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HomeMy WebLinkAbout0024 SADDLER LANE - Health 24 Saddler Lane Marstons Mills A = 151 - 042 TOWN /OF�BARNSTABLE LOCATION � �l"� � LAO SEWAGE# p.0 f`7 " `4 q g, 'VILLAGE WS M 1g6_ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO.a-4)ECQ(QC- Ct1AaQa6eS SEPTIC TANK CAPACITY &As LEACHING FACILITY.(type) (q) 3050 040W349L5(size) 336 )(9 3 t NO.OF BEDROOMS OWNER RanrJ2—e 01, HaUtiev, Mye4A PERMIT DATE: COMPLIANCE DATE: C! (!7 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility � A 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) A1 14 Feet FURNISHED BY 0-106—COQE A d 12 ' A- 12• 4 A'3 A-� �1.a i�-1 - 21 2 0 0 . ��-2 = 25•�� � 'R-3 as.Z 50 .4 - o �l � zNo. \lI� � Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftplitation for Mispo8AY *pBtrm Construction permit Application for a Permit to Construct( ) Repair(A Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.a4.54Dr.4SZ L.64X)6 Owner's Name,Address,and Tel.No. � & U�N Assessor's Map/Parcel JS M IA q� � Installer's Name,Address,and Tel.No,J0f5 r 471_18SI 7 Designer's Name,Address,and Tel.No.Sd'B-,;V73 -0-71 5 — l4�1 Type of Building: -6 Dwelling No.of Bedrooms 3 Lot Size �(p � —sq.ft. Garbage Grinder( ) Other Type of Building RE;S GOi 6ok—No.of Persons Showers( ) Cafeteria( ) Other Fixtures `� Design Flow(min.required) �3 V gpd Design flow provided 346 417 gpd Plan Date O-'14--X0I."7 Number of sheets ( Revision Date Title aZe'r SAbD Alt `AU Size of Septic Tank U, 0 0t) ea4L C ytj Type of S.A.S. 0"' wtl i STmiC Description of Soil (F_ 49 'S-W!A �[ sew Pow 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 H th. Signed Date Application Approved by C Date Application Disapproved by Date for the following reasons ` Permit No. — Date Issued 1 --------------- No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes r 2(pWication for ]Disposal Xpstem Construction Permit Application for a Permit to Construct( ) Repair& Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.dq SdaD(. `^ Owner's Name,Address,and Tel.No. . i4 ERT ' � " !� IG444 Assessor's MaP/ParcelS1 ®4a. � I" Installer's Name,Ad�sTTel.No.50S-471 $$�7 Designer's Name,Address, Tel.No.So'p"a 7 73"03 7 �C15�$ G wit�ylt. � X)�)G [SA &.(/44A&fW44 Type of Building: /- Dwelling No.of Bedrooms 3 Lot Size I(q,5,4 w"sq.ft. Garbage Grinder( ) Other Type of Building KC-,!;[ 61)T l Ar4_No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 3 0 gpd Design flow provided 3146,17 gpd Plan Date ( '43-'ail 7 Number of sheets Revision Date Title ;. Slho C1Z 4404C Size of Septic Tank ®®C) (%A( .061 Type of S.A.S. M Iltd - Description of Soil h4 F=71 A 124AA L t J 1 5taLMA_* �a��� � e�D�� 4 /SC� r Nature of Repairs or Alterations(Answer when applicable) ++ 1CJSTIX 1 C)t7tl �-l�C.OI� S =.Y3Z�c. V r . - -70 (q) ash <Ogt AK8 w n = .�GFrC6 " 5'v17�riut�lat7��'" Date last inspected: a. 'Agreement: '7 a The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in w. accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date I�_(c.E.�o t'7 Application Approved by /7 ,r Date ^(� "Application Disapproved by "^^^*^- Date for the following reasons Permit No. 7 — Date Issued r �4- 1 1-4 1 °+ - -- __.--._ __ _ - ------- --- - -- ---- ------------- - - -- - - --- ----- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(,�) Upgraded( ) Abandoned( )by CAPE,�I DE at A 4 SA D LOL , ,./¢JUG A44 has been constructed in accordance yy with the provisions of Title 5 and the for Disposal System Construction Permit No. 04 L 1LI'dated Installer 0JQP1_.L Designer �`� _ Fgtll.1 �(. X:&)C. #bedrooms Approved design flow .+ gpd The issuance of this ppermit s1hall no be construed as a guarantee that the system will ctio as designed. - Date / M eq 2` �/ Inspectoor%, M ------------------------------------'-------------------- - ---------------------------------------------------------------------------------- No. c7�(J Fee J `� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS ]Disposal 6pstem Construction 3permit Permission is hereby granted to Construct( ) Repair( �) Upgrade( ) Abandon( ) System located at oh.,f)60f I4Xk�' and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. -- Provided:Construction must be completed within three years of the date of this perm dV 7 Date i- " "{ ' Approved by 1 Town of Barnstable oQ Regulatory Services Richard V.Scali,Interim Director Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Homeowner Certification Form for Alternative Systems Property Address:. AY SAn)LE-71 �T AjAjZS W&)S ILJ CLkC & Assessor's MaplParcel: 15t Jib ' i Property Owners Name: RC�( a 7'/.jp-/Z MU61{� In accordance with Massachusetts DEP alternative system approval letters, the following certification information is required by the Owner of record. The Owner of record must place an 'Y' in the applicable box next to each line certifying the information. Yes N1A ❑ I have been provided a copy of the Title 5 I/A technology Approval letters. (15 page Standard Conditions letter and the specific technology letter) ❑ N I have been provided with the Owner's Manual ❑ R I have been provided with the Operation and Maintenance Manual ❑ .® For Systems installed under a Remedial Use Approval,I agree to filfill my responsibilities to provide a Deed Notice as required by 310 CMR 15.287(10) and the Approval ❑ ® For Systems installed under a Remedial Use Approval,I agree to fulfill my responsibilities to provide written notification of the Approval to any new Owner,as required by 310 CMR 15.287(5) ❑ If the design does not provide for the use of garbage grinders,the restriction is understood and accepted R ❑ Whether or not covered by a warranty,I understand the requirement to repair,replace,modify or take any other action as required by the Department or the LAA, if the Department or the LAA determines the System to be failing to protect public health and safety and the environment,as defined in 310 CMR 15.303 I, OA T M\JlCA k agree to comply with all terms and conditions above. roperty Owners printed natne 3 AA ✓1,- Ia �3 Property Owners Signature Diate Note: This form must be submitted along_with the septic system disposal works permit anlLbcatlon for all 11A systems including new construction, repairsNuiparades, with and without aagreaate (stone) and with conventional design criteria or credited design criteria. Q:1SepticUA homeowner wiif eation.doc i 45813 P. 001/ool Town of Barnstable Regulatory Services annrrsr�ecs, Richard V. Scali,Interim Director b' Public Health Division A'PD1A"`� Thomas McKean, Director 200 Main Street, Hyannis,MA 02601 Office: 508-862.4644 Fax: 508-790-6304 Installer& Deggner Certification Form Date: 11_24.11 Sewage Permit#�Vlj'qqg Assessor's Map\Parcel 15( /1 Z- Designer: TG �Y1�,'Y18�cin� Tor- Installer: GaPewide L—"r%V�(Pr(se,� Address: 285`f Ccaebzrr% i (nwa Address: 15 5 Comocrceo\ &F(ee,( Emit 615b8 Masln,Pee.1 rA oz�y9 On 14--14- 11_ Ce% n eth(ae, R 4.r CX3 was issued a permit to install a (date) (installer) septic system at 2� 5 a a81 -r L elm Z based on a design drawn by (address) G tn�ineertr�°� 'Tv�t;. dated Deeemb L l 2, zo1-7. (designer) , I.certify that the.septic system referenced above was installed substantial) accordingt the design, which may include minor approved changes such as lateral relocation of the the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i,e, greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as by designer to follow. Strip out(if required) was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed ' of the I\A approval letters (if applicable) a`r o nrAs e with the terms JOHN (I stalle ' Signat e) CHUc'HIL(,dk. H No 1eO? signer's Signa (Affix Des' er amp Here) PLEASE RET TO $ARNSTARLE PUBLIC lEI1FAlLT IDY SIGN. CERTIFICATE OF COMPL ANCE WIiLL NOT HE ISSUED (UNTIL BOTH THIS FORM ANp AS- BUILT CARD ARE RECEIVED B'Y THE BARNSTABLE PUBLIC HF,ALTH iA](VISION, THAN�'YOU. Q:1SepticlDcsigner Crrtification Form ttev 8-14-13,doc lB Town df Barnstable P# l ASS Department of Regulatory Services tj/v1 411� R sM • I F Public Health Division Date MAU 1 200 Main Street,Hyannis MA 02601 Fws \ ) 9 j Date Scheduled_ I _3d / � Ti'ma �i'ee Pd._ G/ x: Soils Suitability Assessment for Sew Disposal Performed•By: Mll vtae( Qrvylef►4 U1 1, c5c By: Witnessed LOCATION&.GENERAL INFORMATION Location Address ]�[[ a`T s�`✓V L�_ Owner's Nam (ZG� � UG Tp Address d�(� �+�t�AC��C-,N1 Assessor's Ms /Parcel © CV&_R'(bG p Engineer's Namc.