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HomeMy WebLinkAbout0015 SHEEP MEADOW ROAD - Health 15 SHEEP MEADOW • West Bamstable `- ' • • r �^ No. Fee THk COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes AppliLatlon for Disposal 6pstrm Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System Individual Components Location Address or Lot No. t�5A G�� w er's N�edr��s,and TeL No. r, ` Assessor's Map/Parcel Inst llerVagie,A ss,and Tel.No. Designer's Name,Address,and Tel.No. 6 Yc S Type of Building: Dwelling No.of Bedrooms ,� Lot Size sq.ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank eX C�Y Type of S.A.S. U X Pt �S Description of Soil Nature of Repairs or Alterations(Answer when applicable) �)n Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. gne Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. Date Issued " f No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Tipplitatlon for Disposal *pstem Construction permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) 'Abandon( ) ❑Complete System Individual Components Location Address or Lot No. S 5 pems•Tj Rw�erp's NameyAddre s and Tel.No. Assessor's Map/Parcel. `C�)11 0 dal Installer's HNa e,Address,and Tel.,No. Designer's Name,Address,and Tel.No. Sc� yc-r r-,"Oh" S 'Type of Building: Lot Size s Grinder . Dwelling No.of Bedrooms �3, q.ft. Garbage g P? Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title i Size of Septic Tank X�S S�V Type of S.A.S. :2 u K Description of Soil '1 Nature of Repairs or Alterations(Answer when applicable) p p �Lp Q.K t,J �Q Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. gne , Date // 7 Application Approved by )/IRA Date / Application Disapproved by Date for the following reasons Permit No. �r Date Issued i t �. THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliante THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired Upgraded( ) Abandoned( )by ��� �rt x at d W° ias been constructed in accord i ce e- d with the provisions of Title 5 and the for Disposal System Construction Permit No. ated Installer I SC�"�\ �Cc,�•y` Designer J 4 bedrooms Approved*'sign w gpd The issuance of this permits/ 1 not e c strued as a guarantee that the system w fimc t si 'ed. Date Inspector _4es U ff �- ------------------ ------- --------------------------------------------------------------- — - 4� No. / Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS ]Disposal :FPpst M �(ConstrUction Vermit Fermission is hereby granted to Construct( ) Repair Upgrade( ) Abandon( ) System located at S(n¢_.0 c 1) L`1 G a,rt\ and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Constructio ust b co m eted within three years of the date of this permit Date Approved by gs un 02'1409:48p Commonwealth of Massachusetts Title 5 Official Inspection Forma UVSubsurface Sewage Disposal System Form-Not for Voluntary Assessments 15 Sheep Meadow Road Property Address Neal Zall Ownerati Owneta.Name ,req�uuedd for eve West Barnstable MA 02668 5-30-14 � page. every CihdTawn State Zip Code Date of Inspection Inspection results must be submdted on this forth. Inspection forms may.not be altered in any way.Please see completeness checklist at the-end of the forth. �n�form n A. General information on the computer, `a`.��� tH OF A ,use only the tab key to move your 1• Inspector. cunw alum James D.Sears fi _ JAMES. use Name of Inspector. _o: ;y a key. CapeewideEnterprises,LLC o o m/f! Company Name ems;y`'dry i i r •'.� � 153 Commercial.Street �!�ug ,SP,EG```0 Company Address Mashpee MA 02649 CitpRown state Zip Code 50847.7-8877 S1623 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 15A00).The system: 9 ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority d� 5-30-14 rs signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DER)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 DER 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 condition of use. 9%m-3M.3 Tm 5 ofll m frnpecoo"FWn stbsudme Se+sepe oispoeel Sydem•Pape 1 of 17. L Jun 0214,09:49p p.2 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Foam-Not for Voluntary Assessments 15 Sheep Meadow Road propeny Address Neat Zall InkanOwner Neal Name require for is West Barnstable MA 02668 5.30-14 required for every page. Crtyrrown state Zip Code Date of inspedion B. Certification(wont.) 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 15.304 exist.Any failure criteria not evaluated are. indicated below. Comments: Failed Leaching 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", °ncr 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 exfittrabon 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 stnrcturally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than20 years old is available. ❑ Y N ❑ ND(Explain below): sins.3013 Title s 011reir Yapedlen fam:subsuif oe Dkp=0 3YHM•POP 2 a lr Jun 021409:49p ! p.3 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 15 Sheep Meadow Road Property AMMSS Neal Zan ovew Owners Name r isrequI West Barnstable MA 02668 5-30-14 ed forevefy mylr'own state Zip Code Date;oifrapection B. Certification (cont.) ❑ Pump Chamber pumps/slarms not operational System will pass with Board of Health approval if pumpsialarms are repaired. B) System Conditionally Passes(cunt): ❑ 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 beiowy ❑ 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): r C Further Evaluation is Required the Board of Health: �l b y ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is fading to protect public health.safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CUR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑i Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or salt marsh twig•3113 Tius 5 OlAtul Inpetflon Fomr.Suha zOm Swnpe OlspoW System•Pape 3 C117 Jun 021409:49p pA Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 15 Sheep Meadow Road Property Address Neal Zall Owner Owners flame information is for every West Samstable MA 02668 5-30-14 CityRown page. State Zip Code Date of Inspedlon B. Cerdfcadon (cunt.) 2. System will fall unless the Board of Health(and Public Water Supplier,if any) determines that the system is functioning in a Hamner 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 Jess 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,far 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 NO form. 3. Other. 0) System Failure Criteria Applicable to All Systems: You musundicate"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 dogged 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 ert<pooel is less than 6"below invert or available volume is less than'/:day flow MW•3M3 Tiro 5 Mid loon tam:Sti nuftw 3w ape 00poW Systsn-Page a d V f Jun 0214 09:50p p,5 Commonwealth of Massachusetts tipTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 15 Sheep Meadow Road Properly Address Neal Zall 0WMr owners Name . information is required for everyWest Bamstable MA 02666. 5=30-14 page. Citynown state Zip Code Dale.of tnspedion. B. Certification (cunt) Yes No 0 0 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 colifonn 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 Urge system.