Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0010 PERCHERON WAY - Health
i'O Percheron Way A= 174—001 —057 W. Barnstable r► �f FY 1 , INME Town of Barnstable Barnstable Regulatory Services Department ASS � Public Health Division 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director AX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7015 1520 0001 2273 3425 May 24 2016 Richard J. Ruggiero 10 Percheron Way West Barntable, MA 02668 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 10 Percheron Way, West Barnstable, MA was last inspected on 5/4/2016, by Joseph M. Martins, a certified septic inspector for the state of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following: • Leaching pit or cesspool with high liquid level, <12" below inlet (per Town Code 360-9.1) You are ordered to repair or replace the septic system within two (2) years 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 Q:\E PTIC\Letters Septic Inspection Failures or Future Evl\10 Percheron Way W.Barn May 2016.doc r Town of Barnstable RARNSTABM b 9. ,�� Regulatory Services Department Public Health Division I 200 Main Street, Hyannis MA 02601 Office: 508-8624644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 5/11/16 f DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An"x"marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE (1)YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑ Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2)YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any"conditionally passed systems" (broken cover, relocation of a pipe, relocation of a driveway due to H-10 components, etc) Leaching pit or cesspool with high liquid level,<12" below inlet(per Town Code 3 60-9.1) ❑ Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER Repair-deadline: Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc y , ��- 0 0 f- L95� Commonwealth of Massachusetts -- Title 5 Official inspection Form ; t- Subsurface Sewage Disposal System Form-Not for Voluntary Assessments IOPercheronWay West Barnstable MA Property Address IV .I Richard J Ruggiero 10 Percheron Way �+ Ovrner Owner's Name / requir atifo is West Barnstable / MA_ 02668 514/2016 required for every ----- page. City/Town state Zip Code Date of Inspecti 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 flilmg out forms on the computer, use only the tab 1. Inspector: key to move your cursor-do not Joseph M Martins use the return Name of Inspector key. AccuComp Sepcheck Comp� any Name 17 Norihside Dr Company Address South Dennis MA 02660 City/Town State Zip Code 508-385-5891 SI 147 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: 0 Passes E Conditionally Passes 0 Fails El Needs Further Evaluat' by the Local Approving Authority 5/912016 1 pector's Signature Late 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 sbail submit the report to the appropriate regional office of the DER 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. a - tMas•31.13 Title 5 Official Inspection Form:Subsurface Sewage©isposal System•Page-1.of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 10 Percheron Way West Barnstable MA Property Address Richard J Ruggiero 10'Percheron Way Cwner Owner's Name information is required for every West Barnstable MA 02668 5/4/2016 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C„D or E I ahvays complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the f 'lure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure crit a not evaluated are indicated below. Comments: /1 B) System Conditionally Passes., ❑ One or more system compo nts as described in the"Conditional Pass"section need to be replaced or repaired..The stern, upon completion of the replacement or repair., as approved by the Board of Health,will ss. Check the box for"yes", or"not determined'(Y, N, ND)for the following statements. if"not determined,"please ex in. The septic tank is m al and over 20 years old* or the septic tank(whether metal or not)is structurally unsound, exhibits bstantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the isLing 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 Ilede 5 Official lnspecuon Form:Subsurface Sewage Disposal System•Page 2 of 17 l Commonwealth of Massachusetts w Title 5 Official Inspection Form Vr� Subsurface Sewage Disposal System Form-Not for Voluntary Assessments . 10 Percheron Way West Barnstable MA Property Address Richard J Ruggiero 10 Percheron Way Owner Owner's Name information i e required for every West Barnstable MA 02668 5/4T2016 page. City[Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Heal approval if pumps/alarms are repaired. B) System Conditionally Passes (tong): ❑ Observation of sewage backup or break out or high static water level in a distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven ' tribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N El ND (Explain below): ❑ obstruction is removed ❑ Y N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping mor than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(wi approval of the Board of Health): ❑ broken pipe(s)are rep ced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is rem ed ❑ Y ❑ N ❑ ND(Explain below): C) Further Eva nation is Required by the Board of Wealth: 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 Tide 5 Official inspection Form:Subsurhiee fie disposal Syste n Page 3 ci 17 Commonwealth of Massachusetts Title 5 Official Inspection Form �- I Subsurface Sewage Disposal System Form Not for Voluntary Assessments _ 1 10 Percheron Way West Barnstable MA Property Address Richard J Ruggiero 10 Percheron Way Owner Owner's Name information is West Barnstable MA 02668 5/412016 required for every e.. page. city/Town State Zip Code date of inspection B. Certification (cont,) 2. System will fail unless the