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2070 MAIN ST./RTE 6A(BARN.) - Health
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BaajStu'r_)F 1= 21?-( 25 /TOWN OF BARNST�ABLE LOCATION �� ( ,�1 D�t�2 f't SEWAGE# (o VILLAGE QL0 ASSESSOR'S MAP&PARCEL�X I — Z� INSTALLERS NAME&PHONE NO. 01\l4!i6 k, 507 SEPTIC TANK CAPACITY 50 y LEACHING FACILITY.(type)^ 0 ub (size) ID,L NO.OF BEDROOMS OWNER r` PERMIT DATE: c� L l O COMPLIANCE DATE: fill dia Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility K Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist � -within 300 feet of leaching facility) Feet FURNISHED BY �� ,i ,� � � 5 -� �� �� �9�� /� �L� � � � , _ � � _��� ,� � No. Fee Low THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION o TOWN OF BARNSTABLE, MASSACHUSETTS Yes \� ftplitation for Misposal 6pBtrm ConstrULtion Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 'a0�� wner's Name,Address,and Tel.No. Assessor's Map/Parcelrn K `/`• `iy` Installer's Name,Address,and Tel.No. �'�!77_ /77 Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size �•s� �G sq.ft. Garbage Grinder( ) Other Type of Building k7+o5fD-e—*T No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil e� �H Nature of Repairs or Alterations(Answer when applicable) A Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued this Board of jHe , i ed101 DateOwl Application Approved by Date Application Disapproved by Date for the following reasons Permit No. 5f)10 I-- Date Issued 6_7 No. WI mot `-.._.,�:, �t: # Fee} THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ftpliLatlon for M sposal 6pstem Construction Permit Application for a Permit to Construct( ) Repair( )),Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. `r %' wner's Name,Address,and Tel.No. Assessor's Map/Parcel irn 5 tG ) 'T i Installer's Name,Address,and Tel.No. �'�� l�77rj�77 Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size �, sCj 14G sq.ft. Garbage Grinder( `y Other - T e of Building F yp g ���/ n,�yT No.of Persons Showers( ) Cafeteria'( ) • 1 Other Fixtures ; Design Flow(min.required) gpd Design flow provided gpd Plan Date 1 Number of sheets Revision Date Title ;I Size of Septic Tank' Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) ``)�' N r , Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposaf system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued bxthis Board of Hea . i\ ed �/ Date Application Approved by j ///( Date iliaf Application Disapproved by _ Date for the following reasons i Permit No. r Date Issued ° ° HE COMMONWEALTH OF MASSACHUSETTS r4• BA STABLE,MASSACHUSETTS L ertifitate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) . Repaired( ) Upgraded( ) Abandoned( )by at 207,0 {1 has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No dated Installer Designer #bedrooms Approved design flow gpd The issuance of this perml shall not be construed as a guarantee that the system will(ftm do Is design . Date Inspector r - :- _ _ ---- ---- ---- _ _ -------- ff�� / r --- --------- --------------- No.4( 1 Fee �r V THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE, MASSACHUSETTS Misposar 6pstem Construction Vermit Permission is hereby granted to Construct( ) Repair( ) U gr de( ) Abando System located at JO 7 , and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construc ion ust be ompleted within three years of the date of this permit. Date Approved by 7/f 4i IS.G' 23'-6• I6'D• 2) 22 MOVE CEIITEGED ON ADO GADLEAGOVE C_ w C C u 1 I I ❑ A7 Ono FP. C 1 II GA 1 h AA I .I A � M I v L--------T(AULTEtl CEILING) - r--1 II I 1 • NEWe a DECK G.c• )'<• L a<. ..D• s•n In- 1.2 In•• I I A � , N I I LINEN A B �,LVJ• II CABIN J 1 I 4 L 11 (2)2W.6'6' —]� J N'I You J I� FRENCH r 1 I L` )I FIOLLEr 1 I N Jam^'• ' (2)2v.ce• Doons FAUc 6T-0 N NOOE wM1 I DOORS 2`6 NL:W KI EN TpXTH 'rL-----�—'I si 1 (EOVAL DIsrnNCE) (EQUAL Isr Nc' Q (VER I k ITCHEN L_ _;I N LAV T W/OW ER) PA14TRY REMOD. i STUDY T' 1 -- '' la _�_� --- I HALL INSTALLNEWFNEE• 0 —w ' STANDING GAS STOVE Y 2'<•.D'6'' EXIST. INTO EXIST.CIIIMNEY y (VENIf•Y ALL DETAILS 6 DIMENSIONS IN THE —— EXIST. EXIST. FIELD) ' ED ' la ,. OVEN L I E Y LIVING ; REMOD. _J DINING FLVTEO quvo I I REMOD.I i D ca COLUMNS " L--_-LrOYER I © A7 it t%1ST. EXIST. , , EXIST. EXIST. COVE A u6D ILING)I A A7 / NEW 6'apmra FLUTED M.G. FIRST FLOOR PLAN a LEGEND: EXISTING WALLS ©SMOKE DETECTOR C==7 CONSTRUCTION TO BE REMOVED ©cnReoN MONOXIDE DETECTOR ✓` _� J121-71-2NEW CONSTRUCTIONT ®Q REMODELING FOR: `,Waw ., ,`.A'`°°� " SCALE :COTUIT BAY DESIGN. LLC --�- � � �,Da,a,,,a DRAWING NO.: ollr ' 1/4"=1'0" 43 BREWSTER ROAD M . ((508 M-1 02649 RYAN RESIDENCE PH.(508)274-1166 "" DATE: FAX(508)539-9402 2070 MAIN STREET/RTE. 6A BARNSTABLE, MA 2/12/2014 Al Jn.p 2A. 10'4' ' ' I I � 1 1 1 1 I I ' A7 I i A7 1 1 I � � I I 1 I I I 1 I I 1 I A7 I I � 1 I vELux vsJw 1 "KYLIOIIT BENCH 1 11 ED s"Nwn. r' G-2— 1— HALF WALL -------------------� r--J 11 `t WOOPLASB nl D. v WDOOR AT L-1 I•DOOR T-0• `F-i-- _ _-__- ------ REMOD. L X(S Y/NE REMQ1J. BATH ,._T LL, H G [a % EXIST. 0 BEDROOM © D z CHIMNEY CAS F.R.FLUE.CHANCE FRAMING TO L COOE3 IF WOOD OD SUR BDRIANO r �1 —11EW OOF DELO W 1'ONI ICO H 2o,co• EXIST.,.PKT.DO01 BEDROOM CLOS. Ex1sr. II " CLOS. (Ai2C 66)-P NEW PORTICO B �� OF BELOW q A7 A6 A6 J7'.p 2"' SECOND FLOOR PLAN 2 o 4) /2e 1/.S�GY S SCALE: DRAWING NO.: ®Q COTUIT BAY DESIGN. LLC NEW ADDITION/REMODELING FOR: °da�x�a a,a gAxl a 43 BREWSTER ROADUw�NSa 1/4"=1'-0" MASHPEE MA. 02649 RYAN RESIDENCE "�A � i xOxrrw°t": A� ,wAx°°Ia °x« DATE PH.(508)274-1166 FAX(508>539-9402 2070 MAIN STREET/RTE. 6A BARNSTABLE, MA 2/12/2014 �x c „°«�.°t°°x NOTE:DROP TOP OF NEW FOUNDATION TO MATCH NEW SUBFLOOR W/THE EXISTING SUBFLOOR.(VERIFY IN FIELD IF REQUIRED). 15' INSTALL SN•NICUONUOLISA'u0•o.c I'M. 10%0- 22'-6' IW-0' WI SIMPSON BPS 5/9-3 BEARING PLATES PLACE BOLTS VU111"G'-15.OF EACN NEW B'CONCRETE FOUN0A110N 0• 0' Co.MER NIC TOA B'M WINUM BE PIN T-G' T-G' ]•L_ T.Q. tY-0' WALLS W/06VERTICAL CARS AT 40'o c.W'FROM OUTSIDE y,y FACE OF WALL.GRACE GO OARS /� '�•.