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0013 YAWL ROAD - Health
13 Yawl Road Marstons Mills A= 098-033 i Town of Barnstable. P I—// Department of Re atory Services 11 $ Division Date � Kul Public Heai�h D visi ?1J,1�/(, .e�y. 200 Main Street Hyannis MA 02601 A. )e Jr. j Fee Pd /lam- " . Date Scheduled I Time _ toil Suitability Assess m"enl for Sewage Disposal Nrformed By: Wienessed By: LOCATION&GMMLkL INFORMATION Location Address . 3 V� / Owner's Name Adams Assessor's Mapm#cel: Fargineer'a Name NEWSONSIRU T[ON REPAIR )C Telephone# 1 c�'��' �C) Land Use S/ GL L'�/ Slopes Surfacx Shores ilD` Distances from: opm Water Body ft Passible Wec Area ft Drinking Water Wellft 1. Drainage Way ft. Property line ft Other R _ ,,SKETCH:(Street name,dimensiod6f lot,exact locations of test holes&pere tests,locate wetlands in prmdtnity m�holes) yew tf • I N r., hA Parent material(gedWc) fir/ a �"AV I�Q') Depth to Bedrock a""���� Depth to GmrmdwaW. Standing Water in Holc G2'�' t— WaPing B0m Pit Face Bstimated Seasonal fth Groundwater 74* OT !D5t TION FOR SEASONAL MGH WATT TALE Method Used: �'/ I D standing obs.hole: in. Depth t6 soll tltoltllbt In. �t a ! in. Orouadwnter A u anent ft- Depth t NA"ing form side of hole J /7 Rodin Date Index Well level A�.thetor ArlU.droundwaterLevel.:: Index Well# r, g 2S PERGOLA ON TEST Date �►n`—� ° Observation Into at V Hole# �— �� 99me at b" ....._...-- Depth of Pere —�=_— start Pre-soalc't"w.(� , r F ► Cj /y�i/t �—: .s-3 End Preososk -- ' ©C--a Rate Mm./hrch t: Site passed Site Failed. Additional Testing Needed(Y/I� Site Suitability Assepstnen • Observation Hole Data To Be(.'ompleW m Back- Original•.Public He�ltlt Division I ,.. ***If percola 4n test is to be conducted within 1009 of wetland,you must first notify the 1 prior to beginning. C4#11ervation Division at least one(1)wed1c - 2 zx (�Z=b aleQ amisuStS 'Li0'51?Iio Oi£ut paquosap aauauadxapus apadx 'Sutu. matp 1p!m luolstsuoo am Aq pauuopad see►sisgpsus anogs agl imp pug uopoalo 1launtaltnua30 lu2m=daQ agl iq panoidds uopW"M J6MIsna pios acp passed ansq I(mlep)�� uo yscp fucuao IIV J ,J uogeaylaia� lJ'l ---••-- Lpapopm sn Wad 8uum000,tipgm vu;o gldap agl st lsgnn you 11 L[uols,(s uopdiosge pros agl joj p osodoid sans agl lnogSnonp panaosgo am ppB ut,isixa ppoM snomiad Suwnm Affs vajo laaj cool lseap 38 saoQ�p BJaaley�p snoJ�►aad auanaap ►I IUg 3o gl aQ Pk ON kvunoq pow mast 001 unn!m =A --7—oN gnpmm maR oos unp!m 92A ON r Mmmq Poog MA OOS aAogv vlq 511I aauuansul pooh •Smnog'sauoms'MMMLOS) su!mom o1mw). (vase) Cu!)aoopns imo . IIoS MOD Qos ammI 1loS OMPOH I!oS u►ml tpdaa #910H OO'I TIM NOIIVAITHS90 d'3HQ s�Plrrog'sauolS'a�m�utS) onquow olamw) (Vasa) tu!)omms istpo . 1!oS Jo!oo Has. angxay nos uozuoy Ims moo tpdoa #910H OO7 MOH MOLLVAIMSHO dHHQ •sraPlnog'saums'am on4s) Sminow (na W) (vQSN ('u!)anjims ,. iagpo IRS mica ims amML In uoz!ioH IIoS mog tpdaa #010H O0Z 2'IOH AIOLLvA2I'3SS0 ma, .z157 S yw •r Mu d, a f� 'smma'Iauo1S'�man�S) 8a!IuoW UI N� (VQSN Cp!) �'nS XRPo Hos Aco Ims am1Ya.L 1!oS aozpoH IRS moil 4idQU #aloH OO l 2noH NOUVAII'3SSO dHHQ � 1 I sr No. �" �� U Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZippYicatfon for � gpogal bi wp rt Con0truction 30ermit Application for a Permit to Construct( ) Repair(grade( ) Abandon( ) ❑.Complete System ❑Individual Components Location Address or Lot No. 13 y(,,u/j /�'() .C/v�f�{ Owner's Name,Address,and Tel.No. Assessor's Map/Parcel Installer's Name,Address,an Tel.No. Designer's Name,Address and Tel.No. �b.�5145 At 3 0�� is d �! .4Sso��al�S 8 3 -co �� i Type of Building: Dwelling No.of Bedrooms Lot Size 2 sq.ft. Garbage Grinder ( ) Other Type of Building ��y1. No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) ' Q gpd Design flow provided 3 jay, Zr gpd Plan Date Number of sheets Revision Date Title / Size of Septic Tank /�Q rX151-PVC Type of S.A.S. 3L9 SQ /gIAllr o0/ 21.91Y /Z,T, 'Z Description of Soil Nature of Repairs or Alterations(Answer when applicable) (jQSt-&I) N.Pto- S,4 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 Bo-4 of Health. Signed Date P Application Approved by �^ ylltDate t) -4— Application Disapproved by: Date for the following reasons Permit No. ©� S Date Issued I d -----_---- --_----_------------------- No. � Fee f THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOVNN Qf BARNSTABLE, MASSACHUSETTS Yes j pprtcat'lon for �Dtqogar �&pgtem Con0tructton Permit Application for a Permit to Construct O Repair(h/Upgrade O Abandon O ❑.Complete System ❑Individual Components t Voca on Address or Lot No. 1 J li�/� /�(� r5�-P/v Owner's Name,Address;and Tel.No. Assessor's Map/Parcel 071 Installer's Name,Address,an Tel.No. "' rr'4 Designer's Name,Address and Tel.No. -1 833 col// Type of Building: j Dwelling No.of Bedrooms Lot Size 2 St /2 Y sq.ft. Garbage Grinder ( ) I i Other Type of Building _ r�, ,,.y. No.of Persons Showers( ) Cafeteria( ) t Other Fixtures Design Flow(min.required) ?Q gpd Design flow provided aft 75- gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. f�SO Description of Soil i 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 fo place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed • Date ( �8 Application Approved by ^ j• Date /b ' -0 ti APPlidation Disapproved bya .