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Home My WebLink About0735 OAK STREET (CENT./W.BARN) - Health 735 OAK STREET West Barnstable A = 215 - 016 - 002 . �. r n � Commonwealth of Massachusetts o?/5 - b/4 "OO2_ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �1=; rr~i 735 Oak Street µ; Property Address PQ Patrick Smith Owner Owner's Name ; information is - required for every West Barnstable MA 02668 1/15/18 : page. City/Town State Zip Code Date of Inspection ; Inspection results must be submitted on this form. Inspection forms may not be altered it any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information 514r I agog on the computer, use only the tab 1. Inspector: key to move your cursor-do not Brett Hickey use the return Name of Inspector key. Excavation Company ray Company Name 14 Teaberry Lane Company Address Sandwich Ma. 02644 City/Town State Zip Code (508)477-0653 S113747 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 1/15/18 Inspel o s ig ture ' 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 �0)yA6 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 735 Oak Street Property Address Patrick Smith Owner Owner's Name information is required for every West Barnstable MA 02668 1/15/18 page. City(rown 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: 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 735 Oak Street Property Address Patrick Smith Owner Owner's Name information is required for every West Barnstable MA 02668 1/15/18 page. Cityrrown State Zip Code Date of Inspection 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•3/13 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 M 735 Oak Street Property Address Patrick Smith Owner Owner's Name information is West Barnstable MA 02668 1/15/18 required for every page. Cityrrown 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 %day flow t5ins•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 , 735 Oak Street Property Address Patrick Smith Owner Owner's Name information is required for every West Barnstable MA 02668 1/15/18 page. Cityrrown 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" 'n 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 M , ' 735 Oak Street Property Address Patrick Smith Owner Owner's Name information is required for every West Barnstable MA 02668 1/15/18 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 5 735 Oak Street Property Address Patrick Smith Owner Owner's Name information is West Barnstable MA 02668 1/15/18 required for every page. City/Town State Zip Code Date of Inspection D. System Information Description: 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 ears usage d N/A 9 ( Y 9 (gP ))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: currentDate 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 Commonwealth of Massachusetts w - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M y 735 Oak Street Property Address Patrick Smith Owner Owner's Name information is required for every West Barnstable MA 02668 1/15/18 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts M Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 735 Oak Street Property Address Patrick Smith Owner Owner's Name information is required for every West Barnstable MA 02668 1/15/18 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: 1997 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 2' 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.): At time of inspection building sewer appeared to be in good working order with no sign of leakage. Septic Tank(locate on site plan): 1' Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 gallon Sludge depth: 10" t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M ,•''r 735 Oak Street Property Address Patrick Smith Owner Owner's Name information is required for every West Barnstable MA 02668 1/15/18 page. CityrTown 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 26" Scum thickness 4" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 12" How were dimensions determined? measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): At time of inspection septic tank appeared to be in working order with no sign of back-up. Tank is not in need of pumping at this time but should be pumped every 2 years for maintenance. 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 735 Oak Street Property Address Patrick Smith Owner Owner's Name information is required for every West Barnstable MA 02668 1/15/18 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.): 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 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 735 Oak Street Property Address Patrick Smith Owner Owner's Name information is West Barnstable MA 02668 1/15/18 required for 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.): At time of inspection d-box appears to be in working order with no sign of carryover. 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. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located;, explain why: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 r Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 735 Oak Street Property Address Patrick Smith Owner Owner's Name information is required for every West Barnstable MA 02668 1/15/18 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: (2) 500 gal ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): At time of inspection leaching appears to be in working order with no sign of hydraulic failure. 8"of standing water in pit with no staining. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert I 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 I Commonwealth of Massachusetts - Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 735 Oak Street Property Address Patrick Smith Owner Owner's Name information is West Barnstable MA 02668 1/15/18 required for every page. Cityrrown 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 (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 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments '< 735 Oak Street Property Address :Patrick Smith Owner Owner's Name information i e required for every West Barnstable MA 02668 1/15/1.8 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage dispo ss�I ystem, 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 0 a 0 2 z 27 8 2. y sys� s� ' t5ins '3/13 Title 5 Official Inspection Form:.Subsurface Sewage Disposal System•Page 15 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 735 Oak Street Property Address Patrick Smith Owner Owner's Name information is West Barnstable MA 02668 1/15/18 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: No Gw @ 10' 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: 2/4/97 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: Plan on file at BOH. 