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HomeMy WebLinkAbout0032 TARAGON CIRCLE - Health 32 L 14.4 CIRCLE, COTUIT -1 a _ X;LO l' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w 32 TARAGON CIRCLE I I M Property Address FRAVEL 'a Owner Owner's Name information is —j required for COTUIT ✓ MA 12-12-16 every page. Cityrrown State Zip Code Date of Inspection m Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information When filling out cS%�f 1,209 forms on the computer,use 1. Inspector: only the tab key to move your DOUGLAS A BROWN cursor-do not Name of Inspector use the return key. D.A.BROWN INC Company Name P.O. BOX 145 Company Address CENTERVILLE MA 02632 City/Town State Zip Code 508-420-4534 S14297 Telephone Number License Number 4 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. 1 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 12-12-16 4�oei Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or.DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 e Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 32 TARAGON CIRCLE Property Address FRAVEL Owner Owner's Name information is required for COTUIT MA 12-12-16 every page. Citylrown State Zip Code Date of Inspection it B. Certification (cont.) 1. Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: SYSTEM MET ALL PASSING REQUIREMENTS AT TIME OF INSPECTION TANK WAS PUMPED AT TIME OF INSPECTION FOR MAINTENANCE. ONE PIT WAS OPENED AND FOUND TO BE EMPTY AT TIME OF INSPECTION WITH NO EVIDENT SIGNS OF FAILURE. THIS REPORT CAN NOT PREDICT THE FUTURE PERFORMANCE UNDER THE SAME OR INCREASED USE. 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•3113 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 32 TARAGON CIRCLE Property Address FRAVEL Owner Owner's Name information is required for COTUIT MA 12-12-16 every 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 Conditionally Passes(cont.): El 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 f - Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 32 TARAGON CIRCLE Property Address FRAVEL Owner Owner's Name information is required for COTUIT MA 12-12-16 every page. City(rown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Vw� 32 TARAGON CIRCLE Property Address FRAVEL Owner Owner's Name information is required for COTUIT MA 12-12-16 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ®' Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a.surface drinking water supply .. ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply El El Area system is located in a nitrogen sensitive area(Interim Wellhead Protection Area IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M , ' 32 TARAGON CIRCLE Property Address FRAVEL Owner Owner's Name information is required for COTUIT MA 12-12-16 every page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® El available as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ❑ ® Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 440 t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments yy� 32 TARAGON CIRCLE M ' Property Address FRAVEL Owner Owner's Name information is required for COTUIT MA 12-12-16 every page. City/Town State Zip Code Date of Inspection D. System Information Description: ACCORDING TO AS-BUILT CARD SYSTEM CONSISTS OF A 1500 GALLON TANK AND 2 LEACH PITS Number of current residents: Does residence have a garbage grinder? ❑ Yes ❑ No Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ❑ No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ❑ No Water meter readings, if available last 2 ears usage d 16-257 15-183 9 ( y 9 (gp ))� Detail: SYSTEM NOT DESIGNED FOR USE WITH A GARBAGE DISPOSAL Sump pump? ❑ Yes ❑ No Last date of occupancy: CURRENTLY OCCUPIED Commercial/industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CM 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No' Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 9 p Y rY 32 TARAGON CIRCLE Property Address FRAVEL Owner Owner's Name information is required for COTUIT MA 12-12-16 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: CURRENTLY OCCUPIED Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1500 GALLON gallons How was quantity pumped determined? Reason for pumping: MAINTENANCE Type of System: ❑ Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ® Other(describe): TANK AND 2 PITS NO D-BOX t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Assessing As-Built Cards Page 2 of 2, f t f