- .� �. <:, Date for the following re as s i Perm,ittNo. 00 S Date Issued ———————-` :—————=—z——— ———=——————————— ' ` THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance j THIYI,S,TO CERTIFY,that the-On-site Sewage Disposal System Constructed ( ) Repaired ( }/ ) Upgraded ( ) Abandoned(�) y Xj(J j at /`? v,,,,,.)1V%Ad eez9,str Rmho has been constructed in accordance with the provi ions of Title 5 and e fir Disposal System Construction Permit No. 9 5 v dated (G^ Ll -0�. Installer Designer 1�. �1 5 5iY/4 f i f #bedrooms_�J Approved design.flow gpd I The issuance of this permit shall t be construed as a guarantee that the syste wm i�ct of n�ed. Date Inspecto r�l ——— a— -({S� -------- ...—,.. ------------ ---.--- No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS 1=t!5pogal 6p.5tem Con5tructton Permit Permission is hereby granted to Construct ( ) RepairAUpgrade ( ) Abandon ( ) System located at / 1Ja and as described in the above Application for Disposal System Construction Permit.The applicA recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this permit. Date C Approved by I Town ®f Barnstable Regulatory Services Thon4as,F. Geiler,Director STABM Public Health Division QaA �6,Q: �� f Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form Date: /0��� 07 Sewage Permit# -2JD 7-4';_D Assessor's Map\Parcel 7dZ�Jr Designer: i�f�°S Installer: 0"rw its lGl� Address: :�4,0 4d�1/jf/� Address: On d 7 �OY��� �33�w�1.�61�. was issued a permit to install a (date) V (Innsst�alleer))' septic system at /ECG/ based on a design drawn by (address) *�Orrx e_f dated -lop' 7 (designer) v' I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. 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-built by designer to follow. ZAOFMgss Q=� AW VON HONE staller's Signature) Q ,9"#1088 o y - s`��isTEP� /) AN/TAMk%P ,4 e-a (/fit (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form 3-26-04.doc t, COMMONWEALTH OF MASSACHUSETTSVL1? 'r EXECUTIVE OFFICE .OF ENVIRONMENTAL AFFAIRS fie� Ise" DEPARTMENT OF ENVIRONMENTAL PROTECTION d� y D� TITLE 5 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 13 Yawl Road Osterville, MA 02655 Owner's Name: Tom Persico Owner's Address: Date of Inspection: August 13, 2607 Name of Inspector: (Please Print) Jaynes M. Ford Company Name: Janes M. Ford Mailing Address: P.O.Box 49 Osterville,MA 02655-0049 Telephone Number: (508)862-9400 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 15.340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes Nee s Further Evaluation by the Local Approving Authority ✓ Fai s Inspector's Signature: . Date: August 14, 2007 The system inspector shall sub14 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. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 13 Yawl Road Osterville, MA Owner: Tom Persico Date of Inspection: August 13, 2007 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: I have not found any infonnation 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 detennined(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. a` 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: 2 Page 3 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 13 Yawl Road Osterville, MA Owner: Torn Persico Date of Inspection: August 13, 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 unles s ss the sari 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 anunonia 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: 3 Page 4 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 13 Yawl Road Osterville. MA Owner: Tan Persico Date of Inspection: August 13, 2007 D. System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each of the following for all inspections: Yes No Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than %2 day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. ✓ Any portion of the SAS, cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ✓ 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 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.] 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 determine what will be necessary to correct the failure. E. Large System: 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 II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 I� Page 5 of 11 a , OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 13 Yawl Road Osterville, AM Owner: Tom Persico Date of Inspection: August 13, 2007 Check if the following have been done: You must indicate"yes"or"no"as to each of the following: Yes No ✓ Pumping information was provided by the owner,occupant,or Board of Health ✓ Were any of the system components pumped out in the previous two weeks ? ✓ _ Has the system received normal flows in the previous two week period? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection? ✓ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ✓ Was the facility or dwelling inspected for signs of sewage back up? ✓ Was the site inspected for signs of break out? I ✓ _ 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 tLe 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: 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 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 13 Yawl Road Osterville, MA Owner: Tom Persico Date of Inspection: _ AuQust 13, 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: 2 Does residence have a garbage grinder(yes or no): n/a Is laundry on a separate sewage system(yes or no): n/a [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Currently occupied COMMERCIAL/INDUSTRIAL 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 Source of information: Never nuniyed-Per owner Was system pumped as part of the inspection(yes or no): No If yes, volurne 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): Apprcximate age of all components,date installed(if known)and source of information: Instatled on 6123182 per as built card Were sewage odors detected when arriving at the site(yes or no): No 6 IL Page 7 of 11. OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 13 Yawl Road Osterville, MA Owner: Torn Persico Date of Inspection: August 13, 2007 BUILDING SEWER(locate on site plan) Depth below grade: 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 on site plan) Depth below grade: 16" 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: 1000 gal. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 10" 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: 10" How were dimensions determined: Measuring stick Conunents (on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Cement tees were present. The liquid level was even with the outlet invert Recommend pumping GREASE TRAP: None (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.): 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: 13 Yawl Road Osterville. MA Owner: Toni Persico Date of Inspection: August 13, 2007 'TIGHT or HOLDING TANK: None (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: A:arn 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: Even Corn ments(note if box is level and distribution to outlets equal,any evidence of solids carryover, any evidence of leakage into or out of box,etc.): The D-box was normal. PUMP CHAMBER: Nore (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Continents(note condition of pump chamber,condition of pumps and appurtenances, etc.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 13 Yawl Road Osterville, MA Owner: Tom Persico Date of Inspection: August 13, 2007 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: Cormnents(note condition of soil, signs of hydraulic failure, level of ponding,damp soil,condition of vegetation, etc.): The leach Dit was full. The liquid level was up to the inlet nine Solids were present The cover was 12"below Qi ade The leach Pit was in failure. CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan) Number-and configuration: Depth -top of liquid to inlet invert: Dep-.h 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.): PRI`'Y: None (locate on site plan) Materials of construction: Dimensions: Depth.of solids: Convnents(note condition of soil,signs of hydraulic failure, 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: 13 Yawl Road Osterville, MA Owner: Tom Persico Date of Inspection: Auzust 13, 2007 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two pennanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. GAkrA (3q c e , 0 A 8 ryaay 10 z Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 13 Yawl Road Osterville, MA Owner: Tom Persico Date of Inspection: Aurzust 13, 2007 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 25 +/- feet P'ease 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: Topographic and water contours mans Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using Barnstable topographic and water contours maps the maps were showing approximately 25'+/ to groundwater at this sire. This report has been prepared only for the septic system and components described herein. This septic system has been inspected as of the da,.e of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied, relating to the septic system, the inspection, this report and/or any components of the septic system which have not been located and inspected. 11 f Town of Barnstable � pp tHE raY Regulatory Services snuvsrnstie Thomas F. Geiler, Director 9gj639 ,�$ Public Health Division 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. 