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Home My WebLink About0295 HIGH STREET - Health `.295M � hYSt&t ' West'Baristable TOWN OF BARNSTABLE LOCATION SEWAGE# ZOIG - q0Z. VILLAGE ASSESSOR'S MAP&PARCEL 1 -02 INSTALLER'S NAME&PHONE NO. A EXCaVo.A1 O^ y'11.0 G S3 SEPTIC TANK CAPACITY I_S"n� go', T LEACHING FACILITY:(type) (size) 13 x ZS x 2- NO.OF BEDROOMS OWNER Gn�•.oy5 PERMIT DATE: 11 -1(4 - I L COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY A1 " yy0 REAR ,02 J2'W G'o A3.34,y' �9s- ,P3-30S Ay- 33'.? P 3 a No. Fee R 6X/ THE COMMONWEALTH OF MASSACHUSETTS Entered incom uteri Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 21pplitation for Disposal *pstpm ConstCuc � ermit Application for a Permit to Construct( ) Repair((/�pgrade( Abandon( ) Complete System ❑Individual Components Location Address or Lot No. �' � Owe 's Name,Address,and Tel.No. Assessor's Map/Parcel "o wy,) Ti, eggVC C�arri�u5 q6 9-57 l -Off Installer's Name,Addrfi,fnd Te. o. Designer's Name,Address,and Tel.No. 13 4-d3 F,-1�cG Type of Building: `'� Dwelling No.of Bedrooms \J Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 330 gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Saze of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) ` 00 gal lq l O S rr 2U Dy 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 b this Boar of alt i ed j Q Date Application Approved by og Date Application Disapproved by Date for the following reasons r Permit No. XZ� '�� Date Issued No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in corn cater: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftpYication for 30isposai 6pstem Construction Vermit Application for a Permit to Construct( ) Repairs(/)Upgrade( Abandon( ) Complete System ❑Individual Components k !/ Location Address or Lot No. a !s Ow 's Name,Address,and Tel.No. C} Assessor's Map/Parcel ,i 1/►-Y 1eVQ�r 1��`S 't7��i f S �/� Installer's Name,Address, d Tel. o. �—'� Designer's Name,Address,and Tel.No. f G 16 �X Ct.'1'I v 5 G k`'-17� D�5 1✓ SSdc., feS 5 0� �3 3�GY�� Type of Building: ;p;;� Dwelling No.of Bedrtc ii '�•7 { Lot Size_ sq.ft. Garbage Grinder( ) Other Type of Building i q� �` py N .yof P rsons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 / `2/ 1 god Design flow provided gpd Plan Date 1' � Numbe b shdets Revision Date Title Size of Septic Tank { (I f 1 Type of S.A.S.~ / a r � _ y Description of Soil F- Nature of Repairs or Alterations(Answdwhen applicable) f /.5 00 go_[ N t o s r N zod b o y Date last inspected: Agreement: It{l .� -he undersigned agrees to ensure the construction'andymmatenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Env ronmental Code and not to places the systerri in operation until a Certificate of Compliance has been issued b this Boa of al , i ed Date /_a w. Application Approved by ��_Y=//� r f Date �/Application Disapproved by / / / Date J v 1-7 for the following reasons n / ✓ ��Permit No. � � �^ Date Issued i THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance TIES IS TO CERTIF that Ze On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned( )by -t �.80 Uk (U n at 2 q S i�h 5� VXI ,_—B(1 r n 5 i &Alueen con ' in acco ce with the rovision of Title 5 and the for Disposal System Construction Permit N . n� da�i3'ft j P p Y �� Installer �(.ui u W 1 Q n Designer i #bedrooms Approved design flow ', 3 gpd " - The issuance of t s permit shall not be construed as a guarantee that the system will f nctle as designed. n Date Inspector ! ? , a ` ' va -----No.---------,-.-------- --_�1----z----;--`------------------------ -- ----------------- --------------------- Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Disposal ,*pstrm Construction joermit Permission is hereby granted dtto''Construct( ) C Repair( ) Upgrade( ), Abandon( ) System located at "1'� �] �/�( .