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Home My WebLink About0086 DORAL ROAD - Health 86 j DORAL RD. v BA S ABLE , 349, 023 + a i.. - ell,. c -^ ..'x {,+! ', • a.:, - �.:. . c�s�� a' , � �?. r �.�. x J • a f i ai' - 4 ,�2. '•4 �+'4.a,.L i*0./ M1 u P w - - G P`> <' , + L , �# eSIt asikn' < (? ' _. ` � C' ., , .. _ _ _ .. a •Y"- ' v :. , J , , e. , Y: , it !. .. - - _•. ' " „ . t+ P �+r• ..:a�"' p !r -, ,, 'tom' r. - ..irr� °�4� >;•a r ae ,} _�. � ,f a e � „ i r.z .� - -?X;1... -,.. '! ,i u - -'' r _ ,..: :� �„ '�' �,` e,,, ✓ASK - `.:.. -.ti =� ., tii. is ' a J t✓J a F' : .. .v IX .s . '' +,^ T i � R i V � •� , .. ' - :. r. 4 w 4,Y„ r• ,3I N )1 �fiR1N ; f y� � � 3 1.e}. • C• 4 - .r n R � _ , - r i� .. , �i,.. - 'l,- -. .. , ct� ., T .. � i• J 4 • , F d u Y _ . f t f u , " a,� +1- � i 'Ft^`z gje...iW+,. _ ,i: ,, S' _. :• _t u'I. W,. ., d Y•« 7 - •�. - rlt. ' - � .>; - � - �'. -h • ` t..k t7 .:i;,y.l: - n� ,° u � "1 �. � �"� t� Y F. �,: w '� ❑� 1.. , ' x • , wl -','-r-c' , f f k.. tv 114, � • ► �"• rp�` t}., �' �'' :.°' � M q"�,,:n... .:.�,� ,.i,3 #. '!� �' � .. v. .r _ .. .i rn CiJ +� � ,� 1' "' ,� �, " u' � a .ay'-�.i �.ty�„wz Y-. �•`''�' `y,. '� a' '•yk 8 'G y:, • c ,tw f.• v r, ♦ [ t. d `+. 1; °Y `�- :tn r,y •a .' , : 1, .r. y,.. hi..; ,Y ,,..�;.,' r, :•�_ � a :r n �,<� tt' '� 9 '�i- s�.t)- !s h. - .:"" ,;9 �, Ili of't;� .. ',4 ,�. � � t�J' n' .. :, �a`;4." .�.k �•..._ w °.�f.. .. "w� ��.+"._ _ '� ,rJ��, sal. �. r. A Commonwealth of Massachusetts „ Title 5 Official inspection Form I� Subsurface Sewage Disposal System Form- Not for Voluntary Assessments , w 86 Doral Road, Cummaquid M -349• P -23' Property Address Charles Hegarty 5 Owner Owner's Name r ` information is p O. Box 154 Cummaquid MA 02637 April 22, 2014 required for every page. City/Town State Zip Code Date of Inspection , Inspection results must be submitted on this form. Inspection forms dmay.not be altered in any way. Please see completeness checklist at the end of the form. `Va Important:When filling out forms A. General Information on the computer, I use only the tab 1. IfISpeCtor: y .* key to move your • " cursor-do not Troy Williams use the return Name of Inspector ' '`t key. Troy Williams Septic Inspections m C o an ma Name . 19 Hummel Drive - _ • .. Company Address South Dennis MA 02660 - CitylTown State } Zip Code (508) 385-.1300 S1682 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection' was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. ['am a DEP approved system inspector pursuant to Section 15.340 of• Title 5(310 CMR 15.000).The system: ' ® Passes ❑ Conditionally Passes ❑ Fails x Weds'Fu'rther Evaluation by the Local Approving Authority' , t ;April 2, 2014 i r V n Inspector's Signature ," r Date r The system inspector shall submit.a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. . v / t5ins•3/13 Title 5 Official Inspedio onn:Subsurface Sewage Disposal System-Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form- Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 86 Doral Road, Cummaquid M -349 P-23 Property Address Charles Hegarty Owner Owner's Name nformation is P.O. BOX 154 required for every , Cummaquid MA 02637 April 22, 2014 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System meets minimum standards set by Massachusetts DEP at the time of inspection only.This inspection is not a guarantee or warranty on the future working conditions of leaching, pipes, components or the future structural integrity of said components and only represents conditions found at the time of inspection only. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no'` or"not determined" (Y;N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official .Inspection Form ,., Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 86 Doral Road Cummaquid M -349 P -23 Property Address ,• Charles Hegarty Owner Owner's Name information is p O. Box 154 Cumma uid' MA 02637 Aril 22, 2014 required for every page. Cityrrown State' Zip Code Date of Inspection B. Certification (cont.) , ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired: B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water•jevel 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 El` N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑''N ❑ .ND(Explain below): ❑ distribution box is.leveled or replaced, ❑ Y ❑- N El ,ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): obstruction is removed ❑ Y .❑ N ❑ ND (Explain below): S C) Further Evaluation isRequired 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. F; 1. System will pass unless Board of Health determines•in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17, Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 86 Doral Road, Cummaquid M 349 P -23 Property Address Charles Hegarty Owner Owner's Name information is Box 154 P.O. required for every Cummaquid MA 02637 April 22, 2014 page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 official Inspection Dorm Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 86 Doral Road, Cummaquid M -349 P-23 ' Property Address Charles Hegarty + Owner Owner's Name information is required for every MA 02637 Aril 22 '2014 P.O. Box 154 Cumma uid _ page. Cityrrown a State Zip Code Date of Inspection B. Certification (cont.) Yes No , ❑ ® o Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: •. ❑ ® „ Any portion of the SAS, cesspool or privy is below high ground water elevation. ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of.a cesspool or privy is within a Zone 1 of a public well. , ❑ ® Any portion,of,a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than•100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, 3 provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] El ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd.El t The system fails. I have determined that one or more of the above failure"' ® criteria exist as described in 310 CMR 15.303, therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a, design flow of 10,000 gpd to 15,000 gpd. ; For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No f ❑ ❑ thesystem is within 400 feet of a surface drinking water supply 0 ❑ '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'- ❑ ❑ "` 1 . Area-�IWPA)'or a mapped Zone II of a public`�water supply well' If you have answered"yes"to any question in Section E the system`is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins 3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 86 Doral Road, Cummaquid M -349 P -23 Property Address Charles Hegarty Owner Owner's Name information is required for every P.O. Box 154 Cummaquid MA 02637 April 22, 2014 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ®. ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® 1 ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 gpd t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 86 Doral Road, Cummaquid M -349 P--23 Property Address Charles Hegarty Owner Owner's Name _ information is { required for every P.O. Box 154, Cummaquid MA 02637 April 22, 2014 page. City/Town State Zip Code " Date of Inspection D. System Information Description: Number of current residents:;. 0 Does residence have a garbage grinder?. is El Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection El Yes ® ,No information in this report:) Laundry system inspected? " • ` rZ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 13=119,000 gals. g ( y 9 (9P )�' 12=111;000 gals. Detail r Sump pump? ❑. Yes .0 No Last date of occupancy: „ occupied Date Commercial/industrial flow Conditions: }„ Type of Establishment: N/A Design flow(based on 310 CMR 15.203)': N/A Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft.,,etc.): N/A Grease trap present? ❑ Yes 0 No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: N/A t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M ,.