The URL can be used to link to this page

Home My WebLink About1547 SERVICE ROAD - Health 1547 Service Road West Barnstable A = 174—004- 002 n 1 O. Y ' I TOWN OF B STABLE ,t?CA l'lON 7 �IU C SEWAGE # JTLLAGE W. ASSESSOR'S MAP&LOT NSTALLER'S NAME PHONE NO. �I ;EMC TANK CAPACITY ,EACHE,4G,FA.(-4IL1W: (tyre) 701 f' (sine) ' /000 ya. 40.OF'BEDROOMS 7 t MILDER OR OWNER, a 'El aTI)A'TE: ro rLI.ANCE DATE, !i separation Distance Between the: 4 vlaximum Adjusted Groundwater Table to the Bot;cm of Leaching Facility eet t, 'hale Water Supply Well and Leaching Facility (if any wells exist on site or within 200 feet of leaching facility)`! I :�get;8 idge of Wedand and Leaching Facility(if any wetlands exist 11 within 300 feet f leacwng.facility) �� T Peet luraished by � 114—�lrvY�,�,per --,Oe .D C ® � D 0 -0- 33`it WOO jB 3 B(IDV i `,-row ow vt Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 1547 Service Rd Property Address Fannie Mae Owner Owner's Name information is required for West Barnstable MA 02668 3-23-09 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form.Inspection forms may not be altered in any way. A. General Information . 1. Inspector: `� �D s Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name 29 Atwater Dr Company Address E. Falmouth MA 02536 City/Town State Zip Code 508-495-0905 S13971 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 valuation by the Local Approving Authority 3-23-09 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system 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. Recommend pumping septic tank to remove solids now and every 2yrs for maintena e. l/ t5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 i r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments `CwM 1547 Service Rd Property Address Fannie Mae Owner Owner's Name information is required for West Barnstable MA 02668 3-23-09 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: System is in good working order with no sign of failure. 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. ❑ 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: ❑ 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 u t5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments y` 1547 Service Rd Property Address Fannie Mae Owner Owner's Name information is required for West Barnstable MA 02668 3-23-09 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ 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: 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 mannerwhich 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 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. t5insp official document•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 } 1 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1547 Service Rd Property Address Fannie Mae Owner Owner's Name information is required for West Barnstable MA 02668 3-23-09 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or 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 El ® 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. t5ins6 official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 1547 Service Rd Property Address Fannie Mae Owner Owner's Name information is required for West Barnstable MA 02668 3-23-09 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) : D) System Failure Criteria Applicable to All Systems (cont.): Yes 'No" ❑ ® 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 CM 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 1,0,000 gpd to 15,000 gpd. For large systems, you must indicate either`yes"or"non 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 ❑1 ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone 11 of a public water supply well 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. t5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 1547 Service Rd Property Address Fannie Mae Owner Owner's Name information is required for West Barnstable MA 02668 3-23-09 _ every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes"or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? y