HomeMy WebLinkAbout0078 BARNHILL ROAD - Health 78 Barnhill Road
West Barnstable
A=108-021
- l
�3
t y
p
6 ��a
s
F
r
ta
'f
t
M .it �9[S tiI . ! �. L O t - � :K! . 1u �ii6��Irvw��W�i��Jf ��,u� ` _. •... �. r ' , _ �'
h ,
1 •
4 4
a -. a-. a, � � - a '__ _- ... �.-•;::� -
TOWN OF BARNSTABLE
LOCATION '1-9 SEWAGE# 2014- 3y 0
VILLAGE (,�, a rn ASSESSOR'S MAP&PARCEL 10$• 21
INSTALLER'S NAME&PHONE NO. _Gs,A JE 1(CdtV vxA;O^ !}`Yl-O GS3
SEPTIC TANK CAPACITY /000 qot.]
LEACHING FACILITY: (type) SOO qQ.1 LI c�Z) (size) 13-s 25x2
NO.OF BEDROOMS
OWNER S
PERMIT DATE: 9-/q- 19 COMPLIANCE DATE: 2-
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility(If any wells exist on
site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within
300 feet of leaching facility) Feet
FURNISHED BY
Mom.
A,- 4113
:61„
A q4�$
2
� i a
3Z, zi
33, Z9'Z��
Cyr Z4'2
<</teJ,
3
1
No. Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
I1 ftphLatlon for Misposal 6pstem Construction VffmIt
Application for a Permit to Construct( ) Repair(✓'Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. (�Xr nk tr Owner's Name,Address,and Tel.No.QoScr1 Roy .L DV X
Assessor's Map/Parcel /D$ t,,,}, 1 r nS chl as -M ,6Ctrn1%' 11 Rol 0• .Qarn'54e.S IC
Installer's Name,Address,and Tel.No.B tr EXCAVa�ian Designer's Name,Address,and Tel.No. F° c�c.j
14-rC_.)c rrcy L.,J f ores°bla.1 c e��7. 0653 'R O°Sox 331 Ockrco;0,
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) - 1130 gpd Design flow provided ILI q$ gpd
Plan Date $-sj-19 Number of sheets Z Revision Date
Title
Size of Septic Tank 1000 Type of S.A.S. SOO Q(;L) ( �C n?_
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health. °
9 Date
Application Approved by Date
Application Disapproved by Date
for the following reasons
Permit No: j Date Issued
j.' No. Fee
THE COMMONWEALTH OF MASSACHUSETTS' Entered in computer:
Yes
ti PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
2ppliLation for Misposal 6pstrut Construction Permit
Y
1.
Application for a Permit to Construct( ) Repair( Upgrade( ) Abandon( ) ElComplete System ❑Individual Components
Location Address orLot.No. Z ) ,$ �p,tn�1� �� Owner's Name,Address,and Tel.No.R��H RoJ;JLoox �
Assessor'sMap/Parcel it)? W. rnS W °]S (3ar^�" I (dal G�J• �Q ^$°1a SIG
Installer's Name,Address,and Tel.No.B £X�a Vo,.j ion Designer's Name,Address,and Tel.No.
14T�j.�cc-ry as ��residQ.lc, {?�•�ion 1 avc �'} b�hcr'iK
Type of Building:
Dwelling No.of Bedrooms Lot Size sq�ft. Garbage Grinder( )
Other Type of Building—�� No.of Persons Showers( ) Cafeteria( )
' Other Fixtures
Design Flow(min.required) �1:310 gpd Design flow provided ,�U5( gpd
Plan Date 9 Number of sheets Revision Date
4 Title
Size of Septic Tank t0-nin Type of S.A.S.� "j
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health. `
ign d- el y`r- Date
Application Approved byTAff—LI—Tufn 1 ( �. `/ Date
Application Disapproved b Date
for the following reasons
i J
Permit No. �' /� Date Issued /
THE COMMONWEALTH OF MASSACHUSETTS
F
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired Upgraded( )
Abandoned( )by ;C .,I
at!-� rA 6', i 1 ,,, has been cons acWaid
with the provisions of Title 5 and the for Disposal System Construction Permit No. .r
Installer , R FX!C o1-6 a A Designer
#bedrooms Approved design flow-_ gpd
t
The issuance of this permit shall n e o rued as a arantee that the system wil nct' n as d igned._
Date I d ` Inspector
-- .i.. r - = ---------.--- -----------------"--
------------=------- �---- ---- - - � - FeeNo. W ' THE COMMONWEALTH OF MASSACHUSETTS
(� PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Misposai 6pstem Construction Permit
Permission is here y granted to Construct( ) Repair(,,00) -Upp✓grade, ) nn Abandon,
System located at r / /t �. •�t�l r� �r
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions.
Provided: s t' n must be completed within three years of the date of this permit.
Date Co� �� Approved by
Town of Barnstable
Py�FTHF Tp�y regulatory Services
o„ Thomas F. Geiler, Director
Public. Health Division
v Huss.
Thomas McKean, Director
ATED Mph A
-200 Main Street, Hyannis, MA 02601
Office: 508-862-4644 Pax: 508-790-6304
Date: Q- 13, t9 Sewage Permit# 2o19 -3 y0 Assessor's Map/Parcel
Installer & Designer Certification Form
Designer: ror✓uen4o..l Installer: R4.R CXCa.Uo_-j;on
Address: .PO Box 331 Address: Iq Tko�r_rru,_Lr-3..
AQrw',cy
Oil q• 9"l g ( � `� CX� A o n was issued a permit to install a
(date) (installer)
septic system at based on a design drawn by
(address)
�fl��e. Flo��•te-�y dated -s-14
(designer)
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. Stripout (if required) was inspected and the soils
were found satisfactory.
I certify that the septic system referenced above was installed with major changes (i.e.
greater than 10' lateral relocation of the SAS or any vertical relocation of any component
of the septic system) but in accordance with State:& Local Regulations. Plan revision or
certified as-built by designer to follow. Stripout (if required) was inspected and the soils
were found satisfactory. >;
n 0AV10
,(Installer's Sigma ) "ERA, JR
�1No
(Dcsigiier'S Signatu�l (Affix Desig mp Here)
PLEASE RETURN TO BARNSTAJBLE 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:\office formsWesignerceruficauon fonn.doc
SENDER: COMPL.5-TTE THIS SECTION CC,'.','PLEE 7HIS SECTION
ON DELIVERY
■ Complete item;,..,... ,and 3.` A. Signatig e
■ Print your name"Ad address on the reverse X Agent
so that we can return the card to you. ❑Addressee
■ Attach this card to the back of the mailpiece, B. Recepv tinted Nam C.Date of Delivery
or on the front if space permits. K0131 42—
Iress different fr6m item 1? ❑�s
- ielivery address below: o
ROBIDOUX, ROBERT J TR
78 BARNHILL ROAD
WEST BARNSTABLE,MA02668
II I�IIII)IIII I'i(III II II IIII II II I I II( II II'I III 3. Service Type ❑Priority Mail Express®
I ❑Adult Signature p Registered MaiITM
❑Ad.h Signature Restricted Delivery ❑Registered Mail Restricted
9590 9402 5225 9122 7022 67 rtitied Mail® tp 'veryCertified Mail Restricted Delivery umReceiptfor
❑Collect on Delivery rchandise2. Article Number(transfer from service laben ❑Collect on Delivery Restricted Deliverynature ConfirmationTm
n lncurwd Mail nature Confirmation
7 015 1730 0001 4987 7596 ;I Restricted Del(very Restricted Delivery
Ps Form 3811,July 2015 PSN 7530-02-000-9053 i)A►rie tic Returti jReceipt
PostalS.
r3 RECEIPT
CERTIFIED MAI
Q• Domestic Mail Only
Ln
lti EEC==
r r 'ems a�v.
N
Certified Mail Fee
E.