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 735 Oak Street Property Address Patrick Smith Owner Owners Name information is required for every West Barnstable MA 02668 1/15/18 page. Cityrrown 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 r ul06 1411:19p p.1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 735 Oak Street Property Address Kathryn Armstrong Owner Owner's Name information is required for every West Barnstable MA 02668 6-30-14 page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way.Please see completeness`checklist at the end of the form. Important:out out form A. General Information Filling ms `�quu�mprit�i on the computer, �w �H OF use only the tab 1. Inspector: `�2� ._ '• y% �' G key to move your I 6V-1 � �o � ':yG$cursor-do not James D.Sears (((/// =j; JAMES, -,�, use the:return Name of Inspector *: :rA .key. CapewideEnterprises,LLC o� • '�: Company Name 153Commercial Street _^ — ' •5 1Ns? Compa ny Address Mashpee MA 02649 Cityrrown State Zip Code 508477-8877 S 1623 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 PEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 16.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 71- -14 soctor 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. V I 15ins-3113 Title 5 Onidd Ins 10 oam Subsurtaoe Sewage Disposal Sp •Paga 1 Vr 17 Jul 061411:19p p.2 Commonwealth of Massachusetts Title 5 Officia[ Inspection Form UVSubsurface Sewage Disposal System Form-Not for Voluntary Assessments I 735 Oak Street Property Address Kathryn Armstrong Owner Owner's Name information is required for every West Barnstable MA 02668 . 6-30-14 page. City/Town Stale Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check`,A,B,C,D or E I 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 16.304 exist.Any failure criteria not evaluated are indicated below` Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass' section need to be replaced or repaired.The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes","no"or"not determined"(Y, N, ND) for the following statements. If"not determined," please explain:' The septic tank is metal and'over 20 years old* or the septic tank (whether metal or not) is structurally unsound,exhibits substantial infiltration'or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. ' A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. El Y ❑ N ❑ ND(Explain below): t5ins-3113 Tdb 5 0ftia1 Inkpadbn Fomr Subsurface Sewage Disposal System•Page 2 of 17 Jul06 14 11:19p p.3 i Commonwealth of Massachusetts- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1 735 Oak Street Property Address Kathryn Armstrong Owner Owners Name l information is i MA 02668 6-30-14 required for every West Barnstable page. City/Town i State Zip Code Bate of Inspection S. Certification (cont.) , ❑ Pump Chamber pumps/alarms not operational_ System will pass with Board of Health approval if pum / I aired: ps a arms 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 pipes)are replaced ❑ Y 0 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 Hoard 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 4 ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or salt marsh t5ins.'3.13 TO 5 Official kzspection Fomr Subsurface Sewage Disposal System-Pega 3 of 17 z Jul 06 1411:20p p.4 Commonwealth of Massachusetts, Title 5; Official.. Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 735 Oak Street =' Property Address Kathryn Armstrong Owner Owner's Name iequIred for every lion require West Barnstable MA 02668 6-30-14 page. CRy/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health(and Public Water Supplier, N 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- El 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'Wo"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 a is less than 6" below invert or available volume is less than %-day flow 7 (Sins•3113 Tit1s 5 offider ko padioa Fornc SufraiAece Sewage Deposal System•Page 4 of 17 r f Jul06 1411:20p p.5 Commonwealth of Massachusetts ID Title 5 Official` Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 735 Oak Street Property Address Kathryn Armstrong Owner Owners Name information is required for every West Barnstable MA 02668 6-30-14 page. City/Town State Zip Code Nte 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 pprn, 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 El El Area system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone Il 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. ;Sins.W3 } Tile 5Offidel Inspection Form:Subadece Sewage Disposal System Page 5 a 17 Jul 06 1411:20p p.6 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments a 735 Oak Street Property Address x Kathryn Armstrong Owner Owner's Name information is required for every West Barnstable MA 02668 6-30-14 page. CitYlTown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the:system received normal flows in the previous two week period? 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 theifacility 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•3M3 i Title 5 0Hio3al 6rspectlon Form:Sub6urlace Sewage Disposal System•Pape 6 o117 Jul 06 1411:21 p p.7 Commonwealth of Massachusetts Title 5 Official' Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 735 Oak Street Property Address Kathryn Armstrong Owner Owner's Name information is West Barnstable MA 02668 6-30-14 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information a Description: The system is a 1500 Gal:Tank D Box and two 500 chambers. 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 [D No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d well water 9 ( Y 9 (gP ))� Detail: " Sump pump? ❑ Yes ® No Last date of occupancy: 4 ppate resent Commerciallindustrial Flow Conditions: Type of Establishment — Design flow(based on 310 CMR 15.203): Gallons per day(9pd) Basis of design flow(seats/p'ersons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank.present? f ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-3J13 Title 5 Official Inspectiort Farm:Subsurface Sewage Disposal System•Page 7 of 17 i Jul 06 1411:21 p p.8 Commonwealth of Massachusetts. Title 5 Official-, Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments M 735 Oak Street Property Address Kathryn Armstrong Owner Owner's Name information is required for every West Barnstable AAA 02668 6-30-14 page. Cityrr own State Zip Code Date of Inspection D. System Information (cons) Last date of occupancy/use:;: Date Other(describe below): General Information Pumping Records: Source of information: NA 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/Altemative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ fight tank.Attach a copy of the DEP approval. ❑ Other(describe): 15in5.3113 Title 5 Official Inspection Fam Subsurtatm Sewage Disposal System•Page S or 17 i f , ,t Jul 06 1411:21 p p.9 . 3 Commonwealth of Massachusettsi Title 5 Official" lnspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 735 Oak Street Property Address Kathryn Armstrong Owner Owner's Name Information required for every West Barnstable MA 02668 6-30-14 page. C"ttyrTown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed(if known)and source of information: Tank NA-D Box and leaching 1997 permit #97-102. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate-on site plan): 2' 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.): Pipeing is 4" PVC SCH 40. Septic Tank(locate on site plan): 1t Depth below grader feet Material of construction: ® concrete ❑metal ❑fiberglass ❑polyethylene ❑other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes 0 No 1500 Precast H-10 Dimensions: r . 1tt Sludge depth: t5ins-3113 Title 5 oflidal Inspection Form:Subsu rfam Sewage Olspcsat System-Page 9 of 17 Jul 06 14 11:22p p.10 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 735 Oak Street Property address Kathryn Armstrong Owner Owner's Name Information is required for every West Barnstable 4 MA 02668 6-30-14 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) 29' Distance from top of sludge to bottom of outlet tee or baffle 0" Scum thickness Distance From top of scum to top of outlet tee or baffle 8� 18" Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Asbuilt-Tape Sludge Judge 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 at working level:Tank and covers at l'below grade. In and outlet tees. No sign of leakage or over loading Grease Trap(locate on site plan): Depth below grade: ? teat s Material of oonstruction: ❑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: Dam x tsirs-,3113 Thb 5 Official rnspecibn Form:Subsudace Sewage Disposal System Page 10 of 17 t, Jul 06 1411:22p p.11 I Commonwealth of Massachusetts Title 5 Official- Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 735 Oak Street Property Address Kathryn Armstrong Owner Owner's Name information is West Barnstable 02668 6-30-14 required for every 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 outle(invert,evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): L , 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.): I 'Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 4 15ins•3/13 Idle 5 otfidal hspadlon Fcrrre Subsudaoe Saxage Disposal System•Pape I/of 17 Jul 06 1411:22p p.12 Commonwealth of Massachusetts _ Title 5 Official jnspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 735 Oak Street Property Address Kathryn Armstrong --- Owner Owner's Name information is west Barnstable MA 02668 6-30-14 required for every page. City/Town 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.): D Box located and inspected wlcamera. No sign of over loading or solid carry over. 4 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, Soil Absorption System(SAS)(locate on site plan, excavation not required): If SAS not located, explain why: t5ins-3113 Title 5 Official Inspection Form Subsurface Sewage fNsposW System-Page 12 of 17 r Jul06 14.11:22p p.13 Commonwealth of Massachusetts Title 5 Official. Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r 735 Oak Street Property Address Kathryn Armstrong Owner Owner's Name information is required for every West Barnstable MA 02668 6-30-14 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: El leaching pits number: ® leaching chambers number: 2 ❑ Teaching galleries number: ❑ leaching trenches number, length: leaching fields number,dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Typetname of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil,condition of vegetation, etc.): Leaching is two 500 Gal.dry welll chambers w/4' stone. Chambers are 30" below grade 8 water in chambers. No sign of over loading or solid carry over. No high stain line. 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-3113 TBIe 5 Offida;Inspection Form:Subsurface Sewage Disposal system•Page 13 of 17. Jul 06 1411:23p p.14 Commonwealth of Massachusetts ENNISM Title 5 Official .inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 735 Oak Street Property Address Kathryn Armstrong Owner owner's Name information Is required for every West Barnstable MA 02668 6-30-14 page CitylTown 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.): Y 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.): t5lns•W3 Title 5 Official lnspecllan Fomr.Subsurface Sewage Disposal System•Page 14 or 17 f p Jul 06 1411:23p p.15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments - 735 Oak Street Property Address Kathryn Armstrong Owner Owner's Name required foon e West Barnstable MA 02668 6-30-14 required forevery page. Cityrrown 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 aAK A . /3-/ = B-,a -3 - y Q -3 ;s� � A 13- _J7 i 0 0 3 ❑ o f5ins o 3M 3 Title 5 official Inspection Forth:Subsurface Sewage Disposal System•Page 15 of 17 p Jul 06 1411:23p p.16 Commonwealth of Massachusetts Title 5 Official Inspection Form V42WSubsurface Sewage Disposal System Form -Not for Voluntary Assessments 735 Oak Street Property Address Kathryn Armstrong Owner Owner's Name information is West Barnstable MA 02668 6-30-14 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells 10, Estimated depth to igh ground water: feet Please indicate all methods used to determine the high ground water elevation: Obtained from system design plans on record 2-4-97 If checked,date of design plan reviewed: Date Oate ❑ 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: T.H. on design plan 24-97, no G_W. at 10'. Bottom of chambers at S below grade. Bottom of chambers at 5'above T.H.depth. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-W3 Ties 5 Ofidal Inspection Forth:Subsinfaog Sewage Disposal System•Pape 16 of 17 Jul 06 1411:24p p.17 Commonwealth of Massachusetts Title 5 Official. Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r 735 Oak Street Property Address j Kathryn Armstrong Owner Owner's Name information is West Barnstable MA 02668 6-30-14 required for every page. cityrrown 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 ; t51ns•3 113 TIUa 5 Olrldel Mspeclton Fom[Ubsiafeca Sewage Dlspwal System•Page 17 or 17 � p COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS d DEPARTMENT OF ENVIRONMENTAL PROTECTION � d �W v YO TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 735 OAK VSARNSTABLE,MA 02630 M215 P034 L8 Owner's Name: DENNIS CASEY Owner's Address: P.O.BOX 8373 BOSTON MA.02114 RECEIVED Date of Inspection: 4/6/01 Name of Inspector: (please print) JOHN GRACI MAY - 4 2001 Company Name: SEPTIC INSPECTIONS TOWN OF BARNSTABLE Mailing Address: P.O. BOX 2119 TEATICKET,MA.02536 HEALTH DEPT. Telephone Number: 508-564-6813 FAX 508-564-7270 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: X Passes _ Conditionally Passes _ Needs F rthe Evaluation by the Local Approving Authority Fails /' Inspector's Signature: �1 Date: 4/6/01 The system inspector shall submi 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. Notes and Comments THE SYSTEM PASSES TITLE V INPECTION. RECOMMEND PUMPING NOW AND EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. ****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. Title 5 1mcnFrtinn Form iQl V?000 1 L_ Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 735 OAK ST BARNSTABLE,MA 02630 M215 P034 L8 Owner: DENNIS