Loading...
HomeMy WebLinkAbout4332 MAIN ST./RTE 6A(BARN.) - Health 43 2 Main Street Barnstable` A= 351-032 a I .. � � \- Commonwealth of Massachusetts 3 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4332 Main Street '_' Property Address �. Patrick Burns fs5 Owner Owner's Name information is required for every Cummaquid iBaeN. MA 02637 10-3-19 page. City/Town State Zip Code Date of Inspection t 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. OF Important:When filling out forms A. Inspector Information �/# lql o�:. �y on the computer, James D.Sears = JAMES . m' use only the tab key to move your Name of InspectorGo z cursor-do not Cap ewide Enter rises i�'•.o o * use the return TI key. Company Name !F 5 I N gPtiG���`` 153 Commercial Street Company Address Mashpee MA 02649 City/Town State Zip Code reran 508-477-8877 S1623 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 (2, 10-4-19 spector'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 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form �a Subsurface Sewage Disposal System Form Not for Voluntary Assessments .. �% 4332 Main Street Property Address Patrick Burns Owner Owner's Name information is required for every Cummaguid MA 02637 10-3-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The system is a 1000 Gal. Tank D Box and two chamber's. 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 S , Commonwealth of Massachusetts ,ip Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a 4332 Main Street Property Address Patrick Burns Owner Owner's Name information is required for every Cummaquid MA 02637 10-3-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 f c Commonwealth of Massachusetts r Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 0 L 4332 Main Street u Property Address Patrick Burns Owner Owner's Name information is required for every Cummaquid MA 02637 10-3-19 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 of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments � 4332 Main Street Property Address Patrick Burns Owner Owner's Name information is required for every Cummaquid MA 02637 10-3-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® 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 '/zday flow. &4e11/Av( ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4332 Main Street Property Address Patrick Burns Owner Owner's Name information is required for every Cummaquid MA 02637 10-3-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes"to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 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 ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner) provided with ❑ ® information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts x Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 0 r 4332 Main Street Property Address Patrick Burns Owner Owner's Name information is Cummaguid MA 02637 10-3-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Description: 1000 Gal.Tank D Box and Two Chamber's. 1 Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): 2017-9,000 Gals2018- 3,000 Gal's Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Present Date t5insp.doc rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments !% 4332 Main Street `J Property Address Patrick Burns Owner Owner's Name information is required for every Cummaquid MA 02637 10-3-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: NA Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons . How was quantity pumped determined? Reason for pumping: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Y� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4332 Main Street L Property Address Patrick Burns Owner Owner's Name information is Cummaguid MA 02637 10-3-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: Tank NA- Leaching 2017 Permit #2017 - 274. Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): 3" 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form it Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4332 Main Street Property Address Patrick Burns Owner Owner's Name information is Cummaguid MA 02637 10-3-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank (locate on site plan): 2' Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 Gal. Precast H-10 2" Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 28" Scum thickness 0" Distance from top of scum to top of outlet tee or baffle 8" Distance from bottom of scum to bottom of outlet tee or baffle 18" How were dimensions determined? Asbuilt-Plan-Tape Sludge Judge 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 at 2' below grade. 32" inlet cover at 15"w/32" outlet cover at 12". In and outlet tee's. No sign of leakage or over loading. t5insp.doc-rev.7/26/2018 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 c Commonwealth of Massachusetts Title ,5 Official Inspection Form <� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4332 Main Street `J Property Address Patrick Burns Owner Owner's Name information is Cummaquid MA 02637 10-3-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 it Commonwealth of Massachusetts Title 5 Official Inspection Form �o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4332 Main Street Property Address Patrick Burns Owner Owner's Name information is Cumma uid MA 02637 10-3-19 required for every q page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank (cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 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 16"x 16"-47" below grade w/cover at 18". Box is clean and solid w/no sign of over loading or solid carry over. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 118 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4332 Main Street Property Address Patrick Burns Owner Owner's Name information is required for every Cummaquid MA 02637 10-3-19 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.