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3845 MAIN ST./RTE 6A(BARN.) - Health
�S45 Ntaln Street A=335-008-001 ---= ► Barnstable N 1 e - 8 TOWN OF BARNSTABLE 52OCATION 3845 Ric GA SEWAGE# 201`1 ' 38SI VILLAGE ASSESSOR'S MAP&PARCEL33S- $-01 INSTALLER'S NAME&PHONE NO. Q+-q EXCrayb.A i o rs 4` J-OGS 3 SEPTIC TANK CAPACITY 1000 LEACHING FACILITY:(type) &OOya.) L)c. (2) (size) 13 x Z SA 2 NO.OF BEDROOMS 3 OWNER EUER14ART PERMIT DATE: )/- J - J!2 COMPLIANCE DATE: J . )0 - Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet .Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet'of leaching facility) Feet FURNISHED BY Al - ' 3`7 l o 3a' 4 2 83- y9 6 C3, 38`L4 64- Sy'L q C4- .t3 c No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS application for Misposal *pstrm Construction Permit Application for a Permit to Construct( ) Repair(J�Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.3114,5 R41_- 6 A $a rf% Owner's Name,Address,and Tel.No. Erla-RNART M-ULS} Assessor's Map/Parcel cv�&4 , Installer's Name,Address,and Tel.No..04,L3 EXCa► *N,-0 A Designer's Name,Address,and Tel.No. �ja.l+ct�y EwJVJ/'G/Y�Cn'�a� )q Tc-,5crry L►J Foresddo.lc 1417-OGS3 Type of Building: Dwelling No.of Bedrooms Lot Size '7 2 r ZG3 sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) .�330 gpd Design flow provided 34$ gpd Plan Date 10)31 1 1*1 Number of sheets Z Revision Date T Title Size of Septic Tank A 000 Type of S.A.S. S009cp.l L�Cr Description of Soil Nature of Repairs or Alterations(Answer when applicable) -0 43OX - ZZ-SOOgc�j LI 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. , Sled -Ij Date - - Application Approved by Date I. Application Disapproved by Date for the following reasons Permit No. U-01 f Date Issued No: Fee THE COMMONWEALTH OF MASSACHUSETTS yntered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZIPPfltatlon for VsOosal *pstrm Construttion 3permit` Application for a Permit to Construct( ) Repair(t�Up�e( ) Abandon( ) ❑Complete System ❑Individual Components t jj Location Address or Lot No.3B 1).5 Ri c &A 2a r n Owner's Name,Address,and Tel.No. 6t/ERNA RT Tr U.5 + 'f Assessor's Map/Parcel '' Gd IN Installer's Name,Address,and Tel.No. (� . (3 Ex C-M vaA;O A Desi ner's Name,Address,and Tel.No. 1y Tc�ScrrH LrJ F0res4o(alt 14')7 - 0G5-3 Type of Building: Dwelling No.of Bedrooms 3 Lot Size 'd 2 r 2 G3 sq.ft. Garbage Grinder( ) - . Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) .3 30 gpd Design flow provided .3 y8 gpd Plan Date /O,31 1 1-1 Number of sheets Z Revision Date Title Size of Septic Tank 1000 Type of S.A.S. Soo q a l L Description of Soil Nature of Repairs or Alterations(Answer when applicable) _D BOA LICG 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 \ 3, Compliance has been issued by this Board of Health. Si Date 'r- Application Approved by Date '" 1 Application Disapproved by Date for the following reasons Permit No. t 01 f. Date Issued r 1 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS tertif tate of Compliante THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(,/j Upgraded( ) Abandoned( )by {3 X(Z Q V<a t 0✓\ Vat 3$y S i c 48 . ,S' S'� °a has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. `�°(�"38 dated Installer Q Ex A I oN DesignerJ1-oI�c r{a Er,)L/M Rory)IEA�T A L_ #bedrooms .3 Approved design flow gpd The issuance of this pe it sha 1 not-he construed as a guarantee that the syste will fimcti de ign d. Date j ' Inspector -- -- ---- -- - --- - -- - ------------ ----------- ----- -- - - - -- -- - - - - - - - -- .y� - --------------- No. 3 / - Fee wC� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS �is�osaY �pstem �Construttion hermit Permission is.hereby granted to Construct( ) Repair( L,-f Upgrade( ) Abandon( ) System located at ,�a q.�7 Ri A e-- /r4 and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with f' Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three ears of the date of this permit. c P Y P Date ! Approved by l Town of Barnstable Regulatory Services Richard-V. Scali,Interim Director MRIWABIA .� .16 9. Public.Health Division Thomas McKean,Director 200 Main Street,.Hyannis,MA 02601 ., Office: 508-862-4644 Fax: 5.08-790-6304 Installer& Designer Certification Form Date: . 11-3- 19 Sewage Permit# 2oln 3gs7 Assessor's Map\Parce133S %-01 Designer: 1, yc F'lal.�t41c.1 Installer:; B j-B EXCCLVCA i0V Address: Q O. BOX 81 Address: 1q -ic-v�Scct-y Ltd On t 1.! - 1 Q £xCc%0o.Ai 0,1\ was issued a permit to install a (date) (installer) septic system at 69g9 Rie G A Barr%simb1-e based on a design drawn by (address) Ve 10,-,Cr t4 dated i 0- 31 - In .(designer) ✓ I.certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was 'inspected and the soils were found satisfactory. -,I certify that the septic system referenced above.was installed with major changes (i.e. greater,than 10' lateral relocation of the.SAS or any vertical relocation of any component of the septic system) but in accordance with State&Local Regulations. Plan revision or certified as-built by designer to follow. Strip out (if required)was inspected:and the soils were foun&satisfactory. I certify that'the.system referenced above was constructed in,com_pliance with the terms of the ICA approval letters(if applicable) ar t#AVID " D4 ( taller s Signa . ) 0 �fiC/S'FE��i (Designer s.Si ature) (Affix Designers"Stamp Here) PLEASE RETURN TOT,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. QASeptic\Designer Certification Form Rev 8-14-13.doc of I Town of Barnstable P# l 5 G D (o Department of Regulatory Services : ,,,�„�,��,� a Public Health Division -Date o + Mass.