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3735 MAIN ST./RTE 6A(BARN.) - Health
_ 5f n z nBarnstable .�. d.� 1 Commonwealth of Massachusetts Title 5 Official Inspection Form '' M1ia Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u 3735 ROUTE 6A Property Address SEAN MAHER Owner Owner's Name information is BARNSTABLE V MA 02630 9/1/2020 required for every page. City/Town State Zip Code Date of Inspection 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 q, Inspector Information filling out forms on the computer, Christopher Maki use only the tab � key to move your Name of Inspector cursor-do not Cape Cod Septic Services use the return Company Name .key. 350 Main St. Company Address W Yarmouth MA 02673 City/Town State Zip Code ienuo 508-775-2825 SI-14423 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 16.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 9/9/2020 Inspector's Signaaffure 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,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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: 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. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form, t� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments v 3735 ROUTE 6A Property Address SEAN MAHER Owner Owner's Name information is required for every BARNSTABLE MA 02630 9/1/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection.Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: SYSTEM IS IN WORKING CONDITION 2) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc•rev.7/26/2018 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form �o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 3735 ROUTE 6A Property Address SEAN MAHER Owner Owner's Name information.every is required for BARNSTABLE MA 02630 9/1/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N . ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) 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. a. 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: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 18 Commonwealth of Massachusetts 4 - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 3735 ROUTE 6A Property Address SEAN MAHER Owner Owner's Name information is required for every BARNSTABLE MA 02630 9/1/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or, more from a private water supply well". Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No El ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ® Discharge or ponding of effluent to the surface of the ground or.surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 4 o118 Commonwealth of Massachusetts ,@ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 3735 ROUTE 6A V Property Address SEAN MAHER Owner Owner's Name information is required for every 6 RNSTABLE MA 02630 9/1/2020 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.). Yes No El ® 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 '/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 SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal•coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen Is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] The system is a cesspool serving a facility with a design flow of 2000 gpd- ❑ ® 10,000 gpd. ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section C.4. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system ismithin 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection_ Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 3735 ROUTE 6A Property Address SEAN MAHER Owner Owner's Name information is required for every BARNSTABLE MA 02630 9/1/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes" to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 316 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes" or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? . ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on; ® ❑ Existing information. For example, a plan at the Board of Health. ® 1:1 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)] t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 3735 ROUTE 6A Property Address SEAN MAHER Owner Owner's Name information is BARNSTABLE MA 02630 9/1/2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 440 Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage d '18-76 GPD 9 ( Y 9 (gp ))� '18-69 GPD Detail: Sump pump? ❑ Yes ® No Last date of occupancy: CURRENT Date t5insp.doc•rev.7/2 612 0 1 8 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 cam, Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 3735 ROUTE 6A Property Address SEAN MAHER Owner Owner's Name information is BARNSTABLE _MA 02630 9/1/2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑. Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: N/A Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Flo Subsurface Sewage Disposal System Form-Not for.Voluntary Assessments 3735 ROUTE 6A Property Address SEAN MAHER Owner Owner's Name information is BARNSTABLE MA 02630 9/1/2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval., ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 2018 PER PLAN ON FILE WITH BOH. Were sewage odors detected when arriving at the site? - ❑ Yes ® No 5. Building Sewer(locate.on site plan):. 1919 Depth below grade: feet , Material of construction: ❑ cast iron' 0.40 PVC ❑ other(explain): Distance from private water supply well or suction line: 10'+ feet Comments (on condition of joints, venting, evidence of leakage, etc.): LINE CHECKED WITH SEWER CAMERA AND WAS FOUND TO BE CLEAN AND PROPERLY PITCHED t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 3735 ROUTE 6A Property Address SEAN MAHER Owner Owner's Name information is required for every BARNSTABLE _MA_ 02630 9/1/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank (locate on site plan): Depth below grade: 14"feet Material of construction: I ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain) If tank is metal, list age: ears Y I Is age confirmed by.a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 GALLON Sludge depth: 511 Distance from top of sludge to bottom of outlet tee or baffle Scum thickness 411 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? ESTIMATED Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): 1000 GALLON TANK IN GOOD CONDITION. TANK SHOULD BE SERVICED. PVC TEES IN PLACE AND CLEAN. ZABLE FILTER ON OUTLET. TANK AT NORMAL OPERATING LEVEL.- COVERS 3" BELOW GRADE t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 i c Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 3735 ROUTE 6A Property Address SEAN MAHER Owner Owner's Name information is required for every BARNSTABLE MA 02630 9/1/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form a io Subsurface Sewage Disposal System Form -Not for Voluntary Assessments !% 3735 ROUTE 6A Property Address SEAN MAHER Owner Owner's Name information is required for every BARNSTABLE MA 02630 9/1/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert EVEN 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.): DISTRIBUTION BOX LEVEL AND WATERTIGHT t5insp.doc rev.7/26I2018 Tille 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 c � Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 3735 ROUTE 6A Property Address SEAN MAHER Owner Owner's Name information is required for every BARNSTABLE MA 02630 9/1/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ® Yes ❑ No* Alarms in working order: ® .Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): 1000 GALLON PUMP CHAMBER IN GOOD CONDITION WITH ALARM AND PUMP IN WORKING ORDER. * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 12.83'X33.5'X2 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts z Title 5 Official Inspection Form 1. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 3735 ROUTE 6A Property Address SEAN MAHER Owner Owner's Name information is BARNSTABLE MA 02630 9/1/2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure,.level of ponding, damp soil, condition of vegetation, etc.): 12.83'X33.5'X2 CHAMBER FOUND DRY DURING INSPECTION WITH NO EVIDENT STAINING. 