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HomeMy WebLinkAbout0114 BRIDLE PATH - Health 114 BRIDLE PATH MARSTON MILLS A= 149 137 i Commonwealth of Massachusetts 9 1p Title 5 Official Inspection Form <I� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments cam !% 114 Bridle Path r Property Address Sara Hannegan - < Owner Owner's Name / information is Marston Mills V MA 02648 5-13-20 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. 0��►►►,oFp„f�����' Important:When A. Inspector Information °�• C, filling out forms 6/,* t/ �`02;• tiG on the computer, �: JA M ES P' use only the tab James D.Sears =o: key to move your Name of Inspector cursor-do not %* ' Jim The Inspector Man s •.o o use the return 'sue ••F �.•' key. Company Name %�� F •.. ...•�G ``��. P.O.Box 784 ''���y+/ u nu►"���``` Company Address West Yarmouth MA 02673 City/Town / State Zip Code —'� 508-364-4398 S1623 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 5-13-20 ;spec"torsignature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts ,4.p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,�. 114 Bridle Path v Property Address Sara Hannegan Owner Owner's Name information is required for every Marsto-i Mills MA 02648 5-13-20 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® 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: T-ie system is a 1500 Gal. Tank D Box and two 500 Gal.Chamber's. 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,.. 114 Bridle Path V� Property Address Sara Hannegan Owner Owner's Name information is required for every Marston Mills MA 02648 5-13-20 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ 'The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,• 114 Bridle Path Property.Address Sara Hannegan Owner Owner's Name information is required for every Marston Mills MA 02648 5-13-20 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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 c� Commonwealth of Massachusetts Title 5 Official Inspection Form i4 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments � 114 Bridle Path Property Address Sara Hannegan Owner Owner's Name information is required for every Marston Mills MA 02648 5-13-20 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 El ® Liquid depth in 'is I ess than 6" below invert or available volume is less than Y2 day flow Foe/ry ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form I, Subs urface Sewage Disposal System Form Not for Voluntary Assessments 114 Bridle Path Property Address Sara Hannegan Owner Owner's Name information is required for every Marston Mills MA 02648 5-13-20 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 N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 Commonwealth monwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 114 Bridle Path Property Address Sara Hannegan Owner Owners Name information is required for every Marston Mills MA 02648 5-13-20 page. Cityrrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Description: 1500 Gal. Tank D. Box and two chamber's. Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): NA Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Present Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form � Subsurface Sewage Disposal System Form - Not for Voluntary Assessments !% 114 Bridle Path Property Address Sara Hannegan Owner Owner's Name information is required for every Marston Mills MA 02648 5-13-20 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 occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: 7-2019 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Ins pection section Form b Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u 114 Bridle Path Property Address Sara Hannegan Owner Owners Name information is required for every Marston Mills MA 02648 5-13-20 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 1999'Permit#99-332. Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 25"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 4" PVC SCH -40 & SCH -20 t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 c Commonwealth of Massachusetts Title 5 Official l� Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 114 Bridle Path Property Address Sara Hannegan Owner Owner's Name required for is every Marston Mills required for eve MA 02648 5-13-20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 15" feet Material of construction: ®concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 Gal. Precast H-10 Sludge depth: 1" Distance from top of sludge to bottom of outlet tee or baffle 29" Scum thickness 0" 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 18" 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 and covers at 15". Inand outlet Tee's. No sign of leakage or over loading. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 l Commonwealth of Massachusetts Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 114 Bridle Path Property Address Sara Hannegan Owner Owner's Name information is required for every Marston Mills MA 02648 5-13-20 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.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Ii Subsurface Sewage Disposal System Form - Not for Voluntary Assessments !% 114 Bridle Path Property Address Sara Hannegan Owner Owner's Name information is required for every Marston Mills MA 02648 5-13-20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D Box is 16"x 16"-26" below grade w/one line out. Box is clean and solid. No sign of over loading. t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,.» 114 Bridle Path Property Address Sara Hannegan Owner Owners Name information is every Marston Mills required for eve MA 02648 5-13-20 page. Cityrrown State Zip Code Date of Inspection D..System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No` Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ' ® leaching chambers number: 2 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System 9 p y Form Not for Voluntary Assessments 114 Bridle Path Property Address Sara Hannegan Owner Owners Name information is every Marston Mills required for eve MA 02648 5-13-20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching is two 500 Gal.dry well chambers w/4'stone. chambers at 2' below grade. 2'water w/stain line at 8"off bottom. No sign of over loading or solid carry over. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts �9 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments - p 9 Y rY 114 Bridle Path Property Address Sara Hannegan Owner Owner's Name information is required for every Marston Mills MA 02648 5-13-20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): f Commonwealth of Massachusetts �, m Tifln � �1ffi�+i�1 Incr�or'finn �nrr� i f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ` 114 Bridle Path Property Address Sara Hannegan Owner Owner's Name information is required for every Marston Mills MA 02648 5-13-20 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth toi ground water: 40' feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: on file w/B.O.H.. ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: 40'+to G.K. Bottom of chambers at 4'-6" below grade. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 - _ I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 114 Bridle Path Property Address Sara Hannegan Owner Owner's Name information is required for every Marston Mills MA 02648 5-13-20 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 0- Oro,nG i t5insp.doc-rev.7/26/2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 f� o TOWN OF BARNSTABLE , LOCATION 1-r- 1. � _ SEWAGE# VILLAGE--M4 JM I II Z ASSESSOR'S MAP '&SLOT 3 INSTALLER'S NAME&PHONE NO.�JA 063 SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE: - 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) 0Feet I Furnished by A� 37-0 23-0 �l 32-647, � o i9-o z 1 B5 40-0 13Z'M- .A3 3z-V 3 s ;r No. / 3 ��� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS ZIpprication for Migolzal *pgtem Construction Permit Application for a Permit to Construct(" )Repair(✓)Upgrade( )Abandon( ) ❑Complete System El Individual Components Location Address or Lot No. 114 1594 D" PAI- E Owner's Name,Address and Tel.No. 667 Assessor's Map/ParcelP 1��S ?� MA-P I'{'9 L !3-7 GJ &124b4-c- l +-rW Installer's Name,YAddress,and Tel. ��-0�'p Designe�r's�e,Address and Tel.No. P0,156)t. ?oZ fnAAsT©AJ5 MILl6 Type of Building: Dwelling No.of Bedrooms 3 Lot Size r 57A1:!-sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3 3p gallons per day. Calculated daily flow 3 53 gallons. Plan Date �o °4-c1 0) Number of sheets Revision Date Title Size of Septic Tank SDD %4k Type of S.A.S. CdZl CAM-M6602-5 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 En 'ronmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issu by this Board o eal . ,L Signed Date Application Approved by Date Q Application Disapproved for the &IOW99 reasons Permit No. g'— Date Issued ` 1 No. 97- 3 , _ Fee "• THE COMMONWEALTWOF.MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ZIpplication for Mizpozaf *p$tem Congtruction Permit Application for a Permit to Construct(� )Repair(V)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 4 j5z)DA-L PA-nA _ OwnerAs Name,Address and Tel.No. Assessor's Map/Parcel PA +��L l 3-7 Installer's Name,Address,and T .No. D y�Ij Designer's Name,Addre s and Tel.No. Ti /" ES Po, ao t 70Z /V1kXSTon6 mias Type of Building: Dwelling No.of Bedrooms 3 Lot Size r 57A-Csq. ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow 3 53 gallons. Plan Date 4, ' `f al ') Number of sheets Revision Date Title Size of Septic Tank 16-00 24k Type of S.A.S. a x ADD C,11 C9.4- t6fFtLS Description of Soil Nature of Repairs or Alterations Answer when applicable) __ P ( t Date last inspected: Agieement: r F 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 En ironmental Code and not to place the system in operation until a Certifi- pate of Compliance has been issu by this Board o eal h; Signed Date 'Application Approved by Date Application Disapproved for the ollowi g-reasons Permit No. - Z Date Issued ------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On; i e Sewage Disposal System Constructed( )Repaired ( " )Upgraded( ) Abandoned( )by 114_ ) at /l�/ 732.I A*1 /1'1 A-&ZS-roNS /M I t.L5 has been constructed in accordance with the provisio�t s of Title 5 and e for Disposal System Construction Permit No. �9- dated ✓1�Installer --JA-i D L-LL_2K. Designer n ,n4 L`'S A'n o The issuance of this p �t 1 not be construed as a guarantee that the syPeMP�unctiowsdesjg.ned.Date �>7 t/ "� Inspector 1t/�} e V V 1 Tile•` rvt `-A%' ---------------------------------------- No. 7-51" 33 Z Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS x1i5po5ar 6pete/Construction Permit Permission is hereby granted to Construct( )Repair( )Upgrade( )Abandon( ) System located at PA-M M#juTwJS /vJ./4t.-5 and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date: �� - Z/- ! Approved by TOWN OF BARNSTABLE LOCATION �: L — SEWAGE # VILLAGE PSI/WqTM14S ASSESSOR'S MAP &y�LOT 3 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACIL=: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE: 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 I o-off 0 , -z� t� 0_2 i 1/6199 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. - CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) I, JFrM e�; fTDUXV— hereby certify that the application for disposal works construction permit signed by me dated ro r Rq concerning the property located at 114 RQ-t DA-t,- PATA , fV1*t2sra4S Ai" meets all of the following o g criteria: • The failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. • The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. • There are no wetlands within 100 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic system • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching facility p p g ity will not be located less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] • If the S.A.S. will be located with 250 feet of any vegetated wetlands, the bottom of the proposed leaching facility will not be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(using GIS information) B) G.W. Elevation +the MAX.High G.W. Adjustment .� DIFFERENCE BETWEEN A and B S • ' SIGNED : 44AL-- DATE: (Sketch proposed plan of system on back]. q:health folder:cert `— a tSeu 9 sEPri e- f f�A1i� O L4> -ro G 6AI- G 1 S D GP V tt S/w t Dr X QfC u q, cwm e MA-�stoN� fViec /aa� , Sues too ENDS SZ tp 3 Vj>"L" ��t D�iS Tp TA-, L+71 3S-5 GPb Revu I®" ,353 GWD Smic, 94STEM px- -Je 5/11/2020 ShowAsbuilt(1700x2800) �p T/OW�N OF B STABI E LOCATION* f�6��,,.,,I�������� SEWAGE N VIL[AGE_�1'04, .02/u-S ASSESSOR'S �MAP &7�LOOT INSTALLERS NAME&PHONE NO. SEPIIC TANK CAPACM LEACHING FACILrIY:(type) 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 30D feet of leaching facility) Feet Furnished by l 1 37-o i $1 3z-6 A 45 q0-o ka l9-o Z 8Z 38-b A3 3Z-D 83 ¢7-o j • i https://itsqldb.town.barnstable.ma.us:8431/Home/ShowAsbuilt?mp=149137&sq=1 1/1 Health Complaints 27-Jul-00 Time: 9:05:00 AM Date: 7/27100 Complaint Number: 2466 Referred To: GLEN HARRINGTON Taken By: GLEN HARRINGTON Complaint Type: TITLE V SEWAGE Article X Detail: Complaint Description: SECOND PROBLEM WITH SETTLING AROUND BACKFILLED SEPTIC TANK. JOB DONE BY JIM HOLLER & SONS. Property is leased. Ms. Hannigan does not live there. The people living there are even more worried about this problem so Ms. Hannigan wants this fixed. Actions Taken/Results: DZM ON VACATION, EFB BUSY WITH PERKS. Complainant seemed distraught so I volunteered to investigate. I left a message on ° � "^ 64 SIA?x ' l2 Jim Hollers machine 9:20 am (420-0280). a ,�cf, 7'"kd , Investigation Date: Investigation Time: /I ,, gad%A/u-cm W. X 6 ' [v+ sb !