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Home My WebLink About0080 CHERRYWOOD LANE - Health 1 80 CHERRYWOOD LANE,-.-.,.,_-_ _ A= 041.012.012 �n�lr2s.65 Fill i`Ib )c( O`r TOWN OF BARNSTABLE ' c, - v LOCATION�� c kei'roj onk I h , SEWAGE # + VILLAGE (W,10 I � ,A\[4ASSESSOR'S M P & LOTM rD "U INSTALLER'S NAME & PHONE NO. IQ A 7!,F'V 700 SEPTIC TANK CAPACITY /U 0 LEACHING FACILITY:(type) (size)_ _jU®U NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No �� , . r r Commonwealth of Massachusetts Title 5 Official Inspection Fort Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 80 Cherrywood Lane Property Address Peter Murdy N3 Owner Owner's Name r information is required for every Marstons Mills MA 02645 12-15-14 page.e. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form.Inspection forms may not be altered in any W way.Please see completeness checklist at the end of the form. Important:when filling out forms A. General. Information on the computer, \\`��` �,(H OFN /// use only the tab v . ��:• '' •.Sq �•- 1 Inspector: key to move your cursor-do not James D.Sears =� JAMES :m use the return Name of Inspector S —+B y *: ke CapewideEnterpdses,LLC �,•., * z Company Name .,.�> T i F 153 Commercial Street '�4,�5 Company Address " Mashpee MA 02649 Cityrrown State Zip Code 508-477-8877 S1623 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 12-15-14 spector'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. !Sins•3113 Title 5 ofr�c�M L:!2LFj Sewage Disposal ystem•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 80 Cherrywood Lane Property Address Peter Murdy Owner Owner's Name information is Marstons Mills MA 02645 12-15-14 required for every page Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 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: The system is a 1000 tank D Box and pit. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined"(Y, N, ND)for the following statements. If"not determined,"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as.approved by the.Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5ins-3113 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 L i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 80 Cherrywood Lane Property Address Peter Murdy Owner owner's Name information is required for every Marstons Mills MA 02645 12-15-14 page. Cityfrown 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): El broken pipe(s)are replaced ❑ Y ❑ N 0 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): El 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 Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 80 Cherywood Lare Property Address Peter Murdy Owner Owner's Name information is required for every Marstons Mills MA 02645 12-15-14 page. Cityrrown 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 El 1 Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in avwpW is less than 6"below invert or available volume is less than %day flow PfT t5ins•3113 Us 5 official Inspection Fa m-Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 80 Cherrywood Lane Property Address Peter Murdy Owner Owners Name information is required for every Marstons Mills MA 02645 12-15-14 page. Citylrown State Zip Code Date of Inspection B. Certification (cunt.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ 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•3M 3 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 °( 80 Cherrywood Lane Property Address Peter Murdy Owner Owner's Name information is required for every Marstons Mills MA 02645 12-15-14 page. C4rrown 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): 2 Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 220 Official inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 l5ins•3H3 Me 5 Offid nspectl 9e P� Y l Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments "( 80 Cherrywood Lane Property Address _Peter Murdy Owner Owner's Name information is required for every Marstons Mills MA 02645 12-15-14 page. City/Town state Zip Code Date of Inspection D. System Information Description: The system is a 1000 tank D Box and pit. 1 Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No 2013-33,000Gals Water meter readings, if available(last 2 years usage(gpd)): 2014-41,000Gal,s Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Da esent 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: t5ins•3113 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 L Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 80 Cherrywood Lane Property Address Peter Murdy Owner Owner's Name information is Marstons Mills MA 02645 12-15-14 required for every page, Citylrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Dace Other(describe below): General Information 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: 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/Altemative 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 Tree 5 official Inspection Forth:Subsurface Sewage Disposal System•Page 8 of 17 r . - Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 80 Cherrywood Lane Property Address Peter Mundy Owner Owner's Name information is required for every Marstons Mills MA 02645 12-15-14 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: 1991 Permit #91 -282. 2014 New D Box. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Ulf 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 4" PVC SCH 40 Septic Tank(locate on site plan): 22" 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 Ga1:Precast H-10 2" Sludge depth: t5ins-3113 Title 5 official Inspection form:Subwaface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 80 Cherrywood Lane Property Address Peter Murdy Owner Owner's Name information is required Marstons Mills MA 02645 12-15-14 page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Septic Tank(cont) Distance from top of sludge to bottom of outlet tee or baffle 28" Scum thickness 3" Distance from top of scum to top of outlet tee or baffle 12" Distance from bottom of scum to bottom of outlet tee or baffle 15" How were dimensions determined? Asbuilt-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 cover's at 22"below grade. Inlet tee, outlet Tee.. No sign of leakage or over loading. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official hispection 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 80 Cherrywood Lane Property Address Peter Murdy Owner Owners Name information is required for every Marstons Mills MA 02645 12-15-14 page. Wrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes 0 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 15ins-3/13 Title 5 Official Insp ection Form:Subsurface Sewage Disposal System•Page 11 of 17 II Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 80 Cherrywood Lane Property Address Peter Murdy Owner Owner's Name information is required for every Marstons Mills MA 02645 12-15-14 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 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"x16"-35"below grade Wone line out. Box is new 12-2014. Cover a 6"below grade. 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: t5ins•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 "t 80 Cherrywood Lane Property Address Peter Murdy Owner Owner's Name information is required for every Marstons Mills MA 02645 12-15-14 page. cityrrown state Zip Code Date of Inspection D. System Information (cont.) Type: ED leaching pits number 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number. ❑ innovative/alternative system Typetname of technology: Comments(note condition of soil, signs of hydraulic failure, level.of ponding, damp soil, condition of vegetation, etc.): Leaching is a 1000 Gal. Precast H-20 pit w/2'stone. Pit and cover at 35"below grade. 8" water in pit, wall's clean like new. No sign of over loading or solid carry over. Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-3/13 Title 5 official Inspection Fan Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 80 Cherrywood Lane Property Address Peter Murdy Owner Owner's Name information is required for every Marstons Mills MA 02645 12-15-14 page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) 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•3/13 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 80 Cherrywood Lane Property Address Peter Murdy Owner Owner's Name ►equiredifo "� Marstons Mills MA 02645 12-15-14 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately FI'0Nr a .33 � r V �/o o IL0 3 t5i^s Y13 Me 5 OWN kapection Forrrc SubsWm Sswve Disposel System•Pop 15 or 17 Commonwealth of Massachusetts ugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 80 Cherrywood Lane Property Address Peter Murdy Owner owner's Name information is required for every Marstons Mills MA 02645 12-15-14 page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to igh ground water: 151#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: 11-6-91 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) El 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 file at B.O.H. 11-6-91,No G.W.at15'+. Bottom of pit at 9'below grade. Bottom of pit at 6'+ above T.H. Depth. Before filing this Inspection Report,please see Report Completeness Checklist on next page. t5ins-3113 Title 5 Official Inspection Form:SuluuAaoe Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts ugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 80 Cherrywood Lane Property Address Peter Murdy Owner Owner's Name information is Marstons Mills MA 02645 12-15-14 required for every page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3113 Tale 5 Official Inspection Form:Suturuface Sewage Disposal system•Page 17 of 17 L DEC-21-98 11 :28 AM Somebody Else Septic Inc 1 508 996 8557 P. 01 CO.",NONWEALTH OF NIASSACHUSUTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS, DEPARTMENT OF ENVIRONMENTAL PROTEC It IVO." O\F UI\TFR STREET 130%TO\ 19 h4441,' 99 WILLIAM F %k ELU 41A fv Cox ARGEO PAUL CELLVC6 Lt Gaverriv SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM m over PART A OY/ 0a D CERTIFICATION Property address: 86 ebeFrVeAAMJ th. f MIPSTfor) PlIjIlf Address Of Owner: 170X 2144- Oaft of Irtioiction: 12/k/98 (11 different) MY.7 an I's)MA 02e01 Name of Inspector: JR;a A A.,j L ja"f- 0 1 am a DEP approved system iASP@Ctdl pursuant to Section 15.340 of Title 5 (310 CAAR 15.0001 Company Name: All jfA CIE! 57r.0 e- 11)14, Mailing Address: PA. A,;, 17A' :1 -d 149 Telephone Number! 2FC-047 CERTIFICATION STATEMENT I ceeiik that I have perjong1h, nSoec7.ed the se-191? disposal system at this address and that the nioemat,on reooned below is true. accurate and complete as of the time of inspection The irisoect,on was oerfo,med based on my training AMC e%l5eP,eMC(i in the Proper 'UALI-Cr AMC maintenance of on-sae se,vage disposal jvSjgM,%s The mien Conditionally Passes 1-eeds,Fuflhel Evaluation By the Local ApprOving Aulhofpl% ,inspector's SISMAturt: __t�"=`uty � Date: ihlnv (301 days of completing this The System Inspector shall submit a coov.of this inspect-on report to the AOpfOv.m& Aulhof-h within o inspection If the system is a shared System of has a design (low of 10.000 god of greater. the insoeClof and the system owner shall subm-t the report to the appropriate regional OH-ce at the Department of Environmental Protection The original should be sent to the System owner and cooies sent to the buyer. 