12. 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 ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments V � 3735 ROUTE 6A Property Address SEAN MAHER Owner Owner's Name information is BARNSTABLE MA 02630 9/1/2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. 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.): t5insp.doc•rev.7/2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments „ 3735 ROUTE 6A Property Address SEAN MAHER Owner Owner's Name information is required for every BARNSTABLE MA 02630 9/1/2020 - page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at.least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t5insp.doc•rev.7/2612018 Title 5 Official.Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 3735 ROUTE 6A t, Property Address SEAN MAHER Owner Owner's Name information is required for every BARNSTABLE MA 02630 9/1/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: +11' 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: 2018 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the.high ground water elevation: ASBUILT ON FILE AT BOH SHOWS NO'GROUNDWATER ENCOUNTERED AT 15.5' Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18 Commonwealth of Massachusetts x Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 3735 ROUTE 6A Property Address SEAN MAHER Owner Owner's Name Information is required for every gARNSTABLE MA 02630 9/1/2020 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A, Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 ,� , . � :f f -�/ `. �d , �: � w ���� �: l ���,r .�8 02 � O F��+' �' "y" l��' ,. �'�� ��/ !�`.�: ,� �2� � .. � � ,' 4F ,' r• _ ,._,...i� TOWN OF BARNSTABLE LOCATION 73-f" SEWAGE# ZO/,'P^ ��9 VILLAGE ASSESSOR'S MAP&LOT /T d eq�e c� INSTALLER'S NAME&PHONE NO. ��/ i!/o•s�i�f $�� � {4A-?7s=a�11� SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) NO.OF BEDROOMS BUILDER OR OWNER PERMIT DATE: � /c3' COMPLIANCE DATE: ��l7, 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 i 14 Ole � 2 8 ` fls� C N -� 5? ?.� . No. 4 1 i 4�_ P y Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION — TOWN OF BARNSTABLE, MASSACHUSETTS 2pplication for Disposal 6pstem Construction 3permit CdC- W-U�. (.Ii.e., Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components /I /) Location Address or Lot No. ,/ Owner's Name,Address,and Tel.No. f Assessor's Map/Parcel 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(min.required) �yy gpd Design flow provided gpd Plan Date Number of sheets Revision Date Pot fdi r)yy Title Size of Septic Tank Type of S.A.S. Description of Soil / Nature of Repairs or Alterations(Answer when ap 'cable) 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 Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. Date Issued No. 0 l— 1/9 W.Prt C. �/ I t P ' `r„ �°/v�^ �a f l Fee THE COMMONWEALTH/OF MASSACHUSETTS Entered in computer: Yes. .. :. PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS- 21pplication for MispoBal 6pstem.reonBtrUction Per M- it ?~ �"�`� (-" c Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. i Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 3 -7 Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms L/ Lot Size sq.ft. Garbage Grinder ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures t Design Flow(min.required) qt4j gpd Design flow provided s— gpd Plan Date Number of sheets \� Revision Date Title Size of Septic Tank Type of S.A.S. S (jI2 d i Description of Soil i I Nature of Repairs or Alterations(Answer when ap 'cable) rv'r wod 4. r t'nGju r 26 �o 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 Date j Application Approved by Date Application Disapproved by Date for the following reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificatr of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed(✓� Repaired( ) Upgraded( ) Abandoned( )by Phil mrr �uJ /)�c. rercp-1 at "� { t2 has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No,, dated 1' o Installer ate! /yl rf�� Designer #bedrooms Approved design flow � (/ gpd The issuance of this permit shall not be construed as a guarantee that the system wills designed. Date r/2 G / Inspector 3� ----------------- --------------------------------------------------------------------------------------------------------------------- No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS MispoBar 6pstrm Construction Vermit 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 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 by s Town ®f Barnstable Regulatory Services Thomas F. Geiler,Director � BAMSrAsLF MASS. �0� Public Health Division iOpF1639. Thomas McKean,Director 200 Mainz Street,Hyannis,MA 02601 i Office: 508-862-4644 Fax: 508-790-6304 4 4 InnstaRe>r&Desigger Certification Form Date:. 12-0)« Sewage]IDernnnit#c;)0148; / Assesson•'s 1MEaplParccel_ �1'/ A 0 � Designer: UNN Cr& "Wr4appiC1, INC, Innstaner: CWC©p'-e jICSC-1.2:VtC� INC. Address: �9 t✓IkIN 9T�(L Of &A) Address: 50 MAIN �iT( (um�) On ql -5 - - ca_rcxacsDk� vas issued a permit to install a (date) (installer) f septic system at 3D 5 90VFP, (oA ,RAC OTfIIM - based on a design drawn by I (address) dated geV, 4130II8 / (designer I V 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 k distribution box and/or septic tarok. 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. vL I"OF 'yC DANIELA. yam (In er s Signatar OJALAe) CIVIL rtc� 4fi502 (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form 3-26-04.doe No. J� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: •� PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01ppliLatlon for Misposal *pstem ConstrUrtion Permit Application for a Permit to Construct(Repair(Upgrade( ) Abandon( ) complete System ❑Individual Components Location Address or Lot No._77,3.s /fA, Owner's Name,Address and Tel.Nod'A; 4*,F d 66 P Assessor's Map/Parcel /7 fop Installer's Name,Address,and Tel.No.�� T 1-4%-;?-XZ Designer's Name,Address,and Tel.No..S�= Type of Building: Dwelling No.of Bedrooms Lot Size �� 7X',0'6' sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date �� � Number of sheets d Revision Date Y13d _a #/"d we J Title Size of Septic Tank e!'c5U,5) Type of S.A.S. lop Description of Soil ��-� s"�,�� /3� �� /-)d J Nature of Repairs or Alterations(Answer when applicable) s�rc� / 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. Signe Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. ��I Date Issued_ �7yj�7p/p ----------------------------------------------------------------------------------------------------------------------------------- - } µ No. Fee / a - THE COMMONWEALTH OF MASSACHUSETTS -Entered in computer: .•/ PUBLIC HEALTH DIVISION - TOWN OF,BARNSTABLE, MASSACHUSETTS Yes application for Mtsposal.*pBtem Construction permit Application for a Permit to Construct O1;4� Repai,(!i)/Upg ade O Abandon( ) ©•Complete System ❑Individual Components ,(., Location Address or Lot No.-7 73S If':14, � Owner's Name,Address and Tel.No.4'/T- C?�--'6 Q Assessor's Map/Parcel /71® o 7 (K-.7 Installer's Name,Address,and Tel.No.���= >? > �� Designer's Name,Address,and Tel.No. C'�t�� Cr,9�.j!.v'fi•G I��jdti,t� G d��-- ,r.s,5%�yG^c.r�''n�;� - 3�>U�S.LO.rrs� Si /✓: Y r /l /l' �.3�..��!!�•d fj�� �f,�I'-rov./�l�wl� Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(. ) f Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures j y g, Design Flow(min.required) '© gpd Design flow provided 4/'S;j gpd Plan Date e,,11_;1 y�� Number of sheets / Revision Date y��0�2 s FR A,t. r ter of Title 7'r / Sisr ! /'a�r7 , e d 64-j Size of Septic Tank /oU� Type of S.A.S. �`�i,�i> �r �:- Description of Soil �'.�r• SG,,,..� /�aF Lee d4j.t ti , v1J4e. A Nature of Repairs or Alterations(Answer when applicable) ". /:;7 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•/-�_�' �.,s ! ' - G Date Application Approved by ,„, '/ _____ __._ Date lz�wig Application Disapproved by Date for the following reasons Permit No. rt-�,t3 A 1�j Date Issued t/ ------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS b+ BARNSTABLE,MASSACHUSETTS o Certificate of Compliance G THIS IS TO C�ERRTTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(l/)/ Upgraded( ) Abandoned( )by at -7:;- _l"�.