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HomeMy WebLinkAbout0135 CARRIAGE LANE - Health 135 Carriage Lane ' Barnstable F/R A 298 082 t Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments c 135 Carriage Lane, Barnstable M -298 P-82 Property Address �+ David &Gail Puopolo Owner Owner's Name / information is 135 Carriage Lane, Barnstable V MA 02630 October 5 2016 required for every , page. City/Town State Zip Code Date of Inspection tV .A Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information . on the computer, use only the tab 1. Inspector: key to move your cursor-do not Troy Williams use the return key. Name of Inspector Troy Williams Septic Inspections Company Name 19 Hummel Drive Company Address South Dennis MA 02660 CitylTown State Zip Code (508) 385- 1300 S1682 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 ❑ Needs Further Evaluation by the Local Approving Authority October 5, 2016 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 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 17 Y 1 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M yVV`• 135 Carriage Lane, Barnstable M-298 P-82 Property Address David &Gail Puopolo rOwner Owner's Name *information is required for every 135 Carriage Lane, Barnstable MA 02630 October 5, 2016 �- page. City/Town State Zip Code Date of Inspection Y 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: System meets minimum standards set by Massachusetts DEP at the time of inspection only.This inspection is not a guarantee or warranty on the future working conditions of leaching, pipes, components or the future structural integrity of said components and only represents conditions found at the time of inspection only. 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-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System form-Not for Voluntary Assessments 135 Carriage Lane, Barnstable M -298• P-82 Property Address David &Gail Puopolo Owner Owner's Name information is required for every 135 Carriage Lane, Barnstable MA 02630 October 5, 2016 page. Cityrrown 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 (co it.): ❑ 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•3113 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 135 Carriage Lane, Barnstable M-298 P-82 Property Address David &Gail Puopolo Owner Owner's Name information is required for every 135 Carriage Lane, Barnstable MA 02630 October 5, 2016 page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) 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) stem S Failure Criteria Applicable to All S Y pp stems:Y 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 El ® 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 %day flow t5ins•3113 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 yf 135 Carriage Lane, Barnstable M -298 P-82 Property Address David &Gail Puopolo Owner Owner's Name information is 9 required for every 135 Carriage Lane, Barnstable MA 02630 October 5, 2016 page. Cityrrown 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. G ❑ ® 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 ❑ ❑ 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 4 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 135 Carriage Lane, Barnstable M-298 P-82 Property Address David &Gail Puopolo Owner Owner's Name information is required for every 135 Carriage Lane, Barnstable MA 02630 October 5, 2016 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): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth f o Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 135 Carriage Lane, Barnstable M-298 P-82 Property Address David &Gail Puopolo Owner Owner's Name information is required for every 135 Carriage Lane, Barnstable MA 02630 October 5, 2016 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 15=54,000 gals: g ( y g (gp ))' 14=51,000 gals. Detail: Sump pump? ❑ Yes ® No Last date of occupancy: occupied Date Commercial/Industrial Flow Conditions: Type of Establishment: N/A Design flow(based on 310 CMR 15.203): N/A Gallons per day(gpd). Basis of design,flow(seats/persons/sq.ft., etc.): N/A Grease trap present? ❑ Yes ❑ No Industrial wasteholding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: N/A t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 t l Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 135 Carriage Lane, Barnstable M-298 P-82 Property Address David &Gail Puopolo Owner Owner's Name information is g required for every 135 Carriage Lane, Barnstable MA 02630 October 5, 2016 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: N/ADate Other(describe below): N/A General Information Pumping Records: Source of information: Last pumped in 2011 per info from owner. Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons as quantity pe H w wan d determined? opumped Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): 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 135 Carriage Lane, Barnstable M -298 P-82 Property Address David &Gail Puopolo Owner Owner's Name information is required for every 135 Carriage Lane, Barnstable MA 02630 October 5, 2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: D-box and leaching were installed to existiM tank on 9/25/03 per compliance Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 18'+ 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.): Lines were found clear at the time of inspection. Septic Tank(locate on site plan): Depth below grade: 2'with riser to 6" 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: 5'X9'X6' 1000 gallon Sludge depth: 4" 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 >. 135 Carriage Lane, Barnstable M -298 P-82 Property Address David &Gail Puopolo Owner Owner's Name information is required for every 135 Carriage Lane, Barnstable MA 02630 October 5, 2016 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 2'8" Scum thickness 3" 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 11" How were dimensions determined? probe/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.): Pvc inlet and outlet tees were found present and in working order. No evidence of leakage or damage was found. Pumping is recommended. Grease Trap (locate on site plan): Depth below grade: N/A feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain): Dimensions: N/A Scum thickness N/A Distance from top of scum to top of outlet tee or baffle N/A Distance from bottom of scum to bottom of outlet tee or baffle N/A Date of last pumping: N/A Date t5ins•3/13 Title 5 Official Inspection Forth: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 135 Carriage Lane, Barnstable M-298 .P-82 Property Address David &Gail Puopolo Owner Owner's Name information is 135 Carriage Lane, Barnstable MA 02630' October 5 2016 required for 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: N/A Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: N/A Capacity: N/A gallons Design Flow: N/Agallons per day Alarm present: ❑ Yes ❑ No Alarm level: N/A Alarm in working order: ❑ Yes ❑ No Date of last pumping: N/A Date Comments(condition of alarm and float switches, etc.): - N/A 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 1 , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 135 Carriage Lane, Barnstable M -298 P-82 Property Address David &Gail Puopolo Owner Owner's Name information is 135 Carriage Lane, Barnstable MA 02630 October 5 2016 required for 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 level Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box was found level and in working order with equal distribution to outlet lines through speed levelers. No evidence of solid carry-over or backup in the past was found at the time of inspection. 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.): N/A * 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 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 135 Carriage Lane, Barnstable M-298 P-82 Property Address David &Gail Puopolo Owner Owner's Name information is required for every 135 Carriage Lane, Barnstable MA 02630 October 5, 2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 3-500 gallon with stone ❑ leaching galleries number: 33.5'X 12.8'X 2' ❑ 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 ponding, damp soil, condition of vegetation, etc.): Soil was sandy. Chambers had a low water level present at the time of inspection. Checked stone and found dry and clean. No evidence of hydraulic failure or problems in the past were found at the time of inspection. