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HomeMy WebLinkAbout0550 OAK STREET (CENT./W.BARN) - Health ``50 Oak Street B'arn`�s le ti A= 194 - 020 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 550 OAK ST Property Address BEARSE Owner Own is Name informationrequired is Own ��YYr3l a MA re wired for V V r�(/� every page. Cityrrown State Date of 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: A. General Information When filling out D forms on the computer,use 1. Inspector: only the tab key to move your DOUGLAS A BROWN cursor-do not use the return Name of Inspector key. DOUGLAS A BROWN INC Company Name P.O. BOX 145 Company Address ` w 7n CENTERVILLE 0262 MA City/Town State Zip G'ode - 508-420-4534 S14297 Telephone Number License Number : €U W M 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 44a'fi"-- 2/8/10 pect. I �a�e 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•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 C./ I� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 550 OAK ST Property Address BEARSE Owner Owner's Name information is BARNSTABLE required for MA 2/8/10 every page. City/Town 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: ® 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 HAS HAD VERY LITTLE USE SINCE IT WAS INSTALLED 13) 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 550 OAK ST Property Address BEARSE Owner Owner's Name information is BARNSTABLE required for MA 2/8/10 every page. Clty/Town State Zip Code Date of Inspection B. Certification (cont.) 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•09i08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 550 OAK ST Property Address BEARSE Owner Owner's Name information is required for BARNSTABLE MA every page. City/Town D t Zip State Code Datee of 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 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 dogged 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 Y day flow t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 550 OAK ST Property Address BEARSE Owner Owner's Name information is BARNSTABLE required for MA 2/8/10 every 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•09108 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 550 OAK ST Property Address BEARSE Owner Owner's Name information is BARNSTABLE required for MA 2/8/10 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): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 t5ins•09/O8 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form li Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 550 OAK ST Property Address BEARSE Owner Owner's Name information is BARNSTABLE required for MA 2/8/10 every page. Cityrrown Date of State Zip Code Date of inspection- D. System Information Description: SYSTEM CONSISTS OF A 1500 GALLON SEPTIC TANK D-BOX AND 3 3050 INFILTRATORS Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: WELL WATER Sump pump? ❑ Yes ® No Last date of occupancy: UNKNOWN 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•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 r Commonwealth of Massachusetts ,p u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 550 OAK ST Property Address BEARSE Owner Owner's Name information is gARNSTABLE required for MA 2/8/10 every page. City/Town 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: 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•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Mass achusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 550 OAK ST Property Address BEARSE Owner Owner's Name information is required for BARNSTABLE