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HomeMy WebLinkAbout3730 MAIN ST./RTE 6A(BARN.) - Health 3730 RT. 6A/MAIN ST.,BARNSTABLE A=317.027 rl + i a e r � if.. .. ' a- - - ,. ., � .. u • � .. .: - -. � , c. i r a- , N • n " + 3'4 , Y� a a r � � No. {® Fee ®®� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01ppf ration for MispoBal 6pstrm Construction VPrmit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Add res )r Lot No. 3 7 3 0 12 -- 619 Owner's Name,Address,and Tel.NoSO S'—369 °-�) Assessor's Map/Par ��n Sd 9 Gb k /ryes y'h H i� �Lc�h'�. ,�nGW�-7� 117kJ'Xrn Installer's Name,Address,and Tel.No.J -C Designer's Name,Addres ,and Tel.No. 0,-r3 6 QA-445'q/ lzl��SG' �'1acS Co�sd-; 33/zh4efee7S-eA/1 Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder 0 Other Type of Building 12 e-5 No.of Persons Showers( ) Cafeteria( ) Other Fixtures oo�� r� Design Flow(min.required) 3 V gpd Design flow provided 337 gpd Plan Date�i;;n`7 9-7 Number of sheets 11 Revision Date Title /rcv %P�cl�..�� f 4--1�&7 Ile J A -1 973 a X-� Gn 94/1 AW Size of Septic Tank i d0 V AL. Type of S.A.S. Description of Soil S&,, i lei Nature of Repairs or Alterations(Answer when applicable) S:ee &eahqndL Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of H alth. Sign L r Date Application Approved by d ; tW/w`7/i,�j Date / 2 — (n Application Disapproved by')m / �� Date for the following reasons ZA&Sd A'J';t pz Aff A L-I Permit No. Date Issued e IpQ i� No. OCn , i� , Fee / THE COMMONWEALTH OF MASSACHUSETTS Entered in,compu er: Y PUBLIC HEALTH DIVISION TOWN 0F,,BARNSTABLE, MASSACHUSETTS YeS application for Wiposar 6pstem Construction Permit ' Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components A Location Address or Lot No. 3-)3 0 n j, 617 Owner's Name,Address,and Tel.No.4 0 -369 - o'kPI S - Asseeslo�r''sMap/Parcel G�nSJ9G3ti' /h5 At 7h�1>r /l�jn � � � �7S�'����/ Installer's Name,Address,and Tel.No.S� 36d(ol3 Designer's Name,Addres ,and Tel.No. 54 9--3(e Q1 Type of Building: r VV Dwelling No.of Bedrooms 3 Lot Size" �3 �{sq.ft. Garbage Grinder(�0 Other Type of Building r4.e,5 No.of Persons Showers( ) Cafeteria( ) Other Fixtures *`" Design Flow(min.required) 3 3� gpd Design flow provided - 337 gpd Plan Date 4,10 a o, doj b Number of sheets , Revision Date Title /eAc ,✓s%//P W /) 3730 IL7'� !�/a 6/I uS71A Size of Septic Tank (UvV X n L. !St. Type of S.A.S. Description of Soil S& .i( (tee, 1 � Nature of Repairs or Alteritions(Answer when applicable) �e P 6-P A � A ✓i W4l�Jlra 1"� i Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of.the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed ;, \ 01•...A.k.,,_�' ,(-� Ci r 1 ` Date �, - l -•'~� Application Approved by �IW�►"Zl r(i/y Date t Application Disapproved by W 4f ,�VI-L/, ►[y� { ft'. Date for the following reasons Vj ` (n tk,J -� �Ga, ti-'Z -r •w Permit No. [ Date Issued ---------------------------------- <--------------------------------------------------------------------------------------- -------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliante THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned( )by I^ 11.� f��'p 77\0 'S CC k 1 S t at - �3�- R t- (o (j,yr�Sji )Y has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. ®I ICI dated Installer f.' I fah 5 Designer 1�}Q/,fiVl C�/la� YJCc r�.I!S #_bedrooms + 3 Approved desijnEctio flow gpd The issuance of this ermit s all not be construed as a guarantee that the system will as desi ned. P g Yg Date Inspector J, �( ---------------------------------------------------------------------------------------------------------------------------------------- No. �3 L-) ` io " t ' Fee ( oo . THE COMMONWEALTH OF. MASSACHUSETTS s PUBLIC HEALTH DIVISION"—BARNSTABLE,,MASSACHUSETTS Disposal 6pstefteConMrutttott Permit Permission is hereby granted to Construct( ) Repair( ) .JUpgrade~( f) Abandon( ) System located at / 66 4r A/�, 4h„ ;y and as described in the above Application for Disposal System Construction Permit. The pp)icant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions, Provided:Construction must be completed within three years of the date of this permit. Date Approved b +� fl PP Y TOWN OF BARNSTABLE T OCATION 3?30) kt SEWAGE# I h5p fC�,`& VILLAGE ASSESSOR'S MAP&PARCEL,3 INSTALLER'S NAME&PHONE NO. 9431 9JR T;.o(S Coil SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) NO.OF BEDROOMS OWNER 4 Cyr lo," PERMIT DATE: COMPLIANCE DATE: 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 44 u:...sna ruesoiwaevwcam��:ampnmse.�+w�sr����san TOWN OF.BARNSTABLE .LOCATION --'� ® ` d SEWAGE# ® f VILLAGE 85 rn ASSESSOR'S MAP&PARCEL 317 —D;"7 INSTALLER'S NAME&PHONE NO. r f l iS QW1 i-S &-n S4- Sc;k 30,Q�37 SEPTIC TANK CAPACITY /®6o �X/ST_ /do a PC LEACHING FACILITY:(type) el—Zer yP/PZ (size) /7,S k ,?le ,r l?,'- NO.OF BEDROOMS ✓� OWNER /�1/4/-t. tWAI-t PERMIT DATE: COMPLIANCE DATE: �9 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 A - 9R, Ge �s /7, 1 '7A 773U C_ 3 a _ 3 FROM FAX NO. Aug. 29 2016 03:37PM P1 .m Tfi@tA=92 F.Gf1 ff,JNWCCt0r BtlA M. Publfc HeRliffi Division Oft~,,ce: 509-862•-46 Fax: 508-790-6304 lwta leer JB pi@iLR Cer>tlfkallim Form llDate: el c3/7 7 — I �! s 471 •I_ 0_ itic rr�► -Li - y 71 Ha 1 rti y 1. -...v� 1 -e�i'�; 415 el 1 Can �wFIs zMaCd.a peroaitto iris�all o e*dc systm at 'n3o based un a dcsiga drawn bry (iddii s) C), fE, PIJ T.certify'that she Reijtir, sy--#�°m.Yeferenced abme.was ili.Rtallud aubstautiany snowding to thf- tIeagn,-which III Y 1110hdc•lY1TilOT RpP o-ved changes such as lateudrdorsh. n.of idle ffi tributi on.box alv Yar aepfic trek r ceitity that the septic system, above was inatsJled wiih:major cliangoo (Le. . estex tl IO'Ixt 3 r�lncs�tion.Rf,the SAS suy vesiir-alrFlacati z of my rom?oue-rt ufitfle septit;system)lkt in aorurdure-with,States& Local Regalatirms. PhRa ro-d .o ar mfi.etd.as ftilt•Uy desipur LE) ulluw. H OF.lfgs DANIELA. OJALA �P (T2J.YlEillFr'9 S? tuxe) " CIVIL Ul Na A13502 .q NA (l7esipLtc�z'S 3ignaliaa:s,)� � (15:�tsa'F3R1si�Pc's fi�rmr l:�t;.t�;) � . • ��'F4z3��.F�.I.I�T Tip _... • •c'1'.t���,E,..�!'[l�lf,,��: 1�:��.:.i'� 1�.1d1�XtYri. •�1E�37tTIRIf'.,�.`.i'�� �9� �9 UUracrK ray 1,'KER Mug 1) uff J1, +SM MIS FOAM brD M-Bul +I ) .n �;.,CZI & W. emsCD=la err r � �cr. Assessing As-Built Cards Page 1 of 2 • TOWN OF BARNSTABLE Ii. co. LOCATION .37 30 A ►a,,- T.1' SEWAGE# VILLAGE Sf Ab'�� ASSESSOR'S•MAP&LOT 3f_!= '1 INSTALLER'S NAME&PHONE L I SEPTIC TANK CAPACM (000 LEACHING FACILITY:(type) �Sx'�O F'e I.R (size) NO.-.OF-BEDROOMS BUILDER OR OWNER 6 Qe y PERMTf DATE: J �-� ^ ` COMPLIANCE DATE S Separation Distance Between the: I 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 A - � S" I Q- e http://www.town.bamstable.ma.us/assessing/fIMdisplay.asp?mappar=317027&seq=1 5/11/2015 /� p � � �� r ru 0 � F F I C I A L U S E. CO Postage $ rtJ � Certified Fee U�450 O �-- Postmark J O Return Receipt Fee C O (Endorsement Required) Here o ,h Restricted Delivery Fee O (Endorsement Required) C3 Total Postage&Fees �SQ Sent To N Ac u� f"V?