�.. cr 1G NEW CONSTRUCTION REPAIR ,.5UB273-6 3 7 7 1 Tcle hone# Jv�~ 77�� , Lund Use tn°J_ CiM�'1 UWeAtt! g Slopes 0 Surfhcn Stones Distancoa from: Open Water Body ft Possible Wet Area ft Drinking Water Well tt Dmlhage Way i ft Property Line 7/-aft Other ft SKETCHC(Street name,dimensions of lot,exact locations of test holes&pero tests,loonto wetlands In proximity to holes) --See- a4a&�,d i cvl Parent matedal DukivuSl� p oDed'a , r(geologic) Depth t i ok Depth to Groundwater. Standing Water in Hole: Weeping from Pit Foca Estimated Seasonal High Groundwater 7 150 DETERMINATION FOR SEASONAL-HIGH WATER TABLE Method Used: _ ZXT Z& &Se,(Ua k1�ivl 7 �,5 U De th Observed standing in obi.hole: In. Depth to sell mottles: In.' Dc�th to weeping from side of obs.hole: _ in. Oroundwater AdJustidant Index Wall-# — Reading Dato: index Well lmvol�„ Adj,•thctbr„., Adj.Groundwater•Laval„= PERCOLATION TEST Daftl zlTime Observation 1-2-0 7j Hole# Tlma at 9" _ Depth of Pero Time at 6" Start Pro-soak Time @ Time(911•611) End Pra-soak see- Prevt ou s percd l•a ke , rest e 0 61-CW �0 y Ca rlri e4 Say o,n 9-2-D 3 orl Rate Min./Inch La, +'Ac baa,5 6b(L 6 64 eta < Z r Sito Suitablllty Assessment: Sltd Passel! !;S Site Failed: Additional Testing Needed(YIN) N Original: Public Health Division Observation Hole Data To Be Completed on Back ' ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one(1)week prior to beginning. Q:\SEPTlWERCFORM.DOC DEEP-OBSERVATION HOLE LOG Hole# 1 + 2- Depth from Soli Horizon Soil Texture Sdil Color Soil• Other Surface(in.) (USDA) (Munsell) Mottling (Sinuetum,Stonei;Boulders. onslatency. 12- 97- S L. 1-6Yr 5/6 b00L, ens DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. DEEP OBSERVATION HOLE LOG Hole# Depth from Soil horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.. DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Solt Texture Soil Color doll Other Surface(In.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders, Flood Insurance Rate Map: Above 500 year flood boundary No— Yes , Within 500 year boundary No_ Yes Within 100 year flood boundary No,.,—._ Yes death ofaturaUv Occurring Perylous Ma ter Does at least four feet of naturally occurring pervious mtiterlai exist in all areas observed thrpughout the area proposed for the soil absorption system? Y is If not,what is the depth of naturally occurring pervious material?,.�.. . Cer'ti.�on 1 certify that on /v 2.7 r,49 (date)I havepassed the soil evaluator examination approved by the Department of Environmental Protection and thg the above analysis was performed by me consistent with . the required training,expertise an xperien escribed in 4 10 CMR 15.017. Signature • Datb Q:NSEPTIC%PBRCPORM.DOC "' SENDER: COMPLETFF�77HISSECTION ■ Complete items 1,2,and 3. A. Signatyre ■ Print your name and address on the reverse X ❑Agent so thatkve can return the card to you. ❑Addressee ile Attach this card to the back of the mailpiece, B. Received by(Printed Name) C. Date of Delivery or on the front if space permits. 1. Article Addressed to: D. Is delivery address different from item 1? ❑Yes —- If YES,enter delivery address below: ❑No MUCHA, ROBERT M JR&HEATHER K 24 SADDLER LN *WEST BARNSTABLE, MA 02668 3. Service III 9IIIII ICI I6I I II II it I i i IIIiI I IIII II B III i III e❑Adult Signature [IReg Reg Mail istered Maiess® lTm i ❑Adult Signature Restricted Delivery ❑Registered Mail Restricted 9590 9402 1933 6123 1795 80 Certified MailO slivery Certified Mall Restricted Delivery Retum Recelpt for ❑Collect on Delivery Merchandise 2._Article_NumhPr[r.���f.-f- M_.:__ -- 1---1 Delivery Restricted Delivery Signature ConfirmationTM . ,tail ❑Signature Confirmation 1 7 d 15 17 3�' 0 0 01 4 9 9 0 5 6 3 3 Ve f ;j j I Restricted Delivery Restricted Delivery I PS Form 3811,July 2015 PSN 7530-02-000-9053 bomestic Return Receipt 'I USPS TRACKING# First-Class Mail Qtl I Postage&Fees Paid USPS Permit No.G-10 i 9590 9402 1933 L123 1795 80 United States •Sender:Please print your name,address,and ZIP+4®in this box• i Postal Service 7Kon of 8amstable ob mall nIs, rynA" 66? of i i Town of Barnstable Barnstable Mft Regulatory Services Department edcaC j 9 . ,. Public Health Division 200 Main Street,Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4990 5633 November 21, 2017 MUCHA, ROBERT M JR& HEATHER K 24 SADDLER LN WEST BARNSTABLE, MA 02668 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 24 Saddler Lane, Marstons Mills, MA was inspected on 11/09/2017 by James D. Sears, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: 0 Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. You are ordered to repair or replace the septic system within one (1)year 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 B RD OF HEALTH s cKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\24 Saddler Lane Marstons Mills.doc Town of Barnstable ,b� Regulatory Services Department Public Health Division 200 Main Street,Hyannis MA*02601 Office: 508-862-4644 Richard Scab,Director FAX 508-790-6304 Thomas A McKean,CHO Feb 6, 2007 Rev. 5111116 DEADLINES T O*REPAIR FAILED.SYSTEMS (Tovrn Code §360-44 and Title V: 310 CMR 15.000) _ 'n`y'marked in the ❑is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑Discharge or ponding of effluent to the surface of the ground Y . ❑Pumping more than 4 times during the last year not due to clogged or obstructed pipe. :. ❑Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE 1 YEAR DEADLINE CRITERIA tatic liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑Any portion of the cesspool within a Zone 1 to a public well ❑Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis.*(This system passes if the water analysis indicates the well is free from pollution). TWO (2)YEAR DEADLINE CRITERIA q Single'Cesspool- ❑Any"conditionally passed systems" (broken cover,relocation of a pipe,relocation of a driveway due to H-10 components, etc) o Leaching pit or cesspool with high liquid level, <12"below inlet(per Town Code §360-9.1) ❑Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER Repair deadline: /,14ay- a SEPTICMEADLINES TO REPAIR FAILED S MS.doc t•� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 24 Saddler Lane IQ Property Address Heather Mucha ate" Owner Owner's Name information is ? € required for every We*-Be�'' MM MA 02668 11-9-14 page. CityfTown State Zip Code Date of Inspection :+ Inspection results must be submitted on this form. Inspection forms may not be altered in any way.Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms Ia 710on the computer, ```,p�um►urur,,� use only he tab 1. Inspector: ``,\\,� �SN OF iygsIfc�4 key to move your 2 y cursor-do not O use the return James D.SearS 4 _ a DAMES :R, key. Name of Inspector .y Capewide Enterprises e6 Company Name �RT1 -'o 153 Commercial Street /,F 5 IN S?'— Company Address +� Mashpee MA 02649 Cityfrown State Zip Code 508-477-8877 S1623 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority 11-9-17 spector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system 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. t5aas.doc•rev,WO Tille 5Official Inspection Form Subsurface Sewage Disposal System•Page 1 of 17 )-bt�5ta 'IS Si, abed xed dH 96:0F L 60Z Z l, ^oN Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 24 Saddler Lane Property Address Heather Mucha Owner Owner's Name information is required for every West Barnstable MA 02668 11-9-14 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: ❑ 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: Failed system leaching. The system is a 1000 Gal Tank D Box and five chamber's 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): Ukns.doc•rev.6116 Me 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 66 abed xed dH L6:02 L 60Z Z l, ^oN Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 24 Saddler Lane Property Address Heather Mucha Owner owner's Name information is West Barnstable MA 02668 11-9-14 required for every page. cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health; ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. I. 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 Wns.doc-rev.6116 Title S Official Inspection Form:6ubsurfece sewage Oisposel system•page s of 17 02 abed xeJ dH LEW L 60Z Z l, ^oN r Commonwealth of Massachusetts 9 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �wlz 24 Saddler Lane Property Address Heather Mucha Owner Owner's Name informatrequired is west Barnstable MA 02668 11-9-14 required for every page. Citylrown 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 stems: pp 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 MOM is less than 6" below invert or available volume is less than %s day flow 41ACjgiNG t5ins,doe-rev.6116 Title 5 Official inspectlon roim:Subsuffaoe Sewage Disjoasal System.Page 4 of 17 i,Z abed xed did K02 L tOZ 2 6 AON I Commonwealth of Massachusetts U10. