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HomeMy WebLinkAbout0094 OLD JAIL LANE - Health 94,01d-Jail Lane Barnstable P - A ,278 "058• » 5 i COMMONWEALTH OF MASSACHUSETTS z EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS F DEPARTMENT OF ENVIRONMENTAL PROTECTION 0W 5.Y 5V8 TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASS SSrRUMVED SUBSURFACE SEWAGE DISPOSAL SYSTEM FC RM PART A CERTIFICATION J U N 14 2002 TOWN OF BARNSTABLE Property Address: 94 Old Jail Lane Barnstable HEALTH DEPT. Owner's Name: Mathew and Martha Callahan Owner's Address: Same Date of Inspection: 4/10/02 Q Name of Inspector: Timothy Lovell MV �� u Company Name:Accurate Inspections PARCH Mailing Address: 550 Willow Street W.Yarmouth,MA. LOT .. OWAWMW - Telephone Number: M8-771-3700 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 15.340 of Title 5(310 CMR 15.000). The system: _x_Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority ails ,' Inspector's Signature., Date: 4/10/02 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. 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 how the system will perform in the future under the same or different conditions of use. 'Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 94 Old Jail Lane Barnstable Owner: Mathew and Martha Callahan Date of Inspection: 4/10/02 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: _x_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: B. System Conditionally Passes: _N/A One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined"please explain. N/A 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 infiltration or tank failure is imminent.System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: _N/A Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): Broken pipe(s)are replaced Obstruction is removed Distribution box is leveled or replaced ND explain: N/A_The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): Broken pipe(s)are replaced Obstruction is removed ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 94 Old Jail Lane Barnstable Owner: Mathew and Martha Callahan Date of Inspection: 4/10/02 C. Further Evaluation is Required by the Board of Health: _N/A Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect 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: _N/A_Cesspool or privy is within 50 feet of surface water _N/A_Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _n/a_ 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. _n/a_ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _n/a_ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. n/a_ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria 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. 3. Other: Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 94 Old Jail Lane Barnstable Owner: Mathew and Martha Callahan Date of Inspection: 4/10/02 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No _x_Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _x_Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _x_Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool n/a_Liquid depth in cesspool is less than 6"below invert or available volume is less than day flow _x_Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped _x_ Any portion of the SAS,cesspool or privy is below high ground water elevation. _x Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _x_Any portion of a cesspool or privy is within a Zone 1 of a public well. _x_Any portion of a cesspool or privy is within 50 feet of a private water supply well. _x_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.] _no (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 to correct the failure. E. Large Systems: N/A To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd• You must indicate either`yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) 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. 'Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:94 Old Jail Lane Barnstable Owner:Mathew and Martha Callahan Date of Inspection: 4/10/02 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No x _Pumping information was provided by the owner,occupant,or Board of Health _x Were any of the system components pumped out in the previous two weeks.? _x_ _Has the system received normal.flows in the previous two-week period? _x Have large volumes of water been introduced to the system recently or as part of this inspection? _x _Were as built plans of the system obtained and examined?