•''y 86 Doral Road, Cummaquid M -349 P-23 Property Address Charles Hegarty Owner Owner's Name information is required for every P.O. Box 154 Cummaquid MA 02637 April 22, 2014 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: N/A Date Other(describe below): N/A General Information Pumping Records: Source of information: Last pumped in 2011 per info from owner. Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form- Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 86 Doral Road, Cummaquid M -.349 . P -23 Property Address Charles Hegarty f Owner Owners Name r information is required for every P.O. Box 154, Cummaquid - MA k 02637 April 22, 2014 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: Tank, d-box and original 2 leaching pits were installed on 5/5/80 per compliance. Newer leach pit was added on 12/13/96 per compliance. •. Were sewage odors detected when arriving at the site? ❑ -Yes ® No Building Sewer(locate on site plan): i Depth below grade:, f 8t i. - - 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.) Flushed lines and found clear at the time of inspection. Septic Tank(locate on site plan): `T Depth with riser to 8" below grade: feet Material of construction: ; ® concrete ❑ metal ❑fiberglass ❑ polyethylene. ❑ other(explain) If tank is metal,'list age: years . Is age confirmed by a Certificate of Compliance? (attach a copy,of certificate) -❑ Yes ❑ No . Dimensions: 1500 gallon Sludge depth:. t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts _ Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 86 Doral Road, Cummaquid M =349 P -23 Property Address Charles Hegarty Owner Owner's Name information is p O. Box 154, Cumma uid MA 02637 Aril 22, 2014 required for every 4 p page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 2' 8" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 13" How were dimensions determined? probe/measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Inlet and outlet tees were found present and in working order. No evidence of leakage or damage was found. Pumping of tank was recommended. Grease Trap (locate on site plan): Depth below grade: N/A feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: -N/A Scum thickness N/A Distance from top of scum to top of outlet tee or baffle N/A Distance from bottom of scum to bottom of outlet tee or baffle N/A Date of last pumping: N/A Date t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 F . Commonwealth of Massachusetts _ Title 5 Official l.nspection Form* _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments , 86 Doral Road Cummaquid M -349• P -23 Property Address , Charles Hegarty Owner Owner's Name information is p O. Box 154, Cumma uid' MA 02637 , ` Aril 22, 2014 required for every q p _ . Ci /Town State Zip Code • Date of Inspection page. ti P P D. System Information (cunt.) ,. , 3 Comments(on pumping recommendations; inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage;etc.): r Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: N/A. Material of construction: ❑ concrete ❑ metal; ❑fiberglass ❑ polyethylene ❑ other(explain): - N/A Dimensions: Capacity: N/A gallons } Design Flow: . N/A.. _ > . gallons per day Alarm present: ❑,Yes ❑ No ; Alarm level: N/A Alarm in-working order. ❑. Yes ❑ No Date of last pumping: y N/A r . Date - Comments(condition of alarm and float switches, etc.): ; N/A e - 1 - m *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes" ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 F. a Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 86 Doral Road, Cummaquid M -349 P-23 Property Address Charles Hegarty Owner Owner's Name information is required for every P.O. Box 154 Cummaquid MA 02637 April 22, 2014 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert level Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box was found level and in working order with speed levelers in place allowing main flow to newer pit giving older pits some rest with levelers set a little higher. No evidence of backup was found at the time of inspection. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): N/A * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts . Title 5 official Inspection Form # : Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 86 Doral Road, Cummaquid M -.349 P-23, Property Address „. Charles Hegarty Owner Owner's Name information is required for every P.O. Box 154, Cummaquid ` 'MA 02637 April 22, 2014 page. CitylTown State Zip Code Date of Inspection D. System Information (cont ) y ` Type: 1 2-6 X6 pits with ® leachingits number: : P 2,of stone _ t• • . 1 newer 6'X6` pit with 4' of stone f ❑ leaching galleries R number: u leaching trenches number, length: r ❑ leaching,.fields ' .number, dimensions s overflow cesspool _. numbers ' ❑ innovative/alternative system a Type/name of technology: , Comments(note condition of soil,�signs of hydraulic failure, level of ponding; damp soil, condition of vegetation, etc.): No evidence of hydraulic failure or problems in the past were found at the time of inspectior. Cesspools (cesspool,must be pumped as part of inspection) (locate on site plan): ; Number and configuration N/A = Depth—top of liquid to inlet invert N/A - Depth of solids layer N/A F 4 Depth of.scum'layer • N/A ` _ a N/A` Dimensions of cesspool Materials of construction N/A Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17, Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 86 Doral Road, Cummaquid M -349 P-23 Property Address Charles Hegarty Owner Owner's Name information is required for every P.O. Box 154 Cummaquid MA 02637 April 22, 2014 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): N/A Privy(locate on site plan): Materials of construction: N/A Dimensions N/A Depth of solids N/A Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): N/A t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts r Title 5 Official Onspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments MM 86 Doral Road, Cummaquid M -349 P -23 Property Address Charles Hegarty ti Owner Owner's Name informrequired tion is P.O. Box 154, Cummaquid MA , 02637 - Aril 22 2014 required for every .,April � _ page. Cityrrown r. State -Zip Code !Date of Inspection D. System Information cont. s ' Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks:Locate all wells within 100 feet. Locate where public water supply"enters the building. Check one of.the boxes below: ® hand-sketch in the area below. 4 ❑ drawing attached separately 3 ZI ' W 3y ' 20,7r�[�c L t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 86 Doral Road, Cummaguid M -349 P-23 Property Address Charles Hegarty Owner Owner's Name information is P O Box 154, Cumma uid MA 02637 April 22 required for every 4 p �il , 2014 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 15.0'+ feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 1/21/80 Date ® Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: AIW 247 Zone C 23.4' 3.6' adjustment You must describe how you established the high ground water elevation: Test hole recorded on plan showed no water found. Hand augered 4' below bottom of leaching with no water found at a depth of 145. Groundwater adjustment at the time of inspection was 3.6'. Bottom of leaching at 10.5'was found not to be located in the high groundwater elevation at the time of inspection. USGS maps show groundwater to be over 16.0'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official -insPection Form , Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 86 Doral Road, Cummaquid x M =349 P-23 Property Address ' Charles Hegarty z ,« Owner Owner's Name information is p O. Box 154, Cummaquid + MA 02637• Aril 22, 2014 required for every p page. City/Town 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 Ya t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 17 of 17 47 �- 1� a Aq i I� /76.30 Asad Itil LoT 1.:5-2 N 3-5-8G z N I 4q ^� SDK o P I ' 37, 13, I dil �R LS,� ,oe.,--C gt,4z.o 10 a A ; 3�. ow 'yb S6�iq CERTIFIED PLOT PLA F EDWARD E. KELLEY LOCATION ?!v'ST?. CUMMAQUID, MASS. 0263; SCALE . . . DATE t!ZB PLAN REI'ERENCE B�7w� LoT�' ESN OF �Ar \ . . . . .. . �.,� p1,1VAR; > • TOP OF FOUNDATION CONCRE `.