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Home My WebLink About0093 BARNHILL ROAD - Health 93 Barnhill Road West Barnstable A— 108 — 019 0 f 9 ti Commonwealth of Massachusetts log.- of �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 93 Barnhill Road Property Address Dean Meece Owner Owner's Name / information is West Barnstable V Ma 02668 5-26-2020 required for every 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 S/ ` 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 Company Address Sandwich Ma 02563 City/Town State Zip Code arm (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 15.340 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 Brett Hickey Digitally signed by&eit Hickey `Dale:2020.os.2sos:3r58-on•oo, 5-26-2020 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 tirrke.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc-rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 1 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �l 93 Barnhill Road Property Address Dean Meece Owner Owner's Name information is West Barnstable Ma 02668 5-26-2020 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: The system was in working order at the time of inspection. 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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts r� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 93 Barnhill Road L Property Address Dean Meece Owner Owner's Name information is West Barnstable Ma 02668 5-26-2020 ' 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 1 Commonwealth of Massachusetts �n Title 5 Official Inspection Form 1� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments t ............e / 93 Barnhill Road V Property Address Dean Meece i Owner Owner's Name information is West Barnstable Ma 02668 5-26-2020 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 �A Title 5 Official Inspection Form w Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 93 Barnhill Road t.— Property Address Dean Meece Owner Owner's Name information is West Barnstable Ma 02668 5-26-2020 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 El Static liquid level in the distribution box above outlet invert due to an overloaded El or clogged SAS or cesspool ❑ ❑ Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow ❑ ❑ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ El Any portion of the SAS cesspool or privy i s below high ground water elevation. ❑ ❑ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ❑ Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ El Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ 0 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.] ❑ 0 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 16,000 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 Commonwealth of Massachusetts ,p Title 5 Official Inspection Form 13 pie Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 93 Barnhill Road Property Address Dean Meece Owner Owner's Name information is West Barnstable Ma - 02668 5-26-2020 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 ❑ ❑ 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? El El this large volumes of water been introduced to the system recently or as part of this inspection? Q ❑ 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? El ❑ Was the site inspected for signs of break out? El ❑ Were all system components, excluding the SAS, located on site? ❑ ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ El 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: E ❑ Existing information. For example, a plan at the Board of Health. ❑ 0 Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 I Commonwealth of Massachusetts Title 5 Official 'Inspection Form 11. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 93 Barnhill Road v� Property Address Dean Meece Owner Owner's Name information its West Barnstable Ma 02668 5-26-2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: 3 Number of bedrooms (design): Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330/GPD Description: Number of current residents: 3 Does residence have a garbage grinder? ❑ Yes 0 No Does residence have a water treatment unit? ❑ Yes Q No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes No information in this report.) Laundry system inspected? ❑ Yes 0 No Seasonal use? ❑ Yes CE No Water meter readings, if available(last 2 years usage (gpd)): See below Detail: ***WELL WATER*** Sump pump? ❑ Yes ■❑ No Last date of occupancy: currentDate t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 1 Commonwealth of Massachusetts Title 5 Official .Inspection Form + ,1, Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 93 Barnhill Road u Property Address Dean Meece Owner Owner's Name information is west Barnstable Ma 02668 5-26-2020 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/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ 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: Owner- last pumped 3 years ago Source of information: 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 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form 0 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 93 Barnhill Road Property Address Dean Meece Owner Owner's Name information is west Barnstable Ma 02668 5-26-2020 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: New SAS added to existing tank in 2009 Were sewage odors detected when arriving at the site? ❑ Yes ❑■ No 5. Building Sewer(locate on site plan): 2' Depth below grade: feet Material of construction: ❑ cast iron ❑■ 40 PVC ❑ other(explain): Distance from private water supply well or suction line: >100' from well to SASfeet 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 c Commonwealth of Massachusetts Title 5 Official Inspection Form = ,io Subsurface Sewage Disposal System Form -Not for Voluntary Assessments el 93 Barnhill Road " Property Address Dean Meece Owner Owner's Name information is west Barnstable Ma 02668 5-26-2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on,site plan): 1' 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 11" Sludge depth: 25" Distance from top of sludge to bottom of outlet tee or baffle 4" Scum thickness 5" Distance from top of scum to top of outlet tee or baffle 12" 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 in need of pumping at this time and 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 Commonwealth of Massachusetts p Title 5 Official Inspection Form �r Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 93 Barnhill Road V Property Address Dean Meece Owner Owner's Name information is West Barnstable Ma 02668 5-26-2020 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form -- - w Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 93 Barnhill Road - u Property Address Dean Meece Owner Owner's Name information is west Barnstable Ma 02668 5-26-2020 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 copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): 0" 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 working order at the time of inspection. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 I Commonwealth of Massachusetts ,lp Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 93 Barnhill Road Property Address Dean Meece Owner Owner's Name information is West Barnstable Ma 02668 5-26-2020 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 working order: ❑ Yes ❑ No" Alarms in working 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: (2)500 gallon chambers El leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ 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 . 0 Subsurface Sewage Disposal System Form -Not-for Voluntary Assessments `L l _ 93 Barnhill Road u Property Address Dean Meece Owner Owner's Name information is West Barnstable Ma 02668 5-26-2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): The SAS was in working order at the time of inspection. Leaching chambers were 3/4 full 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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form 07 I� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments v � 93 Barnhill Road Property Address Dean Meece Owner Owner's Name information is West Barnstable Ma 02668 5-26-2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): NA Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): ::mow l5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts ip Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 93 Barnhill Road V� Property Address Dean Meece Owner Owner's Name information is West Barnstable Ma 02668 5-26-2020 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: ■❑ hand-sketch in the area below ❑ drawing attached separately 5,2112020 - Asseasiny As-BuOt'Carar TOWN()F.rtAlt_VSTA111J` tNST i.ISR S N.lTfi a:1 30NL N)_ _. 2,... .... - r x t t:r::a t•nt i Irr:,it� �O...Q at!J:�`�� t,/d�.8.3as_ CRttnNCl:'L 'Hf.n:m.�m ny,uwu l}�;�uwe:triat:emmo'nnc.vn o:[....:n¢iq Fair„y _— �' P:i+aro li'wn sytNy\V�i atk l.ea.M1ti�4 F,:ef�ih'Itfanr.els ui¢:on ��'-..........t�e.n� r. .tWALiN wiLVe. mpfe-�n�it) 3 v1ti)1[.L b" �! .t31 _� 3.r to A—'1 30° t3 a-/ tqs c vas` \ o rr 3 aas o ..._ 0-4Av' ✓ C d 7`7 i. t5tf�.:%Jtowri.trttiisiehi.i:ra.tas/1]r. armretits/A sestilii�,f m r1 Vaiues%hlh7tlls lay.as.i?rna.i I ar=i08-(rtq&3eU'-2 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts �m ,/,p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments !J 93 Barnhill Road L Property Address Dean Meece Owner Owner's Name information is West Barnstable Ma 02668 5-26-2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: Check Slope Surface water ❑■ Check cellar M Shallow wells Estimated depth to high ground water: No GW 4' below SASfeet Please indicate all methods used to determine the high ground water elevation: 0 Obtained from system design plans on record 6-10-2009 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) t ❑ 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. l5insp.doc•rev.7/26/2018 Title 5 Official inspection Form:Subsurface Sewage Disposal System-Page 17 of 18 Commonwealth of Massachusetts ,,p Title 5 Official Inspection Form '? �I' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments \ ` 93 Barnhill Road Property Address Dean Meece Owner Owner's Name information is West Barnstable Ma 02668 5-26-2020 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: ■❑ A. Inspector Information: Complete all fields in this section. I ❑■ 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 0■ 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 {Ru t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 TOWN OF BARNSTABLE LOCATION l� lXIl2.-yi Vl P 0 ad SEWAGE# 177 VILLAGE J,L15, G,-yg ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. 2 G 014 n&le -PN SEPTIC TANK CAPACITY 6 o Q LEACHING FACILITY.(type) 0 NO.OF BEDROOM _? OWNER 6 at 4 4 M ofe"z�p PERMIT DATE: COMPLIANCE DATE: �' S`D 9/ 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 1 Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet F;URNISHED BY � 3 A - 130 6 - 1 i9°5 c=y o D- 3 0�3+� TOWN OF BARNSTABLE 4041, / e LOCATION 93 SEWAGE 4 :<Il LAGE ASSESSOR'S MAP&LOT eG 2-•O 19 INSTALLER'S NAME&PHONE NO. � C,.-e JC SEPTIC TANK CAPACITY /ot?d c 6+/�i.•�S LEACHING FACILITY: (type) L4 C44�94es (size) � r NO.OF BEDROOMS -3 BUILDER OR OWNER PERMTTDATE:_ _ 4—COMPLIANCE DATE: /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 4 �l � � � , � - - , 3 � _- ,� a D 3/. D _ � ��, . k� ,�_ r� ac.o � �. ,3 � `s.