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HomeMy WebLinkAbout0090 CINDY LANE - Health 50 Cindy. Lane Barnstable, P A 317 009 Ir Ln M Postage $ C3 V. Certified Fee t' NN IS`/�j ��' Q Return Receipt Receipt Fee ostmark Here 0 O (Endorsement Required)' E3 ON Restricted Delivery Fee 28 � (Endorsement Required) W Total Postage&Fees 1$ Cof r-1 VSPS Deborah A. Colleran TR o %NaimoFamily Irrev Trust 50 Cindy Lane Barnstable, MA 02630 i Certified Mail Provide: n A mailing receipt - n A unique identifier for your mailpiece b o A record of delivery kept by the Postal Service for two years Important Reminders: a Certified Mail may OK"`<be combined with First-Class Mail®or Priority Mail(& o Certifier'"' ible for any class of international mail. e NC RAGE IS PROVIDED with Certified Mail. For vale `,Insured or Registered Mail. a For,, -a-Return Receipt maybe requested to provide proof of deliv, wri Return Receipt service,please complete and attach a Return Rece trrS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required.u ... e For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". n If a postmark on the Certified Mail receipt is desired,please present the artk cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. 1 IMPORTANT:Save this receipt and present it when making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 y4 I � COMPLETETHIS SECTION ON DELIVERY ® Complete items 1,2,and 3.Also complete A. Signature item 4 if Restricted Delivery is desired. ,yy�� ❑Agent 13, Print.your name and address on the reverse ❑Addressee so that we Can return the card to you. B. Received by frinted pdine) A C. Date of Delivery ® Attach this card to the back of the mailpiece, A"- or on ther front if space permits. D. Is delivery add'.ss different from item 1? ❑Yes 1. Article Addressed to: If YES,enter•delivery address below: ❑No Deborah A. Colleran TR - %NaimoFarrik Irrev Trust j 50 Cindy Lane 3. Service Type Barnstable, MA 02630 ❑Certified MOP ❑Priority Mail Express` ❑Registered ❑Return Receipt for Merchandise ❑Insured Mail ❑Collect on Delivery I 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number e - =7n14 12aa o0a1 0358' 5913 (Transfer from service label) - I PS Form 3811,July 2013 Domestic Return Receipt f I I UNITED STATES POSTAL SERVICE First-Class Mail I Postage&Fees Paid USPS I Permit No.G-10 ' Sender: Please print your name, address, and ZIP+4®in this box' ?'� af&?rrt.s�aLl�s pg6,&o h'sa� Ihr�s7� �DD�laia,S�e� f� i; � DZ6D1 I Town of Barnstable Barnstablelime krAMA Regulatory Services Department "" 'h KA i639. Public Health Division D 1� ' 200 Main Street, Hyannis MA 02601 2°°� Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL #7014 1200 0001 0358 5913 October 28 2015 - Deborah A. Colleran TR % NaimoFamily Irrev Trust 50 Cindy Lane Barnstable, MA 02630 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5. • The septic system located at 50 Cindy Lane, Barnstable, MA was last inspected on 10123/2015, by Brian K. Tilton, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Conditionally Passes" under the guidelines of the 1995 TITLE 5 (310 C'MR 15.00) Due to the following: • The distribution-box is deteriorated and needs to be replaced. • Water has settled in pipe due to improper pitch or sag in pipe. The pipe needs to be reset for proper pitch and flow. You are ordered to repair or replace the septic. system within one (1) year from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF TH BOARD OF HEALTH as cKean, R.S. CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\50 Cindy Ln Barn Oct 2015 I f Town of Barnstable Barnstable : . . ; Regulatory Services Department Q p Public Health Division 200 Main Street, Hyannis MA 02601 2007 Office: 508-8624644 Richard V.Scali,Director FAX: 508-790-6304 t Thomas A.McKean,CHO CERTIFIED MAIL# 014 1200 0001 0358 5913 October 21, 2015 Deborah A. Colleran TR %Naimo Family Irrev_Trust 50 Cindy Lane Barnstable, MA 02630 ORDER TO COMPLY WITH STA E IRONMENTAL CODE, TITLE 5 .. The septic system located at 50 Cindy ne, Barnstable, MA was last inspected on 9/30/2015,by David B. Mason, a ce ' le 'septic inspector for the State of Massachusetts. The inspection of the septic syste showed th the system "Failed" under the guidelines of 1995 TITLE 5 (310 CMR 15 0) due to the llowing: r • Static liquid level in a distribution box bove outlet invert due to an overloaded or clog ed SAS or cesspool You are ordered to repai or replace the septic system ithin one (1)year from the date you receive this notific tion. Failure to repair/rep ce the septic system within the deadl e period will result in future enforcement actio . t PER ORDER O THE BOARD OF HEALTH , as McK an, R.S., CHO Agent of the oard of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\50 Cindy Ln Bam Oct 2015[Type text] Parcel Detail Page 1 of 4 , Logged In As: r Tuesday,October 20 2015 Parcel Detail Parcel Lookup Parcel Info --- -- ------------ -- Parcel ID 317-M7 I Develope LOT 18 Location 150 CINDY LANE I Pri Frontage 208 Sec Road I Sec Frontage Village IBARNSTABLE Fire District BARNSTABLE Town sewer exists at this address NO I Road Index 10310 R4 Asbullt Septic Scan: Interactive w 317007_1 Map T .M Owner Info Owner ICOLLERAN, DEBORAH A TR' I Co-Owner NAIMO FAMILY IRREV TRUST Streets 50 CINDY LANE Street2 City IBARNSTABLE State FM—A1 zip I02630 Country Land Info Acres 0.53 � use ,Single Fam MDL-01 I zoning .RF-2 I Nghbd -0108 � Topography Level I Road Paved I Utilities Public Water,Gas,Septic I Location Construction Info Building 1 of i Year 1985 Roof Gable/Hip I' Ext 'Wood Shingle 1 Built Struct Wall Living IRoot Cmp ( AC N-oneI11760 Area Cover AsPh/ GIs/ Type .' sWDK s 9AS 7 I I (DDrywa`ll� Bed Style Ranch 3 Bedrooms 12 is Wallll y . �...�.... Rooms .....�......�..1 Int Bath Model lResidential I Floor.Hardwoodd Rooms 2 Full-0 HaIf ) Z12ifi#R t z -BUT Grade jAverage ...._._I Type Heat Hot Water I Rooms Total I to Stories 1 Story (; Heat Gas Found Poured Conc. �I Fuel ation Gross 3824 Area Permit History http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=26371 10/20/2015 Parcel Detail Page 2 of 4 Issue Date Purpose Permit# Amount Insp Date Comments 1/4/2005 Addition 81557 $23,000 12/6/2006 12:00:00 AM 1/1/1985 Dwelling B27423 $55,000 1/15/1986 12:00:00 AM BA 1 STOR 6/1/1984 Swimming Pool 841165 $0 1/15/1985 12:00:00 AM BA - Visit History Date Who Purpose 10/7/2015 12:00:00 AM Susan Ricci Cycl Insp Comp 4/14/2014 12:00:00 AM Geraldine Clark In Office Review 4/22/2013 12:00:00 AM Pamela Taylor In Office Review 4/2/2013 12:00:00 AM Pamela Taylor In Office Review 7/24/2012 12:00:00 AM Denise Radley Change of Address 7/25/2002 12:00:00 AM Paul Talbot Meas/Est 8/15/1993 12:00:00 AM ME Meas/Est - Sales History Line Sale Date Owner Book/Page Sale Price 1 1/19/2012 COLLERAN, DEBORAH A TR C196132 $1 2 8/22/2005 NAIMO, FRANK D& NANCY TRS C177691 $1 3 8/25/1999 NAIMO, FRANK D& NANCY C154477 $185,900 4 12/16/1985 TAI, LILY C104590 $148,500 5 6/10/1985 GIBSON, RUSSELL A C101929 $23,000 6 12/21/1984 1 RUSSELL A GIBSON INC IC99590 1 $23,000 Assessment History Save# Year Building Value XF Value OB Value Land Value Total Parcel Value 1 2015 $127,200 $42,900 $3,300 $207,300 $380,700 2 2014 $127,200 $42,900 $3,300 $207,300 $380,700 3 2013 $127,200 $42,900 $3,400 $207,300 $380,800 4 2012 $127,200 $42,000 $2,700 $201,700 $373,600 5 2011 $168,700 $3,400 $1,500 $201,700 $375,300 6 2010 $168,600 $3,400 $1,500 $212,900 $386,400 7 2009 $163,700 $2,700 $800 $208,200 $375,400 8 2008 $193,900 $2,700 $800 $232,500 $429,900 10 2007 $174,200 $2,700 $800 $232,500 $410,200 11 2006 $158,800 $2,700 $800 $220,900 $383,200 12 2005 $148,100 $2,700 $800 $203,200 $354,800 13 2004 $120,300 $2,700 $800 $203,200 $327,000 14 2003 $109,500 $2,700 $0 $73,400 $185,600 15 2002 $109,500 $2,700 $0 $73,400 $185,600 16 2001 $109,500 $2,700 $0 $73,400 $185,600 17 2000 $85,700 $2,600 $0 $50,700 $139,000 18 1999 $85,700 $2,600 $0 $50,700 $139,000 19 1998 $85,700 $2,600 $0 $50,700 $139,000 20 1997 $94,700 $0 $0 $30,700 $125,400 21 1996 $94,700 $0 $0 $30,700 $125,400 22 1995 $94,700 $0 $0 $30,700 $125,400 23 1994 $86,100 $0 $0 $34,600 $120,700 http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=26371 10/20/2015 THE Tp� Town of Barnstable + SARNfffABLE, 6 9 ,�� Regulatory Services Department Public Health Division 200 Main Street,Hyannis MA 02601 Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6,2007 Rev. 7/6415 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An"x"marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE (1)YEAR DEADLINE CRITERIA Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑Any-portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes.if the water analysis indicates the well is free from pollution). TWO (2) YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any"conditionally passed systems"(broken cover,relocation of a pipe,relocation of a driveway due to H-10 components, etc) ❑.Leaching pit or cesspool with high liquid level, <12"below inlet(per Town Code §360-9.1) OTHER Repair