#w system must serve:a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems,you must indicate either myese or'non to each of the following,in addition to the questions In Section D. Yes No Cl ❑ the system is within 400 feet of a surface drir*ing water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinidng;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 ayes'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 eontact.the appropriate regional office of the Department. f**-3M3 Title 5 OUN Mapeetlea FUM"MOM Sewage QWPW.Syelsm-PW 5 d 17 a . Jun 0214 09:50p p.6 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 15 Sheep Meadow Road — Propedy Address Neal Zall per Owners Name req uired ation is required for every West Barnstable MA 02668 5-30-14 page. C Yrrown 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 owns occupant,.or Board of Health ❑ ® Were anyy 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 f 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) 0 ❑ Was the facility or dwelling.inspected for signs of sewage back up? 0 ❑ 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); NA Number of bedrooms(actual): 3 u DESIGN flow.based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 L9na-3r a Ties 5 OWW far,""room Swaps D oaW 1bd P"p 8 d 17 Jun 021409:50p p•7 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 15 Sheep Meadow Road. Property Addrm Neal Zall 0W= owner's Name tutor'is West Barnstable MA 02668 5-30-14 regtared for every page. Cityfrown state Zip Code Data of Inspection D. System Information Description: The system is a 1500 Gal.tank D Box and two pits. _ 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 CD No information in this report) Laundry-system inspected? ❑ Yes 0 No Seasonal use? ❑ Yes ® No Water meter readings, if available(Last 2 years usage(gpd)): Well Water Detail: Sump pump? ❑ Yes ® No Last date of occupancy: PresentDate Commerciallbtdustrhd flow Condition. Type of Establishment Design flow(based on 310 CMR 15203): 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 Ihs Tide 5 system? ❑ Yes ❑ No Water meter readings,if avalla 3le. Isns-W - Tft 5 0l W WMMW FOU Semabw Swabs l>bpNd SFAM-Pipe 7 ar17 Jun 0214 09:51 p p.8 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 15 Sheep_Meadow Road P►operty Address —— Neal Zall Owner Owners Name wdca=ton isrequired West Barnstable MA 02688 5-30-14 for every Myrrom State Zip Code Date of lnspeotion D. System Information (cons.) Last date of occupancy/use: Date Other(descriibe below): General Information Pumping Records: Source of information: NA Was system pumped as part of the inspection? ❑ Yes 0 No If yes, volume pumped: gave How was quantity pumped determined? Reason for pumping: Type of.System: ®i Septic tank,distribution box,soil absorption system ❑ Single cesspool Q Overflow cesspool Di Privy Q 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 UA system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval Cl Other(describe): Ma•3n3 Title 5 o(ridd insped on ram:&6=fm sompe Dapma Wwn-Pape a 4 IT Jun 021'4 09:51 p p.9 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 15 Sheep Meadow Road Prperty Mdraw Neal Zall Owner Ownees Name Wormation is requlred for every West Barnstable MA 02668 5.30-14 page. Cdylrown State zip Code Date of inspection D. System information (cont.) Approximate age of all components,date installed(if known)and source of Information: 1988 Permit#88-256. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: r feet Material of construction: ❑cast iron B 40 PVC ❑other(explain): Distance from private water supply well or suction line: feet Comments(on condom of joints,venting,evidence of leakage,etc.): Pipeing is 4'PVC SCH 40. Septic Tank(locate on site plan).- Depth below grade., 1 feet Material of construction: 9 concrete ❑metal ❑fiberglass ❑polyethylene- ❑other(explain) If tank is metal, list age: YWI Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 GaLPrecast Sludge depth: w•3Jr3 TUbSOMWr<+spnk Fours os Saweps 0'a�,ont Srslem•Pepe ed 1 i I Jun 0214 09:51 P P.10 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 15 Sheep Meadow Road_ Property Address Neal Zall Owner Owners Nwne irrfor n is required rot every West Barnstable MA 02668 5-30-14 page. Gtyrrown State Zip code Date of inspecom D. System Information (cone:) Septic Tank(cunt.) Distance from 2W top of sludge to bottom of outlet tee or baffle Scum thickness (r Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 18" 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 outlet cover at Tbelow grade,wlinlet cover at grade. Inlet baffle, outlet tee. No sign of leakage or over loading in tank Grease Trap(locate on site plan): Depth below grade: Material of construction: []concrete ❑metal ❑fiberglass ❑polyethylene ❑other(explainy Dimensions: Sctun 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 ►=n•S+a T1b3OflkW1 ,F 6, F*=S~an Serape OWposd srstam•Pepe to of t 7 f Jun 0214 09:52p PA 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 15 Sheep Meadow Road Propedy Address Neal Zall Owner Owner's Name int Wred for a Wiest Barnstable MA 02668 5-30-14 Pap- d � CRY/Tom Stale Zip Code Date of Inspection �� D. System Information (coat) 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? El Yes ❑ No tSin•3J13 TWO 5 OftW W4000M FCM Subs wraoe SWMP 01SPWW Syslam•PaP 11 or 17 Jun 021409:52p p•12 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 15 Sheep Meadow Road Property Address Neal Zall owner Ownefs Name bftffnad011 is West Barnstable MA 02668 5-30- page. . �Y 44 requited for eMery frown state Zip Code Dale of Inspection D. System information (corn.) 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 is WxW-W below grade,w/two tines out.Wail's are gone on box. Pump Chamber(locate on site plan): Pumps in working order. ❑ Yes ❑ No' Alamo 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. CAro•3nz Tft 8 a9Wa bspaaW FWW gab ftW s.w0.0bPWd syaam•Pam,a 1301 n f Jun 0214 09:52p p.13 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 15 Sheep Meadow Road Properly Address Neal Zall Calmer Owners Name k °on isreq West Barnstable MA 02668 5-30-14 page. for r every COMM State Zip Code Date of leapecdon page. D. System Information (cunt.) Type: ® leaching p-ds number: 2 ❑ leaching chamfers number. ❑ teaching galleries number. ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number:' ❑ innovative/altemative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of pondi ng,damp soil,condition of vegetation,etc.) Leaching is two 4'precast pits,w/2'stone.Pit#1)44"below grade wicover at.14". T water w/stain line at 18". Pit#2)4.0"Below grade w/cover at Z. Pit full up Into rlsor. + `vim �• .S � `x;� 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 ''t9rts•�f13 V" _ Title 5 Olidel Fcnrc&rOasHoe 9sM9De System•Pape 13 of t T .f Jun 0214 09:53p p.14 CommonweaM of Massachusetts Title 5 Official Inspection Form Subsurface.Sewage Disposal System Form--Not for Voluntary Assessments 15 Sheep Meadow Road _ Property Address Neal Zall Owner Ownees.Name kfWnW/0n is West Barnstable MA 02668 5-30-14 Page. required!or every City/rown Steve Zip Code Date of inspection D. System Information (cunt:) Comments(note condition of soil,.signs of hydraulcc failure, level of ponding,condition of vegetation, eb--): Privy(locate on site plan): Materials of suction: Dimensions Depth of solids Comments.