P' http://www.townofbamstable.us/Assessing/IlMdisplay.asp?mappar=041012X 19&seq=1 12/12/2016 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 32 TARAGON CIRCLE Property Address FRAVEL Owner Owner's Name information is required for COTUIT MA 12-12-16 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: APPEAR TO BE ORIGINAL Were sewage odors detected when arriving at the site? ❑ Yes ❑ No Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 2 feet Material of construction: ®concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 GALLON Sludge depth: 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 M , 32 TARAGON CIRCLE Property Address FRAVEL Owner Owners Name information is required for COTUIT MA 12-12-16 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related I a ed to outlet Invert evidence of leakage, etc. TANK WAS PUMPED AT TIME OF INSPECTION FOR MAINTENANCE TANK IS VERY CLOSE TO SONO TUBE ON EDGE OF DECK BUT IT DOES NOT APPEAR TO BE ON THE TANK.RECOMMEND PUMPING EVERY 2-3 YRS FOR MAINTENANCE. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping. Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 32 TARAGON CIRCLE Property Address FRAVEL Owner Owner's Name information is required for COTUIT MA 12-12-16 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection forth:Subsurface Sewage Disposal System-Page 11 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments GM , 32 TARAGON CIRCLE Property Address FRAVEL Owner Owners Name information is required for COTUIT MA 12-12-16 every page. Citylrown 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 N.A Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No" Alarms in working order: ❑ Yes ❑ Nci* 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•3r13 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 32 TARAGON CIRCLE Property Address FRAVEL Owner Owner's Name information is required for COTUIT MA 12-12-16 every page. CityrFown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 2 ❑ 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.): ONE PIT WAS OPENED AND WAS EMPTY AT TIME OF INSPECTION THE OTHER PIT WAS NOT OPENED BECAUSE IT IS UNDER ONE OF THE ROUND DRY LAID PAVER AREAS IN THE BACK YARD. THERE WERE NO CLEAR SIGNS OF FAILURE AT TIME OF INSPECTION. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M , 32 TARAGON CIRCLE Property Address FRAVEL Owner Owner's Name information is required for COTUIT MA 12-12-16 - every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions o Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins-3/13 Tide 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M yt 32 TARAGON CIRCLE Property Address FRAVEL Owner Owner's Name information is required for COTUIT MA 12-12-16 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M , r 32 TARAGON CIRCLE Property Address FRAVEL Owner Owner's Name information is required for COTUIT MA 12-12-16 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: GREATER TAN 5 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: 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 Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 32 TARAGON CIRCLE Property Address FRAVEL Owner Owner's Name information is required for COTUIT MA 12-12-16 every page. Cityfrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Assessing As-Built Cards Page 1 of 2 TOWN OF BARNSTABLE LOCATION -��V M VILLAGE \y L�` ASSESSdR MI LOT 2 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY Ing LEACHING FACUMT:( }T P����{� (size) Z U NO.OF BEDROOMS BUILDER OR OWNER 1(� PERMITDATE: COMPLIAN ATE 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 MO feet of leaching facility) Feet Edge of Wedand and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Fat Furnished by Oec onne L� C0 Asti hq://www.townofbamstable.us/Assessing/HMdisplay.asp?mappar--041012X 19&seq=1 12/12/2016 x f 3 • i f 1� /of r"' dl ) ... .. -.W. Ill yiv ti a -- _...._ _.. i - ._..... ._..._ �.....__._.._.-.__. i f._f..� f L A U Rl CAI- Ell 1 i�:air- �, Tw yy� --�-=-- - _ ---=-_-•"- —_._..-,__-_•_ .___.�.�_.---_-----,- - - IH A HAS L 3° / I I 3� c.j DoQ'� i 7� dyf Commonwealth of Massachusetts Executive Office of Enviromlental Affairs Dept. of Environmental Protection One winter Street,Boston;Ma.'02108` __.John Grad D.E.P. Title V Septic Inspector P.O. Box 2119 Teaticket, MA 02536 WILLIAM F.WELD . (508)564-6813 Governor ARGEO PAUL CELLUCCI Lt.Governor Q> SUBSURFACE SEWAGE DISPOSAL SYSTEM,INSPECTION FORM r` / PART A A � � CERTIFICATION Property Address: 32 TARRAGON CIRCLE COUTIT MAP 41 PAR 18 Address of Owner: Z)1z �© Date of Inspection: 11/24/98 (If different) 13 Name of Inspector: JOHN GRACI DENNEHY to Ig9 - J I am a DEP approved system inspector pursuant to Section 15.340 of Title%(310 CMR 15.000) Sj Ofgq N Company Name,Address and Telephone Number: FAl>Hp�Ai?