�Y'�- &(1)IIORIZONTAL BM AT TOP, (r' NEW RETAINING WALLS MIDDLE IBDTTOMOF WALL _ a VERIFYALLMATERIMS, -- 1! ✓ / DETAILS,ETC.WI OWNERS L.f] WTI¢FIELD NEVI 10'a W CONCRETE FOOTINGS TV W/2-NEY .9•uc. V y P.T.0 x B P09T90'OIA I ]�REMOVE EXIST. CONCRETE SONOTUBES TO 8 4'0•BELOW GRADE.USE - EASEMENT SIM$PON ZAM%AOVGG PORT A7 1 I I WINDOW FA TEN JOISTS TO BEAM CAPSBACB OR ACED POST ("' W/SIMPSON ZMA%HB TIE A7 11 e` i 1 A7 r- I (41CONC,s1AV) I L 1II 10 EAL I I I I P.T,2x6SILLWISEAL-11 P.T.2.W.a a IG'v,c L-- — —1 B• 2 4 _ ---- CONC.WNLSVW TB'X IB' m , FOOTINGS I I ANCHOR BOLT DETAIL SCALE:12"=T•0" v.T.2x 10 LEDGEn DOMppLAC OLT�D TO SOLID tlLOCNNGWI(2)LEDGE Olr9 NOTE:UNDERPIN 9 cy 16'o.e W/JOISTS HANGERS Ai Oi/1 EN09 / .FOUNDATION WALLS AS REQUIRE EXIST -- r ERIFY IN FIELD ,/d r✓ E%ET.0 x6JOI5i3 I T� E%ISTTj�1 ExIST� ]x�J01St5 EXISTING CODCELLM'� ® ¢ �� T1� / /(, F.• � INSTALL NEW 2.10'!< Q ti b NEW}2.A GIRT q W/0 111'DGI. _I - CONC.FODTINGS A7WALLSON 1 I FIRST FLOOR ' b P.T.2 x B'a Ri 1f.'v.c. NOTE: C%IST.CHIL111EY " VERIFY ALL EXISTING FOUNDATION,SUPPORTS,BEAMS JOISTS AND FRAMING CONDITION IN THE FIELD.REPAIR \��TP.T.zx10•\ / OR REPLACE AS NECESSARY.CONTACT DESIGNER AND EXIST. STRUCTURAL ENGINEER FOR ADDITIONAL CONSULTATION S-0• 4 VAPOI20NIRIER OVER b I EXIST,SOILORPOUR2' I INSTALL TWO 0 FULL HEIGHT STUDS B TWD JACK EXIST.STONE FOUNDATION STUD AT EAC11 SIDE OF ALL ROUGH OPENINGS A A TI WALLS TO REMAIN REPAIR >7 T 0• ,0'vc B AS NECESSARY&REMOVE WINDOW A7 &REPAIR ALL ROTTED MBERS AG 2xGWALL NEW IY DIA CONCRETE SONOTUBES 2-P.T.2x10'P \ ON 2W DIA BIGFOOT FOOTINGS TO 4O'9ELWO GRADE.USE 9IMPSON 7'-0' ABU40 POST BASE JACN STUD (ROUGH OPEMNG) 30•-0• 2010' _ ROUGH OPENING DETAIL PLAN. SCALE:1/2„=1'-0" ®� COTUIT BAY DESIGN, LLC VREMODELING FOR: wsd°��s /s„°:'"°ID SCALE: DRAWING NO.: 43 BREWSTER ROAD �""� " RYAN RESIDENCE a 1 NI Zia"= 11-0" wLLcua9� ,•.�P I,vw,� MASHPEE MA. 02649 �PwAawi4N ;„"a% DATE PH.(508))274-1166 a;6,""w DATE: Aff FAX(508)539-9402 2070 MAIN STREET/RTE. 6A BARNSTABLE, MA' Ma" Ix6GA°MBL"° ? mbowwro,mu,•,rou.w�w. TOWN OF BARNSTABLE LOCATION "7 2 SEWAGE# VILLAGEASSESSOR'S-1VIAP&PARCEL ,71.I INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACIi ITY.(type) . 2 (size) NO.OF BEDROOMS'- OWNER r €`irt fa PERMIT DATE: l -!S l o COMPLIANCE DATE: ( , Separation Distance.Between the: Maximum Adjusted Groundwater Table.to the Bottom of Leaching Facility Feet Private Water Supply Welt and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) ] Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) Feet FURNISHED BYV. t _ 1 Page 1 of 1 Miorandi, Donna From: Daniel A. Ojala PE, PLS [downcape@downcape.com] Sent: Friday, November 12, 2010 9:13 AM To: Miorandi, Donna Cc: 'Arne Ojala' Subject: 2070 ROUTE 6A Donna: This email is to clarify the graphical representation of the perc test in the C4 Horizon. The C2 soil horizon was found to be identical in consistency and structure as the C4 horizon. Whereas the C2 horizon needs to be removed to get to the unsuitable C3 Silt Loam, we indicated the perc depth in the identical C4 horizon,so that an installer would not attempt to save the thin C2 horizon. We feel that the soil test form indicating the material in the C2 and C4 is the same and the clarity of removing down'to the 94"-96" level mandate the plan be drafted as shown. Please contact, me with any questions. Thanks, Daniel A. Ojala PE, PLS down cape engineering, inc. 939 Main St. Yarmouthport, MA 1-508-362-4541 x108 1-508-362-9880 fax downcape@downcape.com 11/12/2010 w 2 I Gy�t )C,E 5X1v - ,IT STACACK Y_ f i a r U ul _ n { AM r }e • N� NEW ENGLAND LAND SURVEY MORTGAGE INSPEMON (A Professional Land Surveyors NAME RYAMOD RYAN 25 SUTTON AVENUE 2070 MAIN STREET p Oxford, MA 01540 LOCATION PHONE: (508) 987-0025 BARNSTABLE, MA FAX: (508) 234-7723 SCALE 1"=80' DATE 5/30/2013 REGISTRY BARNSTABLE BASED UPON DOCUMENTARON PROVIDED. REQUIRED MEASUREMENTS WERE CERTIFY TO:SUN HOME LOANS MADE OF THE FRONTAGE AND BUILDINGS) SHOWN ON WS MORTGAGE OF A INSPECTION PLAN. W-OUR-JUDGEMENT ALL VISIBLE EASEMENTS ARE DEED REFERENCE:. )900/316 SHOWN AND THERE ARE NO VIOLATIONS OF ZONING REQUIREMENTS REGARDING STRUCTURES TO PROPERTY UNE OFFSETS (UNLESS OTHERWISE PA CK PLAN REFERENCE: 420/51 NOTED IN DRAWING BELOW). NOTE: NOT DEFINED ARE ABOVEGROUND POOLS. ORZlVMYS,OR SHEDS WRH NO FOUNDATIONS THIS IS A WE CERTIFY THAT,IHE S)ARE MDT WID t THE SPECIAL MORTGAGE INSPECTION PLAN; NOT AN INSTRLIMENT SURVEY. DO NOT USE NO. i To ERECT FENCES. OTHER BOUNDARY STRUCTURES, OR TO PLANT $ FLOOD HAI/3iD AREA SET:FIRM: SHRUBS. LOCATION OF THE STRUCTURE(S) MOWN HEREON 6 MER IN 2500010003D DT0 07/02/1992 COMPLIANCE WITH LOCAL ZONING FOR PROPERTY 11NE OFFSET REQUIREMENTS. OR IS DUPT FROM VIOLATION ENFORCEMENT ACTION FLOOD Ha1ARi?ZONE HAS BEEN DETERMINED BY SUE AND IS UNDER MASS. G.L TTTTF VIL CHAP. 40A.SEC. 7. UNLESS OTHERWISE NOT NECESSflPoIY ACCURATE UNTIL DEFWmVE PLANS ARE ISSUEDNOTED.THIS CERTIFICATION IS NON-TRANSFERABLE THE ABOVE CERTIFICATIONS ARE-MADE-WITH THE PROVISION THAT THE INFORMATION BY.HUD AND/OR A VERRCAL CONTROL SURVEY.IS PERFORMED. PROVIDED 6 ACCURATE AND THAT THE YEASUR04M USED ARE PRECISE EI.LVATIONS CANNOT BE DEFU MAM ACCURATELY LOCATED IN RELATION TO THE PROPERTY UNES. 233.19' N LOT 1 69,164 SF+ N 0 o 207 mat p„oorcLb 117.5T 97.32' MAIN STREET 'SUBJECT TO DOCUMWTS SET FORTH IN DEED. 0' 40' 8w 120' 160' 244W REQUESTED BY: CAPE COD TTTLE & ESCROW DRAWN BY: LAS CHECKED BY ALB SCALE 1�_80' FILE: 13MIP4012 Commonwealth of Massachusetts _. : Title 5 Official Inspection Form Subsurface Sewage Disposal System Form _Not for Voluntary Assessments 7y 2070 Main.Street . Property Address:- ... Pauline Jarvi -.Owner: Owner's Name information is West.Barnstable MA 02668 3/30/13 required for every : -r - - page. City/Town::: State Zip Code Date of rispectlon i Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at.the end of the form. Important:When:filling out foRns A. General Information on the computer; use only the tab key to move your 1. Inspector. cursor-do not.. Ricky Wright- use the return: key. Name of Inspector B & B Excavation,Inc. Company Name 14 Teaberry Lane Company Address :. Forestdale :. : :. MA: . 