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HomeMy WebLinkAbout0037 RUE MICHELE - Health .y s 37 Rue Michelle Barnstable F A 335 065 a �' - r.-...._'s ,�,a. =4r.:e v Y. a p. _. ' �+�i.-e'`T�v .x•4- ...n,, c. , -r:.rry.- y..., , • ` t .. .:� ,._ -. —n�..E-4±-. ..l7;Cr- r, per:.., .$.y. C�- ... � ,. - - • • J n' + , y � 4 _ r - e .. r . a r T � ✓ v y a�'�'o..,�,„ :e=:. az ,�_ �; ye... *-•�,.�,r•�� e�'�.: e t r ArM c .,��. ck--�,: ea. nT �.�esm�• .=�=a—^^r,'a-+7'" ,�e - -� ncII +'�t,.y� -.'�.pQ, A .:, a p- O' ....,-� os�.� ,�-r�¢#�"T`�4r,c'y�- -,.48 =rp•. A t�tre•G} .,.— n tin-. , + ' .,. i -_ --- '• vn ..v ' a,:.C=:�..� p ,p. .:.53 *%�trm.'.�. ':% o .0 rKr'�"r' C• �• -�'i9 ,� .. .. �. y ' � � �.- y 3"G �' o x - r r Ot TaYs. Barnstable Town of Barnstable • snRNS" E • t �pTfD�A,�g Board of Health 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi June 27, 2013 Ms. Marcia Elliott 37 Rue Michele Cummaquid, MA 02637 ;ARE 3TRue Michelle Road;Cummaquid . F'. 4, A 335 065 Dear Ms. Elliot, The order from the Health Agent dated February 7, 2012 to appear before the Board of Health to explain why the septic system was not repaired at the 37 Rue Michelle Road is lifted. The septic system.originally "failed" during a inspection on May 10, 2005 by Brian K. Tilton, a certified septic inspector for the State of Massachusetts. After that failure r inspection report, you informed the Board of Health that the failure was due to a problem with a clogged culvert/drainage pipe in the road before the road was constructed which was finally rectified. The Board then informed you that two additional inspections, by two separate DEP certified inspectors, are required in order to consider reversing the failed inspection of May 10, 2005. Then at the public meeting of the Board of Health held on March 13, 2012, you submitted a March 3, 2012 partial inspection report performed by Brian Tilton indicating the system "passes." This report indicated that the groundwater was ten feet eleven inches below grade. The bottom of the soil absorption system was at ten feet nine inches below grade, two inches above the groundwater. More than a year later, at the public meeting held on June 18, 2013, you submitted another "passing" inspection report dated April 26, 2013. This septic system inspection was conducted by Patrick McDowell with a notation that the leaching pit appears normal. He stated that the groundwater was four to five inches below the bottom of the leaching I facility. Based upon the information presented, the Board is of the opinion that although there is no guarantee in regards,to the system's performance in the future, at this time it has been Q:\WPFILES\ElliotSepticLiftOrder2Ol3.doc f proven that this septic system is not considered a source of pollution.nor a public health nuisance to the occupants or to the neighbors. Therefore, the order dated February 7, 2012 is lifted. Sinc l yours, Wayne iller, M.D., Chairman W j S t QAWPFILESOIiotSepticLiftOrder2013.doc EXCERPT FROM THE BOARD OF HEALTH JUNE 18, 2013 MEETING MINUTES: I. Hearings — Septic (Cont): A. Marcia Elliott, owner— 37 Rue Michele; Barnstable, additional septic inspection completed (continued from.March 2012). Marcia Elliott was present. The Board acknowledged that the most recent septic inspection shows the system is working properly and is not in failure. Upon a motion duly made by Junichi Sawayanagi, seconded by Dr. Canniff, the Board voted to recognize the septic system to be satisfactorily functioning. (Unanimously, voting in favor.) f '! rO` a EXCERPT FROM THE BOH MEETING MINUTES ON 11/8/2011: A. Marcia Elliott, owner— 37 Rue,Michele, ,Barnstable, past deadline repair date. Read statement into the minutes:: This letter is in response to certified mail#7006 0810 0000 3524 5423 Thank you for the opportunity`to respond to the issue regarding the septic system at #37 Rue Michele. I have had the inspection that was previousiy performed reviewed by two other Title Five inspectors one of which is a Chief Engineer. Following is a brief rational as.to,why the past inspection is inconclusive: 1) The report was done before the drainage and the roadway was built and installed...as.mentioned in the report. 2) As stated in the report all of the,components where not opened for a complete inspection: the tank, the Distribution Box and the pit. The inspection was incomplete. F 3) There was no odor when the test holes were done. 4) The one criteria checked on the Title V Inspection report which lead to a failed,. report was in regards to the ground water level...which as stated several times in the report was possibly due to the plugged up culvert drain/pipe in the immediate area. All other criteria passed, 5) Four times the clogged culvert pipe/drain was mentioned,in the report and ' that he (the original inspector) thought it could be the reason for` the abnormally high ground water table...because the water had nowhere to go;due to the clogged drain/pipe. 6) Before the road was built; there was a problem with the culvert pipe/drain. This problem was corrected upon the design and installation of extensive drainage and.the construction of the roadway. would like for this case to be reviewed since there has been extensive drainage installed and there have not been any.problems with the system. ' } Respectfully submitted, Marcia Elliott- Upon a;motion duly:made by Dr. Canniff, seconded by Mr. Sawayanagi, the Board voted to allow further inspections to be done to see whether they are in agreement v with the initial report. In order to reverse the earlier inspection, two,passing' inspections would need`td be done; one in the 'near future and one twelve months after the'first one. (Unanimously, voted in favor.) Crocker, Sharon From: Crocker, Sharon Sent: Tuesday, February 21, 2012 11:48 AM To: Flynn, Judith Subject: 37 RUE MICHELLE, BARNSTABLE This came to BOH on 11/8/2011. System failed in 2005. The Board agreed to allow 2 more inspections to be done and if passing, the BOH will consider reversing the failure. The owner was told to have one inspection done "in the near future". And one 12 months from then. Owner has failed to do one "in the near future it has been three months. Please send her a letter. Thanks, Sharon ,f r 1 �A h ®f Barnstable Barnstable- T®wn pp THE Regulator.- Services,Department' 1�'caC j a MASS. A UARMWABLEPublic Health Division _ °T o"�`b\ .,200-Main Street, Hyannis MA 02601" - ?oo� Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 ;,r Thomas A.McKean,CHO CERTIFIED MAIL #7011-,0470 00014525 5587 February 7,2012 `3 _ Ms. Marcia Elliott 37 Rue Michele a:x Cummaquid, MA,02637 � d The septic system located at.37 Rue Michele, Barnstable,NU,-.-was last inspected on 511012005, by Brian K -Tilton, a,certified septic inspector for the State of Massachusetts. The inspection of the septic system`showedthat the system "Failed"under the guidelines of the 1995 TITLE 5 (310'CMR-15.00).&On 11/08/2011, you were asked to appear before the Board.of Health-to explain why the septic systein had not been repaired. At the discussion with the Board of Health, it was agreed that we would like two Airther inspections in order to-consider rever"sing the inspectiornon 5/10/2005. Two passing inspections would need to be done;,one in the near future and the second twelve months after the fit S-*t one: ,4 It has been three monthsrv`since the Board of Health meeting and, as of today, no additional inspections have been`filed';*If you'can,show us any-documentary evidence- - that the second inspection has been,completed, we wouldappreciate your.submitting such documentation to this office:.4 y Failure to comply with the Board of Health's request may result in future enforcement action PER ORDER F'T BOA Rp OF HEALTH ` _ 3 _ omas McKean, R.S. CHO Agent of the Board of Health , Q:\SEPTIC\Letters Septic Inspection Failures\37 Rue Michele,Barn 2.doc ` �. � ..� . r i r ,. _ � i �T t Barnstable Town of Barnstable , a14medcacily ' '"SAS& 4 Board of Health 1 ► t639, 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-630.4 Paul Canniff,D.M.D. Junichi Sawayanagi March 27, 2012 _-__—Ms. Marcia Elliott - 37 Rue Michele Cummaquid, MA 02637 RE 37Rue 1VI>chelle Roacl, A335 065 .. Dear Ms. Elliot, You are ordered to hire a DEP certified septic system inspector to perform a full inspection of your septic system located at 37 Rue Michelle Road, Cummaquid. The next inspection must be performed six to twelve months after the previous septic system inspection date. Therefore, the next inspection shall be performed sometime between September 2012 and April 27, 2013. This inspection must be performed by an independent DEP certified inspector, by someone other than Brian Tilton. A copy of the completed inspection report shall be submitted to the Health Division Office on or before May 27, 2013 HISTORY The septic system located at 37 Rue Michele, Cummaquid'was inspected two times by Brian K. Tilton, a certified septic inspector,for the State of Massachusetts, once in 2005 and again March of 2012. In 2005, the inspection of the septic system showed that the system "failed"under the guidelines of the 1995 TITLE 5 (310 CMR 15.00). After more than six years of that first failure inspection report on November 8, 2011 you were ordered to appear before the Board of Health due to your failure to repair or replace the failed system. At the meeting with the Board of Health, you informed the Board that the drainage problem was rectified therefore the surface water problem was resolved.. The Board then informed you that two additional inspections are required in order to .consider reversing the failed inspection of May.10, 2005. Two passing inspection reports will need to be submitted to the Board by two separate DEP certified inspectors; one in the near future, and the second inspection to be conducted six to twelve months after the first one per the Board of Health policy. Q:\WPFILES\Failedlnspections37RueMicheeleRoadtliree Inspections.doc At the public meeting of the Board of Health held on March 13, 2012, you submitted a March 3, 2012 partial inspection report performed by Brian Tilton indicating the system "passes." This report indicated that the groundwater was ten feet eleven inches below grade. The bottom of the soil absorption system was at ten feet nine inches below grade, which is only two inches above the groundwater. Again you are ordered to submit a fully complete septic system inspection report to this Office on or before May 27, 2013. Failure to comply with the Board of Health may result in future enforcement action. PER ER OF HE B ARD OF HEALTH ayne iller, D. Chai Q:\WPFILES\FailedInspections37RueMicheeleRoadthree Inspections.doc ti Lr) L I REEK Ul l IF= Postage $ Certified Fee Q5 1'�Psstmark 7 f C3 Return Receipt Fee Were 0 (Endorsement Required) Cu CP t] Restricted Delivery Fee � (Endorsement Required) (9. O Total Postage&Fees $ NV Ms. n o Ms. Marcia Elliott 37 Rue Michele Cummaquid, MA 02637 Certified Mail Provides: o A mailing receipt o A unique identifier for your mailpiece o A record of delivery kept by the Postal Service for two years Important Reminders: o Cert"tfled Mail may ONLY be combined with First-Class Mails or Priority Mails. n Certified Mail is not available for any class of international mail. to NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. a For an additional fee,a Retum Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece'Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a LISPS®postmark on your Certified Mail receipt is required. n For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement RestrictedDeiivety. o if a postmark on the Certified Mail receipt is desired,please present the art!- • cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT.Save this receiptand present it when making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7530-02-000.9047 i J I u,r COMPLETE • ■ Complete items 1,2,and 3.Also complete A. Signature item 4 if Restricted Delivery is desired. X ❑Agent ■ Print your name and address on the reverse ®'Addressee so that we can return the card to you. B. ce ed by( Tinted Name C. D to of elivery ■ Attach this card to the back of the mailpiece, 40 C q -P ld ( 1 or on the front if space permits. D. Is delivery address different f6m item 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑No Ms. Marcia Elliott (3 37 Rue Michele Cummaquid,;MA 02637 '` 3. Service Type ❑Certified Mail ❑Express Mail ❑Registered ❑Return Receipt for Merchandise 0 Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes L 2. Article NumberI s 7011 O'472 °60001 4525 5587 (rransfer from service labeq i ( w L e g PS Form 3811,February 2004, , ; I Domestic Return Receipt 102595-02-M-1540 1 z UNITED STq l;'. SkRjc Paid � yr ... Sender: Please print your name, address,ancf ZrP in this o� Town of Barnstable P Public Health Division 200 Main Street Hyannis, MA 02601 I ... ._._ � 1a�.,I3II1?lII' III?t!-i11111dII111111?!11]1111HIhIIII IIJ f �arnstabe Barnstable Town o ' °pIHE ,Regulatory. Services Department 1efi1c a j I; x. 1 l IIABNSCABLE. •� e - • •I • • m �\ amass. m Public Health Division i639. a 2007 prFa'"A'` 200 Main Street; Hyannis MA 02601 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO - CERTIFIED MAIL # 7011 0410 0001 4525:5587. - February 7, 2012. Ms. Marcia Elliott 37 Rue Michele Cummaquid, MA 02637 The septic system located at 37,Rue Michele, Barnstable, MA,was last inspected on 511012005, by Brian K. Tilton,a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Failed"under the guidelines of the 1995 TITLE 5 (310 CMR 15.00). On 11/08/2011, you were asked'to.appear before the Board of Health to explain why the septic system•had not been repaired. At the discussion with the Board of;Health, it was agreed that we would like two'further inspections in order to consider reversing the inspection on 5/10/2005:'Two passing inspections would need to be done; one in*the near future and the second twelve months after thefirst one. It has been three months since the Board of Health meeting Viand, as of today, no additional inspections-have been!filed. If you can show us any documentary evidence that the second inspection has been completed, we would appreciate your submitting such documentation to this office. Failure to comply with the Board of Health's request may result in future enforcement action. PER ORDER F T BOARD�OF HEALTH , omas McKean, R.,S. CHO z Agent of the Board'of Health Q:\SEPTIC\Letters Septic Inspection Fail6res07 Rue Michele,Barn 2.doc i EXCERPT FROM THE BOARD OF HEALTH MEETING MINUTES ON 11/08/2011: A. Marcia Elliott, owner,— 37 Rue Michele, Barnstable, past deadline repair date. Read statement into the minutes: This letter is in response to certified mail# 7006 0810 0000 3524 5423 Thank you for the opportunity to respond-to the issue regarding the septic system at #37 Rue Michele. I have had the inspection that was previously performed reviewed by two other Title Five inspectors one of which is a Chief Engineer. Following is a brief rational as to why the past inspection is inconclusive: 1) The report was done before the drainage and the roadway was built and installed'..as mentioned in the report. 2) As stated in the report all of the components where not opened for a complete inspection: the tank, the Distribution Box and the pit. The inspection was incomplete. . 3) There was no odor when the test holes were done. 4) The one criteria checked on the Title V Inspection report which lead to a failed report was in regards to the.ground water level...which as stated several times in the report was possibly due to the plugged up culvert drain/pipe in the immediate area. All other criteria passed. ' 5) Four times the clogged culvert pipe/drain was mentioned in the report and that he (the original inspector) thought it could be the reason for`the abnormally high ground water table...because the water had nowhere to go due to the clogged drain/pipe. I , 6) Before the road was built, there-was a problem with the culvert pipe/drain. This problem was corrected upon the design and installation of extensive drainage and the construction of the roadway. would like for this case to be reviewed since there has been extensive drainage installed and there have not been any problems with the system. Respectfully submitted, Marcia Elliott f The Board agreed that they would like further inspections. In order to reverse the earlier inspection, two passing inspections would need to be done; one in the near" future and one twelve months after the first one. f Feb 29 12 02: 37p ME2000 5084327373 p. 2 A6B-SOLUTELY THE B EST.SE ?TIC SERVICE Robert Lothrop PO B 762, Orleans, MA 02653 -- -�-_ --�-- --- - --��. -__ -.Cleaning..& Pumpin g Title V Inspections 508-790-8020 508-737- - F 3777 ebrua 28 201 February 2 037 Rue Michele, Cummaquid, MA 02 637 t Robert Lothrop hereby Performed the inspection at the above PrOPerty. The bottom of the pit to ground surface is 10' Sr. 7 nentioned from the surface was 10' 11', ground Robert M. Lothrop �rMo6. Feb 28 12 08: 06p ME2000 5084327373 p. 1 February 27, 2012 To : Brian Tilton Y Fax# 508.255.9343 From : Marcia Elliott Fax# 508.362.8897 Total Pages including"cover: 4 Hello Brian; Following are the pages that we spoke of on the phone. These 3`pages are the ones that Tom mentioned.' My meeting with Tom McKean.went very well. The changes,being made are based ` on current information.He said that the 10' 9" measurement that was done was all that he needed He also was pleased with the fact that the culvert was no longer plugged- -He said that all that needed to be done was to make the following changes on,the report: Page one:Uncheck fails, check passes Page five:'Uncheck the 2 Yes check-marks to No Page 16: Estimated depth to groundwater: change to 10' 9" If you have any finther questions please let me know. I understand that you are very busy and will assist you in any way that I can. Sincerely, Marcia: 508.326.3600 Town of Barnstable Barnstable. °p SHE T ti Re ulator Services*De artment g Y p BARNWrABLE. • } na: - 039. a Public:Health Division 9�e1fb MPt a`�� c 2007 200 Main Street, Hyannis MA 02601 ry` • .. a .;`� — .. -M Office: 5087862-4644 Thomas F.Geiler,Director , FAX: 508-790-6304 : ' = Thomas A'McKean GHO t CERTIFIED MAIL # 7011047.0 0001.4525 5587 February 7, 2012 Ms. Marcia Elliott -� - f 37°Rue Michele a ' 1 . Cummaquid, MA, 02637 The septic system located at 37°Rue Michele;Barnstable, MA was last inspected on '. 