Loading...
HomeMy WebLinkAbout0187 KETTLEHOLE ROAD - Health i`�7 Kettlehole West Bamstable A = 109 - 060 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 187 Kettlehole Road Property Address William and Nancy Arthur Owner Owner's Name information is required for every West Barnstable MA 02668 November 30, 2010 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 filling out forms A. General Information 1 on the computer, use only the tab 1. Inspector key to move your cursor-do not David D. Coughanowr use the return Name of Inspector key. Eco-Tech Environmental kCompany Name 43 Triangle Circle Company Address Sandwich MA 02563 Cityrrown State Zip Code 508 364 0894 1328 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 16.000).The system: --� ® Passes ❑ Conditionally Passes ❑ Fails F ❑ Needs Further Evaluation by the Local Approving Authority ' f R. �j November 30, 2010 4 _ 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. Iv t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage D' sal Syste ge1of 1) Commonwealth'oftMassactitasetts I _= Title 5 official Inspection Form — — Subsurface Sewage Disp.osal.System Form -Not.forVoluntary Assessments 187 Kettlehole Road Property Address William and Nancy Arthur Owner Owner's Name information required for every West Barnstable MA 02668 November 30, 2010 page. Cityrrown State Zip code bate of inspection B. Certification (cont ). Inspection Summary:'Check &B,C,D or E l alvtrays complete all of Section, , 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 iridicate.d.below: Comments: Inspector's,Note==> A se tics ,stem is deemed to ass this Real Estate Transfer Ins ection if it p P Y p p does not trigger any of Ahe failure criteria listed below. The septic system has been evaluated according to the conditions observed on the day it was inspected. No estimate or guarantee of system longevity is made or implied by a passing determination. B) System Conditionally Passes; ❑ One or more system compQnen.ts:.as described in the"Conditional'Pass"section need to be replaced or repaired. The systeri , upon completion of the replacement.or repair, as approved by the Board of'Health, will pass. Check the.box for",yes", "no" or'"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank,(.whether metal or-not) is structurally unsound,exhibits substantial infltration.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. i 'Y ❑ N ❑ ND (Explain below : i 3 I F t5ins•09108'* Title 5 Offiicial.InspeciionForm:Subsurface Sewage Disposal System--Page 2 of 17 CommonwealWof Massachusetts _ -• `Title 5 Official Inspection Form Subsurface Sewage;Disposal System_Form-Not for Voluntary Assessments 187 Kettlehole Road Property Address William and Nancy Arthur Owner Owners Name information is required for every West Barnstable MA 02668 November 30, 2010 page. Citylrown State Zip;Code Date•of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health); ❑ broken pipe(s) are,replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced. ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s), The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y' ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation,by the Board of Health in order to determine if the system.is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the.system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet.of a°surface water ❑ Cesspool or privy is within 50'feet of a bordering vegetated wetland or a salt marsh t5ins-.09/08 Title 5 Official inspection Form:Subsurface Sewage Disposal System.page 3 of 17 Commonwealth of Massachusetts Tine, 5- Official inspection Form — ` '.3'ubsurface Sewage Disposal System.Form-Not for Voluntary Assessments- '187 Kettlehole Road Property Address William and Nancy Arthur Owner Owner's-Name information is West Barnstable. MA 02668 November 30, 201:0' required for every page: CrtylTown state Zip Code Date of Inspection B. Certification .(cont.) 2 System will fail unless.-the Board of Health.(and Public Water Supplier, if any) determines that the system is functioning'in a manner thatprotects.the public health, safety and environment: ❑ The system has @.