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HomeMy WebLinkAbout1310 OLD STAGE ROAD - Health 1310 Old Stage"Road Marstoris Mills A= 150 — 098 5` 4� - TOWN OF BARNSTABLE LOCATION S b£ 1 of SEWAGE # �009 - 103 VILLAGE M o � l ) ASSESSOR'S MAP & LOT ISO - 98 ' INSTALLER'S NAME&PHONE NO. Q£ 2 £xeAvA-r-rary q?7- 0GS3 SEPTIC TANK CAPACITY /000 ga�_���OgwIIU� �CA LEACHING FACILITY: (type) Sionc ;iclok (size) '1S X30 NO. OF BEDROOMS S BUILDER OR OWNER PERMITDATE: S- a - 0 9 'r- - 'COMPLIANCE DATE: S-al -O 9 " 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 Wedand and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by At- 28" B� - 11 A-Z B2_fig A 3 $3 Aq ' OO 3y-27 d . CS r DS c6-9Y � b /so -090 Commonwealth of Massachusetts ,z Title 5 Official Inspection Form �y Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1310 Old Stage Road p�, u Property Address John Paul Lotz Owner Owner's Name information is '�A/� Ma 02632 5-15-19 required for every 1', _ page. City/Town State Zip Code Date of Inspection y Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information O� on the computer, Brett Hickey use only the tab key to move your Name of Inspector cursor-do not B&B Excavation use the return Company Name key. 374 Route 130 Company Address Sandwich Ma 02563 aff City/Town State Zip Code ,rm (508)477-0653 S113747 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 16.000); 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. 0 Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails Brett Hickey5-15-19 •`o..:me.os.is ivn:n oem Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system 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 t c Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments l; 1310 Old Stage Road V� Property Address John Paul Lotz Owner Owner's Name information is Centerville Ma 02632 5-15-19 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) 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 was in working order at the time of inspection. The tank was pumped after inspection for maintenance. 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 Commonwealth of Massachusetts Title 5 Official Inspection Form la Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a Road 1310 Old Stage 9 Property Address John Paul Lotz Owner Owner's Name information is Centerville Ma 02632 5-15-19 required for every 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: t5insp.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 f iI Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1310 Old,Stage Road V� Property Address John Paul Lotz Owner Owners Name information is Centerville Ma 02632 5-15-19 required for every page. City/Town 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 ❑ El 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 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 1310 Old Stage Road Property Address John Paul Lotz Owner Owner's Name information is Centerville Ma 02632 5-15-19 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ 0 Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ a Liquid depth in cesspool is less than 6"below invert or available volume is less than '/day flow ❑ Q Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ El Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ a 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. ❑ E] Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ El 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.] ❑ 0 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 l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 c� Commonwealth of Massachusetts Title 5 Official Inspection Form I s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1310 Old Stage Road Property Address John Paul Lotz Owner Owner's Name information is Centerville Ma 02632 5-15-19 required for every 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 El ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ El Were any of the system components pumped out in the previous two weeks? El ❑ Has the system received normal flows in the previous two week period? ❑ Q 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) ❑ E] Was the facility or dwelling.inspected for signs of sewage back up? 11 ❑ Was the site inspected for signs of break out? ED ❑ Were all system components, excluding the SAS, located on site? El ❑ 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? ❑ 0 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: 0 ❑ Existing information. For example, a plan at the Board of Health. . ❑ El 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)] l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 r Commonwealth of Massachusetts I Title 5 Official Inspection Form 11 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1310 Old Stage Road Property Address John Paul Lotz Owner Owner's Name information is Centerville Ma 02632 5-15-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: 5 Number of bedrooms (design): Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 555/GPD Description: 8 Number of current residents: Does residence have a garbage grinder? ❑ Yes El No Does residence have a water treatment unit? ❑ Yes 0 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 F!] No Seasonal use? ❑ Yes (E No See below Water meter readings, if available (last 2 years usage(gpd)): Detail: 2018- 112,000gallons 2017- 70,000gallons Sump pump? ❑ Yes X No Current Last date of occupancy: Date l5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 Commonwealth of Massachusetts �m ,/p Title 5 Official Inspection Form w� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1310 Old Stage Road Property Address John Paul Lotz Owner Owner's Name information is Centerville Ma 02632 5-15-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: NA 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: Owner- last pumped 2 years ago Was system pumped as part of the inspection? ❑■ Yes ❑ No If yes, volume pumped: 1000 gallons tank size How was quantity pumped determined? Reason for pumping: maintenance after inspection t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts �o Title 5 Official Inspection Form ; Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1310 Old Stage Road ur Property Address John Paul Lotz Owner Owner's Name information is Centerville Ma 02632 5-15-19 required for every page. City/Town 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. El Other(describe): Tank, pump chamber, d-box and SAS Approximate age of all components, date installed (if known)and source of information: 2009 per plans Were sewage odors detected when arriving at the site? ❑ Yes ❑■ No 5. Building Sewer(locate on site plan): 3' Depth below grade: feet Material of construction: ❑ cast iron ❑■ 40 PVC ❑ other(explain): Town water Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 cam, Commonwealth of Massachusetts �m ,p Title 5 Official Inspection Form 1. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1310 Old Stage Road Property Address John Paul Lotz Owner Owner's Name information is Centerville Ma 02632 5-15-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): 2' Depth below grade: feet Material of construction: X 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 1 Dimensions: 000gallons 10of Sludge depth: 2411 Distance from top of sludge to bottom of outlet tee or baffle 511 Scum thickness 611 Distance from top of scum to top of outlet tee or baffle 11" Distance from bottom of scum to bottom of outlet tee or baffle measured How were dimensions determined? Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): The tank was in working order at the time of inspection. The tank was pumped after inspection for maintenance. t5insp.coc-rev.7/26/2018 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts �m Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ` 1310 Old Stage Road Property Address John Paul Lotz Owner Owner's Name informatio-i is Centerville Ma 02632 5-15-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): NA 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): NA Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 c Commonwealth of Massachusetts �M1 Title 5 Official Inspection Form w Subsurface Sewage Disposal System Form -Not for Voluntary Assessments V 1310 Old Stage Road Property Address John Paul Lotz Owner Owner's Name information is Centerville Ma 02632 5-15-19 required for every 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): Oil Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.,): The d-box was in working order at the time of inspection. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 r— Commonwealth of Massachusetts �e Title 5 Official Inspection Form i nsp Subsurface Sewage Disposal System Form Not for Voluntary Assessments � 1310 Old Stage Road v Property Address John Paul Lotz Owner Owner's Name information is Centerville Ma 02632 5-15-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: Q Yes ❑ No* Alarms in working order: Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Pump chamber, pump and alarm were all in working order at time of inspection. * 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: ❑ leaching galleries number: ❑ leaching trenches number, length: 30'x25' Q leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments I; 1310 Old Stage Road Property Address John Paul Lotz Owner Owner's Name information is Centerville Ma 02632 5-15-19 required for every 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.): The SAS was in working order at the time of inspection. No evidence of past back up was observed. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): NA 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.): II '� t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 r Commonwealth of Massachusetts Title 5 Official Inspection Form I a Subsurface Sewage Disposal System Form Not for Voluntary Assessments � 1310 Old Stage Road v� Property Address John Paul Lotz Owner Owner's Name information is Centerville Ma 02632 5-15-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): NA Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/2 612 0 1 8 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 .. Commonwealth of Massachusetts �m Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u 1310 Old Stage Road Property Address John Paul Lotz Owner Owner's Name information is Centerville Ma 02632 5-15-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑■ hand-sketch in the area below ❑ drawing attached separately TOWN OIL BARNSTABLE LOCATION 13,ip n. D S rA SEWAGE # 2gD`�> l VI LLAGE C'cry l cr v;I 1 .ASSESSOR'S MAP& LOT_/sa - 98 INSTALLER'S NAME 8c PHONE NO, xcAvil-r SEPTIC TANK CAPACITY Zoom r ) LEACHING FACILITY: (type) Sons ipik. ;;"c)ol (sized NO.OF BEDROOMS S" BUU-DER OR OWNER scan `t_altic l<x rti PERMIT DATE: S -/a` D 9 CONIPLLANCE DATE. S 1 C Separation T7istance Between'the: 1-Iaximuni Adjusted O:oundNvater Table t,the B<;ttotn of C aehing:F tcilit) Feet Private W atzr S.upp1y W,'ell and Leaching F actl'ty {Lt'ary wells exist gnslte 0r within;200 feet cif leach%ag facility) Feet Edge of'Weiland and Leaching Facdiry(If any:wetlands exist ivitlun 300 feet of leaching facility"). Feet Ftir bti Al ' A 2 In ° Ay' a CEO I Bq CS Ds' 5 S Q F. t5insp.doc-rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 c Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1310 Old Stage Road Property Address John Paul Lotz Owner Owner's Name information is Centerville Ma 02632 5-15-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ■❑ Check Slope ■❑ Surface water X Check cellar ❑■ Shallow wells Estimated depth to high ground water: SAS 6.3' above ground waterfeet Please indicate all methods used to determine the high ground water elevation: 0 Obtained from system design plans on record If checked, date of design plan reviewed: May-8-09Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database -explain: You must describe how 9 you established the high round water elevation: Y 9 A plan on file at the local Board of Health was used to determine high groundwater. 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 c Commonwealth of Massachusetts �s Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1310 Old Stage Road u Property Address John Paul Lotz Owner Owner's Name information is Centerville Ma 02632 5-15-19 required for every 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 Commonwealth of Massachusetts f 15 b 09 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments C 1310 Old Stage Road (-- Property Address John-Paul Lotz y V Owner Owner's Name information is required for every e tS� 1�13 Ma. 02668 July 7, 2016 a. page. City/Town , State Zip Code Date of Inspection m Inspection results must be submitted on this form. Inspection forms may not be altered in any m way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms on the computer, ]� 1 use only the tab 1. Inspector: ,y t key to move your cursor-do not Thomas Roux use the return Name of Inspector key. 1�1 Company Name 89 Mayflower Lane Company Address East Wareham Ma. 02538 Cityfrown State Zip Code 774-678-9066 S14531 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 b the Local Approving Authority Y PP 9 Y 4� 2,/, S Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �N 1310 Old Stage Road Property Address John-Paul Lotz Owner Owner's Name information is West Barnstable Ma. 02668 Jul 7, 2016 required for every Y page. Cityfrown 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: ® 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: 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 Commonwealth of Massachusetts Tile 5 Official Inspection Foam Subsurface Sewage Disposal System Form -Not for Voluntary Assessments b 1310 Old Stage Road Property Address John-Paul Lotz Owner Owner's Name