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Home My WebLink About0016 KEHTEAN DRIVE - Health POT 16 Kehtean Drive,Barnstable A= �, 4 i Commonwealth of Massachusetts ��- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments '16 Kehtean Drive q96-L, Pro perty e P rtY Address . . John Ferrara Owner Owner's Name information is required for Barnstable MA 02630 05/17/08 every page. Citytrown State Zip Code Date of Inspection Inspection aesults must be submitted on this form. Inspection forme may not be altered in any way. Important: A. General Information When filling out forms on the computer,use only the tab key 1. Inspector: to move your Michael Kellett tV ~ cxr cursor-do not . Name of Inspector use the return P , key. Aardvark Environmental Inspections Company Name -- Q P.O. Box 896 711 Q Company Address -_j East Dennis MA 2641 Cityrrown State lip' Code 508=385-7608 S13742 Telephone Number License Number B. Certification I certify that l 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 Pj was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 05/22/08 Inspecto s Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. , ""This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Selvage Disposal System Form!-Not for Voluntary Assessments '16 Kehtean Drive Property Address John Ferrara Owner Owner's Name information is Barnstable required for MA 02630 05/17/08 every page. Cityfrown state Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E!always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 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. Answer yes, no or not determined (Y, N, ND) in the❑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. ND Explain: h . ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed I Commonwealth of Massachusetts Title 5 Official .Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments '16 Kehtean Drive Property Address John Ferrara Owner Owners Name information is required for ate Barnstable MA 02630 05/17/08 - every page. City/Town St Zip Code Date of Inspection Be Certification (cunt.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ 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 ❑ obstruction is removed ND Explain: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health'in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a'surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 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. 4 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary:Assessments '16 Kehtean Drive Property Address John Ferrara Owner Owner's Name information is required for Barnstable MA 02630 05/17/08 every page. Citylrown State Zip Code Date of Inspeetion B. Certification (coot.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ 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 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 ❑ ® 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 o I r tributary to a surface water supply. I Commonwealth of Nlassach6setts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,r.y '16 Kehtean Drive Property Address John Ferrara Owner Owners Name information is required for Barnstable MA 02630 05/17/08 every page. City/Town State Zip Code Date of Inspection B. Certification (coat.) D) System Failure Criteria Applicable to All Systems(cont): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes If the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen Is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system'is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. Commonwealth of Massachusettft Title 5 Official Inspection Forte Subsurface Sewage Disposal System Form-Not for Voluntary Assessments '16 Kehtean Drive Property Address John Ferrara Owner Owner's Name information is Barnstable required for MA 02630 05/17/08 every page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? Z ❑ 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)] Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments '16 Kehtean Drive Property Address John Ferrara Owner Owner's Name information is Barnstable MA 02630 05/17/08 required for every page. Citylrown State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 2 Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection'required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Sump pump? ❑ Yes ® No current Last date of occupancy: Date Commercial/industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Forme-Not for Voluntary Assessments '16 Kehtean Drive Property Address John Ferrara Owner Owner's Name information is Barnstable MA 02630 05/17/08 required for every page. CityTrown State Zip Code Date of Inspection D. System Information (coat.) General Information . Pumping Records: Source of information: 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) ❑ Tight tank. Attach a copy of the DEP approval. 