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HomeMy WebLinkAbout0065 SCUDDER'S LANE - Health C 65 Scudder Lane Barnstable A= 258-013 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 65 Scudder Lane Property Address Richard Liddy Owner Owner's Name information is required for every Barnstable MA 02630 06/25/11 C (Town State Zip Code Date of Inspection pa e. �Y P 9 Inspection results must be submitted on this form.Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms I on the computer, use only the tab 1. Inspector: key to move your cursor-do not Michael Kellett use the return Name of Inspector key. Aardvark Environmental Inspections �y Company Name PO Box 896 Company Address East Dennis MA 02641 Cityfrown State Zip Code 508-385-7608 SI 3742 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspectio8 was performed based on my training and experience in the proper function and mainteri6nce of or:site »�. sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340-of Title 5(310 CMR 15.000).The system: '`` y C) ® Passes ❑ Conditionally Passes ❑ Fails ' ❑ Needs Further Evaluation by the Local Approving Authority �a1 r r-nrr 06/25/11 Inspector's Signature ` Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ""This report only describes conditions at the time of inspection and 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. �AI(n11I t5ms•11110 I ,, Title 5 Offidal Inspection Form:SubsuAsoa Sewage Disposal System•P 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 65 Scudder Lane Properly Address Richard Liddy Owner Owner's Name information is required for every Barnstable MA 02630 06/25/11 Cityrrown page. State Zip Code Date of Inspection B. Certification (cunt.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 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 65 Scudder Lane Property Address Richard Liddy Owner Owner's Name information is required for every Barnstable MA 02630 06/25/11 page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cunt:): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or 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 6' t5ins-11110 Title 5 0McWl Wopedimt Form:Submtke Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 65 Scudder Lane Property Address Richard Liddy Owner Owner's Name - information is required for every Barnstable MA 02630 06/25/11 City/Town page. State Zip Code Date of Inspection B. Certification (cont.) , 2. System will fail unless the Board of Health(and Public Water Supplier,if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system,passes"if-the-well-water analysis,performed at a DEP certified-laboratory,-for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other. D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ . ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool • ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6"below invert or available volume is less than' day flow t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 65 Scudder Lane Property Address Richard Liddy Owner Owner's Name information is required for every Barnstable MA 02630 06/25/11 page. City/Town State Zip Code Date of Inspection B. Certification-(cunt:)= Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. I ❑ ® 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 Heafth 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—1WPA)or a mapped Zone II of a public water supply well 1f you have answered"yes"to any question in Section f-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. t5t,s•11l1Q Idle 5 Official tapection Form:Subsurface sewage Disposal system•Page 5 of 17 -44 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 65 Scudder Lane Property Address Richard Liddy Owner Owner's Name information is required for every Barnstable MA 02630 06/25/11 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(f any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] D. System-Information Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 440 t5ins•11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 6 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 65 Scudder Lane Property Address Richard Liddy Owner Owner's Name information is required for every Barnstable MA 02630 06/25/11 page. City/rown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ® Yes ❑ No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? x ❑ Yes ® No Last date of-occupancy: current. Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/personsJsq.