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0238 CRAIGVILLE BEACH ROAD UNIT #A - Health
-238 Cccrasgwi he Beach Road v,y f 4 k 41 ; •,� ! . r Flyannis'µ f. i� 0 Fax Send Report MAR-29-201312:53 FRI Fax Number • 15087906304 Name BARNST HEALTH Name/Number GMD / 915088624782 Page 1 Start Time MAR-29-2013 12:53 FRI Elapsed Time 00'16" Mode STD ECM Results [O.K] Town of Barnstable Health Inspector OfTicc Ilours erne Regulator Services . Y 13:30-4:30 cj '1'bomas F.Geiler,Director 3:30—4:30 • rA Public Health Division NAA4 Thomas McKean,Director 21111 Main Street,liyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 AMNFSTY PROGRAM APPLICANT-SEPTIC UES"1'IONNAiRE ag 2oi3 Mu•cqn Date:Febrrarry 20,2013 1. General Information: Size of Property:28 acre Address:239 Craigville Reach Road Hyannis MA 02601 Map 267 Parcc1 120 Name:Mitchell B.Brown and 1{era M.Brown Phone N:843-252-4000 2a. How many bedrooms exist at your property now?5 9 4 in main house- I in apartment) 2b. Are you planning to add any bedrooms?NO _ If yes,how many? 0 2c. ITow many bedrooms lull are proposed at this property(including the amnesty Unit)?4 in main house and 1 in accessory apartment 2d.Please include a copy of the floor plans for the entire property. Neatly use a straight-edge. Show all existing rooms in the dome and the proposed aruucsty apartment. Provide width measurements of any open doorways;Please label each room clearly. 3. Is(lie dwelling connected to Public sewer? NO If the dwelling is connouled to public sewer,skip questions#4 through#9 below. 4. Location of dwelling is OUTSIDE a Saltwater Estuary Protection Zoue? Z � O 5. Location of dwelling is iNS1DU: a Zone ofContribulinn to public supply wells?WP 6. is the dwelling connected to an PUBLIC WATI''R :+. T �7 �Q 1 7. Is a disposal works construction permit on file'! YFS t.n o r 8. If yes,how many bedrooms were approved according to this permit? _ 5_Bedrooms. 9. Were any building permits obtained for construction of additional bedrooms? YES or NO 10, Ts there an engincored septic system plan on file at the Health Division? YES' or NO 1 I. Has the setio system been inspected by a DF.P certified inspector within the last two years'! YFS or NO FURUFMI-r.IMF.ONLY 2V 0 033 The Public flealth Division has no objection to bedrooms at this property. Special Conditions: Sign : -_ Date: 3 Z i McKean, Thomas From: McKean, Thomas Sent: Friday, March 29, 2013 1:56 PM To: Dabkowski, Cindy Subject: APPLICATION APPROVED- 238 Craigville Beach Road/Mitchell Brown and Kera Brown Good Afternoon, I just FAXED over the application approval for the above-referenced address to your Office. The revised floor plans now show five bedrooms total. The new plan now shows a five feet opening provided in between two rooms. The wall is to be deconstructed by a licensed contractor. Five bedrooms are allowed at this property. Sincerely, Thomas McKean -----Original Message----- From: McKean,Thomas Sent: Tuesday, March 19,2013 5:10 PM To: Dabkowski,Cindy Subject: APPLICATION DENIED- 238 Craigville Beach Road/Mitchell Brown and Kera Brown The submitted floor plans show five bedrooms, plus a private"sun room' on the second floor adjacent to the apartment bedroom. This room meets the definition of"bedroom" and therefore the submitted floor plan shows a total of six bedrooms. However, the septic system is designed for only five bedrooms. The privacy to the sun room would have to be removed by providing a five feet opening in the doorway to the sunroom and by removing the door. -----Original Message----- From: McKean,Thomas Sent: Wednesday, March 13, 2013 8:18 AM To: Dabkowski,Cindy Subject: 238 Craigville Beach Road/Mitchell Brown and Kera Brown I received an amnesty septic questionnaire yesterday for the above referenced address. The Health Division has no objection to five bedrooms total at this property. However the submitted floor plans are not labeled. Please submit labeled floor plans. 1 f McKean, Thomas From: McKean, Thomas Sent: Tuesday, March 19, 2013 5:10 PM To: Dabkowski, Cindy Subject: APPLICATION DENIED - 238 Craigville Beach Road/ Mitchell Brown and Kera Brown The submitted floor plans show five bedrooms, plus a private"sun room' on the second floor adjacent to the apartment bedroom. This room meets the definition of"bedroom" and therefore the submitted floor plan shows a total of six bedrooms. However, the septic system is designed for only five bedrooms. The privacy to the sun room would have to be removed by providing a five feet opening in the doorway to the sunroom and by removing the door. -----Original Message----- From: McKean,Thomas Sent: Wednesday, March 13,2013 8:18 AM To: Dabkowski,Cindy Subject: 238 Craigville Beach Road/Mitchell Brown and Kera Brown I received an amnesty septic questionnaire yesterday for the above referenced address. The Health Division has no objection to five bedrooms total at this property. However the submitted floor plans are not labeled. Please submit labeled floor plans. 1 1 i Town of Barnstable Health Inspector pEVE 1p Regulatory Services Office Hours .p 8:30—9:30 Thomas F.Geiler,Director 3:30—4:30 i BARNSTABLE, Public Health Division y� MASS. 1639. Thomas McKean'Director ACED MAC A 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 ; AMNESTY PROGRAM APPLICANT — SEPTIC QUESTIONNAIRE ko,,ch..a'�?,2013 Dater Pebrwwy 20,2013 1. General Information: Size of Property: 28 acre Address: 238 Craigville Beach Road Hyannis MA 02601 Map 267 Parcel 120 Name: Mitchell B. Brown and Kera M. Brown Phone#: 843-252-4000 2a. -How many bedrooms exist at your property now?5 9 4 in main house— 1 in apartment) 2b. Are you planning to add any bedrooms?NO If yes,how many? 0 2c. How many bedrooms total are proposed at this property(including the amnesty unit)?4 in main house and 1 in accessory apartment 2d.Please include a copy of the floor plans for the entire property. Neatly use a straight-edge. Show all existing'fooms in the home and the proposed amnesty apartment. Provide width measurements of any open doorways' Please label each room clearly. 3. Is the dwelling connected to public sewer? NO If the dwelling is connected to public sewer,skip questions#4 through#9 below. 4. Location of dwelling is OUTSIDE a Saltwater Estuary Protection Zone? , 7 5 . Location of dwelling is INSIDE a Zone of Contribution to public supply wells?WP k� C.'D 6.. Is the dwelling connected to an PUBLIC WATER , 7. Is a disposal works construction permit on file? YES 5J N rn 8. If yes,how many bedrooms were approved according to this permit? 5_Bedrooms. try 9. Were any Building permit's obtained for construction of additional bedrooms? YES or NO 10. Is there an engineered septic system plan on file at the Health Division? YES or NO 11. Has the septic system been inspected by a DEP certified inspector within the last two years? YES, or NO ------------------------------------------------------------------------------------------------------------------- FOR OFFICE USE ONLY -;; D/0 •-(- The Public Health Division has no objection to �D bedrooms at this property. Special Conditions: Sign Date: 1 amcopy&printcenter 'ComplimentarySelf-Serve Fax Cover Sheet r/ To: From: � ��cY�CsLcJrl Fax#: — — Phone Date _ Reply Fax#: Number of Pages (Including Cover): Urgent Confidential El Confirm Receipt [] �e�/1ed to f 1o�s per � 0 I� - n h,.a vie Ste, •`� S - �I OT d i ri ht the first time guaranteed.