� � , `' �� :., °w��, No. ®o 1 ' l r • '�.� 1 p« Fee THE COMMONWEALTH O�F,•MASSACHUSETTS Entered in computer: L/ PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Z(ppYication for Th5pont 14&p.5tem Cougtructfou Permit Application for a Permit to Construct( ) Repair X Upgrade( ) Abandon( ) ❑Complete System Andividual Components Location Address or Lot No. f 81QR1`JJ4 ILL 126,417 Owner's Name,Address,and Tel.No. i B 2Ns r�.3L 9069YZ,7— C Assessor's Map/Parcel ! Ab C g/ -j zd Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size Q sq. ft. Garbage Grinder (/U)D Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3® gpd Design flow provided 341 gpd Plan Date UN i- 1p , ZO�>! Number of sheets Revision Date Title 64PTI '3 f",�J Loc4 rsr-> A r 1�tl�C- Size of Septic Tank /�ap0 •�'c9 L Type of S.A.S. GtJcl W- 2� Description of Soil Fort-JrV�TtO� s Nature of Repairs or Alterations(Answer when applicable) /L 5-0 S,�/ �/�/,e� 5,A, 5 , Date last inspected: Agreement: The undersigned agrees to ensure the construction and mainte of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the En n ental C nd not to e th system in operation unti Certificate of Compliance has been issued by this Board of 11 Signed A Q Date Application Approved by Date Application Disapproved by: Date for the following reasons Permit No. 2®D t Date Issued /2 No. 200 1 l i; . `/ ( ► # '- Fee �0 ^/ Entered in computer: tip " THE COMMONWEACTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION \y, TOWN'O_F"-BA`RNSTABLE, MASSACHUSETTS : Yes — ZIppYication for Bigo acY�*pgtern on truction Permit Application for a Permit toLConstruct O Repair(� Upgrade O Abandon O ❑ Complete System •Individual Components ' ` - Location Address or Lot No. 31Qi'2/ J)- I GL L�►� Owner's Name,Address,and Tel.No. N t c1►5-5T C' C ' Assessor's Map/Parcel w L• �� S l�- Installer's Name,Address,and Tel.No., Designer's Name,Address and Tel.No. r 5—A. 5 . 5111Z_V_ey, /NG' . ;Type of Buji lding: Dwelling No.of Bedrooms 3 ,* Lot Size 0�g sq. ft. Garbage Grinder (N)O {Other Type of Building g No.of Persons Showers( ) Cafeteria( ) 1 Other Fixtures " {Design Flow(min.required) gpd Design flow provided 34 t gpd . It Plan Date -J fa tj e /O , 2DDg Number of sheets 1i Revision Date - Title S.c 1�r►(1 N-115' r ' s1-70 1&.. ��Q AJ X/AI.4 7--EL7 7- '3�';3 /3,1,ZNF/1L1- 12 1 Size of Septic Tank A Ilk L Type of S.A.S. j GtJzLLS �c'�N ('�' 134i7 D FCs3L1�1f�77Ur� . Description of Soil Sry� 3 i Nature`of Repairs or Alterations(Answer when applicable) lL p - /s N�G,, ss S . Date last inspected: Agreement: j' 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 EnvxfOn ental C d and not to pI ce th system in operation until"a Certificate of " Compliance has.been issued by this Board of Health e ° © VVA,, -1-7 Signed A A Date - "�- Application Approved by , Date co Application Disapproved by: Date --� for�the following reasons Permit No. 20 0t1 -' ` Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS r Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( ) Repaired ( ) Upgraded ( ) Abandoned( )by I)d/'/"(1- 407 at q3 i ,u C, 61-L has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. Z 40`1- ` 1 , dated `p//2 ZUO I Installer Designer r #bedrooms 3 Approved desi n flows A j( gpd The issuance of this permit shjrll not be construed as a guarantee that the system wi If t o as designed j� Date !f Inspector VN J t No. �Zool 1 - 1 ' Fee /0 Q r "� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION — BARNSTABLE, MASSACHUSETTS 1 Th5poal *p,5tem Construction Permit Permission is hereby granted to Construct ( ) Repair Upgrade ( ) Abandon ( ) p System located at �'J �, � ��,�� ) /Z..L. and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this permit/ Date /2" 2 UOrJ Approved by / , r i to ti TRANS. NO.: CITY/TOWN: L� APPLICANT: C 1 ADDRESS: i+l L. c h �S DESIGN FLOW: 34-e?, gpd REVIEWED BY: - DATE: y t N/A OK NO GENERAL r f X 3 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 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)] Names of soil evaluator and BOH representative [310 CMR 15.220(4)(h) and(i)] Location and date of percolation tests (performed at proper elevation?) [310 CMR 15.220(4)(1)] Percolation test results match loading rate? [310 CMR 15.2421 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 CMR 15.220(4)(n)] Address �L4- To", W. 1At*4s > Mq Sheet 1 of L t . 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 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 water line cross see 310 CMR 15.211(1)[1]) 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 CMR 15.220(3)] LZ 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)] V Test hole adequate to demonstrate four feet of suitable material? [310 CMR 15.103(4)] V Test Holes adequate to confirm adequate groundwater separation? [310 CMR 15.103(3)] Benchmark within 50-75' of system [310 CMR 15.220(4)(q)] Materials specifications noted? [various sections of 310 CMR 15.000] V10 System components not> 36" deep (unless Local Upgrade Approval or LUA requested) [310 CMR 15.405(1(b)] AddressjQ� �LIjp�� /V. L►J�jr[ GL� Sheet 2 of 7 L_ ' N/A OK NO 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)] Note 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 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)] Access to within 6 " of grade - one port for systems<I 000gpd, ✓ two for systems >1000 gpd [310 CMR 15.228(2)] All at-grade covers secured to unauthorized access? [310 CMR 15.228(2)] V/ / I > 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 dwelling 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)] � !f I filLc. .Address �D�, w, � Sf Sheet 3 of 7 N/A OK NO 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 15.211(1)[1]) V/ 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 15.251(8) and 310 � / CMR 15.252(2)(h)] �/ Materials specified (310 CMR 15.251(5) specifies various pipe types allowed) DIA.SRIB1TgI'®N BOX Stable compacted base [310 CMR 15.221(2) and 310 CMR 15.232(2)(a)] Splash plate or baffle tee required on inlet/provided? (when 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 CMR15.232(3)(e)] Watertight cover if<2000gpd); waterproof manhole if>2000gpd [310 CMR 15.232(3)(d)] ab. ..,a„ v,w., .,,,,�r,.,a.�aH*R.`«,s»-waszek ra e' �`aa"° .!"�,.n.,� .�w�:.a".�';,..,,_.,.k �.aa.•• ca. '�Z'e` _.. - :j Capacity(emergency storage above working=design flow)? [310 CMR 231(2)] Proper setbacks [310 CMR 15.211 (same as septic tanks)] Watertight 20-in mimum access manhole at least 20" MUST BE TO GRADE [310 CMR 15.231(5)] Service components accessible (not too deep with piping, disconnects 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)] Stable Compacted Base [310 CMR 15.221(2)] Buoyancy calculations needed ?Provided? [310 CMR 15.221(8)] Address q3 ` 0 Sheet 4 of 7 L / N/A OK NO SOIL;ABSORPTIOlS 'STEyIYIS (SSj�GEN�JR4ML a N� � � ..,a .fix. Ate'.wx. Calculations correct? 4 feet of naturally occurring material demonstrated? [310 CMR 15.240(1)] v 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] `GALLERIES PITS C ERS3 O�CMR�5a25 � y 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 [310 CMR 15.251(2)] Breakout OK? [310 CMR 15.211(1)[4] and Guidance Document] ir BEDSAS (Max=imurnxsize ofbedor field 5000 gpd} -«� �.w.�.,,+. 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. [3`10 CMR 15.252(2)(f)] Bottom area used in calculations only [310 CMR 15.252(2)(i)] Address 1 1 L•� W 5' (,� Sheet 5 of 7 N/A OK NO Pressure Dosed System ? Provided pump and piping calculations as required [310 CMR 15.220(4)(r)] Pressure dosing required on all systems >2000gpd or alternative systems under remedial approval [310 CMR 15.254(2) and I/A Remedial Use Approvals] r 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 CMR 15.255(2)(b)] Retaining wall must be designed by Registered Professional Engineer [310 CMR 15.255(2)(a)] V_ Side slope not exceed 3:1 ? [310 CMR 15.255(2)] Breakout requirements met? [310 CMR 15.252(2) and Guidance Document] At least 5 ft. from impervious barrier to edge of SAS (10 ft. recommended) [310 CMR 15.255 (2)(e)] G'ravellessSystera (IlAApp�ov�l��e ters]� � � �y° �� F� � �� `� "� Check fiDEP Approval letters for credits and design conditions If used with pressure dosing do not allow pressure discharge to scour soil interface AZternatave�Sepfic�.Systems[I/�flpprotval��ettea�s� � � 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? V/ 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 CMR 15.220 (4)(q)] V/ RLS Stamp necessary on plan if a component is within five feet of property line [310 CMR 15.412(4)] New construction or increased flow proposed- [Refer to 310 CMR 15.414] Address Sheet 6 of 7 II N/A OK NO 1Vitro en ,Sensct�ve Areas _ 3 � �.., Is the system in a Designated Nitrogen Sensitive Area (Zone II 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 X 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 y 15.216(1)] /\ . Pumping to septic tank ? [ 310 CMR 15.229] Shared System [310 CMR 15.290] Address �j t7(��N�Ll.` "> VV. '1-i��l� � Sheet 7_of 7 I down cape engineering, inc. SIEVE SOILS ANALYSIS''Stone 93 Barnhill.xlsx DATE OF REPORT: 6/11/09 (TH 5-12-09) .JOB : GRAIN SIZE ANALYSIS-SIEVE TEST SITE: #93 BARNHILL ROAD, W.BARNSTABLE, MA LOCATION: EAS- Ed Stone TH SIEVE ANALYSIS Weight Sample(Grams): 319.8 SIZE :WEIGHT RETAINED ; % RETAINED : % PASSED ------------- - sum - ------------------ ------------------ 1" 0.0: 0.0%: 100.0% ------------- d------------------------------------- 3/4" 0.0: 0.0%: 100.0% --------------L.......................... A-----------_--_---L•------------------ 1/2" 0.0: 0.0%: 100.0% Wi- --------------------5 5r----------- 1 7%�----------98.3% #4 --------- 19.4; 6.1%: 93.9% -------------- ------------------ - -- ------------------•------------------ #10 44.1: 13.8%: 86.2% --------------;------------------------------------------o-I------------------ #20 108.2 33.8/o: 66.2/o #40 216.9: 67.8%: --------------r-----..--------.--........Y------------------�-----------....... #50 255.1, 79.8%; 20.2% -------------- ------------ v------------------•------------------ #80 282.6: 88.4%: 11.6% ------------- ------------------ d------------------ ------------------ #100 291.4: 91.1%: 8.9% ------------- --------------------------A------------------ ------------------ #200 305.4: 95.5%: 4.5% ---------------------------------- -------------------------------------- PAN: 319.8; 100.0%: 0.0% -------------- -------------------------- ------------------------------------- SAMPLE: 319.8: NOTE: TEST ON PASSING#4 ONLY, 1.4% RETAINED ON#4 <45% O.K. RESULTS: SOIL CLASSIFIED AS AASHTO A-3 (GRANULAR, FINE SAND)(UNCOMPACTE jNOFM PERCENTAGE OF MATERIAL PASSING#4 SIEVE : #4 100% (TEST ONLY MATERIAL PASSING#4) OK DAN11 LA. OJALA -+ #5010%-100% OK CIVIL Cn #100 0%-20% OK q No.46502 #200 0%-5% OK �0 G 8TE��O��'`4 MEETS TITLE 5 FILL SPECIFICATION ss,� � N� 1 RESULTS: PERMEABLE MATERIAL-CLASS 1 <2 MINJIN.MATERIAL NONCOMPACTED SOIL DESCRIPTION: MED. FINE SAND, SOME SILT-0.74 GPD/SF MATERIAL W: Town of Barnstable '"E'` ,.