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2370 MAIN ST./RTE 6A(BARN.) - Health
aP 2370,MainStreet t TOWN OF BARNSTABLE LOCATION /0 4e. (eA SEWAGE # o10Il,, VIZLAGE ASSESSOR'S MAP & LOT2-5 110 � INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type(3 ize)��.��)C i O NO.OF BEDROOMS -W08l n Cf� BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE:- -7 ,L , Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and a hi g.. acility.9any wetlands xi t within 30I feet o 1 c 'ty) Feet Furnished by t t fl I- b-� � ► � - C�:1, ►b3 io n �� - (br? a3 70 MC-.^A� 4V4 , r . G. No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pplitatlon for Bisposai 6pstrm Construction permit Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.010 Ma O _,5:-C 21-64 Owner's Name Address,and Tel No. Assessor's Map/Parcel Installer's Name,Address and Tel.No. Desig&,' Nlge,Address,and Tel.No. PKrn Conte �s�r,�-3�31-1gG.�nn r°VP� 3`�9 Q.-he � un�-rD u Type of Building: �y Dwelling No.of Bedrooms Lot Size p sq.ft. Garbage Grinder( ) Other Type of Building 1i25tCA04b Q + No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3n, gpd Design flow provided 3---3n gpd Plan Date 4 1.08/to Number of sheets Revision Date TitleA2,396 Peak 44 Size of Septic Tank 16y 0 a/LV Type of S.A.S. O Description of Soil Nat e of Repairs o1r Alterations Onswer when applicable) �~e /c- i d it` a atiL Date last inspected: Agreement: The undersigned agrees to ensure the constructi n d mainte the ore descri ed on-site sewage disposal system in accordance with the provisions of Title 5 of th nv ent l Code nd not to p he syste in operation until a Certificate of Compliance has been issued by this Board o Signed JJJ Date 0/ -) Application Approved by n'1 Date Application Disapproved by Date for the following reasons Permit No._;��� 3 4 Date Issued a_ No. 1 / 1O 3 " Fee 16 0, THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 0(ppliLatlon for Disposal 6pstrin Construction Vertu Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.A3 7 n A(0 j 7 - -f (R f-6 Owner's Name,Address,and Tel.No. Assessor'sMap/Parcel D?3?, tlZ� /-� Bay" ChorIe5 1a04Arco- a3,)o Pa�/)Sfi i Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. - PK(n Coq+fnC--orS Inc_- 313 MA NgC GrauP, 3�9 Type of Building: f Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building 2e!5;62 41 No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) ) ��j0 gpd Design flow provided 33(o gpd Plan Date��� / (� Number of sheets Revision Date } Title Z3 7 D 1 C/�[�ou 4 6 A Size of Septic Tank /,W D //C) n Type of S.A.S.�� Description of Soil a'D Natpe of Repairs or Alterations Answer when applicable) P/ `c- /1 9 d n - ( r �.�b to Tr , ..3) l �s T / ' Date last inspected: Agreement: The undersigned agrees to ensure the constructiQnnd maintenance- the ore descri ed on-site sewage disposal system in accordance with the provisions of Title 5 of th nvi o en 1 Code rd�d not to - he system in operation until a Certificate of �`' �. Compliance has been issued by this Board oflljealt Signed Date �w Application Approved by M. Date Joe Application Disapproved by '` Date for the following reasons Permit No. 0 (k 7 4 V Date Issued q S_+`-------------------------------------------------------- ---------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Crrtifitatt of Compliance THIS IS TO CERTIFY,that the.On-site Sewage Disposal system Constructed( ) Repaired( Upgraded( ) Abandoned( )by n e— at A has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit K-01. dated-' Installer N m k[��-b) �n Des e<—�� #bedrooms 3 — Approved Qde�ign7flow 33 D gpd / The issuance of this permit shall not be c.nstrued as a guarantee that the•system w'1• p, designed. Date f © { � Inspecto ------------------------------------------------------------- ------------------------------------------------------------------------ ff�� No. V �t o Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Disposal 6pstem Construction permit Permission is hereby granted to Construct( ) Repair(yj Upgrade( ) Abandon( ) System located at U trC e fi 6 ri 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:Construction must be completed within three years of the date of this permit. Date - 1 �� CO Approved by �� Town of Barnstable Regulatory Services Richard V.Scali Interim Director K BABNStABGE M MASS, Public Health Division : Thomas McKean,Director " 200 Main Street,Hyannis,MA 02601 r� NJ a.» Office: 508-862-4644 Fax: 508-790- Installer::&,Designer-,Certificatron_Form Date: 10/2e/16_ Sewage Permit# . _,__Assessor's Map\P$�cel z37/22 Designer: _BSc Group, Inc. Installer: PKM Contractors, Inc:, Address: _349 Route 28, Unit D Address: 313 Hokum Rock Road West Yarmouth, MA 02673 East Dennis, MA 02641 On PKM Contractors, Inc..` was issued a permit to install a (date) (installer) septic system at 2370 Route 6A, Barnstable based on a design drawn by (address) BS.0 Grou Inc- _ �t�..__September 6, 2016_.... ;p, (designer) x I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State&Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required)was inspected and the soils were found satisfa f IN I c fy that the s t ferenced above was constructed:x ompltaace`with the terms - 'of e IAA a r val a if applicable) OF�JAN BRIAN. . y - _ a'; > YERGATIAN -(Installer s Signature) CIVIL ` 9 No.46206 0 G _ esl r s Si a e) (Affix p Here) .PLEASE.RETURN.TO..BARNSTABLE PUBLIC HEALTH DIVISION. _CERTIFICATE OF.COMPLIANCE WILL NOT. BE ISSUED.UNTIL BOTH THIS FORM AND AS BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION THANK YOU:: QASepticMesiper Certification Form Rev 8-14-13.doc To: Page 1 of 4 2016-09-28 16:118:16(GMT) 16176221533 From: BSC Group, Inc FAX COVER SHEET \ TO COMPANY FAXNUMBER 15087906304 FROM BSC Group, Inc DATE 2016-09-28 16:17:49 GMT RE 2370 Route 6A,Barnstable COVER MESSAGE Hi Mary Beth, Please let me know that you received thisfax and we are now complete.Thanks, Craig Craig A. Feld, PLS Director of Operations BSC Group<http://www.bsegroup.com/> 349 Main Street Route 28 West Yarmouth MA 02673 direct 617-896-4581 main 508-778-8919 cell 1 508-958-1619 WWW.EFAX.COM To: Page 2 of 4 2016-09-28 16:18:16(GMT) 16176221533 From: BSC Group, Inc ROOF AREA BH BED#2 BED#3 ATTIC :AREA PORCH EAVES ATTIC ROOF SECOND FLOOR DECK DINING .`. .. 3 SEASON. . ..BEQ1 RoomROOM LIVING I GA RAGE ROOM . . KITCHEN FIRST FLOOR BA :EVE. l T F L O J R=U N F1-N-1 S H EDP THE. BSC GROUP, INC OF 349 MAIN STREET- .NEST YARMOUTH MA. N FLQOR NEW PLAN '.' ..� ... DATE: 9/6/t 6 . f r BSC ► 50044,00 ROUTE 16A. qs BARNSTABLE. SHEET .1. OF.. 1 I BH BED#2 BED#3 SECOND FLOOR DECK' DINING' 3 SEASON BED#1 ROOM L ROOM LIVING KITCHEN GARAGE ROOM PORCH FIRST . FLOOR THE 88k GROUP, INC 349 MAIN STREET WEST YARMOUTH MA NONE FLOOR PLAN DATE: 9/6/16` BSC# 50044.00 k r ROUTE 6A BAR NSTABLE SHEET I OF I To: Page 3 of 4 2016-09-28 16:18:16(GMT) 16176221533 From: BSC Group, Inc .. .. . .., .. . . .....: .:... ... .. . . .. . . .... „ .._ ..:.. . . .. , . .. .. .., fie. ttrtineztt tt, £ Atti �,�*y I �C ....:'.-�.:'�'::1...,.....,-�:...a'.�.I_:1�:.�:.'...�:_.:....i.'....1..;.�,',..��-,��.'.:.'.i'-'.�..a..:.--,'��...I.....%..,.:,.1.:�...::.�.....�:1.I.-.X�...-..1%I:..-..,.'**.-.:�'..�, ,., . ,. . a�' 1 Y Cbt :. o �` ., . as ttract,Ftyuaois iuf,4 tlZ6©1, : a� $; Zi}ta Malu 5 . ... .... .. ,: :. t J r,: ?ate Scttedttled , r 4 , 1 . 