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0095 SCUDDER ROAD - Health
95 Scudder.Road A Osterville P 5 s 140,016 fj i TOWN OF B A RNSTABLE cc LOCATION SEWAGE # Y tt�,, zJ VILLP,aGE Ir ASSESSOR'S & LOT �1� 4 INSTALLER'S NAME&PHONE N.O,e I LffibalChM SEPTIC TANK CAPAC %433_'+g f r LEACHING FACILITY: ( pe) �` (size) 2o x , 51 NO.OF BEDROOMS BUILDER OR OWNER1± y PERMITDATE: 0-4--COMPLIANCE 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) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by Ai ,33` u Nam , 2 - 46 -3—44 1,411 '4_ lob, No.-c 4> 4-4 5 THE COMMONWEALTH OF MASSACHUSETTS t FEE L . BOARD OF HEALTH C�LC� OF APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct ( ) Repair ( ) Upgrade (' Abandon ( ) - ❑Complete System ❑Individual Components Z04 �1--,0 a Cat n :•Lo ati; . Owner's Name !4•''/Parcel# / Address i 15— Telephone# 1 gess N (� Telephone# Telephone# Type of Building: , „��SlG�rr►G� Lot Size 277I Sq.feet Dwelling—No.of Bedrooms Garbage Grinder WA Other—Type of Building No.of persons Showers ( ), Cafeteria ( ) Other fixtures Design Flow(min.required)3 gpd Calculated design flow gpd Design flow provided gpd Plan: Date 2- Number of s eets Revision Date Title Ca C v Description of Soil(s) 0 - a /2-19/S .e L,-CqkL4gj1- F� 24 0 °G Soil Evaluator Form No.%. 49 Name of Soil Evaluator ; J/r r1 Date of Evaluation g:" 113 DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agree t to place the system in operation until a Certificate of Compliance has been issued by the Board of Health. Signe Date - D FORM t - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 (ro>JLOd� THE COMMONWEALTH OF MASSACqusLT4 FEE• j a7 BOARD O OF, H1E A/LT H` s, ;96 r APPLICATION FOR DISPOSAL SYSTEW�- ONSTRUCTION PERMIT I Application for a Permit to Construct ( ) Repair ( ) Upgrade X Abanclo� ( ) - ❑Complete System ❑Individual Components ✓� ..S'c r��lr • . G �Os� �: . C'_�•r-;s�~-I.`�. �r�t r.vw�' v Location Owner's Name t /`lea v pG_ / p/Parcel# Address A/ r of Telephone# `duress MR ddress ' ter, •SS ' �1" "1 C�Z b S�D t� - t "Z.�R•7�"'!✓A^"- i Telep onh e# ' a Telephone# Type of Building:t I OE t Sl�t f!GL Lot Size 11,2,77 Sq.feet Dwelling'-No.of Bedrooms .t rt Garbage Grinder (IUTA . t Other—Type of,Building No.of,persons Showers ( ), Cafeteria ( ) Other fixtures Design Flow(min.required) .7 c3 gpd• Calculated design flow 440 gpd �Design flow provided�gpd Plan: Date 2 0� /Numbe//ro//f"sheets Revision Date � — !�) Title �C� — %D O !/ �/�1! !1 ,PL_ ! ✓ [, G.I�/'�S/ KS Description of Soil(s) r o �Z �A.��L..J v�tSo� . 3Y"—/xe/s U /r Soil Evaluator Form No. PI CI 4X Name of Soil Evaluator,,11;Oh kI Date of Evaluation /� a DESCRIPTION OF REPAIRS OR AL ERATIONS The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of le TITLE 5 and further agrees not to place the system in operation until a Certificate of Compliance has been-issued by the Board of Health. -- Signer Date Inspection r ` FORM 1 - APPLICATION FORIDSCP DEP APPROVED FORM 5/96 No. D �' THE COMMONWEALTH OF MASSACHUSETTS FEE U rry'� (1lk BOARD OF HEALTH CERTIFICATE OF COMPLIANCE Description of Work: ❑ Individual Component(s) Complete System A`\ The undersigned hereby certify tha ithe Sewage Disposal System;Constructed( ),Repaired( ),Upgraded(xj,Abandoned( ) LC- at / t) V f has been installed in'accordance with the provisions of 3 p C �1. .00 (Title 5) and the approved design'�ans/as-built plans relating to application No. Wy' n- dated /.�(/ U Approved Design Flow `i 0 (gpd) Installer 1 V I rn r G v Designer: Inspector hn/. 146ate l,)L/ Thelissuance of this certificate shall not be construe&as a'..gu antee that the system will function as designed. FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM S/96 No�� S THE COMM0NW�E"ALTH OF MASSACHUSETTS FEE lOG a's BOARD OF HEALTH DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to Constru ) Rep it (��Up .rade.( Abandon ( ) an individual sewage disposal system at 8-5 SC / as described in the application for Disposal System Construction Permit No. rD4Zq 9-.S5 ;dated 5� O c-f Provided: Construction shall be completed within three years of the date off/f ids p nn t._Alb oca conditions must be met. Date A� L Board of Heafth__ FORM 2 - DSCP DEP APPROVED FORM S/96 FORM 1255 (REV 5/96) H&W Ho6m&WARREN TM PUBLISHERS- BOSTON R. 7:0 SEWAGE INSPECTIONS GN 9 5 Scudder Road DATE 3/1 9/0E_Osteryi l le,Mass_ ASSESSOR'S MAP & LOT 1 40-0.1 6 -INSPF'd'_POR Joseph P.Macomber Jr. SEPTIC TANK CAPACITY None 2-5' XV Cesspnols LEACHING FACILITY: (type) 1 -LP-1 000 (size) 1900 gallon-,; NO. OF BEDROOMS 3 BUILDER OR OWNERDaniel J. Kelly OWNER MAILING ADDRESS Same `15 y 5�,��d�� t2�a� c���v�'l�¢ � �." a �, � .,N•a�er , 1 • -.,� .t''' i 'g � �\ i i � \� �� ,,\\ i � :s's� � � s 150.0, N 83°21'35" E 0 Q 0 6.9 ry G� LL LY— PT 98.97 C) 7., U DB „98.80 97.81 ST v, 97.81 97.98 Z O 97.07 / 0 co W W v N . W O � z w z U Q rnrn w vJ J 96.91 O S 83°20'54' W 150.0, O C~ 20 0 10 20 40 80 O ( IN FEET ) D" 1 inch = 20 ft. W _ q q T.B.M. FINISH FLOOR OF PORCH EL = 103.67 O ASSUMED ® DAVID C. THULIN, PE, PLS SEPTIC SYSTEM AS-BUILT PLAN 211 MILL ROAD ICJ EAST SANDWICH, MASSACHUSETTS 02537 95 SCUDDER ROAD PREP. FOR: DEMARTIN DRAWN BY: OCT I CHKD BY: OCT BARNSTABLE (OSTERVILLE), MASSACHUSETTS JOB No: 04-009 REV. SHEET 1 OF 1 SCALE: 1" = 20 DATE: 8/16/04 TOWN OF B STABLE LOCATION SEWAGE "eI �j VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&P ONE NO.