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Home My WebLink About0031 IRONSIDE DRIVE - Health LW.31ronside Drive rnstable P 110 001019 BOARD OF HEALTH ' TOWN OF BARNSTABLE Application-for Ve[C CongtructionPermit A pli tion is herebyinade for ermit to Construct ( ), Alter ( ), or Repair ( )an individual Well at: ---------------------------------------------------------------------- Location — Address Assesso s Map and Parcel f --- - --------------- Owner- - Address 6 --- x - ------ 6G" Installer Driller Address Type of Building Dwelling--------2-3a ------------------------------- Other - Type of Building ----------- No. of Persons------------------------—_____—________ Type of Well— -- o - -- — - Capacity——--------- ¢— - - -- ------ ----- Purpose of Well - -- - - ------------ Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation unti a Certificate .o Vncas been issued by the Board of Health. Signed ------------------ ------ ------------------ -------- ----date -- ------ Application Approved By-- =- -- -- --- _-1t— LL'__ _ �J v— �'�s — — — date Application Disapproved for the following reasons:------------------------—-------------------------- -------------------------------------------------- -------------------------------------------------------- --------------------------------------------- date PermitNo. - - -- Issued------------------------------------------ — -------------- date BOARD OF HEALTH TOWN OF BARNSTABLE (Certificate Of (Comphante THIS IS TO CERTIFY, That the Individual Well Constructed �,I, Altered ( ), or Repaired ( ) by-------------- .......................... ----- ------------------------------------------------------------------------------------------------------------------ installer at------- ��— _- - - -- -�--- - - - -- - has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No.��`-�_--��_____Dated---------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE------------------—- —---------—----------- —— Inspector------------------------------------------— - - ----------- -.. ,re....F..,�•+••'a�`?rrd-�.. .�`�"r{'i' � ,*�'V't.d�'i�r+..-"�•��Y+��S1'b��^'^'4*W„..�^�i``�t�-'*v�'!`1"�„�'i�M ��ii�9rr�.'�N�^r^f"Y '�{�1�.Ar"T�l�i't7�4��Y�s..j}�, �,��.�T-A'tr"'t'x+}.:,�r VE/ 0 7- 1 '"� -- - - - NO.--,- :-r-r�-t-'=----8- BOARD OF HEALTH `- - y TOWN OF BARNSTABLE zppilcat ion for Vell ctCootrurt ion Permit" { Ap lication is hereby- na a fore permit to Construct ( ); Alter ( ),—or-Repair )an individual YWell at: --— Location Address Assess Map and Parcel ----- � /��C 'l ' - -w ''' �----------------- ------ - - ----- ------ - - -- Owner. Address I Installer - Driller Address _ 1 Type of Building Dwelling------ Other Type of Building -- ------------------------- No. of Persons----------------------------------—------------- TYPe of Well— � -- -------—-- - ------ Capacity-— —�� - Purpose of Well ---- -' -- -- — — Agreement: I The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The F Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to j place the well in operation unti a,Certificate ofIC 'mice as been.issued by the Board of Health. Signed -- - -- -- ------- - daie Application Approved By-- Ile, --- — date Application Disapproved for the.following reasons:----.— --=------------------------------------------------------------------------- ----------- —-- --------------- --— —— — --- - — - — - ------------------- ----- date E4 i. Permit No. - - '- ---- -- -- - Issued --- -- - - - - _-- date. Pwaa aawr�eb�e�wr arr-ra.�wore.rrw �ms�w:s�nar.e.ao.�+.q►�e..�o�.M,s a+�s�:ioae 0s.a..rr�M.n..m�4ww ciao.sw.art�:wew.rrr�r�+ieso�sRar s�lw grits eae,c,wa®.rs.gi.as.0 BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of ComPriance , THIS IS TO CERTIFY, That the Individual Well Constructe ( ; Altered ( ), or Repaired ( ) by --------- ----- - ------ -- — - -% - --------------------- -------------- --- --------- ------ ---- GG Installer at-------- = - - ''- - _-------- --------- - -- --------- --- has been installed in accordance with the provisions of the Town of Barnstable.Board of Health Private Well Protection Regulation as described in th application for Well Construction Permit No. � '--� -----Dated ------ ------ i �' 0 THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL t SYSTEM WILL FUNCTION SATISFACTORY. DATE-—-- —- -- - --- -- Inspector-- ----------------------------------------- ----- - i I BOARD OF HEALTH j TOWN OF ' BARNSTABLE 4 it t IPeCi Con5tructionpermit o. �,�,/ N ju / �Fee------` -----— - Permission is hereby granted- —-- 7x�=-- - --- —-to Construct ( Alter ( ), or R pair ( ) an.Individual Well at: - No. - — - --, = "=` - d --------W, - = Wiz--- - -- ----- --- -------------- --- fw .�__ _ 3�__"__ treat _ as shown on the application for a Well Construction Permit No. - -W 14 r- ------- -------- - Dated ' --------------- ------—-----______—_ _ _T _________________________________________.