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0280 JOE THOMPSON ROAD - Health
280 JOE THOMPSON RD. W. BARNSTBL A = i o . o TOWN OF BARNSTABLE LOCATION ;.80-..y e, 2 �JZ) &SEWAGE# ®� VILLAGE ASSESSOR'S MAP&PARCELl S� INSTALLER'S NAME&PHONE NO 3AAC 6,15 r 4r r " SEPTIC TANK CAPACITY /a--70 q Ale ie- LEACHING FACILITY.(type)vd 2� dW-f S (size)p;Z 5� X r 3 X NO.'OF BEDROOMS, OWNER PERMIT DATE: .. { ° COMPLIANCE DATE: Separation Distance etw n 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 �3 201 G,.00F��. ®oc�}- rr l' 31 ,�- TOWN OF BARNSTABLE LOCATION o masors SEWAGE# Q?O 10 - ya TILLAGE 0 '-- '' '- �jv"¢t1 g ~S� ESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /000 4a.I LEACHING FACILITY:(type) SOD 9a1 CkaM.S ti L) (size) 13 x 2S x A NO.OF BEDROOMS 3 OWNER mcum Qu1►+ i m' PERMIT DATE: fO -ZO -/O COMPLIANCE DATE: 10 -P/ - Q Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY ❑ � `1 d REAR fl��K r3 Al- a° ' A Bl - S3 AZ _ aG No. 023 Fee �✓" THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftphLation for 7( upgrade sai6pstrut Construction 3der it Application for a Permit to Construct( ) Repai ( ) Abandon( ) [:]Complete System ❑Individual Components Location Addr TZeiLo o« � 1 cm Owner's ddress an TPl No Assessor's Map/Parcel L-7!i —5 Installer's am ,Address,and V.No. Desig r s N me� dress Tel,I� � 4w6vp,jrf:gvb,ti Zi e Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.re ired) � gpd Design flow provided gpd Plan Date D � W� I Number of sheets Revision Date Title Size of Septic Tank rctb1 Type of S.A.S. (0 J Description of Soil Nature Repairs or Alterations(Answer whe7 applicable) w Date last inspected: Agreement: ' The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by thi of H Si e Date Application Approved by Date Application Disapproved by V Date for the following reasons Permit No. Cwl�(— qZ3 Date Issued �� No. _ Fee 1A � THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Ye �rt E,.-PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS pplication for. Disposal *pstem Construction Permit r' / Application for a Permit to Construct( ) Repair( grade( ) Abandon( ) ❑Complete System El Individual Components Location Address or Lot No. Owner's Name Address,and Tel.No. ��. ti 1 Assessor's Map/Parc�el� 1 Installer's Name,Address,and .No. Designer's Name,Address and Tel No,^ Type of Building: f Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.re ired) gpd Design flow provided gpd Plan Date "` Number of sheets Revision Date Title At � 1 Size of Septic Tank Type of S.A.S. Description of Soil 1 r r Nature f Repairs or Alterations(Answer whe applicable) r— Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by thi •oard of H It Signe Date —;�J e-"h I CA t Application Approved by j Date { Application Disapproved by Date for the following reasons Permit No. Z1�21 6J_ t -`j Date Issued ) jq/7.,ntg THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( Repaired( Upgraded( ) Abandoned( )by ►�( I has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construc ton Permit No. datedIII Installer LkI C- U on Designer � �� t•� � C'� #bedrooms Approved design flown gpd The issuance of this fermit shall not be construed as a guarantee that the system will ;notion as designed. Date Inspector / ✓II v n - -,f - No. DFee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair V� Upgrade( ) Abandon( ) System located at v -7 Z and as described in the a eve Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit Date 111412 n�Q Approved by - r Town of Barnstable .lung Regulatory Services Richard V. Scalt Interim Director anrmrsrnet.e. Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form .Date: Sewage Permit#��1� Assessor's Map\Parcel qq 1 g Designer: Installer.64/01 N%, Address: > i V Address: On was issued a permit to install a (d e) �(installer) ��� septic system at D r1Uiy (2114D based on a design drawn by (address) `Y�✓ ` �vL��ti"" dated IC71 (designer) V__�I certify that the septic system referenced above was installed substantially according 10 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. Flan revision or certified as-built by designer to follow. Strip out(if required)was inspected and the soils were found satisfactory. I ce that the system referenced above was construe Hance, with the terms of th IAA approval letters (if applicable) OF&gs� � DAVID NIASON m ( 'stallq/; gna e) ,� No.toss a ITA Affix Desi"'r s am (Designs s Signature ( � P Here), PLEASE RETURN TO BARNS LE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED. UNTIL BOTH TIT. FORM:`AND AS BUILT CARD ARE RECEIVED BY THE BA.RNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. QASeptic\Desiper Certification Form Rev 8-14-13.doc f �1HE Town of Barnstable Inspectional Services Department BARNbrABLE "`'' Public Health Division 4i'°rFo 1639. a`m 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A. McKcan,CHO CERTIFIED MAIL47015 1730 0001 4988 0916 September 30, 2019 PULIT, KAREN L & DANIEL J TRS 280 JOE THOMPSON ROAD WEST BARNSTABLE, MA 02668 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 280 Joe 'Thompson Road, West Barnstable, MA was inspected on 09/24/2019 by Patrick 1'. Sullivan, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. You are ordered to repair or replace the septic system within one (1) year from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. 6PERORDER OF TH- BOARD OF HEALTH cKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mail ing\Failed or Needs Further Evaluation Letters\280.loe Thompson Road West Barnstable.doc Town of Barnstable + BARNSCABLE, M"163 , � Inspectional Services Department Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 4/26/19 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An"x"marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ❑ Structurally unsound septic tank or SAS O 1 YEAR DEADLINE CRITERIA tatic liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑ Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2)YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any "conditionally passed systems" (broken cover, relocation of a pipe, relocation of a driveway due to H-10 components, etc) ❑ Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER Repair deadline: 0:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc c� Commonwealth of Massachusetts Title 5 Official Inspection Form co"' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments f; ,. 280 Joe Thompson Road Property Address Daniel Pulit Owner Owner's Name information is required for every west Barnstable MA 02668 September 24, 2019 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. Inspector Information filling out forms on the computer,use only the tab Patrick T. Sullivan key to move your Name of Inspector cursor-do not Ready Rooter Excavating use the return Company Name key. o Box 89 C � Company Address Forestdale MA 02644 CitylTown State Zip Code 508-509-0802 S112843 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 16.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ❑ Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ® Fails September 25, 2019 Inspectors 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 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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: 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. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal system-Page 1 of 18 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 280 Joe Thompson Road Property Address Daniel Pulit Owner Owner's.Name information is required for every West Barnstable MA 02668 September 24, 2019 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 ist. Any failure criteria not evaluated are indicated below. Comments: 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completi n of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determine " (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years Id*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration o exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replace with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass ins p ction if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the to k is less than 20 years old is available. ❑ Y ❑ N ND (Explain below): t5insp.doc-rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 L I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 280 Joe Thompson Road Property Address Daniel Pulit Owner Owner's Name information is required for every West Barnstable MA 02668 September 24, 2019 page. CityfTown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a roken, settled or uneven distribution box. System will pass inspection if(with approval of 8 of Health): ❑ broken pipe(s) are replaced/ ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed�j ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is le v led 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): i 1 3) Further Evaluation is Required by he Board of Health: ❑ Conditions exist which requir further evaluation by the Board of Health in order to determine if the system is failing to Prot t public health, safety or the environment. a. System will pass u ess Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the yytem is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments I . 