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Ocx Weit•!t. ending L ate:: . L1dex lati taani .. 'Ail�.•4 tor.• _ ,;� Ac .:tlre�s�nttwdt r.i�sau�t.,,,,�, : a � itna, . t fj IDS obaervatlai►: JIKOWk !Iht of Pets: 't'lnus at 6" t-J`' P F ' TWO i' 601 Ptwsoak She Snktibl*AsaMmettt; .8 to Passed w. Sltp Faitto. Additions�l,Te�t pg M ce).('a'1t�1} c3rlginat: PubU Heath l7t bloi Obserydtnn 110.1c.Data Td:fir 6. "i6ile i on.B a k " oirolatiou test.1.s to sae u�t��an.ltiU bgvveflont�;you mi�s��rs� ic�gify��xO' ' Bar #tlile 6nnse�ratier �tfv��aattleost vxxc.�1) veelt prior to begpv=g., Q�1sntrrtc�n€tc:rorsM.�Ctc::` _._. 1 r To: Page 4 of 4 �.I�.7..--.7.....'4--':.-F-�-*.....*..'�......-.%,1'.'.--,-..,---I.--'.--�—��*-.....1...:I....�7.-.'7 I..'..........*.-M...'..-..:��,.%.-'.1u:--)�....V..........*��:..�..'.".'I�:...�.-...i—..4.�..,..�...%.�.q.�....%*...-'.%,.':*1.1..."....�...-.-r�.'..4-."..�I.*-........-.7....�.:..:..�.�I-. 2016-09-28 16:18:16 (GMT) 16176221533 From: BSC Group, Inc ..:.. ,, .-'�.�......I..4..........%t.....—.......-.'.".......�-..!I��.....-.......�-.�'.:..,...-......��'....�:...'--...7i O.6...��..*....�....�- .I--.-.�..—'..—..,7..'---..�.:...-,-....�-�.....j.:..l....,."-.*,,-......:..--.... ..... 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Salt Colo; ' • ill. sas Snrfeea{in (.t S13A) �ivinnsali� Ma[tFEn� :{g:tzactur t{ auld �,.. .: _ :. . .. ...... . .. ......... ... ... .. . .. ... .- , ,...._ ... . .. ....$ .. .. .. .. . - . . . ..-.:-'i'.:: . .... , . . . . .. .. A . _ R ► nt Rate IdTw Abava�il€f�rtsr cxf t�o�ind y N... `lea„ „ o d r a .d a W YCYn4 y d Within kOb pear JJuW boundary.3 tlh o :. LCa hYi�tiBty�c aarrl 1°sr°viaeae � : Y,feat of.ttatursll occurring pac�ic� s mtcYisl�xls^^<za sfl its�t�ervci e�grt��oscct for n ruhat is the dopth of:mtII44 W rioc�s maR�Ylai'� �canta . �n. ,tc,. C� .�:fd�te'�I h:a�e pssaezY the�c�xl calua#r�r e$atnit�stiar� �' �1 t�aie with ' - • ..-Icctfl. fat y ... b.ws$ erfcamied y ?Dc sttit ►t:cs ' twit s se tst xcatectiQn aa�€I th t;the abaye:1 tfft 15.31'� dlred teainirigx riwu use and c erle cep dcseriba�an tho ram , 1s QN s r'rt ITTOR PO ,j l i 4, Barnstable Town of Barnstable Regulatory Services Department A ' MMS.`E ; Public Health Division - 639 2007 200 Main Street,Hyannis MA 02601 Office: 508-862-4644 Richard V. Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO .-r s CERTIFIED MAIL# 7014 1200 0001 0358 4978 3 August 12,2015 Charles A. Lamarca PO Box 826 N Barnstable,MA 02630 RE: System #2 The septic system located'at 2370 Main Street/RTE 28, Barnstable;MA was last inspected on 7/24/2015 by James D. Sears, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Failed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following::. • Single cesspools automatically fail in the Town of Barnstable You are ordered to repair or replace the septic system within two (2)year`s from the date you receive this notification. Failure to repair/replace the septic system.withinlhe deadline period may result in future enforcement action. PER O ER OF THE BOARD HEAL H . Thomas McKean, R.S. CHO Agent of the Board of Health Q:\SEPTIC\Leuers Septic Inspection Failures or Future Ev1\2370 Rte6A Barn 2of2 aug 2015.doc Town of Barnstable BARN STA13M Regulatory Services Department , ptFD MA't A Public Health Division 200 Main Street,Hyannis MA.02601 Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 7/6/15 DEADLINES TO REPAIR FAILED SYSTEMS , (Town Code §360-44 and Title V: 310 CMR 15.000) An"x" marked in the ❑ is the failure criteria and associated repair deadline - 60 DAY DEADLINE CRITERIA. ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not;due to clogged or obstructed Pipe ❑ Backup of sewage into the house due to an overloaded or clogged SAS or.cesspool ONE (1) YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or pries below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑ Any portion of a cesspool within.50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO 2 YEAR DEADLINE CRITERIA Single Cesspool ❑ Any"conditionally passed systems" (broken cover, relocation-of a°pipe, relocation of a driveway due to H-10 components, etc) ❑ Leaching pit or cesspool with high liquid level, <12" below inlet(per Town Code §360-9.1) OTHER , Repair deadline: Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc Jul 30 15 09:58p p.18 ?3r7- �� Commonwealth of Massachusetts Title 5 Official Inspection Form . ' Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �a 2370 Rt 6A Front System (2of 2) � Property Address Charles Lamarca Iw1 U71 Owner Owner's Name information required for every West Barnstable MA 02668 7-24-16 , page_ City/Town State Zip Code Date of Inspection rp I:b 1 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 filling out forts `\�����tµlOF r 4oi����. on the computer; / / ���. ��`t. •,.. ••.Ass, '.. use only the tab 1. Inspector ( ��s'•: key to move your CS •.sG3 cursor-do not JAMES James D.Searsuse m key. return Name of Inspector * :4 U; CapewideEnterprises.LLC Company Commercial Street �arttrmm�ti��•� Company Address Mashpee MA _ _02649 Cityrrown State Zip Code 508-477-8877 S 1623 Telephone Number license Number B. Certification certify that I have personally inspected the sewage disposal system at this address and that the information reperted 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 16.340 of Title 5 (310 CMR 15.000). The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority 7-30-15 pectoes 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. yy VS G� 15ins-3/13 Title 5 Official Inspeotlon Fonrc Subsurface Sawage Disposd System•Page 1 ar 17 Jul30 1509:58p p,19 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 2370 Rt 6A Front System (2of 2) Property Address Charles Lamarca Owner Owners Name information is required for every Westi3amstable MA 02668 7-24-15 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: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 16.304 exist. Any failure criteria not evaluated are indicated below. Comments: Front system Kitchen System-Failed Report 2 of 2. The system is a single c. pool. Wall's covered and caked w/soap. Famed system Per Barnstable Reg. Siggfe Unit. H1 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 0 N C1 ND (Explain below): ,gins-3/13 Title 5 Official inspedion form:Subsurface Sewage Disposal Syslam Page 2 of 17 Jul 30 15 09:59p p.20 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 2370 Rt 6A Front System(2of 2) Property Address Charles Lamarca Owner Owner's Name requir required a West Barnstable MA 02668 7-24-15 required for every Code Date of Ins ction State Z Pe page, City/Town IP B. Certification (coat.) ❑ Pump Chamber pumpslalarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont): ❑ Observation of sewage backup or break out or high static water 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 a 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: Q Cesspool or privy is within 50 feet of a surface water Q Cesspoof or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 15ins•3f13 - Title s official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Jul 30 15 09:59p p.21 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 2370 Rt 6A Front System(2of 2) Propeny Address Charles Lamarca Owner Owner's Name information required for every Wrest eamstable NfA 02668 7-24-15 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 4 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. Q 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: t D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ® El 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 ❑ Q Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow Mina•X13 Title 5 Official Inspection form:Subsurface Sewage Disposal System-Page 4 of 17 Jul 30 1510:00p p.22 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 2370 Rt 6A Front System (2of 2) _ Property Address Charles Lamarca Owner Owners Name information is required for every West Bamstabfe MA 02668 7-24-1 5 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. ❑ 0 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 nitrWer 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 folfowing, 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. 