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Home My WebLink About0041 BARNICLE DRIVE - Health 41 Barnicle Drive Marstons Mills P A = .'057 057 - - - ' Commonwealth of Massachusetts S7Z A Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for'Voluntary Assessments 41 Barnicle Dr Property Address IU Jill Mecley Call Owner Owner's Name O? information is required for every Marstons Mills Ma 02648 10/11/16 page. City/Town State Zip Code Date of Inspection ry G] 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:When filling out forms A. General Information_ on the computer, use only the tab 1. Inspector: key to move your cursor-do not Michael DiBuono use the return Name of Inspector key. DiBuono Sewer and Drain G:l Company Name 8 Johns path Ida Company Address S Yarmouth Ma 02664_ _ City(rown State Zip Code 508-364-9587 S103522 _ 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 10/13/16 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 1 D�w Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 41" Barnicle Dr Property Address Jill Mecley Owner Owner's Name information is Marstons Mills Ma 02648 10/11/16 required for every page. �.'; City/Town State Zip Code Date of Inspection B. Certification (cost.) 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 31.0 CMR 15.303 or in 310.CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System contains a 1500 GI septic tank as well as a concrete distribution box and 3 500 gl concrete chambers in stone. 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): 15ins•3/13 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 41 Barnicle Dr Property Address Jill Mecley Owner Owner's Name information is -Mars Mills Ma 02648 10/11/16 required for every page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): - ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health).- broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation.by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form JSubsurface Sewage Disposal System Form - Not for Voluntary Assessments .e 41 Barnicle Dr Property Address Jill Mecley Owner Owner's Name information is required for every Marstons Mills Ma 02648 10/11/16 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates,absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) . System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool E ® 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 '/2 day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts o Title 5 Official Inspection Fora, Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 41 Barnicle Dr Property Address Jill Mecley Owner Owner's Name information is Marstons Mills Ma 02648 10/11/16 required for every page. CityrFown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed:pipe(s). Number of times pumped: ❑ 1�j Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ Z Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ 0 Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ IN Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ lZ 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.] ❑ FM The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ i� 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwea9th of Massachusetts., Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 41 Barnicle Dr Property Address Jill Mecley Owner Owner's Name information is required for every Marstons Mills Ma 02648 10/11/16 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: 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 Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface. Sewage Disposal System Form - Not for Voluntary Assessments 41 Barnicle Dr Property Address - Jill Mecley Owner Owner's Name information is required for every Marstons Mills Ma 02648 10/11/16 page. CityTown State Zip