Loading...
HomeMy WebLinkAbout0030 CURRYCOMB CIRCLE - Health 30 Currycomb Circle W. Barnstable P A = 151 074 I I � I d 1 0 I WN OF BARNSTABLE /� I_OCATlv?„1 9 /' l- b �G SEWAGEA#� VILL-AGE(.c�P�a� //�s , ASSESSO 'S MAP & LOT070 1I 5PECTOR'S.iNAME&PHONE N O v- SEPTIC TANK CAPACITY I l G LEACHING FACILITY: (type) (Po '� C/� (size) _4C)C) .fir NO.OF BEDROOMS ?. .� BUILDER O OWNER lw �iq Ylo,�i ✓' PERMITDATE: G COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by L7 J -�G ,V�- C, c� COMMONWEALTH OF MASSACHUSE' TS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS RECE��� ► y `; DEPARTMENT OF ENVIRONMENTAL PROTECTI AUG 2 U boo z TOWN EAC HDNo TABLE E, r TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION MAP : ��� .�. Property Address: 30 Curry Comb Circle PAiiCB.: �- West Barnstable LOT Owner's Name: Dave Brajczuwski Owner's Address: Date of Inspection: 8/15/2002 Name of Inspector: (please print) Kevin J.Sullivan Company Name: Ready Rooter Mailing Address: P.O.Box 371 Sandwich,MA 02563 Telephone Number: (508)888-6055 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The System: asses Conditionally Passes Needs Further Evaluation by the Local Authority Fails Inspector's Signature: Date: g�`, T g=a?_ ' The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. 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. Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 30 Curry Comb Circle West Barnstable Owner: Dave Brajczuwski Date of inspection: 8/15/2002 Inspection Summary:Check A,B,C,D or E/ALWAYS complete all of Section D C. System Passes: ..-I ' I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Bo of Health,will pass. Answer yes,no or not determined (Y,N,ND)in the for the following statem ts.If"not determined"please explain. The septic tank is metal and over 20 years old*or the septic tank( ether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is' minent.System will pass inspection if the existing tank is replaced with a complying septic tank as approved b e Board of Health. *A metal septic tank will pass inspection if it is structurally sound of leaking and if a Certificate of Compliance indicating that the tanks less than 20 years old is available. ND explain: Observation of sewage backup or break out or hi static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or unev distribution box.System will pass inspection if(with approval of Board of Health): broken ipe(s)are replaced ob coon is removed dis ution box is leveled or replaced ND explain: The system required pumping ore than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of a Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 30 Curry Comb Circle West Barnstable Owner: Dave Brajczuwski Date of Inspection: 8/15/2002 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board 2dan—e:wnith in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in ac 310 CMR 15303(1)(b)that the system is not fanctioning in a manner which will protec ublic heth,safety and the environment: _Cesspool or privy is within 50 feet of a surface w r _Cesspool or privy is within 50 feet of a horde' vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)de rmines that the system is functioning in a manner that protects the public health,safety and enviro nt: _The system has a septic tank and soil absorption system(SAS)and the SA s 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 Zon of a public water supply. _The system has a septic tank and SAS and the SAS is within 5 feet of a private water supply well. The system has a septic tank and SAS and the SAS is 1 an 100 feet but 50 feet or more from a private water supply well". Method used to determine di ce **This system passes if the well water analysis,pert ed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrog is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis ust be attached to this form. 3. Other: Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 30 Curry Comb Circle West Barnstable Owner: Dave Brajczuwski Date of Inspection: 9/15/2002 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No T j�Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool , Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or _ ogged SAS or cesspool Static liquid level in the distribution box above outlet invert due to and overloaded or clogged SAS or cesspool _ /Y squid depth in cesspool is less than 6"below invert or available volume