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 2 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �. 4332 Main Street U Property Address Patrick Burns Owner Owner's Name information is C Uld required for every umma q MA 02637 10-3-19 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.): Leaching is two 500 Gal. dry well chamber's (13'x25'x2'). Chamber's are wet on bottom w/clean like new wall's. 12. Cesspools (cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts - , Title 5 Official Inspection Form , �N Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4332 Main Street Property Address Patrick Burns Owner Owner's Name information is required for every Cummaguid MA 02637 10-3-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form 0. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 0 4332 Main Street Property Address Patrick Burns Owner Owner's Name information is Cummaguid MA 02637 10-3-19 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 I t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Sep 2E 19, 10:18a Capewide Enterprises 508-477-4977 p.10 TOWN OF B.ARVSTABLE LOCATION 4332 jnn ry_2 SEWAGE# 20t`l •7-`114 j i VILLAGE CU6fma!a Jt L ASSESSOR'S h1AP&PARCEL 3,,) INSTALLER'S NAME&?HONE NO. �r EX07►Va�t On y�� O G53 SEPTIC TANK CAPACITY 1000 f LEACHING FACILITY:(type) 509 LIZ CZ (size) j3 x 2S x Z II NO.OFBEDROOMS 7— OWNER :cA. �cycnci� I PERMIT DATE:_$-IS•1:1 CONIPLIAI`CE DATE: Separador.Distance 3etween the. Maximum Adjusted Groundwater Tabie to the Bottom cf Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on si:e or within 200 feet of leaching facility) Feet i Edge of Wetland and Leaching Facility(If any wetlands exist widen 300 feet of leaching facility) Feet FURNISHED BY I i ti �1Z�3 ►3 L 4 3 , GZ• 39 , c�' So Commonwealth of Massachusetts Title 5 Official 'lnspection Form io Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4332 Main Street Property Address Patrick Burns Owner Owner's Name information is required for every Cummaguid MA 02637 10-3-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells jjc Estimated depth toFigh ground water: 131 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: 7-18-17 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health - explain: ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database -explain: You must describe how 9 you established the-high round water elevation: Y T.H. on Design plan 7-18-17 - 13' no G.W.. Bottom of leaching at 7' below grade. Bottom of leaching at 6'above T.H. Depth. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form < Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4332 Main Street Property Address Patrick Burns Owner Owner's Name information is required for every Cummaguid MA 02637 10-3-19 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 7 4o �£AC'H►�'4 l5'L✓s t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 ' 1�41N O]F t3�NSTh,BLE ILOCIf:'fitON • XVl+I SESSO. R.S iY�+., IN9T1�:LL�It'."�NAt �P�E�Mi3 ND -APA T4C NQ CDF 6® Ot�PIdS ...` .W.- --w. oft.'avdrralz, P'ERNIIT➢ A .._' 4. G1 '°1(;I/NCE`I�AT :_..._••_. .�.�,< .... Sepsuation k ifitounaa Botwea►a;tba' Maxi►tumdt}ustetl Gtputaclwatec Tells to tltc Bcittum oftJeaatiing Nkulity l�iiv��:'�J'at�r aa�ly;U�ati�sict�e�,c:E�ng�acti�ty .�f as�y�ietls exist � as elta ar.wlt in aQQ feet 6�taactugtg facility) lydt�iyf UVeand adI.caclkiPS'Tactltty{tEgriy wetlands exist. wH�ui 30 feat of taaahirig fucilx�Y) ._...r......---_..- �urni�hocl by `-�-" ` L -� i _ �' � _W _� _� O _ _ �.,I W � W � � �1 v - �" 1 �W ;� � � Q � i Ul t W � � (3 � � U � r � � � � �o c � � � ^ 6\ � — �� E TOWN OF BARNSTABLE LOCATION 433 Z (� \cx,,� S4 SEWAGE# -Loin ' z j(4 VILLAGE C L)rnrnaao�►� ASSESSOR'S MAP&PARCEL 3,51 ' 3Z. INSTALLER'S NAME&PHONE NO. G �g EXcb V,4; 0^ L4 )1 • D GS3 SEPTIC TANK CAPACITY 1000 LEACHING FACILITY: (type) sOOc1 C-I(Z� (size) )3 x 2$x Z- NO. OF BEDROOMS Z OWNER EcL 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 ili site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY Al 35 13 13't, C2' 391 © O _ (33" Z3 ' A 4 C3 - yi ' cy- So No. �� .. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 0(ppliLation for -Misposal *pstem Construction permit Application for a Permit to Construct( ) Repair(✓f Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.y33Z RIG L A Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 35'( 32, Edwo rcL..Dc v c.n r-q 32 c--G cu u Installer's Name,Address,and Tel.No.$4Q EXcaalacjjOA Designer's Name,Address,and T 1.N Iy Tcv.Sc.rr� LA Fores-4wr_ y`1l -OG53 / )c�(cr �.Sr�+Vs �O -so rt -q I E: 1. Toll-360 -3311 Type of Building: Dwelling No.of Bedrooms 2. Lot Size Z 9 ZOO sq.ft. Garbage Grinder( ) Other Type of Building R y ld=,n4 la l No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) .330 gpd Design flow provided IsSZ gpd Plan Date `� •Z$ )�] Number of sheets 2• Revision Date Title Size of Septic Tank /DOO Type of S.A.S. SYJO oa.� c,�a M.Sz r5 �2 Description of Soil Nature of Repairs or Alterations(Answer when applicable) 20` 1) no 2 •t4 20 SOO L!c- Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Si ed Date $-f$• 19 Application Approved by Date Application Disapproved by Date for the following reasons Permit No. l l— Z Date Issued Fee '" — h Entered in computer: L/THE COMMONWEALTH OF MASSACHUSETTS Yes PUBLIC HEALTH DIVISION -:TOWN OF BARNSTABLE, MASSACHUSETTS 01pplication' for Disposal psterri Construction Vermit Application for a Permit to Construct( ) Repair(✓4 UpgradeaO A�ri(° ) ❑Complete System ❑Individual Components Location Address or Lot No.tA33 Z RA c. 6 A CJM V Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 3S) 3z. y332 a G+4 Cu.•�m�-q i� Installer's Name,Address,and Tel.No.84 0 EXC­),A',d A Designer's Name,Address,and T 1.N I'�'r�a5crc-�l lv.