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3890 MAIN ST./RTE 6A(BARN.) - Health
3890 MAIN STREET/RT. 6A,BARNSTABL _-� A= 335 021 z TOWN OF BARNS-TABLE Fom SEWAGE # c, P. t. _��:'�LAGE yu��`+ %D�� ASSESSOR'S MAP & LOT S { ENSTALLER'S NAME& PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO. OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) ". Feet Furnished by W ' i c 7';4 / � a CA v\ �1 '1 M � C t p Q TOWN OF BARNSTABLE a LOCATION �8� /R (,,l¢ SEWAGE # I '- VILLAGE Aa,Q,;A,14 ASSESSOR'S MAP & LOT I SS ,� 21 Iw .INSTALLER'S NAME & PHONE NO. A & B CANCO 775-6264 SEPTIC TANK CAPACITY ZG / LEACHING FACILITY:(type) e!J- (size)��,a cw� NO. OF BEDROOMS-.PRIVATE WELL OR PUBLIC WATER a,LC, BUILDER OR OWNER u ac. DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No r� v� J Comae -. Or W ' � a f TOWN OF BARNSTABLE LOCATION�329Q SEWAGE# ZO 19 . LI Z 'VILLAGE C cl r+n M o emu;o� ASSESSOR'S MAP&PARCEL 33S• 2 1 INSTALLER'S NAME&PHONE NO. B £Q E xccwaA;o r\ L1'1'1-a G S 3 SEPTIC TANK CAPACITY /„rj'00 q?gj LEACHING FACILITY.(type) SOON Q,I We (size) 13 x 33;9 2- NO.OF BEDROOMS OWNER t a cc a PERMIT DATE: 1 - 19 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY A►- �$ � ►, Az. 43 Z, B2• In'l, -43810 M�,�� A3- 69 ay' B No.L Fee C w THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, M SSACHUSETTS Yes ftpYication for Misposal 6pstem Corrstru "o>r>r Permit Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) omplete System ❑Individual Components Location Address or Lot No. `IS 10 ft)cp.n Sk . &rnS6 Owner's Name,Address,and Tel.No. lecro�nct, Pjo410" Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. 1=1 o v Q,�O F,mj';rp. Q) 3 9c.x c,,voV-on 1q Tea «� Lr,. NITO& 0(6s P•0- t�ox 331 14acw,c,, fno.. 77q• qq4. 11 IOC ape of Building: Dwelling No.of Bedrooms Lot Size .8 cl Accts sq.ft. Garbage Grinder NO) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) q46 gpd Design flow provided (45 4 gpd Plan Date 101Z�j 1 i Number of sheets Z Revision Date T Title Size of Septic Tank 1 S00 Ogo.11 oo g Type of S.A.S. 3) L$o.oh;n Q Ch , 6,s Description of Soil 5e 0. n It Nature of Repairs or Alterations(Answer when applicable) W- O k0 G go�.Uon 10 XV 7 ck- 10ox o,nof (-S) Sac) g010,� y 0,,Oo�d 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 e lth. Signed ��C,(/ Date ���' iq/ Application Approved by Date Application Disapproved by Date for the following reasons Permit No. D-®I;A,- H p)4 Date Issued A, � -- - - - -------------------------------------------- .�.�.� 4k s J Fee } THE COMMONWEALTWOF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS t , 2pplication for Disposal 6pstem Cons"omplete � n Permit Application for a Permit to Construct( ) Repair("/Upgrade( ) Abandon( ) System ❑Individual Components Location Address or Lot No. '� q 0 (Ylo Si ( r n Sloh�.e Owner's Name,Address,and Tel.No. e rc n c,_ ,�o�4 c.n Assessor's Map/Parcel 3�5 2� Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. �,v. P•0 (�on 331 HQ�w c� me,. 77q • cic(q. 11 U Type of Building: x Dwelling No.of Bedrooms i Lot Size , Rq Arr.y,+ sq.ft. Garbage Grinder(�jU) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Desigti`Elow(min.required) 4140 gpd Design flow provided LI kj gpd Plan Date !nt 2"( !A Number of sheets. Revision Date Title Size of Septic Tank c m U„< Type of S.A.S. Description of Soil C n e C'1 a ! t , Nature of Repairs or Alterations(Answer when applicable) Co 4.i'i �'C)t3 `(1` ,1G� C.ho onb�c5 i�l� Date Iasi 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 a lth. Signed Date Application Approved by Date / -1 Application Disapproved by Date for the following reasons. Permit No. 4 Date Issued --------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS (Eeftifirate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded(tl Abandoned( )by at has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit Noo f)jj 4( dated Installer Designer t o,h o r #bedrooms Approved design flow, c. gpd The issuance of this emit shall not be construed as a guarantee that the systemT io desi d. Date Inspector v U -- .-_7-.7------------------------------------------------------ „ ------------------------------------------------- No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal 6pstem (Construction Permit Permission is hereby granted to Construct( ) Repair( ) Upgrade(V� Abandon( ) System located at 3 185 U 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��� /GJ Approved by Town of Barnstable /F1HE T o Regulatory Services Thomas:F. Geiler, Director HAHNSTABLE, = Public. Health Division .y MASS. �A i639. 'Thomas McKean, Director lfD MAC A -200 Main Street, Hyannis, MA 02601 office: 503-862-4644 Fat: 503-790-6304 Date: A)oO.'? 19 . Sewage:Permit# Zotq • y21 Assessor's Map/Parcel 335- 21 Installer & Designer Certification Form Designer: Installer: Xec3.uv�Ai or1 Address: Qp ox 331 Address: "rco-Svc-rrk L..7 On It- 1 - 19 B4-3 ExCauce-Ai o,n was issued a permit to install a (date.) (installer) septic system at 3$90 R-1,-- 1,i4 based on a:design drawn by (address) dated .10" 2 q- 19 (designer) I 1 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 distri-4ution. box and/or septic tank. Stripout (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' 1ateraf 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 ce.rtified.as-built by designer to follow: Stripout (if required) was.inspected.and the soils were found satisfactory. DAAD _ LAHER , J ,/Installer's Sig u-e) l 1211 ---7 t (Designer's SignatuP/l (Affix Des' p Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BJE ISSUED UNTIL. BOTH THIS FORM AND AS- BU LT CARD ARE RECEIVED BY THE BARNSTABLE ]PUBLIC HEALTH DIVISION. THANK YOU, q:\office forms\designerceruficauon fonn.doc COMMOtiWEALTH OF MASSACHL'SETTS I y EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE W]NTER STREET. BOSTON. NIA 02108 bl 292-5j00 CA] WILLIAM F.%'ELD , TRLDY COXE Governor 350 MAIN STREET 'i r �:'Secrctar% ARGEO PAUL CELLUCCI WEST YARMOUTH, MA DAVID B.-STRUHS Lt.Governor 508-775-2800 MAR 23 1998Comm%OYIioner PVST SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM 1,ALTH EPTA6LE PART A , CERTIFICATION MAP 335 PAR 021 PROPERTY ADDRESS: 3890 Route 6A, Cummaquid ADDRESS OF OWNER:` `` DATE OF INSPECTION: March 4, 1998 Mark Tuttle NAME OF INSPECTOR : James D.Sears I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 9310 CMR 15.000) COMPANY NAME: A& B Canco MAILING ADDRESS: 350 Main Street, West Yarmouth, MA 02673 TELEPHONE NUMBER: (508) 775-2800 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below.is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: PASSES X CONDITIONALLY PASSES NEEDS FURTHER EVALUATION BY THE LOCAL APPROVING AUTHORITY FAILS INSPECTORS SIGNATURE: DATE: March 18, 1998 The system Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer,if applicable and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: A] SYSTEM PASSES: N/A I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: B SYSTEM CONDITIONALLY PASSES: X NO 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 b the Board of Health, will pass. Indicate yes, no, or not determined (Y, N, or NO). Describe basis of determination in all instances. If"not determined", explain why not) N The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached) indicating that the tank was installed within twenty(20) years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank is failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. Page 1 of 10 (revised 04/25/97) DEP on the World Wide Web:hfp://www.magnet.state.ma.un/d M SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (CONTINUED) Property Address: 3890 Route 6A, Cummaquid Owner: Tuttle, Mark Date of Inspection: March 4, 1998 B]SYSTEM CONDITIONALLY PASSES(continued) NOTE: SEE NOTES LAST PAGE Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). Describe observations: broken pipe(s) are replaced obstruction is removed distribution box is leveled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: N/A Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone 1 of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER (revised 04/25/97) Page 2 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART.A CERTIFICATION (continued) Property Address: 3890 Route 6A, Cummaquid Owner: Tuttle, Mark Date of Inspection: March 4, 1998 D]SYSTEM FAILS: N/A You must indicate either"Yes" or"No" as to each of the following: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303.The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an over- loaded 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 Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s) Number of times pumped Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E) LARGE SYSTEM FAILS: N/A You must indicate either"Yes" or"No" as to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply . the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area-IWPA)or mapped Zone II of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 04/25/97) _ Page 3 of 10 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 3890 Route 6A, Cummaquid Owner: Tuttle, Mark Date of Inspection: March 4, 1998 Check if the following have been done: You must indicate either"Yes" or"No" as to each of the following: Yes No X Pumping information was provided by the owner, occupant, or Board of Health. X None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. X As built plans have been obtained and examined. Note if they are not available with N/A. X The facility or dwelling was inspected for signs of sewage back-up. X The system does not receive non-sanitary or industrial waste flow. X The site was inspected for signs of breakout. X All system components, including the Soil Absorption System, have been located on the site. X The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: X The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal System. X Existing information. Ex. Plan at B.O.H. X Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) [15.302(3)(b)] (revised 04/25/97) Page 4 of 10 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 3890 Route 6A, Cummaquid Owner: Tuttle, Mark Date of Inspection: March 4, 1998 FLOW CONDITIONS RESIDENTIAL: Design flow: 330 g.p.d./bedroom for S.A.S. Number of bedrooms: 3 Number of current residents: 1 Garbage grinder(yes or no): NO Laundry connected to system (yes or no): YES Seasonal use(yes or no) NO Water meter readings, if available(last two(2)year usage(gpd): 1996 34,000/ 1997 26,000 Sump Pump(yes or no): NO COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow: gallons/day Grease trap present:-(yes or no): Industrial Waste Holding Tank present: (yes or no) Non-sanitary waste discharged to the Title 5 system: (yes or no) Water meter readings, if available: Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System pumped as part of inspection:(yes or no) If yes, volume pumped: gallons Reason for pumping TYPE OF SYSTEM Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) I/A Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known)and source of information: 1989 PERMIT#89-454 Sewage odors detected when arriving at the site: (yes or no) NO - (revised 04/25/97) Page 5 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ` SYSTEM INFORMATION (continued) Property Address: 3890 Route 6A, Cummaquid Owner: Tuttle, Mark Date of Inspection: March 4, 1998 BUILDING SEWER: N/A (Locate on site plan) Depth below grade: Material of construction cast iron 40 PVC other(explain) Distance from private water supply well or suction line Diameter Comments: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK: X (Locate on site plan) Depth below grade: 6" Material of construction X concrete _ metal _ Fiberglass _ Polyethylene _ other(explain) If tank is metal, list age Is age confirmed by Certificate of Compliance (Yes/No) Dimensions: 1,000 GALLON PRE CAST Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 32" Scum thickness: 0" Distance from top of scum to top of outlet tee or baffle: 11" Distance from bottom of scum to bottom of outlet tee or baffle: 151, How dimensions were determined TAPE&ASBUILT Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) TANK AT WORKING LEVEL, OUTLET BAFFLE, INLET TEE,TANK AND COVERS 6" BELOW GRADE. GREASE TRAP: N/A (locate on site plan) Depth below grade: Material of construction _ concrete _ metal _ Fiberglass _ Polyethylene _ other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments.- (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) (revised 04/25/97) Page 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 3890 Route 6A, Cummaquid Owner: Tuttle, Mark Date of Inspection: March 4 1998 TIGHT OR HOLDING TANK: N/A (Tank must be pumped prior to, or at time, of inspection) (Locate on site plan) Depth below grade: Material of construction _ concrete _ metal _ Fiberglass _ Polyethylene _ other(explain) Dimensions: Capacity: Design flow: gallons/day Alarm level: Alarm in working order _ Yes; _ No Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: X (locate on site plan) Depth of liquid level above outlet invert: 0 Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc,) D-BOX IS 12" X 12" 2' BELOW GRADE, BOX IS CLEAN AND LEVEL, ONE LINE IN, ONE LINE OUT PUMP CHAMBER: NIA (locate on site plan) Pumps in working order: (Yes or No) Alarms in working order(Yes or No) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) a (revised 04/25/97) Page 7 of 10 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 3890 Route 6A, Cummaquid Owner: Tuttle, Mark Date of Inspection: March 4, 1998 SOIL ABSORPTION SYSTEM (SAS): X (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number: 1 leaching chambers, number. leaching galleries, number: leaching trenches, number, length: leaching fields, number, dimensions: overflow cesspool, number, alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) ONE 1,000 GALLON PRE CAST PIT; PIT 3' BELOW GRADE, COVER 12" BELOW GRADE. SEE NOTE LAST PAGE. PIT HAS GROUND WATER RUNNING INTO IT. CESSPOOLS: N/A (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(cesspool must be pumped as part of inspection) Comments:: (note condition of soil, signs of hydraulic failure, , level of ponding, condition of vegetation, etc.) PRIVY: N/A (locate on site plan) Materials of construction: Dimensions: Depth of solids.- Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (revised 04/25/97) Page 8 of 10 J SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 3890 Route 6A, Cummaquid Owner: Tuttle, Mark Date of Inspection: March 4, 1998 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100(locate where public water supply comes into house) 3y, O 3 70' 0 (revised 04/25/97) Page 9 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 3890 Route 6A, Cummaquid. Owner: Tuttle, Mark Date of Inspection: March 4, 1998 Depth to groundwater feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained fro Design Plans on record Observation of Site(Abutting property, observation hole, basement sump etc.) Determine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records Check local excavators, installers Use USGS Data Describe in your own words how you established the High Groundwater Elevation. (Must be completed) NOTE: BOTTOM OF PIT 9' BELOW GRADE, PIT IN GROUND WATER. SEE NOTE.. CONDITIONAL PASS- REVIEWED O SITE BY JERRY DENNING, BARNSTABLE BOARD OF HEALTH, DUE TO EXCESSIVE GROUND WATER INTRUSION CAUSED BY RAIN RUN OFF IN AREA. WATER LEVEL OF LEACH PIT FLUCTUATES. i (revised 04/25/97) Page 10 of 10 Town of Barnstable Barnstable P~ "� A!d-AntBtiCa City Inspectional Services Department BARNb7ABL8. M"3 Public Health Division i639' 6'`g m ArFONiO� 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7015 1520 0000 1967 7580 May 29, 2019 BOYLAN, TERRENCE J SR& VIRGINIA 3890 MAIN STREET CUMMAQUID, MA 02637 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 3890,Route 6A/Main Street, Barnstable, MA was inspected on 04/25/2019 by Brett Hickey, 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: • Any portion of the SAS, cesspool, or privy below high groundwater elevation. • 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 one (1) year from the date you receive this notification. I Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH s McKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\3890 Main Street Barnstable.doc Town of Barnstable • � LY, •' A 039• ,�� Inspectional Services Department Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 4/26/19 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An"x"marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground 0 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 ❑ Structurally unsound septic tank or SAS 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). c� TWO (2) YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any"conditionally passed systems" (broken cover, relocation of a pipe, relocation of a driveway due.to H-10 components, etc) eaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER Repair deadline: Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc Commonwealth of Massachusetts �s Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 3890 Route 6A r" Property Address -" ems, Terrance Boylan tir Owner Owner's Name ." information is Cummaquid Ma 02637 4-25-19 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 filling out forms A. Inspector Information on the computer, Brett Hickey use only the tab key to move your Name of Inspector cursor-do not B&B Excavation use the return Company Name key. 374 Route 130 Company Address Sandwich Ma 02563 City/Town State Zip Code r (508)477-0653 S113747 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 15.000); 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 a�awbsa�.a b,eren w 1 Brett Hickey %���i� � ��� 4-25-19 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 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 Forrn:.Subsurface Sewage Disposal System•Page 1 of 18 I Commonwealth of Massachusetts �m Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 3890 Route 6A Property Address Terrance Boylan Owner Owner's Name information is Cummaquid Ma 02637 4-25-19 required for every 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: ❑ I have not found'any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 2) System Conditionally Passes: li ❑ 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.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 41 3890 Route 6A V� Property Address Terrance Boylan Owner Owners Name information is Cummaquid Ma 02637 4-25-19 required for every 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.R26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 c Commonwealth of Massachusetts 4 - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 3890 Route 6A u— Property Address Terrance Boylan Owner Owner's Name information is Cummaquid Ma 02637 4-25-19 required for every 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 Backup f w i f p o sewage e into facility or stem component due to overloaded or � ❑ 9 Y Y P clogged SAS or cesspool ❑ O 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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Y Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 3890 Route 6A u Property Address Terrance Boylan Owner Owner's Name information is Cummaquid Ma 02637 4-25-19 required for every page. City/Town 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 ❑ a Liquid depth in cesspool is less than 6" below invert or available volume is less than day flow ❑ 0 Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: El ❑ Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ El Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ 0 Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ El Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ E 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.] ❑ a The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. O ❑ 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 CA. 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 cam, Commonwealth of Massachusetts ,p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 3890 Route 6A Property Address Terrance Boylan Owner Owner's Name information is Cummaquid Ma 02637 4-25-19 required for every 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 j under Section CA shall upgrade the system in accordance with 310 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 ❑ 0 Pumping information was provided by the owner, occupant, or Board of Health ❑ 0 Were any of the system components pumped out in the previous two weeks? ❑ 0 Has the system received normal flows in the previous two week period? ❑ 0 Have large volumes of water been introduced to the system recently or as part of this inspection? ElWere as built plans of the system obtained and examined?(If they were not available note as N/A) ❑ E] Was the facility or dwelling inspected for signs of sewage back up? El ❑ Was the site inspected for signs of break out? X ❑ ❑ Were all system components, excluding the SAS, located on site. El ❑ 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? ❑ El 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: ❑ 0 Existing information. For example, a plan at the Board of Health. El ❑ 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)] l5insp.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 3890 Route 6A Property Address Terrance Boylan Owner Owner's Name information is Cummaquid Ma 02637 4-25-19 required for every St page. City/Town ate Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: no design plans 3 'I Number of bedrooms(design): Number of bedrooms(actual): ' DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): NA Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes El No Does residence have a water treatment unit? ❑ Yes 0 No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes F!] No information in this report.) Laundry system inspected? ❑ Yes No Seasonal use? ❑ Yes 0 No See below Water meter readings, if available(last 2 years usage(gpd)): Detail 2017-40,000gallons 2018- 14,000gallons Sump pump? ❑ Yes ❑■ No Last date of occupancy: Sept 2018Date I t5insp.doc-rev.7/26/2018 Tile 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 3890 Route 6A u Property Address Terrance Boylan Owner Owner's Name information is Cummaquid Ma 02637 4-25-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: NA 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 es discharges to: Y 9 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): II 3. Pumping Records: Source of information: Owner- date of last pump is unknown 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.