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration N/A Depth—top of liquid to inlet invert N/A Depth of solids layer N/A Depth of scum layer N/A Dimensions of cesspool N/A Materials of construction N/A Indication of groundwater inflow ❑ Yes ❑ No t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 135 Carriage Lane, Barnstable M-298 P-82 Property Address David &Gail Puopolo Owner Owner's Name information is required for every 135 Carriage Lane, Barnstable MA 02630 October 5, 2016 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.): N/A Privy(locate on site plan): Materials of construction: N/A Dimensions N/A Depth of solids N/A Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): N/A 15ins-3/13 Title 5 Official Inspection Fond:Subsurface Sewage Disposal System-Page 14 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 135 Carriage Lane, Barnstable M-298 ' P-82 Property Address David &Gail Puopolo Owner Owner's Name information is required for every 135 Carriage Lane Barnstable MA 02630 October 5, 2016 page. Cityfrown 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 attachedseparately O ' �jara S.v O 2: a� r �, rl 2- . 7t6 ,, t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 15 of 17 I'I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 135 Carriage Lane, Barnstable M-298 P-82 Property Address David &Gail Puopolo Owner Owner's Name information is required for every 135 Carriage Lane, Barnstable MA 02630 October 5, 2016 page. City/Town 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: 12.0'+ 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: 7/31/03 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: AIW 247 Zone C 24.9' 5.6' adjustment You must describe how you established the high ground water elevation: Test hole recorded on plan showed no water found at 136". Hand augered 6' below bottom of leaching with no water found at a depth of 11.0'. Groundwater adjustment at the time of inspection was 5.6'. Bottom of leaching at 5.0'was found not to be located in the high groundwater elevation at the time of inspection. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•31113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 135 Carriage Lane, Barnstable M -298 P-82 Property Address David &Gail Puopolo Owner Owner's Name informationis required for every Carriage 135 Lane, Barnstable MA 02630 October 5, 2016 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 h { I I t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 I I� TOWN OF BARNSTABLE LOCATION 135- CA,,rwre L../ SEWAGE # _ VILLAGE ba.---s ASSESSOR'S MAP & LOT'����` d INSTALLER'S NAME&PHONE NO. -���i� C G2JTirC7io✓ yak -p'9a� SEPTIC TANK CAPACITY /.ono 6k L LEACHING FACILITY: (type) 210"aC eAkw (3, (size) x- NO.OF BEDROOMS BUILDER O R PERMTTDATE: i COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility an wells exist � PP Y g tY � Y on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by l .av Ca/�t �rrrwir9 �}ns �� Gas. O � i H �' / . r`:c „ �� ( O, , ,��. a�- � as- �� �° ` . �. �� Jn�. / No. 0 Fee " THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZippYication for Oiopaal bpztem Construction Permit Application for a Permit to Construct( )Repair(V)Upgrade( )Abandon( ) O Complete System TIidividuai Components Location Address or Lot No. Owner's Name,Address Tel.No. Assessor's Map/Parcel ^�6 Q, /� Installer's Name,Address,and Tel.No. / ` Designer's Name,Address and Tel.No. cell 7/- 3XZ - 5-V/ Type of Building: Dwelling No.of Bedrooms Lot Size lyf' Z q.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures �f�y� Design Flow gallons per day. Calculated daily flow 7 Zy gallons. Plan Date Number of sheets l' Revision Date Title v`P ® 4::47/-/2 e Size of Septic Tank f©M e&X%9,22 1 Type of S.A.S. '- Description of Soil ✓?'JtiS X/Z 8�3/�C Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: G The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has gbeen issued b s Bo f alth. ��zs�o Signed Date Application Approved byan& S Date O Application Disapproved for the following reasons Permit No. 7ZC>0 . Date Issued D No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION-TOWN OF BARNSTABLE., MASSACHUSETTS r '• Zfppf