is less than ''/:day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped Any portion of the SAS,cesspool or privy is below high ground water elevation. _ZAny portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. eater portion of a cesspool or privy is within a Zone 1 of a public well. - �y portion of a cesspool or privy.is 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis most be attached to this form.] Q(Yes/No)The system La . I have determined that one or more of the above 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 ign 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 crite ' above) yes no. — _the system is within 400 feet of a surface drinking w supply _ —the system is within 200 feet of a tributary to a su , ce drinking.water supply the system is located in a nitrogen sensitive (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in on E the system is considered a significant threat,or answered "yes"in Section D above the large system has iled.The owner or operator of any large system considered a significant threat under Section E or failed der Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact a appropriate regional office of the Department. Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 30 Curry Comb Circle West Barnstable Owner: Dave Brajczuwski Date of Inspection: 8/15/2002 Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No Pumping information was provided by the owner,occupant,or Board of Health Were any of the system components pumped out in the previous two weeks? Has the system received normal flows in the previous two week period? � ZHave 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 than 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 T Existing information.For example,a plan at the Board of Health. _ Determined in the field(if any of the failure criteria related to Part Cis at issue approximation of distance is unacceptable)P10 CMR 15.302(3)(b)J Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 30 Curry Comb Circle West Barnstable Owner: Dave Brajczuwski Date of Inspection: 8/15/2002 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 07 Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): Number of current residents: Does residence have a garbage grinder(yes or no):t Is laundry on a separate sewage system(yes or no):cif yes separate inspection required] Laundry system inspected(yes or no):— Seasonal use:(yes or no): & Water meter readings,if available(last 2 years usage(gpd)):Q©z)c7 = i1,��, Sump Pump(yes or no):6,t:� Last date of occupancy:,L COMMERCIALANDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgftetc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes X;�&e Non-sanitary waste discharged to the Title _ Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part of the inspection(yes or no :_ 6 If yes,volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYPE.OF SYSTEM peptic 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) _Tight tank Attach a copy of the DEP approval _Other(describe): Approximate age of all components,date installed(if known)and source of information: Were sewage odors detected when arriving at the site(yes or no): !nZc,) Page 7 of l 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 30 Curry Comb Circle West Barnstable Owner: Dave Brajczuwski Date of Inspection: 8/15/2002 BUILDING SEWER(locate on site plan) Depth below grade: 3 a" Materials of construction:_cast iron A05 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK:le'lloeate on site plan) Depth below grade:Qy Material of construction:_✓concrete_metal_fiberglass_polyethylene _other(explain) If tank is metal list age:,_ Is age confirmed by a Certificate of Compliance(yes or,no):_(attach a copy of certificate) Dimensions: 6 ,sr y S" Sludge depth: } i " Distance from the top of sludge to bottom of outlet tee or baffle: a Scum thickness: > i " Distance from top of scum to top of outlet tee or baffle: <o,.S " Distance from bottom of scum to bottom of outlet tee or baffle: if How were dimensions determined: w•� ,.