•� h�,� has been constructed in accordance / with the provisions of Title 5 and the for Disposal System Construction Permit No.;7,a dated (4 Installer . �ji � Designer #bedrooms Approved design flow. gpd The issuance of this permit+shall noYb/e construed as a guarantee that the system will action as designed. Date i0�J Inspector - -------------- --------q----- --- - - - -------- --- - ---------------------------------------�-----�------- No. �►FJIt'�_' ! ! - Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal *pBtem Construction permit Permission is hereby granted to Construct( ) Repair(cr)� Upgrade( ) Abandon( ) System'located at 7°3 and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Constr4ction must be completed within three years of the date of this permit. --- Date I7�-, "7 n i'� Approved by o1°qI 1� Town of Barnstable r# r �oF'THE r #, .; + 'fin , y„p tip _�•. Department of Regulatory Services BARNSTABLE, : b Health Division . bate G -MASS. _ 200 Main Street,Hyannis MA 02601 i Date Scheduled. �J':`-' .� Time e Fee.Pd. �d0.. �Q . Soil Suitability Assessment for Se Disposal Performed By: 1 ��n i 1? Gone 4/( Witnessed By: Y LOCATION & GENERAL INFORMATION Location Address Q3 73.S k/o wft G A, Owner's Name ►tea ka-C 1+fir Address Assessor's Map/Parcel;J` r Engineer's NameJ'` � NEW CONSTRUCTION REPAIR, Telephone# .,; Land Use L Slopes(%) [�_5 Surface Stones Distances from: Open Water Body��� ft Possible Wet Area '> `0 ft Drinking Water Well ft :J Drainage Way ( r ft Property Line �2 ft Other ft � SKETCH:(Street name,dimensions of lot,exact locations of test holes&,pere tests,locate wetlands in proximity to holes) VN x ' 2SQ,0' Tar,: 15450�� � S - --- �:. tech holes 1 -3 Parent material(geologic) Depth to Bedrock j Depth to Groundwater: Standing Water in Hole:/N/ Weeping from Pit Face M ri Estimated Seasonal High Groundwater TE ATION FOR SEASONAL HIGH WATER TABLE Method Used: Ia Depth' Observed standing in obs.hole: in Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment $. Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level PERCOLATION TEST Date Time m Observation (� r Hole# I �7 Time at 9". . Depth of Pere. 'b Time at 6" ' Start Pre-soak Time @ Time(9"-6") End Pre-soak RateMin./Inch L 1G 4'�3ri7 lF1C1' Site Suitability Assessment: Site Passed' I Site Failed: Additional Testing Needed(Y/N) 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 X :oA Barnstable Conservation Division at lea,9t one(1)week prior to beginning. Q:\SEPTIC\PERCFORM.DOC No 4 e e. P� DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in:) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistent %Gravel I -3�O 5 L 1Yi' 72-0 C-2. DEEP OBSERVATION HOLE LOG Hole# -� Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistent %Gravel l -3q , i YA / 0&—q Cz r" ,S — 2 DEEP OBSERVATION HOLE LOG Hole Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Stricture,Stones,Boulders. Consistency.%Gravel) Flood Insurance'Rate Mao: , Above 500 year flood boundary No Yes v Within 500 year boundary No Yes Within 100 year flood boundary No V Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pervious material? Certification I certify that on 5 /� (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 3.10 CMR 15.017. !%.�Q.�,��, -'t- Date �301 Signature Q:\SEPTIC\PERCFORM.DOC Deparfinout of To ust Rogwatargy services ' a a d„,4 ry AU Mm 200 Main Slreer,Nynnals MA 02601 Say SC�pTduled ! Tlxxae qp dP ice • /UO ` ,n1; Soil Sukahili Assessme or e Dl kexformedBy: ��,- Witnessedsy: 1�1 Ioaa4anAddress 373S 10o . >'� Owner'sWimc • Address i Assessor's MaP/.Parcei: 3 17 JD 0 W ti e NEW CONSTRUCTIOAi REPAIR Telephone#k S08 �6a �. Land Use: L L IN/�-) Slaprs(5b) Surface StoAes 100 . Distance's from: Open Waterl3ody :1"r�)/� #7 I?Ossible Wat•AraA�/(�J Ik Drinlc[ngWAterY�cll ft Dral'nage Way j ty fk Property Line I V ft Other ft SIMTCH9(Strcetname,dimensions of lot,exact Iocations oi:test holes&.Pero tests;locate watlands'L pxox3rnity to k101es) CA y W10 Q - N C-1_ 2O,d 14y.l6' - _ Parent material(geologic) lJ Depth tvBaclrgal Depth-to Groundwater: StandingWaterIn Hole: N Weeping from FitFnpc �J Nsdrgated Seasonal High Groundwater-IVIA r D .Ca`rA AM.A'1."I Jl'+1' 1'AJLa.A:JUI GrfW411:9EA P WGRL:E Method Used: f, Depth Observed standing in obs.hole: lu, :Daptlt�tp,s.,r11 C�?Qula:. 1t1. Depth to vreepingimm side of obs.hole: ln, c3tnundwptxrl�dJuetmnk 7r. . Index Well# 130ading Doe: Indeu Well 1pYai _ � .A,. ,AU0 �,df,:(3LY?ullt�wtiteP �la1 ,� Observation Foie#k Tlxna•at.9" Dep ft of Pam ' . , TImr At 61' StartPxe-saalt pima @ 'llme{9"-G") 13nd 1'rc-soak po r, Rate Min.Auch Cj 1 �'V V . Sits SultabiIity Asaessznent: 540rgsacd SitrqF'alled:_____^, Additional Testing Needed(,.YIN) Oxiglnal: Publlo Health Dlvlslan QbSe6a:don HoIQ Data To Bo Complote.d on Back----�--_- ""'If pexeolattibu test is to be,eoaadaaeted wiftoL 1001 Of Wafland,You must first aaotaf'y the Barnstable +Coazservation Division at least®jue(1)Weak pxaor to begimaing. r�:�s>~l�zC��Rci�ortia".�oC i LOG Depth from Sail llarizan u�aflTexhare Sdil Cofor golf., OtlZer Surfaea(in.) , (i] bA} (MunseII) Mottling (Structura,Stonel;Boulders,'f'to c�9b'(lravell r1k ME Depth*om Sall Horizon SoIrTextura Boll Color Boil Other Sierpacc(in.) CUSDA-) (Munsell) Mottling (Structure,Stands,Bouldefs. oasis tc 90Gravel) jq T , DEFT013SER�l'.r�.'7[` ONTIOLF,LOG 15010fi1. 3-0(har' _ 1]'epthfrom SollHorizon soiITaxtura Sall Color Soil Surface(ink (USDA) (1Vlunscll) Ivinttltng (Struutuzo)Stones,boulders. ConulfftrTicy, e e- ' DIMP 0338 1V'.�,.TION lawlt Lod Deipthfram SailHadzon SalITexturc Boll Color SatI CYtftcr Surface(in.) (USDA) (Nlunsell) mottl(ng (Structure,Stoats,,Boulders, Casitn 6 ' 9 y'Ynn d�.srsraxrcra�.ate 1V1&'t�: s Above 500•year flood boundary No Yes ._ Wfthln g00 year'boundary. Ida e+ 'Yes, Within 100 year flood boundary No•,_,.v Y .. D eYrfla bf SST xraYY y 9 ccnir�yn erg ous Motor%�Y Daes at least four Feet of naturally aacutring P orvi ov miterial wdst in all ar nm nbscrved thr'pughout the area proposed fbr the soil absorptl'on syetoml _\,t. .z — -- If not,what is the depth of naturally occurring pervious �exiii(Ycatiaxn x Certify that On (date)x have pass' the sail evaluator mcamination approved by the DepaitmoutOfEnvironmentalProtmdon and Martha above anaXysis was pertox»tedbyme eonsistentwith . the regtrifed trainsn r experdse and.emperieneo described In�10 MAR 15.017. Datb j/)y li 7 . • signature . . 4 f down cape engineering, inc. SIEVE SOILS ANALYSIS 3735 ROUTE 6A BARNSTABLE, MA. DATE OF REPORT: 8116/17 JOB : GRAIN SIZE ANALYSIS-'SIEVE TEST SITE: 3735 Route 6A, Barnstable LOCATION: DCE Testi Hole SIEVE ANALYSIS Weight Sample(Grams):.: 132.5 SIZE :.:WEIGHT RETAINED % RETAINED % PASSED ------------- --(sum 4 --------------------•---- ------------ 1, 0.0; 0.0%; . 160.0% ---------- - - -- --------- 0.0; 0.0%: 100.0% -------------:--- ---------- r -------------- o- ---------------o- #4 - 0.0: 0 0%: 100.0% #1 0----- ------------------------- -------- ------- --->------------------ 4 6% : 95.4% --------- -------- - -------- --------- #20` _ 21 2 16 00 84_0% .--__-___- --.--- --..-.--...... ........ _-_---------------__L . #40 41.1; 31.0%; 69.0% I...........................Y-----------__ ......_.-----,--- #50 54.7; 41.3%; 58.7% --------- -. - v---------------- -. #80 94.6: 71.4%: 28.6% - ---- - - - w --------------� - - '' #100 111.9: 84.5%: ___--15.5% -- ----- -- ------ ----- t-------------------- -- #200: 123.3; 93.1%; 6.9% - --------- ---------------------- ---------------------------------------- PAN: 127.5; 100.0%; --------. --- ---------------------*---------------- -------------- ------ SAMPLE 1 . 