ns ection. ® ❑ 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 Y sewage disposal systems? P 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 CM 15.302(5)] t5insp official document•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1547 Service Rd Property Address Fannie Mae Owner Owner's Name information is required for West Barnstable MA 02668 3-23-09 every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x #of bedrooms): 440 Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d Well water 9 ( Y 9 (gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: 12-08 Date Commercial/industrial Flow Conditions: Type of Establishment: : .Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary.waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): t5insp official document-03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 15 I Commonwealth of Massachusetts W Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 1547 Service Rd Property Address Fannie Mae Owner Owner's Name information is required for West Barnstable MA 02668 3-23-09 every page. City/Town State Zip Code Date of Inspection. D. System Information (cont.) General Information Pumping Records: Source of information: N/A Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 1989 Were sewage odors detected when arriving at the site? ❑ Yes ® No t5insp official document-03/08 Title 5 Official Inspecbon Form:Subsurface Sewage Disposal System•Page 8 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form =Not for Voluntary Assessments M 1547 Service Rd Property Address Fannie Mae Owner Owner's Name informatics is required for West Barnstable MA 02668 3-23=09 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 12 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints,venting, evidence of leakage, etc.): Good condition. Septic Tank(locate on site plan): 6" 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 Gal Sludge depth: 16" Distance from top of sludge to bottom of outlet tee or baffle 16" 2" Scum thickness Distance from top of scum to top of outlet tee or baffle 5" Distance from bottom of scum to bottom of outlet tee or baffle 15" How were dimensions determined? Tape t5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 i Commonwealth of Massachusetts w W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments �M 1547 Service Rd Property Address Fannie Mae Owner Owner's Name information is required for West Barnstable MA 02668 3-23-09 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, in and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): H-20 septic tank in good condition with baffles installed and no sign of leakage. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other (explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: a ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): t5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts E Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 1547 Service Rd Property Address Fannie Mae Owner Owner's Name requiratifo is West Barnstable MA 02668 3-23-09 required for every page. City/Town State Zip Code Date of Inspection D. System Information cont. Y (cont.) t Tight or Holding Tank(cont.) 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 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.): Good condition. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes , ❑ No Alarms in working order: ❑ Yes ❑ No t5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 15 y Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1547 Service Rd Property Address Fannie Mae Owner Owner's Name information is required for West Barnstable MA 02668 3-23-09 every page. -City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: ❑ leaching chambers number: ❑ 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.): Pit F: Cover at 24" below grade. Stain line at 12"below top of pit. Pit G: Cover at 12" below grade. Stain line at 36"below top of pit. t5insp official document-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 15 I 1 Commonwealth of Massachusetts f Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 1547 Service Rd Property Address Fannie Mae Owner Owner's Name information is requires for West Barnstable MA 02668 3-23-09 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth —top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp oFicial document•03/08 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of Massachusetts . 