------- Board of Health DATE—-- � - 'l=- - - -- - —---— - W:. ENVIROTECH LABORATORIES, INC. MA Cert. No.: M-MA 063 449 Rte. 130 . Sandwich, MA 02563 (508)888-6460 1-800-339-6460 FAX(508)888-6446 CLIENT: Reef Realty LOCATION: 39A Ironside Drive ADDRESS: P.O. Box 186 W. Barnstable, MA W. Dennis, MA 02670 SAMPLE DATE: 12-20-94 COLLECTED BY: Clifford Well Drilling DATE RECEIVED: 12-20-94 TIME: 2:30PM SAMPLE I.D. : 152 JOB TYPE: New well WELL DEPTH: N/A RESULTS OF ANALYSIS: Parameters Units Recommended Limit Result Coliform bacteria/100m1 (MF Method) 0 0 pH pH units 6.0-8.5 6.20 Conductance umhos/cm 500 102 Sodium mg/L 28.0 8.7 Nitrate-N mg/L 10.0 0.10 Iron mg/L 0.3 0.05 Manganese mg/L 0.05 0.007 Volatile Organic Compounds See report enclosed EPA 601/602 ug/L Chloroform 1 Yes No WATER IS SUITABLE FOR DRINKING PURPOSES FOR PARAMETERS TESTED. X� Date Z Ro ald J. aari Laborator Director LT = Less Than • ' GROUNDWATER ANALYTICAL EPA METHODS 601 and 602 Volatile Organics (GC/PID/ELCD) Field ID: 152 Lab ID: 9552-01 Project: Reef/39A Batch ID: VG2-0515-W Client: Envirotech Sampled: 12-20-94 Cont/Prsv: 40mL VOA Vial/HC1 Cool Received: 12-20-94 Matrix: Aqueous Analyzed: 12-21-94 PARAMETER CONCENTRATION REPORTING LIMIT (ug/L) (ug/L) Dichlorodifluoromethane BRL 5 Chloromethane BRL 5 Vinyl Chloride BRL 5 Bromomethane BRL 5 Chloroethane BRL 5 Trichlorofluoromethane BRL 1 1,1-Dichloroethene BRL 1 Methylene Chloride BRL 1 trans-1,2-Dichloroethene BRL 1 1,1-Dichloroethane BRL 1 cis-1,2-Dichloroethene * BRL 1 Chloroform 1 1 1,1,1-Trichloroethane BRL 1 Carbon Tetrachloride BRL 1 Benzene BRL 1 1,2-Dichloroethane BRL 1 Trichloroethene BRL 1 1,2-Dichloropropane BRL 1 Bromodichloromethane BRL 1 2-Chloroethyl Vinyl Ether BRL 5 cis-1,3-Dichloropropene BRL 1 Toluene BRL 1 trans-1,3-Dichloropropene BRL 1 1,1,2-Trichloroethane BRL 1 Tetrachloroethene BRL 1 Dibromochloromethane BRL 1 Chlorobenzene ' BRL 1 Ethylbenzene BRL 1 meta-and para-Xylene * BRL 1 ortho-Xylene * BRL 1 Bromoform BRL 1 1, 1,2,2-Tetrachloroethane BRL 1 1,3-Dichlorobenzene BRL 1 1,4-Dichlorobenzene BRL 1 1,2-Dichlorobenzene BRL 1 QC SURROGATE COMPOUND SPIKED MEASURED RECOVERY QC LIMITS a,a,a-Trifluorotoluene 30 31 102 % 87 - 113 1,2-Dichloroethane-d4 30 33 109 % 83 - 117 BRL = Below Reporting Limit. * Non-target compound. Method References: Method 601 - Purgeable Halocarbons and Method 602 - Purgeable Aromatics, 40 C.F.R. 136, Appendix A (1986). ASSESSORS MAP car gs' � PARCELN�� /44� THE COMMONWEALTH OF MASSACHUSETTSa. BOARD OF HEALTH c4 MAR 3 U i:�qTj -`o TOWN OF BARNSTABLEMMDEPI � ' Xppliratiou for Bi_npn!3tt1 Wnrk,i Tomitrurttnn it Application is hereby made for a Permit to Construct ( /00'r Repair ( ) an Individual 'iso�sa System at: �j/ 110 .._. tr" � Location-Address 7 r : f=wF. c��_nC � '��',`` ` -�4 iv � fib( �4-c5ZV caner Addre Installer Ad ress U Type of Building Size ....Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of ersons____________________________ Showers a YP g ---------------------------- P ( ) — Cafeteria ( ) Other fixtures -----------------------------------•---------• ---------- Design Flow______________1. -_J�__ - to_____-__-_ __________-_gallons per person per day. Total daily flow-.--_ J ........................ lons. W W Septic Tank—Liquid capacity159__gallons Length-_11_-___-____ Width-----(a...... Diameter................ Depth..._ _...i'FF Disposal Trench—No. .................... Width . Total Length.................... Total leaching area....................sq. ft. Seepage Pit No._(:4-_ ......._ Diameter.-. Z....._..._ Depth below inlet__.4_........... Total leaching area_R_W------sq-- C�r� Z Other Distribution box ( ) Dosing tank ( ) ''11 1 aPercolation Test Results Performed by... Gz`l.l<�.. t�t.C�y.l._bl_I� l.11��...__._._ Date__.` ...n. `g�.__..._._.. a Test Pit No. 1.< ....minutes per inch Depth of Test Pit......3g-_....... Depth to ground water....I-- ......... 44 Test Pit I :__...minutes per inch Depth of Test Pit------LZ40..... Depth to ground water..--- E........ ------- -- •-•---------------- •-•••----•---_----- Description of of.--=p _ . `---T� _ �Sl?t_L...._...._. ... 13b"____�F�._.��`L?__.1nP _Ca��l�4-_�•________. ---- yc� —. � E�. .----------------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable.___________________________________________.................................................... -•-----------------------------------------------------------------------------------------------------------•----------------------•----------_.._..--------..---------------------........•--•-------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environme tal Code—The undersigned further agrees not to place the system in operation until a Certificate of Complia has be sue t e boa of health. - Signed 3QY, ............... .............................�..................................... /APPlication Approved BY ......... //14 � --. --S----- Dare Application Disapproved for the following reasons: .............. ....... ...... ..... .. .............. ... ......... ..................... ............. ...... ...................... ........ Permit No. l.• ' lD 3 _ Issued `�.. �--�- e ................... Dace No. F._•---•-...------.----• �- ----= ss..l v....................... IV s THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Apphratinn for Bi-nVniittl Wor1w Towitrnr#inn rumit Application is hereby made for a Permit to Construct ( Zr Repair ( ) an Individual Sewage Disposal System at: #j ................t --r _S9 t� 1 tP, t`�5, ._....I�2�u P_CFl �` d.........c....."" Location-Address ` or Lot No. ..... --V-� a..c^ - /------ ................................ .......... f..�.��......... Owner 1 ` n Address ....................> (_._r>t.� 'f:.................................t l �(��.-�---�-k'`_(?iL .. _f�!I h1VG ............................., , 1-ti'1 A CZ fd� Installer I Address Type of Building Size Lot... ....;......._....a_....Sq. feet Dwelling—No. of Bedrooms._.__._.-_-.----------------------------------Expansion Attic ( ) Garbage Grinder ( ) a`4 Other—T e of Building No. of ersons---------------------------- Showers YP g ---------------------------- P ( )--- Cafeteria ( ) dOther fixtures --------------------------------------------------------------------------------------- --------------------------- -----•---- W Design Flow............... .......................gallons per person per day. Total daily flow--..�C?...............................gallons. WSeptic Tank—Liquid capacity J((__gallons Length..'.!........... Width..... ...... Diameter................ Depth_--` x Disposal Trench—No. .................... Width.................... Total Length....--....�....---. Total leaching area....................sq. ft. Seepage Pit No..�-�._7---------- Diameter..-�.��nl-----.--- Depth below inlet___............. Total leaching area.f`f'?�......sq. c7 f F� Z Other Distribution box ( ) Dosing tank ( ) f '" Percolation Test Results Performed by..-2,n�-_ems.....F�__i.t r-��.ti►_GF �_ >��......•.• Date--. ............___.._.-... �7 I Test Pit No. 1. ---..minutes per inch Depth of Test Pit....'3�'_-.__. Depth to ground water....1 � ......... LLl Test Pit No:-2-:��.Z......minutes per inch Depth of Test Pit------?..I .." .. Depth to ground water..... .f. �....--. ............................•-..... ----........•---._....._....... Description of Soil----U.......� -r`� t[ c nrJ=-----3fz=..... � �ti1 F ...��w.l�1a V.1_Vic? 1 ..%......---- VC f'.! .fir. .dam................ ---.__( �!' �( ! P e `'�e 1!_°�.c�_t�_ rt .................................................... Z. . .-•--•-•------•---•................................. U Nature of Repairs or Alterations—Answer when applicable.... ........................................................................................... --------••••--•-----•--•--••--•••-•-•••-•-•--••--•-••-••-•••-•••••••-••-•••--•••••-•......_••--••-•---••-••••••••--•••-------•-•-•--•••-••---••-----•••••••••-•-••--•••--••-••••••--•-••-----.....--••-. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued•by the board of health. Signed .1 44/� 1 ---------------------*... ...�/� ..r�..�...... j Application Approved By .........( ` Ap -!- ...... :--`.X-- ............... . .�.. Dan, --------------------- -------------------------- Date Application Application Disapproved for the following reasons- ----------------------------------------------------------------------- ------------------------------------------------------ ........................................................ ........ ............................. ......................................... ---------------------------------------- s /V ` ? Date 7n J1 ....... .......................Issued -----.......� ........ s 3 Permit No. ............ - - Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE (gertifi ate of Compliance THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired ( ) �;�,.. Installer at . �. .. ............ ---/C E- ..i / �------------------_...............--------------..........----------......-------------------------- has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. .25------ ------------- dated 5,/ .. 9 -----------.... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..... .. _ .. ...- - - Inspecto.r--°..�a a ------ - THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No... -.�03� FEE.---�G�U......... Bwpopal Worko Tonntrudinn �erntit Permission is hereby granted l rZn°� !..._ _..0-0?. f r!�':V! ?...----!-!Z' to Construct ( V)or Repair (—) an Individual,Sewage Disposal System at No..,/. . �` f .�:� _, r_ c r; f r"i P _. Street as shown on the application for Disposal Works Construction ermit No 5=.10.3`3 Dated...._�/)./�.........__. -� � Board of Health DATE......-- p ' FORM 3890E HOBBS 6 WARREN.INC..PUBLISHERS TOWN OF BARNSTABLE , a�3 LOCATION \J�' SEWAGE # VIL AGE ,7 ASSESSOR'S MAP & LQT � 4910 t IVSTALLER'S NAME & PHONE NO. ��v�GLoi• �� o ASEPTIC TANK CAPACITY r$o 9 a v f LEACHING FACILITY:(type �6 y (size) d00 NO. OF BEDROOMS RIVATE WEL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No A Lc is i+f CERTIFICATE OF ANALYSIS page: 1 ssAc�irs�>�" Barnstable County Health Laboratory Report Prepared For: Report Dated: 2/20/2003 Order Number: G0318885 Alison M.Di Iulio 29 Pleasant Street FEB 9 2003 Marblehead, MA 01945 7(w, . .