0 Other(describe): Approximate age of all components, date installed (if known)and source of information: 4/27/84 per BOH 2 Were sewage odors detected when arriving at the site? ❑ Yes 0 No Commonwealth of NDassachuseft ID Title 5 Official Inspection For Subsurface Sewage Disposal System Form-Not for Voluntary Assessments '16 Kehtean Drive Property Address John Ferrara Owner Owner's Name information is Barnstable required for MA 02630 05/17/08 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) Building Sewer(locate on site plan): Depth below grade: 3.0 feet Material of construction: ❑ cast iron ®40 PVCµ ❑ other(explain): Distance from private Water supply well or suction line: _ feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic'Dank(locate on site plan): Depth below grade: 1.0 feet Material of construction: ®concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑.other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No -------------------------------------------------------------------------------------------------------------------------- Dimensions: 1000 gal Sludge depth: 4 Distance from top of sludge to bottom of outlet tee or baffle 28" , Scum thickness 211 Distance from top of scum to top of outlet tee or baffle 511 Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? measured Commonwealth of Massachusetts Title 5 Official Inspection ®rm Subsurface Sewage Disposal System Form-Not for Voluntary Assessments '16 Kehtean Drive Property Address John Ferrara Owner Owner's Name information is required for Barnstable MA 02630 05/17/08 every page. City/Town State Zip Code Date of Inspection D. System Information (cost.) 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 sound and tight with tees in place and liquid at outlet invert. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): . Depth below grader Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Commonwealth of Massachusetts Title 5 Official • Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r '16 Kehtean Drive Property Address John Ferrara Owner Owner's Name information is required for Barnstable MA 02630 05/17/08 every page. Citylrown State Zip Code Date of Inspection D. System Information (coat.) Tight or Holding Tank(cont.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Sox(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert even 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.): The box was level and tight with no sign of carryover. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments '16 Kehtean Drive Property Address — John Ferrara Owner Owner's Name information is Barnstable required for MA 02630 05/17/08 every page. Cityyfrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 1 ❑ 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.): This system has a 6'x6'precast pit surrounded by two feet of stone. There was 24" between the inlet invert and the liquid. I Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments. '16 Kehtean Drive Property Address John Ferrara Owner Owner's Name information is Barnstable required for MA 02630 05/17/08 every page. City(rown State Zip Code Date of Inspection D. System Information (cont.) Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments s. t '16 Kehtean Drive Property Address John Ferrara Owner Owner's Name information is required for Barnstable MA 02630 05/17/08 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) 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. r5' Commonwealth of Massachusetts Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form-Not for Voluntary Assessments '16 Kehtean Drive Property Address t - John Ferrara Owner Owner's Name information is required for Barnstable MA 02630 05/17/08 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cost:) Site Exam: ® Check Slope ❑ Surface water ® Check cellar ❑ Shallow wells Estimated depth to ground water: 20 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: USGS maps show an elevation of over 20' Commonwealth of Massachusetts Executive Office of Environmental Affairs Dept. of Environmental Protection One winter Street Boston Ma. 02108IN .Jolu>f Gruci ' D.E.P. "Title V Septic Inspector P.O. Box 2119 Teaticket, MA 02536 WILLIAM F.WELD (508)56 -6813 Governor ARGEO PAUL CELLUCCI ' li U.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION �F/> V.4 ro/ S 2/ Property Address: 16 Kentean Dr.Barnstable Address of Owner:' t SFgOb6 'l9 Date of Inspection: 214l98 (If different) lti�TSlgB `98 Name of Inspector: John Graci McNulty 4` I am a DEP approved system inspector pursuant to Section 15.340 of Title%(310 CMR 15.000) Company Name,Address and Telephone Number. 