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HomeMy WebLinkAbout1105 PHINNEY'S LANE - Health 1105 PHINNEYS,LANE HYANNIS (JM Landscaping) I Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments - Subsurface Sewage Disposal System Form Inspection results must be submitted on this form. Inspection forms may not be altered in any way. A. General Information Important: When filling out 1. Property Information: TM forms to the .,�.�+.,.�,n MA. 02632-1962 computer, use 1105 Phinneys Lane���, only the tab key Property Address to move your Wellington Barret cursor-do not use the return Owner's Name key. 51 Dolphin way Owner's Address Q South Yarmouth MA.' 02664-3040 City/Town State Zip Code 11/29/2006 r e,Um Date of Inspection: , Date c� er 2. Inspector: 1 Brian K. Tilton ' r. Name of Inspector Gw � The Building Inspector of Cape Cod Company Name ' P.O. Box 307 ry Company Address c-n Eastham MA 2642 0 rri City/Town State ip Code 508-255-9343 Telephone Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ N ds Further Evaluati by the Local Approving Authority 11/29/2006 ns e r s Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. 1105 Phinneys Ln.t5insp.doc-03/2006 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 1 of 16 f Commonwealth of Massachusetts Title 5 Official Inspection Form o Not for Voluntary Assessments j Subsurface Sewage Disposal System Form _J B. Certification (cont.) 1105 Phinneys Lane Property Address Centerville MA 02632-1962 CityrTown State Zip Code Wellington Barreto 11/29/2006 Owner's Name Date of Inspection 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 Looks good, no evidence of failure. 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. Answer yes, no or not determined (Y, N, ND) in the ❑ 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. ND Explain: 1105 Phinneys Ln.t5insp.doc•03/2006 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 2 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Not for Voluntary Assessments Subsurface Sewage Disposal System Form B. Certification (cont.) 1105 Phinneys Lane Property Address Centerville MA 02632-1962 City/Town State Zip Code Wellington Barreto 11/29/2006. Owner's Name Date of Inspection B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: 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 1105 Phinneys Ln.t5insp.doc•03/2006 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 3 of 16 I ' Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form B. Certification (cont.) 1105 Phinneys Lane Property Address Centerville MA 02632-1962 City/Town State Zip Code Wellington Barreto 11/29/2006 Owner's Name Date of Inspection C) Further Evaluation is Required by the Board of Health (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 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: 1105 Phinneys Ln.t5insp.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 4 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form B. Certification (cont.) 1105 Phinneys Lane Property Address Centerville MA 02632-1962 City/Town State ZipCode Wellington Barreto 11/29/2006 Owner's Name Date of Inspection 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 ondin of effluent to the rf❑ ® g p g e surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑. ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow ❑ ® 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.] Q ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. Yes No ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 1105 Phinneys Ln.t5insp.doc•03/2006 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 5 of 16 f Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments nM Subsurface Sewage Disposal System Form B. Certification (cont.) 1105 Phinneys Lane Property Address Centerville MA 02632-1962 City/Town State Zip Code Wellington Barreto 11/29/2006 Owner's Name Date of Inspection E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. YES NO ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area.— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 1105 Phinneys Ln.t5insp.doc•03/2006 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 6 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. Checklist 1105 Phinneys Lane Property Address Centerville MA 02632-1962 City/Town State Zip Code Wellington Barreto 11/29/2006 Owner's Name Date of Inspection Check if the following have been done. You must indicate "yes" or"no" as to each of the following: YES NO ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ®- ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) (310 CMR 15.302(5)] I 1105 Phinneys Ln.t5insp.doc•03/2006 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 7 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information 1105 Phinneys Lane Property Address Centerville MA 02632-1962 City/Town State Zip Code Wellington Barreto 11/29/2006 Owner's Name Date of Inspection 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): 330.4 Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 218 GPD 9 ( y 9 (gpd)): Sump pump? ❑ Yes E No Last date of occupancy: Current Date Commercial/Industrial Flow Conditions: Type of Establishment: N/A Design flow (based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/person s/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: - Last date of occupancy/use: Date Other(describe): 1105 Phinneys Ln.t5insp.doc•03/2006 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 8 of 16 f Commonwealth of Massachusetts _ Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form �M D. System Information (cont.) 1105 Phinneys Lane Property Address Centerville MA 02632-1962 City/Town State Zip Code Wellington Barreto 11/29/2006 Owner's Name Date of Inspection General Information Pumping Records: Source of information: Owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system . ❑ Single cesspool 'i ❑ 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) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other (describe): Approximate age of all components, date installed (if known) and source of information: 4/31/2003 Were sewage odors detected when arriving at the site? ❑ Yes ® No 1105 Phinneys Ln.t5insp.doc•03/2006 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 9 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments p Subsurface Sewage Disposal System Form i4^M - SV D. System Information (cont.) 1105 Phinneys Lane Property Address Centerville MA 02632-1962 City/Town State Zip Code Wellington Barreto 11/29/2006 Owner's Name Date of Inspection Building Sewer (locate on site plan): Depth below grade: 2 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.): No evidence of leaks or failure. Septic Tank (locate on site plan): Depth below grade: 1.5 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 ❑ Yes ❑ No certificate) ------------------------------------------------------------------------------------------------------------------------- Dimensions: 5'8"x9'6"x4'10" Sludge depth. 4 Distance from top of sludge to bottom of outlet the or baffle 26 Scum thickness 3 Distance from top of scum to top of outlet tee or baffle 6 Distance from bottom of scum to bottom of outlet tee or baffle 18" - How were dimensions determined? Dip stick, Baffle stick & Tape measure 1105 Phinneys Ln.t5insp.doc•03/2006 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 10 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cont.) 1105 Phinneys Lane Property Address Centerville MA 02632-1962 City/Town State Zip Code Wellington Barreto 11/29/2006 Owner's Name Date of Inspection - Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): System levels ok, all components in place and functioning normally. no evidence of backup or failure. No need to pump at this time. Grease Trap (locate on site plan): Depth below grade: N/A P feet Material of construction: ❑ concrete ❑ metal El-fiberglass ❑ polyethylene ❑ other(explain): I i 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.