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Home My WebLink About0088 SADDLER LANE - Health 88 Saddler Lane Marstons Mills A= 151 - 050 TO OF BA RNSTABLE ;r G VOCATION D ,�,,� SEWAGE# VI1.;LAGE/L 4RAN-/tl: I(S A ESSOR'S MAP&PARCEL nn NAME&PHONE NO. f, OJT VC.I . SEPTIC TANK CAPACITY '000 LEACHING FACILITY:(type) , (size) NO.OF BEDROOMS OWNER ,I k PERMIT DATE: CONUTTANCE DATE: 0C . 0 02 M - - 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 \Q • a.o p"( i Y i 25 ' 30 60 65 TON'�DF3ARNSTABLE �-- 5 2 8AppLER- ' 2003_5 LOCATION - - - SEWAGE #. VMLAGE-4-4 k. ASSESSOR'S MAP & LOT 151 /5 0 INSTALLER'SN tpHH0 NNQQ 'E`L`LIS -BROTHERS CONST. CO SEPTIC TANK CAPACITY Xe57,ee✓C- 106 0 -64C_' LEACHING FACILITY: (type) R Too G14AM 8& S (size) e�.JX o2SIr Peiz NO. OF BEDROOMS 3 BUILDER OR OWNER STEPHEN & MICHELE CARREIRO PERMIT DATE: 11 / 14/0 3 COMPLIANCE DATE: .Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 0 Vat Y*f.-N 13_ � � � ,� 40 d COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS + ,• DEPARTMENT OF ENVIRONMENTAL PROTECTION Sy TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 88 Saddler Lane �� ( Marstons Mills MA 02648 `- �y . Owner's Name: Gregory Varjian Owner's Address: Same F J Date of Inspection: October 2,2007 Job#07-221 1 Name of Inspector: PATRICK M.O'CONNELL Company Name: SEPTIC INSPECTION SERVICES CO. i7,1 Mailing Address: 189 CAMMETT ROAD _ MARSTONS MILLS MA 02648 _ s Telephone Number: 508-428-1779 CD t— CERTIFICATION STATEMENT ca I certify that I have personally inspected the sewage disposal system at this address and that the informa ion 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: r _X_ Passes Conditionally Passes Needs Further Evaluation by the Local Ap roving Authority Fails Inspector's Signature: QDate: 10/2/07 The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments: Tank is not in need of pumping at this time,leaching chambers have 3-4"of effective leaching. ****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. Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 88 Saddler Lane,Marstons Mills Owner: Gregory Varjian Date of Inspection: October 2,2007 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: _XX_ 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: 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 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. 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 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 obstruction is removed ND explain: 'Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 88 Saddler Lane,Marstons Mills Owner: Y J Gregory Varian g Date of Inspection: October 2,2007 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 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 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: L I Page 4 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 88 Saddler Lane, Marstons Mills Owner: Gregory Varjian Date of Inspection: October 2,2007 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No _X_ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _X_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool —X_ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _X Liquid depth in cesspool is less than 6"below invert or available volume is less than_day flow —X— Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _X Any portion of the SAS,cesspool or privy is below high ground water elevation. —X_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _X_ Any portion of a cesspool or privy is within a Zone I of a public well. _X Any portion of a cesspool or privy is within 50 feet of a private water supply well. _X— 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 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.] _No_(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 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• 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 a mapped Zone 1I 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. f Page 5 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 88 Saddler Lane,Marstons Mills Owner: Gregory Varjian Date of Inspection: October 2,2007 Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No _X_ _ Pumping information was provided by the owner,occupant,or Board of Health _X_ Were any of the system components pumped out in the previous two weeks? _X_ _ Has the system received normal flows in the previous two week period ? X Have large volumes of water been introduced to the— _ _ g system recently or as part of this inspection . _X_ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) X Was the facility _ _ _ or dwelling el Ong inspected for signs of sewage back up . _X_ _ Was the site inspected for signs of break out? _X_ _ Were all system components,excluding the SAS, located on site? X_ _ _ 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 . _X_ _ 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: Yes no _X_ _ Existing information. For example,a plan at the Board of Health. _X_ _ 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(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 88 Saddler Lane,Marstons Mills Owner: Gregory Varjian Date of Inspection: October 2,2007 FLOW CONDITIONS RESIDENTIAL 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 Number of current residents: unknown 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): Seasonal use:(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): Two years total: 159,000 gal.=217 gpd. Sump pump(yes or no): No Last date of occupancy: Currently Occupied COMMERCIALAND USTRIA L Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,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: Tank pumped 3 months ago. Source of information: Was system pumped as part of the inspection(yes or no): 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) Tight tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed (if known)and source of information: Compliance date for leaching system:3/10/04 Were sewage odors detected when arriving at the site(yes or no): No • Page 7 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 88 Saddler Lane,Marstons Mills Owner: Gregory Varjian Date of Inspection: October 2,2007 BUILDING SEWER: XX (locate on site plan) Depth below grade: 2' Materials of construction:_cast iron _X_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: XX (locate on site plan) Depth below grade: 2' Material of construction:_X_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:8.5'long x 5.2'wide—1000 gal. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle:28" Scum thickness: trace Distance from top of scum to top of outlet tee or baffle:6" Distance from bottom of scum to bottom of outlet tee or baffle: 14" How were dimensions determined: STICK WITH HINGE FLAP. Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Liquid level at bottom of outlet invert,tees intact and clear. GREASE TRAP: No (locate on site plan) 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.): Page 8 of 11 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 88 Saddler Lane,Marstons Mills Owner: Gregory Varjian Date of Inspection: October 2,2007 TIGHT or HOLDING TANK: No (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): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: XX resent if must be opened) ( p p ) (locate on site plan) Depth of liquid level above outlet invert: 0" Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): No solids or hieh stains. PUMP CHAMBER: No (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.): Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 88 Saddler Lane, Marstons Mills Owner: Gregory Varjian Date of Inspection: October 2,2007 SOIL ABSORPTION SYSTEM(SAS): XX (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: _X_leaching chambers,number: Two 500 gal drywells. _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.): Liquid level in chambers is currently F below inlet pipe High stains in chambers indicate chambers have 3-4"of effective leachin CESSPOOLS: No (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: No (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.): I . Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 88 Saddler Lane, Marstons Mills Owner: Gregory Varjian Date of Inspection: October 2,2007 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. 25 30 60 65 u r Sal; S.i trx 1 Page I] of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 88 Saddler Lane, Marstons Mills Owner: Gregory Varjian Date of Inspection: October 2,2007 SITE EXAM Slope None Surface water None Check cellar Dry Shallow wells None Estimated depth to ground water: More than 30 feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record- If checked,date of design plan reviewed: _Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: _Checked with local excavators, installers-(attach documentation) _X_Accessed USGS database-explain: USGS topo map and town GIS. You must describe how you established the high ground water elevation: Town groundwater contour map shows water below el 40 and topo map shows property higher than el. 100. C Town of Barnstable �Op IME tp� Regulatory Services IA NSUBLE ; Thomas F. Geiler, Director blAn A�0r Public Health .Division AjED AAA's Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original/copy of this report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observation s and interpretations contained within this report. In addition,by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would-be listed on the "Disposal Work Construction Permit". If you should have any questions regarding this report,please contact the certified Septic System Inspector who conducted the inspection. i ' a e No. 2PQ3 Fee�� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: > Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS / ZIPPYication for Zie;pogal *p5tem Congtruction Permit Application for a Permit to Construct( Repair( J�pgrade( )Abandon( ) El Complete System O Individual Components Location Address or Lot No. �' S.1 doI J4 r (rye Owner's Name,Address and Tel.No. Assessor's Map/Parcel Less- al rn Sd'?/3 K !�17&jl&k) O -5g N. 1#14/4510-d�yny Installer's Name,Address,and Tel.No; t°07—362— 623-7 Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow_ 330 X GGc gallons per day. Calculated daily flow 3 gallons. Plan Date 11,lIL0 ) Number of sheets l Revision Date Title Size of Septic Tank 1 49CJ`6 /LY(�� Type of S.A.S. c">- Description of Soil S'pj* Nature of Repairs or Alterations(Answer when applicable) gee S e t7�� G Date last inspected: Agreement: The undersigned agrees to ensure the construW d maintenance of the afore described on-site sewage disposal system in accordance with the provisions of T' of the mental Code and not to place the system in operation until a Certifi- cate of Compliance has be s Boar of Health. '`—`L-0 9 ig d p Date �/ Application Approve Date Lf Application Disapproved for the following reasons Permit No. Q=L 3 5'rJ�— Date Issued -G'3 ————————————————————————————————---— —— � � yir Fee No. C '3 ` THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ✓/ Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS ` . 2pprication for Migonl bp�tem Construction Permit Application for a Permit to Construct(VI/Repair(grade( )Abandon ❑Complete System ❑Individual Components Location Address or Lot No. Sd- -P r L nrY- I Owner's Name,Address and Tel No. J,T�!/e�.J f�/J/l/LP12� Assessor's Map/Parcel rS - (-t G N. dl'JA2,Sf,vs yyI/�1 Installer's Name,Address,and Tel.No. 5`'Y 3 z— k,2 -3-7 Designer's Name,Address and Tel.No. : 62 G2N7 . 2cj 6 Type of Building: Dwelling` No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other -,Type of Building No.of Persons a Showers( ) Cafeteria( ) Other Fixtures Design Flow 330 X gallons per day. Calculated daily flow 3 Y ! gallons. Plan Date /I //,fir r'1 Number of sheets / Revision Date Title Size of Septic Tank 149 C/o 12 7-ULP Type of S.A.S. o)-'- ' �r C1-a,.-, Description of Soil o 'L -I t-;l Nature of Repairs or Alterations(Answer when applicable) C �' S nJ i d Date last inspected: " Agreement: The undersigned agrees to ensure the construction nd maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Tid of the Env' onmental Code and not to place the system in operation until a Certifi- cate of Compliance has be ss this Board of ealth. (`Sign _ Date Application Approve`dLby Date (/ ;0 { Application Disapproved for the following reasons Permit No. ' Lmo 3 — 5 Date Issued 1 `J G � --------------------------------------- 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 r,l I t S Gc-j-4 c) rr h << at c IcJ I e r I--cl f)-Y, IN,05 r,� t5 C3 L�( has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. �,00?, 5.5 dated I I Installer 1` I I eR ;�,c,, .5 r-r ,C Designer r).-,� ✓� °�n( r /n„ a v The issuance of tliis ermit shall not be construed as a guarantee that the syste will unction's designed.. Date � ')u�01{ � Inspector ✓l� — —————G———————————————————————————————— NoQg�Q `S 5 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS 111%i5pooal *pgtem Con$truchon Permit `Permission is hereby granted to Construct( )Repair(L- pgrade( )Abandon( ) System located at 5<'& S9 c1 C�l f r L-7^ / ►n,n.e C T 64 1 r)S✓`)r')�- and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Cons uctio must be completed within three years of the da�f this pe" it. Date:_ ` 9 j0 Approved`by TO�I�N OF IBQRNSTABLE L 2003 -5 5 2 88 . LOCATION A D D L E R.. '-A N SEWAGE # WEST BARNSTABLE= 151 /50 'VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S N &3t�0��q: E L L.I S B R aT H E R S C O N S T. C O SEPTIC TANK CAPAC 't S?a ry�- l 6 LEACHING FACILITY:(type) A Soo C104M&F& (size) JJ X d25"NZ / NO.OF BEDROOMS 3 BUILDER OROWNER STE.PHEN & MICHELE` CA-RREIRO PERMTTDATE: 1 1 / 14/0 3. COMPLIANCE DATE: S. Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) Furnished by Lem -- o � t A--1 �: s Eo--17-- fi—,3 57 '. r3- --fo FAILED INSPECTION -3 5 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTIC�IVc low 7 OCT 2 8 2003 TOWN OF BARNSTABLE HEALTH DEPT. TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 88 Saddler Lane,West Barnstable,MA 02668 MAP Owner's Name: Steven and Michele Carreiro PARCELS Owner's Address: P.O.Box 914 West Barnstable,MA 02668 LOT S , Date of Inspection: September 30,2003 Name of Inspector: REED C.ELLIS Company Name: ELLIS BROTHERS CONST.CO. Mailing Address: 23 ENTERPRISE ROAD, P.O.BOX 59,YARMOUTH PORT,MA 02675 Telephone Number. 