Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0070 POINT HILL ROAD - Health
70 Point Hill Road Q W. Barnstable P A = 136 030 e iJ J1 a UPC 12034 Wo.2. 53LBE "STINGS,UN � � ._� ,� 3 -` ka��T!,b *�rl. � � '!r'.�.Y'}� �.. T4♦.i... �yM � t A �! �j :e' t.. � t F .M:t t ''' .°. ..S ri:� :sr 1 T( { � t - - Fy_ f�a >`aft ` .•�r.$�! ft y t • r.a'{ •yw3':fit '�.. '`t` £ :� �. •'-. + ?' - w« s tt,� 4 ^!'!' 'S,� - r3 la 'dt •` �h S> j^)) L'4•t r, 2 th r. wx�'^ +t ' d "f ry,,, i' +. v Iy ♦ "t � l b '+.• '�` i - r'x �.,• at.., r' a L f" �.r ,•,,:f J� r k+v i� �'r 3 r '. .'. , T. ,{.b �". �+:. J�. ',.1�''.�'t Lf: y ..t'^p: ?t'a f'. '�..'.x �> 7 .. '�-Ys '`•v r , +: sd;. �•= - t arixt•r 's >,t. ' r�'•r _ . ° � '•. <� ,y �' � a`t 1 '' s `+. ' .`.', t. ,t�+�•, -as p•� a sv.`-,t �,1 fyy � '"�.. .:. �.� ♦ r 4i k y;#a3 ,a _-, !� � .e-'' ..•gin �"xf. r: t r.,�" N�, '^,.^+d ��.r t f � ,c ,�y'•k� �+ -, �_sS�},a� K •".F x .+e C ,. t y t.. f, �,� e.... •^!�' s• S� 1y 'f Vr "Y{ An er<. 'it �- 4 '�s a r j�.� f,4. _, �� r.8r •i '.�1t } _ '"�. ,i.+ q� •. +`4.p �'SIp ••f i ' t�•,.'�.ay,s )�� +',sY � x :'.�" l,g�..: � ("1..� .Y,,.• 'r Pam :t Y r ,,`xA` g! x�`� „ ,� .ys.r �b >.'. r`r, '�tm` i.,uy �.^q.� .:�,i .,at, - „ $.r'L• u°i { �++ '� �..vt 'T ti' � { i. � p �`v•�''S, 4'y.1'1• u+#,:w. •M •Fi nti,2'S rr. xrf:•• '':s „ >',¢ 'twi •i t a f1' `.f` r ¢ ed`. i` s F `� a y. •.a;, :+ .L j. Rt- h i•a'. ".,�`; t•y s L.}Jd r.. x,.' r. � ? 5^� .. .vim �t�, ,y_r.T 2Nw• 14�i'tr i:. "'x r1 s.,r h , -fA r a.Y 'ti 1+. �`i�. !': rt i t t ; ��rr„..* .�r :✓ '7a.'4, +rat a,,,t i � %ra ri,• .rr # ( '7` f•.1+Y i r `r i 7 1ix'' r `* ttp,"'k -rf^i v� 2� Ynr ..vr rc�. a'tk-f A 4..� :i t,t ^; t �;:� i` F... i� „�,.• frl^*�J,k �3 r., 7- � w ?.r 'i try x� T' -•? a '.r �j �..- �r .�'., : �rS+.x. ^. 'r °f r � i �i r•Y S ;.qt �_ r}} Jt, t*.+ tt 1 w ,Kt- t� .+- yS•r?� � ys+'J'r3 ..° ^'ZY�`-'. '�yr""'� +t `i 5`f.,"4±i .,�� 4 x.:i.�, �t }i >i 3+� 4r,�>.: �, v" ; bt ^ ♦ "� S ~ j r _ `rt e*`: i�','f's r. k`z T s tb.:{i+ .3�$ ♦ � t np, r �i:x ! } "; ss 14 At +a' f i 4 r'cv r "*r6 ii i r.. s. lt� p •r � r k .,ity i reT's i � '...t � i. avert i ✓' ��ti N tyf ,r1 k ey, S. �•r�t :,s � ra 5..� �.• yKa .••�' Q a.i.r , c _t1'C"(£d+ -.. � i `• ��.- • n• r �^'^ n - •'•.. t TC,7i,f�,, �•- �``� x Y !t •?r�t`,{ �+�,. 't„c -ic�.y� 3r � t'.�. ,y`'.y..C+1� +C�' '� �^�i �*tsq�`z•r "t r K�" J�S`i ",y •' t f ... ,•f- 3 S/e-, sr v y.. q «f �. ¢ -, �:.;i: ;.'` a ,M1 L t r• ° f '' t +1 4ter.,� ^="*`.'• jt t,,.t -f t } !y r 6;s`'• ' .�; Ti.i...wd\ - j '}_{,T i `W.yk: > z'A a`t r T ,��x 4 �7 4*.$�� ,'.�3� } •�„�' :r t :�:h + ��} � �- k�,r�c �� � �'�':><.cam"r":t+R .�ry��r� <� r ,; t ��• ,'sc'+" t t,��^3 ,r �a' �,, @ +?�r° w r ,t •-e 9: .Rf� �. t, '° !� t� dui �Y "F(z't � k#�.tr Y��-' y ,,,� �c r"��+ .d!{t �f '' r�3 i'q',. r s'-`a r ,.t+ .ss.� }' �S y,"i r! , < d1 't'f,;' ih'',.. '+ �:}., •z � r,,'�'.l♦ ^.tr,•�y t ti i spy;••�.,n ,,,'�d,.Y e �r-•tix. ' r a• Jt:r�!• r�:- ? �•j, C V.. £s�» y.Y a✓"` ;.. W 1 :x:' t t �# 'fip # t_ '�-g..;.�r f't x.a'y RY'f-.. sp r�.+�.`. i -r- J•x },. . K{: > m. rt •e ..,rl,a.�tr,*r"r 3 + .s$ x9; 'S'£Sr'' `- �' ` •�y + r t:"' i.* l�� t C l..aS. ;•j.. Sys c. •`- r-'' e. ' w k i • +?^:. r 1 x s�fipr(�,,,y r tit4i.f0.r i'i^f ,�t� 7 fir.' .R.� f '�yii b"T shy ?f--'G. +•V a, �1 ''�f r .`R1 z .r !` T'� `` .1z�y `Y•, 4 `„ +'d +t�" t ySh S 4s. ,.t,. .t` '�+`.' •�.? r �t'"E. ,.3 dk r ,}" '"' � y , t t 1 e; tiv 7�y Lt a'i. yr, Y.i• t• K. " e tN S ..' 1 f" «�". •t`'' � 1 v ' .bt. ,. tt '�"' [i.'t� Z.# '`�y.� .!w�,7:t" r :-,ns 'ts` t x • C +MC •3..•kh 2 ;. r e1 r, Tr ti:•r'w r 4 r r v f fr q 'ttY-.� S J'b� j+..Y °`' 'r''r^ sst t.w a s �r«• � 1",."r� "^� .: F>t }.,k ¢« ar#-`.•• F b !' 7 ..t } a }Y 2ir �� 'r# rls!y + Ret 't` a �,r 9b r ', w ,�; S•y s'- , i ar .t r. 's • bx C ,g ';,; .lah t t .� s {r' a f ''s ',•a mi 14, ,,• R i• , �° �: i :� '} �t �'� ay,4 .;� . h,• +rjg 7 a,. tt�,�13�` f - ,.�,! r''t w'? - .pfcr t.`Y.r'" 'ri .dT y 1 ,f .t 4 c�}e}. e,�w> r +•+�. �,. �- y.s: s ^x ^ .t#.xr s r c�, r Ip.�+�''� �. y.t^"",t s r} . •� i t fi +' , x ,�, '�` r � u !a 4' t . . ..�, a e`.t «„ '.,s. a 1 �.tr�` .. f �"`•r � att��'� •�`r i. ��.,k�rr .tF ���- iZ} h, fc �r •,rt. iS �•� i�> -5 Xrt'�. �,. .. .i i r an s! 1 ?;e rly ,f+f't' \ 1-'i'• i st.,.i }.its# in,". A .i+`r�4'1. �i, t ., s .z .� �y� r * : t.,S i r c ''' ,v� ' r �4• i.Ln «.r Fl y.. 4iW Y;1, +... a �r+^. ' �tr Y• M.t�"^x :fr t �'� r ��tir .r «• R �.. t f t '^ A s+. a...,',S!t tt qt � ,`'3'.'` .•, v„r�,�` ,,, � y ""...Tx>i-° i~ �`b Ai.�" T �"";a� k r � s d' '� � t. �, s..i s t ,,. �•~ ,s,t R t s -� r 4 � ?.`"a s $ `S t,`t^'.i 'S t r.. t►,•?"r►�' -, -'r^'iy� } >M T t. x sf i� r s. .r !"x 4� ,v c ,, a .,r r Yti �J *:� ... .y�� t :.t v t t 1� ss � '-'�• ..+wf�"�: J� ,` t r`nif y,i� y�;� i� y}`te ' ^ 7 r.'.t r t r ft•f..iv'x S k� s.. ! 1 rsig, w+v r.j t x�i'ru r f 'r x ' 's � y -�f x� a ;. .a�>a fi' '•.-.' 4 - } * t.. txFtt o 4 i ° - s 7 stx r;3 ti f-r 4S.. a K t;• x k ee u_ T - - !i i Z• gjr' F r,� ..- w.. .a `pn• r.. .•.r• r sY t y+ ray .-, 3,r :. r a'>r•vY /,i 1' .t�. 'n?'�y'. ;,� 4 t t -. ar r ''..r* �� ��'t 4r..'* rah+ #$ � 'Lgs �N r s t y t'...�6 r +'•:rt >tv Z-.. kK - Cr tr yaQ�3 'tat- a .. t r ��'7+�,•A rK"'d 3�s r ^ ��.Y.-,: n i�. � ri� kt p. .t C S• } � nry. -f`-r t + :1•` t r.!• � t w r y SS£.' ir+ d � f ,t �ra• i° 'yu mp a•, x "•1 i •,!:.r A E i .f ,�.# k .�t x} ,ltir .4 27f' v.� 1.,., `i,�•; a ' `•,t 4 F�.,{[�� , '} !_r ti t ^ .r �tr"`!w�•« F'-'#>'K�T. t z. r��' fai�w, a ..r <�!fy`d . i.y� �,,,M1,• �¢, �. Sc 1;1 ,'s -j't'r ts,`��.�1 �ht t5 w � � �' ` L�-' ^�' a st •`s � t �`��^R�-! z .:.• .. .d. '>� � ar`�r•. ; F:y�Xtt.+ 1 f.(f i.`l`� r`A�'a 4a � S.S.i `� '��fYM}F �i>tµ )1•t �� h 77 y •'�I d -.+t�'�. 3.'�+�,.,s*�•'fn .y. "a"`''z._ -+,M"'si !''3, sy[ #' •kw -rt#i+ 4Y•'• t r �. r o t•` r ".f � r•% .+iw :S a '�. 'r it 1y •,.�a� a ;•r `` x y r! rb +° �+ « i.�t:�f + }a .�7 •" 1 11iCy 4. °t K^�t4" r r ,I � S;• k° r+ir. t� }�,a r?. `t* S".�• T ' t. "4'# 1'fa v rr .Y ";�T •' a r 's.`.. f '1 1` .."' 1' ^`i k�•w4.e tt"-�'• "a ` '''9 !.. b t i y r !" a .b .. ;7 r 1, n a M. r f as x•, ••A.!'?•4 �,4 c. a ;ti. r `7, f ' Y'av�.._ � - � C�w.r.rk� e � Xt•r r @ €•�s tex _rfv ��'�`j, �� �!.:, s •!^ r:• t' 1 `tK ,Z•,�'a x r t sf.. -:� re rt zl r � � i.Y'� ♦n„•>v � r•s t t.� S •>,� i. e"' r.. r +s. '{"a'Ry % ' -Yt T,���,_�'� -� aS r•s Z: �"� c 6, c ales. "#•Y��.A• #"�`xf":r,.t +- 4 ty Asa M* `}"�,s Sr t"' r�c.