HomeMy WebLinkAbout4096 MAIN ST./RTE 6A(BARN.) - Health 4096 MAIN ST./RTE 6A, BARNSTABLE
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' TOWN O F BARNSTABLE
LOCATION 1-4 Ct 1 GJ h44-6.4 SEWAGE#
VILLAGE �� r/O 0" ASSESSOR'S MAP&PARCEL
INSTALLERS NAME&PHONE NO. J^(n,r CO-," .;?G
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) (size)
NO.OF BEDROOMS "
OWNER
PERMIT DATE: ""— COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility(If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
4096 Main Street(Rt 6A)
Property Address r
Joyce Kramer& Marcia Nagle
Owner Owner's Name
information is Cumma uid �� MA 02637 6-28-18 '
required for every a � �`.
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. General Information
on the computer, �� OF Mg3��O��i
use only the tab 1. Inspector: :°4`` 1 • •
key to move your O?� '•yG
cursor-do not James D.Sears A JAMES :m
e the return Name of Inspector
key. s v
Jim The Inspector Man
r� ompany NameP 0 Box 784 i�i F 5► `\o
Company Address t
Own West Yarmouth MA 02673 _�----
CitylTown State Zip Code '
508-364-4398 S 1623
Telephone Number License Number
B. Certification
I certify that I have personally inspected the sewage disposal system at this address and that the
information reported below is true, accurate and complete as of the time of the inspection. The inspection
was performed based on my training and experience in the proper function and maintenance of on site
sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of
Title 5(310'CMR 15.000).The system:
® Passes ❑ Conditionally Passes ❑ Fails
❑ Needs Further Evaluation by the Local Approving Authority
d 7-10-18
pector'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 should be sent to the system owner and copies sent to the
buyer, if applicable, and the approving authority.
****This report only describes conditions at the time of inspection and under the conditions of use
at that time.This inspection does not address how the system will perform in the future under
the same or different conditions of use.
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
.7' Subsurface Sewage Disposal System Form Not for Voluntary Assessments
4096 Main Street(Rt 6A)
Property Address
Joyce Kramer& Marcia Nagle
Owner Owner's Name
information is Cummaguid MA 02637 6-28-18
required for every
State Zip Code Date of Inspection
page. Cityrrown
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E/always complete all of Section D
A) System Passes:
® I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
The system is a 1500 Gal. Tank D Box and two Chamber's.
B) System Conditionally Passes:
❑ One or more system components as described in the"Conditional Pass" section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
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):
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
<iIQ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
4096 Main Street(Rt 6A)
Property Address
Joyce Kramer& Marcia Nagle
Owner Owner's Name
information is required for every Cummaquid MA 02637 6-28-18
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
B) System Conditionally Passes (cont.):
❑ Observation of sewage backup or break out or high 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):
C) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17
I
Commonwealth of Massachusetts
Title 5 Official Inspection Form
h! Subsurface Sewage Disposal System Form Not for Voluntary Assessments
4096 Main Street(Rt 6A)
Property Address
Joyce Kramer& Marcia Nagle
Owner Owner's Name
information is Cummaquid MA 02637 6-28-18
required for every
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
2. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public 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.
3. Other:
D) System Failure Criteria Applicable to All Systems:
You must indicate "Yes" or"No"to each of the following for all inspections:
Yes No
❑ ® Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ ® Liquid depth in is less than 6" below invert or available volume is less
than '/2 day flow ,C,fAUTA.,G
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17
r -
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
4096 Main Street(Rt 6A)
Property Address
Joyce Kramer& Marcia Nagle
Owner Owner's Name
information is Cummaquid MA 02637 6-28-18
required for every State Zip Code Date of Inspection
page. City/Town
B. Certification (cont.)
Yes No
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped`.
❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered.A copy of the analysis
and chain of custody must be attached to this form.]
❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd.
❑ ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection
Area—IWPA) or a mapped Zone II of a public water supply well
If you have answered "yes" to any question in Section E the system is considered a significant threat,
or answered yes' In Section D above the large system has failed. The owner or operator of any large
system considered a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15.304. The system owner should contact the appropriate
regional office of the Department.
t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17
I
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
4096 Main Street(Rt 6A)
Property Address
Joyce Kramer& Marcia Nagle
Owner Owner's Name
information is Cummaquid MA 02637 6-28-18
required for every City/T-ow I State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate"yes" or"no" as to each of the following:
Yes No
❑ ® Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
Y®
Has the system received normal flows in the previous two week period?❑
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑ Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
❑ ® Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS) on the site has
been determined based on:
® ❑ Existing information. For example, a plan at the Board of Health.
❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
D. System Information
Residential Flow Conditions:
Number of bedrooms (design): 3 Number of bedrooms (actual):
4
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440
t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17
c Commonwealth of Massachusetts
Title 5 Official Inspection Form
<I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
4096 Main Street Rt 6A
Property Address
Joyce Kramer& Marcia Nagle
Owner Owner's Name
information is Cummaquid MA 02637 6-28-18
required for every
page. Citylfown State Zip Code Date of Inspection
D. System Information
Description:
The system is a 1500 Gal Tank D Box and two chamber's.
3
Number of current residents:
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No
information in this report.)
Laundry system inspected? ❑ Yes ® No
Seasonal use? ❑ Yes ® No
Water meter readings, if available last 2 ears usage d 2016-22.000Gals
g ( y g (gp )) 2017-25,000Gal's
Detail:
Sump pump? ❑ Yes ® No
Last date of occupancy: Date
a eesent
Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 15.203): Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17
i
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
4096 Main Street(Rt 6A)
Property Address
Joyce Kramer& Marcia Nagle
Owner Owner's Name
information is required for every Cummaquid MA 02637 6-28-18
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Last date of occupancy/use: Date
Other(describe below):
General Information
Pumping Records:
Source of information: NA
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped:
gallons
How was quantity pumped determined?
Reason for pumping:
Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner) and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
4096 Main Street(Rt 6A)
`-` Property Address
Joyce Kramer& Marcia Nagle
Owner Owner's Name
information is Cummaguid MA 02637 6-28-18
required for every State Zip Code Date of Inspection
page. City/Town
D. System Information (cont.)
Approximate age of all components, date installed (if known) and source of information:
1996 Permit # 96 - 623.
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
16"
Depth below grade: feet
Material of construction:
❑ cast iron ® 40 PVC ❑ other(explain):
Distance from private water supply well or suction line: feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
Pipeing is 4" PVC -SCH 40
Septic Tank(locate on site plan):
611
Depth below grade: feet
Material of construction:
® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain)
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
1500 Gal. Precast H-10
Dimensions:
211
Sludge depth:
t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17
c Commonwealth of Massachusetts
Title 5 Official Inspection Form
/-,0 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
4096 Main Street(Rt 6A)
`J Property Address
Joyce Kramer& Marcia Nagle -
Owner Owner's Name
information is Cummaquid MA 02637 6-28-18
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Septic Tank(cont.)