11 applicable. and the approving authority INSPECTION SUMMARY: Check A, 8, C, or D Al SYSTEM PASSES: 600---1 have not lownd any information which indicates that the system violates any of the (allure criteria as delined in 310 CMR 15.303 Any failure Criteria not evaluated are indicated below COMMENTS 91 SYSTEM CONDITIONALLY PASSES: One or more system components as described in the "Conditional Pass- section need to be replaced or reoved The system, upon Completion Of the replacement of repair, as approved by the Board of Health. will PASS. Indicate yes, no, of not determined (Y. N. or NO). Describe basis of determination in all instances. If"not delerrilined", explain whY nO1 The septic tank is metal. unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance tartached) indicating that the tank was -ristalleld within twenty (20) years prior to the date of the inspection, of the septic tank. whether or not metal• is cracked. structurally unsound, shows substantial infillfallcm or exislitatiam. or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a Confofm,ng Septic tarilt as approved by the 8oard of Health. trGVL&gd 04/25191) Pik-go 1 at 10 DEC-21-98 11 :29 AM Somebody Else Septic Inc 1 508 896 8557 P. 02 • `Z SUBSURFACE SEWACE DISPOSAL SYSTEM INSPECTION FORM PART A 1 J CERTIFICATION (continuedl Property AddreS$: 80 CAerrriweep Lft owner: M. Date of Inspection: I'Llal 8 81 SYSTEM CONDITIONALLY PASSES 'cony OC' Sewage baCkuo or breakout or high slal,C wale' level observed in the d,str,bul,on boy is due to broken or obstrvcted oi0em or due to a broken. senled or uneven distribution box The System will pass inspection ,1(with aooroval of the Board of Healthl Describe observations broken pipets) are replaced obstruet,on ,s removed dislribvi,on bo,, ,s levelled or replaced The system required pumping more than iour times a year due to broken or obstructed P3pe',Si The Svstem will Days msoecl,On ,f lw,th aporo,at of the Board or Health, broken pipe-s, are reolaced obsirun,on is remo%eo C1 FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions ex.S1 which reou,re further evaluation by the Board of Health in order to determine ,f the s�lslem+ ,s(ailing to protect the publ'c health. salety and the environment 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ Cess000tjor privy is vr,th n SO feet of a surface wale' Cesspool or privy is w,th,n 50 leer of a bordering vegetated wetland or a Sall marsh r 21 SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER. IF APPROPRIATE) DETERMINES THAT THE SYSTEM 15 FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ The mtem has a Septic tank and soil absorption Svstem tSAS1 and the SAS -s within 100 feet•to a surface water supply or tributary to a surface wale' supol, _ The Svstem has a septic lank and soil absorption sysrem and the SAS is within a Zone I of a public water supply well The system has a septic lank and soil absorption system and the SAS is within SO feet of a orivate water Supply well The system has a septic rank` and soil absorption System and the SAS is less than IN feet but 50 feet or more from a private water supply well, unless a well water analysis far colifofm bacteria and volatile organic compounds ,rid+cafes that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than S porn method used to determine distance (approximation not valid). 3) OTHER (revised 04/25/91) Page. 2 of 10 DEC-21-98 11 :29 AM Somebody Else Sevtic Inc 1 508 896 8557 P. 03 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 80 eherr'►wocl 4 L4. Owner: )4. jqrr,gift Date of Inspection: 02 109e Dl SYSTEM FAILS: Yo ust indicate e-:'er "Yes'or "10' as to each of the iollowing I have deter-med that the system violates one or more or the following failure criteria as defined in 310 C.I1R 13,303 The bass for this deierm.naaon is identified below The Board of Health should be contacted to deietm-me what wdl be necessary to Correa the failure Yes No Backup of sewage into facil-ty or system component due to an overloaded or clogged SAS or cess000f Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or Clogged SAS or cesspool Static Dowd level in the distribution bot, above outlet Invert due to an overloaded or doggec SAS or cesspool LUqu-d depth in cesspool �s less than 6"below Invert or available volume ,s less than 1,1 day floe Re4uired pump-n$ more than u nines in the last year NpT due to clogged or obstructed pipets' Number of times pumped Any portion of the Sod Absorption System. cesspool or privy is below the high groundwater elevation Any portion of a cesspool or privy K within 100 feet of a surface water supply or iribytart, to a surface water supply Anv portion or a cesspool or pnv%, is w-thin a Zone I of a public well. Any portion of a cesspool or privy is within.S0 feet of a private water supply well. .any portion of a cesspool or prw)• is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quarry analvsts, if the well has been analyted to be acceptable. attach copy of well water analysis for cohiorm baser+a, volatile organic compounds, ammonia nitrogen and nitrate mlrogen, E1 LARGE SYSTEM FAILS: You must indicate either "Yes" of "No" as to each of the following: The following Criteria apoly 10 large systems in addition to the criteria above. VAThe system serves a facility with a design flow of 10.000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one