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HomeMy WebLinkAbout0229 SADDLER LANE - Health -------------- 229 Saddler Lane West Barnstable A = 152 051 ff � �i TOWN OF BARNSTABLE / LOCATION�� kO Q &I SEWAGE# VILLAGE ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. Rod&e_ � ,aZce b'— w SEPTIC TANK CAPACITY O D / LEACHING FACILITY:(type) U i 6i e) 7 NO.OF BEDROOMS OWNER �n . PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY 1 Q3 �� TOWN OF BARNSTABLE ",-LOCATION oC o(°9 cJ(,�cOgO,�u_ ems_SEWAGE# VILLAGE �� , 'C3j�ts,, ce.�Qw ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY.(type) `v NO.OF BEDROOMS OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility Of 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 JaC1JL w ° TOWN OF BARNSTABLE LOLATION 044 1� ®� SEWAGE# VILLAGE J V" �� �� ASSESSOR'S MAP&LOT Q=ALLER'S N NAME&PHONE NO. /T f/ "� ( _/yvr0 SEPTIC TANK CAPACITY —5 2 pr/ C— Z1V S,'a£ C-7—� /u LEACHING FACILTI'Y-(type) (size) NO.OF BEDROOMS BUILDER OR OWNER 0 -1P/9 PERMIT DATE: CCE DATE: 0Q` r V Separation Distance Between the: Maximum Adjusted Groundwpabl _ om � a ghFafci�ity FeetR s Private Water Supply wea } g ytt�.i on site or within 200 eeN ileac ng aci ty) a1 J� J) Feet Edge of Wetland and Leaching Facility(If any wetlands exist •l r within 300 feet of leaching facility) Feet Furnished by I �� '/ '�' d ,. ,� r 4j 3�� rR o�r� 3� ��� , y 7, 6 ', r No. 4(— 09 Fee �7Z� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftplication for Misposai *pstem coustrurtion vermit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Aba don( ) ❑Complete System ❑Individual Components Location Address or Lot No. 9 5 ' /7 's Name,Address,and Tel.No. Assessor's Map/Parcel � k ***w�!%Jw �ose_ Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Type of wilding: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) �.�(> gpd Design flow provided_ Z3 gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. L r Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance f the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not o place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Si Date_ I Application Approved by 0001- _ Date / I Application Disapproved Date for the following reasons Permit No. �°--® � Date Issued vI No.4 .0 1 t i; e `w y Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ! PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS f Yes f application for 30isposaf 6pstem (Construction i3ermit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Locaiiorr Address or Lot No. s Name,Addpress,,(and Tel.No. Assessor's Map/Parcel -51_ ,� j'� P ��oh /� e.. Installller's Name,Address,and Tel.No. J 9114 2xvo Designer's Name,Address,and Tel.No. 1?ut/1 W .9ES''sWj-u�t � Type,of Building: ' Dwelling No.of Bedrooms Lot Size sq.ft.' Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) �3 gpd Design flow provided > 3 gpd Plan Date Number of sheets Revision Date , Title Size of Septic Tank Type of S.A.S. Description of Soil 1 , a Nature of Repairs or Alterations(Answer when applicable) 67 #, Date last inspected: Agreemeni: 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 n4oto lace the system in operation until a Certificate of Compliance has been issued by this Board of Health. r., Sig Date /1 Application Approved by Date I i Application Disapproved i Date for the following reasons Permit No. Date Issued - -__- ------ --- ------------- - - _ _---- ------- ---------- ---- ------- THE COMMONWEALTH OF MASSACHUSETTS ' BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( Upgraded( ) Abandoned( )by at has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No D►1-09 dated y'fj/it Installer Rj., lj S Designer S 4LV124' VA-Zl ', r ✓ #bedrooms \� Approved design flow gpd The issuance of this permit shall not be construed as a guarantee that the system wil'l turd tion I as desi ed. Date J - Inspector df ----------- -- ------- - `.�= --_ - . -- - - - - - -- - - No. 7_0 0- Q S LI( Fee TT� . THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal �&pstem ebustruttion 3permit Permissiodis hereby granted to Construct( ) Repair( V7 Upgrade( ) Abandon( ) System located at <,,-J j I p h and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with. Title 5 and the following local provisions or special conditions. Provided:C nst ction must be completed within three years of the date of this permit. Date y y /I Approved by Town of Barnstable oF�HE T "o Regulatory Services Thomas F. Geiler,Director • snRrisc;�ate. MASS. Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form 1,52 - Date: �n/c Designer: � Installer: Address: �v /J 172 9 Address: On 4VIel o�h rlSkel/ was issued a permit to install a (d e) (' staller) septic system at G� Z Al 'V.1,f4OU s. based on a design drawn by (address) / ' � �—'/- / /d Q✓ dated 3. (designer)U') I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major 62anges (i.e, greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State & Local Regulations. Plan revision or certified as-built by def1gner to follow. 1 N OF MAS ' DAVID r sign 0 (Inst er's ature) FIAHERTY, JR. No. 1211 � a FG,STER� SANITAR� �%m (Desi er's Signature /` (Affix Designer's S t p ere) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DI-SION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTb 'THS._FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DWISION. THANK YOU. Q:Health/Septic/Desiper Certification Form f down cape engineering, inc. SIEVE SOILS ANALYSIS 229 Saddler Lane W Barn.xlsx DATE OF REPORT: 3-24-11 (3/17/11 TH) JOB : GRAIN SIZE ANALYSIS-SIEVE TEST SITE: 229 Saddler Lane W.Barnstable, MA LOCATION: E A Stone Testhole SIEVE ANALYSIS Weight Sample(Grams): 263.3 SIZE :WEIGHT RETAINED % RETAINED % PASSED -------------:----- (Su m )-------------v--------------------i---------------- 1" 0.0: 0.0%: 100.0% --------------------- - A-------------- - -------------100_0% 1/2" 0.0: 0.0%: 100.0% -------------' ----------------------------------------------------------- 3/8" 0.0: 0.0%: 100.0% --------------------------------------------------------------- ------------------ #4 0.0; 0.0%: 100.0% -------------- ------------------------------------------------>------------------ - #10 26.4: 10.0%: 90.0% 77 -------------- ---------------------- ---:---------------------•------------- -- #20 -------------------- 6A------------- -- 5%0;---------- 7--- #40 173.1: 65.7%: 34.3% #50 211.1; 80.2%; 19.8% ----------------------------------- ----- 238.5: 90.6%: 9.4% ------------------------------------- ---a---------------------� -- #100 249.8: 94.9%: 5.1 --------------:-----------------------•--A---------------------I------------------ #200 257.91 97.9%;------------2_1% PAN:-------- ------------------- ------------------1 00.0%_-------------- SAMPLE: 263.3; NOTE: TEST ON PASSING#4 ONLY, 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 #5010%-100% OK #100 0%-20% OK #200 0%-5% OK SAMPLE MEETS TITLE 5 FILL SPECIFICATION >98%SAND 3�0,SHOFAt4 RESULTS: PERMEABLE MATERIAL-CLASS 1 <2 MINAN. MATERIAL S°� LANIELA. OJP,LA NONCOMPACTED CIVIL SOIL DESCRIPTION: MED SAND, 0.74 GPD/SF MATERIAL o No.46502 o Town of Barnstable P# Department of Regulatory Services _ Public Health 3 r lth Date 1639• �� 200 Main Street,Hyannis MA 02601 Date Scheduled Time. Fee Pd. 160 Soil Suuitabi 'ty Assessment for Sewage i% sposal Performed By:_ ! L Q Witnessed By: V W �e LOCATION&GENERAL INFORMATION Location Address Owner's Name Q Address 2 �� V 1-F Z Po<. 8 SuVtJ" `!k� Assessor's Map/Parcel: l 52 �S Engineer's a Se viJ - cc.jk 06ZS—&7 NEW CONSTRUCTION REPAIR i tie G% Telepho ?_— 3 6 O 0 Land Use --PN -66L Slopes(%) � 'Q Surface Stones 1�iGl Distances from: Open Water Body--- /w ft possible Wet Area ft prinking Water ell ft W Drainage a / g Y '// ft Property Line —112�ft Other SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) 00 "(; VD I t. , Z29 ' y Parent material(geologic) Depth to Bedrock Depth to Groundwater. Standing Water n Hole: AIAL Weeping from Pit Face Estimated Seasonal High Groundwater _ `I'I2 DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: /e<2Q 06�GrYCtil�r<d�j/ Depth TObserved standing in obs.hole: In, Depth to sail mottias: Depth to weeping from side of obs.hole: /V in, Groundwater Adjustment ft. Index Well# Readin Date: Index Well lev -��g �l--1,z ,,.Adj,factor Adj.Groundwater level �rstn o!i.I�✓ PERCOLATION TESL' Date 3 t1 i t Time (( � 5►rEcvritar�t! Observation Hole# / ,^ \ lime at 9" Depth of Perc - ' - Time at 6"ku IV Start Pre-soak Time @ 'Time(9"-6") End Pre-soak v(/�"Q j�3 �vrtc r k wt Rate MinlIach L Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(YIN) � Original: Public Health Division Observation Hole Data To Be Completed on Back------ ***If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conservation Division at least one(1)week prior to beginning. Q:ISEPTICVERCFORM.DOC I i r DEEP-OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Surface(in.) (USDA) Other ) (Munsell) Mottling (Structure,Stones;Boulders. - onsistencv.91i Orav.n i� 20— Cv /v fZ Zo DEEP OBSERVATION HOLE LOG Hole# 2 x Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. . CoMiSlency.