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0048 SCORTON HILL ROAD - Health
d` R oe 48 SCORTON HILL ROA D A= 111 020 e o , 0 -tOWN PI BARNSTABLB LACA`nn* E to r <M I i , &EWA.(.lE#1' Ai5fi3S�1t'S MAP LOT ©.2 OWTAI NAI j.LPROidB AID. LBAQiB+tt off:. . tNElptl`��$�t19$B6tWB��� P�vaiVV' 'Sn ►Wplt' �3loow of-my c►b �t�OEM ft �facilitYl-: iethind o LeaclsthITfiv{ a east thin Not pg hdciCc�Y} - a 0 3 V Y A,3 - 97' 90- 07 �4- 37 ' I TOWN OF BARNSTABLE LOCATION 115cor6 Mk SEWAGE# 2420 �O VILLAGE U), RoAS��. ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. ER%C_Sjt�V - SEPTIC TANK CAPACITY /560 1 � LEACHING FACILITY:(type) C1M�1 ��B Q � (size) JZ,� NO.OF BEDROOMS OWNER C C,� ' k v, PERMIT DATE: I.Z COMPLIANCE DATE: (� u 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 � , oftNErpN� Town of Barnstable h,... U.S.POSTAGE>>PITNEY6owEs O � Public Health Division Am==w �, BARNSI'ABLE. MA55. � 200 Main Street plEO nn+w0 Hyannis,MA 02601 .y 0ZIP III2 02601 `'' 00L�.Ao!) 00003.7.3143 SEP. 1.7, 27020. 7D15 173D ODD1 4987 7961 1 NIXIE 21.2 DE I 3-f-" iINC j A!Y.ME .!.NC Q.r 2. �t ag. ;2. .ca raw v. a� u.w �st.,2 w 1-1 i •..:u. � ttt� _tIf,aRltlt � � ' r S. ��� e r r;�a �; x• _ �. F• k" f � a � �' ti • • • • • • • Complete items 1,2,and 3. A. signature ■ Print your name and address on the reverse X El Agent so that we can return the card to you. 1 ❑Addressee ■ Attach this card to the back of the mailpiece, B. Received by(Printed Name) C. Date of Delivery or on the front if space permits. 1_.-Article_Addressed to:_i_ D. Is delivery address different from item 1? ❑Yes -'� - delivery address below: ❑No KEARNEY, MARGARET _11851 MOSS ROCK COURT NV MARKET, MD 21774 ❑Priority Mail Express@ U Adun"si nacureJ ❑Registered MaiITM II I�III�I I II ICI I III III III I I I III 1111111 11RI� K13d ult ed n a Ir Restricted Delivery ❑RReeg setry e ere Mail Restricted 9590 9402 5849 0038 3917 16 ❑ ertified Mail Restricted Delivery I Return e Mechand sept for Collect on Delivery 2. Article Number(Transfer from seCvice_iabeh ❑Collect on Delivery Restricted Delivery Signature Confirmation T"' _ 'iI ❑Signature Confirmation 7 015 1730 0001 4987 79 61 iil Restricted Delivery Restricted Delivery PS Form 3811,July 2015 PSN 7530-02-000-9053 F omestiS Return Receipt I USPS TRACKING# ,I First-Class Mail I USPS Postage&Fees Paid Permit No.G-10 9590 9402 5849 0038 3917 16 United States •Sender:Please print your name,address,and ZIP+4®in this box* Postal Service �. a g Town of Barnstable ! Health Division 200 Main Street C Hyannis,MA 02601 f � I I I I l I I �sKE Ire Town of Barnstable Inspectional Services Department �a MASS. Public Health Division � ass. �, 4�,,rfD �A�m 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4987 7961 September 17, 2020 KEARNEY, MARGARET 11851 MOSS ROCK COURT NEW MARKET, MD 21774 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 48 Scorton Hill Road,West Barnstable, MA was inspected on 08/20/2020 by Shawn Mcelroy, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Static liquid level in the distribution box is above the outlet invert due to an overloaded or clogged SAS or cesspool. You are ordered to repair or replace the septic system within one (1)year 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 BOA OF HEALTH I-Tt o c e ,V.S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\48 Scorton Hill Road West Barnstable.doc Commonwealth of Massachusetts Title 5 Official Inspection Form it Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 48 Scorton Hill Rd r Property Address r•, Kevin Campbell Owner Owner's Name information is West Barnstable MA 02668 8-20-20 required for every page. City/Town State Zip Code Date of Inspection r. 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. A. Inspector Information Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name P.O. Box 73 Company Address East Falmouth MA 02536 City/Town State Zip Code 508-495-0905 S13971 Telephone Number License Number B. Certification I certify that:l am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000);1 have personally inspected the sewage disposal system at theproperty address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ❑ Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ® Fails 8-20-20 spe 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 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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: 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•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts �ji I Title 5 Official Inspection Form '� i► Subsurface Sewage Disposal.System Form -Not for Voluntary Assessments 48 Scorton Hill Rd Property Address Kevin Campbell Owner Owner's Name information is required for every West Barnstable MA 02668 8-20-20 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) 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: 2) 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): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 Commonwealth of Massachusetts r� fY Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 48 Scorton Hill Rd Property Address Kevin Campbell Owner Owner's Name information is required for every West Barnstable MA 02668 8-20-20 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or breakout or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y El ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ON ❑ 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): 3) 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. a. 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: t5insp.doc-rev.7/26;2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form N Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 48 Scorton Hill Rd Property Address Kevin Campbell Owner Owner's Name information is required for every West Barnstable MA 02668 8-20-20 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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. System will fail unless the Board of Health and Public Water Supplier, if an Y ( pp � Y) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 18 Commonwealth of Massachusetts fY Title 5 Official Inspection Form r�i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments U 48 Scorton Hill Rd Property Address Kevin Campbell Owner Owner's Name information is required for every West Barnstable MA 02668 8-20-20 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ® ❑ 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: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ® ❑ 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. 5) 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 CA. 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 t5insp.doc•rev.7/2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 18 Commonwealth of Massachusetts r' Title 5 Official Inspection Form C�'l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 48 Scorton Hill Rd Property Address Kevin Campbell Owner Owner's Name information is required for every West Barnstable MA 02668 8-20-20 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes"to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes" or"no"for each of the following for all inspections: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all'system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Wasthe facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form 'i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 48 Scorton Hill Rd Property Address Kevin Campbell Owner Owner's Name information is required for every West Barnstable MA 02668 8-20-20 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flowbased on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Description: Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d Well water 9 ( y g (gp ))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 8-2020Date t5insp.doc•rev.7/28.!2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form %I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 48 Scorton Hill Rd Property Address Kevin Campbell Owner Owner's Name information is required for every West Barnstable MA 02668 8-20-20 page. City/Town State Zip Code Date of Inspection D. System Information (coat.) 2. 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 Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: 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 below): 3. Pumping Records: Source of information: N/A Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form -i Subsurface Sewage Disposal System Form Not for Voluntary Assessments } o 48 Scorton Hill Rd Property Address Kevin Campbell Owner Owner's Name information is required for every West Barnstable MA 02668 8-20-20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 1984 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 22"feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Good condition. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form wa i�l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments A 1,7 Irl 48 Scorton Hill Rd Property Address Kevin Campbell Owner Owner's Name information is required for every West Barnstable MA 02668 8-20-20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 16"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other ex lain ( P ) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance. (attach a copy of certificate) El Yes ❑ No Dimensions: 1500 gal Sludge depth: 12" Distance from top of sludge to bottom of outlet tee or baffle 20" Scum thickness 1" 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" How were dimensions determined? Tape 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 is in good condition with baffles installed and no sign of leakage. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts r� Title 5 Official Inspection Form w:. C1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a 48 Scorton Hill Rd Property Address Kevin Campbell Owner Owner's Name information is required for every West Barnstable MA 02668 8-20-20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. 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.): 8. 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 t5insp.doc•rev.7/26f2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form c�li Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 48 Scorton Hill Rd Property Address Kevin Campbell Owner Owner's Name information is required for every West Barnstable MA 02668 8-20-20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank (cont.) 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 9. 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 had signs of back-up with stain lines above outlet invert. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 i Commonwealth of Massachusetts w Title 5 official Inspection Form i�i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a 48 Scorton Hill Rd Property Address Kevin Campbell Owner Owner's Name information is required for every West Barnstable MA 02668 8-20-20 page. CityTrown State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 1-1000 gal ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 Commonwealth of Massachusetts r� Title 5 Official Inspection Form �t Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 9 p Y rY 48 Scorton Hill Rd Property Address Kevin Campbell Owner Owner's Name information is required for every West Barnstable MA 02668 8-20-20 page. City/Town State Zip Code Date of Inspection D. System Information (cons.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leach pit was holding-24" of water at inspection with stain line above inlet invert and into riser. 12. 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.): i r t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 ` r Commonwealth of Massachusetts Title 5 official Inspection Form dial Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 48 Scorton Hill Rd Property Address Kevin Campbell Owner Owner's Name information is required for every West Barnstable MA 02668 8-20-20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. 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-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts rI Title 5 Official Inspection Form YIli Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 48 Scorton Hill Rd Property Address Kevin Campbell Owner Owner's Name information is required for every West Barnstable MA 02668 8-20-20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. 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 VO ' t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 Commonwealth of Massachusetts P., Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments l�bjl =. ;> 48 Scorton Hill Rd Property Address Kevin Campbell Owner Owner's Name information is required for every West Barnstable MA 02668 8-20-20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 204 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: ® Checked with local excavators, installers- (attach documentation) ® Accessed USGS database- explain: You must describe how you established the high ground water elevation: USGS and town maps show groundwater at greater than 20'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts 3 Title 5 Official Inspection Form !r�"I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 48 Scorton Hill Rd Property Address Kevin Campbell Owner Owner's Name information is required for every West Barnstable MA 02668 8-20-20 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 9pplitation for disposal 6pstem Construction Permit f Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components ` Locations Address or Lot No.q6 SCd 1 It IZL. Owner's Name,Address,and Tel.No.K i� Ca*,. lo e-t As es`sor"s Map7Parce� l` p ?-O 46 �'o,6- kv kk � W• �S�b� K"s Installer's Name,Address,anA Tel.No.JMt L-ST��� Desi er's Name,Address,and Tel.No. P , Al. Mc981 o. �'L � kwt6- oz,01, go S � - ��� c S � Type of Building: Dwelling No.of Bedrooms � Lot Size .?(09 sq.ft. Garbage Grinder( ) Other Type of Building ICt'S No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 330 gpd Design flow provided gpd Plan Date Number of sheets Z, Revision Date Title Size of Septic Tank /� q q 1. Type of S.A.S. 5~ I Z Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: ZGLO Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board o al Signed Date ljwl W Application Approved by Date I i — Z O Application Disapproved by Date for the following reasons Permit No. ) V 20 - /T Date Issued • 41 No. Fee a THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN'OF BARNSTABLE, MASSACHUSETTS Yes Rpplicatlon for Mispost at 6pstem Construction 3permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components x> Location Address or Lot No.&fb ca Hill Owner's Name,Address,and Tel.No.k 4 n C4% lot-it Assessor's Map/Parcel 111 p*q O X© Installer's Name,Address,and Tel.No. s f_IST .5 Designer's Name,Address,and Tel.No.Ne ex--t S nS, I- 8�x?F �Rsf . ?A 144-S A$J56 W-4 y ice- ��A C. Sl`"bk)%t}A h%Q. o z S:?- Type of Building: Dwelling No.of Bedrooms Lot Size N 17 698 sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date d lj/; Number of sheets ,,, Revision Date Title Size of Septic Tank P q/ i. Type of S.A.S. �506 qA Description of Soil Nature of Repairs or Alterations(Answer when applicable) to �7A ` r Date last inspected: Agreement: *- The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of"the Environmental Code and not to place the system in operation,.until a Certificate of Compliance has been issued by this Board of Ieaflth. Signed Date E 1Q Application Approved by ��--^'"1 .� Date ��� C> Application Disapproved by Date -for the following reasons Permit No. 2020 — /g Date Issued _ 3' .2-0 - -- - - - -- --- --------------------------- -- -- -- - -- - - -- ---- - THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned( )by i e1c- at i�` �, has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. ,� .1�iQ dated Installer 4ERIc- iaV"5 Designer NstAl_(L. it. Nl� #bedrooms Approved d�gn�flow -�lj gpd The issuance of this permit shall not be construed as a guarantee that the system�61 function as design d. Date �� 1 a Inspector ---- - No. _ - ci U ?J a Fee " THE COMMONWEALTH OF MASSACHUSETTS- PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Misposal *pstrm Construction i3Prmit Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon( ) System located at 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:Construction must be completed within three years of the date of this permit. Date i 2 3 - Z C) Approved by } Town of Barnstable Regulatory Services Richard V. Sea% Interim Director M Public Health Division �i639. �� Ep►�+ Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: 1 I Sewage Permit# Zd Z6 Assessor's Map\Parcel I D Designer: M �'" S G �' Installer: cg I c S`urlNs Address: �� l Address: fa '� 1 On was issued a permit to install a (date) (installer) p� septic system at �'6 ko lepnl `�� W' �Wbased on a design drawn by (address) dated (desi er) XMe, Q--/� �2/y1 S I certify that thl septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (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 designer to follow. Strip out(if required) was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed in compliance with the terms of the IAA approval letters(if applicable) OF r (In er's`Si afore) DER 1940 (Designer's Signature) (Affix ere) PLEASE RETURN TO BARN ABLE PUBLIC HEALTH D N. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\Septic\Designer Certification Form Rev 8-14-13.doc of 114E t, Town of Barnstable + BARN3fABLE, ' Inspectional Services Department ArFD MA'S A Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 4/26/19 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An "x" marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ❑ Structurally unsound septic tank or SAS O 1 YEAR DEADLINE CRITERIA Static liquid level in the distribution box is above the outlet invert due to an overloaded or clogged SAS or cesspool ❑ A portion of the SAS, cesspool, or privy is below the high groundwater elevation ❑ A portion of the cesspool is located within a Zone 1 to a public well ❑ A portion of the cesspool is located within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2) YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any "conditionally passed systems" (broken cover, relocation of a pipe, relocation of a driveway due to H-10 components, etc) ❑ Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER Repair deadline: Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc December 2,1999 Report Regarding Complaint from R.D. Kearney During a staff meeting on Tuesday November 23, 1999,I received a copy of a complaint letter from Mr. R.D.Kearney(through Thomas Geiler,Director of the Department of Health, Safety and Environmental Services)addressed to Mrs. Audrey Louchnane. The letter was dated October 22, 1999. The complainant alleged that due to collapsed 25 year old orangeberg pipe,which was connected to PVC piping and septic system components installed in May of 1996,sewage"backed-up"and caused$1560 worth of damage in his finished basement. Mr.Kearney stated in his letter that he feels the Town is responsible for$525, which represents that portion of the bill which was not covered by the insurance company. • On April 3, 1996,the original septic system was inspected by William Robinson, Sr.who determined that the system"failed." The septic septic system was owned by Joanne Bauckman. The reason for the"failed"determination was described on page three of the inspection report which reads as follows:"the static liquid level in the distribution box was above the outlet invert due to an overloaded or clogged cesspool." It did not fail due to any collapsed orangeberg pipe. A copy of the nine(9)page inspection report is available at the Health Division Office. It should be noted here that the existence of orangeberg pipe does not trigger any of the"failure criteria"in the State Environmental Code. There is no requirement to replace orangeberg pipe. • On November 23, 1999,I interviewed Health Inspector Edward Barry. He inspected the replacement septic system on May 29, 1996 and issued a certificate of compliance to Skip Macomber,a licensed septic system installer. Mr. Barry explained to me that all the new septic system components and the PVC pipes installed there were in conformance with the State Environmental Code,Title V. It should be noted here that the State Environmental Code does not require an installer to replace existing orangeberg pipe. The Code does disallow the installation of any orangeberg pipe,however. • On November 30, 1999,I telephoned Skip Macomber,the licensed septic system installer who installed the replacement septic system at this site. He stated to me that he remembers the former owner asked him not to remove the wooden deck in order to access the existing pipe. He also remembers some bushes in the area in front of the wooden deck that the former owner did not want removed. Therefore,the existing piping underneath the deck and the piping located closely adjacent to the bushes were left in the ground. • On December 2, 1999,I telephoned the complainant Mr.R.D.Kearney. According to him, the date of the sewage backed-up occurrence was on September 21, 1999,more than three(3)years after the date of the replacement of the septic system components. The new owners,Mr.R.D.Kearney and his family,moved into the home on or about July 1, 1996. Apparently,the septic system and the piping functioned properly for three years and two months. Mr.Kearney alleges that the septic system installer failed to replace the orangeberg pipe with new PVC pipe in the area closely adjacent to some bushes in front of the wooden deck. That area is located within approximately three feet away from the bulkhead foundation. I explained to Mr.Kearney that the State Environmental Code does not require the replacement of existing orangeberg pipe. The system failed due to an overloaded or clogged cesspool,which required replacement. I further explained Mr.Macomber was hired by the previous owner who requested that he save the bushes and the wooden deck. Therefore,Mr. Macomber's staff did not disturb that area close to the bulkhead foundation. I conclude,based upon the facts and information decribed above,that there was no negligence on the part of the Town of Barnstable staff in regards to this complaint. Therefore,I do not believe it would be the responsibility of the Town to reimburse Mr.Kearney$525.00 as requested. Completed By: Thomas A.McKean,R.S.,C.H.O. C� : 1 clq t�- ec-�-rfne ^� r �-�-�� Gin � Q2G -t1,'zt.J J / 1 G �� ,� ell rd�� t v F' , f ' I •i nur�A�s i r;cvu n I 4,3 rr i F I � ti �,i fi r f 11 �,, t +�! �� ,� ��� y�l .I, �I� ��6 1++111�kk 7�d ��� ��a 1�� I� k ��` �'1 I�� y f�� ,, ��� ��� ��� �i� ��� ��# ��� ��� ��� 1I� �{� ��� i� i�� �� �. f;� I� r O 7 J i TOWN OF BARNSTABLE LOCATION �'J� , Z_9A,4 !g�,� SEWAGE # VILLAGE I�f ( ASSESSOR'S MAP Cz LOT 6 Zo INSTALLER'S NAME PHONE No. c SEPTIC TANK CAPACITY !V /O'Do LEACHING FACILITYAtype) (size) /6170 NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: `22- DATE COMPLIANCE ISSUED: (L(,.,a VARIANCE GRANTED: Yes No �- r, l I �Ot O /// C )6 1 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiott for Diopooal lVor1w Tott,itrnrtion rrrmit Application is hereby made for a Permit to C•ortstruct ( ) or Repair (XX) an Individual Sewage Disposal System at: ..AB..Bccxt=-.Bill-.Rcad..klest.-]3eLmst.able••••-••••• •••----•-•--•---------••------•••••-•.....--••••-----•.....••••-•••-•••••........•••.....•••...._. Location-Address or Lot No. ...Ted--Baru�....................................................•------------- --.....--------------...---------••----........-------------•---------.........---.........------. Owner Address jIP.-M3combe. ix----------------------------------------------------------- ------------------------------------------------------------------•------------------------------- Installer Address UType of Building Size Lot............................Sq. feet �-. DwellingM No. of Bedrooms--------------3------------.---------------Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building No. of persons a g ---------------------------- P 3----...._...-------- Showers ( ) — Cafeteria ( ) d Other fixtures -------------------------------------------------------- W Design Flow............................................gallons per person per day. Total daily flow--------------------------------------------gallons. WSeptic Tank—Liquid capacity------------gallons Length---------------- Width................ Diameter................ Depth.............. x Disposal Trench—No. .................... Width.................... Total Length-------------------- Total leaching area....................sq. ft. 3 Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation t N I minutes suits Pe per Test pi o. inch Depth of Test Pit..............._-- Depth to ground water....... ................ L14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ W •.........................................................••---....•--..........._........................................................................... 0 Description of Soil........................................................................................................................................................................ v .....................Sand..&-_Isravel W U Nature of Repairs or Alterations—Answer when applicable..Omit..ceszpQols._Install.-I-71.000...gallon....... ---------------------sepuc.tank..9.-di stra butis�n..k�ax..1.-l.QOQ..gallon..leach..pit.....------..._.......--------._...-------•-•---• 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 bee iss d by the oar of health. Signed .... ..... �1/... F ! ................ ....... ....3/1./..95............. Dare Application Approved By ....... ... .............. �.�,� r,3..^. S"—...... ..—.............---.............._................---............. Dare Application Disapproved for the following reasons: ........................................................................................................................................ ....._.................................. .. ......_..........._.............. ... ... ............. ................................._............................... ............. ........................................ Dare Permit No. .......... .........�..4r......._........ Issued ............ Dare I THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE C�ex#ifirate of Tompliance THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by ................................................. 4811 !—__)r 1t on Bill Pond t^:Ies t r:ar-!1��t�ivih).? ................._......_..-.---.._............._._.............----........... at ------------------ --------.. -_................................... --.............__......................................................................... .... has been installed in accordance with the provisions of TITLE 5 ff The State Environmental Code as described in the application for Disposal Works Construction Permit No. ......7..�....... ..._.- dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. _ DATE..... ........._.... - Inspect _.. ..... .... .. .�..:......_ ................................... . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �I TOWN OF BARNSTABLE ,n 00 FEE..............No. U opooul Work.5 Tom#rudion fermi Permission is hereby granted...., ----------------------------------------------------------------------------------------------------- to Construct ) or Repair 'f"%X) an Individual Sewage Disposal System at No...........4_: 17c�)r_nt:on Nil]- Pg)�d r.;,,SL RnnI7,l..�!( 1n� 1;�5 - Street as shown on the application for Disposal Works Construction Permit No.,'..:'.._ Dated...... ..:.�� e............... ....................••••----- _ . ----------------------------------------------------- Board of Health DATE................... ..................:•1-=----._._...................... FORM 36508 HOBBS&WARREN.INC..PUBLISHERS �~ PARC►1NO, 9.5 Z: Commonwealth of Massachusettsm Executive Office of Environmental Affairs Department of `1 MAY e Environmental Protectiont". 