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Home My WebLink About0025 BAYBERRY LANE - Health . .� .�.. +6'�'.�+ _ •_�w' ib.B�W a :._.: *•--:z•.' Y: 25 BAYBERRY LANE' � a , c' 4 : " •r - - - .. ,. O'•.... �'•..„+'zy+�YS•C-„�.'¢ +'�nb .per!}. - -- --fl .•y .� S I i 4 u - n , u d d !11 , n a - - ' 4 - V `- r y � .. �• a J�...'�. c - a _ d .,. � � v - Ng; '4 u W s , c n �'•¢,..'mt-.,a --•i'.x,.:c, c.�.�_a_,aa'a. -46rf-ix. -.•.. -... +.Sa:. .. _.. � ��.m ,'=-" ru.�:.i".r• f, �:y,.. ..-� �. .. �,,r "= z e=q .tau r>".'. r F�r i.R'„5k .y . ° r• s y r I U" • a a ' i 33�-o�fy Commonwealth of Massachusetts - Title 5 Official Inspection Form j Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 25 Bayberry Lane i,l Y rY Property Address �t=r Ashley and Kyle Deal Owner Owner's Name information is )required for every Cummaguid (Barnstable) ✓ Ma. 02675 December 27,2019 page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information on the computer, use only the tab Thomas Roux key to move your Name of Inspector cursor-do not use the return Company Name key. 89 Mayflower Lane Company Address East Wareham Ma. 02538 Cityrrown State Zip Code 774-678-9066 S14531 Telephone Number License Number B. Certification I certify that:l am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000);I have personally inspected the sewage disposal system at theproperty 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: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails CR M 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 form 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. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 25 Bayberry Lane Property Address Ashley and Kyle Deal Owner Owner's Name information is Cummaguid (Barnstable) Ma 02675 December 27,2019 required for every page. Citylrown 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: ® 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"ConditionalPass" 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): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments �a 25 Bayberry Lane Property Address Ashley and Kyle Deal Owner Owners Name information is Cummaquid (Barnstable) Ma. 02675 December 27, required for every 2019 page. Cityrrown 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: - l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 f cam, Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 25 Bayberry Lane Property Address Ashley and Kyle Deal Owner Owner's Name information is required for every Cummaquid (Barnstable) Ma. 02675 December 27, 2019 page. Cityrrown 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 El ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form �e Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 25 Bayberry Lane Property Address Ashley and Kyle Deal Owner Owners Name information is required for every Cummaquid (Barnstable) Ma. 02675 December 27, 2019 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® 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 '/2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. El ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 25 Bayberry Lane Property Address Ashley and Kyle Deal Owner Owner's Name information is required for every Cummaquid (Barnstable) Ma. 02675 December 27, 2019 page. Citylrown . 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"to any question 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 ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑, Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Wasthe facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR.15.302(5)] t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 25 Bayberry Lane Property Address Ashley and Kyle Deal Owner Owner's Name information is required for every Cummaguid (Barnstable) Ma. 02675 December 27, 2019 page. Cityrrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms(actual): 3 DESIGN flowbased on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): +330 gpd Description: Number of current residents: 3 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: current Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 25 Bayberry Lane Property Address Ashley and Kyle Deal Owner Owner's Name information is required for every Cummaquid (Barnstable) Ma. 02675 December 27, 2019 page. Cityrrown 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): 3. Pumping Records: Source of information: owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 16 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 25 Bayberry Lane Property Address Ashley and Kyle Deal Owner Owner's Name information is Cummaguid (Barnstable) Ma. 02675 December 27, 2019 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: Septic tank is 52 years old, D-Box and SAS are 5 years old. Plan at the Barnstable BOH. Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: feet feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: +10' feet Comments (on condition of joints, venting, evidence of leakage, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 25 Bayberry Lane Property Address Ashley and Kyle Deal Owner Owner's Name information is Cummaquid (Barnstable) Ma. 02675 December 27, required for every 2019 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 1.67' feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 8'L x 5.67'H x 5.67'W 1^ Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 32" Scum thickness 1" 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? measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): The Zabel filter should be removed, cleaned and put back, each time the septic tank is pumped out. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 f c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 25 Bayberry Lane Property Address Ashley and Kyle Deal Owner Owner's Name information is required for every Cummaquid (Barnstable) Ma. 02675 December 27, 2019 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition', structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w 25 Bayberry Lane u Property Address Ashley and Kyle Deal Owner Owner's Name information is required for every Cummaquid (Barnstable) Ma. 02675 December 27, 2019 page. Cityrrown 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 co f min n it copy o current e pumping g 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 existing D-Box cover was severely corroded and cracked. The D-Box cover has'been replaced with a new D-Box cover. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection form:Subsurface Sewage Disposal System-Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 25 Bayberry Lane Property Address Ashley and Kyle Deal Owner Owner's Name information is required for every Cummaquid (Barnstable) Ma. 02675 December 27, 2019 page. Cityrrown. 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: Since the septic tank and D-Box are both functioning correctly. The SAS is draining.properly. Type: ❑ leaching pits number: ® leaching chambers number: 20 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc-rev.7/262018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form �^ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 25 Bayberry Lane. Property Address Ashley and Kyle Deal. Owner Owner's Name information is required for every Cummaquid (Barnstable) Ma. 02675 December 27, 2019 page. Cityrrown 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.): There was no evidence of hydraulic failure at the time of the inspection. 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 25 Bayberry Lane Property Address Ashley and Kyle Deal Owner Owner's Name information is Cummaguid (Barnstable) Ma. 02675 December 27, required for every 2019 page. Cityrrown 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.): 'I t5insp.doc•.rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 25 Bayberry Lane Property Address Ashley and Kyle Deal Owner Owner's Name information is required for every Cummaquid (Barnstable) Ma. 02675 December 27, 2019 page. Cityrrown 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: ® hand-sketch in the area below ❑ drawing attached separately V41-P /loose /V1 � 0 1 °J Af� S .r out : g� e Q-f� 7. 'oot �l fro - e®x - 2�, t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 I Commonwealth of Massachusetts Title 5 Official Inspection Form �r Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 25 Bayberry Lane Property Address Ashley and Kyle Deal Owner Owner's Name information is required for every Cummaguid (Barnstable) Ma. 02675 December 27, 2019 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 12.3' feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 3/17/14 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: From the design plan on file. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u- 25 Bayberry Lane Property Address Ashley and Kyle Deal Owner Owner's Name information is required for every Cummaguid (Barnstable) Ma. 02675 December 27, 2019 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6 (Checklist)completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 Commonwealth of Massachusetts a - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 25 Bayberry Ln Property Address 40 Laureiro .lam Owner Owner's Name information is required for Barnstable Ma 2-1 every page. Cityrrown State Zip Code Date spection fV Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out A. General Information forms on the computer,use 1. Inspector: only the tab key to move your DOUGLAS A BROWN cursor-do not Name of Inspector use the return key. D.A.BROWN INC Company Name P.O. BOX 145 Company Address CENTERVILLE MA 02632 City/Town State Zip Code 508-420-4534 S14297 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the . information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority �. 2-15-16 Inspector's Sig6dture Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 117 ;' .. . ,." r. �� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 25 Bayberry Ln Property Address Laureiro Owner Owner's Name information is required for Barnstable Ma 2-15-16 every page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: S.a.s.is a little less than 2 yrs old:System met all passing requirements at time of inspection. Was not able to get water readings due to today being a holiday. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing.tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 r Commonwealth of Massachusetts 4 r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 25 Bayberry Ln Property Address Laureiro Owner Owner's Name information is required for Barnstable Ma 2-15-16 every page. CityrFown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N '❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 l r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 25 Bayberry Ln Property Address Laureiro Owner Owners Name information is required for Barnstable Ma 2-15-16 every page. Cityfrown State Zip Code Date of Inspection B. Certification (cost.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow t5ins-X13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �M 25 Bayberry Ln Property Address Laureiro Owner Owner's Name information is required for Barnstable Ma 2-15-16 every page. CityrFown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply El ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 117 Commonwealth of Massachusetts R w d Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 25 Bayberry Ln Property Address Laureiro Owner Owner's Name information is required for Barnstable Ma 2-15-16 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no" as to each of the following: Yes . No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ❑ ® Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 3 per assessing DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 25 Bayberry Ln Property Address Laureiro Owner Owner's Name information is required for Barnstable Ma 2-15-16 every page. City/Town State Zip Code Date of Inspection D. System Information Description: As per as-built system consists of a 1000 gallon tank d-box and a stone less s.a.s consisting of infiltrators. Number of current residents: unknown Does residence have a garbage grinder? ❑ Yes ❑ No Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ❑ No Water meter readings, if available(last 2 years usage (gpd)): Detail: System not designed for garbage disposal. I was not able to get water readings due to today being a holiday. Sump pump? ❑ Yes ❑ No Last date of occupancy. Date Commerciallindustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official InspectionForm Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 25 Bayberry Ln Property Address Laureiro Owner Owner's Name information is required for Barnstable Ma 2-15-16 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: unknown Date Other(describe below)- General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system- ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑l Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 25 Bayberry Ln Property Address Laureiro Owner Owner's Name information is required for Barnstable Ma 2-15-16 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: S.A.S. installed in 3/31/14 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 2 feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑•polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gallon per as-built Sludge depth: light to moderate t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 25 Bayberry Ln Property Address Laureiro Owner Owner's Name information is required for Barnstable Ma 2-15-16 every page. Citylrown State Zip Code Date of Inspection D. System Information (cost.