�: "ABLE HE ti�; -DEP1-. Laboratory 'ID#: 0318885-01 Description: Water-Drinldng Water Sample#: 18885 Sampling Location: 31 Ironside Drive,West Barnstable Collected 2/11/2003 Collected by: AMD Received 2/11/2003 Routine ITEM RESULT UNITS MCL Method# Tested LAB:IC Lab Nitrates 1.3 mg/L 10 EPA 300.0 2/12/2003 LAB: Metals Copper 0.2 mg/L 1.3 SM 3111B 2/14/2003 Iron <0.1 mg/L 0.3 SM 3111B 2/14/2003 Sodium 9 mg/L 20 SM 3111B 2/14/2003 LAB: Microbiology Total Coliform Absent P/A Absent 309 2/11/2003 LAB: Physical Chemistry Conductance 172 umohs/cm EPA 120.1 2/11/2003 pH 6.2 pH-units EPA 150.1 2/11/2003 Note: Water sample meets the recommended limits for drinking water of all above tested parameters. Approved By: (Lab Director) Z�Z l�Zc�o3 j Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 r COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ^ F z w � r W � I d h A� � VV Q1A bye TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VMON T ARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM I+O, -I�IR�� PART A �` CERTIFICAT ON DEC 1 $ 2002 Property Address: 31 IRONSIDE DRIVE W. BARNSTABLE,MA 02663 STABLE Owner's Name: DAVID MERSON ST T�WH�LTH DEPT. Owner's Address: 31 IRONSIDE DRIVE W. BARNSTABLE,I4. . -�2cA3 Date of Inspection: 11/19/02 7 9 Name of Inspector: (please print) JOHN GRACI MAP Company Name: SEPTIC INSPECTIONS PARCEL. ' Mailing Address: P.O. BOX 2119 TEATICKET,MA.325-35 LOT _ _ — Telephone Number: 508-564-6813 FAX 508-564-7270 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at tiffs address and that the information i reported below is true,accurate and complete as of the time of the inspection. The inspection was perforrned 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: X Passes _ Conditional) yasses _ Needs Fu Evaluation by the Local Approving Authority Fails Inspector's Signature: : :: 1/11/02 The system inspector shall subm copy of this inspection report to the Appro i�g Authority(Board of Health or DEP)within 30 days of completing this inspe ion. If the system is a shared system or hI s a design flow of 10,000 gpd or greater,the inspector and the system owners all submit the report to the appropriate icg;oc;;:' c�lice of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,and the--p-,;roving authority. Notes and Comments SYSTEM PASSED TITLE V INSPECTION. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. ****This report only describes conditions at the time of inspection uad ;:rarer the conditions of use al that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. f illr C Incnrrlinn Form rli 5/?nn(1 f Page 2of 1 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 31 IRONSIDE DRIVE W.BARNSTABLE, MA 02668 Owner: DAVID MERSON Date of Inspection: 11/19/02 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X 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: SYSTEM PASSED TITLE V INSPECTION. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. 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. Answer yes,no or not determined(Y,N,ND) in the for the following statements. If"not determined"please explain. n/a The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of.Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: n/a n/a Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): _ broken pipe(s)are replaced obstruction is removed _ distribution box is leveled or replaced ND explain: n/a n/a The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): _broken pipe(s)are replaced _obstruction is removed ND explain: n/a r Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 31 IRONSIDE DRIVE W. BARNSTABLE,MA 02668 Owner: DAVID MERSON Date of Inspection: 11/19/02 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system 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 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 I 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 n/a "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 must be attached to this form. 3. Other: n/a Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 31 IRONSIDE DRIVE W. BARNSTABLE,MA 02668 Owner: DAVID MERSON Date of Inspection: 11/19/02 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all-inspections: Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than '/z day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped n/a. X Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone 1 of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. X 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 must be attached to this form.] _ (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design now of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone 11 of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "ves" 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. A Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 31 IRONSIDE DRIVE W. BARNSTABLE, MA 02668 Owner: DAVID MERSON Date of Inspection: 11/19/02 Check if the following have been done.You must indicate "yes"or"no" as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health X Were any of the system components pumped out in the previous two weeks X _ Has the system received normal flows in the previous two week period? _ X Have large volumes of water been introduced to the system recently oi•as part of this inspection ? _ X Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up? X _ Was the site inspected for signs of break out? X _ Were all system components,excluding the SAS, located on site? X _ 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 ? X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no X _ Existing information.For example,a plan at the Board of Health. X _ Determined in the field(if any of the failure criteria related to Paft C is at issue approximation of distance is unacceptable)[310 CM 15.302(3)(b)] 5 Page 6 of 1 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 31 IRONSIDE DRIVE W. BARNSTABLE,MA 02668 Owner: DAVID MERSON Date of Inspection: 11/19/02 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Number of current residents: 4 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no): NO Seasonal use: (yes or no): NO Water meter readings, if available(last 2 years usage(gpd)): n/a Sump pump(yes or no): NO Last date of occupancy: n/a COMM ERCIAL/INDUSTRIAL Type of establishment: n/a Design flow(based on 310 CMR 15.203): n/agpd Basis of design flow(seats/persons/sgft,etc.): n/a 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: n/a Last date of occupancy/use: n/a OTHER(describe): n/a GENERAL INFORMATION Pumping Records Source of information: n/a Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: n/agallons-- How was quantity pumped determined? n/a Reason for pumping: n/a TYPE OF SYSTEM X Septic tank,distribution box,soil absorption system _Singh 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): n/a Approximate age of all components,date installed(if known)and source of information: 1995 BY OWNER Were sewage odors detected when arriving at the site(yes or no): NO 6 Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 31 IRONSIDE DRIVE W. BARNSTABLE,MA 02668 Owner: DAVID MERSON Date of Inspection: 11/19/02 BUILDING SEWER(locate on site plan) Depth below grade: 46" Materials of construction:_cast iron X40 PVC_other(explain): n/a Distance from private water supply well or suction line: n/a Comments(on condition of joints,venting,evidence of leakage,etc.): WELL WATER SEPTIC TANK: X(locate on site plan) Depth below grade: 40" Material of construction: Xconcrete_metal_fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: 1500 GALLONS" Sludge depth: l" Distance from top of sludge to bottom of outlet tee or baffle: n/a Scum thickness:n/a Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: n/a How were dimensions determined: MEASURED Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. GREASE TRAP:—(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping: n/a e or baffle condition,structural integrity, liquid levels as related Comments(on pumping recommendations, inlet and outlet te to outlet invert,evidence of leakage, etc.): n/a 7 Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 31 IRONSIDE DRIVE W. BARNSTABLE,MA 02668 Owner: DAVID MERSON Date of Inspection: 11/19/02 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Capacity: n/a gallons Design Flow: n/a gallons/day Alarm present(yes or no): N/A Alarm level: N/A Alarm in working order(yes or no): NO Date of last pumping: n/a Comments(condition of alarm and float switches,etc.): n/a DISTRIBUTION BOX:X(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: LEVEL WITH BOTTOM OF PIPE 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.): D-BOX IS STRUCTURALLY SOUND. PUMP CHAMBER: _(locate on site plan) Pumps in working order(yes or no): NO Alarms.in working order(yes or no):NO Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): n/a x Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEIV INSPECTION FORM PART C SYSTEM INFORMATION(continued) RNSTABLE MA 02663 , Property Addr ess: IRONSIDE DRIVE W. BA 3 Owner: DAVID MERSON Date of Inspection: 11/19/02 II' SOIL ABSORPTION SYSTEM(SAS). X (locate on site plan,excavation not required) If SAS not located explain why: n/a Type 1000 GAL 6' X 6' leaching pits, number: 2 n/a leaching chambers, number: n/a n/a leaching galleries, number: n/a n/a leaching trenches, number, length: n/a n/a leaching fields, number: n/a n/a overflow cesspool, number: n/a n/a innovative/alternative system Type/name of technology: n/a Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.): DID NOT EXPOSE ONE LEACH PIT. LEACH PITS APPEAR TO BE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY.SYSTEM SHOWS NO SIGNS OF FAILURE. PIT HAD T OF LIQUID IN IT AT TIME OF INSPECT ON.STAIN LINES INDICATE PIT HAS NEVER HAD MORE THAN T OF LIQUID IN IT. CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: n/a Depth—top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer: n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater inflow(yes or no): NO Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): n/a PRIVY: (locate on site plan) Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a Page 10 of l l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(co-tinued) Property Address: 31 IRONSIDE DRIVE W. BARNSTABLE,MA 02668 Owner: DAVID MERSON Date of Inspection: 11/19/02 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two perma►:ent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. 00 c,IL CS 4 t 10, AC, �S Ap I Iy L) L1 C 3 2z r;/;-)2 0 VO 0 Cj c- f�c �'�� L Page 11 of 1 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 31 IRONSIDE DRIVE W. BARNSTABLE, MA 02668 Owner: DAVID MERSON Date of Inspection: 11/19/02 SITE EXAM _Slope _Surface water _Check cellar Shallow wells Estimated depth to ground water 20+feet Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record- If checked,date of design plan reviewed: n/a YES Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a NO Checked with local excavators, installers-(attach documentation) NO Accessed USGS database-explain: n/a You must describe how you established the high ground water elevation: • HAND AUGER-20+FT. 1 � .yt S s�� m < r BORTOLOTTI CONSTRUCTION INC. rooFHO Iy9, 45 INDUSTRY ROAD,MARSTONS MILLS,`MA 02648 s, elge4. 