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HomeMy WebLinkAbout0027 TARAGON CIRCLE - Health ti 27 TARAGOn -CIRCLE COTUIT A= 041 012 -Doa- I I j� 1 t Commonwealth of Massachusetts U/a-00� Title 5 Official Inspection Form 11 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments r . c 27 Taragon Circle Property Address '' Nicholas Tavano Owner Owner's Name {r.. information is required for every Cotuit ✓ Ma 02635 6/19/2019 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. Imponfling out forms n A. Inspector Information cal 3q0 filling out forms on the computer, use only the tab Sean M. Jones key to move your Name of Inspector cursor-do not S.M.Jones Title V Septic Inspection use the return Company Name key. 74 Company A Lane Co Company Address Centerville Ma 02632 City/Town State Zip Code rem 508-658-3456, 774-2484850 SI 4522 sean@smjonestitle5.com License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 6/19/2019 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 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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: 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. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form <ol Subsurface Sewage Disposal System Form -Not for Voluntary Assessments . � 27 Taragon Circle u Property Address Nicholas Tavano Owner Owner's Name information is required for every Cotuit Ma 02635 6/19/2019 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) 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 property located at 27 Taragon Circle Cotuit is served by a.Title V septic system consisting of a 1000 gallon septic tank, distribution box and a 1000 gallon precast leach pit. The system was found to be in proper working condition at the time of inspection. 2) 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): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 27 Taragon Circle Property Address Nicholas Tavano Owner Owner's Name information is required for every Cotuit Ma 02635 6/19/2019 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ 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): 3) 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. a. 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: t5insp.doc•rev.1/26/20111 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 27 Taragon Circle Property Address Nicholas Tavano Owner Owner's Name information is required for every Cotuit Ma 02635 6/19/2019 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. 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 1.00 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. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No El ® Backup of sewage into facility or system component due to 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 cesspool t5insp.doc-rev.7/26/2018 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 27 Taragon Circle Property Address Nicholas Tavano Owner Owner's Name information is Cotuit Ma 02635 6/19/2019 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® 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 1/2 day flow ❑ ® 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 water supply 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 2000 gpd- 10,000 gpd. ❑ ® 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. 5) 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 CA. 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments V 27 Taragon Circle Property Address Nicholas Tavano Owner Owner's Name information is required for every Cotuit Ma 02635 6/19/2019 page. Citylrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: 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)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 27 Taragon Circle Property Address Nicholas Tavano Owner Owner's Name information is required for every Cotuit Ma 02635 6/19/2019 page. Cityrrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 gpd Description: Number of current residents: 3 Does residence have a garbage grinder? ❑ Yes ❑ No Does residence have a water treatment unit? ❑ Yes ❑ No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ❑ .No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonaluse? ❑ Yes ❑ No Water meter readings, if available (last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: current Date t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form F,o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 27 Taragon Circle Property Address Nicholas Tavano Owner Owner's Name information is required for every Cotuit Ma 02635 6/19/2019 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 2. 