280 Joe Thompson Road Property Address Daniel Pulit Owner Owner's Name information is West Barnstable MA 02668 September 24, 2019 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functio 'ng in a manner that protects the public health, safety and environment: ❑ The system has a septic tank d soil absorption system (SAS)and the SAS is within 100 feet of a surface water suppl or tributary to a surface water supply. ❑ The system has a septic to and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic nk and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a sep c tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private wat supply well". Method used to determ* a distance: This system passes i the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indic tes absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 pp , provided that no other failure criteria are triggered. A copy of the analysis must be attached to this orm. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ® El clogged of sewage into facility orste sym 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 or 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 280 Joe Thompson Road Property Address Daniel Pulit Owner Owner's Name information is West Barnstable MA 02668 September 24, 2019 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ® ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® 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 water supply 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 2000 gpd- 10,000 gpd. ® ❑ 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. t 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA/systis Yes No ❑ ❑ th 400 feet of a surface drinking water supply ❑ ❑ thn 200 feet of a tributary to a surface drinking water supply ❑ ❑ thed in a nitrogen sensitive area(Interim Wellhead Protection A mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 r Commonwealth of Massachusetts Title 5 Official Inspection Form ± Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 280 Joe Thompson Road Property Address Daniel Pulit Owner Owner's Name information is West Barnstable MA 02668 September 24, 2019 required for every page. City/town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes"to any question in Section C.5 the system is considered a significant threat, or answered"yes"to any question in Section C.4 above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: 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 El ® this inspection? ® El available as built plans of the system obtained and examined? (If they were not available note as NIA) ® ❑ 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)] t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 280 Joe Thompson Road Property Address Daniel Pulit Owner Owner's Name information is West Barnstable MA 02668 September 24 2019 required for every State Zip Code Date of Inspection page. City/Town D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 349 GPD Description: 5 Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No 2017= 161 GPD Water meter readings, if available(last 2 years usage (gpd)): 2018= 197 GPD Detail: Sump pump? ❑ Yes ® No Current Last date of occupancy: Date t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments p Y 280 Joe Thompson Road Property Address Daniel Pulit Owner Owners Name information is West Barnstable MA 02668 September 24, 2019 required for every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): i Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft, etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank pr sent? ❑ Yes ❑ No Non-sanitary waste discharg to the Title 5 system? ❑ Yes ❑ No Water meter readings, if av ilable: Last date of occupancy/ e: Date Other(describe below 3. Pumping Records: Ready Rooter records: Pumped 4/6/2018 Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26l2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 280 Joe Thompson Road Property Address Daniel Pulit Owner Owner's Name information is West Barnstable MA 02668 September 24, 2019 required for every page. CitYlTown State Zip Code Date of Inspection D. System Information (cont.) 4. 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 ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: Tank installed 1993. D-box and leach system installed 10/2/2010. Certificate of Compliance on file at Health Dept. Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): 28" Depth below grade: feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: n/afeet Comments (on condition of joints, venting, evidence of leakage, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts ie Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 280 Joe Thompson Road Property Address Daniel Pulit Owner Owner's Name information is West Barnstable MA 02668 September 24 2019 required for every State Zip Code Date of Inspection page. City(Town D. System Information (cont.) 6. Septic Tank(locate on site plan): 22" Depth below grade: 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 8 5'x 4.5' x 5' 1000 gallons Dimensions: 2„ Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 34" 2" Scum thickness 6" Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 13" Dip tube and tape measure 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.): Inlet and outlet tees in place. Liquid level at outlet invert. Outlet tee under top of tank. Risers bring covers within 6"of grade Recommend maintenance pumping every two years. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M � 280 Joe Thompson Road Property Address Daniel Pulit Owner Owner's Name information is West Barnstable MA 02668 September 24, 2019 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum top of outlet tee or baffle Distance from bottom of cum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: f ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 official Inspection Form.Subsurface Sewage Disposal System-Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 280 Joe Thompson Road Property Address Daniel Pulit Owner Owner's Name information is required for every West Barnstable MA 02668 September 24, 2019 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float itches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 6" 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.): One inlet, one outlet. D-box is 5.5' below grade. Liquid level at top of d-box at time of inspection. Staining shows level in d-box has been up ito riser. System is in hydraulic failure. Additional riser added to bring cover within 6"of grade. t5insp.doc-rev.7/26/201 S Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 280 Joe Thompson Road Property Address Daniel Pvlit Owner Owner's Name information is West Barnstable MA 02668 September 24, 2019 required for every State Zip Code Date of Inspection page. City/Town D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* J Comments (note condition of pump ch ber, condition of pumps and appurtenances, etc.): * If pumps or alarms 0/not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: 2-500 gal ea. w/ ® leaching chambers number: 4'stone ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 t5insp.doc-rev.712612018 Commonwealth of Massachusetts �- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 280 Joe Thompson Road Property Address Daniel Pulit Owner Owner's Name information is West Barnstable MA 02668 September 24, 2019 required for every State Zip Code Date of Inspection page. City/rown D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): SAS is 6' below grade. Camera used to enter outlet line from d-box to chamber. System is in hydraulic failure. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater in w ❑ Yes ❑ No Comments(note conditio of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 t5insp.doc-rev.7/26/2018 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 280 Joe Thompson Road ` Property Address Daniel Pulit Owner Owner's Name information is West Barnstable MA 02668 September 24, 2019 required for every page. Ci r own State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs f hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 280 Joe Thompson Road Property Address Daniel Pulit Owner Owner's Name information is West Barnstable MA 02668 September 24, 2019 required for every page. Eiji own State Zip Code Date of Inspection D. System Information (cont.) 14. 