15ins•3113 THIe 5 Official Inspedian Form:Subsurface Sewage Disposal System-Page 5 of 17 Jul30 15 10:00p p.23 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 2370 Rt 6A Front System (2of 2) Property Address Charles Lamarca Owner Owner's Name information required for every West Bamstabte MA 02668 7-24-15 page_ City(Town state Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ❑. ® Pumping information was provided by the owner, occupant, or Board of Health 0 ® 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 NIA) ❑ Was tine 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 sett;manholes uncovered, opened, and the interior eUheAmk inspected for the condition of the balZiangr tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? Q 0 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)1310 CMR 15.302(5)) C. System Information Residential Flow Conditions: Number of bedrooms (design): NA Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 15ins-3f13 Title 5 Official Inspedion Forth:Subsurface sewage oisposal System;Page 6 of 17 Jul30 1510:01p p.24 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 2370 Rt 6A Front System (2of 2) Property Address Charles Lamarca Owner Owners Name information required for every West Barnstable MA 02668 77=24-15 page. City/Town State Zip Code Date cf Inspection D. System Information Description: The system is a single c pool 1 Number of current residents: Does residence have a garbage grinder?, ❑ Yes No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No . Seasonaluse? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): 2013-30,000GaIs2014-34,000Gars Detail: Sump pump? ❑ Yes ® No Present Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft.,etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: l5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Jul 30 1510;01 p p.25 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 2370 Rt 6A Front System (2of 2) Property Address Charles Lamarca Owner Owner's Name information is West 8amstable, AAA 02668 7-24-15 required for every page. ORylTown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancyluse: Date Other(describe below). General Information Pumping Records: Source of information: NA 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) ❑ InnovativelAlternative 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 IIA system by system operator under contract ❑ Tight tank.Attach a copy of the aEP approval. ❑ Other(describe): (Sins.3/13 Tile 5 Official Inspection Form:Subsurface Sewage Disposal System•Pege 9 of 17 Jul 30 15 10:01 p p.26 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 2370 Rt 6A Front System (2of 2) - Property Address Charles Lamarca Owner Unmer-Name• information is West Bamstabte MA 02668 7-24-15 required far every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: NA Were sewage odors detected when arriving at the sits? ❑ Yes ® No Building Sewer(locate on site plan): 30" Depth below grade: feet Material of construction: cast iron ❑ 40 PVC ® other(explain): Distance from private water supply well or.suction line: feet Comments (on condition of joints, venting, evidence of leakage,etc.): Pipeing is cast iron and orang burge Line is built up w/soap and sludge. i Septic Tank(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: " Sludge depth: t5ins-3113 Tile 5 Official Inspection Form:Subsurface Sewage Disposal Soom•Page 9 of 17 Jul30 15 10;02p p.27 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form.-Not for Voluntary Assessments 2370 Rt 6A Front System (2of 2) Property Address Charles Lamarca Owner Owner's Name information required for every West Barnstable MA 02668 7-24-15 page. 6tyrrown state Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cunt.) 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? — - Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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 !Sins•3/13 Titre 5 OKdal Inspection Form-.Subsurface Sewage Disposat System.Pape 10 or 17 Jul30 15 10.02p p.28 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 2370 Rt 6A Front System (2of 2) Property Address Charles Lamarca Owner Owners Marne information required for every West Barnstable MA 02668 7-24-15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments{on pumping recommendations;inlet and oudet 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 pet 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 15ins•3113 Title 5 ORdat tnspedion Form:SubsuMeoe Sewage Disposal System•Page 1 t of 17 Jul30 1510:02p p.29 Commonwealth of Massachusetts Title 5 Official Inspection Form a1 Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 2370 Rt 6A Front System (2of 2) Property Address Charles Lamarca Owner Owner's Name information is West Barnstable 02668 7-24-15 required for every page. City/Town state Zip Code Date:f.,Inspection D. System Information (cont.) 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.):. 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.): If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: : t5ins-3l13 Tifle 5 Official Inspection Form:Subsraface Sewage Disposal System-Page 12 of 17 Jul 30 1510,03p p.30 Commonwealth of Massachusetts it01 Title 5 Official Inspection Form o iv; Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 2370 Rt 6A Front System (2of 2) Property Address Charles Lamarca Owner Owners Name information is West Samstable MA .02668 7-24-15 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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.): Cesspools (cesspool must be pumped as part of inspection) (locate on site plan). 1 Number and configuration 30" Depth—top of liquid to inlet invert 4„ Depth of solids layer 11f Depth of scum layer Dimensions of cesspool 6' Deep 'Materials of construction Block Indication of groundwater inflow ❑ Yes No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Jul30 1510.03p p.31 Commonwealth of Massachusetts Title 5 Official Inspection Form -- a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 2370 Rt 6A Front System (2of 2) Property Address Charles Lamarca Owner owner's Name information required for every West Barnstable MA 02668 7-24-15 page. Cityrroym 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.): Single c pool. Pool is V below grade. One line in wlnc tee. No out let's pool has been full in the pass.Single unit in Barnstable failed. Note: Line blocked solid. Pipeing has been done in basementFlow is being sent to rear system. pipeing still tied into.frontsystem. Prrdy lIocate on site plan). Materials of construction: Dimensions Depth of solids Comments (inote condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins-3M3 Title 5 Official Inspection Form:subsurface Sewage Disposal System.