(note condition of sod,signs of hydraulic failure,level of ponding, condition of vegetation, etc.): 15&M-3n3 Tide 5 OAfdld Irapecaion Faro:Sub Swaspe 00poeel Sydem•Pepe 14 o117 f Jun 021409:53p p.15 Commonwealth of Massachusetts Titre 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary.Assessments 15 Sheep Meadow Road RoPeM Address Neal Zall Owmr Owner's Nerve information is West Barnstable MA 02668 5-30-14 required for every pY Page. C frown stale Zip Code Date of inspeodw D. System Information (cons) 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 wager supply enters the building.Check one of the boxes below. ® hand-sketch in the area below ❑ drawing attached separately 13-1 y .� A-a = 1-3 s'; A R B AR 13 de te V. -1/ 9 O �s tsmc•ana 7U 5 OMchd Famr.Subet aw Sewepe Dhpovd System•PuP 15 all? Jun 0214 09:53p p•16 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal.System Form-Not for Voluntary Assessments 15 Sheep Meadow Road Property Address Neal Zali Owner Owners Nsvne r efiDr every is Vilest Barnstable MA 02668 5-30-14 pap.required fo c4fr'own State Zip Code Date of Inspection pap. D. System Information (cunt.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wens 0 Estimated depth t4high ground water: Please indicate all methods used to determine the high ground water elevation: Obtained from system design plaits on record If checked,date of design plan reviewed: 3 25-88Date ❑ Observed site(abutting properrylobservation hole within 150 feet of SAS) ❑ Checked with local Board of Health explain: ❑ Checked with local excavators,installers-(attach documentation) ❑ Aocessed USGS database-expbin: You must describe how you established the high ground water elevation: T.H.on design plan 13'no G.K. Bottom of pit at 9'below grade. Bottom of pit at 4'above T.H_ depth Before fMng this Inspection Report,please see Report Completeness Checklist on next page. t9re-W113 TAs3 teed. Famc sws<.e.oe sew.pe sraesm•t m of t7 f Jun 0214 09:54p p.17 a Commonwealth of Masmchuseft Title 5 Official inspection Form Subsurface Sewage Disposal System.Form-Not for Voluntary Assessments 15 Sheep Meadow Road Pmpe ft Addm Neal Zell Owner Owners Name r0rmaum for isWest Barnstable MA 02668 5-W-14 �� every West State zp Code Dote of Inspection E. Report Completeness Checklist ® Inspection Summary:A, 8, C, D, or E checked Inspection Summary D(System Failure Criteria Applicable to A8 Systems)completed ® System lydormadon-Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15,or attached in separate file gm•W13 TM S Olf M Vgwc on Form SWbad as 3awape Glspaeai Snrore-Papa 1T vI ti S ` Commonwealth of Massachusetts upTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 15 Sheep Meadow Rd. Property Address Neal Zall Owner Owner's Name information is required for every West Barnstable Ma.. 02668 8/15/2014 page. Citylrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, (y/1 use only the tab 1. Inspector: key to move your cursor-do not Raymond Dumas use the return Name of Inspector key. Dumas Landscape Const. �y Company Name 564 Old Stage Rd. Company Address Centerville Ma. 02632 Citylrown State 508-778-0249 S1437 Telephone Number License Number B. Certification I certify that 1 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 16.000).The system: ® Passes. ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 8/15/2014 Inspecto 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. l5ins•3/13 ; Title 5 Official Inspection Form: Waceewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 15 Sheep Meadow Rd. Property Address Neal Zall Owner Owner's Name information is required for every West Barnstable Ma. 02668 8/15/2014 page. CityrFown State Zip Code Date of Inspeaion B. Certification (cunt.) 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): I t5ins•3/13 i F f 1 Title 5 Official Inspe�ion Form:Subsurface Sewage Disposal System•Page 2 0 7 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 15 Sheep Meadow Rd. Property Address Neal Zall Owner Owner's Name information is required for every west Barnstable Ma. 02668 8/15/2014 page. Cityfrown 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): P ( xP ) ❑ 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): • � J 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 15 Sheep Meadow Rd. Property Address Neal Zall Owner Owner's Name information is required for every west Barnstable Ma. 02668 8/15/2014 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fall 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 Y day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 15 Sheep Meadow Rd. Property Address Neal Zall Owner Owner's Name information is required for every West Barnstable Ma. 02668 8/15/2014 page. Cityfrown 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. F. 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 El ❑ Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-3/13 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 15 Sheep Meadow Rd. Property Address Neal Zall Owner Owner's Name information is required for every West Barnstable Ma. 02668 8/15/2014 page. Cityfrown 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 y 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•3113 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 •.''t 15 Sheep Meadow Rd. Property Address Neal Zall Owner Owner's Name information is West Barnstable Ma. 02668 8/15/2014 required for every page. City/Town State Zip Code Date of Inspection D. System Information Description: 1500 gallon tank, d box and 2 pits 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 Seasonaluse? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Present. Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•.3/13 Tice 5 official Inspection Pone:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 15 Sheep!Meadow Rd. Property Address Neal Zall Owner Owner's Name information is West Barnstable Ma. 02668 8/15/2014 required for every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 3 Last date of occupancy/use: Date Other(describe below): Occupied now General Information Pumping Records: Source of information: Mass Cape 7/20/2014 Was system pumped as part of the inspection? ❑ Yes ® No If yes,volume pumped: gallons How was quantity pumped determined? Reason for pumping: Pumped for D-box repair 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-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 15 Sheep Meadow Rd. Property Address Neal Zall Owner Owner's Name information is required for every West Barnstable Ma. 02668 8/15/2014 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: 1988 permit#88-258 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2 ft 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.): pipe is PVC SCH 40 Septic Tank(locate on site plan): Depth below grade: 1 ft 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: none 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 15 Sheep Meadow Rd. Property Address Neal Zall Owner Owner's Name information is required for every West Barnstable Ma. 02668 8/15/2014 page. Cityfrown 