�n(n cA u b( d and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction/must completed within three years of the date of this permit. i)vn !Date Approved by Town of Barnstable Regulatory Services Richard V. Scali, Interim Director �exsraa�, • Public Health Division 039. ♦0 Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Off ze: 508-8624644 Fax: 508-790-6304 Installer& Designer Certification Form Date: /-4 Sewage Permit# .261 Assessor's Map\Parcel /// 7Z Designer: '!� a CLZle Installer: 6!�4149414` Address: flm// i4149W Address: /4 n4 der On was issued a permit to install a (date) (instal lei) septic system at �ret based on a design drawn by (a(fdress) iZ� S S BCg dated //16 W (designer) r/"' I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out (if required)was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed in compliance with the terms of the I\A approval letters (if applicable) ZH OFtiJA AW sue (I er's Signature) o VON HONE v � #1068007 q�IT"A % (Designer's Signature) (Affix tamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\Septic\Designer Certification Form Rev 8-14-13.doc Town of B bit. r# ! 5020 Of slirflces R+dabq • 3 •. ' Pabfic Division .. ZooM&sweet R MA 02601 , Oil SuUabdiltyAssessmeid for Sewoje Dissosal LOCATMN& I1�iF(}RMATION 3 owmesmmo �� l � �r Addm .. 4V• OGp�i�`, AasessnesMWF �7S-/{j� t.d U. i.�i .1r� SWO cam) Sudaoa stomas ' Msu=m a� c�wawft t► �I.Wd nth>l wtn�wal `� :+ Ewa► ►L # —_l ._--a Other g SBLTCII:( nanw dlbPhx� tocadoaa of t�holes�t��.ha;aEe�ethm�in�4 to h�ea) 4-1 _ ;7"' Crl� ��GieS�rr c to s t�nnnaiai(mac) - . Depth to Ommmdaats: gwata ht Rohr` ' ° •Bt6m�a�ed seaamd --}' s 1.TiON FOR SUSO RICH WATER TAM B yr �x wat Readtegth �.._. tadcc wellgam'Wit" '" Obscmdon P7COLATr TO'x`. Hole# Depth of Pew �A t'abilc H Ditf 010� . .. * le•"test is to be emU%cted Wubk].009 4 wegmd,.ym�first R069►the BwLstublc! Division+at least one(1)w�pilot to s /U Vs M1 +tom DEEP OBSERVATION HOL19LOG: . Hole , Depth from SoU Higtm Sai Tmm . Son Qular + sal , .� 1 o . �f stttrt>s.) tusn c g O G'Vk \ DEEP OBSERVATION HOLE LOG' Hole# f ysullimau.) � ([1SDA) l.Rawway 1 mft (SQoanre,SwmjC,BWIldC1A � DEEP OBSERVATION HOLE LOG Hole# Depth frma sat Horimn Sal Tesiure son Cw" Sat • twia s (in.) NsD�U (MMUCIU mawans ( •sti.Boadaa DEEP OBSERVATION HOLE• LOG Hole# Depth from Salt izon Soil Taxdue s�cplar ' 8at Other. :Stones.Eouiders. Surface(in.) - (USDA) {IKynse#1). M►Wliug {Sprncatrq'. ,.:.�., Abm SW yw Flmd boundary No_.._. Yea r _ ` ' Within$00 year baa�ry No Yes,,.,..' Witbin 100 year flood berry No._,__ Ya Denth of Natmol Qgggft e�ous Material Does ai iaasi`&iu foes Of to its i otxatcrlag prNvi eadst,to all area absaved dmughout the ' area proposed for tba wii ab rpd on system4 If not,wbat is the depdt of nawmuy occnring ous material? tvertifi on W Ally, 0(")I have' • �BOB evaluator ex11 911 by tiro IcetRii'y that on P �`° ; . DeparttltetEt of Smsru» ntal h ms and that the above analysis was by dt caddsi vvidt• the rid trai ng, and 'brid::sn 3,LO CM R 15.017. Signahino NO �/~�� i 295 High Street, West Barnstable. On 7-5-2016, Title V inspector Matthew Gilfoy conducted a septic inspection. The septic was located less than 100 feet, but 50 feet or more away from the onsite private well. The homeowner attempted to take the well sample on their own and in doing so, they believe they did not take a proper sample using the procedures required to reduce contamination. The well sample did come back positive for coliform, and the lab recommended retesting. The homeowner then decided to contact their well company. The well company was surprised it failed and agreed that a new test should be done by someone knowledgeable