(F A 1 CERTIFICATION STATEMENT ' nreoe eo w is true accurate information address and that the Inf his addr inspected the sewage dis o"sal system at t P I certify that I have personally inspe g P Y 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: IN X Passes , This Inspection Is based on criteria dented In Title V _ Conditionally Passes code 310CMR16.303.Myfindings are of how the system Is performing at the time of the inspection.My inspection does _ Needs r er Evaluation By the Local Approving Authority not Imply any warranty or guarantee ofthelongevhyorths Falls septic system and any ofits components useful life. Inspector's Signature: Date: 11/24198 T'' , The System Inspector shall ubmit a copy 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 Co7hpliance(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. (revised 0407197) ' One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 0 Telephone(617)292-5500 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A' .CERTIFICATION (continued) t y .. Property Address: 32 TARRAGON CIRCLE COUTIT MAP 41.PAR 18 a Owner: DENNEHY Date of Inspection:1104198 _ Sew,aae backua or.tlreakout or hiah.static water level observed.in.the distrihutiontiox 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: , 3 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' t system will pass inspection if(with approval of the Board of Health): broken pipe(s)are,replaced- obstruction is removed r 4y C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH. f 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 abordering vegetated wetland or a salt marsh; .:. a 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 j of a public watersuppiy 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 coliform 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 D] SYSTEM FAILS: You must Indicate either"Yes"or 'No' _as to each of the'followini'., _ I have determined that the system violates one or more of the following failure criteria as defined in'i 310 CM 15.303. The basis for this determination is identified below. The Board of Health should be s x contacted to determine what will be necessary to correct the failure:- -. w .'• Yes No y, Backup of sewage,in facilit Vr,system component due to an overloaded or clogged SAS or, cesspool. Di�cll�rye ul pwlililiy of fflu�nt to ill@ w-race of life yl uulltJ or aurfl c@ w lt?r�glue ti au uverlua�ed`ill tuyyeiJ cesspool. '� r " SAS is in hydraulic failure. Irevlsed=7197i. es SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 32 TARRAGON CIRCLE COUTIT MAP 41 PAR 18 Owner: DENNEHY Date of Inspection:11124tsa 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 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: 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. (revleed 04rl7)971 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECLIST Property Address: 32 TARRAGON CIRCLE COUTIT MAP 41 PAR 18 Owner: DENNEHY Date of Inspection:11124198 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. ` —x— — 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. x Determined in the field(if any failure criteria related to Part C is at issue, approximation of distance is — — unacceptable)[15.302(3)(b)] (reyleed OWD97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 32 TARRAGON CIRCLE COUTIT MAP 41 PAR IS Owner: DENNEHY Date of Inspection:11124199 FLOW CONDITIONS, RESIDENTIAL Design flow: 330 9•P•d./bedroom for S.A.S. . Number of bedrooms: 3 Number of current residents: 4 `' a Garbage grinder(yes or no): No Laundry connected to system(yes or no): Yes Seasonal use(yes or no): No Water meter readings,if available:(last two(2)year usage(gpd): r rda Sump Pump(yes or no): No Last date of occupancy: We COMMERCIAL/INDUSTRIAL: Type of establishment: nfa Design flow:0 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: Na Last date of occupancy: n1a OTHER:(Describe) n1a 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:0 gallons Reason for pumping: rda TYPE OF SYSTEM x Septic tank/distribution box/soil absorptions system 