Code Date of Inspection D. System Information Description: System contains a 1500 GI septic tank as well as a concrete distribution box and 3 5000 gl concrete chambers in stone. Number of current residents: 2 Does residence have a garbage.grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 218 Gpd 9 ( Y 9 (gP ))� Detail: Sump pump? ❑ Yes ❑ No i 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: !Sins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts _- Title 5 Official Inspection Form y Subsurface Sewage Disp osal posal System Form Not for Voluntary Assessments 41 Barnicle Dr Property Address Jill Mecley Owner Owner's Name information is required for every Marstons Mills Ma 02648 10/11/16 page. City/Town 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: 10/13/14 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts R Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 41 Barnicle Dr Property Address Jill Mecley Owner Owner's Name information is required for every Marstons Mills Ma 02648 10/11/16 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 15 Years Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sawer(locate on site plan): Depth below grade: 2.5feet 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.): System is vented at the roof Septic Tank (locate on site plan): _ Depth below grade: 2feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 1500 If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge dept-i: --- --- ------- - t5ins•3/13 - Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 official In Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments a, .41 Barnicle Dr Property Address Jill Mecle Owner Owners Name information is required for every Marstons Mills Ma 02648 10/11/16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 24 Scum thickness 3" Distance from top of scum to top of outlet tee or baffle 42 Distance from bottom of scum to bottom of outlet tee or baffle 1" Sludge stick How were dimensions determined? p? Tape Measure Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): No evidence of Ieaking,Tees and or baffles in place at time of inspection Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene El other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 • Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 41 Barnicle Dr Property Address Jill Mecley Owner Owner's Name information is Marstons Mills Ma 02648 10/11/16 required for every _ page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tees are in place and levels are normal. Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: -- Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other. (explain): Dimensions: - Capacity: — gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm.level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): `Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 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 41 Barnicle Dr Property Address Jill Mecley Owner Owner's Name information is required for every Marstons Mills Ma 02648 10/11/16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert level and at normal level Comments (note if box is level a!�nd distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out cf box, etc.