CASEY Date of Inspection: 4/6/01 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X 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: THE SYSTEM PASSES TITLE V INPECTION. RECOMMEND PUMPING NOW AND EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. B. System Conditionally Passes: _ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system, upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND) in the for the following statements. If"not determined"please explain. n/a The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: n/a n/a Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection if(with approval of Board of Health): _ broken pipe(s)are replaced _ obstruction is removed _ distribution box is leveled or replaced ND explain: n/a n/a The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): _broken pipe(s)are replaced _obstruction is removed ND explain: n/a Page 3 of I I OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 735 OAK ST BARNSTABLE,MA 02630 M215 P034 L8 Owner: DENNIS CASEY Date of Inspection: 4/6/01 C. Further Evaluation is Required by the Board of Health: _ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone I of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well".Method used to determine distance n/a "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: n/a 0 Page 4 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 735 OAK ST BARNSTABLE,MA 02630 M215 P034 L8 Owner: DENNIS CASEY Date of Inspection: 4/6/01 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all-inspections: Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than '/z day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped nLa. X Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone 1 of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] (Yes/No)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. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large 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. d Pag e OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 735 OAK ST BARNSTABLE,MA 02630 M215 P034 L8 Owner: DENNIS CASEY Date of Inspection: 4/6/01 Check if the following have been done. You must indicate "yes" or"no"as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health X Were any of the system components pumped out in the previous two weeks? X _ Has the system received normal flows in the previous two week period? X Have large volumes of water been introduced to the system recently or as part of this inspection ? X _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up? X _ Was the site inspected for signs of break out? X _ Were all system components,excluding the SAS, located on site? X _ 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 ? X _ 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: Yes no X _ Existing information. For example,a plan at the Board of Health. X _ 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(3)(b)J 5 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 735 OAK ST BARNSTABLE,MA 02630 M215 P034 L8 Owner: DENNIS CASEY Date of Inspection: 4/6/01 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):330 Number of current residents: 2 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no): NO Seasonal use: (yes or no): NO Water meter readings, if available(last 2 years usage(gpd)): n/a Sump pump(yes or no): NO Last date of occupancy: n/a COMMERCIAL/INDUSTRIAL Type of establishment: n/a Design flow(based on 310 CMR.15.203): n/agpd Basis of design flow(seats/persons/sgft,etc.): n/a Grease trap present(yes or no): NO Industrial waste holding tank present(yes or no): NO Non-sanitary waste discharged to the Title 5 system(yes or no): NO Water meter readings, if available: n/a Last date of occupancy/use: n/a OTHER(describe): n/a GENERAL INFORMATION Pumping Records Source of information: n/a Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: n/agallons--How was quantity pumped determined?n/a Reason for pumping: n/a TYPE OF SYSTEM X Septic tank,distribution box, soil absorption system _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records, if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank Attach a copy of the DEP approval Other(describe): n/a Approximate age of all components,date installed(if known)and source of information: 1997 Were sewage odors detected when arriving at the site(yes or no): NO P,age 7 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 735 OAK ST BARNSTABLE,MA 02630 M215 P034 L8 Owner: DENNIS CASEY Date of Inspection: 4/6/01 BUILDING SEWER(locate on site plan) Depth below grade: 12" Materials of construction: cast iron X40 PVC other(explain): n/a Distance from private water supply well or suction line: n/a Comments(on condition of joints,venting,evidence of leakage,etc.): THE LEACH FIELD IS 150' TO WELL SEPTIC TANK: X(locate on site plan) Depth below grade: 6" Material of construction: Xconcrete metal_fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: 150OG L 10' 6" H 5'7" W 5' 8"" Sludge depth: 4" Distance from top of sludge to bottom of outlet tee or baffle:30" Scum thickness:3" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: n/a How were dimensions determined: MEASURED Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): THE SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND. RECOMMEND PUMPING THE SYSTEM NOW AND EVERY TWO YEARS. GREASE TRAP:_(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping: n/a Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): n/a Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 735 OAK ST BARNSTABLE,MA 02630 M215 P034 L8 Owner: DENNIS CASEY Date of Inspection: 4/6/01 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Capacity: n/a gallons Design Flow: n/a gallons/day Alarm present(yes or no): N/A Alarm level: N/A Alarm in working order(yes or no): NO Date of last pumping: n/a Comments(condition of alarm and float switches,etc.): n/a DISTRIBUTION BOX:X(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: LEVEL WITH BOTTOM OF PIPE Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover, any evidence of leakage into or out of box,etc.): THE DISTRIBUTION BOX IS STRUCTURALLY SOUND. PUMP CHAMBER:_(locate on site plan) Pumps in working order(yes or no): NO Alarms in working order(yes or no):NO Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): n/a R Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 735 OAK ST BARNSTABLE,MA 02630 M215 P034 L8 Owner: DENNIS CASEY Date of Inspection: 4/6/01 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: n/a Type n/a leaching pits, number: n/a 500 GALLON LEACHING leaching chambers, number: 3 CHAMBERS leaching galleries, number: n/a n/a leaching trenches, number, length: nla n/a leaching fields, number: n/a n/a overflow cesspool, number: n/a n/a innovative/alternative system n/a Type/name of technology: n/a Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.): THE LEACH FIELD APPEARS TO BE FUNCTIONING PROPERLY,THE SYSTEM SHOWS NO SIGNS OF FAILURE.SOIL PROBED DRY CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: n/a Depth—top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer: n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater inflow(yes or no): NO Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a PRIVY: (locate on site plan) Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a Page 10 of 11 ' r OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 735 OAK ST BARNSTABLE, MA 02630 M215 P034 L8 Owner: DENNIS CASEY Date of Inspection: 4/6/01 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building: Ch A 6 Ac to A `Iti �O � s► in Page 11 of 11 f OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 735 OAK ST BARNSTABLE,MA 02630 M215 P034 L8 Owner: DENNIS CASEY Date of Inspection: 4/6/01 SITE EXAM _Slope _Surface water _Check cellar Shallow wells Estimated depth to ground water 12+feet Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system d-.sign plans on record-If checked,date of design plan reviewed: n/a NO Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a NO Checked with local excavators, installers-(attach documentation) YES Accessed USGS database-explain: n/a You must describe how you established the high ground water elevation: USGS MAPS AND CHARTS- 12+FEET it �P�OFtHET��o The Town of Barnstable m � � DARISTAn 4: Department of Health, Safety and Environmental Services 39� 039 Public Health Division MPY i6 D �'\ 367 Main Street,Hyannis,MA 02601 Office 508-790-6265 Thomas A. McKean FAX 508-775-3344 Director of Public Health March 6, 1997 Dennis Casey 14 Egret Court Mashpee, MA 02649 Dear Mr. Casey: The Board of Health has no objection to your request to construct a new onsite sewage disposal system and dwelling at Lot 8 Oak Street, West Barnstable, in lieu of the recent water test results which indicate high sodium at 48.2 milligrams per liter. The Board members strongly recommend that you test the well water at least once every six months to ensure the occupant(s) of the new dwelling do not consume contaminated water. Sincerely yours, =G. Chairman Board of Health Town of Barnstable SGR/bcs casey N0: TOWN OF BARNSTABLE DATE �7 OFFICE OF } „u,r„n ? BOARD OF HEALTH RECEIVED BY-" r6}9 367 MAIN STREET . e Y HYANNIS,MASS.02601 VARIANCE REOUEBT FORK ALL VARIANCES MUST BE SUBMITTED FIFTEEN (15) DAY8 PRIOR TO THE SCHEDULED BOARD OF HEALTH MEETING. NAME OF APPLICANT ,j, ec Se - TBL. NO. �, /Q"; oa6z�� ADDRESS OF APPLICANT 4a ' NAME OF OWNER OF PROPERTY Co •e_C v` E�7 SUBDIVISION NAME oo DATE APPROVED 6/, a rnS a ASSESSORS MAP AND PARCEL NUMBER 4a, <9 G, 9lgq �/ 03 S° LOCATION OF REQUEST SIZE OF LOT :? SQ.FT WETLANDS WITHIN 200 FT.YES _ N0� VARIANCE FROM REGULATION(List Regulation) REASON FOR VARIANCE(May attach if more space is needed) PLAN - FOUR COPIES OF PLAN MUST BE SUBMITTED CLEARLY OUTLINING VARIANCE REQUEST. VARIANCE APPROVED NOT APPROVED REASON FOR DISAPPROVAL BRIAN R. GRADY, R.S. t CHAIRMAN SUSAN G.- RASRr R.S. JOSEPH C. SNOWp M.D. BOARD OF BEALTH TOWN OF BARNSTABLE ENVIROTECH LABORATORIES, INC. tiov P"W'� MA Cer. No.: M-MA 063 ?,(r 0 J.D f- &o.14- 449 Rte.130 ►�`a5h Sandwich, MA 02563 (508) 888-6460 1800-339-6460 FAX (508) 888-6446 CLIENT: Dennis Casey LOCATION: Lot 8 ADDRESS: 14 Egret Court Oak Street Mashpee MA 02649 West Barnstable MA COLLECTED BY: T. Desmond SAMPLE DATE: 2-21-97 SAMPLE TIME: 4:30 WATER SAMPLE TYPE: New Well DATE RECEIVED: 2-21-97 LAB I.D.#: 97-2249 WELL SPECS.: 110/87 RESULTS OF ANALYSIS: Parameters Units Recommended Results Method Limits Coliform bacteria /100ml 0 0 9222 B pH pH units 6.0-8.5 6.23 4500 H+ Conductance umhos/cm 500 338 120.1 Sodium mg/L 28.0 48.2 200.7 Nitrate-N/Nitrite-N mg/L 10.0 0.57 4500-NO3 E Iron mg/L 0.3 1.07 200.7 Manganese mg/L 0.05 0.067 200.7 Volatile Organics ug/L See attached report. None detected. 524.2 EPA COMMENTS: Sodium level is not a health hazard. Iron level is not a health hazard, but may cause taste and staining problems. Manganese is not a health hazard. YES WATER IS SUITABLE FOR DRINKING PURPOSES FOR PARAMETERS TESTED. Date 3 Ro ald J.Saari Laboratory Dir for <=less than >=greater than TNTC=too numerous to count I or 24 . 1 or 524 . 2 . These tests includes 'analysesa ell f as j02 ; 1 or 5 eable aromat p,,�l'geable lietlocarbons a nd purge able for petroleum hydrocart�one or pestici'i°lit of the 2 ) The Board of Health uidelines the National etermine InterimSPrimaarry well water usingDrinking Water Standards and the U• quality mitt Secondary The water q Maximum Contacommon ParametersMare)as follows : standards for ' Primary Standards i Total Coliform 0 colonies/100 ml . MF ' 10 ppm Nitrate Secondary Standards recommend pH above 5. 0 P}1 S 20 PPm odium 0. 3 ppm Iron ,- When the Board of Health deems it necessary, the Health 3) be present Agent or other agent of the Board of Health may take the to witness the taking of a water sample and/ may laboratory water sample and deliver it to the testing him/herself. 4 ) Th e Board of Health further recdof that every two (2)well owners have their wells tested at a minimum years , and at more frequent intervals when water quality problems are known to exist. lg_ YI L MLL. AIM KATFB M M 1) Before approval , every well shall be pump tested to The pump test shall inclu a dra down for determine yield . rate of 5 gallons p test at a minimum pumping one ( 1 ) hour. well, PUMP, 2) The design of the water ataccessories imust dibe adequateto storage tank , and otherer minute which equals provide a water capacity ill gallons P in addition, the number of water notxber fixtures installed; they peak demand tfor capacity ( in gPm) mu For For the purposes o his the largest fixture installed . water outlet, and regulation a fixture is defined *as , a bathtubs , washing Includes faucets, sinks , machines , dishwashers , and the like. : " TOWN OF BARNSTABLE LOCATION SEWAGE # VILi.AGE V/1 � �� ASSESSOR'S /MAP& LOT2fcS' D 1 201 IN-(TALLER'S NAME&PHONE NO. Jy�"" )0& SEPTIC TANK CAPACITY 1.000 LEACHING FACILITY: (type) S'00gee ff C Aeyn (size) '� X 2S 2 NO.OF BEDROOMS 3 BUILDER OR OWNER Pen m is 6 Se f PERMITDATE: COMPLIANCE DATE: 7 Separation Distance Between the: Maximum Adjustzd 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 l Q � \�Y � - � � � 2> �s6� � �� 6 � y�G�- s5'$Y o � - — �� s y�- s� TOWN OF BARNSTABLE Q f SEWAGE # . VILLAGE I,�� "' ` �/� ASSESSOR'S MAP & LOTa/s' D_3�oo f INSTALLER'S NAME 8c PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) Svo su�, c�+ar,, b�rf (size) 4`4 A NQ,:OF BEDROOMS 3 BUILDER OR OWNER Oen n is t ey '"' 9'Z COMPLIANCE DATE: PERMTTDATE: 1 S" 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 Feet on site or within 200 feet of leaching facility) Edge:of Wetland and Leaching Facility(If any wetlands exist Feet withie 300 feet of leaching facility) Furnished by - L �S �ShS � o O 0 O FL m No. �� '� Fee _ (�3 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: -� a Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 0[ppricatiou for Oigozar *pstem Construction Permit Application for a Permit to