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 24 Saddler Lane Property Address Heather Mucha Owner Owner's Name information is West Barnstable MA 02668 11-9-14 required far every � page. Chy/Town State Zip Code Date of Inspection j B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. j ® 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 13 El the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone li 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. 15ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 ZZ a5ed xej dH 8E:0Z L i3OZ Z[ ^oN r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 24 Saddler Lane Property Address Heather Mucha Owner Owner's Name information Is required for every West Barnstable MA 02668 11-9-14 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 NIA) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health, ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Mns.doc•rev.6H 6 TOWS Niicial InspecUon Form:Subsurface Sewage Disposal System-Page 6 of 17 EZ a5ed xed dH 6E:OZ L 60Z El, ^oN I r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 24 Saddler Lane Property Address Heather Mucha Owner Owner's Name Information is West Barnstable MA 02668 11-9-14 required for every i page. City[Town State Zip Code Date of Inspection D. System Information Description: 1000 Gal.Tank D Box and five chambers. Number of current residents: 4 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 Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 2015-127,000Ga g ' y g (gp ))' 2016-87,00OGal's Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Present Date CommerciaUlndustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seatslpersons/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.doc•rev.6/16 Title 5 Official Inspection Form;Subsurface Sewage Disposal System-Page 7 of 17 t7Z a6ed xed dH KOZ L60Z Zl• ^oN Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 24 Saddler Lane Property Address Heather Mucha Owner Owner's Name information is West Barnstable MA 02668 11-9-14 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont,) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: NA Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/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 IIA system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): 16ine.doc•rev.6/16 Title 5 Official Inspection Forth:SlbeWface Sewage Disposal System-Page 6 of 17 5Z abed xed dH KOZ L 60Z 26 ^oN Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 24 Saddler Lane Property Address Heather Mucha Owner owner's Name formation is West Barnstable equiredforevery MA 02668 11-9-14 page. CityrTown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components,date installed (if known) and source of information: 2003 Permit # 2003-432. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 3711teat 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.): Pi in is 4"PVC SCH -40. Septic Tank (locate on site plan): Depth below grade: 2711 feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene y ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 Gal. Precast H-10 Sludge depth: 2" ISins.doc-rev.6116 Tile 5 Official Inspedion Form;Subsurface Sewege Disposal System-Page 9 of 17 gZ a6ed xed dH Ob:OZ L 60Z 2 1• AcN f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 24 Saddler Lane Property Address Heather Mucha Owner Owner's Name require for is West Barnstable MA 02668 11-9-14 required for every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(coat.) Distance from top of sludge to bottom of outlet tee or baffle 28" Scum thickness 1„ Distance from top of scum to top of outlet tee or baffle 8" Distance from bottom of scum to bottom of outlet tee or baffle 1 7 How were dimensions determined? Asbuilt- Plan-Tape Sludge Judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): Tank at working level. Tank at 27" below grade wlinlet cover at 3"and outlet cover at 8". No sign of leakage. 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 151na.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 LZ a5ed xe:1 dH Ot?:OZ L 60Z Z l, ^cN Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 24 Saddler Lane Property Address Heather Mucha Owner Owner's Name information atl is equlred for every West Barnstable MA 02668 11-9-14 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:elated 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 El 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 (cond tion of alarm and float switches, etc.): •Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ms.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 gZ abed xeJ dH Oti:OZ L 60Z Z I, AoN Commonwealth of Massachusetts Title 5 Official Inspection Form UVSubsurface Sewage Disposal System Form -Not for Voluntary Assessments 24 Saddler Lane Property Address Heather Mucha Owner owner's Name Information is required for every West Barnstable MA 02668 11-9-14 page. Citylfown State Zip Code Date of Inspection D. System Information (cunt.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 2" Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D Box is 16"x16%5' below grade. Box has solid carry over. Level is up into outlet line. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No' Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): "If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System(SAS)(locate on site plan, excavation not required): If SAS not located, explain why: t5ins.doc-rev.6/16 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 6Z abed xed dH OV:02 L 60Z 2 6 ^oN I i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form •Not for Voluntary Assessments 24 Saddler Lane Property Address Heather Mucha Owner Owner's Name information is required for every West Barnstable MA 02668 11-9-14 page. Cityf7own state Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 5 ❑ 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.): Leaching is five infiltrators w13' stone. Ck D Box and camera out line. Leaching is full.Leaching needs to be replaced. 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.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 13 of 17 0£ a5ed xe� dH 6b:0Z L 60Z Z l• AON Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 24 Saddler Lane Property Address Heather Mucha Owner Owner's Name information is required for every west Bamstable MA 0266E 11-9-14 page. Cityfrown 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.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 6£ a5ed xeJ dH 6bVOZ L60Z 26 AcN Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 24 Saddler Lane Property Address Heather Mucha Owner Ownees Name information is required for every west Barnstable MA 02668 11-9-14 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 B O ' -/= f A = 3y � A . 3 + 71 3 t5ins.doe-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Pase 15 of 17 Z£ a6ed xe:1 dH 6b:0Z L tOZ Z 6 ^oN Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 24 Saddler Lane Property Address Heather Mucha Owner Owner's Name information is required for every West Barnstable MA 02668 11-9-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam; ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells N° Estimated depth to+high ground water: 1 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: 9-2-03 Date ❑ Observed site(abutting propertylobservation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: T.H.on Design plan 9-2-03-12' no G.W.. Bottom of leaching at 6' below grade. Bottom of leaching at 6'above T.H. Depth. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5lns.doc•rev.6116 TAIe 5 Official Inspection Form:Subsurface Sewage Disposal System•page 16 0117 C£ a5ed xe� dH i,t,:0e L 60Z Z l, AON Commonwealth of Massachusetts Title 5 Official Inspection Form kvjSubsurface Sewage Disposal System Form -Not for Voluntary Assessments 24 Saddler Lane - Property Address Heather Mucha Owner Owner's Name information is required for every West Barnstable MA 0266E 11-9-14 page. citylrown 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.doc-rev.6116 Title 5 Official Inspection Form:Subsurfaoe Sewage Disposal System Page 17 of 17 t,E abed xed dH Zt,:OZ L60Z 26 AoN TOWN OF BARNSTABLE L, ATION SEWAGE # ihl ASSESS 'S MAP & LOT �— INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) NO.OF BEDROOMS BUILDER OR OWNE PERMTTDATE: 103 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 � ate, i FEE C®MMONWFALT14 OF MASSAC14USETTS Board of Health, MA. APPLICATION FOR DISPOSAL SYSHM CONSTRUCTION PERMIT Application for a Permit to Construct( ) RepairX Upgrade( Abandon( - ❑Complete System Andividual Components Location 24Lrwew•?ornOwner's Name 2k Map/Parcel# 'S 1 p 4-2— Address D NING ENGINEER MUST SUPERVIS Lot# A ? Telephone# THE SYSTEM WAS INSTALLED IN STRIC Installer's Name S SourgC Designer's Name " "vtC Address v-r ^ es�c czk• D A Address m MA Telephone# 5 01;8-6 4 - 6 Z\p Telephone# Type of Building tl2f���• �(L� Lot Size I(r(Q sq.ft. Dwelling-No.of Bedrooms �T�C•2Q_ 3 Garbage grinder Other-Type of Building Oc'1Q No.of persons Showers (01,Cafeteria ( r� Other Fixtures �.A�►aTC1$�� tTC-Mc 1 Slab:, LRuaoR`f 1 Design Flow(min.required) 3 3 gpd Calculated design flowW Design flow provided 338 0 gpd Plan: Date �,�� Number of sheets _ _ Revision Date Title ceooSQh� 7�1� C�S�e2�f111 Vpp�t''.f�Q II Description of Soil(s) ? Vmn Soil Evaluator Form No. Name of Soil Evaluator(_AQMW SHAY Date of Evaluation Z. �3 DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees to not to e t m in operation until a Certificate of Compliance has been issued by the Board of Health. ,•.