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0077 BARNHILL ROAD - Health
77 BARNHILLL"�W. BARNSTABLE A= 108-018 t. �I k No. 4210 1/3 BLU psnd(ZOPS'n ESSELTE 10% O ® 0 0 No. Fee ®© THeCOMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Application for aigoal �&rwm Cou0tructiou Vermit Application for a Permit to Construct( ) Repair/ Upgrade( ) Abandon( ) ❑.Complete System [ 1 Individual Components Location Address or Lot No. 77ec:3d o—er'r's�N/amee Address,grid Tel.No. /® adrpsor' vaarcel Installer's Marne,Addres ,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: / Dwelling No.of Bedrooms Lot Size S (� sq. ft. Garbage Grinder 4)/0 Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures �g Design Flow(min.required) ;�,30 gpd Design flow provided gpd Plan Date S(/2 Number of sheets ` Revision Date —�Z Title Size of.Septic Tank ��� �i,J1C/��! Q Type of S.A.S. Z Description of Soil 12— A Z--,r 7— Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of alth061 . — gned � � Date Application Approved by Date " c;- Application Disapproved by: Date for the following reasons Permit No. C Date Issued 7 d_ Kx .. Fee '-r THE=-COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF�BARNSTABLE, .MASSACHUSETTS Yes Application for Migo' sml *pgtem Con5tructiou 3permit Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) El-Complete System 71 Individual Components Location Address or Lot No. 77 Kam'! o h-1 Owner's Name,Address, +Address,and Tel.No. Assessor's Map/Parcel x Installer's Name,Address;and Tel.No., Designer's Name,Address and Tel.No. 771, Type of Building: -Q Dwelling No.of Bedrooms pp w� Lot Size 3�51/40 sq. ft. Garbage Grinder Other Type of Building /�e..'914G eeCt No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) ` 30 god —Design flow provided 3, ! gpd Plan Date Yl2✓ 1�� Number of sheets l� Revision Date Title { t f Size of Septic Tank hV0 ,IX/S� D 'Type of S.A.S. 2- - Description of Soil 12- X Z.-.J5—.r 7— Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement:- The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. •�•y�-'ate. ---- i.,,/ «.., /� Signed ( � 1 �---7 Date "/ /( Application Approved by ' 't f '} + Date :° " /� T Application Disapproved by: Date for the following reasons a , Permit No. / Date�Issuedt; ------------------------ fl THE COMMONWEALTH OF MASSACHUSETTS ,- - BARNSTABLE, MASSACHUSETTS t f Certificate of (Compliance THIS IS TO CERTIFY,that�t ier�Onyrsite Sewage Disposal System Constructed ( . ) Repaired (Y ) Upgraded ( ) Abandoned( )b0 /r� �t �f / r a at 7 ��� /�� l,+ +�i�'f �� /'/I,Ssra°been constructed in accordance J l p with the provisions of Title and the for Disposal System Construction Permit No. dated `, �4!G .r Installer 03--, �O d ) Designer ~'�>")'n C6 Dom- ` , #bedrooms �j Approved design flowA � G The issuance of this permit shall r of be construed as a guarantee that the system :ill function as designed � 0 / Date �� 1 �' Inspector L/'X/ �r✓• - No. Al,0 —C7ql� =-=Fee /0_ _ G THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION BARNSTABLE; MASS SETTS 3Mpoal i§p!6tem Q.Longtructioft permit Permission is hereby grraajnted to Construct (/ ) lRepair ("�) Upgrade,(�./) yAbandon /� d ( ) System located at ,/ 7 �1��/I/�/ � � (�� !/ /E 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: Construction must be completed within three years of the to of thissppeerr m Date 4) � `I 0 \ Approved-by. A TRANS. NO.: CITE'/TOWN: APPLICANT: ADDRESS: DESIGN FLOW: 3-SO gpd REVIEWED BY: DATE: N/A OK NO N'N 1�, 1 ,S"�}� '"• +i.: ;; Legal boundaries denoted [310 CMR 15.220(4)(a)] Street, Lot, tax parcel number and lot number noted on plan [310 CMR 15.220(4)(u)] ✓ Locus Provided [310 CMR 15.2204(t)] Plan proper scale? (1"=40' for plot plans, 1"=20' or fewer for components) [310 CMR 15.220(4)] Easements shown [310 CMR 15.220(4)(b)] System located totally on lot served [310 CMR 15.405(1)(a) for upgrades]- if not, a variance is required [310 CMR 15.412(4)] Location of impervious surfaces (driveways, parking areas etc.) [310 CMR 15.220(4)(d)] Location all buildings existing and proposed 310 CMR 15.220(4)(c)] Location and dimensions of system components and reserve areas. ✓ , [310 CMR 15.220(4)(e)] System Calculations [310 CMR 15.220(4)(f)] daily flow septic tank capacity(required and provided) soil absorption system(required and provided) whether system designed for garbage grinder J North arrow [310 CMR 15.220(4)(g)] Existing and proposed contours [310 CMR 15.220(4)(g)] Location and log of deep observation holes (existing grade el. on /' each test) [310 CMR 15.220(4)(h)] V Names of soil evaluator and BOH representative [310 CNM 15.220(4)(h) and(i)] Location and date of percolation tests (performed at proper elevation?) [310 CMR 15.220(4)(1)] r Percolation test results match loading rate? [310 CMR 15.242] V/ Certification statement by Soil Evaluator [310 CMR 15.220(4)0)] Observed and Adjusted groundwater (method for adjustment / given or indicated) [310 CMR 15.103(3) and 310 CNM 15.220(4)(n)] Address Sheet 1 of 7 N/A OK NO Location of every water supply, public and private, [310 CMR 15.220(4)(k)] ✓ within 400 feet of the proposed system location in the case of surface water supplies and gravel packed public water supply within 250 feet of the proposed system location in the case V within 150 feet of the proposed system location in the case / of private water supply wells Location of all surface waters and wetlands located up to 100 ft. beyond setbacks listed in 310 CMR 15.211 and any catch basins ✓ located within 50 ft. [310 CMR 15.220(4)(1)] Water,lines and other subsurface utilities located [310 CMR 15.220(4)(m)] (if waterline cross see 310 CMR 15.211(1)[11) Profile of system showing invert elevations of all system ✓ components and the bottom of the SAS [310 CMR15.220(4)(o)] Stamp of designer [310 CMR 15.220(1) and 310 CMR 15.220(2)] ✓ Stamp of Registered Land Surveyor (required if construction activities within 5 ft. of lot line) [310 CNIR 15.220(3)] Test Holes adequate (two in each of the primary and reserve unless trenches as permitted in 310 CMR 15.102(2) or as ✓ approved for an upgrade under LUA at 310 CMR 15.405(1)(k)] Test hole adequate to demonstrate four feet of suitable material? /t [310 CMR 15.103(4)] ✓ Test Holes adequate to confirm adequate groundwater separation? 1310 CMR 15.103(3)] Benchmark within 50-75' of system [310 CMR 15.220(4)(q)] Materials specifications noted? [various sections of 310 CMR 15.0001 System components not> 36" deep (unless Local Upgrade Approval or LUA requested) [310 CMR 15.405(1(b)] �V C ir✓hthrwq�+0� Address Sheet 2 of 7 4 N/A OK NO SE7CICTAWKo' Size OK? [310 CMR 15.223(1)] Inlet tee located ten inches below flow line [310 CMR 15.227(6)] Outlet tee 14" or 14" + 5" per foot for increase ft depth [310 CMR 15.227(6)] Outlet tee with gas baffle or approved filter [310 CMR 15.227(4)] 1',lote regarding installation on stable compacted base [310 CMR 15.228(1)] Separation between inlet and outlet tees (no less than liquid depth) [310 CMR 15.227(2)] Inlet/Outlet elevations at least 12" above high groundwater / (except as described 310 CMR 15.227(5)) or permitted for / J upgrades under LUA [310 CMR 15.405(1)(k)] Minimum cover 9" (Tanks buried more than 9" must have risers on all openings and on the d-box) [310 CMR 15.2228(1) and 310 CMR 15.232(3)(f)] Three access covers (inlet and outlet must be 20" or greater) - middle access at least 8" (by 7/07) [310 CMR 15.228(2)] v Access to within 6 " of grade - one port for systems<1000gpd, two for systems>1000 gpd [310 CMR 15.228(2)] All at-grade covers secured to unauthorized access? [310 CMR 15.228(2)] > 10 ft from building foundation [310 CMR 15.211(1)] Buoyancy calculation Required/Done [310 CMR 15.221(8)] H-20 Where appropriate? [310 CMR 15.226(3)] Setbacks from resources [310 CMR 15.211] Required when other than single-family dwellig or flow>1000 gpd [310 CMR 15.223(1)(b)] First compartment 200% daily flow; Second compartment 100% daily flow [310 CMR 15.224(2) and (3)] "U" pipe through or over baffle, outlet of each compartment with gas baffle or approved filter [310 CMR 15.224(4)] Address Sheet 3 of 7 N/A OK NO Y3�JILD NG''S��VERANT)�OI�H[E �)P ip a rt.:, ;a .