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0100 CAP'N CARLETON'S RD - Health
100 Capri Carleton's��in: r 'cot uit �.. rf I TOWN OF BARNSTABLE [INSTALLER'S ATION � �1�. ��tP t�_a1SEWAGE# �O cab AGE (�Q�"" ASSESSOR'S MAP&PARCEL C �=641 NAME&PHONE NO. G.f. bra�'?-1'1Ti i IC TANK CAPACITY LJcACHING FACILITY: (type) �t!�"�dl i >(size) � NO.OF BEDROOMS OWNERr PERMIT DATE: [I- COMPLIANCE DATE: e Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on , p 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 `Oil ,NOS ,156 C� 41 ST e � ,11 No 1w Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:_fs PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2ppl Cation for Mispo8al *pstrm Cunstruttion 30erm[t Application for a Permit to Construct( ) Repair(v) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.100 CAp �CA'2Le 4-o NS Owner's Name,Address,and Tel.No. A N � ®�S f iSO�� /i/AVZK y��12CKS� 100 G p Assessor's Map/Parcel ,�� -7 4o_1o1_C , Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. *gAr2 A 0c. VQ&f AA4 7 ! 8,214 Type of Building: Dwelling No.of Bedrooms 1S E6 Lot Size OVI B sq.ft. Garbage Grinder(I' j Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) o gpd Design flow provided gpd Plan Date O Number of sheets Revision Date Title 4�--p4cn., 1lQA4 Ak I n, o C40V, CA(L Size of Septic Tank iloon AAr Type of S.A.S. G kAA4 6 c►1 %/g4j!) Description of Soil I,A.5 }- L oto'L A f i�-�= 5A b Nature of Repairs or Alterations (Answer when applicable) _ (3T G JE r:Ai 191-7) LJEA -1, w Yvk A 614 Atie 8C A ' FI L-T) Date last inspected: &A 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 Heal y Si Date 0,0 Application Approved by Date 27 cp� Application Disapproved by Date for the following reasons Permit No. / ���P (� Date Issued 4. '� �+ -she :.� .<F:*,NSF".� ��� F��"$r �,wpai_•a,;«rr�� f:_.' .S ....... ... _ ..Nu Fee «.. THE COMMONWEALTH OF.MASSACHUSETTS Entered in computer: . . ; Yes PUBLIC HEALTH DIVISION - TOWN.OF"BARNSTABLE, MASSACHUSETTS =r' ' r t o 01 fitation for bisposal Epsom Construction Permit Application for a Permit to Construct( ) RepairUpgrade( ) Abandon( )' r�Complete System ❑Individual Components. Location Addressor LotNo.too CAIOW— CkLe i-o NS' Owner's Name,,Address,and Tel.No. oq� /1ha"K /VI.GKCKS lOa Gaga. GA►?.I.EToS Assessor's Map/Parcel 03 , �'� ` . i , i.,. G� 9 M Installer's Name,Address,and Tlel.No. Designer's Name,Address,and Tel.No. MKr=A M T'pe of Building: + ` Dwelling No.of Bedrooms Eb LoPSize sq.ft. Garbage Grinder Other Type of Building No.of Persons•'x Showers( ) Cafeteria( ) Other Fixtures --� Design Flow(min.required) gpd Design flow provided 57 co gpd ' Plan Date L Number f . , O a7 o sheets R r evasion Date TitleIC1�►oAtl A-�- I o CA>z n. CA214...,S GAJ Size of Septic Tank tt p i Type of S.A.S. G kAM 6f.h I ilk D1f Description of Soil oeo ( �� 5AA,b Mature of Repairs or Alterations(Answer when applicable) �p i,�r r Ad �r� LEA�_A I �t, PJ 1 N. Date last inspected: A/Q `a Agreement: f 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 Healt.. ;; Signe ""~-,` Date/ /Z. 10 r-V Y Application Approved by' .. ,� _ - - `Date_. - --QY Application Disapproved byDate for,the following reasons �� [Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS (Drtificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(,4 ) Upgraded( ) _..Abandoned( _)by at has been constructed in accordance with the provisions of Title 5 and the for Disposal,System Construction Permit No J Jdated Installer , Designer #bedrooms '� s "Approved design flow ��� , _gpd The issuance of this permit shall not be construed as a guarantee that the system wild nctio as designed. Date 2 t 1 b 1). r Inspector .r_. _._— No �.^��s�._a- �,T--•---•--_�_. ._ __--_._-----_._._._--- Fee-,��+��-•-- ' THE COMMONWEALTH-OF MASSACHUSETTS PUBLIC HEALTH DIVISION. BARNSTABLE,MASSACHUSETTS Disposal 6pstern`Constructiorn 3pernut Permissio is hereb ranted to Construct Re r U ade Aban pn - r t - a:S stem7.locatedat ' and as described•in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with 4' Title 5 and the following local provisions or special conditions. ; Provided,Constru tion must be completed within three years of the date of this permit. , s Date Approved by _ i No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2ppfication for Misposal 6pstetn Construction Permit ` 20 Application for a Permit to Construct( ) Repair(soof Upgrade( ) Abandon( ) ❑Complete System ,Individual Components Location Address or Lot No. 100 Owner's Name,Address,and Tel.No. Assessor'sMap/Parcel , Lo , (2o'�'t-j � RnneM&UJ . cd(¢JtpO''� Installer's Name,Address,apd Tel.No.,$4$-Y,99-- 89P6, Designer's Name,Address,and Tel.Nor) o� to Cfz���-ruc. �»,73rx. �s vYQusi�ry�' �ca!e .¢ xcau %vim CorP 1/1 Me"Av-e a D Type of Building: a Dwelling No.of Bedrooms 3Lot Size 0.sS 14CW-S sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 33 0 gpd Design flow provided gpd Plan Date JL2 a r) I�10ot 0 Number of sheets Revision Date Title 5 Size of Septic Tank t Sa Type of S.A.S. X 11 /W Description of Soil 6U c_�-_ Nature of Repairs or Alterations(Answer when applicable), l�- �-(U Stri eM U�,Y -33& �C S� C 36'L x 1-4- Date last inspected: Agreement: The undersigned agrees to ensure the construction and maint of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environme ode a of to place the system in operation until a Certificate of Compliance has been issued by this Board of Hegj� Signed Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. Date Issued _____—___—_=_=_=d-- -------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO C RTIFY,that the n-site Sewage Disposal stem Constructed( ) Repaired(d') Upgraded( ) Abandoned )by / A G at B(j ' has been constructed in accordance with the pr vision of TitleA and the for isposal System Construction Permit N . dated Installer s t�0(/la 4 ?IAI ,'T Designer ' #bedrooms Approved design flow gpd The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS Disposal *pstem Construction Permit Permission is hereby granted to,0pristruct( epair X) Upgrad ( ) andon( ) System located atA p and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date Approved by L No.