information is West Barnstable Ma. 02668 Jul 7 2016 required for every Y 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 (cunt.): ❑ 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): s El 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 Heath): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3113 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 r 1310 Old Stage Road Property Address John-Paul Lotz Owner Owner's Name information is West Barnstable Ma. 02668 Jul 7, 2016 required for every y page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: "*This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6° below invert or available volume is less than day flow t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1310 Old Stage Road Property Address John-Paul Lotz Owner Owner's Name information is West Barnstable Ma. 02668 Jul 7, 2016 required for every Y page. Cityrrown 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1310 Old Stage Road Property Address John-Paul Lotz Owner Owner's Name information is West Barnstable Ma. 02668 Jul 7 2016 required for every Y page. Cityrrown 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? ❑ N 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): 5 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): +550 gpd t5ins-3/13 Tile 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 official Inspection Foam Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1310 Old Stage Road Property Address John-Paul Lotz Owner Owner's Name information is West Barnstable Ma. 02668 Jul 7, 2016 required for every Y page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 8 Does residence have a garbage grinder? ® Yes ❑ No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No current Last date of occupancy: Date Commercial/industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1310 Old Stage Road Property Address John-Paul Lotz Owner Owner's Name information is West Barnstable Ma. 02668 Jul 7, 2016 required for every y page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ❑ Septic tank,distribution box, soil absorption system ❑ Single cesspool ❑ 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): septic tank, d-box, pump chamber and SAS. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °y 1310 Old Stage Road Property Address John-Paul Lotz Owner Owner's Name information is West Barnstable Ma. 02668 Jul 7 2016 required for every Y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 7 years, As-Built plan dated 5/12/09. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1.75' feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: +10'feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: .75'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: 10.51 x 5.67'W 5.67'H Sludge depth: 2' t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 official inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1310 Old Stage Road Property Address John-Paul Lotz Owner Owner's Name information is West Barnstable Ma. 02668 Jul 7 2016 required for every y page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 30" Scum thickness 3" Distance from top of scum to top of outlet tee or baffle 1" Distance from bottom of scum to bottom of outlet tee or baffle 19" How were dimensions determined? measured Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): The septic tank needs to be pumped out. Remove, clean and replace the Zabel filter at the outlet end of the septic tank at the time of pumping. 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-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts TIT 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 1310 Old Stage Road Property Address John-Paul Lotz Owner Owner's Name information is west Barnstable Ma. 02668 Jul 7 2016 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order. ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): ' Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1310 Old Stage Road Property Address John-Paul Lotz Owner Owner's Name information is West Barnstable Ma. 02668 Jul 7, 2016 required for every Y page. Cityfrown 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 clean and free of solids. The D-Box is under the stone driveway.The D-Box is H-20 loading. 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.): Pumps and pump chamber are in good condition. * 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: The septic tank, pump chamber and d-box are all functioning correctly. Therefore,the SAS is draining correctly. t5ins•3/13 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 1310 Old Stage Road Property Address John-Paul Lotz Owner Owner's Name information is West Barnstable Ma. 02668 July 7 2016 required for every > page. CitylFown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: 5 c@ 30'+/- ❑ leaching fields number,dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): No evidence of hydraulic failure. Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form: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 b 1310 Old Stage Road Property Address John-Paul Lotz Owner Owner's Name information is, West Barnstable Ma. 02668 Jul 7 2016 required for every West page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 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 Forth:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts - Title 5 Official inspection Dorm Subsurface Sewage Disposal,System Form-Not for Voluntary Assessments 1310 Old Stage Road Property Address John-Paul Lotz Owner Owner's Name information is required for every West Barnstable Ma. 02668 July 7,2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system,including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately At- 28' �, A BI - q2., �s- At_ 2G` ez-38' A3- i B3_ 23.5 A4- 32.' . Do BY' at # 1 CS' 73` r I -2 4>5 —...� t7 i I i j I, I' I i l t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 15 of 17 i Commonwealth of Massachusetts Title 5 Official inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1310 Old Stage Road Property Address John-Paul t_otz Owner Owner's Name information is West Barnstable Ma. 02668 July 7 2016 required for every + page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: +10' 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: ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database- explain: You must describe how you established the high ground water elevation: Elevation of the SAS, in relation to the surrounding terrain would indicate that the depth to groundwater is greater than 10'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 r Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 'f 1310 Old Stage Road Property Address John-Paul Lotz Owner Owner's Name information is West Barnstable Ma. 02668 Jul 7 2016 required for every y page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 r s No. �L 60 1 Fee THE COMMONWtALTH'OF MASSACHUSETTS Entered;n computer: —1C PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pplitation for Misposal ttm ConstCULtlon i3ermit Application for a Permit to Construct( ) Repair( ) Upgrade Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 13 1 O 0 LD 5 ,A O, er's Name,`Address,and Tel.No. ( - `f q_2$(,v Assessor's Map/Parcel � �"` - -cA b ( 1D LO5.1 g.,E pn w . Installer's Name,Address,and Tel.No.6 DES• 1 1 7.065-S Designer's Name,Address,andlel.No. .5Q ?