• CONCRETE COVERS •,! 4�CAST IRON 12"MAX. PIPE (OR 12 MAX. 4"ORANGEBURG(OR EQUIV.) � LEACH EOUIV.)- MIN. PIPE - MIN. ' PITCH 1/4-PER. PITCH 1/4"PER.FTRDI PIT • N VERT v •0 3�`�Q... INVERT 3E 3wSEPTIC TANK EL .,3oG .. ...�. ' . >_ INVERT �,S INVERT v ow a p GAL . L: INVERT e' EL.3SZ3. . . . . . . . . . . . . . E �'� , , p 33.73 : �• •'' W • • Z8 I 3 6 DIA. --+-� . �--- /o DIA. PROFILE OF GROUND Wa , SEWAGE DISPOSAL SYSTEM NO SCALE ate ' .,q fA• , F4 SOIL LOG • WITNESSED BY : BOARD OF HEALTH ATE �,�!•.�•/18o TIME . ��3v Pf�uC .C'. . :ST HOLE I TEST HOLE 2 . ENGINEER _EV. . 91 70 . . . ELEV. . . E'DwA9zD �.• � .. .-. • s�Q_so/c. (gyp soic._ • pt DESIGN DATA �B" /emu. NUMBER . OF BEDROOMS 3L POPTOTAL ESTIMATED FLOWS : GALLONS BOTTOM LEACHING AREA 78's. • $O.FT. tiwE' SLHt.� GrN�� SIDE LEACHING AREA . . .i8� `r. . . SO.Ft./ I S,4wD /Vv NG' GARBAGE DISPOSAL . . . . (5 500 % AREA INCF TOTAL LEACHING AREA 3T ou• SOFT PERCOLATION RATE MIN/II 44 - - LEACHING AREA PER PERCOLATION RATE .8 AO .WATER ENCOUNTERED NUMBER OF LEACHING PITS P.,7. WIrPV PPROVED . . . . . . . . . . . BOARD OF HEALTH~ ' o S,-v vE P&7Z A7- ATE . TIjOMAS E.KELLEY CO. AGENT OR INSPECTOR ENGINEERS —SURVEYORS 346 LONG POND DRIVE: UTH YARMOUTH,MASS. 114e i COMIVIOfN EALTH OF]MASSACHUSETTS ExEcuwzE OFFICE OF ENWIRON1VIEfvRI'� AFFAIRS ' DEPARTMENT OF ENVIRONMENTAL PRj6T *' I(}NL- TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: Owner's Name: Owner's Address:_ c Date of Inspection: Name of Inspector:(please print) Company Name: &4- JGr(� KUiYawM,P �.( 1. c �� ✓ ✓Mailing Address. Telephone Number: CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: 9L Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: — hate: 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. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address flow the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page I ' Page 2 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE D SPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) ` Property Address: Owner. Date of Inspection: p 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. 03 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below_ Comments: B. System Conditionally Passes: One or more system components as described in the"Conditi ass"section need to be replaced or repaired.The system,upon completion of the replacement or repair, approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N;ND)in the fo a following statements.If"not determined"please explain. The septic tank is metal and over 20 years o *or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfi 'on or tank failure is imminent.System will pass inspection if the existing tank is replaced with a complying tank as approved by the Board of Health. *A metal septic tank will pass inspection i is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 y old is available. ND explain: Observation of sewage ackup or break m or high static water level in the distribution box due to broken or obstructed pipe(s)or due to token,settled or uneven distribution box.System will pass inspection if(with approval of Board of Heal ): broken pipe(s)wezeplaced obstructimisyemoved distrili Lion box is Icmted or replaced ND explain: The em required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass ins 'on if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: gage 3 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: v� Owner: Date of Inspection: C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to dete ne if the system is failing to protect public health,safety or the environment, 1. System will pass unless Board of Health determines in accordance with 310 R 15.303(1)(b)that the system is not functioning in a manner which will protect public health,sa 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 wet d or a salt marsh 2. System will fail unless the Board of Health(and blic Water Supplier,if any)determines that the system is functioning in a manner that protects the ublic health,safety and environment: The system has a septic tank and soil rption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surf a water supply. _ The system has a septic tank an AS and the SAS is within a Zone I of a public water supply. The system has a septic d SAS and the SAS is within 50 feet of a private water supply well. — The system has a septi and SAS and the SAS is less than I00 feet but 50 feet or more from a private water supply well* .Method used to determine distance **This system passes' the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatil rganic compounds indicates that the well is free from pollution from that facility and the presence of onia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria triggered.A copy of the analysis must be attached to this form. 3. Other. 3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL:SYSTEM INSPECTION FORM PARtT.A. CERTIFICAT14ON{continued) Property Address: Owner: MAI Date of Inspection: D. System Failure Criteria applicable to all systems: You must indicate`yes"or"no"to each of the following for all inspections: Yes No ( Backup of sewage into facility or system,component due to overloaded or clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool Liquid depth in cesspool is less than 6"below invert or available volume is less than'/z day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped Any portion of the SAS,cesspool or privy is below high ground water elevation. Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis.frhis system passes if the well water.analys* performed at a IDEP certified laboratory;for bacteria and volatile organic_comp�3ds indicates that the well is free from-pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equat.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.] (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must servea facility wi Bow of 10,000 gpd to 15,000 $Pd- You must indicate either"yes"or"no"to each of the folio (The following criteria apply to large systems in addition a criteria above) yes no — _ the system is within 400 feet of a s e drinking water supply the system is within 200 feet a tributary to a surface drinking water supply the system is located in gen sensitive area(Interim Wellhead Protection.Area—IWPA)or a mapped Zone II of a public supply well If you have answered"yes to any question in Section E the system is considered a significant threat,or answered `yes"in Section D abov the large system has failed.The owner or operator of any large system considered a. significant threat un Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The owner should contact the appropriate regional office of the Department. 