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: N/A Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): f , 1105 Phinneys Ln.t5insp.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 11 of 16 Commonwealth of Massachusetts F Title 5 Official Inspection Fora Not for Voluntary Assessments ^N-5 fir• Subsurface Sewage Disposal System Form D. System Information (cont.) 1105 Phinneys Lane Property Address Centerville MA 02632-1962 City/Town State Zip Code Wellington Barreto 11/29/2006 Owner's Name Date of Inspection Tight or Holding Tank (cont.) Dimensions: N/A Capacity: gallons Design Flow: gallons per day i 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 Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 11 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Box is level and equal flow to two galleries. no evidence of solids carryover. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No N Alarms in working order: No ❑ Yes ❑ 1105 Phinneys Ln.t5insp.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 12 of 16 f „ Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form. 'LAM D. System Information (cont.) 1105 Phinneys Lane Property Address Centerville MA 02632-1962 City/Town State Zip Code Wellington Barreto 11/29/2006 Owner's Name Date of Inspection Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption.System (SAS) (locate on site plan, excavation not required): i If SAS not located, explain why: Type: ❑ leaching pits number: ❑ leaching chambers number: ® leaching galleries number: 2/500 gal. ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: r ❑ 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.): Lawn over with no evidence of breakout or hydraulic failure. < 2" liquid 1105 Phinneys Ln.t5insp.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 13 of 16 . Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form ^�M �yV D, System Information (cont.) 1105 Phinneys Lane Property Address Centerville MA 02632-1962 City/Town State Zip Code Wellington Barreto 11/29/2006 Owner's Name Date of Inspection Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration N/A 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.): Privy (locate on site plan): Materials of construction. N/A Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 1105 Phinneys Ln.t5insp.doc•03/2006 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 14 of 16 I Commonwealth of Massachusetts - -- Title 5 Official Inspection Form _ Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cone.) -1105 Phinneys Lane Property Address Centerville MA 02632-1962 City/Town State Zip Code Wellington Barreto 11/29/2006 Owner's Name Date of Inspection Sketch Of Sewage Disposal System: Provide a sketch 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. t� o � 0 2 h At 18 , r 2 S . 34 (o.t/ . Nol T-o SCA LC A g = 33 ' B�= gs� 40 1105 Phinneys Ln.t5insp.doc•03/2006 Title 5 Official inspection Form:Subsurface Sewage Disposal System Page 15 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cont.) 1105 Phinneys Lane _ Property Address Centerville MA 02632-1962 City/Town State Zip Code Wellington Barreto 11/29/2006 Owner's Name Date of Inspection Site Exam: Slope Surface water Check cellar Shallow wells Estimated depth to ground water: t'� /ow SAS s Please indicate all methods used to determine the high ground water elevation: i ® Obtained from system design plans on record If checked, date of design Ian reviewed: 4/31/2003 g p 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: Design plans and soil evaluation on file with BOH. I 1105 Phinneys Ln.t5insp.doc•03/2006 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 16 of 16 r SOIL TEST LOG DATE OF TEST: APRIL 29. 