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 aseptic tank.and SAS,and the SAS is within,a ;Zone 1 of a public water supply. El 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: 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 El 9 clogged SAS or cesspool ® Discharge or pond ing 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 nvert 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 ','z day flow 15ins-09108 Title 5 Official Inspection Form;Subsurface Sewage Disposal System•Pago 4 of.17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 187 Kettlehole Road Property Address William and Nancy Arthur Owner Owner's;Name information is required for every West Barnstable MA 02668 November 30 2010 page, Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes. No ❑ Required`pumping more-than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ Any portion of the SAS', cesspool or privy is below high ground water elevation. ❑ © Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ Any portion of a cesspool or privy is within 50 feet,of a private water supply well. ❑ 0 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. ❑ 0 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 EJ ❑ the system is within 400 feet ofa surface drinking water supply El ❑ the system is within 200 feet of`a tributary to a surface drinking water supply El ❑ the system is located.in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or.a niapped:Zone II of a public water supply well if you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes in Section D above the large system has failed. The owner or operator of any large. system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304, The system owner should.contact the appropriate regional office of the Department. t5ins•.09J08' Title 5 Official Inspection Form:Subsurface'Sewage Disposal System-Page 5 of-1 7 Commonw..OAIM of*issachusetts. Title 5 official Inspection Form — a Subsurface Sewage'Disposal System;Form -Not for Voluntary Assessments � i 87 Kettlehole Road.. Property Address `William and"Nancy Arthur Owner Owner,s'Name information is required for every West Barnstable MA 02668 November 30, 2010. page. Cftylrown state, Zip Code Qate 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 0 ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ 0 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? 0 Q Have.large volumes of water been introduced to the system recently or as part of this inspection? Z ❑ Were'as built plans.of the systern 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? ❑ Vvere.all system components,excluding the SAS, located on site? Z ❑ 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 Q ❑ Existing information. For example, a plan at the Board of Health. El Determined in the field (if any of the failure criteria related to Part C is at'issue approximation of distance is unacceptable) [310 CMR 15:302(5)] D. System Information Residential.Flow Conditions: Number of-bedrooms (design)° 3 Number of bedrooms (actual): 2-3 DESIGN flow based on 31A CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 gad t5ins+.09J08 Mitle_S Ofricial Inspection'Fotn'Subsurface SewageDisposal`System,_Page 6 of 17 Commonwealth of Massachusetts Titl.e 5 Official Inspection Form v Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 187 Kettlehole Road Property Address William and Nancy Arthur Owner Owner's Name information i e required for every West Barnstable MA 02668 November 30,2010 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents. 2 Does residence have a garbage grinder? ❑ Yes Z No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected?' ❑ Yes ❑ No Seasonal use? ❑ Yes 0 No Water meter readings, if available(last 2 years usage(gpd)): n/a-well in use Detail: Sump pump? ❑ Yes E] No Last date of occupancy: currentDate 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/sgft., 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: 15ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 :Commonwealth of Massachusetts -� Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 187 Kettlehole.Road Property Address William and Nancy Arthur Owner Owner's Name information is West Barnstable MA; 02668 November 30, 2.0:1.0 required for every page; City/Town -State Zip'Code Date of Inspection D. System Information ,-(cont.) Last:date of occupancy/use Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as..part of the inspection? ❑ Yes Z. No if yes, volume pumped:' gallons How was quantity pumped determined? Reason for pumping: Typeof System: Septie 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 ofthe DEP approval. ❑ Other(d'escnbe)-, 15ins.