4 Page S of I 1 OFFICIAI,INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PARS'B CHECKLIST Property Address- (� O Owner: Date of Inspection• p� Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes .No — Pumping information was provided by the owner,occupant,or Board of Health _ Were any of the system components pumped out in the previous two weeks Has the system received normal flows in the previous two week period? _ Have large volumes of water been introduced to the system recently or as part of this inspection? Were as built plans of the system obtained and examined?(If they were not available note as N/A) Was the facility or dwelling inspected for signs of sewage back up? _ Was the site inspected for signs of break out — Were all system components,excluding the SAS,Iocated on site? d _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition fthe baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no _ Existing information_For example,a plan at the Board of Health. Determined in the field(if any of the failure criteria related to Part Cis at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] S Pace 6 of I; OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION A Property Address: Owner: , Date of Inspection:_0 t 4 Tf FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual):q DESIGN flow based on 310 CNIR 15.203(for example: 110 gpd x#of bedrooms): •-Wo Number of current residents:_ 2 Does residence have a garbage grinder(yes or no): AJO Is laundry on a separate sewage system(yes or no):-4b {if yes separate inspection required] Laundry system inspected(yes or no);A& Seasonal use:(yes or no): Water meter readings,if available(last 2 years usage(gpd)): Sump pump(yes or no): 1 Last date of occupancy: Gt�y►� COMMERCIAIANDUSTRIAL Type of establishment:_ Design flow(based on 310 CMR 15.203): �apd Basis of design flow(seats/persons/ c.): " Grease trap present(yes or no): Industrial waste holding tank (yes or no):Non-sanitary waste disc -,ed to the Title 5 system(yes or no): Water meter readings, ' available: East date of occup y/use: OTHER(desc ' ): GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part of the inspection(yes or no): t�10 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) Tight tank i Attach a copy of the DEP approval —Other(describe): Approxinpte age of all components,date installed(if known)and ource information: Were sewage odors detected when arriving at the site(yes or no);: �a 6 Page 7 of I I OFFICIAL. INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: araks_,�� ` M�IAd v t Owner: p Date of Inspection: I _ BUILDING SEWER(locate on site plan) . Depth below grade: Y f t� Materials of construction:_cast iron PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: t< (locate on site plan) Depth below grade: _ Material of construction:__(p concrete_metal fiberglass_polyethylene _other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: _ tow Sludge depth: mZ Distance from top of sludge to bottom of outlet tee or baffle: L Scum thickness:4 Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to botto,�Aof outlet tee or baffle:�3 M How were dimensions determined: 1•�et,bv recA Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc. v�IC GS Ott c)C � vl gece ad 1 I GREASE TRAP:_(locate on site plan) Depth below grade:_ Material of construction:_concrete metal fibers __polyethylenes polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum/enceof ee or baffle: Distance from bottom of scf outlet tee or baffle: Date of last pumping: Comments(on pumping re ,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,eage,etc.): 7 Page 8 of 11 OFFICIAL.INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL,SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:. 9& t uk Owner: �ll�a Date of Inspection-_ l_� p TIGHT or HOLDING TANK: (tank must be pumped at ' e of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass_polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: hallo day Alarm present(yes or no): Alarm level: Alarm in rking order(yes or no): .Date of last pumping: Comments(condition of al and float switches,etc.): DISTRIBUTION BOX:7,L(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: y_&A Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage" to or out Oof box,etc.): W 6.0 Is TIA 0 PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no):. Alarms in working order(yes or no)Xcber, Comments(note condition of pump condition of pumps and appurtenances,etc): 8 Page 9 of H OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY NTARY ASSESSMENTS SUBSUItF'ACE SE*ACE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Q Z'� 4 Owner- �J Date of Inspection: p SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: leaching chambers,number- leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions: overflow cesspool,number innovative/alternative system Type/name of technology: Comments(note condition of soil;signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): '( P ro va be ee�t 4f" tv le� �Kt/ CESSPOOLS: (cesspool must be pumped as part of' ion)(locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids Iaver. Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflo (yes—or no): Comments(note condition of oil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: (locate on site plan) Materials of construction: Dimensions: 4 Depth of solids: Comments(note condition of s " ,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 9 Page 10 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: v � Owner: Bate of Inspectfion• SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch 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_ J C-4, s' l r& y, I Ej Page l l of i l OFFICIAL INSPECTION FORM--NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM[INFORMATION(continued) Property Address- Owner: Bate of Inspection: — SITE EXAM Slope VtS Surface water wo Check cellar q{.5 Shallow wells VJO Estimated depth to ground water_Q feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-if checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with Iocal Board of Health-explain: Checked with local excavators,installers-(attach documentation) X Accessed USGS database-explain: You must describe how you established the high ground water elevf�tion: Q e 00 C" P to JOC ltw� a V P11 d i G lI TOWN OF BARNSTABLE LOCATION .Uor4,(, �OQ.d SEWAGE # VILLAGE lQpi sict h L e- - L ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /Gb0 Q OL L L on 5 LEACHING FACILITY: (type) (size) NO.OF BEDROOMS_3 B6B94.QR OWNER S'f e vc d hi a k L ou) PERMITDATE: COMPLIANCE DATE:/ OS� 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 Page to of i l . OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSbffiVTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(communed) Property Add u: S ..✓ g/ j Owner. Date of Inspection: SKETCH OF SEWAGE DOPOSAL SYSTEM Provide a skewh of the sewage disposal system iacmd'mg ties m at least two perms tefetmce landmarks a benchntks.Locum all wells withm 100 fizz Locate where pub0c water supply eimets the 6wlding. K5' .23 _ IJ EJ 1 /t-► - 3 y 9 dc) P _ 23 TROY WILLIAMS SEPTIC INSPECTIONS z Certified by MA Department of Environmental Protection (508) 385-1300 19 Hummel Drive South Dennis, MA 02660 COMMONWEALTH OF MASSACHUSE17S EXECUTIVE OFFICE OF ENVIRONMENTAL,AFFAIRS* DEPARTMENT OF ENVIRONMENTAL PROTECTION 'FITLE 5 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTF,M FORM PART A CERTIFICATION Properh Address: 86 Doral Road Cummaquid, MA Ossner's Name: Al&Joan MacEachern Owner's Address: 86 Doral Road � j Yarmouthport,MA 02675 Date of Inspection: October 10,2001 Name of Inspector: Troy M. Williams E;EALTH PUZUU1 Company Name: TroyWilliams Septic Inspections �'1�N'1ABLE P P DEar. Mailing Address: 19 Hummel Drive South Dennis,MA 02660 Telephone Number: (508)385-1300 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 the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. 