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HomeMy WebLinkAbout0082 THOREAU DRIVE - Health 82 Thoreau Drive Centerville F A = 191 187 110, 12543 a STINGS.phN i - 4 Commonwealth of Massachusetts 7 . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 82 Thoreau Dr Property Address Joanne Delaney Owner Owner's Name information is required for every Centerville MA 02632 7-1-14 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. A. General Information jit P 1. Inspector: d Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name P.O. Box 73 Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S13971 Telephone Number License Number B. Certification _ a I certify that I have personally inspected the sewage disposal system at this address and thit the information reported below is true, accurate and complete as of the time of the in pection. ate insctionl was performed based on my training and experience in the proper function and rjaintenanm of opite sewage disposal systems. I am a DEP approved system inspector pursuant to Section-45.340 of ; Title 5 (310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 7-1-14 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. d t5ins-3/13 Title 5 Official Inspection Form:Subs a'; Sewage Disposal System-Page 1 of 17 F Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 82 Thoreau Dr Property Address Joanne Delaney Owner Owner's Name information is required for every Centerville MA 02632 7-1-14 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 is in good working order with no sign of failure. 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 T'D'WN()F B ARNSTABLE U r act f, SGWtAGE.#' .•.::,_.{...:: `V�L[. Cep �r U M"&LOT _._... ____. } IhiSTt�l.l:Ela'S 1+iAtltl9&"PtIOIATE N0- �}3IC TANK CAPAG1fiX L CILI]�iG lE ACXLIT'X: (tYpe) T (size) N®.OF BOPet]l)i~/(i S.. 6 �P. ..:OR 0"Jyt�1L1R. C(�1VAb(.II�I" l tMEpp �epst�r�tsort�dsP�rc;l�citvrc�n She : � . Nlnxirnum ladjustcd CtpurnJwacet'i'�ble(n tlbG Battam ni�.s;achin�1?��cilsGy. .- .� «�- �- ��'eel 1'blv2a;'9�/tt�a �;uplylcll:a�ycd s c Y.aau9ddn l?ncdl�tS tarryrf:19xtst 7r�tsc9 �n s�te;c5g vvd¢.�in�Qp Fert bi'1�Rehi�►�f�irdllt}�) �--,...:.-------•--.-.�....�,.. ct�;►:cyi"W.Wand and lLe ac in lC±acdli +:� :acty wet{ands ens¢/' /�' ;� ivl81z��1i(1{t(�et tyf i�.�ek�f�d��ucaiz"rye_ A L s Oac� LRI-10- i yP ��, a� Commonwealth of Massachusetts m W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 82 Thoreau Dr Property Address Joanne Delaney Owner Owner's Name information is required for every Centerville MA 02632 7-1-14 page. CityTrown 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 1� Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 82 Thoreau Dr Property Address Joanne Delaney Owner Owner's Name information is required for every Centerville MA 02632 7-1-14 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 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: r ry D) System Failure Criteria Applicable to All Systems: You must indicate "Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 A Commonwealth of Massachusetts F Title 5 Official Inspection Form m Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 82 Thoreau Dr Property Address Joanne Delaney Owner Owner's Name information is required for every Centerville MA 02632 7-1-14 page. City/Town 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- 1 0,000g pd. ❑ ® 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 Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments G'9M 82 Thoreau Dr Property Address Joanne Delaney Owner Owner's Name information is required for every Centerville MA 02632 7-1-14 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 I - Commonwealth of Massachusetts _ F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments VA ,M 82 Thoreau Dr Property Address Joanne Delaney Owner Owner's Name information is required for every Centerville MA 02632 