= lK7cJ � 4 d10 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered ui computer: Vf Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Off ration for bispoBal 6pstrtn Construction 3pPrmiIt 7 -20 a,{ ,4—Application for a Permit to Construct( ) Repair(e� Upgrade( ) Abandon( ) ❑Complete System [Individual Components M; Location Address or Lot No. 100 �°af;v) � ► � Owner's Name,Address,and Tel.No. L/,;08~3199 . i Na IA i•• Anne Mli7„c... /U,ckc i 7 Assessor's Map/Parcel x k yl � ; /rD 61 rR Installer's Name Address,and Tel.No. �a��- la�Co Designer's Name,Address,and Tel.No.,? 1_Xl.50/V q5 X'Jtr.5�Y ` cx2ya xe t zt lG+� C vr� YS A Ierryf At-f blars6r 'n ,rT�llN5 , ,+lAk4 Ur..;&Uk )�,A�,'q . YM A a,9_33: Type of Building: , Dwelling No.of Bedrooms 3 Lot Size • A'e-ffs sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) j Other Fixtures Design Flow(min.required) 330 gpd Design flow provided gpd Plan Date 01,7 r) f pb;t o Number of sheets f Revision Date Title.`,'at)s�Lac✓'Y_5Q5 i �"Liya :G(r., ct. / f� (1, rtur, nn�A.Pts/7s r Size of Septic Tank Type of S.A.S- (,X /) u) Description of Soil 'aj 1 c Qe Z x�eA__ 4 Nature of Repairs or Alterations(Answer when applicable) t(�1 ,.t �r� _rifl3i [M�t � ���� V � j(�'%,)r"-.J 7 ti Date last inspected: a 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-hot to place the system in operation until a Certificate of Compliance has been issued by this Board of Health' Signed _ Date Application Approved by Date " r f N ` Application Disapproved by Date for the following reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS ' BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO C/ERTIFY,,that the On-site Sewage Disposal system Constructed( ) Repaired(,#-*)/ Upgraded( ) Abandoned( )by /p/ a . he iat: ax n accordance with the provisions:offTitlleef5�and /the for/Disposal System Construction Permit No� p dated Installer 1', r410i'1/(f ,l/»�4f a't1r"t�/h) t. C Designer(�+r,i4 #bedrooms Approved design flow gpd The issuance of this permit shall not be construed as a guarantee that the system will functionas designed. _Date Inspector - - - - - - No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal 6pstent Construction J)Prmit Permission is hereby �granntted tloo onstruct( ,) Repair(�) F Upgrade( ) Abandon(Y ) System locatedat/U}(,/ t__Gt�t7.ft5 �2.C`@�i'`�rl"j, e L717►/ / :'S�a r and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with 4 Title 5 and the following local provisions orspecial conditions. ` Provided:Construction must be completed within three years of the date of this permit. DateApproved by Town of Barnstable : Regulatory Services Richard V. Scau Interim Director s Arm ems. Public Health Division Thomas Mtkean,Director 200'Main,Street,'Hyannis,MA 02601 Office: 508=862-4644 Fax: M8400-6304 Homeowner Certification.Form for Alternative Systems' Property Address: 100_Captain Carleton's Road,Barnstable MA 02635= Assessoes MapTareel: 038/041 Property.Owners Name: Mark-and Annemarie Nickerson In accordance with Massachusetts DEP alternative system'approval letters, the following certification information is required by the Owner of record. The :Owner of record must place an "x" in the applicable box next to each line certifying the.information. Yes N\A RY ❑ I have been provided a copy of the Title 5 I/A technology Approval letters. (15 page Standard Conditions letter and the specific technology letter). ❑ I have-been provided with the Owner's Manual VF6r have.been provided with the Operation and Maintenance Manual S stems,installed under a Remedial.Use A ` rova I ee to fti fill'rn' Y pp 1, . Y t responsibilities to provide a Deed Notice as required by 310 CMR 15:287(l0) xnd the Approval El M For Systems installed=under a Remedial LTse Approval,I agree to fulfill my responsibilities to; provide written notification of the Approval to any new Owner, as required by 310 CMR 15.287(5) If the d"esi n.does not;provide far,the use of a ririders the restriction is understood g. P garbag g and accepted ❑ Whether or not covered by a warranty,`I understand the requirement to repair;replace, modify or take any other action as required by the Department or the LAA, if,the Department or the LAA determines the System to be Wing,to.protect public,health and safety and the environment,as defined in 310 CMR 15.303 AUy-�', J��iPfS ls`' - agree to comply with all terms and conditions above, Property Owners printed name .�& Y\ I Ian Property Owners Signature Date Note: This form must be submitted along: with the septic system disposal works permit application for all RA systems including_new..construction, repairs\un:Trade& with and without :aggregate. (stoner and with conventional design criteria or credited desiym criteria. QASeptic\1A homeowner oertification.doc l FEB-12-2021 01:24 From: To:15087906304 Pa9e:1/1 Town of Barnstable Inspectional Services i Public Health Division A63ab�q Thomas McKean,Director . e ' 200 Main Street,Hyannis,MA 02601 Office: 508-8624644 Fax: 508-790.6304 Installer& Desir-ner Certification Form Date: 2/11/2021 Sewage Permit# 2020-366 Assessor's Map\Parcel 0361041 Designer:Justin Lamoureux,Coastal Excavation Installer: Bortolotti Construction Address: 48 Merry Ave,Duxbury MA 02332 Address: 45 Industry Rd, Marston Mills,MA 02648 On 1111712020 Bortolottl Construction was issued a permit to install a ( ate) (installer) 100 Cap'n Carleton's Road,Cotuit septic system at based on a design drawn by (address) Justin Lamoureux,Coastal Excavation dated 10124/2021 _ (designer) X I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. 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 do Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required)was inspected and the soils were found satisfactory. X.. I certify that-the system referenced above was constructed in liance with the to rms of _._ .- ..... ... ... i the val letters(if applicable) Ott 0 a JUSTIN J. LAMOUREUX (Ins ler's Signature) N CIVIL7377 y e (Designer'sSignature) (Affix Desi Stamp 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_BARN_STABLE PUBLIC HEALTH DIVISION. THANK YOU. %UoaWcpusHEALTMEWERconnecASEPTIC 3esignetCeniflcationformRev614.13.DOC - TOWN OF BARNSTABLE O LCCATION O CG C -4v i, SEWAGE # I VILLAGE C,74v 1 - ASSESSOR'S MAP&LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY I b U Q LEACHING FACILITY: (type) (size) ��+� NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: �2 �7 COMPLIANCE DATE: Separation Distance Between the: � �' Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by �No.....k.: ....... _.:+:F�s.,,, ... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH OF............................•---...-...---------------------------------•---•-----•-----.. Appliration for llhip ial Works Towitrurtium Urrmit Application is herebymade for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: -� ��P r V}r 1LIS ....... n._.._.......'...... ....... -- _---••----•------O.P7Lt. Vv� _ .. ..... Loca -Address ram` A ------------ Address Installer Address Type of Building Size Lot__rj_ ` ..Sq. feet U Dwelling—No. of Bedrooms...__.____��_._ _________________Expansion Attic (1ST Garbage Grinder Q) Other—T e of Building No. of persons____________________________ Showers — Cafeteria Pi Other fixtures ...._........................... W Design Flow.............J_t_Q_...................gallons per person per day. Total daily flow................a Z- 54............gallons. WSeptic Tank—Liquid*capacity/LV6_.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 (,K Dosin tank ( ) Percolation Test Results Performed by. .�x���..�k___ _________________________ ate________________ _.__ ..__-. - ____.. De th to round water_rz� �?__��f. fZ a Test Pit No. 1________________minutes per inch Depth of Test Pit..________ p g Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------.................. Pa' --------------IML------------------------------------------------------------•-•----------------•---•--•---------------••-•----------_-_-- Description of Soil........-°-�---------------------------.........�..$>�--''c----- 4 -- 1 - -- - /4 �x14w- (� ------------- •---------- -------------------------------------W --•-•-••--------•-----------•----•--•--•--•----•---••--•---------------••---•---._...-•••••-••••--•-----••-•-•----------..-._..-----•----------------------•••-•....................................... UNature of Repairs or Alterations—Answer when applicable_______________________________________________________________________________________________ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iI`I IZ 5 of the State Sanitary Code— The undersigned further agrees not to place the system#rt operation until a Certificate of Compliance has bWss..ed y the boa• of health Si ne ---- ------------ gDate ApplicationApproved By............... =-A-............................-•--............................ -••- ............. Date Application Disapproved for the following reasons:.....................................•---- --_---•-------................................................. ......-•---•-------------------------•--.....------------------------------------------•------------•------••-•----•- ....... Date Permit No......... yJ---••-••••--------------------------- Issued---......c/••�° ............................. ................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................................ ......OF.......................... .................I--------I.,....................... Appliration for Uispoiial 10orkti Towitrurtion "omit Application is hereby made for a Permit to Construct or Repair an Individuarj-,'S' -vage Disposal systeg� ID A(14PN, It-A-14 - ........................................................................... ....................cllb�& ...r��.......... 7-4 "FT A, ......... ................ ...... --------i .......... '4071-L Lo Ad . or ....... ........A .......co .............. ............ .......... ............................ Installer Address Type of Building Size Lot_r 01FL0d*0-.Sq. feet U Dwelling—No. of Bedrooms.__......al'Sl .*________________Expansion Attic Garbage Grinder 0) pal Other—Type of Building ............................. No. of persons.........__.......__.______. Showers Cafeteria Other fi tures Design Flow.............AD............... ....gallons per-r p- n p- y T o-t- I daily-- fl o-w- ...... ...........gallons. 1:4 Septic Tank—Liquid capacity/ft...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 ( ) ' f ............ ate. 4A 12 "y 1 Percolation Test Results Performed by .. ...... ..... .......... Test Pit No. I....!;k......minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes-per •inch Depth of Test Pit._.................. Depth to ground water._._____.________._.____ P4 ... ........................ ----------..-;eta--------------/------- I 'r I ' I 0 .....................*...... Description of Soil........;;�................................. ..................a............ Vi r� ..A( U ............................................................................... .................................................................................................... ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- U Nature of Repairs-or.'!Alterations—Answer when applicable._............................................................................................. ...................................................................................................................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance;with the provisions of TLITAIL 5 of the State Sanitary Q6de.,.The undersignea.fufthera-gr':ees*hot to place the system'in operation until a Certificate of Compliance has b e y he eb��;4 of healt Sign .................... ... .... ... ...... .......................... ....... /......... .... Date Application Approved By.............. . 7. . .............................. ............................ ..... ...... ....... ........ Date Application Disapproved for the following reasons:..........................................----------------------------------- ............. 7------ ............................................................................................................................................................................... ..................... Date PermitNo.._._... ...................................... Issued...................................................... Date TH-i-'COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............. . :.........OF....:.. .. .......... ................................................ ...... .. ...... Tatifirate of Tompliaurr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired b v h'X zt..�!!�. .................................................................................................................................................. ---------------------�e . — -�W-�'�" . , �$ Installer at............ .Z.......t.. ILI .................. ........n�. ................................................................... .....................e has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works construction dated........7 t.4-0- i, ................ 7�1-------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.... ............ ---------- .......................................... y inspector................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF"!HEALTH ...OF..... "I ..................................... .......No....... ... ........................................ FEE....4 Disposal Works LTonstrudion "Pamit Permission is hereby granted....... ......... ........... .............................................................I.............. .. ... ............... to Construct or Repair an Individual Sewage Disposal System at No............ ............ X, ....................................................................................................... ............................. Street uct16ff ermit-. .......��,1,1�7 as shown the application for'bisposAl"'Works Constrt- No._A't.,..i�..... Dated....92. .............. ..........................................................V ...............I.......... Board of Health DATE.......................................................................t... FORM 1255 HOBBS,,'&k WARREN, INC.. PUaffiS'Hiii4 , Itt, ;=l.Ow 3 Itb K 3 • 33o G.p,D USE: 1000 15PD�Aa. PIT - USE loco Glal.. ; B MAA new• st-. fry'. ,a I .c Sd ca p-D. O { TCrrAL T>%SIGIJ • 5 G.9D. Tt�To t- jai�Y Fc.cw v 330 dkpv ? i v�rzcol.oT►ow 6ZeTc� o¢ LtrtiSF, , N T11, QL OF 41 A i t WTER i' 2I; 1 :a ► ar c4 P4i 21*0 1 v'I # I(iplb Tom- 2'1��g - ' .. , .. T� n.. ��e. • , ��,� Noy. 1:4,=4l, aXPKM 4odiMA#Apo ttAd 2 • t I i TAPAK i t loop 95 R u�,, s A ,i Co Tv IT p'T { i WASMED x yf/� eTIF`1Er�u� Wacea;_ - i G-izttr-,q TI`lAT T_NE �p_W:11I.L.11J(�`' S110�611J P1._41.1 1Z�G'C2E't�.I�E %4V Q V-4&i . GCaNIPL VIG.,< W i-r :`Tla SI D�a_I►-IE i f A►.It� fL'+AGIC 'C-QUi1ZEM1.iTS OF .THE "BXP-I 4rA4 L �A� COt1QT Phu _3 �31 B Q.)(TS.IZv IYE` 1�•IG :� ': aEGtSrcrz�t�:. t.�suc3 `'Sue��Yort� ' T1-11.5 C7L.A1.1 IS �.loT P,AS,EO w� A�.J 0S7Tr;-ZV%LLSi o. M7�S5: 114;retJMEk,4-r •50K%/E'( Ti4L- 0P6G'56;Tlf, ;514oWla ApP1.1 CA•1.1`T 1--br 6c u.,rvca eM %4f- L�V LiWal; ; ' 1 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONffiENTAL PROTECTION RECEIVED nC.T 2 3 2002 TOWN OF BARNSTABLE TITLE 5 HEALTH DEPT. OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 100 Captain Carleton's Road. Cotuit MA 02635 Owner's Name: Abigail Wales Owner's Address: same Date of Inspection:October 11,2002 Name of Inspector: PATRICK M.O'CONNELL MAP Company Name: SEPTIC INSPECTION SERVICES CO. rz�`C ; Mailing Address: 189 CAMMETT ROAD PARCEL " MARSTONS MILLS MA 02648 LOT Telephone Number: (508)428-1779 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DIP approved system inspector pursuant to Section 15.340 of Tide 5(310 CMR 15.000). The system: _X_ Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails a) 2:1,d Inspector's Signature: Pil� Date: 1611e .071._ The system inspector shall submit a.copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments ****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. Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 100 Captain Carleton's Road,Cotuit Owner. Abigail Wales Date of Inspection: October 11,2002 Inspection Summary: Check ARCM or E I ALWAYS complete all of Section D A. System Passes: X_ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfihration or tank failure is imminent. System will pass inspection ifthe existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a.Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution lox. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 100 Captain Carleton's Road,Cotuit Owner. Abigail Wales Date of Inspection: October 11,2002 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(l)(b)that the system is not functioning is a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system('SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ 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 and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 100 Captain Carleton's Road,Cotuit Owner: Abigail Wales Date of Inspection: October 11,2002 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No _X_ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool -X_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X- Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X_ Liquid depth in cesspool is less than 6"below invert or available volume is less than%2 day flow _X_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped X_ Any portion of the SAS,cesspool or privy is below high ground water elevation. - X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface - water supply. X_ Any portion of a cesspool or privy is within a Zone 1 of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. (This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] No_(Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system faits.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 1.0,000 gpd to 15,000 gpd- You must indicate either"yes"or 44no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) 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 It 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. Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 100 Captain Carleton's Road,Cotuit Owner: Abigail Wales Date of Inspection: October 11,2002 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health X Were any of the system components pumped out in the previous two weeks? X _ Has the system received normal flows in the previous two week period? X Have large volumes ofwater been introduced to the system recently or as part of this inspection? _ N/A_ Were as built plans of the system obtained and examined?