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HomeMy WebLinkAbout0051 PRAM ROAD - Health 51 Pram Road Hyannis' 'P. A = 268 039 a y TOWN OF BARNSTABLE LOcA-rioN �` �j/-+ ,�,/�_ SEWAGE# 5-a 6 VILLAGE ASSESSOR'S MAP&PARCEL ' INSTALLERS NAME&PHONE NO. Ze'` oc;'�� SEPTIC TANK CAPACITY LEACHING FACILITY.(type) ��`"�-� x (size) / X NO.OF BEDROOMS OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) / Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY �L% f ` all, OP - I �I ,� TOWN.OF BARNSTABLE LOCATION d/ /lJt SEWAGE # VILLAGE �jGLi� /''� ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. —41�r ' 12AVE4�Z SEPTIC TANK CAPACITY ,� LEACHING FACILITY: (type) 0 (size)NO. OF BEDROOMS BUILDER OR OWNER �y PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (1f 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 fe' 04 cility) Feet "/,c,,0,wAei Y Furnished b s p a ` Ln o. r�©� Ll�LG f Fee v o THE.COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTAB.LE, MASSACHUSETTS Yes Ztpprication for �Bigoal *pgtem Con0truction Permit Application for a Permit to Construct( ) Repair(All Upgrade(/� Abandon( ) ❑.Complete System ❑Individual Components Location Address or Lot No. Owner's N Ad ess,and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: �s Dwelling No.of Bedrooms J Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building -0�>C No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) �'f® gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank 'o'Y-0 Type of S.A.S. /�4� /o2 CP Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this BgaiV,of fHHealth. p Signed Date Application Approved by Date 4 Application Disapproved by: Date for the following reasons Permit No. 2-m 7 `—1 1"fo Date Issued >"f—a 7 No. �LOO Fee .;THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: r Yes HEALTH � TOWN IVI I N - T F BARNSTABLE, MASSACHUSETTS PUBLIC S O O O pplication for �Digpogal *potent Con0truction Permit Application for a Permit to Construct O Repair(/--� Upgrade(Af Abandon O ❑.Complete System ❑Individual Components Location Address or Lot No. '�/ �wM �O- Owner's Naerse,Addr ess;and Tel.No. i Assessor's Map/Parcel - p to a 3� 1 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building s/^ -.?C No.of Persons Showers( ) Cafeteria( ) a Other Fixtures Design Flow(min.required) - gpd Design flow provided " gpd Plan Date Number of sheets Revision Date Title t Size of Septic Tank fo�% , 9�� Type of S.A.S. f/ D . /a1 0 'X a r Description of Soil ` . 1 d Nature of Repairs or Alterations(Answer.when applicable) t Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code andNnot to dace the system in operation until a Certificate of Compliance has been issued by this B paooff Health. Signed ]r Aj Date J `��.••01 Application Approved by _ Date 1 j O _ Application Disapproved by: e .r k4' ��, e i Date w for the following reasons i Permit No. 2 o10 7 'W Z(0 Date Issued q'' .1- `O -------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed (Repaired ( v) Upgraded ( ' ) Abandoned( )by at S`'"-09�7 has been constructed in accordance ' with the provisions of Title 5 and the for Disposal System Construction Permit No. 2 °0�7' -q)-G dated Installer�J- ,W L L- G~ux Designer 4�5.�4 !//,p 07, J���-P �✓��,J'� #bedrooms 3 Approved design flow gpd The issuance of this errviit shaDI n ft be c nstrued as a guarantee that the system i41 f netion as designe //� �, 0 y ! Date _ Inspector - / I U �$ �M J r 1 ——————2——t—l—————————————————————————————————— No.�0� T 1�-�O Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS 0igpogar 6p5tem Congtruction Permit Permission is hereby granted to Construct ( -/< Repair ( ) Upgrade ( ) Abandon ( ) System located at .3f 40pvlflel— 01?6191 �/• and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Construction must be com leted within three years of the date of this permit. ., Date ��"' Approved by Se P 24 0 7 U; 5 3r P. 1' Town of Barnstable Regulatory SeTwnees Thoms Fe Creficr,Director pubfac Heafth MMOR `i ._.. •a:`v%. 