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HomeMy WebLinkAbout0056 BONE HILL ROAD - Health m Bane Hill Road Barnstable P u +r A = 336 050 P _ _--_ .. __��x-.y._ � � — _: .. v - � .._. �.c. .t-. �• y}+�-.CCU .. _ _ - - �. � y� _ _ r ' �I i lid 9 No. AO ✓ 6 Fee COD v THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: f/ Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Application for Migopl *p5tem Cougtruction Permit Application for a Permit to Construct O Repair(�pgrade(pKAbandon O ❑ Complete System ❑Individual Components Location A dress or Lot No. Owner's Name,Address,and Tel.No. J eFt C''A 91VL elt % --6 60N& /-1/L z 9, •C/ZeCI<giae- 1,F Q 0 Assessor's Map/Parcel 3 3 6,S-0 0 0 / W'4e S T 1 0'r Q A to ( a q / Installer's Name Address,and Tel.1 ��/ gy �� Designer's Name,Address and Tel.No. ChASQ 4 177 el�C17h127- Abut L S cute7s�/C o<S hDA) 2 , T d PO GO ;r S G 010 3 Type of Building: (CO Y-) �Ye D-// 6, Dwelling No.of Bedrooms � � Lot Size � 37 sq. ft. Garbage Grinder ( ) Other Type of Building 5kn4c ;(� No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 V gpd Design flow provided r3r7 gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank /3 G © Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 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 plaee the system in operation until a Certificate of Compliance hasbeen issued by this Board of Health. r+: Signed Date / d f Application Approved by,, Date Application Disapproved by: Date for the following reasons. Permit No. �� 00 2_� Date Issued ' `ti } �dj16 No. � '1a'ee A 1 Iil�i y THE'COMMONWEALTH OF MASSACHUSETTS Entered in comput r:11 Yes,= .PUBLIC*HEALTH DIVISION.- TOWN OF BARNSTABLE, MASSACHUSETTS 3pprication for ]0i.5po!5al­*pgtem Cow6truction Permit Application for a Permit to Construct( ) Repair(:�Upgrade(�bandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. L L Owner's Name,Address,and Tel.No. �Fr C`� jJ�I L L'�� + ' d, r3r�rnSTr� � C�Pc �Csic �r� � e Assessor's Map/Parcel 3 3 g b o O O W e S T /—/r7T7- F ni?C/ , �r7 ().6.�G Installer's Name Address,and Tel.N `�o. Designer's Name,Address and Tel.No. � . Ch�9S� �12T 1.30149shol -) ad e n r6"n d r?T �Q 136X // or�S�� '� S r `✓_1��� Type of Building: 6 't Dwelling No.of Bedrooms Lot Size _�j sq. ft. Garbage Grinder ( ) Other Type of Building h ii, �(A iy�,��,t No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 J gpd Design flow provided �f gpd f f Plan' Date Number of sheets Revision Date Title T Size of Septic Tank /5 Q U Type of S.A.S. Description of Soil 4 Nature of Repairs or Alterations(Answer when applicable) Vl rj,P,,%ar � 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 plat_e the system in operation until a Certificate of Compliance has been issued by this Board,of Health. g � xi:.,b'�(. Date Application Approved by Q / ) Date Application Dsa proved by: Date for the following reasons _ Permit No. �D�O's �Q� —————Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of Compliance j THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed' Repaired Upgraded + 4 Abandoned( )by at S(� /��}�)(�, ��/ .( ' d C,[YW 11 T 7W 1,1 P has been constructed in accordance t with the provisions of Title 5 and the for Disposal System Construction Permit No. ). C,(l -Uo 3 dated Installer /?,0's C'.? In p�?t�{� fi yJ7 Designer fz)Z"L #bedrooms . Approved design flow gpd The issuance of this permit shall not be construed as a guarantee that the system wil ftt ct on as designed., Date InspectorNo Fee { THE COMMONWEALTH OF MASSACHUSETTS ' PUBLIC HEALTH DIVISION - BARNSTABLE,,MASSACHUSETTS Mo6ar *rwm Congtruction Permit Permission is hereby granted to Construct ( ) Repair Upgrade (,P,< Abandon ( ) System located at /7// and_as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty tokcomply with Title S and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this permit. ' • Date roved A ��� Pp b Y l �" "Y V'��L•��. � Town of Barnstable �F1HE r Regulatory Services Pv ti Thomas F. Geiler, Director BAIMs'AB MASS. " Public Health Division 9 �p 1639• °TEOMprA Thomas McKean, Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Zia 1 oo 3 Date: Sewage Permit# U �"( `r Assessor's Map/Parcel Installer & Designer Certification Form Designer: `'�`'c' Installer: L � =f �vaa�� tint Address: Address: 30 On �` ��" Li. _4 I�,Pw- 7 was issued a.permit to install a (date) (installer) septic system at t( 2,:� based on a design drawn by (address) dated (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include.minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (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. 