HomeMy WebLinkAbout0094 BARNHILL ROAD - Health 94 r�arnhili Road
W. Barnstable
A = 108 020
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i `TOWN OF BARNSTABLE
LOCATION 94C/ 841I)AII/ had, SEWAGE#r,.b07, �
`VILLAGE �l�.s� u�nS411 ASSESSOR'S MAP&PARCEL
INSTALLER'S NAME&PHONE NO. `�Ke� Lae n S�/vr71�n 77
SEPTIC TANK CAPACITY /s60'
LEACHING FACILITY:(type) 3 X-r60 al�� (size) 1.2 P4
.NO.OF BEDROOMS ���✓'
OWNER /C A�
PERMIT DATE: L171abi COMPLIANCE DATE: I. G Y oho!
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) N Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within
300 feet of leaching facility) 4 i1A Feet
FURNISHED BY �t —�
�gsar�L
ry.
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n" TOWN OF/BARNSTABLE
LOCATION ®/ `� /� x,01,'d ��i�il SEWAGE#
VILLAGE VAtr _ ASSESSOR'S MAPP&PARCEL �®
INSTALLER'S NAME&PHONE NO. %�y- Lc,�,�� c n�✓1 So�-77G•CyLp
SEPTIC TANK CAPACITY /SGO 1pq�4
LEACHING FACILITY:(type) x.3 (size) Y?.j X/aa��a��
NO.OF BEDROOMS
OWNER 124etIq II
PFJ DATE: % • ,0 GQA49LLA.WCE DATE: /6
Separation Distance Between the: K,,,;
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 4/A Feet
Private Water Supply Well and Leaching Facility(If any wells exist on
site or within 200 feet of leaching facility) I/A Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within.
300 feet of leaching facility) Feet
FURNISHED BY
�T
�- l- Y?f1
' _js 4 J11
No. ) 1 `� 7 Fee �L
THE COMALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
ZIpplitatlott for 30isposal 6pstrut Construction j3ertttit
Application for a Permit to Construct( ) Repair(,.Upgrade( )( n( ) ❑Complete System ❑Individual Components
Location Address or Lot No. qY 14wner's Name,Address,and Tel.No. /
Assessor'sMap/Parcel
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. p go, 16 xcey-.k
Type of Building:
Dwelling No.of Bedrooms Lot Size is,e� sq.ft. Garbage Grinder( WIA
Other Type of Building ff,,Se°JGn�44 No.of Persons Showers( ) Cafeteria( )
Other Fixtures �
Design Flow(min.required) LAN
"/ � gpd Design flow provided j gpd
$��617 Number of sheets Revision Date Plan Date ®�
Title
Size of Septic Tank /r,0O 96 fG,�� Type of S.A.S. '/7h ftt 57W I411K C- 61-1 jam\
Description of Soil Y,-e rL14r-A✓!S 1(vkoyei I ? S tD Acenen a►
Nature of Repairs or Alterations(Answer when applicable) L nS / /�c/1 S.'���_&,nay-
Oa—rO Of)A o x5-OW 4,�l�i� y,Gv4�JP1S
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Heath.
Signed Date l a g
Application Approved by Date
Application Disapproved by Date
for the following reasons
Permit No. `' Date Issued /
V.
�'r s f'✓ M I ' Y y qiT
No. Fee
THE COM4110b TH OF MASSACHUSETTS Entered incomputer,��
PUBLIC HEALTH DIVISION - TOWN OF ,BARNSTABLE, MASSACHUSETTS Yes
ti
Zipplication for ]Disoosal 6psteltt Construction Permit
Application for a Permit to Construct( ) Repair(..1);0 Upgrade( A(,15jaon( ) El complete System El Individual Components
Location Address or Lot No. / fjQlpt jq,') 1 lOwner's Name,Address,and Tel.No.
r q'-1l�o.A4dAf,1 w. 61-A��A
Assessor'sMap/Parcel Ilan t/jQjL� � � 11 a to 0CW-t)),V ,5`j�'+a-77fi'�35
Installer's Name,Address,and Tel.No. a W 9)yFj3G 'I Designer's Name,Address,and Tel.No. �x fb 1q3"
/J. PAA5
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Type of Building:Dwelling No.of Bedrooms Lot Size i �jqf e� sq.ft. Garbage Grinder( 141 k
Other Type of Building IS4 4Aa ', No.of Persons Showers( ) Cafeteria( )
Other Fixtures
/`? 1
Design Flow(min.required) t/ 0 gpd Design flow provided gpd
Plan `Date 49�i IJ f �J617 Number of sheets Revision Date
Title
Size of Septic Tank Irga C,41k, Type of S.A.S. 'T h teL .500 swkN C 6v4 jel C �T
Description of Soil I 'V' slit ),Ar rr7u'Jo'S (rA0,1a 1 1e/'1^/Ci+.44
Nature of` epairs or Alterations(Answer when applicable) _fi ffak�� / XJ 1��1 S.T. . 94 y, /t^ov.
o UA C,.�,b1 cv 64 (/O�nle
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of He th.
Signed Date , O f 7)0 6,
• • r
Application Approved by Date i
Application Disapproved by Date 6
for the following reasons
Permit No. 01 J Date Issued )0/ l 7// 'j
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal/system Constructed( ) Repaired( � Upgraded( )
Abandoned( )by /r p i Key- I"d Ca,A S>l C
- at 14- a��/� �Go has been constructed in accordance -
t . n
with the provisions of Title 5 and the for Disposal System Construction Permit No. °/ 'dated I/
Installer �C•K(/' ' DesignerI7�Lt ��JJ
#bedrooms Approved design flow 7 C/q gpd
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
Date 1 Inspector s /y k/,
No. SlDtl — 1 f Fee '�—
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Misposal *pstem Construction permit
Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon( )
System located at /7 111,A�,'n eCf✓n Sia A,t'
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions.
