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Home My WebLink About0037 ALTHEA DRIVE - Health ._ _ -7-7T 37 Althea Drive Barnstable R TOWN OF BARNSTABLE JLOCATION/�� A�'(ne 4 (fir SEWAGE# VILLAGE CUMtA ftt ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY I E'up LEACHING FACILITY (type) Rt r (size) NO.OF BEDROOMS I OWNER R IAA 66r J PERMIT DATE: 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 ,l/1 S R al (a- . Q zc� ` 6 3 a qG , ss r 3 L� No. (9cl 3® Fee/� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Ye PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 0[pprication for Mig gar *p!5tem Construction Permit Application for a Permit to Construct( )Repair�/)Upgrade( )Abandon( ) El Complete System O Individual Components Location Address or Lot No. ' 7AdK e4 . (q Owner's Name,Address and Tel.No. Assessor'sMap/Parcel �U� -333 'j (A f 4, 91AACLA r CU�nnnA � d" Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. CCorc!L-V, cis 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 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) �QL Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been i ed b this BoWd of Health. Sign d Date 1 o 1 . Application Approved by Date Application Disapproved for the following reasons Permit No. ck 1.2- 3 6 1 Date Issued D I — i Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Ye { PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLEs MASSACHUSETTS ZIpprication for Miopozar *pztem Construction Permit Application for a Permit to Construct( , )Repair Upgrade( )Abandon( ) O Complete System ❑Individual Components Location Address or Lot No. �Q /� lk e4 °�('' Owner's Name,Address and Tel.No. Assessor's Map/Parcel (� 333 S�A r - CUi�tnnnA�1U+ � � dry ��1 � C.3IAnCLA r Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. G10 M us Type of Building: 3 Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) i Other Fixtures 1 Design Flow gallons per day. Calculated daily flow gallons. . Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Q A Q1_ (Z " Q�x Date last inspected: ` Agreement: The undersigned'agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been-,iiss�ed bPj this B,e d of Health. J Signed �t� ` Date 0 Application Approved by - ' V Date 8 Application Disapproved for the following reasons Permit No. c ZaI'.D 3 d I Date Issued I U I 1 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired( / )Upgraded( ) Abandoned( )by at 3� (a l tl1 e/a 7 r_ C U, A,\A G o i has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No..'i1�- 30 1 dated Installer GOi'4On G UAIC)V f Designer The issuance of this permit shall noub/e construed as a guarantee that the sy tem wil ,nct o esigned. Dated / /f f . Inspector No. Fee ��U THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLEs MASSACHUSETTS ig ogar �p�ten� /on5truction Permit Permission is hereby granted to Construct( )Repair(,/Upgrade( )Abandon(n ) System located at 3� Ifl�a� r �' -F Ul and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of tlu� s pr r%t. Date: 1 �'" Approved by w. COMMONWEALTH OF MASSACHUSETTS a EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL.PROTECTION TITL;E'S OFFICIAL INSPECTION FORM:-NOT.FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address; 37-Althea Drive Cummaguid:MA 02637 Owner's Name: Barbara Blanchard Owner's Address: Date.ofInspection: Sevternber21, 2012 Name of Inspector: (Please Print) James M. Ford Company Name: James M Ford Mailing Address: P.O.Box,49 Osterville,MA 02655-0049 Telephone Number: (508) 862-9400 CERTIFICATION STATEMENT I certify that I.have.personally inspected the sewage disposal system at this address and that the.information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on in training and experience in the proper function and,maintenance of on site sewage disposal systerns. _I am a DEP approved.system:inspector pursuant to Section 15.340 of Title 5(310 CMR 15:000). The system: ✓;s Passes nditionally Passes Ne ds Further Evaluation by the Local Approving Authority Fa' s Inspector's Signature: % Date: .: October 9. 