HomeMy WebLinkAbout0027 CURRYCOMB CIRCLE - Health 27 CURRYCOMB CIRCLE, W. BARNSTAB
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TOWN OF BARNSTABLE
LOCATION SEWAGE# U l q
VILLAGE Inf KS B��r rri"0�4
ASSESSOR'S MAP&PARCEL
INSTALLER'S NAME&PHONE NO. I)u 11*N5 amp6h I
SEPTIC TANK CAPACITY
} LEACHING FACILITY: e(typ ).2. 96hak tk (size)
NO.OF BEDROOMS j Jgh
OWNER
PERMIT DATE: - .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 lea hi cility Feet
FURNISHED BY
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AS -1 0.2'
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SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
in Complete items 1,2,and 3. A. Signature
■ and address on the reverse ❑Agent
Print our name
y X ❑Addressee
so that we can return the card to you.
■ Attach this card to the back of the mailpiece, B. Received by(Printed Name) C. Date of Delivery
_ .or on the front_if space permits.
cress different from item 1? ❑Yes
delivery address below: ❑No
DUBIN,MICHAEL S&MASAMI Y
27 CURRYCOMB CIR
WEST BARNSTABLE, MA 02668
Mall
II"IIIII IIII lil I III II Il ilil II II I I II I III lil I I ❑Adult Signature e Restricted D 11 elivery ❑Rriegis priority
Mail Re�ted,
9590 9402 5225 9122 7022 50 certified Mall® Delivery
Certified Mall Restricted Delivery return Receipt for
❑Collect on Delivery Merchandise
2. Article Number Irragsferfrom service 1a6e11 ❑Collect on Delivery Restricted Delivery ❑Signature Confirmationym
it ❑Slgnature Confirmation
7 015 1730 0001 4 9 8 7 7565 mooaT I Restricted Delivery Restricted Delivery
PS Form 3811+,July 2015 PSN,7530-02-000-9053 F Domestic Return Receipt
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Certified Mail Fee '�r ^'..�
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Extra Services&_Fees(check box,add le asrappropnafe) ANNIS,MA
❑RetumReceipt(hardcopy) $ �
r3 ❑Return Receipt(electronic) $ I .-. \�
_3 ❑Certified Mail Restricted Delivery $ F_ UG 20 jtere
marktmark I
p ❑Adult Signature Required $ i^"l 02601
[]Adult Signature Restricted.Delivery.$ -�' --
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DUBIN,MICHALL�S&MASAMI Y`
27 CURRYCOMB-CIR:' ._
WEST BARNSTABLE, MA02668
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Town of Barnstable Barnstable
AFMIeli
P� Inspectional Services Department ca�1
BARNS"CABLE„
AS . Public Health Division
i63939, `�
l �
°""A 200 Main Street, Hyannis MA 02601 2007
Office: 508-862-4644
FAX: 508-790-6304 Thomas A.McKean,CHO
CERTIFIED MAIL#7015 1730 0001 4987 7565
August 12, 2019
DUBIN, MICHAEL S & MASAMI Y
27 CURRYCOMB CIR
WEST BARNSTABLE, MA 02668
ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5
The septic system located at 27 Currycomb Circle, West Barnstable, MA was
inspected on 06/28/2019 by Mark Polselli, certified Title V Septic Inspector for the State
of Massachusetts.
The inspection of the septic system showed that the system "Fails" under the guidelines
of 1995 TITLE V (310 CMR 15.00) due to the following:
• Static liquid level in the distribution box above outlet invert due to an
overloaded or clogged SAS or cesspool.
You are ordered to repair or replace the septic system within one (1) year from the date
you receive this notification.
Failure to repair/replace the septic system within the deadline period will result in future
enforcement action.
PER ORDER OF THE BOARD OF HEALTH
e S., CHO
Agent of the Board of Health
Q:\SEPTIC\Title V Inspection Report Letters Mailing\Pailed or Needs Further Evaluation Letters\27 Currycomb Circle West
Barnstable.doc
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��
Town of Barnstable
KAM
039• ,�� Inspectional Services Department
•eTf4 MA'S A
Public Health Division
200 Main Street, Hyannis MA 02601
Office: 508-8624644
FAX 508-790-6304 Thomas A.McKean,CHO
Feb 6, 2007
Rev. 4/26/19
DEADLINES TO REPAIR FAILED SYSTEMS
(Town Code §360-44 and Title V: 310 CMR 15.000)
An "x" marked in the ❑ is the failure criteria and associated repair deadline
60 DAY DEADLINE CRITERIA
❑ Discharge or ponding of effluent to the surface of the ground
❑ Pumping more than 4 times during the last year not due to clogged or obstructed
pipe.
❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool
❑ Structurally unsound septic tank or SAS
O 1 YEAR DEADLINE CRITERIA
tatic liquid level in the distribution box above outlet invert due to an overloaded or
clogged SAS or cesspool
❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation
❑ Any portion of the cesspool within a Zone 1 to a public well
❑ Any portion of a cesspool within 50 feet of a private water supply well with no
acceptable water quality analysis. (This system passes if the water analysis
indicates the well is free from pollution).
TWO (2) YEAR DEADLINE CRITERIA
❑ Single Cesspool
❑ Any "conditionally passed systems" (broken cover, relocation of a pipe, relocation
of a driveway due to H-10 components, etc)
❑ Leaching facility with standing liquid level at or above the invert pipe (per Town
Code §360-20 h)
OTHER
Repair deadline:
Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc
�J
Commonwealth of Massachusetts
Title 5 Official Inspection Form ;
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments '
J Property Address
Al •�
Owner 0 er's Name
information is QS-� &&is�4a,�
required for every
page. Cityi'rown State Zip Code Date of lrj pectio
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 Iwar411-
ation
filling out forms
on the computer, �,�
use only the tab
111
key to move your Name of Inspector
cursor-do not
use the return Company Name
key. 0 o�C
Company Address L9y2 O�
City/Town State /' Zip Code
TG_o ap�
Telephonmber License Number
B. Certification
certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5
(310 CMR 15.000); i 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 t have determined
that the system:
1. ❑ Passes
2. ❑ Conditionally Passes
3. s Further Evaluation by the Local Approving Authority
4_ W;�Faiiture Date
The system inspector shall Eufbmit a copy of this inspection report to the Approving Authority(Board
of Health or DEP)within 30 I ys of completing this inspection. If the system has a design flow of
10,000 gpd or greater,the °� ctor and the system owner shall submit the report to the appropriate
regional office of the DEP.1-y. ,;riginai form should be sent to the system owner and copies sent to
the buyer, if applicable, ano y,approving authority.
Please note: This report or, 2 'scribes conditions at the time of inspection and under the
conditions of u ^: t th: . `rne.This inspection does not address how the system will perform
in the future u, j ;�;'T,me or different conditions of use.
x �.
t5insp.doc•rev.7126j2018 Tile 5_1Maai Irspec5on FoM subsurface Sewage o!soosal system.Page 1 of 18
Y..
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
u r Cow. 6 r
Property Address
Owner Owner's Name
information is � / 1 � 0 1 / 61
required for every W�S7 y � �// d�7 oG (O O
page. City/Town State Zip Code Date of I specti
C. Inspection Summary
Inspection Summary: Complete 1, 2, 3, or 5 and all of and 6.
1) System Passes:
❑ I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are
indicated below.
Comments:
2) System Conditionally Passes:
❑ One or more system components as described in the `Conditional Pass'section need to be
replaced or repaired.The system, upon comp!etion of the replacement or repair, as approved by
the Board of Health, will pass.
Check the box for"yes". "no"or"not determined" (Y, N, ND)for the following statements. If"not
determined,' please explain.
The septic tank is metal and over 20 years old"or the septic tank(whether metal or not)is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass
inspection if the existing tank is replaced with a complying septic tank as approved by the Board of
Health_
A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND (Explain below):
t5insp.00c•rev.712812018 'roe 5 otimai inspeczor,=orn:suosurace sewage Disposffi system*?age 2 of 18
Commonwealth of Massachusetts
f -- P Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
a 7
Property Acdress
Owner Owner's Name r
information on is every
/ /eS� 460�coile
�4WW44spectio
re wired for eve W page. City/Town State Zip Code Date of
C. Inspection Summary (Cont.)
2) System Conditionally Passes (cont.):
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
❑ Observation of sewage backup or break out or high static water level in the distribution box due
tc broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below):
obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
3) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
tha system is failing to protect public health, safety or the environment.
a. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
t5insp.doc•rev.7/262018 -iye 5 official nspecaon=o—..:Suosurface Sewage Disposal system,•?age 3 of 18
r
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments.