-'r Extra Services&Fees(check box,add fee as appropriate)
r.q ❑Return Receipt(hardcopy) $
r3 ❑Return Receipt(electronic) $ -- Park
C3 ❑Certified Mail Restricted Delivery $ f�l re
r-3 []Adult Signature Required
[]Adult Signature Restricted Delivery$
C3
m 0�_;
f` t1:
ROBIDOUX, ROBERT-TIJ
Ln 78 BARNHILL ROAD ''Q
C3 WEST BARNSTABLE, MA 02668
N
:rr r rr rrr•r•
Town of Barnstable Barnstable
P Inspectional Services Department ift&ftarica City
1 I I I•'�'°lFo��A]bw
a
I.F
BARNSTABL
MASS,
39. Public Health Division 200 Main Street, Hyannis MA 02601 2007
Office: 508-862-4644
FAX: 508-790-6304 Thomas A.McKean,CHO
CERTIFIED MAIL#7015 1730 0001 4987 7596
August 12, 2019
ROBIDOUX, ROBERT J TR
78 BARNHILL ROAD
WEST BARNSTABLE, MA 02668
ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5
The septic system located at 78 Barnhill Road, West Barnstable, MA was inspected on
07/18/2019 by Brett Hickey, certified Title V Septic Inspector for the State of
Massachusetts.
The inspection of the septic system showed that the system "Fails" under the guidelines
of 1995 TITLE V (310 CMR 15.00) due to the following:
• Static liquid level in the distribution box above outlet invert due to an
overloaded or clogged SAS or cesspool.
You are ordered to repair or replace the septic system within one (1) year from the date
you receive this notification.
Failure to repair/replace the septic system within the deadline period will result in future
enforcement action.
PER ORDER OF TH BOARD OF HEALTH
ean, R.S., CHO
Agent of the Board of Health
Q:aSIPTICCfitle V Inspection Report Letters Mail ing\Failed or Needs Further['.valuation Letters\78 Barnhill Road West
Barnstahle.doc
i
Town of Barnstable
ib39• ,�� Inspectional Services Department
,or fD MA'S#
Public Health Division
200 Main Street, Hyannis MA 02601
Office: 508-8624644
FAX: 508-790-6304 Thomas A.McKean,CHO
Feb 6, 2007
Rev. 4/26/19
DEADLINES TO REPAIR FAILED SYSTEMS
(Town Code §360-44 and Title V: 310 CMR 15.000)
An"x" marked in the ❑ is the failure criteria and associated repair deadline
60 DAY DEADLINE CRITERIA
❑ Discharge or ponding of effluent to the surface of the ground
❑ Pumping more than 4 times during the last year not due to clogged or obstructed
pipe.
❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool
❑ Structurally unsound septic tank or SAS
O 1 YEAR DEADLINE CRITERIA
Static liquid level in the distribution box above outlet invert due to an overloaded or
clogged SAS or cesspool
❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation
❑ Any portion of the cesspool within a Zone 1 to a public well
❑ Any portion of a cesspool within 50 feet of a private water supply well with no
acceptable water quality analysis. (This system passes if the water analysis
indicates the well is free from pollution).
TWO'(2) YEAR DEADLINE CRITERIA
❑ Single Cesspool
❑ Any "conditionally passed systems" (broken cover, relocation of a pipe, relocation
of a driveway due to H-10 components, etc)
❑ Leaching facility with standing liquid level at or above the invert pipe (per Town
Code §360-20 h)
OTHER
Repair deadline:
Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc
r -
4
Commonwealth of Massachusetts �09-
Title 5 Official Inspection Form z
�= I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r,y
78 Barn Hill Road t
Property Address r,
Robert Robidoux
Owner Owners Name /
information is d t
required for every West Barnstable Ma 02668 7-18-19
page. City/Town State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
Important:When A. Inspector Information cSI:F- /3►VV
filling out forms
on the computer, Brett Hickey
use only the tab
key to move your Name of Inspector
cursor-do not B&B Excavation
use the return Company Name
key.
374 Route 130
Q
Company Address
Sandwich Ma 02563
City/Town State Zip Code
rrxt (508)477-0653 S113747
Telephone Number License Number
B. Certification
I certify that: I am a DEP approved system inspector in full compliance with Section 16.340 of Title 5
(310 CMR 16.000); 1 have personally inspected the sewage disposal system at the property address
listed above; the information reported below is true, accurate and complete as of the time of my
inspection; and the inspection was performed based on my training and experience in the proper function
and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined
that the system:
1. ❑ Passes
2. ❑ Conditionally Passes
3. ❑ Needs Further Evaluation by the Local Approving Authority
4. ❑■ Fails
m a �
Brett Hickey .�,o,�.��°�r�®�������� 7-18-19
Inspector's Signature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board
of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of
10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate
regional office of the DEP. The original form should be sent to the system owner and copies sent to
the buyer, if applicable, and the approving authority.
Please note: This report only describes conditions at the time of inspection and under the
conditions of use at that time.This inspection does not address how the system will perform
in the future under the same or different conditions of use.
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18
cam, Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
`7c 78 Barn Hill Road
V�
Property Address
Robert Robidoux
Owner Owner's Name
information is West Barnstable Ma 02668 7-18-19
required for every
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary
Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6.
1) System-Passes:
❑ I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
2) System Conditionally Passes:
❑ One or more system components as described in the"Conditional Pass"section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health,will pass.
Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not
determined,"please explain.
The septic tank is metal and over 20 years old"or the septic tank(whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass
inspection if the existing tank is replaced with a complying septic tank as approved by the Board of
Health.
"A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND (Explain below):
t5insp.doc-rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
I' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
78 Barn Hill Road
V�
Property Address
Robert Robidoux
Owner Owner's Name
information is West Barnstable Ma 02668 7-18-19
required for every
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
2) System Conditionally Passes (cont.):
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below):
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
3) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
a. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
78 Barn Hill Road
Property Address
Robert Robidoux
Owner Owner's Name
information is West Barnstable Ma 02668 7-18-19
required for every
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
b. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well**.
Method used to determine distance:
**This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal
coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must
be attached to this form.
c. Other:
4) System Failure Criteria Applicable to All Systems:
You must indicate"Yes" or"No"to each of the following for all inspections:
Yes No
❑ ❑ Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ Q Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
1. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
78 Barn Hill Road
v
Property Address
Robert Robidoux
Owner Owner's Name
information is West Barnstable Ma 02668 7-18-19
required for every
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
4) System Failure Criteria Applicable to All Systems: (cont.)
Yes No
0 ❑ Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ a Liquid depth in cesspool is less than 6" below invert or available volume is less
than 1/day flow
❑ a 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.
❑ El Any portion of a cesspool or privy is within a Zone 1 of a public water supply
well.
❑ El Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ El Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered.A copy of the analysis
and chain of custody must be attached to this form.]
❑ El The system is a cesspool serving a facility with a design flow of 2000 gpd-
10,000 gpd.
0 ❑ The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303,therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
5) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the
questions in Section CA.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection
Area—IWPA)or a mapped Zone II of a public water supply well
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18
c Commonwealth of Massachusetts
I TiOfficial In n F TitleInspection Form
0
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
78 Barn Hill Road
v
Property Address
Robert Robidoux
Owner Owner's Name
information is West Barnstable Ma 02668 7-18-19
required for every
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
If you have answered"yes"to any question in Section C.5 the system is considered a significant
threat, or answered "yes"to any question in Section CA above the large system has failed. The
owner or operator of any large system considered a significant threat under Section C.5 or failed
under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner
should contact the appropriate regional office of the Department.
6. You must indicate"yes" or"no" for each of the following for all inspections:
Yes No
El ❑ Pumping information was provided by the owner, occupant, or Board of Health
❑ El Were any of the system components pumped out in the previous two weeks?
El ❑ Has the system received normal flows in the previous two week period?
❑ 0 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)
❑ El Was the facility or dwelling inspected for signs of sewage back up?
0 ❑ Was the site inspected for signs of break out?
El ❑ Were all system components, excluding the SAS, located on site?
El ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions depth of liquid, depth of sludge and depth of scum?
P q P 9 P
❑ a 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:
El ❑ Existing information. For example, a plan at the Board of Health.