(� aA_� L' / 4`�2l2ovv U W 5,1 S dvt•Q �e�d Cv�ov, a �oFtHe l � Town of Barnstable o� Department of Health, Safety, and Environmental Services BABNSTABM •' MASS. Public Health Division 9� i63q. 10� �fDfAOSA P.O. Box 534, Hyannis MA 02601 Office: 508-790-6265 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health //y lib';�L' & / -0, 4vtl. RECORD OF VERBAL COMMUNICATION -oa 9/3 � e ,rd P r l(P1 l f.�o 0Y& �t /(, Y4� VO 44C l�oe.�i d- -Pd WIC � e� 4�.,e �,,.�yw� e� c..e. �,�• �t U lJ lr�- re d��c�of � cb-'v.o 11 r� oL►- pad GZ�z.rr� ors -� p,`� ((. (u�-1 a�G(kfO� G�Gv�..QQ �Z. �`Q^ /-C�-�1C �litlP.6t�,/�.Pi�.• 01 � ���/ r���eo� � wt.,c& pi-e.)J&.R r�-�G�OC 6"-,-'7, IisO�C/� � .�tf �2 G�ecav�.4.P�t Gtri-,off b�. 9�y� G�-G�c�• �a lda�.Qeti. .I-.ec,�e( NJ �c y�0e�.►ZC c., s e c, G v C A/Z Cs--3 5,0W.'e few vc - �^ZT° C V—V3 J'j GQ I n 62 ,ra vs 4ta d(j aw x J ole Ae-c6wje— V4J- AAA- ov W-e o/✓ Si g Jl� n Vi eavNevr-Lfd rLe ` k+& w• ,bdl a/u .off eae.Ge J• /''Ul� /did lll�- 1 c�G' G�.sY//X ✓��•-v� a�y .��-r<i obi o�CXX r`r� � �, r verbcomm.doc ' , t-O C A T ION SEWAGE PERMIT N0. V1 LAGE INSTA LLER'S NAME & ADDRESS BUILDER OR OWNER . a . YY f �/ DATE PERMIT ISSUED _7�=- DATE COMPLIANCE ISSUED �' ,3v _ 7 �_ f - Y y No..........��.. Fzcs... . THE COMMONWEALTH OF MASSACHUSETTS BOA ._ OF H EA T [.d . ............_....o - .. ...... ........................... Appliration for Di-quiial Works Tnnitrnrtton Fermi# Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal s .......... & V1 Z........P�r�f,._1�; �.&& ...................//_-......................... ............................................ Location-Address ��:Z.,-1Lr...P� a I.... .. ... Owner A ress Installer Address dType of Building Size Lot_ _ .j_.....Sq. feet U Dwelling—No. of Bedrooms_._..................................Expansion Attic ( ) Garbage Grinder ( ) p-, Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) aOther fixtures -------------------------------------------------------••----••-•--•-••------••--------..----------• ---------.....-----------•--------------_...... d W Design Flow-----/1_4_______________•--___-__:--_gallons per person per day. Total dgily flow........ _._ ... _..................gallons. WSeptic Tank—Liquid capacity.(�___gallons Length.......:........ Width..... _.-__----- Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area..... __C-------sq. ft. Seepage Pit No__________________-- Diameter.................... Depth below inlet.................... Total leaching ar -_-Z .._.._._sq. ft. Z Other Distribution box ( ) Dosinptan (• �j '-' Percolation Test Results Performed by._--_It-w. =_. t� _1J V_..1-i...-•-•--------•--•-•--...._. Date ./` -----•---- ,� Test Pit No. 1.a...........minutes per inch Depth of Test Pit--_-__•_____________ Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ - --------------- - O Description of Soil.. _)_ �s XA W •---•-----•---------------------------••-•--._...•----.....--------.......-------------••--•-----------•----------------------------•-----------•---••--•----•---••••--•--•-•-----•••----•--•--•--••---- UNature of Repairs or Alterations—Answer when applicable............................................................................................... ---..........-..........................................................._.....---....•-•------••-•••........-•--•----•••-••--•--•----•------------•---••----•--•-----•-••--••-••-----•-----------•--- Agreement: The undersigned agrees to in§tall the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iIT L E 5 of the State Sanitary de— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has e issued by Xn iealth. Signe __ ....... ........ = / -- -- �--------------•- 7W........ —Date Application Approved By-•-•_- / __ � —7 - Application Disapproved for the following reasons_ ____________________________________ -------------------•-----......------......-•----...Date---.....----•- ----------••----------------------•-------....---------------------------••---------------------------------•--•y--------------------------------------------�- ----------------------------------- Bate Permit No......................................................... Issued--� -- -�- Date J No......................... ` y F zs............._............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HALT r..... -•----r.....`�. .�_ ram' -- OF....i-. . ............................. Appliratiou for Disposal Works Tonstrurtion Vintuit . Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Sys �) ............/ .A.f�. L............�R .