8 �J to CERTIFICATION STATEMENT I certifythat I have personally Inspected the sewage disposal system at this address and that the Information reported below is true,accurate P Y P 9 P Y and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: x Passes This Inspection Is based on criteria defined In Title V Conditional) Pas s code 310 CMR 16.303.My findings are of how the system Is performing at the time of the inspection.My inspection does — Needs Fur er aluation By the Local Approving Authority not Imply any warranty or guarantee ofthelongeftofthe _ Fails septic system and any of its components useful life. Inspector's Signature: f Date: 2125198 The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspections. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer,if applicable and the approving authority. INSPECTION SUMMARY: Check A, B,C,or D. A] SYSTEM PASSES: j x I have not found any information which indicates that the system violates any of the failure criteria defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: '4 B] SYSTEM CONDITIONALLY PASSES: ; i k One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair,passes inspection. Indicate yes,no, or not determined(Y, N, or ND). Describe basis of determination in all instances. If "not determined",explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Co7hpliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration,or tank . failure is imminent.The system will pass inspection I the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 04127197) One Winter Street a Boston,Massachusetts 02108 • FAX(617)556-1049 •' Telephone(617)292-5500 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM' PART A CERTIFICATION (continued) Property Address: 10 Kentean Dr.Barnstable Owner: McNulty Date of Inspection:V4198 _ Sewa4e backup or.hreakoutor hioh.static water level observed.in.the distribution box is due to a broken. or obstructed pipe(s)or due to broken,settled or uneven distribution box.The system will pass inspection if (with approval of the Board of Health). Describe observations: broken pipes)are replaced obstruction is removed distribution box is leveled or replaced —The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER,IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: — The system has a septic tank and soil absorption system and is within 100 feet to a surface of water supply or tributary to a surface water supply. — The system has a septic tank and soil absorption system and is within a Zone 1 of a public watersupply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well.. — The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presense of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method usedto determine distance (approximation not valid) 3)Other D] SYSTEM FAILS: You must Indicate either"Yes"or"No"as to each of the following: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No _ — Backup of sewage in facility or system component due to an 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 cesspool. SAS is in hydraulic failure: ; a (revleed 04r17187) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) , l Property Address: 16 Kentean Dr.Barnstable Owner: McNulty Date of Inspection:214198 D]SYSTEM FAILS(continued) Yes No 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 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Numbers of times pumped Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater' elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: The following criteria apply to large systems in addition to the criteria: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist; Yes No 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) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. r (revised 04127)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART S CHECLIST Property Address: 16 Kentean Dr.Barnstable Owner: McNulty Date of Inspection:214198 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: , _X_ — Pumping information was requested of the owner, occupant,and Board of Health. x None of the system components have been pumped for at least two weeks and the and the system has been receiving normal — — flow rates during that period. Large volumes of water have not been Introduced Into the system recently or as part of this inspection. — x As built plans have been obtained and examined. Note if they are not available with N/A. x — The facility or dwelling was inspected for signs of sewage back-up. rs x — The system does not receive non-sanitary or industrial waste flow. -x— — The site was inspected for signs of breakout. • I x All system components,excluding the Soil Absorption System, have been located on the site.., x The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction,dimensions, depth of liquid,depth of sludge,depth of scum. x The size and location of the Soil Absorption System on the site has been determined based on — — The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal Systens. x Existing information. Ex. Plan at B.O.H. 9 x Determined in the field(if any failure criteria related to Part C is at issue, approximation of distance is — — unacceptable)]15.302(3)(b)] (reyleed 04121197) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C - SYSTEM INFORMATION Property Address: Ili Kentean Dr.Barnstable Owner: McNulty Date of Inspection:V4199 FLOW CONDITIONS RESIDENTIAL: d./bedroom for S.A.S. Design flow: 220 g p Number of bedrooms: 2 Number of current residents: e Garbage grinder(yes or no): No Laundry connected to system(yes or no): Yes - Seasonal use(yes or no): No Water meter readings,if availabie:(Iast two(2)year usage(gpd): rda , - Sump Pump(yes or no): No Last date of occupancy: nla I COMMERCIALANDUSTRIAL: , Type of establishment: nla Design flow:0 gallons/day t Grease trap present: (yes or no) Nc Industrial Waste Holding Tank present:(yes or no) No Non-sanitary waste discharged to the Title 5 system:(yes or no) No Water meter readings,if available: n1a Last date of occupancy: nfa ' OTHER:(Describe) roe i Last date of occupancy: ` .GENERAL INFORMATION PUMPING RECORDS and source of information: ' Na System pumped as part of inspection:(yes or no)No If yes,volume pumped:0 gallons Reason for pumping: Na TYPE OF SYSTEM x Septic tank/distribution box/soil absorptions system , Single cesspool Overflow cesspool Privy Shared system(yes or no) ( if yes, attach previous inspection records,if any) I/A Technology etc.Copy of up to date contract? Other: APPROXIMATE AGE of all components,date Installed(if known)and source Information: 1994 Sewage odors detected when arriving at the site:(yes or no) No (revlaed 0412767) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 16 Kentean Dr.Barnstable } Owner: McNulty Date of Inspection:214198 SEPTIC TANK: x (locate on site plan) Depth below grade: 2' Material of construction:x concreate metal FRP Polyethylene—other(explain) If tank is metal, list age ma . Is age confirmed by Certificate of Compliance No (Yes/No) Dimensions: t•9'6"H5T'w4'10" Sludge depth:2" Distance from top of sludge to bottom of outlet tee or baffle: 25" Scum thickness:a Distance from top of scum to top of outlet tee or baffle:5" Distance form bottom of scum to bottom of outlet tee or baffle:a " How dimensions were determined: measured Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert, structural.integrity, evidence of leakage, etc.) Septic tank and all components are structurally around and functloning properly.Recommend pumping every one to two years. GREASE TRAP:_ (locate on site plan) Depth below grade: rda Material of construction: _concrete_metal_FRP_Polyethylene_other(explain) Dimensions: rda Scum thickness:rda Distance from top of scum to top of outlet tee or baffle:rda Distance from bottom of scum to bottom of outlet tee or baffle: We Date of last pumping;,,, Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage,etc.) nfa BUILDING SEWER: (Locate on site plan) } Depth below grade: 2'a Material of construction: cast iron x 40 PVC_other(explain) Distance from private water supply well or suction MOO Diameter: 4„ Qmments: (conditions of joints,venting,evidence of leakage,etc.) ` f (revised MUST) f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM , PART C SYSTEM INFORMATION (continued) " Property Address: 16 Kentean Dr.Bamstable Owner: McNulty Date of Inspection:214198 TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade: rre Material of construction:_concrete_metal_FRP_Polyethylene—other(explain) Dimensions: rde Capacity: We gallons Design flow: rda gallons/day Alarm level:_nra Alarm in working order?_Yes—Nos Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) We „ f DISTRIBUTION BOX: x (locate on site plan) Depth of liquid level above outlet invert: liquid level wUhbottomofpipe. Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or.out of box etc.) D$ox Is structurally sound. PUMP CHAMBER: (locate on site plan) Pumps in working order:(yes or no)No Alarms in working order(yes or no)_ve: Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) We (revised 04/2V97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 16 Kentean Dr.Barnstable Owner: McNulty Date of Inspection:21419E SOIL ABSORPTION SYSTEM.