HomeMy WebLinkAbout0009 LEONARD ROAD - Health 9 Leonard Road
W. Barnstable P
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ECOJECH IMP
Environmental pARCEL
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THIS FORM IS A FACSIMILE OF THE STANDARD SEPTIC INSPECTION FORM ISSUED BY THE MASSACHUSETTS DEPARTMENT
OF ENVIRONMENTAL PROTECTION(revised 6/15/2000) RECEIVED
TITLE 5
OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSJAWb 2004
SUBSURFACE SEWAGE DISPOSAL SYSTEM FO
' PART A TOWN OF BARNSTABLE
CERTIFICATION HEALTH DEPT.
Property Address: 9 Leonard Road
West Barnstable
Owner's Name: Ray Goldman
Owner's Address: 4 Canal Park#402
Cambridge,MA 02141
Date of Inspection: June 23,2004
Name of Inspector: (Please Print) David D. Coughanowr,R.S.
Company Name: Eco-Tech Environmental
Mailing Address: 43 Triangle Circle
Sandwich,MA 02563
Telephone Number: (508)364-0894
CERTIFICATION STATEMENT:
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:
X Passes
Conditionally Passes
Needs Further Evaluation By the Local Approving Authority
Fails
Inspector's Signature / -_ Ds Date: ^Tohp Z4 2yd4-
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
NOTES AND COMMENTS
Inspector's Note==> A septic system is deemed to pass this Real Estate Transfer Inspection if it does not trigger
any of the 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.
****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.
Title 5 Inspection Form 6/15/2000 page 1
Page 2 of 11
OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 9 Leonard Road
West Barnstable
Owner: Ray Goldman
Date of Inspection: June 23,2004
INSPECTION SUMMARY: Check A,B,C,D or E/ALWAYS complete all of section D:
A] System Passes:
Yes I have not found any information which indicates that any of the failure criteria described in 310 CMR
5.303 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,or 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 breakout or high static water level 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 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 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
ND explain
2
Page 3 of 11
OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 9 Leonard Road
West Barnstable
Owner: Ray Goldman
Date of Inspection: June 23,2004
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 and 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.
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 by a DEP certified laboratory, for coliform
bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and
the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other
failure criteria are triggered. A copy of the analysis must be attached to this form
3)OTHER
3
Page 4 of 11
OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 9 Leonard Road
West Barnstable
Owner: Ray Goldman
Date of Inspection: June 23,2004
D)System Failure Criteria applicable to all systems:
You must indicate either"yes"or"no"to each of the following for all inspections:
I have determined that one or more of the following failure conditions exist as described 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.
yes no
X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool.
X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool.
X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool.
X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow.
X Required pumping more than 4 tunes in the last year NOT due to clogged or obstructed pipe(s).Number
of times pumped
X Any portion of the SAS,cesspool or privy is below high groundwater elevation.
X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
X Any portion of a cesspool or privy is within a Zone 1 of a public well
X Any portion of a cesspool or privy is within 50 feet of a private water supply well
X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water
supply well with no acceptable water quality analysis.(This system passes if the well water analysis,
performed by a DEP certified laboratory, for coliform bacteria and volatile organic compounds
indicates that the well is free from pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria
are triggered. A copy of the analysis must be attached to this form)
No (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as
described in 310 CMR 15.303,therefore,the system fails.The system owner should contact the Board of
Health to determine what will be necessary to correct the failure.
E)Large Systems:
To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000
gpd
You must indicate either"yes"or"no" to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
yes no
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.
4
Page 5 of 11
OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 9 Leonard Road
West Barnstable
Owner: Ray Goldman
Date of Inspection: June 23,2004
Check if the following have been done: You must indicate either"Yes" or"No"as to each of the following:
Yes No
Y _ Pumping information was provided by the owner,occupant or Board of Health.
N Were any of the system components pumped out in the last two weeks?
N Has the system received normal flows in the previous two week period?
N Have large volumes of water been introduced to the system recently or as part of this inspection?
Y _ Were as built plans of the system obtained and examined?(If they were not available as N/A)
Y _ Was the facility or dwelling inspected for signs of sewage back-up?
Y _ Was the site inspected for signs of breakout?
including
Y _ Were all system components,exelud the SAS. located on site?
N Were the septic tank manholes uncovered, opened,and the interior of the septic tank inspected for
the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of
scum.?
Y _ Was the facility owner(and occupants,if different from owner)provided with information on the proper
maintenance of subsurface disposal systems?
For information on the proper maintenance of subsurface disposal systems please go to:
WWW.ECO-TECH.US
The size and location of the Soil Absorption System(SAS)on the site has been determined based on:
Y _ Existing information. For example,Plan at the Board of Health.
Y _ 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(3)(b)]
5
Page 6 of 11
OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 9 Leonard Road
West Barnstable
Owner: Ray Goldman
Date of Inspection: June 23,2004
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): n/a Number of bedrooms(actual): 2
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): n/a—No plan on file at Health Dept.
Number of current residents 0
Does the residence have a garbage grinder(yes or no): Yes—removal of garbage grinder is strongly recommended.
Is laundry on a separate sewage system(yes or no): no :(If yes, separate inspection required)
Laundry system inspected (yes or no): n/a
Seasonal use(yes or no):yes
Water meter readings,if available(last two year's usage(gpd): n/a—well in use
Sump Pump(yes or no): no
Last date of occupancy: 2 weeks ago
COMMERCIAL/INDUSTRIAL:
Type of establishment:
Design flow(based on 310 CMR 15.203):: gpd
Basis of design flow(seats/persons/sgft/etc.):
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/use:_
OTHER: (Describe):
GENERAL INFORMATION
PUMPING RECORDS
Source of information: System not pumped in recent past(Owner's agent)
Was system pumped as part of the inspection: (yes or no) No
If yes,volume pumped: gallons--How was quantity pumped determined?
Reason for pumping:
TYPE OF SYSTEM:
Septic tank,distribution box, soil absorption system
X Single cesspool
X Overflow cesspool
Privy
Shared system(yes or no)(if yes, attach previous inspection records,if any)
Innovative/Alternate 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:
System was installed in 1970 per previous inspection report
Were sewage odors detected when arriving at the site: (yes or no) no
6
Page 7 of 11
OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 9 Leonard Road
West Barnstable
Owner: Ray Goldman
Date of Inspection: June 23 2004
BUILDING SEWER_(Locate on site plan)
Depth below grade: not determined—dwelling is built on slab foundation with no access to building sewer provided
Material of construction:_cast iron _40 PVC_other(explain) not determined—see above
Distance from private water supply well or suction line 100+
Comments: (on condition of joints,venting,evidence of leakage, etc.)