C� r-tA fM COBS C,✓"
Property Address
Owner Owner's Name I
information:s �s /e 0 6 a$
required for every T
page. City/Town State Zip Code Date of Inspe tion
C. Inspection Summary (cont.)
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
b. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑; The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well'.
Method used to determine distance:
*k performed at a DCP certified laboratory,This system passes if the well water analysis, pe for fecal
coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must
be attached to this form.
c. Other:
4) System Failure Criteria Applicable to Al{ Systems:
You must indicate "Yes" or"No" to each of the following for all inspections:
Yes
❑ B kup 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
Citle 5 p;fidal ins?ec7cn Fo�—.:su0su'fzce Sewage Disposal System•?age a of 18
5insp.=•rev.7262018
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
22 wr,Ca,r
Property Address, /
u di:
Owner owners Name
inforrnatior.is �
required for every
X�
page, City/Town State Zip Code Date of I spectio
C. Inspection Summary (cons.)
4) System Failure Criteria Applicable to All Systems: (coat.)
Yes o
Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
J iquid depth in cesspool is less than 6" below invert or available volume is less
than /2 day flow
uired pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
[j 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
El !Any
ry to a surface water supply.
rtion of a cesspool or privy is within a Zone 1 of a public water supply
ortion of a cesspool or privy is within 50 feet of a private water supply well.
[] ortion 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
znd 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.
-�/ The system fails. i have determined that one or more of the above failure
tl criteria exist as described in 310 CMR 15.303,therefore the system fails.The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
5) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes: or"no'to each of the following, in addition to the
questions in Section 0.4.
Yes No
n the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surace dunking water supply
the system is located in a nitrogen sensitive area (Interim Wellhead Protection
EJ —' Area—IWPA) or a mapped Zone 11 of a public water supply
?;ue 5 CM02s inspection Form:Subsu�ace Sewage aspos�J System-Page 5 of 18
t5insp.dac-2v.7262018
Commonwealth of Massachusetts
Title 5 Official Inspection Form
j Subsurface Sewage Disposal System Form -Not for Voluntary/Assessments
02( C(A " Co&Aj
Property Address
u
Owner Owner's Name 1 ,y
information is �✓�7 a►D�! //� �� !� 6 a,
required for every 7
page. City/Town State Zip Code Date of In ection
C. Inspection Summary (cost.)
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 indicat "yes" or"no" for each of the following for all inspections:
Yes o
❑ umping information was provided by the owner, occupant, or Board of Health
❑ Were any of the system components pumped out in the previous two weeks?
❑ as the system received normal flows in the previous two week period?
Have large volumes of water been introduced to the system recently or as part of
this inspection?
Were as built plans of the system obtained and examined? (if they were not
available note as N/A)
! Was the facility or dwelling inspected for signs of sewage back up?
Was the site inspected for signs of break out?
Were all system components, excluding the SAS, located on site?
❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
❑ Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS) on the site has
been determined based on:
Existing information. For example, a plan at the Board of Health.
❑ Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable)[310 CMR 15.302(5)]
-iUe 5 0`:`aal irspec:ior,ror—-SUDSLaace sewage Disposal system•?age 5 of 18
t5insp.doc•rev.7/26/2018
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
.27 ONE
Property Address
Owner Owner's Name information is Uo�
required for every —
page_ City/Town State Zip Code Date of ins ection
D. System Information
1. Residential Flow Conditions:
Number of bedrooms (design): Number of bedrooms (actual).-
DESIGN flow based n 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):
Description:
/17� o�
�i is f G✓ s-�,,,�
oZ
Number of current residents:
Does residence have a garbage grinder? ❑ Yes L��o
Does residence have a water treatment unit? ❑ Yes +� o
If yes, discharges to:
Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes No
information in this report.)
Laundry system inspected? ❑ Yes fo
Seasonal use? ❑ Yes L4�10
Water meter readings, if available (last 2 years usage (gpd)):
Detail:
Sump pump? ❑
es No
Last date of occupancy: care
Title 5 c fdal!nspecaon=cmn.scosu'ace sewage Disposai system•Page 7 of 18
t6insp.doC-rev.712 612 01 8
Commonwealth of Massachusetts
P Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,
Property Address -6,14 410 6)oh l4 ztk^
Owner
information is Owner's Name
required for every U d
page. City/Town State Zip Code Date of In ecti
D. System Information (cont.)
2. Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow (based on 310 CMR 15.203):
Gallons per day(gpd)
Basis of design flow (seats/persons/sq.ft., etc.):
Grease trap present?
❑ Yes ❑ No
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:
Was system pumped as par of the inspection? ❑ Yes ❑ No
If yes, volume pumped: gallons
How was quantity pumped determined?
Reason for pumping:
Sinsp.Goc-rev.7126/2018 ?iue 5 Orfldai inscemon=or:Suosur,,ace Sewage Disposal System•?age 8 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
sments
k Subsurface Sewage Disposal System Formo2. Not for Voluntary Asses
( 60 w1
Pro erty Address
P //
u>bt h
Owner Owner's Name
information is (p?J
required for every /State Zip Code :Date of Inspe 'on
page City/Town
D. System Information (cont.)
4. Type of S em:
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 e of all compose . des installer ) and source_ofinforn: ^�%(0 — ln� 7
Were sewage odors detected when arriving at the site?
❑ Yes 'L� No
!�
5. Building Sewer(locate on site plan): C
Depth below grade: feet
Material of construction:
❑ cast iron 40 PVC ❑ other(explain):
Distance from private water supply well or suction line: feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
Page 9 of t8
5dai!nsp2cocn co'_
SuCsurace Sewage Disposes System
-;;;e •
t5insp.doc•rev.7/262018
Commonwealth of Massachusetts
p Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
c� / C o# 1 b C l e-
Property Address
Owner
Owners Name OX6i
information is W
required for every
page, City/Town State Zip Code Date of tspecV6n
D. System Information (cons.)
6. Septic Tank(locate on site plan): a/
Depth below grad C;�o
feet
Material construction:
concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain)
If tank is metal, list age:
years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
Dimensions:
Sludge depth: /
Distance from top of sludge to bottom of outlet tee or baffle
Scum thickness r�
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? no 4W Q(-
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
, /iv �a/f✓
tiinsp.doc-rev.726/2018 71Ve 5 01'loai I nspecacn.o-rn:Sucsurace Sewage Disposal System-?age 10 of to
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System F m -Not for Voluntary Assessments,
07 C.
Property Addris
/
C�J/
Owner Owner's Nam
information is s
required for every
page. city/Town State Zip Code Date of Ins ction
D. System Information (cont.)
7. Grease Trap (locate on site plan):
Depth below grade: feet
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: Date
Comments (on pumping recommendations: inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage; etc.):
8. Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain):
Dimensions:
Capacity: gallons
Design Flow: gallons per day
Site 5 Ct`ca'inspecuon Fom:SUSs"'Oe Sewage Disposal System•?age t t of 18
t5insp.dcc•rev.7l26i2018
c Commonwealth of Massachusetts
Title 5 Official inspection Form
�M Subsurface Sewage Disposal System Form Not for Voluntary Assessments ,
c2-- C4 V117 C061-n
Property Address 41
Owner owner's Na m= / WA
information is
required for every &M!P4,14—
page. City/Town State Zip Code Date of InspectAn
D. System Information (cons.)
8. Tight or Holding Tank (cont.)
Alarm ;)resent: ❑ Yes ❑ No
Alarm evel: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments (condition of alarm and float switches, etc.).
*Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
9. Distribution Box (if present must be opened) (locate on site plan):
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.):
?;ue 5�5c21:nspr on=om.Suos::izce Sewage Disposal System•?age 12 of 18
tfiinsp.doc-rev.?2fi2018
Commonwealth of Massachusetts
r Title 5 Official Inspection Form
Subsurface Sewage Disposal Sys
tem Form -Not for Voluntary Assessments
Subsu 9 P �
nn Crr
Property Address
Owner Owner's Name ��es�— ,Ns `/f e /!-1/6$ 6 /
infornation is b/( �"�/T 4/d(�
required for every State Zip Code Da of In pection
page City/Town
D. System Information (cost.)
10. Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No*
Alarms in working order: ❑ Yes ❑ No*
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
* If pumps or alarms are not in working order, system is a conditional pass.
11. Soil Absorption System (SAS) (locate on site plan, excavation not required):
if SAS not located, explain why:
Type:
leaching pits number:
leaching chambers number:
❑ teaching galleries number:
leaching trenches number, length:
leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovativeiaitemative system
Type/name of technology:
-me 5 O„toa;inspe-nor.=cm•.:SUDs,rtace Sewage Dlsposai System•page 13 of 18
t5insp.doc•rev.7J26120 t 8
Commonwealth of Massachusetts
r Title 5 Official Inspection Form
' I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
CC4 Cr r
Property Address
u�
Opt—
Owner Owners Name//�/
%r � � W6"
information is .`�/W
required for every
page. City/Town State Zip Code Date OfAnspect6d
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_):
Zt ate,, ' �► �- �o P� �.
CAA
av� rc cum ,
12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan)..
Number and configuration
Depth—top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
'me 5 of cu aai jspecn=o.-n.sucsudace sewage Disposai sysiem•Page to of 78
5insp.doc•rev.7/262018
Commonwealth of Massachusetts
Title- 5 Official Inspection Form
Pa Subsurface Sewage Disposal System orm -Not for Voluntary Assessments
Property Address
u �
Owner Owners Nam
information is
required for every
page. City/Town State Zip Code Date of 6specti
D. System Information (cont.)
13. Privy (;ovate 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.):
T,tie 5 o:hcaa nspe-Don=onn,s,sur:aGe sewage Dispose system.Page 15 of to
t5insp.doc-rev.7/26/2018
Commonwealth of Massachusetts
kvTitle 5 Official Inspection Form
mr e-2 7 rC4//4160,644
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
'Wo -
Property Address
U
Owner Owner's Name /
information is
required for every
page. Cityrrown State Zip Code Date of In ection
D. System Information (cont.)
14. Sketch Of Sewage Disposal System:
P Y
Provide a view of the sewage disposal system, including ties to at least two permanent reference
landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters
the building. Check one of the boxes below:
❑ h. d-sketch in the area below
drawing attached separately
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t5insp.doc•rev.7/26/2018 7tle 5 Gifldal lnspecaon FCrM:SUOScrfaCe Sewage Disposal System•Page 15 of 18
Assessing As-Built Cards Page 1 of 2
ASSESSOR'S MA iVQ. "�-�\S PARCEL_
LO CAT ION7a7 5EWAGE PERMIT NO.
VILLAGE
kt
INSTALLER'S NAME A ADDRESS
I UILDE R OR OWNER
DATE PERMIT ISSUED
DATE. COMPLIANCE ISSUEDJ ���
s
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yn/
https://www.townof bamstable.us/Departments/Assessing/Properry_Values/HMdisplay.asp... 6/27/2019
Yl
Commonwealth of Massachusetts
p Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
11' vh CI ✓`
Property Address
Owner Owner's Name 6 d
information is
required for every
page. City/Town State Zip Code Date of Insp ction
D. System Information (cons.)
15. Site Exam:
71 Check Slope
❑ Surface water
❑ Chick 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: pate
oserved site (abutting property/observation hole within 150 feet of SAS)
Check ith local Board of Heal - explain:
Checked with locai excavators; installers - (attach documentation)
Accessed USGS database - explain.-
You must describe w y established the hi h groun`wa er elevati�ny5;_ ! /
G
�061JJEt�
/'pu 64
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
-.tie 5 SSca:jrs?e=cn=crn:subs ace sewage Disposal System•°age 17 Wig
t5insp.doc•rev.728,2018
L
r
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
�7
Property Address dL4 I vy
Owner Owners Name/' S� 01(i�
information is l//_l
required for every
page. City/Town State Zip Code Date o nspec n
E. Report Completeness Checklist
Complete al applicable sections of this form inclusive of:
A. Inspector Information:Complete all fields in this section.
B. Certification: Signed & Dated and 1, 2, 3, or 4 checked
C. Inspection Summary:
1, 2, 3, or 5 completed as appropriate
�Fa e Criteria)and 6 (Checklist) completed
m Information:
For 8:Tight/Holding Tank—Pumping contract attached
For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached
For 15. Explanation of estimated depth to high groundwater included
Tice 5 aa.;nspecuon Form..Suosurtace Sewage Dwposai system•?age I8 of 1
8
t5insp.60c•rev.7126120,8
Town of Barnstable P#
Department of Regulatory Services
* BABNBTABLE. - Public Health Division Date
MASS.
1639. 200 Main Street,Hyannis MA 02601
tlOM �
Date Scheduled_� l /�j Time IZf I Fee Pd.
Soil Suitability Assessment for Sewage-Disposal
Performed By: l/{�G Witnessed By: A1/f(/ !'���/�v "
T'— —
LOCATIO & ENERAL INFORMATION
Location Address Z 7 Owner's NameGO�
Address 7
Assessor's Map/Parcel �7 T Engineer's Name
NEW CONSTRUCTION. REPAIR Telephone#
Land Use �2P1��'� Q's Slopes(%) �Q /r Surface Stones
Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well It
Drainage Way ® ft Property Line ft Other ft
SKETCH:(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands in proximity to holes)
'n
70i g7 �
v
a
16969 ,
Parent material(geologic) �(i G��/ (,CK�� Depth to Bedrock
Depth to Groundwater: Standing Water in Hole: ,` Weeping from Pit Face `jp}ZP
Estimated Seasonal High Groundwater
DETERMINATION FOR SEASONAL HIGH WATER TABLE
Method Used:
Depth Observed standing in obs.hole: 4 Depth to soil mottles: in.
Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft.
Index Well# Reading Date: x Well level Adj.factor Adj.Groundwater Level
PERCOLATION TEST Date P 7- ime l 4lkf
Observation
Hole# Time at 9"
Depth of Perc (o Time at 6"
Start Pre-soak Time u, Q, Time(9"-6")
End Pre-soak 1g,OD
Rate Min`./Inch //t!
Site Suitability Assessment: Site Passed--b,-- Site Failed: Additional Testing Needed(YIN)
Original: Public Health Division Observation Hole Data To Be Completed on Back-=---------
***If percolation testis 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
DEEP OBSERVATION HOLE LOG_ Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure Stones,Boulders.
Consistencv.%Gravel)
Ar Apo
> 6
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency,%Gravel)
e
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Stricture,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,%Gravel)
Flood Insurance Rate Man: -
Above 500 year flood boundary No_ Yes le
Within 500 year boundary No %--""Yes
Within 1Q0 year flood boundary No�® Yes
Depth of Naturally Occurrine Pervious Material ,
Does at least foul'feet of naturally occurring pervious material exist in all areas observed throughout the
area proposed for the soil absorption system? WS
If not,what is the depth of naturally occurring pervious material?
I Certification
I certify that on /1—f��'B (date)I have passed the soil evaluator examination approved by the
Department of Environmental Protection and that the above analysis was performed by me consistent with
the required training,expertise and experience described in 310 CMR 15.017.
Signature��2i �1� L ���G6 Date p,�7 �g
Q:\SEPTIC\PERCPORM.DOC
R►'
No. Fee
THE COMMONWEALTH OF PASSACHUSETTS Entered in compuOer ,
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
Applitation for Misposal *, petem Construction 3pErmit
Application for a Permit to Construct( ) Repair( ) Upgrade(X Abandon( ) ❑Complete System [V individual Components
Location Address or Lot Noll Curryco � Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel
Installer's Name Address,an Tel.No. Designer's Name,Address and Tel.No.
Q1ZW\S S)UY#A h 11y 8g2 a�a�' �i` AdvaAItr COO .7LI.VN-7Lj
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures p
Design Flow(min.r quir ) ` � gpd Design flow provided ` 4 (.,f � gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of .A.S.