132.5; NOTE:TEST ON PASSING#4 ONLY,2.3% RETAINED ON#4'<45% O.K. RESULTS: - SOIL CLASSIFIED AS AASHTO A-3 (FINE SAND) (UNCOMPACTED) . PERCENTAGE OF MATERIAL PASSING#4 SIEVE #4 100% (TEST ONLY MATERIAL PASSING#4) OK #5010%-100% :. OK #100 0%-20% OK #200 0%-56/6 CLOSE SAMPLE IS CLOSE TO MEETING TITLE 5 FILL SPECIFICATION >93% SAND RESULTS: PERMEABLE MATERIAL-CLASS 1<2 MINJIN. MATERIAL (0.74 GPM/SF) LL NONCOMPACTED A SOIL DESCRIPTION: FINE SAND ��a �,tWOF.- �9cy DANIELA o OJALA CIVIL N No.46 Y116117 s � TONAL E �3Smatn �BA�R N 0 O 0 0" Certified ail Fee U041100% $Extra NiC2S&Fee.(check box,add fee as apppnat.)tumeip(hardcopy) $Return Receipt(electronic) $❑Certified Mail Restricted Delivery $OO ❑Adult Signature Required $ Adult Signature Restricted Delivery$O Postage m $ rq Total Po tags and Fees ' $ ,�6 Sent To O Dry ---------------------------- 1 1 Street andApt.No br P -Hox o. `` - b";1�1-----da---aN------------- - Certified Mail service provides the following benefits: 6 A receipt(this portion of the Certified Mail label). for an electronic return receipt,see a retail ■A unique identifier for your mailpiece. associate for assistance.To receive a duplicate ■Electronic verification of delivery or attempted return receipt for no additional fee,present this delivery. 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Important Remirldeis: Adult signature service,which requires the 0�,, ■You may purchase Certified Mail service with signee to be at least 21 years of age(not - First-Class Mail®,First-Class Package Service®, available at retail). or Priority Mail®service. -Adult signature restricted delivery service,which- { •Certified Mail service is notavallable for requires the signee to be at least 21 years of age, intemational mail. and provides delivery to the addressee specified; ■Insurance coverage is notavailable for purchase by name,or to the addressee's authorized agent, with Certified Mail service.However,the purchase (not available at retail). of Certified Mail service does not change the •To ensure that your Certified Mail receipt is insurance coverage automatically included with accepted as legal proof of mailing,It should bear a certain Priority Mail items. USPS postmark If you would like a postmark on., •For an additional fee,and with a proper this Certified Mail receipt,please present your endorsement on the mailpiece,you may request Certified Mail item at a Post Office'for � I the following services: postmarking.If you don't need a postmark on this Return receipt service,which provides a record Certified Mail receipt,detach the barcoded portion, of delivery(including the recipient's signature).; bf this label;affix it to the,matlpiece,apply F, You can request a hardcopy return receipt or an+•appropriate postage and depositthe mailpiece. electronic version.For a hardcopy return receipt,, complete PS Form 3811,Domestic Return.4-1 , Receipt attach PS Form 3811 to your mailpiece; I!MaoRrAtdT save this reeelpt for your records. PS Form 3EOO,April 2015(Reverse)PSN 753"2-000-9047 o Complete items 1,2,and 3. A, Signature ® Print your name and address on the reverse X _ ❑Agent so that we can return the card to you. O Addressee. A Attach this card 4o the back of the mairpiece, [B. eceived by(Printed Name C. a of; livery or on the front if space permits. c. C. r Cce+f 1.Article Addressed to: D.Is delivery address different from item 1 If 13 qes if YES,enter delivery address below: ❑No o8ox Ia�l '�arnstab(e, fY a a Q30 3. Service Type ❑,Priority Mail,Express® II I III DI I II IDI I II II I II I I IIIII I I I I III II III Adult rdlSignature Restricted-pelivery 0 Registered Mail Restricted ed Mail® Delivery 9590 9402 1934 6123 0975 79 ❑Certified Mall Restricted Delivery etum Receipt for 0 Collect on Deilvery Merchandise 2._Article_Number_Clraosfer_fm�ri-cP vir_A Gt an" ❑Couect on.gelivery Restricted Delivery 0 Signature ConfirmatlonT"4 ❑Signature Confirmation 7 015 j 1 17 3 01 0 0 01 14 99, 0 0 5,7,7q#j )Restricted Delivery Restricted Delivery PS Form 3811,duly 2015.PSN 7530-02-000-9053CVC—) Domestic Return Receipt USPS TRACKING# First-Gass Mail Postage&Fees Paid USPS Perrnii ,::. ^-10 9590 9402 1934 6123 0975 79 United States •Sender:Please print your name,address,and ZIP+4®in this box* Postal Service `O' ^q4 Town of Barnstable a Health Division 200 Main Street Hyannis,MA 02601 I I I h � llttrl1t1�1111 � I �lll IIIIi � ti TKE Town of Barnstable Barnstable Regulatory Services Department ;1U 0caC j 1AMSTABLS. ' MAW Public Health Division m fa Mp'1 A 0 200 Main Street, Hyannis MA 02601 2007 Office: 508-8624644 Richar d V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4990 0577 August 2, 2017 DREIER, PRISCILLA C P.O. BOX 1241 BARNSTABLE, MA 02630 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 t The septic system located at 3735 Main Street/Route 6A, Barnstable,'MA was inspected on 07/18/2017 by Frank Nunes III, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails under the guidelines of 1995 TITLE V (310 CMR 15.60) due to the following: • Leaching facility with standing liquid level at or above the invert pipe (per Town Code 360-20 h). You are ordered to repair or replace the septic system within two (2)years from the date you receive this notification, Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH r XomasKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\.3735 Main Street Rte 6A Bamstable.doc IKE fps Town of Barnstable a+.Rxs•rAer,�, . Regulatory Services Department Public Health Division 200 Main Street,Hyannis MA-02601 Office: 508-862-4644 Richard Scali,Dircctor FAX: 508-790-6304 Thomas A McKean,CHO Feb 6, 2007 Rev. 5111116 DEADLINES TO'REPAIR FAILED.SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) r 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 Y . ❑Pumping more than 4 times during the last year not due to clogged or obstructed pipe; ❑Backup of sewage into the house due to an overloaded or clogged SAS or cesspool. ONE (1)YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box.above outlet invert due to an overloaded or clogged SAS or cesspool ❑Any portion.of the SAS, cesspool, or privy below high groundwater.elevation ❑Any portion of the cesspool within a Zone 1 to 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 i�7� q Single Cesspoo ❑Any"conditionally passed systems" (broken cover,relocation of a pipe,relocation_ of a driveway due to H-10 components, etc) o 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: W.SEPTIMDEADLINES TO REPAIR FAILED SYSTEMS.doc 4 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �•� r� 3735 Main Street Rt.6A Property Address Dreier Owner's Name Barnstable f/ MA 02630 7/18/17 ; Cityrrown State Zip Code Date of Inspection t,31 Inspection results must be submitted on this form. Inspection forms may not be altered in any way. A. General Information 1. Inspector: Frank Nunes III Name of Inspector saa Company Name Box 841 Company Address East Falmouth MA 02536 Cityrrown State Zip Code 508.272.6433 Telephone Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority 4W/A, • 7/18/17 Inspect Slgnatu 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. 3735 Main St•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15r/r L0ff �J )II Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 3735 Main Street Rt.6A Property Address Dreier Owner's Name Barnstable MA 02630 7/18/17 Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D. A) System Passes: ❑ 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"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. Answer yes, no or not determined (Y, N, ND) in the ❑for the following statements. If"not determined," please explain.' ❑ The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: n/a ❑ 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 3735 Main St•03/08 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 3735 Main Street Rt.6A Property Address Dreier Owner's Name Barnstable MA 02630 7/18/17 Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ distribution box is leveled or replaced ND Explain: n/a ❑ 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 ND Explain: n/a 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 1 of,a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50µfeet of a private water supply well. 3735 Main St•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 15 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System,Form_-;Not for Voluntary Assessments 3735 Main Street Rt.6A Property Address Dreier Owners Name Barnstable MA 02630 ` 7/18/17 Cityrrown State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less 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 indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: n/a 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 Y day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. 