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HomeMy WebLinkAbout0121 SIXTH AVENUE (HYANNIS) - Health L xth AvenueP ," 064 4, � c u o A h jt 4 1 i o a i� n e n C 4 TOWN OF BARNSTABLE LOCATION 1 ( 51 �b� s # sP. o . 'V-1LLAGE ASSESSOR'S MA/P�&PARCEL IT'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) CktckIMb4try (size) d� NO. OF BEDRROOMS OWNER 60400r-- PERMIT DATE: DATE:3�0 1 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 1 f r•/~/ ! ! f f f f f J J f r f r f J r r r r r r f i J f J f f 25 11 7 14 Back3t Yard Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 121 SIXTH AVE Property Address PRIA HARMON Owner Owner's Name information is T y{V S required for MA 2-26-14 every page. City/Town -IS State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information When filling out forms on the computer,use 1. Inspector: � U b only the tab key �J I to move your DOUGLAS A BROWN cursor-do not Name of Inspector use the return key. DOUGLAS A BROWN INC Company Name P.O. BOX 145 Company Address CENTERVILLE MA 02632 City(rown State Zip Code 508-420-4534 S14297 Telephone Number License Number $. Certification t=certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority CAA 2-26-14 Inspecto gnature 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 repork only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Tit%511tion Form:Subsurface Sewage Disposal System•Page 1 of 17 ` Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments , 121 SIXTH AVE Property Address PRIA HARMON Owner Owner's Name information is required for W HYANNISPORT MA 2-26-14 every 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: SHED IN BACK YARD WAS OVER THE D-BOX AND AT LEAST PARTIALLY OVER THE LEACH CHAMBERS D-BOX AND CHAMBERS WERE VIEWED BY CAMERA B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 ' Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 121 SIXTH AVE Property Address PRIA HARMON Owner Owner's Name information is required for W HYANNISPORT MA 2-26-14 every page. Cityrrown 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 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 121 SIXTH AVE Property Address PRIA HARMON Owner Owner's Name information is required for W HYANNISPORT MA 2-26-14 every page. Cityrrown 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: 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 '/Z day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 121 SIXTH AVE Property Address PRIA HARMON Owner Owner's Name information is required for W HYANNISPORT MA 2-26-14 every 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- 10,000gpd. El ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CM 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 drinkirg water supply El ❑ 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 M , 121 SIXTH AVE Property Address PRIA HARMON Owner Owner's Name information is required for W HYANNISPORT MA 2-26-14 every page. Cityrrown 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 5 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM , 121 SIXTH AVE Property Address PRIA HARMON Owner Owner's Name information is W HYANNISPORT MA 2-26-14 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: ACCORDING TO AS-BUILT CARD SYSTEM CONSISTS OF A 1500 GALLON TANK D-BOX AND 2 500 GALLON CHAMBERS WITH STONE e Number of current residents: 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: SEASONAL USE MINIMUM WATER USAGE Sump pump? ❑ Yes ❑ No Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CM 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M , 121 SIXTH AVE Property Address PRIA HARMON Owner Owner's Name information is required for W HYANNISPORT MA 2-26-14 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: SEASONAL Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) El Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts rs Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M , 121 SIXTH AVE Property Address PRIA HARMON Owner Owner's Name information is required for W HYANNISPORT MA 2-26-14 every page. Cityr'rown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 3-15-04 ORIGINAL AS-BUILT CARD Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 1.75 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 Sludge depth: VARYING BUT LIGHT t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 121 SIXTH AVE Property Address PRIA HARMON Owner Owner's Name information is W HYANNISPORT MA required for 2-26-14 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness THIN AND CLUMPING Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? WOODEN POLE 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 (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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 5 121 SIXTH AVE Property Address PRIA HARMON Owner Owner's Name i information is requiredquired for W HYANNISPORT MA 2-26-14 for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle-condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ 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 i 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 , y 121 SIXTH AVE Property Address PRIA HARMON Owner Owner's Name information is required for W HYANNISPORT MA 2-26-14 every page. Cityrrown 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 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): BOX WAS VIEWED BY CAMERA DUE TO IT BEING UNDER SHED ,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: S.A.S WAS VIEWED BY CAMERA BECAUSE THEY WERE AT LEAST PARTIALLY UNDER SHED t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fdrm Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M , 121 SIXTH AVE Property Address PRIA HARMON Owner Owners Name information is required for W.HYANNISPORT MA. 2-26-14 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 2 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields b 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.): CHAMBERS WEIR DRY AT TIME OF INSPECTION 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 Title 5 Official inspection Fora Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M , 121 SIXTH AVE Property Address PRIA HARMON Owner Owner's Name information is required for W HYANNISPORT MA 2-26-14 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora-. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M ' 121 SIXTH AVE Property Address PRIA HARMON Owner Owner's Name information is.required for W HYANNISPORT MA 2-26-14 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Farm Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 121 SIXTH AVE Property Address PRIA HARMON Owner Owner's Name information is required for W HYANNISPORT MA 2-26-14 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells 5 + Estimated depth to high ground water: 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: FEB 2014 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: 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 Assessing As-Built Cards Page 2 of 2 Commonwealth of Massachusetts Title 5 Official Inspection -orm Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 121 SIXTH AVE Property Address PRIA HARMON Owner Owner's Name information is required for W HYANNISPORT MA 2-26-14 every page. Cityrrown State Zip Code Date of inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 http://www.townofbamstable.us/Assessing/HMdisplay.asp?mappar=245064&seq=2 2/28/2014 I ' Assessing As-Built Cards Page 1 of 2 TOWN OFBARNSTABLE LOCATION 2 }C 4\ p� S»E# 74'Sid VILLAGE tV MAP&PARCEL 11 'S NAME&PHONE NO. SEPTIC TANK CAPACITY 1-560 5" LEACHING FACILITY:(type) CkzLwb4rl� (size) NO.OF BED1/��OOMS 3 OWNER (:o A✓lor PERMIT DATE: COMMMEE DATE:.yr I Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility Of 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 / J ♦ r / r/ rr Jl r -! 25 ' 7 11 14 Back Yard http://www.townofbamstable.us/Assessing/HMdisplay.asp?mappar=245064&seq=2 2/28/2014 ` ^ommonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 121 6th Ave Property Address Martin Connor Owner Own is Name information is required for Q n 111 S MA 02672 March 27, 2012 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out A. General Information forms the I r computer, r,use 1. Inspector: J only the tab key ' to move your Patrick M. O'Connell cursor-do not use the return Name of Inspector key. Septic Inspection Services Co. Company Name 189 Cammett Road SR Company Address Marstons Mills MA 02648 Cityrrown State Zip Code 508-428-1779 SI 12855 Telephone Number License Number LLJ JU"t Co') `A'- B. Certification CCJ c-j 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 a was pJr firmed based on my training and experience in the proper function and maintenance of on site sewagµedisposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5,(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails Needs Further Evalu 'on b he Local Appr ing Authority i J 1 March 27, 2012 Job# 12-51 Inspector's Signature Date The system inspector shall submit a copy of thisJnspection 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. 15ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 121 6th Ave Property Address Martin Connor Owner Owner's Name information is required for West Hyannisport MA 02672 March 27, 2012 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: Tank was not in need of pumping at time of inspection, leaching system had no signs of surcharge or saturation. 