� Regulatory Services Thomas F. Geiler, Director • BAM9rABLL ^A S Public Health Division ra». �s �'' Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 603-862-4644 Fax: 503-790-6304 Installer & Designer Certification Form Date: 510 Sewage Permit# Assessor's iV1ap\Parcel ®� Designer: �rt �U � Installer: Address: 1 d �4�( �� Address: S,A�vw t CA k O'n On was issued a permit to install a (date) (installer) g 93 � � �� b septic system at � based on a design drawn by (address) r1. dated (v 1 0 ® (designe•) I certifythat the se tic system referenced above was installed substantial) acco.rdina to P Y z7 the design, which may include minor approved changes such as lateral relocation of the distribution box an&'or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or anv 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. OF qs DAR EN r, MEl'ER Inst le(s Signature) " No: 1140 SOI TARN' �9 I (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO ARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COiNIPL1ANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q: Health/Septic/Designer Certification Form 3-26-04:'doe s. opTME Town of Barnstable P# Department of Regulatory Services ' Public Health Division s 19- °9 s"s"sT"s►$ ' O Date NAM 200 Main Street,Hyannis MA 02601 DMA't� GG Date Scheduled -1 Time I t Fee Pd. Soil S(u� itability Assesssm t for Sewage isposal Performed By: 9 - � �� 71 J� Witnessed By: 0-952 r LOCATION& GENERAL INFORMATION Location Add res Owner's Name„� � :*9.3 lc6 PJ glGL g �. �3grc./S A t3C 15C_ �v SrJ.Ce TS7 Address9 389Qwf</e�Roon 4J.? Assessor's Map/Parcel: /QB6/9 Engineer's Name L S X Qivy NEW CONSTRUCTION REPAIR Telephone# 0 Land Use ( Slopes(%) c3 Surface Stones U fLP aM� / Distances from: Open Water Body I6_4**'0` ft' Possible.Wet Area� �1—ft Drinking Water Well 'IftJr Drainage Way -/d ft Property Line 35' ft Other ca✓e lu sla Z��ft 130 !t / 7LJ�r?F�ti TZ s'� elcvS SKETCH.}(Street name,dimensions of to exact location of test�les&perc tests,loea!kw a ds in proximity to holes) /Uc8 O /GL SuBA IL44615 Ole )h` 5u4ta LOT-S"I A \ 61 t,J cJ �•� �1 p� bZl SJ(3(1S9 SvQ�S�. /oho Parent material(geologic) �Y__✓4 � ;'�9 % Depth to Bedrock . / i /Z Depth to Groundwater. Standing Water in Hole: N Weeping from Pit Face �/ 2 � Estimated Seasonal High Groundwater / ` eS' 14✓.g 9, DET ATION FOR SEASONALZ HIGH`WATER TABLE Method Used: L ii Depth Observed standing in obs.hole: ��Q In, Depth to still mettles: N In (�V/� 7) Depth to weeping from side of obs.hole: 14 Groundwater Adjiugtmenk ft ellobo' �9 J, Index Well# Reading Date: A- Index Well level AdJ,ihCtor AdJ,Groundwater Level � � PERCOLATION TEST tlate s'a9 Thne 2A Observation Ko Hole# i /A 1 Time at h" Depth of Perc �Y T2-" Time at 6" d' if`f/!� , Start Pre-soak Time @ 9 �3 lime(9"-6") End Pre-soak Rate MinJInch ~i '< �!`�✓ea/ Jam/ S ��7 � Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division ' Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100'of wetland,you must first notify the. Barnstable Conservation Division at least one(1)week prior to beginning. Q:ISEPTICIPERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# .�� 06 . o Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.% ravel X3 L�� Sand fa 2 f �S�l L OM 1 s G /3 .o.v�e9. /v�' e 2��+276� �2- �Zg� ct,9Rse A�q D n 4 G DEEP OBSERVATION HOLE LOG, Hole# 2 ar 1 a/-7 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(ia.) (USDA) (Munsell) _ Mottling (Structure,Stones,Boulders. o nsi en R'oarawn 0�¢ 7 3d'� C&TV �� DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA),, (Munsell) Mottling (Structure,Stones,Boulders. Consistency. Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA),' (Munsell) Mottling (Structure,Stones;Boulders. f onsi n + f Flood Insurance Rate Man: Above 500 year flood boundary No— Yes Within 500 year boundary No Yes Within 100 year flood boundary No, Yes Depth of Naturally Occurrine Pervious Material Does at least four feet of naturally occurring pervi u material exist in all eas ob eoved through 3ut the area proposed for the soil absorption system? S If not,what is the depth of naturally occurring per ious material?�� 9 > 4 � Narn Certification ayi (1v t U/i'e � , v��1 `'"-Lyg r ,�J approved b the 5 I certify that on fr �9 (date)I have passed the Boll edaluator ex��atton pp y Department of Environmental Protection and that the above analysis was performed by me consistent with . the required trat ' e descried in 310 CMR 15.017. Signature n b Date Q:\SEPT10PERCFORM.DOC � r Barnstable ofTHME r� 'own of Barnstable AH Regulatory Services Department "'m'Ce� ` ELARNSPABLE, 1 Public Health Division m °N5°�• 200 Main Street, Hyannis MA 02601 2007 oars Para I lob DI�I Office: 508-862-4644 Thomas F.Geiler,Director FAX: .508-790-6304 Thomas A.McKean,CHO r CERTIFIED MAIL# 70081830000205008888 -6/01/2009 Robert Mackenzie 93 Barnhill Road West Barnstable, MA 02668 W _ ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,TITLE 5 The septic system located at 93 Barnhill Road,West Barnstable MA was last inspected on May 15, 2009 by Robert Paolini, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Failed"under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Static liquid level in the distribution box above outlet invert due to an overloaded r 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. You are ordered to repair or replace the septic system within Sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action:- THE OARD OF HEALTH Thomas McKean, R.S., CHO Agent of the Board of Health •MPLE-tE THIS SECTION COMPLETE . ON DELIVERY ■ Complete items 1,2,and 3.Also complete nat re item 4 if Restricted Delivery is desired. ■ Print your-pame and address on the reverse '1' " CC ssee so that we can return the card to you. B. Received b/pky P nfed N me) C. Date f e very ■ Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: D. Is delivery address d'rfferent from item 1? Yes If YES,enter delivery address below: No 4- �la�ke�12 I )i I_.?�1y ri t YV I q 3. Se ce Type Certified Mall ❑Express Mail ❑Registered ❑Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number ft 7,008 18'30 f b0*02 s0500 '8888.`i i (Transfer from service label) PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 j UNITED STAT { fX,-Z � j t�Pa S-AQ iI • Sender: Please print your name, address, and ZIP+4 in this box • I awn 6f nsfable ' 4-IeaH-v, 0v i 0n �6 ffL iin S-Ivice 4 � f r VOA 02400 444 a y , CO I• • ., • .µ i ro CO C3 OV LnPostage $ /sA C3ru ✓ y Certified Fee f ostmar N C3 p Return Receipt Fee O (Endorsement Required) ere O O Restricted Delivery Fee (Endorsement Required) S C3 m Total Postage&Fees r-9 CD Sent To I� y� VI(---ck e Inz�------ --------------------- f0Street,Apt- o.; q V► I, {!I l !-l/(�V or PO Box No. ory,Safe,Z,P+�� ---- a' Certified Mail Provides: i ■ A mailing receipt ■ A unique identifier for your mailpiece ■ A record of delivery kept by the Postal Service for two years, Important Reminders: ■ Certified Mail may ONLY be combined with First-Class Maile or Priority Mails. ■ Certified Mail is notavailable for any class of international mail. ■ NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For value esrplease consider Insured or Registered Mail. o For an additional gee,a Return Receipt may be requested to provide proof of delivery.`,To obt`' Return Receipt service,please complete and attach a Return Receipt(P-S�r"Ti 3811)to,the article and add applicable postage to cover the fee.Endorse mailpiece"fteturriaeceipt Requested".To receive a fee waiver for a duplicate return r"ecetptg.a!USPS®postmark on your Certified Mail receipt is required. _ ■ For an additionat Jee;'delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". s If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and,present it when making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments , M 93 Barnhill Rd. Property Address Robert Mackenzie Owner Owner's Name information is required for W.Barnstable Ma. 02668 5/15/2009 every 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: A. General Information When filling out I forms on the I�� computer,use 1. Inspector: only the tab key to move your Robert Paolini cursor-do not Name of Inspector use the return key. Capewide Enterprises,LLC. Company Name r� P.O.Box 763 Company Address Centerville Ma. 02632 Citylrown State Zip Code (508)428-4028 S14454 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).The system: ❑ Passes ❑ Conditionally Passes ® Fails x ❑ Needs Further Evaluation by the Local Approving Authority c �-A ' .. v <4 5/15/2009 " Inspector's Signatu Date ' w The system inspector shall submit a copy of this inspection report to the Appro Jng Authority{Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared-system or has a design flow of 10,000 gpd or greater, the inspector and the system own r;shall s`t�rbmit Re report to the appropriate regional office of the DEP. The original should be sentto the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and u1 der the conditions of use at that time. This inspection does not address how the system will perfolr in the future under the same or different conditions of use. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 1 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 93 Barnhill Rd. Property Address Robert Mackenzie Owner Owner's Name information is required for W Barnstable Ma. 02668 5/15/2009 every page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the.tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 I Commonwealth of Massachusetts II Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 93 Barnhill Rd. Property Address Robert Mackenzie Owner Owner's Name information is required for W Barnstable Ma. 02668 5/15/2009 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 'B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 93 Barnhill Rd. Property Address Robert Mackenzie Owner Owner's Name information is required for W Barnstable Ma. 02663 5/15/2009 every page. City[Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ® ❑ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ® ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 r Commonwealth of Massachusetts v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 93 Barnhill Rd. Property Address Robert Mackenzie Owner Owner's Name information is required for W Barnstable Ma. 02668 5/15/2009 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 93 Barnhill Rd. Property Address Robert Mackenzie Owner Owner's Name information is required for W Barnstable Ma. . 02668 5/15/2009 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner) provided with ® El information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ❑ ® Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 I t Commonwealth of Massachusetts 4— Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments c�M 93 Barnhill Rd. Property Address Robert Mackenzie Owner Owner's Name information is required for W Barnstable Ma. 02668 5/15/2009 every page. City/Town State Zip Code Date of Inspection D. System Information Description: The septic system consists of a 1000 gallon septic tank,distribution box and three drywells. Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage d Well Water 9 ( Y 9 (gP ))� Detail: Sump pump? ® Yes ❑ No Last date of occupancy: 5/15/2009 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts 9� W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 93 Barnhill Rd. Property Address Robert Mackenzie Owner Owner's Name information is required for W Barnstable Ma. 02668 5/15/2009 every page. City/Town State Zip Code Date of Inspection D. 