3735 Main St•03(08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal SystemsForm.,%Not for Voluntary Assessments 3735 Main Street Rt.6A Property Address Dreier Owner's Name Barnstable MA 02630 7/18/17 CityrFown State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems(cont.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.) ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ The system fails. 1 have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 16,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 3735 Main St•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M ,• 3735 Main Street Rt.6A Property Address Dreier Owner's Name Barnstable MA 02630 7/18/17 Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ® ❑, Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or.as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑' Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] 3735 Main St 03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments, 3735 Main Street Rt.6A Property Address Dreier Owner's Name Barnstable MA 02630 1/18/17 City/Town State Zip Code" Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No- Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Sump pump? ❑ Yes Z No Last date of occupancy: Occupied Date Commercial/Industrial Flow Conditions: Type of Establishment: n/a x ' Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): n/a 3735 Main St•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 3735 Main Street Rt.6A Property Address Dreier Owners Name Barnstable MA 02630 7/18/17 CityrFown State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: Pumped annually per owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any), ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: Original septic tank, new leach pit 1990 per BOH record M Were sewage odors detected when arriving at the site? ❑ Yes ® No 3735 Main St•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 15 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments y 3735 Main Street Rt.6A Property Address Dreier Owners Name Barnstable MA 02630 7/18/17 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): 2' Depth below grade: feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: >10 feet Comments (on condition of joints, venting, evidence of leakage, etc.): ' Septic Tank(locate on site plan): 18" Depth below grade: feet Material of construction: ®concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No -------------------------------------------------------------------------------------------------------------------------- Dimensions: 1000g 2" Sludge depth: 11 Distance from top of sludge to bottom of outlet tee or baffle >12 Scum thickness trace-1/2" >2„ , Distance from top of scum to top of outlet tee or baffle „ Distance from bottom of scum to bottom of outlet tee or baffle >2 How were dimensions determined? Measured 3735 Main St-03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 15 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 3735 Main Street Rt.6A Property Address Dreier - Owner's Name Barnstable MA 02630 7/18/17 Cityrrown. State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): The outlet T is not in place. It appears to have corroded and fallen off Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): n/a Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): n/a 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): n/a 3735 Main St•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 3735 Main Street Rt.6A Property Address Dreier Owner's Name Barnstable MA 02630 7/18/17 Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) Dimensions: Capacity: gallons Design Flow: • gallons per day . Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No . Date of last pumping: Date Comments(condition of alarm and float switches, etc.): n/a *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0.1 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box is 3'6" below grade and in poor condition Pump Chamber(locate on site plan): Pumps in working order: - ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No• 3735 Main St•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 3735 Main Street Rt.6A Property Address Dreier Owner's Name Barnstable MA 02630 7/18/17 City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): n/a Soil Absorption System(SAS) (locate on site plan, excavation not required): If SAS not located, explain why: " Type: ® leaching pits number: 1 ❑ 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.): The leach pit is full at this time and is backed up in the pipe halfway to the d-box 3735 Main St a 03(08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 15 k . ' Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 3735 Main Street Rt.6A Property Address Dreier Owner's Name Barnstable MA 02630 7/18/17 City/Town State Zip Code Date of Inspection . D. System Information (cont.) Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth-top of liquid to inlet invert Depth of solids layer, Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No ' Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): n/a 3735 Main St•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M , 3735 Main Street Rt.6A Property Address Dreier Owner's Name j Barnstable MA 02630 7/18/17 Cityrrown State Zip Code Date of Inspection: D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. 01 V� 3735 Main St•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 3735 Main Street Rt.6A Property Address Dreier Owner's Name Barnstable MA 62630 7/18/17 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar Shallow wells Estimated depth to high ground water: >12 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-explain: US TOPO maps put home on 32'contour and nearby wetlands approximately 10' You must describe how you established the high ground.water elevation: see above 3735 Main St•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 115 of 15 71 TOWN OF BARNSTABLE LGt�ATION SEWAGE # — O VILLAGE S ASSESSOR'S MAP & LOT817-096 INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) size) NO. OF BEDROOMS. PRIVATE WELL O PUBLIC WATER ' BUILDER OR OWNER DATE PERMIT ISSUED: ��/�y'� DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No i" 0� 0 a t � ASSESSORS MAP N0: 2>7' THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratioo for 11ispooal Workii Tonstrurtiott Vamit Application is hereby made for a Permit to Construct ( ) or Repair O an Individual Sewage Disposal System at: oeation-Address --•-•----- or Lot No. Owner apl/ � Gx/ I kST1X1C / (�/ � Instal.ler Address d Type of Building Size Lo Qd�t_Sq. feet Dwelling—No. of Bedrooms........................................--..Expansion Attic ( ) Garbage Grinder ( ) pa,, Other—Type of Building .... ........... No. of persons............................ Showers ( ) — Cafeteria ( ) a Other fixtures ................... W Design Flow................_..:_._........gallons per person per day. Total daily flow........-_ -----.-------------gallons. W Septic Tank—Liquid capacity/�Q..gallons Length................ Width---------------- Diameter---------------- Depth-:--- ..--.---. x Disposal Trench—No.....:............... Width.................... Total Length.................... Total leaching area..............__._:.sq. ft. Seepage Pit No......../--------. Diameter.................... Depth below inlet.................... Total leaching area...............