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 Water treatment unit present? ❑ Yes ® No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ® No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ® No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. 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: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 27 Taragon Circle Property Address Nicholas Tavano Owner Owner's Name information is required for every Cotuit Ma 02635 6/19/2019 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 4. 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): Approximate age of all components, date installed (if known) and source of information: original system 1991 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): 1.5 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.): Joints ok, no leaks or blockages. Vented through roof t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 27 Taragon Circle Property Address Nicholas Tavano Owner Owner's Name information is required for every Cotuit Ma 02635 6/19/2019 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 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: 1000 gallons Sludge depth: 6" Distance from top of sludge to bottom of outlet tee or baffle 3' Scum thickness 2° Distance from top of scum to top of outlet tee or baffle 5" Distance from bottom of scum to bottom of outlet tee or baffle 11" How were dimensions determined? opened covers and took measurements Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank does not need to be cleaned now but should be done soon and again every 2 years for proper maintenance. water level was even with outlet, tank was not leaking and was structurally sound. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1p,wil 27 Taragon Circle Property Address Nicholas Tavano Owner Owner's Name information is required for every Cotuit Ma 02635 6/19/2019 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 7. 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 Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form < Subsurface Sewage Disposal System Form-Not for Voluntary Assessments u 27 Taragon Circle Property Address Nicholas Tavano Owner Owner's Name information is required for every Cotuit Ma 02635 6/19/2019 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) 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 9. 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.): distribution box was level and in good condition with no rot. Water level was even with outlet invert with no signs of past backup. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �P v 27 Taragon Circle Property Address Nicholas Tavano Owner Owner's Name information is required for every Cotuit Ma 02635 . 6/19/2019 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 10.. 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. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form <� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 27 Taragon Circle Property Address Nicholas Tavano Owner Owner's Name information is required for every Cotuit Ma 02635 6/19/2019 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): s.a.s. consists of a precast leach pit. Pit was video inspected from d-box and was found with 2' standing water with a stain line only 6" higher. 12. 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 Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 Commonwealth of Massachusetts p Title 5 Official Inspection. Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 27 Taragon Circle Property Address Nicholas Tavano Owner Owner's Name information is required for every Cotuit Ma 02635 6/19/2019 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 13. 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.): l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts UTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 27 Taragon Circle Property Address Nicholas Tavano Owner Owner's Name information is required for every Cotuit Ma 02635 6/19/2019 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 14. 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 ---t o� O v 23t6 AZ 3? 6 y3 �7 r4_6 .A3 ,u'b 95 L/o '6r� Li T K� t5insp.doc-rev.7/26/2018 We 6 Official Inspeaim Fam St b ulaoe Sewage Disposal System•Page 16 of 18 r Commonwealth of Massachusetts ra Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 27 Taragon Circle Property Address Nicholas Tavano Owner Owner's Name information is required for every Cotuit Ma 02635 6/19/2019 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 12'+ feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: Groundwater was established by accessing town of Barnstable groundwater contour maps. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts �a Title 5 Official Inspection Form < Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 27 Taragon Circle Property Address Nicholas Tavano Owner Owner's Name information is required for every Cotuit Ma 02635 6/19/2019 page. CitylTown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6 (Checklist) completed ® D. System information: For 8: Tight/Holding Tank-Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 I Stanton, David From: Stanton, David Sent: Friday, April 05, 2019 8:43 AM To: salmon.ash ley92@gmai1.com" Subject: 27 Taragon Circle Septic Attachments: a_1of1.jpg; a2_1of1.jpg Good morning Ashley, As per my phone call this morning,this e-mail is to confirm that you are allowed to have a 3 bedroom house at 27 Taragon Circle. Septic permit 91-251 was designed with a capacity of 549.7 Gallons per day (110 gallons per day per bedroom= .3 gallons shy of a 5 bedroom septic capacity.) Your property is in a restricted area as far as septics. The northern half of the lot is in a drinking water protection area that allows 3 bedrooms on your lot size of 45,300 sq.ft. of land. Additionally(I did not mention this during the phone call4but in reviewing it further due to an error by the original design engineer which listed the lot size a 15,300 instead of the actual 45,300 sq.ft. on the plans) I noticed that with the septic restrictions splitting your lot almost in half,the Southern section of your lot is in the estuary protection, which is a restriction, but less restrictive than the drinking water protection zone. In the Southern section of the lot, a 4 bedroom house is allowed with a 40,000 sq.ft. lot. The sad part is, when the septic was installed in 1991, it was installed in the backyard in the middle of the house, which has it in the more restrictive drinking water protection area, if they had just installed it further South,you would have been allowed 4.bedrooms. On the bright side, should you want a 4 bedroom house, it would be allowed, however,you would need to have a new septic system designed and installed in the Southern half of the lot. I have attached the original septic permit with the important numbers circled (lot size and septic capacity)with an next to them as well as a copy of the map showing the two septic restriction zones on the lot,the Northern side of the lot (darker) is the drinking water protection area, and the white side to the South is the estuary protection. know it can be confusing, so if you have any questions, please feel free to call me. Thanks, David W. Stanton, IRS Chief Health,Inspector Town of Barnstable 200 Main Street Hyannis, MA 02601 Direct phone: (508) 862-4647 Health Dept. phone: (508) 862-4644 Health Dept.:fax(508) 790-6304 . 1 Commonwealth'of Massachusetts Executive Office of Environmental Affairs Dept. of Environmental Protection .Jolui Gf�ci One winter Street,Boston,Ma. 02108 D.E.P.`Title V Septic Inspector P.O. Box 2119 Teaticket MA 02536 WILLIAM F.WELD Governor t� ARGEO PAUL CELLUCCI J1 Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR � O � PART A CERTIFICATION NOV 1998 Property Address: 27 TARRAGON CIRCLE COTUIT Address of Owner: Date of Inspection: 11/4198 (If different) Name of Inspector: JOHN GRACI SARA TRAINER 4* 1 am a DEP approved system inspector pursuant to Section 15.340 of Title%(310 CMR 15.000) Company Name,Address and Telephone Number: S 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: x Passes This Inspection Is based on criteria defined In Title V _ code 310 CMR 16303.My findings are of how the system is Conditionall#ubmit Passes - performing at the time of the inspection.My inspection does Ner Evaluation By the Local Approving Authority not Impyany warranty or guarantee of the longevity ofthe septic system and any of Its components useful life. Fail ' Inspector's Signature: Date: 1115l9s The System Inspector shallcopy of this inspection report to the Approving Authority within thirty(30)days of completing this inspections. 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 Department of Environmental Protection. The original should be sent to the system owner and copies sent.to the buyer,if applicable and the approving authority. INSPECTION SUMMARY: Check A, B,C,or D: A] SYSTEM PASSES: x I have not found any information which indicates that the system violates any of the failure criteria defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: B] SYSTEM CONDITIONALLY PASSES: 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. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Co7hpllance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection,or the septic tank,whether or not metal, is 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 conforming septic tank as approved by the Board of Health. t (revised 04127)97) One Winter Street • Boston,Massachusetts 02106 • FAX(617)556-1049 • Telophone,(617)292-5500 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 27 TARRAGON CIRCLE COTUIT Owner. SARA TRAINER Date of Inspection:111319E _ Sew.aae backup or.breakout.or high static water level observed.in.the distribution box is due to a broken. or obstructed pipe(s)or due to broken,settled or uneven distribution box.The system will pass inspection if (with approval of the Board of Health). Describe observations: broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced _The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed 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 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 within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER,IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT.THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ The system has a septic tank and soil absorption system and is within 100 feet to a surface of water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone 1 of a public watersupply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coiiform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presense of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method usedto determine distance (approximation not valid) 3)Other i • t D] SYSTEM FAILS: You must Indicate either"Yes"or"No"as to each of the following: _ I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage in facility or system component due to an overloaded or clogged SAS or cesspool. Ri 3rharge yr pending of effluent to the surface of the grrnlnd Ar sLlrf9re waters(tclfi to an overloaded or clogged cesspool. SAS is in hydraulic failure. (rerleed OOV97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 27 TARRAGON CIRCLE COTUIT Owner: 8ARA TRAINER Date of Inspection:ttralsa D]SYSTEM FAILS(continued) Yes No _ 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 112 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Numbers of times pumped Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or:tributary to a surface water sLlpply. 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for e coliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: The following criteria apply to large systems in addition to the criteria: _ The system serves a facility with a design flow 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: 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) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further,information. Ireyleed 04/271971 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECLIST Property Address: 27 TARRAGON CIRCLE COTUIT Owner: SARA TRAINER Date of Inspection:1114198 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: _c_ — Pumping information was requested of the owner, occupant,and Board of Health. x None of the system components have been pumped for at least two weeks and the and the system has been receiving normal — flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. x As built plans have been obtained and examined.,Note if they are not available with N/A. x The facility or dwelling was inspected for signs of sewage back-up. x _ The system does not receive non-sanitary or industrial waste flow. _c_ — The site was inspected for signs of breakout. x _ All system components,excluding the Soil Absorption System,have been located on the site. x The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid,depth of sludge,depth of scum. x The size and location of the Soil Absorption System on the site has been determined based on' The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal Systens: x _ Existing information. Ex. Plan at B.O.H. Determined in the field(if any failure criteria related to Part C is at issue,approximation of distance is x — unacceptable)[15.302(3)(b)] U ( revlsed 04fl7)9Ti SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM g. PART C SYSTEM INFORMATION Property Address: 27 TARRAGON CIRCLE COTUIT Owner: SARA TRAINER Date of Inspection:1114198 `FLOW CONDITIONS ' RESIDENTIAL: d./bedroom for S.A.S. Design flow: g•p• Number of bedrooms:? Number of current residents: Garbage grinder(yes or no): No Laundry connected to system(yes or no): Ye: x Seasonal use(yes or no): No last two 2 year usage d Water meter readings, if available:( ( )y g (gp )• nfa Sump*Pump(yes or no): No Last date of occupancy: nla COMMERCIAL/INDUSTRIAL: Type of establishment: nia " Design flow:G gallons/day Grease trap present: (yes or no) No Industrial Waste Holding Tank present:(yes or no) No - Non-sanitary waste discharged to the Title 5 system:(yes or no) No Water meter readings,if available: nra Last date of occupancy: nla OTHER:(Describe) rva Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: Na System pumped as part of inspection: (yes or no)No If yes,volume pumped:G gallons Reason for pumping: rda TYPE OF SYSTEM x Septic tank/distribution box/soil absorptions system - x' Single cesspool Overflow cesspool Privy Shared system(yes or no) ( if yes, attach previous inspection records, if any) I/A Technology etc.Copy of up to date contract? Other: APPROXIMATE AGE of all components, date Installed(If known)and source informatloh.