Provided:Construction must be completed within three years of the date of this permit.
l
Date [ 0 07 7 1 17 Approved by G
6
Town of Barnstable
.�"'E nD •o Regulatory Services
Richard V. Scali, Interim Director
* BARNSPABM #
MASS. ��$ Public Health Division
1639.�Ev3+61 Thomas McKean, Director
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Installer & Designer Certification Form
Date: WhI11,90 Sewage Permit# 0?017-3S7 Assessor's Map\Parcel /0 81a20
Designer: Installer: r4,- L*nol CC,AS41vG k"t
Address: ?• g o k l 4- Address: PC' 60 k -7)C
On d /) /4dG,� �. �;Kee- was issued a permit to install a
(d te) (installer)
septic system at vr-%L�L. based on a design drawn by
(address)
'S i LA-`}—cx'-,'e`=-` `'k'rt5...�-_tE - dated
-1-----
(designer)
I certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank. Strip out (if required) was inspected and the soils
were found satisfactory.
I certify that the septic system referenced above was installed with major changes (i.e.
greater than 10' lateral relocation of the SAS or any vertical relocation of any component
of the septic system) but in accordance with State & Local Regulations. Plan revision or
certified as-built by designer to follow. Strip out (if required) was inspected and the soils
were found satisfactory.
rap i'
I certify that the system referenced above was constru Ced-4in}compliance with the terms
. fir -~ �"i��4Y sa3g
of the I\A approval letters (if applicable) � `�";;\;�
LI ller's Signature) '1
(Designer's Signature) (Affix Des gne 's Stamp Here)
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-
BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.
THANK YOU.
Q:\Septic\Designer Certification Form Rev 8-14-13.doc
Town of Barnstable P#
Department of Health,Safety,and Environmental Services
�1m Public Health Division Date
p� 367 Main Street,Hyannis MA 02601
HARNSTAELE. ` - -
MASS. •.100
O O
i
At ib39 �,�� Date Scheduled Time —�--`f Fee Pd.
d'
fD MAC -
' •a4d
Soil Suitabili Assessment or S e Dis osal
ty f p ., .e:
Performed By: ST p t-' A, PE Witnessed By: T°r
Cr
LOCATION +& GENERAL INFORMATION
Location Address 9 4 tAr—Ll iA I.(—L e p A4t Owner's Name$oN»i
W L&-T ?,!► V_k.-)ST Ar_#4 Ler Address q4 paWLf-i eke tr- %p T
Assessor's Map/Parcel: v9 (oze� Engineer's Name
NEW CONSTRUCTION REPAIR X Telephone# snr 3C,-1 t �oq
Land Use AZ4=I e74v-r"��" Slopes{%) �~ Surface Stones
Distances from: Open Water Body ft, Possible•Wet Area ft Drinking Water Well /SZ f ft
Drainage Way A Property Lille w 4' _ft Other ' ft
SKETCH: (Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes)
�y
Ilk
ZAVW
J
Parent material(geologic) Depth to Bedrock.
Depth to Groundwater: Standing Water in Hole: Y�� Weeping from Pit Face )Lrl+a
EAimated Seasonal Higii Groundwater
DETERII'IY1TATtON PDT SEASONAL.HTI VATR `ABLE
Method Used. <. Nl p
Depth Observed standing in obs.hole: in. Depth to soil mottles: in.
in. Groundwater Adjustment ft.
Depth to weeping from side of obs.hole:
—Index'Weli#_ _. Reading Date:...`_ Index Well level..: Adj.factor_ Adj.Groundwater Level__._
Cn r�:..
Ja��i.�3:ON.rr .�s i�atC T�7rc
Observation Time at 9"
Hole#
Depth of Perc Time at 6"
Start Pre-soak Time @ Time(9"-6")
Fnd Pre-soak
Rate Min./Inch
Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(YIN)
Original: Public Health Division Observation Hole Data To Be Completed on Back j
Copy: Applicant
/ v'
Town of Barnstable P# 10-TW :5
I A
Department of Health,Safety,and Environmental Services /� S
�114E Public Health Division Date `G
O� 367 Main Street,Hyannis MA 02601
eARNRreet e
Huss. ;, O
t5at9j� � Date Scheduled / T me—�� Fee Pd. O ;A
Soil Suitability Assessment for S e Disposal
�.
Performed By: STZ=Z7 R4=*� A K' A' A-Js . Y4!F- Witnessed By: Ca
LOCATION & GENERAUMU RMATION.
Location Address 914 �R,�1A i e..L V7 o A.t� Owner's Name
lA)(_iT Q ArSz.1►�ST��LE Address q,4
Assessor's Map/Parcel: 1 oe �oL Cz� Engineer's Name
NEW CONSTRUCTION REPAIR X Telephone# S;Orj &call L 6q
Land Use /ter Slopes`(%) Surface Stones HE'S
Distances from: Open Water Body -ft, Possible Wet Area ft Drinking Water Well 13-6 ft
I Drainage Way A Property.Line w �' _ft Other ' ft
SKETCH: (Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes)
Parent material(geologic) Depth to Bedrock Z�
Depth to Groundwater: Standing Water in Hole: P AK Weeping from Pit Face NZ¢
- f
Egtimated Seasonal higl•i Groundwater
DETERI�'INATtUN FOR SEASONAI HI( I'VVA`I'ER TABL�I•�
Method Used. N A
Depth Observed standing in obs.hole: in. Depth to soil mottles: in.
Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft.
