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Home My WebLink About2715 MAIN ST./RTE 6A(BARN.) - Health 2715 Main Street Barnstable A=258.040. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 2715 Main Street(Route 6A) Barnstable Village Property Address Erin Maker P.O. Box 552 Owner Owner's Name information is Barnstable MA 02630 February 17, 2010 required for ry every page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important:When filling out A. General Information � forms on the \computer,use 1. Inspector: only the tab key to move your Patrick T. Sullivan cursor-do not Name of Inspector use the return key. Ready Rooter, Inc. Company Name PO Box 371 -17 Jan Sebastian Dr. Company Address -24 Sandwich MA 02563 C City/Town State T Zip Code= 508-888-2805 S112843 Via, Q Telephone Number License Number seta B. Certification --• c I certify that I have personally inspected the sewage disposal system at this address and thaWthe m 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 - ...- ...•� +� -- February 24, 2010 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office 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. Li 2715mainstrt6a-03/08 Title 5 Official Inspection Form:Subsurface S�w.ge Dip-al /"Mlbe 1 of 1 V Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ..�� 2715 Main Street(Route 6A) Barnstable Village Property Address Erin Maker P.O. Box 552 Owner Owner's Name information is Barnstable MA 02630 February 17 2010 required for ry every 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 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the' onditional Pass" section need to be replaced or repaired. The system, upon completion the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in t ❑ for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 y rs old* or the septic tank (whether metal or not) is structurally unsound, exhibits subst tial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the isting tank is replaced with a complying septic tank as approved by the Board of Healt *A metal septic tank will pa inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating t t the tank is less than 20 years old is available. ND Explain: ❑ Observation of sewage backup or break out or high tic water level in the distribution box due to broken or obstructed'pipes) or due to a broken ettled or uneven distribution box. System will pass inspection if(with approval of Board of He ): ❑ broken pipe(s) are replaced ❑ obstruction is removed 2715mainstrt5a•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 2 r - 44 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r` 2715 Main Street(Route 6A) Barnstable Village Property Address Erin Maker P.O. Box 552 Owner Owner's Name information is ry Barnstable MA 02630 February 17 required for , 2010 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more th 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with a roval of the Board of Health): ❑ broken pipe(s)are replac ❑ obstruction is remove ND Explain: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health deternes in accordance with 310 CMR 15.303(1)(b)that the system is not functioning i a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of surface water ❑ Cesspool or privy is within 50 feet f a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board f Health (and Public Water Supplier, if any) determines that the system is fun coning in a manner that protects the public health, safety and environment: El The system has a septic ank and soil absorption system (SAS) and the SAS is within 100 feet of a surface w ter supply or tributary to a surface water supply. ❑ The system has a se is tank and.SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a eptic tank and SAS and the SAS is within 50 feet of a private water supply well. 2715mainsfrt8a•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 3 Commonwealth of Massachusetts Title 5 Official Inspection Form � Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 2715 Main Street(Route 6A) Barnstable Village Property Address Erin Maker P.O. Box 552 Owner Owner's Name information is Barnstable MA 02630 February 17 2010 required for ry every page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less th 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, perfo ed,at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of amm is nitrogen and nitrate nitrogen is equal to.or less than 5 ppm, provided that no other failure crit ria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool . ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. 2715mainstrt6a-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 4 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments y 2715 Main Street(Route 6A) Barnstable Village Property Address Erin Maker P.O. Box 552 Owner Owner's Name information is Barnstable MA 02630 February 17, 2010 required for ry every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): I Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no" o each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 f et of a surface drinking water supply ❑ ❑ the system is within 2 feet of a tributary to a surface drinking water supply ❑ ❑ the system is locat in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or mapped Zone II of a public water supply well If you have answered"yes"to any q stion in Section E the system is considered a significant threat, or answered "yes" in Section D ab a the large system has failed. The owner or operator of any large system considered a significant t eat under Section E or failed under Section D shall upgrade the system in accordance with 310 MR 15.304. The system owner should contact the appropriate regional office of the Department. 2715mainstrt6a•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 5 r - Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 2715 Main Street Route 6A Barnstable Village ( ) 9 Property Address Erin Maker P.O. Box 552 Owner Owner's Name information is Barnstable MA 02630 February 17 2010 required for r every page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system-components, excluding the SAS, located on site? ® ❑ 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)] 2715mainstrt6a•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 6 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,.' 2715 Main Street(Route 6A) Barnstable Village Property Address Erin Maker P.O. Box 552 Owner Owner's Name information is Barnstable MA 02630 February 17, 2010 required for every page. Citylrown State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for exampleA10 gpd x#of bedrooms): 330.04 GPD Number of current residents: 2 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 Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 2008= 104 GPD g ( y g (gp ))' 2009= 107 GPD Sump pump? ❑ Yes ® No Last date of occupancy: CurrentDate 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 T" e 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: — Date Other(describe): 2715mainstrt6a-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 7 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 2715 Main Street(Route 6A) Barnstable Village Property Address Erin Maker P.O. Box 552 Owner Owners Name information is Barnstable MA 02630 February 17 2010 required for rY every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: No pumping records since install (2006) Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: System installed June 2006. As-built and engineered plans on file at Board of Health Were sewage odors detected when arriving at the site? D Yes No 2715mainstrl6a-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 8 Commonwealth of Massachusetts w Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 2715 Main Street(Route 6A) Barnstable Village Property Address Erin Maker P.O. Box 552 Owner Owner's Name information is Barnstable MA 02630 February 17 2010 required for ry every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 