� ��p rmjp 200 Main Street;Hyannis MA 02601 �',• �D 6 Date Scheduled Time , Fee Pd. D P d ' Soil,Suitabili Assessment for Sewage isposal Performed•By: �L/ Witnessed By; lr LOCATION&.GENERAL INFORMA IONS Location Address 3F4tS_ "_ 6/0 Owner's Name &45(�T�L�f . / v'7 Address Assessor's Map/Parcel: Engineer's Name pfivI b / NEW CONSTRUCTION REPAIR - Telephone#T7"p q 1144 �.- Land Use Slopes(96) Surface Stones Distances from: Open Water Body�IVV ft Possible Wet•Area (.vim ft Drinking Water Well �` ft Drainage Way / ]-6 ft Property Line ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pere tests,locate wetlands in proximity to holes) 'r �f �l f nn f / Parent material '^ Uv � l VVl (geologic) ' Depth to Bedrock Depth to GroundwaterStanding Water in Hole:_ Weeping fran Pit FnCa Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL•HIGI1 WATER TABLE Method Used: Depth Observed standing in obs..hole: ln. Depth to soil mottles in.' Depth to weeping from side of obs.hole: _ _ in, Groundwater Adjustment ft. Index Well-#- Rending Datc: Index Well level Y� Adj,factor, , Adj.Groundwater Level,, PERCOLATION TEST Observation .. Hole# swc Y Time at 4"Depth of Pero S�J Time at 6" Start Pre-soak Time @ ( itft D(9"•6") Had Pro-soak Rate Miu./Inch . Site Suitability Assessment: Site Passed 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. Barnstable Conservation Division at least one (1) week prior to beginning. Q:ISEPTI0PBRCFORM.DOC ' DEEP-OBSERVATION HOLE LOG Hole# Depth from Soli Horizon Soil Texture Shcl Color Soil• 4—tb-, Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistency,%Uravcl) O A • .4 -2� 0 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil' I . Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones Boulders Consistency, S rZI& 1 C r- Cf C DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(to.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.. Consistency. DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Sall Other Surface(In.) + (USDA) (Munsell) Mottling (Structure,Stones'.Boulders, Consistency. Mood Insurance Rate Man: Above 500 year flood boundary No-.� Yes Within 500 year boundary No; Yes Within 100 year flood boundary No. Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring per ous material?,._._.� Certification /� �' I certify that on I U (date)I have passed the soil evaluator examination approved by the Department of En iro ental Protection and that the above analysis was performed by me consistent with . the required tra ng,experd ex erirnce described in 10 CMR 15.017. Signature 7e Date, Q-.\S.EPTIC\PBriCPORM.DOC S j G dnw+%o engineering, Inc. SIEVE SOILS'ANALYSIS$$45 ROUTE.6A BARNSTABL,E,MA - E i4TE F-REP T, 1 d/2"6l17 i + � 'RAIN SIZE ANALYSIS-SIEVE TEST` TeE: 384S ROVTE 6A, BAR -A I B&;B Ex. A. A fl,N TEST"HOLE 3 I i 't i A18YE ANAMI We htSampt .pl. SIT 'WE:IGHT DETAINED %.RETAIN ED pJo PASSElD -- (sum t 11 y 11211- --I O.. - _ -0 0% O - 000�. #10 % 74.'$ o i __ , -- - r41�3 J ._._._._ 50.7 n 106 6 69 vx #zao FAN }. 14��s � . ..� 97 4% _ -*---- ? °ln ---r 15C10' 100 0% O O°Cn I , N.OTE.TES`f ON RASSI.NG#4 ONLY; 0:0% R>=TAIN.EI7'ON#4<4 °16.:O.K.. i SI31L�LASSlFIER AS AASHTO A,.(FINE SAND)(;UNC©IVIPACTED) P DENTAGE OP MATERIAL PASSING# SII✓VE 04 O1VI_Y IV.08 IAL PASSIN,44); O:IC SAMP1yE:ItIIEETS TITLE'S FILL SPE�IFICATI4�IV '/n SAND ` Q o O GALA RESULTS;: PERMEABLE MATE CLASS I<2IIfIIN 11N. MATERIAL �' CIVIL NON...COMPf CTEI . ° �ici.46U2: .. 4011.DESCRIPTION,; FINE SANDQ . c � � Ina f m �. • co m ' Q" Certified Mail Fee �w Er Extra SeMces&Fees(check box,add fee as appropdate)d4 F'j0 P ❑Return Receipt(hardcopy) $ p \ G3 C3 ❑Return Receipt(electronic) $— Ryostmark`*t r3 []Certified Mail Restricted Delivery $ C:) ❑Adult Signature Required $ ❑Adult Signature Restricted Delivery$ Postage aTotal Postage and Fees EVERHARZ, BARBARA TR Ln Sent To { C/O FRANK R JEROME ' StieetandApt No.,orP06 375 LEFEVER HILL ROAD- ------------------------- CHESWICK, PA 15024 City,State,ZIP+4� k :11 1 Certified Mail service provides the following benefits: ■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 T1 delivery. USPS®-postmarked Certified Mail receipt to theta ■A record of delivery(including the recipients retail associate. r I signature)that is retained by the Postal Service- Restricted delivery service,which provides rl for a specified period. delivery to the addressee specified by name,or to the addressee's authorized agent Important Reminders. Adult signature service,which requires the `L ■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 notavailable for requires the signee to be at least 21 years of age International mail. and provides delivery to the addressee specked ■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 a7 certain Priority Mail items. USPS postmark If you would like a postmark on 7 I ro For an additional fee,and with a proper this Certified-Mail receipt,please present your fi endorsement on the mailpiece,you may request Certified Mail item at a Post Office-for , the following services: postmarking.fi you don't need a postmark on this -Return receipt service,which provides a record Certified Mail receipt,detach the batcoded portion:.1 of delivery(including the recipient's signature). of this label,affix it to the mailpiece,apply to You can request a hardcopy return receipt or an appropriate postage,and deposit the mailpiece.U� electronic version.For a hardcopy return receipt, i complete PS Form 3811,Domestic Refum Receipt;attach PS Form 3811 to your mailpiece; IMPORTANT:Save this receipt for your records. Ps Form 3800,April 2015(Reverse)PSN 7530.02-000-9047 • • • • • • . ' 79Complete items 1,2,and 3. A. Signatureint your name and address on the reverse X gent that we can return the card to you. ❑ ddressee ttach this card to the back of the mailpiece, B. Received by(Printed Name) C. Date of livery -711117 on the front if space permits. 