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0038 APPALOOSA WAY - Health
38 APPALOOSA WAY, MARSTONS MILLS -� cm- y' I t j dd�'4-�"-040WN OF BARNSTABLE LOCATION1,0T SEWAGE # U�ca7� 1 VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE No. Ifee 6Q?Vh71Ale /7/Z Jbif � SEPTIC TANK CAPACITY /e 6 LEACHING FACILITY:(type) �((� /�lflCP (size) 46XK w/r NO. OF BEDROOMS / PRIVATE WELL OR PUBLIC WATERAa/—c-,o BUILDER OR OWNERJ�ysl� /G���� �6 DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: '� '�' VARIANCE GRANTED: Yes No 6° 0. Commonwealth of Massachusetts Title 5 Official Inspection Form lad Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 38 Appaloosa Way Property Address P Jose Quintana Owner Owner's Name information is Marstons Mills MA 02648 10-15-19 required for every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. ``�,1�11111111r Important:When A. Inspector Information ` filling out forms A. on the computer. James D.Sears JA M E S :m use only the tab key to move your Name of Inspector ? cursor-do not Ca ewide Enterprises '.• Cl- use a;•' the return key. Company Name �F •. . I......i:�IF I . 153 Commercial Street '' ,,� 5 1I4SQ�``�.�` Company Address - �hpnunllllgd Mashpee MA 02649 Cityffown State Zip Code ream 508-477-8877 S 1623 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Tltle 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true; accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 10-16-19 cOKpectoes Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc.rev.7/28/2018 Tide 5 Official Inspection Form Subsurtace Sege Disposal System.Page 1 of 18 LE abed xeJ dH L2:91, 61,0Z 2 100 c Commonwealth of Massachusetts rn Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 38 Appaloosa Way Property Address Jose Quintana Owner Owner's Name information s Marstons Mills MA 02648 10-15-19 required for every page, City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and B. 1) 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: The System is a 1000 Gal. Tank D Box and Field. 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain, The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance ind°sating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t&nsp,doc•rev.7/2612018 Title 6 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 g� abed xed dH R91, 61,0Z 2 130 Commonwealth of Massachusetts Title 5 Official Inspection Form ^ Subsurface Sewage Disposal System Farm .Not for Voluntary Assessments 4 38 Appaloosa Way Property Address Jose Quintana Owner Owner's Name information is Marstons Mills MA 02648 10-15-19 required for every page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes(cont.): ❑ Pump Chamber pumpslalarms not operational. System will pass with Board of Health approval if pumpslalarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ NO (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ NO (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ NO (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 ❑ NO (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ NO (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning In a manner which will protect public health, safety and the environment: 15nsp.doc•rev.7128l20/8 Title 5 Offidal Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 6E abed xed dH 8M6 660E 2 100 f Commonwealth of Massachusetts ,Igs Title 5 Official Inspection Form F11 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments P 38 Appaloosa Way Property Address Jose Quintana Owner Owner's Name Information is required for every Marstons Mills MA 02648 10-15-19 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 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. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: Yes No ❑ ® 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 t5insp.doc•rev.71'612018 Title 5 Official Inspection Form:Subsurface Sewage Dispose:System-Page 4 of 18 Ob a5ed xed dH SM 1, 6 60Z 2 V)0 i Commonwealth of Massachusetts Title 5 Official Inspection Form 1� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 38 Appaloosa Way Property Address Jose Quintana Comer Owner's Name equiredion is, r for every Marstons Mills MA 02648 10-15-19 required page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in arAmpod is less then 6"below invert or available volume is less than 1/2 day flow UellIA14 . ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply wel I. ❑ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15,303,therefore"the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd, For large systems, you must indicate either"yes" or'no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone I I of a public water supply well t5lnsp.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 6b abed XeJ dH 62:91. 660E 2 130 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 38 Appaloosa Way Property Address Jose Quintana Owner Owner's Name information is required for every Marstons Mllls MA 02648 10-15-19 page, City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes"to any question in Section C.5 the system is considered a significant threat,or answered "yes"to any question in Section CA above the large system has failed.The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: Yes No ❑ ® Pumping information was provided by the owner,occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as NIA) ❑ 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)] 15insp.doe rev.7126/2018 This 5 Official Inspection Form:Suttsurfaw Sewage Disposal System-Page 6 of 18 E� abed xed dH 6M 6 60E 2 130 r Commonwealth of Massachusetts Title 5 Official Inspection Form it Subsurface Sewage Disposal System Form-Not for Voluntary Assessments k v 38 Appaloosa Way Property Address Jose Quintana Owner Owner's Name information is required for every Marstons Mills MA 02648 10-15-19 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual). 