27"feet Material of construction: ❑ cast iron ❑ 40 PVC ❑ other(explain): i Distance from private water supply well or suction line: N/Afeet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): 'Depth below grade: 1,5„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: 11'X 5'X 4.5' 1500 gallons Sludge depth: 21, Distance from top of sludge to bottom of outlet tee or baffle 37" Scum thickness 2.5 11 Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 12" How were dimensions determined? Tape measure and dip tube. 2715mainstrt6a•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 9 Commonwealth of Massachusetts l Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 2715 Main Street(Route 6A) Barnstable Village Property Address Erin Maker P.O. Box 552 Owner Owner's Name information is Barnstable MA 02630 February 17 2010 required for rY every 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.): Inlet and outlet PVC tees in place. Liquid level at outlet invert. No sign of leakage. Risers bring covers within 6"of grade. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal /ED] 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 ba e Date of last pumping: Date Comments(on pumping recommendations, inlet an outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of I akage, etc.): Tight or Holding Tank(tank must be pu ed at time of inspection) (locate on site plan): Depth below grade: T Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): 2715mainstrt6a-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 10 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 2715 Main Street(Route 6A) Barnstable Village Property Address Erin Maker P.O. Box 552 Owner Owner's Name information is Barnstable MA 62630 February 17 2010 required for rY every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) n Dimensions: Capacity: allons Design Flow: gallons per day i Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box(if present must be opened) (locate on site plan): Depth of liquid,level above outlet invert Oil 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.): One inle, one outlet. No solids carryover. No high water staining over outlet invert. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: El Yes El No 2715mainstrt6a•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 11 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 2715 Main Street(Route 6A) Barnstable Village Property Address Erin Maker P.O. Box 552 Owner Owner's Name information is Barnstable required for MA 02630 February 17, 2010 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located;explain why: Type: ❑ leaching pits number: ® leaching chambers number: 4-CultecRecharger 330 ❑ 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.): . Camera used to locate and inspect SAS. Cultec Rechargers surrounded by 4'stone. Liquid level is at base of units. No sign of past hydraulic failure 2715mainstrt8a-03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 12 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 2715 Main Street(Route 6A) Barnstable Village Property Address Erin Maker P.O. Box 552 Owner Owner's Name information is Barnstable MA 02630 February 17 2010 required for rY every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet inle Depth of solids layer Depth of scum layer � Dimensions of cesspool Materials of construction Indication of groundwater inflo ❑ Yes ❑ No Comments (note condition of soil, signs,of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan)- Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs /ydraulic failure, level of ponding, condition of vegetation, etc.): 2715mainstrt6a-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 13 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 2715 Main Street(Route 6A) Barnstable Village Property Address Erin Maker P.O. Box 552 Owner Owner's Name information is ry Barnstable MA 02630 ` February 17 2010 required for , every page. CitylTown F State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. t � i I I 1 ' .1- O 3 �3 C g' - 2715mainstrt8a•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 14 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 2715 Main Street(Route 6A) Barnstable Village Property Address Erin Maker P.O. Box 552 Owner Owner's Name information is ry Barnstable MA 02630 February 17 2010 required for , every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ® Check cellar ❑ Shallow wells .Estimated depth to high ground water: >4.