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2725 MAIN ST./RTE 6A(BARN.) - Health
-725`Main Sfreef/Rte 6A(Earn) t Barnstable P r � _ A = 258 077 'i l r I TOWN OF BARNSTABLE elc- avoq LaZATION SEWAGE # A VILLAGE - / ASSESSOR'S MAP &.LOT 7 'STALLER'S NAME&PHONE NO. � `-� -u* x '7?1 —7�/8 Ir SEPTIC TANK CAPACITY 1080 C6?j!L- - LEACHING FACILITY: (type) _(size) o°IS �� t%7t5f NO.OF BEDROOMS 3 BUILDER OR OWNER PERMITDATE: /©l V COMPLIANCE DATE: .S v �I 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 l J L� No. � � Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: "�V PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Yes 01pprication for po�a .bpztem Cow5truction Permit Application for a Permit to Construct( . epair( Upgrade( Abandon( ) El Complete System ❑Individual Components Location Address or Lot No. 2 7 A Owner's Name,Address andTeel.No. f, 7 "' Diu +•+-Q gal"7� S /U- 6,4 Assessor's Map/Parcel ,2 5 S 7 -7 ^,A , Installer's Name,Address,and Tel.No. 5491e^ 7 7f 7}1 a Designer's Name,Address and Tel.No. S®Q— jr 7 7—6-?3)_3 Type of Building: Dwelling No.of Bedrooms Lot Size lLc^-c sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3 3 O gallons per day. Calculated daily flow 3 3 gallons. Plan Date 6L<_/V-5r Number of sheets 157_ Revision Date Title Size of Septic Tank U ` Type of S.A.S. Description of Soil C: Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued b his Bard of Health. S ne Date d a` Application Approve Date AA Application Disapproved for the following reasons M Permit No. 0(9 Date Issued 60 r- N . Fee < 7 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: 14 ' 1 Yes PUBLIC HEALTH'DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS -ate application for M opozal *potent Construction Permit r Application for a Permit to Construct( Kep ( Upgrade( )Abandon( ) O Complete System~ El Individual Components Location Address or Lot No. 2, 7 ,7 5 <C .4 ,4 Owner's Name,Address and Tel.No. Assessor's Map/Parcel 5 f� / 7 -7 Installer's Name,Address,and Tel.No. .Sd 1f- 7'7/—7 5�/O Designer's Name,Address and Tel.No. S a 9- 4� "- 5 3/,3 �,,�xe-.�.-cc.. �e�r.�u��. �1✓iu.�.a:,...c,ct�,: l.Gt/ l�,.(,rJ, G..� \ Type of Building: Dwelling No.of Bedrooms Lot Size`- sq.ft. Garbage Grinder( ) Other TI pe of Building _ No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 330 gallons per day. Calculated daily flow 3 3 gallons. Plan Date 6/4 f 0 Number of sheets o'Z Revision Date Title Size of Septic Tank /O 0(D e+-AJI Ciru Type of S.A.S. Description of Soil C - y-- /d'1 u:¢ f'.�cr • �1/. G� Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to.place the system in operation until a Certifi- cate of Compliance has been issued by this Board of Health. Sjgff Date e l6 110 Application Approve Date Application Disapproved for the following reasons Permit No. �a(7C3 `-1 — rJ Date Issued 61JO A THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance �--- THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( p fired )Upgraded( ) Abandoned( )by �"_I- at A 7 a 5 Ali, has been construct/ed i, accordance with the provisio of T't1 5 and the for Disposal System Construction Permit No. t70�' V dated 6//0 . Installer/ _. Designer / The issua6ice of this permit shall not be construed as a guarantee that thIsstem will fpn•t'on as d i ed. Date ar(I Inspecto . �- V� 4 - - No. Fee _ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS z Wig ogar _5--t—-Construction Permit Permission is hereby granted to Construct( )Repair Upgrade( )Abandon( ) System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Constructio must be completed within three years of the date of`t 'ss Date:_ d y Approved y TOWN OF BARNSTABLE aVOq ^ a 9 ' SEWAGE # LOCATION VILLAGE ASSESSORR''S,MAP&.LOT 67 INSTALLER'S NAME&PHONE NO. '7?/ —7 ✓B SEPTIC TANK CAPACITY LEACHING FACII,TTY: (type� ;�f (size) a°�� t�• NO.OF BEDROOMS ° BUILDER OR OWNER / ' PERMU DATE: roI/4 f V COMPLIANCE DATE:. v L _ 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 A/ on site or within 200 feet of leaching facility) Y" Feet Edge of Wetland and Leaching Facility(If any wetlands exist , / within 300 feet of leaching facility) Feet Furnished by 01 V� l 13 2 z `q Z �3 3 3"3 3 33 Y 7 177 - - , Town of Barnstable '"E" Regulatory Services Thomas F. Geiler,Director BAMSTABLE Q , ; Public Health Division e .,MASS. 1, �: '�TFAMA�p� Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: Sewage Permit# Assessor's Map\Parcel Designer: !,VLq e Installer:- k3 wc�,vo u- &CCwC., Address: l�--Ws s �°`�- 1 Address: On 0 1 U,z( was issued a permit to install a Ode) (installlery septic system at W based on a design drawn by f' t✓ M.c v�l ec (? (address) / ) 4►'n.— g�_ h �� t�9avl-C� dated / / d A _ (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 Regulations. Plan revision or certified as-built by designer to follow. =SE :L talle s Sign re) CMLNo,M !3� tSIEk� (Deli ner's Signature). Affix Designer's Stamp Here g ( g p ) 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. Q:Health/Septic/Designer Certification Form 3-26-04.doc _ - Bulking S (P a 1) Prwew4 Aftess 2725 Moir.St C'ty Samstable Countv Barnstable Sate MA Zip Code 02630-1001 lender 28.0' i Eaves 3 O `! Bath ;Ji I o Eaves ----- -- - j + I�Ci1 8.0' o N %. ry 17.0' �———� j Bedroom' -- ......_......' Bedroom I Walk-in I T o PR E y'Closet • ' r ': { � �CID Eaves 28.0' Favas t - - Wood Deck R 4---- f 2.0' — - -- N Den Second Floor F 1�clstlst �' ° rr. ;; Master 'Foyer Dining Room = Bath i First Floor 4*1 Master E- Bedroom" cli N r C i<` S�Ji Ol AM.1•I" Con,menfsi 28.0' AREA CALCULATIONS SUMMARY LIVING AREA BREAKDOWN Code Description Size Idol Totals Breakdown Subtotals GL42 . Ftrat.r1oor 1354.Ah.-. GLA2 Second Floor 752.00 152.00 28.0 x 26.0 764.000 GAR Garage 464.00 464.00 16.0 x 24.0 384.00 oTH Deck 504.00 5J4.00 14.0 x 14.0 196.00 Second Floor 6.0 x 28.0 112.00 12.0 x 44.0 520.00 4.0 x :8.0 112.00 I I COMMONWEALTH OF MASSACHUSETTS 'EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: M5 RT 6A/MAIN ST BARNSTABLE Owners Name: THAYER . T Owner's Address: ' Date of Inspection: 10/24/06 . c� •� ri Name of Inspector: (please print) Douglas A.Brown i co Company Name: Douglas A.Brown Septic Inspections ' Mailing Address:P.O Box 145 : Centerville,MA 02632 Telephone Number: 508-420-4534 a7 CERTIFICATION STATEMENT 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: X Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: te: 10/24/06 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 sysiem 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. Notes and Comments .system only a little over 2 yrs.old appears to be working good at this time ****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. Title 5 Inspection Form 6/15/2000 page 1 Revised on 10/31/2000 Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS, SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 2725 RT 6A/MAIN ST . BARNSTABLE Owner's Name: THAYER Owner's Address: Date of Inspection: 10/24/06 inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X I have not found any information winch indicates that any of the failure criteria described in 3 10 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. . Comments: SYSTEM A LITTLE OVER 2 YRS OLD AND APPEARS TO BE IN GOOD CONDITION B. System Conditionally Passes: one or more system components as described in the"Conditional Pase' section need to be replaced or repaired. The system,upon completion of the replacement or repair, as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the following statements If"not determined"please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health, *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years'old is available. „ ND explain: ; Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced The system required pumping more than 4 times a year due to broken or obstructed pipe(s).,The system will pass inspection if(with approval of the Board of Health): . broken pipe(s)are replaced obstruction is removed I a ' Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 2725 RT 6A/MAIN ST BARNSTABLE Owner's Name: THAYER Owner's Address: Date of Inspection: 10/24/06 C.Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water , _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2.System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ the system has a septic tank and soil absorption'system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone I of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well".Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility 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: f Page 4 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A `CERTIFICATION (continued) Property Address: 2725 RT 6A/MAIN ST BARNSTABLE Owner's Name: THAYER Owner's Address: e Date of Inspection: 10/24/06 D. System Failure Criteria applicable to all systems: You must indicate"yes or no to each of the following for all inspections: Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow _ X Required pumping more than 4'times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped X Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply or.tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone 1 of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. X 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility 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.] NO (Yes/No)The system fails.I have determined that one or more-of the above failure criteria exist as described in 3 10 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 10,600 gpd to 15,000 gpd• You must indicate either"yes"or no to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no _ the system is mithin 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 yeg`m 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 f Page 5 of I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 2725 RT 6A/MAIN ST BARNSTABLE Owner: THAYER Date of Inspection: 10/24/06 Check if the following have been done. You must indicate"yes"or"no" as to each of the following:, Yes No X Pumping information was provided by the owner,occupant, or Board of Health X Were any of the system components pumped out in the previous two weeks ? X _ Has the system received normal flows in the previous two week period? X Have large volumes of water been introduced to the system recently or as part of this inspection? X _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up? X _ Was the site inspected for signs of break out? f X _ Were all system components,excluding,the SAS,lbcated on site? X _ 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? _ X 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: Yes no X _ 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(3 ))(b)) 5 I Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:2725 RT 6A/MAIN ST BARNSTABLE : Owner's Name: THAYER Owner's Address: Date of Inspection. 10/24/06 RESIDENTIAL FLOW CONDITIONS Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN How based on 3 10 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents- 0 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no): NO.[if yes separate'inspection required] Laundry system inspected(yes or no): NA S G Seasonal use: (yes or no): NO C7�1 " `�-7 4 0 Water meter readings,if available(last 2 years usage(gpd)): OS~ oLS 1-I 31 G P D Sump pump (yes or no): NO Last date of occupancy: 0 COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes.or no): _ Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM X Septic tank,distribution box, soil absorption system _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records,if.any) _Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank _Attach a copy of the DEP approval _Other(describe): Approximate age of all components,date installed(if known)and source of information: 6/04 ASSURANCE EXCAVATION Were sewage odors detected when arriving at the site (yes or no)? NO I Page 7 of 11 OFFICIAL INSPECTION FORM=NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 2725 RT 6A/MAIN ST'" BARNSTABLE + . Owner's Name: THAYER Owner's Address: Date of Inspection: 10/24/06 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: cast iron _40 PVC'_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK:_ (locate on site plan) Depth below grade: Material of construction: X concrete metal_fiberglass _polyethylene other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no)`. _(attach a copy of certificate) Dimensions: 1000GAL TANK Sludge depth: 1811 , Distance from top of sludge to bottom of outlet tee or baffle: 28" Scum thickness: 0 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: WOODEN POLE ,} Comments(on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.)- TANK LOOKS STRUCTUALLY SOUND AT THIS TIME GREASE TRAP:_(locate on site plan) Depth below grade:_ 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: Comments(on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 2725 RT 6A/MAIN ST BARNSTABLE Owner's Name: THAYER Owner's Address: Date of Inspection: 10/24/06 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/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches, etc.): 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.): PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Page 9 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION.(continued) Property Address: 2725 RT 6A/MAIN ST BARNSTABLE Owner's Name: THAYER Owner's Address: Date of Inspection: 10/24/06 SOIL ABSORPTION SYSTEM(SAS):_(locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: X 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.): INFILTRATORS WERE NOT OPENED,NO OBSERVATION PORT ASBUILT DOES NOT SHOW HOW MANY OR WHAT TYPE WERE USED SIZE OF S.A.S.IS 25 X 18.4 CESSPOOLS: (cesspool must be pumped as part of inspection)(locate.on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: , Comments(note condition of soil,signs of hydraulic failure,level of ponding, condition of vegetation,etc.): Page 10 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 2725 RT 6A/MAIN ST - BARNSTABLE Owner's Name: THAYER Owner's Address: Date of Inspection: 10/24/06 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. Al - 1) 131-2� 2- 17 2-23 3-S3 3-�3 y-q7 - S-�2 r-y� c-C7 7-77 7-Ga 2T= A Page 11 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM ] INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 2725 RT 6A/MAIN ST, BARNSTABLE ` Owner's Name: THAYER Owner's Address: Date of Inspection: 10/24/06 SITE EXAM Slope: Surface water: Check cellar: Shallow wells Estimated depth to ground water 5 ' feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of:SAS) Checked with local Board of Health-explain: ` Checked with local excavators,installers-(attach documentation) _ Accessed USGS database-explain: You must describe how you established the high ground water elevation: OFF AS BUILT CARD FROM B.O.H PERMIT#2004-290 co No. ©�y CTv g ` FEE Board of Health, RyiYS 4 , MA. APPLICATION FOP DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repair,( ) Upgrade^x Abandon( ❑Complete SystenfX6 Individual Components Location 27'�� J� �� � Owner's Name ",.'Ut4 S Map/Parcel# -ap �J�^' �,tr -?- Address Pd. go yc L b 2 11!�otf:n s 4,116 VP'l'A Lot# Lo i Telephone# ��� ??s- ,04,190 Z-4 30 sj Installer's Name 7`� Ci4� � L f)X sec b � Designer's Name l� Address '�0 60-f, mo V'O'CeSMck h o � Address Z V%J Lnwy.411141d I& Telephone# S-09-81 3_ pQ e Telephone# -7 T_ l ZIO� Type of Building 5 G L-1 4ti�1 ).'�� i P I� Lot Size 3� fie. 7 7 a-- sq.ft. Dwelling-No.of Bedrooms arbage grinder ( ) Other-Type of Building L,. "4- No.of persons Showers ),Cafeteria ( Other Fixtures AI)A Design Flow (min.required) gpd Calculate design flow jesig ow provided - gpd Plan: Date �/O� Number of sheets Rev D Title S Description of Soil(s) 6•-?d +� 1-.5 `ZO � ct ! L l J ' i Soil Evaluator Form No. Name of Soil Ev luator Date of Eval on DESCRIPTION OF REPAIRS ORALTERATIONS The undersigned agrees to install the above described Indivi al ewage Disposal System in accordance with the provisions of TITLE 5 and further agrees to not to place the system in operation until a ificate of Compliance has been issued by the Board of Health. Si' Date ra C= Q r ZE Inspections C O 'O ,(� }��}�� �T��T�`� �T CD r- N Ts' No. 'l.®l�lll`�llO �v�Y EALT14 ®F MASSACHUSETTS Ul'FEE rn Board of Health, 1?A1W S f-C 6(e , MA. CERTIFICATE OF COMPLIANCE Description of Work: ❑Individual Component(s) ❑Complete System The undersigned hereby certify that the Sewage Disposal System; Constructed ( ),Repaired ( ),Upgraded ( ),Abandoned ( ) by: at has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No. dated Approved Design Flow (gpd) Installer Designer: Inspector: Date: The issuance of this permit shall not be construed as a guarantee that the system will function as designed. No._C � 0 a Z- FEE Board of Health, /�G�t S�'C. <-N, MA. ➢ ISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct( ) Repair( ) UpgradeX) Abandon( ) an individual sewage disposal system ,at —�7 �/� a �'\ / as described in the application for Disposal System Construction Permit No. dated (D Provided: Construction shall be completed within three nears of the date is per it. All local conditions must be met. Form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date-4 � Board of Health No. y FEE Ft• MASSACHUSUTS- Board of Health, � h.S-� ��V MA `. a APPLICATION FOP, DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( .) Repair( Upgrade Abandon( - ❑Complete Systenk(]Individual Components { �ov1-e Cn� 1arn . n�+}-e �-i e`�+-t S Location � 'Z-7'L Owner's Name 4 Map/Parcel# A Z5 1 G�e8 --1 AddressP�� Qo�e 1 0 Z. Afr► 5"\Q M z Lot# Lu 1 Telephone# Lr�g 3�S--Q y 00 p Lfi 3u / Installer's Name 6/q Designer's Name ; Uv r(A 1 7� Address Address, Telephone# Tele hone# Type of Building kjg, k-1 ��'�.^is M u Lot Size A-3 ,, (D V + sq.ft. Dwelling-No.of Bedrooms ��,arbage grinder ( ) Other-Type of Building 1 No.oflpersons Showers ),Cafeteria ( ) ,Other Fixtures N A , Design Flow (min.required) 36 gpd Calculat,b design flow l O esigl'o ow provided gpd Plan: Date e, 14 16A" Number of sheets Revi ion Da e Title c / ` ✓� Description of Soils c 1- 4 L C i C-'Z,. jq w Sail Evaluator Form No. Name of Soil Ei aluato, Dat of Eval�tion 6 04— DESCRIPTION OF REPAIRS OR ALTERATION { The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees to not to place the system in operation until a G�rtificate of Compliance has been issued by the Board of Health. Si Date :- �` lol�� G r-, Inspections s X- No. C'®�9[MONWEALT14 OF �'ASSAC14US ETTS , GJl.,FEE rr � t Board of Health, Ra/-�l. S f C,6 MA. CERTIFICATE OF COMPLIANCE Description of Work: ❑Individual Component(s) ❑Complete System The undersigned hereby certify that the Sewage Disposal System; Constructed ( ),Repaired ( ),Upgraded ( ),Abandoned ( ) by: .h. at has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No. dated Approved Design Flow (gpd) Installer Designer: Inspector: Date: The issuance of this permit shall not be construed as a guarantee that the system will function as designed. No. O'�C.L� l g FEE 50 COMMONWEALTH OF MASSACHUS ETTS Board of Health, fgA�'—A S�"C, h 4 , MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby grante d to; Construct( ) Repair( ) UpgradeK) Abandon( ) an individual sewage disposal system at 1�. 