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Home My WebLink About0174 ABBEY GATE - Health i -_ _- 174 Abbey Gate Cotuit A = 021 041 II 1 i i - r Commonwealth of Massachusetts �( Title 5 Official Inspection Form Subsurface._ Sewage Disposal System Form Not for Voluntary Assessments 174 Abbey Gate Road Property Address -- Margaret Diggins Owner Owner's Name information is required for every Cotuit /� MA 02635 4/22/15 _page. City/Town - State i-1"2ip 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. t Important:When -- filling out forms A. GeneralInformation I on the computer, use only the tab 1. Inspector: key to move your cvrso,-dn not n-^.•-,r..,. �wlc,neEi GiBuono _ use the return Name of Inspector ---- key. DiBuono Sewer and Drain cza Company Name }- , 8 Johns path!- Company Address S Yarmouth _ ;MA - _ 02664 City/Town State Zip Code 508-364-9587 _ S113522 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection: The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system:, ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 4/22/15 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future nder the same or different conditions of use. !Sins•3113 ` Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts W Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,.•''F 174 Abbey Gate Road Property Address Margaret Diggins Owner Owner's Name information is required for every Cotuit MA 02635 ` 4/22/15 page. City/Town State ZipCode Date of Inspection nspection 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: The system contains a 1000 gallon tank as well as a concrete Distribution box. All tees and baffles are in place. The Distribution box is level and at normal level. The leaching is made up of a 1000 gallon leaching pit and at time of inspection levels appeared to never have been at-abnormal levels. -( PUMPING IS RECOMMENDED AT THIS TIME ) " 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 Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 174 Abbey Gate Road Property Address Margaret Diggins Owner Owner's Name information is required for every Cotuit MA 02635-' 4/22/15 page. City/Town 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-Coan•ditiorrally 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 Commonwealth of Massachusetts W Title 5 official Inspection Form _ . Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 174 Abbey Gate Road Property Address Margaret Dig ins Owner Owners Name information is required for every Cotuit -MA 02635 4/22/15 page. Cityrfown 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-Zone1 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 'Y2 day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 174 Abbey.Gate Road Property Address Margaret Di gins Owner Owners Name information is required for every Cotuit MA 02635 4/22/15 page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) Yes No Required pumping more than 4 times-in the last year.N.OT.due...to-clogged or E] ® obstructed pipe(s). Number of times pumped: i ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and.nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. I 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 pP Y ❑ ❑ 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— NVPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts W Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 174 Abbey Gate Road Property Address Margaret Diggins Owner Owner's Name information is required for every Cotuit MA 02635 4/22/15 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: i Yes 'Na- ❑ ® 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? E ❑ 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 15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 174 Abbey Gate Road Property Address Margaret Diggins Owner Owner's Name information is required for every Cotuit MA 02635 4/22/15 page. City/Town State Zip Code Date of Inspection D. System Information Description: The system contains a 1000 gallon tank as well as a concrete Distribution box. All tees and baffles are in place. The Distribution box is level and at normal level. The leaching is made up of a 1000 gallon leaching pit and at time of inspection levels appeared to never have been at abnormal levels Number of current residents: vacant 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? u e. ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): 181.3 gpd Detail: 2013: 82,000 gal - 2014: 50,000 gal Sump pump? ❑ Yes ® No Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): — — Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form = Not for Voluntary Assessments 174 Abbey Gate Road Property Address Margaret Dig ins Owner Owners Name information is required for every Cotult MA 02635 4/22/15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other-(describe below): I General Information Pumping Records: Source of information: N/A Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ ..Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of"latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 174 Abbey Gate Road Property Address Margaret Di ins Owner Owners Name information is required for every Cotuit MA 02635 4/22/15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 18 years i Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer (locate on site plan): Depth below grade: 18 " feet Material of construction: ® cast iron ® 40 ?VC ❑ other(explain): Distance from private water supply well or suction line: — feet Comments (on condition of joints, venting, evidence of leakage, etc.): System is vented throught the roof Septic Ta nk ank (locate on site flan): Depth below grade: 1 ft feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene El other(explain) 1,000 gallon If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1,000 Gallon Sludge depth: 3" 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 •'"r 174 Abbey Gate Road Property Address Margaret Diggins Owner Owner's Name information is required for every Cotuit MA 02635 4/22M 5 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 24" Scum thickness 3 Distance from top of scum to top of outlet tee or baffle 42 Distance from bottom of scum to bottom of outlet tee or baffle Sludge stick How were dimensions determined? Tape Measure 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: NA feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene El other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom.of scum to bottom of outlet tee or baffle — -- Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °°M •'"F 174 Abbey Gate Road Property Address Margaret Di dins Owner Owner's Name information is required for every Cotuit MA 02635 4/22/15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) i Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tees are in place and levels are normal. 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 0 No I5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official. Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 174 Abbey Gate Road Property Address Margaret Diggins Owner Owners Name information is required for every Cotuit MA 02635 4/22/15 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 At Normal Level.. 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 level and at normal level with no signs of carry over or decay. I Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3113 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 a,•'" 174 Abbey Gate Road Property Address Margaret Diggins Owner Owner's Name information is required for every Cotuit MA 02635 4/22/15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1-1,000 gal ❑ leaching chambers number: — ' ❑ leaching galleries number: ❑ leaching trenches number, length: — ❑ leaching fields number, dimensions: ❑ , overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): No signs of carry over. No signs of hydraulic failure. 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Officialm Form Inspection F®r p Subsurface Sewage Disposal System Form - Not for Voluntary Assessments e,•'`v 174 Abbey Gate Road Property Address Margaret Diggins Owner Owner's Name information is required for every Cotuit MA 02635 4/22/15 page. City/Town 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.): No signs of ponding or hydraulic failure. 