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: May 26, 2006 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: ma.water.usgs.gov terraserver-usa.com You must describe how you established the high ground water elevation: Test hole 10' below grade (elv=40.65)found no ground water(2006). Base of SAS at 6' below grade (elv=46). Accessed local ground water contours and topo mapping. No high ground water in area of system. 2715mainstrt6a-03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 15 Notice: This Form Is To Be Used For the Repair Of Failed Septic Systems Only PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM I, )R v 1 t) D , COUG HN GW I,hereby certify that the engineered plan signed by me da i , concerning the property located at RPriw Si �AKMPA-AL(: meets all of the . following criteria: • Two soil evaluations excavated for detailed examination(no hand augering) and two. percolation tests shall be conducted. • This failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. • The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching facility will be located no less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] Please complete the following: A) Top of Ground Surface Elevation(using GIS information) S ` B) G.W. Elevation 0 'oo +adjustment for high G.W. + '"I DIFFERENCE BETWEEN A and B SIGNED : � 1 DATE: Cf 2XC NOTICE Based upon the above information, a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. gASeptic\perccxemp.doc TOWN OF BARNSTABLE LOCATION `- (YU1,a �';, kr1Z CA SEWAGE# `jrt, ASSESSOR'S MAP&PARCELg IN ) R NS AME&PHONE NO. - H �' -- SEPTIC TANK CAPACITY Cw7 TF CJ LEACHING FACILITY:(type)CLaWcC— (size) NO.OF BEDROOMS OWNERI;PERMIT DATE:DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility >Y 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) �lVZ14 Feet FU�RNISS-H��ED BYV<: .--� TOWN OFBARNSTABLE LGCATION �) ��' ICA It SEWAGE# C26 d VILLAGE JJ 5-14 61JL ASSESSOR'S MAP&PARCEL 0-ye INSTALLERS NAME&PHONE NO. � SEPTIC TANK CAPACITY `Sim LEACHING FACILITY:(type) &JO oU I I° (size) -W X Z? K,Z NO'.OF BEDROOMS I' OWNER PERMIT DATE:?— — 0 (P COMPLIANCE DATE: O V 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 - e / S 1 00.00 No. (� ' 36 4P i '4 F iTHE COMMONWEALTH OF MASSAfL'HUSETTS Entered in computer: .PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZIPPrication for MiOogal *pgtent Congtruction Permit Application for a Permit to Construct O Repair( Upgrade O Abandon O ❑ Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address,and Tel.No.2 0 2—4 6 3—21 2 2 2715 Main St, Barnstable Richard Golden Assessor's Map/parcel 2 5 8 4 0 S t Wjoggh 912 Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No.3 6 4—0 8 9.4 Wm E Robinson Sr Septic Eco—Tech PO Box 1089 CEnterville 143 Triangle Cir, Sandwich Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder (10) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank . Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Install a new Title 5 septic system to plans of Eco-Tech, ETE-2361 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal"system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Hea Si ed Date Application Approved by Date Application Disapproved by: Date for the following reasons Permit No. r= (0 Date Issued i No. �' �d (p .. Fe�e100.00 � �\ r THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: .� PUBLIC HEALTH DIVISION`.