Board of Health(and Public water Supplier,if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption syste/PP he SAS i ithin 100 feet of a surface water supply or tributary to a surface ❑ The system has a septic tank and SAS and the SAS is 1 a public water supply. ❑ The system has a septic tank and SAS and the SAS is of a private water supply well. The system has a septictank and SAS and the SAS is less but 50 feet or more from a private water supply well". Method used to determine distance: *"This system passes if the well water analysis, perfo at a DEP certified laboratory,for fecal coliforrn bacteria indicates absent and the presence o 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: ID) 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 of system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the around 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 °Y2 day flow `&ns 3113 Title 5 Official fnspectionform Subsurface Sewage 91sposal System•Page 4 of 9 i lie 'nspect"on Form Subsurface Sewage Disposal System rorrra-Not for Voluntary Assessments off r t r FVa,r 1QG'.c.l�'t"}il , 1eStrai:n5`af3leM '.. �. P opeity Address �} Richard J Ruggiero_i10 P_ercheron. vtvtaer Owur's:Narne — ----_ —� - requiratifore West Barnsfable MA 02668' 5/4/2016 • .required for every _�._ _ _ ... _ ..... ,page, eityffo" State Zip Cede Date of,inspection a9 B. Certification (con : Yes No Required pumping more than 4 iiiries In the last year=T 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 wit.thin.1'00 feet of a surface water supply or. ❑ tributary to a surface water supply. / Q ❑ Z Any Po on 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. ❑ 1�9 Any portion_of a cesspool or privy is less than 100 feet but greater than 50 feet #roan a private water supply well with no acceptable water quality analysis. tTtlis. system passes if the well water analysis, performed at a DEP certified laboratory,for feral coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain.of custody must be attached to this forma ❑ The system is a cesspool serving a facility with a.design flow of 20rJQgpd- 10.000gpd. ❑ The system fails. I have determined that one or more of the above failure criteria exist.as described in 34.0 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. Ef Large Systems: To be considered a large system,the system m ust serve a faejiity w#h a design flow of 103000 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 10 ❑ 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.WelEhead Protection? Area—IWPA)or a nnapped Zone 11 of a;public water supply well If you have answered "yes'to any question in .Section E the system is considered a signihcarit threat„ or answered"yes"in Section D above the large system has failed+.The owner or operatorof.ally`!-arge system considered a significant threat tinder Section'E or faiteo under Section D shall upgrade the system in accordance with 310 CMR 15.804.The system owner should contact the appropriate regional office of the Department. :Sns•M3 l`He 5 Of !aUnspeztion Fotnr,Sta nw(ace Sem9e:0isposal system>.Page 5 of 17 Commonwealth of Massachusetts 1z Title 5 Official Inspection Form fie} Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 10 Percheron Way West Barnstable MA Property Address Richard J Ruggiero 10 Percheron Way Owner Owner's Name information is squired for every West Barnstable MA 02668 5/4/2016 page_ Cityl'fown 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: El M 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 .0 L'if c 'P� ® tributary to a surface water supply. •Y 0 ® Any portion of a cesspool or privy is within a Zone 1 of a public well v�� c ® 0 Any portion of a cesspool or privy is within 50 feet of a private water supply wel 1 _ ViAl ® Any portion of a cesspool or privy is less than 1.00 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis.VMS system passes if the well water analysis, performed at a DEP certified S✓� �, laboratory,for fecal coliform bacteria indicates absent and the presence Nee � � 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. 1 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 0 1 the system is within 400 feet of a surface drinking water supply El E 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 I 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 CM'R 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3713 TiBe 5 Official lnsoeciion 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 10 Percheron Way West Barnstable MA Property Address Richard J Ruggiero 10 Percheron Way Owner Owner's Name information uiredfor is West Barnstable MA 02568 5/4/2016 reaaired for every page. CiWTown 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 0 ❑ 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? El ® 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)1310 CMR 15.302(5)) D. System Information Residential Flow Conditions'. Number of bedrooms(design)- 3 Number of bedrooms(actual): 3 ©Efd DESIGN flow based on 310 CMR 15.203 (for example' 110 gpd x#of bedrooms): 330 t5ins•3t13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Tithe 5 Official Inspection Fort Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 10 Percheron Way West Barnstable MA Property Address Richard J Ruggiero 10 Percheron Way Owner Owner's Name information is required for every West Barnstable MA 02668 5/4/2016 page. City(Town State Zip Code Date of Inspection D. System Information Description: 1000 GALLON SEPTIC TANK, DISTRIBUTION BOX, 600 GALLON LEACH PIT PER AS BUILT. Number of current residents: 1 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)): 114 Detail: 2015: 52,000 GALLONS 2014: 31,000 GALLONS Sump pump? ❑ Yes No Last date of occupancy: 'Date 16 Hate Commercial/Industrial Flow Conditions: Type of Establishment: N/A