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Home My WebLink About0091 STRAWBERRY HILL ROAD - Health 91 Strawberry Dili lid Centerville A = 246 -- 046 SMEAD Nu.V153LOR UPC 12534 smeed.c®m • Made In USA vsCYC(�� W w FW Lum rA iFfti FmcT UPj CERY]RED SOURCING If IVIURA01 u4AIM E / 3 Commonwealth of Massachusetts a S . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 91 STRAWBERRY HILL RD Property Address MARK OMALLEY Owner Owner's Name information is — rQIS 1 V I I Q/ required for MA 02601 6/10/11 every 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:Whenfilling out A. General Information When forms the computer, r,use 1. Inspector: only the tab key to move your DOUGLAS A BROWN cursor-do not Name of Inspector use the return key. DOUGLAS A BROWN INC Company Name P.O. BOX 145 Company Address CENTERVILLE MA 02632 City/Town State Zip Code 508-420-4534 S14297 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 ��/�--- — 6/10/11 Inspecto 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 91 STRAWBERRY HILL RD Property Address MARK OMALLEY Owner Owner's Name information is HYANNIS required for MA 02601 6/10/11 every page. Crtyrrown 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: ® 1 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. 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): f5ins•09I08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 91 STRAWBERRY HILL RD Property Address MARK OMALLEY Owner Owner's Name information is HYANNIS required for MA 02601 6/10/11 every page. Cltyrrown State Zip Code Date of Inspection B. Certification (cont.) 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•09/08 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments '~ 91 STRAWBERRY HILL RD Property Address MARK OMALLEY Owner Owner's Name information is HYANNIS required for MA 02601 6/10/11 every page. City/Town 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 coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or dogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6"below invert or available volume is less than Y2 day flow t5ins•09/08 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 °( 91 STRAWBERRY HILL RD Properly Address MARK OMALLEY Owner Owner's Name information is HYANNIS required for MA 02601 6/10/11 every page. Cltylrown 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 y m 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 I I 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•09MB Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 91 STRAWBERRY HILL RD Property Address MARK OMALLEY Owner Owner's Name information is HYANNIS required for MA 02601 6/10/11 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 t5ins•09= Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 91 STRAWBERRY HILL RD Properly Address MARK OMALLEY Owner Owner's Name information is HYANNIS required for MA 02601 6/10/11 every page. Cdy/Town State Zip Code Date of Inspection D. System Information Description: ACCORDING TO AS-BUILT SYSTEM CONSISTS OF A 1500 GALLON TANK D-BOX AND 5 INFILTRATORS IN AN 11X39 FT AREA Number of current residents: Does residence have a garbage grinder? ❑ Yes ❑ No Is laundry on a separate sewage system?