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HomeMy WebLinkAbout0373 AMES WAY - Health 373 Ames Way �Centerville F/R A = 170 224 OD ford, -NO. 152 1/3 ORA '`= J 1 0% = rw 3 O a a � ; �\ h t :e .� r } } 60,No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes ' PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 7ZIpplication for Mi!6paal *p6tem Construction Permit Application for a Permit to Construct( . )Repair( )Upgrade(Y/)Abandon( ) El Complete System "dividual Components Location Address or Lot No. Owner' ,Vame,Address and Tel.No. Assessor's Map/Parcel cell ` (�/��I 1/ /11, Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms 3 Lot Size ft. Garbage Grinder( � Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow 3-30 gallons. Plan Date Number of sheets �/ Revision Date Title S & �� 3 7 3Fi?il e6tJC� Size of Septic Tank ® Pel , %lr Type of S.A.S. Description of Soil 21 83X 3®xz_ 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 issu thi B d f Health. Signed _. Date Application Approved by i <71 Date Application Disapproved for the following reasons Permit No. Date Issued r Y _ � F 2 Fee ee � ` ✓✓✓ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes ``� PLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 1704;pplication for Migoal 6pgtem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade(v)Abandon( ) ❑Complete System VIIndividual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 3: 3 yes _4y Assessor's Map/Parcel �'Lp� `��//� 'kInstaller's Name,Address,and Tel.No. v _ Designer's Name,Address and Tel.No. Type of Building: Dwelling, No.of Bedrooms - Lot Size /;765 sq.ft. Garbage Grinder Other Type of Building �5 ' /�lG'No.of Persons Showers( ) Cafeteria( ) Other Fixtures / Design Flow / gallons per day. Calculated daily flow gallons. Plan Date Number of sheets ,I Revision Date Title J S%If 2-7,01 /V 7� Size of Septic Tank IMP 0,01 Type of S.A.S. Z Description of Soil x 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 issu th' Board pf Health. �/ /� Signed Date 1 Application Approved by _ Date A0-3 Disapproved for the following reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded(✓ ) Abandoned( )by D f0 I wee at /Y -S 4V,9 I1 1-411 e has been-constructed. in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dd Installer Designer The issuance of this permit shall not be construed as a guarantee that the system Date " 12.- 03 Inspector --- --�� ------------------------- /-- No. o 30 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Migogar *pgtem Construction Permit Permission is hereby granted to Construct( )Repair( )Upgrade(✓)Abandon System located at 7 3 /�/y1`P S LIB �'loi� /�P/IlP 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: Cons `ctiIntust be ompleted within three years of the date of thi t. Date: Approved /1 ) F% � ___� PP bY � T TOWN OF BARNSTABLE LOCATION 373 � SEWAGE #C;*V -� VILLAGE G rr/�`,�;n��r �n ASSESSOR'S MAP& LOT 170—2-2'q INSTALLER'S NAME& PHONE NO. '� SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO. OF BEDROOMS _3 BUILDER OR�!ER fT PERMITDATE: COMPLIANCE DATE: 9 J Z —03 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 C'e�zi �l J 77 TOWN OF BARNSTABLE 1,,OCATION 3 73 SEWAGE #cx'eO'3 VILLAGE Q ASSESSOR'S MAP& LOT 110—22' INSTALLER'S NAME&PHONE NO. .SEPTIC TANK CAPACITY //e- LEACHING FACILITY: (type) 327d e 3 L "IkW4� 6?) (size) �•�r��S ��� 140.OF BEDROOMS 3 BUILDER OR VVNER . PERMTTDATE: ' 7 '/ a COMPLIANCE DATE: �'/2 03 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 �c{uti: GyFt ��yi ass r F yy y AC GAY a 0 COMMONWEALTH OF MASSACHUSETTS �1 I239 EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL P . T>" Z10 RECEIVED MAY 15 2003 TOWN OF BARNSTABLE HEALTH DEPT. TITLE 5 OFFICIAL INSPECTION.FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A *' CERTIFICATION FAILED INSPECTION Property Address: 73 e Owner's Name: Owner's Addr ' . A 01-116 3 D Date of Inspecti n---X7 -�— j, Name of Inspector please.print �`�1, !� l 0�e Company Nam ^ , Mailing Address: �q PARCEL , Z 2 Telephone Number: LOT 2. 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 15.0.00). The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fa' Inspector's Signature: Date: _ tl� The system inspector shall submit a copy of this inspection report to the Approving.Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000. gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the . DEP..The original should be,sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at;.the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/20.00 page I Page 2 of l 1 i 11 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: Owner: Date of spection: Inspection Summary: Check A,B,C,D or E/ALWAYS complete.all of Section D 14 A. �ys�tem Passes: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system, upon completion of the replacement or repair;as approved by the Board of Health,Will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined"please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltratioh or.tank failure is imminent:System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is:removed distribution box is leveled or replaced ND explain: The system required pumping more than'4 times a year due to broken or obstructed.pipe(s).The system will pass'inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed 'ND explain: 2 _ . Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:. >r-1- Owne Date o spection: 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 C.MR 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 surface water supply or tributary to a surface water.supply. The system has a.septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS.and the SAS is.within 50 feet of a private water supply well_ _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a. private water supply well".Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen.is equal to or less than 5 ppm,provided that:no.other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 r Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: A,J710 Owner: APA Date of pection: 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 ✓f Dischare or ponding of effluent to the surface of the ground.or surface waters due to an overloaded or clogged SAS or cesspool V! Static liquid level in the distribution box above outlet invertdue to an overloaded or clogged SAS or cesspool _ Liquid depth in cesspool is less than 6"below invert or available volume is.less than!/z day flow . Required.pumping more than 4 times in the last year NOT due to clogged or obstructed pipes).Number of times pumped _ V Any portion of the SAS,cesspool or privy is below high ground water elevation. �t Any portion of cesspool or privy is within 1'00'feet of a surface water supply or tributary to a surface / water supply. _ V 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,.private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet.from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen,and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 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 dither"yes" or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no _ — the system is within 400 feet of a-surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply _ — the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: AM V Owne Date spection 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? j _ Were all system components,excluding the SAS,located on site ? C 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: Ye�L —o Existing information. For example;a plan at the Board of Health. Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] 5 Page 6.of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: Owner Date o spection o FLOW CONDITIONS RESIDENTIAL .tom Number of bedrooms(design): ?) Number of bedrooms(actual): DESIGN'flow based on 310.CMR 15.203(for example: ITO a x of bedrooms): Number of current residents: _ Does residence have a garbage grinder(yes or nou Is laundry on at separate sewage system(yes or'no�)"[ifyes separate inspection required] Laundry system inspected(yes or n Seasonal use:(yes or no); Water meter readings, i' available(last 2 years usage(gpd)): "VZf©0 `0Z-y��7��0 Sump pump(yes or no . /�� Z��-�` J� •1�� Last date of occupan y: `Z� COMMERCIAL/INDUST.RIAb/% Type of establishment: . Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system(yes or no):_ Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Was system,pumped as part of the inspection(yes or no If yes, volume pumped: gallons--How was quantity pumped determined? Reason for'pumping: TYPE OF SYSTEM OF 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'(d e scribe): Ap rox'yate age of all components,date installed(if known) and source of information: Were sewage odors-detected when arriving at the site(yes or no)v�/1"" 6 Page 7 of l l OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM.INSPECTION FORM` PART C SYSTEM..INFORMATION(continued) Property Address: Owner: Date of pection: Z[' BUILDING SEWER(locate on site plan.)A&Q1 Depth below.grade: Materials of construction:_cast iron _40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC.TAN K. (locate on site plan) Depth below grade: � Material of construction: ✓ concrete_metal_fiberglass_polyethylene _other(explain). If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):—(attach a copy of certificate) _ Dimensions: 90 �.. Sludge depth: [a Distance from top of sludge to bottom of outlet tee.or baffle! 3Z Scum thickness: t_0 _ Distance from top of scum to top of outlet tee or baffle: �— Distance from bottom of scum to bottom of outlet tee or baf e: How were dimensions determined: QQJ}41 o�rj Comments(on pumping recommend tions,Inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, a idence of leak ge,etc.). /nil GREASE TRA%/ locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_fiberglass_polyethylene_other ' (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping:. Comments(on.pumping recommendations,inlet and outlet tee or baffle condition, structural.integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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: T�61AW, Owner: Date of n ection: TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on-site plan) Depth below grade: Material of construction: concrete metal fiberglass_polyethylene other(explain): Dimensions:' Capacity: gallons Design Flow: gallons/day Alarm present(yes or no):. Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches, etc.): DISTRIBUTION BOX: (if present must be opened)(locate on site plan) 5 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 aka-e into or out of box,etc): , PUMP CHAM (locate on site plan) . Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): i Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C. SYSTEM INFORMATION(continued) Prbperty Address: Owner: Date of ection SOIL ABSORPTION SYSTEM (SAS): 610cate on-site plan,excavation not required) If SAS not located explain why: Type,.,- leaching pits,,number: leaching chambers,number: leaching galleries,number: leaching trenches,number, length: leaching fields,number, dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding, damp soil,condition of vegetation, Ott j/`a 40 CESSPOOLS " (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil, signs of hydraulic failure; level of ponding, condition of vegetation, etc.): PRIVY. : locate on site plan) Materials of construction:. Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation; etc.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEMJNSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 7 Ovine Date o n pecti,on: 0,3 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet.Locate where public water supply enters the building. nn 1 o 5d 10 Page l 1 of 11" OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: _4 ?62_L Owner:gec4ticti Date ofeon:�,�ZP�1 3�C� SITE EXAM (/. Slope" Surface water. Check cellar Shallow wells Estimated depth to"ground water f 7 feet Please indicate(check)-all methods used to determine the high.ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed:" Observed site(abutting property/observation hole.within 150 feet of SAS) Checked with local Board of Health-explain: hecked with.local:excavators, installers-(attach documentation) _Accessed USGS database-explain: You must describe how you established the high groundwater elevation: ]1 Permit Number: Date: Completed by- HIGH GROUND-WATER LEVEL COMPUTATION Site Location: 4tla � Lot No. / Owner: ,T(`7e/f/1� �f Address. Contractor: D/'�o%a / ���j`� Address:_ �7 ✓���`1 1�5�/�Y Notes: STEP 1 Measure depth to water'table tonearest 1/10 ft. .....................................................;.......................... .bate 1� . month/day/Year STEP 2 Using Water-Level Range Zone and.lndex Well'Map locate site and determine: 141 OA Appropriate index well...:............ `�� ESL OB Waterdevel range zone ................................. ................... I STEP 3 Using monthly report,."Current Water Resources Conditions" determine current depth s,o . water level.for index well ........... .. ............ ®� � . mont /year STEP 4 Using Table of.Water-Ievel.Adjustments for index well (STEP 2A), current depth to water level for index well (STEP 3), and water-level zone (STEP 28) determine water-level adjustment-................. STEP 5 . Lstimate.depth to high water by subtracting the water- level adjustment (STEP 4) from'measured depth to water levelat site (STEP 1) ...................'.................:.......................................................................... / Figure 13,--Reproducible computation forma . . 't.--�-`. � �� ��`� �.� gin.j - ��` 1 2=J .. A�' �- s � � ' � �_� { f. 8 8 �. a �. ���� g� - ��y�,� • { iN � , �� ` � �=r �`` ` � � � S _ r �"� t ��4 - _ _ � � ��_ i{3t _ � 7�' R . �� ��e�.. 5 I� 3 � - Y j ' � � Y .. 3 0 E..tt �.. � Z. �: .�, � � � . � �� . , �. � y �-r - T �' ' i itT ERR/�^� � .. �� .., j� � r f�1 1 ' � 1 \ SENDER: n I also wish to receive the y Complete items 1 and/or 2 for additional services. d • Complete items 3,and 4a&b. following services (for an extra Gi • Print your name and address on the reverse of this form so that we can fee): > > return this card to you. m • Attach this form to the front of the mailpiece,or on the back if space 1. ❑ Addressees Address N does not permit. •+ • Write"Return Receipt Requested"on the mailpiece below the article number. 