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t51ns•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 41 Barnicle Dr Property Address Jill Mecley Owner Owner's Name information is required for every Marstons Mills Ma 02648 10/11/16 page. CityrFown State Zip Code Date of Inspection. D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 3 ❑ 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.): Signs of carry over in Dbox. No signs of hydraulic failure Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): , Number and configuration ---- Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool — Materials of construction - Indication of groundwater inflow ❑ Yes ❑ No 15ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts U _ Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 41 Barnicle Dr Property Address Jill Mecley Owner Owners Name information is required for every Marstons Mills Ma 02648 10/11/16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): No ponding no break out 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 41 Barnicle Dr Property Address Jill Mecley Owner Owner's Name information is required for every Marstons Mills Ma 02648 10/11/16 _ page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts j _ _ Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 41 Barnicle Dr Property Address Jill Mecley Owner Owners Name information is required for every Marstons Mills Ma 02648 10/11/16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 10+ ft feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed. 6/28/01 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: Test hole data on plan Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Assessing H,s-tsulll uaras rage I_or I rotf^� `' yl TowN OF BARNSTAB E LOCATION !� 1 'L1 SEWAGE# oS`7 TILLAGE ASSESSOR'S MAP&LOT�, 7 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACII.I'I'Y_ r— NO.OF BEDROOMS �[ 13UII,DER OR OWNER PERMITDATE: COMPLIANCE DATE:�T ! A 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 teaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by i I http://www.town.barnstable.ma.tis/assessing/HMdisplay.asp?mappar=05705 7&seq=ll 7/18/2012 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 41 Barnicle Dr _ Property Address --- Jill Mecley Owner Owner's Name information is required for every Marstons Mills Ma 0264'8-': 10/11/16 _ page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ❑ Inspection Summary: A, B, C, D, or E checked ❑ Inspection Summary D (System Failure Criteria Applicable to All Systems) completed I ❑ System Information— Estimated depth to high groundwater ❑ Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file I t5ins•3113 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 17 of 17 „ Y�. 4^'i'T .' 1v' Yi'N"- "Y'X+. +• .•.w T. ,�iv. „!�„{ Y55. ^�F ..q �.' t,,,1_ a S �, . . t, YZa TOWN OF BARNSTAB 'E �/ LOCATION .;��'= .: SEWAGE # o `7—; . LAGE '-C:�'P / ASSESSOR'S MAR & L S-7 ', T� s INSTALLER'SAME&PHO :N NE N0 �P - �Y�”` : � SEPTIC TANK CAPACITY C. " size LEAC' G FACILITY: ) ( ) �. (tY NO.OF BEDROOMS . ;BUII,D„ER QR'OWNER r - i.`J ' A9/d PERMITDATE: - COMPLIANCE DATE; Separation Distance Between the: . Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet ..;: Edge of Wetland and,Leaching Facility (If any wetlands exist . Feet within 300 feet of leaching facility) :. Furnished by ; t r r � u 1/1 �r TOWN OF BARNSTAB E LOCATION IC` — ""j� '6 SEWAGE # VILLAGE �/� ASSESSOR'S MAP& LOT n� INSTALLER'S NAME&PHONE NO. �—�40 d c� �� '�•r, SEPTIC TANK CAPACITY LEACHING FACILITY: "'(ty pg) (size) NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by Li``. ,00 No. Fee L 6V` THE COMMONWEALTH OF MASSACHUSETTS r Entered in computer: Yes/ PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ✓ application for ;Miopooal bpotem Cougtructton Permit Application for a Permit to Construct( . )Repair( )U )Abandon( ) ❑Complete System ❑Individual Components ~ Location Address or Lot No. CC V, t Owner's Name,Addree s and Tel.7o. /-r,sq Assessor's Map/Parcel or Installer' e,Address,and Tel.No. S6 er's Name Address and Tel.No. J' yl,� .Orfc,��, Type of Building: �� Dwelling No.of Bedrooms _ Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures / Design Flow �7 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Z Revision Date Title Size of Septic TankType of S.A.S. Description