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HomeMy WebLinkAbout0024 COLONIAL WAY - Health 24 Colonial Way, Barnstable A= 237 - 049 I' o 's k � ` i oe May 18 1509`49p p.18 Commonwealth of Massachusetts Title 5 Official Inspection Farm o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �W 24 Colonial Way Property Address rrys.l Ed Currant Owner Owner's Name information is West Samstable 7( MA 02668 5-11-155 required for every ' page. CityrTown State Zip Code Date of Inspection. I"ti,3 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. Impfling oartt:when Aut forms . General Information S� (� on the computer, ``\`���� �ZHIOF1jky� use only the tab .� y� key to move your 1. Inspector: _ y y cursor-do not JA M E S N use the return James D Sears = :rn key. Name of Inspector u :0 CapewideEnterprises, LLC Com an Name s% g�TiFC``O IC I p y i� ( '•... x� 153 Commercial Street � Company Address Mashpee MA 02649 Cityrrown State Zip Code 508-477-8877 S1623 Telephone Number license Number I • I B. Certification 1 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 16.000).The system: Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority i 0--ao" 5-11-15 4fispector'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 wilt perform in the future under the same or different conditions of use. t5ine•3113 Title 5 Official Inspection form:Suosurram Sewage Disposal System•Page 1 or t r i i i May 18 15 09:49p p.19 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 24 Colonial Way Property Address Ed Currant Owner owner's Name information required for every West Barnstable MA 02668 5-11-15 page. Cityfrown 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: ` The system is a 1000 Gal. Tank D Box and five chambers. B) System Conditionally Passes: i ❑ 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. i ❑ Y ❑ N ❑ NO(Explain below): i i I [Sins•31`13 Title 5 official Inspection onForm:Subsurface Sewage Disposal Sy stem•Page 2 of 17 1 i i Shay 18 15 09:50p p.20 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 24 Colonial Way Property Address Ed Currant Owner Owner's Name information required for every West Barnstable AAA 02668 5-11-15 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 pumpslalarms are repaired. B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): i ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): I 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 j 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: i I ❑ Cesspool or privy is within 50 feet of a surface water i❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 15irts-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 j i i • F F S I S i May 18 15 09:50p p.21 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 24 Colonial Way Property Address Ed Currant Owner Owner's Name information required for every West Barnstable MA 02888 5-11-15 page. cityFrown state Zip Code Date of Inspection B. Certification (cunt.) 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 160 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 ❑" ® a 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 ❑ S Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Liquid depth in*maps*is less than 6"below invert or available volume is less than %day flow X"('�,y C i 15:ns•3/13 Title 5 Official Inspection Fonn:Subsurface Sewage Disposal System•Page 4 of 17 j May 18 15 09:50p p.22 Commonwealth of Massachusetts ID Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 24 Colonial Way Property Address Ed Currant Owner Owner's Name information required for every West Barnstable MA 02668 5-11-15 page. CityfTown State Zip Code Date of inspection B. Certification (cost.) 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. ❑ 0 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 coliforrn bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 3 ppm, provided that no other failure criteria are triggered.A copy of the analyses and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000g pd_ ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CBRR 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 j El ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection .Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered ayes"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 Tlde 5 Official Inspection Form:Subsurface Sewage Disposal System-Pago 5 of 17 i i l May 18 15 09:51 p p.23 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments , 24 Colonial Way Property Address Ed Currant Owner Owners Name information is required for every West Barnstable MA 02668 5-11=15 page- City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done.You must indicate`yes'or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as 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? ❑ 0 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. i ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue j approximation of distance is unacceptable)131 D CMR 15.3o2(5)) D. System Information Residential Flow Conditions: i Number of bedrooms (design), 4 Number of bedrooms(actual): 3 44 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x*of bedrooms): © I i5ina•3113 Title 5 Vidal kq>aUroe Form;Subsurface Sewage Disposal System•Page 6 of 17 i May 18 15 09:52p p.24 Commonwealth of Massachusetts --MIJIMP Title 5 Official Inspection Form -- " Subsurface Sewage Disposal System Foam-Not for Voluntary Assessments 24 Colonial Way Property Address Ed Currant Owner owner's Name information required for every West Bamstable AAA 02668 5-11-15 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: The system is a 1000 Gal. Tank D Box and five chambers. •Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes 0 No Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ® Yes ❑ No Water meter readings, if available(last 2 years usage(gpd)): 