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Home My WebLink About0024 COACHMAN LANE - Health 24 Coachman Lane West Barnstable A= 152 —041 CERTIFICATE OF ANALYSIS Page: 1 r Barnstable County Health Laboratory Report Prepared For: Report Dated: 1/9/2009 Edward McKenna Buyer Brokers of Cape Cod Order No.: G0950431 P O Box 957 Barnstable, MA 02630 Laboratory ID#: 0950431-01 Description: Water-Drinking Water Sample 4: Sampling Location 2 . . Collected: 1/6/2009C Collected by: E.McKenna Received: 1/6/2009 Routine ITEM RESULT UNITS RL MCL Method# Tested Nitrate as Nitrogen 19 mg/L 0.10 10 EPA 300.0 1/6/2009 Copper 0.88 mg/L 0.10 1.3 SM 3111B 1/6/2009 Iron 0.23 mg/L 0.10 0.3 SM3111B 1/6/2009 Sodium 18 mg/L 1.0 20 SM 3111B 1/6/2009 Total Coliform Absent P/A 0 0 SM9223 1/6/2009 Conductance 270 umohs/cm 2.0 EPA 120.1 1/6/2009 pH 6.2 pH-units 0 SM 4500 1-1-B 1/6/2009 Nitrate level is above the recommended maximum contamination level for drinking water.Retesting is recommen l,d Approved B _ (La irector) tom' cL1 Ln W T> CD ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 TOWN OF BARNSTABLE LOCATION tf Cc.9"C'0t /2,4,& SEWAGE #2.�zi5 005 VILLAGE S%g r Aq&^�S 7&.'A- ASSESSOR'S MAP & LOT a INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY l ; LEACHING FACILITY: (type); 5 67z) CX 9✓i,�66((size)��Xar� X� NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: C' COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Well and Leaching Facility an wells exist Private Water Supply e g ty (If y 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 �)�rAf ��o.9 3 s • r No. 20®cA -oG S Fee /Vo THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftplitation for Misposal 6pstem Construction 3permit Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑Complete System Individual Components Location Address or Lot No. �14 4 X) Owner's Name,Address,and Tel.N . ACv,4E.0 ^oe-1 G.s,,.f j� /r sessor's Map/Parcel j 5-a ,*�// /J �"7 f A Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 'type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder Other Type of Building le S No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 33 y gpd Design flow provided S gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank,CZ I S r l D Cl j) Type of S.A.S. X S-D d Description of Soil z Nature of Repairs or Alterations(Answer when a 'cab Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place a system in operation until a Certificate of Compliance has been issued by this Boar ealth. / Signs? /` Date Application Approved by a OQ.S, Date ®9 Application Disapproved by Date for the following reasons Permit No. 2 co Date Issued , f was.,.- .•..►:....ar-..:�. ,-.....ri.-.r.:... � n -........,.r ...,do.... ,- t ' .,. 41 No O;O S f Fee : 00 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftplication for Zisposit Opstem Construction permit Application for a Permit to Construct( ) Repair(/Upgrade( ) Abandon( ) ❑Complete System ndividual Components Location Address or Lot No. Owner's Name,Address,and Tel.No. Assessor's Map/Parcel S a o�/ / 0 1 r✓,4r Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. /le Gov s T f//�24 £ ../ /-hCYt 2 S—v 13 6a- sad 36 � a �a-2 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(/P/ Other Type of Building C— S' No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 y gpd Design flow provided 3 S-Z `7 gpd Plan Date / Number of sheets Revision Date Title / Size of Septic Tank rx i 5 T le 0 (J Type of S.A.S. e) Description of Soil Nature of Repairs or Alterations(Answer when applicabl )— Date last.inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Boardoof-Health.-. % Signed/ / r� `—` Date Application Approved by OQ• S. Date 0 9 Application Disapproved by Date for the following reasons Permit No. 2 O U 6r — o O ,S Date Issued i.! 4`�, O q THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(✓ ) Upgraded( ) Abandoned( )�by �at �/ ( .9 c r�p w L rl n� E has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit NoZopq--r,,o dated 0 0 Installer C Designer ��f7 q F ✓1 5 1 e lL #bedrooms Approved des'gn flow 3 .3O / /1/ d gP The issuance of this permit shall no be c nstrued a guarantee that the system '.11'fu ct ion as�designed. Date Inspector (. —� }�P - - - -- -- --- ------------ ------- - = -- - - - - - -------- No. 2oO&�— OU K - Fee l oU THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION r BARNSTABLE,MASSACHUSETTS 3Disposal bpstem Construction Permit Permission is hereby granted to Construct( /) Repair( --)" Upgrade( ) Abandon( ) System located at G/ eo,4 e y ;v. Z /-t ry F and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date 7o t-4 , erA• 7:G Approved by ,j Town of Barnstable `"E'�` Regulatory Services Thomas F. Geller, Director MA & Public Health Division Thomas McKean, Director ' 200 Main Street,Hyannis,MA 02601 Office: 503-362-4644- Fax: 503-790-6304 Installer & Designer Certification Form Date: Sewage Permit# 00�1 G�� Assessor's Nlap\Parcel 15 Designer: T Installer: t/-?2Gy eO--57- 60 Address: 1' 0 Address: 947X 13 /la Iciv, VA /7(/,q A-"�/3" /P7 On was issued a permit to install a (date) (Installer) 1 I septic system at � C��"1 �N based on a design drawn by n (address) b-1 ✓✓,',^ /vl t- t`� , dated d U 0 (designer) 1 certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation OF the distribution box an&'or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or am: vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. OF MA / f /DAMEE (In�ltaller's Signature) No. 140 v S01TA�\P� 0 � ' l� (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTA LE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q: Health/Septic/Designer Certification Form 3-26-04doc of Town of Barnstable P# Department of Regulatory Services d �ARNBTAHIF � Public Health Division Date D 200 Main Street,Hyannis MA 02601 rE0 MIKt t' A Date Scheduled i Pffime Fee Pd. Soil Suitability Assessment for Sewage Disposal o b Performed By: M . I 'l �,`/`(, Witnessed By: 0A7.0 LOCATION& GENE INFORMATION Location Address Owner's Name E Address 2 Assessor's Map/Parcel: S�} �� t Engineer's Name/ G,"(1,e J\ NEW CONSTRUCTION �Y REPAIR Telephone# .5O D 34a Aq)a Land Use (2e i fl ► in kl,, Slopes M $ Surface Stones F-vl Distances from: Open Water Body ft Possible Wet Area >?,f.)