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: - s APPROXIMATE AGE of all components,date Installed(if known)and source information: THE SYSTEM WAS INSTALLED IN 1991 PERMIT 191364 Sewage odors detected when arriving at the site:(yes or no) No (revised 04127)971 , SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 32 TARRAGON CIRCLE COUTIT MAP 41 PAR 78 Owner: DENNEHY Date of Inspection:11124198 SEPTIC TANK: x (locate on site plan) Depth below grade: 1' Material of construction:x concreate metal FRP Polyethylene_other(explain) If tank is metal, list age me . Is age confirmed by Certificate of Compliance No (Yes/No) Dimensions: L10'6"H5•7^w5'8" Sludge depth:s,. Distance from top of sludge to bottom of outlet tee or baffle: 28" Scum thickness:4" Distance from top of scum to top of outlet tee or baffle:s" Distance form bottom of scum to bottom of outlet tee or baffle: 14' 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 NOW AND THEN MAINTAINED EVERY TWO YEARS. GREASE TRAP: (locate on site plan) 5 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 f Distance from bottom of scum to bottom of outlet tee or baffle: ria Date of last pumpingnt. 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.) Wa BUILDING SEWER: (Locate on site plan) Depth below grade: vs- Material of construction: cast iron x_40.PVC other(explain) Distance from private water supply well or suction Ilne:rOWN Diameter: n1a_ Qmments:(conditions of joints,venting,evidence of leakage, etc.) (revleed 0412INT) a SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ' PART C SYSTEM INFORMATION (continued) Property AddreSS: 32 TARRAGON CIRCLE COUTIT MAP 41 PAR 18 " Owner: DENNEHY ' Date of Inspection:11r24199 TIGHT OR HOLDING TANK: ;. (locate on site plan) Depth below grade: rya Material of construction:_concrete_metal_FRP_Polyethylene other(explain) Dimensions: nra Capacity: rda gallons t Design flow: rva allons/day Alarm level:_nla Alarm in working order? Yes_No Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) , n!a DISTRIBUTION BOX: x (locate on site plan) ` Depth of liquid level above outlet invert: nla Comments: : (note if level and distribution is equal, evidence of solids carryover,evidence of leakage into or out of box etc:) Na , PUMP CHAMBER: (locate on site plan) Pumps in working order,(yes or no)No ` Alarms in working order(yes or no)_Ya: ' Comments: (note condition of pump chamber,,condition of pumps and appurtenances, etc:) rVa J • (revised U2787) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 32 TARRAGON CIRCLE COUTIT MAP 41 PAR 18 Owner: DENNEHY Date of Inspection:11124198 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: Na Type: leaching pits, number: 2.1000 GALLON LEACH PIT WITH 3'OF STONE leaching chambers,number:We leaching galleries,number: rda leaching trenches,number,length: Na leaching fields,number,dimensions:nla overflow cesspool,number:nla Alternate system: nia Name of Technology:_nra Comments: (note condition of soil,signs of hydraulic failure,level of ponding, condition of vegetation, etc.) THE LEACH PITS ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY.THE PIT C WAS 112 FULL AT THE TIME OF THE INSPECTION. CESSPOOLS: (locate on site plan) Number and configuration: Na Depth-top of liquid to inlet invert: nla Depth of solids layer: Na Depth of scum layer: Na Dimensions of cesspool: rda Materials of construction: rva Indication of groundwater: nla inflow(cesspool must be pumped as part of inspection) rda 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: rva Depth of solids: rda Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc:) Na . .. .. a (revised 04117H7) i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 32 TARRAGON CIRCLE COUTIT MAP 41 PAR 18 DENNEHY 11124198 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) (o A 6C a Page ! of 30 (revleed 04f17197) ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 32 TARRAGON CIRCLE COUTIT MAP 41 PAR 18 DENNEHY 11124198 Depth of groundwater 12, Please indicate all the methods used to determine High Groundwater Elevation: s 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 how you established the High Groundwater Elevation.