2013-66,000Gals 2014-105,000GaI s Detail: • i I • Sump pump? ® Yes ® No Last date of occupancy; Present Date Commercial/Industrial Flow Conditions: Type of Establishment: • i 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? El Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No 1 Water meter readings, if available: mns•'a/13 - Titre 5 Mcial In ecdan Form:Subsurface Sewag e ge Disposal System•Page 7 of 17 i I I j i May 18 15 09:52p p.25 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form-Not for Voluntary Assessments, t 24 Colonial Way Property Address Ed Currant Owner Owner's Name information is required for every West Barnstable MA 02668 5-91-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: NA 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 1/A system by system operator under contract Q Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): tflirb•3113 Title 6 Official Inopaction rorrn:Subsurface Sewage Disposol Syslom•Page 19 of 17 May 18 15 09:53p p.26 Commonwealth of Massachusetts Title 5 Official Inspection Form �i Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 24 Colonial Way Property Address Ed Currant Owner Owner's Name information is required for every West Barnstable MA 02668 5-11-15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 1998 Permit#98-223 Were sewage odors detected when arriving at the site? ❑ Yes 0 No Building Sewet, (locate on site plan): Depth below grade: 34"feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints,venting, evidence of leakage, etc.): Pipeing is 4" PVC SCH 40 Septic Tank(locate on site plan): Depth below grade: 22 . feet I Material of construction: + ® concrete El metal ❑ fiberglass ❑ polyethylene ❑ other(explain) ' i If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 Gal.Precast H-10 Sludge depth: 3 15ins-3113 Title 5 Official Inspection Fomr.Subsurface Sewage Disposal System-Page 9 of 17 ` I I jI May 18 15 09:53p p.27 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 24 Colonial Way Property Address Ed Currant Owner Owner's Name information required for every Vilest Barnstable AAA 02668 5-11-15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cunt.) Distance from top of sludge to bottom of outlet tee or baffle 27 Scum thickness 2 Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? Asbuilt-Tape Sludge Judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): i I Tank at working level. Tank and outlet cover at 22"below grade wlinlet at 6". In and outlet tee's.No sign of leakage or over loading Tank to be maint pumped after inspected P i i Grease Trap (locate on site plan): Depth below grade: feet j Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): a Dimensions: Scum thickness - Distance from top of scum to top of outlet tee or baffle r, I Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Hate t5hs 3f13 Title 5 Official Inspection Form:Subsurface Sewage Disposal Syarern-page 10 of 17 May 18 15 09:53p p.28 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 24 Colonial Way Property Address Ed Currant Owner Owner's Name information a West Barnstable MA 02668 $-41-95 required for every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑concrete ❑metal ❑ fiberglass ❑polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping:. Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No I 1 i Title 5 rficia;inspection Form:Subsurface Sewn Di t5ins e O •3!13 pecft ge sposal System•Page 11 of 17 i I I i i May 18 15 09:54p p.29 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form =Not for Voluntary Assessments 24 Colonial Way UV. Property Address Ed Currant Owner Owner's Name information a required for eery West Bamstabie MA 02668 5-11-15 page. Cityrrown State Zip Code Date of inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D Box% 1 x1T-34' below grade wltwo lines out. Box is clean and solid. No sign of over loading or solid carry over. i . i 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.): I i If pumps or alarms are not in working order, system is a conditional pass. i Soil Absorption System(SAS) (locate on site plan, excavation not required): If SAS not located, explain why: I i ""3113 TiUe 5 Official inspection Form:Subsurface Sewage Disposal System•Pape 12 of'7 i ,May 18 15 09:54p p.30 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 24 Colonial Way Property Address Ed Currant Owner Owner's Name information is required far every West Barnstable MA 02668 5-1 f-15 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 5 ❑ Teaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields • number, dimensions: ❑ overflow cesspool number, ❑ innovativeialtemative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching is five high cap infiltrators w/4' of stone.Ck D Box and camera lines out to chambers. No sign of over loading. .Cess ools (cesspool must be pumped as part of inspection)(locate on site plan): I .. Number and configuration Depth—top of liquid to inlet invert Depth of solids layer i Depth of scum layer Dimensions of cesspool Materials of construction i Indication of groundwater inflow ❑ Yes [] No t5ns•3113 rrtle 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 i May 18 15 09:54p p.31 Commonwealth of Massachusetts ,UIW-; Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 24 Colonial Way Property Address Ed Currant Owner Owner's Name information required for every West Bamstabte MA 02668 5-11-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc,): i i 'airs 3113 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 14 of 17 i i i May 18.15 09:55p p.32 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 24 Colonial Way Property Address Ed Currant Owner Owners Name information for a West Barnstable MA 02668 5-11-15 required for every page. City/Town state Zip Code Date of Inspection D. System Information (cunt_) 