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HomeMy WebLinkAbout2275 MAIN ST./RTE 6A(W.BARN.) - Health 2275 Main,Street West Barnstable A= 237-033 C � • �L Crocker, Sharon From: Crocker, Sharon ' /�— Sent: Thursday, March 25, 2021 5:01 PM To: Tripp,Vanessa; Stanton, David Cc: O'Connell,Timothy; McKean, Thomas Subject: RE: 2275 Main Street, WB Title V Report -House closing today. Vanessa, Tim reviewed the code for Title 5 for Tom in relation to the situation with one inlet cover being partially under the house. The septic tank's other cover is accessible. The code stipulates that as long as the system is able to be pumped, it is not in failure. Tom said I could pass this information on to Jim Sears, which I did, and he will be doing a revised septic inspection report. Thank you all. Sharon Sharon Crocker Office Manager Town of Barnstable—Health 508-862-4739 The information contained in this electronic transmission("e-mail"),including any attachment(the"Information"),may be confidential or otherwise exempt from disclosure.It is for the addressee only. This Information may be privileged and confidential work-product or a privileged and confidential communication.The Information may also be deliberative and pre-decisional in nature.As such,it is for internal use only.The Information may not be disclosed without the prior written consent of the Director`of Public Health and/or the Town Attorney's Office of the Town of Barnstable.If you have received this e-mail by mistake,please notify the sender and delete it from your system.Please do not copy or forward it.Thank you for your cooperation. From: Tripp,Vanessa Sent: Thursday, March 25, 2021 1:02 PM To: Crocker, Sharon Subject: FW: 2275 Main Street, WB Title V Report Vanessa Tripp Lead Permit Technician Town of Barnstable Health Division 200 Main Street Hyannis, MA 02601 Phone: 508-862-4644 The information contained in this electronic transmission("e-mail"),including any attachment(the"Information"),may be confidential or otherwise exempt from disclosure. It is for the addressee only.This Information may be privileged and confidential work-product or a privileged and confidential communication.The Information may also be deliberative and pre- decisional in nature.As such,it is for internal use only.The Information may not be disclosed without the prior written 1 r consent of the Director of Public Health and/or the Town Attorney's Office of the Town of Barnstable.If you have received this e-mail by mistake,please notify the sender and delete it from your system.Please do not copy or forward it.Thank you for your cooperation. From: Tripp,Vanessa Sent: Thursday, March 25, 2021 8:54 AM To: Stanton, David Cc: Desmarais, Donald Subject: 2275 Main Street, WB Title V Report Hi, Jim Sears called asking if this report can be reviewed. It was a Needs Further Evaluation. I received this report on Tuesday, FYI. I haven't logged it in yet, but processed payment.The seller of home and realtor, both wanted to sign papers yesterday and now looking to sign today.Jim wants to speak with you about this report. His phone number is 508-364-4398. Thanks, Vanessa Tripp Lead Permit Technician Town of Barnstable Health Division 200 Main Street Hyannis, MA 02601 Phone: 508-862-4644 The information contained in this electronic transmission("e-mail"),including any attachment(the"Information"),may be confidential or otherwise exempt from disclosure. It is for the addressee only.This Information may be privileged and confidential work-product or a privileged and confidential communication.The Information may also be deliberative and pre- decisional in nature.As such,it is for internal use only.The Information may not be disclosed without the prior written consent of the Director of Public Health and/or the Town Attorney's Office of the Town of Barnstable.If you have received this e-mail by mistake,please notify the sender and delete it from your system.Please do not copy or forward it.Thank you for your cooperation. 2 Ke Iva e1 ( Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments !% 2275 Main St Property Address Pauline Cunniff Owner Owner's Name information is West Barnstable Ma. 02668 3-25-21 required for every — page. City/Town State Zip Code Date of Inspection. Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. Inspector Information I' 1&aaa filling out forms on the computer, Michael Sears use only the tab — — key to move your Name of Inspector cursor-do not Jim The Inspector Manuse the return Company Name key. � Company Address West Yarmouth _ Ma. 02673 City/Town State Zip Code 508-364-4398 S114430 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ® Passes ZN OF MgS4�Gi 2. ❑ Conditionally Passes `����p?�'.... '•sy�''� MICHAEL''sN 3. ❑ Needs Further Evaluation by the Local Approving Authority 'a SEARS c No.ST14430 'Q 1 s*' 4. ❑ Fails %'"�'•�'R 'n ' '.��� TIF�,��0�� IN 3-25-21 Inspector's Signa a Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 t5insp.00e-rev.7/2 612 01 8 I Commonwealth of Massachusetts 6 Title 5 Official Inspection Form ^II Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 2275 Main St V Property Address Pauline Cunniff Owner Owner's Name information is West Barnstable Ma. 02668 3-25-21 required for every — -- page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System is in working order with no sign of failure, however the inlet cover of the septic tank is located under the foundation of the house. Reviewed b j arnstable Board of health System passes 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon 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): t5insp.doc-rev.7/26/2018 Title 5 official Inspection Form:Subsurface Sewage Disposal system-Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 2275 Main St -- Property Address Pauline Cunniff Owner Owner's Name information is West Barnstable Ma. 02668 3-25-21 required for every ty page. Ci /Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a 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): i ❑ 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): 3) 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. a. 