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness very light Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee.or baffle pole How were dimensions determined? wooden p I� Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank looked typical for its age at time of inspection tees were in place. Original outlet was blocked and new outlet was a pvc tee. small riser was on outlet of tank.Tank was right on the inside of fence in the back yard. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 25 Bayberry Ln Property Address Laureiro Owner Owner's Name information is required for Barnstable Ma 2-15-16 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) ' Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 25 Bayberry Ln Property Address Laureiro Owner Owner's Name information is required for Barnstable Ma 2-15-16 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert oil 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.): box was viewed by camera and found to be in working order with no signs of failure or surcharge. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No" Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 25 Bayberry Ln Property Address Laureiro Owner Owner's Name information is required for Barnstable Ma 2-15-16 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: ❑ leaching galleries number: - — ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of poridiig, damp soil, condition of vegetation, etc.): Stonless infiltrators wer dry at time of inspection with no signs of failure or surcharge. 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 II Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 f • Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 25 Bayberry Ln s Y rY Property Address Laureiro Owner Owner's Name information is required for Barnstable Ma 2-15-16 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 25 Bayberry Ln Property Address Laureiro Owner Owner's Name information is required for Barnstable Ma 2-15-16 every page. CityrFown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 • Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments / M 25 Bayberry Ln Property Address Laureiro Owner Owner's Name information is required for Barnstable Ma 2-15-16 every page. CityrFown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: at least 5 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: 2014 code Before filing this Inspection Report, please see Report Completeness Checklist on next page. Lt5,n*s3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Assessing As-Built Cards Page 2 of 2 http://www.townofbamstable.us/Assessing/HMdisplay.asp?mappar=335044&seq=2 2/15/2016 r Assessing As-Built Cards Page 1 of 2 TOWN OF BARNSTABLE LOCATION SEWAGE# ZC! - (37 &PARCEL VILLAGErr- ,- ASSESSOR'S MAP �S 0 Fu�� INSTALLER'S NAME&PHONE NO. RrC SEPTIC TANK CAPACITY 1660 act¢1 n LEACHING FACILITY:(type)far b�T�,}.�k�rs (size) 25�t 11,7ia NO.OF BEDROOMS OWNER 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 Of any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY e l 1 -' �z:►-�` =D3 C A314► i EPAt Noc,Z 3-Z3 M , � r a` 3$Yz C. q8 J f � hq://www.townofbamstable.us/Assessing/HMdisplay.asp?mappar=335044&seq=2 2/15/2016 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 25 Bayberry Ln Property Address Laureiro Owner Owner's Name information is required for Barnstable Ma 2-15-16 every page. Cityfrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-3/13 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 . Assessing As-Built Cards Page 2 of 2, http://www.townofbamstable.us/AssessingyTlMdisplay.asp?mappar=335044&seq=2 2/15/2016 TOWN OF BARNSTABLE LOCATION 2_5' &u h nr :% Iyy SEWAGE# VILLAGE (; ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. k-2%G 5kfkzjN.S .Sp -776-7n q SEPTIC TANK CAPACITY /6®© (7 41 LEACHING FACILITY.(type) JL.665 (size) 7 9 1 'Sa NO.OF BEDROOMS OWNER S 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 A,- �S (3,, 12 A3 yA' a (33,_Z3 ' pp °[ 38/Z - U 'r'r►�. Porgy-- _ CAI° 8 OKI No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE MASSACHUSETTS Ye application for Disposal *pBtrm Construction i3Prmit Application for a Permit to Construct( ) Repair( ) Upgrade(V"Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. ZT Oay VC 0.46c, Owner's Name,Address,and Tel No. 9) Rcit r� Assessor's Map/Parcel Installer's Name,Address,and Tel.No. F9iC1616p s✓y Designer's Name,Address,and Tel.No. iOarrt^ ►vtV1— .?f rr ; ,ts �.�;�l7 t�n►a. $ 77G dS'�% P.o &X OXA, Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 330 gpd Design flow provided 3�6 `� gpd 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) �� ,�; "C�`yv c Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of ealth. i d Date r "� Application Approved by % Date Application Disapproved by' Date for the following reasons i Permit No. :: ' Date Issued `J lob) No. Fee 7 THE'COONWEALTH OF MASSACHUSETTS Entered in computer: II�M - Ye PUBLIC HEALTH DIVISION -TOWYN OF BARNSTABLE, MASSACHUSETTS 0[ppfitation for disposal *pstem Construction Permit _ Application for a Permit to Construct( ) Repair( ) Upgrade,(/Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Z 13a rb(r,� tK �,er� �y{e hu4s<;_ Owner's Name,Address,and Tel.No. 51)!L", fay►trS 7 �yycv �ti. P.�vH��1�� w�a'X Assessor's Map/Parcel 335 yt.j r Installer's Name,Address,and Tel.No. F7i2IC SlCvfg Designer's Name;Address,and Tel:•No. QZrwv. t►n,`�r- PA gor?I nt�rS ins �►^�Il, n�a. 1�-77610V1 �P4 Sax 981 L. 5z�w�ch 1n,w• Sag 36y 2q7Z Type of Building: Dwelling No.of Bedrooms Lot Size y% 311z 1 sq.ft. •Garbage Grinder( ) Other"`` Type of Building (24SA"e, No.of Persons -Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided 3,1Z•9L, gpd Plan Date 31I tZ A 1 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) �h}a,c �� ► ��L�`� Date last inspected: 'Agreement: . . The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. ��n n Date -'�'7 ' Application Approved by1 � Date Application Disapproved by Date for the following reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIIFY,that the On-site S/ewa�ejDi/sosaI system Constructed( ) Repaired( ) Upgraded(�/) Abandoned( )by rX l�' �S at e as` t y. 0 _ has been constructed'in ac}cor ce .with the provisions of Title 5 and the for Disposal System Construction Permit N -'ac •ated Installer E:R�4 sway,1 G Designer , #bedrooms Approved des'gn flow ,.� gpd The issuance of this permit 1 t��b]]e const AI ruue as a guarantee that the system .l� ,�tiion as,designedl r/ 4 f /1 Date Ins ector s No. Fee 1*1' THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Misposal 6pstem Construction permit Permission is.hereby granted to Construct( ) Repair( ) Upgrade( Abandon L ) System located at 2 and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions-or special conditions. Provided:Construction mu be ompletdd ithin hree years of the date of this permit. P� Date Approved by d V Y V Town of Barnstable Regulatory Services Richard V. Scali, Interim Director * BMMSrne[.e. MASS. $ Public Health Division �A s63q. �0 TE039. Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: 31 Sewage Permit# 201111-079 Assessor's Map\Parce13 �ql-/ Designer: Installer: F9\L SkSwm s Address: 1 Address: P6- 13c . 1 On 3 q /y 12i c_ Ae4 eK1 was issued a permit to install a (date) (installer) septic system at Lbased on a design drawn by ad ress) dated / designer) fl W mc� I certify that the septic system referenced above was installed substantially according to is a the design, which may include minor approved changes.such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. 7 greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required) was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed in compliance with the terms of the IAA approval letters (if applicable) OF MAss9�y D R N nst er's Signature) R 1 4 sFCIST (De§ig=r2s Signature) INI TAO PLEASE RETURN TO B STABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- ; BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\Septic\Designer Certification Form Rev 8-14-13.doc f Town of Barnstable °FtHE r Regulatory Services ti .Richard V. Scali,Interim Director Y BARNSTABLE. % Public Health Division 9 MASS. 039• 4. Thomas McKean, Director ED MAy 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Homeowner Certification Form for Alternative Systems Property Address: �� - �A MPA "Ul Assessor's Map\Parcel: 33 VO 0-1 Property Owners Name: L"{2-A A • ffV0&50-A) In accordance with Massachusetts DEP alternative system approval letters, the following certification information is required by the Owner of record. The Owner of record must place an "x" in the applicable box next to each line certifying the information. Yes N\A L� ❑ I have been provided a copy of the Title 5 UA technology Approval letters. (15 page Standard Conditions letter and the specific technology letter) l�' ❑ I have been provided with the Owner's Manual ❑ I have been provided with the Operation and Maintenance Manual ❑ For Systems installed under a Remedial Use Approval, I agree to fulfill my responsibilities to provide a Deed Notice as required by 310 CMR 15.287(10) /and the Approval ❑ YFor Systems installed under a Remedial Use Approval, I agree to fulfill my responsibilities to provide written notification of the Approval to any new Owner, as required by 310 CMR 15.287(5) I� ❑ If the design does not provide for the use of garbage grinders, the restriction is understood and accepted ❑ Whether or not covered by a warranty, I understand the requirement to' repair,replace, modify or take any other action as required by the Department or the LAA, if the Department or the LAA determines the System to be failing to protect public health and safety and the environment, as defined in 310 CMR 15.303 agree to comply with all terms and conditions above. Property Owners printed name Property Owne Signature Date Note: This form must be submitted along with the septic system disposal works permit application for all I\A systems including new construction, rep airs\upgrades, with and without aggregate (stone) and with conventional design criteria or credited design criteria. Q:\Septic\IA homeowner certification.doc Town of Barnstable Barnstable Board of Health 1 � �l `"RNETABU, MAE& 200 Main Street, Hyannis MA 02601 Fp 39. Aim 2007 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi .April 2,'2014 Mr. Darren Meyer P.O. Box 981 J E. Sandwich, MA 02537 RE 25 Bayberry Lane:, Cum`maqu_id Dear Mr. Meyer, You are granted a conditional variance on behalf of your client, Laura Hodgson, to construct an onsite sewage disposal system at 25 Bayberry Lane, Cummaquid. The variances granted are as follows: 1i Section 360-1 of the Town of Barnstable Code: To install a soil absorption system 54.7 feet away from a pond, in lieu of the minimum 100 feet separation distance required. Section 360-1 of the Town of Barnstable Code: To install.the distribution box 52 feet away from wetlands, in lieu of the minimum 100 feet separation distance.required. These variances are granted with the.following conditions: (1) No more than three (3) bedrooms are authorized at this property. Dens, study rooms, offices, finished attics, sleeping lofts, and similar-type rooms are considered "bedrooms" according to the MA Department of Environmental Protection. (2) The applicant shall record a properly worded deed restriction, signed by the owner of the property, at the Barnstable County Registry of Deeds restricting the property to three bedrooms maximum. A copy of the recorded deed restriction shall be submitted to the Health Agent prior to obtaining a disposal works construction permit. Q:\WPFILES\MeyerHodsonBayberrLane2Ol4.doc } (3) The septic system shall be installed in strict accordance with the revised plans dated March 17, 2014. ` (4) The designing registered sanitarian shall supervise the construction of the onsite sewage disposal system and shall certify in writing to the Board of Health that the system was installed in substantial compliance with the revised plans dated March 17, 2014. These variances are granted because the proposed plan appears to meet the maximum feasible design standards contained within the State -Environmental Code, Title 5 and local Health Regulations. The registered sanitarian designed the septic system to be located in an area to attempt to maximize setbacks to wetlands. Sinc rely yours ayn Mille , M.D. Chair an Q:\WPFILESNeyerHodsonBayberrLane2Ol4.doc DATE: z1ti51 <<I 0 RARMABM l � 0.19. REC. BY Town of Barnstable i sCssn. DATE.3 Board of Health 200 Main Street,Hyannis MA 02601 Office: 508-862-4644 Wayne A.Miller,M.D. FAX: 508-790-6304 Junichi Sawayanagi Paul 1.Canniff,D.M.D. VARIANCE REQUEST FORM LOCATION ''j Property Address: O( SA LAWE Assessor's Map and Parcel Number: 3. , ® r Size of Lot: r 7, Wetlands Within 300 Ft. Yes Business Name: No Subdivision Name: {�) APPLICANT'S NAME:D&12-gM M N'e'- Phone J' 3CO-3-5/ 1 Did the owner of the property authorize you to represent him or her? Yes No PROPERTY OWNER'S NAME CONTACT PERSON Name: L.