02644 City/Town State Zip Code 508-477-0653 S14595 I� Telephone Numbers License.Number B. Certification _ __ _ ... I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the:inspection. The inspection was performed based.on my training and experience in the proper function and maintenance of on site sewage disposal systems.. I am a:DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15000). The:system: : El Conditionally Passes ❑ Fails® Passes. � Needs Further Evaluation by the Local:Approving:Authority 4/1/13 4—0: Inspector's Signature Date The:system inspector shall submit:a copy of this inspection report to the Approving Authority(Board of Health or:DEP)within 30 days of"completing this inspection. If the system is a shared system or has a design.flow of 10,000 gpd or greater, the inspector and the.system owner shall submit the... .. _ . report to the appropriate regional office of3theZ P. The original should be sent to the system owner and copies sent to.the buyer, If a'pplicabie,and_�theapproving authority. . .::._..... .. This report only:describes conditions at the time.of inspection and under the conditions of use at that time..This inspectionfdoe� not address how.the system.will perform in the future under the same or different:conditiorir :of i ead _.. .. ..... .... _.. _. 01 t5ins•11/10 Title 5 Official Inspection For urface Sewage Disposal System-.Page 1 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 2070 Main Street Property Address Pauline Jarvi Owner Owner's Name information is required for every West Barnstable MA 02668 3/30/13 page. City/Town 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: 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 2070 Main Street Property Address Pauline Jarvi Owner Owner's Name information is required for every West Barnstable MA 02668 3/30/13 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 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•11/10 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 wM 2070 Main Street Property Address Pauline Jarvi Owner Owner's Name information is required for every West Barnstable MA 02668 3/30/13 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil 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 El ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y day flow t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 2070 Main Street Property Address Pauline Jarvi Owner Owner's Name information is required for every West Barnstable MA 02668 3/30/13 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. An portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® YP P P Y P PPY 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 CM 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 11 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 P 9 P Y 9 L . Commonwealth of Massachusetts .. .. . : Title 5 Official Insple ion Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 2070 Main Street Property Address:. .... ... :... Pauline Jarvi Owner Owner's Name ' information is West.Barnstable MA 02668 3/30Y13 required for every page. City/Town::: State Zip Code.: Date of Inspection C. Checklist . Check if following.have been done:.You must indicate":yes" or"no".89 to each:of the following: Yes: No _.. Pumping Information was provided by the owner, occupant, or Board of Health ❑ N 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? El Z Were as built.plans of the system obtained and:examined?(If they were not available note as N/A): ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® : ❑ Was the site inspected for signs of break out? .® ❑. . Were all system components, excluding the SAS, located on site?. . .... .... ® ❑ Were the septic tank manholes uncovered, :opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? Was the facility owner(and occupants:if differentfrom 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)1 D. System.Information Residential.Flow Conditions: Number of bedrooms(design.):: 5:: : Number of bedrooms(actual_). 5 DESIGN flow based.on 310-CMR 15.203.(for example: 110 gpd x#of bedrooms): . 550 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage:Disposal System-:Page 6 of 17 f Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 2070 Main Street Property Address Pauline Jarvi Owner Owner's Name information is required for every West Barnstable MA 02668 3/30/13 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 1 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 ears usage d n/a 9 ( Y 9 (gP ))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: current 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: l5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° 2070 Main Street M Property Address Pauline Jarvi Owner Owner's Name information is required for every West Barnstable MA 02668 3/30/13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: 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): Lt5,r,s•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 2070 Main Street Property Address Pauline Jarvi Owner Owner's Name information is required for every West Barnstable MA 02668 3/30/13 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: 2010 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 2' Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): >20 Distance from .private water supply well or suction line: I feet Comments(on condition of joints, venting, evidence of leakage, etc.): At time of inspection building sewer appeared to be in working order -no sign of leakage or blockage. Septic Tank(locate on site plan): Depth below grade: 1 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ® No Dimensions: 1500 gal Sludge depth: 6" t5ins•11/10 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 2070 Main Street Property Address Pauline Jarvi Owner Owner's Name information is required for every West Barnstable MA 02668 3/30/13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 31" 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 16" How were dimensions determined? scour stick Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): At time of inspection septic tank appears to be structurally sound. No sign of back-up. 