5/10/ 2005,by Brian K. Tilton; a certified septic inspector for the State of Massachusetts. - The inspection of the septic system showed that the system"Failed" under the guidelines .. of the 1995 TITLE 5 (310 CMR 15.00)`. On 11/08/,201.4 you were asked to'appear " before the Board of Health to explain whythesseptic system had.not been repaired. At the discussion with the Board of Health,•itwa's agreed that we would like'two fVrfherK inspections in-order to consider reversing the inspection on 511012005. Two passing 5 ' inspections would need to be done; one in the near future and the second"twelve months. after the first one. It liar been three.months since the Board of Health meeting and,-as of toddy, no additional inspections have:been'filed:'`If you can show'us any documentary evidence that the second inspection has been:corn le'ted, w_e would'appreciate your'submitting such; documentation to this office. 3 Failure to comply with`the Board of Health's-request mdy,result in future enforcement action: PER ORDER' F I E BOARD OF UEALTH , omas McKean, R.S. CHO Agent of the Board..of-Health Q:\SEPTIC\Letters Septic Inspectionlailures\37 Rue Michele,Barn 2.doc '' November 8,2011 Ms.Marcia Elliott 37 Rue Michele Cummaquid,MA 02637 Town of Barnstable Regulatory Services Department Public Health Division 200 Main St.,Hyannis MA 02601 This letter is in response to certified mail#7006 0810 0000 3524 5423 Thank-you for the opportunity to respond to the issue regarding the septic system at#37 Rue Michele. I have had the inspection that was previously performed reviewed by two other Title Five inspectors one of which is a Chief Engineer. Following is a brief rational as to why the past inspection is inconclusive: 1) The report was done before the drainage and the roadway was built and installed as mentioned in the report. 2) As stated in the report all of the components where not opened for a complete inspection: the tank,the Distribution Box and the pit. The inspection was incomplete. 3) There was no odor when the test holes were done. 4) The one criteria checked on the Title V Inspection report which lead to a failed report was in regards to the ground water level...which as stated several times in the report was possibly due to the plugged up culvert drain/pipe in the immediate area.All other criteria passed. 5) Four times the clogged culvert pipe/drain was mentioned in the report and that he thought it could be the reason for the abnormally high ground water table...because the water had nowhere to go due to the clogged drain/pipe. 6) Before the road was built there was a problem with the culvert pipe/drain. This problem was corrected upon the design and installation of extensive drainage and the construction of the roadway. I would like for this case to be reviewed since there has been extensive drainage installed and there have not been any problems with the system.' Respectfully submitted, Marcia Elliott ru �, • .•. Ln m Postage $ a 000n2- 6 O Certified Fee Return Receipt.Feo �(Endorsemenrrk tRequirad) irRestricted Delivery Feera (Endorsement Required) C3 Total Postage&Fees $ i Ms. Marcia Elliot -- - �� 1� 37 Rue Michele. ! Barnstable, MA 02630 f Certified(Nail Provides: ,a' �e��ea�Z00ZeUn 9 A(nailing receipt [, r'ooes w,od Sd n A unique Identifier for your ml9lpiece t, n A record of delivery kept by the Postal Service for two years important Reminders: n Certified Mail may ONLY be combined with First-Class Maile or Priority Mail®. n Certified Mail is not available for any class of international mail. in NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. a For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required.. 0 For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpieoe with the endorsement"RestrictedDelivety. a If a postmark on the.Certified Mail receipt is desired,please present the artl- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. j - WPORTANT:Save this receipt and present it.when making an inquiry. Uternet access to delivery information is not available on mail•. addressed to APOs and Ms. ,'�•j • COMPLETE . . ® Complete items 1,2,and 3.Also complete A. Signature item 4 if Restricted Delivery is desired. X ❑Agent ■ Print your name and address on the reverse ' �D ❑Addressee so that we can return the card to you. B. Receiv by(Printed Nam a D to of D liy ry ■ Attach this card to the back of the mailpiece,":,, C a r� Z �� or on the front if space permits. D. Is delivery ad ress different;from stern 1? es 1. Article Addressed to: If YES,enter'delivery address below ❑ No Ms. Marcia Elliot Cu r 11A 37'Rue Nliclele 9 Barnstable,MA 02630 s. Service Type lii&rtified Mail ❑Express Mail ❑Registered ❑Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number (Transfer from service'abeo(S i i s i l l i =x ;7 6w s n0 8=1�? 0 0 Q 3 582 4 5423 k PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 UNITED STATES POSTAL SERVICE ,, rsf=Class• it .: :ds t Y+a• !6:,f�-,# dk-2.`Ffi 'S.'�i,9.....,+ Ze ''t"HIQ Sender: Please print your name, address',and .in,'bls box E Town of Barnstable Public Health Division I 200 Main Street I M Hyannis, MA 02601 I I M I I nr I r �pP SHE Tpw Town of Barnsta 1 Barest b'e P ~°; egulatory Services Depa tment sac hy BARNS-TABLE. MASS. p, _ Public Health Division -200 Main Street, Hyannis MA 02601 2007 N' Office: 508-862-4644 �c Thomas F.Geiler,Director FAX: 508-790-6304 ��� Thomas A.McKean,CHO CERTIFIED MAIL # 7006 0810 0000 3524 5423 ` October 28 2011 Ms. Marcia Elliot 37 Rue Michele ; Barnstable, MA 02630 YOU ARE SCHEDULED TO APPEAR BEFORE THE BOARD on Tuesday, November 81h 2011 at 3 pm in the Town Hall, Hearing Room, 2nd Floor 367 Main Street, Hyannis, MA`due to your failure to repair or replace the failed septic system at 37 Rue Michele, Barnstable MA. The State Environmental Code Title V Requires all failed septic systems to be repaired or replaced within two years. The Town of Barnstable Board of Health has more stringent deadlines dependent upon the type of failure identified. In this case, the septic system has been in failure beyond the established deadline. You will be given the opportunity to testify, present witnesses,documentary evidence, and other official information regarding this case. PER ORDER OF THE BOARD OF HEALTH Wayne Miller, M.D. Chairman Q:`:SEPTIC\Letters Septic Inspection Failures\Past deadline k. < , '•� to v D A 9 ~ ru Lrf ru 1 I L � . M Postage $ z..., g E3 O Certified Fee f"T Return Recelpt.Fee s ' postmaik � (Endorsement Required) Here r3 Restricted Delivery Fee rl (Endorsement Required) CO * o C3 Total Postage&Fees $ _ S/ Ms. Marcia Elliot 37 Rue Michele Barnstable, MA 02630 • j • e • • • • • ® Complete items 1,2,and 3.Also complete A. Signature item 4.if Restricted Delivery is desired. ;, _ f ❑Agent o Print your name and address on the reverse X - O ❑Addressee so that we can return the card to you B. Receiv b Printed N ® Attach this card to the back of the mailplece ,. y r.r Dte o� I��ry or on the front if space permits. f D. Is delivery adress, dierenti from item­i? es 1. Article Addressed to: , "^ If YES,enterdelivery address below::; ❑No IN F. Ms. Marcia Elliotly�} 37 Rue Michele ' "°a�3 Barnstable, MA 02630 ! 3. Service Type E�r&ertifled Mail ❑Express Mall ❑Registered ❑Return Receipt for Merchandise ❑ Insured Mail ❑C.O.D. j 4. Restricted Delivery?(Extra Fee) ❑yes 1 2. Article Number , . 7006 0810 0000 3524 5423 (rransfer from seivice label) PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 ' 3 + _ i outbind://2-0000000OD29B6432901 CDB49B30FFF776DBODF8507008249EAC50E 1 D794ABA69D... 4. Flynn, Judith To: Schlegel, Frank Subject: RE: 37 Rue Michele- Barnstable Frank thanks for the infor on Rue Michele.`. my question is#37 has a three bed r6om'house.. .#20,is vacant property... isall the paperwork...Septic systems, variences etc assigned to house#20 really for#37:.... I understand your problem out,there -..hope it gets resolved:'soomfor, `4 both our sakes!!!!!! -----Original Message-7--- From: Schlegel, Frank w' Sent: Friday, October 21, 2011 10:48 AM To: Flynn, Judith Subject: RE: 37 Rue Michele - Barnstable Hi Judith, I don't know why you are having a problem with:the properties on this very-smalI road: It has only been subdivided & re-subdivided about 3 times and I've had to-go back and combine:&.re-split some of the parcels many times! Tom McKeon once asked me to stop changing'everything,out there. I told.him not to shoot the messenger; that I was only reporting what the property owner was .Y doing to their land. It seems like every time the owner gets a buyer, they want a different configuration of the land. Then when the buyer�backs out.of the deal,.the owner changes it-back or to some new definition to try to satisfy a potential buyer.The owner of Rue Michelle once came in to complain that I kept changing the addresses. I told her.that as long as she kept changing the definition of the land, the addresses would change to! Anywho, back to your problem. Number.20, Map 335 Parcel 074 Was deleted and combined with Map 335 Parcel 073 (lot 5A). I currently don't have a new address for Map 335 Parcel,073 because when the two vacant parcels got combined, I'need to know where they plan on°placing the building because now that 2 parcels became one, the parcelhas a lot of.road frontage and l'need to know where the house will sit before I can assign it a number to keep the house numbers in proper sequence. I will not be assigning #3 to any parcel out there. #20 came from the fact it was 200 feet from Rte6A to the center of Parcel 074. [,could assign a number to that parcel because it.had little frontage on the road. Number 3, if it were ever assigned,would be to the first parcel on the street because the house/driveway would need to be 30 feet from Rte 6A and that property is already addressed as#4061 Main St/Rte 6A. This is.why I don't try to second guess a numbeIr'on a large parcel. The owner ends up building the house at a different location than where I try to guess and the numbers end up out of sequence and'I end up changing the house number in the 11th hour of occupancy when the fire department discovers the problem. I hate it when this happens and it doesn't get fixed and causes delays in emergency response. I do not want`to find out about number sequence problems as a result of an emergency:No one said house numbering is easy! Hope this helps! Thanx; Frank -----Original Message----- From: Flynn, Judith .Sent: Wednesday, October 19,.2011 1136 AM To: Schlegel, Frank Subject; 37,Rue Michele.-, Barnstable Frank... 1.2/29/2011 i outbind://2-OOOOOOOOD29B6432901 CDB49B30FFF776DBODF8507008249EAC50E 1 D794ABA69D... j I'm having trouble with 37.Rue Michele vs 20 Rue,Michele....20 Rue Michele.(Map . 335- Parcel 73& 74) has a lot ofYpaperwork pertaing.to aseptic problem....: _ but#20 does not exist in the system; and as I can tell Parcel 74 does not exist. AND,. there are no building on Parcel 73. 37 Rue Michele(Map 335- Parcel.065 Lot 1)has a building with three bedrooms...and, no history whatsoever....could#20 acutualy be#3 think your.phone is off the hook ....is that-on purpose? ` Judith' 12/29/2011 r4 Upon motion duly made by Mr. Kaufman, seconded by Dr. Canniff, the Board '- voted to continue until the next meeting so they can come back with a revised - plan. (Unanimous vote in favor.) �. EXCERPT FROM BOH MINUTES - JUNE 13, 2006: III. Continued Items from Previous Meeting(s): _ A. Mark Dibb, BSC Group, representing Marcia Elliott — 20 Rue Michele, Barnstable, 51,692 square feet parcel, requesting variance regarding amount of pervious material above groundwater, new construction, four bedrooms, -- FAST I/A system proposed. Mark Dibb presented his revised plan dated 5/22/06. He summarized changes to w _ date: changed from a five to a four,bedroom, they incorporated a FAST I/A System, have a catch basin for run-offs, and have added a liner around the entire _�• system. The new plan revision changed the property line adding a pie-shape of - 40 feet(an additional 6,000 square feet). Mr. Dibb explained this allowed them - to move the.leaching area to the south, away from the wetland. They moved the - entire house and drive 10 feet to the south. He also added another foot of �- separation from the ground water, now being 6 feet of separation. 'The only variance they are requesting is the minimal lot variance. Upon motion duly made by Dr. Canniff, seconded by Dr. Miller, the Board voted approval for the marginal lot with (a) Installation in accordance with the engineering plan dated 5/22/06, (b) No more than four (4) bedrooms are authorized at this property, and (c) The applicant shall record a properly worded deed restriction, signed by the property owner, at the Registry of Deeds.restricting the number of bedrooms at this property to four (4), before the applicant obtains a disposal works - construction permit. EXCERPT FROM BOH MINUTES— 9/11/07: : A. Mark Dibb, BSC Group, representing Marcia Elliott — 20 Rue Michelle, Barnstable, 1.24 acres, house addition, one variance. -� Mark Dibb presented the new plan reducing the previously approved.four- bedroom I/A plan to the current three-bedroom plan without an I/A system. --- Arlene Wilson, representing the neighbors, said they are happy to see the - reduced number of bedrooms but had a question on the size of the lawn. Upon a motion duly made Mr. Sawayanagi, seconded by Dr. Cannff, the Board voted to approve the proposed spec plan with the following conditions: (1) a three-bedroom deed restriction will be recorded, and (2) when the final permit is :�.. applied for, the final plan must have the calculation for nitrogen loading (including u, the structure, the driveway, and the lawn) must be under 5 parts per million. (Two voted in favor, Dr. Canniff voted against.) QAMINUTES\EXCERPT OF MINUTES\EXCERPTS BOH 20 Rue Michelle_multiple dates.doc Page 6 of 6 —— j EXCERPT FROM 5/16/06 BOH MEETING MINUTES: Continued Items from Previous Meetirig(s): A. Mark Dibb, BSC Group, representing Marcia Elliott. 20 Rue Michele, Barnstable, 51,692 square feet parcel, requesting variance regarding _ amount of pervious material above groundwater, new construction, four bedrooms, FAST I/A system proposed: Mark Dibb and Richard Clark of BSC Group were present. Mark Dibb said previous revisions are changing from 5 bedrooms to 4 bedrooms, added an ---- FAST I/A System, added run-off control measures to keep additional run-off from - entering wetlands, and added a 40 mil polyliner around, the entire soil absorption system at a depth of 2 feet below the interface (so at a depth of 66 inches). Also, _.: =.. they have not requested any dimensional variances from the wetlands. Dr. Miller mentioned they did a site visit at the property reviewed the test holes done at the other lots. This is the only non-conforming system needed. The Board will review the increased protection versus the increase to cost, which is almost tripled. The lots with abutters on wells will be limited to one bedroom for _ every 10,000 square feet for the project, and # 20 will be limited to 4 bedrooms, Mr. McKean recommended the wastewater effluent must be tested quarterly during the next two years and once,annually thereafter for pH, BOD5, TSS, and TN. Also, throughout the life of the I/A System, the System shall be under an operation and maintenance (0&M) contract. Arlene Wilson spoke representing abutter and stated there are no elevationsm� given for the surface grade at the actual percolation tests and the numbers do - -not correspond to the test pit numbers on the site plan for this lot, Test Pit 2 is actually Test Pit 2A on the site plan. It says groundwater observed is 54 inches, but the symbol on plan says 42 inches. Mr. Dibb explained the ground water is at 54 and the symbol has a line pointing to,54 inches. - Dr. Cann iff discussed reconfiguring the two lots to avoid an easement and avoids an I/A system. Kieran Healy of BSC Group explained the town has a shape factor regulation and in this case, they need a one acre lot and if they do a `pork 4� chop' shaped lot, it will not have,enough room left over. The Zoning,Board of Appeals would need to.approve a variance and it would be hard to obtain this variance. : Dr. Miller expressed that if they have to vote on it as it is, he would vote against it because he feels there may be another option that would be better and that would be to reconfigure unless it creates a hardship by losing a lot. BSC Group would like to continue but believes the variance will still be needed. They will make every effort to avoid the need of the variance. -- -- Q:\MINUTES\EXCERPTOFMINUTES\EXCERPTS BOH 20 Rue Michelle_multiple dates.doc Page 5 of 6 EXCERPT FROM 4/18/06 BOH MEETING: Continued Items from Previous Meeting(s): A. Mark Dibb, BSC Group, representing Marcia Elliott — 20 Rue Michele, -- Barnstable, 51,692 square feet parcel, requesting variance regarding amount of pervious material above groundwater, new construction, five - bedrooms proposed. Mark Dibb stated they made three changes. He revised: (1) plan from a 5 bedroom to a 4 bedroom proposed, (2) included a FAST 0.5 system, and (3) revised the grading in driveway area and added roof downspouts so any runoff will go into a catch basin to prevent it from going into the wetland area along the -y-- road. Also, he made the requested plan edits: (1) it is new construction (not - repair), (2) they have added locations and depths of percolation tests performed, v (3) a note is added to reference the ground water determination used and the adjustment, and (4) added a note regarding plans referenced in the past. They also supplied the Health Division will additional soil test and percolation test data. Mr. Dibb explained there were two test holes on different days very close to each other. Test Pit 2A was performed on May 11, 2005, dug.to 60 inches and stopped as there was quite a bit of weeping. Test Pit 1 B was done in August and - there was no water at the time so they dug 240 inches (20 feet). Mr. Dibb stated they did not see any evidence of fill as they were about 2 feet away from original --- test pit, and for the percolation test, they were down below the initial 60 inches -.