Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
1121 MAIN ST./RTE 6A(W.BARN.) - Health
t, 1x121 .Main St w C_ ,,- 1 178-003 4 West Barnstable NL l ��� 3r d 6 R t3a-J- - (4 ih �2ej No. c,V& l Fee 76 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Nphtation for Ne-po8al 6pstrm Construrtiun VPrmit Application for a Permit to Construct( ) Repair(X Upgrade( ) Abandon( ) ❑Complete System k Individual Components Location Address or Lot No. (a it-IA IA/ r 4 4 Owner's Name,Address,and Tel No. W-3 CAPG CoD GC�l�s�-d ttJ� $40JL Assessor's Map/Parcel MR-J-16400JEAAAAWD 414 Installer's Name,Address,and Tel.No. J®S",417—S F5 Z 1 Designer's Name,Address,and Tel.No. C AP -w coC b�.1TeC?Qt5i,=S 1 s - Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 21i)SS"'ts*" eV 61<j 14--X d D ^'Bd)O &(5a, 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. L Si ed Date `G —)'S Application Approved by Date Application Disapproved by Date for the following reasons Permit No. 11 Date Issued l U No. � `v Fee 75 T,HE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEATH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pplication for Misposal *pstrm Construction Permit Application for a Permit to Construct( ) Repair(X Upgrade( ) Abandon( ) ❑Complete System Individual Components Location Address or Lot No. ( � aZ( (41A w -5-r 4 4 Owner's Name,Address,and Tel.No. Wei CCU CoU Assessor's Map/Parcel 1 rho a� � ,�,� c Nrsr� P4 Installer's Name,Address,and Tel.No. 50 "W?T 8 5-11 Designer's Name,Address,and Tel.No. CAPE44Jt04�7 eNr90415LS (\J IA- 14q3k. s Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures ,Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil .. Nature of Repairs or Alterations(Answer when applicable) RIS''fi GL A)Alt 1 E f�3�O O s Ly S Tom- At$t 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 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. Signed" — Date r / / Application Approved by Date L f /35/� A '- Application Disapproved by Date for the following reasons Permit NO. r Date Issued ------ _- _..-. ---------..___ _- .------.-•-•-- - ____ - -- . . __..___ _ r THE COMMONWEALTH OF MASSACHUSETTS � y BARNSTABLE,MASSACHUSETTS Certificate of Compliance k THIS IS TO CCERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(X) Upgraded( ) Abandoned( )by CA0r=W j at 113-1 !y Ai&) S c- AT/'��¢�� has been constructed in accordance- with the provisions of Title 5 and the for Disposal System Construction Permit No* (( �dated �`l f Installer 1..:APeu_-�CA s; 6172womsd Designer & #bedrooms Approved design flow gpd The issuance of this permit A all notes construed as a guarantee that the system will fimcti"n�as i ed. �--�� Date 5 / . . C.� Inspector ---ry i No: } Fee ✓ THE COMMONWEALTH OF MASSACHUSETTS oCPUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS misposal 6pstem Construction permit Permission is hereby granted to Construct( ) Repair(�) Upgrade( ) Abandon'( ) System located at / t XI &A I A! :51- A fi L.A,, (OEsz R;,} <_9r 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-b/e com leter'd within three years of the date of this permi —�-- Date ! / Approved by £xcs,_ v /07-8-003 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ' 1121 Main Street Rt.6A Property Address Cape Cod Cooperative Bank Owner Owner's Name information is required for every West Barnstable ' MA D2668 6-7-18 page. City/Town state Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms-may not be altered In any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms f#� 13 U�3 �uuuOF A14�1! 11111 on the computer, ````�� `�HOFlyps ,���. use only the tab key to move your 1. Inspector: o�: L- use -do not ,James D.Sears JAMES :m use the return Name of Inspector s u. ;rn key. Capewide Enterprises ICE Company Name =�.,'A RTIf ,.. �p :• 153 Commercial Street '���rs„ Company Address Mashpee MA C2649 Cityrrown State Zip Code 508-477-8877 S 1623 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 16.340 of Title 5 (310 CMR 15.000).The system: Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 5-12-18 pector'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 has a design flaw 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. t5ins.doc•rev.6116 Title 5 Offidal Inspeollol Form:Subsurrace Sewage Disposal System•Page 1 of 17 a5ed xed dH 0£:2 91.02 b 6 AeW Commonwealth of Massachusetts Pismo Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 1121 Main Street Rt.6A Property Address Cape Cod Cooperative Bank Owner Owner's Name information is required For every West Barnstable MA 02668 5-7-18 page CitylTown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E J always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The system is a 1000 Gal Tank D Box and field. 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. 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 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. ❑ Y ❑ N ❑ ND(Explain below): t5ins.doc-rev.6116 Tito 5 Official inspection Form:Subsurface se+vaga Disposal System-Page 2 of 17 - 5 abed xeJ dH 0£:2 860Z b6 42W Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1121 Main Street Rt.6A Property Address Cape Cod Cooperative Bank Owner Owner's Name information is required for every West Barnstable MA 02668 5-7-18 page CityfTown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. 8) 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.doe rev.616 Title 5 Official Inspection Form:Subaurfece Sewage Disposal System•Page 3 of 17 9 a6ed xeJ dH 0642 860Z bl, 4eW Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 1121 Main Street Rt.6A Property Address Cape Cod Cooperative Bank Owner Owner's Name information is West Barnstable MA 02668 5-7-18 required for every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2, System will fall unless the Board of Health (and Public Water Supplier, If any) determines that the system is functioning in a manner that protects the public health, safety and environment: [] The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: "This system passes if the well water analysis, performed at a DEP certified laboratory, for 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 must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due town overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in 801M is less than 6e below invert or available volume is less than day flow CNrrvG t5ins.doc•rev.6116 Title 5 Official Inspection Form:Suosurface Sewage Disposal System-Page 4 of 17 L a5ed xed dH 0£:2 S60Z 176 AeW i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1121 Main Street Rt,6A Property Address Cape Cod Cooperative Bank Owner Owner's Name information is required for every West Barnstable MA 02668 5-7-18 Page C8ylTown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOTdue to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria Indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.) ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd, ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply El El Area 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. 15ina.doc•rev.&16 Title 5 Official U�spection Form:Subsurface Sewage Disposal System•Page 5 of 17 g abed xeJ dH 1,6 F 9102 b 6 4eW Commonwealth of Massachusetts Title 5 Official Inspection Form •i Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1121 Main Street Rt.6A Property Address Cape Cod Cooperative Bank Owner Owner's Name information is required for every West Barnstable MA 02668 5-7-1 S page Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (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): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): mns.doc•rev.6116 -ntle 5 Official Inspection Form:Subsurface Sewage D spore)System Page 6 of 17 6 a5ed xe� dH Z£4Z 860Z b 6 42H Commonwealth of Massachusetts Title 5 p Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1121 Main Street Rt.6A Property Address Cape Cod Cooperative Bank Owner Owner's Name information is required for every West Barnstable MA 02668 5-7-18 page Cityrrown State Zip Code Date of Inspection D. System Information Description: 1000 Gal. Tank D Box and field. Number of current residents: Does residence have a garbage grinder? ❑ Yes ❑ No Is laundry on a separate sewage system? (Include laundry system inspection (❑ Yes ❑ No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ❑ No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ❑ No Last date of occupancy: Date Commercialllndustrial Flow Conditions: Bank'-office BLDG Type of Establishment: 290 Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seatslpersonslsq.ft., etc.); 3672 SD FT. Grease trap present? ❑ Yes ® No Industrial waste holding tank present? ❑ Yes ® No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ® No Well Water Water meter readings, if available: t5ins.doc•rev.6116 Title 5 Drflcial Inspection Form:Subsurface Sewage Disposal System•Pege 7 o117 0t a5ed xe� dH Z£:2 860Z b6 AeW Commonwealth of Massachusetts Title 5 Official Inspecti on Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1121 Main Street Rt.6A Property Address Cape Cod Cooperative Bank Owner Owner's Name information is required for every West Barnstable MA 02668 5-7-18 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: NA Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the IlA system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): i5ins.doe•rev.6116 Title 5 Official Inspection Form subsurface Sewage Disposal System•Page 8 of 17 l.6 abed xeJ dH U4Z 860Z t7l, XeW , f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1121 Main Street Rt.6A Property Address Cape Cod Cooperative Bank - Owner Owner's Name information is West Barnstable MA 02668 5-7-18 page.ed for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 1980 5-2018 New D Box were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 45" Depth below grade. feet Material of construction.- [I cast iron ® 40 PVC ❑other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Pipeing is 4" PVC SCH -40 Septic Tank(locate on site plan): 34" 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 1000 Gal.Precast H-10 Dimensions: 211 Sludge depth: t5ins.doc•rev.W15 Title s ofrw al inspection Form:Subsurface Sewage Disposal System•Page 9 of V Zi, a5ed xez! dH ££:2 860Z t7l, 42W Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ' 1121 Main Street Rt.6A Property Address Cape Cod Cooperative Bank Owner Owners Name information is west Barnstable MA 02668 5-7-18 required for every page. Cofrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont,) 28" Distance from top of sludge to bottom of outlet tee or baffle 0° Scum thickness Distance from top of scum to top of outlet tee or baffle —12 Distance from bottom of scum to bottom of outlet tee or baffle 18" How were dimensions determined? A Sludge -Plan-Tape uilt Sludge Judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): Tank at working level. Tank at 34" below grade wl both cover at B". In and outlet baffle. No sign of leakage or over loading Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Dabs t5ins.doc-rev.6116 Title 5 Official Inspection Form:subsurface sevags Disposal System•Pape 10 of 17 E 6 a5ed xe:1 dH EE:2 860Z b l, XeW Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1121 Main Street Rt.6A Property Address Cape Cod Cooperative Bank Owner Owner's Name information Is west Barnstable MA 02668 5-7-18 required for every page cityrrown stale Zip Code Date of Inspection D. System Information (cunt.) 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 float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 15ins.doc•rev.6,116 Title 5 Official Inepealon Form:Subsurface Sewage Disposal System-Pape 11 of 17 l a5ed xe j dH ££:l,Z R LOZ b l, AeW f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 1121 Main Street Rt.6A Property Address Cape Cod Cooperative Bank Owner Owner's Name information is west Barnstable MA 02668 5-7-18 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cant.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0 Comments(note if box is level and distribution to outlets equal, any evidence of soliIds carryover, any evidence of leakage into or out of box, etc.): D Box is 16"x21"-2' below grade w/one line out. H2O. Box w/steel cover. Note: D Box is new 5- 2018. 