(if yes separate inspection required) ❑ Yes ❑ No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ❑ No Water meter readings, if available(last 2 years usage(gpd)): Detail: 2009---153 2010----172 Sump pump? ❑ Yes ❑ No Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: 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•ogm Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 91 STRAWBERRY HILL RD Property Address MARK OMALLEY Owner Owner's Name information is HYANNIS required for MA 02601 6/10/11 every page. Cltyrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): WEEKEND/SUMMER HOUSE General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ❑ No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system(yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 91 STRAWBERRY HILL RD Property Address MARK OMALLEY Owner Owner's Name information is HYANNIS required for MA 02601 6/10/11 every page. Cltyrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed(if known) and source of information: ACCORDING TO AS-BUILT CARD SYSTEM INSTALLED IN OCT OF 2000 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑cast iron ❑40 PVC ❑other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints,venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene y El 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 Sludge depth: VARYING BUT LIGHT t5ins•09108 Title 5 Offxial Inspection Forth:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 91 STRAWBERRY HILL RD Property Address MARK OMALLEY Owner Owner's Name information is HYANNIS required for MA 02601 6/10/11 every 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 Scum thickness 0 Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? 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 LOOKS CLEAN AT THIS TIME i Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fiberglass ❑polyethylene El 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•09i08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 91 STRAWBERRY HILL RD Property Address MARK WALLEY Owner Owner's Name information is HYANNIS required for MA 02601 6/10/11 every page. Cltyrrown 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: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene y El 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 Mrs•09/08 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 91 STRAWBERRY HILL RD Properly Address MARK OMALLEY Owner Owner's Name information is required for HYANNIS MA 02601 every page. City/Town 6/10/11 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" 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.): BOX LEVEL NO LEAKAGE OR SOLID 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.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: NO OBSERVATION PORTS FOUND t5ins•09/08 Title 5 Official Insp ection Form:Subsurtace Sewage Disposal System•Pape 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 91 STRAWBERRY HILL RD Properly Address MARK OMALLEY Owner Owners Name information is HYANNIS required for MA 02601 6/10/11 every page. Cftyrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 5 INFILTRATORS ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/altemative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil, condition of vegetation,etc.): NO SIGNS OF HYDRAULIC FAILURE IN AREA OF S.A.S Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•09108 Title 5 Official Insp ection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments '< 91 STRAWBERRY HILL RD Property Address MARK WALLEY Owner Owner's Name information is HYANNIS required for MA 02601 6/10/11 every page. Citylrown 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: Dimensions Depth of solids Comments(note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts ' Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments y< 91 STRAWBERRY HILL RD Property Address MARK OMALLEY Owner Owner's Name information is HYANNIS required for MA 02601 6/10/11 every page. Cltyrrown 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 t5ins•09)D8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 117 Commonwealth of Massachusetts ,p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 91 STRAWBERRY HILL RD Property Address MARK OMALLEY Owner Owner's Name information is required for HYANNIS MA 02601 every page. City/Town 6/10/11 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: 5.4 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: 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: RECORDED ON TO AS-BUILT Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•09)08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments "Y 91 STRAWBERRY HILL RD Properly Address MARK OMALLEY Owner Owners Name information is HYANNIS required for MA 02601 every page. Cltylrown 6/10/11 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 TOWN OF BARNSTABLE Df`I �� C, LOCATION `� / 57�41cA�6'eeV /4`/ '��SEWAGE # `3 VILLAGE ,u ac ��"SSESSOR)'S MAP&LOT INSTALLER'S NAME&PHONE NO. � e t ✓�t t'S C``!�l Gi C f' 5-3? —0o SEPTIC TANK CAPACITY Zoo A .01 LEACHING FACILITY: (type)- t�� %ar �f�l (size) ,I x' ' 7 r NO.OF BEDROOMS BUILDER OR OWNER 1)4 'CArQ SO& " ,/✓(;> � ; PERMITDATE: COMPLIANCE DATE: 101 13JO0 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 � 66 Assessing As-Built Cards Page 1 of 1 TOWN OF BARNSTABLE LOCATION �7 I = r�cc,, rpy 1�.��PQSEWAGE # VILLAGE ' ASSESSOR'S MAP&LOT INSTALLER'S NAME&PHONE NO. Pn tom_ f�Gl C.e SEPTIC TANK CAPACITY /J F7'�i�t �. LEACHING FACILITY: (type IPP (size) X .3 1'10.OF BEDROOMS BUII.DEROROWNER MC—L J Soil t�, ,�J� VA PERMIT DATE: COMPLIANCE DATE: ' Q 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 3QO feet of leaching facility) Feet Furnished by f� a a I 36 1 00 V31 y a .0 � S `http://www.town.bamstable.ma.us/Assessing/PIMdisplay.asp?mappai=246046&seq=1 4/12/2011 TOWN OF BARNSTABLE LOCATION .P�SEWAGE # �U J�� i VILLAGE j ASSESSOR'S MAP&LOT INSTALLER'S NAME PHONE NO. S /• C d1 Ct L f' ir?� _00 j SEPTIC TANK CAPACITY _ � ..(fi wry. - CHING FACILIT!'. 40 "9 J.OF-BEDROOMS -- BUELDER OR OWNER `� ►G C /S t�w PERMITDATE: COMPLIANCE DATE: jSeparation 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) Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) Furnished by Feet i . ----------- , i 9 � I , _• 1 No. /,� t1 ♦ FEE L p COMMONWEALTH OF MASSACHUSETTS Board of Health, 8�12��J^1rJ MA. APPLICATION FOP, DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct Repair( ) Upgrade( ) Abandon( - J Complete System ❑Individual Components Location "i 5-raA -/5e Wu- f?-V Owner's Name \j ; "I C,WAL(,50 0 Map/Parcel# 2�� - G�-(o id'�w"`^",�° Address 473 �9Ir3es"r ceN3TErzvlLLGi lam,(le,, Lot# G�{p Telephone# Installer's Name Designer's Name OOZMPI� Address D ® ` — Xo6 Address 10 .M A-(LS H \/t aA-*� VZAj Telephone# elephone# Type of Building 7-� tJy Lot Size S31 000 sq.ft. Dwelling-No.of Bedrooms Garbage grinder ( ) Other-Type of Building No.of persons Showers ( ),Cafeteria ( ) Other Fixtures Design Flow (min.required) -5--3>0 gpd Calculated design flow �9(2D Design flow provided 4G F gpd Plan: Date 06.4 P-a l 00 Number of sheets 1 Revision Date Title SI 17:�- I S eWA.;6 E Oi SQDSAC, Ql-40 UfF 4(., *-5 1 a4a&-e9 Description of Soil(s) Soil Evaluator Form No. Name of Soil Evaluator LAJrJL-W- Cr40t.