1. Article Addressed to: _ D. Is delivery address different from Rem 1? Y s I3. '" If YES,enter delivery address below: ❑No MEW . 375L'1I VI R H[> '4? OALI1 L^ ClIESWICK, PA 15-024 -: II I IIiIII IIII III I II II I I IT Illr�III)I I i III I I 3. Service Type ❑Priority Mail Express® ❑Adult Signature El Registered MailTm ❑Adult Signature Restricted Delivery ❑Registered Mail Restricted 9590 9402 1933 6123 1795 04 �ertified Mail® Delivery ❑Certified Mail Restricted Delivery �Retum Receipt fdr' ❑Collect on Delivery // Merchandise 2-_Article_Numher_Cfransfer from_serwce label) - ❑Collect on Delivery Restricted Delivery ❑Signature Confinnatlon�_ r 7 015 17 3 0 3 D D 01 4 9 9 0 3 7$3 it ❑Signature Confirmation i :{ , 'I Restricted Delivery Restricted Delivery .:- PS Form 3811,July 2015 PSN 7530-02-000-9053 7Domes4ic Return;Receipt 1I USPS TRACKING# First-Class Mail Postage&Fees Paid USPS Pe mi No.G-10 I ! 9590 9402 1933 6123 1795 04 I United States •Sender-Please print your name,address,and ZIP+4®in this bo>4 ! Postal Service ! 0s, Town of Barnstable I Health Division 200 Main Street I Hyannis,MA 02601 I ( illx'!}!1'ljfill��9�111�iir,��il,yll�lltillt�llli�l�ll}�ifiitlltlif Town of Barnstable Brnslable Regulatory Services Department WAms 11caCRY BAMSrASM 0. ,0 Public Health Division °AAA�A 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4990 3783 September 6, 2017 EVERHART, BARBARA TR C/O FRANK R JEROME 375 LEFEVER HILL ROAD CHESWICK, PA 15024 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 3845 Main Street/Route 6A, Barnstable, MA was inspected on 08/22/2017 by Joseph M Martins, 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 15.00) due to the following: • Leaching facility with standing liquid level at or above the invert pipe (per Town Code 360-20h.) Garbage disposal must be removed with permit. 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 B ARD OF HEALTH .h as. cKea ,�/ 0 /�Zp Agent of the Board of Health QASEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Lettersl3845 Main Street Rte 6A Bamstable.doc Town of Barnstable ,AItHSTAHLE, , 6¢ Regulatory Services Department Public Health Division . 200 Main Street Hyannis MA-02. t,H y 601 Office: 508-862-4644 Richard Sca%Director 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) _ An"x"marked in the o is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑Discharge or ondin of effluent to the surface of the ground g P g � w ❑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 CRITERIA q Single Cesspool. ❑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 liquidlevel,<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: WSEPTIMDEADLINES TO REPAIR FAILED SYSTEMS.doc CR Commonwealth of Massachusetts O _pp/ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 3845 Main St Rte 6A Barnstable MA ' Property Address �,wt Barbara Everhart TR c/o Frank R Jerome 375 Lefever Hill Road Owner Owner's Name information is required for every Cheswick PA 15024 8/22/2017•j!� page. Cityrrown State Zip Code Date of Inspection 66 1-4 Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor-do not Joseph M Martins use the return Name of Inspector key. Sepcheck Comp � Company Name 17 Northside Dr Company Address South Dennis MA 02660 City/Town State Zip Code 508-385-5891 SI 147 Telephone Number License Number 0 arc-0-1 o , �S�s 'r�Pd 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. 1 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 8/28/2017 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. , , ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 �o VS Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 3845 Main St Rte 6A Barnstable MA Property Address Barbara Everhart TR c/o Frank R Jerome 375 Lefever Hill Road Owner Owner's Name information is required for every Cheswick PA 15024 8/22/2017 page. 