2 ❑ Restricted Delivery " The Return Receipt will show to whom the article was delivered and the date c dJlyered. Consult postmaster for fee. 3. Article Addressed to: 4a. Article Number d «. a x 4b. Service Type d E ❑ Registered ❑ Insured 3,7j Certified ❑ COD H W ' ❑ Express Mail ❑ Return Receipt for 5 cc Merchandised 7. Date of Delivery 3 >, 5. Signature (Addressee) 8. Addressees Address(Only if requested Y M and fee is paid) 0 H C cc 6. Signature (Agent) ~ yPS Form 3811, December 1991 *U.S.GPO:1993-352-714 DOMESTIC RETURN RECEIPT 1 i UNITED STATES POSTAL SERVICE Official Business PENALTY FOR PRIVATE USE TO AVOID PAYMENT U.S.MAIL OF POSTAGE,$300 I • I Print your name, address and ZIP Code here 0031th Departmo -7 yawn of Bamstable pC BOX 534 3 j tt /yy "./wt�j�rs (M+assachuseffS 26 III!??II i111111111111111liftI111fitIIIIIIIII1I11l1lil111!1lilt :. Z . 348 636 018 Receipt for Certified Mail ® No Insurance Coverr_ge Provided os.� Do not use for International Mail IDST� (See Reverse) 7 Sentt 0) 1 O. Vd O P .,Star" P Code O ACID ostage $ M Certified Fee / /0 O u- Special Delivery Fee An a - ��str'iEt'ed�D'�IiVef� ee �R'etrSf'n''A c�btt S�idUSi�ig� _I to'Whom&Date Delivered Return Receipt Showing to Who'in. Date,and Addressee's Address TOTAL Posta e &Fees g Postmark or Da r STICK POSTAGE STAMPS TO ARTICLE TO COVER FIRST CLASS POSTAGE, CERTIFIED MAIL FEE,AND CHARGES FOR ANY SELECTED OPTIONAL SERVICES(see front). d 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address f2 leaving the receipt attached and present the article at a post office service window or hand it to your rural carrier(no extra charge). 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the return rn address of the article,date,detach and retain the receipt,and mail the article. rn r L 3. If you want a return receipt,write the certified mail number and your name and address on a return receipt card,Form 3811,and attach it to the front of the article by means of the gummed cis ends if space permits.Otherwise,affix to back of article.Endorse front of article RETURN RECEIPT REQUESTED adjacent to the number. co 4. If you want delivery restricted to the addressee,or to an authorized agent of the addressee, M endorse RESTRICTED DELIVERY on the front of the article. y 0 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt.If u, return receipt is requested,check the applicable blocks in item 1 of Form 3811. a 6. Save this receipt and present it if you make inquiry. 105803.93-8-0218 ' r - i Town of Barnstable • � Department of Health, Safety, and Environmental Services AW Public Health Division i639. � °per& 367 Main Street, Hyannis MA 02601 Office: 508-790-6265 Thomas A McKean FAX: 508-775-3344 Director of Public Health 9/27/95 Frank A. Rounsley 373 Ames Way Centerville, MA 02632 ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE, TITLE 5. The septic system owned by you located at 373 Ames Way, Centerville was inspected on August 14, 1995 by Joseph P. Macomber a Massachusetts licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00)due to the following: • Septic tank is one-half full,leaking at the seams You are directed to hire a licensed Town of Barnstable septic system installer to submit a sketch diagram of a proposed system to the Town of Barnstable Health Division Office (Town Hall, 367 Main Street, Hyannis) that will bring the septic system into compliance with 310 CMR 15.00, The State Environmental Code, Title 5 within (14) fourteen days of receipt of this notice. You are also directed to bring the septic system into compliance within thirty (30) days of receipt of this order letter. You are further directed to maintain the system by hiring a licensed septage hauler to pump the septic system to prevent discharge of sewage or effluent into the buildings, onto the surface of the ground, or in to surface waters. Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health [Installer letter] Sl TO: /1// I O u Al s z,.e� (Date) ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE, TITLE 5. eQ�- ��� -4 The septic system owned by you located at 7. 4flZ esz was inspected on ?— I�-- 9-5—by aMassachusett licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00)due to the following: x You are directed to hire a licensed Town of Barnstable septic system installer to submit a sketch diagram of a proposed system to the Town of Barnstable Health Division Office (Town Hall, 367 main Street, Hyannis) that will bring the septic system into compliance with 310 CMR 15.00, The State Environmental Code, Title 5 within (14) fourteen days of receipt of this notice. You are also directed to bring the septic system into compliance within thirty (30) days of receipt of this order letter. You are further directed to maintain the system by hiring a licensed septage hauler to pump the septic system to prevent discharge of sewage or effluent into the buildings, onto the surface of the ground, or in to surface waters. Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health Town of Barnstable �.::% 3 �r G .ay ��1 :!.,ii r�'` I r i 1+ •+.R 9 a � CG E � ` ' I ! 1 , � pp t- � , �•r i art �f�`* � ��' �" !�� � � G � � � 3''h' Rr !' '� •,l�..a I I r I i 1' _ t I� � 1's` $ .`:a 1' ' a: � Fri 'i i r � .rf _ � �•a � ..� � � i ;�f„�, i ! IJ H � p� � "'I� 1 - ,r, r� !r r. r.i' I 'l; r ;.,� � ��� �� ,II ec� ��Cl�fflce� f �n ���� � � ', ! � � ��� I I ;; l � �, 'r�� a+��I•�;;� �, g I F ,M+, It. �III Ik��tl I.., Id► I'I� (�� ? �V I+ a I I•. Ir � �r � Ilr .I t'� JAI �r2m nt. I yqq � � �. �.� .:. Ir � i I i�, I'� C � �. '��' II�� I 'I 'I! ,I •I. Oi., , o- I�,I;! G., ',i. ` I I�t„ � ttr :'v. ..�r.. p , �I � i ���°� , tI J�l .:• I I III I! I I I I � I I j� I i 1�i L G�' Eli :,i �I }�I I„ G�+rJ, � �1,� ��1 r � F .qq F. F Weld ,t I 1 ®trnmot I�. A 1 i I 1� I�.. j• Ifr I ! ui f +� i� I I p � �I Ij I �II ' li rill tgil�plj ' II � � p,G 1 ��, �'�' ' I r� Bacnrtary.EAEA I I I I I I III , III „ a I�i•'l i tl,li I I i I1 II t j O ki lDavid B.Struha Commis I1I 111 ,I r I SYSTEM INSPORMSL' SUBSURFACE SEWAGE DISPO ; PART A III e. CERTIFICATION 11' G I• -; 3 O Property Address:�j Address of wrier: Date of Inspection. �` / • (if different) i Name of Inspector:C14AR Les WveA2iAY✓t_ Company Name, Address and Tel y�,, Q, ,`hpne Il Sr't'c d trt 7 y., 3_C p - 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 inspection. The inspection was performed based on my training and experience)in Ithe proper function and maintenance of on-site sewage disposal systems. The system: _ asses _ Conditionally Passes I t _ Needs Further,Evaluation By the Local Approving Authority Fails I I � � I Inspector's Signature: " Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(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 Department of Environmental Protection. I I f The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority:. INSPECTION SUMMARY: II I I � r I Check A,B,C,or D: AJ SYSTEM PASSES: tI 1!i I I f I I I � r 1 have not found an information which indicates that the system viol ateslany of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. I 'r 111 81 SYSTEM CONDITIONALLY PASSES: One or more system components need to bed replaced or Iemired. The system, upon completion of the replacement or repair, L I ' passes inspection. E . I�` I � I• I Indicate yes, no, or not determined (Y, N, or NO). Describe basis of determination m ail instances. If"not determined" explain why not) _ The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or e'Alt�ation, or tank failure is imminent. The system will pass inspection if the existing septic tan k.is replaced with a conforming septic tank as approved by the Board of Health. f I (revised 8/15/95) (. j I i ' One Winter Street • Boston,Massachusetts 02108 • FAX(617�'556.1049 • Telophone(61 292-55W Print Id on Recycled Papei I � ._. .opuwuiUNGi t a4Hl9JWY� ..