� . Signe Date Inspections L,7 FEE cJv COMMONWE-411-1 ,0F MASSA KUSETTS fHealth,Board o MA. APPLICATION FOP, DISPOSAL �VSTEMC-ONSTRUCTION PERMIT Application for a Permit to Construct( ) RepaiX Upgrade Abandon( ) 0 Complete System/eIndividual Components Location24 Sar0\v Uarc? tJ,Bcxc n c-*r—)rAQ Owner's Name tv\G s�c ice Map/Parcel# c 42- Address Z:)R M' F- Lot# Telephone# Installer's Name Designer's Name Svcs- Address Address yp UT 9. (0a:j F—c I mn,� , M 14 ov;-2,� Telephone# b 6 4B 6,Bkc Telephone# Lot Size (D cc sq.ft. Type of Building Dwelling-No.of Bedrooms Garbage grinder WA9 Other-Type of Building NC)n4P- No.of persons Showers 4 Cafeteria Other Fixtures I-P"jQ-rhRq " k'-rc�AEl) LAu4c�M Design Flow (min.required) © gpd Calculated design flow *�?)b Design flow provided 3�) gpd — I Plan: Date la1OZ) Number of sheets Revision Date Title '-)Q D-\i\(' SU-,,4rFN W 5�,M6�Q Description of Soil(s) Soil Evaluator Form No. Name of Soil EvaluatoraQMLtJ C,-)H AY Date of Evaluation. DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees to not to place the system in operation until a Certificate of Compliance has been'issued by'the'Board of Health. Date �-?-a? Inspections FEE CS�c-a>3No. q3 COMMONWEALT14 OF MASSAC14USETTS Board of Health,7,7FP, MA. CERTIFICATE Of COMPLIANCE Description of Work: "Individual Component(s) C3 Complete System The undersigned hereby certify that the Sewage Disposal System; Constructed Repaired Upgraded ( ,"Abandoned by: at has been installed in accordance with the ons of 310 CMR J5.00 (Title 5) and the approved design plans/as-built plans relating to application No.2w3-q?3 -, dated. PM-6? -. Approved DS�gn Flow--(gpd) Installer Designer: Inspector: Date: The issuance of this permit shall not be construed as a guarantee that the system will function as designed. No.-C FEE COMMONWEALTH OF MASSAC14USETTS DESIGNING ENGINEER MUST SUPERVISE Board of Health, MA- INSTALLATION AND CERTIFY IN WRITING I DISPOSAL SYSTEM CONSTPUCTION PEE'L;VtU-RC-,'..---7 TO'PLAN. L L E D GPI Permission is hereby granted to; Construct( Repair( ) Upgrade(L-4, Abandon( an individual sewage disposal system at (A., as described in the application for Disposal System Construction Permit No.ago-5`3 dated Provided: Construction shall be completed within three years of the date-of, is errnit. All local conditions must be met. Form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date9 )3)0 3 Board of Health,— ASSESSORS MAP NO: c .UV-, CAT10IN PARCEL NO.: SEWAGE PER1IT Nth. V 1, A G 'i A -z \lhcTA LLER"a NAME sADQR £ SS 11 yy- 9 U I L D E 0 aR 0WNF DATE PERMIT ISSUED DATE COMPLIANCE 15SUED y7 96 � t � F ��'� �0� � I � '� r���� ��_ 7" `� 1 .�� '` � U�i • �� �`7 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -7 ...OF.. . .�� Tzt�lslc -............... �®rT Ap,pliration for Uis.pnsttl Wor' ks Tonstrudion 11trind v pplication is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal stem at ation-Address or Lot No. ........... L .S Q Ll-c7s-J ........_._.. ... _........................_............ .. .. ..... ......... Owner Address W Installer Address Type of Building Size Lot...164.60.0...Sq. feet U Dwelling—No. of Bedrooms......-� ................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building No. of persons............................ Showers Gr YP g -----•--...--•-•--.......--- P ( ) — Cafeteria ( ) G4 Other fixtures ................................. ............ ...............................................................................•-•-- . lie�lf', 3� W Design Flow............1./. ..........-.•_-•--•-gallons per-perseirper day. Total Bail flow----•--.....................................gallons. WSeptic Tank—Liquid capacityld� gallons Length.0...'.(�.-..- Width�F.' Diameter................ Depth-.-.f x Disposal.Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No......../........... Diameter......../2...... Depth below inlet....1......... Total leaching area.2!.; _dsq. ft. Z Other Distribution box W Dosing tank ( ) aPercolation Test Results Performed by..... ..t^'-p-1 .. ' '� 1 .--Pam......... Date.._....�.�C7. ,.a Test Pit No. 1................minutes per inch Depth of Test Pit...11 ..... Depth to ground water... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water....--......... a ................ ................••--....... �1 7i................................. ..t - ..._..._...... O Description of Soil._. . ... .....kd_. _... ...1�0---��LJ8 01 -.../._/ .Y..Z.---. ....................................•--------------.--...... ...-----:------ W UNature of Repairs or Alterations—Answer when applicable............................................................................................... .............................................••------•----...........-•----....-------•-•---•-•--..............--•-•--•-•-•---------•-•••-•••-----.......... Agreement The an�ees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the s st in operation until a Certificate of Compliance has sued by a rd of health. Sied....... ...Gtl.. ... .. ....................... ........ -•-•.Jd ..._.... 7� ---' �u Application Approved B •-Y•-- ------•- ------••- -• ........................................................ bate. Application Disapproved for the following reasons:................... .... ........... ........................_..... - _.... .............................................................. Permit No....... ..��........ r._.s, Issued....----....... ..•---...._......_.....D�...... Date .,IS.,yy:+a--�' r�'- "V �t'. `y �i �w,N:.+.r1Yr'�.t...+w.:f". �`•.ir,,,,�r "Tern;,yi�;;;�s�.�.4�.�:,r^•�9,:,p - .. _ _• i '_ j THE COMMONWEALTH OF MASSACHUSETTS r BOARD OF HEALTH . t> .t......o F.. ..... �� '►� T -ice................. � f Appliration'-for Disposal Works Cgonstrurtion rprmit 9 Application is'hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal � �system at: . / / / r'.-0 / Z /6 C;, t7, J, 7�� f-�/Z L- J r� L>�I-IF ,C' l--A l.1'�. ..............`___»»_......._.............._.---.............................»........_ ............... --...................... -..............._......_..__.... -........». Location Address or Lot No. ............. »____ ... .y»...Owaer._.......».---....................._... ...--•---...._....----•---..................Address •••--••----...._......... W M Installer Address Type of Building Size Lot..� ,:. t + �....Sq. feet j Dwelling—No. of Bedrooms.__...:r'................................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—T e of Building .............. No. of ersons..:......................... Showers — Cafeteria a YP g p ( ) ( ) a' Other fixtures ""�YJ> WW Design Flow............: �.2.......:...........gallons per_pc"ersonll _per day. Total daily flow......:.....-'^- ...............gallons. f. W Septic Tank—Liquid capacity�C©Qgallons Length..E::`. ._.Width .. Diameter................ Depth.`'/C." x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage-Pit No....:... .......... Diameter........L.�''-..`.....,Depth below inlet....: '......... Total leaching area.7� :Csq. ft. Z Other Distribution box (><) Dosing tank ( ) Percolation Test Results Performed b ► -�► �-+ � .... Date......:.: 19- Test Pit No. l......:l'"._....minutes per inch Depth of Test Pit... -:-3�....... Depth to ground water...... ._a LL, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to,ground water........................ a ........................•----.....-----........•. ......... _.................._...•--•,..: O Description of Soil.. = ' ''' G e' ( . /� °510 /,G- / •''- 4 w/-Q 4-- G�',4 V E ..................•---...............................-•-..........••-•.......• . ......._ . .... U �....... ............ -........•........---....- --------•------•---- .. ...... W UNature of Repairs or Alterations—Answer when applicable............................................................................................... .............................. ...