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Home My WebLink About0208 MAPLE STREET - Health 208 Maple Street (W. Barnstable) A A �y4 II 0 I f 6i i JJIJ QEcY«oc J °2� UPC 1204 Wo. 2-1531.13E HASTINGS, 1-.,4 11 it 1 j nSU e C 6/7 � o� i 1 � vs Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �r•''p 208-Maple Street Property Address Leonard Curran Owner Owner's Name information is required for every west Barnstable Ma 02668 9/12/14 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, - use only the tab 1. Insoector: key to move your cursor-do not Michael DiBuono use the return Name of Inspector key. DiBuono Sewer and Drain Company Name 8 Johns Path rennn Company Address Yarmouth ma 02664 City/Town State Zip Code -568-364-9587 _ Si13522 Telephone Number License Number B. Certification I certify that•I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 9/14/2014 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. 15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 208 Maple Street Property Address Leonard Curran - Owner Owner's Name information is required foi'every West Barnstable Ma 02668 9/12/14 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: This system contains a 1000 gallon concrete septic tank the inlet cover is to grade. A concrete distribution box and 8 Infultrators 10.25x60x2' . The system is like new and was installed in 2009. All tee's are in place. Dbox is functioning properly. No signs of breakout or ponding. system is 150 + ft from the nearest well 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 cL\� Commonwealth of Massachusetts j Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 208 Maple Street Property Address Leonard Curran Owner Owner's Name information is required for every west Barnstable Ma 02668 9/12/14 page. City/Town 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. 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): i ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): This system contains a 1000 gallon concrete septic tank the inlet cover is to grade. A concrete distribution box and 8 Infultrators 10.25x60x2' . The system is like new and was installed in 2009. All tee's are in place. Dbox is functioning properly. No signs of breakout or ponding. system is 150 +ft from the nearest well ❑ 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 r� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 208 Maple Street Property Address Leonard Curran Owner Owner's Name information is West Barnstable required for every Ma 02668 9/12/14 page. Cltyrrown 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: ** Th is 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 0 ® Backup of sewage into facility or system component due to overloaded or clogged.SAS or.cesspool El ®. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 i Commonwealth of Massachusetts 1= Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 208 Maple Street Property Address Leonard Curran Owner Owner's Name information is required for every West Barnstable Ma 02668 9/12/14 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 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet j from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 t Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 208 Maple Street ' ^M a V Property Address Leonard Curran Owner Owner's Name information is required for every West Barnstable Ma 02668 9/12/14 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,:,occu ant, or Board of Health cup ant, ❑ ® 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 Flown Conditions: Number of bedrooms (design): 6 Number of bedrooms (actual): 6 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 660 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of_17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments .'" 208 Maple Street Property Address Leonard Curran Owner Owner's Name information is required for every West Barnstable Ma 02668 9/12/14 page. City/Town State Zip Code Date of Inspection D. System Information Description: This system contains a 1000 gallon concrete septic tank the inlet cover is to grade. A concrete distribution box and 8 Infultrators 10.25x60x2' . The system is like new and was installed in 2009. All tee's are in place. Dbox is functioning properly. No signs of breakout or ponding. system is 150 + ft from the nearest well ry Number of current residents: 2 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: Well water Sump pump? ❑ Yes ® No Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? El 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: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 208 Maple Street y Property Address Leonard Curran Owner Owner's Name information is required for every West Barnstable _ Ma 02668 9/12/14 page. citWTown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Currently Occupied Date Other(describe below): General Information Pumping Records: Source of information: June 2010 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): t5ins•3/13 Title 5 Official Inspection Form:Subsurface •Sewage Disposal System Page 8 of 17 Y 9 c Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 208 Maple Street Property Address Leonard Curran Owner Owner's Name information is required for every West Barnstable Ma 02668 9/12/14 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: 5 years i Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 18 feet Material of construction: i ® cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: NA feet Comments (on condition of joints, venting, evidence of leakage, etc.): Vented through the roof Septic Tank (locate on site plan): Depth below grade: 1ft feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 1000 Gallon '.If tank is metal, list age: years ' Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gallon Sludge depth: l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 208 Maple Street Property Address Leonard Curran Owner Owner's Name information is - West Barnstable' Ma 02668 9/12/14• ' required for every • page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 18" Scum thickness 2 Distance from top of scum to top of outlet tee or baffle Y Distance from bottom of scum to bottom of outlet tee or baffle 28" How were dimensions determined? Tape Measure Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumped on a regular basis well maintaned 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 a Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface.Sewage Disposal System Form -Not for Voluntary Assessments 208 Maple Street Property Address Leonard Curran Owner Owner's Name information is required for every West Barnstable Ma 02668 9/12/14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Level in tank is normal. No signs of any leaking or decay. pumped on a regular basis 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 208 Maple Street Property Address Leonard Curran -F Owner Owner's Name required for is y West Barnstable . required for ever Ma 02668 9/12/14 page. Cityrrown 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 DBox is functioning properly 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.): Dbox is level and shows no signs of back up. 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: 15ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts o Title 5 .Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 208 Maple Street Property Address Leonard Curran Owner Owner's Name information is required for every West Barnstable Ma 02668 9/12/14 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ® leaching galleries number: 8 ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): 8 infultrators. No signs of break out or pondin . 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 t5ins•3/13 ' Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Wo Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °�, ,•'`r 208 Maple Street Property Address Leonard Curran _ Owner Owner's Name information is required for every West Barnstable Ma 02668 9/12/14 page. Cityrrown State Zip Code Date of Inspection' D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): No signs of hydrualic failure r , Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Y Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments \e 208 Maple Street Property Address Leonard Curran Owner Owner's Name information is required for every West Barnstable Ma 02668 9/12/14 page. Cityfrown 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 I t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments '�.. 208 Maple Street Property Address Leonard Curran Owner Owner's Name information is required for every West Barnsfable Ma 02668 9/12/14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water j ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 20+ ft' feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 2009 Date ❑ Observed site abuttinproperty/observation h ( 9 ole within 150 feet of SAS ® Checked with local Board of Health -explain: plan on file shows 5+ ft seperation between bottom of leaching and adjusted ground water. ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: plan on file shows 5+ft seperation between bottom of leaching and adjusted ground water. Before filing this Inspection Report, please see Report Completeness Checklist on next page. l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of]7 | . . TOWN OF BAR--N STABLE LOC �3�)N SEn/�GE� YU-LAOb ASSESSOR'S ��6PJLPARCEL /�� ` [NI3IALLED'SNALME&PHONS�� _ ^ � SEPT ---' -- -- - cr °~ N8. 0FBEDD00MS OWNER PERMIT DATE: COhPL[ANCEDAT£: ___________________ Separation Distance Between the: _ Maximum AdjustedGroundwater Table cu the Bottom of Leaching Facility 71- fuct � Private Water Supply Well and Leaching Facility(if any wells exist on site or within ZOO feet oOcovbbng facility) / f=t 8d�ro[\��|und�aud��oub��uci6��(if any~*duodsexist within ]OO feet ufleaching facility). _ ficcr . � FDRNlSBEDBY -- _-----_---_'_�_-_---_-_-___--_-__' ' ' - ` / � LE ' '^ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 208 Maple Street Property Address Leonard Curran Owner Owner's Name information is required for every West Barnstable Ma 02668 9/12/14 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 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 T Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 208 Maple st Property Address leonard Curran Owner Owner's Name information is required for everyBarnstable Ma 02068 9/12/14 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 use onlon the y the tab 1. Inspector: U U key to move your cursor-do not Michael DiBuono use the return Name of Inspector key. DiBuono Sewer and Drain rQ Company Name 8 Johns Path IL It Company Address B Yarmouth ma 02664 City/Town State Zip Code 508-364-9587 Si13522 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 9/14/2014L nspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. 15,ns•3113 Title 5 Official Inspecti o :Subsurface Sewage Disposal ystem•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 208 Maple st Property Address leonard Curran Owner Owner's Name required for is every Barnstable required for eve Ma 02068 9/12/14 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: This system contains a 1000 gallon concrete septic tank the inlet cover is to grade. A concrete distribution box and 8 Infultrators 10.25x60x2' . The system is like new and was installed in 2009. All tee's are in place. Dbox is functioning properly. No signs of breakout or ponding. system is 150+ ft from the nearest well 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 208 Maple st Property Address leonard Curran Owner Owner's Name information is required for every Barnstable Ma 02068 9/12/14 page. City/Town 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. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): distribution box is leveled ❑ e ed or replaced ❑ Y ❑ N ❑ ND below (Explain ) This system contains a 1000 gallon concrete septic tank the inlet cover is to grade. A concrete distribution box and 8 Infultrators 10.25x60x2' . The system is like new and was installed in 2009. All tee's are in place. Dbox is functioning properly. No signs of breakout or ponding. system is 150 + ft from the nearest well ❑ 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: I ❑ 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 117 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M ,•'' 208 Maple st Property Address leonard Curran Owner Owner's Name information is required for every Barnstable Ma 02068 9/12/14 page. Cityrrown 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 ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool � ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 208 Maple st Property Address leonard Curran Owner Owner's Name information is required for every Barnstable Ma 02068 9/12/14 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 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °wM ,•''v 208 Maple st Property Address leonard Curran Owner Owner's Name information is Barnstable Ma 02068 9/12/14 required for every 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 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): 6 Number of bedrooms (actual): 6 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 660 l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,. 