Design-flow(based on.310 CMR 15.203): cations per day tgpdt 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. Uns 3113 Tine 5 0Mdai Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Tide 5 Official Inspection Farm Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 10 Percheron Way West Barnstable MA Property Address Richard J Ruggiero 10 Percheron Way Owner Owner's Name information is required for every West Barnstable MA 02668 514/2016 page. city(rown State Zip Code. Date of Inspection D. System Information (coat.) Last date of occupancy/use: Hate Other(describe below): General Information Pumping Records: Source of information: PUMPED IN 2011,2007,2003 PER BARNWWVTP Was system pumped as part of the inspection? ❑ Yes 0 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/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): t5i_'3113 Tille 5 Official-lnspeclion Fwm;Subsurface S-nage-Disposal System•FPage.8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System:form-Not for Voluntary Assessments 10 Percheron Way West Barnstable MA Property Address Richard J Ruggiero 10 Percheron Way owner owner's Name information is required for every West Barnstable MA 02668 5/4/2016 page. Cityffown State Zip Code Date of Inspection D. System Information (cunt.) Approximate age of all components,date installed(if known)and source of information: 23 YEARS PER BARN HEALTH DEPT, INSTALLED 1993 PER BHD Were sewage odors detected when arriving at the site? ❑ Yes No Building Sewer(locate on site plan): Depth below grade: 2 feet Material of construction: ❑ cast iron M 40 PVC ❑ other(explain): _ Distance from private water supply well or suction line: >10.feet Comments(on condition of joints, venting, evidence of leakage, etc.): OK, NO LEAKS. Septic Tank(locate on site plan): Depth below grade: 1.4 -feet Material of construction_ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years — Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 4.9X5.6X8.5' 100OG Sludge depth: 10" t5i,s-3/13 Title 5 Official inspection Form:Subsurface Selvage Dispdsal System-Page 9 of 17 Commonwealth of Massachusetts -y Title 5 Official Inspection Form " - - Subsurface Sewage Disposal System form -Not for Voluntary Assessments 10 Percheron Way West Barnstable MA Property Address -T Richard J Ruggiero 10 Percheron Way Owner Owner's Name information is required for every West Barnstable MA 02668 5/412016 page. Cityffovm State Zip Code Date of Inspection D. System Information (coat.) Septic Tank(cunt.) Distance from top of sludge to bottom of outlet tee or baffle 24" Scum thickness 2 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 14 How were dimensions determined? CORETAKER ,Comments(on pumping recommendations, inlet and outlet tee.or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): HAS INLET PVC TEE,HAS OUTLET CONCRETE TEE. NO EVIDENCE OF LEAKAGE Grease Trap (locate on site plan): Depth below grade: NIA feet Material of construction- concrete ❑metal ❑fiberglass E polyethylene L7 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 7 3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Ville 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments s f� 10 Percheron Way West Barnstable MA Property Address Richard J Ruggiero 10 Percheron Way Owner Owner's Name information is required for every West Barnstable MA 02668 514/2016 page. City+town State Zip Code Date of Inspection D. System Information (cunt.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection){locate on site plan): Depth below grade: NIA 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 Q Yes ❑ No Date of last.pumping: Date Comments (condition 0f alarm and Boat switches, etc): Attach copy of current pumping contract(required)_ Is copy attached? ❑ Yes ❑ No 15ins-3t13 Title 5 Official-Inspection Form:Subsuiece Sewdge Disposal system-Page 11.of 17 Commonwealth of Massachusetts Title 5 Official inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 10 Percheron Way West B:amstable MA Property Address Richard J Ruggiero 10 Percheron Way Owner Owner's Name information is required for every West Barnstable MA 02668 5/4/2016 page, City/Town State Zip Code Date of Inspection D. System Information (coat.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert AT INVERT Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box,etc.): 1 PIPE IN, 1 PIPE OUT. DBOX IS CORRODED AND NEEDS TO BE REPLACED. Pump Chamber(locate on site plan): Pumps in working order: El Yes E] No* Alarms in working order: D Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): N/A If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System(SAS) (locate on site.plait,excavation:not required): If SAS not located, explain why: t5ins-3113 Tide 5 Offici-al Irsoedan.Form Subsurface Sewage Disposal.Systern•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection form i Subsurface Sewage Disposal System Form-Not for Voluntary Assessments u0' 10 Percheron Way West Barnstable NIA Property Address Richard J Ruggiero 10 Percheron Way Owner Owner's Name information is required for every West Barnstable MA 02668 5/412016 page. Cityrrow n State Zip Code Date of Inspection D. System Information (coat.) Type: ® leaching pits number. 1 leaching chambers number: leaching galleries number; ❑ leaching trenches number, length: ❑ leaching fields number,dimensions: overflow cesspool number: ❑ innovative/alternative system Type/name of technology.- Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil, condition of vegetation, etc.): EXAMINED LEACH PIT W CAMERA AND FOUND LIQUID LEVEL WITHIN 2"OF RISER OVER PIPE A FAILURE CRITERIA. Cesspools(cesspool must be pumped as part of inspection) (locate on site;plan): Number and configuration NIA 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•3113 Ttfie 5 official Inspection Form;Subsurface Sewage Disposal System-Page 13-of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form l Subsurface Sewage Disposal System Form-Not for Voluntary Assessments - 10 Percheron Way West Barnstable MA Property Address Richard J Ruggiero 10 Percheron Way Owner Owner's Name information is West Barnstable MA 02668 5/4/2016 :required for every A, page. Cityl-rown State Zip Code Date of Inspection D. System Information (cont.) Comments(Cote condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: N/A Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of po,nding,condition of vegetation, etc.): E fSins-:3/13 Title Official Inspection:Fonn:Subsurface Sewage Disposal SysZOM Page 14 of 11 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments s f w�-� 10 Percheron Way West Barnstable MA �.. Property Address Richard J Ruggiero 10 Percheron Way Owner Owner's Name information is required for every West Barnstable MA 02668 5/4/2016 page. City/Town State Zip Code Date of Inspection D. System Information (cunt) 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 VJ I a ss 7W--Aj 3 17 �; 92- 7- 25- 0 nns 3/i 3 Title 5 Official Tns*tion Form:Subsurface Sewage©ispinal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora t a) Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 10 Percheron Way West Barnstable MA Property Address Richard J Ruggiero 10 Percheron Way Owner Owners Name information is required for every West Barnstable MA 02668 5/4/2016 page. Cityffown State Zip Code Date of Inspection D. ,System Information (coat.) Site Exam: Check Slope ® Surface water Check cellar Shallow wells Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: El Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting propertylobservation hole within 150 feet of SAS) 0 Checked with local Board of Health explain: [) Checked with local excavators, installers- (attach documentation) G Accessed USGS database-explain: You must describe how you established the high ground water elevation NOT.DETERMINED DUE TO FAILURE Before filing this Inspection Report,please see Report Completeness Checklist on next page. t5in 3113 Title 5 Official Insp=_cn'an Form:Subsurface Sun*GeCjispposal System•:Page 16 of 17 Commonwealth of Massachusetts 9 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 10 Percheron Way West Barnstable MA Property Address Richard J Ruggiero 10 Percheron Way Owner Owner's Name information is required for every Vilest Barnstable _ MA 02668 5/412016 page. City/Town State Zip Code Date of Inspect an 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 Sins-3113 Trfw 5 Official tnspecton Farm:Subsurface Selvage 91sposai System•Page 17 of 17 Town of Barnstable P vsyo Dep.artinent of Regulato Services Public� .a,,wtsm�re t blic Health .Division Date 200 Main Street,Hyannis NIA 02601 fOAIA � Date Scheduled �- � Time 1'* Fee Pd. Soil Suitability Assessment for S4. MVP4017 Performed By: (tressed Byl�l/ Uv� n1 �, LOCATION & GENERAL INFORMA,riON i ovation Address 10 )7e,r-rOwner's Name mac"W �+ �c�l Address 10 .w < Assessor's Ma /Par el; L p o �71 "-dU E iginews Name r� let'�_��(l-QC�rY 11� t/\!•u�H YY� C NEW CONSTRUCTION REPAIR. , Ll� telephone o 'a F—y 7-7 Land Use I` J106\f`�o� Slopos(%) /.Ja�2 Surface Stones Dlsta c �- nc s flnm: Open Water Body � R Possible Wet:Arca &/ �4r_ ft Drinking Wntcr Well ���- ft Drelhage Way ft Property Line 0 ft Other ft I{E'TCH' (Street name,dimensions of lot,exact locations of test hales& pero tests,looato wetlands i'n prokl"ty to Doles) r _%. pr rant material(geologic) 'r AVJ_S�6-r-4 2(j Dc pth to Bedrock epth to Orauadwater. Standing Water In Hole: (y Weeping from Pit FROG stlmated Seasonal High Groundwater > Y DETERMINATION FOR SEASONAL' GH WATER TABLE Method Used: Depth Observed standing in obs,hole: In Deptlt to still mettles: . Dekh to weeping from side of obs,hole: , ill,, Oroundwater Adjuetment— ft. dex Well-# Roading Dnto: index Well Jovol„� iAdJ.•fhotbr - A�,drt�utttlwrttar.]oval,, a PERCOLATION TEST bnlu . �., lime bl ervatlon -(T Time at 911 �r apth of Pero S r Time at 6" zo S art Pro-soak Time® d j Tlmo(9"-611) d Pro-soak �� •G ` Rate Mln.aaoh Silo Suitability Assessment: 51to Passed Site Palled:—�— Additional Testing Needed(Y/N) _ rlginal: Public Health Division Observdtion Hole Dl t&To Be Completed on Back----------- **If If percolation testis to be conducted within 100 of wetland, you must first notify the, arnstable Conservation Division at least one (1) week prior to beginning. :1SEPTICU'ERCPORM.DOC c �C DEEP,OBSERVATION HOLaE LOG Hole# 'if- t epth from Soil Horizon Soil Texture SdII Color Soil• Other urfaco(In.) (USDA) (Munsell) Mottling (Structure,Stonef;Boulders, �4ILalt m GX4- 16YQl) DEEP OBSERVATION HOLE LOG Hole#T( - z_ epth from Soil Horizon Soil Texture Soil Color Soil Other Surface(In.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders, (L l� Sa 9 Q.h V-e. � J DEEP OBSERVATION HOLE LOG Hole# "I'P-'3 epth from Soil Horizon Soil Texture Soil Color Soil Other S arrace(In.) (USDA) (Munsell) Mottling (Stmature,Stones,Boulders., Consist noy.%Gravel) 3 13 i DEEP OBSERVATION HOLE LOG Hole# D pth from Soil Horizon Soil Texture Soil Color Spll Other Surface(in,) (USDA) (Munsell) Mottling (Structure,Stones',Boulders, Consist nuJUM211 I'ood Insurance Rate Ma : Above 500 year flood boundary No _ Yes r� Witlun500yearboundary do Yes,; ,: Within 100 year flood boundary No.,� Yee,, e th of-l'inturally Occurring Per i us Materig oes at least four feet of naturally occurring pervious mtiterial exist in all areas observed thrpughout the a ea proposed for the soil absorptibn system? _,_YI„) I not,what Is the depth of naturally occurring pervious material? ertlfiication I certify that on t,l t q.c (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 e required trai g,expertise and experience described In 10 CNM 15.017, Signature DatbZ7 ;158pTIC\PBRCPORM.DOC No. r Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Nplifation for Disposal 6pstem Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade(, ) don( ) ❑Complete System ❑Individual Components Location Address or Lot No. to c Owner's Name,Address,and Tel.No. Assessor's Map/Parcel G i IL(J Installer's Name,Address,and Tel.No. i er's Name,Address,ajnZf Tel.No. 00l.