MA 2/8/10 every 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: SYSTEM WAS INSTALLED IN JAN OF 2007 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 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.): Septic Tank(locate on site plan): Depth below grade: feet Material of construction: ®concrete ❑ metal ❑fiberglass ❑polyethylene El other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 GALLON Sludge depth: TRACE t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of v Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments °~ 550 OAK ST Property Address BEARSE Owner Owner's Name information is BARNSTABLE required for MA every page. Cdy/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 Scum thickness LIGHT BUT VARYING 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? Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene El 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal posal System•Page 10 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 550 OAK ST Property Address BEARSE Owner Owner's Name information is required for BARNSTABLE MA 2/8110 every page. Citylrown Date of State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene El 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �t 550 OAK ST Property Address BEARSE Owner Owner's Name information is BARNSTABLE required for MA 2/8/10 every page. Cityrrown 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 0" Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): 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.): Soil Absorption System(SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 550 OAK ST Property Address BEARSE Owner Owner's Name information is BARNSTABLE required for MA 2/8/10 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 3 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: 3050 INFILTRATORS Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation,etc.): NO SIGNS OF HYDRAULIC FAILURE 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•09A)8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 550 OAK ST Properly Address BEARSE Owner Owner's Name information is required for BARNSTABLE MA every page. Cit r.wn 2/8/10 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.): Privy(locste on site plan): Materials cf construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 550 OAK ST Property Address BEARSE Owner Owner's Name information is required for BARNSTABLE MA every page. City/Town Code Date t State Zip ateo 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts z Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �t 550 OAK ST Property Address BEARSE Owner Owner's Name information is BARNSTABLE required for MA 2/8/10 every page. City/Town bate of 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: GREATER THAN 5 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) ❑ 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: 2007 CODE Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•09/06 Title 5 Official Insp ection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 550 OAK ST Property Address BEARSE Owner Owner's Name Information is BARNSTABLE required for MA 2/8/10 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-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 New Page 1 Page 1 of 1 LOCATION ©QI`CS�T _SEWAGE 0 _ . viLLAGE~l��ratr�ts3,r. `1*'. ASSESSOR'S MAP& LOT INSTALLER'S NAME&PHONE NO: Ink% ' .4►A0±InJ SEPTIC TANK CAPACITY 15 LEACHING FACILITY: (type)"'�$�Y, -�� t. fiS (size)11LSG NO.OF BEDROOMS BUILDER OR OWNER 7.r' hK - A �rs L PERMITDATE:1-( L- r'7 .COMPLIANCE DATE: Separation Distance Between the; Maximum