7i�no l� ean,1. i�tor 200 Main Street,11yawds,MA 02601 Cl£fise:.308-862-4644 Fax: 508-9(\-6304 Installer ]Des_agMer Certification Form Date. J� ,3t� 9"-0 en Designer: cry%7 M T lustaller: f ER6 Address-, � �i A��� Address:. On---_ was issued a permit to install a (cite installer septic system.at � �"l ��`J based on a design drawn by (ems) ��� 1 — I<ccifi yr that the septic system referenced above was installed subs ally according to the deiim which may include minor approved changes such as lateral relocation of the distidbution box and/or septic tanks I ccrbfy ftt the septic system rcfacoced above was 'unuffled wAh Igor c•wo (i.4,.. ater tb2ft 1O' laterd relo do of the SAS or any vertical relocation of any ctampoucna ofile septic systam)but in ac=dance with Staff&Load R.cgulatio s. Phi leviision or ctrfflcd as4xi&by designer to follow_ Sim) (Affix Design ies SteaQap$ere) k "PLEASE RETURN TO A1�1E LICCEMALTH y1XVTSX®]tie CEWrMCAME OF COhffMLL4JRCE WILL NOT $EDED YAM ]BOA •3 Ft3)l Aril? AS, B .T CARD ARE BY THEEARNS7Cx,E P C ID�YJISIOrL THANKYOU. Q:HWI6/Sq3dCMC4V=C&tficadon FOM q< 6 220• ?}cyaranon off laps and Spectncanuian n u r• r •. r< �. - r r Thd plans and specifications for every on-site system shall be prepared as follows: : (1) -Every system shall be designed by a Massachusetts Registered Professional Engineer or a'Massacltusctu Registered Sanitarian provided that such Sanitarian shall not-design a. sys:cm designed to dischargc.morz thin 2,000 gallons per day pu.*suant to 310 CMR 15.203. Any other-agent of the owner.rrnay prepare'plans for the repair of a system.designed to CM?,not more-than than-2,000 gallons per day pursuant to 310 CM 15-203 provided they are- reviewed by.'a Massachusetts Rea stered Sanitarian and.approJed by the approving / authority; / .(2). .Every—plan.submiited for approval must be dated and bear the stamp and signature of - +++��� the designer, (3J Every plan fdr a new system or plan for the upgrade or expansion of an existirrg-systetn-' which_requires a variance to a property'line setback distance,must:also reference'-a plan IA_ which bears the stamp and signature of a Massachusetts; Licensed Land Surveyor in accordance with M.d.L. c: 112, § 81D; 4) Every plan for a system shall be of suitable scale'(onc inch=40 feet or fewer for plot plan and one-irueh=Z0 feet or fewer for details of system.components). fgd shall include. : r de tenon of: ' the legal boundar'es of the facility to be served; _ (b) the holder and location of any easements appunenant to or which could impact the the location'of the all dwclling(s)or building-,00 existing and proposed an the facility : d identifieatidr of thoselo,be served by the system; (d) •=the•'l-acation of ekisting or proposed irnpervious•arcas; including:driveways and king areas () location and-dimensions gf'ch'e system (including reserve area); -.. . fl• syst em design calculations, iriclading design daily sc,vagc flow, septic rank capacity (zcgtzircd and provided); soil absorption system capacity (required and provided); and - hether system' is designed for garbage grinder, ' (e} North arrow and existing and proposed contours; Iodation,and•log of deep'observation Bole tests including the date of test, existing grade elevations marked on each test, and the names of the representative of the a roving authoriy and soil evaluator, (i) location and results of percolation tests including the pate of test and the names of e.representative of trio approving authority and soil vvaluator, . (j) name and ccrtificatioii number-of-the-Sod-Evaluator of record; (k) location of every'water supply,public and private, I. within 400 feet of the proposed system location in the case of surface warm supplies and gravel packed public water supply wells, 2. within ZSO feat of the proposed system location in the case;of tubular public water supply wells, and 3. within ISO feet.of Luse proposed system location in: the. case of private water supply wc11s; 1) location Of of the Co:nrnonwealth;-rivers, bordering veg any surface waters etated wetlands, salt marshes, inland or coastal banks, regulatory floodway, ytlocity zone, surface water supplies, tdbutariei to surface water Supplies,certified vernal Tools,private water supplies or•suction lines, gravel packed-or tubular public water supply wells, ' .. subsu:r1ace .drains, leaching catch basins, or dry wells; and ;he location of any nitrogen cnsitive area identified'in 310 CIvS I5.215 withinwhich poi-dons of the proposed _ 4 _ aro located. location of water lines and.other subsurf4c utilities on the•facility; observed and adjusted ground-water elevation in the vicinity of the system; o) a cernplete pzofslo of the system; (p} a note on the plan listing all variances to the provisions of 310 CMR 15.000 sought �irnjunction wi4't the plat.;he location and.devotion of one berc,'tzaark.within 50 to 7S feel pf the facility is not si;bjcct to dislocation ar loss ding consavction'Orr the facty; : (r) rn when dosing is'preposcd, 'complete design-aii "spceicariorr tsf the•dosing syste �qef--proposed including.but not'limited to dosing-chamber czpae.'ty (regiired and:provided),' V' ump curves and specifications, number .of dOSLRg cycles and depth per cycle; (s) wheat a Rccirculatirig Sand Filter or equivalent alrernative tech.