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 feel Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below tply 14 SCR►'�� , 13- (tA.G�L I � 2ie`c 15ins•W3 Title 5 016da1 4vpeelion Fam Suesurftm s&.,"1)_posal System-page 15 of 17 i I I . May 18 15 09:55p p.33 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 24 Colonial Way Properly Address Ed Currant Owner Owners Name information required for every West Barnstable MA 02668 5-11-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth t high ground water: 22+ feet Please indicate all methods used to determine the high ground water elevation: i ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutti ng g property/observation hole within 150 feet of SAS) I ❑ Checked with local Board of Health-explain: 1 I ❑ Checked with local excavators, installers- (attach documentation) r , i ® Accessed USGS database-explain; . i You must describe how you established the high ground water elevation: U.S.G.S.well aiw.247 22' 4 is 1 w ` Before filing this Inspection Report, please see Report Completeness Checklist on next page. ` I i (Sins•3/1$ Title S Official Inspedion Fomr.Suhsurfaee Sewage Disposal System•Page 16 of 17 t May 18 15 09:55p p.34 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 24 Colonial Way Property Address Ed Currant Owner Owners Name information rquied for e very West Bamstabre MA 02668 5-4 9-15 page. City/rown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed )� System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file 9 I t5ins•3l13 Title 5 Official Inspection Form;Subsurface Sewage Disposal System•Page 17 of 17 t z i i II t 4. 6'< TOWN OF BARNSTABLE o 21 LOCATION 0, ✓ SEWAGE # 13 V,,VLAGE �� '��� 1� ASSESSOR'S MAP &LOT • 4 INSTALLER'S NAME&PHONE NO. < Se' SEPTIC TANK CAPACITY t 0o v Ad�� i' LEACHING FACILITY: (type) j (size) NO.OF BEDROOMS BUILDER OR OWNER PERMIT DATE: 9T_COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by /9 LZL z n No. ! � Z� ►1 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: i` Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pplitation for )0 *paem CoTCgtrUrtion Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Addr s o Lot No. Owner's Name,Address and Tel.No. Assessor's Map/Parce)i ,l r j Installer's Name Address,and Tel.No. Z6 BaK,j,QrA-1,-e_ Designer's Name,Address and Tel.No. offer ob-er¢-.S 4 a )ni,s Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow L,4.0 gallons per day. Calculated daily flow l'� gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Zgn/��`'� l Type of S.A.S. JAIL-- Description of Soilr>°X-S�'� Nature of Re airs or Alterations(Answer when applicable).-57"_!Sr '`` Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has b y i tgn di Date y'C7 Application Approved by 4 Date Application Disapproved for the following reasons Permit No. r Z Z2 Date Issued �1_9 .A.q-. .. -. ..n.-. ._. `- - y•�."..:«.pp o. ..., .. -.. -`.. S. .. ..:tl`T^°'"..,,.. .....,aY :E..G.-..- .m. ...,a s... r "` � _ n I ems. ... 1� _ Nod Fee �s THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: I N t Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 3pol-nation for Oigpont *pztem Construction Permit Application for a Permit to Construct( )Repair(grade( )Abandon( ) Ed Complete System L1 Individual`Components Location Address or Lot No. Owner's Name,Address and Tel.No. Assessor's Makarcel Installer's Name,Address,and Tel.No. „ Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder( J Other Type of Building No.of Persons Showers( ..:)..; Cafeteria( ) Other Fixtures F Design Flow "1 gallons per day. Calculated daily flow L� yF*" gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank L` -An +�-- !n-D Type of S.A.S. c1 tit K. =4 Q— Description of Soil Nature of Repairs or Alterations(Answer when applicable) 1 All\ cA OC'r Y L 'w . -7r�'1'G 1? S (�,�C� f 51-G-. O r�-- ✓rT s Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and'nbt fo`place the system in operation until a Certifi- cate of Compliancehas be y ig Fed Date e I-,3x Application Approved by f Date Application Disapproved for the following reasons or r _ Permit No. Fr-Z 72 Date Issued..4 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site S wage Disposal System Constructed( )Repaired )Upgraded(� Abandoned( )by at i ° U r% t, has been constructed in accordance with the,pr-ovisions of Title 5 and the for Dis osal System Construction Permit No. - 9 ated - Z Z2 . Installer Rwci 'r eO-P, r+ Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date 15 - Inspector No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Zigponl *pgtem -ongtruction Permit Permission is hereby granted to Construct( )Repair( )U grade( )Abandon( ) System located at 1 V� and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date: /`�� Approved by JLcc_c' ,1��- (iq r TOWN OF BARNSTABLE LOCATION 0/0 1 SEWAGE# VILLAGE. q�„S��{j� ASSESSOR'S MAP dt LOT INSTALLER'S NAME&PHONE NO. SEPTIC:TANK CAPACITY _,_ LDo d �•'''� LEACHING FACII. M (type) (size) ,�'o►� AS"— f NO;OF:.BEDROOMS----4_ BUII;TS>rIt OR OWNER S!Lb_ I' PERMtTDATE: '9'9� COMPLIANCE DATE: GI ^- 16. �T - Sepaiation Distance Between the: Feet Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Private'Water Supply Well and Leaching Facility (If any wells exist Feet on site or within 200 feet of leaching facility) Edge.of.Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) Furmsfied by 9: j ! f O o : : Used For the Repair.Of Failed NOTICE: This Form Is To Be Septic Systems Only. • f CH AND APPLICATION CERTIFICATION OF$KET FORA KS CONSTRUCTION PERMIT (WITHOUT s DISPOSAL WOR ERED PLANS) ENGINE , �� " hereby certify that the application for dispos al works y✓ —� I' dated s-l�. concerning the ��� _ `_.• construction permit signed by me '. meets all of the located at �( � ° rt p Y rOPe criteria: • following c Thera an no wetlands located within 100 rector the proposed leaching fkllity CA .a we no private wells within ISO Poet of the proposed septic system There is a Meteese in now Mwer change in use pf"Wed • I There are no vari+nKxs rued or needed. 