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HomeMy WebLinkAbout0380 OLD JAIL LANE - Health 380 Old Jail Lane 4 Barnstable '¢ A=277-018 001 ,J # N o i 0 a P s Commonwealth of Massachusetts Title 5 official Inspection Forr s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 380 Old Jail Lane Property Address Robert Catania Owner Owner's Name information is required for every gamstable MA 02630 0420/13 page. Cityfrown State Zip Code. Date of Inspection Inspection results must be submitted on this form.inspection forms may not be altered in any way.Please see completeness checklist at the end of the form. Important:When A. General. Information filling out forms on the computer, use only the tab 1. Inspector. (, key to move your cursor-do not Michael Kellett olJ use the return Name of Inspector key. Aardvark Environmental Inspections- rah Company Name PO Sox 896 Company Address East Dennis MA ' 02641 Cityfrown State " Zip Code 508-385 7608 S13742 . 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 ins n.The ir"�'�ectid was performed based on my training and experience in the proper function and maintee lance of bti site sewage disposal systems. I am a DEP approved system inspector pursuant to diei,ion 15.340:of Title 5(310 CMR 15.000):The system: _r ® Passes [] 'Conditionally Passes 0 Fails El Needs Further Evaluation by the Local Approving Authority `< c Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. ****This report only describes conditions at the time of inspection and underthe 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. ft5ins 11/10 Title 5Offcial Inspectionmece a Disposal System 17 . Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 380 Old Jail Lane Property Address Robert Catania ' Owner Owner's Name information is Barnstable MA 02630 0420/13 required for every ' page. Cityrrown state Zip Code Date of Inspection B. Certification (cont.) Inspection Summary:Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure 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: ❑ 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): t51ns•11/10 Title 5 Offcial Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts ME Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 380 Old Jail Lane Property Address Robert Catania Owner Owner's Name information is required for every Barnstable MA 02630 04/20/13 page. City/town state Zip Code Date of Inspection B. Certification (cunt) B) System Conditionally Passes(cunt.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructedpipe(s)or due to a broken,settled or uneven distribution box.System will Y 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: 6 ❑ 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 Okra-f 1110 Title 5 Official lnspecdon Form:Subsurface Sewage 01sposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 380 Old Jail Lane Property Address Robert Catania Owner Owner's Name information is required for every Barnstable MA 02630 0420/13 page. Cityfrown State Zip Code Date of Inspection B. Certification (cunt.) 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-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 380 Old Jail Lane Property Address Robert Catania Owner Owner's Name information is required for every Barnstable MA 02630 0420/13 page. Cityfrown State Zip Code Date of Inspection B. Certification (cunt.) 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. El ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no°to each of the following,in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered `yes"in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Departitment t5ins•11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments w 380 Old Jail Lane Property Address Robert Catania Owner Owner's Name information is required for every Barnstable MA 02630 04/20/13 page. CRylrown 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 E ❑ 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 (f 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 r Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15203(for example: 110 gpd x#of