Adjusted Gioundwater'>rable to the Bottom of Leaching Facility Private Water Supply Well and Leaching Facility (If any wells exist t[ � on site or within 200 feet of leaching facility) $�� �IGtIV Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching ficility) WJ Fret ` Furnished by SA1e C y 34' 3 3-s206'' (0-4 q-3Z; s-35, G- http://www.town.bamstable.ma.us/assessing/201O/I Mdisplay.asp?mappar=194020&seq=1 2/7/2010 CERTIFICATE OF ANALYSIS Page: 1 -�i Barnstable County Health Laboratory ssncyl}s�)" Report Prepared For: Report Dated: 3/5/2008 Robert E. Bearse Order No.: G0845221 P O Box 477 West Barnstable, MA 02668 Laboratory ID#: 0845221-01 Description: Water-Drinking Water Sample tt: Sampling Location 550 Oak St.W.Barnstable,MA Collected: 2/26/2008 Collected by: R.Bearse Received: 2/26/2008 Routine ITEM RESULT UNITS RL MCL Method# Tested Nitrate as Nitrogen ND mg/L 0.10 10 EPA 300.0 2/26/2008 Copper ND mg/L 0.10 1.3 SM 3111B 3/4/2008 Iron ND mg/L 0.10 0.3 SM 3111B 3/4/2008 Sodium 42 mg/L 1.0 20 SM 311113 3/4/2008 Total Coliform Absent P/A 0 0 SM9223 2/26/2008 Conductance 170 umohs/cm 2.0 EPA 120.1 2/26/2008 pH 7.6 pH-units 0 SM 4500 H-B 2/26/2008 Sodium level is above the maximum contaminant level. Those on a low sodium diet may wish to consult aphysician. Approved By: (Lab Director) co ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 TOWN OF BARNSTABLE LOCATION-515-0 AICS'T SEWAGE VILLAGE-ba '� il° C��� ASSESSOR'S MAP& LOT INSTALLER'S NAME&PHONE NO. - � ;5 '[�-+ ° .� 4 A 0� � SEPTIC TANK CAPACITY 5 ' ,��, f size 29,X, LEACHING FACILITY: (type)'; n�,�y W. (size) _ NO.OF BEDROOMS BUILDER OR OWNER RAbKA- cs e PERMITDATE: 1 "f`Z—C'1 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility C w-3 Feet Private Water Supply Well and Leaching Facility (If any wells exist gg ` on site or within 200 feet of leaching facility) Sf1f Feet Edge of Wetland and Leaching Facility(If any'wetlands exist Feet within 300 feet of leaching facility) Ftunished by r "1 Co Ale At ��-YJ w�-�2; No. Fee lab ,,*E COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZippYication for �Dizpo!gaf *p.5tem Con.5truction Permit Application for a Permit to Construct( ) Repair M Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 0 er's Name,Adder,and Tel.No. w 3cxrNs-tctlo�� t<O�(1�(fi k5 fs� Assessor'sMap/Parcel 191!V f_v Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. , Type of Building: Dwelling No.of Bedrooms 3 Lot Size kY���� sq.ft. Garbage Grinder ( ) Other Type of Building Nrx7,.,,e No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) "33f gpd Design flow provided 2189f,31 gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank �,� Type of S.A.S.*3-'j4j 1-}-(CA_4rp(- -3Q g-Q? U.) I t 5k(:r ora� Description of Soil Nature of Repairs or Alterations(Answer when applicable) Lo, L 1 j 'CA�aJ .t 2 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 rd of Health. S' ned Date Application Approved b Date �— Application Disapproved by: Date for the following reasons Permit No. 7 ©� Date Issued r — „�� �4 i f T ,t�; •�.�--- _ (ol�trl 7 0 , Fee No. 1 ` '* THE I OMMONWEALTH OF MAST AAk& IS. SETTS Entered in!!mp�uter,.: Yes PUBLIC HEALTH-DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 2pplication for ;h9po5a1 *p.5tem Construction Permit Application for a Permit to Construct( ), Repair,') Upgrade'( ) Abandon O ❑Complete System ❑Individual Components Location Address or Lot No. I '50 0,4(14 5;�__ O,ner's Name,Address,and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. pDesigner's Name,Address and Tel.No. + vS��5 r7 /✓/CIGt/� Type of Building: Dwelling No.of Bedrooms 3 Lot Size 4cf,905^ sq. ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures a Design Flow(min.required) 33D gpd Design flow provided 3fi3�(, gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank ( Type of S.A.S`3 Description of Soil ` t 'Nature of Repairs or Alterations(Answer when applicable) ( k-CA 1 SCUD Ce”c �oolc C",O "D 5 Gc S V P( T)IGA)S rQ\i k/V ,r OON) kAnN)e 11°�l t 9-(GI0c, Date last inspected: J Agreement: 1 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. gned _ Date /:l 07 Application Approved b Date / Application Disapproved by: Date , for the following reasons Permit No. n00-7 ©/L- Date Issued / d" -------------------------------------------- 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 a,�-�.> A 5 /1 r e at SO CAA/G has been constructed in accordance / )� e with the provisions of Title 5 and thefor Disposal System Construction Permit No. �7 L-/ dated Installer_D(�JC,c- b� R�n W r Designer ,E-N,4 I" Y ON r #bedrooms Approved design-flow_169,3 1 gpd The issuance of this permit shall not be construed as a guarantee that the system will fu to n as d"'sgtne . Date / Inspector ` -.rcc� A --•-,�---�� --------------------------------------------- No. -;,00 7 Fee /0 C) THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS wigoal *p5tem CongtrUction Permit Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ) Abandon ( ) System located at 55570 nA V_ <�T 72 Ct cNafiG.ok e and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this pe �it. Date ���O'� Approved by r Town of Barnstable E T � Regulatory Services Thomas F. Geiler,Director ESA 115TABLE 9 MAW Public Health Division Thomas McKean,.Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer-&Designer Certification-Form Date: y 7 Sewage Permit# 107'ul / Assessor's Map\Parcel (y42-4) Designer: �// �44 �'�"/i S' -Installer: 1_'Pl e�i 96VjW Address: Wgy)p Address: /ld On &v1-VA1 was issued a permit to install a (date) —'(installer) septic system at based-on a design drawn by (address) t✓fJ� � dated (designer) I certify that the-septic-system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was -installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. )A OFAW MASS .- VON NONE staller's Signature) w 9.#1068 O esigner's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO -BARNSTABLE PUBLIC HEALTH DIVISION. CERTI-FICATE 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:Health/Septic/Designer-Certification Form 3-26-04.doc I .Town of Bern stable. P# 3 .5 Department of Regulatory Services ' I • Public Health Division Date L ,srw issy ,e'r 200 Main Street.Hyannis MA 02601 Date Scheduled / B j Time l l Fee Pd- �✓ Soil Suitability Assessment for age Dis al Witnessed By: Performed By: , i' LOCATION& GENE1ZAi INFORMATION Location Address' s' y�'y I Owner's Name Ro 6W f j�dS e 01 ' Ctd-Y� Address Assessor's MapI Engineer's Name � �� - . j.NBWCONS7R2t0N REPAIR _kI j Telephone# Land Use ;�2esi P�.fr�� Slopes(%) ' � Surface Stones Distances from Open Water Body. ft Possible Wet Area ft Drinking Water Well �ft Drainage way ft Property Line ft Other ft SKETCH:($treet name,dimensions of lot,exact locations of tot holes&pert tests,locate wetlands in proximity to holes) L - I , s I Y • Depth to Bedrock � Parent material(gedlogic) /�// _ � I p Depth to aroundwa: Standing Water in Hole:' j weeping from Pit Face .�-----, ' '�. J��i. l � �� / rZ.LULU �AGu ) .�/�•C��C� Estimated Seasonal4gli Groundwater DI TERIVIIN�j TION FOR SE �O�AL GIE WATER TABL�F+. -r Method Used rJ _I �' ! "`� S �-`''^rOLI�1- �li f 15- 3 7S Depth dbpkved scantling in obs.hole: in. Depth . I in. clraundwaterA uetment-e,,,e 4- Dep tolweeping from side of oo��hs(�. 