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 Form:Subsurface Sewage Disposal System•Page 14 of 17 Assessing As-Built Cards Page 1 Of 2 tlo'c n�7c� TORT!OF BARNSTA5LE LOCATION �� 1_S RbSe✓ �A�e RJ SEWAGE h VILLAGE U ASSESSOR'S MAP&LOT INSTALLER'S NAME&PHONE NO, SEPTIC TANK CAPACITY—__1040 9.A, LEACHING FACO_.=:(type) /Doo aAA 3), (size) /0X/a NO.OF BEDRooMS, 3 BUILDER ROW � � feel qC4 VU`� PERMrTDATE:7—_'Vzl= ) 'Q COMPLLAJNCE DATE:_4-312_— Separation Distance Between the: Maximum Adjusted Groundwater Table and Bonom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of Icactung facility) Feet Edge of Wetland and Leaching Facility(If any wedands exist within 300 feet of icaching facility) Feet Furnished by r 3 llttp;//W\A'W.townotbarnstable.us/Assessing/HMd1splay,asp?mappar=021041&seq=1 4/21/201.5 Commonwealth of Massachusetts W Title 5 official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments i 174 Abbey Gate Road Property Address Margaret Diggins Owner Owners Name information is required for every Cotuit MA 02&ST 4/22/15 page. City/Town 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 W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 174 Abbey Gate Road Property Address Margaret Diggins Owner Owner's Name information is required for every Cotuit MA Q2635 4/22/15 page. CltylTown 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: 35+ ft 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: 9/22/94 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: Property sits 40 ft above nearest water venue. Test hole data shows NGE at elevation 68 Bottom of pit is at elevation 73 Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 174 Abbey Gate Road Property Address Margaret Diggins Owner Owner's Name ----- information is required for every Cotuit MA 026`35" 4/22/15 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ❑ Inspection Summary: A, B, C, D, or E checked ❑ Inspection Summary-D(Syystem,Failure Criteria Applicabl-e 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System.,Page 17 of 17 ASSESSORS MAP NO- PARCEL NO; F.RjcZ N0.1 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH , TOWN OF BARNSTABLE Appliration for Diiipo!ml Works Tontitrurtion Frrutit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: el ............................... /0._/L. 'r alion Lot .......... Owner 4P 11-L/ Address ...............V .......... .................... ........ ..../19!.� ................................. �7._Qler Address Type of Building Size ........Sq. feet Dwelling—No. of Bedrooms--- Garbage Grinder......... -----------------------------Expansion Attic P4 Other—Type of Building —z-0025 ............ No. of persons_________._____________.._._ Showers Cafeteria P4Other fixtures --------------------------------------------------------------------------------------__............................................................ Design Flow...................................._.gallons per person per day. Total daily flow_----_----------------lt3P.......gallons. WSeptic Tank—Liquid capa6ty/-PZI�..gallons Length_0.4.6._ Width__4/_��/��4_ /7 Diameter................ Depth.. Disposal Trench—No. .................... Width------..-------------- Total Length...______._.._...... Total leaching area............ sq. ft. Seepage Pit No------/............ Diameter___._-__..._..... Depth below inlet-----f.............. Total leaching area,2._6_4....sq. f t. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.-___-_._... ....................................... Date Test Pit No. I......--____minutes minutes per inch Depth of Test Pit---A?............ Depth to ground water....4 OZW-------- 44 Test Pit No. 2......�......minutes per inch Depth of Test Pit-_/Z........... Depth to ground water...111R*1<!-------- 9 ........................... ------ ------------------------------------------------------L............................................. 0 Description of Soil....A.7-#/...._71.1... ........=�....