208 Maple st Property Address leonard Curran Owner Owner's Name information is required for every Barnstable Ma 02068 9/12/14 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: This system contains a 1000 gallon concrete septic tank the inlet cover is to grade. A concrete distribution box and 8 Infultrators 10.25x60x2' . The system is like new and was installed in 2009. All tee's are in place. Dbox is functioning properly. No signs of breakout or ponding. system is 150+ ft from the nearest well Number of current residents: 2 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: Well water Sump pump? ❑ Yes ® No Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ 'No Water meter readings, if available: 15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 208 Maple st Property Address leonard Curran Owner Owner's Name information is required for every Barnstable Ma 02068 9/12/14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Currently Occupied Date Other(describe below): General Information Pumping Records: Source of information: June 2010 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): (Sins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 208 Maple st Property Address leonard Curran Owner Owner's Name information is required for every Barnstable Ma 02068 9/12/14 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 5 years Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 18"feet Material of construction: ® cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: NA feet Comments (on condition of joints, venting, evidence of leakage, etc.): Vented through the roof Septic Tank(locate on site plan): Depth below grade: 1ft feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 1000 Gallon If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gallon Sludge depth: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts N : Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 208 Maple st Property Address leonard Curran Owner Owner's Name information is required for every Barnstable Ma 02068 9/12/14 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 18" Scum thickness 2° Distance from top of scum to top of outlet tee or baffle 3" Distance from bottom of scum to bottom of outlet tee or baffle 28" How were dimensions determined? Tape Measure Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumped on a regular basis well maintaned Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness I 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 208 Maple st Property Address leonard Curran Owner Owner's Name information is required for every Barnstable Ma 02068 9/12/14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Level in tank is normal. No signs of any leaking or decay. pumped on a regular basis 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 (Sins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w„ 208 Maple st Property Address leonard Curran Owner Owner's Name information is required for every Barnstable Ma 02068 9/12/14 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 DBox is functioning properly 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.): Dbox is level and shows no signs of back up. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in work.ng 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official. Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 208 Maple st Property Address leonard Curran Owner Owner's Name information is required for every Barnstable Ma 02068 9/12/14 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ® leaching galleries number: 8 ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): 8 infultrators. No signs of break out or ponding. 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 208 Maple st Property Address leonard Curran Owner Owner's Name information equir for is every Barnstable required for eve Ma 02068 9/12/14 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): No signs of hydrualic failure 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.): l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 f , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 208 Maple st Property Address leonard Curran Owner Owner's Name information is required for every Barnstable Ma 02068 9/12/14 page. Cityrrown 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 t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 TOWN OF BAk-,N"STABLE LOCATION -�4" -S E WIL',G E VILLAGE..t, ASSESSOR'S MAP& PARCEL INST,ALLER'S NANIE&PHONE NO. SEPTIC TANK CAPACITY LEACHI'NIG FACILITY:(type).4 (size) NO. OF BEDROOMS O1,VNER PERMIT DATE: v -COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the 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) 52 feet Edge of Wetland and Leachin-o Facility(if any wetlands exist within 300 feet of leaching facility). 7j— f,2--t FURINISHED BY 10- 1 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 208 Maple st Property Address leonard Curran Owner Owner's Name information is required for every Barnstable Ma 02068 9/12/14 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 20+ ft' feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 2009 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health - explain: plan on file shows 5+ ft seperation between bottom of leaching and adjusted ground water. ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must,describe how you established the high ground water elevation: plan on file shows 5+ ft seperation between bottom of leaching and adjusted ground water. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 -Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 208 Maple st Property Address leonard Curran Owner Owner's Name information equir for is every Barnstable required for eve Ma 02068 9/12/14 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Ole IOU 1 )3 � 3 �kd 6 -' TOWN OF BARNSTABLE LGCATION Aet 4� SEWAGE# 9/-/T,3 VII,L,kGE ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. 'a7`,rx�„ot1 yap=��,,� SEPTIC TANK CAPACITY /GGb C C yCrf�y LEACHING FACILITY:(type�� JV,Sh (size) NO.OF BEDROOMS OWNER Cvfnx PERMIT DATE: /86'Z COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table-to the Bottom of Leaching Facility J feet Private Water Supply Well and Leaching Facility(if any wells exist on site or within 200 feet of leaching facility) 7L feet. Edge of Wetland and Leaching Facility(if any wetlands exist within 300 feet of leaching facility). ��r feet FURNISHED BY � c✓ lOr �a� �� ' � �3, ,� . ( �� , 9 y,V ��o O Y.. y�� v goo I — 1�3 No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 21ppYicatiou for �Diooar *r5tem cow5tructiou Perron Application for a Permit to Construct( ) Repair(V) Upgrade( ) Abandon( ) ❑Complete System LJ Individual Components Location Address or Lot No. ®� a/�l� (�/, Owner's Name,Address,and Tel.No. /3Z ®ZY �`�n Assessors Map/Parcel /joo�hG/ Leopfata/ Ga e Install is Name,Address,and Tel.No. Designer's Name,Address and Tel.No. r�v10 �Co�rr� 771�-1MY adiode4ae ory, U Z -g5yl Type of Building: Dwelling No.of Bedrooms i Lot Size i 4-C .F Garbage Grinder ( Other Type of Building �(', ,i L wee No.of Persons Showers( ) Cafeteria( ) Other Fixtures �y Design Flow(min.required) gpd Design flow provided / gpd Plan Date S—AM01,111 Number of sheets / Revision Date Title Q' B 5' /� c5 X Size of Septic Tank/ �0�094. L°�'f✓y`/�9 Type of S.A.S. — 3 'ZIf 41� ns Description of Soil Nature of Repairs or Alterations(Answer when applicable) 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 Heal Signed Date Aj l "—� Application Approved by Date "/ 7 Application Disapproved by: Date for the following reasons Permit No. a7n� O O q — $3 Date Issued No ` t 'k� _ ,`, Fee } THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pplication for �Diooal *pmem (fouttruction Permit Application for a Permit to Construct( ) Repair(V) .Upgrade( ) Abandon( ) ❑Complete System ©Individual Components Location Address or LotfNo. �- //e 5/ , Owner's Name,Addresss,and Tel.No. 137Assesso OZ�7j Map/Parcel i Install is Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 7 Type of Building: Dwelling No.of Bedrooms 6 Lot Size ?/ C -.;F Garbage Grinder (4-161 Other Type of Building 'a/ -ew e No.of Persons Showers( ) Cafeteria( ) Other Fixtures y ` Design Flow(min.required) gpd Design flow provided ! gpd Plan Date S!///® Number of sheets / Revision Date 6 h XQ 9 Title �fi / ' AJ a� � •/ q // Size of Septic Tank/ la,001 ?y1,5/-/fc9 Type of S.A.S. — 3 07 5 0 f/ram/zgnq i Description of Soil Nature of Repairs or Alterations(Answer when applicable), Date last inspected: { Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in t 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 He l Signed E Date 6 " ©7 Application Approved by Date (a / g Application Disapproved by: Date for the following reasons Permit No. 70001 " / g3 Date Issued 6 —4-Oc'l . THE COMMONWEALTH OF MASSACHUSETTSW , BARNSTABLE, MASSACHUSETTS (Certificate of Compliance e _ THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( Upgraded ( ) Abandoned( )by at 2Q (jt�� j/ �! /yJ�%`Q6�L° has been constructed in accordance i ee with the provisions of Title 5 and the for Disposal System Construction Permit No. 4;?001" b 3 dated 6`18-o Installer Designer ! #bedrooms Approved de si flow (� gpd The issuance of this permit s; all not be construed as a guarantee that the system will; funs•onla's designed. Date Inspector U D F-C -- rr�� _ - -- - -- - - No.g 001 '- 3 Fee �`-�l✓ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION — BARNSTABLE, MASSACHUSETTS Mi!5potal ,6p.5tem Construction Permit Permission is hereby granted to Construct ( ) Repair ( t/) Upgrade ( ) Abandon ( ) System located at ZQ /l�q,Q�� ✓ • �' . �jQ/'y.$�`�,�iA& 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 conditions. Provided: Construction must be completed within three years of the date of this pe >� Date 6_ rti 0 Approved by J _ _ I TRANS. NO.:. CITY/TOWN: �,- -use-t APPLICANT: �— p+ C,•v r- - ADDRESS: DESIGN FLOW: bPd REVIEWED BY: DATE: N/A OIL NO EFN1 ..1P. 1:iSlt` � Legal boundaries denoted [310 CMR 15.220(4)(a)] Street, Lot, tax parcel number and lot number noted on plan [310 CMR 15.220(4)(u)] Locus Provided [310 CMR 15.2204(t)] Plan proper scale? (1"=40' for plot plans, 1"=20' or fewer for components) [310 CMR 15.220(4)] Easements shown [310 CMR 15.220(4)(b)] System located totally on lot served [310 CMR 15.405(1)(a) for upgrades]- if not, a variance is required [310 CMR 15.412(4)] Location of impervious surfaces (driveways, parking areas etc.) [310 CMR 15.220(4)(d)] Location all buildings existing and proposed 310 CMR 15..220(4)(c)] Location and dimensions of system components and reserve areas. [310 CMR 15.220(4)(e)] System Calculations [310 CMR 15.220(4)(0] daily flow septic tank capacity(required and provided) soil absorption system(required and provided) whether system designed for garbage grinder North arrow [310 CMR 15.220(4)(g)] Existing and proposed contours [310 CMR 15.220(4)(g)] Location and log of deep observation holes (existing grade el. on each test) [310 CMR 15.220(4)(h)] Names of soil evaluator and BOH representative [310 CNM 15.220(4)(h) and (i)] Location and date of percolation tests (performed at proper elevation?) [310 CMR 15.220(4)(i)] Percolation test results match loading rate? [310 CMR 15.242] Certification statement by Soil Evaluator [310 CMR 15.220(4)0)] Observed and Adjusted groundwater (method for adjustment given or indicated) [310 CMR 15.103(3) and 310 CMR 15.220(4)(n)] Address Sheet 1 of 7 r N/A. OIL NO Location of every water supply, public and private, [310 CMR 15.220(4)(k)] within 400 feet of the proposed system location in the case of surface water supplies and gravel packed public water supply within 250 feet of the proposed system location in the case within 150 feet of the proposed system location in the case of private water supply wells Location of all surface waters and wetlands located up to 100 ft. beyond setbacks listed in 310 CMR 15.211 and any catch basins located within 50 ft. [310 CMR 15.220(4)(1)] Water lines and other subsurface utilities located [310 CMR 15.220(4)(m)] (if water line cross see 310 CMR 15.211(1)[1]) Profile of system showing invert elevations of all system components and the bottom of the SAS [310 CMR15.220(4)(o)] Stamp of designer [310 CMR 15.220(1) and 310 CMR 15.220(2)] Stamp of Registered Land Surveyor (required if construction activities within 