* a� 3Yreet,Apt No.G - --------- r- PO- l�Z or PO Box No. -----------------------------=------------------------------------------------------- c'"State amsta b/e 6a 630 Certified Mail Provides: o A mailing receipt o A unique identifier for your mailpiece o A record of delivery kept by the Postal Service for two years Important Reminders: o Certified Mail may ONLY be combined with First-Class Mail®or Priority Mailrei.. o Certified Mail is not available for any class of international mail. a NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. e For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. o For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted-Delivery. o If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on�the Certified Mail receipt is not needed,detach and affix label with postage and mail. t � IMPORTANT. Save this receipt and present-it when.making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047_ a SECTIONSENDER: COMPLETE THIS SECTION COMPLETE THIS . . ■ Complete items 1,2,and 3.Also complete A. Sig I item 4 if Restricted Delivery is desired. X ❑Agent ■ Print your name and address on the reverse ❑Addressee so that we can return the card to you. B. eceiv by(Printed Name) C a®of De'very ■ Attach this card to the back of the mailpiece, I or on the front if space permits. 1 D. Is delivery address different from item 1 1 1. Article Addressed to: I!YES,enter delivery address below: ❑No Q� a KilwC114hII I b � Mq bal�3o 3. Service Type I ��nsfa � � Certified Mail® O Priority Mail Express'" ❑Registered CK Return Receipt for Merchandise ❑Insured Mail ❑Collect on Delivery 4. Restricted Delivery?(Extra Fee) p Yes 2. . 17'012.. 1010 0.00.04 '2848 4242811V.Sti PS Form 3811,July 2013 Domestic Return Receipt �I UNITED STATES POSTAL SERVICE First-Class Mail I Postage&Fees Paid USPS Permit No.G-10 Sender: Please print your name, address, and ZIP+4®in this box• I I � I I I I Town of Barnstable Os Health Division 200 Main Street Hyannis, MA 02601 I t!'il{!lflii.tIII)ill"i!Jl li!t'11J]lfl Jti73iFll� }fl; llllJf'J �� I 6 - ia Town 'of Barnstable Barnstable Regulatory Services Department edcaQ IV i B' MASS r Public Health Division I 2007 200 Main Street, Hyannis MA.02601 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL # 7012 1010 0000 2848 2428 August 12, 2016 Arthur& Margaret Kane f P.O. Box 1178 Barnstable, MA 02630 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,TITLE 5 The septic system located at 3730 Main Street/Route 6A, Barnstable, MA was last inspected on 07/22/2016, by Reid Ellis, a certified septic inspector,for the state of Massachusetts. 3 The inspection of the septic system showed that the system "Fails" under the guidelines ' of the 1995 TITLE 5 (310 CMR 15.00) due to the following: r " �• • Static liquid,level in the' distribution box above outlet invert due to 'an overloaded or clogged SAS or cesspool. j You are ordered to repair or replace the septic system within one (1) year from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. ER OF T1,�E BOARD OF HEALTH , om cean, R.S. CHO Agent of the Board of Health. CC: Barnstable Department of Health and Environment Q:\SEPTIC\Letters Septic Inspection Failures or Future Ev1\3730 Main Street Route 6A Bamstable.doc Town of Barnstable RAMS MIX Regulatory Services Department Public Health Division , 200 Main Street;,Hyannis MA 02601 Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 5/11/16 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An"x" marked in the ❑ is the failure criteria and"associated repair,deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or,obstructed pipe ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool O E 1 YEAR DEADLINE CRITERIA V-Static liquid level in the distribution box above outlet invert due to an overloaded or logged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public,well ❑ Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates�the well-is free from pollution). TWO (2)YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any"conditionally passed systems" (broken cover;relocation of a pipe, relocation of a driveway due to H-10 components, etc) , ❑ Leaching pit or cesspool with high liquid level, <12"below inlet(per Town Code §360-9.1) ❑ Leaching facility with standing liquid level at or above the invert pipe (per Town .Code §360-20 h) OTHER , Repair deadline: l WSEPTIMDEADLINES TO REPAIR FAILED SYSTEMS.doc Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 3730 Route 6A, P. O. Box 1178, Barnstable, MA Property Address F.. Arthur f&Margaret Kane Owner Owner's Name Ti information is Barnstable I/ MA- 02630 7/22/2016 required for every . page. Cityrrown State Zip Code Date of Inspection fjo Inspection results must be submitted on this form. Inspection forms may not be altered in any way.Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information c on the computer, use only the tab 1. Inspector: key to move your p cursor-do not REID C. ELLIS use the return key. Name of Inspector ' �►/� ELLIS BROTHERS CONSTRUCTION I--y Company Name 23 ENTERPRISE ROAD Company Address YARMOUTH PORT MA 02675 Cityrrown State Zip Code 508-362-6237 S121891 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system-..- Passes ❑ Conditionally Passes VFails ❑ Needs Further Evaluation by the Local Approving Authority Inspector's gignature ° Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 ^O �/8 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 3730 Route 6A, P. O_ Box 1178, Barnstable, MA Property Address Arthur f& Margaret Kane Owner Owner's Name information is required for every Barnstable MA 02630 7/22/2016 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) - Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: //17 &I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: VA ;-3o A CA ko,U� O` l7 � t-7 B) System Conditionally Passes: ❑ One or more system components as descri ed in the"Conditional Pass"section need to be replaced or repaired. The system, upon cor ipletion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determine '(Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* Dr the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfilb ation or tank failure is imminent. System will pass inspection if the existing tank is replaced with a mplying 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 0 years old is available. ❑ Y ❑ N ❑ ND(Explain bel w): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M SVBy';� 3730 Route 6A,.P. O. Box 1178, Barnstable, MA Property Address Arthur f& Margaret Kane Owner Owner's Name information is required for every Barnstable MA 02630 7/22/2016 page. CitylTown State Zip Code Date of Inspection B. Certification (Cont.) ❑ Pump Chamber pumps/alarms not operation . System will pass with Board of Health Pumps/alarms are repaired. approval if B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out o`high static water level in the distribution box due to broken or obstructed pipe(s)or due to a brc ken, settled or uneven distribution box. System will pass inspection if(with approval of Board of H alth): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): I ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced Y - ❑ ❑ N (Explain ❑ ND( p am below): I ❑ The system required pumping more than 4 tir ies a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval c Fthe Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the oard of Health:. El Conditions exist which require further eva uation by the Board of Health in order to determnine if the system is failing to protect public heal , safety or the environment, 1. System will pass unless Board of