SEPTIC TANK:none (locate on site plan)
Depth below grade:
Material of construction:_concrete_metal_fiberglass_polyethylene
_other(explain)
If tank is metal,list age_ Is age confirmed by Certificate of Compliance_(yes or no):_(attach a copy of
certificate)
Dimensions:
Sludge depth:
Distance from top of sludge to bottom of outlet tee or baffle:
Scum thickness:_
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
How dimensions were determined:
Comments: (on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity,liquid levels
as related to outlet invert,evidence of leakage,etc.):
GREASE TRAP: none (locate on site plan)
Depth below grade:
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:
Comments: (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet invert,evidence of leakage,etc.):
7
Page 8 of 11
OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 9 Leonard Road
West Barnstable
Owner: Ray Goldman
Date of Inspection: June 23,2004
TIGHT OR HOLDING TANK: none (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/day
Alarm present(yes or no):_
Alarm level: _ Alarm in working order(yes or no):_mpin Date of last pug:
Comments:(condition of inlet tee,condition of alarm and float switches,etc.)
DISTRIBUTION BOX: none (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert:
Comments:(note if box is level and distribution to outlets is equal,any evidence of solids carryover,any evidence of
leakage into or out of box,etc.)
PUMP CHAMBER: none (locate on site plan)
Pumps in working order: (yes or no)
Alarms in working order: (yes or no)
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
8
Page 9 of 11
OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 9 Leonard Road
West Barnstable
Owner: Ray Goldman
Date of Inspection: June 23,2004
SOIL ABSORPTION SYSTEM(SAS): Yes (locate on site plan;excavation not required)
If SAS not located, explain why:
Type:
_leaching pits,number
_leaching chambers,number
_leaching galleries,number
_leaching trenches,number, length
_leaching fields,number,dimensions
X overflow cesspool, number 1
—innovative/alternate 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 overflow cesspool appeared unsaturated.No evidence of surface ponding,breakout,lush vegetation,or
other evidence of hydraulic failure was observed. This component was dry.
CESSPOOLS: 1 Primary (cesspool must be pumped at time of inspection)(locate on site plan)
Number and configuration: 2 total—1 primary and one overflow described above
Depth-top of liquid to inlet invert: 4 feet
Depth of solids layer: 0
Depth of scum layer: 0
Dimensions of cesspool: 6 ft x 6 ft
Materials of construction: concrete block
Indication of groundwater inflow(yes or no): no
Comments: (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,
etc.):
Soils above primary cesspool appeared unsaturated.No evidence of surface ponding,breakout,lush vegetation,or
other evidence of hydraulic failure was observed.
PRIVY: none (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.):
9
Page 10 of 11
OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
j SYSTEM INFORMATION(continued)
I
Property Address: 9 Leonard Road
West Barnstable
Owner: Ray Goldman
Date of Inspection: June 23,2004
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'(Locate where public water supply enters the building)
LEONARD ROAD
WELL - OVER 100 FEET TO CESSPOOLS PER PREVIOUS INSPECTION REPORT.
A
EXISTING
DWELLING
# 0
PRIMARY
OCESSPOOL LOCATIONS
OVERFLOW
CESSPOOL A B C
1 41 ft 31.5 ft
2 29 ft 40 Ft
NOT TO SCALE
10
Page 11 of 11
OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 9 Leonard Road
West Barnstable
Owner: Ray Goldman
Date of Inspection: June 23,2004
I
SITE EXAM
Slope
Surface water
Check Cellar
Shallow wells
Estimated Depth to ground water: 35+ feet
Please indicate(check)all methods used to determine high ground water elevation:
Obtained from system design plans on record-If checked. date of design plan reviewed
Observed Site(abutting property/observation hole within 150 feet of SAS)
Checked with local Board of health-explain:
Checked local excavators,installers-attach documentation)
X Accessed USGS database
You must describe how you established the high ground water elevation.
Barnstable GIS department records indicate that property is over 35 feet above groundwater table.
I
i
11
q TOWN OF BARNSTABLE
LOCATION 1 Ltow� Q SEWAGE# 2-012— ZS
VILLAGE W e$t%rn$4A 4 ASSESSOR'S MAP&PARCEL 00
INSTALLER'S NAME&PHONE NO. 6fi A^74 Qv1 .?N-VKL(,vni$ tT1?t911I
SEPTIC TANK CAPACITY I S00 6J CSC l-7 SJ
LEACHING FACILITY:(type) NOC 367 WC (size) I2 x 21
NO.OF BEDROOMS Z
OWNER A 0 E
PERMIT DATE: :5-17-Q 13 COMPLIANCE DATE:
Separation Distance Between the: _
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility f/ Feet
Private Water Supply Well and Leaching Facility(If any wells exist on .-
site or within 200 feet of leaching facility) Z Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within
300 feet of leaching facili A✓A Feet
FURNISHED BY t4x ~ E,0-1
Q245 �.
32
3 z 32.5
q i-7°
No. l lr' Fee
THE COMMONWEALTH OF MASSACHUSETTS
Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
01pplication for Disposal *pstrm Construction Vermit
Application for a Permit to Construct( ) Repair(✓) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. 17 (f or,ti Wg Owner's Name,Address,and Tel.No.
Assessor'sMap/Parcel 136 pa"I �•
Installer's Name,Address,and Tel.No. S' Designer's Name,Address,and Tel.No.
n 1 2t .fin A-- �� IV\ -(2 s'0►�S'
Type of Building:
Dwelling No.of Bedrooms 2 Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
i
Other Fixtures
Design Flow(min.requir d) 7—Z•l7 gpd Design flow provided 333 gpd
Plan Date 2 / Z Number of sheets 2 Revision Date
Title
Size of Septic Tank Type of S.A.S. ►^
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) ?tebf C( d
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 this Board of Health.
Si d Date Z 3
b3
Application Approved by Date /�$/;?10
Application Disapproved by 100, Date
for the following reasons
Permit No. �1 Z_ Date Issued 5 7 2.613
No. ��2' / U n _ Fee
" THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
ftplication for Vsposal 6pstraConstrUction Permit
Application for a Permit to Construct( ) Repair(/) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. PGr ti �/� Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel 13G od qfj• �`1�I`�i-1
r
Installer's Name,Address,and Tel.No. r—n y 2 O,c s Designer's Name,Address,and Tel.No.
