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HomeMy WebLinkAbout0171 ALTHEA DRIVE - Health 171 ALTHEA DI2E�l : - -- -- , Y r Y . Commonwealth of Massachusetts 33�'" zo&40 Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form-Not for Voluntary Assessments o ' 171 Althea Drive (Mailing Address is 171 Althea Drive,Yarmouth Port, MA 02675) aw Property Address Owner Kathy Miller it^, information is required for every Owner's Name page. Barnstable ✓ MA 02630 April 16,2019 City/Town State Zip Code Date of Inspection r�5; Inspection results must be submitted on this form. Inspection forms may not be altered in anyway. Please see completeness checklist at the end of the form. A. Inspector Information 1. Inspector: Michael DeCosta Jr. Name of Inspector Wind River Environmental Company Name 46 Lizotte Drive Suite 1000 Company Address Marlborough MA 01752 City/Town State Zip Code (508)400-8083 SI 13230 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5(310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above;the information reported below is true, accurate and complete as of the time of my inspection;and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: Q Passes ❑ Conditionally Passes ❑ Needs Further Evaluation by the Local Approving Authority ❑ Fails April 16,2019 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system 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. Please note: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.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 1 of 19 Commonwealth of Massachusetts u z Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 171 Althea Drive (Mailing Address is 171 Althea Drive,Yarmouth Port, MA 02675) Property Address Owner Kathy Miller information is required for every Owner's Name page. Barnstable MA 02630 April 16,2019 City/Town State Zip Code Date of Inspection C. Inspection summary Inspection Summary: Complete 1,2,3,or 5 and all of 4 and 6. 1)System Passes: Q 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: 2)System Conditionally Passes: - ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair, as approved by the Board of Health,will pass Check the box for"yes","no"or"not determined"(Y, N, ND)for the following statements. If"not determined,"please explain. The septic tank is metal and over 20 years old"or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or.exfiltration or tank failure is imminent.System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below) t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 2 of 19 Commonwealth of Massachusetts \ W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 171 Althea Drive (Mailing Address is 171 Althea Drive,Yarmouth Port, MA 02675) Property Address Owner Kathy Miller information is required for every Owner's Name page. Barnstable MA 02630 April 16,2019 City/Town State Zip Code Date of inspection C. Inspection summary (cont.) 2)System Conditionally Passes(cont.): ❑ Pump Chamber pumps/alarms not operational.System will pass with Board of Health approval if pumps/alarms are repaired. ❑ 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): 3) 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. a. 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: t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 19 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 171 Althea Drive (Mailing Address is 171 Althea Drive,Yarmouth Port, MA 02675) Property Address Owner Kathy Miller information is required for every Owner's Name page. Barnstable MA 02630 April 16,2019 City/Town State Zip Code Date of Inspection C. Inspection summary (cont.) ❑ 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. b.System will fail unless the Board of Health(and Public Water Supplier, if any)determines that the system is functioning in a manner that protects the public health,safety and environment: ❑ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. c.Other: 4)System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ Q Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ 0 Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 4 of 19 II Commonwealth of Massachusetts f Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments o 171 Althea Drive (Mailing Address is 171 Althea Drive,Yarmouth Port, MA 02675) Property Address Owner Kathy Miller information is required for every Owner's Name page. Barnstable MA 02630 April 16, 2019 City/Town State Zip Code Date of Inspection C. Inspection summary (cont.) 4) System Failure Criteria Applicable to All Systems:(cont.) Yes No ❑ Q Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Q Liquid depth in cesspool is less than 6"below invert or available volume is less than Y2 day flow ❑ Q Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped:_ ❑ Q Any portion of the SAS,cesspool or privy is below high ground water elevation. ❑ Q Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ Q Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ Q Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ Q 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.] ❑ Q The system is a cesspool serving a facility with a design flow of 2000gpd-10,000gpd. ❑ Q 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. 