%faravel_ ------------ DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistena. DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. consistency, Flood Insurance Rate Map: VZ Above 500 year flood boundary No— 'Yes Within 500 year boundary No_+ Yes ' Within 100 year flood boundary No. Yes Death of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pervious material? Certification I certify that on aY� (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required training,a pertise ah experie ce described in 310 CMR 15.017. -% .,, � Signature = = �" Date "/7 QASEPTICIPERCFORM.DOC r °f SNE T°� Town of Barnstable Barnstable P` ~ FAmerica City Regulatory Services Department A 1 { ' lAF-NSfABLE, 9 "'"SS. i57q. n Public Health Division q7 ��� m ArE0 MAC 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO Certified Mail# 7008 323000025178 2336 March 14, 2011 Mr. Aaron Rose 229 Saddler Lane West Barnstable, MA ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,TITLE 5 The septic system located at 229 Saddle3r Lane,West Barnstable,MA was last inspected on 03/07/2011,by Paul C. Martin, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Fails"under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: Liquid depth in System is less than 6"below invert or available volume is less than % day flow. You are ordered to repair or replace the septic system within 60 days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH Th mas cKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures\53 Wingfoot Drive,Bamstable.doc Lommonweaith oT massacnusetm G� r Title 5 Official Ins ecti®n Form �--' p � Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .'� 229 Saddler Ln. W. Barnstable, MA 02668 Property Address Aaron Rose Owner Owner's Name information is requirec"for every W. Barnstable MA 02668 3M11 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 Paul C. Martin use the return key. Name of Inspector AB Canco _Q Company Name - 350 MAIN ST- ROUTE 28 ` Company Address W YARMOUTH - MA City/Town state 02673 ' Zip Code . 800-593-6449 .5016 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ❑ Passes ❑ Conditionally Passes 0 Fails ❑ Needs Further Evaluation by the Local Approving Authority 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 DEI?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•09108 Title 5 Official Inspection Form:Subsurface Sewage Disj osal System•Peg 1 of 16 r %,ommonwemin oT massacnuseas Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r Owner B. Certification (cont.) information is required for every Inspection Summary:Check A,B,C,D or E/always complete all of Section D pace. 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): B. Certification (cunt.) t5ins•09/08 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 2 of 16 Iipommonweann oT massacnusens Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments B) System Conditionally Passes (cont.): Owner ❑ Observation of sewage backup or break out or high static water level in the information is distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution required for every box. System will pass inspection if(with approval of Board of Health): aaae. ❑ 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 B. Certification (cont.) t5ins•09/08 Tide 5 Official Inspection Form Subsurface Sewage Disposal System•Page 3 of 16 tommonweaizn of massacnusens Title 5 Official Inspection Form . Subsurface Sewage Disposal System Form -Not for Voluntary Assessments re ❑ The system has a septic tank and soil absorption system(SAS) and the SAS is within Owner 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 coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ 0 Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ 0 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 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: ❑ p Any portion of the SAS, cesspool or privy is below high ground water elevation. t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 16 r \ L*ommonweaiin or massacnuseits Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments � Any portion of cesspool or privy is within 100 feet of a surface water supply or ❑ 0 tributary to a surface water supply. Owner ❑ O Any portion of a cesspool or privy is within a Zone 1 of a public well. information is required for every ❑ ❑x Any portion of a cesspool or privy is within 50 feet of a private water supply well. me. ❑ M 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 colifor n 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 t1ft. 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 Cl ❑ 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. 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 Cl ED Were any of the system components pumped out in the previous two weeks? O ❑ Has the system received normal flows in the previous two week period? ❑ M Have large volumes of water been introduced to the system recently or as part of this inspection? t5ins•09M Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 5 of 16 r vommonwemin or massacnusens Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) Owner ❑ Was the facility or dwelling inspected for signs of sewage back up? information is required for every ❑x ❑ Was the site inspected for signs of break out? pafae. 0 ❑ Were all system components, including 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? FX1 ❑ 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: 0 ❑ Existing information. For example, a plan at the Board of Health. 9 ❑ Determined in the field (f 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): Unknown Number of bedrooms(actuaq: 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): Unknown D. System Information Description: Number of current residents: 3 Does residence have a garbage grinder? ❑Yes 0 No Is laundry on a separate sewage system? [if yes separate inspection required] ❑Yes Z No Laundry system inspected? ©Yes ❑ No Seasonal use? ❑Yes Fx1 No t5ins•09/08 Title 5 Official Insp ection Form Subsurface Sewage Disposal System•Page 6 of 16 toormnonweaitn or massacnusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Water meter readings, if available(last 2 years usage (gpd)): Detail: Owner information is required for every Rase. Sump pump? ❑Yes 0 No Last date of occupancy: 3/7/11 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑Yes ❑ No Industrial waste holding tank present? ❑Yes ❑ No Non-sanitary waste discharged to the Title 5 system? []Yes ❑ No Water meter readings, if available: D. System Information (cons.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: BOH Was system pumped as part of the inspection? []Yes © No If yes,volume pumped: gallons t5ins-09/08 Title 5 Official Inspection Form Subsurface Savage Disposal System-Page 7 of 16, Vora monwea itn oT massacnusens Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments How was quantity pumped determined? Owner Reason for pumping: Maintenance after previous inspection. information is required for every Type of System: Pam. M Septic tank,distribution box,soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records; if any) ❑ Innovative/Altemative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): D. System Information (cunt:) Approximate age of all components,date installed (if known)and source of information: Approx. 18 years per previous inspection dates. Were sewage odors detected when arriving at the site? ❑Yes © No Building Sewer(locate on site plan): Depth below grade: 24"feet Material of construction: ❑cast iron 2140 PVC ❑other(explain): Distance from private water supply well or suction line: N/A feet Comments (on condition of joints,venting, evidence of leakage, etc.): Line checked with sewer camera. Good flow,joints look good. t5ins•09108 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 8 of 16 %,ommonweelin oT massamuseas Title 5 Official Inspection Form_ Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r< Septic Tank(locate on site plan): 11" Owner Depth below grade: feet information is required for every Material of construction: page. R 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: 1000 Gal H-10 Precast Sludge depth: 4" D. System.Information (cunt.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 26" 3" Scum thickness Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 15" Tape, Sludge Judge How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank looks ok Structuraly. Recommend pumping of tank. Baffles/Tees are in place and look good. Grease Trap(locate on site plan): t5ins-09/08 Title 5 Official Inspection Fort Subsurface Sewage Disposal System-Page 9 of 16 ttommonweam oT massacnuseus Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Depth below grade: feet Owner Material of construction: information is required for every ❑concrete ❑metal ❑fiberglass ❑ polyethylene ❑other(explain): pace. 