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HomeMy WebLinkAbout0056 MORGAN WAY - Health 56 IORGAN WAY,W. BARNSTABLE A = 175 027 Ila v Commonwealth of Massachusetts . =. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 56 Morgan Way Property Address r SHERLOCK, DONALD J & PATRICIA I TRS Owner Owner's Name information is Barnstable ✓ Ma 02630 1/15/20 required for every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. i Important:When A. Inspector Information �"/ filling out forms I LJ33 on the computer, Michael DiBuono use only the tab key to move your Name of Inspector cursor-do not DiBuono Sewer And Drain use the return Company Name key. 35 Content Lane C Company Address Cotuit Ma 02635 City/Town State Zip Code Bucn 508-364-9587 S113522 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. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails I 1/15/20 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.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form to Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 56 Morgan Way Property Address SHERLOCK, DONALD J & PATRICIA I TRS Owner Owner's Name information is required for every Barnstable Ma 02630 1/15/20 page. Cityrrown 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: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System contains a 1500 Gallon septic tank as well as a concrete distribution box and 4 Infultrators 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 Title 5 Official Inspection Form 11. Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 56 Morgan Way V� Property Address SHERLOCK, DONALD J & PATRICIA I TRS Owner Owner's Name information is required for every Barnstable Ma 02630 1/15/20 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 break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): distribution ❑ o box is leveled or replaced Y N ND (Explain p ❑ ❑ ❑ ( pain 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: I t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 c Commonwealth of Massachusetts ,vF Title 5 Official Inspection Form �a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 56 Morgan Way v Property Address SHERLOCK, DONALD J & PATRICIA I TRS Owner Owner's Name information is required for every Barnstable Ma 02630 1/15/20 page. CityrTown 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 ❑ ® 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 � L Commonwealth of Massachusetts Title 5 Official Inspection Form la Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 56 Morgan Way Property Address SHERLOCK, DONALD J & PATRICIA I TRS Owner Owner's Name information is required for every Barnstable Ma 02630 1/15/20 page. Cityrrown 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 '/z day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® 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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 56 Morgan Way Property Address SHERLOCK, DONALD J & PATRICIA I TRS Owner Owner's Name information is required for every Barnstable Ma 02630 1/15/20 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) i 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? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 c Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 56 Morgan Way Property Address SHERLOCK, DONALD J & PATRICIA I TRS Owner Owner's Name information is required for every Barnstable Ma 02630 1/15/20 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 flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Description: Number of current residents: 2 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 Seasonaluse? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ❑ No Last date of occupancy: Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form . Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 56 Morgan Way Property Address SHERLOCK, DONALD J & PATRICIA I TRS Owner Owner's Name information is required for every Barnstable Ma 02630 1/15/20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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: Not provided 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 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 56 Morgan Way Property Address SHERLOCK, DONALD J & PATRICIA I TRS Owner Owner's Name information is required for every Barnstable Ma 02630 1/15/20 page. Cityrrown 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 co of the DEP approval. 