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 10 i � O ElTi- A 3 i C- a.6 ` `S\ � x 1 � 3 l t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 I Commonwealth of Massachusetts is Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 280 Joe Thompson Road Property Address Daniel Pulit Owner Owner's Name information is West Barnstable MA 02668 September 24, 2019 required for every page. Ci yrrown State Zip Code Date of Inspection Q. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells >5 Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 10/15/2010Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: i ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: maps massgis state ma us/oliver.ph You must describe how you established the high ground water elevation: Test hole in 2010 to 150" (elv= 124)found no ground water. Base of SAS at elv= 129 per engineered plans No high ground water in area of system Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc-rev.7l2812018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 280 Joe Thompson Road Property Address Daniel Pulit Owner Owner's Name information is West Barnstable MA 02668 September 24, 2019 required for every page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 No. � 1 { Fee (y®0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:J� PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Application for Mioogal *pgtem Cou5tructiou Permit Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑Complete System Mndividual Components Location Address or Lot No. �T �� Owner's Name,Address,and Tel.No. q Assessor's Map/Parcett Dal-LP01 � 14 5 / Installer' Name,Address,and Tel.No. esigner's Name,Address and Tel.No Of Joe-k(_7z-d&53 bW0 36k36 qkT YJ 0 Type of Building: Dwelling No.of Bedrooms Lot Size rp, �p sq. ft. Garbage Grinder ( ) Other Type of Building 1 No.of Persons Showers( ) Cafeteria( ) Other Fixtures �� p� Design Flow(min.required) �J..1 Q gpd Design flow provided `j Ll I gpd Plan Date �as{�16 Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. �,�lj� p�G.( �✓` Gkct��'�. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by t ' rd of Health. Signed / Date 10 1 a it Application Approved by �l� Q�1(� Date Lo —to Application Disapproved by: Date for the following reasons c�- f Permit No. �('�t� �. �. Date Issued l © DLO 10 , i No.aVI� "I =M' Fee (yo\ / THE COMMONWEALTH OF MASSACHUSETTS Entered in comppter: �/ i Yes �PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS-__ --- r 0(ppricotion for Mizpo al *pgtem Con.5tructton Permit Application for a Permit to Construct( ) Repair(<Upgrade( ) Abandon( ) ❑ Complete System EP Indwidual Components Location Address or Lot No. 20UJ(�(' TJ Y� GZ.. Owner's Name,,Address,and Tel.No. ,r' W. $off^) _DCLf-L Ull f( � � Assessor's Map/Parcel'-Aa JD �7 y �- 2 ,(-o Ue ` ) ,rXp U! t 'I Installer's Name,Address,and Tel.No. Designer's Name,Address and` Tel.No. �/ Type of Building: v ` welling No.of Bedrooms Lot Size sq.ft. Garbage Grinder ( ) Ir -- h 4 Other Type of Building No.of Persons Showers( ) Cafeteria( ) i� Other Fixtures `Design Flow(min.required) 3J 6 gpd Design flow provided ?j 9 1 gpd Plan Date _ 091 io Number of sheets Revision Date Title Size of Septic Tank �j Type of S.A.S. �,-�j(� �GL� CJV,,k ��✓� �1��`�J V Description of Soil li Nature of Repairs or Alterations(Answer when applicable),' I Date last inspected: Agreementr— The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by t -s-!�Prd of Health. Signed y�� �e i• Date iQ r( a [l o Application Approved by 1 r�-�(V�G� \�t Date 0 to Application Disapproved by: Date for the following reasons Permit No. _L4 -4 - Date Issued s U (D THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( ✓) Upgraded ( ) Abandoned( )by -t Q lU at R�U Joe-Th/)rnn5n:n 2 Q- n f n S-� been constructed in accordance with the pja*. ions of Title 5 and the for Disposal System Construction Permit No. -Polo - 4 dated U - /a. ` Installer (sbeRx 6 11-D y Designer _D C)w Q #bedrooms 3 Approved design flow( 33 gpd The issuance of this permit shall not be construed as a guarantee that the system will fungi io snde-sig ed. Date 1 D I a! J Inspector r 'W l l — _--__---------------- -- ------------------ No. ��. Fee ' THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS 1=igpo,qar �&p5tem Construction Permit Permission is hereby granted to Construct ( ) Repair ( �) Upgrade ( ) Abandon ( ) System located at 2 4�L �D� 1 1(�(r Chl�D U-3 W -_2r r n and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this permit. Date f 0 ' 0 C) Approved by Y\A�VNI� t Town of Barnstable P# )Department of Regulatory Services .� Public ��eaft�1fDA�'Asfl®Ilg ]Date HARNBT'AHI$ * . � x' 200 Main Street,Hyannis MA 02601 r61g. ApFri Date Scheduled_ U Time Fee Pd. Soil Suitability Asses,srizentfor Sewage iisposal Witnessed By: �% Ar /e I �erfonned By: iZ 0�1�1t O ��ic inn Pv a A" -INTGIMATION - Location Address taf Owner's Name W aA `J �1� / Address f Assessor's Map/Parcel: '/ /q /—Y/ Engineer's Name 0 NEW CONSTRUCTION REPAIR � Telephone It Land Use r"l(; Slopes(%) Surface Stones Distances from: Open Water Body'y IAI ft Possible Wet.Areafl Drinking Water Well N ft Drainage Way ft Property Line ft Oilier ft SKETCH: (Street name,dimensions of lot,exact locations of lest holes&perc tests,locate wetlands'in pro)[indty to holes) • �;-;,���� � �� �. 1, Parent material(geologic)_ Depth tU Bedrock, i Depth to Groundwater: Standing Water in 1-hole:. NL�� Weeping fPonl Pit Ree Ahr� Estimated Seasonal Hlgh Groundwater D]CTERAUNATION FOR SEASONAL 111011 WAFER TABLE Method Used: Depth Observed standing in obs.hole: I i/�w-[ i In, Depth to 5pll Itls�[ll.g : III, Depth to weeping from side of obs.hole: -__-- ill, C7rttuurJwnlzY dJuSlmettt a I't. Index Well II Reading Date: Index Well level_ Adj,faetdt' R Aar,Gromidwater UvO PERCOLATION BEST Dale to lrlulm /G4� Observation ✓ Holc#I Time at 9" Depth of Pcrc Time at 6" _ Start Pre-soak Time @ _ Time(9"-6") End Pre-soak Rate Min./Inch Site Suitability Assessment: Site Passrd_X Sile,Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Cotnpleted on Back------ll_ *"*It percolation test As to be conducted within 100' of Wetland,you must first notify flue, Barnstable Conservation Division at least one (1) week prior to (beginning. Q:\S 8PT1C\PER CFORM.DOC IDlERROBS]E)(Z VA'�IO ��®L' + L®G Depth from 1f�0➢e# P Soil Horizon Soil Texture Surface(in.) Soil Color. Soil• Other (USDA).. (Munsell) Mottlin g (Structure,Stones;Boulders, Con istency.%' ravel V DEEP OBSERVATION H®LV LOG Depth from Soil Horizon Soil Texture Hole Surface(in.) Soil Color Soil Other (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Z_ Consis ene %0 avel -------------- l7epth from Soil Horizon g'®G #' SirrFace(in.,) Soil Texture Soil Color (USDA) SD1t Other (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Or•,vel) r DEEP OBSERVATION HOLE LOG - Depth from Soil Horizon Soil Texture Hole#— Surface(in.) Soil Color Soil Other (USDA) ., (Munsell) Mottling (Structure,Stones;Boulders, Consistency,e/6 Orayel)--�_ Flood Insurance dilate Map: Above 500 year flood boundary No y Yes�n Within 500 year boundary No Yes ' Within 100yearfloodboundary No Yes Jf�epit➢n ®f l�tutea>ra➢➢y �ecaera�➢n Pervious Materia➢ Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system` „ 1f not, what is the depth of naturally occurring pervious material? Ceut>tfficatl�n . 1 certify that on (date)I have passed the soil evaluator examination approved by the Department of Environm ❑tal.Protection and that the above anaty.-is,was performed by me consistent with the required training,expertise and experience described in �10 CMR 15.017.. . 1 Signature _ o- / I-V Dat Q:1SFPTICIPERCPDRM.DOC down cape engineering, inc. SIEVE SOILS ANALYSIS 280 Joe Thompson TH1.xlsz DATE OF REPORT: 10-7-0-10 (sample 10-15-2010) JOB : GRAIN SIZE ANALYSIS-SIEVE TEST SITE: 280 Joe Thompson Rd, Centerville, MA LOCATION: dce TH1 SIEVE ANALYSIS Weight Sample(Grams): 204.2 SIZE :WEIGHT RETAINED % RETAINED % PASSED -------------- --(sum)-------------v-------------------- ------------------ 1" 0.0: 0.0%: 100.0 0 ------------- --- - ------ a---------------------y------------------ 3/4" --------------------- 0A--------------0 0%:---------100_0% 1/2"---------' -------------------- 6:6'•--------------0 0%'---------100_0% 3/8" 0.0; 0.0%: 100.0% •-------------r..........----.........-__v------------_--------r---__------------- #4 0.0: 0.0%: 100.0% '-------------•.......................-'----------_------------'--._.._.---------- #10 26.6: 13.0%: 87.0% -------------- -------------------------- ---------------------•------------------ #20 : 58.0 ___________-28 4%: 71.6% •-------------1--------------------------A- #40 123.1: 60.3%; 39.76i. #50 149.9: 73.4%: 26.6% --------------.------.