5)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 CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area- IWPA)or a mapped Zone II of a public water supply well t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 5 of 19 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 171 Althea Drive (Mailing Address is 171 Althea Drive,Yarmouth Port, MA 02675) Property Address Owner Kathy Miller information is required for every Owner's Name page. Barnstable MA 02630 April 16,2019 City/Town State Zip Code Date of Inspection C. Inspection summary (cont.) If you have answered"yes"to any question in Section C.5 the system is considered a significant threat,or answered "yes"in Section CA above the large system has failed.The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes"or"no"for each of the following for all inspections: Yes No Q ❑ Pumping information was provided by the owner,occupant,or Board of Health ❑ 2 Were any of the system components pumped out in the previous two weeks? Q ❑ Has the system received normal flows in the previous two week period? ❑ Q Have large volumes of water been introduced to the system recently or as part of this inspection? Q ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) Q ❑ Was the facility or dwelling inspected for signs of sewage back up? Q ❑ Was the site inspected for signs of break out? Q ❑ Were all system components,excluding the SAS, located on site? Q ❑ 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? Q ❑ 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: Q ❑ Existing information. For example,a plan at the Board of Health. ❑ Q 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)] t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 6 of 19 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 171 Althea Drive (Mailing Address is 171 Althea Drive,Yarmouth Port, MA 02675) Property Address Owner Kathy Miller information is required for every Owner's Name page. Barnstable MA 02630 April 16, 2019 City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 440 GPI Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes Q No Does residence have a water treatment unit? ❑ Yes Q No If yes,discharges to: Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes Q No information in this report.) Laundry system inspected? ❑ Yes Q No Seasonaluse? ❑ Yes 0 No Water meter readings, if available(last 2 years usage(gpd)): 927 GPD Detail: Usage: 677,000 gallons/730 days=927 GPD. Usage data provided by email from Barnstable Fire District Water Department. Sump pump? ❑ Yes Z No Last date of occupancy: Current Date t5ins.doc rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System 9 Page 7 of,19 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments iG^M 171 Althea Drive (Mailing Address is 171 Althea ea Drive,Yarmouth Port, MA 02675) Property Address Owner Kathy Miller information is Owner's Name required for every page. Barnstable MA 02630 April 16,2019 City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. 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 Water treatment unit present? ❑ Yes ❑ No If yes, discharges to Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): General Information 3. Pumping Records: Source of information: Wind River Environmental—See attached.Please note: The pumping record incorrectly lists Yarmouth Port rather than Barnstable. This has since been corrected in our system. Was system pumped as part of the inspection? 2 Yes ❑ No If yes,volume pumped: 1500 gallons How was quantity pumped determined? Measured by the pump truck Reason for pumping: Check structural integrity of the tank Lt5,.srev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 8 of 19 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 171 Althea Drive (Mailing Address is 171 Althea Drive,Yarmouth Port, MA 02675) Property Address Owner Kathy Miller information is required for every Owner's Name page. Barnstable MA 02630 April 16,2019 City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: z Septic tank,distribution box,soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system(yes or no)(if yes,attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components,date installed(if known)and source of information: Approximately 32 years old. Were sewage odors detected when arriving at the site? ❑ Yes 0 No 5. Building Sewer(locate on site plan): Depth below grade: 1.6 feet Material of construction: ❑ cast iron Q 40 PVC ❑ other(explain): Distance from private water supply well or suction line: N/A feet Comments(on condition of joints,venting,evidence of leakage, etc.): All the joints are sealed.There are no leaks.The vent is on the roof. t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 9 of 19 f TIN- Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 171 Althea Drive (Mailing Address is 171 Althea Drive,Yarmouth Port, MA 02675) Property Address Owner Kathy Miller information is required for every Owner's Name page. Barnstable MA 02630 April 16,2019 City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 1 feet Material of construction: 0 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: 10'x 5'x 5' Sludge depth: 6" Distance from top of sludge to bottom of outlet tee or baffle 40" Scum thickness 4" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 15" How were dimensions determined? Tape measure Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): All the covers are 6"below grade.The tees are good and the outlet has a filter installed.The liquid level is normal with moderate solids and sludge.The tank appears to be structurally sound and not leaking. Recommend pumping the tank and cleaning the filter annually. t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System a Page 10 of-19 q;. Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 171 Althea Drive (Mailing Address is 171 Althea Drive,Yarmouth Port, MA 02675) Property Address Owner Kathy Miller information is required for eve Owner's Name Q every page. Barnstable MA 02630 April 16,2019 City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: i Q concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): 8. 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): I Dimensions: Capacity: gallons Design Flow: gallons per day t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 11 of 19 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 171 Althea Drive (Mailing Address is 171 Althea Drive,Yarmouth Port, MA 02675) Property Address Owner Kathy Miller information is required for every Owner's Name page. Barnstable MA 02630 April 16,2019 City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) 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 9. 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.): The distribution box is on a riser and the cover is 14"below grade.The box has two outlets accepting equal flow. The liquid level is normal with minimal carryover into the box.The box is in good structural condition,watertight and not leaking. t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 12 of 19 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 171 Althea Drive (Mailing Address is 171 Althea Drive,Yarmouth Port, MA 02675) Property Address Owner Kathy Miller information is required for every Owner's Name page. Barnstable MA 02630 April 16,2019 City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. 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. 11. Soil Absorption System(SAS)(locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: 0 leaching trenches number, length: 3 @ 35' ❑ leaching fields number,dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 13 of 19 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 171 Althea Drive (Mailing Address is 171 Althea Drive,Yarmouth Port, MA 02675) Property Address Owner Kathy Miller informat------ required for every Owner's Name page. Barnstable MA 02630 April 16,2019 City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System(SAS)(Cont.) Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation" etc.): The soil is dry and sandy with no ponding and no signs of hydraulic failure.The vegetation is normal. 12. Cesspools(cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth-top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 14 of 19 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments e 171 Althea Drive (Mailing Address is 171 Althea Drive,Yarmouth Port, MA 02675) Property Address Owner Kathy Miller information is required for every Owner's Name page. Barnstable MA 02630 April 16,2019 City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. 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.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 15 of 19 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Y 171 Althea Drive (Mailing Address is 171 Althea Drive,Yarmouth Port, MA 02675) Property Address Owner Kathy Miller information is required for every Owner's Name page. Barnstable MA 02630 April 16,2019 City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. 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: 2 hand-sketch in the area below ❑ drawing attached separately House(Front) t� O � Driveway Al `247 A2=35' B 1 =40,E B2=5T 1 3 f� t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 16 of 19 r Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 171 Althea Drive (Mailing Address is 171 Althea Drive,Yarmouth Port, MA 02675) Property Address Owner Kathy Miller information is required for every Owner's Name page. Barnstable MA 02630 April 16,2019 City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: Q Check Slope 0 Surface water 0 Check cellar 0 Shallow wells Estimated depth to high ground water: 8'+ 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 0 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: Dug a small hole off the side of the leaching area.The hole was 8'below grade and approximately 5'below the SAS and showed no signs of groundwater. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 17 of 19 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 171 Althea Drive (Mailing Address is 171 Althea Drive,Yarmouth Port, MA 02675) Property Address Owner Kathy Miller information is required for every Owner's Name page. Barnstable MA 02630 April 16,2019 City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: Q A. Inspection information:Complete all fields in this section. Q B. Certification:Signed&Dated and 1,2,3,or 4 checked Q C. Inspection Summary: 1,2,3,or 5 completed as appropriate 4(Failure Criteria)and 6(Checklist)completed Q D. System Information: For 8:Tight/Holding Tank-Pumping contract attached For 15:Sketch of Sewage Disposal System drawn on pg. 16 or attached For 16: Explanation of estimated depth to high groundwater included t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 18 of 19 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �4 171 Althea Drive (Mailing Address is 171 Althea Drive,Yarmouth Port, MA 02675) Property Address Owner Kathy Miller information is required for every Owner's Name page. Barnstable MA 02630 April 16,2019 City/Town State Zip Code Date of Inspection Pumping Record Work Order#0217070809 Cust#1813044 Customer Since-201S Tax:6.2500 W Job Commen]going, Tech Comments 04/16/2.019 SVC 1500 Galls for'75 -RC' Cover(s) secured. 