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0104 OLD KINGS ROAD - Health
104 OLD KINGS ROWCOTUIT i No. J —�0(Q Fee BOARD OF HEALTH TOWN OF BARNSTABLE `� ZIppYicatiou _for Vert Cou5tructiou Permit Application is hereby made for a permit to Construct(� Alter( ), or Repair( ) an individual well at: 1C)L ( OL.)D � r1 S _ AP 5 ti-.o- l 1 Location-Address��rn S � ess Assessors Map and Parcel �^ ( � C�-� �� 1.� ( nG � Owner ` W� ort(I 'Ac4nn Z)� 04x-�")Q d� t _L Br21?��S�SL U Installer- riller Address Type of Building Dwelling Other-Type of Building 6vL-'�'- C) No. of Persons Type of Well PVC SS Sc,\r �Cn Capacity Purpose of Well --TXcr Agreement: The undersigned agrees to install the afore described individual well in accordance with the provisions of the Town of Barnstable Board of Health Private Well Pr tectio Regulation-The undersigned further agrees not to place the well in operation until a Certificate oflianc s b issued by the Board of Health. Signed i D e Application Approved By V A2 Z Date Application Disapproved for the following reasons: Date Permit No. ��� e� —0 0 Issued 3/(S /� 'Date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Compt, uce THIS IS TO CERTIFY,that the individual well Constructed red( ), or Repaired( ) by nstaller at -< K,(-,4 ( (� "1 4 has been installed in accordance with the provisions o e o of Barnstable Boar of14,.aitb Private Well Protection Regulation as described in the application for Well Construction Permit No. Dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Date Inspector No. U� U -QU� Fee BOARD OF HEALTH TOWN OF BARNSTABLE E— 01ppYication ifor lVelf Construction Permit Application is hereby made for a permit to Construct M;`Alter( ), or Repair( ) -an individual well at: k nc c Y2� _ 1 AP -Zz— 9 `5 9 Location-Address Assessors Map and Parcel Vrc1. h c)4 tca�c,. c 1 n ca R4c� -� - Owner Address HJgP_U irvi ,40 )i) Au -V�o,� l`�( L�Vet cL V '1 : -Installer-' riller Address Type of Building Dwe_ling Other-Type of Building 1 rv1 - No. of Persons Type of Well 1A" t V C_ CS �r y- Q,Y-) Capacity 1 Cl C A Purpose of Well —zX V e C G Agreement: The undersigned agrees to install the afore described individual well in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection.Regulation-The undersigned further agrees not to place the f A well in operation until a Certificate of Compliance has been issued by the Board of Health. Signed / 0 7�`� r / 1 Dale Application Approved By l/ ..31/ij/ 2 V - Date Application Disapproved for the following reasons: `' Date Permit No. ( u� 0 V Issued ' 3 Date ---------------- ----7- -1------P-----------------------------------------.-----------------------------� BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Compliance THIS IS TO CERTIFY that the individual well Constructed / Altered or Repaired( by i 4—T v �A[ Installer Y7 r�< at has been installed in accordance with the provisions of the Ton of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. Dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Date Inspector �d------------ ----------'-----"--a----._----------------.. --------------.,m-®----------------------- BOARD OF HEALTH TOWN OF BARNSTABLE ' Verr Construction Permit No. J,)) 0 oaf Fee VJ Permission is hereby granted to t f 0 ,a In 0t Q ° Installer t to Construct( ), Alter( ), or Repair( ) \\ an individual well at: t No. �C C�,c�3 U y~, Street as shown on the application for a Well Construction Permit No. J.� u;t 06 Dated Date 3 2 �—' Approved By 0 �; ,VZTAGlF�' � TENYOFIL E1 w { GENERAL CMSIRUCTIO14 NOTES t.ALLR�n0RK 9 AND UA«EJup Y4,Au tWFO,u ro n.4 P.ilT 5 dtUMAF'A�DMPOSAi a SEWAaRU.ES AND RECULAM415 Fqt 2.AT LEAST ONE ACCESS M T OYER TANK TEES SMALL BE ACCE$ME MNToN!2 IMiES OF EDASN GRADE MEIN ANY REMARRNt ACCESS P�]LT PORTS ORgl6ET ED MTNR,TwLw MPIES DF f NW OBAOE. Prt — i2E : /+' IY Lo 5[uxc irt.xmD, 3.MT,S'ImANpWD TS C ITNE sA ITN". DIEM BYST.M UNpFA OR MYRM,,C a etP Al 7'T(y�C�' 6._.L Wv DF pRlra OR PARKXK N-;D LOA-SMALL K UStb VNDER OR MIWN 1 'AYT � w 6 TPo CA vABM UNLESS N—. THE E%CAVATpRJLYW1RACtOR SMAtt'•£RIiT TE LOCATON nF Nl w''•a�r+�Ap.m M,� 5rE UTLURS PNOR 10 ANY E%GYATnn. S.BEVER MES STALL 0E A'SCNEDULE AO PW LAID AT CLM!LOPE PREC.A`✓T'RflNFORcm CONCRETE. --•• oa.G D15TRIBUTON MY 1.