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HomeMy WebLinkAbout0098 KETTLEHOLE ROAD - Health 98 Kettleh.ole Road West Barnstable A= 109—033 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 98 Kettlehole Road Property Address Kenneth Zeghibe Owner Owner's Name information is required for West Barnstable MA 02668 11/28/09 every 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. Important:When filling out A. General Information forms on the computer,use 1. Inspector: only the tab key to move your Michael Kellett cursor-do not Name of Inspector use the return key. Aardvark Environmental Inspection Company Name P.O. Box 896 Company Address East Dennis MA 02641 Cityrrown State Zip Code 508-385-7608 S13742 Telephone Number License Number B. Certification 1 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. 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 11/29/09 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. �6 lZ 0 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 98 Kettlehole Road Property Address Kenneth Zeghibe Owner Owner's Name information is required for West Barnstable MA 02668 11/28/09 every page. CityTrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. 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: ❑ 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 98 Kettlehole Road Property Address Kenneth Zeghibe Owner Owner's Name information is West Barnstable MA 02668 11/28/09 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ 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 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. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 98 Kettlehole Road Property Address Kenneth Zeghibe Owner Owner's Name information is required for West Barnstable MA 02668 11/28/09 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ 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: 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 than Y2 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. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 98 Kettlehole Road Property Address Kenneth Zeghibe Owner Owner's Name information is required for West Barnstable MA 02668 11/28/09 every page. Citylrown State Zip Code Date of Inspection B. Certification (font.) D) System Failure Criteria Applicable to All Systems (cunt.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 98 Kettlehole Road Property Address Kenneth Zeghibe Owner Owner's Name information is West Barnstable MA 02668 11/28/09 required for every page. Cityfrown State Zip Code Date of Inspection C. Checklist Check if the following have been done.You must indicate'yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ 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 (f any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 5 98 Kettlehole Road Property Address Kenneth Zeghibe Owner Owner's Name information is required forWest Barnstable MA 02668 11/28/09 every page. Cityrrown State Zip Code Date of inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Number of current residents: 0 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)): Sump pump? ❑ Yes ® No Last date of occupancy: 09/09 Date Commercial/industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No 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): i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 98 Kettlehole Road Property Address Kenneth Zeghibe Owner Owner's Name information is required for West Barnstable MA 02668 11/28/09 every page. City/rown State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: 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: 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/Altemative 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: 07/09/87 Were sewage odors detected when arriving at the site? ❑ Yes 0 No Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 98 Kettlehole Road Property Address Kenneth Zeghibe Owner Owner's Name