cation for Mig;pozal 6p$tem Conaruction Permit Application for a Permit to Construct( . )Repair( V)Upgrade( )Abandon( ) EJ Complete System L71ndividual Components Location Address or Lot No. 13 Owner's Name,Address Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address"and Tel.No. ev 47 441 Type of Building: Dwelling No.of Bedrooms 7 Lot Size y�77 sq.ft. Garbage Grinder( ) Other Type of Building �/°5 t Pam/P No.of Persons Showers( ) Cafeteria( ) Other Fixtures /l/1 Design Flow 1169 gallons per day. Calculated daily flow 7 7� gallons. Plan Date_ 5— 2 Number of sheets Revision Date Title S .51/C /1 0,e /3- Q71/:1 e - Size of Septic Tank- 16111rXf 93`/%�' Type of S.A.S. ' Description of Soil ' 33.l 1 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 place the system in operation until a Certifi- cate of Compliance has been issued by, s Boardiof Health. Signed 59 Date �� /Application Approved by •.j Date ,, Ct1c3 Application Disapproved for the following reasons y r l t Permit No. c)c> Date Issued /. d. THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTy�FY, that the On-site Sewage Disposal System Constructed( )Repaired( k!Upgraded( ) Abandoned( )by t7D, �� / at /35`r rf is�,� ��. Ar �1'0514'.b/e has been constructed/in ac,a rdance with the provisions of Title 5 and the for Disposal System Construction Permit No. ?tT) dated ` C1 f:.? Installer I Designer .� The issuance of !Ternu shall not be construed as a guarantee that the system wil, /cti Gas deslgne . . Date Inspector GOW: --------------------------------------- No. r Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Mi5po;af *p.5tem Con5truction Permit -Permission is hereby granted to Construct( , )Repair( �Upgr e( )Abandon( ) System located at ! 3� C'��ti d9C� /.�s. q/f and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Constru tion niust be completed within three years of the date pf this permit. Date: t C/Cf Approved by TOWN OF BARNSTABLE LOCATION C SEWAGE # Q'13 /yr VILLAGE ASSESSOR'S MAP &LOTS' ` INSTALLER'S NAME&PHONE NO.�r ��rr ' �Yy�i,c o✓ S�J 8-p916 SEPTIC TANK CAPACITY e-. LEACHING FACILITY: (type) s�GaL Cl.��dr-3 C3� (size) !3 x 33.✓" ..? NO.OF BEDROOMS BUILDER O R PERMTTDATE: ��e�3 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility �� Feet Private Water Supply Welland 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 bw Lalat rM/yrw.r9 G3. O A i I i i ( O, 62 0} 6a� i r SEP-09-2003 12 :20 PM DOWN CAPE ENGINEERING 508 362 9880 P. 01 939 main street r16a tel.(508)362.4641 yarmoulh port mass 02875 fax(hoe)362.9660 down cape engineering structural design civil engineers& land surveyors September 9, 2003 Arne H,OJala P.E.,P.L.S. lend court Thomas McKean, Director Denlel A.olala,RL.S. survey$ Timothy H,Covell,P.L.B. Barnstable Health Dept, 200 Main Street site planning Hyannis, MA 02601 sewage system Re- Margaret Norod, 135 Carriage Lane, Barnstable designs Dear Tom: inspections To summarize, Mrs. Norod has a failed (by DEP inspection) leach pit which is required to be upgraded to today's standards as a result of an impending sale. There is no permits increase in the number of bedrooms. The question arose as to the necessity of replacing the existing 1000 gallon septic tank with a 1500 gallon septic tank, and placing it 10' off the dwelling, since the existing tank is only about 1' off the(slab) sunroom. At your suggestion, I contacted Brian Dudley of DEP (508-946-2753)yesterday in regard to this situation. He indicated that since the leach pit was the only portion of the system that was in failure, and that the existing septic tank has 200%capacity(it is a 4 bedroom dwelling), then he had no problem with the tank remaining where it was. Should there be an increase proposed in the number of bedrooms in the future, then a 1500 gallon septic tank placed 10' off the foundation/slab would be required. It is my understanding that the Title 5 plan submitted to your office for this site will be approved. Thank you for your assistance in this matter. Very truly yours, Sarah B. Ojala Down Cape Engineering, Inc. cc: Bortolotti Construction Margaret Norod Linda Bryson COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS > DEPA.RTMENT OF ENVIRONMENTAL4 I Zak PROTECTION :RE:,EIVED n ���9LE� INS����'! ®� 6 2003TI T-LE 5 BARNSTABLE1 H[1EPT. OFFICIAL IiSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORIM PART A J ? CERTIFICATION Property Address: / 3S CG✓✓ e 1-/V FAILED INSPECTION Owner's Name: �o O Ow,ner's Address: I4 e G�63cJ Date of Inspection: Q Name of Inspector: lease print) /SG/�� Company Name: /Iv IV — TL—e �{ Mailing Address: o �e /� MAP _r 771 PARCEL O o Z Telephone Number ) [f LOT �,. ... CERTIFICATION STATENIENT 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 Ci IR 15.000). The system: Passes Conditionally Passes eeds Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: 4" The system inspector shall submit copy of this inspection report to the Approving Authority (Board of Health or DEP) %,,ithin 30 days of completing this inspection. if the system is a shared system or has a design flow of 10,OU0 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The ori-1;i.nal should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Notes and Comments / I'C4 LA /I e, F,, ****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. I Page 2 of 1 l OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEjv1 INSPECTION FORM PART A CERTIFICATION (continued) �� ' Property Address: �Gvl^i /v Owner: 0 90 Date of Inspection: r Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. Systcm Passes: I have not found any information which indicates that any of the fa' ure teria 15.303 or in 310 CivtR 15.304 exist. Any failure criteria not evaluated are indicated belowscribed in 3 lU CiVa Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pas'•section elac or repaired. The system.. upon completion of the replacement or repair, as approved b}the Boa d of to Health e%ill pass. Answer yes, no or not determined MN,ND) in the for the following c�:rl::i ,• g statements. If"not determined" please The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound,exhibits substantial in2tradon 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. ND explain: Observation of sewage backup or break out or high static water level in the distribution bo.� Obstructed pipe(s) or due to a broken,settled or uneven distribution box. System will due to broken or approval of Board of Health): pass inspection if(with broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaces: N D explain: The system required pumping more than 4 times a year due to broken or obstructed pipc(s). The system «ill Pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: OFFICL-kL INSPECTION FORIM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATIOLi (continued) Property Address: 13 C� /IC' L� QO Owner: /V0/1a Date of Inspection: O C. Fu her 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 Ci♦iR 15,303(1)(b) that the system is not.functioning in a manner which will protect public health,safety and the environment: Cesspool or pri,,y is within 50 feet of a surface water _ Cesspool or pri`y is within 50 feet of a bordering vegetated wetland or a salt marsh 2. Svstem will fait 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 envirooment: _ The system has a septic tank and soil absorption s}stem(SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface w, ter supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The s<'stem has a septic tank and SAS and the SAS is «ithin 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 laboraton•, for coliform bacteria and volatile or ga the prese nic compounds indicates that the well is free from pollution from that facility and nce of ammonia nitrogen and nitrite nitrogen is equal to or less than 5 ppm provided chat no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: f � Page 4 of I 1 OFFICLkL INSPECTION FORNI — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: �- � /%q Owner: Rip '"s U�63v Date of Inspection: U 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 clod _ v Discharge or ponding of effluent to the surface of the Q* Clogged SAS or cess�oo� Clogged 'ground or surface waters due to an overloaded or t/ wed SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool J�Iequired squid depth in cesspool is less than 6"below invert or available volume is less than '/:day flow pumping more than 4 dmes in the last year NiOT due to clo��cd