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0054 GREEN DUNES DRIVE - Health
5 t Green Dunes Drive z Centerville P 246205 of Ill,ad aEcvc�o UPC'12543 No.53LOR HASTINGS.LIN I TOWN OF BARNSTABLE i LOCATION�q—.. v SEWAGE # 2-oo'1 3�� VII LAG CIV . __ t '�` A SEESSSOR'S MAP & LOT Z —' INSTALLER'S NAME& PHONE NO.�yt(1 nMY \Q1SiZS_I�� SEPTIC TANK CAPACITY _1SM 40,L_ M6w1D LEACHING FACILITY: (type) t7Z`(yJ�L� �5� (size) k-NO. OF BEDROOMS S BUILDER OR OWNERLAULK PERMITDATE: Q ' v COMPLIANCE DATE: 0 3 CST 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 C9,4"ef A-�- yS.s Z-Si' 3 --(a,: me, -rpkflat Q a Q ?, of 515.S -- ?-3ax o ��s�as Soo GRI.. N-zb 33' w 3` of S�u�. mod No. V 0 �✓ Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 2ppricatton for Mfgpooal *pztem Conztructiou Permit Application for a Permit Cons ct pair( )Upgrade( )Abandon( ) Complete System El Individual Components Location Address or Lot o. � �j owner's Name,Addrqs and Tel.No. 015;, Assessor's ap arcel a h �� ne, �� �((� OW Installer's NAme,Address,4nd Tel.No. Jv D1 Designer's Name,Add ss and Tel No. ae-s Type of Build g: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 0 gallons per day. Calcul ted daily flow �L_5 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank V0 F Type of S.A.S. Description of Soil, Nature of Repairs or Alterations(Answer when applicable) ���iFrG(/t� �� J?2 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 th m 1 Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this of Heal Signed Date Application Approved by Date k-3 V Application Disapproved for the fo owing reasons v Permit No. 2U 316 Date Issued k- 3•'d V No. bo q' 30 t I Fee a THE COMMONWEALTH O Entered in computer:p`F MASSACHUSETTS ` Yes P ,'BLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS 2pplicatiou for Migozal bpztem Con!6truction Permit Application for a Permit(Cons-t ) epair( )Upgrade(� )Abandon( ) L�J Complete System O Individual Components Location Address or Lot No. ePa'� J, 1 Owner's Name,Ad/dress and Tel.No. ` l,l>tV1►5 t r Yl C Assessor's Mag/Parcel �� ,y, j AN D 3 ne- �LI �� ma D��1 �_ Installer's Name,Address,and Tel.No. 'cj �`'a-1 Designer's Name,Address and Tel.No., 1 t'S r r� 021n ( z s( G� `)11 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 1 gallons per day. Calculated daily flow 5 gallons. : Plan Date �1 7"-0 f Number of sheets Revision Date Title t `_ Size of Septic Tan r I. U of 1,Type of S.A.S. 6'l !�'tG /' X J Description of Soil 111 rD a n mg ,j Nature of Repairs or Alterations(Answer when applicable) OkUdl e tx4t'`)-; dir. e2Z JJ r( 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 issued by this Boa of Healail, . Signed r ►\ ACV/ d .1v't'..-d'. Date Alication Approved b . PP PP Y � _- Date V- 3 -p'0 I � . Application Disapproved for the f lowing reasons 1 Permit No. .2 U d`l-7kI Date Issued k_ ,3-C) --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate,of Compliance , ..- THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded(�) x. Abandoned( )by�l�i`�l . I�Y.i( '� I�,(.�Q_T- at has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. W Y-3Pq dated -CI V Installer iZ I/htl()!�6 Designer E )W C 6hY11/ The issuance of this permit shall not be construed as a guarantee that the systETr-wli 1 function-Pas&si ned. Date k'`J- Inspector --- t—/ — p—p--------------------------------- No. VUy '1 .3 0 ! Fee /S d THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION . BARNSTABLES MASSACHUSETTS Mizpoof *pztem Cott!6tructiou Permit Permission is hereby granted to Construct( )Repair( )Upgrade( Abandon( ) System located at �.. � 1°t 1 t-VI l.[J, and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this pe Date: Z/3 Approved by I l rb h _�- TOWN OF BARNSTABLE L q LOCATION 1I SEWAGE # VII.LAG?✓UV . 1 ` RAJ ESSOR'S MAP & LOT Z —' INSTALLER'S NAME&PHONE NO.WlCS1gM SEPTIC TANK CAPACITY \SM GAL moron LEACHING FACILrrY:'(type) VAL(vJ t� C5� (size) NO. OF BEDROOMS S BUILDER OR OWNER Q PERMIT DATE: k-3 —U y COMPLIANCE DATE: iSeparation Distance Between the: i Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet -f -~�--~-- - 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 f within 300 feet of leaching facility) Feet l Furnished by f _ 2-SV 1�m 4w_ MbNo © $ -- s Ir'gs40s --tax.; c� ru' , 5" Soo CP4L_ H -2b AUG-10-2004 09 :42 AM DOWN -CAPE ENGINEERING 508 362 9880 P. 02 a� INVERT ELEVA 77ONS PIPE NEAR HSE 33.74 TANK IN 33.24 TANK OUT 32.94 D—BOX IN 31.96 D— OX OU 31.6 S.A.S. IN '1 ?6.0>, 1500 GAL. SEPTIC TANK v� EDGE OF STONE '7 LOT 