° t z Located at least ten feet from any water line? [310 CMR 15.222(2)] Disposal piping at least 18" below water line(when water and sewer cross, see 310 CMR 15.21l(1)[11) Cleanouts required/provided? [310 CMR 15.222(8)] Thrust blocks specified in force mains? 310 CMR 15.221(6)(c)] Slope of sewer line not less than 0.01 (1/8"/ft) 0.02 preferable [310 CMR 15.222(6)] Proper pitch on all runs? (.005 within gravity-distributed trenches and beds) [310 CMR 15.251(9) and 310 CMR 15.252(2)(c)] Siphon problem/ (leachfield below pump chamber) Endcaps or vent manifold specified? Size and orientation of discharge holes specified? (not smaller than 3/8" not larger than 5/8") [310 CMR 1.5.251(8) and 310 CMR 15.252(2)(h)] Materials specified (310 CMR 15.251(5) specifies various pipe types allowed) . ,w D SRIB�,U BO T ,ONX now :-' Stable compactedbase [310 CMR 15.221(2) and 310 CMR V/ 15.232(2)(a)] Splash plate or baffle tee required on inlet/provided? (when J pressure sewer to d-box or steep pitch of gravity sewer) [310 CMR 15.323(3)(a)] Riser if deeper than 9" [310 CMR 15.232(3)(f)] Inside minimum dimension 12" [310 CMR 15.232(2)(b)] Minimum sump 6" [310 CNM15.232(3)(e)] Watertight cover if<2000gpd); waterproof manhole if>2000gpd [310 CMR 15.232(3)(d)] Capacity(emergency storage above working--design flow)? [310 CMR 231(2)] Proper setbacks [310 CMR.15.211 (same as septic tanks)] Watertight 20-in minium access manhole at least 20"MUST BE TO GRADE [310 CMR 15.231(5)] Service components accessible (not too deep with piping, discomzects accessible) Alarm floats - alarm on circuit separate from pumps specified? Exceeds two units must have two pumps operating in lead-lag mode. [310 CMR 15.231(6) and(8)1 Stable Compacted Base [310 CMR 15.221(2)] if Buoyancy calculations needed ? Provided? [310 CMR 15.221(8)] Address Sheet 4 of 7 I N/A OK NO Calculations correct? 4 feet of naturally occurring material demonstrated? [310 CMR 15.240(1)] Required separation to groundwater? [310 CMR 15.212)] Aggregate specified as double washed [310 CMR 15.247(2)] System Venting required/provided? (system under driveway or /. >36" deep) [310 CMR 15.241] ✓ Inspection ports specified and within 3"final grade? [310 CMR 15.240(13)] Breakout requirements met? (No violation of breakout elevation / within 15 ft of SAS unless barrier) [310 CMR 15.211(1)[4] and Guidance Document] GrL`ElE2IES�PITS;C �ERS3�l0�C1a%I2'S3 M Chambers and Gal. in trench configuration supplied with inlet every 20 ft. [310 CMR 15.253(6)] Each structure with one inspection manhole (if>2000 gpd must be to grade) [310 CMR 15.253(2)] Aggregate I'minimum- 4'maximum. [310 CMR 15.253(1)(b)] 2' sidewall credit maximum [310 CMR 15.253(1)(a)] In bed configuration, inlet every 40 sq. ft. [310 CMR 15.253(6)] Width 2'minimum 3'maximum [310 CMR 15.251(1)(b)] 100 feet -maximum length [310 CMR 15.251(1)(a)] Minimum separation 2x effective depth or width whichever greater (3x if reserve between trenches) [310 CMR 251(1)(d)] Situated along contours 1310 CMR 15.251(2)] Breakout OK? [310 CMR 15.211(1)[4] and Guidance Document] B�,;E��kS v"aarn'�u-Ym�si� o e�dSQ�00 gP,�il minimum 2 distribution lines [310 CMR 15.252(2)(a)] Maximum separation between lines 6' [310 CM R15.252(2)(d)] Maximum separation between lines and outside of bed 4' [310 CMR 15.252(2)(e)] Aggregate depth below discharge pipes 6"minimum, 12" maximum. [310 CMR 15.252(2)(g)] Separation between beds 10'minimum. [310 CMR 15.252(2)(f)] Bottom area used in calculations only[310 CMR 15.252(2)(i)] Address Sheet 5 of 7 f e v . N/A ®K NO Pressure Dosed Sy stein ? Provided pump and piping calculations as required [310 CM 15.2204R ( )(r)] Pressure dosing required on all systems>2000gpd or alternative systems under remedial approval [310 CUR 15.254(2) and I/A Remedial Use Approvals] If used in gravelless system -make sure jet is directed as not to scour soil interface [Guidance Document] Inspections once per year (systems<2000 gpd) or quarterly (>2000gpd) good to note on plan [310 CMR 15.254(2)(d)] ` Construction in fall -Did the plan specify that the fill shall meet the specification of 310 CMR 15.255(3)? Impervious barrier and/or retaining wall ? [Guidance Document] Impervious barrier installation must be supervised by designer [310 CUR 15.255(2)(b)] Retaining wall must be designed by Registered Professional Engineer [310 CUR 15.255(2)(a)] Side slope not exceed 3:1 ? [310 CUR 15.255(2)] Breakout requirements met? [310 CUR 15.252(2) and Guidance Document] At least 5 ft. from impervious barrier to edge of SAS (10 ft. recommended) [310 CUR 15.255 (2)(e)] Gra el `ss s em a to a Check DEP Approval letters for credits and design conditions If used with pressure dosing do not allow pressure discharge to scour soil interface �• tee y el? l' Ys en [U RPr' .fi s ,. .scaw.c.Y.nw. ea.. a,,m a... a... Was DEP Approval Letter provided and/or have you reviewed the letter for conditions? Is the technology being properly applied and does it meet all DEP Approval Conditions? Is there a note on the plan regarding the requirement for perpetual maintenance agreement? Any alarms involved on separate circuits Did the applicant submit an operation and maintenance manual? Has applicant submitted a copy of a maintenance Are the variances listed on the plan? [310 CUR 15.220 (4)(q)] RLS Stamp necessary on plan if a component is within five feet of property line 1310 CUR 15.412(4)] New construction or increased flow proposed- [Refer to 310 CMR 15.414] Address Sheet 6 of 7 t_ f T N/A OK NO 1Vitroge�z ,Sensttrve�AreasN "$ �' Is the system in a Designated Nitrogen Sensitive Area(Zone R for a public supply well)? 310 CMR 15.214, 310 CMR 15.215 and / 310 CMR 15.216 - also refer to Policy regarding upgrades of such existing systems] Is the system proposed on the same lot as served by private well ? [310 CMR 15.214(2)] Are the nitrogen loads proposed in compliance? [310 CMR 15 216(1)] Pumping to septic tank ? [ 310 CMR 15.229] Shared System [310 CNIR 15.2901 Address Sheet 7 of 7 r' I I FROM :down cape engineering inc FAX NO. :15083629880 May. 29 2009 11:03AM P1 Town of Barnstable Regulatory Services Thomas Y. Gealer, Director !{AHNFl1'AtlLdS, Public Health Division �in$p `eta 'l'baew.as McKean,Director 200 Main Street, MA (02601 O i Licc: 508-862.4644 Fax: 508-740-6304 Installer chi Designer Certification Form ID�atc: sewage Per>n it# 4 W Assessor's MapTa.rcel / I Itesigm�cx: Jon Irs faaaa9.l.ex: 4��4 �n4 !`Jd-►- Addreast _ fh�n (/ // Address: Vol- Oil �JG �� /a l wa,;issued a permit to install (date) (installer) septic,sytitein at !-�Gt ry► c_ ! b�R.w1. based on a design.d.mwa.by (address) (E signer) l certify that the septic system referenced above was installed subsuviti.ally according to the design, which may include minor approved changes sucla as lateral relocation of the disiribution box ancl/or septic tank. I certify that the septic system referenced above was uistalled with major changes (i.e. greater tban. 10" lateral TeIOGtltion of the SAS or any vertical relocation of any component of the septic ,system)but in accordance with State. & Local Regulations. I'hju revision.or. certified as-built by designer to follow. ---- 4\1i OF Miis1, ' OANIFI,.A, ...... OJALA (rust .. .r. s Signature) CIVIL No.4Fi5(l� 4 (Dtsigner's Si.� (Affix Designer's Stamp There) PLEASE RETURN TO BARNSTABLE PUBLIC D.4y!_1S:f0 N. t_:J,.4t'1:i,C.I[_'A.l<k, OF [:UWLiAAC:E WILL, NOT BE ISSU D UNTIL BOTH THIS &`Cb][M AND AS-BUIL1 CARD ARE AAEt:A'•MA7 Af'4(''iHE BARN STABLE PUBLIC REA9L'TH DMSTON. TRANK YOU, Q:Hca1th/5cptic./Dcsigncr Ccatificalion Farm 3-26-04-doa I 4;a; WN OF BARNSTABLE v LOCATION 15, SEWAGE# ®� VILI�AGE OaasiwceA SESSOR'S MAP&PARCEL�a s®�� INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY A14 it/ l //d LEACHING FACILITY:(type) 6Q✓I (size) NO.OF BEDROOMS OWNER OVY1 r ,+' —//OLu e PERMIT DATE: L� �� Q� COMPLIANCE DATE: S 7 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 !' ire' Out t ISO 4000 No. F,ee, . 'THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 1 0[pplicatton for Mi!5poal *pgtem Cow6truction Permit Application is hereby made for a Permit to Construct( )or Repair( x)an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. 