deadline: Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc M�, Commonwealth of Massachusetts Title 5 official Inspectio Form / -- Subsurface Sewage Disposal System Form-Not for VoluntaryAsses5men, e-® �1 50 tes Address � owner 1 information is N e required for every ZC7 page. City(Town S—tatter L'p=Codes EDate Inspe 'on 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, ifI IIZI Important:When fillA. General Information on out forms �/ n the computer, # use only the tab 1. Inspector: key to move your cursor-do not David B. Mason use the return key. Name of Inspector David B. Mason —Q Company Name 4 Glacier Path Company Address East Sandwich MA 02537 Cityfrown state Zip Code 508-367-1617 S1287 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 Zvl� pector s ignatu Date �Z' 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 ad i design flow of 10 000 r 9 gpd o 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. Wns-3113 Tide 5 ofidel inspection Force SubWace Sewage Dis posal sposal S/stem•Page 1 of 17 Vs r Commonwealth of Massachusetts Title 5 Official inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 4 Property Address Owner Owners Name information is required for every -Z Y lRI 9 ?J-(7 zj�it page. Cky/rown Sta Zip Cade Date Insp 'on B. Certification (cont) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: _j I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: The observations noted in this report represent the condition of the system only on this date of inspection and the information contained herein does not guarantee the continued operation of the system. 13) 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 tarn will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5ins•3/13 TUte 5 Ctfidal Inspedon Form Subswface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewa e.Dis g posal System Form-Not for Voluntary Assessments Oki 04(2-1,4 5 u 1 Property Address Owr>er Owner's Name information Is required for every page. Cityfrown State Zip C e Date of on B. Certification {cunt.} ❑ Pump Chamber pumpslalarms not operational.System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection if(with approval of Board of Health): Q broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): Q 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 Q 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 CHAR 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 5o feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh Wins-3l13 rite'OFz al Inspechan Form:Subsurface Sewage Disposal System•Pegs 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Farm _ ) Subsurface Sewage Disposal System Form -Not for Voluntary Assessments V50 OH Property Address Omer Owner's Name information is `/1 required for every �, ✓ �! 1L�+1Q'GP�� �(� II page. Cltyll'own S to 21p Code Date Inspe 'on 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) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y day flow t5ins-V13 T to 5 Offdal trrspecton Fors:Subsurface Swage Disposal System•Page 4 0117 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form •Not for Voluntary Assessments Lew Property Address ( al0 Owner Owner's Name information is `` requi sered for every City�-, V I , du S e Zip Code Date f Insp coon B. Certification (cont.) Yes No ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ Any portion of the SAS,cesspool or privy is below high ground water elevation. ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal cofiform 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. Lins•3113 Tltla 5 Official trapemon Forth:Subsurface Sewage Disposal System•Page 5 of 17 l— N Commonwealth of Massachusetts Title 5 Official Inspection Form J Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Property Address Owner Owner's Name information is T M (/_7 yO page,requir for every, tyrrown _l L �J N J (D CI o rG Sfa Zip Code ;[Date of nspe 'on C. Checklist Check if the following have been done.You must indicate`yes"or"no"as to each of the following: Yes No ❑ Pumping information was provided by the owner, occupant,or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as NIA) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components,excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(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)1310 CMR 15.302(5)) D. System Information Residential Flow Conditions: Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): t5ms•V 3 Title 5 Official lispection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts .p:4Title 5 Official Inspection Form vSubsurface Sewage Disposal System Form-Not for Voluntary Assessments Property Address Owner nets Name infomation is -t i 2� � required for every ^�'t b" 3 � C D page. City,Town St Zip Code Date of nsp n D. System Information Description: Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection information in this report.) ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Unknown Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft.,etc.)_ Grease trap present? ❑ Yes ® No Industrial waste holding tank present? ❑ Yes ® No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ® No Water meter readings, if available: t5 ns•3P 3 71tle 5 OfB:ial Inspection Farm:SAsaface Ser"o Disposal System•Page 7 of 17 Commonwealth of Massachusetts g Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments $50 aW2 � Property Address Owner Owner's Name information is required for every �� 6ti page. City/Town S e Zip Cod Date o I spectio D. System Information (cont.) Last date of occupancyluse: Date Other(describe below): General Information Pumping Records: Source of information: Board cf Health Was system pumped as part of the inspection? ❑ YeJ If yes,volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank,distribution box,soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no)(if yes,attach previous inspection records,if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ns-3h3 Tale 5 0t6oal hspec:ion Form:Subw.laae Sewage Disposal System-Pace 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a - _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a GIwp t Property Address Owner Owners Name iftrmation is required for every C/'' a.++` i=-- —?"J�.}— D�, q ?�i �(�157 page. City.rrown S to Zip Code Date Ins 'on D. System Information (cont.) Approximate age of all components,date installed(if kno )and source of information: CD 4C t Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan) Depth below grade: 3 feet Material of construction: ❑cast iron . ®40 PVC ❑other(explain): Distance from private water supply well or suction line: 10+ feet Comments(on condition of joints,venting, evidence of leakage,etc.): Septic Tank(locate on site plan): Depth below grade: 2 feet Material of construction: concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 Sludge depth: a° tans•V 3 Title 5 0f iidat Ins potion Form:Subsurace Senage Disposal Systerr•Page 9 of 17 Commonwealth of Massachusetts �9Title 5 Official inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments W. 15D 6IW17q. ui�LqC, Pmperty Address Owner Owner Name . information is 5 ,�yl �r requited for every �' ' r!t Pa". Cltyfrown s Zip Code :Date ectio D. System Information (coat.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 47" Scum thickness V. Distance from top of scum to top of outlet tee or baffle 3 Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? Scour Stick Comments (on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): Effluent level with outlet invert. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fiberglass polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping. Date Mriss-W 3 Title 5 Weial lruoection Form:Su=urfare Sewage Disposal Syslem•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form •Not for Voluntary Assessments Of W Property A,d,dr,�ess// Owner Owners Name information is n 1� Y t 1/CXTW required for every page. City�Town Sta Zip Code Date of In ece n D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑fiberglass ❑polyethylene y ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins.3M3 Title Official Inspection Form..:Subsurface Sewage Oisposal System•Page 17 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Property Address Owner Corner's Name information is `fin, '�, V'� required for every /� `u'1 1Li page. CityfTown S Zip Code Qate of I pspectitn D. System Information (cunt.) Distribution Box(if present must be opened)(locate on site plan))3 Depth of liquid level above outlet invert LU—" ' ` I 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.): _•evidence of solids carryover. • #3U1LV UP 11k..! Ibt� U Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No` Alarms in working order: ❑ Yes ❑ No' Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): `If pumps or alarms are not in working order,system is a conditional pass. Soil Absorption System(SAS)(locate on site plan,excavation not required): If SAS not located, explain why: Leaching field without inspection port. tSns•3u'13 TGe 507ida1 Inspection Fore$Osuface