or of times pumped obstructed pipe(s). Number Any portion of the SAS,cesspool or privy is below high ground water elevation. y port or tributary ion of cesspool or privy is within 100 feet of a surface NVater supplyibutary to a surface water supply. �,Anv 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 %%ith no acceptable water quality analysis. (This system passes if the well water analysis, performc ° DEP certified laboratory,for coliform bacteria and volatile o aanic compounds indicates r::.:. zne 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 arc triggered.A copy of the analysis must'be attached to this form.] (Yes/No) The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CtiIIZ 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 s,s*.ern the system must serve a facility wr gpd- t:7 t dlslgn flow of lt),tNli) (Y a pd ) 15.OUtl You must indicate either"yes" or"no" to each of the following: (The following criteria apply to large s-,-sterns in addition to the criteria above) yes no _ the s}stem is within 400 feet of a surface druildn;water supply. _ the system is within 200 feet of a tributary to a surface driii a water suppiv 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 si "yes" in Section D above the I--fie system has failed The owner or operator of an lac t q� or answered significant threat under Section E or failed under Section D shall u system y g system considered a 15.304. The system owner should contact the appropriate regional office ofrthe to accordance with 310 CIvtR Department. f I Pabc 5 of l I OFFICL-kL LNSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM MSPECTION FORIM. . PART B 77 CHECKLIST 4 Property Addrrys: �Js CGd/ra L4/ �Hf �Edo Owner: 0 0 Date of Inspection: oZ O Check if the follo«in�have been done. You must indicate`�es" or"no" as to each of the foliovvin�: Yes, No PumPing information was provided by the owner, occupant, or Board of Health _ Were any of the system components pumped out in the reviou p s two weeks F�as the system received normal flows in the previous nvo week period — _/ Have large volumes of water been introduced to the S}stem recently or as part of this inspection Iz/ Were as built plans of the system obtained and examined? If th ,vv( they.were not available note as N/A) '—/ Was the facility or dwelling inspected for signs of sewage back up V Was the site inspected for signs of break out _tL — Were all system components, excluding the SAS o , located on site .JZ/— Were the septic tank manholes uncovered opened and the interior of of the baffles or tees, material of construction, dimensions,depth of liquid, [tie tank inspected for the condition / p quid, depth of sludge and depth of scum _ Was the facility owner(and occupants if different from owner)provided%ith 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. Yes no 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 uriacceptable) (310 CMR 13.302(3)(b)] Page 6 of 1 1 OFFTCLAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTENI INSPECTION FORM PART C l [` SYSTEM I.NFORti1ATION 3J Property Address: / C,01 e. L�r/ Owner: �p 40 Date of Inspection: RESIDENTIAL FLOW CONDITIONS Number of bedrooms (design): ly Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd. of bedr Number of current residents: / ooms): Does residence have a garbage grinder(yes or no): 11119 Is laundry on a separate sewage system (yes or no): it^v [if yes se Laundry system inspected(Y or no): iG'o parate inspection requiredl Seasonal use: (yes or no):lT/es U Water meter readings, if available Oast 2 years usage (g )) Sump PAP(Yes or no): 'D Last date of occupanry: In i�e'.4 CONEMERCIAL/LNDUSTRU L Type of establishment:. Design flow(based on 310 CMR 15.203): Basis of design flow(seats/persons/sgft,etc•): Grease trap present(yes or no): Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system(yes or no): _Water meter readings, if available: Last date of=:upancy/use: OTHER bc): Pumpiab Records GENERAL LYFOPN1ATIOY Source of information: ��.+."