H alth determines in accordance with 310 CMR 15.303(1)(b)that the system is not fun ioning 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 fee of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page?of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �.v 3730 Route 6A, P. O. Box 1178, Barnstable, MA Property Address Arthur f& Margaret Kane Owner information is Owner's Name required for every Barnstable MA 02630 7/22/2016 page. Citylrown B. Certification (cont.) State Zip Code Date of Inspection (In 2. System will fail unless the Board of H and Public Water determines that the system is functioninatmanner that protects p heepublic health, safety and environment: ❑ The system has a septic tank and soil a sorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributa y to a surface water supply. ❑ The system has a septic tank and SAS nd the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS nd the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and he SAS is less tha n 100 feet but 50 feet more from a private water supply well". or Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presE nce of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other fail re criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Liquid depth in cesspool is less than 6"below invert or available volume is less than %day flow t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 3730 Route 6A, P. O. Box 1178, Barnstable, MA Property Address Arthur f& Margaret Kane Owner Owner's Name information is required for every Barnstable MA 02630: 7/22/2016 page. citylrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ Any portion of the SAS, cesspool or privy is below high ground water elevation. ElAny portion of cesspool or privy is within 100 feet of a surface water supply or ❑ ;/ tributary to a surface water supply. pp y 0 An portion y p n of a cesspool or privy is within a Zone 1 of a public well. El An portion y p of a cesspool or privy is within 50 feet of a private water supply well. i ❑ An portion y p of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CM 15.303, therefore the system fails. The system owner should contact t Board of Health to determine what will be necessary to correct the�� , E) Large Systems: To be considered a large s stem the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"ye "or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 f et of a surface drinking water supply ❑ ❑ the system is within 200 f et 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 it of a public water supply well If you have answered"yes"to any question in I ection.E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed_ The owner or operator of any large system considered a significant threat under S ction E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.T e system owner should contact the appropriate regional office of the Department. t5ins•3113 Tille 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form-Not for Voluntary Assessments a,•'`r 3730 Route 6A, P. O. Box 1178, Barnstable, MA Property Address Arthur f&Margaret Kane Owner information is Owner's Name required for every Barnstable MA 02630 7/22/2016 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No P❑ umping information was provided by the owner, occupant, or Board of Health ❑ Were any of the system components pumped out in the previous two weeks? Has the system received normal flows in the previous two week period? Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ❑ Was the facility or dwelling inspected for signs of sewage back up? ❑ Was the site inspected for signs of break out? ❑ Were all system components, excluding the SAS,.located on site? ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ❑ Existing information. For example, a plan at the Board of Health. ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms :desi n ( 9 ) Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Off icial Inspection Form § Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 3730 Route 6A, P. O. Box 1178, Barnstable, MA Property Address Arthur f& Margaret Kane Owner Owner's Name information is required for every Barnstable MA 02630 7/22/2016 page. Cltylrown State Zip Code Date of Inspection D. System Information Description: r Number of current residents: Does residence have a garbage grinder? ❑ Yes (/No Is laundry on a separate sewage system? (Include laundry system inspection � information in this report.) El Yes ;;No Laundry system inspected? El Yes Seasonal use? ❑ Yes No Water meter readings, if available(last 2 years usage(gpd)): Detail f/ o� Aw Sump pump? Ell Yes No Last date of occupancy: Date Commercial/Industrial Flow Conditions: �� z .. Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft_, etc.)-. Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? El Yes ❑ No Non-sanitary waste discharged to the Title 5 syste ? ❑ Yes ❑ No Water meter`readings, if available: t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 I Commonwealth of Massachusetts —.0 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 3730 Route 6A, P. O. Box 1178, Barnstable, MA Property Address Arthur f&Margaret Kane Owner information is Owner's Name required for every Barnstable MA 02630 7/22/2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use- Date Other(describe below): General Information Pumping Records: Source of information: .b G0p '1!�e_oeiL Was system pumped as part of the inspection? Lyf Yes ❑ No If yes, volume pumped gallons How was quantity pumped determined? Reason for pumping.- Type o ystem: Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and.a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins°3113 Title 5 Official Inspection Fonn:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 3730 Route 6A, P. O. Box 1178,Barnstable, MA Property Address Arthur f& Margaret Kane Owner Owner's Name information is required for every Barnstable MA 02630 _ 7/22/2016 page. Cityfrown State Zip Code ,Date of Inspection D. System Information (cont.) ;Z" Approximate age of all components, date installed (if ckknown)and source of information: XAl, Were sewage odors detected when arriving at the site? ❑ Yes /No Building Sewer(locate on site plan): Depth below grade: feet _ MZcast terial of construction: iron V40 PVC ❑other(explain): b Distance from private water supply well or suction line: Pftf , Comments(on condition of joints, venting, evidence of leakage, etc.): l Septic Tank(locate on site plan): y Depth below grade: `WGe.� f� feet Material of construction: concrete ❑ metal ❑fiberglass El polyethylene' El other(explai01 ) S C&Ire.— ry av�7+l�i� Dry S If tank is met , list age: /of � Is age co firmed b a Ce if -- y rt icate of Compliance?(attach opertificate) , ❑ Yes ❑ Dimensions: � � Sludge depth: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form - a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 3730 Route 6A, P. O. Box 1176, Barnstable, MA Property Address Arthur f& Margaret Kane Owner Owner's Name information is required for every Barnstable MA 02630 7/22/2016 page. City/Town State Zip Code Date of Inspection D. System Information (cost.