- LA-11" 5_3 1 I)rpe of Building: Dwelling No.of Bedrooms Lot Size 11 1 p_Tsq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided���`. gpd Plan Date (L Number of sheets 2 Revision Date Title Size of Septic Tank 1 Q(S p Type of S.A.S. Description of Soil Se Nature of Repairs or Alterations(Answer when applicable) �Q%iw a 1, �p k�`a oCJ Ib.a i 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 oard of Health. Signed nn Date Application Approved by (L e Date Application Disapproved by Date for the following reasons Permit No. t�� Date Issued t L �j No.��( " Fee THE COMMONWEALTH O°F MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF>BARNSTABLE, MASSACHUSETTS 01ppliLation for Disposal,6pStrm Construction 3permit Application for a Permif'to Construct( ) Repair(: ) Upgrade( ) don( ) ❑Complete System ❑Individual Components t Location Address or Lot Noti i f 1 {< Owner's Name,Address,and Tel.No. Assessor's Map/Parcel IInstaller's Name,Address,and Tel.No. si er's Name,Address,`and Tel.No. (A-1, /3 `..A 1 It ��Gl � ? � - \`}-V1 � ��r t—QJfIt, cif �1�`1 j ji Type of Building: t, Dwelling No.of Bedrooms Lot Size I ;) r, ; sq.ft. " Garbage Grinder( ) �f � 3' Other Type of Building A ' No.of Persons Showers Cafeteria YP g ( ) ( ) ' Other Fixtures Design Flow(min.required) f , gpd Design flow provided fit.1 '_ gpd Plan Date ( ? t L Number of sheets Revision Date y Title Size of Septic Tank i, ( e,, Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when:applicable) l a , F � P (` �, C--.t . r �+ 4 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed`. _ ���. -—n Date Application Approved by t/�4 (/( Z Y[,�j Date Application Disapproved by Date for the following reasons i Permit No. �1 le2 14. f Date Issued to /7 ' i --------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( Upgraded( ) Abandoned( )by�i�... rv� cx at 11`-_ _' 11_ (r ti_a Gj G. has been constructed in accordance with the provisions of Title 5 and the for Disp so al System Construction Permit No ?/ -/� dated lG /Z/6j Installer Designer #bedrooms Approved design flow 3 C5 gpd The issuance of this permit shall not be c nstrued as a guarantee that the system will fu do as igned. Date�21�� Inspector --------------------------------------------------------------------------------------------------------------------------------------- No. o Fee L THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Bisposal .pstem Construction �ermit Permission is hereby granted to Construct( ) Repair( Upgrade( ) Abandon( ) System located at 1 r f t r /,q and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. a Provided::Construction must be completed within three years of the date of this permit. C Date (/ / [ / O Approved by `( ►—�]� Town of Barnstable Regulatory Services Richard.V. Scali,Interim Director t ,�ttrsr,►B,�e; • BUM. Public Health Division Thomas McKean,Director 200 Main streetOlyannits,MA 02601.; Office: 508-8624644. Fax: 50-790-6304 1ustaller&Designer Certification Form Date. Sewage Permit# t Assessor's Map Parcel !7 V—60 Designer: �ncj':v1��, : Y.� Etc^U=s I r. ` Instafler ,a►N1�>(��S. Address: 1 Z rrti7, R.y c`Li_p \1l Address. tc' - 7 On �1 l 0 -'ufcJi was issued apertntt to install.a (date) (installer} septic,s stem at %C 1 rC: 'c �'T Y `x _ based on a design drawn by (address) 'e qV1 c t✓ t-�cr: 't dated CI Z,1l4 (designer) I certify that the septic system referenced above `was installed substantially according to the.design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required} was inspected and the soils were-found satisfactory._ I certify that the septic system referen1.ced above was installed with major changes (i.e. gteater,than, 10' lateral relocation of the SA.S or,any vertical relocation of.any component of the septic system) but in accordance with State& Local Regulations. Plan re ision or eertiFed as-built by designer to follow. Strip out(if required)was inspected and the soils i were found satisfactory. l certify that the'system reference.d,Above was constructed in co fiance>with the terms of'te I1A apprmval letters(if applicable); o PElER T. Installer ignature} McEE >uTE N'o. 35109 (Designer's Signature) (Affix Des i Here); PLEASE RETURN TO BARNSTABLE'PUBLIC HEALTH DIVISION. CERTIF CATE. OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND .AS BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.: THANK YOU. Q:\8WieDesi6 er Certification Form Rev 84.443.duc APPLICA`i'ION FOR PERCOLATION TEST AND OBSERVATION PITS LOCATION ����- I�.l- 1 ��.`�1�,_.D t� ll�:t- P� T lC. NO. ,3 VILLAGE )"P(A(``�-tf � LZ5 DATE ,3 S APPLICANT `J L�� - �- FEE 'tADDRE5S `�� �� 1�-� ��� �Q ' �j ? TELEPHONE NO. -�- / (Non-refundable) ENGINEER Nrl G t TELEPHONE -NO. ' DATE SCHEDULED / Q - --� c s Wa 7 , e • • o 0 0 • e • o o n o o • e o o • • • e e o • o o e • • • • • • • • • • e • • • • • • • • o o • • • • • • • o • e • • • e e • e • • • • • ASSESSOR'0S0 biA0l' & LOT NO. U 1.7q V+ 11 00 a- 0, i0 q-11 W IS SOIL LOG SUB-DIVISION NAME � ..�Q (` t DATE /e � 7 TIME ' �*a EXPANSION AREA: YES ✓NO �.(Y,t h(�(-'-� ENGINEER:N TOWN WATER ✓PRIVATE WELL J r r' ZZ-) BOARD OF HEALTH EXCAVATOR SKETCH: (Street name, etc. ,dimensions of lot, exact location of test holes and percolation tests, locate wetlands in proximity to test holes) NOTES : oo � V 7- D' �. � J vv 0 ,fie 1 PERCOLATION TE: L Z tl7 TEST HOLE NO: ELEVATION: TEST HOLE NO: ELEVATION: 1 G o a_ 2 - 2 3 3 4 _ 4 _ 5 - ��i-J� 5 7�" 6 6 — 9: 8 Iea7- ia�P- 8 9z�_� 9 10 10 11 ✓�'� r= Jam-. 