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: t5lria•11/10 Title 5 OMClal Irepecn Form:SubsLuface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 65 Scudder Lane Property Address Richard Liddy Owner Owners Name information is required for every Barnstable MA 02630 06/25/11 page. City town State Zip Code Date of Inspection D. System Information (cont.) Last-date of occupancy/use: Dee Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes,volume-pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system(yes or no)(if yes, attach previous inspection records, if any) ❑ Innovative/Altemative 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 l/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ms•11110 TWe 5 Official inspection Forth:Subwurace Sewage Disposed System-Page 8 of 17 N Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 65 Scudder Lane Property Address Richard Liddy Owner Owner's Name information required for every Barnstable MA 02630 06/25/11 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: 2002 per BOH Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 4.0 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: 3.0 feet Material of construction: ®concrete ❑metal ❑fiberglass ❑polyethylene ❑other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 gal Sludge depth: 4!1 t51ns-11110 Title 5 Oftial 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 65 Scudder Lane Properly Address Richard Liddy Owner Owners Name information is required for every Barnstable MA 02630 06/25/11 page, Cityrrown State Zip Code' Date of Inspection D. System-Information-(cunt-.)- Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 28" Scum thickness 2" Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 1411 How were dimensions determined? measured Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): The tank was sound and tight with tees in place and liquid at outlet invert. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fiberglass ❑polyethylene ❑other(explain): 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 Forth:Subsurface Sewage Disposal System•Page 10 W 17 Commonwealth of Massachusetts Title 5 Official Inspection Form UVSubsurface Sewage Disposal System Form-Not for Voluntary Assessments 65 Scudder Lane Property Address Richard Liddy Owner Owner's Name information for every on is required Barnstable MA 02630 06/25/11 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑concrete ❑metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order. ❑ Yes ❑ No Date-of-last pumping: Date Comments(condition of alarm and float switches,etc.); *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•11/10 Title 5 OlNtlai inspection Form:subsurface sewage Disposal system•Page 11 of 17 f N Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 65 Scudder Lane Property Address Richard Liddy Owner Owners Name information is required for every Barnstable MA 02630 06/25/11 City/Town page. State Zip Code Date of Inspection D. System Information (cunt.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert even Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover, any evidence of leakage into or out of box, etc.): The box was level and tight with no sign of carry over. Pump Chamber(locate on site plan): I 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: Mine•11/10 Title 5 Offidal Inspection Fomx SubsuRece Sewage Disposal System•Page 12 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 65 Scudder Lane Properly Address Richard Liddy Owner Owner's Name information is required for every Barnstable MA 02630 06/25/11 page. Cityrrown State Zip Code Date of inspection D. System-Information(cont.) Type: ❑ leaching pits number. ® leaching chambers- number: 3 leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): This system has three 500 gallon drywellsurrounded by three feet of stone.There was no sign of ponding or failure in the stones. 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•11110 Trde 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form-Not for Voluntary Assessments. 65 Scudder Lane Properly Address Richard Liddy Owner Owner's Name information is required for every Barnstable MA 02630 06/25/11 page. CityfTown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t51ns-11/10 Title 5 Of al Inspection Forth: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 65 Scudder Lane Property Address Richard Lilly Owner Owner's Name information is required for every Barnstable MA 02630 06/25/11 page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) 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 f Lt5ins-11/10 Title 5 Official Dion Form:SubsuAace Sewage Disposal system-Page 15 of 17 Commonwealth of Massachusetts lipTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 65 Scudder Lane Properly Address Richard Liddy Owner Owner's Name information is required for every Barnstable MA 02630 06/25/11 page- Citylrown State Zip Code Date of Inspection D. System Information (cunt.) Site Exam: ® Check Slope ® Surface water r ® Check cellar ❑ Shallow wells 20.0 Estimated depth to high ground'water: feet feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked,date of design plan reviewed: Date ® Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: You must describe how you established the high ground water elevation: USGS Maps show an elevation of over 20.0 feet.There was also a drop in the back yard of about thirty feet. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11110 Title 5 Oftel Inspection Form:Subsurface Sewage Disposal system-Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ' 65 Scudder Lane Property Address Richard Liddy Owner Owner's Name information is required for every Barnstable MA 02630 06/25/11 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 tSins•11/10 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 65 Scudder's Lane Property Address Richard &Joanne Liddy I Owner Owner's Name information is required for Barnstable Ma. 02630 6/;26/2009 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out A. General Information �I forms on the computer,use 1. Inspector: �J I only the tab key to move your Robert Paolini cursor-do not Name of Inspector use the return key. Capewide Enterprises,LLC. Company Name r� P.O.Box 763 Company Address Centerville Ma. 02632 City/Town State Zip Code (508)428-4028 S14454 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 6/26/2009 Insp to s Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority Gard of Health or DEP)within 30 days of completing this inspection. If the system is a shared systew or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 I Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 65 Scudder's Lane Property Address Richard &Joanne Liddy Owner Owner's Name information is required for Barnstable Ma. 02630 6/;26/2009 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The septic system is in proper working order at the present time. 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-09/08 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 65 Scudder's Lane Property Address Richard &Joanne Liddy Owner Owner's Name information is required for Barnstable Ma. 02630 6/;26/2009 every page. City/Town 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•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 65 Scudder's Lane Property Address Richard &Joanne Liddy Owner Owner's Name information is 26/2009, Barnstable Ma. 02630 6/' required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: *` This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert_or available volume is less than '/day flow t5ins•09f08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 65 Scudder's Lane Property Address Richard &Joanne Liddy Owner Owner's Name information is 26/2009, Barnstable Ma. 02630 6/' required for every page. Cityrrown 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. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 65 Scudder's Lane Property Address Richard &Joanne Liddy Owner Owner's Name information is 26/2009, Barnstable Ma. 02630 6/' required for every 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): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 65 Scudder's Lane Property Address Richard &Joanne Liddy Owner Owner's Name information is required for Barnstable Ma. 02630 6/'26/2009 every page. City/Town State Zip Code Date of Inspection D. System Information Description: The septic system consists of a 1500 gallon septic tank,distribution box and three drywells. Number of current residents: 2 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 ears usage 2007-08 280,000 9 ( Y g (gpd)) Detail: 2007-08:383 gpd. Sump pump? ❑ Yes ® No Last date of occupancy: 6/26/2009 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 65 Scudder's Lane Property Address Richard & Joanne Liddy Owner Owner's Name information is required for Barnstable Ma. 02630 6/'26/2009 every page. City/Town State Zip Code Date of Inspection D.'System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the,DEP approval. ❑ Other(describe): t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 65 Scudder's Lane Property Address Richard &Joanne Liddy Owner Owner's Name information is required for Barnstable Ma. 02630 6/'26/2009 every 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: 2002 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 3'feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: 10+ feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints appear tight.No evidence of Ieakage.System vented through the house vents. Septic Tank(locate on site plan): Depth below grade: 4 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 Gallon`H20 Sludge depth: 4" l5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 r Commonwealth of Massachusetts H Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 65 Scudder's Lane Property Address Richard &Joanne Liddy Owner Owner's Name information is required for Barnstable Ma. 02630 6/'26/2009 every page. Cityrrown State Zip Code Date of Inspection D. System Information .(cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 28„ Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 611 Distance from bottom of scum to bottom of outlet tee or baffle 12" How were dimensions determined? Measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pump septic tank every two years.Inlet and outlet tees are in place.No evidence of Ieakage.Tank appears to be structurally sound. 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•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 65 Scudder's Lane Property Address Richard &Joanne Liddy Owner Owner's Name information is required for Barnstable Ma. 02630 6/'26/2009 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•09108 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 65 Scudder's Lane Property Address Richard &Joanne Liddy Owner Owner's Name information is Barnstable Ma. 02630 6/'26/2009 required for � � every 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 No 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.): Box is Ievel.Box has two outlet laterals with equal distribution.No evidence of solids carryover.No evidence of leakage into or out of box. 