(If they were not available note as N/A) _x _Was the facility or dwelling inspected for signs of sewage back up? _x_ _Was the site inspected for signs of break out? _x _Were all system components,excluding the SAS,located on site? _x_ 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? _x_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: Yes no _x _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(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:94 Old Jail Lane Barnstable Owner: Mathew and Martha Callahan Date of Inspection: 4/10/02 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):_3_Number of bedrooms(actual):_3_ DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents:_4 Does residence have a garbage grinder(yes or no):_n_ Is laundry on a separate sewage system(yes or no):_n_ [if yes separate inspection required] Laundry system inspected(yes or no):_n/a_ Seasonal use: (yes or no):_n Water meter readings,if available(last 2 years usage(gpd)): Sump pump(yes or no):_n_ Last date of occupancy:_Current COMMERCIAL/INDUSTRIAL N/A Type of establishment: Design flow(based on 310 CMR 15.203): and Basis of design flow(seats/persons/sgk 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 or no):_ Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: owner Was system pumped as part of the inspection(yes or no): If yes,volume pumped:_gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM _x_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) _Tight tank _Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: 1999 Were sewage odors detected when arriving at the site(yes or no):_no_ Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) . Property Address:94 Old Jail Lane Barnstable Owner: Mathew and Martha Callahan Date of Inspection: 4110/02 BUILDING SEWER(locate on site plan) Depth below grade: 3' Materials of construction: cast iron x_40 PVC—other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): No signs of leakage joints looked fine SEPTIC TANK:—x (locate on site plan) Depth below grade:_4" Cover Material of construction:_x— — —concrete metal fiberglass_polyethylene—other (explain) If tank is metal list age:—Is age confirmed by a Certificate of Compliance(yes or no):—(attach a copy of certificate) Dimensions: 1500 Gallon Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: 4" Distance from top of scum to top of outlet tee or baffle:_6" Distance from bottom of scum to bottom of outlet tee or baffle:_15" How were dimensions determined: Field Measurements Comments(on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): No sign of leakage fluid was at invert out,tee's were in place I do recommend pumping GREASE TRAP:_N/A (locate on site plan) Depth below grade: — Material of construction:— — concrete—metal fiberglass—polyethylene—other (Explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): I Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 94 Old Jail Lane Barnstable Owner:Mathew and Martha Callahan Date of Inspection: 4/10/02 TIGHT or HOLDING TANK:_N/A (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/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.): DISTRIBUTION BOX:_x (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.): Distribution box structurally sound,No evidence of leakage levels were at invert out PUMP CHAMBER:_N/A (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:94 Old Jail Lane Barnstable Owner: Mathew and Martha Callahan Date of Inspection: 4/10/02 SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type Leaching pits,number:_ _x_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 chambers are structurally sound fluid level was 1'6"below