11 12 /—�.�.� 12 13 13 14 .. �_ z,wr ,�.i 14 15 15 16 - N� ✓1/ �. 16 SUITABLE FOR SUB-SURFACE SEWAGE: LEACHING FIELD LEACHING PITS -SL•a� �` LEACHING TREN:CHE§ y S UNSUITABLE FOR SUB-SURFACE SEWAGE. REASONS: NOTE: ENGINEERING PLANS MUST SHOW NUMBER ASSIGNED .ON PERC TEST APPLICATION ORIGINAL: COMPLETED IN ENTIRETY P . ANJ2 RETURNED O BOARD T OF HEALTH LTH COPY: RETAINED BY APPLICANT . TOWN OF BARNSTABLE LOCATION "e—A SEWAGE# —Q((0 gS VILLAGE ���I� L,(A ASSESSOR'SMAP&PARCEL , INSTALLER'S NAME&PHONE NO.ZtF'►Seh A_c`^ 7 = 7 w—R 3 SEPTIC TANK CAPACITY Q () .4Z j j C` LEACHING FACILITY: e p f (type) ��� �� (size) � a�� x �S-n NO.OF BEDROOMS 3 OWNER ' PERMIT DATE: COMPLIANCE DATE: !o v o 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 u _o4 �� P��G aye-�i 3 5a;°t C-ss -o -9 �© TOWN OF BARN'STABLE ff LOCATION Lol le Pe&l e,,, J SEWAGE # 1Pi 7-00 VILLAGE 6J. ASSESSOR'S MAP & LOT % poi. a5� INSTALLER'S NAME & PHONE NO. J J. f tszo/Ij/ �gb rJ 771- 1040 SEPTIC TANK CAPACITY Dip LEACHING FACILITY:(type) ,D 4 (size) (a0� NO. OF BEDROOMS 3 PRIVATE WELL OR�LIC WATER BUILDER OR OWNER CF ATE,-yW- met DATE PERMIT ISSUED: 7— 11— 91 DATE COMPLIANCE ISSUED: I: VARIANCE GRANTED: Yes No L/ k Dr�,c I/ D 0 v u� V f S cr® ! . cS7 No. .O.�P F3s.........1.67 .. LTH THE BOARD AOF OF HEALTH S ................... j ....................... ( Applirattun for Uiupuual Works Cfunutrurtion Permit Application.is hereby made for a ,Permit to Construct ) or Repair ( ) an Individual Sewage Disposal System at: Z ( Z�f s%rh ................_»...._ .... . -. ..... .. r . ......................... dd s ( oLo No � •----•---•- .... ..........._.... _.. . .... ......................._....... ................ ...- -....._ -_ L06 F OwCnery� Address c �. ..............................11.. :LG.Y.�s 1�Y 1��....._.__............................ .... '_l_'•' ----'-•'•�-f-�t.{lYY Nc t s!.-•-------......_....................... Installer 6 Address Type of BuildingSize Lot._._�.....................Sq. feet .. Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) "4 Other—Type T e of Building .._. No. of ersons____________________________ Showers W YP g ------------------------ P ( ) — Cafeteria ( ) a' Other fixtures ..._.....-_.a 3,2-..--.--•-------------------------•--------.._._........_..-------••----•-•----...................... Design Flow............... gallons per.pfser-per day. Total ily flow.._.........-.3� _.......__.......�allons. WSeptic Tank—Liquid capacity gallons Length. .�P_.n... WidthJ'_F14`__ Diameter................ x Disposal Trench—No..................... Width.................... Total Length............ Total leaching area.--__.``.��____.......sq. ft. o 3 Seepage Pit No...... ............. Diameter.....rZ'...... Depth below inlet-�°. ....... Total leaching areaZrT.��..sq. ft. z Other Distribution box ( Dosing tank ) '~ Percolation Test Results Performed by....__.. '- -- .....-.........er.................. Date.....ZPIS�I�7........ a Test Pit No. I.-I.C.2 _.minutes per inch Depth of Test Pit...16]Q...... Depth to ground water....A)CWE.. LY4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ............................................................... O Description of Soil....... Yx_. 7.3 . V ........... ....•-•--.--.--......._._......__.....-••-------------- -...... •-••-•-------- _------_.....--------- ----- -_-----------•---------•------------..••••-•-•- -•--. ---------- VW •-----------------------------------------------•---•-----•-------------•-------------•-•----------.--...---------..------......-----...---••-----._._.._..-•----.....-•---..._._......._....._.._•_.... Nature of Repairs or Alterations—Answer when applicable....................................................................................:.......... -------------•-------•-•----•--......-----------•-•--------•---•---•---..._...._----••••••••••------•-----._._...-••---•••-•••-•---......_..----------•.....---.._.__...-----••---...-----••.........__. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of::ITL; 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has beep,issue, the board of health. Signed. ...... �6 -. � .... Date Application Approved BY Lo i.y. -=^s,............................. ----........ r.l- ..^.. /...._ Date Application Disapproved for the following reasons:............................................................................................................ -.. ...--•--....-----•-•--•------•..................•---••-------•-•----........----.............--------......--•---•---•--•----------•-------•-•---------._......--••-----...•--...•-----................_ Date Permit No........ ')-O./a....................• Issued-----•------....._..--•-•-••------•---.... ..... Date a© f THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .... .OF............ �t2�1.. r ........ a. Appliration for Disposal Works Tonstrurtion Permit Application is hereby made for a Permit to Construct (X ) or Repair ( ) an Individual Sewage Disposal System at: L-62,7- ................_........_........._..... ._.._........ --•--•---•-----.............._. _... . ..... �---•--••......-......••-•--••----•--- .............._.......................... fl Location-Addrorss ......................_.. f ! ......•- Gt ... ` =". •--------•- •----1\ .................... f-._ ......�...`_....................._...... Address ,w.l t�_-!�/ll/_S/ `l�! .---•-•-•-----•-----•----... ................................./ i/c fit rat 5... ............ Installer l AddressQ� ` Type of Building Size Lot....�......................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building No. of persons............................ Showers W YP g •-----------------•--------- P ( ) — Cafeteria ( ) aOther fixtures .....