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle �u Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? ''� YN Comments(on pumping recommendations, inlet and outlet tee or ba a condition, structural integrity, liquid levels asrlated to outle invert e ' ence of leaka e t : Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fibe glass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or t affle Distance from bottom of scum to bottom of outlet ee or baffle Date of last pumping: Date t5ins.3/13 itle 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments a • 3730 Route 6A, P. O. Box 1178, Barnstable, MA Property Address Arthur f&Margaret Kane Owner information is Owner's Name required for every Barnstable MA 02630 7/22/2016 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet/ndoutlet tee or baffle condition, structural inte rit liquid levels as related to outlet invert, evidence f leakage, etc.): g y' i Tight or Holding Tank(tank must be pumped tLf inspection) (locate on site Ian).- p Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fi r lass 9 ❑ polyethylene El other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switche , etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System.Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora' Subsurface Sewage Disposal System Form-Not for Voluntary Assessments *M 3730 Route 6A, P. O. Box 1178, Barnstable, MA Property Address Arthur f& Margaret Kane Owner Owner's Name information is required for every Barnstable MA 02630 7/22/2016 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert je4 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence o leakage i�g or out of boy, etc.): t �� � �a rat, t Pump Chamber(locate on site plan): Pumpj in working order: Y s El No* Alarm$ in working order: Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): o� AIIA r11A *If pumps or alarms are not in working order, syste ' a conditional pass. Soil Absorption System (SAS).(locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 3730 Route 6A, P. O. Box 1178, Barnstable, MA Property Address Arthur f& Margaret Kane Owner Owner's Name information is required for every Barnstable MA 02630 7/22/2016 page. Cltyfrown State Zip Code Date of Inspection D. System Information (cont.) Type. t ❑ leaching pits number: ❑ • leaching chambers number: ❑ N leaching galleries number: ❑ leaching trenches - number, length: � leaching fields number, dimensions: 16X Y— to ❑ 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_): w_; o df4S 4 Wd- t4ul14r Cesspools (cesspool must be pumped as partolInspecticn) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage � g Disposal System Form-Not for Voluntary Assessments •+ 3730 Route 6A, P. O.*Box 1178, Barnstable, MA Property Address Arthur f& Margaret Kane Owner Owners Name information is required for every Barnstable' MA 02630 7/22/2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hyd aull failure, level of ponding;condition of vegetation,' etc.): 9 Privy(locate on site plan): Materials of construction:' Dimensions Depth of solids Comments(note condition of soil, signs of hydraL lic failure, level of ponding;condition of vegetation' ' etc.): t5ins•3/13 f Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 r Commonwealth of Massachusetts y Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ti 3730 Route 6A, P. O. Box 1178, Barnstable, MA Property Address Arthur f& Margaret Kane Owner information is Owner's Name required for every Barnstable MA 02630 7/22/2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate whe public water supply enters the building_ Check one of the boxes below: hand-sketch in the area below ❑ drawing atta se arately /V 1 ot4l k tip' � • � a Uz. CPA= - i5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 l Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments a 3730 Route 6A, P. O. Box 1178, Barnstable, MA Property Address Arthur f& Margaret Kane Owner information is Owner's Name required for every Barnstable MA 02630 7/22/2016 page. Ci3y/Town State -ZIPCode Date of Inspection Q. System information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells ` s Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) Accessed USGS database-exp lain; XmI You must describe how you established the high ground water elevat' � 3�! 4tY4 .ew Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments a.. 3730 Route 6A, P. O. Box 1178, Barnstable, MA Property Address i Arthur f& Margaret Kane Owner Owner's Name information is required for every Barnstable MA 02630 7/22/2016 page. Cityrrown State Zip Code Date of Inspection " E. ;7.416pection ort Completeness Checklist Summary:A, B, C, D, or E checked Summary D (System Failure Criteria Applicable to All Systems)completed ) ystem Information—Estimated depth to high groundwater Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 AsBuilt Page 1 of 2 4 TOWN OF BARNSTABLE L . L' LOCATION 3 7 JD M 6 SEWAGE# 9?`_3 VILLAGE 13.",T+gblee ASSESSOR'S.MAP&LOT 3f2-23 T INSTALLER'S NAME&PHONE NO. -(ice L e:L 7:q O 2 -S SEPTIC TANK CAPACITY FOOD p r LEACHING FACILITY: (type) ��k`�p ! e �oQ (size) NO.-OF BEDROOMS. _ . BUILDER OR OWNER e _ PERMITDATE: -� 'Z� g COMPLIANCE DATE:. j Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well Leaching Facility (If any welts exist " on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by Q- � I . • s _ http:Hissgl2/intranet/propdat4rebuilt.asp'x?mappar=317027&seq=1 6/16/2016 s to Town of Barnstable P# --ti�G.16 Departinent of Regulatory Services B a< Public Health Division Date �� MA99 relp 200 Main Street,Hyannis MA 02601 Date Scheduldd_ / / r!b Time ; ` f( ' _��_ Fee Pd._ Sail Suitability Assessment for Sewage Disposal Performed-By: Witnessed By:�'.c� ' UICt eS . LOCATION&.GENERAL INFORMATI N� Location Address 3�30 1 Owner's Name > �v4gbi t Address Assessor's Map/Parcel:"3���Z Engineer's Nsme`, �C NEW CONSTRUCTIONREPAIR � Telephone#& — �V/ Land Use ! Ii .�s.►� (� Slopes(96)_ ' Surface Stones Distancesfirm: Open Water Body- no R Possible Wet•Area L ft Drinking Water Well Dtalhage Way- ,W ft Property Line _ Z- _ft Other SICETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands In proximity to holes) } Or -� 4 Parent material(geologic) ten le � Depth to Bedrock Depth to Groundwater. Standing Water in Hole: Weeping from Pit Face - P Estimated Seasonal High Groundwater OR SEASONALMIGH'WATER TABLE Method Used:&BENIT1,11 Depth Observed standing in obs,hole: ,. lu, Depth to loll mottial., ln.' De th t weeping from side pf obs.hole: [n, Oroundwater AdJuetment._._.r. -t�eIndex Wei RondingDato:OYf{ ♦ah� Index Welllevoi AdJ,thetbr„ AdJ-Graundwater•Leval,,,_ PERCOLATION TEST riula Tlmm Observation Hole# •'•ram" ' _ Time at 9" t - Depth of Perot Time at 6" • [C.