-09108 Title.S Official Inspection Form;Subsurface SewagelDisposalSystem t Page 8'&17 Commonwealth of:Massachusetfs, _ - Title' 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments u 187 Kettlehole Road Properly Address- William and Nancy Arthur Owner Owner's Name information is West Barnstable MA 02668 November 30 2010 required for every , page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components date installed(if known)and'source of information: Age 22+years. Certificate of Compliance issued 3/31/88(Board of Health files). Were sewage odors detected when arriving at`the.site? ❑ Yes M No Building Sewer(locate on:site plan) Depth below grade., 3 feet Material of construction:. ❑ cast iron Z 40 PVC 0 other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc,): Sewer lines appear structurally sound with no evidence of`leakage or backup into dwelling. Septic Tank(locate on site plan):. 1 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 Dimensions: 10.5ftx6ftx5"ft(1500 al . - gam= Sludge depth' 2 in t5ins„•09Jt781 Title 5 Official Inspection Form:Subsurface Sewage Disposal System';Page 9 of 17 Comrho, ealth of Massachusetts Title 5 0ffici`al Inspection For Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 187 Kettlehole Road Property Address William and Nancy Arthur Owner Owners Name information is required for every West Barnstable MA 02668 November.30 2010 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont:) Distance from,top of sludge to bottom of outlet tee.or baffle 32 in .Scum_thickness trace Distance from top of scum to top of outlet tee or baffle 10 in Distance from bottofn of scum to bottom!of outlet tee or baffle 14 In How were dimensions,determined? As built card Comments(on pumping recommendations; inlet and outlet tee.or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumping is not required at this time but maintenance pumping is recommended within and every two years: Tank appears structurally sound and functioning as intended. No evidence of leakage in or out was observed. Grease Trap (locate on site 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 bott,om.of scum to.bottom of outlet tee of baffle Date.,of last pumping: oaEe. t5ins-09108' Tdle 5.0fficiai`Inspedon Form:Subsurface Sewage Disposal Sysiem-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal,System Form - Not for'Voluntary Assessments 187 Kettlehole Road Property Address William and Nancy Arthur Owner Owner's Name information is required for every West Barnstable MA 02668 November 30, 2010 page. CityFrown State Zip code Date.of-..Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank:must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: .gallons Design.Flow: gallons per day Alarm present: ❑ 'Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping:: Date Comments (condition of alarm and floatswitches; etc..): "Attach copy of current pumping contract(required); Is copy attached? ❑ Yes: ❑ No t5ins•09108 Title.5.Or5cial'Inspection Form:subsurface Sewage Disposal System•:Page 11 of 17 ,Corrim,6me6ilth"of Wi§s Adhusetts 7it�le 5' �3ffica! 1`ns ection Form . p Subsuiface-Sewage Disposal System Form -.Not for Voluntary Assessments 187-Kettlehole Road Property Address William and Nancy Arthur Owner Owner's Name information is required forevery West Barnstable MA 02668 November 30, 201.0 page. cltyfrown State. Zip code Date of Inspection M System Information (cont Distribution Box;(if present must be opened).(locate on site plan)'. Depth of liquid level above outlet invert at outlet invert Comments(note if:box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out.of box, etc.): Pump Chamber(locate on site plan);; Pumps in working order: ❑ Yes ❑ No Alarms in working.order: ❑ Yes ❑ No Comments-(note condition'of pump chamber, condition of'pumps-,and appurtenances., etc:)` Soil Absorption System(SAS)•,(locate-on,Site plan, excavation not.regUired);: If SAS not located, explain why;, 15.ins-09f08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 187 Kettlehole Road Property Address William and Nancy Arthur Owner Owner's Name information is required for every West Barnstable MA 02668 November 30,2010 page, cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ 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.): Soils above leaching pit appear unsaturated. No evidence of surface ponding, breakout, lush vegetation, or other evidence of hydraulic failure was observed. Pit was opened and effluent level was 2.5 feet below top of pit. No effluent contact staining was observed on riser sidewalls. 