�1e G Was system pumped as part of the inspection(yes or no): /Ti R yes, volume pumped;_gallons —How was quantity ', Reason for pumping; q ty pumped determined'. TY _OF SYSTEM Septic Link,distribution box, soil absorption system _Single cesspool Overflow cesspobl 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 o%mer)- -Tight tank _Attach a copy of the DEP approval Other(describe): Approximate age of all components, dat installed(if kn � ) td source of information: Were sewage odors detected when arriving at'he site(yes or no):/(/D i Page 7 of l l OFFICIAL INSPECTION FORM— NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM Pi iSPECTION FORM PART C SYSTEM INFORN LkTION (continued) r Property Address: 2� /ii r r S �? Owner: �( 0 Date of Inspection: O BUTULNG SEWER(locate on site plan) Depth below grade: ,7� Materials of consuu�on: cast iron _q'� PPVC other(e.-cplain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage, etc.): SEPTIC TPuNh:_(locate on site plan) Depth below grade: C� / Material of construction:_concrete metal fiberglass_polyethylene _other(explain) _ If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no): certificate) _(attach a copy of certifi Dimensions:_ SX Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom o utlet to or baffle: / How were dimensions determined: o Comments(on pumping recommendations, oiler an�ties tee c Vlated to outlet invert,evidence of leakage,etc:): °r baffle condition, structure! integrity, Liquid levels �n.�•i�;_�- © g� GREASE Tom:Al—P gate on site plan) Depth below grade: _ Material of construction:— — — _p ene.— concrete metal fiberglass (explain): olyethyl other Dimetusions: 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 Mlle: Date of last pumping: Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structu al inte ty, li d levels as related to outlet invert,evidence of leakage, etc.): �' Page s of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEiv1 INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: /2 rGr/�1-14 'v Owner: p Date of Inspection: � O TIGHT or$OLDI�i(G TANK:A/""(=k must be pumped at time of irzPection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass_polyethylene other(eeplain): en Dimsions: Capacity: goon Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments (condition of alarm and float switches, etc.): DISTRIB(;Tj""* or Y: _... tf present must be opened)(locate on site Pam) Depth of liquid level abov_ invert:(4�1p,,-, 1 Comments (note if box is lc%cl ar;d distribution to outlets eq leakage into r out of any e�ldence of solids carryover,any evidence of ell O j��f 0 PUMP CH INNER; (locate on site plan) Pumps in working order(ycs or no): Alarms in working order(yes or no): Comments (note condition of pump chamber,condition of pumps and appurtenances.etc.). i Page 9 of I l OFFICLAI. INSPECTION FORM—NOT FOR VOLUNTARY ASSESSN SUBSURFACE SEWAGE DISPOSAL SYSTENI TNNSPECTION FORN[NTS PART C SYSTENI LYFORMATION(continued) Property Address: Owner: /© ,a Date of Inspection: dr SOIL ABSORPTION SYSTEM (SAS): (locate on site plan,excavation not required) If SAS not located explain why: leaching pits,number: S 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 ndin� etc.): Po g,damp soil,condition of vegetation. Fti CESSPOOLS:-4-/'(CesSpOol must be pumped as ,.- *O- part of inspe'ctipla)0ocate on site plan) Number and configuration: FePLh-top of liquid to inlet invert: i)ePtn of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction; Indication of groundwater inflow(yes or no): Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation etc.). PRIVY: (locate on site plan) ) Materials of constriction: Dimensions: Depth of solids: Comments (note condition-of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.): OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORINI PART C SYSTEM INFORMATION (continued) Property Address: I-P7 Owner: Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewa-e disposal systezn including tics to at least ttivo pem=cnt reference landmarks or benchmarks. Locate all wells within 100 feet. Locate Where public wester supply enters the building. Pagc 1 l oC 1 l • • OFFICIAL INSPECTION FOR — NOT FOR VOLUNTARY ASSESSMENTS SUBSUR IM FACE SEWAGE DISPOSAL SYSTEIN1 INSPECTION FORM PART C SYSTEM IYFORIMATION (continued) Property Address: 2,� Owner. (9�o � Date of Inspection: s SITE EXAM Slope Surface water Check cellar Shallow wells 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 rc-,.iewed:served site(abutting ProPem'/observation hole withi'n��p feet of SAS) Checked with local Board of Health-explain: �%"(-1 f f Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must yi src how you es blishVe the high ground wa er levat9on: / �/ how ;P� Ye 074 ------------- 10 r N Gi rD rn✓i arc YP� ' S O li t r O C7 f� 0 ( r L+0CATION SEWAGE PERMIT NO. VILLAGE l�ed � 3 t: PARCEL NU: C)T INSTALLER'S NAME A ADDW \ ® UILDE.R OR OWNER "~ DATE PERMIT ISSUED �x ,{. DAT E COMPLIANCE ISSUED ,�f 5 J' 'r,. w u!