� W - SEPTIC TANK CAPA� LEACHING FACII.TTY: ) °� (size) 9� NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE:_5 ' 77 j COMPLIANCE DATE: d 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.an wetlands exist within 300 feet of leaching facility) y i Furnished by Feet i 3 ° let,,2 -46 3 V -lq -- qq° r 5 - 2-s 131 -e3 2-22' ld - 4 J,4" 4- 5 -23 Town of Barnstable r# �- �pFtHE Tp�� p Department of Regulatory Services sanxsrnare. Public Health Division Date IA V 9.MA �e ro� 200 Main Street,Hyannis MA 02601 s , AlfD MAC�' Date Scheduled Time I U NCI Fee Pd. o U Soil Suitability AssessmentfoY Sewage Disposal �(,/f Performed By:,C/C�V��A [J�%,,I Witnessed By: 401'741:! / /1 G�i'Lri9 / L ATIO & GENERAL INFORMATION Location Address 5' S���( un( Owner's Name �t(� l Address US12(v� ��2 - Assessor's Map/Parcel: y D—n l � Engineer's Name V H od 7l1 n NEW CONSTRUCTION REPAIR Telephone# 6-OR 00e Land Use (����n�-� C �T Slopes(%) y` Surface Stones 1AV/11) Distances from: Open Water Body)ZOei tt. Possible Wet Area ,II A ft Drinking Water Well _zv�q ft Drainage Way /V�A ft Property Line ZJ" / ft Other Alr/� ft SKETCH:(Street name,dimensions of lot,exact locations of test holes.&pere tests,locate wetlands in proximity to holes) 2,4� i_xis 5 CiSLJ Parent material(geologic) y Depth to Bedrock LC� Depth to Groundwater: Standing Water in Hole: N A Weeping from Pit Face I v A Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE 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 ft• Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level— _ -77_ _ _ _ ON TEST EST PEItCO ;ATI . Time. -e ,e __ Observation Hole# I Time at 9" Depth of Perc O� Time at 6" 1 43 Start Pre-soak Time a C) C -" _� ___ - Time(9"-6") _' 3 End Pre-soak � C1 t) CL + Rate MinAnch G5 lYl 1r I A") Site Suitability Assessment: Site Passed ✓r Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one(1)week prior to beginning. Q:HEALTH/WP/PERCFORM DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in) (USDA) (Mansell) Mottling (Structure,Stones,Boulders. consistency,%araveb) Ala Y l2 51 Z t�A S to) ,J. DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders. µ Consistencv.%gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistencv %Graven Flood Insurance Rate Map: Above 500 year flood boundary No_ Yes V Within 500 year boundary No_ Yes Within 100 year flood boundary No_ Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervtpus material exist in all areas observed throughout the area proposed for the soil absorption system? �G.S If not,what is the depth of naturally occurring pervious material? Certification � 1,/w� I certify that on L) (I (date)1 have passed the soil evaluator examination approved by the Department of Enviromrtental Protection and that the above analysis was performed by me consistent with the required trairdi g,expertise anq experience described in 310 CNM 1.5.017. L / Date Z /13041 Signature Q:HEA.LTH/W P/PERCFO.RM Town of Barnstable P# �pFiHE 1pk� p Department of Regulatory Services EAnNMBM : Public Health Division Date I o V y MASS �p 039. 200 Main Street,Hyannis MA 02601 pTfD MAv Date Scheduled Time O V'�1 Fee Pd. U Soil Suitability Assessment for Sewage Disposal Performed By: Witnessed By: L� ATIO & GENERAL INFORMATION Location Address S SCE f . an( Owner's Name �t(l p S+e r vr'(le Address Assessor's Map/Parcel: 1'y D—n 1 b Engineer's Name c✓,U �� n NEW CONSTRUCTION REPAIR _ Telephone# .SCR Land Use ��7`'- Slo es /o// p (% ) �.L� Surface Stones //A Kr•�i/��'/�h�� l r ,, I Distances from: Open Water Body)�t ZOC tt. Possible Wet Area /V A ft Drinking Water Well ft Drainage Way /t ft Property Line ZtJ l ft Other /l�r/� ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) 1>+112V., Cl Scucldv �e)11J Parent material(geologic) Depth to Bedrock L� t Depth to Groundwater: Standing Water in Hole: N Weeping from Pit Face N A Estimated Seasonal High Groundwater. DETERMINATION FOR SEASONAL HIGH WATER TABLE 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 ft. Index Well# Reading Date: Index Well,level Adj.factor Adj.Groundwater Level_ PERCOLATION-T-EST--`—=-Date -,.. .,,Time Observation i Hole# Time at 9" Depth of Perch h b�t Time at 6" 1 0 Start Pre-soak Time a L�r C 0 Time(9"-6") 3 End Pre-soak 16;t)0 Cd d Rate Min./Inch G5 1Yl 1►1 A+� Site Suitability Assessment: Site Passed ✓_ Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one(1)week prior to beginning. Q:HEALTH/WP/PERCFORM DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surfhee(in,) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistencv,°!°©raveD lA Y25%Z t1A Iv 3 r` S' 9 e1n �11 12U1 �n� 1 l�`1'G�lro DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) - (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) DEIP'P OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistencv %Gravel) Flood Insurance Rate Man: / Above 500 year flood boundary No! Yes V Within 500 year boundary No_ Yes Within 100yearfloodboundary No— Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervt us material exist in all areas observed throughout the area proposed for the soil absorption system? G�� If not,what is the depth of naturally occurring pervious material? Certification I certify that on ju-�? ' i I (date)I have passed the soil evaluator examination approved by the Department of Envirorunental Protection and that the above analysis was performed by me consistent with the required train Fg,expertise anq experience described in 310 CMR 1.5.017. / - 4 Signature /. ( r„/ Date�Z13 � Q:H EA.LTI-1/W P/PE RC FORM FORM 11 -SOIL EVALUATOR FORM Page 1 of 3 No. P10,666 Date 2/13/04 Commonwealth of Massachusetts Sandwich, Massachusetts Soil Suitability for On-Site Sewage D& osal Performed By: David C. Thuiin, PE PLS Date: 2/13/04 Witnessed By: Donna Miorandi, Barnstable Health Department Location Address or Lot# Owners Name .._. . __........................