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 none i Scum thickness none Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? dip stick ruler Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): no sign of leakage or overloading in tank 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•3/113 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 15 Sheep Meadow Rd. Property Address Neal Zall Owner Owner's Name information is required for every West Barnstable Ma. 02668 8/15/2014 page. City/Town 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-:3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts R OW Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments lug 15 Sheep Meadow Rd. Property Address Neal Zall Owner Owner's Name information is required for every West Barnstable Ma. 02668 8/15/2014 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert at level Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): New D Box Installed By Mass Cape 7/21/2014 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4, 15 Sheep Meadow Rd. Property Address Neal Zall Owner Owner's Name information is required for every West Barnstable Ma. 02668 8/15/2014 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 2 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Precast Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching is 2-4'pits with 2 ft of stone . Pit#1(or#5 on asbuilt attached)Water 20 inches below pipe Pit#2(or#4 on asbuilt attached to report)water 33 inches below pipe Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top'of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Trtle 5 official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form MWA Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 15 Sheep Meadow Rd. Property Address Neal Zall Owner Owner's Name information is required for every west Barnstable Ma. 02668 8/15/2014 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): all looks good 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 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments t 4 15 Sheep Meadow Rd. Property Address Neal Zall Owner Owner's Name information is required for every West Barnstable Ma. 02668 8/15/2014 page. Citylrown 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 a t5ins W3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 15 Sheep Meadow Rd. Property Address Neal Zall Owner Owner's Name information is required for every West Barnstable Ma. 02668 8/15/2014 Citylrown page. 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: 13 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: 3/25/88 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: Plans on record and septic report dated 5/30/2014 Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5im•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 M 15 Sheep Meadow Rd. Property Address Neal Zall Owner Owner's Name information is required for every West Barnstable Ma. 02668 8/15/2014 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file T 1 Y , � t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 . e I�r ; .Ac C3i ; y7 A AS:, "1 Y c� n ,TOWN OF BARNSTABLE LOCATION (,�V Y�x C� qJ' SEWAGE#���f VILLAGE �G-` F�� ASSESSOR'S MAP&PARCEL I QCi _ INSTALLER'S NAME&PHONE NO. i�e 6cw•�- ® ' SEPTIC TANK CAPACITY LEACHING FACILITY:(type) _3 (size) NO.OF BEDROOMS OWNER N—.�Q G. Z� - PERMIT DATE: �7 f l 7 i V COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet \ Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY e I m ----------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS tertifirate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired Upgraded( ) Abandoned( )by ^� :been constructed in accor ce at \ . o ated with the provisions of(Title 5 and the four(Disposal System Construction Permit No. } Installer Designer Approved ►gn w 4 gpd t� #bedrooms The issuance of this permit s 1 not e c trued as a guarantee that the system func Date Inspector I ' Town of Barnstable Barn 1 i Department ,�. ; Regu atory ServicesQ P >�STA>�. p 9 MASS. 1639. Public Health Division 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL # 7012 1010 0000 28514MI July 21, 2014 Neal A.&Patrice K. Zall 15 Sheep Meadow Road West Barnstble, MA 02668 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 15 Sheep Meadow Road,West Barnstable, MA was last inspected on 5/30/2014, by James D. Sears, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Failed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: Back up of sewage into facility or system component due to overloaded or clogged SAS or cesspool. • Distribution box needs to be replaced. • Leaching has failed • You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH Holding Itr Thomas McKean, R.S., CHO Permit#2014-234 Agent of the Board of Health D-Box installed 7/21/2014 Shall be re-inspected in thrity Q:\SEPTIC\Lctters Septic Inspection Failures or Future Evl\15 Sheep Meadow Rd W.Barn Jul 2014.doc L CERTIFIED MAIL # 7006 2150 0002 1041 9532 Q:\SEPTIC\Letters Septic Inspection Failures or Future Evl\15 Sheep Meadow Rd W.Bam Jul 2014.doc THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M ^C&L DATA - _ . ... © !=J f•tlG IiissQl2tinttanetlGropdat.7lPary ai a.,px7ID F1�P_ I f314�y"°'Li,e 5e�rct P - . http-r ww.town.barnstable... Application Center ®Suggested Sites €Web ryYce Gallery ` Favorites ',IJ Parcel Detail - i _Arc�ky �< 5 4Y ?ra Nashi/rtai �rri' J7aa IJ�a �?Aa ` r General(Support q _Connectionb ' Parcel Info Status Connected ' ri Duration: 03:21:04 ' Parcel I_- -...._.... .... f ,109-029 I Speed 100 0 Mbps ID , 1 �X:l Location 15 SHEEP MEADOW ROADSec Road K'ETTLEHOLE ROAD ti Village;WEST BARNSTABLE Sent— — Received Town sewer exists at this address'No R�' TI Packets 121,940 193,770 h1 Ua Asbuiit Septic Scan: Iri 109029_1 d Properties Disable. ti 1� rIN Owner Info Ctose�� rt+! Owner FZALL-NEAL A&PATRICE K o caner o ..... rfi Streetl>-15 SHEEP MEADOW RD Street2; I y; City jWEST BARNSTABLE I State;MA Zip Country Land Info J r _ y i F-1 mtranet 100% 12:54PM 1'f Parcel Detail-Windows.,, Inbox N mm Y 11 Local Area Connection 5... vg y r� ® -Microsoft Outlooks Official Website of Th., { 9 Reminders` . Ii�Windows Media Player ( , Monday un U1 14 U9:48p p,1 Commonwealth-of Massachusetts Title 5 Official Inspection Form 3 0 a:?