, ti Sorg,
Type of Building: ��
Dwelling No.of Bedrooms 2- f i/)/>}L-t�Size sq.ft. Garbage Grinder( )
Other Type of Building ' No'of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.requir d) Z —y gpd Design flow provided 33 gpd
i Plan Date / Number of sheets 2 Revision Date
Title
Size of Septic Tank /5-b y Type of S.A.S. S-
Description of Soil.�' ?/A
I i -
Nature of Repairs or Alterations(Answer when applicable) p . I f ( C, Phi o v
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 Athe Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
Si d Date Z
Application Approved by Date 5/23�ZT 13
Application Disapproved by Date
for the following reasons
Permit No. A 1 Z.— 7 t Date Issued � �20 1
---------------------------------------------------------------------------------------------------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY that thF On-site Swage Disposal system Constructed( ) Repaired(✓r Upgraded( )
Abandoned( )by n CI 2 f G� S��vt(`d✓-_
at � � �-Pd/`��R � (C- � has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No.y2a Z�� �^Z89 dated
�/23 I7,n 13
Installer j Gi r A C,'�— � Designer � .S o^c/ "1
#bedrooms 2 Approved design flow 2 Z a / / gpd
The issuance of this permit shall neMnsO/asguarantee that the system will 1`un ti �designedDate1 Inspector f
----------------- ---. -----------------------------------------------------------------------------------------------------------------
No. �O 7 ZBC) Fee*(QU
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
MispoBal 6p$tem Construction Permit
Permission is hereby granted to Construct( ) Repair( i') Upgrade( ) Abandon( )
System located at q /:e0JJ 9&:i) Q 64*11)
vGSz Ram 5;p?6
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions.
Provided:Construction must be completed within three years of the date of this permit.
Date �J.;�'�� Approved by
i
;�� ��
��� ��
C�� ��
��
t� �
� ��
ti���'
� J'� ,
���� Fee
No.
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
ftplication for Misposal Opstem Construction Permit
Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ,VComplete System ❑Individual Components
Location Address or Lot No. L � ��( Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.Nopjl_762
e-
Sox 6 6 L, Zn 3 "JI-Zo1-6 Q®k q pe,J'w r dam. C--4 U 2-r.3 7
Type of Building: _
Dwelling No.of Bedrooms Lot Size 24C'-/(2 Z sq.ft. Garbage Grinder(AAA
Other Type of Building c3'i�L �1-44pft4 No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided gpd
Plan Date Z Number of sheets Revision Date
Title
Size of Septic Tank Zs--ZT Type of S.A.S. 514,ei/-2.1e_.✓.5
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) /e®/qc.0 /�.4�/�C� cej:s, ao / !+✓ice,
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 this Board of H lth.
Signed Date �P—/,5_,/Z
Application Approved by Date
Application Disapproved by Date
for the following reasons
Permit No. g O I�2- Date Issued
------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
(Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired;(G� Upgraded( )
Abandoned( )by l,/ � � ✓ ��yZl�.� � �C'
at 1,t C1- has been constructed in accordance
with the provisions of Title 5 and the for Disposal -A
±System Construction Permit No. d-0 I '267dated
Installer �-% U4y1 i dP,�-vim .Zr�c. Designer Are(/2�< S,4oy J- ��-
#bedrooms ?_ Approved design flow' a-o 'gpd
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
Date Inspector
pl Fee
y --� �� � ... � Y
No.
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH-VvISION,'-TOWN OF BARNSTABLE;,MASSACHUSETTS Yes
Zipplicatlon for -Misposal *pstem Construction Permit
Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ,Complete System ❑Individual Components
Location Address or Lot No. ?1 eo v ,,1 R Owner's Name,Address,and Tel.No.
I Assessor's
Map/Parcel 3616j g L✓� �3 �~�,,
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.j?,f 362
°ts ,S/a- -Frhiy IPig c G 2.rvG A-+.c ye.-.4 Jon S
0k Zoe 0 3o x g,F/ fA.
Type of Building:
� 71
Dwelling No.of Bedrooms 7 Z
Lot Size / z2� sq.ft. Garbage Grinder(AOO
Other Type of Building 1,/1 No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 2 C gpd Design flow provided 33 7,, (o U gpd
Plan Date �-/Z -'i 2- Number of sheets Revision Date 4 V A"t
Title
Size of Septic Tank /5:Z2 Type of S.A.S. 47 e r1
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) Ae/7r-t
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 this Board AHe lth.
' Signed Date Z
Application Approved by Date
Application Disapproved by Date
for the following reasons
Permit No. O 12 a�/ Date Issued .Z-
- --- - - - -- ----' - - --- - ------- M------------------------------------------
�
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
(Certificate of Compliance
s THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired W) Upgraded( )
Abandoned( )by S�- A41,.te J45/-.rGG
� (� �- x
at � L• Q UN�-r d �- has been constructed in accordance G;
with the provisions of Title 5 and the for Disposal System Construction Permit No. -�0�� ~'� dated
Installer ZU/S i'�/��� ✓ Y7 'u�r JC'.��. Zi+�L Designer 111f C°//�.✓ ►� S�t�I/1 ::7~�
#bedrooms Z Approved design flow 0 a- 0 and
The issuance of this permit shall not be construed as a guarantee that the system will function as designed. {
Date ? + Inspector!
.--------— --.---- -g _ --- - -. ----.-----.------- ------------------ -------------------------------- --
No. �� a 0 Fee /0
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
]Disposal *pstrm Construction Permit'
Permission is hereby granted/to Construct( ) Repair X) Upgrade( ) Abandon( )
System located at 'f, -e ON4✓d X04 d
Ll/e S7
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions.
Provided:Construction must be completee within three years of the date of this permif
Date� � 7 Approved by
JUN/03/2013/iU1CN 03:'21 FM FAX No. P. 001
Town of Barnstable
Reg1lflatoxy Services
Thomas F.Geller,Director
]PubUc Health Division
Thomas l eXcan,Director
200 Main Street,Hyannis,yi a 02601
Off`icx; 508-8624644 Fast: 508-790-6304
Installer&DesJoer Certification Form
Bate: I�W-S Sewage Permits O ssessor's Itilagil�arcel � -7
r
Designer: 9-VI-Is Installer: (A I- '►✓4'
Address: _0bA 9 SS4 Address: 46 Cr-0 Irt l fZl�
On `!,-,, h T 2 was issued a permit to install a
(date) (installer)
septic system at 1/1G�t� G4 �9� Atniased on a design drawn by
(address)
f 0 . dated
(designer)
I certify that the septic system referenced above was iastal.led substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box andlor 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 anv vertical relocation oFany component
of the septic system) but ixa accordance with State&. Local Regularior_s. Plan revision or
certified as-built by designer to follow.
s
I � G
DA s
(Installer's$igucare) " o. 1140
REG/SIFD
�N1 TA41�p�
(Designer's Signaw.re) (Afft,Designer's Stamp Here)
PLEASE RETURN TO BA rSTABLEPUBLIC HEALTH )DIVISION. CERTIFICATE OF
COMPLIANCE WILL NOT BE ISSUED UNTIL, BOTH THIS FORIM AND j--%.S-BUILT CARD ARE
RECEIVED BY THE.BAFLNSTaBL'E PUBLIC HEALTH)DIVISION. THANK YOU.
Q:HeakWeptic/Designer Certificaiion Form 3-26-01:doc
i
Town of BAIMStable P#
5�
Department of Regulatory Services
L&,
Public Health Division Bate
� �ARIi4rAB � I .
i6!5F¢ /3 2��n Strc e4 Hyannis MA 02601
Fee Pd. v''
Date Scheduled Time '
i
i
Soil Suitability Assessgent,fop Selpyge Disposal
Performed By: RA& Witnessed By:
i
LOCATION & GENERAL INFORMATION
Location Address 0 pop
Owner's Name �L
/ 1. ►T1�- K-(7
'W , i3A-" S j"UIG Ann 4 I Address
Assessor's Map/P4rcel: !7j•�/ab I Engineer's Name tea,jeV%e,,L /4'r'�'`2�
i i.