Description of Soil A— fill S"du JDfm C-m ed- 6',,sQ hd
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board ealth.
Qigne Date "[
Application Approved by Date
Application Disapproved by Date /
for the following reasons
Permit No. Date Issued
No. �� - ft ! -Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes
r
01pplitation for Disposal 6pstem Construction 3permit
Application for a Permit to Construct( ) Repair( ) Upgrade(1)'r Abandon( ) ❑Complete System Individual Components
Location Address or Lot No.w_ i l..3 Y' t t ij►�r�� ' ; t! Owner's Name,Address,and Tel.No.
VV
Assessor's Map/Parcel l 1 ® ��' t'1 C ,1,1
Installer's Name,Address,and Tel.Now j } Designer's Name,Address,and Tel.No.
I�.t�11� i,t i '{ `�� �. � d � 2it„" GUr1 �! + i
Type of Building:
Dwelling No.of Bedrooms , Lot Size sq.ft. Garbage Grinder;( )
Other Type of Building _ t I fir^ No.of Persons Showers( ) Cafeteria( )
Other Fixtures }
Design Flow(min.required) gpd Design flow provided ( ��• " gpd
Plan Date ,l 7 ; ! F Number of sheets Revision Date
Title �� ' � f il: �Pn s1t
7
Size of Septic Tank t/ Type of S.A.S.
Description of Soil k� 0 -M I d
1
Nature of Repairs or Alterations(Answer when applicable) I t�ti ) 1`?F' r
NKI
5
a Date last inspected:
L -
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
• accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health. r- i
�X, dml ir% A .•r. I/ 0 Date `� 1 ;h
Application Approved by � '// ' /f
/� i , I I r r Date
--,Application Disapproved by ' �(( / f Y Date f �
for the following reasons 4 ._
Permit No. /. f , y//,, Date IssuedP/,/7f
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
(Certificate of Compliance
_ THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( le')
Abandoned( )by
�1 at J i 11 . (�t'rl/', C�I ! has been cons ctefd'n aQ�e(o
rrce 1
with the provisions of Title 5 and the for Disposal System Construction Permit
Installer 1 01 1 h K'+ �:_-X(/l yAt t h Designer Y r 1 pA
#bedrooms Approved design flow gpdx
The issuance of this permit shall not be construed as a guarantee that the system will function as designed. n
Date 9 f Inspector
- - - -' --- - r - - - - - - - - - - - --------- - ----------
Fee---
IV'
0.
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS
Misposal *pstem Construction 3permit
Permission is hereby anted to Construct Repair Upgrade i Abandon
System located at
/Kjtf,� {
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-eoriditions.
Provided:Constnacti .musjV�bje complete?within three years of the date of this permit.
Date /r / .Approved by
Town of Barnstable
; ° '�'�►� Regulatory Services
. Richard V.Scali, Interim Director
NAM
Public Health Division
Thomas McKean,Director
2001VIain Street,Hyannis,MA 01601
Office: 508-862-4644 Fax: 508-790-6304
Installer& Designer Certification Form
Date: ?—Z47Zq Sewage Permit# Assessor's MaplParcel /,_
Designer: Installer:
Address-
Address: :3 9
/"f
Qn as issued a permit to install a
(installer)
septic system- at C(/6 L1_` based oo a design¢ira €m by
a�
j - 1k c,- dated '. J
(designer)
I certify that the septic.system referenced above was installed stabstatatially according to
the design, which rosy include ninor approved changes sucks as lateral relocation of the
dirt abution box and/or septic tank. Strap out (if regkured) was inspected and .the soils
were`found tisfaetory.
I op fy. that.the septic system �ferenced above was installed with major changes (i.e.
greater than 10' lateral relocation of the SAS or any vertical relocation of any component
of the septic systetn) but in accordance with State&Local Reilatnoias. Plaai revision or
certified as-built by designer to follow. Strip out(if required) as inspected and the soils
•:Evere found satisfactory.
i
I certify that the system referenced.above was constructed in compliance with the terms
of the IIA approval letters (if applicable)
(4 A
-Installer's Signature) '
(Designer' . Signatiiie) (Affix p here)
PLEASE RETURN TO STABLE PUBLIC IMALTH DIVISION. . CERTIFICATE
OF COMPLIANCE WILL NOT T;E 3SSUED..UNTIL BOTH IBIS FORM AND:.AS_
BUILT CARD ARE RECEIVED BY THE BARNSTABLE:PUBLIC HEALTH RM ION
THANK YOU.,
Q:SSeptic0esigner Certification Form Rcv 8-14-13.doc
THE FOLLOWING
IS/ARE THE BEST
IMAGES FROM POOR
QUALITY ORIGINALS)
I A c(, I
_ m / L
DATA
-
�LL
vim— _.�.vm.�_> .� •���- ��—�S T� �" - -�_.-.�.Rc -- _.^ ��R�+.a--�z^� - -- ,tt-.� `sm�-'-'r= —�-.'p--�s�_.
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_ -
-
WAX
u , � aS B TffftFtikt B'EitVA DFSPOSiCL SYSTEM INSPECTION FORM
-
' � ,"a •, - CERTIFICATION
Property Address: 2Z CurryComb Circle Barnstable Address of owner ,Y
Date of Inspection:10125196 - Q
- -. (If different) V
Name of Inspector:John Grad Micheal Mitchel.
,
Company Name,Address and Telephone Number
CERTIFICATION STATEMENT
I certlfyahat l.haye personall the information r w ccuratethesege:di:sposal system.at this address.andtha e ty mspecte� w
and complete as of the time ofmspectlon. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system:
x Passes
_ Conditionally Passes -
- Needs Further Evaluation By the Local Approving Authority
_ Fails _
Inspector's Signature: Date: 10131196
The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this
inspections. 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 offic
e of th
e Department
of Envi
ronmental
m ental Protection.The on inalshould be sent to:the system owner and copies sent to the buyer, if applicable and the approvin9'authori
tY-
INSPECTION SUMMARY:
Check A, B,C, or D:
Aj SYSTEM PASSES:
x I have not found any information which indicates that the system uiolates any of the failure criteria
defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below.
Bj SYSTEM CONDITIONALLY PASSES:
One or more system components need to.be replaced or repaired. The system, upon completion
of the replacement or repair, passes inspection.
Indicate yes, no, or not determined(Y, N, or NO). Describe basis of determination in.all instances. If "not determined",explain why not.)
The septic tank is metal, cracked, structurally unsound,shows substantial infiltration or exfiltration, or tank failure is
imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved
by the Board of Health
(revised 11115195) m
}ter" { 1�}One Winter Street • Boston,Massachusetts 02108 • FAX(617)556 1049. • Telephone(617)292-5500 �
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.a •� �.. �•. �.a7^•u ;fir;.: _� "' ^H�.- ���' ��- � }4 ay�� 1�'uj' 'W��1.''". y r,,. ,�� ,s s���'�,..-vet .��-<— — a'.
_ �c-cis. v, _ - - _ ,mac._ �' �. c �- .- •"`":.- �`i-'£`- �4? ,...� =�--Q•
e• v t,�_ �..:.��7-- r',.r,.-�.ab-s ���'--ar .Y- �"sc.'�.-� 0'Il�. � � :.a3-- `..-.,-�.... �..- ..s.'r-� -
.�:"""`�"���. � ,�.a�„_z'�--- _ '-�--' -�,,,_._.. .4. _. : -_ -�rv�-•k�.�;_...�-+�_ _ 'tea
�4tasE�N. = .._ram.3 tea" - .,�_ - - '' ��� eT£, "s`�"- ^�•�--""""'� '.'-3-
- _ ME - - -
- - -distrabutron bax is leveled oe replaced
3
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:
Condifinns exist which require further evaluation,by the Board of Health in order to determine if the:: k
system is failing.toprotect.the publie.health, safety and�the environment. -
1)- SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS
R WHICH WILL PROTECT THE PUBLIC HEALTH AND
NOT FUNCTIONING IN A MANNE
SAFETY AND THE,ENVIRONMENT:
Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh.