bedrooms): 440 t5ins-11/10 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 , t Commonwealth of Massachusetts Inspection 1rm=Tit e � Official0 s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments '( 380 Old Jail Lane Property Address Robert Catania Owner Owner's Name information is Barns required for every table MA 02630 0420/13 ' page. Cityfrown state Zip Code. Date of Inspection D. System Information Description: Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[if yes separate inspection required}. ❑ Yes ® No Laundry system inspected? ❑ Yes ® No r Seasonaluse? ❑ Yes ® No Water meter readings,if available (last 2 years usage(gpd)): Detail: Sump pump? ❑,,Yes ®. No Last date of occupancy: CurrentDate 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-I i/l0 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Forth-Not for Voluntary Assessments 380 Old Jail Lane Property Address Robert Catania Owner Owner's Name information is required for every Barnstable MA 02630 04/20/13 page, City(rown 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: Was system pumped as part of the inspection? ❑ Yes ® No If yes,volume pumped: gallons How was quantity pumped determined? Reason for pumping: , Type of System: ® Septic tank,distribution box,soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy . ❑ Shared system(yes or no) (if yes,attach previous inspection records,if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the VA system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t51ns-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 � t Commonwealth of Massachusetts 4 Title 5 official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments yy. 380 Old Jail Lane Property Address Robert Catania Owner Owner's Name information is required for every Barnstable MA 02630 0420/13 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: 04/13/01 per BOH Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 3.2 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.): Septic Tank(locate on site plan): Depth below grade: 2.4 feet Material of construction: ® concrete ❑metal 0 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: 1,500 gal 2" Sludge depth: t5ins•11/10 Title 5Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 N Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 380 Old Jail Lane Property Address Robert Catania Owner Owner's Name information is required for every Barnstable MA 02630 0420/13 page. Cityrrown state Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 28" Scum thickness 2„ Distance from top of scum to top of outlet tee or baffle 6-1 Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? measured Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): The tank was sound and fight with tees in place and liquid at outlet invert. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑metal ❑fiberglass ❑ polyethylene ❑ other(explain): r . 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-11/10 TdJe 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 380 Old Jail Lane Property Address Robert Catania Owner Owner's Name information is required for every Barnstable MA 02630 04/20/13 page. Cityfrown state. Zip Code. Date of Inspection D. System Information (cunt.) Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑concrete ❑metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order. ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches,etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts ` Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 380 Old Jail Lane Property Address Robert Catania Owner Owner's Name information is required for every Barnstable MA 02630 0420/13 page. CityrFown 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 even Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): The box was level and tight with no sign of carryover. 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.): Soil Absorption System(SAS) (locate on site plan,excavation not required): If SAS not located,explain why: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System form-Not for Voluntary Assessments yy� 380 Old Jail Lane Property Address Robert Catania Owner Owner's Name information is required for every Barnstable MA 02630. 