��� I-e v iLtd 9 . • • Black 8 white copies•Color copies•Custom printing•l�ind'u�y•Folding Wide-lornwt copying Custom stamps UPS Dipping Auld more r I �'w 5I06U12sY_OOeSt5 90/10 39Vd £0ZSTLL809 C5:81 £TOZ/9Z/£0 03/26/2013 18:54 5087715203 PAGE 02/05 C'J Il J M 0 a h N m r Z A . N r z 6 C LeSET 3 r N f 0 v n 0 1S 03/26/2013 18:54 5087715203 PAGE 04/05 3 , G � c l � o s 0 3' a V e N - � s �1 03/26/2013 18:54 5087715203 PAGE 03/05 L N l rA G ve-CM I A � �aro.ge �1; I I 7 �000 'Cy/lyq �rJ gpi�nol _ �vp)� 03/26/2013 18:54 5087715203 PAGE, 05/05 FroA a X. p^3 Sir%k vugpJ► 1p 5� �IOoI O� ;A own of Barnstable Health Inspector FTHE t Regulatory Services Office Hours �o oyti g y 8:30—9:30 o� Thomas F.Geiler,Director 3:30—4:30 * BABN9rABLE, : Public Health Division 9 DiAss. g 1639. Thomas McKean Director .oTFp�,Ip � 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 AMNESTY PROGRAM APPLICANT — SEPTIC QUESTIONNAIRE Date:February 20,2013 1. General Information: Size of Property:28 acre Address: 238 Craigville Beach Road Hyannis MA 02601 Map 267 Parcel 120 Name: Mitchell B. Brown and Kera M.Brown Phone#: 843-252-4000 2a. How many bedrooms exist at your property now?5 2b. Are you planning to add any bedrooms?NO If yes,how many? 0 2c. How many bedrooms total are proposed at this property(including the amnesty unit)?4 in main house and 1 in accessory apartment 2d.Please include a copy of the floor plans for the entire property. Neatly use a straight-edge. Show all existing rooms in the home and the proposed amnesty apartment. Provide width measurements of any open doorways. Please label each room clearly. 3. Is the dwelling connected to public sewer? NO If the dwelling is connected to public sewer,skip questions#4 through#9 below. 4. Location of dwelling is OUTSIDE a Saltwater Estuary Protection Zone? 5 . Location of dwelling is INSIDE a Zone of Contribution to public supply wells?WP o 6. Is the dwelling connected to an PUBLIC WATER? Mt 7. Is a disposal works construction permit on file? YES =r- 8. If yes,how many bedrooms were approved according to this permit? 5_Bedrooms. 9. Were any building permits obtained for construction of additional bedrooms? YES or NO �w���Dy Y iV M 10. Is there an engineered septic system plan on file at the Health Division? YES or NO 11. Has the septic system been inspected by a DEP certified inspector within the last two years? YES or NO ------------=------------------------------------------------------------------------------------------------------ FOR OFFICE USE ONLY The Public Health Division has no objection to bedrooms at this property. Special Conditions: Signed: Date: ti�� �bbaro� 1. l�4Eu Hc,ke &;Ie e rron� ' �-aw��s ��• POP Llosj Sink. waoay�,lp� S�e< 5�-artuSe, 'Foy It� °`P J 0 a S 3 F, 0 s c� y E ^Q Yam^^ V • J N J z � N . J u d � � H 11 -t^ S 1`� J y J s 0 J ' T 0 d J � o � ys o � 4n � X 0 M s� of • �n I� � J a h a • N S H r i � s L '3 L I� fl 0 i- I ---r Gl� _ 11 .9 J 0 .o J ,i+ o ' �' v —5" d y f /� O ..s �. I y -� � � `� � D � � O f f�� , -+ a .., 0 � � s o "� o � � ` � � � 'J I � �g of �/� 1 f IOC Gmene, 'Door 1 Firt�el�•ce.— w�sk� p,y�r LtOS�T 5 nk SI�WeI . ��w�ec•Se. McKean, Thomas From: McKean, Thomas Sent: Wednesday, March 13, 2013 8:18 AM To: Dabkowski, Cindy Subject: 238 Craigville Beach Road/Mitchell Brown and Kera Brown I received an amnesty septic questionnaire yesterday for the above referenced address. The Health Division has no objection to five bedrooms total at this property. However the submitted floor plans are not labeled. Please submit labeled floor plans. 1 r Town of Barnstable Health Inspector oFt"e roq, Regulatory Services Office Hours 8:30-9:30 y� o� Thomas F.Geiler,Director 3:30—4:30 B,RNSTABLE, : Public Health Division MASS. �ArFD MP'I A10 Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 AMNESTY PROGRAM APPLICANT — SEPTIC QUESTIONNAIRE Date:February 20,2013 L General Information: Size of Property: 28 acre Address: 238 Craigville Beach Road Hyannis MA 0.2601 Map 267 Parcel 120 Name: Mitchell B.Brown and Kera M. Brown Phone#: 843-252-4000 2a. How many bedrooms exist at your property now?5 2b. Are you planning to add any bedrooms?NO If yes,how many? 0 2c. How many bedrooms total are proposed at this property(including the amnesty unit)?4 in main house and 1 in accessory apartment 2d.Please include a copy of the floor plans for the entire property. Neatly use a straight-edge. Show all existing rooms in the home and the proposed amnesty apartment. Provide width measurements of any open doorways. Please label each room clearly. -- 3. Is the dwelling connected to public sewer? NO If the dwelling is connected to,public sewer,skip questions#4 through#9 below. 4. Location of dwelling is OUTSIDE a Saltwater Estuary Protection Zone? 5 . Location of dwelling is INSIDE a Zone of Contribution to public supply wells?WP 6. Is the dwelling.connected to an PUBLIC WATER? Y= Q 7. Is a disposal works construction permit on file? YES '7) 8. If yes,how many bedrooms were approved according to this permit? 5_Bedrooms. Vol. 9. Were any building permits obtained for construction of additional bedrooms? YES or NO M 1 10. Is there an engineered septic system plan on file at the Health Division? YES or NO 11. Has the septic system been inspected by a DEP certified inspector within the last two years? YES or NO ------------------------------------------------------------------------------------------------------------------- FOR OFFICE USE ONLY The Public Health Division has no objection to bedrooms at this property. Special Conditions: Signed: Date: Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments i 238 Craigville Beach Road Property Address Linda Brownell Owner Owner's Name information is Hyannis MA 02601 12/24/2012 required for y every page. City/Town State Zip Code Date of Inspection i 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. i Important: A. General Information When filling out forms on the computer,use 1. Inspector: only the tab key to move your Wayne Archambeault cursor-do not Name of Inspector use the return key. Company Name box 914 Company Address Hyannis MA 02601 Cityrrown State Zip Code 508-775-1362 355 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 i ❑ Needs Further Evaluation by the Local Approving Authority 12/24/2012 lnspector'rSignature ' 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 i 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. i l5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 9 INN Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 238 Craigville Beach Road Property Address Linda Brownell Owner Owner's Name information is required for Hyannis MA 02601 12/24/2012 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will I 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: I ❑ 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. I 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•11/10 TAIe 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments t i 238 Craigville Beach Road Property Address j Linda Brownell i Owner Owner's Name information is required for Hyannis MA 02601 12/24/2012 every page. City/Town 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: i ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. El ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. i ❑ 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 i ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply i the system is located in a nitrogen sensitive area (Interim Wellhead Protection j ❑ ❑ 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. l5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 238 Craigville Beach Road Property Address Linda Brownell Owner Owner's Name information is required for y H annis MA 02601 12/24/2012 every page. City[T'own State Zip Code Date of Inspection D. System Information Description: i I 1 I Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes N No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Date Date i Commercial/industrial Flow Conditions: Type of Establishment: i i Design flow-(based on 310 CMR 15.203): Gallons per day(gpd) I Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present. ElYes ❑ No � Industrial waste holding tank present? ❑ Yes ❑ No I Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No i Water meter readings, if available: i t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 I i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 238 Craigville Beach Road Property Address Linda Brownell Owner Owner's Name information is Hyannis MA 02601 12/24/2012 required for State Zip Code Date of Inspection every page. City/Town D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: installed 5/5/2010 permit#2010-033 i Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 1.5' Depth below grade: feet Material of construction: ❑cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): .6' Depth below grade: feet Material of construction: ®concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain) 2 tanks(1) 1000st (2)2000st both tanks pumped nov 2012 ` If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No (1) 8.5x5x5 (2) 12x5x5 Dimensions: (1) 0" (2) 0" Sludge depth: t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 i Commonwealth of Massachusetts = Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments g p , i 238 Craigville Beach Road Property Address j Linda Brownell 1 i Owner Owner's Name information is Hyannis MA 02601 12/24/2012 required for State Zip Code Date of Inspection every page. City/Town D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, i liquid levels as related to outlet invert, evidence of leakage, etc.): i i 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 t5lns.11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments j I M 238 Craigville Beach Road Property Address Linda Brownell Owner Owner's Name information is required for Hyannis MA 02601 12/24/2012 every page. City[Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ® leaching galleries number: 5 ❑ 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.): 5 3050 infiltrators with four feet of stone around no signs of liquid in observation port Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert i Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•1111Q 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 238 Craigville Beach Road Property Address Linda Brownell Owner Owner's Name information is required for Hyannis. MA 02601 12/24/2012 every page. Cityrrown State Zip Code Date of Inspection D. System'Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: F� hand-sketch in the area below ® drawing attached separately t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 115 of 17 Commonwealth of Massachusetts j Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments i i 238 Craigville Beach Road Property Address Linda Brownell Owner Owner's Name information is required for Hyannis MA 02601 12/24/2012 . every 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 i ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file 1 l 1 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 I AsBuilt Page 1 of 1 TOWN OF BARNSTABL LOCATION " A., ac.�r SEWAGE# 0/0 d� 3 _ .3 VILLAGE ASSESSOR'S MAP&PARCEL!?-6 INSTALLER'S NAME&PHONE NO. .412 C,4 :;vim r 5'c.7- SEPTIC TANK CAPACrrY,--rx..S/ i&010ivf s;� coo LEACHING FACILITY c/ �tYP� ..�C i..�;;/T� .�d��(size) NO.OF BEDROOMS j , OWNER , c/pp, /3g-o,. v z/ PERMIT DATE: A /d .COMPLIANCE DATE: p Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility, Private Water Supply Well and LeachingFacility(If any wells exist Feet on site or within 200 feet of leaching facility) Edge of Wetland and LeachingFacility Feet tlrty(If'any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY J? Irl � s.3oi 0 233= 3,F' •U 00S7- 7 r 96 L,31 � l�316 http://issgl2/intranet/propdata/prebuilt.aspx?mappar=267120&seq=1 2/20/2013 TOWN.OF BARNSTABL LOCATION ` V � a+ V /�- arO� AGE#�_S/G► r� VILLAGE ASSESSOR'S MAP&PARCEL ���� INSTALLER'S NAME&PHONE NO. 041, C -v1.7' SEPTIC TANK CAPACITY Ax,s? /0,00 LEACHING FACILITY:(typ44)-A1 V %-o? 4. J`a(size) NO.OF BEDROOMS_. p OWNER i N c/il /3,Gc 7-V o PERMIT DATE: COMPLIANCE DATE:.01 S D Separation Distance Between the: Maximum Adjusied 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 Dj w VA 14 oo -� N (..� M Li cN Qi � No. P`�I D ~ O Fee V V THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftplitation for 30ispo8al *pstem CDnstrUttion permit Application for a Permit to Construct( ) Repair(.,,,upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address pr Lo No. AAIIIVc Owner's Name,Address,and Te No. Assessor's Map/Parcel2:lrj i Installer's Name,Address,and Tel.No. Designer's Name,Address,an Tel.No. �� h► .s C f► r'i E.d SIVAY 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(min.required) 5�S~ gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank/pod d- 2,dU9 "Type of S.A.S. � j OJ �✓ ���7�'1 r�t �2 Description of Soil Nature of Repairs or Alterations(Answer when applicable) 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 Certificate of Compliance has been issued by this Board of Health. Signe Date 2 3 /p Application Approved by Date Application Disapproved by Date for the following reasons Permit No. C9L0 10 0 3 3 Date Issued . -R�-rr^_�.-T^,MI.M�tys., -1'^�1�`•Y'*`�— •- _-`.•„- ..�,A.,�. ,.� '�,,,, .a•".a_.. ... - 'M1 v ^'�'�.-•v ..a .^ .n � ...s'....3�I t No.' '0 — =_ Fee y, THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION=TOWN OF BARNSTABLE, MASSACHUSETTS Yes �'- application for bis'osal 6psteut Construction 30erinit Application for a Permit to Construct( ) Repair(,16pgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or L'ot•No. 7 ��11 ', - ,�=✓ja,vw, Owner's Name,Address,and Tel.No. Z ,� ✓l.� � a/5a,X�T J1�►`k Gn-O� I�Q✓u/rvr/� Assessor's Map/Parcel �-- Installer's Name,Address,and Tel.No. t Designer's Name,Address,and Tel.No. 147p2 e h4 <v v s l 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(min.required) 5 S� gpd Design flow provided gpd i Plan Date �/�a?o/d Number of sheets Revision Date { Title Size of Septic Tank/©oo d a Uc.V "Type of S.A.S. 3 O 1_v i �✓ i,?//A /d 2 3 Description of Soil Nature of Repairs or Alterations(Answer when applicable) 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 Certificate of Compliance has been issued by this Board of Health. Signed J� r r��f�r -r Date-2 -� Application Approved by -1.� Date Application Disapproved by Date for the following reasons 1 Permit No. C9 0 to 0 3 3 Date Issued a ' 3` Q ~- , i THE COMMONWEALTH OF MASSACHUSETTS , r �U - BARNSTABLE,MASSACHUSETTS y I� �ertifi SAS- s� /sate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( )" Repaired( ) w -Upgraded( ) - Abandoned( )by l/ at 23% �7,tl yi Jac df,9c l Y7l has been constructed in accordance with the provisions of,Title 5 and the for Disposal System Construction Permit No. 0 b 10 -0 33 dated Z — 3— 1 O Installer /-112l - Designer #bedrooms 5 Approved de ise gmflo _ r '� gpd The issuance of his permit shall not be construed as a guarantee that the system till functidn as designed. Date Jr�r h o Inspector -- ---- No. c?UIO -o:33__.-__.-----------------__�._��__�.�._.------=�----�----------------=---------~ ="!""-------- •_.'". �vV THE COMMONWEALTH OF MASSACHUSETTS Fee PUBLIC HEALTH DIVISION r BARNSTABLE,MASSACHUSETTS Misposal 6pstem (Construction i9ermit Permission is hereby granted to Construct( ) Repair(ter Upgrade( ) Abandon( ) System located at .3 C �62 A i� yi��r 13Fr,e/ u?445� 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. Provid�d:Construction must be completed within three years of the date of this permi C Q� Date__2_13 ( Approved b +/ rr y `l v Paul F. Shea 13 Euclid Avenue Mattapoisett, MA 02739 April 20, 2010 To Whom It May Concern: Please be advised that I rented the house at 238A Craigville Beach Road, West Hyannisport, Mass. from the years 1965 through 1967. There were four (4) bedrooms in the big house (238A), and one (1) bedroom in the garage/apartment house (238B) on the same property, all of which were occupied and rented at that time. Respectfully submitted, Paul F. Shea, Tenant Notary Statemen4Se , d Signature: NgEax Publ � - CiMtj rue ° DUeK NORTH Notary Public Commonwealth of mossachusetts My Commission Expires January 17, 2014 12/14/2009 12:27 7743773890 BROWNELL TRAILERS PAGE 01/05 .! ! i... l ! i i I i� i I. ., I. "�: I I i •� I I � I i, ��l. !,• C I � � � I I I � I .I � I ' I. • .I.--I- --) .i I. .I. .I.. i.�jl •• i •� ! c J. �...F- . � I I Iwo c ' i ! i I � ! I 'ate I 'I i � I i. --•I -� r �.�,� v 1 I l �l:1 •I••I .;• i_. .�;.. I � . ' I U ' i I p I I I i I I i I I i .,. i•• .I I 'I I• I •! I i. _J.. I I I i i � I _• ! I I I � i L I � � I ; ! I �! !• i I i I •I• ! l.. � i .. I .i. i j 1 1 jq `alb , ! I I •'' i t i I , � � I 1 1 1 i _•N , 1 I . . I I i : ' : I ! .. . . I I • �� I ..� 1 ' ��-' J:�:•�:I: I : '.:,: , I ' l.: ; : i '_ .