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: ❑ I have not found any information which indicates that any of the failure crit is described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not aluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components a escribed in the"Conditional Pass"section need to be replaced or repaired. The system, pon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or" t determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal an ver 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substan al infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing nk is replaced with a complying septic tank as approved by the Board of Health. *A metal septic to will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indic ing that the tank is less than 20 years old is available. ❑ Y N ❑ ND(Explain below): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 3845 Main St Rte 6A Barnstable MA Property Address Barbara Everhart TR c/o Frank R Jerome 375 Lefever Hill Road Owner Owner's Name information is required for every Cheswick PA 15024 8/22/2017 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high/neend in the di ribution box due to broken or obstructed pipe(s)or due to a broken, istri tion box. System will pass inspection if(with approval of Board of Health ❑ broken pipe(s)are replaced ❑ D (Explain below): ❑ obstruction is removed ❑ ND (Explain below): distribution box is leveled or replaced ❑ ND (Explain below): ❑ The system required pumping mor than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(wi approval of the Board of Health): ❑ broken pipe(s)are re aced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is rem ed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ` ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 3845 Main St Rte 6A Barnstable MA Property Address Barbara Everhart TR c/o Frank R Jerome 375 Lefever Hill Road Owner Owner's Name information is required for every Cheswick PA 15024 8/22/2017 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public he th, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the S 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 Zon of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less t n 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, perfor ed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure riteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 4 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 3845 Main St Rte 6A Barnstable MA Property Address Barbara Everhart TR c/o Frank R Jerome 375 Lefever Hill Road Owner Owner's Name information is Cheswick PA 15024 8/22/2017 required for every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be . necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"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. l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 3845 Main St Rte 6A Barnstable MA Property Address Barbara Everhart TR c/o Frank R Jerome 375 Lefever Hill Road Owner Owner's Name information is required for every Cheswick PA 15024 8/22/2017 page. Cityrrown State Zip Code Date of Inspection C. Checklist . Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for sig�Zfbkut? ® ❑ Were all system componentse SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ❑ ® Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 2 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 4 M , 3845 Main St Rte 6A Barnstable `MA Property Address Barbara Everhart TR c/o Frank R Jerome 375 Lefever Hill Road Owner Owner's Name information is required for every Cheswick PA 15024 8/22/2017 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: 1000 GALLON SEPTIC TANK, DISTRIBUTION BOX, 6x6' PIT W STONE Number of current residents: 0 Does residence have a garbage grinder? ® Yes ❑ No Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 64 9 ( Y 9 (gP ))� Detail: 2015: 27,000 G 2016: 20,000 G; Sump pump? ❑ Yes ® No Last date of occupancy: 2016 Date Commercial/Industrial Flow Conditions: Type of Establishment: N/A 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: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 3845 Main St Rte 6A Barnstable MA Property Address Barbara Everhart TR c/o Frank R Jerome 375 Lefever Hill Road Owner Owner's Name information is required for every Cheswick PA 15024 8/22/2017 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: PER BARNSTABLE WWTP: NO HISTORY OF PUMPING 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 j ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 3845 Main St Rte 6A Barnstable MA Property Address Barbara Everhart TR c/o Frank R Jerome 375 Lefever Hill Road Owner Owner's Name information is required for every Cheswick PA 15024 8/22/2017 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 37 YEARS. INSTALLED IN 1980 PER BARNSTABLE HEALTH DEPT. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2_3 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: >10feet Comments (on condition of joints, venting, evidence of leakage, etc.): FLUSH TESTED NO LEAKS Septic Tank(locate on site plan): Depth below grade: 1 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: APP 8.5 X6X5 1000 G Sludge depth: 7" t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 3845 Main St Rte 6A Barnstable MA Property Address Barbara Everhart TR c/o Frank R Jerome 375 Lefever Hill Road Owner Owner's Name information is required for every Cheswick PA 15024 8/22/2017 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 27 Scum thickness 0" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? CORETAKER Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): HAS NO OUTLET TEE. HAS CONCRETE INLET TEE. LIQUID LEVEL IS 48"AT OUTLET INVERT. NO EVIDENCE OF LEAKAGE. OUTLET SANITARY TEE WAS INSTALLED BY INSPECTOR. APARTMENT(1 BR) HAS SEWAGE EJECTOR PUMP CONNECTED TO INLET PIPE OF THIS SEPTIC TANK. 