+1{ii1/L� t4o9csoAj Name: M&(AX1— Address• t IAAq71 J 3T . Address:F6 sw U11 Phone: CQAA M"j)t Q V v°'t 04"37 Phone: 9 360 33// V" VARIANCE FROM REGULATION(List Reg.) REASON FOR VARIANCE(May attach if more space needed) Sep- V1 � S NATURE OF WORK: House Addition ❑ House Renovation ❑ Repair of Failed Septic System ca p Checklist (to be completed by office staff`-person receiving variance request application) '1 Please submit copies in 4 separate completed sets. ?.d"a Four(4)copies of the completed variance request forth Four(4)copies of engineered plan submitted(e.g.septic system plans) ;"<Y• ) .. ., Completed seven(7)page checklist confirming review of engineered septic system plan by submitting engineer or registered sanitarian Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant lutcben plans) Signed letter stating that the property owner authorized you to represent himther for this request d 5y _ Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense t(fr Ti VE and/or local sewage regulation variances only) Full menu submitted(for grease trap variance requests only) Variance request application fee collected(no fee for lifeguard modification renewals,grease trap variance renewals[same owner/lessele�`t)tly], outside dining variance renewals[same owner/leasee only],and variances to repair failed sewage disposal systems(only if no expansion to the building proposed]) Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Wayne Miller,Chairman NOT APPROVED Junichi Sawayanagi REASON FOR DISAPPROVAL Paul J.Canniff,D.M.D. C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Con,tent.Outlook\BAJ9P9B7\VARIREQ.DOC I MEYER & SONS, INC. PO Box 981 E.SANDWICH,MA 02537 508-362-2922 25 BAYBERRY LANE, CUMMAQUID, MA The following variances are requested: 1) Per Barnstable Board of Health Regulations, 45.3 foot variance to allow leaching to be 54.7 feet from pond vs.required 100 feet. 2) Per Barnstable Board of Health Regulations, 48.0 foot variance to allow dist. box to be 52.0.0 feet from wetlands vs. required 100 feet. ARCHITECTURE ENGINEERING SURVEYING f MEYER & SONS, INC. PO Box 981 E.SANDWICH,MA 02537 508-362-2922 February 24,2014 David LeClerc Certified Mail Pamela LeClerc Return Receipt Requested 3920 Main Street 70101060000128415798 Cummaquid, MA 02637 RE: Septic System Upgrade—Variance Request 25 Bayberry Lane,Cummaquid,MA Dear Abutter(Map: 335 Par: 057): i This letter is to notify you of a hearing before the Barnstable Board of Health scheduled on Tuesday March 11, at 3 pm in the Barnstable Town Hall Hearing Room to present the proposed septic system upgrade plan and the variance requested for the above referenced site. The proposed system design has taken into account requirements set forth in 310 CMR 15.000 (Title V) and/or the Town of Barnstable Board of Health Regulations. The following variances are requested: 1) Per Barnstable Board of Health Regulations, 45.3 foot variance to allow leaching to be 54.7 feet from pond vs. required 100 feet. 2) Per Barnstable Board of Health Regulations, 48.0 foot variance to allow dist. box to be 52.0.0 feet from wetlands vs. required 100 feet. As an abutter of the property in question, state regulations require that you be notified of the hearing a minimum of ten(10)days prior to the hearing date. You can review the application at the Barnstable Health Department, 200 Main Street, Hyannis, MA, M-F, 8:30am—4pm. If you have any further questions regarding this application, please feel free to contact. me at (508) 362-2922 or attend the hearing on the scheduled date. cerely, Darren M. Meyer Registered Sanitarian ARCHITECTURE ENGINEERING SURVEYING f IN z e FT e --- �, tic w Q Lr t= �IOOYL PLC Js (2 e* IANC— CtiMAWOD ABUTTOR'S LIST FOR 25 BAYBERRY LANE,CUMMAQUID,MA (MAP 335/PARCEL 044) MAP 335 PARCEL 043 KATHLEEN ELLISON NEWMAN 39 BAYBERRY LANE PO BOX 24660 ST. CROIX,VI 00824 MAP 335 PARCEL 046 ESTATE OF RIL HANDRICK CHRISTEN ' 46 BAYBERRY LANE 46 BAYBERRY LANE CUMMAQUID, MA 02637 MAP 335 PARCEL 045 MARK M. FLAHERTY 26 BAYBERRY LANE LEANNE MARIE DECOSTA 26 BAYBERRY LANE CUMMAQUID, MA 02637 MAP 335 PARCEL 051 LAURA HODGSON 3915 MAIN STREET PO BOX 4 CUMMAQUID, MA 02637 MAP 335 PARCEL 057 DAVID & PAMELA LECLERC 3920 MAIN STREET 3920 MAIN STREET CUMMAQUID,MA 02637 MAP 335 PARCEL 021 TERRENCE J. BOYLAN, SR. 3890 MAIN STREET VIRGINIA BOYLAN 3890 MAIN STREET CUMMAQUID, MA 02637 MAP 335 PARCEL 052 MICHAEL D. BROWNE 3885 MAIN STREET MARY P. MCSWEENEY PO BOX 246 CUMMAQUID, MA 02637 February 24, 2014 Re: 25 Bayberry Lane, Cummaquid, MA To Whom it May Concern, I grant permission to Darren Meyer of Meyer & Sons, Inc. to apply as necessary for any and all variances/approvals through the Town of Barnstable Board of Health/Conservation Commission for the purpose of obtaining approvals in conjunction with plans to upgrade/replace the existing on-site sewage system, located at 25 Bayberry Lane, Cummaquid, MA. Sincerely, Laura A. Hodgson,Owner iy Town of BAbnstable. P# Department of Regulatory Serviceslr� --' PublicIealth Division Date qlu a �ass$ 200 Main Street,Hyannis MA 02601 AVrFD IMF E' Date Scheduled - A A Time 0— c Fe91 .1 . Y9 e Pd. ! 4 l ,foil Suitabali Assessment• or- s.7M91 e D Performed By: , ,V� � �' ,Witnessed By: D VVVVr_f LOCATION & GENERAL INFORMATION r Location Address•. /� ,. ' r Owner's Name" �S I ,gyp P : ..•.��'AA IV\ �� 6�i I Address (i/ C �� L Ui I�I� V L n GJ Assessor's Map/Prcel: t�' �/ (�. I Engineet,SNmeMeVerf so7q.s NEW CONSI72UO�ON REPAIR Telephone# .► Do -j 311 Land Use t;1:•� t � �` � Slopes:('Yo). �' Surface Stones �p C ✓'� ft -Drinkin Water Well �/ ft" Distances from: Open.Water•Body • s ft Possible Wet Area g Drainage Way 1 ft 'Property Lane' �© ft Other ft SKETCH:($treet name,dimensions'of lot,exact locations of test holes&pert tests,locate.wetlands in proxttruty't holes) 5 1� I F +o"A.A,/CA-1C- 67' [.L4 I-S. Q el f:p(r) I " 00 M j - I , i - Parent material(g0logic) fA �� 1. Depth to Bedrock �- �x Depth to Groundwaler.•Standing Water in Hole:' 14 _ - f_ Weeping from pit Fgee �- Estimated Seasonal Vigh Groundwater i e DtTERMINATION FOR SEAS 6�,AOIIGH WATER T"LE Method Used: � 1.�:: '' i a'. In. Depth Observed standing in obs.hole: in. ,Depth td soh tndjust -Depth toiwee in from side of obs.hole In. OraUndwater Adjustment p.g_ � �'"�"".'• f.�ctor172, ,,,,._,.L- A�J.f7rnpndwnter].evel,;,,fl• Index Well# _ Reading Date: index Well le AtII _ 3 _ PERCOL,AT'ION TEST . Date- Time .. w Observation 1 Tlitte nt 9" Hole# �z� �d T . (y� < Time at G Depth of Pere" '1 . Start Pre-soak Time P Time(96-6") End Pre-soak Rate MinJInch Site Suitability Assessment:' Site Passed x ' Site Failed. Additional Testing Needed(YIN) Original:,Public 61e$ith DivisionObservation Hole Data To Be Completed on Back— ***If percolation test is to be condincted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one (1) week prior to beginning. DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistenc %Gravel I21 �l _ z tl + leg �1 w_ DEEP OBSERVATION HOLE LOG Hole#' Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gra el 1 d 22' IL rt 9 7l C 22V 6- 2. �l DEEP OBSERVATION HOLE LOG Hole# . Depth from Soil Horizon Soil Texture Soil Color Soil 6ther Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surfac (USDA) (Munsell) Mottling- (Structure,Stones,Boulders. Consistency, ra I �a Flood Insurance Rate May: Above 500 year flood boundary .No— Yes _ Within 500 year boundary No , Yes Within 100 year flood boundary No Yes s Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist;in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring per 'ous material? Certification C I certify that on (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required trat ' expe tise and experience described in 3,10 CMR 15.017. 1 Ia l� 1 Signature Date Q:\SEPTIC\PERCFORM.DOC down cape engineering, inc. SIEVE SOILS ANALYSIS 25 BAYBERRY ROAD CUMMAQUID, MA DATE OF REPORT: 1/9/14 .JOB : GRAIN SIZE ANALYSIS-SIEVE TEST SITE: 25 BAYBERRY ROAD CUMMAQUID, MA LOCATION: DARREN MEYER TEST HOLE SIEVE ANALYSIS Weight Sample(Grams): 211.4 SIZE :WEIGHT RETAINED % RETAINED % PASSED (sum ) --------------:.............................................. ........--------------------- ..................................... 1" 0.0: 0.0%€ 100.0% --------------i......................................................>--------------------- ------------------ 3/4" 0.0: -0.0% 100.0% --------------:.......................................................---------------------------------------- 1/2" I......................................................>-------------------- ------100:0% 3/8" 0.01 0.0% 100.0% ------------ ......................................................:---------------------=------------------ #4 0.0: 0.0%: 100.0% --------------i......................................................r---------------------,..................................... #10 15.6: 7.4%: 92.6% -------------- ......................................................---------------------...................................... #20 73.8: 34.9%: 65.1% --------------......................................................>---------------------,..................................... #40--------- .......................................176.7 -------------83 60° ......................�.6:4.0% 0 0 #50 190.1: 89.9/o: 10.1 /o --------------......................................................>---------------------,..................................... #80 202.0: 95.6%: 4.4% ------------- ......................................................---------------------,..................................... #100 205.6: 97.3%: 2.7% --------------......................................................>---------------------------------------- #200 208.4: 98.6%: 1.4% ------ PAN: 210.11 100.0%: 0.0% -------------- --------------------------+--------------------- ------------------ SAMPLE: 211.4i NOTE:TEST ON PASSING #4 ONLY, 6.9% RETAINED ON#4 <45% O.K. RESULTS: SOIL CLASSIFIED AS AASHTO A-1-b (GRAVEL AND SAND) (UNCOMPACTED) PERCENTAGE OF MATERIAL PASSING#4 SIEVE : #4 100% (TEST ONLY MATERIAL PASSING#4) OK #5010%-100% OK #100 0%-20% OK #200 0%-5% OK SAMPLE MEETS TITLE 5 FILL SPECIFICATION >98%SAND RESULTS: PERMEABLE MATERIAL-CLASS 1 <2 MIN./IN. MATERIAL NONCOMPACTED �"'�= .�a R OF M,gSSAc SOIL DESCRIPTION: MEDIUM SAND �� DAMELA. yGs OJALA CIVIL 1 No.46502 BONA cd / I--cl �IIHMWEr Town of Barnstable Barnstable do NAMeficaC t®, Board- of Health 1 BARN srnstE. 9 M►S& �a 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Junichi Sawayanagi Paul Canniff,D.M.D. October 11, 2013 Ms. Laura Hodgson P.O. Box 4 Cummaquid, MA R.E. 25 Bayberry,Iane, Cummaquid r A y335' 044 Dear Ms. Hodgson, At the October 8, 2013 public meeting of the Board of Health, the Board voted unanimously to grant you an extension to replace or upgrade the hydraulically failed septic system owned by you located at 25 Bayberry Lane; Cummaquid. This extension is granted for two years beyond the original September 3, 2013 order date. Therefore, the system shall be repaired on or before September 13, 2015. This extension is granted with the following conditions: L The water may remain turned-on for no more than three months, to allow for housing inspections during this time period while you are selling the property. 