64 136-rj1 as described in the application for Disposal System Construction Permit No. dated Q r y y Provided: Construction shall be completed within three years of the date-4 is p it. All local conditions must be met. Form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date �/� Board of Health"--Z!'�'�--'tea TROY WILLIAMS SEPTIC INSPECTIONS Certified by MA Department of Environmental Protection (508) 385-1300 19 Hummel Drive South Dennis, MA 02660 -\ COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTIO ' ONE WINTER STREET. BOSTON, MA 02108 617.292.5500 R'ILLIAM F.WELD 1p Govcmor yry0,ce TRUDYj �U/y�NSA Scc Fpll9B!�. N ARGEO PAUL CELLUCCI v9 DAVID B`STRUHS Lt.Govcmor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissio r PART A CERTIFICATION Property Address: �2 7°2 S M a .,, Sf. L3 r" i s'S+ S(`Address of Owner: l-fU t S Date of I o /-z y / `r 7 _T_k 4 ID Inspection: (If different) Y Name of Inspector: Troy Williams Po 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 1S.000) ' CompanyName: Troy Williams Septic Inspections /3"r"' Mailing Address: _19 HUMMpl DriVP , South Dennis , MA 02660 Telephone Number: _j508 385-13.00 ) o a c 3 a � T CERTIFICATION STATEMENT 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 inspection: The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: Passes _ Conditionally Passes Needs Further Evaluation By the Local Approving Authority _ Fails Inspector's Signatur /L,r lnJ,{�l/,�ss-"" pate: io /oa y The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(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 Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Check A, 8, C, or D: A] SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: B] SYSTEM CONDITIONALLY PASSES: A11 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. Indicate yes,no,or not determined(Y, N, or ND). Describe basis of determination in all instances. If"not determined', explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector wiih a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty(20)years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (zwL�d 0�/IS/f71 P.q• 1 of 10 .i, SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Sf. Owner: `y liS Date of Inspection: /0 /1.2 /5 -7 Bj SYSTEM CONDITIONALLY PASSES (continued) A114 Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). Describe observations: broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IT APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but'50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER (rw1sod 04/25/97) PAC. 2 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 7LZ S- m Owner: Dale of Inspection: D) SYSTEM FAILS: You must indicate ei;,.er "Yes" or "No" as to each of the following: I have determined that the system violates one or more of the following ,failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged 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 1/2 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 Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. r Any portion of a cesspool or privy is within a Zoned of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E) LARGE SYSTEM FAILS: A119 You must indicate either "Yes" or "No" as to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No ` the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area - IWPA) or a mapped Zone II of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. 7 (rrvimod 04/25/97) ry Page 3 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Properly Address: Owner: Date of Inspection: oZ 9 c� Check if the following have been done: You must indicate either "Yes" or "No"as to each of the following: Yes_ No Pumping information was provided by the owner, occupant, or Board of Health. None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. AL1,9 As built plans have been obtained and examined. Note if they are not available with N/A. _ The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow. _ The site was inspected for signs of breakout. .k _ All system components,-excluding the Soil Absorption System, have been located on the site. _ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material-of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: The facility owner(and occupants, if different from owner) were provided with information on the proper maintenance of Sub-Surface Disposal System. A/I/? Existing information. Ex. Plan at B.O.H. JC — Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) (15.302(3)(b)) Y (revised 04/75/97) Page 4 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: M � : �. s�. Owner. Date of Inspection: y /� 7 FLOW CONDITIONS RESIDENTIAL: Design flow: 3 O g.P.d./bedroom for S.A.S. Number of bedrooms:_,.3_ Number of current residents: Garbage grinder (yes or no): Na Laundry connected to system (yes or no): Seasonal use (yes or no): Nd Water meter readings, if available (last t\,%•o (2) year usage (gpd): rC l7 - 7/�ui c //„ s Sump Pump (yes or no):_,(U Last date of occupancy: bc- ✓� c . COMMERCIAUINDUSTRIAL• )V14 Type of establishment. Design flow: t allons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no) Non-sanitary waste discharged to the Title 5 system: (yes or no) Water meter readings, if.available: Last date of occupancy: OTHER: (Describe) Last date of occupancy: a GENERAL INFORMATION PUMPING RECORDS and source of information: / -r7 c.✓" i h � J o , O vt.,t U L--J rn ✓' System pumped as part of inspection: (yes or no) No If yes, volume pumped: t allons Reason for pumping: TYPE QF 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) VA Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known) and source of information: _dr• " : r•. 4./ '04Z 13 e4 4L Sewage odors detected when arriving at the site:: (yes or no) . Y (rwised 04/25/97) page 5 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 7 S M Li , �- Owner: H c� S Date of Inspection: ry y 5 BUILDING SEWER: (Locate on site plan) Depth below grade: Material of construction: _cast iron _40 PVC _other (explain) Distance from private water supply well or suction line Diameter Comments: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK: (locate on site plan) Depth below grade: g�r Material of construction: ✓concrete _metal _Fiberglass _Polyethylene _other(explain) If tank is metal, list age _ Is age confirmed by Certificate of Compliance _(Yes/No) Dimensions:_ Sludge depth Distance from top of sludge to bottom of outlet tee or baffle:o? 7 Scum thickness: " Distance from top of scum to top of outlet tee or baffle: 6 �r Distance from bottom of scum to bottom of outlet tee or baffle: How dimensions were determined: pio 6 e—. Comments: (recommendation for pumping, condition of inlet and outlet tees_or baffles, depth of liquid level in relation to outlet invert, structural integrity, /evidence of leakage, leakage, etc.) Py L.Tc �— c,t t.. .�t c r y f << r�r ,_td+1`+ W J TD�J+•� r r G.!o r' V a L t ✓h. JFr•s•. 0 1 .- J �p ✓ 4 ti �+ �! S -P--V.+ -. GREASE TRAP:_i[,iq (locate on site plan) Depth below grade: Material of construction: _concrete _metal _Fiberglass _Polyethylene —other(explain) r_ 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: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) a (revised 04/25/97) _ p . �,. Page 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C cSYSTEM INFORMATION (continued) Property Address: /V C. h S . Owner: y L S Date of Inspection: TIGHT OR HOLDING TANK: (Tank must be pumped prior to, or 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/day Alarm level: Alarm in working order _Yes; No Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: (locate on site plan) 1 Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage i/nto or out of box, etc.) /0- r n Ga.J G r. fJ, L-J O I"cl(t✓ /Y a i c. ti S PUMP CHAMBER:-✓/-g (locate on site plan) Pumps in working order: (Yes or No) Alarms in working order(Yes or No) Comments: (note condition of pump chamber, condition of pumps and.appurtenances, etc.) .i P (ravimad 04/25/97) Page 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: S !✓1 4 �� �T- Owner: 14N y e— Date of Inspection: /o%ay /� ? SOIL ABSORPTION SYSTEM (SAS):_ (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number:_ _ leaching chambers, number: 3 r`�o w Jlc s ws w leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Alternative system: Name of Technology: Comments: (note condition of soil, signs o hydraulic failure, level of ponding, condition of vegetation, etc.) / `/ N,t. •, ,ram ,, L ca c CESSPOOLS: ,k//,4 (locate on site plan) t Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater. inflow (cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level o(ponding, condition of vegetation, etc.) y 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.) (revised 04/2S/97) Page 8 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C 77 SYSTEM INFORMATION (continued) Property Address: 7 2 S /VI c,' J�• Owner. —1 e—; Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) ISM /000� lb ' K 33 3 f-/a w C(' 7ZAr-1 s Y (revised 04/25/97) Page 9 of 10 P SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 2 7�S� 114,; ST Owner: S Date of Inspection: Depth to Groundwater — Feet adjusted high groundwater level Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observation of Site (Abutting property, observation hole, basement sump etc.) Determine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records Check local excavators, installers Use USGS Data Describe in your own words how you established the High Groundwater Elevation. (Must be completed) / 1- C% e.r -c-cA 6 CA eye A _ t r (revised 04/25/97) Page 