(3 ft Drinking Water Well f ( �ft Drainage Way -> 7 U ft Property Line ft Other .�_ ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) '!2/ j ll \\ TH-2 G �C (D r,- ,a.c,�o I G w tp O tic, 70 cnrc of - `j Parent material(geologic) a(, 95 Depth to Bedrock ( Depth to Groundwater. Standing Water in Hole: k� Weeping from Pit Foce Estimated Seasonal High Groundwater DETEI NATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: ____in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: _ in. Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adj,factor _ Adj.dtwutl&ater Level, ,o PERCOLATION TEST Thne, Observation Hole# ii ) Time at 9" 1 Depth of Perc .20 S' e Time at 6" Start Pre-soak Time @ Time(9"-6") - End Pre-soak Rate Min./Inch �r Site Suitability Assessment: Site Passed ^ Site Failed: Additional Testing Needed(YIN) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conservation Division at least one(1) week prior to beginning. Q:\SEPTIC%PERCFORM.DOC I DEEP.OBSERVATION HOLE LOG Hole# 1 Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. r p /} q Consistency. ravel g o a► l Jd nd I C .4�� 7" 3`6'- ot- DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.% ray A Loft �a L U j N ch LOA y2_ a r� un 714 log - Wb cnj � 7f DEEP OBSERVATION HOLE°LOG Hole# N rT Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, a Flood Insurance Rate Man: Above 500 year flood boundary No_ Yes Within 500 year boundary No Yes Within 100 year-flood boundary No x Yes _ Death of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? , If not,what is the depth of naturally occurring pervious material? _.. Certification I certify that on /C7 199 (date)I have passed the soil evaluator examination approved by the Department of Environ "ental Protection and that the above analysis was performed by me consistent with . the required t. xpertise and experience described in 310 CMR 15.017. Signature Date 0) D1 Q:4SEPTIGIPERCFORM.DOC FRDM mown cape engineering inc FAX NO. :15083629880 Jan. 08 2009 09:33AM P2 down cape,engineering, inc. SIEVE SOILS ANALYSIS Meyer 24 Coarhman.xlsx DATE OF REPORT: 1/5/09 JOB : GRAIN SIZE ANALYSIS-SIEVE TEST SITE: 24 COACHMAN W.BARN LOCATION: D.MEYER TH- 12/18/08 SIEVE ANALYSIS Weight Sample(Grams): 699.3 r~ SIZE :WEIGHT DETAINED ; % RETAINED: % PASSED ---.-- ._...(s )........ ---^------ ---- 1"- 0.0: 0.0%: 100.01%" 3/4--------------------------------- 6.6�---------- _0.0%: •-------100.0% 0.0; 0 0%: 100.0% _-^--------- ....... 0.6 0.0%: 100.0% ..... ........:...........................------------ - 0.0%: 100.0% ^10^------ - •---------•-• -------------- -i- - ---•--- -------- 31.7: --0------ - , ------......••151-5.----------21 --- 7...... -------------:.............. -----------._........................ #40 397.5; m.8%: 43.2% ......... ...::...........................,------...._---.�_�._........_.._..�. #50 488.4: 69.8 /" ------------- ---------------------- - -------------------------------- ._.... #80 606.2: 86_.7_"/0: 13.3"/0 1i100-----........................642-6- --------- -- 9%: ...........8.io� -------------�..._.........---.-- --.....---------- ----- - ------------- ---- #200 680.2 97.3%: _ 2_7% PAN: ------f - -699 3:---------100.0%:----- 0.0°/u _....-.............^---------------_^-^-'r------------------------------'------ SAMPLE: 699.3; NOTE. TEST ON PASSING#4 ONLY,4% RETAINED ON#4<45%O.K. RESULTS: SOIL CLASSIFIED AS AASHTO A-1-b(GRANULAR,SAND)(UNCOMPACTED) PERCENTAGE OF MATERIAL PASSING#4 SIEVE MEETS : #4 100% (TEST ONLY MATERIAL PASSING#4) �!i i4.,-c�„ #5010%-100% #100 0%-20% ).)ALA #200 0%-S% GIVII.. �^ REQUIREMENT FOR"FILL"IN TITLE S. �,� pN`' <16c50> 'r <5%PASSING#200 SIEVE -��s � �''�' r a._., c.IONA- . f� RESULTS: PERMEABLE MATERIAL-CLASS I<2 MINJIN. MATERIAL NONCOMPACTED SOIL DESCRIPTION: MEDIUM SAND,TRACE SILT - DATE: 8/14/02 PROPERTY ADDRESS: 24 Coachmam Lane West Barnstable ,Mass . I ------------------------ MAP 02668 PARCEL ; O _ ------------------------ LOT On the above date, I inspected the septic system at the above address. This system consists of the following: RECEIVED 1 . 1-1000 gallon septic tank. 2 . 1-Distributi6n box . 3 . 1-1000 gallon precast leaching pit . ( 6 ' X101 ) SEP 3 2002 4 . 2-500 gallon precast leaching chambers . ( '25 ' X13 'X2 ' ) Based on my inspection, I certify the fo'llowing conditions: TOWN OFBARNSTABLE 5 . This is a title five septic system. HEALTH DEPT. 6 . The septic system is in proper working order at the present time . 4 �2 C 7 . The leaching pit is dry . 8 . The 500 gallon chambers has waste w.ater 19' below the invert pipe . ------ SIGNATUR Name:_ J .- P . -Macomber-jr . Company:Jose-eh PJ_ Macomber & Son, Inc . RECEIVED Address: Box _E_............ 2 8 2002 Cen � v_ille-,-Ma _n632-0066 AUG TOWHEAL H DNPT.BLE Phone: 508-775-3338 THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY JOSEPH P. MACOMBER & SON, INC. Tan ks-Cesspools-Leachfields Pumped & Installed Town Sewer Connections P.O. Box 66 Centerville, MA 02632-0066 775-3338 775-6412 i COMMONWEALTH OF MASSACHUSETTS r EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION V TITLE 5 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 24 Coachman Lane j West Barnstable Mass , Owner's Name:James.., ite Owner's Address: Same 1 Date of Inspection: 8/ 14/02 Name of Inspector: (please print) Joseph P.Macomber Jr . Company Name: J. P.Macomber & Son Inc . Mailing Address:Box 66 . Centerville .Mass . 