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HomeMy WebLinkAbout0101 CYPRESS POINT - Health k 101'CYPRESS PT. BARNSTABLE .G A =3340102 r r•� n.l � E �aA' S � ..:y, "' _ � µ I�if �, Ir .. �' c�•• 'L x ,. •� y. r ItA `. ,) d' ,..- yy L,•.�ypd-t .",'t_ .,��'-- yp� -T$�.`Y.—i � _ r n Is Is ` e a m • sa { is V. �'. r 1hr iv 'f R It r a' � W +. - a.tt �.j A� :a� rA * _ .p .. ;,. ,. s .p - _ , '.. � - r • r7.A 'tt' x "n. •F ,} t r '•.. v :r w`. 4 r ,Ln. '.n _. . "... 1 r,.e i .. A • � x ' � ti3 'P t.u, „ " r• �," ,, tea'' .� _ ,�` �, x �� ,. IF ' ,_ •. ,x `y a • A ,a r tr v�. . r „ , x x � ,A+Fn z` K • - .a ..L -,�: ,. A .y%. }• - Via;s , - � p 'H a vr,"'.' y - ��, 4'� y¢�ie .o :9, � �n' • Is y 10 All Is I , - t .,, �p4 v ;: a H G•ji Is v ' .: ; r• v ' � 4 .y; ¢r.#. W..y, •' wy 'ar .1' �. '7 K, 1 '-P � ., a y'S �, ,y ' g 7 y. y, � , .: �; � .�, '.^•'Y;.� , a ,o..,„ x�:.:.:� _.r•-r ;s';w'�i s>_ ,vr n,. *.a:, n 5R .,dz �y h' ,t3''^ J,''.: ;.n �. � �w , u .� G ' , Y : u,dz>,.. r `• „•. u, ,. . ,, r •). ,Q a„ � .; w .rN u'. - u.4, �' 3�. '� �' -.au +, :'tti-• x, .'�t p:; • r, x . t x, `n , ;' r ti r i" d , 'r{ti• -v. .''i �,� -se. s �' �,�.� e, I k r 5.4If - � r=, n � .. .. +:rp 5.. •rn .. � a, � z .,a „ � ,� F it (� I ^MI s { � 1 •.4 ,b , " 4 iY .S`.. �jirr •'�y � � G A _,4 � ..O a � 0/0 - b o 0- Commonwealth of Massachusetts ip Title 5 Official Bnspection Form Subsurface Sewage Disposal System Form -Not for.Voluntary Assessments' ; 101 Cypress Point u Property Address F David Manning Owner Owner's Name j information is required for every Barnstable ✓ Ma 02637 10-10-19 F� 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 filling out forms A. Inspector Information c on the computer, Brett Hickey ' use only the tab key to move your r Name of Inspector. cursor-do not B&B Excavation use the return Company Name 1• �'• I y 374 Route 130 r L ua Company Address s , Sandwich Ma 02563 City/Town State Zip Code rrmj (508)477-0653 S113747 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as,of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection'I have determined that the system: 1. ❑Q Passes ' Y 2. ❑ .Conditionally Passes. 3. ❑ Needs Further Evaluation by the Local Approving Authority, - r . 4. ❑ Fails D'iNnmry ei�pmn e�Y eren HirH,Y ,. Brett Hickey %.o.o�,m.� ��;.� ...��s 10-10-19 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP: The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority: Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/2 612 0 1 8 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 { i i Commonwealth of Massachusetts , Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 101 Cypress Point Property Address David Manning Owner Owner's Name information is required for every Barnstable Ma 02637 10-10-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The system was in working order at the time of inspection. 2) 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): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form �= Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 101 Cypress Point V� Property Address , David Manning Owner Owner's Name information is required for every Barnstable r Ma 02637 '10-10-19 _ page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) f. t 2) System Conditionally Passes (cont.): . . ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. Observation f w o sewage e backup or break% r out o high i❑ static water level in the distribution box due 9 p 9 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 replace :; ❑'Y ❑ N ; ❑ ND(Explain below): d ❑ obstruction is removed ,< ❑•Y ❑'N ,❑ ND (Explain below): distribution box is leveled or replaced .- ❑ Y,..