-.:_sq. ft. Z Other Distribution box ( ) Dosing tank ( ) i a Percolation Test Results Performed by.................................... ----•------=•---.....---•••--•--..... Date----...........-•--•• -•---- 14 Test Pit No. I................minutes per inch Depth of Test Pt.-----.............. Depth to ground water--------i---------------. (i, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a •-------•--------------•----------------•-.._...............---...--------------•---......•••--....._.........._._....•--------•-.....--••............•----- i O Description of Soil ��--�---------------s .---�--- - �J G1 ' v .....-----�........---.. ..-., alb ......... W UNature of Repairs or Aerations—Answer when applicable.-.1'0 ----A-4:54 �..... .. Agreement: y� The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliant as en issued by t board of health. Signed --- ;- --- --- -- ---------.. ---�5` � Application Approved By --------` �c � ....................... -------- ....................................... S .... e Application Disapproved for the following reasons- --------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------................................................... ........................................ Permit No. 2.. -------- Issued .. + �f�/ v Date " • ,�• _ _ ,�," � - __ t++ 1. +' No. �......_ Fins...E..0........_ ` . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Applira#ion for Pispwial Nurks Tonstrnr#iun Famit Application is hereby made for a Permit to Construct ( ) or Repair (X an Individual Sewage Disposal System at: Ste, � �,st s� . ... . - :..._.... -- -...�..... ----------------= - ...... a.............................. ocation-Address or Lot No. 7� f2.Z�i�c J S7— .�,1 .....F*...................... .z----------- ........... a� .........---- a � DGG7 G�D�-lST •--�------•---------------•----------------------........._...._....-----'----•------•--- ••. .....................:- ---Y....... InstallerPQ Address d Type of Building Size Lou ---Sq. feet t Dwelling—No. of Bedrooms...................... ._..._.._---___-___Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building -S'........... No. of persons---------------------------- Showers Gal � -------�---------------------------------P ( ) — Cafeteria ( ) dOther fixtures ... --------•----------•------------•---------------------•-------------------•----------------------- W Design Flow.................s�r.._______.._..gallons per person per day. Total daily flow----------- _-0L3.x:Q..................gallons. WSeptic Tank—Liquid capacity,/AO..gallons Length................ Width................ Dia_eter................ Depth-_---__-__.-__.. x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No........Z........ Diameter.................... Depth below inlet-------------------- Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) a' Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water_-____-_________---_-__. fLl Test Pit No. 2................minutes per inch Depth of Test Pit--_____-______---. Depth to ground water........................ •-----•-••---•-••••---•-•-•-•--••------•------••-•••----------------------------------------•--•.......................................................... D Description of Soil s�� Gli�t �fS�.-•-_�_-/�- f ... �c1D x c, y .... orJ�D w ----------------------------••------•------............................................................................................................................................................ U Nature of Repairs or Alterations—Answer when applicable.___C�� '.= __ ......�� y- - _ ���---��--�---����i�l_�--�/_. - -C---..�L ��.�----Z, Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of CompliancVas en issued by the board of health. Signed ..-- ----- ---- . ---- • -- ----------- .... Dace Application Approved By . t=~ f u------- ----------------------------- ----------------------------------------------. ------. ----------------------- Application Disapproved for the following reasons- --------------------------------------------------------------------------------------.................................................. --------............................................................................... --------------------------------------------------------------------------------------- ---------------------------------------- Due' u Permit No. '-------.---- Issued �® 2z U ---------------------- e�yves -- ---------- -------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF H *A TH t` TOWN OF BARNSTABLE i Gntifirate IIf "T I ii wic THIS IS TO CERTIFY, That the Individual Sewage Dis osal System constructed (• ) or Repaired (,V - by ------ 1 l ll 7-------- a�sT" 'IN....... --- r i lnsmller t_ at ........ ,37,357 ...----------------------------------................................................._-----............. I ,; ---------' ' ------------------------ ------------------------------------- has been installed in accordance with the provisions of TITLE 5' he State Environmental Code as described in t_ the application for Disposal Works Construction Permit No 2. .GP. f:T: dated ---.-----�—�. " .c{.;y. ...... , r ;._ f THE ISSUANCE OF THIS CERTIFICATE SHALLONSTRUE ►S A GUARANTEE THAT THE, n ; • X •SYSTEM WILL FUNCTION SATISFACTORY. , "' DATE ^°�. / - ......... 'j' Inspector _ .'s� c ........ v. . } THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 2 z TOWN OF BARNSTABLE No.... FEE..:: ...... Permission,is hereby granted............�G�%�Cc_111_ ...G'o .ANC- -- ............... ...---...........---•------•-.........------................._.... to Construct ( ) or Repair (Ne) an Individual Sewage Disposal System Street 1 as shown on the application for Disposal Works Construction Permit Nod___.Z 2&_. Dated...... y1 ............ e � ...................... :. ...._...................-_...............---..... 1 Board cf Health DATE.................. /b`1 q"0.................................... FORM 38508 HOBBS 6 WARREN.INC.,PUBLISHERS AsBuilt Page 1 of 1 TOWN OF BARNSTABLE LOCATION �37�s� /1/,��/�tlF�?� SEWAGE #��e-5'Q VILLAGE X74ekiElCa ASSESSOR'S MAP St LOT817-096 INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) �/l_��L_(sLze) edX-4 NO. OF BEDROOMS -,3 PRIVATE WELL O PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED; DATE COUPLIANCE ISSUED; -5--ZIL l VARIANCE GRANTED: Yes No ./ http://issgl2/intranet/propdata/prebuilt.aspx?mappar=317090&seq=2 5/7/2015 r L G-rC AT ION S E GE PERMIT NO. VILLAGE A 5i1,6 INSTALLER'S NAME i ADDRESS OR OWNER DATE PERMIT ISSUEQ DATE COMPLIANCE ISSUED ® t� 1it y W � �d l i r J _ FEs.... ................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH GCi/(-.............OF.... �Tti:J� 1 ------...................... ,� lirtttion for Diopoiitt1 Workii Tonoirnrtion an'tit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual -Sewage Disposal System at: Location-Address a or Lot No. ` yy Owner �i F Address __ t&o....../VI.G�S!_: tlrf..".Zr.::.... ................. ............................... ........................... Installer' 1 Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) ply Other—Type of- Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a Other fixtures ............................ . �., ,,: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. 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. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ �+ •-----------------------------------------------------------------------•--•-•-•••---........_.............................................................. 0 Description of Soil------------------------------------------------------•----•-----------...-•----------------------------------------------------------...•--•----------•-••--•------•-- x U .........--•--••-------••_.... x --••• ----••----------------••--- .......... U Nature of Repairs or Alterations—Answer when applicable......._ ._-Ac . .-- L ........ ® /_ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iI'l1L 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been iss d thhePoar /Ijk ::. ..... ............V..