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 um in P p 9 Date t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 2070 Main Street Property Address Pauline Jarvi Owner Owner's Name information is required for every West Barnstable MA 02668 3/30/13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: .gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 2070 Main Street Property Address Pauline Jarvi Owner Owner's Name information is required for every West Barnstable MA 02668 3/30/13 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 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): At time of inspection d-box appears to be in good condition. 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.): Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 2070 Main Street Property Address Pauline Jarvi Owner Owner's Name information is required for every West Barnstable MA 02668 3/30/13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ® leaching galleries number: 7-3050's ❑ 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.): At time of inspection leaching appears to be in working condition. No sign of hydraulic failure 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 l5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form. Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 2070 Main Street Property Address Pauline Jarvi Owner Owner's Name information is west Barnstable MA 02668 3/30/13 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 20.70 Main Street Property Address Pauline-Jani Owner Owner's Name information is West Barnstable MA 02668 3/30/13 requiredd for every page. City/Town. State Zip Code Date of Inspection D. System Information (conit.) 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 El "drawing attached separately �B - :. A 3 3 00O ay1 s - A4; UU' e t�tt t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 2070 Main Street Property Address Pauline Jarvi Owner Owner's Name information is required for every West Barnstable MA 02668 3/30/13 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high round water: >144" p g g 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: 10/15/10 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: plan on file Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 2070 Main Street Property Address Pauline Jarvi Owner Owner's Name information is required for every West Barnstable MA 02668 3/30/13 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 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 r - - Town. of Barnstable Barnstable A14medca Cdp - Regulatory Services Department • BA MsrnBM " Public Health Division 1639. �0� m 200 Main Street, Hyannis MA.02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 70083230000251783142 9/07/2010 ZI Aili P. Jarvi Trust O D 2070 Main Street West Barnstable MA 02668 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 2070 Main Street, West Barnstable MA was last inspected on August 10, 2010, by Frank Nunes III, a certified septic inspector for the State of Massachusetts. The inspection"of the septic system showed that the system."Failed"under the Ruidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Backup of sewage into facility or system component due to 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. . t You are ordered to repair or replace the septic system within Sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadlirie,period will result.in future enforcement action. PER ORDER OF THE OARD OF HEALTH Thomas McKean, R.S., CHO Agent of the Board of Health Commonwealth of Massachusetts Title .5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M , 2070 Main St Property Address Jarvi Owne sr' Name W.Bamstable MA 02668 8/9/10 City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. A. General Information f 1. Inspector. Frank Nunes III Name of Inspector saa Company Name 25 Deer Ridge Rd Company Address Mashpee MA 02649 City/Town - - — - - --- -- State Zip Code _ 508.272.6433 Telephone Nu ber B. Certi ication I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training'and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority 8/9/10 Inspect6fs 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 Sewage Disposal System Form-Not for.Voluntary Assessments 2070 Main St Property Address Jarvi Owner's Name ` W.Bamstable MA 02668 8/9/10 CitylTown State Zip Code Date oflnspection 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: Systrem Fails. Obvious signs of backup at cesspool and trench off cesspool is charged with effluent at this time.Any single cesspools which also serve home_would also be considered a"Fail" B) System ConditionallyPasses: ❑ One or more system components as described in the"Conditional Pass"section heed 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: n/a ❑ 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 El obstruction is removed I Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 2070 Main St Property Address Jarvi Owners Name W.Bamstable MA 02668 819/10 City/Town State Zip Code -Date of lnspedion B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ distribution box is leveled or replaced ND Explain: J n/a ❑ 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 ❑ obstruction is removed ND Explain: n/a C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in-order to-determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CHAR 15.303(1)(b)that the system is not functioning in a.mannerwhich 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 salt marsh 4 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 2070 Main St Property Address Jarvi Owner's Name W.Barnstable MA 02668 819/10 City/Town State Zip Code Date of Inspection B. Certification (cunt.) 