Construct(,VRepair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. ,-0 F— �77— $?aG L m� Oul1 syb�l /i2PH�'I o`S Caf�y tf� Assessor's Map/Parcel f7�� +�— _,c f� �• d�1 Coy�v� /)�� //may F� A� J� 7 1 4 P AX, d�1 �l Installer's Name,Address,and rTeel.No. � _Cy`gg� Designer's Name,Address and Tel.No. il / o f 31, 9-1-3 A-,t Type of Building: Dwelling No.of Bedrooms Lot Size y30 $7 sq.ft. Garbage Grinder( ) Other Type of Building Il?PsaVsgt; No. of Persons Showers( ) Cafeteria( ) n Other Fixtures Design Flow `3 3d gallons per day. Calculated daily flow gallons. Plan Date 2-N-97 Number of sheets Revision Date Title Size of Septic Tank iS� Type of S.A.S. 2 -5-00 cat leacL.c4yvcsk&.c Description of Soil O Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this_Zoard of Health. -- Signed Date 1 � y 9;7 Application Approved by Date—73 "7 Application Disapproved for the ollowing reasons Permit No. _ ��7 Z Date Issued et No. '� _ 10 4— Fee /00 g (� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC.HEALTH DIVISION -TOWN OF BARNSTABLEa MASSACHUSETTS s 0(pprication for Digpogar.*potem Cowaruction Permit Application for a Permit to Construct( )(Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. f, Owner's Name,Address and Tel.No. r0 P �li`7- 8?v6 w ' L c t $ Oal,e ST4,, j�ahh%s GaJr (y) `Assessor'sMap/Paz y cel � Jam, 0l�'i_ S7 rJJ Gouvt //'/GJ4 f' /K O��y Installer's Name,Address,and Tel-No. Designer's Name,Address and Tel.No. �� S"J-L .4 y�.,y �e �i,�rhtvr,-�f c 46, a,.?4% v&67J- Type of Building: Dwelhn;... No.of Bedrooms ,. y .7$ -sq.- 1 g 3 Lot Sizeft. Garbage Grinder(`") Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow ?d gallons per day. Calculated daily flow gallons. '~ Plan Date -&f-9 7 Number of sheets Revision Date Title Size of Septic Tank /5'6�0 Type of S.A.S. 2 -sv�4a/ Lard c�p..��p syoyy Description of Soil _ _ /1//P�/i�.►� 5,��..1 O C Nature of Repairs or Alterations(Answer when applicable) Date last inspected: E,..., _.. . .,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 operationruntil a Certifi- cate of Compliance has been issued by this Hoara of Health. Signed ,. Date 9' Application"Approved by Date - `7 Application Disapproved for the ollowing reasons i Permit No. _ Date Issued r ——————————————————— ——————————————————— THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that.the On-site Sewage Disposal System Constructed(t--f Repaired (. )Upgraded( ) Abandoned( )by JOIr I� Age,/fo ram. D�YlN rS C!i SA,. at 4o� $ Ook S>, wpji xwo I has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No 7- 0-a- dated !! j Installer .70L►n L) ,QG}fp Designer 6-r lk .Sur ,Oe ,»p g LH41N/Jv,»��hc The issuance of this permit shall not be construed as a guarantee that the system will fu ct3Qn as`signed. ` Date 7 ; '7 0 -1 Inspector — ! 7 !1©--------------_--------------- Fee I)0 THE COMMONWEALTH OF MASSACHUSETTS rt PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS ig oaf pgtem �Cow5truction Permit Permission is hereby granted to Construct(4,0epair( )Upgrade( )Abandon S ) System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this permit. Date: '� - `i - 7 Approved by Department of Environmental Management/Division of Water Resources WELL COMPLETION REPORT Z WELL LOCATION GEOGRAPHIC DESCRIPTION Adfiress N S E W ,of. (feet) (circle) City/TownrQ/YST1' /3L� Well owner_ Address /�/ .2P T' nAt�e v" N S E W. of /14 e 2 6 (nil,in tenths) (circle) ' Board of Health permit obtained:: yes '7_ no❑ hi(ersect w/ (road! WELL USE WELL DATA Domestic Public❑_ Industrial ❑ Total well depth ACI ft. n� Monitoring❑ Other Depth to bedrock ft. 7 Water-bearing rock/unconsolidated material: Method drilled Date drilled 99 f.S/ Description �d Water-bearing zones: CASING �I Type JL,4 1) From To 2) From To Length/K94 ft.Dia(I.D.) in. 3) From To Length into bedrock ft. Gravel pack well: dia. Protective well seal: Screeii: dia. :Grout-0 Other Slot+'1 length 4-0�lfrom./�rto / STATIC WATER LEVEL(all wells) Static water level below land surface ft. Date, v:2 6' WELL TEST(production wells) Drewdown-4-_ft. aft-or pumping hr.—min.at /6 gpm How measuredi I*ecovery ft a( err hr. .ml'n. o LOG of.FORMATIONS COMMENTS ag Materiels From To I $ V`�Fi Nd DrillerSII,C� C�a�3l3GES .4 o7IJ G Firm Sf�irnz `, Address e:::! 7 City/Town N Supe ising Driller Reg.# a4f A : S Si nature of supervisin sled well drl/ler ,_ _P/eaft Print hrmlY .. t - ----- Fee--- .ice----- - - BOARD OF HEALTH TOWN OF BARNSTABLE 2Ipp[icat ion for Vell Congtructionpermit Application is hereby made forQa permit to Construct (X, Alter ( ), or Repair ( )an individual Well at: 0 A-�67-- ---------- `�!- -�✓- ' 9�t� ''�--------------------- Location — Address Assessors Map and Parcel ------------------ O ner Address u' w ri�L_ ASu- ------ e �5_`i —q&J91L--&' )---------©ww Installer — Driller y OWL pL-Srvtpkja Address Type of Building Dwelling--547'-- -----If---�`=a' ---------------- Other - Type of Building y----------------------------------- No. of Persons------------------------------------------------------- Type of Well— — - — C �`"- u - -- Capacity Purpose of Well ----`--Z--------� 1' - Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until bCertificate .of Compliance has been issued by the Board of Health.. Signed 2 a------------ ------ � -------- to Application Approved By----� ----------------- -- -- 7 date Application Disapproved for the following reasons-.-----—----------------------—------------- —--------- —----- --—---—----------------------------------------------------------------------------------------------------- date PermitNo. --- - -- ------------------ Issued------------------------------------------------------ -------------------- date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( , Altered ( ), or Repaired ( ) Installer at- 1 QT� ®A-v- S — fit 1 4-�--------------------------------------- has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. f-,;L-----------Dated------------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. I DATE--------------—-- — - ----- Inspector-----------------------------------------——- ------------ ------------- Fee--- ---- BOARD OF HEALTH , TOWN OF BARNSTABLE 0ppCication-*rVell Cootructio`nPermit Application is hereby made for a permit to konstr (: � Alter ( ), or Repair ( )an individual Well at: �6J -g-----------Gad -�� ✓-��'��1�uct�� ,��? -- - -=------- Location.- Address Assessors Map and Parcel -- - nt = ------------ -_- -- 1'`t lh u_P ddG`fib O ner Address _.. .41 Installer - Driller7-owL C)9Sr"ohio Address Type of Building / Dwelling-S"Ti' -----h-°- ----------------- Other - Type of Building-------------------------------- No. of Persons-------------------------------------------------- ..,; Type of Well------ ---------f----------------------------------- Capacity-- ----------------------- - ------- ------------------- Purpose of Well---'=r ` a_----- L'J1_{_l G(�ilgc Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in gper-a�tionntil Certificate .of Compliance has been issued by the Board of Health. Signed-','------- —�Z--- ------- ------------------ ----a-�--�-1�5�--------- �^ to Application Approved By---- J d�-L- "`=""�- - -- = c� date Application Disapproved for the following reasons:-------------------------------------------------------------------------------------------- - - -- -------- --- ---------------------------------------------------------------------------------------------------------- date PermitNo. --- -- ------—- - - Issued--------------------------------------------------------------=------------ date �. ...