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.): If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: t5ins.doc•rev.W16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 56 abed RJ dH VE:2 860Z 176 42W N Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1121 Main Street Rt6A Property Address Cape Cod Cooperative Bank owner Owner's Name information is required for every West Barnstable MA 02668 5-7-18 page. Cityrrown state Zip Code Date of Inspection D. System information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ® leaching fields number, dimensions: 25' ❑ overflow cesspool number: ❑ innovative/alternative system Typeiname of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching is a one pipe field (25'x2'x2')Ck D Box and camera out line. No sign of over loading or holding water. Some solid carry over should water blast line. 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 l5ir dec-rev.We Title 5 Official Inspection Form:Subsurface Selvage Disposal System-Page 13 of 17 g l, abed xed dH b£:2 8 60Z t�l• 42W Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1121 Main Street Rt.6A Property Address -Cape Cod Cooperative Bank Owner owner's Name information is West Barnstable MA 02668 5-7-18 required for every State Zip Code Date of Inspection page. CIt_y Town 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.): a 15ins.doc-rev.3/16 'mie 5 ouiel Inspection Form:Subsurfaaa Sewage Disposal System Page 14 d 17 Li, abed xed dH b£:2 860Z b 6 AeW Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1121 Main Street Rt.6A Property Address Cap2 Cod Cooperative Bank Owner Owner's Name information is west Barnstable MA 02668 5-7-18 required for every Cityft•own State Zip Code Date of Inspection page. D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least public water�supply enters the build or Check onerks. Locate of the boxes)belolwwithin 100 feet.locate where p ® hand-sketch in the area below ❑ drawing attached separately �t /V B A o I a :Cjp,4 3 VP /� - 7 A _3 ; /1 sr Rr6 iN sY— Tnle 5 oaldat Ins"etlw Fan:MVYf1ac9 S#"go D;epoaal Syltpm.page 15 of 17 t".doe•rsv.6116 6 b 96ed xe j dH 6EV L V 60 1�0 96 a6ed xed dH V£:2 860Z V 6 AeW Commonwealth of Massachusetts 4 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 1121 Main Street Rt.6A Property Address Cape Cod Cooperative Bank Owner Owner's Name information is required for every West Barnstable MA 02668 5-7-18 page. Chy/rown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells N� 10, Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 7-26-78 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: T.H. on Design plan 7-26-70 G.W. at 10'. Bottom of field at 4' below grade. Bottom at 6'above G W Depth Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc-rev.6/16 Title 5 Officiel Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 66 a5ed xe� dH 9E:2 860Z V6 42W Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1121 Main Street Rt.6A Property Address Cape Cod Cooperative Bank Owner Owner's Name information is required for every West Barnstable MA 02668 5-7-18 page. CitylTown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5irts.Wc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Oisposal SYSIM•Pape 17 of 17 OZ a5ed xe:1 dH 5£:I•Z 860Z b6 AeW ` Town of Barnstable Barnstable MwWo ° Regulatory Services Department cac j :y IAYtNS'P& 9� `" : ,�� Public Health Division 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4990 4063 October 18, 2017 CAPE COD COOPERATIVE BANK 25 BENJAMIN FRANKLIN WAY HYANNIS, MA 02601 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 1121 Main Street/Route 6A,West Barnstable, MA was inspected on 10/03/2017 by James D. Sears, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Conditionally Passes" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Distribution box need to be replaced. You are ordered to repair or replace the septic system within deadline date of 10/03/2018. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF TH ARD OF HEALTH Thomas McKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Conditionally Passes Letters\1121 Main Street Route 6A West Bamstable.doc Town of Barnstable Barnstable Regulatory Services Department AgAmeAcaM j i BAMSTABLC 9 39 �� Public Health Division 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4990 4063, October 18, 2017 CAPE COD COOPERATIVE BANK 25 BENJAMIN FRANKLIN WAY HYANNIS, MA 02601 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 1121 Main Street/Route 6A, West Barnstable, MA was inspected on 10/03/2017 by James D. Sears, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Conditionally Passes" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Distribution box need to be replaced. d t � You are ordered to repair or replace the septic system within deadline date of 10/03/2018. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH Thomas McKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Conditionally Passes Letters\1121 Main Street Route 6A West Bamstable.doc I _ • Town of Barnstable � a,anrcT�arr i Regulatory Services Department Public Health Division 200 Main Street,Hyannis MA-02601 Office: 508-862-4644 Richard Scali,Director FAX 508-790-6304 Thomas A McKean,CHO Feb 6, 2007 Rev. 5111116 DEADLINES TO REPAIR FAILED.SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) _ An`x"marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑Discharge or ponding of effluent to the surface of the ground . ❑Pumping more than 4 times during the last year not due to clogged or obstructed pipe. :. o Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE(1)YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑Any portion of the cesspool within a Zone 1 to a public well ❑Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2)YEAR DEADLINE CRITERIAYEAR DEADLINE CRITERIA q Single Cesspool• ❑Any"conditionally passed systems" (broken cover,relocation of a pipe,relocation of a driveway due to H-10 components, etc) o Leaching pit or cesspool with high liquid level,<12"below inlet(per Town Code §360-9.1) ❑Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER Repair deadline: g' Q\SEPTICIDEADLINES TO REPAIR FAILED SYSTEMS.doc Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments -Q 1121 Main Street R1.6A NO Property Address Cape Cod Cooperative Bank L> Owner Owner's Name / C? information is �/ Q0 required for every West Barnstable MA 0266E 10-3-17 ; i page. City/Town State Zip Code Date of Inspection ;1, Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms p��Nuttrtrrrp�� on the computer, ZH O�M ����i, � i use only the tab �c��. •••.