❑ N ❑ ND (Explain below): a 4 � R ❑ 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):, ti , 3) Further Evaluation is Required by the Board of Health s ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is.failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: + , 4 i 1 t&nsp.doc•rev.7/26/2018 `' e `r Title 5 Official Inspection Fonn:Subsurface Sewage Disposal System•Page 3 of 18 ' f Commonwealth of Massachusetts �n ,jp Title 5 Official Inspection Form _ i0 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 101 Cypress Point u Property Address David Manning Owner Owner's Name information is Barnstable Ma 02637 10-10-19 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is`within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system(SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a.private water supply well ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. c. Other: N 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ El clogged of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ❑ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts , Title 5 Official Inspection Fora rt Subsurface Sewage Disposal System Form -Not for Voluntary Assessments v- 101 Cypress Point tf " Property Address • David Manning € Owner Owner's Name ' information is Barnstable Ma 02637 10-10-19 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) F h 4) System Failure Criteria Applicable to All Systems: (cont.) •' `'� 'fa_ a Yes No _ r El ElStatic liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El ET than depth in cesspool is less than 6"below invert or available volume is less than '/day flow y ❑ Q 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. ❑ a Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ❑ , Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ❑ r Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ El' 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 w of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] The system is a cesspool serving a facility with a design flow of 2000 gpd- - ❑'. r10,000 gpd. , The system fails. I have determined that one or more of the above failure` ❑ criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary.to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or`"no"to each ofthe following, in addition to the questions in Section CA. Yes - No , ❑ ❑ the system is within 400 feet of a surface drinking water'supply, ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water.supply ► . ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection. . Area-IWPA)or a mapped Zone II of a public water supply well r t5insp.doc-rev.7/26/2018 ' Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 18 ' 4 .T Commonwealth of Massachusetts �a Title 5 Official Inspection Form 1. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments A 101 Cypress Point v� Property Address David Manning Owner Owner's Name information is Barnstable Ma 02637 10-10-19 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered"yes"to any question in Section C.5 the system is considered a significant threat, or answered"yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: Yes No 0 ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ E Were any of the system components pumped out in the previous two weeks? 0 ❑ 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? 