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 exhibit s 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 indicatingthat the tank is less than 20 ears old is available. y ❑ Y ❑ N ❑ ND (Explain below): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts . W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 121 6th Ave Property Address Martin Connor Owner Owner's Name information is West H annis required for Y pod MA 02672 March 27, 2012 every page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑' obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 121 6th Ave Property Address Martin Connor Owner Owner's Name information is required for West Hy p annis ort MA 02672 March 27, 2012 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for 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: 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 El ® or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than_day flow 15ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 121 6th Ave Property Address Martin Connor Owner Owner's Name information is P required for y West H annis ort MA 02672 March 27, 2012 every page. Cityrrown 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. El ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 121 6th Ave Property Address Martin Connor Owner Owner's Name information is required for West Hy p annis ort MA 02672 March 27, 2012 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ 0 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-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts = Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 121 6th Ave Property Address Martin Connor Owner Owner's Name information is required for Y p West H annis ort MA 02672 March 27, 2012 every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Currently Occupied. 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-11/10 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 w 121 6th Ave Property Address Martin Connor Owner Owner's Name information is required for West HY p annis ort MA 02672 March 27, 2012 every page. Cityrrown 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: None Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): l5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 .Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 121 6th Ave Property Address Martin Connor Owner Owner's Name information is required for West Hy p annis ort MA 02672 March 27, 2012 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Compliance date: 3/15/04 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): ' Depth below grade: 1 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain).- Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): ' Depth below grade: 1 1 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: 10.5' long x 5.8'wide- 1500 gal. Sludge depth: 3" t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 121 6th Ave Property Address Martin Connor Owner Owner's Name information is required for West Hy p annis ort MA 02672 March 27, 2012 every page. Cityfi-own 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 30" Scum thickness 2 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 12 How were dimensions determined? Measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Liquid level was found at bottom of outlet invert and tees were intact. 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 15ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 121 6th Ave Property Address Martin Connor Owner Owner's Name information is p required for y West H annis ort MA 02672 March 27, 2012 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: 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-11110 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 121 6th Ave Property Address Martin Connor Owner Owner's Name information is required for West HY P annis ort MA 02672 March 27, 2012 every 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.): No solids or high stains present. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 -Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 121 6th Ave Property Address Martin Connor Owner Owner's Name information is required for West HY p annis ort MA 02672 March 27, 2012 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: Two 500 gal drywells. ❑ 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.): Soils and stone surrounding chambers were probed with no signs of saturation found. 