5 ft. of lot line) [310 CMR 15.220(3)] Test Holes adequate (two in each of the primary and reserve unless trenches as permitted in 310 CMR 15.102(2) or as approved for an upgrade under LUA at 310 CMR 15.405(1)(k)] Test hole adequate to demonstrate four feet of suitable material? r CMR 15.103(4)] Holes adequate to confirm adequate groundwater separation? CMR 15.103(3)] chmark within 50-75' of system [310 CMR 15.220(4)(q)] Materials specifications noted? [various sections of 310 CMR 15.000] System components not> 36" deep (unless Local Upgrade Approval or LUA requested) [310 CMR 15.405(1(b)] Address Sheet 2 of 7 f f N/A OK NO erg-+ S Size OK? [310 CMR 15.223(1)] Inlet tee located ten inches below flow line [310 CMR 15.227(6)] Outlet tee 14" or 14" + 5" per foot for increase ft depth [310 CMR 15.227(6)] Outlet tee with gas baffle or approved filter [310 CMR 15.227(4)] Note regarding installation on stable compacted base [310 CMR 15.228(1)] Separation between inlet and outlet tees (no less than liquid depth) [310 CMR 15.227(2)] Inlet/Outlet elevations at least 12" above high groundwater (except as described 310 CMR 15.227(5)) or permitted for upgrades under LUA [310 CMR 15.405(1)(k)] Minimum cover 9" (Tanks buried more than 9" must have risers / on all openings and on the d-box) [310 CMR 15.2228(1) and 310 CMR 15.232(3)(f)] Three access covers (inlet and outlet must be 20" or greater) - middle access at least 8" (by 7/07) [310 CMR 15.228(2)] Access to within 6 " of grade - one port for systems<1000gpd, two for systems>1000 gpd [310 CMR 15.228(2)] All at-grade covers secured to unauthorized access? [310 CMR 15.228(2)] > 10 ft fiom building foundation [310 CMR 15.211(1)] Buoyancy calculation Required/Done [310 CMR 15.221(8)] H-20 Where appropriate? [310 CMR 15.226(3)] Setbacks from resources [310 CMR 15.211] li�Iulfl�`�oixipartznen�T,ganks t_ :� ' �,��+��t'�r%�fi� Required when other than single-family dwelling or flow>1000 gpd [310 CMR 15.223(1)(b)] First compartment 200% daily flow; Second compartment 100% daily flow [310 CMR 15.224(2) and(3)] "U" pipe through or over baffle, outlet of each compartment with gas baffle or approved filter [310 CMR 15.224(4)] Address Sheet 3 of 7 N/A OIL NO ----------------------------------- gJll bry�l�fiU„ *SAC� R _D ®YME+ Located at least ten feet from any water line? [310 CMM / 15.222(2)] J Disposal piping at least 18" below water line (when water and sewer cross, see 310 CMM 15.211(1)[1]) Cleanouts required/provided? [310 CMM 15.222(8)] Thrust blocks specified in force mains? 310 CMM 15.221(6)(c)] Slope of sewer line not less than 0.01 (1/8"/ft) 0.02 preferable [310 CMM 15.222(6)] Proper pitch on all runs? (.005 within gravity-distributed trenches and beds) [310 CMM 15.251(9) and 310 CMM 15.252(2)(c)] Siphon problem/ (leachfield below pump chamber) Endcaps or vent manifold specified? Size and orientation of discharge holes specified? (not smaller than 3/8" not larger than 5/8") [310 CMM 15.251(8) and 310 CMR 15.252(2)(h)] Materials specified (310 CMR 15.251(5) specifies vari M ous pipe types allowed) D�S�RIBUT�ONBO.. A. Stable comp acted base [310 CMM 15.221(2) and 310 CMR 15.232(2)(a)] Splash plate or baffle tee required on inlet/provided? (when pressure sewer to d-box or steep pitch of gravity sewer) [310 CMM 15.323(3)(a)] Riser if deeper than 9" [310 CMM 15.232(3)(f)] Inside minimum dimension 12" [310 CMR 15.232(2)(b)] Minimum sump 6" [310 CMM15.232(3)(c)] Watertight cover if<2000gpd); waterproof manhole if>2000gpd [310 CMR 15.232(3)(d)] Capacity(emergency storage above working—design flow)? [310 CMR 231(2)] Proper setbacks [310 CMR 15.211 (same as septic tanks)] Watertight 20-in minium access manhole at least 20" MUST BE TO GRADE [310 CMR 15.231(5)] Service components accessible (not too deep with piping, disconnects accessible) Alarm floats - alarm on circuit separate from pumps specified? Exceeds two units must have two pumps operating m lead-lag mode. [310 CMM 15.231(6) and(8)] Stable Compacted Base [310 CMR 15.221(2)] Buoyancy calculations needed ? Provided? [310 CMR 15.221(8)] Address Sheet 4 of 7 N/A OK NO Calculations correct? 4 feet of naturally occurring material demonstrated? [310 CMR 15.240(1)] Required separation to groundwater? [310 CMR 15.212)] Aggregate specified as double washed [310 CMR 15.247(2)] System Venting required/provided? (system under driveway or >36" deep) [310 CMR 15.241] Inspection ports specified and within 3"final grade? [310 CMR 15.240(13)] Breakout requirements met? (No violation of breakout elevation within 15 ft of SAS unless barrier) [310 CMR 15.211(1)[41 and ✓� Guidance Document] Chambers and Gal. in trench configuration supplied with inlet every 20 ft. [310 CMR 15.253(6)] Each structure with one inspection manhole(if>2000 gpd must be to grade) [310 CMR 15.253(2)] Aggregate I'minimum- 4'maximum. [310 CMR 15.253(1)(b)] 2' sidewall credit maximum [310 CMR 15.253(1)(a)] In bed configuration, inlet every 40 sq. ft. [310 CMR 15.253(6)] M ]E , x"3 '0 y55 Width 2'minimum 3'maximum [310 CMR 15.251(1)(b)] 100 feet-maximum length [310 CMR 15.251(1)(a)] Minimum separation 2x effective depth or width whichever greater (3x if reserve between trenches) [310 CMR 251(1)(d)] 01 Situated along contours [310 CMR 15.251(2)] Breakout OK? [310 CMR 15.211(1)[4] and Guidance Document] od�f el�� To 9P. minimum 2 distribution lines [310 CMR 15.252(2)(a)] Maximum separation between lines 6' [310 CM R15.252(2)(d)] Maximum separation between lines and outside of bed 4' [310 CMR 15.252(2)(e)] Aggregate depth below discharge pipes 6" minimum, 12" maximum. [310 CMR 15.252(2)(g)] Separation between beds 10'minimum. [310 CMR 15.252(2)(f)] Bottom area used in calculations only [310 CMR 15.252(2)(i)] ` Address Sheet 5 of 7 I 1, N/A OK NO Pressure Dosed Systein ? Provided pump and piping calculations as required [310 CMR 15.220(4)(r)] Pressure dosing required on all systems>2000gpd or alternative systems under remedial approval [310 CMR 15.254(2) and I/A Remedial Use Approvals] If used in gravelless system-make sure jet is directed as not to scour soil interface [Guidance Document] Inspections once per year (systems<2000 gpd) or quarterly (>2000gpd) good to note on plan [310 CNIR 15.254(2)(d)] Construction in fall -Did the plan specify that the fill shall meet the specification of 31.0 CMR 15.255(3)? Impervious barrier and/or retaining wall ? [Guidance Document] Impervious barrier installation must be supervised by designer [310 CMR 15.255(2)(b)] Retaining wall must be designed by Registered Professional Engineer [310 CMR 15.255(2)(a)] Side slope not exceed 3:1 ? [310 CMR 15.255(2)] Breakout requirements met? [310 CMR 15.252(2) and Guidance Document] At least 5 ft. from impervious barrier to edge of SAS (10 ft. recommended) [310 CMR 15.255 (2)(e)] T Check DEP Approval letters for credits and design conditions If used with pressure dosing do not allow pressure discharge to scour soil interface Was DEP Approval Letter provided and/or have you reviewed the letter for conditions? Is the technology be ng properly applied and does it meet all DEP Approval Conditions? Is there a note on the plan regarding the requirement for perpetual maintenance agreement? Any alarms involved on separate circuits Did the applicant submit an operation and maintenance manual? Has applicant submitted a copy of a maintenance Are the variances listed on the plan ? [310 CMR 15.220 (4)(q)] RLS Stamp necessary on plan if a component is within five feet of property line [310 CMR 15.412(4)] New construction or increased flow proposed- [Refer to 310 CMR 15.4141 Sheet 6 of 7 Address N/A OIL NO Nrfrr® era SefasrtzvewAreas ,� -� Is the system in a Designated Nitrogen Sensitive Area(Zone II for / a public supply well)? [310 CMR 15.214, 310 CMR 15.215 and / 310 CMR 15.216 - also refer to Policy regarding upgrades of such existing systems] Is the system proposed on the same lot as served by private well ? [310 CMR 15.214(2)] Are the nitrogen loads proposed in compliance? [310 CMR 15.216(1)] Pumping to septic tank ? [ 310 CMR 15.229] Shared System [310 CMR 15.290] Address Sheet 7 of 7 FROM :down cape engineering inc FAX NO. :15083629880 Jul. 08 2009 10:13AM P1 "Town of Barnstable Reg ulntoi-y Services i ThOlnls F. Geileir,1Director, �A'fA1� f ' Public I.Tealth Div-isi��at. Thomas McKcau,Director 200 IAA xin Strwl,IIy ads,MA 02601 kXR e: 509-862-464/1 fax: 508-790-6304 Installer&14.5i ner Cert,i.4ication Forms Bate: Sewage Pen nit# —/UAssc&gor's Map4'areel J o1 Designer: �d c„1� �e � �rf�+1 l.ans.all o Address: 93� ate-rr��v Ak/ lon/1/ On-�- .� `© � _. T � '.was issued.a.pemit to install a (date) (installer) septic System at 1�001 J�L based on a design drawn.by (address) dated f ...-- _ I certify that the septic system referenced above was installed substaiaially according to the design, which may inchide n➢inor approved changes such as latet-al, relocation of the distribution box and/or septic 4ink I certi - that the 5..__ fy septic system .referenced above was insta11et1 with ni,ajor changes (i..e, greater than, 1.0' latera.l telocation of the S.AS or any vertical relocation of any ec»xipollent Of the se'Ptic system)but in accordance with State& ',Local Regulations. Flan revision Ot� ccrtifiod as-built by designer to follow. ARN E H (lulstal w Si.gllattirc) CIVIL No. 3(.'792 Q r ISTFfZ��>L si.ne.r's Signa j (ll ix Designer:s Stcirnp here) - PLT�A &_. .ItETLTAIV ➢'() RAiBNSTAlk3LE P[T$LYC ➢➢F,A1,T4t i?TV7SAON. ( �•i8TTFI4_A'1' f):V ��C)i!!1�'1,1ANC W.T1,1 t�lCDT �� 1<S.SI(1LLD IJ.;�TTff, 1 0TH.. TES I'URM AND A5-1BiJIT,T CARD ARE RECEIVED BY THE BARNS'1'A&Bt,F PUBLIC REAL!'11 [DIVISION. THANK YOU. - . (1:FTnsillh(Scptic/L3criptticr t-',e�ri.i�cation(form 3-2ti-0^..due I Y '� TOWN OF BARNSTABLE LOCATION Gl d he `/V SEWAGE# VILLAGE Q,rdh Wcg Jb 1 ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. thSm °C�'k"_-1 IZIIIS 6&ko�va��irry SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) NO.OF BEDROOMS nn OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the 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 r ,_ ❑ drawing attached separ2-- til' K 1 33' 4 ti Bi ab B' 32-' tel. (508)362-4541 939 main street rt 6a fax(508)362-9880 yarmouth port mass 02675 down cape engfiaeeiing, 1*#C structural design civil engineers&land surveyors Daniel A.Ojala,P.E.,P.L.S. Arne H.Ojala P.E.,P.L.S. April 28, 2009 Timothy H.Covell,P.L.S. land court Andrew R.Garulay,R.L.A. surveys Thomas McKean, RS, Director site planning Barnstable Health Department 200 Main Street Hyannis, MA 02601 sewage system designs Re: 208 Maple Street, West Barnstable inspections Dear Tom: permits Please be advised that we are in the process of designing an upgraded septic system landscape for the above-referenced site. We have completed the necessary test holes and architecture percolation testing procedure; we hope to have the plan completed in about 1 week. The owner will then send the plan out for quotes to allow a timely repair of the system. Please don't hesitate to call me with any questions. i rV Very truly yours, cr, Q tZ Arne H. Ojala, PE,PLS C:� > a Down Cape Engineering, Inc. tin cc: Lenny and Patricia Curran o i 84'tFIF Town of Barnstable Barnstable Regulatory Services Department 'OftfMcaM aaIMSTABM * 1 1 %639. Public Health Division F°" • 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 70081830000205008543 4/23/2009 Leonard E. Curran &Patricia Curran PO Box 19 West Barnstable, MA 02668 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 208 Maple Street, West Barnstable MA was last inspected on March 30, 2009 by Reid C. Ellis, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Failed"under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Backup of sewage into facility or system component due to an overloaded or clogged SAS. You are ordered to repair or replace the septic system within Sixty (60) days from the date you receive this notification. 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 Commonwealth of Massacnusetm Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 208 Maple Street,West Barnstable, MA 02668 Property Address Lenard E. Curran &Patrica A. Curran Owner Owner's Name information is p required for 208 Maple Street,Box 19, West Bamstale MA 02668 03/30/2009 . every page. CitYRown 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. i Important: A. General Information When filling out forms on the computer,use 1. Inspector: ( ,L only the tab key a.l to move your Reid C. Ellis cursor-do not Name of Inspector use the return key. Ellis Brothers Const. Company Name vt r.0 23 Enterprise Road, P.O.Box 59 Company Address P Y Yarmouth Port, MA 02675 IL r Cityrrown State Zip Code 508-362-f237 S121891 Telephone Number License Number CD B. Certifications ' f I certify that I have personally inspected the sewage disposal system at this address'�and that the �-i information reported below is true, accurate and complete as of the time of the inspection.Th e ins pection was performed based on my training and experience in the proper function and m0intenance,9f onas.Ite sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15:340,0f Title 5(310 CMR 15.000).The system: , ❑ Passes ❑ Conditionally Passes Fails On M ❑ Needs Further Evaluation by the Local Approving Authority a G of inspfitoes Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the - report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under. the same or different conditions of use. LL o 416 ,t5ins•09/08Title 5 Official Inspection Fonm Suboe Sewage Dispp System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 208 Maple Street,West Barnstable, MA 02668 Property Address Lenard E. Curran & Patrica A. Curran Owner Owner's Name information is required for 208 Maple Street, Box 19, West Bamstale MA 02668 03/30/2009 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cunt.