1 am a DEP appros ed system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The sv,tem Passes Conditionall\ Passes Needs l'urther Evaluation b) the Local Approving Authorii) Fails Inspector's Signature: Date: /o //0 A I The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of I lealth 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. Notes and Comments Although system meets the minimum requirements set forth by the Massachusetts Department of Environmental Protection,certification is not to be construed as a guarantee of future working condition of system,piping or components. This inspection represents the conditions of the system on the Date of Inspection noted above. ""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. Title 5 Inspection Form 6/15/2000 Pace I Page 2 of 1 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 86 Doral Road Owner: Cummaquid,MA Date of Inspection: Al&Joan MacEachem October 10,2001 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 anv of the failure criteria described in 310 CMR 15.303 or in 3.10 CMR 15.304 exist. Any failure criteria not evaluated are indicated be low. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to replaced or repaired. The system, upon completion of the replacement or repair,as approved by the Boar of Health, will pass. Answer yes. no or not determined(Y,N,ND)in the for the following statements f"not determined"please explain. The septic tank is metal and over 20 years old* or the septic tank(wh er metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is i inent. Svstem will pass inspection if the existing tank is replaced with a complying septic tank as approved by t Board of Health. •A metal septic tank will pass inspection if it is structurally sound,n leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or breakout or tgh static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or tut en distribution box. System will pass inspection if(with approval of Board of Health): broken ' (s)are replaced obs ion is removed dis tbution box is leveled or replaced NO explain: The system require umping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with roval of the Board of Health): broken.pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of 11 N OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 86 Doral Road Owner: Cummaquid,MA Date of Inspection: Al&Joan MacEachern October 10,2001 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. I. System Hill pass unless Board of Health determines in accordance with 310 CMR 15.303( (b)that the system is not functioning in a manner which will protect public health,safer) and the a 'ironment: _ 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 arsh 2. System will fail.unless the Board of Health(and Public Wat Supplier,if any)determines that the system is functioning in a manner that protects the public he th,safety and environment: The system has a septic tank and soil absorption stem(SAS)and the SAS is within 100 feet of a surface water supple or tributary to a surface water pply. . The system has a septic tank and SAS d the SAS is within a Zone 1 of a public water supply. The system has a septic tank and AS and the SAS is within 50 feet of a private water supply well. _ The system has a septic to - and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well" ethod used to determine distance "This system passe ' the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volat' organic compounds indicates that the well is free from pollution from that facility and the presence o monia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure Grit a are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of 11 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 86 Doral Road Curnmaquid,MA Owner: Al&Joan MacEachern Date of Inspection: October 10,2001 D. System Failure Criteria applicable to all systems: You must indicate."yes"or"no"to each of the following for all inspections: Yes No Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool Static liquid level in the distribution box above outlet.invert due to an overloaded or clogged SAS or cesspool ivi.q Liquid depth in cesspool is less than 6"below invert or available volume is less than V2 day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. y�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 well. N r4 Any portion of a cesspool or privy is within 50 feet of a private water supply well. tylli Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. (This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.) A/ (Yes/No)The system fails. 1 have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303. therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design ow of 10,000 gpd to 15,000 gpd You must indicate either"yes"or"no"to each bf the following: (The following criteria apply to large systems in addition to the criteria ab e) yes no the system is within 400 feet of a surface drinking water pply the system is within 200 feet of a tributary to a surf a drinking water supply the system is located in a nitrogen sensitive a a(Interim Wellhead Protection Area—IWPA)or a mapped Zone 11 of a public water supply well If you have answered"yes"to any question in ction E the system is considered a significant threat,or answered "yes" in Section D above the large system failed.The owner or operator of any large system considered a significant threat under Section E or faile under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should con ct the appropriate regional office of the Department. � 4 Page 5 of 1 1 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 86 Doral Road Owner: Cummaquid,MA Date of Inspection: Al&Joan MacEachern October 10,2001 Check if the followine have been done. You must indicate"yes"or"no"as to each of the followine: Yes No _ 1':.;:,ping information was provided by the owner. occupant, or Board of I Iealtl _ ✓ Were any of the system components pumped out in the previous two seeks _ Has the system received normal Lflows in the previous two week period ? Have large volumes of water been introduced to the system recently or as part of this inspection? Were as built plans of the system obtained and examined?(If they were not available note as N/A) Was the facility or dwelling inspected for signs of sewage back up? Was the site inspected for signs of break out _ Were all system components,excluding the SAS, located on site'? . Wag the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction,dimensions, depth of liquid,depth of sludge and depth of scum? _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems The size and location of the Soil Absorption System(SAS)on.the site has been determined based on: Yes no Existing information. For example,a plan at the Board of Health. _ Determined in the field(if any of the failure criteria related to Part Cis at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] 5 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 86 Doral Road _ Owner: Cummaquid, MA Date of inspection: Al&Joan MacEachern October 10,2ftoW CONDITIONS RESIDENTIAL Number of bedrooms(design):_Y_ Number of bedrooms(actual): 41 DESIGN flow based on 310 CMR 15.203(for example: 1.10 gpd x#of bedrooms): yo Number of current residents: a Does residence have a garbage grinder(yes or no): N0 Is laundrN on a separate sewage system (yes or no):N�. [if yes separate inspection required) Laundry system inspected(yes or no):ALo Seasonal use: (yes or no): ivo Water meter readings,if available(last 2 years'usage(gpd)): W/vi - 7/ o�� _,�,�5 F y/oo = /2 3�„�� 5��•� . Sump pump(yes or no): Aio Last date of occupancy: << , ; ,d COMM ERCIALANDUSTRIA L Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):— Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system (yes r no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part of the inspection(yes or no): Ato 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) _Tight tank _Attach a copy of the DEP approval Other(describe):. Approximate age of all components. date installed(if known)and source of innformation- 3. t t��,YS �.J"�('� Ih }�'t.II Un S�.S 44) LG /V�wc✓ I2/i3 /96 ��r ems- 6,,14 Were sewage odors detected when arriving at the site(yes or no): vo 6 • Page 7 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 86 Doral Road Owner: Cummaquid,MA Date of,lnspection: Al&Joan MacEachern October 10,2001 BUILDING SEWER(locate on site plan) Depth belu�� grade: Materials of construction: _cast iron /40 PVC_other(explain): Di,tinc;• fron. private water supply well or suction line: L1,9 Comments(on condition of joints, venting, evidence of leakage, etc.): d / SEPTIC TANK: _(locate on site plan) Depth below grade: ;l � .