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HomeMy WebLinkAbout0410 CHURCH STREET - Health 410 CHURCH ST. ,W:BARNSTAB•LE MAP -.176 PAR-009 l 0 No. 4210 1/3 BL a ESSELTE 1 0% TOWN OF BARNSTABLE L C TION ®ChLr-G a SEWAGE# 0 VIL AGE BaCnSA01ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. _1�'1 .pG �Y►SEPTIC TANK CAPACITY 6//�� wl-"r CpnV LEACHING FACILITY:(type) (size) NO.OF BEDROOMS OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet J g h' 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 f l -00 J Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary g p y tary Assessments } 410 Church Street,West Barnstable, MA `' u Property Address Nathan W&Danielle k Herschler Owner Owners Name '- information is ' required for every West Bamsatable MA 02668 04/30/2019 page. City/Town State Zip Code Date of Inspection r., 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 Sly (38q3 filling out forms on the computer, REID C. ELLIS use only the tab key to move your Name of Inspector cursor-do not ELLIS BROTHERS CONSTRUCTION use the return Company Name key. 23 ENTERPRISE ROAD Company Address YARMOUTH PORT MA 02675 City/Town State Zip Code > 508-362-6237 S121891 Telephone Number License Number B. Certification 1 certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 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 th7esstem: 1. sses 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails Inspect ig t re Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note:This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 410 Church Street,West Barnstable, MA Property Address Nathan W& Danielle k Herschler Owner Owner's Name information is West Bamsatable MA 02668 04/30/2019 required for every State Zip Code Date of Inspection page Cityrrown C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: I have not found ny information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: 2) System Conditionally Passes: J' v ❑ One or more system components as descri d in the"Conditional Pass"section need to be replaced or repaired.The system, upon com letion 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" r the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltr tion or tank failure is imminent. System will pass inspection if the existing tank is replaced with a mplying septic tank as approved by the Board of Health. "A metal septic tank will pass inspection if it is s ucturally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than years old is available. ❑ Y ❑ N ❑ ND(Explain bel w): Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 Wnsp.doc-rev.7/2612018 Commonwealth of Massachusetts 1.. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments s!� 410 Church Street,West Barnstable, MA Property Address Nathan W& Danielle k Herschler Owner Owner's Name information is required for every West Barnsatable MA 02668 04/30/2019 page. cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes(cont.): ❑ Pump Chamber pumps/alarms not operation il. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out b r high static water level in the distribution box due to broken or obstructed pipe(s)or due to a b ken, settled or uneven distribution box. System will pass inspection if(with approval of Board of I iealth): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replace ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 tii nes a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval f the Board of Health): ❑ broken pipe(s)are replaced ❑` Y. ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ZA 3) Further Evaluation is Required by the Boaration alth: ❑ Conditions exist which require further evay the Board of Health in order to determine if the system is failing to protect public heal or the environment. a. System will pass unless Board of He ilth determines in accordance with 310 CMR 15.303(1)(b)that the system is not funct oning in a manner which will protect public health, safety and the environment: Lt5in g..doc-rev.7/262018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts nk Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 410 Church Street,West Barnstable, MA Property Address Nathan W& Danielle k Herschler Owner Owner's Name information is required for every West Bamsatable MA 02668 04/30/2019 page. CityfTown State Zip Code Date of Inspection C. Inspection Summary (coat.) ❑ Cesspool or privy is within 50 feet of surface water ❑ Cesspool or privy is within 50 feet of bordering vegetated wetland or a salt marsh b. System will fail unless the Board of He Ith(and Public Water Supplier, if any) determines that the system is functioning n a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil abi orption system (SAS)and the SAS is within 100 feet of a surface water supply or tributa to a surface water supply. ❑ The system has a septic tank and SAS ai id the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS ai id the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS ai id 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, erformed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the preser ce of ammonia nitrogen and nitrate nitrogen is equal to.or less than 5 ppm, provided that no other failL re 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 El clogged 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 t5insp.cloc-rev.7/26/2018 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 4 of 18 f Commonwealth of Massachusetts -f ,F Title 5 Official Inspection Form I� Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 410 Church Street,West Barnstable, MA Property Address Nathan W& Danielle k Herschler Owner Owner's Name information is West Bamsatable required for every MA 02668 04/30/2019 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes. No ❑ 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 day flow ❑ V. 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. ❑ ,L.�7/ Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ Any portion of a cesspool or privy is within 50 feet of a private p water supply well. ❑ L�`�'/ 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 ❑ 0and chain of custody must be attached to this form.] The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. Th❑ � e system farts. I have determined that one or more of the above failure allure 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 syst 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"o questions in Section CA. "no"to each of the following, in addition to the Yes No ❑ ❑ the system.is within 400 feet 5f a surface drinking water supply ❑ the system is within 200 feet f a tributary to a surface drinking water supply ❑ ❑ the system is located in a nit gen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Alne II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official in spection Form:Subsurface Sewage Disposal System•page 5 of 18 I Commonwealth of Massachusetts l Title 5 Official Inspection Form �_ to Subsurface Sewage Disposal System Form-Not for Voluntary Assessments sue ' 410 Church Street,West Barnstable, MA Property Address Nathan W& Danielle k Herschler Owner Owner's Name information is West Bamsatable required for every MA 02668 04/30/2019 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 ❑ 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? vo 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? :t! Were all system components, ewcluding 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)] t5insp.eoc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 r L\ Commonwealth of Massachusetts 3 Title 5 Official Inspection Form b Subsurface Sewage Disposal System(S 9 A y tem Form Not for Voluntary.Assessments 410 Church Street; West Barnstable, MA Property Address Nathan W& Danielle k Herschler Owner Owner's Name information is West Barnsatable required for every MA 02668 04/30/2019 page. d7of own State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): Description: Number of current residents: `� i�a�rf.e_a./ Does residence have a garbage grinder? El Yes Does residence have a water treatment unit? El Yes No If yes, discharges to: Is laundry on a separate sewage system?(Include laundry system inspection information in this report.) ❑ Yes /UO Laundry system inspected? Kin ❑ Yes Seasonaluse? ❑ Yes ;/No Water.meter readings, if available(last 2 years usage(gpd)): Detail: i_--A s 6 a sv Sump pump? ❑ Yes WNo Last date of occupancy: 5a, N i �_ Date I t5insp.doc-rev-7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts ,9 Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments i, 410 Church Street,West Barnstable, MA Property Address Nathan W& Danielle k Herschler Owner Owner's Name information is West Bamsatable required for every MA 02668 04/30/2019 page. City/Town State Zip Code Date of inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Alk 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: Source of information: ' '� e— e_e, Was system pumped as part of the inspection? L/ Yes ❑ No If yes, volume pumped: gallons How was quantity pumped determined? iv Reason for pumping: A/4 A.; t5insp.doc•r9v_7P26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts ,19 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments = ' 410 Church Street,West Barnstable, MA Property Address Nathan W&Danielle k Herschler Owner Owners Name information is West Barnsatable required for every MA 02668 04/30/2019 page. Cltyrrown State Zip Code Date of.lnspection D. System Information (cont.) 4. Type of ystem: 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 inform/ration: Were sewage odors detected when arriving at the site? ❑ Yes Y No 5. Building Sewer(locate on site plan): Depth below grade: C� GPI 22—it feet Mat rial of construction: cast iron V40 PVC ❑other(explain): p Distance from private water supply well or suction line: .2-0 e feet Comments(on condition of joints, venting, evidence of leakage, etc.): � A A Al "PAIL GSp . + t5insp.doc•rev 7I26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts v Title 5 Official Inspection Form Subsurface Sewage Disposal° 9 p System Form. Not for Voluntary Assessments 410 Church Street,West Barnstable, MA Property Address Nathan W&Danielle k Herschler Owner Ownets Name information is West Bamsatable required for every MA 02668 04/80/2019 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): _ Depth below grader feet Material of construction: concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain) xW If tank is metal, list ag . years Is age confirmed y a Certificate of Compliance?/ttach a copy of certi/cate) ❑ Yes ❑ o Dimensions: Sludge depth: �� Distance from top of sludge to bottom of outlet tee or baffle �l 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 y How were dimensions determined? 4— Comments(on pumping recommendations, inlet and outlet tee or baffle condition structural g etc.). 