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. Stripout (.if required) was inspected and the soils were found satisfactory. (Installer's Signature) .(Designer's'Signature) (Affix.Designer's Stamp Here) - PLEASE RETURN TO BARNSTABLE 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:\office forms\designercertification form.doc lz .. �7- JOSEPH J. BORGESI P.E. To:Town of Barnstable Board of Health. From: Joseph J Borgesi P.E. Date: February 28, 2011 Subject: Septic System-56 Bone Hill Road M336, P050001 I hereby certify that the above captioned on-site sewage disposal system was installed in substantial compliance with 310CMR-15.000 The State Environmental Code Title 5 and the Rules and regulations of the Town of Barnstable Board of Health. Joseph J. Borgesi P.E. \�N OF,%S9C o� JOS H o GE 2 IFS G S T S�0 L E Civ JL J R. ck 0 "HEAR.N RL S' RS S#'AN RIVER PLAZA 35 ROUTE 134 - P 0. BOX 237 SOUTH DENNIS. MA 02660 506 394-1265 CL�_NT /�/02�a�c1 /�N��<✓G�-�1MC �ti/C DATE /,O d-;, Ilrj J08,f CE' S,TE ( ADD%- SS; S6aNF /tic �D �i92n/Sri l3G�= ' Sn Aa�L E d 1 TEST DESICNA T,ON A S TM D 422 - rES rED 8 Y. T/f� TO TA L WEIGH r 9 95". 3 TARE WEIGH T 2D/.2 SAMPL E WEIGH T 83. SIEVE TO TAL TARE SAMPL E 9 RETAINED 7 PASSING 3• (75-mm) 2 ; (37 5-m.m)' 2/4" 2 30 • 9 20I. 0J 29. 0 7_ 96. 3 3/8" rnm) 403• D r ZG/• / 25, z 74. 3 n4 r'4. 75-m,rJ r,7 g 7. S 49, s Z 7 �.S S #30 (600-um) 798 . I S9 TO• '2 / 23. 9 i5C (300-:,,m) a9 6, 6 9¢ Z S S C. i f- 4 #100 f,.50-um) 952. 8 S0. 95 0 - #200 (75-urn) 973 O l• J 51S• 4 PA.,%` 9�� . / 78 3. 2- SOIL CL.4 S SIr/CA TION NOTES VE ,e y wFC.L C2Ro,c 0 of fr�l3ncrr rf-+��FS T � Sr'-��✓ oiv C'AP�' � t - - x r R J. 0"ASARN PLS RS Slf4N RIY.R PL.4Z.4 95 ROUTE' 194 - P.O. BOX 297 SOUTH OTNNIS. AU 02660 508 994-1265 CRAW SIZE DISTR18UTION CUR of 56 l3o~y OS /o PLOTTED BY �• /�" CLIENT. ,• �n�'� PROJECT NO. N,�K !Z� SAMPLE NO. -1 DATE: o N C O ip O O 0 0 p v O op^ v to nl \ \ o 66 0 0 0 00 6 6 6 100 O 90 I I I I I I I 1 1 1 1 JO 80 20 I I I I I I I I I I 1 I 70 1 1 1 I I I 1 I I I I I 30 ! I I 1 I I I I 1 60 ! f I I i I I I I I I I 40Qj Z Z ! I I I t I I I ) I I Q v�j 50 ! I I I I I I I 1 t I 50 CIC '40 60 ' 30 70 ! I I I J I I I I I I ! r 1 1 i I I I I 1 I i 20 80 10 ! I I I I I I 1 I I I 90 0 100 100.0 50.0 10.0 5.0 1.0 0.5 0.1 0.05 0.01 0.005 0..001 Groin Diameter mm GRAVEL SAND SILT CLAY �4ST1Ll COARSE MED FINE GRAVEL SAND COARSE. MED FINE COARSE FINE SILT CLAY ,Q�f SfjlO GRA VEL SAND SIL T ' CLA Y US.SC,S' COARSE FINE V.C. C I MED. I FINE I V FINE R. J: 0 "HZ4.RN PLS RS 5 YAN RIYER PLAZA 35 ROUTE 134 .- P-O. BOX 237 SOUTH DENNIS, MA 02660 506 394-1265 CLIEN r /��0�f��( n/G i�y tiF iZ/h�C /l/C OA rE /O !o JOBy J08 S%rE ( ADORE5S) 5 130AJF I?n /-7/fA?IVsrR�3L E 1 SAMPLE T/ 2 TEST DESIGNATION ASTM D 422 63 TESTED 8Y iz• Oi`N C T/jz a TOTAL WEIGHT 336. 6 TARE WEIGHT 60 - 2 SAMPLE WEIGHT 2S6 4 SIE VE TO TAL TAPE* SAMPL E 7 PE TAINEO 7 PASSING 1 1 2 (.37 5-mm 714" (19-mm) 3/8" (9.5-mm) 94. 1 gO, Z f3. 9 , � 91- (o #4 (4. 75-mm) l 108• G 28 .4 1/• 8-59A• 9 ,#8 (2. 35-mm) / 26 . 5 G. 3 18 1 - 8/• 9 y30 (b00-um) 214. 6 34. 4 SZ . 4 47. 6 ,#50 (JOO-um) 2 74 , 2— /94. 0 7S• 7 24.3 h!100 (150-!irr) 105. 7 �ZS..S 07.9 1211 /{200 (75-um) 3 '• 6 2 38 4 93.0 10 PAN 1336 . 4- Z5"6. 7- 91919 U SOIL CL A SSIFICA r10N _2Qz2/ZS r� -ZeSt ki D Nora N 1 G-M _ �/�ssii�6 7.