information is required for West Barnstable MA 02668 11/28/09 every page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Building Sewer(locate on site plan): Depth below grade: 2.4 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints,venting,evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 1.9 feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No ------------------------------------------------------------------------------------------------------------------------- Dimensions: 1500 gal Sludge depth: 3" Distance from top of sludge to bottom of outlet tee or baffle 29" Scum thickness 3" Distance from top of scum to top of outlet tee or baffle 611 Distance from bottom of scum to bottom of outlet tee or baffle 15" How were dimensions determined? measured Commonwealth of Massachusetts w . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 98 Kettlehole Road Property Address Kenneth Zeghibe Owner Owner's Name information is required for West Bamstable MA 02668 11/28/09 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): The tank was sound and tight with tees in place and liquid at outlet invert. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): - - i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 98 Kettlehole Road Property Address Kenneth Zeghibe Owner Owner's Name information is required for West Barnstable MA 02668 11/28/09 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order. ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): �I *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 even 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.): The box was level and tight with no sign of carryover. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 98 Kettlehole Road Property Address Kenneth Zeghibe Owner Owner's Name information is required for West Barnstable MA 02668 11/28/09 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 2 ❑ leaching chambers number: ❑ leaching galleries number. ❑ leaching trenches number, length: ❑ leaching fields number,dimensions: ❑ overflow cesspool number: ❑ innovative/attemative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): The system has two 6'x4' precast pits which were dry but had staining nineteen inches from the bottom. I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M , 98 Kettlehole Road Property Address Kenneth Zeghibe Owner Owner's Name information is seguised for West Barnstable MA 02668 11/28/09 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 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.): I f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Y Not for Volun tary ry Assessments 98 Kettl ehole Road Property Address Kenneth Zeghibe Owner Ow nWs game information is West Barnstable required far MA 02668 11/28/09 every page. City/Tom State ZipCode Date of Inspection D. System Information (cont.), 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. qy 31 Commonwealth of Massachusetts w v Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments °M 98 Kettlehole Road Property Address Kenneth Zeghibe Owner Owner's Name information is West Bamstable MA 02668 11/28/09 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ❑ Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: 20.0 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers- (attach documentation) ® Accessed USGS database-explain: You must describe how you established the high ground water elevation: USGS maps show an elevation of over 20.0 feet. I JWN OF BARNSTABLE LOCATION /,p i d SEWAGE # 917 -11-Z VILLAGE ASSESSOR'S MAP & LOT ,V. 9 " 33 INSTALLER'S NAME 6z PHONE NO �S�I��/� SEPTIC TANK CAPACITY�SC�t� O.LEACHING FACILITY:(type) (size) �NO. OF BEDROOMS 3 P VATEVt-&L OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: S 7 DATE ..COUPLIANCE ISSUED VARIANCE GRANTED: Yes No 3 � 3� F:ca....................._.... M THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH _..-..... (� OF........ .....