10 of 10 ' V COMMONWEALTH OF MASSACHUSETTS f EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS a DEPARTMENT OF ENVIRONMENTAL PROTEC 'ION ONE WINTER STREET. BOSTON, MA 02108 617-292-5500 Vey �t WILLIAM F.WELD O C T 2 4 199uDs c'oXE Governor �' ARGEO PAUL CELLUCCI vh'ALTHOF DEPTAbkVID B,STRUHS HEALTH OEPL Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM . C. issioner PART A CERTIFICATION 2727 Main St 14e 6.4 Howard Property Address: terns le Q � Address of Owner: Date of Inspection: ``�7 i (If different) Name of Inspector: Wm E Robinson Sr I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) Company Name: Wm E Robinson Septic Service Mailing Address: PO Box 1 089. Centervi 1 1 e , MA 02632. Telephone Numbers 0 8 , 7 7 5—R 7 7 6 CERTIFICATION STATEMENT 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 inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: _ asses Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: ,/� 1 t,t Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (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 Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Check A, B, C, Or D: A] SYSTEM PASSES: I have not found any information which indicates that.the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: B] SYSTEM CONDITIONALLY PASSES: One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Indicat yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 04/25/97) Page 1 of 10 DEP on the World Wide Web: http://www.magnet.state.me.ustdep j Printed on Recycied Paper • w SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM p PART A CERTIFICATION (continued) Property Address: 2727 Main St Barnstable Owner: Howard Woollard Date of Inspection: BJ SYS EM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). Describe observations: broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed C) FUR T ER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: nditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the p lic health, safety and the environment. 1) SYS EM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WH CH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYS EM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT T SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE E VIRONMENT: The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OT ER (reviaad 04/25/97) Page 2 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) 2727 Main St Barnstable Property Address:. Howard Woollard Owner: Date of Inspection: -f D SYSTEM FAILS: Yo must indicate,ei;!;er "Yes" or "No" as to each of the following: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged 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 112 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 Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy, is within a Zone I of a,public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E) LARGE YSTEM FAILS: You mus indicate either "Yes" or "No" as to each of the following: The'following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to ublic health and safety and the environment because one or more of the following conditions exist: Yes o the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply _ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area- IWPA) or a mapped Zone II of a public water supply well The owne or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requiremen s of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 04/25/97) Page 3 of 10 l SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 2727 Main St Barnstable Owner: Howard Woollard Date of Inspection: 9^a?4— Q 7' Check if the following have been done: You must indicate either "Yes" or"No" as to each of the following: Yes No ' / Pumping information was provided by the owner, occupant, or Board of Health. None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. As built plans have been obtained and examined. Note if they are not available with N/A. _ The facility or dwelling was inspected for signs of sewage back-up. _ The system does not receive non-sanitary or industrial waste flow. _ The site was inspected for signs of breakout. All system components, excluding the Soil Absorption System, have been located on the site. The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub-Surface Disposal System. _ Existing information. Ex. Plan at B.O.H. _ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) [15.302(3)(b)J (revised 04/25/97) Page 4 of 10 .� SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 2727 Main St Barnstable Owner: Howard Woollard Date of Inspection: _ 17 FLOW CONDITIONS RESIDENTIAL: Design flow: 6 p.d./bedroom for S.A.S. Number of bedrooms: Number of current residents:, Garbage grinder (yes or no):�L O Laundry connected to system (yes or no): Seasonal use (yes or no):/tLD Water meter readings, if available (last two (2)year usage (gpd): 1995-1996 125,000 gals Sump Pump (yes or no):j D 1996-1997 110,000.gals Last date of occupancy: c!- C �9�7 COM RCIAUINDUSTRIAL; Type of el* blishment: Design flo gallons/day Grease trap resent: (yes or no)_ Industrial te Holding Tank present: (yes or no)_ Non-sani W stary waste discharged to the Title 5 system: (yes or no)_ Water mete readings, if available. Last date o occupancy: OTHER: ( escribe) Last date occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information:/ System pumped as part of inspection: (yes or no)�l.O If yes, volume pumped: gallons Reason for pumping: TYPE O AYSTEM 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) I/A Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known) and source of information: Sewage odors detected when arriving at the site: (yes or no)LL v (reviaad 04/25/97) Page 5 of 10 f.' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 2727 Main St Barnstable Owner: Howard Woollard Date of Inspection: L—9 7 BUU ING SEWER: (Local on site plan) Depth low grade: Material of construction: _cast iron _40 PVC_other (explain) Distan from private water supply well or suction line Diamet r Comme ts: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK:Y (locate on site plan) Depth below grade: Material of construction: _concrete _metal _Fiberglass _Polyethylene _other(explain) If tank is metal, list age _ Is age confirmed by Certificate of Compliance _(Yes/No) Dimensions: `; y Sludge depth:I—a Distance from top of`s�udge 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 dimensions were determined: Q jekl 74� )� Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid I vel in relation to outlet invert, structural integrity, evidence of leakage, etc. �� �``' 's GREAS TRAP: (locate o site plan) Depth bel w grade: Material o construction: _concrete _metal _Fiberglass _Polyethylene —other(explain) Dimensio s: Scum thi ness: Distance rom top of scum to top of outlet tee or baffle: Distanc from bottom of scum to bottom of outlet tee or baffle: Date of I t pumping: Comments: (recommen ation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, a idence of leakage, etc.) (revised 04/25/97) Page 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) 2727 Main St Barnstable Property Address: Howard Woollard Owner: Date of Inspection: —Z 4• c'i 7 TIG T OR HOLDING TANK: (Tank must be pumped prior to, or at time, of inspection) (locate n site plan) Depth low grade: Material of construction: _concrete _metal _Fiberglass _Polyethylene —other(explain) Dime ions: Capaci gallons Design w: gallons/day Alarm le el: Alarm in working order_Yes; _ No Date of revious pumping: Comme ts: (condi 'on of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX!_ (locate on site plan) Depth of liquid level above outlet invert:_ Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) Z5 PUMP AMBER:_ (locate o site plan) Pumps working order: (Yes or No) Alarms in working order (Yes or No) Comme ts: (note con ition of pump chamber, condition of pumps and appurtenances, etc.) (revised 04/25/97) Page 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) 2727 Main St Barnstable Property Address: Howard Woollard Owner: Date of Inspection: SOIL ABSORPTION SYSTEM (SAS):_ (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number: leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure, level o ponding, condition of vegetation, etc.) Tw o 16 a C.) 5 To t_{ V6 c X c C SPOOLS. _ (Iota on site plan) Num r and configuration: Depth-t p of liquid to inlet invert: Depth solids layer: Depth o scum layer: Dimensi ns of cesspool: Material of construction: Indicati n of groundwater: inflow (cesspool must be pumped as part of inspection) Comm ts: (note co dition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY: (locate on site plan) Materials f construction: Dimensions: Depth of olids- Comments. (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) I (sevieed 04/25/97) Page a of 10 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 2727 Main St Barnstable Owner: Howard Woollard Date of Inspection: ; 4 _ SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) 7d � C.\. ) 5 rL e w l (d (revised 04/25/97) Page 9 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM t PART C SYSTEM INFORMATION (continued) Property Address: 2727 Main St Barnstable Owner: Howard Woollard Date of Inspection: 9 v7-4 $ 7 Depth to Groundwater Y;2 Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record f// Observation of Site (Abutting property, observation hole, basement sump etc.) Determine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records Check local excavators, installers Use USGS Data Describe in your own words how you established the Hp Groundwater Elevation. (Must be completed) 3 i (revised 04/25/97) Page 10 of 10 i TOWN OF BARNSTABLE O LOCATION ?