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HomeMy WebLinkAbout0100 HAMSTEAD LANE - Health 100 HAMSTEAD LN BARNSTABLE A=349 027 f' "r Y,. 3 . , Y 5 , , , a , r t G c h ':. r `y :l ...Y. � .., v :� ,.. ,f♦,. .. .. � -. .. ':.. is '.� ..Y .J C , , ' n r, i„ r • 1 .a Commonwealth of Massachusetts IQ Title 5 Official Inspection Form N . t Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 100 Hamstead Lane, Cummaguid M 349 P-27 Property Address e1 Donald &Diane Michaels Owner Owner's Name information is required for every 100 Hamstead Lane, Yarmouth Port MA 02675 April 23, 2015 page. Cityrrown State '" Zip Code Date of InspectionME x . i 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. ' ".0 Important:When f A. General Informationr- �� ) onn the out forms computer, use only the tab 1. Inspector: key to move your - c cursor-do not Troy Williams. s use the return Name of Inspector key. Troy Williams Septic Inspections . Company Name 19 Hummel Drive Company Address South Dennis MA 02660 Cityrrown State Zip Code (508)385- 1300 S1682 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes El Fails ❑ Needs Further Evaluation by Local ApprovingAuthority 1 - April 23,2015=° Inspector's Signature A 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 u at that time.This inspection does not address how the system will perform in the fu re unde the same or different conditions of use. i5ins•M3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form t Subsurface Sewage Disposal System Form-Not for Voluntary Assessments °< 100 Hamstead Lane, Cummaguid M-349 P-27 Property Address Donald&Diane Michaels Owner Owner's Name information is required for every 100 Hamstead Lane, Yarmouth Port MA 02675 April 23, 2015 page. Cityrrown State Zip Code Date of Inspedion 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 Form:Subsurface Sewage Disposal System-Page 2 of 17 usetts Commonwealth of Massach IVLM ow Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 100 Hamstead Lane, Cummaquid M-349 P=27 Property Address s n Donald &Diane Michaels 4 Owner Owner's Name information is 100 Hamstead Lane, Yarmouth Port MA 02675 April 23,.2015 required for every 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(cunt.): . ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipes)or due to a broken,settled_.or uneven distribution box. System will pass inspection if(with approval of Board of Health):" _ ❑ broken pipe(s)are replaced ❑ Y ❑ N .❑ ND(Explain below): ❑ obstruction is removed ❑ Y `❑ N' `❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping,more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health:. ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment:., , ❑ - Cesspool or privy is within 50 feet of a surface water El Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 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 100 Hamstead Lane, Cummaquid M-349 P-27 Property Address Donald &Diane Michaels Owner owner's Name information is required for every 100 Hamstead Lane, Yarmouth Port MA 02675 April 23, 2015 page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier,If any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: '*This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow t5ins•W3 Tide 5 official Inspection Forth:Subsurtaoe Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 100 Hamstead Lane, Cummaquid • M-349 P-27 Property Address Donald & Diane Michaels Owner Owner's Name information is 100 Hamstead Lane,Yarmouth Port MA 02675 April 23, 2015 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No Y ❑ ® Required pumping more than 4 times in.the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: El ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ®` Any portion of a cesspool or privy is within 50 feet of a private water supply well., ❑ ® • Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] The system is a cesspool serving a facility with a design flow of 2000gpd- _❑ 10,000gpd. ❑ ® The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure: E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd.to 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.