-tology is required or 13roposcd, a complete plan and specification for the system,including a hydraulic prof-1c; (t) a,locus plaru,to slow the location of the facility including the nearest existing scree^, (u the street nu tuber and lot nurnkr., if any, of ttte facility; and, _�Y) the rnaterals of const±vctioa.and the specifcations of the system. Town of Barnstable P# V Department of Regulatory Services Public Health Division Date NAM say.A�� 200 Main Street,Hyannis MA 02601 ,� p�� t� 3, '�fl q11.q b 1 Date Scheduled Time Fee Pd. Soil Suitability Assessment for Sewage Disposal nI / Performed By: 4z J. Witnessed By: LOCATION& GENERAL INFORMAT ON Location Address � � Owner's Name � J1/0" 'oe �� Address Assessor's Map/Parcel: CJ��- Engineer's Name NEW CONSTRUCTION tt°°vJJ' REPAIR v Telephone# <P 7.7 Land Use. �'��'�f' l Slopes(4b) O Surface Stones Distances from: Open Water Body /Y ft Possible Wet Area �ft Drinking Water Well X"*fft Drainage Way 0 7' ✓ ft Property Line �ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) �Z d in cr, 1 - 1 o W nn't Parent material(geologic) D Depth to Bedrock `o o Depth to Groundwater. Standing Water in Hole: /y Weeping from Pit Face Estimated Seasonal High Groundwater J ZU DETER NATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: _ in. Depth to soil mottles: In. Depth to weeping from side of obs.hole: in. Groundwater Adjustment tt. Index Well# Reading Date: Index Well level a Adi.faetor- Adj.groundwater Level PERCOLATION TEST Date Time Observation Hole# Time at h" Depth of Perc Time at 6" Start Pre-soak Time @ Z Ok` 'Time(9"-6") End Pre-soak Rate Min./Inch "j Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation testis to be conducted within 100'of wetland,you must first notify the. Barnstable Conservation Division at least one(1)week prior to beginning. y Q:\SEPT10PERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# 6 Depth from Soil Horizon Soil Texture Soil Color Soil Other' Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistency, ray — 6il ZC /0 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. nsi ten %Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. _ t Consistency.%Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consi e Flood Insurance Rate Man: Y Above 500 year flood boundary No Yes Within 500 year boundary No /� Yes._..r Within 100 year flood boundary No v Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervi us te 'al exist in all areas observed throughout the ma area proposed for the soil absorption system? ._. If not,what is the depth of naturally occurring pervious material? 1 Certification ( I certify that on 0— 47 (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,expe ' and=nedescribeddin,010CMR15.017. ,9 �7Signature Date l Q:\SEPTIMERCFORM.DOC DATE; 6/4/02 PROPERTY ADDRESS:_5_1_ P_r_a_m_ Road___- ____ __West _HyannisPort ....... Mass . On the above date, I Inspected the septic system at the abov.gddres ® This system consists of the following: ro`G '�?o `k 1 . 2-6 ' X8 ' block cesspools in series . yF9 Tyq�. l y�AST•9 � e<F Based on my Inspection, I certify the following conditions; 2 , This is not a title five septic system. 3 . This is a sewage system Two cesspools in series . 4 . The „sewtLge system is in proper working order at the present time . 5 . Pumped the main cesspool at time of inspection . Heavy scum & solids layers were present . There was noLSi-g-ns of water intrusion , The cesspools are structurall sound SIGNATURE;1 Name : _1_?._ Macomber jr.____-- Company: Joseph_)` _ Macomber_& Son , Inc., Address : Box 66 -------------------- Centerville , Ma . 