`------------------....----.................--- ....... '7 ._- XD Application Approved BY - -- = �� Dat Application Disapproved fort ollowi reasons-------------------------------------------------------------------------------------------....•--.........------ Date Permit-No....................................................... Issued....................................................... Date No. 3.:.. ..�%.. FES.....%.C?............... l / THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ic-..............OF..... ..5..T ` G ....................................... Appliratiun for Uiupusttl Workii Tomitrurtiott Permit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: Location-Address or Lot No. j�f�X.......11.2.1.f_-kc.......-•----•---•.............................. ........... - Addr ess............................................... Owner. W L1 1 /°11._c.�_.._.1�1f G ........ ..................•----............---------..... Installer Address Q Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) 04 WDesign Flow.Other fixtures.................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. 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. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Gz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ -------------------------------•-----.---•-•-----------•-------------------•----------------•-•------- •------•----------------...._................... 0 Description of Soil........................................................................................................................................................................ V -----.....-•-•-------------------------•--...•-•-._....--------•-----------•-------•----.......---------•-•---••-•••••••--•••-••-----••------------•--•--•---------------------••-•---••----•-••--••---- W V Nature of Repairs or Alterations—Answer when applicable..._..._ jz�_ �_�............../.l1sd v.._.��x.L_.....,��r`_._. ----------------r� r .......4 Lu...,......-----------------------............--------.....---•----•---------------...---......_ 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 iss d the/Gard,ofjh. /v'r -- . D e Application Approved BY•--••--•---••-- �. ---........................................................ --�`�J---�-•-��•-----••-- f' r Date Application Disapproved for t -1ollowi reasons:....................•...........................------...---•----------•---.............._....•------•......._ -----------------------------------------•--•---.....------------------------•--••-•-------------•---•------------------•--------------------•-•---•-•-•----•-•-••--•--- ••---•-•••--•---••••••••- Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF.................I................................................................... CIrrtif iratr of Tompliatta TH1�rERTIFY, That the Individual Sewage Disposal System cons rutted ( ) or Repaired �i`(��......�s.r4i by........ inscaii er has been installed in accordance withh (rovisions of TIT �5 pf The State Sanitary Codes scribed in the application for Disposal Works Construction Permit No._j............-------- d......... dated_A_--- i_3.................... THE ISSIJANC OF THIS CERTIFICATE SHALL NOT BE CONST E® S A GUARANTEE THAT THE SYSTEM WILX F fNCTION SATISFACTORY. DATE._-�, ..//......................................•---•-••------..........---- Inspector. ....... .--------•- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1 .O F.........:........................................................................... / No...lj.-__...:..Y .�. ! FEE./!2............... onstrtt.rtion permit Permission is hereby granted......I .. . ... . to Construct ( ) or Repair ( ) an Individual Sewage Disposal System atNo............................................................................................................................................................................................... Street as shown on the appli5ottionXr Disposal Works Construction Permit No............: ..,:_: wed.._....._..._.............._._............ ..........................-.--�� -•-------••...................•--•--...._..-----� ,'r� l i oard of Health DATE---f-K --•7 -----�--l.......-•-----••-•------------•-•-••-. /✓ i` FORM 1255 A. M. SULKIN, INC., BOSTON ALL SYSTEM SHALL SYSTEM PROFILE MARKED WITHC MAGNETIC TTAPE OR BE (NOT TO SCALE) COMPARABLE MEANS FOR FUTURE LOCATION. po ° ACCESS COVERS �O WITHIN 6" OF FIN. GRADE l l CONCRETE COVERS TO WITHIN 3" GRADE �J 0 2" PEASTUNE OR GEOTEXTILE TOP FOUND. EL. 33.4 FILTER FABRIC OVER STONE �� a p MINIMUM .75' OF COVER V 29 SLOPE REQUIRED OVER SYSTEM 38.0'-39.0' S oufe 6 r�� WATMRN. 2„ WALL FOR THICKNESS PRECASTBLOCKS PREECASTORISERS PRECAST H-10 RISERS (TYP.) -7 4'OSCH40 PVC MORTAR ALL 31 .0' PIPES LEVEL 1ST 2' COMPONENTS INVERT IN 35.17' 4' ( ) 4' Locus ENDS TYP. SIDES 36.0' >v% 10" EXISTING 14 v E °°°°°°°° ®®�® ®®®®rFn ®®® ®®® G�onit �c TEE SEPTIC TANK" TE 6" MIN. SUMP °° ��o�®®®®®�� ®®0�®�®®®� '8 o 29.6E * Y6'_CRUSHED a ; °° °°°°° ''°°°°°°° `' c °°°0 12" MIN. INT. DIM. o ° ° �0���®�®®®� ®®®�®®®®�� o°o°o°o o J GAS BAFFLE:. J 4, ��DO�O®�0® .00000000 35.44' 35.27' °o°o °o°o°o°e 33.17 a 3/4"-1-1/2" DOUBLE WASHED STONE 4' MIN. H-10 500 GAL. LEACHING CHAMBERS BY ACME PRECAST OR EQUAL. ------- -- ALL AROUND PRECAST STRUCTURES (3) UNITS REQUIRED STONE OR MECHANICAL OVERALL DIMENSIONS TO OUTSIDE OF STONE: 33.50' X 12.B3' OMPACTION. (15.221 [2]) Route 6 ( 2 9 SLOPE) ( 9 SLOPE) FOUNDATION- EXIST. SEPTIC TANK 91 PUMP 87 D' BOX 12' LEACHING CHAMBER FACILITY LOCUS MAP 19.5' BOTTOM TH-1 SCALE 1"=2000'± **INSTALLER SHALL CONFIRM MINIMUM NO GROUNDWATER FOUND *THE INSTALLER SHALL VERIFY THE SEPTIC TANK SIZE AT 1000 GALLONS ASSESSORS MAP 317 PARCEL 90 LOCATIONS OF ALL UTILITIES AND ALL AND ITS SUITABILITY FOR RE-USE. BUILDING SEWER OUTLETS AND REPLACE WITH 1500 GALLON SEPTIC ELEVATIONS PRIOR TO INSTALLING ANY TANK APPROPRIATE TO SITE PORTION OF SEPTIC SYSTEM CONDITIONS IF NOT SUITABLE PROP. WATERTIGHT COVER TO GRADE SYSTEM DESIGN. ALARM AND CONTROL PANEL NOTES LEGEND TO BE INSTALLED INSIDE PROVIDE QUICK DISCONNECT FOR PUMP GARBAGE DISPOSER IS NOT ALLOWED BUILDING. ALARM TO BE ON 1. DATUM IS NAVD 88 99 - EXISTING CONTOUR SEPARATE CIRCUIT FROM PUMP EXISTING 3 BEDROOM DWELLING X 99.� EXIST. SPOT ELEV. 2. MUNICIPAL WATER IS EXISTING 33.0' DESIGN FLOW: 4 BEDROOMS ® 110 GPD = 440 GPD 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. -[99]- PROPOSED CONTOUR U 4. DESIGN LOADING FOR ALL PROPOSED PRECAST UNITS [98•41 PROPOSED SPOT EL. INV. IN 29.42' '\ NO LOW POINTS t� " PRESSURE LINE -�-- SEPTIC TANK: 3�30 6�D (2) = 60 U TO BE AASHO H-10 TH1 1000 GAL. H-10 S/T 2 PRE **RE-USE EX G 1000 GAL. PTIC TANK 5. PIPE JOINTS TO BE MADE WATERTIGHT. TEST HOLE ALARM ON 500 GAL.+ SLOPE TO DRAIN BACK TO PC ADD 1000 GAL. H-10 PUMP CHAMBER ' YYY FLOAT SWITCH RESERVE 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH 2� SLOPE OF GROUND SETTINGS: PUMP ON 0.25" WEEP HOLES 310 CMR 15.000 (TITLE 5.) 8., CHECK VALVE LEACHING: 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO Q� UT;LITY POLE 4" WORKING RANGE MYERS SRM 4 11 SIDES: 2(33.5 + 12.83) 2 (.74) = 137 GPD BE USED FOR LOT LINE STAKING OR ANY OTHER � SUBMERSIBLE 4/10 HP PUMP PURPOSE. yob FIRE HYDRANT PUMP OFF 8" SYSTEM (OR EQUAL) BOTTOM 33.5 x 12.83 (.74) = 318 GPD NOTE: NOT ALL SYMBOLS MAY APPEAR IN DRAWING 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. �o ��oo TOTAL: 615 S.F. 455 GPD 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED PUMP CHAMBER USE (3) 500 GAL. LEACHING CHAMBERS ACME OR EQUAL WITHOUT INSPECTION BY BOARD OF HEALTH AND ( ) PERMISSION OBTAINED FROM BOARD OF HEALTH. (NOT TO SCALE) WITH 4' STONE ALL AROUND WATERPROOF/WATERTIGHT 10. CONTRACTOR SHALL BE RESPONSIBLE FOR CALLING DIGSAFE (1-888-344-7233) AND VERIFYING THE LOCATION OF ALL UNDERGROUND & OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF WORK. �v 11. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL BE REMOVED BENEATH AND 5' AROUND THE PROPOSED \ _ LEACHING FACILITY. 