El El approximation
in the field (if any of the failure criteria related to Part C is at issue
a roximation of distance is unacceptable) 310 CMR 15.302 5
pP p ) [ Ol
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18
f �
4
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
78 Barn Hill Road
u
Property Address
Robert Robidoux
Owner Owner's Name
information is west Barnstable Ma 02668 7-18-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information
1. Residential Flow Conditions:
2 3
Number of bedrooms (design): Number of bedrooms(actual):
220/GPD
DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms):
Description:
Permit shows 2 bedrooms 220GPD 7-5-77. Plans show 3 bedrooms 300GPD.
1
Number of current residents:
Does residence have a garbage grinder? Q Yes ❑ No
Does residence have a water treatment unit? ❑ Yes No
If yes, discharges to:
Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes 0 No
information in this report.)
Laundry system inspected? ❑ Yes g No
Seasonaluse? ❑ Yes [g No
See below
Water meter readings, if available (last 2 years usage(gpd)):
Detail:
***WELL WATER***
Sump pump? ❑ Yes ❑■ No
current
Last date of occupancy: Date
l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18
Commonwealth of Massachusetts
�n Title. 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
78 Barn Hill Road
v�
Property Address
Robert Robidoux
Owner Owner's Name
information is west Barnstable Ma 02668 7-18-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
2. Commercial/Industrial Flow Conditions:
NA
Type of Establishment:
Design flow(based on 310 CMR 15.203):
Gallons per day(gpd)
Basis of design flow seats/ ersons/s .ft. etc.):
9 ( P q )
Grease trap present? ❑ Yes ❑ No
Water treatment unit present? t ❑ Yes ❑ No
If yes, discharges to:
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
Last date of occupancy/use: Date
Other(describe below):
3. Pumping Records:
p 9
Source of information: Owner- last pumped July 2017
Was system pumped as part of the inspection? ❑ Yes ❑■ No
If yes, volume pumped: gallons
How was quantity pumped determined?
Reason for pumping:
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
78 Barn Hill Road
V
Property Address
Robert Robidoux
Owner Owner's Name
information is west Barnstable Ma 02668 7-18-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
4. Type of System:
El Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner)and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank.Attach a copy of the DEP approval.
❑ Other(describe):
Approximate age of all components, date installed (if known)and source of information:
1977 per COC
Were sewage odors detected when arriving at the site? ❑ Yes No
5. Building Sewer(locate on site plan):
11411
Depth below grade: feet
Material of construction:
■❑ cast iron ❑■ 40 PVC ❑other(explain):
>100' from well to SAS
Distance from private water supply well or suction line: feet
Comments(on condition of joints, venting, evidence of leakage, etc.):
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18
cf Commonwealth of Massachusetts
�m Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
I f'
78 Barn Hill Road
Property Address
Robert Robidoux
Owner Owner's Name
information is West Barnstable Ma 02668 7-18-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
6. Septic Tank(locate on site plan):
411
Depth below grade: feet
Material of construction:
❑■ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain)
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No
1
Dimensions: 000gallons
211
Sludge depth:
3411
Distance from top of sludge to bottom of outlet tee or baffle
Orr
Scum thickness
NS
Distance from top of scum to top of outlet tee or baffle
NS
Distance from bottom of scum to bottom of outlet tee or baffle
measured
How were dimensions determined?
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
The tank was in working order at the time of inspection. The tank is not in need of pumping
at this time but should be pumped every two years for maintenance.
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18
c � Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
78 Barn Hill Road
Property Address
Robert Robidoux
Owner Owner's Name
information is West Barnstable Ma 02668 7-18-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
7. Grease Trap(locate on site plan):
NA
Depth below grade: feet
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: Date
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan):
NA
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Capacity: gallons
Design Flow:
gallons per day
l5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18
Commonwealth of Massachusetts
�n Title 5 Official Inspection Form
I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
78 Barn Hill Road
Property Address
Robert Robidoux
Owner Owner's Name
information is west Barnstable Ma 02668 7-18-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
8. Tight or Holding Tank(cont.)
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments(condition of alarm and float switches, etc.):
"Attach cop of current pumping contract(required). Is co attached? Yes No
Y P P 9 PY ❑ ❑
9. Distribution Box(if present must be opened) (locate on site plan):
over
Depth of liquid level above outlet invert
Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
The d-box was in poor condition at the time of inspection.
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18
f
Commonwealth of Massachusetts
�M Title 5 official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
78 Barn Hill Road
Property Address
Robert Robidoux
Owner Owner's Name
information is West Barnstable Ma 02668 7-18-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
10. Pump Chamber(locate on site plan):
Pumps in wcrking order: ❑ Yes ❑ No*
Alarms in wcrking order: ❑ Yes ❑ No*
Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.):
NA
* If pumps or alarms are not in working order, system is a conditional pass.
11. Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
Type:
❑ leaching pits number:
❑ leaching chambers number:
❑ leaching galleries number:
❑ leaching trenches number, length:
24'x 18'
0 leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Ia Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
78 Barn Hill Road
Property Address
Robert Robidoux
Owner Owner's Name
information is west Barnstable Ma 02668 7-18-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
11. Soil Absorption System (SAS) (conk.)
Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
The SAS was in hydraulic failure at the time of inspection. Leaching backed up into
d-box when viewed.
12. Cesspools(cesspool must be pumped as part of inspection) (locate on site plan):
NA
Number and configuration
Depth—top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18
r .
Commonweaith of Massachusetts
�d Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
78 Barn Hill Road
Property Address
Robert Robidoux
Owner Owner's Name
information is West Barnstable Ma 02668 7-18-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Wormation (cont.)
13. Privy(locate on site plan):
Materials of construction: NA
Dimensions
Depth of solids
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18
c� Commonwealth of Massachusetts
�n ,p Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
78 Barn Hill Road
Property Address
Robert Robidoux
Owner Owner's Name
information is West Barnstable Ma 02668 7-18-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
14. Sketch Of Sewage Disposal System:
Provide a view of the sewage disposal system, including ties to at least two permanent reference
landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters
the building. Check one of the boxes below:
X hand-sketch in the area below
❑ drawing attached separately
,
1}
t
"� �•., a4 a�'' �' ' 'E°ja3` 'y x ...
1
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18
Commonwealth of Massachusetts
+� Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
78 Barn Hill Road
V
Property Address
Robert Robidoux
Owner Owner's Name
information is west Barnstable Ma 02668 7-18-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
15. Site Exam:
Check Slope
0 Surface water
100 Check cellar
On Shallow wells
Estimated depth to high ground water: No GW @ 10'
feet
Please indicate all methods used to determine the high ground water elevation:
El Obtained from system design plans on record
7-5-77
If checked, date of design plan reviewed: Date
❑ Observed site(abutting property/observation hole within 150 feet of SAS)
❑ Checked with local Board of Health -explain:
❑ Checked with local excavators, installers-(attach documentation)
❑ Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
A plan on file at the local Board of Health was used to determine high groundwater.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18
<tX, Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
I;
78 Barn Hill Road
V�
Property Address
Robert Robidoux
Owner Owner's Name
information is West Barnstable Ma 02668 7-18-19
required for every
page. City/Town State Zip Code Date of Inspection
E. Report Completeness Checklist
Complete all applicable sections of this form inclusive of:
❑M A. Inspector Information: Complete all fields in this section.
❑■ B. Certification: Signed & Dated and 1, 2, 3, or 4 checked
❑� C. Inspection Summary:
1, 2, 3, or 5 completed as appropriate
4 (Failure Criteria)and 6(Checklist)completed
❑■ D. System Information:
For 8: Tight/Holding Tank—Pumping contract attached
For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached
For 15: Explanation of estimated depth to high groundwater included
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18
TOWN OF B)ARNSTABLE
�U.CAnON� S�1311l" /AQ a SEWAGE#
VILLAGE ��$'� �r/`/�� e 7 ASSESS R'S MAP& LOTfU2-0/ 9
NAME&PHONE NO70 ►' dZ 5
SEPTIC TANK CAPACITY A000 C,b,`/- ioh
LEACHING FACILITY: (type) �D�U
h NO.OF BEDR
BUILDER R OWNER
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility 60 / Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) el Feet.