�' ....... r - .»lWnLLw pr..•.r- I ii Y r � I I •'111 Ili .I. ..�., 1. ; I I p 71•L..r + i �,, C ,:M1 ,�� � 'I •I r I 1, I I,, tl ,. 1 .I '4, � Y 'I it � I ,i ��AI -1'�.•i 'a�I '' I 1llk�_ �.i.. � o-. � �;�. '1 T I � I '•I ! � f� I. ,I 1,N I ; i !"�.n ,., j Y � I :1I �, I I III 4• I"''I ,, y� ' I I 1� ', I 11''I I,', I '� . :lil Y �: "j. ,1' ,, i I ..III f I i �.,. I �' t '' I; 'i' ';"il�' 1,1 ;'i�r �Y•, LN411 {�I�:' F. � IC p.' � t �#� �• r �, ' ;Y f.C( I b •C{ tilt) I I I�I I I , I ', ,„ .� , II: .' ,� � a Il I IL I, �,C, I� ;;,F ,,,.,f ,� Is; to TIIA TR CERTIFCl107? fl �A1(Inc Pr ert Address: �,�! 'M'II' InI' „'r•'1�.Owner' 74/V K AO y iii .Il Date of Inspection: 81 SYSTEM CONDITIONALLY PASSES (continued) I I I Sewage backup or breakout or high static water level obsenield in the distribution)box'-,'due' to broken or obstructed —M1 I 'II ' I CI. M1 I, Board of Health):pipell or due to a broken, settled or uneven distribution boxll'The system'will pass) inspection if(with approval of the ,_•_ broken pipe(s) are replaced obstruction is remove d distribution box is levelled or replaced 1 I I i •'i ' ._ The system required pumping more than four 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 i obstruction is removed I i M1 � I , I C) FURTHER EVALUATION IS REQUIRED BY Q THE BOARD OF HEALTH: i • I , Conditions exist which require further evaluation by the Board of Health in failing to protect the order to determine if the syst�m s public health, safety and the environment. ` 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THETENEVIRONMENT:OT FUNCTIONING IN A MANNER Cesspool or privy is within SO feet of a surface water I I u i Cesspool or privy is within SO feet of a bordering vegetated wetland or a salt marsh. � I 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC,WATER SUPPU IK ItI Al G rII I I, ERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE,PUBLIC ENVIRONMENT: HEALTH AND SAFOTY AND�THE .I The system has a septic tank and soil absorption system and is within 100 feet to a surf surface water supply. ace water supply orltributary to,a The system has a septic tank and soil absorption system and is�within a Zone I of a pub�l I I water Supply well I f The system has a septic tank and soil absorption system and is within'SO feer,of a privatel, I I supply',.. r I The system has a septic tank and soil absorption system and isl less than�1100 feet but SO feet or more from a private water I supply well, unless a well water analysis for coliforin bacteria grid volatile organic compounds)indicates that the well`is I II I II V I li I I:IItl tl q free from pollution from that facility and the presence of ammonia nitrogen and'nitiate�nitrog'I is equal to�or less than 5 (I ppm• i I I r l I I' II'I I' D) :SYSTEM FAILS: have determined that the System violates one or more of the�followin failur for this determination is identified below, The Board`of Health should be'co^tactedriterto ia de eefmin�elvih w j t�� e9 rye basis the failure. i I I I _ �Backup of sewage into.facility or system component;due to an overloaded or,do ed E I i I I 8g 5�15 or cesspool II i ._ Discharge a or g 6, cess ool, pondin of effluent to the surface of the ground or surface waters due to ano i verloaded or loggedSAS or pI1 - 'I � a i ' (revised 8/15/95)I , I 2 'I j4 t y 1 Ii I III III I I i it ' i I I {I I I I i � I. �• ,. I, ,III K.III,u��IlilY111Y11YYlU1�i11iG3GIYJJIId ur YiMu. J �, I.f•t..1•• .. I _11YI II I' ' I( ;! I ,III„qj I I,i'll l l lid l I'I.IIII I.1 El I,II ul_I I'I y 4, r t 1' di 'v a 11{ yqi!, �. I I ! 'Yi•: d 'i `i li ; I rl I l '� !': `�-I'Y , � 4 i '. Y;" � ,:, .I •. ^� i ?.I .j � '91II '.I' .� Ii i.. I''. I� {a. 'd ,,I i r�, � �." I I i Ill. !yt I: I Y •;I' � I � � 6' I My I I 1 j II �1 I! ,�: ilk• I� G li E SUBSURFACE SEWAGE;DOSPOSAt, SYSTpM INp S PECT I N f ORM, III i it "I' I��1�II IN t AIII h CERTIFICATION (continued I i II III u' y q -� �I I •� � (�,�yC�+.� II i I I I' I I I I i Ilb � II I B Ii I I I� I I I I . � y 1 „I I I I I I 9 Property Address: Owner: V-PAme V 1!ll y � I l Date of Inspection: I //!/ -9.7 ! I i l Z/ ��. D) SYSTEM FAILS(continued): C I 's II I Static liquid level in the distribution box above outlet invert due to an overloaded 'or clogged SAS or cesspool. _.... , � j I � III � ':' ' i ' V !, I I!•� Liquid depth in cesspool is less than 6"below invert or available volume is less,than 1/2 day flow. j 'II _ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pi I. Number of times pumped Any portion of the Soil Absorption System, cesspool or privy is below the high Igroundwater elevation! Any portion of a cesspool or privy is within 100 feet of a surface water supply or.tributary to a surface,water supply. - , • � Any portion of a cesspool or privy is within a Zone I of,a public well. I II _ Any portion of a cesspool or privy is within 50 feet of a private water supply well. '1 Any portion of a cesspool or privy is less than 100 feet but greater than SO feet)from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attaipy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. El LARGE SYSTEM FAILS: G The following criteria apply to large systems in addition to the criteria above: j The design flow of system is 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist:: the system is within 400 feet of a surface drinking water supply l I I , li I 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 ai mapped Zone 11 of a public water supply well) I i The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements.of 314 CMR 5.00 and 6.00. Please consult the local regional offici of the Department for'further information. t I 1 • i i I t . I l I y dreviaed 8/15/9S1 3 j I t. li I R I i I I _1. k,la I n• In.I t t ! i 1.= �_' I Y I i I I �l 11 1 II'd I I I II I hl' I II I I � I 71 1 =1J�{ ..