02632 Telephone Number: 508-775-3338 CERTIFICATION STATEMENT 1 certify that 1 have personally inspected the sewage disposal system at this address and that the information reported tito++ is me, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience.in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: t'/�' Passes Conditionaliv Passes Needs Further Evaluation by the Local Approving Authority Fa' s r Inspector's Signature?mit Date: The system inspector shall 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. Notes and Comments ****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. Title 5 Inspection Form 6/15/2000 page 1 • Pa2e 2 of 1 I OFFICIAL INSPECTION FORM— NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 24 Coachipan Lane West Barnsta e , ass , Owner: James White Date of Inspection:8/14/0 2 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: 1 have not fou�53 �exist. hich indicates that any of the failure criteria described'in 310 CMR I5.303 or to 31 C ailure criteria not evaluated are indicated,below. � Comments: `}; ✓1 .. ' 1J s' The septic<:•<system is in proper working,,drder at the present time . tv B. System Conditionally Passes: '�� A/P One or more system components as described in"itte"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. Answer yes, no or not determined (Y,N,ND) ip"the for the following statefnents. If"not determined" please explain. VQ The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. 'A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of I I OFFICIAL. INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Propem Address:74 Coachman Lane West Barnsta le ,Mass . Owoer:James White Date of Inspection: 8/14/02 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system s failing to protect public health, safety or the environment. I. System Hill pass unless Board of Health determines in accordance with 310 CMR 15,303(1)(b) that the system is not functioning in a manner which will protect public health, safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. S.Nstem Kill fail unless the Board of Health (and Public Water Supplier, if any) determines that the s.Nstem is functioning in a manner that protects the public health, safety and environment: 46 The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or rributary to a surface water supply. k6 The sys:em has a septic tank and SAS and the SAS is within a Zone I of a public water supple Ab The sys:em has a septic tank and SAS and the SAS is within 50 feet of a private water supply well • N The sysf.em has a septic tank and SAS and the SAS is less than 1 0 feet bu 50 feet or more from a private "ater suppl\ well, Method used to determine distance �,�j/,�, "This system passes if the well water analysis, performed at a DEP cenified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free f om pollution from that facility and the presence of ammonia nitrogen and nirrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are rriggered. A copy of the analysis must be anached to this form. 3. Other: 3 Page 4 of 1 I OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 24 Coachman Lane West Barnstable , ass . Owner:James White Date of Inspection: 8/14/0 2 D. System Failure Criteria applicable to all systems: You must indicate "yes"or"no"to each of the following for all inspections: Yes VNOackup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ischarge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or logged SAS or cesspool Static liquid level in he distribution box above outlet invert due to an overloaded or clogged SAS or /cesspool � Q� f- I—TM eA�be^3 _ d Liquid depth in cesspeel is less than 6"below invert or available volume is less than '/z day flow ZRequired pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped Q. ny portion of the SAS, cesspool or privy is below high groundwater elevation. Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. y portion of a cesspool or privy is within a Zone 1 of a public well. _ny portion of a cesspool or privy is within 50 feet of a private water supply well. y 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen a.nd nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] i{1%) (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303. therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no !/ the system is within 400 feet of a surface drinking water supply //e 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 11 of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered "Yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:24 Coachman Lane West Barnstable .Mass , Owner: ,Tames .Whi to Date of Inspection: 9/1 4/02 Check if the following have been done. You trust indicate "yes"or"no" as to each of the following: Yes No 1/ Pumping information was provided by the owner, occupant, or Board of Health �V'ere 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 ? 4111_ Were all system components,44cluding the SAS, located on site ? 4 _ 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: Yes no 3' _ Existing information. For example, a plan at the Board of Health. ,V _ 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(3)(b)) 5 Page 6 of 1 I OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 24 coachman Lane West BarnStable .Mass . Owner:,James White Date of Inspection:: 8/14/0 2 FLOW CONDITIONS RESIDENTIAL Number of bedrooms (design): Number of bedrooms(actual): DESIGN flow bases on 310 CMR 15.203 (for example: 110 gpd x # of bedrooms);. .t°me �• �iP,e? Number of current residents: _A Does residence have a garbage grinder(yes or no): .t/0 Is laundry on a separate sewage system yes or no);Va [if yes separate inspection required] Laundry system inspected(yes or no): Y�9 Seasonal use: (yes or no): ,L2) Water meter readings, if available (last 2 years usage(gpd)):'We 11 water . If the well has not Sump pump(yes or no):AZ been tested in t h e Last date of occupancy: past 12 months . It needs to be tested COMMERCIAL/INDUSTRIAL at this time . Type of establishment: �Q Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): AM Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system (yes or no):.60 Water meter readings, if available: Last date of occupancy/use: _AAA OTHER (describe): 14'1� GENERAL INFORMATION Pumping Records Source of information: 3/21/00 4/4/01 4/l/02 Maint . Tank only Was system pumped 3s pan of the inspection (yes or no):,eO If yes, volume pumped: _ gallons-- How was quantity pumped determined? Reason for pumping: TYKE OF SYSTEM: ►/ Septic tank, distribution box, soil absorption system ,�ZD Single cesspool Overflow cesspool ` 4iPrivy Shared system (yes or no)(if yes, attach previous inspection records, if any) 41-3 Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) Tight tank 14ij Attach a copy of the DEP approval �Other(describe): .