__ ...._.. .. _. _.... _.____........................ ................. Lot# Address 95 Scudder Road, Osterville �nnsnan Granmer cio t�ert ueNiartm _... _. .... New Construction Repair❑✓ Telephone;:# 508-326-3734 Office Review Published Soil Survey Available: No ❑ Yes ❑✓ Year Published 1993 Publication Scale 1:25000 Soil Map Unit CdA- Carver Drainage Class ED Soil Limitations Severe - poor filtration Surficial Geologic Report Available: No ❑ Yes ❑✓ Year Published 1975 Publication Scale 1:24000 Geologic Material (Map Unit) Qmp Land Form Outwash Plain Deposits Flood Insurance Rate Map: Above 500 Year flood boundary No ❑ Yes ❑✓ Within 500 Year flood boundary No ❑ Yes ❑ Within 100 Year flood boundary No ❑ Yes ❑ Wetland area: National Wetland Inventory Map(map unit) NA Wetlands Conservancy Program Map(map unit) NA Current Water Resource Conditions(USGS):Month 2/04 Range Above Normal ❑ Normal ❑✓ Below Normal Other References Reviewed: None 11 'A1'FRC1Vffi flOR2�4 12dO7f9S Form copy 2/2/02-DCT FORM 11 - SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot No. 95 Scudder Road, Osterville On-Site Review Deep Hole Number As Noted Date: 2/13/04 Time: 10:00 Weather: Sunny, cold Location (identify on site plan) Right rear of lot Land Use Residential Lot Slope M 0-2% Surface Stones NO Vegetation Lawn Landform Outwash deposits Position on Landscape(sketch on the back) Nearly level land Distances from: Open Water Body_ 200+ feet Drainage way NA feet Possible Wet Area_ NA feet Property line_ 16 Min feet Drinking Water Well NA feet Other NA feet DEEP OBSERVATION HOLE LQG DEPTH FRUM SOIL SOIL SOIL ..... SOIL OTHER SURFACE HORIZON TESTURE COLOR MOTTLING (STRUCTURE STONES;BOULQERSI .... . ........ ....... INCHES- (USDA) ,;'(MUNSELL) CONSISTENCY .&%%RAVEL) TP1 -0-12'I AD Oro Loam 1OYR5/2 NA Sod_...Oroanic L.oa..m 12-38" 7.5YR4/6 Friable, roots_...... Sandv Loam .. ......._... .. 38-126" _ ,C ... _Med Coarse 10YR6/6 NA _ Loose ._.. _ Sand_. NO GROUNDWATER 5 _ 3 .............. ......................... ................................. ........................................ ............... .......... e z L_ ......... __ ___._.... . ........ ----------- ................ .......... ................... _........ .......................... _. .......... ....__.......... ......_. ... ........... . .............. ............... ... ............... ............... ......,.,.. __....................... ..,. ..,.."......- .,....... .............. _......,.. ......... ..................... ....................................................._.......----�...............................-------- __.................................. ............................................... .....................„...................,,.... ..3 .... ....... .. .._.::..... ........_ ............................................................ .............................................. ............................. ............... ............ .................................I........... ............ .............................. .................................... ........................................ W ....... ................ ...._,.._. ........... ..................... ......................... ........................_.__.................................................. .......... ...... .............................. .......................... ............ ..............................._.......................-.................................. ........................................... .............. ............. ................. ....... ...... .. ... . _. _......_: ............ .-. ..__. ........... .. ....... .............. ............................................ ................ ...... .........., .. .,..... ... .. .... ... ..__ ... i ................................... i .......... ......... ».«:,.... ...... ........ .......... .. .......................... ...�.......... ,..........:»...n<......:...�.....a+.�....: �.�.:.�.... ».> ........ .......... .............................. *MINIMUM OF 2 HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA Parent material (geologic) Glacial outwash deposits Depth to bedrock >40' Depth to Groundwater: Est 20' Weeping from Pit Face: Estimated Seasonal High Ground Water: No Groundwater Observed IDEP APFROVffi FOR' 'I;M tt$ Form copy 2/2/02-DCT L FORM 11 - SOIL EVALUATOR FORM Page 3 of 3 Location Address or Lot No. 95 Scudder Road, Osterville Determination of Seasonal High Water Table Method Used Depth observed standing in observation hole None inches Depth weeping from side of observation hole None inches Depth of soil mottles None obs. inches Ground water adjustment feet Index Well Number Reading Date Index well level Adjustment factor Adjusted ground water level Depth to Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? YES If not, what is the depth of naturally occurring pervious material? Certification I certify that on NOV. 1994 (date) I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017 Signature Date L / FORM 12 - PERCOLATION TEST PE'AP'P ovo FORT["11 0 05 Form copy 2/2/02-DCT r a fv Location Address or Lot No. 95 Scudder Road, Osterville COMMONWEALTH OF MASSACHUSETTS Sandwich, Massachusetts _........