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Description: 1000 Gal. Tank D Box Field. Number of current residents: NA Does residence have a garbage grinder? ❑ Yes ❑ No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No 108,000GaI Water meter readings, If available (last 2 years usage (gpd)); 201 2017-17-1,000 Gal's Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Present Date t5insp.doe-rev.7f2612018 Tide 5 Offldal Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 Eb a5ed xed dH 0B 1, 6 60E 2 1:)0 Commonwealth of Massachusetts Title 5 Official Inspection Form 1d Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 38 Appaloosa Way Property Address Jose Quintana Owner Owner's Name information is required for every Marstons Mills MA 02648 10-15-19 page. City/Town state Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancyluse: Date Other(describe below): 3. Pumping Records: Source of information: NA Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc rev.712WO18 Title 5 OfBdaI Inspectlon Form:Subsurface Sewage Disposal System•Page 8 of 18 t b a5ed xed dH 0£:91, 61.02 2 130 r c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 38 Appaloosa Way Property Address Jose Quintana Owner Owners Name Information is Marstons Mills MA 02648 10-15-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) 4. Type of System: ® Septic tank,distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no)(if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: 2010 Permit #2010-225. Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): 3' 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.): Pipeing is PVC SCH -40 tSinsp.doc•rev.7126/201 B Title 5 Official Inspecton Form:subsurface sewage oispossi system•Page 9 of 18 gt a6ed xed dH OE:9 6 6 60Z 2 100 Commonwealth of Massachusetts Title 5 Official Inspection Form r Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 38 Appaloosa Way Property Address Jose Quintana Owner Owner's Name information is required for every Marstons Mills MA 02648 10-15-19 required page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): 27" Depth below grade: feet Material of construction: ®concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 Gal. Precast H-10 Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle 28 Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 8" Distance from bottom of scum to bottom of outlet tee or baffle 17 How were dimensions determined? Asbuilt- Plan-Tape Sludge Judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural Integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): Tank at working level.Tank at 27" below grade wlcover's at 1". In and outlet Tee's. No sign of leakage or over loading. Wnsp.doc•rev.712612018 Title 5 Offical Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 gt, abed xej dH 0£:96 61,2 2 130 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments .' 38 Appaloosa Way �� pP y Property Address Jose Quintana Owner Owner's Name information is required for every Marstons Mills MA 02648 10-15-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc-rev.712 012 01 8 lido 5 official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 �� a6ed xed dH 1,E:9� 61.0Z 2 130 Commonwealth of Massachusetts Title 5 Official Inspection Form • Subsurface Sewage Disposal System Form • Not for Voluntary Assessments 38 Appaloosa Way Property Address Jose Quintana Owner Owner's Name information is required for every Marstons Mills MA 02648 10-15-19 page. City/Town State Zip code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank (cont.) Alarm present: ❑ Yes ❑ No Alarm level. Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert O 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.): D Box is 16"x16"-30"below grade W/cover at 6". Inlet tee w/two line's out. Box is clean and solid w/no sign of over loading or solid carry over. t5inap.doc•rev.712612018 Title 5 Official Inspection Form:subsurface Sewage Dispose)System•Page 12 of 18 9t a6ed xed dH 6£:9 6 61.0Z I•Z })0 Commonwealth of Massachusetts uQTitle 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments -l � 38 Appaloosa Way Property Address Jose Quintana Owner Owner's Name information is required for every Marstons Mills MA 02648 10-15-19 page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No' Alarms in working order: ❑ Yes ❑ No' Comments(note condition of pump chamber,condition of pumps and appurtenances, etc.): If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS)(locate on site plan,excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 14 ❑ leaching galleries number: ❑ leaching trenches number,length. ❑ leaching fields number,dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/25/2018 Title 5 Offiael Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 6b a6ed RJ dH 6£:91, 6 X2 2 100 Commonwealth of Massachusetts e Title 5 Official Inspection Form r Voluntary A W Subsurface Sewage Disposal System Form -Not for of tars ssessments 38 Appaloosa Way Property Address Jose Quintana Owner Owners Name information is Marstons Mills MA 02648 10-15-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cost) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil,condition of vegetation, etc.): Leaching is 14 infiltrator's(two row's of seven units ea. row)Ck D Box and camera out lines. Units are clean w/no sign of over loading-solid carry over or holding water, 12. Cesspools(cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth —top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.): I t5insp.0oc-rev.7126/2018 Title 5 Officuai Inspection Form:Subsurface Sewage Oisposal System-Page 14 of 18 0g abed xed dH 6£:9 6 6 1,0E 2 130 cam, Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 38 Appaloosa Way " Property Address Jose Quintana Owner Owner's Name information is required for every Marstons Mills MA 02648 10-15-19 page. Cityfrown slate Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7M/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 6S abed xed dH E£:9 6 6 60E 2 130 Commonwealth of Massachusetts Title 5 Official Inspection Form ..UW fl� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 38 Appaloosa Way Property Address Jose Quintana Owner Owner's Name information is required for every Marstons Mills MA 02648 10-15-19 page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building.Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately I t5insp.doc-rev.7126=18 Title 5 Official Inspection Form;Subsurface Sewage Disposal System-Page 16 of 18 Z5 a6ed xeJ dH Z£:9 6 61,OZ 2 100 Oct 10 19,01:28p Capewide Enterprises 508-4774977 p,3 TOWN OFBARNSTABLE LOCATION ?S Ap_U, j\raS& SEWAGE@ e701D�'ZbS VILLAGE, i ASSESSOR'S MAP&PARCEL INSTALLER'S NAW&PHONE NO. -,2pw P.,4••dr" 7 SEPTIC TANK CAPACITY 1jCne._ � ! - LEACH NOFACUM:(type)gl'pwlsL'f#rCvtC 0 (*A) 30,E "� 1•g3 NO.OF EEM0016 3 Ow'INPR (ym&(SS,Q4A PERMIT DATE: `%i- ZC to COMPLIANCE DATE: 8`2 Sepatawo Dideoee Bdarew dw ,Mh)daxLUAdj WW OMMAWaterTW9 tO the Batotn of t=bi%Pacilitj Fed Ptivate Weer Sappy Well NJ Leads Fecilitr Ghm we:b awl m site cr within M fa:of leach itsl.(WAY) red FAge of Wsdand and Lmchiog Facility(if aq WOKMIe exist widen 300feet of leadlmg it iliry) Fxc RJS2NISe�y HY Cps:✓� r�'NA'�SLS �•`� I It i p i4S �e.i £5 a5ed Y2J dH ZE:9l 660Z 2 100 f c Commonwealth of Massachusetts Wall Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ' 38 Appaloosa Way Property Address Jose Quintana Owner Owner's Name information is required for every Marstons Mills MA 02648 10-15-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells 0 11' Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked,date of design plan reviewed: 7-2-10 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: T.H.on Design Plan 7-2-10 11'no G.W.. Bottom of leaching at T-8"below grade. Bottom of leaching at 17 4 above T.H. Depth. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5lnsp.doc•rev.7/612018 Title 6 Official Inspection Form:SubsuAace Sewage Disposal System•Page 17 of 18 b5 a5ed xe� dH W9 6 6 1,0E 2 100 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 38 Appaloosa Wa L Pp Y Property Address Jose Quintana Owner Owner's Name information is required for every Marstons Mills MA 02648 10-15-19 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed&Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4(Failure Criteria)and 6(Checklist)completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included dlVVW e#IA, a r "r U�r t5lnsp.doc rev.7/2612018 Title 5 Official Inspection Form:Subsuftce Sewage Disposal System•Page 18 of 18 55 a5ed xe� dH H:9 6 6 XZ 2 100 Town of Barnstable. P# 12 V 5 °t Department of Regulatory Services ' Public Heaijh Division Date KAM 200 Main Sweet,Hyannis MA 02601 A. Date Scheduled 2 ITime /__X,?A1 Fee Pd. Zd2, Soil Suitahil' Assessment for Sewa e. osal Porformed By: &� /C QWitneased By l LOCATION& GENERAL INFORMATION Location.Address p �i, ���5�f Owner's Name pA�/ll L/!t /S SIet� Address38 Aocr��su Gj,.,�/4s55b►�rs rlls Assessor'sMapffl4rcel: w_ �„ Engineer's Name �/N ?�� NEW CONSIRU '[70N REPAIR �i r- re Telephone* 60 Land Use S( ` Q �, Slopes(%) Surface Stones !'Yl Distances from: ripen Water Body ft Passible Wen Area ft Drinking Water Well — ft Drainage Way ft Pmpetty Line Z ft Other ft SKETCH:Oft et name,dimenaiodeof lot,exact locations of t;t holes at perm:test locate wetlands in proxitaity to holes) I . /Z (I Depth to sedmek / ,v Parent mawxial(gedtr►glc)����� � h I - -- Depth to C mxmdwa*. Standing Water in AOIe: /`� Weeping hom Pit Fatx r Estimated Seasoud thigh Groundwater D TION FOR SEASONAL HIGH WATER T'ADLE Method Used: r I _ Depth G;'hpwad stindingi1n obs.hole: ��� in. Depth to aall etottlea:.,_ + in. Aroun�dwhter A uattttatt • �t/o,tw,eeping from side obs.hole p A .Grotrndwater Level.,.�Q�i Index Well it Reading Date: Index Well levdl Adj.fAftf •L PERGOLA ON TEST - Date :2--/PT4w24-&" Observation# Tiitte att 9" Hole .-.---- 7� /�� � 71me at 6" Z..d 3 .-..•----- Depth of Peru: D 0:0 'lime ' StartPrr;samaT<'[itne.C� • _ ; End Pre-soak .� . I Rate Mm./hnch Site Suitabifity pssesstnent: Site Passed 1� Site Failed; Additional Tesdng Needed(YEN), _ Ori •nut::Public He�ltlt Division Observation Hole Data TO Be Comple i� ted Olt Back--- ***If pe�la "test is to be conducted within 100'of wetland,you must first notify the Barnstable Ciservation Division at least one(1)week prior to beginning. DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil ' Other Surface(M.) (USDA) (MI11141) MQUIMg (3t1MOW%SWMes,Boulders, ------------------- 5.-a Iwo %v y 2. d DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in'.) (USDA) (Munsell) Mottling (Structure,Stones.Boulders. Consistency. S 477 � DEEP OBSERVATION HOLE LOG Hole# Depth from• Sal Horizon Soil Texture Soil color Soil ' Other Surface(in.) (USDA) (Munsell) Mottling (Structure.Stones,Boulders. DEEP OBSERVATION HOLE LOG Hole# Depth from Sal Horizon Sal Texture Sal Color ftl Other Surface(in.) (USDA) (Munsell) Mottling (Structure.Stones.Boulders. Flood Insurance Rate Mai): Above 500 year flood boundary No— Yes Within 500 year boundary No-Z Yes Within 100 year flood boundary No Yes Depth of Naturally Occurrine Pervious Material Does at least four feet of naturally occurring pervious material exist.in all area observed throughout the area proposed for the soil absorption system? ,. 4 Q If not,what is the depth of naturally occurring pervious material? Certification a date I have passed the soil evaluator examination roved by the I certify that (date) p approved Department of Environmental Protection and that the above analysis was performed by the consistent with the required training,expertise and experience described in 3:10 CUR 15.017. Signature Date -7- ���a TOWN OF BARNSTABLE LOCATION ��8 A� � pOSA SEWAGE# ;�011D -Z.2'� VILLAGE ASSESSOR'S MAP&PARCEL %7 (� INSTALLER'S NAME&"PHONE NO. C"i A.)Je S',y�;4,a%1 g t �-r — SEPTIC TANK CAPACITY C o �A,o LEACHING FACILITY:(type) S l oo eieCS 1 t/nc, (S) (size) NO.OF BEDROOMS OWNER &Jol e� l,oMlh ( .SS f o•1 fi, PERMIT DATE: 20 t0 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility d // 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 C�!,f �,rJ !©`�`S"eS Luc A /I�z &3 5�z AT �1 3v�J ,34 S-a 13 No. '2m-.L Fee �Q© THE COMMONWEALTH OF MASSACHUSETTS Entered incomputee-#_/ PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Application for 33t5po5al �&p5tem Cow5truction Permit Application for a Permit to Construct( ) Repair k) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. A Pi L oo$r9 L. 0-- , Owner's Name,Address,and Tel.No. �L d o)r k (e ryj rrr��S ice. c' (Q t*I-L ✓�1.A 2 5 izr--,) OO Assessor's Map/Parcel 7 +�>< 2� a x 3 Installer's Name,Address,and Tel.No..C�,I�,�•L� � )c, Designer's Name,Address and Tel.No. t)4 C Fit, Iv�-� 5 LL, , Type of Building: / Dwelling No.of Bedrooms Lot Size `,, sq. ft. Garbage Grinder ( ) Other Type of Building 5 �b trm. `3 No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(mir.r7,W uired) 3 3 gpd Design flow provided �� gpd Plan Date '7 ' t Number of sheets Z Revision Date Title Size of Septic Tank (O OO Type of S.A.S. .5 (U)-L1113J Description of Soil INS L ?