HomeMy WebLinkAbout0148 POINT HILL ROAD - Health 148 Point Hill Road
West Barnstable
A = 138 - 050
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
148 Point Hill Road, West Barnstable M - 136 P-50
Property Address
C. Richard Schmitt
Owner Owner's Name
information is required for every 148 Point Hill Road West Barnstable MA 02668 February 6, 2014
page. City/Town State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
Important:When filling out forms A. General Information
on the computer,
use only the tab 1. Inspector:
key to move your
cursor-do not Troy Williams y U
use the return key. Name of Inspector
Troy Williams Septic Inspections
Company Name
19 Hummel Drive
Company Address
South Dennis MA 02660
City/Town State Zip Code
(508) 385- 1300 S1682
Telephone Number License Number
B. Certification
I certify that I have personally inspected the sewage disposal system at this address and that the
information reported below is true, accurate and complete as of the time of the inspection. The inspection
was performed based on my training and experience in the proper function and maintenance of on site
sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of-
Title 5(310 CMR 15.000).The system: �� Q
® Passes ❑ Conditionally Passes ❑ Falsy
❑ Needs Further Evaluation by the Local Approving Authority
G✓ ze
February 6, 2014 "-�
i �
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.
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
148 Point Hill Road, West Barnstable M - 136 P -50
Property Address
C. Richard Schmitt
Owner Owner's Name
information is 148 Point Hill Road, West Barnstable MA 02668 February6 2014
required for every
page. Citylrown 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:
System meets minimum standards set by Massachusetts DEP at the time of inspection only.This
inspection is not a guarantee or warranty on the future working conditions of leaching, pipes,
components or the future structural integrity of said components and only represents conditions found
at the time of inspection only.
B) System Conditionally Passes:
❑ One or more system components as described in the"Conditional Pass" section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not .
determined," please explain.
The septic tank is metal and over 20 years old'or the septic tank(whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass
inspection if the existing tank is replaced with a complying septic tank as approved by the Board of
Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND (Explain below):
t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
148 Point Hill Road, West Barnstable M - 136 P -50
Property Address
C. Richard Schmitt
Owner owner's Name
information is 148 Point Hill Road West Barnstable MA 02668 February 6, 2014
required for every rY
page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
B) System Conditionally Passes (cont.):
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below):
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The,
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
C) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
t5ins•3/13 Title 5 Official Insp
ection Form:Subsurface Sewage Disposal System•Page 3 of 17
I
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
148.Point Hill Road, West Barnstable M - 136 P-50
Property Address
C. Richard Schmitt
Owner Owner's Name
information is required for every 148 Point Hill Road, West Barnstable MA 02668 February 6, 2014
page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
2. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well".
Method used to determine distance:
*"This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal
coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must
be attached to this form.
3. Other:
D) stem S Failure Criteria Applicable to All S Y pp stems:Y
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 %day flow
t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
148 Point Hill Road, West Barnstable M- 136 P -50
Property Address
C. Richard Schmitt
Owner Owner's Name
information is required for every 148 Point Hill Road West Barnstable MA 02668 February 6, 2014
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Yes No
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered.A copy of the analysis
and chain of custody must be attached to this form.]
❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd.
❑ ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection
Area—IWPA)or a mapped Zone 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 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•3/13 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
,,. 148 Point Hill Road, West Barnstable M - 136 P -50
Property Address
C. Richard Schmitt
Owner Owner's Name
information is required for every 148 Point Hill Road, West Barnstable MA 02668 February 6, 2014
page. Cityrrown State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate"yes" or"no" as to each of the following:
Yes No
® ❑ Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
® ❑ Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑ Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
® ❑ Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS) on the site has
been determined based on:
® ❑ Existing information. For example, a plan at the Board of Health.
® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
D. System Information
Residential Flow Conditions:
Number of bedrooms(design): 3 Number of bedrooms(actual): 3
DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms):
330
t5ins•3f13 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
148 Point Hill Road, West Barnstable M- 136 P-50
Property Address
C. Richard Schmitt
Owner Owner's Name
information is 148 Point Hill Road, West Barnstable MA 02668 February required for every 6, 2014
page. City/Town State Zip Code Date of Inspection
D. System Information
Description:
Number of current residents: 2
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® No
information in this report.)
Laundry system inspected? ® Yes ❑ No
Seasonal use? ❑ Yes ® No
Water meter readings, if available last 2 ears usage d N/A
9 ( Y 9 (gP ))�
Detail:
Private well 156'from leaching.
Sump pump? ❑ Yes ® No
Last date of occupancy: occupied
Date
Commercial/industrial Flow Conditions:
Type of Establishment: N/A
Design flow(based on 310 CMR 15.203): N/A
Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.): N/A
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: N/A
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
,M •''r 148 Point Hill Road, West Barnstable M- 136 P -50
Property Address
C. Richard Schmitt
Owner Owner's Name
information is required for every 148 Point Hill Road, West Barnstable MA 02668 February 6, 2014
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Last date of occupancy/use: N/A
Date
Other(describe below):
N/A
General Information
Pumping Records:
Source of information: Last pumped on 12/28/11 per info from BOH.
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-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
148 Point Hill Road, West Barnstable M- 136 P-50
Property Address
C. Richard Schmitt
Owner Owner's Name
information is required for every 148 Point Hill Road West Barnstable MA 02668 February 6, 2014
page. CitylTown State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known) and source of information:
D-box and leaching were installed to existing tank from 7/7/83 on 12/28/11 per compliance.
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
Depth below grade: 1811+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.):
Lines were found clear at the time of inspection.