�0 riFv� Fnrr. �oo� ro�c5 V NOTES _ r R. f O'H ,4RN PLS RS SX4N R/YE%? PLAZA 35 ROUTE' 134 - P.O BOX 237 SOUTH OSNNIS, A4 02660 SOB 394-1265 , RarN l3o SrZr= F DISTRIBUTION CURVE 4r .II CL/ENT: 024A PROJECT NO. 444, SAMPLE NO. Z OAT£: 16` OS 70 PLOTTED 8Y .c O O O N c �p b p `p� O v `60 p N `� Z ZZ 2 Z 2 22 2 Z Z 100 I I 0 I I I I I I I I f I I i 90 I I I ! I I ! I I I I 10 80 I 20 I I I I I I I 1 I I I I 70 30 I i I I 1 I I 1 I I I t 60 40 OO c) 1 I I I I 1 I I 1 I tl I I Z L I l I i I I I I t 1 f I Q I I I ( I 1 I ! I 1 50 50 �u v� I i I a I I I I I I I I I I 1 4 0 I I I I 1 I I I I I I I 60 30 70 ! 1 i i ,', ! i• I I I I ! i f 20 80 I I la I 1 I i I I 1 I I 1 1 i I I I I 10 L 90 0 100 50.0 1 0.D 0 O 15.0 1.0 0.5 0.1 O.05 0.01 05 100.0 Croin Diomeler (mini) 0.001 GRA VEL SAND SIL T CL A Y fI STiff COARSE MED FINE GRA VEL SAND SIL T CL A Y AASHO COARSE MED FINE COARSE I FINE GRA VEL SAND SIL T Cl.A Y USSCS COARSE F1NE V.C. C I MED. I FINE V. FINE I a N y i - A ca .. o %ix ti � a w � z� r P n P E R IF " A.. v t-%R E C S : Bonf-?ii i- L l Road l t u.m iI'vi ass ' 02637 On Me 00`e date, I, ifl$'ked ale aegmiC S;3teMi-a:t 'she "7 t',d1'r��: Trns Q $,f'm c0''lsi"aid 01 !he REICERWOED I 'J r 6 kiock crybonOUf,j, y� t NOV 13 2003 a sea on My In-5pcc lion s i fj 1')e oil'-CJwt!ng `c,r`lflC)!ii(ns,— TOWN OFBARNSTABLE -- • /h ._z i z not c title Que HEALTH DEPT. 1, I fit,`.z in a / a wage 3 y z]F e m, i 4 0 ,fJl e y A old) plesent time. 5. W pool ia8%E- Wafei Lj 36r. «k'iOwA,hr invent p1.pE=. r>,-rrOp ..b day. ^ r� m r _ .. ._ _ i f'1:C fJ n�7 E C ) t s ✓�' IVI/1P LOT cords 7ria r:EAnFQAT!M OOES NOT ;ONS19UTE ^v GUARANTY ' i . l ! i 1,{ 1k.t (..�3,✓G'Oit tee%it`65Ide � � - F'urnpitd t)zt ijPr; `i 80416 f 'At?tV ! '. !ri.A 2713338 ' '3 � COMMON ,'TI3 0F M "S ,CxIJ 'i.; i'S ExEc 7'YTrvE OP FI C?i� N�jI t;�)?vl;�;r',.NTr�L � i4'F a TR.S EPAITZI'�4I�°`-Mr �J?�'�rI Ohi?�II✓ TAIa PROTECTION' T.1. F ,.E 5 O Ffc-L 1, g N SPE 1"I°: IN F0P N1 - NO, FOR VOLUNTARY ASSESSAENTS �>BW,[RIPACE SM-VAGE DISPOSAL SYSTEt'�.'I FORM PART A CE RTIFICATION Property Address: 56 B(Dnir)i 1_1. :o?d_� 0 S�ri e r`5 I','si 1;7:•:�tk.:l�.:�._1-.�J.1L�Ys�..��<�,��----------�. Owner's Address: Date or inspection:�..1�'�� Name of lnsp ctor: (pier,st: lir!rtt T' _. ; i•EI c m>>G1' J.L Company Name: J!3SEzPh P macwtiber`�& son Inc I cenify that 1 have personaliv inspccted the se,,vage disposal systern at this address and that the information reposed below is true:, accurme and complete as o+ the time of the inspection. The inspection was 'performed based on my t:rairung and experience in the propei function and maintenarice 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 systern: —! / f Passes , _ -- Needs f'unher ':valuation by the Focal Approving Authority —-- F';i''s 1 Iv � e�fCt0? 55 Sig? stilts A' Date, 1� inspector's f�C i 4 r The systern inspector shall �.rrir:it epy of t�lis inspection epart to he ,approving Authority, (Board of Hearth or DEP) within 0 days of competing this inspection. if tilt system is-a shared system or haws a design flow of I O,O00 gpd or greater, the inspector and the system o",ner s}i0 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. "dotes and Comunent5 r- - °°'1 ills report on]) describes Conditions at the time of Inspection and jinder the eunditions of Ilse £!t t1lat �� 1 * time. "I his inspection does not, address )tow, the system ,rill perform iri t1iF lattice uriciP_r the SsmP or r_{iflere.n!� conditions of rise. Title 5 Inspection; ,'orrn dil 5i2000 PAge 1 Page 2 of 11 OFFICIAL INSPECTION FORM®NOT FOR VO L RY AI,SSxUSS NTS SUBSURFACE SEWAGE laSPOSA..:.1 SYSTEM KSPECT'i.ON FC)RM 1 y h g I'i�RT A CERTIFICATION (continued) Proper address: 56 Bonohi l l Road Ctlmpaqui d Owner:Wi ll iam Wasch Date of Ipspec'iou: 0 23, 03 inspection Sur.mao: =Chuk A,B,C,,i;or E!!,%,"n S'eomQde ssH oi'Section B Sv-Si r]l Passes: ✓L' ! have not found any ynvorrr,aiion which indicates that. any,Of ale failure criteria described Ln 31 U CMR 15 303 or 1310 Q411 !.5.304 ex:st. .1_ny failure aheria not evaluated my indicated Ohm Comments: �. B, Systen] Conditionally 1'tsses: All.) One or more sys rn bomponents as destiliof in the ' onditio 111 t?35$•• section need io be replaced oil repand. TA �ystern,ti.)on comps a on Of aw rel)hcerlr nt or repad, as approved by the Board of t(ealth, will pass. Ans•,yer yes, no or not a=_•terinined (Y,N,ND) ill tt14-- for the following statements. if"not