0 al integrity, liquid levels as related to outlet invert, evidence of leakage, g Y'ell AX Jr t5insp.doc.rev.7262018 Title 5 Offiaal insp ection Form:Subsurface Sewage Disposal System.Page 10 of to y Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 410 Church Street,West Barnstable, MA Property Address Nathan W& Danielle k Herschler Owner Owner's Name information is West Bamsatable required for every MA 02668 04/30/2019 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): / Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene El other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or Daffle Distance from bottom of scum to bottom of outlel 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 tin a of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fibergt ss ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5nsp.doc-rev.7@812018 Title 5 Official sp action Form:Subsurface Sewage Disposal System•Page 11 of 18 s Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 410 Church Street,West Barnstable, MA Property Address Nathan W&Danielle k Herschler Owner Owner's Name information is West Barnsatable required for every MA 02668 04/30/2019 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 switche , etc.): "Attach copy of current pumping contract(requ ed). Is copy attached? ❑ Yes ❑ No 9. Distribution Box resent if must b( p e opened) (locate on site plan): Depth of liquid level above outlet invert Comments(note if box is level and distribution to outlets equal, any evidence of ids carryover, any evidence of leakage into or out of box, etc.): h 44 N t5insp.dec-rev.M6/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments v� 410 Church Street,West Barnstable, MA Property Address Nathan W&Danielle k Herschler Owner Owner's Name information is every West Bamsatable required for eve MA 02668 04/30/2019 page. Citylrown 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: El Yes ❑ No" Comments(note condition of pump chamber, c ndition of pumps and appurtenances, etc.): *If pumps.or alarms are not in working order, stem is a conditional pass. 11. Soil Absorption System(SAS) (locate on site plan, excavation not required): If SAS not located, explain why: 5704-C / "Al 441 Type: ' ❑ leaching pits r number: leaching chambers number: I ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ _ innovative/alternative system Type/name of technology: t5insp.doc-rev,7/26P2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 410 Church Street,West Barnstable, MA Property Address Nathan W& Danielle k Herschler Owner Owners Name inforniationisWest Bamsatable required for every MA. 02668 04/30/2019 page. Cltyrrown 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.): r c 0 ppII 12. ces Cesspools p (cesspool must be pumped 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 Comments(note condition of soil, signs c f hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev-7f2612018 Idle 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts (P Title 5 Official Inspection Form la Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 410 Church Street, West Barnstable, MA Property Address Nathan W&Danielle k Herschler Owner Owner's Name information is West Bamsatable e required for every MA 02668 04/30/2019 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of ydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev_7/2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form ` Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 410 Church Street,West Barnstable, MA, Property Address Nathan W&Danielle k Herschler Owner Owner's Name information is West BamSatable required for every MA 02668 04/30/2019 page. Cdyfrown State Zip Code Date of-Inspection D. System Information (cont.) F . 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 ebb ilding. Check one of the boxes below. hand-sketch in the area below El drawing attached separately oi Ur 4147 Ir e i Z.; L .Zs•L Z C#s` 9 .� ; t5insp.doc•rev.7262D16 Title 5 Official Inspection Fomc Subsurface Sewage Disposal System•Page 16 of 16 Commonwealth of Massachusetts i. Title 5 Official Inspection Form f_ Subsurface Sewage.Disposal System Form-Not for Voluntary Assessments .V 410 Church Street,West Barnstable, MA Property Address Nathan W& Danielle k Herschler Owner Owner's Name information is West Barnsatable required for every MA 02668 04/30/2019 page. City town State Zip Code Date of Inspection D. System Information (cont.) 15: Site Exam: ❑ Check Slope ❑ Surface water , ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 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: You must describe how you established the high groun water elevation: 00, +tev­r '�W Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev-7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Di g sposal System•Page 17 of 18 Commonweatth of Massachusetts Title 5 Official Inspection Form 1. Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 410 Church Street,West Barnstable, MA Property Address Nathan W& Danielle k Herschler Owner Owner's Name info rmation Is West Barnsatable required for every West 02668 04/30/2019 page_ Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist Compl all applicable sections of this form inclusive of: Inspector Information: Complete all fields in this section. .B.'Certification: Signed&Dated and 1, 2, 3, or 4 checked C. Inspection Summary: 1,2, 3, or 5 completed as appropriate 4(Failure Criteria)and 6 (Checklist)completed D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation p anon of estimated depth to high groundwater included ' I I Lt5insp.doe•rev.7/26/2018 Title 5 Official In Forth:Subsurface Sewage Disposal System•Page 18 of 18 rtIK�. I.J. L V I J. f J 1 ITI ivu. I),i3 F. [ - F CERTIFICATE OP ANALYSIS Barnstable County Health Laboratory (M-MA009) °,^C-HU, Redpienb Reid C.Ellis order No.: G19IL2906 Ellis Brothers Construction Report Dated: 05/04/2019 23 Enterprise Rnad,P D Box 59 Submitter: Ellis,Reid Yarmouthport, MA 02675 Description: RE I0t-410 Church St. Laboratory ID#., 19112906-01 Water-Drinking water Sample#: Sampled., 04/30/z019 12:40 By. Customer Collection Addr: 410 Church St W.Barnstable,MA Received: 04/30/2019 15:25 By: Palmeri) Sample Location: Turn Around: Standard Analy5D yn Method: EPA 524.2 Dilution:1 Date Analyzed: 05/01/Z019 @ 16:36 EPA 524.2- Volatile OrgankS by GC/MS Result AQL utt MCL K Parameter ug/L ug/L u9/t. Parameter ug/L ug/L ug/L Dichlorodinuoromethene NO 0.50 Chlomethane NO 0.50 Chloromethane NO, 0.50 Chloroform ND 60 0:50 Vinyl chloride NO 2.0 0.50 rig-1,2-Dichlomethene NO 70 0.50 Bromomethane NO 0.50 cig-1,3-1)ichloropmpene NO 0.50 1,1,1,2-Tetrachloroethane NO 0.50 Dibromochlnromethane ND 0.50 1,1,1-Trichloroethane NO 200 0.50 Dibromomethane NO 0.50 1,1,2,2-Tetrachloroethane NO 0.50 Ethylbenzene NO 700 asa 1,1,2-Trlchloroethane NO 5.0 0.50 htexacdorobutedle ne NO 0.50 l,i-Dlchloroethane NO D-SO Isopropylbenzene ND 0.5a l,1-Dlchloroethene NO 7.0 0.50 1 Mefhylene chloride ND s.o 0.50 1,1-Dlchloropropene NO 0.50 Methyl-tert-butyl ether 0.66 0.50 1,2,3-Trichlombenzene NO 0.50 Naphthalene NO 0S0 1,2,3-Trlchlorbprapane ND 0.50! n-Outyibenzene NO 0.50 1,2,4-Trichlorobenzene. NO 70 0.0 n-Propylbenzfene ND MCI 1,2,4-Trimethylbenzene NO o.50 p-Isaprvpybluene NO 0.50 1,2-Dibromo-lchloropmpane NO 0-so sec-Butylbenzene NO 0.50 1,Z-Dibromoethane(EDB) ND 0.50 styrene NO 100 0.50 1,2-Dichlorobenzene NO 500 0.50 tert Bu ylbenzene NO 0.50 i,Z-Dirhlomethane ND 5.0 0.50 Tetrarilloruetherie ND 5.0 Mo 1,2-Dichloropropane NO 0.50 Toluene NO 1000. 0.50 1,3,5-Trimethyibenzene ND 0.50 Total xylenes ND 10000 as0 1,3-Oidfilorobemene NO 0.50 trans-1,2-131chloroethene ND 100 0.30 1,3-Dtdnloropropane NO 0.50 trans1,3-Dlchloropropene ND 0.50 1,4-DldhlorAbenzene ND 5.0 0.50 rtchioroethene ND 5.0 0.50 Z,Z-oldhloropropane ND 0.50 Tdchlorofluoromethane NO 0.50 2 Chlarotoluene NO 0.50 Compound %Recovered QC Umits(/Q) 4-CNorotoluene NO 0.50 1,"lchlorobenzene-d4 105% 70 130 Benzene ND 5.0 0.50 p Bromofluorabenzene 89% 70 T 130 Bromobenzene ND 0.50 eromochloromethane ND 0.50 eromodlehloromethane ND 0,50 Bromoform NO 0.50 Carbon tetrachloride ND 5.0 0.50 Chlorobenzene ND too 0.50 Approved Sy,- i11--- Attached please find the laboratory certified parameter list. (Lab Director) No=None Detected RL = RepoMfig llmit MCI-a Ma)dmum Contaminant level 3195 Main Street, P0.Box 427, Pamstabie, MA 02630 Ph: 508-375-6505 Page 1 of L may. IJ. L V 1 7 1:?7rIVI No. 1h43 F, 1 a CERTIFICATE OF ANALYSIS I SIS Barnstable County Health Laboratory (M-MA009) Recipient: Reid C.Ellis Order No: G19112906 Ellis Brothers Construction Report Dated: 0 / /2 p 5 04 019 23 Enterprise Road,P O Box 59 Submitter. Ellis,Reid Yarmouthport. MA 02675 Description: RE IQ-410 Church St. Laboratom IN: 19112906-01 Matrix: Water-Drinking Water Sample 0, Sampled: 04/30/2019 12:40 D)r Customer Collect+on Address: 410 Church$t.W.Barnstable,MA Received; 04/30/2019 15.25 By; Patmew Sample Location: Turn Around. Sianderd Rouiff?e ITEM RESULT UNITS RL MCL METHOD ANALYST TESTED TIME Nitrate as Nitrogen 4.2 mg/L 0.10 10 EPA 300.0 LAP 06/0112019 9:41 Copper ND mg/L 0,10 1.3 sM 31119 LAP 05/01/2019 18:57 Iron ND mg/L 0.10 0.3 SM3111B LAP 05/01/2019 16.59 pH 7.0 PH AT 25C NA 6.".5 SM 4500-" DCB 04/30/2019 16:66 Sodium 15 mglL 2.6 20 SM 3111 D LAP os/01/2019 16:57 Total Coliform Absent PIA 0 0 SM 92230 RG 04/30/2019 16:60 Conductance 230 umohslcm 2.0 EPA 120.1 DCB 04130=19 16:55 Based on the results of the paremetars tested,the water is suitable for drinking. Attached please find the laboratory certifled parameter list. Approved By. (Lab Director) ND=None Detected RL = Reporting Umlt MCL=Mtt dmurn Contaminant Level 31515 Mein RftP.t. PO. Box 427. Barnstable. MA 02630 Ph:508»375.6605 Pose: t of 1 y. IJ. cv17 i;yrm No. 1543 F. 1 . COMMONWEALTH OF MASSACHUSETTS DEPARTMENT OF EWIkONMENTAL PROTECTION Certified Parameter List as of 01 Jul 2018 M-MA009 BARNSTABLEE-COUNTY HEALTH&ENV DEPT,BARNSTABLE,MA AnaAnalVteS Who-for NON-Potabla Water Methods for Potable Water ALUMINUM EPA 200.8 EPA 200.8 ANTWONY EPA 200.8 EPA 200.8 ARSENIC EPA 200.8 EPA 200,8 BARIUM EPA 200.8 BERYLLIUM EPA 200.8 EPA 200.8 CADMIUM EPA 200.6 EPA 200.8 CHROMIUM EPA 200.8 EPA 200.8 COBALT EPA 200.8 COPPER EPA 200.8,SM 31118 EPA 200.8;SM 31118 IRON SM 31110 LEAD EPA Z00.8 EPA 200.8 MANGANESE EPA 200.6;SM 31110 EPA 200.0 - MERCURY EPA 200.8 NICKEL EPA 200.8;SM 3111E EPA 200,8;SM 31118 SELENIUM EPA 200.8 EPA 200.8 SILVER EPA 20D.8 THALLIUM EPA 200.8 EPA 200.8 VANADIUM EPA 200,6 ZINC EPA 200.8;SM 21118 PH SM 45t10.H•B SM 4500-H•B SPECIFIC CONDUCTIVITY EPA 120.1;SM WOO HARDNESS(CAC03),TOTAL SM 23408 CALCIUM SM 3111B MAGNESIUM SM 31118 SODIUM SM 311113 POTASSIUM SM 31110 ALKANILITY,TOAL SM 2320B SM 23208 CHLORIDE EPA 300.0 FLUORIDE EPA 300.0 SULFATE EPA 300.0 EPA 300,0 NITRATE-N EPA 300.0 EPA 300.0 NITRITE-N EPA 300.0 TURBIDITY EPA 180.1 AMMONIA-N EPA 350.1 KJELDAHL•N EPA 351.2 TOTAL CYANIDE EPA 33&4 EPA 335.4 TOTAL DISSOLVED SOLIDS SM 2540C SM 2540C NON-FILTERABLE RESIDUE(TSS) SM 2540D TOTAL ORGANIC CARBON SM 5310B OHEMICAL OXYGEN DEMAND HACH METHOD 8000 BIOCHEMICAL OXYGEN DEMAND SM 52108 TRIHALOMETHANES EPA 524.2 VOLATILE ORGANIC COMPOUNDS EPA 524.2 PERCHLORATE. EPA 314.0 HETEROTROPHIC PLATE COUNT SM 9215E TOTAL COLIFORM MF-SM 9222E TOTAL COLIFORM EPA 1004 TOTAL COLIFORM ENZSUB.SM 9223 FECAL.COLIFORM MF-SM 9222D MF-SM 9222D' E.COLI EPA 1603 EPA 1604 E.COLI . EPA 1103.1 NA-MUGSM92220 E.COLI MF-SM 9213D ENZ.SUB,SM 9223 ENTEROCOCCI EPA 1600 EPA 1600 Etfeetive bate;01 J41y 2418 Explr8II0n D81e;30 Jun 2019 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for.Voluntary Assessments 410 Church Street, West Barnstable, MA 02668 Property Address r.a+ H. Peter&Anne C C Aitken Owner Owner's Name information is �/ ��� required for every West Barnstable MA 02668 11/25/2015 M: 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 on the computer, 51# use only the tab 1. Inspector: key to move your cursor-do not REID C. ELLIS use the return Name of Inspector key. ELLIS BROTHERS CONSTRUCTION rQ Company Name 23 ENTERPRISE ROAD AA Company Address r YARMOUTH PORT MA 02675 Cityrrown State Zip Code 508-362-6237 S121891 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/(31CMR 16.000).The system: ses ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority Inspectors 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. t5ins•3/13 Tdle 5 Official Inspection Form:Subsurface Sewage Dispo al emn•Pa e•1 of 17 Y 9 t Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 410 Church Street, West Barnstable, MA 02668 Property Address H. Peter&Anne C C Aitken Owner information is Owner's Name required for every West Barnstable MA 02668 11/25/2015 page. Cityfrown 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: ej 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 evalu ated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as de cribed in the"Conditional Pass" section need to be replaced or repaired. The system, upon ompletion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determi ed"(Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years c d*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration ore iltration or tank failure is imminent. System will pass inspection if the existing tank is replaced wit 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 tt an 20 years old is available. ❑ Y ❑ N ❑ ND(Explai below): t5ins•3113 Title 5 Official tnspection Fond: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 410 Church Street, West Barnstable, MA 02668 Property Address H. Peter&Anne C C Aitken Owner Owner's Name information is required for every West Barnstable MA 02668 11/25/2015 page. Cltyfrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. ystem will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or I igh static water level in the distribution box due to broken or obstructed pipe(s)or due to a brok n, 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 tim s:Board due to broken or obstructed pipe(s). The system wilt-pass inspection if(with approval of a 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 Wtheo)ard of Health: ❑ Conditions exist which require further eva ation by the Board of Health in order to determine if the system is failing to protect public heal h, safety or the environment. 