8o, 996 Wllllam F.Weld � � S T yoxe ry Go»rnor Argso Paul Celluccl B:`Strube U.Gonrncx SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Joanne Bauckman Property Address: 48 S c o r t o n Hill Rd Address of Owner. P.O. Box 244 Date of Inspection: W.Barnstable 4-3-9 6 (If different) Name of Inspector. W.E. Robinson SR W.Barnstable 02668 Company Name,Address and Telephone Number. ( 5 0 8 ) 7 7 5-8 7 7 6 W.E. Robinson Septic Service P.O. Box 1089 Centerville MA CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: _ Passes C ditionally Passes _ eeds Further Evaluation By the Local Approving Authority Fails Inspector's Signature: Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INtTIONC SUMMARY: A, B, C,or D: A] SY PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 16.303. Any failure criteria not evaluated are indicated below. B] TEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes inspection. Indics yes, no,or not determined(Y, N,or ND). Describe basis of determination in all instances. If"not determined",explain why not) The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or exfiltration,.or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a ponforming septic tank as approved by the Board of Health. (revi'ed 11/03/95) 1 One Wlnter Street • Boston,Massachusetts 02108 s FAX(617)556-1049 a Telephone(617)292-SM ice,Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 48 Scorton Hill Rd W.Barnstable Owner. Joanne Bauckman Date of Inspection: 4-3-9 6 B)SYSTEM CONDITIONALLY PASSES(continued) Sewage backup or breakout or high static water level observed in the distribution boat is due to broken or obstructed pips(s) or due to a broken,settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(a). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed C) FURTI�ER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: i Cgnditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A WHICH WILL PROTECT THE PUBLIC HEALTH AND 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) SY TEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER,IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND 9 AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet to a surface water 1 supply or surface water supply. PP y tributary to a The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system-and is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for ooliform 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. 3) OTBER { �V\ (revised 11/03/95) 2 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(oontinued) Property Addrew 48 Scorton Hill Rd W.Barnstable Oar. Joanne Bauckman Date of Inspection: 4—3—9 6 D) SYSTEM FAILS: '-baps determined that the system violates one or more of the following failure criteria as defined in 310 Clli1a 16.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an 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 ✓/ Static liquid level in the distribution bout 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 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of tunes pumped Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. _ Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria, volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E GE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: _ 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) Tbs r or operator of any such system shall bring the system and facility into Hill compliance with the groundwater treatment program require /ts of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for farther information.. (revised 11/03/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST PropertyAddreac 48 Scorton Hill Rd W.Barnstable der. Joanne Bauckman Date of In"we"on: 4-3-9 6 Check if the following have been done: Vlumpiag information was requested of the owner,occupant,and Board of Health. _None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. /built plans have been obtained and examined. Note if they are not available with N/A. _1(l A.facility or dwelling was inspected for signs of sewage back-up. ilf//he system does not receive non-sanitary or industrial waste flow _/' he site was inspected for signs of breakout. F1All system components, excluding the Soil Absorption System, have been located on the site. Lhe septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions,depth of liquid, depth of sludge,depth of scum. size and location of the Soil Absorption System on the site has been determined based on existing information or r approximated by non-intrusive methods. `/The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub- Surface Disposal System. i (revised 11/03/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 48 Scorton Hill Rd W.Barnstable Owner. Joanne Bauckman Date of Inspection: 4-3-9 6 FLOW CONDITIONS RESIDENTIAL- Design flow:y- y Ions Number of bedrooms:_ Number of anent residents: Garbage grinder(yes or no): _ Laundry connected to system(yes or no):Y Seasonal use(yes or no): /1/ Water meter readings, if available: Last date of occupancy:—"�+ G COMMERCIAL/INDUSTRIAU Type of establishment: Design flow:, gallona/day 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: OTHER:(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and of information: System pumped as of inspection: (yes or no)_2Z- If yes,volume pumped: gallons Reason for pumping: TYPE OF SYSTEM Septic tanWdistribution box/soil absorption system cesspool LOverflow cesspool Privy Shared system(yes or no) (if yes, attach previous inspection records, if any) Other(explain) APPROXIMATE AGE of all components, date installed(if known)and source of information: by �. S Sewage odors detected when arriving at the site: (yes or no) (revised 11/03/95) 6 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 48 Scorton Hill Rd W.Barnstable Owner. Joanne Bauckman Date of Inspection: 4—3—9 6 S TANK: (locate site plan) Depth be w grade: Material f construction:_concrete_metal_FRP_other(explain) Dimensio SMp de Distance m top of sludge to bottom of outlet tee or baffle: scum from top of scum to top of outlet tee or baffle: Distance m Bottom of scum to bottom of outlet tee or baffle: Comments: (recommen tion for pumping,condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of�`lleakage,etc.) i GREA=ite (locate n) Depth below e: Material of�n:_concrete_metal_FRP—other(explain) Dimensions: Scum ess: Distance from top of scum to top of outlet tee or baffle: Distance bottom of scum to bottom of outlet tee or baffle: Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert,structural integrity, evidence of�akage,etc.) Y (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 48 Scorton Hill Rd W.Barnstable Owner. Joanne B.auckman Date of Inspection 4-3-9 6 TIGHT HOLDING TANK_ (locate on L—n: Depth below Material of co! _concrete_metal_FRP_other(explain) Dimensions: Capacity: i xallons Design flow: Rallona/day Alarm level: Comments: (condition o inlet tee,condition of alarm and float switches,etc.) I DISTRIBUTION BOX:_ (locate on arts plan) Depth of li�t/iid level above outlet invert: Comments: (note if leve)an distribution is equal,evidence of solids carryover,evidence of leakage into or out of box, etc.) PUMP CHAMBER (locate on site I; Pumps in worEing order:(yea or no) Comments: i (note condition o pump chamber, condition of pumps and appurtenances, etc.) (revised 11/03/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: - 48 S c o r to n. Hill Rd W.Ba rn s t ab l e Owner. Joanne Bauckman Date of Inspection: 4—3—9 6 SOIL ABSORPTION SYSTEM(SAS): )/ (locate on site plan,if possible;excavation not required,but may be approximated by non.intrusive methods) If not determined to be present,explain: Type: leaching pits,number:_ leaching chambers,number:_ leaching galleries,number: leaching trenches,number,length: leaching fields, number,dimensions: overflow cesspool,number: Comments: (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.) CESSPOOLS:_ (locate on site plan) Number and configuration:_„ Depth-top of liquid to inlet invert: IC c, Depth of solids layer- Depth of scum layer: R — Dimensions of cesspool: Materials of construction:_ Indication of groundwater: inflow(cesspool must be pumped as part of inspection) .0 I: ! T O �_ I_ L Commenta: (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.) 1 ` PRIVY: 4 (locate on plan) Materials construction: Depth of lids: Dimensions: Commen . (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.) l� (revised 11/03/95) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) PropertyAddrese: 48 Scorton Hill Rd W.Barnstable Owner. Joanne Bauckman Date of Inspection: 4-3-9 6 S10TCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' s f rro�-1 � l DEPTH TO GROUNDWATER Depth to groundwater.. o-0 feet \ method of determination or approximation: 0 t4 \ 1 (revised 11/03/95) 9 AMORS MAP 0 Commonwealth of Massachusetfs Executive Office of Environmental Affairs CIN M PtalV fo De artment of AY 8 Environmental Protection ° 199� WUllam F.Weld T Coxe Go»rrtor 9.ent.y U. Paul Celluccl 9 cAmmSw O»s Lt.Goa.