of Soil 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 T�thhe ' nm tal Code and not to place the system in operation until a Certifi-cate of Compliance has been issued b . Signed oe R Date Application Approved by Date 6 ' 6/ Application Disapproved for the following reasons f Permit No. 7 Date Issued /-3s` s No.7,4,y ;Al,A_i Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS / Zippfication for 33i000l *pztem Construction Permit Application for a Permit to Construct( )Repair( )U/pg� )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Cy � Owner's NName,Adds and Tel l�jo. Assessor's MapMarcel eAw7 54 lnstaller'j Name,Address,and Tel.No. 3 �' F'qf d" (�'F 1 De i er's Name Address and Tel.No. oas Type of Building: o- Dwelling No.of Bedrooms Lot Size / sq ft .._ ..,^ Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank /,S"az/ l,4�l Type of S.A.S. Description of Soil 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 Envir nmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this d Signed Date Application Approved by Date 6 Z d/ Application Disapproved for the following reasons (Permit No. 00 Date Issued — ------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, art the On-site Sewage Disposal System Constructed( Repaired ( )Upgraded( ) AbandonedS by at d// &6 h/t:1. Gi Ai•A-- has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. eWdl dated G' 2 Installer Designer The issuance of this pO shag not be construed as a guarantee that the systw 1 fu - desig Date &" Inspector --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS ig ozaY 6to Congtructfon Permit Permission is hereby gr �ted to Con'struct ea i ( ) pgr de Abandon System located 1 a ( ) I 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: Construct' must be completed within three years of the date of this t. Date: 6 U� Approved by No.2�d71 Fee l THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zfppftcatfon for 33f 6pogal *pgtem Conotruction Permit Application for a Permit to Construct( . )Repair( )U )Abandon( ) O Complete System ❑Individual Components Location Address or Lot No. (3 Owner's Name,Addre s and Tel.1$o. Assessor's Map/Parcel h Installer' 4`�'�e�Ad�ss,and Tel.No. —�8 f d�' � m 04 er s NaeeAddress and Tel.No.xzK y,1/sic V F•QR PyLry . .$i /'— J�F'WM`h � / V �J r�PU/"/ O`�V Type of Building:, �!?�• Dwelling No.of Bedrooms _ Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures � Design Flow / gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank /,Sy lGw Type of S.A.S. Description of Soil 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 Env' nmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this d Signed Date kpplication Approved by - ET Date 6 "CSation Disapproved for the following reasons fPermit No. (- Date Issued a--=-�.C-=-- --- -------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFnY,,k�Lhe On-site Sewage Disposal System Constructed( ; Repaired( ) Upgraded( ) Abandoned S b �Ac&a i at / ti, , h/t:lL (.ti�i �- has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.-Z-04/ dated 1� Z - O Installer Designer The issuance of this pe shall not be construed as a guarantee that the syst 11 fu J%designe Date L� �. Inspector --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Mfgpogaf to Cong;truction Permit Permission is hereby g te tod Construct( e ai ( )' pgr d_e( )Abandon( ) System located at � �� ' �'U�' � L� • 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: Constructio must be completed within three years of the date of this it. Date: 6 U� Approved by i Town of 1 arnstable Depl—tiltent of Ilealtlt,safety,and Elrvirvnntental Services �OffI Public Health Division P 67 Maio Slrccl,I lynnnis MA 02601 nnlweTnm.F ° �u� ev ♦ t„. �' Dale Scheduled —� � --- l inte/�� , Fee I'd. /� -- - Soil Suitability Assessment.,for