� i �.. �► . .� � ! � I � I . 1 I, i ' .l I i �• I '�_ ., _: � . I i �I I.; � I _ : .I I I i i / � !' I i I ! i i I l • LJ.. !.: , ' ; •.fir~_ �.. �� :I� �. .I.. .1.. � ` .I. �I. .L.I.: L. J_.I. L I I I J , i. .I .i. l. I � i I I I i , ...i..: .� '. � .. I � I. l I..I._ ._I 1..1 __ I '_ .!' _ .. ' .' -'• .- _�- I I I I I. ' �, ��� �• I � I I i !. I � I��.�:: .:;. .., ..I..; �. I. I�•I -;. ' ', I _ , , I. J.. I . I ' I ' . _i I I � ' •I I ' I I I j � I ! : i ! LA i I ' i I I .I. I:. .. 12/14/2009 12:27 7743773890 BROWNELL TRAILERS PAGE 02/05 • � t I I _ 1 I..i i i • � i �! (JW � I I j ' � I I II it l _ I _��. �. ..II li• I..; I � I , , I I I � . . � i � I . � I i '� � � .; :I� •ref- . I fi�W '..-4, �� v� I � i 1p _Ole �, � '�'� • '. 1 i I I ,, ; i .l I . I I . I I..; I. I � ! -.. . .I. .I .I . .. ; i- I ' :. i . i -IVY• !�� � I � ; i I ! � I I -• I i• I •I •I I i I ; i I ,�.- I I . •�' i I ' � 1 I I I 1 , ! I ' � I I I �. I i. ; I I I .I j �. (`w I I i I I I I I I i ! I . .I !. I • I 1. I ' , I -7k S. -E-1 . I S" I i I • .i I ' I I � �- I I .. � I ' I. i .I I .I i � I I I I ,� .I l i 1 � � ,. I I 1 ;.,�• I• • , I I I ; i 12/14/2009 12:27 7743773890 BROWNELL TRAILERS PAGE 05/05 i I i i M1I 'I I-I I blill. I I I• I I I i� i .� _. i ' I I I � I I I. I, I I I I I I• ' i ty 'V_Y I l Ir Q. � i � I' I j ! � I � I '• I .. I I - k I I I I I I I I .. ' I ! I � I (• .I. ! ��. I a.: I .I�! .�I I��,�, I �O I I .�.I. �. . i 'I II. I I I .I. . i i j I •• I I j I i I VI� I I i i I I I ' � ! i ! � i •• � I I I .I I I I • � I � I I '' I 1. � � � i -i• ' I I L. i i i i i I .. i .. � !„I• I ., E I i I I i ! i • '. . 'l I i L. ; I ., I I I... i � 1 Jam. I I 4 _ .... _ •. 1 r I I _ m co LO LJ LJ LD m 44 E _._._.. OWE :Ci�j ._.. (n CD m _ ..--- cn TRANS. NO.: CITY/TOWN: APPLICANT: L;ckk ADDRESS: J3 DESIGN FLOW: gpci REVIEWED BY: DATE: N/A OK NO G�+NER�L z Legal boundaries denoted [310 CMR 15.220(4)(a)] Street, Lot, tax parcel number and lot number noted on plan [310 CMR 15.220(4)(u)] Locus Provided [310 CMR 15.2204(t)] L> Plan proper scale? (1"=40' for plot plans, 1"= 20' or fewer for components) [31.0 CMR 15.220(4)] Easements shown [310 CMR 15.220(4)(b)] , System located totally on lot served [310 CMR 15.405(1)(a) for Upgrades]- if not, a variance is required [310 CMR 15.412(4)] Location of impervious surfaces (driveways, parking areas etc.) [310 CMR 15.220(4)(d)] _ Location all buildings existing and proposed 310 CMR 15-220(4)(c)] Location and dimensions of system components and reserve areas. [310 CMR 15.220(4)(e)] Systern Calculations [310 CMR 15.220(4)(f)] daily flow f septic tank. capacity (required and provided)'" soil absorption system (required and provided) whether system designed for garbage grinder North a]TovV [310 CMR 15.220(4)(g)] Existing and proposed contours [310 CMR 15.220(4)(g)] Location and log of deep observation holes (existing grade el. on ,� each test) [310 CMR 15.220(4)(h)] Names of soil evaluator and BOH representative [310 CMR 15.220(4)(h) and (i)] v� Location and date of percolation tests (performed at proper elevation?) [310 CMR 15.220(4)(1)] Percolation test results niatch loading rate? [310 CMR 15.242] Certification statement by Soil Evaluator [310 CMR 15.220(4)0)] ;,✓ Observed and Adjusted groundwater (method for adjustment given or indicated) [310 CMR 15.103(3) and 310 CMR 15.220(4)(n)] Address Sheet 1 of � _ii �' ��� Y��Lt _C'�x .�f"� 1 N/A OK NO Location of every water supply, public and private, [310 CMR 15.220(4)(k)] within 400 feet of the proposed system location in the case of surface water supplies and gravel packed public water supply within 250 feet of the proposed system location in the case within 150 feet of the proposed system location in the case of private water supply wells Location of all surface waters and wetlands located up to 100 ft. beyond setbacks listed In 310 CMR 15.211 and any catcli basins tocated within 50 ft. [310 CMR 15.220(4)(1)] Water lines and other subsurface utilities located [310 CMR 15.220(4)(m)] (if water line cross see 310 CMR 15211(1)[11) Profile of system showing invert elevations of all system components and the bottom of the SAS [310 CMR15.220(4)(o)] Stamp of designer [310 CMR 15.220(1) and 310 CMR 15.220(2)] Stamp of Registered Land Surveyor (required.if construction activities within 5 ft. of lot line) [310 CMR 15.220(3)] Test Holes adequate (two in each of the primary and reserve unless trenches as perrnitted in 310 CMR 15.102(2) or as h!� approved for an upgrade under LUA at 310 CMR 15.405(1)(k)] Test hole adequate to d.errmonstrate four feet of suitable material? f 1310 CMR 15.103(4)] Test Holes adequate to confirm adequate groundwater separation? [310 CMR 15.103(3)] Benchmark within 50-75' of system [310 CMR 15.220(4)(q)] Materials specifications noted? [various sections of 310 CMR 15.000] Sy -R-cniliponents not > 36" deep (unles Local Upgrade" V� Approval or LUA requester- [310 CMR 15.405(1(b)] t Address Sheet 2 of 7 f N/A OK NO SEPTIC TANK _.. a _.x,... . .,. . .. .. :_r .__ .... Size OK? [310 CMR 15.223(1)] Inlet tee located ten inches below flow line [310 CMR 15.227(6)] � Outlet tee 14" or 14" + 5" per foot for increase ft depth [310 CMR 15.227(6)] Outlet tee with gas baffle or approved filter [310 CMR 15.227(4)] Note regarding installation on stable compacted base [31.0 CMR 15228(1)] Separation between inlet and outlet tees (no less than l.iduid depth) [310 CMR 15.227(2)] hilet/Outlet elevations at least 12" above high groundwater (except as described 310 CMR 15.227(5)) or permitted for upgrades under LUA [310 CMR 15.405(1)(k)] Minimum cover 9" (Tanks buried more than 9" must have risers on all openings and on the d-box) [310 CMR 15.2228(l) and 310 t� CMR 15.232(3)(f)] Three access covers (inlet and cutlet must be 20" or greater) - mi.ddle access at least 8" (by 7/07) [310 CMR 15.228(2)] Access to within 6 " of grade - one port for systems<1000gpd, two for systems >1000 gpd [310 CMR 15.228(2)] All at-grade covers secured to unauthorized access? [.31.0 CMR 15.228(2)] > 10 ft from building foundation [310 CMR 15.211(1)] L' Buoyancy calculation Required/Done [310 CMR 15.221(8)] t, H-20 Where appropriate? [310 CMR 15.226(3)] Setbacks from resources [310 CMR 15211] Multi Compartment Ta4ntis R >... Required when other than single-family dwelling or flow>1000 r gpd [310 CMR 15.223(1)(b)] First compartment 200% daily flow; Second compartment 100% daily flow [310 CMR 15.224(2) and (3)] "U" pipe tlu-ough or over baffle, outlet of each compartment with gas baffle or approved filter [310 CMR 15.224(4)] I Address i Sheet 3 of N/A OK NO BITILllIN'G SEVER: ND OTHER PIPInNG s X w t least ten feet from any water .. , Located a ater line? [310 CMR 15.222(2)] Disposal piping at least 18" below water line (when water and sewer cross, see 310 CMR 15.211(1)[1]) Cleanouts required/provided ? [310 CMR 15.222(8)] Thrust blocks specified in force mains? 310 CMR 15.221(6)(c)] ' Slope of sewer line not less than 0.01 (1/8"/(t) 0.02 preferable [310 CMR 15.222(6)] Proper pitch on all nuns? (.005 within gravity-distributed trenches ; and beds) [31.0 CMR 15251(9) and 31.0 CMR 15.252(2)(c)] Siphon problem/ (leachfield below pump chamber) 1 ndcaps or vent manifold specified? L Size and orientation of discharge holes specified? (not smaller than 3/8" not larger than 5/8") [310 CMR 15251.(8) and 310 CMlR, 15.252(2)(11)] Materials specified (310 CMR 15.251(5) specifies various pipe types allowed) � srRIBVT1o1v Box Stable compacted base [31.0 CMR 15.221(2) and 310 CNIR 15.232(2)(a)] Splash plate or baffle tee required on inlet/provided? (when pressure sewer to d-box or steep pitch of gravity sewer) [310 CMR 15.323(3)(a)] Riser if deeper than 9" [310 CMR 15.232(3)(01 V Inside minimum dimension 12" [310 CMR 15.232(2)(b)] Minimum sump 6" [310 CMRl5.232(3)(e)] Watertight cover if<2000gpd); waterproof manhole if>2000gpd [310 CMR 15.232(3)(d)] PUMP Capacity (emergency storage above workin —des n flow 310 CMR 231(2)] Proper setbacks [310 CMR 15.21.1 (same as septic tanks)] Watertight 20-in minium access manhole at least 20'' MUST BE TO GRADE [310 CMR 15.231(5)] Service components accessible (not too deep with piping ,/ disconnects accessible) v Alarm floats - alarm on circuit separate from pumps specified? Exceeds two units must have two pumps operating in lead-lag mode. [310 CMR 15.231(6) and (8)] Stable Compacted Base [310 CMR 15.221(2)] Buoyancy calculations needed ? Provided? [310 CMR 15.221(8)] 3 r.