Sewage Dlsoosw System•page 12 of 17 l Commonwealth of Massachusetts ;Ame Title 5 Official Inspection Form to Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property F+ddress Ommer Owner's Name Information is h required for every V �Z page. uw roum Sta a Zip Code Oteo Insp 'on D. System Information (coat.) Type: ❑ leaching pits number: leaching chambers number: 3 ❑ leaching galleries number: ❑ leaching trenches number, length: leaching fields number, dimensions: — ❑ overflow cesspool number: ❑ innovativetalternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation,etc.): If dimensions unknown but based on probing it is approxiamatelyZ5by )O Soil probed was damp Cesspools(cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-3113 Title 5 Official inspection Form:Subsuia:e Sewage Disposal System-Page 13 of 1? %,#ommonweann oT massacnusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 600 Property Address Owner 0information is ner's Name required for every ri•Q (J Ct r�j��' page. CityfToitylTotan State Zip Code Date insp on D. System Information (cont.) Comments(note condition of soil,signs of hydraulic failure, level of ponding, condition oFvegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•W13 T tle 5 Official ms pection^orn:SubUAace Sgxage Disposal Systan•Page 14 of 17 Commonwealth of Massachusetts �} Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 6HOV Lftj Property Address I Owner Owner's Name information is �/(,A bO� 20� required foreviJj . , 7� `�"- �"i ITS page, Cityfi own State Zip Code Date Ins ion J..D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system,including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately c ?� 52 _l tsns-J13 Title 5 CIfdal hspedan Form:SUZSu fsca Sewage Disposal System-page 15 of 17 uommonwealm of massacnusem Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address Owner Otvnel's�Name information is required for every page. City'Town State .Tip Code Date of Inspection D. System Information (cons.) Site Exam: ® Check Slope ® Surface water Check cellar ❑ Shallow wells Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site(abutting propertylobservation hole within 150 feet of SAS) z Checked with local Board of Health-explain: Groundwater Contour Map ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Groundwater Contour Map Before filing this Inspection Report,please see Report Completeness Checklist on next page. }Sins,•3r13 Title 5 oEriaa Inspec0cr Form:Subswface Sawa a asposel S g ystern•Page 16 of 17 F %OU11unVIMMInn ur twassacnusetts w: Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Property Address Ovmer Owners Name infonnation is required for eve � i�_ page. City/Town State Zip Code Date f Insp ction 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 IZ Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file :5irr.•Sit 3 Tile 5 Official hapecion Fo=SLbsJrtace Sewage OsMsal System•Paca 17 cf 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form . Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 50 Cindy Lane l" Property Address -0 Naimo Family Trust, Deborah Colleran Trustee ' Owner Owner's Name lob information is required for every Barnstable MA 02630 10/23/2015 , page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way.Please see completeness checklist at the end of the form. Important:When A. General Information 61 223 filling out forms # on the computer, use only the tab 1. Inspector: key to move your cursor-do not Brian K.Tilton use the return Name of Inspector key. The Building Inspector of Cape Cod Company Name PO Box 307 Company Address Eastham MA 02642 Cityrrown State Zip Code 508-255-9343 S14392 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information o mation reported below is true, accurate and complete as of the time of the inspection.The inspection P P 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 10/23/2015 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 �ow �s Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 50 Cindy Lane Property Address Naimo Family Trust, Deborah Colleran,Trustee Owner Owner's Name information is required for every Barnstable MA 02630 10/23/2015 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary:Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: 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): N/A t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 50 Cindy Lane Property Address Naimo Family Trust, Deborah Colleran,Trustee Owner Owner's Name information is required for every Barnstable MA 02630 10/23/2015 page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational.System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont.): ® Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ® broken pipe(s)are replaced ® Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ® distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): D-Box is washed out and settled fluid in pipe is at invert'but shows evidence of over invert diie to (pipe settled,7ran Mytanna sewer camera in line and line was clear to leach chamber,LD=box needs to, Fbe replaced,,line pitch-re 9-et-and garbage grinder removed from kitchen. ❑ 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): N/A C) Further Evaluation is Required by the Board of Health: ❑ Condition's exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins-3/13 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 50 Cindy Lane Property Address Naimo Family Trust, Deborah Colleran,Trustee Owner Owner's Name information is required for every Barnstable MA 02630 10/23/2015 page. City/Town 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 stem absorption s SAS and the SAS is within P Y (SAS) 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: N/A **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: N/A D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6"below invert or available volume is less than%day flow t5ins•3/13 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 50 Cindy Lane Property Address Naimo Family Trust, Deborah Colleran,Trustee Owner Owners Name information is required for every Barnstable MA 02630 10/23/2015 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. ❑ ® 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 50 Cindy Lane Property Address Naimo Family Trust, Deborah Colleran,Trustee Owner Owner's Name information is required for every Barnstable MA 02630 10/23/2015 page. CitylTown State Zip Code Date of Inspection C. Checklist Check if the followinghave n a e been done.You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner,occupant,or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(if they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components,excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened,and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions,depth of liquid,depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example,a plan at the Board of Health. ® ❑ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 it Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 50 Cindy Lane Property Address Naimo Family Trust, Deborah Colleran,Trustee Owner Owner's Name information is required for every Barnstable MA 02630 10/23/2015 page. Cityfrown State Zip Code Date of Inspection D. System Information Description: 1,000 gal septic tank, D-box with single outlet and three Cultec SAS chambers in series with stone Number of current residents: 1 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 Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage 2014= 158 gpd; 9 ( Y 9 (gpd)): 2015= 102 gpd Detail: Total gallons used,2014=58,000/2015=30,000 to date(292 days) Sump pump? ❑ Yes ® No Last date of occupancy: CurrentDate 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 waste holding 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< Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 50 Cindy Lane Property Address Naimo Family Trust, Deborah Colleran,Trustee Owner Owner's Name information is required for every Barnstable MA 02630 10/23/2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: N/A Date Other(describe below): N/A General Information Pumping Records: Source of information: Owner Was system pumped as part of the inspection? ❑ Yes ® No If yes,volume pumped: gallons How was quantity pumped determined? Reason for pumping: 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 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 50 Cindy Lane Property Address Naimo Family Trust, Deborah Colleran,Trustee Owner Owner's Name information is required for every Barnstable MA 02630 10/23/2015 page. Clty/rown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components,date installed (if known)and source of information: 1984 With SAS replaced in 1999 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1'6"feet Material of construction: ❑cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line: Town water feet Comments(on condition of joints,venting,evidence of leakage,etc.): No evidence of leaks or clogs