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:
5'X9'X6' 1000 gallon
Sludge depth:
4"
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
*M 148 Point Hill Road, West Barnstable M- 136 P -50
Property Address
C. Richard Schmitt
Owner Owner's Name
information is required for every 148 Point Hill Road, West Barnstable MA 02668 February 6, 2014
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Septic Tank(cont.)
Distance from top of sludge to bottom of outlet tee or baffle
2' 8"
Scum thickness none
6,1
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
14"
How were dimensions determined? probe/measured
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Inlet and outlet tees were found present and in working order. No evidence of leakage or damage
was found. Tank was not in need of pumping at this time.
Grease Trap (locate on site plan):
Depth below grade: N/A
feet
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions: N/A
Scum thickness N/A
Distance from top of scum to top of outlet tee or baffle N/A
Distance from bottom of scum to bottom of outlet tee or baffle N/A
Date of last pumping: N/A
Date
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17
r
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
148 Point Hill Road, West Barnstable M- 136 P-50
Property Address
C. Richard Schmitt
Owner Owner's Name
information is required for every 148 Point Hill Road West Barnstable MA 02668 February 6, 2014
page. Cityrrown 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 must be pumped at time of inspection) (locate on site plan):
Depth below grade: N/A —
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
N/A
Capacity: N/A
p �' gallons
Design Flow: N/Agallons per day
Alarm present: ❑ Yes ❑ No
Alarm level: N/A Alarm in working order: ❑ Yes ❑ No
Date of last pumping: N/A
Date
Comments(condition of alarm and float switches, etc.):
N/A
r
Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
w 148 Point Hill Road;West Barnstable M- 136 P -50
Property Address
C. Richard Schmitt
Owner Owner's Name
information is required for every 148 Point Hill Road, West Barnstable MA 02668 February 6, 2014
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Distribution Box(if present must be opened) (locate on site plan):
i
Depth of liquid level above outlet invert level
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 was found level and in working order with equal distribution to outlet lines. No evidence of solid
carry-over or backup in the past were found at the time of inspection.
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.):
N/A
* If pumps or alarms are not in working order, system is a conditional pass.
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 12 of 17
f
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
,•''� 148 Point Hill Road, West Barnstable M - 136 P -50
Property Address
C. Richard Schmitt
Owner Owner's Name
information is required for every 148 Point Hill Road, West Barnstable MA 02668 February 6, 2014
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Type:
❑ leaching pits number:
® leaching chambers number: 2-500 gal. with
stone
❑ leaching galleries number:
25'X 12.8'X 2'
❑ 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.):
Soil was sandy. Chambers were found clean with little water present at the time of inspection.
Checked stone and found dry and clean. No evidence of hydraulic failure or problems in the past
were found at the time of inspection.
Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration N/A
Depth—top of liquid to inlet invert N/A
Depth of solids layer N/A
Depth of scum layer N/A
Dimensions of cesspool N/A'
Materials of construction N/A
Indication of groundwater inflow ❑ Yes ❑ No
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
e Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 148 Point Hill Road, West Barnstable M - 136 P -50 _
Property Address
C. Richard Schmitt
Owner Owner's Name
information is required for every 148 Point Hill Road, West Barnstable MA 02668 February 6, 2014
page. Cityfrown 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.):
N/A
Privy(locate on site plan):
Materials of construction: N/A
Dimensions N/A
Depth of solids N/A
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
N/A
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
_ o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
..y 148 Point Hill Road, West Barnstable M- 136 P-50
Property Address
C. Richard Schmitt,
Owner Owner's Name
information is required for every 148 Point Hill Road, West Barnstable MA 02668 February 6, 2014
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to
at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate
where public water supply enters the building. Check one of the boxes below:
® hand-sketch in the area below
❑ drawing attached separately
j�vtl
15��
I �
O 2 = 3D ' Z - 21
3
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
M 148 Point Hill Road, West Barnstable M - 136 P-50
Property Address
C. Richard Schmitt
Owner Owner's Name
information is required for every 148 Point Hill Road West Barnstable MA 02668 February 6, 2014
C' rrown State Zip Code Date of Inspection
a e. �Y P P
P9
D. System Information (cont.)
Site Exam:
® Check Slope
❑ Surface water
® Check cellar
❑ Shallow wells
Estimated depth to high ground water: 10.0'+
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: 11/21/11
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:
SDW 252 Zone A 47.5' 1.6' adjustment
You must describe how u established the hi h ro n w relevation:
0 oground ate
Y9 9
Test hole recorded on plan showed no water found at 9.0" Hand augered 4' below bottom of leaching
with no water found at a depth of 8.8'. Groundwater adjustment at the time of inspection was 1.6'.
Bottom of leaching at 4.8'was found not to be located in the high groundwater elevation at the time of
inspection.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
148 Point Hill Road, West Barnstable M - 136 P -50
Property Address
C. Richard Schmitt
Owner Owners Name
information is required for every 148 Point Hill Road, West Barnstable MA 02668 February 6, 2014
page. City/Town State Zip Code Date of Inspection
E. Report Completeness Checklist
® Inspection Summary: A, B, C, D, or E checked
® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed
® System Information—Estimated depth to high groundwater
® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17
i _ .
TOWN OF BARNSTABLE
LOCATION g;)l RQJ SEWAGE# 201/ • L/0?
EVILLAGE ASSESSOR'S MAP&PARCEL /3G 1 SO
INSTALLER'S NAME&PHONE NO. Q*Q Ex CaVCd oA H97• 66S3
` SEPTIC TANK CAPACITY
f .