2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE)DETERMINES
THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE
ENVIRONMENT:
_ The system has a septic tank and soil absorption system and is within 100 feet to a
surface of water supply or tributary to a surface water supply:
.The system has a septic tank and soil absorption system and is within a Zone 1 of a public water
supply-well.
The system has a septic tank and soil absorption system and is within 50 feet of a.private water
Supply well. .:
T00 feet but 50 feet
The system has a septic tank and soil absorption system and is less than et or more from,a private
water supply well,unless a well water analysis for coliform bacteria volatile organic compounds indicates that the well is
free from pollution for that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal or less than 5 ppm:
3) OTHER
D] SYSTEM FAILS:
_ I have determined that the system violates one or more of the following failure criteria as defined in
310 CMR 15.303. The basis for this determination is identified below: The Board of Health should be
contacted to determine what will be necessary to correct the failure.
Backup of sewage in 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
cesspool. -
SAS is in hydraulic failure.
(revised t1115195)
,E� � i# a�4 .a•7r?'�'i�.i.rr "s' a'-'t.,mot ��a^���;��' e � +�:. N.`.�+r r�,yW^`�''� m; t'�
ems"'
' `+�,. /af a� a,ss-m.� 's��^-. ex �+.4 Y ,��' � '� � ''#-3 °� 7r �, tt�y, a '•r°{ x v.
.. ..,.X ta�}�cysz._,fa.,,:n ��:A-ks,...���•`*..2-?::.a'?�.�r. ..:r. �� �.m'K+-�.E����� ... -.r- �._:`,.4^A,.; y.5.�•-r'.^.,�'�."��:! _-._.1_ �3"*R �__ _ ._
ff
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e _tI��E�Ss..�Aefct►ea�MJtcf�i���'-'k,-�'�-'� .�-.��-�,--�,�-�..x-�- �--�.�"`..-s`=,�=� -�_` '-�s.- �"`�� �--�
- �-•-----r_� � __.ram _ �—:�� �- - - - _._ -s - --
"�_._•-_-_.-a�"'�T -�^ -�v�-�-�-�--_. tea.
�� Sfatu~lrqufd fexeUn tthe dsttxtri7t�otxbox abavele#ravert`dae�t6R auertode 04 ggad �Aor eesspeof � _�=
Liquid depth-m=cesspool-is less:than 6 :below invert or available volume is less than 2 day flow"" : !.
Required pumping more than 4 times in the last year NOT,due to clogged or obstructed pipe(s).
Numbers of times pumped
Any portion of the Soil Absorption System cesspool or privy is below the high groundwater elevation A.
I'
_ r
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 f 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 wateranalysis for
coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen.
El LARGE SYSTEM FAILS:
The following criteria apply to large systems in addition to the criteria;
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:
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 If 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 8.00. Please consult the local regional office of the Department for further information.
JJ
l
F' (revisedl.1115195}
yea,"'�, :,.� .c>.� ,N�+ ,<` i
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ry '
:-Yl-' f .n.....Jk Y.a•ra_... z`t,k. .. ,...,c...ze.n..n-.., .. .. ...,.�u Y',.r.,e+'..z - u'%}i7._v*-^' ,t
yOF
. r -
Vim -,�
v
MR
�x
Check itthe followinghave been done ---
X Pumping information was requested.of the owner,..occupant, and Board of Health.
ts have been pumped-for at least two weeks and the and the,system has been receiving normal..
X None of the system componen
flow rates during that period..Large volumes of water have not been introduced into the system recently or as part of this
inspection.
X As built plans have been.obtained and examined. Note if they are not available with N/A
X The facility or dwelling was inspected for signs of sewage back-up.
X The system does not receive non-sanitary or industrial waste flow
s inspected for signs of breakout..
x site was 9
The p
X All system corriponents,excluding the Soil Absorption System,have been located on the site.
X The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected
for condition of baffles or tees,material of construction, dimensions, depth of liquid, depth of sludge, depth of scum.
x The size and location of the Soil Absorption System on the site has been determined based on existing information or.
approximated by non-intrusive methods.
X The facility owner(and occupants, if different from owner)mere provided-with information on the proper..ma ntenance of Sub-
Surface Disposal System.
F
y A
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a �Numbb' of current residents u
arbage gnnder:(yes=orio) Na _
Laundry connected to system(yes or no):-Yes
Seasonal -
Water meter readings, if available: Na
Last date ofoccupancy: nta -
COMMERCIAL/INDUSTRIAL:
Type of establishment: Na
;. Design flow:U • gallons/.day „z; ....
Grease trap present:(yes or no) No.
Industrial.Waste Holding Tank present: (yes or no) No
Non-sanitary waste discharged to the Title 5 system: (yes or no) No
Water meter readings,if available: nla
Last.date of occupancy: roa
OTHER: (Describe) nla
Last date of occupancy:
INF
ORMATION
FORMA TIO N
. I
GENERA
PUMPING RECORDS and source:of information:
System has not been pumped.
System pumped as part of inspection: (yes or no)No
If yes,volume pumped: 0 gallons.
Reason for pumping: n1a
TYPE OF SYSTEM
X Septic tank/distribution box/soil absorptions system
Single cesspool
Overflow cesspool
Privy
Shared system(yes or no) ( if yes, attach previous inspection records,if any)
Other(explain)
APPROXIMATE AGE of all components,date installed(if known)and source information:
1986
Sewage odors detected when arriving at the site: (yes or no) No
4 (revised1:1115195):.
`��"� � r � �" " 2 r,- C �T„ -s" � .F�3 .k�°w.�+• �,t�p$ ���°rr�., u. a �5...,x,�+'?`+sp^r.-:- �"-s..a-.
� ..t�' � s��,n rtr I'`,r��,��4fi�.-�.�,t .J t �� - :+'�'ta 5.���,: at��u� �s x y:.,'; Y � •'� ��ti..^e t ��.dam. u' � _
y' .Y
r
WWI
FRI
_ 'P9SS' �T OmtfdCl[CIe:Rarr�cfaBte � -�'-�„ .�_ ?s=- - �•�_�--� �
Depth below grade 16 — _ _
Material'of construction.X concreate_metal,_FRP_other(explain)
Dimensions: L-8'B'H V 7"W 4'10' — -
:._Sludge depth:7 -
Distance from top of sludge to bottom of outlet tee or baffle. Zo'
Scum thickness 8.
Distance from top of scum to top of outlet tee or baffle:r
Distance form bottom of scum to bottom of outlet tee or baffle: 13'
"
Comments:, --.
(recommendation for pumping, condition of inlet and outlet tees or baffles,depth of;liquid level in relation to outlet invert,structural integrity,,
of leakage,etc.)
do Se tank and all components are structurally sound.Recommend pumping system now and then maintained every year.
GREASE TRAP:
(locate on site plan)
Depth below grade: rda
.Material of construction: _concrete_metal_FRP_other(explain)
Dimensions: nta
Scum thickness:Na
Distance from top of scum to top of outlet tee or baffle:nra
Distance from bottom of scum to bottom of outlet tee or baffle: nta
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet inverf,.structural integrity,
evidence of leakage,etc.)
nla
_a
�p
���- R(revised�11115195} � `3� � .; ° 1 <��.r�-� � ��� '"'�" ,:�•,� 3� },��
..� --.�.-�-.�—-��_^ may.-.�.��-.----...���— �_._ -;_. _.,.' __ - •-_z. ,.,,�-._ .. _�a:-y..
- �—_ � _ �_�-- -. ��-*ice--• -� s� --.�--.
_ =ate
st�•��3='s�------ „'Q-�.- �T� _ _ ''ems-a .��_ `��'--:-.3�� _'--..�- _ w_
t �`` QR+47•�.V llFvi TiR�R�,,. �a+my�s'�.a-�.�' .y- s�€�'�_.�.�-ems . �r�'-$.ri Yr .4- � ."�' �'s"""- -' - -
�.Dep3 ti Caw_grad'e Na"�_' ---• ;- �� _,.MY .� _ _ ".�,�'
Matenial of cEn`structlon- concrete metal FRP=other(explain) ,
Dimensions: Na
Capacity: .11a gallons
Design flow: n1a gallons/day
Alarm level: Na
Comments:
(condition of inlet tee,'condition of alarm and float switches etc.) -
ilia _
DISTRIBUTION BOX: X
(locate on site plan)
Depth of liquid level above outlet invert: Liquid level with bottom of.pipe.