2012 `T The system inspector shall su .t a copy o, this inspection report to the Approving Authority(Board of Health or � DEP)within 30 days of.completmg 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;ffice of the DEP. The original should be sent to the'system owner and copies sent to the buyer,if applicable,and the approving authority. i. bti a..l Notes and Comments '6t ')I ****This reportonly 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 iise:�` 3 �-,' t! i.Ci IiP a:is .. ii s� ft,1 ii; LZ _ Title 5 Inspection Fonn 6/15/2000 - page 1 Page 2 of 11 1, OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM t PART A CERTIFICATION (continued) Property Address: `37 Althea Drive Cummaquiid,MA Owner: Barbara Blanchard Date of Inspection: September 21, 2012 Inspection Summary: Clieck A,B,C,D orLE/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 indic ated below. Comments: • 1 B. System-Conditionally Passes: One or more system components as described in the"Conditional Pass section need to be replaced or repaired.. The system,upon completion of"the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y;N,ND).in the for the following statements. If."not determined",please explain. The septic tank is metal andiover 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 tankis 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 than120 yeais old.is available.. lr 1`i ND explain. r . !r 1�1t 1,1j, 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 _:. .. ovsti_qction is removed distribution box is leveled or replaced.. ND explain ; The system required pumping;more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if.(with appr oval of the Board.of Health): ' broken pipe(s)are replaced obstruction is 'removed ' ND explain:: l - - Page 3 of i l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSM ENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A F ` } CERTIFICATION (continued) Property Address: 37 Ailthea Drive Cummaauid,MA Owner: Barbara Blanchard Date of lnspectioil: s Seytenzbet-21'. 2012 + C. Further.Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by.the Board of Health in order to determine if the system is failing to protect public.health,safety or the environment. 1. System will pass unless Board of Health determines in accordance.with 310 CMR 15.303 (1)(b) that the system is not functioning in a manner which will protect public health,safety.and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of'a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any) determines that the. system is functioning in,a manner that protects the.public health,safety and environment: r'aThe system has,a septic;tank and soil absorption system(SAS)and the SAS,is within 100 feet of a surface water supply or,trLbutary.to'a surface water supply. w , f The system has,a sephcjanl4 and SAS and the SASis within a Zone.l of a public water supply., f The system has'a:septicitank and SAS and the SAS is within 50 feet of a private water supply well. _ Jix it.:The system has aseptic+.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,,ystem passes,if the.well'water analysis,`performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence ofammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered A+c`opy of the analysis must be attached to this form. ti x';i' 6 '°t hu' 3., Other: . ,t;i;;r+ta Ii.,3t', - •.;; 1 ..V+fit �' , _ 3 + Page 4 of 11 , OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS ;SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A. CERTIFICATION (continued) Property Address: 37 Althea Drive Cummaquid,MA Owner. 'Barbara Blanchard Date of Inspection: September 21, 2012 D. System Failure Criteria applicable to all systems: -You must indicate either"yes'.,or"no"to each of the following for all inspections: Yes No ✓. Backup of'sewage into Tacility or system component due to overloaded or clogged SAS or cesspool ✓ ' Discharge_or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due to an,overloaded'or clogged SAS or cesspool ✓ Liquid depth in cesspool is less than 6" below invert or available volume is less than%z day flow LL✓L 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 thel 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 I 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 1,!' 