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: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface sewage Disposal System-Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 2275 Main St Property Address Pauline Cunniff Owner Owner's Name information is West Barnstable Ma. 02668 3-25-21 required for every _ _ page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is 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. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form � a Subsurface Sewage Disposal System Form Not for Voluntary Assessments r� 2275 Main St Property Address Pauline Cunniff _ Owner Owner's Name information is West Barnstable Ma. 02668 3-25-21 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ® The system is a cesspool serving a facility with a design flow of 2000 gpd- El10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section CA. 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 13 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 t51nsp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 2275 Main St Property Address Pauline Cunniff Owner Owner's Name information is required for every West Barnstable Ma. 02668 3-25-21 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered"yes"to any question in Section C.5 the system is considered a significant threat, or answered "yes" to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes"or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? Have large volumes of water been introduced to the system recently or as part of ❑ ® this inspection? ® El available 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? ® El information the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 r Commonwealth of Massachusetts Title 5 Official Inspection Form e Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 2275 Main St — Property Address Pauline Cunniff Owner Owner's Name information is West Barnstable Ma. 02668 3-25-21 required for every page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): 3 — Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Description: 2 Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No 2019- 94000 gal Water meter readings, if available (last 2 years usage(gpd)): 2020- 52000 gal Detail: Sump pump? ❑ Yes ® No Present Last date of occupancy: Date t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 f , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 2275 Main St Property Address Pauline Cunniff Owner Owner's Name information is West Barnstable Ma. 02668 3-25-21 required for every - -- page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): --- Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: — Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Feb, 2021 Was system pumped as part of the inspection? ❑ Yes ® No I If yes, volume pumped: gallons How was quantity pumpe d determined? Reason for pumping: t5insp.doe-rev.7/26/2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 c<\ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments . 2275 Main St Property Address Pauline Cunniff _. Owner Owner's Name information is West Barnstable Ma. 02668 3-25-21 __ required for every - - — — - page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: New SAS 8-1-06 #2006-341 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): 16" 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.): Title 5 official Inspection Form:Subsurface Sewage Disposal system•Page 9 of 18 t5insp.doc-rev.7/26/2018 i Commonwealth of Massachusetts Title 5 Official Inspection Form M1 Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 2275 Main St Property Address Pauline Cunniff Owner Owner's Name information is required for every West Barnstable Ma. 02668 3-25-21 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank (locate on site plan): 6" Depth below grade: feet Material of construction: ®concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain) 1000 gal If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gal 1" Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 29" 0 Scum thickness Distance from top of scum to top of outlet tee or baffle r 8" Distance from bottom of scum to bottom of outlet tee or baffle 18" How were dimensions determined? Sludge judge tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 1000 gal tank with out tee in place, outlet cover at grade, inlet_cover under foundation t5insp.aoc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 2275 Main St Property Address Pauline Cunniff Owner Owner's Name information is required for every West Barnstable Ma. 02668 3-25-21 -- page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. 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 Title 5 Official Inspection Form:Subsurface sewage Disposal system-Page 11 of 18 t5insp.doe•rev.7/2 612 0 1 8 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 2275 Main St Property Address Pauline Cunniff Owner Owner's Name information is West Barnstable Ma. 02668 3-25-21 required for every page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): 0 Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D Box is 16x16 with 3 outlet pipes box is 22" below grade with cover at 3" Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 t5insp.doc•rev.7/2 612 01 8 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 2275 Main St Property Address Pauline Cunniff Owner Owner's Name information is required for every West Barnstable Ma. 02668 3-25-21 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 10. 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. 11. Soil Absorption System (SAS) (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: 20'x38' ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal system-Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u 2275 Main St Property Address Pauline Cunniff Owner Owner's Name information is required for every West Barnstable Ma. 02668 3-25-21 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): SAS is a field 20'x38', field is clean and dry with no sign of failure 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): i Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer -- Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.00c•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 2275 Main St Property Address Pauline Cunniff _ _ Owner Owner's Name information is West Barnstable Ma. 02668 3-25-21 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cost.) 13. 