� f., � �."x �.''rf k�*�•F �� ����� �. #.J�"'�,} �-rK� t� .�°4 •..rX� Sr:,' � 1 `�� '.�s^ "r �T'. rye ` '''D` y � =ie' '°� -�� t ,i "r r•w +f i• 's ''fr,. 'K�rr �' r,� f .',.. r rF 4 !'• s " T F '"JS �f wr •e_ R ..� re -S�. t .3..t •cam ✓ k ..3"tti ar, _ t5 °. +. - • � `r w.T,t � r: t •i,k?: t � ��-�v� �+ �e�f.,x�y C.l k{. f = �6i 1�r• ` tf S--,M°` C �`.!^ r i 7k#. .:'� + 4 r #� s r• y+k t�,,•l � �. r Y. t "% ,t"v TL-1 t ,..� � y A.yri,T� ,e mr•� � ,?� , .`'r.i •^ ,,•, rt 4+Y , w:y r � ,• Y fay f �!A-AS, ,',t.�. .�` _ ��T ,i .. � � - r f ,' 'f � r" -.� .x,r r k'• "Ca"�, t i'.'. vle- `•}t't vr� -... . a'• ♦ �., - •-,T.,.11 it tea.•v `4'yra.x• Commonwealth of Massachusetts .. . .Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments ,M 70 Point Hill Rd. Property Address:. Charles Mueller Owner: Owner's Name information is W Barnstable 4 Ma. 02668 4/5/13 required for every page. City/Town State Zip Code. Date of Inspection - Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms on the computer; .,use only the tab..::,: 1. Inspector: key to move your cursor-do not... Ricky Wright Use the return: key. Name of Inspector - B & B Excavation;Inc. r�= Company Name 14 Teaberry Lane - Company Address. Forestdale ....... MA::. 02644 City/Town State Zip Code 508-477-0653 S 14595 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:ThpjnspEjon was performed based,on my training and experience.in the proper function and maintenance 6f on As sewage disposal systems. I am a:DEP_... g p y approved system inspector pursuant to Section 161IS40 o s Title 5 (310 CMR 15:000). The:system: r,j._ rh 0 Passes. ❑ Conditionally Passes ❑ .Fails El Needs Further Evaluation by the Local Approving Authority 4/5/13 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 bei sent to the system owner and copies sent to the buyer, if applicable, and the approvirig authority..:.. .. ****This report only describes conditions at the time.of inspection and under the conditions of use at that time..This inspection does.not address how.the system.will perform in the future under the same or different:conditions.of use. t5ins•11/10::: Title 5 Official Inspection Form:P. urf.ae Sewage Disposal System:-Page 1 of 17. Commonwealth of Massachusetts v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 70 Point Hill Rd. Property Address Charles Mueller Owner Owner's Name information is required for every W Barnstable Ma. 02668 4/5/13 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: 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-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 70 Point Hill Rd. Property Address Charles Mueller Owner Owner's Name information is required for every W Barnstable Ma. 02668 4/5/13 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 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 or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N FIND (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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 tN Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 70 Point Hill Rd. Property Address Charles Mueller Owner Owner's Name information is required for every W Barnstable Ma. 02668 4/5/13 page. CityrTown 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 Y day flow t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 70 Point Hill Rd. Property Address Charles Mueller Owner Owner's Name information is required for every W Barnstable Ma. 02668 4/5/13 page. CitylTown 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- 1 0,000g pd. ❑ ® 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•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts _. ...:Title. 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments M 70 Point Hill Rd. Property Address p. Charles Mueller ..Owner: Owner's Name .. information is W Barnstable 6 Ma. 02668 4/5/13 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 ❑ [K Were:any of the:system co mponents:pumped out in the previous two weeks? ... p Has the system received normal flows;in the revious two week period'? I Have large volumes of water been introduced to the system recently or as part of this inspection? b. ....... _.. . Were:as built.plans of the:system:obtained and:exam ined?(If they:were not.::: . available note as N/A) Z El Was the.facility or dwelling inspected for.signs of sewage back up? Z El Was the site inspected for signs of break out? ® El. Were all system components, excluding the SAS, located on site?. . .. .... .... .... ® El Were the septic tank manholes uncovered, :opened, and the interior of the tank inspected for the condii.tion 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 p El ® 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: ® El Existing information. For example, a plan at the Board:of Health. 1:1 ® Determined in the field(if any of the failure criteria related to. Part C is at issue approximation of distance is unacceptable) [310 CIVIR 15.302(5)J D. System Information Residential-Flow Conditions: ..Number of bedrooms(desig:n):: 4;;; Number of bedrooms(actual.);; 3 DESIGN flow based.on 310 CMR 15.203.(for example: 110 gpd x#of bedrooms). 457gpd t5ins•1!/10_ 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 M 70 Point Hill Rd. Property Address Charles Mueller Owner- Owner's Name information is required for every W Barnstable Ma. 02668 4/5/13 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d n/a 9 ( Y 9 (gP ))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Fall 2012Date 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: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 70 Point Hill Rd. Property Address Charles Mueller Owner Owner's Name information is required for every W Barnstable Ma. 02668 4/5/13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 70 Point Hill Rd. Property Address Charles Mueller Owner Owner's Name information is required for every W Barnstable Ma. 02668 4/5/13 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: 20 years est. 