-,� ",,�Q p -��� Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): r GREASE TRAP: (locate on site plan) Depth below grade:_ Material of construction:_concrete metal_fiberglas/olyethylene 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 or baffle: Date of last pumping: Comments(on pumping recommendations,inl and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet-invert,evidence of leakage etc.): Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 30 Curry Comb Circle West Barnstable Owner: Dave Brajczuwski Date of Inspection: 8/15/2002 TIGHT or HOLDING TANK: (tank must be pumped at time of in 'on)(locate on site plan) Depth below grade: Material of construction: concrete_metal fiberglass_pol ylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working orde/(yeso): Date of last pumping: Comments(condition of alarm and float switc DISTRIBUTION BOX: (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert:®'. Comments(not if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,coed' on of pumps and appurtenances,etc.): Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 30 Curry Comb Circle West Barnstable Owner: Dave Brajczuwski Date of Inspection: 8/15/2002 SOIL ABSORPTION SYSTEM(SAS):_zoocate on site plan,excavation not required) If SAS not located n ex lai why: P Y Type eaching pits,number: leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): CESSPOOLS: (cesspool must be pumped as of inspection)(locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or n : Comments(note condition of soil,signsyfhydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,si s of hydraulic failure,level of ponding,condition of vegetation,etc.): f Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 30 Curry Comb Circle West Barnstable Owner: Dave Brajczuwski Date of Inspection: 8/15/2002 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch 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. 3 0 i i i 1 0 0 �S"Gh1 67 C �Sw C LJ A i C Va r 0 tt2�- F- = 3 3 , g r3- _ Qq > Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 30 Curry Comb Circle West Barnstable Owner: Dave Brajczuwski Date of Inspection: 8/15/2002 SITE EXAM Slope Surface water Check cellar.f Shallow wells Estimated depth to ground water<< feet Please indicate(check)all methods used to determine the high ground water elevation: _jZ0btained from system design plans on record—If checked,date of design plan reviewed: �q,T Observed site(abutting property/observation hole within 150 feet of SAS) Checked with the local Board of Health-explain: Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: �v ° v - ow PQte,4 00, �� e BORTOLOTTI CONSTRUCTION,INC. 09 765 WAKEBY ROAD,MARSTONS MILLS,MA 02648 INS, 8 d Zai' 508-771-9399 508-428-8926 FAX: 508-428-9399 6' t �Q SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FO PART A e. RTIFIICATION Property Address: �rj,6 ✓ ` ,e Date of Inspection: 9 Inspector's N ie: Owner's Nam and Address: CERTIFICATION STATEMENT* I certify that I have personally inspected the sewage disposal system at this address and that the informa- tion reported below is true,accurate and complete as of the time of inspection. The inspection was per- formed based on my training and experience in the proper function and maintenance of on-site sewage disVPasses tems. The System: Conditionally Passes Needs Further Eval lion B he Local Aproving Authority Fails Inspector's Signature: % Date: The System Inspector shall submit a copy of this.inspection report to the Approving authority within thir- ty(30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTIONSUMMARY, A)SYSIXM PASSES: 1/ I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B)SYSTEM CONDITIONALLY PASSES; One or more system components need to be replaced or repaired. The system,upon comple- tion of the replacement or repair, passes inspection. Indicate yes,nor,or not determined(Y,N,OR ND).Describe basis of determination in all instances. If not determined",explain why not. The septic tank is metal,cracked,structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing sep- tic tank is replaced with a conforming septic tank as approved by The Board of Health. Sewage backkup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of The Board of Health): - 1 - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Broken pipe(s)replaced Obstruction is removed Distribution Box is levelled or replaced The System required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of The Board of Health): Broken pipe(s)are replaced Obstruction is removed C)FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by The Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1)SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 Feet of a surface water Cesspool or privy is within 50 Feet of a bordering vegetated wetland or a salt marsh. 