-- Subsurface Sewage Disposal System Form Not for Voluntary Assessments 15 Sheep Meadow Road Property Address -- Neal Zall Owner Ownets Name information West Barnstable MA 02668 5-30-14 required for every page. Citylrown 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 forth. I Ming ourformss n A. General Information fllEing out forms `����piunnu�ui� on the computer, sg§ ZH OF MAS"i-" use only the tab 1. Inspector. ��s'`` '•'boy. key to move your a`? use the r�etum James D.Sears =� JAMES 1p G key. Name of Inspector s_ :y CapewideEnterprises,LLC Company Name 153 Commercial Street rNSPE�����`�� Company Address Mashpee MA 02649 City./Town state Zip Code 508-47.7-8877 S 1623 ` Telephone Number License Number B. Certification �f f 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 d� 5-30-14 or's Signature Date Q - � fi O The system inspector shall submit a copy of this inspection report tc the Approving Authority( and of Health or DEP)within 30 days of completing this inspection. If the systeiWi;a shareUyste 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 thel4stemnrner , and copies sent to the buyer, if applicable, and the approving authority. ""This report only describes conditions at the time of inspection and un the cozWltiot s of use at that time.This inspection does not address how the system will ped rm in therfutuiV under the same or different conditions of use. o. r rt !Sirs-3M.3 ` IUs 5 ortidw hspeatlon Farm:S sulfate Sewage p wal system•Pape 1 or 17 Jun,U2 14 U9:49p p,z Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 15 Sheep Meadow Road Property Address Neal Zall Owrw Owner's Name Inforraquir atifo s West Barnstable MA 02668 5-30-14 requked for every page. Cityrrown State Zip Code crate 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: Failed Leaching B) System Conditionally Passes: ❑ One or more system components as described in the" ss Conditional Pa "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 exfiltrabon 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): t5iru•3013 Title 5 oftd kvpedion forth:Submur[aoe Sewape Disposal System•Pape 2 or 17 G r Jun 0214 09:49p p.3 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 15 Sheep Meadow Road Property Address Neal Zall Owner Owners Name Information edfo required for every West Bamstable MA 02668 5-30-14 page. City/Town state Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumpsialarms 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 !ordering vegetated wetland or a sale marsh tuns-3f13 Title 5 QekJal Urepe[tion Fcm Subswb a Serape Olaposal System•Pape 3 ct 17 r Jun uL-14 uy:4vp p.4 Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 15 Sheep Meadow Road Property Address Neal Zall Owner Ownefs Name information is required for every West Barnstable MA 02668 5-30-14 page. Cityrrown State Ztp Code Date of Inspection B. Certification (cont.) 2. System will fall 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 coGforrn 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 tltapaW is less than 6"below invert or available volume is less than '/2 day flow A--7— Ma-3/13 7itb 5 000d Inspection Farm:Subsurface Sewage Dtspoeat System-Page 4 of 17 r Jun VC 14 VyVDVP p.to Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 15 Sheep Meadow Road Property Address Neal Zall Owner Ownees Name information is required for every West Barnstable MA 02668 5-30-14 page. City/Town State. Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratory,for fecal coliform bacteria Indicates absent and the presence of ammonia nitrogen and nitrate nitrogen Is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems,you must indicate either'yes'or'no"to each of the following, in addition to the questions in Section D. Yes No Cl ❑ 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 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, 1EIns•3r13 Title 5 OfIC551 Wpecbon Form;Stbsurteee Sewage DooW Syelem•?eye 5 or 17 Jun uL 14 uy:bup p.0 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 15 Sheep Meadow Road _ Property Address Neal Zall Owner Owners Name nformation is required for every West Barnstable MA 02668 5-30-14 require 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 buiR plans of the system obtained and examined?(If they were not available note as NIA) ❑ Was the facility or dwelling inspected for signs of sewage back up? 9 ❑ 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): NA Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 15iro•Y'3 Two 5 Official hapeclion Form"eurreoe Sewage OiwoW Syabfr-Page 0 el 17 Jun,U2 14 U9:b11p P.i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 15 Sheep Meadow Road Property Address Neal Zall Owner owner's fame information e West Barnstable MA 02668 5-30-14 is required for every page. Cityfrown State Zip Code Date of Inspection D. System Information Description: The system is a 1500 Gal. tank D Box and two pits. 2 Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate.sewage system?(Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Weil Water Detail: Sump pump? ❑ Yes ® No Last date of oocupariey: Present fate Commerciallindustrial Flow Conditions: Type of Establishment Design flow(based on 310 CMR 15.203): Gapons per day(ppd) Basis of design flow(seatslpersonsisq.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 availa 31e. I5ns•3113 TAre 5 OrlidW kzped lon Faec Sdbuafew Sege Dbpwd Seatem•Pepe 7 of 17 Jun 0214 09:51 p p.b Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r 15 Sheep Meadow Road Property Address Neal Zall Owner owner's Name red required for every on West Barnstable MA 02668 5-30-14 page_ cityrrown State Zip Code Date of Inspection D. System Information (cunt.) 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/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): Isms•3/13 Tills 5 offiod Irapedtlon Form:Subadew Sewage Disposal SyStem•Pape 8 117 r Jun u:L 14 uv:51 p p.V Commonwealth of Massachusetts Title .5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 15 Sheep Meadow Road Property Address Neal Zall Owner Owner's Name information is West Barnstable MA 02668 5-30-14 required for every page. City/town State Zip Code Date of Inspection D. System Information (Cont.) Approximate age of all components, date installed(if known) and source of Information: 1988 Permit#88-256. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): I Depth below grade: 24rest 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): 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 Gal.Precast. 2„ Sludge depth: rsw.-3113 rae 5 OWKW ti giectlpt Form:SubauAeoe SewBpe Dispotet Syslem•Puye 9o(1T Jun U1 14UV:51p p.-iU Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 15 Sheep Meadow Road Property Address Neal Zall Owner Owner's Name information is required for every West Barnstable MA 02668 5-30-14 page. c4rrown State Zip Code Date of InapeWon D. System Information (cunt.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 28" Scum thickness Distance from top of scum to top of outlet tee or baffle 8" Distance from bottom of scum to bottom of outlet tee or baffle 18 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 outlet cover at Tbelow grade, w/inlet cover at grade. Inlet baffle, outlet tee. No sign of leakage or over loading in tank. Grease Trap(locate on site plan): Depth below grade: lase 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: oats 129M•Sr13 Title 5 Ofrrdel kopecOm Fomr.S~aw Sewage Disposal System-Pepe 10 or 17 Jun u 14 U.9:51p P. I I Commonwealth of Massachusetts litTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 15 Sheep Meadow Road Property Address Neal Zall Owner Owner's Name information is required for every West Barnstable MA 02668 5-30-14 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 15ins•3113 Me 5 Official Inspection Femn Sub6uftm Sewage Disposal Sown•Page 11 of 17 Jun U1 14 Uy:b1p p,i Z Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 15 Sheep Meadow Road Property Address Neal Zall Owner Owner's Name t s required f or every West Bamstable MA 02668 5-30-14 require page. Citylrown state Zip Code Dots 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 is 16"x16"-28"below grade,wNwo lines out.Wall's are gone on box. 