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 ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: >20feet Comments (on condition of joints, venting, evidence of leakage, etc.): At time of inspection building sewer appeared to be in working order no sign of leakage or blockage. Septic Tank(locate on site plan): Depth below grade: 1 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: 1500 gal Sludge depth: no sludge t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 70 Point Hill Rd. Property Address Charles Mueller Owner Owner's Name information is required for every W Barnstable Ma. 02668 4/5/13 page. City/Town 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 no sludge Scum thickness no scum Distance from top of scum to top of outlet tee or baffle no scum Distance from bottom of scum to bottom of outlet tee or baffle no scum How were dimensions determined? scour stick Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): At time of inspection septic tank appears to be structurally sound. No sign of back-up. 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 70 Point Hill Rd. Property Address Charles Mueller Owner Owner's Name information is required for every W Barnstable Ma. 02668 4/5/13 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.): Tight or Holding Tank(tank mu st 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•11/10 Tide 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 M 70 Point Hill Rd. Property Address Charles Mueller Owner Owner's Name information is required for every W Barnstable Ma. 02668 4/5/13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): At time of inspection d-box appears to be in working order, no sign of carryover or deteration. 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.): Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 70 Point Hill Rd. Property Address Charles Mueller Owner Owner's Name information is required for every W Barnstable Ma. 02668 4/5/13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 2 ❑ 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.): At time of inspection leaching appears to be in working condition. No sign of hydraulic failure. Leach pits were dry at time of inspection. 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-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 r Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 70 Point Hill Rd. Property Address Charles Mueller Owner Owner's Name information is required for every W Barnstable Ma. 02668 4/5/13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 r Commonwealth of Massachusetts Title 5 Official Inspectionform . ,. a Subsurface Sewage Disposal.System:Form - Not.for Voluntary Assessments .... . ....... e 70..Poi.nt Hill ;Rd. Property Address Charles Mueller: Owner _ . Owner s Name information is required.forevery .W•Barnstable Ma.: 02668 4 5 1:3 page. City/Town State Zip Code Date of Inspection D. System Information (cost:) 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 areabelow ... El drawing attached separately POINT HILL ROAD LOCATIONS HELL OVER-OVER 150 fl TO SAS PER DESIGN PLAN. A 8 ....... _.. 1. 28 F.L.....13.5 FL....... ....... 2 . 34 Ft.:: 18.5 FL.... . 3 39 Ft. 16 Ft . EXISTING..: .. .. — .. DWELLING e T i SEPTIC a LEACH 'TANKTA ....... NK a ..0 0-6 X .. PI . .. .. .. .'LEACH .... PIT .. .. .. .. .. .. OO NOT TO SCALE f5ins•11/10 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 GSM , 70 Point Hill Rd. Property Address Charles Mueller Owner Owner's Name information is required for every W Barnstable Ma. 02668 4/5/13 page. City/Town 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: >13' 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: 6/21/82 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: Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 70 Point Hill Rd. Property Address Charles Mueller Owner Owner's Name information is required for every W Barnstable Ma. 02668 4/5/13 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-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 t Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 70 Point Hill Road Property Address Robert and Jayne Domke Owner Owner's Name information is required for /�West Barnstable MA 02668 April 21, 2007 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. a (7- Important: A. General Information When filling out [ 7G forms on the ~J computer,use 1. Inspector: only the tab key to move your David D. Coughanowr cursor-do not Name of Inspector use the return key. Eco-Tech Environmental Company Name Q 43 Triangle Circle Company Address Sandwich MA 02563 City/Town State Zip Code 508 364-0894 Pending 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 SectiohA5.340 of Title 5 (310 CMR 15.000). The system: ® Passes ' t ❑ Conditionally Passes ❑ Fails �z ❑ Needs Further Evaluation by the Local Approving Authority �,� -• April 21, 2007 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. t5-2610.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 4 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 70 Point Hill Road Property Address Robert and Jayne Domke Owner Owner's Name information is p required for West Barnstable MA 02668 April 21 2007 every 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: Inspector's Note==> A septic system is deemed to pass this Real Estate Transfer Inspection if it does not trigger any of the failure criteria listed below. The septic system has been evaluated according to the conditions observed on the day it was inspected. No estimate or guarantee of system longevity is made or implied by a passing determination. B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the ❑ for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: ❑ Observation of sewage backup or 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 ❑ obstruction is removed t5-2610.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 70 Point Hill Road Property Address Robert and Jayne Domke Owner Owner's Name information is required for West Barnstable MA 02668 April 21, 2007 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced I ND Explain: ❑ 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 ❑ obstruction is removed ND Explain: 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 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. t5-2610.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 70 Point Hill Road Property Address Robert and Jayne Domke Owner Owner's Name information is required for West Barnstable MA 02666 April 21, 2007 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ 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 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 '/2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. t5-2610.