\q •Jt. S.ANY MASWiNY UNITS VSED RE BRWQ CO`hTPS 10 ORADE SNAIL DE 1500 GALLON PRECAST REINFORCED CONCRETE SEPM TANK MORTARED E PUCE. NFEAI:.n A tfl6 eAK T,FlIIISN t]tADE SHALL XANE A uNOWu 4wE OF 0.0:lLTT PER FOOT. j wMr MsbuCMi wT[AIAJ.4 A@>ttlpw I62L(A NRD,W MALL nNJexps-Y T!llSv..iL PE LaNSmKTn w a6AiDUE No vK 4C ,awxp MOE wwNYON-,x' v. fE'axe A WNw K F NOR M M1n UNE WELti I V*1 bIALL E[C4,K M GD, M M CPiIC tAM(ANp K a M 6J,IFNialR O M PiERft A!A Al E'XeAXW nFAOi+xM1Ei WNTi. 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A E � f ffi NAZNp6 MM rtADLY 110�WABt[RPOYW� ,t-�Y �I� POitn3 K WIVet2 uA1WAl fWi K NEDtOEU'P'v,AC60 ? a-fi R�f1 NAD[D AT'rtS fit@ AM aLP M AAET rzA < \ d I.d EIE WAR tEE WnLL K EbHME®fM DA9 MAIM 99 ' a..� _+.::. ... ..-.,� ,•q.DyiE tl4_a- ..... ... .-.-_�.� `�4 —.. _ -ems.-+. e.., .e. - . ]PD' \ / PEDIroASd ItM Cytbo tut repned DwDlling b / PrtAo.o6&A& i Em RSG w c N / Dh' .` AA 2Epaiw O rAPA LAME LW,nlnt Ilan. .'-r�..8.�__..—._ MxuN.xAO�R�CIKW nhJS � - - ✓ >dY� D � E411 in_.--.IBs_'Y__s— n° UQIb,M:.l ` / � -•-•-r2t d.. i A.Ag. aw.a�D N b--- •a.�t' --`D � a/.vI. 1 P21m/Re F. .,vL- ✓n T�� . ��. 6I A,o — ,. IbNF bSilYti.Pf SSEr :�_•!— e. I�� 1 � 1���9 aaAAv Pn -, �• pwe iAdb_._(n�r1 4D\a. �:'- �.n.9. \ oAiuxE-e0 \•LLL) z NrJ IJ v,P c(q Ss[.Admys_as^IA z__� -t 9AA .�EJ�IELSL � „ ..\ •'+{�'�� 'pa lA. GRAPHIC SCALE �jN ti'• E F' CQTUIT - DARNSTA}LE, I.MA �n m 1 �Y yM' DEPICTING'Did MMffED LaAw:w`L\o' .{E'!-', MAC:h4ILZ.s\N 22F:STD-F NCF i O`v. z' 9aLLx e.eeo.o MU:Jun u,EOSC I ',! Prv,pDred By. SkyitOe J.DDppP end AnexlnteA ' 42 CADEA.-lens.Yetlt M.InreDuL TWwAcnnR.E4 p2550 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments a 104 Old Kings Road - -- -_--- - 9 Property Address MacMillan Owner Owner's Name information is required for Cotuit MA 02635 October 21, 2013 _ -- --- — -- _-----------._ ----... every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out A. General Information forms on the computer,use 1. Inspector: only the tab key �' V to move your Patrick M. O'Connell cursor-do not - -------------------- _....__----------------------------------- use the return Name of Inspector key. Company Name jrse PO Box 1487 ------- Company Address --- -- -- --- — ---- -- Marstons Mills MA 02648 CityfTown State Zip Code 508.428.1779 SI 12855 - --._._— ._._ . ..__ -_._... ..__.. _. _.Telephone Number Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and th0t^the e information reported below is true, accurate and complete as of the time of the in� p'ection. They insp ction was performed based on my training and experience in the proper function andwma ntenance"df on ste sewage disposal systems. I am a DEP approved system inspector pursuant.to Section 1,5!340.of, Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ F4lls t� ❑ Needs Further Evaluation by the Local Approving Authority rri V I + R-- . October 21, 2013 Job # 13-96 In ector's i ature ' Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t51ns•3113 1 die`.,Officiat lnspectinn Form Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 104 Old Kings Road _ . __.._... _..- ....- _. . -- ------- -------- Property Address MacMillan Owner -- ._..--....._.__.........--. ...__... .. - _ _.......__-.._...--._..... -........_.------------------- -- Owner's Name required for is Cotuit MA 02635 October 21, 2013 requiredfor ---------------------- ----_ _____---- -- ---- every page. City/Town State Zip Code Da'--of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E / always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: Tank was not in need of pumping at time of inspection. Leaching system was empty. — 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 followinj 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): S t5ins•3113 1me 5 official inspection form Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments \ ems 104 Old Kings Road Property Address MacMillan Owner Owner's Name - -- --- -- �_ ----- — information is Cotuit MA 02635 October 21, 2013 required for _ every page. CitylTown State Zip Code Da,e of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. 