'supply well with.no acceptable water quality.analysis. [This system passes if the well water analysis, performed at-a'DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that_the well s free from pollution from that facility and the presence of ammonia Esar,!t .t !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.] . No (Yes/No)'The system fails. I:h v'e:detennined that one Or more of the above failure criteria exist'as described in 31.0 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,_System: To be considered a large system the:system must serve a facility with a design.flow of 10,000 gpd to 15,000 gpd. You must indicate either`.`yes"or"no"to each of the following: (The following criteria'apply to large systems in addition to the criteria above) Yes No the system is within 400.feet of a surface drinking water supply the systern:is-within;M0,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 1I of a public,watensupply well If you have answered"yes"to any;,questiori 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 threatunder Section E or,failed.under SectionD shall upgrade the system in accordance with 310 CMR 15.304. The system owner should.con tac,t the appropriate regional office of the Department `! Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY.ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: l37 Althea Drive Cuminaauid,MA; Owner: Barbara Blanchard Date of Inspection: September 21 2012 C. -Check if the following have been done: You must indicate"yes"or"no"as to each of the m foll w'o g 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? ✓ _ ;1.`.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 backup ✓ Was the site inspected for:signs of break out? _ •� - 5. Were all sysiem'components,excluding the SAS, located on site ✓ Were the septic;tarik_ji'mholes uncovered,opened,and the interior of the tank inspected for the condition G ;.! ; -of the baffles or..;tees;;material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? ✓ 1 n Was the facility owner'(and occupants if different from owner)provided with information on the proper, maintenance of subsurface'sewage'disposal systems? The size acid.location of:the Soil Absorption System(SAS)on the site has been determined'6ased on: Yes No.... c1l 3r ti;Pii ,. ✓ _ Existing information. For example,a.plan at the Board of Health: 14, ;1 ti ':cis I Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310'CMR 15.302(3)(b.)].:,i. t 1 lit U 4, 5 .. rJ mid lal _ L ' e Page 6 of 11 OFFICIAL INSPECTIO+1 FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE.SEWAGE DISPOSAL SYSTEM INSPECTION FORM F PART C SYSTEM INFORMATION Property Address 1 37 Althea Drive Cunznraauid MA Owner: . s Barbara Blanc Ihard Date of Inspection: 5eyteniber 21, 2012 FLOW CONDITIONS : RESIDENTIAL Number of bedrooms(design): 4 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Number b of current residents:' rl t, Does residence have a garbage grinder(yes or no): Nla Is laundry on a separate sewagesystem(yes'or no): Nla [if yes separate inspection required] . i Laundry system inspected(Ye s or no): no Seasonal use(yes or no); no Water meter"readings,if available(last 2 years.usage(gpd)): Unavailable Sump Pump(yes or no); No Last date•of occupancy: Currently COMMERCIAL/INDUSTRIAL, Type.of establishment A.', Design flow(based on 310 CvIR-15.203): gpd, Basis of design flow(seats/persons/sq/ft etc.): Grease trap present(yes or no): .Industrial waste holding tank present(yes or no) Non-sanitarylwaste'discharged to;tl!' Titl.e 5 system(yes or no): Water meter readings, if available,.! tr Last date of occupancy/use: OTHER(describe): i -)ear 'c;1 :<; ,}.' . _ . GENERAL INFORMATION Pumping:'Records,.), Source of information:'," Unkno.iv'n : . Was system pumped as part of