�01_fk-------- ----An din4...1.9�Kc.................. - ............. U '> .44 _7 J .................................Ar ..... ----------------------------------------------------------------------------- .......................................................................................................................... U Nature of Repairs or Alterations—Answer when applicable-__-_------------------- ...................................................................... ..................................................................................................................................:..................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Comp.lia Vehas �e issued b the bQarAof--hea1th- Signed --------------- ------------ ................................................................. ------ -----------i........... ...... Application,Approved ....................... -------------------------- ......................................... Application Disapproved for the following reaf onf: ......................._------------------ ------------------------------------------------------------------------------------------ ................................................................................------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------- Date 'Issued -------ZZ7--—/-C/.. Permit No- -------------................................................... --------- Date ——————————————————————————————————————————— ——————————- �1 OL/ 'No.._L........ . ......... �vt�, e-9411 �_'�� FEB.,��-�/ THE COMMONWEALTH OF MASSACHUSETTS r BOARD OF HEALTH . TOWN OF BARNSTABLE Apphratiott for Ali-spinal 111dw Tomitrnrtion 11amit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ....K-74-A ��_c.;...---- Al -------------------------------mod f--------.j............................................ ocaticni-Address or Lot No. ...................2 ��....................��..-. .. rE�..`fir: ��5�� . ..... ......'.. ��. --------- Owner Address Installer Address Q Type of Building Size ........Sq. feet U Dwelling—No. of Bedrooms........... -Expansion Attic ( ) Garbage Grinder ( ) •.� p, Other—Type of Building ___ - _... No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a' Other fixtures ............................... ... W Design Flow.............................�r.5........_gallons per person per day. Total da y flow............................ -------gall`l_.ons WSeptic Tank Liquid capacrty,/0Ov_ .--gallons Length-- ___6__._ Width_.-/_ /v.__- Diameter---------------- Depth----,`r._.:". . Disposal Trench—No. .................... Width_.-----.--____._-_-_ Total Length-------------------- Total leaching area....................sq. ft. Seepage Pit No....../.-...------- Diameter-----j6_........_. Depth below inlet.....4�..._..._.._. Total leaching area_.5�.6.6....sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by............. _ /.............� ....... Date Test Pit No. 1------Z......minutes per inch Depth of Test Pit__.A3............ Depth to ground water....4 a--0--------- (i Test Pit No. 2......y......minutes per inch Depth of Test Pit--��---------- Depth to ground water.../Ve ....... D Description of Soil.... / �. x 'T�L •--a - - = ! ors_,-..-•-S�_2.ta C L------ - - 1� f'� ``' c, f° ------------ s.�, /............. w VNature of Repairs or Alterations—Answer when applicable................................................................................................ --------------------------------------------------------------------------------------••-----------.--------------------------------------------...------------------------------------..._.........•••. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions oI TITLE 5 of the State Environmental Code —The undersigned further agrees not to place the system in operation until a Certificate of Compliance has,been issued by the board--of health. y� Signed .. ✓ � -.... - --- - ------------ Dace Application.Approved By :..J............. '� Application Disapproved for the following reafons: ............................. ---------------------------------------------------------------------------------------....---......