0 e: — Index Well#S w ReadingDate:—17"'• index Well ev61 Adj,ACtoC Adj.(Iroundwater l t;Va1.,. '. PERCOLATION TEST - Dnte Observation /_ Tiine at 9" Hole# q;' L �0 �� t�dvrt� Time at b" .......----- Depth of Pere ; i Time Start Pre-soak Time.@o;,�6— -- s End Pre-soak Rate MinJlnch i Site Failed Additiona(Testing Needed(Y/N) Site Suitability Assc$sment: Site Passed —` Observation Hole Data To Be Completed on Back ` OrigiaaL.Public He'�Itlt Division r« ***If percolaion test is to be conducted within 100' of wetland,.-You u mwt�u' notify the ` ; :Barnstable Closervation'Division at least one t;1)week prior to b gin g DEEP OBSERVATION.HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other .Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,% vel 14- S, Ila yJ0 51z. y 12 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistencv.%Gravel) J Ad 040- DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil I Other Surface(in.) (USDA) (Muasell) Mottling (Structure,Stones,Boulders. Consistency. Oravel I DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, Flood Insurance Rate Mau: Above 500 year flood boundary No Yes Within 500 year boundary No`✓ Yes Within 100 year flood boundary No..Z Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious iAgerial exist.in all areas observed throughout the area proposed for the soil absorption system? A If not,what is the depth of naturally occurring pervious material? Certification I certify that on A 179 —(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 3.10 CMR 15.017. Signature V Date �(o Q:ISEFTICVERCF)RM.DOC , Map 195 Parcel 9 Map 195 Parcel 10 ` W Scale: 1 = 30 Vacant r` . ; Vacant Town of Barnstable. NOTE:No known wells within Barnstable Fire Distict GENERAL NOTES: - OAK STREET,E ET,� 150'of proposed leach facility. ` r 1. VERTICAL DATUM: ASSUMED 2. MUNICIPAL WATER NOT AVAILABLE. A � 3. SCHEDULE 40 PVC PIPE TO BE USED THROUGHOUT SYSTEM jom N� �� `� Edge of pavement (P vN lue, �02� LESS OTHERWISE NOTED. ----- ---- 1oa---- _ ' LL PRECAST UNITS TO CONFORM TO - no----------,*�--- --------- 1 fD �.' �\ AASHTO: H-10 & H-20 -----+ 5. PIPE PITCH-1/4" PER FOOT UNLESS OTHERWISE NOTED. Top of_Bank __----------- �- 1 I �. ALL CONSTRUCTION DETAILS TO BE IN CONFORMANCE WITH MA —�� 195. CODE (TITLE V AND LOCAL REGULATIONS. I / /� .00 � �/ '� ✓ I I 1so' ro CONTRACTOR TO VERIFY LOCATIONS OF ALL UTILITIES PRIOR TO I �� j N 1 ► ; r� II jiow. �1s' CONSTRUCTION.w % LEGEND 13' I z H-1 Parcel 30 �---- 9®-- �- PROPOSED CONTOUR 29 0 ��d, I I 1 0 : g1 House#575 oo / 17'/ ^ 1 a �� ®g PROPOSED SPOT GRADE leano t ✓.� I I 1 1 a C,2 Goode \,G I I . ,� tr , I r � 1 I 1 0•:, \ � — �-0 - EXISTING CONTOUR o 591 i I (Crawl) Replace I 's I 1 ' \ `z — 0.23— EXISTING SPOT GRADE ♦ \ / rr Orangeburg #550 1 ell house 2 3 pipeTOF=119.30 a oI t 1 Q d'o TEST PIT �' � �,/ ... ..,(Full Fnd I I o-'. 1 �� �Q o o 7r ) w 1 ® EXISTING WATER SERVICE 28'\ 110\ j - ., ' `� Deck j I �O /J( �°\ I,1 ff (Cr 1); 0" "C" *Reroute Kitchen \ \ a, �41 �� / Line Plumbing Area \ ( , cP / Internally to match ro ; \ :•1 I 49,225t S.F.+ Pipe"A" 9 19; \ I 23� 1 ` Map 194parc NOTE: is plan is to be used for septic 'y s ��� ► I fs 1 . Garage system p rposes ONLY and IS NOT to ,�$ s (slab) Registered Land be conside d a property lie survey. _� roO\\ ors ` t S f ` BENCHMARK SET: �NOFa s \ i yam. qr+ \ In rock at meter o= s� \\ EL. 118.84 (Assumed) VON�i-IONE #rose ;p BENCHMARK SET: aa• \\ F��S ���� In rock with orange paint � EL. 118.58 (Assumed) > \ ;rad 2ao.00, o°W \ °�ro ° o ?. .