'System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Capewide Enterprises,LLC. Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1000 gallons How was quantity pumped determined? Measured Reason for pumping: Maintenance Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 93 Barnhill Rd. Property Address Robert Mackenzie Owner Owner's Name information is required for W Barnstable Ma. 02668 5/15/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 1999 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 22"feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet. Comments (on condition of joints, venting, evidence of leakage, etc.): Joints appear tight.No evidence of Ieakage.System vented through the house vents. Septic Tank (locate on site plan): 24" 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 Dimensions: 1000 Sludge depth: 0 t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 i ' Commonwealth of Massachusetts _ W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 93 Barnhill Rd. GSM Syeye Property Address Robert Mackenzie Owner Owner's Name information is required for W.Bamstable Ma. 02668 5/15/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle NA Scum thickness 0 Distance from top of scum to top of outlet tee or baffle NA Distance from bottom of scum to bottom of outlet tee or baffle NA How were dimensions determined? Tank pumped at inspection. Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pump septic tank every two years.lnlet and outlet tees are in place.No evidence of Ieakage.Tank appears to be structurally sound. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum.to bottom of outlet tee or baffle Date of last pumping: Date t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 93 Barnhill Rd. Property Address Robert Mackenzie Owner Owner's Name information is required for W.Barnstable Ma. 02668 5/15/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont,) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, (liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 m Commonwealth of Massachusetts _ W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 93 Barnhill Rd. Property Address Robert Mackenzie Owner Owner's Name information is required for W Barnstable Ma. 02668 5/15/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert yes 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.): Box is Ievel.Box has one outlet Iateral.No evidence of solids carryover.Evidence of leakage out of box. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts d Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 93 Barnhill Rd. Property Address Robert Mackenzie Owner Owner's Name information is required for W Barnstable Ma. 02668 5/15/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 3 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): System is in hydraulic failure.Dry wells were full at time of inspection. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts _ W Title 5 Official Inspection Form 0 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 93 Barnhill Rd. Property Address Robert Mackenzie Owner Owner's Name information is required for W.Barnstable Ma. 02668 5/15/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 93 Barnhill Rd. Property Address Robert Mackenzie Owner Owner's Name information is required for W.Barnstable Ma. 02668 5/15/2009 every page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ❑ drawing attached separately r fib tz to do • �` Via: M" t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 k Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 93 Barnhill Rd. �M Property Address Robert Mackenzie Owner Owner's Name information is required for W Barnstable Ma. 02668 5/15/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: Bottom of leaching 70' feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: As-Built Card ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: USED:USGS Observation Well Data.USED:Technical Bulletin 92-0001 plate#2 annual ranges of groundwater elevations. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 r` Commonwealth of Massachusetts _ W Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 93 Barnhill Rd. Property Address Robert Mackenzie Owner Owner's Name information is required for W.Barnstable Ma. 02668 5/15/2009 every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 --=- 12 2005[APR V'ifv OF Br..2tiSTABLE HEALTH UEF T. DATE 3i 4io5 PROPERTY ADDRESS 93 Baanh.iii Rd., N.,Baanzta&.fie. Na.1 T I 02668 LCT 5 1 _ On the above date, the;aieptic system at the address above was inspected. This system consists of the following:. 1., 1-1000 ga eion he/2t.ic tank., 2.4-d.izta.i&ut.ion &oxo 3., 3-500 ga.eion ieach.ing cham&e:as with 2' .3tone aee aaound., Based on inspection, ) certify the following conditions: 4.,7h.iz .iz a t.itie dive zeflt.ic zyztem.' 5.Jhe zeptic zyztem .iz .in /2ao/2ea woak.ing oadea at the 1'2,z nt t.imeo SIGNATURE Name: Robert A. Paolini Company: Joseph P. Macomber &Son Inc Address: P. O. Box 66' Centerville. Mass 02632 Phone: 508-775-3338 or 50&775-6412 •JOSEPH P. MACOMB.ER & SON;. INC* T806-Cessp0016-1,eaChf1elds pumpeo &:Instilled Town Sewer'ConneCrtiona P.O. Box 66 . Centerville, MA 02632-0066 -7754330 . 7 .5.6412 C;OMMOTfWEALTH OF MASSACHUSETTS £RECUT- 114'OPPIOE'OF EI4-VRCO•NMtN TAL AFFAIRS TMENT'OF NVI14 i T`AL TROT CTI013 r 'TITLE 5 OFFICIAL INSPECTION FOM—NQVFOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE'DISPOSAL SYST&M FORM PART•A CERTIFICA,' IUN Property Address: 9 3 B a/in h z e-e =�2c1•. Gl. BaILns.taP,e. (11a. Owner's Name: i2_o_ e t Na c kenz.ie Ownef's Address: z a m e. . Date of Inspection:3/9 4/0 5 Nanie of Inspector: (please print)i2o eat a o A in i . Company Name: :A ge-an geet Mailing•Ad4ress• �n ezyx a ab a. 02¢32 Telephone Number: 5 0.8—7 7 ,3338 CERTIFICATION STATEMENT . I certify that'I have personally inspected the sewage disposal.syste%at this address and that'the.information reported below is true;accurate and complete as of the time of the inspection.- lie inspection was performed based on my training and experience in-the proper fitnetien and maintenance of on-bite sewage disposal systems.I am a DEP approved system inspector pursuant to;Section-IS:340.of•'lyitle 5(3le CNIIt•45:•000). Tice system: Passes -Conditionally Passes Needs F or uatiOn,by the Local Approvin&Authority Ins P .actor's Signature: Data The system inspector shall submit a copy of this inspection•reportto tie•Approving Authority(Board of Health or DEP)within 30 days of completithg this inspecti on.If Ae systeph;is ji,sb*d•sy nor has a design flow of 10,000 gpd or greater, the inspector and the system'owiher.sliall'submit t ie'report to the appropriate 7egional•offiee of the DEP.The origmal should be sent to•tha system ownat aucl copias aentto ft buyer,if applicable,and the approving authority. Notes and Comments - ****This'report only describes conditions at the time of inspectiolrand 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. I Page 2 of 11 OFFICIAL INSPECTION:FORM--NOT:FOR�VOLUNTARK ASSESSMENT'S /` SUBSURFACE SEWAGE DISPOSAL SY$TEM.INSPECTION.FORS. PAAYA CERTIFICATION(continued) Property Address: 9 3 Baltnh.i-U Rd., 0wntr:Ro9e2,t Mar_kenz.ie Date of Inspection: 3/14/0 5 . A Inspection Summary: Checi A;B;C;D WE]/ W�► ��oompiete all of Section:D A. System Passes: n° 1 have not found any information which indiCates-thAtany of the failure criteria described yin 31a CMR 15.303.or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: no One or more system components.as described in then"Conditional Pass"sect"ron.need t0 be replaced:or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not.determined(Y,N,ND)in-the for the following statements.If"not determined"please explain. n o . The septic tank is metal-and aver,20 years ald*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.asappreved by the.Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not�leaking and if a Certifioate of Compliance indicating that the tank is less than 20 years old is available.. ND explain: n o 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 insp4ctign..if(witli approval of Board of Health)` broken.pipe(s)are replaced. , obstruction is removed distribution box is leveled,or-replaced ND explain: no 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 A. obstruction is removed ND explain: Page 3 of 11 OP"P'ICLAL UqMCT.ION FORM-NOT YOR 1V`OL''UNI'ARY AS'SE5•SMENTS SUSg1iJRFACE B,WAGV DISROSWL SYSTEM.INS.MCTI+©NTORM PARTA.. . CIERTITICAMON(6ontinued) : Property Address: 93 Daanh-i i e Rd., ,. GJ 13a2n,tatee.Na., Owner:./Ro&e/ L Marko_azi Date of Inspection: 3/1 4*1 C. Further Evaluation-is.Required by the Board of Health: n o Conditions,exist which require fwther.svaluaticSn by.the•Briard.of.-Health;in•ordento;detemAne if-the system is failing to protect public•health,.safety or the environment. 1. System will Pass unless Board-of Health deterntinesiin aecordapce with 310.CMR 15:303(1)(b)mat the system is-not fuactioni.'ng in.a•manlier which:will.protect public health,safety•atril•ttle:.enaarir men#: n o Cesspool or privy is within,50 feet of a.surface,water n o Cesspool or privy is within 50.feet of•a bordering vegetated wetland or a salt marsh. 2. System will fail unless the Board-of Health{and Public Water Supplier;-if any),determines that the system it functioning in a maminer,that proteets tht public Health,safety and environment: 110 The system has a septic tank and soil absolp#on'system•(SA•S):.and the SAS is within 100 fe.etof a surface.water supply or-tributary to asurface water.supply. n o The system-has-a-septic tank and SAS and the:SAS is 1w•ithin a Zone 1 of a%public water.-supply. n.o The system-has a septic tank anO.W:andtheSAS iswithiwR feet of a private water.supply well. n o The system has a septic tank and SAS and the•SAS is less than 100 feet but 50 feet or.-rdore fiof a private water supply well".Method-used to determine distance• **This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the w.elUs.free from-pollution from.that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5.ppm,.provided that no-other failure.criteria are triggered.'A copy of the analysis must be;attached to his form. 3. Other: Page 4 of 11 OFFIC AL•INSPECT 0N-FORM•--NOTIORYOLUNTARY ASSESSMENTS' -SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 93 Ba2nh-i-ei 'Rd., Gl. Ba2n�ta fie, Na._ Owner: R'o P,eat Nd ckenzi d ' Date of Inspection: D. System Failure Criteria applicable to all systems:. You must indicate"yes"•or"no"to.eacb.of•the:followiagfor alI*pectlonr Yes No x, Bce p.of"sewage:intofat'�Ilty,orsystem�component•due•-Io.overloaded.oiclogged•SAS.or.cesspool x' Discharge:or-ponding of effluent to the,surface-6f the:,guund Pr..surface:waters due to.an overloaded or ' clogged SAS or cesspool _ x , Static liquid level in the distribution bbx above outlet invert due to an overlraaded or clogged SAS or cesspool Liquid depth in-cesspool is less than.6"below invert or.availableevolume is less than day flow , Required pumping more-than-4 times in the last year i�OT due to clogged or obstructeQ pipe(s).Number of times pumped ' Any portion ofthe SAS;cesspool-or privy,is below high ground water elevation. _ : Atiy.portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water-supply. . Any portion_ofa•cesspool•or.privy iswithin,a Zone!1.•ofa:public.well.. Any portion-of a cesspool-or privy is within SO-feet of a private water supply well. 