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A - CERTIFICATION Joanne Bauckman Property Address: 48 S c o r t o n Hill Rd Address of Owner. P.O. Box 244 Date of Inspeotion: W.B a r n s t a b 1 e 4-3-9 6 (If different) Name of Inspector. W.E. Robinson SR W.Barnstable 02668 Company Name,Address and Telephone Number. ( 5 0 8) 7 7 5-8 7 7 6 W.E. Robinson Septic Service P.O. Box 1089 Centerville MA CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: _ Passes _ C ditionally Passes _ eeds Further Evaluation By the Local Approving Authority Fails Inspector's Signature: Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSP TION SUMMARY: C A,B, C,or D: AI SY PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. BI TEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes inspection- yes,yes,no,or not determined(Y,N,or ND). Describe basis of determination in all instances. If"not determined",explain why not) The septic tank is metal,cracked,structurally unsound,shows substantial infiltration or enfltration,-or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a ponforming septic tank as approved by the Board of Health. (rev eed 11/03/95) 1 Winter Street a Boston,Massachusetts 02106 a FAX(617)556-1049 a Telephone(617)292.55M �A1 Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) PropertyAddnem 48 Scorton Hill Rd W.Barnstable Owner. Joanne Bauckman Date of Inspection: 4—3—9 6 BJ SYSTEM CONDITIONALLY PASSES(continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken,settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed CJ FUR ER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: nditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the lic health,safety and the environment. 1) YSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A WHICH WILL PROTECT THE PUBLIC HEALTH AND 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) SY TEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF APPROPRIATE) D INES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND S AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and is Ism than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis 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. 9) O (revised 11/03/95) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) PropertyAddr+ess: 48 Scorton Hill Rd W.Barnstable Owner. Joanne Bauckman Date of Inspection: 4—3—9 6 DI SYSTEM FAILS: —4 'bays determined that the system violates one or more of the following failure criteria as defined in 310 CMR 16.303. IU basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an 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 ��1. _ Static liquid level is 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 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. _ Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E GE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant thrwt to public health and safety and the environment because one or more of the following conditions exist: the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply _ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area(IWPA)or a mapped Zone 11 of a public water supply well) The or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program require nts of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.. (revised 11/03/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Propert3'Address: 48 Scorton Hill Rd W.Barnstable Owner. Joanne Bauckman Date of Inspection: 4-3-9 6 Check if the following have been done: ` V limping information was requested of the owner,occupant,and Board of Health. _None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. built plans have been obtained and examined. Note if they are not available with N/A. _ez facility or dwelling was inspected for signs of sewage back-up. -/(Ie system does not receive non-sanitary or industrial waste flow �e he site was inspected for signs of breakout. VAU system components,excluding the Soil Absorption System, have been located on the site. L./The septic tank manholes were uncovered, opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of construction, dimensions, depth of liquid,depth of sludge,depth of scum. size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. V The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub. Surface Disposal System. (revised 11/03/95) 4 C SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 48 Scorton Hill Rd W.Barnstable Owner. Joanne Bauckman Date of Inspection: 4—3—9 6 FLOW CONDITIONS RESIDENTIAL: Design flow 3®_gallons Number of bedrooms: -3 Number of current residents:e2 Garbage grinder(_yes or no): A _ Laundry connected to system(yes or no):Y Seasonal use(yes or no): /V Water meter readings,if available: Last date of occupancy: L COMMERCIAL/INDUSTRIAI.: Type of establishment: Design flow:_gallons/day Grease trap present:(yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 6 system: (yes or no)_ Water meter readings,if available: Last date of occupancy: OTHER:(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and so of information: /4 System pumped as 1krt of inspection: (yes or no)_.,de" d If yes,volume pumped: gallons Reason for pumping: TYPE OF SYSTEM Septic tank/distribution box/soil absorption system cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records,if any) Other(explain) APPROXIMATE AGE of all components,date installed(if known)and source of information: Sewage odors detected when arriving at the site: (yes or no) (revised 11/03/95) 6 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 48 Scorton Hill Rd W.Barnstable Owner. Joanne Bauckman Date of Inspection: 4—3—9 6 S TANK_ (locate site plan) IJ Depth be w grade: Material construction:_concrete_metal_FRP_other(explain) Sludge de Distance m top of sludge to bottom of outlet tee or baffle: Scum from top of scum to top of outlet tee or baffle: Distance m bottom of scum to bottom of outlet tee or baffle: Comments: (rewmmen tion for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence of ,etc.) GREASE _ (locate on site plan) Depth below e: Material of n:_concrete_metal_FRP_other(ezplam) Dimensions: Scum Distance m top of scum to top of outlet tee or baffle: Distance bottom of scum to bottom of outlet tee or baffle: Comments: (row =an on for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence of ,etc.) WVNI— (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 48 Scorton Hill Rd W.Barnstable Owner. Joanne Bauckman Date of Inspection: 4—3—9 6 TIGHT O HOLDING TANK:_ (locate on plan) Depth below Material of co n _concrete_metal_FRP_other(eaplain) Dimensions: Capacity: on$ Design flow: ons/day Alarm level: Comments: (condition o inlet tee,condition of alarm and float switches,etc.) DISTRIB N BOX:_ (locate on s' plan) Depth of ' 'd level above outlet invert: Comments: (note if level an distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) PUMP CHAMB •_ (locate on site p ) Pumps in wor ' order:(yes or no) i Comments: (note condition o pump chamber,condition of pumps and appurtenances,etc. (revised 11/03/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 48 Scorton Hill Rd W.Barnstable Owner. Joanne Bauckman Date of Inspection: 4—3—9 6 / SOIL ABSORPTION SYSTEM(SAS): V (locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present,explain: Type: leaching pits,number:_ leaching chambers,number:_ leaching galleries,number: leaching trenches,number,length: leaching fields, number,dimensions: overflow cesspool,number: Comments: (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.) CESSPOOLS:_ (locate on site plan) • i Number and configuration:- Depth-top of liquid to inlet invert: u _o i Depth of solids layer. Depth of scum layer:�3 Dimensions of cesspool: t I Materials of construction: 13 l c rG 5 Indication of groundwater: 1,e) inflow(cesspool must be pumped as part of inspection) ® 1- 1 Ta wb lcs e Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) PRIVY: (locate on plan) �rtd. construction: Dimensions: lids: (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.) (revised 11%03/95) g SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(oontinued) PropertyAddrese: 48 Scorton Hill Rd W.Barnstable Owner. Joanne Bauckman Date of Inspection: 4—3—9 6 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' 6`�s lull DEPTH TD GROUNDWATER Depth to groundwater. off-y feet method of determination or approximation: d 1� (revised 11/03/95) 9 TOWN OF BARNSTABLE LOCATION `'f , r,M LL r=:4 SEWAGE # � VILLAGE 1tif '— ASSESSOR'S MAP & LOT 6 ZO INSTALLER'S NAME & PHONE NO.� G'p SEPTIC TANK CAPACITY /d & 4~ Iv / UDp LEACHING FACILITY:(type) - (size) 'OIO NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER (old DATE PERMIT ISSUED: -22- n DATE COMPLIANCE ISSUED: 7 Vu> VARIANCE GRANTED: Yes No goo. No.... .6 FE$..$...30...00....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE .���ltrtttiu�t fur �iu�au�ttl �urk,� C�unu�rnr�iun rruti� Application is hereby made for a Permit to Construct ( ) or Repair (XX) an Individual Sewage Disposal System at: ..48.. cQrlran .......... ---•-----•------------------•-....•--------...------------------------------------•-----......---- Location-Address or Lot No. T@C1--------------•---....--•-----.....-•--•-....................._.... -•----•-----•----------.--------------------------------------•------............................. Owner Address a ..J_P-_Ma+combex--Jx----------------------------------------------------------- -----------------------•----------------------•-------•---•-------------------------......