` SYSTEM IS 7 YEARS OLD. Sewage odors detected when arriving at the site: (yes or no) No (revlaed G4Q7)9T) k SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 27 TARRAGON CIRCLE COTUIT Owner: SARA TRAINER Date of Inspection:1114199 SEPTIC TANK: x (locate on site plan) Depth below grade: V Material of construction:x concreate_m eta l_FRP_Polyethylene—other(explain) If tank is metal, list age Ne . Is age confirmed by Certificate of Compliance Nc (Yes/No) Dimensions: Le'e^H5'7^w4•10" Sludge depth:V Distance from top of sludge to bottom of outlet tee or baffle: 33" Scum thickness:d Distance from top of scum to top of outlet tee or baffle:6" Distance form bottom of scum to bottom of outlet tee or baffle:o How dimensions were determined: MEASURED Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND.RECOMMEND PUMPING SYSTEM EVERY Two YEARS. GREASE TRAP:_ (locate on site plan) Depth below grade: rda Material of construction: _concrete_metal_FRP_Polyethylene_other(explain} Dimensions: rda Scum thickness:rda Distance from top of scum to top of outlet tee or baffle:rda Distance from bottom of scum to bottom of outlet tee or baffle: Na Date of last pumping;va Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage,etc.) . Na - - BUILDING SEWER: (Locate on site plan) Depth below grade: rs" Material of construction:_cast iron x 40 PVC_other(explain) Distance from private water supply well or suction 1ine:TOWN Diameter. nIa_ Qmments: (conditions of joints,venting,evidence of leakage,etc.) (revleed 04127197) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 27 TARRAGON CIRCLE COTUIT Owner: SARA TRAINER Date of Inspection:1114199 TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade: rda Material of construction:_concrete_metal_FRP_Polyethylene—other(explain) Dimensions: Na Capacity: rda gallons Design flow: rda Alarm n working order?—Yes No Alarm level:_nda — Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) rda DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: ^la Comments: (note if level and distribution is equal, evidence of solids carryover,evidence of leakage into or out of box etc:) rda PUMP CHAMBER: (locate on site plan) Pumps in working order.(yes or no)No Alarms in working order(yes or no)_ve: . Comments: (note condition of pump chamber, condition of pumps and appurtenances, rda i (revised 04127)97) f — SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Add re SS: 27 TARRAGON CIRCLE COTUIT Owner: SARA TRAINER Date of Inspection:11►4198 SOIL ABSORPTION SYSTEM (SAS):x (locate on site plan, if possible;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present,explain: nfe Type: leaching pits, number: 1000 GALLON LEACH PIT leaching chambers,number:Na leaching galleries, number: Na leaching trenches,number,length: rda leaching fields,number,dimensions:Na overflow cesspool,number:nIa Alternate system: n!a Name of Technology:_nra Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) 'THE LEACH PIT IS STRUCTURALLY SOUND AND FUNCTIONING PROPERLY.THE PIT HAS NOT HAD MORE THAN V OF WATER IN IT. - CESSPOOLS:_ (locate on site plan) Number and configuration: rda Depth-top of liquid to inlet invert: Na Depth of solids layer: Na Depth of scum layer: Ma Dimensions of cesspool: Na Materials of construction: Na Indication of groundwater: Na inflow(cesspool must be pumped as part of inspection) nla Comments: (note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation, etc.) nfa , PRIVY:_ (locate on site plan) Materials of construction: Na Dimensions: Na Depth of solids: nra Comments:(note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation; etc.) nra (revised 04r27)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 27 TARRAGON CIRCLE COTUIT SARA TRAINER 1114198 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references, landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) 14 , Moe � 4A �3y Page ! of 10 (revlaed04)27197) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 27 TARRAGON CIRCLE COTUIT SARA TRAINER 1114198 Depth of groundwater 12. Please indicate all the methods used to determine High Groundwater Elevation: Obtained from design plans on record. Observation of Site(Abutting property, observation hole, basement sump etc.). Determine it from local conditions Check with local Board of Health Check FEMA Maps Check pumping records Check local excavators, installers x Use USGS Data . Describe in your own words tiow you established the High Groundwater Elevation.