'Any portion of&cesspool-or privy is less-than 100 feet but greater•.than 51D feet from a.private water supply well with no acceptable water quality analysis.•[Thisaystem.passe§if the well water-analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic•compounds indicates:that the well is.thee from pollutioq:frbm::tbat•facflity and:thq presenceof 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 attsehed.to this fora►.] iz o •(Yes/No)The system falls.•I•have determined that one ormore:of:the:above,failure�criteria exist as described in 310 CMR 15.303,therefore the system•fails.The system owner.should contact the Board of Health-to determine what will be-necessary to correct the failure. , E. Large Systems:, flow of 1B;000 gpd to 15�Q00. To be considered a large system-the:systtm must.serKe.a-.facility,with-a•design gpd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no _ x the system is within-400 feet of a surface drinking•water supply _ x the system.is within 200 feet of a tributary.to a surface drinking water supply 'y x. the:system is located In a nitrogen sensidw area Qnterim Wellhead Protection Area IWPA)or a mapped Zone R of a public water supply well If you have-answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed.The owner-or operator of any large system considered a significant threat under Section E or.failed under Section D'sball upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office•of the Department. 4 Page 5 of I 1 OFFICIAL INSPECTION-FORM—NOT FOR VOLUNTARY ASSESSMENTS $SURFACE'SEWAGE DISPOSAE'SYSTEM INS-PECTI.ON FORM PART B CHECKLIST Property Address: 9 3 Baltnh.i eQ Rd., /1 Owner: oPa-al MaLk�nzir, ,� . Date of Inspection: 3/14;gQ5 Check if the following have been done You must indicate"yes"or no"alto each.of the following: Yes No x — Pumping information was provided-by the owner,occupant,or Board.of Health X Were any of the system components pumped out in the previous two weeks? x Has the system received normal flows in the previous two week period? — — , x Have large volumes of water been introduced to the system recently or as-part ofth�bspection? x Were as built plans of the system•obtained and examined?(If they were not available dote is N/A) x Was the facility or-dwelling inspected for signs of sewage back up? x — Was the site inspected for signs of break out? X. Were all system components,excluding the SAS;located on site.?- _x• _ Were the septic tank manholes uncovered,•.opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? _x _ Was.the facility owner(and occupants if different from owner)provided with information oft the proper maintenance of subsurface sewage disposal systems? `. The size and locatiod of the Soil Absorption System(SA$).on'the site.lias been detet�itted bssed on: Yes no x Existing information:For example,.a plan at the Board of.Health. _ x Determined in the field(if any of the failure criteria related to Part C is at issue approxim6tion-4distance is unacceptable)[310 CMR 15.302(3)(b)] K " • 4P• �' .Lr ' 5 Page 6 of 11 OFFI-JAL.A SPTCT.I:OI'.,]F,QRM'-NOT•FOR VflLUNTARY ASSESSWNTS SiT,ESUYFACE.SB-WAGE OISPOSA:L;+SYMM.INSPECTIO.N FORM PART-.G . SYSTEM•.INFOItKATIQN Property Address:-9 3 Pr z n h i it Rr1 .61_,/3nnn A ri o lrla Owner: n P.o a 1 mr,, k a a 7 ; v Date of Inspection:„ 3/9 4/&5 FLOW CONDITIONS RESIDENTIAL Number of bedroortss(design):_,5 3_. 1`lumber of bedrooms.•(actual): 3 DESIGN'tlowBased on 310 C1VTT�15.203.(for ekaiiip'le:•1I0'gpd z -ofbedrooms):'-17.0z 3=3�0 gpd Number of current residents: .: Z Does.Tesidence have a garbage grmderkes or nol n o Is laundry on a separate sew se.system•(yes or.no)n o (if yes separate inslae..�tion reggired] Laundry system inspected(yes or no):q�ez , Seasonal use;(yes or no):n o Water meter readings,if available(last 2 years usage(gpd)): A ( 4x%1) I1Ci 5 nO Sump pum (yes or no): n o nErZ(� }eJf (1� P `� ✓cMc Last date o occupancy:�2 e,6 e n t COMMERCIhfbUSTRLL Type of estall` . , nt: Design flQw_( p. on-310 CMR 15.203):. I apd- gws.of d i i'`flow(seats/persons/sgft,etc.):, Grease trappresent(yes of no)-, Industrial waste holding tank presea(yes or no):_ Non-sanitary waste discharged to the Title 5 system•(yes or no): Water.meter readings,if available: Last'date of occupancy/use: . OTUER(descri$.e):. GENERAL INFARMATION Pumping Records Source of information: . Was system pumped as part of the inspection(yes or no):_ If yes,volume pumped:_gallons--How was quantity pumped determined? Reason for.p..umping: TYPE OF SYSTEM , x x xSeptic tank,distribution box,soil absorption system • . _Single cesspool _Overflow cesspool Privy M _Shared system-(yes,or no)(if yes,attach previous inspection records,if airy) _Innovative/Alternative.technology.Attach a Copy of the current operation and maintenance contract(to be obtained from system owner) —Tight tank. _Attach a.copy.of the DEP.approval _Other(describe): Approximate age of a1J components,date installed(if known) 'and source of information: S ztem inzi-aieed 1999 Were sewage odors detected when arriving at the site(yes or no):aa- Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM A PART C SYSTEM INFORMATION(continued) Property Address: 93 /3a znh.i.2.Q Rd., 0.,l3aanzTa ee (7a.� Owner: k nzze Date of Inspection: - 0 5 BUILDING SEWER(locate on site plan) Depth below grade: 22" Materials of construction:_cast iron xx 40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): \ SEPTIC TANK:�e 4locate on site plan) Depth below.grade: 2 4" Material.of construction:x concrete metal,—fiberglass—polyethylene _other(explain) _ ' If tank is metal list age: n o Is age confirmed by a Certificate of Compliance(yes,or no):—(attach a copy of certificate) •... Dimensions: 8' 60.Ponct/4 ' 10"wide/5' 8"high Sludge depth: t 2 a e e Distance from top of sludge to bottom of outlet tee or baffle: t)t a c e Scum thickness: " Distance from top of scum to top of outlet tee or baffle: 71 Distance from bottom of scum to bottom of outlet tee or baffle: 9 3" How were dimensions determined; m e a z u a e d Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural irate as related to outlet invert,evidence of leakage,etc.)): tY,liquid levels tank. eve2 2-3 eaaz., /ank a/2/2eaaz Zstauetu)taeey zound., t and out Qet teen ate to ace. o e t GREASE TRAP: n o(locate on site plan) Depth below grade: , Material of construction:_concrete metal - fiberglass (explain): — ---polyethylene—other 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•baffl Date of last pumping: Continents(on pumping recommendations,inlet and outlet tee or baffle condition,structural irate as related to outlet invert,evidence of leakage,etc.): sty,liquid levels 2eaze- tzap not 121te4ent. Title S Tnvr%AMinn T7nrM Ail;mnnn 7 Page 8 of I I OFFICIAL INSPECTION FORM—.NOT FOR VOLUNTARY ASSESSMENTS ; >IF;A, EE'WVAGE DISPOSAL.SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 9 3 Ba2nh.i to Rd., Owner.• Rogeat Mackenz.i'e Date of luspeetlon: 3 9 4/•0 5 TIGHT or I•IOLDING TANK: no (tank must be pumped at tune of inspection)(locate on site plan) Depth below.grade: Material of construction: concrete metal fiberglass___polyethylene other(explain): Dimensions: gallons Capacity: g Design Flow: • gallons/da y Alarm present(yes or no): Alarm level: — Alarm'ln working-order(yes or no): Date of last pumping: Comments(c ndition of aiarrrt and flaat•swighes etc.): 2e,,ent o7cght o.e ho �rLIng ank3. not DISTRIBUTION BOX y03(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: no 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*. Box i, eevee.�Box haz one Qcsteaa�. No ev.idenee o� �soQicl� eaaayove2. No evt ence o ea aye cn o loa ou o ox. PUMP CHAMBER: n° (locate on sife.plan) Pumps in working order(yes or.no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances, etc,): l um/? chamFe2 not `22e�ent. Y Y 8 Page 9 of 11 OFFICIAL INSPECTION)FORM--NOT-FOR VOLUNTARY AS$M,MENTS SURSURFACE•SEWAOE.IIISPOSAL.SYSTEM INSPECTION FORM PART—C SYSTEM INFORMATION(continued). Property Address: 93 Baanh.i i Rd., Gl. Baena a e, Na.1 owner. Roge2t (7ac%enzie Date of Inspection: 3114105 SOIL ABSORPTION SYSTEM(SAS): ye�(locate on site plan,excavation not•required) If SAS not located explain why: Located zee /2aye* 10 Type leaching pits,number:_ y e z leaching chambers,number: 3 leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative*system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): s . y, and in No S.ignh off. h yd.¢au P.ic �a i�u2e. So i P i d2 ,No en.idence o� R g. eye a .ton a/2/2eaa,6 noa-ma CESSPOOLS: no (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure,level of pondi. 9 condition of vegetation,etc.): Cezzpooiz not paezen.t.' PRIVY: n o (locate on site plan) N N Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): P .j Vq not 12 a2hent. r Page 10 of 11- - ornCiA TNSPFJ 'TTUN'1"(3RNI=*N0'li',FUR.Vot.0 iTAMASSES bIENTS SII$ ri A 'S'E AG,IMN.QSAL S 3 EA�`INSE�ECT3D ;Ft)rRM PART C" SYS`T'I;M ORM�TVI'ON(;contitined)' Property, Address: 9 3 Bc Owner: Date of Inspection: SKETCH OF SE VAG0ISPOSA.L SYSTEM ovi,&a sketch of the.sewage disposal system includ�he eeS tO at ublic least water two enterts he building eT Pr benchmarks•Locate all wells whin 100 feet•Locate f_ h t Y \ 3 W y • \_tip., ' 10 _ Page 11 of 11S Y ASSEBSME •O• FOR VOLUN'I'AR OFFICIAL INSPECTION FO RM=NOT RM ZJgSLgFACE SEWAGE DISPOSAL SYSTEIVI INSPECTION FO S PART C SYSTEM INFORMATION(continued) Propet•tY Address: .9 3 .B a 2 n h i j j Rd.' Gl. B_a n l a�Q_ (�a. Owner: R^Po2t l�ackeazie 3 Date of Inspaction:�--.�- - SITE EXAM Slope Surface water Check cellar. Shallow wells Estimated depth to ground wateYC=a feet irate(check)all methods used to determine the high ground water elevation: Please indicate-� lan viewed: lens on record-If checked,date of desigmp M n o pbained from system design p e kbserved site(abutting propertylobservathon h,6 within 150 feet 2 d AS) Checked with local'Board of Health-explain:. y e�Checked with local excavators,installers-(attachdooumentati�) e. m a. u h tI e h Accessed USGS database=explain: _ ou established the high ground water elevation: You must describe how y'miller Wodel 12 1 used•USGS observatio used- :'Technical bul — wa er a eva ions. Leaching - ;eat i h Groundwater Adjustment 1.9 ft Per''%irvtu method 3.�. Groundwater: Feet Below Bottom'of Pit & Therefore,the vertical-separation distance between the bottom of the leacWng pit and the adjusted groundwater table is C0 �- ... feet: tt a•rrnrn rr.rra�-r•.—+saermrrnr..rrrrrm=T.rrrarnfrrtvarr!!nQrarm'�+�mrt-rsrRrmsrzntss� •. Tiess-r''tt•r�^i::tr.r••Y TOWN OF BOARD OF HEALTH SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D •- CERTIFICATION ••Te•t_T.;.;;t--sea•:--nms-n-+x.•rrs -TY r..sr.-essr:�-nr+a•.—:Yrrnme-au•n+ne--,-m:*+ewr�esn*rs'e�a�° ssm .:.--rrr•r.--.s•—•.� PE OR PAINT CLEARLY- PROPERTY PROPERTY INSPECTED STREET ADDRESS 93 Ba znhi�ei Rd., � ASSESSORS MAP, BLOQ€K AND PARCEL # OWNER's NAME /2o�e2t l7dekenz�e PART 0 - CERTIFICATION NAME OF INSPECTOR Roeeltt Pa.o4inc r COMPANY NAME ao,seph B•' Nacom&e_)?"