Distance from top of sludge to bottom of outlet tee or baffle
28"
1"
Scum thickness
8"
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
17"
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.):
Tank at working level. Tank and covers at 6" below grade. In and outlet tee's. No sign of leakage or
over loading
Grease Trap (locate on site plan):
Depth below grade: feet
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: Date
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17
c Commonwealth of Massachusetts
p Title 5 Official Inspection Form
le Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
4096 Main Street(Rt 6A)
Property Address
Joyce Kramer& Marcia Nagle
Owner Owner's Name
information is Cummaquid MA 02637 6-28-18
required for every City/Town
page. State Zip Code Date of Inspection
D. System Information (cont.)
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Capacity: gallons
Design Flow: gallons per day
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments(condition of alarm and float switches, etc.):
*Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
4096 Main Street(Rt 6A)
Property Address
Joyce Kramer& Marcia Nagle
Owner Owner's Name
information is Cummaquid MA 02637 6-28-18
required for every State Zip Code Date of Inspection
page. Cityrrown
D. System Information (cont.)
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.):
D Box is H-20 20x20"-66" Below grade w/cover at 2'. Box is clean w/one line out. No sign of over
loading or solid carry over.
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.):
* If pumps or alarms are not in working order, system is a conditional pass.
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17
I
Commonwealth of Massachusetts
Title 5 Official Inspection Form
<ia Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
4096 Main Street(Rt 6A)
Property Address
Joyce Kramer& Marcia Nagle
Owner Owner's Name
information is required for every Cummaguid MA 02637 6-28-18
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Type:
❑ leaching pits number:
® leaching chambers number: 2
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
Leaching is two 500 Gal. dry well chamber's w/4' stone. Chamber's at 6' below grade w/cover at 2'.
Chamber's are wet on bottom w/clean like new wall's.
Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration
Depth—top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17
i
r
Commonwealth of Massachusetts
Title 5 Official Inspection Form
+' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
4096 Main Street(Rt 6A)
Property Address
Joyce Kramer& Marcia Nagle
Owner Owner's Name
information is required for every Cummaguid MA 02637 6-28-18
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
Privy (locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17
I
Commonwealth of Massachusetts
Title 5 Official Inspection Form
5 Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
4096 Main Street Rt 6A
Property Address
Joyce Kramer& Marcia Nagle
Owner Owner's Name
information is Cummaguid MA 02637 6-28-18
required for every State Zip Code Date of Inspection
page. City/Town
D. System Information (cont.)
Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to
at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate
where public water supply enters the building. Check one of the boxes below:
® hand-sketch in the area below
❑ drawing attached separately
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17
f
Page 10 of11
OFFICIAL I14SPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C - A/
SYSTEM INFORMATION(continued)
Property Address: 409¢Route 6A,Cummaquid,MA
Owner: I VYY �w
Date of Inspection:
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or
benchmarks.Locate all Wfells within 100 feet Locate where public water supply enters the building. 2,yC, t
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
Fie Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
4096 Main Street(Rt 6A)
Property Address
Joyce Kramer& Marcia Nagle
Owner Owner's Name
information is Cummaquid MA 02637 6-28-18
required for every
page. CityrFown State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
❑ Check Slope
❑ Surface water
❑ Check cellar
❑ Shallow wells
Estimated depth to kV ground water: 20'+
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: 10-1-96
Date
❑ Observed site (abutting property/observation hole within 150 feet of SAS)
❑ Checked with local Board of Health -explain:
❑ Checked with local excavators, installers-(attach documentation)
® Accessed USGS database-explain:
U.S.G.S. well AIW 247 at 20' Zone A.
You must describe how you established the high ground water elevation:
U.S.G.S. well AIW 247 at 20' zone A. Bottom of Chamber's at 8'-T.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17
I
Commonwealth of Massachusetts
Title 5 Official Inspection Form
e Subsurface Sewage Disposal System Form Not for Voluntary Assessments
4096 Main Street(Rt 6A)
Property Address
Joyce Kramer& Marcia Nagle
Owner Owner's Name
information is required for every Cummaguid MA 02637 6-28-18
page. City/Town State Zip Code Date of Inspection
E. Report Completeness Checklist
® Inspection Summary: A, B, C, D, or E checked
® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed
® System Information— Estimated depth to high groundwater
® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
I
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17
X
7
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TOWN OF BARNSTABLE
LOCATION 4096 MAIN STREET SEWAGE # 96-623
VILLAGE CUMMAQU I D ASSESSOR'S MAP& LOT . ®Sy
INSTALLER'S NAME&PHONE NO. ELLIS BROTHERS CONST CO. 362-6237
SEPTIC.TANK CAPACITY /,TW
LEACHING FACILITY: (type) 2 -5Z10 9AIS. r)6WeLL (size) 1"3`)C 2 S'se.7
NO.OF BEDROOMS
BUILDER OR OWNER SUSAN TENDLER
PERMIT DATE: 2/24/97 COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
oms.ite 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
b�
,S� 1
'0 show jo is .
` TOWN OF BARNSTABLE _ B
-° '�)CP.TION 4096 MAIN STREET SEWAGE # 96-623
VILLAGE CUMMAQUID ASSESSOR'S MAP & LOT-3 -
1
INSTALLER'S NAME&PHONE NO. ELL I S BROTHERS CONST CO. 362-6237
SEPTIC TANK CAPACITY /'gam
LEACHING FACILITY: (type) - -S00 9AIS. lr Y al- (size) 11'1(
NO.OF BEDROOMS
BUILDER OR OWNER SUSAN TENDLER
PERMIT DATE: 2/24/9 7 COMPLIANCE DATE: S-2 9'- 9 2 l
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
�QT . !.
l
l
Ares I `
I
t
' I �
g6
� r ►I �l ► Fee
No., [,—:� 11Y1 1 f Y
HE COMMONWEALTH OF MASSACHUSETTS 0A./mi/M 4��,d l
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
01ppYication for 33tgo5al *pztem Congtruction 3permit per- 5
Application is hereby made for a Permit to Construct(X)or Repair( )an On-site Sewage Disposal System at:
Location Address or Lot No. Owner's Name,Address and Tel.No.
y°4C. N x 5T, Xm� 6.4 __Ws.max -rev-s4*1 ee
!?�x�Na�iB ,tuff. vita3. Frc C�'v �0. u ts�i�
Installer's Name,Address,and Tel.No. Des ner's Name,Address nd Tel.No.
EAR e� �,�v. 'r•.
yiPV- 1b-7-%4 P®0-? '362 .813 2-
Type of Building:
Dwelling No.of Bedrooms Garbage Grinder(AIC)
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow F gallons per day. Calculated daily flow 5 Ilk gallons.
Plan Date /6 /'1 ��. Number of sheets ! Revision Date �o �8
Title 5;&V77C
Description of Soil
6g 1 .
Nature o ef R airs or Alterations(Answer when applicable) �lA
r
Date last inspected: DESIGNING ENGINEER MUST SUPERVISE
INSTALLATION AND CERTIFY IN WRITING
Agreement: THE SYSTEM WAS INSTALLED IN STAIGT
The undersigned agrees4o ensure the construction and uaiAQ=Q 9 f ed on-site wag sal system
in accordance with the provisions of Title 5 of the Environmental Code and not to ace the sys a til a Certifi-
cate of Compliance has bee'ti issued b this Health.