invert in vegetation normal,no ponding CESSPOOLS:_N/A_(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 or no): Comments(note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY:_N/A (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 94 Old Jail Lane Barnstable Owner: Mathew and Martha Callahan Date of Inspection: 4/10/02 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. Front of home > I Approx location of water service ' 83' 8 ' 'Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:94 Old Jail Lane Barnstable Owner: Mathew and Martha Callahan Date of Inspection: 4/10l02 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water_Ll feet Please indicate(check)all 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 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: ih eC�/�9��s� A'-'We C'�Iu • &d"...G/A��e/ Ca ly—o cb,e L�c !GJ a7 Y? a22 3 �:./��'r�t.cl ,�6 a � �i9���'�d d� /�-��;s 7� ad 6J,�.�. 8��"l•��,.' s9�Ora-� �� a y i• , I I / Permit Number: Date: Completed by: _Yl�z Lo HIGH GROUND-WATER LEVEL COMPUTATION v Site Location: O/� �/.Ql� `,¢�c� Lot No. Owner: 17A124e.1 4011'dy,0,? Address: 9e( Contractor: �1iAK, dS� Ulkf Address:_ 13'e e✓.L�da/ s� 6; iFit t/Q Notes: V STEP 1 Measure depth to water table to nearest 1/10 ft. ......... .................. ....... .Date - month/day/year STEP 2 Using Water-LevelRange Zone and Index Well Map locate $ site and determine: OA Appropriate index well................................................... OB Water-level range zone ..................................................... STEP 3 Using monthly report "Current Water Resources Conditions" determine current depth to water level for index well ........:.................. 3 Zao v a T 3 month/year STEP 4 Using Table of Water-level Adjustments ` for index well (STEP 2A), current depth ' to water level for index well (STEP 3); and water-level zone (STEP 213) determine water-level adjustment ...........................::............................................................. 2. STEP 5 Estimate depth to high water by subtracting the water level adjustment (STEP 4) from measured depth to water level at site (STEP 1) ......................: .......................................... •F s.• - - - , t .. -;tag . Wv" Figure 13.7-Reproducible computation form. A 15 j Cj�------TOwrr.OF BARNSTAB LE LOCATIO SEWAGE # '�fZg VILLAGE_ ��eS7 ,�G}/�/j/, ASSESSOR'S MAP & LOT 2 7Si'�S� t INSTALLER'S NAME&PHONE NO. Bct,.5�'e/�✓ ��� ap/� i SEPTIC TANK CAPACITY 16 00 LEACHING FACILTI'Y: (type (size) A?X Z( KZ NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE:. Z-L— COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Welland Leaching Facility � g (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) Furnished by Feet i ' r I i i r TOWN OF BARNSTABLE 0 LOCATION 1,4 Z Zof—d 4e SEWAGE # VILLAGE ALIlfd&lf- ASSESSOR'S MAP & LOT a17,F-d� INSTALLER'S NAME&PHONE NO. ho tiS A- 4 9&9-Zd1 U SEPTIC TANK CAPACITY 1500 LEACHING FACILITY: (type) C441,44 s (size) 73.t' 6X2 NO. OF BEDROOMS 3 BUILDER OR OWNER ` O,��c./ 2A141A,1 PERMITDATE: 7�2LAf COMPLIANCE DATE: Yl b/Zady Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by C s � � r 1 L><F S/ _ `�'� TOWN OF BARNSTABLE �bca LOCATIO /^O i J /�L�� �4i .¢�.e- SEWAGE r � VILLAGE Z��ASSESSOR'S MAP & LOT 278rw INSTALLER'S NAME&PHONE NO. ZO&.3 r/e/C� SEPTIC TANK CAPACITY LEACHING FACILITY: (type) ClI~bele 3 (size) ` /3 x 26 x 2- NO.. OF BEDROOMS BUILDER OR-OWNER PERMTTDATE: —7'2—Z`? COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by ������ 0 o s..� k v � w' � �`�� O�.��_ .�_._ I ,, .^ ��, '( I. No. �- ,, �Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01 pprication for 0iqu of bpotem Cori,5trurtion Permit Application for a Permit to Construct(k)Repair( )Upgrade( )Abandon( ) Complete System ❑Individual Components Location Address or Lot No. 4-07 ='5 0 //� •T a�r/ Owner's Name,Address and Tel.No. Assessor's Map/Parcel �',Cif ®S Q !`Gv✓►11�s / @ Z t� � Installer's Name,Address,and Tel.No. (J (� Designer's Name,Address and Tel.No. 7—SOIJSI=—i�(Gl (9 C TAe% kWKA 34Nd r —2,0 0 p?