&`.Son Inc COMPANY ADDRESS Box 66 Cen1_e1tvi•2.Pe flazz 02632 Street Town or City. State LIP COMPANY TELEPHONE 1508 ) �75 - 3338 FAX ( 508 .1790 - 1578' WWIR CERTIFICATION STATEMENT I •certify that I have personally inspected .the sewage disposk system at this address and that the information reported is true , a accurate, nd omplete as of the time of inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my trainip.g and experience in the proper function and maintenance of on- site sewage disposal systems . • n i t��;+it, Check one: xxx Syste6 PASSED The inspection which I have conducted has .:not found any information which indicates that the system fails to adequately protect .public healt1i or t•he environment as defined in 310 CMR. 15. 303 Any failure criteria not evaluated. are as stated in the FAILURE CRITERIA section of this. form. System FAILED* The inspection which I have con treted has found that the system fails to Protect the jiublic 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 inspect ' o for Inspector Signature Date 1 ne 0copy of this certifi.cat.idn must -be provided to the QWNER, the. BUYER where applicable ) and the BOARD OF HEALTH. * If the inspection FAILED, the owner or operator shall upgrade ' the system. within o'ne year of the date of the inspection, unleSSL allowed or requ.i;red otherwise as provided in 3,10 CM.R 16 - 305 . i )q6 No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 0ppricatiou for Miq;paar *pgtem Cow5tructiou permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Local A ss or of Ffppl,/l �O� O ( � Owner's Name,Address and Tel.No. Assessor's Map/Parcel Installer's ame, dress,and Tel.No. Designer's Name,Address and Tel.No. mat y C T"1 P-j ev 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 ,5 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. 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 th nvironmen 1 Code and not to place the system in operation unti a C rtifi- cate of Compliance has bee e b th' of all Signe O Date Application Approved by ty Date Application Disapproved for the following reasons Permit No. "y Date Issued 4 �► A o. Fee 1 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer::, Yes PUBLIC HEALTH DIVISION -TOVVN OF BARNSTABLE., MASSACHUSETTS. 01pprication for Migooar *pttem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot N . Owner's Name,Address and Tel.No. 9 ,f r�, '�' 11 R Assessor's Map/Parcel W Installer's e,A dress,and Tel.No. Designer's Name,Address and Tel.No. 0 /off 'v�- G 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 Flows gallons perday CalcuYateddaily�fl tow gallons. Plan Date Number of sheets 1 P Revision Date Title f Size of Septic Tank Type of S.A.S. Description of Soil ; 1 f Nature of Repairs or Alterations(Answer when applicable) r` 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 th nvironmen 1 Code and not to place the system in operation unti a Certifi- cate of Compliance has been'asd bthi f It , Signe o Date Application Approved 6 Date Application Disapproved for the following reasons 1 t Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal S stem Constructed( )Repaired ( )Upgraded( ) Abandoned( )by k C., at 13 At Aj go, t has been constructed in accordance with the proviawlis of Title 5 and the for Disposal System Construction Permit No. " dated Installer r v —j r^b,tJ F Designer r s< r. The issuance of this permit shall not be construed as a guarantee that the syst _ wil •unction as designed. Date / Z 1 Inspector ------ /—�-----------------------------�`-- No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION . BARNSTABLE., MASSACHUSETTS �Wmi!5po0ar Opgtem Congtructio'h Permit 4 Permission is hereby granted to Construct( )Repair(X )U gre a ( ) ba 'on System located at 93 r : and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Constructi n must a completed within three years of the date opispePPCDate: Approved by / o, / � �,) y� tl S S ( 1 t t f;egdp a w4}ltr fr; y5 w a 1 y l '° c c Y T' s1 ",x, •5 .c.7 y a r z , '�Fkl f�•� `' Q?a .ems i4�4: cw �^ € �2'r >r 53xu.. - •a.+ ,� ts, t °. y,'fk mJ� s�'K'9.•_ } t,t R' 4� a 1 °" t ..i !a y� ��t 116199 A. t 1�1OT'IC1 : 7C'his Form�ys To Bf- I'sed l�ol• ttfeRej)air Of Failed y c;e��tic Ssteirs On } � rk �� ,A } ai. fix, �'--• — �� ; ;` � ad'°jCfi ��'.� 1R t «� * �. � 9�Q'�,a '�.`" Fti: :•.,. .. `,} ' r yF..', , !7ERTMCATIO',�aFµSKETCH�'ANND AWLICATICIV .VOR A DISPOS._, WORKS CONSTRUCTIONPEI�1Lll (NY'TTHOUTDESIGNED PLANS) • °�pis#� e5. a' �1 r.+ S� ' r .. A? ` , A-0 6 , hereby cx,rtify that the a0plication for disposal v irks co nstrudion permit siigned by�mp�a dated /'r e4{j�i` y , concerning the F � p , 4, rc� a lf�cated at: � •P P �, 4 - � /` meets alp. of the ' l�• The failed'systum is connected to a risidentirI d1w ding only T ierl are no commercial or business uses as.ociated'with'the:dwellui v, r t The soil is clan�ifie as CLASS)'and the pezcolar on rate is less than or equa,tt�5..uI,aWs per inch. xk ��i . - .t l/f The .ire no.wetlrnds within 100:ff of the pro?osed'septic sys em . .4F ( fR��Y .Y�4 rv. ' �i.}„� }.!�'3{y"f 1.�t .•. �'h°r�`ire 110 private wells within t1f 0.`:et of the roposed septic Ttev, 11 M 'The and/or .iiange in use proposed V% There are no variances requestefl�or n�eded.< j " ' � :, per;. •,^ k � "�i,� 4 p {,-'. the bottom of Uie proposed leaching facility wi.: not be Ic ated l ss,n five.feet above tl e maxiniwn adjusted V6undwater table elevation Adjust tl i;grorndwater table using the Frimp.tor, method when aF plimble] • if the S A.S'wiL.be located with 250 feet of air/i ;etated wetlaj ds, tt bottcm of the proposed leaching facilit} wil not be located le:;s than fjw v,n(14)feet al ove 'lie maximum adjusted c r groundwater table elevation,rfi ,,4 r x ; Please ciimplete thr following � , L . ` ' A) 'top of Groiuid Surface E-16 f.ion(using GIS informaUurj O .PG.'W.Elevation ^' �+ 1re MAX.H sh G.W:AdJ men — 6- - y — 1 r DIF?:'RENCE BETS'>"r iv'tA.a,�d B; t SIG � i DATE.'. t Sketch ro Posec o of f s, ste{mx�! od b3ckj.} q:health folder...cert . , f t, t ` TOWN OF BA/RNSTABLE LOCATION 12 le ,;'I SEWAGE # I`1•�� ,l VILLAGE— ASSESSOR'S MAP & LO A INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY _ 10070 LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: Cf COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by r� J a. i o'(.,$ 1 F7--� i i Commonwealth of Massachusetts Executive Office of Environmental Affairs �� Irk f l Department of * s Environmental Protection 1996 Wllllam F.Weld Goannor Trudy Coxs David B %EA SUBSURFACE SEWAGE DISPOSAL SYSTEM INFORMATION FORM S Comminioner PART A CERTIFICATION Property Address: 93 BARNHILL ROAD,W.BARNSTABLE Address of Owner: 407 30TH AVENUE Date of Inspection:1ANUARY 2. 1996 (if different) SEATTLE,WA 98122 Name of Inspector: 1AMES A.ORPHANOS Company Name,Address and Telephone number: CERTIFIED INSPECTION ASSOCIATES 47 CAMERON ROAD, N. FALMOUTH, MA. 02556 (508) 564-5653 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: X Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signatu � O Date: .IANUARY 4. 1996 The system Inspe for sha submit a copy of this inspection report to the Approving Authority within(30) days of completing this inspection. I he sys em is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit port to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer,if applicable and the approving authority. INSPECTION SUMMARY: Check A,B,C,or D: A] SYSTEM PASSES: X 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 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 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)w&1049 a Telephone(617)292-5S00 Printed an Rwyded Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 93 BARNHILL ROAD Owner: DAVID E.LILIENTHAL Date of Inspection: IANUARY 2. 1996 B] SYSTEM CONDITIONALLY VASSES (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 the approval of the Board of Health): broken pipe(s) are replaced obstruction is removed distribution box is leveled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection(with the approval of the Board of Health): 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: 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: n 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 within a Gone 1 of a public water supply well. The system has a septic tank and soil absorption system and is within 50'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 pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. D] SYSTEM FARS: 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 outlined below. The Board of Health should be contacted to determine what will be necessary to correct the failure.. Backup of sewage into the 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 the surface waters due to an overloaded or clogged SAS or cesspool. (revised 8/15/95) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 93 BARNHILL ROAD Owner: DAVID E. LILIENTHAL Date of Inspection: IANUARY 2. 1996 D] SYSTEM FARS (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 1 of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. 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 FARS: 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 H 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 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 93 BARNHILL ROAD Owner: DAVID E_LILIENTHAL Date of Inspection: 1ANUARY 2. 1996 Check if the following have been done: X Pumping information was requested of the owner,occupant,and Board of Health. X None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. N/A As built plans have been obtained and examined. Note if they are not available with N/A. X The facility or dwelling was inspected for signs of sewage back-up. X The system does not receive non-sanitary or industrial waste flow. X The site was inspected for signs of breakout. X All system components,excluding the Soil Absorption System,have been located on the site. X 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. X 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. X The facility owner(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 SYSTEM INFORMATION Property Address:. 93 BARNHILL ROAD,W.BARNSTABLE Owner: DAVID E.LILIENTHAL Date of Inspection: TANUARY 2. 1996 FLOW CONDITIONS RESIDENTIAL: Design flow: 330 gallons Number of bedrooms: 3 Number of current residents: 0 Garbage grinder(yes or no): NO Laundry connected to system (yes or no): YES Seasonal use (yes or no): NO Water meter readings,if available: HOME IS SERVED BY A PRIVATE WELL. Last date of occupancy: NOVEMBER 1. 1995.ACCORDING TO THE OWNER COMMERCIAL/INDUSTRIAL: 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: THE SEPTIC TANK HAS BEEN PUMPED ONCE PER YEAR SINCE 1987 ACCORDING TO THE OWNER NO System pumped as part of inspection: (yes or no) If yes,volume pumped:gallons Reason for pumping: TYPE OF SYSTEM X 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: MAY 31, 1985.ACCORDING TO PERMIT#85-582 ON FILE AT THE BOARD OF HEALTH Sewage odors detected when arriving at the site: (yes or no) NO revised 8/15/95) 5 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 93 BARNHILL ROAD.W.BARNSTABLE Owner: DAVID E.LILIENTHAL Date of Inspection: TANUARY 2. 1996 SEPTIC TANK:X (locate on site plan) Depth below grade: 22" Material of construction: X concrete metal FRP other(explain) Dimensions: 4' WIDE X 8'LONG X 4'DEEP Sludge depth: 1" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 1" Distance from top of scum to top of outlet tee or baffle: 8" Distance from bottom of scum to bottom of outlet tee or baffle: 16" 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.) INLET COVER IS AT GRADE: LIQUID LEVEL IS 48": TANK IS LEVEL: PLASTIC INLET TEE AND CONCRETE OUTLET BAFFLE IN PLACE AND IN GOOD CONDITION• NO ADVERSE INDICATORS NO RECOMMENDATIONS GREASE TRAP: (locate on site plan) Depth below grade: Material of construction: concrete metal FRO 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: 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.) e. (revised 8/15/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) ' Property Address: 93 BARNHILL ROAD,W.BARNSTABLE Owner: DAVID E.LILIENTHAL Date of Inspection: 1ANUARY 2. 