4-12-19 1.1e00 am 2019-150-6099. Normal seater 'level. Heavy top solids. Heavy bottom sludge, Both baffles are intact.. Main line Clear. Filter is present. and has been cleaned as needed. Recommended Boost. additive, CCLs additive. Coverts) secured. Pump every 2 St . years. .3/d/16 - very heavy solids. ashed back. suspender solids into the leaching. Recommend use of bacteria boost/cols to help keep the System healthy and installing a filter to keep suspended solids in the tank... (rc)kr System Owner System Location Miller Kathy Primary Name • 171 Althea Or 171 Althea Dr Yarmouth Port, MA.02,675 Yarmouth Port, MA 02675 (617) 916-9032 Miller Kathy t (617) 916-9932 Service Date: rare o4/16/2019 12,ao PR FreqLwtcr. Cad to Confirm: Service Type: Standard Previous Service: 04/o9/2019 Apprm. Gats. 0 CCt.S: 04/02/2019 r. Location Details: Depth Betow Grade: Custom Ctean Cult game: No Fitter y`0110o /2016 Township: CrBsi [a ors, County- Barnstable4. . trltd tJp z x 33uuu¢� n9 1001 - 1500 m 1 1 394 436 EnvironmentalGi 3a� 1e 1 Envlrrmmntal Cksmpliance �Res"�desrt1,4l tom: � �1 �.$ 3 RIa00 $ �00 � Fuel / Energy Recovery „ 7> 36aFa13 00 We iu*gest these 3 keys steps to keep your systm t"thyt lax t; 0.00 tar seryting +Use CCLS bactela afttive TOW 0.00 •We a fitter Dbpouf Sfte; WSG Dilipmat Volutne: PWment Detill Waste Code: Pumpseptic 1500.0000 Check Sates Rep: M: Ryan Council Due on Receipt Truck: Technktan: Jose A. 6indo Jr. On Stile;11,32 AM P 0 iNritier; Tech fs; System operating Pine, Normal crater level. Moderate top solids. Moderate bottom. sludge. Both baffles are intact.. Main line Not Applicable . Filter is present and has been cleaned as needed. Recommended No Recommendation. Cover(s) Customer � i. , secured. Title 5. i X Customer Siwkib re t5ins.doc 0 rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System*Page 19 of 19 e < f T C0-N1MONn17EA.;TH OF 1_VIAc[1 / �7 SE cr SACHL SE711-S EXECUTIVE OFFICE OF E' .-k;TR0�1 r DEPARTMENT OF EN-VTRONTfENTAL pp OTFcmro TITLE 5 OG� OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSLWACE SEWAGE DISPOSAL SYSTEM FORINJ PART A CERTIFICATION Property-Address: 171 1 �LA e tit wt aQ�,• ��'vr Owner's Name: /'S/� p of � Owner's Address: p f'7 t0 3� n /✓h 0 w Date of Inspection: A Name of Inspector:halease print). Company Name: Dlailing Address: o X a :: . Telephone Number{Spy _ Od64�Z : CERTIFICATION STATEMENT _ =" `- __ I certify that I have personally inspected the sewage disposal system at this address and that the m-omar T ' below is true, accurate and complete as of the time of the inspection.The in e� _ on.e�orted`"-� training and experience in the proper function and maintenance of on site sea ge disposal sems4 ed based a DL:P Y �, t� approved system inspector pursuant to Sec ' n 15:340 of Title 5(310 C1IR 15.000). the s�atem: r- r-? Passes Conditionally Passes Needs Further Evaluation by the Local Approg-in?Authori Fails Inspector's Signature: �4 , Date: a �—p The system inspector shall submit a copy of this inspection report to the Approving_ DEP)within 30 days of completing p �uhority P this inspection.If the system is a shared system or has a de sBQn,^dr ,f Of 1 ^or gpd or greater, the inspector and the system owner shall submi±the report to the appropriate reCional o _, 0 pr !Q,:,,�f1 DEP. The original should be sent to the system owner and copies sent to the buyer r applicable, r� authority. e o= :�e ' aLQ the a_Y_L'r Notes and Comments """This report only describes conditions at the time of inspection and under th time.This inspection does not address how the system will perform in the future e conditions of use at that conditions of use. under the same or different Title 5 Inspection Form, 6/15/2000 Ta nu 7 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLLTNT- A-RY ASSESSIIE 'TS SUBSURFACE SEWAGE DISPOSAL SYSTEM JLNSPECTI©S SSRBI PART A CERTIFICATION(continued) Property Address: 121 41fAell Owner: lye-l'e;► do. Date of Inspection: Inspection Summary: Check A,B,C,D or E/ALRAYS complete all of Section D A. Sy m Passes: I have not found any information which indicates that any of the failure criteria described in 310 C`�•IR 15.303 or in 310 CIvIR 1-5.304 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 needa uaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Heath. iIl Hass. Answer yes,no or not determined(Y,NT,1v�D)in the for the following,statements. If"not determined"please explain. _ The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System ;�?1 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. \D explain: Observation of sewage backup or break out or high static water IeveI in the distribution box due to hroken or obstructed pipe(s) or due to a broken,settled or uneven distribution box. System wi, pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed-Dipe(s). Tie ;T Z- pass inspection if(with approval of the Board of Health): . broken pipe(s)are replaced obstruction is removed N'D explain: Titlo {•TT+encrfinn D.....