-L -' 3 Nature of Repairs or Alterations(Answer when applicable) A)et j 30—��x no c J Date last inspected: '7,a 1© Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Signed Date —7- 2-c Z� Application Approved by Date `?— 2 9—to Application Disapproved by: Date for the following reasons Permit No. 2 0 10 —,2.2 � Date Issued 7—J 9-/O g h �,NO. ���0 �� f Fee f 0G THE COMMONWEALTH OF MASSACHUSETTS Entered in oomputer> PUBLIC HEALTH DIVISION -TOWW6F BARNSTABLE, MASSACHUSETTS Yes ZIpplication for �Bigoal *Vfstent Construction Permit Application for a Permit to Construct( ) RepairY—) Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. 3$ A PPA Oo$9 Lr, Owner's Name,Address,and Tel.No. /2v dQ)r k CO ry7 p9,S3 i, Cu t'4 I t> vi.t Alz$rum-+) M .I Assessor's Map/Parcel 1-7 /) C! f / � Installer's Name,Address,and Tel.No.Col Z •� �� �'1 Y� Designer's Name,Address and Tel.No. v�4 ►qT/o 0q t.'�'5 C ?-yz �Z, rt�l G Ya✓�(. t l.. vl/tM Type of Building: Dwelling No.of Bedrooms Lot Size `b, Z� l sq. ft. Garbage Grinder ( ) Other Type of Building y No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.r720/.t, uired) 3 3 �o gpd Design flow provided 3 5 •7 gpd �Plan Date l Number of sheets Z. Revision Date Title Size of Septic Tank 10 00 Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) A)&J 3)—a--9 1 b Z 5 Date last inspected: Zoto 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 Certificate of Compliance has been issued by this Board of G Signed Date �' 2 ` , 2— C� Application Approved by VV, i ,� Date Application Disapproved by: Date for the following reasons Permit No. 2 o(p — :2 Date Issued /U ! _==_---------------�: ----------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CE IFY,that thee�On-site Seyvage Disposal System Constructed ( ) Repaired P11-1) Upgraded ( ) Abandoned( )by .r49AA) 6C t ��lf—��w'�Qy )t) at P VV3 has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. ?u l 2 dated Installer -AUJI -C 1')C) Designer #bedrooms 3 1 Approved design flotv gpd The issuance of thi pe it shall not be construed as a guarantee that the system wiio as de ' ned.n,� Date t ll Inspector No. ?Oa u .22 i Fee I!G THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS M.5poot 6p!5tem Construction Permit Permission is hereby granted to Construct ( ) Repair X) Upgrade ( ) Abandon ( ) System located at 3 e ti )oaS and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. n Provided: Construction must be completed within three years of the date of this Date "7 — 2 9 - /� Approved by ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments A loo r,✓� Property Addr ss 0 ✓vlriI 06,1 Owner Owner's Name /' information is ��✓S I Q HS /� /j'l� Oa 6 q� 6a J /0 required for 7 every page. City/Town State Zip Code Date o Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information When filling out \ forms on the \ computer, use 1. Inspector: 4 only the tab key to move your cursor-do not Name of Inspector use the return � ,�//V�0 key. Company Name Company Address CGS f tig wt City/Town State 0 Zip Code 508 �J Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ❑ Passes ❑ Conditionally Passes Fails ❑ Needs Further Evaluation by the Local Approving Authority o Inspect is 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. 15ins-09108 Title 5 Official Inspection Form:Subsurface SewagTDI,posal Sy jil- age 1 of 17 Commonwealth of Massachusetts 1 .;U Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address r,0t41101ISS�00 Owner Owner's Na:��K�2 // / �J information is ,/ -� Od L`7 9 d l fv required for every page. City/Town State Zip Code Date of Ins ection B. Certification (cont.) j Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 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): l5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 61 Property Address 01^1v11/Ss/0V? Owner Owner's Name L � information is ��r-S TO ys / "�///-�W Qoj 6 required for every page. Cityfrown State Zip Code Date of Ifispecdon j B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will if with approval of Board of Health): pass inspection ( pp ) ❑ 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 15ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments p s,--\ W � Property Address co k-7 k4l I Owner Owner's Na J /�/� information is required for 741-5- fq0 s= - 6 a1 1V every page. City/Town State Zip Code Dat of In pection 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 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 ❑ 0 Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ❑ Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow 15ins-09/08 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 3 Property Address !/v1!M t ©N ej Owner Owners Name � information is ����5 N f 2 S required for every page. Cityrrown State Zip Code Date of nspec on 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: . ❑ C/ 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. ❑ 2 Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ [B""" Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ L' Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA)or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•09/08 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 4 o C, ('i✓� Property Address �v"1�'`'1lSSlo � Owner Owner's Name / information is required for q 0,2 6 V'.O' /off/LAP every page. Cityfrown State Zip Code Dat o Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No Pumping information was provided by the owner, occupant, or Board of Health ❑ Were any of the system components pumped out in the previous two weeks? ❑' Has the system received normal flows in the previous two week period? ❑ Have large volumes of water been introduced to the system recently or as part of this inspection? Were as built plans of the system obtained and examined? (If they were not available note as N/A) ❑ Was the facility or dwelling inspected for signs of sewage back up? ❑ Was the site inspected for signs of break out? ❑ Were all system components, excluding the SAS, located on site? ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ❑ Existing information. For example, a plan at the Board of Health. �❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flaw Conditions: Number of bedrooms (design): Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments Property Address Cor✓lN9rSSlvH Owner Owner's Name J- /�f p information is uired fori/�G�r.S7�Hf / l ( Oo�6�0 fo �-I/z b every page. Cityfrown State Zip Code D teof Inspectionspection D. System Information Description: ('D rl) l 4l, on' �6 ::aL L4le- Number of current residents: Does residence have a garbage grinder? ❑ Yes No Is laundry on a separate sewage system? (if yes separate inspection required] ❑ Yes 2 No Laundry system inspected? ❑ Yes Er-'No Seasonal use? ❑ Yes R No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes No C"Y/�r�� Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: 15ins-09106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address vv�wl�sS'�ov► Owner Owner's Name information is required for �ol to�ao a every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes e--Ii If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: (]/ Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other (describe): t5ins-09/08 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form NEW Subsurface Sewage Disposal System Form -Not for/Voluntary Assessments Property Address r__0 N4Yllrsrph Owner Owners e information is required for every page.a e. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all comporients date installed (if known)and source of informatioIP: Were sewage odors detected when arriving at the site? ❑ Yes 2- o� 9 Sewer(locate locate on site plan): � I Depth below grade: feet Material of constructi;-40 ❑ cast iron 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): n // Depth below grade: feet C��I Material 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: Sludge depth: t5ins•09/08 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 Property Address Co 01 lv"?I gs/0 1., Owner Owner's Name information is rf��S /�s f ©d 6 4 ,9 Zvi o2/ D required for every page. City/Town State Zip Code Date of firspectfon 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 4 W-74; , How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): / // o C ( �i�✓ Q�� �-PG�s 1✓1 Gj�o o✓► / /old� 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•09/09 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 Property Address coIMWIISf/o h Owner Owner's Name �/f information is /"/ars?oy S /''/� required for every page. City/Town State Zip Code Date of Inspec'on 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 l5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments //Jti�OoS�, G✓G!/1 Property Address C"Ok"vit-11 Owner Owner's N7W'eT,,.54vv,-r /�J,(information is /S / '/7` �a� required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): //0 Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: l5ins•09/08 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 /OOSa t v✓r Property Address r— 0f.1Ol $10.1 Owner Owner's Name information is /// y'�vNS A � � al required for State Zip Code Dale of I s ection every page. City/Town P P D. System Information (cont.) X Type: / leaching pits number: ❑ 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.): i #41 C4 1, /t C 1 /11,"' 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•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form •Not for Voluntary Assessments /a 05'e, t, Property Address Owner Owner's Na7/;Vll information is "s- hs �/S �o ���required for /_, �/01/ I� every page. Cityfrown State Zip Code Date 6f Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•09/08 Title 5 Official Inspection Form: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 Property Address 0WlMCSS ON Owner Owner's Name information is arS�N required for ' every page. Citylrown State Zip Code Date of In ection 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 ✓/Z—, ' �3 S� 15ins•09r08 Title 5 Official Inspectlon Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts AM Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 't �U � OOS 1.✓G Property Address Co 1,*' 0 I'l Owner Owner's Name �( information is /��f's �/1 © 02l required for State Zip Code Date of I s ection every page. City/Town P P D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells — Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) Checked with loc oard of Health -explain: 14 m S 4- /-PS /yo 1�1' ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: .1f .SS s s ovE (cv L',V1 C(Ira ^ Before filing this Inspection Report, please see Report'Completeness Checklist on next page. t5ins•09/08 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 C, loos r, Property Address ro VVI JV?/1S/ o Owner Owner's Name l information is �57�7 f 1-411 40f'1nsp6cfion required for every page. Cityfrown State Zip Code Date E. Report Completeness Checklist Inspection Summary: A, B, C, D, or E checked Inspection Summary D (System Failure Criteria Applicable to All Systems)completed D--'-S-Ystem Information-Estimated depth to high groundwater Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 5t."64 FAMILY 13EVVW M 149 9S. No 6A95AE-F- &POEK :..VAIN,-(- FLOC/ :61AVs.,3 144 SEPTIC TAIJILz a30A % Zor Ate DISPOSAL PIT --1•IVCp dA4- A +� I 51DEWALL APr=A = lWFF 'BOTTOM A264 - SIJ -SF I !r /� / OA 1depD, , � TOTAL DAILY Flp1t/ +' �U Au�uu 8f ame, Stet P9 or RtCHAR0 PETER 1 l BAXTER SULLIVAN / Wo.2�oaa .'.� •" � � N0. 29733 ~ . �SYpNA ENe� O / Tr5 Sd�Sat. 144 14 y�, do �. 5 . ,w. 2 iur• dKT �►+r pie b S�tLIC 'ma's lam iwr wsa BqK W+{ T�Nrt AL L.J. r G ,�11/���j,7 I i 3'�(VZ AtL 5mm�) 61ET �rONE MOM 11 W 4�aeP FaW 9 c Sea w- �o SL- OW, '� 1� aazA 4+ 1 CEVnFy 'T}I r THE � FLA Q' t�wsua+�� %0w N HezeoN c-Dmrc.Y S wrrN liAf- 51p1ELJQF- LvT I f- Mtn. 4 T4(C INN of SAA►A"z nL law. 43q P� . 1-7a+1D 15 vf-:L 0"TvD w1-ralu T14E tuoo m,&I",4 '5A xYL/ ig NYE ING p�55ra.ld� �AU'b Suev�/arzS 74K RAW IS NOT- :�3A�;p aJ tiN l gKTi'-XjFVT" d c-�G�N EEtr,S Sull y AIJD fNE Af SerS '�l�Vt�1..D Uv1' Be 0 >MrzvIu.e MA44 , r . uS�D to EsTti�8�.lsr-� Przo�e�.Ty r.