9 PY pp ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: Installed 11/19/1999 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 2 feet Material of construction: ® cast iron Z 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): System is vented at the roof line t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 I Commonwealth of Massachusetts Title 5 Official Inspection Form la Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 56 Morgan Way v, Property Address SHERLOCK, DONALD J & PATRICIA I TRS Owner Owner's Name information is required for every Barnstable Ma 02630 1/15/20 page. City[Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 1 feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) 1500 If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 Sludge depth: 3 Distance from top of sludge to bottom of outlet tee or baffle 24" Scum thickness 3" Distance from top of scum to top of outlet tee or baffle 411 Distance from bottom of scum to bottom of outlet tee or baffle 30" How were dimensions determined? Tape Measure 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 solid with no leaks i t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts I.? Title 5 Official Inspection Form ` Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 56 Morgan Way Property Address SHERLOCK, DONALD J & PATRICIA I TRS Owner Owner's Name information is required for every Barnstable Ma 02630 1/15/20 page. Cityrrown 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.1/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 56 Morgan Way V Property Address SHERLOCK, DONALD J & PATRICIA I TRS Owner Owner's Name information is required for every Barnstable Ma 02630 1/15/20 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 Normal 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.): Level and at normal level with no sign of back up t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form to Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 56 Morgan Way V� Property Address SHERLOCK, DONALD J & PATRICIA I TRS Owner Owner's Name information is required for every Barnstable Ma 02630 1/15/20 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.): " 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: ❑ leaching chambers number: ® leaching galleries number: 4 ❑ 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 1p Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments V 56 Morgan Way Property Address SHERLOCK, DONALD J & PATRICIA I TRS Owner Owner's Name information is required for every Barnstable Ma 02630 1/15/20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): 4 Infultrators in stone no sign of failure at this time 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 56 Morgan Way V� Property Address SHERLOCK, DONALD J & PATRICIA I TRS Owner Owner's Name information is required for every Barnstable Ma 02630 1/15/20 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 1p Title 5 Official Inspection Form �a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 56 Morgan Way Property Address SHERLOCK, DONALD J & PATRICIA I TRS Owner Owner's Name information is required for every Barnstable Ma 02630 1/15/20 page. Cityrrown 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 I Commonwealth of Massachusetts I(p Title 5 Official Inspection Form f; 0 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 56 Morgan Way Property Address SHERLOCK, DONALD J & PATRICIA I TRS Owner Owner's Name information is required for every Barnstable Ma 02630 1/15/20 page. Cityfrown 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: 20+ft 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: 1/2/99 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: Test hole data on plan 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 56 Morgan Way Property Address SHERLOCK, DONALD J & PATRICIA I TRS Owner Owner's Name information is required for every Barnstable Ma 02630 1/15/20 page. CityTTown 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 1/15/2020 Assessing As-Built Cards ♦v..i.va wna�a..o crw+.a. V g fl/I If / LOCATION 5(0 MOA6AN W 4 11 SEWAGE H7 VILLAGE V1I s l RAgN j!1 RL 1'ASSE$SOR'S MAP&LOT I7S a7, INSTALLER'S NAME&PHONE NO.6-Z EXCAYA fWd. "S-3Y 5� SEPTIC TANK CAPACITY ' LEACHING FACILITY:(type) (size) NO.OF BEDROOMS J BUILDER OR OWNER FR F_D (U#S JJ�a , 7 IC N Rl g 116MI PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Welt 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 AA= I��S" 8A =; 1 A a a A�� � IIC= aS A0: 31 ' 8 =31 P � II Ili https://www.townofbarnstable.us/Departments/Assessing/Property_Values/HMdisplay.asp?mappar=175027&seq=1 1/2 l�S=oa. l l t Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M a 56 Morgan way m Property Address Don Sherlock Owner Owner's Name information is required for every Barnstable (,Ug Ma 02630 1/24/17 page. City/Town State Zip Code Date of Inspection CA Inspection results must be submitted on this form. Inspection forms may not be altered in any r. way. Please see completeness checklist at the end of the form. Important:When A. General Information ( a filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor-do not Michael DiBuono use the return Name of Inspector key. DiBuono Sewer and Drain Q Company Name 8 Johns path Company Address S Yarmouth Ma 02664 City/Town State Zip Code 508-364-9587 S103522 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 1�- 1/29/17 I6spector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a.shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form z Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 56 Morgan way Property Address Don Sherlock Owner Owner's Name information is required for every Barnstable Ma 02630 1/24/17 page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/ always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System contains a 1500 GI septic tank as well a a concrete distribution box and 4 infultrators in stone B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 56 Morgan way Property Address Don Sherlock Owner Owner's Name information is required for every Barnstable Ma 02630 1/24/17 page- City/Town/Town State Zip Code Date of Inspection ection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 56 Morgan way Property Address Don Sherlock Owner Owner's Name information is /Ma 02630 required for every Barnstable 1 24/17 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M0 56 Morgan way Property Address Don Sherlock Owner Owner's Name information is required for every Barnstable Ma 02630 1/24/17 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 56 Morgan way Property Address Don Sherlock Owner Owner's Name information is Barnstable Pala 02630 1/24/17 required for every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 56 Morgan way Property Address Don Sherlock Owner Owner's Name information is required for every Barnstable Ma 02630 1/24/17 page. City/Town State Zip Code Date of Inspection D. System Information Description: System contains a 1500 GI septic tank as well a a concrete distribution box and 4 infultrators in stone. Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ❑ No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ❑ No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ❑ No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ❑ No Last date of occupancy: Date Commercial/industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 56 Morgan way Property Address Don Sherlock Owner Owner's Name information is required for every Barnstable Ma 02630 1/24/17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: None provided Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 'Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 56 Morgan way Property Address Don Sherlock Owner Owner's Name information is required for every Barnstable Ma 02630 1/24/17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Installed 1999 Were sewage odors detected when arriving at the site? ❑ Yes ❑ No Building Sewer(locate on site plan): Depth below grade: 1.5 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.): No evidence of leaking Septic Tank (locate on site plan): Depth below grade: 1 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 1500 If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4M 56 Morgan way Property Address Don Sherlock Owner Owner's Name information is required for every Barnstable Ma 02630 1/24/17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.;. Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 24" Scum thickness 3" Distance from top of scum to top of outlet tee or baffle 42" Distance from bottom of scum to bottom of outlet tee or baffle 1" Sludge stick How were dimensions determined? Tape Measure Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): No evidence of Ieaking,Tees and or baffles in place at time of inspection. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 56 Morgan way Property Address Don Sherlock Owner Owner's Name information is required for every Barnstable Ma 02630 1/24/17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tees are in place and levels are normal. Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form T " Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M °t 56 Morgan way Property Address Don Sherlock Owner Owner's Name information is required for every Barnstable Ma 02630 1/24/17 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Level and at normal level Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ Noy 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. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: II t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 56 Morgan way Property Address Don Sherlock Owner Owner's Name information is required for every Barnstable Ma 02630 1/24/17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ® leaching galleries number: 4 ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth —top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M °y 56 Morgan way Property Address Don Sherlock Owner Owner's Name information is required for every Barnstable Ma 02630 1/24/17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): No ponding no break out Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 r 1/29/2017 Assessing As-Built Cards gun:.wLllllu�J 1r1114L V Y 11'l 11 — � / LOCATION 5(p MOR6,AN Y�hiA tT—SEWAGE N R 75 - .2: & T vn,LAGE ��-5 i .L�f1.R�1���R�� ASSESSOR'S MAP LO .1 � INSTALLER'S NAME&PHONE NO.5'Z 6xcA VA / Tig `f 9S'35�5� SEPTIC TANK CAPACITY /J-0 D LEACHING FACILITY: (type) (size) NO,OF BEDROOMS