---------------------------.t------------------ .........................................................._..._--- ---- ------------..__--------------------------..................----------------------------. -------- ........................................ -f/1 Dac-�-ee -- Permit No. ......... � - - ............_..._-... -.... Issued c�� -1.��.---.. �j Dace . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE MILQrtifiratr of TII1rt plianre TH S IS TO C- RTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by . ... � ram......... / 'r?/'ld /Of- _.... Insndler at .. .........�� Sl?/k S.--- .. �Gc ------------------------ -----------------------------------_---------------------------------------------------------------------------- has been installed in accordance with the provisions of TITLE^5 of The State Environmental Code as escrlbed in --� the application for Disposal Works Construction Permit No. r" ,T �^.. ��....... dated .;. .^-...... --- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE----------------------L ..... )b---_ 7_�.... - ... Inspector ...... -- ------ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE lRioposal Workii Tomitrnrtion "rrmit Permission is hereby granted..------. ................. . --------"------------------ to Construct ( ) o Repair ( ) an Individual Sewage Disposal System at No. 1.7��...1% ��' Grp �'J/ci�7 _`. -` Street s) y as shown on the application for Disposal Works Construction Permit N;._.____..._` •Dated....___�____________________ _....._. ...:.. -- DATE......................... �-n---=_1..7....-------------...... --------- ------------ B oard of H ealth FORM 36508 HOBBS&WARREN.INC..PUBLISHERS 7q TOWN OF BARNSTABLE LOCATION �'� J� �b��.� C��e �'� SEWAGE # VILLAGE �e�y ASSESSOR'S MAP & LOT 02 1 _ y 'INSTALLER'S NAME&PHONE NO. d3°�o�a�C� W SEPTIC TANK CAPACITY 1040 LEACHING FACELITY: (type) (size) X�a NO.OF BEDRO MS BUII,DER R O PERMIT DATE:. . -6 '�7 COMPLIANCE DATE:�?► Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by J -Dec� 3b l v v as z t 0 > y C � NH r o v X � a L ,A �• cp o �. Z i A40 C N v � vNA (t v v 9.31 a � h l I N � e 0 1 � a v �rtoxfr ®�` ��rs Abbe4,00go 'bb T#4)k r j VV n� 16 X 4v �- co 00 co )(0 114 45 E 213.86' cO W � •— / 13 Q� 8 / `• X ' 20 24. TPII �a ca bcE/N' wO TES ELEVfM3.25 ° PIT 2 o° (0 8' 4' LOT 15 21,192 S.F. / 12/ / ,! PI L 1P TI T P%too"U(SE SEDBOX24' / 4, so 0 tv _ LTV.=92�o 5 Cn rn O / r-) , �� D CK N o. / N -� 21 toe 9 / 34' (b 00`L 6'x6' LEACH PIT 90 ESER RETAIN WITH 2' STONE 1 /' ALL AROUND / 3,2 THIS AREA 9)& 9496 98 NOTES: 1. HOUSE NUMBER: 174 i-- 2. ASSESSOR'S, NUMBER: 021-041 3. ZONING DISTRICT: RF 4. FLOOD HAZARD ZONES: C 5. TOPOGRAPHIC INFORMATION COMPILED FROM AN ON THE `GROUND INSTRUMENT SURVEY. 22 6. ELEVATIONS SHOWN ARE BASED ON THE NATIONAL / GEODETIC VERTICAL DATUM. 7. REFERENCE: PLAN BOOK 271 PAGE 56 9/22/94 HOUSE SEPTIC SYSTEM AND WATER SERVICE MOVED & SDH o� GRADING CHANGED DATE DESCRIPTION Drawn Checked R "e•� R E V I S I O N S I" OFS o� &UCHAEL ��. PLOT PLAN N N 58°06 1,0 PREPARED FOR w OF PROPOSED SEWAGE DISPOSAL SYSTEM No.28M 18.50 o�Fs 9F�ISTE��o �wa�: BREEN CONSTRUCTION 23 �'°�� LAND`'�� FOR LOT 15, ABBEY GATE IN COTUIT BARNSTABLE MA NOTICE 10 0 20 Unless -and until such time as the original (red) stamp of the OF i responsible Professional Engineer, or Professional Land Surveyor SCALE: 1 = 20 DATE: AUG. 30, 1994 SCALE IN FEET appears on this plan: �,�'�' 1�,'EOC-fe��L (A) no person or persons, including any municipal or other h al m eS and m cg ra th, inc. I McGBATI'I€3. public officials, moy'rely upon the information contained herein; and CIVIL engineers and land surveyors �` Giv4L (B) this Ryanremains the c of m s & McGrath, Inc. ( 200 main street A No.36313 } SIGNATURE. falmouth, ma. 02540 t DRAWN: MAH SDH CHECKE 94201PP.Dwc JOB NO: 94201 DWG. NO.: 58-3-12 SHEET 1 OF 2 SOIL TEST Finish grade above and adjacent to system shall slope away at a min. of 2%. 