2003 SOIL EVALUATOR: DAVID D. COUGHANOWR. RS WITNESS REOUIREMENT WAIVED - NO VARIANCES SOUGHT NO GROUNDWATER ENCOUNTERED TEST PIT I pERCNATM54�R1A 3 M)N%�1NCH IIN OUTWAC SOILSSH ELEVATION - 78.85 •- - - DEPTH SOL USDA SOIL SOIL COLOR SOL OTHER (NCHES) HORIZON TEXTURE (MUNSELL) MOTTLING 0-12 FILL 12-16 Ap LOAMY SAND 10 YR 4/4 NONE FRIABLE 16-40 B LOAMY SAND 10 YR 5/6 NONE FRIABLE 40-138 C LOAMY IO YR 6/4 NOW LOOSE 30Y. STONES COARSE SAND W/ TRACE LOAM GROUNDWATER ADJUSTMENT EXISTING GROUNDWATER LEVEL BASED ON BARNSTABLE GIS OBSERVED GW::,.-35.0 INDEX WELL: AIW-247 ZONE: C READING: MARCH 2003 LEVEL: 24.8 ADJUSTMENT: 5.5 fi ADJUSTED GW: 40.5 NOTES I) GARBAGE GRINDER NOT ALLOWED WITH THIS DESIGN 21 ALL LINES TO BE SCH 40 PVC AND PITCH AT 1/8 INCH PER FOOT MINIMUM. 3) ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM REOUIREMENTS 01= MASSACHUSETTS TITLE 5 SEPTIC CODE (310 CMR 15) 4) INSTALLER TO' VERIFY LOCATIONS OF ALL UNDERGROUND UTILITIES,- BEFORE EXCAVATING FOR SYSTEM. 5) EXISTING LEACH PIT TO BE PUMPED. COLLAPSED. AND FILLED. OR REMOVED 6) ALL STONE TO BE DOUBLE WASHED AND FREE OF IRON. FINES AND DUST IN PLACE 7) LINES EXITING D-BOX TO RUN LEVEL FOR 2'-0' BEFORE PITCHING DOWN 8) ECO-TECH ENVIRONMENTAL RECOMMENDS THE INSTALLATION OF LOW FLOW FIXTURES AND APPLIANCES. AND BIANNUAL PUMPING OF THE SEPTIC TANK ., 9) SYSTEM IS NOT DESIGNED TO WITHSTAND VEHICULAR LOADING. DO NOT PARK OR DRIVE VEHICLES OVER SEPTIC SYSTEM, 10) INSTALLER TO OBTAIN DISPOSAL WORKS PERMIT BEFORE STARTING WORK. 11) SEPTIC TANKS SHALL BE INSTALLED LEVEL AND TRUE TO GRADE ON A LEVEL STABLE BASE THAT HAS BEEN MECHANICALLY COMPACTED AND ON TO WHICH SIX INCHES OF CRUSHED STONE HAS BEEN PLACED TO MINIMIZE UNEVEN SETTLING 2) SEPTIC TANK TO BE PUMPED DRY AT TIME OF SYSTEM REPAIR AND CHECKED _FOR. STRUCTURAL INTEGRITY. INSTALL PVC OUTLET' YEE FITTED WITH GAS BAFFLE. Pennit Num;_er: mate; ' Cornoleted by: TC7/idrl • /• ��o.� HIGH G SOUND ANATER, LEVEIICOIMPU'TATM Site Location: ftDS �✓rKL .. �'e�'tirJ�Ile MotLot1`0. / -- vuuner: l-- 'en &rr_tc _AdaTess: d771 /�o�p�1i« WA'1 7• y� Q/ia�oJf�. /��f. Coniractor:`fT� !3uek+ 1.�P,p. �oe�+l '� Advrpss: }_ '�D•�JC 3� E A5 r/� MCI • 7�2�_ T - Notes.,X/D LtJnc'���t�_�ss o�•s-Y.mod STEP i Measure depth to water table d � tonearest 7l9J t. ...........................................................-........_......... .batL t� rnomti,/iav/yaar t STEP Z Using �'�a'ter-LEYC: 1=1a:xjE tome _� .._._..�.—._.. _... and Index Well Map locate � site and determine: A 1%1 Appropriate index well.................................................... G level range_one_.......__.,. .. P Water-, R i ($( STEP 3 Using monthly rejaort."Current � l 1 � - iJL'ateY Resources Conditions" determine current depth tO � � Q water level for index uve€l................_. ......_ - ) �nrrtt��r � —� � t STEP a Using Table of Water-ievel Adjustments l ? fair index vvei? (STEP EP 2A), current daj3yh to water level for-index wail (S T EP 3), t and water-leml?one(_qTEP 28) ciEtErCc iC?e UY3tEl-level adjustrrriant ......................................... ........................... f STEP 5 estimate dejih to i•i;uh water by ;ubtractirg the-,water- . { level ad}ustrrent (STEP 4) i irons measured depth to water i :w levelat site (STEP 1) .........................••-__......._-_............----..-_...............-......--..........-............. Figure ice.