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.): Title 5 Official Inspection Form:Subsurface sewage Disposal system•Page 15 of 18 t5insp.aoc•rev.7@e/2018 Commonwealth of Massachusetts f Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 2276 Main St -- '"' Property Address Pauline Cunniff Owner Owner's Name information is West Barnstable Ma. 02668 3-25-21 required for every -- State Zip Code Date of Inspection page. City/Town D. System Information (cont.) 14. Sketch of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately 4 E9`4 Al -Is We jo I JJ .OF MICHAEL ':N o; SEARS *�. No.SI14430 IN t5insp.doc•rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form aI e Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u 2275 Main St Property Address Pauline Cunniff Owner Owner's Name information is West Barnstable Ma. 02668 3-25-21 required for every --_ page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high round water: p g 9 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: 4-4-99 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: No ground water per plan Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doe•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18 Commonwealth of Massachusetts U1Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments . 2275 Main St Property Address Pauline Cunniff Owner Owner's Name information is West Barnstable _ Ma. _ 02668 3-25-21 required for every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4(Failure Criteria) and 6(Checklist)completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewag p Y e Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included 7 tJNeI.� I a' 8' NO�+vvgc+/►y�f„N Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 t5insp.doc•rev.7/2612 01 8 Commonwealth of Massachusetts R Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 2275 Main St Property Address Pauline Cunniff _ Owner Owner's Name information is West Barnstable _ Ma. 02668 3-25-21 required for every — _ page, City/Town State u Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): 4 — Number of bedrooms (actual): 4 i DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Description: Number of current residents: 2 — Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: —Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): 2019- 94000 gal Detail: 2020- 52000 coal Sump pump? ❑ Yes ® No Last date of occupancy: Present Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 a3�- 033 Commonwealth of Massachusetts Title 5 Official Inspection Form l� Subsurface Sewage Disposal System Form Not for Voluntary Assessments - 9 p Y rY v- 2275 Main St Property Address Pauline Cunniff Owner Owner's Name information is West Barnstable Br}Q Ma. 02668 3-18-21 required for every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information on the computer, use only the tab Michael Sears key to move your Name of Inspector cursor-do not Jim The Inspector Man use the return Company Name key. P.O.Box 784 �y Company Address West Yarmouth Ma. 02673 City/Town State Zip Code 508-364-4398 SI 14430 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ❑ Passes `���auuuurun,, OF 2. ❑ Conditionally Passes �`=s� •' ' sgoy MICHAEL '.N 3. ® Needs Further Evaluation by the Local Approving Authority *: No.S114430 4. ❑ Fails �;• o f �o A7 5f+N SPN�� ill 3-18-21 Inspector's SignqleDate The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ` Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform p Y in the future under the same or different conditions of use. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .� 2275 Main St Property Address Pauline Cunniff Owner Owner's Name information is required for every West Barnstable Ma. 02668 3-18-21 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System is in working order with no sign of failure, however the inlet cover of the septic tank is located under the foundation of the house. Can not open cover. 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon 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): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 c , Commonwealth of Massachusetts Title 5 Official Inspection Form II Subsurface Sewage Disposal System Form -Not for Voluntary Assessments � !% 2275 Main St u� Property Address Pauline Cunniff Owner Owner's Name information is required for every West Barnstable Ma. 02668 3-18-21 page. Cityfrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a 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): El obstruction is removed El Y N F1 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): 3) 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. a. 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: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 f Commonwealth of Massachusetts - Title 5 Official Inspection Form I; Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �,•� 2275 Main St t,— Property Address Pauline Cunniff Owner Owner's Name information is required for every West Barnstable Ma. 02668 3-18-21 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is 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. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 M Commonwealth of Massachusetts �n :. Title 5 Official Inspection Form �<li? Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ............. 2275 Main St Property Address Pauline Cunniff Owner Owner's Name information is required for every West Barnstable Ma. 02668 3-18-21 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. 