`3 L Z-4,5141 B-t 13 X XqCLitv(1—�p y IC.toy 'JocixlCCc�e Enc ,neer,r-t \ Cc r Type of Building: J C Dwelling No.of Bedrooms J Lot Size z sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 550 gpd Design flow provided gpd Plan Date - , Number of sheets Revision Date Title 1 1+tt J �j,e ITI n n 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. 4f Signed Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. �Lo0 Date Issued 5-1 2 s d _4 f —4. Fee SETTS Entered in computer: THE COMMPNW&A Al��Vj_X)F MA�SSACHU C�rpp Yes PUBLIC HEALTH DIVISION -TOWN 0.F.BARNSTABLE, MASSACHUSETTS application for Milqoial bpotem Construction permit T Application for a Permit to Construct Repair Upgrade('-j/A6andon E]Compleiie System E]Individual Components Location Address,or Lot No. 3 10 0 l D 54 Cyr O J2U mi I f Owner's Name,Address,and Tel.No. Assessor's Map/Parce1_.>j ,Q j 5 0 -pr.r 1 it) 0 L40 6 -4 rA r V\) ._31n( n54C, I :i a Installer's Name,Address,and Tel.No. 17-O&53 Designer's Name,Address,andlel.No. 5 r� k 3 ne e r , r, Type of Building: Dwelling No.of Bedrooms i Lot Size 7 0 sq.ft. Garbage Grinder Other Type of Building/ No.of Persons Showers( Cafeteria( Other Fixtures Design Flow(min.required) 550 gpd Design flow provided S 5 `� — gpd sl Plan Date Number of sheets Revision Date Title-1-14 ie 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. Sig ned t2 Date Application Approved by c Dat6­ Application Disapproved by Y Date I for the following reasons Permit No. -00 Date Issued_5 1 7 -------------- ----------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance 'THIS IS TO CEWIF t the On-site Sewage Disposal syste Constructed( Repaired Upgraded Abandoned by A VA>rrQxT at 1 _3I0 OW5kan I \Ai t6a() has been constructed in accordance 1- 1) 5 t with the provisions of Title 5 and the for Disposal System Construction Permit No. 1 3 dated o -Oc Installer._:�[A)CZ T Designer-T)CzJ2 L ( In #bedrooms Approved design flok. gpd The issuance of this permit shall trued as a guarantee that the system wilel-ft'hict/ioln as designed not be cons Date 5 Inspector )d" it - IeJ ------------------ ---------- No. 9001 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Permission is hereby granted to Construct Repair Upgrade Abandon System located at \/\j . all and as des-.ribed in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with I Title 5 and.the following local provisions or special conditions. Provided: --onstructi;nmust be completed within three years of the date of this perm#__ Date Approved by F11 did FROM :down cape engineering inc FAX NO. 15083629800 May. 29 2009 01:12PM P1 Town of Barnstable Regulatory Set-vices 'Tha>,Tlnags F. (aei9er, Director BARNSTABLE, + ttt MAW. Publk Hea th Division ` 039. \ ..... 'Thomas McKean,Director 201.) Main Street.,Hyannis,MA 02601 U ll ice: 508-862-464d Fax: 509-790-63 04 Installer& Designer Cer tilicatioan Forge .Rate:lJ ,�U 0 SeW89c:�°crlxAit# �D Assessor's MalpTiarcel Designer, 0I^) V'�,. t_A�( V\,� /> rl. - Taas4mller: Address: �3 / iz,� v� � Address: nn — was issued a pan-nit to install a (date) (installer.) septic system at.. 3 f(] cou J'�&qe �� based o».a,design drawn by V / (address) -... dated v 1 certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank., T ceilify that the septic system referenced above was installed with major changes (i.e. greater than 1 U' later�i), relocf�.ti.ou of the SAS or any vertical relocation of any compin>Icnl of'the septic system) but in accordance, with State &, Local Regulations. flan revision or certified as-built by designer to 1611ow_ 2\ 0 POANIELA.OJAA (ltrst<�ller's S igtlatu e) CIVIL .� No.4Fi502 /()NAL (N (Designer's S.ignatuxe) (Affix Designer's ;tamp lien) PLEASE k TURN '10 HAICNSTAIiLE PUBLIC IIP:ALTiI TITVTSTON. CERT.YrIC:.ATY', OF i_Otl PI.jUNCE WILL NOT HE ISSUED UNTIL BODE, TFTTS FORM AND .AS-.RI.JU.TC CARD. ARE IBF,C-TIW!1)T3'Y'1IM TiAIR.1115'TAT$T.T{,PU10K 11EALT-1 DIVISION. THANK YOU. Q P �• Hkalth/Sc tic/Ucsi cr( (.T, 4Cic:41-iun.Torrn 3-26-04.dk1c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessme t 1310 Old Stage Road Property Address Jean Whelan Owner Owner's Name information is �V t�f1rU/IS i✓�I MA 02668 March 18 2009 required for every page. CityJ/Town - ' - State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important:When filling out A. General Information forms the �) � computer, r,use 1. Inspector: only the tab key to move your Patrick T. Sullivan cursor-do not Name of Inspector use the return key. Ready Rooter, Inc. Company Name VOIQ PO Box 371 -17 Jan Sebastian Dr. Company Address Sandwich MA 02563 ream City/Town State Zip Code 508-888-2805 SI 12843 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 March 20, 2009 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. 1310oldstagerd•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1310 Old Stage Road Property Address Jean Whelan Owner Owner's Name information is required for West Barnstable MA 02668 March 18, 2009 every page. City/Town 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 i�rt any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15. ist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditiona Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the ❑ for the f Ilowing statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old* or tiW6 septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltratio/n or exfiltration or tank failure is imminent. System will pass inspection if the existing tan�/s replaced with a complying septic tank as approved by the Board of Health. �/ *A metal septic tank will pass inspecti ' if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the to is less than 20 years old is available. ND Explain: ❑ Observation/obstcted backup or break out or high static water level in the distribution box due to broken opipe(s)or due to a broken, settled or uneven distribution box. System will pass inspecapproval of Board of Health): broare replaced ❑ obstruction is removed 1310oldslagerd-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 2 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1310 Old Stage Road Property Address Jean Whelan Owner Owner's Name information is required for West Barnstable MA 02668 March 18, 2009 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pXd 4 times a year due to broken or obstructed pipe(s). The system will pass inspeval of the Board of Health): ❑ broken pipe(s ❑ obstruction is ND Explain: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Bt rd of Health in order to determine if the system is failing to protect public health, safety or t vironment. 