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HomeMy WebLinkAbout2260 MAIN ST./RTE 6A(BARN.) - Health 2260 Main Street (Route"'6A)' Barnstable {t ' A, `gyrF i` Y 0 A"= 237 043 r n I � . m Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ? Va 2260 Main St Rt.6A r4r Property Address Neil L Ringler DDS Owner Owner's Name -� information is -West Barnstable MA 02668 4-27-2019 required for every page. City/Town State Zip Code Date of Inspection Nj a.. 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 A. General Information �2 filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor-do not David J. Burnie use the return Name of Inspector III key. High Tide Septic Solutions ICI Company Name 3 Perry's Way Company Address E. Harwich MA 02645 Cityrrown State Zip Code 774-216-1440 S1386 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of � 5(310 CMR 15.000).The system:l0r , ��:• Di"'!D' 9,asses ElConditionally Passes ElFails �:. J. N : U ,! E ❑-T4&ds Further Evaluation by the Local Approving Authority 0 S13 s6 �f5�1INS? G pector s Signature Date-2019 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. l5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments y` 2260 Main St Rt 6A Property Address Neil L Ringler DDS Owner Owner's Name information is required for every West Barnstable MA 02668 4-27-2019 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 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: This system is for a dentist office only. The system is as follows. 2-2500 gallon H2O Concrete septic tanks both at normal operating level, one distribution box also at normal working level and 2 leaching gallies constructed of 500 gallon drywells , the drywells were dry. All components are H2O rated. 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 I I�� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 'y( 2260 Main St Rt 6A Property Address Neil L Ringler DDS Owner Owner's Name information is required for every West Barnstable MA 02668 4-27-2019 page. Cityrrown 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 Forth: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 2260 Main St Rt 6A Property Address Neil L Ringler DDS Owner Owner's Name information is required for every west Barnstable MA 02668 4-27-2019 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 ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �y 2260 Main St Rt 6A Property Address Neil L Ringler DDS Owner Owner's Name information is required for every West Barnstable MA 02668 4-27-2019 page. Cityrrown 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. ❑ ® 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. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 2260 Main St Rt 6A Property Address Neil L Ringler DDS Owner Owner's Name information is required for every West Barnstable MA 02668 4-27-2019 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? 0 ® Have large volumes of water been introduced to the system recently or as part of this inspection? El ® 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 different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption`System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): N/A Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): l5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 2260 Main St Rt 6A Property Address Neil L Ringler DDS Owner Owner's Name information is required for every West Barnstable MA 02668 4-27-2019 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: 2-2500 gallon septic tank tied together with tees. one distribution box and 12-500 gallon drywells for leaching, all are H2O components. r Number of current residents: Dentist Office 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)): yes Detail: Dentist office. 2018=35.000 gallons= 95gpd.......2017=45.000 gallons=124gpd Sump pump? ❑ Yes ;K No Last date of occupancy: Dentist Office Date Commerciallindustrial 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.): -1835.3 sq feet for leaching 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, available:if 2018=95gpd....2017= 124gpd t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments y� 2260 Main St Rt 6A Property Address Neil L Ringler DDS L Owner Owner's Name information is required for every West Barnstable MA 02668 4-27-2019 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Current Date Other(describe below): Dentist Office. General Information Pumping Records: Source of information: Per Owner estimated 2 years ago Was system pumped as part of the inspection? ElYes ® 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): 2nd 2500 gallon septic tank in series. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments '< 2260 Main St Rt 6A Property Address Neil L Ringler DDS Owner Owner's Name information is required for every West Barnstable MA 02668 4-27-2019 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: Plan on file BHD Sulllivan Engineering Co dated 1-16-02......000 issued 4-18-02 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 45" Depth below grade: feet Material of construction: ❑cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line: 10+' feet Comments(on condition of joints, venting, evidence of leakage, etc.): Normal as to what we could view. Septic Tank(locate on site plan): 6" Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain) 2-2500 gallon H2O with Iron Ring and covers 6" below stone parking lot. If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 2260 Main St Rt 6A Property Address Neil L Ringler DDS Owner Owner's Name information is required for every West Barnstable MA 02668 4-27-2019 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 40" Scum thickness 0 to 1" Distance from top of scum to top of outlet tee or baffle 20" Distance from bottom of scum to bottom of outlet tee or baffle 24+11 How were dimensions determined? Tape&estimated 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 does not need pumping at this time, no leaks and concrete looks good. inlet and outlet tees are in good condition. The tank should be pumped in about 2 years depending on usage. 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 t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form , Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 2260 Main St Rt 6A Property Address Neil L Ringler DDS Owner Owner's Name information is required for every West Barnstable -MA 02668 4-27-2019 page. Cityfrown 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.): Septic tanks inlet and outlet tees are in place. tank at normal level. 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-11110 Title 6 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 2260 Main St Rt 6A Property Address Neil L Ringler DDS Owner owner's Name information is West Barnstable MA 02668 4-27-2019 required for every _ page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert normal level Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box; etc.) Cover within 6"and effluent is at normal level 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: Located opened and found damp, no standing effluent in either gallie . t5ins•11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments °y 2260 Main St Rt 6A Property Address Neil L Ringler DDS Owner Owner's Name information is required for every West Barnstable MA 02668 4-27-2019 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: 12 per plan ❑ 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.): Opened and found damp, no standing effluent. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to iinlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 2260 Main St Rt 6A Property Address Neil L Ringler DDS Owner Owner's Name information is required for every West Barnstable MA 02668 4-27-2019 page. Cityrrown 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.): None 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 yy� 2260 Main St Rt 6A Property Address Neil L Ringler DDS Owner owner's Name information is required for every West Barnstable MA 02668 4-27-2019 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 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 ® drawing attached separately i t5ins•11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 'f 2260 Main St Rt 6A sv'y Property Address Neil L Ringler DDS N Owner Owners Name information is required for every West Barnstable MA 02668 4-27-2019 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: I ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated high depth to round water: 15' plus P 9 9 feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 1-16-02 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® , Checked with local Board of Health -explain: Plan on file dated 1-16-02 test hole no water at 15' ❑ 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 test hole shows no water at 15.0'the bottom of the leaching is 7.5, below grade. Test well AIW 247 Zone A& B both show the level at 20,7 and require no adjustment. This allows a seperation of 7 5'to estimated ground water. 