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Home My WebLink About0124 WEST STREET - Health West Street la YA0 = 139 065 7 i=ifth Avenue o a H a No.. '�.1 Z.U�? �f1 Fee _-- BOARD OF HEALTH TOWN OF BARNSTABLE 01pprication jfor Yell Conotruction Permit Application is hereby made for a permit to Cons ru t Alter( ), or Repair( an individual well at: Location-:Address "AAsfessors Map and Parcel ®c� flLs ,�S e �3e! s� Owner �— Address Or Lea fts, 0�� Installer-Driller Address Type of Building Dwelling Other-Type of Building No. of Persons Type of Well 414' -Gc-ff 40 •f VC, Capacity Purpose of Well [rrf ziow)? 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 well in operation until a Certificate of Compliance has been issued by the Board of Health. Signed 3 Z01"Z- bate' op r C Application A roved:B E% f Z PP PP Y ' Date Application Disapproved for the following reasons: Date Permit No. V`' ? )L Issued 3 & �- r Date --------------------------------------------------------------------------------------------------------- BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of (Compliance THIS IS TO CERTIFY,that the individual well Constructed, Altered( ), or Repaired( ) by Installer at has been installed in accordance with the provisions of the Town 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 I , No. t J t Fee j, BOARD OF HEALTH re TOWN OF BARNSTABLE 01ppricatiou jfor Vern Cou5truction Permit Application Is hereby made for a permit to Construct( ;< Alter( ); or Repair O an individual well at,'-, q ✓ Location Address 'FAssessors Map and Parcel' (y Jusatj UPar L � far sr t �c 9W (Vat. r 8� v Owner �. � Address (� Irk 1hc. � X '793, Or LTV n ; 01 65; 6 Installer-Driller Address t Type of Building Dwelling tr' , lLding No. of Persons Other-Type of Bui Type of Well pacl_ Ca ty .. . Purpose of Well 1rr1 a0--'10'? 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 well in operation until a Certificate of Compliance has been issued by the Board of Health. Signed Date .a t a ApplicationApprovedBy ,;! '• .. Date' . Application Disapproved for the following reasons: 1 2 t € ` Date Permit No. �(� Issued 3 J"( ),/ 2-- Date r BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Compliance THIS IS TO CERTIFY,that the individual well Constructed,(, Altered( ), or Repaired( ) by �r n Installer, at f4 has been installed in accordance with the provisions of the Town 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 4 BOARD OF HEALTH TOWN OF BARNSTABLE Vern Cougtructfott permit No. ()Or Fee J �� Permission is hereby granted to <,f�j(0�,J b_3e'l-f "IV, t L/ F Installer - - r: ai to Co O nstruct, , Alter,( ), or.,,Repair O an individual well at:.Y1 e Street as shown on the application for a Well Construction Permit No. W s U'7. O Dated Date / J !'! % Approved By. r � r�I N PJrG. 1 CIS FND.HELD) / / 5y� � / MAP 139 Wg3;a. F4tn �,- / i FARCEL93 N(F DAY MAP 139 "5 43.508 S.F-t ZONE B u5E0 N>, ; LKAP439' PARCEL:94 GALLGN PT10 vjA 1 _ 1 EXISTING 3-BEDROOM DWELLING sl. jt TOF-99.5 w � { B.M. f / Hydrant.Splr�* .r( + Eiev=,00.00' , •4 :.c`.• /h_O,PP. Assumed , DESCRIPTION HC 1 HC2 SEPTIC COVER IN(1) 34.3' 24.9' I ✓r w SEPTIC COVER OUT(2) 40.T 29.9' r CORNER LEACHING(3) 57S' 23.5' CORNER LEACHING(4) ".1' 34.7' �0�� 4 1 CORNER LEACHING(5) 79.V 71H CORNER LEACHING(6) 67-T 69.9' 98.5 o raaoEwa+a+ 9659'.... .w�OEwUReQ,TsryaIr ocEavEn sxE 95.50' 95.59 �-96 iao ,.�-UEm NLEIP u�ON E GoEalloAENCRE A�L NOTES STES w o m N 9703 esp Cn reG,sTPucrw—N ---- - I Eo BIONE - eavm 94 33- , vuCE�PrsENS au Nt OruPHOW Ess rww . 83S I nrasNEnowmE 'Pere mows.srs ssrsE w Y axPwNour 94a � rREwcWi mwoseo _ f „•�•'�" S' swarw ` wars(npiFAimirt 1 wEPn T rNE SnartEVAna��'r _ terra:`�(W6 .I �� O wEE . UY 94_85 ED Ll t }} 9EmCi IX'K BOMDOF NEI6 NfwCP,EEP TO BE NOT IXt ' ret , 94�17' [-11-1 t-11 '� �r'"S�Por n,ws TOu.�n,w�o wENs'rw"`NeEPsm rosiaNws. 0 z S Cl OENEOE ONE l o ED o 0 0 o o o $ o 0 o eZ m EP O SqN -,s.z- -- 'iws EarEP ... .r �� ovEP.rtE�uNrxl.r s>s .. .I .. EI£I rwns lesmM ssutiEo� of mov.rex oer Ego TE w xw oze. � uuitE ory so*rout �--' �a-sn5se rmasTmrwl o oEmEEraosEogutlnteEorx -9t.5 so c,wl ,.eiscr+ cmrroaPENx w m knurz euw mgs ou. rn" PROPOSED 1500 GALLON CONCRETE SEPTIC TANK ,mPs oroa irora o oN EAseNcrts PeEawruir • °a'Es roeE.,,s na 5-S00 GAL :HAM00S LEGH 19.5'WIO 56•DEp7H ,,o. E ensume iro mNeix-rE CROSS SECTION VIEW -' ,TY?IL".Ai.CHAMBERPROFILE ruw Ct1AMBER.ENDuIEty -. sm sN.i eE wnrEml caNP„ I SEPTIC TANK PROFILE DISTRIBUTION BOX DETAIL CHAMBER DETAILS o°u° rtEau wa owNEwAPouuw srooevv"sO - u... Nor sci.A .- -.-- sEvrid �mwaraNrssN�u miuouwowE € � TEST PIT DATA s �o mrr ESu ,a' ocu sNnu. r - tKP� T oarEw Na.w T.� 1,. Ew "PE «N 5: 9V-1 OT OES,GNE Ti+kV MAP 139: - voic � snE eaeronrows NrourNosE shown wla,io eounnuerronov wowK. PTM POEOSEO PitOIECT LOG>�O wrtNP[ ' I g, �"• �i«�` __ �,B. SFSSaP9 MM APCEI a MAP189 —T.x I riouusonm Rl— i L ' ,CU, * m EPrP. 5 roPEN is x3,. .MAF-l39 Y QN t �3 rw o rvM, I. F3+m`c LCCUSFLAN t 4 m IX v I I pxi O r - T----F omam " ----- - - E GEND ' I I ', % r� �.✓ 4-1 ,u: f �, _ s.Tsmo mxio C DESIGN DATA I L E,N —R • I. r_I � �,�} PEA ooN � N�Eo,ENOFPEPP�,o�N, _ -- �,wG� ,<T s —WAT,EP�NE #, i ( I w ;'� Yra,. � I �,°uE"`EPowsm,smawoN SEvac rwN I , EwsnNc s..ar«e f S Bi z!k r•.AaA> N � INSTALL 5-500 GAL.CHAMBERS ,f YI c u I oAuon sEvr�crrxu� I slOEwaLL CAPACITY .�:o rsrareuT r - a .f. t� Sloca.c„cNwsuUmnEx - ----- -- ------ --- -- ------ t BOTTOM CAPACITY:TM .. 1.' T t 1T y: TOTAts .. I P re (PROPOSED SE,TP� STEM UPGRADE r i STEVEN PELLIGRINO IF.oe+o 124 WEST STREET _BARNSTABLE MA 02655� _. x ,. .. P't�Po r tI ro• xr , e p / M'O FO ,T! // cncreNo cm s n s• '� -- - -7� .IC ENGINEERING,INC.HIGHWAY2&94 CRANBERRY EAST WAREHAM,MA 02538 s E t SITE PLAN' I 508.273.0377 ti. �� } t' a ; i TOWN OF BARNSTABLE LOCATION I oZ'l SEWAGE# , VILLAGE 05T61Z_vE"6 ASSESSOR'S MAP&,PARCEL INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 16 60 6 . t LEACHING FACILITY:(type) (size) NO.OF BEDROOMS OWNER PERMIT DATE: COMPLIANCE DATE: Separation;Distance Between the: Maximum'Adjusted Groundwater Table to the Bottom of'Leaching Facility Feet 4Y 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 •� P' '300 feet of le Ching facility) Feet FURNISHED BY 3H 6 -+ 'Q 'ems!• er } Y I r 'r r`- _ R"s No. � � r—I Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer.—� PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS YeS 0[pplitation for bispoBal 6pstem Construction permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ; ndividua:mponents Location Address or Lot No. � �/�2.j Owner's Name,Address,and Tel.No. ,,t As sssor�s Map/Parcel ol �. AC— e(h Ins ller's NaT,Address,and Tel.No.Ttv c:;:},t, Designer's Name,Address,and Tel.No. !J ►CaJ��3'�L�rZit /V /It� Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required)" gpd Design flow provided A0 gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) (+� *&Jj Z. L 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 an etIII p ace the system in operation until a Certificate of Compliance has been issued by this oard f 'alth. dJ Date 49 Application Approved by � Date Application Disapproved byV V Date for the following reasons Permit No. A)zo e)r Date Issued s ,.,.•�:;;t"'a..'C�.�a`'ki•..5f fi`n.,,...r..r. �.; � ..„,..,,,,'1lj- s' .4.1��,, 1 � 1' •- It;:.�s;Ss:ir b,��:R+'„-, r7f1,f�':. '+.. �,.�+•n.�^�K'sF�...�i.+- �Y,.�,..r,•; �.. . �"a.,�1e:T'�r•�r��t.n3, .,Fi�.�-+�.^'..wc�'"�.'.++.+;�..Iik.Tin.,�.r,T,e':•�+..,;:�� 'ra..'