('-L-/ Date of Evaluation 06/Z7/Vd DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agreed to not to place the system'in operation until a Certificate of Compliance has been issued by the Board of Health. Signed Date r Inspectio s Nf• i �• " v6,, ""�"" `z: +' FEE T7 COMMONWEALTH OF MASSACHUSETTS Board of Health, ' 8A1?-0 5! 8C , MA" APPLICATION FOP, DISPOSAL SYSTEM CONSTRUCTION PUPMIT Application for a Permit to Construct Repair( )�Upgrade( ) Abandon( - Complete System ❑Individual Components Location 5("(L��/(- '�i1 HIU 2V Owner's Name \,C�.z (u -4-WA(✓CSox) •Map/Parcel# oq(0 Address.413 `t;2(rvEs7- GEti 1e2U1 U-Z t-4/p, Lot# ..GF G Telephone# Y:D O- 2-0 Z Installer's Name Designer's Name 'l. 09-Mp.tJ G . t �E Address Y Lod Address.—'IC d.S(1 J 1 Elm %Z�E M P 1"At_f� Telephone# Telephone# GA 8. I 1�)2,0 �. t' � Type of Building ��El l tJG Lot Size Z�t � sq.ft. - f Dwelling-No.of Bedrooms Garbage grinder ( ) Other-TV of Building ` „ � � No.of persons Showers ( ),Cafeteria ( ) Other Fixtures i De �q"sign Flow(min.required)i '` 3�� gpd Calculated design flow �a'r,.-a Design flow provided `1'G 3 gpd Plan: Date 06--V Ltb/ UU Number of sheets 1 Revision Date Title SI T� I � r, ( , *2 0 5TJ'I)r2��ZR-y 1 Zc�✓J Description of Soil(s), 'e o Soil Evaluator Form No. I Name of Soil Evaluator LAJQ19MS• C4ulZ!j Date of Evaluation OG�Z 7�UU 1t` 1 DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agree to not to place the system'in operation until a Certificate of Compliance has been issued by the Board of Health. r � fb - /? Signed Date -7 - 5 ;L ro ar ea : Inspectiol F No.- 3 � FEE ( oa E f� ASSACHUSETTS Board of Health, _ MA:•, C ERTIFICAIE OF COMPLIANCE Description of Work: ❑Individual Component(s) ❑Complete System The undersigned hereby certify that the Sewage Disposal System; Constructed (I*f,Repaired ( ),Upgraded ( ),Abandoned ( ) by:at 7 a °/ has been installed in accordance with the provisions of,310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No. dated Approved Design Flow ! (gpd) Installer /`�d o P5 Designer: 6 4191 Inspector: j v _ I9✓r 1 te:l -� The issuance of this permit shall not be construed as a guarantee that the systexiill func 'on as designed. }f No. FEE aQ COMMONWEALTH OF MASSAC14USETTS f Board of Health, , MA. DISPOSAL SYSTLM CONSTRUCTION PERMIT Permission is herebygranted to; Construct(-f Repair( ) Upgrade( ) Abandon( ) an individual sewage disposal system at / 1 J� H '-(� ice- as described in the application for Disposal System Construction Permit No. dated Provided: Construction shall be completed within three years of the date of this permit. All local conditions must be met. Form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date Board of Health ti v Permit Number: Date: Completed by: r HIGH GROUND-WATER LEVEL COMPUTATION I Q / ; Site Location: /� cs!