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0076 SURREY LANE - Health
76 SURREY LANE, BARNSTABLE n A= 298 065 III - - ` TOWN OF BARNSTABLE LOCATION StA rVf_c,,,..o SEWAGE# "f�!'Odd VILLAGE �,�,c-r�� `{� I��r���� ASSESSOR'S MAP&PARCEL ao?99 0 b, INSTA LERS ME&PHONE NO. ,�a�� �►cCe.uo.�bo �i®$- �� Q1 �7 SEPTIC TANK CAPACITY /0'J-0 LEACHING FACILITY:(type) ;r K30a 54 (size) i2 X Z. NO.OF BEDROOMS �5oJe,r-04,g �14 v-tz OWNER rro�•� r -6'j's b o 1" PERMIT DATE: d- 1 COMPLIANCE DATE: IS' 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) �� ift, wo,—Feet Edge of Wetland and Leaching Facility(If any wetlands exist within.300 feet of leaching facility) A/d'/ Feet FURNISHED BY J s Li z 3 :5�q r No. �-"I l_ Fee ' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes 9pplitation for Disposal 6pstem Construction Permit Application for a Permit to Construct( ) Repair�_) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.76 5Uf('&V it,, Owner's Name,Address,and Tel.No. gq-Qnls �t�E,r1A� Assessor's Map/Parcel q�} O j� ' �A i' Sauk Installer's Name,Address,and Tel.No. Seg 4117 007 Designer's Name,Address,and Tel.No. Type of Building: ,p Dwelling No.of Bedrooms "tir Lot Size sq.ft. Garbage Grinder( ) Other Type of Building Z19OZ-i c�Q4'f— No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) ��{cb- gpd Design flow provided �� gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank c-� Type of S.A.S. Description of Soils Nature of Repairs or Alterations(Answer when applicable) S e L W Z4 U. L,&4C-A 'vl a Lti 5 {'eol e,e P c-,poi i-C SA"Z G� 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 C and not to pla the system in operation until a Certificate of Compliance has been issued by this Board of Signeij Date « Application Approved by Date ,V // Application Disapprov y Date for the following reasons Permit No.20 Date Issued_z 1 i . No. i�0 I I-- OZ Fee / • a, THE COMMONWEALTH OF MASSACHUSETTS Enteredto lcoinputer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Rpplication for Disposal *pstem Construction Permit Application for a Permit to Construct( ) Repair((,) Upgrade( ,) Abandon( ) ❑Complete System ❑Individual,Components Location Address or Lot No.76 ''SUfr�° 1r7, Owner's Name,Address,and Tel.No. Assessor's Map/Parcel g4jW51��`E� Installer's Name,Address,and Tel.No. (E7 rI od�7 Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building Ft 'r�P�1't— No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 4(4(-D gpd Design flow provided V 4 q gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil 4Ae Nature of Repairs or Alterations(Answer when applicable) Sw,P 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 Co and not to place the system in operation until a Certificate of Compliance has been issued by this Board of H . t . i Sig (� Date Application Approved by ,S, Date 21,?11/ Application Disapprove y Date for the following reasons Permit No.7D 1 f — Date Issued Z THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired Upgraded( ) Abandoned( )by � ` C J��, f t h b at_ �C,r/� has been constructed in accordance with the provisions of Title he for Disposal System Construction Permit No. -7dated S ( j Installer ' ;, 1 Designer i #bedrooms Approved design flow y C/(� gpd The issuance of this permit s all not be construed as a guarantee that the system will function a P g y n/designed. Date a r/ Inspector r�1 /-. , .. =-------------- --.--- -------- _ - No.22 I( Fee /00 . THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal *pstem Construction Permit Permission is hereby granted to Construct( ) Repair(,C) Upgrade( ) Abandon( ) System located at ( and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date 16? : Approved by Feb 17 11 11:55a manny 5084770177 p.1 Town of Barnstable NE Regulatory Services Thomas F. Geiler, Director _ Public Health Division Thomas McKean Director 200 Main Street,RvAnnis. MA 0260.1: Office: 508-862-4644 F,m 5}8.79t?•6:704 Ilnstaller & 0oigner Certification Form Date: 02/1 7/1 1 llcsi;;ner: Shay F3zviriirl� te�ital Services, Inn, Installer. Ronsmlxcavation fkddress: P.O. Box 1.57E Address: 81 FA6 Road Mashpee, M11 __ lylaslz�xL,_yfA On _0112711 I Gr1 S aKC4�?a "�`rt� Was issued a permit to install a (date) septic system at 76 Surrey Lane, Rarnsrablc.•-MA based or a design.dra-wli by (address) - Shay h»vru�?tr7�nta1 Servict;ti, Ire dated Zr'15/I7 (designer) XX I cent, that the septic system ref'erunced abo*%e was installed subswitially accordiriR it) the design, w 1iich may include minor approved changes :such as lateral rclo4�tiol) 01'tht. distribution box and/or septic. tank. -- I certify that the septic 's),stcm rofercriced above was instal3ed .with major clk�,ges (i=c. greater than 10' lateral:relocation ofthc SAS ar a[ly vertical relocation of any component of the sc�A..ic system) but in accordance witll State & Local Regulations. Plain revision or (:ertiiied as-built by designer to follow. (,Installer's 5i;;natu.rc) �., .r . li Weslgifi is Signature') T (!\^ Js l7cwi,�?cr's::�t� Here) PLEASE. Rl,'1'rt.l1tN TO BARNSTABL.E PLRLiIC HrA.