--- and into undisturbed soil. The pervious material was determined down at 192 inches and that,was undisturbed at that time:. Arlene Wilson, A.M. Wilson Associates, representing the abutters, Karen Samuels and Charles Corey, questions the note now added to the plan regarding ground water adjustment which says an adjustment was necessary.because it was done during the high ground water time of year. Ms. Wilson said the Health Division's records state that work was done across the street, and slightly to the south, for a septic inspection at essentially the same time as this perc was done and shows the ground water as a couple of feet higher than this lot. Data has still not been.given for the surface water in the impoundment areas immediately .: to N and NW of this lot. The plan still does not show the location of the wetland and drainage basin on her client's lot, nor the outlet for that basin which currently _ is an open channel with standing water in it. So, even though there is a setback and the leachingfield is somewhat smaller now, the setbacks r from c s are the end of a pipe and Mr. Dibb does not show what that pipe services. The Town GIS map - for the area showing the wetland area (ponding area) and she believes the wetland at that time was about 90 feet. This information still needs to go on the -- plan to show whether they have sufficient distance of setback of reserve area. :The photographs in the Health files of percolation test and holes shows soil as - pretty grey which is generally an indication that there are saturated soils for a significant portion of the year. The grey soils come up to the surface.and they — Q:\MINUTES\EXCERPT OF MINUTES\EXCERPTS BOH 20 Rue Michelle_multiple dates.doc Page 3 of 6 "' j finally found sand at around elevation 33 (20 feet down), which is also very grey Y- and appearing to be water Logged. Based on Ms. Wilson's observations in terms = of the elevation of wetlands and surface waters, in the pond just to the north of this site, and the correlation.between that and the soil evaluation report for the lot across the street, the ground water is pretty consistent at 47 feet. This is higher than the plan and does not have a ground water adjustment. It is known that the 4�, soils do not percolate. It may be reasonable to lean on the conservative side here. Ms. Wilson summarized the data obtained is inconsistent for the two tests in the front hole which is the only hole that passed, where it failed.in May and passed in August. They will have to dig 17 feet down, and water from surrounding area will leach in. The catch basin at the driveway area, between the SAS and the ponding,area north of the lot, is in bad soil as well and unless = they dig 17 feet for catch basin, it won't work and drainage will fill up the septic . system. The new design is better because of the reduced bedrooms and the nitrogen removal will be good if the system is occupied and used year-round, but system is still questionable to her. Ms. Wilson feels some variance requests are �— still missing, i.e., the setback from the ponding area across the street, and Title V in terms of ground water adjustment method, not doing the percolation test in the --_ most restricted soil, not using slowest percolation to size the septic system, and she feels they clearly did a percolation test in disturbed ground: Dr. Miller asked applicant to find out the distance of setback of reserve area to ponding area. Dr. Miller feels a site inspection would help to make a decision. Mr. Dibb.responded to Ms. Wilson's questions. Mr. Dibb explained when Ms. " Wilson refers to inspection reports and GIS, they are different datums. Mr. Dibb tries to put the plan on a datum close to a Roadway Design Plan. This plan is 0.18 off of a Design Plan from the 70's. These are assumed datums. The inspection report does not say was datum it is on. The original soil tests were _ May 11, 2005. Mr. Dibb researched data from a couple of local wells and found May was the wettest month of year. Therefore, he did not need a groundwater --- adjustment based on the regulation that it was the wettest month of year. Mr. McKean said the Health Division has been trained to use the closest water body level as the guideline; here it would be 47 as Ms. Wilson had mentioned. Mr. Dibb referred to the ponding area, to the clay pipe: he said that ponding area does not have wetland species. It does get wet during the year. If you look at - - 100 feet from reserve area, he feels he still complies using the 47 feet: Dr. Canniff said he has been out to the site and he is not comfortable with the - property and would like a site visit. _= Upon a motion duly made by Dr. Canniff, seconded by Mr. Kaufman,-the Board voted to doo-a site visit with Mr. McKean and Mr. Dibb at the location on May 2 at 3pm, and Mr. Dibb will have it stacked out. (Unanimous vote in favor.) Q:\MINUTES\EXCERPT OF MINUTES\EXCERPTS BOH 20 Rue Michelle_multiple dates.doc Page 4 Of 6 - I 20 RUE MICHELLE, BARNSTABLE: Excerpt from February 2006 BOH Meeting: Variance Requests: A. Mark Dibb, BSC Group, representing Marcia Elliott - 20 Rue Michele, Barnstable, 51,692 square feet parcel, requesting variance regarding amount of pervious material above groundwater, new construction, five bedrooms _ proposed. Mark Dibb was requesting a marginally lot variance for his client and said a soil -- testing was done in May 2005 and August 2005. Mr. Dibb will be seeking . Conservation's approval as well. Mr. Dibb had an approved plan to update the - entire length of Rue Michelle down to the cul-de-sac at end. The plan includes an 8-inch water main installed the entire length which will also service this lot. ; Mr. McKean said the engineer failed to show all test holes.that were excavated on the property and the engineer did not show Locations of percolation tests on the plan. Mr. McKean recommended denying the applicant's request for 1006/o variance from the regulation and that the plan be revised to meet Title V in regards to.the test holes and percolation tests. Mr. Dibb said he will have the percolation test locations added. Mr. Dibb said he will be taking out the clay and replacing with 4 feet of pervious soil. Mr. McKean suggested more, holes be done in the SAS area and pointed out the size of the reserve area is short 120 square feet. Mr. Dibb will be digging down 17 feet. Dr. Miller stated that with water at Test Hole 1 A, one of the concerns is that even if =-= they excavate the clay, it may bring water up to the surface which.would infiltrate -„ the system. This is why only one hole in the SAS area is not adequate. Dr. Miller said he is reluctant to grant the variance to this degree until the lot is more ---_ completely evaluated and determined if there is a more adequate area on the lot. This area of the.town is noted for extreme variability within a given'lot. Mr. McKean noted that the August test was during the driest time of the year. Arlene Wilson, A.M. WiI son.Associates, was representing Karen Samuel and Charlie Cory, owners of the property at corner of Rue Michelle just outside this development. Ms. Wilson was a member of the Conservation Committee in 1970's and had much awareness of Rue Michelle. Ms. Wilson pointed out the plan - submitted had an error in referring to work as a repair. It is actually new construction as spelled out in the variance application. Also, there were.a number of percolation tests done on this Lot according to the log book at the Health Division. There is no water elevation shown for Log 2B which is one:of the doubled up lots. However, there is a note at the top of the log saying "estimated high ground water 44.9. Ms. Wilson assumed that was because there was - Q:\MINUTES\EXCERPT OF MINUTES\EXCERPTS BOH 20 Rue Michelle_nwltiple dates.doc Page 1 of 6 — I -- 1 , a modeling at that elevation, although the modeling doesn't show on the plan. The modeling would be as good an indicator of water weeping in the hole or, actually, standing water. Ms. Wilson stated there was missing information on the plan which should be provided. Ms. Wilson's concern was that there were no soil evaluation reports provided to the Health Division so there is no way for the public to cross check the information. The wetland showing on the lot has surface water in it. Last May, it had quite a bit. Ms. Wilson stated it would have been appropriate for the survey crew to get a water elevation on the pond.last May when they were there. More importantly in terms of what the plan needs, Ms. Wilson said there is an area on her clients' property which also has a pond. On the plan, there are notations saying existing pipe invert. There are pipes that connect the ponds on both sides of road., Some are from the first try at this development in 1973-1974. If the surface water is mapped out, a portion of the reserve area is less than 100 feet from the surface water area.4Houses #37 and`#102 both had septic inspections done 2 days before the May percolation test on this Iot.(On House#1 -- ,37, it said they had high water and didn't dare dig up an- area because they were,-,. afraid of contamination.'?Ms. Wilson says a more actual ground water should be 47 -- feet, not 45.3 feet, in terms of where the bottom of the septic system should be. - Ms. Wilson listed the number of variances missing are: 1) setback for the reserve from the water area across the street, where they need about 10 feet`,.2) the 4 feet of soil above maximum ground water. They are not using maximum,water elevation — should use 47 feet, 3) they haven't requested a variance'from the methodology to determine ground water elevation (they should do percolation in March and April, or use the Frimptor method, 4) Section 28 of Chapter 360 .._ Protection of Private Wells limits septic flow to 440 gallons per acre where any -- neighbors are on wells. The lots to the east are also on wells and since the plan W-T doesn't propose public water for those, the lot needs 10,890 square feet per _ =- bedroom x 5, that means they are short 2,758 square feet. 5) A number of variances from Title V: providing percolation test information, the percolation method, you use the slowest not the fastest results. The assessor's"show these as. two lots. The assessor's value of the two lots of $140,0.00 for both stating they are not really sure this lot can be developed. The way the lot is regraded, most of the surface flow will run into the pond area and no one has looked at what extent it will effect the neighbor. . Dr. Miller said the area has 6 lots under a single owner and therefore, falls under -. the 1650 rule,-require,the consideration of shared or I/A systems. A treatment »�� system may solve some of the problems: Mr. Dibb requested a continuance to April 18, 2006, meeting. Granted. - ^T QAMINUTES\EXCERPT OF MINUTES\EXCERPTS BOH 20 Rue Michelle_multiple dates.doc Page 2 of 6 l , Page 1 of 9 .1 IKKE Town of Barnstable BARNSrABLE, : Board of Health 9 -MASS. 200 Main Street, Hyannis MA 02601 rf0 MAf A y Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Sumner Kaufman,MSPH Paul J.Canniff,D.M.D. MINUTES FOR BOARD OF HEALTH MEETING Tuesday, February 28, 2006 at 3:00 PM Town Hall, Hearing Room _ 367 Main Street, Hyannis, MA A regularly scheduled and duly posted meeting of the Barnstable Board of Health was held on February 28, 2006. The meeting was called to order at 3:00pm by Chairman Wayne Miller,M.D. Also attending were Board Members Sumner Kaufman and Paul Canniff, D.M.D. Thomas McKean, Director of Public Health; and Sharon Crocker, Administrative Assistant,were also present. I. Hearings: Susan Kingman, 20 Moniz Circle, Marstons Mills; requested hearing regarding state and local code violations. Applicant postponed until March 14, 2006. II. Variance Requests: A. Mark Dibb, BSC Group, representing Marcia Elliott— 20 Rue Michele, Barnstable,. 51,692 square feet parcel, requesting variance regarding amount of pervious ' material above groundwater, new construction, five bedrooms proposed. Mark Dibb was requesting a marginally lot variance for his client and said a soil testingwas done in May 2005 and August 2005. Mr. Dibb will be seeking Y 9 Conservation approval as well. Mr. Dibb had an approved plan to update the entire length of Rue Michelle down to the cul-de-sac at end. The plan includes an 8-inch water main installed the entire length which will also service this lot. Mr. McKean said the engineer failed to show all test holes that were excavated on the property and the engineer did not show locations of percolation tests on the plan. Mr. McKean recommended denying the applicant's request for 100% variance from the regulation and the plan be revised to meet Title V in regards to the test holes and percolation tests. Mr. Dibb said he will have the percolation test locations added. Mr. Dibb said he will be taking out the clay and replacing with 4 feet of pervious soil: Mr. McKean suggested more holes be done in the SAS area and pointed out the size of the reserve area is short 120 square feet. Mr. Dibb will be digging down 17 feet. L r F. Mark Dibb, BSC Group, representing Marcia Elliott— 20,'Rue--T Michelle, Barnstable, 1.24 acres, house addition, one variance. 1'Mark Dibb presented the new plan reducing the previous) prod four- bedroom I/A plan to the current three-bedroom of without an I/A system Arlene Wilson, representing the.neighbors, said they.are happy to see the reduced number of bedrooms but had a question.on the size of the lawn. Upon a motion duly made Mr. Sawayanagi, seconded by Dr. Csnnff, the Board voted to approve the proposed spec plan with the following conditions: (1) a three-bedroom deed restriction will be recorded, and (2) when the final permit is applied for, the final plan must have the calculation for nitrogen loading-(including the structure, the driveway, and the-lawn) must be under 5 parts per million. (Two voted in favor, Dr. Canniff voted against.) V. I/A Monitoring Plan: Stephen Haas, P.E., representing Linda Mandella, owner= 168 Lakeside Drive, Centerville, 9,955 square feet lot, review of.1/A monitoring plan. Stephen Haas represented the plan"for a one-bedroom Upon a motion duly made by Dr. Canniff, seconded by Mr. Sawayanagi, the Board approved the monitoring plan with a one-bedroom deed restriction: (Unanimously voted in favor.), VI. Six or More Bedrooms: Sullivan Engineering representing W. Frederick and Diana Uehleir 109 Eel River Road, Osterville, 1.0 acre lot.,-. John O'Dea,.Sullivan Engineering presented the plan for.the two dwellings with one kitchen and one kitchenette and as required, it'll have a two compartment septic tank. The total number of rooms are 17, thus, using 50% interpretation gives'8 bedrooms (actual abeled is 7). . `Y Upon a motion duly made by Dr., Canniff, seconded by Mr. Sawayanagi, the Board voted to approve the plans. (Unanimously voted in favor,) .(revised plans,, will be given.) Vfl.. Discussion: ` POSTPONED Ed Pesce, Pesce Engineering, and John Kenney, Attorney, TO representing 381 Old Falmouth Road, Marstons.Mills — OCT 9, 2007 septic system discussion regarding failure.(continued from BOH January and June 2007 Meeting). VIII. Subdivision (Preliminary Plans): ` Commonwealth of Massachusetts Title 5 Official Inspection form , Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 37 Rue Michele Property Address Marcia Elliott Owner Owner's Name information is Cumma uid MA 02637 Aril 26, 2013 required for every q P page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, S G{ use only the tab 1. Inspector: - 0 key to move your cursor-do not Patrick K. McDowell use the return Name of Inspector key. PKM Contractors, Inc. �V Company Name P.O. Box 775 Company Address East Dennis MA 02641 Cityrrown State Zip Code 508-385-5993 S1 13023 Telephone Number License Number j-4 B. Certification ' I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑' Failsa El Needs Fu Evaluation-by t e L ca pproving Authority . r 00 C7 ' April 26, 2013 Ins ectot°s Signature Date r „ The system inspector shall submit a copy of this inspection report to the Approting Authority (Beard 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. / . 3 t5ins•11/10 Title 5 Official Inspection Form:S s ce Sewage Disposal Syste •Page 1 of 17 j Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M SJer 37 Rue Michele Property Address Marcia Elliott Owner Owners Name information is Cumma uid MA 02637 April 26, 2013 required for every 4 P 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): t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 37 Rue Michele Property Address Marcia Elliott Owner Owner's Name information is Cumma uid MA 02637 Aril 26, 2013 required for every q p page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): . ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) 'Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System.Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form . Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 37 Rue Michele Property Address Marcia Elliott Owner Owner's Name information is Cumma uid MA 02637 Aril 26, 2013 required for every q P page. Cityfrown State. Zip Code. Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier,if any) determines that.the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence.of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool 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 Y2 day flow t5ins•11/10 TRIe 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts to Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �M 37 Rue Michele Property Address Marcia Elliott Owner Owner's Name information is Cumma uid MA 02637 Aril 26, 2013 required for every q P page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® 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. [Phis system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd: ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑. ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should_contact the appropriate regional office of the Department. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments ,M 37 Rue Michele Property Address Marcia Elliott Owner Owner's Name information is Cumma uid MA 02637 Aril 26, 2013 required for every q P page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up?_ ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 37 Rue Michele M Property Address Marcia Elliott Owner Owner's Name information is Cumma uid MA 02637 Aril 26 2013 required for every q p , page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Septic tank, distribution box and leaching pit. Number of current residents: 02 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 Seasonaluse? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: 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(9Pd) 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•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 3, Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments. 37 Rue Michele Property Address Marcia Elliott Owner Owners Name information is mm Cua uid MA 02637 Aril 26, 2013 required for every q p page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: current Date Other(describe below): General Information Pumping Records: Source of information: owner Was system pumped as part of the inspection? ❑ Yes 0 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 El Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ElOther(describe): t5ins•11/10 Title 5 Official Inspection Form,Subsurface Sewage Disposal System•Page 8 of 17 I usetts Commonwealth of Massach Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 37 Rue Michele Property Address Marcia Elliott Owner Owner's Name information rs Cumma uid MA 02637 April 26 2013 required for every q p page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 1974 Were sewage odors detected when arriving at the site? ❑ Yes ® . No Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 2 feet feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) El Yes ❑ No Dimensions: Sludge depth: t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments �M 37 Rue Michele Property Address Marcia Elliott Owner Owner's Name information is Cumma uid MA 02637 April 26 2013 required for every q p , 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 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 How were dimensions determined? Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): All appears normal. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle. Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•11/10 Title 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 M 37 Rue Michele Property Address Marcia Elliott Owner Owner's Name information is Cumma uid MA 02637 April 26 2013 required for every q P page. Cityrrown 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.): All appears normal. 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.): h ' Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•11110 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 M 37 Rue Michele Property Address Marcia Elliott Owner Owner's Name information is Cumma uid MA 02637 Aril 26, 2013 required for every q P page. Cityrrown 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 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.): All appears normal. 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 l Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 37 Rue Michele Property Address Marcia Elliott Owner Owner's Name information is Cumma uid MA 02637 April 26, 2013 required for every q P page. Cityffown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): All appears normal 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 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 37 Rue Michele Property Address Marcia Elliott Owner Owner's Name information is Cumma uid MA 02637 Aril 26 2013 required for every q P page. Cityrrown State Zip Code Date of Inspection D. System Information (coat.) 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 37 Rue Michele . Property Address Marcia Elliott Owner Owner's Name information is Cumma uid MA 02637 April 26, 2013 required for every Q P page. Cityrrown 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 - t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System.•Page 15 of 17 f 'TOWN OF BARNSTABLE LOCATION 3.7 Rae t-t i c�f�- SEWAGE# _¢07 V LLAGE'—�i r 51a C'unc►-t Z q 0"'4- ASSESSOR'S MAP&LOT 3 3 S INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 15DO FAILED iNApFr_�-� LEACHING FACILITY: (type) �' (size) NO.OF BEDROOMS ?/ BUILDER OR OWNER '� � �IL 10 PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility '�`� W4" 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) 100Feet Furnished by 1 3 109 NcT ConF<<w.a.d �Zch� ' gl 33� ? 1+ g1 Zj T10 82. tao' ' r - 2 . Commonwealth of Massachusetts r Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 37 Rue Michele Property Address Marcia Elliott Owner Owner's Name information is April Cumma uid MA 02637 26 required for every Q P � , 2013 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: 4=5 feetfeet 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: Hand Auger around components 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 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments °M 37 Rue Michele Property Address Marcia Elliott Owner Owner's Name information is Cumma uid MA 02637 Aril 26, 2013 required for every G P page. City/Town State ' Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information-Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t , t5ins•11f10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 _ � r Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments G,,M Sye ev Subsurface Sewage Disposal System Form Inspection results must be submitted on this form or on the official Title 5 Inspection Form dated 6/15/2000. Inspection forms may not be altered in any way. A. Certification Important:When filling out forms 1. Property Information: , on the computer, 37 R V e l C k«Q use only the tab key to move your Property Address \ cursor-do not use the return I Q , Fl l U / <a, ArCl.a �1 D key. Owner's Name Z 1 v-e I t c lie l l$ Owner's Address -90Y L S 40 `3 � City/Town State Zip Code 31511 Z 519/ 12oo-6—p i ��, Date of Inspection: Date 2. Inspector: Y\ Name of Inspector Company Name o, G&X 0'7 Company Address F� sf�a ' / t U?-4.y2- City/Town State Zip Code 50$ - 25 'S- `73y3 Telephone Number Certification Statement: 7 :� I certify that I have personally inspected the sewage disposal system at this address and that1he information reported below is true, accurate and complete as of the time of the inspection. The ins e tion was performed based on my training and experience in the proper function and mAintenancelof on>,"te sewage disposal systems. I am a DEP approved system inspector pursuant to Section if.340 0 Title 5 (310 MR 15.000). The system: Passes ❑ Conditionally Passes ❑ Fair W Els urther Evaluatio y the Local Approving Authority n G 3 20/Z Inspec ignature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 1 of 16, o i Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form GSM A. Certification (cont.) e .3 *7 R ti 1 U Property Address T?,�I-C, 637 City T'cU, l r State C ZjpC)ode / 1 (.'I l ID �aCeik Owner's Name G� r� Date of Inspection �7— 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 Required pumping more than 4 times in the last year NOT due to clogged or ❑ obstructed pipe(s). Number of times pumped: ❑ Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ Any portion of cesspool or privy is within 100 feet of a surface water supply or ❑ [� tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ [7 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 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.] 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. t5insp.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 5 of 16 Commonwealth of Massachusetts W Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form �M C. System Information (cont.) r3 P? g v,-� M, c^ 1($ Pro erty Address City/Town State Zip Code �`� Owner's Name Date of Inspection Site Exam: Slope Surface water Check cellar Shallow wells Estimated depth to ground water: j D, a � oker V--e� 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 0� 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: gp4e., JL Lo �l,��r bb-3�oL--E-.ely /-4 52el-c- SRif ��gt�ytie� dJ,e 1d S�5 /a /11 y �V o o n N W Qct� &V Tr✓Y"1 a 4 /"�r t5insp.doc•1 V2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 16 of 16 f Commonwealth of Massachusetts Title 5 Official Inspection Form RECE 6 ..... Not for Voluntary Assessments Subsurface Sewage Disposal System Form < 'r -L%9 MAY 10 2005 Inspection results must be submitted on this form or on the official Title 5 nAlml iir figq a sated Gil 512 .Inspection forms may not be altered In anyway. HEALTH DEPT. A. Certification �=�,�Tl�f� Important: When filling out 1. Property Information: V FAILED L ) / /� / /� corms to the t C/�`�Q r � r ri5T d IJJJ�C C U6K �fU�a / q 2 jo 3 computer,use only the tab key Propert Address to move your t ( cursor-do not OsvnePs Name —- ^- — use the return /� o /J a key. /02 1CV.$ i!'-ittf ltl(e. Owner's Address �+- f(AS^�aQ Ct�r+�wtaCj�act. c3 ©2_l0 `7 Citylrown f State Zip Code Date of Inspection: 2. Ins ector: 18 Name of i ctor a_ t Vl� �t3 Company Ad ss ota City/Town ---- State Zip Code Telephone Number Certification Statement: I certify that I have personally Inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of 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 CI't R 15.000).The system. ❑ Passes ❑ Conditionally Passes VFails ❑ Needs Further Evaluation by the Local Approving Authority -- �- 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 DER 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. 151nsp-ooc•1 U2004 Title 5 Offlclat Inspection.Form:Subsurface Sewage Disposal System Page 1 of 16' y Commonwealth of Massachusetts _- Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification (cone.) - Property Address City/Town State Zip Code . Owner's Name Date of Insp ton Inspection Summary:Check A,B,C,D or E/always complex all of Section D A) System Passes: ❑ I have not found any information which indica that any of the failure criteria described in 310 CivlR 15.303 or in 310 CMR 1 b.3O4 ist.Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Pa ses: [] One or more system c ponents as described in the"Conditional Pass"section need to be replaced or repaired. he system, upon completion of the replacement or repair, as approved by the Board of Heatt will pass. Answer yes,no or n determined(Y, N. ND)in the❑for the following statements.If"not determined,"plea explain. ❑ The septic ink is metal and over 20 years old*or the septic tank(whether metal or not) is structur dy unsound, exhibits substantial infiltration or exfiltr ation or tank failure is imminent. Syste will pass inspection if the existing tank is replaced with a complying septic tank as appr ed by the Board of Health. * metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate Compliance indicating that the tank is less than 20 years old is available. ND Explain: t5insp.doc^1112004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 2 of 10 d R Commonwealth of Massachusetts Title 5 Official Inspection For - Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification (cont.) Property Address City/Town State Zip Code Owner's Name Date of Insp ion 1 B) System Conditionally Passes(cunt.): ❑ Observation of sewage backup or break out or high atic water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, ettled or uneven distribution box. System will pass inspection if(with approval of Board of Heal }: ❑ broken pipe(s)are replaced ❑ obstruction is removed ❑ distribution box is leveled or r laced ND Explain: ❑ The system required pump' g more than 4 times a year due to broken or.obstructed pipe(s).The system will pass inspecti if(with approval of the Hoard of Health): ❑ broken pipes) re replaced ❑ obstruction i removed ND Explain: C) Further aluation is Required by the Board of Health: ® Conditi s exist which require further evaluation by'the Board of Health in'order to determine if . the sy ern is failing to protect public health,safety or the environment. 1. S stern will pass unless Board of Health determines in accordance with 310 C R 15. 03(1)(b)that the system is not functioning in a manner which will protect public health, s ety and the.environment: ® Cesspool or privy is within 50 feet of a surface wafer ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5insp.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 3 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form -- r Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification (cunt.) Property Address ff. City/Town State Zip Code Owners Name /an ate of tnspectio C) Further Evaluation is Required of Heal (cont.): 2. System will fail'unless the B (and Public Water Supplier,if any) determines that the system is fua manner that protects the public health, safety and environment: The system has a septic tbsorption system(SAS)and the SAS is within 100 fleet of a surfacewateibutary to a surface water supply. The system has a septic nk and SAS and the SAS is within a Zone 1 of a public water supply. The system has eptic tank and SAS and the SAS is within 50 feet of a private water supply well. 171 The syste as a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more fro a private water supply well**. Method sed to determine distance: **This syste passes if the well water analysis, performed at a DEP certified laboratory,for coliform ba eria and volatile organic compounds indicates that the well is free from pollution from that facili and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, pr ided that no other failure criteria are triggered.A copy of the analysis must be attached to this ©rm. ' Other: t5insp.doc•1112004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 4 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form . Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification (copt.) SPerty Ad Tess City,frown State ZipCode wnees Nance Date to peciian 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 0"below invert or available volume is less than Y2 day flow Required pumping more than 4 times in the last year NOT dice 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. C] ( 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 coliforrn 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.] The system a Lois.1 have determined that one or more of the above failure Yes 0o 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. t5insp.doc•11,2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 5 of 16 Commonwealth of Massachusetts Title 5 Official Inspection For Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification (cons.) Property Address i City[Town State // Zip Code Owner's Name Date of i pection E) Large Systems: To be considered a large s tern 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"y "or"no"to each of the following, in addition to the questions in Section D. i YES NO ❑ ❑ the system ' within 400 feet of a surface drinking water supply ❑ ❑ the s em is within 200 feet of a tributary to a surface drinking water supply ❑ ® t system is located in a nitrogen sensitive area(Interim Wellhead protection rea—IWPA)or a mapped Zone Il of a public water supply well If you have ans Bred"yes"to any question in Section E the system is considered a significant threat, or answered" es"in Section D above the large system has failed.The owner or operator of any large system co idered 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. t5insp.doc•1112004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System ;gage 6 of 16 T Commonwealth of Massachusetts - Title 5 OfficialInspection r Not for Voluntary Assessments Subsurface Sewage Disposal System Form B. Checklist —a/ Fv'e Prc erty Address tj City/Town State Zip Code 5- Owner's Name _ Date of Insoection 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 NIA) Was the facility or dwelling inspected for signs of sewage back up? _ �❑ Was the site inspected for signs of break out? open woo i d , � a.v st l� g ❑ Were all system components, excluding the SAS, located on site? W � t M X, ❑ Were the septic tank manholes uncovered,opened, and the interior of the tank r,•0 oAd firt , inspected for the condition of the baffles or tees, material of construction, dimensions,depth of Liquid,depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has- been determined based on: �❑ Existing information. For example,a plan at the Board of Health. ❑ ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)(310 CMR 15.302(3)(b)) t5insp.doc•1 V2004 Title 5 Official inspection Form:Subsurface Sewage Disposal System Page T of 16 . i Commont''vealth'of Massachusetts ---- Title 5 Official Inspection For Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information Pro A Add ss kvam'ty; CL, 00&32 Ci own a State Zip Code 9r eltto lg_ 5 I� Owner's Name Date of Inspection Residential Flow Conditions: Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): Number of current residents: Does residence have a garbage grinder? -. B--Yes No Is laundry on a separate sewage system?