••gsS9 key to move your 1. Inspector: :• �y cursor-do not JA M E S N Z use the return James D.Sears ke Name of Inspector 3 ;� �$ :CoY Capewide Enterprises �'� ' *: - Company Name ?�T�R7 153 Commercial Street 'y�4i5 �rtr�N Company Address n� Mashpee MA 02649 City/Town State Zip Code 508477-8877 S1623 Telephone Number License Number B. Certification 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 ❑ Needs Further Evaluation by the Local Approving Authority �- 104-17 spector'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 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. t5ns.doc•rev.ShS Title 5 Official Inspection Form!Subsurface Sewage Disposal System•Page 1 of 17 ' Dry (/S I. a5ed xed did 8ZZ2 Z ME 60 130 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1121 Main Street Rt.6A Property Address Cape Cod Cooperative Bank Owner Owners Name information is required for every West Barnstabie MA 0266E 10-3-17 page. City[Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E! always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: Conn Pass-D Box-water blast line. The system is a 1000 Gal. Tank D Box and field. Note: Tank outlet cover should be raised. 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. Check the box for"yes", "no"or"not determined" (Y, N, NO)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. ❑ Y ❑ N ❑ NO (Explain below): t5ins.doe rev.6116 Title 5 Official inspeatlor Form:Subsurface Sewage Disposal System•Page 2 of 17 z abed xed dH 92?2 L 60Z 60 100 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1121 Main Street Rt.6A Property Address Cape Cod Cooperative Bank Owner Owner's Name information is required for every West Barnstable MA 02668 10-3-17 page. City/Town state Zip Code Date of Inspection B. Certification (cant.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. 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): ❑ yoved Y ❑ ND(Explain below): ® distribution box is leveled or replaced El ❑ N N (Explain below): Need to replace D Box. Need to water blast line out of D Box. ❑ 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 15ms,dac•rev.6116 Title 5 Off6al Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 6 a5ed xed dH 8ZZ2 L60Z 60 130 Commonwealth of Massachusetts AMOSOM Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1121 Main Street Rt.6A Property Address Cape Cod Cooperative Bank Owner owner's Name Information is requi red West Barnstable MA 02668 10-3-17 page. City/Town 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 that protects the public health, safety and environment; ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: "*This system passes if the well water analysis, performed at a DEP certified laboratory, for 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 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 El ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool Cl ® liquid depth in JIMM is less than 6" below invert or available volume is less than '/day flow JA(1 tJG t5ins.doc rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 t7 a5ed xeJ dH R ZZ L 602 60 100 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1121 Main Street Rt.6A Property Address Cape Cod Cooperative Bank Owner Owners Name information Is required for every West Barnstable MA 02668 10-3-17 page. City/Town 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 Beet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this forma ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. tslns.doc•rev.&,a Title 5 Official Inspedon Form:Subsurface image Olsposal System•Page 5 of 17 5 a5ed xed dH KZZ L60Z 60 130 Commonwealth of Massachusetts • Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1121 Main Street Rt.6A Property Address _Cape Cod Cooperative Bank Owner Owner's Name information is required for every West Barnstable MA 02668 10-3-17 page. City/Town state Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as NIA) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened,and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner) provided with ® information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) (310 CMR 15.302(5)) D. System Information Residential Flow Conditions: Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): tSIns.doc-rev.611e Title 5 Official Inspect on form'.Subsurface Sewage Disposal System-Pages of 17 9 a5ed xed dH 8ZZZ L 60Z 60 1c0 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form•Not for Voluntary Assessments 1121 Main Street Rt.6A Property Address Cape Cod Cooperative Bank Owner Owner's Name information is required for every West Barnstable MA 02668 10-3-17 page City/Town State Zip Code Date of Inspection D. System Information Description: 1000 Gal. Tank D Box and field. Number of current residents: Does residence have a garbage grinder? ❑ Yes ❑ No Is laundry on a separate.sewage system?(Include laundry system inspection ❑ Yes ❑ No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ❑ No Water meter readings, if available (last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ❑ No Last date of occupancy: Date Comm erciaVIndustrial Flow Conditions: Bank-office BLDG Type of Establishment: 290 Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seatslpersonslsq,ft., etc.): 3872 SQ FT. 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: Well Water t5ins.doc-rev.WiS Tale 5 Official Inspection Farm Subsurface Sm*wp olsposal system•Pape 7 of 17 L a5ed xe:1 dH 6Z:ZZ L 10Z 60 1c0 Commonwealth of Massachusetts Title 5 Official Inspection Form A Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1121 Main Street Rt.6A Property Address Cape Cod Cooperative Bank Owner Owner's Name information equired for is West Barnstable MA 02668 10-3-17 required for every Paw. 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: NA Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Gns.doc•rev.8116 Title 5 Official Inspecticn Form:Subsurface Sewage Disposal System•Page 8 cf 17 9 a5ed xeJ dH 6ZZ2 L1,02 60 100 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 1121 Main Street Rt.6A Property Address Cape Cod Cooperative Bank Owner Owner's Name information is West Barnstable MA 02668 10-3-17 required for every Y page. Cit !Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information. 1980 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 45" Depth below grade: feet Material of construction: ❑cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Pipeing is 4" PVC SCH -40 Septic Tank (locate on site plan): 34,1 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 1000 Gal.Precast H-10 Dimensions: 211 Sludge depth: 15ins.dac rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 6 a5ed xed dH 0UZ L 60Z 60 ID0 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1121 Main Street Rt.6A Property Address Cape Cod Cooperative Bank Owner Owner's Name information is required for every West Barnstable MA 02668 10-3-17 page. City/Town Slate Zip Code Date of Inspection D. System Information (cant,) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 28" 0" Scum thickness Distance from top of scum to top of outlet tee or baffle 12" Distance from bottom of scum to bottom of outlet tee or baffle 18" How were dimensions determined? Asbuilt-Plan-Tape Sludge Judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): Tank at working level. Tank and outlet cover at 34" below grade w/inlet cover at 8". In and outlet baffle No sign of leakage or over loading Note: Tank outlet cover should be raised. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins.doc-rev.(/18 Title 5 Official Inspectior Form:SLA)sLTlaCe Sewage Disposal System•Page 10 of 17 O t a5ed YU dH 0£:Z2 L OZ 60 130 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 1121 Main Street Rt.6A Property Address Cape Cod Cooperative Bank — Owner Owner's Name information Is required for every West Barnstable MA 02668 10-3-17 page. City/Town State Zip Code Date of Inspedion 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 float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins.doc•rev.6116 TIW 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 1,[ abed xeJ dH 0£ZZ L 10Z 60 100 Commonwealth of Massachusetts 4 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1121 Main Street Rt.6A Property Address Cape Cod Cooperative Bank Owner Owner's Name information is required for every West Barnstable MA 02668 10-3-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D Box is 16"x21"-2' below grade w/one line out.Wall's are gone. Need to replace D Box w/ H2O. Box and raise to grade w/steel cover. Note: D Box is in drive way. 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.): k if pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins.doo-rev.6M6 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 2 6 abed xed dH ZE L 60Z 60 100 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments : 1121 Main Street Rt.6A Property Address Cape Cod Cooperative Bank Owner Owner's Name information is required for every West Barnstable MA 02668 10-3-17 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number. ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ® leaching fields number, dimensions: 25 ❑ 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,): Leaching is a one pipe field (25'x2'x2') Ck D Box and camera out line, No sign of over loading or holding water. Some solid carry over should water blast line. 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.doc•rev.6116 Tide 5 Official hspecdon Form:subswtace Sewage Disposal system Page 13 of 17 £6 a5ed xe� dH ZFE L 60Z 60 100 Commonwealth of Massachusetts Title 5 Official Inspection Form A Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1121 Main Street Rt.6A Property Address Cape Cod Cooperative Bank Owner Owner's Name information is west Barnstable MA 02668 10-3-17 required for every Paw. City/Town 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.): t5irts.doc rev.6116 Title 5Offiicial Inspection Form:Subsurface Sewage Dispnsal System Pape 14 of 17 abed xed dH 6£:ZZ L 1.0Z 60 PO Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 1121 Main Street Rt.6A Property Address Cape Cod Cooperative Bank -- Owner Owner's Name requir on Is West Barnstable MA 02668 10-3-17 requiredd for every page. City/town State Zip Code Date of Inspection D. System Information (cont.) 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 A t. 0 i o 0:f?,4,S 3 13 4 = V 7uA A-3 : as 0, G R I N sq-t- t5ins.doc.rev.SMS rills 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 S6 abed xed dH IEZZ L60Z 60 1:)0 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1121 Main Street Rt.6A Property Address Cape Cod Cooperative Bank Owner owner's Name information is required for every West Barnstable MA 02668 10-3-17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells 0 Esfimated depth t high ground water: 1 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: 7-26-78 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: T.H. on Design plan 7-26-70 G.W. at 10'. Bottom of field at 4'below grade. Bottom at 6' above G W Depth Before filing this Inspection Report,please see Report Completeness Checklist on next page. Mns.doc-rev.5116 Title 5 official Inspection ForM Subsurface sewage Disposal system-Page 16 of 17 g 6 abed xed dH Z£ZZ L 60Z 60 130 I f I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 1121 Main Street Rt.6A Property Address Cape Cod Cooperative'Bank Owner Owners Name information is required for every West Barnstable MA 02668 10-3-17 page. City/Town State Zip Code Date of inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t61m.doc•rev.61t6 Tille 5 Official Inspection Form Subsurface Sewage Disposal System-Page 17 of 17 Li, abed xed dH Z£?Z L WE 60 130 .65t / 3 .•� _�' , _,, pox � �. �. jto, (r �- I � F �,r-L a 1 l--jet __ _ - t QO O --- � \ ��� E- TES• SEiZv�cEC F ►cs � � Al,y,2..TMG ._Y �zl Ck - ��E_� t3�` � l_L�s Z G>►�i N C> GC C��T ALA i�l ►V o. ? ,r .,s Ifa z . a AcY 1 OD tt tZ f , � ,�' y�c�__ �� _ �• �` ,rC p' � Il 4 t=-�1 GG Ala t l \ T e. i r��.�cam \ �.� ` r«V�i" SE✓rl � tZ� Ir;� t pl, -L i �, SuP� rJ �, O►....i �D Log Number: 4769 Bottle # D346 Date: 3/27/85 BARNSTABLE COUNTY HEALTH AND ENVIRONMENTAL DEPARTMENT 7 SUPERIOR COURT HOUSE V BARNSTABLE, MASSACHUSETTS 02630 o • nsa DRINKING WATER LABORATORY ANALYSIS PHONE: 362-2511 EXT. 331 Client: Cape Cod Cov0p Bank - .Collector.