NEW CONSIRU�,20N REPAIR � j Telephone# .,SOS -3 0' 3- ►/
Land UseN Slopes(90) 10'- S��' Surface Stones
Distances from: Open Water Body y Ze�o ft Possible Wee Area �` ft Drinking Water Well ft
Drainage Way y �BD ft Property Line >!D ft Other ft
I�
----------- U
SKETCH'Oreet name ' ` / locate wetlands in proximity to holes)
1 1
150' 100•
Tor
CIZO
VW IA
l� vent 1�, 2, 18• ��; �ji ��
J,1 .tt 'ol�,
,,2-,�4�,
(�Q ,�" �\ ♦\ 3g� RUC \\
t _
\ S32'&4'20"E
a 1 �u1wa5�1 !
Palen[material(geologic) I Depth to Bedrock
Depth to Groundwater. Standing Water in Hole:' i Weeping from Pit FAce.
Estimated Seasonal;High Groundwater /� - f
D#,TERIVIINATION FOR SEASONAL HIGH wATRR TALE
Method Used: I i
Depth obperved standingan obs.hole: in. Depth td soil mottles: In,
Depth toiweeping from side of obs.hole: ! in, Cirouadwater Adjustment �t
! Adj.ACtOr,,•..re— AdJ.flrnundwaterLevel,,e
Index Well#_ Reading Date: Index Well level
. i .
PERCOLATION TEST Datp-e--•—. Tlme •
Observation 1 Tiineat9"
Hole# i lV
Depth of Pere q2-66 Time at 6" M ....------
!n Start Pre-soak Time,@ I Time(9"-6")
!d 2-T
End Pre-soak !
Rate MinJInch
Site Suitability Assessment: Site Passed)_ Site Failed:
Additional Testing Needed(Y/N)
original:,Public blalth Division Observation Hole Data To B e Completed on Back—
***If percola i6n test is to be conducted within Ioo, of wetland,you must first notify the
or to beginning.
Barnstable Conservation Division at least one (1) wedk pri
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
.Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency.%Gravel
A L,a Skh l ,mil N
-TV, 11 ' 62, Sl jf'1d tl
2• S��
I l q'' j1, C a h 2.5Y 7�2.
DEEP OBSERVATION HOLE LOG Hole# 2
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistenc %Gravel)
0 �2 A- rrt l,/ N l�
T
3 "- "
11 LG" z (- 3 w Z ?�
DEEP OBSERVATION HOLE LOG Hole# /V
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistenc %Gravel
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Ho' Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones.Boulders.
Consistency. ra 1
�c
Flood Insurance Rate Map:
Above 500 year flood boundary No Yes
_
Within 500 year boundary No v Yes,
Within 100 year flood boundary No Yes
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pervious material exist.in all areas observed throughout the
area proposed for the soil absorption system? e
If not,what is the depth of naturally occurring pervious material?
Certification
I certify that on (date)I have passed the soil evaluator examination approved by the
Department of Envir nmental Protection and that the above analysis was performed by me consistent with
the required ing,expertise and experience described in 3.10 CMR 15.017.
Signature Date J Z
Q:6SEPTICTERCFORM.DOC
ECOJECH
Environmental
www.eco-tech.us
THIS FORM IS A FACSIMILE OF THE STANDARD SEPTIC INSPECTION FORM ISSUED BY THE MASSACHUSETTS DEPARTMENT
OF ENVIRONMENTAL PROTECTION(revised 6/15/2000)
TITLE 5
OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A C9
CERTIFICATION
Property Address: 9 Leonard Road $4
West Barnstable
Owner's Name: Rav Goldman pa
Owner's Address: 4 Canal Park#402 _.
Cambridge,MA 02141
Date of Inspection: June 23,2004
Name of Inspector: (Please Print) ,David D. Coughanowr,R.S.
Company Name: Eco-Tech Environmental
Mailing Address: 43 Triangle Circle
Sandwich,MA 02563
Telephone Number: (508)364-0894
CERTIFICATION STATEMENT:
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:
X Passes
Conditionally Passes
Needs Further Evaluation By the Local Approving Authority
Fails
Inspector's Signature s Date: 104e 2, 2&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
NOTES AND COMMENTS
Inspector's Note==> A septic system is deemed to pass this Real Estate Transfer Inspection if it does not trigger
any of the 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.
****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.
Title 5 Inspection Form 6/15/2000 page 1
Page 2 of 11
OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 9 Leonard Road
West Barnstable
Owner: Ray Goldman
Date of Inspection: June 23,2004
INSPECTION SUMMARY: Check A,B,C,D or E/ALWAYS complete all of section D:
A] System Passes:
Yes I have not found any information which indicates that any of the failure criteria described in 310 CMR
5.303 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,or 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 exfiltratio or tank failure is imminent. System will ass inspection if n, y p specUo 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 breakout or high static water level 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 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 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
ND explain
2
Page 3 of 11
i
OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 9 Leonard Road
West Barnstable
Owner: Ray Goldman
Date of Inspection: June 23,2004
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 and 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.
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 by a DEP certified laboratory, for coliform
bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and
the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other
failure criteria are triggered. A copy of the analysis must be attached to this form
3) OTHER
3
Page 4 of 1 I
OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 9 Leonard Road
West Barnstable
Owner: EW Goldman
Date of Inspection: June 23,2004
D)System Failure Criteria applicable to all systems:
You must indicate either"yes"or"no"to each of the following for all inspections:
I have determined that one or more of the following failure conditions exist as described 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.
yes no
X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool.
X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool.
X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool.
X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow.
X Required pumping more than 4 tunes in the last year NOT due to clogged or obstructed pipe(s).Number
of times pumped
X Any portion of the SAS,cesspool or privy is below high groundwater elevation.
X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
X Any portion of a cesspool or privy is within a Zone 1 of a public well
X Any portion of a cesspool or privy is within 50 feet of a private water supply well
X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water
supply well with no acceptable water quality analysis.(Th is system passes if the well water analysis,
performed by a DEP certified laboratory, for coliform bacteria and volatile organic compounds
indicates that the well is free from pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria
arc triggered. A copy of the analysis must be attached to this form)
No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as
described in 310 CMR 15.303,therefore,the system fails.The system owner should contact the Board of
Health to determine what will be necessary to correct the failure.
E)Large Systems:
To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000
gpd
You must indicate either"yes" or"no"to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
yes no
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 stem is located in a nitrogen
system troge 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.