4 u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1547 Service Rd 4�M Property Address Fannie Mae. Owner Owner's Name information is West Barnstable MA 02668 3-23-09 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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. C {`c e Cove,- f4 e , D L - , r;are ` A_-E'-39 r � 3r4�,. t5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1547 Service Rd Property Address Fannie Mae Owner Owner's Name information is required for West Barnstable MA 02668 3-23-09 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: 20' I' feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: ® Checked with local excavators, installers-(attach documentation) ® Accessed USGS database- explain: You must describe how you established the high ground water elevation: USGS maps show groundwater at greater than 20'. t5insp official document-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 F BARNSTABLE L°0CATION 6d W L1 SEWAGE # er i VILLAGE ASSESSOR'S MAP & LOT/7 do/-d®3 .� STALLER'S NAME & PHONE NO.)S—&2*WW CVAIs%_ '7 7/ SEPTIC TANK CAPACITY I'LEACHING FACILITY:(type) (size) OF BEDROOMS <'RIVATE WELL O PUBLIC WATER � ILDER OR OWNER QA':'E PERMIT ISSUED: , ' /.DATE COLII'T IANCE ISSUED: VARIANCE GRANTED: Yes Y.� l � � �� ,. � . � ,, .� e � ;D � ~ � � ��,� �/ � � � .��_. ,c�� •� _ �, ,� _ �. r THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....... . ..............OF..... _ ......».......... ,��irtt�i�utt �v� �liu�uuttl �[Gll�u.rlau C�utts��tur�iutt rrutit Application is hereby made for a Permit to Construct ( ) or.'Repair ( ) an Individual Sewage Disposal System at: Location- •owner / L... -��.�..... :.....». CT�f Address «. .... ._.......««............... ....... ........................................... Inrteller Addre�� 9 Type of Building / ��jZE.S q Size Lot...`.........................S feet Dwelling—No. of Bedrooms...... ..............................�. Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building a -•--....................... No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ............................................. ............................................... ........................... Design Flow............. :......... «.. .gallons per person r day. Total tl flow...!5-;2 ..................................ga1Ion.. .. y �0 s. Septic Tank—Li uid ca acit � Width.....—`.L?..... Diameter................ llepth-...'.0�.. x Disposal Trench 9 No................. Width. .............. Total Length.... .......... Total leaching area. .s 3 Seepage Pit No......1,�. ... Diameter.....IQ........ Depth below inlet..��.............. 'Total leaching area �'?v.sq. it. ,►ta Other Distribution box ( ) Dosing �` ) Percolation Test Results Performed b ..../.. 5 �� y..... .. ............. r 1 Test Pit No. ]............minutes per inch Depth of Test P ..L44, Depth to ground water... 4 .. ..... Test Pit No. 2«—�..:yy...........minutes per inch Depth of Test ,Pit.................... Depth to ground water................ Description of Soil.�: ..". g- <C.......��.�..�.L . ....«.._ ....... zip ............. _.................. v !; _..............«......: f. �i :Sa./ f...`t8:l�tr��.. ! 45.... 5 �.....��"3�.I��S: J........... w . .................................. VNature of Repairs or Alterations—Answer when applicable................................................................ .....».. « ..«........................................................................