the;inspection(yes or no): If yes,volume-,pumped:. gallons= How was quantity pumped determined? Reason for pumping , ::� no) TYPE OF_- SYSTEM') ✓ Septici-tank,idistribution.box,soil absorption system Siftgle:cesspool Overflow cesspool 'Shared"system(yes or nq)_(if yes,attach previous inspection records, if any) Innovative/Alternative teclmol69Y. Attach a copy of the current operation and maintenance contract(to be obtained from system;owner) Tight Tanki tAttach a copy of the DEP approval Other Approximate age'of,all components,date,installed(if known)and source of information: Date of installation.711 111 9 8 6 Per as-built yard Were sewage odors detected when arriving at the site(yes or no): No - 6 TWO a Page 7 of 11 OFFICIAL INSPECTION FORM - NOT FOR'VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 37 Althea Drive ' Ctannzaauid MA Owner: Barbara Blanchard Pate.of Inspection: Sevteniber 21 2012 BUILDING SEWER(locate on`site plan) Depth below.grade: ' Materials of construction'. •_cast iron _40 PVC other(explain): Distance from private water supply well`or suction line: Continents(on condition of jgmts,venting,evidence of leakage,etc:): SEPTIC TANK: ✓ (locate on site plan) Depth below grade 148 Material of construction.._ ✓__, concrete, —,i:metal fiberglass _polyethylene _other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no):. (attach a copy of, certificate) y t E Dimensions: 1500 Qal. Sludgedepth;f{'i•'`'''; 2" q Fti ,: r.•:� Distance:from top of sludge to bottom of.`o.utlet tee or baffle:, `30 Scum thickness;" Distance from fdp of scum to toptiof 06ttet;:te'e or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle: - 10" How were dimensions"determined: Measuring sticlr Comments'(owpumping ieconuriendations')inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.). The tees fiver e i eserit:_.The liquid level was'even with the outlet invert."There did not avpear to be Signs o leaha e. The inlet cove) iMs 15"below, lade.-'I . GREASE'TRAP-i, tiNone (locate onisite )lan) Depth below grade: Material of construction: _concrete metal _fiberglass _polyethylene _other. (explain):' . Dimensions: Scum thickness.- Distance from topof'scum to top:of outlet tee or baffle: Distance from lioitom.of scum:to.,bottom.of.outlet tee or baffle: Date of lastpumping., ' i.; Conunents'(on pumping recommendations;inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet)iriyert:evidence of leakage,etc.): 7 ��" 't 711C � 'ii.;•.. 1 . (1:".{kl int C•.1:, I`'. s; Page 8 of I 1 OFFICIAL`INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C a � SYSTEM INFORMATION (continued) Property Address: 37 Althea Drive Cuminaauid MA Owner: Barbara Blanchard . Date of Inspection. Seyteinber 21 2012 TIGHT or HOLDING.TANK: None'('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/day - Alarm present(yes or no): Alarm level: Alarnrin working order(yes oi•no):: Date of last pumping: Comments(condition.of'alarm and float switches,etc.): s DISTRIBUTION BOX: ✓ (if present must be opened) (locate on site plan) Depth of'liquid,lev'el above outlet.invert:!`�I.Pven Comients(note if box is.level andistr dibution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box;etc) _': z 1. The D-`Boz was+brolcen down aiidl>oots.ivei .61side.A new D-Boa was installed. The cover is 4"below rade. `PUMP CHAMBER: None n(locate.oirsite plan) Pumps in workiiig`oider'(yes or no) t - Alarms in working.order-:(Yes o..r..no). Comments'(note_c9ndition.of pump chamber,condition of pumps and appurtenances,etc.): i .. trlf; I� ltt` +tat54. II it :'ill ' r 8 , Page 9'of 11 . OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM F PART C g SYSTEM INFORMATION (continued) . Property Address: 37 Althea Drive Cumnzdauid MA Owner: a Barbara Bldnchard Date of Inspection. September 21. 