(If they were not available note as N/A) _X _ Was the facility or dwelling inspected for signs of sewage back up? _X _ Was the site inspected for signs of break out? X _ Were all system components,excluding the SAS, located on site? X _ 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? _X_ _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no X_ Existing information.For example,a plan at the Board ofHealth. _X_ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)1310 CMR 15.302(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 100 Captain Carleton's Road,Cotuit Owner. Abigail Wales Date of Inspection: October 11,2002 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 Does residence have a garbage grinner(yes or no): No Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use:(yes or no): No Water meter readings,if available(last 2 years usage(gpd)): 104 Sump pump(yes or no): No Last date of occupancy: Currently Occupied COMMERCiALIMUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons,'sgft,e2c.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Has not been pumped for current owner. Source of information: Homeowner. Was system pumped as part of the inspection(yes or no): No If yes,volume pumped:_gallons—How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM Septic tank,distribution box,soil absorption system Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any)No _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank _Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: House built and system installed in 1979. Were sewage odors detected when arriving at the site(yes or no): No r Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 100 Captain Carleton's Road,Cotuit Owner: Abigail Wales Date of Inspection: October 11,2002 BUILDING SEWER X (locate on site plan) Depth below grade: 18" Materials of construction:_cast iron X_40 PVC_other(explain): Distance from private water supply well or suction line: 26' Comments(on condition of joints,venting,evidence of leakage,etc.): Pipe in good condition,no evidence of backup or leaks. SEPTIC TANK:_X (locate on site plan) Depth below grade: 6" Material of construction:_X_concrete_metal_fiberglass_polyethylene other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: 1000 Gal. 4.5'X 8' Sludge depth: 5" Distance from top of sludge to bottom of outlet tee or baffle:28" Scum thickness: 3" Distance from top of scum to top of outlet tee or baffle: 8" Distance from bottom of scum to bottom of outlet tee or baffle: 12" How were dimensions determined: STICK WITH HINGE FLAP. Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Tank in good condition,baffles are intact. GREASE TRAP: No (locate on site plan) Depth below grade:_ 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: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Page S of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 100 Captain Carleton's Road,Cotuit Owner: Abigail Wales Date of Inspection: October 11,2002 TIGHT or HOLDING TANK: No (tank must be pumped at time of inspection) (locate on site plan) Depth below grade: Material of constriction: concrete metal fiberglass_polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: llonslday Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: Not Present (if present must be opened) (locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): PUMP CHAMBER: No (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 100 Captain Carleton's Road,Cotuit Owner: Abigail Wales Date of Inspection: October It,2002 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: Type _X_leaching pits,number: One leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: innovativelahernative system Typetname oftechnology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): Leaching pit in good condition 2%'of effluent in pit never more than 3 W.No excessive vegetation. CESSPOOLS: No (cesspool must be pumped as part of inspection) (locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): PRIVY: No (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.): { Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 100 Captain Carleton's Road,Cotuit Owner: Abigail Wales Date of Inspection: October 11,2002 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all welts within 100 feet.Locate where public water supply enters the building. CAPI Cc�e &0YNn5 14605e lob Pe��h her � P FI)ec k 3Z 1 f Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 100 Captain Carleton's Road,Cotuit Owner. Abigail Wales Date of Inspection: October 11,2002 SITE EXAM Slope Minimal Surface water None Check cellar Dry Shallow wells None Estimated depth to ground water: More than 30 feet. Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) X Accessed USGS database-explain:Checked USGS topo maps and town groundwater contour map. You must describe how you established the high ground water elevation: Property above EL.50.Town groundwater contour map shows groundwater at EL.20. TROY WILLIAMS SEPTIC INSPECTIONS °4 Certified by MA Department of Environmental Protection ' $ 05) 760-1819 40 Old Bass River Road kravED South Dennis,MA 60 �' FEB 2 () 1996 � �IfV6F e 4 commonwealth Of Massachusetts o cn, ""�f Executive Office of EMOrxnenfai Affah Department of � ) p� Environmental Protection V=am F.Wald ew.ewr aT.oi.nr.iy, Davld B. trwlss u SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A C.R� rn �oN CATION Property Address: /00 C u�p n C u.1 e }v;,y Sul. v Address of Owner. Mrs l� k L)"l z S Date of Inspection: 5'1 I j�y 6 �12A( Of different) J Name of Inspector: ro �J, kn P" Y Company Name,Address ag Telephone Number: sQ_t 6- 6OJ ei. CERTIFICATION STATEMENT I certify thl I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection..The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: Passes _ Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspection. if the 4vtem is a shared system or has a'design flow of 10,000 gpd or greater,'"inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer,if applicable and the approving authority. INSPECTION SUMMARY: Check A,B,C,or D: A) SYSTEM PASSES: V/I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 1 S.303. Any failure criteria not evaluated are indicated below. B) SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair, passes inspection. Indicate yes,no,or not determined(Y,N,or ND). Describe basis of determination in all Instances. If'not determined',explain why not) _ The septic tank is metal,cracked, structurally unsound,shows substantial infiltration or vdiltration,or tank failure is imminent. The system will pass inspection If the existing septk tank is replaced with a conforming septic tank as approved by the Board of Health. 