LEACHING FACILITY.(type) p 1, Z. (size) 13 x ZS x 2
NO.OF BEDROOMS 3
OWNER R,cVa>e d
PERMIT DATE: / - - // COMPLIANCE DATE: / •�$•1/
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility(If any wells exist on
site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within
300 feet of leaching facility) Feet
FURNISHED BY
AI. 2q*6"
�Z• �' 39dbd9
22•
A3• q4,
B3• �� ��
Aq 53'
,By• yg'b"
O �
No.
- 1 I '— �V0/� I nnh
d Fee (,�Q Gf^
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
Rpplication for Digoaf 6p5tem Cow6trUCtton Permit
Application for a Permit to Construct( ) Repair( Upgrade O Abandon( ) ❑ Complete System ❑Individual Components
Location Address or Lot No. '4 tr U e l f -+ H l I I Owner's Name,Address,and Tel.No.5 D S 3&2 � I Li 9
iAA ���frybl -Dl LL 5c..h►nn i+�
Assessor's Map/Parcel 1""f" 3 �q re-e[ 50 )9 n I+iQ r n
Installer's Name,Address,and Tel.No. .5 D 1����LJ J Designer's Name,Address and Tel.No. b 9— J 6 z--4-5 4I
�tL3 x cnvo-+(on r�s+c (� 7Db �-t Q 5 En t nee 1119
Type of Building:
Dwelling No.of Bedrooms Lot Size ilifi (??�,- sq.ft. Garbage Grinder ( )
Other Type of Building �IsE�5 1 d60 Ce, No.of PersonsJU* Showers( ) Cafeteria( )
Other Fixtures 2
Design Flow(min.required) gpd Design flow provided J , gpd
Plan Date l 1 /22 ) I Number of sheets I Revision Date
Title Ti �-
Size of Septic Tank 0 00 Type of S.A.S. I ��'�
Description of Soil A1.5
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this and of Health.
Signed %--v k.,�O-A-�S&�9q�
Date
Application Approved by ij� L Date,`
Application Disapproved by: Date
for the following reasons ff f
Permit No. a� C 1 �.� Date Issued 7-- [1
S r
No. I! l,j� jY f I,Fee ( o� c.
I �a
.° THE COMMONWEALTH OF MASS ACR HUSETTS Entered in computer:
PUBLIC HEALTH DIVISION TOWN OF BARNSTABLE; MASSACHUSETTS Yes
N
0[ppYicatf on for �Bigogal 6pgtem Cowaruction Permit;
Application for a Permit tdConstruct( ) Repair( �)'�Upgrade( ) Abandon ❑Complete System
i ( ) p y ❑Individual Components
I� I(1 T f 11 (( r��L� Owner's Name Address and (p z " �1�1 2
Location Address or Lot No. , , Tel.No.I y
�.J�I a p (4 Ire, C 15U I II ` 1
Assessor's Map/Parcel / { �� I t 1 N 1 i I,. i J n(r
Installer's Name,Address,and Tel.No. 5 U k �1 17_L)b5 Designer's Name,Address and Tel No. U 6 z 5
1_1 G XCnval ron �v�.�t� �G!.-�� roc, nee Ing ..
1 >~ PG f �( f5 C-16LCc q31 Ant () 5r
Type of Building:
Dwelling No.of Bedrooms- Lot Size (�� sq. ft. Garbage Grinder ( )
Other Type of Buildiri pS I C�[�0 No.of Persons YP g Showers( Cafeteria
Other Fixtures 2
Design Flow(min.required) gpd Design flow provided J gpd
z
Plank Date 1 11 /2 2 �1 `Number of sheets Revision Date
'Title _ -'I+t 1 P Pi - W
Si of Septic Tank �(i Ci(� f'X l I n G Type of S.A.S. I - a Q�
Description of Soil
f
Nature of Repairs or Alterations(Answer when applicable)
,{
`' Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
Signed Date
Application Approved bA 1y1 WC2 Date k
Application Disapproved by: Date
t
for the following reasons
Permit No. aO (I— L4 1D �_ Date Issued I Z� Z I
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( �) Upgraded ( )
Abandoned(e d�� )by `� 1� �. 7(j fl�/�� ( I C� ❑
at o I r l 'P HII I _k Or C j has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No.acll-`le 8 dated
Installer K b b et ( Designer 1� 1-1-1-1 p / (7 CA t , 1�(� ( i❑�"
#bedrooms J Approved design flow gpd
The issuance of this permit sh lll��not be o/n trued as a guarantee that the syste wtTl`fu c to as designed.
Date 1,19 �CJ / Inspector
:No: � t7li-- ��}� - _ : - ._ _ -_--
Fee ^ 1061 ,�----
vv THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
Tigpoga l 6pgtem Congtruction permit
Permission is hereby granted to Construct ( ) Repair ( ✓)" Upgrade ( ) Abandon ( )
System located at u-� S :7PG l r 1 (
i
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty
to comply with Title S and the.,following local provisions or special conditions.
Provided: Construction must be completed within three years of the date of this permit.
Date (�� Approved by V A L(�� 7 ,w✓ ��
i
FROM. :down cape engineering inc FAX NO. :15083629880 Dec. 28 2011 01:44PM P1
.F F
200'M;agun Street, Ifysnnenin, MA 02600
Uilic.r-,: 3U�-36'�:�•6�•�• 1'3x: 5E)8-'1�J(1-(i:iC14
Isi:��ae]➢en• '-.�Da:�i�ue� K-.e4•rtoifitcr�ltna�llln:tl�'a�F-Hr'a
Date: YY
Sm ageInirP'II ft4 �OII — 1�� AP,,9 9t;0r'^ Mac1�+1V'aa cc9.. �,('IM"047I. �� l� 2 1►1A�» llHns��a➢delra ��`� xC't Lm- r*..