04/20/13 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 3 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number,dimensions: ❑ overflow cesspool number: ❑ innovative/altemative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.): This system has 3 five hundred gallon drywells surrounded by three feet of stone.There was 3'of liquid with no sign of ponding or failure. 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•11/10 Trtle 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 k Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 380 Old Jail Lane Property Address Robert Catania Owner Owner's Name information is required for very Barnstable MA 02630 04/20/13 e page. City/Town state Zip Code Date of Inspection D. System Information (cunt.) 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•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments '( 380 Old Jail Lane c . Property Address Robert Catania Owner Owner's Name information is required for every Barnstable MA 02630 04/20/13 page. City/Town state Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System:Provide a view of the sewage disposal system,including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate- where public water supply enters the building.Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately . front . 24 9arn9e 26 39 • 33 46 36 f t5ins•11110 TNe 5 Official inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System.Form-Not for Voluntary Assessments 380 Old Jail Lane ? Property Address Robert Catania Owner Owner's Name information is required for every Barnstable MA 02630 0420/13 page. Cityrrown 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: 20.0 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 maps show an elevation of over 20.0 feet: Before filing this Inspection Report,please see Report Completeness Checklist on next page. t5ins•11/10 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 380 Old Jail Lane Property Address Robert Catania Owner Owner's Name information is required for every Barnstable MA 02630 0420/13 page. Cityfrown 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 t5ins•11/10 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 i z--- ' `f � Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 380 Old Jail Lane Property Address Michael Cotto Owner Owner's Name information is required for Barnstable MA 02630 03/15/10 - every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any v way. Important:When filling out A. General Information forms on the (� computer,use 1. Inspector: 7v, only the tab key to move your Michael Kellett cursor-do riot Name of Inspector - use the return key. Aardvark Environmental Inspection Company Name P.O. Box 896 i Company Address k, 41 East Dennis MA . r�A Cdy/Town State Zip Code M;r 508-385-7608 S13742rLL ► "� Telephone Number License Number �� B. Certification , •i rn I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority '71t 03/19/10 Inspector's Signature Date t 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. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,M 380 Old Jail Lane Property Address Michael Cotto Owner Owner's Name information is required for Barnstable MA 02630 03/15/10 every 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: ® 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: ❑ 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. ❑ 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 exfiftration 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: ❑ 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 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 380 Old Jail Lane Property Address 1 Michael Cotto Owner Owner's Name information is sequined for Barnstable MA 02630 03/15/10 every page. City/Town State Zip Code Date of Inspection • i B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed ND Explain: 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 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. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 380 Old Jail Lane Property Address Michael Cotto Owner Owner's Name information is required for Bamstable MA 02630 03/15/10 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ 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 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: r 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 El ® 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 day flow ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the 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. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 380 Old Jail Lane Property Address Michael Cotto Owner Owner's Name information is sequined for Barnstable MA 02630 03/15/10 every page. City/Town State Zip Code. Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well ❑ ® Any,portion of a cesspool or privy is within 50 feet of a.private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] . ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with-a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or`no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 380 Old Jail Lane Property Address Michael Cotto Owner Owner's Name information is required for Barnstable MA 02630 03/15/10 every page. Citylrown 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? ® El Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ 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)] Commonwealth of Massachusetts W Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 380 Old Jail Lane Property Address Michael Cotto Owner Owner's Name information is required for Barnstable MA 02630 03/15/10 every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms(actual) 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Number of current residents: 4 Does residence have a garbage grinder? ® Yes ❑ No Is laundry on a separate sewage system? [if yes separate inspection required]. ❑ Yes ® No Laundry system inspected? ' ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: current .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:` Last date of occupancy/use: Date Other(describe): Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 380 Old Jail Lane Property Address Michael Cotto Owner Owner's Name information is required for Barnstable MA 02630 03/15/10 every page. Citylrown State Zip Code Date of Inspection D. System Information (coat.) General Information' 4 Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined?,- Reason for pumping: Type of System: ' ® Septic tank,distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ' ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and' maintenance contract (to be obtained from system owner) ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe):' ` Approximate age of all components, date installed (if known).and source of information: 04/13/01 per BOH Were sewage odors detected when arriving at the site? ❑ Yes ® No Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 380 Old Jail Lane GSM - Property Address Michael Cotto Owner Owner's Name information is required for Barnstable MA 02630 03/15/10 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 3.2 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.): Septic Tank(locate on site plan): Depth below grade: 2.4 feet Material of construction: ® concrete El 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: 1500 gal 3-, Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 27" I' 211 Scum thickness 5,1 Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 16' measured How were dimensions determined? _ Commonwealth of Massachusetts a w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 380 Old Jail Lane Property Address Michael Cotto Owner Owner's Name information is required for Barnstable MA 02630 03/15/10 every 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.): The tank was sound and tight with tees in place and liquid at outlet invert. r. Gr ease Trap (locate on site plan): Depth below grade: feet - I 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 4 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.