---------------- -------------------------•------------- - -- #80 181.8; 89.0%: 11.0% --------------� ------------ a---------------------> - ----- --- #100 -------------------194 6A-------------95 3%�----------- 4=7% #100--------f #200- ----------- 201---- 98.6%;____________1_4% ------ --------------------- PAN: 204.2: 100.0%: 0.0% --------------------------------------.2--Y---------------------------------------- SAMPLE: 204 ; NOTE: TEST ON PASSING#4 ONLY, 1% RETAINED ON#4 <45% O.K. RESULTS: SOIL CLASSIFIED AS AASHTO A-3 (GRANULAR, COARSE SAND) (UNCOMPACTED) PERCENTAGE OF MATERIAL PASSING#4 SIEVE : #4 100% (TEST ONLY MATERIAL PASSING#4) OK #5010%-100% OK #100 0%-20% OK #200 0%-5% OK SAMPLE MEETS TITLE 5 FILL SPECIFICATION e . XSH OF MAs' ti 0 DANIELA. RESULTS: PERMEABLE MATERIAL-CLASS 1 <2 MINAN. MATERIAL o� OJALA NONCOMPACTED CIVIL SOIL'DESCRIPTION: MED SAND TRACE SILT, 0.74 GPD/SF MATERM �No.465020 �SS/O N A L Regulatory Services Thomas F. Seiler, Director B-ARNSTF BLE, �a -IT�n ff Health Division r�� 'Thomas McKean, Director 200 Main Street,Hyannis, TVLA,02601 Office: 508-862-4644 Fax: 508-740-6304 InnstaHer & DeMgEer Certification Form ��te �6 2.L Sew2�e Permitg 0�0��—' /oZ011 Assessor's I oip1]Parcei Designer. OW Q .h Inst2fler: Address: f /_�/ �-- Address: � l b f-✓ �-2 On was issued a permit to install a (date) (installer) septic system at id t M Jv►1 based on a design drawn by '1 (address) V/ /� dated (desi 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. 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. OF M.18c, DANIELA. �s (Installer's Si r ) o OJALA U CIVIL Cn No.46502 r �0 X, r'/STEO�a�� ASS/ONAL ECG esigner's Signature)( (Affix Designer's Stamp Isere) PLEASE RETURN 1O BA NSTABLE PUBLIC HEALTH RIVISION. CERTIFICATE OF COIeTx"UY04CE YdUL NOT BE; ISSUED U—NTEt, BOTH TIRS ECI A_ND AS-IBUILLT CARD ARE ]ftECEW EID BY THE IBARNSTABLE PUBLIC HEALTH H DMSION. THANK YOU. Q:Health/Septic/Designer Certification Form 3-26-04.doc Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form ,Inspection results must be submitted on this form. Inspection forms may not be altered in any way. A. General Information 00/ Important: When filling out 1. Property Information: forms on the computer, use 280 Joe Thompson Rd., W. Barnstable Ma. 02668 only the tab key Property Address to move your Richard C. Silvan cursor-do not use the return Owner's Name key. 280 Joe Thompson Rd. Owner's Address !Q W. Barnstable Ma. 02668 City/Town State Zip Code Date of Inspection: 6/12/2006Date 2. Inspector: Brian K. Tilton Name of Inspector The Building Inspector of Cape Cod Company Name - P.O. Box 307 <_ Company Address t Eastham Ma. 02642r• rn City/Town State Zip Code? � 508-255-9343 Telephone 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 eeds Further Eval tion b the Local Approving Authority 6/12/2006 6$]nsector'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. 280 Joe Thompson rd..doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 1 of 16 it Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments �M Subsurface Sewage Disposal System Form B. Certification (cont.) 280 Joe Thompson Rd. Property Address W. Barnstable Ma. 02668 City/Town State Zip Code Richard C. Silvan 6/12/2006 Owner's Name Date of Inspection 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: Inspection was done days after an unusual amount of rain had fallen system levels were ok and all components were in place and functioning normally. 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. ❑ 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: 280 Joe Thompson rd..doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 2 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments rG^M Subsurface Sewage Disposal System Form B. Certification (cont.) 280 Joe Thompson Rd. Property Address W. Barnstable Ma. 02668 City/Town State Zip Code Richard C. Silvan 6/12/2006 Owner's Name Date of Inspection 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 ❑ obstruction is removed ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: 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 280 Joe Thompson rd..doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 3 of 16 l Commonwealth of Massachusetts W Title 5 Official Inspection Form Not for Voluntary Assessments 41M SVe e Subsurface Sewage Disposal System Form B. Certification (cont.) 280 Joe Thompson Rd. Property Address W. Barnstable Ma. 02668 City/Town State Zip Code Richard C. Silvan 6/12/2006 Owner's Name Date of Inspection C) Further Evaluation is Required by the Board of Health (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 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: 280 Joe Thompson rd..doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 4 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments c,M Subsurface Sewage Disposal System Form B. Certification (cont.) 280 Joe Thompson Rd. Property Address W. Barnstable Ma. 02668 City/Town State ZipCode Richard C. Silvan 6/12/2006 Owner's Name Date of Inspection 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 ❑ ® 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 El ® than '/day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® 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. Yes No ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CM 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be ii necessary to correct the failure. 280 Joe Thompson rd..doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 5 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form B. Certification (cont.) 280 Joe Thompson Rd. Property Address W. Barnstable Ma. 02668 City/Town State Zip Code Richard C. Silvan 6/12/2006 Owner's Name Date of Inspection 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. i 280 Joe Thompson rd..doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 6 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments �M Subsurface Sewage Disposal System Form C. Checklist 280 Joe Thompson Rd. Prcperty Address W. Barnstable Ma. 02668 City/Town State Zip Code Richard C. Silvan 6/12/2006 Owner's Name Date of Inspection 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? ® ❑ 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)] i 280 Joe Thompson rd..doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 7 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information 280 Joe Thompson Rd. Property Address W. Barnstable Ma. 02668 City/Town State Zip Code Richard C. Silvan 6/12/2006 Owner's Name Date of Inspection Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 443 gpd Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): 03=115gd/ 04=99gd/05=181gd Sump pump? ❑ Yes ® No Last date of occupancy: CurrentDate Commercial/Industrial Flow Conditions: Type of Establishment: N/A 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: Last date of occupancy/use: Date Other(describe): 280 Joe Thompson rd..doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 8 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments iG M yya e Subsurface Sewage Disposal System Form D. System Information (cont.) 280 Joe Thompson Rd. Property Address W. Barnstable Ma. 02668 City/Town State Zip Code Richard C. Silvan 6/12/2006 Owner's Name Date of Inspection General Information Pumping Records: Source of information: Owner, Pumper Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: 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) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 5/1991 Were sewage odors detected when arriving at the site? ❑ Yes ® No 280 Joe Thompson rd..doc•03/2006 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 9 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments ;M Subsurface Sewage Disposal System Form D. System Information (cont.) 280 Joe Thompson Rd. Property Address W. Barnstable Ma. 02668 City/Town State Zip Code Richard C. Silvan 6/12/2006 Owner's Name Date of Inspection Building Sewer(locate on site plan): Depth below grade: 2 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: N/A Town water feet Comments (on condition of joints, venting, evidence of leakage, etc.): no evidence of leaks or clogging. Septic Tank (locate on site plan): Depth below grade: 18"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: N/Ayears Is age confirmed by a Certificate of Compliance? (attach a copy of ❑ Yes ❑ No certificate) -------------------------------------------------------------------------------------------------------------------------- Dimensions: 5'8"x9'6"x4'10" Sludge depth: 1/2" Distance from top of sludge to bottom of outlet tee or baffle 32 1/2" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 9 1/2" Distance from bottom of scum to bottom of outlet tee or baffle 15" How were dimensions determined? Dip stick, Baffle stick and tape measure. 