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 I t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 121 6th Ave Property Address Martin Connor Owner Owner's Name information is required for West Hy p annis ort MA 02672 March 27, 2012 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System.Page 14 of 17 e Commonwealth of Massachusetts - 9.7 Title 5 Official Inspection Form W�- Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 121 6th Ave Property Address Martin Connor Owner Owner's Name information is required for y p West H annis ort MA 02672 March 27, 2012 --- __ every page. Citylrown 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 \r\r\r\r\r\r\r 25 11 7 14 Back Yard ' Commonwealth of Massachusetts j Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 121 6th Ave Property Address Martin Connor Owner Owner's Name information is required for West Hy p annis ort MA 02672 March 27, 2012 every page. Cityrrown 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: 15+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: USGS topo map and town GIS. You must describe how you established the high ground water elevation: Town groundwater contour map shows water below el. 5 and topo map shows property at el. 20. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts �7 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 121 6th Ave Property Address Martin Connor Owner Owner's Name information is p y required for ann West H is ort MA 02672 March 27, 2012 every page. Cityfrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 TOWN OF BARNSTABLE LOCATION f /l :,cN` J��e-. SEWAGE# ' = ')_ V'J LAGE h`��.>�>ts /7�::< ASSESSOR'S MAP &LOT,�q,5 % INSTALLER'S NAME&PHONE NO. & 414ifZ; SEPTIC TANK CAPACITY �3 G G.,LEACHING FACILITY: (type) f.�1'X-2f - NO. OF BEDROO BUILDER O OWNER ® /-A /-2 20-1 COMPLIANCE DATE: d`l PERMTTDATE: _ Separation Distance Between the: _ Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility g 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 p6ts o ��:fie E �.-f*-i 4 b � e M� II �i u \ t Sjf No. �—i/d 7 Sp �. /l �. Fee SU� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIppYication for Diopood bpgtem Con!truction Permit Application for a Permit to Construct( . )Repair(✓)Upgrade( )Abandon( ) F Complete System O Individual Components Location Address or Lot No. Zl/ Owner's Name,Address and Tel.No.six a� Mel" Assessor's Map/Parcel Installer's Name,Address,and Tel.No. f/ Designer's Name,Address and Tel.No. -771 Type of Building: Dwelling No.of Bedrooms Lot Size J0040 sq.ft. Garbage Grinder(I-el)o Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow 3J3e gallons. Plan Date / Z.3 M I Number of sheets l Revision Date Title 291 2,1 2Z IZZ 51 ll CY/l/l /T Size of Septic Tank /�®o Type o(S.A.S. 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 Certifi- cate of Compliance has been issued_by this Boaz of Signed Date Application Approved by Date t I Z Application Disapproved Wrthe following reasons Permit No. C) Date Issued L Z D a F fill too 67 ,. 0. Fee i;. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Yes 4 a Z(pplication for �Dizpozal *p$tem Construction Permit Application for a Permit to Construct( )Repair(")Upgrade( )Abandon( ) ©Complete System El Individual Components X ✓ Location Address or Lot No. Owner's Name,Address and Tel.No. Assesso Ma /PazUt7 Installer's Name,Address,and Tel.No. �J Designer's Name,Address and Tel.No. 77/� �3�� 36z - �95ue,/ Type of Building: Dwelling No.of Bedrooms 17 Lot Size 510W sq.ft. Garbage Grinder(_1(1� Other 'I)rpe of Building -f dlC� `No.of Persons Showers( ) Cafeteria( ) Other Fixtures ' Design Flow 114��• gallons per day. Calculated daily flow ✓�� gallons. Plan Date 11/1.31 )3 Number of sheets Revision Date Title 5%le ✓911 Size of Septic Tank /S©� Type of S.A.S., 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 Certifi- cate of Compliance has been issued by this Board-of .ealth. Signed 1 Date Application Approved by a - Date f 2/, Application Disapproved for the following reasons Permit No. Date Issued --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sew,age Disposal System Constructed( )Repaired(v)Upgraded( ) Abandoned( )by ��d/Sy`-; at .�� �` CMG t� }��`/.