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 t of leaching f 'lity) Feet
ed b �JPDG� I
Furnish y
�151 7-`
a
z'2q , ao �
Qfx
CERTIFICATE OF ANALYSIS Page:
Barnstable County Health Laboratory
Report Prepared For: Report Dated: 03/23/1999
ROBIDOUX,Robert Order Number: G9901670
Robert Robidoux
78 Barnhill Rd.
West Barnstable MA 02668
Laboratory ID#: 9901670-01 Description: Water-Drinking Water
Sample#: 01670-01 Sampling Location: 78 Barnhill Rd.,W.Bst. Collected: 03/18/1999
ollected by: R.Robidoux Bathroom faucet Received: 03/18/1999
Test Parameters
ITEM RESULT UNITS MCL Method# Tested
LAB:Microbiology
Total CoMrm Present CFU/100 mL 0 Colilert 03/22/1999
Note: Exceeds.the recommended maximum contamination level for drinking water due to the presence of Coliform Bacteria
i
Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605
CERTIFICATE OF ANALYSIS Page. 2
7' J
a
Barnstable County Health Laboratory
Report Prepared For: Report Dated: 03/23/1999
ROBIDOUX,Robert Order Number: G9901670
Robert Robidoux
78 Barnhill Rd.
West Barnstable MA 02668
Laboratory ID#: 9901670-02 Description: Water-Drinking Water
Sample#: 01670-02 Sampling Location: 78 Barnhill Rd.,W.Bst. Collected: 03/18/1999
ollected by: R.Robidoux Kitchen faucet Received: 03/18/1999
Test Parameters
ITEM RESULT UNITS MCL Method# Tested
LAB:Microbiology
Total Coliform Present Ci:U/100 mL 0 Colilert 03/22/1999
Note: Exceeds the recommended maximum contamination level for drinking water due to the presence of Coliform Bacteria.
Approved By.
(Lab Director)
Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605
i
Bottle Number: 01096-01 Date: 01/11/99
Barnstable County Health and Environmental Laboratory
Superior Court House, Route 6A
P.O. Box 427
Barnstable, MA 02630
Client: . ROBIDOUX, ROBERT Collector: BOB ROBIDOUX
Mailing 78 BARNHILL RD Affiliation: OWNER
Address: WEST BARNSTABLE, MA 02668
Telephone: 362-6053 Type of Supply: WWell Depth: 110 FT
Sample Location: 78 BARNHILL RD Date of Collection: 01/07/99
Town: WEST BARNSTABLE Date of Analysis: 01/07/99
(G/R/ Faucet)
PARAMETER SAMPLE RESULT
RECOMMENDED LIMITS
TTotal Coliform Bacteria/100mL PRESENT ` 0
Conductivity (micromhos/cm) 0
Iron (PPm) 50 50
Nitrate-Nitrogen (ppm) 0. 3
Sodium (PPm) 10. 0
20. 0
Copper (ppm)
1. 3
BASED ON THE ANALYSES PERFORMED, THE FOLLOWING ADVISORIES ARE GIVEN:
* This water sample exceeds the recommended maximum contamination level
for drinking water due to the presence of Coliform Bacteria
.
This is a Retest
a "
Thomas F. Bourne, Laboratory Director
. J. E /`
�, . �► 4
� A
BORTOLOTTI CONSTRUCTION,INC.
765 WAKEBY ROAD,MARSTONS MILLS,MA 02648 - 9 1'9,96, _ {
508-771-9399 508-428-8926 FAX: 508428-9399 " / Q
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM; tl
p
PART A t •t
CER ICATION
Property Address: �O ,)A,,Il
Date of Inspection: - J— Inspector's
ner's Name and Addres
01
CERTIFICATION sTATEmFNT.
I certify that I have personally inspected the sewage disposal.system at this address and that the informa-
tion reported below;is true,accurate and complete as of the i p e time of inspection. The inspection was per-
formed b on my training and experience in the proper function and maintenance of on-site sewage
disposal stems. The System:
Passes
Conditionally Passes
Needs Further Ev uation B t Local Aproving Authority
Fails
Inspector's Signature: Date:
•6
The System Inspector shall submit copy of this inspection report to the Approving authority within thir-
ty(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!
A)SYS M 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.
B)SYSTEM CONDITIONALLY PASSES;
One or more system components need to be replaced or repaired. The system,upon comple-
tion of the replacement or repair,passes inspection.
Indicate yes,nor,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 sep-
tic tank is replacedwith a conforming septic tank as approved by The Board of Health.
Sewage backkup or breakout or high static water level observed in the distribution box is due
td 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):
-1-
l Af
SUBSURFACE SEWAGE,DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Broken pipe(s)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): I
Broken pipe(s)are replaced
Obstruction is removed
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 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: 1 "'
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 FUNCTION-
ING IN A MANNEKTHATPROTECT THE PUBLIC HEALTH AND SAFETY AND THE
ENVIRONMENT:
The system has a septic tank and soil absorption system and 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 is with a Zone I of a public
water supply well.
The system has a septic tank and soil absorption system and is within 50 Feet of a private
water supply well.
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 pollutiodfrom
the 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 ofHealtli
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 efluent 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 clog-
ged SAS or cesspool.
Liquid depth in cesspool is less than G"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
-2-
1
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
I
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 SYSTEM FAILS:
The following criteria apply to a large system in addition to the criteria above:
The design flow of a 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.Protection3Are6"l",'d
(IWPA)or a mapped Zone.1I of a public water supply well. ``" " '' f6
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.
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Check if the following have been done:
✓. Pumping information was requested of the owner,occupant,and Board of Health. '
t/fNone of the system components have been pumped for atleast 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.
,�/'l'he facility or dwelling was inspected for signs of sewage back-up.
The system does not receive non-sanitary or industrial waste flow.
✓The site was inspected for signs of breakout.
+/All system components,excluding the Soil Absorption System,have been located on site.
3'he septic ta&rnanholes were uncovered,opened,and the interior of the septic!tank was`in=='
spected for condition of baffles or tees,material of construction,dimensions,depff of liquid,
✓depthtof 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.
-3-
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST(continued)
The facility owner(and.occupants,if different from owner)were provided with information
on
the proper maintenance of Subsurface Disposal System
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
FLOW CONDITIONS
RESII?ENTIAL:
Design Flow: alIons Number of Bedrooms:_ Nui er of Current Residents:
Garbage Grinder: Laundry Connected To System: Seasonal Use:
Water Meter Readings;if lable:
Last Date of Occupancy: C�(Y"
COMMERCT
d
Type of Estabhshient:
Design Flow ',`t allonstday Grease Trap Present: (yes or no)
Industrial Waste Holding Tank Present:
Non.-Sanitary Waste.Discharged To The Title V System:
Water Meter Readings, If Available: Last Date of Occupancy:
OTHER: Describe)
Last Date of Occupancy:
GENE NFORMATIO
PUMPING RECORDS and source of information: , ���
System Ptunped as part of inspection _ If y ,vol a pumped: gallons
Reason fort pumping:
TYPE OR SYSTEM:
Septic;T40/Distribution Box/Soil Absorption System
Single Cesspool
Overflow Cesspool
Privy
-hared System(If ),atta,fph previous inspectio ecords, ' ny
Other(explain): ht° ,4t'
ROXIMATE AGE.of all1co ponents,date installed(if known)and sourcezf information:
Sewage odors detected when
arriving at the site: Ald
b A
-4-
t
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
GENERAL INFORMATION (continued)
SEPTIC TANK:
Depth below grade: Material of Construction: concrete metal FRP Other. s
(explain) —
Dimisions• Sludge Depth: Scum Thickness:
Distance from top of sludge to bottom of outlet tee or battle: 3y�i
Distance from bottom of scum to bottom of outlet tee or baffle:
Comments;:(recommendation for pumping,condition of inlet and outlet tees or baffles,depth.of fi uid
level)in relation t utlet invert, structural integrity,evidence of leakage etc. 5 6
-e
GREASE TRAP:
Depth Below Grade: Material of Construction:—concrete—
metal—FRP—Other
(explain)
Dimensions: Scum Thickness:
Distance from top of scum to top of outlet tee or baffle:
Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid t
level in relation to outlet invert,structural integrity,evidence of leakage,etc.)-
TIGHT OR HOLDINGTANK:
740
Depth Below Grade: Material of Construction:_concrete—metal_FRP Other(explain)
Dimensions: Capacity: gallons Design Flow: aallons/day
Alarm Level:
Comments. (condition of inlet tee,condition of alarm and float switches,etc.) ;
r5 ,
DISTRIBUTION BO
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 CHAMBER:/
Pump is in working order:
Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.)