0 � R --- 033 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AF IkS E'V ® DEPARTMENT OF ENVIRONMENTAL PRO CIRN 2 5 1997 ONE WINTER STREET. BOSTON. MA 02108 617-292-5500 HEALTE CraT TOWN OFENT"l- - WILLI.AM F.WELD TRUDY CORE Governor Secretary ARGEO PAUL CELLUCCI DAVID B.STRUHS Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissioner PART A CERTIFICATION Property Address: 13 Yaw-1 Rd, Marstons Mills Address of Owner: Joe Figmic Date of Inspection: 1 `%1— ? (If different) 96 Shelter Rock Rd Name of Inspector: Wm F. Rob L%4 n Sr T �lmbull, CT 06611 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 1�.000)- Company Name: WM E Robinson Sr Septic Sry Mailing Address: PO Box 1089 , Cent_Prvi 1 1 e, MA 0.2632 Telephone Numbei3 08_7 7 5_R 7 7 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 and experience in the proper function and maintenance of on-siteXPa e disposal systems. The system: _ sses Conditionally Passes Needs Further Evaluation By the Local Approving Authority _ Fails Inspector's Signature: !ki d Date: 11'n 7 l The System Inspector shall submit a copy of this inspection report to the Approving Authority within 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 office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: A] SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: B] , YSTEM 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. Indicate es, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not. _ The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 04/25/97) Page 1 of 10 DEP on the World Wide Web: http:llwww.magnet.state.ma.usidep Printed on Recycled Paper r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 13 Yawl Rd, Marstons Mills Owner: Joe F '' mic Date of Inspection: 7 `�—11— B) SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). Describe observations: broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four 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 C) FUR HER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: onditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the ublic health, safety and the environment. 1) YSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER HICH WILL PROTECT THE PUBLIC HEALTH AND 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 APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE NVIRONMENT: The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to 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 Zone I of a public water supply well. 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 (approximation not valid). 3) O HER (revised 04/25/97) Page 2 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 13 Yawl Rd, Marstons Mills Owner: Joe Fi mi.0 Date of Inspection: ��.//—�� 1 ] SYSTEM FAILS: Y must indicate ei;,;er "Yes" or "No" as to each of the following: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 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 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. r 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 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E] LAR E SYSTEM FAILS: You mu t indicate either "Yes" or"No" as 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 public health and safety and the environment because one or more of the following conditions exist: Ye No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply _ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area- IWPA) or a mapped Zone II of a public water supply well) The ow ier or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirq ants of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 04/25/97) Page 3 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 13 Yawl Rd, Marstons Mills Owner: Joe FigmiC Date of Inspection: Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: No d _ Pumping information was provided by the owner, occupant, or Board of Health. s _ None of the system components have been pumped for at least two weeks and the system has been receiving normal 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. f _ The system does not receive non-sanitary or industrial waste flow. The site was inspected for signs of breakout. All system components, excluding 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: The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub-Surface Disposal System. ✓j _ Existing information. Ex. Plan at B.O.H. �S T 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)) 1� (revimad 04/25/97) Page 4 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 13 Yawl Rd, Marstons Mills Owner: Joe Figmic Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Design flow:,S3 49 g.p.d./bedroom for S.A.S. Number of bedrooms: 3"_`/ Number of current residents: L�b Garbage grinder (yes or no): o Laundry connected to system (yes or no) S Seasonal use (yes or no):_4L4 Water meter readings, if available (last two (2)year usage (gpd): 9 5/1 3 5, 0 0 0 g ' 9 6/6 0, 0 0 0 ga 1 s Sump Pump (yes or no): -?