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HomeMy WebLinkAbout0057 LONGBOAT DRIVE - Health E gb®at Drive lle. P 3 160 0 6� UPC 12543 No,53_LOR HASTINGS, C7PJ /93 - /6D Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 57 Longboat Drive °^M t.^'.q Property Address add, Robert& Marjorie Mellor Owner Owner's Name "^ information is Centerville Ma 02632 June 2ntl required for every 2017 �, page. City/Town State Zip Code Date of Inspection ' Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information �1 ��3&U on the computer, use only the tab 1. Inspector: key to move your cursor-do not Matthew Gilfoy use the return Name of Inspector key. B&B Excavation Company Name 374 Route 130 Company Address � Sandwich Ma 02563 City/Town State Zip Code (508)477-0653 SI 13640 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 6-2-17 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 9f 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 57 Longboat Drive Property Address Robert& Marjorie Mellor Owner Owner's Name information is Centerville Ma 02632 June 2"d required for every 2017 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System was in working order at time of inspection. Tank was pumped after inspection for maintenance. B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° 57 Longboat Drive M Property Address Robert& Marjorie Mellor Owner Owner's Name information is Centerville Ma 02632 June 2ntl required for every 2017 page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ® Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water - ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 57 Longboat Drive Property Address Robert& Marjorie Mellor Owner Owner's Name information is Centerville Ma 02632 June 2ntl required for every 2017 page. CityFrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: "*This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: f D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 57 Longboat Drive Property Address Robert& Marjorie Mellor Owner Owner's Name information is Centerville Ma 02632 June 2"d required for every 2017 page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. 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. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 57 Longboat Drive Property Address Robert& Marjorie Mellor Owner Owner's Name information is Centerville Ma 02632 June 2" required for every d 2017 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ❑ ® Was the facility or dwelling inspected for signs of sewage back up? ID ❑ Was the site inspected for signs of break out? ® ❑ . Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (Actual) _3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330gpd t5ins•3/13 - Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form. Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 57 Longboat Drive Property Address Robert& Marjorie Mellor Owner Owner's Name information is nd required for every Centerville Ma 02632 June 2017 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage d See below 9 ( Y 9 (gP ))� Detail 2016-54,000gallons 2015-60,000gallons Sump pump? ❑ Yes ® No Last date of occupancy: Current Date Commercial/Industrial Flow Conditions: Type of Establishment: NA Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.):` Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments "M 57 Longboat Drive Property Address Robert& Marjorie Mellor Owner Owner's Name information is Centerville Ma 02632 June 2"d required for every 2017 page. CityFrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: _Pumper driver Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1500 gallons How was quantity pumped determined? Tank size Reason for pumping: Maintenance Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): ' t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 c Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 57 Longboat Drive Property Address Robert& Marjorie Mellor Owner Owner's Name information is Centerville Ma 02632 June 2"d required for every 2017 