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 ❑ t4D (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 151ns•3/13 life`i 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 .,, 104 Old Kin s Road Property Address MacMillan Owner Owner's Name information is required for Cotuit _ — _ _ MA 02635 October 21, 20_13 every page. City/Town State Zip Code Dale 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 protectb 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 fE,3t 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 certifie-' laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. . 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or "No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground.or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than day flow t5ins•3/13 rnie 5 ofhuai tr,specinon Form Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 104 Old Kin s Road Property Address MacMillan Owner - -- - Owner's Name --- - information is Cotuit MA 02635 G.tober 21, 2013 required for eve Cit /Town _. .._ ... .— ------ --- ry page. Y State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 Of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply. well ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a'design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefire 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 surfac-, 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 owns, 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. 15ins•3113 Tree 5 Official inspection Form Subsurface Sewage Disposal system•Page 5 of 17 . � Commonwealth of Massachusetts ' 5 Title 5 Off"c°~~° I" "~=�=~�~�="�~" " Form Subsurface Sewage Disposal System Form ' Not for Voluntary Assessments 104 Old Kings Road -- Property Address ---------------- K8anN1iUan ' Owner Owner's Name ------------'—'-- information is ' required for Cotuit _ __ ___ y�A_ 02635 ___ October 2013 -------- everypage. cxwTo~n ` 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� Yee No ' . Z n Pump ing information was provided by the mwne/, occupant, or Board ofHealth El Z Were any of the system components pumped out in the previous two weeks? Z El Has the system received normal 8ovve in the previous �wowoek period? �� �� Have large volumes of water been inhoduoed \u the system reoenUyoros part of ^~ �~ this inspection? �� �� VVeroaobui|tp|anooftheayotemobkainedondexamined7 (|ftheyweven�� �~ �� available note as N/A) • El Was the facility ordwelling inspected for signs of sewage back up? Z El Was the site inspected for signs of break out? - Were all system components, exduding1h'e'SAS. located onsite? � Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material ofconstruction, � dimensions, depth of liquid, depth of sludge and depth ofscum? � � �� �� VVaethe faoih1yowner (and occupants �d�erent �ommwne� pmv�edwhh � �~ �� 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: ' . Z D Existing information For example. a plan at the Board ofHealth. �� �l Determined in the he� (if any nf the failure onhenarelated VnPa� Ciaokissue �� ^~ approximation of distance io unacceptable) [310CMR 15.302(5)] D. System Information Residential Flow Conditions: | ` | ' 4 4 ^ Number ofbedrooms (design): Number ofbedrooms (oo1ua|)� —�--------- 440 � 'DESIGN flow based on310CMR152O3 (for example 110gpdx # ofbednc:)ms)� ----------- . . t5i=-3n3 nw5 Official inspection,ormxubsu^=°Sewage Disposal System-Page om,r ' Commonwealth of Massachusetts Title 5 Official Inspection Form i; Subsurface Sewage Disposal System Form Not for Voluntary Assessments - , a 104 Old Kings Road Property Address MacMillan Owner ___ _ _ _ _--.