in sampling procedures. DEP was contacted and agreed that a retest could be done if the well sample may have failed due to a sampling error by a homeowner. Desmond well drilling collected a sample on 8/12/16. The well results came back as passing for potable water. Attached to the inspection report is the letter from Desm nd Well Drilling, along with the passing well test results. Based on the info submittep the Title V inspection passes. David W. Stanton, S Town of Barnstable Health Division Q::\septic\295 High Street.doc 4 A Inc. CAPE COD TEST BORING mo �. ,•r §i Yv3 3 'i AMR, s To: Barnstable Board of Health From: Michelle Borghi, Desmond Well Drilling, Inc. Re: 295 High Street,West Barnstable CC: Richard Tompkins Date: August 17, 2016 To whom it may concern: Desmond Well Drilling, Inc. sampled the water from the well at 295 High Street in West Barnstable on August 12, 2016. The water sample was submitted to the Barnstable County Health Laboratory for analysis. The lab report is attached. Please call with any questions. Thank you, Michelle Borghi Desmond Well.Drilling, Inc. 5 Rayber Road P.O: Box 2783 Orleans, MA 02653 • (508)240-1000 Fax(508)240-1003 info@desmondwelldrilling.com • www.desmondwelldrilling.com CERTIFICATE OF ANALYSIS Page: 1 of s M Barnstable County Health Laboratory (M-MA009) h j Report Prepared For: Report Dated: 8/15/2016 Sally Desmond Desmond Well Drilling Order NO.: G1695867 P 0 Box 2783 Orleans, MA 02653 --........-._... --- —....:..................._._. . .... I Laboratory ID#: 1695867-01 Description: Water-Drinking Water Sample#: Sample Location: 295 High St.W. Barnstable, MA Collected: 08/12/2016 Collected by: DWD Received: 08/12/2016 Routine_M ITEM RESULT UNITS RL MCL METHOD# ANALYST TESTED NOTE Nitrate as Nitrogen 0.32 mg/L 0.10 10 EPA 300.0 LAP 8/12/2016 Iron ND mg/L 0.15 0.3 EPA 200.8 VZ 8/15/2016 Manganese ND mg/L 0.0030 0.050 EPA 200.8 VZ 8/15/2016 pH 6.9 PH AT 25C NA 6.5-8.5 SM 4500-H-13 DCB 8/12/2016 Sodium 10 mg/L 2.5 20 EPA 200.8 VZ 8/15/2016 Total Coliform 0 /100ml 0 0 SM 92228 RG 811212016 Conductance 130 umohs/cm 2.0 SM 2510B DCB 811212016 Water sample meets the recommended limits for drinking water of all the above tested parameters, Attached please find the laboratory certified parameter list. Approved Bye, „ - — ... ,..��—�.. (Lab Director) ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level 3195 Main Street, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 W��v� �-e s f4- c�� r� � I � -�}� ✓� sos 6 g Commonwealth of Massachusetts Title 5 Official Inspection Form fa Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 295 High Street C� Property Address Oa Richard Tompkins y Owner �� Owner's Name Ct information is required for every West Barnstable Ma 02668 7-5-16 page. City/Town State Zip Code Date of Inspection ly w Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, use only the tab 1. Inspector: key to move your cursor-do not Matthew Gilfoy use the return Name of Inspector key. B&B Excavation Company Name \. 374 Route 130 Company Address Sandwich Ma 02563 City/Town State Zip Code (508)477-0653 S113640 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority 7-5-16 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 295 High Street Property Address Richard Tompkins Owner Owner's Name information is required for every West Barnstable Ma 02668 7-5-16 page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not 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 be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box fcr"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): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 I Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 295 High Street Property Address Richard Tompkins