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 3890 Route 6A Property Address Terrance Boylan Owner Owner's Name information is Cummaquid Ma 02637 4-25-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: 0 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: unknown Were sewage odors detected when arriving at the site? ❑ Yes R No 5. Building Sewer(locate on site plan): 21 Depth below grade: feet Material of construction: ❑ cast iron ❑■ 40 PVC ❑ other(explain): Town water Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): I t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form ;l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 3890 Route 6A u Property Address Terrance Boylan Owner Owner's Name information is Cummaquid Ma 02637 4-25-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): 1' Depth below grade: feet Material of construction: ❑E concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) I If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No 1 Dimensions: 000gallons " Tank leaking " Sludge depth: n n Distance from top of sludge to bottom of outlet tee or baffle n n Scum thickness Distance from top of scum to top of outlet tee or baffle �� rr Distance from bottom of scum to bottom of outlet tee or baffle viewed How were dimensions determined? Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Liquid level in the tank was low showing tank is leaking. Level in tank is equal to ground water depth. Tank in need of replacement. t5insp.doc-rev.7/26/2018 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 cam, Commonwealth of Massachusetts �a Title 5 Official Inspection Form I; a 9 p Y Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �� 3890 Route 6A Property Address Terrance Boylan Owner Owner's Name information is Cummaquid Ma 02637 4-25-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): NA 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): NA 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 c Commonwealth of Massachusetts �M Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 3890 Route 6A V Property Address Terrance Boylan Owner Owner's Name information is Cummaquid Ma 02637 4-25-19 required for every 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): 0" Depth of liquid level above outlet 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.): The d-box was in poor condition at the time of inspection. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 c Commonwealth of Massachusetts �s ,e Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 3890 Route 6A V� Property Address Terrance Boylan Owner Owner's Name information is Cummaquid Ma 02637 4-25-19 required for every 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.): NA 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: 0 leaching pits number: (1) 6'x6' pit ❑ leaching chambers number: ❑ 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 Tile 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 3890 Route 6A Property Address Terrance Boylan Owner Owner's Name information is Cummaquid Ma 02637 4-25-19 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.): The SAS was in hydraulic failure at the time of inspection. Pit was full into riser. Bottom of SAS is below high ground water depth. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): NA 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.7/2 612 0 1 8 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 3890 Route 6A Property Address Terrance Boylan Owner Owner's Name information is Cummaquid Ma 02637 4-25-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): NA Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): I I t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 II V c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u 3890 Route 6A Property Address Terrance Boylan Owner Owner's Name information is Cummaquid Ma 02637 4-25-19 required for every 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 TOWN'OF BAR.NST'ABLE N LOtATfON, SEWAGE 0 SEPM TANK CAPAACrrY . _-- LEACIM46:•FACILPTy: (ryg c) (size) NO-OF a B'DR00A0 BUILDER C7A QWN'Ef2 w. >PfzF;.'v rOATE: CQMPLL NCE, DATE: " w. . Sepiar�tioa.D`sst,�r�cc Betwstn-,Ehc: ivla.x:i':num,adjustedG.roundwater•'Tab'Seto1heB ttortrofI"eachingi=acility Feet" f'nvate W_ater-SuhF!x'We_lf,.nd Leach_n Facility (If,anywells east on site or'within 2OO,feet 6f1eactiirig facibry) Feet Edge of Wedand Auld Leactun`g F4611ry�(If any,wedands-ekist within 300 feet.of leachinglacilityl Furxtrshed U 37; t5insp.doc-rev.7/26/2018 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 3890 Route 6A Property Address Terrance Boylan Owner Owner's Name information is Cummaquid Ma 02637 4-25-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: FEW Check Slope ❑■ Surface water ❑■ Check cellar ■❑ Shallow wells 30" Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date El 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: A hand hole was augured to a depth of 30" and ground water was encountered. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc-rev.7/26/2018 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 c f Commonwealth of Massachusetts +m Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ' 3890 Route 6A Property Address Terrance Boylan Owner Owner's Name information is Cummaquid Ma 02637 4-25-19 required for every 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 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 i YOU WISH TO OPEN A BUSINESS? � For Your Information: Business certificates [cash. QO fnr 4 yearsj. A business certificate ONLY REGISTERS YULJR NAME in town (+which you f r nUst do by M.G.L.-it does not give you permission Lb (i Nerate.} You must first obtain the necessary signatures an this form at 200 Main St,, Hyannis. Take the completed form to the Town Clerk's Office, is( FL, 367 Main St., Hyannis,MA {)2641 (Town Hail) and get the Business Certificate that is � fequired by law. I DATE: 6/24/11 Fill in please: APPLICANT'S YOUR NAME/S: Virei BE JSINESS YOUR HOME ADDRESS: i _ - 508-35 table TELEPHONE # Home Telephone Number_ 508-362-7 �Ti4 s0PL. SoSPj JIIAME OF CORPORATION: TYPE OF BUSINESS NAME OF NEW BUSINESSGinn Boylan Fan n -IS THIS A HOME OCCUPATION? YES _X NO Assessing] ADDRESS OF BUSINESS,.3R9(1 Main B St prnc;t '� MAP/PARCEL11i11MHEl� [ When starting a new busine5s.tl Ere are several things you must do in order to be in carnpliance with the rules and regulations of the Town of Barnstable. This form is intonded to assist you in obtaining the information you may need. You h11UST G4 TO 200 Main St. - [corner of Yarmouth Rd.