508-M2-6237 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 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 15340 of Title 5(310 CMR 15.000) The system: P sses Conditionally Passes Needs Further Evaluation by the Local Approving Authority 6Fails Inspector's Signature: GrC2;� Date: A 03 The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. 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. 1 Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 88 Saddler Lane,West Barnstable,MAA 02668 Owner:Steven and Michele Carreiro Date of Inspection:September 30,2003 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 T of evaluated are indicated below. Comments: i B. System Conditionally Passes: One or more system components as described in t ie"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacemer t 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 oi tank failure is imminent.System will pass inspection if the existing tank is replaced with a complying septic tank as ipproved by the Board of Health. *A metal septic tank will pass inspection if it is structural ly sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is avails le. ND explain: Observation of sewage backup or break out or ME h static water level in the distribution box due,to broken or obstructed pipe(s)or due to a broken,settled or uneven bution box.System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is remoN ed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times 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 remov ND explain: 2 Page 3 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:88 Saddler Lane,West Barnstable,MA 02668 Owner:Steven and Michele Carreiro Date of Inspection:September 30,2003 C. Further Evaluation is Required by the Board of Heal Conditions exist which require further evaluation by tf e 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 determine in accordance with 310 CMR 15.303(l)(b)that the system is not functioning in a manner which will pi otect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface w tter _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and lic Water Supplier,if any)determines that the system is functioning in a manner that protects the put lic health,safety and environment: _ The system has a septic tank and soil absorption ystem(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water su ply. _ The system has a septic tank and SAS and the SA S is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the S S 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 fat or more from a private water supply well".Method used to determin distance "This system passes if the well water analysis,perfoi med at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates thal 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 m be attached to this form. 3. Other: 3 Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 88 Saddler Lane,West Barnstable,MA 02668 Owner:Steven and Michele Carreiro Date of Inspection:September 30,2003 D. System Failure Criteria applicable to all systems: You/must indicate`oyes"or"no"to each of the following for all inspections: Yet/ No 1/ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or / clogged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or pool _ JV iquid depth in cesspool is less than 6"below invert or available volume is less than'/2 day flow equired pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number times pumped Any portion of the SAS,cesspool or privy is below high groundwater elevation. y portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface ter supply. portion of a cesspool or privy is within a Zone 1 of a public well. ty 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 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.] 4(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 determine what will be 717 to correct the failure. E. Large Systems: To be considered a large system the system ust serve 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 ir addition to the criteria above) yes no _ — the system is within 400 feet of a surf ice drinking water supply _ — the system is within 200 feet of a trib itary to a surface drinking water supply T _ the system is located in a nitrogen sitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in S ection E the system is considered a significant threat,or answered "yes"in Section D above the large system has f ailed.The owner or operator of any large system considered a significant threat under Section E or failed und4r Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the a propriate regional office of the Department. 4 Page 5 of l l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:88 Saddler Lane,West Barnstable,MA 02668 Owner:Steven and Michele Carreiro Date of Inspection:September 30,2003 Check if the following have been done You must indicate"yes"or`no"as to each of the following: Yes rWere ping information was provided by the owner,occupant,or Board of Health any of the system components pumped out in the previous two weeks? s the system received normal flows in the previous two week period? _ Have large volumes of water been introduced to the system recently or as part of this inspection ? Were as built plans of the system obtained and examined?(If they were not available note as N/A) Was the facility or dwelling inspected for signs of sewage back up? Was the site inspected for signs of break out? Were all system components,Qcluding the SAS,located on site? Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition 7of th miles 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: Yes no 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(3)(b)] 5 Page 6 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:88 Saddler Lane,West Barnstable,MA 02668 Owner: Steven and Michele Carreiro Date of Inspection:September 30,2003 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 31,o Number of current residents: Z_ Does residence have a garbage grinder(yes or no):/V O Is laundry on a separate sewage systemelf! );;�&no _ [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use:(yes or no):� 1 —f.3 Water meter readings,if available(last 2 years usage(gpd)):o2M Sump pump(yes or no): t&/c? Last date of occupancy: J COMMERCIALA NDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203):! d Basis of design flow(seats/persons/sgketc.): 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 information: Was system pumped as part of the inspection(yes or no): If yes,volume pumped:/ Ilons—11ow was quantiumpeli determined? Reason pumping: 1JZe TAcLvrkoJ 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 currant operation and maintenance contract(to be obtained from system owner) —Tight tank _Attach a copy of the DEP approval _Other(describe): Appro at of all�ts,dat installed(if own)paid gee of i ation: Were sewage odors detected when arriving at the site(yes or no):JA12) 6 Page 7 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:88 Saddler Lane,West Barnstable,MA 02668 Owner:Steven and Michele Carreiro Date of Inspection:September 30,2003 BUILDING SEWER(locate on site plan) Depth below grade: 14 Materials of construction:_cast iron Z40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition(floints,venting,evidence of lea ge,etc.): SEPTIC TANK: ovate on site plan) b( Depth below grade: + Material of construction: concrete_metal_fiberglass_polyethylene _other(explain) ?Ccertificate) ftank is metal listage:_ Is ge confirmed by a Certificate of Compliance(yes or no): (attach a copy of � � , Dimensions: 4' .5 k y Sludge depth: 7.11 Distance from top of-sludge to bottom of outlet tee or baffle: Scum thickness: f—LI/ Distance from top of scum to top of outlet tee or baffle:_ Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined: At/ Comments(on pumping recommendatfons,inlet and outlet t or baffle Condi' n,structural integrity,liquid levels as r lated to outlet invj evidence of leakage,etc.): GREASE TRAP: (locate on site plan) 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 ffle: Distance from bottom of scum to bottom of outlet 1 ee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet aid outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of l l SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 88 Saddler Lane,West Barnstable,MA 02668 Owner:Steven and Michele Carreiro Date of Inspection:September 30,2003 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberg lass_polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallonsJday Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and/distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into oyt„of x ¢ e4 14/ PUMP CHAMBER: (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 pumps and appurtenances,etc.): 8 11TTTlT A T T1VQ01Vr4TTlI1V Vf%10114 NAT Vf%D Ill1T TTATT A DV A QQ' QQ1L4V%T'i'Q Page 9 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:88 Saddler Lane,West Barnstable,MA 02668 Owner:Steven and Michele Carreiro Date of Inspection:September 30,2003 SOIL ABSORPTION SYSTEM(SAS):��)cate on site plan,excavation not required) If SAS not located explain why: leaching pits,number:_ leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: innovativetalternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc. :Q` CESSPOOLS: (cesspool must be pumped as part f inspectionloocate on sit plan) lan) r Number and configuration: � Depth—top of liquid to inlet invert: Depth of solids layer: ''j �/moos 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 fa ure,level of ponding,condition of vegetation,etc.): 11, PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic fail e,level of ponding,condition of vegetation,etc.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:88 Saddler Lane,West Barnstable,MA 02668 Owner:Steven and Michele Carreiro W � Date of Inspection:September 30,2003 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. A , /4e, 3a ' z7 � o zo 3 0 10 Page 11 of l I FFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 88 Saddler Lane,West Barnstable,MA 02668 Owner:Steven and Michele Carreiro Date of Inspection:September 30,2003 SITE EXAM Slope ';Mace water 0%01�owlcm� Check cellar Shallow wells ! - Estimated depth to ground waterg b leet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ecked with local Board of Health-explain: Checked with local excavators,installers- attach documentation) / Accessed USGS database-explain: Cc— ��e��nli�+iyJ You must describe how you established the high ground water elevation: ZS3 z�rt� LicA y I �}--- _.._ A j�-- S. o " Il f No.35L!5 . FEs...�� o.Q..:. THE.COMMONWEALTH OF MASSACHUSETTS �. BOARD OF HEALTH w'` ............oF......................................7-4 I!� ----------- ----------------------------------•---• Appliration for Uhip oal Ulorkii C omitrudian Verriat Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at may--- �......._.. �-L�Z L r•,r� xduu? �� .�. tw. ---•---- -•- -- ..__.....---- - ._......!4 ..--•--•---�......-- ---•••....__.. -- ------------------•---------_..... ...... erg Louat�Address No ..............................................._.. t Owner Address , � - ....._ fir./..� ..........:.... ............ Installer Address _ Type of Building Size Lot.�3�.`SZ-....Sq. feet Dwelling—No. of Bedrooms...�......'•L�..L�.....:..........Expansion Attic ( ) Garbage Grinder '4 Other—Type T e of Building No. of persons............................ Showers 04 yP g ---------=----------•------• P ( ).— Cafeteria ( ) Q' Other fixtures ...................•---------... ......._ W Design Flow.............. .....................gallons per person per day. Total daily flow...........3'5 .._..:......._....gallons. WSeptic Tank—Liquid capacity!0"b..gallons LengtO.75_..... Width.41!1b... Diameter................ Depth 1.LE)7. x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit .... Diameter.0$. Depth below inlet4 !G :.. Total leaching area 40I:.�....s . ft. Z Other Distribution box (�) Dosing tank �I-ZA A-,Cs ? Percolation Test Results Performed b ..........?L.,.:....A I� 3A... � ;�'� . Date..�,/A?/B-�. ....... Y --•• - --• 3...............-- ,a-1 Test Pit No. 1. .z-r....minutes per inch Depth of Test Pit... 4�......... Depth to ground water.............!4....... f% Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a9g ....._..�. ...:........... .:...... ... t -----......-------•.....r...�. .......... rA*O Description of Soil...... . �$ ..... ; ? . . .. cc�!r .:�. ..... _?. ` r `fit-°`` .�' ._.3!!.1�.�-----------.-----..-•---.-.--•--•----_ .................•---•--------•--.....:.... •---......---•----------••-•-- VNature of Repairs or Alterations—Answer when applicable............................................................................................... •----------------------------------•---••-•-•--••---•--•------------•---.....-----.:.........-•- .....................--............................................................................ Agreement: The. undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of LITL� 5 of the State Sanitary Code—'Ph undersigned further agrees not to place the system in operation until a Certificate of Compliance has hoe th and of health. Signe ...............•-•----------•-•-••-•..._.... x Application Approved By............... .. .............•..... .. Z at Application Disapproved for the f lowing reasons:................................................................................................................. ..............................•--•---•--.....................•.................---••-------............---•...................----------•-------•-----...................••••••-•••--•-....•----------- Date Permit No..... ........................... Issued....................................... Date FEjs THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........ .................OF....................................... ...... ............ Allpfiration for Uhipaual Workii Tonstrurtion Permit Application is hereby made for a Permit to Construct O or Repair an Individual Sewage Disposal System at: ...... ............................................ .................................................................................................. Locate.-Address -4-1 No .. .................................................. R.7... .. 0 Address ..... .. .............. .... ......... ........ Installer Address Type of Building Size Lot.! ....Sq. feet U Dwelling—No. of Bedrooms..........'`"`t�...........................Expansion Attic Garbage Grinder ("e9' 04 Other—Type of Building ............................ No.. of persons............................ Showers Cafeteria 04 Other fixtures ....................................................................I.................................................................................. �< Design Flow..............:!�.....................gallons per person per day. Total daily flow............ ...................gallons. Septic Tank—Liquid capacity!u-4..gallons Length Width:�L:S:... Diameter................ Depth.`!.Orr• Disposal Trench—No.................... Width ............... Total Length................._.. Total leaching area....................sq. ft. Seepage Pit No._O..�-.... Diameter..'X�.6 Depth below ...... Total leaching area.Zk!..........sq. ft. Z Other Distribution box O Dosing tank 4-7--) C,/� Percolation Test Results Performed by..........: ................ ..........Test Pit No. 1.f<..37:r...._minutes per inch Depth of Test Pit...Z. Depth to ground water.. Test Pit No. 2................minutes per inch Depth of Test Pit..................._ Depth to ground water........:............___ .................... ................................................................................................................................ Y-- 0 Description of Soil...... .................... . ................................................................... ............ .......................... se............................ ._�1_-'�-:f-2.t m.:S,;vna... ........... ....................... W ................................................ 1�4..Z.C) Z .............................................................................................................................. .... ....... U Nature of Repairs or Alterations—Answer when applicable............................................................................................... .................. Agreement The undersigned agrees to install the aforedescribed Individual Sewageo.Disposal System in accordance with the provisions of T I T LZ 5 of the State Sanitary Code— Th undersigned further agrees not to place the system in operation until a Certificate of Compliance has e SsId b th and of health. Signed ... ... ....... .. . .. ................................................. . ........ .. ..... .... . ........q Application Approved By........... ........................................... ... . ... ................... ate Application Disapproved for the f6 owing reasons:............I..................................................................................................... ti ........... ................................................................................. . .........4............................................................................ ................ Date Issued........................................................ Permit No......? . .......5.1........................... Date ......... ....... ...........o THE COMMONWEALTH OF MASSACHUSETTS fir' 17:- BOARD OF HEALTH r .....................................0 ....................... Tertifirate of Tompliattre THIS IS TO CERTIF-Y,That the Ind.vidual"Se'wage Disposal System constructed t_--ror Repaired . A.fy.............................................................................w....................................... A....... In alley ............... at..... ----- ............ ...... ........................................ has been installed in Accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the applicatioil for Disposal Works Construction Permit No.._.� .............. dated................................................ THE ISSUANCEAOF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL 'FUNCTION SATISFACTORY. DATE................•Aln�11_-.!KS............................ Inspector.'--.-. . ......................... ............ ................. ................................ THECOMMONWEALTH OF,,MASSACHUSETTS BOAR R, OF HEALTH, ..OF. SO 7ST 01............................................................... No....................... .0top- osal Works Taimtrurtion Prrmit Permissionis hereby granted.......................................................................................................................................7 """ to Construct or Repair an Individual Sewage Disposal System .......................................................................... at No...............................................................................................I 1. 4 as shown on the application for Disposal Works Construction Permit No. . ...... .r-2........ D at g d......... .. ...................... ................................... . ................................... Board of Bea th DATE...... ..... ...................................... APPLICATION .FOR PERCOLATION TEST AND OBSERVATION PITS )CATION Z_S__Q '�/ &y pl e L-Z et- _ N0. - 4- 6 20 LLAGE ��11 rz`°f �" t.J 1 l ' DATE 83 PLICANT_Le �' �Ou De,-yv-- 1/+� T FEE-. 3� DRESS IqTELEPHONE NO. � �7(Non-refundable) IG INEER v ��Dw N.c�'P��-"��•N�l i,lEbK'11` TELE ON 0-- �"�;/-•% !-,�C ,TE SCHEDULED �.. (Applicant' s signature) • • • • • O O O O O O • O • o O o 0 0 • • O 0 • • • 0 0 0 • O O o • • • • • • 0 • • • 0 • • • o • • • • o O 0 0 • • • • • • • o • o • • • o O • o • • • • • SOIL LOG IB-DIVISION NAME W �,�=_e_ (_-)-i Lam. DATE—.7v,j.r_l TIME :PANSION AREA: - YES" N0 _ , �p 2f `� , )k C-_ ENGINEER )WN WATER 'PRIVATE WELL �.C�s� 0, 9 BOARD OF HEALTH EXCAVATOR '.ETCH: (Street name,etc. .dimensions of lot, exact location of test holes and percolation tests, locate wetlands in proximity to test holes ) NOTES : �vT Lv� SU ��T �SS�Zr1 P 8 17 G'O, RCOLATION RATE: L ,ST HOLE NO: ELEVATION: TEST HOLE NO: ELEVATION: 2 S��_ .2 3 �.5� 3 4 48 � 4 5 .. 5 — ---— tH oF:.: 6 Q 6 93 CIVIL H 9 9 .,:.Nq<.3A792 EDI U — -- �.. .•�,oF 9FCfSTIQR��.��Q 10 _ 10 --- �� - 12 ✓�N�. 12 _ 13 13 14 TeA CC 14 16 Ls 16 ►ITABLE FOR SUB-SURFACE SEWAGE: LEACHING FIELD LEACH-ING .PITS_ LEACHING : TRENCHES (SUITABLE FOR SUB-SURFACE SEWAGE. REASONS : ITE: ENGINEERING PLANS MUST SHOW NUMBER ASSIGNED ON PERC TEST APPLICATION ,IGINAL: C0MP1,F;Trn IN ENTIRETY BY P . B, AND RETURNED TO BOARD OF HEALT11 II'Y: RI TAINEI) BY APPLICANT Kim Durkee 88 Saddler Lane Westi 4Barns table,Mass. 02632 System Consists Of; 1 -1000 gallon tank 1 -Distribution box. 1 -1000 gallon precast leaching pit. I i 31 r /-4 7 s �pATE: 17-- _4/ --- PROPERTY ADDRESS: 8$_Saddler_Lane _______ ----uers1...Aas.nstahL� ..- 02668 ------------------------ On the above date, I Inspected the septic ,system at the above address. This system consists of the following; 1 . 1 -1000 gallon septic tank. 2 . 1 -Distribution box. �'�� S 3 . 