Owner Owner's Name information is required for every West Barnstable Ma 02668 7-5-16 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ 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): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 I Commonwealth of Massachusetts r3o Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 295 High Street Property Address Richard Tompkins Owner Owner's Name information is required for every West Barnstable Ma 02668 7-5-16 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is 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: ** 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 must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool El ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts Y Title 5 Official Inspection Form of Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 295 High Street Property Address Richard Tompkins Owner Owner's Name information is required for every West Barnstable Ma 02668 7-5-16 page. CityFrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑_ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ® ❑ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes' in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 295 High Street Property Address Richard Tompkins Owner Owner's Name information is required for evey West Barnstable Ma 02668 7-5-16 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? NA❑ ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ❑ ® Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): No design Number of bedrooms (Actual) 3 plans DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): NA t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 4 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 295 High Street Property Address Richard Tompkins Owner Owner's Name information is required for every West Barnstable Ma 02668 7-5-16 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 3 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d See below 9 ( Y 9 (gp ))� Detail: "WELL WATER" Sump pump? ❑ Yes ® No Last date of occupancy: Current Date Commercial/Industrial Flow Conditions: Type of Establishment: NA Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 295 High Street Property Address Richard Tompkins Owner Owner's Name information is required for every West Barnstable Ma 02668 7-5-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: _Pumped driver Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1000 gallons How was quantity pumped determined? Sight glasses Reason for pumping: Cesspool had to be pumped and inspected Type of System: ❑ Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Ti;ght tank. Attach a copy of the DEP approval. ® Other(describe): Cesspool and leaching trench t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 295 High Street Property Address Richard Tompkins Owner Owner's Name information is required for every West Barnstable Ma 02668 7-5-16 page. City/Town State Zip Code - Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Unknown due to lack of records Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2feet 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.): Septic Tank(locate on site plan): ' Depth below grade: NA feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 295 High Street Property Address Richard Tompkins Owner Owner's Name information is required for every West Barnstable Ma 02668 7-5-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cunt.