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1996 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2 6 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: Town feet Comments (on condition of joints, venting, evidence of leakage, etc.): 4 Septic Tank(locate on site plan): Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 gallons Sludge depth: 7 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 c Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 57 Longboat Drive Property Address Robert& Marjorie Mellor Owner Owner's Name information is nd required for every Centerville Ma 02632 June 2 2017 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 29 Scum thickness 3 Distance from top of scum to top of outlet tee or baffle 6 Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? Measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank was in working order at time of inspection with liquid level equal to outlet invert. Tank was pumped after inspection for maintenance. Grease Trap (locate on site plan): Depth below grade: NA feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Fora, Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M .10 57 Longboat Drive Property Address Robert& Marjorie Mellor Owner Owner's Name information is Centerville Ma 02632 June 2ntl required for every 2017 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: NA Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: . gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 57 Longboat Drive Property Address Robert& Marjorie Mellor Owner Owner's Name information is Centerville Ma 02632 June 2ntl required for every 2017 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 11 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box was in working order at time of inspection with no sign of past backup or carry over. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No" Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): NA " If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 57 Longboat Drive Property Address Robert& Marjorie Mellor Owner Owner's Name information is Centerville Ma 02632 June 2nd 2017 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: (5) cultec 330s ❑ 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.): Leaching was in working order at time of inspection. No high staining, damp soils or lush vegetation were present. Cultecs have pert pipe slung inside. Pipe had no standing water or staining. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration NA Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 57 Longboat Drive Property Address Robert& Marjorie Mellor Owner Owner's Name information is Centerville Ma 02632 June 2nd required for every 2017 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: NA Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 c Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 57 Longboat Drive Property Address Robert& Marjorie Mellor Owner Owner's Name information is nd required for every Centerville Ma 02632 June 2 2017 page. CityFrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately GARAGE FRONT DECK B Al-14' B1-23' A2.27' B2-28' 2 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 57 Longboat Drive Property Address Robert& Marjorie Mellor Owner Owner's Name information is Centerville Ma 02632 June 2"tl required for every 2017 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: No GW @126"feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 7-22-1996 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: Plan on file with BOH. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 57 Longboat Drive Property Address Robert& Marjorie Mellor Owner Owner's Name information is Centerville Ma 02632 June 2"d required for every 2017 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3I13 Title 5 Official Inspection F�m:Subsurface Sewage Disposal System•Page 17 of 17 COMMONWEALTH OF MASSACHUSETTS M EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS d DEPARTMENT OF ENVIRONMENTAL PROTECTION a OW V� M ve TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY AS SESRfiW4yED SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A MAY 1 0 2002 CERTIFICATION TOWN OF BARNSTABLE HEALTH DEPT. Property Address: 57 Long Boat Drive Centerville Owner's Name:,,/;, ,,, Owner's Address: e 0 Date of Inspection: 3/29/02 T Name of Inspector: Timothy Lovell Company Name:Accurate Inspections Mailing Address:550 Willow Street MAP s` W.Yarmouth,MA. PARCM -e o Telephone Number: 508-771-3700 LOT _ - CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: X _Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority / Fails Inspector's Signatures ' Date: 3/31/02 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. 1 , Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 57 Long Boat drive Owner: Date of Inspection: 3/29/02 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: _x_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: _N/A One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please explain. _N/A The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or infiltration or tank failure is imminent.System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: _N/A Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): Broken pipe(s)are replaced Obstruction is removed Distribution box is leveled or replaced ND explain: N/A_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: I Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:57 Long Boat Drive Owner: Date of Inspection: 3/29/02 C. Further Evaluation is Required by the Board of Health: _N/A 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: _N/A_Cesspool or privy is within 50 feet of surface water N/A 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: _n/a_ 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. _n/a_ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _n/a_ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. n/a_ 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: Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 57 Long Boat Drive Owner: 'in, av,n., Date of Inspection:3/29/02 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No _x_Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _x_Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _x_Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _x_Liquid depth in cesspool is less than 6"below invert or available volume is less than'/z day flow _x_Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped _x_Any portion of the SAS,cesspool or privy is below high ground water elevation. _x_Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _x_Any portion of a cesspool or privy is within a Zone 1 of a public well. _x Any portion of a cesspool or privy is within 50 feet of a private water supply well. _x_Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] 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 Systems: N/A 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 I Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 57 Long Boat Drive Owner: J/,n Date of Inspection:3/29/02 Check if the following have been done.You must indicate`yes"or"no"as to each of the following: Yes No _x _Pumping information was provided by the owner,occupant,or Board of Health _x_Were any of the system components pumped out in the previous two weeks? _x _Has the system received normal flows in the previous two-week period? _x_Have large volumes of water been introduced to the system recently or as part of this inspection? _x _Were as built plans of the system obtained and examined?