� d f S 1 3 27 LOC ��° i \\ i ��P`j"°fMASSge, 550 OAK STREET, BARNSTABLE, MA i '� \ � TERRY ANN VH Sheet r,. WARNER PREPARED FOR: D. A. Brown ��Or A NO.38721 associates 5 � , and �.. f+e1d c;ah ASSESSO 'S MAP: 194 -- -_-._ ""0 �,MA Robert Bearse o sRoaa PARCEL: 20 J�� s 159 Parker Road °d� 1 7l West Barnstable MA 02668, om s � � , ll a� FLOOD ZON C Town of Barnstable Parcel21 surveying a by- no #250001 0015 C (8/19/85) ik Vacant Terry.4 #araerP.4S REFERENCE: .C.C: 27761 commonwealth Electric co. Herwichi, MA o DATE od REVISF� SCALE SHEET N LOCUS MAP N.T.S. ` r.� (sos) 432-8300 12/06/06 1 _ — 80' 1of2 t N , Provide Rim over D-box � NOTE: To prevent breakout, final grade of Top of Foundation to within 6"offinish grade ' EL. 108.1 to be carried out a EL:119.3 -� F.G.EL:112.5t minimum 15' beyond edge of leach F.G.EL:115.0418.5* F.G.EL:119.0t �' facility. Invert"A" (Existing) Maintain.Min.2%slope over leach facility F.G.EL:111.0-112.5t Install risen w/covers over Inlet Min. 1 Inspection Port 12"To Grade EL:117.3 &outlet to within 6"of finish Min.2"Peastone or Geotextite Fabric > e a 3/4"-11/2"Washed Stone L 5'(Longest Run) " " 60, ;. 108.1(TOP OF GEOTEXTILE FABRIC) Invert 4"SCH 40 PVC s 4"SCH 40 PVC „ 10' o cp w o 0o m 4"SCH 4o PVC EL:116.5t ...0S=5.2%(2%MI io"i *S=12.6%(1%MIN.) *Invert AC"(Kitchen Line) 'a 6., Q S=4%(1%MIN.) Mtdt:d Proposed EL:117 Install Gas Baffle L:115.75 EL=108.17 EL=108.0 ° 24"INVERT 00 EL:116.0 PROPOSED DB-3 EL. 107.E 7 12 H-10 DISTRIBUTION BOX Use 3 Infiltrators 3050s with Double.Washed Stone (Install PVC Inlet&Outlet Tees) � 6.43' *Kitchen line to be rerouted internally to SEPTIC SYSTEM PROFILE 4'ends,4'sides tie into existing invert"A"at EL.117.3. PROPOSED 1500 GAL H-10 SEPTIC-TANK (29.36'L x 12.25'W x 24"D) N.r.s. H-20 Loading EL.99.17 Bottom of TH-1 SOI".T.SL LOG � •DESIGN CRITERIA SOIL EVALUATOR: AMY VON HONE,R.S. ADDITIONAL NOTES INSPECTOR: DONALD DESMARAIS,RS.BOH Number of Bedrooms: 3 Bedrooms DATE: DECEMBER 6,2006 11,00AM 1. Contractor to verify soils prior to start of construction due to location of test hole Soil Type: CLASS I PERCOLATION RATE: <5 MIWINCH / Permit#11535 offsite. Design Percolation Rate: <2 MIN./IN. TH - 1 TH - 2 2. Failed cesspools to be pumped and filled. Daily Flow: 330G.P.D. Design Flow: 330 G.P.D.(MIN. REgD) EL. 112.40 EL. 111.17 Garbage Grinder: NO A A 3. Contractor to verify all inverts prior to start of construction. Sandy Loam Sandy Loam Leaching Area Required: (330 G.P.D.)/0.74 S.F./G.P.D.=445.94 S.F. 2„ 10YE2/2 112.23 2" 10YE2/2 111.0 4. Regrade to maintain a maximum 3'of final cover over proposed leach facility. Medium Sand Medium Sand Septic Tank Required: 1500 GALLON(Proposed) 511 10YR3/1 111.98 8 10YR3/1 110.5 B B VV V'1 FLOOR R PLAN N USE 3 INFILTRATORS 3050S WITH DOUBLE WASHED Sandy Loam Sandy Loam STONE:4'ON ENDS,4'ON SIDES (29--W X 12.25'X 2') 10YR5/6 10YR5/6 N.T.S. �� �� 107.67 36 C1 109.4 42 C1 Sidewall Areal:, 4(2WW+12.26)= 166.44 S.F. Perc Loamy Sand Loamy Sand Bath Bottom Area: 29.36'X 12.25'=359.66 S.F. so° 2.5Y6/4 2.5Y6/4 Bed 1 Bed 2 Bath Bed 3 Total Area: 626.1 S.F. Design Flow Provided: 0.74(526.1 S.F.)=389.31 G.P.D. Living 1 Room 550 OAK STREET, BARNSTABLE, MA i VH PREPARED FOR: D. A. Brown 138" 1100.9 144" 199.17 aSSOCIateS and Kitche SEPf7 SWMMMWN3 PEW RATE:<4 MIN/IN.("Cl"Horizon) "04041fiwo Robert Bea rse 12"-9":9:00 minutes SOMWA*MA a 6":1Q:21 minutes z0a.8310mi 159 Parker Road No Groundwater Encountered West Barnstable, MA 02668 NOTE:Contractor to verity consistency of soils in location Garage surveying br of prima S.A.S.a minimum oT5' below T"�'.4 X�P-� oad leach facility prior to installation. Hmwich,nMA22 LogR 2645 DATE REVISED SCALE SHEET NO. (soe) 432-6309 12/06/06 1° = 30' 2 of 2