<. � J.0` 8 !/0� -_/_.f.......................................................................... 1 Location.Address r t. ... --•----•--•--•. �_.. - ( !-----2 r v t`sJ� ..........................t /? i S Owner r r Address a �110 Z 6 J fit( ;.! '..... ------•-----------. � :!_3 c '�-� -...... . C _�.l. �?v! Installer Address .. dType of Building Size Lot ll,,_.�.Yl:......Sq. feet Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons..........--............---. Showers ( ) — Cafeteria ( ) Other fixtures -------------••-•--------------- allons per person r day. Total it flow--.......-,3__�__.�►..............•.... Ions. W Design Flow..---,ff..tJ------•--------•--•-------�,g P P � Y• daily gallons. Septic Tank—Liquid capacity.& _.__gallons Length................ Width....� ------ Diameter_----_-__._..... Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area......___..0.......sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching ar --------- ft. z Other Distribution box,( ) Dosin to ( '-' Percolation Test Results Performed by..... ... :. R � -i1_U .... ... Date aTest Pit No. 1.2_...........minutes per inch Depth of Test Pit.................... Depth to ground water............r......--. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Ra • •-- .-•--• ----.... .. . Description of Sol.. d....... -- /- 0 -- - j V ......•...1 - -------, .... .a;�- �..`�..0 •'Jf `" ............................... •----•-•----•--------•-••----•---•-•-------•--....•-•----•-•--------•-•-•-••----•-•----•--••----••----•-•--•----------•------•---••------•-•--••---•-•---•----......................................... U Nature of Repairs or Alterations—Answer when applicable..--..•------------------------------------N-.-.•--.--.•.--..-...•_-----.------_•_-_•-_--•--. ----------------------------------------•-...--------•-----•----------•--...--•--••----•-••-••....-------------•-----------••--•••-------_....--.....••------------•------•-------•---------..._.. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITI.;,:. 5 of the State Sanitary de—The undersigned further agrees not to place the system in operation until a Certificate of Com ance ha e'e issue by th b iealth. d= -- .. .................. - .�.----- --•-- ate D ApplicationApproved By..........................................................................-•-----•--•......---_.. ................ Date Application Disapproved for the following reasons:---•--------------------------------•-----•-----•------••-•------------------•-------------------._....-•••-... ............................................................................................,..,........................................................................................................ Date Permit No. - Issued---- .L.•- Date THE COMMONWEALTH OF MASSACHUSETTS BO, OF HEALTH UJ!v.............OF...... ..,:. n .° .. .. ..n../Z............................ (Irrtifiratr of Toutpliattrr T,-IIS IS TO CERTIFY, FThat the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by.... - ----- - v Instal at �"�. ..--.. ..---- --- ---�-• --------id. -�------ �� �j ......................'"r a , b T r has been installed in accordance with the provisions of•TI_ o e State Sanitary C e as escrl din the application for bisposal Works Construction Permit No.........................._--•-------._ d-ated-.---------------------------------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILLn FUNCTIO SATISFACTORY. 1. DATE............................. Inspector..:.__ . ...... n THE COMMONWEALTH OF MASSACHUSETTS ( t' BOAR.OF HEALTU Z .. 7� �U kA j a,1 .......................' 'tea `" �/ !A Lct - .........................OF.... ........................ No......................... FEE........................ . . Disposal ork� T.anstrt ion rantit Permission is herebygranted C __....._ �" . ..��� ��` g = = ... --A.. ----------•---•---------------------------------•...................---... to Constru t ( or'Re ai ) jdi dual S'''�a e Disposal S st at No...... .... ° a -` #2 / I .••..... �- ..-- ----------------------- v as shown on the application for Disposal Works Construction ./•• •••• ............. .............••-•--••__--__ •---•----•------•---••------.....•---------•.... .............. Board of Health DATE.........5- Z ...Zt(�............................... FORM 1255 HOBBS & WARREN, INC., PUBLISHERS - __ :,""�-..�-_.,,,1�".�'-�--,�V,.,,.-�;I,'-��-v.,�`,-I1,,�;-4"i,..,..�:,�-l�--�i.`'-"��,.�*1 l.-�-.,,1'�,-s,E'-�i-1,t.,�-�:Ll`i,l�,-�.,�,-�,�-I'4��,-. ",v' a ¢ � c :i J 3?'' 4 ��'. 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