(SAS):x (locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods) „ If not determined to be present,explain: rda Type: leaching pits,number: oneleachpn leaching chambers,number:rue leaching galleries,number: rda leaching trenches,number,length: nta leaching fields,number,dimensions:nh overflow cesspool,number:nta Alternate system: nra Name of Technology:_nra Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) Leach pR and all component¢are strueturagy sound and functioning property.Leach p@ never had more than 4'of water In It. CESSPOOLS: (locate on site plan) Number and configuration: rva Depth-top of liquid to inlet invert: nla Depth of solids layer: rUa Depth of scum layer: rda Dimensions of cesspool: nla Materials of construction: Na Indication of groundwater: nla inflow(cesspool must be pumped as part of inspection) rda Comments: (note condition of soil,signs of hydraulic failure,level of ponding, condition of vegetation, etc.) rda PRIVY: (locate on site plan) Materials of construction: nla Dimensions: rUa Depth of solids: nla Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) roa it (revised"77S97) - -- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 18 Kentean Dr.Barnstable McNulty 214198 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references, landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) ec�� (� Id � A6 ab �0 31 f o! 10 (nvb.d6V27A7} � Page � SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 16 Kentean Dr.Barnstable McNulty 214198 Depth of groundwater 12* Please indicate all the methods used to determine High Groundwater Elevation: Obtained from design plans on record. Observation of Site(Abutting property, observation hole, basement sump etc.) Determine it from local conditions Check with local Board of Health Check FEMA Maps Check pumping records Check local excavators, installers X Use USGS Data Describe in your own words how you established the High Groundwater Elevation.(MUST be completed) USGS maps and charts y page o[ (nvlad0411719T) l0 19 LO CATION SEW E PERMIT NO. VILLAGE .R �iNSTA LLER'S NAME i ADDRESS LE R U I L D E R OR OWNER DATE PERMIT ISSUED � � Y- 1-3 DATE COMPLIANCE IS"SUED s i "a CA w No �� .. FEs...�.�.�1. ...*.......... THE COMMONWEALTH OF MASSACHUSETTS dq BOARD OF HEALTH To I.V /.........0F...L ✓ lZw.sT�L 4. 46r' . I , _........ .... Appliration for Utz ntittl Workii Toniitrurtiurt Prrutit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: - �y .�[57-17.'.1'/�/ 2..VL= ......�/ ZN ST,Gf�3�....... .................................� ............-------•--------••-•---.......••---..... ............ ..... ............. Lo• - ddress or Lot No. ' ....w..� . ....... ..: S: y Z�7................................... ..........................� � ;,..... s:.........-----.................... Owner > .�\ Address W ../ .\ 0 Installer i - Address d Type of Building �ff,1 Size Lot.3s37.-......Sq. feet Dwelling—No. of Bedrooms....:_......Z.......................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ------ it t............ r;. 'No. of persons............................ Showers ( ) — Cafeteria ( ) a ��._.`. Other fixtures ............ Design Flow............. 3r.......................gallons per person per day. Total daily flow__.__.....__._..ZZ�........_._.......gallons. WSeptic Tank—Liquid capacity.LDaa..gallons Length.ff'�."... Width..!!'�_...:. Diameter______________ Depth.¢�8".. x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No------------- Diameter........Z�q Depth below inlet....... ........... Total leaching area.. 6 .....sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '-' Percolation Test Results Performed by.._.� Z17�0A_J 2- /-/4- . 2;S: Date..�,/?�.._19'3.-........ . aTest Pit No. LAG.7-4�!o.minutes per inch Depth of Test Pit....e� Depth to ground water........................ Gz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a •-••.....-••-•------------••••-•-•-•••••--•---••----•.......................•--••............•-----.-•--•-------.......-------------•--••-•------•-......--•- O Description of Soil.....52•,�_z¢....... 5 o/G...f.�_Lva4rl....-•-•-- ................. x 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 TLITI LL 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has issued by the board of health. Sid. •..............•---•-----------------......-----------••---....--------•-••-_•.. .......... Application Approveofthe _ ---••--•--- Date Application Disapprofollowing reasons: ......------•..•----- ---•-•---------------•-----....-•-•-•-•-••-•-•-•.....--••---•-------•-•--•..........---...-----...-----•.•-------------•--•---•------•-----•-•••------••-•••--•....--------•----•-......•••------------- Date PermitNo........................................................... Issued----------•---•-----------....._............--•-•------ ' I Date ------------ ----- -- -------- -- --- - - - ------ x k F3 - No.............:<:�'...... F�s............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH - .......70 1V^/.........OF...l5/47Z/V,5TA.;C3L�:'..................................... ApplirFatiun for Dispaii al Workii Towitrurtion unfit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: Location Address or Lot No. SIN//"T BA7z�v.S7AZ3� /174 S z, ............ ............... ............................................... ....................................... ..._.......... .