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal T ❑fiberglass ❑ polyethylene ❑ other(explain): Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 380 Old Jail Lane Property Address Michael Cotto Owner Owner's Name information is Barnstable MA 02630 03/15/10" sequined for every page. CityfFown State Zip Code Date of Inspection D. System Information (coat.) Tight or Holding Tank(coat.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order. ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): = *Attach copy of current pumping contract (required). Is copy attached?'' ❑ Yes ❑ No Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert even Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): The box was level and tight with no sign of carryover. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments G M ; 380 Old Jail Lane - - - Property Address Michael Cotto Owner Owner's Name information is required for Barnstable MA 02630 03/15/10 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 3 . ❑ 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.): The system has three five hundred gallon drywells surrounded by three feet of stone.There was no sign of ponding or failure: R . f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M , 380 Old Jail Lane Property Address Michael Cotto Owner Owner's Name information is required for Barnstable MA 02630 03/15/10 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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.): 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.): Commonwealth of Massachusetts Title 5 ,official Inspection Form . Subsurface Sewage Disposal System Form-Not for Voluntary Assessments I 380 Old Jail Lane Property Address Michael Cotto Owner Owner's Name information is MA 02630 03/15/10 required for Barnstableevery page. City/Town State Zip Code Date of lrupection D. System Information (cunt.) 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. a GOB{ �3 3 b E 1 f Commonwealth of Massachusetts rz Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �M 380 Old Jail Lane Property Address Michael Cotto Owner Owner's Name information is required for Barnstable MA 02630. 03/15/10 every page. Cityrrown 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: 20.0 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 maps show an elevation of over 20.0 feet. TOWN OF BARNSTABLE LOCATION SEWAGE# VILLAGE ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) NO.OF BEDROOMS OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility feet Private Water Supply Well and Leaching Facility(if any wells exist on site or within 200 feet of leaching facility) feet Edge of Wetland and Leaching Facility(if any wetlands exist within 300 feet of leaching facility). feet FURNISHED BY J7C2 TO WN OF : per$ 3-P6 ►mil Vl 's LOCATION: ' lam' 1� �� L•-l.'l VILLAGE: I&X r vy S w LOT # : ` PERMIT # : G'Ca INSTALLER' S NAME -���✓�p �xccr�,y ���� INSTALLER'S PHONE # : tel: - ( � ll LEACHING FACILITY: (typ (size) NO.. OF BEDROOMS :-- BUILDER OR OWNER: PERMIT DATE: Z "Z -7-d COMPLIANCE DATE: y-i3- GI DRAW DIAGRAM ON BACK 7 -��- z VON- ^ iZ Cur- Ltr TOWN OF 180 ,cv�S � � 417/7 0 c LOCATION: VILLAGE: LOT # : PERMIT # : o( .- INSTALLER' S NAME: 7� Q,,A-. INSTALLER' S PHONE # : �c c < /0 LEACHING FACILITY: (type (size) S / NO.. OF BEDROOMS: BUILDER OR OWNER: , 40 PERMIT DATE: COMPLIANCE DATE: q /3- 0 1 DRAW DIAGRAM ON BACK _ N S P No. & 1- 11-3 FEE } .,�EOMMONWEA1LTH Of MASS C14USETTS vV 3edBoard of Health, J3Pj;Z MA. P v Application f9y a Permit to Construct(V Repair( ) Upgrade( ) Abandon( ) - VCmpleteSystem U Individual Components Location 4 OLD j', L JpjjM 1. Owner's Name Map/Parcel# Z17 60 Address Q Lot# Telephone# �'Z— 1123 Installer's Name Designer's Name Addre U Address 306 O LV 71.4r110 F b t Telephone# Telephone# Type of Building Lot Size —1-3 ZZ sq.ft. Dwelling-No.of Bedrooms Garbage grinder (40 Other-Type of Building No.of persons Showers ( ),Cafeteria( ) Other Fixtures Design Flow(min.required) 440 gpd Calculated design flow Design flow provided gpd Plan+:. Date 9/ "1 06 Number of sheets Revision Date Title' Description of Soil(s) Yq'-- •,Soil Evaluator Form No. Name of Soil Evaluator 5 . �(��r s Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned a ees to install the above described Individual Sewage Disposal System in accor ce with the provisions of TITLE 5 and further,agrees t o place the sys operation until a Certificate of CompliaVe has bee issue by the Board of Health. Signed Date Z— d Af Y No. �' / 1-3 ` `�i ......