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 t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts a Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments c 2275 Main St Property Address Pauline Cunniff Owner Owner's Name information is required for every West Barnstable Ma. 02668 3-18-21 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of 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)] t5insp.doc-rev.7/26/2618 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts IP Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 2275 Main St Property Address Pauline Cunniff Owner Owner's Name information is required for every West Barnstable Ma. 02668 3-18-21 page. Cityrrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 2019- 94000 gal g ( y g (gp ))' 2020- 52000 gal Detail: Sump pump? ❑ Yes ® No Last date of occupancy: PresentDate t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 f c Commonwealth of Massachusetts �n ,A Title 5 Official Inspection Form _ II Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ............. !% 2275 Main St Property Address Pauline Cunniff Owner Owner's Name information is required for every West Barnstable Ma. 02668 3-18-21 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Feb, 2021 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc-rev.7/26/2018 _ Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 c� Commonwealth of Massachusetts a Title 5 Official Inspection Form �I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 2275 Main St V� Property Address Pauline Cunniff Owner Owner's Name information is required for every West Barnstable Ma. 02668 3-18-21 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: New SAS 8-1-06 #2006-341 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 16"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.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u- 2275 Main St Property Address Pauline Cunniff Owner Owner's Name information is required for every West Barnstable Ma. 02668 3-18-21 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 6"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 1000 gal If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gal Sludge depth: - 1" II Distance from top of sludge to bottom of outlet tee or baffle 29" Scum thickness 0 Distance from top of scum to top of outlet tee or baffle 8" Distance from bottom of scum to bottom of outlet tee or baffle 18" How were dimensions determined? Sludge judge, tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 1000 gal tank with out tee in place, outlet cover at grade, inlet cover under foundation t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 2275 Main St Property Address Pauline Cunniff Owner Owner's Name information is required for every West Barnstable Ma. 02668 3-18-21 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 f c� Commonwealth of Massachusetts ,p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 2275 Main St Property Address Pauline Cunniff Owner Owner's Name information is required for every West Barnstable Ma. 02668 3-18-21 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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 16x16 with 3 outlet pipes box is 22" below grade with cover at 3" t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 f cam, Commonwealth of Massachusetts Title 5 Official Inspection Form Il Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 2275 Main St Property Address Pauline Cunniff Owner Owner's Name information is required for every West Barnstable Ma. 02668 3-18-21 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 10. 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. 11. Soil Absorption System (SAS) (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: 20'x38' ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form _ I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments !% 2275 Main St u� Property Address Pauline Cunniff Owner Owner's Name information is required for every West Barnstable Ma. 02668 3-18-21 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): SAS is a field 20'x38', field is clean and dry with no sign of failure I 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert 2 Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 i Commonwealth of Massachusetts �n : Title 5 Official Inspection Form I, Subsurface Sewage Disposal System Form -Not for Voluntary Assessments . � 2275 Main St V Property Address Pauline Cunniff Owner Owner's Name information is required for every West Barnstable Ma. 02668 3-18-21 page. CityTrown State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): i t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 I cam, Commonwealth of Massachusetts Title 5 Official Inspection Form Mle Subsurface Sewage Disposal System Form - Not for Voluntary Assessments • 2275 Main St V� Property Address Pauline Cunniff Owner Owner's Name information is required for every West Barnstable Ma. 02668 3-18-21 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below- 0 hand-sketch in the area below ❑ drawing attached separately 4 eac� At -is U0 a-F I apes OF M,QS MICHAEL '.N o: SEARS �' * No.SI14430 ''�.���'•FRTIF�� O �` m a t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form `i; Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 2275 Main St Property Address Pauline Cunniff Owner Owner's Name information is required for every West Barnstable Ma. 02668 3-18-21 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 144' 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: 4-4-99 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: No ground water per plan Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form I; Subsurface Sewage Disposal System Form -Not for Voluntary Assessments t,— 2275 Main St Property Address Pauline Cunniff Owner Owner's Name information is West Barnstable Ma. 02668 3-18-21 required for every page. CityrTown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist)completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included &W-ph c SAS oa 8� /VO Grov.