Septic Tank(locate on site plan): Depth below grade: 1' feet Material of construction: ®concrete ❑metal ❑fiberglass ❑ polyethylene ❑other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 8'3"x 5'5"x 57' Sludge depth: 6 t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 or 17 5 Commonwealth of Massachusetts Title 5 Official Inspection Form � Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ti 50 Cindy Lane Property Address Naimo Family Trust, Deborah Colleran,Trustee Owner Owner's Name information is required for every Barnstable MA 02630 10/23/2015 page. City/Town 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 42" Scum thickness Distance from top of scum to top of outlet tee or baffle 4 Distance from bottom of scum to bottom of outlet tee or baffle 151, How were dimensions determined? Accusludge, Baffle stick&tape measure Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Liquid levels were normal with no evidence of back up or leaks,system should be pumped every three years as preventive maintenance. Grease Trap(locate on site plan): Depth below grade: N/Afeet Material of construction: ❑concrete ❑ metal ❑fiberglass ❑polyethylene ❑other(explain): N/A 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/ADate t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Tithe 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 50 Cindy Lane Property Address Naimo Family Trust, Deborah Colleran,Trustee Owner Owner's Name information is required for every Barnstable MA 02630 10/23/2015 page. Cityfrown 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.): N/A 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): N/A Dimensions: N/A Capacity: N/A p 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 50 Cindy Lane Property Address Naimo Family Trust, Deborah Colleran,Trustee Owner Owner's Name information is required for every Barnstable MA 02630 10/23/2015 page. Cityrfown 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 01 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 is deteriorated and liquid level is below invert,there is staining to 1"over invert,but the pipe is settled in first few feet of pipe section,when camera is placed into pipe water is evident it had settled in pipe due to improper pitch or sag in pipe.D-box needs to be_replaced"and pipes,re set for proper , pitch and flow.' 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: N/A t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M '< 50 Cindy Lane Property Address Naimo Family Trust, Deborah Colleran Trustee Owner Owner's Name information is required for every Barnstable MA 02630 10/23/2015 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: y ® leaching chambers number: 3 ❑ 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 ponding,damp soil,condition of vegetation,etc.): Three Cultec leach chambers in series with stone,lawn overtop,2"ponding in chamber,an inspection port was installed, soil around chamber was clean and no evidence of hydraulic failure or break out at this time. Sun room on piers less than 10'from SAS but not affecting system and all components are accessible. Leaching area 30'x 10'x 2' 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-3/13 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 50 Cindy Lane Property Address Naimo Family Trust, Deborah Colleran,Trustee Owner Owner's Name information is required for every Barnstable MA 02630 10/23/2015 page. Cityffown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: 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 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 50 Cindy Lane Property Address Naimo Family Trust, Deborah Colleran,Trustee Owner Owner's Name information is required for every Barnstable MA 02630 10/23/2015 page. City/rown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system,including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately DRNI?WAI' X To sCa 13 W `GARAGE DVl?'ELLING A B. SUN Rt30M C A2=3ar B2�115' 3 40 A3w 35` B3=1.95' --' A4=412' C4'12.5` SLOpE t5ins•3113 Title 5 Official Inspection Farm Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts . Title 5 Official ffi Inspection o i n Form O c Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 50 Cindy Lane Property Address Naimo Family Trust, Deborah Colleran,Trustee Owner Owner's Name information is required for every Barnstable MA 02630 10/23/2015 page. Cityrrown 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'water encountered 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: 11/7/1984 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Soil and test hole data from approved plans on file with Board of Health,water encountered at 12' Bottom of SAS 4'4"from surface Before filing this Inspection Report,please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 50 Cindy Lane Property Address Naimo Family Trust, Deborah Colleran,Trustee Owner Owner's Name information is required for every Barnstable MA 02630 10/23/20.15 page. Cityrrown 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 PP Y ) P ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 6 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 No. O(y 391 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in co pater: PUBLIC HEALTH DIVISION - T WN OF BARNSTABLE, MASSACHUSETTS Yes application fo osai *pstrm Construction Permit r:. Application for a Permit to Construct pa' Upgrade( ) Abandon( ) ❑Complete System - ndividual Components i-^ p Location Address or Lot No. G N h D"N Owner's Name,Address,and Tel.No. r: Assessor's Map/Parcel D 7 Oct 01, � � � S v� .3 Z. 0`1S ,._. Installer's Name,Address,and Tel.No. Q - U Designer's Name,Address,and Tel.No. 10. Ntc r 5 K-Y - 4 SS Type of Building: ��, n)d LVus pv Dwelling No.of Bedrooms 1 N Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs orAlteratio (Answer when applicable) 1 d(/r i'vti t /Y l Date last inspected: 0Z/,$`" 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 t viro ntal Code and not to place the system in operation until a Certificate of Compliance has been issued by this Boa of Ith. _ Si Date�- Application Approved by Date c Application Disapproved by Date for the following reasons Permit No. Date Issued u t) s » a No. � � Fee �G ). ,. ` THE COMMONWEALTH OF M�4SSACHUSETTS Ente ed,mcomputer.: _1Z _ PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS <`i ' applIcation for 0sat *pstrm Construction permit r"o Application for a Permit to Construct( R p� air ) Upgrade( ) Abandon( ) [:]Complete System �Zual Components �.f 3 Location Address or Lot No. CL�N t Owner's Name,Address,and Tel.No. Assessor'sMap/Parcel 3/7- 0,/).7 On i t( Installer's Name,Address,and Tel.No. {� C t% Designer's Name,Address,and Tel.No. ; 'Lv, P1 LAL, r -\5 SOli 41SS Type of Building: Dwelling No.of Bedrooms ( I -Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures ' v Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title - a Size of Septic Tank%, Type of S.A.S. Description of Soil. Nature of RepairsAor Alteration (Answer when applicable) Date last inspected: 1 U / $` Agreement: The undersigned agrees to ensure Ilie construction d maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the-Environprental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board/f Health. Signed-, rl e/1�<lr � Date .3U /S Application Approved by Date o / Application Disapproved by Date for the following reasons Permit No. 2 ( � �(� Date Issued u U / - ------------------------------------------------------------------------------------------ ------------------------------------------ PAux 4M THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS ph tt rAjl, 4_414 . Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( F-, Upgraded( ) Abandoned( )by I a A r t at /' �} // Jw has been constructed in accordance J with the provisions of Title 5 abd the for Disposal System Construction Permit No. d 1 S-YM(lated 1 / �6 /C" Installer Designer / #bedrooms j►J Approved design flow gpd The issuance of this pen iit shall not be construed as a guarantee that the system will funct}On designed. r Date � �+ Inspector ------------------------7-------------------------------------------------------- ----------------------------------------------------- No. �c� t�— JU1 Fee `fed THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS Disposal &pstem Construction Vermit Permission is hereby granted to Construct( ) Repair("-)' Upgrade( ) Abandon( ) System located at (' and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construct must be completed within three years of the date of this permit. /^ Date U , u/, Approved by e J s AsBuilt Page 1 of 2 TOWN OF BARNSTABLE ' LOCATION PA . SEWAGE M '9 5 Z-�' VILLAGE ASSESSOR'S MAP&LOT z-¢O'7 INSTALLER'S NAME dt PHONE NO._1Za SEPTIC TANK CAPACPPY 10-9--0 _ LEACHING FACILnY:(type) 3'�a-o t!fs NO.OF BEDROOMS 3 BUILDER OR OWNER PERMIT DATE: �COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to a Bottom of Leaching Facility Feet Private Water Supply We and Leac ' g Facility (If any wells exist on site or within 200 feet of Iea 'ng facility) Feet Edge of Wetland and Leaching ility(If any wetlands exist within 300 feet of leachin cili ) Feet Furnished bye R a 36, � 0 httpJ/issgl2/intranet/propdata/prebuilt.aspx?mappar=317007&seq=1 10/30/2015 CO",%B102YWE ,LTH OF MASSACHliSETTS EXECL�TIVE OFFICE OF E:�'VIRON MENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL; PROTECTION , . ONE N%!