280 Joe Thompson rd..doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 10 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cont.) 280 Joe Thompson Rd. Property Address W. Barnstable Ma. 02668 City/Town State Zip Code Richard C. Silvan 6/12/2006 Owner's Name Date of Inspection Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): inlet T, outlet baffle, levels ok no evidence of leaks tank looks good. Grease Trap (locate on site plan): Depth below grade: N/Afeet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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): 280 Joe Thompson rd..doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 11 of 16 Commonwealth of Massachusetts u Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M D. System Information (cont.) 28-0 Joe Thompson Rd. Property Address W. Barnstable Ma. 02668 City/Town State Zip Code Richard C. Silvan 6/12/2006 Owner's Name Date of Inspection Tight or Holding Tank(cont.) Dimensions: N/A 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.): N/A *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" 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.): Box is level and only one outlet to pit. no evidence of leaks or current solids carryover. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 280 Joe Thompson rd..doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 12 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments ;M Subsurface Sewage Disposal System Form D. System Information (cont.) 280 Joe Thompson Rd. Property Address W. Barnstable Ma. 02668 City/Town State Zip Code Richard C. Silvan 6/12/2006 Owner's Name Date of Inspection Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): N/A Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type ® leaching pits number: 1 6x6 pit withstone ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): note a 6'x6' pit was used instead of the 4'x6' pit in the design calculations. Pit was found with 48"of ponding, liquid level was 2' below inlet pipe. No evidence of solids carryover. Liquid level was over inlet at one time due to a faulty toilet flapper valve (see water usage in excess during 2005.) this was a one time incident and the system appears to be functioning normally now. 280 Joe Thompson rd..doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 13 of 16 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Forme M D. System Information (cont.) 280 Joe Thompson Rd. Property Address W. Barnstable Ma. 02668 City/Town State Zip Code Richard. C. Silvan 6/12/2006 Owner's Name Date of Inspection 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 ® No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: N/A Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 280 Joe Thompson rd..doc•03/2006 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 14 of 16 f Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments r Subsurface Sewage Disposal System Form Y yr..e D. System Information (cone.) 280 Joe Thompson Rd. _ Property Address W. Barnstable Ma. 02668 City/Town State Zip Code Richard C. Silvan 6/12/2006 Owner's Name Date of Inspection Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. T OPEN SPACE A ! o I ®'S 150 � � �, � 3 58 ' r Gp,RNGE `q 43l 2 5T{7R`( P p,V ED ' -61- 56+--To C.►. MORE�\ i WAY -NOT TO SCALE �I 280 Joe Thompson rd..doc•0312006 Title 5 Official lnspecbon Form:Subsurface Sewage Disposal System Page 15 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form 1,1r lBBy`0 D. System Information (cont.) 280 Joe Thompson Rd. Property Address W. Barnstable Ma. 02668 City/Town State Zip Code Richard C. Silvan 6/12/2006 Owner's Name Date of Inspection Site Exam: Slope Surface water Check cellar Shallow wells NO"— (C Estimated depth to ground water: 15� 'I" 06- 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: 5/8/1991 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: design plans on file with Board of Health, observed drywell within 50 feet of SAS I I 280 Joe Thompson rd..doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 16 of 16 THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I A- -1 L- DATA Mr 1 . Ci rr yr.' vra cF.iC'�,.. '� r7•t7"��. �'r•-.r.J '. 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't�,''""�.•S�'1� -c a„ ; h3 ' i' a•. r•Q�'y+[�b�"y�'+ �"�5"2 .31 1�. ,•.0 iYf Jkyy�,��4y�,t6N'.,.a , {''�X•• ♦ f1q;b r'F.Way 4� I ti _ L' �`'_•: ia•. Vie. i r � 8s` .'''s"`' ki f 5{ x ,q a`� .�i .r`Y � u�.' 'V' �•u„l��u 1 u . i 2 r y * p, - f• aRa A � �. yy�p[ vp 3 < '�a3y0. .'pf � fib` '�3_ � _ _ .. • -el + r M { W F ay 44 MIN My MCA 1. §Fa�A�.�r �•x. ,�d to � - { .. .�� : n f y ( 4 k�f�� � t n y�:( •�R +,-.,sx't p� g t•y�° <t��+"4" i 9 w � ay h �/''��` + p ,� N <Fa•i i .6 � 4dt�1�� gF � "" { . R x. 1, V t. • Permit Number: Date: Completed by: !/a►1 �C'> .r�4 HIGH GROUND-WATER LEVEL CC'l!/IPUTATION Site Location: ?ra �J&e s� a tjtien pat• Y-�jRr�tS b� Lot No. �y Owner: �le-64 J)A(2r1 Address. ZOO jy�t- 7-1mop"ptwt lea_•__._ Contractor:?-At l��%�eli%w �it4P y Coal Address: 8140• 49Ox 3oj Egs-11-40Ay &gL, eT��� .STEP 7 Measure depth to water table tonearest I/!Oft. .............................................................................. .bate -(-- monthjday/year 4 i STEP 2 Using Water-Level Range Zone k and index Wei W1ap locate site and determine: �j—D W I UAppropriate index well.................................................... 2 , Water-level range zone ..••................................................. ! STEP 3 using monthly report"Current Water Resources Conditions" determine current depth to water level for index well ........................... mon.trfpe�r [ � 1 i S T EP 4 Using Table of Water-level Adjustments for index well (STEP 2A), current depth to water level for index well ;c rl g 3), i—} and water-level zone (STEP 213) t t 1 ... • determineLV2ter-level adjustment ............................................................................... ........ 1 STEP 5 Estimate depth to high water by subtracting the,Plater- level adjustment (STEP 4) from measured depth to uvater levelat site (STEP 1) ........................................................................__._................................. i=igLtre 13.--Peproducible usmputatlor form. Cape Cod Commission: USGS Well Data-May 2006 Page I of 2 United States Geological Survey Observation Wells As a service to Cape officials, engineers and other interested parties, the Cape Cod Commission publishes monthly groundwater data gathered by its Water Resources Office. The water level measurements shown below are taken monthly from United States Geological Survey (USGS) observation wells and compiled during the last week of each month. They are published as soon as possible thereafter. Listed below are nine out of the 61 wells measured across Cape Cod by the Commission's Water Resources Office. These nine are employed as index wells to be used with Technical Bulletin 92-001 to predict high groundwater levels. For your convenience,we've also provided links to USGS national and state data. See the last column in the table and the footnotes below. To see what's happening in real time at a separate well in Brewster,visit the USGS site: USGS 41.463007001.4901 MA- BMW.22.BREWSTER,_MA. For further information about any of the data or links on this,page,please contact Hy_dro:logist Gabrielle Belfit at the Commission offices (508-362-3828). May 2006 Water Record Record Departure from USGS Site Number**** Location Well No. * Average** (links to f.I�SGS national Level* High* Low Monthly Overall water-level.database) Barnstable 23a 22.5 20.5 26.6 0.2 1.1 413956070.1643.01 . Barnstable 24W 22.4 20.5 28.6 1.3 2.1 4141.54070165001 Brewster BMW 2.1 1.5 2.0 414518070020301 II Chatham CGWL38 23.1 20.9 26,6 0.0 0.8 414100070011101 Mashpee 1MIW 29 7.5 5.6 10.0 0.0 0.9 �413525070291904 Sandwich ZI52 46.7 45.8 48.2 0.2 0.6 4144. 8070241601 'i Sandwich �DW 48.1 45.8 55.1 1.4 2.0 414124070265901 Truro TSW 89 11.3 10.2 13.0 0.4 0.7 420206070045901 Wellfleet WNW 17 10.2 7.3 12.8 -0.5 0.2 . 4.1.5353069585401j inm * Measurements are in feet below land surface. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 280 Joe Thompson Road, W. Barnstable Address of Owner: ` ! ,9 Date of Inspection: May 9, 1996 (if different) •79 "` Name of Inspector: Daniel A. Moniz S 9('` d Company Name, Address and Telephone Number: Danson Surveying 8 Engineering, Inc. �4 201 Middle Street, New Bedford, MA 02740 (508) 994-6989 ' CERTIFICATION STATEMENT y __ 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 inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: X Passes _ Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails 1 Inspector's Signature: Date: May 13, 1996 The System Inspector shall submit a copy of this ioces report to the Approving Authority within thirty (30) days of completing this inspection. If the system is a shm or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to thate regional office of the Department of Environmental Protection. The original should be sent to the system owner anent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Check A,B,C, or D A) SYSTEM PASSES: X I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B) SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair, passes inspection. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If "not determined", explain why not. The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (re.yised 8/15/95) 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 280 Joe Thompson Road, W. Barnstable Owner: James Sauers Date of Inspection: May 9, 1996 B) SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if (with approval of the Board of Health): broken pipe(s) are 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 whch require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS 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 within 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 that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. D) SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. (revised 8/15/95) 2 L SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 280 Joe Thompson Road, W. Barnstable Owner: James Sauers Date of Inspection: May 9, 1996 D) SYSTEM FAILS (continued) 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 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _ 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 large systems in addition to the criteria above: The design flow of system is 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: I 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 (WPA) or a mapped Zone II of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 8/15/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 280 Joe Thompson Road, W. Barnstable Owner: James Sauers Date of Inspection: May 9, 1996 Check if the following have been done: X Pumping information was requested of the owner, occupant, and Board of Health. X None of the system components have been pumped for at least 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. X As built plans have been obtained and examined. Note if they are not available with N/A. X The facility or dwelling was inspected for signs of sewage back-up. X The system does not receive non-sanitary or industrial waste flow. X The site was inspected for signs of breakout. X ALL system components, excluding the Soil Absorption System, have been located on the site. X The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. X The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. X The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub-Surface Disposal System. (revised 8/15/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 280 Joe Thompson Road, W. Barnstable Owner: James Sauers Date of Inspection: May 9, 1996 FLOW CONDITIONS RESIDENTIAL: Design flow: 1,000 gallons Number of bedrooms: 3 Number of current residents: 3 Garbage grinder (yes or no): Y Laundry connected to system (yes or no): Y Seasonal use (yes or no): N Water meter readings, if available: Last date of occupancy: Current COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow: gallons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings, if available: Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: Barnstable Board of Health System pumped as part of inspection: (yes or no) N If yes, volume pumped: gallons Reason for pumping: TYPE OF SYSTEM X 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) Other (explain) APPROXIMATE AGE of all components, date installed (if known) and source of information: 1993 Sewage odors detected when arriving at the site: (yes or no) N (revised 8/15/95) 5 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 280 Joe Thompson Road, W. Barnstable Owner: James Sauers Date of Inspection: May 9, 1996 SEPTIC TANK: X (locate on site plan) Depth below grade: 18" Material of construction: X concrete _metal _FRP _other (explain) Dimensions: 4.5" x 8" x 641, deep Sludge depth: 1/2" Distance from top of sludge to bottom of outlet tee or baffle: 32.51, Scum thickness: 3" Distance from top of scum to top of outlet tee or baffle: 8" Distance from bottom of scum to bottom of outlet tee or baffle: 1311 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.) Septic Tank in excellent condition. GREASE TRAP:— (Locate on site plan) Depth below grade: Material of construction: _concrete _metal FRP _other (explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom 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.) (revised 8/15/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 280 Joe Thompson Road, W. Barnstable Owner: James Sauers Date of Inspection: May 9, 1996 TIGHT OR HOLDING TANK:_ (locate on site plan) Depth below grade: Material of construction: _concrete _metal _FRP _other (explain) Dimensions• Capacity: gallons Design flow• gallons/day Alarm level• Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: X (locate on site plan) Depth of liquid level above outlet invert: 0" Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) Distribution box shows no evidence of solids carryover. PUMP CHAMBER:— (Locate on site plan) Pumps in working order: (yes or no) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 8/15/95) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 280 Joe Thompson Road, W. Barnstable Owner: James Sauers Date of Inspection: May 9, 1996 SOIL ABSORPTION SYSTEM (SAS): X (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: 1 - 6" Diameter Leaching chambers, number: Leaching galleries, number: Leaching trenches, number, length: leaching fields, number, dimensions: overflow cesspool, number: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) Leach pit in excellent shape. No standing water inside leaching pit. CESSPOOLS:— (Locate on site plan) Number and configuration Depth-top of Liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: inflow (cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY-- (Locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (revised 8/15/95) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 280 Joe Thompson Road, W. Barnstable Owner: James Sauers Date of Inspection: May 9, 1996 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks Locate all wells within 100' O 1000 gal S. Tank 20 5 0� zo I J0 Dist. Box S t Leach Pit i 160 I S� DEPTH TO GROUNDWATER Depth to groundwater: 10.0' feet method of determination of approximation: Original design plan. No evidence of high water table from visual inspection of Leaching pit. (re.viF.ed 8/15/95) 9 t,. ZBrj TOWN OF BARNSTABLE LOCATiol+ Lam}' ts] floe Q SEWAGE # . VILLAGE 1Ae • ��iin5 ��Lf ASSESSOR'Sy MAP & LOT INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) ���^ � (size)t 000 'i NO. OF BEDROdMS` _PRIVATE WELL OR-PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COUPLIANCE ISSUED: ...VARIANCE GRANTED: Yes No R L ZB0 TOWN OF BARNSTABLE LOCATION Lcr� f5> joy. w� 10'A P a . SEWAGE # 9 C- (7`1 VIL'LAGEF , Vli . Q7�CInS�� P ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY It000 JIUOa4.3 LEACHING FACILITY:(type) L-Okc k q (size)) 000 ei A Itevs NO. OF BEDROOMS_ 3 PRIVATE WELL OR PUS BLIC WATER BUILDER OR OWNER (a 771 DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No t .F• (�IVA �9 3d TOWN OF BARNSTABLE 17 y OD ! OJ77 el LOCH "TON 280 J� —FADM PSCA oL . SEWAGE # b� Y????LAGE (�• 1�o►r n 5�a 6 ASSESSOR'S MAP & LOT -T6gPd40,r5 NAME&PHONE NO. �r►aK K•1 lion So8-ZSS-93'f3 SEPTIC TANK CAPACITY tl 000 LEACHING FACILITY: (type) (size) tJ oot� NO.OF BEDROOMS 3 SUMDBR OR OWNER Yan PERMITDATE: COMPLIANCE DATE: (.112I�o` Separation Distance Between the: f Maximum Adjusted Groundwater Table and Bottom of Leaching Facility 4 -:5 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) �''t�� Feet Furnished by ''t Oui 1 6 --rh c KY Capp C.J w $ 6741 A'a3 . 3o� 4 83 : W 3 0 5 S4 = 43/ {QQd Z : DEC S �` ,. r R lAwE :I - 1 � 1 00l . �,�l r7 I1 No................ s-� Z � f�J� FEs...../ ....... THE COMMONWEALTH OF MASSACHUSETTS �-�� BOARD OF HEALTH ......... .....oF....... (zts ��1 . -----.----------------:-....... Appliratiun for Dispasal Warkii Tonstrurtiun ramit Application is hereby made for a Permit to Construct (J) or Repair ( ) an Individual Sewage Disposal System at_....._.... JCE_-..146�P�p!q // �..... 20 ................_...._._..... ._....ocatiott-Address .... �t I.'. {(.114.�C1!. .................... e Address a ................................. J.: .......... ....._ _� . ....... kv.VA.5--------......-----............. . Installer dress (f� r_ Type of Building Size Lot...t!vI.Aq...Sq. feet .