�w��.tn t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 R R � Crocker, Sharon From: Crocker, Sharon 0,% Sent: Thursday, March 25, 2021 5:01 PM To: Tripp,Vanessa; Stanton, David Cc: O'Connell, Timothy; McKean, Thomas Subject: RE: 2275 Main Street,WB Title V Report -House closing today. Vanessa, Tim reviewed the code for Title 5 for Tom in relation to the situation with one inlet cover being partially under the house. The septic tank's other cover is accessible. The code stipulates that as long as the system is able to be pumped, it is not in failure. Tom said I could pass this information on to Jim Sears, which I did, and he will be doing a revised septic inspection report. Thank you all. Sharon Sharon Crocker Office Manager Town of Barnstable—Health 508-862-4739 The information contained in this electronic transmission ("e-mail"),including any attachment(the"Information"),may be confidential or otherwise exempt from disclosure.It is for the addressee only.This Information may be privileged and confidential work-product or a privileged and confidential communication.The Information may also be deliberative and pre-decisional in nature.As such,it is for internal use only.The Information may not be disclosed without the prior written consent of the Director of Public Health and/or the Town Attorney's Office of the Town of Barnstable. If you have received this e-mail by mistake,please notify the sender and delete it from your system.Please do not copy or forward it.Thank you for your cooperation. From: Tripp,Vanessa Sent: Thursday, March 25, 2021 1:02 PM To: Crocker, Sharon Subject: FW: 2275 Main Street, WB Title V Report Vanessa Tripp Lead Permit Technician Town of Barnstable Health Division 200 Main Street Hyannis, MA 02601 Phone: 508-862-4644 The information contained in this electronic transmission ("e-mail"),including any attachment(the"Information"),may be confidential or otherwise exempt from disclosure. It is for the addressee only.This Information may be privileged and confidential work-product or a privileged and confidential communication.The Information may also be deliberative and pre- decisional in nature.As such,it is for internal use only.The Information may not be disclosed without the prior written 1 consent of the Director of Public Health and/or the Town Attorney's Office of the Town of Barnstable.If you have received this e-mail by mistake,please notify the sender and delete it from your system. Please do not copy or forward it.Thank you for your cooperation. From: Tripp,Vanessa Sent: Thursday, March 25, 2021 8:54 AM To: Stanton, David Cc: Desmarais, Donald Subject: 2275 Main Street, WB Title V Report Hi, Jim Sears called asking if this report can be reviewed. It was a Needs Further Evaluation. I received this report on Tuesday, FYI. I haven't logged it in yet, but processed payment.The seller of home and realtor, both wanted to sign papers yesterday and now looking to sign today.Jim wants to speak with you about this report. His phone number is 508-364-4398. Thanks, Vanessa Tripp Lead Permit Technician Town of Barnstable Health Division 200 Main Street Hyannis, MA 02601 Phone: 508-862-4644 The information contained in this electronic transmission("e-mail"),including any attachment(the"Information"),may be confidential or otherwise exempt from disclosure. It is for the addressee only.This Information may be privileged and confidential work-product or a privileged and confidential communication.The Information may also be deliberative and pre- decisional in nature.As such,it is for internal use only.The Information may not be disclosed without the prior written consent of the Director of Public Health and/or the Town Attorney's Office of the Town of Barnstable.If you have received this e-mail by mistake,please notify:he sender and delete it from your system.Please do not copy or forward it.Thank you for your cooperation. 2 a - =t �. tit 3,�s:, ��F. � •^ �� { �t -' '. 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'. 1 1. :� k S •rfx`-i�LL_.S. ��.rC��i�. ��Y'�,r" sl•.+_�, �C'��" r � d �5 Mg �n St 8n� ns+�bk i `ems/ ti Ila tls S Z —7 S rYI A— A-) PAtA I'v� LOA 5 0 PJL"C-_ o — s s IW N A A N LAND 618 llouta 28 Sh 3 W.Yarmouth MA 02673 50&771.LAND TOWN OF BARNSTABLE LOCATION 213 -5'- /y li l ti S 77— SEWAGE# VILLAGE t4o, /7 A ASSESSOR'S MAP&LOT 3 y �� 11181111-�11R'S NAME&PHONE NO. f (VA.-To SEPTIC TANK CAPACITY Z A�'XIF C l!6 ti LEACHING FACILITY:(type) (size) NO.OF BEDROOMS BUILDER OR OWNER y A-*# PERMIT DATE: Ca1G1PtbkNCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 177 No.. l9 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABI.k, MASSACHUSETTS Yes Zippftication for Migposal *p.5tem Cou.5tructiou Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. p�p?75 �f (p ✓i- Owner's Name,Address,and Tel.No. 4A'1 of ®it S 3-5-0 ltJ e.�C � 4-f (.t/r iNiLa Assessor's Map/parcel '? 3 ?2O;?6 5'05'- 77/ — 7s;�/0 Inns ersNNa`mp Address,and Tel.No. r- 4 4e- Designer's Name,Address and Tel.N . � -f 1 i==�k A44or o 10 771 - o -7' - 7 Type of Building: Dwelling No.of Bedrooms Lot Size 19 7/ sq. ft. Garbage Grinder ( ) -4/0 Other Type of Building e,Q No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided y` gpd Plan Date :&F / O 6 Number of sheets Revision Date Title 44 A X-Zl / Size of Septic Tank Type of S.A.S. -7 Description of Soil -7 Nature of Repairs or Alterations(Answer when applicable G'�Q r ^ l�t�d-aj 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. S' ne A4- Date _!g / O Application Approved b Date e-7 I Application Disapproved by: Date for the following reasons Permit No. Date Issued No. �' _3 - t ` "'� Fee /00 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTA ~, MASSACHUSETTS� Yes t Y ca au for i� ogaY p en Construction Permit Application for a Peiit�to�Construct O Repair O Upgrade O Abandon O ❑ Complete System ❑Individual Components Location Address or Lot No. a p? 75 { (D 4 Owner's Name,Address,and Tel.No. •1 441 of . a 1�'a 550 u�. .s�4. IA4 w, Assessor's Map/parcel 02 K_ 7 3 5'05'- 77/ - 75� Installer's Name,Address,and Tel.No. CXQ Designer's Name,IAddress and Tel.No. 5S® ter �-� t✓• �� -moo 0 D 7 Type of Building: I Dwelling No.of Bedrooms Lot Size 5 7 sq. ft. Garbage Grinder 440 Other Type of Building ggAA No.of Persons Showers(% ) Cafeteria( ) Other Fixtures / Design Flow(min.required) �-� gpd Design flow provided (� gpd Plan Date 7//. / O Number of sheets / Revision Date Title 4 2 -7 1 -Z/ S t Size of Septic Tank 0 r.nQ Type of S.A.S. -76 0 4,� , Description of Soil r_& L12 _13— L°P� 'i►/► f� < a.