>(.:('R 1XV1IS.ION. CERTIFICATE OF COMPLIANCE WILL N@T M. ISSUED UNTIL BOTH THIS FORM AND AS BUILT 1(.'AKD ARJ� RL(-'j;tVEj) BY 't'HP,, BARl~STABLE PUBLIC H*VA:.,TH DIVIS10N. THANK YOU Q. Form Town of Barnstable P# /31Y 1 Department of Regulatory Services seamsr�srB Public Health Division Date V/�1° i639 �� 200 Main Street,Hyannis MA 02601 Date Scheduled o. l� Time / >.. Fee Pd., 1 . Soil uitability Assessment for Sewage isposal Performed By: 1��M b f� 1 � Witnessed By: G� LOCATION& GENERAL INFORMATION Location Address LJ° a Owner's Name 7a,�Ikp_ Address Assessor's Map/Parcel: C;zq 6 165 Engineer's Name NEW CONSTRUCTION REPAIR Telephone# - 1{ _ �:N% Land Use 1'2S\ �-�GSlopes Surface Stones_ /J {} (Dcc- Distances 3 a v I GAT from: Open Water Body ft Possible Wet Area_L4 _ft Drinking Water Well �ft Drainage Way Pr ft Property Line ft Other P IN- SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) U 1 - Parent material(geologic) Depth to Bedrock ►y�( Depth to Groundwater. Standing Water in Hole' 2J690 l3e Weeping from Pit Face 06j�52 I_Ja Estimated Seasonal High Groundwater DETE NATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed scan ng in obs.hole: __— In, Depth to soil mottles: in Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adl.factor Adj.Ciroundwater Level m PERCOLATION TEST Date Tlme,, Observation C c S�S 1S - Hole# QlTtme at 9" Depth of Perc P ;-;-� ` Time at 6" Start Pre-soak Time @ ` ` jl Time(9"•6") End Pre-soak Rate Min./Inch 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:\SEPTICU'ERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# - Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistency,% ravel —1� G42L- ow— 3/a (Z-y 2, ?ts3 S a— 10 Y L L5 �4& Ct rinecA � tal cv�l�le,. 8�-13a C� rued Se •5 Y T/y DEEP OBSERVATION HOLE LOG Hole# Z Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistencv.%Gravel) C-1 L- o Klz 3114. AI I A, CQb-1'�, MeA scry-A A •5Y}I DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. nsi to c Gravel 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 Man: Above 500 year flood boundary No_ Yes Within 500 year boundary No V Yes Within 100 year flood boundary No,____. Yes Depth of Naturally occurring Pervious Material Does at least four feet of naturally occurring pervigtls material exist in all areas observed throughout the area proposed for the soil absorption system? tJ If not,what is the depth of naturally occurring pervious material? Certification t I certify that on I( ?-DO 1 (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,a er' e a d e e 'ence described in 3.10 CMR 15.017. Signature Date _ Q:\.SEPTIC�PERCFORM.DOC f down cape engineering, inc. SIEVE SOILS ANALYSIS 76 Surrey Lane',West Barnstable, MA.xlsx DATE OF REPORT: 1-15-2Q11 JOB : GRAIN SIZE ANALYSIS-SIEVE TEST SITE: 76 Surrey Large, West.Barnstable, MA LOCATION: 115111 Carmen Shay TH I SIEVE ANALYSIS WeightSample(Grams): 284 ' SIZE ;WEIGHT RETAINED % RETAINED % PASSED (sum -------------- .... ...... ._.... -------------- ......... -------- 1" 0 0: 0 0%: 100.0% ---------- _..._....... -------=------ ------ ----------------- 0 0: 0.0%: 100.0%0 • -------------- ---- ---------------------I------------- ---- 1!2", 0 0 ------0-0%: 100.0%0 --------=---- •------ - 3/8" 0 0; 0.0%; 100.0% ---------- �---------------------.--------=---------- #4 0.0; 0.0% 100:0% ---- -------- --• ------------- ---->. -- - •- #10 24 5 8 6% 91.4% #20 72 6 25 6%: 74.4% ----------------------- t-------------- ----4_-_..___. #40 153 4: 54.0%: _ 46.0% _--_'---------%•---------------._•___-185.____ -�- -------- -_-__--•___-3--.--4.7%.- #50 -..............I 65.3%; #80 222.8, 78.5%; ------------- ---------------------------•---------------------_ ---------- - #100 236..6: 83.3%: 16:7% ------------ ---------------=----- ------------------ #200 260.5; - 91:7%; 8 3% PAN: 284.0: 100.0%; 0.0% ------------- ------- -----=----- ,--.0;-_---------------------------------------- SAMPLE: 284 - NOTE: TEST ON PASSING#4 ONLY, 4% RETAINED ON#4 <45% OX: 77 RESULTS: SOIL CLASSIFIED AS AASHTO A,-3 (GRANULAR, FINE SAND) (UNCOMPACTED). PERCENTAGE OF MATERIAL PASSING#4 SIEVE : #4 1.00% (TEST ONLY MATERIAL PASSING#4) OK #5010%-100% OK #100 0%-20% OK #200'0%-5% 8%SLIGHTLY HIGH SAMPLE MISSES TITLE 5FILL SPECIFICATION, SLIGHTLY TOO MANY FINES >85%SAND, NON-PLASTIC RESULTS: PERMEABLE MATERIAL-CLASS 1<5 MIN.IIN. MATERIAL NONCOMPACTED N, - SOIL'DESCRIPTION: MED SAND.WIFINES, 0.74 GPD/SF MATERIAL "m' TOWN OF BARNSTABLE LOCATION .e— SEWAGE # = 171 VILLAGEi ���s ,�J(�/� ' ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. A & B CANCO 775-6264 SEPTIC TANK CAPACITY /, 6,4I /e'l'eg ZOP LEACHING FACILITY:(type) (size) NO. OF BEDROOMS PRIVATE WELL OR UBLIC WATE BUILDER OR OWNER�id�l DATE PERMIT ISSUED: t DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes - No f h Al °'---�'-' TOWN OF BARNSTABLE LOCATION SEWAGE # C7 ( - VTLLAGE " S . ASSESSOR'S MAP &LOT_L Z-G L3-, INSTALLER'S NAME&PHONE NO. C- SEPTIC TANK CAPACITY l o o b LEACHING FACILITY: (type) ���' (size) NO.OF BEDROOMS BUILDER OR OWNER /�"T�00-1., PERMTTDATE: COMPLIANCE DATE: y� 4 Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well arid 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 facili Feet Furnished by ""14, ' v 5� 4t Board of Haalth Town of Barnstable P.O. Box 534 No... Hyannis,Massachusetts 02601 Fim.BAI®Q. ...._...... THE COMMONWEALTH OF MASSACHUSETTS J��e BOAR® OF HEALTH ..........................................OF.......................................................................................... Appliratiou for Uhqpoiial Works Toutitrurtion umi# Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ...... u R R. y L� -----------------------•-- Location-Address or Lot No. Owner Address ..A fl., .eAF...-------------------------------•-•----------------------- M 19.._ -------.