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 D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or battle 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): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes El No ❑ Alarm level: Alarm in working order: ❑ YesNo Date of last pumping: Date thins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 16 \ 6ornrnonweam or massaimusens Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Comments (condition of alarm and float switches, etc.): Owner information is required for every page" *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No D. System Information (cont.)Y ( Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Off Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box is in ok condition. Some scaling on walls but they are intact. Box is level with no leakage. One line in and one line out to leaching. 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.): t5ins•ogroa Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 11 of 16 liommonweaim of massacnuseuis Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Soil Absorption System (SAS) (locate on site plan,excavation not required): Owner If SAS not located, explain why: information is required for every Pace. D. system Information (coat.) Type: ❑x leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number,dimensions: ❑ overflow cesspool number: ❑ innovative/altemative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil, condition of vegetation, etc.): 1-6x6 Leach pit. Bottom of pit is at 102" Line is not piped into leach pit chamber. Line is piped into 18"ads riser above leach pit. Leach pit is completely full and there is staining in riser indicating a higher water level and hydraulic failure. See attached drawing for piping schematic. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 16 N toommonweaim oT massacnusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Depth of solids layer Owner Depth of scum layer information is required for every Dimensions of cesspool Date. Materials of construction Indication of groundwater inflow ❑Yes ❑ No 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 16 i 1 tommonweavin w massacnuseus • Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Owner information is required for every pane. D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing,attached separately t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 16 Vornrnonweaitn oT massacnuseus Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments D. System Information (cunt.) Owner Site Exam: information is required for every © Check Slope Minor aaae. O Surface water None © Check cellar © Shallow wells None Estimated depth to high ground water: 16'+ 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) x❑ Accessed USGS database-explain: Well SDW 252,Zone B, Level 47,Adjustment 20.4" You must describe how you established the high ground water elevation: Used transit to shoot elevations. Was able to shoot a 192"separation from grade over leaching. Bottom of leaching is at 102°. Add 20.4"for adjustment to 102°=122.4°. Minimum of 69.6°separation from groundwater. Before filing this Inspection Report, please see Report Completeness Checklist on next page. 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-09/08 Tide 5 Official Inspection Form Subsurface Sewage Disposal System•Page 15 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 229 Saddler Lane Property Address Aaron Rose Owner Owner's Name information is required for West Barnstable MA 02668 10/08/2008 every page. Cityfrown 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 buildin . � rce A --- 3 a 22W a I 2 A� - A 314 l31 3 N i (v' t5insp.doc•03r08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 ! I I I j I 1 I I + I I.. : rl t �, X I I I I � i i I I i I I I , 4 ; i- i T I it I , ' N i , i i i I I f I I I a � i t I ( r i I ; I i : _ I I � I t j ' I • , i j I -- I I I , : : I ; 1 I � I , ! , I t I I I i I i { f I I LLO , _1. L. 1 , I _ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 229 Saddler Lane Property Address Aaron Rose Owner Owner's Name information is West Barnstable MA 02668 10/08/2008 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. Important: A. General Information When filling out forms on the computer,use 1. Inspector: only the tab key to move your Brad J. White cursor-do not Name of Inspector use the return key. Bluewater Company Name - a 350 Main Street Company Address West Yarmouth MA. k673 City/Town State Zip Code (508)775-2800 E w Telephone Number License Number <j r--J `t c2 v _ �ro _ CZ) .� B. Certification ta's r�- I certify that I have personally inspected the sewage disposal system at this addrec s and that then, information reported below is true, accurate and complete as of the time of the insl iection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: 0 Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 51/ 10/08/2008 Inspector's Ig ature 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. t5insp.doc•03/08. Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 1 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �M 229 Saddler Lane Property Address Aaron Rose Owner Owner's Name information is required for West Barnstable MA 02668 10/08/2008 every page. Cityrrown 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: — Allm. ❑✓ 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: NIP System meets pass criteria. Recommend annual pumping of septic system 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 t5insp.doc-03/08 Till.5 Official Inspection Form:Subsurface Sewage Disposal System>Page 2 of 15 Commonwealth of Massachusetts ti.MUM Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 229 Saddler Lane Property Address Aaron Rose Owner Owners Name information is West Barnstable MA 02668 10/08/2008 required for every page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ 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: 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. t5insp.doc-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System^Page 3 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 229 Saddler Lane Property Address Aaron Rose Owner Owner's Name information is West Barnstable MA 02668 10/08/2008 required for every page. Cityrrown 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 ❑ Be Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool 0 lZ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ 5�re 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 ❑ / Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ 2 Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ Q/ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. t5insp.doc•03/08 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 M , 229 Saddler Lane Property Address Aaron Rose Owner Owner's Name information,is West Barnstable MA 02668 10/08/2008 required for 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. ❑ 20' Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ Z 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- ❑ R/ 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 El El Area system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone I I of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall.upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5insp.doc-03/08 / Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts 4 N Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,M 229 Saddler Lane Property Address Aaron Rose Owner Owner's Name information is required for West Barnstable MA 02668 10/08/2008 every page. CitylTown 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? ❑ Zoe 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) LJ ❑ 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, exeludiAg 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. El approximation in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•03/08 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 229 Saddler Lane Property Address Aaron Rose Owner Owner's Name information is West Barnstable MA 02668 10/08/2008 required far every page. Cityrrown State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms(design): ���"t Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): Number of current residents: -� 3 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 years usage (gpd)): ok-- 7-1,c Sump pump? ® Yes It No Last date of occupancy: Current Date CommercialAndustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CM 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): t5ins .doc•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 7 of 15 P �._.:/ P 9 P Y 9 Commonwealth of Massachusetts