\TER STREET. BOSTON bLA 021OF (61 i)292.550o TRUDY CORE Secretan ARGEO PAUL CELLUCCI DAVID B. STR17HS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property address: 50 Cindy Lane Name of Owner Ll y Tal Barnstable , MA Address of Owner• sa me Date of Inspection: Name of Inspector:(Please Prirrt)WM. E . Robinson Sr . 1 am a DEP approved systems inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) company Name: Wm. E . Robinson eptic Service MaaingAddress: PO Box 0 9, Centerville , MA Telephone Number: CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sew ge disposal systems. The system: Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails e, 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 thirty (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 Department of Environmental Protection. The original should be sent.to the system owner and copies sent to the buyer, if applicable, and the approving authority. NOTES AND COMMENTS o revised 9/2/98 Page Iof11 ✓nrted on Recycled Paper , i a SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued)- 'lop"Address: 50 Cindy Lane , W. Barnstable Jwner: Lily Tai Date of Inspection: INSPECTION SUMMARY: Check A', B, C, o! D: A. SYSTEM PASSES: 6//� I I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist. Any failure criteria not evaluated are indicated below. COMMENTS: B. SYSTEM CONDITIONALLY PASSES: One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Indicate yes, no, or not determined(Y, N, or ND). Describe basis of determination in all instances. If "not determined", explain why not. _ The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty(20)years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four 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 obstruction is removed revised 9/2/98 Page 2of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (corrtinued) Property Address: 50 Cindy Lane , W. Barnstable Owner: Lily T a i Date of Inspection: 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 the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303 Oft)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ Cesspool or privy is within 50 feet of surface water Cesspool.or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. y SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system.has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER revised 9/2/98 Page 3of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM .PART A CERTIFICATION (continued) Property Address: 50 Cindy Lane , W. Barnstable ' Owner: Lily T a i Date of Inspection: D. SYSTEM FAILS: You m st indicate either "Yes" or "No" to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage into facility or system component due to an overloaded orclogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. ! Liquid depth in cesspool is less than 6" below invert or available volume is less than 112 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E. LA GE SYSTEM FAILS: You mu t indicate either "Yes" or "No" to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area- IWPA)or a mapped Zone 11 of a public water supply well) The o ner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office f the Department for further information. revised 9/2/98 Page 4of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 50 Cindy Lane , W. Barnstable Owner: Lily Tai Date of Inspection: Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes , No �1 Pumping information was provided by the owner, occupant, or Board of Health. None of the system components have been pumped for at least two weeks an&the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. _ As built plans have been obtained and examined. Note if they are not available with NIA. The facility or dwelling was inspected for signs of sewage back-up. _ The system does not receive non-sanitary or industrial waste flow. t/ _ The site was inspected for signs of breakout. _ All system components, excluding the Soil Absorption System, have been located on the site. _ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions,depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: _ Existing information. For example, Plan at B.O.H. _ Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) 115.302(3)(b)] _ The facility owner(and occupants,if different from owner) were provided with information on the proper maintenanc."t SubSurface Disposal Systems. revised 9/2/98 Page 5of11. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Iroperty Address: Owner: Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Design flow: cl(oO g.p.d./bedroom. Number of bedrooms(design): Number of bedrooms(actual.):3 Total DESIGN flow Number of current residents: Garbage grinder(yes or no):,,&--p Laundry(separate system) (yes orno),4vO; If yes, separate inspection required Laundry system inspected (yes or no) Seasonal use (yes or no):/- 0 Water meter readings, if available (last two year's usage(gpd): Sump Pump(yes or no):�d Last date of occupancy: ,� COMMERCIAL/INDUSTRIAL: Type of establishment: D)enlow: qpd ( Based on 15.203) Bdesign flow Gap present: (yes or no)_ In Waste Holding Tank present: (yes or no)_ Nary waste discharged to the Title 5 system: (yes or no)Weter readings,if available: L of occupancy:ODescribe) L of occupancy: GENERAL INFORMATION PUMPING RECORDS a d source of information: Syste pumped as part of inspection: (yes or no) e If yes, volume pumped: 3 1-1 gallons Reason for pumping: — n. y 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) I/A Technology etc. Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components, date installed(if known) and source of information� /s yLc/ Jr Sewage odors detected when arriving at the site: (yes or no) A-I/f revised 9/2/96 Page 6of11 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Icontinuedl '►op"Address: 50 C indy Lane , W. Barnstable Owner: s Lily Tai Date of Inspection. BUIL NG SEWER: (Local on site plan) Depth elow grade:_ Mated I of construction:_cast iron_40 PVC_other(explain) Dista ce from private water supply well or suction line Dial ter Co ants: (condition of joints, venting, evidence of Ieakage,etc.) SEPTIC TANK:_ (locate on site plan) r , Depth below grade: Material of construction: ✓concrete_metal_Fiberglass _Polyethylene_other(explain) If tank is metal,list age_ Is.age confirmed by Certificate of Compliance (Yes/No) Dimensions: f & Sludge depth: , Distance from top of sludge to bottom of outlet tee or baffle: 7 Scum thickness: t Distance from top of scum to top of outlet tee or baffler Distance from bottom of scum to bottom of outlet tee or baffle: /Z/ How dimensions were determined: comments: (recommendation for pumping, condition of inlet andputlet t es or b ffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) Zo U l� � GR E TRAP: (locate n site plan) Depth be ow grade:_ Material f construction:_concrete_metal Fiberglass _Polyethylene_other(explain) Dimensio s: Scum thi kness: Distance rom top of scum to top of outlet tee or baffle: Distance rom bottom of scum to bottom of outlet tee or baffle: Date of st pumping: Comm nts: (recomendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, eviden a of leakage,etc.) revised 9/2/98 Page 7of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C z. SYSTEM INFORMATION(continued) ►rop"Address: 50 Cindy Lane , W. Barnstable Owner: fly T a i Date of Inspe�on: TI HT OR HOLDING TANK: (Tank must be pumped prior to, or at time of, inspection) o to on site plan) Dept below grade:_ Mate'al of construction:_concrete_metal_Fiberglass_Polyethylene_other(explain) Dim an ions: Capaci y: gallons _ Desig flow: gallons/day Alarm resent Alar level: Alarm in working order: Yes_ No Date of previous pumping: Co m ents: (condi ion of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:t/ (locate on site plan) 1 Depth of liquid level above outlet invert: Comments: (note if level and distribution s egyal, evi ence olids carryover evidence of leakage into or out of box, etc.) - PUMP HAMBER:_ (locate on site plan) Pump in working order: (Yes or No) Alar s in working order(Yes or No) Co ments: (not condition of pump chamber, condition of pumps and appurtenances, etc.) revised 9/2/98 Page 8orll SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART.0 SYSTEM INFORMATION(continued) Irop"Addfess: 50 Cindy Lane , W. Barnstable Owner: Lily T a i Date of Inspection: SOIL ABSORPTION SYSTEM(SAS):_V (locate on site plan, if possible;excavation not required, location may be approximated by non-intrusive methods) If not located, explain: Type: leaching pits, number._ leaching chambers,number: leaching galleries, number: T leaching trenches, number, length: leaching fields, number, dimensions: overflow cesspool, number:_ Alternative system: ,Name of Technology: Comments: (note condition.of soil, signs o!.