28 32,986 SFt VENT PIPE / / �.f 5 LEACH CHAMBERS ?21,92, JOB # 04-172 AS BUILT SEPTIC SYSTEM PLAN LOCATION 54 GREEN DUNES DRIVE PREPARED FOR: WEST HYANNIS PORT, MASS. CHUCK AND ANDREA SCALE : 1" 30' DATE : AUGUST 9, 2004 BERGERON Off. 501-362-4341 H OF,ygs k�tN OF qqs . l PoK NW-382-SBBO �+ ARNE ARNE H down cope engineering, Inc. H. OJALA � w CIVIL ENGINEERS OJALA Cl No. 348 N 92 LAND SURVEYORS Po 4 939 main st, yormouth, ma 02675 �� Sio Eta\ DATE E AL S., P.E. Town of Barnstable Regulatory Services 1 1 Thomas F.Geiler,Director Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-9624644 Fax: 508490-6304 Installer&Dahmer Certification Form Date: Designer: T,�bW L4 CA3C Installer: lW 1&Pn Address: n Nao�L- Address: yA iZmoU IN1.A 61675 Gi�►as issued a permit to install a (date) (installer) septic system at 'S 6 I)CM based on a design drawn by ¢ 0.►'�- ��� dated ��vf J� &0. I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced=above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. H OF"ASS 9 AR N E �yG� er s SiH. OJALA N No.26348 t 0"e S S qN�SURVE�O (Designers i ) (Affix Designer's Stamp Isere) PLEASE RETURN TO BARNSTABLE PUI3LIC-AEALTH DIVISION. CERTIFICATE OF-COMTLIANCIE WILL NOT BE ISSUED UNTIL BOTH THIS FORM.-AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. O Q:HWth/Septic/Daigm Certification Form l INVERT ELEVATIONS PIPE NEAR HSE 33.74 TANK IN 33.24 TANK OUT 32.94 D—BOX IN 31.96 D—BOX OUT 31.65 S.A.S. IN 2g.2g 2260>, .C.Q 1500 GAL. SEPTIC TANK EDGE OF STONE i LOT 28 / 32,986 SFt I � I � VENT PIPE I 5 LEACH CHAMBERS 221.92, JOB # 04-172 AS BUILT SEPTIC SYSTEM PLAN PREPARED FOR: LOCATION : 54 GREEN DUNES DRIVE WEST HYANNIS PORT, MASS. CHUCK AND ANDREA SCALE : 1" = 30' DATE : AUGUST 9, 2004 BERGERON off. 508-362-4541 1`� N OF Mgssgc \v oc r'gSS9C I fox 508-362-988o �o ARNE tic o A H ycN down cape engineering, inc. H. OJALA OJALA CI Cn CIVIL ENGINEERS No. 6348 N 92 4 LAND SURVEYORS O ly0 939 main st. yarmouth, ma 02675 Z Sio EN DATE E H. AL .S., P.E. A T �� ,� ,� �l � �� ` I ti � , III ----------------- ----------------- -------------- 07 ----------------------- -------------------- ----------------------- - ---------- ------------------ -------------- ------------ ------------------ ---------------------- Lu lu zl 88 - ---------------- ------- ------------ LILU REAR LOFT DN BEDROOM*e 13 ROOF OF-CK BATH#3 W.LG. HALL r------------------- o 1 W.LG. 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AUG-10-2004 09 :42 AM DOWN CAPE ENGINEERING 508 362 9880 P. 01 Town of Barnstable Regul®tory Services ! Thomas F.Geller,Director Public Health Division Thomas McKean,Director 200 Main 6t»ft,Hyanais,MA 026ol office: 508-862.4644 Fax: 509-790.6304 Date: -3-_61 L. . Designer: ?lf G tr►.�v. Installer: w ,� Address: 1' Qcn(. S'r _ Address: issued a permit to install a to (installer) septic system at based on a design drawn by. 0,-,,V r i, O-Ja dated J J aU U I that the septic system referenced above was installed substantially according to the dest4a, which may include minor approved changes such as lateral relocation o the distrlbudon box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component Of the septic systeat) but in accordance with State tit Local Regulations. Plan revision or certified as-built by designer to follow. OF ( ARNE er _ H. OJAIA q No.26348 z q �p 0 1, ti0 3 AV s gads s es grier s stamp OF co Q:"6Wd/s"d0DW W camocwan Fela1 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFA DEPARTMENT OF ENVIRONMENTAL PROTE 10��� T�yF0, <'00 1 OFAr,�B TITLE 5 �F OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 54 Green Dunes Drive West HyannispoM AM Owner's Name: Paula Shoemaker Owner's Address: P.O. Box 445 West Hyannisport, MA 02672 Map: 246 Date of Inspection: March 31, 2001 Parcel. 205 Lot. 28 Name of Inspector: (Please Print) James M. Ford Company Name: James M. Ford Mailing Address: ''PO.'Box 49 - r Osterville,MA 02655-0049' ` , •` Telephone Number: (508)862-9400 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15,340 of Title 5(310 CMR 15.000). The system: ✓ Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Ft Inspector's Signature: Date: April 3, 2001 The system inspector shall su t 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`Cot`nments•j ****This report only describes conditions at the'time.of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) 4 Property Address: 54 Green Dunes Drive West Hyannisport, MA Owner: Paula Shoemaker Date of Inspection: March 31, 2001 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired..The system,upon'completion.of the replacement or repair,as approved by the Board of Health,will pass. Answd'yes,.no or not determined(Y,N,ND)in th_e, 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. 