(MUST be completed) USGS MAPS AND CHARTS (revisedo4)2Tl9T) l9g9 10 0[ 19 TOWN OF BARNSTABLE LOCATION v �' SEWAGE # VaLLA ,E ASSESSOR'S MAP & L07,0y I - 12-®o z INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY nn � M LEACHING FACILITY: (type) t�l����i�" (size) 100 NO.OF BEDROOMS ---�_^ BUILDER OR OWNER S�l°C�' 1 Cl.l fs-Q.0 PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility( Hands exist within 300 feet of leaching facility) - ,, ' Feet Furnished by, �( II _ AC A" DA ,33 E-3 r - TOWN OF BARNSTABLE LOCATION o?,/Ako Q^/ Ct;; e SEWAGE # VILLAGE G/ ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY 1066 LEACHING FACILITY:(type) //-- (size) 6 oU NO. OF BEDROOMS 82 PRIVATE WELL OR.. UBLIC WATER /1 BUILDER OR OWNER (0 lq �b tiC DATE PERMIT ISSUED: oZ� DATE .COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No 33 w I -�7 TOWN OF BARNSTABLE LOCATION :L ��� SEWAGE # VILLAGE Cie' ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY o o O LEACHING FACILITYAtype) j (size) 1,00e NO. OF BEDROOMS _PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER G-No-15- DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No I f sat'; 6 �ofi � '�� 33 y° a° Y n ..>. No.......... ..... .. � FIms..... ........ THE COMMONWEALTH OF MASSACHUSETTS OF���s� �� BOARD OF HEALTH ROBERT _1 0 Y ppliratiou for UhipmFal Workii Tontitrurtion amit /ON ���� lication is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal at: �. .. C T.�......1.�..ZA � ........................................' d . ►vt�r? 4..►. —.!2.. ............................................... ................. - Location• ddress or Lo No. ...... .. ........................•. ..--- Owner ��LR/I"a"'`� ----Address -. ................................. ..._........ .....,._. ..R........ ...........___..._...................... ......_.................__............ Installer Address _ Type of Building Size Lot--- .2 '.Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures ............................ . w Design Flow................5.6.....................gallons per person per day. Total daily flow____.______.2_49:2.....................gallons. WSeptic Tank—Liquid capacitylC�-•-�'1gallons Length__..`_ ` Width..��__!0_' Diameter................ Depth..'-'$`� . x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area..............__....sq. ft. Seepage Pit No....... ........... Diameter.....j _- .`�. Depth below inlet...l, !' ��.___ Total leaching Z Other Distribution box ( Dosin to jk- / ��" Percolation Test Results Performed by .. #COI F-h! `�._.fmz........... Date-./^!�'�!�""_. f------------ Test Pit No. 1......Z.......minutes per inch Depth of Test Pit...1.30/'._.. Depth to ground water.nOV1_9 .......... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water....................... a --------•--•----- --------------------------• ........................................................................................................... 0 Description of Soil...........-•-•-•--•--•-•-•-••...--•-••-•--•-•-•••-----•---......-••--•--•--•--------------------------------•••-..................................................... w UNature 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 iIT 11,, 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the b rd of healt Signed __ - /� `-�•---- ................... -- --.....-•-- D e Application Approved B Date Application Disapproved for the following reasons:.............................................-•-............................................................... -•--•-••--•--••-----•-•..............•-••---------•-•-••---•--•.-•------•--•---•••-------•-•-•-----•••--••-._..-•------------------------------•--•------••------------------------------------------- Date Permit No........Jf. _.. . �1 --------------------- Issued_........................................................ Date 7/- � -� �LTN OF MR THE COMMONWEALTH OF MASSACHUSETTS ROBERT BOARD OF HEALTH X E. ..o o,�) . ......OF............ �. - .: .I- _�? .......... o RA 6 v " �r�rliration for Bispwial Works (fousirurtiutt tIrrmit �10p�AL hcation is hereby made for a Permit to Construct ( 4 or Repair ( ) an Individual Sewage Disposal ' at: _ .... . ......................................; ,.:a ��.«;:.cM w.-----------••. ......��s��----�-.......... .......................................................i Location-Address or Lo No .... .�_'�s. 17 _..���'}?✓,Q ��iz?�� �`'� ? �r:1 /..... Owner Address a ................................ ........... ........... ......-•••••-•---•••-----•-•-•••••--•••...__...........