--------------- •------ •-•------ Owner Address W Installer Address dType of Building Size Lot.-=4 3Z!......Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) PW Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) 04 Other fixtures ............................ W Design Flow.............-0-3 .....................gallons per person per day. Total daily flow.._......._.....Z Z0.................gallons. WSeptic Tank—Liquid capacity_/oa4.gallons Length..! .G_..... Width..4. .... Diameter................ Depth................ x Disposal Trench—No. .................... Width.....................Total Length.................... Total leaching area....................sq. ft. Seepage Pit No........... ...... Diameter........�p.�..._ Depth below inlet......4_....._.. Total leaching area...z: '7._....sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '" Percolation Test Results Performed by —5M7:4"`d....!1�:..94 �/.��.:S:.... Date...�,��4-�......._... as Test Pit No. L.4�_._74?0q minutes per inch .Depth of Test Pit----- Depth to ground water........................ Gti Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ •-----------------------------------------------•-------•-••----................--•-•--•....._--.............................................................. 0 Description of Soil---- ' Z �� 77�`U.S /G... .............................................................' ' /7 ?,� ................ x V -----------------------••------------......---......----------••----------•-----•--•----.....------.....----------------------------------•--------•-•••-••-••......-•-•_...- W x --- -------------- ------------------------•-----------•..._....------------------......----•-•••••-••••---•-•••-•-------•••••-•---•••••••-•••-------••••••••••••-•••--•••••......••--••-•----....--•--- 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 iITL% 5 of the State Sani - Code—The undersigned further agrees not to place the system in operation until a Certificate of Complianc t� ��h issued by the board of health. Sined-•--•------•••--•-••-•--•------•-•...................•--................ � mate ApplicationApproved ................•-•-----------...----•-•-••------•-••--•••-••••......•-------•--•-•-•----•--- Date Application Disapproved for the following reasons:_...---•----------------•---•---....-----•--•-•-------.._..--------------------.........._: .._...._......... ---------•-----------•----------------------•------•-------................------------•--•--..........--••••-•••----•-••-•-•••••-•-••-•-•-••••-•--•-•••--••---••••-•----------------•••....---••-.-•--- Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............. !. /...........OF.......... ......... (Irdif iratr of Tontphaurr IS IS TO CE�TI Y. That the, ividual Sewage Disposal System constructed (✓f or Repaired ( ) Installer at...................................................................................................................................................................................................... has been installed in accordance with the provisions of TITI E j of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated_............................................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..............•-•--•--....---•------.............---•••..........•-•---......... Inspector.................................................................................... ar THE COMMONWEALTH OF MASSACHUSETTS c� BOARD OF HEALTH IN.��...........OF........6A-1Z - /Z 7-4.04 tom' ............................................................... �S No......................... ...................... urk oatu#rttr#iian �rrmi# ��. sio ,is h y ............... ' rust epat> I iv loSewage Disposal System at No............. ......... t' .✓ Street .............. as shown on the application for Disposal Works Construction erm ..... Dated.......................................... /Y �I ........... ... ..................................................................................... _ DATE... ----------------------------••---- .................................. Board of Health FORM 1255 A. M. SULKIN, INC., BOSTON r - : f 4 i a 1�y Fg E *fo'a U` Z17 7w 4 la, Sf-Pf7C- f 72".K- f oo L_`caT "?•`i`c� r �n:�i�y►7G.tJ 6>i'7�/tf+ +'�"fa�xL�.��/ /�+'F}Ga,.1... PLC✓ .3'�k sM.1r a A/ Fv�sND/T7Yc�,�v ,�hh,b�ns �nr nas� AL.d�1 C . lS �c�ATE'` r�sv �:scac.�n eta �3S' Sffok✓/t/ f �. �' 3��ri�� E ae/ .4sv r> �s�!r � - ��+✓/✓�-u.M�"i u 7� a r i r i` —FL. . . •'�.a`-'. . ... . TOP OF FOUNDATION CONCRETE COVER CONCRETE COVERS •o- ''a 4"CAST IRON �� . PIPE (OR 12 MAX. 12"MAX. 4°ORANGEBURGdOR EQUIV) PITCH TCH1— MIN. PIPE- MIN. LEACH ° /4"PER. PITCH 1/4"PER.FT PIT c,n PRECAST o; �NVERT H 1 PIT OR LEACHING c •EL..S.3;��?.. INVERT INVERT ° . o s SEPTIC TANK S ¢� DIST. EQUIV. w c INVERT BOX . 