_O-) Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(00) Other Type of Building Sthc.(.- t7tQn1(4 No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow 13,10,q�4 gallons. Plan Date 7—9!9 Number of sheets 0 Revision Date 0W Title Size of Septic Tank 1,500 Type of S.A.S. L Description of Soil �(c ja Nature of Repairs or Alterations(Answer when applicable) Ir(42w ( dl✓1S7i2tri TaO,� 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 Certifi- cate of Compliance has bee d by thi o Health. Signed Date ?2- Application Approved by Date — Z. ZZ-7 — Application Disapproved for the following reasons Permit No. Date Issued — Z — Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 0" �pprtcaction for -M gpogar *proem Congtructiou Permit Application for a,Permit to Construct(�)Repair( )Upgrade( )Abandon( ) *omplete System El Individual Components Location Address or Lot No. 4-C)'r '+ v/ T'� F/ Owner's Name,Address and nTel.No. Assessor's Map/Parcel :2-7�3 P)� • r 0 i Installer`s Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 08C.. e✓1V1 . -kOc1 -r S A MOkAi k C_v\ (y C IAn s16A n SANG. -2 0 63 -21-77 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(lt Other Type of Building Sivy.-[�e�No.of Persons Showers( ) Cafeteria( ) x Other Fixtures Design Flow 330 , gallons per day. Calculated daily flow 13q0.(4q gallons. Plan Date b -' �.'?-s?51 Number of sheets I Revision Date 11O✓'1 2 Title Size of 5eptic Tank 500 Type of S.A.S. L eG (n (°ham Description of Soil (G n Nature of Repairs or Alterations(Answer when applicable) A-P W CI 6hS?2 tiLT,U✓) 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 Certifi- cate of Compliance has been ' d by thi o o Health. Signed Date 7' 2-2— 9 51 Application Approved by A I - , . . Date -- d. -9'm Application Disapproved for thCfollowing reasons Permit No. 7i Date Issued - Z r THE COMMONWEALTH OF MASSACHUSETTS 4 BARNSTABLE, MASSACHUSETTS, , Certificate of Compliance i THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed Repaired ( )Upgraded( ) Abandoned( )by ?_)QQ!5 C7t e (J &y1 r-7AL!A' Se f-u i C-e t rI c at L 0— 5 OLD laiL. LA n has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. L dated 7 - Z 2- g . Installer In(is 1:7 r P ( Designer A The issuance of this pe rued as a guarantee that the s i 'f/ tion si61fflc Date Inspector --------------------------------------- No. / Zi Fee ' - THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS &5pogar *pMem Congtruction Fermat Permission is hereby granted to Construct( )Re air( )Upgrade( )Abandon( ) System located at� � �L 1 L AILC_ and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this pqrmit. // Q Date: i 2 Z / Approved by b 1 T , z a . u . Y. O I - � oz CD ^ cpL 0 O 3 3 o T 5o a•r..o .. ^ V m, r- - - ------- w - - - - - ' 0 o � 0 ! 7C7 00 P s 10, r /v Om� N 0 7 _ O v. 3 z i t -� 81 J r-1 a O Ii z e m — 6 _ I 27 !1 I C I G I I I I I O;;;u � O i o = I N � "OT =-fl O o O I 5 n � v, �.Xoc3 en ' r- �o� ��� � v 0' o `' w — an d i to W n aS v E 7- o w � Cl) c y :•7a N .PCD cncn G R� r I(ATI E-n N = o c r) rri F zg n Form 11-SOIL EVALUATOR FORM Page 1 Commonwealth of Massachusetts Barnstable, Massachusetts Soil Suitability Assessment for On Site Sewame Disposal Performed By: Jeffrey D.Youngquist (Outback Engineering,Inc.) Witnessed By: Jerry Dunning Barnstable Board of Health) Location,Address,or Lot# Owner's Name,Address,and Telephone# Lot 5 Subon Company F,41 Old Jail Lane P.O.Box 9102 f-3til n/� f `� S. Walpole,Ma. 02071 (508)660-1600 New Construction © Repair ❑ Office Review Published Soil Survey Available: No ❑ Yes Year Published 1993 Publication Scale 1:25,000 Soil Map Unit BgC Drainage Class 1 Soil Limitations , none Surficial Geologic Report Available: No Yes ❑ Year Published Publication Scale Geologic Material(Map Unit) Landform Flood Insurance Rate Map: Above 500 year flood boundary No ❑ Yes Within 500 year flood boundary No 0 Yes ❑ Within 100 year flood boundary No © Yes ❑ Wetland Area: National Wetland Inventory Map(map unit) N/A Wetlands Conservancy Program Map(map unit) N/A Current Water Resource