Signed Date
Application Approved
Application Disapproved forahe following reasons
Permit No. ZaDate Issued
1' FHECO MONWEALTH OF MASSACHUSETTS YMtek vim ,dC�
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
- 0(ppYication for Migogar 6pgtern Construction" Permit aS
Application is hereby made for a Permit to Construct(X)or Repair( )an On-site Sewage Disposal System at-
k Location Address or Lot No' t Owner's Name,Address and.Tel.No.
�vs. T
S057
Installer's Name,Address,and Tel.No. + Designer's Name,Address nd Tel.No.
E,�tac - 3u . y4.
gz3 � v.4
YAv-r- 17)14 P4DOUT 362 8/ 3 Z
r �
Type of Building:
Dwelling No.of Bedrooms 3 Garbage Grinder(W4
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow F 5 gallons per day. Calculated daily flow gallons.
Plan Date 6C ., s' Number of sheets / Revision Date
Title SEaT!C 6YJ7Zw4 ?i)e-:_s4 AD
i�. Description of Soil
Nature of R airs or Alt Mons(Answer when applicable)
ri S Y -
Date last inspected: ti
Agreement:
The undersigned agrees to ensure the construction and waniamme of the afor described on-site siwag dsal system
in accordance with the provisions of Title 5 of the Environmental Code and not to lace the sys 2a nt l a Certifi-
cate of Compliance has been issMb Health.
Signed Date
Application Approved
Application Disapproved for the following reasons
Permit No. l W 6 - Date Issued 2
THE COMMONWEALTH OF MASSACHUSETTS
i
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
Certificate of Compliance -
THIS IS TO CERTIFY,that the On-site Sewage Disposal System.installed( )or repaired/replaced( )on
by for �KQ
as has been constructed in accordance
01
with the provisions of Title 5 and the for Disposal System Construction Permit No. ' dated
Use of this system is conditioned on compliance with the provisions set forth belo47
4411
Fee ` O OJ
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
Mir ?La�,*pgtem //�Con5truction Permit
Permission is hereby granted to tZ7 I
to construct( )repair`�)an On-site Sewage System located at 0 9(9 /VIA
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/,her dutyto
comply with Title 5 and the following local provisions or special conditions. rJ
All construction must be completed within two years of the date below. ' U
�. �- I - 7 f - Date: � v7 Approved by It j it.
i
f
' ��� ash'•
` 0n �^ � �-
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
d DEPARTMENT OF ENVIRONMENTAL PROTECTION
Q
TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
( PART A
1 CERTIFICATION
Property Address: 4W Route 6A,Cummaquid,MA 02637 J 5
Owner's Name: Steven Rizzo t `_
Owner's Address: 40%Route 6A,Cummaquid,MA
Date of Inspection: 10/04/2007 `) - ?`
Name of Inspector:Reid C!Ellis
Company Name:Ellis Brokers Const.Co. Q
Mailing Address:23 Enterprise Road
Yarmoith Port,MA 02675
Telephone Number:508-362-6237
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported
below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my
training and experience in*e proper fimetion and maintenance of on site sewage disposal systems.I am a DEP
approved system inspector,pursuant to on 15-W of Title 5(310 CMR 15.000). The system:
I Passes
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
Fails
Inspector's Signature: Date:
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or
DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000
gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the
DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving
authority. j
Notes and Comments
****This report only descl 'bes 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 fature under the same or different
conditions of use.
1
Title 5 Inspection Form 4/15/2000 Page 1
I,
Page Z of l l
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 4096,1 Route 6A,Cummaquid,Ma
Owner: Steven Rizzo I
Date of Inspection: 10/0', 2007
Inspection Summary: Check AAC I)or E/ALWAYS complete all of Section D
V
tem Passes:
.Ihave not fo any information which indicates that any of the failure criteria described in 310 CMR
or in 310 CMR 15i304 exist.Any failure criteria not evaluated are indicated below.
Comments: I
1
B. System Conditionally Passes: �
One or more systeI components as described in "Conditional Pass"section need to be replaced or
repaired.The system,upon completion of the replacement Dr repair,as approved by the Board of Health,will pass.
�I
Answer yes,no or not determined(Y,N ND)in the f r the following statements.If"not determined"please
explain. I
The septic tank is metal and over 20 years old*or t ie septic tank(whether metal or not)is structurally
unsound,exhibits substantial infiltration or exfilt ation or failure is imminent.System will pass inspection if the
existing tank is replaced v�+ith a complying septiF
k as proved by the Board of Health.
*A metal septic tank will pass inspection if it is turall sound,not leaking and if a Certificate of Compliance
indicating that the tank is.ess than 20 years old ailabl .
ND explain:
Observation of sewage backup or break out or higi static water level in the distribution box due to broken or
obstructed pipe(s)or due to a broken,settled or uneven di.,ubution box.System will pass inspection if(with
approval of Board of Health):
broken pipe(s)are re laced
obstruction is remov
distribution box is lei eled or replaced
ND explain:
The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will
pass inspection if(with roval of the Board of Health):
f broken pipes)are repaced
f obstruction is removec
ND explain:
1 2
2
Page 3 of 11 I
OFFICIAL INSPECTION FORM-NOT SAL SYSTEM INSPECTION FORM ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL
A
I CERTIFICATION(continued)
Property Address: 44096R,oute 6A,Cummaquid,MA
Owner: Steven Rizzo j
Date of inspection:. 10/04�2007 �
C. Further Evaluation. Required by the Board 049
Conditions exist which require further evaluation b the Board of Health in order to determine if the system
is failing to protect public health,safety or the environmen
1. System will pass u�less Board of Health determ' es in accordance with 310 CMR 15.303(l)(b)that the
system is not functioning in a manner which will protect public health,safety and the environment:
— Cesspool or vy is within 50 feet of a surfarA water wetland or a salt marsh
_ Cesspool or privy is within 50 feet of a borde vegetated
2. System will fail unless the Board of Health(and blic Water Supplier,if any)determines that the
system is functioning' a manner that protects the blic health,safety and environment:
_ has tic tank and soil absorpti
The system(SAS)and the SAS is within 100 feet of a
system a septic
surface water supply or tributary to a surface water ly.
— The system h I a septic tank and SAS and the 3AS,is within a Zone I of a public water supply.
— The system has a septic tank and SAS and the 3AS is within 50 feet of a private water supply well.
_ The system has a septic tank and SAS and the AS is less than 100 feet but 50 feet or mor e from a
private water supply well**.Method used to detern ine distance
**This system passes if the well water analysis, ormed at a DEP certified laboratory,for coliform
bacteria and volatile organic compounds indicates the well is free from pollution from that facility and
the presence of ammonia nitrogen and nitrate ni n is equal to or less than 5 ppm,provided that no other
failure criteria are triggered.A copy of the analysis ust be attached to this form.