•••••-•••••--•......._...........-•-.••••-- Installer Address U Type of Building Size Lot.--A.`3. '_ 5?_.Sq. feet ., Dwelling—No. of Bedrooms.................. .......................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) g fixtures .......... s.....:... - 3_ �lons� W Design Flow.__Other .�_.a_ gallons per person per day. Total daily flow............. �2.....................gal WSeptic Tank—Liquid capacity(�kQCQ gallons Length....`a_._ " Width.. !-l" Diameter---------------- Depth..5.-.°q:. x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No....... ........... Diameter...._ ?r. Depth below inlet.. I. ___. Total leaching area._`t:?''+ _ i y Z Other Distribution box ( Dosin I tatlk ( ) Percolation Test Results Performed by .. *1. ,�� �- -. !` - :.-•---..... Date__A :i�<' 26------------- Test192 W Pit No. 1......--_-__-minutes per inch Depth of Test Pit _ Depth to ground water.1!C`+_ -_-_____--- L14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Ix -••-•----•-••--...••••••-•...--•-•-•-•--------••••----•••-•---•--•........-••---••--........•--••••--•-•-•-•••......•-••-•......------••. •-•------------ .-. 0 Description of Soil.................................................................................................................................................. ................. W U •---------•---•---•--•--•-•----•--•-•-•-••-•---•-•-.....-•--•------••••-•••--•--••-•--•...•-••----•--•---•-•--------••---•-•---•----------•...........-•--------•--••---............................. W ------------------- ................................................................................................................................................................................... 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 TIT LE 5 of the State Sanitary 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. Signed...................................................................................... -•----•-------••-----••-•---•••- " Date Application Approved By.............. ----••-•-• Date Application Disapproved for the following reasons:.......................................................... ------•-------•----------------------------------------- ............................................... ---------------------•----...------•----..........------.......--•-----•--...:---•----.......------.......--------------•---•----•-------------------•------------------------------------------••--••--- Date Permit No........rl�_'.._. ,� _ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH { _ OF Ala (Infifirate ,of Toutpliattre THIS IS TO C RTIFY, That thfi Individual Sewage Disposal System constructed �<) or Repaired ( ) by -•---•• ........ .r, .............................................................................................................................. •�' --1 Installer at `f�/ or..• - a- ... -----•------------------------------------------------- has been installed in accordance with the rovisions of I' r 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit NO.....-.Z/-__�s_'_.__...... dated------.-.-.-_.-.-____.-_--------------------•- THE ISSUANCE OF THIS C RTIFICATE SHALL NOT BE CO RUE® AS A NTEE THAT THE SYSTEM WILL FUNCTIO �/ATS TORY. DATE --------------- Inspector.. THE COMMONWEALTH OF MASSACHUSETTS �. ,BOARD OF HEALTH 1G . ..:::....... :...OF.......... =t' No.... .. �. FEE.../�Q........ I . Dispersal Vorkg 'llwitr ion amit Permission is hereby granted.......... "T...... 4Q_-fZ..................................................................................... to Construct or Repair ) an Individual Sewage Disposal S stem at No..........L' - 1 ...... �------.---- Street ••�� . as shown on the application for Disposal Works Construction Permit No. ,fa ?_----- Dated.......................................... ............................... .................................................... DATE................ -•................................ Board of Health -----`._� ..�.--- - FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS f r� The Town of Barnstable «� = Health Department 367 Main Street, Hyannis, MA 02601 A. Office 308-790-6265 Thomas A. McKean FAX 508-775-3344 Director of Public Health September 27, 1991 To Whom This May Concern: This letter is to certify that Lot #2, 27 Tarragon Circle, Cotuit has installed a Title V septic system which was installed and inspected on 8/16/91. Sep is p rmit 41 for the above property is #91-251 o � Donna Z. Mior i Health Inspector I .. T....^ •, T. _ . .:+ 5,9[, ._,,. ,, .`. ,z "#, • .' -... ,,, ":. ...r ..i.L , - i - 1. 1, . , .s *ter � � '�*�, ;•a : .r ., = ,, .F. ... ¢a;, ;� " A -Fad. ., --.,.. ,{ �'. ad..W:\ a' �S•- . r yet '� `�S` f �' •' . scars .►.,.r.. .r...,..