{fl9 � Approximate ate of all components, date installed (if known)and source of information: Tank & pit installed in 1986 . The two 500 gallon leaching chambers were installed . 6 2 99 Permit # 99-322 Were sewage odors detected when arriving at the site(yes or no): 6 Page 7 of 1 1 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 24 Coachman Lane West Barnstable ,Mass . Owner: James White Date of Inspection: 8/14/0 2 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction:44cast iron Z0 PVC other(explain): ,l�,? Distance from private water supply well or suction line: eeo- Comments(on condition ofjoints, venting, evidence of leakage, etc.): Joints appear tight . No evidence of leakage The sytem is vented through the house vents . SEPTIC TANK: Zoocate on site plan) revdl6wW Depth below grade: y Material of construction: a/concreteAb metal tefiberglass4Ld polyethylene 41c5other(explain) If tank: is metal list age:4,70 Is age confirmed by a Certificate of Compliance (yes or no):A)6 (attach a copy of certificate) Dimensions: Sludge depth. Distance from top of sl dge 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: How were dimensions determined: Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of.leakage, etc.): 'Pump the =septi r tank every 7 3 years in] at: & Out let= tees are i n pl are _ Tha se p ti r tank %s -st=£1}6tural1y seund—afid shE)ws no evidence of leakage . GREASE TRA➢E yttlocate on site plan) Depth below grade: Material of construction:,lfl concrete?/Xmetal41AfiberglassrkpolyethyleneyAother (explain): Dimensions: _ 42d Scum thickness: lfl�— Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: .ei� Date of last pumping: —d& Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Grease trap i s rint present - 7 7 Page 8 of I I OFFICIAL. INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:24 Coachman Lane West Barnstable Mass . Owner: James White Date of Inspection: 8/14/02 TIGHT or HOLDING TANK,()&&,(tartk must be pumped at time of inspection)(locate on site plan) Depth below grade: 41A Material of construction: &&concrete metal Akfiberglass AJ�Polyethylene 4)4 other(explain): Dimensions Capacity: A14 gallons Design Floµ AH gallons/day Alarm present (yes or no): A)14 Alarm level: wA Alarm in working order(yes or no): Date of last pumping: AM Comments (condition of alarm and float switches, etc.): Tight or holding tanks are not present . DISTRIBUTION BOX: Zif present must be 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 solids carryover, any evidence of leakage into or out of box, etc.): Distribution box has two laterals . No evidence of solids carry over . PUMP CHAMBER411g&(locate on site plan) Pumps in working order(yes or no): ,IJ� Alarms in working order(yes or no): Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): 8 Page 9 of 1 I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 24 Coachman Lane West Barnsta e ,Mass . Owner,James White Date of Inspection: 8 14 02 SOIL ABSORPTION SYSTEM (SAS)): (locate on site Ian, excavation not required) 1-1000 gallon pree`ast leac ing pit . (6 ' X10 ' ) 2-500 gallon precast eac ing c am ers pac e in o z s one . If SAS not located explain why: Locared see page 10 T zaching pits, number: - �� C�� aCS�X i3rx �/ ; leaching chambers, number: 02 Teaching galleries,number: leaching trenches,number, length: Q 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.): Loamy sand to medium sand to fine sand . No signs of hydraulic failure or ponding . Vegetation is normal . Waste water in t e chambers is 19" below the invert , .The leaching pit isdry . CESSPOOLS, —(cesspool must be pumped as part of inspect ion)(]ocate on site plan) Number and configuration: 0 Depth—top of liquid to inlet invert: 42,4 Depth of solids layer: A30 Depth of scum laver: AM Dimensions of cesspool: yA Materials of construction: AM Indication of groundwater inflow(yes or no): Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Cesspools are not present . PRIVYY44&L(locate on site plan) Materials of construction: Dimensions: Depth of solids: A1 Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy is not present 9 I pig( )0 0( 1 1 OFFICLAL INSPECTION FORM — RIOT FOR VOLUNTA-RY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INRORM>,TION (conHnvcd) ➢roprrfry floor,): 24 Coachman Lane West arns a e ,Mass . TamPC W}l� Dlic of Inlpcclioo: 841 Z /(l2 SK''TCH OF SCWACE DISPOSAL, SYSTEM plo.io( 1 Ikcich,of the Ifwl;f 0iIp01Il Iyllcm including tics to 11 Ica�I nvc pcRn�ncnl rc(crc I+.ncmifk, o, Ocn rfnvkl loch! III -(III wllhl) 100 (m. LOCIIf whcfc public I"JI ncc l�pply cnlcfl the bvi)c wall i Fy 7,Atl�—j C) 0 Ysx O O 10 i Page 1 I of 1 I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address24 Coachman Lane West Barnstable , ass . Owner: James White Date of Inspection: '8/14/O 2 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water ill/ feet Please indicate (check)all methods used to determine the high ground water elevation: rained plans on record - If checked, date of design plan reviewed: /t O served site abuttin ro e bservation hole within 150 feet of SAS) checkecl hecked with local Board of Health-explain: 160 with local excavators, installers- (attach documentation) YES Accessed USGS:database-explain: htt1) Z/town . barnstable .ma . us . You must describe how you established the high ground water elevation: Used : Gahrety & Miller Model . 12/16 94 . Grond water elevations above sea level . Used : USGS : Observation well data Tune 1992 Used ; USGS : Techni.cajup T__Bulletin 92-000-1 Plate#2 Annual ranges of roun ground water elevations . l +� Leaching Pit Groundwater: nd ater: Feet Below Bottom of Pit High Groundwater Adjustment 1.8 ft per Frimpter Method Therefore, the vertical separation distance between the bottom) /^ Of the leaching pit and the adjusted groundwater table is1��/ feet. 11 rr r.-n� -r-m.'nmmrr..r. .rr.:-.•T.-�•a*r:rr-car- m-z-+u*n"a:'rc+'r+n T.r.�r_ � •.._.r.,r_n . Barnstable TOWN OF BOARD OF HEALTH 0 SUNSORFACR 9EEHAGF DISPOSAL 1L SYSTEM I N3I'ECTION FORM - PART D •- CERTIFICATION J•f'!Q.1'RiRTM1Ti i•RT nmrrlr'<tTrrrerrm.::rrr'r-;. .�..