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) Sys em Passes: WO 71 have P*found ally 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: Lt+7 pq ov j 3--17 PAT B) System Conditionally Passes: ❑ One or more system components as d scribed in the"Conditional Pass"section need to be replaced or repaired. The system, upoi i completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not deterr iined"(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 h filtration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is r placed with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection ii 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(ExplE in below): TMA 5 O final Immiction Form:Subsurface Sewaae Dlsoosal Svotem-Pape 2 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 208 Maple Street,West Barnstable, MA 02668 Property Address Lenard E. Curran &Patrica A.Curran Owner Owner's Name information is 208 Maple Street, Box 19 West Barnstale MA 02668 03/30/2009 required for State Zip Code Date of Inspection every page. Citylrown B. Certification (cunt.) B) System Conditionally Passes(cont.): �/ ❑ Observation of sewage backup or break ut 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 Boar( 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 repl ced ❑ 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 apprc val 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 Befard of Health: ❑ Conditions exist which require further evalu ation 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 functi pning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet c f a surface water ❑ Cesspool or privy is within 50 feet c f a bordering vegetated wetland or a salt marsh 'rm.S MOA 1--linn Fnnn:Subsurface Sewaae Disposal System•Page 3 or 17 Commonwealth of Massachusetts Q a UTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 208 Maple Street,West Barnstable, MA 02668 Property Address Lenard E. Curran &Patrica A. Curran Owner Owner's Name information is 208 Maple Street, Box 19,West Bamstale MA 02668 03/30/2009 required for State Zip Code Date of Inspection every page. Cityrrown B. Certification (cont.) 2. System will fail unless the Board of alth(and Public Water Supplier,if any) determines that the system is functioni in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and oil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tribut ry to a surface water supply. ❑ The system has a septic tank and AS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and AS 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 analysi , performed at a DEP certified laboratory, for col'iform bacteria indicates absent and the presence of mmonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure riteria 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 clogged 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 El or 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 '/2 day flow r F M ial insoaction Forth.Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 208 Maple Street,West Barnstable, MA 02668 Property Address Lenard E. Curran &Patrica A. Curran Owner Owner's Name information is required for 208 Maple Street, Box 19, West Bamstale MA 02668 03/30/2009 every page. Citylrown 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. ❑ ZAny 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.] VEI 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 shoulpthef c a Board of Health to determine what will be necessary to correct *1 rE) Large Systems: To be considered a larstem 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"y s"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 3 nitrogen sensitive area(Interim Wellhead Protection Area—1WPA)or a mapr ed 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 larg system has failed.The owner or operator of any large system considered a significant threat under ection E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. he system owner should contact the appropriate regional office of the Department. TWA 5 Ofiidal Inspection Form:Subswface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface p System Sewage Disposal S stem Form-Not for Voluntary Assessments ° 208 Maple Street,West Barnstable, MA 02668 Property Address Lenard E. Curran & Patrica A. Curran Owner Owner's Name information is 208 Maple Street, Box 19,West Barnstale MA 02668 03/30/2009 required for p every 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 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, �aeccluding the SAS, located on site? [� ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank 4 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: ElExisting 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): / 1 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): Title 5 Official Insoaction Form:SubsurfaceSewa9e Disposal olS stem•Page of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 208 Maple Street,West.Bamstable, MA 02668 Property Address Lenard E. Curran&Patrica A. Curran Owner Owner's Name information is 208 Maple Street, Box 19,West Barnstale MA 02668 03/30/2009 required for every page. City/Town State Zip Code Date of tnspection D. System Information Description: Number of current residents: Does residence have a garbage grinder? ❑ Yes N Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes Laundry system inspected? ❑ Yes ;7No Seasonaluse? ❑ Yes EEr/No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes No Last date of occupancy: Date Commercial/Industrial Flow Conditions: w//4_ Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., et.-.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 ystem? ❑ Yes ❑ No Water meter readings, if available: rea n(1RNar inseaqfion Form:Subsurfeee Sewage Oieposel System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 208 Maple Street,West Barnstable, MA 02658 Property Address Lenard E. Curran&Patrica A.Curran Owner Owner's Name information is 208 Maple Street Box 19 West Bamstale MA 02668 03/30/2009 , , required for State Zip Code Date of Inspection every page. CitylTown D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as um ed art of the inspection? Yes El No p p If yes, volume pumped: gallons How was quantity pumped determined? M)C Reason for pumping: Type o System: Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system(yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Altemative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)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): rWa 5 Offidal Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 208 Maple Street,West Barnstable, MA 02668 Property Address Lenard E. Curran&Patrica A. Curran Owner Owner's Name information is 208 Maple Street, Box 19,West Barnstale MA 02668 03/30/2009 required for State Zip Code Date of Inspection every page. CitylTown D. System Information (cont.) Approximate age of all components,date installed (if known)and source of information: when arriving at the site? ❑ Yes I� No Were sewage odors detected w g Building Sewer(locate on site plan): r i/ C� 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.): A� Ize-1114 Awle � Septic Tank(locate on site plan): Depth below grade: feet Materi I of construction: concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compli/r ce?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: r.e F rNrriw rmoection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 208 Maple Street,West Barnstable, MA 02668 Property Address Lenard E. Curran&Patrica A.Curran Owner Owners Name information is required for 208 Maple Street, Box 19,West Bamstale MA 02668 03/30/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 214 Scum thickness Distance from top of scum to top of outlet tee or baffle 14 Distance from bottom of scum to bottom of outlet tee or baffle -, How were dimensions determined? Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): All Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal. ❑fi berglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee c r baffle Distance from bottom of scum to bottom of oul et tee or baffle Date of last pumping: Date rat.G nrcAm tn. tinn Form:Subsurface Sewage Disposed System•Page 10 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 208 Maple Street,West Barnstable, MA 02668 Property Address Lenard E. Curran&Patrica A. Curran Owner Owner's Name information is 208 Maple Street, Box 19,West Bamstale MA 02668 03/30/2009 e ry p for State Zip Code Date of Inspection eve ry pa ge. CitYlTown 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 pump 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 sw' hes, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No TwA 1,offidal Inspection Form:SubsuAace Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 208 Maple Street,West Barnstable, MA 02668 Property Address Lenard E. Curran&Patrica A. Curran Owner Owner's Name required nation is 208 Maple Street, Box 19, West Bamstale MA 02668 03/30/2009 required for every page. CitYlTown State Zip Code Date of Inspection D. System Information (cunt.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert Comments(note if box is level and distribution to outlets equal, any evidence of soli carryover,any evidence of leakage into or out of box, etc.): j Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes 0 No Alarms in working order: ❑ Yes ❑ No Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Soil Absorption System(SAS)(locate on site plan, excavation not required): ._ If SAS not located, explain why: 1W t pl1lJ - �l�h✓ raiw 5 Official inaoection Form:Subsurface Sewage oisposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 208 Maple Street,West Barnstable, MA 02668 Property Address Lenard E. Curran&Patrica A.Curran Owner Owner's Name information is 208 Maple Street Box 19 West Bamstale MA 02668 03/30/2009 required for State Zip Code Date of Inspection every page. cityrrown D. System Information (cont.) Type: � r leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): 1 ,o44 'AAWwZ'2(4'Z'-' At cess is(cesspool must be pumped as p of45 " edon)(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 rwt-S Msriai Inenaction Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 208 Maple Street,West Barnstable, MA 02668 Property Address Lenard E. Curran &Patrica A. Curran Owner Owners Name information is 208 Maple Street, Box 19,West Bamstale MA 02668 03/30/2009 required for State Zip Code Date of Inspection every page. Cityrrown D. System Information (cont.) Comments(note condition of soil,signs of hydraulic failure, level of ponding, condition vegetation, etc.): Privy(locate on site plan): .0-100 Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydra ilic failure, level of ponding, condition of vegetation, etc.): raw 5 official Insoection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 208 Maple Street,West Barnstable, MA 02668 Property Address Lenard E. Curran & Patrica A. Curran Owner Owner's Name information is 208 required for Maple Street, Box 19, West Barnstale MA 02668 03/30/2009 every page. Cltylrown State Zip Code Date of Inspection D. System Information (cont.) WSketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at leas two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate wher public water supply enters the building. Check one of the boxes below: 7 �y hand-sketch in the area below ❑ drawing attached separately f,,A 000 2 6i 1 4 a 71 y, t5ms•09108 Title 5 Official Inspection Form:Subsurface Sewage Disoosal System•Paae 15 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments "< 208 Maple Street,West Barnstable, MA 02668 Property Address Lenard E. Curran &Patrica A. Curran Owner Owner's Name information is 208 Maple Street, Box 19, West Bamstale MA 02668 03/30/2009 required for every page. cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope &ACAW, fve— �/ � � � &Vev ❑ Surface water /-104z— 7 ❑ Check cellar G:f�� atUGC ❑ Shallow wells A1--01 - 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: 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: 067 9 13, 6 Before filing this Inspection Report, please see Report Completeness Checklist on next page. Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 208 Maple Street,West Barnstable, MA 02668 . Property Address Lenard E. Curran&Patrica A. Curran Owner Owner's Name information is 208 Maple Street, Box 19 West Barnstale MA 02668 03/30/2009 required for gee Zip Code Date of Inspection every page. CitylTown E. 7ospection ort Completeness Checklist Summary:A, B, C, D, or E checked Yvspection Summary D(System Failure Criteria Applicable to All Systems)completed ystem Information—Estimated depth to high groundwater Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file Title s official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 CERTIFICATE OF ANALYSIS Page: I Barnstable County Health Laboratory Report Prepared For-. Report Dated: 4/17/2009 Reid C.Ellis Ellis Brothers Construction Order No.: G0951141 23 Enterprise Rd. Yarmouth Port, MA 02675 Laboratory ID#: 0951141-01 Description: Water-Drinking Water Sample#: Sampling Location 208 Maple St W.Barnstable,MA Collected: 4/2/2009 Collected by: R.Ellis Map 132 Parcel 24 Received: 4=009 Routine ITEM RESULT UNITS RL MCL Method# Tested Nitrate as Nitrogen 0.33 mg/L 0.10 10 EPA 300.0 4TM009 Copper ND mg/L 0.10 1.3 SM 311113 4/15/2009 Iron ND "191L 0.10 0.3 SM3111B 4/15/2009 Sodium 10 mg/L 1.0 20 SM 3111B 4/15/2009 Total Coliform Absent P/A 0 0 SM9223 4f2/ O09 Conductance 180 Umobs/cm 2.0 EPA 120.1 4/2/2009 i. pH 7.6 PH-units 0 SM 4500 H-B 4/2r2009 Water sample meets the recommended limits for drinking water of all Me above tested parameters. Attached please find the laboratory certified parameter list. Approved B )irector tor) ND=None Detected RL= Reporting Limit MCL=Maxim"Urn Contaminant Level Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph;508-375-6605 CERTIFICATE OF ANALYSIS Page: 1 Barnstable County Health Laboratory Report Prepared For: Report Dated: 4/17/2009 Reid C.Ellis Ellis Brothers Construction Order No.: G0951141 23 Enterprise Rd. Yarmouth Port, MA 02675 Laboratory ID#: 0951141-01 Description: Water-Drinking Water Sample#: Sampling Location 208 Maple St.W.Barnstable,MA Collected: 4/2/2009 Collected by: R.Ellis Map 132 Parcel 24 Received: 4/2/2009 Routine ITEM RESULT UNITS RL MCL Method# Tested Nitrate as Nitrogen 0.33 mg/L 0.10 10 EPA 300.0 4/2/2009 — Copper ND mg/L 0.10 1.3 SM 3111 B 4/15/2009 Iron ND mg/L 0.10 0.3 SM 311 1 B 4/15/2009 Sodium 10 mg/L 1.0 20 SM 3111 B 4/15/2009 Total Coliform Absent P/A 0 0 SM9223 4/2/2009 Conductance 180 wnohs/cm 2.0 EPA 120.1 4/2/2009 pH 7;6 pH-units 0 SM 4500 H-B- 4/2/2009 Water sample meets the recommended limits for drinking water of all the above tested parameters. Attached lease find the laboratory certified parameter list. Approved Bv: '' P rY P — (La hector) Q w rQ r— cn rn ND=None Detected RL =.Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 06 ` /07 P# Town of Barnstable Departtnent of Regulatory Services HARNBTAgt ; Public:Health Division Date o fix' 200 Main Street,Hyannis MA 02601 plfD M►'t� / y/1 d !/' dV Date Scheduled Tilne D elf Fee Pd. v!/ Soil Suitability Assessment for Seivage Disposal I d �- Perfonned By: 0q-V4-- �-(/� Witnessed By: W IV —7 LOCATION & GENE RAL L INFORMATION Location Address D t� t�p C� l/ QG Owner's Name C tr 1�'� Address Assessor's Map/Parcel: 13a Engineer's Namc l � �-NEW CONSTRUCTION REPAIR Telephone# 6ij A 6 � land Use" Slopes(%) v Surface Stones 0015— P ,Distances from: Open Water Body ;Zoo it Possible Wet"Area ft Drinking Water Well It Drainage Wayft Property Line ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands�n proximity to Doles) tr T. Parent material(geologic) Depth to bedrock Depth to Groundwater: Standing Water in flole: /" Weeping from Pit Pace Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Ip, Depth Observed standing in obs.hole: ln, Depth to Sol mottled: Depth to weeping from side of obs.hole: In, Groundwater.Adjustment--ft. Index Well# Reading Date: Index ell level AdJ.factor_ Adj.Groundwater level z— PERCOLATION TEST Observation I Time at 9" _ n ---- Hole# Depth of Perc l0'✓ Time at G' /,Q b� Time(9"-V)t� — — . Start Pre-soak Time @ � o - End Pre-soak" At 1146AI Rate Min./InchLG Site Suitability Assessment: Site Passed—� Site Failed: Additional Testing Needed(YIN) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted witiliti 100' of wetland,you must first notify the Barnstable Conservation Division at least one (1) week prior to begimiing. Q:\SE"[C\PERCFORM.DOC t D.EEP.OBSE t RVATION HOLE .LOG Hole# f ' Depth from Soil Horizon Soil Texture ° Sdil Color Soil Other Surface(in.) (USDA) (Munsell Mottling (Structure,Stones;Boulders. _ Co istenc % ravel Me ZOV-0 ` DEEP OBSERVATION HOLE LOG Hole# ° Depth from Soil Horizon Soil Texture Surface(in.) Soil Color Soil Other (USDA) (Munsell Mottling (Structure,Stones,Boulders. Consisigricy.%Gael DEEP OBSERVATION HOLE LOG Hole#_ Depth from Soil Horizon Soil Texture. Surface(in.) Soil Color_ Soil Other r (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Co i to c G ve Depth from DEEP OBSERVATION HOLE LOG Hole# Soil Horizon Soil Texture ' Surface(in.) Soil Color Soil O er theth (USDA) (Munsell) Mottling (Structure,Stones;Boulders, Consi ten c Flood Insurance Rate Map: Above 500 year flood boundary No_ ye Within 500 year boundary No Yes Within 100 year nood boundary Not Yes . Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not, what is the depth of naturally occurring pervious material? Certification I certify that on (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required trai '»g,exper 'se and experience described in�10 CMR 15.017. Signature Date �® Q:02 PT ICIPE R CFO R M.D O C i 97/11'2006 TI;E 13:07 P31 508 88S 6446 ENVIROTECH LADS t,001:001 f,.VI/7B 0 TECH LAB ORA TOMES,INC. v Jim sebastlraar DrEse 1101112 Sandwich,M-4 02563 tS11d18&�-S96A 1-800-339-€460 FAX(50)88"446 Cllelat 1 sy,�rrae' Owrarw Faw?eu2 Location M Mote as. Adarei.r 2M Mepie Sit. W.SSarrastable,MA W.5"i stable,MA c26611 Sample Date O 1200 Crallecle d:By, PalrirA Gerw Sample Time i.x Sa NWIe Type Existing Well Yap Due Received cvi2w Lab OFder Nwnbem Dw-2w&1 Well Specs t+lA i I�crrtic+s,-source * .�9ute rallecled Tdtne Coltacfad' Carriraaea:ds .' �Tasp Sf'9�1L�•.., 2s3C' AnalysisRequeafet &nits .fina()=sfsResteir ,1lealaud Aure•t4rr�yzsrl A»!aty;cttl3s 1'*01Cotifurm llttOml a 0 2we 8r1�06 iUc VH 0.43 4M-M43 Vi2 U Cattdu lttttua6lt t+ too 12 _ 120.1 -Z;iF2-O Lt. ___ �9itrsie id mg11. 1.0G _ -'O.004 3-W-0 VlZMW _ L _ _. Sadivrrs._. MVL ` 20.0 1.4 20;i7'- 5116moe Mr- TOW)iran mg/L r Y` 0.3 � Y _ <C.s 200 7 5115129M tie M Manama 1136 ^!A.Of3� 200.7 91 i0c W is flaw reramended tirM anti may hav'o mrmtt a ctrsria j Mw rota EPA,4MOvd5:and to eaa&NO Styr e>«Wft#Jnar,paasrra ars ararstead Date s .Rv.rrd• '.Saari 1/ 411�� av i i BRI.=Below Repariobkr Lhmirx Page 1 of 1 "S, i T®WI'i OF BARNSTABLE LOCATION SEWAGE ASS R'S MAP LOT I STALLE$'S.NAME a PlI®NgNO. . �TIc TANK CBPAGITiNow OF somooms . .. : . .. ---a—PRIVATS WELL OR PUBLIC WATER BUILDS ®l oER PATE,P aT IWEX)� � DATE...CouPL& C9,hSSuN9•. R I I VARIANCE GRAWrED.- Yes fj i- 1 1 i i - - 1 69.FISGS24. PAtt- Jj A 3v Mir"iS'-`.. �>Lffn.Yen%/ Y� p� ;�r ._... '�!:..�..—. _ ...._._•...:_.::�i rA• a a,•,r.t era'. awv+nn..rnifc% - t ... :•L••••o••< n .L+a T4a•Cu _� o•a I 0. �� uuua.0.>,. �•-C� �, u _.rY wr w.,. 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AIf ASSOCIATES AElCIfITECrS 110 QMtabk RPaI, Fir-MI.MA 91601 -_-- --� • �_`_a - - r Irl.SUe-77U•6060 f<s 508.7T07,G 50 "i'—�'� �� `" ~- "' Stvv.•n M.Shufnan.OA ______.__-.tGra l.Ohertb •-•---------•----•----- ,y_-._.- JJ rl.UA PW Oicase Avws .:.L.L_"_o o:..A"._::.��w�r l:- 7:3:l..•..5...:�Iw7-'-tti��:.'?S�^�f^..._...3':R�..-.t.. a , i , `'• o. 4m"'a•- i .a auna.a......•, � w�.� tt�aY-a"--�..9�xp%• '^,•1�.i1^.-__ 4 AF �4 i: ` � � + n \�i:j !� � LL_�- 4SI r�, was �./ :� •1� v..w�yv�.+c�•apiw�nco / Y �� ' I w. w�„_.. ,!' •ram r. llnlalaow � _._._,...__...__.__"'.s�ii'��V Jr"�d,�.• _ nn..ww v 'r � i ��-� as�� fya;sfha d r �! -- -• -- - r— T' ,i• LMa ' cam}' I I _'a.;a'•!f �-, `r� I- ate•' r••� iJ Y ••r. .nmr..._ 6 G_nCAul:�orr:�•rurar � .na e-_.a!'a�,,.a ++4 p �� {�` / � .� •,y�;i -_ A:p;;::,N•+r.naru• s11i`' •nv .. 1. .^',v :i.> • — Tore NoaY.'I9 f✓rYPf Al . 2 At wit drrgovtD _ 1' Ise _ �• .wmen.r � t lave wu.or.leecn na, ...... �=s.c..ee ea.s,,.av / ; -'• ?z. 1 •��t f.G1a,�i'.-r��; S..S._�LSMNI_liRdt.'r_.__ i:�))I�v.rl..6 37� w' 'u 3TAU 2 �= a�aa nssoca9res acit�rv�cas — c -.4 3f0 FMrn 7a6b•Baud,Wyne'q A1A Oxu't _ . . .—.---._—..._. •.:.• V •, 1n9.506.7'T8.6C571 (a;50!>T7 A6 IRA orar Slncram}kN Arm l'�U.T'1m�RA TOWN OF BARNSTABLE LOCA-i1ON U C�� SEWAGE # : 1.1 — 4M VILLAGE ��1 ( �� ASSESSOR'S MAP & LOT (3a INSTALLER'S NAbE&PHONE NO. SEPTIC TANK CAPACITY 10�® LEACHING FACILITY: (tyke) Pppi T, (size),.- NO.OF BEDROOMS �D 1 ,p2s any: BUILDER OR CNN OWNER , PERMITDATE: _ COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the 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 C hl AA fig.319 At- P3 q3 8C 4a Barnstable Assessing Search Results Page 1 of 2 v y Home: Departments:Assessors Division: Property Assessment Search Results New Search New interactive Maps >> Owner: 2006 Assessed Values: CURRAN, LEONARD E JR& PATRICIA A 208 MAPLE STREET Appraised Value Assessed Value Map/Parcel/Parcel Extension Building Value: $531,700 $531,700 132 /024/ Extra Features: $3,400 $3,400 Outbuildings: $0 $0 Mailing Address Land Value: $247,700 $247,700 CURRAN, LEONARD E JR& PATRICIA A Totals $782,800 $782,800 PO BOX 19 W BARNSTABLE, MA. 02668 2006 REAL ESTATE Tax Information: Tax Rates: (per$1,000 of valuation) Community Preservation Act Tax $ 129.24 Fire District Rates Town Barnstable-Residential $1.90 $6.31 Barnstable-Commercial $2.51 Commei W. Barnstable FD Tax(Residential) $ 1,252.48 C.O.M.M. -All Classes $1.06 $6.54 Cotuit FD-All Classes $1.33 Persona Town Tax(Residential) $4,307.84 Hyannis-Residential $1.61 $6.49 Hyannis-Commercial $2.50 Other R, W Barnstable-Residential $1.60 Commur W Barnstable-Commercial $2.46 Total: $5,689.56 Construction Details Property Sketch Legend Building Building value $531,700 Interior Floors Hardwood Style Colonial Interior Walls Plastered Model Residential Heat Fuel Gas Grade Custom Plus Heat Type Hot Water Stories 2 Stories AC Type None Exterior Walls Clapboard Bedrooms 6 Bedrooms http:Hgisweb/assessing/assess06!displayparcelO6map.asp?mapparback=address&mappar=... 7/19/2006 Barnstable Assessing Search Results Page 2 of 2 Roof Structure Mansard Bathrooms 5 Full+ 1 H Roof Cover Asph/F GIs/Cmp living area 4016 BWT[480] 24i1D' Replacement Cost $590785 Year Built 1852 ©F1lIS,. Depreciation 10 Total Rooms1O Land gra l�l�y BMT U7 b ,. 40 CODE 1010 •E1 S Lot Size(Acres) 3.02 q:; GAR Appraised Value $247,700 r24 :6 2k - Assessed Value $247,700 View Interactive Maps > Sales History: Owner: Sale Date Book/Page: Sale Price: CURRAN, LEONARD E JR&PATRICIA A Jan 2 2001 12:OOAM 13463/069 $410,000 PHILLIPS, NORMA E 982/98 $0 Extra Building Features Code Description Units/SQ ft Appraised Value Assessed Value FPL2 Fireplace 1 $2,700 $2,700 FPO Ext FP Opening 1 $700 $700 Property Sketch Legend BAS First Floor, Living Area FST Utility Area(Finished Interior) UAT Attic Area(Unfinished) BMT Basement Area(Unfinished) FTS Third Story Living Area(Finished) UHS Half Story(Unfinished) CAN Canopy FUS Second Story Living Area UST Utility Area(Unfinished) (Finished) FAT Attic Area (Finished) GAR Garage UTQ Three Quarters Story (Unfinished) FCP Carport GRN Greenhouse UUA Unfinished Utility Attic FEP Enclosed Porch PTO Patio UUS Full Upper 2nd Story (Unfinished) FHS Half Story(Finished) SFB Semi Finished Living Area WDK Wood Deck FOP Open or Screened in Porch TQS Three Quarters Story(Finished) I http://gisweb/assessing/assess06/displayparcelO6map.asp?mapparback=address&mappar=... 