Index Well#___. Reading Date:._..__, Index Well level,_:___ .Adj.,factor_ Adj.Groundwater Level_
P bit Tu�rc
Strt �+7�^cs+'� S�bwe" /¢ice A•c.lS s 5
Observation
Hole# Time at 9"
Depth of Perc Time at 6"
Start Pre-soak Time @ Time(9"-6")
Fad Pre-soak
Rate Min./Inch
Site Suitability Assessment: Site Passed L,�' Site Failed: Additional Testing Needed(Y/N)
Original: Public Health Division Observation Hole Data To Be Completed on Back j
Copy: Applicant
down cape engineering, inc. SIEVE SOILS ANALYSIS 94 BARNHILL ROAD W. BARNSTABLE, MA
i
i
DATE OF REPORT: 8130/17
.JOB : GRAIN SIZE ANALYSIS-SIEVE TEST
SITE: 94 Barnhill Road, West Barnstable
LOCATION: Steve Haas Test Hole
i
SIEVE ANALYSIS Weight Sample(Grams): 135.7
SIZE ;WEIGHT RETAINED % RETAINED % PASSED
-------- - ---- (sum -------- ------------- ---- ----- - -- - -v ------- -
1 ------------- =0h- --0.% -----1
3/4" I
-- -A- --------0 0%L-- -100.0%
--------------I- ----- ------
1/2" 0'--------------0 0%: _100.0%
------------- - - ---r----------00.0--
#4 ------ 0 1a- -----00%: 100:0%
#10 24.0' 17.7% 82.3%
#20 60.7 ------------44.7%; 55.3%
------------- - - ---- t- ---
#40 97.4' ------------71 8%: 28.2% ;
#50 ; 111:1v_ 81 9%; 18.1 io
-------------.------------------ ------- -
#80 _121.7,_ -__89 7%: 10.3%
-------------. -------- ------:-- -------
#100 126.3A- ---93_1%`- -----_-6.9%
-------- - ----
#200 j 132.4;_ 97.6%;___------___2.4% j
------------ -------------- ---------------------
PAN: ----134_5, -__------- 100A%;____________0.0%
»—_—___------r______________ T—
SAMPLE:
�I
NOTE:TEST ON PASSING#4 ONLY, 14.3% RETAINED ON#4<45% O.K. i
I
RESULTS:
k
SOIL CLASSIFIED AS AASHTO A-1-b(GRAVEL AND SAND)(UNCOMPACTED)
PERCENTAGE OF MATERIAL PASSING#4 SIEVE :
#4 100% (TEST ONLY MATERIAL PASSING#4) OK
#5010%-100% OK
#100 0%-20% OK
#200 0%-5% OK
SAMPLE MEETS TITLE 5 FILL SPECIFICATION
>97%SAND
s
RESULTS: PERMEABLE MATERIAL-CLASS i.<2 MIN./IN. MATERIAL(0.74 GPM/SF)
NONCOMPACTED y'
SOIL DESCRIPTION: MEDIUM SAND&GRAVELa
Cj. A � I
CIV i u
Nu.4 502
1
�Q.' LE r
a
k
e
F
�Rxwzoo�,l
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Ll\j ts', cs- 0o
P + I c M o
q� (jn►2+�1ttiLL ���p WAS 6�i�T
w Ay p� Cs- i S T"1 M P%tv® RE M Ai N
cQ i �i_ C c5 S.{ZV C`TT®� ,
ENVIROTECH LABORATORIES,INC.
MA CERT. NO.:M-MA 063
8 Jon Sebastian Drive Unit 12
Sanrhvich,MA 02563
(508)888-6460 1-800-339-6460
FAX(508)888-6446
Client Name Hoyt,Scott Location 94 Barnhill Rd.
Address 14 Lock Rannoch Way 1\11" W.Barnstable,MA 02668
Yarmouthport:,MA
02675 Sample Date 07/25/`17
Collected By Client Sample Time 17:00
Sample Type Drinking water Date Received 07/26/17
Lab Order Number DW-172561 Well Specs
-�':-.-
i�Can�rc��
-
����� �. ��;-� ����,.�•l)7/25117� �, �. 17 0_0_,Y,.����.,�.�_� �� ��_ Bathtub;fauce
Analysis Requested Units Recommended Limits Analysis Result I Method JDafe Analyzedl Analyzed By
Total Coliform CFU/100mL 0 0 SM9222B 7/26/2017 MC
--- - -----..-__"_.-.-..--.-........_._...----------....-.._. -....
_ _
pH pH units 6.5-8.5 10.0 SM 4500-H-B 7/26/2017 LL
Specific Conductances umhos/cm 500 333 EPA 120.1 7/26/2017 LL
Nitrite-N mg/L 1.00 <0.006 EPA 300.0 7/26/2017 LL
- - -----------
Nitrate-N mg/L 10.0 0.06 EPA 300.0 7/26/2017 LL
Sodium - _ mg/L 20.0 60 EPA 200.7 7/27/2017 MC
Total Iron _ mg/L 0.3 0.02 EPA 200.7 7/27/2017 MC
Manganese _ mg/L 0.05 <0.005 EPA 200.7 7/27/2017 MC
Potassiumn mg/L _20.0 0.1 EPA 200.7 7/27/2017 MC
Calcium mg/L N/A 0.1 EPA 200.7 7/27/2017 MC
Magnesiuma mg/L _ N/A_ 0.6 EPA 200.7 7/27/2017 MC
Total Hardnesss - mg/L 50-200 2.7 EPA 200.7 7/27/2017 MC
Alkalinity mg/L 200 61 - SM 2320B 7/26/2017 LL
Sulfate mg/L 250 6.1 _ EPA 300.0 7/26/2017 LL
Chloride mg/L 250 64 EPA 300.0 7/26/2017 LL
_ Turbidity NTU 5.0 <1.0 SM 2130B 7/26/2017 LL
Colors APC units _ 15 '<5 -SM 2120E 7/26/2017 LL
Free CO2 mg/L 50 1.1 Calculation 7/27/2017 LL
Lead mg/L 0.015 <0.006 EPA 200.7 7/27/2017 MC
Comments: -- ----------- ------ ------ - -
pH is above recommended limit and should be adjusted.
Sodium level is not a health hazard,but if on a low Sodium diet,consult a physician before drinking
Total Hardness results indicate water is soft.