� 'I, f :i• � pry r 4� I r ax 9 ( I t�" � l 7 ` �� � J �t I I�'I I ' 'll ++ I' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOtiM ,I I I :I„ �IPARTB'jl I ( 'III I� II'I ,I �Ilii �' h lll�l 'IIIII CFIEdbST ,I lul II i III li l l I ( G I � I III ; q , till it s I • r ,! I � I j; �I I Property Address: 3 7S A4 c.tJ Al Owner: 1v� U LU S Y I Date of Inspection: -beck if the followi have been done: ; I _Pumping information was requested of the ow;ier, occupant, and Board of Health. one of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the,system recently or as part of this!inspection. _t -As built plans have been obtained and examined. Note if they are not available with N/A. II I i he facility or dwelling was inspected for signs of sewage back-up. ._.T`� he system does not receive non-sanitary or industrial waste flow � I� he site was inspected for signs of breakout. I All system components, excluding the Soil Absorption System, have been located on the site. 4 A =�_ I . II �'I The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid,(depth of sludge,depth of scum. _The size and location of the Soil Absorption System on the site has been determined based on existing information or approx. ated by non-intrusive methods. I I , The facility owner (and occupants, if different from owner) were provided'with information on the proper maintenance of Sub- Surface Disposal System. ' i I (revised 8/15/9s) 3 q I i � ! I I I •I ' i I �l II�11 j I' i I I I I P I a II I , it1 �I�'!►f I i?)I' ? f ��'�,p� 'I�` 1 n, ha,! tl'.1i;P ,.P. '1'I. i q� :. •,� !• i.. �i4 ,I: u t^-� •4c:' r. 1 11'I �, I, Ilggl�p� 'hr �I�. ti�l'' � � �I. •'��I� N �'.� �I c 1.� �� � ':'9� I I� !9 �i li � I I� i i �.i„I� I1 � � ,�i� ���'1117"'... ,�+ �i � �' �1 , ���� � � �i�� �'" ., � '� � I ��� �i � I. I' � � I :i � I �•il � I'�:(� n� � l ,� 1 •� � j„ � i ll SUBSURFACE SEWA DISPOSAL SYSTEM INSPECTIONI FORM GE f I N PART SYSTEM INFORMATION 37 w y Property Address: Owner: P�w K U Yl/-�L C—V Date of Inspection: p/ I , l l f q( l 7 FLOW CONDITIONS I ! RESIDENTIAL I j Design flowWBal ns p lt�y I a Number of bedrooms: Number of current residents:2-- I 1 ; Garbage grinder tyes or not laundry connected to syste (yes or no):� Seasonal use(yes or no):10 l q 9� 0 = Water meter readings, if available: ��� Last date of occupancy:_�f(j W- COMMERCIAUINDUSTRIAL: I; Type of establishment: Design flow:__gallons/day Grease trap present:I(yes or nol Industrial Waste Holding Tank present: (yes or no)_ II f 1 Non-sanitary waste discharged to the Title 5 system: (yes or no),_ }' Water meter readings, if available: last date of occupancy: OTHER: (Describe) Last date of-occupancy: i I GENERAL INFORMATION I ; PUMPING RECORDS and source of information: a>�W ���•►^P�D ,p� t7ce.��w6�. System pumped as part of inspection: (yes or no)-y If yes, volume pumped: -gallons Reason for pumping: ��^.,P l�� l.,G- -t� I YV 'TAl V 91 TYPE OF SYS j I I eptic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes,attach previous inspection records, if any) Other(explain) dh APP XIMATE AGE of all components, date installed (if known) and source of information: V S 1 I iS l d C-L I Sewage odors detected when arriving at the site: (yes or no) � i trevised 8/3S/95) I r I it 1 II 17�: Il'I ►.•Ir I k I III i',�i I� •b ( �' ! I r II � 1 � lk , III '{,' I j H G MECTNO I SUBSURFACE SEWAD O i i19 PART C SYSTEM INFORMATION (continued)' 3?3 A",l Property Address: I Owner: yC�11i�L RO c)tw �'c C— y Date of Inspection: l 5 SEPTIC TANK:_ (locate on site plan) Depth below grader Material of construction: �oncrete _metal _FRP other(explain) Dimensions--;y Sludge depth: i/ Distance from top o iI dge to bottom of outlet tee or baffle:_ r I I � ; Scum thickness:_ � from to of scum to to of outlet tee or baffle: iI Distance P .�. P Distance from bottom of scum to bottom of outlet tee or baffle: 3 j Comments: 1 I I I (recommendation for pumping, condition of in et and outlet tees or baffled depth of li uid level in relation to outlet inve stru ural integri evidence of leakage, etc.) 1✓� /4 O 0 l� L/ 1.7 z1d AK I ki hn L' O w — L 1 t I t Ii I I II II Id I I GREASE TRAP:_ (Iodate on site plan) I I I Depth below grade: Material of construction: _concrete _metal _FRP —other(explain) I j 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: ( � � I I Comments: I (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level lin relation to outlet invert, structural integrity, evidence of leakage, etc.) ' I ' I I 4 �k II i I I � I I ! I (revised 6/15/95) i I ti I I II f 1 II i' 'NI luµutdswl�N �uxu�. +�..�.•.. � 'I � � 't� V p..uw EM�I NI.,�I y:,Ix.ICiM41Y41�::I" ;,,.I �,,:, I"1'`1"�I,. 't I. IN 11" I I tl rl4nha..:.i:11#5 _P 1',•1 1�i� j III',I t t�'-il It�rl'fJ�'1�tlltl�I�I I I}I I 1 tl III III '�i I 1I 11111111, 111lI' 'I &III ' III I l t.1J AI SUBSCE SEW AGE WkGE DISPOSAL SYSTEM INSPECTION FORM " ° PART, C� Ii 11 111'1 SYSTEM INFORMATION (continued)' wAlProperty Address: Owner: K/ o)v Z rz y Date of Inspection: TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade: Material of construction: —concfete—metal —FRP—other(explain) Dimensions: Capacity: gallons Design flow: allons/day Alarm level:— Comments: i I. { ion of inlet tee, condition of alarm and float switches,hes,etc.) -775-111 11 DISTRIBUTION BOX:_ (locate on site plan) Depth of liquid level above outlet invert: 0" Comments: (note if level and distribution is ual,evidence of solids carryover, evidence of leaks into or out of box,etc.) I U-5 A..,o -3 at 0 LA E kep LA AW y PUMP CHAMBER: (locate on site plan) Pumps in working order:(yes or no)_ Comments: (note condition of pump chamber,condition of pumps and appurtenances, etc.) i it (govised 6/15/951 i7 I It ,r : �. 'i � `` F� �• ( is � �t I I 1 I r ?I�,. a e, t It•.I LI K� I I �Y'Ilel �I" � � I I,ji I. ��t � � !� I ( � �� ! I' Ill �� I� t, � �Cul ,Ili '�71;r II I I I '' ' ' i i I ''. '.r t� i ,L� 'i � I � II'i i, I i i �. I '• ! � I "SUBSURFACE SEWAGEIOISPOSAI SYST(rMl`IIll EEPECTION FORM III 4 iI �a ILII ! It., PARTC 'I '!III�,I It l l II II it b { SYSTEM INFORMATION (continued) II = ,S' 4.ti4 Property Address: 43 7 3'Alrol Owner: C ?-14A/K Date of Inspects n• III SOIL ABSORPTI N SYSTEM (SAS):_ I ! ! (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) j I i If not determined to be present, explain: ! Type: leaching pits, number:_ l�0 � leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: I leaching fields, number, dimensions: overflow cesspool, number: ' I Comments: (note condition of oil signs of hydraulic failure, level of ponding, conditi n of v et;#ion,etc.) CESSPOOLS: (locate on-site plan) I Number and configuration: j Depth-top of liquid to inlet invert: I Depth of solids layer: { r Depth of;scum layer: I Dimensions of cesspool: i Materials of construction: Indication-of groundwater: I inflow(cesspool must be pumped as part of inspection) . I Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) I' PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: +j I I Comments: (note condition of soil, signs of hydraulic failure, level'of ponding, condition of vegetation, t ' .I Irevi'eed,8/IS/95) 8 I III I , i I i j I � d li III I I I I i t 1 �I Ii I i7) II y, .., w,q,�IP��tnb,iduWAll}4blll cd6+FWma mlrY�.�.u�uu. a ,o. • .a.,w l ....•FM:.�� •t.a I•.{,1 i1 � � i 11 jll� .Il 9 :L:,j � I' �t �II,� ,I:Nei lit p� , SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 7 Owner: yv[� yV Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (4 5 r r 3� 0 t �1 q 44 5- 52 DEPTH TO GROUNDWATER Depth to groundwater: �Z/feet Q p method of determination or approximation: �• l• • �1'1 /'�1 (revised 8/15/95) .9 TOWN OF BARNSTABLE T[r L �~ , • /� 1�N1y�EC ( �®� LOCA'-TION .3-73 A y n SEWAGE # VILLAGE ASSESSOR'S MAP & LOTlo INSTALLER'S NAME&PHONE NO. ky2G�t 61�1 1?Ace(-Ur-- SEPTIC TANK CAPACITY l�D 6)0 6-4z- LEACHING FACILITY: (type) P l'� (size) 1,,06D 6-7-f4 o NO.OF BEDROOMS BURAMR OR OWNER TA4 kll:4 (Ze)y YV S L_&Z4 PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility 2 2. + 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 r � � ,.., 4 y � . . 