__ �,. _,__ - r Page 3 of 11 OFFICIAL INSPECTION FORIM-NOT FOR VOI.U4T_RY ASSESS:qj:N TS SUBSURFACE SEWAGE DISPOSAL SYSTEM I?\SpEC _ T-_OR-N! I r0- PART A CERTIFICATION(continued) Property Address: / �/ ���P� 4- Owner: /-52 §r� c o. `� Date of Inspection: C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of H is failing to protect public health, safety or the environment. Health in order to det ?ne;f-xe s°ste,_., 1. System will pass unless Board of Health determines in accordance with 310 C-TR 15303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: — Cesspool or prio-y 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 system is functioning in a manner that protects the public health,safety and environment: the — The system has a septic tank and soil absorption system(SAS)and the SAS is Nvi hin 100, i`et of 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 rater s p-plu_ — The system has a septic tank and SAS and the SAS is within 50 feet of a private water srply-ell. 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 colifo-n bacteria and volatile organic compounds indicates that the well is free from pollu on from that faci--l't-v and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm provided that no of rer failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: Page Pam„4 of l l OFFICIAL INSPECTION FORM—NOT FOR VOLI,?\'T-R - Y ASSESS- M�SPECTICr SUBSURFACE SEWAGE DISPOSAL SYSTE � FOIZI TS PART A CERTIFICATION(continued) Property Address: /// 1,II AP.. �, ►Mv�a ��, f Oa c3' Owner: ? p� Date of Inspection: D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes NO ckup of sewage into facility or system component due to overloaded or clogged SAS or cess000l Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or jogged SAS or cesspool I,-- Static liquid level in the distribution box above outlet invert due to an overloaded or cio6ge /�eessspool d SA_ or iquid depth in cesspool is less than 6"below invert or available volume is less than. '� day ` - _ c_a__ ,� Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe{_)• nbe=/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 u butary _o a surface water supply. �y portion of a cesspool or privy is within a Zone 1 of a public well. portion of a cesspool or privy is within 50 feet of a private water supply well. t/ Any portion of a cesspool or privy is less than 100 feet but greater than 50 f et from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analvsis. performed at a DEP certified laboratory.for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia is equal to or less than 5 ppm nitrogen and nitrate nitrogen .prodded that no oilier failure criteria are triggered.A copy of the analysis must be attached to this form.] AO(Yes/No) The system fails.I have determined that one or more of the above failure criteria existas described in 310 C-MR. 15.303,therefore the system fails.The system owner should contac he 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.fl00 gpd to 15,000 gXIThe d ndicate either"yes"or"no"to each of the following: ing criteria apply to large systems in addition to the criteria above) e system is within 400 feet of a surface drinking water supply e system is within 200 feet of a tributary to a surface drinking water capply system is located in a nitrogen sensitive area(Interim tj'ellhead Protection Area—P%t A 1 :,-=mar-- ell II of a public water supply well' .- youave answered"yes"to any question in Section E the system is considered a sign i "yes"in Section D above the large system has failed.The owner or operator of anti°Tara cart vtvPc�� �? significant threat under Section E or failed under Section D shad upgrade e s "st,.r'Co;,.cidei`d a 15.304. The system owner should contact the a LPg ad the s�Tcfe appropriate reg m in accercan;;e r_-� ;:{; �,� Tonal office of the Department C_ L. r;tlo � t-cnortinn L'nr'+v �.!7:!'lnnn Page 5 of i 1 OFFICIAL INSPECTION FORM—NOT FOR VOLL�'T_�RY ASSESSAMENTS SUBSURFACE SEWAGE DISPOSAL SysTEtif nvsPECTro3 F©RNI PART B /�. CHECRUST Property Address: �Q ��r� Qom,, ' O«-ner• et- p Date of Inspection: Check if the following have been done.You must indicate"yes"or"no"as to each of the f o107, -g: yo Pumping information was prodded by the owner,occupant,or Board of Health N any of the system components pumped out in the re-vious two o weeks 9. Has the system received normal flows in the previous two week period? v Have large volumes of water been introduced to the system recently or as part of thLs i-specion`? Were as built plans of the system obtained and examined?(If they were not available note as ; Was the facility or dwelling inspected for signs of sewage back up? l/ 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 condi .ez. of the bafflesor tees,material of construction,dimensions,depth of liquid, depth of sludge and depth of scum? v — Was the facility owner(and occupants if different from owner)prodded w t'n infor=tion on the - - maintenance of subsurface sewage disposal systems? -ope_ The size and location of the Soil Absorption System(SAS)on the site has beer,deter mined based on: Yes/no _� Existing information. For example,a plan at the Board of Health. _ Determined m the field(if any of the failure criteria related to Part C is at issue appraxLm-ason of distance is unacceptable) [310 CIV>R 15.302(3)(b)] f Page 6 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLLTINTARYASSESSN N7S SUBSURFACE SEWAGE