1. System will pass unless Board of H alth determines in accordance with 310 CMR 15.303(1)(b)that the system is not fun Toning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 fee of a surface water ❑ Cesspool or privy is within 50 feel of a bordering vegetated wetland or a salt marsh t5ins•3/13 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts a Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 410 Church Street,West Barnstable, MA 02668 Property Address H. Peter&Anne C C Aitken Owner Owner's Name inormation is every West Barnstable requiredforeve MA 02668 11/25/2015 page. C4rrown 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 functionin 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 tributai y to a surface water supply. ❑ The system has a septic tank and SAS C nd the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS nd the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and he 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 prese ice of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other fail ire 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 ❑ Ey' 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/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 ay 410 Church Street,West Barnstable, MA 02668 Property Address H. Peter&Anne C C Aitken Owner Owner's Name information is required for every West Barnstable MA 02668 11/25/2015 page. Cdyrrown 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. ❑ An portion cesspool of a r Y p p o 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- EJ ❑ 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/Bod of Health to determine what will be necessary to correct the failure._ - E) Large Systems: To be considered a large systemstem 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"n "to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of E surface drinking water supply ❑ ❑ the system is within 200 feet of z tributary to a surface drinking water supply ❑ the system is located in a nitrogc n 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 systen I 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 sys m owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Ins pection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form e Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 410 Church Street,West Barnstable, MA 02668 Property Address H. Peter&Anne C C Aitken Owner Owner's Name information is required for every West Barnstable MA 02668 11/25/2015 page. cityrrown State Zip Code Date of Inspection C. Checklist Check if the followinghave been done. You ou must indicate"yes"or"n "y o as to each of the followin 9 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) Vj ❑ 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,4kcluding 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). Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 410 Church Street,West Barnstable, MA 02668 Property Address H. Peter&Anne C C Aitken Owner Owner's Name information is required for every West Barnstable MA 02668 11/25/2015 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: Does residence have a garbage grinder? ❑ Yes [t/No Is laundry on a separate sewage system?(Include laundry system inspection information in this report.) ❑ Yes No Laundry system inspected? ❑ Yes EP No Seasonaluse? ❑ Yes No Water meter readings, if available(last 2 years usage(gpd)): Detail: I Sump pump? a ❑ Yes No Last date of occupancy: /4 Date CommerciaUlindustrial Flow Conditions: '/t' Type of Establishment: t 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 Sys t ? ElYes ❑ 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 s, Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 410 Church Street, West Barnstable, MA 02668 Property Address H. Peter&Anne C C Aitken Owner Owner's Name information is West Barnstable required for every MA 02668 11/25/2015 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: Was system pumped as part of the inspection? Pr/Yes El No If yes, volume pumped: 15 c75-17 77—ons ��, How was quantity pumped determined? Reason for pumping: �� �" � A Type of yytem: 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of V Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 410 Church Street,West Barnstable, MA 02668 Property Address H. Peter&Anne C Aitken Owner Owner's Name information is every West Barnstable required for eve MA 02668 11/25/2015 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: A-/"-A/ Cr i-s ��✓��I�S 1�t T�l._c- q- Were sewage odors detected when arriving at the site? ❑ Yes t�r No Building Sewer(locate on site plan): Depth below grade: i feet Mate ial of construction: ;r ����f�+4,� 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.): f / Septic Tank(locate on site plan): Depth below grade: feet Material of construction: �ncrete ❑ metal ❑fiberglass ❑ polyethylene El other(explain) d If tank i et ,list age: A A. / years Is a e conf e�� by a 4ertificate of Compliance? /ftach a Pcopy o�te ref/Yes Dimensions: �L r Sludge depth: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts H y Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 410 Church Street, West Barnstable, MA 02668 Property Address H. Peter&Anne C C Aitken Owner Owner's Name information isequired or every very West Barnstable MA 02668 11/25/2015 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 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 t How were dimensions determined? AAL — Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as r lated to utlet i gvert, evid nce of leakage, etc.): e� elAttj Grease Trap (locate on site plan): r Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fib rglass ❑ polyethylene y ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or affle Distance from bottom of scum to bottom of outle tee or baffle Date of last pumping: Date t5ins•3/13 "le 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form _ a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �A. 410 Church Street, West Barnstable, MA 02668 Property Address H. Peter&Anne C C Aitken Owner Owner's Name information isequired or every very West Barnstable MA 02668 11/25/2015 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations d/�utlet p 9 tee or baffle condition, structural Integrity, liquid levels as related to outlet invert, evidenc of leakage, etc.): Tight or Holding Tank(tank must be pump at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ berglass ❑ polyethylene El 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 switch , etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 410 Church Street, West Barnstable, MA 02668 Property Address H. Peter&Anne C C Aitken Owner Owners Name Information is every west Barnstable required for eve MA 02668 11/25/2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on FA6plan): Depth of liquid level above outlet invert p �Zi )carrryover, � Comments(note if box is level and distribution to outlets equal, any evidence of s any evidence of leakage into or out of box, etc.): r , , Pump Chamber(locate on site plan): O� Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, c ndition of pumps and appurtenances, etc.): *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 410 Church Street, West Barnstable, MA 02668 Property Address H. Peter&Anne C C Aitken Owner Owners Name information is West Barnstable required for every MA 02668 11/25/2015 page. CrtylTown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: — teaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool numb er: ❑ 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_): N i Cesspools (cesspool must be pumped as p f 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-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 410 Church Street,West Barnstable, MA 02668 Property Address H. Peter&Anne C'Aitken Owner Owner's Name information is required for every West Barnstable MA 02668 11/25/2015 page. Cttyrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hyd ulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Q Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of h draulic 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 Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments . 410 Church Street, West Barnstable, MA 02668 Property Address H. Peter&Anne C C Aitken Owner owner's Name information is required for every West Barnstable MA 02668 11/25/2015 page. Cityrrown State Zip Code Date of Inspection D. System Information (cons_) 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 �echere public water supply enters the building_ Check one of the boxes below: R hand-sketch in the area below Q drawing attached separately Al / r 6 ° 2- ' t .♦ / 1 L 241 E3 . 2P 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 410 Church Street, West Barnstable, MA 02668 Property Address H. Peter&Anne C C Aitken Owner Owner's Name information is required for every West Barnstable MA 02668 11/25/2015 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope f/y' ❑ Surface water /t/2I',— ❑ Check cellar e/7-,-t vv- ❑ Shallow wells w�� Estimated depth to high ground water: 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 US GS database-explain: ell u must describe how you established the high ground water elevation: s �� A D 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 4 0 Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 410 Church Street, West Barnstable, MA 02668 Property Address H. Peter&Anne-CC Aitken Owner Owners Name information is West Barnstable required forever MA 02668 11/25/2015 page. Cityrrown State Zip Code Date of inspection E. 7�spectict ort Completeness Checklist n Summary:A, B, C, D, or E checked nspection Summary D (System Failure Criteria Applicable to All Systems)completed ystem Information—Estimated depth to high groundwater 5 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 pARs, CERTIFICATE OF ANALYSIS Page: 1 of 1 w _ Barnstable County Health Laboratory (M-MA009) - tY Report Prepared For: Report Dated: 12/4/2015 Reid C. Ellis Ellis Brothers Construction Order No.: G1591210 23 Enterprise Road, P 0 Box 59 Yarmouthport, MA 02675 Laborator✓ ID 0: 101210-01 Description: Water-Drinking Water Sample#: Sample Location: 410 Church St,W Barnstable Collected: 11/25/2015 j Collected by: Customer map 176 parcel 009 Received: 11/25/2015 I Routine ITEM RESULT UNITS RL MCL METHOD# ANALYST TESTED NOTE i Nitrate as Nitrogen 7.4 mg/L 0.10 10 EPA 300.0 LAP 11/25/2015 j Copper 0.13 mg/L 0.10 1.3 SM 3111 B LAP 12/3/2015 Iron ND mg/L 0.10 0.3 SM 3111B LAP 12/3/2015 I pH 7-.0 PH AT 25C NA 6.5-8.5 SM 4500-H-B DCB 11/25/2015 Sodium 29 mg/L 2.5 20 SM 3111B LAP 12/3/2015 Total Coliform 0 /100ml 0 0 SM 9222B RG 11/25/2015 Conductance 400 umohs/cm 2.0 . EPA 120.1 DCB 11/25/2015 Sodium level is above the maxium contaminant level. Those on a low sodium diet may wish to consult a physician. Attached please find the laboratory certified parameter list. Approved By: _ 0' (Lab Director) / ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level 31195 Main Street, P0. Box 427, Barnstable, MA 02630 Ph: 508-375.6605 CERTIFICATE OF ANALYSIS 3 Barnstable County Health Laboratory (M-MA009) Recipient: Reid C. Ellis Matrix: Water-Drinking Water Ellis Brothers Construction Sampled: 11/25/2015 11:25 23 Enterprise Road,P O Box 59 Received: 11/25/2015 11:38 Yarmouthport, MA 02675 Collection Address: 410 Church St,W Barnstable Order#: G1591210 Sample Location: map 176 parcel 009 Lab ID: 1591210-01 Description: R E IGt Sample#: Date Analyzed: 11/30/2015 @ io:oo Method: EPA 524.2 Analyst: ynDilution Factor: 1 Comment: Sodium level is above the maxium contaminant level.Those on a low sodium diet may wish to consult a physician. 