- nl ... ----•.....................f Appl ration for Disposal Murky Tonstrurtinn Ifrrmit Application is hereby made for a Permit to Construct t)4 or Repair ( ) an Individual Sewage Disposal Sy t .. ... 1, . ....... ......................................... ............... �..L.�IC.L.<. atio i•AddJ,ess�i.. .......... .............................................or Lot No.-....._........................-.»..... Ow Address Installer Address -�- Type of Building Size Lot. .Sq. feet Dwelling—No. of Bedrooms..........4___________________________Expansion Attic ( ) Garbage Grinder ( ) `4 Other—Type T e of Building No. of persons............................ Showers W YP g -----•...................... P ( ) — Cafeteria ( ) a' Other W fixtures __ _ _______________________ Design Flow.............LLO.•. gallons per n per day. Total.daily Pow............ . 90 Septic Tank—Liquid ca acrt .SllO Len h. D.Q. . Width . �1_.. Diameter:. ._-__-_... Depth..~.lons _. . x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area...................sq. ft. 3 Seepage Pit No..... -__.__ Diameter..........10..__ Depth below inlet................ Total leaching area :.. sq. ft. z Other Distribution box ) Dosing tank ( )' Percolation Test Result Performed by.-.'�.A�_.. .Q`1 l S....................... Date....Ct � ......--.. Test Pit No. 1.�1 minutes per inch Depth of Test Pit.... . Depth to ground water.. _- _- 44 Test Pit No. 2................minutes per inch Depth of Test Pit...._....... ...... Depth to ground water.. -.__.... ............ 04 -----------------------------------------------it ... - .._ ...:...... ..... O De tion of Soil_ Q...-..2�'u..1.1JSf??SQLL. Zi !Q..!_... ��.._....•••. . . %�..._ .ley...------... U • . .. ................................•--••-...-.._....,ESIGNIFJG E.UGlh11 ��l�,rr,,, U Nature of Repairs or Alterations—Answer when applicable....':.... . . . td :�S_.. •-•----- -•................. °'TALLATION Al�fy Gtn � t►C- ------------------------------------ •--------- �A-E SYSTE111i WAS'•ijNST'. ............... Agreement: - ,r1R.)ANCE TO PLAN. The undersigned agrees to install the aforedesc ' d Individual Sewage Disposal System in accordance with the provisions of TITLZ 5 of the State Sanitar de The under igned further agrees not to place the system in operation until a Certificate of Compliance has b iss d by the o• d of h Signed. .. ..............� .... ............ .. �. Date Application Approved By C:..... r..l�.:`.:�...--•••--- .................. .....: Date Application Disapproved for the following reasons:................................................................................................................. ....._.. ... '•••�• Date...... ._ Permit No.......... �» _,--... ....... ......... ... Issued.. �.....:� . .:_R...... Date xNJ r N0..��...........�. ... Fps...... ._ ..._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -0)(4,.K0........OF...... . Appliratiun for 11ispusal Works Tonstrudiun Hermit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at ......� .`�( V _; 1 f t'o(-E- eo.......................................ll .............. � .�'�"...1............ .......................................... Location-Address or Lot No. .. row ,, Address.._.._.... - .._..— ...... .......................... W .................. .... ••- .. .—...................................... ....--••••--........._........_..........-••--••--.........................-•-.............._..... Installer Address —7-7, 2 Type of Building Size'Lot....................._......Sq. feet �. Dwelling—No. of Bedrooms...........................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building No. of persons............................ Showers f� YP g .................•-•---•---- P ( ) — Cafeteria ( ) dOther fixtures ....................................n!1�_..__............ .............---.........-•---- W Design Flow................�...( ..............gallons per•pe n per day. Total daily,flow___.........4 ........ ..._....._._....gallons. WSeptic Tank—Liquid_capacity ?,�(�_gallons Length. �.�)'_. Width: '.f�._._ Diameter________________ Depth.�?_.'k.'.. x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area__._.._..._.__._..__sgr ft. 3 Seepage Pit No......7 -___-- Diameter.._..._..1�.___ Depth below inlet....4........... Total leaching area �:._ .sq. ft. � z Other Distribution box.!1 Dosing tank ( ) 1 f '"' Percolation Test Results Performed by 9 I . � - -�---•--..._...-•-•............... Date...------•.-•• --•;•--.._........�. Test Pit No. I...Z �inutes per inch Depth of Test Pit__._i_ ._i<___ Depth to ground water.. �"1r_ _. Lt. Test Pit No. 2................minutesper inch Depth of Test Pit__._ �... ...... Depth to ground water___, -'-- --------------------;............................................................••-•-t::............••••--......................................._••••_..... 0 Description of Soil.L1....!...Q.-.. �.�..I;nn SU(W)It__ ?-4- -_.I 14,q-.-_Lt ePN ViQe .._C-AAJ�......... (-7 n-2�}'" AM-t ct� r �l�(t. �4" --- L.,f�' /�,x t.E-AN Ftr» SW PO " 144'%........... V -•_... -•----- " . ......................... .• •---••-...... il.Jf.-4�a.. U Nature of Repairs or Alterations=Answer when applicable....................................................................LD�31:EEa ................... ......... -- ----•................ .............. ...........• ............._...... ...... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of.:ITLs 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.bo rd of health. Signed. /�(__•'' :. •• ll(� .. ..... ............. ..Y.. _..... ...... � - _ n-2 Application Approved By...... .y-.z. '` ... = Date Application Disapproved for the following reasons:.............:........................._...._..........___.....________.___................................____ ---•-•---•--•-•-•--•----•----••------•----•-••--••-•..............................•-----........---•-•--•....---..........----••-•-----•--•--•--...............---------...........--•..................: f / Date Permit No..........� .....d.�� .��...' Issued.' � 7. 2. �.... .-- �Date ----------------- THE COMMONWEALTH OF MASSACHUSETTS - BOARD OF HEALTH ttt OF.............. �.� ..................................... (Irrtif iratr ,af Tompliana THIS IS-TO CERTIFY, That-the Individual Sewage Disposal System constructed ( "`) or ( ) by............... ...............�\��..aJ S��: i�.. ............--------•--•----...................................---............................. _... .. Installer r-- at.... .............................•-•.............. -----•................................................... ........... ....................... has been installed in accordance with the provisions of TI'D.L-F_-R5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No........ -_. .......� .2 dated__....' �. .�i' .. ....... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.......................................1 ....... ............................................... Inspector--•---. ......•----. .....------..r.......... :....-.... .. ............. ..r+-.........r..-rnr +..w...-w.r++�..r.� s.+.a Fk ♦^ r.v...P N.a r• r a-r ..r w.4 w n-..m .......xr...a&w..x wr wNn..e.. e i • . x a• r.rv+P t w F r^ .•«< n e .r r-..r.....a...�.w......+r � M.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .�._.. �rV...OF....... `� �'"''� No. ............... x.Z......................... Fn....................... Disposal-Works Tunstrnrtiun f amit Permission is hereby granted.-----•. ........................................? ._._ ... ....... to Construct ( ")or Repair ( ) an Individual Sewage Disposal System ..............••----------•----•--.......----......-•-...............--•--......----...---•-•--.........------.............---•----.........................•-•-....... Street / as shown on the application for Disposal Works ConstructioncPermit No�2�.. .______- Dated.._._�-' .7..�!..