of more or the following conditions exist Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area•MPA) or a mapped Zone 11 of a Public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program re0uirements of 314 CMR 3.00 and 6.00. Please consult the local regional office or the Department for further information (COV1 4d 04/15107) Page 3 of 10 DEC-21-98 11 :30 AM Somebody Else Septic Inc 1 508 896 8557 P. 04 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR.m PART$ CHECKLIST Property Address: $0 ChfFry *0,4 141- Owner: /'t, 'jt40114 Dale of Inspection: JL/iL f Check if the following have been done. You must indicate ether "Yes" or "No" as to each of the following Yes No ✓ Pumping information was provided by the owner, occupant, or Board of Health None of the system components have been pumped for at least two weeks and Ole $\•Stem has be" receiving normaa flow rates Iduring that period. Large volumes of water have not been introduced into the system recently or as part of this inspection VA_ As built plans have bee, obtained and examined Note , they are not avallabte with ti:A Aer _ The facdav or dwelling -as inspected for signs of sewage back-uo gt� _ The system does not receive non•sanaacy or industrial waste flow ✓ The site was inspected for signs of breakout. Alt sysie*+components, e.cludmg the Soil Absorption Swem, have been located on the S,te The septic tank manholes were uncovered, opened, and the rnter,or of the septic tank was inspected for condition of baffles at tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum The Siie and location of the Soil Absorption System on the site has been determined based or% .._ The facility owner land occupants. ti different from ownerl were provided with information on the proper maintenance of Sub-Surface Disposal System. _ N/A, Existing rnformauon.'Ex Plan at 8.0.11. t'1A Determined to the field iu any of the failure criteria related to Part C is at issue, approximation at distance is unacceptable) (15.302(3)ib)) (revitaed 04/23/97) late 6 of 10 f DEC-21-98 11 :30 AM Somebody Else SePLic Inc 1 508 896 8557 P.05 SVOSURaACE SEWAGE DISPOSAL SYSTEm INSPECTION FORm PART C SYSTEat INfORKATION Property Address: jso cherrywo6i Lh owner: M. 4rlMn Date of Inspection: al ialle FLOW CONDITIONS USIDENTIAI_ Design (tow ��e g o d bedroom for S A k Nvmbe, of bedrooms Numbe, of cWrenl residents Garbage grinder lves or nogg Lavndry connected to sysier* tees o,nc:.xtS Seasonal use Iyes or no:IQ %vale, meter reading%. it available oja : *%,'O i., veaf usage ipd, Sump PVmp (yes or not Aa— LASI date of occuRancv AQje CQMMERCIAUINDUSTRIAt� Type of establishmenl Design tto.. ganon Crease trap present +ves 0, no,_ Industrial Waste Molding Tank presen''. (.•e$ at no,_ Non•saniiary waste disChar@ed to the T'r(e i system sues or noj_ Water meter read,ng:• ,f avVabte Last datj• of occuctancy OTHER: :Oescrjbe- last dare Or occupancy GENERAL INFORMATION PUMPINC`RECORDS and source of ,ntormation net sJ'er �ytnep System pumped as pan Of -nsoecs(on teens or�nol f,R If yes. volume Ovmped Ian_gallons Reason tot Dumotng 83AL09ied TYPE Of SYSTEM Septic lank/distnbution box/so-I absorption system Single cesspool Overflow cesspool Privy . Shared system(yes or nol Irf yes. attach Previous inspection records. d anyi I/A Technology etc Copy of up to date contract) Other APPROXIMATE AGE of all components. date installed [if known) and source of information 9 91 S SUELf Sewage odors detected when afr(vmg at the site Ives or no) 0 ITSVISed 04/25111) Peg* 5 of 18 DEC-21-98 11 :30 AM Somebody Else Septic Inc 1 S08 896 8SS7 P. 06 SUBSURF.kCE SEWACE OISPOSAL SYSTEM INSPECTION FORM PART C , SYSTEM INFORMATION tcon+inuedl Properiv Addresf; A0 Cher1-'VW0d j LA. Owner: Ms orffhm Date of Inspection: 121/2.'ev8 eUIt01NC SEWER: ILOcale On sae plan Depth belo- grade Material of COnsltup-or� ca>. ,v^ mil}P�C —other .e%pla-n Distance from private waler supply well or SuCoOn line Diameter Comments iconddion of to-m(s, ven,,r`g e-ce^ce 0, iea:avl etc glop SEPTIC TANK: L- r (locale on s,le plant n Oeoth below grade Material of construcltom &-foncre:e _metal _F,1QQ,6Iw _POlveth\lene _oihenerola— If tank ,s metal, list age _ Is age Co-^lamed b,. Ce,nl,cale of Compl.anee ,IYes.'-1O• Dimensions )10#0 42i1 -- Sludge depth, - B� Distance from too of sfudt:e to bon WHIP* er- of ourle. lee o, L_ Scum thickness-� Distance tram too of scum to top Or owlet tee Of bah)e Oistarlce from bottom of scum in bonom of outlet tee Or barite How dimensions were determined ro :Furs Comments !recommendation for pumping. conC,non o, inlet and outlet tees or baffles. depth Of I.ou,d Ievef rn William to pullet invert. structural integrity, evidence of leakage, etc, r GREASE TRASA' (locate on site Depth below grade._ Material of constryctian: _concrete _metal Fiberglass ,,,,_Polyethylene _Othertexpla,nl Dimensions: Scum thickness. Distance from lop of scum to lop of ovi'let tee or baffle. Distance from bonom of scum to bonom of outlet lee or baffle Date of last pumping Comments: (recommendation for pumping. condition of inlet and outlet tees or baffles, depth of Itowd level in relation 10 outlet inven. structural integrity, evidence of leakage, etc I (revised 04125/97) Page 9 et IQ DEC-21-98 11 :31 AM Somebody Else Septic Inc 1 508 896 8557 P. 07 SUBSUR(.