1 wetlands°the bottom of the leaching flscility will be located within 250 feet of any y /proposed the proposed r leaching facility will llel�located less then fourteen(14)feet above the maximum adjusted ' er table elevation• g�undwat � 1 Please eomplete the followl"r. 1 )^? A)tap of Ground Elevation(according to the Engineering Division G.I.S.map) I d dweter Table Elevation(according to Health Division well map) . � B)Observedfi . I • DATE ; slam i . LICENSED SEPTIC SYSTEM�NVALLER IN To TOWN OF BARNSTABLE NUMBER • '� f lail sf lM t��rye•A1rs IttM itanNd M�II�t pe��•"mined plot pia+° � iI G -,tAtae4�•NearoA p .. 1 this plan should be subnlitwill. ; r - Z 203 498 828 US Postal Service Receipt for Certified Mail No Insurance Coverage Provided. Do not us@ for International Mail See reverse Sent ber State,&ZI e Postage Certified Fee Special Delivery Fee Restricted Delivery Fee LO Retum Receipt Showing to Whom&Date Delivered a Return Receipt Showing to Whom, Q Date,&Addressee's Address 0 TOTAL Postage&Fees $ .- ch Postmark or Date € �/-- -I- 90P L2 U) a I I Stick postage stamps to article to cover First-Class postage,certified mail fee,and a charges for any selected optional services(See front). 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address leaving the receipt attached, and present the article at a post office service window or hand it to your rural carrier(no extra charge). 4 Q) 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the a) return address of the article,date,detach,and retain the receipt,and mail the article. LO 3. If you want a return receipt,write the certified mail number and your name and address on a return receipt card,Form 3811,and attach it to the front of the article by means of the _ gummed ends if space permits. Otherwise,affix to back of article. Endorse front of article a RETURN RECEIPT REQUESTED adjacent to the number. Q 4. If you want delivery restricted to the addressee, or to an authorized agent of the addressee,endorse RESTRICTED DELIVERY on the front of the article. co M N., 5. Enter fees for the services requested in the appropriate spaces on the front of this E receipt. If return receipt is requested,check the applicable blocks in item 1 of Form 3811. to I 6. Save this receipt and present it if you make an inquiry. 102595-97-e-0145 a I I Town of Barnstable 1 grABM � Department of Health,Safety, and Environmental Services NAM Public Health Division i619• �� P.O. Box 534, Hyannis MA 02601 Office: 508-790-6265 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health April 3, 1998 Suzanne Howes Box 344 Barnstable,MA 02630 - ORDER TO COMPLY WITH 310 CMR 15.00,THE STATE ENVIRONMENTAL CODE, TITLE 5. i The septic system owned by you located at 24 Colonial Way, Barnstable was inspected on January 12, 1998 by,John Graci,a Massachusetts licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00)due to the following: • The soil absorption system was in hydraulic failure. The leaching pit was"full." You are directed to hire a licensed Town of Barnstable septic system installer to submit a sketch diagram of a proposed system to the Town of Barnstable Health Division Office(Town Hall, 367 Main Street, Hyannis) that will bring the septic system into compliance with 310 CMR 15.00, The State Environmental Code,Title 5 within(30)thirty days of receipt of this notice. You are also directed to bring the septic system into compliance within sixty(60)days of receipt of this order letter. You are further directed to maintain the system by hiring a licensed septage hauler to pump the septic system to prevent discharge of sewage or effluent into the buildings, onto the surface of the ground,or in to surface waters. Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. PER ORDER OF THE BOARD OF HEALTH T�6A. ean, Agent of the Board of Health q\health\dbfiles\title5 i.doc j PAR ] Real Estate System- . General Property Inquiry] Help [ ] Parcel Id: 237 049- - Account No: 147479 Parent : Location: 24 COLONIAL WAY BARN Neighborhood: 78AB Fire Dist : BA Devel Lot : 4 Lot Size : .45 Acres Current Own: HOWES, SUZANNE S State Class : 101 BOX 344 No. Bldgs : 1 Area: 1872 Year Added: BARNSTABLE MA 2630 Deed Date : Reference : 3212/105 January 1st : HOWES, SUZANNE S Deed MMDD: 0000 Deed Ref : 3212/105 Comments : Values : Land: 39800 Buildings : 83200 Extra Features : Road System: 24 Index: 336 (COLONIAL WAY ) Frntg: 162 Index: ( ) Frntg: Control Info: Last Auto Upd: 101996 Status : C Last TACS Update : 101896 Land Reviewed By: Date : 0000 Bldgs Reviewed By: Date : 0000 Tax Title : Account : Taken: Account Status : Hold Status : Cancel [ ] Press XMT for more data Next screen [PAR ] Action [ ] Owners Name [ l Road Index [ ] Road Name [ ] Parcel Number [237] [050] [ ] [ ] [ ] m SENDER: I also wish to receive the v ■Complete items tand/or 2 for additional services. ■Complete items 3,4a,and 4b. following services(for an. d RPrint your name and address on the reverse of this form so that we can return this extra fee card to you. ai ■Attach this form to the front of the mailpiece,or on the back if space does not 1. ❑ Addressee's Address E permit. m ■Write'Retum Receipt Requested'on the mailpiece below the article number. 2. ❑ Restricted Delivery to r ■The Return Receipt will show to whom the article was delivered and the date a delivered. Consult postmaster for fee. =Arficlessed to: 4a.Article Number E 4b.Service Type c°+ ❑ Registered 19 Certified W ❑ Express Mail ❑ Insured q LWUJ W ❑ Return Receipt for Merchandise ❑ COD a 7.Date of Delivery . Z —g ol 5. ceived By:(Print Name) 8.Addressee's Address(Only if requested c I ,k 'e ,e and feeds paid) t t— g 6.Signature:(Addressee or Agent) a. X PS Form 3811, D e er 1994 102595-97-13-0179 Domestic Return Receipt i UNITED STATES POSTAL SEIiVICE-- = " '•- .