(MUST be completed) USGS MAPS AND CHARTS (revlued04)2T197) page 10 of 10 TOWN OF BARNSTABLE Lt:EAn- ON i 0—() C6-1( A(C --jEW.AQE # � VILLAGE e V� ASSESS R' MAP1 & LOT C 1 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (ty )�C� � (size) Z C U NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIAN ATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by �L-1 R ox C dp 3 95� 30 TOWN OF BARNSTABLE r.. 41, LOCATION 3-2, 7,-4m"C-oev C,',e�,Z.,ff 4 SEWAGE # 9� VllL_ GE L ' "' ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. co . :; R C , 1 EPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) Q NO. OF BEDROOMS �/ PUBLIC WATER BUILDER OR OWNER T ecl Ga�kS i c• � 'laAs Cd, DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: Q, VARIANCE GRANTED: Yes No �� i5Cb GPfL r E-7ncTRlk 2z-j 32- 31 T f 600 Ge�L PeE•cPST p�T• w� 3 0� I z s�rvE N-o..... A 12, K Fim A 01 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH '77 ....................0 F.......BrIfYLS&.61P...... Appliration for Disposal Works Tonstrurtion Pumit Application is hereby made for a Permit to Construct (X) or Repair an Individual Sewage Disposal System at -13t7g-.n. .................................................................................................. �Qfo]f................ 4or /9' Location-Address , o;0P, 7%xv......eb�-- �JZ&2----------------------------------------------- ...J)r.... .et .......................... Owner Address .................................................................................................. .................................................................................................. Installer Address Type of Building Size Lot....klq..U.9.......Sq. feet allo. of Bedrooms....- m ar..........................Expansion Attic M) Garbage Grinder a) Dwelling— f PL4 Other—Type of Building ............................ No. of persons...._............_.......... Showers Cafeteria Otherfixtures ..................................................................................................................................................... Design Flow....................................5 ..gallons per person per day. Total daily flow..........................440........eallons. 1:4 Septic Tank—Liquid capacity- -gallons Length.10..�.-&!.. Width. LV.".. Diameter..T==... Depth-`�- 9.11 Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. f t. Seepage Pit No------kA;%:)------- Diameter......ID.-f....... Depth below inlet....jG........... Total leaching area...;573.4.....sq. f t. Other Distribution box (X ) Dosing tank Percolation Test Results Performed by....... (0J.5m................. ---------------" Date.._.405.................... Test Pit No. 1.....Z......minutesperinch Depth of Test Pit....1.41........ Depth to ground wal . ......... -61 Test Pit No. 2................minutes per inch Depth of Test Pit___.._......__...... Depth to ground ...................................................................................................................... 0 Description of Soil........0.— .................................................................................. STFmeELsPIYHoNEN X ., 9"T t a 6... ...07le'r ...... ....... lLura..$Aft�4................................................................ ------------------- ....1. ............................................................................................................................................................... G2 U Nature of Repairs or Alterations—Answer when applicable........................................................ I ..................................................................................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System n accordance wit 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 Compliance has issued by the 4oard of hwkh. Signed -------- .............. I .... ................. -............. ................................ .......... Application Approved By .... . .... ... ..................... .. ............ . . .. ......... .......... ....................................... ------- ...... - has issued S, ... . ... ... ....-F-L te i o 4. Application Disapproved for the following re S: -------------------------------------........................................................--------------------------------------- -----------....................................... .............. ............... Issued ....... ------------------------ ---------- " -�­� ------------------------------------------------------- ------------ ------------ Permit.No. ..... No..... FimB THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Lor,&-N,A- ----.....OF....... -Jr........................................................ Appliration for Disposal Works Ton.5trurtion ramit Application is hereby made for a Permit to Construct (,K) or Repair an Individual Sewage Disposal System at: . -1, ........CQ.fV.1j................... 4 c,i- -r .................................................................................................. Location-Address or Lot No. *... ...................... ... ....../&Z Owner ...................................... Address �k6jt� ........ ........ Installer Address Type of Building Size Lot___kl(-Z�Al.......Sq. feet U Dwelling—No. ofpBedroom's.- n- ---- xc............................Expansion Attic M) Garbage Grinder 4%) j S- P4 Other—Type of Building ..."......................... No. of persons.....__.._._......__.._..___ Showers Cafeteria Otherfixtures ...................................................................................................................................................... Design Flow....................................=.gallons per person per day. Total daily flow..................._..... 4 41C)........gallons. 1 11 - ............ Liquid capacity.K:- Diameter. 1:4 Septic Tank C gallons Length-10:71 nl.. Width-.��.-�.?." .... Depth:r:............. Disposal Trench—No. .................... Width_................... Total Length__................_. Total leaching area....................sq. ft. r...... /Seepage Pit No-:tAyl-:n? Diameter....../10.. Depth below inlet....k,........... Total leaching area.— .....sq. ft. Z Other Distribution box (y, ) Dosing tank ( ) Percolation Test Results Performed by.._..._ .!A-,A 1hza........................................ Date___..5KAJU.................. Test Pit No. I.......9...._._minutes per inch Depth of Test Pit----t-491........ Depth to ground water--- lzj, ti. Test Pit No. 2................minutes per inch Depth of Test Pit____............__.. Depth to ground wat 0 ........... STEPH E Description of Soil........C2.-12......... Lu.c�!J............................................................................................ ....... At �'Z .............m................... U ...&I......................................................................... -W+LSON----- 4 C6 U Nature of Repairs or Alterations—Answer when applicable................................................................... .............................................................................................................................................................................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in a cordance 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 Compliance has been issued by the board of health. Signed ..... ------------------- ............................... ----------------------------------- ................... .. ... ................Application Approved By -----10C---*---70u, ................................ Application Disapproved for the following re o S: ....................................................................................................................................... ... -------------------------------------------------------------------------------------- Da --------------- ;-------------------- ......................... .. . ... 6. Permit No. ssue . ........... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEAL N T - --------------- --------------------- OF BA P-/V-,5 ...46...(.......... . ......... &rtifirate of Tontylinure THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired by...................................................------------........................................................................................-...............9......................................................................... � a io r.I 1�11�, a e4c� - % _i=---)...... t ------- . ........ ..A - .. . ---C111---- Ccrul...-.r------------------------------------------------------------- has been installed in accordance with the provisions of TITLE 5 f The Syte-Environmental d as d cribed in the application for Disposal Works Construction Permit No. ------Y.ij=. . ........ dated ------- T ?/TELf TAT THE THE ISSUANCE OF THIS CERTIFICATE SHALL NOT B CONSTRUED AS A GU R N SYSTEM WILL FUNCTION SATISFACTORY. DATE----- ......................................-----------------------.................................. Inspector ................................................................................................ THE COMMONWEALTH OF MASSACHUSETTS 01 BOARD FA T —0.04..0 F........ NO.11 ............f .......................... FEE100.... . Disposal Works T.PaInstrurtion "nutit Permission 1 hereby ere y granted.,....................................................................... ....................................................... to Constru or R i aUnndi.v-dual r1ewa DISPO 4 System - -V. r.. ................... .............. ........... At C >1 at No........ .. ..... a _d- te eet as shown on the application for Disposal Works Constructio, mit Noqt:!!. ated.....16- ........... Board o eal h DATE........................ ------------------------- FORM 1255 HOBBS & WARREN, INC., PUBLISHERS 20' MINIMUM OR AS INDICATED ON PLAN NOTES: tD' MIN. Cherrywood Ln. 1 . ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.Q.E. Tarragon Cir. MASONRY EXTENSION TO 12" TITLE 5 ; THE TOWN OF , �� ____ RULES AND TOP OF FOUNDATION BELOW GRADE BACKFILL WITH _ e" + col' �G' CLFAN SAN REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE; BEASONRY LOW GRADEEXTENSION TO 12' AND THE REQUIREMENTS OF THIS PLAN. 2. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO ,� LOCUS _ � WITHIN 12" OF FINISHED GRADE. e �+ I . PI 40 PVC PIPE 3. ALL MASONRY UNITS USED TO BRING COVERS TO GRADE /Gr � MIN. PITCH 1/8" PER FT. N ' 4 PER FT FLOW NE 2" LAYER OF SHALL BE MORTARED IN PLACE. stab roe Rd. 1/e" - 1/2" 4. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE 10 TEE � WASHED STONE OF WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR 3" MIN. i i 2'-0" i-rGALLON LOCUS �' '' 2" MIN. LEVEL a WITHIN 10 FT. OF DRIVES OR PARKING AREAS. H-20 LOADING '-0" w LEACH 4 I c� 4 �, c, 6 PIT SHALL BE USED UNDER OR WITHIN 10 FT. OF DRIVES OR �+ 3/4" — 1 1/2- C LIQUID LEVEL DISTRIBUTION F ¢WASHED STONE PARKING. � Treeline Dr. I O Box < 5. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEED RESTRICTIONS OR ZONING REGULATIONS. OWNER/APPLICANT SHALL GALLON SEPTIC TANK OBTAIN SUCH DETERMINATION FROM THE APPROPRIATE AUTHORITY. LOCATION MAP =y� 21 � , i Z; I Z_ 6. HORIZONTAL AND VERTICAL CONTROL, SEE LEVY, ELDREDGE & WAGNER FIELD NOTEBOOK # --,90 ASSESSORS MAP 4_ PARCEL c: LIQUID DEPTH IN SEPTIC TANK DEPTH OF OUTLET TEE BELOW FLOW LINE BOTTOM OF TEST HOLE 4 9 4 FEET 14 INCHES S FEET 19 INCHES OR USGS PROBABLE HIGH WATER LEVEL 6 FEET 24 INCHES Aa�,ac;At3c` Ft,oW Ar rr T- r, 7 CURRENT ZONING INTERPRETATION: DESIGN CALCULATIONS 6I,2z9 ar ,L b-DOn4p�l/q� = 4,o4 `p2.1 SEWAGE DISPOSAL SYSTEM PROFILE MIN. FRONT SETBACK 30 FEET NUMBER OF BEDROOMS _�_ NOT TO SCALE MIN. SIDE SETBACK /5 FEET GARBAGE DISPOSAL UNIT no TOTAL ESTIMATED FLOW MIN. REAR SETBACK �— FEET LOT 20 � ( /10 X 4 BR.) 440 GAL. /DAY REQUIRED SEPTIC TANK CAPACITY GAL. 13 .60 ACTUAL SIZE OF SEPTIC TANK Z�7 00 GAL. LOT 21 PERCOLATION SOIL TEST P- 7800 LEACHING AREA REQUIREMENTS SIDEWALL AREA R.5 GPD./S.F. BOTTOM AREA GPD./S.F. I \ DATE OF SOIL TEST (6 Auwust I4cc I —7 o TEST BY SIDEWALL 277( /0/2)(�)SF x Zs- GPD/SF = 471 GAL/DAY w ..�, .moo,-� BOTTOM 7T (zlo /2)2 SF x A 0 GPD/SF = �_ GAL/DAY WITNESSED BY L U'llor:.,A ��•� — _ _ \ � LOT 18 w 7-(97 ZSI mop b PERCOLATION RATE MIN./INCH x z x a LOT 19 61,229 s ft.f q• \` �_ SF ,�o �i� GAL/DAY T TEST PIT #1 TEST PIT #2 BREAKOUT CALCULATION: / 1 \ 22 ELEV.= (� ELEV.= -0.00 -0.00 � � � �Ylcci . ri 5an.7 LEGEND : EXISTING SPOT ELEVATION OOXO L_(Na tJ.�r, EXISTING CONTOUR-------00----- / FINAL SPOT ELEVATION 00.0 FINAL CONTOUR TP LOT 23 BOTTOM OF TEST HOLE BOTTOM OF TEST HOLE SOIL TEST PIT LOCATION / OR WATER ELEV. C1q, 9 _ OR WATER ELEV. TOWN WATER W W r I SEPTIC TANK ., DISTRIBUTION BOX ❑ WATER LEVEL ADJUSTMENT: PRIMARY LEACHING PIT O RESERVE LEACHING PIT TEST DATE WATER LEVEL / G INDEX WELL z Aso 7/ ,.� 6_ �ti>' / A LEVEL RANGE ZONE 1 8 `i/ INITIAL ISSUE S�lG) 00. DEPTH TO WATER LEVEL FOR INDEX WELL NO. DATE DESCRIPTION BY i.� �� �� / r FOR MONTH OF: SITE PLAN AND SEPTIC DESIGN I__OT 17 WATER LEVEL ADJUSTMENT 64- DEPTH TO HIGH WATER LOT 18 TARAGO N CIRCLE \ � ➢ IN BARNSTABLE, MASSACHUSETTS \ ` OF FOR A STEPH N THEO CONSTRUCTION INC. APPROVED- BOARD OF HEALTH \ F2 WILSON No.302 SITEF �T SCALE: 1 " = 40' JOB No. 1583 PLAN 1 c�^9 n"/a/I`1 ho 5 6tt,, �7�!'r rti fjr�n i o �4 y S°r - ----- ----- -- �J.-.�,/o.,•�/ b� lore"' � .��...i•.�, �/ufr� DATE AGENT f/ LEVY, ELDREDGE & WAGNER ASSOCIATES INC. PERMIT # BNGIM LANDSCAPE AXTIMM PLANNERS LAND SU"KYORS 889 WEST MAIN STREET CENTERVUILE MA 02632 +t A h", A%i Pf PH(X;HAPHiCS&SUPPLY CO