Comments:
(note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box etc.)
d-box is structurally sound.
PUMP CHAMBER:
(locate on site plan)
Pumps in working order.(yes or no)
Comments: -
(note condition of pump chamber,condition of pumps and appurtenances, etc.)
Na
NO
I.fte
" .-, � �"--�." -c- -�...� -.,,a r .�,;s. -sc-�•.-�"'-"' .`�...,='���_""w�a- ems. �'k" �
f
• �- � =yam._-� - - - - '. s` c —a
= R _.
AgS
c
�� =,•fit a -
r ,
Ma
s�rS rENrsgs� � E_._ _
_ � .-
'f3C8e�IESlai1OSSlmXC3Y QE1 n�ti� �- * i
If.not determined to�e:present explain
- -
=ma
Type: -
teaching pits,numbers one 1,000 gallon leach pit ;
-. leaching chambers,number:n1a -
leaching galleries,number n1a
leaching trenches,number, length: Na
leaching fields, number, dimensions:n►a
_.. .
overflow cesspool number:n1a
Comments.(note conditierrof soil,signs of hydraulic failure level of ponding, condition ofvegetation;etc.)
The leach pit shows signs of being 314 full At time of inspection it had 2'of water in it Recommend pumping system every year for maintenance.
CESSPOOLS:
(locate on site plan)
Number and configuration: Na
Depth-top of.liquid.to inlet invert: Na
Depth.of solids layer: Na
Depth of scum layer: Na
Dimensions of cesspool: Na
Materials of construction: Na
Indication of groundwater: Na
inflow(cesspool must be pumped as part of inspection)
Na
Comments:(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
nla
PRIVY:_
(locate on site plan)
Materials of construction: n1a Dimensions: n1a
Depth of solids: ►1a
Comments:(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
PrivyComments
�'�' (fevised 11115195) ��.ra '+1�"rK• , : y _- r f-x% t'3' � i r S i�yf>x 9� h nx
, _ «._ +C � __ sue, ^ikn• �F Z, �".'
� �,-. �-��-���� �• .���Q � ,.�,Ia4G�61SPOSAI-SYS.'�EIU�I �ON�FORM "3 _
�' TG'a4FeC(F1t+ wedgy
_:. '� � T si-•moo.. g �-_ -r C
77
r
--� Jbt6 � pBrFt�kt£Gf�f �el�CS �� ��•`'�'''�"
' IIfsittlrn�OII � s
i L
Ilk
_ '�„"a - _��ry �-Gx^`.3 •'-�a-s" f... � �^�,•} .y.��.= ,.,,-c. ';.�c�" t:_ :-;� ,-r:x. � sr� _.s--
3�
DEPTH TO GROUNDWATER
Depth to groundwater:12 feet
method of determination or approximation:
USGS Maps and Charts
.Aeffi.q 3''.'eG3 '��.t 'a {�.' ,T1� i•r" . fYY h. '` t ;Y :.
hd�1?', '�' *ki +f s�•i`` �� �:: �f `n z-�tr� �� � �a..y��,����4",�`, �59'�"`v .,�z i�.� ��°� a /•• �'�,����.
t r�� � ��...f -�.�s+` �n ,�� r.- � .--,rw'a •x..ti _ 'i� nt��� -Y ? x- � �i
5. J'=
ASSESSOR'S MAP N0.85-) 5' PARCEL
tO CAT ION /07 SEWAGE PERMIT NO.
L..n-\* 3 S- C( 6
VILLAGE
INS1A LLER'S`� NAME t ADDRESS
K .
d U 1 L D E R OR OWNER
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUEDJ � �
AL
ct
No......................._ FEs........ .._ .............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Appliration for Diiipniittl Mirko:Tonstrur#iun tlrrnti#
Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual,Sewage Disposal
System at
:.
Location-A ress or Lot No.
JS
............... '�.. — ......... ....................... ........._............ .... ......•...................... .
a ------ -•---•............. .........................................
Installer ' Address
Type of Building Size Lot.... .��..:�.�.��.....Sq. feet
U Dwelling—No. of Bedrooms................ .....Expansion Attic ( ) Garbage Grinder
Other—T e of Building ............... No. of persons....._....................-. Showers — Cafeteria
p•' 1 Other fixtures ----=--- ------•-•--•-••------'
Wd Design Flow..........�..`.5 ........t..�..,.�..,�..,,gallons p ao ly diV. Total daily ow_....`........ f ...__......,g2llons(t
WSeptic Tank—Liquid*capacity.l Ekallons Length:- ..b.. Width:.! A. Diameter................ Depth/-}_=..1�.
Disposal Trench—
3 Seepage Pit No.. _I---.._--- Diameter...... . Dept obelow inlet............ To allleaaching area!.'.�..sq. ft:
Z Other Distribution box Dosing tank
Percolation Test Results Performed by.`� �.1..�°% ( .. Lr«1�.... Date....../ater-_1
. ..£7i>�A
,tea Test Pit No. 1.�.—_-,..minutes per inch Depth of Test Pit....l. :_. Depth to,ground . _.. 66
44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
...............:...........................V1........-. -- ---.....:......... .....
Description of Soil.......... ....► ee-n. r�.......�.._.._..._.. ��..� _,.
�.. t....
U .................................................. M1 ` .......................................................`
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:ITA U 5 of the State Sanitary Code.— T undersigned further agrees not to place the syste in
oper ion until a Certificate of Compliance has b e su d oard of health.
Si ned......... . --- l .
Application Approved By------------- . .�... .......
....................
Date
Application Disapproved for the flowing reasons:............:
........................................... ...... ..•--....--.................... ................................. ................................................
Date
Pet rmi No. .
Issued........................:...............................
Date
r
THE�COMMONWEALTH OF MASSACHUSETTS 1
BOARD OF HEALTH \l
.
Applirtttiun for lispuual Works Towitrnrtiun Permit
Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal '
System at: 0� o
......... ......l. ?T '^7 �....ic. '... . 4
-_- Location Address : or Lot No.
.. ...........�--- = � - .................... -----•-=----------....------------------• --------...---------•-•................ .
Owner Address
a �- 1 /iI_ ........ f7 :l I-:/C �... ..........................
....................................
Installer � � Address
Type of Building Size Lot... ���'........Sq. feet
U Dwelling—No. of Bedrooms............15..........._,..........Expansion Attic ( ) Garbage Grinder /t)�
Other—Type of Building..........:.................. No. of persons.............:............! Showers ( ) — Cafeteria ( )
a' Other fixtures ................ .......••-•••-....__
Q1 ` -----------------.-•-•---•••......_....... -••--•._.._.__......................
Design Flow.......... �:.�'"✓...................gallons p r.perso peer d y. Total �lY ow---••-•-•---_-- .. _..__..._ lonslt
Septic Tank—Liquid capacity_Nj_.gallons Length._ __, __ Width_______!'_ Diameter..__.....:_._..e Depth___,____D.
Disposal Trench—No. .................... Width.,..�________._._ Total Length____.._......i_-.... Total leaching area....................sq. ft.
. x inlet 3 Seepage Pit No________ ____________ Diameter....... Depth below .___.6?... Total leaching area.Lft .'._,_.sq. ft.
Z Other Distribution box l !S Dosing tank ( ()
Percolation Test Results/ Performed by..� �.. .. � a-t.►�L !.... Date............. . Afe
,..1 t 1 ,/�
,.a Test Pit No. 1._..•o^.�_..�>.:minutes,per inch 7 Depth of Test Pit...._ ..�:__ Depth to:ground water _ .......�..._.-_.
G� Test Pit No. 2................minutes per inch Depth of Test Pit.......:............ Depth to ground water........................
....:-:....
f�+ tit...........................................
O Description of Soil........ ........1���� ........ '"'.`_...._`-y_..L.�' '-�� a_!_ .._.... Y G- .
UU ............................•••......••.......-••••-•• -_........._...__..... ............. __._....•-•-•••-••••............_.................. Gd? ..�- .