-Page 14 of 17 Jul30 151Q:03p p.32 Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 2370 Rt GA Front System (2of 2) Property Address Charles Lamarca Owner Owners Name information required for every West Barnstable MA 02668 7-24-15 page. Cityrrown State Zip Cede Date of tnspection D. System Information (cons.) 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 I1-1 tirawirin atEanc�atl conorntnl.r Or s l � l -f= All vppf(Z f t i i5ir s•W13 TW 5 Official hispeckn Form Subswfaca Sewage Disposal System-Page 15 of 17 Jul 30 1510:04p p.33 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 2370 Rt 6A Front System (2of 2) Property Address Charles Lamarca Owner Owner's Name information required for every West Bamstable MA 02668 7-24-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: [] Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells 461 NO Estimated depth tojhigh ground water 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 hale within 150 feet of SAS) ❑ Checked with local Board of Health- explain: ❑ Checked with local excavators, installers- (attach documentation) ® Accessed USGS database- explain: U.S.G.S.Well SDW 252 You must describe how you established the high ground water elevation: U.S.G.S. Well SDW 252 at 46'-7" Before filing this Inspection Report, please see Report Completeness Checklist on next page. 15ins•3113 _ Ti11e 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 16 of 17, Jul 30 1510:04p p.34 Commonwealth of Massachusetts U Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 2370 Rt 6A Front System (2of 2) Property Address Charles Lamarca Owner Owners Name information required for every West 8amstable MA 02668 7-24-15 page. City/Town State Zip Code bate 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 ISins-W13 780 5 Official Inspection Form.Subsurface Sewage Disposal System-Page 17 of 17 co ►. • Q^ ca L '. 1 I M Postage S�`P°V /'�� Certified IF r9 �� �' Postmark Return Re'a"' s Here C3 (Endorsement Require p Restricted Delivery Fee 0 (Endorsement Required) �s C �C-3 nJ Total Postage&Fees r—i N Charles A. Lamarca PO Box 826 Barnstable, MA 02630 Certified Mail Provides: o A mailing receipt ! `� o A unique identifier for your mailpiece o A record of delivery kept by the Postal Service for two years Important Reminders: o Certified Mail may ONLY be combined with First-Class Maile or Priority Maile. o Certified Mail is not available for any class of international mail. ,I e NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. o For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPSe postmark on your Certified Mail receipt is required. o For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted-Delivery". e If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. r, IMPORTANT:Save this receipt and present it when making an inquiry: PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Sign item 4 if Restricted Delivery is desired. ❑Agent X ■ Print your name and address on the reverse ❑Addressee so that we can return the card to you. B. Received by(Printed Name) C. Date of Del' ery ■ Attach this card to the back of the mailpiece, or on the front if space permits. D. Is delivery address different from item 1? Y " 1. Article Addressed to: If YES,enter delivery address below: ❑No ,C'iiarles A.,Lamarca PO Box 826 Barnstable, MA 02630 3. Service Type ❑Certified Mail® ❑Priority Mail Express' ❑Registered ❑Return Receipt for Merchandise ❑Insured Mail ❑Collect on Delivery 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number ;, •• • - • , (transfer from service label ' I ! t7 L]14 112 0 0.j 0 0 01 i 10 3 5 8 497 8II LPs Form 3811,July 2013 Domestic Return Receipt r { I UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid LISPS. Permit No.G-10 I I • Sender: Please print your name, address, and ZIP+4®in this box" I I I � I I I Town of Barnstable Public Health Division 200 Main Street Hyannis, MA 02601 I � I I I ills- fl" eilii 2t�iiil-aijr lll::a{r:'r.ieii�Fi71ii1??:i{??lire{I?l: ' 7 F , All U; Town. of Barnstable Barnscabie Regulatory Services Department # SAS Public Health Division D 1 , ^ � 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V. Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7014 1200 0001 0358 4978 August 12, 2015 Charles A. Lamarca PO Box 826 Barnstable,MA 02630 RE: System#1 The septic system located at 2370 Main Street/RTE 28,Barnstable, MA was last inspected on 7/24/2015 by James D. Sears, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system-"Failed" under.the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Static liquid level in the distribution box above outlet invert,due to'an overloaded or clogged SAS or,cesspool You are ordered to repair or replace the septic system within one (1)year from the date you receive this notification. Failure to repair/replace the septic system within the deadline period may result in future enforcement action. PR ER R OaTHE W, OF Thomas McKean,R.S. CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures of Future Evl\2370 Rte6A Barn loft aug 2015.doc �r 0 Town of Barnstable + IARNSWIM 4 Regulatory Services Department orfD��p Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 RichaM Scah,Director FAX: 508-790-6304 Thomas A.McKean,CHO r ; Feb 6, 2007 z Rev. 7/6/15 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 316 CMR,15.000) An"x"marked in the ❑ is-the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent,to the.surface of the,ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool, ONE 1 YEAR DEADLINE CRITERIA Static liquid level in the distribution box above outlet invert due,to an overloaded or clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to apublic well ❑Any.portion of a cesspool within'50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2) YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any."conditionally passed systems" (broken cover, relocation of a pipe, relocation' of a driveway due to H-10 components, etc) ❑ Leaching pit or cesspool,with high liquid level,'<12" below inlet(per Town Code §360-9.1) OTHER t.b Repair deadline: Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc ul 30 15 09:52p p.1 MlP �3r1 - o02a Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary.Assessments �a 2370 R6A Rear System (1of2) .d. Property Address Charles Lamarca Q1 Owner Owner's Name = : information required for every Jet Bamstable MA 02668 7-24-15 page. City/Town State Zip Code Date of Inspection Q'I 1'.8'1 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. Genera! Information / ` ,,��irt"ffrrrq filling out forms S� \`�����P�SN OF Iggss4����i on the computer, `��� ,.