Title 5 Official Inspection Form . sl - Subsurface Sewage Disposal System Form-Not for Voluntary Assessments- 229 Saddler Lane Property Address Aaron Rose Owner Owner's Name information is required for West Barnstable MA 02668 10/08/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: System was pumped after inspection Was system pumped as part of the inspection? ® Yes ® No If yes, volume pumped: 1,000 gallons How was quantity pumped determined? Sight tube on truck Reason for pumping: Maintenance Type of System: Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ ("C)) Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: System was installed approx 15 years per previous inspection Were sewage odors detected when arrivingat the site? Yes No t5insp.doc-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,M 229 Saddler Lane Property Address Aaron Rose Owner Owner's Name information is required for West Barnstable MA 02668 10/08/2008 every page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: —� 25 feet Material of construction: ❑ cast iron ❑✓ 40 PVC ❑ other(explain): Distance from private water supply well or suction line: N/Afeet Comments(on condition of joints, venting, evidence of leakage, etc.): —be- Building sewer is in good condition. No evidence of leakage. Used camera to check piping. Septic Tank(locate on site plan): Depth below grade: —� 12' 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: 1,000 Gallon Tank 311 Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 28" 611 Scum thickness 7" Distance from top of scum to top of outlet tee or baffle 11 Distance from bottom of scum to bottom of outlet tee-or baffle . 16 How were dimensions determined? Measured t5insp.doc•03108 ( Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ;M 229 Saddler Lane Property Address Aaron Rose Owner Owner's Name information is West Barnstable MA 02668 10/08/2008 required for every page. Cityfrown 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.): Inlet and outlet baffles are in good condition. No evidence of leakage in or out. Liquid level in tank is normal. Tank is structurally sound. 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): t5insp.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of-15 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form-Not for Voluntary Assessments wM01229 Saddler Lane Property Address Aaron Rose Owner Owner's Name information is required for West Barnstable MA 02668 10/08/2008 every page. Cityrrown 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 -�' 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 level with no evidence of solids,carryover. No leakage in or out of box. Box is 14" below grade with only one outlet leaving it. Pump Chamber(locate on site plan): Pumps in working order: ® Yes ® No Alarms in working order: ® Yes ® No t5insp.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 ( Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,M 229 Saddler Lane Property Address Aaron Rose Owner Owner's Name information is required for West Barnstable MA 02668 10/08/2008 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: ,_,/ 1 @-6'x 6' N leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): aw Soil is dry. No signs of hydraulic failure. Vegetation is normal. No ponding. Leaching pit is 30" below grade. Bottom of pit is 102" below grade. t5insp.doc•03108 ( Title 5 Official Inspection Form:Subsurface Sewage Disposal System=Page 12 of 15 Commonwealth of Massachusetts Tithe 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 229 Saddler Lane Property Address Aaron Rose Owner Owner's Name information is required for West Barnstable MA 02668 10/08/2008 every page. Cityrrown 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.): t5insp.doc•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 229 Saddler Lane Property Address Aaron Rose Owner Owner's Name information is West Barnstable MA 02668 10/08/2008 required for every page. City/Town 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 buildin�Cress _ t *22 9 � I 2 All . 19 o <i A� - 314 531 3 N I-fO i 9)TTIM l . � t5insp.doc•03/08 �' Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 15 I Commonwealth of Massachusetts Title 5 Official Inspection Form d Subsurface Sewage Disposal System Form Not for Voluntary Assessments ,M > 229 Saddler Lane Property Address Aaron Rose Owner Owner's Name information is required for West Barnstable MA 02668 10/08/2008 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 high ground water: —� 16'+ 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: —,N,D- Well SDW 252/Zone B/Level 47.5'/Adjustment 28.8" You must describe how you established the high ground water elevation: Used lazer level to determine groundwater. Bottom of the leaching pit is at 102" below grade. If you add the required USGS adjustment of 28.8" brings the total to 130.8". No groundwater encountered at 16'This leaves an additional 61.2"of seperation. t5insp.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 ------ ----- --------- ---------- 1-25" --­-------- - -------- ... --------- ............ .......... ------- .......... ........ ......... -------- -­---- j i _j ............ ......... ........ ------------ --j....... ...... ------- ............... _22-9- -1 ------ ---------- ------- 069.0r/V 22 (Z-E:-w a6 Ivs G ................ --------- .......... -----------1.......... ---------- -------- TLJ--------- L _J..............­ i i COMMONWEALTH OF MASSACHUSETTS r F EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS d DEPARTMENT OF ENVIRONMENTAL PROTECTION OjM She 350 MAIN STREET WEST YARMOUTH,MA 508-775-2800 TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM 17) i PART A i—.� ,� 5"c�d dd`�h CERTIFICATION �` t' A MAP 152—PARC 051 } Property Address: 229 SADLER LANEj1lf ' ' WES"rB_ARNSTABLE,MA 02668 Owner's Name: . WHEELER,CRAIG € Owner's Address: 229 SADLER LANE WEST BARNSTABLE,MA 02668 _ s Date of Inspection FEBRUARY 114,2006 _ Tj 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 b ispected the sewage disposal system at this address,and that the information reported below is true,accurate and compl,,te 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 puesuant 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: 9 Date: 2-16-06 The system inspector shall su nut a c�offnspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this ai'pection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the sys?em owner shall submit the report to the approp i ate regional office of the DEP. The original should be sent to thre system owner and copies sent tot he buyer,if applicable,and the approving authority. Notes and Continents ****This report only describe;conditions at the time of inspection and undtr the conditions of use at that time. This inspection does not,addre-ss 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 11 OFFICIAL iINSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 229 SADLER LANE WEST BARNSTABLE,MA 02668 Owner: WHEELER, CRAIG Date of Inspection: WEST BARNSTABLE,MA 02668 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 CNIR 15.303 or in 310 CNM 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 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 229 SADLER LANE WEST BARNSTABLE,MA 02668 Owner: WHEELER, CRAIG Date of Inspection: WEST BARNSTABLE,MA 02668 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(l)(b)that the system is not functioning in a manner which will protect public health safety and the environment: Y g P P Y 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 determine 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 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINIJED) Property Address: 229 SADLER LANE WEST BARNSTABLE,MA 02668 Owner: WHEELER, CRAIG Date of Inspection: WEST BARNSTABLE,MA 02668 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 �— 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 leaching is less than 6"below invert or available volume is less than%2 day flow 7— 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. I have determined that one or more of the above failure criteria exist as described in 310 CNIR 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 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 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. s; Title 5 Inspection Form 6115,12,000 4 Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 229 SADLER LANE WEST BARNSTABLE,MA 02668 Owner: WHEELER, CRAIG Date of Inspection: WEST BARNSTABLE,MA 02668 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,including 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)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 CUR 15.302(3xb)] Title 5 Inspection Form 6/15/2000 5 Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 229 SADLER LANE WEST BARNSTABLE,MA 02668 Owner: WHEELER, CRAIG Date of Inspection: WEST BARNSTABLE,MA 02668 FLOW CONDITIONS RESIDENTIAL✓ 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 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)): N/A Sump pump(yes or no) NO Last date of occupancy: PRESENT COMMERCIALANDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): Basis of design flow(seats/persons/sgft,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—NOTE:MAINTENANCE PUMP AFTER INSPECTION. Was system pumped as part of the inspection(yes or no): 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 copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: 2002—PERMIT#2002-203 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: 229 SADLER LANE WEST BARNSTABLE,MA 02668 Owner: WHEELER, CRAIG Date of Inspection: WEST BARNSTABLE,MA 02668 BUILDING SEWER(locate on site plan): ✓ Depth below grade: 10" 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: 7" Material of construction: concrete metal fiberglass polyethylene _ other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1000-GAL PRE CAST Sludge depth: 3" Distance from top of sludge to the bottom of outlet tee or baffle: 27 Scum thickness: 3" Distance from top of scum to top of outlet tee or baffle: 12" Distance from bottom of scum to bottom of outlet tee or baffle: 15" How were dimensions determined: ASBUILT&TAPE Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,ev_dence of leakage,etc.): TANK AT WORKING LEVEL,TANK&COVERS AT 7"INLET TEE—OUTLET BAFFLE. NO SIGN OF LEAKAGE OR OVER LOADING. 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 szum 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 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 229 SADLER LANE `NEST BARNSTABLE,MA 02668 Owner: `AT EELER, CRAIG Date of Inspection: `NEST BARNSTABLE,MA 02668 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: Alarm in working order(yes or no): Date of last pumping Comments(condition of alann 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.,): D-BOX IS 16"X 16"—14"BELOW GRADE,BOX IS CLEAN&SOLID,ONE LINE IN—ONE LINE OUT. NO SIGN OF OVER LOADING OR SOLID CARRY OVER. PUMP CHAMBER: N/A (locate on site plan) Pumps in working order(yes or no): Alarms in working order(dies or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Title 5 Inspection Form 6/15/2000 8 fi. Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 229 SADLER LANE WEST BARNSTABLE,MA 02668 Owner: WHEELER, CRAIG Date of Inspection: WEST BARNSTABLE,MA 02668 SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: —T leaching chambers,number: 2 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(2)500-GAL DRY WELLS W/4'STONE. LEACHING AT 4'BELOW GRADE WITH COVER AT 1'. 3"WATER NO HIGH STAIN LINE. NO SIGN OF OVER LOADING OR SOLID CARRY OVER. CESSPOOLS: N/A (cesspool must be pumped as part of inspectionXIocate 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 10 of i l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 229 SADLER LANE WEST BARNSTABLE,MA 0266.8 Owner: WHEELER, CRAIG Date of Inspection: WEST BARNSTABLE.MA 02668 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. A 74-6 - b r it � r I /4163l34; 0 Title 5 Inspection Form 6/15/2000 10 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 229 SADLER LANE WEST BARNSTABLE,MA 02668 Owner: WHEELER, CRAIG " Date of Inspection: WEST BARNSTABLE,MA 02668 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to no groundwater 10 feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from sys-em 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: TEST HOLE AT 10'NO WATER. TEST HOLE AT 6"BELOW BOTTOM OF LEACHING. BOTTOM OF LEACHING AT 4' BELOW GRADE. 0 y I r - " o�£Aci�fi�w r� A/ o (,Adf�TF� Title 5 Inspection Form 6/1 i;'2000 11 S N-,F,A,)I 00 r r C i RECEIVED !n MAR 0 4 2002 TOWN OF BARNSTABLE COMMONWEALTH OF MASSACHUSETTS HEALTH DEPT. EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS iili DEPARTMENT OF ENVIRONMENTAL PROTECTION m � 6299 w INSPECTION MAP 5Z: T FAILED psl PARCEL. • -' TITLE 5 LOT • 3oR 20 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 229 SADDLER LN WEST BARNSTABLE,MA 02668 Owner's Name: TODD PLUTA Owner's Address: 229 SADDLER LN WEST BARNSTABLE,MA 02668 Date of Inspection: 2/12/02 Name of Inspector: (please print) _ ! JOHN GRACI Company Name: SiWC INSPECTIONS Mailing Address: Pb.BOX 2119 TEATICKET,MA.02536 Telephone Number: 508-564-6813 FAX 508-564-7270 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: _ Passes _ Conditionally Passes Needs Furtheevaluation by the Local Approving Authority X Fails Inspector's Signature: ! Date: 2/12/02 The system inspector shall submit 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. Notes and Comments SYSTEM FAILS TITLE V INSPECTION. LEACH PIT IS FULL OVER PIPES. , s ****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 dillerenl conditions of 11se. Titlf- 5 Inenrr6fin form A/1 5/10N)0''' I Page 2 of!.1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 229 SADDLER-LN WEST BARNSTABLE,MA 02668 t4 Owner: TODD PLUTA Date of Inspection: 2/12/02 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 FAILS TITLE V INSPECTION. LEACH PIT IS FULL OVER PIPES. 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. n/a 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. a, s ND explain: n/a 4 a n/a 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 _ distributtion box is leveled or replaced ND explain: n/a n/a 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 4- ND explain: n/a ij c 7 Page 3 of 1 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE iSEWAGE DISPOSAL SYSTEM INSPECTION FORM cif PART A CERTIFICATION(continued) e � �n Property,Address: 229 SADDLER LN WEST BARNSTABLE,MA 02668 Owner: TODD PLUTA Date of Inspection: 2/12/02 .s 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 i'n a manner that protects the public health,safety and environment: _ The system has a septic tank`afidysoil 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 n/a "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. 4 e` 3. Other: n/a r Z Page 4 of I I E 't OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 229 SADDLER LN WEST BARNSTABLE,MA 02668 Owner: TODD PLUTA Date of Inspection: 2/12/02 '}�11 D. System Failure Criteria applicable to all systems: ,c You m indicate"yes"or"no"to eactKof the following for alLinspections: Yes No X _ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _ X Liquid depth in cesspool is 16ss than 6"below invert or available volume is less than '/2 day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped n/a. X Any portion of the SAS,cesspool or privy is below high ground water elevation. _ X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone I of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. IThis 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.I'A!ll X _ (Yes/No)The system I.}gave determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the syste hl- ails;The system owner should contact the Board of Health to determine what will be necessary to correct the failure. lic+l;i I E. Large Systems: "- To be considered a large system It e�system must serve a facility with a design now 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'sy%stems in addition to the criteria above) yes no X the system is within 400 feet of a surface drinking water supply 9 X the system is within 200 feet of a tributary to a surface drinking water supply X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well 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 �;Iem has failed.'fhe I�`vner 0r 0heralor of any I�1-ge systVnl c�nslrleaetl sl��nifir.;lnt threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The syslcln owner should contact the appropriate regiorial.office of the Department. t d Page 5 of I I „ OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM i PART B CHECKLIST Property Address: 229 SADDLER L:N WEST BARNSTABLE,MA 02668 Owner: TODD PLUTA Date of Inspection: 2/12/02 Check if the following have been done. You must indicate "yes"or"no"as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health _ X Were any of the system components pumped out in the previous two weeks X _ Has the system received normal flows in the previous two week period`? X 'Have large volumes of water been introduced to the system recently or as part of this inspection ? X Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility.of.dW6ti rig:it.ipected for signs of sewage back up? X _ Was the site inspected•for,isigns of break out'? X _ Were all system components;excluding the SAS, located on site'? X _ Were the septic tank`inanh'oles 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 ? X _ Was the facility owner(and o�cupants 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: Yes no X _ Existing information. For'example, a plan at the Board of Health. X _ Determined in thie field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR.15.302,(3)(b)`]i . .z fl!y !n 8 5 Page 6 of 11 i OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 229 SADDLER LN WEST BARNSTABLE,MA 02668 Owner: TODD PLUTA Date of Inspection: 2/12/02 i �? "JLOW CONDITIONS RESIDENTIAL • r Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CIv1R Ii.203 (for example: 1 10 gpd x#of bedrooms): 330 Number of current residents: 1 Does residence have a garbage grin& '(yes or no): NO Is laundry on a separate sewage syste'il'(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no):� Seasonal use: (yes or no): NO Water meter readings, if available(last,2'years usage(gpd)): Wx Sump pump(yes or no): NO 2.00 1 — 31 c 00o Last date of occupancy: n/a COMMERCIAL/INDUSTRIAL Type of establishment: n/a Design flow(based on 310 CMR 15.203): n/agpd Basis of design flow(seats/persons/sgft,etc.): n/a Grease trap present(yes or no): NO Industrial waste holding tank present(yes or no): NO Non-sanitary waste discharged to the Title 5 system(yes or no): NO Water meter readings, if available: n/a. Last date of occupancy/use: n/a OTHER(describe): n/a h 'GENERAL INFORMATION Pumping Records Source of information: n/a Was system pumped as part of the.inspYe�ction(yes or no): NO If yes,volume pumped: n/agallons--.How was quantity pumped determined? n/a Reason for pumping: n/a : r .t. TYPE OF SYSTEM X Septic tank,distribution box,soil absorption system _Single cesspool : _Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records, if any) _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): n/a Approximate age of all components;,date installed(if known)and source of information: 12 YEARS BY OWNER Were sewage odors detected wheii au:.riving at the site(yes or no): NO s i� _' I Page 7 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 229 SADDLER LN WEST BARNSTABLE,MA 02668 Owner: TODD PLUTA Date of Inspection: 2/12/02 BUILDING SEWER(locate on site plan) Depth below grade: 8" Materials of construction:_cast iron X40 PVC_other(explain): n/a Distance from private water supply well or suction line: n/a Comments(on condition of joints,venting,evidence of leakage,etc.): TOWN WATER SEPTIC TANK: X(locate on site plan) Depth below grade: 2" Material of construction: Xconcrete_metal_fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a Ns i?. &'confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: 1000G L 8' 6" H 5V",,W$' 10111' Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle:32" Scum thickness:0" Distance from top of scum to top of outlet tee or baffle: 6" Distance fi-om bottom of scum to bottom'of outlet tee or baffle: 18" How were dimensions determined: 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.): SEPTIC SYSTEM FAILS. LEACH PIT IS FULL OVER PIPES. GREASE TRAP:_(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other.(explain): n/a Dimensions: n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping: n/a Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc): n/a t4 L+ i)i Itl A � t °I 7 Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 229 SADDLER LN WEST BARNSTABLE,MA 02668 Owner: TODD PLUTA Date of Inspection: 2/12/02 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) t, Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Capacity: n/a gallons Design Flow: n/a gallons/day Alarm present(yes or no): N/A Alarm level: N/A Alarm in working order(yes or no): NO Date of last pumping: n/a Comments(condition of alarm and float switches,etc.): n/a 4 DISTRIBUTION BOX: X(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: OVER PIPE Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): D-BOX IS STRUCTURALLY SOUND. PUMP CHAMBER:_(locate on site plan) Pumps in working order(yes or no): NO Alarms in working order(yes or no):NO Comments(note condition of pump chaW.ber,condition of pumps and appurtenances, etc.): n/a � 5 4: t i Q Page 9 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 229 SADDLER LN WEST BARNSTABLE,MA 02668 Owner: TODD PLUTA Date of Inspection: 2/12/02 SOIL ABSORPTION SYSTEM (SAS):,,X (locate on site plan,excavation not required) If SAS not located explain why: n/a Type 1000 GAL 6' X 6' leaching pits, number: 1 n/a leaching chambers, number: n/a n/a leaching galleries, number: n/a n/a leaching trenches, number, length: n/a n/a leaching fields, number: n/a n/a overflow cesspool, number: n/a n/a , innovative/alternative system Type/name of technology: n/a i Comments(note condition of sohl19signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.): LEACH PIT IS FULL OVER PIPES. BOTTOM IS AT 81. CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) i } 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 or no): NO 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 ti . . Page 10 of 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 229 SADDLER LN WEST BARNSTABLE,MA 02668 Owner: TODD PLUTA Date of Inspection: 2/12/02 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. p � 6 C 0 4 AA 31 ,z A8 D CA ►2 ;.i f;. in Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 229 SADDLER'LN WEST BARNSTABLE,MA 02668 Owner: TODD PLUTA Date of Inspection: 2/12/02 P" SITE EXAM _Slope _Surface water _Check cellar Shallow wells Estimated depth to ground water 12 +feet Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record- If checked,date of design plan reviewed: n/a YES Observed site(abutting property/observation,hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a NO Checked with local excavators, installers-(attach documentation) NO Accessed USGS database-.explain: n/a r You must describe how you established`the high ground water elevation: HAND AUGER- 12+ FT. 4 lJl�1�'e i I 4- t { - ' TOWN OF BARNSTABL'E C i Lint ON 017 r74 DD j � ).,,A) SEWAGE # 3 VILLiC �ASS E _ ESSOR S AP & LOT INSTALLER'S NAME & PHONE NO. O��GI�Af r:dc ("'big) 70) SEPTIC TANK CAPACITY 1,06 LEACHING FACILITY:(type) -SW Gaf Ditt AX11,S (size) 13X� NO. OF BEDROOMS .3 PRIVATE WELL OR PUBLIO WATER BUILDER OR OWNER T&Qa_J,k)10 .DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No E /! q,peGT a CA avz>o-ot) r q? �`�,` A ° �' 6 —� c No. ! Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Zfppricatton for �Dtgogar *p5tem Con.5truction Vermit Application for a Permit to Construct( )Repair( )Upgrade(VI) ( ) ❑Complete System ❑Individual Components Location Address or Lot No. a Aq Owner's Name,Address and Tel.No. Assessor's Map/Parcel +�2 s� , {,30� J W, Installer's Name,Address,and Tel.No. O` Designer's Name,Address and Tel.No. � lst�llG ►ddnaR�� $k 1 P.v, U 1-7 Type of Building: Dwelling No.of Bedrooms 3 Lot Size 1Vd y_7 sq.ft. Garbage Grinder( ) Other Type of Building �"o. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 110 gallons per day. Calculated daily flow 336 gallons. Plan Date I g a- Number of sheets I Revision Date Title Size of Septic Tank 1000 Type of S.A.S. Description of Soil 3MA., 4 t9uh Nature of Repairs or Alterations(Answer when applicable) 51ea, i02!Ding 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 Certifi- cate of Compliance has been issued by this Board of Health. Aj Signed " Date J ,l� Application Approved bel Date Application Disapproved for the following reasons Permit No.,--,'010 `��� `� Date Issued "No. L! LJ��.r +�i'"�V ry �y¢ Fee Entered in computer: TH9 COMMONWEALTH OF MASSACHUSETTS , Yes ' PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS Zippricatid'n for ]Digpogar *pgtem Con! trurtion Permit Application for a Permit to Construct( )Repair( )Upgrade(/Abandon( ) ❑Complete System El Individual Components Location Address or Lot No. a pZq (���� � Y►'1,y Owner's Name,Address and Tel.No. Assessor's Map/Parcel ,.' J a , V+ 51 AD+30 * ,W Installer's Name,Address,and Tel.No. 9.01 OAf, Designer's Name,Address and Tel.No. 1J AQ(^ et j4aUR4CQ1 -U 1 P.0. 417 ,YAC,. Scr b V 3;t Slob Type of Building: 1k,, Dwelling No.of Bedro ms 3 Lot Size 19g4W7sq.ft. Garbage Grinder( ) Other Type of Building " o.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 1 1 O gallons per day. Calculated daily flow 330 gallons. Plan Date �i II 21 y Number of sheets , Revision Date Title Size of Septic Tank 1000 Type of S.A.S. Description of Soil —%121 o, ". Nature of Repairs or Alterations(Answer when applicable)�A o-�J/-&Q4t.A,_ Date last inspected- Agreement: A reement: 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 Certifi- cate of Compliance has been issued by this Board of Health. 1 Signed ©' � Date Application Approved b _,. --Date—._mac— rtfl i' Application Disapproved for the following reasons Permit No. Date Issued '' --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance , THIS IS TO CERTIFY,that the On-site Sewa$ee Disposal System Constructed( )'Repaired ( )Upgraded(✓) Abandoned( )by CA C at has been'constructed in accordance with the provisions of Title 5 and the for Disposal System Construction PenOf i!