2)SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER,IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTION- ING 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 water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is with a Zone I 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. The system has a septic tank and soil absorption system and is less than 100 Feet but 50 Feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from the facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. 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 into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of efluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or clog- ged SAS or cesspool. Liquid depth in cesspool is less than G"below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped -2- I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Any.portion of the Soil Absorption.System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 Feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well Any portion of a cesspool or privy is within 50 Feet of a private water supply well. Any portion of a cesspool or privy is less than 100 Feet but greater than 50 Feet froth a private water supply well with no acceptable water quality analysis. if the well has been analyzed to be acceptable,attach copy of well water analysis for colifortn bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E)LARGE SYSTEM FAILS: The following criteria apply to a large system in addition to the criteria above: The design flow of a system is 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: The system is within 400 Feet of a surface drinking water supply The system is within 200 Feet of a tributary to a surface drinking water supply The system is located in a nitrogen sensitive area Interim Wellhead Protection Area (IWPA)or a mapped Zone II of a public water supply well. The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Check' the following have been done: Pumping information was requested of the owner, occupant, and Board of Health. None of the system components have been pumped for atleast two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. As-built plans have been obtained and examined. Note if they are not available with N/A. L/The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow. V" he site was inspected for signs of breakout. ZA11 system components,excluding the Soil Absorption System, have been located on site. --,-The septic tank manholes were uncovered,opened,and the interior of the septic tank was in- spected for condition of baffles or tees, material of construction,dimensions,depth of liquid, _jWpth of sludge,depth of scum. _JeLfrhe size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. -3- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST(continued) P/The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Subsurface Disposal System SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION / FLOW CONDITIONS RESIDF.NTL4,L• ✓ / Design Flow: 319 gallons Number of Bedrooms:3•S Number of Current Residents: Garbage Grinder: Laundry Connected'1'o System: Seasonal Use:_A .)Z) Water Meter Readings, if ilable: k1f_11 k/a'.r Last Date of Occupancy: COMMERCLALILNDUSTRI_AL�Q Type of Establishment: Design Flow: gallons/day Grease Trap Present: (yes or no) Industrial Waste Holding Tank Present: Non-Sanitary Waste Discharged To The Title V System: Water Meter Readings, If Available: Last Date of Occupancy: OTHER: Describe) Last Date of Occupancy: GENERAL INFORMATION Ln PUMPING RECORDS and source of informa ion:j System Pumped as part of inspection: If yes,volume pump 9allons Reason for pumping: TYPE OF SYSTEM: __Zteptic Tank/Distribution Box/Soil Absorption System Single Cesspool Overflow Cesspool Privy Shared System(If yes,attach previous inspection records, if any) Other(explain): ROXIMATE AGE o�7 � f all c mponents,date installed(if known)and source of information: Sewage odors detected when arriving at the site: J) -4- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C GENERAL INFORMATION (continued) SEPTIC TANK:_ Depth below grader Material of Construction: concrete metal FRP Other (explain) Dimisions: Sludge Depth: Scum Thickness: Distance from top of sludge to bottom of outlet tee or baffle: 35- Distance from bottom of scum to bottom of outlet tee or baffle: >J Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid . ' level in relation outlet invert, structural integrity,evidence of leakage tcs 0— /OaU //On p ri a) U kzzo GREASE TRAP: Depth Below Grade: Material of Construction:_concrete_metal_FRP Other (explain) Dimensions: Scum Thickness: Distance from top of scum to top of outlet tee or baffle: Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage, etc.) TIGHT OR HOLDING TANK: Depth Below Grade: Material of Construction:_concrete_metal_FRP_Other(explain) Dimensions: Capacity: gallons Design Flow: gallons/day Alarm Level: Comments: (condition of inlet tee, condition of alarm and'floal'switcl►es;etc.)