►CE SEV%'AGE DISPOSAL SYSTEM INSPECTIOti FORm PART C / SYSIEM INFORMATION (continued) Property Address: 490 CAerrr eveseld 1A, Owner. M. iOA N Date of snspe �on: TIGHT OR HOLDtNC TANK: bank must bC OvfflOCtl prior to Or at l�m�, di +nsPOClfOr" (locate on site plant Oepth below grade = material of COnstruCtion _Concrete ,metal !Fiberglass _Patjeihylene _01herle%plami O'mensions Caoacicy gallon• Design how galionvda% Alarm level Alarm .n +.Ofk+ng prde' es. _ No Date Of previous pumo,mg Comments tcond+tfOr of rniet tee COnduoom of ala,m and float s-1ches VC DISTRIBUTION eOx-ko— !locate on site plan! Depth pi h u,d level above outlet +mvem Comments (note .f level and distribution is equal, euldence of solids c ervovef. evidence of leakage into or out of box, etc M/r &A Cs — rd �l0D PUMP CHAMBER:-9A (lOCate on si(e plant Pumps to working order: (yes of No) Alarms to woekimg order (Yes Or NO) Comments. (mate Condition of pump Chamber, condition of pk+mps and appurtenances. etc) (reviled 04/11/911 page I of 10 DEC-21-98 11 :31 AM Somebody Else Septic Inc 1 508 896 8557 P. 08 SuESURFACE SFWACE OISf OSAL SYSIVA INSPECTION FORm PART C / SYSTEM INFORMATION (continued) Property Address; Bt? cAerryat�lOp4 In r Owntr: K �i'ft-0a Date of Inspection:1298 SOIL ABSORPTION SYSTEM (SAS):-L--� (locate on we plan. if possible, etca,alion not ,eoweed, but ma. be aporox-mated Is nOn-tnttulwe method: If not delerm.ned to be ptesem. exolJ-n Type 6 x 6 precasr leaching pas. number leaching chi-bens. nw^be, leach-mg galleries. nvr*iber Ieachtng itenches, number,tengii, leaching fields, number. cl-ertston� ovet{low cesspool, number Alternative SVStem Name of Tethnologv Comments (note condition of sots. signs of hwdraufiC I.Vure. let'ei 01 pond.^$. COndtl-0n of vegetation etc i CESSPOOLS: 00 Ilocate on site Number and COnfigurat,cin 'Depth-too of liquid to inlet inver-- Depth of solids layer. Depth Of sturn layer Dimensions of cesspool materials of Construction Indication of groundwater inflow(cesspool must be pumped as pan of inspeaionl Comments Inole Condition of soil, signs of hydraulic faifute. level of pond-S, condition of vegetation. etc PRIVY:A A (locate on site plant Materials of construction: Dimensions Depth of solids: Comments: Incite condition of soil, signs of hvdraulic failure. level of pondtng. condition of vegetation. etc t (revia•a 0•/25i97) Polo 4 of 10 DEC-21-98 11 :32 AM Somebody Else Septic Inc 1 508 896 8557 P. 09 • 1 SUBSURFACE SEWAGE DISPOSAL SYSTE+a INSPECTION FORM PART C SYSTEM INFORMATION tcontinuedl Proptrly Address: $D Ghanry«raa� ZA' Owner: M. 4itf.#I' Date of Inspection: /t//119a SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to it least two oermanent reierences landmarks or benchmarks ►ovate all wells within 100' (locale where public water suoply comes into house) EA g. 1 1 L 3. Al- 331 A2.- +4! 8 Z- 44 r 37' tfevissd Pal. 9 of 10 f DEC-21-98 11 :32 AM Somebody Else Septic Inc 1 508 896 8557 P. 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR.m PART C SYSTEM INFORMATION (continued) Property Address. 80 Cberry&*oj Ith, Owner: M, Qrr;.AM Date of Inspection:j2/It/la Depth to Groundwater ;/SFeei Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans an record Observation of Site tAbun,ng property, obsen•a(,on hole, basement sump etc.) Determine ,t from local conditions Check with local Board of health _J!f1fFeck FEMA maps Check pumping records Check local excavators, installers ✓4se USGS Data Describe in your own words how you established the High Groundwater Elevation. (Must be completed) fii4. oc ado ± Eiev. 8"O Ore u nl w4 tdr ±'07e✓. I tssvis•d page to of to No. a"1 � � Fee I " THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ftphration for Disposal 6pstem Construction 3pPrmit Application for a Permit to Construct( ) Repair()4 Upgrade( ) Abandon( ) ❑Complete System Individual Components Location Address or Lot No. go C4Elk"wo6t? Curia O ner's Name,Address,and Tel.No. t��tc� MvR�Y Assessor's Map/Parcel (gt4 f LOIXIOIX M[AqPLY ST Installer's Name,Address,and Tel.No. 508-q7 7—8FS77 Designer's Name,Address,and Tel.No. 15 c1 s-r Type of Building: .3z, k, -- ,� 9 Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures CA Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 804AcE LcyG7 Ric. Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date Application Approved by Date —l�/ — r`7 Application Disapproved by Date for the following reasons Permit No. d 0 Lf `l Date Issued 0--to —r f i No. Fee THE COMMONWEALTH-'OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE MASSACHUSETTS 2pplicatlon for Misposal *pstrm Construction permit µme, Application for a Permit to"Construct( ) Repair()0 Upgrade( ) Abandon( ) ❑Complete System XIndividual Components Location Address or Lot No. go..0 N:"Wo6t? (40 c Owner's Name,Address,and Tel.No. ... PErcu. M vR�\( Assessor's Map/Parcel Oaf 1 O rx O 12- M M qPLYA4pn o s-r w[tD i)cG&Ato Installer's Name,Address,and Tel.No. 508—q l 7—82-7 Designer's Name,Address,and Tel.No. _ I S Gvcu cj sT tt4A-s - M - Type of Building: �� / — �;J y Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) -- Other Type of Building No.of Persons Showers( ) Cafeteria( ) i Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank 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 Environmental Code and not to place the system in operation until a Certificate of_ Compliance has been issued by this Board of Health. >. Signed CC Date x Application Approved by Date ) (0 Application Disapproved by Date k for the following reasons t Permit No. d L `t Date Issued i THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that.the On-site Sewage Disposal system Constructed( ) Repaired( x) Upgraded( ) Abandoned( )by C� A F E W I D GE ' DJ7Z;k?6J SAS C L C_ at 9Q C)J M iM, has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No 9D N-`17 4 dated Installer P&(,&>1n Designer f #bedrooms N Approved design flow / 1^ gpd The issuance of this permit shall not-be c nstrued'as a guarantee that the system will�n iT it p {]� f � � }� g y fu�.,�on as d�estg��{e�d. Date 9 t ' r� 1 Inspector r , ,r � ; rt it ---------------------------------------- -- No�U��'" L�� Fee IIJt� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS ]Disposal *pstem Construction i3ermit Permission.is hereby granted to Construct( ) Repair( Upgrade( ) Abandon( ) System located at R 0 Gkfsv Alf woa 4.Ayag and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. I Provided:Construction must be completed within three years of the date of this permit Date 2 U Approved b y PP Y I No..... . ....... THE COMMONWEALTH OF MASSACHUSETTS �a I•, BOARD O�F HEALTH --7_ c w- ..............OF....