-._._._._--- - Owner's Name - ---- ------------------------ information is Cotuit MA 02635 _October 21, 2013 required for _ _ every page. CitylTown State Zip Code Da!t,of Inspection D. System Information Description: Number of current residents: -Unknown--------- Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)) N/A Irrigation System 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•3/13 !nie 5 Offnat Inspection Form Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s, Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 104 Old Kings Road Property Address MacMillan Owner Owner's Name -------------- information is required for Cotuit MA 02635 October 21, 2013 every page. CitylTownState Code - to of Inspection n -- i ----State Zip Code Dale of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Tank pumped one year ago.___ Was system pumped as part of the inspection? ❑ Yes ® No Ifyes, 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 inspectir n records, if any) ❑ Innovative/Alternative technology Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other (describe): t5ins•3/13 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts F Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 104 Old Kings Road Property Address MacMillan Owner - - - -------- --- —Owner's Name information is required for Cotuit MA 02635 October 21, 2013 _..-- ......-_...- --........._.__.._....:_. _ _ every page. itylTown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Installed: 11/4/99 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other (explain): -- Distance from private water supply well or suction line: feet — -- Comments (on condition of joints, venting, evidence of leakage, etc.) Septic Tank (locate on site plan): Depth below grade: 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: 10 5' long x 5 8'wide _1500 gal. _ Sludge depth: 15ins•3/13 Vile 5 Officual Inspection Form Subsurface Sewage Disposal System•Page 9 of 17 � Commonwealth of Massachusetts . . ~~~.~ ~~ O~ ° °ci~=° Inspection Form Subsurface Sewage Disposal System Form ' Not for Voluntary Assessments � �U4OWKi Road `-. Property _---------- _ -_-- � MacMillan � Owner ----------------'- - -----'--- infonnanunis required for Cotuit [WA O2G35 Ootobor21 2013 every page. ouv�«=» stae �����e -' b-a te-oF���ct-to n '-- D. System Information (cont,) Septic Tank (oonL) 30' � Distance from top of sludge to bottom ofoutlet tee o/ baffle --- � Scum thickness -O'- - _- Distance from bop of scum to top of outlet Kee or baffle '�--- � Distance from bottom nf scum to bottom ofoutlet tee ovbaffle Measured How were dimensions determined? Comments (on pumping naoommendadkons, inlet and outlet tee ' or baffle condition, structural integrity, liquid |evu|o as related to outlet invert, evidence of leakage, etc) Liquid level was foundsUbo�n of inve� and �oswareintact and clear. | � ��� � � _--------- _-_`- - , Grease Trap (locate on site p|an)� Depth below grade: ---_-'-----------_______- fee ^ Material ofconohuomn� 0oononaba El metal 0 fiberglass . El po|yethy|-.ne E] other(explain): ` � Dhnanniona� ^ Scum ' thickness ` ^ Di�nnoefn�mhxpofncum8oho� ofouU ` tee - - Distance from bottom of scum hn bottom ofoutlet tee orbaffle ------ Oaheofkastpump|ng: Date ------ ;��^&,,Sewage Disposal System-Page`vw,, Commonwealth of Massachusetts R. AW, Title 5 Official Inspection Form Subsurface Sewage Disposal -g posal System Form Not for Voluntary Assessments a �e Y''��;:• 104 Old Kin s Road Property Address MacMillan Owner --..-- ------ -- - Owner's Name __---..._..--------------_-_-------- information is COfUIt required for MA 026_35 _ October 2_1, 2_0.13 _ -----------------...-----___...__.__....--- Cif /T _..___._ _ _ every page. Y own 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 Dateof last pumping: __..____. __ .____.......___._-.__..-------.--__.---------------------------.__._. Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No 15ins•3/13 l nle 5 Official inspection corm Subsurface Sewage D,sposal System•Page 11 of 17 Commonwealth of Massachusetts Title - Official - ' ' -- n- - - -' -- ' ' Form Sit Subsurface Sewage Disposal System Form ' Not for Voluntary Assessments 1O4 Old Kings Road Property_ A--ress _ - MacMillan Owner -' - -----� ------'----- inmrmatwnis required for Cotuit MA 02835 Ouhzber21 2013 every page. c«w/mwn State Zip Code Date o,Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site p|an)� Depth of liquid level above outlet invert - --------- ' � Comments (note if box is level and distribution to outlets equa|, any evidenoe of solids carryover. any � evidence of leakage into nr out of box, egu)� . No solids high stains present. . ' � ______-__ _ | -_-__-_- ! , PumpChamber (|ooateonoitep|an): Pumps in working nrder 7 Yen El No* � Alarms in working order ' ^ [l'Yes n No* , Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): | ------' -^---'--'--'�---'--- - ' - ` ° If pumps or alarms are not in working order, system is o conditional pass, | � Soil Absorption System (SAS) (locate on site plan, excavation not required): . If SAS not looahed, explain why: ' ' ---- '- --' --- - - -- --------- t5ins-3/13 1 itles Official Inspection Form ��Sewage Disposal System-Page/2w`/ � Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal Sys em Form Not for Voluntary Assessment 104 Old Kings Road Property Address MacMillan Owner Owner's Name information is required for Cotuit MA 02635 _October 21, 2013 ' eve a Cit /Town every page.e. Y State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: -- — --- -- ® leaching chambers number: 6 Infiltrators- - - ❑ 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.): Interior of infiltrators were video inspected, found empty with no evidence of surchage Cesspools (cesspool must be pumped as part of inspection) (locate on site, plan) Number and configuration ----------------------- -- Depth -top of liquid to inlet invert ------ ---- Depth of solids layer --------- ---------- Depth of scum layer ----------------=- ---- Dimensions of cesspool ------------------------- — Materials of construction ----------__-- ____ Indication of groundwater inflow [j Yes ❑ No 15ins•3/13 1 tle 5 Official Inspection Form Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts . Title — Official .~ ~~~p~~ct°o" ° Form Subsurface Sewage Disposal System Form ' Not for Voluntary Assessments 1O4 Old Kings Road Property Address '-------------- MacMillan Owner - ---- imhnnatwnm | required for Cotuit __________ MA 02635 October 2013 � every page. wp/nw" -- Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level ofponding. condition ofvogetahon etc.): ' ' _---_._' � ............ ............. ^ Privy (locab* unahep|an): ` . Materials ofconstruction: | Oknenaiono � Dppthnfmdids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation etc.): ' ` . __________ ' ' | ' | ' | ` � ^ / Sewage Disposal System-Page ww`, Commonwealth of Massachusetts Title 5 Official Inspection Form `1 --_" iVi Subsurface Sewage Disposal System Form Not for Voluntary Assessments. - :C - -- 104 Old Kings Road Property Address MacMillan Owner Owner's Name informregUir dfotion s COtuit MA 02635 October 21. 2013 required for every page City/Town State Z p 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 we5s within 100 feet Locate where public water supply enters the building Check one of the boxes below ® hand-sketch In the area below ❑ drawing attached separately 29 35 36 36 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 104 Old Kings Road Property Address -- MacMillan Owner - -- - -..._._....__._..._._..._,_.._ , Owner's Name information is required for Cotuit MA_ 02635 _October 21, 2013 _ every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 20+ 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: USGS topo map You must describe how you established the high ground water.elevation: Low areas of adjacent properties with no surface water are lower in elevation than SAS. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5m•3/13 Title 5 Official inspection Form Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 104 Old Kings Road Property Address MacMillan Owner -- -- -- — Owner's Name information is Cotuit MA 02635 _October 2_1, 2013 _ required for eve page. Cit /Town Code__-•-- ry p g Y 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 L15,1-1- 13 Tele 5 Official Inspection roan Subsurface Sewage Disposal System•Page 17 of 17 TOWN OF BARNSTABLE LOCATION 4D I i/u L S RL) Lc)T 'rrcl; g SEWAGE # VILLAGE C O+", k ASSESSOR'S MAP & LO INSTALLER'S NAME&PHONE NO. 6 ,,,, el (`try SEPTIC TANK CAPACITY /5 J LEACHING FACILITY: (type) /4 (size) /U X yy XoZ' NO.OF BEDROOMS BUII.DER OWNE I a PERMUDATE: 1.1 — 3 - COMPLIANCE DATE: / "I Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet 1 Private Water Supply Well and Leaching Facility (If any wells exist i 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 o P4 U i "oe4 cA n No. Fee1141 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes JV PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 0[ppYtcation for Migossar 6pztem Cow5tructiou 3permit Application for a PermilX Co ct( /Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot qCp v u� Owner's Name,Address and Tel.No. '7-Z Assessor's Map/Parcel _ eL`S� Installer's Name,Address,and Tel.No. Designer's Name,AVf2� 1.5. DOYLE & AS qQp.. — . Canterbury Lane East Falmouth, MA 02536 Type of Building. 1 - 2534 Dwelling No.of Bedrooms Lot Size 3(o O sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow AA gallons. Plan Date cc CM Number of sheets Revision Date Title S tr r �t_Ai �- Size of Septic Tank 1 ©D Type of S.A.S. Description of Soil > <S=-4 i .kL- �--t� 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 Certifi- cate of Compliance has been issued by thild y6f Heal i-, Signed G%� V Date Application Approved by Date 6 --17- Application Disapproved for Me following reasons Permit No.__/ 97- 36 2 Date Issued Fee THE COMMONWEALT OF MASSACHUSETTS Entered in computer: Y Yes PUBLIC HEALTH DIVISION ='TOWN OF BARNSTABLE., MASSACHUSETTS 0[ppYication for ]Di!5poga[ *pgtem Cow6truction 3dermit Application for a Permit o C�i.tract(Repair( )Upgrade( )Abandon( ) El Complete System O k(ividual Components AV Location Address or Lot` o. vO�- qc( p t,a �, y Owner's Name,Address and Tel.No. Assessor's Map/Parcel Z I_ostaller's Name,Address,and Tel.No. Designer's Name,Addr*gcLTg 90J. DOYLE & ASSOC. 42 Canterbury Lane Rant Falmouth, MA 02536 Type of Building: Dwelling No.of Bedrooms_ _ Lot Size `3G Octsq.ft. '.� Garbage Grinder( ) Other Type of Building No;.of Persons Showers( ) Cafeteria( ) Other Fixtures t Design Flow gallons per day. Calculated daily flow AAA gallons. m Plan Dateumber of sheets z `. Revision-Date t CrCv �- 11-�{ a e i rTitle S►C'r F1 tom% LA.N sN.O\ 't M e- Size of Septic Tank Type of S.A.S. --=�.i"rkL . �,"� Description of,fSoil Nature of Repairs or Alterations(Answer when applicable) w Date last inspected: 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 theE'nPronmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by thi tkarcVof Health: l ' Signed Date 9 4 Application Approved by ° " " Date —17- /9? Application Disapproved for He following;reasons e I ( Permit No. 7 7- 3 h 2 Date Issued --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS � BARNSTABLE, MASSACHUSETTS 'J Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed Repaired( )Upgraded( ) Abandoned( )by i N/l dW 1 TD 9 at LP,� "7�9 ram( 1�_..�� (�� hv .ta� has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. /07-• 2 dated Installer Designer i l The issuance of this permit shall of be construed-as a guarantee that the s tem will function as esi ned� `' l,C�'r Date p / I �''I Inspector y ��� 4 Aas y /d //r?Ili fr j --------------------------------------- No. 99," Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS x1f 6pozar *pgtem Construction Vertu Permission is hereby granted to Construct(,,,)Repair( )Upgrade( )Abandon( ) System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date: �f ?�— �� Approved by TOWN OF BARNSTABLE LOCATION ©1� �• i. �Q # ,n VILLAGE �6,h) ASSESSOR'S MAP&PARCEL FP S-TAEEE 'S NAME&PHONE N0.J r L c6(,.o 1N,�� �-{ $-1'�' C► SEPTIC TANK CAPACITY 0 c jW CUP LEACHING FACILITY.(type) (size) NO.OF BEDROOMS ^� OWNERP�L PERMIT DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY • k l\ 4 r 4 l 4 \l Y \ 4 4l 4 4+k 4 f / i+i ? f ! / f J+?