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 70 Point Hill Road Property Address Robert and Jayne Domke Owner Owner's Name information is required for West Barnstable MA 02668 April 21, 2007 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.). D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® 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 Iodated 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. t5-2610.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 70 Point Hill Road Property Address Robert and Jayne Domke Owner Owner's Name information is west Barnstable MA 02668 Aril 21 2007 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, 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)] t5-2610.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 70 Point Hill Road Property Address Robert and Jayne Domke Owner Owner's Name information is West Barnstable MA 02668 April 2007 required for P , every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 gpd Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d n/a—well in use 9 ( Y 9 (gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: currentDate 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: Last date of occupancy/use: Date Other(describe): t5-2610.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts u W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 70 Point Hill Road Property Address Robert and Jayne Domke Owner Owner's Name information is required for West Barnstable MA 02668 April 21, 2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: Owner's agent 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) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: Age:Approximately 24 years. Design plan on file with Board of Health dated 6121182. Were sewage odors detected when arriving at the site? ❑ Yes ® No t5-2610.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 r Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 70 Point Hill Road Property Address Robert and Jayne Domke Owner Owner's Name information is required for West Barnstable MA 02668 April 21 2007 every page. CityFrown State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): 3 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.): Sewer appears structurally sound with no evidence of backup or leakage into dwelling Septic Tank (locate on site plan): 1 Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 10.5 ft x 5 ft x 5 ft(1500 gallon) Sludge depth: 4 in Distance from top of sludge to bottom of outlet tee or baffle 30 in Scum thickness 0 in Distance from top of scum to top of outlet tee or baffle 10 in Distance from bottom of scum to bottom of outlet tee or baffle 14 in How were dimensions determined? Probe to top of tank t5-2610.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 70 Point Hill Road Property Address Robert and Jayne Domke Owner Owner's Name information is required for West Barnstable MA 02668 April 21 2007 every 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.): Pumping not required at this time but maintenance pumping is recommended every two years. Tank and tees appear structurally sound and functioning as intended. No evidence of leakage in or out was observed. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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): t5-2610.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 70 Point Hill Road Property Address Robert and Jayne Domke Owner Owner's Name information is required for West Barnstable MA 02668 April 21 2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank (cont.) 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 Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert At outlet invents Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box appears structurally sound with no evidence of leakage in or out. Few solids in sump. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No t5-2610.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts L W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 70 Point Hill Road Property Address Robert and Jayne Domke Owner Owner's Name information is West Barnstable MA 02668 April 21 2007 required for P every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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: Type: ® leaching pits number: 2 ❑ 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.): Soils above leaching pits appeared unsaturated. No evidence of surface ponding, breakout, lush vegetation, or other evidence of hydraulic failure was observed. A bucket of water was poured into the distribution box and was observed to pass through in a rapid and unobstructed manner, and could be heard splashing down loudly into the leach pits. t5-2610.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �^M 70 Point Hill Road Property Address Robert and Jayne Domke Owner Owner's Name information is West Barnstable MA 02668 Aril 21 2007 required for /� , every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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 Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5-2610.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 70 Point Hill Road Property Address Robert and Jayne Domke Owner Owner's Name information is required for /�west Barnstable MA 02668 April 21, 2007 every page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. POINT HILL ROAD LOCATIONS A a WELL - OVER ISO FL TO SAS PER DESIGN PLAN. 1 28 FE 13.5 f t 2 34 FE 18.5 FE 3 39 FE 16 FE EXISTING DWELLING # 7z A I a SEPTIC °� 3 LEACH TANK o ❑ D-60X O PIT z LEACH O PIT NOT TO SCALE t5-2610.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 70 Point Hill Road Property Address Robert and Jayne Domke Owner Owner's Name information is required for west Barnstable MA 02668 April 21 2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to ground water: 25+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: GIS Department records You must describe how you established the high ground water elevation: Town of Barnstable GIS Department records indicate that the property is over 25 feet above groundwater table. Design plan on file with the Board of Health shows bottom of system to be 4 feet above the bottom of a witnessed test pit in which no water was encountered. t5-2610.