---- A Installer Address Q Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) `4 Other—T e of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures ............................... .. W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area.............. .-----sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date.............-.......................... Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water....................... .. Gz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-_-_-_.-__---___.._-__-. a ------------------------------------------------------------•-•-------------------------•---•---......................................................... 0 Description of Soil......................................................................................................................................................................... x U --------------------------------------•-••------------------------•---------•-----------•-....---------••---------•----•-----------•-----------•-------------------------------------•------.......... W --------------------------------------------------•-------.....--------------------------•---------------------------........------------------------------... Nature of Repairs or Alterations—Answer when applicable... .. P�. �---t_�cF.. 1... f------------------------------•----......-•-•---------------------------------------------------------•---------------------------------------•......-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'Al THE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b9eaissued by the board of health. Signed.._ =su ......................•--•...................................... •--. --1.2. �•7•-•-- Date Application Approved By............... --- ........-- 1. Date Application Disapproved for the following reasons:----•--------------------------------------------------------------------------•---------------------•......-- ..-------- ----•-•-•----------•-•---•--•-------------------•--------••------.....-----------....-••---...............------•---------------------------------------••------------------•--...------ Date Permit No......... - .........--------..... Issued------•-------.•---- Date '1 r THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH -•.......................................OF...............................I................. ............................... Appliration for Diipnaal Workii Cnnnitrnrtion runtit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ......7�--- ----`U---- !--, ----------------- or Lot No. r t/ 1.?_) 1 I 1 ..lr ........--•••----.....................•=••............--•--•--------_......--•-•---•••-•-._.... ..........--...................................................................................... Owner Address Installer Address dType of Building Size Lot............................Sq. feet aDwelling—No. of Bedrooms................................ _Expansion Attic ( ) Garbage Grinder ( ) p•, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Pi Other fixtures .........-•••••......-•--•-••••. . W Design Flow............................................gallons per person per day. Total daily flow.............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No.--_____---_-__.--- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth tc ground water......................... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water...______-_______.-.__-. a -----------------------------------------------------------------------------------••---------------......................................................... 0 Description of Soil........................................................................................................................................................................ U W ------------------------------------------------------------------------------•-----•----•-•--••-- --•--••-•-•----------------••--•-•--•-----•---•----•••••------••-••-••----••--••---••-••-•-•--•-•••- U Nature of Repairs or Alterations—Answer when applicable--- _'_.�-------_:_._.!. t3...... ?�: ._ ...._."'I Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with T f1 F'•'� the provisions of�'1 T l i� 5 of the State Sanitary Code—The undersigned further agrees not to.place the system in operation until a Certificate of Compliance has been issued by the board of health. ---- _ Signed ` ==?'raw..-- _ ----------------------------------------- ••• -••..__... Date Application Approved By ..... --------•-------------•••------ Date Application Disapproved for the following reasons-----------------------------------•---------------------------•.------------•--•------------------•-••••-------- ......................••......•-•••••-•-•....-••....•-••-----••-•-•-••••••-•--•--------••....•-•----•----•----••---••....•••---....------.............................................................. Date PermitNo......... '_ ...................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS j BOARD OF HEALTH ~...........,,/.2AZL.<?...........OF...... 1�� +- ;..�+ •,.:s-4 - 2�............................... Trrfifirate of ToutpliFanrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by 1) .... !:� -----------------------------------------------------••-_---- ••- Installer // has been installed in accordance with the provisions of TIT- 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit'No.