-� Dwelling—No. of Bedrooms-------��?............................Expansion Attic ( ) Garbage Grinder ( ) `4 Other—T e of Building a YP g ---------------••-•--------- No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ..................................... .................................................... W Design Flow.............�..��t..... gallons per Rmpan eil daffy. Total daily flow......... WSeptic Tank—Liquid capacity ..gallons Length._.. ...�.. Width:.+.((_... Diameter................ Depth.__ .. x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area.___....____... ...sq. ft. 1 3 Seepage Pit No........]............ Diameter....._. >-:...: Depth below inlet._ ... .... Total leaching area.2 ._.sq. ft'. z Other Distribution box X) Dosing ank Percolation Test Results., Performed by._...... .....V_4. Ti1�� .`........... ................... Date....W..�:Z..,..�7 _...... a rJ Test Pit No. 1.. `. .... minutes per inch Depth of Test Pit._.:.-LQ__�_. Depth to ground water.. ._. . f4 Test Pit No. 2.. .minutes per inch Depth of Test Pit.....L.(Q.�)_.... Depth to ground water.. ._. 0- ..E. 9 •� ------•... ---- .... O Description of Soil.................... L..........._ W V ....... ..------- .......... .... ...................... .------------------------- -....... --- ...._..._..---•--- ------ ------------------------ -......... ... --------------- -- •-- •••...... ........... .. VNature 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 LITLZZ 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Com nce has been ' sued by the board of health. Signed.....' --••------------------ ........ .. ..... Application Approved B / PP PP Y ----_---• .... .. .�f...... Application Disapproved for the following reasons---------------•--.....................--------------•-----.....------------------•-----•--................... ......--^^--•-••-•.........................�-•.....----•---•...............-----...........-••......._..............._...--•--•----.._..............----.._........_..........-•Date.................. PermitNo...i_ ..-----/Z:..1............................. Issued....................................................... Date o -No--- /_ _ , r r Z / `�FEs f � THE COMMONWEALTH OF MASSACHUSETTS o s t q7,3 BOARD OF HEALTH rr i, "oF......` 2...............-.-...-.�. ....-_..--....---....... Appliratiun for Diiipuual Works Tonutrurtiun rrrmit _Ak' ication;is he er byjmade�for a Permit to Construct (�) or Repair ( ) an Individual Sewage Disposal �," System at: I S �- �` PSO i�I 1 C��.P ................»_....»_ .........-• .............................. .........----........---...--•----•--.........-------•-•-••--•....._:_.......................... ! Location-A�ddress� / ! , ...f j ".f� ICD�Mi�t I lf�.d ��..DI_�( �QCp� C. '11 yc A t »I ,n e� 1 _ A�fddress ........._.-...... » ....... .. »t_.. r Ale- Installer Address r qq Type of Building ...� Size Lot... _..;._..Sq. feet . Dwelling—No. of Bedrooms...........Z............................Expansion Attic ( ) Garbage Grinder ( ) a Other--Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q Other fixtures ------------------- .. r die:r --.....- Desi Flow.............,._. n.......:..........gallons per, er on a day. Total daily flow............�_4'..._Q)............ lops. W >m g P P _ _ . p tsy Y C. ]Ions Length _... . Width__lwib. ................ th._ .._ DiameterDe `.�. r.. W Septic Tank—Liquid capacity�����._ga gt __ �_ p x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area.............._.....sq. ft. 3 Seepage Pit No........I............ Diameter......E>n..... Depth below inlet..:-: ..... Total leaching area . ...sq. ft. z Other Distribution box ( ) Dosing tank Percolation Test Rests Performed by..._ v...) ...� ......_...,t................... Date._. ..! -(� af Y................ a Test Pit No. l....:. ........minutes per inch Depth of Test Pit .. ..._... Depth to ground water.C�...�. ::.�_T"_ rX4 Test Pit No. 2..�2--'..minutes per inch Depth of Test Pit..... .. Depth to ground water.. . .C.. O -------------••-•--•-...--------••--•-•--.......-------•-•-----------•-•----.......------•--•--•-•--------•-•••.........•-••....-- Description of Soil............ a ' k.............•----.................-•-•--------. V -------------- •--------- •--------------- --------------------------------- --------------------------------------- ----------- --------------------- ------ •---••--- UW -•-•---•--••----------------•------•. --•-----•-•-----•--•---•---•--•••••----------•••-•...-----•----....•••--••-•--••--•--•--=•---•----••----••-•-----------•....------•................---...••...... 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 TITL 2: 5 of the State Sanitary Code— The undersigned further agrees not to place the system in, operation until a Certificate of Compliance has been issued by the board of health. Signed....CJ/ ._% ?,r!�..... t- ...... /__ ....../ _ ate Application Approved BY - .�.................................................. .......... U� ! f...._.... Date Application Disapproved for the following reasons:...................................•-------•-----•-•----------•---------------•--•-----•------............. .. s .................................................----•----•--.................-•---••---••--•--------......-----------•---------------•--------•--•--••••••---•-------•----•--••-----Date.............- PermitNo.... 1....... .:T........................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �DctJft/ OF....... J..,l..� �F ......... ..................I...................... _, ..................... CIrrtif iratr of Tautplitturr ` 4 THIS I,'�'0 .CERTIFY, That the Individual Sewage Disposal System constructed ( or Repaired ( ) by....................... !t�`�r J..... ........ ..................... •.... .......... / / 'p Insta'uer at........ ...... 1'? ......--•-----•----•----.......----•-•-----................---......--•-•-••............... has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No----W, .-/2.4............... dated__..- ................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTI, N SATISFACTORY. ,.,, rDATE...................... a .......................... Inspector ...................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..................Ow..... ...oF.....-..- ! ' N0... /..1.. .7.... FEE........................ _ Rapauttl Warks Tunutrttrtiutt f rrmit Permissionis hereby granted................................................................................................................................................ to Construct (✓} or Repair ( an Individual Sewage Disposal System D at No../ .1.- _ ..:. la .. ...--fig►�;a�`- ��:....we. _ Street as shown on the application for Disposal Works Construction Permit No. —---- Dated..�5. _:�V..................... C� / Board of fie !4 DATE..�!.._.....[ ---!♦- . ALL SYSTE SHALL SYSTEM PROFILE MARKED WITHCMAGNETICTTAPE ORBE NOTES PROVIDE WATERTIGHT MIN. 20" DIAM. (NOT TO SCALE) COMPARABLE MEANS FOR FUTURE LOCATION. ASSUMED 1. DATUM IS �h ACCESS COVERS TO WITHIN 6" OF,FIN. GRADE 2" PEASTONE OR GEOTEXTILE CONCRa- E COVERS TO WITHIN 3" GRADE vi�h S 2. MUNICIPAL WATER IS EXISTING TOP FOUND. EL. 139.4' FILTER FABRIC OVER STONE \ 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. MINIMUM .75' OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM 137' - 138' 4. DESIGN LOADING FOR ALL PROPOSED PRECAST ' BLOCKS OR UNITS TO BE AASHO H-22 1 37.1 4' 4"0SCH40 PVC MORTAR ALL HRICOAST RISERS P 6 PIPES LEVEL 1ST 2' 4' CO,,4PONENT(TYPS) INv' 1 1. 4' 5. PIPE JOINTS TO BE MADE WATERTIGHT. SIDES " �ENDSo�o EL. 132 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE 10" EXISTING 14 °°°°°°°° ° ,_ .. °°°°°°°° WITH 310 CMR 15.000 (TITLE V.) f TEE SEPTIC TANK** TEE ���� O 0��°� 0��0 ���� °o Q an 35.7f* ° ° ° ° ° ° ° ° 6 6" MIN. SUMP ° ° ° ° o � o � c � 000co ooc � � o � 000 ° ° ° ° e e o o 0 0 0 o�a�oE1aoo o �aoo��o�000 0 0 0 o a n rn f O > ° ° ° o ° ° ° ° ° ° ° ° ° o�aa00000 0 ooaa0000000 00000000 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND ay ddl GAS BAFFLE ::` °°�°o°o°oo°° 12" MIN. INT. DIM. N i000o°o°o D���f�00��C9O �001���0�000 ;°°°°°°,°°,°° ° °°°°°°°° °°°°°°°° NOT TO BE USED FOR LOT LINE STAKING OR ANY �0 5 Locus 131.27 31.10 °°°°°°°° °°°°°°°° 129' OTHER PURPOSE. 