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: y eq pumping y- - 9ke . PiP� )... _. Y .. The.s stems uuedmore than 4 times.a ear due to broken or obstructed i 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: 54 Green Dunes Drive••_. _...._. w • - ,. _ , . West Hyannisport, MA Owner: Paula Shoemaker Date of Inspection: March 31, 2001 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a.manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water-Supplier,if any),determines that the e 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 54 Green Dunes Drive West Hyannisport, MA Owner: Paula Shoemaker Date of Inspection: March 31, 2001 D. System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in cesspool is less than 6" below invert or available volume is less than day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped— ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ✓ Any portion of a cesspool or privy is within a Zone 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 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.] No (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 System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd- You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No 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 `eyes"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: 54 Green Dunes Drive West Hyannisport, MA S- Owner: Paula Shoemaker Date of Inspection: March 31, 2001 Check if the following have been done: You must indicate`yes"or"no"as to each of the following: Yes No v ✓ 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? j ✓ _ 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?w ✓ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? ✓ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption.System(SAS)on the site has been determined based on: Yes No ✓ Existing information. For example,a plan at the Board of Health. ✓ 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)]. c 5 Page 6 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM,INFORMATION Property Address: 54 Green Dunes Drive West Hyannisport, M4 Owner: Paula Shoemaker Date of Inspection: March 31, 2001 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Number of current residents: 1 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): Summer use Water meter readings,if available(last 2 years usage(gpd)): 2000-29,000 Qals.; 1999-39,000 Qals. Sump Pump(yes or no): No Last date of occupancy: Currently occupied COMMERCIALANDUSTRIAL Type of establishment: Design flow.(based on,310.CMR 15.203): Zpd 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: None on file-per treatment plant Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM ✓ Septic tank,distribution box,soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records,if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight Tank Attach a copy of the DEP approval Other'(describe): .. .. Approximate age of all components,,date installed(if known).and source,of information: Feb 28 1990- per as built card Were sewage odors detected when arriving at the site(yes or no): No 6 , .b Page 7 of i l OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 54 Green Dunes Drive West Hyannisport, MA. Owner: Paula Shoemaker Date of Inspection: March 31, 2001 BUILDING SEWER(locate on site plan) 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 TANK: ✓ (locate on site plan) Depth below grade: 20" 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) = i �r Dimensions: 1000 gal. _,_._. •k + . _ . 3 F . r t ;,� Sludge depth: Distance from top of sludge to bottom of outlet tee or.baffle:,. 30" , Scum thickness: 4" _.. Distance from top of scum to top of outlet tee or baffle: 10" Distance from bottom of scum to bottom of outlet tee or baffle: 10" How were dimensions determined: Measuring stick Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): The tees were present. The liquid level was even with the outlet invert. There were no signs of leakage. Recommend pumping every 3 years. GREASE TRAP: None (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: t 6 i 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 e , Page 8 of I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 54 Green Dunes Drive West Hyannisport, MA Owner: Paula Shoemaker Date of Inspection: March 31, 2001 TIGHT or HOLDING TANK: None (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 sit -plan) Depth of liquid level above outlet invert: Even Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): The D-box was level There were no signs of leakage or solids There were no signs of failure in the leach pits. PUMP CHAMBER: None (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.