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 No.W;,,,o-7 -00 5 Fee---- - --- BOARD OF HEALTH TOWN OF BARNSTABLE 0(ppYication forlVerr CootructionVermit 0 Application is hereby, made or a perjnit to Construct ( ), Alter ( ), or Repa' an individual Well at- Location — Address Assessors Map and Parcel -A, r'-'j-�-�-- - ------ Owner ----•-----Address —_—____ ------------------------- ._-------------------- ---------- _ Installer — Driller — Address Type of Building Dwelling A �l-�, 1• - ---------- Other - Type of Building---__—__—______ No. of Persons-- ----.-.----.---.-- Type of Well �4611 ��(' --- —---- 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 Certificate .of Compliance has been issued by the Board of Health. Signed �GtJ - __-- --- -- — ------ date Application Approved By— r`�� 1— 3 - 17 -0 7 date Application Disapproved for the following reasons: [ ) © D date Permit No. "" a® __ 005 Issued----3--- ------------------------------------ date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate ®f Compliance THIS IS TO CERTIFY, That the I dividual Well Constructed ( ), Altered ( ), or Repaired (.14-' --------------- Installer at-.-'2'c � --_ ------------------------- -- __ - ---- - has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. -----------------Dated--------.------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE--- - - Inspector—__- ------------ ------------ No. -�°'�-Di)�—-005- Fee---------�j-- ------ BOARD OF HEALTH TOWN OF BARNSTABLE t 0pp[icat ion-for Ve[[ CongtructionVrrmit Application is hereby made for a permit to Construct ( ), Alter ( ), or Repak(k")an-individual Well at: Location — Address Assessors Map and Parcel _- - --- -------------- Address _ ! i d.-ifer - + � �t -- -------------------------------------------------------------------------- — Driller �� Address Type of Building f Dwelling---�=��t�-�,r� - --------- ------------- Other - Type of Building---_____—_____________ No. of Persons-------------------------__—__._________ Type of Well_l�l�����---------- Purpose of Well------f> �l ----------- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until a Certificate .of Compliance has been issued by the Board of Health. Signed &44 -- 1 ------------- --- - ------- date Application Approved By -----------— 3 - z z -07 date Application Disapproved for the following reasons: date Permit No. a 00 00 S — ---- Issued----3-- --- date ►_________________________________._____ —________—_____—___—_. BOARD OF HEALTH TOWN OF BARNSTABLE C ertif irate ®f Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired (i,')" I s alley has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. -----------____________Dated-------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. --�-' - DATE------- -- - --- Inspector------------------------------------------ - --s-saa-----------M----ss- ---Ne--a-.----a-sa-a-a-o-.--a----------a----- -------- BOARD OF HEALTH TOWN OF BARNSTABLE Vet[ Congtruct ion Permit s No. :�GU_7--0G Fee. (-�- ---__ Permission is hereby granted t _r,✓ --- -- -- -- a to Construct ( ), Alter ( ), or Repair (kof';-an Individual Well at: No. — —� 1 L / G- " A! "='1---- ---- -- ----------------------------------------------- — Street as shown on the application for a Well Construction Permit No.- 2, D p7 ` bO j --- ----- Dated------- -- - - - -- - - - -- ------- DATE-3 " z i- -.... - 7 Board of Health _ `� �----- I. COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS o DEPARTMENT OF ENVIRONMENTAL P izO E.r�; RECOVER �N,H SJ0 /� 350 MAIN STREET AUG 2 3 2003 /"� WEST YARMOUTH,MA ^_ 508-775-2800 TOWN OF BARNSTABLE HEALTH DEPT. TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A f CERTIFICATION MAP MAP 136 PAR 30 Property Address: 70 POINT HILL ROAD PARCEL WEST BARNSTABLE,MA 02668 LOT Owner's Name: CAPUTI,NANCY Owner's Address: 62 LONGVI•EW DRIVE LONGMEADOW,MA 01106 Date of Inspection JULY 28,2003 Name of Inspector: (please print) JAMES D.SEARS Company Name: A&B Canco Mailing Address: 350 Main Street West Yarmouth,MA 02673 Telephone Number: 508-775-2800 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the infonmation reported below is true,accurate and complete as of the time of the inspection. The inspection was perfonmed 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 Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: The system inspector shall su mit a c�ofnspection re��lport 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 tot he buyer, if applicable,and the approving authority. Notes and Continents ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 1 Page 2 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 70 PINT HILL ROAD WEST BARNSTABLE,MA 02668 Owner: CAPUTI,NANCY Date of Inspection: JULY 28,2003 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ✓ 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: N/A One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined" please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or 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 obstruction is removed distribution box is leveled or replaced ND explain: 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 obstruction is removed ND explain: Title 5 Inspection Form 6/15/2000 2 Page 3 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 70 POINT HILL ROAD WEST BARNSTABLE,MA 02668 Owner: CAPUTI,NANCY Date of Inspection: JULY 28,2003 C. Further Evaluation is Required by the Board of Health: N/A 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 salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of 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 detenmine distance **This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: Title 5 Inspection Form 6/15/2000 3 I Page 4 of I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 70 POINT HILL ROAD WEST BARNSTABLE,MA 02668 Owner: CAPUTI,NANCY Date of Inspection: JULY 28,2003 D. System Failure Criteria applicable to all systems: N/A 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 J 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 pit is less than 6"below invert or available volume is less than '/z day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation N/A Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply N/A Any portion of a cesspool or privy is within a Zone 1 of a public well N/A Any portion of a cesspool or privy is within 50 feet of a private water supply well N/A 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.) NO (Yes/No)The system fails. 