�sJ/5,�/ �` has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. UU-%- �dated 2 �U.S Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function�tas.designed. Date_-3 15 J o Y Inspector -------p-------------------------------- No. L 003~S t ( r� --- Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS 30igogal *p.5tem Construction Permit Permission is hereby granted to Construct( )Repair( )Upgrade( )Abandon( ) System located at /Z / S�iZ' 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:Construc 'on ` ust be completed within three years of the date of this pe I �` Date: fZ 2 Approved b ' Y �, TOWN OF BARNSTABLE LOCATION _ Ay/ 5,A N SEWAGE #�e -3 )"`fi_ VILLAGE ASSESSOR'S MAP & LOT,�q, %r, INSTALLER'S NAME&PHONE NO. 751, �3 'D.7 SEPTIC TANK CAPACITY /3 r 0 . C e- LEACHING FACILITY: (type) (size) NO. OF BEDROO BUILDER O WNER PERMITDATE: / G "3 COMPLIANCE DATE: Lo�1 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Fa ' i S 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 byCirJr/ t eC, M1 3✓y�sanyy,, ,� .� eL D AT E: _ 11 /13/96 PROPERTY ADDRESS: 121 Sixth Aye►Aye_.; jYy wAt_S West Hyannisport,Mass . 02672 On the above date, I Inspected the septic system at the above address. This system consists of the following: 1 . - 1-61x6•1 block cesspool. Based on my Ingowction, I certify the following conditions: . 1 . This is not a title five septic system. 2. This-. is a sewage system. 3. .The sewage system is in proper working order at the present time. .4. Should operate well for seasonal use. 5. The age of system. About 40 years old. 8IGNATUR!7,: G� Name: J. P.Macomber Jr.. i Company: J. P_MacoMber &— Son•_Inc . Address:_-Banc-bb-----=�-- -- __Centerville LMass__02632 Phone:--, 7-5�3338------- THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY RL .lOSEPH P. MACOMBER & SON, INC, r- Tanks•Ceupools-Lesihflelds Pumped & Installed Town Sewer Connection: P.O. Box 66' Centerville, MA 02632-0066 775-3338 775-6412 . 0 Commonweafth of Massachusetts - - Executive Office of Environmentol Affairs Department of 'Invironmental Protection Trudy Coxe -- David B.Struhs U.Cavnri„ C.atvnba♦orisf SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 121 Sixth Ave W. Hyannisport Mass Address of Owner. Vincent Ma£fie Date of Inspection:11 /1 3/96 (If different) P. 0.Box 1 745 Name of inspector.Joseph P.Macomber Jr. Plainville,Mass . Company Name,Address and Telephone Number. 02762 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 inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: XXXX Passes For seasonal use only. System under designed for--_-bedroom house Conditionally Passes -_ Needs Further Evaluation By the Local Approving Authority _ F2subdmitj. il Inspectors Signature- Date: 11 /14/96 System The Inspector copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspection. If the system is a shared system or has a design Dow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner ru,d copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: A) SYSTEM PASSES:For seasonal use only. System under designed for -bedroom house. vl� have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B) SYSTEM CONDITIONALLY PASSES: _ P One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair, passes inspection. Indicate yes, no, or not determined(Y, N,or ND). Describe basis of determination in all instances. If"not determined",explain why not) /fddQb The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or exfiltration,.or tank failure is imminent.`The system will pass inspection if the existing septic tank is replaced with a ponforming septic tank as approved by tLr Board of Health. (revised 11/03/95) 1 One Winter Street a Boston, Massachusetts 02108 a FAX(617)556-1049 a Telephone (617)292.5500 C� Pnnied on Recycled Paper t } r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (oontlnued) pr,pe,tyAdd,.e,,. 121 Sixth Ave West Hyanni sport,Mass . Owner. Vincent Maffie Date of Inspection: 1 1 /1 3/9 6 B)SYSTEM CONDITIONALLY PASSES(continued) /&,We Sewap backup or breakout or ho static water level observed in the distribution boa is due to broken or obstructad pipe(s) or due to a broken,settled or uneven distribution boa. The system will pass inspection if(with approval of the Board of Health): broken pipes)am replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). Ths system will pans inspection if(with approval of the Board of Health): broken pipes)are replaced obstruction is removed C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: AJ 0_ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is witbin 60 feet of a surface water .J20 Cesspool or privy is within 60 feet of a bordering vegetated wetland or a salt marsh R) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENh The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 60 feet of a private water supply well. The system has a septic tank and toil absorption system and is Isar than 100 feet but 60 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the wall is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 6 ppm. 9) OTHER 1-61x6l block cesspools. Age approx 40 years old. ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (oontlnuod) P,,pertyAddr•e.s: 121 Sixth Ave West Hyanni sport,Mass . Owner. Vincent Maffie Date of Insprootion: 1 1 /1 3/96 D) SYSTEM FAILS: • y I have determined that the system violated one or more of the following failure criteria as definad in 310 CMR 16.303. Ths basis for this determination is identified below. The Board of Health should be oontacted to determine what will be asoessary to oorr+ct the failure. 40 Backup of sewage into facility or syrtem component due to an overloaded or clogged SAS or cesspool. /0 Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or oesspool. &CWQ,Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. &�D Liquid depth in cesspool is leas than 6"below invert or available volume is less than 1/2 day slow. �D Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _ A26 Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. &,D Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. /VQ Any portion of a oesspool or privy is within a Zone I of a public well. ,d-P Any portion of a cesspool or privy is within 60 feet of a private water supply well. Any portion of a oe.spool or privy is less than 100 feet but greater than 60 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E) LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: IUD The system serves a facility with a design Dow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: th.system is within 400 feet of a surface drialdng 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) The owner or operator of any such system shall bring the system and facility into full oompliaace with the groundwater treatment program requirements of 314 CMR 6.00 and 6.00. Please consult the local regional office of the Department for nuthar Information.. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 121 Sixth Ave West Hyannisport,Mass . Owner. Vincent Maffie Date of Inspection: 1 1 /1 3/9 6 ' Check if the following have been done: ZPumping information was requested of the owner,occupant,and Board of Health. 2NOUS of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Iirge volumes of water have not been introduced into the system recently or as part of this inspection. 4As built plans have been obtained and examined. Note if they are not available with N/A. „J/Ths facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow 4zThe sits was inspected for signs of breakout. AV , All.system components, weluding the Soil Absorption System, have been located on the site. AldA e± l'he septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baIDas or teas, material of construction, dimensions, depth of liquid, depth of sludge,depth of scum. J_//Ths size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. _/The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub- surface Disposal System. RECOMMENDATIONS 1 . The System should be upgraded to a title five septic system. Designed for three bedrrooms . This would allow the house to be occupied on a year round . basis. System will have to be installed ire , the front yard.Present system is not large enough to handle year round useage.The present cesspool would probably not handle full time living on a seasonal basis. 4 months at a time. (revised 11/03/95) 4 ;5 SUIISUI(FACE S µ'AGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Properly Add,c.a: 121 Sixth Ave West Hyannisport,Mass . owner. Vincent Maffie Date of Inspoutivr.: 11 /13/96 FLOW CONDITIONS RES I D ENTIAL- Deeign llow: �d (Zv+ t ►�V Number of bedrooms: Number of current residsau: 6 Garbabv pinder(pee or no):.A P `+ Laundry connected to ry"m (yee or no): b Seasonal use (yes or no): 5 Water meter readings, if available: _ Last data of o=paaty;z / COMMERCL4L/INDUSTRIAL• Type of esublishment: A,M Desi,-n Dow: 4)4 p.11ons/day Grease trap present: (yes or no)A)—# Industrial Waste Holding Taak present: (yea or no) A214 Non•saaitary wasto discharged to the Title 5 system: tycs or no)Alq Water meter reading, if available: A' Last date of occupancy: OTHER: (Describe) IVA Lart dace of oocupancy: 4)fi _ GENERAL INFORMATION PUMPING RECORDS and source of' ortnation: 11.))4)V- /Qd f91 '4 `r , System pumped as part of inspectiou. dyes or no)y If yea, volume pumped: Reason for pumping: TYPE OF SYSTEM yv Septic t&Li)distribution box/sod absorption system 7 Lo3 &i i,e cu",;,c;I Overflow cta:spc.it Privy WT9harad ryrtem (yes or no) (if yea, attach previous inspection records, if any) I Other(a:plain) APPROXIMATE AGE of all componenu, date u:.