------.. Installer Address Type of Building Size Lot............................Sq. feet DwellinM No. of Bedrooms--------------3-_-_-_-_-._.-___---___-_-_-Expansion Attic ( ) Garbage Grinder ( ) '4 Other—Type of Building ---------------------------- No. of persons------. Showers — Cafeteria 04 Other fixtures -------------------------------- W Design Flow............................................gallons per person per day. Total daily flow--------------------------------------------gallons. WSeptic Tank—Liquid capacity............gallons Length-............... Width---------------- Diameter---------------- Depth................ x Disposal Trench—No. .................... Width.................... Total Length-------------------- Total leaching area....................sq. ft. Seepage Pit No------_------------- Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by......................................----------------------------------- Date........................................ 0-1 Test Pit No. I................minutes per inch Depth of Test Pit___--_--..___-----_- Depth to ground water........................ (T Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 ---------------- ............................................................................................................................................ 0 Description of Soil........................................................................................................................................................................ v .....................-Sand..&..gave l------------------------------------------------------------------------------------•----•-•-------------------•------•-----••.....-----•-••-------- W UNature of Repairs or Alterations—Answer when applicable.-CkA7.t-_ceaspQo1s__InstdU...1--1.QQ0--gall 71....... .....................sepjdc...tank...I.=dis-tributim..box..1--1Q0Q.-gal.]on._le.ach..px_t................................................ 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 bee�iss d by the oar of health. Signed .... �� ---- ---.. ' Date Application.Approved BY ....... ,- ... ^ e c ---- Application Disapproved for the following reasons: ................................................................................. It ---------------------------------- ------------- ------ ---------------------------------------------- ---- ---- ---------------------------------------------------------------------------- ---------------------------------- � *� Dare Permit No. -----...,�-�r. -----..---- Issued ----------------------------------------------------------------- Date No.... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Dhi-Vn!3ttl Wnrk,i TrImitrnnrtion Permit Application is hereby made for a Permit to Construct ( ) or Repair (XX) an Individual Sewage Disposal System at: --.4a.ScortM.H-aj. ._ zr c ...................... •------------------------•--•----------•----•--------.....------•--------------...----•-----••--- Location-Address or Lot No. Owner Address Installer Address UType of Building Size Lot............................Sq. feet .—I DwellinrX No, of Bedrooms-------------- 3----------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons------3-------------------- Showers ( ) — Cafeteria ( ) 04 Other fixtures W Design Flow............................................gallons per person per day. Total daily flow--------------------------------------------gallons. WSeptic Tank—Liquid capacity------------gallons Length---------------- Width-----_.------_- Diameter---------------- Depth................ x Disposal Trench—No. .................... Width-------------------- Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..-_-.-_-_-.--.-.-- Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) IH Percolation Test Results Performed by.......................................................................... Date....-................................... 1 Test Pit No. I................minutes per inch Depth of Test Pit-------------------- Depth to ground water_.----.----._-_---_--.-. f� Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ P4 -------------------------------•-•-----•-•••-•.....••....._...••-•---•••--•-•---•--------•-••-------........................................................ 0 Description of Soil....................................................................................................................................................................... W ....---•---•-•--....Sind-• --�.�y.�l---------------------------------------------- W U Nature of Repairs or Alterations—Answer when applicable.-Qnit__Cesspool-s Install 1-1000 gallon septic tank 1--distribution box 1-1000 rlallon leach �?it. • . -••............. 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 issu id by the boar, of health. Signed ........ ��. `-------------------------- �� .� `� .........:.. Dare Application.Approved BY ....................J..._......... .........�c Dare Application Disapproved for the following reafonr- ----------------------------------------------------------------- ------------------------------------.----------- ----------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------- ........................................ G Dare PermitNo. ........... `>-----------2,3_4---------------- Issued ----------------------------------------- ------------------------ Da ce THE COMMONWEALTH OF MASSACHUSE17S BOARD OF HEALTH TOWN OF BARNSTABLE THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (X ) by _._J.P.Nlacartbex Jr. -----------...."---.....-----_------------------------------------------------------ I."" at ---------------- 48b Scornton Hill Load West Barnstable .....__------------------------ --------- - --------------------------------------------------------------------._..._------_-------------------------------------------.._--------................ has been installed in accordance with the provisions of TITLE 5 f The State Environmental Code as described in the application for Disposal Works Construction Permit No. ..._���r.-. .�..___. dated ..----_._._....................._.._..... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. -�� G DATE . - _.. - .....--- -. .............. ----------- ---- - Inspect r^ - - -.✓..._....".__--------......------------- -- �� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH / TOWN OF BARNSTABLE $ 3000 FEE......................... Dinpnnttl Workii Tonotrntrtuan "rrnnit Permission is hereby granted_.J.. Ma nR.....P n it ry-..._......... to Construct ( ) or Repair 1(=) an Individual Sewage Disposal System at No...........48 SCornton Hill Read TIest-•P3arnstableAMas>><------------------------------------ Street C�l � � ? L as shown on the application for Disposal Works Construction Permit No --__ l_ Dated______ _ ____'.:.�� e............... ----------------------------------------•-------•- Board of Health DATE........................... ...... . .t_D.....---------------- FORM 36508 HOBBS&WARREN.INC..PUBLISHERS, 'y-j--•- '�"--•n_ �"- e`"�-v-�. + �c...• .a �-"'�_ :.,,•a,�.•-'.[' �'- ^-a.y �rn... '..c .F; ra".t' '+'�^z.`�^r g-«s^�.�.•- -x ..'_.^--".s--•a•: Tb SAW t TOWN.OF BARNSTABLET~ • �T � SEWAGE# �✓. .l2��� ;.:` f r � 1 F. M ; VILLAGE,1� ( ASSESSO'R`S MAP LOT f .6 Zo w� INSTALLER'S.NAME & PHONE NO. SEPTIC TANK CAPACITY _ ODO LEACHING FACILITY:('typ6L. ' F rr- (size) NO: OF BEDROOMS PRIVATE WELL OR PUBLIC WATER i R OWNER BUILDE OR [' wl' S t A f 4 DATE PERMIT ISSUED: ll DATE `COMPLIANCE ISSUED: VARIANCE GRANTED: .Yes No -.F, rfttr. 1 ! c WN t e {t+ lw lti 1 %s i - '� ''s", - s" 5" w ��a`;'�° r' .s` �rr-�•^.Y .,�'�' ^�'^.:.�,� ,c,-,'sa.%t:: .' x '�-'• ..,"'Fcwn.. ." ^"^'�.yr.G" T"�-r�ti-"' •�t'.k,-" �o-�".FK�. =Gar':"`�,'�`^'�' �;... 7"`"y�."'"�•.�,,,. 'c'�• `,w"`�.Y. � a., .�..n"p�„ac -R.�..z.�^+�.a.•'" 1 2. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH a , TOWN OF BARNSTABLE ,C�Ertifirate of. (90raptinXICE THIS IS TO CERTIFY,. That the Individual Sewage Disposal System constructed ( ) or Repaired O by ...................J.P. at ....................4& :...Scornton•-Hill:...Road...West...l�rns.table..-...........-.............:........ has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for.Disposal Works Construction Permit No. ..... �,r -. 3E.._•••- dated ................................ .-... THE ISSUANCE OF-THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE. SYSTEM WILL FUNCTIONSATISFACTORY.ORY. { DATE p :E ...- sec .................. .-....... .... ...---........--...---.-..................- �fi r guFR Y 7=�tg SgE1` • cA , r� ass - s No.- - --- --------- Fee------ ---- BOARD OF HEALTH TOWN OF BARNSTABLE Appticat ion ArWell C.on5truct ion Permit Application is hereby made for a permit to Construct ( Alter ( ), or Repair ( )an individual Well at: Location - Address Assessors Map and Parcel EC-0 Ito On �^I er - - --— —-- Address -- — — s -- --------------------------—---------— �° — -- — -- — Installer Driller Address Type of Building Dwelling Other - Type of Building-------------------------- No. of Persons--------------------------- Type of Well — Purpose of _—_—_-- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until a Certific�tte f Compliance has been issued by the Board of Health. Signed tt��/Q/ -- datgfn AMApplication Approved By -®--- - at Application Disapproved for the following reasons:--------------------------------- -_—_ ----------- -- --------------------------------- ------- -- date Permit No. -- ------ Issued.