____-_ dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUgD AS A. GUARANTEE THAT THE SYSTEM WILL FUNCT O SA CTORY. DATE............................ Inspector...... °! --_._-----•-•-•--------------•----------_-••--- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH f. "� NO.. .. /' `Z FEE....ako Rspaao al Workii Tonntriir#ion anti# Permission is hereby granted.__._ ..1__..L��F �..?. .........................:_ ---•-•---•-•------.••••••.......---••••••......................... to Construct ( or Repair (>� an Individual Sewage Disposal System atNo..................... ..!�-...... '_ . ......Z--`-'-�==-•..............-----------------------•-•--------------------------•------•---------------------•--........... Street as shown on the application for Disposal Works Construction Permit fl) _ed.......................................... oar d of Health DATE_ - FORM 1255 HOBBS & WARREN, INC., PUBLISHERS TROY WILLIAMS ,o SEPTIC INSPECTIONS t Certified by MA Department of Environmental Protection (508) 385-1300 19 Hummel Drive South Dennis, MA 02660 rd , COMMONWEALTH OF MASSACHUSETTS �6 EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION COPY ONE WINTER STREET, BOSTON, MA 02108 617.292.5500 Ulu W'ILLIAM F.WELD TRUDY CORE Govcmor Sccretary ARGEO PAUL CELLUCCI DAVID B.STRUHS Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissioncr PART A CERTIFICATION �.h. mow, 4- A/G,o s r A r v—:4,s Property Address: �6 S�''''e ✓�N S 7�1J/G. Address of Owner: Date of Inspection: 9//S /ere (If different) /75 Ar l;�. Name of Inspector: Troy Williams `[,, 4VA, '40C. I am a DEP approved system inspector pursuant to Section 1S.340 of Title S(310 CMR 1S.000) r1�u✓r �(�,,,�« Company Name: Troy Will iams Septic Inspections � Mailing Address: 19 Hummel Drive,_ South Dennis , MA 02660 Telephone Number: 50 8T3 8 5-1 10 0 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 inspection: The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: / Y Passes _ Conditionally Passes Needs Further Evaluation By the Local Approving Authority _ Fails Inspector's Signature:— itJ.c�C['.e'�by Date: 6) The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(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 Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: Al SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: 81 SYSTEM CONDITIONALLY PASSES: Al/,-7 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. Indicate yes,no,or not determined (Y, N, or ND). Describe basis of determination in all instances. If'not determined', explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty(20)years prior to the date of the inspection; or + the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfil".tion, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health (rw1a.d 04/25/97) Page 1 or 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) 76 Surrey Lane,Barnstable,MA Property Address: William&Naomi Arvanites Owner` September 18, 1998 Date of Inspection: 61 SYSTEM CONDITIONALLY PASSES (continued) N/A Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). Describe observations: broken pipe(s) are replaced obstruction is removed' distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed C1 FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: N 14 Conditions exist which require further.evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, Il APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis 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 S ppm. Method used to determine distance (approximation not valid). 3) OTHER SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 76 Surrey Lane,Barnstable,MA Owner: William&Naomi Arvanites Date of Inspection: September 18, 1998 D) SYSTEM FAILS: /YIq You must indicate ei;,.er "Yes" or "No" as to each of the following: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage into facility or system component due to an 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 112 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 Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a 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 I 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. i El LARGE SYSTEM FAILS: /WIA You must indicate either "Yes" or "No" as to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (-i..d 04/15/97) V.o• 3 or 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST 76 Surrey Lane,Barnstable,MA Property Address: William&Naomi Arvanites Owner: September 18, 1998 Date of Inspection: Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: g Yes No _ Pumping information was provided by the owner, occupant, or Board of Health. _ None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or / as part of this inspection. SL _ As built plans have been obtained and examined. Note if they are not available with N/A. .�/ _ The facility or dwelling was inspected for signs of sewage back-up. _ _ The system does not receive non-sanitary or industrial waste flow. ._ The site was inspected for signs of breakout. All system components, excluding the Soil Absorption System, have been located on the site. The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material-of construction, dimensions, depth of liquid, depth of sludge, depth of scum. _The size and location of the Soil Absorption System on the site has been determined based on: J41The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub-Surface Disposal System. _ Existing information. Ex. Plan at B.O.H. Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance unacceptable) 115.302(3)(b)) (s (rwls.d 04/25/91) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 76 Surrey Lane,Barnstable,MA Owner: William&Naomi Arvanites Date of Inspection: September 18, 1998 RESIDENTIAL: FLOW CONDITIONS Design flow: iy g,p.d./bedroom for S.A.S. Number of bedrooms: , Number of current residents: 6 Garbage grinder (yes or no):_YFS Laundry connected to system (yes or no):YES Seasonal use (yes or no): /VO Water meter readings, if available (last two (2) year usage (gpd): 96 �Divo 9 4/( ,, �7)` S(3�>0o ".fir." r Sump Pump (yes or no):_ J6 Last date of occupancy: VC., COMMERCIAUINDUSTRIAL N14 Type of establishment: Design flow:_ gallons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no) Non-sanitary waste discharged to the Title S system: (yes or no)_ Water meter readings, if available: Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System pumpedras part of inspection: (yes or no) A/d If yes, volume pumped: gallons Reason for pumping: TYPE qF 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) I/A Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known) and source of information: _A e.0„-& c" -!- P;4- 4 at dt r s, ( S cp�i— fir^{c ,,,% y f Sewage odors detected when arriving at the site: (yes or no) A0 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 76 Surrey Lane,Barnstable,MA Owner: William&Naomi Arvanites Date of Inspection: September 18, 1998 BUILDING SEWER: IV114 (Locate on site plan) Depth below grade: Material of construction: _cast iron _ 40 PVC _other (explain) Distance from private water supply well or suction line Diameter Comments: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK: (locate on site plan) Depth below grade: 3 �'^� r%•+w w`.YL,',,. J '- Material of construction: concrete _metal _Fiberglass _Polyethylene —other(explain) If tank is metal, list age _ Is age confirmed by Certificate of Compliance _(Yes/No) Dimensions:— q /x- 6 ' /600 cy4//yam Sludge depth: n 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: 6 Distance from bottom of scum to bottom of outlet tee or baffle: /.2" How dimensions were determined: prt>;C . Comments:` (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.)�__ s ,,�� wcy l� L t� /�/o t Cl / S �. Y :,• sAL- Jeo.. GREASE TRAP:—/ -//9 (locate on site plan) Depth below grade: Material of construction: _concrete _metal _Fiberglass Polyethylene 1 other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) (rwls.d 04/25/97) o.... c ..• in SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 76 Surrey Lane,Barnstable,MA Owner: William&Naomi Arvanites Date of Inspection: September 18, 1998 TIGHT OR HOLDING TANK: N119(Tank must be pumped prior to, or at time, of inspection) (locate on site plan) Depth below grade: Material of construction: _concrete _metal _Fiberglass _Polyethylene _other(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm level: Alarm in working order_ Yes; No Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:A/A (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal, evidence of solids carryover, 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, condition of pumps and appurtenances, etc.) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 76 Surrey Lane,Barnstable,MA Owner: William&Naomi Arvanites Date of Inspection: September 18, 1998 SOIL ABSORPTION SYSTEM (SAS):- (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: / leaching pits, number. bh c b 'Le-".C- leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Alternative system: Name of Technology: Comments: (note condition of soil.,\signs of hydraulic failure, level of ponding, condition of vegetation, etc.) `�� i t (.J ¢ S 1� y.,,cl' Gy c � +C .r � d � G✓4 �-i a,,, � y Q CESSPOOLS: (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(cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY: (locate on site plan) Materials of construction: Depth of solids: Dimensions: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (ra ia.ad 04/25/97) Paga 8 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 76 Surrey Lane,Barnstable,MA Owner: William&Naomi Arvanites Date of Inspection: September 18, •1998 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where publicwater supply comes into house) 3ti ' y3r Poo y 4 f f�, 55 - • r � • C 'X6 L�a.�� •Ja •' u•,n, y i 5.Fo., (ravla-ad 04/25/97) „T Page 9 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 76 Surrey Lane,Barnstable,MA Owner: William&Naomi Arvanites Date of Inspection: September 18, 1998 Depth to Groundwater= Feet ""' adjusted high groundwatcr lcvcl Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observation of Site (Abutting property, observation hole, basement sump etc.) V Determine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records Check local excavators, installers Use USGS Data Describe in your own words how you established the High Groundwater Elevation. (Must be completed) E'VI 4►...