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: N/A To be considered a large system the system must service a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone 11 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 is 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. Title 5 Inspection Form 6/15/2000 4 I Page 5 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 70 POINT HILL ROAD WEST BARNSTABLE,MA 02668 Owner: CAPUTI,NANCY Date of Inspection: JULY 28,2003 Check if the following have been done. You must indicate"yes"or"no"as to each of the following Yes No ✓ Pumping infonnation 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 nonnal 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 infonnation on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)has been determined based on: Yes No ✓ 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 CM 15.302(3)(b)j Title 5 Inspection Form 6/15/2000 5 Page 6 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 70 POINT HILL ROAD WEST BARNSTABLE,MA 02668 Owner: CAPUTI,NANCY Date of Inspection: JULY 28,2003 FLOW CONDITIONS RESIDENTIAL Number of Bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN Flow based on 310 CMR 15.203(for example: 1 10 gpd x#of bedrooms: 330 Number of current residents: 2 Does residence have a garbage grinder(yes or no): YES Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no): YES Seasonal use(yes or no): NO Water meter readings,if available(last 2 years usage(gpd)): WELL WATER Sump pump(yes or no) NO Last date of occupancy: PRESENT COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CM 15.203): Basis of design flow(seats/persons/sqft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: N/A Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: gallons—How was quantity pumped detenmined? 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) Tight tank Attach copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: 1982 Were sewage odors detected when arriving at the site(yes or no): NO Title 5 Inspection Form 6/15/2000 6 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 70 POINT HILL ROAD WEST BARNSTABLE,MA 02668 Owner: CAPUTI,NANCY Date of Inspection: JULY 28,2003 BUILDING SEWER(locate on site plan): ✓ Depth below grade: 3' Materials of construction: Cast iron _ 40 PVC _ other(explain) Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK(locate onsite plan): ✓ Depth below grade: 3' Material of construction: ✓ concrete metal fiberglass polyethylene _ other(explain) If tank is metal list age: Is age confinned by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1,500 GALLON PRE CAST Sludge depth: 2" Distance from top of sludge to the bottom of outlet tee or baffle: 28" Scum thickness: 0" Distance from top of scum to top of outlet tee or baffle: 8" Distance from bottom of scum to bottom of outlet tee or baffle: 18" How were dimensions detennined: ASBUILT AND TAPE Continents(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): MAIN TANK AT WORKING LEVEL WITH COVERS AT 3". INLET AND OUTLETS BOTH HAVE TEES. NO SIGN OF OVERLOADING OR LEAKAGE. GREASE TRAP(located on site plan) N/A Depth below grade: Material of construction: concrete metal fiberglass polyethylene other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Title 5 Inspection Form 6/15/2000 7 Page 8 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 70 POINT HILL ROAD WEST BARNSTABLE,MA 02668 Owner: CAPUTI,NANCY Date of Inspection: JULY 28,2003 TIGHT or HOLDING TANK: N/A (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass polyethylene other(explain) Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no) Alarm level: Alanm in working order(yes or no): Date of last pumping Comments(condition of alanm and float switches,etc.): DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 0 Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.,): DISTRIBUTION BOX IS T BELOW GRADE. BOX IS SOLID.ONE LINE IN,TWO LINES OUT.NO SIGN OF OVERLOADING OR SOLID CARRYOVER. PUMP CHAMBER: N/A (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Title 5 Inspection Form 6/15/2000 8 Page 9 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 70 POINT HILL ROAD WEST BARNSTABLE,MA 02668 Owner: CAPUTI,NANCY Date of Inspection: JULY 28,2003 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: 2 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.) LEACHING IS TWO 1,000 GALLON PRE CAST PITS.PIT#1 I'WATER. STAIN LINE AT I'WITH COVER AT 18". PIT#2 10"WATER. STAIN LINE AT ]' WITH COVER AT 1'.NO SIGN OF OVERLOADING OR SOLID CARRYOVER. CESSPOOLS: N/A (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 or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation etc.): PRIVY: N/A (locate on site plan) Materials of Construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) Title 5 Inspection Form 6/15/2000 9 Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 70 POINT HILL ROAD WEST BARNSTABLE, MA 02668 Owner: CAPUTI.NANCY Date of Inspection: JULY 28,2003 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. i 1? + t C 1 1 i 1 Title 5 Inspection Form 6/15/2000 10 Pa,e I I of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property.Address: 70 POINT HILL ROAD WEST BARNSTABLE. MA 02668 Owner: CAPUTI..NANCY Date of Inspection: JULY 28.2003 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to no groundwater I I feet Please indicate(check)all methods used to detennine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: ✓ Observation 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: 1 I �oiiort 3 N6' Title 5 Inspection Form 6/15/2000 11 TOWN OF BARNSTABLE t a ION "70 P®( VT .h t� ROA-D SEWAGE # AGE U1@�T c 16wyJsTk6i- ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR 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 2W feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by ECO- hSA���D h POINT HILL_ ROAD - a. k LOCATIONS \ WELL - OVER 150 Pt TO SAS PER DESIGN PLAN. A B \ 1 28 FE 13.5 Ft � s, 2 = 34 FE 16.5 Ft 3 39 FE 16 Ft EXISTING DWELLING # 70 �. ^ a SEPTIC LEACH �\ TANK 30 O-BOX O PIT I k LEACH PIT OO NOT TO SCALE. ,) _ TOWN OF BARNSTABLE '40CATION 1001AI-r f/� L �� SEWAGE # VR CAGE �✓` ��N ASSESSOR'S MAP & LOT 13 Z r 30 INSTAr,r E 'S NAME&PHONE NO. SEPTIC TANK CAPACITY 107/ LEACHING FACILITY: (type). (size) =; NO. OF BEDROOMS ^� C U 7 �4 B.0 II..DER OR OWNER oU f' PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If-any_wetlands exist within 300 feet of leaching facility) Feet Furnished by .. o � O rR g�R Nti--clATION SEWAGE PERMIT NO. -J �,— / V.IILLAGE_ 4-10 P< AI-LL 2�b. L.o-T is �3 rO��o1 EST A 12�S-C1�13 L� I N S T A.LLER'S NAIVE A► ADDRES-S OL-rti�on LLLy yylrrss ® IBUILD-ER OR OW- ER C-,-,k)5a Zvc-i �r\ CAD . 