<.�. -First=Class.M.ail_ .Postage-&.Fees.Paid ? 4 `,P USPS 4 .0 _ _"` Permit No.G-1.0, • Print your name;address, and ZIP Code in this box• Public Health Divisio `" Town of Barnstable P.O.Box 534 Hyannis,Massachusetts 2601 rah.era a'� �► ��=� ��f���,a���:�i�at�f�:,�:��il:a�si�{r=. ��!;����==.�ks:�:��;s��f� Town of Barnstable Department of Health, Safety, and Environmental Services + BMMSfASM + Public Health Division 367 Main Street, Hyannis MA 02601 Office: 508-790-6265 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health TO: u DATE: ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE, TITLE 5. l� The septic system owned by you located at C L-A ra 1 was inspected on e 1-24199 1� by �x �a/�c� , a Massac etts licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the'following: You are directed to hire a licensed Town of Barnstable septic system installer to submit a sketch diagram of a proposed system to the Town of Barnstable Health Division Office (Town Hall, 367 Main Street, Hyannis) that will bring the septic system into compliance with 310 CMR 15.00, The State Environmental Code, Title 5 wi days of receipt of this notice. Ca� You are also directed to bring the septic system into compliance within t ' days of receipt of this order letter. ((e C) You are further directed to maintain the system by hiring a licensed septage hauler to pump the septic system to prevent discharge of sewage or effluent into the buildings, onto the surface of the ground, or in to surface waters. Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health q\he&h\dbfdcd%it1n5i.doc Commonwealth of Massachusetts Executive Office of Environmental Affairs Dept. of Environmental Protection One winter Street Boston Ma. 02108 Jolui Grad ' D.E.P. Title V Septic Inspector P.O. Box 2119 n Teaticket, MA 02536 W LLIAM F WELD �V (508)564-6813 3� Governor ARGEO PAUL CELLUCCI V( �/ Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION O R4 v g ✓AN Property Address: 24 Colonial Way Barnstable Map 237 Lot 49 Address of Owner:. 6 Date of Inspection: 1112198 `— (If different) how/vop 1998 Name of Inspector: John Graci Howes HFA(Ty FpSPIB, 1 am a DEP approved system inspector pursuant to Section 15.340 of Title%(310 CMR 15.000) . T Company Name,Address and Telephone Number. dr 9 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 sewage disposal systems. The system: _ Passes This inspection is based on criteria donned In Title V Conditionally Passes code 310 CMR 16.303.My findings are of how the system is performing at the time of the inspection.My Inspection does _ Needibmit Further, valuation By the Local Approving Authority, not Imply any warranty or guarantee of thelongevhyofthe x Falls septic system and any of Its components useful life. Inspector's Signature: Date: v19198 The System Inspector shall s a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspections. 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. INSPECTION SUMMARY: Check A, B, C,or D: A] SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: B] SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes inspection. 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 conforming septic tank as approved by the Board of Health. (revised Q4n7197) One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 is Telephone(617)292.5500 SUBSURFAC E SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 24 Colonial Way Barnstable Map 237 Lot49 . Owner: Howes Date of Inspection:1112199 Sewaae backup or.hreakout.or. hiah.static water level observed.in.the distribution box is due to a broken. or obstructed pipe(s)or due to broken,settled or uneven distribution box.The system will pass inspection if (with approval of the Board of Health). Describe observations: broken pipe(s)are replaced obstruction is removed distribution box is leveled 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 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 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 a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh.. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER,IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet to a surface of water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone 1 of a public watersupply well. The system has a septic tank and soil absorption system and 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 presense of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method usedto determine distance (approximation not valid) 3)Other D] SYSTEM FAILS: You must Indicate either"Yes"or"No".as to each of the following: x I have determined that the system violates one or more of the following failure criteria as defined 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 _ _x_ Backup of sewage in facility or system component due to an overloaded or clogged SAS or cesspool. x_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged cesspool.. x_ - — SAS is in hydraulic failure. (revised 040197) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A , CERTIFICATION (continued) Property Address: 24 Colonial Way Barnstable Map 237 Lot 49 Owner: Howes Date of Inspection:1112199 D]SYSTEM FAILS(continued) Yes No x Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. x Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow. x Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Numbers of times pumped x Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. —x• Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. x Any portion of a cesspool or privy is within a Zone 1 of a public well. _x_ Any portion of a cesspool or privy is within 50 feet of a private water supply well. x 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] LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: The following criteria apply to large systems in addition to the criteria: 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 x the system is within 400 feet of a surface drinking water supply x the system is within 200 feet of a tributary to a surface drinking water supply _ x 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) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. {revised 04)27)971 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECLIST Property Address: 24 Colonial Way Barnstable Map 237 Lot 49 Owner: Howes Date of Inspection:1I12198 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: ,c_ — Pumping information was requested of the owner,occupant,and Board of Health. x None of the system components have been pumped for at least two weeks and the and 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. x As built plans have been obtained and examined. Note if they are not available with N/A. x The facility or dwelling was inspected for signs of'sewage back-up. x — The system does not receive non-sanitary or industrial waste flow. —x_ — The site was inspected for signs of breakout. x All system components,excluding the Soil Absorption System,have been located on the site. x 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. x The size and location of the Soil Absorption System on the site has been determined based on — — The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal Systens. x Existing information. Ex. Plan at B.O.H. x Determined in the field(if any failure criteria related to Part C is at issue,approximation of distance is — — unacceptable)[15.302(3)(b)] (reylsed 04127197) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 24 Colonial Way Barnstable Map 237 Lot 49 Owner: Howes Date of Inspection:1112199 FLOW CONDITIONS RESIDENTIAL: Design flow: 220 g"p•d./bedroom for S.A.S. Number of bedrooms: 2 Number of current residents: 2 Garbage grinder(yes or no): No Laundry connected to system(yes or no): Ye: Seasonal use(yes or no): No Water meter readings, if available:(last two(2)year usage(gpd): rda Sump Pump(yes or no): No Last date of occupancy: n1a COMMERCIAL/INDUSTRIAL Type of establishment: ma Design flow:0 gallons/day Grease trap present:(yes or no) No Industrial Waste Holding Tank present:(yes or no) No Non-sanitary waste discharged to the Title 5 system:(yes or no) Ne Water meter readings,if available: nie Last date of occupancy: n1a OTHER:(Describe) rda Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System was pumped last summer by Macomber System pumped as part of inspection: (yes or no)No If yes,volume pumped:0 gallons Reason for pumping: n1a TYPE OF SYSTEM x Septic tank/distribution box/soil absorptions system Single cesspool Overflow cesspool Privy Shared system(yes or no) ( if yes,attach previous inspection records,if any) I/A Technology etc.Copy of up to date contract? Other: APPROXIMATE AGE of all components, date Installed(If known)and source information: 1980 Sewage odors detected when arriving at the site: (yes or no) No (revised 04117)91) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 24 Colonial Way Barnstable Map 237 Lot49 Owner: Howes Date of Inspection:1112199 SEPTIC TANK: x (locate on site plan) Depth below grade: 2' Material of construction:x concreate metal FRP Polyethylene—other(explain) If tank is metal, list age o . Is age confirmed by Certificate of Compliance No (Yes/No) Dimensions: L8'6'*H6'7"w4'10" Sludge depth:2" Distance from top of sludge to bottom of outlet tee or baffle: 25^ Scum thickness:3" Distance from top of scum to top of outlet tee or baffle:s" Distance form bottom of scum to bottom of outlet tee or baffle: 15" How dimensions were determined: measured Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) septic tank and all components are structurally sound.Recommend pumping every 2 years. GREASE TRAP:_ (locate on site plan) Depth below grade: FVa Material of construction: concrete metal FRP Polyethylene—other(explain) Dimensions: rya Scum thickness:nla 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: rda Date of last pumpingnt. Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage, etc.) Ma BUILDING SEWER: (Locate on site plan) Depth below grade: 2-e Material of construction: cast iron x_40 PVC_other(explain) Distance from private water supply well or suction line?own Diameter: 4 Qsmments: (conditions of joints,venting,evidence of leakage, etc.) (revised 0427)97J SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 24 Colonial Way Barnstable Map 237 Lot49 Owner: Howes Date of Inspection:1112199 TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade: Na Material of construction:_concrete_metal_FRP_Polyethylene—other(explain) Dimensions: No Capacity: No gallons Design flow: Ne gallons/day Alarm level:-.No Alarm in working order?_Yes_No Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) rda DISTRIBUTION BOX: x (locate on site plan) Depth of liquid level above outlet invert: Na Comments: (note if level and distribution is equal, evidence of solids carryover,evidence of leakage into or out of box etc.) D-box Is structurally sound. PUMP CHAMBER: (locate on site plan) Pumps in working order:(yes or no)No Alarms in working order(yes or no)_va: Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) No (rsylood 04R7ST) J SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 24 colonlai WayBamstable Map 237 Lot49 Owner: Howes Date of Inspection:1I12199 SOIL ABSORPTION SYSTEM (SAS):x (locate on site plan,if possible;excavation not required, but may be approximated by non-intrusive methods) If not determined to be present,explain: Na Type: leaching pits,number. 