2'012 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) " If SAS not located explain why: Type ✓ leaching pits,number: 1 - 6'x6' 1000 gal with 2'ofstone" Per design mall leaching chambers number: leaching galleries;number: . leaching trenches;number, length: leaching fields,:number,'';7imensions: overflow cesspool,=number Innovative/alternative system Type/name of technology: Comments_(note condition of soil, signs ofhydraulic failure, level of pondirig, damp soil, condition of vegetation, etc.): grad yit was d»}and cledn" 77re scumline was 1'un grade. .ro.in the bottom..77iere did riot ayyear to be am,signs of failure 77Ee cover ivas 12 below � . CESSPOOLS: None (cesspool must be pumped as part of inspection) (locate on site plan) r r 4 vi Number and configuration: Depth-top o�liquid to inlet invert Depth'ofsolids')ayer.E a:; ia.r,,t 9.}.,. t: Depth of scum.layer Dimensions Of cesspool: t I ,t! z,,�'•� Materials of constiuchon: Indication:of-groundwater inflow'(yes or no):'-- Comments: (note condition of soil;°signs of Hydraulic failure,level of ponding,condition of vegetation etc): 1 17,.,.bl PRIVY: 'None-(locate''on'site plan) Materials'ofcotistructiori: til)cit ;Yl;i Dimensions. Depth of solids) Comments(note condition of Sol signs of hydraulic failure,level of ponding,condition of vegetation,etc.): - L Page 10 of 11F' Jk OFFICIAL INSPECTIONFORM- NOT FOR VOLUNTARY ASSESSMENTS SU .., BSURFAC E SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: * 37 Althea Drive Cununmwd MA Owner: Bai$ar a Blanchard Date of Inspection Seytember 21, 2012 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100,feet. Locate where public water supply enters the buildingiA y a � t 3 � t,;'. 10 . Page i l of 11 d k OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 37 Althea Drive .`: Cumntaauid MA Owner: Barbara Blanchard Date of Inspection: Septeniber 21.2012 SITE EXAM. Slope P Surface water Check cellar Shallow wells y.e Estimated depth to ground water 50+/ feet Please indicate (check)all methods used to-determine.the high ground water elevation: . Obtained from system design plans on record-'If checked, date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked W' ith'local Board"of Healt+li`explain: Topographic aiid water contours naps Checked with local excavatgrs;:installers-(attach documentation) Accessed USGS database-explain:„ You must describe how,you established the Ibigh ground water elevation: USiiTQ Barnstable topoQr ayhtc grid water contours mans the nails here Aorvinz ayprozimately 50+/. to Around water at this site.. r , r. ci r .d I art n 1_ .. This report has been pr-epared only for;the septic system and components described herein. This septic system has been _ 11ispected1and passed as:of l.the date of inspection. This repoi2 is not a Warranty or guarantee that the system will . ftutction'proper lyin the future Ther;e�have been no warralities oi-gbarantees, either expressed, written or implied, relating to the septic systegi the rrispelction, this report and/or any components of the septic system>vhich have not 'illb11 een located an inspected; t jI_C.lii 'r - L _ 77/45i9 D/z/V C s ' ►.�.a / tzEv. 7-p of ; 96 I 1 I o v xF �''r N � � 9a..� 1 1_ • I h N All 2 AW�-. LOCATION SCALE . . . .:' � . . DATE.. .. . . .. �q8� PLAN REFERENCE CERTIFY THAT TH E -- SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS SHOWN HEREON AND THAT IT CONFORMS TO THE SETBACK REQUIREMENTS OF THE TOWN OF . . . . . . . . . . . .. WHEN CONSTRUCTED. DATE t . . . . . . . . .. . G'eZ-1,0C& je B6t7z461914 L�l icli�z�- Ae7771cwCx—_ REGISTERED LAND SURVEYOR / Ea eV. 7v p of �ST,e= 8y6o ASSvrsdrD 90'� 9t' 7Z37' 1 1- 7&ST ��T / Eze� 771p of I I N` 96 Zea r. M ca \ \ fl M a �` �\ Q r ' � �!s =ram LaT3/ ee. S1 TC' pL LOCATION . .8'`�2.vS"Tq./3.G 6ol. MA s5. SCALE . ��-4c' . . DATE h•)-loz PLAN REFERENCE . .9�A/d: LvT�`3/ �c.�i(� g0 C' . TAG, 8z• . . . . . . . . . . . . . . . . . . . . . . CERTIFY THAT THE ... ...... . -- '� SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS SHOWN HEREON AND THAT IT CONFORMS TO THE SETBACK REQUIREMENTS OF THE TOWN OF . . . . WHEN CONSTRUCTED. DATE � . . . . . . .. . G�v,�cE= B� eS'r9�'F? BLs�,�/c�5/ �- PETiTicry REGISTERED LAND SURVEYOR D2/v ` a--v• r-p of f i3.