1996 TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade: Material of construction: concrete metal FRP other(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm level: 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 if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) PUMP CHAMBER: (locate on site plan) Pumps in working 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: 93 BARNHILL ROAD.W.BARNSTABLE Owner: DAVID E.LILIENTHAL Date of Inspection: 1ANUARY,2. 1996 SOIL ABSORPTION SYSTEM (SAS): X (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: X leaching pits,number: ONE: 6' DIAM X 6' DEEP 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.) COVER IS 6" BELOW GRADE: TOP OF PIT IS 5 3" BELOW GRADE: LIOUID LEVEL IS 52"• LIOUID LEVEL TO INLET INVERT IS 20": BOTTOM OF LEACHING PIT IS 125" BELOW GRADE: NO ADVERSE INDICATORS NO RECOMMENDATIONS CESSPOOLS: (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: inflow(cesspool must be pumped as part of inspection) Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) (revised 8/15/95) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 93 BARNHILL ROAD Owner: DAVID E.LH.IENTHAL Date of Inspection: TANUARY 2. 1996 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' N 31'4" 29' " 38'2 25'8" 36'6" 32'2" >150' PRIVATE WELL 93 BARNHILL ROAD DEPTH TO GROUNDWATER Depth to groundwater: > 72"BELOW PRE-EXISTING GRADE AT LEACHING PIT LOCUS. method of determination or approximation: ACCORDING TO SOH,LOG ON DESIGN PLAN,PREPARED BY LANTERY ASSOCIATES AND DATED 5/31/95 ON FILE AT THE BOARD OF HEALTH TOGETHER WITH PERMIT#85-852 (revised 8/15/95) 9 �I.LA E 1, I G71 DNS A LLER'S it ADDRESS J. �NEDY TRUCKING !NEST BARP<S T.;tali, MASS, 0266$ .fir BUILDER 0 DATE -6 i;RMiT ISSUED D A T r CO01AELIAXCE S5UEO __. z�d16��S a f^ 4 o - �.4a �, ......... a ........... THE COMMONWEALTH.OF MASSACHUSETTS BOAR® OF HEALTH N..----.....OF...... ............................................................................. App iratilan for Dispaiial Warks nnstrnrtiaan pamit - Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System �.��ilOf//L L.......................................................... ................. ---...---.....•--.........� -----------..........---............---•- ^�r'�/,/YIG{' ``/i'f��6lotty�lsjq ys/ or Lot No. ess ... 14 Installer �/G �.�� Address • Type of Building �.�. /V.�r Size Lot___ feet U Dwelling—No. of Bedrooms_____________.......--_____________.___.__._Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of ersons_______.__ __ a YP g --------------------•------- P �-----••--•---- showers ( } — Cafeteria ( ) Otherfixtures. -----•-----------------••---•----•-•------------...---•----•--•-•-••-••--•--•--------------------•.....-------.._...-----•-•-:_.....---•--•-------••- W Design Flow.........:��3Q......................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity�J.S_gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No__________________:= Width.................... Total Length......................Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank '.� Percolation Test Results Performed by--•••---•--•----•----•---------•-•-•••-•••-----------------•-••-•••-_.... Date-----------........................................ Test Pit No. 1______________m nutes er inch Depth of Test Pit....... _r________ Depth to ground water........................ fs, Test Pit No. 2_ .__y �s per inch Depth of Test Pit_.��..._..____. Depth to ground water_____---' ._... P4 O Description of Soil....... . ___________________________________________________ meo� �, � �s. � ,c r le-4-------------------------...... 7 U Nature of Repairs or Alterations—Answer when applicable............................................................................................... -•----------------------•---•---........--------•-----._.....--•-••---------------•--•---...-•--------------------------------------•---------------------------------------------------•--•••--•--•---. Agreement: The undersigned agrees to install the aforedescribed Individual ewage Disposal System in accordance with the provisions of i mLi� 5 of the State Sanitar de—The unde lg d furtl agrees not to place the system in op tion ntil a er fi to of Compliance ha een ssued by th rd ea p Signed...... .. -- •_--•-• --- ------ ---------•----•--•-----•-•• - Date PP icatio Approved y--.._____ ----- Gt.: � ...-•-------•--------•.............••--••-- -•----.: / ,l S. Date PPlication Disapproved for the following reasons:................................................................................................................ --•---•-----•--------•-----•-----•--•...---•-•-••-••--------------•------•-••-•--•--•--•--•••-------...--••----••----•••-•••••--••-•-----•--•-•---•----•--•-----•••-------------••••-------••----•------ Date Permit ...... Issued. Date t - No.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .........O F..... Appliration for Dispoii al Works mitrnrtion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at, L D or Lot No. ... . ti..J...l.../�j ,,��Jli/ •/�j j... ...... .... ... es !/V . ......... A� 1... ........... ..........•. -•- - � - Installer ��Wd'y.J�"7��/LG' Address UType of Building '!/ 'y' Size Lot..:4 ...............Sq. feet �-, Dwelling—No. of Bedrooms.............. .......................Expansion ttic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons........ ............. Showers ( ) — Cafeteria ( ) al Other fixtures ......................... W Design Flow.........4 .Q......................,,g�allons per person per day. Total daily flow....................................._......gallons. GG Septic Tank—Liquid capacityl.?Sgallons Length---------------- Width................ Diameter-_._____-___--- Depth................ Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ), ►-' Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1.............. u s er inch Depth of Test Pit.....___ .......... water Depth to ground water..................... ----- r ......................................................... -- --- O Description of Soil.......ret'a.'-l--. Z>�9 ,�11.116.5AVL . •...... Ay �7�{0.1-d '�--- • €' .2 k N --------------------------------------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable................................................................................................ ----------••-•---------------•----------------------------------------------•---------------------------•----------••••••---- Agreement: The undersigned agrees to install the aforedescribed Individual ewage Disposal System in accordance with the provisions of T '''I:L 5 of the State Sanitary-CRde—The unde 1gn d furtl agrees not to place the.system in op tion til a ertifica.te of Compliance has een ssued by th d ea { a Signed �. ._.-•-•--..... .. �" "" /f / Date pp catio Approved � ........ C �� /7 7 4 .._..__ Date PPlieation Disapproved for the following reasons:.................................................................................................................... N-----------•---...----•--------------•-----------•----------••-•------•-•-•--.......------•----------•-----------------------...----------------------------••-------------------....------ Date PermitNo..... �� .... =� ------------- Issued ....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .........0..............OF..... + r :� ..........--- Trrtifirtttp of Tomplianv TH IS IS TO CERTIFY, That the Individual Se e Dls$osal System cons cted f ) or Repaired ( ) at..... '�"'..-.- ---..... .......................�r�G_... t2fer�. ►.. _! YiV r-y- T. ` has been installed in accordance with the provisions of TIME 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No_... ....... dated------- pi. . ................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE' SYSTEM WILL FUNCTION SATISFACTORY. DATE................. .................................. Inspector---•-..... . ---.40.._. ) . •. --•- ,..... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No...._.................. FEE:.........:....--...... Permission is hereby granted.........` a.'...__t,6 .----?1.................................................................. to Construct (A.) or Repair ( ) an Indivl ua "age Disposal System at No.......;�s:q........ `� -r_ I gat C. ---- ------------------------••--------------•------------------•........ .- .... ="%as-,shown on the application for Disposal Works Construction Permit Street No K_=.'." '_�9_ Dated.. ? . 9/4/,as Board of Health DATE---....-•------ ----------•-----.....------......-------••-....._------..._..... FORM 125S HOBBS & WARREN, INC.. PUBLISHERS Log'Number:4 Bottle # 4h Date: 6/19/% BARNSTABLE COUNTY HEALTH AND ENVIRONMENTAL DEPARTMENT SUPERIOR COURT HOUSE v BARNSTABLE,4MASSACHUSETTS 02630 o • AS$ DRINKING WATER LABORATORY ANALYSIS PHONE: 362-2311 EXT. 331 Client: James Jackson Collector: Edward Meehan Mailing Address: 41 Wayside La. Affiliation: Well Driller W. Barnstable Time & Date of Mass. 02668 — � Collection: ' ' ��5 Telephone: 362_6883 Type of Supply: weh water Sample Location: Lot 57 Barnhill Well Depth:, 100ft ` W. Ba_rnsta.blP Date of Analysis: 6/18/85 12:451m PARAMETER SAMPLE RESULT RECOMMENDED LIMITS F Total Coliform Bacteria/100 ml: 0- 0 H 5.9 Conductivity (micromhos/cm) 84. 500.0 Iron ( m) .03 0.3 Nitrate-Nitrogen ( m) .o6 10.0 Sodium ( m) 20.0 FI I . xx Water sample meets the recommended limits for drinking of all above tested parameters. II . Based only on results of the parameters tested for this sample, the water is suitable for drinking but may present the problems checked below: A. .Water sample has higher than average levels of Nitrate. Future monitoring is recommended (2-3 times per year) to establish any upward ,trends. B. The low pH of the water may shorten the useful life of the house's plumbing. C. Water may present aesthetic problems (taste, odor, staining) due to D. Water sample has high levels of sodium. Persons on low sodium diets should consult their doctor. III. Due to one or more of the reasons checked below, this water sample is unfit for human consumption: A. High Bacteria B. High Nitrates REMARKS: The Barnstable County Health and Environmental Department shall not endorse any statements, interpretations or conclusions made by anyone else concerning these resui�s with ut written consert CC: Meehan Well Drilling CC: Barnstable Board of Health ` . 