---------------------------------F. _.--•---••--....-•--------------------------••--------•----•-------.......................--•--•---_.. Q W Design Flow...............IZ.�a..................gallons per.per-son-pfer day. Total d�ily�flow..._......._a�_.3 _._... ... .........gallons. � Septic Tank—Liquid capacityl-`T�� .gallons Length.�-�_`_. ..._.. Width! ./e..... Diameter................ Depth`_�....�/...... Disposal Trench—No......... ..... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No------ ------------- Diameter..... ...... Depth below inlet-�.:S__..._.. Total leaching areal`{.S7....sq. ft. Z Other Distribution box (IV Dosing tank ) Percolation Test Results Performed by....._.e.. ... .......... .................. Date..... ..�� �7 a Test Pit No. 1 4.7......minutes per inch Depth of Test Pit--- P-X)...... Depth to ground water... fit Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water...............0........ 3 Description of Soil.....__;..___�_._!_r?...__:_.._7.....x� ........................... . U -•--------•-•-•-----------•-•--------------------------------------- •------- •-------- _----------- •-------------------------------- -------------- ........... .......... __•---_----•---- W UNature of Repairs or Alterations—Answer when applicable................................................................................................ ....----•--------------•----••-•---•---------------------.....-..............---•--.....---....................---------........-•----------------------•--•------•---•-------•--------•-••---........-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLEE 5 of the State Sanitary Code — The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been,issued --by the board of health. Signed----• .V GA....4O` ............................................ '�... l�:......... Date Application Approved By.............. .....--=:...................-•-•-------•-- ----•-•-- D17.^.��. Application Disapproved for the following reasons:.........................-................................................................... a•_.........._.. ---........-•...............................•--------------.....-----........-----------------.........--I---------------------------------------•----------•----•----------------------................. Date PermitNo........ � -------------------- Issued_.-----.....------------•. ^•- .�.... .._....-----•-- ---......... Dam m.>-.—..-------------I ..-------F_re. --------- ..>r. -------------------. THE COMMONWEALTH OF MASSACHUSETTS �._ BOARD OF HEALTH C//cif..i..ILc-......oF...............Ar?- ...................................... Trrtifiratp of Tomplittnrr THIS IS TO CE TIF That the Individual Sewage Disposal System constructed (-) or Repaired ( ) by--------------------- ` .:. ._. :. .......----.� . _C.aAa ..... ._._..._._.ate..............-----......------.....------...-- U Q .�, Installer el has been installed in saccordance with the provisions of TITLE, 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No........� j2/�..... dated............... ................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE FUNCTION SATISFACTORY. DATE--WILL..FV '--..1_ra._.-`-C. . • • . Inspector. �, ----- ------ -_a_-.---- t-.,__---- --- .--,_-•__>_--_-------_-_- -__--__.._�. t -----------_- - THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTO/H� ^� 91'�.+fil. OF..-----.... 1' -7!r�/ / .................................. - No..72'AQ6._ Fn.. �t�c)__........ Disposal Works Tonotrnrtion Permit r Permission is hereby granted---------. . = w r! . --------------------------------•----•--------------..-._--._--•---•----.-.--__--•--•-•-•--- to Construct or Repair ( ) an Individual Sewage Disposal System at No..................... -'"f �_ ... c►. ,! t�1 tPa!'_ •{,t.....-- .....•---------- rh.±-----_J,4...,,.. :.! . Street as shown on the application for Disposal Works Construction Permit No�/c.; 0,/, Dated........................................... •.............•----....------ �3-.................................................... V r DATE------------- 7.- Board of Flealth:!�' -•-----------------------••---•. - cS N LEGEND ® —— 98 —— EXISTING CONTOUR 134 PROPOSED CONTOUR x 100.98 EXISTING SPOT GRADE `O U UNDERGROUND WIRES rnDrr�Ncs Ra CL W EXISTING WATER SERVICE LA DERUY UK. ® TEST PIT V Oa0 BENCHMARK 0 o � PEROWFARY m LOCUS 2 pp p2 APPALOOSA J 3Q WAY x 10 4.9 2 � x 103,4'3 HOLDER E RO' PREAKNESS JOE THOMPSON \ \'l0 WA \ LOCUS MAP x 98.7 A \ � NOT TO SCALE I 1\ \\ — \" E \\✓� 5�' �C, -30 N\ -goo oo' LOT 149 94.91 x \ \ M BLU 174 001 057 EXISTING LEACH PIT \•`,103 S.F.t TO BE PUMPED, FILLED WITH SAND AND 95,80 �I VENT '� SP� W � 103.38 x ABANDONED. 1 0 �-- ,.. EXISTING SEPTIC TANK x t S \ TOP OF TANK, EL.=94.13 O —9 �\ INV.(OUT)=92.80(VERIFY) SHED o ,09 - BENCHMARK OUTSIDE CORNER o x 96,57�\\ TP-1 x 9BRICK WALK OF BOTTOM STEP po 19 \ x !� / x 99,68 EL.=96.63 O ' ) 11 TP-2 5.07 Z �►{ � J — o — II � 9 \ — x 98,55 STRIPOUT UNSUITABLE I m 1 SOILS ASSOCIATED WITH �, J o �0 EXISTING LEACH PIT m SEE NOTE 11, SHEET 2) x 98.74 cn�� 97. 7 STM 94.47 BM + 96,1 99.84 0 96,63 x lOQ \ �l x J =-•_-_ = 100,84 x 100,)\3 0 s ,_ ECK -F 95,62/ • \ XI-9"8.5 96.18 \ � x 96,34 \ O \ O CBN � � STAIRS .EXISTING 1C0,56 \ \ rn� o HOUSE (#10) \ wo I �r �\ P o 97.08 T.O.F.=101.86.t 705 \\ -98—- / N .�P SHED — \ . 