508-771-9399 508-428-8926 FAX: 508-428-9399 • fir . , , SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM v PART A CERTIFICATION Property Address: Date Of InspectionM Ins ec is Name: Owner's Na 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 Inspectioin was perform- ed based on my Training and Experience in the Proper Function and Maintenance of On-Site Sewage Dis- posal Systems.T@ system: t/ Passes Conditionally s s ; Needs Furt r al _ do the Local Approving Authority Failure Inspector's Signature Date: 40 ' 7 TheSystem Inspectors all submit a copy of this Inspection Report to the Approving Authority with Thirty (30)Days of completing this Inspection. If the System is a Shared System or has a Design Flow of 10,000 gpd or greater,the Inspector and the System Owner shall submit the Report to the appropriate Regional Offie of the Department of Environmental Protection. The Original should be sent to the System Owner and copies.. sent to the Buyer,if applicable and the Approving Authority. INSPECTION SUMMARY: A) SYST�ilGt PASSES: ✓✓ I have not found any Information which i ndicates that the System violates any of the fail- ure criteria as defined in 310 CMR 15.303. Any Failure Criteria not evaluated are indi- cated below. B) 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,nor,or not determined(Y,N,OR ND). Describe bases of determination in all'instances. If"not determined",explain why,not. r The-Septic Tank-is Metal,Cracked,Structurally Unsound,shows Substantial Infiltration or exfil- - tration;or Tank Failure'is umminent. The System will Pass`Inspi o"n'lf.Eaisting Septic Tank. is Replaced"with a conforming'Septic Tank as Approved by the Board Of Health. .,. Sewage Backup or Breakout or High Static Water Level observed in the'Distribution Box is due to .�v r c� =� t x. rk , "broken or obstructed pipes)orAU6 to 4 b"ro h."settled or neven'Distribi tion Box. The System ,.. will pass Inspection if(With Approval of theBoard-Of�Health) �{ t r, a .SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPE.CTION,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 WELL 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 "thanS'ppm: D)SYSTEM FAHS: 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 over-loaded�orrcclogged SAS or cess 1 . .:. taticllgitid "1 rg the-distnbuGon box above outlet inrt dueve W an ovedoaded or clog- :god SAS w" wesspool . �_ . Liquid depth inoesspool is less than 6"below invert or,available volume is less than 1Y2 -0t iv tv a t Regtiir�odkpttmping more than 4itimes u►the last year NOT due to clogged or,obstructed -� MOM "iK,• ^x. pipes) £Numb`er 0fJMes putnpod �_�� Via : z� . i ' ram,• aa..s r G"` 4 >T B^J r1� -Lt K .�*- '* ;7•� e` -f r?"�- a xc� sd - #- r k d �� .x _�.e�,Gx�'�a'.yzi it�.s� x "� xr 3 '+�" ?£��i-,. 3!,'r 'r 1 ` „'�'r�a..�" ,q ¢ ��y -r- -:'4;•G•f ,k'-Y�t;� �'$. fi �� S �� Y�� r` >...ti•.,,.s�'+ei�� ¢�.�r xC�`.�.��t�` �#E�x � ..• ��t?�'�r."�t�N ::'� '� �� .Yk 4.v'� Y'a 7� '� r- �� i _x5 ."a'2e`'1' Y �. E'�a�.t"a��.^.�i��,-., h sj,'+h�.� F t`'� }b`��pt i- ,�-M1��-.Xx...i��Cr �' 4 'i4 L '�.,�•�*iyt : �4'� ��'-l�r.�. x.. 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 from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. 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 pubiic'health and safety.and the enviroiimen0ecause' one or more of the following conditions exist The system is within 460 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. y 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 if the following have been done: t/ 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. VAs-built plans have been obtained and examined. Note if they are not available with N/A. =The facility or dwelling was inspected for signs of sewage back-up. ✓ The system.does not receive non-sanitary or industrial waste flow. The site was inspected for signs of breakout. All sy__n ooinponeats luding the Soil Absorption System,have been located on site The ieptic'taak mantioles were uncovered,opened,and tfi'intenor of the septic tank was in- _..>bpoctod for condition of-baffles or tees,material of construction,timensions,depth of liquid, depth of sludg depth of scum a �. 7i pi� ?*�777 �,t , . �F 1/The size and location of the Soil Absorption System on the.site has been determined based on earistmg information or approxiiiii "by non intnisive methods. k tea. a r ` 'r f, ,,,-h- 4 t Us.- ✓, Y {2i K 5 y ax''J`3f c. Ty �7```. rt,7 ; �-1 r y ai ,' 7, :, .