4
Page 5 of 11
OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 9 Leonard Road
West Barnstable
Owner: Ray Goldman
Date of Inspection: June 23,2004
Check if the following have been done: You must indicate either"Yes"or"No"as to each of the following:
Yes No
Y _ Pumping information was provided by the owner,occupant or Board of Health.
N Were any of the system components pumped out in the last two weeks?
N Has the system received normal flows in the previous two week period?
N Have large volumes of water been introduced to the system recently or as part of this inspection?
Y _ Were as built plans of the system obtained and examined?(If they were not available as N/A)
Y _ Was the facility or dwelling inspected for signs of sewage back-up?
Y _ Was the site inspected for signs of breakout?
including
Y _ Were all system components,excluding the SAS. located on site?
_ N Were the septic tank manholes uncovered, opened,and the interior of the septic tank inspected for
the condition of the baffles or tees,material of construction,dimensions,depth of liquid, depth of sludge and depth of
scum.?
Y _ Was the facility owner(and occupants,if different from owner)provided with information on the proper
maintenance of subsurface disposal systems?
For information on the proper maintenance of subsurface disposal systems please go to:
WWW.ECO-TECH.US
The size and location of the Soil Absorption System(SAS)on the site has been determined based on:
Y _ Existing information.For example,Plan at the Board of Health.
Y _ 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(3)(b)]
5
Page 6 of 11
OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 9 Leonard Road
West Barnstable
Owner: Ray Goldman
Date of Inspection: June 23,2004
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): n/a Number of bedrooms(actual): 2
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): n/a—No plan on file at Health Dept.
Number of current residents 0
Does the residence have a garbage grinder(yes or no): Yes—removal of garbage grinder is strongly recommended.
Is laundry on a separate sewage system(yes or no): no :(If yes, separate inspection required)
Laundry system inspected (yes or no): n/a
Seasonal use(yes or no):yes
Water meter readings, if available(last two year's usage(gpd): n/a—well in use
Sump Pump(yes or no): no
Last date of occupancy: 2 weeks ago
COMMERCIAL/INDUSTRIAL:
Type of establishment:
Design flow(based on 310 CMR 15.203):: gpd
Basis of design flow(seats/persons/sgft/etc.):
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/use:_
OTHER: (Describe):
GENERAL INFORMATION
PUMPING RECORDS
Source of information: System not pumped in recent past(Owner's agent)
Was system pumped as part of the inspection: (yes or no) No
If yes,volume pumped: gallons--How was quantity pumped determined?
Reason for pumping:
TYPE OF SYSTEM:
Septic tank,distribution box, soil absorption system
X Single cesspool
X Overflow cesspool
Privy
Shared system(yes or no)(if yes,attach previous inspection records,if any)
Innovative/Alternate 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:
System was installed in 1970 per previous inspection report
Were sewage odors detected when arriving at the site: (yes or no) no
6
Page 7 of 11
OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 9 Leonard Road
West Bamstable
Owner: Ray Goldman
Date of Inspection: June 23,2004
BUILDING SEWER_(Locate on site plan)
Depth below grade: not determined—dwelling is built on slab foundation with no access to building sewer provided
Material of construction:_cast iron _40 PVC_other(explain) not determined—see above
Distance from private water supply well or suction line 100+
Comments: (on condition of joints,venting,evidence of leakage,etc.)
SEPTIC TANK:none (locate on site plan)
Depth below grade:
Material of construction:_concrete_metal_fiberglass_polyethylene
other(explain)
If tank is metal,list age_ Is age confirmed by Certificate of Compliance_(yes or no):_(attach a copy of
certificate)
Dimensions:
Sludge depth:
Distance from top of sludge to bottom of outlet tee or baffle:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
How dimensions were determined:
Comments: (on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet invert,evidence of leakage,etc.):
GREASE TRAP: none (locate or,site plan)
Depth below grade:
Material of construction: concrete metal fiberglass polyethylene
— g —
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:
Comments: (on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet invert,evidence of leakage,etc.):
7
Page 8 of 11
OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 9 Leonard Road
West Bamstal le
Owner: Ray Goldman
Date of Inspection: June 23,2004
TIGHT OR HOLDING TANK: none (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:_gallonstday
Alarm present(yes or no):_
Alarm level: _ Alarm in working order(yes or no):_
Date of last pumping:
Comments:(condition of inlet tee,condition of alarm and float switches,etc.)
DISTRIBUTION BOX: none (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert:
Comments:(note if box is level and distribution to outlets is equal,any evidence of solids carryover,any evidence of
leakage into or out of box, etc.)
PUMP CHAMBER: none (locate on site plan)
Pumps in working order: (yes or no)
Alarms in working order: (yes or no)
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
8
Page 9 of 11
OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 9 Leonard Road
West Barnstable
Owner: Ray Goldman
Date of Inspection: June 23,2004
SOIL ABSORPTION SYSTEM(SAS): Yes (locate on site plan;excavation not required)
If SAS not located,explain why:
Type:
_leaching pits,number
leaching chambers,number
_leaching galleries,number
_leaching trenches,number,length
_leaching fields,number,dimensions
X overflow cesspool, number 1
—innovative/alternate 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 overflow cesspool appeared unsaturated.No evidence of surface ponding,breakout,lush vegetation,or
other evidence of hydraulic failure was observed. This component was dry.
CESSPOOLS: 1 Primary (cesspool must be pumped at time of inspection)(locate on site plan)
Number and configuration: 2 total—1 primary and one overflow described above
Depth-top of liquid to inlet invert: 4 feet
Depth of solids layer: 0
Depth of scum layer: 0
Dimensions of cesspool: 6 ft x 6 ft
Materials of construction: concrete block
Indication of groundwater inflow(yes or no): no
Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,
etc.):
Soils above primary cesspool appeared unsaturated.No evidence of surface ponding,breakout,lush vegetation,or
other evidence of hydraulic failure was observed.
PRIVY: none (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.):
9
Page 10 of 11
OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 9 Leonard Road
West Barnstal:le
Owner: Ray Goldman
Date of Inspection: June 23,2004
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'(Locate where public water supply enters the building)
i
LEONARD ROAD
WELL - OVER 100 FEET TO CESSPOOLS PER PREVIOUS INSPECTION REPORT.
A
EXISTING
DWELLLJING
6 J C
PRIMARY
OCESSPOOL LOCATIONS
OVERFLOW
CESSPOOL A B C
1 41 ft 31.5 ft
2 29 f t 40 f t
NOT TO SCALE
10
r
Page 11 of 11
OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 9 Leonard Road
West Barnstable
Owner: Ray Goldman
Date of Inspection: June 23,2004
SITE EXAM
Slope
Surface water
Check Cellar
Shallow wells
Estimated Depth to groundwater: 35+ feet
Please indicate(check)all methods used to determine high ground water elevation:
Obtained from system design plans on record-If checked. date of design plan reviewed
Observed Site(abutting property/observation hole within 150 feet of SAS)
Checked with local Board of health-explain:
Checked local excavators,installers-attach documentation)
X Accessed USGS database
You must describe how you established the high ground water elevation.