��....... DATE.... Board of health (_../ ...................... � ENVIROTECH LABORATORIES . � 6 Lewis Bay Road • Massachusetts 02 601 - $12;77 y72 5 2 � k -4 CLIENT Kenneth Zeghibe LOCATION: Lot Kettle Hole . 33333S 79 Monument Neck Rd W. 8arnstable ,MA � Rourne ,MA 02532 d_ 7 COLLECTED BY: £4 Meehan SAMPLE ./2]/87 TIME: 11 : 35 AN F DATE RECEIVED: 3/2 3/8 7 SAMPLE ID:NO12 _2 q � JOB t New Well WELL DEPTH: 120 £t F m � . . k RESULTS OF ANALYSIS k F . � Parameter . Unb Recommended limit Result q K . Co,|br b dera/10 m (MF Method) 0 0 F - � 7 PH TjH units 6.0-*5 9991 � Conductance . Co d @e umcm Ok Ip . q . . & Sodium mg L 20.0 11.2 F , N»*eN mg L l&O .32 Iron mg L &} 2.72 k � q Manganese m L 091e 4 & � % Hardness mg L as CaCO 500 `k Sulfate mg/L . 250 j 7 A & Potassium mg L 20.0 / & 2 F Alkalinity mgL 20 Chloride mgL 2O E . _F d k k_ k % 7 COMMENT Iron level is not a health -hazard, but may cause taste an staining E problems. 2 — Water is suitable for drinking purposes for all parameters tested, k DATE 2 & /J-7 k . . . . . / �Pyo,THET TOWN OF BARNSTABLE 6 �+� OFFICE OF BAfl MAB& L = BOARD OF HEALTH � rasa �p 03q. e�° 39 w� 367 MAIN STREET HYANNIS, MASS. 02601 Sewage PermitI - Applicant Proposed Installer: The plan for the on-site sewage disposal system at [,_. has been approved with the condition that the design engineer must be on-site and supervise installation as well as certify in writing that the system was installed in strict accordance to the approved plan. Approved By Date Co : �e� - . . 4� VIJ Oda l� �� ce-P Ens 7v\e� f 362-4541 926 main street rt 6A yarmouthport mass. 02675 down cape ell gineering civil engineers& land surveyors structural design i Arne H.Ojala P.E.,R.L.S. land court Richard R.Fairbank P.E. surveys July 9, 1987 site planning sewage system Town of Barnstable designs Board of Health 367 Main Street Hyannis, MA 02601 inspections Attn: John.Kelley Dear Mr. Kelley: permits This is to certify that the sewage system on lot 18, Kettlehole Road, West Barnstable, was installed in accordance with approved plans, dated 2-2-87, revised 2-19-87, for Ken Zeghibe. Respectfully, Arne H. Ojala,R.L.S., P.E. ij Department of Environmental Management/Division of Water Resources i WATER WELL COMPLETION REPORT WELL LOCATION n Address �) /Q e..,q/r 11rJ lP City/Town (tN . 0 r f1.0 12 4-,,l r� G.S.Quadrangle Map v Grid Location Owner A'%;At)00'V ji Address ,74r.sro WELL USE CONSOLIDATED WELL Domestic dPublic ❑ Industrial ❑ Type of Water-bearing Rock Other Water-bearing Zones Method Drilled 1) From To 2) From _ To Date Drilled 7 3) From To 4) From To CASING Depth to Bedrock Length r-,?/1' Diameter Type hlf.Siw4 UNCONSOLIDATED WELL STATIC WATER LEVEL Water-bearing Materials Feet below land surface_ Sand: fine medium ! coarse❑ Date measured g7 Gravel: fine❑ medium❑ coarse❑ Screen: ' GRAVEL PACK WELL / Slot# /A length T�from to Yes ❑ No U Split Screen (or 2nd screen) WATER QUALITY TESTS MADE- Sl. length from to Chemical .i/ Biological ❑ Depth To Bedrock PUMP TEST Drawdown 0 feet after pumping days 6thours at n?Q GPM. s How measured nCD it lY:>r"/�'1 t�/1 Recovery feet after hours. q �.. =.y LOG of FORMATIONS COMMENTS: (On well or water) Materials From To —A o Cb m 1'yIo / DRILLER m f Firm rnojo"fin Wo1 ny"ill or ° Address Mxn City ,P.5T-r4/.i It- Registration No. 1 ug 14 operator's Signature Please print firm v BOARD OF HEALTH COPY zsm to as sonot ...r®...,.•-: .....•.—u..:.r_...w-.-.,d.l::•:._�...,s,- .. 'r 7•r--p. •. --r<.,�,..�w_ . ....a� • __,- - - �awl y i, r^t. ,a�}. .y� . . 4 , - . „ . ! •. y s. M 74 SECTION,- SEWAGE' x x.• - fit•. � i'' '�' t r 1 y l f1l, ' � .� J. t• �. ` ' ` �^ • t,2 . ' • yyyyyy�y�• 4 l(/i�) ! �.• A • 11 TOPOf KC'tN'r "` r t 'C^ 4 . ' , �'�d�«tMSW• � ,' - r . , � wAs E• � a a. F w, O STo N '3 .r OUT m 40 OUt d SEPTIC 1 rJiT TANK D► 3. .© VA Et.EY� Et.EVr ELM ., ` ! „ !'+ epQ• � a a lox w' r ElE .. �S6.6V. 4 ' "', r•- 7 ,,, .. ^ .' ,n 4s•. QF>rie••ly" -�' "� ��' �,r"V � .;i, .;. •`�'S(. 'w V A , Tole As �fls E . i p, • �'DLir��Z. � �• `•f , „ , "• z, +'k „• . i �t� , r is 1 �� ' , r -TEST .HOLE LOG F* 62Z,0_` :x 4" 1 r+ '" iFa r :.r�.