--•-•-•----•----.....--.-•-•-.....---------_--_-_-----•---•-•-----...----..----------------.--_---------------------•---_----------•--------•---------------. Agreement The and ;9ees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place/thhes. stem in operation until a-Certificate of Compliance has been-issuedby the bboard of health. Signed:. .................... 'a:e. ..�.... ,. _: .. Application Approved By�. -•-•••-•••-•.•••-• / ••--.......---•...--••••-•................•----- • Date Application Disapproved for the following reasons:.....................?.•.-----•-•---.....------..........--------•--•------.........---................--- _......................................................................................--••••----...._..........-------•--••-•...._....................•---.................--.......--••-----•••-- PermitNo.....-. .-�_....... r......_...».._.___....._ Issued....................................__._D�..._ Date. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �%�Aryrn Qa�i n� � a co O F..................................................................................... Trrtif rab.of Tamptittnrr 1 THIS IS TO CERTIFY, That the Individual Sewage Disposal -System constructed (✓) or Repaired ( ) by -•••-•-•.............. ' .. l CKCY...»�Gills eUcK2l ..---.....---..........---.......------------........................»...._ - -_- " :Installer at...•-•------•.....��?-� ... �N�`e� !/ 5��,� c��z ..... .{!-•• J, f�' �a = .-•-•-•......-•-•.....--•- .--..•--- has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......~'�-7_.. . 3 .. dated......... ,S'p5 THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUN CT N ATISFACTORY. DATE...................... ... ........................... Inspector........rlf } THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...v....pJ . OF......... �a..... . .clsr.. ►,: L. .................................N ........... FEE......... . . I Disposal Morks Tonstrtution ilrrmit Permission is hereby granted.....................!y�� C r!c/STPuC .............•----........_ .......--•---..................... to Construct (� or Repair ( ) an Individual Sewage Disposal System at No.............A`?'�.....2(:?X /�i:rtl ;r. ��'��_.. S ?v�l P!' G��....afn4011:..._....._... ' y street _ as shown,ori the application for Disposal Works Construction hermit No......_3_��� Dated.. <. �..�.�y. ............... P � I ........................ - -----:.---------- ...------ •-------------------- ----- _ "'""` Board of Health DATE___ )ti.. : �. . __......... ................. t� lv, t FORM 1255 HOBBS &'WARREN, INC.. PUBLISHERS } TOWN OF BARNSTABLE LOCATION SEWAGE # VII,LAGE Ttii ASSESS 'S MAP&LOT � —O _ _ INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY if LEACHING FACIi..ITY: (type) i`t G ���� 6MVO(size) e I NO.OF BEDROOMS BUILDER OR OWNS PERMITDATE: . 1 103 COMPLIANCE DATE: Separation Distance Between the: i Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility.(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by i I d Tfi4CK 1, 37 Sep - 20-01 13 : 52 BARNSTABLE HEALTH DEPT 5087906304 N • uL s2s;o� )TICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM cv, TJ hereby certify chat the engineered ian signed by me QME Y Y � P � o� u�tec 3 O�J concerning the property located at �eets all of the i^I:owirig ;nteria, This failed system is connected to a residential dwelling only. There are no _orimerzial or business uses associated with the dwelling. • T? e s011 is cidss:;:ed as CLASS I and the percolation rate is less than or equai to -ri.nitts per inch. The applicant may use historical data to conclude this f3c: or may :onduc( tests at the site without a health agent present • There :s no incr:ase in flow and/or change in use proposed • There a:"e ,io variances requested or needed. • The bo(corn :)f the proposed leaching facility will not be located less than Fourteen aoove the maximum adjusted groundwater table elevation. fAdiusc the nunc_.yater cable using the Frimptor method when applicable] Pease complete the following: -1.i l'op of Ground Surface Elevation (using GIS information)An 4 __ 5� t� 1"Y' Elcvat:on _ ad;us(ment for .nigh V.W. , = ��• O -)'R--T.R,HNCF BETWEEN and B 8�1• S'(�.VED __. - DATE: ...--- ---------- - -- NOTICE , 1 31asec i-ort t^c above information, a repair permit wil! be issued for )edrooms T.a<.,r^.u.r: `:r` ,iddiiv)nal bedrooms aie authorized in ttie future wictiout engineerec — - — — --- s•+scer-i plans. �c:un:r,ou Pc1cc.im9 Permit Number: Date: Completed by: HIGH GROUND-WATER LEVEL COMPUTATION Site Location: Z4 c. 04d\er LAt1E ��(' �_ Lot No. Z Owner: � aQ�'Q� �� Address: t>QmQ Contractor: dS�93 j Qcn.1x1Cm C1\Q\ Address: Sit G3. Notes: STEP 1 Measure depth to water table tonearest 1/10 ft. .............................................................................. .Date O3 mont /da /year STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine: 5 to OAppropriate index well.................................................... 5 OB Water-level range zone ..................................................... STEP 3 Using monthly report "Current Water Resources Conditions" determine current depth to tih — SO•�water level for index well ........................... mon /year STEP 4 Using Table of Water-level Adjustments for index well (STEP 2A), current depth to water level for index well (STEP 3), and water-level zone (STEP 26) determine water level adjustment ..............................................:.................................... STEP 5 Estimate depth to high water by subtracting the water• level adjustment (STEP 4) from measured depth to water levelat site (STEP 1) .................................................. ............................... fr Figure 13.--Reproducible computation form. 15 CARMEN E. SHAY (508)-548-0796 ENVIRONMENTAL SERVICES, INC. P.O. Box 627,East Falmouth,MA 02536 September 5, 2003 RE: Certification of Title V Septic System Installation: Residential Property—24 Saddler Lane,West Barnstable, MA Dear Sir or Madam: On September 3, 2003, Roger Roberts, Inc. was issued a permit to install a Title V Septic System at 24 Saddler Lane, West Barnstable, MA, based on a design drawn by Shay Environmental Services, Inc., dated, September 2, 2003. X� I Certify That The Septic System Referenced Was Installed Substantially According to the Plan I Certify That the Referenced Above Septic System Was Installed With Changes but in Accordance With State and Local Regulations, Revisions or As-Built Plans/Sketch will Follow. The Septic System Was Not Installed Per State and Local Regulations and Corrective Action is Required. If you have any questions,please do not hesitate to call the undersigned at (508)-548-0796. Sincerely, CARMEN E. SHAY ENVIRONMENTAL SERVICES,INC. rojszv\v_� &Pp�/ Carmen E. Shay, R.S., C.S.E. President FAILED UUSPECTIO COMMONWEALTH OF MASSACHUSETTS z W EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS r d DEPARTMENT OF ENVIRONMENTAL PROTECTION O,'M Svev 350 MAIN STREET & WEST YARMOUTH,MA WIM 508-775-2800 TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION MAP 151 PAR 042 Property Address: 24 SADDLER LANE WEST BARNSTABLE,MA 02668 Owner's Name: ROSS,MAGGIE Owner's Address: 24 SADDLER LANE RECENED WEST BARNSTABLE,MA 02668 Date of Inspection AUGUST 20,2003 Name of Inspector:(please print) JAMES D.SEARS SEP 0 5 2003 Company Name: A&B Canco TOWN OF BARNSTABLE Mailing Address: 350 Main Street HEALTH DEPT. West Yarmouth,MA 02673 Telephone Number: 508-775-2800 CERTIFICATION STATEMENT 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 perfonned based on my training and experience in the proper function and maintenance of on site sewage disposal systems. 