W ,• .
VNature of Repairs or Alterations—Answer when applicable----------a- r
••---•-----•-••--•---•-•.................................•-•---•-------•------..._._.......------••----.........--•--------------•--------•---....-----... ............................................
Agreement:
The, undersigned' agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLZ= ;'5�of the State Sanitary Code— T�,e undersigned further agrees not to place the system in
oper 'on until a Certificate of Compliance has fee> > su'd bye e oard of health.
�n- , Signed ...... .... ................,....._........_. ...._...._.........__. ._...... ..---.........................
V�'�+ � Date
Application Approved-By............. _._ '.__ :L�`�...� -.-
•--•-••........................... ...........
Date
Application Disapproved.for the flowing reasons:---......--•-•--•----....-•--••--------------•---------------••--------------•--•-•-•••.....................,..
............................................1.............................................................................................-••••••-•-•••••-•..............................................
Permit No..........
.Z�.,�.. . _ -t•�--.. Issued-------------------------- ...............Date .....
Date
..................... ....... ...,e._...........�..y.. ku»,.«.NmW..» .,...» ...z.». »,_ a .<... .l........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD x0F HEALTH
..................... ..........OF.... ..............-_......._...
Trrtifiratr of Tomplinurr
THIS IS TO CERTIFY; That the Individual Sewage Disposal System constructed (• ' or Repaired ( )
by. : ...................
.... �_..! _E C _`/• •.%� ..!.....!._ :- ?--•- !!! � , `►.:��................
....... ... .. y
Installer '
has been installed in accordance with the provisions of TI T L,P 5 of The State Sanitary Co f. as described in the
'£ application for Disposal Works Construction Permit No........S� .' _.._ ? __ dated..... y=� :. .................
w, THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY. d
al�v�,�_ f...N•�G-.rrV..E..{w R Vk.✓5� jv�Er�vl S±DATE........................... E ...
............. ..... e ... .. +.. r........ ..... ...... ...... ,\�pVVS T12,.�—I IUd✓ 6uD THE COMMONWEALTH OF MASSACHUSETTS
�Er2�r f'/ -� tIE Sy�T�wl r15- l3u1� j BOAR OF HEALTH »
' //// .......................:................:OF-..........._. �.:_,1..,?..a`3:-:.. ....................
No...... r' CI•-b 6 FEE.........�.4�....,:....
Disposal works Tonotrurtion Permit
to Permission is hereby granted-•--• ! .: ��.: _. .�1 '` .............:_...-----------.....:.....--••------...._.........._....
Construct (�)or Repair ( ) ark, Individual Sew ge Disposal-System
at No.................._. ._ `? % �� / r x; /_`I3 •�` if �'� � .......................
1 ..
.......................... J...__._...._.......... .._ _. _•.
I' / Street " ! ! OO ec
as shown on the application for Disposal Works Construction Permit Noe���-''___lk Dated_f �1_- .. ..4-� ....
• r
........................................ .........
oar of Health
t�� ,+ f
DATE.......... - 4_....�.._-��....................•---•--••--------.......... �.
i -.
NOTE: Install 40 ml Polyvinyl Liner15' off GENERAL NOTES:
13 , 6 northerly edge of stone for bregkout. . Top
1' 3.02
� EL. 141.0, Bottom EL. 137.0. . � 1. VERTICAL DATUM: ASSUMED ________
16 2. MUNICIPAL WATER _ IS AVAILABLE.
•� ,r� 3. SCHEDULE 40 PVC PIPE TO BE USED THROUGHOUT
13 ,;u4
C} / \ SYSTEM UNLESS OTHERWISE NOTED.
4. ALL PRECAST UNITS TO CONFORM TO
`Q 3 ,� ���\ z.97 AASHTO: I-I_10 _&_2_0 _
�' dap Garage 5. PIPE PITCH-1/4" PER FOOT UNLESS OTHERWISE NOTED.
i , x 136.96
O J , �; �` '� �� ./k x�11. 4 x 13a.67 6• ALL CONSTRUCTION DETAILS TO BE IN CONFORMANCE
U p _ � 9 O 2
136 t WITH MA ENVIR. CODE (TITLE 5) AND LOCAL
310��l a .-' ¢0 10 REGULATIONS.
� 4 .60 J $3 3 7. CONTRACTOR TO VERIFY LOCATIONS OF ALL UTILITIES
09 9 PRIOR TO CONSTRUCTION.
o �-
t 63 ry�� r' ^� LEGEND:
1. � 140.1 � � .�. O
'. 9P Lan 2`�• �' �9s—�- PROPOSED CONTOUR
ZA ..- Lg. Benchmark: To of
34:8`. .`..:::. 13 1412 1 4 �\ P
...,.:.� Rtiody /c� ,� -.92 ,� 4` Bottom Step at 99 PROPOSED SPOT GRADE
\_ / 40.4 Q
/ F :-2 g P TH X1e S Elev. 149.4'
rT 40 EXISTING CONTOUR
8® 21 /r X 30.23 EXISTING SPOT GRADE
7' TEST PIT
r,� 7 Edge �
eo•'50
�� . 3�� 5 _ vwn t4 . 0 ® EXISTING WATER SERVICE
41 r - hi Wire ?
e, rkti c
' O ST 0►_ Gas Mtr o)(o WORT( LIMIT LINE
q„1�\e a� Lawn
147.19
t. ;.Paved Walks., i 49. 38
_ .ate. ��� ..•�.`.: ..�,;
Lawn X0\8.17
IrrO �`� 4F M9ff9
A5 Box Exist. Dwell.
145.0 '` `�G F/ Top Fndn. = o AMY L.
142. Elev. 149.3' VON HONE
4Ei.45 v vi
FO9e / .46:9T. . 48.73 No, 1068
vr, 44J� Garage P O
//// a'
� - 69 ' `.. :,; . FBI STERN.
1 4
NOTE: Pump and backfill failed. leach pit.
14� 13 Q
Re-use existing 1000 gal Septic Tank.
48.24
Gravel Parking —D� eek.
p� NOTE: This plan is to be used for septic system purposes
�x N .59 only and is not to be used for any other purpose.
co,
3
27 CURRYCOMB CIRCLE
+ if WEST BARNSTABLE, MA
ROUTE 6 LOCU Lot 37 associates PREPARED
MIDCAPE ► Wy 15,162f sf sm= SYSTEM DESIGNS FOR: Michael Dubin
0 320 Cotuit Road
a Sandwich, MA 02563 SEPTIC 27 Currycomb Circle
�J rn ASSESSORS MAP: 151
l
(0)508.833.0041 SYSTEM West Barnstable, MA
� o � �E L PARCEL: 64 (a)508.274.0074
°' o v o T REFERENCE: PL. BK. 420 PG. 97/DB 11646 PG. 276 Surveying by: DESIGN 02668
co AH Ojala Surveying
o v o FLOOD ZONE: X Town of Barnstable Arnex. 0ja1a,P.L.S.
a a a �' #25001 CO561 J (07/16/14) ' z11 Mcple Street DATE REVISED SCALE SHEET.N0.
Went CU eamat 9. 026s 08/31/19 1" = 20' 1 of 2
LOWS MAP N.T.S. soe-362352-0934
n
Install risers w/covers over inlet and Provide Riser over. D=box NOTE: All components to be marked with NOTE: To prevent breakout, install
outlet to within 6" of final grade to within 6" of final grade magnetic tape or similar prior to final cover. 40 ml Polyvinyl Liner along
d
T.O.F. (Full) (Cover to be watertight) northerly Maintain Min. 2% slope over leach facility to 141.0, Bo ea of stone. Top
EL. 137.0. Reg EL.
rade,
EL. 149.3 '~ F.G. EL: 148 - 149f F.G. EL: 144.5 prevent ondin
° Existing F.G. EL: 148.0 P P 9• F.G. EL: 143.0-144.St as needed, to maintain maximim 3'
and minimum 1' of final cover.