Water meets EPA standards and is suitable for drinking forparameters tested.
i
Date 7/27/2017
Ronald J.Saari
Laboratory Director
BRL=Below Reportable Limits *See Attached Page 1 of 1
❑Certification is not avallable for this analyte for potable water samples.. ti
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Town of Barnstable
O Health Division
200 Main Street
Hyannis, MA 02601
I �I�
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Town of Barnstable Barnstable
Regulatory Services Department Mwiffmc j
q HARNSfABI B
" . ,� Public Health Division
200 Main Street, Hyannis MA 02601 2007
Office: 508-862-4644 Richard V.Scali,Director
FAX: 508-790-6304 Thomas A.McKean,CHO
CERTIFIED MAIL#7015 1730 0001 4990 6418
July 25, 2017
MCNALLY, BONNIE
94 BARNHILL RD
WEST BARNSTABLE, MA 02668
ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5
The septic system located at 94 Barnhill Road,West Barnstable, MA was inspected on
07/12/2017 by Joseph M. Martins, certified Title V Septic Inspector for the State of
Massachusetts.
The inspection of the septic system showed that the system "Fails" under the guidelines
of 1995 TITLE V (310 CMR 15.00) due to the following:
• Leaching facility with standing liquid level at or above the invert pipe (per
Town Code 360-20 h).
You are ordered to repair or replace the septic system within two (2)years from the date
you receive this notification.
Failure to repair/replace the septic system within the deadline period will result in future
enforcement action.
PER ORDER OF THE BOARD OF HEALTH
Xcean.I.S.. CHO
Agent of the Board of Health
I
Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\94 Barnhill Road West
Bamstable.doc
Town of Barnstable
IAMISrATT-F,
MA ,,b� Regulatory Services Department
Public-Health Division
200 Main Street,Hyannis MA-02601
Office: 508-862-4644 Richard Scali,Director
FAX: 508-790-6304 Thomas A-McKean,CHO
Feb 6, 2007
Rev. 5111116
DEADLINES TO'REPAIR FAILED SYSTEMS
(Town Code §360-44 and Title V: 310 CMR 15.000) _
An"x"marked in the ❑ is the failure criteria and associated repair deadline
60 DAY DEADLINE CRITERIA.
❑Discharge or ponding of effluent to the surface of the ground .
❑Pumping more than 4 times during the last year not due to clogged or obstructed
Pipe =
❑Backup of sewage into the house due to an overloaded or clogged SAS or cesspool
ONE (1)YEAR DEADLINE CRITERIA
❑ Static liquid level in the distribution box above outlet invert due to an overloaded or
clogged SAS or cesspool
❑Any portion of the SAS, cesspool, or privy below high groundwater elevation
❑ Any portion of the cesspool within a Zone 1 to a public well
❑Any portion of a cesspool within 50 feet of a private water supply well with no
acceptable water quality analysis. (This system passes if the water analysis
indicates the well is free from pollution).
. TWO 2 YEAR DEADLINE C
q in o
❑Any"conditionally passed systems" (broken cover,relocation of a pipe,relocation
of a driveway due to H-10 components, etc)
❑Leaching pit or cesspool with high liquid level, <12"below inlet(per Town Code
§360-9.1)
%L Leaching facility with standing liquid level at or above the invert pipe (per Town
" Code §360-20 h)
Repair deadline:
Q:\SEPTICIDEADLINES TO REPAIR FAILED SYSTEMS.doc
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
r'
94 Barnhill Rd West Barnstable MA ✓ r
Property Addressy
Bonnie McNally c/o Scott Hoyt 14 Loch Rannoch Way
Owner Owner's Name
information is
required for every �Yarmouth Port MA 02675 7/12/201 t',1
page. Cityrrown 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 filling out forms A. General Information s/, yy.3
�a
on the computer,
use only the tab 1. Inspector:
key to move your
cursor-do not Joseph M Martins
use the return Name of Inspector
key.
Accu Sepcheck
Comp
Company Name
17 Northside Dr
AA Company Address
South Dennis MA 02660
City/Town State Zip Code
508-385-5891 SI 147
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
❑ Needs Further Evaluation by the Local Approving Authority
7/12/2017
nspector'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 is a shared system or
has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the
report to the appropriate regional office of the DEP. The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
****This report only describes conditions at the time of inspection and under the conditions of use
at that time.This inspection does not address how the system will perform in the future under
the same or different conditions of use.
,erQ�V�
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Di osal System-Page 1 of 17
I
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
°M 94 Barnhill Rd West Barnstable MA
Property Address
Bonnie_McNally c/o Scott Hoyt 14 Loch Rannoch Way
Owner Owner's Name
information is required for every Yarmouth Port MA 02675 7/12/2017
page. Cityrrown State Zip Code Date of Inspectio
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E/always co /ailure
A) System Passes:
❑ I have not fcund any information which indicates thaof
iteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Analuated are
indicated below.
Comments:
B) System Conditionally Passes:
❑ One or more system component as described in the"Conditional Pass"section need to be
replaced or repaired. The syste upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
Check the box for"yes", "no"or° of determined" (Y, N, ND)for the following statements. If"not
determined," please explain.
The septic tank is metal and ver 20 years old*or the septic tank(whether metal or not) is structurally
unsound, exhibits substant' I infiltration or exfiltration or tank failure is imminent. System will pass
inspection if the existing t k is replaced with a complying septic tank as approved by the Board of
Health.
*A metal septic tank II pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicatin that the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND (Explain below):
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
94 Barnhill Rd West Barnstable MA
Property Address
Bonnie McNally c/o Scott Hoyt 14 Loch Rannoch Way
Owner Owner's Name
information is required for every Yarmouth Port MA 02675 7/12/2017
page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of He approval if
pumps/alarms are repaired.
B) System Conditionally Passes(cont.):
❑ Observation of sewage backup or break out or high static water level i he distribution box due
to broken or obstructed pipe(s)or due to a broken, settled or uneve distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s) are replaced ❑ Y ❑ ❑ 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 ore than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection with approval of the Board of Health):
❑ broken pipe(s) a replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction * 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17
E
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
° M 94 Barnhill Rd West Barnstable MA
Property Address
Bonnie McNally c/o Scott Hoyt 14 Loch Rannoch Way
Owner Owner's Name
information is required for every Yarmouth Port MA 02675 7/12/2017
page. Cityfrown State Zip Code Date of Inspe 'on
B. Certification (cont.)
2. System will fail unless the Board of Health (and Public Water pplier, if any)
determines that the system is functioning in a manner that pro cts the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system AS) and the SAS is within
100 feet of a surface water supply or tributary to a surface w ter supply.