1. System will pass unless Board of Health de%/a ines in accordance with 310 CMR 15.303(1)(b)that the system is not functionin manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet o a surface water ❑ Cesspool or privy is within 50 f t of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Bo d of Health (and Public Water Supplier, if any) determines that the system is f ctioning in a manner that protects the public health, safety and environment: ❑ The system has a sep is tank and soil absorption system (SAS) and the SAS is within 100 feet of a surfac water supply or tributary to a surface water supply. ❑ The system has a eptic 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. 1310oldstagerd•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 3 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1310 Old Stage Road Property Address Jean Whelan Owner Owner's Name information is required for West Barnstable MA 02668 March 18 2009 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SA s 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 an sis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the prese a of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no oth failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ® ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. 1310oldstagerd 03r08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 4 Commonwealth of Massachusetts u W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1310 Old Stage Road Property Address Jean Whelan Owner Owner's Name information is required for West Barnstable MA 02668 March 18 2009 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® 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" o each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 40 feet of a surface drinking water supply ❑ ❑ the system is withi 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is I ated 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 a question in Section E the system is considered a significant threat, or answered "yes" in Section above the large system has failed. The owner or operator of any large system considered a signific nt threat under Section E or failed under Section D shall upgrade the system in accordance wit 10 CMR 15.304. The system owner should contact the appropriate regional office of the De rtment. 1310oldstagerd•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 5 Commonwealth of Massachusetts w Title 5 Official Inspection Form e Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1310 Old Stage Road Property Address Jean Whelan Owner Owner's Name information is required for West Barnstable MA 02668 March 18 2009 every page. Cityrrown 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)] 1310oldstagerd•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 6 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1310 Old Stage Road Property Address Jean Whelan Owner Owner's Name information is required for West Barnstable MA 02668 March 18 2009 every page. Cityrrown State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 GPD Number of current residents: 1 Does residence have a garbage grinder? ® Yes ❑ No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 2007= 120 GPD g ( y g (gpd)): 2008= 82 GPD Sump pump? ❑ Yes ® No Last date of occupancy: Current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq. ., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank pr ent? ❑ Yes ❑ No Non-sanitary waste dischar d to the Title 5 system? ❑ Yes ❑ No Water meter readings, if vailable: Last date of occupan y/use: Date Other(describe): 1310oldstagerd•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 7 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1310 Old Stage Road Property Address Jean Whelan Owner Owner's Name informations required for West Barnstable MA 02668 March 18 2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: No pumping records found Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 100 gallons gallons How was quantity pumped determined? approx. Reason for pumping: Overfull D-Box 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: System installed July 1, 1987. As-built plans on file with Board of Health. Were sewage odors detected when arriving at the site? ❑ Yes ® No 1310oldstagerd-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 8 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments "t 1310 Old Stage Road Property Address Jean Whelan Owner Owners Name information is required for West Barnstable MA 02668 March 18, 2009 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 16"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.): Septic Tank(locate on site plan): Depth below grade: 8"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: 8 X 4.5 X 4.5 1000 gallons Sludge depth: 2' Distance from top of sludge to bottom of outlet tee or baffle 11" Scum thickness 8° Distance from top of scum to top of outlet tee or baffle Tee missing Distance from bottom of scum to bottom of outlet tee or baffle Tee missing How were dimensions determined? Dip tube 1310oldstagerd•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 9 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r 1310 Old Stage Road Property Address Jean Whelan Owner Owner's Name information is required for West Barnstable MA 02668 March 18 2009 every page. Cityrrown 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.): Tank needs to be pumped. Heavy solids present. Inlet PVC tee in place. Outlet tee missing. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain): Dimensions: f Scum thickness Distance from top of s/scto outlet tee or baffle Distance from bottom ttom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fibe7rglass ❑ polyethylene ❑ other(explain): 1310oldslagerd•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 10 Commonwealth of Massachusetts OF Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1310 Old Stage Road Property Address Jean Whelan Owner Owner's Name information is required for West Barnstable MA 02668 March 18, 2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of al/andt switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 10" 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 overfull with liquid and solids. Needed to pump down D-Box to complete inspection. System is in failure. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 1310oldstagerd-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 11 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1310 Old Stage Road Property Address Jean Whelan Owner Owner's Name information is West Barnstable MA 02668 March 18 2009 required for , every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 3- Flow Diffusorsw'stone ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching.fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): SAS located with electronic location to insure line was not damaged. Hand probing found ponding over SAS. System is overfull. 