7/19/2006 Search for Map/Parcel 32024 Town of Barnstable For Parcel Number 132024 rt Rental Property(Y/N): r' Business Name: Yr. _ _ _ _ "�; Zone of Contribution(Y/N): it Area r — ---- r r N Contaminant Rel(Y/N) l 00 it Phone: 0 0000000 Fuel Storage Tank Permit: Card On File: Disposal Works � Perc Test Well Permit Construction File/Permit No: w20024 191-472 Issuance Date: 07/15/20021 10/25/1991 l' Completion Date: J_11/07/199�' Size of Septic Fr Type/Size of SAS: Tank: Comments: engineers letter on file stating good enough for 6 bdrms 132024 Owner: —- _ - —_— - mappar: CURRAN_LEONARD E JR&PATRICI j,proploc: 208 MAPLE STREET Innovative/Alternative Technology Septic Systems Single or Clustered I/A Type: f I/A Service Type: _, add F—, deiete recor—d—s—?ji T,, — AN, /A r+r.r A. TATr-rwrrr,-r VLY, lvl'-'J1A 5CL Ol. Vv 1✓1iVCK1 , J.,3..t.. REAL ESTATE Our most important transaction is yours. Mr. & Mrs. Leonard Curran 208 Maple St. W. Barnstable, Ma. 02668 Duly 25, 2001 Dear Mr. & Mrs. Aran, According to information furnished me by(Glen Harrington)at the Barnstable Health Department, his calculations indicated that the present sanitary system is designed and built for a septage flow of 668 gallons per day. This is far in excess of the requirements for a four-bedroom house. He suggested that you have your engineer calculate the capacity of your system and re-submit your request for a building permit. Sincerely, IA�bee Encl: design calculation copy.of disposal works permit 143 Main Street 3282 Main Street 102 Route bA Commercial/Remtai Yarmouthport MA 02615 P0. Box 217 Sandwich,MA 02563 47?Main Street 508-362-1993 Barnstable,MA 02630 508-833-7578 Yarmouthport, MA 02675 508-362-2505 508-362-2123 wkaw.capecodrealestate.com!in iw- ,r- � 6 MN A . I e e rin inc. east cape eng�e nee g� 44 Route 28 P.O.Box 1525 Orleans,Mass.02653 LAND SURVEYING COURT CIVIL.ENGINEERING LAND LAN"I SITE PLAN" WATER RESOURCES 508-255-7120 CERTIFIED PLANS ENVIRONMENTAL SANITARY Fax 508-255-3176 STRUCTURAL WATERFRONT July 24, 2002 David W. Stanton Health Inspector Town of Barnstable 200 Main St. Hyannis, MA 02601 RE: 208 Maple Street, West Barnstable Dear David: Thank you for your time to review the file for 208 Maple Street in West Barnstable relative to the existing septic system. Following our discussion, it is my opinion that the septic system is large enough for six bedrooms. From the Board of Health records, it appears that there is a 1,000 gallon septic tank and a 1,000 gallon leach pit with 3 feet of stone. Assuming that the system is installed in 2 mins.per inch soil and using the 1978 code design factors,the septic system is adequate for 678 gallons per day. As such, the system is adequate for six bedrooms. Again, thank you for your time. If you have any questions, please feel free to contact me anytime. Sincerely, ;"d`"'qs� ter° TIMOTHY J. Zs o DY F CIVIL 769 a � Timo by . rady, .L.S. I� GJ31E C President—East Cape Engineer' S TJB:jlo enclosure �o�-e a3Ns/:la"il aN Zel£Z s C"117 . � I rn�l'?0'14.. j�/i9:Zl arnixa el eaV / 00 I - ttioQaU38- ! x3 KWS man i. S29-06L (909) auoya bb£€`5LL (809)Xe j I I � 9 020 spsnpesseW 'siuueA H �3 z- 1�50'Y1 PEG Xo8 Od afgelswe8 jo umoj ®gslAf® WBiegH :1119 p �'.i` II h aanoaea�cv Zna'cv /�\ 'o. /VOTI04¢1 --"OM IIIT I1� 'ti 91+tlwc�n31•s �p � jo l7fad �..i[l t'�J•IG�y II � a",i n'n`' 4 Jzc 14 crm(3ag'x3 I �jona•�m�b bM323.3�9 ?%Yeb9 �• n -r�.'��.'- y - 0: �! � 1'. 1 I -. ,fY.•!li'�' [t / / t \!I I'1�1.x5-. Jnovf i i �,•47-.G' III U 'I � �i'--rri •- J � �- �I I I�,�jT1i •7,v*7�- �. t-.-. - i _ �� :.' -44La ,,I vvo02t"J111V �rvl;;;� .tip. � ga' ^ .•/ _-- � � -•e- ..l ` `�—��.,0 1 f� I 4i y9 i !.x c no.nmo»S I � •.rs,•-:vavd :�.6•.+v� � I �I! 1 � I I 1 I t, i r•I I 1 ,, m i�'fifd?nOYf�'d 15t�L- - __ _us AVM y, n ny; In •, n LV W , V na 31'riz .3 G .ciy J / I �,-�.1..;a•�mj»gin _ 'Yncnt 0 _ nvm ' O � I I I i � ij.. njr�3a�; it v.a�•yssT_�4 IL�n3ri3 �n I _� _. i--._—.d,y___-.r- 0].6'. t• I,-:f b'' r�3 I '77.G^�",1' C1 G],.iil•n �..�.� 'aZ 2.,H _3 . t low 'fit ! _ 1W I ! I v//E'SPl•GrU.:- "NICI �' �"'-aFJ.r.J\'C°prF,TIWS 1 \ i Rtit-�o\'E Kt•c'{EU 12521 ' tx.•7(°� I I �Lri• EX.�.°�Sev:iJ-'- _ ! �-�o. .i 5�'✓c t�' I 1 _ r I r 292� 2522_ I I ' I � .t-� '. Ru—c. R:M S 1 ' \� II I EX"GS£EGIi,'D 1Y w N o �' TH - II, 1' { S,LE �I{ASE ZALCrtI OF.! -orc.ovucN41G 9oc��c.. r ,-.1 ��ELvw� �. ucwo ..<r :o:c_'_ka•` I • I <f�7,��' 11�� -� -�;�= -_. �. _ .� M r+tew,ceoE 1 - t KII'- FAMiLl( ROOM h?oF i Or— .ELT i=e/ WnTE- VII P'tiE.'"iJEE TD. FOC P+.;,sEII _ K PAS' S—T! ON 1.:r'.. rt Ic ti V li �I��- ^HrELT 'E1d[; `Ft 1CTl vE TH Sty 34""¢f. 3c -aq'ti Uuc ! cX.ST.. pw' ' i:QE-A.-ei AT'o GF'LJ3r.:4 9-r•�� PN.1L i -,t�-1- V� .' P, 21.L J. � 1 �� ` � I � � < /12"✓w f.lu saw WiY.6. F:-=E':5. ' 2x _ I '��T 'k L i Movc veoz 1SEru GE sp>K- ... °Y.E:ou4t i..<tf•1P. I � G Lo SE oP p G'oor:Te n oY• L4)5W WSW n%r Cx. - :Y wrNvow i tX.xeor 91EV5 •tc:.u.cf� Sr°r.r_ f 1JEw SToDP r1ZrS1:1Zc 1 -tasrt� eEOEGoI�, _ FY.y'.01IJo' I T' 2-zx2's 'c —'i nsk Pao- I ;\ II PROJECT DATA I �rj �� LOT INFORMATION: 4iLY 1ZopM �___I r MAP 132,LOT 21 I 11 �I AREA-3.02 ACRES -• - LOT COVERAGE EXISTING-1975 SF(INCL.PORCH), 23 SF DECKS ' I '.�.1rY.'CEt'-1o2 KEMcGF= Sk F°O021UL I - IQ Win°—NL` E>: STD i\- II - I EV PoecN EX. LIVIRJG -foC EX W71JC S^5.c AMF,RFj�A Wt- t FLOOR- 405 SF - .REPLA.r.'£r�gSF! E�.11J-�,6 L1FJ6R5 Ir'D FLOOR• I05.0 SF To ". j TC.W EX. TOTAL SCREENED PORCH 245.5 SF SF FINISHED SPACE 1 -� ftEMOv6 vIUYL SIPIUc- DECKS 412.6 SF —..Fot-y V'D.oe coin. covc< I _ iZEPAI�Or n�P A[E .CsP PBONtL f�TP�I� !. I =REPtAZE KOOFIt•7L RENOVATIONS: �(.�g51}•1F'„h' -'FESN It.)4LF-30UTH C.l:a UE WLV, 1 FLOOR- 729 SIT 2"tD FLOOR• 30 SF 1 :'Xzo• FT&• - -� NO.BEDROOMS: 00T 1NQf�-u ��• '/• E%tSTING. 4BEDROOMS FOK PLUM IUL xn. ►ROPOSED• 4 BEDROOMS ! - . CASE E�^. _ I \ I ✓ 1 I . IK5'f YLOOr: PLA{'J - 1OPt IDNS 9Q\jGVh7!O!JS I� L"_t i0 2-2 Fo� Town of Barnstable I� I..L'I..t.FoeNp�n ;I ��__1'/i'gR GG L[% C-IES L'G U•61,Etic- IJ+i^,_. — I Pam. I . PO Box 534 �-.1 .` 1 J e I I _� I � C'.g. - .. ." AWUIl7.:- 5•E rJ E� IO APT VCJ'� i 4 Hyannis, Massachusetts 026C a GASEN Et Tr SEZi�C , a 1 ATJ PAL �: PtrStLR SIPPOC.T -VFe.-Y A1.L.FCCF�.- ✓.::..cs �o�SSE w� I ��I Fax(508)775-3344 :�� ;�� - rune.MlcCCM11.ICe - �ll.l L%6F� '6UIJ7-�EV,.1-E �U,D.Fh:10900L'- Phone(508) 790-6265 -� oPE�-,u��ur- 6'rE o Pxx E �S6`SG 9A°3.B z�"or'.t i•F,S. 98 33G- 10"D6 Ih' FL_ooz Pc tr �F 1o�s L= 4.4 eu.u.F,: �/eTT.G wo°o.•e s. o i wtc.�v%r/o I 6� .AKRO ASSOCIATES ARCHITECTS L 310 Barnstable Road, Hyannis, MA 02601 ael. 508-778-6060 fax 508-778-2558 Steven M.Sburnan,RA Alice L.Oberdorf,RA of`" .....m RM ft m AA _y a _�w S, TOWN OF BAR NSTABLE V 1�1&9 Al 570L.LOCATION SEWAGH VILLAGE W. ASSESSOR'S MAP & LOT R'S NAME'ra PHONE:NO. 7754164 ... INSTALLER'S 0 A & B SEPTIC TANK?CAPACITY: HIN J�Mlty:_ fr C ED: PRIVATE WELL OR PUBLIC WATER Ul DEROK".0im. pBItMIT ISSUED DATE COPLTANCB ISSUED;, 7t: VARIANCE GRANTED: Yes- No 7-7- 77777 up � .-A Olt east cape engineering, inc. 44 Route 28 P.O. Box 1525 CIVIL ENGINEERING Orleans, Mass.0265.3 LAND SURVEYING WATER RESOURCES LAND COURT ENVIRONMENTAL 508-255-7120 SITE PLANNING SANITARY CERTIFIED PLANS STRUCTURAL Fax 508-255-3176 WATERFRONT July 24, 2002 David W. Stanton Health Inspector Town of Barnstable 200 Main St. Hyannis, MA 02601 RE: 208 Maple Street, West Barnstable Dear David: Thank you for your time to review the file for 208 Maple Street in West Barnstable relative to the existing septic Jsystem. FoTI'owing oiir'discussion;'°if is my opinion that the septic system is large enough for six bedrooms. From the Board of Health records, it appears that there is a 1,000 gallon septic tank and a 1,000 gallon leach pit with 3 feet of stone. Assuming that the system is installed in 2 mins. per inch soil and using the 1978 code design factors,the septic system is adequate for 678 gallons per day. As such, the system is adequate for six bedrooms. Again,thank you for your time. If you have any questions, please feel free to contact me anytime. Sincerely, ��SN OF 4f.A8s9 o � TIMOTHY J. yam o DY CIVIL _ 9T�i V rady, .L.S: �� c; "-�s�o S 1 President'—East Cape Engineers FS V,.. •�. Y ,r+sip %. T:y'' „�;.a Y'<• .}1�'v' `jt n, ' •� 'TJB 416 enclosure _ ENVIROTECHLABORATORIES,INC. MA CERT.NO.:M-MA 063 449 Me.130 Sandwich, MA 02963 908(888-6460) 1-800 339-6460 FAX(908)888-6446 CLIENT. Leonard Curran LOCATION: 208 Maple St. ADDRESS: PO Box 19 W. Barnstable, MA 02668 W. Barnstable, MA 02668 COLLECTED BY. Meehan Well SAMPLE DATE. 3/13/2002/3/15/02* SAMPLE TIME. NA WATER SAMPLE TYPE. New Well/Replace DATE RECEIVED: 3/13/2002/3/15/02* LAB I.D. #. 0203162/0203215* WELL SPECS.: 60' RESULTS OF ANALYSIS: Parameters Units Recommended Results Method Date Analyzed Limits Coliform bacteria /100m1 0 0 9222 B 3/13/2002 pH pH units 6.5-8.5 5.98 4500 H+ 3/13/2002 Conductance umhos/cm 500 302 120.1 3/13/2002 Nitrate-N mg/L 10.0 7.00* 300.0 3/15/2002 Nitrite-N mg/L 1.00 < 0.004 300.0 3/14/2002 Sodium mg/L 28.0 31.4 200.7 3/14/2002 Iron mg/L 0.3 0.4 200.7 3/14/2002 Manganese mg/L 0.05 0.036 200.7 3/14/2002 COMMENTS: Low pH indicates high corrosive characteristics. *Retest Sodium level is not a health hazard. Iron level is not a health hazard. WATER MEETS EPA STANDARDS AND IS SUITABLE FOR DRINKING PURPOSES .FOR PARAMETERS TESTED. <=less than Date 3I/ >=greater than Ro A#Id J. Saar TNTC=too numerous to count Laboratory Director C No. -Q-------�-- Fee----,�---------- BOARD OF HEALTH TOWN OF BARNSTABLE 0[ppfication jorlVell Con5truct ion Permit 13 2 -o�-y Application is hereby ade for permit to Construct ( ), Alter ( ), or Repair ( )an individual Well at: / Location — Address Assessors Map and Parcel A OOIw-ner Address — , Installer — Drillery�--- --� ------------ -------- ---- Address _ — Type of B ' Dwelling--- ----- ---- --- —- Other - Type of Building-------------------- No. of Type of Well /�-- — -- Capacity-------------- -- — 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 ertificate .of Compliance has been issued by the Board of Health. Signed _— -- �--- dat Application Approved By----, 0 .2 ----- Application Disapproved for the following reasons: ------------, --------------- —_^date-- Permit No. J_&J 2 002 -_ — Issued � ------- --_ - —----- date BOARD OF HEALTH TOWN OF BARNSTABLE C ertif irate Of Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( ) by — Installer —— -- ---- has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Prot tion Regulation as described in the application for Well Construction Permit No. �a-W2�6-Dated-7 - THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE-- Inspector Fee- -------- BOARD OF HEALTH I� TOWN OF BARNSTABLE t Application for VrIt"Coa5tructionPermit t r 2 -o y oXE ,�/� _ f Application is'hereby ade for a permit jo Construct ( .)., Alter ( ), .or Repair( )an individual Well.at: Location — Address Assessors Map and Parcel -- Owner , Address , � -Gar//D,p / � -------G�� %�•Ys _--- -------- .�. ^-- Installer — Driller Address , Type of B 'lding Other ;Type,of Building — --- - No•. of Persons — ..;. Type of Well --___— Capacity;,;_ � ;.`\ \`�---��— .\1��\� hc� Purpose of Well- -- — yin Agreement: The undersigned agrees to install the aforedescnbed-individual well.h accordance with the provisions of The Town of Barnstable Board of Health Priv to Well Protection Regulation -� he n e `igned further agreesnot to place the well in operation until a Certific�to of Compliance has b n;41�,isue �y hoard of Health. Signed— -/date Application.`Approved .. date Application Disapproved for the following reasons: date \�• !\\\ 5_/O .7 Permit,No o � wn*v� ��o02 Issued— / f Y� d ate — ,_,.�.�. ,_ �� . � �.,—:.rya.•---. _�.��..�....�, f "` �,.�_: T -�:: , . _.•..- .._. ,:_... -.,.,. ._. .. - :- .�_ BOARD OF HEALTH All r TOWN OF% BARNSTABLE Jr. certificate ®f Compliance . THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( ) Installer 1' at has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulatiom'as described in the application for Well Construction Permit No. 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 . L Ivell Conoruct ion Permit - No. - 002_ J Fee— --- Permission is hereby granted -- ---—� . 1 to Construct ( Alter ( ), or Repairtt( ) an Individual Well at: St reet• Y r' as shown°on`the application for,a Well' Construction Permtt I �UUI No.- `s' --�. —��—_—_ Dated r - --------------------------- �. i ----- ------------ a /s' . :z Board of Health DATE T I I 4�16� //v sere s' el-, 07/09/2002 08:09 5082553176 EAST CAPE PAGE 01 r SITE PLAN PRO�o� 208 MAPLE L STREXT WEST ARN STABLE. MA SYST�� pR£PARED FOR' �EUNARC'3 CURRAN SCALE'- 1^p3U' JULY 1. 2002 i REty: ASSESSORS MAP 132 PARCEL 1 24 NaT4r: TNI£ EXISTING WELL S To S£ ABANDONED BY FIL1rING Y. WITH CLEAN FUDDLED ITE P NEAT CEMENT GROUT. OR 9ENTONITE PELL.I=TG - IN T Ct-I A MANNER AS TO pREVENT IT FROM ACTING AS A CdNDUIT FOR POI-1-UTI� TO TN€ GROUNDWATER- In tu AREA ly IA6,B�� .�q,#t. uple*,d l inserings Inc. N 170,516 8q Pt-:t tato t Eco Caps F-nv v a.ql Wrest total 01,41_'ENGINEERS Q LAND SURVEYORS (Q1Ta # 44*outs 26. Orleans, ~lost. Z (pot3) ze�T�20 la ZN CF Mass OF Ame. TUulo Hy I ?