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: One-3113 TMe 5 OMetW bwpeefm Form:$ubstafaae Sewage Dtspostl System•Page 12 or 17 i Jun 02 1409:52p p,13 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 15 Sheep Meadow Road Property Address Neal Zall Owner Owner's Name information is required for every West Barnstable MA 02668 5-30-14 page. Cityrrown State Zip Code Date of Inspecllon D. System Information (cont.) Type: ® leaching pits number. 2 ❑ leaching chambers number. ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/altemative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching is two 4'precast pits,w/2' stone. Pit#1)44" below grade w/cover at 14". 1'water w/stain line at 18". Pit#2)40"Below grade w/cover at 2'. Pit full up Into rlsor. 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 l5ins-3113 Too 5 Orkdal Inspectlnn Form Subsutaw Srnp Disposal System•Page 13 of 17 r Jun U1 14 Ubl:Wp p.14 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 15 Sheep Meadow Road Property Address Neal Zall Owner Owner's Name Informrequire for is West Barnstable MA 02668 5-30-14 required for every page. CIty/Town State Zip Code We of Inspection D. System Information (cunt.) 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.): t5 is•3113 Title 5 Mko IrepmftnForrn:Subsurface Sewage Disposal System•Pape 14 of 17 Jun 02 14 09:b3p p,1 5 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 15 Sheep Meadow Road Property Address Neal Zall Owner Owner's Name iequir dfo is West Barnstable MA 02668 5-30-14 required for every page. Cityrrown Stale Zip Code Date or InspeWon 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 -a - � ' I .13 _ G 3 - y= Al/ DO 1 OJL ❑ � �y s Mns-3113 7Me 5 Offiaal kspecfion Form:Sube vw Sewage Disposal System-Papa 15 of 17 f Jun u-L 14 uv:b;Sp pai d Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 15 Sheep Meadow Road Property Address Neal Zali Owner Owner's Name information is West Barnstable MA 02668 5-30-14 required for every page. CItyrrown Stale Zlp Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells 0 Estimated depth t high ground water. 13' 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 8 Date ❑ Observed site(abutting propertylobseryation 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 13' no G.W.. Bottom of pit at 9'below grade. Bottom of pit at 4'above T.H. nth. — Before filing this Inspection Report,please see Report Completeness Checklist on next page. INne.3113 110 5 OWN hrssp KMM Fans SOW OM Sewage Dhpoael Syshm•Papa 16 of 17 Jun uL 14uv:o4p p,-i I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 15 Sheep Meadow Road Property Address Neal Zall Owner Owner's Name information's required for every West Barnstable MA 02668 5-30-14 page. CitylTown State vp Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, 6, C, D, or E checked ® Inspection Summary D(System Fadure 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 t5ft•3M 3 Trio 5 Oletlei r,epeaion Form;SuDetafece Sewage 015Posel system•Pepe 17 or 17 AsBuilt Page 1 of 1 TOWN Op BARNS'TABLE cy� SEWAGE o + �— L(ZCA'TION�GIy VILLAGE ! `!` .S'? At,ASSESSOR'S MAP & LO T INSTALLER'S NAME rsx PHONE NO. t / SEPTIC TANK CAPACITY .� (s ) LEACHING FACILITY:(tYQO) n OF BEDROOMS �P�VATE,, OR PUBLIC NO. BUILDER OR OWNBIt DATE PERMIT ISSUED: DATE COLIPLIANCE ISSUED• NO VARIANCE GRANTED- 44 s yY �a 11 __ http://issgl2/intranet/propdata/prebuilt.aspx?mappar=109029&seq=1 6/20/2014 TOWN OF BARNSTABLE LOCATIONto7-/L) �1�� >'VIei O&Q SEWAGE # -��L! VILLAGE � .O4ZN �o�� ASSESSOR'S MAP LOT C? INSTALLER'S NAME &: PHONE NO. SEPTIC TANK CAPACITY ti LEACHING FACILITY:(type)--/2i7' n NO. OF BEDROOMS--�,Z_PRIVATE WELL OR PUBLIC WATER Lo LZ BUILDER OR OWNER n DATE PERMIT ISSUED: g DATE COMPLIANCE ISSUED_ VARIANCE GRANTED: Yes PIo l� � Cc Ll' Ck 1 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �u.. /.......or�i� ./ j-'��. .............. Appluation for 33toposal Works Tunidrurtion Permit Application is hereby made for a, Permit�nstruct ( or Repair ( ) an Individual Sewage Disposal System at: iL`�/c _ - -� - ress .. o a :�.�r�.e...®�..owner--•...................................... C l7.V' ......�.. .......: . .C^t t Installer Address UType of Building t2 Size Lot J?..Sq. feet .. Dwelling—No. of Bedrooms...........................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building .......... No. of persons............................ Showers (fir YP g ................:. p ( ) — Cafeteria ( ) 04 Other fixtures W Design Flow........... ......................gallons per personer#y. Total da4yoow...........���..........g�}1} - WSeptic Tank—Liquid capacity�6a20gallons Length............... Width..-..".... Diameter.............. Deptl.._............ x Disposal Trench—No. ..........`-:...... Width....... ....... Total Length........ ........ Total leaching area....=...........sq. ft. 3 Seepage Pit No......_Z-....... Diameter.../ ....... Depth below inlet...J�,.- ..... Total leaching area....0.............sq. ft. Z Other Distribution box ( ) Dosi g tank o./ di. �J�e Percolation Test Results Performed .......... ®! !d!4 .... .... .......... ! Date.. /� ......../ ,.a Test Pit No. /, ..minutes per inch Depth of Test Pit.,/ Vie.`.... Depth to ground water. Li Test Pit No. 2...... ...._minutes per inch Depth of Test Depth to ground water,/C/y.'.'P/� AG ................. i .........a • ---rt Description of Soil..o.�_. ..t. a/ ...... ..... C o =..........---..............---..... ..........0.......-- ----•.-.-.-.-.-.-............. w ..................................................................... x ..............................................................--..................._................................-............................................................ ...... U Nature 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 T m IT LE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in 1 operation until a Certificate of Compliance has been issued by the and of healt�hp pA Sign -......_. ..�.�. � :..................----. --- ----- ate Application Approved By..........C� ... ...�. _..... . �........ .................— -- - ..........D Application Disapproved for the following:reasons:..........................................................................................................___ ...........................................................................---............_..-----------.......•------•-----------------•---...............---.._.............----- -- 0.....3?.R...._s :� L .. _.. ...__...... ....._......_....._Date Permit N ._... Issued..... --_..... Daft ONWEALTH OF MA ��A+",*,h'_•'�t_.rf:�'i..Yg,Z;�.�....�r.-'-xs.,s�..wn+-r�r:r.,.••.�aelw++,n�..:�vt�.r.,-,.r'��x...��.-•-a.++' Y+.��.+s•-^•-r-y..-'V�,.l.yr...'*l�v�..,:, sY"y'T^`^ 0�"tom-..r 'r-:'.i.,y�".-- -:...•.r.,�\sw�.-.-....�..i't-��ry#''�r•: y ac�� JGG r FEz....7 THE COMMONWEALTH OF MASSACHUSETTS �. BOARD OF,:eHEALTH /.. w_..,/.......or, ..2. % .t ,............. ApplutttT Permit Application is hereby made for, Perrriit Yo,anstruct ( or Repair ( ) an Individual Sewage Disposal System at: G -� %/S - , Imo!:---`----- �. atcoa'dAddress 1.. . ". a11A11..1"G'\.