¢, �� • \I � _� - �/ sre= 8y6o.stssf/Hev j ae , I i Ian 86, D�sr 7f'S7- P1T N O .S&ThTC 90 92-1 2;Z — _-- N P.eoPosry � .So s¢ 9a s i iii h..C•.A,,.rl�y, It M \ E cloy �. _ \ \ `y+6- �� r:•'".-V LaT.-`.3 Sr 7 PL.g LOCATION . .8 .��vvSTx�;13,L �.. SCALE . . ��-4c' . . . DATE . ,!9,• r qs� PLAN REFERENCE -9�71YC ZoO7 / 5/76 1LIA/ oN /e 410 O �c,�►,��; 1 CERTIFY THAT THE ....... ........ -- SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS SHOWN HEREON AND THAT IT CONFORMS TO THE y SETBACK REQUIREMENTS OF THE TOWN OF . . . . . . .. . .. . .. WHEN CONSTRUCTED. DATE . . . . . . . . .. . Gtr,,ecz- BfIx89�� BL �c�Y �- PE'T7T/oyv REGISTERED LAND SURVEYOR /aG Thy i�l D/2r V tzev. rvp of 85F-6o ASSu.yo-V ee , I I lVi > Imo. — B6 \ � 3 Be,- 9 1 � � sc�vE- I�I A 91, 24 DAY 7V3F86g 94, °r 901 Ar tu Fo ee LACATION . .8�9lzvs?�?�3G� 1.45s. SCALE . . / ... .... . . . DATE PLAN REFERENCE PG, 8Z. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 CERTIFY THAT THE ... ...... . -- SHOWN ON THIS PLAN IS LOCATED ON THE GROUND 0.5 AS SHOWN HEREON AND THAT IT CONFORMS TO THE SETBACK REQUIREMENTS OF THE TOWN OF . . .. WHEN CONSTRUCTED. DATE � . . . . . . . . .. . G�a�ecC- 8�1 �a9� BLI �cl,��1Tz�- PctTiTiv-vim REGISTERED LAND SURVEYOR z of L TOP OF FOUNDATIOiF ' CONCRETE COVER .,• CONCRETE COVERS 71, /z.00 i 4"CAST IRON 2'MAX. r,.7-�, OR SCHEDULE48 12"MAX. ' P.V.C. PIPE 4"SCHEDULE 40 PV.C.(ONLY) PITCH 1/4"PER. PIPE- MIN. LEACH PITCH 1/4"PER.FT. PIT °'• PRECAST •'' NVERT LEACHING '•� EL... �::?� INVERT INVERT w S�; PIT OR . . SEPTIC TANK EL • t��o DIST, ELg�gg EQUIV. .•� INVERT isoo BOX �_ ' '•' EL.. GAL. INVERT d' �=a 0: EL.g °.. INVERT W W a: :i: 3/4"TO I V2' 83,oo :' tL t] �: �. U. WASHED STONE � Now/F PROF)LE OF GROUND WATER TABLE SEWAGE DISPOSAL SYSTEM NO SCALE P- 4 3 SOIL LOG WITNESSED BY : DATE !!; !?g'. TIME. `�:30.... . . ,TA'`✓, '!��^! . BOARD OF HEALTH TEST HOLE I TEST HOLE 2 �;7j)n/�Ytr�• �: 6l�ZG �/ ENGINEER ELEV..87.,0 DESIGN DATA : EZ. 84.So 36 it /; B3•oo NUMBER OF BEDROOMS . . Z. . . . TOTAL ESTIMATED FLOW . . ;22d, . GALLONS/DAY nmc, BOTTOM LEACHING AREA 7O�'S� /8B,.5 0 SIDE LEACHING AREA . . . . . . . . . : . SO.FT./PIT/47/ C-PP. oo GARBAGE DISPOSAL . .^'O:" .(50% AREA INCREASE) �Z•?S, ^'�a• TOTAL LEACHING AREA , Z 6 7.4�'. . SO.FT . Sara o EZ 74 a D 73 cc PERCOLATION RATE .Gas ?L,!o MIN/INCH ^/O .WATER ENCOUNTERED LEACHING AREA PER PERCOLATION RATE ..�. SO.FT/C;P.D NUMBER OF LEACHING PITS APPROVED . .. . BOARD OF HEALTH • TJ.vo• •F� °�"�'J� °"/ '`�GL S/D�s DATE. . . . . . . . . . . . . . . . . . . . . . . . . : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i 1 AGENT OR INSPECTOR EDWAd7D R. .�L �X KEEP N s27 •/�L77-/�� • .7D/Z/V&- . . . 26100 a O • . . . . . F STEPS PETITIONER •2c� � a�az� Beoqvc A/,47Z L) a THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............rO: -Al.............OF.......E'�Yl2q7- 4.................................... Appliration for Uhipoiial Works Towitrurtion ramit Application is hereby made for a Permit to Construct (t.-I or Repair an Individual Sewage Disposal System at: -7 .......................................................... ....................................................... ................... C"'.%/"",g 0 L,."D *�3;t Z07- Location-Ad-dress or Lot No. ............ . ....................4:!.dl 4D L�,/-D ..................... .............................................. Owner Address .......... .................................... .................................................................................................. Installer Address Type of Building Size Lot.... .�..Sq. feet U .................Expansion Attic Garbage Grinder Dwelling—No. of Bedrooms........................... '--4 Pk Other—Type of Building ............................ No. of persons............................ Showers Cafeteria 04 Other fixtures ------------------------------------------------------------------------------------------------------------------------------------------------------ Design Flow...;............. .....---..__.._..gallons per person per day. Total daily flow............Z.... ........................gallons. P4 Septic Tank—Liquid capacity..l.