determined"please explain, x�3 � •Ti]l lepiic tank is inf t,l and ovt 0:'ears old' or ti=e semi(' tans: (!y}lethCt rnctal or not) is structurally •- - y unsound WOW su-stanAl InluraWn or exf Titration or tank failure is imrnhwnt.System m ill pass inspection if the exi .ng tank is replaced whh a cOmP019 peptic Al as approved by the Board Of HqM±. cA metal septic tailk 15'?ll pass inspection if.it is stud-urdly sound, not leaking and if a Certificate of Compliance indicating that the t k is less Van 20 years eid '. iivullilbi%, t i lJ explain. Obsen-ation of scmage backti or break out or h; ^: static !' r 1,) r --- P t s.at.c ;s•ater �.y.i he dis,.ribution box due to brui;en or Obstructed pipes)or(.sue ill a broken senled or wnyeu distribution box. System will pass inspection if(with approval of Board or Health): -_- broken pipc(s) are replaced --- obsmuctlon A myn+ ved LOx is leye.le:d or replaced ND explain: >r 'rhe system: requked pumping,m rc tl^Ian a thws a yew :dt.F to Braun of obstructed pipe.is;i, he system will pass inspection if(wits] approval 01 the Board of He-91th): broken, pipe(s) are rcp'laced ------ obstruct on 1_itmovetd ND explain: OFFICIAL INSPECTION FORM NOT FOR VOI,UNTA;tY SUBSURFACE SEWAGE DISPOSA.I.., SYSTEM ASr'E can 00; FORA, PART A ` Y-ri R i CERTIF'ICA`t(°ION'Gontin"j d) Property Address:56 )Bonehill Road utn�ma �ui - Own" ,pl liam wasch We of Inspection 1 0 23 03 C. Further Evaluadou Is Required by the Board I.l,:jh: ' r -z9L Conditions exist which require nrri,.er ev luativtt vy +;e e�0a.r(1 Off 1?: th Is tallo to protect ruble ' " r.,. i! in order to determine if the s stem !C ht4:L QrY 0 the CnyL onment. Y 1. System will pass unless Board of Irjea1th determinn in avordan:'e wtih 310 t�i � t+' systt•rn is trot tuactfoning In ? :�t ° •� � R t_.3C3,, %lb) that the l'7nC' sY.kh %vi p oten public health, Wen and 00 Vd Cesspool or privy Is within 5o fcN! of a surfacr: -,-vt:er 1 2 Cesspool or privy Is 01hl.'1 50 feel Of a boAcki vq(:ti9i"c{ Si'et!iU?d or astilt rr8r:(1 :. System will tail unless the Board Or Health `_n[_ PubHu i'r:iy Suppler, if any) determines that it system is functioning in a In2Jly" that prOtects (lice pubk health, iyNg and en ironment: �' (•% The system has a septic tank and soil absorptier! sy;tt Cr! ;Sr1`.ij irrd the SAS is wit;.in i00 re, of a SUr% Water supply or trib'ytZJ i 10 a sur)iiie wafer StJ,' ly, -�C) T*hC sysi:r:l h::S a SCpIlC t(i,;:� ilU SAS i'nU We 1 ` (� -., s Whin a Zone n 1 0 fa ,:!Jo�jc ,•;ate; s�;pp!,• �l '�,D The Vsarn has a septic mnk and SAS and Me SAS bs `ahln 50 fret of a pC;Y34F �'r iirr SUG'71V tivC'l. , f I 'to The "nem ho a s t tit: t .t r 1 C i' `rJ` f AS Sn-( ! ie S t s � 0 b Il 50 tt'i �� , ;lur: I� f,��) ri Fi f 011 3 PA" u'at.. .��,�!�•�.yc;i° �` (t,?o` us ,�; t,� � y or more fr v 'This synein p s eC dim " H 1yi.!" ana!Ysh, r r,..., ! )icr 0 l,CC i( 1 DEP c rlikc! Iaboatory for CaCte.'!a Compounds Col fOT7an-t cliaric Incir7Cs t , r4 +el t5 G�t tl'0!'�l t)Otlllill)n 1]of17 {i?2l th d(?fBClllf �e presence of ammonia nitrogen and „ivate, ni"gen is Cqua! t0 Or less than 5 pprnF p,.ovldGU tN n0 Uhler CO"A are viggered, �'� copy of the dt1aNis insist be anachcol t0 lI1lS Fon-n. 3. e sewage system conKztz I' LOt"I" : 5r? _r 0 L�6--1 R .6i C 2 4-,r?,Te`•._'.,_...__...,_, �.....- Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) e Property Address:56 Bonehill Road Cummacfuid Owner:William Waseh Date of inspection: 10/23/03 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: . Yes No Dackup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ischarge 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 _ ,Required depth in cesspool is less than 6"below invert or available.volume is less than %.day flow ,Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped 0 . I ae/lAny 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. VIA ny 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 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,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.) W10 (Yes/No)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• You must indicate either"yes"or"no"to each'of the following: (The following criteria apply to large systems in addition to the criteria above) yes no/ t/ the system is within 400 feet of a-surface drinking water supply ! th system is within 200 feet of a tributary to a surface drinking water supply the system is located '— _ y to 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. 