^"'�1 l J No.:' .., "' / �. ,R' Fee THE COMMONWEALTH,OF MASSACHUSETTS Entered in computer: Y es z PUBLIC HEALTH DIVISION . TOWN OF BARNSTABLE, MASSACHUSETTS application for iMisposar bpstent CDII$trutti0ll 3perttlit Application for a Permit to Construct( ) `Repair( )..Upgrade( ) Abandon/( ) ❑Complete System Ur ndivI idual Components Location Address or Lot No. 44) Owner's Name,Address,and Tel.No. p,-,�� y . �?.f�/tt�Q; —! yr "�. ea �- Get �c� S, �d�v�� r� As essor's Map/Parce.l \31 1 f� 14 Installer's Name,Address,and Tel.No. tp� G4:ber:.0 Designer's Name,Address,and Tel.No. Type of Building: - Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder.( : ) Other Type of Building No.of Persons Showers( ),Cafeteria( ) Other Fixtures Design Flow(min.required) �j� gpd Design flow pro"vided /y/1 gpd Plan Date Number of sheets Revision Date k + Title Size of Septic Tank '' Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) ,., r t two Arc' I Z. LFl% cs �` � 6. ., ilrn F'e►�nr c ^ceE_ ' f_ Gr2.riu�W ICA— Date•I5s"t inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system'-.m'f accordance with the provisions of Title 5 of the Environmental Code and .ko-place the in operation until a Certificate of Compliance has been issued by this B �d iof dalth. ` s Signed. Date ® � �ZZ 1 f Application Approved by i Date, Application Disapproved b 11' Date r .s for the following reasons Permit Nd. Date Issued z - ----- ------ ----- ------- -- - - - - ---------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( Repaired( ) Upgraded( ) Abandoned( )by -r-R A j "�51r,p/,-°r a -at .lk �,r , _"J t,��; t.- has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. :01,0-01 dated 17 Installer F l.ti � 1e�►tl�crn.®►v'� Designer /1/I �.. #bedrooms A rq Approved design flow & gpd The issuance of this permshall not be construed as a guarantee that the system-Will-function as s signed. Date Inspector\_ 14 No. 1 d/ Feed ao THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION BARNSTABLE,MASSACHUSETTS Misposaf 6pstem Construction 3perm& Permission is hereby:granted to Construct( ). Repair( ) Upgrade( ) Abandon( ) System located at: 005 1�ji(�'►1 I iI r' and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. ,,4 •,, Date_,l ?�? ?)_ Approved by -----» `"` t c .}pftfiN!(f I;IIWG j p( r;I): bir"I(xi p: rt ! 'fit,:r J!.:;r 1.q i;(j.I C i i _:el1l. r. !�I'.,., t�. r� SE.,• (�J:: i!J"A,^ j :IJt;^ 3{HJ Jt�t. lr..l313�'.�a� lr jrj^,... (: A_7�.:.) .t :1��.;L1J1�i' .�-�;r, tl. !ji_*;Ij i..:C1;ti 31' :C��.14;:1�r'. �:�,' l!i`1,,! /., '1 ;� - ou �n Ape .L,F!;:r, ro:]O,),I ,r;( F i MOMS ._ A;.-. :,.- ,., !.,, i i t '...•. ... ggi, _l , f t Y. i'• MUM( C q t AR SS;�,t` �� i ,�•..0 R q ...r-t q A�,..a'x ' ..�.a ib�...,v} ? *' 4 OWN OF BARNSTABLE CC LOCATION f U/ e s T 5 7 SEWAGE # 2 Ud` — 035 VILLAGE C�.S �'�a2"f��L�._� ASSESSOR'S MAP & LOT 3 G ,ram INSTALLER'S NAME&PHONE NO. / %YI A C G7 A/► �.R�— S c�N SEPTIC TANK CAPACITY A SS G LEACHING FACILITY: (type) .S" /_9 k Ul el1S(siie) A •% NO. OF BEDROOMS BUIL ER:OR OWNER PERMITDATE: 1 0 COMPLIANCE DATE: 3 � U t Separation Distance Betweeh.the:.. Maximum Adjusted Grqundwater>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 va r .Y No. GO 3 cl go 20 (1 Fee /Q r �E COMMOZWEALTH OF SSACHUSETTS Entered in computer: v � Yes ♦ PUBLIC HEALTH"DIVISION -TOWN OF BARNSTABLEs MASSACHUSETTS Zipprication for ZifSpogal 6potem Construction Permit Application for a Permit to Construct( . )Repair( )Upgrade( )Abandon( ) O Complete System El Individual Components Location Address or Lot o. I-R4 Ej e- Owner's Name,Address and T 1.No. c)+ZX�en Velli v in.p Assessor's Map/Parcel )�n — b.54A n ©D.1 oe Installe Name,Address, Tel.No� 6 e7 Desi erCs.N�e,Add and Tel No. 1.6 e,_tr &VI L to x Ce Cv C xl t 1� ® , I_ Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day, Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil, Nature of RepW�rs orAlteratigns(Answer when applicable) , 1 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' by s Bo f Health. Signed �� Date fl Application Approved by Date Application Disapproved for the following reasons Permit No. G o —0 3 Date Issued 44d y --. -.�:� _:�-� ::.e .✓ r, e, -.,,.-y _ .,, ti � �r �:ti.,».:��---..--. .-ram -... `^ -v..�-_�� .r- _•- _. _�� ee No. 60 L1 �V J l OhI^ F t THE COMMONWEALTH OF M `SSACHUSETTS 'Entered in computer ¢ 4�+w-=. o - ism s TH OF Mi t- Yes . -PUBLIC HEALTH DIVISION`-TOWN OF BARNSTABLES MASSACHUSET-'S- 2porication for M'igogal bpztem Cowaruction Permit Application for a Permit to Construct( . )Repair( )Upgrade( )Abandon( ) O Complete System El Individual Components Location Address or Lot N . 1 A 4 U 8g� �t Owner's Name,Address and T I.No. CS(�tYl p Assessor's Map/Parcel �,q / boS,�Q r r ry 0 D,I Ole t CQ t�� 4r Install,'s Name,Address,and Tel No. Designer's Name,Address and Tel.No. -�i' , covrvbrzr �xl.� V7 C. E.moxlee_r xr7C c.e(0 Cron-6w 1 �� On L OA �. , r 1 A , Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( �) ° Other Fixtures Design Flow "'� gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank - Type of S.A.S. Description of Soil, J Nature of Rep 'rs or Alterat{i�ons(Answer when applicable) p� it ;n C. `St T 6 1 4 Date last inspected:' ' t Agreement:' - � Thevndersgned agrees to.ensure the construction and maintenance of the afore described on-site sewage disposal system in acc6rdance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certif- Cate of Ufthance tias been issued by this Board of Health. `1 Signed , i Date Application Approved by s �, yin�� f� Date 4 t, ' Application Disapproved for the following reasons Permit No. 0 y—u3cl Date Issued 116) / r —————— THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the�On�-.site Sewage Disposal System Constructed( )Repaired( )Upgraded(. ) Abandoned( )by �� . 1mC�Ut� I 1' C. at I at) V46 :)nAy YU 1 lb,'. �l 1 n � has been constructedd in a cordance with the provisions of Title 5 and the for Disgesal System Corsft scdon Permit No. 'z�t�^ 1/ dated 1 / rl Installer J ` �t�COt1' CRE 4fJ 5J6 <ti a. Designer The issuance of this permit shall not 66 conetruedas a guarantee that the system will function as designed. n Date 1 (� Inspector --rr--------- --\--------- _ — - ---- No. o��10'7 �3� `,, —— - ————Fee U THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS ` Migozal *poem Construction Permit Permission is hereby granted to Construct(X)Repair( )Upgrade( )Abandon( ) System located at !`�y e �� 'elc�t �P. 1 (1_ , ,)and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to corn ply with"Title 5 and the following local provisions or special conditions. Provided!.,Construction~ must be completed within three years of the date of this pernut Date: U �� Approved by �k-�`' �1�✓. eL — .--SEWAGE INSPECTIONS !� DATE 912103 VILLAGE _0,6�LeztviiCg, Na.a,6. ASSESSOR'S MAP & LOT i3 -INSPECTOR 7o�3gph %. Nacomge2 a2. SEPTIC TANK CAPACITY 1000 ga teon .septic'.tank. LEACHING FACILITY: (type)1-LP- 1000 (size) 1500 gaiionz NO.-OF BEDROOMS 3 BUILDER OR OWNER Jean 72eeman OWNER MAILING. ADDRESS •1 Z [0o zzpa t Lane Nancheztea Conn. 06040 J y �� I-� i � i �� ,� o O ' Q "' � ��1�� `� � 6 � �,tJC� S% S? Town of Barnstable A Board of Health P.O. Box 534, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Susan G.Rask,R.S: Sumner Kaufman,MS Wayne Miller,M.D. Mr. John Churchill, Jr., P.E. January 30, 2004 JC Engineering, Inc. 2854 Cranberry Highway East Wareham, MA 02538-1314 Dear Mr. Churchill, You are granted permission to construct a soil absorption system designed to be connected to a six bedroom home proposed to be constructed at 124 West Street, Barnstable. The septic system shall be constructed in accordance with the submitted plans dated f December 31, 2003. Since ly yours, 'dyne iller, M.D. Chair an BOARD OF HEALTH TOWN OF BARNSTABLE Q:HEALTH/WP/ChurchillPelligrino JC ENGINEERING, Inc. Civil & Environmental Engineering 2854 Cranberry Highway. 