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts s Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 65 Scudder's Lane Property Address Richard &Joanne Liddy Owner Owner's Name information is required for Barnstable Ma. 02630 6/'26/2009 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 3 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Sandy dry soil.No signs of hydraulic failure.Drywell had 6"of water at time of inspection with stain line 12' below invert. 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 65 Scudder's Lane Property Address Richard &Joanne Liddy Owner Owner's Name information is required for Barnstable Ma. 02630 6/'26/2009 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Map Page 1 of 2 Town of Barnstable Geographic Information System Parcel Viewer Custom Map Abutters Map Size Zoom Out ®In . y K R R 7 P K 1d J ® O 6r , a 5! t 20 Feet Set Scale 1" = Zp I Aerial Photos I MAP DISCLAIMER Cnnvrinhf OMr-,)nnO Tnum of Romefohlo one All rinhfc rocunn httn'//www.town_harnstahle.ma.us/arcims/anngeoann/man.&snx?nronertvTD=2580I Uman... 6/29/2009 Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 65 Scudder's Lane Property Address Richard &Joanne Liddy Owner Owner's Name information is required for Barnstable Ma. 02630 6/;26/2009 every page. CitylTown 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: Bottom of leaching 40' feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: As-Built ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: USED:USGS Observation Well Data.USED:Technical Bulletin 92-0001 annual ranges of groundwater elevations. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 65 Scudder's Lane Property Address Richard &Joanne Liddy Owner Owner's Name information is required for Barnstable Ma. 02630 6/;26/2009 every page. Cityfrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 TOWN OF BARNSTABLE LOCATIONS St' f2 , �� SEWAGE # VILLAGE_ ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. LWI2.2.~ i SEPTIC TANK CAPACITY X-5'Q Q A-�—c Z2 0 LEACKNG FACILITY: (type) 3—:500 C?A2 ,t. C NO.-OF BEDROOMS , BUILDER OR OWNER A"97*031Z -¢r-1,4 BoQ PERMTTDATE: d O COMPLIANCE DATE: k12A�- 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 -1 L Y j .t. •• TOWN OF BARNSTAB'LE `. LOCATION `�_� (;f7 ; Q:�� dL SEWAGE # �. VILLAGE ASSESSOR'S-MAP &c LOT - �INSTALLER'S NAME&c PHONE NO. l u/L1 /rrl ;fJ1��. 0 221 tit :SEPTIC TANK CAPACITY'+ y'�'r)D LEACHING FAC-ILM: (type) " 5 00 Z''�r l 4. C (size) NO.OF BEDROOMS__ BUILDER OR OWNER /gPL�S ��4/2302 ��Cf' r 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 eust °: Feet on site or within 200 feet of leaching facility). Ed W wetlands 't e of Hand and Leaching Facility If an etland ezis 8 e g t3'( Y within 300 feet of leaching facility) Feet Furnished by F A 'y. F CJ� MC-A73 b f No. 200 Z 3d`� s i ' + Fee 00 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ' Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppfication for riopool *p tern Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( /)Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. �� s[V Dj>E8 L A/ Owner's Name,Address and Tel.No. h� D V l t7 f:6^177VI 9 �f►oPg EG LA Assessor's Map/Parcel �8 ^ ©! rn 1 v T/9 A X 6 S Garnrr� v>� ✓ .4 0263 OZ Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. /' FALMeV-`I 25;Vd 1 1Z45.e1A14 •"Al C- TSsu r�� cQnS ►�-t� " /6� ?aw.v 1/91c se Ac>r�ac�7N IVA, &2_S#0 Type of Building: Dwelling No.of Bedrooms _ Lot Size sq.ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 'i�S;S, gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Tithe S S�v�� �s CAI Size of Septic Tank �i X-00 Type of S.A.S. SZV eu Description of Soil S ��A i✓ t�� S 7 Nature of Repairs or Alterations(Answer when applicable) M&LI 26677G , Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been is ed ty 1Board of . f ' Signed Date -7-9 5 429 Application Approved by Zzht Date Application Disapproved for the following reasons Permit No. Date Issued I LP d 7,1171, 1 oD 'qNo. 70 Z : L/ f 1 +°".Z Fee f' r r F Entered in co uter: THE COMMONWEALTH OF MASSACHUSETTS p Yes ; ,UBLIC-HEALTH DIVISION -TOWN OF BARNSTABI--Es MASSACHUSETTTS .f App rfcation.for t o r �p tee Congtructior� Permit - � r i Applicatroln for a Permit to Construct('. )Repaire )Upgrade( ),Abandon( ) El Complete System El Individual Components Location dress or Lot No.�5' se y DDEQ-S 14VV , net'. Name,Address and Tel.No. 01 vj-z> f e^j7w/A Assessor's Map/Parcel �fn MS ;/�&/3 d X 6 S_ c2 ;,e C��►rn ouii� ✓+�A oa63 Installer's Name,Address,and Tel.No. ge^,signer's Name,Address and Tel.No. !'++L/y1GvTH FN6/NEE@/NG Z'N r. SSu f vn( COAOyvc,t'u-` /G/ ?dw,Ov NAc�"`58 sIc,r�ruTN IVA, a2T/1B Type of Building: Dwelling No.of Bedrooms f Lot Size sq.ft. Garbage Grinder( ) ,- Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow SS gallons per day. Calculated daily flow gallons.' F r Plan Date 7 -9 0 2.