1310oldstagerd•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 12 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1310 Old Stage Road Property Address Jean Whelan Owner Owner's Name information is required for West Barnstable MA 02668 March 18 2009 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 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 nflow ❑ Yes ❑ No Comments (note cond' Ion of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): i Materials of construction: Dimensions Depth of solids Comments (note condition of soil, hydraulic failure, level of ponding, condition of vegetation, etc.): 1310oldstagerd 03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 13 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1310 Old Stage Road Property Address Jean Whelan Owner Owner's Name information is West Barnstable MA 02668 March 18, 2009 required for every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks..Locate all wells within 100 feet. ems' Locate where public water supply enters the building. I I I I ( f I , i I � I f I I � f 6 Q uv p 37 4f 1310oldstagerd•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 14 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1310 Old Stage Road Property Address Jean Whelan Owner Owner's Name information is required for West Barnstable MA 02668 March 18 2009 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 4 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: 1987 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers- (attach documentation) ® Accessed USGS database-explain: ma.water.usgs.gov terraserver-usa.com You must describe how you established the high ground water elevation: No variance needed for system install.(1987)Accessed local groundwater contour and topo mapping. 1310oldstagerd•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 TOWN -^O�F BARNSTABLE LOCATION 0�c a SEWAGE# 77I" VILLAGE hS � ASSESSOR'S MAP&PARCEL 'INSTALLERS NAME&PHONE NO. Z::Z,S:;P, SEPTIC TANK CAPACITY h LEACHING FACILITY: (type) (size) c:�,•,�,,,,��,r.,r- aT NO.OF BEDROOMS "'�� OWNER PERMIT DATE: `o/0</4'7 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 c 72 13', �3Ly ooa gd 2 f • � Z Z ' E3 El --------- - z Z tal O' co - _......_... -..__... .d... ---- .._...- -----.. 6.. . ram' i •. - --. --• -• ..:rr .. iilkl • ims�ff�f. I � � � � . IIIr�, FM ErTl I r T ; • I I • I 1 I 2rn r 1 f I i - ' 1 Town of Barnstable Barnstable °T Regulatory Services Department j caT j aatuvscns� MASS, . 10 Public Health Division 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 70081830000205008284 4/15/2009 ?ean Whelan 1310 Old Stage Road Marstons Mills, MA 02648 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic"systein`loc`ated at`1310 Old Stage Road Marstons Mills,MA was last inspected oii-MaircYI'S, 2009;by Patrick T. Sullivan, a certified septic inspector for the State of Massachusetts. The'inspectiori of the septic systerrl showed that the system "Failed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Backup of sewage into facilityor system component due to an overloaded or clogged SAS. • Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS. You are ordered to repair or replace the septic system within Sixty (60) days from the date you receive this notification. Failure to repair/replace theseptic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD-OF HEALTH Tlio'mas McKean R.S:, CHO' Agent of fife Board of Health as ;. oFt�t� Town of Barnstable Barnstable y Regulatory Services Department AlAmm`Ce P ]MIWST" , MASS. , ` Public Health Division �F°" • 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 70081830000205008550. 4/23/2009 J-an Whelan 205 Linden Ponds Way Apt 125 Hingham, MA 02043 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,TITLE 5 The septic system located at 1310 Old Stage Road Marstons Mills, MA was last inspected on March 18, 2009,by Patrick T. Sullivan, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Failed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Backup of sewage into facility or system component due to an overloaded or clogged SAS. • Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS. You are ordered to repair or replace the septic system within Sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH Thomas McKean,R.S., CHO Agent of the Board of Health I ASSESSORS MAP NO: 0—M5 w drI hO5 V I13 N42..:..... .Y. PARCEL NO: Fss.. ....2Q...QIQ._ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ....................OF..........8U!A.61AOle...................................... .......... Appliration for Dispaii al Works Tonotrnrtuan ramit Application is hereby made for a Permit to Construct ( ) or Repair ) an Individual Sewage Disposal System at: .1-3110D..QI-d...51aze...Road...C:Qz t. v 11 -------- --•...-•------------------------------------------•--------••---------------------...--- Location-Address or Lot No. Mrs...R� bet: h�len 6,wne�­­ Address -•--.....----•--•--------...---•------------..._.....------------------------------------•----...- Owner Address a J..2.2aaamher............................................................... Installer Address Type of Buildin Size Lot............................Sq. feet aDwellingNo. of Bedrooms.......... .............................Expansion Attic ( ) Garbage Grinder ( ) p., Other—Type of Building ___.........•............... No. of persons............................ Showers,'( ) — Cafeteria ( ) a' Other fixtures ----------------•-••......••--•------•. . W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 1:4 Septic Tank—Liquid*capacity............gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area--____----_-------sq. ft. Seepage Pit No--_---------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z" Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by----------- .............................................................. Date..........................--------•--- aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth,to ground water........................ (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water____-_-__-_-___---______ R+' ------------------------------------------•----------------.-•---.-•---------.....-•--•-------•----.... ------ -...... -------------------------•--------..---- 0 Description of Soil........B-&nd.............................................................-----••-••••--•-----•--- x W -••••-•--•-------------------•---.....-•-•--......---------------•-•--..............-----•............--•---. - •••-•-----•.---_•- •••-.• •-•-•-••--•---•-•-----------•-•-------•--..... x 1000 galXon. .an4 U Nature o= Repairs or Alterations—Answer when applicable----__._•____ ____________ ___________ ______________________•---------------------__. 