1 i EPA 524.2- Volatile Organics by GC/MS Result MCL MDL Result MCL MDL Parameter ug/L ug/L ug/L Parameter ug/L ug/L ug/L Dichlorodifluoromethane ND 0.50 i Chloroform ND 80 0.50 Chloromethane I ND o.so as-1,2-Dichloroethene ND 70 0.50 vinyl chloride ND 2.0 0.50 cis-1,3-DldUoropropene ND i 0.50 Bromomethane ND 0.50 Dibromochloromethane ND 0.50 1,1,1,2-Tetrachloroethane ND. 0.50 Dibromomethane ND. 0.50 1,1,1-Trichlorcethane ND 200 0.50 Ethylbenzene ND 700 0.50 1,1,2,2-Tetrachloroethane ND 0.50 Hexadhlorobutadiene ND 0.50 1,1,2 Trichloroethane ND 5.0 0.50 Isopropylbenzene ND I 0.50 1,1-Dichloroethane ND 0.50 Methylene chloride ND 5.0 0.50 1,1-Dichloroethene ND 7.0 0.50 Methyl-tert-butyl ether ND 0.5o 1,1-Dichloropropene ND 0.50 Naphthalene ND 0.50 1,2,3-Trichlorobenzene ND 0.50 n-Butylbenzene ND 0.50 1,2,3-Trichloropmpane ND 0.50 n-Propylbenzene ND 0.50 1,2,4-Trichlorobenzene ND 70 0.5o p-Isopropyltoluene ND o.so - 1,2,4-Tomethylbenzene_ _._,_ . ND I_ 0.50 __ sec-6utylbenzene ND _ 0.50 1,2-Dibromo-3-chloropropane FY ND 0.50 Styrene ND 100 0.50 1,2-Dibromoethane(EDB) ND 0.50 tert-Butylbenzene ND 0.50 1,2-Dichlorobenzene ND 600 i 0.50 Tetrachlor ethene ND 5.0 0.50 1,2-Dichloroethane ND 5.0 0.50 Toluene ND loon 0.50 1,2-Dichloropropane ND 0.50 Total xylenes ND 10000 0.50 1,3,5-Trimethylbenzene ND 0.50 trans-1,2-Dichloroethene ND 100 0.50 1,3-Dichlorobenzene ND 0.50 trans-1,3-Dichloropropene ND 0.50 1,3-Dichloropropane ND 0.50 Ttichloroethene ND 5.0 0.50 1,4-Dichlorobenzene ND 5.0 0.50 Trichlorofluoromethane ND 0.50 2,2-Dichloropropane ND 0.so 2-Chlorotoluene ND 0.50 Surrogates %Recovered QC Limits(%) 4-Chlorotoluene p-Bromofluorobenzene 91% 70 130 ND 0.50 Benzene 50 1,2-Dichlorobenzene-d4 98% 70 130 ND 5.0 0. Bromobenzene ND aso 113romochloromethane ND 0.50 Bromodichloromethane ND 0.50 Bromoform ND 0.50 Carbon tetrachloride ND 5.0 0.so Chlorobenzene ND 100 0.50 Chloroethane ( ND o.so Attached please find the laboratory certified parameter list. Approved B `C yd7 (Lab Director) ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Lever 3195 Main Street, P0. Box 427, Barnstable, MA 02830 Ph: 508-375-6006 Page 1 of 1 I - COMMONWEALTH OF MASSACHUSETTS DEPARTMENT OF ENVIRONMENTAL PROTECTION Certified Parameter List as of.01 Jul 2016 M-MA:009 BARNSTABLE COUNTY HEALTH&ENV DEPT,BARNSTABLE,MA Anal es Methods for NON-Potable Water ALUMINUM EPA 200.8 Methods for Potable Water ANTIMONY EPA 200.8 ARSENIC EPA 200.8 BARIUM EPA 200.8 EPA 200.8 BERYLLIUM EPA 200.8 EPA 200.8 � EPA 200.8 CADMIUM EPA 200.8 CHROMIUM EPA 200.8 EPA 200.8 EPA 200.8 COBALT EPA 200.8 COPPER EPA 200.8;SM 31118 IRON EPA 200.8;SM 31118 LEAD SM 3111B MANGANESE EPA 200.8 EPA 200.8 MERCURY EPA 200.8;SM 31118 NICKEL EPA 200.8 EPA 200.8;SM 311113 SELENIUM EPA 200.8 EPA 200.8;SM 3111 B SILVER EPA 200.8 EPA 200.8 EPA 200.8 THALLIUM EPA 200.8 VANADIUM EPA 200.8 ZINC EPA 200.8 PH EPA 200.8;SM 3111 B SPECIFIC CONDUCTIVITY SM 4500-H-13 SM 4500-H-8 EPA 120.1;SM 2510B HARDNESS(CAC03),TOTAL SM 2340B CALCIUM SM 3111 B MAGNESIUM SM 3111E SM 3111B SODIUM SM 3111 B POTASSIUM SM 3111-B SM31i1B ALKANILITY,TOAL SM 2320B CHLORIDE SM 2320B - --- - _ EPA 300.0 FLUORIDE - -- - -- SULFATE EPA 300.0 EPA 300.0 ` NITRATE-N EPA 300.0 EPA 300.0 NITRITE-N EPA 300.0 TURBIDITY EPA 300.0 TOTAL DISSOLVED SOLIDS SM 2540C EPA 180.1 NON-FILTERABLE RESIDUE(TSS) SM 2540D SM 2540C TOTAL ORGANIC CARBON SM 5310B CHEMICAL OXYGEN DEMAND HACH METHOD 8000 BIOCHEMICAL OXYGEN DEMAND SM 5210B TRIHALOMETHANES VOLATILE HALOCARBONS EPA 624 EPA 524.2 VOLATILE AROMATICS ' EPA 624 VOLATILE ORGANIC COMPOUNDS 1,2-DIBROMOETHANE EPA 524.2 1,2-DIBROMO-3-CHLOROPROPANE EPA 504.1 PERCHLORATE EPA 504.1 EPA 314.0 HETEROTROPHIC PLATE COUNT TOTAL COLIFORM SM 9215E TOTAL COLIFORM MF-SM 92226 --- --- --_.-._EPA 1604 TOTAL COLIFORM FECAL COLIFORM MF-SM 9222D ENZ.SUB.SM 9223 E.COLI EPA 16.03 MF-SM 9222D E.COLI EPA 1604 EPA 1103.1 NA-MUG-SM9222G E.COLI MF-SM 9213D ENZ.SUB.SM 9223 ENTEROCOCCI EPA 1600 EPA 1600 Effective Date:01 July 2015 EYnirnfinn n�f . I W &i Yrs � 7 nn 1 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 410 Church Street, West Barnstable, MA 02668 Property Address Frederick M and Nancy O'Regan, P. O. Box95)r, West Barnstable Owner Owner's Name information is required for every West Barnstable MA 02668 08/14/2013 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 n ell the computer, \ I /l use only the tab 1. Inspector: v v key to move your cursor-do not REID C. ELLIS use the return Name of Inspector key. ELLIS BROTHERS CONSTRUCTION VQ-11 Company Name 23 ENTERPRISE ROAD Company Address YARMOUTH PORT MA 02675 City/Town State Zip Code 508-362-6237 S121891 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 TitleZQCMR 15.000).The system: ses ❑ Conditionally Passes ❑ Fails E r' rn ElNeeds Further Evaluation by the Local Approving Authority `3 'oe ¢-= ` InspeInspe 'cto sr sr Signature Date rry The system inspector shall submit a copy of this inspection report to the Approving Auth rI (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. 46 �/� t5ins•3113 Title 5 Official Inspedi TF : ubsurface Sewage Disposal System•Page 1 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 410 Church Street,West Barnstable, MA 02668 Property Address Frederick M and Nancy O'Regan, P. O. Box957,West Barnstable Owner Owner's Name information is required for every West Barnstable MA 02668 08/14/2013 page. Cityfrown 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 founranyformation 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 df scribed in the"Conditional Pass"section need to be replaced or repaired. The system, upoi completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not detern fined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years Id*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or i lxfiltration 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 t is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less i han 20 years old is available. ❑ Y ❑ N ❑ ND(Explai i below): t5ins-3h.3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 410 Church Street, West Barnstable, MA 02668 Property Address Frederick M and Nancy O'Regan, P. O. Box951, West Barnstable Owner Owner's Name information is required for every West Barnstable MA 02668 08/14/2013 page. City/town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. ystem will pass with Board of Health approval if pumps/alarrms are repaired. B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break o 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 o Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaci d ❑ Y ❑ N ❑ ND(Explain below): ❑ The system: required pumping more than 4 mes 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): Af C) Further Evaluation is Required by the B rd of Health: ❑ Conditions exist which require further evalu tion 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 Heal th determines in accordance with 310 CMR 15.303(1)(b)that the system is not functh ining in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet o a surface water ❑ Cesspool or privy is within 50 feet o a bordering vegetated wetland or a salt marsh thine-3113 Title 5 Oftel Inspection Form:Subsurface Swap Disposal System-Pose 3 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 410 Church Street,West Barnstable, MA 02668 Property Address Frederick M and Nancy O'Regan, P. O. Box95y, West Barnstable Owner Owner's Name information is required for every West Barnstable MA 02668 08/14/2013 page_ Cityrrown State Zip Code Date of Inspection B. Certification (cons.) 2. System will fail unless the Boar of ea h(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 tribu ary 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 an J 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 pre ence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other fi filure 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 ❑ L.�/ 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•313 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 410 Church Street, West Barnstable, MA 02668 Property Address Frederick M and Nancy O Re9 an, P. O. Box957,,West Barnstable Owner owner's Name information is required for every West Bamstable MA 02668 08/14/2013 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: ❑ VAny 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 20009pd- 10,000gpd. The system fails. I have determined that one or more of the above failure El criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should cont ct the Board of Health to determine what will be necessary to correct th i re. E) Large Systems: To be considered a larg 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 4 0 feet of a surface drinking water supply ❑ ❑ the system is within 2 0 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located i i a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a ma ped Zone II of a public water supply well If you have answered"yes"to any question I Section E the system is considered a significant threat, or answered"yes" in Section D above the la ge system has failed. The owner or operator of any large system considered a significant threat undei(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. 15ins-3113 Title 5 Official Inspection Forth: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 , 410 Church Street,West Barnstable, MA 02668 Property Address Frederick M and Nancy O'Regan, P. 0. Box951, West Barnstable Owner Owner's Name information required forevery West Barnstable MA 02668 08/14/2013 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? El were all system components,f�cluding 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? I/ 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 Soft!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): - Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): t5ins-3112 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 f N Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,..�' 410 Church Street,West Barnstable, MA 02668 Property Address Frederick M and Nancy O'Regan, P. O. Box951,West Barnstable Owner Owner's Name information is required for everyWest Barnstable MA 02668 08/14/2013 page. CO/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: Does residence have a garbage grinder? ❑ Yes /No Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes Vt o information in this report.) Laundry system inspected? ElYesVNo Seasonal use? El Yes Water meter readings, if available(last 2 years usage(gpd)): Detail: - Sump pump? %! ❑ Yes No Last date of occupancy: 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.fL, etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 sys m? ❑ Yes ❑ No Water meter readings, if available: t5ins,3M 3 Title 5 Official tnspection Forth:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts 9y Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 410 Church Street,West Barnstable, MA 02668 Property Address Frederick M and Nancy O'Regan, P. O. Box951,West Barnstable Owner Owner's Name information is required forevery West Barnstable MA 02668 08/14/2013 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occu anc /use: s t p y Date Other(describe!below): General Information Pumping Records: Source of information: `� Was system pumped as part of the inspection? ❑ Yes (/No If yes, volume pumped: 1+- -N 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/Altemative 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•3113 Title 5 Official Inspection Form:Subsurface Sevrage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments b 410 Church Street,West Barnstable, MA 02668 Property Address Frederick M and Nancy O'Regan, P. O. Box957,West Barnstable Owner Owner's Name - requir required is west Barnstable MA 02668 08/14/2013 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Z, -t ,;-I- W 97- -6i? Approximate age of all components, date installed (if known)and source of information: 1 Were sewage odors detected when arriving at the site? ❑ Yes 8"'No Building Sewer(locate on site plan): n Depth below grade: feet Mat lal of constructi;/40 cast iron PVC El other(explain): r;-c7 i-�— Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: loll feet VeI of construction: rete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain) If tane: y ars Is ge.Alnfirmed by a Certificate of Compl/nce? ach a copy of certificate) 41"Yes ❑ /0 ) imensions: > Sludge depth: b � t5iru•W 3 Title 5 Of6dal Inspection Forth:Subsurface Sawage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments klr�w 410 Church Street,West Barnstable, MA 02668 Property Address Frederick M and Nancy O'Regan, P. O_ Box9U, West Barnstable Owner Owner's Name informrequired is West Barnstable MA 02668 08/14/2013 required for.,very page. Citylrown State Zip Code Date of Inspection D. System Information (cunt.) Septic Tank(cunt.) Distance from top of sludge to bottom of outlet tee or baffle C.J Scum thickness l� Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle r APR-, How were dimensions determined? Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet inver( evidence of leakage, etc.): 4A, WAI - Al J 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 t or baffle r "" 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 Swage Disposal System-Page 10 of 17 __ I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 410 Church Street,West Barnstable, MA 02668 Property Address Frederick M and Nancy O'Regan, P. O. Box95"(,West Barnstable Owner Owner's Name information is required for every West Barnstable MA 02668 08/14/2013 page. Citylrown 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 pumps tttfie of inspection)(locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑ berglass ❑ 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 switct as, etc.): *Attach copy of current pumping contract(req ired). Is copy attached? ❑ Yes ❑ No t5ins•3M3 Title 5 Official Inspection Farm:Subsurface Sewage Disposal System•Page 11 of 17 • 3 Commonwealth Of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments i 410 Church Street,West Barnstable, MA 02668 'Property Address Frederick M and Nancy O'R an, P. O. Box9V West Barnstable Owner Owner's Name information is West Barnstable MA 02668 08/14/2013 required for every C�y�o State Zip Code Date of Inspection page. wn D. System Information (cont.) Distribution Box(if present must be opened)(locate on a plan): /VP Depth of liquid level above outlet invert Comments(note if box is level and distribution to outlets equal, any evidence of solidanrryover, any evidence of leakage into or out of box, etc.): a -S Pump Chamber(locate on site plan): Pumps in working order. ❑ Yes ❑ No* Alarms in working order. ❑ Yes ❑ No" Comments(note condition of pump chamber, ndition of pumps and appurtenances, etc.): *If pumps or alarms are not in working order, 4,ystern is a conditional pass. Soil Absorption System(SAS)(locate on sitE plan, excavation not required): If SAS not located, explain why: Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 12 of 17 t5ins•3H3 l Commonwealth;:of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 410 Church Street, (Nest Barnstable, MA 02668 Property Address Frederick M and Nancy O'Regan P. O Box95'j West Barnstable Owner Owners Name information is required for every West Barnstable MA 02668 08/14/2013 page. Cityrrown state Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: 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.): C" VX-OZZ00, -'C Cesspools(cesspool must be pumped 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-W 3 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth1of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 410 Church Street,West Barnstable, MA 02668 Property Address !Frederick M and Nancy O'Regan, P. O Box95%West Barnstable Owner Owner's Name information is required for every West Barnstable MA 02668 08/14/2013 page. Citylrown 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 hydraulic failure, level of ponding,condition of vegetation, etc.): t5ins•3113 Title 5 Official won Form:Subsuface Seaage Disposal System•Page 14 of 17 I Commonwealth]of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments I 410 Church Street,West Barnstable, MA 02668 !Property Address Frederick M and Nancy O'Regan, P. O Box95t,West Barnstable Owner Owner's Name information is required for every West Barnstable MA 02668 08/14/2013 page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) 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 ;Zand-sketch public water supply enters the building. Check one of the boxes below: in the area below ❑ drawing attached separatelyv A 1 1 I D •h' a 1 � .20e,64 t5ins•3M 3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 i i Commonwealths of Massachusetts Title 5 Official Inspection Form 'i Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 410 Church Street,West Barnstable, MA 02668 Property Address Frederick M and Nancy O'Regan, P. O Box9g,West Barnstable Owner Owner's Name information is required for every West Barnstable MA 02668 08/14/2013 page. 6tylTown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ��li ❑ Surface water ❑ Check cellar CA'fz0z' ❑ Shallow wells All-A Estimated depth to high ground water. 6 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: You must describe ow you established the high ground water elevation: °� R 6 Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3113 Title 5 Offidal Inspection Forth:Subsurface Sewage Disposal System-Page 16 of 17 0 <C\ Commonwealthlof Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments i 410 Church Street,West Barnstable, MA 02668 Property Address Frederick M and Nancy O'Regan P. O. Box95j,West Barnstable Owner Owner's Name information s West Barnstable MA 02668 08/14/2013 required for every page. Cityrrown State Zip Code Date of inspection E. 71nspectonrt Completeness Checklist Summary:A, B, C, D, or E checked inspection Summary D(System Failure Criteria Applicable to All Systems)completed MI/System Information—Estimated depth to high groundwater [Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file r t5ins-3113 Title 5 Official Ursp won Form:Subsurface Sewage Disposal System-Page 17 of 17 � i y6A• 6: 2013 9855AM No. 1557 P. 1 r�yo€fi�� T CERTIFICATE ANALYSIS Page; 1 of 1 Barnstable County Health Laboratory (M-MA009) aruu`+ Report. Prepared For: Report Dated: 08/19/2013 Reid C. Ellis Ellis Brothers Construction ®refer No.: GI376336 23 Enterprise Road,P 0 Box 59 Yarmouthport, MA 02675 Laboratory ID#: 1376336-01 Description: Water-Dunking Water Sampte#c Sample,Location: 410 Church St.West Barnstable,MA Collected: 08/1412013 Collected by: Customer Received: 08/14/2013 Routine ITEM RESULT UNITS RL MCL METHOD# ANALYST TESTED * NOTE Nitrate as Nitrogen 8.0 mg1L 0.10 10 EPA 300.0 LAP 08/14/2013 Copper 0.11 mg/L 0.10 1.3 SM 31119 LAP 08/152013 Iron ND mglL 0.10 0.3 SM 31118 LAP 0811512013 pN 7.2 PH AT 25C NA 6.5.8.5 SM 4500-H-B DCB 08/1412013 Sodium 32 mg1L 2.5 20 SM 31115 LAP 08/15/2013 Total Cclitorm Absent PIA 0 0 SM9223 RG 08/14/2013 Conductance 510 umohs/cm 2.0 EPA 120.1 DC8 0811412013 Sodium level is above the maxium contaminant level. Those on a low sodium diet may wish to c_on_.suit a physician. _ Attached lease rind the laboratory certified parameter list_ Approved By: P N P (Lob Manager) J AID None Detected RL = Reporting Limit MCL s Maximum Contaminant Level Suporlor Court douse, P®.Box 427, Barnstable, CIA 02630 Ph: 508-37M605 �SHE3' Town of Barnstable Qn Department of Health, Safety, and Environmental Services BA LE MASS. public Health Division � A99. � sexy. , 367 Main Street, Hyannis MA 02601 Office: 508-790-6265 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health UT� TO: r mr5 uu PeLe"C DATE: rl � I/�, � vA 2Z 2N ILI ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE, TITLE 5. // II� The septic system owned by you located at 41 1�'� .�WA S -)bu � was inspected on by _�u 11 it(ic W S a Massachusetis licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: ��y-�--�- n ��San S �( MA You are directed to hire a licensed professional engineer (PE) to design a system that will bring the septic system in compliance with 310 CMR 15.00, The State Environmental Code, Title 5 within twenty-one (21) days of your receipt of this letter. You are also directed to hire a licensed septic system installer to install the system components within forty-five (45) days of your receipt of this order. You are further directed to maintain the system by hiring a licensed septage hauler to pump the septic system to prevent discharge of sewage or effluent into the buildings, onto the surface of the ground, or in to surface waters. Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health �mmnmdwesaa okIKE Town of Barnstable Department of Health, Safety, and Environmental Services BAMSTABLEt"� Public Health Division �Fo a 367 Main Street,Hyannis MA 02601 Office: 508-790-6265 Thomas A McKean,RS,CHO FAX: 508-790-6304 Director of Public Health January 6,1998 Mr. and Mrs.Rudy Peschel P.O.Box 692 Mantolo King,NJ 08738 ORDER TO COMPLY WITH 310 CMR 15.00,THE STATE ENVIRONMENTAL CODE, TITLE 5. The septic system owned by you located at 410 Church Street, West Barnstable was inspected on July 11, 1997 by Troy Williams a Massachusetts licensed septic inspector. 'The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00)due to the following: • A portion of the soil absorption system was below the high groundwater elevation. You are directed to hire a licensed professional engineer(PE)to design a system that will bring the septic system in compliance with 310 CMR 15.00,The State Environmental Code,Title 5 within twenty-one !;21)days of your receipt of this letter. You are also directed to hire a licensed septic system installer to install the system components within forty-five(45)days of your receipt of this order. You are further directed to maintain the system by hiring a licensed septage hauler to pump the septic system to prevent discharge of sewage or effluent into the buildings,onto the surface of the ground,or in to surface waters. Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. PER ORDER OF THE BOARD OF HEALTH <�4 �omascKean,R.S., C.H.O. Agent of the Board of Health r 6, 1 TOWN OF BARNSTABLE �F THE TO OFFICE OF } ,A"ITIIL BOARD OF HEALTH moo rut 6 9. `{�' 367 MAIN STREET a MAY k, HYANNIS, MASS.02601 October 7, 1997 Stetson Hall, R.S. Edward Kelly,P.L.S. 46 Collie Lane Cummaquid,MA 02637 Dear Mr. Hall and Mr. Kelly: You are granted variances, on behalf of your clients Rudy and Carol Peschel, to install a replacement septic system at 410 Church Street,West Barnstable. The variances granted are as follows: Part VIII,Section 10,00, 113, To install a leaching facility 73 feet and 78 feet away from the edge of vegetated wetlands, in lieu of the required 100 feet separation distance. Part VIII,Section 10.00,2.1: To include the sidwall areas in the calculations for the application area in lieu of the requirement that bottom area only may be calculated. Part XI, Section 2.0 To install a leaching facility 108 feet away from an existing well on the same property, in lieu of the required 150 feet separation distance. The variances are granted with a condition that the designing registered sanitarian shall supervise the installation of the septic system and shall certify in writing to the Board of Health that the system was installed in substantial compliance with the submitted plans. The variances are granted because the existing septic system "failed" an inspection on July 11, 1997 due to the fact that a portion of the leaching pit was below the groundwater table elevation. The proposed replacement septic system will meet all of the requirements of the State haIWI Environmental Code,Title V. The Board is of the opinion that the new septic system will alleviate a source of pollution to the groundwater in the area. Sincerely yours, t ior Town of Barnstable RAM/bcs haIWI TOWN OF BARNSTABLE LOCATION 410 CHURCH STREET SEWAGE # 9.7-5.13 VILLAGE W_ BARNSTABLE ASSESSOR'S MAP & LOT / �,, Oo 'INSTALLER'S NAME & PHONE.NdLLIS BROTHER CONST. CO . 