«_P�t ��.t t� ` M Nature of Repairs or Alterations(Answer when applicable) �,Q _ T /111)Q62,y 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 .rt / Date / O G c. Application Approved bL \ Date Application Disapproved by: Date for the following reasons Permit No. ago (c) ' 3 Date Issued r v THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( (Upgraded ( ) Abandoned( )by Ilk at -7a -7 S /ylo /._-t ' kl, Ye e has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer Qom !! �/e L ' Designer !!�l -ifs/ ;9, , #bedrooms `—f- Approved design flo w1 4SC O gpd The issuance of this .,^mit shall not be construed as a guarantee that the system will f nu cti�on as desi"id , C Date (�>� �. Inspector G T J �y 1 ——————————————————e————------------- No. 6 --3 L) Fee Q THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS �igpo!6al i§p!5tem Conotruction Permit Permission is hereby granted to Construct ( ) Repair ( yr Upgrade ( ) Abandon ( ) System located at 7 S A 4 dy 21 4 and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special condiions� Provided: Constructi n mu t be completed within three years of the datelof this permit. Date 1 In _ Approved by f A & M Land Services 15 Sunset Drive`, ''MA South Yarmouth,- 02664 508-737-1;7.77 August 28, 2006 Town of Barnstable Board of Health 67 Main Street Hyannis, MA 02601 RE: 2275 Route 6A Dear Health Director, On or about August 15, 2006 Assurance Construction began construction of the septic system located at,,2275.Route.6A.Barnstable'. We inspected the hole prior to them installing the SAS, we also inspected the system components prior to backfilling. To the best of my knowledge and belief the septic system construction and location is in substantial compliance with CMR 15 Title V, Local BOH Regulations and the Site and Septic Plan dated July 19, 2006. Sincerely, i low .' po P.E. SPOFF w_�iatcN ri r. 0 TOWN OF BARNSTABLE - UNDERGRUUND FUEL AND CHEMICAL STORAGE REGISTRATION MAP NO. PARCEL NO. ADDRESS OF TANK: VILLAGE: fvumb�r Ytr��t MAILING ADDRESS ( IF DIFFERENT FROM ABOVE ) : OWNER NAME: PHONE: INSTALLATION DATE: I Y: INSTALLER ADDRESS: -CERT.i4O. *TANK LOCATION: D C C C RtZ D C T A N MC L O Q A T Z O N W I T H A Q C P Q C T T O Y U Z L D Z N O) CAPACITY TYPE OF TANK AGE YRS. FUEL/CHEMICAL TESTING CERTIFICATION [ ] PASS [ ] FAIL DATE LEAK DETECTION [ 1 CHECK IF N/A TYPE/BRAND ZONE OF CONTRIBUTION ( ] YES [ NO DA TL'TO BEI REMOVED_ �]�"7 A� FIRE DEPT. PERMIT ISSUED [ ] YES [ ] NO DATE CONSERVATION ( ] CHECK IF N/A DATE f BOARD OF HEALTH TAG NO. [ ] DATE * PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD ETA-A/K D v � E _ M f 1 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Allp iration for Uiupuuttl W urk,i Towitriartiun ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal y , = ----------------------------------------•-----------------------------.........•-•••-------••-•--• ocatiVii dr s t o � P � - . Owner- Y-6 �O �C a q.S.. d Installer Address d Type of Building n Size Lot............................Sq. feet U Dwelling— No. of Bedrooms---------____T-_.-_________-_ ._ __ExpansionAttic ( ) Garbage Grinder ( ) ---------------------------- No. of ersons-------------•-•••••--•-... Showers —per,, Other—Type of Building p ( �) Cafeteria ( ) Other fixtures ................................. . W Design Flow..................................._---__._gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacityA allons Length................ Width---------------- Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No.....P .......... Diameter____________________ Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit_................. Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water..-----------........... P. -------------------------•-•---------------------------------------------------••------•--•--------.........---....................-•----------•-•-•••..----- ODescription of Soil........................................................................................................................................................................ W •-••----•---•---------------•-----••--•-•••-•-••----------------•-•••---••-••--•••••••••-•-----------------------'----------------------------------•--------•---......--------••-•---•--------........ U Nature of Repairs or Alterations—Answer when applicable.___._.. ��,,,_- ........_... ...12� -•-------------------------------•-•-----------'-----------•---•--------------------•--------------------------- ------------------------------------------------------------........ Agreement: The undersigned agrees to install the aforedescribed Individual Sew Disposal System in accordance with the provisions of TITLE 5 of the State Environmental e—The u er further agrees not to place the system in operation until a Certificate of Com li een issu a -d v ealth. Signed . ...... ......... .. .... ---- ------------- ------------- ---------- ................................. Date Application Approved By - - .................. - Date Application Disapproved for the following reasons: ............................................................................. .. .................................... ............------- --------------------------.................------------------.... ----------- Date ' PermitNo. ......ILY--------r� �------------------- Issued ........ ------------------------------------------------ Date r No..,7�: Fxs ( .............. THE COMMONWEALTH OF MASSACHUSETTS - BOARD- OF. HEALTH TOWN OF BARNSTABLE , ppfiration for Dig)Jmml Worko Tonotrnrtion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Sys!Pem- at: --........•.----•-------------- ------•--------------------------�..----•-�o•-•---•----...•..----.----....---.......