1 NL . �.��N�� - a" ,►�-� c 1�PUT z ,�_oNT Fes(]-DabJ .Crl RSS . D A T E PERMIT ISSUED- 1O _ R -pd- D-AT E COMPLIANCE ISSUED Lo 1 ( t 4 y c. • t No. ._ ��Z /.... Fx$......`3` .... Y THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH Town Barnstable ..........................................O F....................--...-.-.-......... Appliration for Uhipniial Workii Tjoutitrurtinn Wrmff Application is hereby made for a Permit to Construct ( x) or Repair ( ) an Individual Sewage Disposal System at: Point Hill .& Holway Rd. Assessor's Map 136130 ......... ...._ ...-----• .... ..............-•- -•-........... •--.._.....__....... ........ ........ Loc 'on-Ad e5s Lot No. Jobn & Nancy apu s Longmeadow, bass. -------.....................•--•---•-•-....._ •---•••-•---- ----•-•-•--•---................-•-----...........-•-----------.............----•-- W Paul T. Lebel Owner 0sterville, lass. a ---------------------------g---------------.......--------........__.......--------------------- ------------------------------------------.........---.._..----------�40.._.....q-------- Installer Address d Type of Building Size Lot._-.33_9_ ______________S . feet Dwelling—No. of Bedrooms-_Dwelling No. Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons................_........... Showers ( ) — Cafeteria ( ) P4Other fixtures --------------- ---•-•---••---- --------•--•---------•-----•••---------• ------------- ............................................................. W Design Flow._...._.1.1 ............................gallons per person per day. Total daily flow.......3.0............................gallons. WSeptic Tank—Liquid capacityl.QOlagallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-------------------- Dia'meter._.�_0. 'jf t Depth below inlet__. f t Total leaching area____2 ?_....sq. ft. Z Other Distribution box ( ) ; Dosing_tank ( ) Jones—p. Murray Percolation Test Results Performed by...-_.-ames Bowman—Allen --_ Date__________________________________ '.1 9-77 a z i3 ft ie-z6-77 Test Pit No. l................minutes per inch Depth of Test Pit-----_. ..._-__--__ Depth to ground waternAyIe.._-__..... 44 Test Pit No. 2.......2.__-_-minutes per inch Depth of Test Pit....13.__f t Depth to ground waternone ----------------------------------------•--------•---------•--....-•----•-----•_-•-------•-----....•........................................................ 0 Description of Soil..________--Clean fine sand x - --------•------•------------•--........••-----------•----------------------•-•--•-•-------•--•-••---------•-------------------------------••- _---� x ----- - -•- -•-•---•-•----------------- -- •-• -. - --------------------------- -- -------- -- - U Nature of Repairs or Alterations— n wer when applicab .-.--- ___________ ____ __ _/ -_ �_- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITI.i� 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 o ealth. Application Approved By.. .....---------•-------•-------------------------------•----• A10 % Date Application Disapprov f o the following reasons:-----•--------•-----------------------------------------------•----------------------------.._..-----....._..._ --.......-•--•-----------------------------------------------•-----------....-•------.......•----_..... ---------••------- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...................... ...............OF..........................-----........------........................................... ppliratiou for 14spos al Workii (9jawitrurtiou amit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ................_........_...................................................................... -•-----------•-----•----......------------------------------••------------------------........ Location-Address or Lot No. ..............•------------.....•...........-•----......-----------•........................•.... ...._......_..........------•--•••-••--•-••••- Owner Address W Installer Address Q Type of Building Size Lot-------------------------------Sq. feet U Dwelling—No. of Bedrooms................................ .....Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria QI Other fixtures ------------------------------------•........---• -- . Q ---------------•----------------------------- 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. 1----------------minutes per inch Depth of Test Pit..................... Depth to ground water......................_. GT4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-___-______--___--___--. 9 •---•••--•--------------•-•-•-----••--•-----------••----••-----...---------........••--•-•-•---........-----------•----••-•------------._......_.._-•-_--••. 0 Description of Soil........................................................................................................................................................................ x V .............................................---------------••----•--•----------• .......... ..... ................. ................... ------•---............................. •-------- -- ---------------•---------- --- - ............................. U Nature of Repairs or Alterations— n wer when applicab (_ _ ----------------------------•-----------------------------------•--- -----........ ...................................................... -----••----- tiJ ......... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 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. Sied...................................................................................... ••-- Application Approved ------ -- - Y-- Date wg reasons-Application Disapprovo ---------------------------••------------------------------------------------------------------------•-•••--..... --......-•----•-----•---......---•--•----•---------•-----•--•-------------•-----•-•--•-•--------•---...