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code= The undersigned further agrees not to place the system in operation until a Certificate of Compliance has beep ' s ed by t bo of health. Signed... ... __...... _._. Application Approved B .. «.................... ..1.1•4ate....... .. .... y .j�.. ... ....................... ........1pl.......,?„ r... . .« Application Disapproved for the following reasons:................................................. D,te .................................«................................................................................. .............---- Date Permit No..._ .:.�.7.. ..._..........«. Issued«............... ..............«........»....«_ Date i e I +T THE COMMONWEALTH OF MASSACHUSETTS BOARD OF ; EALTH f AVVIIrtiliuit for Iliupuuttl Worlto Clio tts lrurliutt Verutil Application is hereby made for a Permit to Construct ( ) or. Repair ( ) an Individual Sewage Disposal System at: «»..»._».» .�� . ...lion••A•dr• »..»..._«»... »... .»..�..��..».�.t.�.�'�it�-'�.•'.... .... •Owner ............_«« r ... .��: 2...... .».......__...._..................... Addreaa............................_............. _ c—� Type of BuildingAddr � Size L Lot.. . ...��..,;__,1 � ', feet aDwelling—No. of Bedrooms........... ...............................Expansion Attic ( ) Garbage Grinder ( ) p, Other—Type of Building No. of persons............................ Showers ( ) Cafeteria ( ) a' Other fix9i: � ................................................. Design Flow................................ .. ... allonseCersori __..................... ........ ... ...........e........ ........................ ........ ../.=g P p . W-bay. Total daily flow........5;4,2_�........................gallons. W Septic Tank—Liquid'ttpacity............gallons Length. ............. Width....4.-/.. Diameter................ x Disposal Trench—Nd, 2...._._....... Width. Length...... ....... lleptl�...�^.�..4 . TotalTotal leaching area....................sq. it. 3 Seepage Pit No..........:.......... Diameter.................... Depth below inlet..... ...-...--. Total leaching area.,_ rt: q• ft. Z Other Distribution box ( ) Dosingadc� Percolation Test Results* Performed by....... " r! ,�i................/ � Date... ? fy -.. ....... ... y . Test Pit No. 'I................minutes per inch Depth of Test PiLl......1.44 Depth to ground water......1:4 . Test Pit No. 2 minute inch Depth of Test Pit.................... Depth to ground ........ �C%.--.. •�� ••� water .... O Description of .� .� fly ........................... .�.�................. p Y...... S:� -;r:.`•--�'•.�'f' Y ....�.....l......................r�-.s?.�C .... 1 f/�....... V _...................................................... y.. '..1'� `::..... .cl!�• �rltl-5... j••f••..�j s; ............................ ................:............................................................................ ................................................/�f....D ............................ Cj Nature of Repairs or,Alterations--Answer when-app 1ic�tble.-•.Y•-•.-•-•--•••-•-••--•-......•.•••.,.•-••_•_-••-„......•.•..•.....•...-..•••... _-_.••.._ •III• ..._..... Agreement: The undersigned agrees to install the aforedescribl d individual Sewage Disposal System in accordance with the provisions of TITLF. 5 of the State Sanitary Code -- The undersigned further agrees not to place the system in operation until a Certificate.of Compliance has been issueii2thecard of health. Signed..... .................... ...Application Approved By. .... ............_.._•__-•_. Application Disapproved for the f of owing reasons:.......... ............... _.................................. .................... ..................._....... .......................................................................................... .....__ Date PermitNo... ... � j.......... ..._. Issued..._...-.................._................__...._ Date THE COMMONWEALTH OF MASSACHUSETTS 130ARD 0 HEALTH ............ OF t . ..................................... QUprtif irtil.e of ftutplittitre by....THIS IS TO CERTIFY, That the Individual Sew. ge Disposal System constructed (1)_14 or Repaired ( ) .......................•.._.�.................._.....:......