[if yes separate inspection,required] ❑ Yes �No Laundry.system inspected? Yes ® No Seasonal use? ❑ Yes 2 No Water meter readings, if available(last 2 years usage(gpd)): Sump pump? ! R ❑ Yes Chif No Last date of occupancy: Date CiN/e `f— Commerciallindustrial Flow Conditions: Type of Establishment: a Design flow(based on 310 CMR 15.203): Gano er day(gpd) Basis of design flow(seatslpersons/sq.ft.,.etc.): -- — Grease trap present? ❑ Yes ❑ No Industrial waste holding tank presents ❑ Yes ❑ No Non-sanitary waste dischar to the Title 5 system? ❑ Yes ® No Water meter readi if available: - — — Last date occupancy/use: Date ®t r(describe): — w 3 , t5insp.doc•1112004 Title 5 Official Inspection Form:Subsurface Sevrage Disposal System Page 8 of 16 Commonwealth of Massachusetts Title 5 Official Inspection For - - Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (corn.) operty Address �} Ctu 01S , �C°UW11Al2Y�i(� 1 t �_ C-ty[T State Zip Code Owners Name Date of Inspection General Information w , Pumping Records: Source of information: — Was system pumped as part of the inspection? ❑ Yes B--No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of Systems: Septic tank,distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool: r ® Privy ❑ Shared system(yes or no)(if yes, attach previous inspection records, if any) ❑ innovativefAlternative technology.Attach a copy of the current operation and , maintenance contract!to be obtained from system owner) ❑' " Tight tank.Attach a copy of the QEP approval. ❑ Other(describe): Approximate age of all components, date installed(if known)and source of information: Were sewage odors detected when arriving at the site? ❑ Yes No t5insp.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System- Page 9 of 16 f Commonwealth of Massachusetts r r Title 5 Official Inspection For Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System lnformabprn (cons.) Property—f�=`i-ddres� City/Town --�— State Zip Code Owners Name gate of Inspection Building Sewer(locate on site plan): Depth below grade: feet Material of construction: [;cast iron ❑40 PVC E j 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): Vol �tL Depth below grade: feet t , Material of construction: concrete ®metal 0 fiberglass 0 polyethylene [ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of ® Yes No certificate) Dimensions: --_-- Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle -- Distance from bottom of scum to bottom of outlet tee or baffle ----— How were dimensions determined? - t5insp.doc•11/2004 Title 5 Official inspection Form_Subsunace Sewage Disposal System Page 10 of 16 Commonwealth of Massachusetts Title 5 OfficialInspection Foy _ Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cant.) 3T? _AV—C c Property Address `,__.,� Aaj a A-a 6 V—CO Ci (Tmvn * State Zip Cade Ub Owner's Name Date or Inspection Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): Dr ea dL4-ew-IC-2"LIX)LA.) 5 o rA c-e- Grease Trap(loc t on sit plan): Depth below grade: feet -- Material of construction: concrete ❑metal. ®fiberglass ,polyethylene E]other;explain): Dimensions: --- Scum thickness Distance from top of scum to top of outlet tee or baffle , Distance from bottom of scum to bottom of outlet tee or baffle - Date of last pumping: - -- Date Comments(on pumping recommendations,,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence;of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: — - ' A Material of construction: concrete [],metal C]fiberglass [3 polyethylene E other(explain): t5insp.doc•1112004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System F yell of 16 ' f Commonwealth of Massachusetts - Title 5 Official Inspection Form. - Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. Sys-tem Informationk(cont.) Property Address City/Town State Zip Code Owner's Name Date of Inspection Tight or Holding Tank(cent,) Dimensions: --- - -- Capacity: gallons DeSigi,Flow: allonsperday Alarm present: 0 Yes � No Alarm level: Alarm in working order: ❑ Yes❑ No Date of last pumping: i Date Comments(Condit" of alarm and float switches.etc.): Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert a� tc�Cg Ld, 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.): 7 k" �w� ��,Le ��ss duse C ogieJ Pt, f lvwd Cu tmed dfain sr, is kc qy� tom`CLtz, A0A C1 f v L 5V( A e_Q._ 14a V C1/4 r Pump Chamber(locate on site plan)- Pumps in working order, ❑ Yes ® No Alarms in working order. [ Yes No t5insp.doc•11/2004 Title 5 Official inspection Form:Subsurface Sewage Disposal System Page 12 of 15 Commonwealth of Massachusetts -- Title 5 Official Inspection Form Not for Voluntary Assessments ` Subsurface Sewage Disposal System Form C. System information (cost.) __z _{�r C Pr I a Addreps < M!, t v lab Cukk ( C1; Q( o t D � Ci /Town state Zip Code Owner's Name Date of Insp&ction 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. I ❑ leaching chambers number: ❑ leaching galleries number: — ❑ leaching trenches number, length: [ leaching fields number,dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: -- Comments (note condition of soil,signs of hydraulic failure, level of ponding, damp soil,condition of vegetation, etc. : f PJ Aq9 r 4 4 + 41 c bvo}s , Gielow 5V146Ct— - #e a r ®�o ivy r��.y.. a.�- s vi�'a� w��n. �ig�► >�'��%�l� �� t5insp.doc•11/2004 1 itle 5 Official inspection Form:Subsurface Selvage oisposat System Page 13 of 16 Commonwealth of Massachusetts i_ Title 5 Official Inspection For Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) City/Town State Zip Code Owners Name Date of Inspection Cesspools(cesspool must be pumped as part of inspection)(locat 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 n No Comments(note condition of soil,si ns of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on sit Ian): Materials of con uction: — - Dimensions a Depth of lids - Com nts (note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•1112004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 14 of 16 Commonwealth of.Massachusetts _ Title 5 Official Inspection Form Not for VoluntaryjAssessments Subsurface Sewage Disposal System Form C. System Information (cont.) Property Address JC City/Town State Zip Code Owner's Flame Date of Inspection Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water su enters the building, r l 'p� F' A �n 8 'J «T r� 2' t�►� 'q N odor NoT To < LE 1- D A ' 50f P(ce— tUi,M .rloc>l?/2004 Title 5 Official Inspection._Form:Subsurface Sewage Disposal System Page IS.ol16 f . r Commonwealth of Massachusetts i g Title 5 OfficialInspection t Not for Voluntary Assessments' ,3 Subsurface Sewage Disposal System Form C. System Information (cost.) — - Property Address t ON,-3 City/Town T— State Zip Code Owner's Name Sate of Inspection Site Exam: Slope Surface water y Check cellar. - Shallow wells " lac ked u Es#ima#ed de th to ground water t -¢ 0A 4�r�Qt�;r) }u4 p Please indicate all methods used to determine the high ground water elevation: [ obtained from system design plans on record !#checked, date of design plan reviewed: Date Observed site(abutting:prripertylobservation hole within 150 feet of SAS). El Checked with local Board of Health-explain: ® Checked with local excavators, installers-(attach documentation) Accessed USES database-explain:. You must describe how you established the high ground water elevation: Cow o u , t5insp.doc•1112004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System> Page 16 of 16 Oct 26 11 12;43p The Bldg Insp of Cape Cod 15082559343. p.1 111"RE BUILDING INSPECTOR O CAPE COS PO BOX 307 Eastham, MA 02642 4 508-255-9343 ph./fax FAX COVER SHEET The B u i( in Inspector .of . Page 1 of 20 Cape C04 Date 10/26/2011 —ko To, Judith, Town of Barnstable Health Dept l fm� .r? Fax:508-i911-6304 CC: x:. From: Brian Tilton Subject: 37 Rue Michelle Septic Inspection The contents of this fax are confidential and intended for the receiying party addressed at the top of this cover page, if you received this fax in error please destroy all documents. P.O.Box 307- Easthari. MA 02642 Ph:846-737-8244 Fax:508-255-9343 thebuiidinginspector@)Wnicast.net SI 'y 1_ Oct 26 11 12:43p The Bldg Insp of Cape Cod 15082559343 . p.2 �� L+>)i16iiiitdlY7>:stillir ii! ilt.�a�ae�ruas.:w 1 a MUM Inspection roam, 14 - - nit for Vaunts, y Assessments Subsurface Sewage Disposal System Form impea0a rsasutts must tm gubffttt ed an this fcrm or an the> WxM Ttie 5 hwoeclion F*M did 8T't5awl 1"Sneeft"fWM may rill!%be eltwedIn 8i!YtlM. A. Certifficatior. IsnpoR�at .� � infcrrr�iior.: t a . WIMR cn.�t u!6„ �Y c cpMR9 we iYlpXutsiruse only bw tab i;� Pr*p;,t �teesass i to nave your ( 1 8! :Ai-w-do not owr�aTE Morrtg ss-3 the catum s t tee. ,fir L �tJ•2 i�i�iC.f -. _-- -- ' ----� Owner's Address Cigdro+asn M state Zip Code ' Bate of Inspection: Date -. I � - ^_ Inspector. _ Name of _may -a: €n — Cvmpany NaLpe r Citufrown Tap Cada i eiephone hlumber Cerfificatson SWemen$ l ceri)11�r that i ttave personaily irGpeded the sewage disposal system at this address and that the inforraaWl',i orted ba M is trite,aocu at,e and oonViete as of Ma titma of ttte inspacftn —Me.Inspection perforimed based on any tmining and expe:ance in the pros.f function and rnainte€arsee of on site se rate dispel systems.I am a DEP alpFsro�+e is teat irr t%r pursasrtt to$scion iSAW of Tide s(3-ja£Mft iS.Offl).The synAm: ❑ Passes: Conditionally Passes Fails - Needs FLVNer Evaluation by the Local Approving Authollry Insuectars ssgrrattsre Date ----- —the system ilispeptor shag submit a copy of!his inspection report to the Approving Authon (Board or SeWdh or DEP)vA hira 30 days of completing this,irrspeclion.If the sirs+tern is a shared sysLem or has a design fbw of 10,00D gpd orgreeler,the inspeder and the system:owner shaif submit ihe report to the appropriate regionei office of the GEP-?he original should be sent to the system owner and copies sent to the buyer,if applicable,and the apprafir4 sutWty. * ?his report only desc ribas conditions.at the time of iszspoetion and under OW candifaww of use at that time.This inspection does i:at address how the system will perform In the future under the same or different canditlons of usQ. s5srsp.doo- ttM-i+t3a 'fM5011cta fnsreCUM FssRn:SaMUcr2Ce 521Mg9 Us+sesat S}SEW Pas; I of 16 Oct 26 11 12:44p The Bldg Insp of Cape Cod 15082559343 p.3 GomnlonVleaf1 of assachusetts = r � inspection orm- V_• -� Not for Vgluniurvy Ass"srnents Subsurfar-Sewage DOOSal System Fomt Clyfio>rrr -- S&Le Gnmz:s hlaris Dated.hwea- f inspection Summary-Check A,3.C.D or E f always complOb all at Section 0 R) System Passes: i have nag found any infarr mhoiy which€ndica that any of the failure aria described in 3 1 u Clt,5.3D3,5i"Is9 0 C Nil R 15.3t04 '1C-SL AAy ailUre.Cki Wis FWE ava'suatsrd are indieated below. -ornments 8) System Conditiomi!y P s: One or more system ponents as des&,bS f in the`CondiSmel Pass",se✓`:an need to be replaaW or repair-rd. rke sy-sterm upon completion e the replacement or repe€r.as appicoyed by the Board of Heat' Wi9 pass, . A newer yes,no or detennitted(`l.K ND)in the Q for the follo+AN statements.tf{not deterrtahmV p explain- The he se i nk is metal and aver 20 years eld"or the septic tank(whether metel or no£1 is S€ruciu. ur=und,exirDift suv€an;iaI in£.i":ion o:--xfii"tic—,or tank Wtoe is irn,ninent Sy will pass inspectican if Me a dstiN. tank is solaced with a=npty fV.WPW tmnk as appr d by the Hoard of Health. metal septic tank will pass inspection if a is struclurally sound, not leaking and if a Certificate CornplWr:,e irdic ong that the tank is less than 20 years old is available. ND gain: talnap.00c•i1/20U9 � "mine 5 C>tifsdaf iFssaCC1�S[s htNm:.Su�ra'f3faB;s�v� i 3y6dBm Page of'IQ Oct 26 11 12;44p The Bldg Insp of Cape Cod 15082559343 p.4 Commonwealth of Massachusetts ~ � O �° farm ''- Nat for VblunUry Asessnwnts `�`° Su4�ssc#rrac.� rel1 Disposal Syetw rortn A_ LerfificafiDn (mot) CdplTovd� stare Zip Code l7do`17c�3 N3r,� - -Qme,R knpeiftn i rl Observation of sewage backup or break out or highofatic water level in the distribution box due to brzz n r obs�i-0N:ted pipes)ar due b a'�ken, attled4 or uneven d7stribubaa box.System will pass inspection if{whit Wgravai of Board of t'le brolker-1 pipets;are reoWcad r g ohsfiucfan is rerrmyed . 1� El distribuffiort urns is leveled ar faced ND Explain: � r ❑ Ths system rewired purrs. g retire ibae 4 times a year dua to broken or obstmcted pipe(s).The sys#arn wnl pass irtspecti if Lwith approval of the Boardof Health): tilrbke,pipe(s)Xe repWced f [] ob3Lr,eciiorl' retaovad hID Explain: �S Ful her .atuat"son is Required by the Board of health: Condit' sexist which require further evaluation by tt'YB Board of Health in Order to detet.•.-nine if the sy �r is iai#i^g to protect public health,safety or the ernWronmerrL 1. iterri gill pass unless Board lof#iealltYi determ-Inns irn acc dWOO with.310 P' ±5u �){b)that -systern is¢got funct c"ina in a manner which wcif Meet pia-tic.ltP, ey and the en+rirartlYaerlr. Geoai as#xivy is tHitttirt SQ feet of a surface water . Gi . esspoof or privy is wAmn ao feet of a bordering vegeteied wetip�d or a salt marsh F5111SP.et1C•j} 4t Title S 0MIC131 1lSS¢EC M i T01-1.SUM UM St--AJV 1?ispuss#`jgak rn . 9 --.-,c7G}g Oct 26 11 12:45p The Bldg Insp of Cape Cod 15082559343 p.5 Corns»onweafth of Masmthusettz r -title n t-t1 Inspein t m A f4ot for Y®lurlury As"SSM1011ts Subsurface Sewage Disposal System FL'rm A. Giylievrl zip Cade 0whart mama DdE¢of b1sp�CC C} f:urther Evatuatien is kequ-red hY tise ward vn visa 2. Syst~n will fait Lniess the Board Of flea (qnd Public Water Suppfifir;if any) detsermis "that tl'.e systern is iAnctiorlireg•s a masnner that protect$th-pabllc hGRILits s.-afety and environmesr is rl r ae systern has a seAc tank ar.56 1 absorpfi6r+system(SAS)and jbe SAS is virthin +4t7 feel cf a surface vu2Eer s iy OfFy`.D a surf +rrater sc.• iy. _ tte systerss im5 a septic nk and SpZ and the SAS is„rtifiin a zone pi a p iic ate:, s�pa3�. The system has c laf3't end SAS and the SAS is within 6o feet of a,primate water supply r well- Thesmote as 2 septic tank and SAS and the SAS is less than ia0 feet but 50 feet or mare f*o privat+e water supply well'_ Marrhod JJJ s to determine distance. "¢TNS syst passes if tF:e tivelt wet-2natysis,pefrl�med at a r3E?ce-fified lgFym-atM,£or co{iiorrrr b aria stud volatle organic compounds irdics!es that the well iS irea fctAn poffaf 0n from that facil and the presence of ammonia ndrogen and nitrate Mtrogert is eqt l tQ cx fees than 5 :a ar-ts�ered.A copy of the analysis must he attached pp;n, u tt t no firer failure exit to this oars /SCIher . Tins 5 Official sas�eckicK.Form:Se3sstata�e 50vts3g0 L�Isvosa153+stzsn t5insp.a�-�srzoru Pace 4 d If, Oct 26 11 12:45p The Bldg Insp of Cape Cod 15082559343 p.6 ,, ,c!` - ��E�tlo���stea'R�h��3SSaC�tti:�"i5► vim A We trial inspection orni, NotforAssemeats Subsurface Sewage Disposal System Fora A. cerifica#ion(mot. _T Add; . T 7 31 Uy" M%,in State i j a ! �3 wner's Na ie date ectlort D)System Failure Criteria Applicable to All Systems: t'�'►E:"SCa3 S:;�T.�ictr�ss�-.o�4n t�L�'$C�?�yf zi^.•:�f}��d'�'�3F cat LR.'i3.'-,.RQ��3�'t�: Yes No BaG�-up of seu��ge into facility or sys#ern carr�p9aneri#due#o o�erJaailed or In dogged AS or cesspool Discharge or ponding of gifluenf.to the surface of the ground--r surfaCd wa#ers due to an overloaded cr cicMed SAS or cesspWi Static liquid level in the dst ibuan;�box above"let invert due la;Wr avalioaded or clogged SASS or oesspcoi Liquid deP#h I cesspool is Jess:hare gn below invert or 8ltaiiabie voiuF;i2 is less u --s the' d�f'ilo` Required pump more itsan 4 ti:res in the'motyear Ii<`due to dogged or -3 0be'1pUMd pipa(s).S+1tglW Of bales PlJ4 PfAk - pny poriiori of the SAS,cesspeol or pfroy is i e aa v Thigh ground w al tor elevation- Any And►portion of cesspool or privy is within 100 feet of a sudace"Stet stapply or 10 iritritaly to a S3,*r-M-matersupphl. ' (� Any portion of a cesspool or privy is within a Zone 1 of a public welt_ Any portion of a cesspoot or privy is wnthln 50 feet of a private Water supply well. Any portion of a cesspool cr pricy is less than 10u je-vt but greater than 50 feet ffdttl a private water supply vmtt with no acceKttable water q fiy anaty5 s.[This syslem passa..s if the well water anaWs,perforrwd at a D€P certified - taborato y,for coufarm baceteria and vataMe orgatrtic compartnds ti - indicates thatthO well is free from pollution from t[ta t f'acRY and'1�z i prese- rumof ammonla nitrogen anti gate triibrogen'is a l to or; tkmn 5 Pole,pfovided*tat no,ally fadum crttetea are trtagered.A copy of the analysis must tvs attached to this IOM_1 Yes �--� The systun fags,t have determined that COO O:more of the above t ..'we c!'i e W as�int 31 tt CMR'15,303,tyre#le sySterir fats.The S;`St€:ril Q!'''ter S134t2 CCTtt?Gt the aaard e-4 Health to detem- is a ti iehal�diit be tse ry to ovrract ft failure. e t'amso.dnc•1712t1�4 J ue s otheim tnrspeewnf orm.gUbMdaW S�vaW Disposes!Syster•• Page". 