�Nis dPPL I r A N'T'; TA-YSMe IVIV ►►6 Goo (aL, i Town of Barnstable "E Regulatory Services Thomas F. Geiler,Director Public Health Division °1 Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form Date: 0 is'—Z. /0 Sewage Permit# �10/0- :5-.Z,,�-Assessor's Map\ParceI 17' /XZq J()(,30 Designer: Installer: Z!F4* L°.f Address: -31.0 �0k11A14:9 1 Address: �� Aw 76.3 On 0 7-.2?/U 5ok40-C*S' was issued a permit to install a (date) (installer)���� septic system at ✓d �n� 100 ! c�kq based on a design drawn by rf�� (address) ,4"t, Z. !/D<9 /`�W /Fs. dated (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. _,N0 FAf48 sq z AW VON HOME (Installer's S ture) v #1068 SgN,TARP (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:HeaWSeptic/Designer Certification Form 3-26-04.doc FEE No..1.,,�� .....- _/�d...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Diti-Vai3al Workii Towitrnrtinn ramit Application is hereby made for a Permit to Construct ( V) or Repair (' ) an Individual Sewage Disposal System a 11 at \dds ^ or Lot No.-- -----._... wneti"y-` !�"` �-------Address ........_--•--- ... • ----- Installer Address / / Type of Building �,/. Size Lot...&V �'i(�?_.....Sq. feet ,., Dwelling—No. of Bedrooms--------_h_ --.--Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Buildiiio��t&_ _-a No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures ---------------------------------- dnn --p,-�--------------- - W Design Flow.......................�/_!�-._r____--gallons per j, � per day. Total daily flow------.---/V..__....___._.._.__._._._gallons. WSeptic Tank—Liquid capacityi6 gallons Length_.............. Width---------------- Diameter...-- .......... Depth................ x Disposal Trench—No. .................... Width______._-.____-_--_- Total Length----------------_--- Total leaching area....................sq. ft. Seepage Pit No..................... Diameter____.__.......--_--_ Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing taAk ( ) '~ FQ Percolation Test Results Performed by. Date.------_!__.� _.� .............. a ,-. Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water..................... 0-4 Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water........................ ....._ -----•--------- -------------------•---------------------------•--•-......................................................... 0 Description of Soil.... _ ._..._ __ �lslt_______________ x W -------------- -------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------••-- VNature of Repairs or Alterations—Answer when applicable................................................................................................ ..------•-•---------------------------------------------•--•------------------------•---•-----------------------------------------------------------------------------------------------••-•••.._...._.. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The un ersigned further agrees not to place the system in operation until a Certificate of Corn Iance s b iss>�Ied b the board of health. Signed .. ------------ -------------------------------------- Dace Application.Approved By .... -.. .. - -^ .--- ---------------_ lce Application Disapproved for the following reafons: ............................................._..............................................._ ------------------------------------------------------------------ ----------------------- ---- -------------------------------------------------------------------------------------------- ------------------------------------- Dace Permit No. s...-... .................. Issued ..... -..... ."- -p `9.1° .............are 7 - - No.._.. ,... ,...! FE&.................o...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Apipfiratiutt for Diupuua1 Workii Tatuarurtitun Prrmit Application is hereby made for a Permit to Construct ( V) or Repair (' ) an Individual Sewage Disposal System at: C(_._..1�G'.�,�-------------------------= C ....._ .. (6ft ation-Addri�s^�^ /�_ or Lot No ------------------------------------------------------------.................---......•-- Address �......... ............. - � .............Installer Address ` `�� Type of Building r Size Lot... _/_.�.._______l�___....Sq. feet U Dwelling— No. of Bedrooms._________ ___ __ --_.-Expansion Attic ( ) Garbage Grinder ( ) U aOther—Type of Buildiug�N,,JJ"Gil-�. t 'No"of persons---------------------------- Showers ( ) — Cafeteria ( ) Otherfixtures .. r,5--------------------------------------------- ---------------- --------••---••---•-•-----•----------•-- W Design Flow.......................//A.........__._gallons per p ,scan per day. Total daily flow........y_Y0.._______.___.........__gallons. WSeptic Tank—Liquid capacity./5 -gallons 'Length---------------- Width__---._-__. -- Diameter_------------- Depth................ x Disposal Trench— No. .................... Width--------------------- Total Length-------------------- Total leaching area....................sq. ft. Seepage Pit No-------------------- Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing t qk ( ) `" Percolation Test Results Performed by. -• Date r a a Test Pit No. I----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.-.-___--_.___-_---. Depth to ground water........................ r x �.� O Description of Soil...... - ---... U --------------------------•------ ' x -- ---•--- y - ------...-------------------------------------------------•-----------------------------------------------------------------------------------•-•-------•-•-----•-•---- W U Nature of Repairs or Alterations—Answer when applicable.........................................__.___.__._..._....._.............._____............__. --------•-------------------------------------------------------------------------------•--•----------------------------------------------------------................................................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Comp`rKa-n-7ehas been issued b the board of health. Signed . / �__ -----------------'----! -------......... .................................:...... Date Application.Approved By .......... ~"`_ `s------------------_--------------- ~Date: Application Disapproved for the following rearonf- ------------------------------------------------------------------------------------------------------------------------------ ------------ ------------- .-..-.-..--.----- ...-....q..--.....