11-1- O 1 /7/85 Lab tory D' ctor Explanation of.Test Results, Total Coliform.Bacteria ` Coliform bacteria are -an indicator.of the sanitary quality of a water supply. Water.' supplies may become contaminated from malfunctioning.septic systems, cesspools and surface .runoff. A total coliform count of zero indicates that your water supply is safe and approved for human consumption.A total colifbrm count of greater than zero is most often-the result of accidental contamination of the sample bottle through'improper sampling methods. For this reason:'ii would be advisable to retest any well water that is not approved._• '- pH pH is the measure of acidity or alkalinityof the water. On the pH scale,the number 7 is neutral,less than 7 is acidic . and more than 7 is alkaline. The pH of water on Cape Cod tends to be acidic in the range of 5.0 to 6.5. Conductivity Conductivity is a measure of the dissolved salts in solution.Amounts in excess of 500 micromhos/cm are generally considered unacceptable and may have a laxative effect upon users. Iron The presence of iron in water in concentration of .3 ppm or greater may: give the water a bittersweet astringent taste, cause an unpleasant odor, often gives the water a brownish color and cause staining of laundry and porcelain. .The average concentration of iron in Cape Cod's water is .2 -..6 ppm. Although the presence of iron in water may cause the problems listed above, it is not considered deleterious to health. Iron may be removed by use,of an iron removal system. Nitrate-nitrogen ~ The Massachusetts Drinking Water Regulations have set a maximum contaminant level for nitrates at 10 ppm. Excessive concentrations may cause methemoglobinemia (an infant disease) and have been suggested to form potentially carcinogenic nitrosamines. Contamination sources include fertilizers, cesspools and industrial wastes. Copper Due to the acidic nature of the water on Cape Cod, copper tends to leach from pipes. This normally does not present a health hazard; however, concentrations in excess of 1.0 ppm may cause a metallic taste and/or a bluish-green stain om porcelain fixtures. Sodium P A concentration of sodium over 20 ppm is only of concern to people who are on a low sodium diet. If the water supply has more than 20 ppm sodium,it is up to the people who are on such a diet to find another source of drinking Water or`contact their doctor to determine if consuming the water is advisable. Concentrations exceeding 50 ppm indicate that there may be ocean water:or road salt runoff water getting into the well. 2 { 4l.'-49''E 1-7G. oo - L o-r 5 7 . 35, o585t= ' N /000 � N . ---nQsegve —` #2 EKI 15T/N $f' 41?Jl1 DlhT/GAS !� 10 I CERTIFY THAT THE FOUNDATIONLS/9��30 SHOWN DOES NOT VIOLATE ANY 0,4 02 `- MMING ZONING REGULATION OF RE TOWN OF 6'^2,J ST'r%,F3LE , . :BA R N5TAQ>LE MASS, D Ti WALTER p, J,gn�t t✓S k-SO co 41 WM,51 c N , W-13ARN57AFSLI No.232Qy ; OS Etjc,P, ASSOC, INC. fZa4gMOAi U C7E'SrI G N 1 �— 5�+ °°--- �� ----- , NL)T : iZEM�YE re 4- ALL I MPE N i MS I TL N p. m / / :% uF✓r,- 2ouND 1"1ATE'i�lA LS � SINGLE FAMILY DWELL//VG w/3 SF_1 RnomsS a a`^< �. . AO GA 2BAG,E D 1S,0a.5A L L O T 5 7 � ( � / � � 10/ A PO U N D DAILY FLOW = // O x Z = _z '� G. P. D. � 3 3D,DEst fi SE P-ri c TAtlk C VOL. 9,Eg /3 0 1 ; Q 33O G.P. D , GALS. 4- WELL o . /D DO GAL . TANK K. - O.•K. j Et,oao D l,S PD S A L PIT o C, "'). ev*, ,. o ,o F USE Co — ,r000 yr D/A. X � � DP. -F Z � ST�Me � � o GA'1..9:T. E FFECT J Ve DE PT N = 4Z_Q� r a. CAP' Ld T Y : Ir x x Lo x Z - tl ' ./ Q I D . 1 r ID 7q o / � Q O `rDTA L CA PA C I T `( S rC; / Q T GALS. - � ,� ,,,, 1�,_h 0 pl-r rr� M o.lz� ® i2 N 49 FIN. FLOOR S l TE PLAN/ EL. JOC2.Q TE3T Pr 7.3 � P.ERC TEST r (ASSUMED) � L FtN. GR.Eb 96.0 ND 1 [^ - r` ML��(E ALL_ �X isT/NG � c, v . '(oP OF WALL J EXISTING GR.EL. q-D HAsY�\ t'EL. A9I� / \ L�Jeie.w�E / -.� x x x - 11�1 P C�Z'�l i �� M:,'1T ER 1 A�S — —a—= —�- —g6I , xx l O' ARO U T`I�❑ r-o Rr�,T _� r �ki-1 ,u RISERS �s NECDEL� svEso,L: V. O LAY '�.�.° �ST;_ � C. 4 PVC �� N ►N �. V. aVIE. P,<ac. al`` o KINGSoURY INU 9f.� I 0 DO J 9�25 � i NV. �— _ , r „ n .4 - 83 ND L E tf 2 aXONCND SU��'/ GAL. 1'' G m X P.C.C o N;�. ��t' rsT �:,�• GrLLA10'MIN. SEPTIC 0 EL.NYE INJ• '-- ❑ I S PC-SA L PIT i BrAly tE c �r TANK �� t {u wjSAN� SEWAGE ❑ISP05AL SYSTEM DESIGN W Z o f .3/� -I•o 1 / GAY e�y 20'MIN. WASNEb S?ONE FOR -- -- NIi JA MES -SACYSO N- - 2' �'�5 ?' ALL. AFLOuND W`?- 4I__ WMAY51Z)9-*—L1�,�Vti� SCALE �- - - - ----------- 810 LAYER PE,ASTON w. �$lzr4s AbL IAA• -- �D RZ. 1 11 = 10' EL. -- -_. _. ... . . T k i - �a �O ON I DP. t.i DERCti> pZO� S7�• l VERT. t"= 4' oN S i of L �®-r -_/_ 2ARN 14ILL -V U.. - MEbIUM 70 COA25E -7T79A. 1L\0 PRDFILE of DISPDSAL SYSTEM y SAND Y- 0,eAVEL -P�STAZL-F= WAA I`IOTE : DISPOSAL 5Y3'rEM To BE CONs'rRUCTED IN 3-rFmCT 7(a_ �(f} L A NTERY ASSOC. t�1 O -- EivG'fZ ACCORDANCE of COMM- OF MASS. ENV1R.oM. GobE-T/ TLE #5, YESTEz: 3 1 c4-Ic1rb5 CONSULT. E.SANb• MA . MA�:; � ; , ,:: =,; XGA�IATD�''FFTTEfZI•P»05,: FIRST FLOOR PLAN . V4 NST�BLE ' BATH LOT 56 •�" p� O KITCHEN PARCEL ID: FAMILY DINING 108/018 /WET GARAGE /ROOM ' /pp LIVINGROOM 00� \ AREA/ _Q0 87 8$ �� - I I REMOVE OLD LEACHPIT O• BEDROOM BATH DURING STRIPOUT `LO ,gam 9' 89 ��- LOCUS � LOT 51 rn HALF STORY ��A PARCEL ID: o FLOOR PLAN BEDROOM � w 108/013 M F � 0) �O LOCUS MAP rn °' l \ I 0) \ PARCEL ID: LOCUS INFORMATION ABANDON 019 �j I / %ISTING S•A'S' 108/ PLAN REF: 301/99 AK 0 TITLE REF: 23548/272 150' LOT 57 O PARCEL ID: MAP 108 PAR. 19 NOT IN STATE ZONE 0 ZONE: "RF" "WELLHEAD PROTECTION ZONE" (WP) FROM WELL I O AREA=35,058f S.F FLOOD ZONE: "C" GOLD �� J� COMMUNITY PANEL: 250001-0011—D DATED:07/02/92 �sTH p3 ;�• 0 0�Qo � � SEPTIC SYSTEM 7 \ UTILS. /'04 ? - O \ REPAIR PLAN 11? 32 / \ LOCATED AT: TBM ELEV.=106.88' �v�aq� � `�� '�- = A�\ s #93 BARNHILL ROAD TOP OF NAIL (SET) -/ O OLD = GAR. __° _ ___ TBM=105.400� WEST BARNSTABLE, MA. N AK �\ \#1 '` __(SLAB) - _ COR. BLHD PREPARED FOR q r _ EXISTING ROBERT C. & DEBORAH A. � 'TANKGAL. M A C K E N Z I E =_#93 °F�, o TO REMAIN JUNE 10, 2009 PARCEL ID: OF 'o 0 108/007002 �, `�" � �s -� c N / \ o i� = WFLL G = �o EDVVARD Syr )fl�EN G _ -- / l N \ ,0 m �' Fc�9�IRa � � Sg� NF s N� A NtTARNPN I � ,�� 708 � �Dc� ^ 1 G c2�� 00 I "O 9 � � cD cry, ` \ '�-0 PARCEL ID: E . A. S. Doti I �\ Q / Nr rn 131 062 SURVEY, INC. \ G-< \ / o WELL GRAPHIC SCALE 141 ROUTE 6A SALT POND BUILDING / 30 0 15 30 60 120 P.O. BOX 1729 I SANDWICH, MA. 02563 - = % FEET ) 1 inch = 30 ft. BUS:(508)888-3619 FAX:(508)888-2496 p �� SHEET 1 OF 2 J 1176 TOP OF FOUNDATION - 2" LAYER OF ELEV.= 106.0' MIN,SCHEDULE PITCH 1/84 PER FOOT PROFILE ,OF 1/8" - 1/2" SEWAGE DISPOSAL SYSTEM DOUBLE WASHED STONE 10' MINIMUM-►I (NOT TO SCALE) OR FILTER FABRIC ` 21' EXISTING TO REMAIN EL= 103.2' = 6' EL 101. 6" MAX:` ............::� ,� EL= 101.4 6 MAX.' ..... ;;a1:: :;ati... 6' MAX. XISTING 7iSDERR 5, .. ,,,. ...... r;;:ti::. .,... ... ............... ;t '%'%% sTRIPOUT CLEAN SAND FILL RISER CONC. TO MEDIUM INVERT ,� 9" MIN./ 5' RISER & COARSE EL= 98.65 �, PER 310 CMR 15.255 2 COVER L= 101.5 COVER LEVEL SAND �� 36" MAX. TO M DIUM EXISTING PIPE FOR 2' HORIZON COARSE S=0.11 92' S= .0145 -� FLOW LIN S=.o1 EL= 99.4 SAND EXIST. EXIST. HORIZON INVERT EXIST. INVERT _ INVERT INVERT INVERT o 0 0 ° Q Q Q Q o Q Q Q Q o� ° °°EL=102.75' EL=100.42' MIN. AEL=100.25 EL= 98.92' 6 SUMP EL=98.75' 24" ° °° ° o o � od, C� ODD Q Q ODD C� �o� 4ABAFFLE8" BASE OF MECHANICALLY p O pqb COMPACTED SAND ° ° °Cb EL=96.65 PROP. DB3 DISTRIBUTION a 4'0' 8.5' 4.0' TYP. EXISTING BOX 3/4" TO 1-1/2" ( 25' 1 ,000 GALLON TANK DOUBLE WASHED STONE 2-500 GAL. (H-10) DRY WELLS (4'-10" X 8'-6" X 2'-9") rn (TO REMAIN) SOIL ABSORBTION (TRENCH FORMATION) CO SYSTEM (S.A.S.) 12.83' X 25' 5' STRIPOUT ALL AROUND (23' X 35') GENERAL NOTES I CERTIFY THAT I AM CURRENTLY APPROVED BY THE DEPARTMENT OF BOTTOM OF TEST HOLE #2 ELEV.= 89.7' ENVIRONMENTAL PROTECTION PURSUANT TO 310 CMR 15.017 TO CONDUCT GROUND WATER & MOTTLES SOIL EVALUATIONS AND THAT THE ABOVE ANALYSIS HAS BEEN PERFORMED 1. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. BY ME CONSISTENT WITH THE REQUIRED TRAINING, EXPERTISE, AND EXPERIENCE TITLE 5 AND THE TOWN OF BARNSTABLE RULES AND REGULATIONS DESCRIBED IN 310 CMR 15.017. I FURTHER CERTIFY THAT THE RESULTS OF MY DESIGN DATA: FOR SUBSURFACE DISPOSAL OF SEWERAGE. SOIL EVALUATION, AS INDICATED ON THE ATTACHED SOIL EVALUATION FORM, 2. AT LEAST ONE ACCESS PORT OVER TANK TEES SHALL BE ARE ACCURATE AND IN AfSORDANCE WITH 310 CMR 15.100 THROUGH 15.107. ACCESSIBLE WITHIN 6' OF FINISH GRADE, WITH ANY REMAINING ACCESS PORTS BROUGHT TO WITHIN 12" OF FINISH GRADE. NUMBER OF BEDROOMS......... 3_ 3. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE GARBAGE DISPOSAL................. NO CAPABLE OF WITHSTANDING H-10 LOADING UNLESS THEY ARE ED ARD A. STONE, CERTIFIED SOIL EVALUATOR TOTAL ESTIMATED FLOW UNDER OR WITHIN 10' OF DRIVES OR PARKING AREAS THEN THEY 330 MUST WITHSTAND H-20 LOADING. (110 GAL./BR./DAY X 3 BR.) 4. THE EXCAVATION CONTRACTOR SHALL VERIFY THE LOCATION TEST PIT RESULTS: 330GPD X 200% = 660 GAL OF ALL UTILITIES PRIOR TO ANY EXCAVATION. USE EXIST. 1000 GAL. SEPTIC TANK 5. ANY MASONRY UNITS USED TO BRING COVERS TO GRADE SOIL TEST DATE: JUNE 5, 2009 OR WITHIN 6" OF GRADE SHALL BE MORTARED IN PLACE. INSTALL: 2-500 GAL. DRY WELLS W 4' CRUSHED STONE 6. FINISH GRADE SHALL HAVE A MINIMUM OF 2% GRADE B.O.H. AGENT: DAVE STANTON ( / OVER THE S.A.S. AND DISTRIBUTION Box. SOIL EVALUATOR: EDWARD A. STONE ON THE SIDES, 4' ON THE ENDS) AND BACKFILL 7. SEPTIC TANK SANITARY TEES SHALL BE CONSTRUCTED OF WITH CLEAN SAND FILL PER 310 CMR 15.255 SCHEDULE 40 PVC AND SHALL EXTEND A MINIMUM OF 6" ABOVE BACKHOE: ROBERT FARRELL THE FLOW LINE AND SHALL BE ON THE CENTERLINE AND LOCATED DIRECTLY UNDER THE CLEANOUT MANHOLES. SOIL CLASSIFICATION................__ ____ 8. THE INLET PIPE INVERT ELEVATION SHALL BE NO LESS THAN TH#1 EL.=101 .0 DESIGN PERCOLATION RATE..... <2 Iv11N.-/LN. 2 INCHES NOR MORE THAN 3 INCHES ABOVE THE INVERT ELEV. DEPTH IN. HORIZON TEXTURE COLOR MOTTLING OTHER EFFLUENT LOADING RATE.........__74 ELEVATION OF THE OUTLET PIPE. ( ) REQUIRED LEACHING CAPACITY.....330 GALZDAY 9. THE SEPTIC TANK SHALL HAVE A MINIMUM COVER OF 9 INCHES. 100.5 0-6" A LOAMY SAND 10YR4/3 LEACHING CAPACITY PROVIDED.....34_9 GA�DAY 10. THE OUTLET SANITARY TEE SHALL BE EQUIPPED WITH A GAS „ BAFFLE, 4 INCHES IN DIAMETER AND CONTRUCTED OF 4" PVC. 98.33 6-32 B LOAMY SAND 10YR5 6 11. ALL PIPES SHALL BE SCHEDULE 40 PVC SEWER PIPE AND " ' DISTINCT COMMON SIDEWALL: (12.83' + 25')x2x(2 SIDES)(.74)= 112 GAL/DAY FIRST TWO FEET OUT OF THE DISTRIBUTION BOX SHALL 82.00 32-22$ C1 19 SILT LOAM 5Y4 2 - BE LEVEL. 78.00 228-276" Cd2(23') MED. COARSE SAND 10YR4/6 �MPI BOTTOM: (12.83' x 25')(.74)= 237 GAL/DAY 12. CHANGES OR REVISIONS TO SEPTIC DESIGN REQUIRE NOTIFICATION MOTTLING & GROUNDWATER ENCOUNTERED ® 138" ELEV=89.5 TOTAL= 349 GAL/DAY TO EAS SURVEY INC. FOR B.O.H. AND DESIGN ENGINEERS REVIEW AND APPROVAL. TH#2 EL.- 101 .7 349 GPD PROVIDED - 330 GPD REQUIRED = 19 GPD RESERVE CONSTRUCTION NOTES: ELEV. DEPTH (IN.) HORIZON TEXTURE COLOR MOTTLING OTHER kAOF . OF OFMq 101.3 0-4" A LOAMY SAND 10YR5/3 EDV�(ARO�c� N� SEPTIC SYSTEM DETAIL PAGE 1. CONTRACTORS / INSTALLERS SHALL VERIFY GRADES AND �' 93 BARNHILL ROAD ELEVATIONS AND SITE CONDITIONS PRIOR TO COMMENCING 98.7 4-36" B LOAMY SAND 10YR6 6 A. °� Im # WORK ON THE SITE. 97 �' 2 36-54 C1 SANDY LOAM 10YR6 4 ST NE "; v MEYER �' WEST BARNSTABLE, MA. 2. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE » DISTINCT COMMON p 89 O `' No. 1140 WITH DEEDED OR ZONING REGULATIONS. OWNER / APPLICANT 83.7 54-216 d2 18 SILT LOAM 5Y4 2 o JUNE 10, 2009 IS TO OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. 79.7 216-264" 3 22' MED. COARSE SAND 10YR4 6 ss s J �`�G1sT - 3. ALL SYSTEM COMPONENTS SHALL BE MARKED WITH MAGNETIC MARKING SgN1TAR�P� TAPE OR A COMPARABLE MEANS. MOTTLING & GROUNDWATER ENCOUNTERED ® 144" ELEV=89.7 SHEET 2 OF 2 J# 1183