/ ��J��. �7��i /494� Lot No. i Owner:GU Address: 6% -- i Contractor: Address: Notes: STEP 1 Measure depth to water table tonearest 1/10 ft. .............................................................................. .Date month/day/year t 1 . j STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine: O Appropriate index well.................................................... MIvJ29 �i OWater-level range zone ..................................................... G t STEP 3 Using monthly report"Current Water Resources Conditions" determine current depth to water level for index well Oo Od month/year l 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 3" STEP 5 Estimate depth to high water by subtracting the water- I level adjustment (STEP 4) from measured depth to water I levelat site (STEP 1) ........................................................................................................... �O ' 1 � 1 Town of Barnstable P# Department of Health,Safety,and Environmental Services �11129' Public Health Division Date 367 Main Street,Hyannis MA 02601 enruvareerra. ib /Y lfnlNor� Date Scheduled /?ITime Fee Pd. d(� Soil stability Assessment for Sewage Disposal Performed By: Witnessed By: -> LO+ ATION & GENERAL INFORMATION Location Address wner's Name 7S1 i4e �3��y Ae0 'Address Assessor's Map/Parcel: '09 46, 14 G Engineer's Name NEW CONSTRUCTION ✓ REPAIR Telephone# Land Use 21�6iD YA3- w_ Slopes(%) — Surface Stones I ne o�7ic�xV� Distances from: Open Water Body �'1 Q ft Possible Wet Area d_ft Drinking Water Well ®Y ft Lylowvlt v fi Drainage Way 01A It Property Line 2�ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) 246o/4� - �---- V V N N l "44i z 401 "t t ov Parent material(geologic) Depth to Bedrock _ U d Depth to Groundwater: Standing Water in Hole: ` Lto%\ Weeping from Pit Face_5�-, —to Estimated Seasonal High Groundwater .; . . R SONAR.HtD tr Method Used. �S144 ORBS._1�� Depth Observed standing in obs.hole: ��8�i (9.8`1 1 in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well#MLLp._Zq.Re.ading Date:(oh o Index Well level.. 8.0 _ Adj.factor_( Adj.Groundwater Level�,7' �ER�G'O ,A TO1 :TEST Hate ev: I�me Observation Hole# z Time at 9" VIA h Depth of Perc �� Time at 6" Start Pre-soak Time @ lip'.zo Time(9"-6") End Pre-soak 10 Ve;jo Rate Min./InchVw�� 71 Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back j Copy: Applicant n) �laarrl� J ... -. DEEP OBSERVATION HOLE LOC Iia1� Depth from Soil Horizon Soil Texture Soil Color m Soil ther Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency,o Gravel) 1 a S t, +U c O e DEEP OSSER:VATION HOLE LOG . Depth from Soil Horizon Soil Texture I Soil Color Soil 10ther Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency,o Gravel ] Q /7 (DEEP B ;ERVATION HOLE LOB Hole .: Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency,%Gravel O obeSEVAONHOL . .......D ... Depth . from Soil Horizon :Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency-o o Gravel) Flood Insurance Rate Mao: / Above 500 year flood boundary No_ Yes .✓ Within 500 year boundary No ✓/ Yes Within 100 year flood boundary No" Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? ,If not,what is the depth of naturally occurring pervious material? Certification I certify that on o4 I`M 5 (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training,expertise and experience described in 310 CMR 15.017. Signature CIAAA Date p(e- Z4 -Z,:, ,0 f . e SEPTIC 'SYSTEM PROFILE SOILS LOG $ ,FIRST FLOOR 24.5 FIN. GRADE OVER FIN. GRADE OVER FIN. GRADE OVER PERCOLATION ELEVATION FIN. GRADE TI N TEST AT HOUSE SEPTIC TANK DIST. BOX SOIL ABSORPTION SYSTEM TOP of 21.7 21.5 TEST HOLE FOUNDATION 22.5 22,0 _. � TEST HOLE 2 A •'. 