�`�- 9gC,:9 dated Installer A, n-.4&kf.M AAL O Designer dill PBOA.t .dC, The issua a of this�erm shall not be construed as a guarantee that the syste)) ill fun/c�tion as desig led Date �.(1)4 Inspector, (, . L)" !l. �r..�,G_�' ,�� ------------------------ `"•� No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Migpogal *pgtem Congtruction Permit Permission is hereby granted to Construct( )Repair( )Upgrade(/)Ab ndon( ) System located at ;a ag and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with.Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this it. Date: �' '� _L�ze� Approve� by i a TOWN OF BARNSTABL:E LOCATION •-c2017 5#4DD kelt J A) SEWAGE # 3 VILLAGE ,I&SI 1 4' 44 (— ASSESSOR'S MAP & LOT 1 Sd—057 y .Q- INSTALLER'S NAME & PHONE NO.,�) ,®` �a t�L;„l JAC D2-49 9"7 SEPTIC TANK CAPACITY 1,Q08 G4( LEACHING FACILITY:(type) o2-S'X 641 Da/rye (size) NO. OF BEDROOMS 3 PRIVATE WELL OR PUBLIC WATFR y BUILDER OR OWNER w _ —� .DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No n F y jDo� 44t ��ox� � o i A Or No...71---•_L.V-- f VV Fizz.....A...-........ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH © TOWN OF BARNSTABLE Applutt#iun fur Disposal Works Tonstrurtiun Famit Application is hereby made for a Permit to Construct (tl) or Repair ( ) an Individual Sewage Disposal System at: 'W��'Z �� , Goa �9T1.,J �}Qc��_......._... ....... ..�'. ......_ - ...._....._....-L . ............ .__... ----------...... Location-Address or Lo No. � ��Vwn r �a�p Address/y' �l � .�•� C�7�?!? ! �!` ................. P____ f�... .... `.. ...../.....`. T._. Installer Address dType of Building Size Lot...... -___)-"7.Sq. feetl. V Dwelling—No. of Bedrooms.__..._.. Expansion Attic ( ) Garbage Grinder ( ) '4 Other—Type of Building No. of persons____________________________ Showers — Cafeteria a' Other fixtures ---------------------------------- ----- W Design Flow..........����........................gallons per person per day. Total daily flow......... ��__ ................gallons. WSeptic Tank—Liquid ca.pacrt ___.P gallons Length_-�__.____ Width------ ..._. Diameter________________ Depth_, x Disposal Trench—No..................... Width.......t............ Total Length____-_----.---_- Total leaching area..........._........sq. ft. Seepage Pit No----/--------------✓- Diameter.../Z........ Depth below inlet....--------- Total leaching area._.�?_o!_l...s .. Z Other Distribution box ( 4) Dosin tank ( ) 11 7 Percolation Test Results Performed byf�aw .__. ,�` _.....g ----- Date.... a Test Pit No. l Z-_..minutes per inch Depth of Test Pit----- .... Depth to ground water------------------- Test Pit No. 2.'�.2—_minutesper inch Depth of Test Pit.,-:�Q_y. Depth to ground water------------y......... --------------------------------•------------•-••-------......-----•------.. -•-••••--....._......................................................... ODescription of Soil-------- ? 7...._. .� ....... ------------------------------------------------------------------------ x U ------------------------------------------- ----------------------------------------- ---------- ------------------------------ ------------------------------------W -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- UNature of Repairs or Alterations—Answer when applicable................................................................................................ ---------------------------------------------------------------------------------------•------------------------------------...------------------------------------..............----•---•••••••--.----- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compl' nce has been issued by the b9,ard of health. Signed .......... ' -7 .......... re Application Approved By ........... ----- . ... V� ..- ---------------------------- ------------------------------ ------ ------e ..-. � Application Disapproved for the following reasons- ----------------------------------------------------------------------------................--------------------------------------- ---------------- ------------------------------------- ----------------------------------------------------..................... -------------....-------------- --.....---------------. ......---------- --------------------- Dare PermitNo. ............l.. - l--...-----------------....---- Issued ----------------...........----------------------_------ ...... Dare T. Fps.. w...:r_ THE COMMONWEALTH OF MASSACHUSETTS F I' BOARD OF HEALTH O TOWN OF BARNSTABLE A Iiration•f nr Disposal Works Tonstrnr#ilan nmi# Application is hereby made for a Permit to Construct (�or Repair ( ) an Individual Sewage Disposal System at: Location-Address �// or LoiDNo . �'�.�.A.._ .. �".•_..._...p... ------------------------ `��j�- -R��,/_. --T��'.6 "' .�'�s... ... Owner i6 Address � .sa ci>Z -`.&-----.-.-- [� r .../1` ... !e�....'!.�?lr!�''�.--._.`'/-�."7---._--- nstaller Address Type of Building Size Lot... _1� � _... feet 4- U Dwelling—No. of Bedrooms............ ----------------------------Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons-__.•________ ____________ Showers — Cafeteria p•l Other fixtures ---------------------------•------ ------- W Design Flow..........7�.55------------------------gallons per person per day: Total daily flow........... _ - --------------gallons. WSeptic Tank—Liquid ca.pacity/0_gejallons Length_.,_..•.._ Width------- Diameter________________ Depth__�5,�_...._. x Disposal Trench—No. .................... Width......._............ Total Length--------------__.... Total leaching area.....................sq. ft. Seepage Pit No.___F-------______________ Diameter.. _ _------- Depth below inlet____ ._..... Total leaching area. �`¢/s9 Z Other Distribution box ( �' osing tank ( ) l•/�� ; '-' Percolation Test Results Performed b ,_" Y,,V-6'-,-,r•J----41_`Az -s Date..... T �....s.. Test Pit No. 1 _._minutes per inch Depth of Test Pit----- 4_ Depth to ground/wate7s fs, Test Pit No. 2__ _ __minutes per inch Depth of Test Pit_ __". Depth to ground water----------;_y_...._... ' ------------------------------- ---•------------•---•----•.----- -------•---- .............._...._..-----------•-----------••--------------••--•-•-- Description of Soil........-_�-- ----•. -r- - ��= ---- '� G'''t -------------------------------------------------------•-•------------- x v .--------------------•-------•-------------•--------••--------------•-•-•----•-----••----------------•••-------•---------------------•---•------•--------•----•---•------••--------------•--•-•--•---•-•. -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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 TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by She board of health. Si ned / /Y --. ... t . Application Approved By --------------- ApplicationDisapproved forth fo g reasons- ---------------------------------------------------------------------------------------------------------------------------------------- ............._........-------------.........-------------------------------------'------_------------------------------......------....._------------------ ------- -------------- — . --- ------------ -are PermitNo. .........?. /-`----------------------------------- Issued .----------------------.o�.e..----------------------- ----...-- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Ce>r#ifira e of Complianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( /) or Repaired ( ) by ....................... .. ................-------------- -----------........... Installer at ... `� -- ... --- -- --- ---- - -- has been instal e-(-- i accorda ce with the provisio�645o The State Edvirdnmenta Co e as de�eribed in the application for Disposal Works Construction Permit No. --------�-.-.-.�...--..))---- ---------- dated ----...---.-.-------.-------------..--..--.----- ISSUANCE OF THIS CERTIFICATE SHALL NOT BE �NSTRUD AS A GUARAT THAT THE �. SYSTEM WILL FUNCTION SATISFACTORY.' DATE-------------------------------------------------------------- � Inspector ---------rL� �44 -- THEVv ------------------------ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No... ....... .... ... FEE--- - Disposal Works Tuntrwtiott 1hrutit Permission is hereby granted = n, a ---------------------------------------------•--• to Construct) or Repair ( ) an Inkwidoal Sewage Disposal System as shown on the application for Disposal Works Construction Permit No'?/-:,ll.__._._ Dated----------------------------------------- _ ----------------------oarJd of Health -� ,�------------------------------------ k FORM 36508 HOBBS IN WARF,�EN,ING..PUBLISHERS I` WEST BARNSTABLE 0 \�\ \ ROTCHURCH ST. P PR,�EEt 2 9 N OAK 12" 69 4p.3 „ \ 88 \ rR '71NGSR R�C/TF BENCHMARK:. 00 94 6 \ \ o LqN \ v E 6 TOP OF p� ca GALVANIZIED SPIKE �j� � �,,• 9p \ / —+ oELEV.