__.. i PERCOLATION TEST I 3 Date:. 2/13/04 Time: 10:00 i0bservation Hole#' 1 SECOND TEST WAIVED BY De 'th of Pere, p 800" Bottom HEALTH INSPECTOR Start Pre-soak 0:00 EXTREMELY POROUS SOILS i End Pre soak; 1 10:00 End presoak 25 gal Time@,12"' Time,@ 9: 10:00 ' Time @:6,. 10:43 1 Time �9 6"}' 0:43 i i �Rt6'Min Jiricfi <5 l * Minimum of 1 percolation test must be performed in both the primary area AND reserve area. Site Passed © Site Failed ❑ Performed by: David C. Thuiin, PE PLS Witnessed by: Donna Miorandi, Barnstable Health Department Comments: Strip out required for Ap and B Horizons DEV A'pPROVO ro*%("jjm7)95 Form copy 2/2/02-DCT a MAP ti.. ► 'CEL , O DATE:3/19/03 ---- PROPERTY ADDRESS:95_Scudder Road ,.. __Q�1<ervilletMass. --- 02655 --- -- � � � 2003 ----- APR ttdwARNST R DEPTABLE On the above date, I inspected the septic system at the above address. This system consists of the following: I . This is not a title five septic system. ► ►5� ?. This is a sewage, system. -. 3. T.he 'sewage system is inproger, working order at the present ` ime '; k` " Based on my inspection, I certify the following conditionns 1. The system consists of 2-5'X7' b3ock cesspools and 1-1000 gallon precast leaching pit. This are all in series. >. Pumped the main cesspool at time of inspection.Heavy scum and solids layers were present.No signs of water intrusion. ' i. Waste water is 66" below the invert pipe of the leaching pit. SIGNATUR / Name:_ J . P . �7 _-----Macomber--- -- COr`hpany:, g5.tPh _per_M�rQm¢tLr 8_ Son, Inc. Acid r t:s S :__5Qx _f_ti------------ __-Q9.IU2rytUP,_Na__2Z632-0066 Pnone : 508- 775_ 3338 THIS CERTIFICATION DOES NOT•CONSTITUTE A GUARANTY OR WARRANTY JOSEPH P. MACOMBER & SON, INC. Tanks•Cesspools•Leachflelds Pumped & Installed Town Sewer Connections P..O Box 66, Centerville. MA 02632.0066 775.3338 775.6412 .�\ COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION i TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 95 Scudder Road 0sterville,14ass. Owner's Name:DaniPi J_ Kelly Owner's Address: 4ama Date of Inspection: 3 19 0 3 Name of Inspector: (please print)Joseph P.Maeomber Jr. CompanyName: J.P.Macomber & Son Inca Mailing Address: Box 66 02632 Telephone Number: 508-775-3 38 CERTIFICATION STATEMENT 1 certify that 1 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 traiping and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to/Section 15.340 of Title 5(310 CMR 15.000). The system: • f` j� Passes m`Conditionally Passes _ Needs Further Evaluation by the Local Approving Authority _ Fai s g Inspector's Signature: Date: The system inspectors bmit 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 •"'T61s report only describes conditions it the time of inspection and urider`the conditions of use'at that time.This inspection does not.address hoiv the system'will perform in the future u.ndet the same or different .. future ; conditions.of use. Title 5 Inspection Form 6/15/2000 page 1 • Page 2 of I 1 , OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM •PART A CERTIFICATION (continued) Property Address: 95 Scudder Road Ostervi a Mass. Owner: Daniel J. Keny : Date of Inspection: 3 1 9 Inspection Summary: Cbeck A,B,C,D or E/ALWAYS complete sill of Section D A. tem Passes �G� I have not fount(annformation which indicates that any of the failure criteria described in 310 CtvUt j 15.303 or to R 5.304 exist.Any failure criteria not'evaluated are indicated below. Comments: The .SE+wagQ System is in proper --working.' order fe -af- the praseni- time.. B. System Conditionally Passesi �Q 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 eme nt• 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. ' �Q 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 c0itration 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, 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.box. 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: �(lL� 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 t 2 - f. Page i of I I , OFFICIAL INSPECTION FORM • NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL. SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 91; gcjjddt=r Road nstervi l_le.Mass. Owoer: DanielvJ.yKelly Date of Iospectioo: 3/1 9/0 3 C. Further Evaluatioo is Required by the Board of Health: Ind Conditions exist which requ've further evaluation by the Board of Health In order to determine if the system is failing to protect public health,.safety orihe environment. i. S,stem will pass unless Board of Health delermloes In accordance with 310 CMR 15.303(1)(b) that the- system is not functioning in a onaooer wbich will protect public bealtb,safety and the envlronment: N,O Cesspool or privy is within 50 feet of a surface water Cesspool or privy is witbin 50 feet of a bordering vegetated wetland ore salt marsh 2. S,i stem 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 sank and soil absorption system(SAS)and the SAS is