77 Barnhill Rd Greg Weaver W. Barnstable 362-7162 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. W.E. Robinson Septic P.O. Box 1089 Type of Building: Dwelling No.of Bedrooms 3 Garbage Grinder Po) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Description of Soil gravel Nature of Reairs or Alterations(Answer w�ten applicable) Install an additional overflow according o engineer p an 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 aW not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board ealth. c Signed '`�� Date —,72.2-- / Application Approved by� Nn,� —P6 Application Disapproved for the following reasons Permit No. / 1 / !�e Date Issued =� �7�/ ,. � -. _.,.. .-.-.. � .• •r�r.'w' e r. T".4,••�' ,.i. ��.�ra+.'. .;,• .. ...._ —`.;r•. _ ems.. .a.. / 4Q•00 No. �,.� Fie " ¢ 1 'HE OMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - TOWN OFF. NSTABLE, MASSACHUSETT&, Zlpprication for )i!5po4-Y_*pgtem Construction 3ermii Application hereby made for a Permit to Construct( )or Repair( X)an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. 77 Barnhill Rd Greg Weaver W. Barnstable 362-7162 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. W.E. Robinson Septic P.O. Box 1089 eenterville 775-8776 Type of Building: Dwelling No. of Bedrooms 3 Garbage Grinder(no) 0ther Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures a s+" Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title l > Description of Soil grave '°^�.w...,_.. (( Install an additional overflow Natu g oI e��itrtg r i fle e"ont eererpw�ieanri plicable) 1 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 aild not to place the system in operation until a Certifi- cate of Compliance has been issued Ja/y'this Board QAealth,, Signed !/�/ y o y o Date 3 Application Approved by °Cn P6 Application Disapproved for the following reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLEs MASSACHUSETTS Certificate of Compliance - THIS IS TO CERTIFY that the On-site Sewage Disposal System installed.( )or repaired/replaced( X)on b W.E. Robinson Septic for Greg Weaver a�—Barnhill ya W. Barnstable -has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Use of this system is conditioned on compliance with the provisions set_fort low: r p No. � I L Fee 40.00 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLEs MASSACHUSETTS lwigoal *p!5tem Con5tructiff1permit W.E. R Permission is hereby granted to obinson Septic Sery to construct( )repair( x)an On-site Sewage System located at 77 Barnhill Rd' W. Barnstable 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. All construction must be completed/within two years of the date below. Date: Approved by , 0 0 0 3 --7�2 40 �� . I 0 -pQoPos�o N 3 g E}DDOM IL - " uSE ZfoDF"n EFF.OF-Fr'j lot SJA6.g / �) 2 V� w� x ID, 3A�N1�IG Gr -cy C cv aT aj , TOWN OF BARNSTABLE LCC;�TION �r r�(r: SEWAGE# cm rI V —LAGE �7 7 80Pvtlht (I ���� ASSESSOR'S MAP&LOVAM O d INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY ( t5 LEACHING FACILITY: (type) fJi (size) i�'� NO.OF BEDROOMS BUILDER OR OWNER a-,r� PERMITDATE: 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 tlighl- Si�E. _ 9L r t yy i h p `� Page: CERTIFICATE OF ANALYSIS Barnstable County Health Laboratory sActiu . Report Prepared For: Report Dated: 02/05/1999 ROBIDOUX,Robert Order Number: G9901262 Robert Robidoux 78 Barnhill Rd. West Barnstable MA 02668 Laboratory ID#: 9901.262-01 Description: Water-Drinking Water Sample#: 01262-01 Sampling Location 78 Barnhill Rd.,Cold Water Collected: 01/29/1999 Collected by: B.Robidoux Received: 01/29/1999 Test Parameters ITEM RESULT UNITS MDL MCL Method# Tech'n Tested LAB: Microbiology Total Coliform Present CFU/100m1 0 1 EPA AS 01/29/1999 Laboratory ID#: 9901262-02. Description: Water-Drinking Water Sample#: 01262-02 Sampling Location 78 Barnhill Rd.,Hot Water Collected: 01/29/1999 Collected by: B.Robidoux Received: 01/29/1999 Test Parameters ITEM RESULT UNITS MDL MCL Method# Tech'n Tested LAB: Microbiology Total Coliform Absent CFU/100ml 0 1 EPA AS 01/29/1999 Approved Bye'Gr (Lab Director) 72 Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-362-2511 r Commonwealth of Massachusetts Executive. Office of Environmental Affairs Department of Environmental Protection Wllllam F.Weld Gmemor Trudy t Axe Secretary,EOEA David B.Struhs Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM 7 7 h;l l /Q v PART A k/. ���,,��r /� CERTIFICATION Property Address: 9 Address of Owner: Date of Inspection: —2 (If different) Name of Inspector: W.E. Robinson Sr. Company Name, Address and Telephone Number: W.E. Robinson Septic Service P.O. Box 1089 Centerville MA CERTIFICATION STATEMENT '77�77 1 certify that I Ihave personally inspected the sewage dispos�l sps7Ur t 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-site sewage disposal systems. The system: 4L/sses _ Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority _ Fails 4�,14 Inspector's Signature: dll� y her Date: — ti 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] 71'havePASSES: 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. B] YSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair, Lyes, es inspection. Indicano, 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, 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 8/15/95) 1 One Winter Street a Boston,Massachusetts 02108 a FAX(617)556-1049 a Telephone(617)292-5500 ��,Printed on Recycled Paper i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: 'r. ItJ-2.4 f/'C Z Date of Inspection: 'I_j-- 9l0 B1 SYST 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): broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced _ Th system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass ins ection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed C1 FURTHER EVAL TION IS REQUIRED BY THE BOARD OF HEALTH: Conditions a 'st which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, afety and the environment. 1) SYSTEM WILL ASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL ROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cessp of or privy is within 50 feet of a surface water Cessp of or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WIL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYST IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRON ENT: _ The .\,stem has a septic tank and soil absorption system and is within 100 feet to a surface wale, supply or tributary to a surfac water supply. _ The svvem has a septic tank and soil absorption system and is within a Zone I of a public water supply well. The sys em has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The sys eni has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply ell, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free fro pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. D1 SYSTEM FAILS: I have determi that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determi ation is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backu of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Disc arge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or ces pool. (revised 8/15/95) 2 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: s7 `] %��'17 h, Owner: Date of Inspection: DJ SYST FAILS(continued): 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. 