--ftrockl ble computation form. r Cape Cod Commission: USGS Well Data- October 2006 Page 1 of 2 United States Geological Survey Observation Wells As a service to Cape officials,engineers and other interested parties,the Cape Cod Commission publishes monthly groundwater data gathered by its Water Resources Office. The water level measurements shown below are taken monthly from United States Geological Survey (USGS) observation wells and compiled during the last week of each month. They are published as soon as possible thereafter. Listed below are nine out of the 61 wells measured across Cape Cod by the Commission's Water Resources Office. These nine are employed as index wells to be used with Technical Bulletin 92-001 to predict high groundwater levels. For your convenience, we've also provided links to USGS national and state data. See the last column in the table and the footnotes below. To see what's happening in real time at a separate well in Brewster, visit the USGS site: C.JSGS 414630070014901 MA-BMW 22 BREWST R,:MA-A record high was broken in June 2006. For further information about any of the data or links on this page,please contact HY drologist Gabrielle Be]fit at the Commission offices(508-362-3828). October 2006 tisGs Site Water Record Record Departure from Nunibea ` Location Well No. Level* High* Low* Average** (links to t.JSGS Monthly Overall national water-level database) Barnstable 230 23.8 20.5 26.6 0.7 -0.2 41'9560701,6430.1_ Barnstable 24w 23.1 20.5 28.6 2.0 1.4 4,1- .1507t.1.6500-1-_ Brewster BMW 21 8.4 6.9 13.6 2.0 �� 4.1. s 1 s0700203c?1, Chatham CGW138 24.2 20.9 26.6 0.4 -0.3 1+14.10007001.1.1.0.1.. Mashpee MIW 29, 8.7 5.6 10.0 0.5 -0.2 41352507. 0291904 Sandwich SDW 47.3 45.8 48.2 0.3 0.0 E4180 . . 241601 Sandwich SDW 48.1 45.8 55:1 2.3 2.0 4.1241070.?Ei5.y0.1. Truro TSW 89 12.1 1.0.2 13.0 0.3 -0.1 20206070045901. r - ----i�- � �l/CYO cat (it-crr h6w vV fibt& Date /� /�TOWN OF BARNSTABLE I� TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: AA I L /; 2 S!E6a A-Ai✓2 Qi�SiCAJ BUSINESS LOCATION: 1/0a i)IUe-Y', ZA- ,% ,ILE C'6_ nI/ /,�z INVENTORY MAILING ADDRESS: C/ 3r a f�60 X) �4 u A4)/0 is TOTAL AMOUNT: TELEPHONE NUMBER: 5708 `70 - CONTACT PERSON: ' A F EMERGENCY CONTACT TELEPHONE NUMBER: 36 5�'f°/ gMSDS ON SITE? TYPE OF BUSINESS: LAA/ysc^a _ INF RMATION/RECOMMENDATIONS: Fire District: r v y /ICI �-'iyo A)® PdcXhXj. Waste Transportation:_4 4/(- Last shipment of hazardous waste:—AJOV Name of Hauler* Destination: 0(-)=C2 Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materials use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed/Maximum Observed/Maximum Antifreeze (for gasoline or coolant systems) Misc. Corrosive NEW USED Cesspool cleaners. Automatic transmission fluid Disinfectants Engine and radiator flushes { Road Salts (Halite) o Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides NEW USED (insecticides, herbicides, rodenticides) (JlG IV Gasoline, Jet fuel, Aviation gas _ Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil NEW USED Ij Misc. petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) (CJ Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda w Rustproofers Misc. Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers ( Asphalt & roofing tar PCB's 0 Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (inc. carbon tetrachloride) NEW USED Any other products with "poison" labels Paint &varnish removers, deglossers (including chloroform, formaldehyde, Misc. Flammables hydrochloric acid, other acids) Floor &furniture strippers Other products not listed which you feel 0 Metal polishes m be,o is 6rhzardous (please list): Laundry soil & stain removers (including bleach) Spot removers &cleaning fluids �, t9 _ `,f h'ye 0 (dry cleaners) riot, (✓ Other cleaning solvents _ 0 co �l71 Bug and tar removers Windshield wash V j Sufi toU-0 'a,ji P /t.WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS TOWN OF BARNSTABLE LOCATION ' �05 �f11a�Aey`S SEWAGE # Z 'ZI Z YII.LAGE r?rAPs-t7A\e ASSESSOR'S MAP& LOT 11L INSTALLER'S NAME&PHONE NO. �0 ► SEPTIC TANK CAPACITY G�a�" u LEACHING FACILITY: (type) �'{0 � i1 —(size) J NO.OF BEDROOMS BUILDER OR OWNER PERMIT DATE: S�� >3 COMPLIANCE DATE � Il U3 Separation Distance Between the: Feet Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility "Private Water Supply Well and Leaching Facility (If any wells exist Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) Furnished by _41=.7-3 g 1 0y yZ 1 3 w NT 110 5", �VN L M C E w T FAu 6 LL E - M A _& K to o IL ----"' 3 S . a �F SHowEll PUMP G►�ME Roc NK }glNnooM ST�R�IrE S1 j A Ro0M i } 1 1 �c) Ioob�, G st hus- I LM �ENTEk\j\ LLL - MAk �f�ONT KlTC A UM TOWN OF BARNSTABLE LOCATION J l0 5 Vh 16\t1e,"`S 1 n . SEWAGE # Zo53 VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. 