7-1-14 page. City/Town State Zip Code Date of Inspection D. System Information Description: f t} Number of current residents: 1 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 Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 7-2014 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•3113 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 �M 82 Thoreau Dr Property Address Joanne Delaney Owner Owner's Name information is required for every Centerville MA 02632 7-1-14 page. City/Town 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: Owner--pumped 3yrs ago Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? 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•3M 3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 82 Thoreau Dr Property Address Joanne Delaney Owner Owner's Name information is required for every Centerville MA 02632 7-1-14 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: 2003 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 24"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.): Good condition. Septic Tank(locate on site plan): Depth below grade: 18"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 gal Sludge depth: 10" t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 82 Thoreau Dr Property Address Joanne Delaney Owner Owner's Name information is required for every Centerville MA 02632 7-1-14 page. City/Town 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 22" lotScum thickness 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? Tape Comments on pumping n recommendations inlet and outlet tee or baffle condition structural integrity, ( P P 9 � 9 Y, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed and no sign of leakage. Grease Trap (locate on site plan): Depth below grade: 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts m Title 5 Official Inspection Form iA Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 82 Thoreau Dr Property Address Joanne Delaney Owner Owner's Name information is required for every Centerville MA 02632 7-1-14 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.): I Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons 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 M 82 Thoreau Dr Property Address Joanne Delaney Owner Owner's Name information is required for every Centerville MA 02632 7-1-14 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 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.): Good condition with water at working level and no sign of back-up from chambers. 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.): * 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 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 82 Thoreau Dr Property Address Joanne Delaney Owner Owner's Name information is required for every Centerville MA 02632 7-1-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 2-500's ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leach chambers in good condition and empty at inspection with stain line at 2"off bottom of chamber. 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•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 82 Thoreau Dr GSM Property Address Joanne Delaney Owner Owner's Name information is required for every Centerville MA 02632 7-1-14 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: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): I t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 r Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary.Assessments 82 Thoreau Dr Property Address Joanne Delaney Owner Owner's Name information is required for every Centerville MA 02632 7-1-14 page. Cityrrown 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 _ UpJ� Lo ?j 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 M 82 Thoreau Dr Property Address Joanne Delaney Owner Owner's Name information is required for every Centerville MA 02632 7-1-14 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: 12 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: Original design plans show no groundwater at 12. 