-5-
v ,
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
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: Leaching chambers, number: Leaching galleries,number:
Leaching,trenches,number,length:
Leaching flelds,''number,dimensions:
d
Overflow cesspool,number:
Comments: (note condition of soil,signs of hydr uli failure 1 1 o nding,condition of vegetation,
etc.) 6 EY i'� cC 'X. 1 1
c
CESSPOOLS:
Number and co guration: Depth-top of liquid to inlet invert:
Depth of solids layer: Depth of scum layer: Dimensions of Cesspool:
Materials of construction: Indication of groundwater:
Inflow(cesspool must be pumped as part of inspection)
Comments: (note condition of soitk, signs of hydraulic failure, level of ponding,condition of vegetation,
etc.)
PRIVY:
Materials of construction: Dimensions:
Depth of Solids:
Comments: (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,
etc.)
-6
r
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
SKETCH OF SEWAGE DISPOSAL SYSTEM:
Include ties to atleast two permanent references, landmarks or benchmarks.
Locate all wells within 100 Feet.
i
ear m
2 17
1t
DEPTH TO GROUNDWATER:
Depth to groundwater: & Feel
Meth of Determination or A proxi ation:
�D�o �rr�
-7-
• BOUSFIPLI) SANITARY SERVICE
17 Burbank Street
Sandwich,Massachusetts ✓yn �
02563
i
79
Name Surer Permit No.
Location:
Builders a Name and Address �yi'1Ia
Date Permit Iseued:7�7y/1/
Date Compliance Issued: _ 7
r
�h
��
�.
i � , _
�, �
. �
, ! i
� �► I �
,
AG
THE COMMONWEALTH OF MASSACHUSETTS
BOARD HEALTH
.................. ...... ----------.oF....... . u�1r.L........................................................
Appliration for Uhipati al Works Tonstrnrtiun ramit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage D• osal
System at: ,6
,i.................................. ...........................................................
��� '^ �Locatio�dress or Lot No.
...._ie{ -- "-1—. ... .... — ................
• _.. ._ ..
Owner Address
W
a .......... --•---• ..................... ............................................ ..........
.._..-•-•----•-•----•-------••--•
Installer Address
U Type of Building V `1 Size Lot____..!.�� __.....Sq. feet
Dwelling—No. of Bedroom ................................. Attic ( ) Garbage Grinder
'� Other—Type of Building No. of persons____________________________ Showers — Cafeteria
Design Flow....................._ allons er erson er
Other fixtures .••••-------• -• ---------------------------------------------------•-------------------._..._........_••_---•--
W �� -------...--•---g P P P day. Total daily flow...........012--Q.................gallons.
WSeptic Tank J-Luid capacity_/LOO.gallons ength................ Width................ Diameter................ Depth................
x Disposal Trench No.____/.............. Width...A-_�._____.. Total Length.....t2._.V_...... Total leaching area____. 32_sq. ft.
Seepage Pit No..................... Diameter.................... Depth belo inlet ............. Total leaching area..................sq. ft.
Z Other Distribution box (V1 Dosing tank 77
aPercolation Test Results Performed by...... __ _....................................... Date__________._.______._______. __4
,.a Test Pit No. 1.........P._minutes per inch Depth of Test Pit____________________ Depth to ground water.:-___)__:___:
4i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
ter----•-•----•; .._......
Description o Soil-•----------------�..`.'....-•---- ..---••---•--•- --•----�•• - ---------- ------- --
._..------.7-- ------ . ....-. . .� ------------
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 iITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has be iss ed by the board of llth.�
gned.... . .......... ......d\__..._......-•C,�-=".................. .........................._....
( Dal(—
Application Approved By.............. -- �i1: !� v4 -_..._ :......
• � Date
Application Disapproved for the following reasons_________________________________________________________________________________________________________________
................•---•------....-•-----------•----------------......--------------•------.._..--------•---•--._.._...._..._..-•-•--•--•-----------�•�-----••-----------------------------------------
ate
PermitNo.......-•-•---•-•-------•..._--•••-------•............... Issued-........ ...................�,.�
_ - ate ............ ........ .
No....`.. .T...... . FEs............... .....
THE COMMONWEALTH OF MASSACHUSETTS
BOARD �OF HEALTH
-------------- ' -- ... ..............OF...... ..... ..........
4 Appliration for Dispoiia1 iftrkfi Tnntrnrtinn ranfit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at
' r�•-----.----: t i3� `"
................__...... ._..............---.........---------.....----•---•--•----•-. .............................................. ---------------•-••----•--•--------•--•----
Fl Locati�-"Address s or Lot No.
.... •••.• • ... _. -------- ---------------------------------------------•-d -•-------------------------------------------
Owner Addredress
W
Installer Address 61 C)
Q Type of Building Size Lot---------------------------Sq. feet
Dwelling—No. of Bedrooms._.._.__..'............................Expansion Attic ( ) Garbage Grinder
aOther`--, Type of Building ............................ No. of persons___-____-___-.-.--..-__..-__ Showers ( ) — Cafeteria ( )
Q' Other fixtures�:
----- ------•------------------------------•---
W Design Flo ............. `'.................` { gallons per person per day. Total daily flow__.___. t ... ...................gallons.
WSeptic Tank I�quid capacity --__._...gallons '` Length................ Width. . . ...__ Diameter................ Depth ...........
x Disposal Trench No..._�!............... Width_._... ......... Total Length....
... ft.
Seepage Pit No-----------_-------- Diameter.................... Depth below i i et............._._.... Total leaching area..................sq. ft.
Z Other Distribution box (�) Dosing t9ak
~' Percolation Test Results Performed by__ t t.1. ...;.......................................... Date---.................
-..----.d......-. .
Test Pit No. I....... ____minutes per inch Depth of Test Pit.................... Depth to ground water-_._Zl_........
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
Descr>p ' of Soil / f
j
x •------------•--...-----••. •-••-•-•---------------•----•-•---•----•-----...----•-----•-••---•-----P.............................
.. ........ ------------------
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 TITIE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has b -n issued by the board of health.
Signed.. ....../t t�.•,........................................'
Application Approved By........ .�----- 7.
Date
Date
Application Disapproved for the following reasons:------•-----------------------------------------.........................••...................................
...............-.....................................................................................................................................------------------------------------------...------
Date
PermitNo......................................................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
f N
(it ifi Ir Of Toutplittnrr
T TO E FY, That th- In vi al Sewage Disposal System constructed or Repaired ( )
_
by... ....... ...... .... .. ..................... �. _........ ------.-..-.-----.-__....... ----•----------•-
- Installer
.. l! '! -�.-!• -------------------------------------------
has been installed in accordance with the provisions o TI i r of The State Sanitary Code as de cri ed in the
application for Disposal Works Construction Permit •.0??__.._ G._Z.............. da.ted...i�`--- -.—' �......_._........
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A RANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE......:.. _ Inspector------- -......................
THE.COMMONWEALTH OF MASSACHUSETTS
(� ............BQARD kO.l� HEALTH
OF.. ......................................................................... �l
No......................... FEE.. .................
Disp sa or ntr rrntit
Permission is hereby ranted.-. ._
to oar .,R Constru5t�) epair ('. ) an Individual �a e>DiApos System f f
atNo.--•••....................•••---.•--- .... . ` .f.. F`
as shown on the application for Disposal Works Construction a 1-street
t �__.. . .... Dated..����...j...................
-----------------
Board of Health
DATE................................................................................
FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS
t�'9 fiw.. I 1 1 Rom, 77� f rl ,•
Rill
r, .� .O, r �� a a• � .