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: /6)6 CUph Owner: w 4 es Date of Inspection: oZ �z/� d e) SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed Cl 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 the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system nas a septic tank ano soli absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm• DI SYSTEM FAILS: /U/4 I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. revised 8/15/95) 2 i f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: / °" G��'h C ✓�� s� Owner. (,v�,, e S Date of Inspection: a//a l 6 D) SYSTEM FAILS (continued): Static liquid level in the distribution box above outlet invert due to an overloaded or dogged SAS or cesspool. Liquid depth in cesspool is less than 6' below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to dogged or obstructed pipe(s). Number of times pumped Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of.a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ Any portion of a cesspool or privy is less than 100 feet but greater than SO feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E) LARGE SYSTEM FAILS: /C/// The following criteria apply to large systems in addition to the criteria above: The design (low of system is 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: _ the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area PWPA) or a mapped Zone 11 of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 6/15/95) 3 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: %DU Cµ`o ti u z 4-t-,L Owner: „ S Date of Inspection: o2 Check'if the following have been done: Pumping information was requested of the owner, occupant, and Board of Health. None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. As built plans have been obtained and examined. Note if they are not available with WA. _ZThe facility or dwelling was inspected for signs of sewage back-up. , The system does not receive non-sanitary or industrial waste flow ✓The site was inspected for signs of breakout. ZAII system components, excluding the Soil Absorption System, have been located on the site. The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. , The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. _The facility ownp, (and occupants, if different from owner) were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 8/15/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: /00 Owner: N G f Date of Inspection: w FLOW CONDITIONS RESIDENTIAL: Design flow:-3-L4—) galIons Number of bedrooms: Number of current residents: Garbage grinder (yes or no): /-/0 Laundry connected to system (yes or no): y�5 Seasonal use (yes or no):—Z!�S Water meter readings, if available: `f Last date of occupancy: COMMERCIAUINDUSTRIAL: Type of establishment: Design flow: gallons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title S system: (yes or no)_ Water meter readings, if available: Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS //and source of information: �/ �• // H,- h J Y `�t c- 1/-t/i-h{o-C d i� �c S / -v! /J-Lr i ri/b T//O w. L.JH G✓ , System pumped as part of inspection: (yes or no)l[o If yes, volume pumped i allons Reason for pumping: TYPE O� SYSTEM Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) Other (explain) APPROXIMATE AGE of all components, date installed (if known) and source of information: y s 742 cv- c, s - 4�, '• lf-. Sewage odors detected when arriving at the site: (yes or no)_ (revised 8/15/95) S SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 160 Lap'" Owner: (-)- )LS Date of Inspection:a A /y 6 SEPTIC TANK:, (locate on site plan) Depth below grade: I / Material of construction: -L/Concrete _metal _FRP —other(explain) Dimensions: b U O y A 1 0.. c Sludge depth: y , Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: ON/: Distance from top of scum to top of outlet tee or baffle:A/6 Distance from bottom of scum to bottom of outlet tee or baffle: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.)�e- - j � b o - a�-��✓ /�� -/) T" /e,- /k Gt q e a k- S T'Y J L '7�J.- 1 / A- u wT 6t y a, cn GREASE TRAP:,I--//A (locate on site plan) Depth below grade. Material of construction: _concrete _metal _FRP—other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom ni srum t^ t?onorr of oude! tee or banie- Comments: teecommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) — revised 8/15/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner. vJw c 5 Date of Inspection: a TIGHT OR HOLDING TANK: 6/ (locate on site plan) Depth below grade: Material of construction: concrete metal_FRP other(explain) Dimensions: Capacity: gallons Design flow: aa[Ions/day Alarm level: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:_I (locate on site plan) Depth of liquid level above outlet invert: G�< Comments: mote if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) O Qlox c�4 t �U .� �Q✓G / G V+ rI InJO� Lt G. 5 d✓�t�/ - PUMP CHAMBER: /`///.9 (locate on site plan) Pumps in working order.(yes or no) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 8/15/95) 7 SUBSURFACE SEWAGE DISPOSAL. SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: /D0 e, Owner: 1A)a I LS Date of Inspection: /I a�9 SOIL ABSORPTION SYSTEM (SAS):,z (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) if not determined to be present, explain: Type: r leaching pits, number.