—- 1 DISTRIBUTION BOX: V/ l Depth of liquid level above outlet invert: Comments: (note • evel and distribution is a ual,evid ice of so ids carryo er,evidegce of 1 age int or ou of box,etc. ` 7 ` Q PUMP CHAMBER: Pump g is in working order: Comments: (note condition of pump chamber,condition of pumps and appurtenances, etc.) -5- sM 4+ai SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (coulinued) SOIL ABSORPTION SYSTEM(SAS): (Locate on site plan, if possible;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present, explain: Type Leaching pits,number:Leaching chambers, number: Leaching galleries,number: Leaching trenches, number, length: Leaching fields, number,dimensions: Overflow cesspool, number: Comments: (note condition of soil, signs of hydraulic failure level o pondin , condition of vegetation etc. 'S 10 -C. V� ! e')10 W, el I/ 0 CESSPOOLS:_ Number and configuration: Depth-lop of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of Cesspool: Materials of construction: Indication of groundwater: Inflow(cesspool must be pumped as part of inspection) Comments: (note condition of soilk, signs of Hydraulic failure, level of ponding,condition of vegetation, etc.) PRIVY: s of con Materialstruction: pimcnsions: Depth of Solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.) k -6 - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM S r` PART C C� SYSTEM INFORMATION (continued) I SKETCH OF SEWAGE DISPOSAL SYSTEM: R Include ties to atleast two permanent references, landmarks or benchmarks. _ a Locate all wells within 100 Feet. p Li DEPTH TO GROUNDWATER: , Depth to groundwater: S3 Feet Method of Determination o Approximation: -7- ASSESSOR'S MAP NO.bS a\s PARCEL `3 c L0 C'h.T.•1ON a,a f ComC'• �. SEWAGE PERMIT N0. V 1 UL A G t �5 i INSTALLER'S NAME A ADDRESS CA- r e U I L D E R OR OWN ER 0 DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED LUG v- *n k sv° :z�' -- �.5. r FEa........�. ._— U THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH V�(I�............OF...T� tiASTAr-,M4_£--_----_----_---.-- Appliratinn for Dispnnttl Workg Tonntrurtinn Permit Application is hereby made for a Permit to Construct 16eor Repair ( ) an Individual Sewage Disposal System at: 44 U►tree H 1!_l_I' .. Comm.(, ►Q:. 1 d. �3�- .-:--I`��°+� .LOT. �,..��" ��cam" .. I •..: Location-Address •-- or Lot No. .._..... ' J f?.V. ... - .......................: .-•----..........__.._._............................ a tl Address xw .............................. M Installer Address Type of Building Size Lot-,1.D,.5.e......Sq. feet U Dwelling—No. of Bedrooms... .tl.OEgE...daa)Expansion Attic ( ) Garbage Grinder p4 Other-Type of Building ,.,....... .................. No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ------------------------•---.----- . W Design-Flow...........Ito.........................gallons per.persau per day. Total daily flow............-3-�`.,rS.7_.................gallons. N Septic Tank—Liquid capacity.).0-DD.gallons Length g'-.(V'. WidthA!,-10'Diameter!-.-.............. Depth-ram 1-4P x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No.... Diameter........5........ Depth below inlet......(Za�....... Total leaching area-0?1.,..1...sq. ft. Z Other Distribution box (, Dosing tank ( ) C. • - '" Percolation Test Results Performed by.... y6!(,�.� 1 ................. Date.....7//--�/�J`........ Test Pit No. minutes per inch Depth of Test Pit...14eZ..... Depth to ground water.-}}.�'-_..1t 11.{...... 44 Test Pit No. 2-.4_e.....minutes per inch Depth of Test Pit....1.$O?".. Depth to ground water..ZZ I�LQ! l _. po i �.�'L'.?:�--C?�cs' CCJ�4 !!r•U�'�`- n..c GL Q1L:t. (o!'- :t .1!_5 [t1?......... 0 Descrip'on of Soil..62!!7:..->,6!'..CA#.Y-,.-:?.6'-'..:te64.NGL.C-,.W_. �.1,jme--- ................... .5�...G''... .PCt.....Q�o._.