>Hr; g.. s F SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST(continued) 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 Y Design Flow: gallons Number of Bedrooms: � Number of Current Residents: Garbage Grind - . .Laundry Connected To System: Seasonal Use: WaterMeterFReadinngs,Ziailable:, - Last Date of pan COIV MXRCI_AiIINDLiSTRLAi: _ 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 headings,If Available: Last Date of Occupancy: OTHER: Describe) /J(� Last Date of Occupancy: GENERAL INFORMATION PUMPING RECORDS and source of informa ion: � .Q A j ,wau 421 � System Pumped as part of inspection: If yes,volume pumped. gallons Reason forpamping:s TY F:,AYSTEM: 3 Septic,Tank/Distribudon Box/Soil Absorption System Single Cesspool Overtlow:C.eesspool to h Privy Shared�SSyys�t�e! (If yes,attach previous inspection records,if[any).,,_"Other ; ( _ lain). ak. vs APP OXIIYIAT& GE of all,components,date installed(if known)and'source of information: _ Sewage odocs`detidillwhen"arriving a� a site /tag- , .Y lY t' i"f }t§" 'R'2XT"�� y. ,y5. `Y 1 j t3"s ! aa'aaSY�`L n`y1'4 h�,,(� }� xil".'7 �'.sr e i .•`E', kE ' Y SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C GENERAL INFORNIATION (continued)I t� gwoe.c SEPTIC TANK:_ 3 Depth below grade: Material of Constriction: t/concrete metal FRP Other Dimisions:_/D•S'x& 'y Sludge Depth:- c-,2 _Scum Thiccness: / / Distance from top of sludge to bottom of outlet tee or baffle: 34 / Distance from bottom of scum to bottom of outlet tee or baffle: /Z Comments:(recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in lation t udet i vert, structural integrity,ev' ence of leakage, etc. ' / f GREASE TRAP: Depth Below Grade: Material of Constniction: concrete metal FRP Other (explain) `` ' — — —• — _ Dimensions: - Scum Thickness: Distance from top of scum-totop 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: Matenal of Constriction:__coitcrete_metal—FRP—Otlier(explain) Dimensions: Capacity: gallons Design Flow: gallons/day Alarm Level: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: t/ Depth of liquid level above outlet invert:1zz �a Comments: (note if�elanddistribufiort is equal evid a of solids carR,over, evidence of leakage into out of box,etc. PUMP CHAMBER.--AV---- Pump is in working order: Comments:(note condition of pump chamber,condition of pumps and appurtenances,tic.)r ^ _ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) 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: Commen : (note condition of soil,signs of hydraulic failure level of nding, nditio of v gelation, etc.) - i ,� i > CB'SSPOOIS-W)_ ; 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(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: Materials of construction: Dimensions: Depth of Solids: Comments:(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.) - -6- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) SKETCH OF SEWAGE DISPOSAL SYSTEM: Include ties to atleast two permanent references, landmarks or benchmarks. Locate all wells within 100 Feet. i 3 DEPTH TO GROUNDWATER: Depth to groundwater: S-f Feet Method of Determination or Approxi 'on: /sz /�Plyf/ 4 ' l9w c o u agar , 0 _7_ tc r ; N ASSESSORS , S MA • 110 , TEST HOLE . LOGS NOTES: ES.xEY.PARCEL: 1-19 q G CONTOUR:,EXISTING _ . , , V ; ............... N I EER. E ENGINEERING f. VERTICAL DATUM ASS FROM QUAD NGVD + ) CONTOUR: E G N DOYL N PROPOSED N W IAVAILABLE., C ATER SNOT.. CURRENT ZONING.: 2 MUNI APAL .` r -B� WITNESS. JERRY DUNNING , 04 ION _ EXISTING_ G SPOT ELEVATION; 25,5 - �+ . , EX T N v 4 USED SETBACKS: 3. SCHEDULE 40 PVC PIPE TO BE ED THROUGHOUT SEPTIC SYSTEM. $ BUILDING E 4 10 87 s a : 0 DATE.. ATI N. ELEV 25. : PROPOSED-SPOT . Q S W _ _ 80'_ S, R. `4. ALL PRECAST UNIT TO CONFORM WITH AASHTO H 10 & H 20 8j F r.1�' PERCOLATION RATE. < 2 MIN/IN r_ c � TEST HOLE. LOADING SPECIFICATIONS. 'UTILI TY POLE: -0- . PER OOT . r FLOOD ZONE.. C TH 1 TH 2 5. PIPE,PITCH F UNLESS NOTED OTHERWISE FENCE C LINE. 0 'a 8. FIRST 2' OF PIPE OUT OFD B X TO B E LAID D LEVEL: 5HYDRANT: aELE V TOP EL RV SEPTIC `SYSTEM HAS NOT BEEN DESIGNED TO ACCOMODATE THE s sUrlson snBsorL 7. THE EPTI N E _ Loco RETAINING WALL. USE OF A GARBAGE DISPOSAL. c .j. se s" 63 / s .o 8. ALL CONSTRUCTION DETAILS :ARE TO BE IN CONFORMANCE.WITH THE �i TITLE FIVE AND LOCAL ..STATE OF.MASS .ENVIRONMENTAL'CODE ( ) . '.�lAP �lEAIU�! MEDIUM-LOCATIONHEALTH`.REGULATIONS. r SAND SAND W WITH . t�'rr 9. CONTRACTOR TO VERIFY LOCATIONS OF ALL UTILITIES PRIOR ` LOT 39A - COL'BLE COBBLE 34,773 s F 0 CONSTRUCTION. AND AND T GRdVEL _ GRAVEL 10: PROPOSED ACCORDANCE D SEPTIC SYSTEMSYSTEMAND WELL LOCATIONS.ARE IN A CDRDANCE E WITH MASTER PLAN, ON FILE WITH THE BARNSTABLE HEALTH DEPT. - 738" 5.6 , 126' A2 06 1w So 49S S 11. DESIGN ENGINEER TO VERIFY SUITABLE SOIL CONDITIONS TO A DEPTH s a ? OF 4 BELOW LEACH"PIT AT TIME OF CONSTRUCTION. liro 1 S ,ENCOUNTERED . 1 t 1 sr NO GROUNDWATER 1 1 1 1 (SITE TOPOGRAPHY SHOWSNO S6•t t EXISTING WELL GROUNDWATER AT ELEV� 34 1 t 1 a ) \ t 1 j 6 , 1 l 6 1 1 � i 1 1 1 QO 1 - BENCHMARK ATSEPTIC SYSTEM DESIGN 1 ( t 1 CATCH BASIN ELEV as 805 DECK 1 1 50'i ► N . _� t J 1 i t t 1 J ids . i 1 t 1 o FLO ESTIMATE 1 i t 15 � , 1 PROPOSED \ LT+ G) PROP 1 1 i r $ _ r t IN - DROOM GAL DAY i i ) S .� BEDROOMS AT 11�L GAL/DAY/BE 550 / , � C UTILITY CLUSTER :. 24 t \ 11 e 5 BEDROOM i I 2 / 1 i 1a� DWELLING . 1 i � DiI t \ t i / SEPTIC TANK PROPOSED WELL CAR / (155'TO PROPOSED GAL AY * 1.5 DAYS — 825 GAL r / r LEACH PIT 36' / t . � i � USE 500 GALLON SEPTIC TANK ,r 1 r J t J PROPOSED DWELLING I J LEACHING AREA. 1 t \ S S 0 LEACH PITS 6 x 4 WITH 30' OF TONE , USE TW 1 �, r _ a a -••-� � '� 12 EFFECTIVE DIAMETER z 4 DEEP)'' LP ;. -To r Q. ,: 8 .. 