within 100 Net 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 I of a public water supply The system has a septic tank and SAS and the SAS is within SO feet ore private water supply well The system has a septic tank and SAS and the SAS is less than 100 feet but 50 fee or more from a private eater supple well'I Method used to determine distance j./ 'This s\sscm passes if the well water analysis,performed at a DEP eertir'sed laboratory, for eoliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nirrogen and.nirrate nitrogen is equal to or less than S ppm,provided that no other failure criteria are rrigaered. A copy of the analysis must be attached to this form. 3. Other: r 3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 95 Scudder Road 00-p Vlll -'Mass_ Owner: Daniel J. Kelly Date of Inspection:3/1 9/0 3 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes N��Daischarge _ ckupof sewage into facility or system component due to overloaded or clogged SAS or cesspool or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool Q 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'h day flow . Required pumping more than 4 times in the ast year,NOT due to clogged or obstructed pipe(s).Number f times pumped. % ,duly'/!i¢i� / .� y 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. _ t�y portion of a cesspool or privy is within a Zone I.of a public well. y portion of a cesspool or privy is within 50 feet of a private water supply well. y 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 r 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.] /V6 (Yes/No)The system fails. 1 have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303.therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design now of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following: _, (The following criteria apply to large systems in addition to the criteria above) yes no/ _ _ the system is within 400 feet of a surface drinking water:supply 2the system is within 200 feet of a tributary to a surface drinking water supply _ Zhe system is located in a nitrogen sensitive area(interim Wellhead Protection Area—IWPA)or a mapped rt Zone 11 of a public water supply well If you have answered"yes"to any question in Section E the systetn,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. 4 r Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 95 Scudder Road netaryill �MaGG_ ' Owner: nani P1 ,7_ KPl ly Date of Inspection:'i 1 q f o'i Check if the following have been done.You must indicate`yes"or"no"as to each of the following: Yes No �/ Pumping information was provided by the owner,occupant,or Board of Health Were any of the system components pumped out in the previous two weeks Has the system received normal flows in the previous two week period? Have large volumes of water been introduced to the system recently or as part of this inspection? Were as built plans of the system obtained and examined?(If they were not available note as N/A) tJ — Was the facility or dwelling inspected for signs of sewage back up? Was the site inspected for signs of break out? �= Were all system component s,,e eluding the SAS located on site? (! — Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum ? Was the facility.owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems?, The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no/ 9/ Existing information.For example,a plan at the Board of Health. Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CIAR 15.302(3)(b)) 5 Page 6 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART C SYSTEM INFORMATION Property Address: 95 Scudder Ave Ost yi11P.,Maca Owner: Daniel J_ Kel 1 Y Date of Inspection: 3/1 9/0 3 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): XI10 Number of current residents: , Does residence have a garbage grinder(yes or no):Is laundry on a separate sewage syster> _es or no):_ [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use:(yes or no): ;VV Water meter readings,if available(last 2 years usage(gpd))2 0 01 —7 2,0 0 0 qa 1 lons=1 9 7.2 6 .GPD Sump pump(yes or no): -06 2002-60, 000 gallons=l 64. 39 GPD Last date of occupancy: COMMERCIAL/INDUSTRIAL Type of establishment: rL. Design flow(based on 310 CMR 15.203): /�iQ d Basis of design flow(seats/persons/sgft,etc.): 6 Grease trap present(yes or no): Industrial waste holding tank present(yes or no):�J� Non-sanitary waste discharged to the Title 5 system-(yes or no):1W Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION , Pumping Records Source of information:1/ Was system pumped as part of the inspection(yes or no): GG 5 If yes, volume pumped: allons--How was quan Ity pumped determined? Reason forpumping:Heavy Scum & solids laierc were present. TYPE OF SYSTEM Septic tank,distribution box,soil absorption system _Single cesspool � —,"Overflow cesspool r O�t:✓'S'�rt� All /6L Privy /QQ Shared system(yes or no)(if yes,attach previous inspection records, if any) IQQ Innovative/Alternative technology.Attach a copy,of the current operation and maintenance contract(to be obtained from system owner) .Q6 Tight tank _Attach a copy of the DEP approval 4-)0 Other(describe): NA Approximate age of all components,date installed(if known)and source of information: cesspools 35 years old pit is 10-15 year-.