- Number of sheets Revision Date Title S 50 AvtE,6 CAI { Size of Septic Tank !S'Dn?> Type of S.A.S. / 5'&V J J. �S. f s ti Description of Soil: 96E PIA� 6�/ y IT N. " Nature-of Repairs or Alterations(Answer when applicable)A fEW S 7Te-, I Datelast inspected-.- Agreement:, The undersigned agrees to ensure the construction and•maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been is ued 'y s,Board of Health. I .� Signed! . Date 7 Application Approved by /." +� ^ Date 17- ''Q Application Disapproved for the following reasons I � t Permit No. too' - "-30ys '� Date Issued "P7 It le to z- i THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS ' Certificate of Compliance i THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( .)Repaired( )Upgraded( (� Abandoned( )by at—&5'M S e t.. dR.✓° 5 L►¢� �5a- vLS Y3�t bLk o MA--- N-hi;been constructe in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated [t 6 7- Installer Designer .�. The issuance o this permit shall not be construed as a guarantee that the sys a�i will fu Action as dens' ed. Date �f u;L Inspector )A_ 1*1 11 . ✓ Y C4 No. C)(1 3c Fee THE COMMONWEALTH OF MASSACHUSETTS { _ PUBLIC HEALTH DIVISION- BARNSTABLE, MASSACHUSETTS -Mi5po0ar *patent Congtr coon Permit Permission is hereby granted to Construct( )Repair( )Up rade(Abandon( ) System located at L5 C r_ G o`S I A-14- h S+r,61 Q . ►M�" and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. ' Provided: Construction must be completed within three years of the date of this permit. �'; Date: t` Approved.by L. `PTO '` 2 s " - TROY WiLLIAMS _ SEPTIC INSPECTIONS Certified by MA Department of Environmental Protection (508) 385-1300 19 Hummel Drive South Dennis,14A 02660 Z -� COMMONWEALTH OF MASSACHUSE'I"I'S EXECUTIVE, OFFICE, OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Propert% Address: 65 Scudder Lane Barnstable,MA Owner's Name: Lee Austin Owner's Addres-s: 145 East 92 d Street , Date of Inspection: New York,NY 10128 October 2,2001 Name of Inspector: Troy M. Williams Company Name: Troy Williams Septic Inspections Mailing Address: 19 Hummel Drive Telephone Number: South Dennis,MA 02660 (508)385-1300 CERTIFICATION STATEMENT 1 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 inspect ion,was performed based.on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approi ed system inspector pursuant to Section 15.340 of Title 5(310 C MR 15.000). The sv-lem Passes Conditionallx, Passes Needs Further Evaluation by the Local Approving Authont� Fails Inspector's Signature: Date: 16 /21,o i The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of I lealth or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments Although system meets the minimum requirements set forth by the Massachusetts Department of Environmental Protection,certification is not to be construed as a guarantee of future working condition of system,piping or components. This inspection represents the conditions of the system on the Date of Inspection noted above. ""This report only describes conditions at the time of inspection and under the conditions of use at that time. phis inspection does.not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 pace I i Page 2 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A 65 Scudder Lane CERTIFICATION (continued) Property Address: Barnstable,MA Lee Austin Owner: October 2,2001 Date of Inspection: 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 t any of the failure criteria described in 310 CN4R l 15.303 or in 310 CMR 15.304 exist. Any failure criteria of evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to a replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Bo of Health, will pass. Answer yes. no or not determined(Y,N,ND)in the for the following stateme s. If"not determined"please explain. The septic tank is metal and over 20 years old* or the septic tank hether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure ' imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approve y the Board of Health. •A metal septic tank will pass inspection if it is structurally so d,not leaking and if a Certificate of Compliance , indicating that the tank is less than 20 years old is available ND explain.- Observation of sewage backup or bre out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settl or uneven distribution box. System will pass inspection if(with approval of Board of Health): roken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The sy m required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspe 'on if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 1 Page 3 of l 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART CERTIFICATION(continued) Property Address: 65 Scudder Lane Owner: Barnstable,MA Date of Inspection: Lee Austin October 2,2001 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 Hill pass unless Board of Health determines in accordance with 310 CMR 15.3 (1)(b)that the System is not functioning in a manner which will protect public health,safety and t 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 s marsh 2. System will fail unless the Board of Health(and Public W er Supplier,if any)determines that the system is functioning