� F"ores-►dale /Yicycr s snn1� t10 baA 9g1 �� OG.,3 8. .S-_7rbl Type of Building: Dwelling No.of Bedrooms Z Lot Size 29,, Z,D.O sq.ft. Garbage Grinder( ) 1 Other T e of Buildin yp g (�c_,�c•�C r '�•�oa� No.of Persons Showers( Cafeteria( ) Other Fixtures Design Flow(min.required) 330 b gpd Design flow provided gpd Plan Date `) 2 S - ) ,7 Number of sheets 2. Revision Date Title \ Size of Septic Tank /000 Type of S.A.S. 1500 5,0.) CNa n�SzTS �'Z 1 f�r Description of Soil ` Nature of Repairs or Alterations(Answer when applicable) kl Z 0 ' _D (3a X Z ' �4 ZO Soo Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in,.operation until a Certificate of Compliance has been issued by this Board of Health. ed ` Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. -�2o Date Issued �_�� THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(✓f Upgraded Abandoned O by 3 EA Cc\V o.4 N' O at q 33 2 R-I A C�U�v�7.0, c has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.jV0I I -97T dated lInstaller CQ✓o.A ; a n Designer _0o r t-c-rM M!�Gr #bedrooms Z. Approved design flow 830 gpd The issuance of this p it'hall no be construed as a guarantee that the system 6vi11 functio igne•. ^ Date n/ 2 Inspector . ----------- ---------------------------- - ----------- ------------------- ---- - �No. � � / Fee ` THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal Opstem Construction 301erinit Permission is hereby granted to Construct( ) Repair(✓) Upgrade( ) Abandon( ) System located at q 3 3Z R� ,_ GA �cJ►'h M'� u,o� 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 ears of the date of this permit P Y P Date _ S— Approved by Town of Barnstable Regulatory Services - Richard V. Scali, Interim.Director RAMSTMIX ALAAR ��$ Public Health Division Thomas McKean,Director i 200 Main Street,Hyannis,MA 02601 g Offce:. 508-862-464.4 Fax: 508-790-6304 Installer &Designer Certification Form Date: Sewage Permit# 1.0111 -Z'ly Assessor's Map\Parcel Designer: (, v_�.0 Installer: Address:: a [ Address: On- _$ - 1 S -I T7 _8 4 S3 ExCcLyoA;w\ was issued a permit to install a (date) (installer) septic system at 3��' S� 1 M MAG 01,0 based on a design drawn by (address) dated -'ulca 28_ 1.9 (desi er) Sm Maa S [.1"t- I certify that the septi system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if"required)was inspected and the soils were found satisfactory. I certify that-the system referenced above was construct a with the terms ..of the IAA approval letters(if applicable) Qa , 9c E (Installer's ign e) ; I (Designers Signature) (Affix Designer amp Here) PLEASE RETURN TO BARN ABLE PUBLIC HEALTH DIVISION. CERTIFICATE _OF COMPLUNCE WILL NM BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. QASeptic\Designer Certification Form Rev 8-14-13.doc f 4 j } down cape engineering, inc. SIEVE SOILS ANALYSIS 4332 MAIN STREET CUMMAQUID, MA DATE OF REPORT: 7/24117 .JOB : GRAIN SIZE ANALYSIS-SIEVE TEST SITE: 4332 Main Street, Cummaquid LOCATION: Darren Meyer Test Hole SIEVE ANALYSIS Weight Sample(Grams): 197.0 SIZE ;WEIGHT RETAINED % RETAINED % PASSED --------- -----(sum------- ------------ -------- 1" 0.0: 0.0%: 100.0% ------- -------------------------O.OA---------------6 ------------ - -------------;--------------------•-----A-- 1/2" -------------------�------------------ 0.0; 0.0%: 100.0% 3/8" ______ 0.0: 100.0% -- --------------- Y---------------------p------------------ #4 : 0.0: 0.0%: 100.0% -------------- ----------------- #10 0.3: 0.2%: � 99.8% #20 1.5 0.8%� 99.2% --------------;-.........................t---------------------: ................. #40 5.1; 2.6%: 97.4% _-------------r..........................•f----------------••----f---..--------..._. #50 25.6' -------------:------•--...-------•------Y---------------------•------------------ #80 116.4' 59.1%: 40.9% #100 : 150.8: 76.5%: 23.5 0 #200 8.0% r --^-•------------- 8.0% 1 PAN: 195.4; 100.0% 0.0% --AMPI---: -------------------- 97.0r---------------------------------------- SAMPLE: 197.0: NOTE:TEST ON PASSING#4 ONLY, 0.4% RETAINED ON#4<45% O.K. .F RESULTS: SOIL CLASSIFIED AS AASHTO A-3(FINE SAND) (UNCOMPACTED) PERCENTAGE OF MATERIAL PASSING#4 SIEVE : #4 100% (TEST ONLY MATERIAL PASSING#4) OK #5010%-100% OK #100 0%-20% CLOSE #200 0%-5% CLOSE SAMPLE IS CLOSE TO MEETING TITLE 5 FILL SPECIFICATION >92%SAND RESULTS: PERMEABLE MATERIAL-CLASS 1<2 MINAN. MATERIAL(0.74 GPM/SF NONCOMPACTED �SWOFMA SOIL DESCRIPTION: FINE SAND DANIELA. �Gm o OJALA + CIVIL N No.46502 S/�or'P�c a Fs�� 'TKWE r ti Town of Barnstable Barn .� Regulatory Services Department ' 1 edcaC j MASS. Public Health Division 200 Main Street, Hyannis MA 02601 2007 Office: 508-8624644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4990 2519 May 18, 2017 DEVENEY, EDWARD I &PENELOPE L P 0 BOX 336 CUMMAQUID, MA 02637 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 4332 Main-Street,Barnstable, MA was inspected on 05/10/2017 by Shawn Mcelroy, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails".under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Leaching facility with standing liquid level at or above the invert pipe (per - Town Code 360-20 h). You are ordered to repair or replace the septic system within two (2)years from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE B RD OF HEALTH Thomas McKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\4332 Main Street Bamstable•.doc �1HF T ' 3 Town of Barns table Regulatory Services Department Public Health Division 200 Main Street,Hyannis MA'02601 Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A McKean,CHO Feb 6, 2007 Rev. 5111116 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) _ An"x"marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑Discharge or ponding of effluent to the surface of the ground . ❑Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑Backup of sewage into the house due to an overloaded or clogged SAS or cesspool i ONE (1)YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (21 YEAR4EA�T,TNF f'RIT�.IZIA� q Single Cesspool ❑Any"conditionally passed systems" (broken cover,relocation of a pipe, relocation of a driveway due to H-10 components, etc) I ❑ Leaching pit or cesspool with high liquid level, <12"below inlet(per Town Code §360-9.1) OkLeaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) ' OTHER Repair deadline: Q:\SEPTICIDEADLINES TO REPAIR FAILED SYSTEMS.doc • �3�j- 0 3 2 + ' Commonwealth of Massachusetts Title . Title 5 Official Inspection Form �If;., Subsurface Sewage Disposal System Form Not for Voluntary Assessments 4332 Main St Property Address C Ed Deveney ,� Owner Owner's Name �+ information is /JA-�1 , required for every Cummaguid 9k- ' MA 02637 5-10-17 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. ti A. General Information 0j4 /ate 1. Inspector: Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name P.O. Box 73 Company Address " E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S 13971 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: y ❑ Passes ❑ Conditionally,Passes ® Fails, ❑ Needs.Further_ valuatio the Local Approving Authority `. 5-10-17 . spector's Signature Date The system inspector shall submit a copy'of this.inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 �o (fl. y� Commonwealth of Massachusetts r a=I , Title 5 Official Inspection Form 1�-I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments s Jr 4332 Main St Property Address Ed Deveney Owner Owner's Name information is required for every Cummaguid MA 02637 5-10-17 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ 1 have not found any information which indicates.that any of the failure criteria described in 310 CMR 1-5.303 or in'310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 ' r Commonwealth of Massachusetts Title 5 Official Inspection Form � I Subsurface Sewage Disposal System Form -' Not for,Voluntary Assessments -�; 4332 Main St Property Address Ed Deveney Owner Owner's Name information is Cummaquid MA 02637 5-10-17 required for every ` 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. f B) System Conditionally Passes (cont.): j ; ❑ 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts , a=1 f Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4332 Main St Property Address Ed Deveney Owner Owner's Name information is required for every Cummaquid MA 02637 5-10-17 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 cesspool is less than 6" below invert or available volume is less than Y2 day flow t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Rage 4 of 17 f ' Commonwealth of Massachusetts Title 5 Official Inspection Form �l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments, a� ,,-ems%ai 4332 Main St Property Address Ed Deveney Owner Owner's Name information is Cumma uid MA 02637 5-10-17 ' required for every q page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No , ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool,or privy is below high ground water elevation. r l: ❑ ® 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 16,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA)>or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts � Title 5 Official Inspection Form .azl j� ' �;-i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a% 4332 Main St Property Address Ed Deveney Owner Owner's Name information is Cumma uid MA 02637 5-10-17 required for every q page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 2 Number of bedrooms (actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 220 — t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 it r • Commonwealth of Massachusetts f Title 5 Official Inspection Fora �'l Subsurface Sewage Disposal System.Form -Not for Voluntary Assessments �_;;!✓ 4332 Main St ..Kw Property Address Ed Deveney Owner Owner's Name information is Cumma uid MA 02637 5-10-17 required for every q page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection El Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? i ❑ Yes ® No Last date of occupancy: 5-2017 f? Date 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 l Commonwealth of Massachusetts �a=1 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4332 Main St Property Address Ed Deveney Owner Owner's Name information is Cumma uid MA 02637 5-10-17 required for every q page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Owner--pumped 1-2yrs ago Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Maintenance 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 � Commonwealth of Massachusetts la Title 5 Official Inspection Form :'Ri Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �_ssa 4332 Main St Property Address Ed Deveney Owner Owner's Name information is required for every Cummaguid MA 02637 5-10-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1978 with pit added in 1991 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 30"feet Material of construction: ® cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line- feet a Comments (on condition of joints, venting, evidence of leakage, etc.): Good condition. Septic Tank(locate on site plan): 24" Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by.a Certificate.of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gal Sludge depth: 12" t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 l_ Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Z 4332 Main St Property Address Ed Deveney Owner Owner's Name information is Cumma uid MA 02637 5-10-17 required for every q 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 20" Scum thickness 2" 5" Distance from top of scum to top of outlet tee or baffle � Distance from bottom of scum to bottom of outlet tee or baffle 15" How were dimensions determined? Tape 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 is in good condition with baffles installed and no sign of leakage. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts , Title 5 Official Inspection {Form �1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4332 Main St Property Address Ed Deveney Owner Owner's Name information is umma uid MA 02637 5-10-17, required for every C q " page. City/Town State Zip Code Date of Inspection D. System Information (cont.) - Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): ' Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: . y Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity:. t • gallons' Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order:" ❑ Yes ❑ No Date of last pumping: ' Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts 1a=1 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a� 4332 Main St Property:Address Ed Deveney Owner Owner's Name information is Cumma uid MA 02637 5-10-17 required for every q page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 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.): 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 r Commonwealth of Massachusetts a Title 5 Official Inspection Form ' 1A Subsurface Sewage Disposal System Form Not for Voluntary Assessments 4332 Main St ---- Property Address Ed Deveney Owner Owner's Name information is Cumma uid MA 02637 5-10-17 required for every 4 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 F t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 i Commonwealth of Massachusetts - a=� f Title 5 Official Inspection F&M I.., : I Subsurface Sewage Disposal System Form-Not for Voluntary Assessments a�. 4332 Main St Property Address Ed Deveney Owner Owner's Name information is Cumma uid y ' MA 02637 5-10=17 required for every 4 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope + ❑ Surface water = ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 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: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: ® Checked with local excavators, installers- (attach documentation) ® Accessed USGS database explain: You must describe how you established the high ground water elevation: USGS and town maps show groundwater at greater than 20'. - Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 3 4332 Main St Property Address Ed Deveney Owner Owner's Name information is required for every Cummaguid MA 02637 5-10-17 page. City/Town State Zip Code Date of Inspection D.ISystem 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 E 4 of UO F. 4 -1 - 13 -/ � Aa? ...�... . . ■r�� / V�i 3 W � A -cf - 32 'r 371) t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts _+ f Title 5 Official Inspection Form :WRI Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4332 Main St Property Address Ed Deveney Owner Owner's Name required for is y Cumma uid required for ever 4 MA 02637 5-10-17 page. City/Town 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 ICI Commonwealth of Massachusetts Title 5 Official Inspection Form �11 �W-1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4332 Main St Property Address Ed Deveney Owner Owner's Name information is Cummaquid MA 02637 5-10-17 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 2-1000 gal ❑ 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.): Both leach pits were filled beyond capacity and into riser. 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 t Barr) t ■ Complete items 1,2,and 3. A. Signature ■ Print your name and address on the reverse J 0 Agent .so that we can return the card to you.. QVAddressee ■ Attach this card to the back of the mailpiece, eceived by(Printed Name) C. Dalle of D ive or on the front if space permits. / � 1.Article Addressed to: D. Is delivery;address different fr96 item 17 113 Yesk If YES,enter delivery address below: i]No C�i�2� J �llla�aslz�� �i �&/ ox 3� II 3, Service Type ❑Norlty Mall Express®��III�I III IBI I II II I II I IIII I I I �I�I III I I O.Adul Signature O Registered MWITm ❑Adultt Signature Restricted-Dell ❑very Registered Mail Restricted 9590 9402 1934 6123 0980 95 gCertlfled Mall® Delivery Certified Mail Restricted Delivery *etum Receipt for ❑Collect onDelivery Merchandise ncfirls_Num6er_CfranSfef fr41n selviCe label) ❑Collect on Delivery Restricted belivery 0 Signature ConfihnationT ❑Signature confirmation 7 015 17 3 0 0 0 01 4990 2519 , Restricted Delivery Restricted Delivery P� s Form 3811,July 2015.PSN 7530-02-000-9053 Domestic Return Receiptjl USPS TRACKING# I First-Gass Mail Postage&Fees Paid USPS Permit No.G-.10 9590 9402 141 'ti23 0980 95 United States •Sender:Please print your name,address,and ZIP+4®in this box• Postal Service ,��1 `Town of Barnstable Health Division 200 Main Street { Hyannis, MA 02601 1••?? 1 : 11 1?_._�_ gp-; :d'• tE ?::•?.: ?i}.I s: I . t .,{�.I 11 !3d ? L; CATION SEWAGE PERMIT `NO. /-14l1V `��' 7 7 j 41 S� ' LLAGE -�_ r)3. S UNSTA LLER'S ME & ADDRESS �i� G.✓a c r� � OWN ER jj/ 4e DATE PERMIT ISSUED G DATE COMPLIANCE ISSUED ® ��-- .�2 �- '`, � v�` J � a �. 3 �� a. :, r'� �� ' �. < <�;,; y ��'♦ �.' y -r r r -01 No......................... p ,. Fua....... ................. THE COMMONWEALTH OF MASSACHUSETTS �; BOARD OF HEALTH � ............OF........ . � _- __ �_ _41 _......................... Appliration for Dispoli al Worko Tonstrurtiun Vamit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: pp .....= - ..C.! •- - - ................ .......... .. .................................. cation-Address P or Lot No W Owner Add ss a 0'X.-. �-------------------------------------•--------. ---------------------...... �----. A,�.-��-...-----.......------.....---------------.. Installer Address �4 �� Type of Building Size Lot. _.._..