BUILDER OR OWNER E6 F_ lU.VS 85k6: (G,NJ �Ph KI 01 PERMITDATE: COMPLIANCE DATE:�IJ Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by BB / Q - y httD://www.townofbarnstable.us/Assessing/HMdisolay.aso?ma[)Dar=175027&sea=1 1/2 , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 56 Morgan way Property Address Don Sherlock Owner Owner's Name information is required for every Barnstable Ma 02630 1/24/17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 56 Morgan way Property Address Don Sherlock Owner Owner's Name information is required for every Barnstable Ma 02630 1/24/17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 10+ ft 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) lain:❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database -explain: You must describe how 9 you established the high round water elevation: Y 9 USGS Maps indicate Ground water over 20 + Ft deep Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 56 Morgan way Property Address Don Sherlock Owner Owner's Name information is Barnstable Ma 02630 1/24/17 required for every _ page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ❑ Inspection Summary: A, B, C, D, or E checked ❑ Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ❑ System Information — Estimated depth to high groundwater ❑ Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 TOWN OrF'BARNSTABLE OP I lq LOCATION MOREAN � Y4 11 SEWAGE # VILLAGE W E I FAA R NS j&R4. F ASSESSOR'S MAP & LOT �75 �7 INSTALLER'S NAME&PHONE NO.�' z 6X'Cf4 YA T/o,V ` —J7�.`/� SEPTIC TANK CAPACITY / � t LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER f R Q. toils " ��C-- - !G¢-! �� g tkmlY i PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by IF - Qg �, _ 9 9 s Ez No.. a �! THE COMMONWEALTH OF MASSACHUSETTS FkE > 0Hoi n BOAR O F E A LT Hai}�g OF APPLICATION FOR ISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct (" ) Repair ( pgrade ( ) Abandon ( ) ❑Complete System ❑individual Components Mrs - R� - M� Location Owner's Name Oa Map/Parcel# Address L t ktotTelep ne# J n tall is Name Designer's Name Addres �, ddres� Telephone# Telephone# Type of Building: - Lot Size 61 D I Sq.feet Dwelling—No.of Bedrooms Garbage Grinder ( ) Other—Type of Building No.of persons Showers ( ), Cafeteria ( ) Other fixtures Design Flow min.required gpd Calculated d sign flow 3 gpd Design flow provided gpd Plan Date- - S Number of sheets Revision Date Titl G lA� Des . otio of Soils `�- 4 rct.u G``- mot w w S arc( 10 Soil Evaluator Form No. Name of Soil aluatox- ,SLtitn,�cli f, Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS DESIGNING ENGINEER MUST SUP VISE AND CERTIFY IN WPITiNG INSTALLEDTill! SYSTEM WAts IN STRICT ArrGGRDANGE.To PbkN. The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees no lace the s m in operation until a Certificate of Compliance has been issued by the Board of Health. Signed 1 Date FORM t - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 v }*- i9,Y, THE COMMONWEALTH OF MASSACHUSETTS 6 BOARD O:F._ -E A LT H � -) a O F ` w. .APPLICATION FOR PVISPOSAL SYSTEM CON TRUCTION PERMIT A, lication for a Permit to Construct ( ) Repair ( pgrade ( ) Abandon' ( . Complete System ❑Individual Components `PP i Mvr RA , , Location Owner's Name 1 &- ©a Map/Parcel if Address e M e Telep ne# s y, y ,r n tall is Name Designer's.Name r r 'Telephone# Telephone# Type of Building Lot Size r2► 01 Sq.feet " ..y ,;_ Dwelling' No.of Bedrooms �� Garbage Grinder ( ) 7 v Other Type of Building No.of persons Le Showers ( ), Cafeteria ( ) Other fixtures . L 1,+ Desi n Flow min. re uiied d Calculated design flow 3 gpd Design flow provided pd g q gp /. { " ` Plan: Date -a5-c(g Number of sheets ` Revision-Date ' Titl 6 1 Descriptio of Soil(s)J"---Uh 6"_ ?�Lo"- 1p �•_ t_ •° csvti Soil Evaluator Form No. ' Name of Soil Ualuator Date of Evaluation DESCRT'PTION OF REPAIRS OR ALTERATIONS • The undersigned agrees to install the'above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5''arid further;agrees no Wdw' min operation until a Certificate of Compliance has been issued by the Board of Health. ! ' Signed�; Date .r I� 1En a t' ns FORM 1 - APPLICATION FOR DSCP S DEP APPROVED FORM 5/961 € t Noo 'rl�r €/ry� THE COMMONW ALTH OF MASSACHUSETTS FEE PM ACMI BOARD OF HEALTH CERTIFICATE OF COMPLIANCE Description of Work: ry ❑"Individual Component(s) ❑Complete System The undersigned hereby ceztify that the Sewage D s oral ystern;Constructed,(,j`) Re aired( ),Upgraded( ),Abandoned( ) at / j has been installed in VordarlL it.�t provisions oq'1'0 CMR°15.0(T(Title 5) and the approved design plans/as-built plans relating to application No: / dated e �F ". Approved Design Flow (gpd) ,•� 1 < '< , - ' Ins>:a`ller ' Designer: InspF ct � Date 14f` oot* R' r The issuance�of.this certificate shall not be construed as a guarantee that the system will function as designed. 