� S FEE 3� Board of Health, BPF.1J 5r,.( b) , MA. . � APPLICAfTON FOP, DISPOSAL SYSTEM[ CONSTRUCTION PERMIT Application for a Permit to Construct(i Repair( Upgrade( ) AbandonO - Complete System O Individual Components Location Lo T S 13 D.L-D 1A1L _ L IEOwner'sName Map/Parcel# — 1 Address 0 G 0 I d 1 44-', t, 4 ;ft Lot# Telephone# Installer's NameLk � Designer's Name Addre L) 0) � �'" � f- Address 3 0� O L V \71., 7-9 dG 1?P, F Telephone# ' Telephone 1�\ 6 Z / O Type of Building ,,�� Lot Size -1 3 Z Z C, sq.ft. Dwelling-No.of Bedrooms 4- Garbage grinder(�J® Other-Type of Building No.of persons Showers ( ),Cafeteria ( ) Other Fixtures Design Flow (min.required) 4"40 gpd Calculated design flow t Design flow provided gpd Plan: Date 106 Number of sheets Revision Date Title 2l,t>u, a 5401�tN6 -r'N� rn�' .� T'RD PtjZ � 9wi I� b GE Description of Soil(s) Soil Evaluator Form No. Name of Soil Evaluator 45. AP643+_ `Date-of Evaluation 27 v 1 DESCRIPTION OF REPAIRS OR ALTERATIONS r , The undersigned a ees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees t o place the sys n operation until a Certificate of Compliat a has bee isrsuell by the Board of Healthy Signed v Date Z U /// Ira�eertit7it5 v eii' . eF l{ Y No. /—t!? FEE COMMONWLAL114 OF MASSAC14USETTS , .'. r Board of Health, 96lw S-E ; MA. . CERTIFICATE OF COMPLIANCE t? "r,r-e� jv ti-A pa/a U� Description of Work: ❑Individual Component(s) Q omplete System tn.. f C, (e (,r f(�I The undersi ned ereby certify that the Sewage Disposal System; Constructed (aired ( ),Upgraded ( ),Abandoned`( by: J-UJka) at LF1-f S 2 0 / �Q � � vr1 CHl9 has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No.7bV t dated 2 77 G Approved Design Flow (gpd) Installer •. Date; Designer: ~Inspector.�O,v��r��:-;�..;„ ;`: . The issuance of this permit shall not be construed as a guarantee that the system will function as designed. No.-Z"tr 3 FEE Board of H 1�ealth, 0,, Vlniyi4e MA.* SYSTEM k DISPOSAL � JL ST EM CONSTRUCTION PERMIT r 4 Permission is hereby granted to; Construct(v) Re air( ) Upgrade( ) Abandon( ) an individual sewage disposal system ` at 76 0 a �����Q.f yr}Lt (X/ as described in the application for \ Disposal System Construction Permit No. dated / 2 U . Provided: Construction shall be completed within three years of the date oft 's permit. All loca co ditions must be met. Forrm1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date a/?-7 0/ Board of Health -- v a TOWN OF a&NBt=PIi w; LOCATION: lam' �� 1 -a VILLAGE: - S b w LOT # : PERMIT # : Q� r_INSTALLER' S NAME: rxcc, ;cnr� j INSTALLER' S PHONE # : 5 — C, 8 0 LEACHING FACILITY: (tvpe ( size) S . ,..., NO.. OFB BEDROOMS : BUILDER OR OWNER: p_ e PERMIT" DATE: COMPLIANCE DATE: Y-(3- G DRAW DIAGRAM ON BACK l Q_3 r u z 9 0; gg M 8.: a 6 i $ N `WI a i g { a, o� .Yf': .I. O:L: O.l. �TE�. .B:S •f 4. y:'L 9�—rt � C,a ...' � � Y F ..m �r r mk o F ol I JI y i - \ J s , y .. ._. .. J. :. I In _ 1 owil c)I Jl�cl Ilst�lta-1( --rrr ��/� Depilrinlcnl of Ilcailll,Snfco" and Eilvirunntcnlal Scrvlccs ;f)>a PIII)]iC Ilcf)I11) I)ivisiOn n;)11 ' �7 L7 av 307 Malo Sited.I lymmis MA 02601 1 I unnnnrArilr_ 1 ►1Ags. l .