5 of IG Oct 26 11 12:46p The Bldg Insp of Cape Cod' 15082559343 p.7 L41rlmonwealm of assathusetLs , Fitle i0lin C I Insped"' 0ri _ __. .. Net fipr Vojwtary Assessments S;lbsurfaw Sgmge ©ISPOS21 System Form. praperl�A3dress / C�;roven zip cede C)v W'..Nan* ,f E) Lasge gistems: To tse carsidered a large rn the spsfem must s$r:e a ftGiRtY with a design€bDIN of 10,rtag tgpd$Q 15,000 gpd. For large wms.Y :rtd:�te either"y "dr"no'to each of ihefoltcw�g, iri edditinn to the qu.resfors in jon D. YES riO ❑. Q the&,jstem vubilin 400%at of a surface�dnking water suppfiya Ej the s M is w�lhin 200 feet of a Crib--°tart�a surface drinking water supply ;h s}sera€s located in a nitrogen sensiti~re area(Interim Wellhead Protection C l �a—tWPA)o a mapped Zone tl el 2 puNC wster supply well if you have "yes"to ary question in Sertian E the system is considered a significant threat, or answered` ee in Section D above the large system has tailed.The ow►ne[or operator of any to ge system +deTed a sigacant 1hreai under Section E or Wad under Secfion D shai!upgfade li?8 system in accorda.w-a w-M.3 asks G M R 1 a_3t�A_The system:owner should contact the approprimc regional off of are Department. Limsp_8ec•.11lJrSkr Ti119 5 othcw lnsp i ason form'-4=vrfaoe 6ewtage L�. N3SW Syslem- .. 9 Oct 26 11 12;46p The Bldg Insp of Cape Cod 15082559343 p,8 lot-Voluntary A&w-s*rents = Subsurface Sewage Dis SX� FOrr -5. Co'hec li S CI l oCllt .^Tf$IL�� r Tip Code Owner's Nang Gate af rnspect;M Check if the io#{awing h2ve beer:done.You must iriditaie')ms"or°no"as to each of the fo;lovmrng; YES/NO f ]] p!siring mess -,Vas provided b j ttie ol�ne.r,vS.L�?rlt,o Board of t"'ealLl fwgroA any of ini?sysiern Do=anents pwriped out in Me pf eviGL&iWo tueaRs? Has the system rSCe!%'d rr -Ml ficws in be premnau°s week pes9act- Have age;roJumes o€water been introduced to the syst+rrs recentty or as part of tb�s.inspedflon? %fere as built pldas of The system obtained and exarruned?(fl ttmy were not available twbe as WA) E Was the faeitity or drmlii lg inspecieci far signs of sewage back�' _ Was the site inspected for signs of break out? l4}, Were all system componenrj-.exciucrirlg Me SAS,located on s'str+ kv 9+ � �- J+hrx ia3fp [j Were?he septic ta:tit manholes uncovered opened,and the interior or:the tank •c. v�ad V. -� , N.- is�s�ec'c d:a.ha ca;.�itian a baffle;a.teas,material of co-ztrLwton, f . dirmnsians,Vlept:oft-quid,;dsptt'.of sludge and dew of stun? �'Egi7zi� t�4t�Yl�t trdz-,`fie-1a,dtity owner(arid ratcupania r r,iffart►t fYorr,owmer)provided with inforr:'iauon on 4he proper rna:rdenwice of subsurface sewage dis�i s,+sterns? The size and location of the Soil Absorption.System tSAS)on The site leas- been determined based f)r) :_s Existing information:For example.a plan at the Board of Health. Determined in Tha field(if any of the failure crilana related to Parl C is at issue appmxirnatian cf instance is unacCeptaole)[318 CMR 15. f32(31(b) '5insp.>tbc 1 f/100 l' ?Rlia 5`Offrcial InspaWm form:Subsurface Sewzg5 04moi System Page T of 16 s Oct 26 11 12:47p The Bldg Insp of Cape Cod 15082559343 p.9 - Wal,for Voluntary ASSOSS>i OMAS `~`Y Sl,t�stn ice Sewage Desoosal SysteM Ftxm C. System Inflo atio;r Prape!y AZIn q� GiiTcn�n ii _ State / Zip Cade6-7 - Mf Id awrar s dame gate 0`fBSpecVm nesidenina!l=kw!Conditions: � � - .4u-rber of bedrooms(design): — — Number of bedrooms(actual): DESIGN fic++u based on31 0 CtvlR 15.203(for example:110 gpd x#of bedrooms): . 2 Murnber of current residents: — Does residefme; a garba- 7 ? rev �} Na is Isurldry on a separate sa waae system cif yes separate inspet--ion required! 0 Yes ET NO aLincit -s lam inspected? `es CI No Seasonal use? U yes �/iao Water meter readunrgs,if available bast 2 ears Lmage(PPd)Y. CuUmpurm? f , f G Last date of oup<ricl- tJaa Commeecialllndus trial Flow Car'.d}tfon Type.of E-stablishmmy Design flow kbased•gin 3-10 CAAR'15203 Cairo-` day tsadl -- - - Basis of design flow(seatslparsonsf9q.tt, $iC.Y Grease t.+ap present? � Yes No Indusiriat Waste bolding tank presenf� Ye" 1.:� Ala Non-sanitary wKwte ftch fo the f r e 5 system? Ej Yes � No Water meter ready ,if available: last dat .c;=paro&se: Date t5insp.aoc-31P2a04 i`,f 'S Official insVebai F6m:Summfam sewm a amm�e$ly,16sat Swtem- Oct 26 11 12:47p The Bldg Insp of Cape Cod 15082559343 p.10 Cotnmopweaith of MassMhusetts fficial Inspection Form Not for Vo mftr}f ASSe"M-0fift ` 5ubsurfaW Sewage UISPasa!System Form c. systern information 7=M-1 fS'f� �iff t+t2t�'t!! Ket T b2-� - CitylTaae►► , � ., _ ,t see -`P ccae ,?inners Name Date of Residential Flow ConditiDns NUrrkber of bedrooms(design): Number of bedrooms(actual): DESIGN fow lased art 310 CMR 15.203(for example:110 gpd x#of bedrooms): 2-20 Numb"of Current residents: Does residence have a garbage grinder? Yes No Is laundry an a separate sewage system?(if yes separate inspection required] D Yes ff-*No Laundry system inspected? No. Seasonal use? ❑ Yes'1 Water rreler readings,if available(last 2 years usage(gpd)): Sump Pi+'rtP? - Yes No Last date of ascupaney. Date Commerciall1irtdustrial Flow Conditions: "type of Estabtishmen Design flow(bawd as 31 C CMR 15-203P Ga i er day{sld) Y Basis of desW doer(sealsjpemons."sgA, etc.): Y Grease trap pmsent? Q Yes �- No Industrial waste holcrmg lank present? !� Yes ' No Non-sanitary waste tlischar to tits E tte 5 system? Yes ! No Water meter read if available:: Last date ofocc upancy/use: Gate Gather(describe): f5VISp.000 k 1l', 1 TMO 5 c MwW ImpedW Form:Subsurface Se rip Disposat 45$9- pages el is Oct 26 11 12:47p The Bldg Insp of Cape Cod 15082559343 p.11 .� Commonwaalth of Massachusetts � �,� r Uff nspe i �wow.� i in aac�t for V-WunUiN A.,nesssner:ts = = e r'ispsamFoySubsur€ace Sewag } System info"-naft.q(wnt.) perfy Address _ Zips e;tyr �- oviner's rear- Oats of trespeedw General€nforrnation a Source of information ' Was system pumped as part of the inspection? Yes if yes,volume punVer f Hoy^!was 4uantiity pjm-ped determined? Reason for pumping: Type of System: Septic tank,divribution box,soil absorption system J Overtiow cesspool Privy Shared system(yes or no)(if yes,attach prevint;s inspection records,if any), Innovath etAlternative technology.Attach a copy of the current operadort and rci'ntermnce conhaat{to be obtained from system owner) {� trfit tank.attach a copy of the DEP appnxral. [� other(describe): Approximate ate of aU components;date installed of knmvn)and source of information: Were sewage odors detected when arriving at the site? Yas ..r No 151nsp.Goo-tifZCio4 tote�t7iflC!'ffi IRSCeCrlDn ptrnx Suesur��ce Seev2ge t7�pE►sas 3ysrsm Oct 26 11 12:48p The Bldg Insp of Cape Cod 15082559343 p.12 ` Cctmownweah of Massat husefts ,,tie 51 Official nsct - Not for WmnUry azS M=ft aub5urf cs Se�r:ge Diapmai Srtem Fob Arld h� utu Ul ._� f' lrt sID '' ;lyfTo«m sty ITip Code Owners:darm FJef�tiFgectic+rt BuituiZ9 Sebver rbmte or,site fin): Depth below amide: feet 4�terlat L+F,Cr.'1S�^.i+.t�n: cast iron 40 PVC other wplairt} Divalce trcm.ptivate water suWy vre l or suctim tine Comments(or condition of;oint,,venting,evic:ence of leakage,etc.): StpV.c Tank imcato un stte p3anx 'Depth t; tea T Material ct:.csrstrucvcn: ✓concas rrsetai r'>foergless f 0 polyethylene other(explain) if tank is metal, list age: rs is age cornirmed Jy a Culificale fl1 Cernplianc2?(aiiach a copy of f; 'Yes 07 NO ce:Mate) Dlrmenslws Studges depth: J Distance f:om top of sludge to bottom of nutlet tee or baffle. Scum thickness. — — Distance from tap of scum to top of ou°iket tee or baffle - Distance trom bottom of scum to bottom of outlet tee or battle -- ow were dir snstoons determined? t5insp.1doc•9IM03 Zi1te 5 Ulfsr at ��:st �rtsssista�Sevr�e S'y of i• e 2( o it i Oct 26 11 12:48p The Bldg Insp of Cape Cod 15082559343 p.13 comrnonwaaler of Massachusetts Ve 5 fridal Inspectingrorm Suturtace Sewage Dis-pnsal uy �m Fob ~ r,. System 1nf0rM €ate (can:. �,�.,��'� �� l� �.�erii.N•L'��L•tf t+ l t�`° l�d.�►�I- --- C' IfoNro( J state 27p fade .M- tTrm-.t4aree eve ceivkrim Comrna-'.3(or.pumping reconmtendaWns,inlet and outlet tee or baffle conditcn,sxuchAml inwity, t y<<;d L.%,et`as relate to outlet iaveft,eti%idenrM tf ieskcage,eta}. Grease. "rap{IocAt ani p } Depth Bela grade: Mator'rat concrete ❑metal rite glass v polyethylene other(explain): virnensions:. --- Scum ftci BessDistance tam top of scum to top of ouliei tee or baffle Distance f�!bottom of scum to ball ant of cutiat tee or baffle - - :sate of last ourrepirtg: Commen s(on p;anping recoadnendat ons,inlet rtd outlet tee or baffle c6nditiion,structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): Tight or balding Tank(lank trust be pumped at time of inspection),locate on site plant' Depth be-17an axe: Matefial of construckcn: concrete r.1 meta! fiberglass polyelgfiene other(explain): t5hap.dm•11,120D4 t i5e 5 uMPAM Irapecoun view.sumurisce-.SWMq Lumsat system. t'c�c1i 7f1u Oct 26 11 12:49p The Bldg Insp of Cape Cod 15082559343 p.14 cwmonwean of Massachuwtts No __ a i `No Form :. : ,No fvs Volluntairy Assessments IKubsurface aewage p asat System Form i �0 System 114ormation,(cf3nt) ; Properly AdMM 2V Code cilyrrown Owner's Name Cd MVactost Tight or Folding Tank(cons.) '3irI7ERSlril�: � ••- Design HOLM � �-`�x�s per may.. _ la �lrl £ orlt: O 'tra yes j fitQ Alarm levei: Alarm in wading order. L Yez No r Data of last pumping: lam . - Gorn-nents(c m#i of alarm and Rest Witches:etc.): 0&-ribution Box fd present rnLai tie opener?)Qmats on SAe plan): med, Depth aC l;CIuj,:l level etbave Q+lAet invert Comments(note if box is ie�slid diS�bUtion to oudetS equal.slit/Ovid ene�of so?ids Carl}'QYEr-any evidence of leakage into or neat c°box_efc.) ak Of Flu 1 klL -15�oI tauml;'G:2catberlc�eate on site plan): IN o Pumps in imWng order 0 Yes `�' Aiarmsin'-wmRing order' 0 vzs. 1 No F. �ins�dci: i LIW4 :ive 5 O*dpA bnmpettM-OM-SObsurfaM.S L'is"NCSW SYSlMn Peep IAei I 1 Oct 26 11 12:49p The Bldg Insp of Cape Cod 15082559343 p.15 C€>ttt monweafth of Massachu f5 O # �ubsLaface. Sewage i iscosal System Fom C'.Svstem ItJ`f6 ation fwntl1 iT:+ns[r Stye T=Cade OvlrtP.tS f4etil� - i}at2 t1f p�v-Cil?�t Comments(note condition of pump charnber,condition of pumps and appurberiames,etc.): Soit Abscrp an,System(SAS)(Jecate on s4e pan,excavation not recuired): f SAS;,ot bce=ed: explain why, "Le-- d� jj. 46- .1 - Ty , 2vtT�`e Pitspus19abe.r El iaaching chambers number. [caching pa4taries number ieaohing trenches number,length: —--- - rr is.ahingfWds numt-ar.dim.ensionrs' Overflow cesspoot number inncvati►elaiternsgve system rwpe1narna os technology Cornmwts(nete$cond%on of�6,sigrm of rydra4lic faita�reg,,level of pondirtg,damp sail,condition ai VEgElHtJDrJ, Ci r',)' :t ,`� �;„ —��i____'i' ivl•'�', �3 �dR,@C�.: (,�-�4-r•�,`_'c�'„-, r 1-7 E.oat a L ?S, .doc•1112UN ;d;s 5 official irspadim 1-=:&.ftwfac a Sm.-Va LAPO3PJ 61'stem Oct 26 11 12:50p The Bldg Insp of Cape Cod 15082559343 p.16 Comf;t';®l''E+ eOM q.f Massachuseft P: We for%fduntary ssme A s .� bsu figce Sewage Dis- Posel SYStem rOM . Stet Information (wnt.) . cifyr i or�:� �8 23p - ... .... .._— O�vne htaFne Owe of(aspe06en �- Cesspools/,cesspool!rust be pumped as oarr ai inspection)(locaf os site plan): Number and.configurador. Depth-top ni ligLk La inlet inv..r€ 0epth of sclfds layer --- - —wensions of cesspool - --- -- - Meterials of canstnicbon indication ofrjroundwster inflow f O Yes NoComm enls( condition of sdi.si•,Ins of hydraulic failure.level of ponding,conditan ofv,.getaficn, etc.): POVY(locate crt /-,=- 01 ): M2teriats�f n- uo : Dime nsic s --. Depth d- ds — Camr oho s(note,c^riditicn of soil, signs of hydraulic failure,level of ponding,oon+dWon of t-;etat:on, etc.): 15insP.dcc-1 t12G(t4 Ede 5 oSfnMt Inspection Fwfrr SubsunBoe SVVMe UWA3S 1 S}stern t'�31AOi 1G Oct 26 11 12;50p The Bldg Insp of Cape Cod 15082559343 p.17 comrnomy ealth emmachusetts - ,,� . t Official Ins pe d _ .3 Not for Valuntar�Assassl Its cubsufface Sawa 0 Disposal SY&W, Form C. System Infbffrot€on (cart'. Proms��s —.. p CityrrGrn State =ip Code L ,t flNmzr's Name Date rat hslsctian Sketch Of Sewage Mposal Systerm Provide a sketch of the sewage disposal system including ties f to at leasl<txo perrmne�referQn�landmarks or ben4�4-marks. ►_orate all wel#s wiflIn 100 feet. T Locate where public vm er aw enters the WRding. wee t� it t 21 3e, O sk- �r ; f tom t Mi l;k - TMe 5 O�i Vapection Firm.S17�I5Uft"dU@ Sims ge�iD'(a,5at S�PJa! ' i Oct 26 11 12:50p The Bldg Insp of Cape Cod 15082559343 p.18 Y Commonwealth of�Aassachust�ts Ville 5 Official Inspection Form :_ ... Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont) �. Property Address CI'1}��2+ l.� � • �� #: N State � � -230 Code ,,._•� Owners Name Date of Impecb Sketch Of Sewage Disposal System:Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or bertchmarks.Locate all wells within 100feet LooWe where public crater supply enters the building. IF auk vP C ONO& PjAT to O T `z) i 'D t6kisp.doa•l lr=4 Tdle 5 Official Inspecimn Fume_Subsutfam Se sz�qa;24.— Oct 26 11 12:51p The Bldg Insp of Cape Cod 15082559343 p.19 - usutts � �rOl?l��bfl4lif�� alt�a;iSeCit TRIG 5 Offidal Inspection dorm As Not for V,,-4un,.!ary Assessments 5ud3tt#at�e Sege t2sss«i 5t m Form Property Address 02 owmws*dame Q fna`�f2LtlLB Site ExarrF: Slope 3 efface MtFr IF,, Check caller Shalbw-doffs Estimated dSpL4 to gerund grow. � E -�i �A�Eti7ic;+� L,a - tip Please indicate a;l meRt ds used to determine the high ground water elevation_ mined ftm system design}Mans on reterd If creickL data at desle plan reviewed: Date l [] 0�seived site(abutting prapertylabservation:hate wNri 150 feet v;SAS) Chericed with 1=1 Board Health-explain:_ Checked with local excavator, Insta:lem-(attach documentation) E Accemed USGS da-tabasa-explain ^ ail Yo{J(trust descrio how you estabrished the high gmund mister efavfaticn: t:inaa.doc-1 U260& t` ' Title 5 ofnc cw inspudion Form;Subsu,iaw Se►r.Qe Disposal System s Stanton, David From: marsh@cape.com Sent: Monday, September 12, 2005 11:30 AM To: Stanton, David Cc: jmorris1@gis.net Subject: About Elliot hearing Dear David, As an abutter to the Elliot property on Rue Michele, there is one issue that is relevant to the long boundary i share with Ms. Elliot regarding the proposed lot on the northeasernmost corner of her propertis on Rue Michele. This lot, which also has a wetland on it, is the closest to my well, which is located on 335-026 quite near the property line. I researched the well permit which is number W2005- 001 (I guess ours was the first this year! ) . The well was recently redrilled in its location since 1980. I should have thought to GPS the location for you, but it is within 50' of the lot line. Just wanted to get this on the radar screen prior to the meeting. Thank you Dr. Marsha Alibrandi Cape Cod: NCSU: Raleigh: 4093 Main St/Box 396 402J Poe Hall, Box 7801 2315 Hales Road Cummaquid, MA 02637-0396 Raleigh, NC 27695-7801 Raleigh, NC 27608 508-362-4993 919-515-9655 919-789-9944 cell: 919-349-4080 i 2 -2 61 1 P. 1 COMMUNICATION RESULT REPORT ( SEP. 15.2005 7:25AM ) TTI BARNSTABLE BOARD OF HEALTH FILE MODE OPTION ADDRESS (GROUP) RESULT PAGE ---------------------------------------------------------------------------------------------------- 109 MEMORY TX 915087788966 OK P. 1/1 i ---------------------------------------------------------------------------------------------------- REASON FOR ERROR s E-1) HANG UP OR LINE FAIL E-2) BUSY E-3) NO ANSWER E-4) NO FACSIMILE CONNECTION Stanton David From: marsh@cape.com Sent: Monday, September 12, 200511:30 AM To; Stanton, David Cc: jmorrisl@gis.net Subject: About Elliot hearing Dear David, As an abutter to the Elliot property on Rue Michele, there is one issue that is relevant to the long boundary i share with Ms. Elliot regarding the proposed lot on the northeasernmost corner of her propertis on Rue Michele. This lot, which also has a wetland on it, is the closest to my well, which is located on 335-026 quite near the property line. z researched the well permit which is number W2005- 001 (1 guess ours was the first this year! ) . The well was recently redrilled in its location since 1980. Y should have thought to GPS' the location for you, but it is within 50' of the lot line. Just wanted to get this on the radar screen prior to the meeting. Thank you Dr. Marsha Alibrandi Cape Cod: NCSU: Raleigh; 4093 Main St/Sox 396 402J Foe Hall, )Box 7801 2315 Hales Road Cummaquid, MA 02637-0396 Raleigh, NC 27695-7801 Raleigh, NC 27608 508-362-4993 919-515-9655 919-789-9944 cell: 919-349-4080 r No. C-;�06 THE COMMONWEALTH OF MASSACHUSETTS FEE BOARD OF HEALTH "I"aW/U OF /?,�l -'04---ST FI /' L Z- APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct ( ) Repair Upgrade ( ) Abandon ( ) -,.a Complete System []Individual Components .3 Z�Z/ ,DUy 4 Location Owner's Name 3 3 S`" s 3 7 W Map/Parcel# Address Lot# Telephone# ` Installer's Name Designer's Name Address A dress Telephone# Telephone# Type of Building: C - Lot Size / � Sq.feet Dwelling—No.of Bedrooms Garbage Gander (J�) e e -9C,o;r p Other—Type of Building No.of persons Showers ( ), Cafeteria ( ) Other fixtures Design Flow(min.required) 3 S gpd Calculated design.flow gpd Design flow provided 1 gpd Plan: Date S- /S!