- XA U`. S 4 SEWAGE # VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY o o y 4 1 LEACHING FACILITY: (type) S (size) NO.OF BEDROOMS 3 BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: 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 Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by ,�" oY p\ �-� �� M M `�-� . � � �' � �� c� In : � _ . `� �_ ..� -.. .J a4 l0 CATION S E ACE PERMIT NO. "�ILLACE o . 71 4 I N S T A LLE NAME ADDRESS y r i -c 8 U I L//D E R OR / OWN ER a ttOV)uY c+ e d DATE PERMIT ISSUED DATE COMPLIANCE ISSUED J- 7, : e No........ .�...a... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...._..... o.�/hl..............oF........L��h�-.. Appliratiun for Diupuuttl Worku Tunutrurtiun Prrutit Application is hereby made for a Permit to Construct (&._� or Repair ( ) an Individual Sewage Disposal System at: Location.Address or Lot No. ..SyG L---- ..... ............................ ....... ..............................•--- /� 1 Owner Address _---------1��-- IrX cTlc�mrr....................... ..... ...... ........................................ Installer Address Type of Building 3 Size Lot.................... ......Sq. feet U Dwelling—No. of Bedrooms................................ ' .Expansion Attic ( ) Garbage Grinder ( ) ~ Other—Type T e of Building ............................ No. of ersons................._..._.._._. Showers — yp g p ( ) Cafeteria ( ) a' Other fixtures ---------------------------------- W Design Flow............... ............................. 04 Septic Tank—Liquid capacity./000_gallons . Length__P���.".... Width.. ��". Diameter................ Depth_ 'o.....�.. Disposal Trench—No. ....../........... Width...! *..__..... Total Length......Z.43........ Total leaching area.....-..._fZ....sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by....42?kk��....E ........... e'er---- ��_Date aj Test Pit No. L.!LZ......minutes per inch Depth of Test Pit....A�Kz"...."Depth to ground water...... Test Pit No. 2...G ......minutes per inch Depth of Test Pit..... Depth to ground water----.—.............. a -••••-•••--•••---•-----•-•••-----••••••--...--•--•-•--•-------------•-•••------.....----------...•--......................................................... Description of Soil............. 0—/z , /z . z;�•_.51,6—Se/G L4'�— � - . --- • -----------------•-•••-••- W UNature of Repairs or Alterations—Answer when applicable............................................................................................... -•--------------------------•-------------------------------------------.......-•-••---------.......---•--•....••--••-•••••••-•---•••----•---•••••----•-•----------••-•-••-•••-•--•----•------.......... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System.in accordance with the provisions of iITIE 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in operation until a Certificate lia ce has been ued y the board f health. APPlicaion Approved By........................................... ----. .. -•---- - --._ _ .......--- ........ . Date Application Disapproved for the following reasons .. ..................•-•.._..................-••.............._......_............... .._......••-•--.-------- •-••--••--------------------•----•--•-----------......---------------•-••--•-----•--------••---------•---------------...................•-•-...••-•----•--•--......•-••-•••-•----••-••••--•-...--------- Date PermitNo......................................................... Issued-....................................................... Date No............... ... Fim$.......................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 70�.�/ ` .............it/. OF......... • Y?L!t!5:7�t'i3'� = .............._... Apphration for Diopooal Worko Tonotrurtion rrutit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: o/�= G •/}i2n/sr/�'x3L� / Location-Address or Lot No. ...S��C7L� B. ?1h/ :4.............. �.9azu, .� ................._..._...._............. ._................. _.. C 7 %Ad �S -•.......................................•...................-•----•----.......-•------------ ---------•-. Installer Address go Type of Building Size Lot............................Sq. feet V Dwelling No. of Bedrooms............................................Ex ansion Attic� g— p ( ) Ga-bage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) P4Other fixtures ------------------------------------•-••---•--•-------•--•-----------...-----------._...-----------------......-•--•--•---....--------•••.._.....•---- W. Design Flow...................�.............................gallons per person per day. Total daily flow............._..:3 ................gallons. WSeptic Tank—Liquid capacity..A4e9•gallons Length--- _��.'�._ Width...'4_�G Diameter................ Depth..S&,, x Disposal Trench—No........l.......... Width....�G..._...... Total Length.......Z:o....... Total leaching area.....3'`^Z -.-sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by..... !�✓ ._... _.....CNz. C .......... Date....�'�'�3-:.. -2 /5&-9 ••�--------------•- a Test Pit No. 1..�._ ......minutes per inch Depth of Test Pit..... - z.'� Depth to ground water..__.. zo ( , Test Pit No. 2....L�.....minutes per inch Depth of Test Pit.....j7�....... Depth to ground water...................... r4 ••------•••--•••••••--•••••...-•................•-•--••-......••----................••••••••.._......•••••••........_............---•--......•-•••---•....... D Description of Soil............. lee, i / z y .S`�3- o�G L.4 '- L" �i��`' ... ................................. ..... . ...................... v ----------- W Z •••-••••-•-•--------------------•-------•••••••••••••--••••--•-••••••-•-•---••--------•----•-•---•••--••••-••-•------------•••••-•-••---••----•-•••.........--•-••••-----••••--••••-•--•................ U Nature of Repairs or Alterations—Answer when applicable............................................................................................... -•--------------------------•---------------------•--------•---•------•--•••••••••--......•••-•--•-••-••••-••-•---•••--•••------••- ••----••----•••-••••-•••---••-••.....-•••••......-•-•-•......-•-••-•• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T ITIE 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in operation until a Certificate of'Compliance has been sued y the board health. yvc ried....=---...........................................�'el�................................ 5------............(-.------ _ Date Application Approved By.............................................!}�,1�-..-Vp --. C-�...l�Al j --------- =a Date Q Application Disapproved for the following reasons:-;. ---•---••-------•-------------•--•-----•---•-••---------•---......---••-•........................----•--- ...............................••-•-• ......-••-••-•--•-••••-•---•--••-•---•--•------••••-••---••-•.................-••-•-••-••----•-----••-••-•••••--•---•-••----...-••-••-•-...._Date PermitNo................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .........I.....TI^/.^/.......OF........... A id...S7/........................................ (5rdif iratr of Tautp ttna THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (L-1 or Repaired ( ) J , Installer at........t............................................. F. ---_... �..........--•• -•-•f-•....-•C.....•-•-------•-.......••••••••-••........•--•-•------•--•...•••------••••..._----•-..... has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code a� described in the application for Disposal Works Construction Permit No........................�1_��_...._.._.. dated-------------- .,(..��.............. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUEID AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION TISFACTORY. DATE................. . ........................... Inspector............... S�A1� '`''�'011 THE COMMONWEALTH OF MASSACHUSETTS �� -{-.•� c � Y� � BOARD OF HEALTH _1 " e No.........................1 '$ ............. � .2.. Disposal Works Tonofrtution S Permission is hereby granted......... F/ 5-yUr � c'-- to Construct ( L, )eor Repair ( ) an Individual Sewage Disposal Siy tem ��1'9 `� -a `'j at No............................................o �t --- h t , 21 Z S C �-'� �>1`r,v t A t�( ..................... - --- Street `l�� cj f ry ....... as shown on the application for Disposal Works Construction Permit No.....:.............. Dated.... d . .---- • ..........-•---•-•--•--- ...............Bo,�rd—bf`FIea�lth ••-•-•---•- r................ DATE............... /. ......0..... .. •� FORM 1255 A. M. SULKIN, INC., BOSTON CD- 5? - � 1 1>-� 0T aS� � ,� • Gam/ 1\,t:�l { , LOCATION SCALE . .!.��. � . . . DATE .M PLAN REFERENCE . .si`r�?wn� on! •9 . . .D ... . . . . . . . . . . N07Z .62"509770N3 SII SED OOV L � ,3 {y a 0 T e 3o s #�/p. op/// . o� E©'v�f>RD /, �1Y A �. p EL L.EY / `fn 9EGISiiF� 'Oh / t,sr. t — ,sex fie' \ I 1i g ! K1 1 Lt�xy A& y I I G�1 I r V ov • 3o i �P of �lr -T Pnpos gy .��aa7 4 FJ Lg, Cho�'✓�G- /��77 Ti pNe:2 L. 4G.! o TOP OF FOUNDATION CONCRETE COVER CONCRETE COVERS 4' CAST IRON II " r OR SCHEDULE 4b2 MAX. 12"MAX. ' I P.V.C, PIPE PI SCHEDULE 40 pV.C.(ONLY) PITCH I/4"PER.FT . PIPE - MIN. PITCH 1/4"PER.FT `NoNr PRECAST c'e /6 K ZO Fie*w— INVERTS w1rr1 ° 4 INVERT INVERT P . TfW q DIF�soes SEPTIC TANK EL,_:164/• • DI ST. EL`>•� , • Fcow_ .,. ,.e INVERT BOX ••"••' /000GAL. •� / Di�vsu¢s ��� e; EL.40�7B,• INVERT ' ' ::i: 3/4"To I I/' ; f EL... ..7. 40.00 % WAS EL... .!• STONE 71.o' �.��.•�� _ E2.3Z_oa PROF)LE OF GROUND WATER TABLE SEWAGE DISPOSAL SYSTEM NO SCALE 3a 7 SOIL LOG WITNESSED BY : DATE ?ram . /7!fg`' TIME. /°�'O ?oN,T/, TACa/3/ BOARD OF HEALTH TEST HOLE I TEST HOLE 2 ENGINEER ELEV. . .4Z,oo. . . ELEV. . 