- 6 Ai Last date of occupancy: COMMERCIAUINDUSTRIAL: Type of establishment: Design flow:_gallons/day 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: _ Jp OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS arid source of information: System p ped as part of inspection: (yes or no)� b If yes, volume pumped: gallons Reason for pumping: TYPE OYSTEM '/ 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) I/A Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known) and source of information: S e2 S Sewage odors detected when arriving at the site: (yes or no)L J (revised O4/25/97) Page 5 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 13 Yawl Rd, Marstons Mills Owner: Joe Fi miC Date of Inspection: B TQNING SEWER: (Locate n site plan) Depth)er ow grade: Materif construction: _cast iron _40 PVC— other (explain) Distanrom private water supply well or suction line Diam Com ents: (condition of joints, venting, evidence.of leakage;.etc.) SEPTIC TANK: I/ _ (locate on site plan) Depth below grader Material of construction: L concrete metal Fiberglass _Polyethylene _other(explain) If tank is metal list age Is age confirmed by Certificate of Compliance _(Yes/No) — Dimensions: 41 y k J ' / V -�- a 9 , Sludge depth: ' ' I � Distance from top of slud e I bottom of outlet tee or baffle: L Scum thickness: = , Distance from top of scum to top of outlet tee or baffle:/Q Distance from bottom of scum to bottom of outlet tee or baffle: —� How dimensions were determined: d "-� A 0 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.) �'C► !2 GREAS TRAP: (locate o site plan) Depth bel w grade: Material If construction: _concrete _metal _Fiberglass _Polyethylene —other(explain) Dimensi ns: Scum t ckness: Distah a from top of scum to top of outlet tee or baffle: Dista a from bottom of scum to bottom of outlet tee or baffle: Date o last pumping: Commen s: (recomm ndation 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.) (revised 04/25/97) Page 6 of 10 y ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) -Property Address: 13 Yawl Rd, Marstons Mills Owner: Joe Figmic Date of Inspection: �7—//-- 'J TIC T OR HOLDING TANK: (Tank must be pumped prior to, or at time, of inspection) (locate on site plan) Depth low grade: Material �f construction: _concrete _metal _Fiberglass _Polyethylene —other(explain) Dimensi ns: Capaci gallons De si flow: gallons/day Alarmivel: Alarm in working order_Yes; _ No Date of evious pumping: Comment ": (conditio of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:_ (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) PUMP HAMBER:_ (locate o site plan) Pumps i"working order: (Yes or No) Alarms '� working order (Yes or No) Comm nts: (note ondition of pump chamber, condition of pumps and appurtenances, etc.) 1 (revised 04/25/97) Page 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM 'INFORMATION (continued) Property Address: 13 Yawl Rd, Marstons Mills Owner: Joe Figmic Date of Inspection: SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number:k leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Alternative system: Name of Technology: Comments: (note condition of soil, s gns of hydrraau/Iy�,c failure, lee I of ponding, condition of vegetation, etc.)A4 6.i` .t CESS 0' _ (locate on site plan) Numbe and configuration: Depth-t p of liquid to inlet invert: Depth o solids layer: Depth o scum layer: Dimen ons of cesspool: Materi Is of construction: Indic tion of groundwater: inflow (cesspool must be pumped as part of inspection) Comment (note con ition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY: (locate on site plan) Materials f construction: Dimensions: Depth of lids: Comment (note con i ion of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (revised 04/25/97) Page 8 of 10 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 13 Yawl Rd, Marstons Mills Owner: Joe Fi mic Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) b y' /0 6 z- cr .. r\� J f�^�rr1 ' G 0(yi• } }L � 4 (revised 04/25/97) Page 9 of 10 J SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 13 Yawl Rd, Marstons Mills Owner: Joe Figmic Date of Inspection: —//" 7 Depth to Groundwater LL4Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observation of Site (Abuttingproperty, p pe rty, observation hole, basement sump etc.) Determine it from local conditions / (/ Check with local Board of health Check FEMA Maps Check pumping records y- Check local excavators, installers Use USGS Data Describe in your own words how you established the High /Groundwater Elevation. (Must be completed) 1 0 r3 t3��� )1_s ) I (revised 04/25/97) Page 10 of 10 TOWN OF BARNSTABLE L ,OC ATION f S Y� /A(✓' �C SEWAGE# VILLAGE d,� v, R X4 ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY t W) LEACHING FACILITY:(type) P,T (size) 6 NO.OF BEDROOMS 3 OWNER 1 C 0 PERMIT DATE: 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 o' Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) I Feet �/FURNISHED BY 1 SOebT n 3. �#/C A CAA (3A�Ic 0 . � 3 a- tia ay a 31 TOWN OF BARNSTABLE LOCATION i s yA w L ?Z T) SEWAGE # -?0 0 7 ` VILLAGE CDC 4- TV d jr ASSESSOR'S MAP & LOT -0 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY A000 E XJ S T-t n1 E LEACHING FACILITY: (type) .$ (size) 12, 29 Y XI— NO.OF BEDROOMS BUILDER OR' R OWNER PERMITDATE: y 2 O 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 V Assne 1rAiero r � 0S 3 5- 25� gat4 -3y �l = d'� --63 3 LO ATI SEWAGE PERMIT NO. V f L L A G E 9(• INSTAL R'S NAME i A 0 0 Rp S V ;�L KAPI(Y-711 e UIIDER OR O N DATE PERMIT ISSUE D l a Z f aq DATE COMPLIANCE ISSUED _- 1 r PIT � J DIS c t w� Fs s............................ THE COMAONWEALTHOFUA�SIA�Tu TS BOARD F 1 a Appliration for Diiputial Workii Tuustrurtiun Prrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: vt .......... •__: .................................. ......_....... .......... Loca o ddr� -- .._...... t:.: <S... ....... -•-•.............. ..... ................... ... .. _--Gc Q •............... caner = Address .... �----------------••-•---_._ . ........... .0 . . ....... ....._. .................. _ Installer Address dType of Building Size Lot............................Sq. feet Dwelling—No. of Bedroom _..._.�___..........................____.._._.Expansion Attic ( ) Garbage Grinder ( ) p`4 Other—Type of Building��____ No. of persons........... ............ Showers ( ) — Cafeteria ( ) a' Other fixtures ------------------------------------------------------------------------------------------------------•--------•--------•-----------------•----------- W Design Flow.........____1__�r�_..............____.gallons per person per day. Total daily flow...... ....................gallons. WSeptic Tank—Liquid*capacity./MA.gallons Length, Width...... Diameter------- "._ Depth................ x Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Other Distribution box ( ) Dosing tank ( ) 36 / Percolation Test Results Performed by`'rf ___________ __ ____________ ______ Date....ICt._.._ :'_ l................................ aTest Pit No. 1...z.........minutes per inch Depth of Test Pit____________________ Depth to ground water........................ f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ - - O -••- Description of Soil -- ---- _7___ ......... ..._....•-. .. ._ f....... - -- ........... - - - - v -----------------------•--•------------ ---------------------------------------------------------------------------------------------------------------------•------------------------•--•-------------- W ------•-----------•----••----•-••-•--•-------------••-----------•------•---•---•---•--••------•-------•---•••-•••----•--•-•-----••---------•••--••-•---•.......................................... U Nature of Repairs or Alterations—Answer when applicable-------_---------------------- .....................................................-...................... -•---------------•--------------------------------------------••-•-•------------------------------.._..--•------..._••---• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITI ILE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been i0bed by the bo.r iealth Signed ---- -------- ----- ------ --- -------_------• _- Date Application Approved BY �` - Z` .-.----••--•--- Date Application Disapproved for the following reasons---------------------------------------------------------------•-------------•--•----------------------........_ .................................••-•--•----•---._...--------------------•...•••--------•----••-•------...-•---------------•---•------••-----•-----•----•-•-------------- ................-.............. Date PermitNo......................................................... Issued-....................................................... Date No................_....... Fxa.. S. ...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ------ ......i.,.- t-f......OF...... � Allpfiratiun for Ui_gpwi al Works Cfuntitrurtion lerntit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: 2 Location-Address") or Lot�Io. ......... ......................2. J ...�"'.O%w�n.eLr .C._..._..rnz^..f.z..4....t.................... t� ... ...!......../ <..^�...r.--r�--•-••-.-n--/' /7_.�..-s^ Q� ........_. Address ... i. Installer Address / d Type of Building Size Lot.......................... Sq. feet U Dwelling—No. of Bedrooms--.......J..............................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—T e of Buildin ' '-Yc'O.... No. of persons................6.............. Showers — Cafeteria dOther fixtures -•••--•--••-••-•----••••-•••••----•------------•-----•.•----.....••-•-•--•-•----••-•-•.._..--•--••--•-••---•--•------••..............•--......_.-----• W Design Flow......... -Fes`'.__-.......................gallons per person per day. Total daily flow........'�a l-�..................gallons. W Septic Tank—Liquid capacity./Ulgallons Length—Z�_..4--. Width.._.X...... Diameter..._....... _._. Depth................ Disposal Trench—NTo..................... Width.................... Total Length........--.......... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '4 Percolation Test Resin/j Performed by__7__!-------------------•----� �`'��..a-n�r•+� Date_...�.....��....��.....__. aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water--___.._-__•_-_-..._-__. Test Pit No. 2................minutes per inch 'Depth of Test Pit.................... Depth to ground water........................ W ---------f................................................ O Description of Soil...._... ::...:..''- __;._..: . �C� •!--�� i ?,� ......?�:? r�:uz� 'J,'L,'z. ••� i U --••--•-•-•-••••--.......