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 r c Commonwealth of Massachusetts f Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 82 Thoreau Dr Property Address Joanne Delaney Owner Owner's Name information is required for every Centerville MA 02632 7-1-14 page. CityTTown State Zip Code Date of Inspection E. Report Completeness Checklist E 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 E Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 a . l� Health Complaints 12-Jan-04 Time: 10:29:00 AM Date: 12/15/2003 Complaint Number: 17194 Referred To: DAVID STANTON Taken By: DENISE WITTER Complaint Type: GENERAL Article X Detail: UNSANITARY CONDITIONS Business Name: Number: 82 Street: THOREAU DRIVE Village: CENTERVILLE Assessors Map_Parcel: Complaint Description: NEIGHBOR HAD A SEPTIC SYSTEM INSTALLED AND NOW EVERYTHING IS DRAINING TOWARDS YARD AND HAS A BIG PUDDLE Actions Taken/Results: DS SPOKE WITH TM ABOUT SITUATION. TOB HAS NO REGULATIONS ON THIS. TM SPOKE WITH TOWN ENGINEERING. AND THEY SAID THEY HAD NOTHING ON IT. TM CALLED INSTALLER (ELLIS BROS)AND WANTS DS TO MEET THEM AT SIGHT JUST TO LOOK AT IT. WILL MEET IN JANUARY TO LOOK AT IT. DS MET WITH LARRY. NO ONE KNOWS WHERE THE SEPTIC PERMIT OR PLANS ARE FOR 82 THOREAU, BUT LARRY SHOWED DS THE LOCATION THEY INSTALLED IT AT. THE FINISHED GRADE IS THE SAME AS PRIOR TO THE NEW SEPTIC AS SEEN IN THE PHOTOS ON FILE. THE FINISHED GRADE ON BOTH LOTS SLOPES DOWN TOWARDS THE MIDDLE AT THE APPROXIMATE PROPERTY LINE. THIS IS NOT SEPTIC RELATED. THERE COULD BE AN INCREASE IN PUDDLES, AS THERE WAS A MORE FREQUENT WET SEASON, AND 1 Health Complaints 12-Jan-04 THE FACT THAT GRASS CANNOT START GROWING IN THE WINTER. THE WATER APPEARS TO BE COMING FROM THE DOWN SPOUTS OF THE ROOF GUTTERS ON THE PROPERTY, WHICH THE HEALTH DEPARTMENT DOES NOT GET INVOLVED WITH. ELLIS BROS VOLUNTARILY INSTALLED SOME HAY AT THE BASE OF THE DOWNSPOUTS TO PREVENT SOME EROSION. NO ACTION REQUIRED BY THE HEALTH DEPARTMENT. DS SPOKE WITH THE COMPLAINANT AND EXPLAINED TO HER THAT WE COULD DO NOTHING AS IT IS NOT SEPTIC RELATED WHILE SHE WAS HANGING OUT HER BEDROOM WINDOW DURING MY INVESTIGATION. Investigation Date: 1/7/2004 Investigation Time: 10:00:00 AM 2 11 4r RECEIVED COMMONWEALTH OF MASSACHUSETTS OCT 0 12003 EXECUTIVE OFFICE OF ENVIRONMENTAL AFF=T1011 N of BARNSTABLE HEALTH DEPT. DEPARTMENT OF ENVIRONMENTAL PROTE MAP 9 FAILED INSPECTION PARCEL, I $� LOT TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM- PART A CERTIFICATION Property Address: T Th©r e—olL4 0,,- r V./ Owner's Name: LL i 2� ✓) Owner's Address: r e t4 / ,Ile Date of Inspection: Name of Inspector:(please print) Company Name: AFAIVI'D Mailing Address: 0 & c / k'ja Telephone Number. c 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 tram 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 O>OedfFWther Evaluation by the Local Approving Authority ls Inspector's Signature• Date: q ,1 0? The system inspector shall sub t a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments Hy dl-oi x-c F,-j ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A p CERTIFICATION (continued) Property Address: O 4 Th ore-it^ Q/ Owner: Date of Inspection: 4 0--2 Inspection Summary: Check A,B,C,D or E I ALWAYS complete all of Section D A. Syste asses: I have not found any information which indicates that any of the failure criteria described in 310 CUR 15.3A.3 pr in 310 CMR 15,304 exist Any faitttrs Grits:ia not evalttatsd* irldit lailow, Comments: YtB, Syst Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the . for the following statements.If"not determined,please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pips(s)or due to a brolccn,Settled or uneven clistribvtion