4 y r Page S or I I OFFICIAL INSPECTION FORM ' NOT FOR VOLUNTARY SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION 1,O)- PART B CHECKLIST Property Address:56 Bonehill Road Cummaquid , Owner,wi l l i.am Date of Iospcctloo; 1 0/ 3/03 Check if the following have been done.You must Indicate 1 Zis"or"no"as to each of t'r,e i:1;14 Yes Zurnp(Al information was provided by the owner,occupant,or Board or Health Were any of the;ystcm components pumped'out in the previous two WC44$? ,ZHas the system received normal flows in the previous two wcck period? Nave large volumes or water been introduced to the system recently or as p:ul of 0,,s I _ „ZWcre as built plans of the system obtained and examined?(If they were not Was the facility or dwelling Inspected for signs of sewage backup? Was the site inspected for signs orbreak out? . ✓_ Were all system..eomponents,-mluding the SAS, located on site.? 7. A& Were the septic tank manholes uneovered,opened,and the interior V0t c t�::r; >l;c tc' i;• � ;- c,;n�: of the baffles or tees,material ofeonsnetion,dimensions;depth orliy.jid, dc;;:: t✓,';•,��'r, ar! co t.'. :,';: r• Was the racili y owner(and,occupants if different from owner)providcJ w4l, maint nance of subsurraCe sewage disposal systems? The size and loeatlon of the Soll Absorption System(SAS)on the site has been dawrini nc 1 x:c': o:,: Yes no a . _✓Exlstirig information, For example, a plan at the Board of Hcaioi. ' oo� Determined in the field(irany of the failure criteria rcl_ted to :��n C is � rr is unaccc table 310 3 CMR 13,302 P )( ( )roll 4 Page 6 of I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION '1s Property Address: 56 Bonehill Road Cummacsuid Owner: 1 Date of Inspection: 1 3 FLOW CONDITIONS RESIDENTLAL Number of bedrooms(design):—1- Number of bedrooms(actual): DESIGN now based on 310 C,v%.I 1�II S--.2o7 (for example: 110 gpd x Y of bedrooms): Number of current residents: Does residence have a garbage grinder(yes or no):A;D Is laundry on a separate sewage system jy s or no):��d, (if yes separate inspection required) Laundry system inspecteQ(yes or no):��, Seasonal use. (yes or no):2kl Water meter readings;if available(last 2 years usage(gpd)):2001=6000 gallons 16. 44 G%D Sump pump(Yes or no): -Vo = , gail onb=19. 18 GP D Last date of occupancy: COMMERCIALANDUSTRIAL Type of esublishmenR Design now(based on 310 CMR 13.203) d Buis or design now(scaWperson sgft,ctc.): Grease trap present(yes or no): Industrial waste holding unk present(yes or no);vz Non sanitary waste discharged to the Title S srs1 (yes or no): Water meter readings,iravailablc: Last date of occupancy/use: OTHER(describe). X14 GENERAL INFORMATION Pumping Records Souroc of information: Wu system pumped as part of the inspection(yes or no).- If yes, volume pumped:. gallons•. How was quantity pumped determined? Reason rot pumping: TYPE OF SYSTEM . a Septic tank,distribution boz,soil absorption system —7 Single cesspool-. rxd i ?Overflow eesspozo O Privy JM Shared system(yes or no)(ir yes, attach previous Inspection records, if any) &VInnovativc/Altcmative technology.Atueh a copy of the current operation and maintenance contract to be obVtned from system owner) !�bTij ht tank KG AtUcb a copy of the DEP approval XJA Other(describe): ,U npprox m to see or all components,date installed(Irknown) and source of information: Wcrc sewage odors detected when arriving at the site(yes or no)3---y'y Page 7 of I I OFFICIAL INSPECTION FORM.