1 St . 111- 9 3 9 SEPTIC TANK CAPACITY .160() 61-e er• LEACHING FACILITY: (type)(Z) 'A iO 500, 11on (size) 1 Z - _X Z. P NO.OF BEDROOMS BUILDER OR OWNER a ' S PERMTTDATE: 5/!�63 COMPLIANCE DATE: =110 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 I i b � � l 4 � OD E � (707;Z, 'o o. r7, G r- �W c ' '> fir-- No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZIpplication for Mi0pont Opotem Construction Permit Application for a Permit to Construct( . )Repair( )Upgrade Abandon( ) O Complete System Adividual Components Location Address or Lot No. Owner's Name Address and Tel.No. Assess r' ©l, > //Ile e 11i f Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. B6r CM,--/ 771"93/�' Type of Building: Dwelling No.of Bedrooms Lot Size Mee sq.ft. Garbage Grinder(_/0 Other Type of Building i° 'e No.of Persons Showers( ) Cafeteria( ) Other Fixtures 2 Design Flow gallons per day. Calculated daily flow 3 3(9 gallons. Plan Date Number of sheets Revision Date Title r®'9 car /O ;e S � Size of Septic Tank 9 _ Type of S.A.S. Z e-r Description of Soil Z y,KfZ •,5—X Z Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued b his Bo o Health. Signe Date _�7/©3 Application Approved by Date . Y L Application Disapproved for the following reasons Permit No. ° LC�, 3 Date Issued d --------------------------------- ------ - No. %c _ _ Fee -5 o / ` THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: 1/ Yes PUBLIC,HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS application for �oizpozar bpmem Conotruction Permit 1 Application for a Permit to Construct( )Repair( )Upgrade(Abandon( ) Complete System /Individual Components ' Location Address or Lot No. Owner's Name,Address and Tel.No. Asses is a Oarce� (�C / !/ J C e l i//e- Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: ] f 1/ Dwelling No.of Bedrooms 1 .Z" Lot Size 2aj!1D sq.ft. Garbage Grinder Other Type of Building Ol*e,.fV L°01C_ No.of Persons Showers( ) Cafeteria( ) Other Fixtures f Design Flow / �1 gallons per day. Calculated daily flow 3 Jz gallons. Plan Date 1-?/ /,2 3 Number of sheets Revision Date Title - Size of Septic Tank r/D/J 9n A-Z/9 Type of S.A.S. Z Description of Soil Z Y ill Z '✓` X V Nature of Repairs_or Alterations(Answer when applicable) u,2 di i Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued b this BO !d o Health. Signe 71 Date r171r-3 Application Approved by Date -5/7 ) Application Disapproved for the following reasons Permit No. d23 Date Issued CS3 ————————— ————— —``————————--—————— THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (tertificate of (tompliance THIS IS TO CERTIFY,that till On-site Sewage Disposal System Constructed( )Repaired( )Upgraded(J/) Abandoned( )by ©//4 C4 it'S at //d S . 9 /e&& t/S �i� , C'�dl c� has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. u°3-a I 1 dated Installer Designer The issuance of this permit shall not be construed as a guarantee that the sys�g, will function as designed. Date 51 12,I n� Inspector p /1 Y . r No. I;'co � —� � c ---------------- Fee 5 0 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS lwi5pogar *pstent Con0truction Permit Permission is hereby granted to Construct( )Repair( )Upgrade(✓Abandon( ) System located at /A�S �/t1AP�/ 14/ ee-e and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction /nstr of uction must be completed within three years of the date this ermmt. /�1 Date:_ 5 !C-)3 Approved by FLOW PROFILE TOP OF FOUNDATION RAISE COVERS TO WITHIN EL - 79.15 6 in OF FINAL GRADE . -RAISE ONE COVER ON GALLERY r All 2- LAYER OF 1/8' " I \ /D