-_ �11r . ..:.? t.?" T.r� �1.-,/ S �ls;t M Installer Y Address Y Type of Building ' , - Size Lot-�_7b3..Sq. feet ,may,a Dwelling—No. of Bedrooms._..:...... .......................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building f__._.:..... � � ........ No. of persons............................ Showers ( Cafeteria ( ) Q Other fixtures . ............:................................. -"- W Design Flow........... . ....................gallons per person per#y. Total-da4yffiow._..........��----4�__Q...........__ lens. WSeptic Tank—Liquid ca aci` t.04 Ions Length......... :-.... Width.. :._.... Diameter__ ......... D tlr :....... x Disposal Trench—No--' ...... Width........"....... Total Length........ ........ Total leaching,,area................sq. ft. Seepage Pit No.___..:4..._... Diameter... _.� P ' r- 3 S: `� i � pag ,�---•--.._._ Depth below inlet.......:.....:.::�. Total leachlrlg.area.._...........:!n:sq:ft. z Other Distribution box ( ) Dosi tank Percolation Test Res is Performed ) �'v /,1'� *" �/ tZA aTest Pit No. Z-:..minutes per inch Depth of Test Pit-/5 ..... Depth.to ground f4 Test Pit No. 2.............minutes per inch !.? Depth-,to grounel te'r/y �..P�US Q�i „ ..........rt [n.... ..r�.... .................. Description of Soil..:"" Z{f �/?c �,,•' Z cr/...- v �'q ,=) W ..............x,;---.-_- _.. .... ....._. ?' --' r"` .. . fir r l r ,* P p ...... ..............•_.___•-__•.• U Nature of Repairs or Alterations—Z"Answer-*trt en�`applkable ". s....: t__ ..... ....................•"--..................---...---.......---....---•----•--........----•----.................-•------....----.................. Agreement: L''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 been issued by the board of health Signea�_ ..�_..�-----------------..��....t:........................... _6lC-/�t __-.-_.... r ........ .. ... .1.. ..............._ ........................................Date Application Approved By- _ .. Date Application Disapproved for the following reasons:..................................................................................... ......_._.__.._ E ............................................•----.....-•------...---•-••-----...........--•--..........•------•--•-............._.....----.._..-•--......----•.....------....--•-•------•--•---....._ Permit No.....�..�a...:..�::. .. ...............�— Issued ......---... ..............._... D�..-- ...... Daft THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . ..:... k f rrtif utttr,,` (ffjam#liana ' THIS 1 TO CERTIFY, That the Individual Sewage Disposal System constructed ( or Repaired ( ) by.................f 0�-a�..�;1..eA,. ........._...-----.............-•---•--- . ---.........--••--•----....-- •-------"-"-•-----...--"--.................. .-_...._ •T7� Insta`ll�er� -- a --- at.---.._... r1.1..._.J�/.....3.k? Ce,�. lr�,/- 'cx.cQ ��'..1C .........�....... s:�: Y................. has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.......'iL.. ...... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE......................... �� ..... Inspector-"--- - ....... ....... -..-.--................. ...... ---_._--_-_______________- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH JJ....... ...................O F.... ,� No... .a�..SG .. 5.... ...... �-..................... � FEE.. .... .... '�itt�ntttt u ks f�untttr�utuan_�rrutit .�` Permission is h eby granted.......... �_.0 4�✓'................... ........ r to Construct ( or Repair ( ) an Individual yS�ewage Disposal System at No............. .¢_ L --.�. 1 r/ ��' �Cllf-. .a:. Street as shown on the application for Disposal Works Construction e t No.... S!. Date ....._................. ...,.... ...... P ... ...... ..... q /_ B rd of Heal h DATE.....--••--......T l . FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS OFFICE LABORATORY 1498 HIGH STREET 176 PLYMOUTH STREET BRIDGEWATER, MA 02324 t BRIDGEWATER, MA 02324 OLIVEIRA ENVIRONMENTAL LABORATORIES, INC. FOOD- DAIRY PRODUCTS-WATER-WASTEWATER CHEMICAL Et BACTERIOLOGICAL ANALYSES (508)697-2650 May 27, 1988 L. Wile & Son Drilling Co. 11 Annasnappitt Drive Plympton, Mass. 02367 Source: Well Water - Drilled Well - 4 inch PVC Well - 82 Feet deep - producing 10 gals./min. Located on the John Richards-Builder- property - Lot 14 - Sheep Meadow Road - West Barnstable, Mass. Coliform Count /100 ml @ 35 C 0 Membrane Filter S.P.C./ml @35C 4 Color (APC units) 10.0 Sediment slight Turbidity (NTU) 6.20 Odor none Taste satisfactory pH 6.3 Specific Conductance micromhos/cm 85.0 mg /liter Total Alkalinity (CaCO3) 11.0 Free CO2 10.7 Total Hardness (CACO,) 20.0 Calcium (Cal 6.40 Magnesium ('Mg) 0.98 Sodium (Na) 9.10 Potassium (K) 0.91 Total Iron (Fe) 0.02 Manganese (Mn) L 0.01 Silica (Si02) 13.0 Sulfate (SO,) 12.0 Chloride (CI) 8.00 Nitrogen - Ammonia 0.13 Nitrogen - Nitrite 0.004 Nitrogen - Nitrate 1.31 Copper (Cu) L = less than On site collection made by L. Wile - 5/24/88 at .3:00 P.M. Sample delivered to laboratory by Mr. L. .Wile - 5/25/88 at 11:50 A.M. Bacterio-logically, this well water is of a satisfactory sanitary standard and is suitable for drinking and domestic purposes. Chemically, this well water meets the standards for all of the chemicals tested. The turbidity is affected by the sediment and should clear up with usage. Director r r The Standard Plate Count indicated the general bacterial population of the well at the time of collection. Coliform Group Bacteria: Significance The coliform group bacteria includes organisms found in the intestinal tracts of warm blooded animals, birds,decaying organic matter(hay, leaves, wood, etc.), the top 2 to 3 feet of the soil, lakes, ponds, brooks, rivers, drainage and types of vegetation. Because the organisms can cause some illness; because the presence of coliform organisms in the water suggests that other more harmful organisms may be present, water containing one or more coliform group bacteria per 100 ml of sample should not be used for drinking or cooking purposes unless boiled 5 minutes or disinfected by other means. This bacteria is of animal origin (intestinal tract)and may be considered as closely associated with disease causing organisms.On this factor, none should be present. Color — APC Units- Ground water ought to be practically free from color. For attractive water- color should not exceed 15 units. Turbidity — NT Units - Recommended limit not to exceed 5 units. Odor Er Taste — For water to be of high quality, the water should be odor free and taste good. pH — The pH value defines the concentration of free hydrogen ions in solution. Expressed on a scale extending from 0 or very acid to 14 or very alkaline with 7.0 being neutral. Specific Conductance — Conductivity is a good criterion for measuring the degree of mineralization and assessing the affect of diverse ions on chemical equilibria. Total Alkalinity — The alkalinity of this water represents its content of carbonates and bicarbonates. Free Carbon Dioxide — Well water having a low pH and a Free CO2 level in excess of 50. mg/I will be corrosive to iron, bronze, brass and copper tubing and fittings. Total Hardness — Standard not