Sewage".pis��ou(l s �.; Performed fly-: Wilncsscd fly: / LOCA't!UN & GI,�NI ItAL IN3FOlt1,!A"t'ION I,ocnlion Address O,vner's Nwnc PZ�1,Vi LA t I Address /4 'Fe V:,e aa, L W o.CrI-a-fr�o0 M A Assessor's hlap/I'arccl: linginecr•s Mimic cv-Poe; P. opt; PE, NEW CONS I Rl1C-1 ION REPAIR telephone 11 > • 5clo band Use R�'.S!j Slopes("/�)_ Z Snrhnce Sloncs ��O Uislinces front: Open\Valcr LkttlyK� Il w I'ossih,e WcI Ares �/�_fl •Drinking Water\hell 1 • Drainage\Vny /(J it Property Liar. _3Q�r Il (MICI tl Slot TC11: (Slrccl name,d,lilcrlsmlls orlot,Cxacl locations of test holes C pCrc Icsls,locale lvetlaods in proximity to holes) 4,72- 81 7- 0 I 1 � 00 00 1Al 4-0 f '1 rk Z TH � I Zv Parent material(geologic) Cdk rVG✓• Depth to Dedrock Depth to Groundwater: Standing Wilcr in Itole: A/e 7 e Wccpjng from Ili(Pncc M'"i t Estimated Seasonal I Iigh Ground ilcr 2 ! llLI'C]t11XXNA SIGN Voit 8t,AS0IVAL 1I.1G31 t rA`a'1�,1 '1'A13LL Method used _ Depth Observed standing in obs.hole: in. Depth to soil mottles: Depth to weeping fron,side of obs.1101c: _ �/ .� _in. Groondwaicr Adjoslmcnt �pf _fl. Index Well N_ Rrndin,g Dnlc: _ Index Well level Adj. factor Adj.(iroundwnicr I,cvcl -- ---- ':..EZtCLA`X` C�N '[' 5'I' Time/ Observation _ - _ +: y� it_ _ •s _ _ r r I lot iini 9"/f1: _ Depth ofPerc l imc it G'• /O;21-UX` losSW;2a •+• ' 5larl Pre-soak Tinlc @ /O: 4s fhnc(v"-G")'_30.1e<°_ 3o SCc, • End Pre-soak 242A1. /0 Rile Min./Inch < Z, Site Suitability Assessment• Site Passed jl� Site Failed: Additional Testing Necdcd(Y/N) /✓ Original: Poblic Ileilth Division Observation hole Dala To Be Completed on 13acic j copy: Applicant I - - • V bEEP>OBSERVATION IDLE LOG Mole # Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munscll) Mottling (Structure,Stones,Ilouldcres. Consistency.% ravel /3 3 SG��m z.sys/4 ,3v-4z 4i2, {,00myand ?-J 13 s �_/3�„ Z ',, 1 G C.3, .. —t Med��vstl .5`/ �� dl Zola 4� G7nave� C+a a DEEP,, OBSERVATION HOLr LOG..: Hole # Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munscll) Mottling (Structure,Stones,l3oulderes. Consistent °o Gravel 0—4 SQ-ia4y a.5y4 3 No 4a dm 4 -18'r 8\ SGn dy 2-5''Y5. 4 �y Lv9t • I —33 �•' Saty z.Sy 7/4 N 1� C� �o4.n Jzar C ititesd�v'.-, Z.XY 7/¢ rr 2a�o Grave/ 33— 2 ,o a.,s _ Sa►-ii oL i S t DEEP'OUSERVATION 110LL LOG : > -Hole#: . . .. ('<) .;:> z; _, (; ) �<: ') ., g (Structure Stories,l3oulderes. $ Depth from Soil Ilorizon Soil texture Soil Color 1 Soil Other Surface m. USDA (Muns0i Moltlin Consistency,%Gravel 1 , I I PEEP;OBSERVATION:HOLL LOG::... Hale # Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) y {Munscll), Mottling (Structure,Stones,l3oulderes. Consistent % ravel Flood Insurance Rate Maw Above 500 year flood boundary No— Yes Within 500 year boundary No_ Yes Within 100 year flood boundary No_ Yes Depth of Naturally Occurring Pe, rvi_ous Material ,; �'• t x h t•1. 4r ,r f - e - oywM• l s. ,�ar\.6. .. -.Y„Jd yx..- ,•ti+ Does at'least four feeti$1'�tt"tttlrl�xlly octnnpervtousi�ntettTaxist in all areas,observed throughout tile i area proposed for the soil absorption systent`? ' If not,what is the depth of naturally occurring pervious material? Certification _ r :'certify that on •Nw 94 (date)I have passed the soil evaluator examination approved by the ,Department of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. Signature Date r . psi i vvv :v� •/YJ S6.S XO& 'O d -- �66/ Sos S:1 b/voss6e 37.wQ js 1�� fV/ 7•biJ.S /OOZ �L 7/Yd b' , OZ =77fYJs �~ Q do�i 7 /wY V4 C77 JN/77�/b(Cj L✓OOZ/P�b' Qa'SOdOYd /YV 7dvi CLa F ti y n , 69ssc roh S t bnt yr d !11`31AOQ' yJ N14or Jo b� C, - S* f/1 � _ S 7 b'10 1 NON/ a'�d J�/L✓ Z /Q'/vb'2/OJG✓ f!/Y/VOQ' fi''O'8 �7f7b1S/Va'H8 �s O�� - , .9 '£E d `1�otis 9/6"Y YOJb'/n7dA� s-7/o 6 6 = z/-8 � ��d Q L sal � o'N�o�'b �/vols✓ v.