(If they were not available note as N/A) _x_ _Was the facility or dwelling inspected for signs of sewage back up? _x_ _Was the site inspected for signs of break out? _x _Were all system components,excluding the SAS,located on site? _x _Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? _ _x_Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption S on the site has been determined based on: rn System(SAS)) Yes no _x _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)] Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 57 Long Boat Drive Owner: 1,v% QU,,%-% Date of Inspection:3/29/02 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):_3_Number of bedrooms(actual):_3_ DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): _330_ Number of current residents: 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):_n/a Seasonal use: (yes or no):_no Water meter readings,if available(last 2 years usage(gpd)): . cry)3600 6�1 CZ�I�ySao� 6R1 Sump pump(yes or no):_no Last date of occupancy:_Current COMMERCIALANDUSTRIAL Type of establishment: N/A Design flow(based on 310 CMR 15.203): end Basis of design flow(seats/persons/sgfl,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: Barnstable sewer 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 _x Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank _Attach a copy of the DEP approval _Other(describe): Approximate age of all components,date installed(if known)and source of information: 1996 Were sewage odors detected when arriving at the site(yes or no):_no Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 57 long Boat Drive Owner: It Date of Inspection: 3/29/02 BUILDING SEWER(locate on site plan) Depth below grade:_2'6"_ Materials of construction:_cast iron _x40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): No evidence of leakage condition looks fine SEPTIC TANK:_z (locate on site plan) Depth below grade:_1'8" Material of construction: x 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: 1500 Gal Sludge depth Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness:_1" Distance from top of scum to top of outlet tee or baffle:_6" Distance from bottom of scum to bottom of outlet tee or baffle:_15" How were dimensions determined: Field Measurements Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): No evidence of leakage levels looked fine at invert out,structurally fine tee's in place GREASE TRAP:_N/Alocate 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.): Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 57 Long Boat Drive Owner: pv,,,n Date of Inspection:3/29/02 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: N/A Material of construction: concrete metal fiberglass_polyethylene other(explain): Dimensions: 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:_x (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert:_0" 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.): Liquid levels are fine at invert out no sign of leakage PUMP CHAMBER: N/A(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.): Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:57 Long Boat Drive Owner: .J,, Date of Inspection:3/29/02 SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type Leaching pits,number:_ Leaching chambers,number: Leaching galleries,number: _x_Leaching trenches,number,length: 1 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.): System consist of 5 Cultec 330 recharges surrounded by 2'of stone CESSPOOLS:—N/A(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:_N/A(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.): Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 57 Long Boat Drive Owner: Am i2aar, Date of Inspection: 3/29/02 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. %06A t 0f 66(e46,6 I I?OAIO Oor 11614C ,a a3 o a�, Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 57 Long Boat Drive Owner: -11rn Q,,4 n/ Date of Inspection: 3/29/02 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water4?,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: Checked with local excavators,installers-(attach documentation) __X Accessed USGS database-explain: You must describe how you established the hi ground water elevation: Y �1�' f �as.v7A�irn CA-*e �ir�arl dA4,e. Cod WA-�,e- Ubl: ee,7400.