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 15ins•09108 Tale 5 Official Inspection Forth;Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts -- Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r 187 Kettlehole Road Property Address William and Nancy Arthur Owner owner's Name information is required for every West Barnstable MA 02668 November 30, 2010 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins-09108 Title 5 Official Inspection Foos:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of{Massachusetts title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 187 Kettlehole Road Property Address William and Nancy Arthur Owner Owner's Name hilhimrequIr dfotion is West Barnstable MA 02668 November 30,2010 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (coot.) 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 0 u ► 44 . s s-1 O (/! �Q) fi $10+3 v Q �`G► { r Wo • t5l"-09= Thle 8 Orfdal InspaWon FWM;Subsurface Smp Dkpmw System•Page 16 of 17 C:orhmonwealth oftMassachusetts u, Titl:e 5 CJffica Inspection Form �Subs_urface,Sewage Disposal System Form - Not for Voluntary Assessments 187 Kettlehole Road, Property Address `William and Nancy Arthur Owner owner's.Namer required,foron West Barnstable: MA 0266:8 November 30.2010 required for every , page: Cityfrown State Zip Code Date of inspection D. System Information,(cost`) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ,.❑ Shallow wells Estimated depth to high ground water:- 25+ft 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': -bate. Observed site (abutting property/observatio,n hole within 150 feet of SAS) ❑ Checked with local Board-of Health -explain,: ❑ Checked with local excavators, installers (attach documentation) Accessed USGS database-explain: Barnstable GIS Department records You must describe how you established the'high ground water elevation: Barnstable GIS Department records indcate,property is over 25 feet above groundwater table. Before filing this Inspection Report,please see,Report Completeness Checklist on.-next'page. 15ins'e 09108' Tillo:'S Officia1lnspeet bn Fohn:Subsurface Sewage Disposa(sy§fem•Pablo 16 of'17 Commonwealth.of'Massachusetts .; Title 5 Official Inspection Form. Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 187 Kettlehole Road Property Address William and Nancy Arthur Owner Owner's Name information is required for every West Barnstable MA 02668 November 30, 2010 page. City/Town State Zip Code Date:of Inspection E. Report Completeness Checklist Z `Inspection Summary: A, B. C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information— E§§mated depth to high groundwater Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file l5ins•09/08 Title 5 Official inspection Form:subsurface Sewage Disposal System•Page 17 of 117 Robert M. Davidson, P.E. 38 Greenhouse•Road g� Forestdale, ,Mass.'. 02644 � Match 31, 1988 Board of Health .� • Town of. Barnstable r• + Barnstable; Mass. Re: Permit #87-60 t _ ` Lot 49A Kettlehole Road F' v '' } � ' W. Barnstable Sir. At the-,owner's request I, have inspecte& the installation of the septic: system, located at -the above location instaiie&-by Erik-Br'oman and checked by your department ,on 3=25-88.�'fIn-.my nion;�this,,system was installed properly; and { in accordance with the poposed plan and og`ginal design. Yours truly, ROSERT c' m Robert M. Davidson P.E. p` �{a M. DAVID' ON-* RMD/ad No. 24500 ,^ ............... THE COMMONWEALTH OF MASSACHUSETTS BOARD HEA T ------ . .... ................OF... Appliration for Disposal Works ongtrurtion Vamit Application is hereby made for Permit to Construct or Repair an Indiyidual Sewage Disposal s -. .. - ... 4 M de for Permit m i.t..t??oi yst ___. ... ...... ...... .. .. ...... a ddre or Lot No. . ....... . . . . .... ............................ ............................................ ............................................... Ow wner Address .00 !........................................................................................... ................................................................................. ............. Installer Address Type of Building Size Lot..elox...I...........Sq. feet Dwelling—No. of Bedrooms__.