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 Jiggered.A copy of the analysis must be attached to this form. 3. Other. n/a D) System Failure Criteria Applicable to All Systems: You must indicate"Yes", or"No"to each of the following for all inspections: Yes No 0 ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool El 0 Discharge or ponding of effluent to the-surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ 0 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 67:below invert or available volume is less than Y2 day flow El Z Required pumping more than 4 times in the last year NOT due to clogged or. obstructed pipe(s). Number of times pumped: ❑ Z Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ 0 Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Commonwealth of Massachusetts Title 5 Official Inspection Form , Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 2070 Main St Property Address Jarvi Owner's Name W.Bamstable MA 02668 8/9/10 Cityrrown State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems(cunt): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. El Z 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 El ❑ 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 El 1:1 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 Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments , 2070 Main St Property Address Jarvi Owner's Name W.Barnstable MA 02668 8/9/10 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? 1 ® ❑ 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 ofscum? ® ❑ 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- 0 ❑ 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 2070 Main St Property Address Jarvi Owner's Name W.Barnstable MA 02668 . 8/9/10 Cityrrown State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms(design): 4 - Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 440 Number of current residents: 1 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? El Yes ® No Water meter readings, if available(last 2 years usage(gpd)): -- - - --- Sump pump? ❑ Yes ® No Last date of occupancy: occupied Date Commercial/Industrial Flow Conditions: Type of Establishment: n/a_ 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 n/a Other(describe): f Commonwealth of Massachusetts Title 5 Official Inspection. Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 2070 Main St Property Address Jarvi Owner's Name W.Barnstable MA 02668 819110 Cityfrown State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: Pumped about 1 yr ago per 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: El Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system(yes or no) (if yes,attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the 1/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ® Other(describe): Single cesspool W/leach trench added in 1985 Approximate age of all components, date installed{if known)and source of information: Original cesspool w/new leach-trench 1985 per BOH file. Were sewage odors detected when arriving at the site? ❑ Yes 0 No Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 2070 Main St Property Address Jarvi Owner's Name W.Bamstable MA 02668 8/9/10 Cityttown State Zip Code Date of Inspection D. System Information (cunt.) Building Sewer(locate on site plan): 3' Depth below grade: feet Material of construction: ® cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet feet Comments(on condition of joints, venting,evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: n/a feet Material of construction: ❑concrete ❑ metal ❑fiberglass ❑polyethylene ❑other(explain) If tank is metal, list age: years Is age confirmed b a Certificate of Compliance? attach a co of certificate) ❑ Yes ❑ No 9 Y � p - ( PY - ) ------------------------------------------- ---------------------------------- Dimensions: Sludge depth:- Distance from top of sludge to bottom of outlet tee or baffle 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 How were dimensions determined? Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 2070 Main St Property Address Jarvi Owner's Name W.Barnstable MA 02668 819/10 City/Town State Zip Code Date of Inspection D. System Information (coot.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): Pumping suggested every 3_yrs to,prolong the,rife of the system. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: 0 concrete ❑ metal ❑fiberglass : ❑ polyethylene El other(explain): n/a 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.): n/a Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal Q fiberglass El polyethylene ❑other(explain): n/a I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 2070 Main St Property Address Jarvi Owner's Name W.Bamstable MA 02668 8/9/10 City/Town State Zip Code Date of Inspection D. System Information (cont.) 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 andfloat switches, etc.): n/a "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 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 box, etc.): no d-box Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No f Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 2070 Main St Property Address Jarvi Owner's Name W.Bamstable MA 02668 8/9/10 Cityfrown State Zip Code Date of Inspection D. System Information (coot.) Comments(note condition of pump chamber,condition of pumps and appurtenances,.etc.): n/a 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.): Trench is charged w/effluent of this time r Commonwealth of Massachusetts Title 5 Official inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M , r 2070 Main St Property Address Jarvi Owner's Name W.Barnstable MA 02668 8/9/10 City/Town 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 under water. 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.): Cesspool w/obvious signs of failure. Stained soils around cover;staining on backside:of cover,muck and paper on top of outlet T, outlet line to trench fully charged w/effluent 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.): n/a f Commonwealth of Massachusetts Title 5 Official inspection Form Subsurface Sewage Disposal System form-Not for Voluntary Assessments 2070 Main St Property Address Jarvi Owner's Name W.Bamstable MA 02668 8/9/10' Cityrrown State Zip Code Date of inspection D. System information (corn.) 