4 East Wareham, Massachusetts 02538-1314 Ph. 508-273-0377—Fax 508-273-0367 January 1, 2004 4 Town of Barnstable 'JAN 0 5 2003 Board of Health TO! 200 Main Street w`= Hyannis, MA 02601 RE: 124 West Street, a.k.a. 106 West Street Dear Honorable Board: Please find enclosed three copies of a septic system upgrade plan entitled"Proposed Septic System Upgrade, Prepared for Steven Pelligrino located at 124 West Street, Barnstable, MA" dated December 31, 2003 for your review. The plan as designed is for six bedrooms and in accordance with your requirements,we are requesting to be placed on the next agenda for discussion. The property is not located in a Nitrogen Sensitive Area and a reserve area has been shown on the plan. Please advise at your earliest possible convenience and if there are any questions or concerns please feel free to contact our office. Respectfully, --P4'Yhill., John L. C ., P.E. President Enclosure—Three Plans JCE#569 t i (i — �� 1 � i m - I ❑f I Uw �ffi i L El Z + i LU o a.c- LU Luy u ao E W F 1 R 5 T FLOOP PLAN - a- MSPO V SGFF..VULE DOOR 5i,PEP)U N . (L w � , LU LL 21 LU N � - - _ ILL ---- A101 i t;' �e El + � I cl I II - S � I g (,p - yr,-: E s n LJ Z - f ` 0 13I n Q � o — - "�--== jx a r a SEGOND- FLOOR PLAN - � FIRST FLO O-R PLAN W O I W d + C7 II MVON DOOR SCHEOUILE a o — Ix OJ i U 21. A103 i - � ro i IT © O W _ i F Cl� "' I , ❑ 4 m a J- LU N w Z w w W 3 0 _ .oEO"O-ND FLOOR FL AN O cx .. ..... sr .._ -:.. .. .p ..:..:. F 4 J a � � O 00 LL-- - ..... i N.In A102 5AS�ENE:N.T FLOOR PLAN. �— {l own--z - I h To n of Barnstable V, Lr # ° �l �p VE Tp� o Department of Regulatory Services Public Health Division snaNsrABr.>;. Date v Mnss. 200 Main Street Hyannis MA 02601 ab;q. �m , Y �ATfD MAv� Date Scheduled ;? 7 0 y Time lb Fee Pd. Uv -Soil Suitability Assessment for Sewage Disposal Performed By: �.I CtC�l�t� &rjolp EIT of. Witnessed By: I / v/� . I LOCATION & GENERAL INFORMATIONp e Owner's Name 51c,&t\ r£Ill q'Im D Location Address j r?2� pp Address LC �LGU:,h S�� UJS)" Assessor's Map/Parcel: 3q/ r Engineer's Name J G�nyi�eC^1 hLf�T+7 NEW CONSTRUCTION REPAIR Telephone# 50,?-2_73 O j 77 G Land Use Res ide-11 I&I Slopes CA) 1"3 �u Surface Stones /4,5.11e Distances from: Open Water Body> �G1� ft Possible Wet Area 6C ft Drinking Water Well ft Drainage Way ft Property Line -- 6v ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) 11A bjA� _01 C^ tt !� Parent material(geologic) ©Ir`> tS Depth to Bedrock > i�U 6G5 Depth to Groundwater: Standing Water in Hole: do OilC Weeping from Pit Face 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 Hl��d` —SPT PERCOLATION TEST Date Z7 Time Observation I j Hole# "2 Time at 9" Depth of Pere 33'S 3d Time at 6" Start Pre-soak Time a /OWAm ID�ZUON Time(9"-6") End Pre-soak lb`Upi I0'�6 4M Rate Min./Inch `2 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:HEALT[H/WP/PERCFORM a DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders. Cuitsistencv.%.Caravel)..__-_-_-. A 16YR IN 21 54nofu ic;GY, la �K 6fy d 9 y y' W1�CL 4 s�Y 7/4 K MIj I-rK71Y v A w 4gse) r . and bj S e I ,i l o -e�,) DEEP OBSERVATION HOLE LOG Hole# 2- Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) U- A 10 51P n9 c S6n4 613 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) Flood Insurance Rate Man: Above 500 year flood boundary No_ Yes X Within 500 year boundary No Yes Within 100 year flood boundary No Yes Depth of Naturally Neurring 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? iGJ- If not,what is the depth of naturally occurring pervious material? Certification I certify that on 7 Z4 63 (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 trai ing,expertise and experience described in 310 CMR 1.5.017. �QY,U Date Signature Z7 1 Q:H EALTH/W P/PERCFORM If won ® - t Cif CvNln 1 r '.;' � � _. �. � j yd (�,� I I 1 I � �� ,. (n GT- 1 I rt I ;• 11 c -!- -• '---fl�..� � .uJi✓`(IL•_� �.LLL.P � �. � : ff` �-.f)`"..� /cu�- .. ��SL.{�(� -- --'I ��:4 � ..I � -e� -2-1 '^' fo.,e t!�1 �. ` i I 1-.1... �l"tJ� ,. .Ili----� - - r a i .��✓+s lr—r -- f�7 1 'l- 1-.—II tt t.0 tj rt11. lroi[ - .. too— < s p r> Lid —' lot.�v.Fi,i�c.r�u.. . t � �5 j...q, �N.e�j _II � µj .12�� .�� .y �.c r• ��. - � � _' Ir I ` 1 1 r II - �t ion 1 j - - 1 ,i- i z i�' .i i e 't a _ I r f Ln {T nL I T-- -. --,�--n-- 2 9 i JAM - e . . I U2 14 - .. 'o {� pJdB ro fi.�.P� P f/ u Imo_ 1, ; �roPeSeS '�elrco" Y �R BA.o I - �{• I , L .. ------ -- — ---- --R •'O T--'-� g Ci4i Ellr •"� � 1 �� Ilir.li - Y � V(J�.I.y o'lL..v I i F. tlylq 1 1I ... .. N +14 r i iri7.' ...... 18-0 `S � ( u (I a• COKU�f�t�l I e tIe C�uc� 5 c COMMONWEALTH OF MASSACHUSETTS = EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION - TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR.VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address:106 61e6t S.t2ee.t Owner's Name: learn T2eema2 Owner's Address: 12 Do2.3e.t Lane anche61-p2 Conn. 06040 Date of Inspection: 912103 Name of Inspector: (please print)aohe/?h P. /'lacom9elt a2. Company Name: J. P. Nacom e-a on rtc. Mailing Address: Box 66 ea e/tv,i e, as.3. 02632 Telephone Number:508—775-33 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 training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: !// Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: �1' The system inspector sh mit a copy of this inspection repo 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 4 .****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. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of I I + OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM.INSPECTION FORM PART A _ CERTIFICATION (continued) Property Address: 106 went S;tIteet 03te2viQQe, Owner:aearz /fteeflrarz Date of Inspection: 912103 Inspection Summary: Check A,B,C,D or E/AL WAYS-cotnplete all of Sectloa D �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: _7he zepi—ic 3yztem tz zn paope2 woe/clrzg oadea a erzt tome B. System Conditionally Passes: One or more system components as described in the "Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes: no or not determined(Y,N,ND) in the fo explain. r the following statements. If"not determined"please 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 sepric 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: Y _ 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:• y The system required pumping more than 4 times a year due to broken or obstructed pipc(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: e 2 1 Page 3 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Add ress:106 Ue.6t S.t.,zeei 0-6teAv-M-1e, Ma,37 Owaer.Leant Tltee naz Date of Inspection: 9/2103 .;. C. Further Evaluation is Required by the Board of Health: , Vb Conditions exist which require fwther evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. I. 