box, System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: f Page 3 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: v ai V Owner: �► Date of Inspection: Zd C. hirt _ 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(i)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water — Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment; _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory.for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form 3. Other: Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address; Oreea,c4 z — i l i �Z Owner:, N Date of Inspection: D. System Failure Criteria applicable to all systems: You must indicate`fires' or"no"'to each of the following for all inspections: Ye No ckup 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 9r cessp991 tatic liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _ _���/// Xifiluid depth in cesspool is less than 6"below invert or available volume is less than%:day flow Reyuircd pumping more than 4 times in the last ycar N T due to clogged or obstructed pipe(s),Number ,A1 f times pumped „y 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. _ portion of a cesspool or privy is within 50 feet of a private water supply well. _v 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 analyiis must be attached . this form.] &-;5(Yes/No)The System fails.I have determined that one or more of the above failure criteria exist as described in 310 CUR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate 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 drinldng 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"ves"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. I .. Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Preperty Address: ✓� ✓vv Owner. vt Date of Inspection: Check if the following have been done.You most indicate"yes"or"no"as to each of the following: Yes No information was provided by the owner,occupant,or Board of Health ere anmy of the system components pumped out in the previous two weeks e system received normal flows in the previous two week period _,ram Have large volumes of water been introduced to the system recently or as part of this inspection ere 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 stem components,excluding the SAS,looted on site system Po g _ _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition 7as of tees,material of construction dimensions,depth of liquid,depth of sludge and depth of scum the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no xisting information.For example,a plan at the Board of Health _ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] C Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: Z� l 1�10s�rrcq C Owner. Date of Inspection: 0 OW CONDMONS RESIDENTIAL Number of bedrooms(design):-7 Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): Number of current residents: f � � Does residence have a garbage grinder(yes or no): /Y./C* Is laundry on a separate sewage system(yes r no) R[if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use: (yes or no):_ZA Water meter readings,if ava#&le(last 2 years usage(gpd)): Sump pump(yes or no): Last date of occupancy: I,,C vv COMtERCIALIINDUSTRIAL Type of establishment: Design now(based on 310 CMR 15.203): sad Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system(yes or no):_ Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMA ON Pumping Records . Source of information: Was system pumped as part of the inspection(yes or no):_ If yes,volume pumped: gallons—How was quantity pumped determined? Reason for pumping: TYP SYSTEM _ c tank distribution box,soil absorption system _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innavatrve/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: 192s— oi-/ Were sewage odors detected when arriving at the site(yes or no): r � Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C Q SYSTEM