02632-0066 -------------------- Phone: 508-775-3338 THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY JOSEPH P, MACOMBER & SON, INC. Tanks-Cesspools•Leachf lelds Pumped & Installed Town Sewer Connectlons P.O. Box 66 Centerville, MA 02632.0066 775.3338 775.6412 • COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION 1 Propert}'Address:51 Pram Road West Hyannisport ,Mass . Owner's Name: Ed Largey Owner'sAddress-305 'Hurley Street Cambridge .Mass . 02141 Date of Inspection: 6/4/0 2 Name of Inspector: (please print)Joseph P. Macomber Jr . Company Name: J. P.Macom er & Son Inc . Mailing Address: Box 66 Centerville .Mass . 02632 Telephone Number: 508-775-3338 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: /Passes / Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails 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. Notes and Comments ` This report only describes conditions at the time of inspection and under the conditions of use at that— I time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 r Page 2 of 1 1 OFFICIAL INSPECTION FORM— NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 51 Pram Road West yannis . Owner: Ed Largey Date of Inspection: Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: have not found and in ormation hich 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: The sewage system is in proper working order at the present time . The overflow cesspo—ol has never been full . Waste water 37" below the invert pipe of the-overilow. Main pool as required . Cess pool is structurally sound and shows no evidence B. System Conditionally Passes: of water intrusion . _Ak 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. AWt The se tic tanks metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, e ibxh its substantial infiltration or exfiltration or tank failure is imminent. System will ass inspection if the P P 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: f7 x�IG Observation of sewage backup or break out or high static water level in th _ istri_ u—uon bo due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: //L The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 51 Pram Road West Hyannisport ,Mass . Owner: Ed Largey Date of Inspection: 6/4/0 2 C. Further Evaluation is Required by the Board of Health:' /00 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: A�0 Cesspool or privy is within 50 feet of a surface water 05 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. /A0 The system has a septic tank and SAS and the SAS is within a Zone I of a public water supply. Al The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. 100 The Svstem has a septic tank and SAS and the SAS is less than 100tifeet 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. Oth This is a sewage system. The system consists of two 6 'X8 ' block cesspools in series . The main cesspool acts as a septic tank . Solid waste is contained in the main cesspool the effluent passes ,over to the second cesspool . 3 ti Page 4 of I 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:51 Pram Road West Hyannisport ,Mass . Owoer:Ed Largey Date or Inspection: 6/4/02 D. System Failure Criteria applicable to all systems: You must indicate 'yes"or"no" to each of the following for all inspections: Yes No 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 A10AX+ Static liquid level in the ismbution box hove outlet inven 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 ''A day (low Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe($). Number of times pumped I . �iAny 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 ater supply. _ Any ponion of a cesspool or privy is within a Zone I of a public well. �� /.�ny portion of a cesspool or privy is within 50 feet of a private water supply well. !/ Anv 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 qualiry analysis. jThis 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 trust be attached to this form.1 (Yes'No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15 303. therefore the system fails. The system owner should contact the Boars e 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 now 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) des noJ ✓ the system is within 400 feet of a surface drinking water supply v e system is within 200 feet of a tributary to a surface drinking water supply d th _ — _ e system is located to a nitrogen sensitive area (Interim Wellhead Protection Area IWPA) or a mapped Zone 11 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 es" in Section D above the large system has failed. The owner or operator of any large system considered a $!,vificant threat under Section E or failed under Section D shall upgrade the system in accordance with 3 10 CMR 30� The system owner should contact the appropriate regional office of the Depamnent. 