—nld Were sewage odors detected when arriving at the site(yes or no): 6 k 1 Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 95 Scudder Road Osterville,Mass. Owner:Daniel J. Kelly Date of Inspection: 3/1 9/0 3 BUILDING SEWER(locate on site plan) Depth below grade: ;Py . 4" orangeberg pipe & fittings Materials of construction:Zcast iron/&40 PVC V, other(explainf rom the house' to the two Distance from private water supply well or suction line:,V A cesspools. 4 light wieght Comments(on condition of joints,venting,evidence of leakage,etc.): pipe to the leaching pit. jnints appear tight.No evidence of leakage.The system is vented through the house vents. SEPTIC TAN}C _,Sgdlocate on site plan) Depth below grade: 4)19 Material of constructionylJ�concrete 04 metaL'W fiberglasWA polyethylene iUJother(explain) V,4 If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no):,V4(attach a copy of certificate) Dimensions: ti/) Sludge depth: 1411-9 Distance from top of sludge to bottom of outlet tee or baffle: .1410 Scum thickness:W Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined: A/W Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of.leakage,etc.): Pumped the main, igponl , annuall i G p racanIt Septic tank -is 'not''presen GREASE TRAA�t�locate on site plan) Depth below grade: -to Material of construction:,�concret&V4 metal/ZAfiberglasslg_polyethylen&%Aother (explain): /U09 Dimensions: Scum thickness:-14 Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: �I 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.): . Grease trap is ,not present. 7 Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL-SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 95 Scudder Road nsteryi11A Macs. OwnerDaniel J.Kelly Date of Inspection: 3/1 9 f 0 3 TIGHT or HOLDING TANKd 1rLL(tank must be pumped at time of inspection)(locate on site plan) Depth below grade: AJA Material of construction: 4)A concrete V4 metal Ao 4 fiberglass.�polyethylene M9ther(explain): Dimensions: Capacity: A119 gallons Design Flow: gallons/day Alarm present(yes or no): ,414 Alarm level: 4o� Alarm in working order(yes or no): 4/4 Date of last pumping: Comments(condition of alarm and float switches,etc.): Tight or holding tanks are not present_ DISTRIBUTION:BOX (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert:t/ 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.): Distribution box is not present_ PUMP CHAMBEW41C(locate on site plan) Pumps in working order(yes or no): 'V Alarms in working order(yes or no):LU�1 Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Pump rhamher is not present , 8 Page 9 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 95 Scudder Road Cisterville,mass. Owner:Daniel J. Kelly Date of Inspection: 37 9 7 0 SOIL ABSORPTION SYSTEM(SAS): 1/ (locate on site plan,excavation not required) 2 5X cesspool ' 7 ' Block and 1 -1000 gallon precast leaching _ pit in series. If SAS not located explain why: _Located: See page 10 Type eaching pits,number:1 leaching chambers,number: b d leaching galleries,number: e'9 leaching trenches,number, length:_ O eaching fields,number,dimensions: overflow cesspool,number: 2—cesspools prior 78 innovative/alternative system Type/name of technology:�code 1 _1 nnn n; t 78 Cody Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): —Loamysand to boney medium sand to fine sand.No signs of filure or ponding.Soils are dry. vegeYation is normal.Waste water is 66" below the invert pipe o the leach g pit.Has never been higher than this. CESSPOOLS: (cesspool must bF pumpe s part of inspection)(locate on site plan) V r Number and configuration: ` Depth—top of liquid to inlet invert: I Depth of solids layer: Depth of scum laver: 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.): Same as above- PRIVY.tL&g�locate on'site plan) Materials of construction: Dimensions: Depth of solids: dl Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc,): Privy is not present. 9 Page 10 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:95 Scudder Road Osterville,Mass. Owner: Daniel J. Kelly Date of inspection: -i/1 9/n-i SKETCH OF SEWAGE DISPOSAL SYSTEM . Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters"the building. �5 SL'UdQlr '�oa,1 o�kcrvil�2 may' I^Y' 10 • 1 Page 11 of 11 f� OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 95 Scudder Road Osterville,Mass, Owner: Daniel J-Kell y Date of Inspection: I /19 B l SITE EXAM Slope Surface water Check cellar , Shallow wells Estimated depth to ground water feet Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record-If checked,date of design plan reviewed: NA YES Observed site(abutting property/observation hole within 150 feet of SAS) l_a_Checked with local Board of Health-explain: NA YES Checked with local excavators,installers-(attach documentation) YES Accessed USGS database-explain:http: //town,barnstable.ma.us. You must describe how you established the high ground water elevation: sed: GahratY X MillPr Model 12/16/94 Ground water elevations above sea level. sed: USrSq- QhGPrvatinn wall data Tune 1992 sed' USGS Tacbni real hiil 1 ati n 99 onn 1 P1 atP 02 Tanuar)4 1992 Annual ranges Leaching / /1 Pit ` I.-eet Groundwater: Feet Below Bottom of Pit High Groundwater Adjustment 1.8 ft per Frimpter Method Therefore,the vertical separation distance between the bottom ! Of the leaching pit and the adjusted groundwater table is feet. 11 i �.•T.T T'\•�T.T!•r 1T�\TR�/I..