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 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 3845 Main St Rte 6A Barnstable MA Property Address Barbara Everhart TR c/o Frank R Jerome 375 Lefever Hill Road Owner Owner's Name information is required for every Cheswick PA 15024 8/22/2017 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: N/A Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments , 3845 Main St Rte 6A Barnstable MA Property Address Barbara Everhart TR c/o Frank R Jerome 375 Lefever Hill Road Owner Owner's Name information is required for every Cheswick. PA 15024 8/22/2017 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert AT INVERT Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): DBOX IS DETERIORATED AND NEEDS TO BE REPLACED 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.): N/A * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments wM 3845 Main St Rte 6A Barnstable MA Property Address Barbara Everhart TR c/o Frank R Jerome 375 Lefever Hill Road Owner Owner's Name information is required for every Cheswick PA 15024 8/22/2017 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 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.): LEACH PIT IS UNDER DRIVEWAY BY 1.5'. EXPOSED COVER. H-20 CONSTRUCTION,.HEAVY STAINING AT T ABOVE PIT BOTTOM W VARYING STAIN LINES AND SCUM OBSERVED OVER INCOMING PIPE TO LEACH PIT. ROOTS OBSERVED COMING IN THRU OPENINGS. FERRIC SULFIDE STAINING OBSERVED AT COVER LEACH PIT TOP INTERFACE. LIQUID LEVEL WAS 2"WITH LOTS OF BLACK SOIL AT BOTTOM OF LEACH PIT. SOLIDS AND STAINING ARE INDICATIONS OF HYDRUALIC FAILURE OR OVERLOAD . SYSTEM HAS HAD AN EXTENSIVE PERIOD OF NON USE. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration N/A Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ;M 3845 Main St Rte 6A Barnstable MA Property Address Barbara Everhart TR c/o Frank R Jerome 375 Lefever Hill Road Owner Owner's Name information is required for every Cheswick PA 15024 8/22/2017 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: N/A Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Y , CommonweaNii of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 3845 Main St Rte 8A Barnstable MA Property Address Barbara EverhartTR c%o Frank R Jerome 375 Lefever Hill Road. Owner Owner's(dame information isCheswick PA 15024 8/22/2017 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks- Locate all wells within 100 feet Locate where public water supply enters the building.Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately AIA r • 1 S FAAJ 1n/ r a /sous �� �32-' 8 2 ` 2 3 J. C3 Nrts t5ins-3113 Title 5 Of cal ftqxKb=Form:subsatace sewage omposat Systen-Page 15 of 17 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 3845 Main St Rte 6A Barnstable MA Property Address Barbara Everhart TR c/o Frank R Jerome 375 Lefever Hill Road Owner Owner's Name information is required for every Cheswick PA 15024 8/22/2017 page. Citylrown 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: 16 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: TOWN ASSESSING MAP DATABASE ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: TOPO MAPS , FRIMPTER, CCC GROUNDWATER CONTOUR MAP You must describe how you established the high ground water elevation: SAS SITE IS 36'ASL W GWATER CONTOUR AT 16'ASL. GRADE TO SAS BOTTOM IS 8.5'. ESTIMATED RISE FOR A1W247B IS <=4'. SEPARATION MATH: 36-(16+8.5+4)=7.5 Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments G M s 3845 Main St Rte 6A Barnstable MA Property Address Barbara Everhart TR c/o Frank R Jerome 375 Lefever Hill Road Owner Owner's Name information is required for every Cheswick PA 15024 8/22/2017 page. CitylTown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file I t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 TOWN OF BARNSTABLE p ?_OCAno �� , e SEWAGE # CF VIL LAG E2�i1/�S���l ASSESSOR'S MAP LOT 1 INSTALLER'S NAME & PHONE NO. �t • �. i SEPTIC TANK CAPACITY LEACHING FACILITY:(type) c� (size) t�C-400 GZt O NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER70WSK BUILDER OR OWNER DATE PERMIT ISSUED: g DATE. COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No w� �_ _ � . d lP r F _�s � V'1r 1 L s r r 1 r _ s No........... ..-....... 0 -� _ Fps.. .. ................. U o THE COMMONWE!AL'1 W'f F MASSACHUSETTS 3 BOAR®- OF HEALTH R .... 01 / /. oF............. jib irFatiun for Uhipoii al Workii Tunitrurtiun ramit $` Application is hereby made for a Permit to Construct (><) or Repair ( } an Individual Sewage Disposal Sysat: --- ---••--•----•------•................... ....•..._......................--••- ..................................................... Gr�_.z,_ . . G 1. ation-Address or I.ot No. .....0� !.. --------- -� —.. i !r!S.T.. �.�z........................ ... % n,- Address ............ ✓........ - ---------------------------------- ----•••---••----------•-••-•-----•---•-•-•-.........•-----•--••----••-............................ � nstalle Address Type of uilding Size Lot./1-4. .0......Sq. feet U Dwelling—No. of Bedrooms....... .............................Expansion Attic ( ) Garbage Grinder ( )�.. ........ aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures _________________________________ d --•-------------------------------•---•-•----•----- -------------••---.............. I,�EDi2�GiN-. . - - W Design Flow.......;: /..0............................gallons per..per-wn per day. Total daily flow............Z.Z..