�iyclraulic failure, level of ponding, damp soil, condition of vegetation, etc.( ; CESSPOOLS:_ (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: j )epth of scum layer: Dimensions of cesspool: " Materials of construction: Indication of groundwater: inflow (cesspool must be pumped as part of inspection) Corn en (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRI 11 ate on site plan) Ma erials of construction: rN Dimensions: De th of solids: Co ments: (n to condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) revise,_5 Page 9ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Noperty Address: 50 Cindy Lane , W. Barnstable , Jwner: Lily T a i Jate of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) 'tA) LLJ j �6L I , revised 9/2/98 Page 10of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) roperty Address: 50 Cindy Lane , W. Barnstable Owner: Lily T a 1 Date of Inspection: NRCS Report name Soil Type_ Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep SITE EXAM Slope Surface water Check Cellar Shallow wells JC Estimated Depth to Groundwater Feet Please indicate all the methods used to determine High Groundwater Elevation:. Obtained from Design Plans on record Observed Site (Abutting property, observation hole, basement sump etc.) Determined from local conditions Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators, installers Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) revised 9/2/96 Page ttof11 TOWN OF BARNSTABLE aLCATION l SEWAGE # \II.LAGE j '/yS ��c� / - -ASSESSOR'S MAP& LOT '7� I INSTALLER'S NAME&PHONE NO. n ��� '1 2 CL 91 2-Z SEPTIC TANK CAPACITY•' / LEACHING FACILITY: (type) S (size) &—c o41- NO.OF BEDROOMS BUILDER OR OWNER., � .�p-G�✓� PERMITDATE: �' �C'"� COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table eFacility e Bottom of Leaching Facility Feet Private Water Supply Well and Leac ' (If any wells exist on site or within 200 feet of lea ng facility) Feet Edge of Wetland and Leaching acility(If any wetlands exist within 300 feet of leachin acili ) Feet Furnished by We ' m J /P_ s:.5 `'��� �f .., �ti S, 6 o �, ,. elift f' N. 10 Fee $5 0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Ye PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 3pprication for Xigponl *pgtem Construction Vermit Application for a Permit to Construct( )Repair(X )Upgrade( )Abandon( ) Complete System El Individual Components ��it Add s or of No. Owner's Name,Address and Tel.No. iny �ane , Barnstable John Carpenter Assessor's Map/Parcel 31'7- od �? Ins ler's N e,Addr ss and Tel.No. Designer's Name,Address and Tel.No. M. Robinson Septic Ser. P 0 Box 1089, Centerville... Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil S and. Nature of Repairs or Alterations(Answer when applicable) new Title-5 leach system D-box and 3 H 20 Cultexes 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 Environ ental Code d not to place the system in operation until a Certifi- cate of Compliance has been issue by this Bo H th— 1.���6` P� Signed Date Application Approved b Date - Application Disapproved for the following reasons Permit No. " Date Issued `` °' No.\ '� G� >*• `w. Fee $5 0 r THE COMMONWEALTH OF MASSACHUSETTS Entered in computer`: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES Ye MASSACHUSETTS 0[pptication for IDigpo.5af *pgtem Construction Ver it-- 1 Application for a Permit to Construct( )Repair(X )Upgrade( )Abandon( ) El Complete System El Individual Components Barnstable OwnJohri'Carpent o. Assessor's Map/Parcel 3 j Q a { w In�a�ler's e, dr ,s d Tel.No. Designer's Name,Address and Tel.No. Wm. ' ". ` oebinson Septic Ser. P 0 Box 1089, Centerville, Type of Building: f "' j Dwelling No.of Bedrooms Lot Si4 ( sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date I Title Size of Septic Tank ° ` =- .,Type of S.A.S. Description of Soil Sand. E Nature of Repairs or Alterations(Answer when applicable) rieW Title-5 leach system D-box_,and-3 H 20 Cultexes pate last insp elqted: 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 Enviro ental Coded not to place the system in operation until a Certifi- cate of Compliance has been issue by this B f H th. l/ Signed Date L Application Appro ed b Date �tlei Application Disaved for the following reasons 1 Permit No. " Date Issued R__ ----- `�----------------------------- THE COMMONWEALTH OF MASSACHUSETTS Carpent!e/ BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired (X )Upgraded( ) Abandoned( )by Wm. E. Robinson Septic Service at 50 Cindy Lane, 0. Barnstable I has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No - � dated Installer Wm. E. Robinson Sr. Designer The issuance of this permit shall not be gowtrue as a guarantee that thee syM eil unction as de 'gne Date 9 ?--- 6e Inspecto ��►"''" 00, Q ---------------------------- ---- — 6/ y Feei0 No. M, THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTKDWI1S Nr- BA STABLES MASSACHUSET-TS Carpenter � �-� •� t dg C p5tem, �0 Mructton Vermtt . Permission is hereby granted to Construct( )Repair(X )Upgrade( )Abandon( ) System located at 5 Cindy in y Lane, I$). Barnstable ~, � and as described in,the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local,provisions or special conditions. Provided: Construction must be completed within three years of the date of thi Date: �' % Approved b i t r V 0 ? 1/6/99 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) I, William E . Robinson,S,zhereby certify that the application for disposal works construction permit signed by me dated �— ��— , concerning the property located at 50 Cindy Lane, W. Barnstable meets all of the following criteria: • The failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. • Zete s it is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. • are no wetlands within 100 feet of the proposed septic system • re are no private wells within 150 feet of the proposed septic system • ere is no increase in flow and/or change in use proposed • re are no variances requested or needed. • The bottom of the proposed leaching facility will not be located less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] • If the S.A.S. will be located with 250 feet of any vegetated wetlands, the bottom of the proposed leaching facility will not be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(using GIS information) L� • B) G.W.Elevation +the MAX.High G.W. Adjustment. _ DIFFERENCE BETWEEN A and B SIGNED : ,�'O i- L DATE: [Sketch proposed plan of system on back]. q:health folder:cert. ;� ,:i ,- �` L�� �-f � 1 � v �� � �� y � - __ TOWN OF BARNSTABLE LOCATION O / SEWAGE # 99 VILLAGEIVS SP & LOT I 7 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: S (size) 1A - NO.OF BEDROOMS 3 I BUILDER OR OWNER PERMUDATE: l COMPLIANCE DATE: 7 n/ Separation Distance Between the: Maximum Adjusted Groundwater Table to a Bottom of Leaching Facility Feet Private Water Supply Well and Leac ' g Facility (If any wells exist on site or within 200 feet of lea ng facility) Feet Edge of Wetland and Leaching acility(If any wetlands exist Within MO feet of leachin acilig.. .) Feet Furnished by I - 1 ' --- J �► i L-<'O.:C i T I Q N Sd :;�S E W A G E PERMIT NO. VALLAGE � INST. A LL_ER'S� NAME i ADDRESS e U t-D E R;+ ` DR OWNER �+ -f AV . DATA PERMIIT ISSUED ` DATE :COMPLIANCE ISSUED}- d� ' G e F :,�_ 11 No...••--�! .. THE COMMONWEALTH OF MASSACHUSETTS 3�7 - 0D' BOARD OF HEALTH 10w.�.................OF... `�0.r•Vl� v\e ......... Appl ration for Disposal Workii Tonotrudion f rrmit i Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: r q C� D __ 1 Yl 0.Yl l__ U� , C. �. 1 1 1 .............. .__............. ......._.. ---••-_..._.....•-----.... .........•-••-•--•••••........ - ........ ......._._.......• -................... ocation Address or Lot No. .. ......... --- ....-•......................... Owner Address a .... ! s... .........--•-••....._..... .....-•-••- -- Installer Address Type of Building Size Lot2:3�4 ..... Sq. feet a Dwelling—No. of Bedrooms..-...� .................................Expansion Attic ( ) Garbage Grinder (p� N Other—Type of Building ............................ No. of persons.....................:...... Showers ( ) — Cafeteria ( ) QOther fixtures ........................•---.........--•---..._..........:........................-•--------•----.................-----.......................--_-•••• W Design Flow---------------J --_-----------•-_-----gallons per person per dray. Total day Oow...._.__-___.______.�3.©____... to WSeptic Tank—Liquid capacity 9!?2gallons Length...:? ... Width:.4._.:?-.._ Diameter:............... Depth..___. .. .. x Disposal Trench—No............... Wid Total Length Total leaching area.._......_.., s ft. P --__- _ ••-•--. g r g q• - Seepage Pit No...... .......... Diameter.l�_.E'_•.. _ : Depth below inlet.__:..e 'S G � P� �' --- �� P Total leaching area.�._.....:_...sq�-ft- Z Other Distribution box Dosin t,artk ( _) Percolation Test Results Performed by.....:....usynaa „ Date...A_1...... .. .g.