-- O.f Number of sheets 2 Revision Date Title 4966/f,,. o�Lp f S L�'�1/�i, t�- Qi 6 .6'y 6-,p 5`��i��i ga Description of Soil(s) T�� �'��i2. Soil Evaluator Form No. Name of Soil Evaluator tV 12 ol(' 121dea Date of Evaluation cS=%/ e2 6- DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE S and further agrees not to place the system in operation until a Certificate of Compliance has been issued by the Board of Health. Signed Date 4 Inspections FORM t - APPLICATION FOR DSCP DEP APPROVED FORM S/96 No. OQ cD-3q THE COMMONWEALTH OF MASSACHUSETTS FEE — 131-70i,-5Z:/?eG-E BOARD OF HEALTH CERTIFICATE OF COMPLIANCE Description of Work: ❑ Individual Component(s) ❑Complete System The undersigned hereby certify that the Sewage Disposal System;Constructed( ),Repaired( ),Upgraded( ),Abandoned( ) by: at '3 l has been installed in accordance with the provisions of 3_10 jQMR t 00 (Title 5) and the approved designs plans/as-built plans relating to application No. 0005 dated 5 Approved Design Flow la (gpd) Installer Designer: Inspector Date The issuance of this certificate shall not be construed as a guarantee that the system will function as designed. FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM S/96 No. y�3 I THE COMMONWEALTH OF MASSACHUSETTS FEE �sJ/C'•'/'Si� '�� BOARD OF HEALTH DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereb grante to Construct ( Repair (�Upg�de ( ) Abandon ) an individual sewage disposal system at L) i I;� L`lT�-rw>1� '1 as described in the application for Disposal System Construction Permit No. �J �J I ,dated 5 Provided: Construction zhll be completed within three years of the date this pe a nditions must be met. Date Board of Hea FORM 2 - DSCP DEP APPROVED FORM 5/96 FORM 1255 (REV 5/96) H&W HOBBSB WARREN TM PUBLISHERS- BOSTON No. v�O6 5 `; 3� .THE COMMONWEALTH OF MASSACHUSETTS FEE - � BOARD OF .HEALTH 7-O w/Y- OF RA f JA7 s5 1 :�-=' ' . . .",APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for fa Permit to Construct j ) Repair pgrade ( •,) Abandon ( ) -, Complete System [:]Individual Components -�` Location Owner's Name Map/Parcel# Address a ---- - Lot# _ Telephone# Installer's Name Designer's Name Address -dress -7 4� Telephone# Telephone# Type of Building: /C? e S Lot Size 2• / 3 Sq.feet Dwelling—No.of Bedrooms 3 Garbage Grinder �rd 8 'r Other—Type of Building ' No.of persons Showers ( ), Cafeteria ( ) Other fixtures Design Flow(min.required) 3 3 a gpd Calculated design flow gpd Design flow provided 3 3 gpd, Plan: Date S- /$ 6�5 Number of sheets 2- Revision Date j Title 06 5/ it L.F 00f z oc s f/c fy 4r�a ai aB�.Geri IP Description of Soil(s) Soil Evaluator Form No. Name of Soil Evaluator 01,94- g2I.A?d Date of Evaluation 3' //- /.a 6 DESCRIPTION OF REPAIRS OR ALTERATIONS lThe undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees not to place the system in operation until a Certificate of Compliance has been issued by the Board of Health. r Signed Date Inspections - FORM 1 — APPLICATION FOR DSCP DEP APPROVED FORM 5/96 r No. C S c: -3R THE COMMONWEALTH OF MASSACHUSETTS FEE 8-170A-5r,0,f1_E BOARD OF HEALTH CERTIFICATE OF COMPLIANCE i Description of Work: ❑ Individual Component(s) ❑Complete System The undersigned hereby certify that the Sewage Disposal System;Constructed( ),Repaired( ),Upgraded( ),Abandoned by. at �Y1.e'C.�e �� j- has been installed in accordance with the provisions of,310J MR 1 00 (Title 5) and the approved design plans/as-built plans relating to application No. �5� dated ' `' / �' �J` Approved Design Flow 3 (gpd) Installer Designer: Inspector Date The issuance of this certificate shall not be construed as a guarantee that the system will function as designed. FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED'FORM 5/96 - a No. I THE COMMONWEALTH OF MASS HUSETTS h FEE / �✓ 8_09w4ekS BOARD OF HEALTH ' DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to Construct ( ) Repair (V'�-Up ade ( ) Abandon ) an individual sewage disposal system at U Q m C�� as described in the application for Disposal System Construction Permit No. P � I ,dated 1 Provided: Construction shall Sc completed within three years of the date�f this rnu"t. "11"1'oeal'c nditions must be met. Date 5/cn � Board of Health FORM 2 - DSCP DEP APPROVED FORM 5/96 }� FORM.1255 (REV 5/96) H&W HOBBs_8 WARREN TM PUBLISHERS- BOSTON,, Town of Barnstable P# Q Department of Regulatory Serv' es Public Health Divisio Date bsa � 200 Main Street,Hyannis MA 0260 L ""'+• lV� Date Scheduled Time Fee Pd. Soil Suitability Assessment for Sewage Dis osal C�4 `S Performed By: MACK 1oreea Witnessed By: y� LOCATION&GENERAL INFORMATION / Location Ad s ��@e l Owner's Name �rl I�� yq/G3 E 7? AA��e 1't Address /dZ eleUS ��/��L�' Assessor's Map/Parcel: 014,0 OKISI �� Engineer'sName I SL. �a®1�'d� NEW CONSTRUCTION _ REPAIR Telephone# !P9 719 Land Use p ig v2 Slopes(%) "' Surface Stones Distances from: Open Water Body Possible Wet Area �5- ft Drinking Water Well ft Drainage Way IV4 ft Property Line tI { - ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) ,r � Z Parent material(geologic) Depth to Bedrock 411t Depth to Groundwater. Standing Water in Hole: f Weeping from Pit Face N� r/ Estimated Seasonal High Groundwater e ��f{ DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: 1.7 65 Depth Observed standing in obs.hole: ���U C�#Z in. Depth to soil mottles: Depth to weeping from side of obs.hole: in, Groundwater Adjustment fr. Index.Well# Reading Date: Index Well level Adj.factor- Adj.aroutidwaterLevel, PERCOLATION TEST bate 5� '1'itne/2' Observation , Hole# /',/ Time at 9" Depth of Perc 66 e>Te-Af a� Ca'J471'ir6W5 Time at 6" Start Pre-soak Time L (CC qJfrCA!r Time(9"-6") End Pre-soak a/q Rate Min./inch V Site Suitability Assessment: Site Passed _ Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back---------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conservation Division at least one(1)week prior to beginning. Log , Q:XSEPTIC\PERCFORM.DOC A " DEEP.OBSERVA,TION HOLE LOG Hole# i Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Con istency,% ravel y/2. 3r3 NnN10. &I 5rt1VO /Q Y12 G/9 lVPA40 07 Art DEEP OBSERVATION HOLE LOG Hole# Z Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel). t 2 2'1's 6 L. 5°�vt//a to yog S 6 wolut 2��''- 6S1f �► S,C'(./��c.ov1•w� �vY2 6�3 ���. . �� s °t-126" (' wt,5AIVO 0 iL voNr Sos�� sso,.r � DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consi to c Gravel) 3a'' L - 5°9N • ° DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistency, Flood Insurance Rate Map: Above 506 year flood boundary No_ Yes Within 500 year boundary No= Yes Within 100 year flood boundary No— Yes Death 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? Nr? — 657 el 02 If not,what is the depth of naturally occurring pervious mateyial?,...,.._ Certification I certify that on o Z. (date)I 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 CUR 15.017. Signature Date 2 0 Q:%$E!FnG1pERCF0RM.D0C 'I Town of Barnstable P# Department of Regulatory Services Public Health Division Date D� 200 Main Street,Hyannis MA 02601 Date Scheduled Time%r Fee Pd.- 16 Soil Suitability Assessment for Sewage isposal Performed By: / /A/QK DtQj6 �f',s; ���'�� Witnessed By: 2s1 LOCATION& GENERAL INFORMATION Location Address #7 � ue Ml,,�1_-t ��..y Owner's Name 6�,) \ C' `�`� t� Address /D 2 1z✓fr Assessor's Map/Parcel•pw-o 3 3O', Amen, 65 Engineer's Name lNegfic dws'si Ax NEW CONSTRUCTION REPAIR _4X_ ,�gTelephone# SD 9 77e—U0?/g Land Use �d'SZDE�yT� � Slopes m Surface Stones N� Distances from: Open Water Body _ft Possible Wet Area gjV f ft Drinking Water Well Z d 4t Drainage Way 3CD 4 ft Property Line ZD f ft Other ft i SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) W P 2 4 l , ' Parent material(geologic) Depth to Bedrock A0 Depth to Groundwater. Standing Water in Hole: ���� Weeping from Pit Face Tel Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole. in, Depth to soil mottles: Depth to weeping from side of obs.hole: 1AP 9F zin, Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adi.factor— Adj.Grouttdwater level PERCOLATION TEST - -bute- Thne _ _. Observation Hole# Time at 9" ..m. Depth of Perc '3!7 Time at 6" Start Pre-soak Time @ I� Time(9"-6") lh+w"lri End Pre-soak Rate MinJlnch rAPr Site Suitability Assessment: Site Passed _ Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ¢***If percolation test is to be conducted within 100'of wetland,you must first notify the Barnstable Conservation Division at least one(1)week prior to beginning. Q:1SEPfICVERCFORM.DOC • y DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture x .Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistency.% ravel U—g t,5+ND r 7q- I < r • 5 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) D ,g LSAN� A)r� 3l3 2 c�. �/ / /r'1 S/9i✓0 /o �y-i��/ CZ �t�r/��r✓ z.9'7�/3 �,�ac�a o w�a�r�iZ lVq-zpy DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other. Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) DEEP OBSERVATION HOLE LOG Hole#. Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. onsi e Flood Insurance Rate Map: Above 500 year flood boundary No_ Yes e Within 500 year boundary No= Yes Within 100 year flood boundary No— Yes Depth of Naturally Occurring Pervious Material I ial exist in all areas observed throughout the Does at least four feet of naturally occurring pervious mater area proposed for the soil absorption system? /-V ��. If not,what is the depth of naturally occurring pervious material? Certification I certify that on bZ . (date)I 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 Q:\SEP,TICIPERCFORM.DOC > A THE COMMONWEALTH OF MASSACHL SETTS BOARD /OF �,��P d w7�......... ......... � Appl ratinn for Disposal Warks Tonstrurtion Vrrmit Application is hereby made for a,�P/eraut t Cc t (,)() or Repair (,,)q an Individual Sewage Disposal Systan at: 3` R1�� '-ll � jam " / - Tofff� !!• a e�6 xe. da --•--•-••----------•-•--E._--t•-�---------._.----------___—._ Cccm�na. GucCa` 7r1ASs W Q Oveer ......p... . .. ......•l.4/M6u i!7YI._.: ?.2. 55.......................---...... Igetaller Addrae a Type of Building Size Lot...........................Sq.feet Ua Dwelling—No.of Bedrooms...._....................................Expansion Attic ( ) Garbage Grinder ( ) Oo'. Other—Type of Building .P9!!nf No. of persons....._1.'.1.........Showers (/) —Cafeteria( ) Otherfl.Uures..................:........_............_...................._.------.............._...._.....--........ - < Design Flow-•-.-.-....�....�...........'--.-. gallons per person per day.-Total daily flow................_._..._gallons. _ W Septic T.'Imk uid rayacity. .gallon Length................Width..-- Diameter............-_- end Disposal Trench—No........ ....Width-.. .. Total Len . Total leaching ar ......_._.. sq.ft. x p :... Z+� gth 3 Seepage Pit No....................:Diameter....................Depth below inlet........,-.... . .ToJ�1 ing area. .n sq.,jt./� '} z Other Distribution box( ) Dosi c l l ... per. Percolation Test Results Performed by. ..-l^�' -M•s4-....rY.••Date. ....... ..... .. Test Pit No. 1 minutes per inch Depth of Test Pit .Depth to,ground water............. L..r -- rA {: Test Pit No.2..............sninuteo er inch Depth of Test Pit - ...................- i - .•'. ..:'."�.- -P, P� ....-.....Depth to groundwater... Description f Soil.. ..... .. .......� .. 4'::... ,. ...�,at-g.. ... .. .......1/. �.... U _......_.... -..._V.... -. _ .. *ppbl�.�:.­ !TNature of Repazrs or Alterations—Answer when . _.......... ......°.�,�, ......_.....4 "7 i 1 ✓ ................ ._........ .................. ..................... ............-..........:'...-.............?............._............................................... ... ......... Agreement:' The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b issued by e b tgned ... .. L... ................ .......... ..._...........Application Approved By......... . G a.�..�.... .....- -- - -•--p .f V-.V............. Dat :...._.....__._...__...-.. ............ .. L ? ...,4.�w �.-'"chi � Date e t � Permit No.......- ..... --- - —/ -_._ Issued r- TOWN OF BARNSTABLE LCK:ATION 3! Rum 1 C SEWAGE # 7 &1AGEIJkAMi�b(p _ ASSESSOR'S MAP & LOT €;ate INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY "LEACHING FACILITY: (type) (size) r NO. OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) -Feet' Furnished by -. 14-e. �� � 1 i I I I I � i I I 'i �. I'i '� �� a9 � ' � '� � ',' Ij II li i li �, ', L �, � i � ���8, � I i � , � I � � '� � �i o' i �� ; c i i^ j I �- � F ., � �, �� � �. � � � L. � I i � Iv �s I � I - - t I � � I ' i �.I . PI I r ��� �� I I � ! ! � ' � � �. i i � f ' �i 'i I �I Ii I I I h � Y � I ,l I � �.. :� i v. ptp:. - _ - _ 1 A a f + J � J � I "� - - TOWN OF BARNSTABLE LOB:4TION 7 �� � eL i SE'3JAGE # —¢07 y�,; ,gGE�t�ctr'�S�zb(a /Curc►�t2�urd ` ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 15DO EAIIEDUN2SPECTIGN 'LEACHING FACILITY: (type) �� (size) NO.OF BEDROOMS BUILDER OR OWNER . Mr°G(,.�1(z F/f +o f4- PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility — Feet Private Water Supply Well and Leaching Facility (If any wells exist 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 N 0 CJ� �`= 3 \,v\ � � / O r � ��� r to s - - s � iw. o —�! , � �.�,� ,�: -=�, , � L0CA TA;0 SEWAGE PERMIT NO. . / D 7Ll VILLAT pT&:Ll= S=a�S 4,4 IN TA LLER'S NAME A ADDRESS e 1 B U I L D E R : OR 0 ER DA T E PERMIT ISSU E D DATE C0 M P L I A N C E ISSUED �.,`' _� \ -� � i <,_ �1 �-� ,�C,�_ _'.`.� s �:'r�. r,t�. i �:. �.. � . 4-y �� - ... � �� ___ _ �� t y =�. �.` . _, '�, _ ,,rM � c ;_ �� � — � -- � __ 1 - ----- ,a�. �a — O / �%•�� f� ��`�d� g - � ' � - � \0 e-. �.� �, � _� I f -_� � ' .. /�as.ov � i � � i � � i ,� � � � � 1 � � ; � � � r I i� � � � � , � � , j I j � ; # i I { t ti # � ' �:_ I j ` � ' 1 I j i 1 � _ I � ! i 1 � � � a - � � � ; j � � 1 ;- � � � � � � ,� _ 1 a ' i + � . . � ; � i � � �`` � � � � i � i I { � � � i i 4 ! ! �� i � i � � I � � } `` { I i ! � � � j � j � �� i ! � � �1 � # j � � � t ! ► ! � � � � i i � , � I � � j � � � � � ! .. � � f ! i � � � I � � i � i � _ I ► � � � I i , t F au" g 5 Fas (J �. THE'COMMONWEALTH OF MASSACHUSETTS BOARD QF H T -..-------.OF........ t... _:.._.. ...:_....................... App irFatialaa -fair 11!iva1oal Works Totts1rurflon Vrrnfit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: --------------------------------•------------------------.•...------------------------------.••••• ............................................................................................... Location'Address or Lot No. ----•------•----=-------------•----............----••-----•-------• --•--------------•----------:. Owner -Address W •' a . ----•••••-••-----•---•-•--•---•-•-•----••-•-••- - Installer Address dType of Building Size Lot----------------------------Sq. feet U Dwelling—No. o: Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons::-------------------------- Showers ( ) — Cafeteria ( ) Q' Other -lures ----- -------------------------------------- s,Q ------------- ...................... gallons per e son per day. Total daily flow...................... .... Mons. W Design Flow ---- ----- - ----= g P Pam. P Y Y ----------- g� W Septic Tank 4-Liquid capacity 3 ---gallons Igength................ Wldth_.. -!--- . . Diameter_____.......____ 1� .-._..__... ,�"` x Disposal Trench—No._______ W>.dt1, . .... Total Length f___ __------ Total leaching area. ' sq. ft. Seepage Pit No..................... Diameter ""' :......_______ Depth below inlet........ PTot�rylfle ng area... -.-.- .sc,n-ft z Other Distribution box ( ) Dosing nk ( ) f�~ f S ; Percolation Test Results Performed b _... -- - -------- -------- Percolation • � ---.. .�?. 'Date---•---...... a Test Pit No. 1 _minutes per inch Depth 'of Test Pit.................... Depth to ground water------------------------ L� Test Pit No. 2....:...........minutes per inch Depth of Test Pit.................... Depth to ground water- _:-. :---_-----.---. — - s- f - D Description of Soil P ... *w"......-••-•�---- ----- -- ---- U. y .:f. . �� W '' `' --- -------------------------- ----------------------------------------- - U Nature of Repairs or Alterations Answer when apJKle._.__ ------------------------------------------------------------------------ --------------------------------------------- ------------------------------------------------------------------- -------------------------------------• • -------------------------------------------- Agreement: f The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance �Oith the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certizcate of Compliance has been issued by the board of health.. igned = ---------•--•--------•-------•----------------- ------ ----.-•--- . _. .� . . ,a • , to Application Approved B .. _ . -- --- =- _ 9 - - 1_ Application Disapproved for the following reasons--------------------------------------------------------------------------------------------------••----•......-- ---•-------------•---•---------•---•------•----------------•--•-•-•--------------------•------•---------------•-•-•------•--•---•--•-•---------•-•-•-----•-----•------------------ '---------••---•--•- Date — Permit No......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .. ..... ............OF...... /�r'i ,................................ :�rrfif irate of T"ampliana THI IS TO CERTIFY,F a the Individual Sewage Disposal System constructed (Z�<or Repaired ( ) Installer � f at. ---- I,r r �r ,' '° --- -•--•-- -.._... ...... .... .... has been installed in accordance with the provisions of-Article XI of The State Sanitary Co as as described in-the : application for Disposal Works Construction Permit No......... ... `.__' :............. dated__../.. '}..... ....._.__j. ........ THE ISSUANCE OF THIS CERTIFICATE SHALL. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE------------------------------------------------------------------------------- Inspector.,4!................................................................................ E THE COMMONWEALTH OF MASSACHUSETTS � it `, BOARD OF EALTH J t of. . ¢.......... .... No........ d. FEE.. . ............ %spo,i Mark TIonsirurtion Prrmi# �c. Permission i�kereby.granted ��'------. --- - to Const t ) yr Repair ) an Indivi w sposal em t� • .a. at No.- r --- �' ••------ ' ~.. .. 