> r Material of construction: concrete_metal fiberglass=polyethylene —other(explain) If tank is metal list age:._ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: E.S'"x Sludge depth: 91, _ Distance from top of sludge to bottom of outlet tee or baffle: 2 ' ' Scum thickness: ^/an/r Distance from top of scum to top of outlet tee or baffle: ,A,,o s Distance from bottom of scum to bottom of outlet tee or baffle: s How were dimensions determined: Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as r ated to outlet invert,evidence of leakage, etc.): _�(� 5._._V.IA✓t ✓..n.A _ L.. V�V 4.!K• y 4✓�_-a._✓ as_Gv .0 J/� /C G.h•arJ GREASE TRAP:_(locate on site plan) Depth below grade:_ Material of construction:_concrete_metar/ffl7 fiberglass�olye ylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outle Distance from bottom of scum to bottomfle:Date of last pumping: Comments(on pumping recommendatioee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of lea 7 Page 8 of 1 1 OFFICIAL INSPECTION FORM—.NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 86 Doral Road Owner: Cummaquid,MA Date of Inspection: Al&Joan MacEachern October 10,2001 TIGHT or HOLDING TANK: (tank must be pumped at time of' ection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglas polyethylene other(explain): Dimensions: Capacity: gallons Design Floe. gallons/day Alarm present(yes or no): Alarm level: Alarm in working orde yes or no): Date of last pumping: Comments(condition of alarm and float itches,etc.): DISTRIBUTION BOX: (if present must be opened)(locate on site plan) Depth of liquid level'above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover, any evidence of leakage into or out of boo� k x,etc`.): I- Q-0 u W t,.5 '7b,_ cy.� W,'tom Sao- .� fl t..�.. �.�f I 1 a u �. Y 7'/� u✓ T� n -n� a A L:. Vi ` ti__e✓ 1 .(r P.]S _raS W,f� p.�/� ... h a.�•✓ Qd�� . G li;r�e...,�f- � 7` �u...�j1 eJ :,i - s�l� PUMP CHAMBER: —(locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condi nm and appurtenances,etc.): 0 8 , ' Page 9 of 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 86 Doral Road Owner: Cummaquid,MA Date of Inspection: Al&Joan MacEachern October 10,2001 SOIL ABSORPTION SYSTEM (SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type o� Or: 5• ti a l � .�� ' Lim-h r�k s ,,,.,(l,. .�'Sf-cr..�-. ✓ leaching pits, number: leaching chambers,number: leaching galleries,number. leaching trenches,number, length: leaching fields,number,dimensions: overflow cesspool,number: innovative/altemative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation, etc{.):�y.�'s... I t✓.C, VJ..Y 'YL i ,/ u...� i�. •fYl 1/G� �G - Lo i -1 c. .1 %4 !�S��O s��fi o.. L..!'i� n o u ✓ ��t.�c,c G >� _��ro.✓ �. � �' j✓�-.._ u v �.—�� ti....s h 'I5� �� S .t ✓..� a� �... �'Yh�..7u%� ihrrct"4-X0A, CESSPOOLS: (cesspool must be pumped as part of inspectio ocate on site plan) i Number and configuration: Depth-top of liquid to inlet invert:— -- - -- Depth of solids layer: Depth of scum laver. Dimensions of cesspool-- --- Materials of construction: Indication of groundwater inflow(yes or n Comments(note condition of soil,signs hydraulic failure, level of ponding,condition of vegetation,etc.): PRIVY: (locate on site plan) I Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic f Zure, l of ponding,condition of vegetation,etc.): 9 Page 10 of I 1 OFFICIAL INSPECTION FORM.—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 86 Doral Road Cummaquid, MA Owner: Al&Joan MacEachern Date of Inspection: October 10,2001 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch 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. �vo►. VL O Ap = 1.5 - 2s� G w�u 7 r3 H = 39 (j G C G z l C N = ys ' L/ (14-20 C>"T`^`� I 10 'Page I l of t l OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION. FORM PART C SYSTEM INFORMATION (continued) Property Address: 86 Doral Road Owner: Cummaquid,MA Date of Inspection: Al&Joan MacEachern October 10,2001 SITE EXAM Slope Surface water Check cellar v/ Shallow wells Estimated depth to ground water feet Adjusted high ground water elevation — feet Please indicate(check)all methods used to determine the hi;h ground eater elevation: v Obtained from system design plans on record- If checked,date of design plan reviewed: 96 l 11Z, /80 _ Observed site(abutting property/observation hole within 150 feet of SAS) S/.p< Checked with local Board of Health-explain: f&f+ &.—,,r�. - _ /z/r 3/9 Checked with local excavators, installers-(attach documentation) ✓ Accessed USGS database-explain: /q w t 6 , You must describe how you established the high ground water elevation: A N H - �un._...J 4 Tom✓.,-„� q.-1-- 'aL-w *-,k A L7 $�✓ti •�r,j y ru., :,..l W,y..f-,�� .�..._.� , �!s L ) Cj.-o...�� .r•-'i-.r r...�r � S t'to J �:,. .H.,ILw,�.�.�_v b,+ s CIL4v 17 t, low.. . TOWN OF BARNSTABLE LOCATION DO TCA L. t SEWAGE # 76 ' `y Vn:I AGE .3 �/L� / � ASSESSOR'S MAP& LOT INSTALLER'S NAME&PHONE NO. r)U(K � L`?a -7 G b 1�CZEPTIC TANK CAPACITY LEACHING FACILr Y: (type) 177 (size) -n OF BEDROOMS BUILDER OR OWNER PERMITDATE:1 G - I 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 i Furnished by _o ,�fo fro �- �mpa r -- ASSESSORS MAP NO:.,., - -_ No.- •-••- - pARC('L NO: �� - 1. ' , �` FEic...y........ ......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH rr,� F TOWN OF BARNSTABLE Appliratiou for Di_npoiul Warko Tomitriir#ion Famit Application is hereby made for a Permit to Construct ( ) or Repair (�n Individual Sewage Disposal System at: T .................................................. �!mil_.-•----------------------•--•-- ..................------..........-------•----------.........--------•-------•-------•----•------. Ocatio t-Address or Lot No. AL....... G-..�ll c�-(e rz,�.............................. ................` ...`.... y��Y -----------------------•----------------....---...------ Owner Address a -- �---- vr�.4z=--------------------------------------------------- 1 1 2r .............................................................. Installer Address Type of Building l/ Size Lot............................Sq. feet ., Dwelling— No. of Bedrooms.__-_ --------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons__.._-___.______--____-._... Showers ( ) — Cafeteria ( ) 0.' Other fixtures -------------------------------------------------------------------------------------------- W Design Flow_--•---_---_-__............................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity------------gallons Length---------------- Width_------------- Diameter.