� -TYPE OR PRINT CLEARLY- PROPERTY INSPECTED STREET ADDRESS 24 Coachman Lane West Barnstable ,Mass . ASSESSORS MAP , BLOCK AND PARCEL # OWNER' s NAME Jim White PART D - CERTIFICATION r NAME OF INSPECTOR Joseph P .Macomber Jr . COMPANY NAME J . P.Macomber & Son Inc-:,,' COMPANY ADDRESSBox 66 Centerville ,Mass . 02632 Street Town or CSty Stat• E I P COMPANY TELEPHONE ( 508 ) 775 - 3338 FAX (508 790 _ 1578 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at ®rlecoinmendaLions his address and that the information reported is true , accurate , and omplete as of the time of .inspection , The inspection was performed and any regarding upgrade , maintenance , and repair are consistent .4ith my training and experience in the proper function and maintenance of on- site sewage disposal systems . Check one ; Wss t e m; PASSED y The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or Lhe. environment as defined in 310 CMR 15 . 303 , Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form . System FAILED* The inspection which I have conducted has found that the system fails to Protect the public health and the environment in accordance with Title 5 , 3.10 CMR 15 , 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form , Inspector Signatu Date T �� ne copy of this certification must be provided to the OWNER, the BUYER ,here applicable ) and the BOARD OF HEAL711. * If the inspection FAILED, the owner or"operator shall upgrade • the eystem wir.hin one year of the date of the inspection , unless allowed or required otherwise as provided in 310 CMR 15 . 305 . partd . doc 1 A— Page: 1 f� YE CERTIFICATE OF ANALYSI Barnstable County Health Laboratory AUG 2 0 2002 t3' rY Report Prepared For: Report Dated: 08/15/2002 TOWN OF BARNSI AbLL ALTH DEPT• Order Number: James Macurdy P O Box 203 Centerville, MA 02632 Laboratory ID#: 0216715-01 Description: Water-Drinldng Water Sample 4: 16715 Sampline Location: 24 Coachman,West Barnstable Collected: 08/13/2002 Collected by: RCF Received: 08/13/2002 Routine ITEM RESULT UNITS MCL Method# Tested LAB: IC Lab Nitrates 1.0 mg/L 10 EPA300.0 08/13/2002 LAB: Metals Copper 0.1 mg/L 1.3 SM 3111B 08/14/2002 Iron <0.1 mg/L 0.3 SM 3111B 08/14/2002 Sodium 9 mg/L 20 SM 3111B 08/14/2002 LAB: Microbiology Total Coliform Absent P/A Absent 307 08/13/2002 LAB: Physical Chemistry Conductance 116 umobs/cm EPA 120.1 08/14/2002 pH 6.7 pH-units EPA 150.1 08/14/2002 Note: Water sample meets the recommended limits for drinking water of all above tested parameters. Approved By: o....... (Lab Director) ��/✓�I200z t i Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 TOWN OF BARNSTABLE LOCATION 024 Ca SEWAGE # VILLAGE t—�, QA QjA a�, 1 ASSESSOR'S MAP & LOT -0 INSTALLER'S NAME&PHONE NO.MRc`_n f)1 f2-,, SEPTIC TANK CAPACITY _ 1006 LEACHING FACILITY: (type) 27 - v E r (size) -_c5~Oct NO. OF BEDROOMS BUILDER OR OWNER / PERMUDATE: L- COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by y6 �. l TOWN OF BARNSTABLE qq- g ,� 4 C9,—ATION 024 Ca clK M SEWAGE # 04 VILLAGE t�, 2a,�u�� b ASSESSOR'S MAP& LOT 'D INSTALLER'S NAME&PHONE NO. f 1�R[°_[�tY1 � fL 7'� =3 5 S-1 SEPTIC TANK CAPACITY 1000 sgiy LEACHING FACILITY: (type) -= 04v wt✓11 T (size) S06 NO.OF BEDROOMS a BUILDER OR OWNER PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 1 \ � C�\ �` � �� O � � t �� i _ -s .^`4, \ �� r ,y. � .r' 1 No. �9- a,'a , '1 Fee 5 O. 0 O THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Vy Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pprication for Mfgpont *pgtem Congtructiou Vermit Application for a Permit to Construct( )Repair(X X)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. J i m Wh i t e Owner's Name,Address and Tel.No. 24 Coachman Lane W. B. Jim White Assessor's Map/Parcel ld.,R 24 Coachman Lane West B a r n s t . Installer's Name,Address,and Tel.No. 5 0 8-7 7 5-3 3 3 8 Designer's Name,Address and Tel.No. 5 0 8-7 7 5-3 3 3 8 J. P.Macomber & Son Inc . J.P.Macomber & Son Inc . Box 66 Centerville ,Mass. 02632 Box 66 Centerville ,Mass . 02632 Type of Building: Dwelling X X No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 355 gallons per day. Calculated daily flow 3 x 1 1 0-3 3 0 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 1500 gallons Type of S.A.S. 2_90O g-a 11 o n chambers Description of Soil Loamy sandto boney granular sand . Nature of Repairs or Alterations(Answer when applicable) Add in g two 500 gallon chamber.-, to to an existing 1000 tank d-box & 1000 gallon leach pit. Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been iss ed by ' &firr rpealth.W Signed Date 4/19/99 Application Approved by C Date 6 3_- Application Disapproved for the followinj reasons Permit No. �J `��. Date Issued _ Fee S O. OO t ;k THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes . PUBL`IC HEALTH DIVISION- TOWN OF BARNSTABLE, MASSACHUSETTS ZIpprfcation for Migogar 6pgtem Cottgtruction Permit Application for a Permit to Construct( )Repair(X X)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. J i m W h i t e Owner's Name,Address and Tel.No. r 24 Coachman Lane W.B. Jim White Assessor's Map/Parcel `s.. D / 24 Coachman Lane West B a r n s t. ' Installer's Name,Address,and Tel.No. S O 8—7 7 5—3 3 3 8 Designer's Name,Address and Tel.No. SOH—7 7 5—3 3 3 8 t J.P.Macomber & Son Inc . J.P.Macomber & Son Inc . Box 66 Centerville,Mass . 02632 Box 66 Centerville,Mass. 02632 f Type of Building: ,Dwelling XX No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder Other N Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures 4 Design Flow 355 gallons per day. Calculated daily flow 3 x 1 10-3 3 0 gallons. Plan Date Number of sheets Revision Date Title Size of eptic Tank 1500 gallons Type of S.A.S. 2—5(1 1 14*tJc h a ITi be r s Descriptio of Soil Loamy sanAto boney granular sand . V Nature of Rfpairs or Alterations(Answer when applicable) A d d i n g t w o 5 0 0 g a 11 o n c h a m b e r s 't o to an a isting 1000 tan0-d-box & 1000 gallon leach pit . Date last irfspeected: Agreemenv The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordanle with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Co>ngliance has been is ed by i Bo o Health. Signed /, /' Date 4/19/9 9 Application Approved by Date A- 1- 2* Application Disapproved for the Yollowing reasons Y Permit No. — J 2'1 Date Issued --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (certificate of (Compliance THIS IS TO CERTIFY, that the On=site Sewage Disposal System Constructed( )Repairedl(XX)Upgraded( ) Abandoned( )by J.P.Macomber & Son Inc . at 2 4 C o a c h m a n Lane West B a r n s t a b l e.Mass. has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.77-3.