____.___0... .................Expansion Attic (4/0 Garbage Grinder (40) Other—Type of Building ............................ No. of persons............................ Showers Cafeteria Otherfixtures ..............................................................................-----------------..................................................... Design Flow.................:r.r...............gallons per person peril day. Total dail� flow...... ..................gallons. Liquid capacit3eAM__gallons Length--K......... Width___51........ Diameter________________ Depth___...___.__.Septic Tank . .......... Disposal Trench—No. .................... Width___.__..____._______ Total Length__.__._____._._____ Total leaching area....................sq. f t. Seepage Pit No.......?........... D' meter----/_y--------- Depth below inlet_____ ............. Total leaching area__ k .....sq. ft. Z Other Distribution box Dosing�tank Percolation Test Results Per-formed by-. .... .. 4.Ay.V........... ......................... Dat 4 0.401JIf S"______.__..__. Test Pit No. I................minutes per inch, th of Test P* ................... Depth to ground water_.____._....___.____.__. rZ4 Test Pit No. 2................minutes per inch Depth of Test Pi .................... Depth to ground water_._______.________.._... ........................................................................................................... Description of Soil--------- ............................................................................................................................... 0 ..................... ........ ................................................................................ ------------------ QIV ING 'ER -----------­­-------------------- ............... .............................................................................................n20'. ----------- UAA........ ---- U Nature of Repairs or Alterations—Answer when applicable....T,4 AND CFRTI Tav............. -------�--SYSTEtW------------------ '- WAS IN;�T.ALI-F_DJt-.t .............................................................................................................. .............. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TL I'i U 5 of the State Sanitary Code— The undersigned,further agr s not to place the system in further operation until a Certificate of Compliance has been issued by the board of li Ith. ..... .... ............ ... ..Signed...4"'A. ..... ........ .. ..................... Date.....- ate Application Approved BY----- ..................... ...... Date Application Disapproved for the following reasons:............................................................................................................. ........................................................................................................................................................................................................ Date Permit No.--------... .. C" ...................................... Issued-....................................................... Date r 4, A No ,r 1 :.tea FEB THE COMMONWEALTH OF MASSACHUSETTS -- BOAR® HEA T- q ApplirFatiun for Bi-qVusal Vvr�sjaustrudijatt 1hrmit Application is hereby made for q, Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Sy '' fhb 5,v,4,t:�_'�Zel .....................av Loca ddre or Lot No. ----- -- ----•--------•----•••-•-•---... y f Owner Address Installer Address `^ UType of Building Size Lot.4t0 _____________Sq. feet �., Dwelling—No. of Bedrooms........... ___________________________Expansion Attic Wk� Garbage Grinder (t/Q) Other—T e of Building No. of persons____________________________ Showers — Cafeteria Otherfixture,,r --------------------------------------•--------------------•-•-------------------- W Design Flow......... ?:___._____....______gallons per person per,,day. Total daily flow_____ __ _______._.______..gall�ns. WSeptic Tank—Liquid capacity' ?__gallons Length._......... Width_..Y--------- Diameter________________Depth.__.____._.-- . xDisposal Trench—No_ ____________________ Width.................... Total Length.....................Total leaching area____:________:......sq. ft. Seepage Pit No.......f------------.Diameter:...ZI......... Depth below �inlet___________________ Total leaching area__;.A.: ___sq. ft. Z Other Distribution box ( Dosing.,tank ( ) Percolation Test Results Performed by........ ------------------ Dato/4- •__� ________._____- `�a Test Pit No. 1................minutes per inch,/ epth of Vest Pje__ p g_______________ Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pi ____________________ Depth to ground water-------------------_--- -------------------------------------------------•------_:......__------------•--___---•-••----•----•--•-••---•------•---•--------•--••••--•--------------- Descriptionof Soil-------- �! - j=-1Y0-.........-----------•---------------••---•--------------•--------•-•---•-----------------------•----------------.._....._..__. x W UNature of Repairs or Alterations—Answer when applicable................................................................................................ --------•-----•----••-•-•-------•----•-•--••----•-••--•--------------•-•------••---...-------------------------------•--•--•----•••••---•--••--•--------------•-------------•-----------------.....----- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLL 5 of the State Sanitary Code—The undersigned f rther agr s not to place the system in operation until a Certificate of Compliance has been issued by the boar of 1 , r Zt, w Signed-- _ Date Application Approved BY ..> -bate Application Disapproved for the following reasons:-----.....-----------------------------------------------------------.......................................... -----------------------------------------•--•----•-•----------------------------•---•---------...----------....••••-._...•---------•------------•-•----------•--------•-----------•-•----------..------- Date Permit No.............L-• ..C: Date THE COMMONWEALTH OF MASSACHUSETTS _. BOARD, F HE T ..........................OF ........ .... :........................ ....... �rrtifiratr ,af f putpli�at rr T THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) ................... .. ._. `.r. __r ...,_. - .. -. ......................................... ----------- - nstaller f at = � " l t---f--- , _.... - ----------- - has been installed in accordance with the provisions ofl TITL. 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No....... ....... dated---- ................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. � DATE3 .................................................... Inspector ............................................................. THE COMMONWEALTH OF MASSACHUSETTS ., BOARD, OF HEALTH �� ....................................... No. •----.. �..... FEE.............. ...... Disposal Work.5 %-Euntr ion rrntii Permissionis hereby granted...........................-................................................................................................................... r to Construct ( ) or Repair ( ) an Indio PIE S:wag Disposal System _ at No......................-'`,_! 41 f f F P I `! �C_ r ( - ' h � .......................... .............................................. Street as shown on the application for Disposal Works Construction Permit No----.. ____.. D'ated..____ .`-__ _1 r 3- 1 ••-••••• Board of Health DATE------------------------------ — -------------- FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS TOP OF FOUNDATION CONCRETE COVER ° CONCRETE COVERS Q_ /oq 4"CAST IRON 12"MAX. 12"MAX. r ' OR SCHEDULE 40 4"SCHEDULE 40 PV.C.(ONLY) • P.V.C. PIPE PIPE- MIN. LEACH ` I • ' PITCH 1/4"PER.FT. PITCH 1/4"PER.FT. PIT PR Sl LEAl INi a :,;. o' INVERT �� �. ° e•e ' . e EL ,(a,�,o o �O �y INVERT INVERT �' PIT R ,•, SEPTIC TANK o DIST. 06 w ';� E 'IV. EL/.. 7 S. . . . BOX ELl....0... ' : >_ • ' ,•e INVERT �,SOO GAL. INVERT INVERT ��a 0: 3/441T Ill/ e; EL./.4.7.. ... EL106..r• •: �o �. .,&. •`� EL✓.PZP u WAS ED w STO11E 1 e ° /O /0 —�— ..; �--- /y DIA. j PROR LE OF UND WATER TABL SEWAGE DISPOSAL SYSTEM 1 NO SCALE S01 LOG WITNESSED BY : I P y3yp f,�/, C,o • • • . , BOARD OF HEALTH DATEf1/3!e •d�.... TIME. Upper ape TEST HOLE I TEST HOLE 2 Engineering Cp.. . . . . ENGINEER EL-E_v./.o.g•. . . . . . ELEV. .//12 . . . . . 7 Fern Ave. I E. Sandwich;MA 02537 • • • t p.3 ToPdlonn K . _y� P 4,1A DESIGN DATA : NUMBER OF BEDROOMS 3. . . . . . . . :. . . . . TOTAL ESTIMATED FLOW . 