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)LARGE S TEM FAILS: The following criteria apply to large systems in addition to the criteria above: The design flow of system is 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: 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 we'll) The owner r operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 8/15/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: Owner: Date of Inspection: Check if the following have been done: �umping information was requested of the owner, occupant, and Board of Health. L)None of the system components have been pumped for at least two weeks and the system has been receiving normal flow races 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. _✓he facility or dwelling was inspected for signs of sewage back-up. t/The system does not receive non-sanitary or industrial waste flow LA he site was inspected for signs of breakout. _VAII system components, excluding the Soil Absorption System, have been located on the site. V 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 or approximated by non-intrusive methods. The facility o�+ner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 8/15/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C n, SYSTEM INFORMATION �'h'P Pro a Address: / 7 n A > l R D ki 1`���17 s 7,57ZI-e— Owner: Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Design flow:-U4 0 allons Number of bedrooms: Ll Number of current residents:T Garbage grinder(yes or no):�z Laundry connected to system (yes or no Seasonal use (yes or no): A-' Water meter readings, if available: Last date of occupancy: el �- 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: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System pumped as part of inspection: (yes or o)_A/ If yes, volume pumped. gallons Reason for pumping: TYPE OF STEM 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) Other(explain) APPROXIMATE AGE of all components, date installed (if known) and source of information: l "/ •�%z $ Sewage odors detected when arriving at the site: (yes or no) (revised 8/15/95) S SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 1-7 r� r�' // A V 0 , Owner: �'. UxAve x Date of Inspection: SEPTIC TANK:_ (locate on site plan) Depth below grade: Material of construction: uconcrete _metal _FRP—other(explain) , 'Ga 'rc a =al61 Dimensions: '` — 10 Sludge depth: 3' i Distance from top of sludge to bottom of outlet tee or baffle: 4_1Q Scum thickness: O —/—/ ' Distance from top of scum to top of outlet tee or baffle: 3' Distance from bottom of scum to bottom of outlet tee or baffle: )2, 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.) (�a 0 C o! A 1 1 0' .S _v L g- GREASE T P:_ (locate on si plan) Depth below rade: Material of c nstruction: _concrete _metal _FRP —other(explain) Dimensiortionfor Scum thic Distance fm to top of outlet tee or baffle: Distance f 5rttm 11 bottom of outlet tee or baffie: Comment (recommemping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, kage, etc. (revised 8/15/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C +� r� SYSTEM INFORMATION (continued) Property Address: Owner: Date of Inspection: TIG T OR HOLDING TANK:_ (locate n site plan) Depth bel w grade: Material o construction: _concrete_metal _FRP—other(explain) Dimene- 10 Capacial Ions Designgallons/day Alarm Comm (conditndition of alarm and float switches, etc.) DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert:_ Comments: (note if level and distributiun is equal, eridence of solids carr,-ovc , evidence of leakage into or out of box, etc.) PUMP CHAMB R:_ (locate on site pl n) Pumps in workin order:(yes or no) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 8/15/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C � " / SYSTEM INFORMATION (continued) / Property Address: / Owner: �- Date of Inspection: S 9 SOIL ABSORPTION SYSTEM (SAS):v (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' � J l t, es in 9 ,o 1 S %d A—L, � leaching pits, number:_ leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.) CESSP LS: _ (locate on ite plan) Number an configuration: Depth-top of iquid to inlet invert: Depth of soli s layer: Depth of scu layer: Dimensions cesspool: Materials of onstruction: Indication o groundwater: i low (cesspool must be pumped as part of inspection) Comments: (not condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY:_ (locate on site plan) Materials of constr ion: Dimensions: Depth of solids: Comments: (note c ndition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) 4 WV (revised 8/15/95) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: lv'2U�� i Date of Inspection: 5 _ 960 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks j locate all wells within 100' r +t ) ) 1 r f i f b� c 4 (r i � I 0' ; 1 I ys r J I JVQ rrc. A i..2 i4 r 1 o o a r DEPTH TO GROUNDWATER Depth to groundwater. { l! ° feet method of determination or approximation: I y ►� /�l�l (revised 8/15/95) 9 TOWN OF BARNSTABLO LOCATION ��_� U,11 SEWAGE# VILLAGE- ASSESSOR'S MAP &LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CA)'ACTTY LEACHING FACILITY: (type) �I ®�° �r � (size) NO.OF BEDROOMS y BUILDER OR OWNER. ,-.IA if a4ia4-1 PERMITDATE: 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 r i i. y �, �� - i� ,-..gyp S �, � ��, .. �� � � ���� c DATE:2./.6/..96; . PROPERTY ADDRESS: "77 Barnhill' Road' West Barnstable ,Mass -02668. On the above date, I Inspected the septic system at the above address. This system consists of the following: 1 . 1-1000 •gallon tank. 2. 1-Distribution box. 3. 1 -1000 gallon leaching pit. Based bn my Insr*ction, I certify the following conditions: 1 . -This is a title five .septic s•ty'.s.tem•. ( 78 Code ) 2. The septic sytem is in failure. 3 . Watirr•• is standing in the chimney of the leaching pit build up. ) 4. SYstem must be upgraded.. SIGNATUR!7-: ` Name _J P Macomber Jr... i --_--J5�0e.P�8c.—•.JMb�..ab7.5c—.o--.►3Q-3b-3e—r8=_�&_—Son- Company: -_. _ Address: s �` "ft�C-�EIi E o __CentervilleAgps__02.632 FEB tNoF Phone: , L;THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY vwv JOSEPH P, MACOMBER & SON, INC. Tanka-CesupoolrLaachfIaIds Pumped & Instilled Town Sewer Connections P.O. Box 66' Centerville, MA 02632-0066 775-3338 77"412 t . (Tct at Commonwealth of Massachusetts Executive Office of Environmental Affairs . Department of Environmental Protection Wllllam F.Weld • Trudy C • . . 8w.wy.EoxeOEA David 0.Struhs SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 77 Barnhill Road W. BarnstablAdd of Owner: r. Date of Inspection: 2/2,,/96 diffffeerent) =<;r Name oflnspectur: Josepjhh P M o ber Jr. Company Name,Address arid-Telephone m�er: J.P.Macomber & Son Inc. Box 66 Centerville ,Mass-. 0�2632 508-775-3338 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-site sewage disposal systems. 'The system: Casses onditionally Passes Needs Further Evaluation'By the Local Approving Authority _ Fails Inspector's Signatur Date: 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: J) A) SYSTEM PASSES: S yS TR-4-'1 4,:t o 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 ind!cated below. 61 �SYSTEM CONDITIONALLY PASSES: V One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair, passes inspection. Indicate yes 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, cracked, structurally unsound, shows substantial infiltration or exftltration, or tank failure is . imminent. The system will`pass inspection if the existing septic tank is replaced with a conforming septic tank as �J approved by the Board of Health. (revised 8/15195) �J SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 77 Barnhill Road West Barnstable,Mass. Owner: , Linda Weaver Date of Inspection: 2/2/9 6 B)SYSTEM CONDITIONALLY PASSES (continued) AID 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): 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 Cl 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 the public health, safety and the environment. �1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: 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 PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: �U The system nas a septic tank anu suii absorption system and i;within 100 feet to a surface water supply cr tributary to a surface water supply. A& The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. A0 The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. AJD The system has a septic tank and soil absorption system and 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• D) SYSTEM FAILS: 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. 