3626237 SEPTIC TANK CAPACITY /Co o LEACHING FACILITYAtype) S' f Z o S (size) /;L x 4k�X / NO. OF BEDROOMS_ PRIVATE WELL OR PUBLIC WATER Lid :.BUILDER OR OWNER RUDY PESCHEL DATE PERMIT ISSUED: - / 7 `DATE COMPLIANCE ISSUED: � ' c3 0 77 VARIANCE'GRANTED: Yes No I _,AS C%Q H.n,0)4' September 29, 1997 Barnstable Board of Health Attn: Mr. Jerry Dunning 367 Main Street Hyannis, MA 02601 Dear Mr. Dunning, Please be informed that on September 25 and 26, 1997, I was present during the construction and installation of the septic system at 410 Church Street, West Barnstable, MA. The owners of the property are Rudy K. and Carol A. Peschel. The septic system was surveyed by Mr. Edward Kelley, Registered Land Surveyor and me for compliance with setback distances and elevations with the site plan I prepared for Rudy K. and Carol A. Peschel August 22, 1997. I found the installed septic system to be substantially in compliance with the site plan I prepared as noted above. Sincerely yours, o � P4 � l EVALUA�®fl® Stetson R. Hall, R.S. 28 Rambler Road Osterville, MA 02655 TOWN OF BARNSTABLE LOCATION 410 CHURCH STREET SEWAGE # 97-513 VILLAGE W_ BARN- ,,TABLE ASSESSOR'S MAP &{LOT 1 'JA, po°/ INSTALLER'S NAME & PHONE.NdLLIS BROTHER CONST . CO. 3626237 SEPTIC TANK CAPACITY LEACHING FACILITY:(type) S F4.o S (size) % 46(X NO. OF BEDROOMS_ PRIVATE WELL OR PUBLIC WATER BLtG BUILDER OR-OWNER R U D Y P E S C H E L s. DATE PERMIT ISSUED: 2!— cf 7 DATE COMPLIANCE ISSUED: VARIANCE'GRANTED: Yes No ✓� CAooc.64 t .. Off r i No. \V/ Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: BLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS VYe Yication for ;ig o Y gtem Con0ructiott Permit Application for a Permit to Construct( )Repair( Upgrade( )Abandon( ) ❑Complete System O Individual Components Location Address or Lot No.�� .L Owner's Name, Address and Tel.No. Assess"or's M p/�azcel- A4 Installer's Name,Addr ss,and Tel.No. Designer's Name,Address and Tel. o. 6�to '41� 11-�✓ �S'�> 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 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 �L i Nature of Rep ai Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the cons ctio and mai nance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 e En ironme a ode d not to lace the system in operation until a Certifi- cate of Compliance has been issued by thi o d o alt Signed Date Application Approved by Date Application Disapproved for the following reason Date Issued J No. / _ Fee THE COMMONWEALTH.O.F_MASSACHUSETTS r Entered,n computer: �QC A 1 ;�BLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS JYes + 7Ap application for Mi57Upgrade ,f Stem �tCon5truction Permit plication for a Permit to Construct( )Repair( (F )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 6 /n-C�� ' Owners Name,Address and Tel.No. A/L gf� Assessor's Map/Parcel ( ' Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. /YsQ Type of Building: , / � V Dwelling No.of Bedrooms f Lot Size sq. ft. Garbage Grinder( Other Type of Building No. of Persons, Showers( ) Cafeteria( ) Other Fixtures Design Flow ��� gallons per day. Calculated daily flow �� gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repaips-ar Alterations(Answer when applicable) .- �0�'s� --v tP z `6 Date last inspected: Agreement: The undersigned agrees to ensure th4consction and mai nance of the afore described on-site sewage disposal system in accordance,with the provisions of Title nme a1:Code d not to place the system in operation until a Certifi-Cate of Compliance has been issued by thalth /' Signed —Date. Application Approved by D Date Application Disapproved for the following reason Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS 1J BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CE t the O -site Sewage Disposal System Constructed( )Repaired (/pgraded( ) Abandoned( )by at jCIE h constructed in accordance with the provisions of Title 5 and the for Disposal System onstruction Permit No. ✓ ated Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date 2- _'25 0 �/ 7 Inspector N - — —— ——— ——— 1 ———— 1—————————— — No.— Fee THE COMMONWEALTH OF MASSACHUSETTS I PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Mifspooal Ste Con.5truction Permit Permission is hereby gr5pBd to Construct( � Re ) grade )Aba don ) System located at r, and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/he 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 t Date: Approved by } l NO. TIM r DATE RARN"ARM d FEE 14AM .165� Town ,of Barnstab a BY Board of Heal 367 Main Street, Hyannis M 6(31 ep 1 Tow HFT g An R R.S.Fql� 9�FOmce: 508.790-6265 R. R.S.. FAX: 508-775-3344 B(f Ralph, rphy,M.D. A VARIANCE E Z All vnri mcc requests must be submitted nt Icnst fificen(ISI dnys prior to the scheduled llonrd of Ilenith meeting. NAME OF APPLICANT Rudy K & Carol A Peschel TEL. N0.732-892-4162 ADDRESS OF APPLICANT P.o.Box 692, Manoloking N.J. 08738 NAME OFOWNER OF PROPERTY Rudy K. & Carol A. Peschel SUBDIVISION NAME NtA DATE APPROVED ASSESSOR'S MAP AND PARCEL NUMBER 176/9 LOCATION OF REQUEST SAME 410 Church Street west Barnstable SIZE OF LOT 2.76 SQ.FT WETLANDS WITHIN 200 FT. ES NO- VARIANCE FROM REGULATION(List Regulation) we11 regulation REASON FOR VARIANCE(May attach if more space is needed) PLAN - FOUR COPILS OF PLAN MUST BE SUDMITTED CLEARLY OUTLINING VAMANCE REQUEST. VARIANCE APPROVED Susan G. Rask, R.S., Chairman NOT APPROVED Brian R. Grady, R.S. REASON FOR DISAPPROVAL Ralph A. Murphy, M.D. r Z 392 955 503 US Postal Service Receipt for Certified Mail No Insurance Coverage Provided. Do not use for International Mail See reverse Sen to Street&Num r s PostQfflc State,&ZIP C Postage $ Certified Fee 3 Special Delivery Fee RestricleV-O' eg LO rn Retu o toj� Wh m2& ate D d Q Re eipt Shorn to Who), 1 Q Date, Addressee!address TO AL , f Fees .717 M Postm r;pg� � e U) a Stick postage stamps to article to cover First-Class postage,certified mail fee,and charges for any selected optional services(See front). 1.If you want this receipt postmarked,stick the gummed stub to the right of the return address leaving the receipt attached, and present the article at a post office service window or hand it to your rural carrier(no extra charge). 2. if you do not want this receipt postmarked,stick the gummed stub to the right of the Q) return address of the article,date,detach,and retain the receipt,and mail the article. rn 3. If you want a return receipt,write the certified mail number and your name and address on a return receipt card,Form 3811,and attach it to the front of the article by means of the gummed ends if space permits. Otherwise,affix to back of article. Endorse front of article a RETURN RECEIPT REQUESTED adjacent to the number. Q 4. If you want delivery restricted to the addressee, or to an authorized agent of the addressee,endorse RESTRICTED DELIVERY on the front of the article. Go ch 5. Enter fees for the services requested in the appropriate spaces on the front of this E I receipt. 11 return receipt is requested,check the applicable blocks in item 1 of Form 3811. 8 6. Save this receipt and present it if you make an inquiry. t o25s5-s7-e-ot 45 a. Z 392 955 499 US Postal Service Receipt for Certified Mail No Insurance Coverage Provided. Do not use for International Mail See reverse Seq"t /x'— Street&Numbe S r Post Office,State,&ZIP Code O Qa� Postage $ Certified Fee Special Delivery Fee Restricted Delive Fe � r i Return Recqi t'Sh g o y v/ Whom&D t ive Retum Rec wing to Q Date,&Ad s Address �l Q 63 TOTAL Po age FeN97 $ C € Postmark or to Ucr' 0 LL a Stick postage stamps to article to cover First-Class postage,certified mail fee,and charges for any selected optional services(See front). f! 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address leaving the receipt attached, and present the article at a post office service window or hand it to your rural carrier(no extra charge). In 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the a) return address of the article,date,detach,and retain the receipt,and mail the article. rz LO 3. If you want a return receipt,write the certified mail number and your name and address on a return receipt card,Form 3811,and attach it to the front of the article by means of the gummed ends if space permits. Otherwise,affix to back of article. Endorse front of article a RETURN RECEIPT REQUESTED adjacent to the number. Q Ili O i 4. If you want delivery restricted to the addressee, or to an authorized agent of the C I addressee,endorse RESTRICTED DELIVERY on the front of the article. 00 M 5. Enter fees for the services requested in the appropriate spaces on the front of thin E receipt. If return receipt is requested,check the applicable blocks in item 1 of Form 3811. li 6. Save this receipt and present it if you make an inquiry. 102595-97-8-0143 d Z 392 955 500 US Postal Service Receipt for Certified Mail No Insurance Coverage Provided. Do not use for International Mail See reverse Sentto / Street&Number . . 36k- 7 Post Office,State,&ZIP Code �G Postage $ _ Z Certified Fee 35 Special Delivery Fee Restricted,qeli�jfie u� Return owing Who &per a Deli n, Retu R� t Showin om, Q Date, ee's Aess 0 TOTA Po g� t es Postmark Drite 1,. 0 LL o_ i Stick postage stamps to article to cover First-Class postage,certified mail fee,and charges for any selected optional services(See front). 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address leaving the receipt attached, and present the article at a post office service window or hand it to your rural carrier(no extra charge). 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the �-return address of the article,date,detach,and retain the receipt,and mail the article. I� IN 3. If you want a return receipt,write the certified mail number and your name and address rn on a return receipt card,Form 3811,and attach it to the front of the article by means of the gummed ends if space permits. Otherwise,affix to back of article. Endorse front of article a RETURN RECEIPT REQUESTED adjacent to the number. Q 4. If you want delivery restricted to the addressee, or to an authorized agent of the C addressee,endorse RESTRICTED DELIVERY on the front of the article. co ch 5. Enter fees for the services requested in the appropriate spaces on the front of this E receipt. If return receipt is requested,check the applicable blocks in item 1 of Form 3811. ti 6. Save this receipt and present it if you make an inquiry. 102595-97-8-0145 a Z 392 955 502 US Postal Service Receipt for Certified Mail No Insurance Coverage Provided. Do not use for International Mail See reverse Sent to Street&Number A P ce Statg,&ZI Mode Obi Postage is :3 Certified Fee ?j Special Delivery Fee Restricted Delivery Fee Return Rtysgccwigg '-' Who 14 Q Retu Rec pt Showing to Q Dat,& ressee's Ad " 0 TO Ott og�r Fees Post ark, Date LL co J / tL r Stick postage stamps to article to cover First-Class postage,certified mail fee,and charges for any selected optional services(See front). 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address leaving the receipt attached, and present the article at a post office service y window or hand it to your rural carrier(no extra charge). 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the Q) return address of the article,date,detach,and retain the receipt,and mail the article. Cr LO 3. If you want a return receipt,write the certified mail number and your name and address o) rn on a return receipt card,Form 3811,and attach it to the front of,the article by means of the gummed ends if space permits. Otherwise,affix to back of article. Endorse front of article a RETURN RECEIPT REQUESTED adjacent to the number. Q ` 4. If you want delivery restricted to the addressee, or to an authorized agent of the O O I addressee,endorse RESTRICTED DELIVERY on the front of the article. 0 5. Enter fees for the services requested in the appropriate spaces on the front of this E receipt. If return receipt is requested,check the applicable blocks in item 1 of Form 3811. ti 6. Save this receipt and present it if you make an inquiry, 102595-97-B-0145 a Z 392 955 501 US Postal Service Receipt for Certified.Mail No Insurance Coverage Provided. Do not use for International Mail See reverse Sen to. �.O Street&Number ost qffice,State,&ZIP C902 Postage $ Certified Fee 3S Spedal Delivery Fee Restricted Delivery Fee LO CO) Retum Receipt S wing to O Whom& ate elivere Q Return eo@ip Q Date ee' ess CDP TO AL ostage 6 Fees Go Ir .z" Po trp� or D �97 o � CD rL Stick postage stamps to article to cover First-Class postage,certified mail fee,and charges for any selected optional services(See front). 