4 Page 5 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 51 Pram Road West Hyannisport ,Mass . Owner: Ed Largev Date of Inspection: 6/4/0 2 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 ? Z/Were as built plans of the system obtained and examined? (If they were not available note a<9 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, luding the SAS(Iocated on site ? . .i Ae),V W4ere the, a tic tank manholes uncovered,opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction,dimensions, depth of liquid, depth of sludge and depth of scum ? Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: Yes no/ _l // Existing information. For example, a plan at the Board of Health. Determined in the field(if any of the failure criteria related to Pan C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] I 5 Page 6 of I I OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 51 Pram Road West yannisport , Mass . Owner: Ed Largey Date of Inspection: 0 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual): �. DESIGN flow based on 310 Cl 15.203 (for example: 1 10 gpd x # of bedrooms): ksl;�; nts Number of current reside : Does residence have a garbage grinder(yes or no):�(lD Is laundry on a separate sewage systeajSy'es or no):,tZ (if yes separate inspection required) Laundry system inspected (yes or no): 5 Seasonal use: (yes or no): 4-b Water meter readings, if available (last 2 years usage(gpd))?00 0-0 1=18 , 000 gallons=49 . 32 GP Sump pump(yes or no):40 UUI—UZ=JZ , /-')0 gallons=88. 36 GPD Last date of occupancy A 9/��/'`"" COMMERCIAL/INDUSTRIAL Type of establishment: ,IJ: Design now(based on 310 CMR 15.203): A0 Basis of design flow(seats/persons/sqft,etc.): I� Grease trap present(yes or no): Industrial waste holding tank present(yes or no):2 Non-sanitary waste discharged to the Title 5 system (yes or no):,JL,"'� Water meter readings, if available: Last date of occupancy/use: 12� OTHER (describe): GENERAL INFORMATION Pumping Records Source of information: None available . Was system pumped as pan of the inspection (yes or no): If yes, volume pumped: tb gallons-- Ho ,w ,q anti pumped determi ed? Reason for pumping: 7` OWA'91� cesspools are st uctura y sound ./ Shows no evidence of water ;jPE OF SYSTEM intrusion . OS Septic tank, distribution box, soil absorption system Single cesspool Overflow cesspool Privy ,OShared 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) A46 Tight tank kh Attach a copy of the DEP approval yv Other(describe): Appr ximate OC. of ill componen , ate installed (if known) and source of information: Were sewage odors detected when arriving at the site(yes or no):/6� 6 Page 7 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 51 Pram Road West HyannispoTrt ,Mass . Owner: Ed Largey Date of Inspection:6 4 0 2 BUILDING SEWER(locate on site plan) Depth below grade: /?",) , Materials of construction: A- cast iron Z0 PVC ether(explain):p ' Distance from private water supply well or suction line: �- l'isk� Comments(on condition of joints, venting, evidence of leakage, etc.): Joints appear tight . No evidence of leakage The system is vented through the house vents . SEPTIC TANK4&-1t(locate on site plan) Depth below grade: AM Material of construction:,V&concrete V4 metal,4/4 fiberglass vypolyethylene ,ILA other(explain) A If tank is metal list age:Ald Is age confirmed by a Certificate of Compliance (yes or no):.,e/!4(attach a copy of certificate) Dimensions: AM Sludge depth: IV,* Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: � Distance from top of scum to top of outlet tee or baffle: Al Distance from bonom of scum to bottom of outlet tee or baffle: �/11 How were dimensions determined: A# Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Septic tank is not present . GREASE TRAP�y (locate on site plan) Depth below grade:Ay Material of construction:y,4 concrete4/&metaI40 fiberglass_0polyethylene4/9other (explain): a,4 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: 40 Date of last pumping: ,14/ Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): Grease trap is not present . 