—Z'>- C �X 6 L c w �— 1., i t C� S1-1z:>H-e— leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of v getation,etc.) ';I-V A-" a SS 173 Ye / a� u D ti t O h u CESSPOOLS: NIfJ (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer. Depth of scum layer: Dimensions of cesspool: materials of construction: indication of groundwater: inflow (cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY: �19 (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) ,revised 6/15/95) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) i Property Address: �6 Q � C Owner: Date of Inspection: a/ia/q 6 SKETCH OF SEWAGE DISPOSAL SYSTEM: indude ties to at least two permanent references landmarks or benchmarks locate all wells within 100' 32' I S'6 y 38' aa'6 w S �c. . DEPTH TO GROUNDWATER Depth to groundwater: — feet adjusted high groundwater level method of determination or approximation: 14z, .A Ajr ` ' 4., revised 6/15/95) 9 I� LC`AT ION 7" S �IWA G E PERMIT NO. L a a k _- VILLAGE Col INSTALLER'S NAME & ADDRESS A -Y c A Oo ,-h ur � -e B U IL D E R OR OWNER DATE PERMIT ISSUED —af—�� DAT E COMPLIANCE ISSUED 3 " v l� r. Q V� l � � / 99k 227 K' WASTEWATER NOTES kc?aC1ay y. ACCEPTABLE NATI4"E GRANULAR SAND OR LOAMY , r122 + I QJ rt �t VllOt) t SAND BACKFILL MATERIAL OR TITLE 5 SAND ELEVATION,PROPERTY LINE AND EXISTING CONDITIONS O ACCEPTABLE NATIVE GRANULAR SAND OR MIRAFI 140N FILTER FABRIC THIS PLAN ARE BASED ON A SURVEY CONDUCTED BY COASTAL ` 4"PERFORATED INSPECTION PORT WITH EXCAVATION,CORP.APRIL 2020. LOAMY SAND BACKFILL MATERIAL.OR TITLE 5 OR APPROVED EQUAL 4"PERFORATED INSPECTION PORT WITH SCREW ON CAP SCREW ON CAP SET WITHIN 3"OF FINISH SAND FREE OF STONES GREATER THAN 6",CLAY, ABOVE CHAMBERS SET WITHIN 3"OF FINISH GRADE(SEE PLAN FOR LOCATION) GRADE(SEE SITE PLAN FOR LOCATION) 3�4 � � WOOD DEBRIS,OR IMPERVIOUS MATERIAL 2. UNLESS OTHERWISE NOTED,ALL SYSTEM COMPONENTS AND 2 SEE SCHEDULE FOR C CONSTRUCTION METHODS SHALL BE IN ACCORDANCE WITH .,� � FINISHED GRADE MIRAFI 140N FILTER FABRIC CHAMBER ELEVATIONS FINISH ELEVATION-GRADE FOR POSITIVE 1 c'•?,.. �... THE STATE ENVIRONMENTAL CODE AND THE RULES AND SLOPE 2%MIN OR EQUAL ABOVE CHAMBER DRAINAGE OVER FIELD(2%MIN.SEE PLAN) LOAM&SEED REGULATIONS OF THE LOCAL BOARD OF HEALTH. I I I'I _Jill 3. THIS PLAN IS INTENDED TO ADEQUATELY PROVIDE THE INFORMATION NECESSARY TO LAYOUT AND CONSTRUCT THE *\ 6 0 2 53 -Ell III_- 3'MAX. -; I=r1 Y MAX• PROPOSED SEWAGE DISPOSAL SYSTEM REPRESENTED ON IT. 9"MIN. 1j 9"MIN. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE I= ENGINEER AND/OR THE LOCAL BOARD OF HEALTH(BOH)STAFF. �- W111 -_ 4. PRIOR TO CONSTRUCTION,THE CONTRACTOR SHALL \\ 0 0 ��� CHAMBER COORDINATE WITH THE PROPERTY OWNER AND ENGINEER ON 34" I h 4"SCH.40 PVC (�l11I .l _I I I!_L! 12"HEIGHT AREAS. TO INVERT I TYP. -=_ QUICK 4 STANDARD FROM D-BOX � THE CONSTRUCTION SITE ACCESS AND MATERIAL STOCK PILE f \ + 40 l _ _ I�I� -_- -'I��I'I III-I-I I�- I I-I-I I- - - -.CHAMBER OR EQUAL I I' - - - - ' 1� +� � 12` III=lJ�--II, •j LU.=1 I!-Ll.! I�Ill•U I=I I I I =I L--��= - = I°1LL f�1==I I�=.� +I i=-�1,= �I- - -`� =�-"�--1!_= 5. TRENCH SAFETY SHALL BE THE RESPONSIBILITY OF THE TYPCONTRACTOR INCLUDING ANY LOCAL AND/OR STATE PERMITS 1 11=III=�}}�III=1 �}.�I I =1 = = Ii I 1=III=1 I=1 I I III; REMOVE SANDY LOAM IF I I=III=1 I�I 11=I I 1=91 -Yl I I=I I I=III=I 11=III=I I I�I=ICI I=I I III'I=�I-I I=I I -I-I I=I�I �I I-I I-III=�I REQUIRED FOR THE TRENCH WORK. THIS WORK MAY BE �s - - - - = UNDISTURBED EARTH OR NECESSARY AND REPLACE r !1L-1 L1-!J1 - - _ _ REQUIRED TO TAKE PLACE OUTSIDE OF NORMAL HOURS OF COMPACTED BACKFILL WITH TITLE 5 SAND I - -� � _I II I I-� -I I�� -� ��-III- - -III-I I -- -I I III-III III OPERATION FOR THE FACILITY.THE CONTRACTOR SHALL PLAN -J1-111-LLL-Ll.1 LLl ��LJ. 11�L1 J11 LLL .!!J. LL - I ll!L!1 lll LL! 124 ' s I i I I I-I I I-I I I=I I M I I=I i+-I(I-I 6!-III-III-I I I I!-III-III-)I i_I III-III-III-1 I I- 5'MIN. ACCORDINGLY. f r 4 TRENCHES OF 9 CHAMBERS AND END PLATES -!I I-I I " -I SEPARATION � �� SEE SITE PLAN 6. THE CONTRACTOR SHALL REPORT ANY DISCREPANCIES FOUND �q5 TYPICAL PROFILE IN SITE CONDITIONS FROM THOSE SHOWN ON THE PLAN TO THE UNDISTURBED EARTH OR NOT TO SCALE59 DESIGN ENGINEER. v- COMPACTED BACKFILL 7. CONTRACTOR TO PUMP SEPTIC TANK. prof y1 GROUNDWATER:NOT ENCOUNTERED UP TO 10'BELOW SURFACE 8, FAILING TO PROPERLY INSPECT OR PUMP THE SEPTIC TANKS r i AND TREATMENT SYSTEM OR CHANGES TO EFFLUENT FLOW, SANITARY ABSORPTION FIELD - LEACHING FIELD GRADING,OR LANDSCAPING,EITHER ON-SITE OR ADJACENT TO �� S THE SITE,MAY RESULT IN IMPROPER FUNCTIONING OF THE PROPERTY ��r4, '\, QUICK 4 STANDARD INFILTRATOR CHAMBER DETAIL SEPTIC AND LEACHING SYSTEM(S). NOT TO SCALE 1 0 49� ,� 9. CALL"DIGSAFE"AT LEAST 72 HOURS PRIOR TO COMMENCING 94 CONSTRUCTION AT 1-888-DIG-SAFE AND ANY OTHER y PIPE ALL CONNECTIONS TO HAVE WATER APPLICABLE AGENCIES TO FIELD VERIFY LOCATIONS OF TIGHT HYDRAULIC CEMENT SEAL MANHOLE COVER 6"BELOW GRADE SET CONCRETE ACCESS HATCH OR EXISTING UTILITIES. 10. THE OWNER SHALL INSPECT AND PUMP THE SEPTIC TANK ONCE 4 t �47�i � EVERY 2 YEARS. r 1 ' + EL.:SEE PLAN `..t� 4-INCH PVC LOAM&SEED - 11. THIS ON-SITE WASTEWATER TREATMENT SYSTEM IS NOT (. s - DESIGNED FOR USE WITH A GARBAGE GRINDER. �0 7 f 22 4 THREADED CAP TOP OF D-BOX = I 12. PROVIDE WATERTIGHT SEALS BY USE OF NON-SHRINK GROUT j. 3Fi 3-4"BELOW SURFACE I 2 I 1 / _I I FLOW MIN. FLOW 11 STRUCTUREAT ALL S. WHERE PIPES ENTER OR LEAVE ANY CONCRETE oar1. LEAN BACKFILL � �� I 13. USE SCHEDULE 40 PVC PIPING WITH WATERTIGHT JOINTS �,a 35 s'*�Y _I III I III(I- 1!- UNLESS OTHERWISE NOTED ON PLAN. ALL PIPE SHALL BE \ FREE OF STONES GREATER LOCUS PLAN `` PROVIDE ADAPTER TO 45\DEGREE PVC AN 2 INCHES IN DIAMETER SEPTIC TANK SEPTIC FIELD 14. ANY AREAS THAT ARE FOUND BASE. ~ JOIN SEWER OR LATERAL 4 SCH 40 PVC IT 4' SCH 40 PVC"C PLACED ON A COMPACTED ND TO HAVE UNSUITABLE SCALE: 1"=250' `\ © TO 4-INCH ELBOW BEND AT THE END MATERIAL SHALL BE REPORTED TO THE ENGINEER. 61 OF LINE OR 6"MIN. WYE CONNECTION SUMP 15. THE CONTRACTOR SHALL RESTORE ALL SURFACES EQUAL TO NATIVE MATERIAL THEIR ORIGINAL CONDITION AFTER CONSTRUCTION IS _- - 4,$- / FLOW OR IN LINE OR GRANULAR FILL -_ GRAPHIC SCALE �. 