� ^+ der ko ,h ct v r.,^A t- C... .J� (r—i a.d 04/25/97) fi Fag. 10 of 10 I � r %/ TROY WILLIAMS �E� �-�" SEPTIC INSPECTIONS N.a . Certified by MA Department of Environmental Protection ci-- (508r)-760-1819 40 Old Bass River Road �> South Dennis,MA 02660 1 Commonwealth of Massachusetts ©p� Executive Office of Environmental Affairs Department of Environmental Protection William F.W*ld Trudy Cox* Governor .8-naary ArGw Paul Cellucel David B.Struhs�Conuslorwr LL SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION /1 Property Address: 7� S U `"6 L h �^r�t lam+ b l-e Address of Owner. W 3 1 i w Date of Inspection: G A2 s l5 (If different) �Sw G ) Name of Inspector- y IJ i ���-r'• S Company Name,Address: d Telephone Number. S e-L /9-L J G: 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 inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature � Date- 1 The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(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 Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer,if applicable and the approving authority. INSPECTION SUMMARY: Check A,B,C,or.D: AJ SYSTEM PASSES: 1 have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evahiated are indicated below. B) SYSTEM CONDITIONALLY PASSES:1\11A One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair, passes inspection. Indicate yes, no,or not determined(Y, N,or ND). Describe basis of determination in all instances. If"not determined",explain why not) The septic tank is metal, cracked, structurally unsound,shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a Conforming septic tank as approved by the Board of Health. (revised 11/03/95) 1 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A cc CERTIFICATION (continued) ' Property Address: �6 c�U YY-e.if Owner. Aevck" TG S Date of Inspection: BJ SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pan inspection if(with approval of the Board of Health): broken pipe(s)are replaced _ obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed CI FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: /`/41 Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND 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. Z) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis 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. 3) OTHER (revised 11/03/95) 2 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 7 (J✓r'e—/ Owner. /4i-VCA K 4-es Date of Inspection: (. /azs_ l�6 DI SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. — Backup of sewage into facility or system component due to an 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 1/2 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 Soil Absorption System, cesspool or privy is below the high groundwater elevation. — Any portion of a 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 I 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen. El LARGE SYSTEM FAILS: A/I/ The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: — 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) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 11/03/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Prope1"h'Add 7 C S0.-,-C y L� Owner. Date of Inspection: Check if the following have been done: Pumping information was requested of the owner, occupant, and Board of Health. None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. VA,built plans have been obtained and examined. Note if they are not available with N/A. ✓The facility or dwelling was inspected for signs of sewage back-up. ZThe system does not receive non-sanitary or industrial waste flow J,/The site was inspected for signs of breakout. ZAII system components, excluding the Soil Absorption System, have been located on the site. The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffies or tees, material of construction, dimensions, depth of liquid,depth of sludge,depth of scum. The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. ZThe facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 11/03/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: � ` .5.,r r�y L�. Owner. �yd Date of Inspection: RESIDENTIAL- FLOW CONDITIONS Design flow: yy° gallons Number of bedrooms; e/ Number of current residents: Garbage grinder(Yes or no):_Z S Laundry connected to system(Yes or no): t1-S Seasonal use(yes or no): A/I Water meter readings, if available: S ovc /o�. r -� Q U a Lest date of occupancy: o G c-<,/f o: L d. COMMERCIAL/INDUSTRIAL•A114 Type of establishment: Design flow:----.gal1ons/day Grease trap present: (Yea or no)_ Industrial Waste Holding Tank present: (yea or no)_ Non-sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings, if available: Last date of occupancy: OTHER (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING FXORDS and source of information: / i,a r A - ♦�+ C.� ti/e U S h c� ♦ O dls� QvJfitQ(%System Pumped ae part of inspection: (yea or no)_& If yes,volume pumped; gallons Reason for pumping. TYPE OF SYSTEM Septic tank/d skibu490 madsoil absorption system Singie cesspool Overflow cesspool Privy Shared system(yea or no) (if yea, attach previous inspection records, if any) Other(explain) -b APPRO)aMATE AGE of all oompo eats, date installed(if!mown)and source of information: A� L c�c a!L* Hk 1 Sc phi .,,,1, 6', y/�t� / CL Sewage odors detected when arriving at the site: (yes or no) (revised 11/03/95) 5 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C `` SYSTEM INFORMATION(continued) Property Addr sw 76 S v✓rG y L h. Owner. r Date of Inspection: SEPTIC TANK:_✓ (locate on site plan) Depth below grade:_3 S e.-5 Material of construction: ✓concrete_metal_FRP—other(explain) Dimensions: �5"' X 9 k G 6 O p Sludge depth: V Distance from top of sludge to bottom of outlet tee or baffle: a2 Scum thickness: / /' Distance from top of scum to top of outlet tee or baffle: 6 Distance from bottom of scum to bottom of outlet tee or baffle: IS Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, de h of liquid level in relation to outlet invert,structural integrity, evidence of leakage, etc.) S W/< ✓ c i c.