2. In three months, sometime in January 2014,the water shall be turned-off. 3. Once the home is sold, the septic system shall be repaired within sixty (60) days of the real estate transfer date. This extension is granted because you indicated in your e-mail letter dated September 9, 2013 that the home is currently unoccupied. The Board is of the opinion that the septic system should not pose a.threat to public health or to the environment if/while the home remains unoccupied: Sincer Y yours, Wayne #ler,.Mi.D , Chairman Q:\WPFILES\fiodgsonExtensio.nTwoYears2Ol3.doc Crocker, Sharon From: McKean, Thomas Sent: Monday, September 09, 2013 1:23 PM To: •• Crocker, Sharon Subject: FW: failed septic 25 Bayberry Ln - FOR October Agenda- -----Original Message----- From: Pooku87@aol.com [mailto:Pooku87@aol.com]. Sent: Monday, September 09, 2013 11:26 AM To: McKean, Thomas Subject: failed septic 25 Bayberry Ln September 9, 2013 Thomas McKean, R.S. CHO Agent' of the Board of Health Regulatory Services Department Public Health Division Barnstable, Ma. re: 25 Bayberry Lane, Cummaquid Certified Mail # 7012 1010 0000 2850 995$ Dear Mr. McKean: I'm writing in response to your letter dated Sept 3rd regarding the failed septic system at 25 Bayberry Lane in Cummaquid. My stepmother had. been living in the house for the last 15 y�ars, but went into a nursing home earlier this summer. I assumed control of the property July lst. It has been vacant since that time and will remain so. I have recently put it on the market, but I 'm reluctant to repair the septic as there is a good chance the house will be torn down - in which case the new owner would want a system that suited their needs. I 'm selling it "as i is" with the understanding the buyer would repair the septic. With this in mind, I hope you will grant me an extension of the repair order. Should you need.additional information, please let me know. Thank you for your attention to this matter. Sincerely, - , Laura A. Hodgson PO Box 4 Cummaquid, Ma. 508-362-6728</HTML>'' A. 1 I Town of B.I bnstable. P# Department of Regulatory Services arAe� : Public Health Division Date , M ,6$ 200 Main Street,Hyannis MA 02601 - - Fee Pd. J r / ` t" � .. : Time _ . Date Scheduled Qom,, , i Foil tSuitabilio Assessment for S Atlfro V, Performed By: ( (ll. r1 �� Witnessed By: e LOCATION & GENERAL'IlVFORMAT] Location Address r�t)(�S o /q 2.4/ 6AYME FILI L kN! Owner's Name C1.L MMA 9L)IJ) I Address yB�C �� Gtrl/r ✓�E��!�Ln �'1/ 3`3�'�.o I � . Assessor's Map/P�Ccel: Engineer's Name �t? �f sO;nl.c i NEW CONS ION REPAIR Telephone#' g © r 33 r/ Land Use ® ,�' ` Slopes:('Yo) �, `Surface Stones Distances from: (�pen;Water Body ` �0 ft Possible Wee Area 'ft Drinking Water Well N�ft .:f Drainage Way 1 ft .'Property lane 41) ft Other ft SKETCH:_(street name;dimensiods%f lot,exact locations of test holes&perc tests,locate wetlands in proxitnity"T holes) Y. r l a i ' o VYf�.Ut r b 0/1.Y M i , `J Y ArC.t ✓ , I Depth to Bedrock `l ' Parent material(ge(logic) ' _u I t from Pit Face' Depth to Groundwa.Or. Standing Water in Hole:'.• - . f sweeping "Estimated SeasonatiHigh Groundwater DfTERM N TION FOR SEASONAL HIGH WATER TADLE Method Used: 1 sMPA - /.)'. 2 In. "" Depth db�served standing in obs.hole: In. Depth td s011 mottles: Depth toiweeping from side of obs.hole:; '�"� ltt. Oroundwnter Adjustttlent ) ` Adj.Groundwater Level Readin Date Index Well level- -�--� Adj.f�cfOC 3_ f index Well# — _ g PERCOLATION TEST . D�tp x � Observation � � Time at 9 _ Hole# I � 3.: -•Time at6' t Depth of Pere "0 } p Time(9"6n) Start Pre-soak Time.@ End Pre% -soak t2ate 1vrnJInch ' L � • Site Suitability'Assessment Site Passed Site Failed. Additional Testing Needed(YIN) x r Original:_Public te$tth Division Observation Hole Data To Be Completed on Back— ***If Percola#On test is to be conducted`within 100' of wetland,you must first notify the Barnstable Comservatien Division at least one (1)week grioi-to beginning. DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel Qtl'12 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gra el �t►_�`1 t1 �" LOA I YZ(V As j DO 2. /j DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture, Soil Color Soil 6thcr ts,7ILT Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel DEEP OBSERVATION HOLE LOG Hole#. Depth from Soil Horizon Soil Texture Soil Color Soil Other Surfac (USDA) (Munsell) Mottling (Structure,Stones.Boulders. �.., Consisten ra I 1 Flood Insurance Rate Map: Above 500 year flood boundary No_ Yes,/ Within 500 year boundary No % Yes Within 100 year flood boundary No Yes — Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist.in all areas observed throughout the area proposed for the soil absorption system? ---V _ If not,what is the depth of naturally occurring pervious material? Certiflcation I certify that on ( (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required trot ' expe•tise and experience described in 310 CMR 15.017. Signature l` Date Q:\.SEPTICIPERCFORM.DOC i down cape engineering, inc. SIEVE SOILS ANALYSIS 25 BAYBERRY ROAD CUMMAQUID, MA DATE OF REPORT: 1/9/14 .JOB : GRAIN SIZE ANALYSIS-SIEVE TEST SITE: 25 BAYBERRY ROAD C "UMMAQUID, MA LOCATION: DARREN MEYER TEST HOLE SIEVE ANALYSIS Weight Sample(Grams): 211.4 SIZE :WEIGHT RETAINED % RETAINED % PASSED --------------':............(sum)........................... ------------=- i 1" 0.0 0.0%. 100.0% --------------...................................................... 3/4" 0.0 0.0%; 100.0% --------------:......................................................---------------------------------------- 1/2" 0.0 0.0%: 100.0% -------------I......................................................>---------------------------------------- 3/8" 0.0`: 0.0%@ 100.0% -------------:......................................................--------------_0__.0__%_-------------------- #4 0.0 ------------- ...................100.0% #10 15.6 7.4%: 92.6% -----------_-_.......................................................--------_------------...................................... #20 73.8€ 34.9% 65.1% --------------......................................................>---------------------..................................... #40 176.7: 83.6%i 16.4% -------------- ..................................................... .---------------------........................ .............. #50 190.1€ 89.9%€ 10.1% --------------i......................................................}---------------------:..................................... #80 202.0 95.6%:: 4.4% -------------:......................................................---------------------...................................... #100 205.6€ 97.3%: 2.7% --------------......................................................t---------------------------------------- #200 208.4' 98.6% 1.4% --------------:......................................................---------------------------------------- PAN: 210.1: 100.0%€ 0.0% -------------- --------------------------+---------------------z------------------- SAMPLE: € 211.4' NOTE:TEST ON PASSING.#4 ONLY, 6.9% RETAINED ON#4 <45% O.K. RESULTS: SOIL CLASSIFIED AS AASHTO A-1-b (GRAVEL AND SAND) (UNCOMPACTED) PERCENTAGE OF MATERIAL PASSING#4 SIEVE : #4 100% (TEST ONLY MATERIAL PASSING#4) OK #5010%-100% OK #100 0%-20% OK #200 0%-5% OK SAMPLE MEETS TITLE 5 FILL SPECIFICATION >98%SAND RESULTS: PERMEABLE MATERIAL-CLASS 1 <2 MINJIN. MATERIAL '— �3 NONCOMPACTED m OFiyqSS9 c SOIL DESCRIPTION: MEDIUM SAND �� DANIELA. yes OJHL a CIVIL cn No.46502 1 G/ EYL NA c / I—cl CO I• � s Ir O •I a Ln 43 Postage $ru M A Certified Fee C� O O Return Receipt Fee JDU �Q O (Endorsement Required) Restricted Delivery Fee O (Endorsement Required) M Total Postage&Fees r=11 rul r=1 Laura A. Hodgson TET AL N a. P O Box 4 - Cummaquid, MA 02637 - - ' Certified Mail Provides: o A mailing receipt ,. y e A unique identifier for youf mailpiece o A record of delivery kept by the Postal Service for two years Important Reminders: o Certified Mail may ONLY be combined with First-Class Mail(D or Priority Mail®. o Certified Mail is not available for any class of international mail. o NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. o For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain-Return Receipt service,please complete and attach a Return Receipt(PS Forrr);3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for• a duplicate return receipt,a LISPS®postmark on your Certified Mail receipt is required. o For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery. J e If a postmark on the Certified Mail receipt is desired,please present the arti-. cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 . 'i 7Attach te'iterns 1,2,and 3.Also completeA. Signat re f`Restricted Delivery is desired. tur name and address on the reverse Addesseewe can return the card to you. B. Received by(Printed Name) C. Date of De ivery his card to the back of the.mailpiece, � �GSorone front if space permits. D. Is delivery address different from item 1? ❑Yes 1 Article Addressed to: If YES,enter delivery address below- �No 'Laura A. Hodgson ET AL P O Box 4 3. Service Type Cummaquid, MA 02637 ❑Certified Mail ❑Express Mail ❑ Registered ❑Return Receipt for Merchandise ❑ Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2:Article Number ', � ; �� (Article N fromrom service labe9 7�12 1V D O OD 2 8 5 0 9 9 5 8 PS Form 3811.February 2004 Domestic:Return Receipt 102595-02-M-1540;� I r1NITED.-S�1 ES ItSTAL SERVI First-Class Mail Postage&Fees Paid O uSPS Permit No,G-10 Sender: Please print your name, address, and ZIP+4 in this box • Town of Barnstable _ Public Health Division 200 Main Street I Hyannis, MA 02601 I i i ' '. .«i«...ram.r•-. ��lto��illitl.�t2��l?iii'Iiltf11�)tlffll��!)1��!!�}if�l�i!!�1li F) I s Town of Barnstable Barnstable Regulatory Services DepartmentMAn r • �m rr Public Health Division 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL # 7012 1010 0000 2850 9958 September 3,,/013 Laura A. Hodgson ET AL P O Box 4 Cummaquid, MA 02637 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE. TITLE 5 . The septic system located at 25 Bayberry Lane, Cummaquid, MA was last inspected on 8/10/2013 by James D. Sears, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • System is in hydraulic failure. You are ordered to repair/replace the septic system within sixty (60) days from the date you receive this notification.. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH r Thomas McKean, R.S. CHO Agent of the Board of Health QASEPTICU etters Septic Inspection Failures or Future EvaU5 Bayberry Ln Barn Aug2013.doc }�ug 11 13 10:37p p.1 nx Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal! Form -Not for Voluntary Assessments 25 BayBerry Lane Property Address Lilly Hodgson Owner OwneYs Name Information required for every Cummaguid MA 02637 8-10-13 page. Citylrown State Zip Code Date of Inspection Inspection results must be submitted on this form.Inspection forms may not be altered in any way.Please see completeness checklist at the end of the form. Important:When t� filling out forms A. General InformationoF' on the computer, /� ��•��... ASS�'�.. use only the tab 1. Inspector. �`j /1 o=. -- •rye: key to move your JAMES • N�_n cursor-do not James D.Sears s o: 'm" _ S •�- use the return Name of Inspector S€1�f� •"' key. Ca ewide Enterprises,LLC i'•°F °:' Company Name IN SPE `�� 153 Commercial Street "'�Inrrun11110 Company Address Mashpee MA 02649 Citylrown - State Zip Code 508-477-8877 S1623 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ❑ Passes ❑ Conditionally Passes ® Fails .5 F£ />a 7T ❑ Needs Further Evaluation by the Local Approving AuthorityTE2 8-10-13 ors Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. *"'This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ire•3113 TM 5 OMdd#L.Sewage Diaposel Syatwn•Page 1 of 17 Aug 11 13 10:38p p.2 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 25 BayBerry Lane Property Address Lilly Hodgson kv Owner Owner's Name reqlireion foris eve Cummaguid MA 02637 8-10-13 page. every Citylrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary:Check A,B,C,D or E I always complete all of Section.D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in M CMR 15.303 or in 310.CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: 8) 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 hollowing 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)_ t5lm•3113 Title 5 Ofioal Inspection Form subsurlaoe sewage oisposal System•Pape 2 of 17 r. Aug 11 13 10:38p p.3 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 25 Bay$erry Lane Property Address Lilly Hodgson Owner Owners Name information is required for every Cummaguid MA 02637 8-10-13 page. Cityrrown State Zip Code Date of Inspection B. Certification (cunt.) ❑ Pump Chamber pumpslalarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cunt.