—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C r SYSTEM INFORMATION (continued) Property Address: 56 bone Hill Road umma ui t Owner: William -wase Date of Inspection; 2 BUILDING SEWER(locate on site plan) Depth below grade: 4" oaangel.eag pipe th4ough Monists of consrruction: cast iron•kft) PVC,.,other(explain)Ptat the 6 y6t ern. Distance from private water supply well or suction Iine:.b )P- Comments(on condition ofJ'oints, venting,evidenrtce orleakag ,c c.): o intb ��eaz tight. No evidence o� �•ecekage. Sy6tem i6 vented znaough the 2azn"a. � `— SEPTIC TANYW"locate on site plan) DVth below grade: Material or construction: concrete ametaWAfibergl ass 4/bolyethylene 4-0othcr(cxplain) if oath is mcul list agc Is age confirmed by a Certificeie of compliance(yes or no): (attach a copy of certificate). Dimensions: Sludge depth: IV _ Distance from top of stud c to bottom of outlet tee or baffle: Scum thickness: Distance from top of scum'to top of outlet tee or battle: /¢ Distance from bottom of scum to bottom of outict tee or baffle: How were dimensions determined: Comments(on pumping recom tio mendans, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence or.leakage,etc.): Sv_/?.t ir- tank .i..s not !22ezen r'• , CREASE TRARIAWlocate on site piq r✓ ✓• Depth below grads: Material orconsvuction:4Aconcrete 1ometalAfiberglasulypolyethy1cneglother (explain): Dimensions: Scum thickness: Distance from top of scum to top,of outlet!ee or baffle: Distance from bottom of scum to bottom of outlet tee or battle:,�_ Date of last pumping: A- )I� Comments(on.pumping«commendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of icakage,etc.): Ga �iS a 1.6 not R4e6ent 7 Page8of11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ' , SYSTEM INFORMATION(continued) Property Add ressS6 Bone Hill Road Cummaauid Owner: William Wasch Date of Inspection: 10 2 3 0 3 TIGHT or HOLDING TANK4&&.(tank must be pumped at time of inspection)(locate on site plan) Depth below grade: V,4 Material of construct o ,concrete4y_metal Akfiberglass 1polyethylene 4ft_other(explain): ld Dimensions: Capacity: allons Design Flow: allons/day Alarm present(yes or no):.,dk Alarm level: • ,tJi? Alarm in working order(yes or no):4 Date of last pumping: &0 Continents(condition of alarm and float switches,etc.): 71ghf na hn0rlinn in akaaka n0i p4ezeni DISTRIBUTION BOX (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 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.): 7a.tfniQiifinn p►.CLY �'� R0.Z:�1�8�8Rtr. PUMP CHAMBEW40e- (locate on site plan) Pumps in working order(yes or no): �R Alarms in working order(yes or no):�i Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): rhnmQnn !A n f�nno.6,9a), II { 8 Page 9 of 1 I t OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) ` r Property Address: 56 Bone Hill Road ti Cumtngauid Owner:. William Wasch µ\ Date of Inspection:- 1,.o 2,3LfL r SOIL ABSORPTION SYSTEM (SAS), (locate on site plan,excavation not required) If SAS not located explain why: Lo cat ed� sn v �-9� 1 n Type _leaching pits,number: 8 ,00 leaching chambers,number: O Dleaching galleries,number:Q leaching trenches,number, length: O leaching fields,number,dimensions: n overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding,damp soil,condition of vegetation, etc.): Lonmg Annd in Qnnoy 6nnif fn mod li'm Zi a' d g� aaa-eic Nc�-4���s hyd �a�2u2e o/ � dinO. SO���,�o�da �/yanfnf�nn � A nnmm�0 v CESSPOOLS: ✓/(cesspool CSr ,,��ust be,,pp��mped as part of inspection)(locate on site plan) lJ Number and configuration: Depth—top of liquid to ihl c invert: . " Depth of solids layer: Depth of scum layer: Xf a Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no):,,&�Q Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): Same as agove. PRIVYd&�vglocate on site plan) Materials of construction: ,di4 Dimensions: Depth of solids: .0, Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): 11tiyu i_s not nnn.Svnf_ Page 100 11 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Add ress:56 Bone Hill Road Cummaquia Owcer:William Wass Date of laspeccioo;l-0/23/03 `r SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including tics to at least two permanent reference landmarks or, benchmarks, Louis all wells within 100 fool. Locals where public water.supply enters the building, ,f c.v e y �tr= t5 10 Page 11 oril OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued): Property