� TIMOTHY y cn kL TN DATE . .3 07/09/2002 06:09 5082553176 EAST CAPE PAGE 02 J ! PROPO5ED STEM pER GARD y �C�C'. • / �'�Q • G g G PAVED r APRON loll-ol � EXI5TING WELL ` P• �' Ur TO BE ABANDONED tO • lip 6 ' POLE RE1'-'IAIN5 OF 42, ` N FOUNDATION GB FND. `S S . `s APPROXIMATE LOCATION O L;r.Xl5TlNG LEAr-WING SYSTE", DV0:0+o37WP Q1-^037 COMMONWEALTH OF MASACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET BOSTON MA 02108(617)292-3500 TRUDY COXE Secretary ARGEO PAUL CELLUCCI DAVID B.STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 208 MAPLE ST WEST BARNSTABLE, MA 02668 M132 P024 Name of Owner NORMA PHILLIPS / Address of Owner: 208 MAPLE ST WEST BARNSTABLE,MA 02668 Date of Inspection: 10126/00 �- I��✓r Name of Inspector: JOHN GRACI I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) Company Name: SEPTIC INSPECTIONS Mailing Address: P.O.BOX 2119 TEATICKET,MA.02536 / Telephone Number: 508-564-6813 FAX 508-564-7270 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection.The'inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.The system: X Passes _ Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: Date:1112100 The System Inspector shall su it a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. NOTES AND COMMENTS t "The inspection is based on criteria defined in Title V code 310 CMR 15.303.My findings are of how the system is performing at the time of inspection.M,, inspection does not imply an warrant oe'''uarantee of the longevity of the septic system and an of its com onent's useful life." P PY Y Y 9. 9 Y Y Y P THE SYSTEM PASSES TITLE V INPECTIOGV.RECOMMEND PUMPING THE SYSTEM EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. x r revised 9/2/98 Pace 1 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 208 MAPLE ST WEST BARNSTABLE, MA 02668 M132 P024 Name of Owner NORMA PHILLIPS Date of Inspection: 10/26/00 INSPECTION SUMMARY: Check A, B, C, or D: A. SYSTEM PASSES: X I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not evaluated are indicated below. 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 o the replacement or repair,as approved by the Board of Health,will pass. Indicate yes,no,or not determined(Y,N,or ND).Describe basis of determination in all instances. If"not determined",explain why not. n(a The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. nla Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)o due to a broken,settled or uneven distribution box.The system will pass inspection if(with approval of the Board of Health). _broken pipe(s)are replaced _obstruction is removed _distribution box is levelled or replaced n1a The system required pumping more than four times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): _broken pipe(s)are replaced _obstruction is removed revised 912198 Page 2 of 11 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 208 MAPLEt ST WEST BARNSTABLE, MA 02668 M132 P024 Name of Owner NORMA PHILLIPS Date of Inspection: 10/26/00 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303(1)(b)THAT THE SYSTEM I! NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT ThE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER.IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER-HAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well, _ The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply wed,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollutioi from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,Method used to determine distance n/a (approximation not valid). 3) OTHER n/a h PMk f revised 9/2/98 Pane 3 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 208 MAPLE ST WEST BARNSTABLE, MA 02668 M132 P024 Name of Owner NORMA PHILLIPS Date of Inspection: 10/26/00 D. SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303.The basis for this determination is identified below.The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No - X Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow, X Required pumping more than 4 times in the last year NOT due to clogged or obstructed i e s . Number of times pumped nLa. Y 99 PP ( ) P P X Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. II - X Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone I of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well, X Any portion of a cesspool or privy is less-than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis.If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a,tributary to a surface drinking water supply X 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) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.30412). Please consult the local regional office of the Department for further information. revised 9/2/98 Paoe 4 of 11 it SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 208 MAPLE ST WEST BARNSTABLE, MA 02668 M132 P024 Name of Owner: NORMA PHILLIPS Date of4nspection: 10/26/00 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health. X _ None of the system components have been pumped for at least two weeks and-the system has been receiving normal flow rates during that period.Large volumes of water have not been introduced into the system recently or as part of this inspection. _ X As built plans have been obtained and examined. Note if they are not available with N/A. X _ The facility or dwelling was inspected for signs of sewage back-up. X _ The system does not receive non-sanitary or industrial waste flow. X _ The site was inspected for signs of breakout. X _ All system components,excluding the Soil Absorption System,have been located on the site. X _ The septic tank manholestwere uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum.The size and location of the Soil Absorption System on the site has been determined based on: X _ Existing information,For example,Plan at B4O,H, X _ Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable)1 5.302(3)(b)] X _ The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Subsurface Disposal Systems. revised 9/2198 Paae 5 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 208 MAPLE ST WEST BARNSTABLE, MA 02668 M132 P024 Name of Owner NORMA PHILLIPS Date of Inspection: 10/26/00 FLOW CONDITIONS RESIDENTIAL Design flow: 110 g.p.d./bedroom Number of bedrooms(design): 4 Number of bedrooms(actual):I!IFa. Total DESIGN flow: 440 gpd Number of current residents:1 Garbage grinder(yes or no):NO Laundry(separate system)(yes or no): NO If yes,separate inspection required Laundry system inspected(yes or no): NO Seasonal use(yes or no): NO Water meter readings,if available(last two year's usage): n/a gpd Sump Pump(yes or no): NO Last date of occupancy: n/a CO M MFRCIAIJINDUSTRIAL Type of establishment: n/a Design flow: n/a gpd(Based on 15.203)` Basis of design flow:n/a 3! Grease trap present:(yes or no): NO Industrial Waste Holding Tank present:(yes or no): NO Non-sanitary waste discharged to the Title 5 system:(yes or no):NO Water meter readings.if available: n/a Last date of occupancy:n/a OTHER: (Describe) n/a GENERAL INFORMATION PUMPING RECORDS and source of information: SYSTEM WAS PUMPED APPROXIMATELY ONE MONTH AGO System pumped as part of inspection:(yes or no):NO If yes,volume pumped n/a gallons Reason for pumping:n/a TYPE OF SYSTEM X 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) _ I/A Technology etc.Attach copy of up to-date operation and maintenance contract _ Tight Tank Copy of DEP Approval Other:n/a APPROXIMATE AGE of all components,date installed(if known)and source of information: APPROXIMATELY10 YEARS OLD. Sewage odors detected when arriving at the site:(yes or no), NO revised 9/2/98 Page 6 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 208 MAPLE ST WEST BARNSTABLE, MA 02668 M132 P024 Name of Owner NORMA PHILLIPS Date of Inspection: 10/26/00 BUILDING SEWER:X (Locate on site plan) Depth below grade: 12" Material of construction: _ cast iron X 40 Pvc _ other(explain) Distance from private water supply well or suction line: n/a Diameter: n/a Comments: (condition of joints,venting,evidence of leakage,etc.) TOWN WATER SEPTIC TANK: X (locate on site plan) Depth below grade: 6" Material of construction: X concrete- metal_ Fiberglass_ Polyethylene_ other explain: n/a If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): NO Age: n/a Dimensions: 1000G L 8'6"H 5'7"W 4'10"" Sludge depth: 0" Distance from top of sludge to bottom of outlet tee or baffle: 0" Scum thickness: 0" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: n/a How dimensions were determined: MEASURED Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage,etc.) '!0 THE SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND.RECOMMEND PUMPING EVERY TWO YEARS. su GREASE TRAP: _ ;J (locate on site plan) Depth below grade: n/a Material of construction: _concrete_ metal_ Fiberglass _ Polyethylene_other Explain: n/a Dimensions:n/a Scum thickness: n/a Distance from top of scum to top of outlet tee onbaffle: nla Distance from bottom of scum to bottom of outlet tee or baffle n/a Date of last pumping: n/a Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage,etc.) n/a 11A revised 9/2/98 Paoe 7 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 20 8 MAPLE ST WEST BARNSTABLE, MA 02668 M132 P024 Name of Owner NORMA PHILLIPS Date of Inspection: 10/26/00 TIGHT OR HOLDING TANK: _ (Tank must be pumped prior to,or at time of,inspection) (locate on site plan) Depth below grade: n/a . Material of construction: _concrete_ metal_Fiberglass _Polyethylene _other Explain: n/a Dimensions: n/a Capacity: n/a gallons Design flow: n/a gallons/day Alarm present: NO Alarm level:N/A Alarm in working order:NO Date of previous pumping: n/a Comments: (condition of inlet tee,condition of alarm and float switches,etc.) n/a DISTRIBUTION BOX:_ (locate on site plan) Depth of liquid level above outlet invert: n/a Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) n/a PUMP CHAMBER: _ (locate on site plan) Pumps in working order:(Yes or No): NO Alarms in working order(Yes or No): NO Comments: (note condition of pump chamber,condition of pumps and appurtenances.etc.) n/a revised 912/98 Paae 8 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 208 MAPLE ST WEST BARNSTABLE, MA 02668 M132 P024 Name of Owner NORMA PHILLIPS Date of Inspection: 10/26/00 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: n/a Type: leaching pits,number:(1)1000 GAL 6'X 6' leaching chambers,number: (n/a)n/a leaching galleries,number: (n/a)n/a leaching trenches,number,length: (nla)n/a leaching fields,number,dimensions: (n/a)n/a overflow cesspool,number: (n/a)n/a Alternative system: n/a Name of Technology: nla Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) THE LEACH PIT IS STRUCTURALLY SOUND AND APPEARS TO BE FUNCTIONING PROPERLY.THE PIT HAD 1'OF WATER IN IT AT THE TIME OF THE INSPECTION. CESSPOOLS: _ (locate on site plan) Number and configuration: n/a Depth-top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer. n/a Dimensions of cesspool: nla Materials of construction: n/a Indication of groundwater: n/a inflow(cesspool must be pumped as part of inspection)NO % i. t It Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) n/a PRIVY: (locate on site plan) Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) n/a revised 9/2196 Paoe 9 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 208 MAPLE ST WEST BARNSTABLE, MA 02668 M132 P024 Name of Owner NORMA PHILLIPS Date of Inspection: 10/26/00 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) glic k t c AA A- 3i`� k 3L Ui 3� Fk � PAD � revised 9/2/98 Paoe 10 of 11 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 208 MAPLE ST WEST BARNSTABLE, MA 02668 M132 P024 Name of Owner NORMA PHILLIPS Date of Inspection: 10/26/00 NRCS Report name: n/a Soil Type: nla Typical depth to groundwater: n/a USGS Date website visited: n/a Observation Wells checked: NO Groundwater depth: Shallow_ Moderate_ Deep_ SITE EXAM _ Slope _ Surface water _ Check Cellar _ Shallow wells Estimated Depth to Groundwater 12 Feet n/a Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed Site(Abutting property,observation hole,basement sump etc.) - Determined from local conditions Checked with local Board of health - Checked FEMA Maps Checked pumping records - Checked local excavators,installers X Used USGS Data Describe how you established the High Groundwater Elevation..(Must be completed) USGS MAPS AND CHARTS-12 FEET revised 9/2/98 Page 11 of 11 ` TOWN OF BARNSTABLE LOCATION Q(Z�W MCI,�� SEWAGE # VILLAGE R)a b� ASSESSOR'S MAP & LOT 13a INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) P (size) ®� A NO.OF BEDROOMS 3 �D Y �s 2✓��' C'�7 BUILDER OR OWNER On�� \ PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the 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 NUT g AA0 P3 q 6� gD r y_ No.. . ......... .... Fps. . ............ .. A P P k-,0 V E D THE COMMONWEALTH OF MASSACHUSETTS BarnstabluConsorvationCommission BOAR® OF HEALTH �� _oS2 TOWN OF BARNSTABLE Signed DateAppliratton for Diipooal Works Tonotrnrtion Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( jeran Individual Sewage Disposal System at: .... .$._....' 'r�..�: `...........6: .:........................... ..... .......� 2 N w Q ....................................... ,-Location-Address or Lot No. Owner Address P © 0 9�fj5 r�_ inn®0 7" UType of Building Installerr SizeLot.___,C ....................Sq. feet Dwelling—No. of Bedrooms.._.4...................................Expansion Attic ( ) Garbage Grinder ( ) aA4 Other—T e of Building No. of persons............................ Showers YP g ---------------------------• P ( ) — 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--------------------- 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........................ fT Test Pit No. 2................minutes per inch Depth of.Test Pit---................. Depth to ground water........................ 04 ---•----•--------------------------•----.......-•--------------.....----•------------...-----•--........---•----------.......------------............-•------ 0 Description of Soil........................................................................................................................................................................ x U •-----------------------------------------•----------------------------------------------•-•-•--------------------------------------------------------------........................................... ------------------------------------------------------------------------------------------------------------- � j,� -- ............ Nature of Repairs or Al eratio s—Answer hen a li bl ? __--_�®�... . Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Co pliance as been issued e board of health. Signed ...... .... :,. .. .... . - D '�� 9/.-- ... ®.................. ......... ... .............. ........--Date.-.... Application Approved BY -. .. . ........ ......... ................Date ................ Application Disapproved for the following reasons: III --------------------------------------------- -----........ ..........---....-------------. -- --- --------............--------------...-----. ... L; ----------.---------- ......... Date Permit No. -- -- ................ Issued V Dace �jNo... . _ Fss.�. ...."".... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH aS'u&,kTOWN OF BARNSTABLE Appliration for Bi-qpm al Works Tomitxnr#iun ramit Application is hereby made for a Permit to Construct ( ) or Repair ( j,�an Individual Sewage Disposal System at: J._a........................•--.... 1 .........a " . �a< Y' fK�.�`" .-••--•--------..�_......JM- ---.n..�.............. .......... .................... Location-Address or Lot No. • rz: !A..__..: ?.N.. L-LI AS-------------------------••. ..........--................................. .... _...... -.........- Owner Address ................ .....fix . r-r.................................................. ...................... .. Installer / Address UType of Building ,,// Size Lot............................Sq. feet Dwelling—No. of Bedrooms.._.fit.........______________________Expansion Attic ( ) Garbage Grinder ( ) A4 Other—T _of Buildin Wyp e. g ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) d Other 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..................... 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........................ (14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ x ---------------------------------------------------------------------------------------------------................------------- -----------------------•-- ODescription of Soil........................................................................................................................................................................ x ---------------------------------------------------------------------------------------------------•---------------------------------------------------=-------------•--------••--••---- Nature of Repairs or Alterations—Answer when a licable`__-,,�� !d c�-o n fro-�' ',a q10 r-�"C-•T�,n U .. PP '�- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions.of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compl'�i e'has been issued by tth'e board of health. Signed ........ .::... \ ? -' �.a..', ` ._-_9/._ 1 v ---*-- �............... .. ...-�:.----.......... Due A lication A roved B ` PP PP Y .... .. ° ---�"-:: --------- .................................------- Dare Application Disapproved for the following reasons: --------- Permit No. .-� l` Issued .......fv- ---�---( . .................. Dare THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Cer#ifirate of C ontlaliance THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( v.) .� - --.0---------- ------------------- -------I_......-...............................................--------------- ---- . ...---------------------------------------.-- bY.......... ....'�.'.'a9---...._._ Installer at -- -C -----------`fir .P7;44_......... ........ ._( ..&...7......._�k__...+a...Q_ t< � e / has been installed in accordance with the provisions of TITLE 5 of The S ironmental Coe dese�r in the application for Disposal Works Construction Permit No. ........`.. � t ,, dated ...� .. .. . . ......... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE � SYSTEM WILL FUNCTION SATISFACTORY. *r' DATE.............................. ... °7 � �?... - Inspector ..... �� f--r /,! °" ................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �►L� TOWN OF BARNSTABLE �� No...�� . ............ FEE.... .....,. �i��rr��a1 nrk� C�nn��nr#Uan rrmi� Permission is hereby granted .. .. A ICJ. -------------------- to Construct ( ) or Repair ( -an Individual Sewage Disposal System atNo.. =7 5--- c=--------'= ....... : ..... _ _ _' .. ..... y'.�------------------- - -° .�........ Street as shown on the a<plication for Disposal Works Construction erm t No.... . ......... ate,d._.1.0 __,.._._.................... --------------------------------------- . -- ...•-- ..... _.�._.. `� G� Board of TIealth DATE...... ( 7 ! ......................................... FORM 36508 HOBBS Q WARREN.INF..PUBLISHERS I I u. E t f �W�... 5 �- 1917 �99 L, // /) U �;0 -tiXERLIYE RM. SYEi2.1:RDOF_Sf.kUGSU gE" M A .. �/� r �tAwu,� u` C.P•E-MOVE tXT:�WAU-5 ,`_��'S Imo.. � m: ':� ', // ! I 1. � Yt � � €I �� _�5/q:%'yti'�RAPau1,r•� � --..N T- yJI � !Lq .. ., (J/ •/' `� .. 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W 1rwC?URE Li I -R.-- I .. .. ._ I `I I PROJECT DATA - S� LOT INFORMATION: =1 ;FArAtLY k,oOM - I ' --i MAP 132,LOT 21 AREA-3.02 ACRES .�' n.,e•4 FJc"_ i �._.._ _ I 1 LOT COVERAGE EXISTING-1875 SF(INCL.PORCH) j-��I E:Ctc_KIaE 1?gteoL LOT COVERAGE PROPOSED-2001 SF HOUSE PLUS 423 SF DECKS _......_.._._� f.5f-.' _.. FL45'4 1�c M,uc Oc"7,IEP 2i.9•ct6"a E_X $T R I _ - 64'.'fa erw I For EX.VlIA17o�tIS T� R.1��lAl'1 1 1 FLOOR- IOSSF Iu I.J EIe.5 2iD FLOOR- 205.0 SF D.tD 2flo'q �IG'Ocy t To "AilTek EX. TOTAL 24SS SF FINISHED SPACE REMovE v,u•(yytp,v;. SCREENED PORCH BSS SF DECKS 422.65E O � i� nE?IALc KOCFIUG E,t..$A:¢J.lF1Tr RENOVATIONS: (C,uG fDv. ql.I-,' - t'(£W'_ CErS:,v TI ' I 1 - KESH:PJ>LE SOUTH �n'3':.£:h At.t. 1�FLOOR- 769 SF i J KEYED_ra ( "y to pm, 4P�vE 7 1 _ 2 FLOOR- 320 SF I NO.BEDROOMS: ," 54FPIT/YALEU GE e{iI-tUt1AL Yl�IL)IEt: RAILb-� r er_ Q-uC- 1 PROPOSED 4 B_ - ..... . .... .. xa. EDROOMS golS II-�-c.c.oRv / EXISTING- 4 BEDROOMS -'--'-I, _ P_cr M � 1- °` � ;I \�I I Z:Z•. .ICI .. . ..`Tf1U Doyv S. � 0 V F 1k x G/�GL:�F C I_5. Ci+.t qi(,t;NU AJi� DH'L NAT,./2AL .._I �._ ..I-.� -J V�� •.1 I I ,� ��. i f•.•il ll IFJ�:. 3E C.IE `,' ( 41 CwsErmr w/ i i !�, _. I 1 Y: ?r a: t• _... :.. - w N.F,Er.L ""+ ... PN•-�E1.S - - �il.l^.�;� c..,,,1✓F_:.,_;,,r{ . .O m*r__ %6C PA71J-,VOL- u �-O` (•�� 54""'/64.:_ - FCITGH EI-J tt_EV. scn�e A.5 I�DTED nrrno"eo er ua..wr,ar � AKRO ASSOCIATES ARCHITECTS a /.-•I 310 Barnstable Road, Hyannis, MA 02601 a! - H Fi(.5n!Rw e£c'�x,G snlL S%o3 -;tel. 508-778.6060 fax 508-778-2558 - Steven M.Shuman,RA Alice L.Oberdorf,RA ALL SYSTEM COMPONENTS SHALL BE MARKED WITH MAGNETIC TAPE OR SYSTEM PROFILE NOTES LEGEND- COMPARABLE MEANS FOR FUTURE LOCATION. SYSTEM DESIGN. PROVIDE IF NEC. WATERPROOF (NOT TO SCALE) 1. DATUM IS -APPROX. NGVD (GIS SPOT EL.) LOCUS 99 - EXISTING CONTOUR FIN. FL. ELEV. 56.25' ACCESS COVERS TO WITHIN 6 OF FIN. GRADE - - P 2" PEASTONE OR GEOTEXTILE PROVIDE INSPECTION- PORT TO WITHIN 3" OF FINAL GRADE 2. MUNICIPAL WATER IS NOT AVAILABLE 69 X 99.1 EXIST. SPOT ELEV. GARBAGE DISPOSER IS NOT ALLOWED \ FILTER FABRIC OVER STONE �PM• MINIMUM .75' OF COVER OVER PRECAST 4;2.8 29L SLOPE REQUIRED OVER SYSTEM 41'- 41 .8' 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. 99 PROPOSED CONTOUR DESIGN FLOW: 6 BEDROOMS ® 110 GPD = 660 GPD PRECAST H-10 n TO DESIGN4. LOADING OR ALL PROPOSED PRECAST UNITS Maplel Silo l 198.4] PROPOSED SPOT EL. USE A 660 GPD DESIGN FLOW RISERS (TYP.) ,{.. 4"SCH40 PVC 2'0 ADD TEE 4"OSCH40 PVC 2" DOUBLF WASHED PEASTONE street TH1 RE-USE EXIST. 1000 GAL. SEPTIC TANK** PIPES LEVEL 1ST 2' OR GEOTEXTILE FABRIC 5. PIPE JOINTS TO BE MADE WATERTIGHT. TEST HOLE R (OLD CODE: 660 x 1.5 = 990 GPD) 38 8 ' 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH c •��' RE-USE 1' q .y' t0 1000 GAL H-10 14 310 CMR 15.000 (TITLE V.) o 2 SLOPE OF GROUND TEE TEE o00 000 LEACHING: SEPTIC TANK** 44.2f I ES2 60.8 + 10.25 2 .74 = 210 GPD ° °°°°°°°°°°°• °°s" SUMP 38.3 UTILITY POLE S D ( ) ( ) GAS BAFFLE ° °o°o°o°o°°°°°° o°12" INT. DIAM. MIN. 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO ° °°°°°°°°°°°° °° _�p BE USED FOR LOT LINE STAKING OR ANY OTHER BOTTOM 60.8 x 10.25 (.74) = 461 GPD 38.47'' 3 .3' 0 2 FIREVYIZ" HYDRANT o00 o�0 36.3' PURPOSE. . NOTE NOT ALL SYMBOLS MAY APPEAR IN DRAWING TOTAL: 906 S.F. 671 GPD H-20 3050 INFILTRATORS 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. �' r " k' 3/4" TO 1 1/2" DOUBLE WASHED STONE 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED st USE (8) H-20 INFILTRATOR 3050 S 6 CRUSHED STONE OR MECHANICAL OVERALL DIMENSIONS TO OUTSIDE OF STONE: 60.8' X 10.25' WITHOUT INSPECTION BY BOARD OF HEALTH AND WITH 2' STONE AT ENDS AND 3' AT SIDES COMPACTION. (15.221 [2]) PERMISSION OBTAINED FROM BOARD OF HEALTH. *THE INSTALLER SHALL VERIFY THE 6,.3' 10. CONTRACTOR SHALL BE RESPONSIBLE FOR CALLING LOCATIONS OF ALL UTILITIES AND ALL DIGSAFE BUILDING SEWER OUTLETS AND LOCATION (1 F ALL UNDERGROUND AND VERIFYING THE LOCUS MAP ELEVATIONS PRIOR TO INSTALLING ANY MIN LOCATION OF ALL UNDERGROUND & OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF WORK. ( 1 796 SLOPE) 1 30.0' BOTTOM TH-1 SCALE 1"=2000'f ( x SLOPE) 30 GROUNDWATER FOUND 11. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL BE PORTION OF SEPTIC SYSTEM MA LEACHING REMOVED 5' BENEATH AND AROUND THE PROPOSED ASSESSORS MAP 132 PARCEL 24 APPROVED DATE BOARD OF HEALTH FOUNDATION EXIST. SEPTIC TANK 34' D' BOX 2' - _---_ LEACHING FACILITY. FACILITY NO CONSTRUCTION PROPOSED (UPGRADE OF 12. EXISTING LEACHING FACILITY SHALL BE PUMPED AND SEPTIC SYSTEM) REMOVED OR PUMPED AND FILLED WITH CLEAN SAND. 1 **INSTALLER SHALL CONFIRM MINIMUM SEPTIC TANK SIZE AT 12 /' / 1000 GALLONS AND ITS SUITABILITY FOR RE-USE.LREPLACE WITH 1500 GALLON H-10 SEPTIC TANK IF NOT SUITABLE. BUTLER, NORMx1 / - -- 211 MAPLE ST elf / / / / W BARNSTABLE, MA 02668 , I I rJ i / / Exist. We% TEST HOLE LOGS ENGINEER: ARNE H. OJALA, PE, SE ' O �" I l / / o , F 1 I DAVID STANTON IRS / 6 WITNESS: / l h ae>\t\ ( ' I e / / / / // / , 1 I I DATE: 4/15/09 e / / I e _ J / / PERC. < 2 MIN INCH e RATE - -' 12530 CLASS SOILS P# ' ali, ELEV. ELEV. 1 � aftl, /Lot Area, 1 _ 4 Q / 1 „ I p 43.4 p 41 .0 / 13.80f Acres G Tota all a °� , \ 1 _ .30f Acres / / 1 1 I FILL FILL c land 3 i / P • `� / '' \ 0$ 0\�9 5 / / / / / /W tland=0.50f Acre �\ L I LS LS CB/DH61 / / / // / / / I I I �• �T, I I ,\!I, 10YR 4/2 1OYR 4/2 _ - � 11 BENCHMARK: USE TOP OF EXISTING 14 14 � I SEPTIC TANK AT EL. 45.6' / \\ \ ` •` ` I B B �,o \ \ ` \ \ / \ �� / / /i / / / / / / I \ \ ` ` I LS LS j \ \5o� �`� / / % / / ,/ I \ \ i \\ •.• all, 10YR 7/2 ,. 10YR 7/2 \ - - / \ � 41.7 20 39. 20 3 is / \ �c ApRCox. SeQtic`3ystemCN ` Parking / / i r \, \ . 1 O PERC C C -Area ` r • / PROVIDE APPROX. 103 z • I OF 40 MIL LINER AT 5 H 1 / / OFF SAS IN AREA / // I ( I I M FS M FS Exist. 150 / o -�40 \ / / SHOWN. TOP AT EL. i / I all, V N_ o, \ / 39.2, BOTTOM AT EL. i / ` _ _ , / I L=Q We// Sprinkler head \ • ��/ / /35.2�. ENGINEER TO / i /' / 1 I V 2.5Y 7 5 2.5Y 7 5 (tYP•) \ H / / / INS ECT./ / /' / r l l » / / , _ \ i 120 33.4 132 30.0 NO GROUNDWATER ENCOUNTERED a�� / ��Y`7� \ � �'''�jl� • . ill, /i� /' x , T � \ ;• TITLE SITE PLAN � CB/DHOF POKRASS, EDWARD H & SARA C / \ \ �wetw / / / _ all, ZZ PO BOX 495 30- i C / / / i W BARNSTABLE, MA 02668 ' '\ --r ° � �6G /' #410 �• _ ,\ , ' - � CIE) l 83 208 MAPLE STREET I R / _ c � � � �� .,,., ,• / 1 / G SS A " T ? N WEST B� S ARN #409/ STABLE PREPARED FOR #408 / \ LEONARD AND PATRICIA CURRAN MAY 11 , 2009 r \ _ \ , I, REV. 6/1/09 \\ ail�'• \ ' / / #406 / �'� cy FA OF , = o ARNE H, c• � �a - / Scale: 30 \ \�'• \ \\ / / • o OJALA o�� ARNE 9cyc z MIN CIVIL y �� NMIN \_ N Nam,• \ \ \ ` _ / No. 0792 H' �, 0 15 30 45 60 75 FEET / \ / / #407 / / v p p o w<t OJALA m \ N •6' �'''\ � / / / a11, / °,� c� Egg �w ,p �, e- all, t a �N OFEs c\O�F off 508-362-4541 SURVE�� fax 508-362-9880 downcape.com © „ ; s �,OFI • /.� '�. S �j ASS / ,�,, �� ,� down cope engineering inc. // ,�0 �o� ARNE yGN �o ARNE H civil eng ineers ineers o. / 1/�(0 o H. �a a OJ g OJALA v N cj ( ja 30 land surveyors / it �F 939 Main Sheet Rte 6A "BEGIN':/ PvG ss\° NE o E cs YARMOUTHPORT MA 02575 06- 107 /� � �SURVE S/pNAL �� • 06-107.DWG(SBO) i