0 ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ❑ • El Was the facility or dwelling inspected for signs of sewage back up? El ❑ ,Was the site inspected for signs of break out? E ❑ Were all system components, excluding the SAS, located on site? El ❑ 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? ❑ O 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: El ❑ Existing information. For example, a plan at the Board of Health. V El Determined in the field (if any of the failure criteria related to Part C is at issue El approximation of distance is unacceptable) [310 CMR 15.302(5)] l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts �- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments v— 101 Cypress Point r Property Address z David Manning Owner Owner's Name information is Barnstable Ma " 02637 10-10-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: 5 4 Number of bedrooms(design): Number of bedrooms(actual): 605/GPD DESIGN flow based on 310 CMR 15.203(for example: 110 gpd'x#of bedrooms): Description: e- Number of current residents: Does residence have a garbage grinder? "` _ ❑ Yes El No Does residence have a water treatment unit? x +` ❑ Yes Q No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection information in this report.) '' _ ❑ 'Yes 0 No Laundry system inspected? ❑ Yes 0, No Seasonaluse? r - ❑ Yes No See below Water meter readings, if available (last 2 years usage(gpd)): Detail: - 1 ***2018- 183,000gallons .2017- 169,000gallons***'t Sump pump? ❑ Yes CoNo ' r , current ' Last date'of occupancy_ Date . , t5insp.doc•rev.n7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 cN Commonwealth of Massachusetts �m Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 101 Cypress Point V Property Address David Manning Owner Owner's Name information is Barnstable Ma 02637 10-10-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: NA Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc:): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date` Other(describe below): 3. Pumping Records: Source of information: Owner- pumped 1 year ago Was system pumped as part of the inspection? ❑ Yes ❑® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments. 101 Cypress Point R v Property Address 4 David Manning , Owner Owner's Name information is Barnstable Ma 02637 10-10-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ❑ Septic tank, distribution box, soil absorption system Single cesspool El Overflow cesspool ❑ Privy ❑ Shared system (yes or no),(if yes,.attach previous inspection records, if any), - ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system.by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other;(describe): Approximate age of all components, date installed (if known)and source of information: 5-14-1999 per COC y Were sewage odors detected when arriving at the site? ❑ Yes ❑D No 5. Building Sewer(locate on site plan): Depth below grade: ., °" feet Material of construction: ❑ cast iron 0 40 PVC, - El other(explain): f Town water Distance from private water supply well or suction.line:, - . feet Comments(on condition of joints, venting,.evidence of leakage, etc.): t5insp.doc•rev.726/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 ' 4 * e c Commonwealth of Massachusetts Title 5 Official Inspection. Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 101 Cypress Point u Property Address David Manning Owner. Owner's Name information is Barnstable Ma 02637 10-10719 required for every page. City/Town State Zip Code Date of Inspection D. System Information ,(cont.) 6. Septic Tank(locate on site plan): 11 VGn Depth below grade: feet Material of construction: 0 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 2 Dimensions: 000gallons Q rr Sludge depth: V 3011 Distance from top of sludge to bottom of outlet tee or baffle Orr Scum thickness NS , Distance from top of scum to top of outlet tee or baffle NS Distance from bottom of scum to bottom of outlet tee or baffle measured How were dimensions determined? Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to,outlet invert, evidence of leakage, etc.): The tank was in working order at the time of inspection. The tank is not in need of pumping at this time but should be pumped every two years for maintenance. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 101 Cypress Point L Property Address, David Manning ' L Owner Owner's Name information is Barnstable Ma 02637 10 10 19 required for every page. City/Town State 'Zip Code Date of Inspection D. System,Information '(cont.) .r 7. Grease Trap(locate on site plan): ,r Depth below grade: . • 5 NA + 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 t Date of last pumping: + ; Date 4 Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): NAc , t Depth below grade: ' Material of construction: + ❑ concrete ❑ metal',. ❑fiberglass ❑ polyethylene ' ❑other'(explain): Dimensions. 'f.. Capacity: gallons - Design Flow: gallons per day l5insp.doc-rev.7/26/2018 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments I; 101 Cypress Point Property Address David Manning Owner Owner's Name information is Barnstable Ma 02637 10-10-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: . ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): o„ Depth of liquid level above outlet invert Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): i The d-box was in working order at the time of inspection. t5insp.doc•rev.726/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts �R Title 5 official Inspection Form' ' ' 1 Subsurface Sewage Disposal System Form,-Not for Voluntary Assessments' 101 Cypress Point Property Address David Manning Owner Owner's Name information is Barnstable " r Ma 02637 r ` 10-10-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): k° Pumps in working order: A '❑ Yes ❑ No* Alarms in'working order: ElYes ❑ No* e , Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): NA *If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation notfrequired): If SAS not located, explain why: - Type.„ ; ❑ leaching pits ' f R number: ❑ leaching chambers. number: ❑ leaching galleries number: ❑ leaching trenches number, length: (9) infiltrators F' leaching fields - number, dimensions: ❑ overflow cesspool number: ❑ in system Type/name of technology: r _ t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts i Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 101 Cypress Point u Property Address David Manning Owner Owner's Name information is required for every Barnstable Ma 02637 10-10-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): The SAS was in working order at the time of inspection. Leaching has 2" of standing water when viewed. 12. Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): NA Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 Commonwealth of Massachusetts 'x Title 5 Official Inspection Form w Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ' ' 101 Cypress Point u •� Property Address David Manning Y Owner Owner's Name information is Barnstable 'Ma '02637 10-10-19• required for every page. City/Town State "' Zip Code Date of Inspection ` D. System Information (cont.) 13. Privy(locate on site plan): ' NA p Materials of construction: • - - 4 • , Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation', etc.): h e . • 1 S .. t5insp.doc-rev.7/26/2018 rr, ? ♦ Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 ` a i Commonwealth of Massachusetts +m Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 101 Cypress Point u Property Address David Manning Owner Owner's Name " information is Barnstable Ma 02637 10-10-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building-. Check one of the boxes below: Q hand-sketch in the area below ❑ drawing attached separately Tt Wr4 OF BARNS' TAT3L"E LOiCATIC?1!t e> t ri&t lz �.' sf✓WAcg — vx a &a*` L r+..r vi i►.SSlESSClItS,1NAP�c LOT,-- J.: fa'- E rsrAu x s NAME a�PxCVE.rx SPIIC TANK GJSI'1AE?1TlY`. Cs.:.. I l=i1C#�3G FACIL TtY {cype {ss ne) �sw✓� isA• NO 01T S EiE..... f7ltilS e' : Bt7II T31 R•OR OW2Vl li i4r�� ,oAIAVLa 7t^ #F3T TTJ M TE: ! d f f cxa anrrc 17A L:�,R- .y/ scparatioa€lastainc±e 8etween.rtse: PvtaacmumAdjustMGroundwatrrTablc-;tntRe-l3iittrsxlofL::eac7xin F3scftzty ', _ :. art. Pn"ft W sitpgly Well and T eachtrig Esexli ty {if""any vvells.exist oa sat c.or w9thin Ibd feet of leachtn s,fscali[y) ecr, Edge of SNctlaad.and l eaching l?acilicy{If any weslanrs ti€asx m ithin,30D rxc of leaaliiis fac.licy) l-^eet.. Fivaished la d v� t5insp.doc"rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System"Page 16 of 18 I - t Commonwealth of Massachusetts t Title 5 Official Inspection Form :f 2 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 101 Cypress Point Property Address David Manning Owner Owner's Name information is required for every Barnstable Ma 02637 10-10-19 • page. City/Town- State Zip Code Date of Inspection D. System Information•(coat.) 15. Site Exam: Check Slope f { Surface water T. Check cellar -- n G❑ Shallow wells NoGW@120" , Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: E Obtained from system design plans on record 10-26-98 If checked, date of design plan reviewed:, Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑, Checked with local Board of Health -explain: ❑ Checked with local excavators, installers -(attach documentation) ❑ Accessed USGS database -explain: . f You must describe how you established the high ground water elevation: A plan on file at the local Board of Health was used to determine high groundwater. Before filing this Inspection Report, please see Report Completeness Checklist on next page. i t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18 , Commonwealth of Massachusetts 1, Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 101 Cypress Point Property Address .David Manning Owner Owner's Name information is Barnstable Ma 02637 10-10-19 required for every page. City/Town State. Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: A. Inspector Information: Complete all fields in this section. B. Certification: Signed & Dated and 1, 2, 3, or 4 checked U C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6(Checklist)completed 0 D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included P l5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 i TOWN OF BARNSTABLE / e LOCATION t,010'r SEWAGE #' VILLAGE C a 030": v1--ff ASSESSOR'S MAP&LOT33q hSC r INSTALLER'S NAME&PHONE SEPTIC TANK CAPACITY O ® A LEACHING FACILITY: (type) JaX (size) c0 IJAJI'i �ii9L) A NO.OF BEDROOMS --3- BUILDER OR OWNER (l e &A aJ Ito ,cP PERMTTDATE: ���' COMPLIANCE DATE: Separation Distance Between the: .,,Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility':) Feet Furnished by I- J-A = i-*J- grq - c �6•® r z.p ill,® Z -c a w rNo. Fee ALTH F'MASSACHUSETTS Entered in computer: THE COMMONWE � Yes Q PUBLIC. HEALTH DIVISION -TOWN OF BARNSTABLE,. MASSACHUSETTS �2 ")Repair i� ogar Stem Co �gtr cttott ermit Application � Application for a Permit to Construct( ( )Upgrade( )Abandon( ) Complete System ❑Individual Components Location Address or Lot No. 0 C �✓ Owner's Name, d re s and Tel.No. � Assessor's Map/Parcel ye d cel J � o� o� ,�]G ; In aller's azne Address,and Tel.No. I Desi ne/%s Name,Ad a and Tel.No. /\ orb rnllr� Type of Building: Dwelling No.of Bedrooms Lot Size 'I sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 0 gallons per day. Calculated daily flow gallons. Plan Date 7 o "f 4 Nu er,of sheets Revision Date 1 Title e -k L'r✓ o �e P q/PiI f/✓�e Size of Septic Tank 0 Type of S.A.S. 0 A Fi ft&o-R Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of th E v nmental C e and not to place the system in operation until a Certifi- cate of Compliance has been iss y this o al c Signed A��✓`� Date �< l Application Approved by c A a Date Application Disapproved for the following reasons Permit No. — 7 Date Issued k No. Fee �~� � � E�r"ed in�ompu[er: THE COMMONWkA�TH`S,�F MASSACHUSETTS Yes PUBLIC HEALTH DIVISION - TOWN OFBARNSTABLES MASSACHUSETTS 2Yication for igpool *patent (Con�tr coon Permit VApplication for a Permit to Construct( Repair( )Upgrade( )Abandon( ) Complete System El Individual Components Location Address or Lot No. 701 C e S Owner's Name, ddre s and Tel.No. Assessor's Map/Parcel Ins aller's a Address,and Tel.No. Des, ne3,'s Name,Ad a and Tel.No. /\ 09C l�''l!n �O SSrr/G �� ,��or�s � �a�s � 4 Type of Building:' ' Dwelling No.of Bedrooms Lot Sizes �z 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 707ANu er of sheets Revision Date / Title e O �2 s O � Q�/7 fQ� e ._. _ Size of Septic Tank � O Type of S.A.S. 0 n Fil ft Q o s Description of Soil 4 Nature of Repairs or Alterations(Answer when applicable) i 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 th E v' nmental C e and not to place the system in operation until a Certifi- cate of Compliance has been iss -d y this o eal t Signed ✓` Date For Application Approved by Date //­/1'j'7— Application Disapproved for the following reasons Permit No. Date Issued 9- 19 7 THE COMMONWEALTH OF MASSACHUSETTS /mil ` BARNSTABLE, MASSACHUSETTS x (Certificate of (Compliance THIS IS TO CER FY that the Oq-site Sewa Djis OV.Systet Constructed(/)Repaired ( )Upgraded( ) Abandoned( )by at C - i.I--1 vi-i, 0` C►'d7 r ;(� has beenconstructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 97- Y/ dated Installer Designer f The issuance of this permit sh t be ongfrued as a guarantee that the syst¢ ill functi n as dcgigned. � Date Inspector / t/ ifiz�4al*& _ ___ tom_ . . _. . _ _ _-- /�►j/ - I No. ��/ =-------------- "--�--e------Fee THE COMMONWEALTH OF MASSACHUSETTS �3 UBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Migpo!gal *pitem Construction Permit Permission is hereby granted to Construct( )Re air( )Upgpde( )Al andon( ) System located at 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 e t. Date: �/ 2� ` g/ Approved by PLAN REFERENCE : BARNSTABLE COUNTY REQISTRY OF DEEDS PLAN BOOK 338, PAGE 80. S 190551001'W 197.64' N Exist. Foundation co OD 20' LOT 2 _ 1.17+/-Ad. O I N Existing SYSTEM TIES m co GAR Foundation � 3-A 13.5 t d 80, N 2-A 32.5 (6 17'* Q2 O j 1-B 42.0 � 2-0 19.0 D-BOX � . I-D_ 25.6 Q I-c ss.o 14't 2-D 41.0 SEPTIA 2-C 35.5 © TANK bo N 16°4728"E 201.33' z rn N _ O V O� O 10.15' o in N 13°37'50"E m `O CYPRESS POINT hereby certify that this foundation is located on the ground as shown and that it conformed to the Town of BARNSTABLE ' Zoning By-Laws regarding minimum setback requirements at the time it was constructed and that the roe - y p p rty is locate: in Flood Zone "C", as shown on F.I.R.M. 250001 0005 C 12�2�g for the Town of BARNSTABLE, revised to 08/19/85. Norman Grossman, R.P.L.S. ; Date MAP: 334 SEC: PAR: 10.02 LOT: 2 HSE: #101 FOUNDATION LOCATION PLAN- -- � �A�'" Of LOT 2, I®e CYPRESS POINT NoRMAN BARNSTABLE, A:� - � GROSSMAN I No. 12775 �o SCALE : 1" = 40' Norman Grossman, R.P.L.S. A f c E 10 Marsh View Road DATE : DEC. 28, 1998 l L6��0� East Falmouth, Ma. PLAN NO. : C- 524 508-548-1920 REV.01/12/99 CHANGE HOUSE NUMBER REV.07/15/99 ADD SEPTIC SYSTEM AS-BUILT �d TOWN OF BARNSTABLE LOCATION#/�! �Pse s�'1' SEWAGE # VILLAGE &ry.51AVeC✓.y►�r v: ,/l ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY OOO ,4 nn LEACHING FACILITY: (type) (size) c/ u:v: NO. OF BEDROOMS 5 3 BUILDER OR OWNER PERMITDATE:, // f COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist . on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by r� %- D ' sS / F 12-C c ; a I � - , SEPTIC SYSTEM PROFILE 'FIRST FLOOR SOILS LOG F>< 62.0 ELEVATION FIN. GRADE FIN. GRADE OVER FIN. GRADE OVER FIN, GRADE OVER PERCOLATION TEST AT HOUSE SEPTIC TANK DIST. BOX SOIL ABSORPTION SYSTEM TOP of FOUNDATION 60.0 59.0 57.6 57.3 TEST HOLE I TEST HOLE 2 ELEVATION 61.0 - - '•'.'i' r ; . .