4" diam. cast Iron or Schedule 40 PVC pipe (tight joints). Date of soil test: AUG. 30,1994 Test taken by. S. HANDY 20' min. distance (building to edge of leaching system) Results witnessed by: E. BARRY 10' min. dist. Percolation rate: 2 MIN./IN. GENERAL NOTES Ground water NONE ENCOUNTERED I First floor elev. = 92.00 1) No change to this system shall be made unless approved in writing by holmes and mcgrath, Inc. SOIL LOG SOIL LOG 2) Subject to inspection during construction by the Board of Health and holmes and mcgrath, Inc. NO 1 NO 1 3) Heavy construction equipment shall not travel DEPTH SOILS ELEV. DEPTH SOILS ELEV. over disposal system during or after construction. Removeable Covers within 4 Disposal system to be constructed in accordance }r ) Di P 0 80.0 0 81.0 12" of Finished Grade with Title 5 of the State Environmental Code. S = .02 Dist. box 5) A copy of these plans must be kept on the site TOP, TOP, ` during the time of construction. 3 0' SUBSOIL 77.0 3.0' SUBSOIL 78.0 12" X. 2' S=.02 6) A copy of these plans must be furnished to the Removable cover contractor constructing the disposal system. Foundatio level I 7) Before backfilling, the contractor shall notify i i ev_ holmes and mcgrath, inc., or the Board of Health design S = .04 Agent to inspect the system as constructed. MEDIUM by others � N � �---�=�-� _ g p � MEDIUM ^ TJ 7/ —+--- Riser 8) If the contractor encounters any variation between TO FINE SAND o SEPTIC TANK o SAND 00 1000 GAL. Co cp a Inv. elev.= 79.84 the existing conditions shown on the plan and the Il Il O 00 Clean backfill conditions encountered on the site, or any soil — N " condition different than shown on the soil to or 9 —� — - ' 11 p 2 layer of 1/8" to 1/2" an adverse soil, the contractor shall immediate) 13.0' 67.0 13.0' 68.0 ' Y Y y • 75 11 °oov° 00000 washed stone u ooao C o contact holmes and mcgrath, inc. Holmes and mcgrath, Inc. will examine the soil condition c 5 " c 0 a C 0 and report to the owner any suggested revisions. > �r- v Precast C `� 0 2 ft. of 3/4" to 1/2" washed stone a tl ,o o concretec.4) 0 all around precast pit, providing an ID leaching n o effective diameter of 10 ft.MILE Not to Scale it 0 ° ° P �3 ° w c o 00 00000 Elev.= 71.0 PROVIDE 12" LAYER OF COMPACTED GRAVEL UNDER 10'diometer THE DISTRIBUTION BOX Design Criteria 4' Number of bedrooms: 3 Equivalent to 330 gal.'s/day Elev.= 67.0 Garbage disposal unit: No BOTTOM OF TEST HOLE Leaching area capacity required: 330 gal.'s/day Side area proposed: 188 sq. ft. Bottom area proposed: 78 sq. ft. Total area proposed: 266 sq. ft. Proposed leaching capacity. 549 gal.'s/day Water supply: Town Precast concrete units: H-10 loading design 8'-6" E r: Unless and until such time as the original (red) stamp of the j, ALL ACCESS MANHOLE COVERS FORresponsible Professional Engineer, or Professional Land Surveyor appears on this plan: .; o SEPTIC TANK, DISTRIBUTION BOX, (A) no person or persons, including any municipal or other i AND LEACHING STRUCTURE SET MORE public officials, may rely upon the information contained herein; and THAN 12" BELOW FINISHED GRADE, (BLE this plan�remain�sthgrpty of Holmes & McGrath, Inc. INLET OUTLET SHALL BE RAISED TO WITHIN 12" OF sIGNATu FINISHED GRADE. �r DATE: V FRAME & COVER STEEL REINFORCED PRECAST CONCRETE` OVER "T'S" WHERE REQUIRED. PL/l N VIEW 9/22/94 `:�-�'fi="`'�5'Tf�`l�9 INVERT ELEVATIONS CHANGED SDH t1 V PRECAST CONCRETE DATE DESCRIPTION Drawn Checked 3" 3" TANK RISER WHERE REMOVABLE COVERS REQUIRED R E V I S I 0 N S p 4„ L INSTALL TUFTITE SPEED LEVELERS f OT PLAN DETAILS e��3" min. clearance required R r ALL OUTLET PIPES FROM THE ON ALL OUTLET PIPES z min_ inlet to outlet 6 mini INLET "T D1ETR'Bv��°FOR°ATS�E s 62 FT. CONCRETE COVER OF PROPOSED SEWAGE DISPOSAL SYSTEM INLET 12" —{— OUTLET PREPARED FOR 10" min. . Liquid level -- 3 — 5" OUTLET r JOSEPH BREEN a ; `� KNocl<ouTs FOR LOT 15 ABBEY GATE Eto , o o i _ l 15.5" OUTLET + �� 28" INLET IN o l J • ' , , ' BARN STABLE, MASS. =, �� 8" 6" 8' 12" . ,:. 3 �s=o";. 4'-10" 15.5" 1.75" SCALE: AS SHOWN DATE: AUG. 30, 1994 ' k C PLAN SECTION CROSS--SECTION holmes and mcgrath, inc. McGRATH CROSS—SECTIONEND—SECTION- civil engineers and land surveyors CIVIL 200 main street Na.psis TYPICAL 1000 GALLON SEPTIC TANK 3 HOLE DISTRIBUTION BOX falmouth, ma. 02540 ��o�FRF STER • NOT TO SCALE NOT TO SCALE DRAWN: SDH CHECKED/ JOB NO: 94201 DWG. NO.: 8-3-12 SHE 2 OF 2 i