❑ The system has a septic tank and SAS and the SAS i ithin a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the S is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the S 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 analys* , performed at a DEP certified laboratory, for fecal
coliform bacteria indicates absent and the pr sence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that no oth 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 Y day flow
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
wM 94 Barnhill Rd West Barnstable MA
Property Address
Bonnie McNally c/o Scott Hoyt 14 Loch Rannoch Way
Owner Owner's Name
information is required for every Yarmouth Port MA 02675 7/12/2017
page. Cityrrown 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 th Ilowing, in addition to the
questions in Section D.
Yes No
❑ ❑ the system is within 400 feet o surface drinking water supply
❑ ❑ the system is within 20 eet of a tributary to a surface drinking water supply
❑ ❑ the system is loc d in a nitrogen sensitive area (Interim Wellhead Protection
Area—IWPA r a mapped Zone II of a public water supply well
If you have answered"yes"t ny question in Section E the system is considered a significant threat,
or answered"yes" in Secti 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 accords with 310 CMR 15.304. The system owner should contact the appropriate
regional office of the Department.
t5ins•3/13 Title 5 Official Inspection Forrn: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 94 Barnhill Rd West Barnstable MA
Property Address
Bonnie McNally c/o Scott Hoyt 14 Loch Rannoch Way
Owner Owner's Name
information is required for every Yarmouth Port MA 02675 7/12/2017
page. Citylrown 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
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): n/a Number of bedrooms (actual): 4
r
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):
440
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
94 Barnhill Rd West Barnstable MA
Property Address
Bonnie McNally c/o Scott Hoyt 14 Loch Rannoch Way
Owner Owner's Name
information is required for every Yarmouth Port MA 02675 7/12/2017
page. Citylrown State Zip Code Date of Inspection
D. System Information
Description:
1000 GALLON SEPTIC TANK, 6x6 LEACH PIT , NO DBOX FOUND
Number of current residents: 1
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No
information in this report.)
Laundry system inspected? ® Yes ❑ No
Seasonal use? ❑ Yes ® No
Water meter readings, if available last 2 ears usage d WELL WATER
9 ( Y 9 (9P ))�
Detail:
WELL WATER
Sump pump? ❑ Yes ® No
Last date of occupancy: 7/12/2017
Date
Commercial/Industrial Flow Conditions:
Type of Establishment: N/A
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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
wM �< 94 Barnhill Rd West Barnstable MA
Property Address
Bonnie McNally c/o Scott Hoyt 14 Loch Rannoch Way
Owner Owner's Name
information is required for every Yarmouth Port MA 02675 7/12/2017
page. Cityrrown 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: UNKNOWN
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped: gallons
How was quantity pumped determined?
Reason for pumping:
Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner)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):
NO DISTRIBUTION BOX
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
94 Barnhill Rd West Barnstable MA
Property Address
Bonnie McNally c/o Scott Hoyt 14 Loch Rannoch Way
Owner Owner's Name
information is required for every Yarmouth Port MA 02675 7/12/2017
page. Citylrown State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known)and source of information:
41 YEARS. INSTALLED IN 1976 PER BARNSTABLE HEALTH DEPT.
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
Depth below grade: feet
Material of construction:
❑ cast iron ®40 PVC ❑ other(explain):
Distance from private water supply well or suction line: >10feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
NO EVIDENCE OF LEAKS
Septic Tank(locate on site plan):
Depth below grade: 2.5 HAS RISER MIDDLE COVER
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:
APP 8.5X6X5 1000 GALLON
Sludge depth:
10"
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
�M 94 Barnhill Rd West Barnstable MA
Property Address
Bonnie McNally c/o Scott Hoyt 14 Loch Rannoch Way
Owner Owner's Name
information is required for every Yarmouth Port MA 02675 7/12/2017
page. Cityrrown 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
22"
Scum thickness 0-2
511
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
16"
How were dimensions determined? CORETAKER
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
HAS WALL BAFFLE. HAS CONCRETE OUTLET TEE. LIQUID LEVEL IS 3"ABOVE OUTLET
INVERT INDICATING HYDRAULIC BACKUP OF SYSTEM.
Grease Trap(locate on site plan):
Depth below grade: N/A
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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage(Disposal System Form-Not for Voluntary Assessments
94 Barnhill Rd West Barnstable MA
Property Address
Bonnie McNally c/o Scott Hoyt 14 Loch Rannoch Way
Owner Owner's Name
information is required for every Yarmouth Port MA 02675 7/12/2017
page. Cityrrown 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: N/A
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Capacity:
gallons i
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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
94 Barnhill Rd West Barnstable MA
Property Address
Bonnie McNally c/o Scott Hoyt 14 Loch Rannoch Way
Owner Owner's Name
information is required for every Yarmouth Port MA 02675 7/12/2017
page. Cityrrown 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 N/A
Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
NO DBOX ON AS BUILT OR FOUND
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.):
N/A
*If pumps or alarms are not in working order, system is a conditional pass.
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
,M 94 Barnhill Rd West Barnstable MA
Property Address
Bonnie McNally c/o Scott Hoyt 14 Loch Rannoch Way
Owner Owner's Name
information is required for every Yarmouth Port MA 02675 7/12/2017
page. City[Town State Zip Code Date of Inspection
D. System Information (cont.)
Type:
® leaching pits number: 1 6X6
❑ leaching chambers number:
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
LIQUID LEVEL IS 6.5'. LEVEL IS >9" OVER INLET PIPE .-A FAILURE CONDITION. GRADE TO
SAS BOTTOM IS —9'.