0rl 1 zI 2-`1 I ' waS i.sscLUd. canit to lstan,{
--. .._ _ �T..0 �,-
(r AfP-) p p (in�t�i.ltr) f j
septic system.at LO l p 1 �� � + f '04 haped on a de:a p drLLwn by
(address)
aa.1 o fQ'I a a- PE. W dated
--
-x-
(dc;�;b
I. rPTtify that Lhµ tivpdc. sysLc-.rtz referenced al)ove was i„ustri(ed mbstantially according to
the�de ' which may include Tninn a c-d r, ` rs s c a, Jatev,) ce nr_atioja of the
situ, vr. .. y -.......r ppiov }sang � �� .lz . .. � l
disInTi-otio?a boar.snd./or septic tank
T certify 'dua (}ic:, sc;ptie:: sys' [Cau re.furimced above was,. installed with maim dlangey (i.e:.
gl'esfer than. i.0' ],�:tel-:il.Telocul.i.ont of the- :)'AS or suy Witi.c;a.f re.locstion of a:uy c033,.11011e: It
lr('Lhe st.T�tit: systi:tu.) ljt>t il►sr-.corcictnce with PlaT) Tevisioll of
c(tLtif_'ied.u-built by de:siptT to l'nllow.
��ZRi QF M,gSc
DANI >.,A.
-- OJAI.A ..4
(l.11strlleT'`; �r'lgT.lfLllA1.'_) �' CIVIL `A
d No.46502
r 'P U �y
/ON L G�w
(T)e3i-;mer'`i S1�rfalac) (A('li)-\ T)e,,iiEncr's StaTmp fft -,)
PLEASE kRD �`!'fYt�T 10 bL,kRj� TS'Y'lUM]E, PUBUC.. 8TA'ri!'tl`H_ UIVISION. CERT.0.AICATE dell+'
VA9l PYTT TBT.S FORM. AN-1) AS.-BTALT C1 �.D_ 9glt � f
3R.*.f'F;TVRD BY,1'1&.*H.AJ N2'T A'RLE THANK YOU.
Q:Tinulili/2eptiuDr-.signr,C i;rrti�.eaLiun corm 3-26-04.doc
FROM :down cape engineering inc ' FAX NO. :15083629880 bec. 01 2011 02:41PM P1
down cape engineering, ir'ISIEVE SOILS ANALYSIS 148 POINT HILL.ROAD WEST BARNSTABLE, MA
DATE OF REPORT:11121/11
JOB : GRAIN SIZE ANALYSIS-SIEVE TEST
SITE: 148 POINT HILL ROAD (NEST BARNSTABLE, MA
LOCATION: DCE TEST HOLE 0-Zi-il
SIEVE ANALYSIS Weight Sample(Grams): 235.0
SIZE ;WEIGHT RETAINED %RETAINED %PASSED
/4" ^--- ..................�fli--------------��gCzi -=------100.D%
112" ----- -�...... . .. ...... 0.0' 0.0% ------- 100.0%
31$"------- --- -................ ----------- D 0%o _ r _ 100.0%
---- .........................OY ----------- 0.0°tor— 100.0%
-------------�............. ........... •---------------_�r-b- -----•-----•---
#10 8.4' _3.6%; . 96.4%
^20 r---s -�.................. .26.$A .. _11_4°1oi........._....I-
p- 74.7. 31.$%: •68,2%
- -- •• -----
_"-------�-_-.:..................
0 114.8; 48.9%; 51.1%
$0 177,1' 75,4%, 24.6
_
100 ----- -----•..............201.4-----------857%'-- .....---14.3%
i......................... .,. ...... .------...-'�-__•_-___......__-_
200 ...........
95.4/° 4.6%
PAN: 100,0%; 0.0%
----- --—-- _-- - ------------ --------�--------------
SAMPLE 235.0•,
NOTE:TEST ON PASSING#4 ONLY, 0.7% RETAINED ON#4 <45%O.K.
RESULTS:
SOIL CLASSIFIED AS AASHTO A-3(GRANULAR,COARSE SAND)(UNCOMPACTED)
PERCENTAGE OF MATERIAL PASSING#4 SIEVE:
#4 100% (TEST ONLY MATERIAL PASSING#4) OK
96010%-100% OK
#100 0%°-20% OK
9200 0%-5% OK
SAMPLE MEETS TITLE 5 FILL SPECIFICATION
>98%SAND
RESULTS: PERMEABLE MATERIAL-CLASS I<2 MINJIN.MATERIAL ����
NONCOMPACTED 0ANIIaI A.
SOIL DESCRIPTION: MEDIUM COARSE SAND C?JAIJ1 °
�. CIVIL
�— Na.46502
II
r ,
/*
'own of Barnstable
1Bepart=xat of Regulatory Services , f
y rinnrtaTAaaz § Public Hea th Division Date
Public ` l
",JIB-'L200 Blain Street,Hyanuis MA 02601
U4.t6y � J,
Date Scheduled
Time Fee Pd.