-,. t ; Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped.Zone 11 of a public water supply well . x If you.have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large„ system considered a significant threat under Section E or failed under Section D shall upgrade the System in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional,office of the Department. t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form,-Not for Voluntary Assessments "< 100 Hamstead Lane, Cummaquid M-349 P-27 Property Address Donald &Diane Michaels Owner Owner's Name information is required for every 100 Hamstead Lane, Yarmouth Port MA 02675 April 23, 2015 page. City/Town State Zip Code Date of Inspection. C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments "f 100 Hamstead Lane, Cummaquid M-349 P-27 Property Address Donald &Diane Michaels Owner Owner's Name information is 100 Hamstead Lane, Yarmouth Port MA 02675 April 23 required for every '" AP + 2015 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: h Number of current residents: 2 Does residence have a garbage grinder?. ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonaluse? ® Yes ❑ No Water meter readings, if available last 2 ears usa e d 14=75,000 gals. 9 ( Y 9 (9P )) 13=82,000 gals. Detail: . r ,f ' a - Sump pump? , + ❑ Yes ® No Last date of occupancy: occupied Date Commercial/industrial Flow Conditions: Type of Establishment: N/A Design flow(based on,310 CMR 15.203): N/A • - h - 'Gallons per day(gpd) " Basis of,design flow(seats/persons/sq.ft., etc.): N/A Grease trap present?, ❑ Yes ❑ 'No Industrial waste holding tank present? ❑ Yes ❑• No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: 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 100 Hamstead Lane, Cummaquid M-349 P-27 Property Address Donald&Diane Michaels Owner Owner's Name information is required for every 100 Hamstead Lane, Yarmouth Port MA 02675 April 23, 2015 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: N/ADate Other(describe below): N/A General Information Pumping Records: Source of information: No pumping info available. Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Altemative 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 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments "< 100 Hamstead Lane, Cummaguid M 349 P-27 Property Address Donald &Diane Michaels Owner Owner's Name information is required for every 100 Hamstead Lane, Yarmouth Port MA 02675 April 23,2015 page. Cityrrown 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 on 7/14/99 per compliance. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 181# + ., feet Material of construction: ❑cast iron ®40 PVC ❑ other(explain): a Distance from private water supply well or suction line: feet Comments(on condition of joints, venting,evidence of leakage, etc.): Lines were found clear at the time of inspection. Septic Tank(locate on site plan): Depth below grade: 2'with riser to 6" - 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 Dimensions: 6'X10.5'X6' 1500 gallon Sludge depth: t5ins-3/13 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments °( 100 Hamstead Lane, Cummaquid M-349 P-27 Property Address Donald &Diane Michaels Owner Owner's Name information is required for every 100 Hamstead Lane, Yarmouth Port MA 02675 April 23, 2015 page. City/rovlrrl 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 21811 lot Scum thickness 611 Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 13" 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. Pumping was recommended. Grease Trap(locate on site plan): Depth below grade: ffWt 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 lastpumping: N/A Date t5ins-3113 Title 5 Official Inspedion Fort:Subsurface Sewage Disposal System-Page 10 