&Main Street] to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1'. BUILDING COMMISSIONER'S FIC1= This individual hay;hoe ed of y perrnJC requirernei-Its that pertain to this type of business. Authorized Sign ture* COMMENTS: Mn 2. BOARD OF HEALTH This individual h been in€or e p r it requirements that pertain to this type of Business. Authorized 'S naturell C IMMENTS: 3, CONSUMER AFFAIRS(LIC S G AUTHORITY) This individual has e �for _ lice e i nts that pertain to this type g{ fJusiness. Authoriur '� COMMENTS: I -` TOWN OF BARNSTABLE �` Date:(fl /d7 TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: C/Af"Y B oY4W-F*Q FV L BUSINESS LOCATION: 39�ro e--IA ii j SZCZ� INVENTORY MAILING ADDRESS: f'• 0. 730)C 6'6/ • CI c>"�1 A-q Ut 1 t► /�' aAp3 TOTAL AMOUNT- TELEPHONE NUMBER:��0 34 a - 79gS CONTACT PERSON: Y tRQ1 A3 I /4 T 6 Y L/I-Af EMERGENCY CONTACT TELEPHONE NUMBER. s/ a`I -3F3 I MSDS ON SITE? TYPE OF BUSINES "9E- pP,N-n VE:) o ►r SIXU Gn S ��j INFORMATION/RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The board of health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) 0 U Miscellaneous Corrosive ❑ NEW ❑ USED C) O Cesspool cleaners d 0 Automatic transmission fluid (3 0 Disinfectants C), 0 Engine and radiator flushes C Road salts (Halite) O Q Hydraulic fluid (including brake fluid) Refrigerants C] Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) 1 © Gasoline, Jet fuel,Aviation gas (, Photochemicals (Fixers) 4 ® Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED (3 Miscellaneous petroleum products: grease, () Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED ej O Degreasers for engines and metal C) Printing ink d Degreasers for driveways &garages 0 Wood preservatives (creosote) Caulk/Grout ® Swimming pool chlorine ( , Battery acid (electrolyte)/Batteries d v Lye or caustic soda d Rustproofers Qb Miscellaneous Combustible Car wash detergents v () Leather dyes Cl C) Car waxes and polishes �Wertilizers Q 0 Asphalt& roofing tar U PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, d Lacquer thinners ell 'U (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels 6 (including chloroform, formaldehyde, (� Paint&varnish removers, deglossers U hydrochloric acid, other acids) Miscellaneous. Flammables U Other products not listed which you feel ® v Floor&furniture strippers may be toxic or hazardous (please list): Q � Metal polishes 0 Laundry soil &stain removers (including bleach) li Spot removers &cleaning fluids Q U (dry cleaners) C) C) Other cleaning solvents D U Bug and tar removers Windshield wash WHITE C04 KALTH DEPARTMENT/CANARY COPY-BUSINESS App,scan s Signature Staff's Initials CO1L11O'X%VEALTH OF MASSACHI:SETTS ~ EkECLTI�'E OFFICE OF E:�-VIRO\:1IE\TAL AFF_�IP.s DEPARTMENT OF ENVIRONMENTAL PROTECTION 94 r ONE nZ'%7ER STRrET. B0S T O\ %A 0210t; 161'i 292-55ov � y 81 Sn >1 TR'f y COL � Secre:a--n ARGEO PALL CELLtiCCi uc Governor DA�p B%STP. Com.niss:one- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 3890 Rt. 6A, Cummaqu Nance of Owrter il; l 1 Mi, 1 i n iliress of Owner: Date of inspection: F 2 5/_" Name of Inspector:(Please Print)WRI. Ell Robinson Sr. 1 am a DEP approved s eM inspector to Section 15—W of Title 51310 CMR 15.000) Company Name: Wm• E . Robinson Septic Service MaTingAdd►ess: PO Box 1OF9. Centerville MA Telephone Number: CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true. accurate and complete as of the time of inspection. The inspection was performed based on my training and-experience in the proper function and maintenance of on-site sews disposal systems. The system: asses Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority _ Fails inspector's Signature: r v// Date: — The System Inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty (30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to The system owner and copies sent to the buyer, if applicable, and the approving authority. NOTES AND COMMENTS TPviSed 9/2/98 Paprlorll Z? - -lei o^Reavc:rd Panr• r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(eontlinued) Nap"Address: 3890 --Rt. 6 A , Cummaquid cto 1�1 �11 i n INSPECTION SUMMARY:'Check!st,1 B, C, or D: A. SYSTEM PASSES: �J have not found any information which indicates that'any of the failure conditions described in 310 CMR 15.303 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 o1 the replacement or repair,as approved by the Board of Health,will pass. Indicate es,no. or not determined(Y. N.or NO). Describe basis of determination in all instances. H "not determined'.explain why not. The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within twenty (20)years prior to the date of the inspection: or the septic tank, whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration. or tank failure is imminent. The system will pass inspection If the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipets) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). broken pipets)are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipets). The system will pass inspection if(with approval of the Board of Health): broken pipets)are replaced obstruction is removed revised, 9/2/98 Page 2ofII P � 5 a . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Icontinued) Property Address: 3890 Rt.6A, Cummaquid Owner: gill Mullin Date of Inspection: G—,?—Lqt-6-6 o C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CIMR 15.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) STEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF ANY)DETERMINES THAT THE SYSTEM IS NCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm: Method used to determine distance (approximation not valid). 3) OT ER f { . re.,' se 5 iL/G� PaQc3of11 o e r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 3890 Rt.6A, Cummaquid Owrwr: Bill Mullin Date of Inspection: D. SYSTEM FAILS: You st indicate either "Yes" or "No" to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct,the faiiure. Yes o Backup of sewage into facility-or system component due to an overloaded orelogged SAS or cesspool. _ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 112 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less-than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E. LAR E SYSTEM FAILS: You must ndicate either "Yes' or "No' to each of the following: e following criteria apply to large systems in addition to the criteria above: T e system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public h alth and safety and the environment because one or more of the following conditions exist: Yes o the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA) or a mapped Zone II of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of th Department for further information. rev-seQ 5j2/58 Pagr4ofII j . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM, PART B CHECKLIST Property Address: 3890 Rt.6A, Cummaquid Owner, ns B; 1 1 • Mullin Date of I Check if the following have been done:You must indicate either "Yes" or "No" as to each of the following: Yes No _ Pumping information was provided by the owner, occupant, or Board of Health. _ None of the system components have been pumped for at least two weeks and•the system has been receiving nermal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. _ As built plans have been obtained and examined. Note if they are not available with NIA. The facility or dwelling was inspected for signs of sewage back-up. _ The system does not receive non-sanitary or industrial waste flow. _ The site was inspected for signs of breakout. _ All system components, excluding the Soil Absorption System, have been located on the site. J _ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions,depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: _ Existing information. For example, Plan at B.O.H. Determined in the field(if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) 115.302(3)(b)) _ The facility owner (and occupants,if different from owner) were provided with information on the propermaintananc4i'-0f SubSurface Disposal Systems. revised 9/2/98 Page 5 of I I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION ►rop"Address:3890 -Rt.6A, Cummaquid Owner: Bill Mullin Date of Inspection: � �`9 L`P"0 FLOW CONDITIONS RESIDENTIAL: Design flow: g.p.d./bedroom. Number of bedrooms(design):, Number of bedrooms(actual): Total DESIGN flow 3Z o Number of current residents: Garbage grinder lyes or no):�i0 Laundry Iseparate system) (yes or no):,46,41; If yes, separate inspection required Laundry system inspected (yes or no) Seasonal use (yes or no):AL O Water meter readings, if available (last two year's usage(gpd): 1 Sump Pump (yes or no):h a' Last date of occupancy: )-�) 1 998-1 999 53, 000 gal. COM RCIAVINDUSTRIAL: Type of establishment: Design ow: gpd ( Based on 15.203) Basis of esign flow Grease t p present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no) Non-sani ary waste discharged to the Title 5 system: (yes or no)_ Water m ter readings, if available: Last of of occupancy: O : ( escribe) Last a of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System pumped as part of inspection: (yes or no)�i'� If yes, volume pumped: gallons Reason for pumping: TYPE F YSTEM Septic tank%distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records;if any) IIA Technology etc. Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components, date installed lit known)and source of information: Sewage odors detected when arriving at the site: (yes or no) �e se 5 Page 6of11 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION leoatinued) 'ropertyAddress: 3890 Rt.6A, Cummaquid Owner. R, Date of Insp J,l Mullin BUILDING SEWER: (Locate on site plan) Depth b low grade:_ Material of construction: cast iron 40 PVC other(explain) Distant from private water supply well or suction line Diamet r Comm nts: (condition of joints, venting, evidence of leakage,-etc.) SEPTIC TANK: Ilocate on site plan) Depth below grader Material of construction: ✓—concrete_metal_Fiberglass _Polyethylene_other(explairi) If tank is metal, list age_ Is age confirmed by Certificate of Compliance_ (Yes/No) Dimensions: Sludge depth: —z/ Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: Distance from top of scum to top of outlet tee or baffle: f J Distance from bottom of scum to bottom o outlet tee or baffle: How dimensions were determined: ' ��- r :omments: (recommendation for pumping, condition of inlet and ou et tees Sbaffleksclepth of liqu' level in Ala ion to outletjnvert, struct rel int%grity, evidence of leakage, etc.) CS'f�--Q� �s ��' 21V /�I-la3 L"- ya7 t GREASE T (locate on site)Ian) Depth below gr de:_ Material of cons ruction:_concrete_metal_Fiberglass _Polyethylene_otherlexplain) Dimensions: Scum thickness: Distance from t p of scum to top of outlet tee or baffle: Distance from ttom of scum to bottom of outlet tee or baffle: Date of last pu ping: Comments: (recommend tion for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of eakage, etc.) «l'15� 9/2/58 page 7orn SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) JlropenyAddress: 3.890 Rt. 6A, Cummaquid Owner: RR NMf Date of tnorf'U 111 ri TIG OR HOLDING TANK: (Tank must be pumped prior to, or at time of, inspection) Ilocat on site plan) Depth b low grade:_ Material f construction:_concrete_metal_Fiberglass_Polyethylene cther(explain) Dimensio s: Capacity: gallons Design fl w: gallonslday Alarm pr sent Alarm le el: Alarm in working order: Yes_ No_ Date of revious pumping: Comme ts: (condi on of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:_ (locate on site plan) Depth of liquid level above outlet invert:_ Comments: (note if level and distribution is equal, evidergof solids carryover, evidence of leakage into or out of box. etc.) PUMP CH MBER:_ (locate on ite plan) Pumps in w rking order: (Yes or No) Alarms in w rking order (Yes or No) Comments: (note condi on of pump chamber, condition of pumps and appurtenances, etc.) c / _ev_sec �/2, 9c Page eorll SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(c«tfiinued) erty Address : Owner: 3890 -Rt.6A, Cummaquid Date of Qi�4u 11 in SOIL ABSORPTION SYSTEM(SAS):_ (locate on site plan, if possible;excavation not required,location may be approximated by non-intrusive methods) If not located, explain: Type: leaching pits', number:_ 1 leaching chambers, nummbber._ leaching galleries, number._ leaching trenches, number, length: leaching fields, number, dimensions: overflow cesspool, number._ Alternative system: Name of Technology: Comments: Inote condition of soil, signs of hydraulic failure, level of ponding, damp soil, con ition oyvegefio�4)c.) 1 e CESO OLS:_ (locate n site plan) Number nd configuration: Depth-to of liquid to inlet invert: Depth of olids layer: Depth of s um layer: Dimension of cesspool - Materials f construction: Indication f groundwater: i flow• (cesspool must be pumped as part of inspection) Commen s: (note co dition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY: (locate on site plan! Materials f construction: Depth of s lids: Dimensions: Comment (note con ion Of soil. signs of hydraulic failure, level of ponding, condition of vegetation, etc.) I t Pap(9 of I I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) NopertyAddress: 3890-- Rt.6A, Cummaquid Jwrsef' Bill Mullin Jate of Inspect on: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) st 1 1 37 . �. 1 r=r_sec 5,'2/9E PaRc10ofII • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART C SYSTEM INFORMATION(contnued) f paAleu` 3890 Rt.6A, Cummaquid Owned B• dnl Mullin Da te o NRCS Report name Soil Type_ Typical depth to groundwater uSGS Date website visited Observation Wells checked Deep Groundwater depth: Shallow Moderate SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to Groundwater Feet Please indicate all the methods used to determine High Groundwater Elevation: . Obtained from Design Plans on record Observed Site (Abutting property. observation hole, basement sump etc.) Determined from local conditions L Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators, installers Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) rev-- sea �� ��9E Pagcnof11 � 9, 2, No....l1- - --K5- Fimic !'t®."............. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF ((HEALTH ow n in.............'.OF. rns c� le.....--.... ApplirFation for Bisvm al Workri Tons- tra'dion ramit Application is hereby made for a Permit to Construct ( ) or Repair (- ) an Individual Sewage Disposal System at: .. .84s?...N�4 ..... .:...... ..M ... ..........__.........•--............------------------------------........--------............---- Location-Address _ or No. I l_t:t CciYl /� Owner _ ddresp aIS _4...4:�E34 i�S2..... .............................................. 1..l1U�6.•�{ Ct�MGLt . Installer Address UType of Building Size Lot............................Sq. feet Dwelling=No. of Bedrooms___.___.__.��_ ____________________________Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building ______________ _. No. of ersons.__._____..,___.___ Showers 1 tl+ yP g --,..------- P --- ( ) — Cafeteria ( ) Q' Other fixtures W Design Flow............................ _...............gallons per person per day. Total 'daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length________________ Width................ Diameter_------------- Depth................ x Disposal Trench—No_ ____________________ Width......................Total Length..................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter`._.___._._..._.... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by............. ............................................................ Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water_____._._............... 1X4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water......................... 94 .....--•-------•-------...•-------------••---•---••-••--•----._.....---------•-.....-----------••---........................................................ 0 Description of Soil........................................................................................................................................................................ x V .....--•----•-••-•-•--------••••--------------•-----•....-------..._...-•-•---------••----•---•-••-•------------•---•----------•---------•••--•--------••-•----------------•----•---••------•-•---•---•-• W x •---------•-----------------------•------••-•-••------•------••-------•-----------••---••--•----•-------•_--- ---- -{ U Natur of Repairs or Alterations—Answer when applicable. tt15 _._l,_�?a�?__ �X.IoY!__ '�� c -;-.Q ,r- ,---••• '�_��.�._�.+L-%'�...w� 2" .s� v� �Z�---re' 'r�--------------------------------------------------------------------------------------•-•---------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the boa d of health. p Signed... =�`�-..../-----•-------._ 21 Date Application Approved By...............• �._ -------_T � -' '' Date - - - Application Disapproved for the following reasons---------------------------------------------------------------------------------------------------------------- .....................................•------------•--------._.....-------•-•-----------......-----------------.._._..••-••-••-••-----------------------•••-------------•--•-•-------•-••------•--------- Permit No. O__ �p Date .................�---•....__..... Issued,-•---------------------------------------•------------ Date No.. �J Fxs..... :0...-.............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Owt) �y,r»��4�.1� e ...........................................O F...................................... ............................................. Appliratiou for Diupuiia1 Works Tonstrurtion Vautit Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal System at: ii I r\ r_rn�.1......I. Location-Address Lot Nrill . aj,I_IZX�1� 7 Z41 i1)F� t r --7.. ? .. c.Owner Address W �.� ...��[_iG'C) sJn `(j(tRyl ii'PC� �1je ��! r �[ Iii -- .................•-• -- ....................•- Installer� Address UType of Building Size Lot............................Sq. feet a Dwelling=No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) QI Other fixtures ............................. •---•-•-•--•--- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No---------------_---- Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................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......---_-. ---. ---. R+' -----------------------------------•--•--•----------------•-----•---------------•-•-........................-----------•------•---------------._._......._... ODescription of Soil........................................................................................................................................................................ x V ......••••-•-•-••--•---....-••-•••--.........-••--•-------•-----•--•••-----...••-••-•-------•---•-•-••------••--•---•----------------•-•------••-••••----••-••---•--•----••...........-------••-•-----••. W x ••••-•••--------------------••--........••-•--..........•--•--------•--••--------- •---•-•-••---•------•-- ---�......--------•-••------......-----•----•---•- j ----•- U Nature Of Repairs or Alterations—Answer when applicable.-Z"..51- `____I,Uc?o_c%Q�,,, Sc,l c_ r,,___40!tr_C`�1•-___- =• -•---- -•-.... ---------------- -------- ------•• -------- -------- -------- -------- ---------- Agreement: . The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. n Signed...................Ler , r n•ry, �:(� o n f Date Application Approved By................. ---- , >--------------------------------- --------!i---' 1l Date Application Disapproved for the following reasons----------------------------------------------------------------------------------------------------------------- -•--------------•----•-----..........----••-•----.........------•----------------•----.....••--------------••----•--•••--••-•••-••-• -------•----------------------•-----------------------...---•- Datd PermitNo----------KZ------ ................ Issued......'-------•---------•---•-..........----------••. Date' THE COMMONWEALTH OF MASSACHUSETTS.' )� BOARD OF HEALTH ...................OF...................;t c� ............................. Cnrdifiratr of Toutplianq Y THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by......... �Cj......1 � � f�6-�....................................................... .... ....................................•...............••.................... � staller / s/VJ s at..... .... ..... ......--•,----...L k:^:----- •----.................- -,------- --.1......------------------......--------------------------•--------------- has been'installed in accordance with the provisions of T-!* - j of The State Sanitary"Code as described in the application for Disposal Works Construction Permit No...........�-_.....5�....... dated- ..................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CON TRUED AS A GU'ARANTEE THAT TIME SYSTEM WILL F CTION ATISFACTORY. DATE.....;7.•••.`y ... ................................ Inspect o - ---------------------- .---------•.......................... i � THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -_ V t c� ..... .......................OF.........L.rr15....`.......�.................................. No..... ' �5 .. FEE....ao — Rapoua1 Works Tfunotrttrtiun [rrmff Permission is hereby granted............ --•r. k� t�!4..--------........... -------------------- to Construct I -or Repair ( ) an Individual Sew e Disposal Syst 4 Street (� as shown on the application for Disposal Works Construction Permit No.�`_:- 5 4 _ Dated.......................................... .................................. -•-•r ---•--•••••••--•-----•--••-----•----•...-------- �_ / Q (J Board of Health DATE --------/-----•-- --...•-•---••--- FORM 1255 HOBBS & WARREN. INC., PUBLISHERS T— ` . I4 I r- l I I e,4r �Ar 4 �00 I ao'x t,a, i - ! 1 i 3 i { - r `` I , 4i, i ° ij- _I• I � I j _I I I ,,'•i___..�I "' I I� I 1 I �, i I f 1 t, .I 1I, -io.M- (r`e�V�_ e.10si I 1 xl(G r 1 j ( - i 1 I , I I 1 - "I I I i f i I. I 1, I � I " ? I I I I - ; i I I ; , - t " ; rl..l ,. ..l i I I -1 ' �- I " 1 I i I1 Iiffl '_ I { Iii I I l � � ' II 11 1 f I j. _+ I I ( 1 I i 1 t I �. � !-I r I, I I I � 1 1 1 i• : 350 Main St. W. Yarmouth, MA 02673•775-6264 O� JEFFREY CANNON. { I ✓ I !