- IMR 4 ro✓Kt��cd &K �24#1 86d WA-40- c"Jel/ StJw 46a A4� Y"q'b AJJB'Jed, 7 f , "_ loU•cue, `I� 70 S 6 Permit Number: Date: Completed by: HIGH GROUND-WATER LEVEL COMPUTATION Site Location: ,:�-,7 Zo n�e /I/A� Lot No. Owner: J—//" QtZs /7- J Address: S7 Contractor: Address: 6Y6 'd,ltoog rS4-- (4-r4,ytS (�Notes: v�o oor /A S�cc./s o(�QrT��'�k ✓ z'a©© �vaie� �� �{6� v STEP 1 Measure depth to water table tonearest 1/10 ft. .............................................................................. .Date month/day/year STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine: OAppropriate index well.................................................... db' OWater-level range zone ..................................................... STEP 3 Using monthly report "Current Water Resources Conditions" determine current depth to water level for index well ........................... InAfc4,ZW,?_ q8d month/year STEP 4 Using Table of Water-level Adjustments for index well (STEP 2A), current depth to water level for index well (STEP 3), and water-level zone (STEP 2B) determine water-level adjustment ............................................ STEP 5 Estimate depth to high water by subtracting the water- level adjustment (STEP 4) from measured depth to water level at site (STEP 1) ............................................................................. d3 / 0 0 00 KS- le) s13� Figure 13.--Reproducible computation form. 15 _ _ v TOWN OF BARNSTABLE � L6--k. TION 7 10,V6 r60,41 ORI t/6 SEWAGE # V LLAGE 14ed¢�✓✓���e ASSESSOR'S MAP & LOT �r3 INSTALLER'S NAME&PHONE NO. Of 10 104�i �°rioa.S�i✓���ar� 77/-S'� 5 SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) 5 3Y-) G°W e e— NO. OF BEDROOMS BUILDER OR OWNER (1,- k AMAta^ u� Ir/v✓S/Oui��/ �/s� Q�/,s?il PERMIT DATE: I SS COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by G.a izAG F - �a2oAli of a a$, ` 5r TOWN OF BARNSTABLE LOCAInON L&—, 6.3 SEWAGE # 6 - 3 -5 VMLAGE Ci-nQ's�?i/t L-L- ,-- ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. MZQ U'�_�-i tt re&�'- —7-7/-gJ'fl SEPTIC TANK CAPACITY � v o LEACHING FACILITY: (type) C—a— (size) NO.OF BEDROOMS BUILDER OR OWNER r t ,4,-aA E i U&I 11 e t 6 b i0a ` I PERMUDATE: COMPLIANCE DATE: ' Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by iy ` J qo, _> z f ASSESSOPSMAP110: : No. CJ' ' � b,� FEE THE COMMONWEALTH OF MASSACHUSETTS &Q-tASTASUE MASSACHUSETTS &kpytirattun for Pisposal Sgstem (gonstrnrtion Ilermit Application is hereby made for a Permit to Construct(/or Repair( )an On-site Sewage Disposal System at: Location Address or L o Owner's Name,Address and Tel.No. LOT 0:3i L0N6G30trr OQ,,Vs CNAMPiON eUNt-DE9-5, G0E1J'T1 2_V t LLE nNi '3O O O A'� S-r$SET, S u tT E t S T PEM�(3R01LE , Me,_._oL35� sob SN, (44,6 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. �ORrOw-Tt e>7cvStQ.�c.TotJ , ttiC., �A�tT�-D_ $ �►YE, ►+.�c. -1�� wArLEBY 9_0Ata $\Z MAkQ SPWS_T MARSTOW5 WULS 02-G q t3l Type of Building: Dwelling No. of Bedrooms Garbage Grinder(Na) Other Type of Building No. per Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 4-g-(a gallons per day. Calculated daily flow 33® gallons. Plan Date J u L-f 2 L. I!q {(a- Number of sheets Revision Date Title PIZEttMiNAM St'CFL- PLAN AT r_Oi G,S, 1om6P"nA'C DPkyE .C.ENiTFkyi ,AAA Description of Soil SEE A.4TA.LIAED ?LAW . Nature of Repairs or Alterations(Answer when applicable) Date last inspected: JUL-4 o . 194,t, Agreement: The undersigned agrees to ensure the construction and maintenance of the aforedescribed 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 Certificate of Compliance has been issued by this Board of He Ith. Signed Date 6 Application Approved E Date -1 4� Z--zg Application Disapproved_for the following reasons Permit No. � '• Date Issucd � "' S- TOWN OF BARNSTABLE LOCATION 6.3 A� �a� SEWAGE # 363 VILLAGE Cc— ASSESSOR'S ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE N0. �Zi U-Lc� l't ��� I Pam- -77 SEPTIC TANK CAPACITY tS OTJ fit_ _ LEACHING FACIL17 Y: (type)1 iZ��t�(� size JL NO:.OF BEDROOMS ICT e- Jlao BUILDER OR OWNER PERMI.TDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge'of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by A�jq Do No. �b 3 *FEE THE COMMONWEALTH OF MASSACHUSETTS �iARNSTA_P�L.E MASSACHUSETTS ckyyltrattun for PieposalSgstent Tonstrurtenn jhrrait Application is hereby made for a Permit to Construct (V�or Repair( ) an On-s:te Sewage Disposal System at: Location Address or L o Owner's Name,Address and Tel.No. LOT (05., LONGr304T 1C2,,j CHAMPION l3uNl.DE9S, 1c - GCN�FJZvlll_l` n✓\/i 300 oAL� STWcET, SUt rtiE iS S PEMr3R0r C Mn �L35� sot n (o(c4 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. SOR7-ow7Cl G0NS79_�1cT\0N , I1vC . 