°.........._...._...gallons. WSeptic Tank—Liquid capacity/QA,12..gallons Length Width.'¢7- 'Diameter-----------_--- Depth...��_ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------I----------- Diameter../Q..A.r.. Depth below inlet_.. •L r... Total leaching area..Zl.7...sq. ft. Z Other Distribution box (X) Dosing tank ( ) � � / `-' Percolation Test Results`. Performed by--- 1...... ... - Depth to Date_. Ovat ........................ o9 ,a� Test Pit No. L___C .__minutes per inch Depth of Test Pit....?J�____ p ground 44 Test Pit No. 2__G_z-....minutes per inch Depth of Test Pit..;11e .... Depth to ground water........................ a --- ------------- D Description of Soil_Q.---�� ...... dA/� ---6.. �w y--SU1�SD/C .. �f......................................... , . .�/ -----7'....-4.O.V eZSA.....--��'`'��......=.......�Z. .... _a......eQ-�-Mi..... 1 W .��u..._.__.1�f ... �° FlNFs__....rr9?CP....... -----.fly"- .E5.--••-•-----•-•---------------------------•......------..... UNature of Repairs or Alterations—Answer when applicable._................ ............................................................................. ------ ------------------------•--....----•-------•----•--•--------...-----•...__.._..••-••--•-----------•--------------------••--•-------•---•-----•------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT1Z 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Sigd---- ................................................. Date Application Approved -By.- 2` . . 1�� �Gf 1��f" ....... Date Application Disapproved for the following reasons:................................................................................................................ ......................................................................................................................................................................................................... Date PermitNo........................................................... Issued........................................................ Rge THE COMMONWEALTH OF MASSACHUSETTS - BOARD OF EALTH 41 :.a ..............OF........... ... . ..... ............................................. Tgrtifiratr of Tu pliatta TH lCERTI Yhat e Individual Sewage Disposal System constructed (� Repaired ( ) by...... --------------- ` - �alr 1 at.. z -•�- - -Cam•-=-----��-- - •• - ---has been installed in accordance with the provisions of T5 6f The State Sanitary Code as described in the application for Disposal Works Construction Permit No.. .._.Z14--__.._----- dated---------�e9:n ,........ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... 1 No............... ...... Fim$.............................. THE COMMONWEALTH-_-OF MASSACHUSETTS BOARD OF HEALTH - 1 /N......OF........... A .............. Appliration for Disposal Works Tonotrurtinn ramit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System ma�at: •-- ... •.................•..........._....... -••••..........------•.. ..............................t - ........_..........-•----•---• ...... _--.... Locaf )Address Lot No. . .1..�l..Gtf�9..lz Q?_...---•----s...�GI�Y.ri/_.�'�t!�2..f.�'�:�._ ..,e��!T..��-------------�.�"�../Z!�/�S..T��.�..�......._..------- Owner>;' Address W . Installer A Address Type of Building r Size LotAQ-.-g.D9!e......Sq. feet U Dwelling—No. of Bedrooms............................... .Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building ............... No. of ersons......_..............__._.._ Showers — Cafeteria a yP g ------------- P ( ) ( ) Otherfixtures . F D:2i--'--------------------------------------------------------•---�-j-----.---------------•---------••- W Design Flow............/1.0......................gallons p�r:p sen per day. Total daily flow____-__--_---_-�r g.ls._Q_...............gallons. R; Septic Tank—Liquid'capacity/jO .gallons Length.c9'l74.... Width_A/".. Diameter................ Depth_._.-A ` Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area.._.................sq. ft. Seepage Pit No......../----------- Diameter../a.FT.. Depth below --- Total leaching area....ZG 2..sq. Z Other Distribution box (>l) Dosing t nk (. ) `~ Percolation Test Results Performed by ......... ........................ Date....... as Test Pit No. 1...2X_-minutes per inch Depth of Test Pit... .J ---- Depth to ground water........................ Test Pit No. 2.G_Z...minutes per inch Depth of Test Pit..l '.. Depth to ground water........................ ��.O Description of Soil-•-/' :.. ---�------•-----. ----, -....7ti1_... �`' rl Z-----.-� �._. ��.... a / !` -rl.��..Ff�l!5 -s - U Nature of Repairs or Alterations—Answer when applicable......................................... ..................................................... ---------------....................................................................................................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITIZ' -5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. { Sigd---- ----------------------------------••------- Dat Application Approved By-.*--• ..... �•'i _...---•-----------•--------. ...... `-- a r Date Application Disapproved`f or the following reasons:-------•---------•-------------------------------•------------•----------------••-•-----•- ---•---••-.......-- F ..............................................................................................................................................