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Home My WebLink About0462 MAIN ST./RTE 6A(W.BARN.) - Health 4 Q MAIN ST. RTE 6A WEST BARNSTABLE A = 133 004 No � Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 0[pphLation for MispoSal 6pstem COItBtCULtion J)Prmit Application for a Permit to Construct( ) Repair(v� Upgrade( ) Abandon( ) ❑Complete System [Individual Components Location Address or Lot No. 461 A Q,n Si W. Q)M(nSWb) Owner's Name,Address,and Tel.No. Ch,\d S Assessor'sMap/Parcel . •6Qy PO (50-A $a2 W QA(m}oblV Mo. So%. 3b2.34Z Installer's Name,Address,and Tel.No. 17 t 4 `LX cavofion Inc, Designer's Name,Address,and Tel.No. 344 Roo�� 130 Sv%ndw�oti Mo, S'08•Y}1.0b53 NA Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank• 10 1500 Qgkkon Type of S.A.S. p•100i and Tank 0 n(V it Description of Soil Nature of Repairs orAlterations(Answer when applicable) Ins}eXa ion 04 N• 10 1500 aailnn s+ and N• Zo d-box ar%kth Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Si Date t 20'LO Application Approved by Date Application Disapproved by Date for the following reasons Permit No. Date Issued M '.may ~. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS `ftplication for Misposal 6pstem Construction Permit Application for a Permit to Construct( ) Repair(V) Upgrade( ) Abandon( ) ❑Complete System ❑rIndividual Components Location Address or Lot No. 467. M o,,, SA 'vJ. c r S't�%'l Owner's Name,Address,and Tel.No. C si 11 t(- C,r.�t ct S Assessor's Map/Parcel w• (�C,c n�}v,\as c 1�,, o` �a4.? 3yzl, Installer's Name,Address,and Tel.No. 17j ; vt rava4 nc. Designer's Name,Address,and Tel.No. 3 `I Rostc 1ao r+nl�w.(1. /.,�� jCJ? `( • CSC:�3� NA _. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank 0 '500 o,;" Type of S.A.S. bp- nnet 'Tor%c On(v Description of Soil _`l Nature of Repairs or Alterations(Answer when applicable))n 5A a11oa'c*n q i (A- 10 1 OO tA1 Zo 6-box oo� ,J,, 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 t Compliance has been issued by this Board of Health. Sign p c _ .. Date Application Approved by _ Date !/•�� Application Disapproved by Date for the following reasons C Permit No. r .)•---"^"' ` ' Date Issued 44� � � s� `! THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance HIS IS TO CERTIFY,that-the On-site Sewage Disposal system Constructed( ) Repaired(,�) Upgraded( ) Abandoned( )by Q) 'f,x c mvo, ;o n 1 n c.• at q(o I- d"V ca,, E has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit Na dated t� Installer Q) C\k 1Kk,,,n Inc . Designer �J A c #bedrooms Approved design flow gpd The issuance of this permit shall not be construed as a guarantee that the system will functio'n as designed: Date J L) 01)40 Inspector - .-•,.. ....'"�,..�,,�� No. I�X " r Fee /€/ - THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Misposal *pstem Construction Permit Permission is hereby granted to Construct( ) Repair(f) Upgrade( ) Abandon( ) System located at 4�1 kl an 5i f Q A 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 �AHaku Approved by � J TOWN OF BARNSTABLE LOCATION 41,2 RAG G A SEWAGE# ZOZO- Z877 VILLAGE (J_ Qc,�c-i� , ASSESSOR'S MAP&PARCEL 13 3 OqY INSTALLER'S NAME&PHONE NO. Ri'Z CXCA.yy►Aior,, SEPTIC TANK CAPACITY /SOo' LEACHING FACILITY: San X ��e U laaetm r,� nA NO.OF BEDROOMS OWNER ES HER C PERMIT DATE: 9- 4- Zp COMPLIANCE DATE: 0 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 At- Lis 3� 4 7 F'con� A2.52�� r :d 52-y9'3 A3- 59 ` O 133- (4-) " 9 ' l O Ay• l�s It �3y• s y �sTo�ti Town of Barnstable Inspectional Services BARNSPASM MASS.039 Public Health Division i639 ��' jfO"" A 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Thomas A.McKean,CHO FAX: 508-790-6304 CERTIFIED MAIL#7015 1730 0001 4987 7916 July 21, 2020 CHILDS, ESTHER L PO BOX 76 WEST BARNSTABLE, MA 02668 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE TITLE 5 The septic system located at 462 Main Street, West Barnstable, MA was inspected on 06/29/2020 by Daniel Hawkins, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Conditionally Passes" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • The distribution box is rotted. • The septic tank needs replacement. You are ordered to replace the distribution box and the septic tank 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 BOARD OF HEALTH omas McKean, S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Conditionally Passes Letters\462 Main Street West Barnstable.doc f Town of Barnstable BARNSfABL£, ' p b 9 A,mg Inspectional Services Department tfD�1 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 ONE (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 §36�0-20 h) OTHER ❑ InI O..d [ c2r e it i Repair deadline: r Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc 133- ooy Commonwealth of Massachusetts � ,p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 462 Main Street Property Address Ester Childs Owner Owner's Name information is required for every West Barnstable Ma 02668 6-29-2020 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. Inspector Information S� it+ y filling out forms (p� on the computer, use only the tab Daniel Hawkins ,key to move your Name of Inspector cursor-do not B&B Excavation use the return Company Name key. 374 Route 130 cs Company Address Sandwich Ma 02563 City/Town State Zip Code ,ram (508)477-0653 S114324 Telephone Number License Number B. Certification I certify that: I 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 the property 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. 0 Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails Dan Hawkins Digitallysigned by Dan Hawkins - "Date:2o2o.ozoeos:oi:3s-oa•oo. 6-29 2020 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system 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 r Commonwealth of Massachusetts Title 5 Official Inspection Form ±= ,1� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 462 Main Street r Property Address Ester Childs Owner Owner's Name information is West Barnstable Ma 02668 6-29-2020 required for every 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: ❑Q 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): Liquid level in septic tank was below outlet invert showing tank is leaking. The d-box has heavy deterioration and the liquid level is also below outlet invert. Tank and d-box in need of replacement. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 462 Main Street v� Property Address Ester Childs Owner Owner's Name information is West Barnstable Ma 02668 6-29-2020 required for every 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 break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): El distribution box is leveled or replaced ❑0 Y ❑ N ❑ ND(Explain below): The D-box is in poor condition. ❑ 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 I, w Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 462 Main Street V� Property Address Ester Childs Owner Owner's Name information is West Barnstable Ma 02668 6-29-2020 required for every 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 any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: '*This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 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 El El Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ O 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.712 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 1 Commonwealth of Massachusetts �a Title 5 Official Inspection Form mJ.� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 462 Main Street Property Address Ester Childs Owner Owners Name information is West Barnstable Ma 02668 6-29-2020 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ 0 Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ a Liquid depth in cesspool is less than 6"below invert or available volume is less than '/2 day flow ❑ 0 Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ 0 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. ❑ El Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ 0 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. ❑ Fi 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 r Area—IWPA) or a mapped Zone II of a public water supply well t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts ,lp Title 5 Official Inspection Form �= 1� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments t 462 Main Street �u— Property Address Ester Childs Owner Owner's Name information is West Barnstable Ma 02668 6-29-2020 required for every 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 ❑ El Pumping information was provided by the owner, occupant, or Board of Health ❑ 0 i Were any of the system components pumped out in the previous two weeks? ❑ 0 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? El ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ❑ M Was the facility or dwelling inspected for signs of sewage back up? El ❑ Was the site inspected for signs of break out? El ❑ Were all system components, excluding the SAS, located on site? 0 ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: El ❑ Existing information. For example, a plan at the Board of Health. ❑ a 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 p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 462 Main Street v� Property Address Ester Childs Owner Owner's Name information is west Barnstable Ma 02668 6-29-2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: No design plans 3 Number of bedrooms(design): Number of bedrooms(actual): DESIGN.flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): NA Description: No design plans or permits were available at Board of Health. Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes No Does residence have a water treatment unit? ❑ Yes 0 No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes F!] No information in this report.) Laundry system inspected? ❑ Yes F!] No Seasonaluse? ❑ Yes [E No Water meter readings, if available (last 2 years usage (gpd)): See below Detail: "WELL WATER" Sump pump? ❑ Yes 1101 No Last date of occupancy: May 2020 Date l5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form In, Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 462 Main Street u- Property Address Ester Childs Owner Owner's Name information is West Barnstable Ma 02668 6-29-2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: NA 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: Owner- date of last pump is unknown Was system pumped as part of the inspection? ❑ Yes ❑■ No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 Commonwealth of Massachusetts �e Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ........... 462 Main Street Property Address Ester Childs Owner Owners Name information is West Barnstable Ma 02668 6-29-2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: 0 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: 1990 per asbuilt Were sewage odors detected when arriving at the site? ❑ Yes FNI No 5. Building Sewer(locate on site plan): 3'6" Depth below grade: feet Material of construction: ❑ cast iron ❑■ 40 PVC ❑other(explain): Distance from private water supply well or suction line: Town waterfeet Comments(on condition of joints, venting, evidence of leakage, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form - i, i11. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 462 Main Street J� Property Address Ester Childs Owner Owner's Name information is west Barnstable Ma 02668 6-29-2020 required for every page. City/Town State Zip Code Date of Inspection - D. System Information (cont.) - -- -- 6. Septic Tank(locate on site plan): 216" Depth below grade: feet Material of construction: 9 concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No 1 � Dimensions: 000gallons ea k'In Sludge depth: Tank is leaking if Distance from top of sludge to bottom of outlet tee or baffle Scum thickness n n Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Viewed Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): The tank was leaking at the time of inspection. Liquid level in tank was below outlet invert when viewed. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts �. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ............. 462 Main Street u— Property Address Ester Childs Owner Owner's Name information is West Barnstable Ma 02668 6-29-2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): NA Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): I 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): NA Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 Commonwealth of Massachusetts �M Title 5 Official Inspection Form ±= 1. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 462 Main Street Property Address Ester Childs Owner Owner's Name information is west Barnstable Ma 02668 6-29-2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information cont. Y (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.): I "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): offDepth of liquid level above outlet invert Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): The d-box was in poor condition at the time of inspection. D-box had heavy deterioration and the liquid level was below the outlet invert. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 r c Commonwealth of Massachusetts Title 5 Official Inspection Form to Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 462 Main Street Property Address Ester Childs Owner Owner's Name information is West Barnstable Ma 02668 6-29-2020 required for every page. City/Town 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.): NA *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: 0 leaching pits number: (1 ) 6'x6' pit ❑ 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 �m Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments I 462 Main Street _V Property Address Ester Childs Owner Owner's Name information is west Barnstable Ma 02668 6-29-2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information on ccont. . 11. Soil Absorption System (SAS) (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): The SAS was in working order at the time of inspection. Pit had 1" of standing water and waslstained 1/2 way up for the bottom. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): NA 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 l5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 462 Main Street Property Address Ester Childs Owner Owner's Name information is West Barnstable Ma 02668 6-29-2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: NA 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 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 462 Main Street V� Property Address Ester Childs Owner Owner's Name information is West Barnstable Ma 02668 6-29-2020 required for every 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 Assessing As-built Cards TOWN OF BARNST'ABLE � .� . i_3 3 --0 0 LOCATION tnrtGcvvw:,. SUWAOR VILLAGE ( , i , i 7 r ), E ASSE RSOR:sS MAP& LOT INSTALLER-S.NAME&PHONE No. A.& B CANM ` 27,,626e SEPTIC TAWXCACAPAAC 7iTY LEACI-iXG PAOILI'TY_(tne): cf. Ki NO.00 BEDROQMS :_1 WELL Uft.]P.UBLIC WATER BUILDER!OR a WISER __,. i DATE,PERMIT I55U6I3a RATE COUpLIA1VCEi.ISSUETS 1 ? VARIANCE GRAXTEOz Yes Nics 147` /So r t5insp.doc•rev.7/26/2018 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 462 Main Street Property Address Ester Childs Owner Owner's Name information is west Barnstable Ma 02668 6-29-2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: Check Slope 0 Surface water 0 Check cellar 0 Shallow wells Estimated depth to high ground water: No GW 2' below SASfeet 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 El 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: The bottom elevation of SAS was determined with a transit and transfered to low area (directly across street). The bottom of the SAS is >2' above high ground water. 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 462 Main Street u� Property Address Ester Childs Owner Owner's Name information is West Barnstable Ma 02668 6-29-2020 required for every 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. 0 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 �I t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 No. 2-0 Fee 60 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Application for Disposal *pstem Construttfon Permit Application for a Permit to Construct( ) Repair 64 Upgrade( ) Abandon( ) ❑Complete System Vindividual Components Location Address or Lot No. m ron si Own 's Name,Address d Tel.No. 13 Assessor's Map/Parcel w c 5't f3�.CnS .b �`� C' M�� 3• Installer's Name Address,and Te o. Designer's Name,Address,and Tel.No Type df Building: x oY :?t a-19 4 Dwelling No.of Bedrooms Lot Size ®Oa sq.ft. Garbage Grinder(40 Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures p Design Flow(min.required) 3�® G ` gpd Design flow provided 32 a U gpd Plan Date—!-? h-) f (j Number of sheets pZ Revision Date Title Size of Septic Tank („ j® =0 Type of S.A.S. Description of Soil �\r--c, CA`�� . ��rl�J� 1 �( � LI'n{5 Nature of Repairs or Alterations(Answer when applicable) 9(20161„4 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Bo Health. - r Signed Date't l Application Approved by �1. {!- Date Application Disapproved by Date for the following reasons Permit No. V-0 Date Issued ri.}„� .:oe,a.•'..��1,',:h1..-..,,�1.�..+.. ,-..r�..,;.-'�i.._.M ", � _ yy��.i.a"r►�i�.".`"•-..«�x�'�n:�°'�.- ��pk f' i �. t� }. �..x-.r•h,+"'*..r:,...L-..-.•^•r•',,.,r-^•qs_. P .� '.,-n�.t-y.�.�:��.l.F' �'� ��p^r �4gy,1 •...e�'*,.�«.vi:*yr.P'"��r'T..^7Fr' t'r �`• ' .. No. Fee / THE COMIITIDOWLEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS application for Disposal *pstrm Construction permit Application for a Permit to Construct( ) Repair(✓) Upgrade(' ). Abandon( ) 0 Complete System /Individual Components Location Address or Lot No. (a ('✓4i.1.� S� Owner's Name,Address dCel.No. Asse`s"sor's Map/Parcel 33 --1 �..�CS§ f3��nS b C�«t4+ 3� �d Main S�' W C� Installer's Name Address,and Te o. Designer's Name,Address,and Tel.No. �" SGv lw �c-,v✓�!C t t C�[tJ ��t(.,r n^.wKr. �J G ti,,v-c co 'bat-ow r c'c-f t LX-% y r SV5 �(C) of>14 & c ,.ff r i S C G r Type of Building: ,S+DY Z?Io v4 2r5 y Dwelling No.of Bedrooms Lot Size Oa sq.ft. Garbage Grinder(40 's Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) o C•, gpd Design flow provided gpd Plan Date ? la 7 1.. Number of sheets 01 Revision Date Title .. �" Size of Septic Tank ,v C'_u H /(D mn Type of S.A.S. Z Z ts-X Le C,e_ m:TZ f k 4� Description.,of Soil �, k r-C •S fr^d v c Q. rAj'\ 1 j,l nz 5 Nature of Repairs orAlterations(Answer when applicable) .. � v 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 off Compliance has been issued by this Bo -of Boajd-of Health. SYgned - -� :Date / ° .. ? - ApplicationApprovedby Date + V Application Disapproved by Date for the following reasons �. Permit No. O)o — Date Issued �► " `�``� THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(� Upgraded( ) Abandoned( )by 7sCc),o M !'r (A j-,K at _ M r%�� 4,)trnnb�as been constructed in accordance `with the provisions of Title 5 and the for Disposal System Construction Permit No. ��0 1 b!dated ••i .iti rk ,�. ,� AA Installer � p (� � V Designer s ' CU)0461,1 L(7}J C #bedrooms Approved design flow ?, gpd The issuance of this permit shall not be construed as a guarantee that the system ill funct o �as,designed. Date /,�f Inspector ./``....