• gallons Length-_� Width..4..'G-".. Diameter................ Depth...5-/a .............. Z Disposal Trench—No- .................... Width....._. ._..__._... Total Length............. ..... Total leaching area....................sq. ft. Seepage-Pit No------------I--------- Diameter....__.. Depth below inlet........4.......... Total leaching area.._�7.....sq. f t. Z Other Distribution box ( ) Dosing tank ( ) — Percolation Test Results Performed by..... .......... Date!�!e - -------------------------- ------------------ - Test Pit No. I....-e—..-L-...minutes per inch Depth of Test Pit-__-_ !�.tg...L"Depth to ground water-----............... 0-4 Z —�Tq Test Pit No. 2.... per inch Depth of Test Pit.._..:5 ....... Depth to ground water........................ P4 ......................................................................................................................................... 0 Description of Soil.............. ...... 9;'' Sl�'R—SOIZ- .3,> "— /—i-Z 1-4, ^/� ......................6............................................................................................................. --�V , /"Vz-- U ..................................................................................................................I...................................................................................... W Z ......................................................................................................................................................................................................... U Nature of Repairs or Alterations—Answer when applicable................................................................................................ ........................................................................................................................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal Systemin accordance with the provisions of'L I TL U 5 of the State Sanitary Co —.The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b sued by the, h. Signed ... .. .. .... ...... ............................. .......................... D ........... Application Approved B ......... ............ .................................... ----/Z", ate Application Disapproved for the following reasons:............................................................................................................. ......................................................................................................................................................................................................... Date PermitNo...--- ............. IssuedL....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH T Wi, ' OF........15/` 'A'.:-1 GC.- ..................................................... Appliratiun for Diopoottl Works Tonotrnrtion r.erutit Application is hereby made for a Permit to Construct (4--7 or Repair ( ) an Individual Sewage Disposal System at 1'�y Acj...... �.�`y ...................................� ----------------------•--...-•----•�.'T-•-�-� -•--------..•..............-•-••••---.. •••••••Location-A dress or Lot t v•�6 i.'Gt:f•.... . i�� G=�...-rr�s4 Owner Address W lz _%G/z in/G /..v ...................................... ....•-•-•------•%a/�J n/—�3/--'%3 G-----•---•--------------.--.------------.--- Installer Address W �-Type of Building Size Lot......4.................. ..Sq. feet Dwelling—No. of Bedrooms..............Z...._ .......................... Attic ( ) Garbage Grinder ( ) a`4 Other—T e of Building ._..... No. of persons............................ Showers YP g --------•---:._.....- P ( ) — Cafeteria ( ) dOther fixtures .---......•---- -----•--•---•......-•----------•--•--•----•-••••-••---•----•-•---•----•--•----••-----------------------------•-------••------....... W Design Flow..................:%..............._.gallons per person per day. Total daily flow...........Z_Zv......................gallons. WSeptic Tank—Liquid capacity_.!S��gallons Length__.!