( }a , C-1 o ✓ A y o r c A ✓ !) S i C„h S 7` /-e!� K..A G C)or f-�j�✓ 1'J I iJ GREASE TRAP: ,q (locate on site plan) Depth below grade: Material of construction:_concrete_metal_FRP_other(ezplain) 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: Comments: (recommendation for pumping, condition of inlet and outlet tees or banes, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage,etc.) (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ^� cc / SYSTEM INFORMATION(continued) Property Address: / J v r✓C y L[•� . Owner. Date of Inspection: G /,2 r 1`4 C TIGHT OR HOLDING TANK:1V(/) (locate on site plan) Depth below grade: Material of construction:_concrete_metal_FRP—other(explain) Dimensions: Capacity:- ¢allons Design flow: gallons/day Alarm level: Comments: (condition of islet tee,condition of alarm and float switches,etc.) DISTRIBUTION BOX:_'t#11 (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal, evidence of solids caxTyover,evidence of leakage into or out of box, etc.) No OA f- o h o. s G ✓ , PUMP CHAMBER:- (locate on site plan) Pumps in working order:(yes or no) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 11/03/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C /SYSTEM INFORMATION(oontinued) Property Address: 76 So trr G/ L L. .. Owner. /�r✓�.�„ , � L S Date of Inspeotion: SOIL ABSORPTION SYSTEM (lOcaA an sets Plan,if possible;excavation not required, but may be approximated by non-intrusive methods) If not determined to be present,explain: Type: leaching pits, number'O h L. b /k� �� GCS leaching chambers,number:_ leaching galleries, number leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Comments: (note condition of so' signs of hydraulic failure, level of pond�� ��ion, J e G, CESSPOOLS:LV119 (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 oonstruction: Indication of groundwater: inflow(cesspool must be pumped as part of inspection) 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.) (revised 11/03/95) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (conned Property Address: 76 Su r r c y L" . Owner: I S Date of Inspection; SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' / y� 3h y3 I �Y6 � ��� 1. S Ave, C- DEPTH TO GROUNDWATER Depth to groundwater: -- feet — adjusted high groundwater level method of determination or approximation: 140 ,revised 6/15/95) 9 SECTION A _A 2-18 DIAM. ACCESS MANHOLES SITE LOCUS OCUS MAiN STREET - RT 6A PROFILE VIEW OF LEACHING SYSTEM 1•`�•�-� = '�-'"y':•-== : ''' * VENT PIPES*Least 24 inches tall) 4 . p' NOTE: ALL PIPES ARE TO BE 4" SCHEDULE 40 P.V.C. Schedule 4d PVC w/Charcoal Odor Filter Not t0 Scale 5 J Maras m old 10' min. from .-. � Existing Foundation house to septic tank o ! " 1 .2" hashed Feasto'ns � / `• � 0 2 m o S• tank coven must be D-BOX cover must be 8" f /8 / TOP OF FOUNDATION ELEV. 100.00 wrylhin a in, of finished grade wfthin a In, of finished grads 8/4" to ! ! 2 " Washed Crushed Stone ` \ OUT Q C� °' -6 p Grads over Septic Tank- 98.00 Grade over D-Box-98.00 de over SAS-98,00 Mi THE ACCESS COVERS FOR THE SEPTIC TANK, Z O o / Z ,ITE •; Q �^;Ii It.��• Y ar NOW 4" PVC (CAPPED) INSPECTION PORT TO BE 1' _ �;• DISTRIBUTION BOX AND LEACHING COMPONENT >_ ei o a ";tv''nf,¢`''�^;; 'f..i•'^^'+' T'.•:,,�.,'•A,, SET DEEPER THAN a INCHES BELOW F IISHED S ,06 � e, S r 0,02 s HOLE H-2O I INSTALLED AND TO BE WITHIN 6" OF GRADE GRADE MALL BE RAISED TO WITHIN a OF c EXIST. S-0.01 or Greater DIST. Box STEEL REINFORCED PRECAST CONCRETE a + 3' Maximum Cover Top OF System-Elw. -94.Tb FINISHED GRADE. A rXIS1,PM 1O $. 1000 GAL. So 0 01"Per foot ELAN 1N V�EW INSTALL TUF-TITE GAS BAfRLLES OR EQUALS FROM EXIST, FOUNDATIQN � � SEPTIC TANK n ui N 15' 3-2e REMOV BLE COVERS CONCRETE Fuu. O) li H-10 0eA°epM „ M rn n * 2' EFFECTIVE DEPTH 2 4" Ef f e c tZZ e ii t •'". :,: 4- s'::, GENERAL NOTES e�i 8 in.of 3/4"-1 1/2" .t 4 + g ._�..�.1 S'bGe2UGYi � r: "+•• :. C compacted steno o' 4 rn 5 UYhItS @ 6,25' _ 31.25 8 min. m2 ms meat to outlet it I,l._.mi e"Z 1. Contractor is responsible for Digsafe notification, Verification of Utilities a 11 OUTLET .; p 31,25' L�qulTTswi" - and protection of all underground utilities and pipes. E e E4fective Width 0"min• 14' " 3 a 5' 5' fi+_ a __,. ;' b+ _7. 2. The septic tank a distri L#ion box shall be set Not to Scale 6 in.of 3/4"-t 1/2- w level on 6" of ' 44 1 1�2 stone. g Effective Length «: 3. Backfill should be clean sand or gravel with no compacted stone 4'-0 min. NOTE: ALL COMPONENTS MUST HAVE RISERS TO WITHIN 6" BELOW GRADE m 36.25' •S Liquid depth stones over 3" in size. 4 stem 's b inspection ring installation L�7 Bottom of Test Hole 1 Elev.- 87.00 SOIL ABSORPTION SYSTEM (SAS) „ �••• Carmen E. Sho,e- Environmental Servicesinc. This _ _ _ _ ,,� .:. " c'• f•• .W., +'' f by C Y Groundwatsr Observed- NONE OBSERVED 5. The contractor shah install this, system in accordance CULTEC 3050 INFILTRATOR CHAMBER H--20 (OR EQUIVALENT) 4 -10 with Title V of the Massachusetts state code, the approved plan QRM SE T{� IQ END-2 QTIO and Local Regulations. NOTE: OVERALL HEIGHT OF INFILTRATOR IS 30" /EFFECTIVE HEIGHT IS 24" 6. If, during installation the contractor encounters any TYPICAL 1000 QALLQN SEPTIQ T4N� soil conditions or site conditions that are different from those shown on the soil log or in our design NOT TO SCALE installation must halt & immediate notification be made to Carmen E. Shay - Environmental Services, Inc. 7. No vehicle or heavy machinery shall drive over the l / 6 PERCOLATION TEST septic system unless noted as H-20 septic components. Date of Percolation Test: 1/05/11 8. Install Tuf-Tate gas baffles or equals on all outlet tee ends. �► W Y 7 i '' Test Performed By. CARMEN E. SHAY, R.S., C.S.E. 9. All Distribution Lines shall be 4" diameter Sch. 40 NSF PVC pipes. Results Witnessed B David Stanton, .,,•• �' OF �,,,..