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority ✓ Fails Inspector's Signature: Date: The system inspector shall suPrnittpy 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 tot he buyer,if applicable,and the approving authority. Notes and Comments ****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. Title 5 Inspection Form 6/15/2000 1 Page 2 of i l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 24 SADDLER LANE WEST BARNSTABLE,MA 02668 Owner: ROSS,MAGGIE Date of Inspection: AUGUST 20,2003 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: N/A I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: N/A 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 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 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. ND explain: 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 obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping snore 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 obstruction is removed ND explain: Title 5 Inspection Form 6/15/2000 2 Page 3 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 24 SADDLER LANE WEST BARNSTABLE,MA 02668 Owner: ROSS, MAGGIE Date of Inspection: AUGUST 20,2003 C. Further Evaluation is Required by the Board of Health: N/A 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 salt marsh 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 public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance **This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: Title 5 Inspection Form 6/15/2000 3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 24 SADDLER LANE WEST BARNSTABLE,MA 02668 Owner: ROSS,MAGGIE Date of Inspection: AUGUST 29,2003 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 pit is less than 6"below invert or available volume is less than 'h 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 N/A Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply N/A Any portion of a cesspool or privy is within a Zone I of a public well N/A Any portion of a cesspool or privy is within 50 feet of a private water supply well N/A 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.) YES (Yes/No)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 detennine what will be necessary to correct the failure. E. Large Systems: N/A To be considered a large system the system must service a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no to each of the following: (The following criteria apply to large systems in addition to the criteria above) 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 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 is failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D h s all upgrade the system in accorda nce n y ace with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. Title 5 Inspection Form 6/15/2000 4 Page 5 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 24 SADDLER LANE WEST BARNSTABLE,MA 02668 Owner: ROSS,MAGGIE Date of Inspection: AUGUST 29,2003 Check if the following have been done. You must indicate"yes"or"no"as to each of the following Yes No J Pumping information was provided by the owner,occupant,or Board of Health J Were any of the system components pumped out in the previous two weeks? ✓ Has the system received nonmal flows in the previous two week period? J 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? J Were all system components,excluding the SAS, located on site? J 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 infonnation on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)has been determined based on: Yes No ✓ Existing infonnation. 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 CM 15.302(3)(b)] Title 5 Inspection Form 6/15/2000 5 Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 24 SADDLER LANE WEST BARNSTABLE,MA 02668 Owner: ROSS,MAGGIE Date of Inspection: AUGUST 20,2003 FLOW CONDITIONS RESIDENTIAL Number of Bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CM 15.203(for example: 110 gpd x#of bedrooms: 330 Number of current residents: 1 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no): YES Seasonal use(yes or no): NO Water meter readings,if available(last 2 years usage(gpd)): N/A Sump pump(yes or no) NO Last date of occupancy: PRESENT COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CM 15.203): Basis of design flow(seats/persons/sqft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of infonnation: JULY 2003 Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: gallons—How was quantity pumped detennined? Reason for pumping: PUMPED AFTER INSPECTION,SYSTEM FULL 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 co of the current operation and maintenance gY PY p contract(to be obtained from system owner) Tight tank Attach copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: 1986 PERMIT#85-877 Were sewage odors detected when arriving at the site(yes or no): NO Title 5 Inspection Form 6/15/2000 6 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 24 SADDLER LANE WEST BARNSTABLE,MA 02668 Owner: ROSS,MAGGIE Date of Inspection: AUGUST 20,2003 BUILDING SEWER(locate on site plan): ✓ Depth below grade: 20" Materials of construction: Cast iron _ 40 PVC _ other(explain) Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK(locate onsite plan): ✓ Depth below grade: 27" Material of construction: ./ concrete metal fiberglass polyethylene _ other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1,000 GALLON PRE CAST Sludge depth: 1" Distance from top of sludge to the bottom of outlet tee or baffle: 29" Scum thickness: 0" Distance from top of scum to top of outlet tee or baffle: 8" Distance from bottom of scum to bottom of outlet tee or baffle: 18" How were dimensions detennined: ASBUILT AND TAPE Comments(on pumping recommendations,inlet and outlet tee or baffle condition_,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): MAIN TANK AND COVERS 27"BELOW GRADE.TANK FULL TO COVERS. INLET TEE,OUTLET TEE. GREASE TRAP(located on site plan) N/A Depth below grade: 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: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,.structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Title 5 Inspection Form 6/15/2000 7 Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 24 SADDLER LANE WEST BARNSTABLE,MA 02668 Owner: ROSS, MAGGIE Date of Inspection: AUGUST 20,2003 TIGHT or HOLDING TANK: N/A (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/day Alarm present(yes or no) Alann level: Alarm in working order(yes or no): Date of last pumping Comments(condition of alann and float switches,etc.): DISTRIBUTION BOX: ./ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: OVER 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.,): DISTRIBUTION BOX IS 40"BELOW GRADE. WATER LEVEL IN BOX IS 4"OVER COVER. BOX MAY BE NO GOOD, 17 YEARS OLD. BOX IS FULL,COULD NOT SEE WALLS. PUMP CHAMBER: N/A (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Title 5 Inspection Form 6/15/2000 8 Page 9 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 24 SADDLER LANE WEST BARNSTABLE,MA 02668 Owner: ROSS,MAGGIE Date of Inspection: AUGUST 20,2003 SOIL ABSORPTION SYSTEM(SAS): ./ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: 1 leaching chambers,number: leaching galleries,number leaching trenches,number,length leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) LEACHING IS ONE 1,000 GALLON PRE CAST PIT.PIT IS 4' BELOW GRADE WITH COVER AT 2'. PIT IS FULL UP INTO RISOR. PIT IS NOT LEACHING AND NEEDS TO BE REPLACED. CESSPOOLS: N/A (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 or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation etc.): PRIVY: N/A (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.) Title 5 Inspection Form 6/15/2000 9 Paae 9 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 24 SADDLER LANE WEST BARNSTABLE, MA 02668 , Owner: ROSS, MAGGIE Date of Inspection: AUGUST 20,2003 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. Locate where public water supply enters the building. 00 t� i� G Ri �3 / l L f �Y' v Title 5 Inspection Form 6/15/2000 10 Page 11 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) e Property Address: 24 SADDLER LANE WEST BARNSTABLE, MA 02668 Owner: ROSS,MAGGIE Date of Inspection: AUGUST 20,2003 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to groundwater 46.8 feet Please indicate(check)all methods used to detennine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observation site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators. installers-(attach documentation V Accessed USGS database-explain: You must describe how you established the high ground water elevation: USGS WELL DATA: WELL SDW 252 46.8 ZONE A .9 I„ � �� 67,fAD £ �I Title 5 Inspection Form 6/15/2000 11 SECTION- .SEWAGE (O —SEPTIC TANK— —"D"BOX — 4 —LEACH TOP OF_FON 2 (MSL)a -"2"OF I/$TO lb" (� WASHED STONE TF IN• OUT• IN• OUT• � � r13 L O O G ACSEPI(_ I LO TaI21 SEPTIC c 7 ELEV. ELEV. ELEV. ELEV. / P. Te O (\� _ ,C \� Cv\` I ELEV. ELEV. . o / OF 3A -LMe" \ 1 WASHED STONE - , TEST HOLE LOG o TEST BY �. r�c.Zr1k. •-1• `--�P'1�4R"\ C�,o,•lH ,� ��1.� i ~�. 'j `� „/(/ p WITNESS j� /� 0 TEST DATE �(- D BEDROOM HOUSE 3 C �� T.H. ,r 1 T.H. w 2 1 \ e`er ��� >L r ELEV. I 23/ ELEV. C NO PERC RATE ^"^415 /iN. DISPOSER DISPOSER mob_ I _- FLOW RATE 33(? (GAL/DAY) �a v 24 SEPTIC TANK 33c� (I•�= -1-1 k S REQ'D SEPTIC TANK SIZE 1 �w V �� � C\7► SIB i LEACH FACILITY c� SIDE WALL 12rr4 _ 166, 6_ t2 ,00) . 301, 6 G/D. A s of 2/2 Tr _ 113.1 93;9 BOTTOM (J ,Z (p,��j) = G/D. _ 14q,, !11 (21 ' TOTAL Z&!%q a MI5 5�/D qv t�l�l • GI.uS'TI;P USE: R-t G LEACHING AC-}«3. 75% k; e-r->ac-Tbht of � �' t✓c ��rt-� k 12' vr� - 7���..