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. Liv\ i 1 a a r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 2070 Main St Property Address Jarvi Owner's Name W.Barnstable MA 02668 819110 City/Town State Zip Code Date of Inspection D. System Information (cunt.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: undetermined 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: System Fails. Ground water elevation undetermined L FROM :down cape engineering inc FAX NO. :150836213880 Nov. 22 2010 12:20PM P1 z mAI NtTCAUZ s KAfia. �'lr$�'1� dTie ��llaivi:�l�a>� I ' �:-'.�a-r�;_,�y= .Tk�,apr6uas �c.4�csiue,�ia•a;a:�asg ~ 20�Ia'1[.aira 8i'rc t't� lip_yrS�:¢Yn)i6,lylA 02601 Office: S09-962,460 Fa.;: =08-740-f,:104 ' fined:; elll�><�R:'RR)�.;frferr•d����ii�n�attnar�n]6'cro�-aan }:Paste: �1 l�' /0 S��a gc ll'er�nbu4#`�01 D ` l�J�1 Ar;����sa:rr'� 109 sr>�C11i'aa ec.d _.. L-.� _ > ! ��sugvaee•^ s i'1; .._ :h �aFs sr&Eca: 0��,ct �',YC_A.:✓1z ' ,O��n•essa I Go mt imind a permit to install a (date) r7 _s jtr�llex} septic systcv.at e / u- l t. .. ... -.... ._based on a design dium by }�— I certify that tI_ic septic system r(:fc rw-n"d above-sNaS i.n.stalled srobstantial ly according V the design, whir.}r voLy include minor approved ohaugas sucI1 as lateral relomdu)i,o-f the rlistrib-oti.on box and/or SFptic ta:flar. 1. certify rhat the septic: system vtt. reneed above ..T ,'T was i ;tailed with M re c;lan.ges (i.u, greater.than 1.0' lateral relocation of the SAS or any)7ellical. elocution of any compolient of the scplie system) but in acco.ucha .=with.State c1'r Local Rapnilation.s. Plan revi:.;ion oy. ccrtitied.as-built by designer tv follow. ~f Ains 1t�OFrr'3, rsnatire AFtNF W e. CfVIL u No 30792 ( esigxtc'r'S Signaltdc) (At['ix �p Hera) i �T.7 lLSF_-U,TtJBN T_f}:._ 4�II,L IN i U'F_ £1H_I,%UE + CT:TIT, '!EcJ d A� '�1 a,k: 1�f3 tiY�_.�1VJt� AS--11:101 9. .(:4ttb7 1s 73y'iJM DA1R..NIj3.AHL1✓',1E"UBL.14`HEALTH]@MSIIQ.rq, 'AH'ALVK Wilt I I Q:Iir,AUhlSc�ticlDesign.r,�C;crtif cliionFoun 3-�G-(il.cnc tel. (508)362-4541 939 main street rt 6a fax(508)362-9880 yarmouth port mass 02675 dOW,7 cope enofineeriaif, h7C structural design civil engineers&land surveyors Daniel A.Ojala,P.E.,P.L.S. Arne H.Ojala P.E.,P.L.S. ` September 17, 2010 Timothy H.Covell,P.L.S. land court Andrew R.Garulay,R.L.A. surveys Thomas McKean, RS site planning Director, Barnstable Health Department 200 Main Street Hyannis, MA 02601 sewage system designs Re: Jarvi, 2070 Route 6A, West Barnstable inspections Dear Tom: permits Please be advised that we have been retained by Pauline Jarvi to design an upgraded landscape septic system for her home at 2070 Route 6A. The test hole procedure is set for architecture September 21St. Sincerely, c SarakB. Ojala Down Cape'Engineering, Inc. cc: Pauline Jarvi Towu of Ba rnsta e „E �# IDepartrmCnt of Regulatory Services t mMgrAt♦LF� » Public Health Division Date 200 Main Street,Hyanuis MA 02601 16 l u /ao Uy Date Scheduled_ � Time ee 13d. ►oil Suitability Assessment for �'eipa e Disposal 1'crfonned Dy: Witnessed By: Ern✓ ' _ ]LOCATION & GENE,RAL INI+ORMATION Locntion.Address .a D?./��, O W2 j/ r..� Owner's Name w u�r�� � Address lJ Assessor's Map/Parcel: 01/7 Engineer's Namc (�U V0 NEW CONSTRUCTION REPAIR Telephone If C�UeJ "L? Land Use 3 I Slopes(Ira) Surface Stones `'/�(lL� Distances from: Open Water Body Almmm ft Possible Wet Arep ft Drinking Water Well�V ft Drainage Way ft Property Line ft Other Ft SKE''J CH., (Street name,dimensions of lot,exact locations of lest holes Sr here tests,locate wetlands 41 proxinuly to holes) T � . c P U A(/G. R, e FCp Y G�2 �7o 6A Parent material(geologic) ge/'a I�1/ �— Depth to Bedrock, Depth to Groundwater: Standing Water in Hole: NO ri 4� Weepiltg front Pit Pltoe N®N Estimated Seasonal High Groundwater DIC`IERXIINATION FOR SEASONAL, HIGH WAFER TABLE Method Used: �• Depth Obs?rved,s! ndurg t�o t,nlr. aN ,. .t,V�--. Depth to weeping from side of ohs:hole: _,�„,__l!t, C7roulldwnter Adjuslment„P I't. Index Well✓# Reading Date: Index Well level A41,ftletol'— Aaj,Otowidwater Level PERCOLATION 'I'EST , ilud� il,tm lu/►1 Observation Hole## linlent9'.'. ��•+ _� :_� Depth of Pcrc LD, 1'Imr at 6" /�•/,�A,� • Slar[Pre-soak Time @ • U 0 _ _ Time{9'-6'7 k ~ End Pre-soak x Rate Min./Inch4�4 Site Suitability Assessment: Sile Passed Si("Failed: Additional Testing Needed(YIN) '. Original',Public Health Division Observation Mole Data To Be Completed on Back---y-- -- *--'*If percolation test 1S to be conducted vVidlin 100' of wetland,you must first!uotlfy tlle. Barnstable C'onservtltion DiViSion at least one (1) week prior to begQllt➢lh-19- Q1S CPTICIPCR CFORM.DOC Depth from Soil Horizon Hole# � Surface(in.) Soil Soil Textures Color Soil (USDA). Other (Munsell) Mottling (Structure,Stones;Boulders, 04Z— L.5 j0 y2-4/Z Con istenc % ravel IZ-3O U- � C' z q o A) DREP OBSERVATION HOU LOG Depth from Soil Horizon Hole # Z. Surface(in.) Soil Texture Soil Color (USDA) Soil Other (Munsell) Mottling (Structure,Stones,Boulders, Consis ency %Gravel) 2- G� In5 - 's- D c v Z.5 =T- 7o — �q s. DE EEP ®BSE RVATION DOLE, LOG Depth from Soil Horizon # Surface(in.) Soil Texture Soil Color. (USDA} 5oi1 Other (Munsell) Mottling (Structure,Stones,Boulders. Corlsisteney 9a Orwell Depth from Soil Horizon �'®�` ®le# Surface(in.) Soil Texture Soil Color Soil (USDA) (M .. Other (Munsell) Mottlin g (Structure,Stones;Boulders, Consistenev °k Oravrll 1 I — - ]Flood rnsurance Rate lira Above 500 year flood boundary No— Yes _ , Within 500 year boundary No Yes. _ within 100year flood boundary No Yes . Depth o__ f Naturally Occurring) erviou,s mfiterlal Does at least four feot of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? P�--- „ If not, what is the depth of naturally occurring pervious material? Ce>cte�ca$lon I cel•tify that onQ (date)I have passed the soil evaluator examination approved by the Department of Environmental.Protection and that the above analycsis,was performed by me consistent with the required training, expertise and experience described in f0 CMR 15.017. �} Signature 14lz JiD�uC L.