—,=— - --- ------- -- -__-_ date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance THIS IS TQ ?RTIFY, That the Individual Well Constructed M Altered ( ), or Repaired /O y Installer 0-1 /[ has been installed in accordance with the provisions of the Town of Barnstable Boa4d of Healthyrivate Well Protection Regulation as described in the application for Well Construction Permit No ��f/ -Dated---- ----- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE--------- -- Inspector------------__— — —___ 'tire•s.--»� '...-t�—a,.,.. -'.:...s�++n.+�v-i.. +e r.r r r�:... _,,. ..-.,:.r '-- - -. .. - . �-. , No.- - --= -------= - Fee-----j---- ------ BOARD OF HEALTH " TOWN OF BARNS�TABLE rVell Conotruction application� hermit Application is hereby made for a permit to Construct ( Alter ( ), or Repair ( )an individal Well at: 4_1t -5CO.10 Location Address r' 1" Assessors Map and Parcel Z!: O ner Address -- --------- Cp -^' - --------------------- Installer — Driller ,. Address. Type of Building Dwelling ✓ ----- - , Other - Type of Building -- No. of Persons.------------------ --------___- Type of Well y =- —---------- ---—-- - Capacity---— - ---——--=- --— Purpose of Well1?a Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private,Well Protection Regulation — The undersigned further agrees not to place the well in operation until a Certific to . f Compliance has been issued by the Board of Health. Signed dat (7f Application Approved By at Application Disapproved for the following reasons:-------------------- ----_—_— —_ s� — date ,, y , Permit No. -- Issued---- . -- --- date_----- ----- ------- :.w±��::±c�:2va�.:xa4�!-ass:+ci+�w�-+_:oa+'awere►�x�ia'�.i.;x-x>:'r Tawnui:>s`asks-�arsnaea.�;rsrze'crsl�.aesesl�:aarslsloaspereea+maeaaa'�weaawc:seas±.a�ta+�fi.TaaaaanwT�cTkv!se,�m.rh BOARD OF HEALTH TOWN._, OF_. BAR.NSTABLE C ertif irate ®f Compliance THIS IS/TQ VRTIFY, That the Individual Well Constructed ( Altered ( ), or Repaired Installer ---------- --- `p // /� I t"l r has been installed in accordance with the provisions of the Town of Barnstable Boand of Hea rivate Well Protection Regulation as described in the application for Well Construction Permit No �� - _Dated---- ----- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE—-------- = -- Inspector----------------- —- - JlAWM'�Ti4i4i46:1ii!'►lilil:Aal/i±iBiM±o±iRa!@�±GKIOAesiilitiTW9Ti±i±kYli@i4Y@p96±i01i4iSiliyiQili9fl�±ieNaYectilY4rQi;li!i�JY!MtiTiTi4iT GlTl6:,YTiTiTi!NiTi!iTi!.iTaTF!Yti'± BOARD OF HEALTH TOWN OF BARNSTABLE Vell Construct ion Permit No. --- --- Fee— - -- Permission ' hereby granted 4 to Construct ( , Alter ( , or Repair ) an Individual Well at: Street as shown o �tegplicatio r a Well Construction Permit No. —�_ —�--__ Date — ------ ----- F3 - K q JZ DATE Board of alth _— ASSESSORS MAP NO: PARCEL No._--------- NO: Fee-_� BOARD OF HEALTH TOWN OF BARNSTABLE Application-*rVell Con5truction permit Application is hereby m de r a permit to Construct Alter or Repair (,"**)an individual Well at: 44, ,i ' r L' 13 a Location Address Assessors Map and Parcel 44-- sco ff /17 J Address S.0 -ner , b A , e 0 /Coy /L4 Ct 6 Installer Driller Address Type of Building ,, Dwelling------------------------------------------------------- Other - Type of Building No. of Persons------------------- fy r/ JO,,J L Type of Well _Ojb AL__e ----------- Purpose of Well--- Agreement: The undersigned agrees to install the aforidescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a Certificate of C b nce has been issued by the Board of Health. Signed- date Application Approved B1 rate Application Disapproved for the following reasons: date Permit No. _A� Issued date BOARD OF HEALTH TOWN OF BARNSTABLE Certifi sate Of Compliance THIS IS TO CERTIFY, That the ndividual Well Constructed Altered or Repaired (4< DA Installer at to—, Lj —----- has been installed in accordance with the provisions of the Town of Barnstable Board off f Health Private Well Protection Regulation as described in the application for Well Construction Permit No. ��--5�f---,�Dated-Z= THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE Inspector ^ ,..�r•^cy r+'rw "rn"Y"'^r*..+'Y�•.-,..v�+r.-^rw.-►...s-n+K�.'.5+.+*..n;.w..:..•:.=ti,;�. _.... ._._..._ .:3rti.4rsr..,....n..r ti,...>..}�.-..- i- r ,. ..s.+*'-s •tr•. .+'7 No.- '_ (� , �j Fee--�f-----"--------_ BOARD OF HEALTH TOWN OF BARNSTABLE i �ationoreir'Con5tructioriertriit A plication'issco.hereby :made r a permit to Construct (K, Alter ( ), or Repair. ( ind• iduaa Well at: 'Location ,_Address ' Assessors Map and Parcel ---- ----------------------- Owner Address ' A SSG art '(• � , o - � M �� .� —A J ----� ----' - - -—..- -------- -------- ----- Installer - Driller - - Address - TYPe of Building Dwelling= =- Other Type of Building---- -------------- No. of Persons------------------- Type of Well-�� P CapacityA - - - —� -- - - Purpose of Well Agreement:, The undersigned agrees to install the aforedescribed individual well in accordance with the ovisions of The Town of Barnstable Board of Health Private Well Pr section Itgx-lation,.,- The undersigned rther agrees not to place the well in operation until a Certificate .of ompl• nce has been issued by;he B` of Health. 1 Signed. ..Crw� ---------�'� „�-�:r � --���at�------ � Application A roved B "� "'�"► PP PP -- - -- ate Application Disapproved.for the following reasons: -=-- ------------- date Permit No. 5'" Po-- °�� ---- Issued_- 2f -„ - ---—-- date s�e��-»a±.yes:os:�ee�meros�.+aoes�sid+tee:>!s®sa»::e.*.psi.,�a+r�meea+�evaceausea�er�saeaasa�er.nae�csaue`961�tl'SISSG•IQSA.i.9NEi�BboTi^d3Gt6RlfYY6SilB il�.ifile�51a!'.:lY Ai:Itli�S?a�iYu+w�ao�o BOARD OF HEALTH - TOWN OF .BARNSTA�BLE ' Certif%tate Of Compliance THIS IS TO CnER�T,IFY,F That tl}e/�ndividual.Well Constructed ( ), Altered ( ), or"Repaired /^1 J by -- -------- -- --- -- -- 1� . Installer has been installed in accordance with the provisions of the Town of Barnstable Board offeHealth Private Well Protection ' Regulation as`described in:the application for.Well Construction Permit No. Dated THE ISSUANCE.OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE- -_- —- - Inspector—__--_-- -__--------—-- � t:e:±.!pa:ecscss±aespasasiasseo4s:easvisa.�.s+.v�±a�easasa�vws�sascsasaa:s�.isa4+:w.asrwsea:�cesasasaearae.:eeaae:.ra•,ry.e+±a±,ttaeetas+eon.±a+!�asuce+±a±r We`ra�r.�r..:±aet BOARD:OF HEALTH TOWN Of BARNSTABLE Melt Con�tructionPermit 1 No..�:�': Fee ors Permission i.s hereby granted. c4 na*..� to Construct ( )-Alter ( . ),or Re air,(�an In ividu .Well at: No. 4 g SCvdr.,� � r ! t�r Street —------—-- - - - -as shown on the application for a Well Construction Permit s No.-�!' — Dated- �` ��- ----- ------ - Board of Health DATE "" " — -- i i • �� 11'fie �,�» Q � � � No, Fee- - --- - c�5 ----- ------=-------------- BOARD OF HEALTH TOWN OF BARNSTABLE 0pplicat ion-for Vell Con$tructionVermit Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair (V)an individual Well at: -- A-- I1 /-!� -- --- ------------------ - - -- -- - - - Location — Address Assessors Map and Parcel q/V - -------------------------------- --------------- Owne`'� Address -1'}'J�-Ehi�g1�/ lit�LLL 1 eiajMh.............. ------------------------------------------------------------------------------------------------ Installer — Driller Address Type of Building Dwelling------------------------------------------------------------------ Other - Type of Building------------------------------------- No. of Persons-------------------------------------------------------- a� !1 Typeof Well d- ------------------------------------------------------ Capacity------------------------------------------------ -- 'Purpose of Well-- ---------------------- ................ The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The. undersigned further agrees not to place the well in operation until a Certificate .of Compliance has been issued by the Board of Health. ------ -- ---- - - - - = =-9 Signed- P Q date Application Approved By —--— - - ® - - - ---------------- date Application Disapproved for the following rea ---------- ----------- -- - - -- --- - - ---- - - - -- ---------- ------------------------------------------------- date Permit No. - - ----- - ----- ---------------- Issued----- - - --� ------- —— d -------- -----—---------------------- ate BOARD OF HEALTH TOWN OF BARNSTABLE (Certificate ®f (Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( ) by------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Installer at------------ ------ - ------------------------------------------------------------------------ has been installed in accordance with the provisions of the Town of Barnstable Boa d f HN1h rivate Well Protection Regulation as described in the application for Well Construction Permit No - - ---- Dated-------------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE- --- —--- - -- - ----- - -- Inspector---------------------------------------------------------------------------- A �7 - - ., ��y.;- • �'.-. 'Vsa 4: ha No.-- ------a-- IFee-3-5'---------.- - BOARD OF HEALTH TOWN OP ' BARNSToO BALE Applicationjor'Vell ConMr-uc-tipA9ermit Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair (V)an individual Well at: -S GOI2Toiv !`fI_t,J--_r�L t ,__ i9iZ�l ] $[ --.........----=...