--_ --------- ------------------ -- - No. 01 t1 161 Fee �(! THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Disposal 6pstr Construction Permit -✓ Permission is hereby granted to Construct( ) Repair(V Upgrade( ) Abandon( ) System located at <5-3 (nG.k t^N S,k (. X\1N Z !r NSN4S0q , II 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 ' [2— L4 ICJ Approved by J i • t J• Town of Barnstable Regulatory Services �. Richard V.Scab,Interim Director p Public Health Division Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 IL Office: 508-8624644 Fax: 508-790-6304 Installer& Designer Certification Form Date: qi 1G1 z o Sewage Permit# Assessor's MaglParcel V Designer: DG&A Ca!J1 k t9wr Installer: )A W Address: 15� GPo k-Y�e� �� So Address: 3 0k .(N-ci��4 CkIlhOm VW A 0z633 0-� On U Sc<,,A r\ was issued a permit to install a (date) (.installer) " septic system at S�•6 mGe' based on a design drawn by (address) ��lvtt Coo f 17"Ow✓ - dated 3127 10 (designer) I I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than l 0' 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. 1 certify that the system referenced above was constructed in r ith the terms of the ]\A approval letters(if applicable) DAWD Yes D. COUGHANOWR " (Installer's Signature) No. 1 093 I'STV- �o ' 1VIraa N (Designer's Signature) (Affix Designer's SUEp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. 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:',SepticlDesigner Certification Form Rev 8-14-13.doe TOWN OF BgRNSTABLE fl 13 rrl,el/l/Vv LOCATION �� SSEWAGE # VILLAGE L ) !?a 1210,,9 , , ASSESSOR'S MAP Cz LOT r: INSTALLER'S NAME & PHONE NO. A & B CANCO 775-6264 SEPTIC TANK CAPACITY h�� LEACHING FACILITY:(type) 41- 106 e) (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No ^ r ye,lt xt � - 9 W7 4 No.-------------------- Fee--------------------- BOARD OF HEALTH TOWN OF BARNSTABLE Application-*rVell Cootruction Permit , Applications/is hereby made for a�p)ermmiitt,(t�o Construct ( ), Alter ( ), or Repair ( )an individual Well Location Address A so4<a and Parcel Owner r Address Installer — Driller Address Type of Building ,°_/_lam__ Dwelling---� � ------------------------------ Other - Type of Building - No. of Persons-----_____________-_—__--_______ Type of Well —�6 �— -— Capacity --——---- --—YP - -- --------- ------------- ----- Purpose of Well---------- —- ----— ----- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a Certificate of Compliance has been issued by the Board of Health. Sign&A-- APQ-- _—�� ---- date Application Approved By — — -- _ date Application Disapproved for the following Zans: -------=------------____—_________— __�_ -- - - --- ---- ----- ----- ---------- -- date � I/ Permit o. -- __—_____ Issued--�! � -® --------- date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance L /f 5 a/7/1it17 THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( ) --- -- - ------------------------------------ ��//f A4 / > Installer at lO� Gy, � .�'.t/. i��Ehas been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. -------------Dated--- —_-- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE---- - -- Inspector-----------__— —_ No.---=---------------- ---- BOARD' OF HEALTH TOWN OF BARNSTABLE � zippCicationArIV ell,Congtruct ion Permit . Application is hereby made for a permit to Construct (: ) Alter ( ); or Repair (,o,)an individual Well y tiocahon ,.,Address. .`. , \� \1�\��,�� sor3°iGlap and Parcel Owner Address Installer - Driller 11, Type of Building . ! ; P�i�q 4 ^ Dwelling — - 7.7-1 Other - Type of BuildingNo. of ''ersons---— ------------ ---- ---- Type of WellQ � � — -- �. -----� Capacity— -- - - ----- Purpose of Well---------- - --- i Agreement: The undersigned agrees to install the aforedescribed individual E,,, cordance with the provisions of The I re nn c 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 Com-01-ance-h�-bee -i sued by the Board of Health. Sign - — — ---- date. �16k� Application Approved By; e - Gate `- Application Disapproved:for'the following -asons: 01 f --------- --- t ---------- -- - /�------ date. - Permit Issued:.. .,date r.�.sa:e:e:�c+:ers c:� a R:.rstarae:�.wayr.t�a� e.e.z�aaucsity7 a+aas�taarsa!•a+faffir�r'trreuvssseas.