�=_QRM..�.11�.-----'`�B__.5u�L35c�/_L- •�S--•---��--•-�Y��_C�.,���1L.1�•-�»�51�T........ W ..... -...... o_..'.100.- •..���U..�_��RY�_.1�Q.'.:"..����..C4.��Vt1..C�?�41c5�...�r°rt�ll.?............. UNature 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 LITLZ 5 of the.State Sanitary Code — The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been isAued by heoPoavVbf health. �e�aJSigned....... .. ... ... . . lam'_' ... Application Approved By............. �.......:... .. ................................. .............. ate Application Disapproved for the f owing reasons:.........--•............................•-------•-••---•--•-............................._...................... ...............................................................................................................................................................................................---••----- Permit No..... �d� -�-�-7 0- Date ...........•-•-•-•......._......-------------_..... Issued.............. Date z ,No ...._...._....._ f FEs. ...... _...... THE COMMONWEALTH OF MASSACHUSETTS ,rat ,' �• - t" BOARD OF HEALTH ....-......0F .. 1�..t. I . ' Appliration.for Disposal orks -Tonstrurtion Permit Application is hereby.,made for a Permit to Construct mO or Repair ( ) an Individual Sewage Disposall System at: U.N c Cle, (4 i.LL --- ..: -- ---- --- =r'�-?' � -r—. ......._. Location-Address a or Lot No. ..... -...._.__.................. _... ..............................................- ---........................................... —Pwner ddress (� . 1��r=Y �—u e(/�� —rrPI( M Installer Address Type of Building Size Lot_ ..Sq. feet" Dwelling—No. of Bedrooms._:T i-A_�E.E—.__.(:� �Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building No. of persons............................ Showers — Cafeteria 04 Other fixtures -----••••---... •---•---••-••--• _ _________________•--------••----•-•-•------•--•------_----- d eject - -v'*--y-•---------------------- s W Design Flow...........)_M.........................gallons per.person per day. Total daily flow.._________=5 3 .................gallons. WSeptic Tank—Liquid capacity. 020 gallons Length S...._...... WidthA 1. �(�� Diameter_______ ______ Depth? x t Disposal Trench—No......:.............. Width_._....__._.______._ Total Length______..:.._ .... Total leaching area....................sq. ft. �- 1 3 Seepage Pit No �.1�_____ Diameter___..._.`3.__._._. Depth below inlet...... ..... Total leaching. ...sq. ft Z Other Distribution box l;}�)� Dosing tank ( ) / Percolation Test Results Performed by.... =?�il�?S.!..��4q tCL�hz....: ........ Date.....7f/.�f_.l-`�...._--. ,al Test Pit No. per inch Depth of Test Pit ) �.F�" Depth to ground water..s.4.....___mac_.. t Li, Test Pit No. 2... minutes per inch Depth of Test Pit_ 1 ''_. Depth to ground water K 2�_E__ ......... O Description of Soil.. .`.!= r�' �L�cl`�' ` l!'...y Sf!! ! .�t�i_w.__ c-© a. r :._. za�tl ........... r .............................. f`__C=-/L-7-------- W ° ''..._�<'{a'.:-.__ IUF-r'l �Y� '� ! ................................... V Nature of Repairs or Alterations—Answer when applicable................................................................................................ ................•-......._...--•--....--•--••-•-•--••----•-•---•---.._...._.._...-"-...---..........__._.......---"•----..__.--------•----•--------"-----•---•---------------..._........:.............. Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with . the provisions of A ITLZZ 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 of of health Signed.... .�. �` ................... ...• • 3�� j . ApplicationApproved By............... ........ .................................. ............................ Date ` Application Disapproved for the f o owing reasons:•---------••__________________•-------------•---•---•-••---•---•---------------..........-•-•--•----.........,.. •............... ...................... ---.......'-7-........ __...---------•-.... ............. ...__....---_----- •-•---.._....__..._--•-•-.... •--...._.... V/ Date PermitNo........ ............................................. Issued....._..----.._...---------.. ............. Dace ...--r,,, ---a . .......................7.' ,......!..a uw r-e........ o..« .�..... _ ............ 