`'.�G___. Width_.. -- Diameter................ Depth..a... '.... x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area.....................sq. ft. 3 Seepage Pit No..........�._...... Diameter.........X4...... Depth below inlet.......G......... Total leaching area....Z�7..sq, ft. L Z Other Distribution box ( ) Dosing tank ( ) '-' Percolation Test Results Performed by.................................. / -LGG, OcT �� /�j�' S a ------•.............•-•----•----. Date--•-----..__..._._,r......._.._..------ $4 Test Pit No. I_._.�.t-...minutes per inch Depth of Test Pit....... S ..... Depth to ground water.....-"".._........... Gi, Test Pit No. 2..... __7:_..minutes per inch Depth of Test Pit...... ' ._ Depth to ground water..__._'.............. a ........................................................ Description of Soil.............d".:3p� 3 - Init s . _____ ......................•---......--••------•------•---------------•----•----/•-.-5•Z•--•-•------/----.--s•.✓...G..-----S----,-a-----,--1-�-- U W -------------- ........................................................................................................................................................................................ 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 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. Signed....................................................................................... ..........................-.... ........... .„.... Dare lDfJ Application Approved BYE" � ......................................... ate Application Disapproved for the following reasons:........................................•----...------------•--•-----------•------•-------•---••-----•---_..._ .......---•..................•-•-------.....-•--•--------•--•---.........----------------.......----...-------•.....-•---•-----------------------••-•----•--•-•-•••-•••-•-•••-••------•-••-----•-------- Date PermitNo....... _ ........ -------•-- Issued........................•---•--------•----•----••-•-•... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 701AIA/....O F............,.....,g�is�./ST�I ................................................................ Tertifiratr of Toutplittnrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (i.•j" or Repaired ( ) by------------ :. _n.f' ----------------------------••-----•------•----------•--------..............:........................................................................ W�-^ Inst�Iler at �._ _ .._.. . -r r ----------•---------------------------•------ has been installed in accordance with the provisions of TITLE 5 of The hate Sanitary Code as escr•bed in the application for Disposal Works Construction Permit No..'�_,�.-- �'O........ dated............�1g ; ........... THE ISSUANCE HIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTE THAT THE SYSTEM WILL F . 10 TISFACTORY. G�1 DATE-------------------- --- ................................. Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH /G .........OF............. i .................................................T/�7�L �'.. No....._.. liopoottl Morko Tonotrurttion Fermit VC Permission is hereby granted.................... ..../ .--------•.....................•--•--•------------•-----•------------••--•-•--••--................----_. to Construct ( �"or Repair ( an I d'vidual Se�;a a Disposal,�System at No.•-------L.�(----------; ' )------- Street EIS Ed A j as shown on the application for Disposal Works Construction Permit Npatid '-� DATE_ Board of Health z _.. FORM 1255 A. M. SULKIN, INC., BOSTON t f ASSESSOR'S MAP NO. PARCEL O LA CATI0 SEWAGE P IT N0. LOT*3 NLFA a Ir -- 3 �� VILLAGE � INSTA LLER'S NAME i ADDRESS B U I L D E R OR OWNER G Fox(, d Z xkl r1-1 DATE PERMIT ISSUED "_ DAT E COMPLIANCE ISSUED F{LOw T 30 /4 0 ---------- Ic -A- CX— --------------- --krx.r .......... '31! I I II I � � C� � { I I } f ........... ----------- OL, 7X) -------------- i d LJ ... ....... I ----------- ..........- ------------- 42-in A�l A4 I VY Cv jj -77 J-J 4C ............. I A, ---------- LL