1 F %FORM 3 -'CERTIFICATE#OF COMPLIANCE DEP APPROVE.D.FORM 5/96 No. ' �✓ THE COMMONWEALTH OF MASSACHUSETTS FEE BOARD OF HEALTH DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to Construct Repair ( ) Upgrade ( ) bandon ( ) an individual sewage disposal system at ��' A � as described in the application for Disposal System Construction Permit No. '` datedr ' Provided: Construction shall be completed within three years of the date of this permit.All local conditions must be met. Date �.�/ Board of Healthf_.�,.-ar.- -~t FORM 2 - DSCP DEP APPROVED FORM 5/96 FORM 1255 (REV 5/96) H&W HOBBSB WARREN TM PUBLISHERS- BOSTON 1. 1 A - JIt�°�ITJIv1IlU]<<,�S11JI '�IIIU`J� �C UJ� OU�JC GGi�U`�Jcc. 131 SPRING BARS ROAD FALMOUTH, MA 02540 (508) 540-3699 October 15, 1999 Barnstable Board of Health Barnstable Town Hall South Street Hyannis, MA 02601 RE: Lot #161 Morgan Way, Barnstable Ma, Map 175, Parcel 27, Lot 161, Lot 56 Dear Mr. Barry; In regards to our plan dated October 9, 1999, which was prepared under my immediate supervision. It was witnessed during construction and was found to have been installed in accordance to the notes on the above referenced plan. Sincerely, ,1 U George Scruton, P.E. GS/sp L Town of Barnstable 114 Department of Health,Safety,and Environmental Services �T Public Health Division Date 367 Main Street,I Iyannis MA 02601 BARN317ABMMASS �°rEvraa+" Date Scheduled ll Time Fee Pd. I Soil Suitability Assessment for Sewage Disposal Performed Bya( _ i =0 G`1� Witnessed L3yr�--/"of a I-�-e LOCATION & GENERAL INFORMATION Location Address ��, �ICt�C: '�rn.� ( 0'. Owner's Name Address IAssessor's Map/1 arcel• `—��\pZ L4 l(p` Engineer's Nam o,(�W NEW CONSTRUCTION REPAIR Telephone# Land Use w a a d - Slopes(%) 3 J� L b Surface Stones Distances from: Open Water Body R Possible Wet Area tt Drinking Water Well n Drainage Way It Property Line R Other n SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) Ipq .7e 33 i l y,. Parent material(geologic) (�✓"lbw g s Depth to Bedrock Depth to Groundwater: Standing Water in Hole: Weeping from Pit Face Estimated Seasonal High Groundwater DETERMINATION FOR SEASON1:1IOa Method Used: Dept` Ociserved standing in obs.noie: in. Depth to soil mottles: in. Depth m weeping';en:side of obs.hole: in. Groundwater Adjustment tl. Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level PERCOLATION TEST Date q-/d time Observation 2 I lole# Time at 9" 2 2 D Depth of Perc Z& �r Time at 6" Z 3 S Start Pre-soak Time c@t 1 2 O S,- Time(9"-6") End Pre-soak / Z 2 O Rate Min./Inch Site Suitability Assessment: Site Passed �� Site Failed: Additional Testing Needed(YIN) Original: Public health Division observation Hole Data To Be Completed on Back > Copy: Applicant ' 1 013SEIZVATION HOLE LOG Hole # orizon Soil Texture Soil Color Soil Other (USDA) (Munsell) Mottling (Structure,Stones,noulderes. Consistency,° ll �-0 a S4„ r loY/�s�6 sq k waoi L!� OBSERVATION HOLE LOG Hole # orizon I Soil Texture Soil Color Soil Other (USDA) (Munsell) Mottling (Structure,Stones,Doulderm Consistency,%Gravel L.o 4 ..a 10 y42. YL IL o 4 Sp� 7 �oy2 s� sSu 7 e y 2 &/� /0 20 s l° /L 55 OBSERVATION HOLE LOG Hole # rrizon Soil Texture Soil Color Soil Other (USDA) (Munsell) Mottling (Structure,Stones,Houldcres. Consistency,% ravel OBSERVATION HOLE LOG Bole# rizon Soil Texture Soil Color Soil Other (USDA) (Munsell) Mottling (Structure,Stones,Houlderes. Consistency.°° ravel I od heundery No— Yes undary No v Yes od boundary No v Yes urring Pervious Material . jnaturally occurring pervious material exist in all areas observed throughout the I absorption system? Y,-. f f naturally occurring pervious material? (date) I have passed the soil evaluator examination approved by the ental Protection and that the, above analysis was performed by me consistent with ertise and experience described in 310 CMR 15.017. Date 9/ g � 1 , r DEEP OBSERVATION HOLE LOG Hole# Depth from Soil I lorizon Soil Texture Soil Color Soil Other Surface(in..) (USDA) (Munsell) Mottling (Structure,Stones,I3oulderes. Consistency,° Gravel) Q "" /6 N � .�d — jog sqk No r d Q., pt C� Ukau, Li� DEEP OBSERVATION HOLE LOG Hole# Depth from •Soil I3orizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Doulderes. Consistency,%Gravel to yp� /L G y �l2 U iSw ,w7 /D f� Y 2 �L qz"- /o o C' SSa. 10 /0a-/68 s,b lc 21/ C (�Krd DEEP OBSERVATION HOLE LOG Hole # Depth from Soil Ilorizon Soil•texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Bouldcres. Consistencv.°o Gravel) DEEP OBSERVATION HOLE LOG Hole # Depth from Soil I lorizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,I3oulderes. onsi tenc °° ravel I riuud insuran ;e Rate Map: Above 500 year hood b^und:,:y No_ Ycs-- Within 500 year boundary No Yes Within 100 year flood boundary Nov Yes Depth of Naturally Occurring Pervious Material. Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? Y.e. r If not,what is the depth of naturally occurring pervious material? Certification I certify that on Ozc (date) I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training,expertise and experience described in 310 CMR 15.017. Signature Date 9�� g S YS TEM PROFILE NOT TO •SCALE TOP FNDN, y FINISH GRADE OVER FINISH GRADE EL . 