�,�'�` —4R? j ..................................... � —7—I 75 lb Appliration for Bi-spnsaal Works Tonstrndiun ranfit Application is he ay made for a Permit to Construct ( �r Repair ( ) an Individual Sewage Disposal S stem at: , I- w® . . .............. p 1 ' � LQ �A .. ----•-•-•--•..................... --------- ........ a i ss orWo. .�� ;.. Owner Address W Installer Address d Type of Building Size Lot___. �9z..__...Sq. feet V Dwelling No, of Bedrooms..................,........................Expansion Attic ( ) Garbage Grinder ( )`4 Other—Type e of Building ............... No. of ersons_.._.__.____.....__.._..__._ Showers p,, yp g _____________ p ( ) — Cafeteria ( ) a' Other fixtures ............................ . W Design Flow................ ......................gallons per person per day. Total �ily �ow................z�................gallons. WSeptic Tank—Liquid'capacityl...___.'�_.gallons Length. -b.... Width- .'_(6___ Diameter---------------- Depth...Jr_- ., x Disposal Trench—NhJ�o. .................... Width....._....._...... Total Length....... _._. Total leaching area............___.....sq. ft. Seepage Pit No....... .i........... Diameter... _ Depth below inlet..?---D.......__ Total leaching area.ar�_^�r . z Other Distribution box (L-)" Dosin ank (} ) / '—' Percolation Test Results Performed by.... - P1._ _: -1 f"-•--- Date.- _0��..1��.�9 1 W l -„ � Test Pit No. 1....:._.........minutes per inch Depth of Test Plt._1 EL-0.___.. Depth to ground water,'lwCh v� fs, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 ••••----------------------------•--•----............-•-•-•-----•--------..._......--•••-•-----------......................................................... 0 Description of Soil........................................................................................................................................................................ x U --------------------------- •--------------- ---------- _------------------------------------------------------------------------------------------------------------------------- --------------- W UNature 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 TITi L 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the boar of health t Signed-- -- ................. ...... ...... /_4 l.._ a• Date Application Approved By.............�)��•-Y- � 1r= e _ 1... Dat Application Disapproved for the following reasons:............................................--.................................................................. .----------•-•------•--------•---•---••-•-...._......•--------••---••-----•-------------------------------..•---••------•-•--•------••----------------------------•-------•-•-----------------•---•••-••-- Date PermitNo.....g --•----------------------- Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TO.Lvj.............OF.... = -" ' Allp iration for Biapwial Workii Tnntitrnrtion ramit Application is hereby made for a Permit to Construct ( �r Repair ( ) an Individual Sewage Disposal S stem at ........OT....:!:..J�. �.........r'°.�...�. s?j 11�ICa IK !A .... ,i f2 )0 .p �^ I�6atio'•fjddress or IYo. Owner Address W Installer Address Type of Building Si� ......Sq. feet Dwelling No. of Bedrooms.............�..........................Expansion Attic ( ) Garbage Grinder ( ) `., Other—T e of Building No. of persons............................ Showers P., YP g -•------•----------------•-• P ( ) — Cafeteria ( ) Otherfixtures .................................................<11 ----- ••---------------------------------------------------•-------------------•------------------- W Design Flow.............r25.................�...gallons per person per day. Total lily flow__._.............Z.-0...............gallons.11 WSeptic Tank—Liquid capacity!��; gallons Length-__u'-1°a .. Width. ,.-_I!�_.. Diameter---------------- Depth...: _.. . x Disposal Trench—No..................... Width...`.yi........... Total Length.......�____..1.... Total leaching area..._....-_____.....sq. ft. Seepage Pit No-------A........... Diameter---l0.'-U._fnk Depth below inlet...6'�........ Total leaching area..-��--__4s�.�t Z Other Distribution box ( ' DosinPercolation Test Resuls Performed by... ' "... ►f4.�. + :3&I,c..... Date-__'j ... ... ............ £� t Test Pit No. 1................minutes per inch Depth of Test Pit.A.."J_...a...... Depth to ground water.t0_.'?n�:.�?'�1� fT. Test Pit No. 2................minutes per inch Depth of Test Pit.............._.__... Depth to ground water........................ P4 ..........................•................................................................................................................................. 