+�:earta�tawawes�awsa�c�a�sraeaeress�a�raea�-ta.se�..aesea*a�:«a�ci BOARD OF.HEALTH r TOWN OF BARNSTABLE C ertif irate Of Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ); or Repaired ( , by— -- Installer - 11 at---- a has been installed in accordance with the provisions of the Town of Barnstable Board of Health�Private Well Protection I` 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 r SYSTEM WILL FUNCTION SATISFACTORY., DATE---- x -- ------=^___ — Inspector -- ---- —___ — _ ' ors BOARD OF HEALTH TOWN OF BARNSTABLE Veil.Congtruct ion Permit No. Fee =�.r Permission is hereby granted to Construct ( ), Alter ( ); or Repair ( t•') an Individual Mell at: ' " No. -�/� ' �� 1,c�ir%s,� ,,- ---- ---------- street f / as shown pn the application fo a 7ell Construction Permit No.-t+1�V/ '� ------=-- Dated ------------ -- - -=------------ ... __ Board/of Health r DATE— THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 777bLs-0................0 ............................ Appliration for Uispoiial Works Tonarurtion ramit Application is hereby made for a Permit to Construct or Repair ( �an Individual Sewage Disposal System at: ............................ .... ................................... ,Loc..,,n LAJress C.- or Lot No. JNJSL_0 W ........................................................... ........................ ......• ... ...................... -Q-ner Address j. ............................................. ......................................... ....&I......... .. i.4 ..... ............... Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.__.....8..................................Expansion Attic Garbage Grinder Other—Type of Building ............................ No. of persons............................ Showers Cafeteria Otherfixtures ----------------------------------------------------------------------------------------------------------------------------------------------------- Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 04, Septic Tank—Liquid capacity............gallons Length................ Width.........._..._. Diameter._____.......... Depth................ Disposal Trench—No..................... Width.................... Total Length..................._ Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................._. Total leaching area..................sq. f t. Z Other Distribution box ( ) � Dosing tank ( ) Percolation Test Results Performed by......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit._.........._._...._ Depth to ground water.._..._..............__. Test Pit No. 2................minutes per inch Depth of Test Pit_............_.._... Depth to ground water._.................._... ............................................................................................................................................................. 0 Description of Soil------------------------------------------------------------------------------------------------------------------------------------------------------------------------ W ....................................................................... *---------------------------------------------------------------------------------------------------------- ........ ................................................................................................................................................ .. ............ ------------- U Nature of Repairs or Alterations—Answer whipn applicable_A67.. ......&V ............ ---------- A .................................................. ...q.0 .....PJ..........�111.......SID.Wtr....................... - Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'I"I T1 TIE 5 of the State Sanit Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance I s bee issued by t"oard of health. Signed.....q.. - ------------ --------------------------------------- ... Date Applicition Approved By......... ---------------------------------------- Date Application Disapproved for the following reasons:................................................................................................................. ......................................................................................................................................................................................................... Date PermitNo..._._.�40...... -------------------- Issued..................Date.......................4...... No....74::...Y-Z/ Fica Qa...:-......... THE COMMONWEALTH OF MASSACHUSETTS ` BOARD OF HEALTH 777�C?.v . ...............oF.......hFA:. a .. :..r ._fi`_ T -..........------............--•-- ,� r rlir #iun for Diopuoal Works Tonotrnrtion Prrmit Application is hereby made for a Permit to Construct ( ) or Repair ( 0--'an Individual Sewage- Disposal System at: _ ..............�._... .+.c.... '` ' .. _t..._..�'�:L. 1 .Cilfr •-••-•---••---------- ------------- Location-Add re or Lot No. ...w-x+j&-Nova......�1�i..-� �'...-------•---------------------- ..........------------------------------ ------......