+tallud (if ltriown) and source of information: _ VL0,4;".19 Sewave odors r..etAr-tart —11a ti SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C• • SYSTEM INFORMATION (continued) Property Address: 121 Sixth Ave West Hyanni sport,Mass . ? Owner: Vincent Maffie Date of Inspection: 11 /13/96 SEPTIC TANQA& . (locate on site plan) Depth below grade:<14 Material of construction:diAoncrete _metal _FRP—other(explain) Dimensions:_ Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle:-,VA- Scum thickness: JQL Distance from top of scum to top of outlet tee or baffle: A1/� Distance from bottom of scum to bottom of outlet tee or baffle._ Comments: (recommendation for pumping, condition-of inlet and outlet tees or baffle depth of liquid IPvel in relation to outlet invert, structural •rity, evidence of leakage, etc.) NAil GREASE TRAP. (locate on site pian) Depth below grade:,I� Material of conslri'irtion)J?:oncrete _metal _FRP _other(explain) AM Dimensions Scum thickness: Distance from-top vi scum to top of outlet tee or baffle:A)/9- Distance from bottom n( scum t- hOnnm 01 outlet tee or baft)e•-A)jQ Comments: (recommendation for pumping, cond!— of inlet and outlet tees or baffles, depth of liqq��td level in relation to outlet inven, structural integrity, evidence of leakage, et ci_ �r�14 e -ZL09 15: A)07- /rJJ t!S6VT, s V (revised 8/15/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM S UBSURF TEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) F4oPeih'Address: 121 Sixth Ave West Hyanni sport,Mass . owner. Vincent Maffie Date of Inspection: 11 /13/9 6 TIGHT OR HOLDING TAN&,,&kyV, (locate on site plan) • Depth below grade:, Material of constructkat6:0ncrets_metal_FRP_other(explain) - Aa Dimensions: Capacity: A'1'4 gallons Design flow ons/day Alarm level: Comments: (condition of inlet tee, adi ' n of alarm andfloat switches,etc.) DISTRIBUTION BOX;IWe, (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level an distribution is eq nos of solids carryover,evidence of leakage into or out of box,etc.) PUMP CHAMBER:4 �4v—' (locate on site plan) Pumps in working vrder.(yes or no),&L Comments: ( edition of p��r,coaditiop of pumps and appurtenances, etc.) ,O � i¢�l Gioli' 1S �1/DT e s6i1/T (revised 11/03/95) 7 ""'`: " ' •',� . y U SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(oontinued) Property Address: 121 Sixth Ave West Hyanni sport,Mass . Owns. Vincent Maffie Date of Inspection: 1 1 /1 3/9 6 SOIL ABSORPTION SYSTEM (SAftz (locate an site pkN if possil ;excavation not required,but may be approximated by non-intrusive methods) • If not determined to be present,explain: Type: Lochin pit.,number. Lachine cbambsrs,aumber.Q leaching galleries,number. lathing trenches, aumber,length: V leaching fields, number,darns overflow cesspool, number: Comments: (note condition of soil,signs qf hydraulic failure,level of ponding,-condition of vgetation,stc.) CESSPOOLS: (locate on site plan) Number and configuration: Depth-top of liquid to inlet vert: Depth of solids layer. CJ Depth of scum layer Dimensions of cesspool: Materials of construction: Indication of groundwater:__ inflow(cesspool must be pumped as part of inspection)_ IVi4- sQiL nmilinz. cond' o signs ,lyara4�.ic a`�lu'lre- or of on ng�f�vo egetaiion; Medium sand o ins son . PRIVY: (bate on site plan) Materials of , /1, Dimensions: Sig Depth of solids: (note condition of soil,signs of hydraulic&Bur*, level of pondin&condition of vegetation,itc.) (revised 11/03/95)• g bj�,ju1Z.F'ACE SEWAGE DISPOSAL SYSTEM INSPECTION .POI ri SYSTEM INFORMATION continued SKETCH U SEWAGE IISPOSAL SYSTEM: include :ies to at least two permanent references landmarks or benchmarks locate a 1 wells within 100 ' Not_..Me.te.rad-------._ i -II DEPTH TOIGROUNDWATER 121 + l depth to groundwater i i-4th_od o -determinesion or approximation: •Installs s —terns_.-a "8 �a ..live 8 -82 1•z 6th Avo #86-1099, 491 6th Ave 11_ _ 0' o"v3at B encounters 2 n of these oca.tiori t ._.. /� (Z. N COMNIONIVEALT-3 OF MASSACHUSET'4- S I )N-1 OF ENVIRO- *�MENTM - P1R,0TFi(_`T_J ( BE IT KNOWN' THAT -Joseph P. Macomber Y Jr. Has satisfied the Department's qualifications as required and is hereby authorized tc, use the title CERTIFIED TITLE 5 SYSTEM -INSPECTOR as provided in 310 CMR 15 .340 and Section 13 of Chapter 21A o.1 General Laws. Issued by The Depari I rent of Environmental Protec Jung 8, 1995 �CLIng Director of the��`ion of Water Pollufit:)�., r •n'nr-r.—nrrr.—.�r-arnrmr•nmrr�+rr::rrrrar:•.r+-.�.► nr-�nn* ne•ny*+�+�sr.rre .�,�-�—...-. ,—..,F I TOWN OF Barnstable WARD OF HEALTH SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D •- CERTIFICATION \� F^•rr�-r...-car—r. r.^.--..,nr.n•rt.�+r-.ama�rrrnrr�r�+--Burn-�ar+nar•-rse*ra.rs��.a�+�rt mm� ..