DISPOSAL SYST LZ I1v5PECTIO FOR AT PART C SYSTEM INFORMATION Property Address: Owner: �.e Date of Inspection: FLOW CONDITIONS RESIDENTIAi, r Number of bedrooms(design):`j Number of bedrooms(actual): J DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x= N of bedrooms):` D Number of current residents:�_ Does residence have a garbage grinder(yes or no): /" is laundry on a separate sewage system(yes or no):/IiD [if yes separate inspection required? Laundry system inspected(yes or no):If/a Seasonal use: (yes or no): Water meter readings, if availa e(last 2 years usage(gpd)): Sump pump(yes or no): N' Last date of occpancy:u COINMERCI.4L/LNDUS TRIAL Type of establishment: Design flow(based on 310 C'_vLR 15.203): - gpd Basis of design flow(seats/persons!sgft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no):— Non-sanitary waste discharged to the Title 5 system(yes or no):— Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFOR-MATION Pumping Records Source of information: X—pL4�, Was system pumped as part of the inspection(yes or no):/I-, If yes, volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TY�POFYSTE�7 nk, 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 coa`acr _{,b= obtained from system owner) —Tight tank _Attach a copy of the DEP approval —Other(describe): Approximate age of all components,date ' talled(if knd n)and source of information: 00 Ol o C Were sewage odors detected when arriving at the site(yes or no): Rio T;tto G tncnurtinr� rr Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLL•=1��ZY aSSESS1fF TS SUBSURFACE SEWAGE DISPOSAL SYSTEM, INSPECTIOIN�F'OR:vj PART C SYSTEM INFORMATION(continued) Property Address: / ��� n �r Owner: /3e Ph Date of Inspection: oZ t—op BtiILDING 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: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK:_�(locate'� on site plan) Depth below grade: J Material of construction:_concrete_metal_fiberglass_polyethylene —other(explain) If tank is metal list aae:_ Is age confirmed by a Certificate of Compliance(yes or no):_(auach a com, of certificate) V Dimensions: (5 x /Q Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: c 2 Scum thickness: ii Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottorpof outlet tee or baffle:4—� How were dimensions determined: o% i Comments(on pumping recommendations,inlet and out et tee or baffle condition, structural integrity, liquid ievels as related to outlet invert, evidence of leakage,etc.): A ✓7a,r1S � G G/ ✓-0 1� c� orf- fhb 41 rho, T c,Y, GREASE TRAP: ` locate on site plan) Depth below grade:_ 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: Comments(on pumping recommendations,inlet and outlet tee or baffle condition, struct ral ate~ e__ as related to outlet invert, evidence of leakage,etc.): - Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR-N PART C n SYSTEM 0TFORMATION(continued) Property Address: H V" N, Owner: ye 'E Date of Inspection: /-0/0' TIGHT or HOLDING TAI'K:/1""(tank must be pumped at time of in_�pection)(locate on site-;)Ian) 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: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: // (if present must be o ened locate P )( on site plan) Depth of liquid level above outlet invert:toe Z-- Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover, any evid-2nce of leakage into o�Put of box; etc.): ve PUMP CHAMBER: !l/ (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances. etc): T;rlo S Page 9of11 OFFICIAL INSPECTION FORM--NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION, FOR-I PART C SYSTEM INFORINIAATION(continued) Property Address: Owner: Date of Inspection: T SOIL ABSORPTION SYSTEM(SAS): (locate on site plan.excavation not required) If SAS not located explain why: Type leaching pits,number: leaching chambers;number: s leaching galleries,number: �✓/S� �� leaching trenches,number,length: leaching fields,number, dimensions: n a overflow cesspool,number: 7 Ix innovative/alternative system Tvpe/name of technology: Comments Snote condition of soil, signs of hydraulic failure;level of ponding,damp soil, condition of i-egetaiion. etc.): / / / / / L� JJJ h e G H �Q (� (2G ✓7 Gt rt C C`✓ 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 or no): Comments(note condition of soil,signs of hydraulic failure,level ofponding, condition of vegeta ion. et; is PRIVY: locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil, signs of hydraulic failure,level ofponding.condition, of vegIL e,at;o Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBS URFACE SEW - _ AGE DISPOSAL SYSTEM I\SPECTIO- FORM PART C SYSTEM INFORMATIO'i'(continued) Property Address: 4/744,1-, Ovcrner: G ,., o✓ Date of Inspection: SKETCH OF SEWAGE DISPOSAL.SYSTEM Provide a sketch of the sewaae disposal system including ties to at least two permanent reference Iand.nark_or benchmarks. Locate all --ells within 100 feet. Locate where public water supply enters the builldinR. Fro ✓� I � e-- a � �4 V��G Page 11 of 11 e OFFICIAL. INSPECTION FORM—NOT FOR VOLLfiTARY ASSESSNTE I S SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOP-11 PART C SYSTEM INFORMATION(continued) Property Address: Owner: e., o Date of Inspection: —a/—p' SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water '6� feet o V1 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 rep-ewed: erved site(abutting property/observation hole Rjthin 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must deribe how you established the high ground eater elevation: d 42 1; OWN OF BARNSTABLE°le - A AfA i LOCATION EWAGE # -76 c�,Q VILLAGE J/ SSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. W L1�,1 YaC� 11 SEPTIC TANK CAPACITY 1�00 6AL Q LEACHING FACILITY: (type),�LYI oU� 11�Nf11�1 Zsize)5 1.2 i NO.OF BEDROOMS BUILDER OWNER �� PERMIT DATE: J25 �� COMPLIANCE DATE: — Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist : . . 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... .: - -- 8m Z � s 90. -� OQ51 Q o z S'9�) 5- V ' ,ZS -s- � 40 _ 0 to z�'/� TOWN OF BARNSTABLE". P LOCATION — 2 SEA ej 71 —76 ((,,�� EWAGE # VILLAGE 'l+ SSESSOR'S MAP & LOT "- - INSTALLER'S NAME&PHONE NO. lX,1 . �� I SEPTIC TANK CAPACITY ISDO ML LEACHING FACILITY: (type) oUs �1ILII� size)5�i�� 8� 1 NO.OF BEDROOMS BUILDERfWNE �PERMTTDMAM �25 r COMPLIANCE DATE: — Separation Distance Between the: Maximum Adjusted Groundwater Table and,Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist 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 -3- S2` A -q- 6► ' P A �560 C .- 2o =20 vs -L- 25; 56 -2- 35 47.5 ao s � 2 . No. 0 Fee( r THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01ppYication for Migogar 6pgtem Con6truction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) El Complete Syste ❑In tdual Components ®r l� L'ocation AddressLo�N . ���� � e�-- � Owner's Name,Ad dress ddrerss and Tel. Assessor's Map/Parcel 1 .. I' r�f O � Installer's Name Address and Tel. o. esi`gtner's Name,Address and Tel.No.. lt)rn. :1Dur l�r a4zlr�.,tz°.,Y'llly �(—d 1 rriPr _ 1 , I- �� GJ 1 S Type o 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 ` alions. Plan Date Number of sheets Revision Date — Title Size of Septic Tank Type of S.A.S. 5 Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure tructio d maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Tit of the iron tal Code and not to place the system in operation until a Certifi- cate of Compliance has beer d y B az f H Q q Signed Date 0-;_3 Cg( Application Approved by Date 04 Application Disapproved for the following reasons Permit No. ? 0-7 Date Issued 0 -r -7 O`7.. �,......e,rr: Fee/ • No. _ f THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ` V - Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS (� 3pplication for Zigpo.gar *proem Cow5truction Permit Application for a Permit to Construct( )Repair( ).Upgrade( )Abandon( ) D Complete System ❑Individual Components D- )q-1 Location Address or Lo N t o va � 6� 6A , Owner's Name,Address and Tel.No. � �'1�Pe6 ►' 1 e� c- ai,1L,,r y- x �fl.� , ;C�r) �6 rrn Iy of: ���ti,) c ._(6 Assessor'sMap/Parcel �t l _ /_ `i t Installer's Natn � e,Address and Tel. o. Designer's Name,Address and Tel.No.- •-.ern, �our �°..g �IZ-f� r . d�.cx� �n�►�i�� �`� - a Tel. Type of Building: Dwelling No.of Bedrooms Lot Size�3 sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 1 � gallons per day. Calculated daily flow t gallons. Plan Date "�l Number of sheets Revision Date 77 Title Size of Septic Tank Type of S.A.S. 1 S .,.._- , Description of Soil CC Nature of Repairs or Alterations(Answer when applicable) `Tate last inspected: Agreement: The undersigned agrees to ensure co tructio d maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title of the iron` tal Code and not to place the system in operation until a Certifi- cate of Compliance has be ri issu d y s oar f,He h. C q Signed Date 10 "a 3 1 g! Application Approved by d Date AO Application Disapproved for the following reasons` --- Permit No. 9 `70- Date Issued �0--Z S= ------------ - --------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABL'E, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, at the On-site Sewage Disposal,s.y-stem Construck ( )Repaired( )Upgraded'( ) Abandoned( by �('n . ` ( l�°5 C_(�C�`.�`IYl�G1 at a &Y 0 6 C 0- 4-h L OL i- ,&._�f Y)OV& has be n co true e�in taccor ce with the provisions of Title 5 and the for Disposal System Construction Permit No. 9- 7e-7 dated /o'Z . Installer On, 12 .• i !,66S Designer 1 —i4f r 1 f LA r The issuance of thi shal of be construed as a guarantee that the }� em.wyll functio a�de�ig�d� K„,� Date Inspector ']Il� / ;�� —?�— 0�-------------------------- No. Fee /VCJ' THE COMMONWEALTH OF MASSACHUSETTS 33 zl`o 6 © PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS �igpogal *pgtem Congtruction Permit Permission is hereby�granted to Construct( )Repair( ` )Upgrade( )Abandon System located at wT (Y,,66 Y) Fl and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three'years of the date of this permit. Date: /� Z /$ Approved by N :r _ '7. •.• � .,. �\: - �� .! \• �i�- - :� .tom I. � �' / �':t'J �. 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I i� �] �• ,'�I/ --I b � _.K-d<'G'J .::'D I 1 `;.ate; U3 UN - .r4._, HO•t�no l•ru _ uina.drtv.s ' t�'� ICI ar s , Q , HI /17 i I s 1 � l't pj SEQ '-`5.<:'�l'n:.e �i•U \ \�//��\ �� I \`rl ••rc 2, ! i1 I I ly f 1 V _ 9EDR7C 7� I ..........,: IC \"I.il: r'�III .il:� I \�/ �Y Y I f .J:�G /1��_❑ ___� s k, � fv7 -- i^ �—,�, r. - `� ,. is I a� T a I I •,��� ----�� -'�_`_`-`-1 C.i � _ --'a '`+ w --� _- -''=- '� .I I I Drat• �<BEr.R si 9 / aFL •I % � ,r,L. I\ :1'— / II,•1�.' '..,� \ II i ti.eti,a '•' I: y .�°':�cE"' a I �' :: L---------- ------�-- -- i s .� --;— -----;— ---- --- —tl-� i a I I ;I I I ' I d I �• '/a ' 6 6 I I #I I I I I• b b! l i ' I �r.i• I I I 71 ROOF d CEILING STRUCTURAL PLAN I I \I I i•M..,..J_.