�___________________Sq. feet U Dwelling—No. of Bedrooms.......3............... .Expansion Attic ( VI Garbage Grinder ( t 0 aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures .................................. W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity.lQ lCgallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..........._ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No...l0016_ ameter.................... Depth below inlet......... Total leachin area..................sq. ft. Z Other Distribution box Dosing tank Percolation Test Results Performed by.......................................................................... Date_-:'_ ....2`A`_7-- ------. W Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Lz, Test Pit No. 2................minutes,p r inch Depth of Test Pit.................... Depth to ground water.................... O `? —•.__... ./1!�!- •,z P .............•----...---...... ---....-----.....---- 0......................s_._. Description of Soil ......•••. .... -- ----------------C� -- P C W 4 UNature of Repairs or Alterations Answer when applicable-----------------------:....................................................................... -•---------------------------------------------------------•-----------------------.....--------------------...----------------------------------------•---------------------------.....------....-----• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been iss ed by the board of hn alth: Sign e .............................r-•-s ;l- �; !r� ------ ... ...`�` '"' /...77 ��� Date Application Approved BY _./s '�.._ ................. `^ a Date Application Disapproved for the following reasons:-----------------•'✓�-••---....--------•-----------------••-------......------------------................. ....................................=.................................................................................................................................................................... Date Permit No.................••••---••------••----.......-••-------. Issued:. w ?— ?-7 �' _ - Date No.. ..................'.. Fx$.......A..sue........ THE COMMONWEALTH OF MASSACHUSETTS, BOARD' O HEALTH � �_ ..w � .. . r A. OF Appliratign for Disposal Works Tonsirurtiun - rrmit Application is hereby made,for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Syst at ation-Address or Lot No Owner - Add s _ ••. ' - ----------------- --------------------------- .................... Installer Address Q Type of Building Size Lot.-AT Aq ----Sq. feet U Dwelling=No. of Bedrooms . .....Expansion Attic ( Garbage Grinder ( 04 Other—Type T e of Building - ............... No. of ersons....................._______ Showers Cafeteria W � .� yP g --------- - P ( ) ( ) a' d Other fixtures -------------------------------- . w Design Flow...... ........................ .........gallons per person per day. Total daily flow............................................gallons. WSeptic Tank-Liquid capacity-/ allons Length................ Width................. Diameter---------------- Depth................ x Disposal Trench . o. ..... ..... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No tg�� ameter.................... Depth below i let....... Total leaching area..................sq. ft. Z :. Other Distribution box (�" , Dosing tank Percolation Test Results Performed by................................................ Date___ '._ 'V` 7 * Pa "Test Pit No. -1..............:.minutes per inch Depth of Test Pit.................... Depth to ground water................... w Test Pit No 2 minutes 1jer inch Depth of Test Pit.................... Depth to ground water......................... O Description of.Soil .... r _---- : . x w ----- U Nature of Repairs or Alterations—Answer when applicable_.:----__._•--------------------- ------'_............................-....................... .. .. Agreement The undersigned agrees to install the`'aforedescribed Individual Sewage Disposal System in accordance with r the provisions of TIT1L: 5 of the,State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been iss ed by the board of health. S. + .... ... ... z Date Application Approved.By------ -----•--------------•--- .................... '. t Date Application Disappr6' d f or the following reasons:_ ..................... - •------ --------- ,: -- - •. . .............• . a4 PermitNo.........................................................--------------------------------------- Issued............................................................ � Date THE COMMONWEALTWOF MASSACHUSETTS } BOARD OF.: HEALTH .� as ............ '' .... OF .. ... ...:: ..a.... Trrtgfi t of Tumplianrr: THIS)Q T C T Y, That the Ind vidual Sewage Disposal System`constructed or Repaired ( ) by.. . - . ......_. . � ... . .. . .................... ................ -----..........------...._......._ -----� nstall � Y at --..."K ..... --•-- ----• --- -. k, ! has been installed in acco with tie provisions.of T 5.of,The State Sanitary ode as described in the application for Disposal.Works Construction Permit,No... .:........... dated "`-f`": 7 ..................... THE ISSUANCE-OF THIS CERTIFICATE SHALL NOT-BE'CONSTRUED AS A GUARANTEE THAT THE SYSTEM'WILL FUNCTION SATISFACTORY. :e. DATE................................................................................ Inspector....................................... ........................................... rr THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH- ...................................... No......................... FEE...: `.. *..... Dispos t rk� �nn��r ilan rrmit y errtl> lion is reby granted.......... -.._-- ----". . •------ -----•--• ---- -------- to Constr epair ( ) an Indivldu Sew Disposah at ys J/` Street` as shown on the application for Di posal Works Construction Perm i ....... :. ......s atedI~__ _.