INFORMATION(continued) Property Address: � rho/ea�'t 1�� e� ivI �1f Owner: " Date of Inspection: O BUILDING SEWER(locate on site plan) Depth below grade: /9 L Materials of constructi�iron _40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK. (locate on site plan) Depth below grade: Material of construction:_concrete_metal fiberglass_polyethylene _other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: 'b Sludge depth: Distance from top of sludge to bottom of outlet tee or bale: -2 P ` Scum thickness: /" 1� Distance from top of scum to top of outlet tee or bale: �2 // Distance from bottom of scum to botto outlet tee baffie: 'S How were dimensions determined o/e c Comments(on pumping recommendations,inlet and mtfet tee or bale condition,structural integrity,liquid levels as fated to outlet invert, 'dance o�u�ge�etc.): �n H � ,�j ��s � clw n.. T �/ Gi H 6, OH I QM• �'G f GREASE TRAP: (Iocate on site plan) Depth below grade:_ Material of construction:_concrete_metal_fiberglass polyethylene_other (explain): J Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or bale: Distance from bottom of scum to bottom of outlet tee or bale: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or bale condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): r Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: / A p,e ej&I Owner. Date of Inspection: / TIGHT or HOLDING TANK: tank must be pumped at time of inspecdonxlocate on site plan) Depth below grade: Material of construction: concrete metal fiberglass polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: ga1lons/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:/V*'-(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): PUMP CHAMBER: 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: ._.-6 e a t& yl�li°' Owner. Al Date of Inspection: SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type �gpits, eaumber: leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): /�/uC / / Ve✓' = dcru ie- q u�� i • /1/ as of i on ovate on site plan) CESSPOOLS. (cesspool must be pumped. part nspectt xl 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:/ovate 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.): t p Page loaf 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION{wed) Property A"mm ec� TA D/PU vDXteet On[— .I 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 wahm 100 feet Locate where public water supply enters fire bmidiM C t213 lit 1 ,r © t ri / Ir �l J d,I L r Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C. SYSTEM INFORMATION(continued) Property Address: Or C of , ,/ Owner: AA4 Date or Inspection: / SITE EXAM Stom Surface water Check cellar Shallow wells Estimated depth to ground water 13,Sfeet 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 w+�incest Rtvar�xplain: - Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: Yro ust descriX how ou established the high ground water elevation: 10 co, o/, o -3 7f S l-e- bi 1, u� C TOWN OF BARNSTABLE LOCATION 82 THOREAU DRIVE SEWAGE 42003-553 VELL�,'tGE "-` ASSESSOR'S MAP & LOT 1 91 / 18 7 INSTALLER'S NAME&PHONE NO. ELLIS BROTHERS CONST. 362-6237 SEPTIC TANK CAPACITY / Tc/J LEACHING FACILITY: (type) GL� C'h1J,"&-(size) NO.OF BEDROOMS J- j BUELDER OR OWNER E I L E E N A N T E L L PERMTTDATE: I I 10 3 COMPLIANCE DATE: III 3 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 r 8 A i1-2- 13 4 2� `� l " No. �"3 �5 5 Fee 5d i THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppYication for�Mizpoe; Y *p5tem Construction 3permit Application for a Permit to Construct( Repair( Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address soarcorlLot No. �.+a O r' �9 V !