(Access ; ove s min. 201, m. r Code) Min. 2" of 1/8" - 3/4" Washed Stone or Inspection Port within 6" to grade
Geotextile Fabric
Existing 4" PVC �' L=31'
Pipe EL. 145.8 L=13' 4" SCH 40 PVC ; Tee t 3/4" - 1 1/2" Double Washed Stone (Top of Unit EL. 141.5)
SCH 40 PVC :� CAS=12.97.(17.MIN) Top of Peostone or Geotextile Fabric EL. 140.83
i
0S-2.9� 2%MIN 0
10' ®a ®a
s � as®�a®® 24 Eff. Depth
la• P
L-10
a® e®a®
L. 145.17 12 - ®®tea®®®s
EnA EL. 145.42 Install EL. 141.17 EL. 141.0 4" SCH 40 PVC
Rnttnm
Gas Baffle. PROPOSED DB-3 ®S=5%(1.0%MIN) EL. 140.5
H-20 DISTRIBUTION BOX Use 2 - 500 Gallon Precast Chambers 9 5' 3.33'
Watertest for levelness (H-10) with Double Washed Stone
(Install PVC Inlet & Outlet Tees) '
EXISTING 1000 GALLON if more than one 4 Ends, 4 Sides
35.17
H-10 SEPTIC TANK outlet (25' x 12.83' x 2') Bot. o.f1TH-EC' 02 Bot.lof TH-1
SEPTIC SYSTEM PROFILE. DESIGN CRITERIA
SOIL LOG N.T.S. Number of Bedrooms: Existing 3 Bedrooms
SOIL EVALUATOR: MARK POLSELLI, S.E. #2912 Soil Type: Class I
INSPECTOR: DAVID STANTON, R.S., BOH ADDITIONAL NOTES Percolation Rate: <2 min/Inch
DATE: AUGUST 27, 2019 11:00 AM
PERCOLATION RATE:<2 MIN/INCH IN C1 1. Contractor to confirm soil suitability prior to installation. Contact BOH and Dail Flow:
(Soil Test July 17, 1985 Design Sanitarian in the event of varying soils from original soil test. y 110 G.P.D./Bedrm x 3 =330 G.P.D.
Oown Cape En ineerne Design Flow:
330 G.P.D.G.
(Min. Required)
)
BOH: J. Conlon)
2. Existing failed leach pit to be pumped and backfilled. Any contaminated
TH - 1 TH - 2 materials within 5' of proposed Leach Facility to be removed. Garbage Grinder: Not Allowed
EL. 145.0 EL. 143.0
A 3• Proposed Distribution Box to be laced on 6i' crushed stone or compacted, Leaching Area
Fill P P P (330)/0:74 = 445.94 S.F.
level base. Required:
29" 142.58 6» 143.0 �� 2S. 330 G.P.D. x 200% = 660 G.P.D
e
A E Septic Tank Required: Existing 1000 Gallon Tank
Sandy Loam
O
10YR3/2
31" 142.42 24" 142.5 Use 2 - 500 Gallon Precast Chambers H-20 with
SEPTIC TI ES Double Washed Stone: 25' x 12.83' x 2'
B
Loamy Sand
1OYR4/6 Cr 8' 2(2.5' + 12.83')2= 151.32 S.F.
Clean sand Sidewall Area:
50" 140.83 38' Bottom Area: 25' x 12.83'= 320.75 S.F.
& Gravel Total Area: 472.07 .S.F.
C1 Perc 5 48'
o Des i n Flow Provided: 0.74(472.07 S.F.)= 349.33 G.P.D.
Med.-Fine Sand ® 3 1
2.5Y7/2 69" Bottom 70' 2' 27 CURRYCOMB CIRCLE
15% Cobbles V WEST BARNSTABLE, MA
associates PREPARED
118"1 1135.17 168" 1129.0 Exist. Dwell. SEPTIC SYSTEM DESIGNS FOR: Michael Dubin
No Groundwater Observed Top Fndn. = 320 cotuit Road
Elev. 149.3' Sandwich, MA 02563 SEPTIC 27 Currycomb Circle
(a)508.833.0041 SYSTEM West Barnstable, M A
<8"® 15:00 minutes PERC RATE: <2 MIN/IN. ( C1 Horizon) } (c)508.274.0074 ,
Surveying 02668
Garage r a br.
I, Mark Polselli, hereby certify that I am currently approved by the DEP 9 DESIGN .
pursuant to 310 CMR 15.017 to conduct soil evaluations and that the AHOjalaSurveying
above analysis has been performed by me consistent with the ArneH 0ja1a,P.L.S. DATE REVISED SCALE SHEET NO.
requirements of 310 CMR 15.017. 1 further certify that I have 2i� Maple Street
q Y west 55W-3-3-3ez-934 MA azsss 08 31 19 '
successfully passed the Soil Evaluator's Exam on December 14, 2004. � ' / / 1 = 20 2 of 2 ,
aa}
w 1 �
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SECTION - SEWAGE .
la -SEPTIC TANK- -"D"BOX- �Z -LEACH
TOP O(F�(FD/�N
-�F 1-..00(MSL)• "2*'OF i/8TO w! .. `
J WASHED STONE t P 1
143,5 Q
2 L.oT 3
C 14219 C �,. 1
IN• OUT• IN• --- 0 v ` r
OUT• IN• ` �O OQ
\_CD OOGI /..
�� Q � �-' •
I q ,oo TANKtFLiS."�� '3 7.�(� -- /l• Q` �/ i �s
ELEV. A / G - 1140
ELEV. ELEV. ELEV. Co `
ELEV. ELEV.
--4
WASHED STONE ~\
TEST`HOLE:;LO �A- 4 t� i�; 'fir.• s ��; �� _ f y
TEST BY
TEST WITNESS
1� -'S WITNESs -BEDROOM-HOUSE
DESIGN ;' o. '
1 T.H. +� 2 - Iqp'i �� �
s �2 j`l m
ELEV. L ELEV. NO
a ( '2 PERC RATE `= MIN/JN. -DISPOSER DISPOSER k3V-6,AICDUT 6 X tom= ICnIL11
2 4 FLOWfATE �y�c�AL/oAv) 30 55 iqz� '` L 7 1 :3
SEPTIC TANK �j� (fsl= j7 y�
A
106k t-t REQ'D SEPTIC TANK SIZE 1.9�t ' I 1��8
t LEACH:FACILITY OT �� \
q.Tom; �r�. - f`� ,`� (.Z � ) i,U G/D.
SIDE WALL � 150
. BOTTOM ��/z_� r� _ tea.?: .(( .� ! - ISO.5 /o. f9.c '
I TOTAL i l J = 2? 2-
a
USE. O,LEA HING
h
2
' G 1,tS �
O �ti6et�► x'.. c,�, F= i :..['`�{t1 �l✓T8 �5 -75 %a r
WATER ENCOUNTERED —�
ICI (2lDlS�'1"I�►�L �F � / Q PE/l,/ S����.�
NOTES (UNLESS OTHERWISE NOTED) � 1 I �I 5)1
hl E
1
-���` �.
DATUM MS -TAKEN FROM ���T� r--:..�-QUADRANGLE MAP
1.DA ( U
2.MUNICIPAL WATER \ AVAILABLE
3-PIPE PITCH:%"PER FOOT tK Of f r
4.DESIGN LOADING FOR ALL PRE-CAST UNITS:AASHO- H -44
S.MIN.GROUND COVER OVER ALL SEWAGE FACILITIES:(2)FT. .9 ARNE H. yG
6.PIPE JOINTS SHALL BE MADE WATERTIGHT
7-CONSTRUCTION DETAILS TO BE ACCORDANCE WITH COMM.OF MASS. OJRLA i
� 8 .
STATE ENVIRONMENTAL CODE TITLES IVIL OI SITE PLAN
w xjr_ O�-��.�C A....�D 7�- .�`� s2' .,� ' .��y LOCuS: L oT -317 QuR2-e c"C._t••CS C 1 C-?C LA-
1_„LC �T�.�1+._►c� . m ARNE G� n f
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Nut REF:
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r down Cape ell ineeri� �.!"�� � PREPARED FOR: �� ow�
vQ' L 4
CIVIL ENGINEERS f� �p
BOAROOFHEALTH LANDSURVEYORS RE- LANDSURVEYOR 11 t T_
CONTOURS (PROPOSED)-O-O-O-O- APPROVED DATE ` IMA -MA SCALE DATE