3wFlowdi 'f ussors Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of i i .. p 5 of the State Sanitary Code— The under iWnedrther agrees not to place the system in operation until a Certificate of Compliance has be issued by t e b lth. Signed a... ..... ....6/29/$7-------- Date Application Approved By.............. Date Application Disapproved for the following reasons:.............................................................................................................. - .................................................................................................................-------------------- - --- -- ---------- ---- Date PermitNo.-.....6 3-=---1�2..------------------------ Issued....................................................... Date No�FZ. .!z_Y... Fps..• ......._...._.�... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �.� ;..._..................OF........ :.::. .:r.. t i. -- _ ---------------------------------------------••-------.._....... Appliration for Dispoiittl Works Tonstrurtion Prrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: 1 ` i .t ,3• r� . ........---._...........•----••---•-----------------------•--•-----._._..................---- --.......•------•-•--•--...........--•--••-•-----•---_..-------•--•-----------•••-•-...........-- Location Address or Lot No. .................. Owner Address W J Instal ier Address d Type of Building Size Lot............................Sq. feet U Dwelling-- No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building No. of persons............................ Showers — Cafeteria GaOther fixtures ----------------------------------------------------------------------•-------------------------••-••---••---- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic '-ank—Liquid capacity............gallons Length................ Width................ Diameter________-___.._. Depth................ x Disposal. Trench—No..................... Width.................... Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed bY--••••••-•••-••••-••••--------•--•----.....---•----------•----•••---•--_.. Date ................. a Test Pit No. 1---_............minutes per inch Depth of Test Pit.................... Depth to ground water........................ Gr. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 ••••••--••••----------------•-•••--•-•-•----•--•--•-----•.......------................_...--•-•-•--......_...••-••••...•••••--••----••••----------...__....•. 0 Description of Soil.......: x V ----•--••••-•-•--••-----•••------•••-••-----•-------•---•---•--•-------•--•--•-•-•••-------------•••••----•----•------•......---•---•----•--••-••---•---•••............................................ W - 'a . iJ.. L '_ .J.i U Nature of Repairs or Alterations—Answer when applicable.__...�..... . .... .:.................................................................... --------------------------------•-------------•-------------------------------------.......•--••----•-•......-••----•----------•••-••-••-------••••-•-••-•--•-----•--•--•--•-•••-••-•--..........••••-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of i TT_, 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 board of health. Signed............... .............................................. ' r_ � � Date ApplicationApproved BY.............�-�--.:�►:�-- _---�--------------------------------- ........................................ Date Application Disapproved for the following reasons:----•-----=--------------------------•-•------•--------•----•----------------------------------------.....--••-- ....--••••••--•----••--•••...-••-...--•---•-•--•----•--••••--------•------••-•.....................•----.._.....•-•......._..--••-•--------•••---...-----••--••-----•-•-••-•--••-----••-----••••--------- Date PermitNo----- , .-...1/1,11-.......................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH i.�y-rr . t . I.F. r ..........................................OF..........................`.......`.............................................. Trrtifirtttr of Tontplittnrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired`( ) ci . k ,_ bY --••--••••..:- ....-•-----------•-----•••-•-•----••--•••-•••••-•-•-•---•-••---------•••-••--•-------••-•••---------------•---•----------•--•..........-----.....-•---------------•----.-- r J 't , C .t.�` 1 [ t 1(Installer at. = •------------- �.:.. ----------------- ----------•••-••-••----------••--------------•••----••••---------••••----•-•-••----•------•-••-----•---- has been installed in accordance with the provisions of T i TIE of The State Sanitary Code as described in the application for Disposal Works Construction Permit No............... . .......... dated—------- _----------------------............ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT YHE SYSTEM WILL FUNCTION SATISFACTORY. �..e DATE....................7 -•7......--•------------•-----. Inspector.... n-,�. -�—? ....... ------. --••--•---...........-- V THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �. ll (— Y FEE.2..................... Disposal Workii Tons#rurtion rratit Permission is hereby granted......j'-P•`!'j-'t' `J ------------- to Cons .0 t ( or Re air an Individual Sewage Disposal System at \o......-•••-•--•-•-•-----------•••--•-•---•-........---•-•--•.............................•-•--•--•••-•....---------•---•-•--••-•••---•••--•••-•-•--------••-----••-•-•-----•......-•••-•--•••• Street as shown on the application for Disposal Works Construction Permit No5_7'y y... Dated..................•....................... •---•---------- -- •-------• ------------------------- ---DATE................................................................................ Board of Health FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS TOWN OF BARNSTABLE lam :;• 10CATION 1310 01CI aF SEWAGE # VILLAGE ASSESSOR'S MAP & .LOT. 09 INSTALLER'S NAME & PHONE NO.�, SEPTIC TANK.CAP:ACITY GL LEACHING FACILITY:(type)) 4J) (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No c/ �e11 �. IN ' 27 it SYSTEM PROFILE ALL SYSTEM COMPONENTS SHALL BE Qom LEGEND O ILE MARKED WITH MAGNETIC TAPE OR NOTES <<y WATERTIGHT COMPARABLE MEANS FOR FUTURE LOCATION. WATERTIGHT (NOT TO SCALE) 99 - EXISTING CONTOUR ACCESS COVERS TO WITHIN 6" OF FIN. GRADE ACCESS COVER TO FIN. GRADE 1. DATUM IS APPROX. NGVD (CIS SPOT EL.) 5�ae e 6 o°a ddie� ��n N . �5.1' 2. MUNICIPAL WA EXISTING a TOP FOUND. EL TER IS \ - PROVIDE INSPECTION PORT TO WITHIN 3 OF FINAL GRADE 5 X 99•� EXIST. SPOT ELEV. MINIMUM .75' OF COVER OVER PRECAST 691.5' 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. o` 99 PROPOSED CONTOUR a scH4o PVC � 4.2 2% SLOPE REQUIRED OVER YSTEM 3.7 PRECAST H-10 4. DESIGN LOADING FOR ALL PROPOSED PRECAST UNITS RISERS (TYP.) PRECAST H-10 4"OSCH40 PVC I (98.4] PROPOSED SPOT EL. 2'0 2" DOUBLE SHED PEASTONE TO BE AASHO H-]Q *THE INSTALLER SHALL VERIFY THE RISERS (TYP.) PROP. TEE�, PIPES LEVEL 1ST 2' (D.75" MIN TH 1 2'� LOCATIONS OF ALL UTILITIES AND ALL 72.9 5. PIPE JOINTS TO BE MADE WATERTIGHT. BUILDING SEWER OUTLETS AND ° TEST HOLE 10.. EXISTING t4 0 0 0 0 0 0 ° 0 0 0 0 0 0 0 0 0 0 0 0 ° ° ° ° ° ° ° ° ° 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH Locus p K ". 