Barnstable GIS department records indicate that property is over 35 feet above groundwater table.
11
Commonwealth of Massachusetts
q
Executive Office of Environmental Affairs S 19
96
96
m,
William F. Weld
Govemor
Trudy Coxe
Secretary.ECEA
David B. Struhs
Commissioner
tI7J +o SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
O + PART A
CERTIFICATION
Property Address: y eeo.lurc/ leoQq� OPW5 MO/L Address of Owner: jeal oG.
Date of Inspection: -311 y�o (If different)
Name of Inspector: C u/p lyn Day%
Company Name, Address and Telephone Number:
qjV 6v//y t.eene
Sci4 �vIc 1,, '"4 0�5�,3
CERTIFICATION STATEMENT (SbB)X KT—y'/7-LS
I certin• that I have personall, 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 sy
Pais _P `�
.P dmonally Passes �� '�'
'eeds Funher Eyaliation By the Local Approving Authority qv'a ,/�', ,s•�r f.f.',�
Fails 4^"�
% Date: ,3�i�/96V110.
5;3
Inspector's Signature:
PLO.::ai53 i
�rJTL,.✓ ' `' •'
E� f\
The System Inspector shall submit a cope of this inspection report to the Approving Authority within thirty (30) days of com
inspection If the system is a shared systen-, or F,as a design fioy, of i0,000 gpd or greater, the inspector and the system owns,
the report to the app,00•:a:e ,ee-o-at ofi:c_ of the nepanmen.t of Environmental Protection.
i ne ori£i a.
INSPECTION SUh1N1AR1:
Check A. B. C, or D
A] SYSTEM PASSES:
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)
AZD 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.
(revised E/15/55;
One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 • Telephone(617)292-5500
t
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: y Le6T✓74r r'cl' 1�d,j 6a~W-5b1 e
Owner: Ray G• 600r�.yiu�
Date of Inspection: 91//1,76
BJ SYSTEM CONDITIONALLY PASSES (continued) /
�✓er-F/OW fP��od ,
V/ Sewage-68elttjp e��high static water level observed in the d+stfibUtiON ilex is due to der 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
LU 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 o the Board of Health):
broken pipe(s) are replaced
obstruction is removed
C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the
public health, safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER
WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
_ Cesspool or privy is within 50 feet of a surface water
Cesspool or pnv%! 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 PROTECT THE PUBLIC HEALTH AND SAFETY AND THE
surface N%ater supply.
_ The svge�- ha, a Sept c tank and soil absorption system and is within a Zone I of a public water supph wel:
_ The s\stem has a septic tank and soi! absorption system and is within 50 feet of a private water supply weii.
_ The s�sten-, has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private s�a:er
supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the vvell 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 faciliy 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/:`_/55) 2
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: cl Leo17, —d led/
Owner: 2u y G.
Date of Inspection: 3j///f01
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 cesspoo! 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.
El LARGE SYSTEM FAILS:
The follov;ing criteria appi, to lane systems in aod:t:on to the criteria above:
_ The oe_ign i!o\% of stem. :_ iO,G J gp o.- grey:e: (Large System'. and the system is a significant threat to public health and safe,;
anti the environment because on- or more of tn,� foiiowing condit;on_ exist.
the system is within 400 feet of a surface drinking water supply
the system is vv ithin 200 feet of a tributary to a surface drinking water supply
_ the s.stenr :s located :n a nitrogen sens:i:ve area (Interim Wellhead Protection Area MAIPA) or a mapped Zone II of a
pubic v.ater sup.,r, v,e:
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: ? teOhu,`d �eU'�
Owner: ka y Co• 6 0C?C 1-* a-7
Date of Inspection:
Check if the following have been done: .
Pumping information was requested of the owner, o�aai, and �. �he��r
None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates
d ring that period L ge volume= of water have not been introduced into the system recently or as part of this inspection.
(�wellf ny (JSPc av
0✓1 4✓e&,e_o_ s P�h/y
IVA As built plans have been obtained and examined. Note if they are not available with N/A.
The facility or dwelling was inspected for signs of sewage back-up.
_ZThe system does not receive non-sanitary or industrial waste flow
_ZThe site ,vas inspected for signs of breakout.
inc min 9
i/,AII system components, e> ad+cK the Soil Absorption System, have been located on the site.
The --ki-lew, were uncovered, opened, and the interior of the se�FrFiank was inspected for condition of baffles or
tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum.
II; /The size and,location of the Soil =,bsorption System on the site has been determined based on existing information or
approxima'ec U.
_ ::.._... :.._. -.... � e n•n�'iCje.;t a.'it� in(n..--?tinn nn tho nrnno- maintenance Of SUI?-
Surface Disposal System
(revised 8/15/55; 4
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: l
Lec7nal-cl led, 6urhs�zib/2
Owner: WaY G. Goodfw, qr2
Date of Inspection: 3////96
FLOW CONDITIONS
RESIDENTIAL:
Design flow: 330 Rallons
Number of bedrooms:—_
Number of current residents: ,purT-1-714e)
Garbage grinder (yes or no): e5
Laundry connected to system (yes or no):41iS
Seasonal use (yes or no):-yjf--5
Wa:er meter readings, if available: 617-51-re- iced
Last date or occupancy: 7-(NeeKe.x�S o� �Y a /--77i--- 7711-7e
CO..Ntti1ERCIAUINDUSTRIAL:
Type of establishment:
Design flov.:__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:
Las; date of occupancy:
OTHER: i,--)escribel
Las: date e° occupancy.
GENERAL INFORMATION
PUMPING RECORDS and source of information:
nP,rer- OL9v'.dee%e-, Ou."n e r'
System pumped as car. of inspection wes or no` $ �d O�
11 3/r3�9�0
\•es, volurno c,;r. r._ oo gallons �r LrI// K30ds r7 B
Reason for pumping; rr0s.D�n/ /`e�yi%��5 �m�ih9 �er Ie9cllQ7l'o`1S
TYPE OF SYSTEM t/
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: _;45M11fW 1/7 /920 ee?- O.r//Je P-"
Sewage odors detected when arriving at the s4e: (yes or no)aO
z
(re-:: -/15/55) S
sed
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: led /3giw57`gble
Owner:
Date of Inspection: V111176
SEPTIC TANK:1Ar
(locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _FRP —other(explain) s
Dimensions:
Sludge depth:
Distance from top of sludge to bottom of outlet tee or bafiie:
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.)
GREASE TRAP:.4,'O
(locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _FRP _other(explain;
Dimensions
Scun. ;nlc�ne:.
Distance from top of scum to top of outlet tee cr baffle:
f`:�,a„ P f.nm �.�ttnm n. cr •-. �,. !�nCf�r^ Ci' C';�•�P IPP n �.�n�r.