=95.00 (GISt STONE N 58 12„ LOCUS I — OAK \ 13p \ m ADDLER -' 00 S NE N \ \ �� o to o /joJ/ se 96 \ ��� Y,BASIN v REMOVE EXISTING S.A.S. _� 96 //�X 32 5' � ®� LOCUS MAP AND D—BOX PER TITLE 5 ?s �ue, ____ � 19 \ LOCUS INFORMATION J �.3�• O �12 _ = Q / \ PLAN REF: 420/96 & PENDING LCP 38261 , O'�/0 OAK _ _ \ \ TITLE REF: 21030/37 PARCEL ID: MAP 152 PAR. 51 NOT IN STATE ZONE I I O �C Rqrq� _ ZONE: "RF" TCF=99.00 _ P 52C 051D\ 0 C / FLOOD ZONE: PANEL: 250001-0015-C DATED:OS 19 85 .- 6'- % _ _ -�� , AREA=14,896t S.F. �J / / SEPTIC SYSTEM -' .9 ==-_ #229 \ / REPAIR PLAN I _ __ 3-BEDROOM PARCEL 52/054D: �c��, __=DWELLING -_ �W LOCATED AT: � = G G CB/DH / #229 SADDLER LANE // I WEST BARNSTABLE, MA. -� A - _ _ ^ PREPARED FOR os �� _- / P(33 43 AARON & SARAH o �i441 ROSE MARCH 28, 2011 (*\C.B A SI N I ®F FP PARCEL ID: \ �lyq�T 7 o� EDWARD 152/050 / \\ 9j- \ A. STONE No. 28980 PGA Z O41 T s Gj �c�`?, \ c0 Z Aj 0 FLOOR PLAN 41�44 V E. A . S. QvoQQ � SURVEY, INC. ary O 141 ROUTE 6A GRAPHIC SCALE �� Q SALT POND BUILDING ,. P.O. BOX 1729 20 0 10 20 40 80 SANDWICH, MA. 02563 ( IN FEET ) BUS:(508)888-3619 CELL:(508)527-3600 1 inch = 20 ft SHEET 1 OF 2 J 1314 TOP OF FOUNDATION EL=99.00 4" SCHEDULE 40 P.V.C. OBSERVATION PORTS 10.6' MIN. PITCH 1/8" PER FOOT W/SCREWCAPS TO GRADE OUTSIDE END UNITS EL=98.0 EL= 97.6 EL= 96.5 ,,,,,,,,,,,,,,,. EL= 96.2 nnn " EL= 97.2 s" MAX. 6"..MAk: 6 MAX. :::::::::::: :::,,,,::.:.,,,,,..,,,,,,, ,,.,, ::c::: i;i;; ;, ADD RISER ADD RISER �Vry CLEAN SAND FILL CONC. AtF PER 310 CMR 15.255 RISER LEVEL 2.,V INVERT BETWEEN AND TO A MIN. OF 6" 2.8' �Cv 10.6' S=.11 FOR 2' LONGEST RUN EL= 94.06 OVER UNITS h oJ� FLOW LINE zS= .09 ADD -J 13.0' S=.01 �° EL= 94.4 �S EL=97.5 110" INVERT INVERT "� I LA Ll LA �° " I L INVERT EL=96.32 MIN 14 IEL=NVERT 96.15 INVERT 12 (EXIST.) EL= 94.36 6" SUMP EL=94.19 8" INVERT 4' GAS (EXIST.) EL= 93.4 (EXIST.) BAFFLE 6' BASE OF MECHANICALLY COMPACTED SAND 32.0' PROP. DB3 24-(H-10)QUICK 4 STANDARD PLUS INFILTRATORS DISTRIBUTION SAVE EXISTING BOX W/"T" (34"W X 48"L X 12"H) EACH 1 ,000 GALLON TANK STONELESS SOIL ABSORBTION SYSTEM (S.A.S.) z (BED FORMATION) 8.5 X 32 STRIPOUT(18.5 X 42') PROFILE OF `G^ f- 34" CLEAN SAND FILL :��ti o SEWAGE DISPOSAL SYSTEM Q°� N ZQ68 `i (NOT TO SCALE) y $" C S I CERTIFY THAT I AM CURRENTLY APPROVED BY THE DEPARTMENT OF END VIEW GENERAL NOTES ENVIRONMENTAL PROTECTION PURSUANT TO 310 CMR 15.017 TO CONDUCT BOTTOM TEST HOLE ® ELEV.= 83.8 SOIL EVALUATIONS AND THAT THE ABOVE ANALYSIS HAS BEEN PERFORMED NO GROUNDWATER/NO MOTTLES 1. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. BY ME CONSISTENT WITH THE REQUIRED TRAINING, EXPERTISE, AND EXPERIENCE TITLE 5 AND THE TOWN OF BARNSTABLE RULES AND REGULATIONS DESCRIBED IN 310 CMR 15.017. 1 FURTHER CERTIFY THAT THE RESULTS OF MY FOR SUBSURFACE DISPOSAL OF SEWERAGE. SOIL EVALUATION, AS INDICATED ON THE ATTACHED SOIL EVALUATION FORM, 2. AT LEAST ONE ACCESS PORT OVER TANK TEES SHALL BE ARE ACC TE AND�IN ACCORDANCE WITH 310 CMR 15.100 THROUGH 15.107. DESIGN DATA ACCESSIBLE WITHIN 6" OF FINISH GRADE, WITH ANY REMAINING C-N. ACCESS PORTS BROUGHT TO WITHIN 6" OF FINISH GRADE. ` 3. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE .F � � NUMBER OF BEDROOMS.........3----- CAPABLE OF WITHSTANDING H-10 LOADING UNLESS THEY ARE EDWARD A. STONE, CERTIFIED SOIL EVALUATOR GARBAGE DISPOSAL................. -- UNDER OR WITHIN 10' OF DRIVES OR PARKING AREAS THEN THEY TOTAL ESTIMATED FLOW MUST WITHSTAND H-20 LOADING. _ 330 4. THE EXCAVATION CONTRACTOR SHALL VERIFY THE LOCATION TEST PIT RESULTS: P 13 2 2 0 (110 GAL./BR./DAY X 3 BR.) OF ALL UTILITIES PRIOR TO ANY EXCAVATION. 330GPD X 200% = 660 GAL 5. ANY MASONRY UNITS USED TO BRING COVERS TO GRADE SOIL TEST DATE: MAR. 17, 2011 USE EXIST. 1000 GAL. TANK OR WITHIN 6' OF GRADE SHALL BE MORTARED IN PLACE. INSTALL: 6. FINISH GRADE SHALL HAVE A MINIMUM OF 2% GRADE B.O.H. AGENT: DAVE STANTON 24 (H-10)QUICK4 STANDARD PLUS INFILTRATORS (34"W X 48"L X 12"H) OVER THE S.A.S. AND DISTRIBUTION BOX. SOIL EVALUATOR: EDWARD A. STONE AND BACKFILL WITH CLEAN SAND FILL PER 310 CMR 15.255 7. SEPTIC TANK STRUCTED OF SCHEDULE 40 PVC HALL EXTEND A MARY TEES SHALL BE IINIMUM OF 6" ABOVE 8.5 X 32 STRIPOUT 18.5 X 42 BACKHOE: JOEY DeBARROS ( ' ') W ' '/ ( ) THE FLOW LINE AND SHALL BE ON THE CENTERLINE AND LOCATED DIRECTLY UNDER THE CLEANOUT MANHOLES. SOIL CLASSIFICATION................_-�---- 8. THE INLET PIPE INVERT ELEVATION SHALL BE NO LESS THAN TH#1 EL.=96.8 SIEVE TEST @96��<2MIN./IN. *DESIGN PERCOLATION RATE..... <2-M1N,/B. 2 INCHES NOR MORE THAN 3 INCHES ABOVE THE INVERT EFFLUENT LOADING RATE.........- .74--- 9. ELEVS ION O THESOUTLEHAVEEA MINIMUM COVER OF 9 INCHES. ELEV. DEPTH (IN.) HORIZON TEXTURE COLOR MOTTLING OTHER REQUIRED LEACHING CAPACITY.....330 GA�DAY 10. THE OUTLET SANITARY TEE SHALL BE EQUIPPED WITH A GAS 95.3 0 -18 FILL LEACHING CAPACITY PROVIDED.....336 GAL7 BAFFLE, 4 INCHES IN DIAMETER AND CONTRUCTED OF 4" PVC. 95.1 18"-20" AEO LOAMY SAND 10YR4 3-5 1 --- - (3) ROWS OF (8)INFILTRATORS X 4.73 S.F./L.F. 11. ALL PIPES SHALL BE SCHEDULE 40 PVC SEWER PIPE AND 6 5YR5ND 7 SA .3 20"-42" B LOAMY FIRST TWO FEET OUT OF THE DISTRIBUTION BOX SHALL 93. ----- 96 L.F. X 4.73 S.F./L.F.= 454 S.F. BE LEVEL. 88.8 42"-96" Cl SANDY LOAM 10YR6/6 ----- ------ 454 S.F. X .74 GPD./S.F.= 336 GPD 12 CHANGES OR TO EAS SURVEY, C VININS TO SEPTIC FOR B.0 H. AND DESIGN 84.8 96"-144 DESIGN QUIRE NOTIFICATION '. C2 MED./COARSE SANC 2.5Y7/6 ----- ----- 336 GPD PROVIDED - 330 GPD REQUIRED = 6 GPD RESERVE ENGINEERS REVIEW AND APPROVAL. 13. NEIGHBORHOOD SERVICED BY TOWN WATER NO GROUNDWATER/NO MOTTLES DOWNCAPE ENGINEERING SIEVE TEST ANALYSIS TH#2 EL.= 95.8 \J�%OF CONSTRUCTION NOTES: ELEV. DEPTH (IN.) HORIZON TEXTURE COLOR MOTTLING OTHER �s```� qcy SEPTIC SYSTEM DETAIL PAGE / 94.5 0'-16 FILL o DAVID 1. CONTRACTORS INSTALLERS SHALL VERIFY GRADES AND � �� � ELEVATIONS AND SITE CONDITIONS PRIOR TO COMMENCING � 229 SADDLER ROAD WORK ON THE SITE. 94.1 16"-20" AEO LOAMY SAND 10YR4 3-5 1 ---- FAH R W. BARNSTABLE, MA. 2. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE 92.5 20"-40" B LOAMY SAND .7.5YR5 6 ----- WITH DEEDED OR ZONING REGULATIONS. OWNER / APPLICANT 87.8 40"-96" ClSANDY LOAM 10YR6 6 G� R� MARCH 28, 2011 IS TO OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. / ----- ------ ssE 3. ALL SYSTEM COMPONENTS SHALL BE MARKED WITH MAGNETIC MARKING 83.8 96"-144" C2 MED/COARSE SAND 2.5Y7/6 ----- ----- sq I A \Pa TAPE OR A COMPARABLE MEANS. NO GROUNDWATER/NO MOTTLES SHEET 2 OF 2 J# 1314 �-. t"o 7 �� \ ` TEST HOLE LOG DATE: \ SOIL EVALUATOR: til. d �fOUIG.�c CSC WITNESS: O, Sr-gyT�, ,�,��acr-✓ ��✓T PERC RATE: 0 � " yc</a S9� �J G3 13Z" V �X DESIGN DATA Q \ \ DAILY FLOW: (3) BDRMS. x 110 GPD = v GPD \ 2 SEPTIC TANK: 330 GPD x 200% = 4-'4c GPD U \ USE:/p v o GALLON PRECAST SEPTIC TANK LEACHING FACILITY: USE'.'-�Z� S XB,($�.r`Z,^— So a Qv.0 t'yccJECL S n k 3 / 7 ' o,� .s�� � I� \ CAPACITY: v \ SIDEWALL: �.S BOTTOM: /3/X 7-:5�/< o,2 5/= Z70,.S TOTAL: 35.3, �o r Z > 3a 1 3 ,49 Q DANIEE E. �'yG NOTES: iS' �ti .+, BRAMAN CIVIL r 1. ALL PIPE TO BE 4" DIA. SCH 40 PVC. ti �No,326 2. PIPE TO BE LAID LEVEL FOR 2' OUT OF DISTRIBUTION 15 V 6C N BOX. �?' 3. RAISE ALL APPLICABLE MANHOLE COVERS TO WITHIN aaj �V�f �1STF V\�� 6" OF FINISH GRADE. � .Ya :. .,5 ASS/ONA1 4. SEPTIC SYSTEM IS NOT DESIGNED FOR THE USE OF A 4,1 v C;� GARBAGE DISPOSAL. 5. SEPTIC TANK AND DISTRIBUTION BOX TO BE INSTALLED Y 6 �! ON A 6" LAYER OF STONE. 6. INSTALL GAS BAFFLE IN OUTLET TEE. ;t 2" LAYER OF 3/8" PEASTONE OVER ----------- ----'-i h"-14" DOUBLE ;=KED STONE .... ALL AROUND TOP OF FOUND. 0- 00>< @ ELEV. (oo,o0 /ooa *sr - . -. - � •� S�3 S � SEPTIC SYSTEM PROFILE Sz,3 SITE SEWAGE PLAN FOR GENERAL NOTES ZZ� �f��OG�2 G� GcJ i t���QiS/1j A,(�CyG 1. CONTRACTOR TO BE RESPONSIBLE FOR THE LOCATION / OF ALL UTILITIES, ABOVE AND UNDERGROUND, PRIOR TO ANY EXCAVATION OR CONSTRUCTION. PREPARED FOR 2. SEPTIC SYSTEM TO BE INSTALLED IN COMPLIANCE WITH 310 CMR 15. 00: TITLE V. 3. THIS PLAN IS NOT TO BE USED FOR PROPERTY LINE DETERMINATION. DATE: Zao Z SCALE : 1" = 20 4. ALL DISTURBED AREAS TO LOAMED AND SEEDED. 5. CONTRACTOR TO PROVIDE 24 HOUR NOTICE FOR ANY REQUIRED INSPECTIONS. WELLER & ASSOCIATES 1645 FALMOUTH RD. SUITE 4C P.O. BOX 417 CENTERVILLE, MA 02632 TEL: (508) 775-0735 FAX: (508) 775-0754 APPROVED BY: T� �� �hlp�T•k� G�„l'1 w�Z. O Co .p J•CEO 1,J O Ta &X77&/l/D FALL APF'L/CABLE — -- — — — — e X/S7-/r79 9rOUr7O' /-o,ci le � � T- � P � VE �2T. MAti/-lOL E CO VE.e S To WIT141 A J ' F L.01A J —r- �mlrt. % `/�er�� , FLOW Z.. lager of scHED �-G F"V c. ©/e ('rn/n1rnur7 ! Y" Per- f'oof') /a• �eas-fone `,` � EQulqL To SEPTIC PIPE To 86- a a- (�VEL FOR q'-o- I` �O Ca LIQUID ! LeVEL D//S7- B oX � I,a l®oo GAL. SEPTIC 7-,glJ G S H PlT I ti I 0 - »D Dot a r - r-)Ol HouS� DATA -ir> TEST 8Y• I - - _ - .!' Iri.v`t` r '�---- " �` r ?rP � ���I�-� O � V,.I-. ,�,,r-,GEC. /•�!'i 7-G. �l '` 7/Jul. ---------- 1-- - --- --- - ---- -- \ 0 s r _ v� W Ju 1 I 5IDEWt9L1-: G.P.D. E307-roM: ME�+L1r U� TOT/9 L, . �ln. I G.P.D. ✓1 �.3 8d-'' � . (I� d-'>C G 1..�.^:�-1 f I I lJ ! 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