Conditions(USGS): Month September 1997 Range: Above Normal ❑ Normal ❑ Below Normal Other References Reviewed: None 1 4 y Form 11-SOIL EVALUATOR FORM Page 2 On-Site Review Deep Hole Number 1 Date 9/5/97 Time: 11-36 Weather Sunnv Location(identify on site plan) front center of lot Land Use wooded Slope(%) 2 Surface Stones none Vegetation decidious trees Landform Ground Moraine Position on Landscape(sketch on back)_ on slope Distances from: Open Water Body 400+ feet Drainage way 100+ feet Possible Wet Area 100+ feet Property Line 75 feet Drinking Water Well 100+ feet Other N/A feet DEEP OBSERVATION HOLE LOG Soil Other Soil Depth from Surface Texture Soil Color Soil (Structure, Stones, (Inches) Horizon (U.S.D.A.) (Mansell) Mottling Boulders,Consistency, 0"—12" A Loamy 10YR 3/3 None %Gravel sand 12"—40" B Loamy 10YR 4/6 None sand 40"—56" Ci Silt loam 10YR 6/4 None 56"— 120" C2 Coarse 10YR 6/3 None sand Parent Material(geologic) Glacial Till Depth to Bedrock 120 + Depth to Groundwater• Standing Water in the Hole: none Weeping from Pit Facer none Assumed Seasonal High Ground Water:_ 120"(bottom of deep hole Form 11-SOIL EVALUATOR FORM Page 2 On-,Site Review Deep Hole Number 2 Date 9/5/97 Time: 11:48 Weather Sunny Location(identify on site plan) front center of lot Land Use wooded Slope(%) 2 Surface Stones none Vegetation decidious trees Landform Ground Moraine Position on Landscape(sketch on back) on slope Distances from: Open Water Body 400+ feet Drainage way 100+ feet Possible Wet Area 100+ feet Property Line 75 feet Drinking Water Well 100+ feet Other N/A feet DEEP OBSERVATION HOLE LOG Soil Other. Depth from Surface Soil Texture Soil Color Soil (Structure, Stones, (Inches) Horizon (U.S.D.A.) (Munsell) Mottling Boulders,Consistency, %Gravel 0"— 12" A Loamy IOYR 3/3 None sand 12"—40" B Loamy 10YR 4/6 None sand 40"—60" C, Silt loam 10YR 6/4 None 60 120 C2 Coarse 10YR 6/3 None sand Parent Material(geologic) Glacial Till Depth to Bedrock 120'+ Depth to Groundwater:. Standing Water in the Hole: none Weeping from Pit Face: none Assumed Seasonal High Ground Water: 120"(bottom of deep hole) Form 11 -SOIL EVALUATOR FORM Page 3 Location,Address,or Lot# Lot 5 Old Jail Lane Determination for Seasonal High Water Table Method Used: ElDepth to bottom of deep hole(assumed seasonal high groundwater) 120 inches ❑ Depth observed standing in observation hole inches ❑ Depth weeping from side of observation hole inches ❑ Depth to soil mottles inches ❑ Groundwater adjustment feet Index Well Number Reading Date Index Well Level Adjustment Factor Adjusted Groundwater Level Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? Yes If not,what is the depth of naturally occurring pervious material? Certification I certify that on April 1995 1 have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training,expertise,and experience described in 310 CMR 15.017. Signature — Date �� / / r - Form 12-PERCOLATION TEST Location,Address,or Lot# Lot 5 Old Jail Lane Commonwealth of Massachusetts Barnstable, Massachusetts *Percolation Test Date: 9/5/97 Time: 11:36 Observation Hole# 1 2 Depth of Perc. 60"—72" 60"—72" Start Pre-Soak 11:36 11:48 End Pre-Soak :Unable 11:52 Time at 12 Time at 9" Time at 6" Time(9"-6") soak Unable to presoakRate(Minutes/Inc <2 M.P.I. * Minimum of 1 percolation test must be performed in both the primary area AND reserve area. Site Passed 0 Site Failed ❑ Performed By: Jeflrev D. Youngguist (Outback Engineering Inc.) Witnessed By: J Dunnin arnstable Board of Health Comments: 1 wN a ul lf�ti ►►SI�tU►� Ca0 � De arlment of Health,Safety,and Environmental Services pale r Public Health Division d tNa 367 Mein Strcet,Ilyennis MA 02601 t ,er,►ns l Time Fee pd. s Sol Date Scheduled ' essment for Sewage Disposal •, Soil Suitability Ass f Witnessed By: Performed By: AT3GnyN a GENION &RAL INFORMs� 7:.