3. Other:
I
I
I 3
I . 3
r
Page 4 of 11 j
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
I CERTIFICATION(continued)
Property Address: 4096 Route 6A,Cummaquid,MA
Owner: Steven Rizzo
Date of Inspection: 10/04(M7
D. System Failure Criteeria applicable to all systems:
You must d'cate"yes"of"no"to each of the following for all inspections:
Yes
kup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
_ ischarge 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
pool
i d depth in cesspool is less than 6"below invert or available volume is less than%2 day flow
pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number
— o . pumped .
on of the SAS,cesspool or privy is below high ground water elevation.
_ on of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
P1Y-
_ _ rtion of a cesspool or privy is within.a Zone 1 of a public well.
_ y portion of a cesspool or privy is within 50 feet of a private water supply well.
Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water
supply well with no acceptable water quality analysis.[This system Passes if the well water analysis,
performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds
indicates that the well is free from pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria
are triggered.A copy of the analysis must be attached to this form.]
I
_44es/No)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 deteermine what will be necessary to correct the failure.
I
E. Large Systems:
to 15,000
To be considered a larg system the system must serve a facilitywith a des flow of 10,000 gpd
You must indicate either!`yes"or"no"to each of the foll wing:
(The following criteria apply to large systems in addition to the criteria above)
yes no f
— _ the system is within 400 feet of a surface drinld ag water supply
_ — the system is within 200 feet of a tributary to a urface drinldng water supply
_ the system is 1acated in a nitrogen sensitive Qnterm Wellhead Protection Area—IWPA)or a mapped
Zone Il of a public water supply well
If you have answered"y les"to any question in Section E e system is considered a significant threat,or answered
"yes"in Section D above the large system has failed.Th owner or operator of any large system considered a
significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR
15.304.The system own x should contact the appropriate regional office of the Department.
1 4
L - - -- 4
Page 5 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSALB YSTEM INSPECTION FORM
PART
1 CHECKLIST
Property Address: 4096 Route 6A,Cummaquid,MA
Owner: Steven Rizzo I
Date of Inspection: 10/0"M
Check if the following have been done.You must indicate"yes"or"no"as to each of the following:
I
Y No I
pumping information was provided by the owner,occupant,or Board of Health
re any of the system components pumped out in the previous two weeks?
— — the system received normal flows in the previous two week period?
_ Have large vol{nines of water been introduced to the system recently or as part of this inspection?
_ examined?(If they were not available note as N/A)
Were as:built plans of the system obtained and
Was the facility or dwelling inspected for signs of sewage back up?
— Was the site in pected for signs of break out?
Were all system components,eluding the SAS,located on site?
Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition
of th affles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum
_ _ Was the facility owner(and occupants if different from owner)provided with information on the proper
maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System(SAS)on the site has been determined based on.
Y no
Existing infor nation.For example,a plan at the Board of Health.
Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance
is unacceptable)[310 C*15.302(3)(b)]
I 5
Page 6 of 11 {
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART
I SYSTEM INFORMATION
Property Address: 4096 Route 6A,Cammaquid,MA
Owner. Steven Rizzo
Date of Inspection: 10/04/=7
FLOW CONDITIONS
RESIDENTIAL J
Number of bedrooms(design): Number of bedrooms(actual):
DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms):
Number of current residents:
Does residence have a garbage grinder(yes or no):
Is laundry on a separate sewage system(yes or now[if yes separate inspection required]
Laundry system inspected(yes or no):
Seasonal use:(yes or no): M7 Co �_
Water meter readings,if available(last 2 years usage(gpd)): A-
sump pump(yes or no):
Last date of occupancy:
COMMERCIAL/INDUSTRIAL �I/ —
Type of establishment:
Design flow(based on 310 CMR 15203): Td
Basis of design flow(seatsfpetsons/sg8,etc•):
Grease trap present.(yes or no):—
Industrial waste holding tank present(yes or no):—
Non-sanitary waste,discharged to the Title 5 system(yes r no):
Water meter readings,if available:
Last date of occupancy/use:
OTHER(describe): 1A
GENERAL INFORMATION
Pumping Records IK - �'� ��- ZU q '-,- 7
Source of information:
Was system pumped as part of the inspection(yes or no):
o H w was determined?
If yes,volume pumped: � q ty piimP�
;Sn;r pumping:SYSTEM tank,distnbution box,soil absorption system
_Single cesspool
_Overflow cesspool
—Privy
_Shared system(yes or no)(if yes,attach previous inspection records,if any)
_Innovative/Alternate,fe technology.Attach a copy of the current operation and maintenance contract(to be
obtained from system om ner)
—Tight tank _At ach a copy of the DEP approval
_Other(describe):
i
Approximate age.of all co rents,da�kmtaIIed(if own), source of info ` Ali
A/Ve
Were sewage odors detected when arriving at the site(yes or no)
6
{ 6
f
Page 7 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSALC SYSTEM INSPECTION FORM
PART
SYSTEM INFORMATION(continued)
Property Address: 40%Route 6A,Cummaquid,Ma
Owner:Steven Rizzo
Date of Inspection: 10/04% W
BUII.DING SEWER(loci to on site plan) H
dl �y� W � O L
Depth below grade:��
Materials of construction: cast iron /40 PVC_other(explain):
Distance from private water supply well or suction line: L 7 e
Commen�(sn con ' 'on ofloints,y tin evidences of leakage,etc.): q/ � JplO 14
`ytJ �U 4
SEPTIC TA:e7
on site plan)
Depth below
Material of construction: ! concrete metal fiberglass polyethylene
/ other(explain)
y no):—(attach a copy of
/a+fttank is metal list age:i Is age conf rmed by a Certificate of Compliance( es or no
certificate)
Dimensions: a k I S k N
Sludge depth: "� 14
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 bale:
Distance from bottom of cum to bottom of outl tee or battle:
How were dimensions determined: liquid levels
Comments(on pumping recomm ns,inlet and outlet tee o baffle condition, aural integrity,
#s rglated to outlet" ve e ' ence of 1pkag ,etc.):
.01
JJ,-a-= jo) 44 evJ
GREASE TRAP: (locate on site plan)
I
Depth below grade:_
Material of construction:Lconcrete metal—fib Tglass_polyethylene other
(explain):
Dimensions:
Scum thickness:
Distance from top:ofp scc to top of outlet tee or bafflt
Distance from bottom of cum to bottom of outlet teebaffle:
Date of last pumping: li uid levels
Comments(on pumping mmendations,inlet and let tee or baffle condition,structural integrity, q
as related to outlet inverf, evidence of leakage,etc.):
------------------
1 7
Page 8 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SME S
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION
FORM
PART C
SYSTEM INFORMATION(continued)'
Property Address: 4096 Route 6A,Cummaquid,MA
Owner. Steven Rizzo
Date of Inspection: 10/04' 007
TIGHT or HOLDING T K: (tank must be p d"at time of inspection)(locate on site plan)
T
Depth below grade:
Material of construction: concrete metal fil erglass_polyethylene other(explain):
Dimensions: I
Capacity: i gallons
Design Flow: I gallons/day
Alarm present(yes or no):
Alarm level: Alarm in working order(yes or no):
Date of last pumping:
Comments(condition of alarm and float switches,etc.):
I
DISTRIBUTION BOX:�Itf present must be opened)(locate on site plan)
Depth of liquid level abo�a outlet invert:,
Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of
1 into r out of bot .)t
PUMP CHAMBER: I (locate on site plan)
Pumps in working order�es or no):
Alarms in working order(yes or no):
Comments(note conditio i of pump chamber,conditioj k of pumps and appurtenances,etc.):
I
� 8
I� I
Page 9 of I I
OFFICIAL.INSPECTION FORM—NOT FOR VOLUNTARYSVEF ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION
ORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 4096 Route 6A,Commaquid,MA
Owner:Steven Rizzo I
Date of Inspection: 10/04I%1007
SOIL ABSORPTION SYSTEM(SAS): to on site plan,excavation not required)
If SAS not located explain*hy:
1
i
Type
Pits,num
ching ber— d�4
I
ching chambers,number•.r
leaching galleries,number.