-, bu , 'fA^I Dtl(c Scllc(lnled `'7/z7 UU _»•role ✓f' FCC I'tl. ;dv ic SUil. It.wahr.lil:p.;AYsen iren. O''PSe)I)(T &-Di,SI)-O5'<lU + *' I s%- �elfuimcd Ily' ;r \Vllncsscd Ily: l�' I�0CATI0N & 'GI;i`II[ (1�f>.:RAID INIrOk 'T`�(51N Locnllon Addlcss B Opvncr's Nan1c w/i-t �'c'T S D -%� v"�1-, L C Arc iC s C'cn{-l�,c-z crF /•hvh�Sf�ciJS Address _ Assessor's flap/I'nrccl: Z-1'� / •P,0- � a Ialginccr's nlnlnc S%Z7A/t�`acA IT+cib,l Nli\V CONSTRUCTION lu--l'Alll I'cicphunc 11 —<2519 36 QJ/,jz- I.vl(l 1)sc Slopes(:o) -!5' -t Surfncc Slun•cs -- }�C=.S Uislanecs from: Open\Vnlcr Dolly 11 Possible\Vcl Alen fl Urinking 1Vnler \Ve1J s Urninnge\Vny Il I"topclly l.tnc v Il `Olhct fl```` SKEITC11: (S(Iccl nnnlc,dlnlcnslons of lot,exnel lucallon,c ol'Ies1 holes h pere'Iesis,loenie svellnnt)s.in proximity to holes) _ s i9^o9 10 r 431 68 1 261.68 1150.00 °i \�• N Y 3 r-t✓'�� � c1 4' % U3 a N LOT 5 A o 0 O cw 66,118 50.FT.OR 1.518 ACRES a SHAPE 16.59 - I 0 %0 \ ' y LOT 5,� r? "v COe; - 73,226 SO.FT.OR 1.681 ACRES . r �' • ^ i SHAPE•16.77 �\ CO 0 dJ'9 ti� Z p© p 70 'os co f/V Vol 'TP- 0�33 4 r cg 7. t �t ti; \ * r l�37 4.300q 8 A.. 91 y y s �g56 Ne 216 Q1 e ry Valcnl nlnlclinl(Lcolugic) =114)X/h A"p y�''�:'r� r • I)cplll lu Ilcdrack ��r' � V _ 01:1101 to(itulmdwnlcr: Slnndj+s�\Voter in I iilc — _`'{ 1Vccping fluill'l'il I ncc lislhnnlcd Scnsunnl l ligh Oloundsvnlct N1A.. _- DETERMINATION I�O.R.SE SONi�L MGII.WAI ICI I'AUL1, Method Oscd: Depth Observed slandiog In(ills.hale: in. Dcplll to soil mollles: OcplII In tvcclrlllp 1110111 sldc of obs.liolc: In, Gluundmicr Adlnslmutl IL I1111cx Well It _ IlnndIllp i)nlc: _ ImIcxAvc.1l level _ _ A1II,faefor Adj.0101111dwafeil.cvel , I'IIZCC)I;A'I'XON 111I81I' bill -71u1c`11 + 'I Iri1e of 7 � ;_ _ i)cplh of l'c1c l�l s•y +�Y+`"•`' t,� � r', ` s" �'{. •f 'T'Imc nl G' ,, : ' Siall 11rc•sonk 11111c 'I Imc(9"G,), I II(ITIc soak ititle I'VIIIIJInch Silc Styilnbilily Asscssmcitl: SIIc I'nsscd �^ Sill:pnlled: Addiliondl'I'csfiog Nccdcd(WHI) 011ginnl: Pobllc 11CIIIIIIDIVlslun 0I15CI-1'1111ott Hole Dahl To 11c CollipIcled on Ilncic j Cupy: Appllcnnl ,y _. .. -- 1 • 1)F110/ U1351'rItVA i:i ON.110Ui. w 6liOlc 11 I)c rlh finrrl I Coil Ilurizull Soll'I'cslurc Still Color $oil Micr (�l orscll) �Ionling (.Sl.... C.Sltincs,lln)dducs, -- • I)IJIJI' nI31J1IJIZ I,[A'I'I(�N AI(.�IJ IJ IJ.O AA(JI 1f Dc.11111 hoar I soil l lnllr.on .Sail-I cxlurc Gdf Ctilnr Soil Swjrlc:c(ill.) Uihcr (ILSUA) (�lunscll) Nlotlllug (Slnlchlrc,Sh tics,Iluulducs. 5 )( - — _S.II11113L411S.1'..:c�aSitI1Y<I) - - — --— --- — L . S. I)li;li;1' OIJSI�;;,lt1'/l'1'(()N IIOL,I; I,O(; f1Olo1! l)c(rlh Pool Soil I lollr.inl !foil Tullot: Soil Color .Soil Surfhcx(in.) OIhcr ---- (IJSI)A) (f\lunscll) �Inllling (Slruclurc,ECloncs,Iluulducs. - - — _ .S.IllIS31j4(S5:•_cSLIIY�I) I)clrlll hoar Soil Ilotll.un �inil'I'cxlurc Soil("ulor- SufGlcc(In (7i11u (USDA) (t;lunscll) Nlullling (SIIIIC1111C,Slnncs,Ilouldt:lcs. - �aI113131S:JIL'J�1i.(llilYS1) - -- I 11�JS1�Ij511)'11 jjC(:�)1Am 1u Ahovc 500),c;1r flood houririnr)' No /- 1 cs wllliln SIII)ycnf llourulruy Mn y Ycs IUhih1 I nU ycnr Ilnod boundary Mn � Ycs ---�- -. - _- I)i:.Ij(Ij_c(i1a{ll.l(1.111�-V•c�(j)sluh_I�i►j�s��ijjlcrl;>) _ I)ocs ;II Icasl lOIII' fcc( of flalurally occurring I)crviorls arc; )ro )osc(I Ior Ilrc oa)s( r1)lon nlal il i ;III arc<s u )scrvc(I Illrlu,lli f l [Ile Sy5lClll7 ��5 - . I I'nol, wllal is Ills (Ic1)lll of nahn ally nccurl ing 1)crvious 111;11cri;ll•1 I cel lily 111al nil _//�� ((la(c) I have I)asse(I the soil evalualor cxnnlilinln' • l I)cl1srrllrlcol of lillvirnllnlc))l;(I I'ro(cclioll Ill,(, (11,11 IIle nbovc nn;llysis was I)crforlc(I byllnc consislccl willl file rc(Iltirc(I (raining ex1)crltse alld exl)cricncc (ICSCriI)C(I in J IU CM 15.017. 4— �. �v . • GENERAL NOTFS.' _ �o`t"�: *�9rA r✓L ��S �AF �E o p -~ �u� �1k-7")o r� •, s o u-fL�-� rE SOIL TEST PIT DATA' p 1. THIS PLAN IS FOR THE DESIGN AND �- "� ® T.P. - T.P. - CONSTRUCTION OF THE SEWAGE DISPOSAL INVERT ELEVA TIONS. GRND. ELEV. 7� f � GRND. ELEV. FACILITY ONL Y. INVERTG. l✓. ELEV. G. W. ELEV. AT BUILDING � _ — 2. ALL CONSTRUCTION METHODS MA TERIALS AND INVERT IN A T SEPTIC TANK .�?