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. (s ed S/1S/9S) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 77 Barnhill Road West Barnstable,Mass . Owner: Linda Weaver Date of Inspection:2/2 9 6 D) SYSTEM FAILS (continued): • Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Wo• fir AS Liquid depth in ce-pool 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 A:iy portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Ad Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. AM 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. Ej LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: The design flow of system is 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: AN the system is within 400 feet of a surface drinking water supply Ally the system pis 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 11 of a public water supply well; The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 8/15/95) 3 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 77 Barnhill Road West %arnstable,Mass . . Owner: Linda Weaver e Date of Inspection-2/2/96 Check if the following have been done: ,Pumping information was requested of the owner, occupant, and Board of Health. 44/hone 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. -L/ As built plans have been obtained and examined. Note if they are not available with N/A. 2The facility or dwelling was inspected for signs of sewage back-up. ZThe system does not receive non-sanitary or industrial waste flow ZThe site was inspected for signs of breakout. U ZAII system components, Aluding the Soil Absorption System, have been located on the site. ZThe septic tank manholes were uncovered, opened, and the interior df the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. ZThe size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. The facility owne; tand occupants, if different from owner) were provided with information on the proper maintenance of Sub. Surface Disposal System. Recommendations . 1 . System conditionally passes. 2. This means the system will pass when the system is ugraded. 3. The water in the leaching pit .is above the invert of the pit. 4. Actually the water is up in the chimney on the leaching pit. 5. Failure would not show up at the septic tank or the distribution box because the pipe comes into the chimney on the pit. See page 10A. 6. See page 5A Page 1 paragraph 4. Revised 11 /3/95 (revised 8/15/95) 4 GUIDANCE FOR THE INSPECTION OF SUBSURFACE SEWAGE DISPOSAL SYSTEMS INTRODUCTION On-site sewage disposal systems are governed by Title 5 of the State Environmental Code (310 CMR 15.000) . Experience has shown that when properly designed and sited, these systems provide an acceptable level of wastewater treatment and are a legitimate treatment and disposal option in areas where centralized. sewers are not available. However,. given the traditional view that these systems are temporary solutions- until sewers are provided, they are often neglected and this can result in harm to the environment and threats to .the public health. In order to address this problem and correct the prevailing attitude toward on-site. systems, Title 5 requires that systems be inspected under certain circumstances. . In this ._ manner, system owners can be educated about the importance of properly maintaining their systems, and those systems which are an environmental or public health threat can be identified and upgraded. This •document is intended to provide guidance. to both the system owner ,*j and the system inspector for evaluating the adequacy- of existing subsurface. sewage disposal systems. Approved System Inspectors are charged .with the responsibility of inspecting systems in accordance with 310 CMR 15.302, 15.303, and this guidance and reporting their findings to the approving authority. The goal of the inspection is to provide sufficient information to. make a determination as to whether or not the system is adequate to protect public health and the environment. If conditions exist which show the system is failing to protect public health or the environment,. the system must be repaired, replaced, or upgraded. The only grounds for failing a system or conditionally passing a system are if any of the criteria listed on the inspection. form and specified in 310 CMR 15.303 are met. The inspection must avoid disruption of the functioning of .the system and should be conducted to minimize disruption of the site in general. However, at a minimum, all manholes, covers, and: cleanouts must be exposed in ordpr_to achieve the goal of this inspection. Pumping of system components, when required,, shall be done after an initial inspection of the entire disposal system to observe normal operating conditions. Each component requiring pumping can then be reinspected after pumping has been completed. The Department has developed an approved System Inspection Form (attached to this guidance) which is to be completed by the Inspector when doing an evaluation. The Form consists of: Part A- Certification Part• B- Checklist Part C- System Information (revised 11/03/95) 1 L SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C - SYSTEM INFORMATION Property Address: 77 Barnhill Road West Barnstable ,Mass/ Owner: Linda Weaver Date of Inspection: 2/2/96 • FLOW CONDITIONS , RESIDENTIAL: Design flow:'gall s'&r a ' Number of bedrooms: Number of current residents: Garbage grinder(yes or no): Laundry connected to system(yes or no): � Seasonal use (yes or no):,00 Water meter readings, if available: Au e d u�ArY Last date of occupancy: COMMERCIAUINDUSTRIAL: Type of establishment: j3fi Design flow:1)h allons/day Grease trap present: (yes or no),•&4 Industrial Waste Holding Tank present: (yes or no)�� n-sanitary waste discharged to the Title S system: (yes or no)&R \,,ater meter readings, if available: Last date of occupancy: AW OTHER: (Describe) Last date of occupancy: 426 GENERAL INFORMATION PUMPING R CORDS an ource of informatign: �i'�97.K2ilI Dr >; IN? I s i? av�t i/t1 o1�r�% .¢�-rye ��`a r, •��ou r .4yer o System pumped as part of inspection: (yes or no)4& d�i�y' c✓�Y`7 �t'+�"���' ply If yes, volume pumped. � gallon Ne Wzco44 01' �cvl9� �D ' Reason for pumping: TYPE (?j SYSTEM Septic tank/distribution box/soil absorption system _Alb Single cesspool Overflow cesspool _ Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) _ Other(explain) P XIMATE AGE f II com op vents, date installed (if known) and source of information: AP -� ' �e/Z)• ,rage odors detected when arriving at the site: (yes or no) (revised 8/15/95) 5 No. ..:EA_ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................. .OF.......................................................................................... ,� tirtt#init for Permit Application is hereby made for a Permit to Construct.( ) or Repair ( ) an Individual Sewage Disposal Syej t' tIon•Address or Lot�W, .........................................».. .........................................»........... Addreu ......»........»..»»...»........... » Owner a ....... .......er......................................... Address Size Lo ' Type of Building t 0���0.......Sq. feet ...............Expansion Attic Dwelling—No. of Bedrooms............3............ ( ) Garbage Grinder ( ) pa Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria aOther fixtures ...................................................................................................................................................... d e gallons per person p day. Tota) 444Y flow.............320....................gallons. Design Flow............................................ tJJ WW .......... Depth................ a Septic Tank—Liquid ca acit ...........gallons Length....... ..... �Vidtl .. Diameter...... w Disposal Trench—No.................... Width....................Total Length....................Total leaching area...................sq. ft. x � .....eiameter.................... De th below inlet.................... Total leaching area..................sq. t. Seepage Pit No............... p Z Other Distribution box ( Dosing t�ank ( ) 9 L/9NI.e.Y.........................A ! . . ............... Date.........?/g.y Percolation Test Results Performed by....... y Test Pit No. 1.......... minutes per inch Depth of. Test Pit.................... Depth to ground water........................ aj..... � ......... Depth to ground water...... Test Pit No. 2...�a...:�......niinutes per iiicli Depth of Test Pit.......l. a .......... ................. ... p ...j P. Xe�...SlAt i2. .. Q�.