�i I ' •SECOND FLOOR PLAN Iv.. Z =I d a � I I II I I1 �P ♦, Qw `• ZR = }� ��y S � a� '4iD DT�JL<N'GrED LOW eEtR.l. ——— G-'F-•E A:iGiE!O.^J ra.u+K. 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C B SECTION v.•.nc• ^STAIR SECTION r.a• 9 j`r m••.Vx9�M u runO R�)!a•Ir •ua.(;rMrO.C �rY , � EiiE • nr frina rv+r» xc.,mo ro r'•TLroa ' n'o a Aew,,at ao seu.+o.-e•o� w nv.»Me+. I � � , o•v.ai•w erAowen .�..°..�M� f..M AR r,l LATltl 0'/.•OTr•%l• �r�.'.�W Ei '1 � �rGZrTppATiPe°GR •-,y�x CurT.lT �yr°..w+.a� .�F�'ct.Y"f,! N•RT,COO plr0l ADe Ai I i •"c•Ytlle uY nu.eurans°m..• AL���Aecu - rI acne KMT O I Sxi\•ENT _ _ __ 3y► __ �—vCI�KVT SAL G\•ooea� y, , J•� LEliTtl �. �a I qxx K),> `lx-lewx c°°Ll >�etae 4C1E:xiD u'A70L '. ] � I — 9E�TiO. A7 VAULTE CEILING gn- -------� I �— _ .- gpC1¢t•�9)__ _�_—_� �_ ant ' _— -ri�ear P=z ice_—_ —_— ___ ___ °•OO•.aG • ° �/ BUT ICfi aFl0. LATTC .v'LLJ ' LE?T ELEVATICN PRCNT ELEVATION r'� ..L i� S �—r.a r•w.Ee Z = e _ �f.•91 17� ® V� L . xa u m�-nn •�Vr 4CM ram. --_. _.. — _________ -- I'L ._: PLO,Sn I RIGHT ELEVATION e,•... °•� D,.ee� REAR ELEVATION ' rA�.ar s�•n....0 .ue•OL°°e.mT.R mN i -I".T,- c= 2- Cr T- T 5A7 Q , � i I :za s-.o uLt u:-�. �� I � :]xr occe.o'x; n1:x_e I i I I I - ---------- _T�OO,­AT L!VNC-RROO'l n't 24 a C- u A, SECTION —----—-—-—- • —ex X=1 em ---------- Ig1DA— Av . ....... _A- 'DETAIL !AR_-,=_L.�. _L . TIPLE 5AV LAM=ETAIL WALL SECTION s LC4US ROOM ------------ SECT ICN 6 FORC4 AT.-=---T Ol' Qo TO ALL tAILOW 10 fl V 'o u R-JO frill_ :X61 AT M—­T cam• IT— r 2'Al.M- 'llOO AT r A. ­c C C. T-1!.PLAM us Rcom U, .......... HE 1-0—A-A—0. L A, GTlisTt -- ex new B ILAI "7 si WALL 5=_CT1CN "A' SECTICN 5EC-.1C"4 W NdW u - T.O.F. AT EL. 111.0' SEPTIC PROFILE TEST HOLE LOGS ACCESS COVER TO WITHIN 6" OF FIN. GRADE (NOT TO SCALE) LOW AND WELLER, INC ACCESS COVER (WATERTIGHT) TO ENGINEER: 108f MINIMUM .75' OF COVER OVER PRECAST WITHIN 6" OF FIN. GRADE J. CONLON (BOH) 2% SLOPE REQUIRED OVER SYSTEM 105.0' - 106.0' WITNESS: DATE: 8/2/85 107.0' — FOR FIRST 2 UN PIPE EL 2" DOUBLE WASHED PFASTONM 2 MIN/INCH PROPOSED 1 J�!, 103.5 PERC. RATE _ 103.0 106.0' GALLON SEPTIC05.75' I TEE o FLO P# AA 4801 �v AKMONT TANK (H- 1 O AS , LINE 2o SIDESpALTHEA a BAFFLE 104.17' o000 104.0 F-. ( 4 % SLOPE) 6" CRUSHED STONE OR MECHANICAL 28 14" �'8 4 100.5' 7 LOCUS COMPACTION. (15.221 (21) 3/4" TO 1 1 2' DOUBLE WASHLD STONE DEPTH OF FLOW = 4 14 0 / ' � ELEV. 4 a TEE SIZES: ( % SLOPE) O ML 0' O' 97.0 INLET DEPTH = 10" LOAM LOAM OUTLET DEPTH = 14" - SUB SUB LOCATION MAP FOUNDATION— 23' . SEPTIC .TANK 11 p' ' LEF�k`KING 15.5' 36" 103.0' 36'� 94.0' BOX 18 FAC ITY ASSESSORS MAP 334 PARCEL 60 ZONING DISTRICT: RF-1 YARD SETBACKS: FINE MED. FRONT = 30' 85.0' SAND SIDE = 15' DENSE REAR = 15' 0��� 15'47' IF ANY UNSUITABLE SOILS ARF ENCOUJTERED IN AREA OF SAND PLAN REF. - 400/82 QQ /Q SEPTIC SYSTEM, REMOVE FOR'5' AROUND PERIMETER OF FLOOD ZONE: C 0 LEACH FACILITY DOWN TO SUITABLE SOIL LAYER. REPLACE qy 2 WITH CLEAN MED. SAND 51. 168" 92.0' 144" 85.0' PROP. PAVED DRIVEWAY LOT 22 NOTES: t: 1 cn 1 / s 1 Y1 53,405 SF± NO WATER ENCOUNTERED / 98 -14<1 I o 1 SEPTIC DESIGN: (GARBAGE DISPOSER Is NOT ALLOWED ) 1 . DATUM IS ASSUMED / 05 s , ���/' ,\�b� TH , o Dr FLOW 5 BEDROOMS ( 110 GPD) = 550 GPD 2. MUNICIPAL WATER IS AVAILABLE 1 1 �4y-94 X U; I= A Jw GNU DE il(UN hLUW - ,31 MINIM OM f iPE PITCH O BE 1/C PER Fvv, SEPI'IC TANK: 550 GPD ( 2 ) = 1100 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO H- 10 ' rn 5. PIPE JOINTS TO BE MADE WATERTIGHT. _150 USE A 0 GALLON SEPTIC TANK Q ' s ,, o> __ 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS. o LEACHING: ENVIRONMENTAL CODE TITLE V. BENCHMARK <v,! {' �, < 1 I'<f , LOT 21 CONCRETE moo/ 96 - o J , o� 2(56 + 8.83) 2 (.74) = 192 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO BE BOUND SIDES: USED FOR LOT LINE STAKING. ELEV = 97.78' ls� t 1 R 56 x 8.83 (.74) = 365.9 \ BOTTOM: 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. 4 °3 TOTAL: 753 S•F. 557.9 GPD 9, COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT PROP, ROCK RETAINING ,/--98 1 s I USE (8) H-20 HIGH CAPACITY INFILTRATORS WITH INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED WALL, MAX. 6' HIGH SA 109 04 FROM BOARD OF 'HEALTH. 3' STONE ALL AROUND AND 14" UNDER GAR ''o /°6 FINAL GRADING AROUND HOUSE SHALL. \ EXPOSE NO MORE THAN 1' OF FOUNDA.TION " LEGEND �j x o DVWOEp, s> Toe 100.0 PROPOSED SPOT ELEVATION TF 111 :' ;ti SI TE' AND SEWAGE PLAN .. 1 t0 ' 110 , :! 10Ox0 EXISTING SPOT ELEVATION OF COto , ? �E / i "r 4.3 ' LOT 22, COR. ALTHEA DR. AND OAKMONT RD n 0- PROPOSED CONTOUR o \ 11 IN THE TOWN OF: PROP. 1' ROCK LANDSCAPE WALL 100 EXISTING CONTOUR ' (CUMMAQUID) BARNSTABLE OAK 4" OR GREATER DIAM. PREPARED FOR: THEODORE J. MYERS t PROP LAMP POST ^.zhx-"' PROP. CLEARING LIMIT 40 0 40 80 120 Feet q 1 16 LOT 23 o \ ,\1'.,<�•`f,�,<. <<> � ,� BOARD OF HEALTH "I CONC. BND FOUND A \` \ �� / MA SCALE: 1 = 40 DATE: AUGUST 10, 1999 APPROVED DATE REV. 8/t9/99 \�M 10 1 3'/! / ,1 REV. 8/26/99 a ` off 508-362-4541 REV, 8/27/99 , fox 508 362-9880 44 �tH of MAS �P�\N DF down cape engineering, Inc, ��,`tA '��y o�� ARNE LA G� FIELD SURVEY PERFORMED 8/6/99 AR A H.OJALA y CIVIL ENGINEERS C CIVIL H N z e e LAND SURVEYORS A �f792 GIST soRo 9 f S I cc E Q Q 99-218 939 main st. yarmouth, ma 02675 — -------------- AR OJALA, P.E., P.L.S. DATE