-L2 dated J.P.Macomber & Son Inc . J.P,.Macomber & Son htic , p Installer Designer The issuance of this permit shall 1i0 b cons, ued as a guarantee that the syst w i 1 function as designed. Date r� Inspector / �iJ'L ( ,' 0 4 No. ��- 1� C Fee 50. 00 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Mi5pogal *pgtem Congtruction Permit Permissions* here b ranted to Construct( )Re air X )Upgrade( )Abandon( ) System located at �4g Coachman Lane Wpest Barnstable Mass. and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date: & 7.— 7 q Approved by x n 116199 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. - CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) I, _Joseph P.Macomber J r . , hereby certify that the application for disposal works construction permit signed by me dated 4/19/9 9 concerning the property located at 24 Coachman Lane West Barnstable MA meets all of the following criteria: /The failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. There are no wetlands within 100 feet of the proposed s3' septic stem P There are no private wells within 150 feet of the proposed septic system There is no increase in flow and/or change in use proposed i� There are no variances requested or needed. Y The bottom of the proposed leaching facility will not be located less than five feet above the maximum adjusted groundwater table elevation. (Adjust the groundwater table using the Frimptor method when applicable] If the S.A.S. will be located with 250 feet of any vegetated wetlands, the bottom of the Po ro sed P leaching facility will not be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(using GIS information) B) G.W. Elevation �3 S— +the MAX. High G.W. Adjustment.�" DIFFERENCE BETWEEN A and B SIGNED • /j DATE:^4/19/9 9 (Sk,ich oposed plan of system on back]. q:health folder.cert i Igallon Existing 10Leaching pi Distribution box 2-500 gallon chambers packed in 4 ' of stone . Existing 1000 gallon Leach pit . 03fiSSI I3NV11JW03 31Va a I n s s I ilwaId 31Va ri u3 NMo 80 If 10 11 n a I SSIdaaV t I W V N s.0311 VisNI 3514 19V11IA . 'ON 11Wb 3d 3 9 V M3 s N01 O I i Vol � izTI 3 'Z T � 7-1 6 ! Noa�a Fins THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH , pphratinn for 13ispnsttl Works Tonstrudion Prrutit Application is hereby made for a Permit to Construct ()0) or Repair ( ) an Individual Sewage Disposal System at: %!11.9. ...... 1�.. 1. ........... ............... Q7-. ........_._............................_.__.__.... ation_Ad ss or Lot No. . .ftn1..... st�.f ... r�:;.s�l 51 .:-Tlt.axi ...: R_�,nll... .:r2c1---...... Own - A dress a .._�!'/� 1....- c✓-.� I ..��lesl_. !..... ar.... ..-----._ t?S.l ( (`/V - / Installer Address J Type of Building Size Lot...`.. .�aZQ. .Sq. feet .. Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) 'k Other—Type T e of Building ............. No. of ersons__....__._..........._...___ Showers a YP g ............... P ( ) — Cafeteria ( ) a' Other fixtures d c�'2�?M:................. •------,--`-------------------------- �.� 0 low.................- .�_ ..... W Design Flow............ ................. ..gallons per.geFsea per da'y. Total daily ............................................gallons. W Septic Tank—Liquid capacity? gallons Length._ _._.. Width...'.`t�4!... Diameter................ Depth.... ... ..... x Disposal Trench—No..................... Width..........__-...... Total Length................V.. Total leaching area....................Sq. ft. 3 Seepage Pit No........./........ Diameter........f_��__.... Depth below inlet........6....... Total leaching area._-.3 ...sq. ft. Z Other Distribution box (J) Dosing tank ( ) aPercolation Test Results Performed by....... t � Gl? Date___../__2_:_.�Y_:_6y... Test Pit No. 1...".3(..mmutes per inch Depth of Test Pit....._A/f.____ Depth to ground water...... G4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ aOa ............ ....... ........... .........••...... -----�.. ..._------ � I .... Description of Soil....._�,0.`I�Zt_...........----T Pr----•- ............S.P.8.. .rc ..........M/ ... ..... ......F1N.. S . '.._.. - ... _.. w UNature of Repairs or Alterations—Answer when applicable............................................................................................... ..__.....-•................................................•------.....---................----......--•-•--•-•-••-•--------.............._..----•--•--•--••--•--........._..........._..._............_. Agreement: I The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued a board of health. Signed: .. ....................... ------------------__ Application Approved B :--- — ' PP PP Y...... .....�.� _-____Da ..�>r?.. Date Application Disapproved for the following reasons:..............•---•-•--------------•----••--•--._.....----••---•-------••-•---•-•-••-------••-----•--------- .............._......•----............................................................................ Date PermitNo................................. --- ....................... Ewe •y�,,.-✓-- ,. ..�n'*:�+..e+w.,;�.i^�...�.Y�......+....jr...«.,y,_.t N+�`'`3s.,:�`+„-+g •""•sw'Y"rv^•..».q......;.:•c*•W-t ,Y w' '4-.F..z6�-.1%4+.....J`.. r -o; { Ilk THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........... t . . , Brat on for Disposal Works Tonsteurtion rnmit Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal System at: ......-.��' t!;�!/ i 1 �,�11�.... ...._ .............�-�? -.........-- --...................-......_...._- Location Address or Lot No. CT, o t�s �:� ;,�n �a ,rri .:., 4 l Sr'1 `7-ld n1___„,"? jj //1 owner Address .. If! ( ,.>. /n ti i ,r-• err..... R.T .ass rJP ,a �:................................. ....................... .........._. ... .-. ................................................