� .� r I- - .fit. .} .. ... • ,, ` / �p ., ..FI.
,;Ng.♦a yp I_,� _ I,.a C n� - '1 �p r'►� +'l�^li' ;2!{
k � 1 t d�+r ����+ t� .' 41, ,:.i•.. � �'�`�: '�1 +'.- '+�'�. W•t,L ��,atl 1'
b N•rS Y�tf , ' ' r`• � tit ,,, dll }i - A F .. •. � � .,tr�M,y,:
P a grs - .,h,�' rv'i ♦ - e is } r,'Ip1 ui
^ t ERA
C. k r
°
��''���.
y,K M�4�+�'�iS.P'r.L Jh' � ,:t: �-� !=4 .:,' b 5 I i' ..,-0.f A ' ( ' I l�rl •�'' i b ' � '
,ltr L si {ti �+� tp l/j t:• 1 ��` o t 1 4 { it
r t• ,r,
t(S; L
01
>+ na�±n 1r, /C11'f !A �7-• . ' rt# t'C'�.r
xl� 4• � •J V Ir. ., y VFtY�Sl 7i, {
-j.- sty t� ;d 1♦ —\ , „ r ,Y t 1 r. A 1 1
k 4.
G •� r '.iL ,1'
e
5 h CERTIFIED PLOT- PL''W, ''''
' ,qr $A9rlN/LL RG,
'i�fi�W' ''G41d9TRUCTION ONLY s _WE T .0 4, Aol7�ISi-�
��------
X,
`V: FOUNDATION 18 FEET
1141(8"bvt low, PAINT OF' ADtA ENT
�: y�,f'�wjOti E� ;�• �1,-, 5 •w+u �y1� a�,t'• i ,, iJ' ,: :Yg QI°/. /� a I'd i '�^ �pn .y Z t+ y a_-� ;� � t
j.
�1. 1� �a � n'�a'asr°�`to3f.� •p�,P y{i� ) + .1''�,+�s ::L`i1r� ,f ' •i.t.,?5 }� r.�7V�•6.EY� /�. "'�U ,Vy05A,11��,�QP� `, /^'Pr'�y ,�•1
�r• `v ` '����Y 1�' �.lttr '+'" J'��f�6�'i.Fa v ,fd�•�e
'' L �.I o l7 iL t;�� 4.' (�• n a�dT-� i��l�� .iy^F � �y� �� '
y k 6 py
'All
•t ','Yd`i ,[ '1/'� �) ., x i +% 9 t 'n' k3•J �3
---- 29 FT MIN.
FT. MIN. X _
°° i
4 PVC PIPEof
CONCRETE MIN. PITCH _ 4 DOUBLE �l
�— /GG• '� COVERS 1/8 PER FT. PERFORATED
d PVC PIPE
10°°
LIQUID LEVEL CLEAN SANG
s..l. 4 CAST ii•
IRON PIPE
MIN. PITCH- ••% '.• • .. . . •• _
I/4°fPER FT SEPTIC TANK a DIST. (SEESn
BOX C TABULATION)
LEACHING FIELD B .
SEC rlaV OF GROUND WAtER TABLE
SEWAGE DIS#4WAL SYSTEM
3FT. 6 FT. O.C. SCALE //4"= /LO" X SOIL ' LOG
2 LAYER 4" DtEF
UBLE
ELE-VATION
OF 1/8' -3/8RATED SOIL TEST �r
WASHED STOIPE _
DATE OF SOIL TEST
_ CLEAN SAND RESULTS WITNESSED BY
PERCOLATION RATE E MIN./INCH
DESIGN CRITERIA
PERFORATED y00STAKES ,�
PVC PIPE WASHED STONE NUMBER OF BEDROOMS
SET 8 F
ON CENTER GARBAGE DISPOSAL UNIT y . ..
- - ESTIMATED FLOW 0� GAL./DAY
SEMOOOI X- X LEACHING AREA SO. FT.
- SG4L£ //4 ? / O
RESERVE AREA 13 S0. FT. TABULATION
_ DIMENSM A �,5 FT.
INVERT ELEVATIONS DIMERSON B_-?.,FT.
3. DIMENSION C 4:"/ FT.
t /� �N OF d1q q: tp ®s' INVERT AT BUILDING �'y.5 FT.
�. r.-
3Y INLET SEPTIC TANK =l FT.
e t N �' V� ERi N', �.lb Vfn�cv . . 9 r WE7�T +/�'/fS;'
RO$ OUTLET SEPTIC TANK
' 7 FT.
to ELDREDGE. N kv INLET DISTRIBUTION 80X -s•v FT
OItTLET DISTRtB •ION BOX ell? FT <ELMEDGE ENG04MIRING CO. IIC.
.`
t;�s,'` �, 1.
2.NO. ST 712. -MAIN ST END 4F LEACHNG FIELD ` T33
n�r f m"-s #IASS O. 1f4 7o_]Joed7
TOP OF FOUNDATION COVERS TO BE WATERTIGHT AND SEPTIC SYSTEM PROFILE Flaherty Environmental Services
FINAL
BROUGHT TO WITHIN 6"OF GRADE (not to scale) COVER TO BE W/I 3" OF GRADE
EL. 58.0' EL. 56.0' CLEAN SAND P.O. Box 331
ti •
2"of j" to§" DOUBLE WASHED EL. 56.0' Harwich, MA 02645
4"CAST IRON or EQUIVALENT PEASTONg-OR GEOTEXTILE 774.994.1166
MIN. PITCH 1/4" PER FOOT FILTER FABRIC '•. • ' . ' • . .
4"SCHEDULE 40 PVC PIPE 4" SCHEDULE 40 PVC PIPE COVER TO BE W I 3" O GRADE
VENT REQUIRED
FLOW LINE (first 2'tobe
"...: .
..<
L.EXIST. 1q" ®� o 0 0 0
!: 00000000000 O •®� C�ARM
•� °O°°°O°OC
EL.EXI EL.53.6' 000°000 0 0 °000 00000000e
EL.52.83' r 000 ° o o°o°o°o° °o°O°OOOC ED:
�•' o 000000 0000c2.0
EL.53.0' o o°o°o°o°o°o°0 � ® o°o°o°00 —
GAS BAFFLE a EL.52.8' 0°00010000 000000 0°0000000 5' REMOVAL OF UNSUITABLE
0 0 0 0 0 0 0 0 'd' .� 0 0 0 0
" (H-20D-BOX) 000000000 000000 „� •• 00000000c EL p 8 MATERIAL LATERALLY AND
BENEATH SAS TO EL.49.5'
' STALL INLET TEE SOIL ABSORPTION SYSTEM
y 6"CRUSHED STONE OR 1"ABOVE OUTLET INVERT
:'s. '•..'e�.,,:a': MECHANICALLY COMPACTED (2J SOO GALLON H-20 CHAMBERS
1000 GALLON SEPTIC TANK 5.3'
(DATUM: ASSUMED) (EXISTING) I„ WITH 4'STONE AROUND IN A
4 to 1� DOUBLE WASHED STONE 12,83'X 25'X 2' CONFIGURATION
BOTTO
M EL. 5
M OF TEST HOLE EL. 45.5' 45. '
\
52 1 USGS ADJUSTMENT: N/A LOCATIONMAP
f GROUNDWATER ELEV: N/A
N TH
5 ® / \
1 � Sim `�a, �
56 z
CYLOCUS
52 , o
/ Rt.6 Exit 5
54
NTS
58
DRIVEWAY
o'� y
LOT 59 G
�O -'
GARAGE EXISTING
- 150' TO WELL (SLAB) 3 BR MAP
ACRES* D
AP 108 LOT 21
10.0' DECK DVELLDHG
}a: 23.0 56 AFPTARI
Y• (qC , p
2Y ST. S.T.
W DATE'91512019 REVISED:
DEIST. SAS
BENCHMARK:
TOP OF FNDN
0 EL.58.0'
LEGEND (REMOVE AS NECESSARY) 356• f SZTE AND SEWAGE PLAN FOR
B & B EXCAVATION, INC./
a 6 G GAS LINE se ROBERT 1. ROBZDOUX JR.