� .. ._ ..,. �.ass�ar?ar:.:'e;.wY..rw+.whrw.i::i�,.w-y.+�4..�r.:r,4rw.c?rFMs'�.�.+exra+.!kti.w'-►+�tisSs�. �1r5,��Yaw�dlar�sC"+.�aiY� �. .: ., .. BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of. Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( '), Altered ( ), or Repaired ( ) Installer at-� Q-�- -- C)4 t�- 'S( C�;u�5�-=�_�}�_t�(�T14�1�- --------------------------------------------------- has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection c Regulation as described in the application for Well Construction Permit No. - 7n-,�------------Dated-----------------------=- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE--------- ---- —_ - ---- - -- Inspector-------------------------------------------------------------------------- :•,.�rw:�5s�r�.�c�a+rt��w�n.e:..w!osra,wr.�.�•r,.: +.w�ei,�.�.ee�.�+.r+.yit awe!�Ms'a.�.rsw_+,.�!�.,�e.a °Aaanir. .W"MaU��Mrp. ... ... .. .:.. BOARD OF HEALTH TOWN OF BARNSTABLE �eCi �Con�truction�ermit No. -- -_- — Fee--- Permission is hereby granted -- -- -=---- -- ----------------------- -- 11<� ----�--o-�- ------�, � ------ to Construct X), Alter ( ), or Repair ( ) an Individual Well,at: " Street as shown Qn the application for a Well Construction Permit c� No. --------- '- - -- ----------------------------- Dated ------ F - ---------------------- 3------------------------------------------- �J Board of Health DATE - - No... _ _" Fss....''✓... .. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Apphratiou for Diripwial Wor1w Tous$rurtilm Frrmit Application is hereby made for a Permit to Construct ( ) or Repair (�an Individual Sewage Disposal System a .......22Z . ..sSi------ ::__��`��. 6�-------------------------------------------- ------------ ---•- .....----------- Location-Address or Lot No: � . F _._... .----•- ------------------ --------------------------•------•--- --•----;•.--.----•---------.------------- O+rncr Ad ress e ---, �(...�rC%�i�- ._a-:...:....Q/.1A..)....._Hyfe_&� d J Installer Address Type of Building Size Lot............................Sq. feet �. Dwelling—No. of Bedrooms.-- ...................___.____..___Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons_------_-_-_______-_--.--- Showers ( ) — Cafeteria ( ) a' Other fixtures ...................................................... W Design Flow............................................gallons per person per day. Total daily flow--------------------_-.----.---_-----:--....gallons. �' Septic Tank—Liquid capacity............gallons Length---------------- Width---------------- Diameter................ Depth........_....... Disposal Trench--No. .................... Width-------------------- -Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No--------..-_-_-_-- Diameter.................:.. Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ �T4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water......_................. a ------••---•------------------•-•-••---...---•---•--••••------•--•---•--•-•---•-•-•-••-•-••--•--••--.........-•-•-••••---•-•-•-•••...-•-..................... 0 Description of Soil....................................................................................................................................................................... V --------------------------------------------------------------------------------------------------------------- ff -s--�/°OG Nature of Re airs or Alteration Answer when a llcable--___-_. ...._... !°} 5. .. ,...__._�.�.... -.. U _P ,r s— P cat . ,. ► a .�_ ... o`� ..... C� � a ...................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with .the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b n iss ye e o rd of health. Signed --.............. .. .............. ..... ..-- ....2 ... ��.. .7................................. .. Da ApplicationApproved BY ............. .......... .. ...............................--- ----------- ............................................. -......................�f .�.�.. Date Application Disapproved for the following reasonr: . .................... ............... ................................ ..... .. . .. ....... ......... ....... .............. ................... --------------------- .------ *--- ........----------------............... ..... ................................ Permit No. a" .... l Issued ........�.`.��,..<�......'~..1.....1�.. Date I y•.. �.�r .�tv ._2� .i --y _ w. No... ...............................� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Di!3pmial Work,i Tontrnrtion rrrmit Application is hereby made for a Permit to Construct ( ) or R12ptir (�an Individual Sewage Disposal System at: --...... .... �. . ----- ............... Location-Address or Lot No. ?.1-3............................................... --------------------------...-•----..........-------•----...----.............----..............-- Owner Ad ress � ------------------- Installer Address Type of Building Size Lot............................Sq. feet Dwelling— No, of Bedrooms---3-----------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther —Type of Build itg ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures --------------------------------------------------------------------------------------- --------- _ W Design Flow...........................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquidfcapacity------------gallons Length__ ___________ Width................ Diameter................ Depth................ x Disposal Trench--No. Width...............:.. Total,Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter"""---_"--.-------------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by ---------------- Pit.................... Depth to ground water........................ (1 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ............ ---------------------- •-------- •------- •--- -............ .---------.............-•---------- .......... -•-=........................................ 0 Description of Soil.....................................................................................................................--•----------------------------•--.......--•-•---- UW ---------------------------------------•--........--•----•----.._.......--------•-----•--•--•-•-------•--•-----------------------•-•------------•----•--••--------------------............