__.;;:.. •----.-- ..... Test Pit No. 1....._• ..minutes per inch Depth of Test Pit_..._) `r...._. Depth to ground water...�.��... (3, Test Pit No. 2................minutes per inch Depth of Test Pit...... Depth to ground water.... 3......_....... a ................ r�.... -.. ti...... 1r._•....._a -- rr-.... r._. O �..' O Zg . Oavn - • r,-,ec�-. �} Description of Soil..... �....... �.......... a.... _, •• .� Y__.� 2 .. c©arse sue,.• i.fj 2 O -� ���___�. - Z �c�r- e�►ti ...... 1...._-.._ 1 ..... �� t •--- UNature of Repairs or Alterations—Answer when applicable............................................................................................... ......................••--•-•--•--•-----•-----•-....-•-----------------------------•-•--....---•----•--............•---......................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'ITL� f the State Sanitary Code— The undersigned further agrees not to place the system in operation ntil a Ce i• e f Compliance has be issu by the bo rd of la h. Signe __...... v ��• X....... r .............. :....--• •........................._.... Dat AppleAtionpproved By............. -- _...� _ --............-•-•--•-•-------- Date Application Disapproved for the following reasons:....................................................................................................... ........ ...........•........................................•--•••-•-----...-----.........------........_...............-•----•--•-----•--•---••-•--•-•---.......-------..............._..........._ - e Date Permit No.-•---V�------I.I..b.5.................. Issued......---� r:.' ' -+............. Date F No....... Cl .................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................. ..................:OF......................................................................................... Appliration fOr Dispasal arks Tonstrurtivit Frruat Application is hereby made for a Permit to Constructo�) or Repair an Individual e Sewa'g Disposal' System at: ..... . ............w........................................... ................ ......... ocation-Address or Lot No.........V011. . ................E.1aleiv..................... ............................................. ............................................... Owner Address ................................ .............................................. .................................................................................................. Installer Address Type of Building Size tot.� 4..............-Sq. feet P —No. of Bedrooms__ 5.................................Expansion Attic Garbage Grinder _wAing Other—Type of Building ............................ No. of persons............................ Showers Cafeteria Otherfixtures ...................................................................................................................... .. ....................... Design Flow................5.. ......................gallons per person d Total dj 'o ri, r ay. o ; . ly pow................................. 6e----ilt W Septic Tank—Liquid*capacit�!P gallons Length:!!O:�t..­ Width....*.......... Diameter................ pt Disposal Trench—No..................... Widt4.....PTI......... Total Length Total leaching area ".sq. ft. " SS-A-sqvft. Seepage Pit No.._21............ Diameter.� .!�4:11. .- Depth below ink .... . Total leaching area.. ........ Z Other Distribution box O Dosing tank Percolation Test Result p Performed by....Ve....Uq_tnn��............ ------------------- Date... Test Pit No I... _minutes per inch Depth of test Pit......i.1 1.4 Depth to ground water..........4-1......... ­­..... ...... 44 Test Pit No. 2................minutes per inch Depth of Test Pit_.._. Depth to ground water.__ ........ ................... ..................... ....... .03 4Z. CA 0 Descripopn of Soil7l..�:l.................. ........... -4. ' ---------...........................All....... j K �Wo'A .............. N ------------------- ......................q.A......................................................... ......................... ............ .................................................. U Nature of Repairs or Alterations—Answer when applicable.............................................................................................. ..................................................................................................................... .................................................................................. Agreement: The undersigned agrees to install the aforedescribed, Individual Sewage Disposal System in accordance with the provisions of TITLE -,,,5--of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certific#q �f Compliance has be?fflgs�ua by theb and of i- th Sign�A ............ 1 )......... ....a...2- N......... ..........Date__....-.__._. .......................... . ......... ...Application Approved By............ Date Application Disapproved for the following rec��sons .. ............................................................................................................ ........................................................................................................................................................................................................ +Date Permit No........::i? .—..'A.b.5..................... Issue(L .:..A::} _a- s. Date THE COMMONWEALTH MMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH _k ..........................................OF... ... ..................... . ............_... wwwrtifirtitr of Tomphatta' THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed Y) or Repaired ........... ............................... ...................................................................by--------------------------- ....... ............. . -------------5 Installer at................................ .. ......... ............. .............................................. .... .......cjf�dA . ........ ------------- has been installed in accordance with the provisions of TIT 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.___Xy ..Zzds......... - dated......D: .....�-..,R.9 ..................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CON �"EPJA_,` -,UAPANTER-THAT THE., SYSTEM WILL FUNCTION SATISFACTORY.. W� Insp&tor........ .DATE.. ......... .............. ................................... V ---------- Nd IN THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH of W\ ...OF.O.s ...........................-.......... ............................ ......................................... FEE... ........ Disposal Works Tonstrudivit frrutit Permission is hereby granted............................ -_------------------------....................................................................... to Construct or R` ai an Individual Sewage Dispo System ..... .... ..... .............. at -NO!................ ........................... ........ 47.. Street as shown on the application for Disposal Works Construction Permit Noks--- Dated........ .... ................ ... .. 'rd-o`f�H-caith DATE:...... 5_7.SUS.w�.....................I.........f I N I o i N n 1 f ��- Z N SOT ° +1 J N v N .o /,Gf \Z P I • LocATio�v: BAP►.;uT{�E,t_E . M 5L. FlFwEf='pF; D Fc)F-_ SCAg4.E: LOT T7 L. c. F. 1 994 P 2 s-/Ee�6Y CE T/FY Tf/.4T 7-AV45 BGJ/LD/�clG Ss-/OAVAJ O.V TA-ZI �4.V /S LOCATEa ON T.NE G'ou.VD .�iS �NO YVN A4E,eEOit/. OF ��9cti N E, G AR � I � N� OJAL-A vs wry cam �n9ineerir,9 #2.6348 C/V/L EVG/.tJEEGS 2GU \�14�85 ` �� Lq.va suev6Yo.a� �+ �� �c,85 _- i 362-4541 926 main street yarmouth mass. 02675 Gown cope engiaeeriag civil engineers& land surveyors structural design Arne H.Ojala P.E.,R.L.S. land court Richard R.Fairbank P.E. surveys site olanning April 1, 1985 sewage system John Kelley designs Board of Health 367 Main Street Ibyannis, MA 02601 inspections RE: Lot # 7 Cindy Lane Barnstable, MA permits i This is to certify that on March 29, 1985, Down Cape Engineering staked out & inspected the installation of the sewgge system �i and it meets the requirements of our plan #84-267 • t , VTY AHO PE-RLS ' s _""r :, q. r. _ '1 '.i. ,'r'.;�...-",".!1,_,__',t�,..V!i,-,4 0-.:,1�-..,4"�;".,�--.­,,,,:�­,_-...­..��.::,,,��.*.-I._��-""��.;-"I''�:.-.�_,..-.-.b,_I-.l'���.�.',I�:..,._.-",��,.-�i-I%'...,.�II-.:.._.,1.,',,--%..:.�",!�.......!.--,I,.,1�....!.,��._,:...',,.,��'��,:-...,.,"�..��.1..,.�.'_.,.l i,;�,.L:;::J,:!,.":',.,­iz%�-:,:'..:..I.-;�.�-�l:I,�,....'.,I;I,-.W.��.�'-:.:,,.,,,..�k'.:;;_O.._1 I'��I�.�I'��;.,�"­I:;.I�"4,:."".I.�-­I.','.�.;:,t::l��,..-..,,,.-",..I;,-I,,...--,"�­.­--:',,,k.��..I 1..',-­'..I-.:�_61..i,...,.�.�'::-.,_"*1'�.'1`q",..-,I'.b�..,�;-.�''"....-�I.�,1,..I�I_-.;.r.-..:;-�..r.._'I��..�:­.I,L,.,.;:�.I I�,,I�I',:�:-�1",.i_:�I�.�..�,,,"�.I-,-",Ze�-:-..­-_,.,-�"-.;_,:.-.t,,-�,'­��t..-�.,.%�,..I I-,,.o�,1-­.1I..,.._,,�.1��,.I,,,- ,6".-,"-;."'._1,:-I;:�:....r,­?�,-.':'..1�lIi.,--.,.�.-;--.,,.b:­.".�."�.I-"�-I.'..:,.,.*�I','I,.�-��.