� Address ] C'CC_��C ti:.,\��z �. '.��C�� ��� Sheet 4 of? o N/A OK NO SOILxI3SORPTIONSYSTM°S (SAfS) GENERALz Calculations correct? 4 feet of naturally occurring material demonstrated? [310 CMR 15.240(1)] Required separation to groundwater? [310 CMR 15.212)] Aggregate specified as double washed [310 CMR 15.247(2)] System Venting required/provided? (system under driveway or >36" deep) [310 CMR 15241] IV/ Inspection ports specified and within 3"final grade? [310 CMR 15.240(1.3)] Breakout requirements met? (No violation of breakout elevation within 15 ft of SAS unless barrier) [310 CMR 15.211(1)[4] and Guidance Document] Gr�LL�ERIES,PITS,C°HAN1B ERS 310„CMR 15,2'S3` � ,n ,, a�, � � �-F 3 Chambers and Gal. in trench configuration supplied with inlet every 20 ft. [31.0 CMR 15.253(6)] Each structure with one inspection maid-iole (if>2000 gpd must be to grade) [310 CMR 15.253(2)] t Aggregate I' minimum- 4' maximum. [310 CMR 15.253(1)(b)] ✓ 2' sidewall credit maximum [310 CIvIR 15.253(1)(a)] In bed configuration, inlet every 40 sq. ft. [310 CMR 1.5.253(6)] TIZENCI�ES�310 GM`R`Iz5 25�1 rt a�� z � z � ` �� Width 2'minimum 3' maximum [310 CMR 15.251(1)(b)] 100 feet- maximum length [310 CMR 15.251(1)(a)] Minimum separation 2x effective depth or width whichever greater (3x if reserve between trenches) [310 CMR 251(1)(d)] Situated along contours [310 CMR 15.251(2)] Breakout OK? [310 CMR 15.211(1)[4] and Guidance .Docum.ent] Y3]CD SAS�(MaXirnu,m s�z�e of�Ued of field SOOQ,gh�d) , ��' � s imn=lni 2 distribution lines [310 CMR 15.252(2)(a)] Maxin.ium separation between lines 6' [310 CM RI5.252(2)(d)] Maximum separation between lines and outside of bed 4' [310 CMR 15.252(2)(e)] Aggregate depth below discharge pipes 6" mmi.nrum, 12" 1-11 maximum. [310 CMR 15.252(2)(g)] Separation between beds IU minimum. [310 CMR 15.252(2)(f)] Bottom area used in calculations only [310 CMR 15.252(2)(1)] Address J -` Sl1eC C 5 of N/A OK NO Pressure Dosed System ? Provided pump and piping calculations as required [310 CMR 15.220(4)(r)] Pressure closing required on all systems >200091)d or alternative systems Linder remedial approval [310 CMR 15.254(2) and UA ' Remedial Use Approvals] If used in gravelless system - make sure jet is directed as not to scour soil interface [Guidance Document] Inspections once per year (systems< 2000 gpd) or quarterly (>2000gpd) good to note on plan [310 CMR 15.254(2)(d)] Construction in fall - Did the plan specify that the fill shall meet the specification of 310 CMR 15.255(3)? bnpervious barrier and/or retaining wall ? [Guidance Document] Impervious barrier installation must be supervised by designer [310 CMR. 15.255(2)(b)] Retaining wall must be designed by Registered Professional. Engineer [310 CMR. 15255(2)(a)] Side slope not exceed 3:1 ? [31.0 CMR. 15.255(2)] Breakout requirements met? [310 CMR 15.252(2) and Guidance DOCUnnent] At least 5 ft. from impervious barrier to edge of SAS (10 ft. f' recommended) [310 CMR 15.255 (2)(e)] V Gt'aUettess sySfenl � f>l�A�J�J1 OUCIl,L2tteY5ya x � � z d „ a. .. Check DEP Approval letters for credits and design conditions ,f If used with pressure dosing do not allow pressure discharge Vr' to scour soil interface ky. ,� �, � -�a, e s1�• �,r- -,act 3 c, � � ter } r Was DEP Approval Letter provided and/or have you reviewed the letter for conditions? Is the technology being properly applied and does it meet all DEP Approval Conditions? Is there a note on the plan regarding the requirement for perpetual maintenance agl-eenien.t? Any alarms involved on separate circuits Did the applicant submit an operation and maintenance manual? Has applicant submitted a copy of a maintenance Are the variances listed on the plan . 310 CMR 15.220 (4)(q)] RLS Stamp necessary on plan if a component is within five feet of property line [310 CMR 15.412(4)] New construction or increased flow proposed - [Refer to 310 CMR 15.414] Address Ac- Sheet 6 of 7 C I N/A OK NO �VltYO�L'11',S('/ZSLtlV0A78LLS Is the s stein in a Designated Nitrogen Sensitive Area ('Lone 11 for a public supply well)? [310 CMR 15.214, 310 CMR 15.215 and 310 CM.R 15.216 - also refer to Policy regarding upgrades of such existing systems] Is the system proposed on the same lot as served by private well ? f [310 CMR 15.21.4(2)] v Are the nitrogen loads proposed in compliance? [310 CMR 15.216(1)] i✓ Pumping to septic tank ? [ 310 CMR 15.229] Shared System [310 CMR 15.290] C `1 Address Sheet 7 of 7 Oil o C v ii P.q T4 -rlAl r -fG`'l�GEpe scnally appeared before me, and proved his/her identification through satisfactory evidence,which to I be the person whose name is signed on the preceding or attoched documentinmypresenceonthis� day.of TIonE �i!?Yt,) . Adam CConrad ConmonweolthofMassachuseits Notary Public h' mission Erpiresl)ecemberl,2 i 1 is . Paul F. Shea 13 Euclid Avenue Mattapoisett, MA 02739 Date: To Whom It May Concern: This is to notify you that I rented a house at 23.8A Craigville Beach Road, West Hyannisport, Mass. from the years 1965 through 1967 and the small, separate garage/apartment house on the same property (23 8B) had a tenant as well during that time. Respectfully submitted; Paul F. Shea y N tary Statement, Seal, d Signature: IMA JA- Lk�Je T. - OATH Notary Public * commonwealth of Massachusetts My Commission Expires .January 17, 2014 08/02/2020 22:48 FAX fa001/001 Town of Barnstable "E' � Regulatory Services I Thomas F. Geiler, Director • BARNBiABII. MASS 639. Public Health Division s � Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-8624644 l--ax: 508-790.6304 Installer& Designer Certification Form Date: Designer: _Shay Environmental Services, Inc. Installer: {2CN �U�Schon Address: P.O. Box 627 Address: , l� _East Falmouth, MA 02536 OTT\%. (A On — n OrC.w l� ,c�'E"k.c was issued a permit to install a (date) (installer) septic system at t G. �� CxC�, based on a design drawn by ( ddress) Shav Environmental Services. Inc._ dated (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include mino approved changes such as lateral reloc ion of he distribution box and/or septic tank. [Vo old Od y a I�o� f C t�vJ �/e C V I certify that the septic system referenced above was installed with major changes (i.e, greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. IK OF M4SS \ r CARMEN��' �7 Z,;e(Ins • ller's Signature) E. SHAY ,f No. 1'181 FG1S1t�� s gner s Si name) (Affix Dc ci p Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION THANK YOU. Q:HcaldVScp6c/Desigricr Certification Form Town-.of Barnstable P# � ? — oF� S f i Department of Regulatory Services Public Health Division �ArE4i��b� 200 Main Stree 0 t,Hyannis MA 02601 Date' U Date Scheduled U Time Fee Pd. j Soil Suitability ,Assessment or Se Performed By: wag Dasposal Witnessed By; ptW� Location Address LOCATION & GENERAL Wb � R � R.MATION U CC(l 1 V i ',^�ZC owner's Name � /, O Address �U Assessor's Map/Parcel: 6/ � �(nv�A, Engineer's Name �+�(Z�l G.S ZVI NEW CONSTRUCTION REPAIIt j tc Telephone# �6B Is 3�i- Land Use i�jP 11 `� �' Slopes m) Distances from: Open Water Bod -� �-- Surface Stones y ��- ft. Possible We[Area Drainage Way A�_ • ft Drinking Water Well ft Property Line , ) �Ft Other /V ft SIM TCx: (Street name,dimensions of lot,exact locations of test holes&perc tests,locate we tlands in proximity to holes) wV"Y C_CA�4 .i; C Parent material(geologic) 0 J P S%A Dcpth to Bedrock Depth to Groundwater, Standing Water in Hole:Acne Weeping*om Pit Pace Estimated Seasonal High Groundwater Method Used: DETERMINATION FOR SEASONAL HI ' WATER TABLE Depth Observed standing in obs.hole: Dcpth to weeping from side of obs.bole: in. Depth to Sol]mottlas: Index We11I#�^ Reading Date: �e•, iGr6undwntAdjusme.. in, index Well level AdJ,factor ft. AdJ,d.roundwater Level Observation PERCOLATION TEST Hole# ' 7�tttc ` itne. 