�-i-IIl-fl j -=i I I 1 1 aL N Septic S ervicesaPumping8 z� ' 11 Instalation Division o/Canco Energy Corporation i t TOP OF FOUNDATION COVERS TO BE WATERTIGHT AND SEPTIC SYSTEM PROFILE BROUGHT TO WITHIN 6"OF FINAL GRADE Flaherty Environmental Service, EL. 62.0' EL. 60.0' (not to scale) INSP. PORT W I 3" OF GRADE CLEAN SAND P.O. Box 331 2"of 8" to Z" DOUBLE WASHED EL. 60.0' Ha/wich, MA 02645 PILTER FABRIC GEOTEXTILE 774.994.1166 4"CAST IRON or EQUIVALENT FILTER FABRIC -�� MIN. PITCH 1/4" PER FOOT 4',SCHEDULE 40 PVC PIPE 4"SCHEDULE 40 PVC PIPE ' FLOW LINE 1 ENT IF REQUIRED (first 2 tD be le ° 20' 1.5% —�► 1 5' 1% " 7 0' ;.e.'• L.59.5' 14" .®•®�• �. ' �® EL.57.75' — --� o0000000000 0 . - p o°o°o°o°c EL.57.5' 000°000 0 0 0000 _ °°°°000°c REQUIRED: 0 0 0 0 0 0 0 ® �®� 00000 0 0 EL.57.03' o 0 0 0 0 0 0 4 _10'MIN.(2.5 TEL.57 2' o 0 0°0°0°0°0°0°0 ® ®� 000 00 oo�2.0' �5' REMOVAL OF UNSUITAB JGAS BAFFLE (H-20D-BOX) EL.57.0' °°o°o°o°o° °o°o°o �., °o°o°o°o° " MATERIAL LATERALLY AND 00000000 0 O°O°O° a4 O O O O C a o 0 0 o EL 55.0' BENEATH SAS TO EL.43.0' .';'g;•'+;`•�.i�;,,a�:•; 6"CRUSHED STONE OR SOIL ABSORPTION SYSTEM MECHANICALLY COMPACTED (3) 500 GALLON H-20 CHAMBERS WITH 4'STONE AROUND IN A 5.0, DATUM: ASSUMED) -J " to 1 " DOUBLE WASHED STONE 1500 GALLON SEPTIC TANK g2aB3'W X 33.51 X Z'D CONFIGURATION (PROPOSED) BOTTOM OF TEST HOLE #3 EL. 38.0' EL. 50.0' ' W USGS ADJUSTMENT: N/A LOCATIONMAP W jaw WEEPING G.W. ELEV: 50.0' / cod N TH N / 60 Rt.64 LOCUS / �50 ,OoO BENCHMARK: r C ? TOP OF FNDN N j EL.62.0' w se 100' TO HANK ATTACHED / S' REMOVAL A BARN/STUDIO J LP Tt1'4 2� '. 3 C f-2 _ He�<Ta�Y JR ACE NEW 1500 `�A Q M SA LOCATI �:' `• AS EXI INS 1000 T 'i�'F}•• TH-1 �Q1 T� D3 D G CTING a'4�flITA DRIVEWAY c 0.89 ACRESt DATE,•1012412019 REVISED: MAP 335 LOT 21 LEGEND J £ GAS LINE STREET �-- — — 60 J p / T. 6A SITE AND SEWAGE PLAN FOR. �q w� B& B EXCAVATION INC./ -�! V—„=,r WATER LINE •Z �0''� � i '�1v�A�1tl � -E E E E E EXIST. ELECTRIC i TERRANCE BOYLAN 99 EXIST. CONTOURS 3890 MAIN STREET RT, 6A ————— 99 PROP. CONTOURS D_ BARNSTABLE, MA EXIST. FENCE SCALE : 1" -- 40' REF.DB 26551 PG 56 PAGE 1 OF2 l�- ................................................................................................................................................................... ....... .............................................................................................................................................................................................................. ................................................................................................................................................................................................................. .................................................. .......................................... ................................................................. ............. GENERAL NOTES DESIGN CAL CULA TIONS SYSTEM DETAIL Flaherty Environmental Services (NTS) P. 0. Box 331 1. ALL PRECAST COMPONENTS TO BE H-10 Harwich, MA 02645 RATED UNLESS OTHERWISE SPECIFIED, NUMBER OFACTUAL BEDROOMS 3(DESIGN FOR 774.994.1166 DISTRIBUTION BOX(ES)AND ANY COMPONENTS WITH ANY ANTICIPATED GARBAGE DISPOSAL UNIT NO VEHICULAR TRAFFIC TO BE H-20 RATED. 12.83' - 2. THE DESIGN OF THIS SYSTEM DOES NOT TOTAL ES TIMA TED FLOW 5' REMOVAL TO ELEV. 43.0'± ALLOW FOR THE USE OF GARBAGE (110GAL/BR1DAYX4BR) 440 GAL./DAY GRINDER. REQUIRED SEPTIC TANK CAPACITY 860 GAL, 3. MUNICIPAL WATER IS AVAILABLE. 4. ALL CONSTRUCTION TO CONFORM WITH SIZE OF SEPTIC TANK 1500 GAL. (PROPOSED) 310 CMR 15.000 AND ALL OTHER APPLICABLE LOCAL, STATE AND FEDERAL SOIL CLA SSIFICA TION CODES AND REGULATIONS. 5. INSTALLER/CONTRACTOR TO REVIEW& DESIGN PERCOLATION P.4 TE <2 MIN./INCH ' VERIFY ALL ELEVATIONS AND DETAILS (SEIVEANAL YSIS ATTACHED) iESTHOLE#4YTPT-19-158 AND REPORT ANY DISCREPANCIES TO Evoluator.- David D.Flaherty Jr.,RS,REHS EFFLUENT LOADING RATE 0.74 GAL.IDAYIFT2 SE#2755 DESIGNER PRIOR TO CONSTRUCTION OR BOH Witness: David Stanton,RS ASSUME ALL RESPONSIBILITY, LEACHING AREA 33.5' 0 Date: October 12,2019 6. INSTALLER/CONTRACTOR IS (2)x(33.5'+ 12.63%2) =185SF RESPONSIBLE FOR MAINTAINING SAFE TH-4 ELEV.60.0' 33.5'x 12.83' =429 SF WORK AREA, VERIFYING ALL UTILITIES 614 SF x 0.74 =454 GPD -21" A 0' LS IOYR212 AND NOTIFYING "DIG SAFE" (1-888-344-7233) 72 HOURS PRIOR TO USE(3)500 GALLON H-20 CHAMBERS WITH 4'STONE O 21'-40' B LS 10 YR 516 CONSTRUCTION, AS DIAGRAMMED IN A 33.5'X 12.83'X 2'CONFIGUR4 TION 40"-63' C1 Slft 10 YR 212 7. ANY CHANGES TO OR DEVIATIONS FROM (LINEAR FEET) Clay Loam THIS PLAN MUST BE APPROVED IN WRITING BY FLAHERTY ENVIRONMENTAL RESERVE LEACHING CAPACITY 454 GPD 63"-204' C2 Marine Clay SERVICES AND LOCAL BOARD OF" HEALTH. GWatE1.50.0' (weepIng) 8. FINISH COVER OVER COMPONENTS IS NOT TO EXCEED 3'PER 310 CMR 15.000 UNLESS SHOWN PER PLAN. EL. 43.0' 9. ALL ABANDONED SEPTIC SYSTEM 204"-264" C3 MCS 2.5Y615 SEIVE 5 COMPONENTS TO BE PUMPED DRY AND SOIL EVAL UA TION BOTTOM rH-4ELEV 38.0' FILLED WITH CLEAN SAND OR REMOVED TESTHOLE#1 TPT-19-158 TESTHOLE#2 TPT-19-158 TESTHOLE#3 TPT-19-158 7 certify that on November 12,2002, have passed AND REPLACED WITH CLEAN SAND. Evaluator- David D.Flaherty Jr.,RS,REHS Evaluator. David D.Flaherty Jr.,RS,REHS Evaluator- David D.Flaherty Jr.,RS,REHS the examination approved by the Department of 10,ALL COMPONENTS TO BE PROVIDED SE#2755 SE#2755 SE#2755 BOH witness: David Stanton,RS BOH Witness., David Stanton,RS BOH Witness, David Stanton,RS Environmental Protection and that the above analysis WITH WATERTIGHT ACCESS PORTS Date: October 3,2019 Date. has been performed by me consistent with the October 3,2019 Date: October 12,2019 WITHIN 6"OF FINISH GRADE. required training expertise and experience descnbed in 310 CMR 15.018(2). 11.ALL SEPTIC TANKS, DISTRIBUTION TH-I ELEV.60.0' TH-2 ELEV.60.0' TH4 ELEV.60.0' BOXES AND PIPING TO BE INSTALLED IN OF .-9. 0.0 WATERTIGHT. A LS I0YR212 -91, A LS I0YR212 0"-21" A LS 10YR Z2 12.NO KNOWN WETLANDS OR WELLS 9'-17" B LS I0YR516 911-17, B LS 10 YR516 21"-40' 8 LS 10 YR 516 D WITHIN 100 FEET OF PROPOSED LEACHING. 17"-60" C1 LS 75Y313 17'-60' C1 LS 7.5Y313 40%63" C1 Sift 10 YR 2& F bog 13.THIS IS NOT A CERTIFIED PLOT PLAN (bog iron) ( iron) ClayLoam AND UNDER NO CIRCUMSTANCES IS THIS "'60 -82 C2 Slit Clay 10 YR 212 60--82- C2 S/ft Clay 10 YR 212 63--204- C2 marine Clay PLAN TO BE USED FOR ZONING OR ITAM Loam Loam BUILDING PURPOSES, G W at El.50.0' 14.LOT IS SHOWN AS ASSESSOR'S MAP 335 G.W ELEV.51.7' G.W.ELEV.53.3' (weeping) (weeping) LOT 21 . ---- (weeping) SIT E AND SEWAGE PLAN FOR 15.LOCUS PROPERTY IS NOT LOCATED 8& 8 EXCA VA TZON, INC"/ WITHIN AN AQUIFER PROTECTION 82%138" C3 marine Clay 82--132- C3 Marine Clay EL. 43.0' TERRANCE BOYLAN 204"-264' C3 MCS 2.5Y615 DISTRICT(ZONE 11). 3890 MAIN STREET RT.,6A BOTTOM TH-1 ELEV. 48.5' - BOTTOM TH-2ELEV. 49 BARNSTABLE, MA BOTTOM TH-3 ELEV. 38.0' PAGE20F2 DATE:1012412019 ..............................................------------------------------------------............ ..................................................................................................................................................................... ................................................. ......................................... .......................... ...... ............................................................................................................... ...............................................................................................................................................................................................................................