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. LH-20 500-GAL. LEACHING CHAMBER BY ACME PRECAST OR EQUAL. I o 3/4"-1-1/2" DOUBLE WASHED STONE X' MIN. (2) UNITS REQUIRED 9. COMPONENTS NOT TO BE BACKFILLED OR i ALL AROUND PRECAST STRUCTURES ti CONCEALED WITHOUT INSPECTION BY BOARD OF z o 6" CRUSHED STONE OR MECHANICAL OVERALL DIMENSIONS TO OUTSIDE OF STONE: 25' X 12.83' HEALTH AND PERMISSION OBTAINED FROM BOARD `� c; COMPACTION. (15.221 [2]) C� OF HEALTH. ( 5 % SLOPE) ( 1 % SLOPE) 10. CONTRACTOR SHALL BE RESPONSIBLE FOR CALLINGFOUNDATION EXIST. SEPTIC TANK FACILITY 1 88' D' BOX 12' LEACHING VERIFYING IGSAFE THE LOCATION OF ALL233 UND UNDERGROUND & *THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL **INSTALLER SHALL CONFIRM MINIMUM SEPTIC TANK SIZE AT NOO G OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF G BOTTOM TH-1 GROUNDWATER FOUND WORK. LOCUS MAP UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS 1000 GALLONS AND ITS SUITABILITY FOR RE-USE. REPLACE PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM WITH 1500 GALLON H-10 SEPTIC TANK IF NOT SUITABLE 11. ANY UNSUITABLE MATERIAL ENCOUNTERED NOT TO SCALE SHALL BE REMOVED 5' BENEATH AND AROUND THE PROPOSED LEACHING FACILITY. ASSESSORS MAP 174 PARCEL 1-59 12. EXISTING LEACHING FACILITY SHALL BE PUMPED VARIANCES FOR SEPTIC SYSTEM REPAIRS WHICH MAY BE BENCH MARK - HYDRANT ON AND REMOVED OR PUMPED AND FILLED WITH CLEAN LEGEND IMMEDIATELY GRANTED BY THE BOARD OF HEALTH AGENT OR TAG#1597 ELEV. = 135.8 SAND. BY HEALTH INSPECTOR 99 - EXISTING CONTOUR �1 33.61 PAPERWORK AND HEARING REDUCTION PROPOSALS APPROVED X 99.1 EXIST. SPOT ELEV. BY THE BOARD OF HEALTH REVISED DURING A PUBLIC �� PROP. VENT WITH CHARCOAL FILTER 99 xO33 6 AND BUGSCRE (FINAL PLACEMENT BY PROPOSED CONTOUR HEARING HELD ON AUG. 4, 2009 Y CONTRACTOR WITH HOMEOWNER CONSULTATION) SYSTEM DESIGN" � 198 4 3) FAILED SYSTEMS ONLY : SOIL ABSORPTION SYSTEM ] PROPOSED SPOT EL. '3 c k\34.23 GARBAGE DISPOSER IS NOT ALLOWED INSTALLATIONS PROPOSED MORE THAN THREE FEET BELOW 'ps TH1 CAUTION: GASLINE GRADE NTH PROPER VENTING (PIPED TO THE ATMOSPHERE) PROPOSED WORK IN AREA OF p, 7 \ TEST HOLE AND WITH H-20 LOADING, BUT IN NO CASE SHALL THE SAS '�6 3� \ DESIGN FLOW: 3 BEDROOMS ® 110 GPD = 330 GPD YY BE LOCATED MORE THAN SIX FEET BELOW GRADE. 2> SLOPE OF GROUND � �09 c� 35.41\\ USE A 330 GPD DESIGN FLOW -- �� � UTILITY POLE ` - -Tf+ 73 35_s `' 135.07� O SEPTIC TANK: 330 GPD (2) 660 FIRE HYDRANT 2 Ix136.32 - Tlfl **RE-USE EXISTING SEPTIC TANK NOTE: NOT ALL SYMBOLS MAY APPEAR IN DRAWING I 13g G ?36.9�TH 1 ( \135.69 LEACHING: 138.15 `L G/ \ 1 �19 _7 36.41 \ O SIDES: 2 (25 + 12.83) 2 (.74) = 112 GPD TEST HOLE LOGS .16 1 t, 1gy�a 13 .64 o\\ \136.25 3 BOTTOM 25 x 12.83 (.74) = 237 GPD ARNE H. OJALA PE, SE 14006 r�Fa o \ y TOTAL: 472 S.F. 349 GPD . ENGINEER: �.o WITNESS: DAVID W. STANTON, IRS1 8.30 ! J ��'�y ��s w '�� \113'' 08 Z USE (2) 500 GAL. H-20 LEACHING CHAMBERS (ACME OR EQ L) DATE: 10/15/10 141. 1 39 4o W 137.1 WITH 4' STONE ALL AROUND PERC. RATE _ < 2 MIN/INCH 38.s1 EXISTING 1 7g 0 HOUSE #280 137.52 oc� 102 138.68 8.56 PAVED 137.88 137.95 I 13090 TOP FNDN. A3 -bECK = 139.4 T DRIVE 138.14 138 CLASS SOILS p# O 1 8.4 I 13 'AA 1 1.7 37.14 ELEV., ELEV., SAS 142. �Q� O 138.86 70 T 138.38 V 138.30 I O„ 4 136.5 137 7 6 x x 38.8E �138.71 7 R8 142. 9 / 1�8.81 138.8\ 138.29 �° I �Q x 1 8.86 38.62 1 MA „ FILL UNSUIT. FILL UNSUIT. � '�9 �QQ3 � � 139.50 24 12 s° 146.33 /RS , 43 � 13872 x 138.70 \138.73 APPROVED DATE BOARD OF HEALTH A/B A/B `�.� �Q \ /SL UNSUIT. /SL UNSUIT. x 146.77 145. �e71117 71 138.55 x 138.83 138.81 1NQ , TITLE 5 SITE PLAN 26" 1OYR 2/1 14" 10YR 2/1 �d A ®13�Rk D AIN 139.21 �9 4S .8 139.32 LOT 151 �T I OF B B s s x 16,629 ± SF /SL UNSUIT.. /SL UNSUIT. ?°°' 's� ° x 42 '46 \ x 141.18 1 1 7 '4106 �280 JOE THOMPSON ROAD 60" 10YR 5/6 52" 10YR 5/6 ° 0° `� 144 CENTERVILLE ° 148 1 7.4 _ C 1 s� 160.00' Si,LOAM UNSUIT. Si,LOAM UNSUIT. PREPARED FOR 2.5Y 6/2 2.5Y 6/2 Ej NG LEACH PIT TO BE PUMPED AND FILLED WITH 118" 126 $' 72„ 131.0' WEAEA N SAND ��`jNOF"'Assq� � oFMgss B&B EXCAVATION/PULIT DANIELA. yGs� o`'� DANIEL 9cti� C2 C2 OJALAOCTOBER 18, 2010 SIEVE No.4 IL o JAI ` off 508-362-4541 fax 508-362-9880 LS LS o` ir- w ONAU, downcope.com 0 LA 1 OYR 5/4 „ 1 OYR 5/4 46502 ti .o.4o.4 down cope e4llfieering 14C, 150 124.0 120 127.0 P , �� , ''.STeR ` civil engineers Scale: 1 '= 20' 3u land surveyors NO GROUNDWATER ENCOUNTERED I®-1�`Z� At - ' �' ` 939 Main Street ( Rte 6A) 0-2 > 9 0 10 20 30 40 50 FEET DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675 ... _...,..,. ,.,... .. ,.,.-.. .. .....o. L Rt:.w.. ,...:tip,.......,.5-;...':f:,u_..�`..:'�_..._.._._-......_. .r. __ .. ......-,....�.._—_ ..�_ .. ._ ..._. .... ..._.... ...�..... _-.. ......_....., .a..,o.—.__. .._.�.._._.. —..--._,... �._.... ..i_..,...__—..._.,su _.u..... ..._-........ .,,..�..___�.,-.._�—_. .._ � .. ... ASSESSORS MAP: � -� �j I EST HOLE LOGS 1) The installation shall comply with the State Environmental Code Title V and Town of PARCEL: —4 I — s<3 Board of Health Regulations. FLOOD ZONE: _ SOIL EVALUATOR: 2) The septic system as proposed on this plan shall not be installed until a licensed town installer ��._._ ���-�s--iC��— WITNESS : , REFERENCE""(� ` receives approval and an installation permit from the applicable town. rZ .. DATE: t PERCOLATION RATE:-G 3) Prior to installation,the installer shall verify the Location of utilities,sewer inverts,sewer lines ` C;) 1 1 and existing septic components prior to installation. 4) All gravity sewer piping is to be 4 inch schedule 40 PVC at 1/8"per foot. The first 2 feet out of TH- i TH-2 the distribution box shall be level. All piping connections to be glued. 5) This septic design plan is not to be utilized for property line determination or for any other '�li,t✓ �� purpose other then the proposed septic system installation. Lo 6) All Title V components are to meet Title V specifications. ( 7) Parking shall be prohibited over Title V components unless components are H2O loaded. 1 22 LOCATION MAP 8) The existing leaching or cesspools shall be pumped and filled with material per Title V (4j �� abandonment procedures. Leaching and cesspool(s)and contaminated soils within the Y� proposed SAS shall be removed and replaced with clean sand per Title V specifications. E Wd I ol�" � /_ � � 9) Septic components are to be 10'from a water service line.Sewer lines crossing a water line shall � is �� �.� ' 'L 1,00 be sleeved with an appropriately sized schedule 40 PVC with ends grouted. The water service i , D line or the septic line can be sleeved with the sleeve being a distance of 10'on both sides of crossing the line. ` � 10) If a garbage grinder exists in the structure,it is to be removed if the septic system is not AMATdesigned to accommodate a garbage grinder. f' Y 11) The installer is responsible for care of excavation around all utilities on the property and SEPT I C SYSTEM DES I G N protecting the structural integrity of all structures during the installation process of the septic _0 S 135 ti� �� ,/� system. 1 rQ•o• o l c� �y�� �` ` 4�, FLOW EST!MATE 12 This Ian only represents that a septic stem can be installed on the property meeting Title V � ) p Y P P Y P P Y 8 requirements. �```� 2 - — -- Q c `•-/ BEDROOMS AT �U GAL/QAY/SEDR4OM �j��t,! GAL/DAY � w � � �.-_ __. 13s oQ �h 13) The property owner shall review design criteria to approve the total number of bedrooms and design flow.Installation of the septic system as proposed and receipt of payment for the design 3 /., 3 ? SEPTIC TANK shall be deemed approval of the design criteria by the property owner or agent of. ' 13 7 O. 3�7CAL/DAY x 2 DAYS - GAL 14) The validity of this plan shall expire with the expiration of the town installation permit issued for this plan or the validity of this plan shall expire on the expiration of the Certificate of Compliance USE IMO GALLON SEPTIC TANK Fx( .e.± /� } "'r issued for the installation of the proposed system on this plan. 1 .i..1.938BSaRP T _9 O Sl'5T Q ,� RopesHz-I� �L. Lr POPCN SIDE AREA: 7i Z.�j •rt- �� f xZ�",7 •q n G �O r- T T T---+�'r r���'�� �� BOTTOM AREA: � j �c � �.?j� "o ti SEPTIC SYSTEM SECTION Q 1 5� $?t \ 110 lip T-- 140 Lr -o,_ a2 + 142 + ,ti' �' _ 43 -- � y GAL + 143 ----'�~�l f 11 � ,� � 000 wt�'"�3:., I ,�� �� _ �_w � t lr---•- �T��-....�...1 ��..1�_I �vLc./v ,, 44 143 1" _ 144 4 �`° SEPTIC TAN ! 'r 144 145 146 �46, -- 145 �1� 146 - 148 74$ 74) �46 WPM DAVID �ss�' w 49�� ' - SITE AND SEWAGE PLAN Las --- — 149 B. G MASON cm"'' ,so Ise 1OC� O( _ %1�- i '____. ` �a �, rvo.loss LOCATION . 2 ' 151 M151 _ 152 - 52.00• s2 � � ,� ' V PREPARED FOR : ,i1�,� _ c - /_ o SCALE - DAVID B . MASON,RS DATE: © z DBC ENVIRONMENTAL DESIGNS J U DATE HEALTH AGENT 14 z r I Co_7 3 A �,4 T tJ o5e, U ki ntz_'�O�P:4 Ckv-xi en •. /V /� � � \,;�� `��v ,� t�Q, - Kam" f 3 i \ - .._i 1 1"iA•;J"f- L (s'4C7, 74V_E o A•VAjLA yGr y ,r i rav_ ��Cry plTG�j ILA.,lsr-u�J+-t;ss C'L4sgw'-c oe1 tev• .. -- -�-�-Z Z, � rS. !fit 4� .�O I►.!TS �1�1A L l_ gE Me t� G 2 cl t38 Cp Gotii�recX-T �� CTat�s Tc to a.ccc� .� I�1trN I^f�,t .�'. Ftl�t'rcG�1iM��Td -I� GODS ThT'�.�� `x,�('`,�'`� , MW_�C,oy��nYEe I'f.Lno� i; 1O g��� j �✓� t.7� _ �� f"'� �_ �. A # +, -(t Z t-JnEDSTo.lE— L 8 T ti Z c.I 17 z ,? pGF G4L LE !� e-ot .tMI2fr; ,� .! lj �, �,� ti ? ` �� l�� A"D Tp72L � _W t-t}-►_ �7� ��p_�-.�i aj� n��sLR�_. . — --- �'`a�`J�T ;'�AEr.; t^ � � .M�. -- --- -tL!"Iis2 Glom cG/�-e c179Incer;1'7� At_E C t J t L E►-"I t-lEE,E AQNE A . Q1AL4, ! R.L .5 . � P.15, DATA -_ APPeOVEC" CAT n .- - .