101,12 o I o 99,40 100,96<_: " :; o 101.52 p I , r C x x 101.21 Q • � I J 1 p ( x 100,59 x 100.85 WALK 1 100.46 ti CB x 101.16 I 182 DRIVEWAY; --�\ x l ' 100.21 SHRUBS x 102.50\ 100,05 \ 103.43 \ LAM \ x 001 \ \ L=114.22' 106.33 R=559.74 ' 99.52 102.99 / \ 96.91 104.14 98.79 EDGE OF PAVEMENT 100,46 103.52 102,59 a ON WAY OF MASf9c PERCHE Pam\ o PETER T. yG� MC:ENTEE CIVIL No. 35109 PROPOSED SEPTIC SYSTEM UPGRADE PLAN 10 PERCHERON WAY, WEST BARNSTABLE, MA Ip NG ` Prepared for: Richard Ruggerio, 10 Percheron Way, West Barnstable, MA 02668 (0,�l Engineering by: SCALE DRAWN JOB. NO.OWNER OF RECORD RUGGEIERO, RICHARD J & VIRGINIA C Engineering ineerin Works, Inc. 1"=20' P.T.M. 153-16 10 PERCHERON WAY 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. WEST BARNSTABLE, MA 02668 (508) 477-5313 6/2/16 P.T.M. 1 Of 2 NOTE: TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE < EL.92.3 FOR A DISTANCE OF 15' AROUND THE SEPTIC TANK PERIMETER OF THE S.A.S. INSTALL RISERS & COVERS OVER INLET & PROPOSED D-BOX PROPOSED S.A.S. OUTLET AND SET TO 6" OF FINISH GRADE INSTALL RISER & COVER INSTALL RISER & COVER OVER ONE CHAMBER (MIN.) AND T.O.F. SET TO 6" OF GRADE SET TO 3' OF F.G. TO SERVE AS INSPECTION PORT " F.G. EL.=96.8t F.G. EL.=96.2t F.G. EL.=95.6t F.G. EL.=96.0 to 97.9t VENT L = 29' L = 13' S=1% (MIN.) p S=1% (MIN.) 2" LAYER OF 1/8" TO 1/2"4"SCH40 PVC 4"SCH40 PVC 6" DOUBLE WASHED STONE to"I . 6 aBaSaaa (OR APPROVED FILTER FABRIC) '. 4" 24" 6363 a EXISTING 48" LIQUID INV.=92.80t EFF. DEPTH aaaaaaB ---3/4" TO 1-1/2" DOUBLE LEVEL 4' 4.8' 4' WASHED STONE GAS BnFFLE INV.=92.00 INV.=91.83 PROPOSED D-BOX EFFECTIVE WIDTH = 12.8' EXISTING SEPTIC TANK INV.=91.70 2-500 GALLON LEACHING CHAMBERS SURROUNDED WITH STONE AS SHOWN _ H-20 RATED NOTES: TOP CONC. ELEV.=92.8 I 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE BREAKOUT ELEV.=92.30 7 EV EL .=91. 0 ease INVERTS, PRIOR TO INSTALLATION. INV. aaaa eases eases 2) D-BOX SHALL BE SET LEVEL & TRUE TO GRADE aaaa aaaaa ON A MECHANICALLY COMPACTED 6" CRUSHED BOTTOM ELEV.=89.70 fF 4' STONE BASE, AS SPECIFIED IN 310 CM 4' 2 X 8.5'=17.0'R 15.221(2). 4' OF NATURALLY OCCURRING EFFECTIVE LENGTH = 25.0' 3) INSTALL INLET & OUTLET TEES AS REQUIRED. I PERVIOUS MATERIAL 4) CONTRACTOR SHALL INSTALL AN APPROVED EFFLUENT 5' (MIN.) ABOVE G.W. FILTER ON THE OUTLET TEE. BOTTOM OF TP-1, EL=84.7 - 11EACHING SYSTEM SECTION SEPTIC SYSTEM PROFILE N.T.S. GENERAL NOTES: SOIL LOG 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL SOIL EVALUATOR: PETER McENTEE PE (SE#1542) BOARD OF HEALTH AND THE DESIGN ENGINEER. DATE: JANUARY 26, 2013 (REF P#15,056) 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS WITNESS: DAVID STANTON R.S. HEALTH AGENT OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE LOCAL RULES .AND REGULATIONS, EXCEPT AS REQUESTED BELOW: ELEV. TP-1 DEPTH ELEv. TP-2 DEPTH ELEv. TP-3 DEPTH -310 CMR 15.405(1)(b): 95.7 A 0" 94.3 A 011 97.5 A 0" 1) A 3' variance to the 3' maximum cover requirement, for SANDY LOAM SANDY LOAM LOAMY SAND up to 4' max. cover. S.A.S. shall be H-20 and vented. 10YR 4/2 10YR 4/2 10YR 4/2 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR 95.2 B 6" 93.8 B 6" 97.0 B 6" TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE SANDY LOAM SILT LOAM LOAMY SAND DESIGN ENGINEER. 10YR 5/4 10YR 5/3 10YR 5/8 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING 93.7 24 91.3 36" _ _FROM THOSE SHOWN-HEREON-SHALL-BE-REPORTED TO THE DESIGN SILT C1 C - - 94-5.. _ _. 36" ENGINEER BEFORE CONSTRUCTION CONTINUES. 10YR L�/3 AM C PERC 5. ALL ELEVATIONS BASED ON AN ASSUMED DATUM. (UNSUITABLE) 36"/54' 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF 91.7 _C2 48 SILT LOAM F THE CONTRACTOR OR OWNER TO NOTI:= FINE SANDY THE LOCAL BOARD OF 5Y 5/3 FINE 6/6 2.5Y 6/6 HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. (UNSUITABLE) 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. / F-C SAND 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S. ✓ 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS 84.7 132" 86.3 96" 85.5 144" AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE PERC RATE 2 MIN/IN. ("C2" HORIZON TP-1 & "C" HORIZON TP-3) DIRECTED BY THE APPROVING AUTHORITIES. 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY NO GROUNDWATER ENCOUNTERED THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING CONSTRUCTION. 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE / SOILS IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE VE130 S.A.S. AND REPLACE WITH SAND AS SPECIFIED IN 310 CMR 255(3). ® ®E3®® 37„ 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE ; 3INSPECTED BY > CERTIFIED SOIL EVALUATOF' PRIOR TO BACKFILL. 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND Z IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY. 102" 4" KNOCKOUT D'SIGN CRITERIA / 20" DIA. COVER NUMBER OF BEDROOMS: 3 BEDROOMS ✓ 4" KNOCKOUT / 4" KNOCKOUT 58" SOIL TEXTURAL CLASS: CLASS 1 0 DESIGN PERCOLATION RATE: 2 MIN/IN DAILY FLOW: 330 G.P.D. 4" KNOCKOUT DESIGN FLOW: 330 G.P.D. GARBAGE GRINDER: NO EXISTING SEPTIC TANK: 1000 GALLON CAPACITY 500 GALLON CAPACITY, H-20 LOADING PROPOSED DISTRIBUTION BOX: 1 OUTLET, 3 INLETS (H-20) CHAMBERS LEACHING AREA REQUIRED: (330 GPD) = 445.9 SF N.T.S. .74 GPD/SF USE 2-500 GALLON LEACHING CHAMBERS IN SERIES PROPOSED SEPTIC SYSTEM UPGRADE PLAN SURROUNDED BY DOUBLE WASHED STONE ON ALL SIDES 10 PERCHERON WAY, WEST BARNSTABLE, MA SIDEWALL AREA: 2(12.8' + 25.0') X 2 = 151.2 S.F. Prepared for: Richard Ruggerio, 10 Percheron Way, West Barnstable, MA 02668 BOTTOM AREA: 12.8' x 25.0' = 320.0 S.F. Engineering by: SCALE DRAWN JOB. NO. TOTAL AREA:..............................................................471.2 S.F. ✓ Engineering Works, Inc. N.T.S. P.T.M. 153-16 DESIGN FLOW PROVIDED: 0.74 GPD/SF(471.2 SF) = 348.7 GPD 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. (508) 477-5313 6/2/16 P.T.M. 2 Of 2 Y - +s C I i i r j � EQG E ti.�t1 r n:r / - j `t�+,t-,•:. ��-"� �\ � c��� � � `emu !3G"� C'l n UA Syr N _ - S "Tr_V T t c�44T. `` T - ' 1 4fl.+b CIO { - cr�>� cov.,r� Sa�,r� t�3nS rS [ � _ r , � I t _I Z W a4;t4 Crn _ r GPO G4L USE O GAt f%71� Td t j1C_ LE AC 44 V t4 G eOTTOrA Tod o,L ck _ 1 ARNE M. y rta a FFL' rJ<_ t _ N , V.�_C �-+ ti 1_ - 4>+4Gt s_._ 4r -t_� �La)r7 G6lpe Cyr' 1r/cen1ri lnG _ 119 ! �I-11LEt-46 hlE e-S -- r PATE A DATE 14,9 G .r.