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Grease Trap (locate on site plan): Depth below grade: NAfeet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts r* W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 295 High Street Property Address Richard Tompkins Owner Owner's Name information is West Barnstable Ma 02668 7-5-16 required for every i page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: NA Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: - Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 295 High Street Property Address Richard Tompkins Owner Owner's Name information is required for every West Barnstable Ma 02668 7-5-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert NA 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.): 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.): NA * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 295 High Street Property Address Richard Tompkins Owner Owner's Name information is required for every West Barnstable Ma 02668 7-5-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: 1 trench (lengthunknown) ❑ 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.): Leaching was in working order at time of inspection. Trench had no standing water present Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration 1 Depth—top of liquid to inlet invert 101, Depth of solids layer 5 Depth of scum layer 2 Dimensions of cesspool 6'x8' Materials of construction Blocks Indication of groundwater inflow ❑ Yes ® No t5ins•3/13 Title 5 0fficial Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 295 High Street Property Address Richard Tompkins Owner Owner's Name information is required for every West Barnstable Ma 02668 4 7-5-16 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: NA Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins-3113 Title 5 Official Inspection Form Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage!Disposal System Form - Not for Voluntary Assessments 295 High Street Property Address Richard Tompkins Owner Owner's Name information is required for every West Barnstable Ma 02668 7-5-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately REAR well Al-89111 g .g7;4" 6T CESSPOOL COVER TO ORATE t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 i Commonwealth of Massachusetts L Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ' 295 High Street Property Address Richard Tompkins Owner Owner's Name information is required for every West Barnstable Ma 02668 7-5-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: >12 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: Perk test on neighboring lot shows no ground water @ 12'. Bottom of cesspool @ 10' showing bottom is not in ground water. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 295 High Street Property Address Richard Tompkins Owner Owner's Name information is required for every west Barnstable Ma 02668 7-5-16 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 t• ,�ypF iuhJ CERTIFICATE OF ANALYSIS pee: I of D J s Barnstable County Health LaboratoryM- ( MA009) ��rrncrtus�S�'. Report Prepared For: Report Dated: 7/14/2016 Joan Tompkins Order No.: G1694664 P.O. Box 568 W Barnstable, MA 02668 .......... .. _............._..._.. - _Laboratory ID#: 1694664-01 Description: Water-Drinking Water Sample#; Sample Location: 295 High Streetm W. Barnstable,MA Collected: 07/1-1/2016 Collected by: Customer Received: ..07/11/2016 Routine ITEM RESULT UNITS RL MCL METHOD# ANALYST TESTED NOTE I Nitrate as Nitrogen �0.33 mg/L 0.10 10 EPA 300.0 LAP 7/12/2018 Copper ND mg/L 0.10 1.3 SM 3111 B LAP 7113/2016 i Iron ND mg/L 0.10 0.3 SM 3111E LAP 7/13/2016 pH 6.8 PH AT 26C NA 6.6-8-5 SM 4500-H-B DCB 7111/2016 Sodium 9.4 mg/L 2.5 20 SM 3111E LAP 7/13/2016 Total Coliform Present P/A 0 0 SM 9223 RG 7112/2616 Conductance 120 umohs/cm 2.0 EPA 120.1 DC8 7/11/2016 j Recommended maximum contamination level exceeded due to Cotifam Bacteria. Tested negative for E.coll.Retesting Is recommended. Attached please find the laboratory certified parameter list. Approved By.. (Lab Director) r ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level- 3195 Main Street, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6606 i U-tI(, Pole 117.09 Howland Ln- OCUS ASSESSOR'S MAP: 111 GENERAL NOTES: PARCEL: 72 .1 fd a of Povef�ent yjgh 1. VERTICAL DATUM: __Assumed____ REFERENCE: DEED. B 27 89 Street 2�MUNICIPAL WATER NOT_ AVAILABLE. tea. \v0 v ,,;ate FLOOD ZONE: X Tow of Bar I 164, 7Z1 3. SCHEDULE 40 PVC PIPE TO BE USED THROUGHOUT s I #250 0532J /1 4) t SYSTEM UNLESS OTHERWISE NOTED. 