--' �\�� , � �„�� y. Barnstable BOH 10. All solid piping. tees & fittings shall be 4 diameter SJ F00-� R1GH �r ��O�.t oa+19 ,�, /�,� '��,,. EXCAVATOR: Shay Environmental Services, Inc. Schedule 40 NSF PVC pipes with water tight joints, Cqp r -� 3 / 6.00 /� /r, f $ Percolation Rate: <5 MPI 84 per seive analysis. 11. MUNICIPAL WATER iS CONNECTED TO THE SITE and Surrounding 8 Test Hole Test Hole Properties. No. 1 No. 2 DEPTH SOILS ELEV. DEPTH SOILS ELEV. / r oe //" % .''/ .'�' r'' 0 9800 0 98.00 !/ Oqv ,•�" '' � Andy any THE PROPERTY LINES ARE APPROXIMATE AND Loam Loam COMPILED FROM THE PLAN BY CHARLES SAVARY INC. aj N�+ ,+''�, , �,' ; ,,.'' r��' a� 10 YR 3/2 10 YR s/2 ENTITLED "SUBDIVISION PLAN OF LAND IN OF BACON FARM ESTATES N�_ r 0"-12 Ap 97.00 0`8" A, 7. 3 , BARNSTABLE. MA" DATED MARCH JUNE 27, 1972 / // , '', �� ' , , ' �� �,. ' ""90 Sand LOAMY PLAN BOOK 260 PAGE 42. i y Loam / /f/,, 'A�� y�'� /�, '/� '���i '�'�, fr��./'f� LOT #28 10 YR S/b 10 SAND YR b/8 AND IS NOT INTENDED TO BE A SURVEY PLOT PLAN -9 IT SHOULD BE USED FOR NO PURPOSE OTHER THAN %v '' �' 1 ! �''�'� ''' �''� 12"-48" 8, 94.67 8"-fio" Bs 93.00 THE SEPTIC SYSTEM INSTALLATION. � Sift Loom Med, Sand ASPHALT i / �' .' �' �' 9 NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE �•' .•^'` 2,b Y 8/2 2.b Y 7/4 DRIVEWAY { /'$Lo r' „ „ „ FROM THE EXISTING LEACH PiT TO BE DISPOSED 48- 84 C, 91.00 60 -132 1 ' ' '/ k' 'r/' ''/ 'ter/ _-96 Med. Sand C, $7� OF AS PER BOARD OF HEALTH SPECIFICATIONS. 'XI PARTIAL STRIPOUT 2.5 Y 7/4 EXISTING LEACH PIT TO BE PUMPED DRY & -_______gg Note: Remove soil down to el. 91.00 & replace with FILLED IN PLACE 84"- 132 C, 87.00 clean coarse sand w/perc. rate less than or or equal to 2 min./in. before & after placement 1 i, , , 1 , ,,' ,,,..-- gg`�.-_---_--- -_ (5 FOOT STRIPOUT ALL AROUND AS SHOWN) I -- ��� ASSESSORS MAP - 298 PARCEL 065 \ i / Perc #1 ZONING RESIDENTIAL Depth to Seive Sample: 84 ,p _ Pere Rate- <5 MPI per Salve Analysis NO WETLANDS ARE PRESENT WITHIN 200 OF THE PROPERTY \1 / i/!/ i �'� ,� �Cp,, IDS Groundwater Not Observed ' PROJECT BENCH MARK '1 t i /' >� l i i �' �' �: 1 No Observed ESHWT TOP OF FOUNDATION ' ` 1 t ' 1 %'� 1 % '� ° , �' i ADJUSTED H2O Elev. _ 1 t 1 1 1 I/ �... , , I i � / i r © , None ELEV. = 100.00 (Assumed) ALL OUTLET PiPES FROM THE DISTRIBUTION BOX SHALL BE ��/ SET LEVEL FOR AT LEAST 2 FT. 12" CONCRETE COVER 1 1 1a ► , , , - " , .,.. LEGEND 8 5 OUTLET . �, 2 #78 KNOCKOUTS , ,,'' OUTLET ) 12" INLET S8X0 DENOTES PROPOSED EXISTING , t 1� 4 BEDROOM / von - �` ', ,s SPOT GRADE t 2 /� Pi ' ' X 104.46 DENOTES EXISTING e' 11 1 I t 1 i 1 i 1 !' '1 1 / HOUSE / Pipe 15.5" 1. SPOT GRADE 1 1 \ / / / ;\ \ 1 1 11 / Mp,� ' • ', L N-- I N PROPERTY LINE CRQS� S�CTIQN p� -- ,DECK ; .�' ti��" •a' �''� ) HOLE DISTRIBUTION BOX H2O PROPOSED CONTOUR 1 I W I „� ' f�, z / NOT TO SCALE 1 CV , , I , tl �I \ f '' • .w � 97-- --97 EXISTING CONTOUR r 1 co t 1 / i 1 1 \\ ! 1 EXIST. 1\ \\ l ' 1000 gal. \\\ �� •, S /TEST HOLE #1 t\ ASPHALT \ \ Septic TO DEEP TEST HOLE & DRIVEWAY ELEV.- 98.00 Number of Bedrooms: 4 Equivalent to 440 Gal./Day 1 \ 1\ >-. \ Garbage Grinder: No PERCOLATION TEST LOCATION \gg1 \\ �' \ D-Box / �6 Leaching Capacity Proposed: 330 Gal./Day Minimum ^ \ <� 9(�• O Septic Tank : - 2 x 440 Gal./Doy -880 USE EXIST. 1,000 GAL. TANK FENCE i i 11 \\ `�` �� \� /r FAILED SOIL ABSORPTION AREA: Using percolation rate of <5 Whin./inch LEACH PIT TEST HOLE 2 cj Bottom Area: 0.74 gal/sq. ft. x 435 sq. ft, - 321.90 gallons PRIVATE DRINKING WATER WELL ELEV.= 98.00 09 Sidewoll Area: 0.74 gal./sq. ft. x 193 sq, ft. - 142.82 gallons Providing: = 464.72 gallons LOT #26 * LOT #27 Use: (5) 3050 H-20 INFILTRATOR CHAMBERS, HAVING A 2' EFFECTIVE DEPTH, REVISIONS 1, j i �, �\ \\\ \��� �� 36,358 Square Feet +/- Via, (4'�W x 6.25' L) TO BE USED WITH 4' OF WASHED STONE ON THE SIDES AND N0. DATE: DEFINITION :1 DE, HQU5E FLOOR SCHEMATIC1 , 1 \\ \ 2.5 OF WASHED STONE ON THE ENDS, (Description Provided By Owner) FamilyRoom 1 1 ' i I '1 C ' I r0 Living Room ; �, � I i 1 � \\ , O z Kitchen Dining i� i i ,/ ,. / , 1 PROPOSED GARAGE � J '4` ' it II �• / i! 12g'13 � � t 1 PREPARED 30„� 1 a FOR .7-1Iy ; N 74D s00 SUBSURFACE SEWAGE DISPOSAL SYSTEM 1st FLOOR OF GIRARD C . BRISBOIS 76 SURREY LANE 1 76 SURREY LANE WEST BARNSTABLE, MA LOT #25 WEST BARNSTABLE, MA 02630 PREPARED BY: Bedroom Y f rARHEY E. ASHA Y 02 VARIAUC,E REQUESTED: 0 20 40 50 $. r ENVIRONMLrNTAL SERVICES, INC. 1. REQUEST A VARIANCE TO INSTALL A SAS MORE THAN 3 FEET BELOW GRADE P.O. BOX 1576 ATTIC STORAGE Bedroom M �° A 4" PVC VENT HAS BEEN PROVIDED. .' MASHPEE, MA 02649 Iry 2. REQUEST A VARIANCE TO SUBSTITUTE A SEIVE ANALYSIS FOR A PERCTEST. SCALE: 1"=20' THE PROJECT IS A REPAIR WITH NO ADDITIONAL INCREASE IN FLOW PROPOSED. TEL/FAX 508-539-7966 2nd FLOOR SCALE: 1 "=20' DRAWN BY: CES DATE: JAN. 21, 201 1 PROJECT#SD--1202 ILENAME: SD1202PP.DWG SHEET 1 OF 1