---••-••---••----•---•--------•................ •-•--•••----••--...----•-•--•-•-----•-•..........----•---•._._.._............---------- W •-•-•-•---••-----------------•-••-••••••----•-•-•••-•---------•-••-•-•••-•..._......•••---•--•••••------••-•-•••---------•--------••--•••••--••'---•------•-••-•-•-••--•••---••--.....••................ UNature of Repairs or Alterations—Answer when applicable............................................................................................... --'----------------•-...---'------------------------•--•---•------------------------....................._.....••••-••---•--••••-•--•---'•-•----••••---........._.....--•--•-••••----•-•-•-•............ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iTIL 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed........................ Date Application Approved By.... ��/ ..... .,:t n/. ............. Date Application Disapproved for the following reasons-..............................................................-................................................. ---•-••-•---'•---•-••-•--------••-••--••--•--•-•----•••••------...-••-•-•-•-••--.........-•----•---•---•--•--•---•••-"-•-'•-----•-•-•••••-•••-•------•---•"'--••---•••----•••------"-•••--•--------•- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH cr7OF....:r`r ................1-........ ................. .................. At wrtifiratr of Moutpliatta THIS IS TO CERTIFY, That the,Individual Sewage Disposal System constructed ( ) or Repaired ( ) ./7� i?—s' .. ................................................................................... 7�7 Installer at. ........................................::... ;------------------------=--- ---- _,._ .o =. -- -- 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.---- «- '-------------- dated_............................................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..... l2. .......... Inspector..... ........................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .. ................... No._ ...- FEE Disposal Workv Tonstrurtion nutit Permission` is hereby granted_....._ _ f-•---•--.�.--- ----------------------------•-----•-•-•-•-•-------------...........----•--•---.. to Construct or Repair an ndivld al Sewage Disposal System at No _._ ,1 f Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... B d f H alth DATE.............................................. �-�.�.-`•'•-------------•-• FORM 1255 HOBBS & WARREN. INC., PUBLISHERS j j T.O.F.(Full) Provide Riser over D-box ° NOTE:All components to be marked with NOTE:To prevent breakout,'final grade EL. 104.57� to within 6"of final grade magnetic tape or similar prior to final cover. of EL.97.12 to be carried out a minimum 15'beyond edge of leach F.G. xis F.G. EL: 100 Existing 102.0 108.5t F.G. EL: 101.48t .Ot Exis ' Maintain Min.2%slope over leach facility to prevent ponding F.G. EL:99.5-100.0t facility. �- Install risers w/covers over inlet and Min.2"of 1/8"-3/4"Washed Stone or Geotextile Fabric Inspection Port within 3"to grade outlet to within 6"of final grade ' Existing 4"SCH 40 PVC __ L=50' l 3/4" 1 1/2" Double Washed Stone 5.4°Ins ue Per Unit To Be Confirmed 4"SCH 40 PVC „L=10' Top of Peastone or Geotextile Fabric EL 97.12 @S=(2'y 4"SCH 40 PVC to"I @S=1.2%(1%MIN) 8 @S=10%(0.5%MIN) 24" Eff.Depth EL.98.41t EL.97.63 Install Gas Baffle EL.97.8 EL. 96.62 4.62 PROPOSED DB-3 o Use 3 Infiltrator 3050s EL. 98.66t H-10 DISTRIBUTION BOX (H-20)with Double Washed Stone 6 22' NOTE:Contractor to verify minimum 4'Ends,4'Sides 1000 gallon septic tank.Replace (Install PVC Inlet&Outlet Tees) SEPTIC SYSTEM PROFILE (29.4'x 12.25'x 2') with minimum 1500 gallon tank if EXISTING GALLON EL. 9.62 u ndersized or damaged. H 10 SEPPTICTIC TANK N.T.S. Bottom of TH-2 EL.72.62 SOIL LOG ADDITIONAL NOTES Approximate Groundwater DESIGN CRITERIA SOIL EVALUATOR: -AMY VON HONE, R.S. S.E.#2517 1. Contractor to confim soil suitability prior to installation. Contact BOH and Design INSPECTOR: DONNA MORANDI, R.S., BOH Sanitarian in the event of varying soils from original soil test. Number of Bedrooms: Existing 3 Bedrooms DATE: SEPTEMBER 5,2007 10:00 AM PERCOLATION RATE: <2 MIN/INCH Permit#11946 2. Existing leach pit to be pumped and backfilled. Any contaminated soils within 5'of Soil Type: Class I proposed leach facillity to be removed. Design Percolation Rate: <2 min/Inch TH - 1 TH - 2 3. Water line to be sleeved at any sewerline crossings and within 10'of any septic Daily Flow: 330 G.P.D. EL.100.55 EL.99.62 components, as needed, per Water Department requirements. Design Flow: 330 G.P.D. (Min. Required) Fill A 4. Existing septic tank to remain. Owner must maintain easy access to minimum one Garbage Grinder: No 1611 99.22 Sandy Loam 10YR4/1 cover for inspection and pumping services. A 9„ 98.87 Leaching Area Required: (330)/0.74 = 445.9 S.F. Sandy Loam . B 5. Maximum 3'of cover to be maintained over leachifacility. Regrade area over leach 10YR4/1 Loamy Sand facility to maintain maximum cover. Septic Tank Required: 1000 Gallon (Existing) 19' 98.97 10YR6/8 B 36" 96.62 Use 3 Infiltrator 3050s with Double Washed Stone: Loamy Sand " " (H-20)4' on Ends, 4' on Sides: 29.4'x 12.25'x 2' ...... C1......:.... 