable._.__-............................:............................................................. --------•------------------•----------------------------------------...-----------------------------•--•--......._. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code-The undersigned further agrees not to place the system in operation until a Certificate of Compliance as en . ed the and of health. Signed .... ............. ------------------------------------------------------------- ------- ---------------------------- Application.Approved By .... ' --- -...... �..__..... '"-� '"_ -- --- -- Dace Application.Disapproved for the following rearons- -------------------------------------- ........... ......... ............ ........ .......... ......_..... ................_............ .. .......... ........ .... . .. .............. ..._ ------------------..-.----------- -- --------------------------------------...- ----------------------------------- �.+ Permit No. _ Issued Dace THE COMMONWEALTH OF MASSACHUSETTS - BOARD OF ,HEALTH TOWN OF BARNSTABLE Apphrativtt for DiripuBal Worl,w Tomitrurtton Vautit d;- r Application is hereby made for a Permit-to Construct (kj or Repair ( ) an Individual Sewage Disposal System at: 0 L4ivN C��iti►.� 7- ...1.. aa�.aea Location- / ry or Lot No ». .. ..--• -•----•• Owner Address ,�/ ---------------•- Installer Address Type of Building Size Lot_ _ ` .. Sq. feet R'I g ------------ p• ( ) Garbage Grinder ( ) U Dwelling No. of Bedrooms--_________- Expansion Attic aOther—Type of Building ------------`____-_-_____- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) 0.1 Other fixtures -------------------------------- . d ------ ---------------•----•--------•----•••--•----------•--•-•--•-- W Design Flow------------- _______________________gallons.per person per day. Total daily flow............3_Tt?...............------gallons. OG Septic Tank—Liquid capacity AF_ P_galIons Length__�q_f Width: 'Q`'_ Diameter----.----------- De th_"O"-. W Disposal Trench—No- --------Z--------- Width.___.� ':___-_ Total Length_-_. - -____ Total leaching area..... ��....sq. ft. x 3 Seepage Pit No.................. Diameter____________________ Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) . Dosing tank ( ) - '—' Percolation Test Results Performed by s S�____.� y -G-- S�-•-•- Date__�� Test Pit No. I.... '_._minutes per inch Depth of Test ----- Depth to ground water---------------- 44 s Test Pit No. 2... :.7-___minutesper inch Depth of Test Pit---/!��....... Depth to ground water... °'"_ ...... 4�� RV.. X. _ H S+ o � O Description of Soil..... � G..��" 3 4-A,,0�'4. '= ��" �j : W "----------•--------------"--•------____----__••••-------••-•--...__•-•_..._. U Nature of Repairs or Alterations Answer when applicable------------------------------------------------------------------------------------------------ ........................................................................................................................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the Y system in operation until a Certificate of Compliance as -en s ed the hard of health. P e - Signed ---------------------------------------------------------------�.-------- ------------ ...................--------------------- -_ ---------------------- Application,Approved BY -- � -i- ��" Date Application.Disapproved for the following seasons: -------------------------------------------------------------- -----------------------.----------------------------------- - - --------------------------- ---------------------------- -------- ' Date Permit No. d..�C.-------------- Issued ------ --- -------------fin-- --------------------- ----- Dare THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE C�Er#ifi Cate of Gria li zixiCP THIS IS TO CE FY, the div al Sewage Disposal System constructed ( or Repaired ( ) by - - - p ...-�'�..- ------------------------------------------------; Insrdler at .....I . /t ¢ !/' -----�v (�'�' - b. Cl!f`� _ �!<- ��.. -------_--------------_ ......... - - has been installed in accordance with the provisions of TITLE5 of The Statevironmental Code as esfcribgd_in the application for Disposal Works Construction Permit No. ------ dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE--------------------------------...