---.........................._.....-----------............. Date Permit No................. ........................................ Issued....................................................... Ate THE COMMONWEALTH OF MASSACHUSETTS BOARD OF EALTH ! io. .........OF..... .... Tntifiratr of Tomplianrr , :> THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( or Repaired ( ) by --•- ................. taller a ....Al has been in tilled m accordance with the provisions of TI 5 ZThe State Sanitary Code-as d scrib_ the application for Disposal Works Construction Permit iV o.._. ` T '1 dated - . THE ISSUANCE OF THIS CERTIFICATE' SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE ,.SYSTEM>:1AlILL FUNCTION SATISFACTORY. DATE..... .............................................. Inspector..............................................---•-----------•-•.._..-•-••-•-••-••--- 5'f4.1E COMMONWEALTH OF MASSACHUSETTS fi BOARD OF; HEALT .e- a.: ti J OF........... �.fi% �� ................. i `N . Q '1 ..�eJ0 .t•1FEE........................ Y Permission is hereby granted.------ _ ..---- -•............................•- .......... to Construc (. pai ( ) an�Indivl 1 ewage Dis o Y Sys Street as shown on the application for Disposal`. corks Construction Per No Dated---- d� ........ ..... f �) Board of Health DATE........./:- ....It . (/ ------------••-•---- FORM 1255 ,HOBBS & WARREN, INC., PUBLISHERS SOIL TEST INVERT ELEVATIONS NOTES- � DATE OF SOIL TEST 7Z 3 -79 INVERT AT BUILDING 4 4. FT. ALL WORKMANSHIP AND MATERIALS WITNESSED BY—EL' Ll INLET SEPTIC TANK z 66 FT SHALL CONFORM TO D.E.Q.E. TITLE .S PERCOLATION RATE< —MIN. 4d-�~I ,4Us"z_, z- OUTLET SEPTIC TANK 2s2G. � FT AND THE TOWN . OF �r�rr�!�o,��RULES 4 INLET DISTRIBUTION BOX LQFT. AND REGULATIONS FOR SUBS�IRFACE' OBSERVATION HOLE I OBSERVATION HOLE 2 DISPOSAL of SANITARY SEWAGE I ELEVATION = /•� ELE VAT ION= /,?,7 • " OUTLET DISTRIBUTION BOX Z.a-4 FT. 0 INLET LEACHING PIT . /rL_5% 0 FT. «=b�'� 1�! 1�j,• tip; BOTTOM LEACHING PIT FT. - sum •,�,;� DESIGN CALCULATIONS LAi" U> ,' -- ''� NUMBER OF BEDROOMS .. . . . . . . . . . . . . . . . . . . .'. . . . . . . . . "Z = 3 , GARBAGE DISPOSAL UNIT... . 0 Ll - TOTAL ESTIMATED FL0W (.io GAL./BR./DAY x__2_7 BR.).., GAL./DAY C=��a►1; �t'�'�,�� �` '!E-= '" � f ;j REQUIRED SEPTIC TANK CAPACITY. . .. . . . . . . . . . GAL.. ��=►�� . �' �� `. !s r.i r� ��N< ACTUAL SIZE OF SEPTIC TANK TO BE INSTALLED... . GAL. LEACHING AREA REQUIREMENTS SIDE WALL AREA 2-a _GAL./S.F. BOTTOM AREA�2_-6� GAL./S.F. O10� �-`�' ` '� �� LEACHING CAPACITY ( BOTTOM -�-SIDEWALL ). . . . . . . . 4.40-� GAL NTH, i :-%'- �./¢xS,Y~X(7•is_ ./¢x/rJY r C� � _ - 3 77 0 _. RESERVE LEACHING' CAPACITY. . . GAL. I T 0 P OF j FOUND. - I iELEV.= ///.0 iC' CONCRETE 4 SCH. 40 — CLEAN SAND COVERS PVC PIPE CONCRETE MIN, PITCH COVER ' 1/8 PER. FT. - 2% MIN. PITCH ,�o��µ�OFr��w i 12 MAX. ��` /. Z u !'— n i C R1CHAfD yG\ ,JJ` R:CNARD JAM! N 2 LAYER OF I18- 1/ �o JAMSI• { oFiFa�� FLOW LINE WASHED STONE. 1� r aNFARN, ` 1 r �No- z;yJ, • t t No. 67{ I r ' ,� H l 4�� CAST IRON �0Z t_ D 3/4" 11/2�� �G'i;T=` l' �''�; C�5T %�-r PIPE - MIN. PITCH D, 0 LiJ �D WASHED STONE sq,�l � „ _• +�.� I/4 PER FT. DIST. o 4 — F- PRECAST LEACHING f BOX n v °- o o BASIN OR EQUIV. D W lit LL ! -GAL_. n w O , -:'r - ,C� ! MASS .• � SEPTIC •• L..,_—, ' _ c� Dl,d TANK 10� �Iti. �-� M,,.► R. J. O�HEARN, INC., RLS, PS I 1348 ' ROUTE 134 PROFILE OF GROUND WATER TABLE EAST DENN13 , MASS. JOB NO.~9.sz;�g CLIENT. ot-�N 1. +k,�ln►q SEWAGE DISPOSAL SYSTEM Ill I ntnr •rn orA1 c COVERS TO BE WATERTIGHT AND SEPTIC SYSTEM PROFILE' TOP OF FOUNDATION BROUGHT TO WITHIN 6" OF FINAL GRADE (not to scale) Flaherty Environmental Services EL. 60.0 EL. 58.0 r INSP. PORT W I 3 OF GRADE CLEAN SAND P.O. BOX 81 2" of e" to z"•DOUBLE•WASHED Yarmouth Port, MA 02675 PEAS'�ONCOR GEOTEXTILE EL. 54.0 _ , 4" CAST IRON or EQUIVALENT FILTER FABRIC _ 774.994. 1166 MIN. PITCH 1/4" PER FOOT 4 4"SCHEDULE 40 PVC PIPE " SCHEDULE 40 PVC PIPE • s VENT REQUIRED FLOW LINE (first 2'to be level) " 70' 12% _� c .°°° °°° •;� °° EL.48.0' LOCAL UPGRADE APPROVAL: °°°°°° —� ` '•'"' '•• r c°o°o°o MAXIMUM FEASIBLE COMPLIANCE- • ' —�- ® o E= CO o [� o 0000o a 310 CMR 15.405 1 b L.EXISTING 14++ �n •. �•� �][� ( )( ) —�. o00000000°0 0 ®® 0®� 000o0o0oc INCREASE IN MAXIMUM EL.EXIS G L. 55.6' —�' °o°o°o° ° o o°o° 0°0°0°o°c EL.46.83' °o°o° o o°o°o°o° C= o°o°o°o°c COVER OVER SAS o 0 0 0 0 0 0 0 0 0 0 1 EL.47.0' " o 0 0 0 0 0 °°°0°0°CC 2.0 FROM 3'TO 6' GAS BAFFLE EP (H-20 D-BOX) 0 0 0 0 0 0 0 0 o u�® ®� '�'.�® 000000ooe— £L.46.8' 0 0 0 0 0 0 0 0 0 0 0 o c (H-20&VENTED SAS) .' 000000002 0°0°DO '�a •••� '� '0°O°O°00 o 0 0 o EL.44.8' NSTALL INLET TEE SOIL ABSORPTION SYSTEM REQUIRED: ';fig••'• a 6"CRUSHED STONE OR 1"ABOVE OUTLET INVERT 5' REMOVAL OF UNSUITABLE • 1000 GALLON SEPTIC TANK MECHANICALLY COMPACTED (2) 500 GALLON H-20 CHAMBERS ' ► BENEATH SAS TO EL 1O' LATERALLY 90' MATERIAL N (DATUM: ASSUMED) (EXISTING) 3" to 1 " DOUBLE WASHED STONE WITH 4 STONE AROUND IN A — 12.83'X 25'X 2' CONFIGURATION EL. 34.8' �A�N STREETS" r BOTTOM OF TEST HOLE EL. 34.8' LOCATION MAP sa USGS ADJUSTMENT: N/A ROUTE 6A ( _ �g2.66, �+ I GROUNDWATER ELEV: N/A N TH LOT 1 72,263 SFt !` r MAP 335 BENT �. J LOT 8-1 32' TH- TH-2 I c LOCUS 28' "' 100' FROM SAS Route 64 s NIS EXISTING I SR EVE1 �ytN OF ss90 ss DAVI ` D. ' ' F ER J U 58 ! 