-.-..-_.-_-.._ Depth................ x Disposal Trench—No. .................... Width-------------------- Total Length--------------------- Total leaching area---_____-_----.---sq. ft. Seepage Pit No------1.............. Diameter__.-- Depth below inlet.... ._......... Total leaching area_y 0. .sq. ft. Z Other Distribution box ( ) Dosing tank ( ) a 1 v C'017 Percolation Test Results Performed by.......................................................................... Date........................................ a ..� Test Pit No. 1----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ (Z Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water...--__---_-___---___--. Description of Soil--••-•-•••--•----• .... /d ------ y =Pd �� x VNature of Repair or Alterations—Answer when applicable................................................................................................ ........................................................................................................................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has_4oen issu by the board of health. Signed .:.........................._ ------- .----- .-------------------.-----------... ---------------- ......------- ----------------- Dace Application.Approved B�� - - Date .. 7 Application Disapproved for the following reasons: ............I....:............... ----------------------------------------------------...................................... ............................................................... Dare,. Permit No. �........ --------- -✓`------....--------- -,� -- Dme -------------- I ------ No... �?._.~. � Cy 45 Fxs... .�'................. THE COMMONWEALTH OF MASSACHUSETTS A", BOARD OF HEALTH -moo TOWN OF BARNSTABLE . pphrtttiou for DiopitiMl Works Tontitrurtion ramit Application is hereby made for a Permit to Construct ( ) or Repair (xan Individual Sewage Disposal System at: ..... ................. .... .....- Location-Address '�.� I. or,Lot No. ,..._ ---------- ------•--------•••.............. ..•-•---• -------- •...-- .......... .................. Owner i. '[ • ABdres i f �-' • ..........................................----•-----------------------------••••-•------ ----------------- ....-•-••------ --•---------•-----------------------------------_---•-- Installer /` Address Type of Building //// Size Lot............................Sq. feet Dwelling—No. of Bedrooms------`7"..------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons.____-____-..._----..__._.__ Showers ( ) — Cafeteria ( ) dOther fixtures .----•------•-------------------------------------•----------------------------------- .............................................................. W Design Flow______ ____________________________________gallons per person per day. Total daily flow--------------------------------------------gallons. WSeptic Tank—Liquid capacity.-_-__..___gallons Length---------------- Width_______________ Diameter---------------- Depth-------------- Disposal Trench—No. .................... Width-------------------- Total Length-------------------- Total leaching area------\.............sq.ft. Seepage Pit No.------ _...--._._.. Diameter____t0._f. 76_'. Depth below inlet____G........... Total leaching area._y.�_�_�-__.sq. ft. Other Distribution box ( ) Dosing tank ( ) '/-/ (, P-/7 Percolation Test Results Performed,by.......................................................................... Date........................................ Test Pit No. 1________________minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ 44 Test Pit No. 2______._____•--_minutes per inch Depth of Test Pit.................... Depth.to ground water........................ �?1- ,------------------- --;----- O Description of Soil----------------- -- :�----l7 � �'r.--- '�i l ��r'i�s, � x �^ V ; U -----------------------------• --- ---_-_-__.-_.----------__-_____------________.__.._..................................... ----------- *............... W ..1---• It/'.� �/fl----' ..gip 'S ''!'' f '��P 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 TITLE 5 of the State Environmental Code —The undersigned further agrees not to place .the system in operation until a Certificate of Compliance has been issued by the board of health. Signed --- 611'-1.. �y�`-�`_ (1` - .. .- Date Application Approved B z 2 - .... ------------------------------------------ Application Disapproved for the following reasons: .. ..............._........----......_......------------._------------------------------------------------------------- ... ......... Dace /•� Permit No. `� �7......... Issued -------------f....�- _�. ... ..'...Z ..... .......................... Dace THE COMMONWEALTH OF MASSACHUSETTS J BOARD OF HEALTH t TOWN OF BARNSTABLE. Certifir to of �IIStt �t�SYiCP THIS IS TO CVjIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by `------.. ..--------.-6--------- InswIter G 2 �...>� at ------- ......... ...... ..... ..__.................._... - .... --------.....__...-- - ------ ---------------------------------------------------- has been installed in accordance with the provisions of TITLE, oif,,The State Environmental Code as described in the application for Disposal Works Construction Permit No. .._ ...__ / �' r-% �_. dated .-��'�� b THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE ..... _.�.� ...--,.. i�,�......._------- ---- ----- Inspector - `�±....... -------.--------------------------------------------------- -- ---__--_.-_.w_,----- •------ _------- ------- ------- --•-_,_,-----_--•_.--i THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH q�� TOWN OF BARNSTABLE L1 No �.... FEE.._.,...--••....... Uiopooat orko Tonotrudion "nutit Permissionis hereby granted.......��........- -�-----�------------------------------------------------------------------------------------------ to Construct ( ) or Repair �an Individual Sewage Disposal System at No. �5 C, c�-N h1 t_._.__;..... 1 J street as shown on the application for Disposal Works Construction Permit,la ��-�'/_ ��✓. ��G? -� .... i Board of Health DATE.----- .. .................................... FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS L0 A'T10 SECyAGE PERMIT q0. 6 pt VILLAGE _ _ air a,-� Yc•G�!K � .. 'IhSTA LLEWS 91AOE b ADDRESS ur .. . o U I L DE Cl 0 or7a ER �� ru/ L s✓4✓e 7incf� ' DATE PERMIT ISSUED DATE COMPLIANCE ISSUED .;i v ' V M M1 �alolfl/ :x ,R v, V 4° .S/- rer /a L SN r-T 72,t011 s LorAie m 3S84 z- s )Cr,t q. )C NIN �^ elf-, �� sync V I / k ' ° �s•'��p��cF 16 Q 1 f a.S.s vsr jo 5L,4Z.o F 31' oN i`lbA+ei S13r4 L�v�L CERTIFIED PLOT PLAN €DWARD E° KELLEY LOCATION CUMMAQUID, MASS. 026.3'1 SCALE DATE • ' !.zB 1980 PLAN REFERENCE Lo �NOF14S4 Ae, A /Z .B� Z'Q L' 7 !es EDVEARD S ALSO Tv/.3G /Q.y�. . . . . Y No 231-9?� fez) I CERTIFY THAT THE ... ... SHOWN ON THIS PLAN 1 TES ON THE GROUND AS SHOWN HEREON MAP CONFORMS TO THE SETBACK REQU E � OF THE TOWN Of i �U S AFZ-e+t-7 y 77l' ST . . . . . . . WHEN CONSTRUCTED. 86)e ¢ DATE . . . . .. . PETITIONER: REGISTERED LAND SURVEYOR SNE�T Z o/c Z SN�T,S TOP OF FOUNDATION CONCRETE COVER CONCRETE COVERS 4"CAST IRON 12� � r 12"MAX. "" • PIPE (OR 4 ORANGEBURG(OR EOUIV.) T EOUIV.)- MIN. PIPE- MIN. 1 LEACH ' PITCH 1/4"PER. PITCH 1/4"PER.FT. PIT e,u PRECAST o'� N VERT a LEACH I N G EL.3S-'rQ... INVERT INVE T n . t PIT OR SEPTIC' TANK 3�06 DIET. 33/ - ; j= EOUIV. • INVERT EL" BOX EL.. `e; EL. 3Sz3 �S�• •• •• GAL. INVERT INVERT ;•' V W W a :;a 3/4.TO I I/2' EL 33 73 ° EL...-..... .' �� WASHED W STONE W DIA. --+-� �- � . • �-�- /o' DIA. A10Ale PROFILE OF < GROUND WATER TABLE SEWAGE DISPOSAL SYSTEM - NO SCALE PRE LUN ZGAUY SOIL LOG WITNESSED BY DATE .4?