10YR6J6 Sandy Loam(Tight) FLOOR PLAN i. 42° 97.05 Sidewall Area: 2(29.4'+12.25')2' = 166.6 S.F. • 2.5Y7/2:.:.:.:.:.:.:.:. @ C1 60" 94.62 : Bottom Area: 29.4'x 12.25'= 360.1S.F. Coarse Sand N.T.S. t Total Area: 526.7 S.F-. 62"Bo m 2 5Y6/4 74" 94.39 Medium Coarse Sand Design Flow Provided: 0.74(526.7 S.F.)=389.75 G.P.D. C2 2.5Y6J3 13 YAWL ROAD, BARNSTABLE, MA Medium Fine Sand Bed 1 Bath.. Bat h � Dinin 2.5Y6/3 VH 15%Gravel t Room PREPARED FOR: Douglas Brown Inc. n, associates g , 120" 90.49 120" 89.62 errTnc evcrcn+o�slcNs 09/30/07:Revised a n d Leach Elevations PERC RATE: <2 MIN/IN.(C1&C2 Horizon) <9 Inches @ 8:53 minutes 320 Cotult Road Ron Haley No Groundwater Observed in TH-1 or TH-2 Bed 2 Living sandwich,MA02563 Approximate groundwater per Barnstable Groundwater Map @ EL.21.0(27't below grade) Bed 3 Room 508.833.0041 c/o 13 Yawl Road Groundwater adjustment:Well SDW 253,Zone C,August 2007(3.5')(27't below grade EL.72.621) Ostervi I le, MA 02655 1,Amy L.von Hone,RS.,hereby certify that I am currently approved by the DEP pursuant to ay er Terry A A.. W Warner.P.L.S. 310 CMR 15.017 to conduct soil evaluations and that the above analysis has been Harwich,Long ntgARooad a8as DATE REVISED SCALE SHEET NO. performed by me consistent with the requirements of 310 CMR 15.017. 1 further certify that I have successfully passed the Soil Evaluator's Exam on November,2004. 1 (so8) 432-M09 09/18/07 09/30/07 1" = 20' 2 Of 2 o' PK/SET9•09 i/ �� LOCUS o �.�(�AD GENERAL NOTES: `�� W L0 go o& �, 3? ,tip o0 Route 28 - 2 .� �� YA ;o�, tio°`'Ps �� °o , , 1. VERTI DATUM: Assumed ti a� W �0��3 ati0�� r----ti0�?/Edge of pavement �� C� '� i•�/ Tom- VffitABL-E:---f'���2. MUNICI TE}7- �, i r 3. SCHEDULE 40 C PIP Eo. BE USED THROl1GHOUT SYSTEM '-11NLESS OTHERWI NB ET D. 5° 1t7"E 'er ' ��'4. ALL PRECAST UNITS 0 CONFORM TO Yaw m Nr" .19' i �� � '� i AASHTO:_ H-10 Ro ter _ �ti �1� �o��� i�,�� , ' 5. PIPE PITCH-1/4" PER FOOT UNLESS OTHERWISE NOTED. o �p°r' 1ti: ti0 /ti Cam\ 01 q� 6. ALL CONSTRUCTION ETAILS TO BE IN CONFORMANCE WITH MA ENVIR. CODE(TITLE )AND LOCAL REGULATIONS. LOCUS MAP N.T. . j i �0i�/ �, ''' �A �9• CONTRACTOR TO VERIFY LOCATIONS OF ALL UTILITIES PRIOR TO li / + / SO, CONSTRUCTION. 11 o� ;' .:,'`: E ► ; (o oo " �`'+ LEGEND: Benchmark set: it r O�OO \\ PROPOSED CONTOUR Right corner bot om stepr :." 4 tih -' ; 99 PROPOSED SPOT GRADE r �.. / / — 40 - EXISTING CONTOUR EL.= 108.62(As umed) � ' - - • � �� -.,. j j _ �O� �/ �(p �ro�� m �� - 30.23'- EXISTING SPOT GRADE J TEST PI r r, .. ; Oar ,1 i ° 1 i E T •25'.:::: C1 `�••1 ® EXISTING WATER SERVICE Lot a� i r y —X— WORK LIMIT LINE Ca uQ Q 28,124rt S.F. 10 Y' �' , y3 o�yl ti� H-2 35 �--_,, W 0.65-� AC. o���; , �o��;lea �° tio1 (� I l +40 6' LI:.I ti , Q, c, ��'y r, + i 9 �� Map 08 / 1 + o Parcbl33 / 4- ' cu ; / �N' ,'' tiF ; NOTE: 5' removal o unsuitable soils cv 22 ,.. �. If IF (Sandy Loam)arouhd and below leach M rn r` i r O� Off` �� - , facility to an appro imate depth of 60" d ; ) o���� �02 �.. ! may be required iq area of Test Hole 2. o Q O. CO 1 I O %Y �1 a. � r � P, � � IG tip' . r . , � Replace with clea}h fill per Title 5 specs. Existing I �"� D� -'-+ , g {•� � r dank to Re4inS��pti`•� I\ O Q �.� ::, / 0 1 ,.�.1�.....j j. o r r / /i. c ... / IFIF Q M r 1f < Ede N _ O 0 Mq O � ss `� � � ti , r: � NOTE: This n i o be used fi qc �, ti \ h s pia s t ed or septic r RY s� ti0� I OZ i ti0 ' �f ` f �� o I b �q � � � � � Fo; ! � � g•I.��` system purposes only and is not to be $ WARNER N Ike do �,q !� �� `� G� considered a property line survey. 160.38 21 10�+ I i i .� , + �� o 9 ,tio 2 0 9 13 YAWL ROAD, BARNSTABLE, MA AW H Pump and Baekfill � Y�INOiUE � PREPARED FOR: 67 o� T°OG W Failed Leach Fit 9�n 1068�a associates Douglas Brown, Inc. 1 N 6 S /$6- SEPTIC SYSTEM DESIGNS a n d Ron Haley 320 Cotult Road , gASSESSOR'S MAP: 98 Sandwich,MA02563 %o Benchmark set: PARCEL: 3 q R 508.833.0041 c/o 13 Yawl Road Left corner concrete pad REFERENCE: PL. BK' 306 PG. 22 Survai„g by, Osterville, MA 02655 o EL.= 102.02(ASSumed) 11 Terry A. Warner.P.L.S. FLOOD ZONE: C Town of Barnstable Harwich, MA►MA Road DATE REVISED SCALE SHEET NO. care: 1"= 20' #25500101.0016 D (7/02/92) (50) 432-W09 09/18/07 1" = 20' 1 of 2 ",�• ----- _ �"�T� �!l--1�.t_.t... ��/. S -/n.� A,� M G A.*..S SEA t,,,.�J�'t,.•., -yam s "D O�,j V-S.C. 4 G.5 P L.A►, j e ' / ..._ � .--� C.•>tilL1~SS C�T�-�iEi�.)t5�_ '�f'F�G�F�+�'17. A l_.ev_. Pt f .� ?'U 6.00 i ki Tt-fj_� S4 STe t J St -�'Ae t.- �„ 15 CA's ti2A•..1 tom. a�t7c,)t�.,E t- Ail.. `SEPTIC TA"14S, 0VSTV-\St TtoJ ZoX, Al-10 l.E�►•Gi--1►+J Pn - S",,N ..L- 1!:.G lDiES1GiQEV r' (D (C) 0 C (D ( N. 2.,o Q ENtOJ� Au- s s , 0 000 000 , -j-�-1� t►.1JEt�r £ vAT'to...iS o1 I..EACk 4 t,.lEr QtTs ".� .IL" - j to A CAt'7t V S OF W lTl-� C L.A. F�l ' T -� o C O • 11T Q 51�_1t� I►e�.l L C-�zcQ.1�.�J�l� . pit 0000 o) 0 -� b ��. i � �� �. 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