18.24 ` ��'`��"`'• 7.55 4. ALL PRECAST UNITS TO CONFORM TO Weeping err 117.38 7.36 118. ° yit P g r AA H T0: H_10 & H_20 o St. Existing Well n`e r� 117.82 :.`:: ::;: :':° 11 7 a,m 1s.23 5149 ITCH-1/4" PER FOOT UNLESS OTHERWISE NOTED. ( / 'y Lg. Jap�iese Maple ALL CONSTRUCTION DETAILS TO BE IN CONFORMANCE Dose //313 1)s.ss) MA ENVIR. CODE (TITLE 5) AND LOCAL Util. le Percva r. �� REGUL CFO S. LOCUS MAP N.T.S. o`e,�e .;`118.49 Lot Area 7. CONTRACTOR�T VERIFY LOCATIONS OF ALL UTILITIES 0s4 +/- Ac. PRIOR TO CONSTRICTION. . 118.61 117.92 11s.so Maximum Feasible Compliance: <r Exist. Dwell. Title 5 15.405: '.•. Top Fndn. _ 1g >. Elev. 119.2' 117.92 \\ Sleeve Sewer Lines at e(Full) Porc 118.29; ':':; Existing Well o Waterline Crossings and g 1. 0.8'variance, proposed 3.8' Invert out'.: 118.47 ': ,:''., `;; 1 ee within 10' of Private Well. Existing Well at el. 117'78 House279 I of final fill over leach facility Sewer line to be sleeved :`'•116.7' `'' y 10' on either side of 7 Crawl Garage ater line with 6" flexible A Pipe or equal with 19 2 Slab 117.88 end cemented. **Loundr r 118.23 Line 0 3. 18.00 �`o 116.42 Lg. Apple , > �`Oo Oa 150 \ 100 Fire Pit 0 Gea out °B 7 e 4 (' 1,Y.28 / Brick Pa C J i / 8.12 - Cleanout � . \ AMY L. y� .68 Elec. Box �o o VON HONE 16 8 CPf 3°� x 0 #279 11 25 J'117.53 �m �� No. 1068 \ 6" APPI rees ,o �°. 118.18 �FGI ST ER�� 7.44 7.51 NOTE:** Laundry Line exits Garage Fruit Tree Slab Floor (Sch. 40 4" PVC Pipe). 1 18 -1 TH-1 a� Installer must confirm existing 11-1-2 \ 1 7 NOTE: This plan is to be used for septic connection to cesspool. Existing line m Be / ncFimark:• Use Threshold may be located beneath rear brick °� 18.55 at Elev. 119.5' •. system purposes Only and is not to be patio. Reroute to new system 14 O Elec. Box used for any other purpose. outside foundation or plumbing to �S 10' 118.11 be rerouted inside crawl space into 119.00 Gara e g / 118.38 existing 4" Cast Iron main line. vent Workshop°p 295 HIGH STREET V NOTE: No known abutting wells l LEGEND: WEST BARNSTABLE, MA within 150' of proposed leach �_ _/- associates PREPARED facility, within 100' of all septic j 99 PROPOSED CONTOUR ISM= SYSTEM DESIGNS FOR: tanks, or within 100' of proposed 00 ss PROPOSED SPOT GRADE B & B Excavation P P ❑ • 320 Cotut Road subject property leach facility. All q 40 -- EXISTING CONTOUR sandwich, MA 02563 and wells located in field or through e� (o)508.833.0041 Health Department records. boo X 30:23 EXISTING SPOT GRADE (c)508.274.0074 Steve Garrigus ce TEST PIT Surveying by: LOT 18 118.03 AH Ojala Surveying Well this lot is ® EXISTING WATER SERVICE ArneH. Ojala,P.L.S. DATE REVISED I SCALE ISHEETNO. >150' to locus �X�� WORK LIMIT LINE 2t1 Maple street West Barnstable, MA 02668 11/10/2016 1" = 30' 1 of 2 Az, Provide Riser over D-box NOTE: All components to be marked with NOTE: To prevent breakout, final T.O.F. (Full) to within 6" of final rade magnetic tape or similar prior to final cover. EL. 119.2 g grade of EL. 114.2 to be carried (Cover to be watertight) out a minimum 15' beyond edge F.G. EL: 118.5-119.5 F.G. EL: 117.5 F.G. EL: 118.0 � Maintain Min. 2% slope over leach facility to of leach facility. System to be Existing revent ondin F.G. EL: 118.0 nted due to depth variance. Install risers w/covers over inlet and Min. 2" of 1/8" - 3/4" Washed Sto a or Ins ection Port within 6" to grade Exist. Invert outlet to within 6" of final grade :` Geotextile Fabric L=114 (Access Covers min. 20 diam. per Code) •• EL. 116.62 ° 4" SCH 40 P 10 L=15' 3/4 - 1 1/2' Double Washed tone • 4" SCH 40 PVC Top of Peastone or: Geotextile Fabric EL. 114.2 (Cast Iron ::.