74 , o FINISH GRADE may- �� FINISH GRADE OVER DIST. 80X y r OVER TRENCHES SEPTIC TANK 7h'• 3 • e:,o_p 12" MAX. _ C o:4 Q; y .J•.., C•' a� 4 e'D ' ''a'�'D.b+ p 'J.i• ! o _ -_ 1 --. -- --- --- -- _ - - - - - --- - a TOTAL TAENcH LENG7,H OUTLET PIPE LEVEL 3 , 3 FOR 2 FT. MIN. �; z 7 /i2 ' 3V OF s/a'-s/2' , Qc•:b o .•p ® O ShW PEASTONE 3•�•o 0 4 v � DOUBLE MA '0 pAv'. 70 3 0 6 . , , - •� r1S' s' • •:z•:a'o:. '. :o.•: .e'da ` C. I. OR PVC TEES ' 70,70 70 �7 7atio c�o �ro d:• .D• ��,e7 /NL ET.4 CAP E •°e e � b; 24 00 esMr F = .1500 GA L L ON D D. 'S TR.� �JTION BOX s �fbr r;-' 3/4" - 1-1/2" DOUBLE MASHED G L . oo.o.0 s �` c ,.o EL 8. S ..o. o `"�=.�:. o _ CRUSHED S TONE 4•v ' 9� INSTALL ON LEVEL BASE �. ' c x ' ca ,'`�'$• �- ••� PRECAST CONCRETE e• •Q. .p•, ti :c• REINFORCED TRENCt! SIDE SECTION a.. •,,: �. .,° �, C;1 UW'SU1'C�-r- V 7- eV_tt. . �rlrTl�lt l 5' OF L�GLtit�lC ir:' .•a.o;tic.o •v u• i• •p •e:: . .:�.p•p,i;b� .�4 Y.0�7a4: _ FL�G1L1-C`( _ISJ'i0 _�E _YL�Ca✓EO LAND V_r-_n hr_r=D W%-rU Gl.E(� SEP TIC TANK - c z s�•-.' 'L �' TRENCH END SEC TION INSTALL ON LEVEL BASE NO TE: EXCA VA TE TO EL EV V.c3- �` OR N L ORER TO REMOVE ALL IMPERVIOUS MA TERIA L BENEA TH THE L EA CHING AREA i REPLACE EXCA VA TED MA TERIAL WI TH i�--r=i CL EAN, CLA Y FREE SAND 3' M. DIAN. i 3" 3" OF 1/8"-1AE r - w.:x�r' I` DOUBLE 'WA SHED' 4, I 3/4" — ?—?/2" PEASTONE O s DOUBLE WASHED 'O9•s `°g.� t :. CRUSHED STONE no L 0 GENERA L NOTES l 1. ALL ELEV- TINS SHOWAl ARE BASED ON ASSUMED - - - TRENCH WIDTH - •�' � � 2. ALL PIPE, IN THE a YSTEM MUST BE CAST IRON f c� �` SCHEDULE 40 PVC. TION �..N11 _ OR n - -- - .�• ///� BQl1�D {./F J re=•.•c•-. •.w®-___.h ls1 i s•. +l &OF Od.�ER�� '� r a \�•. .. � - a✓i IViJ/1,P""1 L.i./ ._._ , .i... .,..,...o_... ._,_.r ...r.. _. >y RHEN CONSTRUCTION IS COMPLETE PRIOR P-9247 \� TO BA CKFI L L ING PERCOL A TION RA Ti �. r f <5 MIS'./IN. 4. ANY CHANGES-JN TgIS PAN MUST BE APPROVED BY THE BG'4"RD OF 'HE:AL TH AND CAPE 6 ISLANDS WITNESSED BY.• -- _ o o �z SURVEYING CO... INC. GERRY DUNNING- oo 5. MA TERIALS .AND INSTALLATION SHALL BE IN COMPL IANCE WI TH' THE S TA TE SA NI TARP BARN• BRO.. OF HEAL TH ,DESIGN DA TA °j 3 SEPT. ?8, ?� 9B o 7y ` CODE - TITLE V - AND LOCAL APPLICABLE DA TE.' _ _ _ _ _ _ 7Z �a ti RULES AND PEGUL A TIONS / ��x h/el Ae-_- �� s ` `� 6. NORTH ARROW/ ISM FROM RECORD PLANS AND (�z t �, 73. NUMBER OF BEDROOMS ,4r,, L o a�. .___ i Y R Zi T GARBAGE DISPOSAL NO IS NOT TO BE USED FOR SOLAR PURPOSES �„ NON-HAZARD 3 �Q .__._sA �'_ 330 za . 7. .FL DOD HAZARD ZONE 7 DA IL Y FL ON GAL . --- _�N i y \ I�A TER SUPPLY TOMV PIA TER _ -- ----- B. n y '/t 150 0 SAL . SEPTIC TANK REO D. dz„ 1500 G, SEPTIC TANK PROVIDED GAL � ., 330 GPO. 1 DESIGNING ENGINEER MUST SUPERVISE a LEACHING REQUIRED WRITING INSTALLATION AND CERTIFY IN N STRCCT y r E SYSTEM WAS INSTALLE ? THE TO PLAN, n Y GEC -L I /dam - ion SIDEWALL AREA = 236 S. F. f �o 236S. F. X 0. 74G/S.F. _ ?74 GPD. � — A-77.oo BOTTOM AREA = 220 r--�a t s��� S. F. / LEGEND 220 S. F.X 0. 74G/S. F. 162 GPD R-34.5.00 �/ i o y G/b' L EA CHINS PRO VIDED = 336 GPD �•1 2 CG O,1. ///// _-�o_ C j,-i+r•1 w�v, PROPOSED EL E VA TION r; MORGA✓✓ WAY 7-� 72 __ EXISTING CONTOUR SINGLE FAMILY RESIDENCE G t OSSERVA TION PIT 0 DISTRIBUTION BOX ►mew E� 7S 4�' �f A`Ass9 PROPOSED SERA GE DISPOSAL S YS TEM - o RICHARD r ----� JAMES BERTRAND N PREPARED FOR 29894 ALL A. B 6 Cl UNSUITABLE MATERIAL "O� �FGISYER``� !✓I THIN 5 FT. OF THE LEACHING FACILITY IS TO O O SEPTIC TANK °FFss THE IRENE TRUS T BE REMOVED AND REPLACED MITH CLEAN SAMD HOUSE NO. ,�6 MORGA N WAY . I i RESERVE AREA �•--� �A4A OF VlJ s 9� �✓ES T BA RNS TA BL E MASS. t3AvID �J PIPE INVERT EL EVA TION o CNARLES c SANICKI r" PLOT PLAN . �28085 o DA TE.- s���-, ?_�I �Rt3 �sr CAPE 6 ISLANDS ENGINEERING SCALE.• 1 "� ,�o ' 027 /�/ �'G . ss. FCI ST ?N SCALE AS NOTED 133 FA L MOU TH ROAD — SUITE 2E Al L NO �p r.: sir I P.7l PLAN NO S O9 2561 5 MA SHPEE, MA SS. LOT ��sF - - - - ----- 4� -PLAN -AREA ' 'SYSTEM ' ��FIL�'E SCA L E."I 20 NO T, TO SCALE rtVISH SAADE FINISH:4GRADE - FINISH 49RADE,-,, 78.0 0 VER TAW .77-b o vER mpvcH. gil mp V, W , rn TOP FAD, : , : r-1 V f % vC .: SCH A407r t OR AT 7W TTHE CFIEXCAVA770V CA S T IRON 7 EES TWNE' JVAS A STATPOUr TO OF 168' AA0 5 14.34 A DEPTH ALL AROM0 7W LEACHIAW BSN T FLR 7WIV 1,%EAAf SAAV MAS 1500, GAL. AREA. BROUGHT V 7*0 TW 6OT70H �DIST.BOX CONCRE SAS CF 7WLEACHZVG SYSMN. rE _FLE BAF TO BE,INS 7A L L ED. ON A LEVEL srABLE,BASE 7 C)' ; SEPTrC TAW 7RENCH Latm trench wj th f4) 'A 71ORS hT rH EAFrL 7R -A To BE NsTALLED 0 4* stone ail around LEVEL SrABLE BASE 32 X 10-10 X 2 deep mr -H 5 # N. ErGHr NO TE: DO tO T' RUN HEA V Y, EGUrPMEN T OVER SYSTEM A BO VE-OBSER VED 'GOUND)WA MR LEACHINk INFIL TPA TOR SEC TION DA TA :­ S PE NOT TO SCALE OIL 'AIVD '� RCOLAtTION.' FOR FINISH GRA DE rCA TION P-9247& SEE SYSTEM PROFLE., MIN.2m - WASHED STONE -TAKEN BY CAPE rSLAAVS i-tWOrAtERAW Mr TIVESSED BY SERR Y DUW _,ZM A 18, 1,998 DA TE;�,SEP 7ENVE % 4"DIA.PIPE— res r Pr r EL E V. fl) 72.5 2) 7-9-9 TEST htxE% 0. EFFEC T1 VE 'AIV' A TUA L SOIL e �,�OYR 212 DEP TH 0 0 #500 314 -.1 12 nod*of La4MY SAAV 10YR 51/1 ta4XY'S4AV jOY 6 WASHED S TONE tjc ten* EFFEC TI VE WID TH 36' acy 0 EXCA VA TED SIDENALL sn ry.L a4,v j o YR s16 -0. SILTY LOAN JOYR 616. ........... slitysand catones all ty.sand 8 stones IMMVER 'OF,, TRENCHES I Joel 10 NUMBER OF: A(FrL TRA TORS �.AL FrAr SAAV,YOYR 618 YR rrNE SAD 10 :,A10 SPOUVAIA DESIGN ' DA TA rrw tu S F. SOEWA L L AR8A - 7-4 GALSISF �1,26 GALS. 171 NO.OF BEDROOMS rrolv Drspo,!ML ,.