3: �. . . .. . . GAL. INVERT ;? a 3/4"TO 11/2 o; EL S¢G`. .. EL� 4/. INVERT .,: w o o`o ELS3,7G ,. w �: STONEWASHED w .�,. •• �r� DIA PROR LE OF GROUND WATER TABLE SEWAGE DISPOSAL SYSTEM NO SCALE G- /9go SOIL LOG WITNESSED BY DATE 5�?P�� .. TIME E./o:3w A!7G!� ? •S BOARD OF HEALTH TEST HOLE I TEST HOLE 2 ENGINEER 7J77/7- So.0 s 9 DESIGN DATA NUMBER OF BEDROOMS . . . . . 'Z. . . . sz,z�s Wit_ s•�y� ,2,2.E TOTAL ESTIMATED FLOW . . . . GALLONS/DAY BOTTOM LEACHING AREA �. . SQ.FT. /PIT Ste, S4rA✓O SIDE LEACHING AREA �8� " . . SO.FT./ PIT GARBAGE DISPOSAL . ."o . . . (50% AREA INCREASE) TOTAL LEACHING AREA SQ.FT PERCOLATION RATE .!L s. PIA". MIN/INCH LEACHING AREA PER PERCOLATION RATE . Z?'. . SQ.FT, "�d. .WATER ENCOUNTERED NUMBER OF LEACHING PITS ./. !��T' "'/!''�'/ APPROVED . . . . . . BOARD OF HEALTH DATE . . AGENT OR INSPECTOR OF AS 4% R LL y PETITIONER SAprrAR%� Town of Barnstable P# V 3 3 6' De artment of Health Safety,and Environmental Services V Public Health Division Date I _ ! � 367 Main Street,Hyannis MA 02601 RAPIMABM /rA88.',iSI . ' — �� o Fee Pd.* Date Scheduled — S Time �, l DO.DD `Soil Suitability Assessment for Sewage Disposal Performed By: V S. Witnessed By: -.I , DvN1\►t F -- w.,'• , . , a ' a ::.::..:: ::.::... LOCATION.:& GENERAL INFORMATION :::::. Location Address Ig KFVE 4F_' : LMF— Owner's Name' G VMMA 61 VI D t MA- Address Assessor's Map/Parcel: M 351) P Z13 Engineer's Name VQ4%AAZP TVDD j 12,5. NEW CONSTRUCTION`_� REPAIR Telephone# 5 0 b &CI& ,31 W s Land Use LAwbj AREA- Slopes(°/0) 2_7 9C Surface Stones__�ID•N E i Distances from. Open Water Body, 1 DD ft Possible Wet Area h R Drinking Water Well>I DD It i 'Drainage Way. ft Property Line ,S+ ft Other ft 'SKETCH:(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands in proximity to holes) E. Z_ \ 90' llpr 4 (O fa sF $ T� 144,05 A c lI�Q FIT- "6 ,4 : Y �f� Parent material(geologic)'&kCAL TILL_ Depth to Bedrock Depth to Groundwater`Standing Water in Hole: k& Weeping from Pit Face Estimated Seasonal High Groundwater t ::.:»:::::::::•D ................................................A.........T....E.......:.`..`.:..:;...:....;:.:...: .RSONHIT WRM :: ;' :..E ............ �.A..... O ........................................Method Used: ........ Depth Observed standing in obs.hole: in. Depth to soil mottles: in. ( Depth to weeping from side of obs.hole: in. Groundwater Adjustment_ @. Index Well# -Reading Date: Index Well level..--- Adj.factor Adj.Groundwater Level_ >': ::: < <PERCULATION:: :EST vale : r Observation Hole# ( 51FE ANALYS 15 Time at 9"' Depth of Perc'! Time at 6" _ Start Pre-soak Time Q Time(9"_6") a r End Pre-soak = Rate MinAnch Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back—� Copy: Applicant ' EE ..OBSERV' TIO HOL ;L G Hole::#. ..... :.D..;..: .:..;:.. A....:.....: �1:.::.:.: .... . . 0.:.....:.::.:.:.:.....:.. ._:....:: :. .:::.... : . :. :..::.:._.::.::..::::..::::.::..:.. .:.::.;.:::;:.;:.;:::.;: Depth from '� ''+ .'Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. % 6 F') -- Ir 5 4NOY � WIASSi VE --I O 2 ►.a0t4E VEKY FXIAL51-F- ,51 M017LES - Feh/-eoA/4tW Stir i-a4m � o S u AM )VC t fI.CIN t�t�v1 u/u Ift-19b C2• s 2rS Y . :`: DEEP:OBSERVATION ROLE LOG Hole# Depth from Soil Horizon Soil Texture-- Soil Color Soil Other Surface(in.). ,a (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. r . . . o ici- vill �v,taM I YK`yL NO'N6 44 K",V n.;: 3 o v f I Cfl R tD1(o 0 :,7 E,eYSF� 17-Zo4" G ' . Socr �� -� M'r*Lt3-FEW 7,S .1 ve FArj f • ,�El��viN _. DE OBSERYATI01 IOZ.E LQC:< >>:' Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Cons&;Mcy.%Gravel) ::.::: DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture, Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. u Flood Insurance Rate Man: Z6000 1 000 1 p Above 500 year flood boundary No_ Yes V Within 500 year boundary I No—Z Yes Within 100 year flood boundary No/ Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? YES If not,what is the depth of naturally occurring pervious material? 5 Certification I certify that on rA1.1. cj& (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training,expertise and experience described in 310 CMR 15.017. ~, Signature &&d�VDate i 5 C BERSIN ENGINEERING , PO BOX-1031 - EAST ORLEANS, MA 02643 508 255-7066. SAMPLE NO: 1 SITE: 18 Keveney Lane Cummaquid, MA January 9, 1999 .SIEVE PERCENT OV CUMULATIVE _ OPENINGS MESH NO`�s ;RETAINED r RETAINED rin/mm' ' � z_tA m j`' , FINER'` , . 0.187/4.75 4 4.5 4.6 95.4 0.0787/2.00 10 1.7 1.7 93.7 0.0117/0.30 50 77.9 78.8 14.9 0.0059/0.15 100 1.3.6 13.8 1.1 0.0029/0.075 200 1.0 1.0 0.1 0.0021/0.053 270 0.1 0.1 0.0 <270 0 0.0 0 Total Weight of Sample 98.8 100.0 REMARKS: SIEVE ANALYSIS OF FINE AND COARSE AGGREGATES: THE SAMPLE IS A MEDIUM SAND Ir Sampled By: Richard Judd BE File No: 99-1 Tested By: JZB Sheet 1 of 1 I