to exceed 50. mg/I. Waters having a hardness level of 50 to 100 are in the medium hardness range, over 100 very hard. Calcium -- Calcium contributes to the total hardness of water.Appreciable amounts of calcium salts break down on heating and form scale in boilers, pipes and cooking utensils. Magnesium — Magnesium is a common constituent of natural water. Magnesium and calcium ions are principal contributors to water hard- ness. Concentrations in excess of 125 mg/I can exert a cathartic and diuretic action. Sodium — Recommended limit not to exceed 20 mg/I. Potassium — Potassium concentrations in drinking water seldom exceed 20. mg/I. Total Iron — Standard not to exceed 0.3 mg/I. Manganese — Standard not to exceed 0.05 mg/I.The principal reason for limiting the concentration of manganese is to reduce esthetic and economic problems. Silica — Silica content of natural water is most commonly in the 1 to 30 mg/I. Silica in water is undesirable because it forms difficult to remove silica scales. Sulfates — Standard not to exceed 250 mg/I. Chloride — Standard not to exceed 250 mg/I. Nitrogen — Ammonia is present in variable concentrations in many surface and ground waters. Its occurrence in ground water is generally a result of natural reduction processes. Nitrogen - Nitrite — Nitrite in water poses a health hazard, but fortunately seldom occurs in high concentrations. Waters with a nitrogen - nitrite concentration over 1 mg/I should not be used for infant feeding. Nitrogen - Nitrate — Standard not to exceed 10. mg/I. Nitrate, in high concentrations can and do cause methemoglobinemia or so-called nitrate poisoning in infants. Water with 10 or more mg/I of nitrate is unsatisfactory and is not considered safe for drinking or cook- ing. It is especially dangerous to children and should never be used in infant formulas. Copper — Standard not to exceed 1.0 mg/I. Departmentbf Environmental Management/Division of Water Resources a i WATER WELL COMPLETION REPORT WELL LOCATION Address.1Q1- �li.lt..t-.o -,,hz-"-ig1764Ll City/Town 60,"rI& A Al:k4"NM" 4r ��7 5 G.S.Quadrangle Map Grid Lo ati n Owner C IAAi) Address gh ttI? -4 0,0,0 ff,3 0/, /. /F! WELL USE CONSOLIDATED WELL Domestic Public ❑ Industrial ❑ Type of Water-beaffTo Method Drilled Other Water-bearing Zo 1) From ITo 2) From Date Drilled S/ a 3) From To 4) From To CASING Depth to Bedrock Length Diameter_ Type PY C_ UNCONSOLIDATED WELL STATIC WATER LEVEL Water-bearing'Materials Feet below land surface y Sand: fine❑ medium❑ coarse❑ Date measured .A� Gravel: fine❑ medium®'coarse[] " , GRAVEL PACK WELL Screen: �e Yes No Slot# /,$, length 'LT from rl'�y to ? 2- [] L�±'J ° Split Screen (or 2nd screen). WATER QUALITY TESTS MADE Slot# length from to Chemical Biological [� Depth To Bedrock PUMP TEST Drawdown /4 feet after pumping days S hours at GPM. How measured�AP Recovery feet after hours. LOG of FORMATIONS COMMENTS: (On well or water) Materials From To Cb U U DRILLER rz L Firrnd fds% dL 3 i(A J Address4A,A,4-, . ✓ Q �- City J�f'/Y` 1"4 - Registration No. Operator's ignature ease print firmly BOARD OF HEALTH COPY 25M-10-85.807101 Tj -y 1� ---y _ ze I i� � ' t t -L Cal c7' (p< 41 v V , N19 p) P ;NVI 0 0 61 el. A-e 4. Z > 0-/7 .......... -z all' ............... 4Q .S Z- LP tic, SITE S S PLAN SHOWING PROPOSED CONSTRUCTION S H. 0 F H L 0C AT 1 0 N X, -7- F 0 R SCALE: D A T E '- 19 8 eD R E F E R E N C E -Zz: '00.e CL IF THIS PLAN DOES NOT BEAR AN ORIGINAL RFT) SEAL OF AND SIGNATURE, THEN THIS PLAN IS AN UNAUTHORIZED cJOSEPH CRNQ REPRODUCTION AND J . M. MONAHAN, JR. (5 ASSOCIATES AND/OR A PROFESSIONAL LAND SURVEYOR OR ENGINEER, No. WHOSE SEAL APPEARS HEREON, DO NOT ASSUME ANY aVIL GIST J . M . MONAHAN ., JR. & ASSOCIATES RESPONSIBILITY FOR ITS CONTENT. SUM PROFESSIONAL LAND SURVEYORS & ENGINEERS AL TOWNE PLAZ- A - 900 ROUTE 134 .-SOUTH DENNIS., MA . 02660 JLIN. 0 1 lose JUN. 0 1 1986 . N . F I L E SOIL L O +G DATE :- W ( T N E S S E D B Y ' \ � t� �-i n - 2 ELEV. TOP OF MANHOLES AND COVER TO BE BUILT WITH ; N FOUNDATION , - �> 12"/ OF FINISHED GRADE 3 ` I FfIVISHED GRADE \ MIN. 2 SLOPE 4- DIA .. .,� PI PE :u. •" .* . .., 4 DIA . PI PE ''• __s� �; ti MIN PITCH (/44�FT. 2'LEvELr - MIN .`2" LAYER P I T C T �fN 14� T. ,+ p,o• q! I/8 - I/2 PEA STONE F o, IN VE R T INVERT— SUM P . ❑ - A: .r� GALLON W. INVERT �. d INVERT D 1ST ,,;� ;,e�_o „ I ,, SEPTIC TANK T. 47 D O X SO Q y p',A� 3�4 - I /2 D I A ..... ,....,..+«•, INVERT o : U p�A WASHED STONE ALL (/3�r n 1 N V E R T ..`sue � v b'g AROUND a PLACE BAO E �^� /b —� --� � c � N`6� ELEV BOTTOM (� GARBAGE 20 MIN a-Z�`w6 O �Zf� a.t• GRINDER _ DIA ,�O���f9'�'�.,..�-�.::�•� ELEV V. ..31 9. PROFILE OF OBSERVED GROUND WATER TABLE ELEV =� �; r f - � SANITARY' DISPOSAL SYSTEM � NOT TO SCALE DESIGN DATA `- ' 417 , /� ? � BEDROOMS • CONSTRUCTION OF SAN tTARY DI POSAL SYSTEM DESIGN FLOW � GAL.�DAY SHALL CONFORMTO M T A 'SS. ENVIRONMENAL CODE i TITLE V REVISED 7- I - 77) AND THE TOWN OFF fa ;, EACH RATE _ Z_ _z_ -' MIN./INCH HEALTH REGUILATI ONS CURRENTLY IN EFFECT. REQUIRED SEPTIC TANK GALS • SEPTIC TANK, DISTRIBUTION BOX AND LEACHING UNIT PROPOSED SEPTIC TANK,,�rcU GALS. • FOUNDATION LOCATION AS SHOWN ON THIS PLAN TO BE OF REINFORCED CONCRETE SHOULD BE STAKED PRIOR TO EXCAVATION AND AGAIN MIN. CON CRETE STRRENGTH 3, 000 P. S. I . PROPOSED LEACHING CAPACITY.* IN EXCAVATED H OLE I F NECESSARY BY SURVEYOR , MIN . STEEL STRENGTH 20 000 P. S. I . A MINIMUM OF 4-8 HOUR NOTICE (WORK DAYS) I S REQUI RED . Z f � {:- -��,,� ,c /.Q �TTSbz- MIN . DESIGN LOADI NG H - /b 1� 0 CONSTRUCTION TO BE IN STRICT ACCORDANCE WITH GALS/DAY THIS PLAN ANY CHANGES MUST' BE REQUESTED AND • DRIVEWAYS NOTTO �BE LOCATED OVER SYSTEM UNLESS H - 20 DESIGN LOADING ! S USED . APPROVED I N WR ITING BY THE DESIGN ENGINEER' S ALL PIPES AND FITTING 'STO BE WATERTIGHT AND APPROVED 19 WHO'S SEAL APPEARS HEREON . CONTRACTOR ASSUMES TO BE OF CAST IRON OR APPROVED P. V. C . FULL RESPONSIBILITY FOR ANY VARIATIONS FROM THIS PLAN NOT APPROVED BY SAID ENGINEER . D. E . Q. E. NO. BOARD OF HEALTH AGENT FLOOD ZONE AS DELINEATED ON THE FLOOD INSURANCE RATE MAP, SITE PLAN SHOWING PROPOSED CONSTRUCTION SH'-OF -SHS COMMUNITY P A N C EL NO MAP REVISED LEGEND IF THIS PLAN DOES NOT BEAR AN ORIGINAL RED SEAL BY FEDERAL EMERGENCY M L 0 C MANAGEMENT AGENCY A"" 1 0 N . r i AND SIGNATURE, THEN THIS PLAN IS AN UNAUTHORIZED - REPRODUCTION AND J. M. MONAHAN, JR. & ASSOCIATES ZONING DATA : _ SCALE: DATE �""� �` " G��. ( C� � AND/OR A PROFESSIONAL LAND SURVEYOR OR ENGINEER, ZONE E X I STING CONTOUR — — i 6——— WHOSE SEAL APPEARS HEREON, DO NOT ASSUME ANY � �-. REFERENCE: RESPONSIBILITY FOR ITS CONTENT, MIN . AREA `" `? SQ. FT PROPOSED CONTOUR I61y/ i MIN . FRONTAGE _ _- FEET °cl) MIN . FRONT YARD SETBACK -C2 FEET EXISTING SPOT ELEVATION 17.6 PROPOSED SPOTELEVATION ITT x MIN. SIDEYARD SETBACK -O FEET �twOfr,� �'JAI 0F PROPOSED WATER SERVICE W MIN REARYARD SETBACK Af_: <2 FEET © JOSEP cc EXIST ( NG GAS SERVICE — G M. `� o 2 J AP PROVED 19 PROPOSED ELEI� & TEL E ,&T J . � MONA HAN J 0.� L --- -_ --- - �o R.& ASSOCIATES 1 _ TEST HOLE LOCATI ON �q"oGsu ��-y° PROFESSIONAL LAND SURVEYORS & ENGINEERS BUILDING COMMISSIONER TOWNE IPLAZA- 900ROUTE 134-SOUTH DENN ( S, MfA. 02660 — .Dl11V.01 1999 �p O 1 1988 J. N . F I L E