leaching trenches,number,length:
leaching fields,numlier,dimensions:
overflow cesspool,ntu n
innovativelalternativf system Type/name of technology
Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,
etc.)- r
�CESSPOOL
I,S- (cesspool must be pumped as part 0inspectionxlocate on site plan)
Number and configuration:
Depth—top of liquid to inlet invert:
Depth of solids layer.
Depth of scum layer 1
Dimensions of cesspool:
Materials of construction:'
Indication of groundwatej-inflow(yes or no):
Comments(note conditio 1 of soil,signs of hydraulic fail ,level of ponding,condition of vegetation,etc):
1
yi
i
PRIVY- (locate on bite plan)
Materials of construction
Dimensions:
Depth of solids: I
Comments(note condition of soil,signs of hydraulic fail ,level of ponding,condition of vegetation,etc.):
i
I 9
I 9
Page,10 of 1.1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C Al
i SYSTEM INFORMATION(continued)
Property Address: 4096 Route 6A,Cummaquid,MA
Owner: Steven Rizzo
Date of Inspection: 10/0Q007
I
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or
benchmarks.Locate all Wells within 100 feet.Locate where public water supply enters the building. sNebo A-11
6
IA
VJ Pfi
kqri
VeI r�
V4
10
2-
iq
T:al..G T...�....w:..�T`--L i1 t NnM 10
Page u of rl
OFFICIAL INgPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURF. CE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
I PART C
SYSTEM INFORMATION(continued)
Property Address:. 4096 Route 6A,Commaquid,MA
Owner: Steven Rizzo {
Date of Inspection: 10/0,M2007
SITE EXAM
Slope
Surface water /VJ N-v /Q .l,{/.l �'✓
Check cellar 17 c mac_ Gv c&,oZ a4.. fie► -•s2- Goa
Shallow wells �� c
Estimated depth to groan water feet 1/lY'tl
t/ (.�v► iv V
Please indicate(check)a#methods used to determine the high ground water elevation:
Obtained from system design plans on record-If checked,date of design plan reviewed:
Observed site(abutting property/observation hole within 150 feet of SAS)
Checked with local 13oard of Health-explain:
� Xhecked with local excavators,installers-(attach documentation)
V Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
I1 �
r.
- -�-c Mrs& Pie- le-a v14 goy
A
�.,�i4r.1.�
/ b�
� 11
Town of Barnstable
OF THE Tp�
Regulatory Services
,STAB Thomas F. Geiler,Director
AIED MA'S A
1639. Public Health ,Division
Thomas McKean,Director
200 Main Street, Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
This septic system inspection report was completed by a private inspector who is certified
by the State of Massachusetts, Department of Environmental Protection.
Although the Town of Barnstable Health Division received the original/copy of this
report; this Division does not warranty the functionality of the septic system in the future
nor does this Division agree with any technical observation s and interpretations
contained within this report.
In addition, by receiving this report the Town of Barnstable Health Division does not
automatically approve the number of bedrooms listed within this report. The actual
number of bedrooms approved at a particular property would-be listed on the"Disposal
Work Construction Permit".
If you should have any questions regarding this report,please contact the certified Septic
System Inspector who conducted the inspection.
F
F
e
S WEETSER ENGINEERING
P.O. BOX 713 - SOUTH DENNIS - MASSACHUSETTS 02660
TEL (508) 398-3922 FAX (508) 398-3063
LAND SURVEYING - ENGINEERING
8 9
10
May 30, 1997
r
J U-N 2 1997
Health Department TOWN OFBARNSTABLE N
TOWN OF BARNSTABLE HE41_TN OPT
367 Main Street
Hyannis, MA 02601 4*
RE: Septic Certification @ 4096 Main Street
Cummaquid '
I have conducted inspections"during various stages of construction of the
septic system at the above referenced property on May 20, 24, and 25, 1997,
and find the system was, installed in substantial compliance with a Plan by
Eagle Surveying & Engineering, Inc.' on a-scale of l" = 20' dated November,
18, 1996.
Removal of unsuitable material in the area of the SAS was completed to a
depth of 22- feet, and.. replaced with clean medium sand.
.
Very truly yours,
Theodore A. Dumas, R.S., S.E.
CC: Ellis Bros.
TAD/cwk
COMMONWEALTH OF MASSACHUSETTS
ExECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
h �
TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION RECEIVED
Property Address: L4 0'CI& F n S� 2) 6'�
(l ars °tJi) .� ,�-��-- � 3� NOV 0 5 2001
Owner's Name: �( _Sry r
Owner's Address:_ (06 Lam,:+ lG� % �i y TOWN OF BARNSTABLE
HEALTH DEPT.
fit• �� 7g
Date of Inspection 5C,3k
Name of Inspector:(please nint) R E I D C. E L L I S
Company Name: E L L I'S g CRIERS CuNst . cu.
Mailing Address: 23 ENTERPRISE ROAD, P.O. BOX 59, YARMOUTH PORT, MA
Telephone Number: 5 011_3 6 p_5 2-1 7
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported
below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my
training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP
approved system inspector pursuant to Section 15.M of Title 5(310 CMR 15,000). The system:
/Passes
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
Fails
Inspector's Signature: Date:�-- •-
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or
DEP)within 30 days of completing this inspection.If the system is a shared system or has a design now of 10,000
gpd or greater,the inspector dnd the system owner shall submit the report to the appropriate regional office of the
DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving
authority.
r
Notes and Comments
****This report only describes conditions at the time of inspection and under the conditions of use at that
time.This inspection does not address Itow the system will perform in the future under the same or different
conditions of use.
rpm- 7�3(oOSC-A
t._r-
Title 5 insnectinn Fnrm 6/15/2nnn naoe 1
G.
Page 2 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 1--10�� l��/..A A t- !�
Owner•
Date of Inspection: (n 1_;fir, i b!
Inspection Summary: Check ,B,C,D or E!ALWAYS complete all of Section D
A. System Passes: NQ/J
A I have not found any information which indicates that any of the failure criteria described in 310 CMR
15.363 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below.