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 [Wanner which will protect public bealth,safety and the environment: IVCesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. Svstem 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: UO 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. VJ 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 50 feet of a private water supply well. � - The Svstem has a septic tank'and SAS and the SAS is less than 100 feet bu 0 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 QEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 "Page 4 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 106 Ue a t Stbzeet` 03te2u� e, a 33. Owoer:aean 72eem¢rz Date of Inspection: 9/2/0 3 a 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 /U�,(/el Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool /-�A/&1) Cho J _ /Liquid depth in eesspooi is less than 6"below invert or available volume is less than 'h.day flow ; Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped Q. y portion of the SAS, cesspool or privy is below high ground water elevation. y portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface /water supply. arty portion of a cesspool or privy is within a Zone 1 of a public well. arty 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303.therefore the system 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• 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 /he system is within 400 feet of a surface drinking water supply _ v the system is within 200 feet of a tributary to a surface drinking water supply _ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area— IWPA)or a mapped Zone 11 of a public water supply well T If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate.regional office of the Department, Page 5 of I I OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Properry Address: 106 'Wes-t S.t2eet h t e/t Owoer:aeurz /Aeernarz Date of lospection: 91,21,01, ra°• Check if the rollowin,R have been done. You must indicate "yes',or"no"as to each of the followin 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 ? ZH the system received normal flows in the previous two week period? t/ Have large volumes of water been I' ntroduced to the system recently or as pan of this inspection ? Were as built plans of the system obtained and examined?(Ifthey were not available note as NSA) ✓ _ Was the facility or dwelling inspected for signs of sewage back up? t/ _ Was the site inspected for signs of break out ? — Were all system components,wuding the SAS, located on.site ? _ Were the septic tank manholes uncovered,opened, and the interior of the tank inspected for the con iton of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum ) 4 _ Was the facility owner(and occupants if different from owner maintenance of subsurface sewage disposal systems ? )Provided with information on the proper The size and location of the Soil Absorption System (SAS)on the site has been determined based on: Yes no / Existing information. For example, a plan at the Board of Health. J Determined in the field (if&ny of the failure criteria related to Pan.0 is at is unacceptable)(310 CMR 15.302 3 Issue approximation of distance 5 Page 6 of I I A ' OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION 106 Oeat St2eet i Property Address =FAT777e, ass Owner: aeon. 7/ eem R Date of Inspection. 912103 FLOW.CONDITIONS RESIDENTIAL Number of bedrooms(design): ?J Number of bedrooms(actual): .. 1p� DESIGN flow based on 310 CMR 15.203 (for example: 1 10 gpd x it of bedrooms): Number of current residents: Does residence have a garbage grinder(yes or no): � Is laundry on a separate sewage system es or no): 0 (if yes separate inspection required) Laundry system inspected es or no): S Seasonal use: (yes or no): S Water meter readings, if available (last 2 years usage (gpd)):2001_ 11 5 5, 000 ga'iLonz 424. 66 C/ D Sump pump(yes or no) gai-eon.6=676. 72 gPD Last date of occupancy: ,'S/2/zink ie2 pee'6ent. COMMERCIAL/NDUSTRIAL z, Type of establishment: Design now(based on 310 --MA 15.203): X11Y gpd Basis of design now(scwVpersons/sgft,etc.): Grease crap present(yes or no): Industrial waste holding tank present(yes or no):,( Non sanitary waste dischugcd to the Title S system (yes or.no): ' Water meter readings, if available: )- Last date of occupancy/use: OTHER (describe): /17 GENERAL INFORMATION Pumping Records -. Source of information: . Was system pumped as pan of the inspection(yes or no): If yes, volume pumped: 0 alions •• How was quantity pumped determined? Reason for pumping: ' TY E OF SYSTEM ,. S c p t i c tank, soil absorption system Single cesspool Overflow cesspool } Privy Shared system.(yes or no)(if yes, attach previous inspection records, if any) :9 lrtnovative/Alternuive technology. Atuch a copy of the current operation and maintenance contract (to be , obtained from system owner) F Night tank A11V Much a copy of the DEP approval m Other(describe): Approxi arc a¢e of all comp c ts, daft ' stalle if kno nd source of information: Were sewage odors detected when-arriving at the site (yes'or no): . ' Page 7 of I'I. OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) .Property Address: 106 lile,st St zeet Owner: dean T2eeman Date of Inspection: 1 r- BUILDING•SEWER(locate on site plan) 4" Oaangegeag /?../ze thaough out .the inzta.P-eat-ion. Depth below glade: S �t tem. Materials of construction: _cast iron�40 PVC,,/other(explain): y Distance from private water supply well or suction line: Comments (on condition orpoints, venting, evidence of leakage, etc.): ointa anpeaa tight, No evidence o�, ,ejakac/e. The 3yhtem iz oen.ted thorough .the 2oo,�' vennt.6. SEPTIC TANK: locate on site plan) lettgl9 lm-6 Depth below grade. _ Material of construction: ✓concrete;metal,{Aftberglassf2d polyethylene ,;other(explain) If tank is rrietal list age:IVA Is age confirmed by a Certificate of Compliance (yes or no);,A(attach a copy of certificate) Dimensions: '9 6 .(D•t14 �� l/� ��? �/�,/� Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: Z;�e Distance from top of scum to top of outlet tee or baffle: Distancc from bonom of scum to bottom of outlet tee or b�ffle�L�(�� How were dimensions determined: Comments-(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc. Pum the .6eptic .tank annua—P y. Gangage die12oaa.P 1,3 /22ehent. {l2#,L tank i-6 '3t2uc.tull& y zoun an .6 owz no evz ence of .leakage. Liquid tevei iz 51" at the outiet inveai. GREASE TRAP,(e jlocatc on site plan) Depth below grade: A Material of construction;concrete,.AmetaVAfiberglas44 polyethyleneldother f (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle; Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: �1/9 Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Gaeaae t2aR iz not /2ae,,sent. 7 y Page 8'of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 106 Oe,t S.t2eei , e2u7 e, a,,. Owner: ,dean 72eernan Date of Inspection: 9/210 3 TIGHT or HOLDING TANW,-(tank must be pumped at time of inspection)(locate on site plan) Depth below grade: 10 Material of construction: 614 concrete _metal'414 fiberglass L,/ Polyethylene.t/h other(explain): Dimensions: ,t/' Capacity: �iQ r gallons Design Flow: . AIM gallons/day Alarm present(yes or no): ),4 Alarm level: d4 Alarm in working order(yes or no): Date of last pumping: AM Comments(condition of alarm and float switches,etc.): Tight on hoiding tank, ate not fiazzent. DISTRIBUTION BOMi LL(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 40 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.): D.i,ta.igut.ion Sox i, not eae,ent PUMP CHAMBERr? " (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber, condition of pumps and appurtenances,etc.): l)iimp rhnm0.on i4 no.f n-P iPni 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. 106 Oe,6t Stbzeet ; P ,6 t e-zvt e, a.6.6. Owner: 912103 Date of inspection: can Zeeman SOIL ABSORPTION SYSTEM (SAS): locate on site plan, excavation not required) 1- 1000 as ioa R2caet ieach-ina pit If SAS not located explain why: Located: See Kaye 1 Type leaching pits, number:J / leaching chambers, number: leaching galleries,number: O leaching trenches,number, length: d ,4)b leaching fields, number, dimensions: NU overflow cesspool, number: Q innovative/alternative system Type/name of technology: /772"e, Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil,condition of 'egetation, etc.): Loamu hand to medium eoa2he nand. No e.i n,s o� hyd zau-eic /a.iPuae oa 12on_d.ing. So i.ib ate cL2y. Vegetat ion .i.6 ho2ma a.