------------------------------------------------------ ---------- --- ------------------...-----..------------------------- ---------- --------.-..... -.. Permit No. ........... ..... ...?... . y Issued . .........Due............. - Date THE COMMONWEALTH OF MASSACHUSETTS -BOARD OF HEALTH TOWN OF BARNSTABLE V ertifiratE of Tontylia ce T iS 1/LTO CERTIFY, That th divi 1 Sewage Disposal System constructed ( �) or Repaired ( ) by ----\ ( ------------- -,.f/ ..�Q at 1!"(l1 --— - -------L ?J.�f. ��. hst.net — X ... — —... — — -- has been installed in accordance with the provisions of q ITI.E 5 f The State Environmental Code as described in the application for Disposal Works Construction Permit No. ---_---.. —3 -_ dated _.._._. —1 - THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRU A AS A GUARANTEE THAT THE SYSTEM W l-1 FU- CTI :M SATISFACTORY. DATE... y .. ..- - Inspect r- ------ !/ .�/.I � �� -------------- ----------- ---__.---A ---�,�,----_---_--�--------- ----__,- - - !.----------- THE �l COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE NO....1...,1... L4L FEE_.__.l.............. �inu Turku Tutto#rtiu rutit hereby granted g '`.----- to Construct ( !/�orr Repair (ed) an Individual Se Disposal System /a� / at No...rl .. lC.. -it'�!1•....! !(...... t Street 4 as shown on the application for Disposal Works Construction Permit No._ J3y� Dated ... `�.4:.............. PP P V t DATE----4< ..................................... l/ Board of Health FORM 36508 HOBBS R WARREN,INC..PUBLISHERS ZJE719 a `DATA VFW S! %64 FGIIw 3 . MIS No 6A�A�"E CyR1►JDEJZ �s ' :..V.AIL--(- FLOW sE?rl c TaNV.,_ 30 n �I, . �ern.. � �.. . .-�� � ., : r -� y•' ,`�, . DISPOSAL PIT 14-1poVdA - ASTOW& 51DEWALL AREA ='WI>r ` 0 BOTTOM AQF _ S� 1 j I r 7.3 / 0 Tf�TAI_'Uc�I6N = � 6i3+• � � I�vs � TOTAL MAIL- ; FUYV s 30 : !�I PEIZGOL.AT1ON �M ac100 Imw/I 1f4 D A( �QI, Y► r RtCHARD `��;. PETER I 1 e1� SULLIVAN �' t Na 21048 + No. 29733 ~ i q oNA too ' t --, W✓ 145 Sdv�6a�► ,�," ,lkl. 2� � �Wr� °KT uab Sq��1L'IC "M's 1� iwr v wlda 9oK I44+1 TARE 1 AL M1D -3 1 z w,Iti�� �T•0111: MOM T14W 4 VOW lsPlw GiI�B &4&L %& A-7.o . � �' --•� O' r14 F'LI_ 1�23 It IX 90 C.OZrPED RAW 15 SL-119 44 wf (:4 RAW" 4" 11495 LAN � ¢E�/� '�►'``�to i cF.mT-Y 'CHAT TKE L oT Me toOW W KE►ZEoN CDA4r .5 wrrA lvf- 51Pp�ELJNE P..EQ. 0r ' !4(C TAN OF 15AAN*rlw%4 121, Bwc 4.%q P& . 17 441D 15 Df,L-044TV WI-ra1d TUE Vt40D ttW",4 pxvc-',. 3 I.q r G ��-__. 8A XTLr/_ 4. AYE INC PPDFE' f0644L LAft SuZVEyoZf 719K FLA Q 15 NOT- :�A<,p C*4 AA 1 tKT¢MFVr c�.,i� 4 0,1e l N U 5 SulzvC�f AWD rN F- 'OWS er 44001..D U Ur VS 51E2v i u.E MA,! . ul Cm To e%Aeu-5k Finarawry u wei I ,dPPL1 cA N'T"; '$A•ySmD! 'Bwca►ui r - �5 xa ? , x 130 �ATa opeN 5 Ppl.E- 51k6jFArGLJW $�n�c. c 6A>zF3AC�E Gf�Ii�ER. FLoW , = ms` DtS?06AL PIT !-lamd- 1 MV >< brt,69 51DF-WALL AAA = l5llO;F BOTTOM AZA = S;�> =rF $ I o ' TOTAL tr-6I6N TOTAL DAILY pw PS2¢ V .AT1 oN ¢A-rE /LeloV. OF Tf a RICHARD �r ,' v A. �, A PETER G, I \ > "i SULLIVAN \ No.2aoae ; 'No'29733 APPALPOSA. YED TEST 9�2.g7 yVA�(�e�� T. =146 P V.CWV- 145 . Ap 'SdPlSpL uW• . DKT ►Nr. Iar• 6AL 14 8 Z .. .� I►,r 1 e4 4 11C t V i 11 O o Wd 90iC 14�r1- GAL LQ S ;wl.TTl•t WA49EP Au_5rw4tva*s s�T s'1"ONEMbW WA►J 4:1�kEP Gr138 slat_ -za ' l'td• 'ML_ 1. 2-j IX 30 Cezt"i rL� Ror FLA,4 ! 'PwLl.opt� 'P�zoFIL�-- Loc.�R�oN : LrJem✓x.c N. 1 a o' L� _EGA L_s i' �� VAIV-1 4" {`I IS t% op�os FLAN 'FEREJ�fC.E�t . : : 1 CF.iY P i. TOAT TIDE t>wg&4.Jwt- ' LdT lag %oviw Hezwt4 ( oDmr 5 %urrA *Nf- 51'QEUiIE 40 15 Pf- L-044TED f WithId 'ISLE; rLoOD MAI"'r . . -ct _. .5A XTS 'V— o NYE (WL PP4F -%los44L�A SuP�I `>otzS ' : 70.5 FLA W . IS NCr !i3A�lD . oN .AN L W4-TMXtEl1T f Sutzv j A>Jv rNLr: OR=SeTS : c�ou . v a1'. 0 5TErzv I u.e MAC . uSC-1� To eS'rA t-K Przopeory U wei APFLI C.A NT; 'BkYSM)i "BOW W6 eo (44. I X 80 — -- _ ' ' OP GENERAL NOTES: n M°cgar OPEN x SPACE — — — --, , ` 8 ' � —=�'— _ _�e EN SPACE r saddler L cre0N 8 0:- - _ Q _ - .10' - N 89°29'03" E�- -_ - x 79,03 1. VERTICAL DATUM: Assumed LOCU - 1 82 149.95' _ - -�80 MUNICIPAL WATER I_AVAILABLE. c, 40 m Polyvinyl Liner(EL. 82.0-78.0) _ _ -1 - — , _ 3. �C\HEDULE 40 PVC PIPE TO BE USED THROUGHOUT SYSTEM in HoldeAppr 30.4_x.283'- ` - " x 83,63 �; �82 LINL` SS OTHERWISE NOTED. 84- - a 84:61 8 :. . - - — 4. ALL P EAST UNITS TO CONFORM TO o 6 TH-1 " TH-2 .AST UNITS 0akgt .4b. 1 0 AQ _ -,85.99 8� 5. PIPE PITCH-1/ ER FOOT UNLESS OTHERWISE NOTED. B - ° - " 7 '` 6. ALL CONSTRUCTIO DETAILS TO BE IN CONFORMANCE WITH MA 14 - Lot 125 �8 ace Ln ENVIR. CODE(TITLE 5)AND LOCAL REGULATIONS. '_ - - - a6-- ' 16,289t S.F. - 7. CONTRACTOR TO VERIFY LOCATIONS OF ALL UTILITIES PRIOR TO , 0.37f A� LOCUS MAP N.T.S. \ x 87. 8 x 88.31 8 CONSTRUCTION. :-(-8 6.7 8 Mom,p-174 ASSESSOR'S MAP: 174 x 89,28 - x - Parcel 1/X29&X30 LEGEND: © - a o 87 28 IRRIG, BOX i �x 89,94 �_ 99 ' PROPOSED CONTOUR °` 91 � . 5 £ PARCEL: 1X29 & X30 REFERENCE: PL. BK. 500 PG. 10 SE Tic CO� ' _ 88g� '"� , .` ■ 88.77 99 PROPOSED SPOT GRADE O FLOOD ZONE: C Town of Barnstable I 8,99 ''c 88.88 40 EXISTING CONTOUR #2500010015 C 8/19/85) _ 3 Existing 1000 gal. 5 E: IC8 9�V '73 Tank to Remain i / - 30.23 EXISTING SPOT GRADE I 964 x � / 90 9 0 A 6 x 9 0: 4 a TEST PIT x 1 9 8685 / M ® EXISTING WATER SERVICE 94.94 `� 1 '1 � I I © o WORK LIMIT LINE Regrade to maintain ' I 1.23 I 91:5 Deck X oR maximum 3' of cover o ti over leach trenches. ° W rn ro 1 90:1� ° ti Slab i #384. �r. a �F M,gffq` � OF #Afsq I (Slab) (OF-93.04 0 e - o�� TERRY �y� Assumed o ANN �, / " o WARNER I� 91. 9 �0.06 No. 1068 I No. 38721 Benchmark set: 92_ i Left corner bulkhead I I N NOTE: Pump and backfill EL.= 91.94 Assumed m I 91.59 failed leach pit. 8 9/7'1 �b 90.8 /89:91�p' NOTE: This plan is to be used for septic . Paved ''r,: / — system purposes only and is not to be Drive: '. : 9.89 considered a property line survey. CIS , >`:::•..: .:�:.:- '. :.,`::: ..:::.: .�.. 38 APPALOOSA WAY, BARNSTABLE, MA \ \ : .91.75 V H.: I 8 90.68 =CT/PEDS PREPARED FOR: I A-59 90.83 ' associates W SH � SEPTIC SYSTEM DESIGNS Rudolph & Patricia Commissiong I R. .O 1 92,03 91:64 ; 38 Appaloosa Way 320 Cotult Road LEACH TRENCH OPTION 2: Use 7 Infiltrator Quick I Sandwich,MA02563 5os.a33.00a1 Marstons Mills, MA 02648 4 High Capacity units(H-10)with washed stone: I `92.451 "� 2' ends, 4'sides for 34.4' L x 10.83'W x 0.96' H. I { Total Capacity = 339.94 gpd (459.39 s.f.) s/E ge of pave Surveying by: i 92:37 � �T,35 Terry A. Warner.P.L.S. i B/DH/FND ' H rwichh, MA22 Long R02645 DATE REVISED SCALE SHEET NO. 93.75 9,. , PPAWOSA WAY (808) 432-83W 07/02/10 1" = 20' 1 of 2 I T.O.F.