24 \ 12. EXISTING LEACHING FACILITY SHALL BE PUMPED AND 04 REMOVED OR PUMPED AND FILLED WITH CLEAN SAND. 126.02' IS SUITABLE 13. EF R TO E RIFY THE R ICAL M OR PUMP CONNECTION. ELECTR CAL 25 PERMIT REQUIRED. 23 � Al / ASEMEN C,SS0 4so I ,/ LOT 202B 1 �11 42,969± S.L. 7 7 25 24 �27 TEST HOLE LOGS TEST HOLE LOGS DANIEL E. GONSALVES, SE 13587 DANIEL E. GONSALVES, SE 13587 2a ` � ENGINEER: # ENGINEER: # _ RS (BARNSTABLE UNSUITABLE DON DESMARAIS, RS (BARNSTABLE 29� r WITNESS: DON DESMARAIS, ) SOIL WITNESS. ) DATE:_ 8/14/17 DATE:-- 4/30/18 you PERC. RATE _ < 2 MIN/INCH PERC. RATE _ < 2 MIN/INCH GRAVEL CLASS I SOILS P# 15450 CLASS _ 1 SOILS P# 15653 PARKING ✓ 5 ELEV. ELEV. ELEV. ELEV. ELEV. 51 �� , „ 4 ' 4 4 , 4 ' 0 36.0 0 39.0 0 38.0 0» 39.0 0�° 40.0 S/ S/ „ SL / SLR Q 16 10YR 4/2 14 10YR 4/2 PAVED 10Y� 3/2 10YR 3/2 10YR 3/2 B B ' / DRIVE 10 14» 12» / SL 0 36 , „ / SL / 37.2' B B B� 36 10YR 6/3 . 34 1OYR 6/3 41 LS /SL ESL /SiL 1OYR 5/6 10YR 5/6 1OYR 5/6 O / / 33.5' " 35.5' " 34.3' " 2.5Y 5 3 33.0' " 2.5Y 5/3 34.5' O - 30 � ;� , 42 44 72 / 66 G C2 C2 EXISTING PORCH / / FS FS DWELLING TOF = 33.4 /'SL �SL SL 96" 2.5Y 8/2 31 .0' 90" 2.5Y 8/2 32.5' 55. „ 1OYR 5/4 2.5Y 6/4 2.51 6/4 C C j�- 132 25.0 138 27.5 132 / 27.0 3 - 3 i SiL 'SiL Q� 2.5Y 5/3 /2.5Y 5/3 32 �C2 C2 C2 168„ i 25.0' 162„ , 26.5' SIEVE SiL FS FS 21 0, 0 /' PERC C4 PERC C4 O 0 2.5Y 5/3 2.5Y 7/4 2.5Y 7/4 VA MS X MS O // / 10YR 6/8 20-1 ,� O 1 OYR 6/8 198" �, 19.5' 186" 23.5' 186" 22.5' 240" 19.0' 240" 20.0' DECK BENCHMARK TOP of WALL , ' NO GROUNDWATER ENCOUNTERED EL. = 33.8' ANTINGS O I � r �\ �l ----- --- O O h o; TH 1 Co,J 37 38 TITLE SITE PLAN ' TH3 OF TH 3735 ROUTE 6A TH4 BARNSTABLE, MA 43 PREPARED FOR 5' REMOVAL OF-/UNSUITABLE SOIL/ " REQUIRED AROUND PERT T OIE' CAPE COD. SEPTIC/ LEACHING .FACILITY, DAWN TOO SUITABLE 45 SOIL LAYER. REPLACE'WITH CLEAN M SAND, TO MEET SPECIFICATIONS OF 310 " __�)C 46 -- H R�-5J255(3) SHED DATE: APRIL 24, 2018 REV: APRIL 30, 2018 (4 BEDROOM DESIGN) Scale: 1"= 20' 100. ' 0 10 6 ;u 'I ��n FEET ,1 �_ZH OF XfASs� �ZN OF MAss DANIELA. f 43� Q� �� OJALA `N oho DAAIEL G� m CIVIL GJALA m off 508-362-4541 -10 No.46502 fax 508-362-9880 o �� �No.40980P downcape.com 0�FFQ/STER��a °FFss\0 SSIONAL ��v N�SUR\10 down cope engineering, inc. L C civil engineers i._ I --� land surveyors / 939 Main Street ( R to 6A) " DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02575 DCE ## 17-241 ' 17-241 BORTOLOTTI DREIER.DWG ALL SYSTEM COMPONENTS SHALL BE SYSTEM PROFILE o ' MARKED WITH MAGNETIC TAPE OR (NOT TO SCALE) COMPARABLE MEANS FOR FUTURE LOCATION. o A ESS COVERS TO WITH 6" OF FIN. GRADE 2" PEASTONE OR GEOTEXTILE CONCRETE COVERS TO WITHIN 3" GRADE p _ FILTER FABRIC OVER STONE o \ TOP FOUND. EL. 33.4 MINIMUM 5' OF COVER V 2% SLOPE REQUIRED OVER SYSTEM 38.0'-39.0' out& 6 2 e WATERTEST D BOX FOR LEVELNESS PRECAST RISERS PRECAST H-10 MIN. 2" BLOCKS OR WALL THICKNESS RISERS (TYP.) 4"OSCH40 PVC MORTAR ALL v ��e 31 .0 PIPES LEVEL 1ST 2' 4' COMPONENTS INVERT IN 35.17 4' LOCUS ,.: m �ENDS (NP') SIDES 36.0' • .• .0000°o° O/I/ 10" EXISTING 1 0 ®®®® ®®®® ®®®®- ®®® ;0000°°°° ° 0000 TEE SEPTIC TANK 6" MIN. SUMP ° o ®®��®®�®®®® ®®®®0®�®®®® o�o�o�o� `> ## T E .6 * Q °p�o�o°o'o�o °ooa°o°o O O a 0000. 0 0. 12" MIN. INT. DIM. n ...0000° ®�®�®®®®®®® ®®®®®®��®�� °o° 0000 O J W >00000000 ®�®®®®�0 •00000000 , cD GAS FFLE a o 35.44' 35.27' > ° ° ° 0000°o°0 33.17 y Q ° 0000°° j co >r: H-10 500 GAL. LEACHING CHAMBERS BY ACME PRECAST OR EQUAL. + ' 3/4"-1-1/2" DOUBLE WASHED STONE 4' MIN. (3) UNITS REQUIRED ALL AROUND PRECAST STRUCTURES 6" CRUSHED STONE OR MECHANICAL OVERALL DIMENSIONS TO OUTSIDE OF STONE: 33.50, X 12.83, COMPACTION. (15.221 [2]) Route 6 ( 2 % SLOPE) ( 1 % SLOPE) FOUNDATION- EXIST. SEPTIC TANK 9' PUMP 87' D' BOX 12' LEACHING CHAMBER FACILITY LOCUS MAP 19.5' BOTTOM TH-1 SCALE 1"=2000'± **INSTALLER SHALL CONFIRM MINIMUM NO GROUNDWATER FOUND *THE INSTALLER SHALL VERIFY THE SEPTIC TANK SIZE AT 1000 GALLONS ASSESSORS MAP 317 PARCEL 90 LOCATIONS OF ALL UTILITIES AND ALL AND ITS SUITABILITY FOR RE-USE. BUILDING SEWER OUTLETS AND REPLACE WITH 1500 GALLON SEPTIC ELEVATIONS PRIOR TO INSTALLING ANY TANK APPROPRIATE TO SITE PORTION OF SEPTIC SYSTEM CONDITIONS IF NOT SUITABLE PROP. WATERTIGHT COVER TO GRADE SYSTEM DESIGN. LEGEND ALARM AND CONTROL PANEL NOTES TO BE INSTALLED INSIDE PROVIDE QUICK DISCONNECT FOR PUMP GARBAGE DISPOSER IS NOT ALLOWED BUILDING. ALARM TO BE ON 1. DATUM IS NAV 99- EXISTING CONTOUR SEPARATE CIRCUIT FROM PUMP EXISTING 3 BEDROOM DWELLING 2. MUNICIPAL WATER IS EXISTING X 99• EXIST. SPOT ELEV. 33.0' DESIGN FLOW: 3 BEDROOMS ® 110 GPD = 330 GPD 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. -[99]- PROPOSED CONTOUR '<�!���%��� %yi�y���/may%��y ; ��;%;��;��;%�;;,;/,// USE A 330 GPD DESIGN FLOW 4. DESIGN LOADING FOR ALL PROPOSED PRECAST UNITS 198 4 NO LOW POINTS TO BE AASHO H-110 ] PROPOSED SPOT EL. INV. IN 29.42' SEPTIC TANK: 330 GPD (2) = 660 TH1 1000 GAL. H-10 S/ 2" PRESSURE LINE ** RE-USE EXISTING 1000 GAL. SEPTIC TANK 5. PIPE JOINTS TO BE MADE WATERTIGHT. TEST HOLE ALARM ON 500 GAL.+ SLOPE TO DRAIN BACK TO PC RESERVE ADD 1000 GAL. H-10 PUMP CHAMBER 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH FLOAT SWITCH 0.25" WEEP HOLES 310 CMR 15.000 (TITLE 5.) 2% - SLOPE OF GROUND SETTINGS: PUMP ON CHECK VALVE LEACHING: 8" 7. THIS 'PLAN IS FOR PROPOSED WORK ONLY AND NOT TO UTILITY POLE 4" WORKING RANGE MYERS SRM 4 SIDES: 2(33.5 + 12.83) 2 (.74) = 137 GPD BE USED FOR LOT LINE STAKING OR ANY OTHER PUMP OFF 8" SYSTEM SUBMERSIBLE 4/10 EQUAL) P PUMP PURPOSE. _ " PVC. Y FIRE HYDRANT BOTTOM 33.5 x 12.83 (.74) = 318 GPD 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" C NOTE NOT ALL SYMBOLS MAY APPEAR IN DRAWING 000 00000o TOTAL: 615 S.F. 455 GPD 000000 0000 0 0 0000 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED PUMP C HAM B E R ( ) ( ) WITHOUT INSPECTION BY BOARD OF HEALTH AND USE 3 500 GAL. LEACHING CHAMBERS ACME OR EQUAL PERMISSION OBTAINED FROM BOARD OF HEALTH. (NOT TO SCALE) WITH 4' STONE ALL AROUND 10. CONTRACTOR SHALL BE RESPONSIBLE FOR CALLING WATERPROOF/WATERTIGHT DIGSAFE (1-888-344-7233) AND VERIFYING THE LOCATION OF ALL UNDERGROUND & OVERHEAD UTILITIES - PRIOR TO COMMENCEMENT OF WORK. 11. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL BE REMOVED BENEATH AND 5' AROUND THE PROPOSED LEACHING FACILITY. 12. SHALL BE PUMPED 24 RpU�'E ` \ EMOVEDING R PUMP DGA DCILITY FILLED WITH CLEAN SAND.ND .q 13. INSTALLER TO VERIFY THE ELECTRICAL SYSTEM g 02, IS SUITABLE FOR PUMP CONNECTION. ELECTRICAL PERMIT REQUIRED. 25 23 / D Al E 1 ASEMEN �,Tso 22 '�,so 1 � Q LOT 202B 42,969± S.F. C) 22 CO 23 25 24 TEST HOLE LOGS 27\ 28 ENGINEER: DANIEL E. GONSALVES, SE #13587 2-9WITNESS: DON DESMARAIS, RS (BARNSTABLE) UNSUITABLE SOIL I - - - - - - DATE: 8/14/17 yo I PERC. RATE _ < 2 MIN/INCH I GRAVEL CLASS I SOILS P# 15450 I PARKING I ELEV. ELEV. ELEV. 0" 36.0' 0" 39.0' 38.0' A A A DLO LS SL ESL GA PAVED 1OYR 3/2 1OYR 3/2 1OYR 3/2 3 DRIVE 10 14" 12" �2 - B B B 2 �a �. LS SL �SL J di nt CA // // �j J 1OYR 5/6 10YR 5/6 35.5' �. 10YR 5/6 34.3' 0 30 33.5 42 44 C C J EXISTING PORCH SL SQ1 0," S 1 �( DWELLING / / / TOF = 33.4 Z 132" 1�R 5/4 25.0' 138" 2.5Y 6/4 27.5' 132" 2.5Y 6/4 27.0' �J 32 C2 SIEVE C2 C2 /S i L FS FS 210' 0 2.5Y 5/3 2.5Y 7/4 2.5Y 7/4 o > O 193" 19.5' 186" 1 1 23.5' 186" 1 1 22.5' DECK BENCHMARK TOP OF WALL , ' NO GROUNDWATER ENCOUNTERED EL. = 33.8' / ANTINGS ,3s of TH1 36 7 37 38 TITLE 5 SITE PLAN H3 OF 3 1 � O H ,� 3735 ROUTE 6A BARNSTABLE, MA 40 6� �2 PREPARED FOR 5' REMOVAL OF NSUITABLE S L 43 REQUIRED A UND PERIMETE 0 CAPE COD SEPTIC/ LEACHING AGILITY, DO SUITABLE 45 _ SOIL L R. REPLAC WITH CLEAN SAND, 0 MEET S CIFICATI 310 55(3) 46r_� MAHER 44 SHED DATE: APRIL 24, 2018 Scale: 1"= 20' 100. 0 10 20 30 40 50 FEET 43� RR� OF RngSs a tN OF 9 off 508-362-4541 9�5� oc DANIELA. cti% fax 508-362-9880 DANlEL s� � OJALA N� I downcape.com A. + o , OJALA Cn CIVIL "' • • No.40980 ��N No.46502 down cape Lp blee�bng, /nC. { cs F 01STE ��� civil engineers gI'DSUR � ONAL land surveyors 939 Main Street ( Rte 6A) DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02575 DICE # 17-241 17-241 BORTOLOTTI_DREIER.DWG