� e iva e2 ca ge.iow the ��.cnve zt /2.c/2e. CESSPOOLS1,dc/e- (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: 4 Depth-top of liquid to inlet invert: . Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no). Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.): Cea.6poo -6 ate not paehent PRIVYr1�a,.,)4(locate on site.plan) Materials of construction:_ Dimensions: Depth of solids: Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.):, Paiyy .i.6 not paebent. U 9 Page 10 of 1 I OFFICIAL INSPECTION FORM —NOT FOR,VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: eaa /T2eema2 P e.3 2ee Owner: 076 t e/iv Te T e, 77 a.6.s Date of Inspection: , 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. I �o� i y (,cJ0ST S? 10 r � Page 1 I of 1 1 OFFIC IAL IAL INSPECTION FORM O. — NOT .. V RM O FOR VOLUNTARY AS SESSMENTS SSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C G SYSTEM'INFORMATION (continued) Property Address: 106 -wehz` Si<2eet' r zt e�zv-i eie, t'azz, rf Owner: dean _ T2eernan Date of Inspection: 0, SITE EXAM t Slope , Surface water ,. Check cellar Shallow wells - Estimated depth to ground water feet`s '- Please indicate (check)all methods used to determine the high`ground water elevation: A114 Obtaine lams on record -,If checked,date of design plan reviewed: Observed site(abutting property( bservation hole within 150 feel of SAS) T ,M) Checked with local Board of Health-explain: Checked with local excavators, installers-(attach documentati n) Accessed USGS database-explain: r You must describe how you established the high ground water elevation: zed: gah22_u 9 tT v P1pdeQ 12116424 'aanLnd 'wrizvn oQv»rrfinn i aPon )o ,tvn QeUee. zed: aS4S: 0&AgAya4jna &vy,P.P dn.ta � � 199? zed: dS4S: 7vrhn-rn0 a1)_Pfvfin 9,? On0 1 %)O(ifv 47 aU 12 g,2 t nii»�l wa on .-O�OJl!/f�nn/� �nnii rr nor 1997 - *. n --------------- Leaching �, x Pity .eet r Groundwater: Feet Below Bottom of Pit -`High Groundwater Adjustment 1.8:ft per Fr mpter Method � Therefore, the vertical separation distance between the bottom of the leaching pit and,the adjusted groundwater table is feet. x - a. 1r Z"' DATE :9/z/03PROPERTY ADDRESS: -- _ [Jes 2ee -------'steav i Pe, tlazz. 02655 ---------- - On the above date, I inspected the septic system-at the above address, Tni$ system cOnSISIS of the 10110wing: : 1. 1- 1 UUU ya.e.eon ze/zt.ic t MAP I�9ank. _ 2. No D-iztAigul-ion &ox. PARCEL 3. 1- 1000 ga e.eorz /2/teca-6t ieach.ing /tit. L0 Baseo on my inspection, I certify the lollowing conditions: - 4. 7hiz .i-s a t.it ee dive kept is zy,34em.. (78 Code) 5. The ze/14.ic zyztem .iz in 122ope2 wo2king ozde2 at the /Meaent time. 6. Qazte wate2 .ih 60" &eiow the .invent /2.ipe o/ the .beaching 12.i4. SIGNATUR r;)�V_ Name _ _J_ _ P . -Ma comber Jr . ompany : l4�eRR ��_ t��S4mR�C;a_ Son, .Inc . - ccre'Ss @Q; _�� ----- ---- -- - - -C—e.nsecYLLLP-- �ja _ -Q.2.6 ) 2--0066 TmIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY JOSEPH P. MACOMBER & SON, INC. lanks•Cesspools•l.eachllelds Pumped b Installed Town Sewer Connections P 0 Box 66 Cen►erville, MA 02632.0066 275•3338 775.6412 e- 1 rw.nT..-nT�•rr- rwr wn•nnwnr+.�'e.T.Tier.�.•+wwrwnT.w.. ne��+*�T�w•• •- TOWN OF 13a znhta&.Pe 130ARD OF HEALTH 91111SHFACR 9FWA(;E DI Sf'OSAL SYSTEM I NSUCTION FORM - PART D •- CERTI FI CATION Tf1•T••.••.'.-T.1 I1tTTT1w��1'1.111 TR1ff/1T�T.T-{1 T•'y� R��T'�l�A��Rt � 1 -TYPE OR PRINT CLEARLY- PI?OPERTY INSPECTED STREET ADDRESS 106 Ue,st Staeet 0,3te*�zvie.fe, Na,3.6. ASSESSORS MAP , BLOCK AND PARCEL OWNER' s NAME dean FZeefflgn PART D - CERTIFICATION NAME OF INSPECTORJ-oseph P.Macomber Jr. COMPANY NAME J P Macomber & Son Ind4 COMPANY ADDRESSBox 66 Centerville Mass . 02632 Street - To►m or City - state IIP COMPANY TELEPHONE ( 508 ) 775 - 3338 . FAX ( 50$ ), 790 -1 578 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at 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 . Check one ; _L/System: PASSED The inspection which I have conducted has not found any ' information which indicates that the system fails to adequately protect public healLh or Lhe. environment as defined in 310 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 acted has found that the system fails to Protect the public health and the environment in accordance with Title 6 , 310 CMR 15 . 303 , and as specifically, noted on PART C - FAILURE CRITERIA of this inspection form, Inspector Signature Date ne copy of this certification must be provided to the OWNER, the BUYER O Nhe re applicable ) and the 130ARD OF HEAL-1.11, * If the inspection FAILED, the owner ors"operator shall upgrade he aYstem within one year of the date of the inspection , unless allowed ortrequired otherwise as provided in 3.10 CMR 16 - 306 . Par td . doc TOWN OF BARNSTABLE " LOCATION l %U e S T 5 7-j SEWAGE # 2VOL ` 035 VILLAGE Q S 'e d V I ZZ ASSESSOR'S MAP & LOT 13 INSTALLER'S NAME&PHONE NO. 44 A C 0 44 fl✓ — SEPTIC TANK CAP S"00 LEACHING FACILITY:.(type) .S' n )z f-a (size) A2,l - .71 NO. OF BEDROOMS I BUILDER OR OWNER. I/r'QPIA PERMITDATE: 1 0- COMPLIANCE DATE: 3 / t Separation Distance Betwa#,the: Maximum Adjusted Groundw' 4e Table to the.Bottom of Leaching Facility Feet Private Water Supply WeII 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 f within 300 feet of leaching facility) Feet . Furnished by o _ we51- S7- Commonwealth of Massachusetts Title 5 Official Inspection Form l; Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ° 124 West Street Property Address •; Stephen Pellegrino Owner Owner's Name ;4 information is required for every Osterville MA 02655 7=12-19 page. City/Town State Zip Code. Date of Inspection ' tip 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. ```�uuunupppby Important:When filling out forms A. Inspector Informationon the use only�th�e tab puter, - JA M E m James D.Sears S key to move your Name of Inspector 7 cursor- notuse Ca ewide Enterprises `�''•,c o key.the return urn Company Name Tlf •.• �O` _.-. 153 Commercial Street1tdSPtiG��`�� Company Address _Mashpee MA 02649 CityfTown State Zip Code 508-477-8877 S 1623 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection;and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 7.13-19 In ctor's Signature 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 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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: 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. t5insp,doc•rev.7126=18 Title 5 Offidal Inspection Form:Subswfaoe Sewage o1sposal System•Page 1 or 18 I, al5ed xe� dH '50:01, 6602 LI, lnr i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 124 West Street Property Address Stephen Pellegrino h Owner Owner's Name Information is required for every Cisterville MA 02655 7-12-19 page. City/Town State Zip Code Date of Inspection " C. Inspection Summary , u Inspection Summary: Complete 1, 2, 3,1or 5 and all of 4 and 6, 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 orin 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below: x Comments: : The system is a 1500 Gal. Tank D Box and five chambers. E ° 2) System Conditionally Passes: ❑ One or more system components'as described in the"Conditional Pass"section.need to be. replacedor repaired. The system, upon completion of the replacement or repair,as approved by the Board of Health,will pass. Check the box for"yes",`no"or"not determined"(Y,N, ND)for the following statements. If"not . determined," please explain. The septic tank is-metal and over 20 years old"or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal.septic tank will pass inspection if it is structurally'sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. - ❑ Y ❑ N ❑ ND (Explain below): , t5insp.doc-rev.7@8/2018 - r + Title 5 Official nspection Form:Subsur'ace Sewage Disposal System"Page 2 of 18, z a6ed xed dH 50:0 6 6 60Z L I, lnr Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments !y' 124 West Street Property Address Stephen Pellegrino Owner Owner's Name information is required for every Osterville MA 02655 7-12-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes(cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumpslalarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection If(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) 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. a. 