•I.In.IlT..iTT.TR1.11rIT�.IITTT'TT AtT+.L.'A't♦.T.I.1.R\ ']'OWN OF Barnstable -BOARD OF HEALTH SUUSURFACF SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D •- CERTIFICATION T'•i�T••••.'.—T.It��.TTT.T."w•R.1I.TR1rJRtf�T'1gTT-51T71T11if�TArwA�,�w�wr� rwn y.+�-.-•r•�.,. -TYPE OR PRINT CLEARLY- PROPERTY INSPECTED STREET ADDRESS95 Scudder Road Osterville,Mass. ASSESSORS MAP, BLOCK AND PARCEL 0 _e�g OWNER's NAMEDaniel J. Kfelly PART D - CERTIFICATION NAME OF INSPECTORJoseph P.Macomber Jr. COMPANY NAME J.P.Macomber & SoR Ind'.` COMPANY ADDRESSBox 66 Centerville,Mass.02632 Street Town or City State LIP COMPANY TELEPHONE ( 508 ) 775 - 3338 FAX ( 508 ) 790 -1 578 n mw CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system °nt this address and that the information reported is true, accurate, and omplete as of the time of -inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . 2ec one : Systevi PASSED _ _. , 1 The inspection which I have conducted has not found any'information which indicates that the system fails to adequately protect public health or the environment as defined in 31.0 CMR 15. 303 , Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. System FAILED# The inspection which I have con lcted has found that the system fails to Protect the jiublic health and the environment in accordance with Title 5 , 3.10 CMR 15 . 303, and as specifically noted on PART C - FAILURE CRITERIA of this inspection fo M. Inspector Signatur A2�Z Date copy of this .ification must be provided to the OWNER, the BUYER )w'.ne re applicable ) and the BOARD OF HEALTH. If the inspection FAILED, the owner or"'o erator shall u* p pgrade ' the system ' within one year of the date of the inspection, unless allowed or required otherwise as provided in 3.10 CHR 16 . 305 . partd .doc Town of Barnstable Regulatory Services _ 1 Thomas F. Geiler,Director ' AM Public Health Division �} '°TEc Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 jj c Office: 508-862-4644 (Fax: 508-790-6304 c) � Installer&Designer Certification Form ca Date: olyf m a Designer: Installer: PtVL1ZWAJ PM5t ff f YJ Address: � I A6yb Address: r On -6'0 0� e- i was issued a permit to install a (date) (ins lei septic system at based on a design`drawn by (address) . Vj dated _ ' E(designer) �l/ 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. 1 certify that the septic system referenced above was installed with major changes (i.e. greater 10' lateral relocation of the SAS or any vertical relocation of any component of the s c system)but in accordance with State &Local Regulations. Plan revision or certifi -built by designer to follow. DAVip 9 C. THULIN m o No.29976 (Installer's Signature) " 9� CIVIL �O " /ST A?NALEN�'\� esigner's Signature) (Affix Designer's 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 BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form t s � i n - ' �rvin ' 'r oeD � a i 4 4 , ft` _ Y t } L.* j IN 2x6 BRACE; n ;' XIMUM 6'-0' SLIDER 6 —0 SLIDER S. USE MA t12HIGH TRANSOM t12HIGH TRANSOM j LENGTH 6 E> a 0 1/ to x: to TW2446 00 co O FAN I LY ROOM , ' (WOOD FLOOR) CEILING q'—O" 2 COMMON HOUSE W, 20 MIN IN DR TO HAVE 5/8" FIRI TYPE x GYPSUM CUT NEW DOOR OP INSTALL NE WOOD AND SINGLE TREAD EXPOSED CONCRETE STAIR DESIGN: — — — — WALL IN GARAGE q'-1" CEILING +12.5 DECK; - — -- — COMMON HOUSE WALLS F—>F 10'-1.5" OR 1(0 @ 7.55" TO HAVE 5/8" FIRE CODE TYPE x GYPSUM co 8'-7" N 3 ,z I I E/ 151TNG 17'-6 IN E BRACE; US GARAGE �S. USE-MAXIMUM i ; LENGTH TW2446 9'-0" 9/8 6/8 8'-8 1/2" 24'—10" FIRST FLOOR PLAN SCALE: 1/4" 7'_0" 10'-0.1 7'-5;1/2" . TW2442-2 TW2442-2. I OPTI AL G FIREPLACE . I 21'-10 1/4" o N � I - I N N I oM N N VERIFY HEADROOM WALL, BOX BACK ONE TREAD IF REQUIRED 2/6x6/6 6 PANEL n 8'— 1 2 �w (�Z 5-3 /2n "(ID a 3'—VI N(C � 2'—On _ 0 � M O 32 TW2442 R'—R 1/9" _ u a Lo rn NOFMgs �tNOFMgs - -` ,� r _. /- �f.. p N ��P ©AVID s90 �t�P DAVI s4o CO �; V-.- yG O� C. yG Q f ti r Cr) 00 G: m THULIN m 0) t r L r �w.. p ' .a C 00 THULIN -, -i `` ` " t w m No.39403 rn v • • EXISTING CAST IRON c� I L r„� � � �, r • �'�. D 00SOIL PIPE '� � T P� � � * R� * �ia�• �. Z m: o r � s � � t' { Cti �' J Q � PROPOSED LEACHING TRENCH �� y ��;+ + / �� _ Q < 2'D X 4'W X 36'D ' 2'L office Fence « •■ ■M t f _ �- � s♦ ° Stake *+�� � ..;� +A��'• vr;�� �' V pool Q `1� ! �* 0 w Q Cess ,►' :' + x * a gt a �,R J 010 stake j • � • �.w 00 5 00 TO BE REMOVED N 83'21'35 E q t + + ` F,+• wz M Q ■ Q 96, � z * a Q 00 cvw • �' O �� � �.�try� � '� +►�a ,", � ., Stoke `r ) I N r � y\>t R +! z }' ■ ' ` �� o a q a + t . ,4,-bo1_uite • SMT ST FU m V + DO EXISTING HOUSE Cess000/ F F. 104f Cesso w Q LOCUS MAP z TO BE REMOVED B N ry , GROUND WATER OVERLAY DISTRICT: 5 Z j - CRAWL � AP (AQUIFER PROTECTION) Ouj f rn f llJlfff� SPACE cD v c,+ cr PROPOSED / 0 O ASSESSORS MAP 140 LOT 16 w o o N f, ADDITION Q o z P BSMT f Eage of Driue PLAN REF: v> Ln N w o f FULL f BOOK 115 PAGE 41, LOT B2 m z a �0 N V APRIL 27, 1954 f�f f: Q Y (n Q m O %'0 f�f f�` �' LOT AREA: 14,277 ±SF o 0 o V) U- 24.0' (n 11 0 w N SEPTIC SYSTEM LOCATION FROM zz N Q o N 2' w BARNSTABLE BOARD OF HEALTH RECORDS f= O v a /moon Poe o a S 83.20'54 Q W o V)Q z 150.o' LEGEND L each Pit vwi __:1 :20 0 A�bo�uife ujo O LA EXISTING CONTOUR a- EXISTING w_j TO BE ABANDONED 20 0 10 20 40 80 =� O 0 _ o a OR REMOVED X 500 EXISTING SPOT ELEVATION 12- c) w w~ ( IN FEET ) PT I En mN a T.B.M. FINISH FLOOR 1 inch 20 ft. Q TEST PIT/PERC TEST QUO ow OF PORCH EL = 103.67 — G— EXISTING GAS MAIN a V) J L`N N ASSUMED — W— WATER SERVICE w m x OFFSETS TO PROPERTY LINES ARE FROM STRUCTURES AS PROPOSED BY APPLICANT AND DO NOT CONSTITUTE A DETERMINATION OF Q COMPLIANCE WITH ZONING SETBACKS OR AN OPINION AS TO APPLICABLE HORIZONTAL OR VERTICAL SETBACK REQUIREMENTS. IT SHALL UTILITY POLE V) (n O BE THE RESPONSIBILITY OF THE APPLICANT TO PROVIDE SUFFICIENT FACTS AND DOCUMENTATION FOR DETERMINATION OF ZONING /I1 z m COMPLIANCE BY THE BUILDING PERMIT ISSUING AUTHORITY. CONSIDERED SUFFICIENT FOR CERTIFICATION OF AS-BUILT COMPLIANCE . of Q O m a 04—009 . _ SHEET 1 OF 2 0 1500 GALLON SEPTIC TANK (n LENGTH VARIES - SEE SEPTIC SYSTEM DESIGN DATA - :i?