=.�,1_' S. F. BOTTOM AREA , 74 GALSISF GALS.' 346 ' 256 GALS' EST. TOTAL: DAIL Y EFFL UEN T S-96 PrrC TANK 1500 SAL SE 51 7 S. F. TO TAL� AREA GA L SISF GALS. GENERA 60 - NO TES L07 L PON N0 TE.'� I � I 'T 11 1 � I I -, . . ',11 . . I-, TS SHALL BE',.INSTALLED ALL S YS TEM COM EN 'ACCORDANCE' NITH,�,TITLE'.�5.'OF �THE�,ST TE,SANITARY�,COOt�,­�,_ EXCA VA TE TO ELEV. Clot -OR L OMER AS EGUIRED A 'DA TED 9.95 AND �ANY LCCAL-: RUL MA RCA1, _:APPLtCABLE .,, 'TO REYOVE�ALL LOAM AND CLA Y CON T4 rIVrNG NG A REA REPL A CE THE L EA CHr MA TEZA L BEA1EA TH 2.' A N Y CHA AIGE IN -THIS S T BE,,APPROVED �'PL A IV MU EXCA 1-07 VA TED mA TERrA L wr rH a EAv, CLA Y FREE GA VEL f 6.f OF :HEALTH AND ERREZRA� ',Assoc , BY. THE BOARD HECRANICALL Y COMPACTED rN PLACE , 5. Oj 7fSr' �COMP TO HEN CONS TRUC TION IS , LETED,­PRIOR BA CKFrL.L 3. NOTIFY BOARD OF, HEAL'TH, FOR -ZA1SPECTI0ff. .:- )'Z FND. EL E V. MUS T BE CHECKED hH X 'COMPL E TED -MUST, NOT BE VHA --BUILT' PLAN IS A THS 'A . 5. EL E V. RfivrsravOF,A PLAN LEGEND DA rED EPTEMER 25. 199B 40 PREPARE* ' ME BOA RD OF HEA L 7HI A PPRO VA L BY CAPE G ISLAAW EN19"EEIAFS, "REG D 6. BOAR& OF HEALTH INSPEC rON N,,EXCA VA TED , MlrH APPLrCATION NO. 'P-9247 -xisr.oRouND ELEv.-.', Aaw 1r­—.FrJVrS,4 GROLWD ELEV..00 --�BW L fv SEWA GE DISPOSA L -S YS TEM PL A PrPE xNvEnr ELEv. .0 :.:PEPAEO., FOR jib, Ttsr Prr LocArrov CEIVEO,t WRIDGE- WOMES rG Foo , P TIC 7AW C'r . 1999 - 'NO MORGAN "WAY, OT ' 161 ROA" TO C3 DS T9 ,9U TION OX SS. BARNSTABLE OVC WA �Y WA 4 ArC.1.OR SCH 40 4oarr.rtBER PIPE-TSHT ONTS 7, ER EIA - -,ASSOCIAT S OCTOBER -9. 1999 FROPERT7 LINES DESrGNED:DRAIN: 'SC 13 SPRING P0AD",7:­­ ALE.*AS .'SHO N SETBACK DrS7ANC6 BA RS,,,,' .5,6 - 27 :_1 61 FA L'kd U TH SS-­ Dmw CIECKED rNs 09991 0 'E ' SEC PCL ---------------- __ _ - - -- - _ - .+.. . ��. . : ., .:,, �, , z. r.• -,r. .. r R - ;. ,' , .. , 3. - :,. ,: - .:,_ r :. .� r.. , .. - , :. ♦. _ • ::,. . .. , - ,.. .. ,. ,:.*..r.,,:t ., .. - r , : ,'3. • • « , - .' , LAN AREA .P . . - ..: M SYST I EM PROFILE , 1 • dt a , SCALE. ? 20 , _ , FINISH GRADE NOT `TO $GALE ... ._ , , . , ­. ..p �:: • 7�.5 FINISH GRADE FINISH GRADE . 78.o :.r' ��. OVER TANK OVER TRENCHES. 77.a ? y TOP FM :61; , / � i a•, � /, .i y� M` `� `iq�� ���/+ , v , •. , , • _ . . _ SCH 40 PVC Afore ;., . % OR .> .4 • AT THE TIME OF EXCAVATILNI �IN 75.LS ►� •:• °4 71KERE 1✓As A srRZPOur To • ?i CAST IRON TEES �: t; _ - A DEPTH OF 168' AND 5' .� 75.00 " ` •�,: :r r;i:,R}..... 74.3,,.II�-,1,.�_1,,,I.ILI .,,­,II�I I.'�",.1,,I.r II.-,I­�"_II1;--',­'�L.I,I I�I.�I.�L L.-,-I,L:.I,II1.�w:;-._,L,I_IL,1II­�II�'1,.!II�ILr..I�II L�-I L.I:.,:�.II I'r I��L�.I�,._.I�L 1L LI;'.,�,L!-'�-L..L''*��.'"�,I�:I"III�I-.I-I L'I..IILI1..I.I.L II LI,�L.'.LILI.",I I,I1I�I�,I�.L"�-�'�I.-I L..','-�..II",I.-L I��­.I�`'i I.�-'I-I:.I,'I1��II­I.I�1.��,r._I L.I�I Il I.�­-.IL1.r.I�,.Il"IL.,I.�i,"1'I�I.'.IL I�I­�.I L"-..I.I I.,�III',I�1,'L�,.'.I'.I"�1'..I.I,,IL I.,'�I'I1 1 II..I I.."1L..1.IL`".IIL'1.,I I I...'.L I.1 II�L­1�.L II..,'1I.1 I.;L;.,'II*I.'".;.L".r.­11 I..1 LI'I."1�­1..I"�.:,�,I L.I�..-I_1.�,1,I.II I­,I1.IL I LII1.L,I L.I,�­I I1 1�.-�I�'L.I,L��I­.I-IL.L.L I..1IL'I1L�L 1,.I I"1 I,--_,�IL L-.�.-�I LrL.L�-�,I1II,�I'L 1 LL.-".-�I1 I 1-�.��1�,_I--.�'-LI_I._'.I.I�-IL�I�_L-I I-I II'L I,I-,.'�IIL.L"i..-1:I I-.IL L:.�l..I�II"I1..-_,-1:�"�L:�'I II-,�,._:,1I�.�1.�.;'N(�I.L.1�I�bI.-�:,1 I-,�:..�-1 I,.I..�.�I,�_._I..':.�.'.,,�I�".I_L-,,.­'I�..._I-..�I',�,.I,I,:.,.���L,IL��1-�I�.*',I,:-,,,�I,,I...I L.�I'1�,,.\,I__I,_1I-:,�-:L:�'I.�II�I.,.,II I,_;­ILILL��_I,-.��1 j-1�.I�.�_-L.:-.,_'I:-��­.II.___'',II,I 1'I�I�­>-,�%_I_11 L_�,.L_I-_��-_'I,.LI�7,t�-I.-,,7%I,I�.-.':Ir,,�.,.-"I I-,�A L�-I,1�II,Z,­'�.�,­,�.-,--�..�.�11 1-,1i_,"I LII I,I II�.L�"�I14,��,:,,I I-I�.I(,,,L:­�..-,I'.I.I'-�����4,-.,,I,��\II,�;.\,-.f,L",I I��_I�.-I I_"-I,I I j,L_-,'"-,,_I-,%,IL-,-�"1.,._�I�L"_.I:_--�7LL._,�_I._._�-�Lr^".I.-'�-_IIL_.._�I.,i�L1L\i�L­.1:�,I�:­I,,,'-,._,.I_,-I�.�I_..\:.��­I_\I,��%N'*,"-,_I._ ."�_­%1IL,-.I�.,-.�.1,_�_1I'�-I.'�1I I%�_'.,..4,',.'1�_,_..LI .;�,.­''.�'_,L_;'.',�I__I.'_-'..'I1I.,.7_,:'�%_;''­I--I..1 I���rI�-.�,,.­*��­,*4'_..,��'I:;I0�."­�-I��I!,,.�7--.­:,L�'�..::*,N L 1"LL,�:0,.I-".I.,.I I,,'),'AI---1�,,.,I.'4.'L..,.�_wI,:.IL--..,,,;'I-I.I,_,'_L._*�.���-..L,�I�/,*:-4,,,.,L,`�.l"�,,11., L":�QI/1 _I,,1 L._.1 1,L.,__1.IL LI_-_�"'.�.10I1,._1,,_1 I�I,-",,_�1'I Ir I_I I,,1�_,�L�-�I'- 1.II_I"I.I�..�I�L.IIII III I..I I L._.I-I�LI L II rI_LL.I II L I I:.,I.I I_L II_I�.I_LI L,II.II I.�_I,II,I �I..II.L,.��1L"I1�II f I-I I.I.,rI I.I II...I I_11.1.IL LI I L.I I II.I.'I.I..I I. 