43c/o DESIGN DATA : n &Z.4/.0o it � 4z.io ,t S�9 s-lj-So��. NUMBER OF BEDROOMS 3 rr TOTAL ESTIMATED FLOW . . :3.3�, , GALLONS/DAY BOTTOM LEACHING AREA 3?b. • . . SO.FT. /PITIC,P.D. Sao ' SIDE LEACHING AREA . . . .?? . . . . . SQ.FT./ PIT1/Be,1r P D 9G" !s2 3¢,00 Im GARBAGE DISPOSAL .!S!4N ,(50% AREA INCREASE I TOTAL LEACHING AREASQ.FT / PERCOLATION RATE 5 ?� !T�!✓o MIN/INCH /3z OZ.3,#oo_ 13z' b°Z• 3Z•/o LEACHING AREA PER PERCOLATION RATES,, SQ.FT.1C,RD. ! ?.'..WATER ENCOUNTERED NUMBER OF LEACHING PITS . . . . . . . . . APPROVED . . . . . . . . . . . . . BOARD OF HEALTH �G ��� 7711--��� •`�W���/ vSa,es DATE . . . . . . . AGENT OR INSPECTOR 0.� �T Eta Et�1i4r(aR G .. /E. '._a ca AL H KELLEYNo. 26100 M /-•s'7'�Y4L� . . sso �£GfSTFF�°�� ' SANRAPIP� PETITIONER �hmL LAt�� HIGH GROUND-WATER LEVEL COMPUTATION S i to Locat ion: a/� 6�'11 9H;7Z-A1-5Ti93Ge� Lot No. LoT Owner: Sy�tA C/�N/�G Address: B�aUvsT�i3GE� /`7AS5 Contractor: Address: Notes: STEP 1 Measure depth to water table to nearest 1/10 ft.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Z //7/9¢ /o, o date STEP 2 Using Water-Level Range Zone and Index Well Hap locate . site and. determine: A) Appropri ate index well . . . ../ L. L. . /1iw a-41 : B) Water-level range Zone ZoNC. .fJ . . �a�e i t STEP 3 Using monthly report"Current Water Resources Conditions" determine current depth to ¢7 Z water level for index well . . . . . . Z/®¢ mo yr a913 STEP 4 Using Table of Water-level Adjustments for index well ' STEP 2A , current depth to water level for index well (STEP 3) , and water-level f-L zone (STEP 2B) determine F.7- 3; water-level adjustment . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . AAAAA Iti O �Asss STEP S Estinate depth to high water a by subtracting the water- o N 04 4 level adjustment (STEP 4) o 27,, , - from measured depth to water �� level at site (STEP 1) ►sr . . . . . . . . . . ... . . •3'ANRAR\P� w _w 7 �.f. / eti������ ,A/ to f/o �► �,Ca..i Z r�o•..A� 1�r• LLq ` Ai E� iQ✓�uJ�v2/ /y� r Figure 3 /,1 4v co ,-r 20,ve 4 ►1/�S� �(J•S.�-f /ai✓n/✓�I a�. �A•�(E S O� �+Zo✓N'— .w�re,� ��✓E c ,y.r J �,✓�E - wE�/ / 9r,-1 � �R CA Pe- CO'�, wr4 >,,q< _. .:4 h;crc� —7— EDWARD E. K ELLEY REG. LAND SURVEYOR CUMMAOUID , MASS. 02637 TEL : (617) 362-2266 Town of Barnstable Dec. 30, 1986 Board of Health Hyannis, Mass. Ref: 86-499 Sheila B. Crowell, Lot #1 , off Route 6A, Barnstable On Sept. 10 , 1986 the sewage system was inspected with . the following results; the sewage system was installed in accordance to the approved plan and meets all requirements of Title V and the Town of Barnstable Health regulations. a OF�c jff�s., J9 EDWARD �yG� E. CA Ey No. eg. a a RegP,r�ofeesa'onal JUrIM Land ;. •1 $�15.00 THE COMMONWEALTH OF MASSACHUSETTS �_"BOARD OF HEALTH Town OF Barnstable --------........................................ liration for Biopoottl Works Tomtrur#ion truti# Application is hereby made for a Permit to Construct ( ) or Repair (X ) an Individual Sewage Disposal System at: Main St. Barnstable, Ma. Lot 2727 -•-•:..........._................................................................................ .................................................................................................. Location-Address B Lot No. able, Nla. HQ' ?xd_!l�aall.ard•••-•---••••...............................•----- . ..272 f � ,St•..••- arnst Owner Address W A___ r.__ ___ es�x�no1...S�ruac-e__....._•................... 128 Bishops Terrace, 'Hyannis, .Ma. y _......•..............•..•_-•-•_-.-•..-...............-.....•..........................-........-. Installer Address dType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons.........---.........--..... Showers ( ) — Cafeteria ( ) a+ Other fixtures .................................. W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter------------_-. Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No--------------------- Diameter.............--..--. Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test'Results Performed by.......................................................................... Date........................................ ` Test Pit No. I................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.---...................- �+ ---------- ------------------------------------------------------- ...... ........ .....-------------..-....------..----.-..-...---................------------- ODescription of Soil.........................................................:--•----•••--....-•---•---------------------.........•---.:: ......----......---- V .••-•---•...---••--•---•-•-••••-•••-•••---•••--........-•-•......•-•-•---•----••...-•--•--------••-•-•••...•-•-•.....--•....-••-------••----••---••--•••......-•--•.................................•••. ------------•---------------------------------------------------------------------------------•----------------------------------------------------.................................................... U Nature of Repairs or Alterations—Answer when applicable.......F. 1-1----J. 1 :c.e-s„pap- -------re-placed----with 1.00Q--gal...septic...tank---wi.th....D-13.ox...aaad-...1.4Q©---gal...Leah---P.i-t------------- ---------------------- Agreement: The undersigned agrees to install the aforedescribed Individual'Sewage Disposal §Ni'.ii in accordance with the provisions of iITLU 5 of the State Sanitary Code—.The undersigned further agrees not'to place the system in operation until a Certificate of Compliance has been issued by board ea 9 ' C� Si ned �-' '1' f...................... . Date Application Approved By........................ ................... .....................D---ate........ D Application Disapproved for the follow, reasons:-----•----------------------•--•---------•--•---------------------------------------------...............--•--- ••••-•--••----•-•----------------••-•-------•-----•---------•--------........•--••--•------••-------............--•--•-••-••-----...------------....-••••••••••-••-••......•-•-•....- ••••......... Date PermitNo................................................... Issued....................................................... Date No... 3 Fms_..1.1.5-00 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............Town....------..---.OF..........Barnstab7 e AppliratiOn for Biiposal Works Ton#rur#ion Ferutit Application is hereby made for a Permit to Construct ( ) or Repair (x ) an Individual Sewage Disposal System at:Main St, Barnstable, Ma, Lot 2727 ....:...........__......_................................----•-•----......_.................... .......-••-...•-••-..._.........................--•••••........................................... Location-Address rltabl a Ma .....Howard_WQQ'I' . •- ....... 2.7.2 Ma�.n._. ,, ..................... ......?!. .............. _..... Owner 128 Bishops Ter 'Ubi Hyannis Mao Wj •...................CeS,9�Qo)_..,5.ex'-V-:.c-e-........................... ------------------•----•-•--••---..............------...........---...•. ..... Installer Address Type of Building Size Lot............................Sq. feet ,.. Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—T e of Building No. of persons............................ Showers a —Type g --------•--•......................•---••--• --�• ------------------ (....)--- Cafeteria ( ) dOther fixtures .................................. ...--------------•--•-•-••-------------. Design Flow............................................gallons per person per day. Total daily flow..........__.--_-_------.--------_..--.---•.gallons. Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter........._._.... Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage 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. I................minutes per inch Depth of Test Pit.................... Depth to ground water._....................... f= Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ M ............................................................................................................................................................. ODescription of Soil................•-••-----•-•-----••------•---•-•---------•-----.....----•------.............----....._...._.,......... .............. W --- ---- ------.----. U Nature of Repairs or Alterations—Answer when applicable.......F ll. in .old c.e_sspa repl,BCad...with ••....000-••.a1_..sept e...�ank._....... ._ : d._1QQQ 1 Le .oh__.P.it.............................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System.in accordance with the provisions of TITLE 5 of the State Sanitary Code The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by Om board ea Si ed. `ram _ . --------- -- ••.......... .........._.... Date Application Approved By......................... ...... .... :. ........................................ Date Application Disapproved for the f ollo reasons:------•-•----------------•-•-•-•---•--.........-•------•---•--...--------------------•-----•-•--•......._._.._ .......----•--•-•--•--•--•---•---•..............•--.....-•--------..........----------.•.......------........---•----------.....-•---------...-----.......-----------••----•......---•................. Date PermitNo..................................................._.... Issued-..................................................... - Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town oF.....Barnstable ............. .. ................................................ Trdif irate of Toutplitture THIS IS TO CERTIFY That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by......z..A...