_.............f.�...�. ..i�s� .. at.........../. Q1-_-_..... ........A.4.L_,��'..?,5.....:IrQ?C. �....�' . �.. a� .......................................___...._ ll has been installed in accordance with the provisions of TITIZ 5 of T he State Sanitary Code as described in the application for Disposal Works Construction Permit No.... '/71::P..........••••.• dated......................:.................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........«...... ��.:�f ........S ................_..:............ �... Inspector............. ............................... THE COMMONWEALTH OF MASSACHUSETTS le / �L BOARD OF HEALTH No. c.:1. SP.. .......`-1...... ..........OF..........i!. c4?z` - (!( r(':...:.......................... Fu...2 ....._.. Diu�lluttl Wuxltu Till tulrurliuit pfrutif Permission is hereby granted........ ........ l ................................................................._«.. to Construct or Repair ( ) an IndividoVw Sewage Disposal System at No.........L S'...._.. ..:..... ...c G a-ts�.......�� ........__W_ .:..... �??�+ j...►�^tea .................... !itreet as shown on the application for Disposal Works Construction Permit NA / .. Dated.............. V _..�.�.....:..... Board of DATE......................... ./. ?..t.�.. ...................._...... Health FORM 12'85 NORDS & WARREN. INC.. PUBLIONERS �lliiltitlilittt'3tiii(titii11iti iiftfiitiii(ililtititifitttiumilil(ti tiiifilit;fiititititiititittiiiiitititiitiiFllf, ENVIROTECH LABORATORIES 66 Lewis Bay Road • Massachusetts 02601 (617)•,771-7265 - s= o CLIENT: Bayberry Homes LOCATION: Lot #4 Access Rd E ADDRESS:. 3821 I?t 28 Bldg —C W. Barnstable,!14A Marstons Mills,MI A 02648 COLLECTED BY: >~T• Kapo i s SAMPLE DATE: 114946 ce TIME: 11. 30 All DATE RECEIVED: 1 /R6SAMPLE ID:E- 3A JOB # New Well. WELL DEPTH: 3 F RESULTS OF ANALYSIS: Parameter Units Recommended limit Result Coliform bacteria/100 ml (MF Method) 0 0 - H P H units 6.0-8.5 6. 4 0 c p � Conductance umhos/cm 500 78 Sodium - mg/L 20.0 11. 1 _ �x Nitrate-N mg/L 10.0 Less than . 02 F3 Iron mg/L 0.3 .22 _» C Manganese mg/L 0.05 w EE Hardness mg/L as CaCO 3 500 z Sulfate mg/L 250 Potassium mg/L 20.0 Alkalinity mg/L ' 200EE =� _ :Chloride mg/L 250 fr COMMENT: Water is. suitable ,foT drinking purposes for_ all pararleters tested. c DATE 1 +!}u:tslstttitilstutiiitiiiti#slibssissslt#1It##i#!##ttsi!#11 st ::s::::::,:,:•::,::•:, :: ::::,:::•:: :::s::i: >; # iii#isssstsisiti:stsotslstusssussustssssu::ssiiiiii:su:sssstu:usulusssilu#ssiltsssssusiutsssisttussssu#i:tlsusssstissssssslssisltIissisullss#sssssu:sssuatLb' Massachusetts Water Resources Commission/Division of Water Resources " WATER WELL COMPLETION REPORT WELL LOCATION Address City/Town / G.S.Quadrangle Map . .....-,._ Grid Location Owner -� Address LLUSE CONSOLIDATED WELL Domestic Public ❑ Industrial ❑ Type of Water-bearing Rock Other Water-bearing Zones METHOD DRILLED 1) From " To Rotary(type)1ie4& Cable ❑ 2) From =To Other 3) From To 4) FFrr m To CASING Depti�o Bedrock Length•Zd S Diameter Type UNCONSOLIDATED WELL STATIC WATER LEVEL Water-bearing Materials Feet below land surface ltd® Sand: fine❑ medium Er`coarse Date measured Gravel: fine❑ medium❑ coarse❑ Screen: GRAVEL PACK WELL r/ / Slot#�length�from� to� Yes ❑ No Split Screen(or 2nd screen) WATER QUALITY TESTS MADE Slot# length from to Chemical ❑ Biological Depth To Bedrock PUMP TEST Drawdown feet after pumping day. hours at GPM. How measured Recovery - feet after hours. LOG of FORMATIONS COMMENTS: (On well or water) Materials From To O)ry Cep e �� o. s DRILLERCb ireti AddressA2 !'start S'(w City f ylLr` n)2 i. W,;-4A5_C Registration No. T✓l ' Q .f erator s ignature Please pant irm y _ 10M-8/81.184843 i Massachusetts Water Resources Commission/Mvision of Water Resources WATER WELL COMPLETION REPORT WELL LOCATION Address City/Town G.S.Quadrangle Map Grid Location Owner Address WELL USE CONSOLIDATED WELL Domestic❑ Public ❑ Industrial ❑ Type of Water-bearing Rock Other Water-bearing Zones METHOD DRILLED 1) From To Rotary(type) Cable ❑ 2) From To Other 3) From To 4) From To CASING Depth to Bedrock Length Diameter Type UNCONSOLIDATED WELL STATIC WATER LEVEL Water-bearing'Materials Feet below land surface Sand: fine❑ medium❑ coarse❑ Date measured Gravel: fine❑ medium❑ coarse❑ Screen: GRAVEL PACK WELL Slot# length from to Yes ❑ No ❑ Split Screen (or 2nd screen) i WATER QUALITY TESTS MADE Slot# length from tc Chemical ❑ Biological ❑ Depth To Bedrock PUMP TEST Drawdown feet after pumping days hours at GPM. How measured Recovery feet after hours. LOG of FORMATIONS COMMENTS: (On well or water) Materials From To 0 m DRILLER y m Firm Address ` City Registration No. Aerators Signature Please print firmly 10M-8181.164843 TOW OF BARN TA E d`- C-OCATION Zo-7- f `T d SEWAGE # VILLAGES _ A SESSO S MAP & LOT INSTALLER'S NAME PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) ,/ . �. , ' `- (size) c NO. OF BEDROOMS P OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: --f+ -� DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No ' ; � I ; .. {• 1. .• �^ ..i-�� is .` � . � �. .. �',• I SEWAGE SYSTEM PROFILE & DETAILS Q Q TOP FOUNDATION a67.5 el. top stone 45.0 r raised anchl SF.F.= 72.5 S FINISH GRADE- 63.0 FINISH GRADE 59.0 FINISH GRADE 58.0 FINISH GRADE 56.0 6 1 Y OVER TANK- OVER D BOX- OVER LEACH PIT- �40 /_ _ /= CLEAN BACKFILL ill , slab 64.0 4" min. air space \ conc.covers and risers to within III "PEASTONE 12" of finished grade. -- -- - -- Ill 10"TEE c ` Eom 58.0 56.0 + 14 TEE .• 000000000000�. Ill I 55.8 klSnNc DRY •� 3" 4'0" 55.75 0 I I0000000000001 40 Ay LIQUID DISTRIBUTION " I J 62 EggEMENT LEVEL BOX -I� z4 I0000000000001 2Z4 \1 1500 GALLON iSEPTIC TANK \l o IOOOOOOOOO000 o rI1 in -SET LEVEL---' Ill o I0000000000001 w i I0000000000001 I�l rn ®pre . BOTTOM 37.5 0000000000001 3 �% �O4s teat OF PIT I�l s 40 NOTE: BREAK OUT CALCULATION ° a ►� USE 2/6' DEEP LEACHING PiTS. L O T 4 60/15 x 150 = 37.5 top of stone is to 'be kept 52.0 ous tests 1 . 6 3 a C. . ^ below elevation 4`r.0 to NOTE:Pipe shall dot d 1/31i/r 86 were �? CV prevent BREAK-OUT enter riser at elavation 52.0 (not into pit as shown.) excavated below elev. 26.0 " The conclusion is that lot 3 there is no high ground DESIGN CRITERIA water problem with this lot. NUMBER OF 'BEDROOMS 4 SOILS LOGS a { P M 2 _ .av / �• / 40 PERSONSER BEDROOM 73.0 lot 5 DAILY �LOL'J PER ,�E..cnni 55 oaf _ - - 0' 64.0 0 w - ' LEACHING REQUIRED a'-30" 2 883 gpd top-subsoll to -aubsoil --- re• LEACHING PROVIDED 883.9 gpd P'" p•- 36 1� e. 3 CALCULATIONS 48 L63.0 'N `� r j 2(.785x100x.83) 130.3 coarse sand coarse sand -� 42,27• 1 N BOTTOM _ 3.14 D K _ 2(3.14x1ox6x2)-753.s � 50 SIDE - 3.14DHK - 883.9 gpd GALLONS PER DAY = with boulders with boulders o rvis 50.0 - _ _ N aro6 64 o ch o f. .a 72.5 Rj , 70 50.0 N `60 6 . $wore �9.0 GENERAL NOTES 52.0 61.0 no h20 found no H2O found 1° 1. ALL ELEVA11ONS SHOWN ARE PERCOLATION RATE _ 4 MIN./INCH MEAN SEA LEVEL. rn 2. ALL PIPES IN THE SYSTEM TO BE OBSERVATIONS BY: .-Lgr$unnina 2 MASHPEE BOARD OF HEALTH CAST IRON OR SCHEDULE 40 P.W.C. DATE TESTED: 3/8/88 3. REMOVE ALL UNSUITABLE MATERIAL 80 BENEATH THE INVERT ELEVATION FOR A RADIUS OF 10' AND BACKFILL ---- W/ CLEAN COARSE GRANULAR MiATERIAL. 4. ALL CAPE SURVEY CONSULTANT - MUST BE NOTIFIED WHEN THE APPLICANT: ROBERT SMITH SYSTEM IS PRIOR /� ` �_--- -- _ • BACKFlLUNGNSTALLED FOR INSPECTION.TO , PROPOSED DWELLING LOCATION 5. UNLESS OTHERWISE NOTED ALL - SYSTEM COMPONENTS SHALL BE PROPOSED SEWAGE SYSTEM LOCATION INSTALLED IN ACCORDANCE WiTHI MASSACHUSETTS TITLE V SANITARY SEWER CODE AND LOCAL RULES y ,-WHICH MAY BE APPLICABLE. LOT 4 ACCESS ROAD 90 80 6. THIS LOT IS NOT IN THE FLOOD PLAIN. 7, A GARBAGE GRINDER WILL NOT BE INSTALLEI?.,oN-,TFiE SYSTEM. WEST BARNSTABLE, MASS. 'S3'20"W SS '19'00"W SCALE: - - 40 DATE: 3/24/88 DWG. NO.: smit153 82.1 LEGEND 71.8 R o CHECKED BY: jj JOB NO.: so t; yia 1 ` � 14 U. sr N DRAWN BY:cc PROP. SPOT ELEV. _ EXIST. SPOT ELEV. _ L c , W `._ j,��;�y \. uR��-y° ALL CAPE SURVEY CONSULTANT PROP. CONTOUR = ROUTE 28 SUITE 301 SUMMERFIELD PARK - MASHPEE, MASS. EXIST. CONTOUR - -