- TOWN OF BARNSTABLE, MASSACHUSETTS Yes r 2pplication for �Diq;pogar 6p.tem-Con.5tructioH Permit Application for a Permit to Construct O Repair( Y Upgrade O Abandon O ❑ Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address,and'Tel.No.2 0 2—4 6 3—21 2 2 i 2715 Main St, Barnstable Richard Golden Assessor's Map/parcel 2 5 8 4 0 p&1StI)FWp0ffRh 912 Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 • Designer's Name,Address and Tel.No.3 6 4—0 8 9 4 Wm E Robinson Sr Septic ' Eco—Tech PO Box 1089 CEnterville 43 Triangle Cir. Sandwich Type of Building: - I Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder (aO) Other Type of Building No.of Persons Showers( ) Cafeteria( ) J_ Other Fixtures Design Flow(min.required) gpd Design flow provided — gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank _ Type of S.A.S. Description of Soil Nature of Repairs orAlierations(Answer when applicable) Install a new Title 5 septic system to plans of Eco—Teg ., #ETE-2361 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of He a. Sig ed ZO ,`; Date y Application Approved by Date (o r Application Disapproved by: Date for the following reasons ii Permit No. ~/ 1 30 Date Issued 4, t l � THE COMMONWEALTH OF MASSACHUSETTS Golden BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired (X ) Upgraded ( ) Abandoned( )by Wm E Robinson Sr Septic Service at 2715 Main St, Barnstable has been constructed in accordance A with the provisions, ffTitle 5 and the for Disposal System Construction Permit No. &0d 6 r 3(3p dated 7 Installer `�'P T�S l'l�— Designer #bedrooms Approved design. ow :3 3 6 gpd The issuance of this permit shall of f construed as a guarantee that the system will functi�d�sig"1ed. Date / �r� Inspector.�:=Z ———————————————————————————————————————————— No. —:3 FI 10 0.0 0 Godidlen THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS 10igogal 6pgtem Construction Permit Permission is hereby granted to Construct ( ) Repair ( X ) . Upgrade ( ) Abandon ( ) System located at 2715 Main St, Barnstable and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Construction must completed within three years of the date a thf"�i pe it Date1:276 Approved b}, 1, Town'of Barnstable �ftHEl Regulatory Services, Thomas F. Geiler, Director BARMADIA MASS' �� Public Health Divisioll A If�MAy Thomas McI{ean, Directoi- 200 Main Street,11vannis,NIA 02661 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: - /- � Sewage Permit# 30 6 Assessor's i\MapTarcel Designer: Eco-Tech '` Installer• Wm E Robinson Sr Septic Address: 43 Triangle Circle Address: PO Box 1089 Sandwich Centerville On Wm E Robinson Sr Sept' was issued a pen-nit to install a (date) (installer) septic system at 2715 Main St, Barnstable based on a design drawn by (address) Eco;Tech dated t -L (designer) 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. 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 tons. Plan revision or certified as=built by designer to follow. � �N OF DAVID cyc D. C� COUGNANOWR (Installer's Signature) q No. 1 m93 o �a# 6a� SgNI i A a (Designer's Signature) (affix Designer's Stamp Here) PLEASE RETURN TO BMI-NST,01-E PUBLIC HEALTH DIVISION. CERTIFICATE ()F CO-AIPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CjUtD -\RE RECEINID BY THE B:URNSTABLE PUBLIC IIEALTI4 DIVISION. THANK YOU. Q: Health.SepticiDesienerCertificatwn Form 26-6-1.doc 1 PLAN REFERENCEa`06- CONTOUR ► z ' l an a =W DEED BOOK 7946 PAGE 94 EXISTING - - - - - - - 50 N rn m°o m r- �o o_je ASSESSOR'S MAP: 256 MINIMAL GRADING PROPOSED A LOT: 40 MAIN STREET o<w + Lnoz oor �cwn� �� LOCUS w m cn cn mm z z �cn NOTE m BENCH MARK TOP OF DRAIN GRATE EXISTING CESSPOOL AND ALL BARNSTABLE. I MA IN THE 52 ELEVATION = 51.B3 VICINITYCONTAMINATED ARE DTO OBESREMOVED LOCUS_ M A P w BARNSTAbLE GIS DATUM AND REPLACED WITH CLEAN NOT TO SCALE oo o �` 51 MEDIUM SAND PER TITLE 5. cn !!! Z W w LEGENDS �� <r \6 Z z Li < OZ � 4(Y 1500 GALLON _ I W W \ \ 50 SEPTIC TANK 64, e 'CIS 3 < x� m �. �,�3 O e� Tj� D-BOX O �` TEST PI O T O W �00 s�o 0 /�� S��G�� tip cF� LOT 4 �. EXISTING O �, , S -.3S O,V c��tip� AR A = 7034 S +- CESSPOOL z m wm Ln Q� .off '9Q w LL 00Lii 4� 9 UTILITY POLE ❑l S>/, 0 LL O 53 \ timh � /50 TREE /� Z W ( / -NUMBER REFERS TO I, ' TP-1 DIAMETER IN INCHES. 