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments `< 100 Hamstead Lane, Cummaquid M-349 P-27 Property Address Donald &Diane Michaels Owner Owner's Name information is required for every 100 Hamstead Lane, Yarmouth Port MA 02675 April 23, 2015 page. City/Town State Zip Code Date of Inspection - D. System Information (cont.) f 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 ❑ polyethylene ❑other(explain): Dimensions: N/A Capacity: N/A P �' gallons ' f Design Flow: N/A gallons per day + Alarm present: ❑ Yes ❑ No Alarm level: N/A Alarm in working order. ❑ Yes ❑ No Date of last pumping: N/A Date Comments(condition of alarm and float switches, etc.): N/A . 6 *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 f 4 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments "Y 100 Hamstead Lane, Cummaquid M-349 P-27 Property Address Donald & Diane Michaels Owner Owner's Name information is required for every 100 Hamstead Lane, Yarmouth Port MA 02675 April 23, 2015 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 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. No evidence of solid cant'-over or backup in the past was found at the time of inspection. 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.): N/A *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•3113 Title 5 official Inspection Forth:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form . Subsurface Sewage Disposal System Form-Not for Voluntary Assessments y 100 Hamstead Lane, Cummaguid M-349 P-27 Property Address ' Donald &Diane Michaels ' Owner Owner's Name information is 100 Hamstead Lane, Yarmouth Port MA 02675 -April 23, 2015 required for every page. Cityrrown State Zip Code Date of Inspection D.-System Information (cont.) Type: ,.. ❑ Teaching pits number: y 6 infiltrators with ® leaching chambers number: stone r 38'XTX2' ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ' ❑ innovative/alternative system Type/name of technology*' Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Soil was sandy. 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) (locate on site plan): Number and configuration N/A Depth—top of liquid to inlet invert' N/A r N/A Depth.of solids layer N/A Depth of scum layer Dimensions of cesspool 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 ugTitle 5 Official Inspection FormSubsurface Sewage Disposal System Form-Not for Voluntary Assessments 100 Hamstead Lane Cumma uid M-349 P-27 Property Address Donald &Diane Michaels Owner Owner's Name information is required for every 100 Hamstead Lane Yarmouth Port MA 02675 April 23, 2015 /Town C' page. �Y 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. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 100 Hamstead Lane, Cummaquid M-349 P-27 Property Address Donald &Diane Michaels Owner Owner's Name information is 100 Hamstead Lane, Yarmouth Port• MA 02675 April 23, 2015 required for every p page. City/Town 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 _ 3 '(- L z 37,31I f 3c) , t5ins•3113 • 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 y� 100 Hamstead Lane, Cummaquid M-349 P-27 Property Address Donald & Diane Michaels Owner Owner's Name information is 100 Hamstead Lane, Yarmouth Port MA 02675 April 23, 2015 required for every 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: 14.0'+ 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. 11/15/98 Date ® Observed site(abutting property/observation hole within 150 feet of SAS) 0 Checked with local Board-of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: AIW 247 Zone C 23.1' 3.2'adjustment You must describe how you established the high ground water elevation: Test hole recorded on plan showed no water found at 14.0'. Hand augered 4 below bottom of leaching with no water found at a depth of 10.0'. Groundwater adjustment at the time of inspection was 3.2'. Bottom of leaching at 6.0'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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts ugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 100 Hamstead Lane, Cummaguid M-349 P-27 Property Address Donald &Diane Michaels Owner Owner's Name information is 100 Hamstead Lane,Yarmouth Port MA 02675 April 23, 2015 required for every page. City/Town State Zip Code . Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file F r t5ins•3113 Tide 5 Official Inspection Foam:Subsurface Sewage Disposal System•Page 17 of.17 T1D� 0 TOWN OF BARNSTABLE 0 LOCATION L��'# 63 f"S}ecc,J I-N. SEWAGE # ®7 vFLLAG CQ<n .ASSESSOR'S MAP & LOT ' INSTALLER'S NAME&PHONE NO. 'C-C-'-V©5-5c. SEPTIC TANK CAPAC= , l LEACHING FACILITY: (type) ® f f I kr4J�t�!; (size) X s NO.OF BEDROOMS -3 ".. IL o el BUII.DER QR OWNER �� T PERMITDATE: 6 11- Q COMPLIANCE DATE:-- Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any,wells exist ~' on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching_ Facility(If any wetlands exist within 300 feet of leaching facility) a Feet Furnished by "•f p t 16 4 13 �7. a► F On)F t " � � ',• err r No. ' .y Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01ppliCotton for Migpo al *pgtem Con.5truction Permit Application for a Permit to Construct Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No �(o�' /(p.3 An7STiAO ,[�/ Owner's Name,Addre d el.No. SD � q'te/ po�►�crr. a(✓e lM c�')ae1S Assessor's Map/Parcel ~"r i4°ecr.a W141 a 706 i ��e 4"12 ,d- p Installer's Name Address,and Te.No. SO$ Sc1O `1 Designer's Name,Address and Tel.No. sOSBtPP l�as v�, p �o&&z _4A .��ECinNe�l.� l ve—. 57 etl^e✓ rve_, Al yo 7S Type of Building: Dwelling No.of Bedrooms Lot Size &Y 714— sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3�y gallons per day. Calculated daily flow 3�► 5� gallons. Plan Date 3/r-7/? T Number of sheets ( Revision Date Title S i Size of Septic Tank /S—v o Type of S.A.S. .ZX',4ez.,A r1Zg^tea OG /tilA,Ar ,erj Description of Soil ✓�fk��—/t.� Nature of Repairs or Alterations(Answer when applicable) 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 issuedj�yythis Bgp�o of H alth. — l n— Signed ` c Date d Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued 9p- THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE,, MASSACHUSETTS Application for Migoaf *p!gtem Construction Permit Application for a Permit to Construct(�)Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No �!D�^ /(03 /`1A�ST,�/L� �� Owner's Name,Address aid el.No. 5aY5 Fo✓l�(vl �t f�!Cfv'J MIc 6aek7 Asse`ssor'sMap/Parcel — I M `]Olti✓i Lu✓1e 2 s`76 0 �44. Installer's Name .Address,and Te No. SOS Designer's Name,Address and Tel.No. 'SO�PPI' 140,vko 2s7 Pct�iMPv 4ve. �dklci l�� .�.vC,—„��r;,�i.4/c, /niU. Type of Building: ' Dwelling No.of Bedrooms' Lot Size !o sf -/T sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures VV04 µ Design Flow 3 v gallons per day. Calculated daily flow\ gallons. Plan Date 3/i -7/ i Number of sheets / Revision Date Title S i r2 7 5i�, �, - 157A of G 7 /c.3 i 1�h��,S �� � G, Size of Septic Tank /57v o Type of S.A.S. Description of Soil ' Natue of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: I t The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued.,this B of H alth. Signed ��.: 1k Date d / is .4 K Application Approved by Date Application Disapproved for the following reasons Permit No. d Date Issued 1� v ——— ———————— — —— — —-— — ———_ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed(;l )Repaired( )Upgraded( ) Abandoned( )by 1QSP� Mrtvve at /00 14„4ASTe Cal)f_ CuW,M Olu id has been construct in accordance with the provisions of Title 5 and the for Disposal System Construction Permit NY '`� 40 dated "} . Installer '3Os 6 tea✓yeyL, Designer Down Pak i Ah The issuance of this permit s r4not b�e-c- strued as a guarantee that the st 11 function as desigd.Date lrl f i Inspector � 'I� 4� IU�Al , 11 f I v t / — ---------------------------- No. Fee -/ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE,, MASSACHUSETTS igoar *pmem Con!truction Permit Permission is hereby granted to Con truct( f Re air( Upgrade( )Abando ( ) �..,. -7 System located at sw ,�! _ , ' 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 in be om le ed 'thin three years of the date of th' et�t. C �f G.