�i Fr�o1.t'r- 30'-7,�1 ' �� ,3� �` �`-'_WATER ENCOUNTERED 51 NOTES: (UNLESS OTHERWISE NOTED) fj 1.DATUM(MSL):TAKEN FROM � ��� QUADRANGLE MAP 2.MUNICIPAL WATER�1� _-____AVAIL.ABLE 3.PIPE PITCH:V4"PER FOOT 4.DESIGN LOADING FOR ALL PRE-CAST UNITS:AASHO- -44 "'"' .•!,a 5.MIN.GROUND COVER OVER ALL SEWAGE FACILITIES:(1)FT. 6.PIPE JOINTS SHALL BE MADE WATER TIGHT 4� Q" _ fi' G�t 7.CONSTRUCTION DETAILS TO BE ACCORDANCE WITH COMM.OF MASS. o t?.:• ;-� N STATE ENVIRONMENTAL CODE TITLES " C•I'�iL (. SITE PLAN 107 2 ez— ►-to-c- �� U�D r•a� �ra�Z�`C L-��tC�- �T��:+._at � ,�� Q,� LOCUS: _ S 0 f ti14sJ\ REG.P GINEER ' i o 4RNE ems\ REF: SSz/ down cape eogineering b PREPARED FOR: _ CIVIL ENGINEERS 3 __ LAND SURVEYORS �* A BOARD OF HEALTH IyS _ ` S�OR (EXISTING) s➢'�d Ms1A 8t.. pql i���i' SCALE �J CONTOURS APPROVED DATE (PROPOSED)-O-O-O-O- MA <- DATE ��-ZI S � t I I -- VENT PPE O Least 24 Inches ton).- -- - SECTION A -A 1' _ '2000' +/- Schedule 40 PVC w Charcool Odor liter ou FaaN 1lIE 10' min. from *N ALL PIPES ARE To BE a SCHEDULE 40 P.V.C. / PROFILE VIEW 'OF AUDITION`TO LEACHING SYSTEM " DDa-,RIeuTT01 9VOC 9IIAt1 BE R Existing foundation �house to septic tank *NOTE: SET LEVEL FOR AT LEAST 2 FT. 1r CONCRETE COWER U T s d Septic tank cown must be 3 of 1/8 1/2' Washed Peoston TOP OF FOUNDATION ELEV. 100.00 (Assume ) w"M B k,• of mashed grade y 3/4', to 1 1/2 Washed Crushed Stone »i_ 3-5'OUTLET Grade over Sap1le Tank- 9850 67ad°aver D-Box'- 97.00 war SAs-97.00 �rY•+c c, _ .. ,. _ -• - . KNOCKOUTS •.: - /p0 : ±. 4'PVC(CAPPED)IN9'EC110N PORT TO INSTALLED AND TO BE MTrl1 E'OF CRAOE SS }. 12 MET S - G.02 3 HOLE H-10 - 3' Yoxknam Cover Top Loud-Bev.-9100 \ / I' v [MST. BOX - 13' EXISTING `5.0.01 w Greater Tap of SAS- Elev.-91:Ti0 ' • , ,rh MST, PIPE � � $ 1,000 GAL u, 18 s-- ern' Per toot A s 4' - SCH. 40 T 1.rs- 'cr 9 as FROM EXIST. FMRMYM. w 6 SEPTIC TANK 05 H-10 5 Units a 6.25' _ ,30• PLANSECTION CROSS-SECTION /1 > 9 •.... � cli 3, 3, CONCRETE F11U fvtlNo►TION-� - v N TO REDUCE t4 a+ 0.83 10 inches 9 y a _( ) SIT �Qy - o e wAT]t vaoaTr , 31.25 3 HOLE H-10 DISTRIBUTION BOX , `. r° SYSTEM PROFILE s 9,D-eoX 0 37.25' c' 'o 0 1 , Effective Length NOT TO SCALE LOCUS U MAP Not to Scale - v 0 3.58' 3.58' 1 SOIL ABSORPTION SYSTEM (SAS> c v , c 8 - 5' BRIEN G EN ER INFILTATRO ('� B In.of 3/4"-1 1/2' c AL NOTES > Eroec tie taacn v R HIGH CAPACITY (H-20 LOADING)/ GEORGE O > Provided � t°d "tO"° (OR EQUIVALENT) Not to Scale - 1. Contractor Is responsible for Dtgsafe notification m NOTE OVERALL'HEIGHT OF INFILTRATOR IS 16 /EFFECTIVE HEIGHT IS 10 and protection of all underground utilities'and pipes. 2. The septic of anq distr ution box shalt be set Bottom or Test Hal. 1 acre-85.Nx1 I level on 6 of 3/4 -1 12' stone. ' 3. Backfill should be clean sand or gravel with no stones over:3" in size. 4. This system is subject to inspection during installation by Carmen E. Shay Environmental Services, Inc. d' OPEN SPACE 5. The contractor shall ,install this system in accordance -PERCrj ep�o��)0 n I �Cc� r� �� I / 1 with Title V of the Massachusetts state code, the approved plan OLATION R 1 V TEST / i i r+ I and Local Regulations. 3 1V 00 64d S ' 45 / i 6. If, during installation the contractor,encounters any Date of Percolation Test: SEPTEMBER 2, 2003 / I 75.00' ► + soil conditions or site''conditions that are different Test Performed By: CARMEN E. SHAY, R.S., C.S.E. 1 i 5' \\ from those shown on,the soil log or in our design Results Witnessed By. WAIVER ( per BARNSTABLE B.O.H.) / I I I I \ installation must halt & immediate notification be ROBERTS SEPTIC SERVICES ' f I I TEST HOLE 1 I -.-... - \20' 7. No or machinery drive Services, Inc. �• Percolation Rate: Less Than 5 MPI ® 60" i ► I I 0' Y .- i I I Th flit •� •.. heavy cry over the / I ELEV. 97.00/ \ septic system unless noted as H-20 septic components. I Test Hole f j i '' ;r 4" PVC` 8. Install Tuf--rite gas baffles or equals on all outlet tee ends. � 1 � � j j ��- Vent \� 9. All Distribution Lines shall be 4' .diameter Schedule 40 .NSF PVC pipes. No. 1 it D-Box `£S- F \\\ 10. All solid piping, tees do fittings shall be 4" diameter DEPTH SOILS ELEV. r I Failed r = • =` t Schedule 40 NSF PVC pipes with water tight joints. 0 97.00 I ' n1 I I v 37.25' + I I f I Leach Pit / -, �: , 11. Municipal Water is Connected to ALL OF The Residence and Abutting SaanYnd I 1 00 i i 1 }t • I I A, 96.25 w I I / 1 PrProperties Within 150 Feet. I io tix 3/2 i I `z- THE PROPERTY LINES ARE APPROXIMATE AND l Gj COMPILED FROM THE SURVEY PLAN GENERATED BY I Sandy DOWN CAPE ENGINEERING of YARMOUTH, MA Lour" i rl +` ENTITLED " CERTIFIED -PLOT PLAN OF #24 SADDLER LANE 10 M 5/E W. BARNSTABLE, MAC. DATED JANUARY 1. 198E 8'- 24" Be 95.00 AND IS NOT INTENDED TO BE A SURVEY PLOT PLAN LSoam PROJECT BENCH MARK I I 2 '\\+ i IT SHOULD BE USED FOR'NO PURPOSE OTHER THAN z5 Y 8/I TOP OF FOUNDATION I / } / THE SEPTIC SYSTEM INSTALLATION. 34'- 60" G 92.00 ELEV. = 100.00 (Assumed) i I e� a Septic T k gale 1 /' y ► EXISTING !EACH PIT TO 8E PUMPED OUT AND Mad - Fine Sand , / - / Co REMOVED TO FACILITATE INSTALLATION OF NEW SAS.` � Y74 I 1 I / / 25 / I I ! I - ► _ �_ _ HATE _; -00 - - --- _ ! ! / / co NOTE. -ANYTRIP,STRIPPED -0.lT SOIL COhT4.INING--�.EAC IISD'-.144 I I - -- _ / LOT #1 / DECK / FROM THE EXISTING LEACH PIT TO BE DISPOSED i24 ; OF AS PER BOARD OF HEALTH SPECIFICATIONS. NO WETLANDS ARE PRESENT WITHIN 200' OF THE PROPERTY U3 EXISTl / } LEGEND Perc #1 t � NG / Depth to Perc: 60" to 78" OPEN SPACE I i i 3 BEDROOM i Perc Rote- Less Than 2 MPI t ► t \ HOUSE � Observed ESHWT- None Observed I t t \ ADJUSTED H2O Elev. = None i i 1+ 1, + `� 104X 1 DENOTES PROPOSED i t t t SPOT_GRADE 1i i 1► 1+ li i t� \�`� DENOTES EXISTING x 104.46 SPOT GRADE PL PROPERTY LINE PROPOSED CONTOUR ASPHALT ; \ �\ - - - - - -97 EXISTING CONTOUR DRIVEWAY t LOT #2 16,600 Square Feet DEEP TEST HOLE & 2-19' DIAM. ACCESS MANHOLES p +, tt `� i i �� ia. �\ 9� PERCOLATION TEST LOCATION • �. •7 _� �. } t� i `� `� - 6 FOOT STOCKADE FENCE - . b I + ► } , \ bo MAP 151 j�'AC4C.t_ 04-2. \ THE ACCESS COVERS FOR THE SEPTIC TANK, / 1 1/ DISTR93UTION BOX AND LEACHING COMPONENT INLET \ OLI SET DEEPER THAN B INCHES BELOW FINISHED FGRADE SHALL INISHED GRADEE RAISED TO NITNIN B" OF0T P LAN INSTALL TUF-n7E GAS BAFFLES OR EOUALS _- 110'00 OF PROPOSED SEPTIC SYSTEM UPGRADE STEEL REINFORCED PRECAST CONCRETE /, , 5p9.92+ j PLAN VIEW .PREPARED FOR ; 102------------ / ___ MS . MARGARET ROSS 3-24' REMOVABLE COVERS AT _. , A DLE'R, .CANE 24 SADDLER LANE �3 min. clearance p ItaET a' mk,.-F 2- mine inNec ca outlet I.mr� ,r wLEr (50 F00T RIGHT OFF WAY) 6' TA[�LE MA WEST BARNS TABLE, ,nti� ,.• OUTLET w � W -r A. £� t - 5 -r Design Calculations s F o : 4•-a' min. C a qyr PREPARED BY: b � d°Pn' Number of Bedrooms 3 Equivalent to 330 Gal./Day (330 gal./Day Min. per Title V) 0 20 40 50 o C G Garbage Grinder: No __i . z �. � CARAL�'N E. ;LSH.A Y Leaching Capacity Proposed: 330 Gal./Day Minimum (Min. Per-Title V) o '- s ..�. .- t _ Septic Tank - 3 x 330 Gal./Day = 660 USE 1,500 GAIL'''Septic!Tank. ENVIRONMENTAL SERVICES, INC. _. l -,• -.�-ems Y- •_•=- 8:_0. 4' -101i SOIL ABSORPTION AREA: , Using percolation' rate of <2 min./inch r o' 1 Bottom Area: 0.74 ' al . ft. x 370 sq. ft. = 273.8 gallons „- P.O. BOX 627 CROSS SECTION END-SECTION 9 Sidewall Area: 0.74 gal.gal./sq., x 78 sq. ft. SS gallons SCALE. 1 -20 �rSTEP _.Lt � g / g SgNITAP,\N EAST FALMOUTH, MA 0253E Providing: 331.80 gallons _ TEL/FAX 508-548=0796 - Use: 5 INFILTRATOR HIGH CAPACITY H-10 UNITS, HAVING A 0.83' (10 INCHES) EFFECTIVE DEPTH, "- ' „DATE: SEPT. 2003 USE EXISTING 1000 GALLON H 10 SEPTIC TANK O SCALE. 1 -zo DRAWN BY: cEs �, TO BE USED WITH `3.58' OF WASHED STONE ON THE SIDES, AND 3.0' OF WASHED STONE NOT TO SCALE ON THE ENDS. No STONE UNDER. PROJECT#SD467 FILENAME: SD467PP.DWG SHEET 1 OF 1 PROP. VENT WITH CHARCOAL'FILTER TO ABOVE GRADE NON-WOVENAASHTO M288 CLASS 2 GENERAL TES T.O.F. EL.= 130.8 ± FINISH GRADE OVER D BOX 130.3 t ! PROVIDE EXTENSION RISER i INSPECTION PORT WITH ACCESS ' CONSTRUCTION I. UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CO WITH COVER OVER INLET& REMOVABLE WATER-TIGHT COVER OVER � F.G. OVER CHAMBERS 12�•9 �30•3 1-1/2"DOUBLE WASHED STONE TO 6" + METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL RISER TO WITHIN 6 OF FINISHED GRADE BOX TO WITHIN 3 OF F.G. (SLOPE @ 2%MIN. OVER SYSTEM) CODE AND ANY APPLICABLE LOCAL RULES. FINISH GRADE OUTLET TO WITHIN 6"OF F.G. � MIN. ABOVE CROWN OF CHAMBER FND. EL. 130.0'± F.G_ OVER TANK EL. =130.0'± 5" DIA. OUTLET(S) -- -- -------- - 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE _ ._�_ _ -- DESIGN ENGINEER. i 4"SCH. 40 PVC @ _ PROPOSED 4!' 3.6' MAX. MIN. SLOPE 1% 4.65' MAX. 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL z- . - ,'`'• _ r. _._.. _. ._.. 