- • , use only the tab 1. Inspector: key to move your =� JAMES •N cursor-do not = r_^i use the return JamesD,Sears =� S �r Name of Inspector key. * *s Capewide_Enterprises,LLC Company Name 153 Commercial Street rnnun„tt"`�� Company Address Mash J MA 02649 City/Town State Zip Code 508-477-8877 S1623 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 Title 5 (310 CMR 15.000).The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority 7-30-15 ,,,�Vlnspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection- If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ""This report only describes conditions at the time of inspection and under the conditions of use at that:time. This inspection does not address how the system will perform in the future under the same or different conditions of use. 151ns•3113 Title 5 Official lnspecOon Form Subsurface Sewage Disposal System-Pago 1 of 17 A Y# Jul 30 15 09:53p p.2 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 2370 R6A Rear System (1 of2) Property Address Charles Lamarca Owner Owner's Name information required for every West Barnstable MA 02668 7-24-15 page. Cityrroam State Zip Code Date of Inspection B. Certification (cunt.) 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: Rear system-Failed report 1-of 2. The system is a old block c pool -D Box and three pipe field. Field Blocked wfroots pipeing holes'bkxk and lines load w!sludge. B) System Conditkmally 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 leakirrg and it a Certificate of Compliance indicating that the tank is less than 20 years old is available_ ❑ Y Q N ❑ ND (Explain below): t5ins•3/13 Tifle 5 Offidal Inspection Form:Subsurface Sewage Disposal System•Page 2 at 17 Jul 3.0 15 09:53p p.3 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 2370 R6A Rear System(1of2) Property Address Charles Lamarca Owner Owner's Name information is -West Mkt 02ti68 -2�-f3 required far every tB State Zip Code Date of Inspection page. Cityfl'own B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water 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•3113 Tale 5 O'ficial Inspection Forth:Subsurface Sewage Disposal system-Page 3 of 17 Jul 30 15 09:53p p.4 Commonwealth of Massachusetts Tithe 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 2370 R6A Rear System (1of2) Property Address Charles Lamarca Owner Owner's Name information required for every West Bamstable MA 02666 7-24-15 page. Cityfrown State Zip Code Dale of Inspection B. Certification (cunt.) 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 systern has a septic tank and SAS and the SAS is less than 100 beet but 50 fleet 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 fora(. 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 El ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool El or liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Liquid depth in casual is less than 6" below invert or available volume is less than 1/2 day flow F.�Z /-,b (Sinn•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Jul 30 15 09:54p p.5 Commonwealth of Massachusetts > Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 2370 R6A Rear System (1of2) Property Address Charles Lamarca Owner Owner's Name information is West Bamstabre MA 02666 7-24-15 required for every — page. City/Town State Zip Code Date of Inspection B. Certification (cunt.) 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 ammonfa 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 faits. 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 foffowing, 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. 15ins•3H3 Title 5 Official Inspedion Form:Subsurface Sewage Disposal Swam Page 5 of 17 f Jul 30 15 09:54p p.6 Commonwealth of Massachusetts. Title 5 Official Inspection Form -- Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 2370 136A Rear System(1 of2) Property Address Charles Lamarca Owner Owner's Name information required for every West Barnstable VA 02666 7-24-15 page. City/Town Stale 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 NIA) 0 ❑ 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 s9p0&t&PA manholes uncovered, opened, and the interior comic inspected for the condition of the bafiftmw tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ Z 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)1310 CMR 15,302(5)) D. System Information ' Residential Flow Conditions: Number of bedrooms (design): NA Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 1.10 gpd x#of bedrooms): 330 15i;s 3113 TNe 5 Official Inspection Form:SubsWace Sewage Disposal System-Page 6 of 17 Jul 30 15 09:54p p.7 Commonwealth of Massachusetts MEN Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments . 2370 R6A Rear System (1 of2) — Property Address Charles Lamarca Owner owner's Name information is required for every West Barnstable MA 02668 . 7-24-15 page. CitylTown state Zip Code Date of Inspection D. System Information Description: The system is an old block c pool - D Box and three pipe fields. 1 Number of current residents: Does residence have a garbage grinder? ❑ Yes 19 No Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 2013�O,000Gals g ( Y 9 (gP )) 2014-34,000Gal's Detail Sump pump? � Yes No Present Last date of occupancy: Date Commercialllndustrial Flow Conditions: Type of Establishment Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seatslpersonslsq.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: t5ins•3r13 Titk 5 Official Inspoelion Forth:SuEsurfaee sewage oisposal Systam•Page 7 of 17. Jul 30 15 09:55p p.8 Commonwealth of Massachusetts Title 5 Official Inspection Form fi IVA Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 2370 RIBA Rear System(1of2) Propeny Address Charles Lamarca Owner Owners Name information is required for every West Bamstable MA 02668 7-244 5 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancyluse: Date Other(describe below): General Information Pumping Records: Source of information: NA Was system pumped as part of the inspection? ® Yes ❑ No 1f yes, volume pumped: 1000 Gal. gallons How was quantity pumped determined? _ Pump Truck Reason for pumping. Part of Inspection Type of System: ® Sepfiatepk, distribution box, soil absorption system ® 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 tarrk. Attach a copy of the DEP approval. ❑ Other(describe): (sins•3113 Tille 5 Official Inspection Form:Subsufaoe Sewage Disposal System•Page 6 of 17 Jul 30 15 09:55p p.9 Commonwealth of Massachusetts -- Title 5 Official Inspection Form U1WSubsurface Sewage Disposal System Form- Not for Voluntary Assessments 2370 R6ARear System (1of2) Property Address Charles Lamarca Owner Owner's Name information required for every West Barrmstable MA 02668 7-24-15 page. CitylTown State Zip Code Date of Inspection D. System Information (cons.) Approximate age of all components, date installed (if known)and source of information.- NA Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): _ Depth below grade: 32" feet Material of construction: ® cast iron ® 40 PVC ®other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Pipeing House to main pool cast iron and orange burge other pipeing 4" PVC;. Septic Tank(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ .No Dimensions: Sludge depth: k5ins-3113 Title 5 Official Ins ction Forth:Subsurface pe Sesvne Disposal System•Page 9 01 17 Jul 30 15 09:55p p.10 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 2370 R6A Rear System (1of2) Property Address Charles Lamarca Owner Owner's Name information is West Barnstable MA 02668 7-24-18 required for every Ci ITown page. b State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cunt.) 