330 GALLONS/DAY BOTTOM LEACHING AREA 753 . . . . SQ.FT. /PIT 5/ - ED e�/ A�✓D SIDE LEACHING AREA . . . . . . . SQ.FT./ PIT 3•S-5 ED eoAfsat.o9rE/� GARBAGE DISPOSAL . . ��. . .(50% AREA INCREASE) Sij N0 w1rW Gi TOTAL LEACHING AREA SQ.FT y 2 ED C'oel Sf N0 w 1<- ED Gou COLATION RATE . . . . . . . . MIN INCH i .!vP .WATER ENCOUNTERED LEACHING AREA PER PERCOLATION RATE .. . . ... SQ.FT. NUMBER OF LEACHING PITS 2 APPROVED . .. . . . . . . . . BOARD OF HEALTH 77 R ' 3'�yL f�� � Fj ` '7�� •�D/����7 2oi/o/1 �1 -RH Y. !?S�ir�i.G�� DATE. . . . . %o i A( ZIDD.a?12. AGENT OR INSPECTOR I� � N Of • O 9 J. BI IF S&;Al ,.DESIGNING ENGINEER MUST SUPERVIS w• H INSTALLATION AND CERTIFY IN VJRITIN 14 J'OSE�t/• • DF/?A.QTi�/o, .1._ SYSTEM WAS INSTALLED IN 3TR;C � �0 �� /`Do C'jpoc,�E,Q• • 1�d 10RDANCE TO PLAN. s/STER PETITIONER : , JITAR�P� �° R Aekartmer:of,EnvgKnmental Management/Division of Water Resources _ WATER WELL COMPLETION REPORT WELL LOCATION Address l A-I �� City/Town G.S.Quadrangle Map Grid Location Owner mnr-° g he Y 10,r 4- p Ga Address es �r r,r I,,-V, R, i �AI. ell A, C_1�17PI WELL USE CONSOLIDATED WELL Domestic❑Q�Public ❑ Industrial ❑ Type of Water-bearing Rock Other Water-bearing Zones 1) From To Method Drilled a4 r 2) From To Date Drilled Q- J!- /r, 3) From To 4) From To i CASING Depth to Bedrock +t Length y r DiameteArl. Type P�L'l•_S r� UNCONSOLIDATED WELL STATIC WATER LEVEL Water-bearing'Materials /� Feet below land surface �� Sand: fine❑ medium Q' coarse❑,� Date measured Gravel: fine❑ medium❑ coarse❑ GRAVEL PACK WELL Screen: �/ Slot# 14 ength v from to Yes ❑ No Split Screen for 2nd screen) WATER QUA,CIITY TESTS MADE- Slog length from to Chemical ®°� Biological ❑ Depth To Bedrock PUMP TEST Drawdown feet after pumping days !!V hours at /9 GPM. r How measured / I .AOr n Recovery feet after hours. LOG of FORMATIONS COMMENTS: (On well or water) Materials From To 0 r yy,,ho; � � F -- n� J DRILLER/ Cb Firm ! I�G KJA� [Ap II d* A i�f( ►t�e ( � Address t elf ))> \ City Fare S*r 4r4rP Registration No. 14'-(C " pe"rators ignature ease print tirmly BOARD OF HEALTH COPY isln to ss sonot ENIIROTECH LABORATORIES 66 Lewis Bay Road • Hyannis• Massachusetts 02601 • (617) 771-7265 rmav-f wv CLIENT:Mee n Well Dri l ling Ca LOCATION: T,nt 4AA ADDRESS:Fnrestale, MA KPttIP Hole Rd W_ Rarnstable,MA COLLECTED BY: F.rl MPPhan SAMPLE DATE:9/22./86 TIME: 3:45 PM DATE RECEIVED:9/23/86 SAMPLE ID:ET 32A JOB #: New Well RESULTS OF ANALYSIS: Parameter units Reccniffiended limit Result na- Coliform bacteria/100 ml (MF) 0 0 P pH units 6.0-8.5 5.87 Conductance umhos/cm 500 144 Sodium mg/L 20.0 12.6 Nitrate-N mg/.L 10.0 2.1 Iron mg/L 0.3 .04 Manganese mg/L. 0.05 Hardness mg/L as CaCO3 500 Sulfate mg/L 250 Potassium mg/L 20.0 Alkalinity mg/L 200 COMMENT: Water is suitable for drinking purposes for all parameters tested. [.� DATE 17, . ( 9 j4 TOWN OF BARNSTABLE f a° ,a ; LOCAyTION a1 VILLAGE WjtzASSESSOR'S 'MAP LOT •. "x;t�. ' F . ^y i•:ti.,� _�J � F.1t tr �e r } �' � s !-; �d �i',• `4 �+�..�y�',� � t �s INSTALLER'S NAME. PHONE NO �i` � SEPTIC TANK'CAPACITY '•( �O.C�Qom-` ,., `' LEACH : ( LEACHING FACILITY* :' ) `�'. 4 / •, YPe t + size .(p( QAL `I Sid c NO. OF.BEDROOMS .F RIVATE,W OR PUBLIC WATER• •`i; . - � . BUILDER OR'OWNER DATE PERMIT ISSUED: ( 'ZZ ' + N DATE COMPLIANCE ISSUED• : 'y l VARIANCE GRANTED: Yes No "� S � r5„ f ' 7 11 a d 12-4 ----- Y2_� = R J � 14 a T +r7 - -- -- ___ *eML�1_3T4_VqV4 4. tT �,j' T- i 4f� C 1 17 Ill _ '4 f 4 ►i�t Q f tw o , Z� J L/O Oo o `' �rus���_wEsrw�il rzr rwALL 3=Ns7Y+u_NB�J n i c)iaDoUs -- O O L 7 . �) I CounitTv 5 PvRNIf rs1)9c1 hP 6 REPA/2CE�unIG CAn�� ovEnl MiCrtov/• all n^ VI ----- 119�^f �G7C i _ Pfj-irvr�STl;'in/ Gf/Aus� � s , 1 g�17 a r r /,PAinrT/ >ni..�ru uu�s eE�i : r s IPwaRA7R� ro 6 r P - y ..fhG�U.49-L I ��IVTP. REfRIG. a,A., L -JLRLL R�^1.5 FU2nitsHf-�57J3LL�uKP./� TUB _1risJ�rt u)i77/ 23o_ iRT31S1h��1 RMf., C(ZLi rs-ro-• —.BLU��-�SKtr�COATCEIt�C�— VAN � ,DINT ARM i 5 Pti7 i N7tILLSru�GM _ r : 00 .: l—t New CWsaooRS RM 1 *3-�INES7l�lUffi 1-- -Wig/zv_s��Gu uGrfT vn�El9��t2b ', _ a w _Mv DOLW AUS C6 u�lc To I— FJf_ A7L'l f Ek(S/Itilh _ j o OTES 6 , - a`+ - — - - — —— i a W QS Na (C WC, STRAPPING -- .1 -- (- --i-_ 3.GKPSur/ �4(4,rr/s/min/4LLCVAG[ /�9/J�la.-._ stf r lvi>JG NEw,Hn cowev2�- oacsN�eQur2Nrsr�i2 TRIM -779 Mrf-TC/f�kmnlCr .._._._ AND rood ea�Fr IT RNA7 'x/_ I _ S r Nt C�uyG 8�irl.n naOWV T7 BAs�F ur3 t eilNE no O 5SgGLVW6 ' i- - � i � �� ���� �� -��-� . ...