7 Page 8 of 1 I OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 51 Pram Road West Hyannisport , Mass . Owner: Ed Largey Date of Inspection: 6/4/0 2 TIGHT or HOLDING TAN1OI�jCt- (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: A'A Material of construction: concrete 14 metal 64 fiberglass&;j polyethylene�/ _other(explain): el? Dimensions: AIA Capacity: gallons Desien Flow: gallons/day Alarm present(yes or no): A Alarm level: 4)11 Alarm in working order(yes or no): .tV Date of last pumping: ,4/A Comments(condition of alarm and float switches, etc.): Tight or holding tanks are not present . DISTRIBUTION BOX (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: _O 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.): Distribution box is not present. PUMP CHAMBER6140YG (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.): Pump chamber is not - present . 8 Page 9 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 51 Pram Road West Hyannisport ,Mass . Owner: Ed Largey Date of Inspection: '6 4 02 SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, excavation not required) 2-6 ' X8 ' Block cesspools . n series . If SAS not located explain why: Located : SPP page 10 Type �),D leaching pits. number: 4/0 leaching chambers, number: 10 410 leaching galleries, number: A leaching trenches, number, length: O ATO leaching fields, number, dimensions: overflow cesspool, number: 1 , CC NLi innovative/alternative system Type/name of technology: _ l'YdP l7� Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil,condition of vegetation, etc.): Loamy sand to medium fine sand . No signs of hydraulic failure or ponding .Overflow has never beem--full . Soils ar'e dry . Vegetation is normal . CESSPOOLS: Zcesspool must be pumped as pan of inspect ion)(locate on site plan) Number and configuration: !�Al Depth - top of liquid to inlet invert: / Fcam/ Depth of solids layer: 141"" Depth of scum layer: Sp 11 Dimensions of cesspools Materials of construction: a/'e- Indication of groundwatef inflow(yes or no): O Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Same as above . Pumped main cesspool at time of inspection o signs of water intrusion . Cesspools are structurally sound . PRIVY4."(locate on site plan) Materials of construction: Dimensions: Depth of solids: 1251X Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy is not present 9 Pagc )0 of I I OFFICLAI INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Properr7 Address: 51 Pram Road Owocr; Ed larg St Hvannisport , Mass .. Datc of Inspcctioo; SKETCH OF SEWACE DISPOSAL SYSTEM PTOridc a skctch of the scwaec disposal systcm inclvding tics to el icast two permancnt refcrcnce InnCmarks or ocncnmuks. Locatc all Wclls within 100 (<cl. Locltc whcrc pvblic wt,tcr svpply cnicrs the bviloing. PJ ��/ Sltxlxncitt (1'� f� 10 Page I 1 of I 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 51 Pram Road West Hyannisport , Mass . Owner: Ed Largey Date of Inspection: 4 02 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water feet Please indicate(check)all methods used to determine the high ground water elevation: &_Obtained fro designplans on record - if checked, date of design plan reviewed: served site roe bservation hole within 150 feet of SAS) hecked with local Board of Health-explain: Checked with local excavators, installers-(anach documentation) Accessed USGS database-explain:h t t p ; 11 t own , barns t a b l e ,ma . us You must describe how you established the high ground water elevation: Used ; Gahrety & Miller Model . 12/16/94 Water elevation above Sea level . Used ; USGS. Observation well data. June 1992 Used ; USGS ; Technical bulletin 92-000-1 Plate #2 January 1992 Water tabble annual rang e� � __ ft vrouna Leaching t) Pit qJ'.eet Groundwater. Feet Below Bottom of Pit High Groundwater Adjustment 1.8 ft per Frimpter Method Therefore, the vertical separation distance between the botto 0 of the leaching pit and the adjusted groundwater table is L feet. 11 n r+rnnr-n—arr. arr.nts+rrrnr..rrr.rrr..•.rr.e'err:�+rsrn+m�vt.anrrrer,trn .rn-rrr-�—r•-...-..—..,F y-rr TOWN OF Barnstable BOARD OF HEALTH SUIISIIRFACF SEHAGF DISPOSAL SYSTEM INSPECTION FORM - PART D •- CERTIFICATION t .•••�•'t-T••.••.•e-�.11 �.�T.T.�II'R.'TT T'1T TT.T ST,•TI•.r-•.•1*••1TTR't RRT-'TTtTAt T IiTS1TIi'n1'TCt7 an •T'^^�^To'*rr*+r.'n-.•..:rrr r•n. .