Comments:
(recommendation for pumpinC. condition o-. inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural
integrity, evidence of leakage etc
(revised 2;:5/95) 6
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: Le0ilQrGl IeC19 da rJ5T7I b�C'
Owner: Zuy G� 600ce�iQr!
Date of Inspection: 31111,7p
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/dad
Alarm level:
Comments:
(condition of inlet tee, condition of alarm and float switches, etc.)
DISTRIBUTION BOX:A)
(locate on site plan'
Depth of liquid level above outlet invert:
ICI
Comments
_ ;d ��Cc G
(noie n ie�e, c'1U U:�l� �u iy,.: c• .,_ .:i .�, ..�. �.. :4, ;�•�:, . lcd,agE IC;v C: C.,.,. . e'.c.'
PUMP CHAMBER:—.6/W
(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) 7
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: E'C'J h G/'a,
Owner: G. GOo a�hiArl
Date of Inspection: 3////9to
SOIL ABSORPTION SYSTEM (SAS): +�
(locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods)
If not determined to be present, explain:
Type:
leaching pits, number:_
leaching chambers, number:_
leaching galleries, number:
leaching trenches, number,length:
leaching fields, number, dimensions:
overflow cesspool, number:_/
Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.) fPcar�G* fPSS�Poo/ %S
l-h ,7 v / he e h4, Y�
CESSPOOLS:
(locate on site plan) /
SAS
Number and configuration: a (-.l oyet-00-15 T"O 5eco"70/,
Depth-top of liquid to inlet invert: it
Depth of solids layer:Depth of scum layer: D��
i
iCr e�`eI"
Dimensions of cesspool: Qa,AyX, r'e G/
Materials of construction COrrcl-eTe blocK hyi7;t OPe� \/O'�//TS
inc;ca; o, c.'grc ,, .Z:c ✓Jo/'Ie-
inflow (cesspool must be pumped as part of inspection)
Comments: (note condition .of soi', signs of hydraulic failure, level of ponding, condition of vegetation, etc.;
r at Tye
3/c%e T�P ` o ve
a„ '1 "' >/� � °
ed cove
Pool 60"s-6 el rod °
PRIVY: Nlo
Materials N
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:
Owner: /Cm y G•
Date of Inspection: 111j1196
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchn3AS
locate all wells within 100' C I-eOl7u le
;✓aver svp��j� 'Well
gar �s f
0
r
a5 .0`
ove�f'/o w
00
DEPTH TO GROUNDWATER
Depth to groundwater: > 8 feet
method of determination or approximation: 70 'Glf'i!c<! OF grp�/rrG�uJu)`P/" i`,Y Sep�nr�� Cc�SS,�Oo/
(rev_sed 5/15/95, 9
BARNSTABLE
E LEGEND CAPE COD BAY
TIN LEONARD ROAD
uPOLE ��, PROPOSED CONTOUR A
33�`'—y_ ® PROPOSED SPOT GRADE :, S NECK
� J. S43'30'2�" � � BEAA CH
Ck t02.61 — — EXISTING CONTOUR :
� ♦/ �g �� + 96.52 - EXISTING SPOT GRADE
W— EXISTING WATER SERVICE gyp• 'N LOCUS
5 F7, 501E _ ♦♦ TEST PIT �G'F 9 LEONARD RD.
REMOVAL �/ �''�' ♦ P�,o :'
// �e ♦♦
LOT 13A / � �
rasp ports �`!Q - -0
20" U ER.
CEDAR C.
vent_ ». - nR ,So, <a� LOCUS MAP
LOT 6
.1O PARCEL ID:0• N� LOCUS INFORMATION
�
` 3 .. ... 136/009
in LA p"7 /e/ %%% AREA=28,112f S.F.
j I wi to,—%;;;; TITLE REF: 25934/43
�" PARCEL ID: MAP 136 PAR. 009
NOT IN ZONE� ( 4 o I FLOOD ZONE:
I I'C"
I, Mp e #9 lee, COMMUNITY PANEL: 250015-0001—D DATED:07/02/92
e,2—BEDROOIv'
.... DWELLING ... WELL
12" - 38�,` i ';;;, f.00 �t.... ;;;;,, SEPTIC SYSTEM
OF-
iii OF37.00 (qSf
I � 3 _
`TR'/OA,1 .1. REPAIR PLAN
LOCATED AT:
9 LEONARD ROAD
OVERPLQW
�� CESSPOOL \
N ; BARNSTABLE, MA.
PREPARED FOR
S32*$42p"f ���� WI LLI AM F. AH LEM EVER
3
r Q
1PROP. 1 ,50OG 2oo.00 AhN SEPTEMBER 12, 2012
5EPTIC TANK H20)
Al. OF A!q
I F
LOT SA �
F ,
1
DP,RF� � M.
vMEYER
No. 1140 ICI v
I �E6/STENO
GENERAL NOTES: SANITAR�aa
1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY
BOARD OF HEALTH AND THE DESIGN ENGINEER. THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING
2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS CONSTRUCTION.
OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE 10. EXISTING CESSPOOLS TO BE PUMPED, CRUSHED AND FILLED PER TITLE V.
LOCAL RULES AND REGULATIONS.
3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION 9
TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY MEYER & SONS, INC.
DESIGN ENGINEER. AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY
4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING 13. ALL AFFECTED PRIVATE WELLS ARE SHOWN ON THE SITE PLAN.
FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN 14. ALL PIPING TO BE 4" SCH 40 ® 1/8"/FT (UNLESS SPEC: OTHERWISE) P.0. BOX 981
ENGINEER BEFORE CONSTRUCTION CONTINUES. 15. THE DESIGN OF THIS SYSTEM DOES NOT ALLOW `
5. ALL ELEVATIONS BASED ON ASSUMED DATUM. FOR THE USE OF A GARBAGE GRINDER
6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF EAST SANDWICH, M A. 02537
THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF 16. NO WETLANDS WITHIN 100 FT. OF PROPOSED LEACHING
HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION, 17. INSTALLER TO REMOVE UNSUITABLE SOILS 5 FEET AROUND PROP. LEACHING 7. WATER SUPPLY PROVIDED BY PRIVATE WELL. TO EL. 26.50 OR TOP OF "C3" LAYER AND REPLACE WITH CLEAN MEDIUM SAND (5 0 8)3 6 2—2 9 2 2
8.ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED PER TITLE 5.
TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR.
SCALE: 1"=30'
„ SHEET 1 OF 2 J 1424
t
r, f}
NOTE: TO PREVENT BREAKOUT, THE PROPOSED
NOTE: MAGNETIC TAPE TO BE PLACED OVER ALL COVERS FINISH GRADE SHALL NOT BE < EL:33.91
FOR A DISTANCE OF 15' AROUND THE
1 PERIMETER OF THE S.A.S.
SEPTIC TANK PROPOSED D-BOX PROPOSED S.A.S.