1 -1000 gallon precast leaching pit. Based on my Inspection, I certify the following conditions: 4 . This is a title Five Septic System. ( 78 Code ) 5 . The septic System Is In Proper working order at the present time. 6 . Pumped septic tank at time of inspection. SIGNATURE:f --•�•=JG N a m e: J. L,-1ssmt?Lr--),L>;'.,______ Company: Jcae,Qh_E- Naccmb l:-! Son , Inc . Address Box_66 -------- Centerville Ha__02632-0066 Phone: S08 77S_3338_______ THIS CERTIFICATION ODES NOT CONSTITUTE A GUARANTY OR WARRANTY ri 60SEPH P. MACOMBER & SON, INC. Tanks•Ceispools•Leichf Is Ids Pumped L Instilled Town Sewer Connections P.O. Box 6y75.3338 �e77, MA 02632-0066 r� ��CEI��IrJ f APR 2 5 2000 TDN'N OF WNSTABLE HEALTH DEPT. COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON MA 02108 (617)292-5500 TRUDY CORE Secretary ARGEO PAUL CELLUCCI DAVID B. STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 88 Saddler Lane Nana of owns.Kim Durkee West Barnstable Mass. 02668 Address of Owner: Date of ktspection: 4/1 7/.60 h P.Macomber Jr.. Name of kupeaw: (Please Print)_Joseph I ern a DEP aporoved system Inspector punkwd to Section 15.340 of Title 5(310 CUR 15.000) Con ryNww, J. Macomber &1Son Inc,ivias 2632 Ma&v Address: r Telephone Number: b U 6— 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 Inspection. The inspection was performed based on my training end experience In the proper function and maintenance of on-site sewage disposal systems. The system: Passes _ Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority ?Fails Inspector's SignaturData:The System Inspectbmit a copy of this Inspection report to the Approving Authority(Board of Health or DEP)witNn thirty (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 otfica of the Department ohfnv ronmentat Protection. The original should be.sent toZtts system owner and copies sent to the buyer, if applicable, and the approving authority. NOTES AND COMMENTS revised 9/2/98 Page Iof11 10 Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ' PART A CERTUiCATION (oon*weO Ptopa Addeu: 88 Saddler Lane We$t Barnstable,Mass. Owner. Kim Durkee Dane of kup+oti«t:4/17/0 0 a4SP£CTION SUMMARY. Ch ck A, B, C, of D: A. SYSTEM PASSES: I have not found any Information which Ind)cates that any of the failure conditions described In 310 CMR 14.303 exist. Any tallwo criteria not evaluated are indicated below. t�btllFNTS: S. SYSTDA CONDMONAUY PASSES: V0 One or more system components sa described In the 'Conditional Pass'section need to be replaced or repaired. The system. upon completion of the replacement Of repalr,as approved by the Sowd of Health,will pus. Indcate yes, no, or not determined(Y, N. or NO). Describe bask of determination In all kutance#. If 'not determined', exclaim why rxrt. The septic tank Is metal, unless the owner or operator has provided the system Inspector whh s Copy of a Corttflcets of ComplIance (attached)Indceting that the tank was Installed within twenty(20)years prior to the date of the U%spection; c the sepdc tank, whether or not metal,Is crooked,structurally unsound, shows substantial Infiltration or exfUvstion. w tan failure Is Imminent. The system will pass Inspection If the existing septic tank Is replaced with a complying septic tsru< as approved by the Board of Health. Sewage backup or brsakout or high static water level observed In the distribution box Is due to broken or obswcud pipe( or due to a broken, &etdsd or uneven distribution box. The system will pass(napecdon If(wldt approval of the Bond of Health). broken pipe(&) ue replaced obstruction Is removed distribution box la levelled or replaced 119� • The synom foquirsd pumping-Mors tttartiOur-tirnes t+•yoardus to broken or obnmeted pips(s). The.y.wm ter>V-pow— Inspection If(with approval of the Board of Health): broken pipe(&) us replaced obstruction Is removed revised 9/2/98 Psge:of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) P,oWtyAdd,.: 88 Saddler Lane West Barnstable,Mass. Owner: Kim Durkee Dace of Inspection:4/1 7/0 0 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: V0 Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and 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 WMCH.WILL.PRQIECT THE PUBLIC HEALTILAND SAFETY AND THE ENVRONMENT: 1_�b Cesspool or privy is within 50 feet of surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a 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 HEALT4i AND SAFETY AND THE 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 soil absorption system and the SAS is within a tone I of a public water supply well. t ) The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis 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. Method used to determine distance Xb� (approximation not valid).- 3) OTHER revised 9/2/98 Page 3of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A ' CERTIFICATION (continued) PmpertyAddress:88 Saddler Lane West Barnstable,Mass. ownw: Kim Durkee Dau of 4up"t'°`: 4/1 7/0 0 D. SYSTEM FAILS: You.tnust Indicate either 'Yes' or 'No' to each of the following: .410 I have determined that one or more of the following failure conditions exist as described In 310 CMR 15.303. The balls for this determination Is Identified below. The Board of Health should be contacted to determine what will be necessary to correct the tallure. Yes No -•,F/ •+Tete Backup of sewage i oornpone •SAS-oreesspd. -�.•-... . nto feciRty�ern+ rtt•doe�to sm overio�ded orolegged 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 th distri�tion box above outlet Invert due to an overloaded or clogged SAS or cesspool. i-� r Liquid depth in usspeel Is less than 8' below Invert or available volume Is less than 112 day flow. Required pumping more than 4 times In the last year NOT due to clogged or obstructed plpe(s). Number of times pumped�. Any portion of the Soil Absorption System, cesspool or privy Is below the high groundwater elevation. Any portion of a 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 I of a public well. Any portion of a cesspool or privy is within 60 feet of a private water supply wall. Any portion of a cesspool or privy is Isss•than 100 feet but greater than 50 feet from a private water Supply wall with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of WOO water analysis for .coliform bacteria, volatile organio,compounds, ammonia Ntrogen•and nitrate nitrogen. E. LARGE SYSTEM FAILS: 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: The system serves a facility with a design flow of 10,000 gpd or greater(Large System) and the system Is a significant threat to pub health and safety and the environment because one or more of the following conditions exist: Yes No/ _ L/ the system Is within 400 feet of a surface drinking water supply _ 4 > the system-ie-wiO%;n 200 feetolitrirouteryto++urtaoedrir wq�►aier'suply -- _ !� the system is located In a nitrogen sensitive area(Interim Wellheed Protection Area;IWPA)or a mapped Zone II of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regions office of the Department for further Information. revised 9/2/98 page 4orii ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:88 Saddler Lane West Barnstable,Mass. Owner: Kim Durkee Data of InspectionzI/1 7/0 0 Check if the following have been done:You must indicate either "Yes" or "No" as to each of the following: Yes No , Pumping information was provided by the owner, occupant, or Board of Health. None of the system-composents hamsimen puwNwd*w4VtJaast tWoawaaka aw&the-system hasbasaa*caieirrgwssal flow rates during that period. Large volumes of water have not been Introduced Into the system recently or as part of this inspection. As built plans have been obtained and examined. Note if they are not available with N/A. _ The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or Industrial waste flow. _ The site was inspected for signs of breakout. _ All system components, luding the Soil Absorption System, have been located on the site. _ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on•the site has been determined based on: Existing information. For example, Plan at B.O.H. _ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) [15.302(3)(b)) The facility owner.