0" ELEV. = 19.0 0,. ELEV. _ 49.0 ELEVATION 23.5 ;°, 2% MIN: GRADE RISERS 77-7777777-777 SANDY SANDY 6" OF FIN, GRADE 10" p/A LOAM 8" O/A LOAM INVERT at �•:,y: _ , FOUNDATION ; , 2' MIN.DOUBLE WASHED !Y8 1/2 STONE 21,00 -,- - -�•-_ LOAMY LOAMY ELEVATION SAND SA .. ,•. ND s' °o ; ;,i ._.,_ Y- , 8� •:e�1 2.5Y 5/6 b > 20.50 20.10 ;,..,. {9.93 196 i• - - _ _. � P.,l, 1iw 4" 20.75 _ w v 0 i:• k s _ '•::La; 36 B3/4" 1 1/2" 3 PERC _ sDOUBLE WASHED STONE °:: 1 # v ° GAS BAFFLE ON OUTLET TEE o �- _________._____ _ _ • ti Crt1 DIST. BCC ' •✓.. " ° GALLON LV N ►, ,n 39.25' TOT.EEF.LENGTH 3 IUO A - J 10.83' .EFF. W H LOADING SEPTIC TANK =� - -- -~�=01 MEDIUM MEDIUM FLOOR ;� -- LOADING TO BE SET ON A RED _ - SAND SAND ° 3 H BASEMENT ., i 1 � C� -•.: •-�' CRUSHED 0 --�.��•-- ��-- ELEVATION ,ti . . .• . 6" C HED STONE ) 1 _. • -I 2.5Y 5/6 2.5Y 5/6 15.7 a' ,' 6" ,�''CRUSHED STONE BASE BASE °p :s.;�,�:. �.^., ;..v... . ,..,..1.. r .r_> .^f, { ACME DB-3 OR - + 10'--6 '�� :• T --- �` APPROVED EQUAL ) i 9.2 118" 9.2 SEPTIC TANK SET LEVEL AND TRUE TO GRADE 16•', ---- --- -- - ---- -__ OBS. WATER WATER OBS, WATER ON 6" CRUSHED STONE BASE ON ( Profile not to scale 1 , COMPACTED NATURAL MATERIAL �! ' • . MECHANICALLY 126" C 8.5 126" C 8,5 1: OBSERVED GROUND WATER: 9.2 INFILTRATOR DETAIL ADJUSTED GROUND WATER: 12.3 NOT To SCALE PERCOLATION RATE: 2 MIN./INCH SOIL CLASS: 1 y EFFLUENT LOADING RATE: 0.74 GPD/SF SOIL EVALUATOR: J E LANDERS-CAULEY CERTIFICATION NUMBER: ` 7 7 7 y 2a WITNESS: E. Y BOARD OF HEALTH, TOWN OF nc ^ BAR STABLE r 100' 22 DESIGN DATA DATE OF TEST: 06/27/00 I I I I NUMBER OF BEDROOMS 3 } 24 G.P.D./BEDROOM 110 G.P.D. GENERAL. NOTES TOTAL DAILY FLOW 330 G.P.D. ( ( I LOT GARBAGE DISPOSAL NO I • LEACHING .REQUIRED 330 G.P.D. L ELEVATIONS BASED UPON NGVD DATUM. �- 0.53± AC, LEACHING PROVIDED 463 G.P.D., -2. ELEVATIONS AND LOCATIONS SHOWN ON THIS PLAN SEPTIC TANK REQUIRED 1500 GALLONS ARE NOT TO CHANGE WITHOUT WRITTEN APPROVAL SEPTIC TANK PROVIDED 1500 GALLONS OF THE ENGINEER AND THE TOWN HEALTH AGENT. SIDEWALL AREA -200.3 S.F. 3. ALL SYSTEM COMPONENTS ARE TO BE INSTALLED IN WITH S C TIT V AND LOCAL HEALTH - + BOTTOM AREA - 425.1 S.F. ACCORDANCE W S.E.C. LE L °° \ 4 462.8 G.P.D. D REGULATIONS: ' N \ TOTAL ..PROVIDED=625.4 S.F. x 0.7RULES AN j 462.8 G.P.D.%TRENCH x 1 TRENCHES _ 462.8G.P.D. 4. ALL PIPES ARE TO BE CAST IRON OR P.V.C. SCH. 40. Lij j 5. THE BOARD OF HEALTH AND/OR ENGINEER TO BE * 16.0 NOTIFIED WHEN SYSTEM IS COMPLETELY INSTALLED � < ( NOTE:: EXCAVATE TO EL. OR LOWER A5 SOIL , CONDITIONS REQUIRE TO REMOVE ALL TOPSOIL; AND READY FOR INSPECTION, I _ Q . G. NORTH ARROW IS NOT TO BE USED FOR SOLAR I CLAY OR OTHER UNSUITABLE MATERIAL BENEATH THE J101 N INLET INVERT OF THE SOIL ABSORPTION SYSTEM FOR ORIENTATION. 201i LOT 45-2 A DISTANCE OF 5' MIN., AND BACKFILL WITH CLEAN ( W I 22 N SAND, PER 310CMR 15.255:3. � .I N \ - r'1 I I DErX 2 .5 I , PROPO ED DWELL NG I HSE3,6# I 24' 22,5 I I _ Nryr REV BY DATE DESCRIPTION � ,`;fir' ►�x-KaMAra �r;` o S. :�CIVIL,z� s A SITE 8� SEWAGE . DISPOSAL PLAN cim v - LOT 46, l STRAWBERRY HILL R0 , Aw 3,* � OF Gui USBARNSTABLE, MA. / �s N APPLICANT. w�ra�n APPLiC NT, WILLIS MICHAELSON c 7 s2 75 ADDRESS: 473 PINE STREET rv« 12775 ; � Art, BEfa CENTERVI LLE, MA.'02632 ti ��;� wE, � -L ROAD 4 I` ENGINEER: GROSSMAN,S T RAW��R R Y H I L " NURMAN R I .P.E. LOCUS MAP --- SCALE: I = 2000 10 MARSH VIEW ROAD FLOOD ZONE NO ZONING DIST, E ELEVATION MAP EAST F/aI..IVIQUTI'I, MA. RB C --- 12500010008D 508-548-1920 MAP SEC PCL LOT HSE PLAN REFERENCE: SCALE DATE DWN. BY / CK D BY PLAN NO, BARNST. CNTY. REG. PLAT` SK PG SITE PLAN---SCALE I - 30 246 46 #91 AS NOTED JUNE 28.'2000 JTH / 'NG H- 646