••.,.+.... ..,.:.,_.,...:x ...r.,.. «.-.ww•»_,.:....,...,...•...+►•,..,......._,..,..,. .....s,...,.+.+. rw.:• ..s.... ..,:..,•._......_...::..,,.,•._...x,......,..,r.........« .....+..n, •,.-_.,..>._..,...,•..>•.,w„. .,._ .,.:x....+«:w....•...+w..... ...s.,._....._... ».. s - IV P _ yy I Al L ELEVATIONS SHOWN ARE ISASE^ TC>PSOiI # U.S.C.BG.S. T f` t'T `S i 1 1 r'-{.x. A `.SRN#'M UM OF 1/8" / 1''-i' LI ._ "- OL G.R 0n 9 '9 @ 0 a G 000 OIL OTHERWISE SPEC,PIED. 1 C I " -_{ R OC, J @ ® ® : 0 C 0OW 3. ALL PIPES �TG AND IN THE SYSTEM SHALL BE CAST „ t E -o C100 . 0 0 0 C (I r oQ ON JR SCHEDULE 40 PVC. A_ 4, ALL SE'QTII" TANKS, DtSTRI Sty IGit�;'� �' g S AND L i" 2 'fE- r , , _ -�- •��, , 'cL C ' rJ ''? ➢ C� O �J C C� t i �') } ' EAOH#NG PITS SHALL BE DE;�IGI'd��J FC► +' -"�fl irh4 ~ �001 1") 0 �9 �� C- O nC LOADINGS WHEN UNDER PAVING. i R c Ott 0 ,) l © � 0 C 0 Cl F'00 5 REMOVE A' L UNSUITABLE MATERIAL BENEATH AT'H THE i 3,r { 14" }�(1 ';� , ? t� U �� o; C, C' C10 I NVERT ELEVAT!ONS OF' THE Lf ACHINC >'fT FOR: f � Y # � , f�l � .! 1 GOO, G � , ,, 3 @ C �? � CCQ A DISTANCE OF POET AND B4C;i{FILL 'MITI-# ( L,AY FREE_ ;AND 5 GRAVEL. HAVING A PERCCA-ATION RATE # I ,i;;G _EEL r/ __ _ _____ OF 2 MINUTES PER INCH OR LESS. __. L � -_-L` = '� -- ---� f-- f�DTE 0"- DISTRIBUTION BCX 4ND 1000 6 THE TOWN OF BARNSTABLE #3�JARD OF HE.A I_H MUST NO WATER OBSERVED GAL REINFORCE" SEPTIC TANK 8`�' BE NOTIFIED WHEN _t �� SYSTEM (S NEAR CC?MPLI TIC�N , - ?BG R A 3 N ? TYF'ICA� 1000 GAL. E.�TfG TANK ACME PRECA ' OR TYPICAL_-�,EAC`M%�v� Pi �� AND PRIOR TO I�au�Fl��.#N� } �}N!_ESS ;;T'HERvYiSE NOTED, ALA SYSTEM C,om NTS R ` rrx" ;� `_Q7ItN RATE , 2 min/inch NOT '"' ;�4c E 'r �r Tt,1 SCA�L SHAi_L I3E INSTALLED !N AGCORGANCE WITH BSE'► VATICMIS F� EDWARD BARRr NOTE TANKS REINFORCED THROUGHOUT WITH OF THE STATE SAN TARY CODE ANC% ANY L.�:AL. BARNSTABLE 3 )A!�D HEATH ELE4TWC WELDED WIRE WITH 24-1/2' RULES WHICH M:14 ApP"`( `NEFR ARO ENGINEERING INC. EMBEDDEC, STEEL RODS IN TOPS BOO- 8 CONTRAi:TOR IS TC NC?T�I`Y E�iG!WEER, PRIOR TO THE TOM C��N%RETE 4 U{}O PSI TEST iNSTAL.L_ATION CT SE�'TIC S' STtM OF ANY UISC;REP- �)ATI~ MARCH26, 1991 ANCIES BET WEE N .'EST p;T RE5l1I rr �1"VD f=iELu Y 9 ACCESS MANHOLES SSTi;' TANKS Afv �'=A��f-1IAI( PITS TO BE BUILT OP TO INCHES E3ELaW. F!I`�1S;rt .4'.: 1510 GRADE S \ _ 10, NJ)RTH ARROW 15 NOT T,� ICE USED FOR 50L_A� F'URF'!7-,r.� q FOUNDATION 1 , tl 1 l\.• - -ELEV =60.0 �-. P • �•--FINISH GRADE —FINISH GRADE . KNISH GRADE ,.�JI~r ti-fa`:t-t fvu -•-_-� FINISH GRADE OVER TANK OVER 'ui BOX AREA ELEV = 57+0 �ELEv.' 57.7 � ELEV =5T.5 ELEV = 57.0 - EXIST , LOT 2 � J`"` __-. „� � "�/y?`Y,^y+``/�,.v;-v _>..v� .�'�i.�;,i`��`�s"`Vr,'a'�••, .. t.. .. .�.- .... 'SR,.dii`Q'. "'�'�' "5.,^ ,'� 'F-�- _ ..____._., ._.__-. _-. - -� _» ._-»�..:wp`r S GROUND _ �y3/4 It 153 OY _ _ .. I (` NV " '¢*7 lO00 =54+50 NV = 54+,/3 , .. f 5 5 I ( 1 IN1r >° 0 54 + __ _ _ .- MST Ht^X U . . ^, Y 1t { , .. .. 24 �r 1 p4 ,.Y+'" s. ♦ t VF.v.._..».w_-_.,--._..µ-_ '.._..__�..� f.7�R SlHLJI.-[.. f d. q ..•i� •• • • •. «+ • 1 F . / — r1► JE y -; B INVe 54.0 �:z ' 8#00 Q 0 ++� 4 lei Q .��' ---Js� F pl r'A�, SEWAGE SYSTEM.._ 1✓ ROF'k- E PRECA�. L�ACHIW j � x >� 3E }_. VE'�. a STARLF, :gi001 Y F�+e�ir�c VO TO 56;4 E 1,7 s �R� � LEGEND � T MAP r a , E X•{�T ','ON TOUR _.._. _.,._.. ___ _...-_ � --' �'"`.-'IOICO�L'�• :'�"' � 40 8�y41 PROPOSED CONTOUR ---- N 4 ,}4 44• EXIST SF"�T ELEVATION 8 X 0 , y PROAos�o " sg PR�)P��SE:D SPOT ELEVATION 8 t Q --.- --- • , DN'ELunr I ZONING b!SYRICT E� �fJ HA_ ZONE .ff x .o I GA 57. CL A , �_. ..__ ..,.__ _._ - :: �, r _ -:. - 7 �`n A R PER AT ESr Irr :- x, _ .- Y 8 [ ,x *K ��C.�yl YI{� � � S A M PIT �# �- RF •*y • I ` tit x`��i t. <s �r r � � _ } � � �� �� #� Its - ("� ON f .,t 5b•Z CAE �.IGN CRITERIA ,� PROPOSED ��- `�' Ew� � `�� 3E DISPOSAL SYSTEM .. t JR(�L�l�� _�yy�+pyy(( �! �]{{ Cary( !�+( r �/•���•1/�,F( /�,��.I 3bi i F ti`6 ,1 1 j\,ul 'M 1— 1. 1\ 4/Iy D,1,�,'1w�1.1 s r S, f OR P _,. �s s � LOT 2 TARAGON CIRCLE �.>"AC{ ,► } RE . 22o gpd COTUIT ( BARNSTABLE ) Mc� tl A tip EArC/'f��'`R/�1i..7P1,/,r�!y, C 549A.'7 gpd `DI�'11'�OS41. NO �•'" :f� T ro ,..•++...:.s..n.,..«..w.s,.,ws.:.... Y*,.ur. .+snw...w+.n .xw,vr..►... ,nr„rrw,..++,.i+n.•.wr. ►+* ..+.•row.-- x, RAGON `CIRCLE 6 ,z �. �_ PPLI tiN � __— - — - ARID ENGINEERING INC.,�, �� TNEO CONSTRUCTION CO. S '•• .. %�7 1 tiS¢ cal � 'b ,e` •"' "—""'-�� ._.. -* ...,.. .__._ .. . , . .._..__,._.,__ � {�%' `' '' '' ! 24 GREAT POND DRIVE 139 STRIPER LANE • , ., G53 154 4 712 a S. YARMOUTH, MA 02664 E. ALM#OUTH, MIA U' 6 40 0 40 80 120 I-,E W,4. 2 x R x 5 x 6 x 2.5 = gpd ti MEW 'T x 51x /.0 = 78.5 gpd Y % GRAPHIC SOAK_E': -- � �. � AS SHOWN f MARCH27, 1991 / OF 1 549.7 gpd . . ., . ... . ... .w i 4� REP, r�ac:E� A-699 P 7733