Soil Suitability Assessmentfor Se -e Disposal
UYI.e Witnessed By.:
1'crYonn d By; M;��;
& G�C4NEYqqL rnr A O RMt Tr N
UXOpTAON
Location Address Q -� yQ f` Owner's Name
0 06 1✓1
Address
Assessor's Map/Parcel: C / /1D Cngiucer's Narnc gO)W n Coy e�j j�
NEW CONSTRUCTION REPAIR Telephone Il (,TUv 3 W —*v ! /
� p
Laud Use' � ,�,� Slopes(moof s�
`r a b Surface Stones y�
Distance's from: Open Water Bodyt2do1`1 Possible WeL A`a ���ft Drinking Water W�f•7 ft
r(,f Nf 1 /
Dralhage Way Y�ft Property Line f[ Oilier ft
t V
SICETC]HL: (Street name,dimensions of lot,exact locations of test!toles Sc pert tests,lacnte wetlands'In p'o)(indty to Boles)
AN
M III
CEP
IV
Parent material(geologic)_ l Depth LQ Bu(b'oek
a Depth to Groundwater: Standing Water in)-tole: /r Weeplhg II'onl Pit Noe
Estimated Seasonal High Oioundtivater
]CET EPJVIII\TrATION r,OR SEAS ON AL HI��tl
�Ila
� TABLE,
LE,
Method Uscd:
Depth Observed standing in obs.hole: In, DY;
Depth to weeping•,from side of obs.hole: � I1a, C7ruui)dwuter AdJuslment,u�m� fr.
Index Well fk Rcading Date: Index Well level AdjI,ftletof..,,,,.,.�_ MI.01v ntlwatel'uVid _s
IF ERCOLAT4ON 7l'JCS".Q' - - MIN 'xbm _ -
Observation
Holc A
Tinw et 9"
Depth of Pcrc Tlutp at 6"
StarL Pre-soak Time @ � [� Time(9"-6")
End Prc-soak
'Rate Min./Intl) , ♦,, fir .v, �i,;.ir I't'f.'¢r ;,Jk.'� .. o•. ('-,r,� l•'�, .._..
Site Suitability Assessment: Site Yesseil !\ SiL,G Failed: Additional Testing Needed(Y/nl)
Original; Public Health Division Observation ac)ke,,D-ka To Be Cotnpteted on Back- ---- - --
***If percolation test is to be conducted witizin 100' of wetland, You rnuxst Jfirslt notify tlxe.
Barnstable Conservation Division at least one (1) wecla prior to begh)[Uh.11g.
QASCPTtC\PCRCPORM.DOC
DE R P.OB S)T�']I FV '�0N H®)C,'E LOG
Depth Bonn Soil Horizon h$®1
Surface(in.) sail Texture 'Sdil Color t
Soil
(USDA). (Munsell) Other
Mottlingture,Stones;Boulders,
�' ( �— SL dZ', (StrucCon isteac % ravel
3l�
L41
z-..may�/� � •
U
DEEP O-pSE_R
Depth from Soil Horizon VATION HOLE' LOG #
Surface(in.) Soil Texture Soil Color
(USDA) Soil Other
CM sell) ; ,_: M�ltling 4 le(StrUclure,Stones, Boulders.
®�" t'L Cons tency %Ortave11
-100
®AID Lq�I.� '}�1 'F ----- ,
Depth from RVATTON ROLE LOCx ".
Soil-Horizon Soil Texture 5,: j--2-101,#
Surface(in.� Soli CoWs�a%• :'.'. T"Soil
(USDA) (Munsell) Mottlin Other
g (,.structure,Stones,Boulders.
Consistency,%Onvell
VATIONHOLF
Depth fi'om Said Horizon LOG, Hole#_
Surface(in.) i Soil Texture S 5p11
(USDA) oil Color Other
(Munsel)) Mottling (Structure,Stones; Boulders,
Cons'Istency �h Orny��
]GVood Ynsurance Rate map,
Above 500 year•flood boundary No Yes i
Within 500 year boundary No
41
Ves.
Within on year flood,boundary Np
](�efrltV� o_l�ratln�a9➢� �d�usa rfla��]En]n irvao>_¢s Material *.
1]oes at least fot;r feat of naturally-occurringperviaus m�t0rlal exist-it,all areas observed throughout the
ax-ea proposed for the soii absorption system'
If not, what is the depth of naturally occurring pervious maroritil?
Ce�'t9g9�at90lfB " :.. ,
I certify that or, �C�(date)I have passed the soil evaluator examination approved by the
]Department of Environmental.Protection and that the above analysis,was performed by me consistent with
.he Feq "red lrsiring, axs,ertise anci experience described in �10 Cl'V Z 15.017,
Signature (/k�
Q:IS,C??TrC\PERCr0RM.DOC $ i�+1
zee �� �i� _ ?
l C A T ION EWAGE PE RMIT NO.
vILCAVE
L,
INSTA LLER"$ NAME i ADDRESS
� Jr 4L -
,d UILDE R , OR OWNER
f� � d 6 WER
DA T E PERMIT ISSUED �� 1
ODAT E COMPLIANCE ISSUUD z
- ►36 -SC7
V
• A
'` ,
.. , '. v i
� n
.� � � �
� ��� � � � �
;,.
�FP-orJT
�7�0�
No._1. .. 1! Fimis..........................._
. THE COMMONWEALTH OF MASSACHUSETTS
2 BOAR® OF HEALTH
..........I.........h/..............OF.....-6. .W-45 9.... ............................................
Appliratiun for llispoii al Works Tonutrnrtiun ramit
Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal
System at:
Pcn L1i 12! .., . u� .......... ................................... i
or Lot No.