0 Description of Soil........................................................................................................................................................................ x V -... ------------------------------------------- --------------------------------------- ------- •------ •----------------------------------- •----------------------------------------- •-------- •-----.------ W UNature 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 TITS 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued op by the boar�Iiealtl Q J Signed.-------- --------------- .� 1/ Date Application Approved By..............``° .... = / r Application Disapproved for the f o.(wing reasons-......................................................................................------ .................. ..----••...........................•---•-•------•-----------•-------------....--------....-••--------------------------•------------------------------------------------------------------------------•- �y Date PermitNo.......A-4 ........................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...............��.. J..........OF........ ,.i.:-`'r r��. ................. Trrtifiratr of TumpliFanre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( /for Repaired ( ) by••---••-----.... -M ------..... ----------------------•-------------------........------------------------------...........------•...........-----....---- p Installer �-• at_... -� o'� ;v` 7 f C "�--------------------------- has been installed in accordance with th provisions of T "_•.I-,: 5 of Tl State Sa.nitary\Code as described in the application for Disposal Works Construction Permit No--------- . ,_ . ._....... dated................................................ THE ISSUANCE OF THIS qERTIFICATE SHALL NOT BE CON E® AS A GBJAANTEE THAT THE SYSTEM WILL FUNC O ISFACTORY. DATE. , ....................... Inspector........ !!L :. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ��- ...1/ ` `''�-�...............OF..........Yrr1�.1?,�. `�� 1.t rl .......................... N0............ FEE._/Al .......... Disposal Vorko Tmntrnrtinn amit Permission is hereby granted......... t �.' � T c -•----------•----------------------------------•-----------•--------------- to Construct A-) or Repair ( ) an Individual Sewage Disposal System atNo. '�.� �•„= s=vim°- �------ � ..........................................•.. Street as shown on the application for Disposal Works Construction Permit No.._-f Dated.......................................... ................................. ---- -----------------------------•- of Health DATE................................................................................ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS APPLICATION FOR PERf:OLATION TEST AND OBSERVATION PITS �®/ a. �, . 4 NO.')07 73 LOCATION KILLAG� ',•.` DATB /l��¢7 APPLICANT ` � =•-� D� CCsL _� - - .; vs (Non-refundable) ADDRESS )7r, TELEPHONE NO. ENGINEER, TELEP110N NO. DATE SCJIEDULED / - • (Applicant's Signature) ............................................................................................................................................................ ASSESSOR"3 MAP & LOT NO: ' SOIL LOG i SUB-DIVISION NAME S 7��.„ Ifve DATE TIME e EXPANSION AREA:,YES NO ENGINEER. 'TOWN.WATER PRIVATE WELL BOARD OF HEALTH BXCA V t►TOR SKBTgIIi.,(Street name, etc., dimensions of lot,.exact location of test holes nn.d percolation tests, locate wetlands In proximity to test holes) NOTBS: r OLATION RATE.:; ' ' HOLE NO: '' ' EELEVATION: TEST HOLE NO: ELEVATION: . 1 1 2 2 3 3 • 4 - ! g ' 6 g • 9 9 • 10 10 , 11 11 12 12 ' J . 13 j 13 ' 14 14 / 15 15 ' 16 ( 16 . • 'ABLE FOR SUB—SURFACE SEWAGE: LEACHING FIELD LEACHING PITS LEACHING TRENC11E5 'N ITABLE FOR Sl1B•-SURFACE SEWAGE. REASONS•! ..�.......••••• ENGINEERING PLANS MUST SHOW. NUMBER. ASSIGNED ON PERC TEST APPLYCATION INAL: COl•IPLHTEU IN ENTIRE'1~Y BY P. E. ANU RETURNED TO BOARD OF HEALTH �= RETAINED BY APPLICANT •� C� 20' MINIMUM OR AS INDICATED ON PLAN NOTES: , 10• MIN, 1: ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.Q.E. MASONRY EXTENSION TO 12' TITLE 5 THE TOWN OF 2,)2�tns RULES AND TOP OF FOUNDATION BELOW GRADE BACKFILL WITH S$ O s4.2 8• MIN. 5'$�.0 SE.o cLEA SAND AND THE REQUIREMENTS OF THIS PLAN. REGULATIONS FOR THE 'SUBSURFACE DISPOSAL OF .SEWAGE;.:: U woo BELO MASONRY ASO Y E,DXTENS10N TO 12• 2. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO i Z WITHIN 12" OF FINISHED GRADE. n ., 40 PVC PIPE MIN.. PITCH i/8" PER FT. ALL MASONRY UNITS USED TO BRING COVERS TO GRADE �MI PI iv 1 4 PER FT FLOW LINE 2' LAYER OF SHALL BE MORTARED IN PLACE. _ 1/8• - 1/2- 4. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE 10' TEE , !OO o WASHED STONE 56 b 3• MIN. OF WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR 's 2- MIN. LEVEL LE WITHIN 10 FT. OF DRIVES OR PARKING AREAS. H-20 LOADING SSA , 4,-0•MM. ✓�+,.3+ ss,7 61 o PIT < 3/4' - 1 1/2• SHALL BE USED UNDER OR WITHIN 10 FT. OF DRIVES OR ' LIQUID LEVEL oisTRleuT�oN s3.o F WASHED STONE PARKING. BOX W 5. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEED RESTRICTIONS OR ZONING 'REGULATIONS. OWNER/APPLICANT SHALL q7'o OBTAIN SUCH DETERMINATION `FROM THE APPROPRIATE AUTHORITY. GALLON SEPTIC TANK \ LOCATION MAP. I Z' 4/ 1 Z ` I z 6. HORIZONTAL AND VERTICAL CONTROL, SEE LEVY, ELDREDGE ASSESSORS MAP 4! PARCEL 7-5- ! & WAGNER FIELD NOTEBOOK # �5�_. LIQUID DEPTH IN SEPTIC TANK DEPTH OF OUTLET TEE BELOW FLOW LINE /O 4 FEET 14 INCHES BOTTOM OF TEST HOLE s FEET 19 INCHES OR USGS PROBABLE HIGH WATER LEVEL 6 FEET 24 INCHES CURRENT ZONING INTERPRETATION: DESIGN CALCULATION SEWAGE DISPOSAL SYSTEM PROFILE _44- MIN. FRONT SETBACK .30 FEET NUMBER OF BEDROOMS �a \\ A 1 l 1 F l hZ/:Z'T', 4? NOT TO SCALE 6z, - &7- MIN. SIDE SETBACK 15 FEET GARBAGE DISPOSAL UNIT rta o�.