—W W W W: WATER LINE 78 BARNHZLL ROAD
C 6 E E E EXIST. ELECTRIC (WEST) BARNSTABLE, MA
99 EXIST. CONTOURS s————— 99 PROP, CONTOURS SCALE : 1 _
- 40-'
CIE d�E NBC UNDERGROUND UTD_.
a REF.'DB 31209 PG 193 PAGE 1 OF2
i
t�
........... .................................................................................................................................................................................. .................. .............................................................................. .......................... ...... ....................................... ........... ............................. ..................................... ........................ ............. .... ..... ................
GENERAL NOTES DESIGN CAL CULA TIONS S YS TEM DETAIL Flaherty Environmental Services
P. 0 . Box 331
1. ALL PRECAST COMPONENTS TO BE H-10 Harwich, MA 02645
RATED UNLESS OTHERWISE SPECIFIED. NUMBER OFACTUAL BEDROOMS 3 774.994. 1166
DISTRIBUTION BOX AND ANY
COMPONENTS WITH ANY ANTICIPATED GARBAGE DISPOSAL UNIT NO
VEHICULAR TRAFFIC TO BE H-20 RATED,
2. THE DESIGN OF THIS SYSTEM DOES NOT TOTAL ESTIMATED FLOW
(110 GAUBRIDA YX 3 BR) 330 GAL./DAYALLOW FOR THE USE OF A GARBAGE
GRINDER. 5' REMOVAL
3. MUNICIPAL WATER IS NOT AVAILABLE. REQUIRED SEPTIC TANK CAPACITY 660 GAL.
25'
4. ALL CONSTRUCTION TO CONFORM WITH SIZE OF SEPTIC TANK 1000 GAL. (EXISTING)
310 CMR 15.000 AND ALL OTHER
APPLICABLE LOCAL, STATE AND FEDERAL SOIL CLASSIFICATION I
CODES AND REGULATIONS.
H
5. INSTALLER/CONTRACTOR TO REVIEW& DESIGN PERCOLATION RATE <2 MINAINC
VERIFY ALL ELEVATIONS AND DETAILS
AND REPORT ANY DISCREPANCIES TO
EFFLUENT LOADING RATE 0.74 GAL.IDA YIF T'
0 0 12,83'
DESIGNER PRIOR TO CONSTRUCTION OR
LE,4CHINGARE4
ASSUME ALL RESPONSIBILITY, (2)x(25.0'+ 12,83)(2) = 151SF
6. INSTALLER/CONTRACTOR IS 25.0'x 12.83' =320 SF
RESPONSIBLE FOR MAINTAINING SAFE 471 SF x 0.74 =348 GPD
WORK AREA, VERIFYING ALL UTILITIES
AND NOTIFYING "DIG SAFE" USE(2)500 GALLON H-20 CHAMBERS WITH 4'STONE
(1-888-344-7233) 72 HOURS PRIOR TO INA 12.83'X25'CONFIGUP.4TIONASDIAGRAMMED
CONSTRUCTION.
7. ANY CHANGES TO OR DEVIATIONS FROM
RESERVE LEACHING CAPACITY NIA
THIS PLAN MUST BE APPROVED IN
WRITING BY FLAHERTY ENVIRONMENTAL
SERVICES AND LOCAL BOARD OF
HEALTH.
8. FINISH COVER OVER COMPONENTS IS
NOT TO EXCEED 3'PER 310 CMR 15.000 (NTS)
UNLESS SHOWN PER PLAN.
9. ALL ABANDONED SEPTIC SYSTEM
COMPONENTS TO BE PUMPED DRY AND SOIL EVAL UA TION
FILLED WITH CLEAN SAND OR REMOVED
TESTHOLE#1 TPT#19-118 TESTHOLEV TPT#19-118
AND REPLACED WITH CLEAN SAND. Evaluator. David D.Flaherty Jr.,RS,REHS Evaluator. David D.Flaherty Jr,RS,REHS it%
1 O.ALL COMPONENTS TO BE PROVIDED SE#2755 SE#2755
"
BOH Witness David Stanton,RS BOH Witness:iness, David Stanton,RS
b
WITH WA TER TIGHT ACCESS PORTS
Date: August 22,2019 Date. August 22,2019
WITHIN 6"OF FINISH GRADE.
SEIVE ANALYSIS WAS PERFORMED
j
I 1.ALL SEPTIC TANKS, DISTRIBUTION FOR THE C2 HORIZON(SEE A TrA CHED) TH_2 ELEV 56 0, 1,2
rH-I ELEV.56.0'
g,M57ALLED
.BOX
WATERTIGHT 0"-17" FILL 0"-17" FILL
0
NITARk
12,NO KNOWN WETLANDS OR WELLS 17'-25" A LS IOYR312 17'-25" A LS IOYR3)2
r 0 P OPOS
WITHIN 150 FEET OF PROPOSED
LEACHING.
25'-46" B LS IOYR514 25"-46' 8 LS IOYR514
13,THIS IS NOT A CERTIFIED PLOT PLAN
AND UNDER NO CIRCUMSTANCES IS THIS
-1 certify that on November 12,2002,1 have passed
PLAN TO BE USED FOR ZONING OR the examination approved by the Department of SITE AND SEWAGE PLAN FOR
46"-78" C1 SL 7,5Y616 46"-78" C1 SL 7.5Y616
BUILDING PURPOSES. 10%cobbles 10%cobbles Environmental Protection and that the above analysis
has been performed by me oonsistant with the B & B EXCA VA TZON, INC./
14.LOT IS SHOWN AS ASSESSOR'S MAP 108 required training,expernse,and experience described
78"-136" C2 FS 2.5Y614 78--120- C2 FS 2.5Y614 ROBERT J. ROBIDOUX JR.
In 310 CMR 15.018(2).
LOT 21 .
15.LOCUS PROPERTY IS NOT LOCATED (SEINE) 78 BARNHZLL ROAD
WITHIN AN AQUIFER PROTECTION (WEST) BARNSTABLE, MA
DISTRICT(ZONE 11). G.W.ELEV NIA G.W.ELEV NIA
BOTTOM TH-I ELEV. 45.5'. BOTTOM TH-2 ELEV. 46.0'-
PAGE20F2 DATE:81712019
.... .... .......................... ............................................ ...............................................................................................................................................................................................................................................................................................................................................................................................
........................................................................................................... ................................................................................................................ .................................................................................................
TOP OF FOUNDATION COVERS TO BE WATERTIGHT AND SEPTIC SYSTEM, PROFILE Flaherty Environmental Services
BROUGHT TO WITHIN 6"OF FINAL GRADE (not to scale) COVER TO BE W/I 3" OF GRADE
EL. 58.0 EL. 56.0 CLEAN SAND P.O. BOX 331
2"of k to Z" DOUBLE WASHED EL. 56.0' Harwich, MA 02645
4"CAST IRON or EQUIVALENT PEASTONE-OR GEOTEXTILE 774.994,1166
FILTER FABRIC
MIN. PITCH 1/4" PER FOOT
4"SCHEDULE 40 PVC PIPE 4" SCHEDULE 40 PVC PIPE COVER TO BE W I 3" O GRADE
..
VENT REQUIRED
FLOW LINE 41=hjflrst2'to be letrel) '..
�:'• : ,:.