__..._......:. _ - //� _ {G. Board of Health'.; DATEV--- /A•----- ---•-------------• - FORM 1255 'HOBBS & WARREN. INC., PUBLISHERS w \ J 1 \ �t r.l kW gip' ai`s 6. -.55� -ALh Do j `.. � o /7 LEGEND , EXISTING SPOT ' ELEVATION 0x0 . CERTIFIED PLOT— P-LAN_ EXISTING CONTOUR — - - 0 =Z FINISHED SPOT ELEVATION `�,� />�a / . I �FIPO( SHED CONTOUR 0 Eif�;il'E "-1t� IN ,-APPROVED : BOARD OF HEALTH DATE AGENT tiu s:+ // 7J _ , SCALE I .= © DATE �/ L®KEDGE ENG/A/EERlWG CO. l CLIENTM/11" I CERTIFY THAT THE PROPOSED EGISTERE �REGISTERED1 E - /O/6 BUILDING SHOWN ON THIS PLAN CIVIL I JOB NO. __� LAND II CONFORMS TO THE ZONING LAWS f ENGINEERS,j �5URVEYORS,J D R. EJ Y 131 OF BARNSTABt_ E MASS. 33 NC MAIN 5T 712 MAIN ST. CH. BY: 8. `�: �� 16,/7.7 0. YARMOGrIi, MASS. MYANNI MA`'' SHEETL. OF 2 _ ATE eEG. LAND , SURVEYOR I 20 FT. MIN. 10 FT MiN. I CONCRETE 4„ PVC PIPE MIN PITCH _ COVERS I/8„ PER' FT w I. 10 CLEAN SAND A CONCRETE LIQUID LEVEL COVER 41j CAST �. IRON PIPE MIN PITCH- SEPTIC -PER FT SEPTIC TANK _mot ' 2„ LAYER o �f.EID'IOVE um.+� �. OF 1/8n- 3/811 1 T.• ' ' ' ' ' . ° WASHED STONE • ' ' ' EFFECTIVE' ' °, �- 3/4"- 1 1/2 DEPTH ° ' ° ' WASHED STONE INVERT ELEVATIONS ° , 1 • • • / , PRECAST SEEPAGE ° I / . PIT OR EQUIV. INVERT AT BUILDING f% O FT. • • • e • 1 1 ° INLET SEPTIC TANK .//[r-8—FT. 6 FT DIA. �. OUTLET SEPTIC TANK ./sue !AFT. �- 10 FT DIA. C (SEE TABULATION) INLET DISTRIBUTION BOX 1L!,_Y_FT -- OUTLET DISTRIBUTION BOX .// , 2. FT GROUND WATER TABLE . INLET SEEPAGE PIT L'—o_FT SECT/ON OF TABULATION SEVIAGE DISPOSAL , SYSTEM DIMENs10N A FT DESIGN CRITERIA SCALE 114 = / _ O DIMENSION B ro- FT. NUMBER OF BEDROOMS — DIMENSION C Y FT Cm 10. GARBAGE DISPOSAL UNIT 19,467 (No Wp977_=rZ TOTAL, ESTIMATED FLOW _35!! GAL./DAY SOIL LOG SOIL TEST NUMBER OF SEEPAGE PITS � ELEVATION t � DATE OF SOIL TEST �EC1 2y /97'�,, SIDE LEACHING PER PIT J_�S0. FT. 1p��+ s� RESULTS WITNESSED BY F,44& />Ic/ y . BOTTOM LEACHING PER PIT �8_ SQ. FT. Sur3soic., TOTAL LEACHING AREA. �_"__SQ. FT. ( PERCOLATION RATE .G 2 MIN/INCH RESERVE LEACHING AREA �� SQ. FT. 8 CLAY -� %N o> ass �H OF Q9 . RO B E RT �i�-'.` ��� C� i. BRUCR , � PHILIP �'yN _•�( _ �QT 2, F'L�N /7,_ 73 E:LDREDCk: WEINBERG Mo. 368 TLDREDGE ENGINEERING CO. INS FC�ST��. QQ_ o G/STE��• �Q �� �F � 33 NO. MAIN ST. 712 MAIN ST. �NO SURD.,, ss/ONAL� N6 tt 47162 Tr-ft3to5 SO. YARMOUTH MASS: HYANNIS MASS. %/ail s� �7✓cou�rrE2t'a CV. 4�f J 0 B NO /c5✓(� S H E E T? 0 F �F Town of Barnstable S 4 1 Departitnent of Re Sl, gulatory Services a"atter,�t� Public Health WAR'on nat�------------ > F • �7A ass 200 Main Street,Hyannis 1iA 02601 Date Scheduled �ll / Tline� V.m. Fee Pd. ail Suitability Assmnmeni for S age Disposal Performed•By: ` l /I/ 1 E� 1m�` U+� J ,Witnessed By: i Location Address LOCATION&GENERAL MFOWZ U ION �� �Ql`11wna's Name Address Assessor's Map/Parcel 36/ V pr _ - / Engineer's Name , NEW CONSTRUCTION REPAIR Telephone Land Use• ' Slopes(96) b Surface stones Dlst fto _ance9 m: Open Water BodY t7 ft Possible Wet Area?�ft Drinking Water.Well�tl S Oft i Dralhago Way le 0, ft Property Line ft Other {t 51 1'CII:(street name,dimensions of lot,exact locadons of test holes&pem tests,locate wetlands i+n proximi to holes ` C, ty, T Parent material(goologlc)m Ol S''I Depth to Pedrook Depth to Groundwater. Standing Water In Hole: Weeping flvm Pit Fnee Estimated Seasonal High Groundwater DETERMINATION FOR SEAS Method Used: ONAL HIGt WATERTABLE Depth Observed standing in obs.hole: Ia,• Depdi to Boll mottles..DelIth to weeping from side of obs:hole: Itt, Index Well 0 Reading Date: Index Well levol._�,_•_� � ©Poundwater Adjustment � Adj.factor_ Adj,Groundwater Level Observation PERCOLATION TEST bate rya - 'Hole# I # % Time at 9" IN Depth of Pero ..F"T Time at 61, Start Pro-soak Time®. { . Time(9"•611) End Pro-soak -es4 CAV-cv) Rate'Min./Iuch , Site Suttabillty Assessment: Site Passed X Site Failed: Additional Testing Needed(YIN) Original: Public Health Division Observation Hole Data To Be Completed on Back-- ***If percolation test is to be conducted witfiln 100'of wetland,you must first notify the. Barnstable Conselr vation Division at least one(1)week prior to beginning. Q:\S EPTIC\PERCFORM.DOC f, C O J DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Sdil Color Soil. Other Surface(in.) (USDA) . (Munsell) Mottling. (Stnucture,Stones;Boulders. ralstenncy.%Y3rave1l ci Ci, „, (0 DEEP OBSERVATION HOLE LOG ]Hole#� Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. it to 'iCIL- DEEP OBSERVATION HOLE L Hole,# V ON O LOG � . Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structuiro,Stones,Boulders. Consistency. DEEP OBSERVATION HOLE LOG Hole#, Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (U$DA) (Munsell) Mottling (Structure,Stones'.Boulders, Flood Insurance Rate Map: Above 500 year flood boundary No_ Ye _ Within 500 year boundary No Yes Within 100 year flood boundary No,� Yes Depth of Naturals Occurring Pervious Material Does at least four feet of naturally occurring p rvl s atorlal oxist in all areas observed thrpughout the area proposed for the soil absorption systam7 If not,what is the depth of naturally occurring p"rvious matorlall Certification I certify that on. (date)I have passed the soil evaluator examination approved by tha Department nvl nmental Protection and that the above analysis was performed by me consistent with the required tralni a or so nd ex or co described 1 10 CMR 15.017. Signature Datt • 2,01 Q:\S.EP-rlLNPBRCFORM.D0C R r> t CUMMAQUID <1 RgpR �50 e� NP PARCEL ID: ' PARCEL ID: J's 351 030 OO 351/032 3r. / P No g6 AREA=29,200f S.F. 6'. BONE HILL 50 �� RD ROUTE 6A N + EXISTING 1,o00G SEPTIC TANK LOCUS �3 #4332=__ ' If- s LOCUS MAP ` t _ LOCUS INFORMATION \ \ \ a' W `_ _ Q �4 PLAN REF: 199/73 F1 co = =- 12rn—1 TITLE REF: 2176/151 ` $ \ ` 36" PARCEL ID: MAP 351 PAR. 32 .� \ .�_z ZONING:. "RF-2" S�, W rn \ BENCHMARK: �, y , FLOOD ZONE: "X" CONC LIFOUNDATIP 'd o � �r � COMMUNITY PANEL: 25001CO559J DATED: 07/16/14 ,4 . V. Z W EL=41.00 5FT NOTE SEPTIC SYSTEM (SEE ) REPAIR PLAN LOCATED AT: r- Ln , \10 _ pN� 20„ �_� I \ cl 4332 MAIN STREET __ ----� � � ' ''�, i ,_-- �, .