^s���( Owner's Name,Address and Tel.No. AssessCo� Map/Pel /yt / l L L 5 e-1^ Installer's Name,Address,and Tel.No. �Qb-3l�a G�37 Designer's Name,Address and Tel.No. I11's hvwb ,rP 0>�,sd- a��na„�-��,� ��� ���► ����� a � sue- Type of Building: +� Dwelling No.of Bedrooms ✓ Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Desigu Flow 1)0 X 3- 3 3 0 62 gallons per day. Calculated daily flow 35 G. gallons. Plan Date CO-1- 3. a-og Number of sheets i Revision Date Title Size of Septic Tank Type of S.A.S. 0, — GOO G �DVTS Description of Soil Nature of Repairs or Alterations(Answer when applicable) S'er))�A C Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions o 5 of the Envi mental Code and not to place the system in operation until a Certifi- cate of Compliance has b is this Board lth. Date Application Approved by Date Application Disapproved for the following reasons Permit No. - '—5 Date Issued No.Oew Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS miopogar *pgtem Co .5truction 3permit Permission is hereby granted to Construct( )Repair( pgrade( )Abandon( ) System located at 1F:�' LI lb C s f 4 U )-Ir 1, fin°, 6-y;a 0 9 G3) ! /-7! and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date f thisf e'_i. Date:_ l � / L�! Approved by i ;y No. M 't Fee THE COMMONWEALTH OF MASSACHUSETTS/ Entered in computer: T es PUBLIC HEALTH DIVISION.;TOWN OF BARNSTABLE., MASSACHUSETTS 01ppfication for tqo!g Y *pgtem Construction 3dermit Application for a Permit to Constru t OWRepair( Upgrade( )Abandon( ) O Complete System ❑Individual Components Location Address or Lot No. Thor 4 Q / 7{7 (J 1J I ^L Owner's Name,Address and Tel.No. Assessor's nMap/Parcel ��' 1 L Lo Y h ' l } /f ✓n 5 r-! /C Installer's Name,Address,and Tel.No. 30 36a 603 7 Designer's Name,Address and Tel.No. / 1 1 is V/JCC�`f CC h S' CC l f I is S�11/a�" 1 S f 3;�d 4-311 aq Type of Building: .t Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures ' Design Flow G = 3 G 2 gallons per day. Calculated daily flow 35 gallons. Plan Date n G 1-,3 ol') Number of sheets I Revision Date Title Size of Septic Tank SC O Type of S.A.S. oZ — Sao ay,l C b QlS Description of Soil C Nature of Repairs or Alterations(Answer when applicable) $ C Sr/9/ , C Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of 1 5 of the Envi mental Code and not to place the system in operation until a Certifi- cate of Compliance has been issg this Board lth. Date Application Approved by - Date Application Disapproved for the following reasons - - Permit No. r" :_-_- Date Issued U —— ———— — THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed ( ) Repaired ( )Upgraded ( ) Abandoned( )by A Cv fine�S C c h t"J , (G at e Z' ) 2LI 13,7 5 l-0 /)1 r` ,has been constructe in ordance with the provisions of Title 5 and the for Disposal System Construction Permit No.2ai3`5,_ dated I Installer 1711 j b c 7^p_ S t•-<,,) c , Designer )'G ,.f_ iY - The issuance of this p rmit shall not be construed as a guarantee that the syste m V ' �rnqtis es" d� Date Inspector w .y TOWN OF BARNSTABLE LOCATION 8 2 T ht O R E A U DRIVE SEWAGE #2 003-553. VII,LAGE B A R N S T A B L E. ASSESSOR'S MAP&LOT 191118 7 INSTALLER'SNANIE&PHONENO. ELLIS BROTHERS .'CONST. 362-6237 SEPTIC TANK CAPACITY " - c, / LEACHING FACILITY: (type) �k-(size) NO.OF BEDROOMS Z EILEEN ANTELL BUILDER OR OWNER PERMIT DATE; i "'1 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 Feet within 300 feet of leaching facility) Furnished by i i i I I � o � l, 13 A LOC O SEW 6,C,E PERMIT MO. . IWSTNL ER�S 1J� E --- BUILDER 5-IJAM - _ -_._DIN,TE-.PERNAI--T -1.55UED - -` _ _ O &T.E -COMPLI At`lCE ISSUED � � ®'� � 9 � �/9 BENCH MARK TOP OF FOUNDA70N ! 20 FT. MINIMUM FROM CELLAR SO{L TEST ELEV. _ 100.00_ I 10 FT. MINIMUM 10 FT. MINIMUM FROM SLAB OR CRAWL SPACE DATE OF SOIL TEST �_______-..__ CLEAN SAND SOIL TEST DONE BY (ASSUMED) CONCRETE WITNESSED BY COVERS 4" SCHEDULE 40 PVC PIPE -LOAM AND SEED OBSERVATION HOLE i ELEv.= 97,40 MIN. PITCH 1/8" PER FT. ` PERCOLATION RATE _< 2 MIN./INCH AT _ 9--84_ INCHES 1/8"ATOR 1/2" DEPTH IHORIZI TEXTURE COLOR I MOTT. OTHER . 32* 984 MAX. ASHED STONE EXISTING . 