- Date: Approved by i TOWN OF BARNSTABLE I' LOCATION Loft �63 5 i'ccj L,N 3 7 SEWAGE It 0 VII.LAGE�C1-Jn'1 c,cy; ►�rn S�l& ASSESSOR'S MAP &LOT INSTALLER'S NAME&PHONE NO. '��OSS C' �;•, - ��3�j3 SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) a X 6 •s NO.OF BEDROOMS B UILDER OR OWNER eS PERMUDATE: 6— IT- COMPLIANCE DATE: I t 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 (V 0J74 r he b � n « 1. c '.l l a _ 3` x + Y v a SEPTIC PROFILE TEST -HOLE LOGS T.O.F. AT EL. 87.0` ACCESS COVER TO WITHIN 6" OF FIN. GRADE (NOT TO SCALE) ACCESS COVER (WATERTIGHT) TO » D.A. OJALA, SE, PLS ENGINEER. MINIMUM ,75' OF COVER OVER PRECAST 1MtTHIN 6" OF nN, GRADE JERRY DUNNING 83.0' 2% SLOPE REQUIRED OVER SYSTEM 83 0' WITNESS: • _ RUN PIPE LEVEL 2" DOUBLE WASHED PEASTOtJE DATE: OCT. 15, 1998 I �► 83 0 1500 -FOR FIRST 2' ,/ < 2 MIN/INCH TH2 AND TH,3 PROPOSED ERC. RATE _ . GALLON SEPTIC - _ % 3' MAX.MAX 81. 80.75 CLASS I SOILS P# 9261 ` TANK (H- 1O ) - �`S I `79.6' BAFFLE 79, o000 MIN. 0 79.5' - G r - ATE G ( 2 R SLOPE) V`6" CRUSHED STONE OR MECHANICAL t ' COMPACTION (15.221 [21) DEPTH OF FLOW = 6 J ( ' SLOPE) ac� TEE SIZES: , $ g ohs$ 14., o" oo80 00 77.5' INLET DEPTH - 10" - ' OUTLET DEPTH = 14 3/4" TO 1 1/2" DOUBLE WASHED STONE Q ELEV. Q ELEV. Q Q � 84.0' Q 8� 1' � 83.0 LOCATION MAP SCALE 1" o s . 2 2" C 2„ 0 £�FcTR�C 2 5YS� 1 E YL7 E LS ASSESSORS MAP 349 PARCEL 27 `\ CO �" / 4" 2 5 /1 4„ 2.5Y 7/1 ZONING DISTRICT: RF--1 t YARD SETBACKS: SL LS LS B B 10YR 5/6 10YR 5 6 10YR 5 6 FRONT = 30' 36' 81.0' 36' / 80.1' 36" / 80.0' Cl Cl F Cl SIDE = 15' , \\ LOT 163 FIRM SL Pe48 LS pe2 Ls rc REAR = 15' FIRM PLAN REF, - BARN. PL. BD. APPROVAL 1969 I I 64,715 s.f. 96„ I OYR 6/4 2.5Y' 6/6 FIRM 25Y 6/6 I I (1.49 OC.) 108" 20% COBBLES 108" 20% COBBLES FLOOD ZONE: C C2 C2 C2 LS I 25Y 6/6 I + LS FIRM LS FIRM 2.5Y 6j6 25Y 6/6 ( \ \ \ \ 90�c j �; 168" � 70 0' 156" 70.1' 168" 69.0' NO WATER E N C 0 U N T E R E D NOTES: SEPTIC DESIGN: (GARBAGE DISPOSER Is NOT ALLOWED ) 1 . DATUM IS ASSUMED - / PD) GPD 2. P.gIJN!C!PA.L WATER tC AVAILABLE F`JVd: CEDROOMS / 11Q r 330 USE A 330 GPD DESIGN FLOW 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT, SEPTIC TANK: 330 2 10 GPD ( _ _ ) = 660 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO H- 5. PIPE JOINTS TO BE MADE WATERTIGHT. USE A 500 GALLON SEPTIC TANK 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS. qF \ LEACHIN(t . ENVIRONMENTAL CODE TITLE V. _ - ._(38.5 + 7) 2 (,74) 134,7 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO BE USED FOR LOT LINE STAKING. 38.5_x 7 74 - 199.4 _ y _ BOTTOM,. ---�---� 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40--4" PVC. TH2 1 / i '/; -�- - =- T0T,4L: 451i S F 3�34 VG�,� 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT / i 86 5 `xl �» , l I F HIGH P INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED /8 - _ USE � CA ACIT( INFILTRATORS WITH " AT SIDES o' / '� STH3 / �� / / _ - FROM BOARD OF HEALTH. 0.5' AT END: AND 14" UNDER ca GAR l I °° ( CP SLABy DECK " LEGEND SITE' AND SEWAGE PLAN L100.0 PROPOSED SPOT ELEVATION OF -$� PROP. 3 BR I / L(�T 163 HAMSTER AN - / / DWELLING /� f / / 100x0 EXISTING SPOT ELEVATION -LANE - 00 r // IN THE TOWN OF: I 86 � TF = 87.0' �r / /� 100 PROPOSED CONTOUR � q' I ► , G ( CUMMAQUID) BARNSTABLE 42' %s. / / -- - 100 -- - EXISTING CONTOUR PREPARED FOR: HAMILTON HOMES 30 0 30 60 90 v / L= 14 7 69 1 ` ` _ BOARD OF HEALTH MA SCALE: 1 = 30' DATE: MARCH 17, 1999 APPROVED DATE cbUTIL. -� 1 off 5M-382-4541 CLUSTER `� \ L=31 _06 ; I/�/ / �0�� 88- -- (ox 508 362-98E0 D �� \��\ ` �s1- - down cape engineering, lnc. t� � x .0 \ \� ` \ \ _92✓ CIVIL ENGINEERS AMOK `ta oI BENCHMARK - HYDRANT LAND SURVEYORS ON TAG BOLT #155 � ' 98--�383 � � � 939 main st. yarmou'th, ma O2,475 --�. -- . � �, ~' -ELEV. 88.9' 71 .1"E