--...... --- - --- --- - -- - - Location — Address Assessors Map and Parcel N---------------------------------- —- ------------------------------------------------------- ------------------------------------------ Owner\ Address C?'JF—E----HAN----JAI �J�j/LiGL/N(7 - ------------------------------------------------------------------------------------------------ Installer — Driller Address Type of Building Dwelling---------------------------------------------------------------- Other - Type of Building ---------------- No. of Persons---------------------------------------------------- Type of Well- r� - -- -- -- ------------- ------ Capacity------------------------------------------------------------ --- -- Purpose of Well----b n!!C�--------------------------------- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until a Certificate .of Compliance has been issued by the Board of Health. f_ ti Signe ---- - ---------1- — O O date Application Approved By ----------___ __ _ ____ _ ______— ---------------- date Application Disapproved for the following rea s:-------------------------------------------—--------------------------------- --------------------- - ----- - --- ——- - - - - - - - -- ---------- ------ ----------------------------------------.. � date PermitNo. - -- ---------- Issued---- -- ----- --- --- -------------------------------------------- date zee- rbecssaeG�aa-aaa4=00205, a'Sao-:e�s�a�ef:�asa �zt��as:+c, arrs�mSe: r�sa:ac BOARD OF HEALTH TOWN OF BARNSTABLE Certificate (Of Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( ) bY-------------------------------------------------------------- Installer at- -- --- - --------- ----------------------------------------------------------------------------------------------------- has been installed in accordance with the provisions of the Town of Barnstable Wd He th rivate Well Protection Regulation as described in the application for Well Construction Permit No ------ 7Dated------------------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE- ---- ---- -- Inspector------------------------------------------------------------------------ BOARD OF HEALTH TOWN OF BARNSTABLE )Dell Con5tructioupermit .� fee 36 - x�l -------s-- - -- ----- Permission is hereby granted---------------/----� to Construct ( ), Alter ( ), or Repair ( ) an Individual Well at: No. - ----------------------------------------------------------------------- ------------------ ------------ - -------------------------------------------------------------------------- Street as shown o e pplicatio r ell Construction Permit . No. r -- - - DateX ---- V� --- -- ------------------4- - Board6 of DATE - --—------------ TOWN OF BARNSTABLE LOCATION QO SEWAGE#/1;'�`- f3b' VILLAGE�,ao.��� ASSESSOR'S MAP&LOT/// --OIL INSTALLER'S NAME&PHONE NO. 111,4e6d 1 k-C, SEPTIC TANK CAPACITY 1500 CAI, LEACHING FACILITY: (type) /666 VA (size) NO.OF BEDROOMS BUR DER OR OWNER 4 —/Teit CA PU 14LA./ PERMUDATE: "=3 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and.Bottom g Facility of Leaching Facili Feet J _ 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!l aaching facility) Feet Furnished by 0 In ��'' N 4 �, 0 �. WELL LEGEND WEST BARNSTABLE PROPOSED CONTOUR �oG� POLETY ® PROPOSED SPOT GRADE sq 32 ——gg —— EXISTING CONTOUR / + 96.52 EXISTING SPOT GRADE \ s / �\ W— EXISTING WATER SERVICE 34 \\ \ TEST PITPN� / 3 \ � SCALE: 1"=30' NO 09\ 40 38 0 le 0 / 4101, RD, 0P LOCO S 42, 1 \ \ \ \ 48 SCORTON HILL RD. \ LOCUS MAP 44_- 46 1 -32 LOCUS INFORMATION \ as 11 \\ / FROM PLAN REF: 224/141 \\ vent \ ` \ ---- \` \` \\ we<� TITLE REF: 27735/001 ` \ PARCEL ID: MAP 111 PAR. 020 PROPERTY HAS PRIV. WELL. SUBJECT TO NIT. RESTRICTS. 48 C o `j4a7,X \\ \\ �\\ FLOOD ZONE: PROPERTY NOT IN FLOOD ZONE \ t \\ SEPTIC SYSTEM 34 REPAIR PLAN �. LOCATED AT: ok / `\ ,, 36 48 SCORTON HILL RD. EXIST. 1,50013 ��°AoF<<ti c W. BARNSTABLE, MA SEPTIC TANK �:��. ------- -----38 PREPARED FOR ` s oti\\\ \ X \ \ - - KEVIN CAMPBELL -40 ` 42 NOVEMBER 2, 2020 i� \ \ PAVED DRIVEWAY\ -�3 � \ 43 / 44 .46 DA� M s s• 1 ; 0.. / QNITAR�p� IZ'� LOT 3 • PLAN BOOK 224 PA8GES141 9�h9 M EYER & SONS, INC. \\ ASSR MAP 1 1 1 PCL 99 ' P.O. BOX 981 PLAN EAST SANDWICH, MA. 02537 BENCH MARK / SCALE: 1 in = 30 ft PH: (508)360-3311 TOP OF FOUNDATION 0 30 60 FAX: (774)413-9468 43.57 �\ meyerandsonstitle50gm ail.com BARNSTABLE GIS DATU - � 0 10 20 30 60 / SHEET 1 OF 2 1 J 894 ELEV. TOP NOTE: PLACE MAGNETIC MARKING TAPE OVER ALL COVERS FOUNDATION: BRING ALL COVERS TO WITHIN 3" OF FINISH GRADE (upper) FINISHED GRADE (45.0) = 43.57�..�F.G.EL: 43.0 F.G.EL: 43.0 F.G. EL: 44.0 � VENT a MAINTAIN 2% MIN SLOPE OVER LEACHING AREA 2" OF 3/8" DOUBLE WASHED a " _ " V.* F.G.EL 41.0 STONE OR FILTER FABRIC DOUBLE WASHED STONE 4 6" " •'� 4" SCH 40 PVC 10" ®1®®®• Q ®®®® a' TEE'S ARE TO BE 14" s ® S= 19� (MIN.) ®®®®®®®®®®®® :Y 4 SCH 40 PVC INV. 39.55 2 EFF. DEPTH ®®®®®®®®®®® INV. 39.75 INV. 39.35 4i 2 X 8.5' 4' GAS PROPOSED DB-3 EXISTING OUTLET BAFFLE EFFECTIVE LENGTH = 25' <.. .. .. .. ..... . DISTRIBUTION BOX INV. 40.0 Aft (H20) INV. ELEV.= 39.20 EXIST. 1,500 GALLON SEPTIC TANK OF GAS BAFFLE TO BE INSTALLED ON ����� Mgs�9� BREAKOUT OUTLET TEE AS MANUFACTURED BY o D RRE M ys ELEV.= 40.20 NOTES: TUF-TITE, ZABEL, OR EQUAL TOP CONC. ELEV. 40.20 1) CONTRACTOR SHALL VERIFY ALL EXISTING No. 1 .40 INV. ELEV.= 39.20 ®® PIPE INVERTS PRIOR TO CONSTRUCTION ®®63®®®®E3 2) D-BOX SHALL BE SET LEVEL AND TRUE TO ��� a a 0 a a®® GRADE ON A MECHANICALLY COMPACTED SIX '�NITA��a� E3mm mmlE3 INCH CRUSHED STONE BASE, AS SPECIFIED IN , �l BOTTOM EL.= 37.20 3,75' 5 FT. 3.75' 310 CMR 15.221(2) 1� V " go 3) REPLACE EXISTING 1,500 GALLON SEPTIC TANK WITH 1500 GALLON SEPTIC TANK IF FAILED, SEPARATION 7.20 FT. EFFECTIVE WIDTH = 12.5' DAMAGED OR UNDERSIZED. SEPTIC SYSTEM PROFILE 4) INSTALL INLET & OUTLET TEES W/ BOTTOM OF TESTHOLE EL: 30.00 _ SOIL ABSORPTION SYSTEM (SECTION) GAS BAFFLE AS REQUIRED (500 GALLON H-20 LEACH CHAMBER) SOIL LOGS P#: TPT-20-203 GENERAL NOTES: DESIGN CRITERIA **IN ESTUARIES PROT.** DATE: OCTOBER 2, 2020 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL NUMBER OF BEDROOMS: 3 BEDROOM DESIGN SOIL EVALUATOR: DARREN MEYER, R.S., CSE 1614 BOARD OF HEALTH AND THE DESIGN ENGINEER. SOIL TEXTURAL CLASS: CLASS I (0.74 GPD/SF) # 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS WITNESS: DON DESMARAIS, BARNSTABLE HEALTH DEPT. OF THE STATE ENVIRONMENTAL CODE, TITLE V. AND ANY APPLICABLE DESIGN PERCOLATION RATE: <2 MIN/IN LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW: DAILY FLOW: 110 G.P.D. X 3 BR = 330 G.P.D. - 310 CMR 15.405 (1) (B): Elev. TP-1 Depth Elev. TP-2 Depth 1) A 4.80 Fr. VARIANCE FROM 310CMR15.221(7) TO ALLOW LEACHING GARBAGE GRINDER: NO (not designed for garbage grinder) 40.00 A TO BE 2.80 Fr (MAX) BELOW GRADE VS REWD 3 FT. (H20/VENT PROVIDED) SEPTIC TANK: 330 gpd x 200% = 660 gpd, USE EXISTING 1,500 GAL. SEPTIC TANK L0 S4A/NiD 0" 40.05 A t 1 0" 3. T THE INSEWAGEIONISD PSYSTEM SHALL R THENOT B BACKFI LE APRIORND THELEACHING AREA REQUIRED: (330)/0.74 = 445.94 S.F. 39.42 7" 39.47 7" DESIGN ENGINEER. B LOAMY SAND B LOAMY SAND 4• ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION, DIFFERINGFROM THOSE USE TWO (2) 500 GALLON PRECAST H-20 LEACH CHAMBERS W/ 4' 1OYR 5/6 1OYR 5/6 " E REPORTED ENGINEER BEFOREWCONSTRUCTIOON CEREON ONINUES. TO THE DESIGN STONE ON ENDS & 3.75' STONE ON SIDES: 25' L x 12.5' W x 2'D PERC TEST C 37.25 33" 37.38 C 32 fig; 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. • EL. 3592 LOAMY SAND LOAMY SAND LEACHING IS 5 FT. 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF BOTTOM AREA: 25 x 12.5 = 312.5 SF 10YR 6/6 1OYR 6/6 BELOW GRADE AND WILL THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF 35.00 60" 35.05 60" HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. SIDE AREA: (25 + 12.5) X 2 X 2 = 150 SF MEDIUM MEDIUM EXTRAPOLATE PERC C2 C2 BE IN C2 LAYER YOU TEST 7 WATER SUPPLY PROVIDED BY PRIVATE WELL TOTAL SQUARE FEET PROVIDED = 462 vs. 445.94 REQ'D ., SAND SAND PROFILE. 8.ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED 2.5Y 7/3 2.5Y 7/3 TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. DESIGN FLOW PROVIDED: 0.74(462 S.F.) = 342.25 G.P.D. vs. 330 G.P.D. req'd 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE ��► THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING 30.00 120" 30.05 120" CONSTRUCTION. PROPOSED SEPTIC SYSTEM UPGRADE PLAN 10. EXISTING LEACHING TO BE PUMPED, CRUSHED AND FILLED PER TITLE 5. PERC RATE <2 MIN/IN. ("C2" HORIZON) 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION 48 SCORTON HILL ROAD, W. BARNSTABLE, MA NO GROUNDWATER OBSERVED 12. THIS PLAN IS TO BE USED.FOR SEPTIC SYSTEM PURPOSES ONLY AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY Prepared for: Campbell • I, Darren M. Meyer, R.S., CSE, hereby certify that I am currently approved by MADEP pursuant to 310 CMR 15.017 13. NO PRIVATE WELLS WITHIN 100' OF PROPOSED LEACHING. Design and Site Plan by: SCALE DRAWN DATE to conduct soil evaluations and that the above analysis has been performed by me consistent with the 14. NO WETLANDS WITHIN 100' OF PROPOSED LEACHING. MEYER&SONS,INC. N.T.S. DMM 1 1/02/20 requirements of 310 CMR 15.017. 1 further certify that I have passed the Soil Eval. Exam in October, 1999. 15. ALL PIPING TO BE 4" SCH 40 • 1/8"/FT (UNLESS SPECIFIED) PO BOX 981 EAST SANDWICH,MA 02537 REV DATE CHECKED SHEET NO. 50e-W-2922 DMM 2 of 2