� - -TYPE OR PRINT CI.EARLY- PROPERTY INSPECTED STREET ADDRESS 121 Sixth Ave West Hyannisport,Mass . ' ASSESSORS MAP, BLOCK AND PARCEL # 245-064 OWNER' s NAME Vincent Meffie PART D - CERTIFICATION I NAME OF INSPECTOR Joseph P.Macomber Jr. COMPANY NAME J.P.Macomber & Son Inet COMPANY ADDRESS Box 66 Centerville Mass . 02632 Street Town or city Stat• tip COMPANY TELEPHONE ( 508 1 775 - 3338 FAX ( 508 ) 790 - 1578 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true , accurate , and complete as of the time of .inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . Check one: XXXXXXXXXXSystem PASSED For Seasonal use only. The inspection i+hich I have conducted has not found any information which indicates that the system fails to adequately protect public health or the 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 11/•13/96 One copy of this t.ification must be provided to the OWNER, the BUYER ( where applicable ) and the BOARD OF HEAL711. * If the inspection FAILED, the owner or•roperator shall upgrade he aYete within one year of the date of the inspection, unless allowed ortrequiredm otherwise as provided in 3.10 CHR 15 . 305 . partd .doc SYSTEM PROFILE ES HOLE LOGS TOP FNDN. AT EL. 21 .0'- TEST + ACCESS COVER TO WITHIN 6" OF FIN. GRADE (NOT TO SCALE) PROVIDE INSPECTION PORT WITHIN / " ACCESS COVER (WATERTIGHT) TO cRAfGwLLE g�per+ ROAD --- 1' CRAwLSP. /! / 6" OF FINISH GRADE ENGINEER: D.A. OJALA, SE 19.5' MINIMUM .75' OF COVER OVER PRECAST WITHIN 6" OF FIN, GRADE 2% SLOPE REQUIRED OVER SYSTEM I 19.0' WITNESS: INVERT THROUGH SAM WHITE, RS D CRawLSP, FLOOR RUN PIPE LEVEL 2" DOUBLE WASHED PE ONE\ DATE: 1 1/15/03 !. PINE FOR FIRST 2' 3' MAX___j?_E . < 2 MIN INCH PROPOSED 15g0 � PERC. RATE / ••� LOCUS 17 25' GALLON SEPTIC 17.0' 16.0' CLASS i SOILS P 10616 TANK (H- 10 ) GAS • ''. BAFFLE 15.67' �� 15.50 l� 0 C7 C] 0 C7 CJ C] MIN 15.17 CJCIE� ED ED MI-] M n ( 2 % SLOPE) �6" CRUSHED STONE OR MECHANICAL �3� m m m � m 0 L' E� C� COMPACTION. (15.221 [21) Sa$g 2' 0 ED 0 ED m [O C] 1:1 1 0 13.17' Q ELEV. 4 DEPTH OF FLOW = MIN 18 9 TEE SIZES: ( 5.7 q, SLOPE) ( 1 % SLOPE) 3/4" TO 1 1/2" DOUBLE WASHED STONE 0 A INLET DEPTH = 10„ /SL 14" 4 10YR 3/2/ uNsuir. OUTLET DEPTH - LOCATION MAP NTS /B LEACHING ASSESSORS MAP 245 PARCEL 64 FOUNDATION--- 11 SEPTIC TANK 23' D' BOX 12 FACILITY 6 27' /i"S UNSUIT. 10YR 5/6/ 36" 15.9' SL / UNSUIT. 6.9' /10YR 6/2 72" C2 MS f 2.5Y 7/3 144" 6.9' 3 E✓IU NO WATER ENCOUNTERED NOTES: 4 I APPROXIMATE VGVD +1r + 21.1 1 TU S 12" MAPLE I �- - � I•i�SIGN FLOW: 3 E3EDROOA'; (�1 2...GPD) - 3 i �;{='p 2. 1N,:IPAL WATER IS _ XI` -- ----- + 0. M __ 0 c. v . 2 FLAG 205 2 8 y>,S � USE A J3v GPD iESriwN =L13�' J. i�1 �vil vivi r�ir _ rl i�,'H i 21.1 DECK ATIS� nil +-2$ w w v 21.0 10 SEPTIC TANK: 330 GPD ' = 660 4. D_:.SIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO H- 20 4 + 20. ` 5. P PE JOINTS TO BE MADE WATERTIGHT. BENCH MARK - NAIL SET IN 19.6 I 1 USE A 1500 GALLON SEPTIC TANK 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS. FENCE POST ELEV. = 21.1 EXIST. DWELL. + 2 .5 I LEACHING: ENVI°RONMENTAL CODE TITLE V. � 1 I 73' x 2 (' )/4 108 7. THIS PLAN IS FOR PROPOSED SEPTIC SYSTEM ONLY AND IS NOT �Ur r Q•r 1'f CRAwLSP. TONE 206 `'� PERIMETER: -- TO BE USED FOR ANY OTHER PURPOSE. + 19.3 M TF = 21.0' DRIVE a I:;OTTOM AREA: 306 SF (.74) = 226 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. RE-LOCATE SHED p 451 334 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT .-- G I TOTAL: S.F. GPD INSP�CTION BY BOARD OF HEALTH AND PERM SSION OBTAINED SH 1 1 G 1 .6 + 2 1 0 USE (2) 500 GAL. LEACHING CHAMBERS (ACME OR F;�01v1 BOARD OF HEALTH. r4 + 20.0 EQUAL WITH 4' STONE AROUND EXCEPT AT 5' REMOVAL OF UNSUITABLE SOIL REQUIRED 1 "" ) ( 10. PUMP & REMOVE (OR FILL W/CLEAN SAND) EXISTING SEPTIC SYSTEM AROUND PERIMETER OF LEACHING FACILITY, 00 ( 20,2 + 19.8 NORTHEAST CORNER - SEE DETAIL) DOWN TO SUITABLE SOIL LAYER (TO C2 LAYER P is 19. - SEE TEST HOLE LOG). REPLACE WITH CLEAN p 1 �pVe + 5 G 19.5 MED. SAND. ' 1+ 1 .1 H LOT AREA � I LEGEND 8,000t SQ. ,T1 FT. �4`s k TITLE 5 SITE PLAN + .3 100.0 PROPOSED SPOT ELEVATION OF � 100.00' + 19.2 19-----��" 19 18.7 121 SIXTH AVENUE 7, 100x0 EXISTING SPOT ELEVATION IN THE TOWN OF: �S• CRAwLSP. 100 PROPOSED CONTOUR (WEST HYAN N I S P 0 RT) BARN STAB L E 0 100 EXISTING CONTOUR PREPARED FOR: gORTOLOTTI CONSTRUCTION/CONNOR bo 20 0 2O 40 60 12.8' BEARD OF HEALTH SAS DETAIL APPROVED DATE MA SCALE: 1 " = 20' DATE: NOVEMBER 23, 2003 1" = 20' off 508-362-4541 fox 508 362-9880 down cape engineering, Inc, FL ;.>� Of 4, pRNE s ✓off ARNS H. yG CIVIL ENGINEERS w• � � OJAIJ� LAND SURVEYORS � No.'s348 � C c IVIL N y W92 43--328 9.,9 main st, yarrnouth, rya 02675 A OJAhA, a:� D..ATE rah