------......-----................. Ow er Address a — .... .. .�.....0........ ............................... .......................................... Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.... ...................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers ( ) — Cafeteria ( ) a Other fixtures --------------------------------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid 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 ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ (X4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P' •------------------------------ -............................ -------------------- •--•-------•--------------------------- ---.-------- -....•.... ..... ----------- 0 Description of Soil........................................................................................................................................................................ . -- U --•--•---•---•-•--.....•-------------------------------•-----------•----- •--•-•-•------........---•-•-------------•....•- -------------------------------------------•--------•---------------------- .--......-•--------------••------------------------------------.._....----------.........---•-------•-••---. U Nature of Repairs or Alterations-Answer when . .... T applicable.is _�t.�._._.)aa:<-:9t_J.`c'-Z-a). :...y....b� .............. J �0 u _ J .. -------------------------------------------------•----. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITL% 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by t4e,board of health. Signed ...� ..`.........azzz ... Date Application Approved By......... . ..... --------•----------------•-----------•-- ......... ... .. L {fJ Date Application Disapproved for the following reasons-----------------------------------------------•------------•--------•-------------------._...--------------•--- ...................................••--.......--------------....----------------.._...........................---------•••--------------•----------•--------•------------------------ ..........-- Date PermitNo....... ..................... Issued-------------•-----Date............................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...................OF.. .................................... (In ifiratr of Toutplianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (,.j S-�`h)!) U-•............................................................................................................................................. Installer at..... -------�-= ---•----------------l.. ------ _ --• .--------..... has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ��.. �� -r- ,►�.................... �=................................. Ropoottl Worko %Tono#r tion rrutit Permission is hereby granted...... ! •-----C 1:1. < ---•-•----•-••--•----------------------------•---•--........................--•-•--•-•--. to Construct ( ) or Repair (� an Individual Sewage Disposal System qj Street as shown on the application for Disposal Works Construction Permit No �\/-7�f'-_ Dated.......................................... •--------------•----••--•--- ......................................................... DATE............... . • -•-•--•- o Board of Health / ". FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS 0 , tea Q t THIS IS a _- - -- LEGEND S .N 'p. SEPTIC COMPONENTS I COLOR LEpCNING ABANDON I— p PLAN USE COLOR PLAN ONLY p,00 f< <(I FIELD EXISTING FOR INSTALLATION 25 ptOP MAIN 57 1000 GAL � c as°oa P c y , FULL DETAIL IS BEST NG �NfIl. I 5 SEPTIC TANK `��` SQ�c �,�°¢• �v. � VIEWED IN eps INSTALL NEW FULL COLOR 18 O� ®0 1000 GAL 19 _ 5 SEPTIC TANK ! /} \ y5le M DISTRIBUTION BOX® MINIMAL +._ WEST BARNSTABLE, MA F GRADING �— -� (IthTEST PIT PROPOSEDLOCUS MAP 20 \c LOT 1 AREA = 45002 sf+— \ LAND COURT PLAN 35113—A 21-� - \ / E® \ ASSR MAP 133 PCL 9 UTILITIES Q Q GAS LINE -�6 ,�C� 1 NT \ QO / \\ GARB +, JOVERHEAD WIRE off PROPOSED SOIL 22 PIPE\ Q ea \ \ \ to I"4 G OT POLE "` �'� A OWED ABSORPTION o_ D 18 Q / �� SYSTEM > WELL - Z G1 \ -SEE DETAIL 23 ON BACK {b {\ a ,,.x> M w E L EXI 24 F 3 NI EL r✓N0N V C) 15 .� NCH IW A p \ # \ �V PPNSIABLE GIS DATD � � 19 e M r � \ °_ G ��.�„.„!�\ ELEVATION \ OP OF �� FOUN�P \� G PLAN 20 OF* 2 SS P��N OF MASS 26 r \ \ p� DAVID 9�tiG� o� DAVID 9�yG S CA L E: I in = 30 f t ° PROPO� D. COUGHANOWR O 3O 60 \ L OCAItU ," D. � % US WELL G 21 COUGHANOWR n -- --- ` � � � No. 1093 No. 461 O 1O 20 30 224 2 ° 4$23 .� � � .