-.. -TYPE OR PRINT CI.EARLY•- PROPERTY INSPECTED STREET ADDRESS51 Pram Road West Hyannisport ,Mass . ' ASSESSORS MAP , BLOCK AND PARCEL #i dt � ;Y OWNER' s NAME Ed Largey • PART D - CERTIFICATION I NAME OF INSPECTOR Joseph P.Macomber Jr . COMPANY NAME J. P.Macomber & Son Ine-r COMPANY ADDRESS Box 66 Centerville ,Mass . 02632 Street Town or city State LIP COMPANY TELEPHONE (508 ) 775 - 3338 FAX ( 790 ) 1578 _ tS A CERTIFICATION STATEMENT Dr I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true , accurate , and omplete as of the time of .inspection . The inspection was performed and any ecolnmeltdations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems , Chec one : System PASSED The inspection t4hich I have conducted has not found any information which indicates that the system fails to adequately protect public health or Lhe. environment as defined in 310 CMR 15 , 303 , Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form , System FAILED* The inspection which I have conducted has found that the system fails to Protect the public health and the environment in accordance with Title 5 , 3.10 CMR 15 . 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form , Inspector Signature Date a( ne copy of this c t.ification must be provided to the OWNER, the BUYER where applicable ) and the BOARD OF HEAL1'JI. ' I * If the inspection FAILED, the owner or operatorshall upgrade ' the eystem within one year of the dnte of the inspection , unless allowed or required otherwise as provided in 3.10 CMR 16 . 305 . partd -doc I I ASSESSORS MAP : TEST HOL PARCEL : � ��/ ` E LOGS NOTES: . FLOOD ZONE: mac. / >7 SOIL EVALUATOR: .� ...,.fi. .., WITNESS : I C7t 4� �, 1'`�" 1G1 -- � 1 1) The installation shall comply with Title V and Town of Barnstable Board of REFERENCE: D eQ 3��/ 7�� � P4,&r?,;� c. �Z DATE t 11 Regulations. _ __.._.. � '_41 "� C IIea t t eau ations. PERCOLATION RATE: .� 2. 1 t�.l E , , � 2) The installer sh�ll�verify the location of utilities, sewer inverts and septic components prior to installation and setting base elevations. All ravit septic piping to be 4 inch Sch 40 PVC at 1/8 - -� _. F TH-2 ) g Y p P p g per foot. The first _._. two feet out of the d-box to the leaching shall be level. 01, a 4) This plan is not to be utilized for property line determination nor any other 3 purpose other than the proposed system installation. L aA+ht Y to p1� ;�'% � f ist- 5) All septic components must meet Title V specifications. ( �; lbt 6) Parking shall not be constructed over H10 septic components. LOCAT I ON MAR ✓7 { tv i / � 6 7) The property is bounded by property corners and property lines. S) The property owner shall review design considerations to approve of total design flow and number of bedrooms to be considered for design. Receipt of payment for the plan and installation based on the plan shal➢ be deemed ld lf7 � approval of the design flow by the owner. T i 9) The existing leaching or cesspools shall be pumped and filled with material per Title V abandonment procedures. Those within the proposed SAS shall be ►}�{ - � removed along with contaminated soil and replaced with clean.washed sand t � l'�4 ` per Title V specs. 10)System components to be 10 feet from water line. Sewer lines crossing the water line shall be sleeved with 4 inch SCH 40 PVC with ends grouted if SEPT I C SYSTEM DES I G N applicable. 11) If a garbage grinder exists it is to be removed and is the responsibility of the I FLOW Et1T I MATE owner to ensure such. ------- ---------- 12)The installer is to take caution. in excavation around the gas line if applicable. /�d, -- 'eJ BE:' ROOMS .AT GAL/DAY/BEDROOM -3:0GAL/DAY 13)The installer shall verify the location quantity and elevation of the sewer lines .�/ exiting the dwelling prior to the.y/ e installation. r I SEPT IC TANK i is L/DAY x 2 DAYS ': 'GAL ° ° USE 1`- GALLON SEPTIC TANK ....� S (( .. u G G et2., v�(ST` l n --- S0 f L A1150RP1 I ON SYSTEM '1 a c.. r � I Q J 1 "i 1�- _._. L)� 2 x '�reG "T3r , E, ( t MA SIDE AREA. ' �. ,'o t{�6o " q U TTOM AREA• 2- X O��` «. ' 2. 4,q/S T eV, F\ _PT I \.. SYSTEM SECT I ON — - �� , � .... . [� . I�. �t� .._ ���_ �,u-cLl um..• ` w, GAL. ' DO � u M �'�3 SEPTIC TALK � r II .� j SITE AND SEWAGE PLAN j LOCAT I ON : G PREPARED FOR : 1 � .. M o o SCALE: a DAVID B . MASON R DATE: DBC ENV I RONMEN�AL DESIGNS W DATE W HEALTH AGENT EAST SANDWICH . MA Z ( 508 ) 833- 2177 6)Tr