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? Comments (on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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 t5ns•3113 Title 5 O idal Inspection Form:Subsurface Sewage Oisposal System Page 10 of 17 i Jul 30 15 09:56p p.11 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 2370 R6A Rear System (1of2) Property Address Charles Lamarca Owner Owner's Name information is required for every _West 8amstable MA 02668 7-24-15 page. Cityrrown 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-3113 Title 5 Official Inspeaon Form:subsirfaoe sewage Disposal System-Page 11 of 17 Jul 30 15 09:56p p.12 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 2370 R6A Rear System (1of2) Property Address Charles Lamarca Owner Owner's Name information required for every West Barnstable = MA 02668 7-24-15 page. City/Town State Zip Code Date of Inspection D. System Information (cost.) 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.): D Box is W"x 21"AN' below grade w13 line's out. Walls are gone on box, 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.): If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: r5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage 01sposal System•Page 12 of 17 Jul 30 15 09:56p p.13 Commonwealth of Massachusetts --., Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ` 2370 R6A Rear System (1of2) Property Address Charles Lamarca Owner Owner's Name information is required for every West Bamstable MA 02668 7-24-15 page. Cityfrown State Zip Code Date of Inspection D. System Information (cone.) Type: ❑ leaching pits number. ❑ leaching chambers number. ❑ leaching galleries number. ❑ leaching trenches number, length: ® leaching fields number, dimensions: 20'x8' ❑ overflow cesspool number: ❑ innovativelaltemative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching is a three pipe field 20'x8'. Leaching hole's in pipe's are blocked wlsludge. Sludge and roots in lines. Leaching is failed. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration 1 Depth—top of liquid to inlet invert 4" Depth of solids layer 61 Depth of scum layer 2 Dimensions of cesspool 1000 Gal. Materials of construction Block Indication of groundwater inflow ❑ Yes ® No 15ins-3113 Title 5 Official Inspection Forth:Subsurfwa Sewage Disposal System-Page 13 of 17 Jul 30 15 09:57p p.14 Commonwealth of Massachusetts Title 5 Official Inspection Form �I Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ' 2370 R6A Rear System (1of2) Property Address Charles Lamarca Owner Owner's Name information is required for every West Barnstable MA 02668 7-24-15 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.): 1000 Gal. Block c pool w/cover at 10"below grade. Two inlet's Who tee's. Orte out let PVC pool level at out let line. Note main pool pumped at time of inspection 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•NQ Title 5 official Inspection Forth:Subsurface Sewage Disposal System-Page 14 of 17 Jul 00 15 09:57p p.15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments = 2370 MA Rear System(1&2) Property Address Charles Lamarca _ Owner Owner's Name information is required for every west Barnstable MA02668 7-24-15 page. Cityfrown State Zip Code Date of Inspection D. System Information (cunt.) 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 pubffc water supply enters the building. Check one of the boxes belour. ® hand-sketch in the area below ` drawing attached separately i O • r 1j �PP i f% O t r t5ins•3113 Title 5 otfida W%Pocbm Forrry Subsurface Sewage Dsposal System-Page 15 of 17 Jul 30 15 09:57p p.16 Commonwealth of Massachusetts _ Title 5 official Inspection Form ' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 2370 R6A Rear System (1of2) Property Address Charles Lamarca Owner Owner's Name information required for every West Barnstable MA 02668 7-24-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells M. Estimated depth to/nrgh ground water: 46 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 propertyfobservation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: El Checked with local excavators installers- attach documentation ® Accessed USGS database-explain: U.S.G.S.well SDW 252 You must describe how you established the high ground water elevation_ U.S.G.S.well SDW 252 at 46.7'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. 151ns•3113 T31e 5 Orfidel Inspection Form:Subsurface Sewage Disposal System•Page l6 or l7 , Jul 30 15 09:58p p.17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 2370 R6A Rear System (1 of2) Property Address Charles Lamarca Owner Owner's Name information e fo required for every West Bamstable MA 02668 7-24-15 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 I 15ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Pepe 17 of 17 a L0 CAT ION SEWAGE PERMIT NO. No'." VILLAGE I N S T A LLER'S NAME i ADDRESS J It' A e a.tit cue.P -f S o"V 8 U I L D E R OR OWNER DATE PERMIT ISSUED _ DAT E C0IMPLIANCE ISSUED h _ o .Z; o {IN y i f� r. N 1 v t C H � H r•m W � IN i 3 i i i f I I, I - i • i AsBuilt Page 1 of 1 a m N ' LOCATION SEWAGE PERMIT NO. VILLAGE T 1 2 3 rl C �. INSTALLER'S NAME a ADDRESS I! U I L D E R OR OWN ER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED http://issgl2/intranet/propdata/prebuilt.aspx?mappar=237022&seq=2 6/18/2015 No........ .............. ...... . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .. " Appliratiou for Diipnsal Works (� tr rti n prutit Application is hereby aor a mit to Construct ( ) or Repair ) an Individual Sewage Disposal System at X-4J.&I .. .�.. . .f �F - -----------------------------------•- _ tion- ddress o o• o-------- ���--------------------------- ----------. ......---------- d .. ._.._._ dam ...Owner -ress..�:.../.. .•............... ►� ``P �� Installer Address Type of Building Size Lot............................Sq. feet V Dwelling—No. of Bedrooms......_....................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons........................:... Showers — Cafeteria Q, Other fixtures ..--•-------•----•-••----....... .._ W Design Flow.............................................gallons per person per day. Total daily flow......................._....................gallons. WSe tic Tank—Liquid*capacity............gallons Tgth------------- - Width______ f.. Diameter---------------- Depth................ x Disposal Trench No. _._, ?.....:: _ Width........ .......... Total Length-------/�...... Total leaching area....................sq. ft. 3 eepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. 1________________minutes per inch Depth of Test Pit.................... Depth to ground water-._________--------____. Gz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ --------------------------- -- .... O Description of Soil.....��,✓�../a .............................................. -- .... - - - - - V ...... •---------------------------------- --------------------------------- --------------- .....------- •••------------------------------------------ =--- W .................... ----------------------------------------------•----------------•------•----•••------•-••••---•---------------... ,--- U Nature of Repairs or Alterations—Answer when applicable � � -._.______ �.. 