-,-1,I P.-�I.�1,.,1.,��,.,.:�,,...,­..�.�'..�N..I-I I4�..I..-..-.-.��s.,,._I.1.�.�.._.'.n',..,.O,I�.,-,...-I.;.�I-�,.�4.,.'.:r,._�I.--:..�----.*-I-*',l�:..:�.1I�,_�;,-".I�I�--z4�.,i-,1'i;�,��,:�I.z..'.-I.I�.:1-.-�.:-.-...-_..-.....,.I.,��."-1,I,o..,.-._,1."*I-�*.�:F,.,-%I-"�.,­�"...�-':�:*,:;.,.,.,:.,-�,,..!,,.,­�-I_.,...�.�II'I�1.'.O,�.-,..-�-I.,.�.,�...,1.�.,I.,.-.1.,�I:..i I 1��i:.­.-,_,...I-,I.,,.l.�.:�I.,,*..."N,��;..l.I.:!�I o,�I�._-�.­,-I,-iIe.��..,.,I i.1.1I'I,�..._I!,1���4,..II'I�....,,-.�.-i-i,,,,..-i."-..��...�.I..,�I.:�-IZw�.-'.I..�I.1�.-_�.-.1....�:--..-,,�-.��.�..,.".�":.-.1-­-..�.,zl.-,,_....�..-I-I��...,....-.',.-,."-A..;I�-.-�.I,.,.:.-...,.I_��-.,I.'-..:.­..I..--h�.':.....�:,�_.:,.�I..t-�4*�.I.:._:.�...-..-.,.;.'.-..-..��....�;":-...r I:,.1I-.1......I:._I.1..I-.Ij1.3...�2.,..I..I.-1.r I I.....,.'0 I.I I.1..-&..I1..Q.�.:I:I.:.-....1-1.... ..-...�,1.I,.I.,.1..I-.�.�.-.�p...I.�,..I r..�,�-�r..�.I.-....I.I..,,��.I...�.��`..­��...­.II.I.I�..I I-�.I II-I.II.-,�I.I:1.�.,�.,.�,.v.c uII.'-��,.l\`...':���,��-.I:�.I�..II­1 I..'.�42�.��.11.-:,,,_I.,.��4-,.-:,....- I�I­,I I;I.­I�..�..?.I�l.I.I..II.,I�.�..,�.-I...I I�,I...'�.l.e;.I.1,If_:�I��.".....I:�..�I.f,_I"I...I I.s-I...I,-��iI.I��.;.I.��I�.I_.,�I�1....�;­1�,,..��'.Z I.I.I..I.I,....I�I..�,_I...._.'.%.\.�..-....aI..I....w�'�,,�."5..I1.5 s.....mI�.�_-I,-�/I...I,I.1 I.,�-..I.r.-.I._.�I.*:�t-�:I.I.I.-......-II.I.""...I,6.I..I,�.a.1.IiI..��­I 1�..-.1 I,...,..-.....I..,.III..1�..1�I�..I I,.'...,I.�,..� ..-;.,..._.-I;.,1_..,:,I.,,;I,,..II_.j....�.�--I%-.�-.j,..,..,I-�II�I�l,I��.k�.�'1.6�'�I;I..I-1..-�I,i:.."��..�11,".I II.--I1,I-'I.-.,...I..1N I1".,II...,._-I I.1.m�_-1 1.:.I'"I.:�,,,�t—��!,�.-�'..I_�,�---�"I.-"1,,.��,�-.�._�7.�_..,�I,It';�-:I:.�:q�., ...w_."._.�.,-.;,I�,�.�-��.��:.,,I:,.1,..;��.-.1­.��.,..1.z..._:'�-.;_l.-.-I-_I,l.,.I:_.�I&1:��',II;.II._I�I,:!+.I..�1 l.1-,A�',_I��I.�I;,:T�.m"'o�I.'1-,/.4:.:.:_,1�­-L.;.���.1I,�,1.�1.._.A-�".I.��...I�,�.I..-:-.�."_..�.4� ..i..­.�I:,.,.:­--_.T.�:4N�..,!I,'.:1����-�. �.q:,.��"�,".�.�4..I,..,I-�­..��....-1.-...,.1,..�.��1,.X.,.-��.:.�1%­.-i..-I.,.:.-,,�-�%...-"-,.�....,I..,v,..!.�1:.Ia."I.���.�I.%...I.�:..�-...,.._�k..I...�i�'-1�,".,:1.�.-._ ,.i,:�-.:­-:J;�.-.,-;:--I y�q�.�r 4-.cA.,�-����.�:;m j.....:.�;.I:.'.,;�.�.-­..,,:,I�,I..l',,.,.--,.­".'--­..�.�:.:1 7.I-.�-.I...l.,�.,,..�.e",�'.,",,.,�.-/..�.I �,I,I-:I..?1...... 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'. .. ., i, I, i"I.. fir_ 7 . .' •. .v. "' ' ,'.! S` 'Q •,.}- i. .. .. , �,: r h �. t, _ p . LEAI H SE TIC TAN D 80X = C 'S . ! r r f: /Gt r S k .� r . E'SnN'10Ev?$ A.�..I l,lhiSL�Pt"A►•.13 L6. M�'I'�S'..1 ,.:. .,ji 4 'ES. v. L R-. .r .' ?� 1.. M L 2.. F a:, ~a• ( 5 ) ve-NG GE. c,*,-.IC7 F-• e:,.wo C31.aTIRx O. eT0!h 4 '8' .,.:,, wA FI �. 3g , t ,,(r., tCmP�G.+-1' Ti'rS->0- D cl�. r?M..i:' SH0-6TdNE' i Gt�N.e' 'Sls�is _ _ __ -�, ._ -1 13 r _ I ,; YI ` f' . ,\ , / ... ., 1. .. ,,:._ .` y - -.: , ,,a. . r ,; ►. , . o.: Pr" '` ro w • ' r,, lb IU 0. , ,�3 > 1 Y'1 t K - _. - .. . ., .i IN, :11 OUT ,`�% 1 1 x1 `I. «. I N .OUT• =r-Y• . r .... - .is L r;. S' i C.[? 3. s t, G. _ a f J r S P \ 4 I• SE TIC x r Z..' Q:o: 40 � . r . T'AN K •ram " ELEV. t: I ELEV. ELEV. .. r: ., . .. . - 4-0.5'7 ^/,,�.40 y�K[i a1 i. _ ,'v 1_ ,i . .. }; ' ELEV: ELEV. Z :.jam �].Z 1 / /Jy ` . .3 1a 1 !, . G•c7 . _ : A ti . FLCY 1. Z 1. ., E- - -- -J£i4 l+h : .. .wAstt> ps3 0 NE i ':; . .. . sn r,,t.: .1 ..A } y _ AI 1 - , :VEST HOLE'. . . .I . <, s . . ._�-- 7EST�Y Y P.:��M�- C'� 6�ci-.c o�t�> C�c�'{ 1y ��1, �' �- - �---r- , *. WITNESS rTEST DATE tiov:ry I ice '-�' BEDROOM:NOUSE t: �+, _ _/ DESIGN fit _ 4z T.H. ,x 1 T.H. 2 1, �1 , ;�,. 74 r . 4Z t I•Z a O¢+� ELEV.. U{+" ELEV. . �_ No ': N DtSPOS.E,R. DISPOSER A•o:�� q - PERC RATE 2 _MIN/(N. pf 6` o . 2ti.:.; A:.. 4 .I fi.z. _ - , I.: E W RATE :. z A - = LO t?-C� (GAL•/OAV-) 3(� •J \ " _� . �., L1QCq 1 SEPTIC TANK ?�a0 11 sls_ I � L- � ` arm 36.1. �vt...,.. y`s. \. IOfaC.. . , .. , .I �JY - REO'D SEPTIC TANK SIZE . \ :. :t. ,-,I. 1 ri r, 1 iyz ,:. ,.- .:. , , .. ' . ': LEACH. FACILITY 'J ` I �.. SIDE WALL C )C ) {Z.�, )_': '._�_.G/D. 1„„. c is nIr . BOTTOM to � �,�, I •� -I 5 G./D. a i Si,, \. 1 ► tp s ' h s x e S. 2 . _' a. u-'.-:: AD.: w.t~: • -441.,ro �a - ,L. n .Q .r:,/t a. ~ ,' ' _.... __ pTso.vt 1.. .;. '... 3 2.c. . :a� ez_.y+� .. !1'`� .*^n+ C } ,.,Ww-r�c>;... og��• S .,<>"' -. Z_� -" - �T'.�_1 Ca _ _ ,f�1 .:', r M ,,I �\ :- �..�.ti ,r- ..~'--t'.dtie4ET ': 'F'l:�c.Fr: ., - - .: U / 1 ' SE: LEACHING. a 1jo. 2 .Z 1O a. 7. �. 'I� . N ? (.ti i 1 �­ \- 1r�"�WATER ENCOUNTERED _ - - �1 _ _ t ._ - - . 4 ,,.;,,:.-.,..,v,....%.,q.,I.L,,....�,,.1.�,_�­:.i.,1.-�..�1.���.:,�..�z,-�*,',.�..vLC,�%�,:.,....I­;�._�..II.,�,�;',��,.J.,.��.,4 1 p.4';':V,��::.I..-*1.,_�:�...,-o I;..lI.,�I,.I�;�I,..%�I--1_..I,�:..���)-..,I�,�-,.�,:I.f.�I�;�:,,.I�*.�-.1,.I�..*.­ \,�."l,I.-1,..�I. ...,.w-.I....*I,,,I"-.:..:­:.�.�:�%,�..i,)I;.I" ,;.-.1�I.1,./.I­I,!,­1�I..".�II��...�.;'.,.;:�.,".�.�l A.,r....,.�,-,,z.-' NOTES -(UNLESS OTHERWISE NOTED( :.\ ' * o. t; - a a> '~ 1 �A, ,� { t (. r 3. . r: .. / Gf 1 a E . 1 . . a R N MAP �, ✓x r iQ UAD A GLE S , • l:DATL7M'tM$k)_TAKEN FROM..__:.-------_-_-.-_.-__._-. ate@� ,F A��N �h�;n, ,€' t 1s A . '__mil ' ----•__.__-__._.._._..A A LABLE ,�x'•' � 'Y'" mob, � . 'T. z ,. ' 2 MUNICIPPILWATER:.__....____,- /���,/ j, /�,�t3° -" 9 .1 ��„ 9.PIDE PITCH,:4. PER FOOT l ca / T I •4%�All H: G a "1 / o 4' IGN LOAOING.FOR ALL PRE-CAST UNITS: AASHO- _ '44 �.. ,, r _- Afi, tl . , ' _.\_ .''fir. ^ DES, t./a/dL_A :'� ,.l VER OVER ALL SEWAGE FACJLITIES': 1 FT. __ •"�` r - ---DISTANCE AS CERTIFIED f ?r,J t „ ( ) r. UN CO -.. `1`" T�.MtN.GRO O I .ca I 1 v I. , 6.PIPE JOINTS SHALL BE MADE WATER TIGHT �'� ' ! , „ 7.,CONSTRUCTION DETAILS TO BE ACCORDANCE WITH COMM.OF MASS. tdli,3t)Td�' `� hw.1' �3.Y ` STATE ENVIRONMENTAL CODE,TITLE 5 . . ,m �' E: PLAN � �61VC yp ,P..e.a . .,.:--- ..-r�,6�.�_.��,.�,1,,-1�,,I�,,.t-,-,.�-,:�,,�_.;�I'I.1-�',;,:j�;,,­I1-t X���.-�_,. REG.PROFESSIO EER: REF: )_-o7-,1a. t-,�-p"i -1"'t`�c+�,' , E down cope en�'ineelnlg PREPARED FOR: C Qb� m �i -' '? ate`" 1 s,-,,,._f'-�,I 4�."..,,1_­'��k!,.,.:.i�.i.-�.­,;­.,�:,,_.-_--_�.._�,,.'-1­,..,.�I-1 .,�..'".`I1.,.,..I 1 , I A R ----------CIVIL CIVIL ENGINEERS BD'A x L N,D SU VEYORS ND SURVCYOR R OF HEALTH, , 9'6 MIfl $tw `// L (EXISTING) .:._._:.... �.��ItsT/�,��. Y R NU,"!RS.° � MA ,�.�Iq EG.LA i .,..,Iz--�I.-!I A""��.��.��.I.�.1II,,1:J.�._:-,'�....�.-.,;,�.-._.�-*. _,.,..,���,k,...4,,­ .�-..-,:.�.-.,I-.-:--*..,I"_...�._.�.I,.,-"I 1,:�.,,',.,II..�\7,.��.-��.I:-.I. .,.I�­.;I t."I�.v.....,�.....I�',,�,.1."-i N;..,­.�.`,..I,.4��,.-.�I�.,I.,��1....,.,---_ -.I,.1�.1.L 4.,..._�,.,�I--1_�/ 4v = jPROP03ED)-O-O-O-CE- APPROVED GATE- .1 , DAME :, .Ca!_, -. �-� . .. .� 11. r fi : : a f I SECTION - SEWAGE —SEPTIC TANK — — "D"BOX — — LEACH 4 TOP OF FON 'i••?Tr7K14?VRi �rh.1`+l 4Nao4.lYw"A1' Lr. MAl'GL(2...Fw1•-- \•� - (MSL) �c�lir A [ale.TP n-tiGl CrF iG5 F*, fapp��D C,haYlGLik- 2r'OF"870�i" trCaHc 1-! TaiT"f G +6 P fcP�Ar w�T� C. A ns \ASHEO STONEIT 1 IN- OUT IN- OUT 1 . • ---r'b- •---- y `f IZ_ .gZ. TANK L].Q.ts] C}C?.� 4 r ° 4a•�' fir-' ELEV. ELEV. ELEV. ELEV. y � 1\ ELEV. ELEV. Y •2; -�+-�-7- Z' OF V4" � WASHED STONE TEST HOLE LOG - ��.► ��..._...�.��-} ���.. „�..�••��. �,\ � �..•----".,-r ,�~ TEST SY ter:✓.'' tT Ali?* WITNESS TEST DATEDESIGN BEDROOM HOUSE ��, � •. ^�"". - E�,4?-� '_..,, T.H. +r 1 Qt,t T.K +� 2 41. bca' ELEV. OC. ELEV. NO DISPOSER DISPOSER �, PERC RATE S, MIN/IN. .. 4A mad rl Lln.! G4 _ 5�.� FLOW RATE 3�G (GAL./DAY) - SEPTIC TANK '7110 (IS)= 4. c--Ca %Q'D SEPTIC TANK SIZE 4-L.► Wiz. 3G,.i '�� �5•�-- .\ '� '•,,~� � � � ��,, � � -� LEACH FACILITY / tp 4 ,�. ✓ __ ,�.,,, ` SIDE WALL 14CTz �`� (2 Ca (2.� 1 _ '�►c# G/D. �� " � . I T �I _• '�. a ' BOTTOM Icy�l� �' 'S ( ►•© 1 �g'a G/D. �� !, _ �2w� _ TOTAL ze.� 4 �? AC7ju�iS1..� •-....... n.. 1.!a C,7 `-2a• 7•• "f t?'i r`'� C7!(. `•,. `�'�• .L' �•/�' '�. S 2..n ` ,^Mt~ ^ w/�a c54C d6.i, ° _ S \ �r. \ Gr ITT ort'LrA.cL-c USE: Tw`'� LEACHING z:.q•'y„ 10 , iA., X �•`'•� r,./ +r- 1 ,1 �,�~�`, ~"' z, "S •• ` _ 1 \��- WATER ENCOUNTERED NOTES: (UNLESS OTHERWISE NOTED) - 44 Of `E'A•,tal..t1 S _QUA DRANG E MAP \'� '�Jr \'� i4"�• t+`; <j• \�jl '' �a 1. DATUM(MSL). TAKEN FROM-.Y.__. ..__ _...- }r- ` `c 2.MUNICIPAL.WATER_ -__ - ( .......-..........•__-AVAILABLE `a `' 3.PIPE PITCH:'y."PER FOOT � ACNE H. �yl. ���, �- G �1,•� r •y• �`\ �'� � ,,...--'^" 4� 1 c. .n c ARP E 4.DES)GN LOADING FOR ALL PRE-CAST'UNITS:AASHO •44 r' OJALA �''1 ).! '. ;'g--Q-•--DISTANCE AS CERTIFIED ( � 5.MIN.GROUND COVER OVER ALL SEWAGE FACILITIES: (1) FT. r .c 1 CIVIL, cn �3 01\LA 6. PIPE JOINTS SHALL .MADE WATERTIGHT No 30792 �� I� :•�, 348 � � SITE PLAN 7.CONSTRUCTION DETAILS TO BE ACCORDANCE WITH COMM.OF MASS. 1 � r� STATE ENVIRONMENTAL,CODE TITLE 5 aISTKEQ '� \ Qr�•j, .�C• LOCUS: `f`SfQf�lA � REG.PROFESSI0 '— r EER ' REF: SOW/! ca►,Oe engineer1ng PREPARED FOR: - r' CIVIL ENGINEERS LAND SURVEYORS _---_----___ REG.LAND SURVEYOR BOARD OF HEALTH 9" Main St. CONTOURS (EXISTING)-------- •--- APPROVED MA Yam yt`J�yi/5i1 SCALE (PROPOSED) 'D O U O` DATE ¢ ♦!C DATE