�. ':..l..t')...... ----- ... ------ Inspector -j.. 1.-.:...,a . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No................. - ` FEEL.................• Raposal Permission is hereby granted...... ............................................................................................... to Construct r Repair ( , ) an In vidu Sewa e Dispo� System y gal � at No. `f�_.. �.,At ' _-..�� °Q---.----G•-lj, Ir, ��� ------•--•-----••--•-•.............. Street �! / as shown on the application for Disposal Works Construction Permit N,P?_""�✓����Dated../__'�-- �.'�-��_:._____..__ •-- �DATE...................... f2 _ Board of Health................ ................................. y FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS 4. APPLICI�T*1014 'FOR' A .LOCATION JNO VILLAGE D A.T E I APPLICANT FEE'xz-e- -k-- 'y (Non-refundab: g7 ADDRESS r o-iA C i > TELEPHONE NO. : ENGINEER A>. TELEPHONE DATE SCHEDULED ej?,C (Applicant' s signature) . . . . . . . . . . . . . X*SU�961A-�*M'D & LOT NO: 33S 8 Z SOIL LOG SUB-DIVISION NAME /i- DATE A,,C TIME /&:e,&4L, EXPANSION AREA: YES NO ENGINEER TOWN WATER &,,-PRIVATE WELL BOARD OF HE A' 42-as,-- Co. EXCAVATOR SKETCH: (Street name, etc- ,dimensions of :Lot, exact location of test holes and--.— percolation tests, locate wetlands in proximity to test holes ) NOTES : 9 kA 0 It -2�-�z eWX,-Af&W 7-S' 4vv PERCOLATION RATE: TEST HOLE,,NO' E TEST HOLE NO:,:? ELEVATION: : %;r0q ,./,O gl �,*#— - , v*Y 2 2 9,Q Y 3 3 A7 7/& .14 /6 yx a14 / -4- JS7 -5 - — - - — C 6 6 J- 71LI 7 9 10 el,:� 10 11 12 A16 13 13 14 14 15 15 16 16 SYPITABLE FOR SUB-SURFACE SEWAGE: LEACHING FIELD 'LEACHING PITS_ LEACHING TRENCHES UNSUITABLE FOR SUB-SURFACE SEWAGE. REASONS : NOTE: ENGINEERING PLANS MUST SHOW NUMBER .ASSIGNED ON, PERC - TEST APPLICATION ORIGINAL: COMPLETED IN ENTIRETY BY P , E, ­-AND RETURNED TO BOARD OF HEALTH COPY: RETAINED BY APPLICANT sr 5v6z-;r- Z sN LOCATION �j,/)2!ti/;STAQGF�C�r>ti�9g?v.P)'. SCALE . .!..: .' .�. . . DATE PLAN REFERENCE .'PG. .G S. . . . . . . . . . . . . ... . . . . . . . . . . - -� 1 / F g8 tiW � r nV 2 �.•�� � ., a`�c, io� ems+ �T�/ S7 , i Ace L7 O -a Ekls OF cLLEY �'L&v 7. p o� �` ; C,�. Gsc. Rio. 26100 EL.. Z c,c' Z. {- TOP OF FOUNDATION r,- .57.$-l-, CONCRETE COVERS 4"CAST IRON rrvr 9� ; ¢j OR SCHEDULE 40 4"SCHEDULE 40 P,V.C, (ONLY) 9' MIN . P,V.C:PIPE MIN. r- Fias7l4ri 36" MAX. PITCH I/4"PER.FT PIPE-MIN. �a8--lcvi LEACHING 'TRENCH (../..REQUIRED) PITCH 1/4 PER.FT. '� �� WASHEDnSTONE ; �-, 4 v'. ItJVERT- � n`h krn �� n'M n � /Z, EL.: //... INVERT DIST. INVERT -f SEPTIC TANK ELs3 S� BOX EL53730 3/4 -11/2 WASHED STONE /Z �., INVEBo /S o ; GAL.. INVERT INVERT EL......�....... FLOWDIFFUSORS INVERT EL.-�1! J EL SS.b( EL. ,r--F • ' 6"CRUSHED STONE REQ. - rVa"/c ., .� PROFI LE OF GROUND WATER TABLE SEWAGE DISPOSAL SYSTEM TYPICAL CROSS SECTION SOIL LOG NO SCALE LEA l CH NG TRENCH DAT•'/) .. . . TIME . ... . . . . . . . . . NO SCALE c ...... ,. •j TEST HOLE I TEST HOLE 2 , ELEV. . ,7:9.?. . . ELEV. :�t45... - DESIGN DATA : ' .: 9."EdiN• WASHED 36 MAX. NUMBER OF BEDROOMS `3 .4 N�r� sa*,ay�,l 6 q �� %a%/on z saroY "yv STDN E CZ. 57.43 co�si —a _ 4 a ' fZ t�, TOTAL ESTIMATED FLOW . . :�:'�� . . .. GALLONS/DAYS AAa2•/Z. SssTroy yeBOTTOM LEACHING AREA . . 3 t� ... SQ.FT./TRENCH ZB¢!LI2o G D.D. o 0 .. . EL.S3:BS 33 Ez,S/,67 . . �7G,a SIDE LEACHING AREA SOFT./TRENCH -,p,p - 3/4°-II/2°WASHED C/ IZ4 Z. STONE. GARBAGE. DISPOSAL ^/dA/4F ..(50% AREA INCREASE). -. . Z /q1/2 7�$ TOTAL LEACHING AREA : ..-���t a..: SO.FT. ¢/ � 4CSS 7l/A�/ Z H/,V SAuD PERCOLATION RATE . . . . ... . . . . . . . ..� PER.INCH �Z iwx�D /o y2 GZ LEACHING AREA PER PERCOLATION RATE .1 .4,! SO.FT/CRD. s4"o /nyr- 8/4- GROU'NO ' WATER TABLE 4J,q,3 /57," n,.�¢,3 APPROVED .. . . . . . . . . . . . .. BOARD OF HEALTH ..WATER ENCOUNTERED DATE ... . . .. . . . . . Iv,o,y s WITNESSED BY . AGENT OR INSPECTOR �t� O�~r at s. Vic\ L✓�/=b �i/�/?JZ'C/ BOARD OF HEALTH ^� P lL ENGINEER EY o . . . . . . �rlde. 26100 Q/STE�� 4 . . PETITIONER { I