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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17
I
Commonwealth of Massachusetts
a Title 5 Official Inspection Form
_ a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
M 94 Barnhill Rd West Barnstable MA
Property Address
Bonnie McNally c/o Scott Hoyt 14 Loch Rannoch Way
Owner Owner's Name
information is Yarmouth Port MA 02675 7/12/2017
required for every
page. City/Town State. Zip Code Date of Inspection
D. System Information (cont.)
Comments (note condition of soil, signs of hydraulic f 'ure, level of ponding, condition of vegetation,
etc.):
Privy(locate o/ndition
Materials of co N/A
Dimensions
Depth of solids
Comments (nosigns of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17
Commonwealth of Massachusetts
Him Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
94 Barnhill Rd West Barnstable MA
Property Address
Bonnie McNally c/o Scott Hoyt 14 Loch Rannoch Way
Owner Owner's Name
information is required for every Yarmouth Port MA 02675 7/12/2017
page. Cityrrown 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
°we�c
W
U
A SEA� 8
-1
0
2 O
3 ° ISTA
AI= 23'
A 2 - 25 ' , 13 2=sy
yp `
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M ,•y'�r 94 Barnhill Rd West Barnstable MA
Property Address
Bonnie McNally c/o Scott Hoyt 14 Loch Rannoch Way
Owner Owner's Name
information is Yarmouth Port MA 02675 7/12/2017
required for every
page. Cityfrown 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: 80
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:
❑ Checked with local excavators, installers-(attach documentation)
® Accessed USGS database-explain:
TOPO, CCC GROUNDWATER MAP
You must describe how you established the high ground water elevation:
SITE IS 120'ASL . GROUNDWATER CONTOUR FROM CAPE COD COMMISION 32'ASL. MAX
RISE ABOVE MAP IS 8'. GRADE TO SAS BOTTOM IS 9'. SEPARATION MATH: 120-(32+8+9)=71
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17
Commonwealth of Massachusetts
_ Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
94 Barnhill Rd West Barnstable MA
Property Address
Bonnie McNally c/o Scott Hoyt 14 Loch Rannoch Way
Owner Owner's Name
information is required for every Yarmouth Port MA 02675 7/12/2017
page. Citylrown 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17
L —
Page: 1
CERTIFICATE OF ANALYSIS
Barnstable County Health Laboratory
Report Prepared For: Report Dated: 03/01/1999
McNally,Bonnie Order Number:
G9901427
nnie McNally / g�
58 arnhill Road
West Barnstable MA 02668
Laboratory ID#: 9901427-01 Description: Water-Drinldng Water
Sample#: 01427-01 Sampling Location: 5$•, Barnhill Road,W.Barostable Collected: 02/17/1999
Received: 02/17/1999
ollected by: B.McNally
Routine
ITEM RESULT UNITS MCL Method# Tested
LAB:IC Lab
Nitrate <0.1 mg/L 10 EPA 300.0 02/18/1999
LAB:Metals
Copper
<0,1 mg/L 1.3 SM 3111 B 02/20/1999
Iron 0.4 mg/L 0.3 SM 311 1l3 02/20/1999
Sodium 38 mg/L 20 SM 311 113 02/20/1999
LAB:Microbiology
Total Coliform Absent P/A Absent P/A 02/17/1999
LAB: Physical Chemistry
Conductance 163 umohs/cm EPA 120.1 02/18/1999
pH 7,5 pH-units EPA 150.1 02/18/1999
Note: Based on the results of the parameters tested,the water is suitable for drinking but has high levels of sodium.Persons on low
sodium diet should consult their doctor. Water may present aesthetic problems(taste,odor,staining)due to iron:
Approved B
(Lab Director)
3/317
Superior Court House, PO.Bog 427, Barnstable, MA 02630 Ph: 508-375-6605
R. A. Bousfield Backhoe Service
17 Burbank Street
Sandwich, Massachusetts
02563
e
JON
Hame-5 s7>4r r7 ex, re, Sewer Permif .
Location: 7` /r21/
ASSESSORS MAP NO• /12iff
�,�e�C ceee-c�r
PARCEL NO:
Builder s Name and Address . sa e
Date Permit Issued:..ne I
e
Date Compliance Issued: A
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THE COMMONWEALTH OF MASSACHUSETTS
�I ,� v _ BOARD OF HEALTH
..._ 7_41 V .............OF ....4~. ..
.....................................
Appliratiun -fur Disposal on urku Tstrurtiun Vrrniit
Application is her made for Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at: Il X P 1 for,
Location. ddress or Lot No.
-----------------------------
. 1(-4 Add st�
- �?�\
Installer Address
Q Type of Building Vj///N f Size Lot_-...._../...__!�2-----Sq. feet
Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( Garbage Grinder (NO)
Other—Type of Building ---------------------------- No. of persons............................ Showers Cafeteria ( )
dOther fixtures --•--------------------------•------•----------------- -----...._......_......-----••----....--•............_....--••----------------•••••••--.••----
w Design Flow.............(:iV...`...........____gallons per person per day. Total daily __-------------.gallons.
WSeptic Tank- Liquid capacity/1 allons Length............... Width................ Diameter---------------- Depth..---...........
x Disposal Trench—No..................... Width..f , Total Length-------------------- Total leaching area--------------------sq. ft.
Seepage Pit No......�_____--__ Diameter.__ p Total leaching<trert..................sq. ft.
- ---------- Depth belo,,in el �'—! b �G.
Z Other Distribution box ( ) Dosing tank ( ) /�'
a Percolation Test Results Performed by..__--7... / �esst
dam- ..__................. Date_-k''___�1. s_
Test Pit No. 1----------------minutes per inch Depth of Pit.................... Depth to ground water........_-___.--_.----..
LT. Test Pit No. 2................minutes per inch Depth of Test Pit.___-___--_..-_____- Depth to ground water_-.--._..._------._____-
xa
=
ODescri do of Soil C
'W------
" -_ . .-�-? --------- -et" �-----------------Uw
VNature of Repairs or Alterations—Answer when applicable.---------------------------------------------------------------------------------------------.-
--------------------•-------- ----_---------------•-----------------------------------•--•-•------- -------------•--------------------•--------------------•------------------------• ---------.-------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article YI of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been 'ssued by b ar o health.
Sig d..... ------- 1�/ ��-------
ate
Application Approved BY /C-r.e�a -----------------------
Date
Application Disapproved for the following reasons:................................................................................................................
---------------------------------------------•-------- --------------------------------••---------------•.•--------••------------------------------.........-------------•--------------------------••...