Owner Address
W
Installer Address ��ff
Type of Building Size Lot...`70 7 ...Sq. feet
Dwelling—No. of Bedrooms............________________________________Expansion Attic (—) Garbage GrinderAla
aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
dOther fixtures ...--•-•----•-• ---------------•'----•-----'----'-----------'-----------------•-----....--------'-•-•----••-"----•'-----'-'-•....-'----......._____.
W Design Flow__________________S ................... per person per day. Total daily flow_.______� _p.___i.._________.__.__ Ions.
WSeptic Tank—Liquid capacity/0_4_gallons Length_$__/a"_-__ Width_S._ 0 _ Diameter_4__�_0__._ De th_ 6a__--
x Disposal Trench—No._. ............ Width....1C1.__....... Total Length---- _ ..___ Total leaching area___ ....sq. ft.
Seepage Pit No..................... Diameter.................... Depth below inlet..................... Total leaching area..................sq. ft.
z Other Distribution box Dosing tank ( )
~" Percolation Test Results Performed by... ... ............................................. Date__._6_'_ ..^ _�
as Test Pit No. l.__L. __minutes per inch Depth of Test Pit_____le...._____. Depth to ground water...__P____.__.__.
(i Test Pit No. 2__c MI._minutes per inch Depth of Test Pit___6A'I:` !__ Depth to ground water..s3-
P43 cSPr-S.---------------------------------------•-----------.......------.....4�w' ..........................................SA-t—I- ..
O Description of Soil----�—[7` �L��`►1^ !=------------------------- - ---- ......- �.....
x 4 /� � s Gi n--.a�--------7--r---II_-?-�--_�----------- ...............U Nature of Repairs or Alterations—Answer when applicable...............................................................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TI1'11 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Complianc has been issued by the board of health.
Signe -------------------•--••-'-•-----------------..._...------....-'----'--••-'-'--------. '•-•-
Application Approved By----• `� •-•--•-------------------------------•---'-'._...-"--'-'•-•--'••-- /Z l ay.
-----------
Date
Application Disapproved f th following reasons-------------------------------------•--•----------- ..........................................................
Date
PermitNo......................................................... Issued.......................................................
Date
No.. Y:_. ... , .........................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
---------------- ._.................--------------------......._......-----------------
Appliratinn for Disposal Works Tonstrnr#iun Fermi#
Application is hereby made for a Permit to Construct (�) or Repair ( ) an Individual Sewage Disposal
System at: ���
�T/`l1lt/ n/5 .. .
or Lot No.
......................-.......................................................................... ..........--.....................................................................................
Owner Address
W
Installer Address
UType of Building Size Lot...............7.._.__...Sq. feet
Dwelling=No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder
p, Other—Type of Building ............................ No. of persons................------------ Showers ( ) — Cafeteria ( )
QI Other fixtures ............................
W Design Flow....................................... per person per day. Total daily flow.._.....Z.� ....•.................
04.
. Septic Tank—Liquid capacity/�a 0_.gallons Length 6--6._..... Width.S__-t 0..... Diameter9-..�Q.. Depth.,._.�__...
x Disposal Trench—No.... C............ Width....6D..._...... Total Length___- ....•.... Total leaching area... y.....sq. ft.
Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box Dosing tank ( )
~' Percolation Test Results Performed by........ �..!___.Cf?.�.�ti•......._....•......... Date....?..26..:.&..............
L
� Test Pit No. 1...............minutes per Inch Depth of Test Pit.....��._........ Depth to ground water.._8_____.._.._.__.
f34 Test Pit No. 2. . ..minutes per inch Depth of Test Pit._:5h` .�... Depth to ground water._,5. .5:...----
a3 S4""------------------------••-•--••--•-•-•--------•--•-............•-••--- "'-�-•---•---••-•-----••--••....-•--••.......:5 :-�-------
O Description of Soil•-•O- / <J'iPw� --•-------- ......--- -----
- - ----------------- --•--
7- 4Ji G'� �r w�l c� F3 21�-= j;
U Nature of Repairs or Alterations—Answer when applicable...............................................................................................
---------------------•------•---••--------------•---•-•••-••--•---------•------•---••--•----------•••--••---....---------------------•-•---•••••--------------------------------••--••-•••-•••••--••-•--
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITIE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliaannce has been issued by the board of health.
Signed--------------------•--------------------•-------------.......-•----------..........-- ..... /...........
/' )Sate
Application Approved By.. f4 ............................................................ /._ ''; D-�k..-----•---
te
Application Disapproved+for tfie following reasons:................................................................................................................
..............................................--••-•---•••-•-------•-----••••---------------------•••...._........._._......•----•--------------•--••--•---•-•--••-•---------------•••••--•••--•••--••--
Date
PermitNo......................................................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.........�....�N................OF...... ^ `ST�I-�.`...................................
Trrfifiratp of ToutpliFanrr
(�II4,t" RTIFY, That thWnGvi 1 Sewage Disposal System constructed ( ) or Repairedby ------� --•---Installer
at -� -- --------------------------------------•------- ,.,*<-•------•------------------•-
has been installed in accordance with the provisions of TITLE 5 of The State Sanitr�. odscribed in the
application for Disposal Works Construction Permit No----------------------------------------- dated................................................
THE ISSUANg OF THIS CERTIFICATE SHALL NOT BE CONSTRU S A GUARANTEE THAT THE
SYSTEM Wl F CTION SATISFACTORY.
DATE........1 ............... Inspector..... . -----------•---------------•----------•--...----------•---••-•-----•---
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
G 16�.v ST4�L
No.a..1..� ��.. FEE........................