1000 GAL r , o°o°o°o°o°o°0°00000°0000 0 0°00000000000000000000 00000000001000 2% ELEVATIONS PRIOR TO INSTALLING ANY TEE SEPTIC TANK TEE 66.86 * 10" 0 ° ° .o ° ° � 72.54 000000000000000000000000 0 0000000000000000000000 00000000000;000 310 CMR 15.000 TITLE V. SLOPE OF GROUND 1000 GAL H-10 ° ° ° ° ° ° ° � ( ) one d PORTION OF SEPTIC SYSTEM RE-USE** 66.67 TEE o o°o°o°o°o°o° °c 200000000000000000000000 0 000000000000000000000 000000000001000 71.90' Ro e L S 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (EXIS T.) PUMP CHAMBER o 000000000000 0c o 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ( ) • 7. THIS 9 C-OL) UTILITY POLE (SEE DETAIL) _ S PLAN IS FOR PROPOSED WORK ONLY AND NOT TO j • OR LOT LINE STAKING OR ANY OTHER .•_":;. ;, GAS BAFFLE & ON 6 DOUBLE :: 72.87' 72.70' 4" PVC SET AT 005'/' SLOPE BE USED F T TUF-TITE EF-4 WASHED 3/4" - 1 1/2" STONE PURPOSE. �a• FIRE HYDRANT HYDRANT EFFLUENT FILTER 6" MIN SUMP NOTE: NOT ALL SYMBOLS MAY APPEAR IN DRAWING (OR EQUAL) "' 12" MIN INT. DIAM. 0 0 0 0 0 0 0 0 0 0 o c 1i 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. cod 00000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 o c OVERALL DIMENSIONS TO OUTSIDE OF STONE: 30' X 25' CO co' j o�o�o-onono, o^onon no'o' 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED o 6" CRUSHED STONE: OR MECHANICAL WITHOUT INSPECTION BY BOARD OF HEALTH AND **INSTALLER SHALL CONFIRM MINIMUM SEPTIC TANK SIZE AT ( 1 SLOPE) COMPACTION. (15.221 (2J) min PERMISSION OBTAINED FROM BOARD OF HEALTH. 1000 GALLONS AND ITS SUITABILITY FOR RE-USE (WATERTIGHT). REPLACE ( 1 % SLOPE) USE ADJJ. G-W AT 10. CONTRACTOR SHALL BE RESPONSIBLE FOR CALLING WITH WATERPROOF 1500 GALLON H-10 SEPTIC TANK IF NOT SUITABLE. ELEV. 6`5.6' DIGSAFE (1-888-344-7233) AND VERIFYING THE LOCUS MAP ELEV. 63.0' BOTTOM TH-1 & 2 LOCATION OF ALL UNDERGROUND & OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF WORK. NOT TO SCALE PUMP LEACHING 11. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL BE FOUNDATION EXIST. SEPTIC TANK 19, 91 D' BOX 10 FACILITY REMOVED 5' BENEATH AND AROUND THE PROPOSED ASSESSORS MAP 150 PARCEL 98 CHAMBER ' tEACHING'FAOUTY. NO CONSTRUCTION PROPOSED (SEPTIC UPGRADE ONLY 12. EXISTING LEACHING FACILITY SHALL BE PUMPED AND SITE IS WITHIN AP AND ESTUARINE PRTOTECTION FILLED WITH CLEAN SAND. DISTRICTS 13. INSTALLER JO CONFIRM ADEQUACY OF EXISTING TEST HOLE LOGS \ \ ELECTRICAL SYSTEM TO SUPPORT PUMP \ ALARM AND CONTROL PANEL MIN. 20" ARNE H. OJALA, PE, SE TO BE INSTALLED INSIDE WATERTIGHT ACCESS COVER TO FIN. GRADE ENGINEER: SYSTEM DESIGN. \ BUILDING. ALARM TO BE ON f WITNESS: DAVID STANTON, IRS4,6.14\ SEPARATE CIRCUIT FROM PUMP GARBAGE DISPOSER I S N 0 T ALLOWED \ \ �!�;� ����%'i��<:�<'%<'%�'% ''%''� y�������>��. DATE: AP RI L 23, 2009 DESIGN FLOW: 5 BEDROOMS ® 110 GPD = 550 GPD \ •' \ \ INV. IN 66.6T USE A 550 GPD DESIGN FLOW 1000 GAL. H-10 S 2" PRESSURE LINE PERC. RATE _ < 2 MIN/INCH �N\ r550 GAL.+ SLOPE TO DRAIN BACK TO PC ) CLASS I SOILS P 12537 \ \ ALARM ON PRESERVE rr (NO LOW PTS. # \ \ FLOAT SWITCH 0.25 WEEP HOLE SEPTIC TANK: 550 GPD (2) = 1100 \ c�7 SETTINGS: PUMP ON CHECK VALVE RE-USE 1000 GAL. SEPTIC TANK** ` 6.6" WORKING RANGE 5" ELEV. 4 ELEV. x MYERS SRM 4 0" 73.0' 0" 4 73.0' LEACHING: BENCH MARK - TOP OF TOWN 6 6i SUBMERSIBLE 4/10 HP PUMP OF BARNSTABLE CONC. BOUND PUMP OFF 10"' SYSTEM (OR EQUAL) A SIDES: N/A ELEVATION = 70.0 -� - - 62.17' o .83 00�0�000 pp p o O 0000 LJ BOTTOM 25 x 30 (.74) = 555 GPD FILL 10„ 10YR 3/2 PUMP CHAMBER- 36" 70.0 TOTAL: 750 S.F. 555 GPD � 64.78 (NOT TO SCALE) I � B 6 s WATERPROOF/WATERTIGHT � I USE 25 x 30 x 0.5 DEEP LEACH FIELD OF 4 PERF. PIPE AND LS DOUBLE-WASHED STONE. MIN. SEPARATION BETWEEN LINES: 4' (SEE PLAN) I PF2EVENT ANY OUTLET OF TO SEALED C 20„ 10YR 5/6 713, MAX. SEPARATION BET. LINES, 6'. EXIST. SAS AND D'BOX 12N•24' 64.9, TC PROP. PENT WITH CHARCOAL FILTER 6> ` `.• FS 66.16 ` AND BUGSCREEN (FINAL PLACEMENT BY in 6a• PERC MA x � BUOYANCY CALC: t✓ APPROVED DATE BOARD OF HEALTH CONTRACTOR WITH HOMEOWNER x 68.19 64.62 68 ° x ` \ CONSULTATION) 10 0 6 3.43 x 8.5 x 4.8 x 62.4 = 8732 LBS UP 102" `OBS. `HATER 64.5' 102" OR" E 64.5' \ 1000 GAL. H 10 (SHOREY) TANK WEIGHS 8240 LBS WAT + S B / U. F .5 .83 - 5140LBS 1N ( )OIL WGTI•• 90 L S C T. x 8 x 4 x 1 4' '?�Jr ®!( �I FS x67.78 2.5Y 6/4 139.51 8 6 I PROVIDE APPROX. 15' OF 40 LINER x 7 22 2.5Y 6/4 AT 5' OFF SAS IN kREA SHOWN. TOP x 71. 5 x 69.33 69 120" AT ELEV. 73.0', BOTTOM AT EL.69.0'f x 1 EXIST. 1000 GAL. ENGINEER TO INSPECT " 69 SEPTIC TANK 63.0' 120" 63.0 Q 72 O 0 (RE-USE)** �0 O 1 0 x 0 x 70.42 x 71.52 VARIANCES FOR SEPTIC SYSTEM REPAIRS WHICH MAY BE IMMEDIATELY GRANTED BY THE BOARD OF HEALTH AGENT OR x 71.53 BY HEALTH INSPECTOR x 71 7t 2 DECK 608.86 NOTE: PERCHED GROUNDWATER FOUND AT ELEV. 64.5' (TRUE G-W ELEVATION AT 37t' PER TOWN x 7 , 8 70 PAPEIRWORK AND HEARING REDUCTION PROPOSALS APPROVED 2. 3 13 x 71 BY THE BOARD OF' HEALTH REVISED DURING A PUBLIC GROUNDWATER MAP.) USE 1.1' ADJUSTMENT EVEN THOUGH NO MOTTLES FOUND. 7 • 1 1 x 7 75.85 7� 72.40 HEARVNG HELD ON MARCH 10, 2009 33' TH2 73.09 x 7 .9 4. 3 FAILED SYSTEMS ONLY - SEPTIC TANK OR PUMP CHAMBER 74.27 1 PROPOSED TO BE LOCATED LESS THAN 100 FEET BUT MORE Tj�t`( x 72,65 x 71.15 THAN 75 FEET AWAY FROM WETLANDS OR A WATER COURSE. u FLAG. r / I TH1 I `vC� PATIO x 72.40 73.69 BARN N 73.7 I 5.05 -v_1 `x 73.27' x 7 92 73.54 0 I 74.26 O _ 5 x 73.50 (D d 34., 73.61 73.26 x 74:97 x 74.56 O 73.88 CS! 74. 3 73.6� 30 73.30 / SHELL AREA - 3.41 1 37�4900 .57 / 4' 1� 74.02'' 73.74 PAVED DRIVE 4.10TI SITE PLAN 59 73.53 83.1 EXIST. DI ELL. x 7220 - 5 5 TOP FNDN. = 75.1' 7 5' REMOVAL OF UNSUITABLE SOIL REQUIRED 73.47 / OF AROUND PERIMETER OF LEACHING FACILITY, DOWN TO SUITABLE SCIL LAYER. REPLACE 73.3g i47 x 73.49 WITH CLEAN MED. SAN), TO MEET 7 16 i i SPECIFICATIONS OF 310 CMR 15.255(3) / 74,92 8 52 13 1 O O L ICn J STAGE ROAD 73.49 73.22 c 73.31 � \73.44 CENTERVILLE 75.10 72xq` 2. .00 x 2.60 73.14 F x71 9 PREPARED FOR 1.27 x 72•6 x 70.41 B&B EXCAVATION/J. WHELAN LOT 3 x 72.71 T)71.50 c 51920 SF f �c 71.16 c9�� MAY 8, 2009 70.86 l 70.35 cqS Scale: 1"= 20' cF I x 71,17 0.51 0 10 20 30 40 50 FEET L=225. 00 ' - x 70.97 R=536. 37 ' 83.00' 69.49 OFMgssq tZNOF4fq off 508-362-4541 �� cy sqo fax 508-362-9880 G �o DANIELA. s� �0 DANIEL yG o OJALA a downcape.com o A. \ 0 CIVIL OJALA N _ k OLD STAGE ROAD 69.26 46502 No 40980 down cope engineering, inc. 01STE� G�� °� Sao P ClVIl @/79/nee/"S ` SSioNAL1000) 939 Main Str and et ( R ttor s yOrS �- DATE DANIEL A. OJALA, P.E., P.L. YARMOUTHPORT MA 02675 09-074 09-074.DWG(SBO) i I I i