Date
PermitNo......................................................... Issued........................................................
Date
______ __________
No.' Fas......1.................._
.....
THE COMMONWEALTH OF MASSACHUSETTS
BOARD�jOF HEALTH
...............OF.....vr .�� ...................................... l
Appliratinn -for Dispoo 1 Works (nnnitrurtion Vamit
Application is hereby made f a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
Sysat
J'//f
r ocaJt�n-A r ss 2 or Lot No.
-a� wn < Address
Installer Address
UType of Building Size Lot_��5,,_�--____Sq. feet
., Dwelling—No. of Bedrooms-------------- Attic (--) Garbage Grinder (i10)
�
aOther—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( )
Q' Other fixtures ......................................................
W Design Flow______________�4--- ............... per person per day. Total daily flow__-� /..-___-—
W Septic Tank Liquid capacity_._ allons Length................ Width................ Diameter-........ Depth....--.-.-..._.
x Disposal Tren h—No- ____________________ Width------------__�_ Total Length.................... Total leaching area--------------------sq. ft.
Seepage Pit No.___-.__f-------- Diameter_/,''l!._ Depth below inlet...... .......... Total leaching area-._--.-_-.--_____sq. ft.
z Other Distribution box ( ) Dosing tank
~' Percolation Test Results Performed b .___..-....t !tj r 4'�._.:_______________ Date...,.__-1_;S_' _�i_,____._..
a y ,(-� �
Test Pit No. 1................minutes per inch Depth of "Pest Pit.................... Depth to ground water------------------------
f� Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water--.-_.______-__.-__--.
i+ •---•------------------------------•-------..... --------------- -- - '
Descnptton of Soil £� . _ .: • ----- �x ------------
-----
x t ^
V ............. p='= f-. Z l`_ r_ %f_ .o r! /i J /L 1 r r f..
W
________________________________________________________________________________________________________________________________________________________________________________________________________
V Nature of Repairs or Alterations—Answer when applicable-----------------------___---•---.-•-._..-.-.-_.-.-_--.--._-.._._------_--...._-..-.-__._..-..
--------------------------------------------------------------------------------------•-----------------------------•-------------------------------------------------------------------------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued jbye ar f health.
Signed- ----1� -7 ?
1 Date
Application Approved B z`r = ..... ' '✓z =E �`�: ' ? -
PP PP Y
J r Date
Application Disapproved for the following reasons------------------------------------------------•----------------------------------------------------------------
-------------------------------------------------•---. --------------
Date
PermitNo......................................................... Issued...................... --------------•--•-•------------•
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.......... ^-[..,•r.�..............OF............ ...;.........................................
QIprrtif iratr of Tilutptiaurr
THIS,IS TP CERTIFY, That the/Individual Sewage Disposal System constructed ( G or Repaired ( )
by..... !� „! -- / •-- - -- --------------------------- - --------------------------
-r
�� / Installer
has been installed,Xn accordance with the provisions of A XI of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No. �.._N�___r............... dated .__yt,._-
'" ---------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE---- ! �` fit. L..- Inspector•--- ••. .--- • t -----------------------•--
: i ? r ».
of
+' t THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.....:.... �1�-,................OF...........,%. t� ................-............
No. ..........
FEE....�ff.............
Di spatial nrk C nn trixr i�ait, rrutit
Permission ' ereby granted....... 'j---•-----•-----------------------------•----------•----------
yr `E'n_ �f
to Construct l( ) or Repair ( )Fan Individual ewage D.isp s /System
_ l
wt
No----
as shown on the appZation for Disposal Works ConstructioZPFe it No::.. .... ... Dated... + ..c_1 __1 G.__._........
''' r�y.yaG.'-'.✓ --•--------------••-------------_
t Board of ealt
DATE................................................................................
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
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ACCESS COVERS MUST BE W!THIN
9" MINIMUM. INVERT EL E VA T l ONS : DESIGN CR II TER I A : GENERAL NO TES :
6" OF FINISH GRADE
100.79 FIRST G TO 3' MAX/MUM COVER
INVERT AT BUILDING: 96.7" DESIGN FLOW:
99.0 BE LEVEL MIN 2" OF PEASTONE INVERT IN SEPTIC TANK: 96.0 4 BEDROOMS AT l l 0 G.P.D. PER I. THIS PLAN IS FOR THE DESIGN AND CONSTRUCTION
97 2 99.0 Max OR FILTER FABRIC INVERT OUT SEPTIC TANK: 95.75 BEDROOM EQUALS 440 G.P.D. OF THE SEWAGE DISPOSAL SYSTEM ONLY.
4' DIAM PIPE 96•0 INVERT IN DIST. BOX: 95.37
96.7f 95.75 95.2 + 2 �' DOUBLE WASHED STONE INVERT OUT DIST. BOX: 95.2 NO GARBAGE GRINDER 2. VERTICAL DATUM IS ASSUMED. FOR BENCH MARKS
96.0 v Bn.7 �� 95.37 IX I 95.0 93.0 INVERT IN LEACH CHAMBER: -05.0
SET. SEE SI TE PLAN.
eAFFtE SEP T l C TANK REQUIRED
3 OUTLET 3-500 GAL LEACHING CHAMBERS / I BOTTOM OF LEACH CHAMBER: 93•0 iummemmumpml 440 G.P.D. X 200% - 880 GAL. J. ALL CONSTRUCTION METHODS AND MATERIALS AND
D-BOX W14' STONE AROUND. 12.8-'x x 33.5'1 x 2'd l�J ADJUSTED GROUND WATER: N/A
1500 GAL H-20 SEPTIC TANK- PROVIDED: /500 GAL. MIN. MAINTENANCE OF THE SEPTIC SYSTEM SHALL
OBSERVED GROUND WATER: N/A CONFORM TO MASS. D.E.P. TITLE 5 AND LOCAL
SEPTIC TANK 5' CRUSHED STONE OR BOTTOM OF TEST HOLE tel: 87.0 '
SOIL ABSORPTION SYSTEM REQUIRED: BOARD OF HEALTH REGULATIONS.