-- - `/�� J ��(�/ ocati i1 sOwner_ 6D ( /� /S.1dd / Installer V Address UType of Building �/ Size Lot............................Sq. feet Dwelling—No. of Bedrooms.............................................Expansion"pic ( ) Garbage Grinder aOther ---- -Type of Building ____________________________ No. of persons--------- -.............. Showers ( /) — Cafeteria ( ) dOther fixtures -------------------------------------------------------••----------------•......--•----'--.......•••••-•-••-•------••--••......-•-----•••••-----••••• W Design Flow--------------------------------------------gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity./gallons Length................ Width......---------- Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.....P........... Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................-_- Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ 0 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ............................................"......................................................................................_....................... . 0 Description of Soil........................................................................................................................................................................ W V ........•••••-••••••----••...••••-••-••--•-••-•-••••--••••••-•••••••••••-•--•••••••---•••••••-•--------•-•••-•--•-----------------•......•............................................................. 0 Nature of Repairs or Alterations—Answer when applicable---.--..` _ .... + _ .11.E- _.-,......__.__.ln��c...v ....... ..•• -•-•••...•••----••-••••-•-•-•-•••••-••--•-•---••••••••••••••••----------•-•-••-••--•-•••......-----•---•--•-- Agreement: The undersigned agrees to install the aforedescribed Individual Sew ge Disposal System in accordance with therprovisions of TITLE 5 of the State Environmental Ci"e —The u er 'gnie`d,further agrees not to place the system in operation until a Certificate of Com li een issu e � rd-of ealth. Y � Signed - ------ ------ ------ ------------------------------------------- -----. .....................c----- Date Application Appro ed By ...............q -. -�-. �. � ..................... ........................................... _ ...... }j .. �r - Date Application Disapproved for the following reasons: ................................................. . . --..................... . .................----------- .............................................................................. .................................................... ......--.................................... ................... -- ' Dare PermitNo. ......�.Ll...'----�<�.-cox ----------_---- ---- Issued ------------------------- ....................... Date --------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Terttfirate of Contlaliance THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) b V_..,_-C 9 r--c-h-,:>------------------------------.-....----------------......_ --------........ - _ . ..... ............. ' ...................... .................... . In;taller_ , -7 k �at ... -- ---------... �fi � ------------------------------------------------------------- has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ._.............__----------...-------------- dated _-- ......... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION DATE....... ,� � SATISFACTORY. { ...""... - - ------------ Inspector-"'-- . ` THE COMMONWEALTH OF MASSACHUSETTS, BOARD OF HEALTH C TOWN OF BARNSTABLE N. r•••--••--•••...r��:J FEE._.��C ........ Diopoottl Vorkii Tonotrurtion "rrmit Permission is hereby granted-----------1/'e r- ------------------------------------------------------------------- to Construct ( ) or Repair (u) an Individual Sewage Disposal System r -------------------------------------- _ s &�°�-=" ....... -7-----------� at No.............. ....... - '� . 7'� 1 Street as shown on the application for Disposal Works Construction Permit No.-. Dated...... �--�-•-...�l�ji..•- DATE--------- ---------------•--------............ Board of Health FORM 36508 HOBBS&WARREN.INC.,PUBLISHERS TOP OF FOUNDATION STANDARD NOTES EL _ Rio,` 5- -�--ter' , G- 2� o. Raise covers to within 6" of 1) THIS PLAN IS FOR THE ..,, i�,?•l-J jA _ OF A SEPTIC SYSTEM. 50_a N. G. �, !' finish grade install risers as needed �" 2) ALL INSTALLATION PROCEDURES AND VTERL4LS`eH,4LL CONFORM TO 310 CMR 15.000, THE STATE ENVIRONMENTAL CODE,GROUND SURFACE' Ems r (TITLE 5, AND THE TOWN OF �, � _ _ SUBSURFACE DISPOSAL REGULATIONS, .... 3 NO DETER MWATION HAS BEEN MADE AS TO COMPLZAAUE OF A VAILABLE PROPERTY INFORMATION WITH RECORDED DEED OR ZONING REGULA ONS. t TI c 4 OWN WATER : SERVICE THIS FROPERTY „ C ! TOP EL ", ) DOES . ,S _ Q 2 MIN-3 MAX % ''�- L1 ,� 5) THERE ARE NO EXISTING WELLS WITHW 200, OF THE PROPOSED SOIL ABSORPTION SYSTEM _ MIN 2' LAYER DOUBLE WASHED „ INVERT EL '� �- D-BOX 1/8`- 1/2' STQNF,7 6) ALL COVERS OF SYSTEM COMPONENTS SHALL BE BROUGHT TO WITHIN 6 OF FINISHED GRADE 7) ALL SYSTEM COMPONENTS SHALL REMAIN ACCESSIBLE FOR INSPECTION. NO STRUCTURES SHALL BE LOCATED DIRECTLY Proposed TINS WHI H 14 , 1 EFFECTIVE UPON OR ABOVE THE COMPONENT ACCESS LOCATIONS C WOULD INTERFERE WITH THE PERFORMANCE ACCESS W S ti , PECTION i A ALL �' .� IDEWALL INSTALL .� .d' IN R REPAIR RT EL r INVE &' STONE BASE I GAS ..� � s`®a IN EL 8 1N0 DRIVEWAY PARIffNG OR TllRNWG AREA OR OTHER ERVIOUS A BAFFLE' (fix �"enl ) , IMP ARE SHALL BE LOCATED ABOVE A SOIL ABSORPTION .r. �/ L/ r, L. . E _INVERT T lt� .S'YS EM EXCEPT WHEN VENTING HAS BEEN PROVIDED� 3/4 1 1/2 D❑UBLE , VIDE Proposed , ' cca WASHED STQNE 9) ,SEPTIC TANKS, GREASE TRAPS, DOSWG CHAMBERS AND DISTRIBUTION BOXES SHALL BE PLACED ON A 6" STONE BASE INVERT EL _ mar 3 � ,-� �, 1� .TO ENSURE STABILITY AND PREVENT SETTLWG. � D Box c INVERT EL ®,� , � 5 BOTTOM EL (Typical) 10) IOUTLET DISTRIBUTION LWES SHALL REMAIN LEVEL FOR A MINIIMUM OF THE FIRST TWO FEET OF THEIR LENGTH. Existing ! , ( - { ' ac1 Q, 11) ALL SYSTEM COMPONENTS SHALL BE CAPABLE' OF WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN 10' 1,000 Gal Septic Tank ' - v j o I -.