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 1� - , -_Y_— � ter•{ \ rf y11yr_/ (/�/��.//J� �i � : '�r_"....-.. � �.rf-t`J +{ter'__—i ��'•--_. �-rt��4 T`� 1 F f "�.I- — � ;�'�.r rw.,j.�.-. ��.+....����M_rr��.��� .�. .`,_� ' r�•��,..= Y 1 _...�I...�_�..��.ram." � `��..�,_ '��....� •'-' _. i _- - -i-- ��.._ �.,.� .r...'.e_i..._..`.�. t _ ,.._p Y �`�.�.�; �_ #yam; �F '�- - "--"-f�+ + it , �_ � i � ,.•,_r �,.._.,.;�..:•._.....;---�_ ; ..�i .. r_�it—�.�- �t .f vt��_-rrrir��ff_.w,r.r.�w.__t_�!w��.,_.�.r�•»nr'v.-..� f tom_.-r._(`r���.r�6 ' �-srt_wt.� MA -17 - r t 1 i 1 ��• 77 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 2260 Main St Rt 6A Property Address Neil L Ringler DDS Owner Owner's Name information is required for every West Barnstable MA 02668 4-27-2019 page. Cityrrown 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•11110 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 17 of 17 TOWN OF BARNSTA.BLE 0 v LOCATION Z-Z4,d der., SY' Awn SEWA�E # 00� —lib VILLAGE ASSESSOR'S MAP & LOT 37'© INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY Sa- LEACHING FACILITY: (type) S—U C�►-/G-,r.11f (size) / Z NO. OF BEDROOMS BUILDER OWNE ���� ✓ PERMITDATE: O Z COMPLIANCE DATE: a U Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells.exist on site or within 200 feet of leaching facility) �� Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) , Feet Furnished by �Q 1 ��' � c�� r 1 S� �� " �-� ��, ,, � y,-, ��� � ��J I :� ` '" ,.�, .. ,�_ . � ._ �_ - � . �2� �i . � No. y�V U _d r Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppriration for 33i5pozar *p5tem Congtruction Permit Q Application for a Permit to Construct( )Repair(✓)Upgrade( )Abandon( ) []Complete System O Individual Components Location Address or Lot No.2%0 MAIN ST, 15ARNSTAIBLE Owner's Name,Address and Tel.No. NEIL L.R%9tv"1K DpS Assessor's Map/Parcel RO.Boat 747 I MRNS-T S SOS-31WZ-4b%S Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. KLcKey Cols-muc,TtpN -`•p01vAgTGRKWS SuLL V IJ EA161NEMN(a 38 RoSRRy t-MNE 7PARKER ROAD,Ro.Box(pSl �Y4t1r1i rJ0 — Og-4S�Z OST�rtuE Sog-�{Za•'s3`I Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building be4�3 OFrrK_E No. of Persons Showers( ) Cafeteria( ) Other Fixtures (o CHAIRS Design Flow (Zy8 gallons per day. Calculated daily flow IZ-00 gallons. Plan Date BAN 16.ZoOZ- Number of sheets I Revision Date Title SITS ?LAN I?(W oSItD SEPTIL VPCR�VU hT ZZtoo MWJ ST BARAISTR�LE N1� Size of Septic Tank Z- ZSOO 6At_ Type of S.A.S. IZ`-I& x 0(; LEAW%kco IFIELb yj IZ-500 GRI.- l.Ei1N6 G1iAw1Q6 Description of Soil (YMZIE5) O-e T'u_l.- !oo-foZ" 0-LME-L CSANDy l�Aln- ►'� •L E tJ - -lA BO-16" C,-LAYE►Z (CQh1t!S1E Ghg% c(V— 0_Z-LKj12► SoA2SE SAND Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of Health. Signed Date ts, %'L Application Approved by 0 Date u 2 IPA- Application Disapproved for the following reasons Permit No. )-U U U U Date`Issued U Z l •e `��,No. d d a '�G U 14 P y Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: t/ V Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Tipprication for Moozal *pgtem Construction Permit Application for a Permit to Construct(, )Repair(>/)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.22(,o MAIN ST 3ARNSTAbC,-_ Owner's Name,Address and Tel.No. NEIt_ t..P'�NUL &R pDS f Assessor's Map/Parcel 237(v4-5 kw RO.'gol( 74-7 CSARNSTA(3L[ 5o8-3G�Z~4685 + Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. M�.CKEy CO)JST?,U(J%()V SvLL%VNN ENGWEERW&, 3a ROo A?Y LANE 7PARKER ROAD,'p.o.%.I(.S`t Hyanrt�S 50 -509- 45�IZ 0S'TeRvwu-e Sob-428. 334y Type of Building: y. Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder( ) Other Type of Building T>.iA � O 'L,E No.of Persons Showers( ) Cafeteria( ) 16� Other Fixtures (0 UN\K 5 .Y Design Flow (Zyb gallons per day. Calculated daily flow IZ-00. gallons. Plan Date INN 1(c. Z0C L Number of sheets I Revision Date Title SITE ?LAN 1?RURoS>✓b SE;PT«. �P\ 6RA\�& NY ZZtoo MAIN ST, 13A10NS7kZLE Size of Septic Tank Z- ZSOO 6& Type of S.A.S. IZ-Ivy x 10(o' LEA(."*- F(ELb wl IZ-500 (off L LEAM1N(o CHAD 1t3E — Description of Soil NttikItS) O- FILL (oo-�Z' O-LANE2 CStWC�y LoA1n� �Z--11 " A'LXN E R SAt�IDy Lam 1-2 d' (Sl>NpY Lo - ��-56' C LAYtZ C�-LNJE�CoK�kS>r SAND Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 cf the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of H alth. C 1 Signed o-� �_'--two Date 'N Application Approved by. W"d, ­Iv" Date Application Disapproved for the following reasons + jn Permit No. �-o o - l U Date Issued / 2 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( graded( ) Abandoned( )by k, (Z eo.UN `<,.c at 2ZVa T lacy\ SN- Vrz b- has been constructs,in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. D007-l6 0 dated q Installer Designer The issuance of this pert shall not be construed as a guarantee that the sys will function as a gn d. Date n Inspector •V✓1 � r ---------------------------------—----------- No. d u U a -160 Fee So — THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS liq;pozat 6pgtem Construction Permit Permission is hereby granted to Construct( )Repair( "Up rrade( )Abandon( ) System located at -L-Z 6a M���- �� rs-7-��'-- and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this p- it. Date: Approved by 1�\ J - � v i ro a TOWN OF BARNSTABLE c� LOCATION - ZZ�d /c.w Sr`►3 SEW1 # #02 —/ (I VILLAGE �,�ee�w�Ser�IE ASSESSOR'S MAP & LOT 37'OY 3 INSTALLER'S NAME&PHONE NO. lake>, SEPTIC TANK CAPACITY -- 114 su LEACHING FACILITY: (type) rod h/1 6 (size) / 2- NO. OF BEDROOMS BUILDER OWNE!fir vt i PERMITDATE: 0 Z ' COMPLIANCE DATE: U Separation Distance Between the: I . Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility.(If any wells exist on site or within 200 feet of leaching facility) �� Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by Nr� I S\ J tits ,g,t Town of Barnstable Department of Health,Safety,and Environmental Services v �T Her Public Health Division Date /�.�/��f Q 367.Miin Street,I lyannis MA 02601 3 OARNB7AOLE, � - MAIr9. lEarNd" Date Scheduled ' U Time Fee Pd.11 00 61,6 y .. .. Soil SuiiabiNy Assessinelldfoil Seivage bishosal Performed By:—? Witnessed By: LOOt1 I ION 4 :G►I,NL,Itl1 L:INi+.OItMA'I`ION Location Address L2f�b rnn S>t �e 6A Owner's Name Address I SZ :5LAe.kc �ctn e • Px�rnSE.��\Q,MA Assessor's Map/Pnrcel: 231 0Ll Engincer'sNime 5u\11\1an F-(\ ' NEW CONSTRUCTION REPAIR Tcicphonc N Land Use ��`�i�(C./�i I'•t� Slopes(%) 0-30/0 Surface Stones Dist nnccs from: Opcn Water Body rt R Possible Wcl Area 500*. (t Drinking Water Well '506 fi . R Drainage Way It Properly Line 2�d R Other NIA Il SKETCH:(Strccl nnme,dimensions of lot,exact locations of test holes Rr perc tests,locate wetlands in proximity to holes) O I 12-Z d I - <Y I n I - (D a tz-► ea I al N 1.0 t ac ( 3 13 .66 AC . V l a Iq 05. ti Parent material(geologic) U ' Depth to Bedrock •<100 t - Depth to Groundwater: Standing Water in I Ioic: N Weeping from Pit Face ` ►�/�- Estinmlcd Scasonal high Groundwater 50' Ul '1' Zt1YIIlVA'1'ICJ1V X4OYt SEASONAL 1I1G7Y'WA`1' Yr'1'AT3 ,L Method Used. SEA ;I� Depth Observed standing in obskholc: in: I)pth to soil Ittot(les: Depth to weeping from side of obs.hoie: in. Groundwater Adjusuncnl n, Index Well N_ _ Banding Date:.__ `_ Index Wcll level Ad.i,factor Adj.Groundwater Level I'EIi OULA`I`ION 'I LS irate 4 t�IIE Observation llolc N 1 Z Time at9" I13'SZ C)*.LIZ Depth of I'crc - Titne at 6" Start I'rc-soak Timc a I U.1-7 k 0.1 Time(9"-6")- End Pre-sonk '.jL Rate Mill./Inch Site Suitability Assessment: Site Passed t.i� Site Failed: Afdditionaa[Tcsting Needed(Y/N) in: t'+�' O'MPV IQ Original: Public llcnith Division J Obsefvati n hole Data To Be 8ompfeted on 13aclt j Copy: Applicant rW s t q} 1)LLl +IJI3SHky', :.l><OIV L�LOC Depth from Soil Ilorizon Soil'lexture Soil Color Soil Other t Surface(in.) (USDA) (Munscll) Mottling (Structure,Sloncs,13oulderes. 0 V) I l_ �UMl avcl (Zoylder,:1 LOAM 10A1 I(O^I I`I Il c I&AKI `N? Jb I (O14 llEEI':OI3SLRyf1,'i'II�N IJOLL LOG ][Ile �# Z Depth from Soil Ilorizon Soil'l'exttrre Soil Color Soil Other • Surface(in.) (USDA) (Munscll) Mottling (Struclurc,Sloncs,noulderes. rr t— itnc rac Ll f— I. .L 9oMt sCou t D 5 ND M OA, f 1_( ' 1JD �o S ? 