6 _ � /_ . .SIDE AREA:.. 12 x PI x 4 ='151 SF ` 2.5 = 377 GAOL DAY i — : > � - - GAL _DAY DIV,. BOTTOM AREA: 6 x 6 x PI 1f3 SF (f O) . _ 113 /, / SI. _ _ . � . � N -_-- CAPACITY — 490 C�41. Il AY : / j qRp _. TOTAL / , 1 1 D .� � O � x 2 PITS — 980 GAL DAYCARA := E I i i i S a p STEM SECTION z PE'ASTONE - 5.,�'.�'TIC SYSTEM W RO POTS q 5 F J. a _ 6b _- Rao OF 314" 1/2aa — _ .DI► Y !•. J COVERS WITHIN 12" T f _ .F= o WASHED STONE � ,�— 7Q0 . y � 78.0 OF FINISHED GRADE _.1 . .. TOP OF FOUNDATION 6a / 1 ! / i I UTILITY Q � CLUSTER ; Q \68.43so60.83 a r Qr EDGE of PAQ� - 4 ELEV.E D BOX LEV. — r r � � 68.68 E LP 1. 47.5 / 1500 GAL r > _ r � LP 2. 43S / 7 SEPTIC TANK 6 : y r PROPOSED WELL _ 0 1 r ! LP 1. 51.5 f--s .-�ELEV. / fir, EL _ 3' 3' LP 2. 47.5 TEE SIZES: 1 > ELEV. UNDER �— a �...4 ,r t ( ELEV. 12 PROPERTY LINE INLET. 6� UP 10 DOWN r BASEMENT a TWO LEACH PI6 x 4 WITH (WORK LIMIT LINE) ET.,6" UP 19" DOWN � j FLOOR) OUTL 1'o BE STAKED F ) 3' OF STONE 12 EFF. DIAA[. x 4' DEEP X—20 - j 16 y � e BREACKOUT CALC. 52 46 46 x 150 — 20' sr 1g1 � �/� N a YT 5 BREACKOUT CALC. 48 38 S3 x 150 — 24 �5U 6 - � �/ LIS s 8x To 9 SLT.�' AND SEWAGE PLAN 00 000000 ` LOCATION. L . EDGE OF WETLAND . ......f �1 0 �Ar LOT "39A IR`ONSIDE DRIVE O r ti }- . f O ! ! - R' T 1. t � ... _000 WEST RARNST ABLE MA S PREPARED "FOR. 7 � r,r k,ir .e .� )'I'�s ,. . r .DM , tREEF .REALTY EDGE OF DITCH � � e -,f �.,a cLELLAX ENGINEERING,;. � r — � ' DEYAREST jt ;d � °�� ,1 SCALE. 1" 30' DATE 11 12 94 24 SCHOOL STREET P.O. BOX 463 REV: 11-28-94 wasT DENNIS,' tASSACHUsaTTs 02670 REFERENCE. P LAN BOOK. 421 PAGE. 57 i s ST:JR. P.L S. g ♦ a THOMAS McLELLAN,',P.E. JOHN:.Z. DEMARE REV, 4-12-95 REV. 3-20-95 DM � 94-039_39 _ f { i I r „1 _z I N 'i ASSESSORS MAP. 110 4 PARCEL. . 1-19 TEST -.MOLE LOGS NOTES: 1. VERTICAL _ y � ENGINEER. DOYLE ENGINEERING ICAL DATUM: FROM QUAD GVD +f ) J, 2. MUNICAPAL WATER I V o CURRENT ZONING: RF� WITNESS: JERKY DUNNING SNOT AVAILABLE. ' $ a• BUILDING SETBACKS: 9 DATE. 4-10-87 3. SCHEDULE 40 4" PVC PIPE TO BE USED THROUGHOUT_SEPTIC SYSTEM. F. 30' S. 15 R. 15, PERCOLATION RATE: < 2 MINI IN 4. ALL PRECAST UNITS TO CONFORM WITH AASHTO H-10 & H-20 LOADING SPECIFICATIONS. 0 FLOOD ZONE: C ` TH 1 TH-2 5. PIPE PITCH " PER FOOT(UNLESS NOTED OTHERWISE). 5 61.0 661 6. FIRST 2' OF PIPE OUT OF D-BOX TO BE LAID LEVEL. TOP fit' ELEV TOP ELEV Locus &c 7 1 V . SUBSOIL SUBSOIL THE SEPTIC SYSTEM HAS NOT BEEN DESIGNED TO ACCOIIODATE THE USE OF A GARBAGE DISPOSAL. 36" 58.0 se 1 8. ALL CONSTRUCTION DETAILS ARE TO BE IN CONFORMANCE WITH THE LOCATION MAP MEDIUM MEDIUMSTATE OF S. V MASS. ENVIRONMENTAL CODE:(TITLE FIVE) AND LOCAL SAND SAND HEALTH REGULATIONS. LOT 39A WITH WITH 9. CONTRACTOR TO VERIFY LOCATIONS OF ALL UTILITIES..PRIOR 34,773 SF COBBLES COBBLES AND AND TO CONSTRUCTION. GRAVEL GRAVEL 10. PROPO SED ED SEPTIC SYSTEM AND WELL LOCATIONS ARE IN ACCORDANCE WITH MASTER PLAN, ON FILE WITH THE BARNSTABLE HEALTH DEPT. 3 49.5 5.6 50 18" 126" 5 2 ,ro v I t s--- fl. DESIGN ENGINEER. TO VERIFY .SUITABLE SOIL.CONDITIONS TO A DEPTH 1 OF 4' BELOW LEACH PIT AT t 1 1 S� TIME OF.CONSTRUCTION. 1 l 1 1 1 5 NO GROUNDWATER ENCOUNTERED i ► t 1 1 6' EXISTING WELL � l S - 3y� 6b BENCHMARK AT SEPTIC SYSTEM DESIGN WALK 1 CATCH BASIN 1 t 1 t t t t 6'2 ELEV = 805 1 -I 1 v 1 1 �j N 58' DECK i t 5C To FLOW ESTIMATE: Wf 01 IN BEDROOMS AT G AGx UTILITY CLUSTER - - 110 AL/DAY/BEDROOM 330 GALjDAY PROPOSED s6' ` / ► i , t t 2,? 3 BEDROOM 1 1 cS` s DWELLING SEPTIC TANK: PROPOSED WELL GARAGE r 130 GAL jDAY * 1.5 DAYS = 495 GAL 26• / i i 1 -}�s',• USE 1000 ,GALLON SEPTIC TANK 3-f i -¢TH-z LEACHING AREA: PROPOSED DWELLING USE ONE LEACH PIT (6 x 49 WITH 3.0 OF STONE Ire r rTH4 co _(12' EFFECTIVE DIAMETER x 4' DEEP) O 2 A 1-6So SIDE AREA: 12xPI x4 = 151SF (2.5) = 377 GAL/DAY . BOTTOM AREA: 6 x 6 x PI = 113 SF (1.0) 113 ' GAL DAY r / ' s� Lp _ , TOTAL CAPACITY = 430ALjLAY 80 SEPTIC SYSTEM SECTION z" PEASTONE s0 ?5 X - _ - OF3j4„ - f 1 2" . D $D • ' - _ - COVERS WITHIN 12" s �pp5 1 o WASHED STONE Pg EDG / �'- DRIVE : 76.0 OF FINISHED GRADE /. - - - 3�s1,LI6Q - -� .� ` \ -. .. + TOP OF FOUNDATION TPA 80 � /:' . '••� � UTILITY. . i 5 CLUSTER 7\�' � � � GAS I � ..• � � s' .�._.—t / Q 62.75 0 0 _• EDGE OF PAVE o / ; •• ► 63.0 f000 ELEV. D-BOX CAL 62.52 ELEV. 10 PROPOSED)TELL SEPTIC TANK 62.69 ELEV 49.0 . +9 TEE SIZES. 53.0 UNDER ( ELEV. 3' ELEV. } . 6f BASEMENT INLET. 6' UP, 10 DOWN CJ / / ..—i+ OUTLET: 6" UP 19" DON ^, _ONE LEACH PIT (6' x 4')) WITH / 76. FLOOR) 3' OF STONE (12' EFF. DIAM. x 4' DEEP) (H-20 lip .• BREACKOUT CALC: 53.5 - 46 48 x 150 = 2,T .• g • e EDGE OF WETLAND SITE AND SEWAGE PLAN KEY: EXISTING CONTOUR. LOCATION. PROPOSED CONTOUR. EXISTING SPOT ELEVATION. 25.5 LOT 39A IRONS IDE DRIVE E PROPOSED SPOT ELEVATION:R 25 WEST BARN ST ABLE MA TEST HOLE: UTILITY POLE: -o- PREPAREDFOR. FEN CE LINE: DM . HYDRANT. 0 REEF REALTY RETAINING WALL. DEMAREST M LELLAN ENGINEERING SCALE. 1„ = 30' DATE: f1-12-94 24 SCHOOL STREET P.O. BOX 463 WEST DENNIS, MASSACHUSETTS 02670 REFERElb CE. PLAN BOOK. 421 PAGE. 57 94-039-40 S cLELLAN P.E. JOHN Z. DEMARES JR. .L.S. DM # N THOMA M � T . P i