- ;.r - I :�I'_g�ct.. /Jb'iJ � P/!/✓EL Pines-,Dac?'{"Tip DIN/NC _ .. -- - � - - . .i SAn(v,/pit ✓ c .�sr�s�e sH�TTt�Zsysnlm vs o FLU6R ,. : 2iJiaH�Tn/. /-L ,t/_,u.8f15E G9.8idsT(6')ni LilWJa2 ! !. I 1 i -- - , {{ rNFru I y -J7? 7i,�r� - �� Cto !nl� Aea I a ! Mao 1 ;-_L�-g_A ►-_FNIs—f(- aw FLocN�s�q^E � � ;.�izP�,: „_^ -- - A �-����:.>�-xr7 I�-•,- _� �ULIS_H KNf�WRLC R2c�uND STAIR I -- - � � --- ---- RIME PR('T fr7U1b1�CL 7�tT - -- _ ur FuQnll56f t1[�7l}I L 3:_lo-R4N�L I I L RAP I�VE P/dE FL OR pLYwooD f}zta� inl Pltil<_1�OG12S/F/� r3�NH/GOUfi2 I -: aPr IMFLL CIE J Z���RPo-IINGf3 vahD �Nszmc,CuxT�� �3 . I ' � I _-_-3_G�[_�o�R�r—iRo�gu.oz wa.��s _ �l�l f. t��D NSIA SH_5W/lnlG uboD \ —. C LA_Zp_1nIG A4 0 KR; I—v _&A/,USeoRT 7 PfFlnlrq 57TYN F/CL CEi(1UGs_ �' De-o:VfrJiT}/ I _. �} t�fJRNrsHs779LC G�l(11£ pin/ :fU�2_t��5(J}i/J r _ I f wAT1�X..Fi.Visy.Fuw��sf+ smc� rv8ys� j .. n5uit''FE�t� ��/LvrSFI���rs�-%U�/DE PiN��a> e � �R/ �/N.A_�7�r?�__ a 6•_o., OFr1CN S�iiJG;�.As_R���m _�Lvo21nIG , inl�.L//A7GOX,3GoATs� _._ - — _ $ REMOVEUNIr7 2��Ns..Tj1LL 9 ?Z _ 1/ sC3 —— - < Melf577n/6..Pr+Tul<tF/a/G( 3 uNrT'- .w.. __ - _ H 1.J i E• OJ-TS�oc ll wt� ,.: X 3 TICSO _ - ? -TI L Sffeds L/ J�cr �iy.Vq /s/c!/< nl4PLkcE -- _ __ ­.-SC COW FLoJRLRI _ FLOORFIRS PUN---------- T - — _ --- - HEATING SYSTEM Gas boiler Burnham/Well McLain or equal Indirect hot water heater Amtrol or equal Slant tin base board PL 2 heat zones "5`'s7-$ArEH9JT WMACOW6 - O � � � � - � � � � � �4 LOCAT7p� 1 zone for hot water heater _ 2 thermostats _ Gas piping N/A/ER Zone piping . Pul Fl P. Row valves,expansion tank ' Circulators for each zone and water heater .. Dryer vent ductwork . .. Bathroom exhaust ductwork All permits .. Alternate#1 Heat for new rooms/end floor IM Alternate Alternate HVAC System M ' HeaUAC combined - .. - Design Build ... - . UIJ��iJE'�� ��r✓G�/tom✓o - ... PLUMBING New laundry sink Reset existing toilet in laundry room - - - w Washer water and drain connection - Kitchen Sink with disposal Dishwasher - - - Gas connection to stove - - Water to fridge - First floor bathroom - - Rough to all fixtures .. - . Tub and shower valve . . ... ' New toilet New sink and faucet Second floor bathroom . New tub w/fiber9 las surround .. Tub and show .. - - .. er valve .. New toilet ee ` Doo. ME- New sink and faucet -_ - - - '� - Alternate#1 New bathroom 2nd floor : - ----- C1M�xekva-r�D . Owner to furnish bathroom sinks,kitchen sink,faucets,shower/tub valves ELECTRICAL - -New 200 AMP main panel New sub panel for emergency generator - . New circuits throughout the house - Install light fixtures furnished by Owners Cable/phone/data wiring 1FE7�no, r rZ6Rq�s10�r!ti�;... c2 Circuits for boiler,water heater,water pump,Irrigation.appliances,exhaust duct work _ - ALTERNATE#1 New rooms second floor - ALTERNATE#2 New natural gas emergency generator REPINE Sl�co"�f� , ALTERNATE#3 Alterhate HVAC systems I --/ 8 - A7 P—Ea)RED. DH I IIIJ.D .. HeaUAC combined . .. � � � � - �� � � � � Design build AIR CONDITIONING - Replace AC fan in attic 2nd Floor - - LOS frs .12FT�cfl Replace AC compressor for 2nd floor at rear of house Clean duct work, required as replace r - �P eq .477 Alternate#1 AC for new rooms 2nd floor - , Alternate#3 Alternate HVAC system Heat AC combined - Remove hydronic heat system complete and existing AC system -- Design build .. —- - ---- J. ... .. .. - - .. 05-a8an-e6...!ks. ?P.Jf�fiA 15t16145 /}ttp I . - 5733r/LS Tti Fay 6� UP TrJCLJDr�I(_ RRl r� �. �&si17— - '. .. tt STR D G Af�! !a Rs Rc4 JfR E — - - , r _ F JJc Io..F1ooR�ofs/ - - AD W F k/ Pfr� ��U ()tA71 ,D.r s kk t ' — y SD _S_MOKE_..D . ..c.I�R Ls�C�ONS l—�y_�� BASE ENT FM�I �s - BNs - --- _ - e Sarns�a blc ,� Iff _ , 010-Z OF t t �H� of 44}`� �o+a� ^\ \ \ a� Pain. JACOBI }w A. MERTHEW 5� 81432096 NATAXv R�P�,c • 2 �L \ \ 1 �h� \¢l��3. \\ 0 16 C 0.08 'f V• vJ � ll � A � 3 4- -c � i \ ,\ of ✓ p , \ r 0. 3 8. -01 --te �„ f .. �ti� n: \ %'� I / Soo-i5-oa w ��, f \ / \ "p 13 pot .. n . a d f i• 7, ;� . t 4 ; M r, • .:, . i I : : .w k 'l -q� / : �y,• �,s'` `• —,.,..,..�.... b _ f , •�. ,� �''� � .. ./—�`...o:.,n...,w• :.r••...r+.........«..,. .. .y^'^'"..... ` - i �— . Z \ � •.�\ .� .\- 2 Y r �^� � f f<_(/./��/�/ f i% � / - • / Q •*' t b IA r - Z ,I #�►-'" ..'i'n• v1 ' .p•*"' -..-. \ 1� h t(7 MI t Yf Y� xx 116 ol lool 1 4-1 00 _ r rUl �'� — 0'f i r 1p a 0 EPH lies . C�EMAf�TINO ZONE ' RF