�., Z% MIBo TIME. /�•.3�•A'?�! PAuG C. ti1u'e e'g y . . BOARD OF HEALTH TEST HOLE I TEST HOLE 2 40 : ENGINEER ELEV. .38.70 . . . ELEV - SuQ.So/C� �� ►;"` SIB so , DESIGN DATA : 3 overt) LL18 NUMBER OF BEDROOMS TOTAL ESTIMATED FLOW. GAL Li7NS/DAY BOTTOM LEACHING AREA 78 s. . . SO.FT /PIT Ss SA/E SIDE LEACHING AREA . . .iBB S SO.FT./ PIT SAwD GARBAGE DISPOSAL NvNG: (50% AREA INCREASE) TOTAL LEACHING AREA . �'3 oo SO.FT 'e PERCOLATION RATE ? !l'^'?S-sue MIN/INCH LEACHING AREA PER PERCOLATION RATE .88T. SQ.FT. .60 .WATER ENCOUNTERED Z Oi73 Wirt/ 7�/0 NUMBER OF LEACHING PITS . . . . . . . . APPROVED . .. . . . . . . . . . . BOARD OF HEALTH of S�V6 A&M A,7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . DATE. . . . . THOMAS E.KELLEY CO. AGENT OR INSPECTOR ENGINEERS—SURVEYORS 346 LONG POND DRIVE' U'IH YARMOUTH,MASS. ��H OF / /SZ ��OF IW4 02664 ' o?� FIiO S �j�' ul+ C�fif11�-195i/?j � fVZ ED P s( LEY -{ ' y No 1 .2426Q� ti �AZr,/C��S• �L7�/ TlZc,dT � K ELLEY No 251 OD PETITIONER �IgTr- 6NALE ✓� •fir. _ No................ .: FE$..:. a... THE COMMONWEALTH OF MASSACHUSETTS .�x BOARD OF HEALTH mow. : . OF.............................................................•......................... Application is hereby made-for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Y S stem t• ........ 71. .... . AA O�A =Address or Lot No. Ir�c�y�: = :_�1�>ego ..r r � __:--4..W&6r !rt---._? r�r.. ... ........................ Owner ss ar -t---N.�-w-EAV--•......•---.a ------------------------ �� 5 -i--.T _ ---.` r _-'A- Installer Address Size Lot__ .✓� Type of'Buildlr}g� �b __}e/6_2.....Sq. feet aDwelling e No. of. Bedrooms_____4__._.:____________________________Expansion Attic ( ) Garbage Grinder• p4 Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Q, Other fixtures . ---------------=- W Design Flow_____________... _______________________gallons per person per day. Total daily flow..___.+0............................gallons. WSeptic Tank—Liquid capacityWD _.gallons LengthjD __.___. Width___ __________ Diameter................ Depth...............:. x Disposal Trench—No_ _________ _________ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..._.�........... Diameter......6...___._.. Depth below inlet......________. Total leaching area__.5.✓.l_....sq. ft. Z Other Distribution box ( ) Dosing tank ( ) H y a Percolation Test Results Performed by.._rIfUUldl----f'i___i...._ZE14,t '.................... Date_ __,m*_________.____... Test Pit No. 1................mmutes per inch Depth of Test Pit.................... Depth to ground frq Test Pit No. 2..........__....minutes per inch Depth of Test Pit.................... Depth to ground water........................ afl....................._......... ..............-------- x Description of Soil---------- � - � ?"I-------------_- �0[L----�.P.�tU...Q_�!l_� �3zF c� `?�Io... t`� 1�=� ................-------. Al�ll?----- 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 T i`T� g 5 of the State Sanitary Code-::The undersigned further agrees not to place the system in operation until a Certificate of Compliance has,been issued by the board of health. �.; Sig ed -------------------------------------------•--•------------------ ----•-- —� -,S" Datjz Application Approved BY L •----•------------------• - -•----•---D-t- •-----•----- ae Application Disapproved for the following reasons:----•---------••-----------------------•---------------•-----------------------•------------------._....-------- -: Date PermitNo.................. .................................. Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS r: BOARD OF EALTH 6. r' �`.......... ......OF............... f:. .....d '' ........................................... �rrtifiratr oaf Tu�Yt THn TO R FY, hat th Individual Sewage Disposal System constructed ( ) or epaired ) by - -F l � - (� _ __... ` at.._.."" r/ 'v! l � ► D 111 Z __. �T 4 4E r / ~!� t ` 7 4411, . ? pN ._.... --- has been installed in acco dance with the provisions of TI' r r of p, State Sanitary CodVa&•�Gci d i the application for Disposal Works Construction Permit No------ _..____[(_//__________________ dated---------------------------------------......... THE-ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED-AS A GUARANTEE THAT THE SYSTEK WILL FUNCTION SATISFACTORY. DATI................................................................................. Inspector.-•---••-----------------------=•--••-- ------------------------------------•----- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF ALTH , / d„ .....-::........-` �. F.................. ...: ........................................................... � No..... ..... .....al. FEE............. i rlar� l ,ki Rn n ami# Permission.is re granted----•-..:--- ---'�-�---------------=�----------- --------------------- ----••--- .......!........._._ to Construct r Repai ) nXIn Valwage D• y ? �f o at No....... � � .`..---- -- �t ` Street S'�`►�`+G/-� as shown on the application for Disposal Worlcs'Construction Per i __________ ___ � ___ ------------------------ tom' J �l ------------------• ........................................----------••----- -------••---•---•- /_ V Board of Health DATE.......... ==---...---•-----------•- ------------------•-----•-•--------•--- r. FOR?A 1255 HOBBS & WARREN. INC., PUBLISHERS ' No. .......... Fps....`....................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH t.,..:. ............ ...... OF. . ....... ... 1,(. 14.i llp iration for Bhip ,sal IlVorks Towitrurtion Urrmit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal system at: , ��//�� !....t1.�1 Locatho :Address O wner i`�{ r + n Addres : ... ----------------------------------------------- --- k �- � t 6,...44{ .._..... Installer Address d Type of Build Size Lot__'M)'Sh�--.......Sq. fee Dwelling No. of Bedrooms_._......._'............................Expansion Attic ( ) Garbage Grinder•V� aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures .---.....--••-•-----•---•------• . W Design Flow........ __:c.............................. per person per day. Total daily flow_.._._-_�-`- gal • ---------------------•---._ Ions. WSeptic Tank—Liquid capacityJ5,70 -gallons Length---.��...___ Width._ - Diameter________________ Depth................ x Disposal Trench o. .. ..._. Width._................. Total Length.................... Total leaching area______-__-__-••----sq. ft. Seepage Pit No....___ _ Diameter.._...._ Depth below inlet..... Total leaching area.. s ft. P . g q Z Other Distribution box ( ) Dosing tank ( �_4 rr Percolation Test Results, Performed by... - - ••-• Date__-- -- .�•-....--••-••---- Test Pit No. lt"MI�J�Ginutes per inch Depth of Test Pit...................• Depth to ground water._ ....... 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Pr' . -------•---------•---.--.• -•••--..... -•---•-••--...-•-..... ---••--- ----------------- 0 Description of Soil..... 7.VVV�1LR1----�0...... '� 12�__wS� k �QA Ql f�> - ?( s 'C ---------------- W ---------------------------------------------------------- ---------------------------------------•-------•--•---------------------•----------••--•---••--•---•-••-•-••--•---•--•-••-•-•-•-•----•••••-- VNature 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 TTT, 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Sig ed - •------------------------------ • �,� Date lic ion A roved B -"-----._�___......... :_.._. PP P Y AtdnMrl l! isap r ved r th` folio ng reasons--.-.',. t: --1 `� .........• .............. L -2`..--. ...... ............. `.2 ----------------------------------------------------- Date Permit No.................... �f I ued. -Jr- -`-- 4� Date