- .a R. R. Clough Mailing Address: % j. Crowell Affiliation: Clough & Cahoon Weil Drilling Kt, by Time'& 'Date"of W. Barnstable, MA 02668 Collection: 3/26/85, 9:00 a.m. Telephone: Type of-Supply: 'wel`t water Sample Location: Rt. 6A Maine Post & Beam Well Depth: 851 W. Barnstable, MA Office Date -of Analysis: --3/26/85 PARAMETER SAMPLE RESULT RECOMMENDED LIMITS Total Coliform Bacteria/100 ml 0 0 H 5.8 Conductivity (micromhos/cm) 86, 500.0 i Iron ( m) 0.36 0.3 Nitrate-Nitrogen ( m) <0.04 10.0 Sodium ( m) 20.0 I . Water sample meets the recommended limits for drinking of all above tested parameters. II . Based only on results of the parameters tested for this sample, the water is . suitable for drinking but may present the problems checked below: A. Water sample has higher than average levels of Nitrate. Future monitoring is recommended (2-3 times per year) to establish any upward trends. B. The low pH of the water may shorten the useful life of the house's plumbing. C. xx Water may present aesthetic problems.(taste, odor, staining) due to high iron D. Water sample has high levels of sodium. Persons on low sodium diets should consult their doctor. III. Due to one or more of the reasons checked below, this water sample is unfit for human consumption: A. High Bacteria B. High Nitrates The Barnstable County Health and Environmental REMARKS: Depar,ment shell Rot Qg,4 ,a alau cW pments. interpre`ations or concl!--=ions made by anyone . 1 else concerning these r.:sulEEs without written consent, CC: Barnstable Board of Health CC: Clough & Cahoon Well Drilling Laboratory- Director 1 /7/85 Explanation of Test Results. Total Coliform,Bacteria Coliform bacteria are an indicator of the sanitary quality of a water supply. Water supplies may become contaminated from malfunctioning septic systems, cesspools and surface runoff. A total coliform count of zero indicates that your water supply is safe and approved for human consumption. A total coliform count of greater than zero is most often the result of accidental contamination of the sample bottle through improper sampling methods. For this reason, it would be advisable to retest any well water that is not approved. pH pH is the measure of acidity or alkalinityof the water. On the pH scale,the number 7 is neutral,less than 7 is.acidic and more than 7 is alkaline. The pH of water on Cape Cod tends to be acidic in the range of 5.0 to 6.5. Conductivity Conductivity is a measure of the dissolved salts in solution. Amounts in excess of 500 micromhos/cm are generally considered unacceptable and may have a laxative effect upon users. Iron The presence of iron in water in concentration of .3 ppm or greater may: give the water a bittersweet astringent taste,cause an unpleasant odor, often gives the water a brownish color and cause staining of laundry and porcelain. The average concentration of iron in Cape Cod's water is .2 - .6 ppm. Although the presence of iron in water may cause the problems listed above, it is not considered deleterious to health. Iron may be removed by use of an iron removal system. Nitrate-nitrogen The Massachusetts Drinking Water Regulations have set a maximum contaminant level for nitrates at 10 ppm. Excessive concentrations may cause methemoglobinemia (an infant disease) and have been suggested to form potentially carcinogenic nitrosamines. Contamination sources include fertilizers, cesspools and industrial wastes. Copper Due to the acidic nature of the water on Cape Cod, copper tends to leach from pipes. This normally does not present a health hazard; however, concentrations in excess of 1.0 ppm may cause a metallic taste and/or a bluish-green stain on porcelain fixtures. Sodium A concentration of sodium over 20 ppm'is only of concern to people who are on a low sodium diet. If the water supply has more than 20 ppm sodium,it is up to the people who are on such a diet to find another source of drinking water or contact their doctor to determine if consuming the water is advisable. Concentrations exceeding 50 ppm indicate that there may be ocean water or road salt runoff water getting into the well. 362-4541 926 main street yarmouth mass. 02675 down cape eagiaeering civil engineers& land surveyors structural design James H.Bowman P.E.,R.L.S. Arne H.Oiala P.E.,R.LS. land court John W.Jalicki surveys site planning sewage system December 9, 1982 designs inspections Town of Barnstable Board of Health Town Hall permits Hyannis, Ma 02601 Gentlemen: This is to certify that the sewage system for the Cape Cod Cooperative 'Bank has been installed according to the plans enclosed. Sincerely, �iv�e. iv Arne H. Ojala, -P.E., R.L.S. AHO/mkh Enclosures cc: John 'Crowell of SAgti BARNSTABLE COUNTY HEALTH DEPARTMENT SUPERIOR COURT HOUSE J BARNSTABLE, MASSACHUSETTS 02630 o • �►l,�g8 PNONBi sst-aa�, ENT. 331 Date Tuly- 24 i q8J To: Cape Cod Co-op Bank John, Crewell Rte. 6A Yamouthport, Maas. 02675 The following laboratory test(s) have been performed on a sample of water from your I g Well B+Q 6A 1403+ Rarr9-1+ehi n Location Other Location Bacteriological Analysis Chemical Analysis Total Coliform Bacteria MF/100 0 Iron ,30 Fecal Coliform Bacteria MF/100 pH 6•o Other Copper Chloride 25 Other COndulltivit3► '" �3 On the basis of the above results, this water is: I X Approved bacteriologically for human consumption Not approved bacteriologically for human consumption Approved for swimming ^� Not approved for swimming �I Examined for results only COMM MS: cc: Mr. Jahn Kelly; Director Barnstable Board of Health Boat 534 Hyannis, Maas. 02601 . a Clough & Cahoon Box 486 West Barnstable$ Mass. 02668 J� DOWN CAPE ENGINEER IN 926 Main Street Rt. 6A LETTER YARMOUTH, MA 02675 z. �r;rwE �,a Phone 362-4541 _ Date To..:_.... 7-0culy . .0�....._. Subject �./ 2._..... r/ 21J�_ _. finis rs.. 7 c4e�2.1%/-y. /NS. .ct/O_.�/ TJ.........._/aiR I ........ 1.ti._-.19c,t-G2._C�/� -v01.T/fi y'! _ .........fi7 0 ....'.6w�°...._..._� focvnN....... ....4W 7`lf c..:.: ............ . .. .... . . _....../ .SIGN._ ......... 8� �✓.. .....M��NT/� /f .... , ........ ........ . . . /. ... .. -/ ... . . ..../.>Z..S_l._!n�/...._ .90.�_. i175... Uoc.T Iyfl . .. ............ G v15 SIGNED ❑ Please reply ❑ No reply necessary G , \L 91Z f 34 32 3o Z S Z 13- GSA - ` L=24&.%7r 12EM.e�vr Of O �l SLP MI\TEA1 al. ( i LC�i- 5..>a t 0 I lo' A'Zovti1D I12'e 11I1r�Ca TRJ�11.