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: t.5insp.doc•rev.71'M2018 Tine 5 Official Inapecf'ron Form:Subsurlaoe Sewage Disposal System•Page 3of 18 6 al5ed xezl dH 50:01, 61,0Z L l, Inr f Commonwealth of Massachusetts Title 5 official Inspection Fora �- Subsurface Sewage Disposal System Form -Not for Voluntary Assessments V 124 West Street Property Address Stephen Pellegrino Owner Owners Name information is Osterville MA 02655 7-12-19 required for every page Cityl-rown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning,in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface.water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. El The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for 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. c. Other: 4) 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 t5lnsp.doo•rev.712612018 Title 5 Official Inspection Form:Subsurface Sewage 0isposa'System•Page 4 or 18 b a5ed xezl dH 50:06 660Z L6 lni- Commonwealth of Massachusetts Title 5 Official Inspection Form �I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 124 West Street Property Address Stephen Pellegrino Owner Owner's Name information is required for every Osterville. MA 02655 7-12-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No 11 ® Static liquid level in the distribution box above outlet invert due to an oveHoaded or clogged SAS or cesspool ® Liquid depth in erfsrapfffi is less than 6" below invert or available volume is less than %day flow A44('iY1-4eir ❑ ® 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 water supply 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 2000 gpd- 10,000 gpd. ❑ ® The system fail . I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) 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 CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA)or a mapped Zone 11 of a public water supply well 15insp.doc rev.7126/2018 Title 6 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 18 5 abed xe ' n � dH 50�06 660Z L6 l f Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments . �e � 124 West Street Property Address Stephen Pellegrino Owner Owner's Name Information is required for every Osterville MA " 0265$ 7-12-19 page, City[Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered"yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes" or"no"for each of the following for aJ!inspections: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? Have large volumes of water been introduced to the system recently or as part of ❑ ' ® this inspection? ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions,depth of liquid,depth of sludge and depth of scum? 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: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] I t6insp.doc-rev.7f26l2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 i 9 abed dH 90:06 6102 Li, l.nr ct\ Commonwealth of Massachusetts Title 5 Official Inspection Form W. Subsurface Sewage Disposal System Form •Not for Voluntary Assessments 124 West Street Property Address Stephen Pellegrino Owner Owner's Name information is required for every Osterville MA 02655 7-12-19 page City/Town State Zip Code - Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 6 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 660 Description: 1500 Gal. Tank D Box and six chamber's. 4 Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system'inspection Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ® Yes ❑ No Water meter readings, if available (last 2 years usage (gpd)): 2017-169,000Gat 2018-306.000Gal's Detail: Sump pump? ❑ Yes ® No Present Last date of occupancy: Date 15insp.doc•rev.7f<6I2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal SyMern Page 7 of 18 L a6ed xed dH 90:06 660Z L6 tnr 7 Commonwealth of Massachusetts Title 5 Official Inspection Form �I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 124 West Street Property Address Stephen Pellegrino Owner owner's Name Information is required for every Osterville MA 02655 7-12-19 page City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commerciallindustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seatslpersons/sq.ft.,etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings,if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: - p g - Source of information: NA Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: 151nsp.doc-rev.7/20/2018 Tide,5 Official Inspection Form:Subsurface sewage Disposal System-Page 8 of 18 g a6ed YPJ dH 90:06 6602 L6 tnr c Commonwealth of Massachusetts Title 5 Official Inspection Form `e Subsurface Sewage Disposal System Form Not for Voluntary Assessments 124 West Street Property Address Stephen Pellegrino Owner Owner's Name information is required for every Osterville MA 02655 7-12-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: - ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no)(if yes, attach previous inspection records, if any) ❑ 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 Cl Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: 2004 Permit #2004-039. Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 20" 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.): Pipeing is 4" PVC SCH 40. t5insp.doc•rev.7128)2018 Title 5 Official Inspection Form!Subsurface Sewage Disposal System-Page 9 of 18 6 abed xeJ dH L0:06 61,0Z L l, tnr Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 124 West Street Property Address Stephen Pellegrino Owner Owner's Name information is required for every Osterville MA 02655 7-12-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): 10" 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: .1500 Gal.Precast H-10 Sludge depth: V 29" Distance from top of sludge to bottom of outlet tee or baffle Scum thickness 0" Distance from top of scum to top of outlet tee or baffle 8" Distance from bottom of scum to bottom of outlet tee or baffle 18" How were dimensions determined? Asbuilt-TapeSludge-Judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank at workinging level. Tank and covers at 10"below grade. In and outlet tees. No sign of leakage or over loading. i t5insp.doc•rev.7126121315 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 10 of 18 Ot a6ed xed dH L0:06 660Z Ll, lcr r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 124 West Street Property Address Stephen Pellegrino Owner Owner's Name information is required for every Osterville MA 02665 7-12-19 page. City/Town State Zip Code Date of Inspection D. System information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): t I B. 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 trrnsp.doc•rev.7128t2018 Title 5 OfBdal Inspeatlon Form:Subsurfaoe Sewage Disposal System Page 11 of 18 66 abed xed dH L0:01. 