1,000gallonleachpft leaching chambers,number:Na leaching galleries,number: Na leaching trenches, number,length: Na leaching fields,number, dimensions:Na overflow cesspool,number:Na Alternate system: Na Name of Technology:_Na Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) SAS Is In hydraunc failure.The soil Is past the effective depth of leaching,pit was fun. CESSPOOLS:_ (locate on site plan) Number and configuration: Na Depth-top of liquid to inlet invert: Na Depth of solids layer: Na Depth of scum layer: Na Dimensions of cesspool: Na Materials of construction: Na Indication of groundwater: Na inflow(cesspool must be pumped as part of inspection) Na Comments: (note condition of soil,signs of hydraulic failure,level of ponding, condition of vegetation, etc.) Na PRIVY: (locate on site plan) Materials of construction: da Dimensions: Na Depth of solids: Na Comments: (note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation, etc.) Na - (revised 04127)97) c � SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 24 Colonlal Way Barnstable Map 237 Lot 49 Howes 1112199 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references, landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) i o Page 9 of 20 (revised OWTS7) - ----------- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 24 Colonial Way Barnstable Map 237 Lot 49 Howes 1112198 Depth of groundwater 12. Please indicate all the methods used to determine High Groundwater Elevation: " Obtained from design plans on record. Observation of Site(Abutting property,observation hole, basement sump etc.) Determine it from local conditions Check with local Board of Health Check FEMA Maps Check pumping records Check local excavators, installers X Use USGS Data Describe.in your own words how you established the High Groundwater Elevation.(MUST be completed) USGS maps and charts j (reylsedomI7197) )aqe 10 of 10 _ �.'OCATI N -SEWAGE P T NO. �r z V l l A G E I? us�-y r!ILL er_ PA AlE 4�_vlko I?jlc Lf�c4 I N S T A LLER'S NAME i ADDRESS BUILDER OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED M s ��'1 �� •• ,0 ' ��' J ,.-� ..... a. . .� v _.,,,� �� �.... L ,. t �� • S THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH !...::.....OF........ ................................... Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: • ---••----•----��_J_.�l-_....6 Pfu�....... - ........................ Locati n-Address or Lot No. :a...h6c'.1?• •-----•--- ---------------•----------------- --- ----------------------------- ----------------------•----•-------- Owner Address ----------------- ---------------------------------- -----------_--__------_--_-----__--_-_----- Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms___....._ .Ex Expansion Attic Garbage Grinder P ( ) g W� pa,,, Other—Type of Building _ .1fi t1. -------- No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ------•-------------------------- W Design Flow..... __. ........5�-�:___gallons per person per day. Total daily flow------------- ....................gallons. WSeptic Tank—Liquid*capacity__ `AQtallons Length---------------- Width...:.......... Diameter----------------- Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area...... ....sq. ft. i 3 Seepage Pit No �...__._... Diameter.t?,� __- _:.�._. _;_._..... Depth below inlet ....... Total leaching area....9�__.7_2...sq. ft. Z Other Distribution box (✓) Dosing tank / '-' Percolation Test Results Performed by._.._..l2tS.�1s:�r .....�...� ..`...'' � a"l .. f�d Date. aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water...................... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water--._-___-_--__.._____-_. ............................................................. O Description of Soil ----- ----- --•--- - - ---- U ................................. .............t -_Z_� �..=------- --------------....-- U W -------•------------------------------------------ -------------------------------•----•-•-------------------------------------...---------- ••••-•-•-•---•-•••-•-.....-•-••--•••---•-•---...•--••- 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 I i:L, 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been • sued b the bo d of health. / Date Application Approved By--..---- --- ......�----••----------------------•-- ------------- -&-el---------- Date Application Disapproved for the following reasons:-----------•-------------------------------------------•--------------------------------------------......------ ..............•------------------•-•------------------------......--------••-•--------------------------•----------------------------------------.-------------------- ------...-----------...------ Datar Permit No......................................................... Issued....... - /P- � ...... Date 2� FEs......... Q No......_••••• - THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -ti/1Y........OF........:/3/q/L/vSTJq J3't---------------------------------- ApV irttf ou for MgpogFa1- Works Tonstrurtion Urrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at / f4. y �CfDflfrQ d .0 -- ��L-o3 Address or Lot No. ............... ....._._.._-___........•__........._....-••--._....._......._..___._........_... _.....-------•-•••-...--••---•---•--..........._.....-..•..................................._..... Ownq�1 .J�.!Y 1.... Address Installer Address d Ty pe of Building Size Lot............................Sq. feet U Dwelling—.No. of Bedrooms______________ ___________________Expansion Attic ( ) Garbage Grinder (N# pa, Other—Type of Building __ _____________ No. of persons__._________________________ Showers ( ) — Cafeteria ( ) �+ 01tures W Design Flow...................................._-------gallons per person per day. Total daily flow.............................................gallons. WSeptic Tank—Liquid capacity____A!Qallons Length---------------- Width---------------- Diameter-------_........ De 1_.______._._..-- x Disposal Trench—. ..................... Wi h____t______________ Total Length_____ ______i___._ Total leaching area....._ _..sq. ft. p g ....................