. . . . . . •'• o°o°o°o°e
:.'•: L.EXI5T. 14, o000000000o t� _ Awn,
.. 0000000oa
EL.EXIST EL.53.6' i o000000 0 ° o000 ®{� 0°0000o°eEL.52.83' oo° ° °0000000aoa � o°o.00
o°O°o°c 2.0' REQUIRED:
EL.53.0' o o°o°o°o°o°o°o �® ® 0��. ® o°o°o°o°e-
EL.52.8' 00000000°000 0000 o o° 5' REMOVAL OF UNSUITABLE
r• GAS BAFFLE0 0 0 0000
0 e ; o 0 0°0
....a. (H-20D•BOX) k oo°o°o°o° o°o°o° ' •• ••.0 " °o°o°o°o° EL. .8' MATERIAL LATERALLY AND
•.• BENEATH SAS TO EL. 49.5'
STALL INLET TEE SOIL ABSORPTION SYSTEM
CRUSHED STONE OR 1"ABOVE OUTLET INVERT
.•,�5. ;,'u;,;..:•a : MECHANICALLY.COMPACTED (2) 500 GALLON H-20 CHAMBERS
1000 GALLON SEPTIC TANK 5.3'
(DATUM: ASSUMED) (EXISTING) 3" WITH 4'STONE AROUND IN A
4 to 1, UOUBLE WASHED STONE 12,83'X 25'X 2' CONFIGURATION
BOTTOM OF TEST HOLE EL. 45.5' EL. _4 5,
52 \ USGS ADJUSTMENT: N/A LOCATIONMAP
GROUNDWATER ELEV: N/A
/ N TH
5 ® /
a• �
s6
LOCUS
Rt.5 Exlt 5
54
NTS
�gC DRIVEWAY
�ZN OF
LOT 59 ? C�
GARAGE EXISTING 0.85 ACRES* O D
GR ts0 T WELL A E MAP 108 LOT 21
3 DR t
10.0' DECK DWELLING F H
12 .
23,0' •p p
.^ah, 56 �. lcQ.rSTE��t.
N(TAR%I`� (q
O
T♦il :,n.oti T. S.T.
DATE.•91512019 REVISE
EXIST. SAS
BENCHMARK:
TOP OF FNDN
Aoj EL.58.0'
LEGEND (REMOVE AS NECESSARY)
SITE AND SEWAGE PLAN FOR
B & B EXCAVATION, INC./
6 6 6 6 GAS LINE ss ROBERT J. ROBIDOUX 1R.
-W W µ-- w WATER LINE 78 BARNHILL ROAD
-E E E E E EXIST. ELECTRIC (WEST) BARNSTABLE, MA
99 EXIST. CONTOURS _
————— 99 PROP. CONTOURS SCALE : 1 -- 40'
tj iG U,.E Uirg _ UNDERGROUND UTIL,
� REF.'DB 31209 PG 193 PAGE i OF2
............... .............................................................................................................................................................................................................................................. ........................................................................................ ..........................................................................................................................................................................................................................................................................................................................................................................................................................................
GENERAL NOTES DESIGN CAL CULA TIONS
S YS TEM DETAIL Flaherty Environmental Services
P. 0. Box 331
1. ALL PRECAST COMPONENTS TO BE H-10 k Harwich, MA 02645
RATED UNLESS OTHERWISE SPECIFIED. NUMBER OFACTUAL BEDROOMS 3 774.994.1166
DISTRIBUTION BOX AND ANY
COMPONENTS WITH ANY ANTICIPATED GARBAGE DISPOSAL UNIT NO
VEHICULAR TRAFFIC TO BE H-20 RATED.
2. THE DESIGN OF THIS SYSTEM DOES NOT TOTAL ESTIMATED FLOW
ALLOW FOR THE USE OF GARBAGE (I 10 GA UBRIVA Y X 3 BR) 330 GALADA Y
GRINDER.
REQUIRED SEPTIC TANK CAPACITY 660 GAL. 5' REMOVAL
3. MUNICIPAL WATER IS NOT AVAILABLE.
25'
4. ALL CONSTRUCTION TO CONFORM WITH SIZE OF SEPTIC TANK 1000 GAL. (EXiSTING)
310 CMR 15.000 AND ALL OTHER
APPLICABLE LOCAL, STATE AND FEDERAL SOIL CLASSIFICATION
CODES AND REGULATIONS.
5. INSTALLER/CONTRACTOR TO REVIEW& DESIGN PERCOLATION RATE <2 MIN./INCH
T
VERIFY ALL ELEVATIONS AND DETAILS
EFFLUENT LOADING RATE 0.74 GAL.IDA YIFT2
AND REPORTANY DISCREPANCIES TO 12,83'
DESIGNER PRIOR TO CONSTRUCTION OR
LEACHINGAREA
ASSUME ALL RESPONSIBILITY, (2)x(25.0'+ 12.83 7(2) = 151 SF
6. INSTALLS RI CONTRACTOR IS 25.O'x 12.83' =320 SF
RESPONSIBLE FOR MAINTAINING SAFE 471 SFx a 74 =348 GPD
WORK AREA, VERIFYING ALL UTILITIES
AND NOTIFYING "DIG SAFE" USE(2)500 GALLON H-20 CHAMBERS WITH 4'STONE
(1-888-344-7233) 72 HOURS PRIOR TO INA 12.83'X25'CONFIGURATIONASDIAGRAMMED
CONSTRUCTION.
7. ANY CHANGES TO OR DEVIATIONS FROM
RESERVE LEACHING CAPACITY NIA
THIS PLAN MUST BE APPROVED IN
WRITING BY FLAHERTY ENVIRONMENTAL
SERVICES AND LOCAL BOARD OF
HEALTH.
8. FINISH COVER OVER COMPONENTS IS
(NTS)
NOT TO EXCEED 3'PER 310 CMR 15.000
UNLESS SHOWN PER PLAN.
9. ALL ABANDONED SEPTIC SYSTEM
COMPONENTS TO BE PUMPED DRY AND SOIL EVAL UA TION
FILLED WITH CLEAN SAND OR REMOVED
TESTHOLE#1 TPT#19-118 TESTHOLEW 7PT#19-118 OF
AND REPLACED WITH CLEAN SAND. Evaluator David D.Flaherty Jr.,RS,REVS Evaluator. David D.Flaherty Jr.,RS,REHS
1 O.ALL COMPONENTS TO BE PROVIDED SE#2755 i SE#2755ti
BOHWItness. David Stanton,RS BOH Witness: David Stanton,RS
WITH WA TER TIGHT ACCESS PORTS Date., August 22,2019 Date. August 22,2019
WITHIN 6"OF FINISH GRADE. F
SEIVEAAAL YSIS WAS PERFORMED
121
11.ALL SEPTIC TANKS, DISTRIBUTION TH-I ELEV.56.0' FOR THE C2 HORIZON(SEE ATTACHED)
TH-2 ELEV. 0'
BOXES AND PIPING TO BE INSTALLED
GISTE
WATERTIGHT. 0"-17" FILL 0'-17' FILL
MUM
12.NO KNOWN WETLANDS OR WELLS
17"-25" A LS 10YR 312 17"-25" A LS 10YR&2 'g
WITHIN 150 FEET OF PROPOSED
LEACHING.
25'-46" B LS 10YR 514 25"-46" B LS 10YR 514
13.THIS IS-NOT A CERTIFIED PLOT PLAN
AND UNDER NO CIRCUMSTANCES IS THIS
7 cert)y that on November 12,2002,/have passed
PLAN TO BE USED FOR ZONING OR 46"-78' C1 SL 7.5Y616 46"-78" C1 SL 7.5Y616
the examination approved by the Department of
SITE AND SEWAGE PLAN FOR
BUILDING PURPOSES. 10%Cobb/es 10%cobbles Environmental Protection and that the above analysis
14.LOT IS SHOWN AS ASSESSOR'S MAP 108 78"-136' C2 FS 2.5Y614 78"-120' C2 FS 2.5Y614
has been performed by me consistant with the B & B EXCA VA TZON, INC./
required trainIng,expertise,and experience described
ROBERT 3. ROBZDOUX JR.
LOT 21 . in 310 CMR 15.018(2).
15.LOCUS PROPERTY IS NOT LOCATED (SEIVE) 78 BARNHZLL ROAD
WITHIN AN AQUIFER PROTECTION (WEST) BARNSTABLE, MA
DISTRICT(ZONE 11). G.W.ELEV.NIA G.W.ELEV.;N/A
BOTTOM TH-1ELEV. 45.5'L BOTTOM TH-2 ELEV. 46.0'
PAGE 20F2 DATE:81712019
..........................................................................................................................-......................................................................................................................................................................................................................................................................................................... .................................................................................... .......................................................................................................................................................................................................... .....................................