(Full) Provide Riser over D-box #r NOTE:All components to be marked with NOTE:To prevent breakout, install 40 ml. EL.93.04 to within 6"of final grade i magnetic tape or similar prior to final cover. polyvinyl liner 5'off northerly trench. (Cover to be watertight) Top EL.82.0, Bottom EL.78.0. F.G Ex st9gOt !- F.G. EL:89.73t F.G. EL:85.0t Maintain Min.2%slope over leach facility to prevent ponding F.G. EL:84.0-85.0t Install risers w/covers over inlet and y Clean Fill per Title 5 Specifications Inspection Port within 3"to grade Existing Main Line outlet to within 6"of final grade EL.90.21 L=18' (Access Covers min. 20"diam.per Code) Te Natural) Occurring Suitable Sand 4"SCH 40 PVC L=50 Y g �48 Inst lied Per Unit a a 4"SCH 40 PVC 4"SCH 40 PVC Top of Unit/Breakout EL 82.0 @5=21/o(2/oM1 lo, a ia• @S= 1/oMIN) 8^ @S=5%(0.5%MIN) 0.96 Eff.Depth L.85.73 " EL.82.0Bottom EL.8 .54 Install Gas Baffle EL.82.17 `..' `" `' PROPOSED DB-3 EL.81.5 H-10 DISTRIBUTION BOX Use 14(2 Rows of 7 units)Quick 4 High Capacity Infiltrators with End Caps in a 6.84' Watertest for levelness if Trench Configuration set 6'apart L.86.48 (Install PVC Inlet&Outlet Tees) EXISTING 1000 GALLON more than one outlet SEPTIC SYSTEM PROFILE (30.4'x 2.83'x 0.96') H-10 SEPTIC TANK EL. 3.7 N.T.S. Bottom of TH-1 SOIL LOG ADDITIONAL NOTES DESIGN CRITERIA 1. Contractor to confim soil suitability prior to installation. Contact BOH and Design Number of Bedrooms: Existing 3 Bedrooms SOIL EVALUATOR: AMY VON HONE, R.S. S.E.#2517 Sanitarian in the event of varying soils from original-soil test. INSPECTOR: DAVID STANTON, R.S., BOH 11 Soil Type: Class I DATE: JULY 2,201010:00 AM 2. Failed Leach Pit to be pumped and backfilled per Title 5 abandonment procedures. Design Percolation Rate: <3 min/Inch PERCOLATION RATE: <3 MIN/INCH IN C1 w 1 a,� tAY) V1 3. Water Fine to be sleeved at any sewerline crossings and within 10' of any septic Daily Flow: ` 110 G.P.D./ Bedroom x 3• 330 G.P.D. 1 components, as needed, per Water Department requirements. Design Flow: 330 G.P.D. (Min. Required) TH - 1 TH - 2 ��.� _ 4. Contractor to verify elevations of Tank Inlet and Outlet inverts. Outlet invert elevation EL.84.7 EL.85.49 � Garbage Grinder: Not Allowed establsihed from water elevation in tank from inlet end during field survey. Existing Fill Sandy Loam septic tank and tees passed inspection on June 21, 2010. See Inspection Report by Leaching Area Required: (330)/0.74 = 445.94 S.F. 18 83.2 I, 1oYRa/2 Envio-Tech. 5„ 85.07 Septic Tank Required: 330 G.P.D. x 200% =660 G.P.D A 5. Distribution box to be placed on 6" crushed stone or compacted, Level base. Sandy Loam B Minimum 1000 Gallon (Existing) Sandy Loam 10YR2/2 10YR5/8 Use 14 Quick 4 High Capacity Infiltrators in a Trench Configuration: 20" 83.03 26 83.32 (H-10.) 2 Rows of 7Units Each with End Caps: 30.4'x 2.83gx 0.96' FL B C1 00R PLAN Effective Leaching Area: Sandy Loam 10YR5/8 Fine Sand w/Stones N.T.S. 7.93 SF/LF x 4.0'/Unit= 31.72 SF/Unit (Per DEP General Approval Letter) t 38" 81.53 2.5Y6/3 14 Units x 31.72 SF/Unit= 444.08 SF r Perc C1 4 End Caps x 1.2 LF x 7.93SF/LF=38.06 SF @ Fine Sand w/Stones Bath 74"Bo m 2.5Y6/3 W D Kitchen Dining Design Flow Provided: 482.14 SF(0.74) =356.78 GPD Room PERC RATE: <3 MIN/IN.(C Horizon) 1st Floor Garage 38 APPALOOSA WAY, BARNSTABLE, MA 12"-9"in 6:44 minu s Living 9"-6"in 7:03 minut s Bed 3 V H Room PREPARED FOR: associates 132" " 74.99 Rudolph & Patricia Commission 73.7 126 SEPTIC SYSTEM DESIGNS p g No Groundwater Observed No Groundwater Observed Bath 320 Catult Road 38Appaloosa Way Bath Bed 2 Sandwich, 0 Marstons Mills, MA 02648 508.833.0.0041 2nd Floor Bed 1 1,Amy L.von Hone,R.S., hereby certify that I am currently approved by the DEP pursuant to LWall6In__j Surveying by: TerryA. Warner.P.L.S. 310 CMR 15.017 to conduct soil evaluations and that the above analysis has been et Open t0 Harwich,222 L s�o28as DATE REVISED SCALE SHEET NO. performed by me consistent with the requirements of 310 CMR 15.017. 1 further certify that Below I have successfully passed the Soil Evaluator's Exam on November,1994. " (508) 432-8309 07/02/10 1" = 20' 2 of 2 I 33'-8" 14'-6" 21-311 16'-11" 2 X 2'- "WINDOW 2'-5" 36"X6'-8" DOOR EGRESS 771 k k SHELVES t x_ PLAY AREA ' W W } +z MECHANICAL&STORAGE AREA = (UNFINISHED AREAL_ ---0 'O > �` �. .•'fit 0 .� .� ,-. �._-., � �'_ Lu 3 00 ca »r. N ......................................................... ................................................................. .......... . ...................................................................................................................................... Y .............. ... ... F .. .............................................................. ............... . ..... ........... r J CLOSET 00 1 rye` W x a, m: a O n � ,.73 :. TV AREA STAIR-UP GYM AREA141 wrs t �� i'=.."'^�,�F`F"„""`"',,.q°_K?�.s"�.re.r'�'s'7��,�"b 4��,.."�a.�,l,.�:•�,,..'"'!.^�q`N 35i`.��:'y54 .r`r�i ' _ METER 7-7-e- F. 7 7 7,77 1 '-0" 18'-8" 33'-8" 38 APPALOOSA WAY - BASEMENT REMODEL PROJECT BASEMENT PLAN - FURNITURE / EQUIPMENT LAYOUT SCALE: 1/4" - 1' - 0" Page 2 of 13 33' 8" 14'-611 2�-3�� 16'-11" 2 X 2'-3' WINDOW 2'-5" 36"X6'-8" DOOR C EGRESS E p :$? ,f:,5':-" ,t'"'"•-`,=�....*Jr-r': i^" "':F'i r.-+1#'-:r,#'3d ed"3�.�"�.f:::a",!? rl'.c�'. Q}'tl" � `"'4a+" i'.'%4 a"`mz: ,�v.+x... t k4 1 Y.r.: 'i�'.`A'':'�.f,.rc Y -4 19'-2" 13'-8" B PLAY AREA OFFICE AREA MECHANICAL&STORAGE AREA B �* (UNFINISHED AREA) r, M CLOSET U/STAIR NVAC 0o Girder N ,`,� WATER BOOSTER PUMP ............ ............................................................. ........................................ .................................................... .......................................................................... .. .... .... ...... .... STAIR UP / Box-in 3 1/2" Dia.Stl. Post ....\ 1D WATER EATER fie. A TV AREA GYM AREA .k ` 15'-0" 17-6" A D1 ELECTRICAL PANEL D1+j OF WATER METER D C 15'-01' 18'-811 33'-8" 38 APPALOOSA WAY - BASEMENT REMODEL PROJECT BASEMENT PLAN - WALL FRAMING SCALE: 1/4" - 1' - 0" Page 3 of 13