Disposal Vorks Cnnntrnrtion Vvrrmit
Permissionis hereby granted..............................................................................................................................................
to Construct ( ) or Repair ( ) an Individual Sewage Disposal System
f
atNo..............................................................................................................
?Stredj -- ' 7f --•--•-•-•--- ------.....
+ % `
as shown on the application for Disposal Works Construction Permit No..................... Date......................................
---•-••-- -------
5� � Board of Health
DATE. ....
-----•---------•--•----------•-
FORM 1255 A. M. SULKIN, INC., BOSTON
® � 'SS` N `SINN K
�N I idOHS — — — — — -- -- ——--
ONia-ling ONINOISK
ONI���NION� 4
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4ge;pt'1 r_),N`I4boj Nn1y,94
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owoaI-
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ads o 7- z Oct NY
b32 �o �q o1 1 >ntv�l N�d3� a
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SYSTEM PROFILE MARKED WITHC MAGNETIC TTAPEAOR BE NOTES
NOT TO SCALE) COMPARABLE MEANS FOR FUTURE LOCATION.
PROVIDE WATERTIGHT MIN. 20" DIAM. � 1. DATUM IS NGVD Cape Cod Bay
ACCESS COVERS TO WITHIN 6" OF FIN. GRADE 2" PEASTONE OR GEOTEXTILE CONCRETE COVERS TO WITHIN 3" GRADE
TOP FOUND. EL. 17.8' FILTER FABRIC OVER STONE 2. MUNICIPAL WATER IS NOT AVAILABLE
\ 2% SLOPE REQUIRED OVER SYSTEM 14.3 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. �<°\
MINIMUM .75' OF COVER OVER PRECAST Its
PRECAST H->o BLOCKS OR 4. DESIGN LOADING FOR ALL PROPOSED PRECAST o (pbe
` RISERS (TYP.) PRECAST RISERS UNITS TO BE AASHO H-1Q 2 G
x, 2'0 1 cJ 9' 4"OSCH40 PVC MORTAR ALL PREC o�
: . .. •
H-10
.. PIPES LEVEL 1ST 2' �4. COMPONENTS 4, 5. PIPE JOINTS TO BE MADE WATERTIGHT. o�
ENDS SIDES 7' c°
TYP. INV'S EL
10" EXISTING 14„ IN ACCORDANCE o
y P°�° °° °� 6 CONSTRUCTION DETAILS TO BE
TEE SEPTIC TANK** TEE °°°°°°°° 0��0 A ®��❑ ��OD ®®� °o°o°a WITH 310 CMR 15.000 (TITLE 5.) d o/ a
14.5 *f 6" MIN SUMP ° ° ° ° ° ° ° °
°°°°°°° oaoaoa®®®®� ®®a®a0000� °°°°°°°° 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND z aYW°y
ooc,co0 _ 0 ,°°°°°°°° °°°°°°°° �a 8 (ds
0 o,00000�0� 12" INT. DIM. ° ° ° ° O��QQ 0����0C] �a�aoaooaoa ° ° ° ° NOT TO BE USED FOR LOT LINE STAKING OR ANY Hillia
GAS BAFFLE ; 0 0 0 0 0_ °°°°°°°° °°°°°°°°
" '>0.000000 aa�aoa®tea®ram ��oaaaoaoaa 00000000 ,
13.17 13.0' °°°°°°°° °°°°°°°° 10 9 OTHER PURPOSE. 5 Locus
- ; . LH-10
8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC.
500 GAL. LEACHING CHAMBER BY ACME PRECAST OR (EQUAL
3/4"-1-1/2" DOUBLE WASHED STONE 4' MIN. (2) UNITS REQUIRED 9. COMPONENTS NOT TO BE BACKFILLED OR a
ALL AROUND PRECAST STRUCTURES CONCEALED WITHOUT INSPECTION BY BOARD OF
6" CRUSHED STONE OR MECHANICAL OVERALL DIMENSIONS TO OUTSIDE OF STONE: 25.0' X 12.83' HEALTH AND PERMISSION OBTAINED FROM BOARD 'h
COMPACTION. (15.221 [2]) 'o o OF HEALTH. o
(6.3 % SLOPE) ( 1 % SLOPE) 10. CONTRACTOR SHALL BE RESPONSIBLE FOR
CALLING DIGSAFE (1-888-344-7233) AND
FOUNDATION- EXIST. SEPTIC TANK 21' D' BOX 12' LEACHING , VERIFYING THE"LOCATION OF ALL UNDERGROUND & LOCUS MAP
FACILITY USE G-W AT EL. 4.9' OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF
*THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL **INSTALLER SHALL CONFIRM MINIMUM SEPTIC TANK SIZE AT CLAYEY SOILS AND TIDALLY WORK. NOT TO SCALE
UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS 1000 GALLONS AND ITS SUITABILITY FOR RE-USE. REPLACE INFLUENCED 11. ANY UNSUITABLE MATERIAL ENCOUNTERED
PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM WITH 1500 GALLON SEPTIC TANK APPROPRIATE TO SITE 1.9' BOTTOM TH-1 & 2 SHALL BE REMOVED 5' BENEATH AND AROUND THE ASSESSORS MAP 136 PARCEL 50
CONDITIONS IF NOT SUITABLE PROPOSED LEACHING FACILITY.