in a manner that protects the public alth,safety and environment: _ The system has a septic tank and soil absorptio ystem(SAS)and the SAS is within 100 feet of a surface \\ater supply or tributary to a surface wat supply. The system has a septic tank and SAS d the SAS is within a Zone 1 of a public water supply. The system has a septic tank an AS and the SAS is \N ithin 50 feet of a private water supply well. _ The system has a septic t • and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well** ethod used to determine distance **This system passe ' the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volat' organic compounds indicates that the well is free from pollution from that facility and the presence o monia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure crite are triggered.A copy of the analysis must be attached to this form. 3. Other: • 3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 65 Scudder Lane Barnstable,MA Owner: Lee Austin Date of Inspection: October 2,2001 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 clo22ed 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 ,*S4.., i.—, /: s:6�_, t4v— , ----} -- ,.t'..))% - . V _ Liquid depth in cesspool is less than 6"below invert or available volume is less than %day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. 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 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 s.vstem 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 desi flow of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria ove) yes no the system is within 400 feet of a surface drinking ter supply _ the system is within 200 feet of a tributary to surface drinking water supply the system is located in a nitrogen sen ' ve area(Interim Wellhead Protection Area-IWPA)or a mapped Zone 11 of a public water supply w If you have answered"yes"to any que on in Section E the system is considered a significant threat,or answered "yes"in Section D above the large stem has failed.The owner or operator of any large system considered a significant threat under Section or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner s Id contact the appropriate regional office of the Department. 4 Page 5 of I 1 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 65 Scudder Lane Owner: Barnstable,MA Date of Inspection: Lee Austin October 2,2001 Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No l'.:;r,ping information was provided by the owner. occupant. or BoarJ of I Lai,,l, _ 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? _ /k� A 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 '? �v 4 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: Yes no _-Z 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)J 5 Page 6 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 65 Scudder Lane Owner: Barnstable,MA Date of inspection: Lee Austin October 2,200RLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual): 9 . DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): y yo Number of current residents: U Does residence have a garbage grinder(yes or no): Ali) Is laundn on a separate sewage system (yes or no):w, cif yes separate inspection required] Laundry system inspected(yes or no): �,//,g Seasonal use: (yes or no): No Water meter readings,if available(last 2 years usage(gpd)): _ou-o i= `?;UU �t� f y y_ u� z 73, Sump pump(yes or no): /Jo Last date of occupancy: V4 COMM ERCIALANDUSTRIA L Type of establishment: Design flow(based on 310 CMR 15.203): gpd 1 Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no)- Non-sanitary waste discharged to the Title 5 system ,es or no): Water meter readings, if available: _ Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: At. Was system pumped as pan of the nspects or no): Aj. If yes, volume pumped: gallons-- How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM _Septic tank,distribution box, soil absorption system _Single cesspool - Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records, if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank _Attach a copy of the DEP approval _Other(describe):. Approximate age of all components. date installed(if known)and source of information: _1 J 4l u F c-c s s .., .,1 c Were sewage odors detected when arriving at the site(yes or no): nvu 6 Page 7 of I 1 P OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 65 Scudder Lane Owner: Barnstable,MA Date of Inspection: Lee Austin October 2,2001 BUILDING SEWER(locate on site plan) Depth belo�ti grade: le, Materials of construction: cast iron _40 PVC ,/other(explain): Di�tanc: from. prate water supply well or suction line: N/,, Comments(on condition of joints,venting,evidence of leakage, etc.): SEPTIC TANK:_(locate on site plan) Depth below grade: Material of construction:_concrete_metal_fiberglass_polyethylen —other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Com ance(yes or no):_(attach a copy of certificate) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baf Scum thickness: Distance from top of scum to top of outlet tee or b Distance from bottom of scum to bottom of out tee or baffle: How were dimensions determined: Comments(on pumping recommendatio '-inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence o eakage, etc.): GREASE TRAP:_(locate on site plan) Depth below grade:_ Material of construction:_concrete_metal fiberglass_poly ylene_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 to r baffle: Date of last pumping: Comments(on pumping recommendations, ' t and outlet tee or baffle condition, structural integrity,liquid levels as related to outlet invert,evidence of le ge,etc.): 7 Page 8 of 1 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 65 Scudder Lane Owner: Barnstable,MA Date of Inspection: Lee Austin October 2,2001 TIGHT or HOLDING TANK: (tank must be pumped at time of inspe on)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass olyethylene other(explain): Dimensions.- Capacity: gallons Design Flo\ gallons/day Alarm present(yes or no): Alarm level: Alarm in working order s or no): Date of last pumping: Comments(condition of alarm and float itches, etc.): DISTRIBUTION BOX: (if present must be opene ocate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution outlets equal,any evidence of solids carr),gver, any evidence of leakage into or out of box,etc.): PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condit' of pumps and appurtenances,etc.): 8 . S Page 9 of 1 1 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 65 Scudder Lane Owner: Barnstable,MA Date of Inspection: Lee Austin October 2,2001 SOIL ABSORPTION SYSTEM (SAS): (locate on site plan,excavation not required) If SAS not located explain wh) Type leaching pits. number: _ 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.): L �7 / 1 ._ :t > w<r, Ti --A 1.... 'I O /- IN 4-a✓ /�v-e..� .�,.. i- ca h T.�. -•� . c n ell V. J--• • 1 SLiw} /� ' Ga..� Srr.,t 1 Jcr� �y 11 wl.c.. �.. .....� ..✓<.-f c, 1. c.•.i .•'n "�,� /9 G, 1, I�>s �� r CESSPOOLS: __k/ (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: o"ti ,.,w.- c��>y»„ t - Depth—top of liquid to inlet invert: It, Depth of solids layer: 3' Depth of scum la*er: Dimensions of cesspool: 7 • d Materials of construction: C / S/o ( U s a 6- Indication of groundwater inflow yes or no): No Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): C-16 k ") 1 L.,c.. S 9'C ,0 w:aft w� 1 /—, —( up +b n v i-Imo •4- / "—. f*L S 43" 1 A J OR •fJ`��/•�.� G �4✓-t. I r Y.t S G..NA ci�o Yi S G✓ ,/7Z A i ) �e vi 'A tir. �.t U1� 6w kvri ih ft <<'5 SF.- I hti� Gu./ 1(J L_ l,­t ` ,t ` 1t l � PON I / PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hyXcfailure, level of ponding,condition of vegetation,etc.): 9 Page 10 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 65 Scudder Lane Barnstable,MA Owner: Lee Austin Date of Inspection: October 2,2001 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. � ` 3 AA l � r I r i 10 / S, Page 11 of 1 1 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 65 Scudder Lane Owner: Barnstable,MA Date of Inspection: Lee Austin October 2,2001 SITE EXAM Slope V/ Surface water ✓ Check cellar Shallow wells Estimated depth to ground water feet Adjusted high ground water elevation _ feet Please indicate(check)all methods used to determine the high ground %%ater elevation: Obtained from system design plans on record- If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: C_e < 1 w4f /U• s Gh� w . s hoF /� cc. fit � S S_r,tDUr.J wo--r�r �-c...tl � 1 1d'' 11 �6Z1-OZt�-80S ��NOHd Nb�fd SS�ZO b'W `��f-11/�z1�150 Clb'Ozl J.d9 15�M 8 } �T 'VW 'A-l9b1SN?4'V9 z N3aan�)s G9 RIOILV=7 gm q Q .9-8 A-i9 �t8 y 3 r' 3`_ d NO F II �fiJma = _ rcn�rca� Z a - L � � oh m J I LL g II v= L J .01 1 III I I — Il� It a �ylUllllp II a - ZZyI w An lL 1yf{ a.11 m z b II _JL___ r----- -------- II 1 I II I I �9 Ir——————— I no �3 I I 4 I�¢Yn 0 _ _ —_ I r------- >� I w I Ans, I 0 I L__—__—_ cn, { I £ I r~1 y coI I �d I CI-4 C J r µ s a Ong ,s aI I i I I � i I E I II I 11 i E I I I _ , z.. 41 PAY L# I 1 V 2" x 11'6" I I --- _ j - A � w x411 1 � ( f 1 4 I f I I _ 1 4. r E II • E r I { � I � � 1 �p MIES 4 B VW 21EO WATER / � V i B VW 1 PONL9 B VW A ooti VW E j -16 • B VW D } OF WATER OF 1 r b ' EDGE b VW C B VW B � h i I! i , I , \ \ O� \ � - \ .H LOT 2�1 LOT �32 1 I \ \\ OF JURISTICTION 9 ' , . I, goo _ O / ° — — m _ 0 \ \ THE CONTRACTOR SHALL EXCAVATE 5' ALL AROUND i AND DOWN TO THE SAND LAYER (ESTIMATED AS 7') 9 - 5� GALLaV CHAMSERS AND REMOVE ALL UNSUITABLE MATERIAL AND REPLACE Of/W 4'Ole Sr6ff'ALL .4ROIUNO WITH CLEAN COARSE SAND UP TO THE TOP OF THE SYSTEM. CQ THE REPLACEMENT MATERIAL SHALL CONFORM TO THE00 SPECIFICATIONS SET FORTH IN 310 CMR 15.255(3) (TITLE 5) I I \ ¢' LOT 26 8" MAPLE .,.... ¢ ...,. � — — �, y', ;. 'TEST HOLE 1. 6 ACRE - - — H2o W 10 I \ BENCHMARK: CENTER OF STEP / ELEVATION - 108.50 \ STONE DRIVE / GENERAL NOTES . 1. HOUSE NUMBER: 65 106 1ss'f 2. ASSESSOR'S NUMBER: 258-13 Z TO BERE/VOI/,4T0 .� 3. ZONING DISTRICT: RF-1 Oo �1 W w ` � 4. FLOOD ;HAZARD ZONE: C Q i "� _ w \ EXISTING WATER SERVICE 5. TOPOGRAPHIC INFORMATION AND PROPERTY LINES COMPILED FROM A PLAN BY OTHERS � (ANROXIMATE\LOCATIO ---__ w -- n pR�`IE \ \ \ \ 6. ELEVATIONS SHOWN ARE BASED ON AN ASSIGNED DATUM V O S.