&...B---Cess qol Se v c®-••-....n..alshoas...�e���C�..I �:��.s}._.M� --•••••.............._ - -- ----- 2 2 Main St Barnstable Maa Installer at__..........................-•-----------------•-•---•-=-- e.... .....---•----------------•--------....------...............------•--•-----•-----.................... has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described inIE e application for Disposal Works Construction Permit No._. .- ........ dated �THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUA A E HAT SYSTEM WILL FUNC ION SATISFACTORY. 1 -• ., DATE.......... =-------•---.....-•-•-•-••-•-_.......--- Inspector....._ _10 r . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town........OF...••••-•...Barnstable2..., No.. .... .................................. ••.. ................. F _ ...�` ...p... Rio o oO's IT VIM ttr#ion rern i# e,;�vv Permission is hereby grante ------------------•-----.-----..-..------... ................:.................................................. _-_.. to Construct ( ) or kRepair ..an Ind'vi u�� ,dew wisp st at No.......................©..._...._....... . { �' r�1T age; ............•.............................--••--. g >'"%�. �•�.....__............. .' ... Street / 7 as shown on the application for Disposal Works Construction. Permit No........... ........ Dated.._.__17.3 ......... . oard of4Heh DATE............ `......./.. ...................................... FORM 1255 A. M. SULKIN, INC.. BOSTON , lq—aZoe LOCATION aka` SEWAGE PERMIT NO. VILt.AGE _ INSTALLER'S NAME i ADDRESS BUILDER . OR OWNER- DATE PERMIT ISSUED _ lG,� s' DATE COMPLIANCE ISSUED '> � � , V s v' � t LOCATION SEWAGE PERMIT NO. VILLAGE I N S T A LLER'S NAME j ADDRESS A i R: UILDE R . OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED ��_ / i i r,. i, } 414' LEGEND 3 PROPOSED CONTOUR o ° o Matlnioe , t s PROPOSED SPOT GRADE La T (v 1 d J C Zh , 10 v � tJ % o g ! `n 83- _ —� —— EXISTING CONTOUR D _ % LOT 1 `� < ! � EXISTING SPOT GRADE Rote 6A 0 \Q� �; 43,630 S,F,+ « 1 .46 N �0 1.00 AC,+ x (9 TEST PIT A l 3 ru N d E 103,19 0 258 Map OH W OVERHEAD WIRES Parcel 77 Locus S ^ W EXISTING WATER SERVICE ROUTE 6 * CD EXISTING : 99 3 BEDROOM STRIPDUT DOWN - s "�i N.T.S. HOUSE (#2725) -TO "C" HORIZON x 100,36 LOCUS MAP TDF=104.82 BREAKOUT BARRIER x,99.29 (Assumed) 'p - x 103,24 - 40 MIL PDL Y LINER PLACED ALONG LIMIT OF STRIPOUT WEST SIDE OF S.A.S. h EL: 100,5 TD 99,3 103.4 , x. rrs J.A.S. LAYOUT1015 w - 5 �;. t v 101. 0. i S.,A.S: tiCl/ V P/ 12/3 10356 EXIST S.A,S, r x Q .4 12 TO BE ABANDONED �,: ti GENERAL NOTES: x 101,06 Cr' � ' x ] 3 5 EXIST,. SEPTIC TANK 1Q3,43 to3,94 1 ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL TOP EL: 101,80 �' BOARD OF HEALTH AND THE DESIGN ENGINEER. INV(DUT)=I00.45 Q 03.81 2_. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS x t01.46 �i+ x , EXISTING 104x OF THE STATE ENVIRONMENTAL CODE, TITLE-V, AND'-ANY APPLICABLE Benchmark Set 3 BEDROOM Y04 LOCAL RULES AND REGULATIONS. Right cor, bulkhead HOUSE (#2725) " 3 THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR E1,=103,77 (Assumed) TDF=104,82 a -- TO INSPECTION AND APPROVAL BY .THE BOARD OF HEALTH AND THE (Assumed) DESIGN ENGINEER. , x 1 1.64 103,24 Water svc, 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING (a rox) FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN PP 100.45 - ''e " ENGINEER BEFORE CONSTRUCTION CONTINUES. x 102s3" Deck r 5.- ALL ELEVATIONS BASED ON ASSUMED DATUM. - �o P a -. - 1's,2oENGI 6• THE THE DESICONGN ACTORNORROWNER IS TTOENOTOIFY18 HE LE F LOCAL BOARD OF OR THE FAILURE OF , �, . •' •. - ' :': HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION.. 100,64 Garage x 1Q1.o3 9 7: WATER.,SUPPLY PROVIDED BY TOWN WATER SEREVICE. BOULDER/10FTlo3'�Q WELLS LOCATED WITHIN 150' OF -THE S.A.S. r :: x 05,29 8. THERE ARE NO PRIVATE x .01 104.30 ,G 9. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED TO A' CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. _TO VERIFY THE ra 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR' D lo2.os p x - BEGINNING UTILITIES PRIOR TO �� ,Garden 104,23 THE LOCATION OF ALL UNDERGROUND , 99.03 �0 1oss34 . CONSTRUCTION. , w 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS o . o IN THE AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF THE S.A.S. , AND REPLACE WITH CLEAN FILL AS SPECIFIED IN 310 CMR 255(3).'. 100.71 OF M9�fq�� • o� PETER T, �� SEPTIC SYSTEM REPAIR/UPGRADE McENTEE _ CIVIL 2725 ROUTE 6A, BARNSTABLE, MA g, No, 35109 p%g3 00 A AFC/S1 1) Prepared for: Lynette Helms, 2725 Route 6A, Barnstable, MA ,G=109 99 R��S FSSi �G\C� Engineering by: SCALE DRAWN JOB. NO. R=403 OD Engineenng far S' ,"=30' P.T.M. 37-04 c` �Q 12 West Crossfield Road, Forestdole, MA 02644 DATE 77- CHECKED" •'SHEET NO. (508) 477-5313 6/4/04. P.T.M. l Of '2 } { NOTE: TO PREVENT. BREAKOUT, A 40 MIL POLY F.G. EL: 101.5t LINER SHALL BE PLACED ALONG THE WEST TOP OF FOUNDATION OF THE S.A.S., AS SHOWN ON PLAN, AND (EXISTING) (EXISTING) F.G. EL: 103.6t ' F.G. EL: 102:0t BETWEEN ELEVATIONS 100,5 AND 99.3. n. MAINTAIN 2% MIN SLOPE OVER S.A.S. u•: j; INSTALL RISERS OVER INLET & OUTLET TO WITHIN 6" OF FINISH GRADE A L =34' L =8'(MAX) __74" SCH 40 PVC A 4" SCH 40 PVC ° �° is @ S= 17 (MIN.) S. =LEV. S= 17 (MIN,) -2 :r:j :::j (EXISTING) : 6" EFF.DEPTHEXISTING INV. 99.94(EXISTING) 1000 GALLON INV. ELEV.=100.11I_ SEPTIC TANK D-BOX INV.ELEV.=99.86 r 4 x 6.25' = 25.0' INV. ELEV.=100.45 INSTALL INLET & OUTLET TEES (EXISTING) USE 3 ROWS OF 4-STANDARD INFILTRATOR CHAMBERS (H-20) IN GAS BAFFLE TO BE INSTALLED ON SERIES SURROUNDED W/STONE TO FORM A 18.4' X 25,0' S.A.S. OUTLET TEE AS MANUFACTURED BY TUF-TITE, ZABEL, OR EQUAL D-BOX SHALL BE SET LEVEL AND TRUE TO GRADE SOIL ABSORPTION SYSTEM (PROFILE) " " ON A MECHANICALLY COMPACTED SIX INCH CRUSHED NTS. STONE BASE, AS SPECIFIED IN 310 CMR .15.221(2). 2" LAYER ❑F 1� 5 5' 16' �2.. SEPTIC. SYSTEM PROFILE BREAKOUT ELEV.=100.36— WASHED "ST❑NE DOUBLE 15,5' \i 12' N.T.S.' BOTTOM,:ELEV.=99.28 3/4'-1 1/2 DOUBLE WASHED STONE 6' r, 8' 2' 2.8' 3' 2.8' 3' 2.8' 2' ' Z 5' MIN, ABOVE BOTTOM OF T =T.P. EXCAVATI❑N OR G.W. EFF; WIDTH 18,4' 2' H-10 LOADING (3) 4" DIA.OUTLETS SOIL ABSORPTION SYSTEM (SECTION) FILL UNUSED KNOCK-OUTS HIGH G.W. EL, 93.7 (mottUng) p� ��� N.T.S. 1—�^—'� WITH MORTAR SECTION Z������ �F NjAJ�9��G DISTRIBUTION BOX DESIGN CRITERIA PETER T. SOIL LOG R,. " o _. MCENTEE N.T.S.' CIVIL y NUMBER OF BEDROOMS: 3 BEDROOMS No. 35109 SOIL TYPE: CLASS I S1_ DATE: JUNE 3, 2004 DESIGN PERCOLATION RATE: <2 MIN./IN. S/0 SOIL EVALUATOR: PETER, T. McENTEE P.E. DAILY FLOW: 330 G.P.D. 0 0 0 0 0 rro000 0 0 0 0 o INSPECTOR: NOT .REQ'D—CLASS 1 SOILS DESIGN FLOW: 330 G.P.D. 0000000 000000000000 GARBAGE GRINDER: , NO I TIP f---- 28"—�I , t� 28„ I Elev. Depth SEPTIC TANK: 1000 GALLON (EXISTING) --I 0" 330 = 445.9 S.F. 100 7 LEACHING AREA REQUIRED: A LOAMY SAND LEACH Closed End. Plate Open End Plate 10 YR 3/3 .74 99.0 20" USE 3 ROWS OF 4—STANDARD INFILTRATOR CHAMBERS (H-20) IN e LOAMY SAND SERIES SURROUNDED W./STONE TO FORM A 18.4' X 25.0' S.A.S. ~ R 5/8 10Y , k I 97 2 42° SIDEWALL AREA: ) (NOT APPLICABLE Z C1 BOTTOM AREA: 18.4' x 25.0' = 460.0 S.F. j FINE SAND 756.4 S.F. 12 -3„ : 6 11, TOTAL AREA 10YR 5/4 DESIGN FLOW PROVIDED: 0.74(460.0) = 340.4 G.P.D. 93. MOTTLING — 84" „ 7 _ 34 -1 75 C2 1.25 F—M SAND SEPTIC SYSTEM REPAIR UPGRADE Side View End View 10YR 5/6 91.6 STG. H2O 109" 2725 ROUTE 6A, BARNSTABLE, MA STANDARD INFILTRATORS, H-20 LOADING 90•9 MOTTLING 117' Prepared for: Lynette He 2725 Route 6A, Barnstable, MA Engineering by: SCALE DRAWN JOB. NO. INFILTRATOR CHAMBERS PERC RATE <2 MIN/IN. ("Cl & C2" HORIZONs) Eng%neer%ng OroAs NTS P.T.M. 37-04 N.T.S. ESTIMATED SEASONAL HIGH G.W.`EL: 93.7 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. (508) 477-5313 6/4/04 P.T.M. 2 of 2 j f. ALL .. ' w sb VINF1 J N � W } LEGEND PROPOSED CONTOUR h F16 PROPOSED SPOT GRADE d J ML tthias% 5 c F -15 -- EXISTING CONTOUR u a LOT 1 Route 6A N 43,630 S,F,+ 15.46 EXISTING SPOT GRADE � A 1.00 AC,f ® TEST PIT V N �C 10319 G I Map2SB --- QHW--- OVERHEAD WIRES � J � Parcel 77 LOCUS 2 8s ^ h W EXISTING WATER SERVICE RouTE s o � EXISTING x 99 3 BEDROOM STRIPOUT DOWN �. HOUSE (#2725) TO 'C' HORIZON x t00.36 y LOCUS MAP N.T.S. TOF=104,82 BREAKOUT BARRIER x 99.29 ,:• 101 (Assumed) x 103.24 40 MIL POLY LINER PLACED oa ALONG LIMIT OF STRIPOUT ', 8 WEST SIDE OF S.A.S. �`' EL. 100,5 TO 99.3 x'• ' a n i.: 103.47 V i. n � Stone v x 99.79 Drive d S.A.S. LAYOUT 4 Q' , Z� / �X, t. w y0 x 1ol.s Q•:• \ / S.A.S. P/ 12/3 0356 EXIST, S.A.S. 8�'•• x 102.4 0 TO BE ABANDONED cv: o GENERAL NOTES: EXIST, SEPTIC TANK x 101.06 103.43 103.94 o x 1 ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL TOP EL. 101,80 �� BOARD OF HEALTH AND THE DESIGN ENGINEER. INV(OUT)=100.45 J c 03.81 x 1o1.a6 EXISTING � 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS 1oaOF Benchmark Set 3 BEDROOM 21 a LLOCALERULES AND ENVIRONMENTAL ODE, TITLE V, AND ANY APPLICABLE REGULATIONS. Right cor, ,bulkhead HOUSE (#2725) 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR Et•=103.77 (Assumed) (Assumed) TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE (Assumed) DESIGN ENGINEER. x 1 1,64 103,24 Water.svc. 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING Aro 1�' .00, x 100.45 (approx,) EN �N EROSE BEFOROEWCONSTRUUCTIONEON ACO NTINUESORTED TO THE DESIGN x 102,53 Deck 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. 4poro�t�Q�c' oh/y ro I 520 6 THE THE CCONIGN TRACTORNORR IS OWNERTTOENOTIFYIBLE THE FOR THE FAILURE OF LOCAL BOARD OF x`10o,64 HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. x 101.03 Garage 7. WATER SUPPLY PROVIDED BY TOWN WATER SEREVICE. BaUL0ERn0FT103s0 8. THERE ARE NO PRIVATE WELLS LOCATED WITHIN 150' OF THE S.A.S. x 0105.29 104,30 9. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED x "` TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE 9 Garden lo2.os 104,23 b� x THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING 99.05 $ 105.84 CONSTRUCTION. 0 0� 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS o - IN THE AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF THE S.A.S. AND REPLACE WITH CLEAN FILL AS SPECIFIED IN 310 CMR 255(3). 1ooa1 0 F oz PETER T SEPTIC SYSTEM REPAIR/UPGRADE McENTEE CIVIL 2725 ROUTE 6A, BARNSTABLE, MA No, 35109 _ 03 0� FFC/S1E��� �� Prepared for: Lynette Helms, 2725 Route 6A, Barnstable, MA A_1 p9 99 P/ ��5 90FFsslO/ Engineering by: SCALE DRAWN JOB. NO. A'=403 00' R Engineering Works 1 "=30' P.T.M. 37-04 A.�� 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. (508) 477-5313 6/4/04 P.T.M. 1 of 2 • NOTE: TO PREVENT BREA!<OUT, A; 40 MIL O_PLY F.G. EL: to2.Ot LINER SHALL BE PLACED ALONG THE WEST TOP OF FOUNDATION OF THE S.A.S., AS SHOWN ON PLAN, AND (EXISTING) (EXISTING) F.G, EL: 103.6t F.G. EL: 102.5t BETWEEN ELEVATIONS 100,5 .AND 99.3. a� �— MAINTAIN 2% MIN SLOPE OVER S.A.S. u•. C. INSTALL RISERS OVER INLET & OUTLET TO WITHIN 6" OF FINISH GRADE a L =34' L =8'(MAX) 4" SCH 40 PVC 4" SCH 40 PVC . (EXISTING) A i4' @ S= 1% (MIN.) s° @ S= 1% (MIN•) EXISTING INV. ELEV,=99.94. 6° EFF.DEPTH (EXISTING) 1000 GALLON INV. ELEV.=100.11 SEPTIC TANK D-BOX INV.ELEV.=99.86 r 4 x 6.25' = 25,0' INV. ELEV,=100.45 INSTALL INLET & OUTLET TEES (EXISTING) USE 3 ROWS OF 4-STANDARD INFILTRATOR CHAMBERS (H-20) IN GAS BAFFLE TO BE INSTALLED ON SERIES SURROUNDED W/STONE TO FORM A 18.4' X 25.0' S.A.S. OUTLET TEE AS MANUFACTURED BY TUF-TITE, ZABEL, OR EQUAL D-BOX SHALL BE SET LEVEL AND TRUE TO GRADE - SOIL ABSORPTION SYSTEM (PROFILE) ON A MECHANICALLY COMPACTED SIX INCH CRUSHED N.T.S. STONE BASE, AS SPECIFIED IN 310 CMR 15.221(2). 15.5' 1..- 16— 2, 2' LAYER OF -� SEPTIC SYSTEM PROFILE BREAKOUT ELEV.=100.36— DOUBLE WASHED STONE 15.5' 12, N.T.S. BOTTOM ELEV.=99.28 3/4`1 1/2' DOUBLE 8' WASHED STONE 6' 2' 2,8' 3' 2.8' 3' 2.8' 2' 5' MIN, ABOVE BOTTOM OF EFF, WIDTH = 18.4' H-10 LOADING (3) 4" DIA.OUTLETS 2. T,P, EXCAVATION ❑R G.W. HIGH G.W. EL, 93.7 (mottUng) SOIL ABSORPTION SYSTEM (SECTION) PLAN FILL UNUSED WITHMOR AR-OUTS SECTION N.T.S. pF M9�sq DISTRIBUTION BOX DESIGN CRITERIA o PETER T. SOIL LOG o McENTEE N.T.S. CIVIL ti RT.:. No. 35109 ' NUMBER OF BEDROOMS: 3 BEDROOMS - SOIL TYPE: CLASS I SIFK�� ' DATE: J.UNE 3, 2004 DESIGN PERCOLATION RATE: <2 MIN./IN. 5/ON E SOIL EVALUATOR: PETER T. McENTEE P.E. DAILY FLOW: 330 G.P.D. 0 0 0 0 0 0 0 0 0 o INSPECTOR: NOT REQ'D-CLASS 1 SOILS DESIGN FLOW: 330 G.P.D. 0000000 0000000 o0000000 0000000o GARBAGE GRINDER: NO f-- 28„ I I 28 TP-- 1 Elev. I Depth y SEPTIC TANK: 1000 GALLON (EXISTING) --I fl-- LEACHING AREA REQUIRED: (330) = 445.9 S.F. Closed End Plate Open End Plate 100,7 A LOAMY SAND .74 Ilf 10 YR 3/3 • 99•0 20" USE 3 ROWS OF 4—STANDARD INFILTRATOR CHAMBERS (H-20) IN B LOAMY SAND SERIES SURROUNDED W/STONE TO FORM A 18.4' X 25.0' S.A.S. ~ 10 YR 5/8 I W - 97.2 42" SIDEWALL AREA: (NOT APPLICABLE) Z C1 BOTTOM AREA: 18,4' x 25.0' = 460.0 S.F. I FINE SAND _ TOTAL AREA: 460.0 S.F. d„ ^ 12" 3., 1 OYR 5/4 �- DESIGN FLOW PROVIDED: 0.74(460.0) = 340.4 G.P.D. �I 75" 34 —'1 93.7 MOTTLING _ 84" 1.25 C2F-M SAND SEPTIC SYSTEM REPAIR UPGRADE Side View End View 10YR 5/6 2725 ROUTE 6A BARNSTABLE MA 91.6 > STG. H2O 109 STANDARD INFILTRATORS, H-20 LOADING 90•9 MOTTLING 117' EEngineering ed for: Lynette Helms, 2725 Route 6A, Barnstable, MA by: SCALE DRAWN JOB. NO. INFILTRATOR CHAMBERS PERC RATE <2 MIN/IN. ("Cl & C2" HORIZONs) yYorks' NITS P.T.M. 37-04 Kr.s. ESTIMATED SEASONAL HIGH G.W. EL: 93.7 DATE ssfield Road, Forestdole, MA 02644 CHECKED SHEET NO. 313 5/20/04 P.T.M. 2 of 2 LEGEND ' PROPOSED CONTOUR 2h �' q 1 s PROPOSED SPOT GRADE o J MLo tthiae� o <v i IOj,g3, v c EXISTING CONTOUR a = J % C4 LOT 1 EXISTING SPOT GRADE Route 6A i c Z. T- CL Q h nr , 43,630 S.F.+ 15.46 1.00 AC.+ X TEST PIT o V N Ma 258 103.19 0 P OHW OVERHEAD WIRES ` Parcel 77 Locus Q W EXISTING WATER SERVICE RouTE s EXISTING STRIPOUT DOWN 99 3 BEDROOM I ? LOCUS MAP,N.T.S. HOUSE (#2725) TO "C' HORIZON x,1oo.36 7 s r,ed82 BREAKOUT BARRIER x 99.29 101 x 1o3,za 40 MIL POLY LINER PLACED a ALONG LIMIT OF STRIPDUT X WEST SIDE OF S.A,S, o° w� �. n EL. 100.5 TO 99.3 Ui x'� /;; , 103.47 cci stone �. //� x 99,79 �C,• /' /`/ r Drtve q 1 c. �F In ExFst. S.A.S. LAYOUT �'�� , X 101.5 4 p ! 103 6 EXIST. S.A.S. ��,,• p TO BE ABANDONED �,; o X 102.4 GENERAL NOTES: InEXIST, SEPTIC TANK x 101.06 103A3 103134 0 0 x 1 3 5 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL TOP EL: 101,80 �4 BOARD OF HEALTH AND THE DESIGN ENGINEER. INV(DUT)=100,45 G 03,81 `A` O X 101,46 V� X 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS EXISTINGNMENTAL Benchmark Set 3 BEDROOM y 1pA loazl a. LOCAL RULES STATE AND IROEGULA IONS_ ODE, TITLE V, AND ANY APPLICABLE Right cor, bulkhead HOUSE (#2725) 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR E1.=103,77 (Assumed) TDF=104,82 TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE (Assumed) DESIGN ENGINEER. x 1.64 103.24 Water svc. 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING (a rox,) FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN prppPr 12S0p x 100.45 PP ENGINEER BEFORE CONSTRUCTION CONTINUES. �) //Ift x 102.53 Deck 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. Qporok/n,gyc� only N 1 s.2o 6• THE THE CONTGN RACTOR RACT RINORR IS OWNERTTOENOTIFYIBLE THE FOR THE FAILURE OF LOCAL BOARD OF \ HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. X 100,64X 101.03 Garage 7. WATER SUPPLY PROVIDED BY TOWN WATER SEREVICE. !� BOULDER/10FT103.50 8. THERE ARE NO PRIVATE WELLS LOCATED WITHIN 150' OF THE S.A.S. X 0105.29 X 104,30 9. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. P !ar/ T �� 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO,VERIFY THE ,,Garden 102.08 104,23 b� x THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING -)O Q 99,05 u 105,e4 CONSTRUCTION. u' 0 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS a d' IN THE AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF THE S.A.S. AND REPLACE WITH CLEAN FILL AS SPECIFIED IN 310 CMR 255(3).. 100,71 a��� �F M9ffq '• PETER T, L�� g McENTEE ^ SEPTIC SYSTEM REPAIR/UPGRADE CIVIL N 2725 ROUTE 6A, BARNSTABLE, MA g� No. 35109 p,%g3 00 0 AFC/S1E��o ���, Prepared for: Lynette Helms, 2725 Route 6A, Barnstable, MA A-109 99, SSIONA E Engineering by: SCALE DRAWN JOB. NO. R=403 00, R� Engineering Works 1"=30' P.T.M. 37-04 v I QA- 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. (508) 477-5313 6/4/04 P.T.M. 1 of 2 n� NOTE: TO PREVENT BREAKOUT, •A 40 MIL POLY F.G. EL: 102.0t LINER SHALL BE PLACED ALONG THE WEST TOP OF FOUNDATION OF THE S.A.S., AS SHOWN ON PLAN, AND (EXISTING) (EXISTING) F.G, EL: 103.6t F.G. EL: 102.5t BETWEEN ELEVATIONS 100,5 AND 99.3. p• �— MAINTAIN 2% MIN SLOPE OVER S.A.S. , e•: a• INSTALL RISERS OVER INLET & OUTLET TO WITHIN 6" OF FINISH GRADE A L =34' L =8'(MAX)' 6 4" SCH 40 PVC 4" SCH 40 PVC @ S= 1% (MIN,) s' (EXISTING) 14' @ S= 1% (MIND 6' EFF.DEPTH (EXISTING) EXISTING INV. ELEV.=100.11 INV. ELEV.=99.94 a .. 1000 GALLON SEPTIC TANK D-BO INV.ELEV.=99.86 !� 4 x 6,25' = 25,0' ..... . .. INV. ELEV.=100.45- INSTALL INLET & OUTLET TEES (EXISTING) USE 3 ROWS OF 4—STANDARD INFILTRATOR CHAMBERS (H-20) IN GAS BAFFLE TO BE INSTALLED ON SERIES SURROUNDED W/STONE TO FORM A 18.4' X 25.0' S.A.S. OUTLET TEE AS MANUFACTURED BY TUF—TITE, ZABEL, OR EQUAL D—BOX SHALL BE SET LEVEL AND TRUE TO GRADE SOIL ABSORPTION SYSTEM (PROFILE) ON A MECHANICALLY COMPACTED SIX INCH CRUSHED STONE BASE, AS SPECIFIED IN 310 CMR 15.221(2). 15_ 5' 16' �2, 2' LAYER OF SEPTIC SYSTEM PROFILE BREAKOUT ELEV.=100.36— WASHED STONE LE N;T,S,' 3/4`1 1/2' DOUBLE 1ss. C - �- 12• BOTTOM ELEV.=99.28 6• ?', 8' 2' 2.8' 3' 2.8' 3' 2.8, 2 WASHED STONE �' ` - 5' MIN,. ABOVE BOTTOM OF EFF, WIDTH = 18,4'' 2, T.P. EXCAVATION OR G.W. H-10 LOADING (3) 4" DWOUTLETS HIGH G,W, E 93J <r�ottling) SOIL ABSORPTION SYSTEM (SECTION) LF PLAN FILL UNUSED KNOCK—OUTS SECTION - N.T.S. WITH MORTAR ����1� DISTRIBUTION BOX o T. DESIGN CRITERIA McENTEE SOIL LOG o N.T.S. CIVIL H nrs. . NUMBER OF BEDROOMS: 3 BEDROOMS No, 35109 SOIL TYPE: CLASS I FC/S1FR�� DATE: JUNE 3, 2004 DESIGN PERCOLATION RATE: <2 MIN./IN. /ONA �. SOIL EVALUATOR: PETER T. McENTEE P.E. DAILY FLOW: 330 G.P.D. � ! r0000000 , 00 0 0 0 000 0 o INSPECTOR:. NOT REQ'D-CLASS 1 SOILS DESIGN FLOW: 330 G.P,D. Op0000000000 II I 00000000 I z GARBAGE GRINDER: NO ham--- 28"--I t� 28"—�1 Elev. "' TP— 1 Depth SEPTIC TANK: 1000 GALLON (EXISTING) 100,7 330) = 445.9 S.F. Closed End Plate Open End Plate A LOAMY SAND O' LEACHING AREA REQUIRED: (.74 10 YR 3/3 99.0 20" USE 3 ROWS OF `4-STANDARD INFILTRATOR CHAMBERS (H-20) IN B LOAMY SAND SERIES SURROUNDED W/STONE TO FORM A 18.4' X 25.0' S.A.S. ~ 10 YR 5/8 W I 97 2 42„ SIDEWALL AREA: (NOT APPLICABLE) ' Z C1 BOTTOM AREA: 18.4' x 25,0' = 460.0 S.F. j FINE SAND TOTAL AREA: 460.0 S.F. 6. 12 1OYR 5/4 DESIGN FLOW PROVIDED: 0.74(460.0) = 340.4 G.P.D. `•I 75" •34" —�1 93.7 MOTTLING 84 1.25" C2F-M SAND SEPTIC SYSTEM REPAIR UPGRADE Side View End View 10YR 5/6 2725 ROUTE 6A, BARNSTABLE, MA 91.6 STG. H2O 109" STANDARD INFILTRATORS, H-20 LOADING 90.9 MOTTLING 1:,t7' Prepared for, Lynette Helms, 2725 Route 6A, Barnstable, MA Engineering by: SCALE DRAWN JOB. NO. INFILTRATOR CHAMBERS PERC RATE <2 MIN/IN. ("Cl & C2" HORIZONs) Engineering Words' NTS P.T.M. 37-04 Krs. ESTIMATED SEASONAL HIGH G.W. EL: 93.7 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET N0. (508) 477-5313 5/20/04 P.T.M. 2 Of 2