�to '� Start Pre-soak Time® _ Time(9"4") End Pro-soak r� a Rate Mtn.Mch Site Suitability Assessment: Site Passed lC, SItF Failed: - Add[tionnl Testing'Needcd(Y/N) S Original: Public Health Division Observation Hole Data To Be Completed on Back---------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one(1) week prior to beginning. Q:ISEPTIC%PERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# ! Depth from Soil Horizon Soil Texture Shcl Color Soil• Other Surfacc(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. o tsiatency.96't3raval) FZ -1 z . DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders, • e ' :SE S �t DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Sall Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.. Consifitengy. DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Solt Color Boll Other Surface(In.) (USDA) (Munsell) Mottling (Structure,Stapes;Boulders, Flood Insurance Rate Map: 'Above 500 year f tood boundary No— Yes . Within 500 year boundary No Yes Within 100 year flood boundary No. YEs Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed thrpughout the area proposed for the soil absorption syt tem7 t If not,what is the depth of naturally occurring pervious material? .. Certification t ' I certify that on `6���,-'� d (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required training,expertise and experience described In 10 CMR 15.017. Signature Datb , Q:13HPT1C%PHRCPORM.DOC S r fi w �s i 9 �y—,►,,� —c r No. vf/U kJ Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Y PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIpplication for Miquar *pztem Construction Permit Application for a Permit to Constrict( )Repair( '�1),Upgrade( )Abandon( ) El Complete System El Individual Components Location Address or Lot No. y?O e b�l/�!4t!'t Owner's Name,Address and Tel.No. � Assessor's Map/Parcel / _ D 4-2 5"'r f a- &- e— Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) <r c, 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 issu d by is Bo of Health. Signed Date Application Approved by . Date F" — w Cr"D Application Disapproved for the following reasons Permit No. �f/1 J�ZJ LF Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded( ) Abandoned( )by-... -� at / 4 AO 4L111 di..S 4 bt tea�n constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No'ff�dlJv dated`'r O Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector No. ��` Fee v'u1 Co ?.r THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS , Rpprication for Migozar *pgtem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) El Complete System D Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. Assessor's Map/Parcel EMI Installer's Name,Address,and Tdf No. Designer's ame,Address and Tel.No. Type of uil mg: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) .� Other Fixtures . 4Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil .y Nature of Repairs or Alterations(Answer when applicable) ) _ _ r Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until-a Certifi- cate of Compliance has been issued by this Board of Health. Signed Date q..7 _e, Application Approved by Date Application Disapproved r th o' wmg e son /` r Permit No. Date Issued � THE COMMONWEALTH OF MASSACHUSETTS _ BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TOi CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded( ) Abandoned( )by �N at t e t has been constructed in accordance with the pro sin Ritle thee fo isposal SystemKonstruc ion ertnit No., _ dated .1�_ow o # O 1 r sr Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector --------------------------------------- No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS lwigozal *pgtem Con6truction 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:Construction must be completed within three years of the date of this permit. Date: ,« _14�, Approved by no. 1 7 — S Fee 50.00 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Application for Migofsar *pgtem Congtruction Verm' it Application for a Permit to Construct( )Repair( x)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 3730 Rt 6A Owner's Name,Address and Tel.No. AssC eus o cr parcel Wanda Alber/Attorney Dunn Arthur Cane I t is �q1e p e s,dud 1.No. Designer's Name,Address and Tel.No. }�UU�I1 rOI�1 bd 1C g LP.O. Box 1089 Centerville 775-8776 Type of Building: ; Dwelling No.of Bedrooms 3 Lot Size sq. ft. Garbage Grinder(ng Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons'. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Clay and sand N..aturre of Repairs or Al rations s r hen a 1' el 5 foot overdig install 1 ,000 gal p station, d of an'S MN' ��i Yi6 rs 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 tMB2d of Hea Signed Date �S __-="Application Appro•:ed _ - - _--- Date 1 Application Disapproved for t e following reasons Permit No. 7- 1�5''1 Date Issued THE COMMONWEALTH OF MASSACHUSETTS. BARNSTABLE, MASSACHUSETTS CCertificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( ) Repaired ( X) Upgraded( ) AbandQ� O(Rtl b6yA Wm. E. Robinson Sep+-ic Service at'_. has been constructed in accordance R with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Inkaller Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Da.tc Inspector — — SZ Fee 5l------------------r-------- —� / THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS hoo.5ar *pgtem ConfStructiort per Permission is hereby g e to Construct( )Re :air(X )Upgrade( )Abandon( ) System loeated at � Rt 6A;Ctutunayuipd / F . ter,% and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this permit. Date: Approved by :O THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) A i I m / � LI DATA 'p`! TOWN OF BARNSTABLE L:i(ATION J 7 30 Ok rs A SEWAGE # 7 �'-3 ~VILLAGE a-r-A S�'�cb�� ASSESSOR'S MAP &LOT✓�!/Z�b'Z!7 T.hh.STALLER'S NAME&PHONE NO. ����� L eQ y 7 Q D � SEPTIC_ TANK CAPACITY (coo ' f(e LEACHING FACILITY:.(type)==� -EX 3 p (size) NO.OF BEDROOMS ' 'BUILDER OR OWNER ' PERMTTDATE: 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 s � � Cr . � � .'� . � r � - o = '- G ,. _ _� _ � � � �._ S1 � � -- �� ��� �� � -.` ��, � � - . ' TOWN OF BARNSTABLE a LGC�,TION CuMMASIL i'll SEWAGE # 7 2-1S'Z VI,LAGS 37W R1 fob ASSESSOR'S MAP & LOT. 17 INSTALLER'S NAME&PHONE NO. .N 7 7 S-27 X SEPTIC TANK CAPACITY i000 LEACHING FACILITY: (type) (,f/ -6x (size) f o yC 1 � 3 Z NO.OF BEDROOMS Z BUILDER OR OWNER ou AZ PERMITDATE: Jag Jq I COMPLIANCE DATE: Ce -2 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 �Y y� o c'r C .� rv� NMI No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZippYication for ;h5 poe ar *pgtem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. j 'Pie 6 �Q ��4• Owner's Name,Address and Tel.No. '( /! 1<a�1 � Assessor's Map/Parcel — Q a� 372 v Installer's ame,Address,and Tel.No. a� Designer's Name,Address and Tel.No. /�ck6E ceaun Y Type of Building: MC Dwelling No. of Bedrooms 3 Lot Size Z sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons x— Showers( ) Cafeteria( ) Other Fixtures Design Flow U gallons per day. Calculated daily flow G gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. ?0 Description of Soil a Nature of Repairs or Alterations Answer when applicable) rcL L e.,_-Lc 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 ardIealth. Signed _ A Date Application Approved b Date 5-- Application Disapproved for the following reasons Permit No. Date Issued G �` D t 'No. V Fee Y THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Application for Oigogaf *pgtem Con.5truction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( )' ❑Complete System EJ Individual Components Location Address or Lot No. ,j 0 ,P1(� �1 ^ Owner's Name,Address and Tel.No. %C�cc n e Assessor's Map/Parcel 3 1 `, — 0 a� 3 7 Installer's ame,Address,and Tel.No. o� Designer's Name,Address and Tel.No. �e Type of Building: GtC Dwelling No.of Bedrooms Lot Size z sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons °.Z— Showers( ) Cafeteria( ) Other Fixtures Design Flow a gallons per day. Calculated daily flow S C/ gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. �'[/�7`�e 3 �G �—c- Description.of Soil Nature of Repairs or Alterations(Answer when applicable) I' cc I j eldo L e a L"t Date last inspected: Agreement: The undersigned agrees to ensure:}he construction and maintenance.of the afore described on-site se-wage 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 oard ealth. Signed Date Is C_ APPlication Approved b .