Address: 56 Bone Hill Road Cummaauid Owner: iam eh \. Date of Inspection: l 0 233 4 ;.. SITE EXAM Slope Surface water Check cellar Shallow wells f Estimated depth to ground water , feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record• If checked,date of design plan reviewed:,V,4 _ Observed site(abutting property/observation hole within-!So feel of SAS) Checked with local Board of-Health-explain; NR �ElChecked with local excavators, installers•(attach documentation) Accessed USGS daubasc.cxplain:_h.tt� n://d own. kaanzi-ag e. ma. u4. You must describe how you established the high ro nd water elev tion: zed: Gah et & f1.iiiea NOdai. 12116�9 wound wa.�ea e.Pevat.ions move zea .2evei. zed: llS.q i data. une zed. �J C • T n nAu i n�9.. a// OQO�'l 7 G a 92-000= 1 / .late i nnua 2ange•s o ga 199Z 2-61X6' Mock cezz/?00-9z. Lcachinp, ;Pit :cc( ~ t #.. all r cct Below Bottom of Pit High Groundwater Adjust mint ment 1 8 ft per Frim to P p Method Therefor:, the vertical separation distance between the bosom of the leaching pit and the adjusted gToundwatcr table is 7j2. feet. 11 ' >•Iw[nt" ' 'DOWN OF _bARNSTABLE WARD OF HEALTH SU(I$U(1PACF SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART D'- CERTIFICATION J -TYPL 94 PRINT CI.CAALY P110PERTY INSPECTED STREET ADDRESS 56 Bonehill Road Cummaduid , ASSESSORS MAP, BLOCK AND PARCEL � 336-050 OWNER' s NAME William Wasch PAJiT D - CERTIFICATION NAME OF INSPECTOR JoseRh_P.MacomberJr. COMPANY, NAME J_,P.Macomber & Son Ind COMPANY ADDRESS ox 66 Centerville,Mass. 02632 str•.t Torn or C1 ty 9t.t. LIP COMPANY TELEPHONE ( 508 ) 775 - 3338 FAX ( 508 ) 790 -1578 R CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system nt )rlecoinmendat his address and that the information reported is true , accurate , and omplete as of the time of .-inspection , The inspection was performed and any ions regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems Chec one: System PASSED 7 The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public healL11 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 con 'eted has found that 'the system fails to protect the jiublic health and :the environment in accordance with Title 6, 310 CMR 15 . 303 , and es specifically noted on PART C - FAILURE CRITERIA' of this inspection form , v , _ Inspector Signature4z0go Datarn O( d . copy of thisc c rtification must be provided to the• OWNER, the BUYER uh.ere .ap,plioabje ) and the BOARD OF It8ALT114 w If the inspection FAILED, We owner or operator shall upgrade the eyatem within one year of the date of the inspection, unleas allowed or required otherwise as provided in 3.10 CHR 15 . 305 , ' partd .doc i SOIL TEST _ COVER TO BE WITHIN 9 � O � TOP OF FOUNDATION 6" OF FINISHED GRAD DATE OF SOIL TEST At ELLEV. L, /02.2 CONCRETE WITNESSED BY DUNNfi Z. MIOAF S- <�N �, z tidcvs � 4 COVERS DAN CRaTf--AU E� . 3/4" TO 1-1/2" CLEAN WASHED TONE SOIL EVALUATOR Rave 9" MIN. COVER TYP. 4" SCHEDULE 40 PVC PIPE PERCOLATION RATE T 2 MIN./INCH. IN. PITCH 1/8 PER F 2" PEASTONE _ OBSERVATION HOLE 1 - . arP4tT CCJ ELEV. 9 _ I ,e�-; ►,Its• ,�rr.a� -.{ 2o'r�x'n �=u���g�, EL.= --- J +t -�n-,ram- ELEV. DEPTH HORIZ TEXT COLOR MOTTLING - �1=6��I��I��p— �t r2uvCE „AI�II�II�A 9G.32 O—i 2' A S, NDf LOAM tU Yk A FLOW IN _ CLEAN BACKFILL BREAKOUT 93.3 I�_ 5�.1ta4 LOAM tp Y,� LO LINE __ 2 Tars pr- 1-Le, rz oC� EL.= 9 a�_ TANK = .� �i .f,� 4E-io4" C, StcTt' LORPh �,u y5/ ELEV. = 9 22 - ELEV. _ _9� � TANK K04 15C C , '' 10 ELEV. = 2,5 97 " --� 0 E4.3 z toaMb Mer.�r asp z s y A A7 F>QOPOSEG 14„ wu" 2 MIN. F ClEt�r��v1' MIN. L L B .F� �sG-r6a cv MEst. tF, . - ; LOCATION MAP 4'—loll ��- 94. 9 �L -Z r O ®O O l� D O O O 4" CAST IRON PIPE LIQUID (OR EQUAL) MINIMUM LEVEL GAS BAFFLE ELEV. _ � _• O �= =i� === f�i� �= BOT, OF DF F. - r.:�::.; f _ _, ASSESSORS MAP. PITCH 1/4- PER FT I S TR 1 B U TI O N `' rvvk A _ BOX 6' `� WATER AT144__ EL.