�....:�... . .. f, ....... Description of Soil. 4 SAY 2t' r.-...P .................... ......IYleat.t,.ti...C�11x3 e....S l !V r.?. ..� .............................................................................................................•----....................................... U Nature of Repairs or Alterations—Answer when applicable............................................................................................... 77 .................................................................................. Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certifi to of Compliance ha een issued by the hoard of health. Date Si ed .. Jo.1J.4, ...41It.�.9� P APpli on Approved By.. Date Appli tioii Disapproved for the following reasons:.............................................................................................................» ......................................................... ...............................................................................................-•---.................. .Date............. Issued.................. Permit No...................................................»..» .D�.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................t O F..................................................................................... 9atif ratt of Tomplitturr XZU-S-IS TO,CERTIFY, That the Individual Sewage Disposal System constructed or Repaired by..... .. Or?. .....................................:....i.0.wiie�.............--.-............................................................................. at..........L ......' N .........._......................................................0........................................ has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Coe as described in the application for Disposal Works Construction Permit No.........L's::.:t....-:�y.......... dated...:;:t � : ...................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL F NCTION SATISFACTORY. � ..........................V--..........DAT :................:: 1. Inspector..... ..ti.ti..�.r..1......�..::.5.�?:4:..... ..1.................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .OF............................................................ .................. ..'.... •FEELr.--..................a.r..t...........NO ...:: �i��ro ko �on�#r�tr#iun �rrutit . Permission is hereby granted....-.n-44.......'. (46-.................................................................................................... to Construct ( ) or Repair, ) an Individual Sewage Disposal System atNo...... ..................... !`.:a......-........................................................................................-........... Street r_q 'as shown on the application for Disposal Works Construction Permit , Dated..... a.P.................. .............................:: .!.... ..I;k�G!'....................... .... DATE:... ........���.........1.�.g��....' •' ,sua�d of Health FORM 1255 A. M. SULKIN, INC., BOSTON i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 77 Barnhill Road West Barnstable,Mass . Owner: Linda Weaver Date of Inspection:2/2/96 SEPTIC TANK:—k'*1f IBoO p�i¢Vdv A�� (locate on site plan) Depth below grade: Material of construction: /concrete _metal _FRP —other(explain) Dimensions: r' '0' / 6 ' ' Sludge depth: Distance from top o:sludge to bottom of outlet tee or baffle: 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: Comments: t•--ommendation for pumping, condi ion of inlet and outlet tees or baffles, depth of li uid level in relation to outlet invert, structural ;rity, evidence of leakage, tc.) L" Y' k 8 t±oveT OAJ ll GREASE TRAP:/ lff (locate on site plan) Depth below grade:, Material of construction oncrete _metal _FRP_other(explain) Dimensions: Scum thickness. Distance from top of scum to top of outlet tee or balfle:12L Distance from bottom n, ar„n, t,, bottom of ouue! iee or oan!e•XR 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.i r' (revised 0/:5/95) --".6' SUBSURFACE SEWAGE DISPOSAL,SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 77 Barnhill Road West Barnstable ,Mass . Owner: Linda Weaver Date of Inspection: 2/2/9 6 TIGHT OR HOLDING TANK: Ve, i (locate on site plan) Depth below grade:d ,4 Material of construction:AAconcrete_metal _FRP—other(explain) Dimensions: AM Capacity: izallons Design flow:�allons/day , Alarm level: X/ Comments: (condition 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 ii level nd distribut-Ki. 13 equal, evidence of solids carryover, evidence of leakage into or out of box etc.) 4th1 2 / p r PUMP CHAMBER: 44/e (locate on site plan) Pumps in working order:(yes or no) . Comments: (note condition of p p chamber, condition of pumps and appurtenances, etc.) rl�e (revised 8115195) 7 f SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 77 Barnhill Road West Barnstable ,Mass . Owner: Linda Weaver Date of Inspection: 2/2/9 6 SOIL ABSORPTION SYSTEM(SAS): I—loo0� "-""' "-' ` intrusive methods) (locate on site plan, if possible; excavation not required, bu emay be approximated by non- If not determined to be present, explain: Type: leaching pits, number: leaching chambers, number: leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number:0— Co nts: (no con ition soil,signs of hydraulic failure, level of ponding, condition of vegetation,etc.) CI..,_OOLS: gkNc (locate on site plan) Number and configuration: AJA Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool Materials of construction: Indication of groundwater:- tau inflow (cesspool must be pumped as part of inspection) Q)l9 Comments: (n to condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) IVA �JryletirS PRIVY:a4le, (locate on site plan) AO Materials of constru i n: &A Dimensions: Depth of solids:- Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (revised 8/15/95) 8 l0 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART G SYSTEM INFORMATION (continued) Property Address: 77 Barnhill Road West Barnstable,Mass . Owner: Linda Weaver Date of Inspection: 2/2/g 6 • SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or ben ,marks : � ILr �E�2 ) '- locate all wells within 100' U)C-Lk W/ 7&4 ��l`.L ►`hG>�N / 1Q� Qs7 - 1bdPA1 e a ui�r- p v �e +^A?STA,�it v#rd DEPTH TO GROUNDWATER Depth to groundwater:• feet method of determination approxi ation:_y ,�,� e/A .. (reviped 8/15/95) 9 p r I ,4„ 94•z C DtST .O y�rn r 5.0 94.E 1 000GAl..�►.t� 94.4 6 F`r Dl,gM COhI cQErE LEAai I N 44 SEPTI G TAN1� 94•Sa 92. 6 ,p�� 444 4a44 4 .♦ Fr. 4 4A4 o as 3/r�klo lY2�WgSHED 0444 , 4 II 76.6 44AA ;% j STaNE 9G.GTkcnv BoYP�TE�v. S.�fS501�, I 54.6 PAuceo SaN o 31 �Aep PA) 4 , �E'S I G N pATA STaNE F�RCOLATION P,,c,-TE 2A41ti/IwcHTF- D oP 3 g PtRFORMED SEpr 7, V984- by EDROOM S X 11 O GV-V = 3 So G PD LEAcHw<-, Be NO GARB,AGc DISPOSALUSE 1000 GAL- SE'PTjc-- i 82.E is� CAP^c ` R20 V IOE D lV1ED�u nor SOTS-ODD -IT L z fc I , O - l 1- `OARSC S l DE S -n- ,z x (o K z• S - s� 5 G Pp . SP. ..,° 70TN LCA PAC tT"`f oviZ:'C-0 6 78 GPD T-iTLE S OF Tom+ E MAss. ENV12vuv�E�C Co of �Z• I S' MO 67QouNO WA-MC 7EST PIT-OL. , L—o T i L L �jA2/Ji'PF'�LL: q7a' 4-9—� 170. 77 �o 0 OF Mgs��cy Q WALTER AF c E c, v SMITH,JR.CIVIL #15128 O Q . to f N ESSIO�dAt F.�a',L' o► "pQoposCC) Jv o M ►r�'4F(, N E I 3 BED cOMSE 9 6u o 3 EFT.G��� lot �T�iC4�u4iC j 11/` vE E4<£►,\CNr `,c.s•.vG 1 1$p Mom'_.+. 3o'x 'Do Q; wE`�' -----\--- 9.°0 ��sPos � PLAN • W CL — 44 G fur l I76 LN . BAeOs'TAgLZ a� t{ 6 _ THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) m A�C(�J C DATA i i I ., • J• E. KENNEDY A SON TRUCKING AND EXCAVATING INVOICE 575 WILLOW STREET 711rv is WEST BARNSTABLE# MA 02666 TEL. 362.3005 SOLD TO J " V SHIP TO J CUSTOMER'S ORDER SALESMAN TERMS SHIPPED VIA F.O.B. DATE oop OIFOgM�. 7S724 'OLY PAK(50 SETS)7P724 r Lon TOWN OF BARNSTABLE Permit No. 28210 t I Building Inspector Cash X A Y OCCUPANCY PERMIT Bond Issued to Frederick C. Hart .Address 17 Barnhill Road, West Barnstable Wiring Inspector (j / �: —° Inspection datelaspe tion date Plumbing Inspector., -"c-•' —.. c Gas Inspector ✓���` / mspectioa date 3 Engineering Department ` J Inspection date Board of Health i �� �� -Inspection date i, •.J,. THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION in.0 OF THE MASSACHUSETTS STATE BUILDING CODE. �" Building Inspector !l '•RT{TJ♦-Rf'Rt-.9•'i-1TlI��•ri�?T.T.STS T.T.:•:Rf T.fTT:SRr:R.;f1Tif...L: .