1�� 'i -•---•--•--------------------------••----------------------------------------------...........-•--------••--•-----------------------------------------......--•-•-•-•----•---•••••-•---•------.......... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iIT?s. 5 of the State Sanitary Co e— The ersigned further agrees not to i the system in operation until a Certificate of Compliance h s bee -byboard of health. le Sign ---- ----------------------•--•-•-••.-----• •-•---- 7_._----... y Date Application Approved By----- -- ---------------- -1��=...Z 4F D ate Application Disapproved for the following reasons---------------------------• •-----------------------•-•------•-•------------•--...--------------------.•..._.................---......---------------•----------------.............................................................. Date Permit No......................................................... Issued -�'--- -� a f`! �-- ` Dat,te �t No. •.................. ........... ......... THE COMMONWEALTH OF MASSACHUSETTS , _ s BOARD OF HEAL 1-� _ . .. ' ......OF....: y Appliratiuu for llwpasa1 Works oltrur#tuu ramit , Application is hereby made for a P rmit to Construct ( ) or Repa• ) an Individual Sewage'Disposal. System at: Gam' " i+ .29 .....................Ao.. a}non-- ddd�e s0. - eft � .-----•------------- dre ............. ij Owner f� �k Ad ss Installer Address ' QType of Building Size Lot............................Sq. feet- U Dwelling—No. of Bedrooms___________________________________________Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building No. of ersons____________________________ Showers — Cafeteria f� YP g P ( ) ( ) Ga Other fixtures --------------------------- DesignW Flow.........................................__g allons er errt on er day. Total daily flow............................................gallons. " g P P � P W Tank—Liquid capacity.._.__-____ allons Len h________________ Width__ ______-Diameter------------:---- Depth __._______.._ x D s tosal,Trenc 1. No_____________________ Width_.. :::_____ Total Length........ { ___ Total leaching Area____._ _-- :.':.sq. ft. eepage" rt o______________________Diameter.______.___..................... Depth below inlet ;Total leaching area-_.____._______.__sq. ft. Z Other Distribution box ( ) Dosing tank" '~ Percolation Test Results Performed by .____... ............................. _.___________.___. Date_:........................................ aTest Pit No. 1_______________minutes per inch Depth of Test Pit___________ _ Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of,Test Pit..................._ Depth to`ground water.......-,_.............. --•-- ......-•----••---.•................• ........................................................... D Description of Soil_-__ -y------------------ x .................................. ••. . U ----------------------------------------------- •-•--•------•---•-----------_..__._....._----------__.......------------------------- •------------- -_---- •-•----•------•--------------------------•---- W -•--••----------------------------•------------•-•----•-----------•----•-•...._--•--------••--•-- ---- �» UNature of Repairs or Alterations—Answer when applicablej�re>✓� ___ _._ �. ! -- � ------------------------------------------------•-•----•---•---------------•---..---......--•-----------•---------------------------------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System-in.,accordance with the provisions of TITLE 5 of the State Sanitary Co —The diersigned further agrees not to pl the system in operation until a Certificate of Compliance s be y and of health. is Sign ....................................................... _._ f 7 Date Application Approved By....... '' *_ ---------- ..... Date Application Disapproved for the following r`easons:...........--•--•--•---•--••----•_..---••------------••--••-....--••----•-----•--•------••----•-•----•-_••-•-- ....-•--•----.....--••----•--•--------------•-----------------------------•-----•---.........----....-----------••-••-------•----•-----•••-----------•••----------------•----••------ ................. Date PermitNo................... . ....•••-••...._..----•••••- Issued Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF ,HEALTH �.1 ..........OF.. . ' ................................... Tatifiratr of Toulphaurr THI IS CRE 71PY fat the Individual Sewage Disposal System constructed.(. ) or. Repaired ( ) I at_, +. _.fowl � ' - -- --------------- .................. .............been installed in accordance wlth,the provisions of T 5 of The State Sanitary e as described,in the y application for Disposal Works Construction Permit No.:. ------------- dated--`` - - --�� -��-�------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GU RANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY DATE... .�/..-�� ?* �� Inspector....._:.._.. ........._ ..... _..._...... �-� THE COMMONWEALTH OF MASSACHUSETTS N BOARD OF HEALTH N �*_/j ........ ...:.. .,OF......... uuit FEE..._. .. -............ iu�r 1Porksutrurtiuu rrutit _,Permission is hereby gra to Tua�-:-•-•......---•-•••... ...................................................:................ to Construct ( ) or Repair ) an Individual Sewa D•s osal. at No. r. Street as shown on the application for Disposal Works Construction Per Lt No..___________ ated_._e _ � ------ _-_-_____ .......... _: . ....... . - • ................. j ,Board o Heal DATE.......... ----...--�•----/--- ---`�-- ". FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS _ c j byrr' y 500 GALLON CONCRETE LEACHING CHAMBER (H-1 ,0) LOCUS INFORMATION, d s`, F$Cre Xn- , kk+NOT TO SALEDISTRIBUTION BOX D E TAB.L (H-10) NOT TO SCALE �Q CURRENT OWNER: MARGARET E. LAMARCA =; `r N REMOVABLE COVER 6" MAX. ^ 1992 TRUST , CCfCLiS j 1 4 PERFORATED PVC 20" ACCESS COVER ` • " TO WITHIN 3 INCHES W/SCREW CAP To EXTEND DOWN of FINISH GRADE TITLE REFERENCE: DEED BOOK 18349/163 TO NATURAL SUBGRADE LOAM AND SEED tg.s5wxtt« : PLAN BOOK 73/79 ALL DISTURBED AREAS O PLAN REFERENCE HDPE RISER � �5" DIA. KNOCKOUT (T1fP.) �' 3 21" ,�. ASSESSORS MAP: 237 o 1-1/2" TAPER 2" WALLS; I- " - �- PARCEL. 022 HDPE 12-36 COVER _,.!_ 0.5 t s°c «n RISER a O. . . .• ._ .a, . ' " " / " ', �' ZONING 2 a N c JE 2 LAYER OF t 8 To � G DISTRICT: PRIMARILY ,RF-1/2 DOUBLE WASHED9-1 2" L " SETBACKS: FRONT 30,STONE ABOVE CROWN / (5) 5 DIA. i� SIDE 15 34" 24" 0OF PIPE0 " i3 TKNOCKOUTS REAR 15' LOCUS MAP 0 OO =M 11-1/2OVERLAY DISTRICT: APYP' EFFECTI 3/4" TO 1-1/2" . . - NOT TO SCALE C�C7 DEPTHC� CO O 0 � DOUBLE WASHED Q NITROGEN SENSITIVE STONE TO CROWN OF PIPE 2" LZONE: NOT A ZONE-11 BOTTOM ON LEVEL " FEMA FLOOD STABLE BASE 6 MINIMUM 8'-6" 3/4" To 1-1/2" PLAN VIEW • CRUSHED STONE ZONE DISTRICT: ZONE "X", ctt 0FM 10-10 sEcnoN vlEw DATED JUL I� 16, 2014 FRONT VIEW �°` - PANEL #2560 0554J SIDE VIEW ��. BRIAN I NOTES: COTES: MINIMUM LOT SIZE: 43,560f S.F. o YE CIIV LIAN CIO J N 1. ONE ACCESS COVER PER SYSTEM SHALL BE RAISED TO FINISH GRADE. 1. PROVIDE INLET TEE OR BAFFLE WHERE SLOPE OF PIPE EXCEEDS 0.08 FT./FT p� -0 9 No.46206 Q OR IN PUMPED SYSTEM. '� EXISTING LOT SIZE: 91,898t S. �90 `*-isTEQ4 2. CHAMBERS SHALL BE 500 GALLON LEACHING DRYWELL, MANUFACTURED BY SHOREY OR APPROVED EQUAL 2. FIRST TWO FEET OF PIPE OUT OF DIST. BOX TO BE LAIDILEVEL �^ X1. 