• 7.�, 1,+C:.l f' �' - �r ... ` ' ♦' �Y ,l v �� y `•.^' � „� v •, TEST SY5E�� , WITNESS 'BEDROOM HOUSE . 1 �U►O TEsrwoAr . DESIGN-. T.H.''* "i. T-.H, 0.2 K y��►/ P r ELEV.%j7 EI.EV.js NO T ' e' t�o ;5 �RxOt� ►•rh � � $ERC RATE G DISPOSER w FI:O RAT I!Q tcAt•,/@AY 6i> SEPTIC TANK wo REO'D SEPTIC TANK SIZE, t.G r ' 00 t LEACH FACILITY I r .' � GID xntEt.t. SIDE WAL 1 l - --(oZ.Z —�---- Cal.rG BOTTOiVi � n TOTA f Z VzAe. l•t 4-;S ]�y} 1 y I,fACHINti USE: s�.IkS"S�- � ) WATER.ENC6UNTEREO ��- � vist x --•'�- 1�-.- ,. LINE R muST UP�flj• 1 t„e �C �� . .. GWNG EN FY NO ` Si IUtiLESS QTHER{h�ISE NO Eo? .` ��s1 _ � N V;TALLATION AND CERTI E 34bATVM jkliL) TARE_N F'ROIIm QUADRANGLE MAP S INSTALL I� _ �. 1 ti,, SYSTEM WA1i1t/aTl't - 51..t.-' 2.MUNICIPAL WATEt3♦ 1 „AVAt1 ABLE ' ` �'' C To PLAN. �F,+• � �(� ff y�y 3.PIPE Prrm#A"PIER - t '.'T+'�� C t' " T'T 4�LiJ7 4,C)" fGN LOAOiNG ft*At,.L PRECAST VNITS:'AASHO Pt 44' iFACILITIES. S.1NIN,GRC3k/IVt�GOjVERiC_7VE1 'AI LEWA4E fi) FT, + tt, G:PIPE'iOiNT$St tAI C 9E tdAQE WVATER TIGHT •` J r{' y �' I SITE ' r . 7.CONSTRUCTION,OLETAILSTO$E ACCORDANCE W11H COMM.OF MASS. t STATE ENVI ONMIIEWA1.CODE'TITLE S i. �t•{t5 P1.��.I.ai '�;l -�t:� J• _ . . , . � ." -�; ,���� :� p , t.Otu's-�' �.� • �. �.. ,`' , F � J. - FOR F y' i r _ . yl' r� f 4��������� r• n. s, .�+''.��-\rI a - ''�'� �i1 i - A ^ � '_ 'r ,. . � 7•.Yh r ! � �� y ,,ma�yy . � , .. ' . e�iiE�q', tt t ,{. lI�tEE4Y� S �. il,'4,.. /��tNE: .. RE� :.F�v_.n �"tiI!}{ t'^�•tr�' . .. ... .. .. • ..y. ' F.rw.. 4 +T;�'. �. �. f . ,'.S' .� �a +�.", .�f fi r�rw..e• a, • T' r i P •� EPA - f .�Rr do �► cc a efti?4eel,rng y y . �. tY� F. , . - R ' AR0 0#;` ESL"I) + :. IfIL a :• f �" i L y � < xp suRYEYo s •, ISTSNcv�'�. -• _ :� � / � .. ._. Otl $ ,. �` Ci�N1 R tE . a`�t4PE'+�ES?t..;ft,rrn�•'••�;�-.r fSPPRS?vf=0,^• ., �.�QAT�,. ` t.7MlE.Y ir5 1 �:. .: .. Y t . a f .. _. ..__ 20 FT MIN. TOP OF FOUND. E L = 10 FT MIN. CONCRETE 4 SCH, 40 PVC —CLEAN SAND COVrRS 1 �`►' f PIPE- MIN. PITCH CONCRETE 1/8" PER FT. COVER - 2" LAYER OF ' A tT { ° 4" CAST IRON r, =,� !r 12 MAX. __-. I 1/8 - 1/2 WASHED PIPE- MIN. PITCH �u I 1/4" PER FT. STONE A . I z FLOW LINE _ �0 Le MIN. i -10 I ' EL. 24, 1 E L. J0 " _ _ r oc, DI ST EL.= /oa.`-- ' w _----_ LOCATION MAP BOX ° °n - o WASHED STONE � A V . ., PRECAST LEACHING °�" GAL. ' Et BASIN OR EQUIV. SEPT I C . i TANK GROUND WATER TABLE EL. = t. PROFILE OF ,:�, ,.r SEWAGE DISPOSAL SYSTEM NOT TO SCALE i fill DESIGN CALCULATIONS SOIL TEST Ir NUMBER OF BEDROOMS DATE OF SOIL TEST GARBAGE DISPOSAL UNIT. 4 j TOTAL ESTIMATED FLOW L PERC WITNESSED Y OLAT !ON RATE MIN /INCH GAT. /8R.lDAY x BR. > GA /DAY REQUIRED SEPTIC TANK CAPACITY... GAL OBSERVATION HOLE I OBSERVATION HOLE 2 h I 1 ACTUAL E SiZE OF SEPTIC TANK. GAL `- ELEVATION = Rj_ ELEVATION - LEACHING AREA REQUIREMENTS _t--1 t':�E" - SIDEWALL AREA+ —_ GAL /S.F �}'�' '`� " I BOTTOM AREA GAL./S.F. _ LEACHING CAPACITY ( BOTTOM -+ SIDEWALL) . i _--- GAL. ^L4 r. I 11i RESERVE LEACHING CAPACITY _ GAL. A' 4-+ LAY t NOT LE S I ALL WORKMANSHIP AND MATERIALS SHALL CONFORM � TO D.E.O.E. TITLE 5 AND THE TOWN OF O RULES AND REGULATIONS FOR SUBSURFACE DISPOSAL ` OF SANITARY SE WAGE 2 COMPLIANCE WITH ZONING REGULATIONS SHALL BE P R BUILDING " r f BUILDING SETBACK REGULATIONS E - � DETERMINED BY BUILDING INSPECTOR OR BUILDING INSPECTOR OR BUILDING COMMISSIONER COMMISSEONER 3.EXISTING AND FINAL GRADES SHALL REMAIN ESSENTIALLY MIN. FRONT SETBACK THE SAME MIN. REAR SETBACK ' SIDE SETBACK t +n. APPROVED : BOARD OF HEALTH DATE AGENT PROJECT LOCATION .. f �yfA'4 APPLICANT . .1 �tL, LEGEND r SCALE: ATE �' $ DR 8Y' Q y EXISTING SPOT ELEVATIONS 00 4'' _ JOB NO 1 A Y PPO. BY RSV } 3r EXISTING CONTOUR - - - - - - 00 - - - - - FINAL SPOT /� FINAL CONTOURLEVATIONS 00 ��� R J D'HEARN, INC. DRAWING SITE PLAN N SOIL TEST LOCATION R£6. LAND SURVEYORS- REG. SAN?AR/ANS NO. 1348 ROUTE /3 4 - P. 0. BOX 1263 SCALE � EAST DENNIS , MASS. OF --.-- _T