— r _Date .7.7 t Application Disapproved for the following reasons Permit No. Date Issued 4 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIIi Y,that the On-site Sewage Disposal System Constructed( )Repaired! )Upgraded( ) Abandoned( )by I 1 at has been constructe In accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. N�/ dated 4 ' ��' y' Installer Designer The issuance of this rmit hal -to ee--construed as a guarantee that the syste will function as desigtied. Date Inspector )I L) No. Fee`- i THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS 'Wi.gpogai *p!gtem Con!5truction Per mit Permission is hereby granted to Construct ct( Repair( ) grade( ) band n -� ( ) 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:Construction must be completed within three years of the date of th* it. Date: Approved • 1/6/99 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMTT (WITHOUT DESIGNED PLANS I, A/L �e f6k hereby certify that the application for disposal works _1. construction permit signed by me dated 5-- (P ^ �' concerning the property located at S?-1 O meets all of the following criteria: • The failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. • The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. • There are no wetlands within 100 feet of the proposed septic system. • There are no private wells within 150 feet of the proposed septic system • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching facility will not be located less than:five feet above the - ma..dmum adjusted groundwater table elevation. (Adjust the groundwater table using the Frimptor method when applicable] • If the S.A.S. will be located with 250 feet of any vegetated wetlands, the bottom of the proposed leaching facility will not be located less than fourteen(14) feet above the maximum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(using GIS information) 5 B) G.W. Elevation +the MAX. High G.W. Adjustment . _ DIFFERENCE BETWEEN A and B ' SIGNED : DATE: (Sketch proposed plan of system o back]. q:health folder.cent � a �L �v y C v l e c Re c knaa, /� �Sto�� No. 1 Fee50.00 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE,. MASSACHUSETTS Application for Migogal *potem Congtruction i3ermit Application for a Permit to Construct( )Repair( x)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 3730 Rt 6A Owner's Name,Address and Tel.No. Cummaquid Wanda Alber/Attorney Dunn Assessor'sMap/Parcel Arthur Cane I t is a d� ss, d T I..No. Designer's Name,Address and Tel.No. iA9 n 'ep iC P.O. Box 1089 Centerville 775-8776 Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder(ng Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Clay and sand Nature of Repairs or Al rations Cps r hen a��l�pa�e� 5 foot overdig install 1 ,000 gal PUMP station, a—box ann ul`-ex i a ors 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- pate of Compliance has been issued by this B d of Hea Signed v Date "Application Approved Date Application Disapproved for e following reasons Permit No. �— 1���� Date Issued No. 1 7 '�"" ` — -_ _ Fee 50.00 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION —TOWN OF BAR NSTABLE,.,,MASSACHUSETTS Yes 01ppYication for Migpogar *v mem Congtruction permit Application for a Permit to Construct( )Repair( X)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 3730 Rt 6A Owner's Name,Address and Tel.No. Assmmiaaqui parcel k, A1berlAttornelyDunn } ur Cane I t is s, r8. Designer's Name,Address and Tel.No. P.O. Box 1089 Centerville 775-8776 Type of Building: { Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder(no) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Descriptr n of Soil Clay and sand Nature-of Re airs or Al rations s e-r hen a^ e 5 foot overdig install 1 ,000 gal pump js�a�ion, a-tb03 ante `lzl` ex � Date last inspected: Agreement: 'w The undersigned agrees t ensure the construction and maintenance of the alorre 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 issLed by this Board of Health. '-Signed xv !�j r Date 3—a2-5� Application Approved � Date ? r Application Disapproved for the�following reasons .r ' > Permit No. q 1 '-n) Date Issued ' -------------------- - -------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired( X)Upgraded( ) t Aband ed b WM• L. Robinson Septic Service at. 3�30(Rt) 6yAmmequid has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date /^ _ 4 Inspector No. 7 — !r>'Z --6----------------Fee 50.00 s THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Mwi5pogar *pgtem Congtruction Permit Permission is hereby g nted to Construct( )Repair(X )Upgrade( )Abandon( ) System located at 3.730 Rt 6A 0xima[quipd and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date"of this permit. Date: Approved by ��`� —% J r t NOTICE: This form is to be used for the repair of failed septic systems only CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS) r; I,William E. Robinson, Sr. ,hereby certify that the application for disposal jworks construction permit signed by me dated concerning the property located at 3730 Rtr6A, Cummanuid;MA 02637 meets all f f of the following criteria: C' c k * There are no wetlands within 300 feet of the proposed septic system. * There are no private wells within 150 feet of the proposed septic system. * The obseved groundwater table is 14 feet or greater below the bottom of the leaching facility. * There is no increase in flow and/or change in use proposed. f * There are no variances requested or needed. SIGNED:GeV` _ DATE 1r 9 2 LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER 60 (Attach a sketch plan of the proposed system. Also if the licensed installer proposes a certification plot plan,this plan should be submitted). l- .y - d J.s9 sa. w TOWN OF BARNSTABLE LOCATION (�UMMA!i V1 n SEWAGE # VILLAG ASSESSOR'S MAP & LOT2 1 INSTALLER'S NAME&PHONE N0.1�1 P16A N SEPTIC TANK CAPACITY 1 000 qi,V S LEACHING FACILITY: (type) yr_U Or- (size) Jo/6 A, 3 Z NO.OF BEDROOMS `l BUELDER OR OWNER— ,) w, AZ PERMI'TDATE: COMPLIANCE DATE: q// ? 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 sl.l a 2� C ,f. t ", F Ro✓ HE'D N' 0 f ' TOWN OF BARNSTABLE LOCATION C"MMAq'Ji r) SEWAGE # VILLAGE 3730 ASSESSOR'S MAP & LOT3 0 (� INSTALLER'S NAME&PHONE NO. 77 5-97 X SEPTIC TANK CAPACITY _ l 00 LEACHING FACILITY: (type) C_y( {'G (size) 10,C 1 NO. OF BEDROGIMS Z BUILDER OR OWNER e ,� 4,< AZ PERMITDATE: COMPLIANCE DATE: _/ Separation Distance Between the: + i 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 i f *C r 50.00 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 0(pplication for �Bigomt *, p!5tem Con5truction Permit Application for a Permit to Construct( )Repair( x)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components . Location Address or Lot No. 3730 Rt 6A Owner's Name,Address and Tel.No. Cummaquic? Wanda Alber/Attorney Dunn Assessor's ap/Parcel Arthur Cane I�1 apy 'sV�ij d� regs,�pdPT.