►►c4-i 24' � . � \ T N 21 M ELSEwio6N II WO / iRAofSga� HRoFs+-t ZZ Ioz �• t" �'" / kl 'ems- - 40 as 1'f'' � � T,I••1.�19 � t�aa.10�. M-EXIST tN 4r�AKti� ' 8. � 8us�01µ6 � t / s e �UNVBfZ �OKST� J r A 99 - Z P., TO 12SA2 F y CERTIFIED Pl-0T' ALRN . V/ GN C X e U � 40/N L� / ' T D AS G DIgTA'NCE AS CERTIFIED SEwi➢c6 svv"^t L .grlo v &f)f a 40AEBY CERTIFY THAT THE BUILDING SITE PLAN SHOWPI ON THISr PLAMIS LOCATED ON THE o�� ,�, ' GROUN{ A$SHOWN HER &THAT IT flat S LOCUS: �- T P—d 07 CONFORM To THE ZONING BY LAWS OF.•THE OF / �.r�1ST�t�LE fV 55. : :'1`bWMOF `Bd!<RNS'tF1SVse , :AS 8u1t..T' q DATE it IN ISO o ARNE ' H. 1, REF: LGLnC�- Cc,_ Jt"T' CdSe'sF • • o OJALA 'd®I,n C9*0d* eftfI eedelfig" -if 48 '3 PREPARED FOR: C4p�-,. C.✓ tii CIVIL ENGINEERS LAND SURVEYORS -'�1-�L C��T1v h` N R r Yarmouth&Orleans;MA SCALE �¢®� 3 O S DATE SECTION - SEWAGE -SEPTIC TANK - - "D"BOX - - LEACH IWC- -reetjr_" ELEV, 3Z.00 Vs� SCH. 4o rIPE (MSL)u CEPIEA7H vot`✓CV-IAY' •12"OFt/8T0421, NOTE: WASHED STONE REMOVE ANY UNSUITABLE MATERIAL FOR A DISTANCE OF 10 FT.AROUND ENTIRE LEACH - TRF C AND REPLACE WITH CLEAN COARSE SAND. c �'1 IG t OUT-' I)I IN• I000G .�S'} — OUT•:Z'$ SEPTIC IN LS.SO . s .•A ,'�r 28.Z7 28.oza °. ELEV: TANK 21.'l3 �•' ELEV. ELEV. ELEV. r` Z 7.g 1 Z'1.94 / ELEV. ELEV. Pot o FL..21.5 NOTE: L, ► 2� _ BRING ALL COVERS TO WITHIN �'�^�'Q I'�' Z) WASHED STONE 1 FT.OF FINISH GRADE. TEST HOLE LOG , -2(cAA,aa', PAL)L. morzak-r-,— 5.kmw. TEST BY PAIIL5 'e.. ,QE; f3�, o� I-1's� t_YL1 �•�1�I'1f�+� WITNESS `' TEST DATE 2(2 111<3 DESIGN T.H o. `le T.H. * 21 (2)S$ory z Sal2'�".P Za.o 29.3 T�1cE�-t �►.c ct_Ga►.J t=tr.IF_ spaces �'ISc sJ�rt90E9s�= oq�� -Q4 ..., .. ELEV. O` ELEV. -5A1>10 (1-0. �,)..#. 1 EL'2�,•Off' NO _ l.O g50tr_ Lc5 4-4 Or3SDI�- ,� DISPOSER DISPOSER IZ Z�j.o 42u 28.E PERC RATE MIN/IN. FLOW RATE 29D (GAL./DAY) F3 Qow ±�I SEPTIC TANK 29 x (Ls)= 4 36 t4 o "' ���� REO'D SEPTIC TANK SIZE 1 oc ,PEP(_ - tts T21.bS C - 22.3 kl Frt LEACH FACILITY SIDE WALL Z"x 2 5 X '[ x j Z.S} a 254 G/D. BOTTOM15 i2o" I 19.3 TOTAL l 5 D 5.•� _ _ 3 O O „�e .�? �c 1C9�: l dJ•�. S 1 ( T M i? n� ) ., _ USE. LEACHING . T2EA1c.N 144,5 ,o Ii�O�xin'= W�Er� ' � 25� loncj x G'Y��IG(Q �C 2'dezep CUeJo:� 'p�:.p�,� 'r WATER ENCOUNTERED NOTES: (UNLESS 6THERWISE NOTED) Lo 1.OATOM(MSL)+ TAKEN F OM QUADRANGLE MAP 2:MUNICIPAL WATER �>) _ SN OF aE� 3.PIPE PITCH:40.'PER'FOOT EXC@FT A4 Swow1-j v� 4.DESIGN LOADING FOR ALL-PRE-CAST CAST UNITS:AASHO- ~�—ZO 44 ZQ lea r, JAMES cgC 5.MIN.GROUND COVER OVER ALL SEWAGE FACILITIES: (1) FT. Al� �e` � H 6.PIPE JOINTS SHALL BE MADE WATER TIGHT G P� ^, BOWMAN !!• 7.CONSTRUCTION DETAILS TO BE ACCORDANCE WITH COMM.OF MASS. ND u AN ) STATE ENVIRONMENTAL CODE TITLE 5 "19D S 24Q�fl O I z4A4ov\n REG.PROFESSIONAL ENGINEER i BOARD OF HEALTH CONTOURS (EXISTING)------------- (PROPOSED)—0�-0-0_ APPROVED DATE � MA DOWN CAPE ENGINEERING------ 926 Main Street ="�Rt. 6A ,f J ���� r�j � LETTER YARMOUTH, MA 02675 / Phone 362 4541 � Date ... .. To zdE..�� —O.�U�/._....0�.---./.�<9e�Jl/S7/��Z� _._..... _....... _._. ... Subject .�� . .. .......M�i ./3L.2S .. /f finis. � ..__.� ........GC2.r.// y ._... RT ..._1 ...hlAv.E... __n'1�4p£ ..._ /V_ ..... ...G.�....T../- �...__ ._Sc1l�.�.T....... S.c /.t�r�'G..�-.........S...YST .�'1..._._.. 5..:_ /Jvi� ... A.N�7_..:... ..../_afiG*i.....__. /= ..__ ....... .ti.......9 (G.2... /3.ltc.L—. ..........4c��.rif. .:.... ...7� L..—.. . T .....T r fitfL-. .......... . . ..7 L.. . .(.v£S.T. . /=. ....T�`fL:.. ... LrC/ fi/l�h/.._...✓rfi�DGv/V........ � / .. Lf.t=...._.. ............ . .......... L.,9.w...... .........9LL........... ........... ............... 3��. ✓............/l'�.A}�tv..Ti � �F/ ....,...5? . ....._..fi :............C2/CJ.� 5........._/GLC...._... .........45 }v. ........................._...... cs'ti/..._. .....r� �...__ . ..CJ�s_ �ti_ .... . .9av_.. .. i�5 ....................... ............................. ........................................................................................................................................................ . . ............................. ......................... ............................... .. ........................................... sicNeo 21 El Please reply El No reply necessary // e , T�T �-Iv`j E ,L� \\MDi55, TP��/E125E Yid,. 1'1`. 9 rI Z INic- E0Crr ©G r A�►.1T' 34 =2#fd.9571 1 ue,ls� f ��- , tl:GtrCV�- �c5.1� f � I , lo' �2ou►vo L. 12�. I.�NIn.1Cr TRIF�.iG4.1 I \l loo�� 1. / J �� 2F_3ErlzV F- / TN;fZI III �. g M ' .,— III SAS GONSA Holt I59 7/ �I/ CjBAOfSSA� RoFIFE � . Of / Za 4,, J 10Lis tj 2 To. 19 J � fi$ STIN�+�flMl� .5 ZS.O 6EL.=21.S� JV� L. � •$t�tl�l µto' _� �� {, o(uNoeti cocasr•� P-Av I_o i 'tAjEt.1.. { h ._.-1" :tea -r•: .��.• a To. F 1�2 :w 1 2� z 3 t CERTIAr/E0 Pl-b7 ALf�N s, . . �ER�/F/ED HS 70 BcgLO/mC. L40CiOt/ON DI�TdNCE AS CERTIFIED S£w9c� SYs72.�t LorAT/ow 6.toAO� - SITE PLAN OWN CERTIFY TH�IT THE BUILDING SHOWN OIt1 THIS PLAN IS LOCATED ON.THE ;.£�' GROUND.AS SHOWN HEREON&THAT IT Ooi=S LOCUS; - CONFORM T.0 THE ZONING BY LAWS 09=.THE �•t,`�1 OF �,� \�_ `• , .`TOWN OF '$ARNS'TAt31-6 , <AS 8V1LT �� �� ,� YV IsS i DATE I I I W ISO o ARNE u�\o � _ H. `�,1 REF: Lo.-rid Coon+ `3:�t-74 7L downdown . / �g 6� o OJALA c- /` cape equielerm 26 48 i, PREPARED FOR: C c�c� .. CIVIL ENGINEERS r� LAND SURVEYORS `y SCALE Yarmouth-&Orleans MA DATE °� 'SECTION SEWAGE —SEPTIC TANK — — "D"BOX — — LEACHING `_2F-QCW 3Z:oo USE- .sr-H, 4c. PIPE. ---- (MSL)#._ "2"0F1/eTO1/:" NOTE: WASHED STONE REMOVE ANY UNSUITABLE MATERIAL FOR A DISTANCE OF 10 FT.AROUND ENTIRE LEACH - Tfa' J�N AND REPLACE WITH CLEAN COARSE SAND. / Fr Co.00v7- OUT- IN• =7iE -OUT-- r3 IN 2$.SO . 2'i_'l3 vELEV. . ELEV. ELEV. rj 2'f g I z l-94 ELEV. ELEV. 96WO 13L:N2Lrj r Z�.(ol NOTE: e BRING ALL COVERS TO WITHIN V�r� --C� TIa,U Z,I WASHED STONE 1 FT.OF FINISH GRADE. 1 \ TEST:HOLE LOG ,' l?acHA .o PAuL. Murcia kv,— 5Nra i. TEST BY FAlydtAi�ic. ,Pfi: (3�, c� I-I>,�t_Tu C3�ti► .� . . WITNESS G7��4G .' 131mvr : TEST DATE ADCC�IGA1 T.H. #,.'19 T.H. # 21 DESIGN , ..., ZS.o 29.3 Tc�,t;E�.1 try cLr_,�1.! rtNF_ s act G� 'IS �fo0r35�-:2Cla y . 1� FL 2 0� P 4 0 ELEV. O' ELEV. BAUD C "f: ' NO ►? Z .o 120 Ze PERC RATE MIN/IN. DISPOSER DISPOSER _ Y FLOW RATE 2430 (GAL./DAY) 290 L SEPTIC TANK 29n x (L5)= .43( �. 