4) 12. EXISTING LEACHING FACILITY SHALL BE PUMPED
'- y8\ AND REMOVED.`
HllllgR�,
LEGEND EXIST. WELL ~'-+'`103 S HA
"'WAY
99- EXISTING CONTOUR 18.09 7. 1_ -+-1GafT -1 - -�t -��
16.52
X 99.1 EXIST. SPOT ELEV. 17.9
�8.07' 17.64
�Q �120.0p
99 PROPOSED CONTOUR Q
17.xj 7.52 x �� SYSTEM DESIGN:
98
•41 PROPOSED SPOT EL. V �^ - I
\
TH1 v 7.67 -IIJ32 I GARBAGE DISPOSER IS NOT ALLOWED
TEST HOLE Q104
X
LOT 35A
YYY /f\ z 17.62 g 16.8 I DESIGN FLOW: 3 BEDROOMS ® 110 GPD = 330 GPD
2� SLOPE OF GROUND O� 46,072 SFt _ 17 57 0h" x 17.35 111 USE A 330 GPD DESIGN FLOW
UTILITY POLE Q 1 x
1,47 x17.19 �16.61 I /
17.60 ERR SEPTIC TANK: 330 GPD (2) = 660
17.6
17.41 x 16.79 I
I
FIRE HYDRANT 17.38/ ___ _ _____ __ _____ _ar .__.;�. �_ . I - -- I **RE-USE EXISTING 1000 GAL. SEPTIC TANK
NOTE: NOT ALL SYMBOLS MAY APPEAR IN DRAWING 1x7 4785 10 #"1 .�3 / LEACHING: -- _
26 4 I /
I
GARAGE - �,31 I SIDES: 2 (25 + 12.83) 2 (.74) = 112 GPD
BENCH MARK 17.44 6:42 yc 15. 6 1 .4
TEST HOLE LOGS DOORSILL 'C,, 1XX1 7. BOTTOM 25 x 12.83 (.74) = 237 GPD
ELEV. = 18.9 �• xX 1729 ��-�g6.33 �15.65
R: ARNE H. OJALA, PE, SE 16.52 A6
ENGINEER: �7.33 TOTAL: 472 S.F. 349 GPD
/ I
17.4-�,� x 16.97
DON DESMARAIS IRS r 17.0 16.99
WITNESS: 16.18 / I USE (2) 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL)
Co , ,
/ WITH 4 STONE ALL AROUND
DATE: NOVEMBER 21, 2011 ��/ X
�5
PERC. RATE _ < 2 MIN/INCH O EXISTING DWELL. 18.88 QP/x 7.13 I I
TOP FNDN. =17.8 . 6.9b< CEDAR GRO / m /
CLASS I SOILS P# 13469 7 3.30 6T?.%o X I / MA
1 20 �.17.11 i APPROVED DATE BOARD OF HEALTH
ELEV. ELEV. 17.09x 17.18 PAT( ��/�` 6.14 I I
�.s /
o„ 4 ,. 4 ' �'�eR'� x .88 ! ; 6.08 1 .98 TITLE 5 SITE PLAN
13.9 p 14.3 i 0 � O x 4.2 I
'` /1 �\ 16.9 Q i` 7.D k�5.42
A A NO
OF
/SL UNSUIT. ESL UNSUIT. �' #1s.7 /6 \Z17.12'k/Q,/x.1Zi�
7/ I N I
0 `�16.74 3 'S�' ro148 POINT HILL ROAD
10YR 2/1 10YR 2/1 1 / I /
8» $n p / 15.09 16.98 /� 1 � O (�
B B #14`'S if ` mx 2.03 WEST BARNSTABLE
/ 11 APPROX ARE EXISTING 13 8� 33' m I
SIT LOAM SILT LOAM UNSUIT. CHING FACILITY (SEE 1 .63 PREPARED FOR
UNSUIT. iiii '/
10YR 6/6 10YR 6/6 13.68 �� NOTE AND 1 / T / '13.45
_ I B&B EXCAVATION/SCHMITT
30 30
1 I
` 1 / 4 1 14 �23jr 113.20 4 3.4 C%9
C1 C1 ft�
99 \ R�Fiy NOVEMBER 22, 2011
SILT/LOAM UNSUIT. SI T LOAM UNSUIT. �ac 13� �345
�F 'c11.6 off 508-362-4541
2 5Y 6/6 2.5Y 6/6 12.47 SHED 12.76 I I fax 508-362-9880
--�12 ��� `� I downcope.com
96" 5.9' 100„ 7 5.9 / \\�u11 0 \\18 �� ,k�o 201 down cope engineering, inc.
C2 C2 / � � � � �
108" OBS WATER 4.9' 112' OBS WATER 4.9' 0,gg civil engineers
land surveyors
MS MS %��SH oFMAss' ����SH oFMgs. Ito
\\ 1 e �' 9 85 939 Main Street ( Rte 6A)
SIEVE io DANIEL ys�� �° DANIELA:. �, � 78
YARMOUTHPORT MA 02675
n A. in� 0 OJALA � � TO EGA,
OJ,ALA CIVIL ( 5 REMOVAL OF UNSUITABLE SOIL REQUIRED
144" 1OYR 6/4 � " 10YR 6/4 , 96O„ N AROUND PERIMETER OF LEACHING FACILITY,
1 9 148 1 9 I I �Ly
� r 13 502 10 ��. DOWN TO SUITABLE SOIL LAYER. REPLACE
c
fi s�ln� Fss /s a G I WITH CLEAN MED. SAND, TO MEET Scale: 1"= 20'
A SPECIFICATIONS OF 310 CM R 15.255(3) I F
11 _26 ' 'DATE DANIEL A. OJALA, P.E., P.L.S. I 0 10 20 30 40 50 FEET
_ _ --
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