�Hs bM �'o ,� P�a'3LN/�00 -y _L 0 H1//►f - '�9lUb f�b�7 .9 OOS ��a'f/1 as/7 4 /.Z6 •7� -,ZE'/ �S S6S' `'c �t 0%S�9 yL O ;- Pc/9 Ovf� '7=7 Z/ /vo/1 d�osg 17d.9 O aJ� O// A- 'SWb' P fr sWOoa'��g .tom ,( s'Z PNbS S/v0/1 b'7n,776J N9/S�� W�1S�(S �9y/vJ�S �j �cs•t 6✓n/v3W . E 0N&S "z� z l� SE,vo/ 7� ��07 i�� S Z /+G✓d 07 7 ° c o v , 00/ 7�7 „O£ 00 g°o°o ,cs z .�1�is O I allols s��gW b' -k - /i ON V.s .'e. //C �'S'Z J n O/YbS . �-. �/�aS-PfNitt�b Ss -- o l7 . XrvykiWy r.96 £/ E0/ -Ns / eon 73 7r2s��Z ( `V P . �iOs TOP F:av/VD4 7•/O/V EL. /0•5 SE A1146 E SYSTEM' PROF/L E RAd E M%N SL pPE OF 2 p 6„MAX. . 9"Ml1J. 3�"MAX .D/ST, BOX V/O"sc/MP' G o- SGN, o PVCF /YVV•/00-20 ! - _ - L/Qc//b LEVEL ! sCH. 40 ; PYC t7lllv sc/!./,vt/ �o"MN- l4'' /, v- /,v ¢DPvc/jj 9e /U07/ V1190-57 6 ' J, (I Sa3) 5006_� STON 7 �. 98. Zo - (/SE /500 G,4 L. PRECAST SEPTIC TANk KI/TN /n/L ETI O vTL E T TE E s ¢.• - -- -- CONSTROCTC-D PER 310 C l''I P, /5. 22.7 S•/ TTOM GF �E5T P1T T- — 33'G - WASHED STONE, �-, ; IZ, ,0., ¢ (3) SOO C,i L CA CH C /AMf.3 EW 5 VIEW or 5. A , 5. i 1 f W TN SAD � fIBSOrePT/ON P 1 w s.3 �RoPt��A 24-' Doti /,�• Dw�� 1ce NOIL, T,giVK 9•�, 3� /�, r•t TER _ /Z. 8IL r� xis o .� I . ' 3 4 N mb m I a 23; I I X 7.3 75 0 03.8 oB4 S�AMC E SYSTEM` PROF/2- E ,SpyL S 7ES7- /f E S C/GTS /v1//1/. SLOPE O Z r Th/-2 v 6"MAX. . 13C'."M D AX .D/ST, ,SOX W��"SUMP MAX 9.�M„�, 0 36'MAX. pIA S�9NOy Z.5y 43 O/A SAND y Z•S Y 4/3 a. SCN, INV./00.20 - -- '� I •, G040 L.0.91►� PVC 'LIQUID LEVEL N scH. 4U PVC scH. 40 pVG v 2 COVER OF /4- �2 STONe� `f� S11NDy Zq 5/G B 4-' SgND 2.Sy /'V✓ /b Ml/J, �l4 /NV. /.v S y /D/•24 Iaa-9� /OD-7/ /.vd• 75C � ,, � B . y /84' S LG /DO .S7 /00.40 /Z =-4 » t� » o n 'W-Jyr S/[Ty 2.5Y %6' BED of , :;:c d C� LOAMS/LTS� Z.SYCgUSHEp (3� 5006 LEACH CNAMBEIZS STONE 2 EFF, D6PTN `��o » r� » ' �' _ vo-s C,8 30, Ld M Ey /00 L L=L. /00.35 4 y / 33 '98- 20 ..0 .. 4 d aoo 0 00 Lit SAND 2.5 3 USE /$DD -L GAZ. PRECAST -SEPT!C �' -�• 4,1011 — �f' 4Z•, TANK WITH INLET/OUTLET 7,-ES S-/ - - IZ'/6" MHO/uM Z•sY %yc. CON57I2LJC716.D PE l� 310 C 1`9 K l 5. 227 MEd AN c2 Co,4AsE EL, 9.3. /C J— c 3 GOAgy& 6-4 AID fOTTONf OF �5T FIT .SAND 2.S y �y� SEWAGE SYSTEM DES/6,t,/ CgLCtJLAT/ON5 . /. ,DESl6/l/ .�AIL Y FLCyI•t/ FD�Q 4 BE-D200M5= 4 BDRMs. aC //O GP.D = -040 457P2) L 33• Z. M q'41/RED ABSD,QP T/ON AXe,4 : 1240" " 93•/ /3Z,, EL. 92•/ 440 GpD O. 74 CIS'FI.D Y •5"9.5 S F WASHED. STONE, , 4' G/IDuNoh1ATL�2 JVOT ENCo�//V7L�/2E1� • __ 3. USE T//REE 50.0 C. LEAJ CW C.4.4/n,6,6: 5' A//Ty �V 900 G L EACH c AMB FRS ,4 -I-' AC ` ,4 SHED S?on/E A�eO/./n/D • TEST ,DATE : B-/2 - 9 9 .9BSORPT10A1 AR54 PRO✓/s/oN= SOILS 1/444/472OR : C f4 Ag S!/ORT, P E. ` 4• 80770M - /Z- 84 " X 33. 5 ' = g30 sF 3lq"177 9'BLi!5 B.O. q, ' AON.1,4 /►7/41R,4N.a/ s/aEs= 625•G 8 a- G 7, x RA7� •< 2 M/�. PgR /NC N• PLAN VIC-N OF S.A. S. _ - O7-A/. = c/5 S•F T!/-/ /�5,eC. JE RTA/ - 42 - 54-" a r �y ,•, 0 ba o� JOHN 0• __ �. VWILUIW P. -3 '\ Li�Q�R�LAIy 4z> DOYLE,[if -' R rp. ,.1�� , •. .p :+.. ItJ971Q •, v Nassa89 FQLNIOG�?/� r /9' ,.' �q�f(/ISTEU lq- 2$ O `r vT `03 3 J \ AY µ a SUR`1� VTE -5- x 2 l J��W R •�--- L OcUs o f \u 1 w 44u� 5.3 o !! 3.L� �EDROO/''� `S,, Q ov► � � v N 3 -A oil, °a < / ' m - , /.5-DD 6. .D SERVICE _ _ /O0 r< �a SEPTIC .5• T rr i% • 7' 9 v�A R .8 9• •r-.9N.Y ' ' kA N ff' O X kh p 3 .1.1114 �03•y N NOTE: 7W/s P4A Y WqS REV/3 Ep ON �¢ C'CUS /4,I f' -eAL�: "= ,�000 ' n 'P . /¢•3 /•, LoT/too. 6/ O N ; 7'0 X&-0CA7•E T/1E RESERVAD EXP�9NSIaN zr I - ' 323 fps` 7HE S•A•S- To T//E WEST /DE of 7.3 6-/TR �JND EWA6E PLAN S 3 Tfl S• •S• By ,/ PiPEPARE,D /�D�' X E �} „aoyLE ASSoC/AT�S- 7s, 3� , ,,,,• X '2• /TZPATi�/G/�' �O/►'1EBU/GdI.A/G CO, O, L d JoX.8 T NO. al ,CAA/YN/C L. � RDA Z> J�X /d`/`•S`P SCALE /"=ZO ' ,4P/�/L 7� 204/ 5, 3z„ y f /Oz scAL.E X A//s -o�- .� 5 �¢'� 3 .T DOYU: 4SS04M TES Sob -�G.�• /99� A O•SOX s'9S' W, GALMo ZUTH OZ-4-74