COMPACTED BASE
WEu DESIGN PERC RATE C 5 M I N/I NCH
PROF l L E : NOT TO SCALE SOIL TEXTURAL CLASS - 1 4. ALL SEPTIC SYSTEM COMPONENTS LOCATED UNDER
EFFLUENT LOADING RATE - 0.74 GPD/SF AREAS SUBJECT TO VEHICULAR TRAFF 1 C OR GREATER
440 GPD / 0.74 GPD/SF - 595 S.F, REQUIRED THAN 3 ' IN DEPTH SHALL BE CAPABLE OF WITH-
ST
ANDING H-20 WHEEL LOADS. _
PROVIDED: 3-500 GAL LEACHING CHAMBERS
W/4' STONE AROUND. A-614 S.F. 5. ALL SEWER PIPE SHALL BE SCHEDULE 40 PVC OR
614 S.F. x 0.74 - 454 G.P.D. APPROVED EQUAL. -
SOIL TEST P l T DA TA& 6. SEPTIC TANK AND D-BOX SHALL BE REINFORCED
PRECAST CONCRETE OR APPROVED POLYETHYLENE.
INDICATES �_ INDICATES BOTH SHALL BE WATERTIGHT. D-BOX SHALL BE WATER
PERCOLATION _ OBSERVED
TEST - GROUNDWATER TESTED FOR LEVEL WHEN THERE IS MORE THAN ONE
TP *1 P*15463 TP *2 OUTLET.
` - TEXTURE HORIZON TEXT COLOR HORIZON TEXTURE COLOR
_� �� o• - 97.0 0- 97.0 7. BEFORE CONSTRUCTION CALL 'DIG-SAFE".
LOAMY IOYR LOAMY IOYR
A SAND 212 'Q SAND 212 !-888-DIG-SAFE AND THE LOCAL WATER DEPT.
\ 6, 5' - - - - - - - - - - - - - - - 96.6 61 - - - - - - - - - - - - - - - 96.5 FOR LOCATION OF UNDERGROUND UTILITIES.
LOAMY IOYR p LOAMY IOYR
SAND 4/6 O SAND 4/6
- - - - - - - - - - - - - - -
__ '-so \ 24- - - - - - - - - - - - - - - - 95.0 22' - 9s.2 8. SEPTIC SYSTEM INSTALLER SHALL NOTIFY THE
� LOAMY IOYR LOAMY IOYR
-- - ` ` ` ` C l C l DESIGN ENGINEER TWO DAYS PRIOR TO CONSTRUCTION'
SAND FIRM 6/3 SAND FIRM 6/3
72' - - - - - - - - - - - - - - - 91.0 72' - - - - - - - - - - - - - - - 91.0 OF THE SYSTEM TO ALLOW FOR SCHEDULING OF THE
C2 LOAMY IOYR C2 LOAMY IOYR CONSTRUCTION INSPECTIONS.
SAND AND 5/4 SAND AND 5/4
GRAVEL GRAVEL
dp, STONES STONES 9. EXISTING SEPTIC SYSTEM TO BE PUMPED DRY AND
BACKFILLED.
/is oaK- '"84\CeRNER'BN `\ 1\ `��� � � \1 / �/l/// i20. NO (CATER e7.0 12 w WATER ✓ a7.o /0. ALL UNSUITABLE MATERIAL IA A B HZNS. Cl L:AYR)
EL�\/00 79 ENCOUNTERED BELOW THE INVERT OF THE LEACHING
DATE: AUGUST 24. 2017
TEST BY: STEPHEN HAAS FACT L I TY TO BE REMOVED FOR A DISTANCE OF 5'
EXI A /ENG
WI TNESSED BY: DONALD DESMARAI S AROUND AND REPLACED W i TH SAND I N ACCORDANCE
PERC RATE: f 2 MIN/INCH BY SIEVE TEST -
3-500 GALL07J `� `�\ 5(j>5 *2 SYS7IEM 1 I m \\ 1\11 1 1 1 1 I o I _
LEACHING CHAM$ERS \ 98.9 I v - WI TH TITLE 5.
� / 99.5 _
W/4' STONE AROt�D 98. 97 1500 G�LtON/+g OAK / m y WELL
\ TP*I SEPT NC TANK / .�• 1 / \1 1 1 y i 1 1 1
\ \ \ 10
•� \ .... \ \ ' I I I I \I 1 11 \ \ Wow
•fir I :: '`:'r._'.:: \ .� \ 24'QAK I ) / / ) I I / /
15
99.2 / I
y�o / cn':_:\:r: \\ D-BOX \ \ \\ F 99. r --
r1 SOIL REMOVA
SEE NOTE l S�pNE\wP t�i � / / // HELL ` ---
// roo.o
rn \
186,3A�21 // // -_9s, 98- 11 1 \ \
W
o SEPTIC VENT!----\ `\ 5 koy� SE� / T / C V / V T E ! V/ LJ E7 `J l C3 N
0
94 3ARNH I L L ROAD . MAP 108 . PARCE-L 20
�a WEST BARNS TABL E . MA .
P R E P A R E D F O R
L OCUS+ sT sr�F�� LEGEND
B O N,�N__-l__E M c NA L L Y
0 CB CONCRETE BOUND
rF s -W WATER L I NE
SCALE •� l 30 ' � AUGUST 29 20 17 y
O HYDRANT
G GAS LINE __-STERHEN A HAAS
OHW- OVER HEAD W/RES
14- LIGHT POST _ ENGINEERING , I NC
-E- UNDERGROUND ELECTRIC LINE h . O . B o x 16
°Q South Donnis MA 02660-T- UNDERGROUND TELEPHONE LINE NE I� h� � 8 p 8 3 6 2-8 1 32
EXIT 5 -CTV- UNDERGROUND C48LEVfSf ON LINE
+40.4 SPOT ELEVATION
� ) �(VIA ........40------- EXISTING CONTOUR
LOCUS S A P 0 15 30 60 40 PROPOSED CONTOUR JOB NO: 17-027