` Ste' ke. 2'D X 4'W X 36'L• 00 (l,r ire y . : ,«^ FINISH GRADE ..� s r' .� STONE TRENCH 23.6' o N s i f • '"" EDGE_WASHED.STONE wEARTH I� Ny 05 BAACKFIILL END CAP ,z{� �- - - - I END CAP ��J EXISTING w 00 r HOUSE w V) SLOPE PERT. PIPE 0.005FT 3- PEASTDNE A ``` �' _ ` rf p I Z 00 V t� ' r«t J N x_ Q Q > WASHED pO o STONE . I 20' x C U z U LEVEL BASE - -� - - - •- - - �� 5" DIST BOX ;rri0 w Z N rn r^ _� V) olo SECTION A - A 4' PERF. SCH40 PVC NOTE: IMSUITABLE SOIL REMOVAL / O RAGE 0000 1-1 GA PLAN WHERE REQUIRED TO EXTEND AT (O: Q Q �. LEAST I. LIMITS BEYOND LTS OF 00 LEACHING TRENCH DETAIL STONE '" ,' 2'D X 4'W X 36'L 20' " W Lo i STONE TRENCH 4.0' ADDITION NTS SEPTIC SYSTEM DIMENSION DETAIL GENERAL NOTES 1. ALL MATERIALS AND CONSTRUCTION METHODS a!ALL 4. T SEPTIC S YS TE'M DESIGN DATA HE LOCATIONS OF UNDERGROUND UTILITIES SHOWN 6. REMOVE ALL UNSUITABLE SOIL, Ap, AND 8 CONFORM TO THE PROVISIONS OF THE COMMON'.VEALTH ON THIS PLAN ARE APPROXIMATE. AT LEAST 72 HORIZONS FROM BELOW THE SAS INVERT ELEVATIONS OF FORMMASS TO THE S ENVIRONMENTAL CODE ONI- V. HOURS PRIOR TO ANY EXCAVATION FOR THIS AND WITHIN 5 FEET OF THE PROPOSED LEACHING SEWAGE FLOW ESTIMATE PROJECT WORK, THE CONTRACTOR SHALL MAKE THE SYSTEM. REPLACE WITH CLEAN SAND FILL MEETING 2. EXCEPT AS OTHERWISE NOTED, ALL PROPOSED REQUIRED NOTIFICATION TO DIG SAFE (1-800-322- THE REQUIREMENTS OF 310CMR 15.255. SOURCE UNITS GPD/UNIT QTY GPD COMMENT SEPTIC SYSTEM PIPING SHALL BE 4'0 SCH40 4844). AND THE LOCAL WATER DISTRICT FOR PVC SET TO THE LINE AND INVERT ELEVATIONS VERIFICATION OF LOCATIONS SINGLE FAMILY RESIDENCE BEDROOM 110 4 440 310 CMR 15.02 (13) 7. ALL EXISTING SEPTIC SYSTEM COMPONENTS LOCATED WITHIN MOWN. THE MINIMUM PITCH OF PIPES CARRYIIIG 5. CONSTRUCTION OF THE SEPTIC SYSTEM SHOWN ON 10 FEET OF THE PROPOSED`FOUNDTION WALL, WITHIN 5 FEET TOTAL ESTIMATED PEAK DAY FLOW 440 GPD - NO GARBAGE GRINDER SEWAGE OR SEPTIC TANK EFFLUENT SHALL BE 1/8TH THIS PLAN IS.SUBJECT TO THE INSPECTION OF THE OF THE PROPOSED SAS COMPONENTS OR AS MAY OTHER SEPTIC TANK INCH PER FOOT IF NOT OTHERWISE NOTED. TOWN OF BARNSTABLE HEALTH AGENT. NO PART OF WISE INTERFERE WITH CONSTRUCTION OF THE ADDITION OR Z 3. PRIOR TO CONSTRUCTION OF THE SEPTIC SYSTEM THE SEPTIC SYSTEM SHALL BE BACKFILLED OR MADE SEPTIC SYSTEM AS SHOWN SHALL DEMOLISHED AND REMOVED O TOTAL FLOW K DET. TIME = 440 GPD X 2.0 DAYS = 880 USE 1500 GALLON TANK S DEPICTED ON THIS PLAN, THE CONTRACTOR HELL INACCESSIBLE UNTIL INSPECTED AND APPROVED BY FROM SITE. OTHER COMPONENTS MAY WITH ABANDONED IN 5 (n DETAIN A DISPOSAL WORKS CONSTRUCTION SHPERALT THE HEALTH AGENT. THE CONTRACTOR SHALL PLACE BY PUMPING DRY AND FILLING H CLEAN SAND. 1 LEACHING FACILITY FORM THE TOWN OF BARNSTABLE BOARD OF HEALTH. SCHEDULE INSPECTIONS AS REQUIRED. LEACHING TRENCHES LEACHING AREA CAPACITY F NO. LENGTH WIDTH DEPTH SIDE BOTTOM SIDE BOTTOM TOTAL U (ft) (ft) (ft) (sf) (sf) (gpd) (gpd) ( pd) + WATER SUPPLY FOR THIS LOT 1S PUBLIC WATER CONNECTED '- 0o 0 2 36 4.0 2.0 160 144 235 213 449 w m v z " SOIL TEST DATA AT THE STREET LINE IN THE APPROXIMATE LOCATION SHOWN. V) O w PERCOLATION RATE: 2.0 MIN./IN. LEACHING RATE: (GPD/SF) SIDE - 0.74 BOTTOM - 0.74 THE PROPOSED SEPTIC SYSTEM SOIL ABSORPTION SYSTEM IS } Q cV w DATE: 2/13/04 NOT TO BE LOCATED WITHIN 150' OF AN EXISTING PUBLIC OR m ao (N PRIVATE WATER SUPPLY. WHERE SERVICE PIPE IS LESS THAN Z EXCAVATOR: BOUSFIELD 10 ' FROM AN EXISTING OR PROPOSED SAS IT SHALL BE m t� -� Q Y (n Q m 0 B.O,H. AGENT: D.MIORANDI SLEEVED IN 2" 160PSI HDPE OR SCH40 PVC PIPE. of x w 0 w 105 APPROX. rop. FND 102. 2' LEVEL PIPE SECTION .' ENGINEER:D.THULIN 0 U In V) RES. RISER O WITHIN l LOCATION: TP-1 6" OF FIN. GRADE FINISH GP ADE = EXISTING � _ � M ELEV. DEPTH � N � - - - - - - - - - - 100.7 0.0 Q � O 100 RIP q7 Ap - SOD,ORGANIC LOAM O x AND REPL CE W/CLEAN :LAND 99.7 1.0 U Q TOP EFF. D TH 97.94 p Q B - SANDY LOAM SUBSOIL Q U) 100.3 ES 97.5 3.2 Q Q Z x Pvc H 99.10 98.84 s o ozo 9 .32 15 C - MED. TO COARSE N Q=O 95 SAND O W W Ld� � �a DISTRIBUTION BOX 80T. EFF. DEPTH 95.94 PERC -. Q MIN PER IN 0 Q 5 < 1500 GALLON Qv�c il 94.0 6.7 LL Q of SEPTIC TANK OUTLET TE 010 5 ONE TRENCH J'W X 2'D X 36 L '�' H W N I LET TEE GAS BAFFLE LIQU DE LE lT LOW TWO REQUIRI., Z O w-w 90 90.2 10.5 Q /U/� v O N LIQ ID LEVEL 3 .0' BOTTOM d V/ -1 cV m co NO GROUNDWATER H m X ,^ Q 19 2' 25.8' .5' N L J O NOTE: T Z m SOIL PIPE ELEVATION AT HOUSE IS D_ O 85 APPROXIMATE. PRIOR TO INSTALLATION OF Q d SEPTIC TANK UNCOVER EXISTING SOIL PIPES m -10 0 10 20 30 40 50 60 70 80 90 100 110 AND ADJUST COMPONENT GRADES AS REQUIRED TO MEET MINIMUM PIPE SLOPES. SECTION THRU SEPTIC SYSTEM 04-009 SHEET 2 OF 2