�c,it c. a w �. I 4(o,cis2 X 330,�33 ta4 = 356 qp4 4,0 MIN. REAR SETBACK /S TOTAL ESTIMATED FLOW W FEET ( //o GAL./BR./DAY X z BR.) Lzo GAL. /DAY 519 REQUIRED SEPTIC TANK CAPACITY GAL. ACTUAL SIZE OF SEPTIC TANK lo2,L GAL. PERCOLATION SOIL TEST LEACHING AREA REQUIREMENTS - SIDEWALL AREA 2,4 GPD./S.F. BOTTOM AREA /, O GPD./S.F. �,.. .._ DATE OF SOIL TEST cI 3uru I99f SIDEWALL /0 S(, 27T( /2)C H )SF x 2,�GPD/SF _ �7 / GAL/DAY .. .. _._S¢ TEST BY Ago F-Qc:n zt.1c BOTTOM 7T ( fb /2 ' SF x /.o GPD SF = 75 GAL DAY 5-4 ._ ... --- WITNESSED BY C• t2arr w 5�. PERCOLATION RATE �'z.J-a MIN.. . 1 /INCH .: Z.G7 _ SF Sam"4 GAL/DAY TEST PIT #1 TEST PIT #2 BREAKOUT CALCULATION: A ELEV. sue. s ELEV.= l —0.00 -0.00 / i f &5 r 41o,9SZ 51- 4 t s �}1c�4iv"1 Sand tiy.. _ 42 LEGEND . EXISTING SPOT ELEVATION OOXO EXISTING CONTOUR-------00----- I5 — FINAL SPOT ELEVATION 00.0 FINAL CONTOUR i 00 TP 1 SOIL TEST PIT LOCATION BOTTOM OF TEST HOLE BOTTOM OF TEST HOLE 54 OR WATER ELEV. Z.S OR WATER ELEV. TOWN WATER ====W W 1t, 2�C . t SEPTIC TANK 00, 4� DISTRIBUTION BOX C7 G / ! v"5 \� \ WATER LEVEL ADJUSTMENT: PRIMARY LEACHING PIT O t/, •� r RESERVE LEACHING PIT ` sZ •. t �, t w TEST DATE WATER LEVEL .3 INDEX' WELL "` D`ti WATER LEVEL RANGE ZONE 9/ INITIAL ISSUE DEPTH TO WATER LEVEL FOR INDEX WELL N0. DATE DESCRIPTION BY ,' ! FOR MONTH OF: u - ) WATER 'LEVEL ADJUSTMENT St-re Des►cos is 5ePT-%,. -?LA 0 s "` L,a T ,a R C H 6--arz e w oa v L. to i= �oG ` AA , DEPTH TO HIGH WATER I 4 \ -FH EO co os-r R ic.-n o o co, =0 c. t�k STEPH:EN ALLYN APPROVED. BOARD OF HEALTH WILSON � �o.,.,�to.4r a-� !o c_r»yc e@ B/15�5'/ a� N 30216 b* Q %oho rwfd�i _twJe g �a►.�tr-q �Ye+st fia N rk SCALE. Itt_ �4- 0i JOB NO. ►5 6 3- ►o A SITE PLAN f« .n�«�ti laird 7/Z4`9/ !C? DATE AGENT gj p° LEVY, ELDREDGE & WAGNER ASSOCIATES INC. PERMIT # BNGDM IDS O ARCRiTBt.'iS PLANNERS LAND SURVEYORS N 889 WEST "MAIN STREET CENTERV= MA 02632 NEW ENGLAND REPROGRAPHICS SUPPLY CO .. ,.. .. ..,, . 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A S TANKa , 1S�'NiBUTIvM1t1XE.� _, /� �y i.EACI*!11d p1TSHALL BE DESIGNED FOP !-! '`.) �/r+Et. . r f SAND — T—— V-- , }, ' ._10AD+NGS WHEN N UNDER PAVING SOME - j--Y--___ -- ---; i '► -� .�. > p, 5. REMUVE AL_t` o'NSU �ALk_F MATERIAL gE AT T HE t; ' 3' 'a f�: INVERT ELEVA'T IONS � f 4E i E��t•ItNC 'PIT FOR GRAVEL ..� I TYPICAL DISTRIBUTION R±.�X i a� �i ¢ L; :` 0(1 A DISTANCE ::}F 10F T ANE' �i��,�rlt_�. w�:�+ •- I 1 '_ t 1 - --- E '�RiEE SAND 15 GRA[,E-L -1AV VING A Pt?R ,.A`04 R t- � l.,r 4i.�.. �'. _�.,,._- _ - - O G Mi NUTFS ""Ek INCH l� Lf54S. t' f5.0' 1 EL,=42+50 _ ` �_ � -j•, - - ' _.___:.�'� - ►. 1/OlE DISTRIBUTION BOX AND 1000 I 6 T► E TOWN OF BARNSTABLE BOAR'1 ,;F HE At-T -i M:-. NO WATER ENCOUNTERED ___ TANK 8Y 9E NOTIFIED Wr" '+ THE SYSTEM IS NEAR �_ET''�t ! Y-40 SA` REINFORCED SEP7KC � ;A'_ 1000 PTIC; TANK ACME 'PRECAST OR EQLJA: TYF'I CAI._ LFAC�t�G P4T arlD PRIOR Tn Hac�tl+,�� rN� a ,. , k '.UNLESS OTHERWISE �10rE0 ALL SY`i?F•Al! 'S s B9'36'37'IV i'YOT TO SCAL f SHALL. BE INSTA.E�-ED 'N ACCf3RI:�t�ICE VY!TFi TIT°�. � f� ' > ;;�+ �'i )' �•� > 2 min/inch 107' )� t 10 CAE THE STATE SANITARY C06C ! fiD AK I:. Ya.. , .�+'vC:'';. �1de� , {. ED BARRY VV.,rf TAkKl `, RE 'NF'�C Er✓� rN140UX;HOUT W! T� 12 t�k1t.ES WNfCH MAY APPLY BARNST�IBI.E �aJ -a E�ErTR'C •NEk_DEr� *jf?E WITH 24-�!/2 � i f �Nf�.hSE:t:R trc err ENIB :Dt)Et� STEEL_ RCS IN COP 8 c 68 8 Ci;NTR,s►�T3R IS TO N1;fi'IY ENGt_h1t, ;Ir} T'I E ,. �NSTALLATIO k OF SFPT!C SYSTEM, O AW VWK _ _ 'i K\i' F\,G, R i N 5� �' 4 - ...:+-�� „yid a k@, ' TCW, -0KRETE ,1 4,+M PIS I � f�/� DATE JUNE 1I, 1991 66 ANCIES ET1�tEP!v I ESQ Pr. R R_TS AND FWWE�.I_i Q / 64 u. At'CESS N1IJt..ES ''J S ,P'T►C 'TAWS A E I1,.: _ ?tTS X BE BUILT UP TO 12 INCHES � F " GRADE: 1 q r 10. "i H ARROW IS ^SOT TO BE USEL FOR ..AIR P„,.pP!�E'r -r 1 TOP Q 60 r , -'�--rELE 00 INi'sH r---F•IN!SN GR'DF FINISH GRACE OVER LE-A0ZINC .".DF 0`>r'ER OVER 5:f'+ Ei X AREA E�.EV - 5T+00 % t "•: r. S6.00 _L E': 54.50 RQLJNL LOT /08 5 E L_ti 56.00 a �" I V , ( ER c�q ; Nfi Fi� �� _. _ r , ._.- ,*..__., .. RISE 'f/C `<° ,�'• -r�h ,� .p' }N'vi" lS3.70 � ..._ _i_�� t iAs`,n �2•a0 — - 19 ti� 52463 1000 -' �'R' 56 54 46+50 48 46 TYPICAL SEWAGE - SYSTEM PROF1 LE - 44 t 50 LEGEND f{is A J t« EXIST C.4N TOt1R MAP z� T I « .: . ; PROPOSED CONTOUR -------�- -- __ _ _. _� _ - _ f 3. F'OST SPCT EL.EVAT)ON 8 X.0 _A 4 6952_sf , moo ♦ / PROPOSE, SP! IT ELEVATION .F" 0� / -1 PE AT i:)N TEST - ?CNN#�3� G f}4STR T Fitr. #AA�tC � oT � � � -j Q RF 21 P OEAVAr ION PIT 0 kr # N G ClY P , .E D k._��'�. AT I.ON OF DW L INC DESIGN CRJERiA - O ...___.. ..._ ...__ . '� <„ p _ } f;i+1+.i. C_ t Spo wit/ �•4i.._ g 4 a a E. •�ERS(;tU et ?aw+ LOT I OA KERRYWOOD CROSSING r �7 .I �N PER '.} �J�N � � 1/!y� «• ./ ,K,r>Q r,' Q ' Z A� _C S 22o d �z ' - COTUIT (BARNSTABLE) MA. Al, � � 9'r_ LEACHING ffiE0A.1+Rf_:D 9P � � � LEACHING PR0VIDEC 366.6 gpd NO . ., 7r'Ai.. .__..... .. ....a,rr......•.«.._, ...,.._..».._....•_.... ..r..r.,wr.w+,...•.,.+v.•.....•«.....,.....w..«...- .. ,.:., rt gyp• 1 l �a TNEO C�`�NSTRUC'T F ; \pi \ 'E O > r ' '' 'I�'` ; ba ,�-, IGN CO ARa ENGINEER,NG iNG. h _ /I �� N J r _ r�� . : . --�•. 24 GKE,AT POND DRIVE 39 Sl R!f'ER LANE - �� q�- _ SM1rARMOUTH, MA, 02664 E_ ylrAl_MUIfTh MA. 02536 2nx5x6x1.67 = 314.6gpd , ...... -. ... . ,: a� '52x 0.66 = 51.8 gpd r: r ,• .- i IIO O O BID ..� y llt:2siE; '� a _ GPD AS SHOWN ._.. 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