✓te� Date U Q Q:\S.EPTICU'ERCFORM.DOC r LOCATION SEWAGE PERMIT NO. r0 �111yS� VILLAGE 1 TA LLER'S NAME i ADDRESS BUILDER OR OWNER DAT-. E PERMIT ISSUED ' t7�� DATE COMPLIANCE ISSUED 3.4 19-5- _ '-`•''ems z t �N 2 �l)� JM -1��I�M�Iaool � d1 74=IAL'tN tVrq) n �Nl1stS�C3 . j'j a r sxv rnana r No... Fims....... 5..... © �1 THE COMMONWEALTH OF MASSACHUSETTS I BOAR® OF HEALTH *777U�n ..N........OF.... .............................. AvOratiun for Diupuua1 Hlorkii Tonotrurtiun Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ..... .................. .........•--.......... Location-Address n or Lot No. .L-------------•---•--- ................ ....................................................... Owner C Address ..--_. p............................ Installer Address d Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms.__Y....................... .Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures -•.•-----__-•--------------------- W Design Flow........... ..........gallons per person per day. Total daily flow.........!�rtuA..®................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--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by........................--•----------•-•-----•-••--•••------------------- Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ (a Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_-_______---._-_---___- a --•------ ..................................................................................................... O Description of Soil........... rn ....u� 7fn�!!- .._.tea. ��c �F.C?�, . x W ----------------------------- ------------------------...... . .afl......-:Tf2_ENCA---•--••-••----•-------- VNature of Repairs or Alterations—Answer when applicable_..... K)_ _._._ 't".._SN.. __.._sS !^'..... ------•--- / Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT=% 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance en issue b of "7�0�5�S ------ ------------ ----------•- •--........................... -_.. .. ........................... ApplicationApproved By........................----- ----•-- ............................. -•--......�...-------- Date Application Disapproved for the following reasons-------------•-----•---•---------------------•------................---------•--.........._......---...._....---- .............•-------•---•-•-•---••--......--•--._...----•-----...--=-•-•-------•--••-----••-----------•--•-•---------------------------•••-••---•---••--••--------------•-----•---------•-•--...._.... Date PermitNo......................................................... Issued_........................................................ Date No......................... Fxs.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH � h�-----...OF....................................... ........... Applira#ion for Bispasal Works Cfnntrurtiun .rrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: a0-7 7 AA •w ........ .....................-----G-j---'--C-------W.........l.--�--u-/---v.t.s...«. .`..e....----•-------------•--•-....------ .7 -- .....-----------.................... Location-Amass or Lot No. \ v' - >M A_ ..... �� --�-- =�.......J.�- ".....-----..`\....... ...............s�--J-----------........'...S--•--•--..�T�......--•---. Owner — Address ►W-a .......... �K � n� . ( S Zwcti ............... ............................ •............... ....... .....-P............................ Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building .. No. of persons............................ Showers � YP g --------•--•---•--------=- P ( ) — Cafeteria ( ) Other_fixtu es --••---------------........................................................----------- ••-•-•---•-•-••-----------•--- ............................. W Design Flow........... .......................gallons per person per day. Total daily flow......._.(-k_�:�_.�____...._.._....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--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ a ,.� Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ---•t ...................................•- D Description of Soil---------------C._1-�W.... `' 2 ........................................................ x w UNature of Repairs o Alterations—Answer when applicable b _.__ _�. ..___ _' ____W_3 ... �i`' '_. ---.................... a........-------------•-----------•-•----•-----------------------------------------....------------. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITL% 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance een�issueyb o�mith: Signed............................. �7........ ................................ ..............•-- Date ApplicationApproved By.................................................................................................. Date Application Disapproved for the following reasons:--------•------------------••------•--------•----------------•----------------....-------•---------------....._ .............•-•-•---------........................--------•------------------•-----•----......---•-----•..--•------------------------------•----••--------------------------------••------------•------- Date PermitNo....................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .........................................;OF..................................................................................... (Irdifiratr of Tiamplittnrr THIS IS TO CERTIFY,Jfha the Indivi ual Sewage Disposal System constructed ( ) or Repaired ( ) bY--------------------------------------------------�'! - - ---.... -•---------------- Iyaller at.............................