Comments:
B. System Conditional Pas
ses: (repair.
One or more system components as described in thitional Pass"section need to be replaced or
repaired.The system,upon completion of the replacement as approved by the Board of Health,will pass.
Answer yes,no or not determined(Y,N,ND)in the fo the following statements.If"not determined"please
explain.
The septic tank is metal and over 20 years old*or th septic tank(whether metal or not)is structurally
unsound,exhibits substantial infiltration or exfiltration or failure is imminent.System will pass inspection if the
existing tank is replaced with a complying septic tank as apj Toved by the Board of Health.
*A metal septic tank will pass inspection if it is structurally iound,not leaking and if a Certificate of Compliance
indicating that the tank is less than 20 years old is available
ND explain:
Observation of sewage backup or break out or high tic water level in the distribution box due to broken or
obstructed pipe(s)or due to a brokm settled or uneven distr tibution box.System will pass inspection if(with
approval of Board of Health):
broken pipe(s)are reph ced
obstruction is removed
distribution box is level or replaced
ND explain:
The system required pumping more than 4 times a yc ar due to broken or obstructed pipe(s).The system will
pass inspection if(with approval of the Board of Health):
broken pipe(s)are replacpd
obstruction is removed
ND explain:
Page 3 of I 1
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: L-1 cf P1 -i r;,
owner: S e n . t -
Date of Inspection: II
C. Further Evaluation is Required by the Board of Health%vo
Conditions exist which require further evaluation by the B d of Health in order to determine if the system
is failing to protect public health,safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the
system is not functioning in a manner which will proted public health,safety and the environment:
_ Cesspool or privy is within 50 feet of a surface water
_ Cesspool or privy is within 50 feet of a bordering veg tated wetland or a salt marsh
2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the
system is functioning in a manner that protects the public I ealth,safety and environment:
_ The`system has a septic tank and soil absorption syst (SAS)and the SAS is within 100 feet of a
surface water supply or tributary to a surface water supply
The system has a septic tank and SAS and the SAS is within a Zone I of a public water supply.
— The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well.
— The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a
private water supply well's.Method used to determine di tance
"This system passes if the well water analysis,performec at a DEP certified laboratory,for coliform
bacteria and volatile organic compounds indicates that the ell is free from pollution from that facility and
the presence of ammonia nitrogen and nitrate nitrogen is e jual to or less than 5 ppm,provided that no other
failure criteria are triggered.A copy of the analysis must I e attached to this form.
3. Other:
Page 4 of I 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: -c:1 o t h . . - Q
Owner. Si'l s ll
Date of Inspection:1j_j._,T�l._ _
D. System Failure Criteria applicable to all systems:.
You must indicate"yes"or"no"to each of the following for all inspections:
Yes No/
�/�ackup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
, Llogged SAS or cesspool
V Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
— _t
� cesspool
id depth in cesspool is less than 6"below invert or available volume is less than/2 day flow
_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number
�df times pumped
V portion of the SAS,cesspool or privy is below high ground water elevation.
V Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
/water supply.
y rtion of a cesspool or privy is within a Zone I of a public well.
y portion of a cesspool or privy is within 50 feet of a private water supply well.
Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water
supply well with no acceptable water quality analysis.(This system passes if the well water analysis,
performed at a DEP certified laboratory,for 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,provide that no other failure criteria
are trigge A py of the analysis must be attached to this form.)
(Yes/No)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 trino orrect the failure.
/`P"�
E. Large Systems:
To be considered a large system the system must erve a facility with a design flow of 10,000 gpd to 15,000
gpd.
You must indicate either`yes"or"no"to each of th following:
(The following criteria apply to large systems in add ition to the criteria above)
yes no
the system is within 400 feet of a surface ing water supply
r _ the system is within 200 feet of a tributary o a surface drinking water supply
the system is located in a nitrogen sensitiv area(Interim Wellhead Protection Area—IWPA)or a mapped
Zone I1 of a public water supply well
If you have answered"yes"to any question in Sectio i E the system is considered a significant threat,or answered
"yes"in Section D above the large system has failed.The owner or operator of any large.system considered a
significant threat under Section E or failed under Sec ion D shall upgrade the system in accordance with 310 CMR
15.304.The system owner should contact the aPPrOPI'ate regional office of the Department.
Page 5 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: V j(,
Owner:
Date ofInspection: IQ /�0
Check if the following have been done.You must indicate"yes»or"no"as to each of the following-
JYIN4 o
ping information was provided by the owner,occupant,or Board of Health
_ Were any of the system components pumped out in the previous two weeks
the system received normal flows in the previous two week period?
_ Have large volumes of water been introduced to the system recently or as part of this inspection?
Were as built plans of the system obtained and examined?(If they were not available note as N/A)
Was the facility or dwelling inspected for signs of sewage back up
Was the site inspected for signs of break out?
Were all system components,anclu ding the SAS,located on site?
Were the septic tank manholes uncovered,opened;and the interior of the tank inspected for the condition
of the ffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum?
_ Was the facility owner(and occupants if different from owner)provided with information on the proper
maintenance of subsurface sewage disposal systems
The size and location of the Soil Absorption System(SAS)on the site has been determined based on:
lnoe7
Existing information,For example,a plan at the Board of Health.
Determined in the field(if any of the failure-criteria related to Part C is at issue.approximation of distance
is unacceptable)[310 CMR 15302(3)(b)j
Page 6 of i l
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address= _ _ x
Owner: 5'4,6 r._ f-e
Date of Inspection: IOC tv 01
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design):. Number of bedrooms(actual):
DESIGN flow based on 310 CMR 15203(for example: 110 gpd x#of bedrooms):
Number of current residents: / _
Does residence have a garbage grinder(yes or no):/vy
Is laundry on a separate sewage system(yes or no);,f if yes separate inspection required]
Laundry system inspected(yes or no)'40
Seasonal use:(yes or no):,ej(eV
Water meter readings,if available(last 2 years usage(gpd)):
Sump pump(yes or no):
Last date of occupancy:
COMMERCIAL/INDUSTRIAL
Type of establishment:
Design flow(based on 310 CMR 15.203). gpd
Basis of design flow(seats/persons/sgftetc,):
Grease trap present(yes or no):_
Industrial waste holding tank present(yes or no):_
Non-sanitary waste discharged to the Title 5 system(yt or no):T
Water meter readings,if available:
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information: Zl-kJLo—/4 V-- Aj,/y, .09
Was system pumped as part of the inspection(yes or no)4fum,
If yes,volume pumped: sbo jpns Ho j�was quaned determined? �.. ON
Reason for pumping: L2.e� r �J
VTY OF SYSTEM
Septic tank,distribution box,soil absorption system
—Single cesspool
_Overflow cesspool
Privy
4 Shared system(yes or no)(if yes,attach previous'inspection records,if any)
Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be
obtained from system owner)
_Tight tank Attach a copy of the DEP approval
Other(describe):
Apr prone of allmponentt , tinslie (ifgp )� s of' ormation:
Were wa ooddors�detected w en arnviig/the site or no):,
Page 7 of l 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: '}Gi r 5'i �i`6
Owner:
Date of Inspection: )o1jal. 1 61
BUILDING SEWER(locate on site plan)
Depth below grader d ork'"— 6 v G
Materials of construction: cast iron 40 PVC_other )
(ex lain: ^i
P
Distance from private water supply well dr suction line: t C.q ;Aft
Co mme is(o c ndition of jowts,yeating,evidence of leakage etc.