63AXTCQ $ WYE, I+JC . -GS wA��BY V_0AV $\Z M.XAkQ ST2C� M/�RSTOtJS It_LS 02(04$ oST'C-9-wi.LE "A OZ.LSS Sot d-Z$ gt31 ' Type of Building: Dwelling No. of Bedrooms TI�� Garbage Grinder(NO) Other Type of Building No. per Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 4-4[o gallons per day. Calculated daily flow O gallons. Plan Date .�U L'-1 2'L. I!g9(a — Number of sheets I Revision Date Title .1PL2EL11Y)iNA2Y S t-rt= PLAN AT t_ai j?, L oKjGPtntA--r D2\vE . rEn,TE"Ltvt��E ,N�p Description of Soil SEE AT1rA,(_kAE0 PLAN J Nature of Repairs or Alterations(Answer when applicable) Date last inspected: JUL l 9 {qq(, Agreement: The undersigned agrees to ensure the construction and maintenance of the aforedescribed 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 1 Certificate of Compliance has been issued by this Board of He lth. Signed Date ��� Application Approved Date � Application Disapproved for the following reasons Permit No. � � (_9 Date Issued THE COMMONWEALTH OF MASSACHUSETTS AZ tVS i ARk_E MASSACHUSETTS Certeftr�to of C10myltttnre THIS IS TO CERTIFY, thatYthe On-site Sewage Disposal System installed(/) or repaired/replaced ( ) on by Ro21?c�t_c-Tr L %INC .for rkAAi.APK)tV P,t,I��r2S at 1vC tJ—W�km.-1 Oasbeen constr cted in I accor�ce wit he pro isio s of Title 5 and the for Disposal System Construction Permit No. A dated '" Use of this system is conditioned on compliance with the provisions set forth below: The issuance of.this certificate shall not be construed as a guarantee that the system will function as designed. This Certificate expires on J'� DATE AID G/ i Inspector .� THE COMMONWEALTH OF MASSACHUSETTS No.��` 315/. ��Q�I`��� �-� , MASSACHUSETTS FEE ,VjsVIIsttl ,,SVstem Cnuns#rixc#tIIn ermt# 0---7r Permission is hereby granted to to construct( ) or repair( )an On-site Sewage System located at - r and as described in the above Application for Disposal System Construction Pe'amt. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions: y All construction must b!�e_mple!�)w7i�i�,thiree years of the date below<::__ DATE — / Approved by FORM 1255 Rev.3/95 A.M.SULKIN CO.-BOATON,MA l J y' ! 11 ;..2wAL� coNG. 3-`11a' N/bFf - EXIST EX 6T• w �7 9 � a ,v�cl 5°xlp6 7,JTE27D2 D.wP _9ccY co) �j�;Lt,S N1vU.Al6LL / GE1LtN6, T3 r c�PrTat t 3'x6 8"t- I -_ S+ e E 7 R.O lwp c+ M tU p + P2//Lt 45 \n X --g.m 3 7'a" jbM� 67-'AAP Pr Nv R�CZur P--EU \" v I _$64-0 PrPEs t r 1 + /u4Lt y By Csl nr�Zl LAIAIL.e�S / y ti!a p UNT-I rJ\51-t�'D %Q t/\!-t= ON L-�� 0x I/ ��C �O is, 0T56°C-D .� hQ y 1• - axy �T SILL w j I GlarNOT-I " a = �xr5n.uv WJ1-C.Gy fidoU:c �aCONL. ccW-t�fi n/o GH/1NG-7=j 3m C`DX6� ` - r Avti D k N�Q �GOok a Q P�iPt PIPE_.. p �•�t I - H 1 6- 7'0 cowCS ro 3 t EXPOS 21,3 T+- " DPM1n P2OO7=/,v6 a / rcXL,,7-7 N& O/U-1 - 'S CL/%NT A 3 :y NFw a r WA - -, W _ ;f1F ; PA WATER- RS 3-7" NEw IWAL(,S ,Y° EDGE of By GLI�aI% n t S i/t 125 ,t 5 S HOcJ nJ l oFF I h s 4/hFfTINC� F Elr3G. ('uT�r_-TS �/101zZ/ AGGEf j p0 O Ia R$GE"Sj��D G"ROv.v7 - PANfL GLtr Pt 0 ! _LOC-+7-7Ox) 7D SE TJON'� O/J 37 TL 1D I �7Ar�5 Avo GHAN0c-3 �UTL T/7 7a G0L * - U Ar-Ft Ar I-S 14 Pp W Z RE r,�STA4- CX15 LALLyS N/1- ' 2.4 rL - DOOK-J 8 C../t0/7 T/ I N `: •3bX &PA n1-EL fl'A50N I i5 60A(,. 