*- 'a � n � ��'•`T rJ 'f 4 � ,1 i� 5 } ,� h o �v �� �' .� .. (! LOICATION _ -w SEWAGEPERMIT E MIT NO. V I L L A C E A.Am. FARM NU:-iv V?,, �o - 1NSTA LLER'S NAME i kV .� o .1'./3 h' v�1 ociYIY B U I L D E.R OR OWNER 40 wl DATE PERMIT ' ISSUED ~ . DATE COMPLIANCE iSSUED � a � � s3 j _ a I TOP FNDN. = 87.1 SYSTEM 'PROFILE TEST HOLE LOGS ACCESS COVER TO WITHIN 6" OF FIN. GRADE (NOT TO SCALE) PROP, INSPECTION PORT, USA LYOI�S, IRS ACCESS COVER (WATERTIGHT) TO � WITHIN 6" OF FIN. GRADE ENGINEER: WITHIN 6" OF FIN. GRADE /// SAM WHITE, IRS MINIMUM .7S' OF COVER OVER PRECAST � 27 SLOPE REQUIRED OVER SYSTCM � 85.0, WITNESS: 2� L 7/31/03 I �, RUN PIPE LEVEL 2" DOUBLE WASHED PEASTCNE DATE: f LOCUS -= FOR FIRST 2' PERC. RATE - S_ Z MINZINCH IExISTING 1000 S MAX. GALLON SEPTIC 82.2'f* CLASS_____.._- SOILS P# 10536 \ _ 82.01 `? TANK (H- 10 ) 8128' "GASfdAFil1 81 ,45'764\ . c3coaa 0 17-1o0 __:1 a a �4' A�R0UN0 0R� 81 .17 (� C1 Cl C] � CD O Cl 6" CRUSHED STONE OR MECH m m m m 0" ELEV. COMPACTION. (15.221 (2)) �$ 2' M [� I� CI 0 M 0 © c -`- DEPTH OF FLOW z 4' _ 79.17 ( 1.4% slope) ( 1 r SLOPE) TEE SIZES: 3/4" TO 1 1/2" DOUBLE WASHED' STONE FILL INLET DEPTH 10,. . 13" OUTLET DEPTH = 14 LOCATIO,' IMAP NO SCALE O/E i FOUNDATION-- EXIST SEPTIC TANK 53' D' BOX 13' LEACHING LS ASSESSORS MAP 298 PARCEL 82 FACIL TY 16,0 10YR 2 2 *THE INSTALLER SHALL VERIFY THE 7.27' LOCATIONS OF ALL UTILITIES AND ALL g BUILDING SEWER OUTLETS AND ELEVATIONS PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM L5 „ 10YR 5/ 71.9' 44 79.5 C PERC 25% COBBLES. 82.2 LS AND BOULDERS 0 2.5Y 6/4 9 Q• 1 36., 71.9' NO GROUNDWATER ENCOUNTERED NOTES: A 0.7 ASSUMED 1 . DATUM IS r r zo SEPTIC DESIGN: (GARBAGE DISPOSER Is NOT ALLOWED - -` (�C1 A do r+�� �. M' INICIPAI 'NAT R IS FXlr�ln!fa 3. MINIMUM PIPE PITCH TO BE 1 8" PER FOOT. USE A 440 GPD DESIGN FLOW / LOT 61 = �'~ SEPTIC TANK: 440 Gpp (_2 _) 88O 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO H- 10 _ GALLONS � -^ 5. PIPE JOINTS TO BE MADE WATERTIGHT. r �0 34,977f SQ. FT, 0 1000 ( ) 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS. r fo USE A _ GALLON SEPTIC TANK RE-USE EXISTING LEACHING: ENVIRONMENTAL CODE TITLE V. 19.4 2(33.5 + 12.83)2(.74) = 137 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO BE SIDES: 6 USED FOR LOT LINE STAKING. 79.9 0.6 85.8 N BOTTOM: 33.5 x 12.83 (.74) = 318 i 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. k±)eo.2 EXIST. DWELL. s sss rn TOTAL: 614_ SF 455 _ GPD 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT 79•8 �•�61.79' TF USE3 BOULDER �, INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED .� � - $�•� R=39.30' 6 + 86. + •3 �• � ) 500 GAL. LEACHING CHAMBERS WITH 4' FROM BOARD OF HEALTH. 79.4 80 3 STONE ALL AROUND 10. LEACH PIT TO BE PUMPED AND FILED WITH CLEAN SAND OR CD s + 85. REMOVED AS NECESSARY. 80.0 8 .1 8 . .5LEGEND \\ `� o s SEXIST f 100.0 PROPOSED SPOT ELEVATION ./..�` 1.1 •3 188.3 SE) TITLE 5 SITE{.. �L f'7N \\ 81.1,01 ess 100x0 EXISTING SPOT ELEVATIONPA E OF DRIVE �,. + 8 + 8 , 86.2 10o PROPOSED CONTOUR 1 ,35 CARRIAGE LANE �� \ s 2.2 �� 83, �� s, IN THE TOWN OF: `'�' 1.9..-, \ u, I � 100 EXISTING CONTOUR AR N T B S ABLE � 83.3 83,2 / 83. 86.1.5 PREPARED FOR:. MARGARET NOROD � / BOULDER 3,9 P 90, J g / + 88,3 OD BOARD OF HEALTH 83.5 /83,5 + 83.2 +�s.7 30 0 30 60 90 MA T . ' APPROVED DATE 84 v00 -- 84.7 6 BENCH: MARK TOP OF 8 + 90. SCALE: 1" = 30' DATE: ,AUGUST 5. 2003 :.. - � CONC. BOUND EL. = 87.5 \ s 3 0 off WS-362-4541 + fox 508 362-9860 8 8 0 + O Of 8 down cape engineering, inc, F � IARNE _. ,.. o.,....: v 8 8s.2 M. CIVIL ENGINEERS OJALA .-.e e..a o:IA,LA c%a ' CIVIL No.2W4o �. LAND SURVEYORS No. 2 . I � 939 main st, yarmouth, ma 02675 s �� ` �`AM ��_DA OJALA, P.E., P.L.S. TE i