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM.INSPECTION FORM PART C --• "SYSTEM INFORMATION (continued) Proper ryA dress: 54 Green Dunes Drive .v� . _ ._ . West Hyannisport, MA ^, Owner: Paula Shoemaker Date of Inspection: March 31, 2001 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required). If SAS not located explain why: Type ✓ leaching pits,number: 2-4'x 6'with 3'stone(per design plans) leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: ' - overflow cesspool,number: _ Innovativelalternative system_. ._Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): The pits were located but not dug up: There were'no signs of failure in the--D-box. The bottom to-gradewas approximately 8'. CESSPOOLS: None (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: i Indication of groundwater inflow(yes or no): Comments (note condition of soil,signs.of hydraulic failure, level of ponding,condition of vegetation,etc.): PRIVY: None (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 SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 54 Green Dunes Drive West Hyannisport, kM Owner: Paula Shoemaker Date of Inspection: March 31, 2001 Map: 246 Parcel: 205 SKETCH OF SEWAGE DISPOSAL SYSTEM Lot: 28 l system including ties to at least two permanent reference landmarks or Provide a sketch of the sewage disposal y g benchmarks. Locate all well i within 100 feet. Locate where public water supply enters the building. �rt'onT w.�do�✓ �$ C A Al - aoZ Aa- Ay' 3_' Qy_ 3s' y S i3 S. 33 C S- 30 . 10 Page l l of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEMTINFORMATION (continued) Property Address: 54 Green Dunes Drive .._ � •� r`<� :-° ,`_ :-`. ,:. ' r,.', -' ..-,_;." West Hyannisport, MA Owner: Paula Shoemaker Date of Inspection: March 31, 2001 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain:topographic and water contours maps Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: ' The bottom of the leach pits to grade was appr&imately 8. Using the Barnstable topographic map and the Cape Cod Commission water contours map the maps were showing approximately 35'+/-to groundwater at this site. This report has been prepared and the system inspected andpassed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed,written or implied,relating to the system, the inspection and/or this report. 11 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL OTEC 1 RECEIVED J U L 10 2003 TOWN OF BARNSTABLE HEALTH DEPT. TITLE S OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 54 Green Dunes Drive West Hyannisport, MA Owner's Name: John&Elaine Brouillard Owner's Address: P.O. Box 445 West Hyannisport, M4 02672 Map: 246 Date of Inspection: July 3, 2003 Parcel: 205 Lot: 28 Name of Inspector: (Please Print) James M. Ford Company Name: James M. Ford Mailing Address: P.O. Box 49 Osterville,MA 02655-0049 Telephone Number: (508) 862-9400 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ✓ Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fai Inspector's Signature: Date: July 6, 2003 The system inspector shall sub t a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 54 Green Dunes Drive West Hyannisport, MA Owner: John&Elaine Brouillard Date of Inspection: July 3, 2003 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair,as approved by the Board of Health, will pass. 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 exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: 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: 54 Green Dunes Drive West Hyannisport, MA Owner: John&Elaine Brouillard Date of Inspection: July 3, 2003 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of 11 e OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 54 Green Dunes Drive West Hyannisport, MA Owner: John&Elaine Brouillard Date of Inspection: July 3, 2003 D. System Failure Criteria applicable to all systems: You must indicate either"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 '/2 day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ✓ Any portion of a cesspool or privy is within a Zone I of a public well. ✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ✓ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the,well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] No (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 System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No 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 i Page 5 of 11 e OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 54 Green Dunes Drive West Hyannisport, M4 Owner: John&Elaine Brouillard Date of Inspection: July 3, 2003 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: Yes No ✓ 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)]. f Page 6 of 11 C OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 54 Green Dunes Drive West Hyannisport, AM Owner: John&Elaine Brouillard Date of Inspection: July 3, 2003 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Number of current residents: 2 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Currently occupied COMMERCIAL/INDUSTRIAL 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: None on file-per treatment plant Was system pumped as part of the inspection (yes or no): No If yes, volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM ✓ Septic tank, distribution box, soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Feb 28 1990- per as built card Were sewage odors detected when arriving at the site(yes or no): .No 6 i Page 7 of I 1 q OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 54 Green Dunes Drive West Hyannisport, MA Owner: John&Elaine Brouillard Date of Inspection: July 3, 2003 BUILDING SEWER(locate on site plan) 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 TANK: ✓ (locate on site plan) Depth below grade: 20" 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: 1000 pal. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 29" Scum thickness: 6" Distance from top of scum to top of outlet tee or baffle: 9" Distance from bottom of scum to bottom of outlet tee or baffle: 9" How were dimensions determined: Measuring stick Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Tees were present. The liquid level was even with the outlet invert. There were no signs of leakage. Recommend pumping. GREASE TRAP: None (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: 54 Green Dunes Drive West Hyannisport, MA Owner: John&Elaine Brouillard Date of Inspection: July 3, 2003 TIGHT or HOLDING TANK: None (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) Depth of liquid level above outlet invert: Even Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box, etc.): The D-box was level. No solids were present. PUMP CHAMBER: None (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.): 8 ' Page 9 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 54 Green Dunes Drive West Hyannisport, AM Owner: John&Elaine Brouillard Date of Inspection: July 3, 2003 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits, number: 2-4'x 6'(600 gal.)with 3'stone (per design plans) leaching chambers,number: leaching galleries,number: leaching trenches,number, length: leaching fields,number, dimensions: overflow cesspool,number: Innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil,condition of vegetation, etc.): One pit(#4) had 1'6"of water on the bottom. The other pit(0)was dry. There were no signs of failure. The bottom to grade was approximately 8' CESSPOOLS: None (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: None (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.): rf ' Page 10 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 54 Green Dunes Drive West Hyannisport, MA Owner: John&Elaine Brouillard Date of Inspection: July 3, 2003 T Map: 246 Parcel: 205 SKETCH OF SEWAGE DISPOSAL SYSTEM Lot: 28 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. t'BOAT' w►n LO W A 8 � A a a a� ao `/ 3 s 3 30.6 as 33 30 10 Page 11 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 54 Green Dunes Drive West Hyannisport, MA Owner: John&Elaine Brouillard Date of Inspection: July 3, 2003 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 35 +/- 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: topographic and water contours maps Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using the Barnstable topographic map and the Cape Cod Commission water contours map the maps were showing approximately 35' to ground water at this site This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied, relating to the system, the inspection and/or this report. 