� � �FGISfE � gPpROVEO PRINT ON ll x 17 in PAPER �"r 2tb.t6 f< 25 l , b "' " / S4 t SO Al FOR PROPER SCALE 26 .x�M�� ' 4r " f t� NO OTHER WELLS WITHIN 150 ft OF - a�', �M ' „`�h�" � �� "� THIS PLAN IS.INTENDED SOLELY FOR INSTALLATION OF THE SEPTIC SYSTEM THE PROPOSED LEACHING FIELD �E �OF,.Pw� Sir � DEPICTED ON IT. FOR ANY OTHER CHANGES TO THE PROPERTY INCLUDING 'T M E� � � w", ' :, W ,w'� PLACEMENT OF ADDITIONS. SHEDS, FENCES OR SWIMMING POOLS. OWNER SHOULD CONSULT WITH A MASSACHUSETTS REGISTERED LAND SURVEYOR. NO OTHER LEACHING SYSTEMS- WITHIN �� 150 ft OF THE PROPOSED WELL O u T woTEs Q �. �� a SEWAGE DISPOSAL ,�`w SYSTEM PLAN USE OT THE EXISTING LOCUS WELL AS OF -TO SERVE A POTABLE WATER SOURCE IS TO BE ° S EXISTING DWELLING VARIANCE REOUES"TED DISCONTINUED. ANEW WELL SHALL BARBARA AND BE DRILLED IN THE LOCATION , MAY BE GRANTED IMMEDIATELY BY HEALTH AGENT OR HEALTH INSPECTOR. - WELL INDICATED ON PLAN. JAMES BARRETT 310 CMR 15.221(7) - COMPONENT - EXISTING SEPTIC TANK IS TO BE PUMPED DRY. F RECORD PUNCH ANOHOLE IN BOTTOM PER TA ONINS ENTAD. C OWNSnb°MAIN STREET DEPTH TO FINISH GRADE. 36 in REGS EXISTING SOIL ABSORPTION SYSTEM W. BARNSTABLE, MA MAX REQUIRED - VARIANCE TO TO BE ABANDONED IN PLACE. 155 Geo Ryder Rd •S PROPERTY ADDRESS 60 In OF COVER REQUESTED. TREE.REMOVAL AT INSTALLERS DISCRETION. D hath nn, MA 2633 DATE: MARL �hothom, MA 02633 H 27, 2020 508 364-0894i Pc. 1/2 -joa& ETE-4444 ^BCoE, 4500 GALLON SEPTIC 'TANK'` DISTRIBUTION BOX �DB�3 H20Y` SOIL EVALUATOR: DAVID D. COUGHANOWRf ASE At461 DESIGN FLOW: 3 BEDROOMS X 110 GPD - 330 GPD ! DIMENSIONS & DETAIL DIMENSIONS PIPES EXITING D-BOX TO RUN LEVEL WITNESSED BY: DAVID STANTON, HEALTH DEPT. AND DEtAit FOR. .2 FEET BEFORE PITCHING DOWN. NO GROUNDWATER ENCOUNTERED SEPTIC TANK: 330 GPD X 2 DAYS = 660 GALLONS USE SHOREY ST-15oo-H-10 TEST PIT PER( AT 68 In - 2 MIN/INCH IN C SOILS ABANDON EXISTING 1000 GALLON SEPTIC TANK ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER AND INSTALL NEW 1500 GALLON SEPTIC TANK. I in NOT INCHES HORIZON TEXTURE (MUNSELU MOTTLES -r�,,, TAPER T 0 c MIN 1 22.50 - 0-4 O LOAM 10 YR 2/1 NONE FRIABLE DISTRIBUTION BOX: INSTALL UNIT DEPICTED BELOW. SCALE i -► 4-12 A SANDY LOAM 10 YR 3/2 NONE FRIABLE ' =t L0 FROM g SOI ABSORBTION SYSTEM•L it 12-40 B LOAMY SAND 10 YR 4/4 NONE FRIABLE �(�,,,T� R N TANK il uo to 1 TO 19.17 THE LONG TERM ACCEPTANCE RATE FOR A CLASS ONE o ' ,: � �� k �� , � a; ^ SAS 40-132 C FINE SAND 10 YR 6/3 NONE FRIABLE SOIL WITH A PERCOLATION RATE BELOW 5 MINUTES � � � � � S f t- Q 11.50 PER INCH = 0.74 GALLONS PER DAY PER SQUARE FOOT. o 8 in :. NO GROUNDWATER ENCOUNTERED THE 25 ft x 18 LEACHING FIELD \� 6 in STONE BASE TEST PIT 2 PERc AT 68 in - 2 MIN/INCH IN C SOILS DEPICTED BELOW CAN LEACH: � ��. ` � 21 in A 2� CROSS SECTION VIEW ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER BOTTOM AREA = (25 18) = 450 s ft. .F� INCHES HORIZON TEXTURE (MUNSELU x MOTTLES q :+ 22.25 0-4 O LOAM . 10 YR 2/2 NONE FRIABLE SIDEWALL AREA =0 0 s . ft. 4-12 A SANDY LOAM 10 YR 3/3 NONE FRIABLE FLOW = 0.74 x 450 = 333.0 45�0Ida ft. /Q ft-6 18 92 12-40 B LOAMY SAND 10 YR 4/4 NONE FRIABLE 9 y STONE TO BE DOUBLE WASHED & 40-132 C FINE SAND 10 YR 614 NONE FRIABLE INSTALL A 25 ft x 18 ft x LEACH FIELD AS CONFIGURED H/N LEA C G FREE OF IRONS, FINES & DUST. 11.25 = BELOW. FLOW CAPACITY 333 of/day WHICH EXCEEDS 9 INLET OUTLET FIELD DIMENSIONS CONNECT PIPE ENDS TO VENT. '_- - - THE 330 gal/dog REQUIRED FOR A THREE BEDROOM DESIGN_, - - -- COVER COVER � INSPECTION PORT WITHIN 3 in -INSTALLER TO OBTAIN DISPOSAL WORKS 3 IN DROP OF FINAL GRADE. N PERMIT BEFORE STARTING WORK. -FLOW LINE FROM lO in 14 TO -ALL COMPONENTS INSTALLED SHALL MEET BUILDING THE MINIMUM REQUIREMENTS OF '^ D-BOX CODEA(310SETTS CMR 15)TITLE 5 SEPTIC 48 in GAS n LIQUID N -INSTALLER TO VERIFY LOCATIONS OF ALL BAFFLE UNDERGROUND UTILITIES BEFORE LEVEL Qo ' 00 rt EXCAVATING FOR SYSTEM. n 2 ft -ECO-TECH RAPID RESPONSE RECOMMENDS THE INSTALLATION OF LOW FLOW 6 in STONE BASE FIXTURES & APPLIANCES. AND PERIODIC SEPARATION BETWEEN INLET & OUTLET Oz PUMPING OF THE SEPTIC TANK. TEES NO LESS THAN LIQUID DEPTH -SYSTEM IS NOT DESIGNED TO WITHSTAND VEHICULAR LOADING. DO NOT PARK OR DRIVE VEHICLES OVER SEPTIC SYSTEM. CROSS SECTION VIEW 25 ft DISCHARGE HOLES NOT SMALLER THAN 3/8 in. NOT GREATER THAN 5/8 in. I L E TOP OF FOUNDATION RAISE COVERS TO WITHIN ALL PIPE TO -4 in BE SCH. 40 PVC VENT EL = 24.15 +— 6 in OF FINAL GRADE AND TO PITCH AT 1/8 in/ft MIN PIPE 21.5 22.5 D—BOX S' MAX INSTALL USE H-2o , 18.33 20.82 1500 GALLON Oa 000000.00e 000d o aooao.a4o 0000 Ooo ap opo OQoo opoo o0 p o0ooaopoo po oopo o0oop Oo opo�o ooaoa 17.87 EXISTING SEPTIC TANK 19.25 ��a��oo�0000000aooa�90 oo�0000 o O00090 po 0000008-Oe°poo0 00 o0o opoa0o0 Ooo Oo gOoo aoOopOoo oo o0000�0000000.o oo ooao da000 oo00000000009 18.05 19.50 REFER TO DETAIL BOX S6 in LEACHING FIELD 18.22 )g.00 —REFER TO DETAIL BOX EXISTING BASE O 6 in STONE BASE 16 ft 68 ft 3-7 ft 17..37LO BELOW NO GROUNDWATER 11.25 MOTTLING OBSERVED SEWAGE DISPOSAL SYSTEM PLAN 1526 MAIN STREET W. BARNSTABLE, MA MARCH 27. 2020 ETE-4444 PG 2/2