-No. Designer's Name,Address and Tel.No. �O Seic P.O. Box 1089 Centerville 775-8776 Type of Building: Dwelling No. of Bedrooms 3 Lot Size sq. ft. Garbage Grinder(nq Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Pisan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Clay and sand p a g� 5 foot overdig install 1 ,000 gal Nature of Repairs or I rations s r hen a 1' e pump station, x an ` ul`�ex i a ors 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 B d of Hea Signed AV v Date 3—,7_g_ Application Approved Date 741Gi7 Application Disapproved for t e following reasons Permit No. 7 I Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS.TO CERTIFY that the On-site Sewa e Disposal System Constructed,( . ) Repaired ( X) Upgraded ( ) -oanded Rt)b6yA Wm. E.-Robinson-Septic Service, uld has been constructed in accordance ';,l.h the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer Designer ne issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector --------------------------------------- No. 7 - l 5L Fee 50.00 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS ligool e&pstem con6trUction Permit .Permission is hereby grog 8 to Construct( )Repair(X )Upgrade( )Abandon( ) System located at / Rt 6A 63mT ui and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to omply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this permit. J Date: �_ Approved by 6 7 Commonwealth of. Massachusetts r� Executive Office of Environmental Affairs co Department of Environmental Protection 'ylF9ti�1�,1�9"9 William F.Weld �j9udy�Coxe Gorrarnor Argeo Paul Celluccl 'David B.U.Goarnor ~ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A - CERTIFICATION MAIN sue/ Rfr2Ns �c Arthur Kane/ Property Address: 3730 ,,Route 6A, (Cummaquid; MA Address of Owner. Wanda A1ber Date of Inspection: 4/1 1 /9 7 (If different) Name of Inspector. W.E. Robinson SR Company Name,Address and Telephone Number. (5 0 8 ) 7 7 5-8 7 7 6 W.E. Robinson Septic Service P.O. Box 1089 Centerville MA 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 17 - Inspector's Signature: 4 i ! —4-- Date: �'1/ Q 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] SYS PASSES: 7ive not found an information which indicates that the m violates an of the failure criteria as defined in 310 CMR 15.303. y �� Y Any failure criteria not evaluated are indicated below. B}�SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes inspection. to 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, 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 ponforming septic tank as approved by the Board of Health. (revised 11/03/95) 1 One Winter Street a Boston,Massachusetts 02108 a FAX(617)556-1049 a Telephone(617)292•SM �A1 Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) propertyAddresx 3730 Route 6A, Cummaquid, MA Owner. Alber/Kane Date of Inspection: 4/1 1 /9 7 B]SYSTEM CONDITIONALLY PASSES(continued) Sewage backup or breakout or high static water level observed in the distribution boat 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): 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) THER 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,IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and 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 is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and 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 lose than 5 ppm. S) THER (revised 11/03/95) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) PropertyAddreew 3730 Route 6A, Cummaquid, MA Owner. Alber/Kane Date of Inspection: 4/1 1 /9 7 7SYSTEM FAILS: . 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. _ 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 tunes 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. El E SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: 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: the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area(IWPA)or a mapped Zone 11 of a public water supply well) The owne or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program require nts of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for thither information.. (revised 11/03/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST PropertyAddrew 3730 Route 6A, Cummaqu d MA Owner. Alber/ Kane Date of Inspection: 4/1 1 /9 7 Check if the following have been done: ZPU3nping information,was requested of the owner,occupant,and Board of Health. ,L/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. V As built plans have been obtained and examined. Note if they are not available with N/A. 124he facility or dwelling was inspected for signs of sewage back-up. ,/The system does not receive non-sanitary or industrial waste flow �fhe site was inspected for signs of breakout. -b'"—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. VThe size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. he facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 11/03/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION propertyAddress: 3730 Route 6A, Cummaquid, MA Owner. Alber/ Kane Date of Inspection: 4/1 1 /9 7 FLOW CONDITIONS RESIDENTIAL: Design flow: one Number of bedrooms: _-3 Number of current residents: / Garbage grinder(yes or no):A-0 Laundry connected to system(yes or no):4(�S Seasonal use(yes or no):_ Water meter readings, if available: 1995 - 68, 000 gals 1 9gti - 1 1 1, , nnn gA�- Last date of occupanry:-S ^//_4 COMMERCIALANDUSTR AL: Type of establishment: Design flow:_ gallons/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: GENERAL INFORMATION PUMPING RECORDS and source o information: / ..nti 1.e4 zj f p _ ? System pumped as part of inspection: (yes or no)_ If yes,'volume pumped: /i9p 6 d Gallons Reason for pumping: TYPE OF SYSTEM Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records, if any) Other(explain) APPROXIMATE AGE of all components,date installed(if known)and source of information: lii bi" i Sewage odors detected when arriving at the site: (yes or no)Ad" (revised 11/03/95) 6 A_ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 3730 Route 6A, Cummaquid, MA Owner. Alber/ Kane Date of Inspection: 4/1 1 /9 7 SEPTIC TANK . (locate on site Pisa) <l Depth below grade-1 6 / Material of construction: lZmaete_metal_FRP_other(ezplain) Dimensions: Z, L `C Sludge depth:_ Distance from top of sludge to bottom of outlet tee or baffle:-�:4� Scum thiclmess: U % 1 Distance from top of scum to top of outlet tee or baffle: Ii.— _ Distance from bottom of scum to bottom of outlet tee or baffle: I `/3 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.) -Ta Ss G E TRAP._ (kica on Bite plan) Depth low grade: Mate ' of construction:_concrete_metal_FRP_other(e:plain) one: Scum ess: from top of scum to top of outlet tee or baffle: from bottom of scum to bottom of outlet tee or baffle: Comme to: (repo ndation for pumping,condition of inlet and outlet tees.or baffles,depth of liquid level in relation to outlet invert,structural integrity, eviden of leakage,etc.) (revised 11/03/95) 6 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) PropertyAddrees: 3730 Route 6A, Cummaquid, MA Owner. Alber/ Kane Date of Inspection: 4/1 1 /9 7 TIGHT OR HOLDING TANK:_ (locate on site plea) Depth grade: of construction:_concrete_metal_FRP_other(eaplain) Dime ns: Ca gallons now: gallons/day Alarm level: Co nts: (oo tion 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 boa,etc. A/ "Z4/ Y - � L3 6 V PUMP CHAMBER_ (locate on site plan) Pumps in working orderAyes or no)c� s Comments: (note opd1tion of pump chamber,condition of pumps and appurtenances,etc.) r (revised 11/03/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 3730 Route 6A, :Cummaquid, MA Owner. Alber/ Kane Date of Inspection: 4/1 1 /9 7 SOIL ABSORPTION SYSTEM (SAS): (locate on site plan,if possible:excavation not required,but may PP 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: Co uts:.