�'I e 1NS�.Gt�N ��Q A16 tok-s - - >,�•�.
SEPTIC TANK: locate on site plan)
Depth below grade:
Material of construction: concrete metal fiberglass_polyethylene
other(explain)
If tank is metal fist age:— Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of
certificate)
Dimensions: �
Sludge depth:
Distance from top of sludge to bottom of outlet tee or baffle: 30
Scum thickness: 1 4.
Distance from top of scum to top of outlet tee or battle: It"
Distance from bottom of scum to bottom of o tlet tee or baffle: L 3`t .
How were dimensions determined: wvti A.o 4--
wsOi T
Comments(on pumping recommendations and outlet A or ba a eondit onon,structural wctural integrity,liquid levels
as related outlet' v q
ui ert,evidence of leakage, .}:
�.
J
GREASE TRAP:,,,„(locate on site plan)
Depth below grade:-
Material of construction: concrete metal fiber s____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 orb flie:
Date of last pumping:
Comments(on pumping recommendations,inlet and outle tee or baffle condition,structural integrity,liquid levels
as related to outlet invert,evidence of leakage,etc.):
Page 8 of I 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: LI C'%
Owner: 5 s
Date of Inspection:_ )� (al Ol
N i�
TIGHT or HOLDING TANK: (tank must be p d at time of inspection)(locate on site plan)
Depth below grade:
Material of construction: concrete metal fl berglass^polyethylene other(explain):
Dimensions:
Capacity: Gallons
Design Flow gallons/day
Alarm present(yes or no):
Alarm level: Alarm in working order(yes or n
Date of last pumping:
Comments(condition of alarm and float switches,etc.):
DISTRIBUTION BOX:�1"'if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: A10
Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of
leakage into or out o box,etc.):
c � C
PUMP CHAMBER: (locate on site plan)
Pumps in working order(yes or no):
Alarms in working order(yes or no):
Comments(note condition of pump chamber,condition f pumps and appurtenances,etc.):
Page 9 of I I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: Lj C (9
Owner: S 4,n
Date of inspection: a(fil p
SOIL ABSORPTION SYSTEM(SAS): ocate on site plan,excavation not required)
If SAS not located explain why:
Type
leaching pits,number:_
'00"P leaching chambers,number.
leaching galleries,number.
leaching trenches,number,length:
leaching fields,number,dimensions:
overflow cesspool,number:
innovative/alternative system Type/name of technology:
Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,
etc.):
s41 -- , —�
1
CESSPOOLS: (cesspool must be pumped as part f inspectiom)(locate on site plan)
Number and configuration:
Depth—top of liquid to inlet invert:
Depth of solids layer.
Depth of scum layer:
Dimensions of cesspool:
Materials of construction:
Indication of groundwater inflow(yes or nor
Comments(note condition of soil,signs of hydraulic farure,level of ponding,condition of vegetation,etc.):
PRIVY: (locate on site plan)
Materials of construction:
Dimensions:
Depth of solids:
Comments(note condition of soil,signs of hydraulic fa lure,level of ponding,condition of vegetation,etc.):
Page 10 of I 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:_�{,a
Owner:
Date of Inspection:
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or
benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building.
2y
A.. Qy
7?
3 �
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Page 11 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued).
Property Address: !-Ae(a P-, j -(,
tc '
Owner: S 4S-qn 4-eq4Zt
�-
Date of Inspection: i0 j a� j D l
SITE EXAM
Slope -
Surface water y 6"
Check cellar .
Shallow wells AA—
Estimated depth to ground water,/7 feet'
M
Please
'indicate(check)all methods used to determine the high ground water elevation:
ed from system design plans on record-If check date of d reviewed.• 0''r�"'
ys gap checked, design Plan
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: �2. O
You must describe how you established the high ground wate elevation:
�eot t
or wat/-
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GENERAL NO TES : INVERT ELEVATIONS : ICES 1 GN CR I TER ,I A : .
GRND EL 42.0 ORND EL. 39:4 GRND EL. 34.5 ORND EL 38.a
O.W.EL. N/A O,w.FL. NIA G.W.EL N/A O.W.EL. 2 1.8 DESIGN FLOW
INVERT AT BUILDING: 37 05
I. THIS PLAN IS FOR THE DESIGN AND CONSTRUCTION HORIzoN rExruRE catOR HOR1zoN rfxTURE cotOR HORIZON TEXTURE cotoR INVERT IN,SEPTIC TANK: 5.6 2.-.BEDROOMS AT110 G.P.D. PER
0. 42.0 0 $9,4 0 34,5 0' 38.8
OF THE SEWAGE DISPOSAL SYSTEM AND 'WETLAND INVERT OUT, SEPTIC TANK: 35.35 BEDROOM EQUALS 330 G.P.D.
SANDY /OYR SANDY IOYR SANDY /OYR
PERMITTING PURPOSES ONLY. A LOAM 3/4 A LOAM 3/4 A LOAM 3/4 SAME AS TEST PIT r3 INVERT IN DIST, BOX: 34.77
/0'. ................................... 41.2 10' ...................... 38.6 10' .... 33.7 15' ................................... 3.8 NO
COMPACT 2.5Y COMPACT 2.5Y COMPACT 2.5Y 2 GARBAGE GRINDER
••• INVERT OUT DIST- BOX: 34,6
2. ALL CONSTRUCTION METHODS AND MATERIALS AND 8 -sANDr LOAM 4/4 B sANDr LOAM 4/4 B SANDY LOAM 4/4 COMPACT INVERT IN LEACH CHAMBER: 34,4
MAINTENANCE OF THE SEPTIC SYSTEM SHALL 24 ........• ........•.............. 40.0 24' ............ ..................... J7.4 24- ................. .... ...... 32.5 17• LOAMY SAND 21.8. sA SEPTIC TANK REQUIRED:' _
BOTTOM OF LEACH CHAMBER: 32.4
CONFORM TO MASS: D.E.P. TI TLE 5 AND LOCAL caMPAcr 2.sr LOAMY SAND 2.5Y COMPACT 2.5Y = -ID-G.P,D. X 200x 660 GAL.