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GAS 3 - :`.4 •:. r TO BE INSTALLED ON A • ....:._..•.. ..-'.l, .s �,+. ... . • . - LEVEL STABLE BASE . . . - SEPTIC TANK ? o existing leaching Z : ,,TRENCH LENGTH, trench with N) ._ IMFzc MA rolls l✓I77d TO BE INSTALLED ON A • 4• atone all around LEVEL STABLE BASE , 92'. - 0' . 32' X 10'-10' x 2' deep 5'MIN.HEIGHT _ NOTE. DO NOT RUN HEA VY EGUIPMENT OVER SYSTEM AaovE OBSERVED_Op )v GROUND l✓A TER ,:: Sa \. .4C+F �� . N L EA CHING INFIL TRA TOR SECTION �. Nor To SCALE SOIL AND PERCOLATION :DA TA ,. s =;: . 39� FOR FINISH GRADE . '�`'s' SEE SYSTEM ROFILE APPLImTION Av. P-92,y R : ,S F p _ p- p ' 8 ..,_, "'o O - 10 �! ii r i� / / MIN.2 1/8 i/2 iio ,K s�/F�.S ,� ',/C / .0 /�'�'k�/R''�4/ �'` ,c► /` WASHED STONE PERC RA TE' a MIN/IN. - ,. ,` ',• •o ti /I(+ <12„MIN.J a TAKEN BY:CAPE B ISLAAOS ENGINEERING H •.• . ,s. .::-,: a �-�•.: :„� ,-�::::::::...,. :; h1rMESSED BY SE99Y DIM NG .► •v , .. . . ,. .•. • DATE 'SEPTEIEA t8 l998 'i N ae `.. •• 76 : .` . + 4 DIA.PIPE .., . i''''f`-- TEST PIT ELEV• (t) 72.6 (2) 73.9 _\ , • • r„ ex r r ,� ;; f,, ,� fE5T HbLE i TEST MILE 2 ; __ d DoX 'e e. o ,•• - 1 .,• iat, \ ` - �-.NATURAL SOIL -' ; • ' • EFFECTIVE 0 •A�,• A. 0 74 p so• .v 0,;•. DEPTH 1oYR 2/2 JOYR 2/2 vO ex a � .ow • .1. N 6 �, 6 1 , 3 4 -1 1 2 . .. e• •" • . ' B 13 `� / / • . • . e .. B 00 - •. ... •00 . .•�• .�, e• .• , A gal ., e • septic `�. WASHED STONE •�•.�e . �,..S,.o: r�.' .. .•..•, o . �,.�.. .• •r,• ; . s; "* .. LOAMY SAND tOYR 5%6 LOAMY SAND JDYR 5/s- �' �iw ­ 7 EFFECTIVE WIDTH' 96' '4 . i 4 •.. -•.. ` 0 EXCA VA TED SIDEWALL t0'-i0' - •C!• . f j r ??__-, f f ft'` 4'-0' 41-0' SILTY LOAM 10Y9 t7/6 SILTY LOAN JOYA 6/6 .` + .. silty sand 6 atones - NUMBER OF TRENCHES J 1 silty sand B atones , , T4 . .W � � � iaB • ` NUMBER OF INFIL TRA TORS 4 .C2. !oe' : ,' a1 FINE SAND 10YR 6/8 FINE SAND 10YA 6/8 ?. ti N M ise - 144 - • • AV SROUN011A707 i c. ,_r O o , _ .r 4. , ' . Ex' DESIGN DA TA J rsrrNG do 4 USE J' 171 S. F S.MENAL L AREA �74 GAL S/SF 126 GALS. C�DNSTq UNDE67 ND.OF BEDROOMS 3 UCTION DISPOSAL .=- , j � ,� 346 S. F. BO T TOM AREA . 74 GAL S/SF 256 - GAL S. , 0 O EST.70TAL.:DAILY EFFLUENT,a�o GALS. x f o SEPTIC TANK�500 GAL. . h 517 S. F. TO TAL AREA GAL S/SF 382 GALS. • a . ` „ ! / N <. .: ,. i5,7• O -: ,. ,- „- ,r` co , t or 16o GENERAL NO TES , , ' , I . ( r NO r E. 9 I \ > I. ALL -SYSTEM COMPONENTS SHALL BE 'INSTALLED :IN •.r:-, i 4 , . ., m" it. ',, w ACCORDANCE irll TH TITLE 5 OF THE STATE, SANI TARY: CODE o EXCAVATE TO ELEV. OR COMER AS RE@UIRED - - 1 I /� 63.0 1 -' ,; 1 "`�--'' DATED MARCH 1995 AND ANY. LOCAL RULES APPLICABLE I /� TO A'=MOVE ALL LOAM AND CLAY CONTAINING t MA TESIAL BENEATH THE LEACHING AREA.REPLACE 2.` ANY CHANGE IN THIS PLAN :MUST BE APPROVED °'.; .. -- y 7z c.8 9 0 LOT l61 EXCA VA TED MA TERIAL NI TH CL EAN, CLA Y FREE GRA VEL B Y THE BOARD OF-HEALTH AND `FERREIRA .AI SSOC. � - , " ' \-fA Ol7* MECHANICALL Y COMPACTED IN PLACE ., r%,; �°�• 63• sF 3. WHEN CONSTRUCTION IS COMPLETED PRIOR TO ,BA CKF.IL L ING' . 8 "J . , � R TH OR NSPEC TION . -.. . �a ,� NOTIFY BOA D OF HEAL F I �� %,, ` NOTE 4. FND. EL EV. MUS T BE CHECKED WHEN COMPLETED . -,., 1 THIS 'AS,BUILT' PLAN IS A , :>. " - LEGEND - AEvsszoN of A PLAN DATED 5. THESE ELEV.MUST NOT BE CHANGED WITHOUT : F ,: - � "` SEPrEMBER 25• 1998 6 PREPARED THE BOARD OF `HEALTH APPROVAL__, ; ` _ Y CAPE 6 MAMS EN6INEERIN6 ,,_ '`_ B I 6. BOARD .OF HEALTH INSPECTION REO D WHEN EXCA VA TED '.• ' - •� --- ..-•• AFrTH APPLICAMA NO. P-92•I7 r, . _ 74_-- EXIST.GROUND ELEV.. . k;l;, i .., , , r __• _ .: .. , , , ,- : - 1 _ - A-7 ?� FINISH GROUID ELEV. �, , ;' ". , 7.00 - � w : - a..` R 345.00 c;9 AS BULL T SEf✓A GE DISPOSAL SYSTEM PLAN 75.ZS PIPE INVERT ELEV, " .. R ; ` j PREPARED FO : G , . I . , _ T TEST PI T L O€,A TION ' .e . , _. « �/ , - ---. d '; �. u + ' --_.._'� O O SEPTIC TANK s . HIGH ' RIDGE HOMES . - , - _ri MORGAN '. .,• r I., - .. _. 7 - . �o ._ LOT 1 Ss MORGAN h�A Y. ; .oo'k. „ , i Do DISTRIBUTIOt BOX ,- .,. .., r - v.- : :. :._� .. : .. .t... .tip: S T SS BARN ABLE, MA A Y . f. 4 v I �, 4C.I.ORSC:� 0PC T_ . _ .: „r - " OF H , ;a t M p - ' r . .r E S _ : ::.-. - _._ . .,. _:- 4 BI T.FIBER PIPE TIGHT �/OINTS . . � __ ., ° GEORGE �. - ' --, ,., --- PROPERTY LIMES' SCRUTON - o DESIGNED OA TE: °, u SA OCTOBER 9. 1999 `�, No. 41 , , . .: ;' FERREIRA � ASSOCIA TES - ` . , �;y ;, Y. C • ,,; S BAC DIS AN s ; NN „ ; ,; ORAM/V. • SCALE AS.SHO _ - I 131, SPRING:BARS -..ROAD.::,: ,1,n _ 1', ,,,,,:,,. -,. , 175 27 _161 56 F s - .. " s e� FALMDUT, ASS. :, ED , DRAMING NO. . CHECK . 6S l00999 _ MAP SEC PCL LOT HSE :._ ,r , •. . ; . , .. .. - -:. : .. .. S .1:'.' :'I .. .. �: :. .. t .':. .-..-. .-rr ..-. -... .: r ..., :.n: ,:,... , ,.. , n v r , .. , ,. ., .� , , :r .. .,,,. , ,:.. �.: , ..:. .: <. 1 - Y u'- , ^qh v, . r.. ..., -,a,: ,- ' _ - ,. , .. : ., ,r , n u r _ : - .. .. ., - -. 9 :'. .. . f. : . n �. : ,. ...-. ... ..-.. ,: + ._.• - ..., ., ,-. -q__.� _.___< _ _,._ _. �-____ _ .. u_S�_�:.' ...._