-------------•--•--••-----•-•------------••----------•••----------------•---------------•---••--• Date PermitNo......................................................... Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF H A TH i...........................OF.... ........... ......... : ...-T.......................................... Trrtifiratr of Tompliana T, 1 T Cf&`' Y, That the Individual Sewage Disposal System constructe or Repaired ( ) [ a�-A....... .. ----- ----------------- --------------------------------------------------------- -••-...._..--•- staller at � ...... ........ - .-------•-------------- ------------ has been installed in accordance with the provisions of TITLE ` of The State Sanitary Code d ribed in the application for Disposal Works Construction Permit No.. ..�._ r� da.ted.:. V ---- -�-•--•-•--•-••... THE ISSU CE qF THIS CERTIFICATE SMALL NOT BE CONSTRUE AS A GUARANTEE THAT THE SYSTEM WIL FUN 1 Id SATISFACTORY. j rr 1/ DATE.....1 .. - ................................. Inspector................ --- --•-- ...................................................... THE COMMONWEALTH OF MASSACHUSETTS BQARD F HE L No......................... FEE..Jj . �t��t�a� � aaa�tr�rti.mrn rr�tit Permissio s reb ranted__ -:-- �Z< ....e 5.....:........ Yg � to Constr or Repair ( ) Ind' du e a posal System at No. . .--...... �-•....... .. . ....... ....... ......-----------------------.......--------•--------------------•----• .------ ................. Street as shown on the application for Disposal Works Construction Permit No..................... Dated.... .................... -r_...._.... -•-----•-------•-------------------------- ............................................................ Board of Health DATE................................................................................ FORM 1255 HOBBS & WARREN. INC., PUBLISHERS - r TIOIV - SEWAGE ,U07-Le-- .� ��Y U,.,��• , �� �� .,,Y. 4eg-,4 s' �Pc�c,Qc tt-�a 71F - SEPTIC TANK - - "D" BOX - - LEACH i?Fec5 OP OF pFDN l Q -..Z..OF 1/eT0 4z.. - (MSQ) \WASHED STONE _`-_i-�"`- �,.v, / . -J � � �• ti. `�'CEa4tcN PIT OUT t 8 IN- OUT IN- z�,oa ETA K Zb'7 �1�,00 l _ -� Z 1_+�F� ���i � \ A,V ELEV. A F.I_EV. ELEV.. ELEV. v ELEV. ELEV. I� 1 �A OF 3/4^ lye" WASHED STONE �ol.�olJ'J oG Q ,Ztr���v!i D o ��`, 'j��/ 5 s• �� �.-a/�` '-��- , �T HOLE LOG _ 1 , �?. $or/ o LJ T+sT �feiG� /, (A BY Z �•.c.P/�l3,oNk ReL2� 4C7 u.��Lc�/L �. C .E . i � 'ems'\ l�c����•�'-�'�` / ��- `T�_'•i� WITNESS / /v ?7 DESIGN —BEDROOM HOUSE DATEj���(/�1�77 � � i \ T.H. # 1 �eAA T.H. # 2 ELEV.34, ELEV. ZS.S' � � `� �.. A I ° � � •X/ f � lam' ^ !vArrri Tc� so/C i PERC RATE. � Z MIN/IN. y3�'dY (GALJDAV) Oaq.: 3 :r3S�/L 32;a /o`/ FLOW RATE _ �- 4 Z'=! (7 �. �� I SEPTIC TANK _330 V 5)._ - f 35;�4 C. REO'D SEPTIC.TANK SIZE �� eeo ,v i ( F'E'O oo �- LEACH FACILITY s � SIDE WALL I z S l = Sut2�4GE O�' NACre ems..n BOTTOM -_ lo.�o s,r. b 9G - G/D. �m TOTAL I-- --/5,X50 USE: o,u,� LEACHING - �\ -WATER ENCOUNTERED I )TES: (UNLESS OTHERWISE NOTED) ,�p�P���1 OF Mgs9 f 1 OF c ATUM (MSL) +TAKEN FROM _...::S N�w�G _--_---QUADRANGLE MAP qc `�o�� JAMES JNICIPALWATER----•-....... r - ------------AVAILABLE �� 'y t PE PITCH: 1/4"PER FOOT DAMES' �' BOWMAN -' 6 R.xes�r"S =SIGN LOADING FOR ALL PRE-CAST UNITS: AASHO -_ --/a —44 N DISTANCE AS CERTIFIED H. _A #24040 i -- N. GROUND COVER OVER ALL SEWAGE FACILITIES: (1) FT. — BOWMAN N SITE A PE JOINTS SHALL BE MADE WATER TIGHT SITE PLAN INSTRUCTION DETAILS TO BE ACCORDANCE WITH COMM.OF MASS. ,O #Z1O38 9�EG/STER``� 7,HEREBY CERTIFY THAT THE BUILDING 'ATE ENVIRONMENTAL CODE TITLE 5 o, ���1;)TER40 �� ` Nn v�0 SHOWN ON THIS PLAN IS LOCATED ON THE - .J Locus: LaT /5 B Z49 fP i07 A THAT IT-- SS/OVAL EtiG\� CONFORM TO TGROUND AS OE ZON NG BWN H5.R.EONY LAWS OF THE . ___�^^•= ' TOWN OF yJ REG.PROFESSION, L"ENGINEER WHEN CONSTRUCTED. DATE GUEST ��.�C+t/STL�F�LdCT• /.���5�' REF: 0- n Cope eIIgIII�erI�I - PREPARED FOR: f CIVIL ENGINEERS LAND SURVEYORS REG.LAND SURVEYOR �� BOARD OF HEALTH I SCALE / �' Z MA J Yarmouth&Orleans,MA DATE ).NTOURS (EXISTING) _---- AP PROVED . DATE— (PROPOSED) 1 (PROPOSED)-O-O-O-O- F } t I 77 1 SECTION — SEWAGE ' , { G wCN/fv� �e� .4 -5 �c7cAcE' 4A-'1/��•-,-CUBIs E Ss�Nt� /r T ✓�I - SEPTIC TANK - - "D" BOX - - LEACH TOP OF FDN ; Z .o pp y .�.[•_Q. (MSL) —„2„0F'18TO 42" \ ` WASHED STONE 'L Oj x3��EmT �4 L TIN - IN- OUT- IN- 6 (�•� �\ \ Z8.00 Z 7,oa �TAN;l ,?�. ?Q,coo I ELEV. ELEV. ELEV. ELEV. T AAAK 2G, ELEV. ELEV. - OF 3/4" WASHED STONE O [ Sz-�, � \ 1 O 3 yli TEST HOLE LOG AGn. .Q..r -i✓ouE� Of rvl L/CA' B. gv It TEST BY DE �•,C_,01d2,S,41Vk r?60 pi cuccc�2 r7. C.E . / T - `/ /�r/�7 ( 0ke' 77 WITNESS BEDROOM HOUSE ��\�,J C.....o 9\ t TEST DATE�� / v DESIGN U .�-� �,'t}rj �� tf �4J T.H. # 1 T.H. # 2 h �Y — — 1C ELEV.34, ELEV. L" qn� Tv�so,l !/, PERC RATE .�'2 MIN/IN. E31Si35ER ©, �x �' SuBSa»L ; 3Z y3ci y / f!` , S LOW RATE (GAL./DAY ) 3Qt� ? _�. '/ / 6 / - o f Z l3 F _ / O 7'� cr�,Y,�cl SEPTIC TANK ,330 V 51 ro //7'�FGfc,A" REQ'D SEPTIC TANK SIZE LC1fJ4- c.a. F'E�oPasEv Clay • LEACH FACILITY >✓� u/EGG ZS5 SIDE WALL /�lB, ( Z,S 1 = 7�'� G/D. SWAG 10=0 rr/n -" Su�1CQGC O�E'L7:eN444��t�'Y, t BOTTOM 6,61 s, ( 410 c�fG G/D. .: TOTAL /47�L3fVM - � USE: �'�`$` LEACHING No WATER ENCOUNTERED NOTES: (UNLESS OTHERWISE NOTED) OF c ���t� OF Mj 1. DATUM (MSL) +TAKEN FROM _-_:.SAnJo�✓/G-------------QUADRANGLE MAP MASiPq JAMfS CyG 2. MUNICIPAL WATER... r.(O.T ._____-,_-.__--_A V A 1 LABLE J - V Cy 3. PIPE PITCH: 14"PER FOOT � /a DAMES r 1` BOWMAN — 4. DESIGN LOADING FOR ALL PRE-CAST UNITS: AASHO -_ -44 m, �� cn 5. MIN.GROUND COVER OVER ALL SEWAGE FACILITIES: (1) FT. �l H -+ #24040 ----()--DISTANCE AS CERTIFIED G. PIPE JOINTS SHALL BE MADE WATER TIGHT c BOWMAN N . 7.CONSTRUCTION DETAILS TO BE ACCORDANCE WITH COMM.OF MASS. A #21038 �q'9E�ISTER��p4 p I',HEREBY CERTIFY THAT THE BUILDING SITE PLAN STATE ENVIRONMENTAL CODE TITLE 5 9`^ O 4 /{, SHOWN ON THIS PLAN IS LOCATED ON THE o LISTER `� �`� WN 1 LOCUS: Go T' �'sS/01VAL E � - I CONFORM TO TGROUND AS HE ZON NG BY LAWS OF THE:. �� - �,ry T 1-1/6 L �CL� �' /-/OG 44-),14 y .1��,[J E•^. _ TOWN OF _ REG.PROFESSIONAL ENGINEER WHEN CONSTRUCTED. iDATE �(J�$y 13l1/'�:l(/ST.OSLE REF: wI /1� NQNC y G A20Pc1 -1 p down cape enow eCIfil PREPARED FOR: CIVIL 1.ENGINEERS Lo/ya/Y/c'7+'tt7oG�r �i5:r- LANDSURVEYORS ------------ BOARD OF HEALTH J REG. LAND SURVEYOR 4F/�f+ ,/67 ' i/?//DZ f nNTnURS (EXISTING) ---- MA Y Yarmouth&Orleans,MA SCALE /DATE , , (PROPOSCD) 0-0--0-0— APPROVED nATF r