- q D.'o MAINTENANCE FOR THE SEPTIC SYSTEM SHALL INVERT OUT AT SEPTIC TANK •00 ACCESS COVERS MUST BE NITHIN G ' OF FINISH GRADE. CONFORM TO MASS. D.E. 0.E. TITLE 5 AND LOCAL IF)ems)5 V) V-4,7'G INDICA TES BOARD OF HEAL TH REGULA TIONS. INVERT IN AT DIST. BOX _ . c", j�--- --" D�S1� 5.,� -5 , PEfTC. TES T INVERT OUT A T DIST. BOX _ $--. �.L. 610, o D 3. ALL SEPTIC SYSTEM COMPONENTS SUBJECT TO `-P'�,�-Ch'`- �'�o VEHICLE L DADING U.E. UNDER DRI VELA YS, ETC.) INVERT IN A T S.A. S. b MIN. 2" OF Rli SHALL BE DESIGNED TO MITHSTAND H-.20 LOADING. ! $io ,Sp 1/B'-1/2' DIA. BOTTOM OF S,A. S. © - t- 14 ' MIN. i C INDICATES See- f.IOUIG �-d I WASHED �TONE 4. ALL SEWER PIPE SHALL BE SCHEDULE 40 OR 035FRIED G,90UNDWA TER 0 OBSERVED APPROVED EOUAL. DEPTH ` ,- GROUIVOWA TER ADJUSTED GROUNDWA TER 10° ��_��—-- OIST. N I 3/4 1 1/2 DIA. v 5. BEFORE STARTING CONSTRUCTION CALL DIG SAFE m ---�f' 'Goo SAL. BOX I W Q WASHED ST /VF 1-800-322-4844 FOR L OCA TION OF SEPTIC TANK �.j- 1 84� ! INDICA TF_S UNDERGROUND UTIL I TIES. , TEST PIT SEPTIC TANfC 6 D-BOX TO BE SE':F ON A 5. DATUM IS A S 5V5y'lf,- V 6' BED OF COMPACTED CRUSHED .':T ONE. P-2'0 � i CONTRACTOR TO Y'A TER TEST D BOX TO PROP. S.A.S. 7. NO DETERMINA TION HAS BEEN MADE AS TO COMPL LANCE SHOW LEYELNESS• WITH DEED RESTRICTIONS OR ZONING REGULATIONS, IT SHALL REMAIN THE OWNER'S RESPONSIBILITY TO OBTAIN ALL REQUIRED PERMI rS, SPECIAL PERMITS, 3 ct a` a u►,u.r u sauv,a• )uN iu~✓u�.or, -, ;Irll�:u_„r, DATE.• 7127k© . VARIANCES, ETC. FOR THIS PROJECT. Ut,AI, SnIIII..,h Sull �rlu.. F,Nt.t.r �III,t. I•Bw llna prU (iLt ItA1 (nitnulirl A!+.tilriy, ($Inxlni<.\loop.ILnAdan. •- _ - l" 8, IT SHALL REMAIN THE OWNER'S RESPONSIBILITY r 4.S v r`, /13i TEST BY.' ww - , a ......_. ._A....,.__ --[_.� .. �' TO HA VF THF_ PROPOSED DMEL LING FOUNDA TION �ow5 r Q- - -'-- "- ,���"SIGNEr TO ACCOUNT FOR THE EXISTING GRADi" to ?*Q:'.... _._..__�._.._..__ __.tr,.S�___7a�'�` _: - y h'ITNESSED BY.' ED B01V AND SOJR Cl`."'',IONS AT THE LOCATION OF THE a �� 1. ____._ ` .�.. _. __.. .._ 5 ' PROPOSs ' Ln?LL.ING. - I / PERC. RA TF .G ✓ MIN./ IN. . e ►M11:11011SIi(vn•r10 Ifoucwo a�l�rr r DESIGN CRITERIA: I htab fu.n, tigAIIrin.m &AITuune Sul)Culm FA smfl,'Athl) (IISIM) IMwutill M,1tu,d (bDuth",71u.ot,th"OdctYl. DESIGN FLOW. S ucuLlulu, iSh uuU, 11r� tt L.S. r�J 4- _ BEDROOM Dh'ELLLNG ? 110 GAL/DAY PER BEDROOM EOUAI.S GALS. PER DAY. 1 .. ..... SEPTIC TANK RFGUIRED.' e� Kati � s ." C�---- --x_�._ - _ - .. .._. �.. _- -_ ... ........ 5� q Q GPD X .200,r II SD GAL. SEPT TO TANK PROVIDED.' _ 5QO GAL. ® V Uis7'1�tiM1fYA'(10N N JlI&lrA4()NAI, „ 1 l;i.,) __ A l,tlunl llKil. a-! .t..8 j - - ' r '? �... --i-1�• -- (;F L. �Lr.1N6' rAL.11_l l r rlCuultrc.L! , G � - 2�"•f [+ �' ^ Ikitlh lNtnrvu nrn uy Lr ub,6ale !7,p0,to toil r,oigcr _y In p t t { �7.f A,` flvpiL lu,reePfuR Ooiu lldo of ubt.lrnk. 1 Uro.M,hr,tu Adf,tlwonl 4 ualc,We114_ It.win UMC _ 11"I"WS11I...I Adl.Aum AJ.Qlound,rtt i I.arcl DESIGN PERC. RA TE , u MI! ;E�n,-n�J /INCH ricu;o.Ar;aty i `si hdl� l7wt (I tw _ 440 GALLO,VS PER 0AY t, SMuurrfai '! i SIZE OF LEACHING FACILITY PROVIDED.' I Ignt o!Ihrc ,t 7 but.1 6• G�Gi //^^tom- �1 •A�ry1Y7 cp� (/� eg— St.n Iti.t,.rY 1I�p �__'o if oc ty-•d'1 �. �. � � _ L.1.. " �o l.=Y T / �.J..i ri+ � �.�`�I��J�LJ �j L'� (� i S ... ,u iJ trT�-: R�1�OV�. U u S 13��1�8 L� SIDEWAL L �G S.F. X c7� .�.+ (I1Mt Ml.nlKl, N IIli/i,a �V Ol L Btu ' �d�ct-S fl1-+�---t .4 - T BOTTO!•N S.F. X �•7 32 GPD \.A+ Shy S,dmbNNy AnnuuSnt; Slit Fmlowil 1 k I'dlol; Addhhmd'I'nd»{NatdtJ(YM) ( D � a �U}-S►l/ 'T �� ` Y G S ,�'( TOTAL S 2 Z S.F. G c GPD . r Otlrl,gi PodJ{tIktJ1MiNYldun 0111ctYgllull ilulc lit(A T"nc coutpleled tell Ilaclt j O � 0 + 1 cawr Apok.a , 0itt of g.. C_> sr �• ROGER PAUL `B��' � -P c)VVIIL REVISIONS. �f» NO. DA TE REVISION /OFJAL $g t Ste• ce 1sTo , r 2 a • 00 r " ° v'�or�oa�s� oeclt 1 9{Jf�f TF �L61ic Health DLL, io -or• Co,s-CovR �. I m �zoa Town of 8amsta6le n r I a.�'�•+ PO Box 534 PRo�- b t RrGG-�io � Y'o� �me•.rt 1 hyannis SL 91.50 �'' o 9To o ,Massachusetts 02601 �•v '� -i 4' 0 PO RC FV�N O F Mgss Cl Fax(508 775-3344 '� T p- = R. �- �. T �. (.� 790-6265 PAUL .r� 'y �+,�,+/� �+ �* /+ 6 t-�s Pho/n�e(508 _ �. RYLL PLAN 7f S fOW AU ��.... O J.�17�4t 0i � l-170d`�il�?�� ^> ! ,� No.32448 SU35UR`/•�Q. — SEPTIC JI S OSAL J /Sf i95. TP-3 TO • v 0 5 Gad � �"' �'AME BARNS ABd! ' A - to M» SEPMA1,3 R .1,19, 2000 SCALE .f r 40 . a.� L 30 0 R r'�s roN;��. LAN r�roR 14L L��O S R��'E '1 NG G�� OLD LIAR— '114 �R o�, Sill GAMORE WAJW - �/ W V_L O S' R�} ri�5 t�r'$ - Pr�Qcl��i; f�11/�'.?f�Et� 0o—.t.[f