3 SEE NOTE 21 � SEE NOTE 21 TOP of SAS/B.O.= 125.65' SYSTEM UNLESS OTHERWISE NOTED. SCH. 40 PVC _-_- ;-. - _ .. . ..-: _ OUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN _ . - _ - - 4 TO PREVENT BREAK SEWER PIPE -. . _ _ - I = 1 'AROUND THE PERIMETER OF THE SAS. UNLESS A ,, ..r . . .� ELEVATION 125.65 fOR A DISTANCE of 5 6" 3„ 3,� DROP MAX 3" 9" L - ± _ , 4 MI E MEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE TOP OF : ... 2 DROP MIN M+N.s�o���,% PROVIDE WATERTIGHT "` _ ti^ � 3_ r 4" PVC IN FROM JOINTS TYP. 2.50' 30"TYP YL1 THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. 13" t (TYP.) 22:25"TYP 1.85' o w: SEPTIC TANK 4"PVC OUT TO 1.85' .. L I 0/o MINIMUM. I :_. .. 14 CONTRACTOR TO PROVIDE LEACHING FACILITY 3 5. SLOPE ALL SOLID PIPE AT 1. s ,. ,� 2.5' 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. I SPECIFIED DROP BETWEEN 12 6 , 4.25 (51 ) INLET AND OUTLET CONTRACTOR CONTRACTOR SHALL 12S,7O' MIN. 12'S•53' 125.0 123.15 (LAID FLAT) (Np } 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK OUTLET TEE 2 5 SHALL VERIFY SIZE 48 VERIFY CONDITION OF 7 12' 2.5 FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS AND CONDITION OF EXISTING TEES GAS BAFFLE 6"CRUSHED STONE (TYP.) NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH t EXISTING SEPTIC AND REPLACE AS OVER MECHANICALLY TANK NECESSARY COMPACTED BASE 5' MIN. 6.83' AND DESIGN ENGINEER. 33.48 8. ELEVATIONS BASED ON APPROXIMATE MEAN SEA LEVEL DATUM. BENCHMARK ELEVATION OUTLET DISTRIBUTION BOX I OF 130.00' ESTABLISHED ON TOP OF CORNER OF RETAINING WALL AS SHOWN ON PLAN. TO BE INSTALLED ON A LEVEL STABLE i BASE. FIRST TWO FEET OF OUTLET GROUND WATER ELEV= < 117.80' 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION SEPTIC TANK PIPES TO BE LAID LEVEL. THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT EXISTING 1 ,000 GALLON CONCRETE SE i 3050 CLAMBERS (PROFILE) 3050 CHAMBERS (END VIEW) 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES CROSS SECTION VIEW TO THE DESIGN ENGINEER. O ( -�- �* ' ) r•� r ( I I i `�s T `� O A , DETAILS10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC. STRUCTURES SHALL BE MADE WATERTIGHT SEPTIC T PROFILE 2 $ I IUTU� � LI . NOT TO SCALE NOT TO SCALE NOT TO SCALE _ ; 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING : • __,..,_____ _ ___� __ __ ____. .____.__.._____ _ ______________ _ ___ _.______._._------------ REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM - -- --- --- ---- - -- - -- --- - -- ",z-'"° r € - -- kp P"#IT DATA APPROPRIATE AUTHORITY. j-fit' i. .t- TEST i fl Ir - t/ r' �` �. 15550 _ A N UNLESS LOCATED,, _ r' " ; PERC NO. tI _ :�� 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H 10 LOAD G U OC D INSPECTOR: Donald Desmarais,RS UNDER MORE THAN 3 FEET OF COVER OR LOCATED UNDER PAVEMENT, DRIVES, OR s ..y •7j, l/t Alt, i TRAVELED WAYS IN WHICH CASE THEY SHALL WITHSTAND H-20 LOADING. C-2 i =�', ' ". ,,- -e I - „ EVALUATOR: Michael Pimentel, EiT, CSE i _ + = \� ' Oct. 1999 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. . . f C.S.E. APPROVAL DATE: .• ,'i `* - r" . '� . November 30 2017 MOVE ALL LOAM SUBSOIL AND UNSUITABLE i I x. ,j' ;'+. r , "�,i DATE: 14. WHERE REQUIRED, CONTRACTOR SHALL RE r ' , w i; ,, /�; ,,, ,,..,✓'-' � `°... s MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. TEST PIT#. 1 I HC- 2 € ` v'` '";0 :, REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, { k; ; Ii t't. .Y '; _ i A IN ACCORDANCE WITH 310 CMR 15.255(3). 1 ,� ;�" � �,�'`� � , ELEV TOP 130.30 , FINES OR OTHER UNSUITABLE MATERIAL C. Zx ' x r ELEV WATER <117.80 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. PERC RATE= 2 min./inch LOCUS 96. PROPOSED PROJECT IS LOCATED WITHIN: ;ry �; ;.: q ��.. DEPTH OF PERC= 42' 60"* ASSESSOR'S MAP 151 PARCEL 42 t, TEXTURAL CLASS: 1 OWNER OF RECORD: ROBERT M. MUCHA, JR. a !�`"' , 16� ! %' --_ "� ° �. - l ADDRESS: HEATHER K. MUCHA N ��,��O `` I k f ; -,*y .�`"= .- 24 SADDLER LANE 'ITP� �50 3 3) # ,.r ,.-" 0,f 130.30' TA LE MA 0266$ m.. WEST BARNS TABLE, Fill I i FEMA FLOOD ZONE X Ogg O :O' .- € x' COMMUNITY PANEL* 25001CO542J � , B Sandy Loam / ------ --- --- -- - -._ _. + t ?'. • `; C7 - ! 10Yr 516 17. DEED REFERENCE: BOOK 17926, PAGE 86 tC -'. MAP 151 _ , •/`r '-#• , 'j =-w'� § 42" 126.80' OR SWING TIES PLAN 1 .< -� w--- � - �._ •+ f' >+ t -W- + i 1$. PLAN REFERENCE: PLAN BOOK 420, PAGE 98 LOT 42 _. . .. ,. ...� x , I Perc SCALE: 1 20 {:R " ,: ,U ti v 16,598±S.F. +: - '+ s ,I _� • `*` 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. N 1 ,. . "+ i �/* 60' 125.30 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY - ranber t 4 , , FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY o+ ! FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE: - MAP 151 ' "" .. Medium Sand SWING-TIES MEASUREMENTS e C F LOT 43 -r. 121. IN ACCORDANCE WITH 310 CMR 15.401 -15.405,THE FOLLOWING LOCAL UPGRADE •,_= ,-'"~ 7 cobbles& APPROVALS ARE REQUESTED FROM 310 CUR 15.221(7): 9 HC-1 HC-2 �,�, Some co ,n DESCRIPTION :; i - �%" ( l - - --' boulders} (1.) A 1:65`WAIVER(3.00'-4.65') FOR THE MAXIMUM COVER OVER THE LEACHING FACILITY. (2.) A 0.60'WAIVER(3.00'=3.60') FOR THE MAXIMUM COVER OVER THE DISTRIBUTION BOX. CORNER STONE(1) 20.3 25.1 CORNER 1OF STONE(2) 25.0' 22.6' I t LOCUS PLAN �\ CORNER OF STONE (3) 55.0' 56.0' \ i SCALE: 1"= 1000' j �, , l t� #24 ,,1+ >> CORNER iOF STONE(4) 53.0' 57.1' 150 117.80 EXISTING 't{ w No Standing or Weeping Observed { - � ��= ,.;'f 3-BEDROOM i`+ _ I s? �v DWELLING ,f.: li ,�� f. E G NJ �. A T , Based on Percolation Test conducted by LEGEND f,.'t` TOF = 130.8'± lJ Carmen E. Shay on September 2,2003 on BFE = 123.8'± %; ;, record with the Barnstable Board of Health p ' .� NUMBER OF BEDROOMS (DESIGN) 3 50x0 EXISTING SPOT GRADE _ DESIGN FLOW 110 GAUDAY/BEDROOM TEST - - 50 - EXISTING CONTOUR MAP 151 DECK „i �� TOTAL DESIGN FLOW 330 GAUDAY PERC NO. 15550 _ 50 ___ PROPOSED CONTOUR i LOT 41 TP 2 -a PROPOSED H-20 DISTRIBUTION BOX ,r 130x3 �% DESIGN FLOW x 200 % = 660 GAUDAY INSPECTOR: Donald Desmarais, RS J 2 ' - L.r 4 d _ _ EXISTING UNDERGROUND UTILITIES �, Z,'•. EXISTING WOODEN RETAINING EVALUATOR: Michael Pimentel, EIT, CSE USE EXISTING 1,000 GALLON SEPTIC TANK WALL TO BE REMOVEDct. 1999 W ___-W • TP 1 C.S.E.CSE APPROVAL DATE: w. ��----- EXISTING WATER LINE ( November 30, 2017 130x3 ! DATE: PROPOSED FOUR (4) 3050 PLASTIC ' 1 i GAS EXISTING GAS SERVICE LINE CHAMBER w/ SURROUNDING AGGREGATE w INSTALL FOUR (4) INFILTRATOR 3050 TEST ELEV TOP= 130:30' Benchmark = I CHAMBERS W/ SURROUNDING AGGREGATE '�' TEST PIT LOCATION Comer of _ - '-ram ,2� ELEV WATER <118.30' ' EXISTING 1,000 GALLON SEPTIC TANK Ret.Wall ,- SIDEWALL CAPACITY L � � `. ;, '', EX. �� I � PERC RATE (LENGTH + WIDTH) (2 SIDES) (1.85 HIGH) (0.74 GPD/S.F.) = GAUDAY SHED I PROPOSED 4"SOLID SCHEDULE 40 PVC PIPE Approx. MSL i (33.48'+9.25')(2) ( 1.85' ) (0.74 GPD/S.F.) = 117.00 GAUDAY DEPTH OF PERC= P \ 1 i ® PROPOSED H-20 DISTRIBUTION BOX TEXTURAL CLASS: 1 BOTTOM CAPACITY PROPOSED INFILTRATOR 3050 CHAMBER (LENGTH x WIDTH) (0.74 GPD/S.F.) = GAUDAY PROPOSED INSPECTION PORT I (33.48'x 9.25') (0.74 GPDfS.F.) = 229.17 GAUDAY i \ � I 0 I „ 30' Fill � ` I .IL 13 1? TOTALS: PROPOSED 4" PVC VENT PIPE; 12" 129.30' EXACT LOCATION PER OWNER 4 C Sand Loam REV. DATE BY APP'D. DESCRIPTION _ -__ ��'6�. \ �,,\ TOTAL NUMBER OF CHAMBERS E B 10Yr 5/6 TOTAL LEACHING AREA 467.80 SQ.FT. PROPOSED SEPTIC SYSTEM UPGRADE TOTAL LEACHING CAPACITY 346.17 GALJDAY 42" 126.80' 9 l MAP 151 I PREPARED FOR: 9 j `1 LOT 47-T00 r NOTES: I CAPEWIDE ENTERPRISES i 1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP EDGE OF EACH i� � LOCATED AT SEPTIC SYSTEM COMPONENT, G Medium sang 24 SADDLER LANE 2.5Y 6/6 2. CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE LOCATION OF THE WEST BARNSTABLE, MA 02668 ) (Some Cobbles& __. _� .,._ PROPOSED LEACHING FACILITY TO ENSURE CONSISTENCY WITH TEST PIT DATA E boulders) I � � SCALE: 1 INCH = 20 FT. DATE: DECEMBER 12, 2017 SHOWN ON THIS PLAN. REPORT TO ENGINEER AND LOCAL BOARD OF HEALTH IF I SOILS ARE NOT CONSISTENT WITH TEST PIT DATA. o �0 20 ao so FEET f - _ �H y PREPARED BY: 3.) ENTIRE PROPERTY IS LOCATED WITHIN THE ESTUARINE WATERSHEDS. RESERVED FOR BOARD OF HEALTH USE 4� L s� JC ENGINEERING, INC. 144 118.30' CW..M LL,�t. 2854 CRANBERRY HIGHWAY e 4.) PER INFILTRATOR SYSTEMS INC., 3050 CHAMBERS CAN BE INSTALLED WITH A MINIMUM OF 18 INCHES TO A MAXIMUM OF 96 INCHES OF COVER WHEN INSTALLED No Standing or weeping Observed tteo� ,� // EAST WAREHAM, MA 02538 � S? IN ACCORDANCE WITH DESIGN AND INSTALLATION MANUAL FOR INFILTRATOR SITE PLAN 508.273.0377 CHAMBERS IN MASSACHUSETTS, DATED MARCH 2O15. „_ _ _ � : : �_. _ _._'__..�. srawfi y MCP Designed By:MCP Checked By:JLC JOB No. 4027 SCALE: 1 -20