1. If you want this receipt postmarked, stick the gummed stub to the right of the return address leaving the receipt attached, and present the article at a post office service window or hand it to your rural carrier(no extra charge). 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the Q) return address of the article,date,detach,and retain the receipt,and mail the article. LO 3. If you want a return receipt,write the certified mail number and your name and address on a return receipt card,Form 3811,and attach it to the front of the article by means of the gummed ends if space permits. Otherwise,affix to back of article. Endorse front of article CL i RETURN RECEIPT REQUESTED adjacent to the number. Q 4. If you want delivery restricted to the addressee, or to an authorized agent of the addressee,endorse RESTRICTED DELIVERY on the front of the article. W Cl) 5. Enter fees for the services requested in the appropriate spaces on the front of this E I receipt. If return receipt is requested,check the applicable blocks in item 1 of Form 3811. ti 6. Save this receipt and present it if you make an inquiry. 102595-97-e-0145 d Z 392 955 50.4 US Postal Service Receipt for Certified Mail . No Insurance Coverage Provided. Do not use for International Mail See reverse Sent Street&Number / Postice, te,&ZIP Cql// 0. Postage Certified Fee Special Delivery Fee Restricted Delivery Fee LO rn Retum ipt o,yviag to VVtr `0a n R dWi eipt Sh t Q Address oT L Po a0&Fees00 CO stm e € G c 1 � fir'' 1 rn a Stick postage stamps to article to cover First-Class postage,certified mail fee,and charges for any selected optional services(See front). 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address leaving the receipt attached, and present the article at a post office service m window or hand it to your rural carrier(no extra charge). `I 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the W I return address of the article,date,detach,and retain the receipt,and mail the article. cc it LO 3. If you want a retum receipt,write the certified mail number and your name and address Von a return'receipt card,Form 3811,and attach it to the front of the article by means of the gummed ends if space permits. Otherwise,affix to back of article. Endorse front of article a RETURN RECEIPT REQUESTED adjacent to the number. Q j O 4. If you want delivery restricted to the addressee, or to an authorized agent of the I addressee,endorse RESTRICTED DELIVERY on the front of the article. M 5. Enter fees for the services requested in the appropriate spaces on the front of this E receipt. If return receipt is requested,check the applicable blocks in item 1 of Form 3811. ti 6. Save this receipt and present it if you make an inquiry. 1 o2595-97-s-oi a5 a TROY WILLIAMS '`r� SEPTIC INSPECTIONS t-, co ✓� �� N Certified by MA Department of Environmental Protection �y��y�o,� Q 508) -1500 19 Hummel Drive South Dennis, MA 02660 COMMONWEALTH OF MASSACHUSETTS Z D UVEXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET. BOSTON, MA 02108 617-292.5500 WILLIAM F.WELD Governor TRUDY CORE Secretary ARGEO PAUL CELLUCCI B.STUHS Lt.Govemor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM DAVIComm Roney PART A CERTIFICATION Property Address: Y S 4 W• /3a✓h 5 h,k Je- Date of Inspection: 7 f �g 7 Address of Owner: p Troy 0 Williams l l i a m$ (If different) Name of Inspector: y I am a DEP approved sy astem inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) _ Company Name: Troy .W111iams Sept iC I.nsectio.ns Mailing Address: _19 Hummel Driven South Dpnnjss MA 02660 AlO,`"+O �� V,,``J` i /1/J. Telephone Number: (F 0 A) 3 R F_1 3 0 0 v ]3 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: _ Passes _ Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority Fails �' Inspector's Signature: (i(/ Date: -7Af ��7 The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: AJ SYSTEM PASSES: A //4 I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: BI 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. 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, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty(20)years prior to the date of the inspection; or the septic tank,whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 04/25/91) Page 1 of 10 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A / C1 CERTIFICATION (continued) Property Address: t iv C�, ✓ �` JT Owner: /'e_S C— e Date of Inspection: 7 /1/ /9 7 B] SYSTEM CONDITIONALLY PASSES (continued) AltI19 Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). Describe observations: broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: 'V /✓J 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 PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen-is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER (revised 04/25/97) Page 2 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: Date of Inspection: DJ SYSTEM FAILS: You st indicate ei;!.er "Yes" or "No" as to each of the following: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No / Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. _ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _. _ Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. ,/ Any portion of a cesspool*or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. El LARGE SYSTEM FAILS: / /4- You must indicate either "Yes" or "No" as to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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) 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 04/25/97) Page 3 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: L// 0 C ✓ Owner: Date of Inspection: Check if the fo'lowing have been done: You must indicate either "Yes" or "No" as to each of the following: Yes, No Pumping information was provided by the owner, occupant, or Board of Health. _ None of the system components have been pumped for at least two weeks and the system has been rece ving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. Al/I As built plans have been obtained and examined. Note if they are not available with N/A. _ The facility or dwelling was inspected for signs of sewage back-up. _ The system does not receive non-sanitary or industrial waste flow. 341 _ The site was inspected for signs of breakout. _ All system components, excluding the Soil Absorption System, have been located on the site. _ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material-,of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: The facility owner(and occupants, if different from owner) were provided with information on the proper maintenance of Sub-Surface Disposal System. Nf,g Existing information. Ex. Plan at B.O.H. _ Determined in the field cif any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) (15.302(3)(b)) (revised 04/25/57) Page 4 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C C L SYSTEM INFORMATION Property Address: Y/ C�J 1, Owner: �LS L1, / Date of Inspection: 7 >(/ /7 7 FLOW CONDITIONS RESIDENTIAL: Design flow: '/y� g.p.d./bedroom for S.A.S. Number of bedrooms: Number of current residents: O Garbage grinder:(yes or no): No Laundry connected to system (yes or no). Ile S Seasonal use (yes. or no): ^/d Water meter readings, if available (last two (2) year usage (gpd): Sump Pump (yes or no): Last date of occupancy: COMMERCIAUINDUSTRIAL: Type of establishment: Design flow:_gallons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no) Non-sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings, if.available: Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System pump d as part of inspection: (yes or no)_"a If yes, volume pumped: gallons Reason for pumping: TYPE 9F SYSTEM Septic tank 4-14Wibuuewhex/soil absorption system �✓ ohs 6w>`� �-,.� /0.J �y� Single cesspool —�— Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) I/A Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known) and source of information: _ /�y• a J y s s ; f 4- �r < <r�sor•X 3d f-6 (/J 7r3 ��'A ' Newar� 4�< Sewage odors detected when arriving at the site: (yes or no) N J (revised 04/25/97:• Page S of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: �� 0 Gf; S Owner: / Date of Inspection: BUILDING SEWER: (Locate on site plan) Depth below grade: Material of construction: _cast iron _40 PVC _other (explain) Distance from private water supply well or suction line Diameter Comments: (condit on of joints, venting, evidence of leakage, etc.) SEPTIC TANK: -,�b,� �a •. .,�1 /4 J 7 y (locate on site plan) Depth below grade: -�o �✓,A A C, Material of construction: -�Zfoncrete _metal _Fiberglass _Polyethylene —other(explain) If tank is metal, list age _ Is age confirmed by Certificate of Compliance _(Yes/No) Dimensions: 3• S X S IC s Sludge depth: 5` " Distance from top of sludge to bottom of outlet tee or baffle: A S� Scum thickness: .21• Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle:_ How dimensions were determined: 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.) _L I c f ���h{ N U / f �1, J c.� w "� l�J e, 0✓ f�7 �1�� 1�� xvr�. W t GREASE TRAP:_ (locate on site plan) Depth below grade:-Ta Material of construction: _concrete _metal _Fiberglass _Polyethylene —other(explain) Dimensions: P2 ' x ' X a Scum thickness:__,^/-0_iVi^ 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: vrt kh­ 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.) Sc, I ✓ J cam' '7iY c.� t�J cn C-a, L.r. et vs b ( S : S ✓� ...��h fl -fwo i j 72 C-v e L Cx 5 -,'I' ("vised 04/25/97) Pago 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 41I 0 C( r 'J� Owner: Date of Inspection: TIGHT OR HOLDING TANK:(Tank must be pumped prior to, or at time, of inspection) (locate on site plan) Depth below grade: Material of construction: _concrete _metal _Fiberglass _Polyethylene _other(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm level: Alarm in working order_ Yes; — No Date of previous pumping: Comments: (cond,ition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: /V 1 (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) Alarms in working order(Yes or No) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 04/25/97) Page 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C C SYSTEM INFORMATION (continued) Property Address: ��� G//�J✓� v f, Owner: Date of Inspection: SOIL ABSORPTION SYSTEM (SAS): !/ (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: 0.� S ` leaching pits, number: 0"t 6 c a (� vo,' ,L �5i j S-{z h c...d do:4�_L,-. /r leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length;. leaching fields, number, dimensions: , overflow cesspool, number: o h- 3.s' � 5 0�w f!",�.. G c k P 1 Alternative system: \ L Name of Technology: Comments: (note condition of soil, signs of hydraulic failur , level of ponding, condition of vegetation, etc.) r �.. 'O Cc/5 o✓c � u ✓ ,� � s Y �— r ✓ t. bay ,� ✓:. ` G.� e, L -eC_ C- 11 CESSPOOLS: /moo �jo Tl, f (locate on site plan) Number and configuration: 0 h t c �( /o Depth-top of liquid to inlet invert: Depth of solids layer: .S �• Depth of scum layer: Dimensions of cesspool: 'cke o I OL Materials of construction: Indication of groundwater: inflow,cesspool must be pumped as part of inspection) CI-0 �1 a✓w `,� c� r lo&-d Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) vC 6J 4f �lJw • -t �` h /� 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 04/25/97) Page a of 10 r �Ltl dr M`y� arL V SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C jj SYSTEM INFORMATION (continued) Property Address: C/�d G h,, S Owner: Date of Inspection: �L'S SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) Sd�a bl S S� 75 oU�✓�Co�✓ Gccs�a� (• . �3 (revised 04/25/97) Page 9 of 10 C,r,A SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 9 Owner: ,p�3 G Date of Inspection: Depth to Groundwater,7 Feet / adjusted high groundwater level Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observation of Site (Abutting property, observation hole, basement sump etc.) Determine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records Check local excavators, installers Use USGS Data Describe in your own words how you established the High Groundwater Elevation. Must be completed) 0654ytjac ro w�. �cr �. (/Gc.