660Z L6 lnf Commonwealth of Massachusetts Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form •Not for Voluntary Assessments f? r 124 West Street Property Address Stephen Petlegrino Owner Owner's Name information is required for every Osterville MA 02655 7-12-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level Alarm in working order: ❑ Yes ❑ No' Date of last pumping: Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required), Is copy attached? ❑ Ye s ❑ No 9. Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0 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.): D Box is 16"x16"-1' below grade w13 lines out. Box is clean and solid wino sign of over loading or solid carry. t5insp.doc-rev.7262018 Title 5 Official Inspactlon Form:Subsurface Sewage Disposal System Page 12 of 18 Z� a6ed xej dH L0:06 61.0Z Li, lnr t Commonwealth of Massachusetts � Title 5 Official Inspection Form i- r . Not for Voluntary}I� Subsurface Sewage Disposal System Form Assessments �.% 124 West Street Property Address Stephen Pellegrino Owner Owner's Name information is required for every 05tervilie MA 02655 7-12-19 Page City/Town State Zip Code Date of Inspection D. System Information (cont.) 10: Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No" Alarms in working order. ❑ Yes. ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances,etc.): f * If pumps or alarrns are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): ' If SAS not located, explain why: Type: ❑ leaching pits number: 5 ® leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches • number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5imp.doc•rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 El, abed xed dH L0:01. 660Z L l, lnr Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form •Not for Voluntary Assessments 124 West Street ,1 Property Address Stephen Pellegrino Owner Owner's Name Information is required for every Osterville MA 02655 ' 7-12-19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System(SAS)(cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding,damp soil, condition of vegetation, etc.): Leaching is five 500 Gal. Dry well chambers at 20"below grade.Chamber's are wet bottom,w/clean like new wall's. 12. Cesspools ('cesspooI 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 r Dimensions of cesspool Materials of construction + Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7126/2018 Title 50fflclel Inspection Form:Subsurface Sewage Disposal system•Page 10 of 18 1 - I b6 a6ed xed dH 0:06 6WZ Lb tnl. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,F 124 West Street Property Address Stephen Pellegrino Owner Owner's Name information is required for every Csterville MA 02655 7-12-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont) 13. Privy (locate on site plan): Materials of construction: Dimensions Depth of solids a Comments (note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.): I 15insp.doc-rev.7/261201 B Title 5 Official fnspeotion Form:^.wowrraoe Sewage Disposal System,Page 15 of 16 c S 6 abed xed dH LD:U 660Z L l, lnr Commonwealth of Massachusetts Title 5 Official Inspection Form I• Isl Subsurface Sewage Disposals System Form Not For Voluntary Assessments �P 124 West Street `� • Property Address Stephen Pellegrino Owner Owner's Name information Is Osterville MA 02655: 7-12-19 required for every CitylTt7wr1 State Zip Code Data of Inspection page. D. System information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately , Q. t5lnsp.doc-rev.W2612018 Title 5 Official inspection Form Subsurface sewage Disposai System•Page 16 of 18 96 a6ed xed dH LODI, 660Z Ll 1hr TOWN OF BARNSTABLE LOCATION /- y U,/ f- S S Tr SEWAGE 03GI VILLAGE O S re k V Il! • ,p ASSESSOR'S MAP & LOT 1306 INSTALLER'S NAME&PHONE N0, / /Yl A C a e.R— S v N SEPTIC TANK CAPACC A 0 LEACHING FACQ.ITY:.(type) S- a 9 T t I,eICS'(size) �-d NO. OF BEDROOMS BUILDER OR OWNER PERMITDATE: f 0. COMPLIANCE DATE: Separation Distance Betwct�'the: Maximum Adjusted Ground"taf Table to the.Bottorn of Leaching Facility Feet Private Water Supply Wel! 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 i within 300 feet of leaching facility) Feet Furnished by r - �\ L 6 abed xe� dH LUM 6lOZ L 6 lnf Commonwealth of Massachusetts Title 5 Official Inspection Form d Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 124 West Street Property Address Stephen Pellegrino Owner Owners Name Information is required for every Ostervi Ile. MA 02655 7-12-19 page. City/Tov m State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to thigh ground water: feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record k If checked,date of design plan reviewed: pate ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: on File W/BoH. ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: 12'+ no G.W.. Bottom of chamber's at 20" below grade. Bottom of chamber's at 10'+above T.H. Depth Before filing this Inspection Report, please see Report Completeness Checklist on next page. 15insp.doc-rev.M61018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18 86 a6ed xeJ dH 80:06 660E L6 IT Commonwealth of Massachusetts Title 5 Official Inspection Form r Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 124 West Street Property Address Stephen Pellegrino Owner Owner's Name Information Is Osterville MA 02655 7-12-19 required for every page. Cityfrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information:Complete all fields,in this section. ® B. Certification: Signed & Dated and 1, 2, 3,or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6(Checklist)completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth.to high groundwater included so d OIti I' ,jL XAcpnvr o t5lnsp.doc-rev.7126/2018 Tile 5 OfBda(Inspection Form:Subsurface Sewage Olsposal System•Page 18 of 18 61, a13ed xed dH 80:06 660Z Ll, lnr 8e.e endoASSE, ."..Ii - 1 - `r ` -.. j'.`y �IR�� c•.a i... 1 �7' itCJ �i3t}h�r 4$ . t•.. ,, mow•` , •tf\' �"!,• AM O-RS REF ® Re—bar w/cap ifth (40' wide - Private way) \ 1 � t O CB/OH (root Constructed) _ ,_ -` Map 139, Parcel 065 ..E E�`t 4 :�, ., .,j ® Water N '"' QM� - -'r 4Avenuv ' 3 Gate (round) t crk a Gas Gate - N65 28'10"E 164.99 - � a ® ZONE. tsnAa La rG , ier Catch Basin : e -m Guy RF-1 -0" Utility Pole Area (min: 87,120 SF nn Utility Hand Hole Fron to e (min) 20' G Underground Utility Line o / ` HI m Width tn 125 "w` = m ' o Setbacks: ] �s Front 30 .. o Side 15' �o_ N: Approx septic Z,� Rear 15 Location IVIe"��System As Per row BDH OVERLAY D/ST1C7`o 1"-2.Oo0f' aw o AP - Aquifer Protection. District � w, FLOOD ZONE c "&7 n1a Ao ProposedZone X •o` . . .\. . . . . . . . . . . . . . . . . . Based on Map #c sr, osure. \ . . . . . . . :. . . . . . . . . . . . . . . . � 25001 C0562J a°� m c C -- Ce 16, 2014 ' 1' Fen �. July Proposed fool o ent o _j oWC rzuREVX as.s LH tit ° RQX4®, t y i i a s UO_30 21 o Garage i 1 fy Parcel Area 43,500f SF i y 4I:8' i Stone 1 � Note: i Drive 30.7' ' s►�ee i W 1.) The property line information shown was S65'28'10"UV 27009� '__ __ --' compiled from available record information. �, �s2•� 345.09' 2.) The structure locations were obtained from Stone ; ' 1\ an on the ground survey performed on �. or between 221JUL119 and 25/JUL/19. POment Edge Fourth, Pavamenr Edae 3.) The datum used is NAVD '88, a fixed mean (40' Wlde — Private Vlay) venuvsea level datum. O 15 30 45 60 FEET Sheet # Title: Plan Swing Proposed Pool repare or: Notes Revisions: Scale: Ccoapeo"' ur See Above C515_17g1. �g r�,g W��® # Doug & Sue Yearley Date: i"=30' of f 1 Gam° West Street 23 West Bay le MASuite 02655 9 y �V rest 'is,9(Osterville) ass- (5W)420--3994(503)�� fax 08/OCT 19 -_"- 5" DIA. OUTLET(S) FINISH GRADE OVER CHAMBERS = 95.50' - 96.10' GENERAL NOTES TOP OF FOUNDATION = 98.5' REMOVABLE CONCRETE COVER SLOPE @ 2% MIN. OVER SYSTEM 1. UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION TO WITHIN 6"OF FINISHED GRADE 4"SCHEDULE 40 PVC MIN SLOPE 1% 3/4"TO 1-1/2" DOUBLE WASHED STONE TO CROWN OF PIPE METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVFINISHED GRADE � 0� FINISH GRADE OVER D-BOX- 95.50' DE AND ANY APPLICABLE LOCAL RULES. RONMENTAL @ FOUNDATION = 97.03 FINISH GRAD E OVER TANK EL.