'p S et as shown on the application for Disposal Works Construction rmit : ___.. _fr _ .. Dated.._!......... ..................... ---- ---- --- -- ------------ Board of Health DATE--------1 e---~-------------------- ----- ••-••----•--•---• s FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS. No.. ®. .... i Fps.... ................. THE COMMONWEALTH OF MASSACHUSETTS vti1 � a e BOA( ® QF H ,.........OF......... - Appliration -fox 13itipwial Works C utuitrurtion Urrmit Application is hereby m�'ade for a Permit to Construct (,O or Repair ( ) an Individual Sewage Disposal System at: / U—L /� G�/Q���r(J� . cCc�r�na u�� R5: - o-�f� �O 1�J1 - a,t � ------ ------- -•-•_. ... a. _Mation-Address or.�.ot No. -----••--•.-•-•- --•-------------------••----••-•--•---•--..........._ Gc s Owner Address Installer Address Q Type of Building Size Lot----------------------------Sq. feet Dwelling—No. of Bedrooms_____ ___ _________________________________Expansion Attic ( ) Garbage Grinder ( ) per, Other—Type of Building&-ex)A/__ft f No. of persons------A_7_41-____-_.__ Showers Cafeteria ( ) Q' Other tures __---------------:----------------------------------- .� W Desi n Flow__ _____________ Mons per person per day. Total daily flow___________..____ Mons. g ----------------•-- g P P P . y. Y g< r Septic Tank Liquid capacity _ _dv_gallons Length................ Width-_- Diameter_-.__.____-__. e>tl x Disposal Trench—No. ____.. :.._.___. Width.__ __-__ Total Lengtih._. ..___. Total leaching are. _._____.__�'sq. ft. Seepage Pit No---------------------- Diameter-------------------- Depth below inlet-'--......... To 1 e ing Brea.-____� s(I. it./ Z Other Distribution box ( ) Dosin nk ( �i a Percolation Test Results Performed by '1_ q: Date----___-------------------------------- . Test Pit No. 1 minutes per inch Depth of Test Pit.................... Depth to ground water.._.__--.____-.._..___-- Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground wafer------------------------ . '................>.....- Description of Soil ......... .. . .. .... .....•--•••--- --- --------- -- -------- ---------- x _ . ..... 1, ••-- „- .L D Nature of Repairs or Alterations—Answer when a 1' ble.._-_____a___._....'`�- ' _. UPPS ------- -f;,. - / --------------------------•--------------------------- --•--------•---•--------------••- Agreement: 1 The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—,The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be issued by tEbir?rglth igned ate A lication Approved B s�" - Dat 1o�t�rovedom-�/Qefhzeii re�cs�hs--------------------------- - ------- ---- ---------- ------------- - --- /-�-- ------ ---- -- lab . .._. \ ya Date Permit No.......................-................................. issued----------------------------- 2Y.— � Date REVISIONS VARIANCES REQUESTED: IN-HOUSE WELL VARIANCE LEACHING FIELD OETAIL: NOT TO SCALE No. DATE DESCRIPTION PROFILE: NOT TO SCALE: NOTE: ADD 18" CONCRETE COVER ON D-BOX I 1. 5/23/05 ADD DTH #2 TO WITHIN 6" OF FINISH GRADE h 36" MAX .COVER 2. 5 26 05 RAISE SAS 5' ADD 2" TEE AT END OF FORCE MAIN SECTION 397-8-E, WELL LOCATION / / FINISHED GRADE ABOVE CLAY MANHOLE COVERS AS REQUIRED FIRST PIPE LENGTH TO ALLOW A PROPOSED NEW SEPTIC SYSTEM TO BE 120' FROM (BRING TO FINISH GRADE) TO BE SET LEVEL GENERAL NOTES: EL.=49.3 FOR MIN. 2' AN EXISTING ON-SITE WELL TO REPAIR A FAILED S.A.S. A 30' CAP ENDS 1. THIS PLAN IS FOR DESIGN AND " FINISH GRADE 4" PVC • •_` �� • p 4�' pE�2F Sfglj 40 g�(C S=Q.005%' ��� � l�' � CONSTRUCTION OF THE SEWAGE 4 PVC SCH 40 ° °" ° °" ° °" ° ° ° DISPOSAL FACILITY ONLY. 53.0-52.8 VARIANCE IS REQUESTED. a •, �''�a°► °' °' ` 61 "TM �' oe oe oe oee ee ee e• or a e+ oe oe a+ e ee o♦ ego o 2. ALL CONSTRUCTION METHODS AND Y,4,. .�� w a a a °rw/ // Z ,�C � / ZMATERIALS SHALL CONFORM TO MASS. 4" PVC J LEVEL BOTTOM =t o.E.P TITLE 5 AND LOCAL BOARD 2" PVC FORCEMAIN 25' OF HEALTH REGULATIONS. w 3. ALL PIPES LOCATED UNDER PAVEMENT VC Z_ OR TRAVELED WAY SHALL BE SCHEDULE \!CH 40 ��4/�-r. BAFFLE I-H LEACHING SYSTEM -' PROFILEMIN. = 40 OR EQUAL. = C I=D (=E Z - M M 36" MAX. - 12" MIN. COVER 4 LOCATED THERE RWITHIN 150 FT. OFE NO KNOWN A THE TE WELLS BOT ELEV - K PROPOSED LEACHING FACILITY NOR I'=F N d 2X MIN. FlNISFI GRADE 00 4" MIN. LOAM & SEED ANY KNOWN WELLS PROPOSED WITHIN = 'n J LOAM & EEO DISTURBED AREA 150' OF ANY KNOWN LEACHING FACILITY. 6" STONE BASE I=G 5' SEPARATION w w KtXDM 5. WITHIN LIMIT OF EXCAVATION REMOVE ALL TOPSOIL, SUBSOIL 1,500 GALLON 1,000 GALLON wy/ w �1 7 MN = ; - e ° ° e -� � I IMPERVIOUS MATERIAL. AND OTHER 4� I/ S' Ain �� t K I ..�.r�.I .. _ PRECAST CONCRETE PRECAST CONCRETE Z T Z g a ?M �M�•'ge' L " 6. REPLACE ALL EXCAVATED MATERIAL WITH SEPTIC TANK PUMP CHAMBER -� �' ie ''� - e ° e 2 MIN. OF 1/8 TO 6, aa,e e e+ ° ° ° CLEAN AND FREE FROM 6.2' TOP OF CLAY LAYER a P.d °w ;''r ' 1/2 WASHED STONE " p p ' ix MIXTURES AND LAYERS OF DIFFERENT CLASSES 6 STONE BASE �- pp Z OF SOIL SHALL NOT BE USED. THE FILL SHALL f 3 T NOT CONTAIN ANY MATERIAL LARGER THAN VISIBLE PERCHED TYP J TWO INCHES. A SIEVE ANALYSIS USING A #4 3/4" TO 1-1/2" DOUBLE CROSS-SECTION SIEVE, SHALL BE PERFORMED ON A GROUNDWATER = L WASHED STONE (NO FINES) REPRESENTATIVE SAMPLE OF FILL. UP TO 45% BY WEIGHT OF THE FILL SAMPLE MAY BE f RETAINED ON THE #4 SIEVE. SIEVE ANALYSES INVERT ELEVATIONS: ALSO SHALL BE PERFORMED ON THE FRACTION / OF FILL SAMPLE PASSING THE #4 SIEVE, SUCH BASEMENT FLOOR 49.4 ANALYSES MUST DEMONSTRATE THAT THE N/F ff MATERIAL MEETS EACH OF THE FOLLOWING 4029 MAIN STREET SPECIFICATIONS: JANIE BARBER 1 4 INVERT AT= BUILDING 47.90 A 100% MUST PASS #4 SIEVE ASSESSORS MAP 335 ! 4" INVERT AT SEPTIC TANK (IN) 47.60 B (4.75 mm EFFECTIVE PARTICLE SIZE) 107E-100% MUST PASS #50 SIEVE -- PARCEL 75 / �: 4" INVERT AT SEPTIC TANK (OUT) 47.35 C (0.30 mm EFFECTIVE PARTICLE SIZE) TOWN WATER ! f ♦ - OX-20% MUST PASS #100 SIEVE N F ! ! �� ► 4" INVERT AT PUMP CHAMBER (IN) 47.30. p ' (0.15 mm EFFECTIVE PARTICLE SIZE) 4039 MAN STREET 1 / FlELDt " 0%-5% MUST PASS #200 SIEVE NOAMM 4 INVERT AT PUMP CHAMBER (OUT) 47.95 E (0.075 mm EFFECTIVE PARTICLE SIZE) STANDING CARYN SAMUELL, TRUST J j 7. EXISTING UTILITIES WHERE SHOWN WATER ASSESSORS MAP 335 r f 4 INVERT AT DIST. BOX (IN) 52.07 F IN THE DRAWINGS ARE APPROXIMATE. PARCEL 58 ! / 4" INVERT AT DIST. BOX (OUT) 51.90 G THE CONTRACTOR SHALL BE RESPON- �`i.._ TOWN WATER STANDING /� SIBLE FOR PROPERLY LOCATING AND r WATER I ' �/ y�O� COORDINATING THE PROPOSED CON- N/F � .� .- i INVERTS AT LEACHING FACILITY: STRUCTION ACTIVITY WITH DIG-SAFE 4027 MAIN STREET - r AND THE APPLICABLE UTILITY ROBERT T. MACNAMEE -\`'-_ -. �- - --' r .- r a d f / �� / ' ! " COMPANY AND MAINTAINING THE ASSESSORS MAP 335 � �-�„ �-�. .` ,,--- ' .�'" .� --�'" 6 CLAY / J / 4 4 INVERT AT BEGINNING EXISTING UTILITY SYSTEM IN SERVICE. PARCEL 30 f -. _ _ J d / l 1 OF LEACHING FIELD 51.83 H DIG-SAFE SHALL BE NOTIFIED PER '' "" ~' / ,r / / STANDING TOWN WATER / / �`�- .- / ( / / / / 2 AL • �� WATER " STATUTE CHTHE STATE APTERS82,, sEc noN 4o9 I 4 INVERT AT END _ 344-7233. THE AT TEL.ENGINEER DOES NOT GUARANTEE OF LEACHING FIELD 51.7 THEIR ACCURACY OR THAT ALL ELEVATION AT BOTTOM UTILITIES AND SUBSURFACE STRUCTURES OF LEACHING FIELD 51.2 K', ARE SHOWN. LOCATIONS AND 84 09~'"� / / / / �` d 46.2 TAKEN FROM RECORD UNDERGROUND TME CITIES TOP OF CLAY LAYER f ✓ d- IV� / d / / 6324 ---- - _ __ _ _ PERCHED CONTRACTOR SHALL NVVERTS OF UTILITIES 0�"F 170' / / / GROINDWATER 45.0 L AND STRUCTURES AS REQUIRED PRIOR d 102' TO THE START OF CONSTRUCTION. d / BEN'CHMA.`�K EXISTING SEPTIC - COMPONENTS TO - ____� / / k _ • 6. THIS SYSTEM IS NOT DESIGNED j I , AA T FOR a • / / TOP OF , BE PUMPED AND = l _ �` / / / D I`i I U M. THE USE OF A GARBAGE GRINDER. d co cRETk' VERTICAL DATUM: ASSUMED / iV� \ EXISTING / / a EXIST. GARBAGE GRINDERS ARE TO / l � BO�1ND � ABANDONED IN , �F \ DRYWELL `` -- - -- " ----, d 4 EL-48.60 ACCORDANCE WITH d / / BE REMOVED DUE TO RECOGNIZED TITLE 5 / / / _ BENCH MARK USED: BARNSTABLE GIS MSL± FACILITY.VERSE IMPACTS TO THE LEACHING d , / CONCRET / / BENCH MARK SET: CONCRETE BOUND 48.60 9. EXISTING INVERTS ARE TO BE CHECKED BY / I � i 700' 1 �\ O { FOUND / v / THE CONTRACTOR PRIOR TO CONSTRUCTION. / I C„� l I 0. THE ENGINEER IS TO BE NOTIFIED OF TIO / / LOCUS N FO R M A TI O N ANY FIELD CHANGES THAT MAY BE ! 37 / REQUIRED. EXISTING TWO UNIT j '►'. / C , / 111 i / 68.6 / ` / CURRENT OWNER: DOYLE ;9 BSC 1 �W 30 3 BEDROOM / / / GROUP 0 FCk DWELLING -- - \ / / �� TITLE REFERENCE: DEED BOOK 3363, PAGE 246 O 1 d d rn 1 1 - w / \ / / -�-� . 657 Main Street, (RT.28) d o j ' / / ` \/ PLAN REFERENCE: PLAN BOOK 276, PAGE 95 W.Yarmouth Massachusettst 6 N/F // l 2 f j I � ! � �_ ' PATI � C.O. 119 / - _ � / � � ASSESSORS MAP: 335 02673 4011 MAIN STREET / / / TP •.� � 12.8 SEE NOTE 3 \ / \ / / #32 - #42 RUE MICHELE PARCEL: 065 508 778 8919 BERNARD KELLY '' .', �' 28 1•- AII� P \ / G / EXISTING / N/F ASSESSORS MAP 335 / /fro /: .�,. R WELL / / ELLIOTT ZONING DISTRICT: RF-2 PARCEL 60 ,o �, d = OUP \� /%f I / ASSESSORS MAP 335 SETBACKS: FRONT 30' PROJECT TITLE: TOWN WATER a� , �--� / 1 d / PARCEL 72/73 SIDE 15 50 // \\ f / PRIVATE WATER REAR 15' -- DESIGN FOR 37 Rue t4liGWe / •pK0POSED 15 • MINIMUM LOT SIZE: 43,560 S.� , r,,.xais,6sA =.o' �. / -- BOULDER GALLON SERTCC 202' � / f EXISTING LOT AREA: 23,193t S.F. SEWAGE DISPOSAL \ / OVERLAY DISTRICT. OLD KINGS HIGHWAY LIMITS OF _`° '" ANK d I ,�/ f Sun row ° EXCAVATION. SEE - / ' - _ ' , SYSTEM REPAIR NOTES 5 AND 6 -- r PR ROSE EXISTING \ `�'� / / f NITROGEN SENSITIVE 27 0 - ts:c s 1000 ON �, �, / 1 ZONE: NOT A ZONE II �y --'� Ft j(o�gPUMP GARAGE / / f (WELL ON PROPERTY) Kitchen W � ^I / #37 Bath Dining 40 .MIL-P�OC'YLINER $ �/ ? �° �11 CHA ER \\ / / FEMAFLOO AL AROUND PROPOSED ,�'' \ / N63• 13.0' `� / // ZONE DISTRICT: "C", DATED 7/2/92 RUE MICHELE / 18 x25 LEACHING / ?4, 1 / EXISTING PANEL #250001 0001 D M �r9�n Living Room X / FIELD. 4' HIGH i r •� �-/ GObly �` TP#1 �` ! / i/ WELL CU M M AQU I D BOT.TOP EEL :47:1 L. f � l !l l J ADDITIONAL NOTES: LOCUS PLAN: NO SCALE N L , --� �,'' ���, l t j l l 1.) EXISTING SEPTIC COMPONENTS TO BE PUMPED MASSACHUSETTS AND ABANDONED IN ACCORDANCE WITH TITLE 5 , ---, / / 6A 3 c N - _ / / / 2.) OUTLET PIPE IS APPROXIMATE. LOCATION AND > ELEVATION TO BE CONFIRMED BY INSTALLER LOCUS 3 £ PREPARED FOR: PRIOR TO CONSTRUCTION. d Z z Y Ms. MARCIA ELLIOTT Basement t'" / / / / Z = Q 0 P.O. BOX 76 20 30 WINDWARD WALK 1�C' N/F \ / I / �' ELLIOTT ``�...` �/ / / / y HARWICH N #49 RUE MICHELE 1 / / d Z 3 MA 02645 N Dining Kitchen Bath ASSESSORS MAP 335 `J / / PARCEL / C-+ DATE: MAY 18, 2005 cU Living Roam tN OF VACANT LAND / / �J�' c TOWN OF BARNSTABLE NEW REGULATIONS BAY COLONY RR _ a I .Z�' ti COMP. DESIGN: K. HEALY' c Sitting Rain , f�/ ri Bedroom „, VV ° DBs' REQUIRE SOIL EVALUATOR TO INSPECT PLAN VIE 3 CIVIL CHECK: M. DIBB I,�, � BOTTOM OF EXCAVATION PRIOR TO ANY m `, Clif. SCALE: i" 20 FEET 6 DRAWN: K. HEATY Q, T ����Q INSTALLATION AND ALSO PRIOR TO FINAL FIELD: D. GAZZOLO / J. MCCARTIN 00 �.� BACKFILLING. 3 FILE NO. 8828SEP2.DWG 0 10 20 40 FT. DWG NO. 5626-01 co SHEET 1 OF 2 �/2e, JOB NO. 4-8828. 30 _a ci ' BENCHMA K EXISTING SEPTIC REVISIONS `-` "- --•.._. .� ""`"' _ N0. DATE DESCRIPTION TO OF COMPONENTS TO --, -- --- ..,� ,�..-•- 1. 5/23/05 ADD DTH #2 CO CRETE BE PUMPED AND \ f 2. 5/26/05 RAISE SAS 5' DESIGN CRITERIA: BO ND ABANDONED IN ,'�iVc EXISTING I ABOVE CLAY DESIGN FLOW: EL- 48. 60 ACCORDANCE WITH DRYWELL 3 BEDROOMS AT110G.P.B./D 330 G.P.D. TI TLE 5I'll" o CONCRET REQUIRED SEPTIC TANK: \ 330 X 200% = 660 GAL. / A � = AL. 0 � � O � A. V BOUND SEPTIC TANK PROVIDED: 1500 Gnalt ► FOUND SIZE OF LEACHING FACILITY REQUIRED: Q �/f/ F TIO I DESIGN PERC. RATE: <2 MIN./ INCH q/�, -#37 /0� 1 LONG TERM APPL. RATE 0.74 G.P.D/S.F. Z 6! �EXISTING - _ 330 GPD = 0,74 GPD/SF - 446 S.F. 111 -_ - =- TWO UNIT 68. 6' W = 30 3 BEDROOM SIZE OF LEACHING FACILITY PROVIDED: p S SEC DWELLING / _ � � o 330 GPD 0,74 SF/GPD 446 S.F. O1 J J / Lo 1 1 J S� 'e USE LEACHING FIELD / p -4J J BOTTOM = 18' x 25' = 450 S.F Z� �` J J • _ (s1 PAT 0 C. O. `~ / 450 S.F X 0,74 SF/GPD = 333 GPD TP J J J 1 2. 8 SEE NOTE 3 � � q/ � � / EXISTING 2 8 � � � N�._,.. J TO WELL O / our DISTRIBUTION BOX DETAIL: NOT TO SCALE / FINISHED GRADE NO. OF OUTLETS 9 " --P R"O P 0 S ED 15 0� -- REMOVABLE 3 WALLS / COVER /- --- �� BOULDER GALLON SERTIC 202 5" PVC era NOTES: T 1. DIST. BOX TO WITHSTAND H-20 LOADING ,� LIMITS OF 0 --- A N K " 2. PROVIDE INLET TEE OR BAFFLE WHEREEEDS 0.08 FT./FT OR p� '�-• `�J ._. / T 20 SLOPE OF PIPE EXC /' 6" 9,5" OUTLETS : T8" IN PUMPED SYSTEM. EXCAVATION . SEE - --- �-� + 3. FIRST TWO FEET OF PIPE OUT OF DIST. f� P R 0 R\0 S E D' ,�� da " 'd • •d od 'du`�°dc T' BOX TO BE LAID LEVEL. N 0 TE S 5 AND 6 �.--- / E X I.STING � � % L_ 4" -� ,-- 1000 G-A'_L O N o BOTTOM ON LEVEL 4. ALL PIPE CONNECTIONS AND CONCRETE SiiaBLE BASE E" MIN. 3/4" TO CONSTRUCTION SHALL BE WATERTIGHT. �, '� /� --- --- GARAGE �, o 1 1/2 CRUSHED ` 8 �.� 0 PUMP r\ CROSS-SECTION STONE BASE 5. FIT BREAKOUT BARRIER SNUG AROUND / \ D-BOX AND USE EPDXY RESIN FOR WATER .-- --' � • 2 r �` Cv TIGHT SEAL / CHAMBER �'� ti-• / 6. FILL ALL UNUSED KNOCKOUTS WITH MORTAR. 4 0 _M I L- P-0t'Y L I N E R , I--- � \ / 30" PRECAST DIST. XL AROUND PROPOSED . -'" 1 1 `� �, Li 30" BOX / 18 , , ,.- �6 0 �, 1 3. 0 \ / NET ,� 18 x25 LEACHING } �' 32 , ~- -� � >> / � / FIELD . 4 .HIGH � � -' PLAN VIEW '� � 0 � � � " TOP EL. 51 . 1 �-- -�` TP #1opw PLAN VIEW r = if / BSC GROUP B 0 T. EL .��1 SCALE: 1 10 FEET / ol 657 Main Street, (RT. 28) Unit 6 o 0 5 10 FT, W.Yarmouth hlassachuset 026M SEPTIC TANK DETAIL: 1 ,500 GALLON SOIL TEST PIT DATA: P-10998 5W 778 8919 1000 GALLON H - 10 PUMP CHAMBER DETAIL: 2.��'� R os °yam PROJECT TITLE: TEST PIT - 1 TEST PIT -#2 = X 5.66' X 10.5' = 7 046 LBS GRD. EL. 53.0 GRD. EL. 49.0 HIGH GROUNDWATER COMPUTATION BUOYANCE FORCE _ (6'-3.55') X 62.4 Ib/cf X 5.3' X 9' = 7,292 LBS CIVIIL BUOYANCE FORCE 1.9 X 62.4 Ib/cf , cc WEIGHT OF TANK = 11,480 LBS EST HIGH GW 46.8 EST HIGH GW. 45.0 BASED ON TP#2 WEIGHT OF TANK = 8,240 LBS �� 37 DESIGN FOR WEIGHT OF SOIL = 1' X 5.66' X 10.5 X 85 Ib cf = 5,070 LBS WEIGHT OF SOIL = (1' X 5.3' X 9') X 85 Ib/cf = 4,054 LBS T a � ( ) / A A DEPTH TO PERCHED WATER _ 4.0' 11 480 LBS + 5 070 LBS = 16,550 LBS > 7,046 LBS - OK LOAMY SAND LOAMY SAND EL. 45.0 8,240 LBS + 4,054 LBS = 12,294 LBS > 7,292LBS - OK oN�L SEWAGE DISPOSAL ' 10YR 3 2 8" 10YR 3 3 18" w SYSTEM REPAIR LOAMY SAND LOAMY SAND a (BASED ON TP#1) NOT TO SCA LE 10YR 6 6 7.5YR 4/6 d Z DEPTH TO OBSERVED GROUNDWATER _ 19.5 5. INLET AND OUTLET TEES TO BE CAST IRON, " w Q EL 33.5 " NOTES: 1. SEPTIC TANK SHALL BE STEEL SCHED. 40 PVC OR CAST-IN-PLACE CONCRETE. ELEV 51.2 21 24 ,n ..�5 -- 8-2 -�5"�--- DOSING CALCULATIONS: REINFORCED CONCRETE. Z = 330 GPD #37 2. SEPTIC TANK TO WITHSTAND H-10 LOADING TEES TO BE CENTERED UNDER MANHOLE COVER. C-1 C-1 UNLESS UNDER PAVEMENT, DRIVES OR 6. TANK TO BE WATERTIGHT AT FACTORY. MEDIUM SAND MEDIUM SAND Q DESIGN FLOWN CHAMBER 10YR 7/3 " 10YR 5/3 REQ'D EMERGENCY STORAGE = 330 GAL RUE M I CH ELE TRAVELED WAYS, WHEREIN H-20 LOADING 37 " w OPUMP 8 SHALL APPLY. ELEV 46.2 34 o Z & FLOAOWER 4'-5" 5'-3" 41 PER N 3. ALL PIPE CONNECTIONS AND CONCRETE ENUMBERMERGENCY STORAGE PROV'D CONSTRUCTION SHALL BE WATERTIGHT. ELEV 46.8 _ 74" - DEPTH P R CYCSLEG CYCLES CU M M AQU I D - 48" w w CABLES L » " = 13 GALS DOSE a 4. FILL ALL UNUSED KNOCKOUTS WITH C- S.CLAY LOAMDESIGN TDH co 5 x4-5 x8 -2 x7.48 GAL/CF / y MORTAR. = 30 GPM M ASSACH U SETTS +, S.CLAY�LOAM 2.5 5/3 " INLET DESIGN GPM 14 FEET / TEE CL 10YR 6 3 210" ELEV 37.0 144 E C-3 C-3 5 WALLS 2-24" DIA METAL MANHOLES MEDIUM SAND MEDIUM SAND m COVERS WITH BOLTS BROUGHT 10YR 7 3 2.5 Y 6 4 24 DIA MIN. C.I. MANHOLE COVER TO FINISH GRADE OBS. G.W./ BROUGHT TO FINISH GRADE BOLT ON COVERS 234" 204" FIN. GR. EL. = 4s.3a PREPARED FOR: TEE TO BE UNDER 12" MIN EL = 33.5 - EL = 32.0 INDICATES Y PERCHED APPROX. 24" COVER Ms. MARCIA ELLIOTT M.H. OPENING OAR " TOP EL. = 48.55 NOTES: 'PUMP CHAMBER TO WITHSTAND �� DATE: DATE: �-- a� 3 - SEASONAL HIGH N RAISE M.H w ` 4" 5/11/05 5/23/05 GROUND WATER 1 FROM OTANK SEPTIC 2" PVC `H-10 LOADING 30 WINDWARD 7WALK SECURE CHAIN -� TEST BY: TEST BY: INV.=47.30 TO WALL DISCHARGE N 10'-6" SEWER BRICK a. -d.e:: :rd o & MORTAR " THE BSC GROUP, INC. THE BSC GROUP, INC. INDICATES PIPE INV 6.05 2. WATERPROOF AT FACTORY HARWICH 0 10 0 NORMAL WATER LEVEL 12 OBSERVED 6'-0" SMOR. = w 2" GALV. UNION OR APPROVED EQUAL. MA 02645 N " 3" WITNESSED BY: WITNESSED BY: - GROUND WATER ALARM ELEV.=44.63 _ 10 14" DONALD DESMARAIS, R.S THOMAS MCKEON, R.S 5" m o CHECK VALVE 3. ALL PIPE CONNECTIONS AND CONCRETE PRECAST SEPTIC TANK PUMP ON EL 44.85 2 SCH 80 CONSTRUCTION SHALL BE WATERTIGHT. 2005 C e INLET TEE :a V-g" PERC. RATE: PERC. RATE: INDICATES �PERC. _ o w PVC THREADED DATE. MAY 18, ;Oof _ MIN./INCH .�-MIN./INCH TEST 5" w m PIPE N 5'-2" 4'-6" '' 4'-0" MIN. eo+o a+ d 4. RAISE MANHOLE TO FINISH GRADE WITH COMP./DESIGN: K. HEALY nor 5'-4" SOIL EVALUATOR SOIL EVALUATOR PUMP OFF EL = 43.80 Q n- w 3 MERCURY FLOAT SEWER BRICK AND MORTAR. FULL OUTER m - - - " LIQUID'-0 DEPTH ) e - 5'-8" :r MARK DIBB P.E. CRAIG FIELD, S.E. - 10 °-�' CHECK: M. DIBB N INDICATES BOT. EL = 42.55 ►bw LEVEL CONTROLS MORTAR PARGE TO PROVIDE WATER LL1 �' •' UNSUITABLE d YDROMATIC SUBMERSIBLE TIGHT SEAL. DRAWN: K. HEALY SOIL CLASS: SOIL CLASS: MATERIAL °'�`b°�d ��°�� '�°�� �°°��° 'd° SEWAGE PUMP FIELD: D. GAZZOLO J. McCARTIN 1-n 14] ::�d:=' 5. POWER CABLES TO BE PLACED IN / 3 BOTTOM ON LEVEL STABLE BASEc 3" 1 1 6" MIN. 3/4" TO 1 1/2" STONE (MODEL MYERS) FILE NO. 8828SEP2.DWG OR EQUIVALENT CONDUIT IN ACCORDANCE WITH LOCAL PLAN VIEW �,� ,rr,� , \ L.T.A.R. L.T.A.R. BUILDING AND WIRE CODES. 0 6" MIN. 3/4" TO CROSS-SECTION VIEW LOCATED UNDER MH DWG N0. 5625-01 N 1 1/2" STONE 0.74 G.P.D./SQ.FT. 0.74 G.P.D./SQ.FT. NOT TO SCALE 30 GPM ® 14' TDH JOB N0. 4-8828.11 SHEET 2 OF 2 a a