1 u w O m L�7ti /�� O-AK LETTER M--MAPLES P-PINE 18 P V J ; � 1 �TP-2 51 �w WN ,0 r m 53 � �1 m z3�� m 103 is-M / L� 52cnLm � � FLAN 29ftX10tX2ft O z o « w J ~ SCALE. 1 in = 20 FL ': LEACHING GALLERY SEWAGE DISPOSAL SYSTEM PLAN (1/ p o J (Dm zz U TO SERVE EXISTING DWELLING LJ— Q m cn � � 20 20 4 RICHP� RD GOLDEN zm � � 0 10 20 jNOFAfgS. 2715 MAIN STREET BARNSTABLE. MA o m �o� DAVID yG� a D. ECO-TECH ENVIRONMENTAL �„ w � COUGANOWR 43 TRIANGLE CIRCLE m Ln 4- No. 1093 SANDWICH MA 02563 10 OWLn - �� sTF_ 50B 364-0694 PN _a ETE 2361 JUN E 8. 2006 1/2 � 200 THIS PLAN IS BASED ON AN INSTRUMENT SURVEY AND IS INTENDED � C SOLELY FOR INSTALLATION OF THE PROPOSED SEPTIC SYSTEM DEPICTED HEREON. FOR ANY OTHER CHANGES TO PROPERTY INCLUDING PLACEMENT OF ADDITIONS. SHEDS. FENCES OR SWIMMING POOLS. OWNER SHOULD CONSULT WITH A MASSACHUSETTS REGISTERED LAND SURVEYOR. SOIL TES L_ nG - DESIGN SIGN CALCULATIONS - DATE OF TEST: MAY 26. 2006 DESIGN FLOW: 3 BEDROOMS X 110 GPD = 330 GPD SOIL EVALUATOR: DAVID D. COUGHANOWR. R.S. WITNESS REOUIREMENT WAIVED - NO VARIANCES SOUGHT SEPTIC TANK: 330 GPD X 2 DAYS = 660 GALLONS NO PAARENOTUMAATERIIAL:EPROGLACIRALD OUTWASH INSTALL 1500 GALLON SEPTIC TANK (MINIMUM ALLOWED) TEST PIT 1 ELEVA.TTnN = 51.30 +- PERC AT 56 in 5 MIN/INCH IN C SOILS DISTRIBUTION BOX: USE 3 OUTLET D-BOX. DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER SOIL ABSORBTION SYSTEM: A 26 f t x 11 FL x 2 + L LEACHING GALLERY CAN LEACH (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING A b o L = ( 29 x 10 ) = 290 s f 51.30 — Asdw = ( 29 + 29 + 10 +10 ) x 2 =156 0-16 Ap SANDY LOAM 10 YR 2/2 NONE FRIABLE A t_o L = 446 s f 16-39 B SILTY SAND 10 YR 5/4 NONE FIRM V L 0.74 x 446 = 330.04 G P D 48.05 39-120 C LOAMY SAND 10 YR 6/6 NONE FRIABLE - FEW USE A 28 FL x 10 Ft:- x 2 f L GALLERY. VL = 330.04 GPD > 330 GPD REOUIRED SILTY POCKETS 41.30 NO RED TEST PIT 2 PAARENOTUNDWATE MAATERIA :ENCOUNTE PROGLACA L OUTWASH ELEVATION = 51.65 +- 5 MIN/INCH IN C SOILS DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER LEACHING GALLERY 51.65 (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING CONSTRUCTION DETAIL 0-15 Ap SANDY LOAM 10 YR 2/1 NONE FRIABLE CULTEC RECHARGER 330 UNIT. ST0 15-40 B SILTY SAND 10 YR 5/4 NONE FIRM 2 ft EFF. DEPTH 48.32 2 9.0 f t. 40-132 C LOAMY SAND 10 YR 6/6 NONE FRIABLE - FEW SILTY POCKETS v 41 40.65 m Li- [acl B N m B D NOTES 2.5 f't 24.0 Ft- 2.5 f't m 29.0 FL NOT TO 1) GARBAGE GRINDER NOT ALLOWED WITH THIS DESIGN SCALE 2) ALL LINES TO BE SCH 40 PVC AND PITCH AT 1/8 INCH PER FOOT MINIMUM. 3) ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM REQUIREMENTS OF MASSACHUSETTS TITLE 5 SEPTIC CODE (310 CMR 15) 4) INSTALLER TO VERIFY LOCATIONS OF ALL UNDERGROUND UTILITIES BEFORE EXCAVATING FOR SYSTEM. 5) EXISTING CESSPOOL TO BE PUMPED. COLLAPSED, AND REMOVED 6) ALL STONE TO BE DOUBLE WASHED AND FREE OF IRON. FINES AND DUST IN PLACE Zl LINES EXITING D-BOX TO RUN LEVEL FOR 2'-0- BEFORE PITCHING DOWN GROUNDWATER ADJUSTMENT 8) ECO-TECH ENVIRONMENTAL RECOMMENDS THE INSTALLATION OF: LOW FLOW FIXTURES EXISTING GROUNDWATER LEVEL SEWAGE DISPOSAL SYSTEM PLAN AND APPLIANCES. AND BIANNUAL PUMPING OF THE 'SEPTIC TANK BASED ON TOWN OF BARNSTABLE GIS DEPARTMENT RECORDS. 9) SYSTEM IS NOT DESIGNED TO WITHSTAND VEHICULAR LOADING. DO NOT -TO SERVE EXISTING DWELLING DRIVEPARK OR R SEPTIC SYSTEM. 10) INSTTALLER TO OBT IN DISPOSAL WORKS PER ITBEFORE STARTING WORK. INDEX WEL W 0 L A1W-24Z RICHARD GOLDEN ZONE B 11) SEPTIC TANKS SHALL BE INSTALLED LEVEL AND TRUE- TO GRADE ON A LEVEL READING DATE APRIL. 2006 2715 MAIN STREET BARNSTABLE. MA STABLE BASE THAT HAS BEEN MECHANICALLY COMPACTED AND ON TO WHICH READING 22.6 ECO-TECH ENVIRONMENTAL SIX INCHES OF CRUSHED STONE HAS BEEN PLACED TO MINIMIZE UNEVEN SETTLING ADJUSTMENT 1.9 - ADJUSTED GW 14.9 43 TRIANGLE CIRCLE SANDWICH MA 02563 ETE-236I JUNE 8, 2006 2/2