11 N��TOWN OF BARNSTAHLE LQCATION (-6+ Z� "��� Oct►^-C.S ��. SEWAGE VILLAGE_ h; ASSESSOR'S biAP & LOT gINSTALLER'S NAME & PHONE NO._�.�, Cis cD+� ��7 j— 3617 a \-SEPTIC TANK CAPACITY 11 d do C LEACHING FACILITY:(tvpe) L tAeG '�+} - _ (size) (006 a�.S �NO. OF BEDROOMS __PRIVATE WELL U PUBLIC WATER BUILDER OR UWNER °� 4� S; DATE PERMIT ISSUED: . DATE COMPLIANCE ISSUED_ 26_ _ VARIANCE GRANTED: Yes No ` r 35 3e ' O A t M//0 '05 No..IF9�4 F:ns.--- .S�'t... —5-7f THE COMMONWEALTH OF MASSACHUSETTS OARD F HEAL ...... ... ..OF....... --- . ---- -L _. C����. lulirat ion for Uhip ottl Works Tonstrudion jrrmit Application is hereby made for a Permit to Constructer Repair ( ) an Individual Sewage Disposal System at: . , ........... � . •-•-•--. r* ' - ----------------------•.................. .. ... .._....Locacion: a......... .5 ............................... .......••---•--....-•••------.._....._•---or Lot No.......--•---......................_..... wn Address a _.... .................. ..... -q: Installer Address Type of Building Size Lot..._. ..._._ ...._ feet ., Dwelling—No. of Bedrooms.................. ........................Expansion Attic ( ) Garb a Grinder ( ) Other—T e of Building No. of ersons............................ Showers a YP g . •.. P ( ) — Cafeteria ( ) Other fixtures •-----•-----.----•--------------•--- Q - -•---•--------------------•--------.----.-..-.-- Design Flow...........�..1 ..--.-•--. �- galons lions pe _ p r Total w... �. ori.. W ;� � fir. �c ai�y �, ...................................... �eSeptic Tank—Liquid capacit .t3 Lengt .. ..�7.... Width`.t.2,..�. Diameter................ Depth.�.�. ....�.. x Disposal Trench—Igo- ------------------- Width.................... Total Length....................Totalleaching area......... ......sq. ft. 3 Seepage Pit No..................... Diameter.....1_� Depth below inlet•.....7.. Total leaching area•..-.. .a...sq. ft. Z Other Distribution box ( Dosing tank ~" Percolation Test Results Performed by............ ............. r ..�........._... Date....../..v._k �� Test Pit No. 1.. n inutes per inch Depth o Test Pit.....-1* _ Depth to ground wat r..... CLI Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ---•-•••...-••---------•----•------••--•.........•••...................................................•-----..._..........••-------•-...................••-- 0 Descrip ' f Soil..W ... . . ......•--•---••---..... ..-•...................................................•---.._..............._....: .------.-••-•-•---..... ............. ... ... --••- ---•-- •--•- ------•--•---•----•-•-----...............--••--............................................................................................ U Nature of Repairs It rations—Answer when applicable............................................................................................... •-•-------------•-----•----••-•-•.....------......•--- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Dis osal System in accordance the provisions of:ITL; 5 of the State Sanitary Code— The undersigned furth r a rees no ace the s min operation until a Certificate of Compliance has been issue by the bo•r f health. G Signed ...........: . --- l�...... . Application Approved By.................. •.... ;...... �-- - ------ ----------. .. ,1•- � Date Application Disapproved for the following reasons:...........................................•-•--.......---•--••••-•-••••-•---••---••-......••-•--.............. ..............•--............-•-•--••-•--•--•---•--......•--......•-•••---•-•-.................----.........._.....-•--•------•-----••••--•-----....... ........ ............ Permit No... r' ... ........... Issued.- 71r --.Date...... im No—iff--. , . �, � FEB...............a�' THE COMMONWEALTH,OF MASSACHUSETTS BOARD OF HEALTH-,7 - ti `',�l lirtttiun fur Uiipusal Workg Tomitrurtion Permit Application is hereby made for a Permit to Construct`(yyL) or Repair ( ) an Individual Sewage Disposal System at: Location•Addr"ess or Lot No. .................Wt•...... ------------------------------- -•----•------------------------------•----------------------------------------------------------- (� Owner`l Address - Installer ��ii// Type of Building Address Size Lot .._....�.�q. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Gaa4 Other-Type of Building ....................�..•.. No. of persons............................ Showers ( ) — Cafeteria ( ) Q Other fixtures ------------------------------------ :f.f. f... �........ Desi Flow............ ...r� ........I./._.. lons er_per—person 6r da- . Total dais flpw........................ WW gn �, � P Pe' P ,,Y � ,Y ;, ..............garlon C� Septic Tank—Liquid capacity.`! gallons Lengtht/i...6.._.. Width:�_.. . Diameter................ Depth 4; /..__. ---- Disposal Trench—:`To..................... Width...................rTotal Length_..._..�.._...... Total leaching area.__............✓.sq ft. Seepage Pit No.........:-'""__.. Diameter.._.. _ --.. Depth below inlet_...��LY, Total leaching area- !-.�4 P� P - a - g .r -•r--._....sq. ft. Z Other Distribution box (V Dosing tank, ( V Percolation Test Results Performed by.......... :....... �cJ�c�/r--�-.._.._..(....._....-_. Date....../.v..........!. %y.._�.i Test Pit No. 1..� minutes per inch Depth ,of,�Test Pit_'_._�_.7.. . Depth to ground wat r.... .% .!.... _. LZ4 Test Pit No. 2................minutes per inch. Depth of Test Pit.................... Depth to ground water........................ 9 ........•----•-•-•-....•--•-•-----•-•...............•--•-...............-••---.......--..................--------...........---•--..................__...... 0 xDescription of�Soil..�. __..............•--•-•---•••--•-••-•....................•••----•.._......-•-•-••-----•--••---M •-----•--•-----.....•---•--•-•--•----•...._................---.....--•- c, .................•-•-- W l '. .. 1------------------=•------------------------------------------------ -- U Nature of Repairs or Alterations—Answer when applicable............................................................................................... --------•-------------------••-----------------------------------------...-•----•---...........................-----------------------•----------------••----..............................-----........ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance ith the provisions of TITLZZ 5 of the State-Sanitary Code— The undersigned further agrees not(lo race the sy'sfg in operation until a Certificate of Compliance has been issued by the board.of health. /l Signed. .......... z Application Approved BY----.------ .,�'v...!i-G'-.4���� . .....................-... �.r -.......���` r `. ......--`•-=. Date Application Disapproved for the following reasons:_.---.-••-------------------- ......... ------------------------ - --------------..............._. ..............•--...--•--...-•--•---•-•--•--•--......--•-•-....--•---•----...-------•------•--------.......------.....---•----•----•----......•--..._...._-•--•---•---•....`t t • --_..:.. Permit No........ - "" -. Issued...._. ZZf Dg, ,41e ;�_.._... ..... v f.•.v1r..w...T a_!.-.. 1�rwn ara--------------- -------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............. ........OF....... .................................. (9rrtif irate of Toutpliattrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (4.) or Repaired ( ) QG Installer _ ----- --------------- - ----..,...------.................•-••--............. has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated................-_.............................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..... ...�� ' - .... Inspector.:• /_•.'7`_ "�t/� i V•...•••••.•••*.o.*........•.d ...••••..»ww►.}.eM��f.Nw MbRsnr✓�w�✓w......... ............ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH FER..Z. .... Disposal Works Tonutrurtion Permit Permission is hereby granted..._ �-..�! �................................................................................................... to Construct O or Repair ( ) an Individual Sewage Disposal System at No.. .. �'_..s.��`!/�. !.... it/h�,n ..�1. - Y !IGL! v �ll`r __.... . Street ' T� _..as shown on the application for Disposal Works Const>�uction=Permi�I�o�. ._-._�;��r4Dated.._., '�"+_'�....:! � �.• Board of Health DATE..... ...< y: <....................................... A 1 / �` \ e, 3e ' Z �kl,I`OWN OF BARNSTABLE LOCATION �-aT Z-� <a^��h ��I�.es ��. SEWAGE # VILLAGE Wei �c� 3 0�- , -----.�--- ASSESSOR.S MAP LOT INSTALLER'S NAME di PHONE NO. 3 6 l7 - SEPTIC TANK CAPACITY_11 d,00 CLEACHING FACILITYAtype) Le4e� P►} (size) 606 des �IdO. OF IIED1tOOMS `_PRIVATE WELL C) PtJDLI�WATER • BUILDER OR OWNER ." 5j�6 DATE.PERMIT ISSUED: ' t It y� DATE COMPLIANCE ISSUED:i=G,� VARIANCE GRANTED: Yes No �SIy i 3 , i `I r.cae r� Su�orl f, paT� TL YE tJ '' \ c��. �� ��� ! �, PIPE PI7G�• I�q- /F1 Uh1l.ES.S OT�E2WlSE. r1pTEP• 1 -7 \� 44 S, P� Jo�r.1Ts Sft_l. �E M6GE �a'CE271(rNT. (�P, c-o�,i-S.E N v��tl 0 nEiTT64 G 7 Uc e �` ~ C 7 . 7'-4 i S 1FLb41 e-i�;erfosEo wo ov_oil L.