3 6"OF 3/4"COMPACTED COMPLETE. AREAS NOT DISTURBED BY CONSTRUCTION SHALL "- - - L=71•930, R= \ \ \ \�j` INLET TEE PREVENT DAMAGE TO SHRUBS,TREES,OTHER LANDSCAPING 20 O O ZO 40 RE TO $O CRUSHED STONE BASE BE LEFT NATURAL.THE CONTRACTOR SHALL TAKE A NOTES: AND/OR NATURAL FEATURES. WHEREAS THE PLANS DO NOT SHOW ALL LANDSCAPE FEATURES,EXISTING CONDITIONS MUST PROVTDF.OUTLET DISTRIBUTION BOX WITH BAFFLE INSTALLED ON LEVEL STABLE BASE. BE VERIFIED BY THE CONTRACTOR IN ADVANCE OF THE WORK. INSTALL FIRST 2 FEET OF OUTLET PIPES LEVEL(NO SLOPE). ONE OUTLET FOR EACH - - \ DISTRIBUTION LINE. OUTLETS NOT USED SHALL BE CAPPED 16. EXISTING SEPTIC SYSTEM TO BE REMOVED OR BACKFILLED (in feet) PROPOSED H-10 DISTRIBUTION BOX DETAIL AND ABANDONED PER TITLE 5 REQUIREMENTS.TITLE 5,310 CMR TYPICAL CLEANOUT DETAIL 15.354(3). \ 1 INCH = 20 FEET NOT TO SCALE NOT TO SCALE 17. AREAS UNDER THE LEACHING FIELD FOUND TO HAVE - ' UNSUITABLE SOIL MUST BE REPLACED WITH TITLE 5 SAND AS SPECIFIED IN 310 CMR 15.255(3). _47 __ SCHEDULE OF ELEVATIONS TREATMENT SYSTEM DESIGN CRITERIA 18. PRIOR TO CONSTRUCTION THE CONTRACTOR SHALL FL. RI y SLOPE COORDINATE WITH THE HOMEOWNER AND ENGINEER ON THE S38` 46' 45"E USE SINGLE FAMILY CONSTRUCTION SITE ACCESS AND MATERIAL STOCK PILE \ 157.75' BUILDINGFOUNDATION 55.50 NUMBEROFBEDROOMS(EXISTING) 3 BEDROOMS AREAS. BUILDING INVERT OUT 51.92 8.00 2.00°'0 WARNING E \ \\ A9 , \ SEPTIC TANK-INLET 51.76 NI-IMBII2 OF BEDROOMS(DESIC�1) 3 BEDROOMS 19. INSTALL METALLIC DECTABLE ABOVE THE SEWER PIPE AND CH B R FIELD 6-9-INCHES I \ TOTAL DAILY DESIGN FLOW 330 GPD BEDROOM SEPTIC TANK-OUTLET 51.51 .7 I \ \ \ 18.00 6.409 o GARBAGE DISPOSAL: NO 20. REPLACE TEE IF NOT IN CONFORMANCE WITH T5 15.227 \` "D" BOX-INLET 50.36 INSTALLATION INSPECTION NOTES \ SEPTIC T?►1SK 1. THE CONTRACTOR SHALL PROVIDE A MINIMUM OF 24 HOURS r \ \ \ \ "D" BOX-OUTLET 50.19 c� I r � �T E L I N E �// � I 2.00 0.00°o 2000'o OF DESIGN FLOW: 660 GA LLON ADVANCE NOTICE TO THE ENGINEER AND LOCAL BOARD OF HEALTH FOR ANY INSPECTION. o0• `\ SJ \ \ _ 4 AJ 8.00 6.4000 2. ALL WASTEWATER SYSTEMS SHALL BE INSPECTED BY THE - \ \ s �� CHAMBER-INLET 49.68 � ,� � ¢� ENGINEER OR THE LOCAL BOH REPRESENTATIVE PRIOR TO o CHAMBER BOTTOM TO INNTRT 0.67 BACKFILLING. AT A MINIMUM THE FOLLOWING ITEMS SHALL BE n D-BOX \jN: 'A� �y cFIAMBER-BOTTOM 49.01 ABSORPTION SYSTEM DESIGN CRITERIA INSPECTED: 20.0' 4" CLEANOUT UPSTREAM OF 45 DEGREE BEND Fj BREAK OUT 50.01 2.1. ALL SYSTEM COMPONENTS BASE AND INSTALLATION PRIOR TO BACKFILL 4" SCH. 40 PVC M \ \ S TOP OF SAS 50.01 SOIL ABSORPTION SYSTEItl 2.2. ABANDON EXISTING SYSTEM \ LOWEST FINISH GRADE 52.00 2.3. FINAL INSPECTION OF BACKFILLED SYSTEM (ALL PIPE) I \ \\\ \,\ O-y© MINIMUM COVER 1.99 LEACHING SYSTEM USED: INFILTRATOR TOR CHAMBER FIELD 3. THE CONTRACTOR SHALL BE RESPONSIBLE TO MAINTAIN UP-TO-DATE N09' 17 12' E \ HIC�IEST FINISH GRADE >3.00 DESIGN PERCOLATION RATE: - MIN.• N. AS-BUILT DRAW LNGS AND NOTES INDICATING THE HORIZONTAL.AND -45 VERTICAL LOCATION WITH TWO TIES OF ALL SYSTEM COMPONENTS 169.64' \ \ \, MAXIMUM COVER 2.99 SOIL CLASS: I INSTALLED. THESE AS-BUILT DRAWINGS AND NOTES WILL BE \ �,\ DWELLING WALKWAY \ MIN.ASSUMED 42.00 LONGTERMAC'CEPTANCERATE(LTAR): 0.7-1 CiPDiS.F. UruIZEDBYTI>E ENGINEER FOR THE PREPARATION OFRECORD 3 BEDROOMS \ i, GL MIN.SEPARATION TO G.W. 7.01 TOTAL MINIMUM AREA REQUIRED-TITLE 5: 446 S.F.(BOTTOM AREA) PLANS' tM I FF.=55.5't I I r EX. 1,000 GAL. SEPTIC I �ZH OF titgs PATIO TANK TO REMAIN ` ` TOTAL AREA PROPOSED: ��FP sgcy w 20.8` (CONFIRM MEETS TITLE 5) \ \ \\_ 44 DEP APPROVED EFFECTIVE LEACHING AREA 4.72 S.F.-ZF �� LAMOUREUX G� cn EFFECTIVE LEA PER CHAMBER 13.37 (SF/CHAMBER) o z 11,Ij �,- ,); \\ `" A� 1 CIVIL PORCH TOTAL EFFECTIVE AREA -36 CHAMBERS 481 S.F. N 47 7' N 5` �?�I CONNECT TO EX. TANK W/CLEANOUT \ S o ,o I \ UPSTREAM OF TWO 45 DEGREE BENDS l C TOTAL ALLOWABLE FLOW: 356 GPD F L ENG z SEPTIC \ GRAVEL \ \ \ - 43 LDr MINIMUM DESIGNFLO��*: 330 JGPD I1 TANK DRIVEWAY \\ \\ tNE1-36'Lx1VWYBIDWTTH36I1SFIITRATORSYSTIIILS IIC'K4STAISDARDCHAbBERS Q I 36.0' GARAGE / I ABANDON EX. LEACHING \, �" z I &D-BOX PER TITLE 5 5 ' 4 I SURFACE TP-1 ELEV. SURFACE TP-2 >� Coastal Excavation Corp. 52 Z INCHES FEET INCHES FEET 10.0 +�� �� I � � o.o^ 52.z o.o° 51.s www.coastalexcavationcorp.com I I PROPERTY INFORMATION A A 48 Merry Ave, Duxbury, MA 02332 11.3 LEACHING \, 1 ( �, _ 5131 ` / / I Office Phone: (781) 291-8014 �\ RA S I N / SANDY LOAM SANDY LOAM `t OWNER: MARK AND ANNEMARIE NICKERSON z.o^ sz.a a.o^ 51.1 °� X I ADDRESS: 100 CAP'N CARLETON'S ROAD,BARNSTABLE(COTUIT) MA, FILL E � ° E `'� I ASSESSOR'S MAP: 038,PARCEL NUMBER: 041 LOAMYSAND LOAMY SAND INSPECTION'PORT o 10.0' / / I I' `� PLAN NUMBER: 34623-B,BOOK: 472,PAGE: 64,TITLE NO.: 58784, LOT: 21 Plan Title: LOT SIZE: 0.55 ACRES s.o^ s0.5 a PROPOSED SANITARY /� �, �a E 51.5 12.0' B SANITARY SYSTEM REPAIR ABSORPTION FIELD \ i u1 \ 1 \-L=46.750; R=25.00' ZONING: RF AT s� NUMBER OF UNITS ON THE PROPERTY: I RESERVE FIELD AREA \� `\ / _ , NUMBER OF BEDROOMS EXISTING: 3 TOTAL SOIL TEST PIT DATA LOAMYSAND SANDYLOAM 100 CAPTAIN CARLETON'S ROAD *' \ ` . '1 4 / / NUMBER OF BEDROOMS PROPOSED 3 TOTAL BARNSTABLE (COTUIT) MASSACHUSETTS d / / / L'_.0" 51.2 39.0' 48.2\ pk0 N 1 SINK GARBAGE DISPOSAL: NONE PERFORMED BY: JUSTIN LAMOUREUX, B C ��� , �� `� P.E., SOIL EVALUATOR, S69' 04 04 E \ ` THE LOCUS IS LOCATED IN FLOOD ZONE X(AREA OF MINIMAL FLOODING) WITNESSED BY: DAVID STANTON 0 145.29' `, j'/ I BARNSTABLE BOARD OF HEALTH SANDY LOAM MEDIUM SAND L=46.250, R= 11.740 Prepared For: N ,� � / = , - SITE IS NOT WITHIN A TOWN WATERSHED OR WELLHEAD PROTECTION DISTRICT DATE: OCTOBER 23 2020 l� "1 certify that have passed the 390" 49.0 1z0.0^ 141.5 MARK & ANNEMARIE NICKERSON M P C NO OBSERVED GROUNDWATER / �S1?p ,/ SOIL SURVEY DESIGNATION: EAST CHOP LOAMY FINE SAND, 0 TO 3 PERCENT SLOPES examination approved by the Department of PERc 100 CAPTAIN CARLETON'S ROAD n p� O� Environmental Protection and that the above n, BARNSTABLE,MA 02635 THERE ARE NO KNOWN WETLAND RESOURCES WITHIN 100 FEET OF THE PROPERTY. analysis has been performed by me MEDIUM SAND �N consistent with the required training, expertise, 9 g p 120.0^ 47.(i 4,, Date: Project Number: Sheet: E uj /� GP' 1 THERE ARE NO KNOWN PRIVATE WATER SUPPLY WELLS WITHIN 100 FEET FROM THE and experience described in 310 CMR 15,018(2). No oBSERN ED GRotn«ATFx 1 0/27/2020 z PROPOSED SEPTIC SYSTEM. 2001 1-A 1 Of 1 dM ii I.- NICKERSON SEPTIC.dwg Saved: 10/30/2020 9:06 AM Plotted: Oct 30,2020 9:06:am