= 96.5 2"OF 1/8"TO 1/2" DOUBLE WASHED STONE 2. ANYICHHANGES TO TOHIIS PLAN MUST BE APPROVED BY THE BOARD - __ - _ _ � OF HEALTH AND THE DESIGN ENGINEER. 20" MIN. ACCESS COVER PLACE RISERS ON ALL CHAMBERS 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL (TYPICAL FOR 3) 36"MAX. 9"MIN. TOP OF SAS = 94.33 TO 6"OF FINISHED GRADE BE USED IN DISPOSAL SYSTEM UNLESS OTHERWISE NOTED. 93.5 36" MAX. BREAKOUT EL = 94.0' 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN PROPOSED 4" ELEVATION =94.00' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS SCHEDULE 40 PVC OF MIN. 46- 3" 2� DROP MIN. 3" g" - PROVIDE �pTERTIGHT A 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S. AND THE TOP 0 o THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. -- 3 DROP MAX. ( ) - 4" PVC IN FROM O o000 O o0 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. 14" 94.40' SEPTIC TANK 4" PVC OUT TO o0 o Gb o 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. 94.65' 10LEACHING FACILITY oo 0 0 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO 9S 0C�l 0o BACK FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR - 95.25 94.17' MIN. 94.00' 2 o o o INSPECTION. SYSTEM IS NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING 48" OUTLET TEE " o 00 o APPROVAL FROM BOARD OF HEALTH AND DESIGN ENGINEER. 16.2' " R 6 CRUSHED STONE oo _ 8. ELEVATIONS BASED ON ASSUMED DATUM OF 100.00 MSL OBTAINED 22 ZABEL FILTE OVER MECHANICALLY MODEL#A1801 HIP(GAS COMPACTED BASE 3.75' I 3.75' 4 0, 4 0� FROM A TOP HYDRANT SPINDLE AS SHOWN ON PLAN. BAFFLE ON BOTTOM) 8.5� 4.9' 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION 5 OUTLET DISTRIBUTION BOX 50.0' (NP•) THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE TO BE INSTALLED ON A LEVEL STABLE GROUND WATER ELEV.= < 86.09� AT 1-888-DIG-SAFE AND,ANY OTHER APPLICABLE AGENCIES. REPORT ANY FIRST TWO FEET OF OUTLET 91 .5 12.9' DISCREPANCIES TO THE DESIGN ENGINEER. BASE. PROPOSED 1500 GALLON CONCRETE SEPTIC TANK PIPES BE LAID LEVEL. 5 - 5OO GAL. CHAMBERS 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONCRETE LENGTHI 10.5' WIDTH 5.66' DEPTH 5.58' 5' MIN. STRUCTURES SHALL BE MADE WATERTIGHT. CROSS SECTION VIEW TYPICAL CHAMBER PROFILE CHAMBER DETAILS CHAMBER END VIEW DETAIL 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR SEPTIC TANK PROFILE DISTRIBUTION BOX ZONING REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH NOT TO SCALE NOT TO SCALE NOT TO SCALE DETERMINATION FROM APPROPRIATE AUTHORITY. - - - -- _ _ 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING -- - - - - _ - - - - - - .r Ea 8 t l TEST BIT DATALOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE • * 0 � THEY SHALL WITHSTAND H-20 LOADING. • • r + a,l• ' AGENT: Unwitnessed 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND �+ . + •• • FINES. 3 • . % ''� R� EVALUATOR: Samuel Philos Jensen P�`' • • • • . • • �' ,, ;;r DATE: November 7, 2003 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND v-(l • + * + s + • �✓ UNSUITABLE MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF �� ♦ TEST PIT#: 1 F�� E��O • ,� • aN *, LEACHING FACILITY. REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN ��N�� ► ; + • II + •r ELEV TOP - 96.09 COARSE SAND FREE FROM CLAY, FINES OR OTHER UNSUITABLE MATERIAL IN l4 .. • • . • " ++ • • ACCORDANCE WITH 310 CMR 15.255(3). �/• * . • • • •• ELEV WATER= <86.09' -� CB FND,HELD / / ° aZg� '•�� • •• ' + • 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN ( ) / / N65 2 g9 �� oU't : • • • : ` • • • •; PERC RATE _ <2 Min/In SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. MAP 139 - �e + • • • • + •� U Qo 16. PROPOSED PROJECT IS LOCATED WITHIN: PARCEL 93 • ! .• • DEPTH OF PERC= 33"-51" Neck �� + ASSESSORS MAP 139 PARCEL 65 , l 1I N/F DAY _ 6 0 . •+ • • TEXTURAL CLASS: 1 OWNER OF RECORD: STEVEN PELLIGRINO 10 9�� / - = •' 0 96.09' ADDRESS: 66 BEACON STREET Cv / / �, MAP 139 �� A any Loam BOSTON, MA 02108 V. / � PARCEL 65 Se��' • 8" 95.42 FEMA FLOOD ZONE C W I 95 V / 43,508 S.F.± ' ',`� • ' B Sand Loam AS SHOWN ON COMMUNITY PANEL# 250278 0045C / ,,� 4 I �� \ �� kT O ' " 10Y 6/8 17. PLAN REFERENCE:" B (FND,HELD� �� 8 .�_ •• +• 0 29 93.6T 1. PLAN TITLED PLAN OF LAND IN WIANNO, OSTERVILLE, MASS BELONGING TO FRANK A. EXISTING LEACHING PIT i \ ` � , Jf; -' � • '�► C-1 " DAY JR. & DANIEL BROS. INC."SCALED 40 FEET TO 1 INCH AND DATED FEBRUARY 27, 1964. i ��p 33 Medium Sand 93 34 q� TO BE PUMPED AND ZONE B - f � Perc 2.5Y 7/g PLAN BOOK 186 PAGE 123. FILLED WITH CLEAN SAND \ \ \ ti SOS, \ • 48" c= 92.09' . 91.84' 18. DEED REFERENCE: 1 \96 $g.2 ZONE C 51" 1. DEED BOOK 145-) PAGE 657 EXISTING 1000 GALLON i E 1 • 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. Q 1� �� 4 ti� Medium Sand SEPTIC TANK TO BE I O �� _,� 2 5Y 7/4 LY.APPROXIMATE. THIS PLAN IS TO RE LISED ONLY PUMPED AND FILLED \ i �' \ '. O PROPOSED N�� ,/� • U 20. PROPERTY LINE INFORMATION IS ON WITH CLEAN SAND ° MAP 139 " r '� , 'Y FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY \ DISTRIBUTION BOk r'oo uj FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. ALSO, BOTTOM TO BE ( \ PARCEL 64 PUNCTURED M I PROPOSED 5-500 GALLON po o ACCORDANCE WITH ' \ LP / i4 LEACHING CHAMBERS C-2 � N/FOLD � TITLE V--- PROPOSED 1500 _ 3) x GALLON SEPTIC TANK LOCUS PLAN a ® � / O •' -'/ Weeping Groundwater, or Mottling N l x� SCALE: 1" = 1000' 120„ Observed 86.09' LO LEGEND DESIGN DATA HC f - - 50 - - EXISTING CONTOUR I Tic Eir1c ' c _eiric \ \98 \ 50 PROPOSED SPOT GRADES I �g3 I HC 1 PROPOSED CONTOUR NUMBER OF BEDROOMS (ASSESSORS) 3 a / EXISTING f NUMBER OF BEDROOMS DESIGN 6 E/T/C EXISTING UNDERGROUND UTILITIES O \ /cv ' s J 3-BEDROOM / \ DESIGN FLOW 110 GAUDAY/BEDROOM DWELLING r TOTAL DESIGN FLOW 660 GAUDAY EXISTING WATERLINE �1 _ / 1 DESIGN FLOW X 200 % = 1320 GAUDAY �( ------- n wl �/ w TOF =98.5 PATIO / �9g` USE PROPOSED 1500-GALLON SEPTIC TANK GAS EXISTING GASLINE / I / w EXISTING �f / / a?/ JNDERGg0UND / \� TEST PIT LOCATION W c� i1i UTILITIES \� W :D I �� o 0 i \ / \� INSTALL 5 - 500 GAL. CHAMBERS O t0 O PROPOSED 1500 GALLON SEPTIC TANK C0 J XISTING / f 4"SOLID SCHEDULE 40 PVC PIPE ow I / AS LINE u) SIDEWALL CAPACITY ❑ DISTRIBUTION BOX i \ EXISTING X��C�X - ^•:' TER UNE X�X , " (LENGTH +WIDTH)(2) (2 HIGH) (.74 GPD/S.F.) = GAUDAY ® 500 GAL. LEACHING CHAMBER (50' + 12.9') (2)(2') (.74 GPD/S.F.)= 186.2 GAUDAY I �S X'X� 20 / ' BOTTOM CAPACITY (LENGTH x WIDTH) (.74 GPD/S.F.) (50'x 12.9') (.74 GPD/S.F.) = 477.3 GAUDAY REV. DATE BY APP'D. DESCRIPTION / B.M. \ / I Hydrant Spindle - N� PROPOSED SEPTIC SYSTEM UPGRADE Elev= 100.00' \ ,Q JAM TOTALS: PREPARED FOR: Assumed , \�� /�OF by 3,0 ECG TOTAL NUMBER OF CHAMBERS: 5 STEVEN PELLIGRINO TOTAL LEACHING AREA: 896.6 SQ.FT. DESCRIPTION HC 1 HC 2 TOTAL LEACHING CAPACITY: 663.5 GALJDAY LOCATED AT SEPTIC COVER IN (1) 34.3' 24.9' 124 WEST STREET i y I / SEPTIC COVER OUT(2) 40.7' 29.9, RESERVED FOR BOARD OF HEALTH USE BARNSTABLE, MA 02655 �.� P`��• CORNER LEACHING (3) 57.5' 23.5' -- - SCALE: 1 INCH = 20 FT. DATE: DECEMBER 31, 2003 �N l CORNER LEACHING (4) 70.1' 34.71 ----- --- ---------- ------- -- 0 10 20 40 80 FEET Ov r✓''„of I FO �OE� CORNER LEACHING (5) 78.5' 71.6 `sue / leg� PREPARED BY: CORNER LEACHING (6) 67.5' 66.9' ` JC ENGINEERING, INC. ^+ �• •�� 2854 CRANBERRY HIGHWAY 's-Te\ EAST WAREHAM, MA 02538 508.273.0377 - - - - SITE PLAN 12I3)103 Drawn By: DS Designed By:DS Checked By:JLC JOB No.569 SCALE: 1"=20'