-T�'�-.TLT.r .- .. -.. -. . .. • -.TT. T.TT-.T.T�T-.T,.�.T.•� TOWN OFBarnstable BOARD OF HEALTH 3l1IfSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D •- CERTIFICATION - . F.•••�..:-�....-::.—r.:r..^-�..r.�:•r.:rr:--r.—nr.--ra-s�- -r•r—:.:-r--r..rr-s--r+R.r�•ss :s+Res•mrr�+rssa•T+�-rrrer -TYPE OR PRINT CI.EARLY- PROPERTY INSPECTED STREET ADDRESS 77 Barn Hill Road West Barnstable Mass ASSESSORS MAP, BLOCK AIJD PARCEL # OWNER' s NAME __Weaver PART D - CERTIFICATION r NAME OF INSPECTOR Joseph P. Macomber Jr. . COMPANY NAME J.P.Macomber & Son Inc. COMPANY ADDRESS Box 66 Centerville ,Mass . 02632 Street Town or City State LIP COMPANY TELEPHONE ( 508 ) - 775 3338 FAX ( 508 1 790 �- 1 7Q - - -- -- - — 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 . complete 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: System PASSED The inspection t+hich 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 15 . 303 , Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of };;r his form. System FAILED* The inspection whictl I have conducted has found that the system fails to Protect the public health and the environment in accordance with Title 5 , 3.10 CMR 15 . 303, �and as specifically noted on PART C - FAILURE • CRITERIA of this inspection form . , Inspector 8ignature Date •-+ One copy of this certification must be provided to the OWNER the BUYER ( where applicable) and the BOARD OF )JEALT11. ' * If the inspection FAILED, tht owner or"operator shall u d within one Year of the date of the inspection, unless allowed orthe requi.redm otherwise as provided in 310 Chln 15 , 305 . . .- * t 01, . 3r THE CO MMONWEALTH OF MASSACHZTSETTS DEPARTM EN7C OF E ON�I�CENT,A.L PROTECTION BE IT KNOWN THAT Joseph R' Macomber, Jr. _r Has .satisfied ,.the -Depar=,nt's qualifications. as required and-is hereby authorized to use the title CERTIFIED TITLE 5 SYSTEM INSPECTOR as provided..in 310 CMR 15.340 and Section 13 of Chapter 21A of the General Laws. Issued b The De ax�tnaent P y p of Environmental Protection. r , Jug a, ins r Acting Director of the ' '•ion of Water Pollution Control 3 ;N PERMIT€ ' to G 1. 57 �# Q. V 1?L L A NIHS7A EP'S' N ME A DDRESS BUILD [ R OR Of W NED 0A6 E dOMPLI ,ANCE I S 5 U E D a t [ PC -r. •L.•or'4=..y 11� 1- �' , � ` Ll No..��...:�`..... Fmc.... ...`tea......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........................................O F.....................-----.----........._------------------...................--------•- Apli iratiun for Uispuutt1 Marko Tunitrur#inn thrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Y Zs AV L11 l ��rM - 6 .... ........._ .........- . ••-••••-•....-- ....... ..... .. .._... ocation-Address or Lot No. tY . ._........ ._.i:RI....--••--•-----......-----^................ � Owner Address -•---------•---------•--•--•-••---••--••------------ ••••.......-----•..............••.....----••-•-......-•---....._......•----•-•-•-•---S---- nstaller Address feet - 'i U Type of Building Size Lot 3$00 O - q Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures -------------------------------- - W Design Flow............................................gallons per person pe day. Tota flow.............2.3®....................gallons. WSeptic Tank—Liquid capacity f O° ..gallons Length....... idt ... ............ _..Diameter________.___ . Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No---------------- iameter.................... Depth below inlet.................... Total leaching area...:..............sq. ft. Z Other Distribution box (` Dosingtank ( ) / / '� Percolation Test Results Performed by...LAR�C�Y�/...... SSOe1A*u.............. Date__g!.7f_R_`?�......._...._.__.. Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fi Test Pit No. 2..`?,. ......minutes per inch Depth of Test Pit........!(......... Depth to ground water_- ...... - Description of Soil........•Y O PQC Q.. Ke�'- lAN r>. ? - YQ �N `� N e---I...1-S....... 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 TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certifi to of Compliance ha een issued by the oar of health. I ' J. Signed..... Date Applic on Approved BY-------------- ('a= --- Date Appli tion Disapproved for the following reasons--------------------------------------------------------------•-------------------------------------------...... Date PermitNo......................................................... Issued....................................................... Date Fmc.... ...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........................................O F.......................................--------------.........------................-•--•- Appliration for Disposal Works Tonsirnr#inn anti# -:Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal S?yst a�na.tA .. ` �!;;kY Rl S l-1 � Location-Address or Lot No. .... .ur LA pg...... Ia-AAUK.............................................. .................................................................................................. hilt--I Owner Address ----'►.........................n--•-•---.- .................................................... ............................... staller Address ©© d Type of Building Size --------Sq. feet U Dwelling—No. of Bedrooms........... ............................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons.....................__.____ Showers ( ) — Cafeteria ( ) Otherfixtures ------------------------------------------------•----......---------------------------------------•---------------------------................._------ WDesign Flow...........................................gallons per person pejX day. Tota y flow...........-:3.3 ....................gallons. WSeptic Tank Liquid'capacit)�pO..gallons Length......9..... Widt�............. Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. � Seepage Pit No..................... Diameter.........___.._..... Depth below inlet.................... Total leaching _P g area ---••---•------sq. ft. Z Other Distribution box (✓ Dosin tank ( ) Percolation Test Results Performed by.. �?.T.' `C _..._. SZ-OC-!g1 �:............... Date_. 7 y aTest Pit No. 1.......�;.....minutes per inch Depth of Test Pit.................... Depth to ground water........................ (i Test Pit No. 2__'`� J.-_--_minutes per inch Depth of Test Pit......1.4......... Depth to ground water..Na!!t:....... Description of 014, -r> ---- '-9, ------- U --------------------------------- ---IsA ..9 S Amj.....16.................................................................... 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 TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance h een issued by the hoard of h alth. Date A lic n A roved B �.0.. � �`'= PP PP Y - ��.:_: ............ Date APpli ion Disapproved for the following reasons:.............................................-•---...-•--•---•--•------•-••••-•---•-----•------...----........_ •--------------------•--------------------•-----------------------------....------------........-----------------•-----•------•------•-----•-•--........................ .............................. Date PermitNo.................................................... Issued--•------------•---•............................•------ Date r THE COMMONWEALTH OF MASSACHUSETTS COMMONWEALTH BOARD OF HEALTH .............................. ....... :O F..................................................................................... rN ..,,l r#ifiratr of Tomplinna TO CERTIFY, That the,Individual Sewage Disposal System constructed ( or Repaired ( ) b ` ; 3 a ;.. Y - ........ I% �•--.....---(..............••-----••--------Installer------------..._.....-----•-••----•---------•-•-•-----•-- rt �f at l►�..........S710.......` 'z3Y_ft xtt..Jc rt_.:���''N ---------------•-•-------------------.......-------------------------------------•-------------•---•--•-----•-••----•••. has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Coe as described in the r-- .r- application for Disposal Works Construction Permit No.......