( ndition'of soil,signs of.hydraulic failure, level of L c_ fj�A 3Y� f il �D pondig,condition of vegetation;etc.) A L L✓ %J CF�SPOOLS•_ ( to on site plan) N and configuration: De -top of liquid to inlet invert: Depof solids layer. Dep of scum layer: ' ns of cesspool: rials of construction: tion of groundwater: � inflow(cesspool must be pumped ae part of inspection) Comm nts: (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.) P _ (1 on site plan) Mate of construction:tion• Dimensions, Depth f solids• Cc nts:(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etcJ (revised 11/03/95) 8 w SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(oontinued) PropertyAddreas: 3730 Route 6A, Cummaquid, MA o*ner. Alber/ .Kane DO"Of Inspeotiono 4/1 1 /9 7 SIC MN OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' J I 1 -------------- ��,r2 s •'-� I - DEPTH TO GROUNDWATER Dash to groundwatar:j__fset method of datermimtion or approximation: )1-,S_j�/,�n'/� (revised 11/03/95) 9 TOWN OF BARNSTABLE LOCATION 7 3d �, �s, 4 �T SEWAGE # VII.LAGE cLrn,Sl�'�b�cn ll// ASSESSOR'S MAP & LOT_312- b 27 INSTALLER'S NAME&PHONE NO. MC Ke L e c,f' y 7 c O 2 S-.f SEPTIC TANK CAPACITY LEACHING FACILITY: (type) fS—k 3© !' �� � (size) NO.OF BEDROOMS BUILDER OR OWNER (` e PERMTTDATE: , COMPLIANCE DATE: 3 i 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) Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) Furnished by Feet I i 1 MARK CORNERS OF LEGEND SYSTEM PROFILE LEACHING FIELD W/ NOTES Barnstable Harbor REBAR SET 4" BELOW H-20 VENT W CHARCOAL FILTER 1. DATUM IS NAVD 88 99- EXISTING CONTOUR PROVIDE MIN. 20" DIAM. WATERTIGHT (NOT TO SCALE) GRADE INSPECTION PORT / ACCESS COVERS TO WITHIN 6" OF FIN. GRADE 2% SLOPE X 99•1 EXIST. SPOT ELEV. � H-20 CAST IRON __� 2. MUNICIPAL WATER IS EXISTING � TOP FOUND. EL. 25.8 COVER TO GRADE FILTER FABRIC ' L.3--- _TOP 22.56' FINISHED GRADEj4." LOAM & SEED OR PAVE AS REQ. 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. -[99]- PROPOSED CONTOUR \ 20.0 21.0 MINIMUM .75' OF COVER OVER PRECAST o � 2" SC i � 4. DESIGN LOADING FOR ALL PROPOSED PRECAST UNITS Q ` TO BE AASHO H-22 D 198.41 PROPOSED SPOT EL. PRECAST H-FT1EE PRECAST H-20 PRESSURE � CLEAN FILL RISERS (TYP. RISERS (TYP.) LINE a TH1 2'0 2'0 4"OSCH40 PVC ; '.: ;..•:....;:.:<• • ..::. :•..:r . ....::. .•.;.:. .,:•.,.. , :r5. E JOINTS TO BE E WATERTIGHT. s PROP. TEE PIPES LEVEL 1ST 2' o .: ::.:. ;, . , 4" PERFORATED PVC 4' O.C. S=0.005-� '° AN VENT I NT LocuTEST HOLE ° 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITHSLOPE OF GROUND " *EXISTING 14" 10" **EXISTING 3/4"-1-1/2" DOUBLE WASHED 06"DEPTH MIN 310 CMR 15.000 (TITLE 5.)EPTIC TANK TEE TEE PUMP CHAMBER 7.5" STONE LEACHING FIELD BELOW INV. o *18.75 f °°°°°°°°°opo NOTE: 2" MIN. WALL 22 23' ° 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO oufe Q� Q� UTILITY POLE °so°Oo°o°o°09 THICKNESS REQUIRED LEVEL BOTTOM 0 BE USED FOR LOT LINE STAKING OR ANY OTHER o- n > PURPOSE. a� FIRE HYDRANT a.: 22.45 22.28 26.0' " v NOTE: NOT ALL SYMBOLS MAY APPEAR IN DRAWING •` 'i;...r :•<..; �•.. :. :: : .. ';;•,.r•:..<Y 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4 PVC. ZABEL FILTER 21.6' 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED (A100) 6" CRUSHED STONE OR MECHANICAL WITHOUT INSPECTION BY BOARD OF HEALTH AND OUTLET TEE NOTE: INSTALLER TO CONFIRM W/EXTENSION EXISTING PUMP TO BE MYERS COMPACTION. (15.221 [21) 5.0' PERMISSION OBTAINED FROM BOARD OF HEALTH. SRM 4 SUBMERSIBLE 4/10 HP 10. CONTRACTOR SHALL BE RESPONSIBLE FOR CALLING LOCUS MAP PUMP SYSTEM DIGSAFE (1-888-344-7233) AND VERIFYING THE (OR EQUAL) (ON BLOCK) 16.6' ADJUSTED GROUNDWATER LOCATION OF ALL UNDERGROUND & OVERHEAD UTILITIES NOT TO SCALE REPLACE IF NECESSARY PRIOR TO COMMENCEMENT OF WORK. ( 1 % SLOPE) 11. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL BE ASSESSORS MAP 317 PARCEL 27 H-20 G-W ADJ. DATA: REMOVED 5' BENEATH AND AROUND THE PROPOSED FOUNDATION EXIST. SEPTIC TANK EXIST. PUMP CHAMBER 117' LEACHING D' BOX 7' (MARCH) LEACHING FACILITY. FACILITY WELL: AIW 247 12. EXISTING LEACHING FACILITY SHALL BE PUMPED AND ZONE: B **INSTALLER SHALL CONFIRM MINIMUM SEPTIC *THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL ADJ: 2.7' REMOVED. TANK AND PUMP CHAMBERS SIZE AT 1000 UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS 13. WETLAND FLAGGED BY BRAD HALL OF BLH GALLONS AND THEIR SUITABILITY FOR RE-USE. PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM ENVIRONMENTAL CONSULTING. REPLACE 1500 GALLON SYSTEM DESIGN. APPROPRIATEHTO SITE CONDITIONS (F) NOT SUITABLE. GARBAGE DISPOSER IS NOT ALLOWED DESIGN FLOWN 3 BEDROOMS @ 110 GPD = 330 GPD USE A 330 GPD DESIGN FLOW SEPTIC TANK: 330 GPD (2) = 660 RE-USE EXISTING SEPTIC TANK & PUMP CHAMBER** LEACHING: TEST HOLE LOGS 330 GPD (.74) = 446 SF REQUIRED 17.5' X 26' = 455 SF OK _ 6 0' ENGINEER: CRAIG J. FERRARI, SE #13871 455 SF X .74 = 337 GPD OK WITNESS: DAVID W. STANTON RS USE A 17.5' X 26' PIPE AND STONE LEACHING FIELD DATE: 4/13/2016 O PERC. RATE < 2 MIN/INCH _ CLASS I SOILS P# 15016 O 9 - ELEV. ELEV. 00•� 0" 4 21 .1' Ott f N FILL FILL 12" 12" 70 _ _ A A LEACHING DETAIL LS LS 1" = 10' 21 10YR 2/2 18" 10YR 2/2 72 � B B 3LIlt PERC III FS FS 48" 10YR 5/6 17.1" 46" 10YR 5/6 17.3" 4 A C1 C1 6 �O• EDGE OF wET�AN "` S i L S i L �. 13 � 60" 10YR 5/2 16.1' 72" 10YR 5/2 15.1' C2 C2 ,•.�... VW 1 � M S MS ...\ 10YR 6/3 10YR 6/3 "�•.. �., 18 120" 11.1 120" 1 1.1 ' 0 \ 317 PCL 27 ; GROUNDWATER ENCOUNTERED AT 89" EL. 13.7 oo• 79 43,454f SF. w W RK L IT LIN SIL FEN 20 INS T LLER TO V RY PUM ...... TITLE 5 SITE PLAN - "�• _ CHA BER IS H- 0 PRIOR X x TO I STALLING A PORTIO - O I OF OF EPTIC SYSTE •� 21 �••� � O I ?2�•• '� PROM E 36' OF 40 MIL LIN AT 5' APPR DRIVE ° 3730 ROUTE A I �•" GRAVEL DECK"� / n OFF S S IN AREA SHOWN. TOP AT LEACHING •� ELEV. 2 .5', BOTTOM AT EL. 1 .5 t [23 EXISTING I BARNSTABLE, �2 \ DWELLING I ►- 5' REMOVAL UNSUITABLE SOIL REQUIRE _...TOF = 25.8 OUND PERIM TER OF LEACHING FACT ITY, PREPARED FOR D 0 SUITA SOIL LAYER (APP OX. 76 I 5-6'). EPLACE N MED. S ND, TO MEET PECIFICATIO OF 10 CMR 1 255(3) i I W A R T H U R KANE I T2 iTH1 0� LJ " BENCHMARK Z DATE: APRIL 22, 2016 I � 1� I ONCRETE BOUND EL. = 26.1' - -2---- 25 18 I REV.: JUNE 16, 2016 (PER BOH) o / 79 c, I Scale: 1"= 20' 20 PROP. VENT WITH CHARCOAL FILTER _ _ - - _ - - _ AND'BUGSCREEN (FINAL PLACEMENT BY - -�- _ 22 21 AND 0 10 20 30 40 50 FEET CONTRACTOR WITH HOMEOWNER 26 CONSULTATION) _ _ 8,q8� _ off 508-362-4541 AA?O - - `r s fax 508-362-9880 /� �P�,<NnrMgss ya` icy I downcape.com 46 DANIEL q� S� • • • OANIEL.A. � (; o AiA down cape eng/neer/ng, /nC. ` w----- w w____ 3 OCIVI A c N°.40960 v civil engineers w�'�- w _ �����G�3Tti��O �� �S land surveyors N w `'' �'�(, `�ssr 939 Main Street ( Rte 6A) Z DATE ANIEL A. OJALA, P.E., P.L.S. YARMOUTiHPORT MA 02675 DCE # 16- 108 16-108 KANE.DWG