'LW Time at 911. Depth of Pere tt Time at G" 1 Start Pre-soak.Time @ Time(9° �") mi n End Pre-soak Rate Min./Inch LaM_�1 Site Suitability Assessment: Site Passed Site Failed: Additional Testing o Needed(Y/N) Original: Public Health Division Site 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, QAS EPTIC\PERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole SurfsDept from Soil Horizon Soil Texture Soil Color Soil Surface(in.) (USDA) Other (Munsell) Mottling (Structure,Stones;Boulders. on istene % ,rRvel) ®— SC 10'?C 3 I.L 1J q mac' a� IDy25 ,-- � 3�-►3a c, 11 S a,S� . " 10 °7a U�,1 Depth from DEEP OBSERVATION HOLE LOG Hole# __ Soil Horizon Soil Texture Surface(in.) Soil Color Soil Other (USDA) (Munsell) Mottling (Structure,Stone:,,Boulders. --Consistency,%onve_?) Fir n C1 M_C ScnJ 5 ,, DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Surface(in.} Other _ (USDA) (Muusell) Mottling (Structure,Stones,Boulders. Co i tcpcy,3' Gravel DEEP OBSERVATION HOLE LOG Hole# Deptlt from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consi ten I W s l_ a, { Flood Insurance Rate Map: Above 500 year flood boundary No— Yes Wid-dn 500 year boundary No—11/:-Yej Within 100 year flood boundary No e Yes . Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring perviou material exist in all areas observed throughout the area proposed for the soil absorption system? If not;what is the depth of naturally occurring pervious material? Aj Certification I certify that on 1 (date)I have passed the soil evaluator examination approved by the Department of,Dnvironmental P otecti n and that the above analysis was performed by me,consistent with . the required trainin ex er ' e a d ex ri n e described in 310 CNM 15.017. Signature Date I 1 09 1Q9 Q:\S.E"IC\PI RCFORM.DOC 'f f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 238 a+b Craigville Beach Rd. Property Address Linda Brownell Owner Owner's Name information is required for W.Hy p annis ort Ma 02647 10/6/2009 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: A. General Information When filling out forms on the computer,use 1. Inspector: only the tab key to move your Robert Paolini cursor-do not Name of Inspector use the return key. Capewide Enterprises,LLC. Company Name P.O.Box 763 Company Address ` Centerville Ma 02632 City/Town State Zip Code (508)428-4028 S14454 Telephone Number License Number B. Certification 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. r^'°r 10/06/2009 _ A I In s p k ors S i'9n a tb ra U Date The system inspector shall submit a copy of this inspection report to the Approving Auth y(Burd of Health or DEP)within 30 days of completing this inspection. If the system Is a shared S%Lsten r has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit theme report to the appropriate regional office of the DEP. The original should be sent to the syIem per 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. L t5ins-09/08 Title 5 Official Inspection Form:Subsurface Se ge Disposal System qP. e 1 of 17 I t Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 238 a+b Craigville Beach Rd. Property Address Linda Brownell Owner Owner's Name information is required for W.Hy p annis ort Ma 02647 10/6/2009 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: ❑ •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-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 238 a+b Craigville-Beach Rd. Property Address Linda Brownell Owner Owner's Name information is required for W Hy p annis ort Ma 02647 10/6/2009 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-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 238 a+b Craigville Beach Rd. Property Address Linda Brownell Owner Owner's Name information is W required for Hy p annis ort Ma 02647 10/6/2009 ' 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 1/2 day flow t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 238 a+b Craigville Beach Rd. Property Address Linda Brownell Owner Owner's Name information is required for y p W H annis ort Ma 02647 10/6/2009 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the fast 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 238 a+b Craigville Beach Rd. Property Address Linda Brownell Owner Owner's Name information is p required for y W.H annis ort Ma 02647 10/6/2009 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes"or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ ® Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® El information 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): 5 Number of bedrooms(actual): 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 t5ins•09/08 Title 5 Official Inspection Fcrm:Subsurface Sewage Disposal System•Page 6 of 17 f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M s 238 a+b Craigville Beach Rd. Property Address Linda Brownell Owner Owner's Name information is required for Y p W H annis ort Ma 02647 10/6/2009 every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: The septic system consists of a 1000 gallon tank and pit,one cesspool. Number of current residents: 0 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 ears usage NA 9 ( Y 9 (9pd))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: unknown 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 Tide 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 ;M 238 a+b Craigville Beach Rd. Property Address Linda Brownell Owner Owner's Name information is W.H annis ort Ma 02647 10/6/2009 required for y p every page. Cityrrown 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: i ® 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 systems 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 M 238 a+b Craigville Beach Rd. Property Address Linda Brownell Owner Owner's Name information is required for W.Hy p annis ort Ma 02647 10/6/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate.on site plan): 2,0" Depth below grade: feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): 1 0'+ Distance from private water supply well or suction line: 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: 18' 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: 1000 Sludge depth: T' t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 238 a+b Craigville Beach Rd. Property Address Linda Brownell Owner Owner's Name information is p required for y W H annis ort Ma 02647 10/6/2009 every page. City/Town 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 25" Scum thickness 5" Distance from top of scum to top of outlet tee or baffle 4" 9" Distance from bottom of scum to bottom of outlet tee or baffle 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 tank every two years.inlet and outlet tees are in place.No evidence of Ieakage.Tank appears 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 238 a+b Craigville Beach Rd. Property Address Linda Brownell Owner Owner's Name information is p required for y W.H annis ort Ma 02647 10/6/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 238 a+b Craigville Beach Rd. Property Address Linda Brownell Owner Owner's Name information is p required for y W H annis ort Ma 02647 10/6/2009 every page. City/Town 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 D-Box present. 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.): 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 Forth:Subsurface Sewage Disposal System•Page 12 of 17 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 238 a+b Craigville Beach Rd. Property Address Linda Brownell Owner Owner's Name information is required for W.HY P annis ort Ma 02647 10/6/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Sandy soil.System in hydraulic failure.Pit has heavy staining to top showing it has been full. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration 1 Depth—top of liquid to inlet invert 6" Depth of solids layer 5" Depth of scum layer 7" Dimensions of cesspool 6'x6' Materials of construction Concrete Block Indication of groundwater inflow ❑ Yes ® No t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page'13 of 17 l Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 238 a+b Craigville Beach Rd. Property Address Linda Brownell Owner Owner's Name information is required for W Hy p annis ort Ma 02647 10/6/2009 every page. City/Town 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.): Cesspool is for apa rtment.Cesspool was full at time of inspection.Cesspool overflows into leaching pit for main house. 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 14ap Page 1 of 2 Town of Barnstable Geographic Information System Parcel Viewer Custom Map Abutters Map Size Zoom Out In 1 It R.r RE TO w .ems . .-. .. F� 11. 1, i 1 1 t: r{ i NW 1 � v 1 � 1' f / J 20 Fe f i ..... ........ .... Set Scale 1" = 20 I Aenal Photos I MAP DISCLAIMER r%--rinhf 9MF_9MQ T-A-of lQn—efohlc hAA All rinhfe men—, - http://www.town.bamstable.ma.us/arcims/appgeoapp/map.aspx?propertyID=267120&ma... 10/22/2009 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 238 a+b Craigville Beach Rd. Property Address Linda Brownell Owner Owner's Name information is required for y p W.H annis ort Ma 02647 10/6/2009 every page. City/Town 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 LP 12.4' 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: USED:USGS Observation Well Data.USED:Technical Bulletin 92-0001 plate#2 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 y Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments GSM ,•'' 238 a+b Craigville Beach Rd. Property Address Linda Brownell Owner Owner's Name information is required for W.Hy p annis ort Ma 02647 10/6/2009 every 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 i t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Fxs.....5._�.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF........................... Apphratinn for Uh4poiia1 Warks C9.angtrurtinn 1hrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: d Locati�sd or Lt No.� er Addrs Intaller e Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.. .--_...........................-----_Expansion Attic ( ) Garbage Grinder ( )Other—T e of Building . No. of persons....................•. a yp g P Showers ( ) Cafeteria ( ) d 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........................ 914 Test Pit No. 2........:.......minutes per inch Depth of Test Pit.................... Depth to ground water...._................... 9 y.•• ------------------------------------------- ---- Description of Soil.... PLC.. --`f=- - • ��---••-----••--•------------------------•-------------------------------------.----------- x U ---••-••--•---•----•••••-••-••-•---•-------•-••-••........................•--•••-•-•••--•----•-•--•••-•-••----•----•----•-------••--......•----- W ----------------•------------...------------------------------------......._..----------------------- ------. f: -------------------------------------- • U Nature of Repairs or Al erati��"•",s—Answer en applicable --- I...... C�4G� ........----••....................•-•---•-•-------•-•--•-------•--------•-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of LI':LE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been%iss ed by the bard ealth. Signed •-•••-•-••-•---...--••-•.Z•••-•-•-•--•--•--•-••-••-•---••--••--- --•- Date Application Approved By-••-. �.�r•--• ...................... --.. - 2'S= - Date Application Disapproved for the following reasons:............................................................................................................... -•-----•------------------------•-••.----•--•----•-----••--...-----••-•-•-------••-••------•---•••--...--••----•------•-••-------•-----••-••-•-•--•---------•----•-------•-----••------••--••-•----•-•- Date ' Permit No..................... Date No.--- ' °:.. _f FE........ ... ....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...-•.....................................OF.........................................----.--------------........................._..-- Appliratinn for Uiipnsal Works Tnntitrnrtiun Vamit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System : , «. .. « .. .. .. ....................... _ __...... .............«........................_. �yy :-.' Location-Ad s or Lot No. ...- �.... . .. ................ ................... ..-...... .... ..}� --. ..--. �--.- ................. a er `I a l .... Addr f a ......:._..... .. -------------- Installer Address UType of Building Size Lot----------------------------Sq. feet Dwelling—No. of Bedrooms-. ._ .--- --.-__---_Expansion Attic ( ) Garbage Grinder ( ) ------------------ `� Other—T e of Building ............. No. of persons.._..__.............._...... Showers — Cafeteria Other fixtures ..................................................... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 9 Septic Tank—Liquid capacity............gallons Length................ Width........_....... Diameter................ Depth................ 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........................................ aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water--_-_-_-___-_.__..-_ Pz4 Test Pit No. 2................minutes per inch Depth of Test Pit..............._.... Depth to•ground water........................ ----------- ----------------------------------. ...................................................--•-•-•-•--- =-........................................ Description of Soil ' `'--................................... U -------------------------------------------------------•----.....................-----.......------........--•--•---•--•--•• ---------••-•- ---•-- W --••••-------------- ........................................................................................ ........... U Natur of Repairs or A rat* ns—Answer en a plicable................................��... �y�. ' fi"�. _........ -• - •••--•-••••••-• ....... ...............................:....................-...................................................................... Agreement: ; The undersigned agrees to install the aforedescribed'�Individual Sewage Disposal System in accordance with the provisions of TTTLEE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in _ operation until a Certificate of Compliance has been is ed b the b and ealth. Signed---....... .................vv ..............••--•----•-•-••-.• ..................... Date Application Approved .... : ----------------- Application Disapproved for the following reasons:.................................................................................. -------.Date.............. ---------------------------------------------------------------------------------------------------------.-----------------------------------------------------------------------------------....._--•--- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF, MASSACHUSETTS . . .BOARD OF HEALTH OF........................................... ......................................... array c;,, %urrfifirali of Toutplianrr Wthe Individual Sewage Disposal System constructed ( ) or Repairedby... ��.�.,N Installer ,9 6 op has been installed in accordance with the provisions of TITLE; j 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 CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SA ISFACTORY. DATE.........................................' ... �YL..........•••. Inspector--•-- _/�-..-----...------------------•----.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No '. .�'� .. ...........,<•. ......OF....� . .�, � ..... FEE.. .. 1�-•- Dispns I° or Sinn rrmi Permissionis hereby granted.............. .............................I......./PP//...+Zf ll--.._..-----------------------------.........------------......................•.. to Const�r�uct ) or Repait• ) Ind lidu wag isposal System IL - 1 Street as shown on the application for Disposal Works Construction Permit No..................... D ted. --- -:• - .-. � .. -------------------------------------« rd,Health DATE . ' .