--------------- J i . . ................................. has been installed in actor nce with the provisions of TITLE 5 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........................)13-2 --------------------------------- Inspector............. 7ETTS --- -&t.ld&� • ---••- -•-- •.J THE COMMONWEALTH OF MASSACHU BOARD OF HEALTH OF..................................................................................... Disposal rk� ��anotr � "' ;Fit Permission is hereby granted-------------------- ---- -- ------•----�•--- -----•--------....._•-----......................... to Construct ( ) or Repair ( ) an Individual e r ge Dispos Syst -- ----- ........------• ------------------•-------••-----••---.•-- . Street as shown on the application for Disposal Works Construction Permit No................. Dated._ .___ ..__......__.....______._..J Z al1thth DATE............. �... -g =='' = ....................... FORM 1255 A. M. SULKIN. INC., BOSTON C- Z Z � r � a ----- -- 31 00 o0 s % Z. s 1 � � lr• o m � z x �0 7 IL 1304 o•4 z6'a " ❑ � Q Z � GL ark ti d o n= m a � -, LEGEND SYSTEM DESIGN: SYSTEM PROFILE ALL SYSTEM COMPONENTS SHALL BE NOTES MARKED WITH MAGNETIC TAPE OR PROVIDE MIN. 20" DIAM. WAT RTIGHT (NOT TO SCALE) COMPARABLE MEANS FOR FUTURE LOCATION. 1. DATUM IS APPROX. NGVD 99 - ExIsrlNc CONTOUR GARBAGE DISPOSER IS NOT ALLOWED .ss' ACCESS COVERS TO WITHIN 6E`' OF FIN. GRADE PROVIDE INSPECTION PORT TO WITHIN 3" OF FINAL GRADE 2. MUNICIPAL WATER IS EXISTING X 9-9 EXIST. SPOT ELEV. DESIGN FLOW: 5 BEDROOMS ® 110 GPD = 550 GPD \ 11 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. 81 .0 MINIMUM .75 OF COVER OVER PRECAST 2% SLOPE REQ ED OVER SYSTEM 99 PROPOSED CONTOUR USE A 550 GPD DESIGN FLOW ' 0 �g8.4] PROPOSED SPOT EL. MIN. 8' DIAM. 4. DESIGN LOADING FOR ALL PROPOSED PRECAST UNITS SEPTIC TANK: 550 GPD (2) = 1100 TO BE AASHO H-1Q 4"0SCH40 PVC n/ TH1 PIPES LE\'EL 1ST 2' 2" DOUB�f WASHED PEASTONE 5. PIPE JOINTS TO BE MADE WATERTIGHT. �} TEST HOLE USE PROP. 1500 GAL. H-10 SEPTIC TANK , *83 7 OR GEO ILE FABRIC 76 5' Railroad 2> SLOPE of GROUND LEACHING: *83.5 79 0' 1�E �50o GAL H-�o6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH 3.7 + 10.25 1.85 .74 = 175 GPD SEPTIC TANK \78.759310 CMR 15.000 (TITLE 5.) W° ergo Al a SIDES: 2 (5 ) ) 4' uq. LEVEL Vo° °o°o$°000°o0.00o�'Ooo c 76.0' 0 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO L°° UTILITY POLE ACME OR EQUAL GAS TjAFFLE ° °o°o°o°'o°o°o o° BOTTOM 53.7 x 10.25 (.74) = 407 GPD 76.18' 76.01' BE USED FOR LOT LINE STAKING OR ANY OTHER FIRE HYDRANT $ 2 74.0' PURPOSE. Locus TOTAL: 786 S.F. 582 GPD o Cope Cod NOTE: NOT ALL SYMBOLS MAY APPEAR IN DRAWING too O O O`O O. O O ,o O O C 6" MIN. SUMP 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. 0 0 0 0 0 0 0 0 0 0 0 " H-20 3050 INFILTRATORS o Community 000000000010"Or'or'07 0000000c 12 MIS. INT. DiM.., .. ., r. ., Col%ge o USE (7) H-20 3050 INFILTRATORS WITH 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED 2' STONE AT ENDS AND 3' AT SIDES s" CRUSHED STONE OR MECHANICAL 3/4 TO 1 1/2 DOUBLE WASHED STONE � WITHOUT INSPECTION BY BOARD OF HEALTH AND � COMPACTION. (15.221 [2]) PERMISSION OBTAINED FROM BOARD OF HEALTH. OVERALL DIMENSIONS TO OUTSIDE OF STONE: 53.7' X 10.25' 7, �� O Route 6 THE INSTALLER SHALL VERIFY THE 10. A SHALL RESPONSIBLE FOR CALLING LOCATIONS OF ALL UTILITIES AND ALL DIGSAFE (1-888-344-7233) AND VERIFYING THE IJ6 BUILDING SEWER OUTLETS AND LOCATION OF ALL UNDERGROUND & OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF WORK. ELEVATIONS PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM ( 1 +X SLOPE) (5•4 X SLOPE) ( 1 X SLOPE) 11. ANY MA 32' REMOVED U5S BENEATH MAND RAROUND OTHE PROPOSED BE APPROVED DATE BOARD OF HEALTH FOUNDATION SEPTIC TANK 48 D' BOX 31 LEACHING O G OM GROUNDWATER & FOUND 67.0' LEACHING FACILITY. LOCUS MAP FACILITY NO GROUNDWATER FOUND 38' 12. EXISTING LEACHING FACILITY SHALL BE PUMPED AND NOT TO SCALE REMOVED OR PUMPED AND FILLED WITH CLEAN SAND. ASSESSORS MAP 217 PARCEL 25 EXIST. DWELL. TEST HOLE LOGS ENGINEER: ARNE H. OJALA, PE, SE WITNESS: DAVID W. STANTON, RS DATE: 9/21/10 x 78.48 PERC. RATE _ < 5 MIN/INCH CLASS I SOILS P# 13058 o.. Q ELEV. ELEV. 79.0' o" Q 79.0' A A 5' REMOVAL OF UNSUITABLE SOIL REQUIRED AROUND PERIMETER OF LEACHING FACILITY, LS BLS DOWN TO SUITABLE SOIL LAYER. REPLACE WITH CLEAN MED. SAND, TO MEET 12" 10YR 5/2 10" 1 OYR 5/2 SPECIFICATIONS OF 310 CMR 15.255(3) IX B B _ �--77-'�3_ 76.87 W ��8.35 - 7T82 _T779 30" 10YR 5/6 32" 10YR 5/6 LL 78.36 /M S MS / • 54" 2.5Y 6/4 - , 55" /2.5Y 6/4 BENCHMARK C2 C2� Ix 78.76 / \\ NAIL IN �' X//LS /LS 14" OAK ELEV. = 80.2' 72" 2.5Y 6/6 70" 2.5Y 6/6 (W7.8:: �8 I((e .03 \\ (�s' 1 \\ �C3 C3 �79.55 \ Si LOAM Si LOAM X �� \ 96" 10YR 6/1 71.0' 94" 10YR 6/1 71 .2' �08 C4 C4 x 80.61 \ 9.0 x 80.2 \ 2 8 .17 PERC LS LS l 180.. MAP Y .06 / _ 144" 2.5Y 6/6 67.0' 144" 2.5Y 6/6 67.0' x7 x "N36 81.2 1.2 1.01�8 CLOTHESLINE x 8 86 x Q x 79.20 NO GROUNDWATER ENCOUNTERED 8 . � � � IN 30" P V L , /1 8�C.0. 0 0 x 80. " x(AI'LE `. 8 x LEGEND: = EXTENT OF REMOVAL x/82.36 Z8 EX. SASf__,t CPf` 82 Z I 2 83.10 x 82.16 x 83.45 x 8 . OIL 83.61 x 83.8 x 83.40 T x 82.4 EXIST. it 4. GARAGE x 06 SA 11 £�44.79 x x84. x -- TITLE 5 SITE PLAIN' x 84 INV OUT a ki INV OUT >gS 6¢-, .13 8 0 83.7t P VED -,,,83.63 k 84.1 O 83.5'f WA L \ OF EXISTING 84.96 Q x 83.25 \-/83. 7 ��x 83.35 DWELLING 00 FIFLOl o ELEV.LEW = 87.66 PAVED 84.57 2070 ROUTE 6A � 84 85.19 \ � DRIVE 1` WEST BARNSTABLE 84.56 84.33 x-g4 70 PREPARED FOR 184.68 1L 59 ACt 4- \� I PAULINE JARVI m N ` 9' 117 84.90 x 84.91 84.49 84.93 - OCTOBER 15, 2010 - _ - - 84.98 �JHOFMA kT\'IHOFMgss d 7 _ / - _ S�.S �� SsgOy ��� DANIEL q�yG Scale: 1"= 20' 9 .32 - - - _ - - - �° DANIELA. �N OJALq A _ - - - - - - - - _ - - VIL 4 OJALA _"5 - - No.40980 0 10 20 30 40 50 FEET SIDEW .7T5 `No.46 p SN OF /N OF � off 508-362-4541 x 88- - L7 y��P ASs�c ��'T 1 66"C fax 508-362-9880 DANIELA. DANIEL ��� I downcope.com o OJALA o A. RO c. Nad,0980 UT 6 A E CIVIL " OJALA down cape ellgi/leeriag� h7 . q ��� o ��� F 01 civil engineers F S T °S/ONA land surveyors J 1 939 Main Street ( R to 6A) DATE DANIEL A. CJALA, P.E., P.L.S. YARMOUTHPORT MA 02675 00-296