-� f� fInstaller Address Type of Building Size Lot..._"a _: Sq. feet .., Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) `a Other—Type T e of Building No. of persons........................ Showers Gw YP g ............................ P ---- ( ) — Cafeteria ( ) Q'W Other fixtures ............................................d __ •-•.......... ................................... 3...... .......... Design Flow.............///)._...-._............gallons perpersonper dy. Total daily ow.........______- ". r2............ .gallons. ?Se tic Tank—Liquid ca aci h / Ions Leng th. �_ ..... Width.. �.« Diameter................ DePth_..�'. / x Disposal Trench—No. ................... Width.................... Total Length................. Total leaching area....................sq. ft. 3 Seepage Pit No.........�_........ Diameter......... ��.... Depth below inlet........ Total leaching area.-:3:.� ...sq. ft. z Other Distribution box (X) Dosing tank ( ) Percolation Test Results Performed by.......��!.PL�f ••__ C,rl A x.�lc R /•• — V-< ---•- . .. .. .. ..�........... .....:.......•---. .... ..... Date....-- � -�----....� 41 Test Pit No. I...!!: ..minutes per inch Depth of Test Pit......:.r?�� Depth to ground water-.-......":-........... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a .....:.......•--•---...........................--.... .......-............__-----•••...•--..................-------......................... p CA rV _ ? 4/t' -7- //__ l 4 AJ5 O C l 0 n-,-A-/� �c�� -�! Description of Soil......... .........................................•----.......--•-•---.............---•--••-•-••----.....__..._.._._... .. •••.........-•---._......-•------•-•--••......................................... W . ....-•---•-•-------------------------------------------••-•-----•--•----......-----•-•----•-••--.....---...----•-...........----.....-•----._............_...--••-•---..........................-_..... -U Nature of Repairs or Alterations—Answer when applicable............................................................................................... .........--•...............•--••-----•-•------•--..........._...........-----................---•-••.._.......-----.......... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by-,the board of health., AC . Signedv-- ------•-- •-•- ..........................Da Application Approved By.�='.- ........ 410,.._U c ``:�........................... ------�..--.....----....... .------ Date Application Disapproved for the following reasons:..........................................................................................................--- -......................................................................................--•-••--••-•••-...._..--••--•••......-••-•----..__._._..........------....--•-••-----...------...•-•••-•--- Date sPermit No............._....._.......-................_..._ Issued.--_................................__..-_--......... Date - � -�j L L THE COMMONWEALTH OF MASSACHUSETTS �'..� BOARD OF HEALTH .. �r }�. ._, c , , (9Pr#ifutttr of Tomplianu THIS IS TO CERTIFY That the Individual Sewage Disposa �System constructed ( ) or Repaired ( ) b �. 7 r y ? ...�/�. ... ....:.................................................................- . .. .. has b�een:<nstalled in accordance with the provisions of TITLE, 5 of Tee tate Sanitary Code as described in the application'foi Disposal Works Construction Permit No......... - ��... ....... dated.:.............................. ............... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE...... G ��( .j,t` ............................. Inspector l `°7\- r........ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF....................... ........... �- �, No........::. .-.. .1 FEE..:...................... Disposal Works (gat U h fmit Permission is hereby granted----... � �c Out .... .:..._.."_: .....i----- -----------------------•-----.........-•---.......... to Construct ( ) or Repair (_ .) an Individual Sewage Disposal System at No........... Wit.....=........... .... .`:.}t.1�lx=^ '............ .......... ............... ..........:......... ............ ............. ..................... ' Stree as shown on the application for Disposal Works Construction Pe-� �?':�_- -)-- Dated....t...-`�J.:.��'._�� _ .................. .........'... -- "• .;,�, -..__.............:..................... _ DATE.................----- 7. Board of Health . ��.....__., / :� • FORM 1255 HOBBS 8- WA R N. Itd' -.LISHE' RS ,i v LEGEND PROPOSED CONTOUR 99 PROPOSED SPOT GRADE s �J — 98 EXISTING CONTOUR ' r; + 96.52 EXISTING SPOT GRADE iJ 5Ile W— EXISTING WATER SERVICE r->�-E' w +,A. TEST PIT co r 5 ft. Soil Removal Ln (see note 16) LOCUS MAP N.T.S. Zoom GENERAL NOTES: \ V 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL \ F q V �� , w BOARD OF HEALTH AND THE DESIGN ENGINEER. \ Q ? DRi 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS j�Z�o _ �EVv.�' ^/� OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE a - —___ f LOCAL RULES AND REGULATIONS. O°� GAS / LL 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR \• J `oLJi % \ TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE \ % I DESIGN ENGINEER. 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN ENGINEER BEFORE CONSTRUCTION CONTINUES. 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. 173�1 wo I / �� I I 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF lti THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. 7. WATER SUPPLY PROVIDED BY PRIVATE WELL. 8. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. 1. l o 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE Exrs'.IngiL aFh/pg THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING (XO t'%/yO) 11 11�! /o T CONSTRUCTION. 10. EXISTING LEACHING TO BE PUMPED, CRUSHED AND REMOVED. REPLACE WITH CLEAN, MEDIUM PERC. SAND. 