4" CAST IRON PIPE " (OR EQUAL) MINIMUM g'90 MIN PITCH 1/4" PER FT. a "Z r I A LOAMY SMD 1OYR 1 NO ZABEL. FILTER ` \ FLOW LINE M' 95.40 PLUMBING TD BE RAISED 10" 8-32* 8 OAMY SAND .10NO 94.73 AND RE--PIPED BY A ELEV. _ �Z3 _ -- -MIN. 2 0 ° ° ❑ ❑ ❑ ❑ © ❑❑ ❑ ❑ ❑ ° LICENSED PLUMBER AS ELEV. _ _9- LEVEL ° ° ❑ ❑ ❑❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ NEEDED ELEV. _ _9K75- GAS ELEV• _ _96.20 6" BUMF ELEV. _ _96.0� o °I BAFFLE ° ° ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ° 2' 0 32-72" C1 FINE SAND__10YR714 NO 91.40 DISTRIBUTION ELEv. _ ° ° ° ❑ ❑ ❑ ❑ o ❑ ❑ ❑ ❑ ❑ ❑ ° ° (QUID UTLET BOX _� �� ° ° ° ° ELEV. a 92.65 FEET 14 INCHES (TO BE PLACED ON FIRM BASE) TO BE WATER TESTED 172-144*1 C2 COAM SANDI 10YR7 4 ' NO 5 FEET 19 INCHES IF MORE THAN ONE OUTLET 2-500 GALLON ORYWRLS W1T?1 STONE 6 FEET 24 INCHES 1500 GALLON 7 FEET 29 INCHES (TO BE PLACED ON FIRM BASE) IN A 1,3' X 25' X 2' TRENCH FORMA77QN Z WELL N/A NO WATER ENCOUNTERED AT _ ELEV. = _ M'_40 8 FEET 34 INCHES SEPTIC TANK 3 4" TO 1 1/2" CLEAN 3 25 ON / SOIL ABSORPTION DOUBLE WASHED STONE ADJUST DESIGN CALCULATIONS FREE OF FINES & SILT SYSTEM (SAS) NUMBER OF' BEDROOMS __3._._.. MIN. USGS PROBABLE WATER TABLE ELEV. = _pl,�A_ GARBAGE DISPOSAL UNIT NO, NM-ALLOWED SEWAGE DISPOSAL SYSTEM PROFILE OBSERVED WATER TABLE ( / / ) ELEV. = _ TOTAL ESTIMATED FLOW ^ NOT TO SCALE 80TTOM OF TEST HOLE ELEV. _ �_ (110 G4L../2RIDAY X 3 61R) �3(L.. GAL.IDAY REOUIRED SEPTIC TANK CAPACITY _B$a,_ GAL. ACTUAL SEP77C TANK CAPACITY i504 GAL, SOIL CLASSIFICA TION --I- DESIGN PERCOLA 770N RA TF 55__ MIN./INCH EFFLUENT L DA DIN G RA TE _1L7. GAL-IDA Y15.F. LEACHING AREA --427.- SO. rT (13'x25')+(76'x2') LEACHING CAPACITY _9_ GAL./DAY 477 X 0.74 / RESERVE LEACHING CAPAGTY M/.A_ GAL./DAY ■ 99.8 NOTES: 1. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. TITLE 5 AND THE TOWN RULES AND REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE. 2. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO WITHIN 6" OF FINISHED GRADE. 99.2 3. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS. H-20 LOADING SHALL BE USED UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS. (, 98.4 � `� 4. ANY MASONRY UNITS USED TO BRING COVERS TO GRADE SHALL " BE MORTARED IN�P� LACE. 98.5 �}�� \c t ��>>� 5. NiO DETE_mmiINA T;OPi HAS BEEN MADE AS T E' 'WITH COMPUANCITH Q c DEEDED OR ZONING REGULATIONS. OWNER / APPLICANT IS TO %4 OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. 6. UTILITIES SHOWN ARE APPROXIMATE ONLY, EXCAVATION CONTRACTOR IS TO CALL "DIG-SAFE" AT 1-888-344-7233 AT LEAST 72 HOURS (,� c PRIOR TO COMMENCING WORK ON SITE. 98 0 gp,g" 7. CONTRACTOR IS TO VERIFY GRADES AND ELEVATIONS AS WELL AS OlC_ GARAGE SITE CONDITIONS PRIOR TO COMMENCING WORK ON SITE. ANY VARIATION IS TO BE BROUGHT TO THE ATTENTION OF THE DESIGN ENGINEER 98.6 IMMEDIATELY. 7 6 8. PARCEL IS IN FLOOD ZONE - C __. op9. LOT IS SHOWN ON ASSESSORS MAP 191 _ AS PARCEL `187 _ '1�» 10. ALL UNSUITABLE MATERIAL SHALL BE REMOVED FROM UNDER, AND FOR A MINIMUM OF 5 FEET FROM AROUND THE SOIL ABSORPTION SYSTEM, 96.7 EXISTING AND BE REPLACED WITH SAND AS SPECIFIED IN 310 CMR 15.255-. (3) DWELLING '=K° (I.E. TITLE 5) IF ENCOUNTERED BELOW S.A.S. PIPE INVERT. 99.0 99.3 Y> }* II 1'� ,1 �-"�� 11. EXISTING SEPTIC SYSTEM TO BE PUMPED AND FILLED WITH SAND OR REMOVED. SUN .:� � � 12. CONTRACTOR TO PROVIDE SHORING AS NEEDED TO PROTECT BUILDING 1, C,li7 �� N AND PROPERTY LINE. ROOM l APPROVED: BOARD OF HEALTH 8.9 ��' SEE NOTE /11 ,'r , � �c'cCt�.��J� �/!/♦/ _ 97. x, " 97.4 99.0 (^ J#2515 DATE AGENT ■ 98.6 y 95.4 98.6 ;' ; PROPOSED SEPTIC DEMON ' 971 `..5.,x 96.7 EILEEN ANTED 97.3 ti o�' Q o I 82 THOREAU DRIVE ■ 96.7 i �� ' BARNSTABLE, MASS LOT 21 - 15, 411 f S.F. o c v s CWG R SHORT, P.E. I AavOv4 235 GREAT WESTEPN ROAD 508- P. 0, BOX 1044 c, >zCL45 398-8311 SOUTH DENNIS, MASS. 02664 o b ! DATE OCT 3, 2003 scALE _ 20' j LOCATION MAP ! Ev ; SHEET 1 OF 1 Ol-0991 Antell SP.dwg 0 2003 CRAIG R. SHORT, P.E, r a