�=2 . 2� to" 4" SCH 40 PVC r.. 3.3% 1.0%M aB as ,. Pipe) 14" ®S=3.3% 0.5�vIIN aaa8ea® 24 . ff. Depth EL. 114.0jj�i aB®800® EL. 114.25 Install Gas Baffle . EL. 113.6 EL. 113.5 111.0 PROPOSED DB-3 EL. 113.0 Use 2 - 500 hambers Laundry Line L=95' H-20 DISTRIBUTION BOX (H-20) with Double Washed Stone Exist. Invert 4" SCH 40 PVC 5.83' EL. 117.2f =3% 2% - (Install PVC Inlet & Outlet Tees) Watertest for levelness 4 Ends, 4' Sides PROPOSED 1500 GALLON if more than one (25 x 12.83 x 2') (4 Sch. 40 (to Cleanout) H-10 SEPTIC TANK outlet SEPTIC SYSTEM PROFILE EL. 105.17 PVC below Bottom of TH-1 & 2 Garage Slab) N.T.S. SOIL LOG ADDITIONAL NOTES DESIGN CRITERIA SOIL EVALUATOR: AMY VON HONE, R.S. S.E. #2517 1. Contractor to confim soil suitability prior to installation. Contact Number of Bedrooms: Existing 3, Min. Design 3 Bedrooms INSPECTOR: DAVID STANTON, R.S., BOH BOH and Design Sanitarian in the event of varying soils from original (Lot in Zone II- Private Well) DATE: NOVEMBER 10, 2016 10:00 AM soil test. Soil Type: Class I PERMIT: #15200 Percolation Rate: <2 min/Inch PERCOLATION RATE: <2 MIN/INCH IN C1 2. Pumpand remove backfill Failed Cess ools. An contaminated / P Y Daily Flow: Bedrm x 3 =330G.P.D.D P. . materials within 5' of proposed Leach Facility to be removed. Design Flow: 110 G. / TH - 1 TH - 2 330 G.P.D. (Min. Required) EL. 118.0 EL. 118.0 3• Water line to be sleeved at any sewerline crossings and within 10' Garbage Grinder: Not Allowed of any septic components, as needed, per Water Department Loamy Sand Loamy Sand requirements. Contractor to verify location of water line prior to Leaching Area Loamy 3 loamy S construction. Required: (330)/0.74 = 445.9 S.F. 12" 117.0 12 117.0 4. 330 G.P.D. x 200% = 660 G.P.D B B Septic Tank and Distribution Box to' be placed on 6 crushed stone Septic Tank Required: Loamy Sand Loamy Sand or compacted, level base. Minimum 1500 Gallon (Proposed) 10YR5/6 10YR5/6 33" 115.25 34" 115.17 5, Sleeve Sewer Lines at Water Line cr ossings (2) with 6„ flexible ADS Use 2 - 500 Gallon Precast Chambers H-20 with - C1 C1 Pipe placed 10' on either side of water line. Ends to be sealed Double Washed Stone: 25' x 12.83' x 2' Sandy Loam Sandy Loam , 2.5Y5 4 2.5Y5 4 with cement and within 10 of existing well. / / g° 2 25' + 12.83' 2= 151.32 S.F. L k Bottom 11 Area: ( 25' x 12.83'= 321.25 S.F. 60" 113.0 60 113.0 Bottom Area: C2 C2 °~c ; Total Area: 472.57 S.F. ed.-Coarse Sand ed.-Coarse Sand SEPTIC TIES 1-10 Desi n Flow Provided: 0.74 472.57 S.F.)= 349.7 G.P.D. 2.5Y6/4 2.5Y6/4 295 HIGH STREET Perc ® ° V WEST BARNSTABLE, MA 80" BottomPRE 41' associates FOR: PARED 154 105.17 154 105.17 na sysTEM m9GNsj R & B Excavation No Groundwater Observed Q ,36 320 Cotuit Ruud `J 10' Sandwich. MA 02563 (0)508.833.0041 a n d <9" ® 7: 17 minutes PERC RATE: <2 MIN/INCH C2 Horizon 1 1 Garage/ (c)508.274.0074 Steve Garrigu s I, Amy L. von Hone, R.S., hereby certify that I am currently approved by (Slab) Surveying by: the DEP pursuant to 310 CMR 15.017 to conduct soil evaluations and AHOjala Surveying that the above analysis has been performed by me consistent with the ArneH. Ojala,P.L.S. DATE REVISED SCALE SHEET NO. requirements of 310 CMR 15.017. I further certify that I have �>> rvapi, street successfully passed the Soil Evaluator's Exam on November, 1994. west 8amstob�e. Mn 668 11/10/2016 1" = 20' 2 of 2