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ NO(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ NO (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 ❑ NO (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ NO (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ine•3113 Tito 5 OMdal Inspection Fomt Subsurface Sewage Disposal System-Page 3 or 17 Aug 11 13 10:38p p.4 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 25 BayBerry Lane Property Address Lilly Hodgson Owner Owner's Name reformation required for every Cummag uid MA 02637 8-10-13 page. Cityrrown State Zip Code j Date of Inspection B. Certification (cont.) 2. System will fall unless the Board of Health (and Public Water Supplier,if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: .o '*This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal col'rform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other. D) System Failure Criteria Applicable to All Systems: You must Indicate"Yes"or"No"to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS orcesspool /N T#f f0,455 ❑ ® 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 ❑ 0 Liquid depth in cesspool is less than 6"below invert or available volume is less than'A day flow i' z S t5ins•3A 3 Tfe 5 Mdal bspedon Form:Subsurface Sewage Disposal System•Page 4 of 17 Aug 11 13 10:39p p.5 Commonwealth of Massachusetts Title 5 Official inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 25 BayBerry Lane Property Address Lilly Hodgson Owner Owners Name information is required for every Cummaguid MA 02637 8-10-13 page. CdyR'o" State Zip Code Date of Inspection B. Certification (cunt.) Yes No ❑ ® Required.pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. (This system passes if the well water analysis,performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than S ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.) ❑ The system is a cesspool serving a facility with a design flow of 2000gpd- 10.000gpd. ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails_ The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 16,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. r 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 11 of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered`yes"in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. 15ins 3113 Title 5 MdW Inspedion Form:Subwiface Sewage Dispose)System-Page 5 of 17 Aug 11 13 10:39p p.6 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 25 BayBerry Lane Property Address Lilly Hodgson Owner Owner's Name information is required for every Cummaguid MA 02637 6-10-13 page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as NIA) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ❑ Were the septic tank manholes uncovered,opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions,depth of liquid, depth of.sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System JSAS)on the site has been determined based on: ® ❑ Existing information. For example,'a plan at the Board of Health. ❑ ® 1 Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)1310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 t5irts-Y13 Title 5 Official Inspection Forth:Subaafaice Sewage Disposal System-Page 5 of 17 Q Aug 11 13 10:39p p.7 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 25 BayBerry Lane Property Address Lilly Hodgson Owner Owner's Name information is Cumma uid MA 02637 8-10-13 required for every g page. Cityrrown State Zip Code Date of Inspection D. System Information Description: The system is a 1000 Gal. tank D Box and four flows. Note: Old system stilt tied in. (D Box and orange burge,two pipe field.) Full of Black Sludge. Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes 0 No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes 0 No Water meter readings, if available(last 2 years usage(gpd)): 2011-57,0OOGais 2012-49,000 Gal's Detail: Sump pump? ❑ Yes ® No NA Last date of occupancy: Date ComroerciaUlndustrial 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.): e Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: [Sins•3/13 Title 6 ORIGel Inspection Form:subsurface Sewage Disposal System•Page 7 or 17 Aug 11 13 10:40p p.8 Commonwealth of Massachusetts Title 5 Official Inspection Form " Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 25 BayBerry Lane Property Address Lilly Hodgson - Owner Owners Name reformation is Cumma uid MA 02637 8-10-13 required for every g page, cityrrown state Zip Code Hate of Inspection D. System Information (cunt.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: 01/05/10 Capewide Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? ' Reason for pumping Type of System: ® Septic tank,distribution box,soil absorption system ❑ Single cesspool ❑ Overflow cesspool . i ❑ Privy ❑ Shared system (yes or no)(if yes, attach previous inspection records,if any) ❑ Innovative/Afternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the UA system by system operator under contract El Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3113 - This 5 olfldal Impectlm Fo11tx Subsurface Sewage Dreposal System-Pegs 8 of 17 Aug 11 13 10:40p p.9 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 25 BayBegy Lane Property Address Lilly Hodgson Owner Owners Name required � Cummaguid MA 02637 8-10-13 required for every page. City/Town state Zip Code Data of Inspection D. System Information (cunt.) Approximate age of all components, date installed (if known)and source of information_ Leaching 1976 permit #76- 125 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 30" Depth below grade: feet Material of construction: ❑ cast iron ®40 PVC ® other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints,venting,evidence of leakage, etc.): Old system orange burge. 1976 system 4" PVC SCH 40 Septic Tank(locate on site plan): Depth below grade: 16" feet Material of construction: w ®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: 1000 Gal. Precast Sludge depth: 211 t5ins•3113 * Title 5 Olfidal kmpectlon Form:Subsurfeoe Sewage Disposal System•Page 9 or 17 Aug 11 13 10:40p p.10 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ' 25 BayBery Lane Property Address Lilly Hodgson Owner Owner's Name information is required for every Cummaguid MA 02637 8-10-13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 26" Scum thickness 011 Distance from top of scum to top of outlet tee or baffle 12" Distance from bottom of scum to bottom of outlet tee or baffle 18" How were dimensions determined? Sl uudgg-Tape Sle Judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Tank at working level. Tank at 16"below grade w/covers at 6". Inlet baffle, two outlets. Baffle to old system. Other outlet w/no tee to 1976 system. Note: 4"of solid's on top of outlet line to Flow,s. Grease Trap(locate on site plan): Depth below grade: f 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: Dace 151ns-3H3 TWe 5 Ofidel Inspeafon Form:S1bsuAare Sewage Disposal System•Page 10 of 17 Aug 11 13 10:41 p , p.11 Commonwealth of Massachusetts Title 5 Official Inspection Form . Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 25 BayBerry Lane Property Address Liliy Hodgson Owner Owner's Name information is required for every Cummaguid MA 02637 8-10-13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑concrete ❑metal ❑fiberglass ❑polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): 'Attach copy of current pumping contract(required)..Is copy attached? ❑ Yes ❑ No t5ins-W3 Ute 5 Official ksspadion form:subsurface sewage oisposM system•Page 11 of 17 Aug 11 13 10:41 p p.12 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 25 BayBerry lane PropeAy Address Lilly Hodgson Owner owner's Name Inrmation is required tor every Cummaguid MA 02637 8-10-13 page. City/Town state Zip Code Date of Inspection D. System Information (cunt.) 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.): Note: Two D Box's. Box(1)Old system w/two orange burge line's out to failed field. D Box (2) 16"x21"-2' below grade w/two line's out NG wall's are gone. Need to replace D Box. y Pump Chamber(locate on site plan): Pumps in working order. ❑ Yes ❑ No* Alarms in wonting order. ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): *If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System(SAS) (locate on site plan,excavation not required): If SAS not located, explain why: t5ins+3r13 Tine 5 Oftal Inspection Forut Subxfaee Sewage Oleposal System•Pape 12 of 17 Aug 11 13 10:41 p p.13 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 25 BayBerry Lane Property Address Lilly Hodgson Owner Owner's Name requir reqtionuired s Cummaguld MA 02637 8-10-13 required for every page. CitylTown- State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number. ® leaching chambers number. ❑ leaching galleries . number ❑ leaching trenches number, length: ® leaching fields number,dimensions: 20 ❑ overflow cesspool number: ❑ innovativelalternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding,damp soil, condition of vegetation, etc.): Leaching (1)two pipe field failed. Leaching (2) Four Flow's at 2W' below grade. Camera out line's and into flows. Camera came back coverd•w/thick black sludge. Flows are not leaching. Need to replace.leaching. 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 15ins•Y13 Title 5 Official Inspection Farm:Subsurface Sawage Disposal System-Page 13 of 17 Aug 11 13 10:42p p.14 Commonwealth of Massachusetts Title 5 Official Inspection Form -- Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 25 BayBery Lane Property Address Lilly Hodgson Owner Ovvner's Name Information is required for every Cummaguid MA 02637 8-10-13 page. Citylrown State Zip Code Date of Inspedion D. System Information (cunt.) Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.): t5ins•3lt 3 Title 5 Clfkiel Inspection Forth:Sys x1low Sewage DIVosal 4slem•Page 14 of 17 Aug 11 13 10:42p p.15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 25 BayBerry Lane Property Address Lilly Hodgson Owner Owner's Name Informabrequired a Cummaguid MA 02637 8-10-13 required for every i page. City/Town state Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below , ❑ drawing attached separately 5� o c 1 t5ins-3113 Tft 5 01fidel Inspedion Form:S ibsurface Sewage Oisposai System•Page 15 of 17 Aug 11 13 10:42p p.16 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 25 BayBegy Lane Property Address Lilly Hodgson Owner Owner's Name information is required for every Cummaguid MA 02637 8-10-13 page. Citylrown State Zip Code bate of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells NA Estimated depth to high ground water. feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with focal 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: tried hand auger holes hit rock, unable to get past 4' deep. r Before filing this Inspection Report,please see Report Completeness Checklist on next page. t5ins•3113 r, Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Aug 11 13 10:43p p.17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 25 BayBerry Lane Property Address Lilly Hodgson Owner Owner's Name information is Cumma uid MA 02637 8-10-13 required for every 9 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B,C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file r 15ins•3113 Title 5 Official hspeaim Form:SubsWace Sewape Disposal System•Page IT of 17 Au6 11 13 10:43p p.18 . .. .. . .... .. .. . . .. - - f IL DATE: 8/3/99 PROPERTY ADDRESS:_25•_Bavberry Lane_______ Cummaquid , Mass . ------------------------ utf On the above date, I Inspected the septic system at the above address. This system consists of the following: 1 . 1-1000 gallon septic tank. 2 . 3—F1ow 'Diffussors . I certify the following conditions: Based on my Inspection,. y g 3. This is a title five septic system. ( 78 Code ) 4 . The septic system - is in proper working order at the present time . 5 . Pump tank annually . Garbage disposal is present . SIGNATURE: 1 J. Name:_1, P_ Macomber JTr------- 6 9 s Company: Jose.2h_P . Macomber_& Son , Inc . V Address: Box 66 q�C fi 199 Centerville , Ma__02632-0066 )'0;',0,F� ✓ Phone: 508_775_3338_______ � f TNIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY • JOSEPH P. MACOMBER & SON, INC. Tanks-Cesspools-Leachflelds Pumped & Installed Town Sewer Connections P.O. Box 66 Centerville, MA 02632-0066 775-3338 775-6412 • USETTS COMMONWEALTH OF MASSACH \ EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON MA 02108 (617) 292.5500 TRUDY COX Secretes• ARGEO PAUL CELLUCCI DAVTD B. STRIP Governor Co:r_ss:oc, SUBSURFACE SEWAGE DISPOSAL SYSTEM WSPECTION FORM PART A CERTIFICATION P,, ,,yA6..s:25 Bayberry Lane Nam. of owner Jack Hodgson Cummaquid ,Mass . Ad&"4ofownw:Box 944 Date of Inspection: Hyannis ,Mass . 02601 Name of inspector:(Plaasa Print) Joseph P. Macomber Jr. I am a DEP approved system Inspector pursuarrt to Secdon 15.340 of Tide 5 (310 CMR 15.000) c«rw—yName: Joseph.