+f r f J ? F i ! ! / f F J•f ? J+f+f+f f ' \ \ •'Y k Y \ • 4 4 Y \ Y \ • \ \ Y Y \ k k k \ Y Y Y Y k \ • • 4 Y \ Y Y ♦ \ Y \ 4 • • \ 4 Y 4'•rlow, L+'•!4! 35 3 36 36 L �D TOWN OF BARNSTABLE LOCATION 40 &(/U 6 S Po LU? SEWAGE # VILLAGE C O+U t I" ASSESSOR'S MAP & LO INSTALLER'S NAME&PHONE NO._ c)k SEPTIC TANK CAPACITY /So J LEACHING FACILITY: (type) G 14 aj L/'®thJ�� (size) /U X`(yr xoZ' NO.OF BEDROOMS BUILDER OWNE PERMITDATE: l/—3 '9 I COMPLIANCE ;DATE:_ Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) 4' Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by (3 . �A(Z' 3 ' 13 a 3Y/ s 35 36' 36, _o Town of Barnstable P# Department of Health,Safety,and Environmental Services �THEhy- Public Health Division Date 367 Main Street,Hyannis MA 02601 BARNSTAHM °rfnntn�. Date Scheduled Time Fee Pd. Soil Suitability Assessment for Sewage Disposal Performed By: r), L+4— Witnessed By: _ LOCATION +& GENERAL INFORMAT ON Location Address Lot qq _ d l� f�l1�C�S �� Owner's Name Address STEPHEN J. DOYLE & ASSOC. Assessor's Map/Parcel: Z��a� Engineer's Name 42 Canterbury Lane East Falmouth, MA 02536 NEW CONSTRUCTION REPAIR Telephone# Telephone: 508 2534 Land Use S Slopes(%) Z ` Surface Stones Distances from: Open Water Body �5 V ft Possible Wet Area OR Drinking Water Well �R Drainage Way R Property Line 1l7 t It Other R SKETCH: (Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) 5 N - lye �z Parent material(geologic) Depth to Bedrock Depth to Groundwater: Standing Water in Hole: Weeping from Pit Face Estimated Seasonal High Groundwater D 1'E NATION OR:SEASONAL;IIIGt 'WATER TA L Method Used 9..�/ap�`�j p�w�Pv�+•tvt� Depth Observed standing in obs.hole: in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment It. Index Well N_._. Reading Date:_._._ Index Well level Ad.j.factor_ Adj.Groundwater Level P 4'RCOLATION TESO pate Time Observation Hole# Time at 9" Depth of Perc Time at 6" Start Pre-soak Time @ Time(9" ' End Pre-soak L1 to R�L—_ -r.0 5.t vt�1__ Rate Min./Inch Z � / I�� �`ll��• Site Suitability Assessment: Site Passed V Site Failed: Additional Testing Needed(YIN) Original: Public Health Division Observation Hole Data To Be Completed on Back j Copy: Applicant Town of Barnstable >t# Department of Heal I p t�,Safety,and Environmental Services oFIM Public Health Division Date o„ 367 Main Street,Hyannis MA 02601 BARNBI'ABLE, � MASS. Date Scheduled '°rEn rnn+ Time Fee Pd. Soil Suitability Assessment for Sewage Disposal Performed By: Witnessed By: LOCATION & GENERAL INFORMAT.,ION Location Address Owner's Name Address Assessor's Map/Parcel: Engineer's Name NEW CONSTRUCTION REPAIR Telephone# Land Use Slopes(%) Surface Stones Distances from: Open Water Body It Possible Wet Area R Drinking Water Well ft Drainage Way It Property Line it Other n SKETCH: (Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) Parent material(geologic) Depth to Bedrock Depth to Groundwater: Standing Water in Hole: Weeping from Pit Face Estimated Seasonal High Groundwater b `Y ERMINA`I'tON F SEASONAL,HIGH V'Am ER TA L Method Used: .. Depth Observed standing in obs.hole: in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment n. �- index Well# .. Reading Date:_ __ Index Well level.___ _ Add.factor Adj.Groundwater Level PERCOLATION TEST ;> pate Tune Observation Hole# Time at 9" Depth of Perc Time at 6" Start Pre-soak Time @ Time(9"-6") End Pre-soak Rate Min./Inch Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back j Copy: Applicant I ! 3 4, mx)( , GoJ147, Oq v-r tL. Sf s t'e�M GSM N�k r'S S TOP FOUND. EL AZ.•U GENERAL CONSTRUCTION NOTES ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. TITLE 5 AND THE TOWN OF -�;A. RULES AND REGULATIONS FOR --- WATER TIGHT Covet �- THE SUBSURFACE DISPOSAL OF SEWAGE. Y MiN. 1/ 8- TO 1/2- WASHED STONE LEVEL2. AT LEAST ONE ACCESS PORT OVER TANK TEES SHALL BE ACCESSIBLE r ' --�`�I 'H _ 3"►,0 WHITHIN SIX INCHES OF FINISH GRADE WITH ANY REMAINING ACCESS INV. EL 3'B-A _ PORTS BROUGHT TO WITHIN TWELVE INCHES OF 'FINISH GRADE. INFILTRATOR g' FLOW LINE --� Q 2, to• MIN. MIN. 6• c „ - E.FF, DEPTH 3. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF 14JL " INV. Et a-�• soup 3/4 1 </`OwASHEO STONE WITHSTANDING H--10 LOADING UNLESS THEY ARE UNDER OR WITHIN 10' _— F-L 3 .o OF DRIVES OR PARKING. H--20 LOADING SHALL BE USED UNDER OR WITHIN 10' MiN. UOUM DEPTH 10' OF DRIVES OR PARKING UNLESS NOTED. INV. EL. 'i•4 INV. EL. „ d� S.A.S. LOMG x �° WIDE x?EFF. DEPTH 4. THE EXCAVATOR/CONTRACTOR SHALL VERIFY THE LOCATION OF ALL INV. EL '37-q WITH HIGH CAPACiTY INFILTRATOR CHAMBERS SITE UTILITIES PRIOR TO ANY EXCAVATION. 5. SEWER PIPES SHALL BE 4" SCHEDULE 40 PVC LAID AT 0.02 SLOPE. PRECAST REINFORCED CONCRETES .-so,o _._ __ DISTRIBUTION BOX 6. ANY MASONRY UNITS USED TO BRING COVERS TO GRADE SHALL BE 1500 GALLON PRECAST REINFORCED CONCRETE SEPTIC TANK MORTARED IN PLACE, INSTALL ON A LEVEL BASE MINIMUM CONSTRUCTION MATERIALS PER 310GMR 15.226(2) MINIMUM WALL THICKNESS a 2" 7. FINISH GRADE SHALL HAVE A MiNIMUM SLOPE OF 0.02 FEET PER FOOT. TEES SHALL BE CONSTRUCTED OF SCHEDULE 40 PVC AND MINIMUM INSIDE DIMENSION a 12" x SHALL EXTEND A MiNiMUM OF 6 ABOVE THE FLOW LINE " OUTLET INVERTS SHALL BE EQUAL 7O EACH 39.ii OF THE SEPTIC TANK AND BE ON THE CENTERLINE OF THE MANHOLE K LOCATED DIRECTLY UNDER THE CLEAN-OUT OTHER AND AT 2' MINIMUM BELOW INLET INVERT. O O THE DISTRIBU11014 LINES FROM THE DISTRIBUTION BOX THE INLET PIPE ELEVATION SHALL BE NO LESS THAN 2` NOR SHALL ALL HAVE EQUAL INVERTS AS DETERMINED BY FLOODING ,yryr MORE THAN 3" ALE THE DISTRIBUTION BOX TO THE HEIGHT OF THE DISTRIBUTION ' ABOVE THE INVERT ELEVATION OF THE LINE INVERT AFTER ALL LINES HAVE BEEN SEALED IN PLACE. ` OUTLET PIPE. `` INVERT ADJUSTMENTS SHALL BE MADE BY FILLING WITH DURABLE x AND NON-DEFORMABLE MATERIAL PERMANENTLY FASTEND TO THE SEPTIC TANK SHALL BE INSTALLED LEVEL AND TRUE TO GRADE LINE OR RECONSTRUCTING THE LINES UNTIL ALL INVERTS ARE OF 35.4' ON A LEVEL STABLE BASE THAT..HAS BEEN MECHANICALLY. EQUAL NATION. COMPACTED AND ON TO WHICH SiX.INCHES OF CRUSHED STONE HAS BEEN .PLACED TO ENSURE STABILITY AND TO PREVENT 41.5 SETTLING. SEPTIC TANK SHALL HAVE A MINIMUM COVER OF 9". q� 7� , r THREE 20" MANHOLES WITH READILY REMOVABLE IMPERMEABLE �tj� COVERS OF DURABLE MATERIAL SHALL BE PROVIDED WITH ACCESS PORTS BEING PLACED AT THE CENTER AND OVER THE INLET AND OUTLET TEES. THE OUTLET TEE SHALL BE EQUIPPED WiTH GAS BAFFLE LO T 9 36,096 sq.2L X 39.1" _ r 00 x 39.9" 41.5' n2 39.9' A x Denotes Existing Spot Elevations x 39.5' Proposed VE00 Gallon Tank Proposed Dwelling ?s. Prc>posed .S.A.S. o� InfAtrator Trench S o� �o REFERENCE MAP: t'�,1, : . 40' SOIL OBSERVATION DATA: Airy — - --------------- ----- ' x 40.1' 'Off, 3`i�• AQ r r, CAPE COD S.A.S. anslon Area r o WATER TABLE CONTOURS ij i� AND _ PUBLIC WATER SUPPLY O 2' TEST DATE " Z$"�� WELLHEAD PROTECTION AREAS a� 1 6'�'Cl• b SOIL EVALUATOR S. t7•y�t r SEPT€►BEER 1995 DESIGN DATA: 40' WATER RESOURCES OFFICE - ,: " , , B.O.H. AGENT _ `S�.aP-m c-aats� CAPE COD COMMISSION STRUCTURE -i 3' x u/Pole ' EXCAVATOR ;��L.t p TYPE NO. BEDROOMS GARBAGE DISPOSAL40 PERC/RAIE �- Z N\)1• \HIA� DESIGN FLOW EL.4o.p ' I • ' ' ' ZONING DISTRICT: RF r BUILDING SETBACKS: � . /-L l o y7C, -3 •3 `!, i , ^� ; FRONT 30' ter, �3 zA SEPTIC TANK _44 O O SIDE 15' fir,l, O c� REAR 15 it "$ 7.5 57(0 `G '1,5'� sJ� \ ,O• �~ '� OVERLAY DISTRICT: AP 29 3 i LEACHING FACILITY I o A-�o A- Ao Ao � Z = mock � ' , .•�� � 1 DO ,, ,' ��� FEMA DATA: ZONE C -�- ASSESSORS DATA. MAP 22 - 95 Z 1e X �� = Ao0 'r REFERENCE DEED: 2931/35 'V W{ �•' tK F M�s1 REFER E PLAN: 271/58 soup 5�?J 0. _ Q4Q - 9� 39 I j'. !/ �,�' r cys ENy,1 Of,�� {Zoo k AOD1�C "Ic �; �`� r S I r / ,' $ WILLIAM a4'� 6l51ErPEQ C* �Z� it 1Z011 i 41 ,�` ,, LIEBERMAN u+ STEP" ,5' b�� I /1 ,,, .'',' �O�FCr ST£�� �� DOnE A 1 Z�•�i rONAL GRAPHIC SCALE / ,;,, �qy0 sum 20 G 10 20 40 80 ITE PLAN C) F LAND / � Existing / Pavement , IN C O TUIT — BARNS TABLE, MA 40 ,' , 20 �� 'rs DEPICTING THE PROPOSED 1 inch ft. BM: TOP HYDRANT ,' EL 43.7' �,.' �,.' PL .z\T' vIEW LDATUM: NGw MACMIL,LAN RESIDENCE ��u/pole ,.' , Scale: As Shown Dater June 11, 1999 Prepared By: Stephen J, Doyle and ARRociatee 42 Canterbury Lane, East Falmouth, Massachusetts 02536 Telephone: 508/540--2534