* Depth below inlet___'' _._.___ Total leaching area .7`_�_.s Seepage ft. a e Pit No_____________________ Other Distribution box ( Dosing to k ( ) r Percolation Test Results Performed by-------------------------------------------------------------------------- Date---------------••-•---- -............. aTest Pit No. 1..........:.....minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_____________.__________ P4 ......................................................................................................................................_....................... 0 Description of Soil_ U W ••-•------•---------------------------------------•--•-------•-•-•-------------------------------------•-•--•----------------------------- ........................................................... 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 p 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been i`sued th*bd of eh;alth ed - �� � cy / L Y"k ApplicationApproved By.......... --------•-•••• = ----------•------------------- ---------•-------------------•- Date Application Disapproved for the following reasons------------------------------------------------------------•---------------------------------------........._.._ --••••----•--•••-•----•------•••--•••-----•----••...•---••---•---------------•-----._......._••---•--••-----•••--•-----------•-••••-----------------•---•----•--•--•---•-...•••-•••--••-•-••----------- Date PermitNo--------------------------------------------------------- Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ti ..............OF...............!. +'' ........................................ C�r�tifirtt�.� of �n�t��ittnrr THIS Tp CER�V hat the Individual Sewage Disposal System constructed ( or Repaired ( ) by-•-•--_--•-• ----•----//-_______-__--•______________________•-------•----_-_-------------------------___-______________-----------_____-__-____-__--_________-.. C.015 t w st. ll- O/� 6 0 w.+tiE at............................................................... -- oe has been installed in accordance with the provisions of TIC: > f The State Sanitary Code as described in the application for Disposal Works Construction Permit No.__���C_ ____________('_____......... dated_._..__/ ...................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. _. DATE... ... �..� \f-_-__•-_------•---•--------••------ Inspector_... .._. -•----•----_----- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �O4_0 N OF...-...Ts�1.9T-� ........................................................ 57.9�Cci" ........................................ ... N ............ FEE........................ 0 �i��r.tt�1 �rk� �nn��raUan rrnti� ,: WIC"JZ Sa A) Permissior�s,hereby granted........--------------------------•-----•--------------------------------------------------------------•-••---•--------------.._....-----•--- to Construct ( ) or Repair (�' ) an Individual Sewage Dis osal System at No......GGT._..... coCoN /AL !'`�Ay &W&Aj5r'0_��-_Lt' Street as shown on the application for Disposal Works Constructi rmit No............ Dated........................................... --_ - {�� oard o1 He�Ith DATE -•----•-- •-- -•••-••---.._... FORM 1255 HOBBS & WARREN, INC., PUBLISHERS T fb OV' f SECTION - SEWAGE -- - _T - -_ - -- - - -- _ --- - * 7 - - SEPTIC TANK - - "D" BOX - - LEACH TOP OF FDN __ l9 �S-Q' (MSL)# f� 2"OF 1t8TO 42" e ( f ✓ - \ \ NOTE: \ WASHED STONE I/ REMOVE ANY UNSUITABLE MATERIAL FOR A DISTANCE ,k I OF 10 FT.AROUND ENTIRE LEACH AND REPLACE WITH CLEAN COARSE SAND. OUTI N-- ( Y - ---• �•. ^ ---.__...-...,. -,-^• ) OUT- IN• q \ T1 T• IN» OUT 1 ` a (!7 �✓ C \\ � ` SEPTIC TANK �01.�5 �nO. i'S j 6-p, i ELEV. ELEV. ELEV. ELEV. y' + ( I� //�f \\ �•v \ Li Q \ ELEV. ELEV. I IK ~I I �� /�j -r \ v / NOTE: BRING ALL COVERS TO WITHIN ------ OF34"-1?iz 1 FT.OF FINISH GRADE. WASHED STONE r f GIf r G 1'r»G r 1 TEST HOLE LOG �� ' 1 TEST BY w.1=AiFf3�'�x.aK:, t-'.E, — -Yh�s` rn:.aC'�AY - l�.l-F.t�. ,' J !7 ,.-..-- �� WITNESS V i. • / ._/' „ - z�_` TEST DATE FZ Z r.H. # 1 T.H. DESIGN BEDROOM HOU�E O� — COO -6Z ELE V. (. frs- " ELEV. �.:�..•�_ '�_� r / ✓ /'••" /! �. L NO oin. - � �rJ��'=� i PERC RATE R T S DISPOSER ( DISPOSER i MIN/1N. r' ' FLOW RATE --aO (GAL./DAY) / SEPTIC TANK 2r (w.5)- �`3v. --` % �{} J s �( r;4 �-2- REOb SEPTIC TANK SIZE f�� _..ter-__ ��1r,��- '-��{.r r ��u> _ _ � � �•. / ( �' _ ,� t(1 J -f' r LEACH FACILITY (►� t SIDE WALL L �'� .x II.�, �` c G/D. �Crr c r;:i-'�n l -�w,w,yr:nw....,a�•..a+,...._:w.-•�`».;,w.:.,�, f a�� _ BOTTOM 4 TOTAL �1`"`t*'* r�-;� ,�- ; � - / - t 4 I 14 _ - 70 USE: �'nCy _.—LEACHING C,; ,Ca.r'C, T WATER ENCOUNTERED t<.♦:tie i 1k{_k.tr "1 �`-�.` �f.•.u.?r->. C_H r!,.�...�,•?1.:r. .... k ..:+ ._'iw. - c;�C,y+`�, _s �: ii ::� NOTES: (UNLESS OTHERWISE NOTED) 1 ...... 1. DATUM (MSL)+TAKEN FROM ~��' " __-----QUADRANGLE_--_-_QUADRANGLE MAP " ` 2. MUNICIPAL WATER �,� _ .k ` ..__...._.._AVAILABLEh". G •- x 3. PIPE PITCH: 44"PER FOOT 4. DESIGN LOADING FOR ALL PRE-CAST UNITS: AASHO - �� _-44 Jk 4�* 5. MIN. GROUND COVER OVER ALL SEWAGE FACILITIES: (1) FT. (\\\ `'.4 '----Q'-- DISTANCE AS CERTIFIED 6. PIPE JOINTS SHALL BE MADE WATER TIGHT "4 a 7.CONSTRUCTION DETAILS TO BE ACCORDANCE WITH COMM. OF MASS. t C'+' * r.., SITE . PLAN STATE ENVIRONMENTAL CODE TITLE 5 1 6 "°"� I HEREBY CERTIFY THAT THE dUIL.DING SHOWN ON THIS PLAN IS LOCATED ON THE 9 . GROUND AS SHOWN HEREON SoTHATI6T LOCUS: - Lfxp L_'yow t r t.x l/�EiY MAL CONFORM TO THE ZONING BY LAWS OF THE TOWN OF y�. »hb �t ?.C�r>l�. I REG.PROFESSIONAL ENGINEER WHEN CONSTRUCTED. DATE ( IICape r REF: I GW CCape �'/glileeIl�� PREPARED FOR: ^-> •t i CIVIL ENGINEERS BOARDOF'HEALTH ^' LAND SURVEYORS ------------ CONTOURS (EXISTING) •---• --- . REG. LAND SURVEYOR (PROPOSED)--O-O-O-O- APPROVED --.-DATE—,— - SCALE _. MA Yarmouth&Orleans,MA DATE At I �I'