21 tjs � o 3b � 52 � . �. yq �'; i r� )C ML( TOWN OF BARNSTABLE LOCATION SEWAGE # VILLAGE ASSESSOR'S MAP&LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: h Separation Distance Between the: a`. 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 x a 7 3 t4 A4 5 hD DATE: 8 1619 5____ PROPERTY ADDRESS: 373 Ames RECEOVCD Centerville ------------------------ AUG 2 4 1995 Mass . 02632 HEALTH DEPT ------------------------ TOM.OF BARNSTABLE On the above date, I inspected the septic system at the above address. This system consists of the following: 1 . 1-1000 gallon tank . 2. 1-distribution box . 3 . 1-1000 gallon leaching pit . Based on my Inspection, 1 certify the following conditions: 1 . This is a title fiveLseptic system. ( 78 Code) 2 . The septic system is in failure . The septic tank is only half full . It obviously is leaking at the seams . This is where the septic tank sections are sealed together . SIGNATURE: = _ Name:—Joseph P_Macomber Jr . Company:_3 J. P_Macomber & Son—Inc . Address:_Box 66 -------------- Centerville ,Mass . 02632 -------------------- Phone: THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY JOSEPH P. MACOMBER & SON, INC. Tanks-Cesspools-Leachfields Pumped & Installed Town Sewer Connections P.O. Box 66 Centerville, MA 02632-0066 775-3338 775-6412 • 7 S- dACE DISPOSAL SYSTEM Address Of PropeE•t ., 373 Amesway Centerville ,Mass .. Owner ' s name Frank Raunsley Date of Inspection 8/14/95 PART A CliUCKLIST Check if the following have been done: Pumping information was requested of the owner, occupant, and Board of Health. None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period . Large volumes of water have not been introduced into the system recently or as part of this inspection. As built plans have keen obtained and examined. Note if they are not available with N/A. __Z The facility or dwelling was inspected for signs of sewage back-up. V/ The site was inspected for signs of breakout.. V/ All system components, Z4cluding the SAS, have been located on the site. The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge , depth of scum. The size and location of the SAS on the site has been determined based . n existing information or approximated by non-intrusive methods. The facility owner (arid occupants, if di.fferent from owner) were provided with information on the proper maintenance -.of SSDS. R com.-zendai.i.on.z 9 7ank to,? muzi 9e . .emoved and r.,em ae.ae pub •,'a at ,th,2 6e<<m, .7ank •top can then. to 2e..;ef, Poise pat Pack Z. 7ank mu,6t t.e pumped to a.-6.6u.,ze thatt. .the weep of tfce tank .in not ii_ak..ing af,3o. (7eAzage I . I am u.zde.2 .th,, unde.6iand ing the c2.i.y.i onai .in 6i_aP.2j_2 •L•6 go-ing to xak.e th-!_.3.P.. 2!�?rL•G2�1. I� anti LJftZ./2 '. t�2,_'.bP._ 2e^a.i.2iS a2ti. madL 2 and ir._zp'.ec.ted 1,_y Vie 3..2n h t;eO,.Qe Borilzrl 0/ hea-eih, A4e .6y tem d w,iU no . ga ' n 0aiiUaP.. It wou.P. Y 12n.,,. $. ( 78 Code ) i �� SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART S SYSTEM INFORMATION l ' y J FLOW CONDITIONS: If residential _.3_. number of bedrooms . number of current residents YE_ garbage grinder, yes or no laundry connected to system, yes or no ' YES seasonal use, yes or 'no If nonresidential , calculated flow: Water meter readings, if available: 199' 40, 000 9LS_109. 59=jCPD 1994 46000 y,'J=1 6 . 03=qP Occupied Last date of occupancy GENERAL INFORMATION Pumping records and source of information: ?um. ,ed e^ owne2. 7an.k hay .Qer..kagv_. P^o�n< :c pumped part of inspection es or • _� System um ed as y no ' if yes, volume, pumped ' � 'i'� Reason for pumping: . Type of system XXXX Septic tank/distribution box/soil -absorption system NO Single cesspool NC Overflow cesspool NO Privy V Shared system (yes or no) (if yes, attach previous inspection records, if any) 0,10 Other (explain) . • Approximate age of all components. Hate installed, if known. Source of information:_ ... ......_....._ _. NQ Sewage odors detected when arriving at the site, yes or no i 9 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SEPTIC TANK: 1-•1000 gr iic,n tank (locate on site plan) depth below grade: material of construction: ' XX concrete metal FRP other(explain) dimensions: 8' 6" Long, 5 ' 7" ;'I-igh Vide X'YXX sludge depth XXXX distance from top of sludge to bottom of outlet tee or baffle XXXX scum thickness XXXX distance from top of scum to top of outlet tee or baffle XXXX distance from bottom of scum to bottom of outlet tee or baffle Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet. invert, structural integrity, evidence of leakage, recommendations for repairs, etc. ) Sep,4-ic tank F hou.9d �._ �zu-�z.-�e:l ar t':tl, .tame io check Ioa ieakagte .th2ou. the wee,o ho e in the .moo o.m o _. the tank, Za-n.lcaz heaeuo.A =:aA.agv_. n a .k ie w.h.t.P.e �.ei.n.±•, - c � ,. „ /� ,�o m. n ..h_, o... lhl.. ank rr_ top :m..uit Pe n,.emoDoed an.1 nn.wV he-i.P put on tank hJi ° •Lnd ze-6e-t tie .tank fog l ank 2iopipec! wl'j. .6ch. 40 4" IV(-- 12.112e, DISTRIBUTION BOX: qES (locate on site plan) NO depth of liquid level above outlet invert Comments: .(note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of �kox, recommen4ati�or� for repairs, etc. ) '',lo 1so,.zd caa2 oven on Xec1xage ?.n o2 our o1, the No nn n, i n A nnn�ln l �i� �{ i .c f ;wQ PUMP CHAMBER: NONE (locate on site plan) NQAIF pumps in working order, yes or no Comments: (note condition of pump chamber . condition of pumps and appurtenances, • recommendations for maintenance or .repairs,etc. ) 10'JF SUBSURFACE SEWAGE DISPOSAL SYSTZ?i PART 8 INSPECTION ?ORK . ` SYSTEM` INFORMATION continued SOIL ABSORPTION SYSTEM (SAS) : 7-9000 gct.2.Q-on 1each_ing (locate on site plan, if poss.ib •excavation not° reQuired, but 'may be approximated by non-intrusive•• methods) If not determined to be present, explain: Type leaching pits and number /22PC,,h -reach 12 leaching chambers and number leaching galleries and number leaching trenches, number,* length n leaching fields, number, dimensions 0 overflow cesspool, .. number Comments: (note condition of soil, signs of hydraulic failure level of condition of ve etationeco�1 men ati� s ' pondirig., i r:;.,..�;ee;N( zignh 'o -. ycl/za!- -c �.2.��� �'�i � � or repairs etc. �.e ,a%�-.s nee ..ems a CESSPOOLS (locate on site plan) : number and configuration 0 . depth-top of liquid to inlet invert depth of solids layer J depth of scum layer dimensions of cesspool 01 materials of construction indication of groundwater inflow (cesspool must be pumped as part of inspection) , NONE Comments: (note condition of soil, signs of hydraulic failure, level 'of ponding, condition of vegetation, recommendations for maintenance or repairs,etc.) NO V E PRIVY: NON6 (locate on site plan) materials of construction NONE dimensions depth of solids Comments: (note condition of soil, signs of hydraulic failure, - level of .pondin condition of vegetation pairs recommendations for maintenance or re g' ,P• SUBSURFACE SEWAGE DISPOSAL SYSTEM 'INSPECTION FORM PART B SYSTEM INFORMATION continued SKETCH OF SEWAGE L:SPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100 ' i' t•I 7 3 /`} S DEPTH TO GROUNDWATER ' zC).