13 ec 1 C-LA Y REQ'D SEPTIC TANK SIZE f o Cn,L pEP_C — — rCS T2'3.b4 L fir.! FtnL — Z23 LEACH FACILITY SIDE WALL Z'x 25'x 2 x (2.5► = 254 . wo ��„ 19.3 BOTTOM 2' x zs ' x ( 1•0 ) _` 5 Q . G/D. xr.lCfg�. (9.0. I TOTAL .. S 1 LT M USE: � �� LEACHING TPZEI`aia" oxlo� I�YEr-z Zr�' �onca� x 21v�Ide �c 2'dee� CUelow 'pl.Fe-� WATER ENCOUNTERED T— a s 55. 12j1��'113 NOTE,9: (UNLESS OTHERWISE NOTED) I.GATOM(MSL):TAKEN.FROM NY N 5---_-------QUADRANGLE MAP - --� 2:MUNICIPAL WATER^��5�I�"IY �.J ' S!a OF—_AVAILABLEa,„��_. &\ 3.PIPE PITCH:Vi, PER FOOT EXCE;PT AS swowIJ �• 4.DESIGN LOADING FOR ALL PRE CAST UNITS:AASHO- 44 24JA!MES S 5.MIN.GROUND COVER OVER ALL SEWAGE FACILITIES: (1) FT. ' �� .IAt�r1 6.PIPE JOINTS SHALL BE MADE WATER TIGHT p tAA BOWMAN 7.CONSTRUCTION DETAILS TO BE ACCORDANCE WITH COMM.OF MASS. U r STATE ENVIRONMENTAL CODE TITLE 5 1�1D' S NA 24040 pev r 1�1 {b t f �'J _ � F ISTf- 3T _ v W_w'";_,.. REG.PROFESSIONAL ENGINEE BOARD OF HEALTH CONTOURS (EXISTING)•----------- (PROPOSED)-0-=0-0-0— APPROVED DATE ���St �L�� MA Sever Permit ?;o _ Ly --- location- (t - -» <a-' S/ _GL:`_ N7_ ¢ .._�- -- _-- ------------------ ---Installer's Name dame and Address i~) ` �1 _t (7t)wS ) ----- . T'�zilder's Name and Address Date Permit Issued: Date Compliance Issued' � v i a �J V ,r. 0 Vl� + ee�et� 1 s i• 4 r.A Omu A- 9- v s �. �- YZ 11, �l+ � 'cgs 33ue sand Address �._..r-- _ AID io fiance Ts6tt'ed - ,7 ,k n ''? •-p SLY"k �� , No. --� =— Fee-- _�-- BOARD OF HEALTH TOWN OF BARNSTABLE ZippCitation-for Iftl Con5truct ion permit Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair (--411'an individual Well at: f-- — --- --- — — -----10 ———— _—— --_—_— Location — Address �( / Assessors Map and Parcel ——_——--— -- — — -- — — --------------- Ow er Address 6o__B'�iG�`jam rat o�GY Installer — Driller Address Type of Building Dwelling---------------___________--------------------- Other - Type of Building-- u' !t___—_------------ No. of Persons------------------- --- T e of Well UP!"—eS � _ __—_____________ Ca acit Purpose of Well -- -�� - - --- — — - Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a Certificate of Compliance has been issued by the Board of Health. Signed—� _-------—--- --- - �� " "� date Application Approved By---%� — — date Application Disapproved for the following reasons:------------------------------------ — date Permit No.-_ - -/ -- - ---— - Issued date BOARD OF HEALTH TOWN OF BARNSTABLE ' Certificate Of Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired (>e) by—' � D�----___ - - - --- -- ---- Installer at— has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No.�"_9-A=_t__Z-Dated-- — THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE------——---- -- — Inspector-----------------------------— -— -- - ---- -— Fee---:=!T----- -- BOARD OF HEALTH TOWN OF BARNSTABLE 0ppfitat ion-for lVerr Con! tructionPermit Application is hereby made for a permit to Construct ( / ), Alter ( ), or Repair ( ✓)an individual Well at: •-J J �. �. lif jr"K,d�tS:Y�t� {.) h f ' Location k— Address Assessors Map and Parcel ` 7— Owner Address— r Installer — Driller Address Type of Building Dwelling- ------- - - ----------------- Other - Type of Building �------------------- No. of Type of Well Capacity-----------P---e--r-s--o-n---s-----------_-_-_--------------------------------------- Purpose of Well---4--"- A-l--a-—c ----_—___—_—____ Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until a Certificate of Com•liance has been issued by the Board of Health. Signed-- =/•a,,• — _—_ •_'1______ date Application Approved By--__— � _ _ _�d�; �-� _ _________ _L-)_�_ 9� _ — —--- date Application Disapproved for the following reasons:--------------------- ----------------------------------------------------- -- — - -- - -- -- - � date Permit No.---- ! �_-- --�!----- -- Issued--------_________ -____-- date BOARD OF HEALTH TOWN OF BARNSTABLE (Certificate Of Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ---- --------------------- ---------------------------------- Installer at-------11 has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No.t ,a,— - --Dated--------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE-- --_- --- - -- - ----- --- Inspector-- --- ---- ----------------------- BOARD OF HEALTH TOWN OF BARNSTABLE Yell (Con5tructionPermit No. 11 Q� - �'�-� Fee--- -=��'---- Permission is hereby granted-- _b-__;_A----- !t- to Construct ( ), Alter ( ), or Repair an Individual Well at: No. _° Y1 a n,A ---------------------------------------------- Street as shown on the application for a Well Construction Permit ' No.___-___ --- - --- -------------------- Dated--------jj,z-----v----- ------------------ DATE — —`` �� � -- ------=- -- VBoard of Health —_-(�__�_.�_--���-----------_----- 1 v � y +/ .7 izz CP 01, I � 4kl 1 1/ / / � I � , \` C.C>M P�S��'E. - Sis.�..►D w I G N �, 1•A Y A►�►..+� S 4��.a.��s a 1 L, / \t P. 1= tr I \ I `�_�_ � , ,1 1I l J.% / ''� --_-O'°�0�/q�� II .� \ \ '� . . .� �/I IT•N C-F�S �AL.IL b!�U��.AY� >3. �. �-1. f� �p� C,N� \f 'y' 1"� ! ( i E I 1 0. \ / ! 19 ✓, ,,c Zq .w6 .✓, Z-1. a .51 t_TY tsMED, p -_- -1` % \ � � ,_ �..•c� - �- — -; Qh,` MINI Gam.. 0 02-S \ 1 \ C-9 \ \ \ q".Z''4- i4x-r e>?wP l&C7- Ts5ul`rZ-1tiG Z.goc� . t�- Cal -�'� 9jdl�c�c�4 S�.}�• = ZIc7 ci/d. n,.,G : 4-4 5 0 �9.�$. C�'s —r s q jd/10 ov Sq. 321`1 q \ \ USG G7waM Zj`>©n L Ti4�.i� 5��i. WAS.-.� Ct3� t E +-4Z+4-Z j�1.5� X Z•5 � 4�o q�a r30T i d M (I�K �••2.> (�.O� � 'T�`TAI.._ = 1�Q Ctr �jd �� _��� 3Z o _dWL�t F�=USOf2 'S Z Q ) EZnovC �tiv vruSu re�� G 1/IAT�t2�A� F�iz A _1SC t ��tt �G� GAG1-111.JC D�daTA ti,cC c�F �0 1-F.!J�FE_GT1VG t71MG►�S1o►+1S : 1ST .nfi�� X 4Z.:' �G�wtG �woktr�EszS Esc-.cZv� a. p a�,oR A•cC vir -r" GL C)n i'.S6 u NJ ----j. coo e A � Z���- --_ - �r.�zr.:�.��� •��., r.�,. c-1. zS.S r3�_1 �►�c� �+ Z ©,.� 4h.tv© Cv u►ZT �,t.� Iv c) 3 -2.4� Gtvtt, E.1.,l�,Iti�EZS - -- I I "A.rvD Su v�Yo��� — 1 .d` off' �/4- - 1�/L ...:a.3�•�GD S-TaN e. i --� .ani 'cvG > nic�.Cl _t►.r� t ��-�� SuF3�t�, StC�t.l ��►.►c�► rvG \ `1 i C mow• � � '.-.'--f----••� ���/,./ "� _ Z[o SO ;c�' � 0f - Q Mq `� ,G �� � v 'XZ&.33 o.vca - 0.5C4 r; ,�,• -�� �� wit.i. �v, �-- r � � — av+L o,nlA L_,o. 1 h.�, C S7- 13 /J,�P...l1 S A 1 M A� �,�- I.v -- - ,_ —_ - •fit No. 3©792 1:a .-6348 - - - - -- .ices. O 4zZ ;per:�31Yy i. AT'c:..�Z , i at