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY 13. NO ADDITIONAL PRIVATE WELLS WITHIN 150' OF PROPOSED LEACHING. I 14. NO WETLANDS WITHIN 100' OF PROPOSED LEACHING. / \ 15. ALL PIPING TO BE 4" SCH 40 ® 1/8"/FT (UNLESS SPECIFIED) 16. REMOVE ALL UNSUITABLE SOILS 5 FEET AROUND L�ACHING TO EL. 89.02 OR TOP OF C2 LAYER AND REPLACE WITH CLEAN MEDIUM SAND PER TITLE V. RO/ PROPOSED SEPTIC SYSTEM UPGRADE PLAN o D A� M�; 24 COACHMAN LANE, W. BARNSTABLE, MA / No. 11`40 DPrepared for: Arch Construction SURVEY REFERENCE: 6/ � O MAP. 152 Engineering by: Surveying by: SCALE DRAWN JOB. NO. LOT:041 DARRENM.MEYER,R.S. Eco-Tech Environmental 1"_30' DMM PLAN OF LAND BY DOYLE ENG. ASSOC. v S4ANW, '* POBOX981 DATED: MAY 22, 1984 ? ✓ Db DEED BOOK.' 17025 EAST SANDWICH,MA02537 (508) 364-0894 DATE CHECKED SHEEP N0. �) fib '®� DEED PAGE.• 088 50&362-2922 01/08/09 DMM 1 of 2 y ELEV. TOP FOUNDATION "NOTE: ALL COVERS TOIBE MARKED WITH MAGNETIC TAPE (Existing) = 99.02 � F.G.EL: 97.0 F.G.EL: 97.50 F.G. EL: 9:'7.50 FINISH GRADE=97.75 a MAINTAIN 2% MIN SLOPE OVER LEACHING AREA COVER OVER LEACHING = 3.0 FT. moommm COVERS TO WITHIN 6 OF GRADE 2" OF 3/8" DOUBLE ,. . WASHED STONE 3/4" - 1-1/2" DOUBLE 6" 4" SCH 40 PVC WASHED STONE 4" SCH 40 PVC CAS=2% 10"I " ' li3®®®- p ®®®® (MIN.) 14 MIN. s p S= 1% (MIN.) TEE'S ARE TO BE ®®®®®®®®®®® ..�.:: 4" scH 4o PVC INV.95:20 2 EFF. DEPTH ®®®®®®®®®®® 1 INV.95.34 INV.95.0 , GAS J _ 4 2 X 8.5 4 EXIST. OUTLET , PROPOSED DB 3 BAFFLE L EFFECTIVE LENGTH = 25' H--10 DISTRIBUTION BOX INV. 95.59 EXISTING 1,000 GALLON SEPTIC TANK INV. ELEV.= 94.75 GAS BAFFLE TO BE INSTALLED ON BREAKOUT OUTLET TEE AS MANUFACTURED BY TOP CONC. ELEV. 95.25 ELEV.= 95.25 - TUF-TITE, ZABEL, OR EQUAL - INV. ELEV.= 94.75 -®®� ®®- NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING ®®®®®®® PIPE INVERTS PRIOR TO CONSTRUCTION ®®®®®®® ®®®®®®® 2) D-BOX SHALL BE SET LEVEL AND TRUE TO BOTTOM EL.= 92.75 ®®®®®®® GRADE ON A MECHANICALL COMPACTED SIX 4' 5 FT. 4' INCH CRUSHED STONE BASE, AS SPECIFIED IN R 310 CMR 15.221(2) I SEPARATION 10.73 FT. EFFECTIVE WIDTH = 13' 3) REPLACE EXISTING 1,000 GALLON SEPTIC TANK WITH 1500 GALLON SEPTIC TANK SOIL ABSORPTION SYSTEM (SECTION IF FAILED, DAMAGED, OR UNDERSIZED. SEPTIC SYSTEM PROFILE BOTTOM OF TESTHOLE EL: 82.02 e ) 4) INSTALL INLET & OUTLET TEES AS REQUIRED (500 GALLON LEACH CHAMBER (H-10) LOADING) SOIL LOGS N.T.S. DESIGN CRITERIA P#: 12442 NUMBER OF BEDROOMS: 3 BEDROOM DESIGN DATE: DECEMBER 18, 2008 SOIL TEXTURAL CLASS: CLASS I (per sieve analysis) DESIGN PERCOLATION RATE: <2 MIN/IN DAILY FLOW: 110 G.P.D. DESIGN FLOW: 330 G.P.D. SOIL EVALUATOR: DARREN MEYER, R.S., CSE GARBAGE GRINDER: NO (not designed for garbage grinder) WITNESS: DONNA MIORANDI, BARNS. BOH SEPTIC TANK (VOL. REQUIRED): 330 gpd x 2 = 660 gpd (USE EXIST. 1,000G SEPTIC TANK) Elev. TH- 1 Depth Elev. TH-2 Depth LEACHING AREA REQUIRED: (330) = 445.95 S.F. 97.02 0" 97.50 0" .74 A LOAMY AND A LOAMY SAND t 10YR 4 1 4/ USE TWO (2) 500 GALLON PRECAST LEACH CHAMBERS (H-10 LOADING) 96.35 8 8" 96.83 0 8" WITH 4 FT. OF STONE ON ALL SIDES: 25'L x 13'W x 2'D SANDY LOAM SANDY LOAM 10YR 5/8 10YR 5/8 93.85 94.33 38" r BOTTOM AREA: 25' X 13' = 325 SF 38" u c1 c1 SIDE AREA: (25 + 13) X 2 X 2 = 152 SF SANDY LOAM SANDY LOAM TOTAL SQUARE FEET PROVIDED = 477 vs. 445.95 REQ'D 2.5Y 7/4 2.5Y 7/4 TOTAL G.P.D. PROVIDED: 477 (.74) = 352.98 gpd vs. 330 gpd required 89.02 108" 89.50 108" �� OF ,q4S C2 C2 � s9�y PROPOSED SEPTIC SYSTEM UPGRADE PLAN LOAMY SAND DAR N_ M. l'✓+ LOAMY SAND SIEVE SAMPLE ®120" 2.5Y 7/4 MEF 24 COACHMAN LANE W. BARNSTABLE MA .,¢ 2.5Y 7/4 - �`pr " o. 1 40 Ln Prepared for. Arch Construction .� 82.02 180" 82.50 180" �6�SjFO Engineering by: Surveying by: SCALE DRAWN JOB. NO. DARRENM.MEYER,R.S. Eco-Tech Ehvironmenta/ N.T.S. DMM PERC RATE <2 MIN/IN.** ("C2" HORIZON) '�NITARP PO BOX981 **(see sieve analysis results attached) _ (508) 364-089a �STSANL�W/CH, NO GROUNDWATER OBSERVED �Q�O �r� 1NA02537 DATE CHECKED SHEET N0. l 50&362-2922 01/08/09 DMM 2 of 2 :. _ mm 19 ti °' 20 FT Mlt. TAP OF FOUND, E L. r'� ? t I 10 FT MIN. � I CONCRETE fit, SGH PVC CLEAN SAND j \ COVERS- PIPE- MIN PITCH { t NCRETE 1!8�� . C PER FT ' � pVER r a i 2 LAYER OF 4 CAST IRON -- 1 - 12 MAX. 1/2 WASHED PIPE: - MIN, PITCF { STONE 1 a Cx 1/4`` PER FT a' — OW i t_ ,r' g•f ii LINE— Q i r � E L - x / MIN ( - _ - EL. EL s i _ w JJJJ �DI T �r uj yy LOCA-FION l� L 8 , BOXLj Cl �� I _u a c U �: 111 G O WASHED STONE j.- o � � a i It (l J. Jrl Z_0� PRECAST LEACHING eau Fes. , f= 0/� GAL. -}I �L= _ BASIN OR EQUIV. I n� ,x _ TN 1 ; BOTTOM OF TEST DOLE CAR USGS PROBABLE WATER TABLE EL, = n f PROFILE OF GROUND WATER TABLE( / / ) EL, SEWAGE DISPOSAL SYSTEM NOT TO SCALE sj _ r SOIL TEST NUMBER OF BEDROOMSSOIL _ _ DATE O F �"I L T t•~:S T GARBAGE DISPOSAL UNIT:. _�:� %`f-'•�'S'' < -'" ,- �'. � :14, TOTAL ESTIMATED r _OW WITNESSED BY � r - rN j , r BR s GAL.�'QA� P E R C 0 .AT10N RAT, MIN./1NC1! GAL /BR./ D A r x �. . _ F e A OBSERVATION HOLE I OBSERVATION HOLE 2 - C SCPTIG' TANK CARAC IT ....,, . - GAL. _ .._ REQUIRED ;. _ _f _ v -s _ c r._,; GA:'_. - ELEVATION -ELEVATION -,: I ! "� AC UAL SIZE OF ,�cPT1C TANK.,.., . .. . . LEACHING AREA ;R MENTS SIDEWAL -4' { GAL, S,F � CTT01't an�� ( AL./S.F LEACHING -CAPACP ( BOTTOM + SIDEWALL). ~> ��, GAL, i REStRVE. , !PEA C"HING CAPACITY. . NOTES h _ WORKMANSHIP AND MATERIALS SHALL CONFORM 1.'ALL WOR c TO D.E.Q.E TITLE 5 AND THE TOWN OF RULES AND REGULATIONS FOR SUBSURFACE DISPOSA'-. , 51 OF SANITARY SE WAGE 2 ALL COVENS T6 SANITARY UNITS SHALL BE BROUGHT TO { WITHIN 12" OF FINISHED GRADE, 3. EXISTING AND FINAL GRADES SHALL REMAIN ESSENTIALLY SETBACK MIN FRONT SET THE SAME, M}?ti. REAR SETBACK 4, NO DETERMINATION HAS BEEN MADE BY THIS OFFICE AS TO f w' I MIN, ,SIDE SET-BACK. COMPLIANCE WITH TOWN ZONING REGULATIONS. OWNER'/APPLICANT APPROVED BOARD OF HEALTH 0 ORT41N SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. "✓ - , v- F$ DATE AGENT f _ PROJECT LOCATION' r� 6. i r f <.... ;. ._ -: ..."'•..,�.t,,...+a�-,y,mwtt r. } '-• „a r Y? ` f r} r y.+/d=tx .i � .rx,^tc j py'''.''�/e,a^"T r F� ,. .. .. . - - • -. ;.. ik¢ / 12 99 LEGEND SCALE: DR- s, SATE: - ELEVATIONS 0 p c F act. . EXISTING SPOT ELEV ONS OX JOB NPpp. By rEV EXISTING CONTOUR - --- - - Op 4 CHARD , ,r r r f i2i BARD S: FINAL SPOT ELEVATIONS' Od:O ,_ r, ,fir Y•'r o..r ,,.r,-.: r. .. :r-., `'+ =a!, .l.� - a?" - ��iM�c ��_ a �.j J �, d > f '� �i ,� DRAWING FINAL CONTOUR 00 f3'�EARti j - - o.B44 I Sol'- TEST LOCATION �::r REG. LslfVU SURY N�. YQRS- REG. ,SANITAR/411.'> II SITE PLANAlri .r5 F' '� � C1UTE 134 _, , / SOG' / G'EN1V/ 1Ifi S OF