`I At,1 D c,,A C Ll l.p K107 LiOT To �c E Or 41, --- -;F4- _ /tit / _v�zQyEe j .o i•�', ; C �Q ` � � � • � � --- -- Te:r ran � '� � � � � -- - s��.so,= — �3>>v e F- f' � � � -�/' _ I � �i4' -112 WaS�+ED STo�-lE '• ..z �.�E T`= = G��i.o►.l TdN IC T 1 ` ./`ems",,--�---'``��j,. � "�,,t-' �- Re�►��� i � ',C �,�'�;. � ' z- . f emsm H +i C Jfi.A #;. f/ AFUi cryL E GE '27� 6,4 -(ACMOUT?4, Moss ARe,I�� T. 03ALA'', R,L,rt,. FIRST FL. AT EL. 38.12' SYSTEM PROFILE TEST HOLE LOGS ACCESS COVER TO WITHIN 6" OF FIN. GRADE (NOT TO SCALE) PROVIDE INSPECTION PORT WITHIN ACCESS COVER (WATERTIGHT) TO 2% SLOPE REQUIRED OVER SYSTEM 6" OF FINISH GRADE ENGINEER: C YOUNG & /f MINIMUM .75' OF COVER OVER PRECAST WITHIN 6' OF FIN. GRADE OR TO FIN. GRADE IF UNDER DRIVEWAY C, OR TO FIN. GRADE IF UNDER DRIVEWAY E. BARRY F!r = �51 3 32.( WITNESS: �qh 0 2" DOUBLE WASHED PEASTONE 10 1 I' ELEV. 34,58' m RUN PIPE LEVEL / \ DATE- ELEV. 6/89 I �y \ Q FOR FIRST 2' L15-V o,� � 3' MAX. PERC. RATE _ < 2 MIN./INCH CRAIGVILLE BEACH RD, � GALLON SEPTIC 33.1't** o� 29.83' CLASS I SOILS P# 74195T TANK (H— 10 ) GA5 0 CI LOCUS ( ) BAFFLE `29.28' 0 29.0' I� O (� Cl C7 C� OC] � Q ELEV. 6" CRUSHED STONE OR MECHANICAL 8�o0� 2' a C] 0 C7 0 0 (] C1 o 0 '' z a COMPACTION. (15.221 [2]) oo25F� 0 27.0' 35.0 2 DEPTH OF FLOW = 4 ( 37 % SLOPE) ( 1 p 1% SLOPE) ( % SLOPE) 3/4 TO 1 1/2 DOUBLE WASHED STONE LOAMLi TEE SIZES: 12" INLET DEPTH = 10" OUTLET DEPTH 14" LOCATION MAP NTS 1 _ FOUNDATION— EXIST SEPTIC TANK 5' SEPTIC TANK 17' D' BOX 13' FACILITY 36" 32.0' ASSESSORS MAP 246 PARCEL 205 EL. 34.5' 4 "THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL UTILITIES AND ALL ST2 BUILDING SEWER OUTLETS AND ELEVATIONS >z�,j PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM POSED 1 PTIC CLEAN 31,25' GALL epTlc 31.0' MED/FINE TANK (11— 1 GAS N 23.0' SAND WITH BAFFLE 0 f � BALLS OF �6" CRUSHED STONE OR MECHANICAL C G W EXPE SILT AND S COMPACTION. (15.221 [21) OCCCOBBLES 5 VAL-'F UNSUITABLE SOit REQUIRED �. AROUND ON OF PE13iM£TER OF LEACHING �Z J FACILITY, DOWN ITABLE SOIL LAYER vb J (APPROX. H&TCfH ARE LACE WITH ! ` / Z�J� GAS LINE CLEAN-MED. SAND. ' PLA TINGS MAY NOT BE STRAIGHT 144" �a� 2 6.6), ONLY ONE FLAG SHOWING 23.0' ��-- - 2 NO WATER ENCOUNTERED _ �----------------- 2g� PfR PR[ C L ��aC� .� PROP. VENT WITH CHARCOAL FILTER ^ / ��� ----� / <0 NOTES: AND BUGSCREEN (FINAL PLACEMENT BY F\/ /\' CONTRACTOR WITH h 0MEOWNER / ^ 2q NOT ALLOWED I S V- L (h!SGS QUAD VAoI CONSUL7A7i0N) �,[., % i RUN � � � SEPTIC DESIGN: (GARBAGE DISPOSER IS ) UA.L w: iJ '' DECK o 04s LEC i DESIGN FLOW: 5_ BEDROOMS ( 110 GPD) = 550 GPD 2. MUNICIPAL WATER IS EXISTING �4z� ,, p 2, ` - MEIER yE7ER USE A 550 GPD DESIGN FLOW 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. T 8 SEPTIC TANK: 550 GPD O = 1 �'l-�Pw �Z''j``f%.� 4. DESIGN LOADING FOR D'BOX & CHAMBERS TO BE AASHO H- T 32,986 SFt 5. PIPE JOINTS TO BE MADE WATERTIGHT. ,h"` ) CORORCBRICKKKLANDING USE A _ GALLON SEPTIC TANK (ELEV 37.45' 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS. \` I ENVIRONMENTAL CODE TITLE V. i/ A ° I EXIST.DWELL. �'N 1 LA LEACHING: 7. THIS PLAN IS FOR PROPOSED SEPTIC SYSTEM ONLY AND IS NOT `FLOOR - 38.12• - SIDES: PERIMETER = 117' X 2 (.74) = 173 TO BE USED FOR ANY OTHER PURPOSE. AK 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4' PVC. 37 TH - BOTTOM: 516 SF (.74) = 381 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT �ws _ ' -- LPADO �2� _ ADD•N TOTAL: 748 S.F. 554 GPD INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED FROM BOARD OF HEALTH. USE (5) H-20 500 GAL. LEACHING CHAMBERS WITH 3' 10. PUMP & REMOVE (OR FILL W/CLEAN SAND) LEACH PITS & D'BOX STONE AT SIDES, 2.5' AT ENDS, IN CONFIGURATION _ 6S. ^ SHOWN (SEE DETAIL) PROVIDE APPROX. 44' OF 40 r LEGEND MIL LINER AT 5' OFF SAS IN ` ^ TITLE 5 SITE PLAN AREA SHOWN. TOP AT EL. 29.8', BOTTOM AT EL. 23.8' , L�� 1 100.0 PROPOSED SPOT ELEVATION S) SI L� f�2 92 OF 54 GREEN DUNES DRIVE 100X0 EXISTING SPOT ELEVATION IN THE TOWN OF: 0. oo PROPOSED CONTOUR WEST H YA N N I S P O R T 100 EXISTING CONTOUR PREPARED FOR: CHUCK & ANDREA BERGERON A03 t� EXIST. SEPTIC SYSTEM SHOWN AS PER 30 0 30 60 90 S- AS-BUILT CARD. CARD INDICATES A 1000 GAL. SEPTIC TANK WAS BOARD OF HEALTH INSTALLED. INSTALLER TO CONFIRM SIZE PRIOR TO INSTALLATION OF ANY APPROVED DATE MA SCALE: 1" = 30' DATE: JULY 17, 2004 PORTION OF SYSTEM. rn � -4. �+ off 508-362-4541 fox 508 362-9880 1 down cape engineering, inc. 0 8 CIVIL ENGINEERS LAND SURVEYORS SAS DETAIL 939 main st. yarmouth, ma 02675 04- 172_5BR 1" = 15' ARNE H. OJALA, P.E., P.L.S. DATE