�oNE ' - �,�Y _.:. \ \ \ \ \ 7. PLAN REFERENCE: L.C. PLAN 20950E N/F ANDREW S. KECK CERTIFICATE #288820 PLOT PLAN AU STI N ESTATE ' #65 SCUDDER'S LANE I I _. .. PREPARED FOR 360. 64 N o '� BARNSTABLE HARBOR BUILDERS $J� J�5 o w \ I N BARNSTABLE MA VA of M4,9Sc PLAN DATE: JULY 9, 2002 PLAN SCALE: 1" = 20' T o MICHAEL 3 N/F ALBERT & NANCY LAMB o BOCISVIELU N C CIVIL ENGINEERING WETLANDS PERMITTING u CERTIFICATE #1145671 .o �� 350�4� : WASTEWATER DESIGN FALM OU TH COASTAL ENGINEERING 9p� GlSTER ��',� A FS3fONAl ��Ca TITLE 5 PLOT PLANS EN GI N EERI N Ga PIERS AND DOCKS i LAND USE PLANNING COMMERCIAL/RESIDENTIAL Serving Cape Cod and Southeastern Massachusetts 101 TOWN HALL SQUARE - FALMOUTH, MA - 02540 - 508.495.1225 - 508.495.3229 fax PROJECT NUMBER: 02044 CADFILE NAME:02044MSTR PLAN NUMBER 01-31 SHEET 1 OF 2 i FINISH CRAOISNAll SE 2Z M/N/MUM OkER ALL SERW SYSTT"M 6WRaYEN7S USE 4 D/A. SCHED/JLE 40 RW LAP CAST/ROV PIPE 20'M/NWIM SETBACK FROM EDP OF STONE 7o CELLAR #WZ 10'M/N/MUM SETBACK 1aP OF FOUNDATION REMOVABLE COVERS SET TO WITHIN r ELEV = 108J75 12" OF FINISH GRADE (TOTAL OF 4) 1 TEST HOLE #1 S 0j-L_ TEST -Q_QLA: - 2"LAYFP GD'' 1/B" 3' 0" A 103.3 GATE OF SOIL TEST NO// 13, 200, S - .02 TO 112"PEr4ST1�VE SANDY LOAM yr, SLOPE IiAR/ES " 10 YR 4/3 S = .01 MIN. /NI�ERT ELEK = 9d 17 15 e 102.1 1500 GALLON zr.A/RST 32" SANDY ODYR 6 8 100.6 4. )%N SEPTIC TANK �.jlLEI�£LCl '°� ���� ®®® ;'�r ' ''' ' 42" 10 YR LOAM 99.8 !�Y/TNESS.• DA 1�/D STANTON (H-20 LOADING) ®®®m®®a®mm®®® Op f MED. SAND/F1NES ' ®®®®�®®®®®®®® ELEK '_ �6/t 52 10 YR 6/6 98,9 IOZR OLA/ION BATE 3 MINUTES PEN /NCH II p /UST BOX; !' » 'I (hl 0 LOAD1 � „ �. +r ��, ; c3 � � hr 01 '�, 'ti' "' r� SANDY LOAM BASIS FOR DESIGN - SET SEPnC TANK AND D/SIR/B1J71ON BOX y', "i', ti 1 y' f' �.'y' s'',y'' +' ti; ti 84" 10 YR 5/4 96.3 DEPTH TO GNOUNOWA7Z NOT ENCOUNTERED ~ ON 6"LA YER OF CRUSHED STONE ";� "''' I� '" C4 '+" ' " MED. SAND/FINES 10 YR 6/4 TOTAL DA/L Y FL Oil//S BASED ON 4 BEDROOMS, NO GARBAGE DISPOSAL PROFILE. " Z INSTALL J14" rn 1 112" 156 90.3 NOT TO SCALE fWAS�/ED, CRUSHED STOVE ALL TOTAL OA/L Y FL OH/ = 110 GPD/BEDPOW X 4 BEDROOMS = 440 GPD AROUND CHARSiRS AND ,00MV TO THE BOTTGl1/ !c' 7HE CHAVWR (-60nw OF TEST HOZF) THE CONTRACTOR SHALL EXCAVATE 5' ALL AROUND PROPOSED BOTTOM AREA.• 430 S.F. SISS7FMF6W&6WEDETAILS AND DOWN TO THE SAND LAYER (ESTIMATED AS 7') AND REMOVE ALL UNSUITABLE MATERIAL AND REPLACE WITH CLEAN COARSE SAND UP TO THE TOP OF THE SYSTEM. PROPOSED S/DE AR IA.- 185 S.F. THE REPLACEMENT MATERIAL SHALL CONFORM TO THE SPECIFICATIONS SET FORTH IN 310 CMR 15.255(3) (TITLE 5) TOTAL PROPOSED LEACH/NG AREA. 5 S.F. APPL/CATION RATE = 0.74 GPD/S.F. DESIGN LEACHING CAPACITY = 455 GPD ,> 440 GPD i 4" i 2 — OUTLETS 1 3/4" OUTLET 00 INLET TYPICAL OF 5 M N �ILET 8" a " g" 4" y 9 - REMOVABLE 24"D/A. CODERS REMOVABLE 24"D/A. COPPER j 2 - OUTLETS 24* �- TEE 6PEN A 76P SET ; PLAN VIEW CROSS-SECTION .�"MIN ��' TA"K cor�R INLET KNOCKOUT / /D OUIZET/(NOCKGiUT INLET TEE SET a//7,rT TEE SET DB-5 DISTRIBUTION BOX (H-20 LOADINGS 10"MIN 6ELoMI 1411BEL00, L/lJ1U/D LEkfZ L/W/D LEYFL lrz� NOT TO SCALE CAS BAFFLE I ° .' % f, d t r 10' - 0" 5' - 2" 11' - ON 6' - 2" 8' 3 1/2" 1500 GALLON SEPTIC TANK (H-20 LOADINGa - NOT TO SCALE 6" ® ® ® ® 0 ® � ® 34" I 24"CONSTRUCTION NOTES: 8' 6" 1. INSTALLATION OF THE PROPOSED SEPTIC SYSTEM SHALL BE IN ACCORDANCE WITH TITLE 5 j AND THE BOARD OF HEALTH REGULATIONS. CROSS—SECTION 8' - 6" 2. A COPY OF THE PLANS SHALL BE AVAILABLE ON SITE FOR REFERENCE AT ALL ;TIMES DURING THE INSTALLATION OF THE SEPTIC SYSTEM. ° • #, 8 KNOCKOUT 3. NO CHANGES TO THE DESIGN SHALL BE PERFORMED WITHOUT APPROVAL OF BOTH 4 21' DIAMETER COVER FALMOUTH ENGINEERING, INC. AND THE BOARD OF HEALTH. 0 r r KNOCKOUT — 5! KNOCKOUT PLOT PLAN "A U S TI N ESTATE" 4. THE SEPTIC SYSTEM IS SUBJECT TO INSPECTION BY BOTH FALMOUTH ENGINEERING, INC. j #65 SCUDDER'S LANE AND THE BOARD OF HEALTH. 4 1 PREPARED FOR 5. THE CONTRACTOR SHALL NOTIFY FALMOUTH ENGINEERING, INC. AND THE BOARD OF HEALTH S" KNOCKOUT BARNSTABLE HARBOR BUILDERS TO INSPECT THE SEPTIC SYSTEM BEFORE BACKFILL. IN SOME INSTANCES," MORE THAN ONE INSPECTION MAY BE NEEDED. THE "' • •' ' IN CONTRACTOR SHALL ONLY BACK;FILL THE PORTIONS OF THE SYSTEM THAT HAVE BEEN INSPECTED AND APPROVED BY FALMOUTH PLAN VIEW BARNSTABLE MA ENGINEERING, INC. AND THE BOARD OF HEALTH. 500 GALLON LEACHING CHAMBER (H-20 LOADINGS PLAN DATE: JULY 9, 2002 PLAN SCALE: 1" = 20' ��H Of MggS 6. IF THE CONTRACTOR ENCOUNTERS ANY VARIATIONS IN THE SITE CONDITIONS, SUCH AS DIFFERING SOILS, TOPOGRAPHY, WETLANDS SCALE: 1' = 2' o���MiCHAELJ�yG,n` BORSELLI CIVIL ENGINEERING WETLANDS PERMITTING OR OTHER CONDITIONS THAT MAY REQUIRE RE-EVALUATION OF THE DESIGN, THE CONTRACTOR SHALL IMMEDIATELY NOTIFY FALMOUTH g '._. CIVIL No 35054 : WASTEWATER DESIGN FALM OU TH COASTAL ENGINEERING ENGINEERING, INC. Q sSGONALP�NU���� ENGINEERINGN TITLE 5 PLOT PLANS PIERS AND DOCKS ��n� c LAND USE PLANNING COMMERCIAL/RESIDENTIAL Servrny Cape Cod and Southeastem Maswchusetts 101 TOWN HALL SQUARE — FALMOUTH, MA — 02540 — 508.495.1225 — 508.495.3229 fax PROJECT NUMBER: 02044 CADFIUE NAME:02044MSTRTPLAN NUMBER 01-31 SHEET 2 OF 2 _ -- ---------- -- - - - - ----- - ——— - - -- --- ----- — - - -- - —_ — _ — --- - _ ___--..