-- .:-_<__.-�� . _....... dated___ 2_ "'- _.................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........... - ...il..� .j........................................ Inspector..----- --lee• 1r1 '1......•-----....--- • � J THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -^!yl! No...._....-.. -FEES...................... Bin1rrr ks TIanstrwti an anti# Permission is hereby granted...--------- •---- i ....................................................... to Construct ( ),or Repair�(, ) -an Individual Sewage Disposal System at No. , 1 *_ r n_..-' ................... .... ........................... ------------•-•---•-••-•-----••-----------•--•--•-••-•--••-••-----•--•--•--...--•......-- Street �Ias shown on the application for Disposal Works Construction Permit ......---�Dated.._..��ra.��.................. -•••• " ........................ Z)j ice p� Board of Health 7 r;' FORM 1255 A. M. SULKIN, INC., BOSTON --- - -_=>_-----77 o , 0 WALTER E. La SMITH,JR.CIVIL N 1f lJ #15128 �O Q 9FGISTE<� -1 N SIONA�- N N1/7hQ 40, 0poscD dv J� o Ih N 3 BE ODM MUSE 160 -9 j piG4i+JAbE j` 11 VG t• BARtJST-F'�F3�� AS�' - 7�i sPos�� ��►J + EX�7T�� w 44 4 P-A,►.j 17E bQ . a2ti1STAE3Lc �AyfJAAM a CD 1 q4.2- 14.. q4.4 �o FiT' l71 A tom( GAl•GONG CollcZErE LEacHiN S �14-Sb 82. 6 E�TIC �A?JI� G � Gd" •s: 2 . r�8 -�-c 3�a w�.��l,�.,� �!��re A44 °o n a .• 3 F-r. a Aa4 97,C-- �' 7�•6 an4 a 9G•6 S�f3s0(�� 14AP o PAcJGEP SA Ai v 31 �A2D PA/J DESIGN DATA=' STONE �CZCOLATtO� RATE 2�i/u'1p�1CN D oF' r TEST PERFoRMEp SEpr 7, I g84- by L� y 3 BEDRaor�tS >t 110C 330 G PD LEAcuiu< +,Qb CIO Cam. ARE�Gt✓ �15pOSgLU SE' l O oo �,q� S�'�lc�•i 82.6 /S CAPAC tT`{ RRO V lOE D M M, o`T'roc� i L z sc l , O = i 13 G Pr) (fOARS£ S t DES -IT S(c., S G Po S-R "D -ToT?�,LC A PA C tT'k-( F?W-,>ou I pE D 678 G P D IId Cl P-A��� Now — CJtSPpS�L SYSTEM •L7�5 �c�NE- p ��.t `c oR� �►.1cE �n! t T'� PR.o�! t s t o�t s o w 7\-T L E S O F-- 7 t" E MASS. �t�l l CZU�.I D�CSC Co of . ?2 z s' TEST Y i TS' I 2— Soy S-T-��-�-�, S �-r 2 -•,47 0 O.ZUdO�C� DUP ,r s s J. E. KENNEDY & SON INVOICE INVOICE No. TRUCKING AND EXCAVATING 575 WILLOW STREET , • WEST BARNSTABLE, MA 02668 TEL. 362-3005 SOLD TO `� SHIP TO CUSTOMER'S ORDER SALESMAN TERMS SHIPPED VIA F.O.B. DATE Olt . t ! f a � REDIFORMJ. 7S724 POLY PAK (50 SETS)7P724 4 P 4 1 00 11�-✓ 77 �7 0 0 OF Mgssq , o• .��' cyG WALTER �� cmE. ti \ SMITH,JR. CIVIL s #15128 in ti1 9 t���`�Q s,► `� •09 FGISTE zr N, , �1 a O,c 'o „' 6, 40 0 a) i �Q0 Poe.to N �v o M +' N 3 BEb12ooM '� `IP n � 6 usE 66) _ � � 12'D�^ EFF.OEPf►� le` jpiC4,wALd VG ' I ��"1��' ,��IGi�0�1.'I fir.) _�-- � I EAS£4.1Etii• .b�/ A EA 3A CN �I�RtJST-�43LE, �isPoSAL PL.AQ W ELL- 11 44 C tzA,�j ,rE Lij • BAp -&TAp , : OS EtG,e. A-fac.. loc, RAl4mAAp cp.L t"-4o' May it, lga� r r. 1 ti fie ti. SYSTEM PROFILE NOTES FT%FNDN. AT EL. 101.9 PROVIDE IF NEC., 20" MIN DIAM WATERTIGHT 1 APPROXIMATE NGVD ACCESS COVERS TO WITHIN 6' OF FIN. GRADE (NOT TO SCALE) . DATUM IS ACCESS COVER (WATERTIGHT) TO ACCESS COVER TO WITHIN 3" OF GIN. GRADE 2. MUNICIPAL WATER IS NOT AVAILABLE 6 MINIMUM .75' OF COVER OVER PRECAST WITHIN 6" OF FIN. GRADE 2% SLOPE REQUIRED OVER SYSTEM � q 92•5' 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. o� I IMill� 8" MIN DI 96 90 RUN PIPE LEVEL 2" DOUBLE WASHED PEASTONE FOR FIRST 2' OR GEOTEXTILE FABRIC 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO \*EXISTING "EXISTING 1000 H- 10 0�e Willow ' *EXISTING GALLON SEPTIC TANK *95•5� 89.5' 5. PIPE JOINTS TO BE MADE WATERTIGHT. Str BAFFLE 89.17' 9_ 89.0' a o 0 o O o 0 0 T LOCUSs MIN. SUMP 88 67' 0 = = 0 0 O 0 0 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH s CRUSHED STONE OR MECHANICAL 12" MIN. INT. DIAM. 80 MASS. ENVIRONMENTAL CODE TITLE V. `q' " 0 0 � (] 0 0 s JCOMPACTION. (15.221 [2]) 2 a o� 86.67' 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO DEPTH ES FLOW = 4 (2.4% SLOPE) ( 1 % SLOPE) BE USED FOR LOT LINE STAKING OR ANY OTHER PURPOSE. TEE SIZES: 3/4" TO 1 1/2" DOUBLE WASHED STONE INLET DEPTH = 10„ SAS DIMS: 25' x 12s3' OVERALL 4' SUITABLE SOIL AND NO - 14 G-W WITHIN 5 OF BASE 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. ch �r�h sf OUTLET DEPTH - LEACHING (CONFIRM AT TIME OF 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED FOUNDATION EXISTING SEPTIC TANK 263' D' BOX 13' FACILITY INSTALLATION) WITHOUT INSPECTION BY BOARD OF HEALTH AND PERMISSION SCALE: 1 " = 2,���' OBTAINED FROM BOARD OF HEALTH. *THE INSTALLER SHALL VERIFY THE **THE INSTALLER SHALL ASSESSORS MAP 108 PARCEL 18 LOCATIONS OF ALL UTILITIES AND CONFIRM MIN. SEPTIC TANK 10. CONTRACTOR SHALL BE RESPONSIBLE FOR CALLING LOCUS IS WITHIN AP OVERLAY DISTRICT ALL BUILDING SEWER OUTLETS AND SIZE AT 1000 GALLONS AND DIGSAFE (1-888-344-7233) AND VERIFYING THE LOCATION ELEVATIONS PRIOR TO INSTALLING ITS SUITABILITY FOR RE-USE 5' REMOVAL OF UNSUITABLE SOIL OF ALL UNDERGROUND & OVERHEAD UTILITIES PRIOR TO ANY PORTION OF SEPTIC SYSTEM REQUIRED AROUND PERIMETER OF COMMENCEMENT OF WORK. LEACHING FACILITY, DOWN TO SUITABLE LE SOIL MEDIUM SAND.REPLACE �O>�J 11. EXISTING LEACH PIT TO BE PUMPED AND REMOVED (OR WTH s PUMPED AND FILLED WITH CLEAN SAND). SUITABLE SOILS AND NO G-W TO BE CONFIRMED TO PROPER DEPTH \ +s1.as LEGEND PRIOR TO INSTALLATION OF ANY 12. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL BE COMPONENTS (NOTIFY TOWN FOR REMOVED 5' BENEATH AND AROUND THE LEACHING FACILITY. 100.0 PROPOSED SPOT ELEVATION INSPECTION) \ R L MAYBE VARIABLE (SEE SOIL LOGS). °� � SYSTEM DESIGN: +100.00 EXISTING SPOT ELEVATION \ 5 pp cep�� GARBAGE DISPOSER IS NOT ALLOWED 10o PROPOSED CONTOUR - - 100 - - EXISTING CONTOUR d ass OR \6 C, 2. IN;; DESIGN FLOW: 3 BEDROOMS ® 110 GPD = 330 GPD _ g • �� USE A 330 GPD DESIGN FLOW . EXISTING WELL y BENCHMARK: USE C . DRIVEWAY AT EIL 97.5' i I +9 .41 ! " G EXISTING GAS LINE +96.64 6 / i r, -'' SEPTIC TANK: 330 GPD (2) = 660 _ - - --- L RE USE EXISTING 1000 GAL. SEPTIC TANK E EXISTING UNDERGROUND ELECTRIC, NOTE: SLEEVE SEWER .95 L6 }9 .94 9 CHIP ` EXIST. \ LINE FOR 10' EITHER �'P �}E9s.\ AREA +9a/i a+9as7 LEACHING: CABLE OR TELEPHONE WEL SIDE OF CROSSING OF -'F �' 97.53 i u 00 WATERLINE '8- - SIDES: 2 (25 + 12.83) 2 (.74) = 112 GPD _494.81 BOTTOM 25 x 12.83 (.74) = 237 GPD TEST HOLE LOGS 01 $.13 �'.7. TOTAL: 472 S.F. 349 GPD EXIST. ' PAVED *97 t4 95.00 o. USE (2) 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL) ENGINEER: DAVID FLAHERTY, R.S. �yo3.00 ,�� DRIVE � WE '`� 52 �� .0398-64e98.6° 9695 WITH 4' STONE ALL AROUND WITNESS: DON DESMARAIS, R.S. °o+027 -�'1z.64 1 6 9 14 DATE: AUGUST 18, 2006 �.\\' �zo` ,-Froo.6i s.- h9 7 .99 }97. 2 94 +93.73 96 f +96.39 Q 02. - PERC. RATE = 5 MIN/INCH °�+T-s2. LOT 56 01.94 .�- ` ,� MA \��0� 1 2.21 +99.61 ,Qt ., �, / 35,960 SFt ' I SOILS P# �� �'� [ �`` +1 _ �, ,/ � APPROVED DATE BOARD OF HEALTH CLASS p, ° 43 DECK TTT9194 ISOLATED WETLAND EXISTING + .30 oo �. DWELLING 1> 6 6 f 23 6� p mod', _ ELEV. ELEV. �� �� \\�j DRAINAG TOF=101.9' ' �� 6 o �� +,fASEMENT 0097 \ +93 ° 6 TITLE 5 SITE PLAN O" 4 102.0' O" 101.0' 97.48 ( 91.91 + 0.23 24" FI LL 100.0' 24" FI LL 99.0, � \O7 0 1 e6 = 91.91 A A- �� \ ol. +, .46 + 078 9 68 + .72 0 77 BARNHILL LANE LS LS 6 o, a 0.A0 9•64 +97. 9 94.72 (WEST) BARNSTABLE, MA 0. 1 10YR 4/1 10YR 4/1 o ° `0` � gp`76 0 27s� 99,7 27n 98 7� +100,70 O +97.69 PREPARED FOR C7 0\\` 101.24 ST #1 00 1 °° 53 10 ;2/0 9 98.92 LP BORTOLOTTI CONSTRUCTION/ B B EXIST. /p a z0 ( TH-2 LS LS WELL O °�+9 02.3° +' `� 33 THOMAS MCCARTHY-HOWE 36" 10YR 6/8 99.0' 36" 1 OYR 6/8 98.0' �Q oo� TH_ 1 Qj `1 OL 102.79 . 103 DATE: AUGUST 25, 2006 PERC c1 c1 UTILITY 9�.�\ + 75 REV. 4/22/09 FMS FMS CLUSTER 103 EXEC 1 METER 84" 2.5Y 6/2 95.0' 86" 2.5Y 6/2 93.8' TEL RISER R _. C2 ELEC HANDBOX off 508-362-4541 LS fax 508 362-9880 102" 1OYR 6/4 93.5' C2 LS �zH of�4,q5S C3 1 OYR 6/4 ��~NOFMASSgC' �o ARNE H ycycN down cape engineering, inc. SILT LOAM ARNE yGm o OdA ^' Cl VIL ENGINEERS 126" N/5 91.5' 156" 88.0' o O A CIVI 2 N LAND SURVEYORS Scale: 1"= 30 2Z! N . o �� 939 Main Street - YARMOUTHPORT, MASS. NO GROUNDWATER ENCOUNTERED ST 0 15 30 45 60 75 FEET DATE e °,�Em OJAL s .94L s�' DCE #06-186 qN�SURVEyC 06-186 BORTOLOTTI_MCCARTHY_HOWE.DWG (SBO)