2 30X66 P/A E5 /SbT INT. -F2-ENGF/ ;ax 2p C14' (oP>ss4 t- UNT-raJL5f-tED V� �7-•h r�a ` MA]700 T� � I • I N�rJ r CK FouN�4-T 0 A.) PLxt-n1 - a a, ,} thus olaw\,ry,Were prepared b /q-EL LO t2 �1-5EM�NT P_r A-10 L_ Y Caprzzr Hume C Improvement for the use of Capizzi Home tmprovement t emPlo;iees;nrf',:bcontractors. Anyone using these SCALE:/�"�/Sri APPROVED BY: �REVISED ;.ol:i•'er;yy all axistin gcornllLons. DATE: ? -OS oo;(•,rruty to local ere; building cod fyt!'Icy of thesa JraWrngs. Cazz Home / 4APo ,re r7Improvc,n�jtdr= avnsany respon$ibility for an l ((}} problems which arise from the 1 and all use of these Coro f' by DRAWING NUMBER Anyone other than employees&subcontractors of Cf1 P/77/ NoM� /[�J/� ya8-9S/8 _ io F/ f Capjzzf Home improvement t op 0 e ; i Cos 4 ublic o ��_ •p . Landing 6•.o " LOG OF SOIL EVALUATION ° p DATE: 07-09-96' No. P - 8726 SOIL EVALUATOR: JOHN R. ELLIS, BAXTER & NYE, INC. BOARD OF HEALTH: EDWARD F. BARRY, TOWN OF BARNSTABLE LOCAMON MAP EXCAVATOR: SHORELINE CONSTRUCTION HYANNIS QUADRANGLE FND EL = 103.5' #1 SCALE: 1:25,000 FG = 102.5' TP #2FG = 103' S CULTEC RECHARGER 330 CHAMBERS EL=96.4' EL=92.7' ASSESSORS MAP 193 PARCEL 160 100.0' 0 EL=96.4' 0 EL=92.7' 101.0' O FOREST DEBRIS 0 FOREST DEBRIS ZONES: 100.8' 1500-GAL 0-1" EL=96.3' 0-1" EL=92.6' SEPTIC TANK OE 100.4 100.2' LOAMY SAND E LOAMY SAND 100.6' AQUIFER PROTECTION OVERLAY DISTRICT BOTTOM EL = 98' 1"-5" EL=96.0' 1"-5" O EL=92.3' OB MEDIUM SAND BO MEDIUM SAND ZONING DISTRICT: RC BEDDING AS 55" ¢5" EL=92.7' 5"-45" EL=89.0' TOP EL=92.4 MINIMUMS PER TITLE 5 - PERC Cl MEDIUM SAND 2.5' M BOT EL=91.4' AREA = 43,560 S. F. 10 _ 10.5 7 4� s' 4s-so' EL=ss.s'- FRONTAGE = 20' - SAND CO MEDIUM WIDTH: = 100' . , C2 SANDY LOAM 90"-108' EL=87.4' FRONT SETBACK.= 20' C3 MEDIUM SAND 45"-120' EL=82.7' SIDE SETBACK = 10, 108"-126" EL=85.9- REAR SETBACK = 10 BUILDING HEIGHT 30' DEVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM NO GROUND WATER ENCOUNTERED (OR 2.5 STORIES IF LESS) - IN EITHER TEST HOLE NOT TO SCALE FLOOD ZONE: C 4" PVC PIPE 37' 6" - -- - - - -- --- - N Cp i DIST BOX ,• d 40• , 'l PLAN VIEW - LEACHING CHAMBERS NOT TO SCALE FINISH GRADE DESIGN FLOW E SINGLE FAMILY 3 BEDROOMS NO GARBAGE GRINDER i 'o DESIGN FLOW: 3 x 110 GPD = 330 GPD w - - - - - 1/8" - 1/2" _ - - - - - STONE SEPTIC TANK: 330 GPD x 200% - 660 GPD _ USE 1500-GALLON SEPTIC TANK :a ' < '4'. 4 , LEACHING SYSTEM DESIGN: 4p o r, . i •.' 3/4DOUBLE/2. USE 6' CULTEC RECHARGER 330 CHAMBERS WITH 2' STONE 00' d •. a N e ,, • • ,.A . . WASHED APPLICATION AREA REQUIRED: ' CULTEC 330 STONE 330 GPD _ 0.74 GPD/SF = 446 GPD APPLICATION AREA DESIGN: ( / 52' SIDEWALL AREA = 40' .x 2' x 2 = 160 SF 8, BOTTOM AREA 40' x 8' 320 SF TOTAL AREA - 480 SF I / PERCOLATION RATE: LESS THAN TWO ,MINUTES PER INCH j CROSS--SECTION OF CHAMBER SOIL CLASS I !V NOT TO SCALE Q` a F 40�( Q P T0l�'� CB/OH FND EL = 100.0' 9 o OF. 99. 100 (ASSUMED) `�`'P rt-- G� � 102 w / 104 106 ¢g1g6 x 10577- 107.3 100.4 �. CB/DH D \ x. x 10 .0 07.6�-r/S� / im 100.2. E Fq Mc c / 9PA\OING TO RE 107.5 7 y{i v,�� a 9 . � F OWED 033 POLE #3 .0 x 104.7 7.2 DRIVEWAY � CB/DH FND 106 \ \ PROPOSED 10 7.8 Fck 107.6 x 10 104 / X\ .4 \� CUT LINE / 102.1O \ PARKING 107.7 G i 1"07.2 AREA x O \ x 102.6 IS-nSG 100 O'PO c�0 O / \�/ gy x 103. ,0- F x 1 0.3 / w ROPO S• moo_ 100 104 PRELIMINARY SITE PLAN -p 102 x 98.6 � 100 o`' p` °�h ss 100 AT s, x 96. 96 '9 ,�°Q OJT� 98 LOT 63 7 L 98 ONGBOAT DRIVE G �'� �A 396.4 96 96 A y 9 4 �. TH #1 CENTERVILLE, MASS. 0 , 94 96 NTH 12 x 93.1 y 092. FOR 94 x 94.8 92 -9� 92 CHAMPION BUILDERS 90 .1�x ,88.7 90 SCALE: 1" _ 20' JULY 22, 1996 � 88_ 88 BAXTER & NYE, INC. L 0 T 6 3 ss -- ---� I .812 MAIN STREET OSTERVILLE, MASS., 02655 �8 x 86.7 x 86. (508)-428-9131 21,795 S. F. t \4 86 \` o - x 82.4 � o GRAPHIC SCALE IV84fy 20 0 10 20 40 80 ,SRO S$" W ( IN FEET ) / ' x 81.0 1 inch = 20 ft, / 2 i m1 x 81. LOT 65 . o�F fq roN'� Z j N/F BINDA Wq7tR NOTES: TOWN WATER WATER SUPPLY FOR THIS LOT IS MUNICIPAL WATER LOCATION OF U1IUTIES SHOWN ON THIS PLAN ARE APPROXIMATE. AT LEAST 72 HOURS PRIOR TO ANY EXCAVA11ON FOR THIS PROJECT THE CONTRACTOR SHALL MAKE THE REQUIRED NOTIFICATION TO DIG SAFE (1-800-322-4844) AND APPROPRIATE WATER DISTRICT FOR LOCATION DATA. THE CONTRACTOR IS REQUIRED TO SECURE APPROPRIATE PERMITS FROM TOWN AGENCIES FOR CONSTRUCTION DEFINED BY THIS PLAN. INSTALL RISERS AS REQUIRED`TO WITHIN 12" OF FINISH GRADE. fOF ALL STRUCTURES BURIED FOUR FEET OR MORE OR SUBJECT TO Cyr PETER VEHICULAR TRAFFIC TO BE H-20 LOADING `�, SULLIVAN H NO.29733 y o. 74 3 CIVIL 0 a-�/23f 9Ca 96078 (PPP01.DWG) ° 7�2