=_85-3_ NOTES— PARCEL. c� 5U0 0 TO BE WATER TESTED ---- 4'0 4 x8 �p StW `_A A>At.YSraG�,BG� 10 STRENGTH 1) SEPTIC SYSTEM TO BE INSTALLED ACCORDING TO 310 CMR 15.000 'x 3 TITLE 5 AND THE TOWN OFr __c-s�_�_' RULES AND REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE. BOTTOM OF TEST HOLE ELEV. _ .5� 2) EXISTING AND FINAL GRADES SHALL REMAIN ESSENTIALLY THE SAME. /5v 0 GALLON 6" STONE ON NATIVE GROUND OR (UNLESS ELSEWHERE NOTED) --- MECHANICALLY COMPACTED BASE OBSERVATION HOLE 2 ' ' = 98.a 3) ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF SEPTIC TANKS 4 x8 CONCRETE FLOWDIFFUSORS ELEV. ____.4 WITHSTANDING H-.�oLOADING. O STRENGTH 1 Q STRENGTH ELEV. DEPTH HORIZ TEXT COLOR MOTTLING 4) ANY MASONARY UNITS USED TO BRING COVERS TO GRADE SHALL BE C, SI _, L6A�: r MORTARED IN PLACE. SEWAGE DISPOSAL SYSTEM PROFILE 6S•Q I 1`�'-'S� C z t�"`�'``� ``' �`���'' �•�' �� 5) NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEED 104-156" RESTRICTIONS OR ZONING. NOT TO SCALE 6) THE INSTALLER IS TO VERIFY THE LOCATION OF UTILITIES AND SEWER LINE ELEVATIONS PRIOR TO INSTALLATION. -� 7) SOIL ABOVE THE Cy LAYER (SHOWN ON SOIL LOGS) SHALL BE REMOVED �pfz p� ci/ AND REPLACED WITH CLEAN SAND ACCORDING TO MASS. LOCAL O N SPECIFICATIONS WITHIN 5' AND BELOW THE S.A.S. NO WATER ATlG z EL =�'��-_�� 8) EXCAVATION FOR AREA WHERE FILL IS REQUIRED SHALL EXTEND 5 FEET LATERALLY BEYOND S.A.S. 9) VERTICAL DATUM < / 10) BENCHMARK �D/��/�_C-r�4T ��� �iQ __ / — , „ 1 1)ALL PRECAST UNITS ARE TO BE PLACED ON 6" MIN. CRUSHED STONE - DESIGN CALCULATIONS, � \ N 8 8 2 5 0 2 W 396. 90 MECHANICALLY COMPACTED. 1 / S 12) GROUND COVER -OVER SYSTEM COMPONENTS SHALL NOT EXCEED 3 FEET t EXISTINGG� BEDROOM DWELLING Q>ATH FAMILY � � � � 13) ALL EXISTING UNUSED COMPONENTS SHALL BE PUMPED, REMOVED AND/OR B BEDROOMS x 110 GPD/BEDROOM 2zo_ GAL./DAY / - FILLED WITH CLEAN SAND ACCORDING TO LOCAL REGULATIONS. k t tcN EtJ I � TOTAL ESTIMATED FLOW M th;t imufA 330_ GAL./DAY \ / - _"� 14).- CONTRACTOR TO VERIFY--ALL t'LU�iEfNG "iN-'1"FI= -i�iJiLi3fNG-fLOWS. TO ' �� '`� PROPOSED SEPTIC TANK. GARBAGE DISPOSAL UNIT N�___ � / AE�,c, I T R 15) THIS PROPERTY /DOES NOT FALL WITHIN THE WATER, RESOURCE AREA. /� ��,y o� 16) THIS PROPERTY FALLS IN FLOOD ZONE _C_ AS SHOWN ON FIRM COMMUNITY IPANEL NO. ,2 UQv►_-2QUt --- DATED REQUIRED-SEPTIC TANK CAPACITY _ _ -tn�oU �^ --------- _ _ . _ - - 3/ __ 17) GAL. 4Y r . _ACTUAL SIZE OF -SEPTIC TANK � + �' GAL.- 3 ^ ACX�STlN� Y_�� '�''�/� .�Y, 7 /2EPL�4 Ck 0 �'1�/?/�:�'���►�'j f�'�tD .. LEACHING AREA REQUIREMENTS c-r+ �/ 57�, _ Q µ / �G fR F� -"%' �rcTE/✓ S 'LAtZAQA E ,LY.�� SIDEWALL AREA 0.74 GAL./S.F S.A.S. COMPONENTS O Q� ,,�`.,��'����" 3 BOTTOM AREA U•!� GAL/S.F. _ - 4'x8' CONCRETE FLOW �/ � 5=� O O O -,.�-�..�. LEACHING CAPACITY - o,74 (��214�� = 379,23 �Po DIFFUSORS ON �" OF N / P�c�a,�,�pG[�rrP;..*� 9�� _- g2 � NR�---_: .�:-� -� 39G.9� SIDEWALL- 3 z t 2. 12 t 12) x t.4ra D���'- 128,g�`f 3/4 - 1-1/2RUSHED STON N O ' zz - - C 7AIV.EL.9� BOTTOM- X i Z " -- S'Ror�A TOTAL- USE s1 - 32 SF DIFFUSORS �j/2`��Q.FT. ;G" T i SHOWING PROPOSED RESERVE LEACHING CAPACITY S/2.4�SQ.FT. O o / �-- � g6 � N SITE PLAN �.74 GAL/DAY/,. _ - . -_< ��. a � ak � �o o, ,�� .9� / / - k -- - SEWAGE DISPOSAL SYSTEM j IN BARNSTABLE MA LEGEND: / / AS PREPARED FOR DESCRIPTION SYMBOL / ' � � /- JEFF . CHANDLER EXISTING SPOT ELEVATION Ox 00 EXISTING CONTOUR --�`00-�- / Sig->9-�� Q,to FINAL SPOT ELEVATION / / < s ��-Si. �'� 56 BONE HILL ROAD `� FINAL CONTOUR ox00 SOIL TEST LOCATION / 1 1 0 , 0 4 3 S Q . FT. PA UL E. S WEE T SER UTILITY POLE -a- / , ACRES �- � 2 . 53 — PROFESSIONAL LAND SURVEYOR TOWN WATER = W W / CATCH BASIN \®% , P. O. BOX 1146 GAS LINE =G V G / / DENNISPORT, MA 02639 I (508) 394-4924 FIRE HYDRANT � _ co QO PLAN - REFERENCE— �Ss s q co 00 REVISIONS— DATE 0cTj9 ,201-0 O 0. , �° p JO PH cy� svgc- o J � c�\4 S 7 0 44 R c A o� I �o �u� �. SCALE 1 " =20' 9 19 34 " S �� a APPROVED: BOARD OF HEALTH E 5 o �(' �a / qq 80 )5 /� �) \���SUft1Ei�✓' c�S /STER ���� � � Z�A� ,V `�- �s�Na� ENS, cwc,�6 -ram t Ic c�c\ FILE NO. s 7 -- A O PS U �`� ' DATE AGENT SHEET 1 OF 1 i ..ter,-.+_. ,/...-..,.a.-........ + .._-a' Z.... _-...,,...1,...<...-.....-.v... M. ... - ...-.. ._ ._._....-._. __- ., _.._. -._. _.. .__•_.�_ -.-.-_..�..._-.__..-- .-._...--__.__..�._. __.___... �.�_ ._-. --_._ -_.-___'-_-__ -.___-�.... _-__._--_ -..`__. .._._--_. --.. - -. --- - _