=dCAIT owner's Name r :.. Location Address rj¢ O La Address '' y'¢''1"�' s �,,J S;.v-3 t_E /1'1/`�• l.nBtneer'a Name Assessor"Map/Ptucel' �--I Telephone _�- NEW CONSTRUCTION R EPAIR Sutrace Stones Slopes ON Land Use B Drinking wgW Well n �— R Distances from: Open Water Body�--- tt possible Wet g property Line —tea Drainage Way.._-----"' Ions of lot,exact locations of test holes dt pare lash,tocote'a'etlands M proximity to holes) SKETCH:(Street name,dimens ,i r I +4 ,L3 R Z ► rr J � k•y ni .1 r 1 � • A �—rL Depth to Bedrock parent material(geologic) in item Pit Pace weeping Depth to Groundwater: Standing Water In Hole: i t Estimated Seasonal High Groundwater N FOR SEASbNAV-loGn-WA` 0%TALE UETF,RMINATIO In. In. Depth to soil mottles: A• Mcthod UscJ: in obs.hole: in• Groundwater Adjustment Depth Observed standing Ad).rector —Adj.(;mundwaler Level Depth to weeping from side of obs.hale: Index Well level Index Wcll N__.. - .Reading Date: — ' :.,, '`•'i(fit! PFRCOI:ATION`I'EST": Tlnte at 9" •--=— Observatlon Hole N Depth of Pere —"— Time(90-61 start Presoak Time® t 1 End Pre-soak 'lb �A�'� Rate Min.Anch _— Additional Testing Neede�(Y" f Site Failed: Site Suitability Assessment: Site Passed on Back----Back-----)_�— Division Obsery ,ation Hole Data To Be Completed • Ongtnal: Public health , • r....• An[lical t ION 110"' sell villa �)((51�'ItvA� snllColnr Slructun,Slones,nonidettf. Soillexlrlre (Munsell) mottling (• Ikpth from Soil Ilorizon (USDA) Surface(in.) L o 4K.,✓ Ja z.. 71 A to r, G z Gon R's.= UG �: .:•, Ur�p OBSrltVATI II�L iLolnr son Mottling (Swetu(Xhe?Stories. Soil7exlute (Munsell) Depth from Soil Ilothon (USDA) , Surface(In.) U� ' 1° r Z 4D told#G �---��er son (;,(;p di35C(tVA'r1�N 110L�C, color iln (structure.Stonef,Donideres. (� Son texture (Munsell) Mott g peplh from Soil llotizon (USDA) Surface(In.) N 1IOL� LUG Other OBSERVATION I Soil soil Color Mottling (stmcture,Stoner,(Iouldctes. DEEP soil (Munsell) I)cpih frnm .Soil Ilorixon (USDA) Surface(in.) 1 Above 3001eer Hood boundary No Yet' et — Wlthin 500 year boundary No Within 100 leer Hood boundary No Yes n all areas ob served ed throughout the Does at Icast four feet of naturally occurring pervious material exist i ro oil absorption system? area proposed for the s h of naturally occurring pervious materlal? ICnot,what Is the dept �.-- > dale 1 have passed the soil evaluator examination approved by the efformY ed b me consistent Willi I certify flint on rip nnrinrCnt of(;nvironnicnlal Protection and that tile above nn CMR 15,011, V' ra X I Pill Ill !p - .. .,.. _ :I—ASSESSORS MAP : �78 TEST H Qi 1 ,E LOGS PARCEL : -,?, FLOOD ZONE : T h'.�'I��! /C��tt-� SOIL EVALUATOR � N tit UIJTWk REFERENCE . ' �r�e7 DATEFS �ErI vl-q:7 (1� PERCOLAT I 0 RATE . /rI/ ra/, —0ram A�'a/jf D;�, �-,�f,L T/y, 36� 7 T H- I T H-2 i-✓ ' I LOCATION MA P �`? o" .✓%s, , \ 1 \ is/L? eoA/k) r�/LT L D /� G i�11 r�C , f '�.' ,/,j. li�,/r� f 1 _ / /' r-+ /� �•'''' /� /'-yl fir- ` . n//.•.+ _ oe , `' •D;Zb/ }� /`"')/1 f,,y.../°f; •/^J �'%L..^''L'li C.r'' y;,'i�.' Cwc`t J l6- ...! `A i"..r l�' l '?<..� r:....p'. � _ �j'''` t / `.. � � �\ \ \ Q "•w`1� 1:�\ 1 ����. ���� � � ,� ✓% ,icy J r- ^",.',.. /�i/ �!.. 4 1-J•' I ^ C` J �;•�-C.�2. —T',�;,�,�_ �? ..�;��...; �'•..--. ��.�..,:�!�-.l''c�� '�t'�..1f,,.,/ '..(:.' SEPTA SYSTEM DESIGN ` FLOW ESTIMATE BEDROOMS AT GA /vAY/BEDROOM GAL/DAY rj�,,,j"j ' � �-•',_•„c"�,�j SEPTIC TANK � i C�--�'�<� �''�7�-- �. � �;�r: ,�',,,�G...'<,� �'. r�,�, %�,_, ,►/�r• 'i"�:.�` FUGAL/DAY x 2 DAYS - j GAL USE /�5. ALLON SEPT i C TANK1V , j! t /o[, /�.Ar, /�v�. ' �-r�LJ 1 �G��� - �, - l r CLI �, ``; - „� �( ►, �� ' 'r SOIL ABSORPTION SYSTEM N -�-7,s� - rNi SIDE AREA : . i3 �'y X X 0, 7 = /0. 4c= �, ' BOTTOM AREA: cl, 7 tt SEPT ! C SYSTEM SECT I ON �� \ '� /1 `, r •, �, 1 44 D BOX GAL i . SEPTIC TANK :t� � � / �T ' \ i'- 1 oif o' ! \ � 1= _,/�fl/�'I�► Y { S I TE AND SEWAGE PLAN \ �' �' �` 1 bZ ._.- " - •-x.r3 _ 76 L-0 C A T I 0 N : , cif c .t.�` y •' %� °.1 (� � � -rs '.r✓� / � .'/ ~ , jJ/•//J,r�`f ', ! �`� ._. •'-°"'.,.. --"" '"` �j�1 CJ "r �t .��(��� � l --•'��'"'�! ' ,�L./' C.. .. Y r��'-�`.f,�..� r�'�" f , PREPAR D FOR % = t C"r '_ w,,,,,_ '_' ; � / / yam•?. J��/ �j�� � r r;� �''';�,/''� • +�'P '"l^� <.r f' -� LE y G r I MASON DATE DAV D B MAS 6 I DBC ENVIRONMEI'TAL DESIGNS ! DATE HEALTH AGENT EAST SANDWICH . MA ( SOS ) 833 - 2177