( OF DRIVEWAYS OR PARKING OR TURNING AREAS, M WHICH CASE H-20 COMPONENTS SHALL BE USED. ,S = �f �Z (Typical) p ,-e�'va 2� S' = �` ' - S = ` "mil ? t j , -1 12 ALL BUILDING SEWER LINES SHALL HAVE AN INNER DIAMETER OF 4" AND SHALL BE CAST-IRON OR SCHEDULE 0 4 PVC. U' ✓ .-�"` � 13) 1lHE DEPTH OF THE TOP OF ALL SYSTEM COMPONENTS SHALL NOT EXCEED 36 UNLESS VENTWG HAS BEEN PROVIDED. 3 r1 E L /, ,-rp 4-.W T ST HOLE ;� 14) 1IN THE AREAS OF EXCAVATION, EXISTING GRADES SHALL BE REESTABLISHED UNLESS NOTED AS PROPOSED CONTOURS. 15 AT SOILS ARE ENCOUMTE'RED LIVRING THE EXCAVATION OF THE SOIL ABSORPTION SYSTEM THAT DIFFER NOTABLY \� ) FROM ' - D�"HE' EEP OBSERVATION HOLE LOG, CONTACT...THE ENGWEER BEFORE PROCEEDWG. 16 CONTRACTOR TO VERIFY LOCA.ZION OF ALL UNDERGROUND UTI UN CITIES 17) XtSTINtPLL {BING 'ET-�?ROPOSEF . O• �...�� p.,.J �--� � �`..- (� �=E�i�A�IONt °AO. L r ROUTE to ry a ( 30(�P`,u h- j 0 6A 1�Z S f , ( 18) E�k'1STWG LEACHINU TO BE PUMPED AND FILLED PER TITLE 5 S 60°I0'37" E S 53*1630" E ( 19) . __._..._.--- �r�- "" 29. 74 127,23' �., ,17'50" E 4 Fred MHB 9 , 5 a�x 8.1 _ 3 tk _ 0 / R 25.00 1 Top MHB �d Mxa / L = 27.98, ter DESIGN DA TA lYa t _ � DEEP O.BS.E'RVATIDN DEEP OBSERVATION TBM ELLine- 51. 75 Lot JA GAS � �e ..MOLE LOG HOLE LOG i Number of Bedrooms: 43 571 * 5�r( _ Test Hole #1 Test Hale #2 V = = L Garbage Grinder: (LL �, t) (EL f'�� �? f•) g NO 1 O `f ph ev Soil Soil Soil D� �,h ev Soil soil soil ag.8) 14) l� fn �ft) Horizon Texture Color ( j (eft) Horizon Texture Color. Design Flow ZL40 i ( 1pg• _.-- �„' J � (USDA) (Mansell) (USDA) (htunsell) I 1i0 Gal BR x e DTH 1 ( / /Daq Number of BR) Bldg #2 3 Be 1 0 - 20" y�3, f A LOAMY SAND i0YR4/a D - �4'° q3,` A LOAMY SAND i0YR4/a Septic Tank: 6) 7 2) p 1, 000 4• A• � _- J `�1 20" - 46" y�a.gt B LOAMY' SAND 10YR5/6 14" - 38" `�f. B LOAMY SAND 1��YR5/6 (�m�• = Design Flaw x 200% g ) Gal. 46" - 480" 4/ 77 t Cd1 SILTY CLAY IOYR6/4 38" - 240" 2 L1,t, Cd1 SILTY CLAY IOYR6/4 Leaching Area: J / \ LOAM LOAM ® 50" 7.5YR5/ Sidewalk. TBM EL = 50.0 -� ` L- / / \ — Large Eoidders Rim S-Tank ('� \ �, Deep Obs Hole Date: 06/08/06 Deep Obs Hole Date, 06/08/0_, (2 Sidewalls x _Ft x --Ft) + Existing -1,000 / / B��.n Soil Evaluator: ED STOWE, Soil Evaluator. ED STONE Z O Witnessed B D. DESIMOSEUS Witnessed D. DESINOSEUS o DTH dal -Tank Garage o Rate: (2 Endwalls x FT x ---Ft) a 9 Gal S T Pere Rate: Pere #1 1) 9� h / `.a �o Soil Survey Description: CARVER,-. Soil Survey Description: CARVER tom, (44.7) ( �9 \ r, y P y P Bottom: 740 N / Geologic Material~ GLACIAL OU77ASH MORRAINS Geologic Material• GLACIAL 00WASB MORRAZZE , Depth to Standing Water: NA Depth to Standing Water: NA 20 Ft v 38 ( Depth to Weeping Water. NA Depth to Weeping Water. NA „ ,. " , p" Shed 11 T J � _ / ,,. _._ -__.,,___.._. ._.._ _. _.,_ _ -- __ •. Depth to Mot� ..a.or,, �46 7.��'9?., c, -.. uaa(Color). ® 7� / Est Seasonal h GW: 40 Est Seasonal h GW: q 0, g USGS Observation Weu: NA � USGS Observation Well: NA � Long Term Acceptance Rate (LIAR): ®- �� ��•� ' 46' ) Edstiagg Leach Pit Pump slid fill as �}7.2) f�8) Date of last Measurement: NA Date .of Last Measurement. NA Leaching Area Design Capacity p ( Comments: Comments: � required per Title V / / (Sidewall Area + Bottom Area) x LTAR rcxl �` . �.2) Prop D=Box v GPD Provided - �40, GPD Required - l 6 Reserve (4�7• -- -- DTH :.: 4:: r Shed` DEEP OBSERVATION DEEP OBSERVATION 3 (476. 7.9} �- HOLE LOG HOLE LOG r 47 � ,l . f Test Hole #3 Test Hole #4 NSF , k '� See Excavation Notes (EL 7. / f) (EL 7.S f) �rN OF IF Cart well �- �- 1mftHoroiHzon Texture Color m ftvHonoDzon Tea�ture C lor ) ��D� �h F1 Depth F1 ONE DWARO' ' � it 1t ) (USDA) (Munseil) ( I ( } (USDA) (Mansell ^c Map 237 Parcel 34 001 , � 0 - to" q� -3 A LOAMY SAND 10YR4/S o - 1z" qb, A LOAMY SAND 1oYR4/3 a`� ws tstow � � �STONE Bsso PROPOSED LEANING FACILITY B LOAMY SAND 1'JYRS/6 3 SPOFfQ s STe4 M. (50,5) 7) to" - 26" `{,`� B LOAMY SAND 10YR6 j6 12" - 32" Ll 14 26" - 62" y C1 1.0 '� � 2.SY7/6 32" - 66" 2 �' i 52.9) 20 X 38 Long Leach Field W.I th c1 LOAMY SAN .�:5Y7/s �a ��ar ��► ��` ._ three 4 lines 62" - 156" C2 SANDY LOAM 2.5Y6/3 66" - 144" 35.E C2 SANDY LOAM 2.5Y6/4 0 92" 7,5yr5/0 "j 0 To tsl Area = 20' x 38' 156" - z36" 2 C3 COARSE SAN 2.5Y7/4 144" - 1,2" �. C3 MEDIUM SAND 2.5Y7/4 Deep Obs Hole Date: 06/O8/Os Deep Obs Hole Date: 06/0e/06 SITE AND SEWAGE' PLAN REPAIR/UPGRADE Soil Evaluator: ED STONE Soil Evaluator. ED STONE Witnessed By: A DESIMOSEUS Witnessed By: D. DESIMOSEUS Pere Rate: 4 7npi ® 44" Pere: Rate: 7 mpi 0 90" ry Soil Survey Description: CARVER Soil Survey Description: CARVER PROJECT LOCATION 2275 5 Route 6A Geologic Material: GLACIAL ODU77/ASH MOJ"N8 Geologic Material' GLACIAL MWASa MOVWNE o0nj FJ Depth to Standing Water. NA Depth to Standing Water: NA Barnstable, MA Depth to Weeping Water. NA Depth to Weeping Water. NA r Depth to Mottling(Color): ® 92 Depth to Mottling(Color): NA 28/ 33 --�- a� ,/e, ` Est ;sea$onal lei h GW: ASSE'SSOR,S MAP LOT Est Seasonal High GW g �j/�i USGS Observation Well: NA USGa Observation Weil: NA Date of Last Measurement: NA Dates of last Measurement: NA Cant Comments: Comments: Y APPLICANT- Map 237 Parcel 32 Jeff Br0 WI2 2275 Ro u to 6A EXCAVATION NOTES ��,�,����f Barnstable, MA 1) EXCAVATE ALL MATERIAL ABOVE SOIL HORIZON C (SEE DEEP OBSERVATION G„ , HOLE` LOG) AT APPROXIMATE ELEVATION '~f 4�,9 FOR A LATERAL DISTANCE OF 5 t PREPARED ,8.1' :�T/.F` (WHERE POSSIBLE) IN ALL DIRECTIONS BEYOND THE OUTER PERIMETER OF THE LEACHING AREA A GQ' ICI La I2 CI Ser VI C e,s OhIson 2) FILL MATERIAL SHALL CONSIST OF CLAN GRANULAR SAND, FREE FROM ORGANIC ` Ma 237 Parcel; 34 002 MATTER AND OTHER DELETERIOUS SUBSTANCES, WHICH MEETS THE TEXTURAL 24 Commonwealth Avenue t0 South Yarmouth, MIA 02664 CRITERIA PUT FORTH IN SECTION 15.255(3) OF TITLE 5. (508) 737-1777 3) SCARIFY THE BOTTOM SURFACE OF THE EXCAVATION PRIOR TO PLACEMENT © , OF FILL INTO THE RETAINING STRUCTURE. 4) PLACE FILL ONLY WHEN BOTTOM SURFACE IS DRY. -, SCALE, 1 " = 20' DATE., Jul 19, 2006 y 1- /4 5 Plan Reference -----__--_--__--�--_-------- ------ %A, p �2 Locus Ma REV. Title Reference .1� 2275 Route 6A Flood Zone ___ Lot Size -`l 3" _-7_1 _' r Barnstable, MA DWG. NO, 3248 SHEET 1 OF 1 I T-- __-