SANDY LOAM 316 W/COBBLES ` 4/4 SANDY LOAM 5/6 ADJUSTED GROUND WATER: 25.4 BOARD of HEALTH REGULATIONS. w/COBBLES 60' •.••• SEPTIC TANK PROVIDED: IS00 GAL: =
34.4 wicoBBLEs OBSERVED GROUND WATER: 21.8
COMPACT 2.5Y
3. ALL SEPTIC SYSTEM COMPONENTS LOCATED UNDER C2 SANDY LOAM 516 sanrRDSE BOTTOM OF TEST BORING *4: 11,8 SOIL ABSORPTION SYSTEM REQUIRED:
w/COBBLES
AREAS SUBJECT TO VEHICULAR TRAFFIC OR GREATER DESIGN PERC RATE -1 MIN/INCH
102' 0 WAT R 33.5 96' 0 WATER 31.4 96' NO wAT R 26.5 27' d!.8
THAN 3' IN DEPTH SHALL BE CAPABLE OF WITH- SOIL TEXTURAL CLASS
STANDING H-20 WHEEL LOADS. DATE: AUGUST 29, 1996 1 EFFLUENT LOADING RATE - 074 GPD/SF
DATE: OCTOBER 1. 1996
STEPHEN HA S 330 GPD J_ 0,74 GPD/SF - 46 S.F.
TEST BY TEST BY: TEPHEN HAAS
4. ALL SEWER PIPE SHALL BE SCHEDULE 40 OR
APPROVED EQUAL WITNESSED BY: ED BARRY WITNESSED BY: ED BARRY
WETLAND 14
PERC RATE: NONE MIN/INCH \� PERc RATE: � 2 MIN/INCH PROVIDED:_2-500 GA__L� ACHI�[ jjA F�ERS
\ W/4' STONE AROUND, A-471 S.F.
5. BEFORE CONSTRUCTION CALL 'DIG-SAFE'. , �\ ♦�♦ �---- \\� ASSUMED IN COARSE SAND LAYER
1-800-322-4844 AND THE LOCAL WATER DEPT. ` ♦♦ �\ �� WETLAND 13
FOR LOCATION OF UNDERGROUND UTILITIES. \ `
6. VERTICAL DATUM IS: NGVD
N
7, FOR BENCH MARKS SET. SEE SITE PLAN.
.� !a\ LE WETLAND 12
8, EXISTING CESSPOOL TO BE PUMPED DRY AND o \` \\ \��`- \� ��� N -4,
BACKFILLED. MAPLX
15' MAPLE 4r
4 \ \ N WETLAND I
9. ALL UNSUITABLE MATERIAL (A d B HORIZONS. 8' 94PL) 2� TREE \\ '���� \\ \ w WETLAND a
COMPACT SANDY LOAM AND LOAMY SAND) ENCOUNTERED i5• M, LE yti \y \� \\ 4N0 WETLAND WETLAND s
BELOW THE INVERT OF THE LEACHING FACILITY _.........0 ... `'..:...............Eo ...... .�..... ♦..w.... \ \` f0 METLAND to r' �!' Foy
�r-
A z W. ILLS _^
\ \ \
TO BE REMOVED FOR A DISTANCE OF 5' AROUND \ \
\ 7' HAWTHORNf \\ \\ - ��`
(DOWN TO THE COARSE SAND LAYER) AND REPLACED \ \ 1500 OAL N G
W/TH SAND /N ACCORDANCE WITH TITLE 5. \\s \ WETLAND 9 / \
�\ \ £PT 1 C TANK \ \ ,�- \ J r fYETLAND 4
� \ \ `'�� •�` � \ 0 ,_•FOUR 8' MAPLE \ •��y, "''''` -�.I( // \ -
\ \
l0. .WHERE THE WATER AND SEWER L INF. CROSS. THEY ARE 8' PLE \ �\\EssPOoZ� WILLO
TO BE CONSTRUCTED IN ACCORDANCE WITH TITLE 5 AND
LOCAL BOARD OF HEALTH REGULATIONS. a PATIO i ���� �s�` ��``\ \\\ ♦\\ �o. \\, 'i
\ \ It ` � .�CEO
40' AAPLE IN \ \ �•P,NVER BA RN TPr3 �� \\ ~�� --- _ � AvETLAND 3
A:[�`� `♦ '2%' TREE \ �\ ----- ' ' -�
_ C OSD
pos V y Fp \ / WETLAND 2
VARIANCES REQUIRED :
TOWN OF BARNSTABLE HEALTH REGULATIONS: \♦♦24• TREL�-�z~� BH\ v x�^�N` _ -__3 `-`""- --- --r�y cccF°r l 1 �9 •`� _
Tl�k g WAPLfS - _.- IYE L '. `
1 !y• , T BIND �Sa
SECTION I. 13: l 00' IS REQUIRED BETWEEN THE EDGE OF WETLAND AND S1
SOIL ABSORPTION SYSTEM, 60' 1S PROPOSED. A VARIANCE OF 40' IS � , . '��� � \ ` J9 �•" P o ''••
------
REQUESTED.
e `n \.\ 1 NG �LL \♦ p .,.,,..,; - UR i VE ` - UP
z \ gE
p�0
T\ \
\ \
4 \ 5' SOIL REMOVAL
UP 204 sfe NOTE 9. DESIGNING ENGINEER' TPa i
jT
R MUST SUPERVISE
/ - 2-300 GAL LEACH INSTALLATION AND CERTIFY IN WRITING
a 1 - CHAMBERS W 4 STN THE SYSTEM WAS INSTALLED IN, STRICT,-
.68 Z O W T/ ' / PCCORCANCETA
e 5 ,'-� S E-P T / S Y S' ` T EM S I G 1V
r,
Q •.
-4 MA / /V S TREE• T
BARNSTABLE HARBOR \ ��
I�, • , I ,4 !�p
MS TA S 1» E- C UMMA 0 U / D
\ uP 3/20)_ i FREPA RED FOR
m\
S USA N T E-/\ /D L E R
j� 9' MINIMUM. F' . 0 BOX 3(5 > CUMMA QU / D MA 02637
/ ACCESS COVERS MUST BE WITHIN. j _ 3' MAXIMUM COVER
G- 6' OF FINISH GRADE
LOCU FIRST 2' To MH TO FINISH SCA L E : / 20 0 TOBER / 4 . / 996
BE LEVEL GRADE RE- V / S E'D /V O V E-MB ER
Rour sA ``�� MIN 2' OF PEASTONE
y1a j 4- PVC 314' - i 1/2• D/A. E'14 GL .E .S'UR VIE Y rNG �`3L L'NGIN,�'E'R ING INC
scHFDULE 40 7 �92 3 1� O u z� e CA
i `•,.• �5 �, WASHED STONE
37.05 (EX/I 2•ST) - GAS :D 32L2
SLR BAFFLE
RA (PROP 'D) OUTLET 2-500 GAL LEACHING CHAMBERS Y6z 17Z 0 U l` f2'" 0 MA 0 ? �'�'67
_ l0' MIN, D•-BOX W/4 ' STONE AROUND. 12.8'X 25'X 2'
1500 GAL .S
SEPTfC TANK 6_ CRUSHED STONE BASE �- .5 0 -4 32 _ 5.3 3 .3 '
i _ �.
PROF I .• o' oSCALE,.-' .. . ,
! �+ L E NOT, r o . to _ 20
L 0 M,4 P
_ JOB NO r 96-�287 D. V ,. . �
FIELD R B/POR _.CALC. = SAH/CFW CHECK• CFW• ORN• SAH
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