3. GEOTEXTILE FABRIC MAY BE USED IN LIEU OF DOUBLE WASHED STONE. �'� S/ONAL EN 3. ALL PIPE CONNECTIONS AND CONCRETE CONSTRUCTION ,SHALL BE WATERTIGHT. 4. FILL ALL UNUSED KNOCKOUTS WITH MORTAR. 5. CONCRETE COVER SHALL BE RAISED TO WITHIN 6 INCHES OF FINISHED GRADE. SOIL TEST PIT DATA SCHEDULE OF ELEVATIONS NOT TO SCALE BRIAN G. YERGATIAN DATE TOP OF TEST PR TP-1 TEST PIT TP-2 0 N S TE SOIL EVALUATION 4 INVERT OATDBUILDING EXATION IST a PROFESSIONAL ENGINEER GRD. EL. 55.2 GRD. EL 55.2 (PI#1 5131 VARIANCES REQUESTED . 4" INVERT AT SEPTIC TANK (IN) U.40 C SHGW EL. 42.2 SHGW EL N A -QED 4" INVERT AT SEPTIC TANK (OUT) 52.15 D 4" INVERT AT DIST. BOX (IN) 51.47 E Ap A DATE: AUGUST 23, 2016 NONE ry,�O�ry 4" INVERT AT DIST. BOX (OUT) 0,.30 F LOAMY SAND LOAMY SAND TEST BY: BSC GROUP, INC. SEPTIC SYSTEM 10YR 4f3 10YR 4/3 WITNESSED BY: DAVE STANTON, R.S. ELEVATIONS AT LEACHING FACILITY: EL. 54.5 8" EL. 54.5 g" LICENSED SOIL EVALUATOR: BRIAN G. YERGATIAN, P.E. hti " DESIGN PERCOLATION RATE- 4 MINS./INCH ,�'S 4 INV. AT LEACHING CHAMBERS 51.20 G (BRKOUT 52.0) Bw Bw SOIL CLASS: CLASS 1 h LOAMY SAND LOAMY SAND BOTTOM OF LEACHING CHAMBERS 49.20 H 10YR 5/4 10YR 5/4 L.T.A.R.: 0.74 GPD/S.F. ��RCEL EST. SEASONAL HIGH GROUNDWATER 42.20 J EL. 53.3 23" EL 53.2 24" 38,781t S F. LEGEND #2370 ROUTE 6A C1d C1d a FINE SAND LOAMY SAND 9 IN EL. 50.3 i OYR 6/4 59" 10YR 6/4 UNSUITABLE g�� GENERAL N 0 TE S � MATERIALS `I BARNSTABLE M EL 44.2 132" EL. 44.5 129" (TO BE REMOVED) �p0� Nj9• 1 DISPOSAL. THIS NFACIU ES AND THE BUI IS INTENDED FOR THE LDINGI ADDITIONTTING . CONSTRUCTION OF THE SEWAGE MASSACHUSETTS a MEDIUM SAND MEDIUM SAND PERCOLATION y ESTIMATED 4yA , �OF 2. ALL CONSTRUCTION METHODS AND MATERIALS SHALL CONFORM TO 310 CMR 15.000 SEASONAL HIGH f�! (BARNSTABLE COUNTY) 2.5Y $/3 2.5Y 8/3 TEST RANGE _ GROUNDWATER PARCEL ��� AND BARNSTABLE BOARD OF HEALTH REGULATIONS. EL. 42.2 156" EL. 43.2 144" 9 CIO - �� 53,117t SF. O' 3. THERE ARE NO KNOWN OR PROPOSED PRIVATE WELLS LOCATED WITHIN 150 FT. OF THE o NOTE: JNO GROUNDWATER OR REDOXIMORPHIC FEATURES �h� J PROPOSED LEACHING FA�'UTY. .WERE OBSERVED IN EITHER TEST PIT. .3� SITE PLAN ors, h0� 4. IF AN OVERDIG IS SPECIFIED, REMOVE ALL TOPSOIL, SUBSOIL AND OTHER UNSUITABLE o 'yh ,\h ham/ f/ MATERIALS. �h h� 5. IF AN OVERDIG IS SPECIFIED, REPLACE ALL EXCAVATED MATERIALS WITHIN THE LIMIT OF 1_^ GALLON SEPTIC TANK (H-10). EXCAVATION WITH CLEAN GRANULAR SAND, FREE FROM ORGANIC MATERIAL AND a NOT TO SCALE / DELETERIOUS SUBSTANCES. MIXTURES AND LAYERS OF DIFFERENT CLASSES OF SOIL SEPTEMBER 6, 2016 J SHALL NOT BE USED. FILL SHALL NOT CONTAIN ANY MATERIAL LARGER THAN 2 M EXISTING SEPTIC STRUCTURE SHALL BE PUMPED INCHES. A SIEVE ANALYSIS USING A J4 SIEVE SHALL BE PERFORMED ON A a DRY, CRUSHED, REMOVED FROM SITE & DISPOSED NOTES: RAISE AT LEAST ONE EXISTING COVER OF AT A LICENSED FACILITY REPRESENTATIVE SAMPLE OF FILL UP TO 45% BY WEIGHT MAY BE RETAINED ON THE TO WITHIN 6" OF FINISHED GRADE #4 SIEVE. SUCH ANALYSES MUST DEMONSTRATE THAT THE MATERIAL MEETS EACH OF N 1. SEPTIC TANK SHALL BE STEEL REINFORCED CONCRETE. THE RISER SHALL BE 18" HDPE PIPE ei 2. SEPTIC TANK SHALL BE CAPABLE OF WITHSTANDING H-10 0 LOADING. SEPTIC ALLON �,y0• THE FOLLOWING SPECIFICATIONS: 3. ALL PIPE CONNECTIONS AND CONCRETE CONSTRUCTION 6„ MAX CONC. COVER P 100% MUST PASS SHALL BE WATERTIGHT. #4 SIEVE O 10% MUST PASS 50 SIEVE a 4. TEES SHALL BE SCH. 40 PVC AND SHALL BE LOCATED `Q� '! � •""' �`S? g�'� 0-20% MUST PASS 100 SIEVE WITHIN 12 OF TANK WALL AND ACCESSIBLE FROM TANK 1 I�O 0/ / 10.8 ' -,� \ .h 2 COVER. �VJ h�.`t' 0-5% MUST PASS 200 SIEVE °O 5. FILL ALL UNUSED KNOCKOUTS WITH HYDRAULIC CEMENT. O NO. DATE DESC. I 4 ro W 500 GALLON 6. EXISTING UTILITIES WHERE+SHOWN ON THE PLANS ARE APPROXIMATE. THE ENGINEER CLEANOUT TP-2 LEACHING CHAMBERS N 10'-6" d- O W/4' CRUSHED STONE DOES NOT GUARANTEE THEIR ACCURACY OR THAT ALL SUBSURFACE STRUCTURES ARE " ( \ - � ON SIDES AND ENDS SHOWN. CONTRACTOR SHALL VERIFY THE SIZE, LOCATION AND ELEVATION OF INVERTS 10-0 ` S • OF UTILITIES AND STRUCTURES, WITHIN THE LIMIT OF WORK, PRIOR TO THE START OF 10" E 3. _ = o � •�, g• CONSTRUCTION. IF"ANY DISCREPANCIES ARE DISCOVERED OR FIELD CHANGES F; y cr� PROVIDE RISER TO WITHIN REQUIRED, THE CONTRACTOR SHALL NOTIFY THE ENGINEER IMMEDIATELY. C 4 MIN. " X 54.5 3 INCHES OF FINISHED o - - _ 4'-6" LOCATE DEPTH LIQUID 5_8 / --- C^ GRADE 7. THE CONTRACTOR SHALL BE RESPONSIBLE FOR PROPERLY COORDINATING THE o DIST. BOc rho, PROPOSED CONSTRUCTION ACTIVITIES WITH DIG-SAFE AND THE APPLICABLE UTILITY INLET TEE 5'-8" - - _ UNDER COVER yy OUTLET AS BAFFLE 3" �� \ W/RISER � OF COMPANIES, AND SHALL COMPLETE THE PROPOSED WORK WITHOUT ANY INTERRUPTIONS / / 0 3" C mac° SCH�40 PVC / 'dr,� IN SERVICE. L� J roh PL EXISTING bWEW G / �+ TOF=63.6"e✓ SHT 8. CONTRACTOR IS REQUIRED TO NOTIFY DIG-SAFE, PER MASS. STATUTE CHAPTER 82, •��-, �,�ry SLAB=55.95 ( �b 38�9 C IST DUI ING SEWERS qF SECTION 40 (1-888-344-7233) A MINIMUM OF 72 HOURS PRIOR TO THE START OF ON CT EW / f • CONSTRUCTION. PLAN VIEW CROSS-SECTION VIEW q'y 6� \ 3 61 T �EP C. K PIPING / .� EP / / 9. THIS SYSTEM IS NOT DESIGNED FOR THE USE OF A GARBAGE GRINDER. INSTALLATION ��` OR USE OF A GARBAGE GRINDER AT THIS PROPERTY IS NOT ALLOWED PER 310 CMR -�v / .� _ ! / �� - Z O L 15.240(4). PREPARED FOR: o � ��`• 6 S / 10. THE CONTRACTOR SHALL VERIFY THE LOCATION AND DEPTH OF THE EXISTING BUILDING CHARLES A. LAMARCA DESIGN CALCULATIONS / �/ �- `,� h�/ f• THIS SEWER LINE SHALL BE RECONFIGURED INSIDE SEWERS PRIOR TO CONSTRUCTION AND REPORT THE FINDINGS TO THE BSC GROUP C/0 ROSS JOLY C) --, �S ✓� ^15 THE BASEMENT OF THE DWELLING BY A LICENSED IMMEDIATELY. 965 ROUTE 28 / / TW BUILDING LING.PLUMBER. IT SHALL BE TIED INTO ONE of THE SOUTH YARMOUTH, MA 02664 DESIGN FLOW / '� �` 9 ��/ / 1 roN`1 TWO BUILDING SEWERS TOWARDS THE REAR OF 11iE '3 3 BEDROOMS O 110 GPD/BEDROOM = 330 GPD ✓ .„� 8 , / ( r� �- / P SYSTEM PROFILE 9 REQUIRED SEPTIC TANK 57 •�C� 330 GPD X 200% = 660 GALLONS NOT TO SCALE/ / ` �� J / h /� 4" SCH. 40 aBSC o USE 1,500 GALLON SEPTIC TANK / _ C �� \ / / L= .01 FT. � / /� TOP FOUNDATION 5=0.01 Unit o SIZE OF REQUIRED LEACHING FACILITYFIRST c Sg •?4,1 / \ TO BEPSET LEVELH FINISH GRADE W. Yarmouth,hute � Massachusetts DESIGN PERC. RATE: <2 MIN/INCH 0 / .�' �" a LONG TERM APPL RATE: 0.74 GPD/SF `�-�� / EL 57t S=0.01 N PVC FOR MIN. 2' 54.5-54.9 02673 330 GPD + 0.74 GPD/SF - 446 SF SS BENCHMARK: (MIN.) 4" SCH. 40 PVC -`- w �a"W / P.K. NAIL SET 508 778 8919 c SIZE OF LEACHING FACILITY PROVIDED RI), w 16 5 -�- h EL. 49.32 r V /�I� 1'� f Q 2016 BSC Group, Inc. L USE (3) 500 GALLON H-10 CONCRETE LEACHING CHAMBERS IN TRENCH /� law &,00 oCONFIGURATION WITH 3' STONE ON ENDS AND ON SIDES. PUBL/� ,^, yl, 1=8 i=D I=G o 0 0 o 0 0 0 a SCALE: 1" = 30' = V'gRTgBZELY/ ��/� a _ �' .t� 1=E 1=F 'L H `I�1.2 mmmw y BOTTOM AREA. 31.5 X 10.83 341.1 S.F. - DTy ' 1��r I C I�` �� �1 0 15 30 60 �T SIDEWALL AREA: 2 X (2 X (31.5 + 10.83)) 169.3 S.F. :i l��. 51' LEACHING i s L EFFECTIVE LEACHING AREA = 510.4 S.F. DISTRIBUTION 7.0' SEPARATION ✓ CHAMBERS ! SEPTIC TANK BOX FILE:\\bscbos\yar\...\Civil\_Drawings\5W4W-SP.dwg 510.4 S.F. X 0.74 GPD/S.F. = 377 GPD (INSTALLED CAPACITY) ��` - J `t2•Z DWG. NO: 6391-01 z 377 GPD > 330 GPD (47 GPD RESERVE CAPACITY PROVIDED) MAGNETIC REFLECTIVE TAPE SHALL BE PROVIDED ESTIMATED S.H.G.W. (BOTTOM of TEST PIT) SHEET 1 OF 1 IN THE TRENCH OVER ALL PVC PIPING JOB. NO: 5-0044.00