�� ��°c CUMMAQU:ID, MA. PARCEL ID: PREPARED FOR 351/031 \ EDWAR'D & PENELOPE _ UPOLE DEVENEY W " �� JULY 28, 2017 � PARCEL ID: 351/034 o D E O 4k �P��O N.. 1SIT Dc6 Dc G S �� SANI TAR��`� r n S �S SCALE: 1"=30' MEYER & SONS, INC. o-, o s PARCEL ID: LEGEND P.O. BOX 981 �` �0 351/033 EAST SANDWICH, MA. 02537 l PROPOSED CONTOUR 2S�o ® PROPOSED SPOT GRADE PH: (508)360-3311 gg -- EXISTING CONTOUR FAX: (774)413-9468 moo., + 96.52 EXISTING SPOT GRADE meyerandsonsinc©gmail.com W— EXISTING WATER SERVICE ® TEST PIT SHEET 1 OF 2 J#1943 i NOTE: MAGNETIC TAPE TO BE PLACED OVER ALL COVERS NOTE: TO PREVENT BREAKOUT, THE PROPOSED FINISH TOF SEPTIC TANK GRADE SHALL NOT BE < EL:37.0 FOR A DISTANCE GENERAL NOTES: INSTALL RISERS & COVERS OVER INLET & PROPOSED D-BOX 15' AROUND THE PERIMETER OF THE S.A.S. EL.=41.0t OUTLET AND SET TO 6" OF FINISH GRADE PROPOSED S.A.S. INSTALL RISER & COVER 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL SET TO 6' OF GRADE - INSTALL LOCKING COVERS IF AT FINISH GRADE INSTALL A RISER OVER ONE CHAMBER (MIIN) BOARD of HEALTH AND THE DESIGN ENGINEER. AND SET TO 3" OF F.G. • F.G. EL.=40.Of F.G. . ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS f .G. EL.=41.SOt F.G. EL: 4O.Ot OF THE STATE ENVIRONMENTAL CODE, TITLE V. AND ANY APPLICABLE F.G. EL•' 40.0(MAX.) LOCAL RULES AND REGULATIONS. 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR 9" MIN COVER/ TO INSPECTION ANO APPROVAL BY THE BOARO OF HEALTH AND THE DESIGN ENGINEER. 36" MAX COVER L = 20' L = 20'(MAX) ® S=1% (MIN.) EL.=38.48t ® S=1% (MIN.) ® S=1% (MIN.) 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING 4"SCH40 PVC • 4"SCH40 PVC 4"SCH40 PVC 2" OF 3/8" DOUBLE WASHEDFROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN STONE OR FILTER FABRIC 3/4" - 1-1/2" ENGINEER BEFORE CONSTRUCTION CONTINUES. LLj t0" " 6 DOUBLE WASHED STONE 5. ALL ELEVATIONS.BASED ON ASSUMED DATUM. INV.=37.40 . 14" 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF 48"UOUID INV.=37.15 ®®®®. Q ®®®® THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF LEVEL - HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. 1 ' PROPOSED ®®®®®®®®®®® GAS BAFFLE E3®EM EM EM E3 E3 E3 E3 E3 E3 7. DWELLING IS SERVICED BY MUNICIPAL WATER. D-BOX INV.=36.5T ®®®®®®®®®®® INV.=36.70 'DB-3 8. ALL AREAS DISTURBED DURING CONSTRUCTION.SHALL BE RESTORED TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. EXISTING 1.000 GALLON SEPTIC TANK 4' 2 X 8.5' 4' S. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO STARTING WORK. EXIST. SEWER OUTLET EFFECTIVE LENGTH = 25.0' 10. EXISTING LEACHING TO BE PUMPED, CRUSHED AND REMOVED PER TITLE 5. REPLACE WITH CLEAN MEDIUM SAND PER TITLE 5. INV. ELEV.= 36.0_Lj 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION BREAKOUT 12• THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY- AND NOTES: 1} CONTRACTOR SHALL VERIFY ALL EXISTING AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY PIPE INVERTS PRIOR TO CONSTRUCTION TOP CONC. ELEV.= 37.0 EL. 37.0 13. NO KNOWN PRIVATE WELLS WITHIN 100 FT. OF PROPOSED LEACHING 2) D-BOX SHALL BE SET LEVEL AND TRUE TO INV. ELEV.= 36.0 ®® 14. ALL PIPING TO BE 4" SCH 40 ® 1/8-/FT (UNLESS SPEC. ) GRADE ON A MECHANICALLY COMPACTED SIX 1363E 15. THE DESIGN OF THIS SYSTEM DOES NOT ALLOW ®®E®®63® FOR THE USE OF A GARBAGE GRINDER. INCH CRUSHED STONE BASE, AS SPECIFIED IN EEE63EE® ' 310 CMR 15.221(2) BOTTOM EL.= 34.0 E®EE®®E 16. NO WETLANDS WITHIN 100 FT. OF PROPOSED LEACHING 3) REPLACE EXISTING 1,000 GALLON SEPTIC TANK 4' 5 FT._ 4' 17. REMOVE ALL UNSUITABLE SOILS 5 FT AROUND LEACHING WITH 1500 GALLON SEPTIC TANK IF FAILED, EFFECTIVE WIDTH = 1'3' TO EL. 32.40 AND REPLACE WITH CLEAN MEDIUM SAND DAMAGED, NOT H2O LOADING, OR. UNDERSIZED. SEPARATION' 5.60 FT. PER TITLE 5 SPECIFICATIONS. 4) INSTALL INLET & OUTLET TEES W/ SOIL ABSORPTION SYSTEM (SECTION) GAS BAFFLE AS REQUIRED SEPTIC SYSTEM PROFILE BOTTOM- OF TESTHOLE EL: 28.40 _ (500 GALLON H2O LEACH CHAMBER) N.T.S. S 0 I L LOGS P#:1 s441 DESIGN CRITERIA **NO PROPOSED INCREASE IN FLOW** NUMBER OF BEDROOMS: EXIST. 2 BEDROOM DWELLING/3 BEDROOM DESIGN DATE: JULY 18; 2017 SOIL TEXTURAL CLASS: CLASS I (0.74 GPD/SF) DESIGN PERC RATE: . <2 MIN/IN SOIL EVALUATOR: DARREN M. MEYER, RS, CSE WITNESS: DON DESMARAIS, BARNSTABLE HEALTH DAILY FLOW: 110 G.P.D. X 3 BR DESIGN FLOW: 330 G.P.D. GARBAGE GRINDER: NO (not designed for garbage grinder) Elev. TP-1 Depth Elev. TP-2 Depth SEPTIC TANK: 330 gpd x 200% = 660 gpd USE EXIST. 1,000G SEPTIC TANK 42.20 A ,LOAMY SAND 0" 41.40 A LOAMY SAND 0" LEACHING AREA REQUIRED: (330)/0.74 = 445.94 S.F. 41.45 B 10YR 3/2 9" 40.40 B •1OYR 3/2 12„ USE TWO (2) 500 GALLON H2O PRECAST LEACH CHAMBERS LOAMY YR s/ 38.58 C D LOAMY SAND W/ 4' STONE ON ENDS AND 4' ON SIDES: 25' L x 13' W x 2' D 39.62 C 31" t OYR 5/8 34" SANDY LOAM SANDY LOAM BOTTOM. AREA: 25 x 13 = 325.SF 10YR 6/6 10YR 6/6 SIDE AREA: (25 + 13) X 2 X 2 = 152 SF 33.20 C2 108" 32.40 C2 108" I TOTAL SQUARE FEET PROVIDED = 477 vs. 445,94 REQ'D SI®3SAMP 1.0 FINE FINE DESIGN FLOW PROVIDED: 0.74(477 S.F:) = 352.98'G.P.D. vs. 330 G.P.D. req'd SAND SAND 2.SY 6/4 2s.2o 1ss" 2840 2.5Y 6/4 15s � �F MAssq�y PROPOSED SEPTIC SYSTEM UPGRADE PLAN PERC RATE <2 MIN/IN. ("C2" HORIZON)PER SIEVE TEST DA E `\M/ 4332 MAIN STREET, C U M MAQ U I D, MA NO GROUNDWATER OBSERVED N 1 40 Prepared for: Devene SCALE DRAWN DATE �� • I, Darren M. Meyer, R.S., CSE, hereby certify that I am currently approved by MADEP pursuant to 310 CMR 15.017 $TF- MEYER&SONS,INC. N.T.S. DMM 07/28/17 to conduct soil evaluations and that the above analysis has been performed by me consistent with the fq P / PO BOX981 requirements of 310 CMR 15.017. 1 further certify that I have passed the Soil Eval. Exam in October, 1999. NITAR� �/ EASTSANDWICH,MAo2537 REV DATE CHECKED SHEET N0. 508-362-2922 DMM 2 of 2