(and.^^c-pants.if diffarapt frODIALYIIerI.>dierB prG]{IGIBd.with i-formatioo.Dn tFLA pLnpat m91ntaAa ^f SubSurface Disposal Systems. revised 9/2/98 Page 5ofII i SUBSURFACE SEWAGE DISPOSAL SYSTEM,INSPECTION FORM PART C SYSTEM)INFORMATION Property Address: 88 Saddler Lane West Barnstable,Mass. owner: Kim Durkee Date 01 lrml`6 °°":4/17/0 0 FLOW CONDITIONS RESIDENTIAL: Design flow: g•p.d./bedro Number of bedrooms d sig Number of bedrooms(actuaq• Total DESIGN flow Number of current residents: Garbage grinder(yes or no): Laundry(separate system) A,s or6o:_; If yes, separatelnspection,required - Laundry System inspected Wor no) Seasonal use(yes or no):AV' Water meter readings,If availaa le(last two year's usage(gpd): Sump Pump(yes or no):�`' . Last date of occupancy: 1? CO M M ER CIA L/INDUSTRIAL: Type of establishment: Design flow: A, d ( Based on 15.203) Basis of design flow Grease trap present: (yes or no) & Industrial Waste Holding Tank present: (yes or no)-4210 Non-sanitary waste discharged to the Title 5 system: (yes or no) Water meter readings,if available: Last date of occupancy:--A?e.41- OTHER:(Describe) Lest date of occupancy: 1 GENERAL INFORMATION PUMPING RECORD and our e f information: 041 System pumped as part of inspection: (yes or no) If yes, volume pumpedllons Reason for pumping: !�y tl W1 a- TYPE OFF SYSTEM // Septic tank/distribution box/soil absorption system —",L d Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes, attach previous inspection records,if any) etc.Attach copy of up to date operation and maintenance contract I/A Technology P Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components, date installediif known)-and Bourse of4oformation: Sewage odors detected whemarriving at the site: (yes or no) revised 9/2/98 Page 6of11 • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(contirx►ed) PmportyAddr.": 88 Saddler Lane West Barnstable,Mass. Owns: Kim Durkee Date of Insp.ctlort:4/1 7/0 0 BUILDING SEWER: (Locate on site plan) Depth below grade: Material of construction: cast Iron Y 40 PVCAbother(explain) AIT Distance from Private water supply well or suction line le�A_ Diameter 4 Comments: (condition of Joints,venting, evidence of f.aka�.,♦tc.) Joints appear tight No yidenre of 1Pakage System SEPTIC TANK: AAA (locate on site plan) i! Depth below grader Material of construction:Zoncretel metatu�Flberglass�t/�Polyethylene N�other(explain) If tank is Instal,list age Nof Js.ags.conArmed by Certificate of Compllance_(Yes/No) Dimensions: O ir�Sd i 41141 Sludge depth: Distance from top of sludge to bottom of outlet tee orbaffl4r. " Scum thickness:_ Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottgrn of outlet tee or baffle: ey How dimensions were determined: Comments: (recommendation for pumping, condition of Inlet and outlet tees or-baffles, depth of liquid level In relation to outlet Invert, structuraa••integrity, evidence of leakage,etc.) P1111112 se - Inlet & outlet tees are in place. The evidence of leakage The tank rrnvarc Are— 36" hminW rvr•aAc• Thg covers GREASE TRAP: (locate on site plan) Depth below grade: Material of construction A/�concrete.�metabt�Flberglasa,(/Polyethylenether(explain) _ A44 Dimensions: IA Scum thickness: Distance from top of scum to top of outlet tee or baffle: .d Distance from bottom of scum to bottom of outlet tee or baffle: Al * Date of last pumping: A&- Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet Invert, structural Integrity, evidence of leakage, etc.) Crease trap i s nnf- precanf- revised 9/2/98 Page 7of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORMA PART C SYSTEM INFORMATION(cortdrxied) P,.wtyAddresa: 88 Saddler Lane West Barnstable,Mass. own«: Kim Durkee Daft of h,sp.cd—' 4/1 7/0 0 TIGHT OR HOLDING TAN K:ALSATank must be pumped prior to, or at time of, Inspection) (locate on site plan) Depth below Breda:-62 Material of construction:4/dconcreteR�Ametalt�/AFlberpl ass 12PolyethyleneAljother(explaln) Dimenslons: Aht Capeclty: A14 gallons Design flow: gallons/day Alarm present Alarm level: Alarm I working order:Yes�No_V Date of previous pumping: Comments: (condition of Inlet tee, condition of alarm and float switches,etc.) Tiqht or holding tankG arp not prQsent . DISTRIBUTION BOX: Ioocate on site plan) Depth of liquid level above outlet Invert:A)C) Comments: (note if level and distribution Is equal, evidenoe of solids carryover wldence of leakage Into or out of box, etc.) - Distribution box h There is evidence of solids carry over.No evidence or ieakage into or out of the hnx- Box Cover is 31 hel caw qrAap The -hQ- raised. PUMP CHAMABER:Alw Ioocate on site plan) Pumps in working order:(Yes or No) 414 Alarms In working order(Yes or No) : A Comments: (note condition of pump chamber,condition of pumps and appurtenances, etc.) -Pump C not racanf-� revised 9/2/98 Ps eel of II SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM . PART C SYSTEM INFORMATION(continued) Property Address: 88 Saddler Lane West Barnstable.Mass. owner: Kim Durkee Date of Inspectk-:4/1 7/0 0 SOIL ABSORPTION SYSTEM(SAS):_ (locate on site plan,if possible;excavation not required,location may be approximated by non-Intrusive methods) If not located, explain: Type: leaching pits,number: leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields, number, dim sions: overflow cesspool,number: Alternative system: Name of Technology: Title Five ( 78 Code Comments: n to condition of oil, igns of hydraulic failure level of ponding, damp soil, condition of vegetation, etc.) ,gamy sand c aX ase sane# to sand. No si ns of hydraulic ai ure or ponding. Soils are dry, Vegetation is normal CESSPOOLS: ,w` (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(cesspool must be pumped as part of inspection) o - Cesspools are not present _ Comments: (note condition of soil, signs of hydraulic failure,level of.pending,condition of,vegetation, etc.) Cesspools are not present PRIVY:A�46 (locate on site plan) Materials of construction: 11W Dimensions: �19 Depth of solids: / Comments: (note condition of$oil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.) Privy is not present revised 9/2/98 Page 9or11 SUBSURFACE SEWAGE DISPOSAL SY5TD4 INSPECTION FOP-M PART C SYSTDA INFORMATION(cortdra*d) Propwcy Addrw: Owner: Omits of 4upocdon: SKETCH OF SEWAGE DISPOSAL SYSTEM: Include des to at Fast two permanent reference landmarks or benchmark# locate all wells wlthln 100' (locate where public water supply comes Into house) Zp I., /147 revised 9/2/98 Pa`sloorIt SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ' PART C • SYSTEM INFORMATION(con*xwd) Ptogwty Ad&*":88 Saddler Lane West Barnstable,Mass. owner: Kim Durkee Data of 4upacd-4/1 7/0 0 NRCS Report name Soil Type_ Typical depth to groundwater USGS Date websits visited Observation Wells checked Groundwater depth: Shallow Moderate Deep _ SITE EXAM Slope Surface water Check Cellar Shallow wells r Estimated Depth to Groundwater Feet Please Indicate all the methods used to determine High Groundwater Elevation: _Obtained from Design Plans on record Observed Site (Abutting property observation hole, basement Bump etc.) 4/1 r- -- stermined from local conditions Checked with local Board of health Checked FEMA Maps _I/Checked pumping records l' Checked local excavators, Installers Used USGS Data Describe how you established the High Groundwater Elevation, (Muet be completed) Used water contours Map. Gahrety & Miller Model 12/16/94 revised 9/2/98 Page 11of11 a•nrsnnr.