93 C COARSE SAMD IoI P, — Ll' (►1(#S +YZ�A`1`lON 1OL>rJ<LOO' Mule .. ..3 Depth from Soil Ilorizon Soil l'cxturc Soil Color Soil other Surface(ill.) (USDA) (Munscll) oltlin g (Structure,Sloncs,Uvuldcres. I i to re ° 'ravel O_ 2" 1 L-� SoM� i- r 5pV L K 7q-TZ„ A NDyo�mm IN 9Z- no" U LOAM Z-511 5/LI �- , Ito-IZ8 G' Co �sE �u`P � OUS�+;IVA,TZONJ 00 Depth from Soil Ilorizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Muiiscll)' Mottling (Struclurc,Slums,13onlderes. coll5iletter %Gravcl R Y flood Insurance Rate Map: Above 500•ycar flood boundary"-"No_ Yes�[ Within 500 year boundary No Yes Willi ill 100 year flood boundary No V/ yes le th of Naturally Occurring 'crviouS Matcrial Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption systcm11 _ If not,what is the depth of naturally occurring pervious material? I certify that on f i (dale)I have passed the soil evaluator examination approved by the Department of Environmental Protectioli and that the above analysis was performed by file consistent with the required train' ,expertise and experience described',in 310 CMR 15.017. Signature g .,200Z I ! SEPTIC SYSTEM DESIGN 1 t NOTE: Existing System to be 4z: ° Abandoned or Removed. Map: 237 * Design Flow Dentist Office:200 GPD/Chair c o 000 Parcel: 043\ _ -� /� e / / - 6 chairs= 1200 spd . -Septic Tank. LOT AREA• 40 50 SF Sized Q 200%of design flow = 2400 '1 '2 MIN ? / Use 2-2500 Gallon Tanks in Series W j�, EX. pLDG �;,- f � \ �P#io,l3y � -��— Leach Field . r Required Area=GPD/0.68 1765 sf- \ / O O �� / o- / Field Size=1Y-10"Width x Length Colo (� .\.� `. , 4 l / / Length= 106.0 ft .� _/a R .� / A px '=—Use 2-17-10")W fields with 6(six)500 gallon leaching chambers per field No Observed / / Area Provided= 1835.3 sf' 0 c l , All Components To Be H-20 Wetlands Within 100'/ f I ~ t � r I.Water Supply For This Lot is Municipal Water ¢ t 2 Location of Utilities Shown on This Plan Are Approx. I At Least 72 Hours Prior A EX. STONE ! c. to Any Excavation The Requir d RIGHT OF WAY Project,The ConlractorShall Make The Required Notification to Dig Safe(1-888-344 7233) 3. The Contractor is Required to Secure Appropriate -Permits From Town Agencies For Construction ' Defined by This Plan. oX '� 4. Install Risers as Requiredto'W hin 12!'of Finished Grade. � J 5.All Structures Bdried Four Feet or More or Subject 3S • ! �� SCALE: lft — „70t y0 to Vehicular Traffic to be H-20 Loading. 6, Septic System to be Installed in Accordance With 310 CMR 15.00 Latest Revision/And The Town of 5�i �� 50 For Data See Plan By Barnstable Board of Health Regul6tions ' J. Lapsley, Registered Land Surveyor 7. All Piping tobe Sch.40 PVC. Cape Cod Survey Consultants - I Finish Grade F Filter •Com acted Fill + G. 53' F.G. Fabric F P F.�. 50 �a s NOTE: If Remove&Replace i All Unsuitable Soils Within 5'of the 6L.SO' r �� y Outer Perimeter of the System. ' 2500 Gq�-X-oN 2500 Gallon Top EL 49.6 Leaehtn9 ? w w $EPT\L TANK • 3/4 -11/2 . 5L.49.8' 7\Q - Septic Tank E�'y9 ' r Chamber �.;::;: Bot.El. 4(s•0 a tDwDtevVo�l,ed ' i H-20 44. EL 49,G H-2.0 Stone o MIN �= Bedding as 12-10' 2_6MI14 Per Title 5 , $ATOM o� 'Ct:S i.,t1ol. -EL'j+•t • , DELVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM Ho��,NvwaTs�; CROSS SECTION OF CHAMBER 4 NOT TO SCALE. Not to Sale SITE PLAN Perc Test/Test Hole-Pi110,134 1/10IO2 + SElnc. P.Sullivan J.O'Dea z' OF - PROPOSED SEPTIC UPGRADE.=- ' T.O.B-Board of Health:David Stanton AT Test Test j Hole 1 T 3 � I'� • -o/e �li o eo FILL rest Hole z —�— - ,x97�9 2260 MAIN STREET i 0-77 mi so s7' O Sandy Loam 10 YR 4/1 0-48" FILL 72-74 O Sandy Loam 10 YR 4/1 BARNSTABLE, MA 62-71" A Sandy Loam 10 YR 5/6 48.50" 0 Sandy Loam 10 YR 4/1 • FILL 71-W' B Sandy Loam 2.5 Y 5/4 50-61" A Sandy Loam 10 YR 516 74-92" A Sandy Loam 10 YR 516 .0 i r $Y 80-96, C1 Coarse Sand 10 YR 7/3 61-7T B Sandy Loam 2.5 Y 5/4 `�-110 B Sandy Loam 2.5 Y 5r4 � SULLIVAN ENGINEERING 96 114 C2 Coarse Sand 10 YR fi/4" 72-93" C1 Coarse Sand 10 YR 713 110-128"_ C1 Coarse Sand 10 YR W3 No Water Encountered No Water Encountered '128-1sa' C2 Coarse Sand 10 YR 6/4 OSTERVILLE, MA Perc Test 96" 6.7 miMnch Perc Test 72" 6.7 min/inch No Water Encountered, DATE: JANUARY 16,2002 a ..-..�..-.. -.,. -. F