� C. �o •��-�� fi�+� � off' -1 / \t L c, SQL. t� 7� ��• �V✓ .e- 7 / J c—r3t,III-071 '"� �'� � 07C Ih�• 7 C� SS �G � t �uS L f o JG✓ a c t; 51A0-,4) t1 v l<" S S• 7 �-- � S �- : s �, �- S • L, 5 v y H..GI y�ln C L 5 S V r (revised 04/25/97) Page 10 of 10 i • ' Permit Number: Date: 7111 /Q 7 Completed by: HIGH GROUND-WATER LEVEL COMPUTATION Site Location: 7�(� L�c�✓ c�� S Lot No. Owner: (� ( Address: Contractor: Address: Notes: STEP 1 Measure depth to water table tonearest 1/10 ft. .............................................................................. .Date month/day/year STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine: OA Appropriate index well.................................................... IS) Water-level range zone ..................................................... STEP 3 Using monthly report"Current Water Resources Conditions" determine current depth to water level for index well . ........................... month/year STEP 4 Using Table of Water-level Adjustments for index well (STEP 2A),current depth - to water level for index well (STEP 3), and water-level zone (STEP 2B) C determine water-level adjustment .......................................................................................... STEP 5 Estimate depth to.high water by subtracting the water- level adjustment (STEP 4) from measured depth to water levelat site (STEP 1) ............................................................................................................. ` . TOWN OF BARNSTABLE r� v lTo✓✓t� LOCATION 40 D ����e- ` 5¢= SEWAGE # VILLAGE L-)- 9 "22 5 , ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS q BUILDER OR OWNER PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) /Z,S Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) 6 Feet Furnished by ►7 G'� VO / s5 �3 O 6 Z 392 955 501 Z 392 955 502 1 Z 392 955 503 US Postal Service US Postal Service US Postal Service Receipt for Certified Mail Receipt for Certified Mail Receipt for Certified Mail No Insurance Coverage Provided. No Insurance Coverage Provided. i No Insurance Coverage Provided. Do not use for International Mail See reverse Do not use for International Mail See reverse Do not use for International Mail(See reverse Sea��to Sent to _ Sen to VG�1�L�.0-p4 c> l/ l /L� c/✓may` Street&Number Street&Number r Street&Number ost gifice,State,&ZIP C P ce Statg,&ZI ode Post fic State,&ZIP Co e Postage $ 3 Postage 32 Postage $ Certified Fee / 3S Certified Fee - -'j 5 Certified Fee / 55 Special Delivery Fee Special Delivery Fee Special Delivery Fee Restricted Delivery Fee Restricted Delivery Fee Restricted Delivery' V7 LO ..,..._...._. U7 i 4! Retum Receipt Showing to /, D Return ReEeipPSNowing fo•.. /,�U Returri Receipt Showing to Whom&Date elivere Who Date Delivered" ;: Whdm&,Date D r, r@d n Retum Aecerpf taWlioln, Q Retu Rec�fpt Showing toom,;,\ Q Reim�iAceipt Showingrto Who , Q Dater. " sse ee" ress ¢ Dat,&A ressee's AddrCs's• `, 1 a Dale;$ ddressee' ddress p UL C i r O tt \ ITn 40 TO �L ostage Fees $ Q T06L f'?os�egrr Fees ! '$ Ono TO7.AL Postage&Fees; ch Po tree or Da}597 c C) Postt`ark or Date i ch Postmark-or Date LL LL a U� � cn d Z 392 955 500 Z 392 955 499 Z 392 955 504 US Postal Service US Postal Service US Postal Service Receipt for Certified Mail No Insurance coverage Provided. Receipt for Certified Mail Receipt for Certified Mail Do not use for Intemational Mail See reverse No Insurance Coverage Provided. No Insurance Coverage Provided. Sent to Do not use for International Mail See reverse Do not use for International Mail See reverse / Seni jg Sen Street&Number Street&Numbey, Sttreeeet&Number�A � Post Office,State,&ZIP Code post Office,State,&ZIP Code Post Office,State,&ZIP Code '" �G Uaf � JPostage � �"$ - 977 3� Postage $Certified Fee 3 S Certified Fee Special Delivery Fee Special Delivery Fee Special Delivery Fee Restdcted�gelive—F � `-5�- Restricted Delivery-Fe Restricted Delivery Fee rn Return et;er"'"OwingiO Who &� a Deli r' �, Shp wing Return Ele£i 1 S o�Win to / �� Retum Rec t Sh win to o, @@ p � g a Retu R e tShowi Whom&D�te�p�fiver = Wh ,_DatelfverddQ Date, Atlli ea's Aess m a a Return Rec ingto o n R urnn:R eipt Sh g t6•Wfr6mlO Q Date,8 Ad 's Address M Q at0�Addressed ess TOTA Po g ± �es $' c 7� O SgJ 7 $ �� OT L Po ta�&Fees �, Go O TOTAL Po toe Fe 19 Postmark'o{Date;,. Go tp . stm rk'drip e E \ I Postmark or le a i - — � `�, r- / LL — IL --- �Y• .1 ii.nW i i iu .. v Ai 4ir ray. .r u'i iriii, . i 'Ir WI niN na TA 4U WY liii Wn mu i ,,ry -. �^ •_ .. ,..... ,'W_ Np 'W!11 Wl iul- 1W INl W.r•r BEDROOM BEDROOM r A TT/C vi ON N `L `i _------ _ a It � � I i RESTORED I LOO NEW TILED i I VEIL i I 5HOWER i STALL REMODELED NE/'V I I I �O 5HOkYER I I BATHROOM STALL I NEW PEDE5TAL 51NK I o MER FLOOR � V SUNRISE SPEC r I I I a • 66"CLAWFOOT TUB d I I I e[g door c ning F I y 3, ` ----------- / I PAD WALL R PLUM50 I 1 1 NEW RTITION DINING ROOM CH/MNEYS I NEN BEDROOM ! NEW PEDESTAL SINK i BATHROOM P f'AP OUT EXTERIOR I t WALL TO ALLOW FOR 5 2"CL05ED CELL I EX/STING SPRAY FOAM I FLOOR 3 PROPOSED SECTION INSULATION I LEVEL i RED (TYPICAL) 1�• NEW I I AREA OF I 1 1n1iM� ��❑❑❑ WALLS NEW , WORK , MA �J EWALLS (� � 4_ _ PROPOSED PLAN �os � A— 1 -- - PROJECT: ` DATE: DRAWING TITLE: SHEET NUMBER HICKOX WILLIAMS ARCHITECTS AITKEN 10 APR 2014 - PROPOSED SECOND FLOOR 58 Winter Street, Boston,Massachusetts 02108 4 10 CHURCH 5 T (617)542-1080 fax:(617)542-3407 # PLAN WE5T BARN5TABLE, MA 5Cale 1 /4"= V-O" o 4 a ,6 --------------------- ATTIC -DN N t — ——— —— ---------------- -- --- --- 3 - -n E w -w r n • . Y ,t_a T A n r EXI5 TIN& I �' - FINI5HE5Aim 5 TAR �RE fo HALL DN xORL R t , _ n ----------- I DININ&ROOM GHIMNEY5 ENTRY MASTER '. BEDROOM Ob I i 1 EX I5TING SECTION / X- 1 1/4"= 1'-0" II II AREA O P S E NE�NDDEMOLITION NcKw WORK F r r � EXISTING ` ————————— --/ o No.5603 y / 2 EXI5TIN& PLAN TH Of fAPS`''o PROJECT: DATE: DRAWING TITLE: SHEET N HICKOX WILLIAMS ARCHITECTS AITKEN 10 APR 2014 EXISTING SECOND FLOOR 58\Vinter Street, Boston,Massachusetts 02108 4 10 CHURCH 5T - (617)542-1080 fax:(617)542-3467 PLAN WE5T BARN5TABLE, MA 50ale 1 /4"= 1 '—O" 0 4 8 ,6 ti • ;. aP c-3_ a 1 i �NP r/i• �' '� 8 4i wA./ a,c- BtE / 2, 74 1 'N A Irv- Y Q. i r co 100, — �I PLAN a f s is t w .y �•r0/?S ✓f '-'r aW4OW '.h 1 r"�}f. c�a�3rFS',p,{ Y4R/•�,e$r�'s+,�t+1'� ��tSZ 'i;t +sS�.} , "'S`}.� \;� � •`'t. ��� /, ` . bvzz i�r`4x ...'� s NJ F r} r k � d � � •��`:\ ../ 1++f\ 7 �1 KN _ I Z8 SITE PLAN WEST BARNS .TABLE, MA, FOR RUDY K. AND CAROL A . PESCH EL I c C ' S at��'47 � itiE<=u.0�J7 i rp9f,.0 L3r-tTAv/CE Ck*[✓ts / Tf/c ✓9TL WcZZ 0,VZ C£9Cfl fps 9 T /oB may* /✓orGS: Rena✓G /aCL i^JPFe✓/,o Ar i79T6R.,4C 0r' IEs,r./ TW- <Iewr// rb, A Q.U'T.q„1,r•E o c s- i✓ qlC ' Dr�.�CTiD.vi ��l'/fyaA��J oy�f9 GRau✓awgrf.Z 4QT04r-)Z-7- s U.ri✓G TVCj! `J7 C✓RRO^1 w.g77'Y XX✓dC /47-yG,51 ' FOR �SDr✓2S2 Z•✓DEx r✓ELLr 20•✓� dS, �.(c✓/aT-�G�/S BSIr'�J fin//�SSU�J �irdM L'xrSTi:✓G.SEyCf/Pr.�3 7d JE Lem n/iT//.r ,vz) .CcGsND i .d'TEzton/ R /1AL[ RS. CEEO 06,% j?YAT�aN 1-,040L4 LD G pf or//f `so:( Jo i 4. lsb:� Je rL �0A,"V" h6, 440-1 7£XTJ4L CnCaQ tX.+Cr ..rvr✓,.� 43 .... G/PE �'/c✓EL o-r'1 TOP OF FOUNDATION ,F.Qc�n�O Si 6oh a CONCRETE COVERS FN• v/<7/*I7E 8. 7/ ' 4"CAST IRON 9 �6 I OR SCHEDULE 40 \\ 4"SCHEDULE 40 P.V.C.(ONLY) 9'MIN. 3 'MAX. { P.V.C.PIPE MIN. PIPE-MIN. ' r - LEACHING TRENCH (.A.-REQUIRED) _ � PITCHI/4"PER.FT PITCH I/4'PER.FT.�I I�q"�Z�WASHEDttSTDNE -�,' I','. . { c�_ n6 r"arii n J r(J n r,` .96' r' i•. INVERT INVERT INVERT `-- - ,'' ELir�il .... SEPTiC TANK DIST. EL7-194 4"-II/2"WASHED STONE EL� � BOX i �.. INVERT 4r GAL INVERT INVERT FLOWDIFFUSORS INVERT " :' EL.�i. � • ELB.gR.... EL.Z ��. (.5') REQ. 'ECZ.4Y4�... 6"CRUSHED STONE /7 ZZ' � .r• PROFILE OF .,. /!oS GROUND WATER TABLE" e/,S-' ( {; SEWAGE DISPOSAL SYSTEM TYPICAL CROSS SECTION da LEACHING TRENCH SOIL LOG NO SCALE NO SCALE OATET.V�X .•%�� TIME TEST HOLE I TEST HOLE 2 DESIGN DATA : I/B=1n" ` ' EIEV. 9"MIN. WASHED 3fi MAX. ELEV.. �aO•....• ...... re; 1qr�✓ NUMBER OF BEDROOMS 9•• - STONE t'� s IAA�''1 - .•'... 4' f2w EL S.O' M TOTAL ESTIMATED FLOW .....49Q..GALLONS/DAY :tsu ..r,NpY LoA .96 30' 6G3.s BOTTOM LEACHING AREA ...r:SU9...SO.FT./TRENCH o o / 6¢•. SOFT./TRENCH Mea SIOE LEACHING AREA ... . OJ 3/4"-II/2"WASFI ONES Jy'✓G GARBAGE pISPOSAL...!fR...(50% AREA INCREASE) i3 � ttL0.0 71~ •• ✓grae a TOTAL LEACHING AREA . ..�G?��'.•: SO.fT. VU i✓ PER.INCH :�' 1•'?:� PERCOLATION RATE ... ..�.�•�•• - r'ti�%l LEACHING AREA PER PERCOLATION RATEFl9r/.7..SOFT/Ga3 1 ycS GROUND WATER TABLE=«/-3 j, APPROVED .... . . .. ....... BOARD OF HEALTH . .t q;�?,,WATER ENCOUNTERED DATE....... ..... �j►����i''f fi AGENT OR INSPECTOR kYw -11AOF �10 WITNESSED BY * ' � f� � Duniivi ,. BOARD OF HEALTH .. . . . . .. . . . . . . . . . . . .. v R ► r) 57�L''T N •F7-7 / �. /?AGC- •-ENGINEER �r}s' 1/v&sr /j/-12i/STAliGC REo pN�` " ` L-ZL/s B✓ZpS,•ES7l.F!✓;. .. ;� . so= l I �► �evAWAt°.' PETITIONER RvOy �K °L /�XJ/c�L ►►►►vvvvv� i ac Y �(%IV Y d ay i Ppx `Sre uT- C q�DA �y t/,9�.y.rc.E �c�✓,a.cr : � ✓19�i•9n/c,E i.: F'�Q�cs;-�o f,�'c�,. T,�/c .F3»�.v�c-T.�Bf;� Bcra.�� o� /•%o�Lr,`f �y�u.CgTip,-,.Ls �FC�c%•�rNG %� /�O J-pc^l 4'c �T.TrCrC C/S�J�/lE .0 h/��-../ 7 i.�[ i�l✓�9 1✓� LL /9,/z .CE",�3�ff /�S'r/9 T /08 . sy Ty G '' ciao ' /►'art-�; RE�7c% /-JLL /�IF'�.P✓ioLAr /Y7�Tt,?��L r,1✓ld irf/ T��-<f,�7e/ 7it'f.✓�.�✓ ��✓.� j'a,�" .q �•.r�,�.,/c,E or s ' i.✓ SILL E / z 171 h/l le, 'EZ J t �Rauti/.��✓�-,CR /ate Svc.:�lfl✓T _ /, .S � _ vsr.✓G �'v,c y J �"� ��✓a-c ��- %G, 9 GL ` ,LO i G XIS Ti/✓U .<'�yl// P/.'� %G 'r�l/�r'j�f //ivy .riC L-.� +✓ir/Y. l r!t/.� it qj r r r, � r r to /' pr Ta 6� f'ra,2rvr� // F /t t' •.�i-�;�sa•,/ ,g �I14L L /`�S. 0 ' ,+ 0 ! ,1, / a , Df�P Grcr"r�YAT1 G/V , L = L Q C e5 ` �`` if ./ �' 1 ' t hJ L3•�-Td>fi'. �S a Z .ro J L SG'i c .drn;L G;f/r-� ' of `�'• �.�'j� � t � � A '/ t1. ��Uh'°•�`!!L ,IfG'f'�.'Ci✓ T�'x Ti £ �L:: ''l�`T.r-..►.f?- J „ r.. /4" _.gyp Z /c • E . , PLAN SCALE III = 40 :A_ i 4 1 TOP OF FOUNDATION /PE cL�,�t✓EL CONCRETE COVERS pox �� Qj 4j - wr .t.5`- %r 8 i f 1.✓ZiF- f t ., mm� >m•-7i77. m n,,,� �iM. _,Z4-pe r _ -,a y t�fc.�S •J 9`crs-r./e c^/ ti t 1 2 !'. 4 CAST IRON 9 , r _ �J',i ' / �y �� 2 •�iDe.i. -r'es c'r:a. ,�; OR SCHEDULE 40T"" f _ / 4 SCHEDULE 40 P.V.C. (ONLY) 9 MIN u �✓ A •r 1 4,.• '.� P.V.C. PIPE MIN. r _ 36 MAX. " �i '.. •. PIPE MIN. z PITCH I/4 PER.FT LEACHING TRENCH (./,...REQUIRED} + PITCH i/4 PER.FT. .. .. L„ WASHEDrt STONE + r � .. - • . r.-ran-. ,�„ - I _--� 1 c: r INVERT , �i f n•t`� n n �_ ri'CJ n •96 �- D)ST. �.. :�• EL,;��•k�.,... � INVERT INVERT „mot r: � SEPTIC T NK _ _........_ _ ,_ .:: .•, - `. EL�44:. EL7,.�2.. 3 4 -11/2 WASHED STONE` D 7rN4 / I . w_ E, � __ _ -�•--- .:• INVERT .4 ...`GA[_. INVERT IIOX t3 � - . INVERT FLOWD�FFU 'R INVERT T EL...L......... ELd:C19... � SO .S � .. ' ELZ,GI4... (.5) REQ. ELZ.Yt?...... 7 40 I• z- T ,f 119�' 9 , '' ., PROFILE OF 7' . ' , I i '`' ' '.;�, i9zsS" GROUND WATER TABLE-z_'/„J_' SEWAGE DISPOSAL `'SYSTEM TYPICAL CROSS SECTION SOIL LOG NO SCALE NO TRENCH ; DATE TEST TIME, /./•I:P.4h�''J. NO SCALE ` a. TEST HOLE 1 TEST HOLE 2 ELEV. . . :0�. .. . . ELEV. . . . . .. . . .. DESIGN DA7 A 9."MIN. I/8'=I/Z'• � WASHED 36, MAX. 7,777rBEDROOMS ", � ,coq�•'� NUMBER OF BEDROOMS STONE Z /Zr E1,T,G TOTAL ESTIMATED FLOW . . . . . .. GALLONS/DAY �. ¢ 134 BOTTOM LEACHING AREA ... SQ.FT./TRENCH o c� •96 I• SIDE LEACHING AREA . . . .�G . . SQ.FT./TRENCH 3/4"-II/2"WASIIEO 0,I �.g.✓� GARBAGE DISPOSAL . . /fp . ..(50% AREA INCREASE) STONE 72N n.9T=Z Ao%ELO,O C' TOTAL LEACHING AREA . ..6c76a .: SQ.FT. PERCOLATION RATE . . . . . �.4.!'j!"�/ PER.INCH LEACHING AREA PER PERCOLATION RATE'".' .7.. SQ.FT/��'� 9a� GROUND WATER TABLE= APPROVED . . . . . . . . . . . . . .. BOARD OF HEALTH SITE PLAN W C S T RA P N TABLE l V l f ft!7.0 ..'.WATER ENCOUNTERED AGENT OR INSPECTOR c 1N °� WITH ESSED BY • s ' FOR � -7� �. off$ ER[) yr' C/G!�dNr/Jtr. .. BO;RD of HEALTH y {` t " ' ' . . . . . . . . . . . . . . . . .'_ . KEi_t.EY S �,�i ALL �3.�. RUDY K. AND CAROL A . PESCHEL � . . .. . . . . . . . . . . . . . . Etl6LNEER a_ '�, N6. 26100 � �* 'PFCISTER� CZL1s /Zoa J• ESQ ✓. . . f 7`/� �f rx ,, SCALE AS NOTED AUGUST 22 1997 L LA1�� PETITIONER 2c.�ay ��,eoC. f�sct•' Y r - • �. ' _ fC'C-ti'�SE1� APT • PLAN RE - PL.BK . 307 -PG . 53