19 THE COMMONWEALTH OF MASSACHUSETTS ' BOARD OF HEALTH clG�e. l�2rUs l;'} �c= OF..... ............................................................................... (Irrfif irate of Tomplianre THIS IS TO CERTIFY, That the Indivi ual Sewage isposal System constructed ) or Repairedby ( ) ......---•--------------•-----..............-•-- instaiier ---._... ... .. �O'" ?.� ..a f' - -1 �v G7?( ',�l/ f?�J 'L c -•--••---------------------- has been installed in accordance with the provisions of TIT LE r of The State Sanitary Code as described in the application for Disposal Works Construction Permit No._ T� ated.....................".......................... THE ISSUANCE OF.THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUN CTIONSAjrISFACTORY. DATE.................. ..... .. .�....... .. � Inspector ........... ............. ........... �� Fr REµAau�l THE COMMONWEALTH OF MASSACHUSETTS C_WO94 Meg BOARD OF HEALTH ROE Pckt{ �'/ // G yl�u G Ssg'7� ...-......�U.!! ..!'................OF._......_..c` ................................................. No........................ f , f `FEE' .....:.............. nttl}fur u (tons wrniierut 3 _ Permission is, ereby granted,._ .......................... _____�-��i/ 2...' to Construct ( or Repalr ( ) an Individual Sewage Disposal System at No... -- 3� �'.s�C?L�=...----.._._r- ............................ ..�-.'ST(�QGF...................................... Street as shown on the application for,:Disposal Works Construction Permit N ._._S_.______________ Date___.__..._....................... ............... A ............................... - - uard Iealth DATE.....LQ_�AlaISS7 ,; 4 362-4541 926 main street yarmouth mass. 02675 4J6wn Cope eft gin@elift,f civil engineers& land surveyors structural design Arne H.Ojala P.E.,R.L.S. land court Richard R.Fairbank P.E. surveys site planning sewage system October 3, 1986 designs inspections Board of Health Town of Barnstable permits South Street Hyannis, MA Gentlemen: On October 1, 1986 Down Cape Engineering inspected the septic system on Lot 35 Currycomb Circle, Centerville. The construction complies with Mass.Environmental Code Title V and the Barnstable Health Regulations and conforms to our site plan #85-215-35 revised 5/6/86 except that collars were installed on top of the leach pit to bring the cover within 2' 'of final grade. This change will not affect the functioning of the system. Very truly yours, Arne H. Ojala, P.E., R.L.S. Inspected by Carol ;Young AHO/amp SECTION - SEWAGE 32' —SEPTIC TANK— II _..D..BOX — S' —LEACH— TOP OF FDN 3�' ..2..OF118TO Y". WASHED STONE Z(D.o1� IN• OUT• IN• OUT• (� ^�/, �Qv . IN 121.'1 Cp LQQo_G /� SEPTIC 6�r I TANK _1 '"�• S4 u ELEV. ELEV. ELEV. �jI�AV�I ELEV. ELEV. ELEV. Nc WASHED STONE TEST HOLE LOG F' Q94 11. TEST BY tQL r= t�•649a--Oki �V•�•fT� ` �p�' WITNESS LM��`� �1 � TEST DATE �!I��(�_ DESIGN 3 BEDROOM HOUSE ,� RG�K �' ' .a ` (� T.H. ,� 1 T.H. # 2 �[✓ r"LE'! �2/ ELEV.i Q` NO 4 (oil ICiD•S �le . ( Tji DIS OSER ISPOSER .2.4' I� PERC RATE MIN/IN. FLOW RATE`I 10 (GAL/DAY) U-- SEPTIC TANK �•�/� ( . — ! ' , "� :� -~� r `` ! L REQ'D SEPTIC TANK SIZE l C•7' q(o' I l7' LEACH FACILITY p, a I G Y SIDE WALLIa"1��IPi�t17-4) _ G/D. r , � 3 �J +201� 11�� BOTTOM I' �21 1"T- I GL—((�Q I: :.G OZ ( , D TOTAL III ;. �/ I 1$0" IiOI USE: ��� LEACHING PI`f' ► 10 10, CIF C>,& -•l ert Y I'o' fit% t�EPTI—I WATER ENCOUNTERED NOTES: (UNLESS OTHERWISE NOTED) 1.DATUM(MSL)+TAKEN FROM �_f "QD-)j -QUADRANGLE MAP " 2.MUNICIPAL WATER __�„_, —AVAILABLE 3.PIPE PITCH:'A"PER FOOT t 4.DESIGN LOADING FOR ALL PRE-CAST UNITS:AASHO-�` ' -44 I 5.MIN.GROUND COVER OVERALL SEWAGE FACILITIES:(1)FT. }<' 6.PIPE JOINTS SHALL BE MADE WATER TIGHT h T 7.CONSTRUCTION DETAILS TO BE ACCORDANCE WITH COMM.OF MASS. SI 1 E PLAN STATE ENVIRONMENTAL CODE TITLE S BT+�ISRI�n1 rORPI5D t•1pRK pI.1LYDK1�51-bIJ LOCUS: L��-r �5�f5 IRRr�r.�l� Cltt� K10 r � 11�A FOR ..PRope-F � LI► S _ `' �. �o.rr o,,�u I..K�I..t I T�s�::E Ni 4-r�I,c.s..•�erv�� -------------- _ ltilE�r- 6�t.I�-rAai�: REG.PROFESSIONAL ENGINEER p �I e-1.�4T1o(•1.' I ZI .00Z Aj-tD .1 I S.Oo A40 ',,'E.PL,4.-G I � REF: }-f IILC'fER NILI. 4 w,,rl.(- c.c-r✓,� .ems_ �-E Zo;;NcE�(utic �-�.:�rJ � .. � - � . I _ k down ca, gi e/!�'/�I�°�!'!/I�' PREPARED FOR: `LEBEIL- ..,. _ ... . . ' CI NGINEERS ^ >., CIVIL,'E _ ... -, ,. ... _ _• I , 'LAND SURVEYORS ------------ BOARD OF HEALTH o " REG.LAND.SURVEYOR 11.` CONTOURS .(ExisTING)........ SCA E�� (PROPOSED) APPROVED DATE-- jsG __� A 1YI�NA y . - j�. ,_ •..:. _ •:; ,; ': OAT 2!S 0 x+� •