—P. Macomber & Son, Inc. µasu,g Addrau: 2632-0066 TelephorwNumber: 511A- 5-33,38 CERTIFICATION STATEMENT I cartify 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 Inspection. The Inspection was performed based on my training and experience In the proper hrnction and maintenance of on-site sewage disposal systems. The system: _ Passes Conditionally Passes Needs Further Evaluation By the Local App ving Authority Fails inspector's Signatul V/4/j�/'4 Date: The System Inspe r shall submit a copy of this Inspection report to the Approving Authority (Board of Health or OEP)within thirty (30) days of completing this Inspection. If the system Is a shared system or has a design flow of 10,000 gpd or greeter, the inspector and the system owner ' shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to Trrs system owner•and copies send to the buyer, If applicable, and the approving authority. NOTES AND COMMENTS r: A revised 9/2/98 Pa¢a l oru ur, Printed on Recycled Prper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (corrtirwed) PropertyAddre": 25 Bayberry Lane Cummaquid ,Mass . Owrw,. Jack Hodgson Date of klspectl«+: 8/3/9 9 INSPECTION SUMMARY: Check A, A C, or D: A. SYSTEM PASSES:! y. I have not found any information which indicates that any of the failure conditions described in 310 CMR 1fi.303 exist. Any failure criteria not evaluated are indicated below. COMMENTS: B. SYSTEM CONDITIONALLY PASSES: One or more system components as described In the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair,as approved by the Board of Health, will pass. Indicate yes, no, or not determined(Y, N, or NO). Describe basis of determination In all Instances. if "not determined', explain why not. The septic tank Is metal, unless the owner or operator has provided the system Inspector with a copy of a Certificate of Compliance (attached)Indicating that the tank was Installed within twenty (20) years prior to the date of the Inspection; or the septic tank, whether or not metal,Is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure Is Imminent. The system will pass Inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. Sewage backup or breakout or high static water level observed In the distribution box Is due to broken or obstructed pipe($) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). broken pips(s)are replaced obstruction is removed distribution box Is levelled or replaced - The system required pumphtg•mory then'fourdmes ayeardue to broken or obstructed pipe(s). The system wi4f7a3r- Inspection If(with approval of the Board of Health): - broken pipe(:) are'replaced obstruction Is removed 40 revised 9/2/98 Page 2of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) PropenyAddre": 25 Bayberry Lane Cuaimaquid , Mass . owner: Jack Hodgson Date Of Inspection: 8/3/9 9 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: At Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES W ACCORDANCE WITH 310 CMR 15.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH.WLLL.PRaTECT THE PUBLIC tIEALTHIAND SAFETY AND THE EMMONMENT: Cesspool or privy is within 50 feet-of surface water f+o 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 AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS Is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance _(approximation not valid). 3) OTHER AID ,vA 4 revised 9/2/98 Page 3of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Pr,p,MAddre": 25 Bayberry Lane 'Cummaquid ,Mass . owns.: Jack Hodgson Drte of inspection: 8/3/9 9 D. SYSTEM FAILS: You must Indicate either 'Yes' or 'No' to each of the following: 4D_ 1 have determined that one or more of the following failure conditions exist es described In 310 CM R 15.303. The basis for this determination Is Identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes N Backup oFsewage irrtoiecliitY-or•rrytem component-due tto en overloaded orcbgged'SAS•orcesspool. 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 lev I innihe disoib on box above utlet Invert due.to an overloaded or clogged SAS or cesspool. Liquid depth In' Is less than 6• below Invert or available volume Is less than 112 day flow. Required pumping more than�4 times In the last year NOT due to clogged or obstructed pipe(s). ,SG Number of times pumped . Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a 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 Zonal of a public well Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less-than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, anach copy of well water analysis for coliform bacteria, volatile prganiccompounds, ammonia nitrogen-and nitrate nitrogen. E. LARGE SYSTEM FAILS: 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: The system serves a facility with a design flow of 10,000 gpd or greater(Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No i the system is within 400 lest of a surface drinking water supply the system•is-within 200 a curfao"rinkir+g•wate(-suPPly • ' -- the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area -IWPA) or a mapped Zone 11 of a public water supply well) The owner or operator of any such system shall upgrade the system In accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further Infor,(ttation. m revised 9/2/98 Page 4ofIt I ; , j SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Prop"Address.25 Bayberry Lane Cummaquid ,Mass . Owner: Jack Hodgson Data of Inspection: g/3/9 9 Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: i� Yes No VPumping information was provided by the owner, occupant, or Board of Health. Z -None of the-system-compoaants.hawejeen panNnd4or-st-Jeast twoawe"a sadthe'aystem hasAmbea1=caiaia9es6sasal flow rates during that period. Large volumes of water have not been Introduced into the system recently or as part of this inspection. . _ As built plans have been obtained and examined. Note if they are not available with N/A. _ The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow. _ The site was inspected for signs of breakout. _ All system components,aluding the Soil Absorption System ave been located on the site. _ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on-the site has been determined based on: — Existing information. For example, Plan at B.O.H. J _ Determined in the field (if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) (15.302(3)1b)1 The facility owner.(and.occupants.if differaai from.owner),weraprn-ided.with iafarmatioann?ham n�apar-in Aa*an mea cf SubSurface Disposal Systems. , I revised 9/2/98 Page sortr SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: Owner: Date of 4upection: FLOW CONDITIONS RESIDENTIAL: Design flow: 411 g.p•d./bedroom. Number of bedrooms d sig Number of bedrooms(actual): Total DESIGN flow Number of current residents: Garbage grinder(yes or no): Laundry(separate system) (yes or t.: if yes, separatelnspaction.required Laundry system Inspected (�aslor no) Seasonal use (yes or no): Water meter readings,if available (last two ye:,r's usage (gpd):1 Sump Pump(yes or no): A , iQdd A� •�JS r Last date of occupancy: COMMERCIAL/INDUSTHIAL: Type of establishment: _ Design flow: 64 2pd ( Based on 15.203) Basis of design flow_ Grease trap present: (yes or no Industrial Waste Holding Tank present: (yes or no)ALM AM Non-sanitary waste discharged to the Title 5 s stem: (yes or no)_w Water meter readings,if available:_ - Last date of occupancy:_ OTHER:(Describe)_ Last date of occupancy: GENERAL INFORMATION PUMPING R ORDS aVq source o ' forrnatior�— System pumps as part of inspection: (yes or no)Ab If yes, volume pumped:—}(-�� 5allons Reason for pumping: TYPE OF SYSTEM Septic tank/distribution box/soil abswpuon system Single cesspool APO Overflow cesspool _ W Privy AID Shared system (yes or no) (if yes, attach previous inspection records.If any) AIR Technology etc. Attach copy of up to date operation and maintenance contract A Tight Tank _AA Copy of DEP Approval Other z)h IJ AP OXI r of all lo1TjpOqj6Pt3;dato i:,stalfed,-W known)•and sowce o44Aformation: 'GtEiiyl�j Sewage odors detected whan,srriving at the site: (yes or no) revised 9./2/98 P2ee6Of11 Macomber Customer History Screen SAW � Customer number 6680 Company Name Create New Invoice Customer Name Rnger Hodoson Find Invoice JobAddres-5 25 Baybony Lane JobCity Cu�uid Find Customer JobState MA Add Billing Address j JobZip Tel 362-2 Print History Fax Customer List Billing Address Box 56 BillingCity _�cuid Print BillingState MA BillingZip 02637 Notes A276 syslem 1500.00 51276 86 ,i of /89 PUMP 1105.00 10/31/B9 5114192 * T 31 5.00 ad 12194 letter E097 j urDc 1145.00 613197 r _ _ I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (cWdnue,d) PTopertyAddrass: 25 Bayberry Lane Cummaquid ,Mass . 0*(TW. Jack Hodgson Dal.#of irupection:8/3/9 9 BuU-DwG SEWER: (Lout• on sit• plan) Depth below graded Material of construction: cast Iron 240 PVC_other(axplaln) Distance from pjivete water supply well or suction line - Diameter _ omments:(condition of Joints, venting, evidence of leakage,-etc.) oints apoear SEPTIC TANK: (local# on ails plan) N Depth below grade.`l Matsrlal of construction: concre • etal&Fibarglass�Polyathylenwff other(explain) If tank Is (natal, list age ls.age.confvmad by Certificate of Compllanca (Yes/No) Dimensions: Sludge dap Distance from top of sludge to bottom of outlet tea ortraffla•�� Scum thickness:�lfe / Distance from top of scum to top of outlet tee or baHlet_�__,1_ Distance from bottom of scum to bonqm of outl�et)tes or batfle: How dimensions were determined: �j Comments: (recommendation for pumping, condition of Inlet end outlet too$ or•batfles, depth of liquid level In role Von to outlet nv�rt, tVuctLr ev.�lagnt' evidence of leakage, etc.) Pump tank A�n,tat-11.g :r.,D. Tn1Pt i n d nntlat tees are GREASE TRAP: (locate on site plan) ,�1 Depth below grada: l1 Material of constructions( concrste Amatal4 Fibarglass4,/�Polyethylsne.4ENother(explain) Dimensions: //¢¢ Scum Wckn#ss: Distance from top of scum to top of outlet tee or baffler Distance from bottom of scum to bottom of outlet tee or baMe:—" Date of tact pumping: Comments: (recommendation for pumping, condition of Inlet and outlet tees or baffles, depth of liquid leval In relation to outlet invert. svucrural iniegrir evidence of leakage, stc.) Grease revised 9/2/98 Page 7of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ` SYSTEM INFORMATION (continued) PTopertyAddrass: 25 Bayberry Lane Cummaquid ,Mass . Own&: Jack Hodgson Dau of Irupection: 8/3/9 9 TIGHT OR HOLDING TANK: (Tank must be pumped prior to, or at time of, Inspection) (locate on site plan) Depth below grade: Material of constructionWAconcreteN&netalA)AFiberglassV&PolyethyleneA other(explain) AJAQ Dimensions: Capacity: gallons Design flow: gallons/day Alarm present Alarm level: Alarm is working order: YesV NoJ171Q Date of previous pumping: Comments: (condition of Inlet tee, condition of alarm and float switches, etc.) Tight or holdin2 tanks ara nor ireQent DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet Invert: 41.6 Comments: (note if level and distribution is equal, evidenov of solids carryover, evidence of leakage Into or out of box, etc.)--- Distribution box hac mane Iateral.Evideaee e-f sr=uffl ear-r-y PUMP CHAMBER:,/ (locate on site plan) Pumps in working order:(Yes or No) 40 Alarms in working order(Yes or No)W Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc,) _ Pulp chambPr ; g not precept - -- - revised 9/2/98 PeecaofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C , t SYSTEM INFORI.IATiON (condrwed) pTop.-tyAddress: 25 Bayberry Lane Cummaquid ,Mass . Owr>e(: Jack Hodgson Dat,of kupection:8/3/9 9 SOIL ABSORPTION SYSTEM IS-SORPTION Ired,location may be approximated by non-intrusive methods) (locate on site Plan,It possibly, •xcavation not requ I If not located, explain: Type, 1aching pits, number:0 leaching chambers,number:I1 leaching galleries, number: leaching trenches,number, length: leaching fields, number, dimensions: overflow cesspool,num er:D— Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation,.etc.) C1 au is ai ge a ion empty a e res CESSPOOLS: (locate on site plan) Number and configuration: Depth-lop of liquid to Inlet Invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater. inflow (cesspool must be pumped as part of Inspection) Cesspools . Comments: (note condition of soil, signs of hydraulic failure,.level of ponding,condition of.vegetation, etc. ass oo PRIVY:. (locate on site plan) Dimensions: Materials of constructi p: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, revel of ponding, condition of vegetation:etc.) Pri P;ee9erll revised 9/2/98 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMIATION(corrdrx►od) NopaMAddrau: 25 Baybe-rry Lane Cummaquid ,Mass . Owner: Jack Hodgson. Dota of tea•«:8/3/9 9 SKETCH OF SEWAGE DISPOSAL SYSTEM: Include tlss to at 1e931 two permanent tolerance landmarks or benchmarks local$ all wells within 100' (Locate white public water supply comes Into house) • 6 T ' 6,46A revised 9/2/98 Plitt 10otlt ti we TOWN OF BARNSTABLE lQf' m�Qyo�T T OFFICE OF ` BARNSTAN BOARD OF HEALTH i639• �0m M\ 397 MAIN STREET HYANNIS, MASS. 02601 April 2, 1976 Mr. Roger Hodgson Lot 2 Bayberry Lane Cummaquid, Massachusetts Re: Variance for Lot 2, Bayberry Lane, Cumaaquid Dear Mr. Hodgson: _ We have reviewed your request for a variance to repair your present sewage system and the following corrections are made in our letter of March 19, 1976: (1) System must be .68 feet from wetlands as outlined in your plan. (2) All clay must be ,excavated until pervious material encountered and replaced with clean fill, as out- lined in your letter of February 27, 1976. (3) A minimum of 4 Rotondo flow diffusors, Model 4 x 8-L will be required. (4) All other regulations contained in Title 5, of the State Environmental Code, and the Town of Barnstable Health Regulations apply. (5) All conditions of the Conservation Commission must be followed. (6) This variance will expire March 18, 1977. V y ruly your bert L. Childs, Cha rman Ann Jane shbaug Gerald W. Hazard, M. D. BOARD OF HEALTH JMK/mm cc: Joseph P. Macomber & Son, Inc Conservation Commission (� VI 41 y SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C , SYSTEM INFORMATION (continued) Property Address:Jack Hodgson . Owner: 25 Bayberry Lane Cumma'quid ,Mass . Data of Inspection: 8/3/9 9 NRCS Report name Soil Type_ Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep _ SITE EXAM Slope Surface water Check Collar Shallow wells Estimated Depth to GroundwaterA�rFeet Pleas/e�Indicate all the methods used to determine High Groundwater Elevation: u/ Obtained from Design Plans on record Vbserved.Site (Abutting propert observation hole, basement sump etc.) etermined from local conditions Checked with local Board of health _Checked FEMA Maps Checked pumping records hocked local excavators, Installers —Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) Used water contours Map . Gahrety & Miller Model 12/16/94 revised 9/2/98 Page 11 of 11 • tr .1T.