=._ depth to groundwater method •of determination or approximation: T,; h 0., Bonn in t}�•D1� iflOR on. .-:i o7 1 ..eri ._ nt�n n4 &4nr ata t' 12 . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C �) . FAILURE CRITERIA Indicate yes, no, or not determined (Y, N, or ND) . Describe basis of determination in all instances. If "not determined",explain why not) Backup of sewage into facility? ND Discharge or ponding of effluent to the surface. of the ground or surface waters. Static liquid level in the distribution box above outlet invert? depth in R Liquid de � P feel <6" below invert or available volume< 1/2. day flow? A/Q Required pumping 4 times or more in the last year? number of times pumped A&yewt �Qai i,4gg0f Septic tank is metal? cracked? structurally unsound? substantial infiltration? substantial exfiltration? tank failure- imminent? SQ )L,Q.;o X, < �4,4ob, i 4Lr 5e mo 6/ 7,*&vX 'UeV _� Is any portion of the SAS, cesspool or privy: Q below the high groundwater elevation? _A within 50 feet of a surface water? .P within 100 feet of a surface water. supply or tributary. to a surface water supply? /Q within a zone I of a public well? . (� within 50 feet of a bordering vegetated wetland or salt marsh- (cesspools and .privies only, not the SAS) ? within 50 feet of a private water supply well? less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis? If thewell has been analyzed to be acceptable, attach copy of� well water anal, for coliform bacteria, volatile organic compounds, ammonia nitro 'I and nitrate nitrogen. gen TOWN OF 3a1?.n.6.t aP,.&,. BOARD OF HEALTH SUBSI)RFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D •- CERTIFICATION -TYPE OR PRINT CLEARLY- PROPERTY INSPECTED STREET ADDRESS 373 2m.�.s Gja C n..t�.w.i. Ge, lea s��. 026 32 ASSESSORS MAP, BLOCK AND PARCEL # OWNER' s NAME f aan.k Raun-!,ieu PART D - CERTIFICATION I NAME OF INSPECTOR IoAefzh l�, P]z.c�m0ea. a2. COMPANY NAME ;. P. rlac.omf-elt R Son. INC. COMPANY ADDRESS Bo.,c 66 Centc.ay.i.P/'e, (sae 02632 Street. Town or City State LIP COMPANY TELEPHONE ( 508 ) ?75 - 3338 FAX ( 508 ) 790 -.1587 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposed system at this address and that the information reported is true, accurate , and complete as of the time of inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . Check one: System PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15 . 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. ;.ZLUSystem FAILED* The inspection which I have conducted has found that the system fails to protect the public health and the environment in accordance with Title 5 , 3.10 CMR 15 , 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form. Inspector Signature ,r 1 DateB!14%95 One copy of this certification must be provided to the OWNER, the BUYER ( where applicable) and the BOARD OF HEALTH. * If the inspection FAILED, th-e owner r or `� ' eator shall u P pgrade ' the system within one year of the date of the inspection, unless allowed or required otherwise as provided in .310 CMR 15 . 305 . partd.doc �.y .._ C:,m„mcnweccn cr Messccnsers Execurive Gtfice cr Envircr,^ erITC Department of Environmentai Protection Water Pollution Ccnrrol Tecnnccl Assocnce end Training Eecnons w►uL&m F.weld Ga. vb. Tridy cos. s.Q.ry.roe► Thomsa e.Powers 06/12/95 ATTN: Joseph P. Macomber, ;lr. Joseph Macomber and Scan PO Box 66 Centerville, MA 02632- Dear Joseph P. Macomber, Jr. , I am pleased cc inform you that you have attended training, met the experience qualifications, and have passed the Title 5 System Inspector exam, pursuant to 310 CwF 15.340. The passing grade for the exam was 39/52 or 75%. This is an official notification that you are a Certified Department of Environmental Protection System Inspector pursuant to 310 CMR 15.340. You will receive a System Inspector certificate at a later date. If.-you have any futher questions, please write to me at the following address: Kimball Simpson D.E. P. Training Center 50. Route 20 Millbury, MA 01527 Thank you very much for 1/0ar time and consideration in this matter. Sincerely, Kimball DEP T.raininq Cc- : er Direcco.r (2405) Rout•20 • •Ibury, MA 01 FAX 508.755.92S3 • T•... one 508-756-77"' Water -..,.. Conservation SAVE Tips ME! I CHECK FOR LEAKS Water Loss in Gallons Due to Leaks :;:p ss Per Day l.'oss Per Month 120 3,600 360 10,800 ° 693 20,790 ° 1,200 36,000 1,920 57,600 ® 3,096 92,880 .0 4,296 128,980 ® 6,640 199,200. 6,984 200,520 81424 252,720 9,888 296,640 AMk 11,324 339,720 12,720 381,600 14,952 448.560 ASSESSOR'S MAP NO.I �� LO C,A.To N .� EWAGE PERMIT NO. VILLAGE _ 170 Z�y T � INSTA LLER'S NAME i ADDRESS 3 I'D a. isy zw 4 R U I L D E R OR OWNER 0 t fop y DATE PERMIT ISSUED D'AT E COMPLIANCE ISSUED :� . , ' } � �, . ®� %� ��h, A �� ->�-��� . _____�. 6 N Fxs........................... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH r ........ .W. .......OF.......... /�"�.r. _- t- .............................. Appliratuan for 11hipaaiial lVarkB Tnnitrnrtinn ramit Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal System at: Location-Add r s orr�r t No. L'2 � _ --Ct=LJr_ ...._... �r................... ....... ' .............................Lu .... ••.................. Owner Address W .......................... ...'. "n`\...................................................... ......•........................................................................................... a Installer Address UType of Building Size Lot...1_:1¢3.....-__.__..Sq. feet Dwelling—No. of Bedrooms.............3_..........................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures --------------------------••-••••- W Design Flow.......... . ..................:....gallons per person fr day. Total daily flow._..........._...�.�C�...........gagons. WSeptic Tank—Liquid capacity/..04- _gallons Length..�..�... Width.-:-/.!;_ Diameter---------------- Depth-�...-6 x Disposal Trench—No..................... Width,.................. Total Length............................ Total leaching area................._.sq. ft. Seepage Pit No.......f............. Diameter-�.--- _�± Depth below inlet_ �'O Total leaching area...�D . G Z Other Distribution box (>e� Dosing/t nk ) _ _ Percolation Test Results Performed by.... --�_-•_. dl. f SO6 _ a /� .-••---.•••• . ._ Date------.a.....................-•---. Test Pit No. 1........ minutes per inch Depth of Test Pit.../Z FY?'Depth to ground water___:�L�. (s, Test Pit No. 2------- ..minutes per inch Depth of Test Pit__ ..__. = Depth to ground water._. ►x ---•.•••. ------......•-• ----•-••---•-•-•---•-••-.. . Or' f ,_ J ----- .. x Descr>ption of Soil ... L� - Q!' je+�� j != T'i4/� C�/"�:v '-> 7-� 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 iITi!L- 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance,has been issued by the board ofhealth. igned. —..--------•-----•• ?1i1`..... '------•......... ................................ Application Approved By._.._.... �Gt._. ... ..•._.. ... o �' Date Application Disapproved for the following reasons-----------------------------------•---------------------------------------------------......................... --•-•-•-----------•-------•••-••------•------•--•----•-•----•-••...............••---...---...------•--•--•-•---------••-----••••-•-••-••••--•-•-...-•-••--••-••-••••-••--•------------•-•-••------------ Date PermitNo............ ........... Issued....................................................... Date BOARD OF HEALTH Application is hereby made for a Permit to Construct or Repair am Individual Sewage Disposal System at: Installer Address Type of Building Size Lot....J-2i.1- ..Sq. feet Z Other Distribution box Dosing tank � THE COMMONWEALTH OF MASSACHUSETTS ` Desc c- .--._-- .................................................... / U Nature of Repairs or Alterations--Answer when --_---_---_-._-.-'''-''_'--_.---__'__- r ------'------------'-------''-'''--------'-'--------'--'-----''---'---'''----------- Agzceueoc: � The undersigned agrees to install the aforedexcribed Individual Sewage Disposal System 6oaccordance with | the provisions ofZZTIf- 5 of the State Sanitary Code— The undersigned further agrees not to place the system in � operation until u Certificate of Compliance ---------- -----------'--- Dat Anolicution Approved 8y'---'��~=0�����L-�����"~ ------- - ------ ^ ..e Application Disapproved for the following reasons:................................................................................................................ ---------`------`-----------`-'-----`------`------------------''----------------''------`------ ' . Date Permit NoIssuedL- Date - THE coMMomvvExcrH OF wAsSxonussTrs BOARD OF HEALTH ............./...��'8 ��......OF-- ��-''_----' OwWrtmfirate jaf Tomptiatta THIS \ IS TO CERTIFY, That the Individual System constructed or Repairedhas been installed in accor ance wit the r iwwh of TITIE 5 of The State Sanitary Cod d THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILLFACT��R�� D/�][IL-------' �=. �-'I.....I.............................. Inspector -----------------------------------' ' ` ~ ` THE coMMowwsAcr*oFmAssxC*uSsrrs ' | ' BOARD jQF HEALTH ___����&�/,��___r�� __. Street as shown on the application for Disposal Works ConstrurtiGn--PeFFkf No_ Dated............ ............................. to Construct or Repair an Individu4_Sew4ge Disposal System Board of Heal FORM 1255 HOBBS & WARREN. INC. PUBLISHERS #3 g1X3 136.25 L o-r'02 17 748 s F {Z'DAM• L�o.rN•QcT ( � , !o FT• �FFEc.T�Y� �� DePTA DUST. Sov- I- SE rT't c T4-k N iL Q � � ti 0 � rR.oPO'SE� N 'V 1 W serr�ice ` 41 3 �oeooN V i N 1`�tJ 14� 01 ca ®. o, q8�n k=30.00 L'4712 qS�q 73.42 Io O.n hMES WAY ' I Er t,ef,u<J aCi'V!L 40 AA �` � fuNAL Env BA RN STABLE,MASS. CLIFF PERRY - Bl.Dtz- SANDWICH MASS. NOS ENG•ASsoc•=NC• RAYNHAM SCALE= 1 =30' MAfZ 1?, tS6.6 '� 5 -7 43 v:� Y 1 � 101 • O H g;5 to ,P C � otsT.,g� '• � ooOC-tial, co" 45'B �o Ari �cFr.• DrAn�. SaP�►�„ Ton l� 9l0.0 4 4Q Gor.tG. LEAc.NIAlC,r Pi.7- a AA4 a46 0 eoT. PrT Et.try �'j'i �q. r�L'+K!°511ed S tonc To PSprL 5 u S sor L Pm-1 0 L-cN,-r 10 N RA-t-�; Z All,, c l-J �R o P q6•� 2,o' TEs-r PF_.TZ• FORM ED OVt R 2e r�• �, l 9 g6 3 Q� DRooMS �C 140 C-�QD 33pC Pp LEAWIr4C., �=rN-e No C�Ar-zaq�e D(SposgL USE 67RA�L l o 0o GAL.SER-'ccT,Ak CA PAc. (Ty Pp _OVID � p o T-r o l.rl C) 13 Cq p p SIDES 7j' I2 V_ G X2. 5 s6$ C� PD �f.Q 71 I OTp.L CAPPtG�(Ty R7,ovlpE,v> 7 C.,pG� N oTE - D vs Po s A(... Sq s-i-, tl D�sfcgNED ( N CL-EA l IVIEDtuM T'( TL� S o?~ TNT. �A�SS . >=N�1 �20t�1Mr=r.tT/aL SAND 87 O Gorr. OF I per • t,� S 5' — 12 -5 r �-A o 6po u N D k�JATEt); T�s-r�tTs "I2 C LIEF �' Ry LoT 2 AkAG S IlJA,4 S7- 4Tt�, P FN AT EL; 51.3' SYSTEM PROFILE . TEST HOLE_ LOGS TO D ACCESS COVER 7O WITHIN 6" OF FIN. GRADE (NOT TO SCALE) 4 HOS ENGINEERING I, ACCESS COVER (WATERTIGHT) TO ENGINEER: MINIMUM .75' OF COVER OVER PRECAST WITHIN Fa" OF FIN, GRADE 2% SLOPE REOVIRED OVER SYSTEM 48 7' WITNESS; BARNSTABLE HEALTH DEPT. . 2" DOUBLE WASHED PEASTONE�,' DATE: 3/5/86 EL. 47.7' RUN PIPE LEVEL -�---- I FOR FIRST 2' 3' MAX. PERC. RATE - 4 2 MIN/INCH EXISTING 1000 _12E GALLON SEPTIC 4 .3'f 46.5' CLASS I SOILS P# 5743 i TANK (H- 1 O ) .� GAS ,_. �trl 5 R , © (� C7 �l 0 CJ1 I. 7 C spa Ns c acL BAFFLE 46,0' txc�o ,-- 45.65 C�7 �C-h ©� = �C�-']} C70 [rJ Q-} 6" CRUSHED STONE OR MECHANICAL fts2' ] [= 0 (� 'j Lam__ T t- 43.6rJ' ,� ELEV. etrtEsrnY COMPACTION. (15.221 (2]) MIN 49.0 LpCUS DEPTH OF FLOW = 4 MIN ( SLOPE) 3/4" TO 1 1/2" DOUBLE WASH_b STONE TOP & BRIC, r vazM TEE SIZES: (--1 % SLOPE) SUBSOIL INLET DEPTH 10 2' i OUTLET DEPTH 14" LOCATION MAP NTS ' FOUNDATION EXIST, SEPTIC TANK 14' D' BOX 1 LEAC H I I,,G 6' FINE ASSESSORS MAP 170 PARCEL 224 FACILIT)" 6,65 GRAVEL *THE INSTAL-ER SHALL VERIFY THE .. 7' 42.0' LOCATIONS OF ALL UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS r PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM �. 48.8 • _, ... CLEAN MED. / 7 \� '' a7, SAND 42' o / 1-1 46.7 4 49,9 4 46.1 / LOT 2 17,859+SF 7so.o / 12' 37.0' NO WATER ENCOUNTERED NOTE. . - so.o + 41,e / , - / TH1 \� - SEPTIC�DESI:;N: (GARBAGE DISPOSER r5 _NOT ALL W ) 1 . D. .TUM iS ASSUMED / AVED / \\ DRIVE / ��G,, a .8 DESIGN FLOW: BEDROOMS ( 112 GPD) = 330 GPD 2.. M.,lNICIPAL WATER IS . EXISTING 502 - - ghn ,.ti' e tr f! I`I nlAl / 17,7: 2�:. SQ. FT. 1 \ / • p, / SEPTIC TANK. 330 GPD ( 2 ) = 660 4, D��SIGN LOADING FQR: ALL PREt�AST UNITS TO �E AA HO H-- 10 5. PIKE JOINTS TO ICE MADE WATERTIGHT. USE A 1000 GALLON SEPTIC TANK (RE-USE EXISTING) 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS, LEACHING ENVIRONMENTAL CODE TITLE V, / y 2(30 + 9.83) 2 (34) = 118 7, THIS PLAN IS FOR PROPOSED SEPTIC SYSTEM ONLY AND IS NOT + 5 / SIDES; _ TO BE USED FOR ANY OTHER PURPOSE. 30 x -9.83 (,74) 218 BOTTOM: -=- ----�--- �, TO SGM, 40- 4.. PVC. + 49.6 8. PIPE FOR SEPTIC SYSTEM EXIST, DWELL. 45436 TF = 51.3' 49. / �„ TOTAL: _ S.F.SF GPD 9. COMPONENTS NOT TO BE BAC;KFILLED OR CONCEALED WITHOUT BENCH MARK - CORNER OF �' USE (2) 500 GAL. LEACHING CHAMBERS (ACME OR INSPECTION BY BOAPD OF HEALTH AND PERMISSION OBTAINED CONC. PULKHCAD EL 50.6 + 50,E a 45.7 +QI FROM BOARD OF HEALTH. 5 .3 1 W EQUAL) WITH 2.5' STONE AT SIDES, 4' AT ENDS AND 5' 49.5 EXIST. 1000 GAL, _ o ,.l 1 I BETWEEN UNITS 10 REMOVE E ANY CONOVE TAMINATEDOR FILL wSOILS WITHIN 5/CLEAN SAND) FOFbNEW LEACH AC PIT SEPTIC TANK RE-L1 E G .,� N FACILITY GARDEN SE ( S ) DECK G Gs / �r + 49, / Q .5 <07.7 49.2 Tt�L 4 �*�•,,J , TI TL E 5 SITE PL lV *•� � ` -� '- / 100.0 PROPOSED SPOT ELEVATION 0 F A(- + 48.9 6" MAPLE / 373 A M E S WAY + 7 / 100x0 EXISTING IN THE TOWN OF: . SPOT ELEVATION 6 16" W.PI E � / 100 ~°� I / s PROPOSED CONTOUR (CENTERVILLE) BA R N S TA B L E ��` ,----� 6" OAKS aB.o k / 100 --�--- EXISTING CONTOUR PREPARED FOR: 4 /+ 45.1 BORTOLOTTI CONSTRUCTION/BAKER �36 28, + 48.2 to 1 47, 20 0 Zo 40 60 ^7 BOARD OF HEALTH MA SCALE: 1 = 2Q' DATE: JULY 12, 2003 tr / APF2OVED DATE 44.7 off 508-362-4541 fox 508 362-9880 aOf down cape engineering, inc. kfi, A N �� � �� A H. I ►ALA LA p''c �a C CIVIL_ ENGINEERS � � r �A 26348 4 LAND SURVEYORS p;c 939 vain st, yarrlouth r1a 02675 RQi 3-- 1 � ARNE H. OJALA, P.E., F.L.S. DATE