-•--------••-- Alterations,— - - -- . - . ......0 Nature offepairs or nnswer_when applicable. . : :::: -:r Agreement. w The undersigned agrees to install the aforedescribed'Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b n iss tad` e board of health. f r� Signed ,-_ ... ...... ...... '`--...... ................ .... �. .cJ.... .7. Application Approved ByC- .................................................................. ................/..j.. ..,........................................... ................''G.�!.�� •/iCY/,;� D�re Application Disapproved for the following reasons: ....... ....... .............. ............................................................................................. .. ................ . .......... ................... .... . ..................................................... .......................... .--------------- Permit No. ., .1�''------�...� ..---------------... Issued ........../...... '. ..�.'.. �f... Dace THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE C�Ertt'firate of TIIl< plianve THIS IS TO CE IFY, That the Individual Sewage Disposal System constructed ( ) or Repaired Installer r at ....... ......U..4........c.. . ..Q.. ............................................. . .......................................... has been installed in accordance with the provisions of TITLE q The,,Stat ,Environmental Code as describ i- the application for Disposal Works Construction Permit No. f t..: .......... dated`-7...:.g1 .Y ....... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. t DATE .. .................�......tt�........�.. }y.`f.. ......... -- Inspector ...........................................•--....................................._.......... I THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 9�j�� l' TOWN OF BARNSTABLE. No........L........... FEE... ....................' Diopoottl Wore Tonatrurtion rrmit Permissionis hereby granted-------- ".,-------------------- ------------------------------------------------------•-----•••••-- to Construct ( ) or Repai (L6n Individual Sewage Disposal System atNo............... - ....... G ............ ............ '•=•----r - = ............................................ Sir et as shown on the application for Disposal Works Construction Permit Dated...-..;�...�j.......�.... ------------------- ------. ...-��.... . . Board of Health DATE ._ ml.... .r� ..�...... FORM 36508 HOBBS 6 WARREN,INC..PUBLISHERS ir *OC. T I SEWAGE PERMIT NO. VI$ LAGS Nc 1A) , RZ.A f-N-S 0(12 1NSTA LLER'S NAME & AO.DRESS e U I L D E R OR OWNER DATE PERMIT ISSUED Za DATE COMPLIANCE ISSUED 1 _ s S �G �� 'i v� / �;� , � � I . �� .. - - 0 INVERT EL EVA T l ONS . DES GN CR / 'TER IA . , , .. . y GENERAL N0 TES • 2 INVERT AT BUILDING, 98 DESIGN FLOW. , CAPE COD w, ; 0 DESIGN AND CONSTRUCTION 1. THl S PLAN:!S F R THE , '� cau>`n/Nr rr' _ '. , . INVERT IN SEPTIC TANK. .: 97. 85 ..� BEDROOMS AT�L�'G. P; D, PER'. ...- OF : - Q CtX LE8E G PO SYSTEM ONLY. ,� , OF THE SEWAGE DISPOSAL Y INVERT OUT SEPTIC TANK. EQUALS / 9716 BEDROOM EQ L 330 G.P. D. LOCUS �* T ODS AND .MATERIALS. AND Vi , 2. ALL CONSTRUCTION ME A H .+, •\E'o , INVERT IN DIST. BOX. 97. 42 MAINTENANCE. OF ..THE SEPTIC 'SYSTEM SHALL NO GARBAGE GRINDER s e , INVERT OUT DIST. BOX: 97. 25 .. ": :CONFORM TO MASS.' D.E.P. TITLE S AND LOCAL �: � ' TRAN " INVERT BOARD OF HEALTH REGULAT/QNS, R� � ,, oU't N RT IN LEACH CHAMBER:' 97. 0 1 aoo- o SEPTIC "TANK REQUIRED: / ROP P VICE BOTTOM OF LEACH CHAMBER: 95. 0 LOCATED UNDER `a sERvl /yF 0 G. P. D. X '200% 660 GAL'. 3. ALL SEPTIC SYSTEM COMPONENTS AREAS SUBJECT TO VEHICULAR TRAFFIC OR GREATER \ ADJUSTED GROUND WATER: N/A \. SEPTIC TANK PROVIDED: 1500 GAL . THAN 3 IN DEPTH SHALL BE CAPABLE OF WITH OBSERVED GROUND WA TER: N/A STANDING H 20 WHEEL LOADS, 0 9 90. D 6 or BOTTOM OF, TEST HOLE l SOIL ABSORPTION SYSTEM REQUIRED. 2 L 0 00S MA P 4. ALL SEWER PIPE SHALL BE SCHEDULE40 OR m •� Q�'g 0 DESIGN PERC RATE 5 M1N/INCH APPROVED EQUAL. V SOIL TEXTURAL CLASS - l S. BEFORE CONSTRUCTION CALL OlG SAFE ,/� CHERRY eusH N � . PRO ED WELL 1-600-322-4644 AND THE LOCAL WATER DEPT. ' 1 , f CHERRY$Uses wr '.r.t'►.F'�r''^' x v 0 °^a+I-+r 4, e4*Mf OF UNDERGROUND UTILITIES. / FOR LOCATION t BURNINo BUSH /N 3 BLUE $P ":' - PROVIDEd: 2-500 GAL LE_,4Ch, /r~ IAMBERS LIP ? •.. i CHERRY BUSK 6. VERTICAL DATUM IS. ASSUMED JIN BLu SPRUCE ' /'" W/4 ' STONE AROUND A-47I S F.- IOU. - , ti 7• FOR BENCH MARKS SET. <SEE SITE PLAN. A. I -_ 6IN BLUE SPRUCE .1Of SOIL TES T P I T DA TA BENCH MA TOP C 6 --- .1''R 6/N BLUE SPRUCE/ INDICATES INDICATES s .�_PERCOLATION _ OBSERVED TEST- = GROUNDWATER BUR i 0 BUSH/ / q TP 2 P GRND EL GRND EL.O,p/Yf N/A G.W.EC N/A • _ BURNING BUSH , • _-- ORIZON TEXTURE -COLOR OTHER HORIZON TEXTURE ` COLOR OTHER CHERRY Buses by+y / « •� LOAMY l r � �� 'LOAMY lOYR IOYR A SAND 3/2 LOT , 8 SAND 3/2 43787 S.F. :i o LOAMY LOAMY _lOYR IOYR � ,/ 1N APPLE `. /'• B B ; .. .. .,} HAS BEEN MADE AS TO ` / / ` $ SAND 516 SAND 5/8 8. NO DETERMINATION � . _ e p, y' _ �. / _ - . COMPLIANCE WITH DEED RESTRICTIONS OR ZONING / � � $ v sl,� APPLE .. .. 36 .:..,.......,...............,....:...... ......• 97.0 30 96.0 REGULATIONS. IT SHALL REMAIN THE CLIENTS , r m MED-COARSE IOYR GRAVEL MEDIUM fOYR GOBBLES / // �. C i ' '� •' rr z // SAND 6/6 SAND 6/6 RESPONSIBILITY TO OBTAIN ALL PERMITS. SPECIAL / c, TP#2 ./ 60. PERMITS. VARIANCES ETC. FOR THIS PROJECT. 9. IT SHALL REMAIN THE CL I ENT'S RESPONSIBILITY :y LEACHING CHAMBERS �. 0 HAVE THE PROPOSED BUILDING FOUNDATION / r• W14 STONE , �arN APPLE / ��.� 6IN APPLE DESIGNED TO ACCOUNT FOR THE EXISTING GRADE ID-BOX / . THE O 'O / �� x JIN APPL.. AND SOIL CONDITIONS AT THE L OCA T l N F .. 1500 QAL 4' N APPLE PROPOSED BUILDING. . __-----,, �� SEPTIC TANK VACANTYIN APPLE. / ' ' ` f- 6I N APPLE / / NO WA TER NO WATER 87 5 l 0. ALL UNSUITABLE MA TER I AL (A c4 B HOR I ZONS) .� TP l; ! %-) ,44 �• 120 90.`0 132 ENCOUNTERED BELOW THE INVERT OF THE LEACHING -_ .� , .� EBRUARY 4. 1997 1 FACILITY TO BE REMOVED FOR A DISTANCE OF 5 F � / ! ; , � DATE.:. AROUND AND REPLACED WITH SAND IN ACCORDANCE STEPHEN HAAS - � , ,,-� , a , � TEST B Y WITH TITLE 5. I �` / 1 \ .o, �...... •� 'r ;� WI TNESSED BY: JERRY DUNNING - f 3 ..µ - i �� % f ', .<• , i � i \tip �� x t ► ' ; PERC RATE: ! 2 MIN/INCH 'ate C a1 j,, ,. t _ ;• ,. h ",1/N APPLE / / / % .r L R° �_� WHITE PINE f4w ^ • �. ..� :. a�,..._,,_ ., -- . • / L 0 T 8 OA /< S TREE T r EF S T Al RRER/4 RED FOR ; VACANT ACCESS COVERS MUST BE WITHIN �, 5 As E v 9 .MINIMUM. .` : / i i :. ti 0 ��' " 6' OF FINISH GRADE 100.5 3' MAXIMUM COVER FIRST 2• TO / -4 EGRET COUR 7- . "ASHREE . "A . 02649 BE LEVEL MIN • OF PEASTONE :�. SCALE / " —` 30 FEBRUAR 4- PVC I i i f/ f - � � �• 3/4' = 11/2 DIA. i i i i 4 SCHEDULE 40 i i / i -a WASHED STONE L�"'.�4 GL .E' S'�.R VE'Y.I .IV G 13i .�'NG I N�''.�'R I NG . I NC . .... -GAS • , , , , , BAFFLE , 2-500 yGAL LEACHING CHAMBERS , , / . �2 3 .R'O U 1 fP �' W/4 STONE AROUND, 12.B,x 25 ,/ < . OUTLET: �s Yar In t,< rh or 10: MIN. D-BOX z 1500 / GAL / / 5'0rt. ... ' SEPTIC TANK 6 CRUSHED STONE / O SCALE 0 . . , PROF l L E NOT CALL. SAH/CFW CHECK. eFW =DRN: SAH'JOB N0. 97-203 FIELD. CFW/PDR ' -0 15 3+1 60 S