—A II•�•"T- 11f1"JeR•I.i.RI�TR.'w'IJR.1fRT•�T�f►I�nT AR4L 111�11-t 1r11 TOWN OF Barnstable WARD OF HEALTH i -•..-Tt1�_SUIISU(tFACF 9F.H�A(JF DISPOSAL�SYSTEM IN�i'F�CTYON FORM - PART D^- CEft'fIFlCAT10NR_11 _..1 -TYPE OR PRINT CLEARLY- 1 PROPERTY INSPECTED STREET ADDRESS25 Bayberry Lane Cummaquid ,Mass . ' ASSESSORS MAP, BLOCK 'AND PARCEL # OWNER' s NAME Jack Hodgson .vl>� PART D - CERTIFICATION NAME OF INSPECTOR Joseph P.Macomber Jr . COMPANY NAME J. P.Macomber & Son 'Inc . COMPANY ADDRESS Box 66 Centerville ,Mass . 02632. Strevt Town or City scat• z1P COMPANY TELEPHONE (508 ) 775 - 3338 FAX ( 790 1 1578_ ( 508 ) A CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true , accurate , and complete as of the time of ,inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent With my training and experience in the proper function and maintenance of on- site sewage disposal systems . Check one : c: !� Systeci PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15 . 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. System FAILED* The inspection which I have cond1cted has found that the system fails to Protect the public health and the environment in accordance with Title 5 , 310 CMR 15 . 303, and as specifically doted on PART C - FAILURE CRITERIA of this Inspection form . Inspector Signature Date One copy of this c rtification must be provided to the OWNER, the BUYER ( where applicable ) and the BOARD OF HEAL1'li: * If the inspection FAILED, the owner oril"operator shall u d within one year of the date of the inspection, unless allowed ortrequiredm otherwise as provided in 3.10 CMR 16 . 305 , partd .doc TOWN OF BARNSTABLE LOC:ATIOi�- f 0� �-� SEWAGE # s VILLAGE a _C��.�� ASSESSOR'S MAP& LOT 33SG-`{`I INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: 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 w tlands exist within 300 �xflodchwin facility) eet Furnished b Q b _ Aye `L B 1 to ,I o LOCi��'ION SEWOC,E PERMIT 1J0. VILLAGE IIvST L ER 1 &ME ADDRESS BUILDER 5 Q &MF- P, AD , RE SS DATE PERMIT ISSUED •- _ ` r DATE COMPLI &MICE ISSUED ; �Jd i b' z. 'T i i THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALTH ............OF............ ... ...: ✓- .._..-..... Appliration -for lRbipwial Works Tonitrurtiott Vrrotit Application is hereby`made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: -----------------------•-- •-•--••••-••---•••••-•---•--------••-••••-•-••-- z-•-----••--•--•---•-••-••----.....-- L a n- ddress or Lot No. Owner ss a . ... ...... .. .......�......_ . G.°°�!'!. .. r .......__�! 6 ' �""'`........................................... _ ._ Installer Address Q Type of Building Size Lot............................S . feet U YP g q Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) per-, Other—Type of Building __________________________- No. of persons..-.____---_______-____--__- Showers ( ) — Cafeteria ( ) Q' Other fixtures _..__ ------------------------------------------------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. P4 Septic Tank—Liquid capacity------------gallons Length................ Width................ Diameter----------------- Depth---------------- xDisposal Trench—No- ____________________ Width.................... Total Length-------------------- Total leaching area....................sq. ft. Seepage Pit No..................... Diameter-------------------- Depth below inlet.................... Total leaching area------------------sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by-------------------------------------------------------------------------- Date---------------------------------------- Test Pit No. 1----------------minutes per inch Depth of 'Pest Pit-------------------- Depth to ground wa.ter..._-._..--.---._..--..- (� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ............... . .a. ---------- --------- -/...---- -•--•-••-- -•--•-... ---- ...._.. G - -- ---------- - - D scription o oil----- -� :----- ---------- .1 l W4--------------------- ------------------------ .................................................................. ------------- --- ------------ U Nature of Repairs or Alterations—Answer when applicable._.__'_-__'�-`"'�___________ _____ ____________�+iaQ.,_..._ ..✓ __ _��Q;w Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to plate the system in operation until a Certificate of Compliance has be issued by the bo�aa d of he It / ned----- -- -----.......•--• G 6_'� ---------------- -- ------------ ------------------------------- y,/ Date Application Approved By...- - - ..... _... :='� L--�-.--7e.... Date Application Disapproved for the following reasons:----••---------•---•---•---------•-------------•--•----•-----•------------------•-•--•-•----------•-•----------- ----•---•----------------------------------------------------------------------------------•----------------------------------------•--------- ---------------------------------------------------- Date PermitNo......................................................... Issued........................................................ Date No.. ........ FEE .................... THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALTH ----.OF............ . ... ..................................................................... AVVIiratioo -for Diipo,ial Works Tomitrortion Vrroiit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: Lo t' n "" dress or Lot No. Owner rr es Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther Other—Type of Building ............................ No. of persons_..._._.................._. Showers ( ) — Cafeteria fixtures ---------- ------------------------------------ W Design Flow--------------------------------------------gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity------------gallons Length---------------- Width-------......... Diameter................ Depth.._....._...... x Disposal Trench—No. .................... Width-------------------- Total Length-------------------- Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter-------------------- Depth below inlet.................... Total leaching area..............----sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed bY.......................................................................... Date..............------------------------- Test Pit No. 1................minutes per'inch Depth of "Pest Pit-------------------- Depth to ground water................_...._.. f� Test Pit No. 2................minutes per inch Depth of Test Pit-._.._-.------_._--- Depth to ground water........._..-.._..------ R�i Description of Soil t! - r - t! x ,----------------------------------------- U Nature of Repairs or Alterations—Answer when applicable..------------ ° `"�_.--_f....�.. - " �4_.....-_...._. �,....... 44 -------------- ---------------------------------------------------------------------------------------------------------------------•.----------------------.....----------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI 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 he lth. -- �-- Goa ., ned ................ ................................ Date Application Approved By. .... �' - =~---------- -1---...4- � Date Application Disapproved for the following reasons--------------------------------•---....---.........._..---------... .....--------.............•-----......---••- ---.......--••--•--•-----------------------------------------------------•----------------•----------•-----------...------•---------••-------•------------•--------------------------------------------- Date PermitNo.................. -•---'--------••---------•-••--------• Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS 1;12 A)o 1 BOARDA HEALTH O—A - fl le vAxr '�:.......O F......... . ......... .... G�' �r ttfiratr of Tomplianrr THIS S T CE That the Ini/vidual Sewag Disposal System constructedr Repaired s� ''.- ' ,_ t ----•- - l Instatler at.....4) }. - --- ............ ................. has been installed in accordance with the ovisions Vr, 'c e X of The State Sanitary Code as desc ibed in the application for Disposal Works Construction Permit No............. 4 ------------- dated----- = ................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE© AS A GUARANTEE THAT THE SYSTEM WILL-FUNCTION SATISFACTORY. DATE---------��....-..... 14,................. Inspector-r`..'en THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEAL H No. � 1. ..... t' I`.......OF....... . .. �------------•------------- Dinpo,ial Work. noo�trortion Vrr i Permission is hereby granted_—. ...�.�.- Y__ .. -.��'h to Const ct ( or� }��}• e�pair ( /-ran dividual S �i,age Disposal eVylstem at street as shown on the application for Disposal W rks Construct n Peru o.--- 7 ated - ----------------•------- ......... L.lirk�- . /DATE..... 7 ------------------------------------ Hoard of Health FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS I i { SCALE: 1"=20' CUMMAQUID W&LOT o LOCUS: ��, :. PGA 25 BAYBERRY LN. 84 Q\� 6 P .�� - ,� Nx PARCEL ID: 335/052 \'�. �� A PARCEL ID: � v ,� / \ RAILROAD c 335/044 o Z v �� '' �� AREA=44,342f S.F. v • ... - i 'ell LOCUS MAP ` WETLAND -------------------- DITCH_-- - --- AL �'� z7.9 �\ �� ,, 61 LOCUS INFORMATION ------ eT e oT ff:; .W. �. 9 ` 6 - --- - --" - \� —a� -- `�`� 3 WETLAN,D' PLAN REF: 163 21 B TITLE REF: 22045/277 B2 PARCEL ID: MAP 335 PAR. 44 ZONING: RF-2 , /� FLOOD ZONE: 2 TT UPOLE / /�� COMMUNITY PANEL: 250001-0001-D DATED:07 02 92 TOF=29.00 ' �� — �' G---- _ _ B8_ 2� .-�-"""" '28.3 N � _ off - - __� _ _- SEPTIC SYSTEM so- a'. v _ �— ' . ,�� REPAIR PLAN S ------------- - _ ,,-�-� LOCATED AT: RATIO. - l; �,. , _ � i 25 BAYBERRY. LANE Z$ sdt fe cema' ales TBM _ I R1VE`N AY _ -'-'��%f -o C U M M A Q U I D M A. n GARAGE D , 2g �s COR=28.4 N \ r''' ---- Al ,PREPARED FOR ------ -- _ NAIL 1 - 2 0 0� W LAURA , A HODGSON.�--TH-.I. --- • 4 --------- ET -AL TH-2 ^� /�)„P 16'I. i `il �i iR ; 1°m � i lo JANUARY 10, 2014 \ REV. VARIANCE NOTES PER`BOH REQUEST: 03 17 14 �. ` EXIST. 1';000G i SEPTIC TANK AL insp. po i (re-use) A E hood. 16„P i. op ,i \ /Y�. WETLAND DA E 68 wt 9,00 ) SS2. �" AL �O � � � No. 1140 x 50� SANITAR�Pa 14, UPOLE �t� , �\ A3 o� �}., �/ � �� PARCEL ID: �jo �� ` \ Ir O `V 335/043 . d�,1� ,1>3 96 �l�QAS \ co MEYER` & SONS, INC LEGEND P.O. BOX 981 I PROPOSED CONTOUR VARIANCE TO BARNSTABLE BOH REGULATION:. I UPOLE ® PROPOSED SPOT GRADE EAST SANDWICH, MA. 02537 - 48.0' VARIANCE, TO ALLOW D-BOX TO BE NO LESS ——98 —— EXISTING CONTOUR (5 O 8)3 G'2—2 9 2 2 THAN 52.0' FROM B.V.W. VS: REQUIRED 100'. J + 96.52 EXISTING SPOT GRADE - 45.3' VARIANCE, TO ALLOW LEACHING TO BE NO LESS W EXISTING WATER SERVICE THAN 54.7' FROM B.V.W. VS. REQUIRED 100'. WETLAND DELINEATION BY BRAD HALL TEST PIT SHEET 1 OF 2 J#1603 NOTE: TO PREVENT BREAKOUT' THE PROPOSED NOTE: MAGNETIC TAPE TO BE PLACED OVER ALL COVERS FINISH GRADE SHALL NOT BE < EL:26.23 DESIGN CRITERIA FOR A DISTANCE OF 15' AROUND THE PERIMETER OF THE S.A.S. NUMBER OF BEDROOMS: 3 BEDROOM DESIGN SEPTIC TANK PROPOSED D-BOX PROPOSED S.A.S. SOIL TEXTURAL CLASS: CLASS I T.O.F. EL.=29.0 INSTALL RISERS & COVERS OVER .INLET & INSTALL RISER & COVER INSTALL A• 4" DIAMETER INSPECTION- PORT OVER OUTLET AND SET TO 6' OF FINISH GRADE SET TO 6" OF GRADE ONE CHAMBER (MIN) AND SET TO 3" OF F.G. ' DESIGN PERCOLATION RATE: <2 MIN/IN . F.G. EL.