T.O.F. EL.=37.00
INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & COVER INSTALL A 4" DIAMETER INSPECTION PORT OVER INSTALLED
t� OUTLET AND SET TO 6" OF FINISH GRADE SET TO 6" OF GRADE ONE CHAMBER (MIN.) AND SET TO 3" OF F.G.
F.G. EL:=36.8t LENGTH �10 OF ,yAs9
F.G. EL.=36.50t F.G. EL•36.50t F.G. EL: 36.5(MAX.) �. S
9.45.
D"RE9" MIN COVER/ VENT `L = 12't 36" MAX COVER •` L = 10' L = 15'(MAX) INSTALL TWO INSPECTION PORTS (MIN.) 1237" 0
® S=1% (MIN.) EL. 35.75 ® S=1% (MIN.) ® S=1% (MIN.)
4"SCH40 PVC 4"SCH40 PVC 4LLj "SCH40 PVC E
INV.= 34.50 10" 14' 6 11N75ERTO NITAR�p�
48'LIQUID INV.=34.25 COUPLER DETAIL iZC,
LEVEL INV.= 33.40
OAS BAFFLE PROPOSED
D-BOX 4 ROWS OF 4 UNITS 0 5'/UNIT + 3 COUPLERS 0 1.16'/UNIT = 23.48'/ROW
^' INV.=33.75 pa-5(H-20) INV.=33.55
SOIL ABSORPTION SYSTEM (PROFILE)
PROPOSED 1.500 GALLON (H-20) SEPTIC TANK RESTORE VEGETATIVE COVER
EXISTING OUTLET COMPACT BACKFILL IN LIFTS UP TO 18"
TOP OF'CHAMBERS FOR VERICLE LOADING
BACKFILL WITH CLEAN PERC SAND
TO TOP OF CHAMBERS 60"
NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING �•• :, ;. . .. •:
PIPE INVERTS PRIOR TO CONSTRUCTION - "'.:'.'. ;:. ••: :,.``;,,� ;•'�.''•:'
2) TANK AND D-BOX SHALL BE SET LEVEL AND BREAKOUT=TOP ELEV.= 33.86
TRUE TO GRADE ON A MECHANICALLY COMPACTED INV. ELEV.= 33.40
SIX INCH CRUSHED STONE BASE, AS SPECIFIED IN BOTTOM ELEV.= 32.53 EXISTING SUITABLE
310 CMR 15.221(2) 2.88' MATERIAL
3) INSTALL INLET & OUTLET TEES W/ 5' MIN. ABOVE BOTTOM OF
GAS BAFFLE AS REQUIRED T.P. EXCAVATION OR G.W. EFFECTIVE WIDTH = 4 x 2.88' = 11.52
(10.03' PROVIDED) USE 4 ROWS OF 4-ADS ARC 36HC
BOTTOM OF TESTHOLE EL.=22.50 (H20) UNITS - NO STONE W/ 3 COUPLERS
IN EACH ROW
SEPTIC SYSTEM PROFILE
TYPICAL SECTION
1s"
N.T.S. NJA
DESIGN CRITERIA
SOIL LOG P#: 13559 DATE: MAY 3, 2012 SECTION INVERT
NUMBER OF BEDROOMS: 2 EXISTING BEDROOM - NO INCREASE IN FLOW PROPOSED SOIL EVALUATOR: DARREN M. MEYER, R.S., CSE. #1614 HEIGHT END CAP
SOIL TEXTURAL CLASS: CLASS I WITNESS: DONALD DESMARAIS, BARNSTABLE BOH
DESIGN PERCOLATION RATE: <2 MIN/IN TP-1 Depth ADS - ARC 36HC CHAMBER (H20 LOAD]
Elev. Elev. TP-2 Depth
DAILY FLOW: 110 G.P.D/BR. DESIGN FLOW: 330 G.P.D. 36.20 A 0" 36.00 A 0" MODEL ARC 36HC
GARBAGE GRINDER: NO (NOT DESIGNED FOR GARBAGE GRINDER) LOAMY SAND
LOAMY SANDLENGTH- -_- - �-
I 35.28 10YR 3 2 11" tOYR 3 2 63 NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT
SEPTIC TANK: 330 gpd x 200% = 660 gpd USE PROP. 1,500 GALLON (H20) SEPTIC TANK B 35.00 B 12 EFFECTIVE LENGTH 60" TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY
SANDY LOAM SANDY LOAM DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE.
LEACHING AREA REQUIRED: (330)/0.74 = 445.94 S.F. 33.20 C 1OYR 6/8 36" 33.00 1OYR 6/8 36" SIDE WALL HEIGHT 10.75"
1 DISTRIBUTION BOX: 5 OUTLETS MINIMUM H2O LOADING PERC ® MEDIUM SAND C OVERALL HEIGHT 16"
I ( )( ) M SAND
EL. 31.20 1OYR 5/6 IOYR S OVERALL WIDTH 34.5" 4640 TRUEMAN BLVD
PRIMARY S.A.S. 29.70 78" 29.50 78" 10.7 CF HILLIARD, OHIO 43026
{ USE 4 ROWS OF 4 - ADS ARCHC 3616 H2O UNITS-NO STONE CZ SILT LOAM C2 SILT LOAM CAPACITY (80.0 GAL) ADVANCED DUNAGE SYSTEMS, INC.
AND EXTENDED 1.16' W/ COUPLERS IN BETWEEN EACH UNIT 26.70 C3 2.5Y 5/6 114" 26.50 C3 2.5Y 5/6 114„
PROPOSED SEPTIC SYSTEM/SITE PLAN
BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.80 SF/LF OF CHAMBER) COARSE SAND COARSE SAND
tay (CHAMBERS: 4/ROW)16 UNITS x 5.0 LF x 4.80 SF/LF = 384.00 SF 22.701 2.5Y 7/3 162„ 2.5Y 7/3
(COUPLER: 3/ROW) 12 UNITS x 1.16 LF x 4.80 SF/LF = 66.82 SF 22.50 162" 9 LEONARD ROAD, W. BARNSTABLE, MA
TOTAL AREA = 450.82 SF PERC RATE <2 MIN/IN. ("Cl" HORIZON) Prepared for: Ahlemeyer
DESIGN FLOW PROVIDED: 0.74GPD/SF(450.82SF) = 333.60 GPD > 330 GPD req'd NO GROUNDWATER OBSERVED Engineering b : SCALE DRAWN
9 9 Y Surveying by:
MEYER&SONS,INC. MfaePoug&n Survey NTS D.M.M.
• I, Dorren M. Meyer, R.S., CSE, hereby certify that I am currently approved by MADEP pursuant to 310 CMR 15.017 pOBOX981 (508) 419-1086 DATE:
to conduct soil evaluations and that the above analysis has been performed by me consistent with the CHECKED SHEET NO.
requirements of 310 CMR 15.017. 1 further certify that I have passed the Soil Eval. Exam in October, 1999. �STSANDW/CH,MA02537
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