� r i 2% MIN. GRADE 0" ELEV. 61.0 0" ELEV. 60.0 ram. . 0/ 0/ ' 0''• RISE ca ._. .�.. `_. , ir. . , 'rl .Yr ,� /. . .. , 'e-� ��. �;, \w INVERT at 6" OF FIN GRADE 5.. / 5,. /E FOUNDATION �'�'' •• ,.:, +:•=ti . .'. ELEVATION 58.35 _ 3� 2'MIN. DOUBLE WASHED 1/8 .1/2"STONE-r�_ 2' ,• �j, _�- SANDY LOAM, SANDY,LOAM -' - • _�• IOYR 5/6 IOYR 5/6 • � r 57 25 o > ,• 56.40 56.23 56•p M•: - �- = -� •;: •I.57.00 0 r J 'L I 'q , ,. ,�.:': i• •j• , DOUBLE WASHED STONE ; GAS BAFFLE ON OUTLET TEE += _•.�`= _ ...__.` ._�� •..! 54.00 LOAMY SAND .�ob n o• DIST B O X � 5 r s s� 6 25' 3L25 2'-0" IOYR 6/8 LOAMY SAND ;�.. 3.. �n`O `/� /� n ;n 48" CI 48" IOYR 6/8 o_• ; O G A L I.. O N J 36.25' TOT. EFF, LENGTH :. H-IO LQADING .8a To EF> . w1 E[-TI TANK ERC CI 0' • v - l6 BASEMENT- FLOOR - 60" 6 N- 10 LOADING TO BE SET ON A `�^ _ _ - -- - ELEVATION - -._ i.. ..... �....•,...,,,..;...,•.,►` .�.'. +•�• ••q'yY!• ..,�, .• -•�, 6 CRUSHED STONE ='� � �� ���- . PERC I 53.0 , 6" `' CRUSHED STONE BASE BASE I-a.a �7; ; ACME DB-5 OR 10'-6 APPROVED EQUAL �`-easa-- SAND SAND 2.5Y 6/4 2.5Y 6/4 SEPTIC TANK SET LEVEL AND TRUE TO GRADE 1 ON 6 CRUSHED STONE BASE ON ( Pro file not to scole ) r . �• ' MECHANICALLY COMPACTED NATURAL MATERIAL ' ^� 120" C2 51,0 132" C2 49.0 ► '� OBS RUED GROUND WATER: NONE ,. t` ADJUSTED GROUNDWATER: 15' cLua h� PERCOLATION RATE: '�5 MIN./INCH J�MA©U;0 GOLF -""--� INFILTRATOR DETAIL w----- SOIL CLASS: I • NOT TO SCALE EFFLUENT LOADING RATE: 0.74 GPD/SF I �2 SOIL EVALUATOR: J.E. LANDER-CAULEY CERTIFICATION NUMBER: �� S 4 G. DUNNING WITNESS G i BOARD OF HEALTH, TOWN OF BARNSTABLE I w - DESIGN DATA DATE OF TEST: 08/25/98 '* NUMBER OF BEDROOMS 5 G.P.D./BEDROOM I10 G.P D. -- NOT n S fay 1.1i=+iL 't �•L.1.11�'1' :iJl.% (i.��.i�. \..jLri "1ii..,i ♦ � ��'�.i TE�J PROPOSED d GARBAGE DISPOSAL NO `r' 2 POOL N LEACHING REQUIRED 550 G.P.D. 1. ELEVATIONS BASED UPON NGVD DATUM, 40. LEACHING PROVIDED 605 G.P.D.: :2. ELEVATIONS AND LOCATIONS SHOWN ON THIS PLAN S2 SEPTIC TANK REQUIRED 1500 GALLONS ARE NOT TO CHANGE WITHOUT WRITTEN APPROVAL I g ' SEPTIC TANK PROVIDED 0 GALLONS OF THE ENGINEER AND THE TOWN HEALTH AGENT. 200 "' 5 - 52 LOT 179a , SIDEWALL AREA = 168.3 S.F. 3. ALL SYSTEM COMPONENTS ARE .TO BE INSTALLED IN _ BOTTOM AREA .7 S.F. ACCORDANCE WITH S.E.C. TITLE V AND LOCAL HEALTH H Ss z a4 TOTAL ROVIDED=409.0 S.F. x 2 x 0,74 = 605.3 GPD RULES. AND REGULATIONS. 60A PR POSED 4. ALL PIPES ARE TO BE CAST IRON OR P.V.C. SCH. 40. 5 BZR00 M N 5. THE BOARD 'OF HEALTH AND/OR 'ENGINEER TO BE DWEL (NG ` o 5s NOTE: EXCAVATE TO EL. 55.0 OR LOWER AS SOIL NOTIFIED WHEN SYSTEM IS COMPLETELY INSTALLED m AND READY FOR INSPECTION. CONDITIONS REQUIRE. TO REMOVE ALL TOPSOIL, SUBSOIL, ---- u, s 6. NORTH ARROW IS NOT TO BE USED FOR SOLAR �4� _. . . •,: CLAY OR OTHER UNSUITABLE MATERIAL BENEATH THE i -60 INLET INVERT OF THE SOIL ABSORPTION SYSTEM FOR ORIENTATION. �`n, �° �s2 A DISTANCE OF 5' MIN., AND BACKFILL WITH CLEAN m - 4 , PER 310CMR 15.255:3. .SAND GAR. 0 59.0 cfl 98'± +r '� 20006 LON c0 N \ ` S A.S. - 5 TIC TANK PRE BARN60 L- ----- 22' p'• E Y 238.59' � RTE. 6A. REV BY DATE DESCRIPTION 2O'* 30' `-" �• .i •_p6'-00" E 16.58' - SITE 8 SEWAGE DISPOSAL PLAN ' 441.59' a CYPRESS. /[� Z " '' CYPRESS ' c c ` N 76._22'-10„ W 1 i R ES. 1 is 1 1 ! E J..7 POINT N 1 .. POINT f • u BARNSTABL M G E A \ O Wide OOT- - WiNOE • SPrivate � LOCUS {VE APPLICANT. DAVE 8 BARBARA MANNING „ LOT a sK �T - ADDRESS: 32 ACRE HILL ROAD ; - BARNSTABLE, MA. 02630 " ENGINEER: "- NORMAN GROSSMAN, R.P.E. LOCUS MAP SCALE: I 2000' 10 MARSH VIEW ROAD ZONING DIST. FLOOD ZONE: ELEVATION MAP NO, EA FALMOU EAST TH, MA. �.. RF I C - 50001 0005 C 508-548-1920 MAP SEC PCL LOT HSE SCALE DATE DN+N. BY ! CK'D BY PLAN NO. PLAN REFERENCE: , BARNS7. CNTY. REG. PLAN BK 338 PG'80. SITE PLAN---SCALE 1 = 30' 334 10.02 2 #93 AS NOTED OCT. 26, 1998 JTH t NG N- 530