=28.5t DAILY FLOW: 330 G.P.D. F.G. EL.=28.75t F.G. EL: 29.0t F.G. EL: 29.0(MAX.) DESIGN FLOW: 330 G.P.D. GARBAGE GRINDER: NO (NOT DESIGNED FOR GARBAGE GRINDER) 9" MIN COVER/ PROPOSED SEPTIC TANK: 330gpd x 200% = 660 gpd (USE EXIST. 1,000G TANK) L = 18't 36" MAX COVER L = 10' - L = 10'(MAX) INSTALL TWO INSPECTION PORTS (MIN.) LEACHING AREA REQUIRED: 330 = 445.95 S.F. ® S=1% (MIN.) EL. = 39.00 ® S=1% (MIN.) 0 S=1% (MIN.) ( ) 4"SCH40 PVC 4"SCH40 PVC 4"SCH40 PVC 19 .74 t0 14 s 3.8".TO DISTRIBUTION BOX: (4 OUTLETS (MINIMUM)) INVERT_ PRIMARY S.A.S. INV.=26.50 48" L10I INV.=26.25 LEVEL USE 4 ROWS OF 5 = ARC36LP LOW PROFILE (3.8" INVERT) t 1 PROPOSED INV.=25.98 4 ROWS OF 5 UNITS AT 5.0'/UNIT 25.0'/ROW GAS BAFFLE D-BOX UNITS WITH NO STONE r' DB-5 INV.= 25.88 INv.=26.15 SOIL ABSORPTION SYSTEM (PROFILE) BOTTOM AREA: (GENERAL�USE ,APPROVAL FOR 4.73 SF/LF OF CHAMBER) EXISTING 1.060 GALLON SEPTIC TANK (CHAMBER UNITS) 20 UNITS x 5.00 LF.x 4.73 SF/LF 473 .SF RESTORE'VEGETATIVE COVER TOTAL AREA = .473 SF „ EXISTING SEWER OUTLET BACKFILL WITH CLEAN PERC SAND DESIGN FLOW PROVIDED: 0.74GP0/SF(454SF) 350:02 GPD > 330 GPD req'd OP OF CHAMBERS TOT 60" NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING " PIPE INVERTS PRIOR TO CONSTRUCTION 'BREAKOUT=TOP ELEV.=26.23 2) D-BOX SHALL BE SET"LEVEL AND TRUE TO INV. ELEV.= 25.88 GRADE ON A'MECHANICALL COMPACTED SIX BOTTOM ELEV. 25`.56 INCH CRUSHED STONE BASE, AS SPECIFIED IN 1 EXISTING SUITABLE , 2:83' ,, P , MATERIAL 310 CMR 15.221(2) 5' MIN: ABOVE BOTTOM OF 34" 3 REPLACE EXISTING 1,000 GALLON SEPTIC TANK T.P. EXCAVATION OR G.W. EFFECTIVE WIDTH = 4 x 2.83' = 11.32 `WITH 1500 GALLON SEPTIC TANK 1F FAILED, (5.29' PROVIDED) USE 4 ROWS OF 5 ARC 36LP DAMAGED, OR UNDERSIZED. ADJ. GROUNDWATER EL.=20.27 (3.8" INVERT) UNITS-NO STONE 4) INSTALL INLET & OUTLET `TEES�W/ ` GAS BAFFLE AS REQUIRED �. SEPTIC' SYSTEM... PROFILE PROFILE TYPICAL SECTION N.T.S. .. N.T.S. �y DATE: OCTOBER 31, 2013 P#: 141 �-- so�, GENERAL NOTES.- OF 64 OF Mqs SOIL EVALUATOR: :DARREN'-MEYER, CSE, 1614 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE,LOCAL+ S 8 BOARD OF HEALTH AND THE DESIGN ENGINEER. WITNESS: DONNA MIORANDI, BARNSTABLE HEALTH J.8" 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS DA OF .THE STATE ENVIRONMENTAL CODE,'TITLE V, AND ANY 'APPLICABLE � M- R, � � SECTION � END CAP Na, 114o Elev. " TP= 1 Depth Elev. TP-2 Depth LOCAL RULES AND REGULATIONS, •EXCEPT LISTED ON PAGE 1.- 1 N -� 29.40 0 '29.50 0" ARC36 LP (3.8" INVERT) UNITS . -, 3. THE SEWAGE'DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR FILL FILL TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE CiSTEREO 28.40 A LOAMY SAND 12" 28 50 A LOAMY SAND 12 MODEL ARC 36LP DESIGN ENGINEER. 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING SANIT00, ,10YR 3/2. 10YR 3/2 , LENGTH 60" 27.57 22" 27.50 24" NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN 1 _ ENGINEER BEFORE CONSTRUCTION CONTINUES. 1� B B EFFECTIVE LENGTH 60" TO CHANGE WITHOUT NO110E. PRODUCT DETAIL MAY 5, ALL ELEVATIONS BASED ON ASSUMED DATUM. 1� DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE. LOAMY SAND LOAMY SAND 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF 10YR 6/8 10YR s/8 SIDE WALL HEIGHT 3.8". ` 26.40 36" 26.34 38" ` THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF C C OVERALL HEIGHT 8" HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. SILT- LOAM SILT LOAM OVERALL WIDTH 34" 7. WATER SUPPLY PROVIDED BY MUNICIPAL WATER SUPPLY. 10YR 7/2 1OYR 7/2 8. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED 17.07 w/10YR 5 8 148" 1717 w 10YR-5 8 148" TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. C2 C2' CAPACITY 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE ' SIEVE ® EL. 15.0 MED SAND MED SAND THE LOCATION OF ALL UNDERGROUND UTILITIES,`PRIOR TO BEGINNING - 2.5Y 6/4 2.5Y 6/4 PROPOSED SEPTIC SYSTEM/S.I TE PLAN CONSTRUCTION. 12.90 198" 12.83 200" ` 10. EXISTING LEACHING TO BE PUMPED, CRUSHED AND REMOVED PER TITLE 5. a 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION 25 BAYBERRY LANE, C U M M AQ U I D, MA 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY PERC RATE <2 MIN/IN. VIA SIEVE TEST ON 'C2' SOILS AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY GROUNDWATER-OBSERVED AT 148" EL. 17.07 Prepared for: Hodgson WELL: AIW-247, ZONE B. LEVEL 23.9, ADJ. 3.2 FT., USE EL. 20.27'FOR ADJUSTED GROUNDWATER 13. NO ABUTTING PRIVATE WELLS WITHIN 150' OF PROPOSED LEACHING. - Design and Site Plan by: SCALE DRAWN DATE: 14. NO WETLANDS WITHIN 100' OF PROPOSED LEACHING. MEYER&SONS, INC. NTS D.M.M. 01/10/14 15. ALL PIPING TO BE 4" SCH 40 0 1/8"/FT (UNLESS SPECIFIED) • I, Darren M. Meyer, R.S., CSE, hereby certify that I am currently approved by MADEP pursuant to 310 CMR 15.017 i PO BOX 981 16. REMOVE UNSUITABLE SOILS 5 FT. AROUND LEACHING TO EL. 17.07 OR TOP OF to conduct soil evaluations and that the above analysis has been performed by me consistent with the EAST SANDWICH,MA 02537 REV.:DATE: CHECKED SHEET NO. 'C2" LAYER AND REPLACE W/ CLEAN MEDIUM SAND PER TITLE 5. SOILS AND HORIZONS MAY VARY. requirements of 310 CMR 15.017. 1 further certify that I have passed the Soil Evol. Exam in October, 1999. 03 17 14 D.M.M. 2 Of 2 508-362-2922 I SCALE: '1"=20'. CUMMAQUID WHOLE LOT �1 ' 92P • g LOCUS: P61 P 25 BAYBERRY LN. B5 tx PARCEL ID: AIL 335/052 'i \` �� PARCEL .ID: o ��' �= �� ` RAILROAD c \ .335/044 o Z D AREA=44,,342f S.F. o z LOCUS MAP ,ilk • ' , • • • � ,; - � • -*-------------.-----.---------J WETLAND -=-- DITCH _ , AL _- ; �279 � �, ` � - A------- eTge oTB.V,W: ry. _ \�' WETLAND LOCUS INFORMATION. - -�6-- _ _. n \`�_ .\ — �� — PLAN 163/21 e1 ORMATIO . - _ _ 67 _ B3 7 i �— r'-!�� •TLTLE REF: 22045/27 . --- r �� ;_— 62 _-- . PARCEL ID: MAP 335 PAR. 44 _ ZONING: RF— _ F \ J Z 2 AIL -------- — /' �-j �\ `\ — — -� 2' FLOOD ZONE: C.. #25 �- _ — UPOLE COMMUNITY PANEL: 2.50001-0001=D DATED:07/02/92 -I _ TOF=29.00 `\'. \� _ — --- -- -- -- B8 __— ` "'"— SEPTIC SYSTEM 28.3 I ___------ 27 c„ -`' - -- --- - �. PAIR PLAN cb� RE I CA A WPATIO _ 25 . BAYBERRY LANE fencema ales M _ \ . I R, w A �,. - C U M M A Q U I D, 5a GARAGE p vE - — M`A 9 =�\ COR=28.4; - \ <. ,��`�� ' ----- �� PREPARED FOR --- ------ — ~� NAIL - - -- ----- Al 0�' W LAU R A ' A. H ODGSON m 127.8s ET AL -- JANUARY 10, 2014 I � Ty-2 ^� /('2"P 16• �r m� I i, i VARIANCE NOTES PER BOH REQUEST: 03 17 14 EXIST..1,000E \I u i '��.�i ., REV. ' _. SEPTIC TANK msp. po �` I OF (re—use} A E i�__ �y �'.�� tN MgSs9� o l c"P �' -- �'� WETLAND I y�00 5�G - `1cpiO DAR N M LZI S? bps O I M 1 A"CED ------ �y� Q' - SANITAR�P� I PARCEL ID: OPOLE _ ` • 50' ) �\` A r: o 'o 335/043 �� _ gs L �A5 ti MEYER 8c SONS, INC. j D - ` ` ` LEGEND P.O:' BOX 981 PROPOSED CONTOUR VARIANCE TO BARNSTABLE BOH REGULATION: uPOLE ® PROPOSED-SPOT GRADE EAST SANDWICH, MA. 02537 — 48.0' VARIANCE, TO ALLOW D=BOX TO BE NO LESS ——98 —— EXISTING' CONTOUR - (5 0 8)3 6 2—2 9 2 2 THAN 52.0' FROM B.V.W. VS. REQUIRED 100'. + 96.52 EXISTING SPOT GRADE — 45.3' VARIANCE, TO ALLOW LEACHING TO BE-NO LESS l . W— EXISTING WATER SERVICE THAN 54.7' FROM B.V.W. VS. REQUIRED 100'. WETLAND DELINEATION BY: • BRAD. HALL TEST PIT SHEET 1 OF 2 J#1603 NOTE: TO PREVENT BREAKOUT THE PROPOSED NOTE: MAGNETIC TAPE-TO BE PLACED`OVERsALL COVERS FINISH GRADE SHALL NOT BE <. EL:26.23 DESIGN CRITERIA FOR A DISTANCE OF 15' AROUND THE -PERIMETER OF THE S.A.S. NUMBER OF- BEDROOMS: 3 BEDROOM DESIGN SEPTIC TANK PROPOSED D=BOX PROPOSED S.A.S. SOIL TEXTURAL CLASS: CLASS I T.O.F. EL.=29.0 INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & COVER INSTALL A 4" DIAMETER INSPECTION PORT OVER OUTLET. AND SET TO 6"'OF FINISH GRADE SET TO 6" OF GRADE ONE CHAMBER (MIN.) AND SET TO 3" OF F.G. DESIGN PERCOLATION RATE: <2 MIN/IN F.G. EL. F.G. EL.=28.75f F.G. EL: 29.Ot F.G. EL: 29.0(MAX.) DAILY FLOW: 330 G.P.D. DESIGN. FLOW: 330 G.P.D.' GARBAGE GRINDER: . NO (NOT DESIGNED FOR GARBAGE GRINDER) 9" MIN COVER/ 1' PROPOSED SEPTIC TANK: 330gpd x 200% = 660 gpd (USE EXIST. 1,000G TANK) L 18't 36" MAX COVER L = 10' L = 10'(MAX) INSTALL TWO INSPECTION PORTS (MIN.) ® S=1% (MIN.) EL. = 39.00 ® S=190 (MIN.) 0S=1% (MIN.). LEACHING AREA REQUIRED: (330) = 445.95 S.F. 4"SCH40 PVC 4"SCH40 PVC 4"SCH40 PVC 74 DISTRIBUTION BOX: (4 OUTLETS (MINIMUM)) 20.1s 3.8" To PRIMARY S.A.S. •� INV.=26.50 48"LIQUID 14 INVERT INV.=26.25 LEVEL - - USE 4' ROWS, OF 5 - ARC36LP LOW PROFILE (3.8" INVERT) _ PROPOSED INV.=25.98 4 ROWS OF 5 UNITS AT 5.0'/UNIT = 25.0'/ROW UNITS-WITH NO'STONE GAS BAFFLE - X �0 SOIL ABSORPTION SYSTEM (PROFILE BOTTOM A DB-5 INV. 25.88 REA: ; (GENERAL USE APPROVAL FOR 4.73 SF/LF OF CHAMBER) ` .• •. INV.=26.15 . )� _ EXISTING 1.000 GALLON SEPTIC TANK' ` (CHAMBER UNITS) 20 UNITS x 5.00 LF x 4.73 SF/LF, = 473 SF RESTORE VEGETATIVE COVER TOTAL .AREA 473 SF EXISTING SEWER OUTLET DESIGN,FLOW-PROVIDED: 0.74GPD/SF(454SF) 350.02 GPD >• 330 GPD req'd BACKFILL WITH- CLEAN PERC SAND TO TOP OF CHAMBERS 6O„ NOTES: 1) CONTRACTOR SHALL VERIFY•ALL EXISTING a PIPE INVERTS PRIOR 10 CONSTRUCTION BREAKOUT=TOP ELEV.=26.23 2) D=BOX SHALL BE SET LEVEL•AND TRUE -TO INV. ELEV.= 25.88 GRADE ON A MECHANICALL COMPACTED SIX BOTTOM ELEV.= 25.56 EXISTING SUITABLE INCH CRUSHED' STONE BASE, AS SPECIFIED IN 2.83' MATERIAL 310 CMR 15.221(2) 5' MIN. ABOVE BOTTOM OF 34 3) REPLACE EXISTING 1,000 GALLON SEPTIC VTANK T.P. EXCAVATION OR G.W. EFFECTIVE WIDTH 4 x 2.83' = 11.32 WITH 1500 GALLON SEPTIC TANK IF FAILED, (5.29'. PROVIDED) USE 4 ROWS OF 5 ARO 36LP DAMAGED, OR UNDERSIZED. ADJ., GROUNDWATER EL.=20.27 (3.8 INVERT) UNITS-NO STONE 4): INSTALL ,INLET & OUTLET TEES W/• _ F I GAS BAFFLE AS REQUIRED , �. SEPTICr SYSTEMw PROFILE TYPICAL SECTION PROFILE N.T.S. N.T.S. -� O�s DATE: OCTOBER 31, 2013 P#: GENERAL 'NOTES: 14164 - �� OF Mqs SOIL' EVALUATOR: DARREN MEYER, CSE 1614. 8» pq 1. ALL CHANGES TO THIS PIAN MUST.BE-APPROVED BY THE LOCAL Q� Sq " BOARD of HEALTH AND THE DESIGN ENGINEER: WITNESS:'. DONNA MIORANDI, BARNSTABLE HEALTH , N , rM 3.8 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS G }. �, - OF THE STATE ENVIRONMENTAL CODE,-TITLE V, AND ANY APPLICABLE' DARKEN M ` SECTION" t END CAP LOCAL RULES'AND REGULATIONS, EXCEPT LISTED ON PAGE 1. Elev. TP- Depth Elev. - Depth N; 1 TP 2 29.40- o" 29.50 0" ARC36 LP- (3:8" INVERT)'UNITS a 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR \ FILL FILL TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH"AND THE REC�SjEREO 28.40 A LOAMY SAND 12" .28.50 A LOAMY SAND 1 2" MODEL ARC 'S6LP DESIGN ENGINEER. " !1 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING SgNIiAR�P� 10YR 3/2 10YR 3/2 LENGTH 60" FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE.DESIGN 1 27.57 22" 27.50 24" NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT ENGINEER BEFORE CONSTRUCTION-CONTINUES. �, t)� B B EFFECTIVE LENGTH 60" TO`CHANGE WITHOUT NOTICE.- PRODUCT DETAIL MAY 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. 'i. ` LOAMY SAND LOAMY SAND DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE. 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF 10YR, 6/8 10YR 6/8 SIDE WALL HEIGHT 3.8" THE CONTRACTOR OR OWNER TO NOTIFY,THE LOCAL BOARD OF 26.40 C 36" 26.34 C 38 OVERALL HEIGHT 8" HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. SILT LOAM SILT LOAM OVERALL WIDTH 34" 7. WATER SUPPLY PROVIDED BY MUNICIPAL WATER SUPPLY. 10YR 7/2 16YR 7/2 8. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED 17.07 w/tOYR-5/8 148" 17.17 w 10YR 5 8 148" TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. C2 C2 CAPACITY 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE SIEVE 0 EL.- 15.0 MED SAND MED SAND [' THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING 2.5Y 6/4 2.5Y 6/4 PROPOSED SEPTIC SYSTEM/SITE P LA N CONSTRUCTION. 12.90 198" 12.83 200" 10. EXISTING LEACHING TO BE PUMPED, CRUSHED AND REMOVED PER TITLE 5. 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION .2 5- BAYBERRY LANE, 'C U M M AQ U I D, MA 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY PERC RATE <2 MIN/IN. VIA SIEVE TEST ON "C2" SOILS AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY GROUNDWATER OBSERVED AT 148" EL. 17.07 Prepared for: Hodgson WELL: AIW-247, ZONE B. LEVEL 23.9, ADJ. 3.2 FT., USE EL. 20.27 FOR ADJUSTED GROUNDWATER 13. NO ABUTTING PRIVATE WELLS WITHIN 150' OF PROPOSED LEACHING. Design and Site Plan by- SCALE DRAWN DATE: 14. NO WETLANDS WITHIN 100' OF PROPOSED LEACHING. MEYER&SONS, INC. NTS D.M.M. 01/10/14 15. ALL PIPING TO BE 4 SCH 40 0 1/8-/FT (UNLESS SPECIFIED) • I, Darren M. Meyer, R.S., CSE, hereby certify that I am currenNy approved by MADEP pursuant to 310 CMR 15.017 PO BOX981 ' 16. REMOVE UNSUITABLE SOILS 5 FT. AROUND LEACHING TO EL. 17.07 OR TOP OF to conduct soil evaluations and that the•above analysis has been performed by me consistent with the EASTSANDWICH,MA02537 REV DATE: CHECKED SHEET NO. requirements of 310 CMR 15.017. 1 further certify that I have passed the Soil Evol. Exam in October, 1999. 03 1 7 14 / D.M.M. 2 Of 2