1 G! TE?- sa C o l /�/' SgNITAR\P a EXISTING BR 2 • t - BENCHMARK: DWELLING DATE.•1 013 1/2 0 1 7 REVISED: TOP OF FNON EL.60.0' PATIO SITE AND SEWAGE PLAN i I FOR B & B EXCAVATION, INC./ - BARBARA EVERHART 3845 ROUTE 6A • SCALE : 1 n 40' BARNSTABLE, MA REF.PB 335 PG 99 PAGE 1 OF2 .......... .................................... . ........... ................................. . ...... ...... ............................................................................. ......................................................................................... .............................. ....................................................................................................... ................................................. ............................................................................................................................................. ........................................................ ................... GENERAL NOTES DESIGN CAL CULA TIONS S YS TEM DETAIL Flaherty Environmental Services P. 0. Box 81 1. ALL PRECAST COMPONENTS TO BE H-1 0 Yarmouth Port, MA 02675 RATED UNLESS OTHERWISE SPECIFIED. NUMBER OFACTUAL BEDROOMS (HOUSE+(1)GARAGE=3 774.994.1166 DISTRIBUTION BOX(ES)AND ANYw' COMPONENTS WITH ANY ANTICIPATED GARBAGE DISPOSAL UNIT NO VEHICULAR TRAFFIC TO BE H-20 RATED. 2. THE DESIGN OF THIS SYSTEM DOES NOT TOTAL ESTIMATED FLOW ALLOW FOR THE USE OFA GARBAGE (110 GALIBRIDA YX 3 BR) 330 GAL./DAY5' REMOVAL GRINDER, REQUIRED SEPTIC TANK CAPACITY 660 GAL. 3. MUNICIPAL WATER IS AVAILABLE. 4. ALL CONSTRUCTION TO CONFORM WITH SIZE OF SEPTIC TANK 1000 GAL. (EXISTING) 310 CMR 15.000 AND ALL OTHER APPLICABLE LOCAL, STATE AND FEDERAL SOIL CLASSIFICATION CODES AND REGULATIONS. 5. INSTALLER/CONTRACTOR TO REVIEW& DESIGN PERCOLATION RATE <2 MIN.11AICH, VERIFY ALL ELEVATIONS AND DETAILS EFFLUENTLOADING RA TE 0.74 GAL./DAY/FTC12,831 AND REPORT ANY DISCREPANCIES TO DESIGNER PRIOR TO CONSTRUCTION OR LEACHINGAREA ASSUME ALL RESPONSIBILITY. (2)x(25.01+ 12.83)(2) = 151SF 6. INSTALLER/CONTRACTOR IS 25.0'x 12.83' =320 SF RESPONSIBLE FOR MAINTAINING SAFE 471 SFx a 74 =348 GPD WORK AREA, VERIFYING ALL UTILITIES AND NOTIFYING "DIG SAFE" USE(2)500 GALLONH-iO CHAMBERS WITH 4'STONE 25' (1-888-344-7233) 72 HOURS PRIOR TO INA 12.83'X25'CONFIGURATIONASDIAGRAMMED- CONSTRUCTION. 7. ANY CHANGES TO OR DEVIATIONS FROM RESERVE LEACHING CAPACITY NIA THIS PLAN MUST BE APPROVED IN WRITING BY FLAHERTY ENVIRONMENTAL SERVICES AND LOCAL BOARD OF HEALTH. 8. FINISH COVER OVER COMPONENTS IS NOT TO EXCEED XPER 310 CMR 15.000 (NTS) UNLESS SHOWN PER PLAN. . 9. ALL ABANDONED SEPTIC SYSTEM COMPONENTS TO BE PUMPED DRY AND SOIL EVALUATION FILLED WITH CLEAN SAND OR REMOVED TESTHOLE#1 F#(Unsuitable Material) TEST HOLE#2 P#15506 AND REPLACED WITH CLEAN SAND. Evaluator: DavidD.Flaherty Jr.,RS,REHS Evaluator.• David D.Flaherty Jr.,RS,REHS SN OF Mq 10.ALL COMPONENTS TO BE PROVIDED SE#2755 SE#2755 BOH Witness Don Desmarais,RS BOH Witness: Don Desmarais,RS WITH WA TER TIGHT ACCESS PORTS Date: Octobers,2017 Date: October25,2017 WITHIN 6"OF FINISH GRADE. c F I 1.ALL SEPTIC TANKS, DISTRIBUTION TH-I ELEV 54.0' TH-1 ELEV.54.0' 2 BOXES AND PIPING TO BE INSTALLED WATERTIGHT. 0"-6" A SL I0YR212 0- 8- A SL 10YR 212 S T F-?- 12.NO KNOWN WETLANDS OR WELLS NiTA i WITHIN 100 FEET OF PROPOSED 6--22- B SL 10YR 414 8--0- 8 SL 10YR 414 LEACHING. 13.THIS IS NOT A CERTIFIED PLOT PLAN AND UNDER NO CIRCUMSTANCES IS THIS PLAN TO BE USED FOR ZONING OR 7 certify that on November 12,2002,l have passed the examination approved by the Department of SITE AND SEWAGE PLAN BUILDING PURPOSES. 28--180- C1 Silt 10YR 615 Environmental Protection and that the above analysis R 14.LOT IS SHOWN AS ASSESSOR'S MAP 335 Clay Loam has been performed by me and with the FO requiredt-Ining expertise and expenencedescribed 1 LOT 8-01 . 22'-120" C Silt 10YR 615 In 310 CMR 15.018(2). B & 8 EXCAVATION, INC. 15.LOCUS PROPERTY IS NOT LOCATED Clay Loam BARBARA EVERHART WITHIN AN AQUIFER PROTECTION EL.39.6' 180--230-�C2 FS 2.5Y614 G.W ELEV.NIA 3845 ROUTE 6A DISTRICT(ZONE II). BOTTOM TH-I ELEV 44.0' G.W.ELEV.NIA BARNSTABLE, MA TH-2ELEV. 34.81 BOTTOM FISIEVEANALYSISAT 190" PAGE20F2 ...................................................................................- ............................. ................-.......... .................................................................... .......................................................... .................................................................................... ......................................... .......................... ........................................................................ ........................................... ............................................................................................... ............. .�.M. - s. r3 r^�O •� --_ - - -l-J- LOT 9 f�s s✓�►-�� p r L 01 7-41 LOT f r 'ti c ,E `T y _ r SEA-37 t^ DRIVE kr -'--- 4 _ 7 E E r3 E/✓4' -- -- Fly/ _ '"/N SJ-•UT EL.f_ 4 AT/O/V'S Jx O �G/,./7 - �` 33 /V(D7-E Sh'o wh,' ����' T�v/S ��,�f✓ �'onlForr�S 7-0 EX 1 S T/N G (3 57 f),L7 E A"A-7 Ell L e- F S S C/'J T119!_L Y 77 ....--�`-,-�`_----------------- - - PLUT Ic�Lz91\1 JAMES � � JAME'' r• SCALE: / APPROVED BY DRAWN BY ,oC AR DATE: IN DRAWING NUMBEh �7,c7 S T xTELEDM P06i 1EAB-W