—n.TlrTt�lrn:mr•ntenrsTlf r.nrt*.+r:-•1r+�tl7nrAnm+AVA1Y1�n�n1fT T�TTT_vr.:r^...t-.r••F TOWN OF Barnstable BOARD OF HEALTH SUBSU11FACE SEWAGE DISPOSAL SYSTEM INSPRCTION FORM - PART D - CERTIFICATION I «•rn�•.,•;+ —�. ••".-rn rn+non.•earnrrssrrn�rr.�s�^tven� �eww.�.n.7 ern .�r-.+•r.-�:—..A -TYPI OR PRINT CI.EARLY- PROPERTY INSPECTED STREET ADDRESS 88 Saddler Lane West Barnstable,Mass. ' ASSESSORS MAP, BLOCK AND PARCEL # OWNER' s NAME Kim Durke2 PART D - CERTIFICATION NAME OF INSPECTOR Joseph P.Macomber Jr. . , COMPANY NAME J.P.Macomber. & Sot`i inc. COMPANY ADDRESS Box 66 Centerville,Mass. 02632 . Street Town or City State ZIP COMPANY TELEPHONE ( 508 ) 775- 3338 FAX ( 508 ) 790 - 1578 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true , accurate, and omplete as of the time of .inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . Check one : -Z System PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 16 . 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form , System FAILED* The inspection which I have con Voted has found that the system fails to Protect the j-,ublic health and the environment in accordance with Title 6 , 3.10 CMR 15 , 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . Inspector Signature Date 7 a( ne copy of this rtification must be provided to the OWNER, the BUYER here applicable ) and the DOARD OF HBALT11. * If the inspection FAILED, the owner or""o` erator shall up grade pgrade ' the system within one year of the date of the inspection, unless allowed or required otherwise as provided in 3.10 CMR 16 , 306 . partd .doc SECTION - SEWAGE , Z -SEPTIC TANK- 4- -"D"BOX - 4: -LEACH TOP OF FON `L .z• � MSL)o IT"OF 118TO Vz" WASHED STONE. - — 0.OpI=�- TFtZ iO.o� �j� Iso Q IN- OUT• +' IN• I I O 00 G OUT N SEPT C 144-'ctD 1 TANK in.33 ELEV: ELEV. ELEV. ELEV. ELEV. ELEV. I ' -� ffi / WASHEDSTONE , ez> 1 ► \,SO SO - CA ��• _ r,. \148 L.co,- S2 - TEST HOLE LOG z� za' laq14 TEST BY 'T6'•'�t" �yt , TEST DATE _ WITNESS DESIGN BEDROOM HOUSE 142 .�4 TA *' I I T.H. 2 ` �zn _ _ 140 ELEV. 92- ELEV. C�` NO Ca t oam 2 DISPOSER DISPOSER PERC RATE MINAN. \ FLOW RATE (GAL./DAY) lieI:_ b13>9 SEPTIC TANK 5Ar A �` ,f REO'DSEPTIC TANK SIZE 1522� r ""� /�- `� � 142 - LEACH FACILITY r� — 144 SIDE WAL1 BTc.� = CS©. (2.(��/ S) �>"i-) • 'C(,/D. —146 . BOTTOM z�Z:�, EI0,� (1.v ) . S(7.3 CG/D. 15Z -� �_ - 148 F�� -��, TOTAL ZD1 1 S� 41_i 3 �"'� 70. 6o USE: LEACHING P 17 © WATER ENCOUNTERED NOTTE.S: (UNLESS OTHERWISE NOTED) 1.GATUM(MSU~TAKEN FROM �4ti!'%L IJIC 1� QUADRANGLE MAP C 2.MUNICIPAL WATER .�,1iVAILABLE PJOT& G L-0 S'f e- 3.PIPE PITCH:W"PER FOOT 1, 'lp,o/o tc-T�4+-+_�?V= Ate '• -t�bL.. 4.DESIGN LOADING FOR ALL PRECAST UNITS:AASHO- -44 �UF3L-�,�/,�tDlll Qv+fZE1�lE�l-L c� S.MIN.GROUND COVER OVERALL SEWAGE FACILITIES:(1)FT. 6.PIPE JOINTS SHALL BE MADE WATERTIGHT 7.CONSTRUCTION DETAILS TO BE ACCORDANCE WITH COMM.OF MASS. YT STATE ENVIRONMENTAL CODE TITLES SITE PLAN i-L-A--i F*—'T-- �4 RN It.- LOCUS: Le>T 5/ WbAj-rEF? HILL S/u>D[.E2GV ti.lor �E USES Pa�;.'.7.Zc?c.L�`f L..�"V brd+��+...►G� ,/NEST L--�;l mkj` -r PL.E A41.9 1F S I GINEER �t . 7r ' ARNE REF.LvT .��' / NuNrErz N1��"l� A 3; down cape engineering �o LEaEL_ so L L.A 5 � A PREPARED FOR: _ a CIVIL ENGINEERS BOARD OF HEALTH LAND SURVEYORS -- OR. CONTOURS (EXISTING)------.------- �T-twsrihc3(�. ► >➢�8 �� . Al�{90 SCALE 4U (PROPOSED)-O-O-O-O- APPROVED DATE 1MA � �rr�A. — DATE -�� L J TOP FNDN. AT EL. 150.42' SYSTEM PROFILE TEST HOLE LOGS ACCESS COVER TO WITHIN 6" OF FIN. GRADE (NOT TO SCALE) PROVIDE INSPECTION PORT WITHIN / ACCESS COVER (WATERTIGHT) TO 6" OF FINISH GRADE ENGINEER: R. FAIRBANK, PE CURRYCOMB CiR MINIMUM .75' OF COVER OVER PRECAST WITHIN 6" OF FIN. GRADE 2% SLOPE REQUIRED OVER SYSTEM J. CONLON . 145.8' WITNESS: 2" DOUBLE WASHED PEASTONE 6/7/85 !" EL. 145.0' RUN PIPE LEVEL �/ �, DATE: I FOR FIRST 2' 3' MAX. PERC. RATE _ < 2 MIN/INCH EXISTING 1 Q00 a GALLON SEPTIC �* Ll 142.8 CLASS I SOILS P# 4625 �+ TANK (H- __10 GAS .� Focus (RE-USE) BAFFLE �� 142.15' Cl Q Ci Q Cl Cl _� 142.32 0 142.0 MCI CO C7 M M 0 CI ': a 4' AROUND r..� oaa a aaa �- Q ELEV. 6" CRUSHED STONE OR MECHANICAL $ 2' C] 0 M E Cl C� O CI a 140.0' �� 147.0' COMPACTION. (15.221 (2]) MIN o00 DEPTH OF FLOW = 4 ------- MIN % SLOPE) ( ' % SLOPE) 3/4" TO 1 1/2" DOUBLE WASHED STONE LOAM >Q vomp3o" TEE SIZES: 6" INLET DEPTH = 1 O" OUTLET DEPTH = 14., LOCATION MAP NTS I , LEACI-3'NG SUBSOIL ASSESSORS MAP 1-51 PARCEL 50 FOUNDATION--- EXIST. SEPTIC TANK 35 --� D BOX 12. FACILITY *THE INSTALLER SHALL VERIFY THE 8 " LOCATIONS OF ALL UTILITIES AND ALL -- - 48 143.0' BUILDING SEWER OUTLETS AND ELEVATIONS PRIOR TO INSTALLING ANY PORTION OF _-+150.83 SEPTIC SYSTEM SADDLER LANE SAND _ &�_- - -_4-t51,30 -R-oo------FPS} �51.71 __-f1 �� 52 STONES 65 ' ' WATER GAS 151. 132.0 (GRAVEL) LINE 53.63 g8' 1 ,00 3 UTILITY R61p.01 gin. RISERS MED & FINE 1 CATV,TEL,ELEC i SAND ' PAVED i / cyn ; DRIVE 1 4, 6 W/TRACES z SILT �1 9Q 3,88 1801" 132.0' 1 LOT si 1 NO WATER ENCOUNTERED 15,592 SFt t j � NOTES: 'toll 1 1 1� i11 433 / S._P?ri% DESIGN: (GARBAGE DISPOSER IS NOT AI I OWED ) 1 . DATUM IS ASSUMED ;_SIGN FLOW: _3 BEDROOMS ( 110 GPD) = 330 GPD 2. MUNICIPAL WATER IS EXISTING �:SE A 330 GPD DESIGN FLOW 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT, I EXISTING DWELLING 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO H- 10 152,78 rF=150.42' , S_PTIC TANK: 330 GPD ( 2 ) = 660 5. PIPE JOINTS TO BE MADE WATERTIGHT. LOT 52 USE A lam GALLON SEPTIC TANK (RE-USE EXISTING) 6, CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS. CST waTiL a 4 L.:-'ACHING: ENVIRONMENTAL CODE TITLE V. LOT 50 C_ SIDES: 2(25 + 12.83) 2 (.74) = 112 7. THIS PLAN IS FOR PROPOSED SEPTIC SYSTEM ONLY AND IS NOT TO BE USED FOR ANY OTHER PURPOSE. + 3 DECK 148.84 BOTTOM y: 25 x 12.83 (.74) - 237 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. I` --�1 6,76 _ P-r�- + 147.55 T]TAL: 472 S.F. 349 GPD 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT ti5� + 44.9 INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED 00 EXI T SEPTIC TANK USE (2) 500 GAL. LEACHING CHAMBERS (ACME OR 8 �� ( E- SE) - FROM BOARD OF HEALTH, R 00 ~ 1-1 7,34 -} 146,78 EQUAL) WITH 4' STONE ALL AROUND 10. PUMP & REMOVE (OR FILL W/CLEAN SAND) EXISTING LEACH PIT o EXI LP (SE TH N E 10) +1 O BENCHMARK 149,86 NAIL IN FENCE POST LEGEND +1 .70 ELEV s 150.26' T � ._ _E SITE 1 ,�'W. +147,6 146,28 aI 100.0 PROPOSED SPOT ELEVATION OF 16" OAK 88 SADDLER LANE 49. 145 100x0 EXISTING SPOT ELEVATION IN THE TOWN OF: I 147. 1 100 PROPOSED CONTOUR ( WEST) B A R N S T A B L E 1A�` 143,45 148,63 .-_. _ �.._...- 3.77 100 EXISTING CONTOUR PREPARED FOR: STEPHEN & MICHELE CARREIRO pGE 1.A �83 -' +}4-7. ---+ -9bT °st " 20 ® 20 40 60 wt tst 86T BOARD OF HEALTH st Ost 6bI 149.71 APPROVED DATE MA SCALE: 1" = 20' DATE: NOVEMBER 1, 2003 - ISI �St ESI--_�St ZSI X st XSI 06 off 508-362-4541 fox 508 362-9880 70,00' ... down cape engineering, Inc. -jjj OF Mq OF ARNE ARNE H. G CIVIL ENGINEERS H. � U,,IALA � <a t)JALA � 64a v, LAND SURVEYORS No.263 �` -��7�'1 2 939 main st. yarmouth, ma 02675 03-316 ,