BOX 1/2' STONE r �3" DROP d FLOW LINE 3/4--1 1/4- b 14 PRECAST STONE 48'' GAS �� a `` S DRYWELL RAFFLE y:r ' • : BOTTOM OF 75.25 •- 6 in SOL ABSORPTION EXISTING STONE \_71.11 LEACHING SYSTEM EXI$TM BASE EXISTING 74.82 GALLERY 5.00 fr a EXISTING 74.35 1000 GALLON (END VIEW) 71.35 EXISTING SEPTIC TANK 75 fl of 5 fr 12.5 ft b) 14 rr v _ ESTIMATED SEASONAL HIGH GROUNDWATER �J 0►'yfT •� ma r-$ m Zx a �zo = z� �x 8 W r!.Ir, o \ Q2 (Ar r / C°(( D b o m z y c) m�+ r 3 ry -n r� ti p> rt' 7 > m E / _ L N� -- � w rn R , N j9 Y � f 7 COMMA (� W p V 03 \ Z G7 y 0 -- _ D O w A Z ' z 1zFt 0' PA lt4'fSVr rn Z�N m W <' ) � �— m PN/N/VEys -0 1 E n AN40 fAt = m o H N > I Z zZ G7 >o � ^� m � � mm mm m v O m l l U> Z � C � cn z Con = m U> a o m -4 o cn n, 55 D fTl 3 m <=> m r �� M o rn f z� � N 0) m Z R'�s�o o A u, C m ro m ao GT� z m my W I n N z <!> v m a m Ly �, wo O Z m f1l n br� KD � � � zmmz � -- � (OD ® o Ao g r .p = 3 c f (T1 n �� 3m tnZE 1- 3 > �o� v z D Z r > Z —� r 3 ° C,UyE 207Mozm m _ m o it 0vm� N Ln x Cn � Z m �' a S SOIL TEST LOG DESIGN CALCULATIONS DATE OF TEST: APRIL 29. 2003 SOIL EVALUATOR: DAVID D. COUGHANOWR. RS DESIGN FLOW: 3 BEDROOMS X 110 GPD - 330 GPD WITNESS REOUIREMENT WAIVED - NO VARIANCES SOUGHT NO GROUNDWATER ENCOUNTERED SEPTIC TANK: 330 GPD X 2 DAYS - 660 GALLONS TEST PIT I PARENT MATERIAL: PROGLACIAL OUTWASH PERC AT 54 in : 3 MIN/INCH IN C SOILS USE EXISTING 1000 GALLON SEPTIC TANK IF IS SOUND STRUCTURAL ELEVATION - 78.85 +- CONDITION. IF NOT. INSTALL 1500 GALLON SEPTIC TANK (MINIMUM ALLOWED) DEPTH SOL USDA SOIL SOIL COLOR SOL OTHER DISTRIBUTION BOX: USE 3 OUTLET D-BOX. (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING SOIL ABSORBTION SYSTEM: A 24 ft x 12.5 ft x 2 ft LEACHING GALLERY CAN LEACH 0-12 FLL _ Abot - ( 24 x 12.5 ) - 300 sf 12-16 AP LOAMY SAND 10 YR 4/4 NONE FRIABLE A s d w - ( 24 + 24 + 12.5 + 12.5 ) x 2 - 146 s f Atot - 446 sf 16-40 B LOAMY SAND 10 YR 5/6 NONE FRIABLE V t 0.74 x 446 - 330.04 G P D 40-138 C LOAMY 10 YR 6/4 NONE LOOSE. 30i STONES USE A 24 ft x 12.5 ft x 2-. ft GALLERY. Vt 330.04 GPD > 330 GPD REQUIRED - COARSE SAND W/ TRACE LOAM GROUNDWATER LEACHING GALLERY ADJUSTMENT EXISTING GROUNDWATER LEVEL CONSTRUCTION DETAIL BASED ON BARNSTABLE GIS DEPARTMENT RECORDS: DRYWELL UNIT STONE 8'-6'x 4'-10'x 2'-9' OBSERVED OW: 35.0 2 fi EFF. DEPTH INDEX WELL: AIW-247 24.0 ft . ZONE: C READING: MARCH 2O03 LEVEL: 24.8 M ADJUSTMENT: 5.5 ft o ADJUSTED GW: 40.5 M NOTES N O 1) GARBAGE GRINDER NOT ALLOWED WITH THIS DESIGN 2.5' 8.5' 2 fT , 8.5' 2.5' , 2) ALL LINES TO BE SCH 40 PVC AND PITCH AT 1/8 INCH PER FOOT MINIMUM. NOT TO 3) ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM REQUIREMENTS 24.0 ft scntE OF MASSACHUSETTS TITLE 5 SEPTIC CODE (310 CMR 15) 4) INSTALLER TO VERIFY LOCATIONS OF ALL UNDERGROUND UTILITIES BEFORE EXCAVATING FOR SYSTEM. 5) EXISTING LEACH PIT TO BE PUMPED. COLLAPSED. AND FILLED. OR REMOVED 6) ALL STONE TO BE DOUBLE WASHED AND FREE OF IRON. FINES AND DUST IN PLACE SEWAGE DISPOSAL SYSTEM PLAN 7) LINES EXITING D-BOX TO RUN LEVEL FOR 2'-0' BEFORE PITCHING DOWN 8) ECO-TECH ENVIRONMENTAL RECOMMENDS THE INSTALLATION OF LOW FLOW FIXTURES -TO SERVE EXISTING DWELLING AND APPLIANCES. AND BIANNUAL PUMPING OF THE SEPTIC TANK 9) SYSTEM IS NOT DESIGNED TO WITHSTAND VEHICULAR LOADING. DO NOT LYNDA M. DZENAWAGIS PARK OR DRIVE VEHICLES OVER SEPTIC SYSTEM. AND NELLIE WELSCH 10) INSTALLER TO OBTAIN DISPOSAL WORKS PERMIT BEFORE STARTING WORK. 1105 PHINNEYS LANE C ENT ERV ILL.E: MA 11) SEPTIC TANKS SHALL BE INSTALLED LEVEL AND TRUE TO GRADE ON A LEVEL STABLE BASE THAT HAS BEEN MECHANICALLY COMPACTED AND ON TO WHICH ECO-TECH ENVIRONMENAU` SIX INCHES OF CRUSHED STONE HAS BEEN PLACED TO MINIMIZE UNEVEN SETTLING 12) SEPTIC TANK TO BE PUMPED DRY AT TIME OF SYSTEM REPAIR AND CHECKED 43 TRIANGLE CIRCLE SANDWICH MA. 02563 FOR STRUCTURAL INTEGRITY. INSTALL PVC OUTLET' TEE FITTED WITH GAS BAFFLE, ETE-1421 APRIL 31. 2003 ' 2