> ----------------------•--•- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS 3" of 1/8" - 1/2" Washed Peastone *NOTE: ALL PIPES ARE TO BE 4" SCHEDULE 40 P.V.C. VENT PIPE (0 Least 24 Inches toll) 10' min. from Schedule PVC w/Charcool Odor Filter 3/4 to 1 1/2 DOUBLE Washed Crushed Sto i 1 [house Existing Foundation to septic tank " =��' TOP OF FOUNDATION ELEV. 100.00 (Assumed) =c taie covers •t roes BIOnXe of Grade be 4 PVC (CAPPED) INSPECTION PORT TO BE e . of p . '�a ' woee over c-eox-99•so over SAS- 99 o INSTALLED AND TO BE WITHIN 6" OF GRADE ► over Septic Tank-99.60 3 HOLE H-10 . DIST. BOX If; ;'_tI• �•""'"'u ��� ' �*�� r S 0.02 0.01 �-2 - lI , c 3' Nmdmun Cover Top OF System-Elw. -96.00 a s.++y •� o A.,s' S.0.01 or orot.r 24" Effective . s MIT.POPE m 0-40' .500 AL S. O.Ot• a FRON EXIST.FOLeOIAT>al / � rA S T 15' per toot � � yy / ,6' // - Sidewal 00NORETE FULL FOUNDA 6 Unfts @ 7' =42' 2 EFFECTIVE DEPTH �; S SHDWQ o I r�\ o o, 4 4 4 JNot to Scate ,r`y, SYSTEM PROFILE •J12, u Effective Length _ Not to scale c EPF. e + 6- GENERAL NOTES NOTE: SEPTIC TANK & D-Box TO BE CONSTRUCTED ON LEVEL COMPACTED BASE a In•of 3/r-1 1/2" 0 �° SECTION A -A O01"p°ctid st°n• 0 PROFILE VIEW OF LEACHING SYSTEM 1. Contractor is responsible for Digeofe notification, Verification of Utilities NOTE: ALL COMPONENTS MUST HAVE RISERS TO WITHIN 6' BELOW GRADE of o m and protection of all underground utilities and pipes. e SOIL ABSORPTION SYSTEM (SAS) 2. The septic.tank / J distri4u$ion box shall be set �aI Bottom of Test Hole 1 Elev.- 88.50 level on 6 of 3 4 -1 1 2 stone. CULTEC 3050 INFILTRATOR CHAMBER H-20 (OR EQUIVALENT) 3. Bockfill should be clean sand or gravel with no Groundwater Observed - NONE OBSERVED NOTE: OVERALL HEIGHT OF INFILTRATOR IS 30" EFFECTIVE HEIGHT IS 24" stones over 3" in size. ALL OUTLET PIPES FROM THE 4. This system is subject to inspection during installation PERCOLATION TEST DISTRIBUTION BOX SHALL� ,r �,��,� by Carmen E. Shay - Environmental Services, Inc. SET LEVEL FOR AT LEAST 2 FT. ,,. ,. , • . 0 20 40 50 5. The contractor shall install this system In accordance Date of Percolation Test: NOV. 9. 2009 " ""'' "`''' with Title V of the Massachusetts state code, the approved plan Test Performed By. CARMEN E. SHAY, 4 PIPE TO BE DOUBLE SLEEVED and Local Regulations. R.S., C.S.E. �� Results Witnessed By. DAVID STANTON (BARNSTABLE BOH) - as• ouTu T , ,r INLET WITH 6 SCH 40 PVC - 6. if, during installation the contractor encounters any EXCAVATOR: SHAY ENVIRONMENTAL SERVICES, INC. e• 10 FEET EITHER- SIDE OF WATER LINE soil conditions or site conditions that are different Percolation Rate: Less Than 2 MPI 0 36" 0 TP1 SLEEVE PIPE TO BE SEALED AT EACH END SCALE: 1"=20' frogs those shown on the soil log or in our design +as' ' installation must halt do immediate notification be 4' - SCH. 40 Te �, Test Hole Test Hole C a'� a� made to Carmen E. Shay - Environmental Services, Inc. No. 1 No. 2 PLAN SECTION CROSS-SECTION ,V4 91 tiP 7. No vehicle or heavymachine shall drive over the DEPTH SOILS B EV. DEPTH SOILS ELEV. S 85D 51 02"E septic system unles noted as H-20 septic components. 0 99.50 0 99.50 3 HOLE H-10 DISTRIBUTION BOX 8. Install Tuf-rite gas baffles or equals on all outlet tee ends. Sandy Sandy NOT TO SCALE TEST HOLE #1 Failed 107.90 , e�,� 9. All Distribution Lines shall be 4' diameter Schedule 40 NSF PVC pipes. Loam Loam ELEV.= 99.50 LEACH PIT t0 S' a 10. All solid piping, tees dt fittings shall be 4" diameter to TR 3/2 10 vR 3/2 0' 8' ,E 3S' (� ,,r-5 0"-6' A 99.00 0"-6' A 99.00 " �� S Schedule 40 NSF PVC pipes with water tight joints. ELEV. of OUTLET PIPE OF EXIST, TANK = 96.50 4 PVC fy ,•• c p VENT y " ✓� 11. Municipal Water is AVAILABLE to ALL OF The Residence and Abutting sandy Sa nay EXISTIN P, V Properties Within 150 Feet. , NO PRIVATE WELLS PRESENT W/IN 200' 10 TR s/s +o rR s/e 1. MAIN HOUSE KITCHEN IS CONNECTED TO EXISTING 1,000 GALLON p - } ; ' � ;i,w t:�'• `"sr'' a• rt 1 BEDROOM X� ''+ .THE PROPERTY LINES ARE APPROXIMATE AND Be .50 6•_�• B• 96.50 t;p S. ' GARAGE Mod-Coarse Mod-Coarse SEWER LINE 10 FEET EITHER SIDE OF EXISTING WATER LINE M O B Con rete COMPILED FROM THE PLAN BY GEORGE LOW do CO.., ENTITLED Sand Sand TEST HOLE #2 p IO APART. PLAN OF LAND of CAROLYN G. FARDY in HYANNISPORT, MA Y ce Failed ELEV.= 99.50 r zs Y�/4 2s A 2. GARAGE APARTMENT KITCHEN IS TO BE CONNECTED TO NEW N DATED DEC. 1 1980, PLAN BOOK 348 PAGE 24 36"-132' Ci 88 50 38"-132' C, 1500 GALLON SEPTIC TANK. Q LEACH PIT O AND IS NOT INTENDED TO BE A SURVEY PLOT PLAN cL , IT SHOULD BE USED FOR NO PURPOSE OTHER THAN DOUBLE COMPARTMENT TANK NOT REQUIRED PER TOM MC KEAN O A I NEW Uuo THE SEPTIC SYSTEM INSTALLATION. ON JANUARY 13, 2010. I 1500 Gal I EXISTIN 0 l .E-H 'Septic Tank I �" � EXISTING LEACH PITS TO BE PUMPED OUT AND 1000 GAL 0 DECK j �' I REMOVED TO FACILITATE NEW SEPTIC SYSTEM INSTALLATION SEPTIC TANK w ' w H � NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE PROJECT BENCH MARK FROM THE EXISTING LEACH PITS TO BE DISPOSED . - -- aj OF AS-PER-BOARD--OF HEALTH-SPECIFICATIONS. TOP OF FOUNDATION i " I ----- EXi'STING I I co -b Perc #1 ELEV. = 100.00 (Assumed)�.� 4 BaDRooa� I ASPHALT i 4 THERE ARE NO WETLANDS ARE PRESENT WITHIN 200' OF THE PROPERTY Depth to Perc: 36" to 54 " ,,. I I DRIVEWAY I co Perc Rate- <2 MPI Assumed / HOUSE I I O ASSESSORS MAP 267 LOT 120 Groundwater Not Observed No Observed ESHWT �,� w #238 ILEGEND ADJUSTED H2O Elev. - None y9 i z i 104X1 DENOTES PROPOSED Design Calculations I I SPOT GRADE Number of Bedrooms: 5 Equivalent to 550 Gol./Day �'� I I �LOTS #3B & #41, Garbage Grinder: No f co (f 12,376 Square Pest �/ X 104.46 DENSPOT GRES ADE EXISTING Leaching Capacity Proposed: 550 Gal./Day Minimum ♦ A b j, Septic Tank - 2 x 550 Gal./Day - 1100 USE NEW 1,500 GAL. Septic Tank. �� b --------- ----------- I I � SOIL ABSORPTION AREA: Using percolation rate of G2 min./inch ASPHALT PL PROPERTY LINE° DRIVEWAY I Bottom Area: 0.74 gal/sq. ft. x 552 sq. ft. 408.48 gallons •� y I Sidewoll Area: 0.74 gal./sq. ft. x 232 sq. ft. = 171.68 gallons --1___ ___ ; , 96P PROPOSED CONTOUR Providing: = 580.16 gallons ��/ ----- . -------------��---7-------- ____-__-- - - ----97 EXISTING CONTOUR Use: (6) 3050 H-20 INFILTRATOR CHAMBERS, HAVING A 2 EFFECTIVE DEPTH a 107.37' �' (4 W x 7' L) TO BE USED WITH 4' OF WASHED STONE ON THE SIDES AND i I N 85D 24 2 W I 99 _ ® DEEP TEST HOLE & 2' OF WASHED STONE ON THE ENDS. ; I \ PERCOLATION TEST LOCATION I -------------------------------- ----------------' -------------------- -� 6 FOOT STOCKADE FENCE TYPICAL 1 GALLON SEPTIC TANK NOT TO SCALE CRA I G VIL L E .B.EA CH R OA D 3-24•IXAM• AOCEss MANHOLES (H-10 LOADING) +o'-e• (40 FOOT RIGHT OF WAY) 1 BR GARAGE GUEST HOUSE-(Provided by Owner) 4 BR 2 Story HOUSE-(Provided by Owner) P LOT P LAN Utility Bat OF SEPTIC SYSTEM UPGRADE INLET Bedroom INLET / ``/ `�/ THE ACCESS COVERS FOR THE SEPTIC TANK, Spiral O g Bedroom Bat PREPARED FOR DISTRIBUTION BOX AND LEACHING COMPONENT Stairs Stain , : .,.:M .T �. ,.,� ..,��.,_,�,•:' SHALL BE RAISED TO WITHIN 8" OF Bedroom r GARAGE - L I N DA B R 0 W N E L L t•.•t r...^ •i ••.. -T. +• . FINISHED GRADE. STEEL REINFORCED PRECAST CONCRETE INSTALL TUF-TiTE GAS BAFFLES OR EQUALS Slttlnq e Y AT PLAN VIEW ON ALL OUTLET TEE ENDS Rom 3-24•REMOVABLE covERs-� MAIN HOUSE 2nd FLOOR - L{ gc-(" 238 C RAI GVI LLE BEACH ROAD°•`� HYANNISPORT, MA 02601 ,i +r "� GARAGE 2nd FLOOR Bath �� m INLET e• min 2-ink,Net to outlet GARAGE 1 st FLOOR Bedroom t r mh. OUTLET " L,. °r t , , PREPARED BY: 0'Th L phi TivN w• y o l nS \< V_r 4 S'-7' ARMEN �'l . SHA Y i r f# a"w,, r ,;ftth LOCAL UPGRADE APPROVAL VARIANCE REQUESTED Idrvs 'U t� NV 0 E IR NMENTAL SERVICE S,ES, INC. •;' ,�i 1/2 Bath �& , 1. REQUEST A LOCAL UPGRADE APPROVAL TO DOUBLE SLEEVE / � Bedroom ,-/iea � .;:� Laund LL , rY Fs RN TH L� 0 BERRY CIRCLE % t:•-,v •.... .:.. �: f Kitchen SEWER LINE 10 FEET EITHER SIDE OF EXISTING WATER LINE i T MA 02649 �� MASHPEE, s•� r ry CROSS CTIONEND-SECTIONTEL FAX 508-539-7966a WITH 6" SCH. 40 PVC. TO BE SEALED ® ENDS OF SLEEVE. Dining ': �b S E S 2. REQUEST A LOCAL UPGRADE APPROVAL TOput SAS SCALE: 1"=20' DRAWN BY: CES DATE: FEB 1, 2010 GREATER THAN 3 FEET BELOW GRADE, A VENT PIPE HAS BEEN PROVIDED. MAIN HOUSE 1st FLOOR PROJECT#SD1167 FILENAME: SD1167PP.DWG SHEET 1 OF 1