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0046 CHIPPINGSTONE ROAD - Health
46 Chippingstone Road Marstons Mills A= 027 - 043 1 i ASSESSORS MAP NO: g j PARCEL N0: NO.---------------- Fee----------`-°=�--11 BOARD OF HEALTH TOWN OF BARNSTABLE Applicat ion Ar Veil C ongtruct ion Permit Application is�fhereby made for a permit to Construct ( ), Alter ( ), or Repair (Vjan individual Well at: —AA =— --— Location — Address Assessors Map and Parcel Owner Address -- 4J-} ------------ Installer — Driller Address Type of Building Dwelling-- "= -e--- --------------------------------------------- Other - Type of Building------------------------------ No. of Type of Well --- Purpose of Well--Qn� esc---w -�% ------------ Agreement: The undersigned agrees to install the aforedescribed 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 C rtifi ate .of Compliance has been issued by the Board of Health. Signed — — --- - r 21 --- date Application Approved — � Y' - - a 4 " date Application Disapproved for the following reasons:--------------_____—_—_--____ _ --_ ------------ - --- -------------------------------------- ! �} date Permit No. fp ` v _-- Issued date BOARD OF HEALTH ASSESSORS MAP NO: TOWN OF BARNSTLLV C ertif icate ®f Compliance THIS IS TO CERTIFY, That the Individual Well Constructed (g ), Altered ( ), or Repaired ( zy by-- --D A Seicw�e ��-- — — ------------ - -------------------------- Installer at__t1 G i �� 4 r s�� P ✓li n1 tM ----___--- -- --_-_--- -- 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 Dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE------ - - Inspector-- ------ -- —----- - - - - - - _- - - - - - -� No.-A�--------- Fee-----�---' 1 BOARD OF HEALTH 1 TOWN OF BARNSTA,i%T�� k AppticationArVe1[ Con0ructionA9ermit• Application is hereby made for a permit to Construct ( ), Alter.( ), or Repair (pjan individual Well at: Location - Address �-—-- —�— —-- — — Assessors Map and Parcel Owner T— Addresscl — — Installer — Driller �, ' Address Type of Building Dwelling -Xl. e-- - l Other - Type of Building------------I No. of Persons---—----------______—__— 1 Type of Well!L loJ ---- -- ----— - Capacity---- -- ---——--- Purpose of Weil--- Agreement: ! The undersigned agrees to install the.aforedescribed individual well in accordance with the provisions of The { Town of B e oar of Health Private Well Proteet-ioa•-Re-gelation dersi ned further agrees not to place the well in.operation until a C mate .of Compliance has been issued by the Board of Mt .--- Hea J Signed I —C— ---- date Application Approved. yr-- _ r-— date f Application Disapproved for:the following reasons: date.--^--- Permit No. Issued---- L ---- _ date i�:roe:awl:+iea.sae�da�a.+a•fav:s�e:e:eas�t:x+t a±a.q +oce�•±alasasatas.�s±a�aesassa4.sseasaga.wlwlsvaaelrasa+±++sessassse,r+c*ao..,litalalescewasa+clarsslalaeaaazea!a�•+.+e-±os�+j BOARD OF HEALTH TOWN O•F BARNSTABLE Certificate ®f Compharice THIS IS TO CERTIFY; That the Individual Well Constructed Altered ( )", or Repaired ( 4,Y ----------- ------------------------- Installer c , 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 THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE Inspector— �!i�.sY:i±8�lai±iu�?!'iti±aTfiT8li3i±ita9ila3W!i�Y±Yima4iYi^i!L'!aTitsa!iG.i'!lYilY�!itiTalMi±tllF.e.�i4ili±,Y,IY?i4Gti¢6liRYV!i?i!Efliw�6±lrAiTrYa�'!i4°Yisle�alb�'i4a�8P3�a+.:�iisYi±��- j BOARD OF HEALTH TOWN OF B A R N S T NRJM9MAP NO: Well (ConstructIonperttjl ARCEINo: No. Fee� k -mot ASSESSORS MAP NO' Permission is hereby granted PARCEL __--_— to Construct ( ); Alte ( ), or,Repair ( �an Individual Well at: No. 4/1 C �1 PoA . s , /l J .. Street as shown on the piplication for a Well Construction Permit ' No.'- P ----=- Dated—� _`�/ �' 9. - ---------- l� /,� Board of Health DATE — C 1 i I Commonwealth of Massachusetts . Title 5 Official 'I nspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 46 Chipplingstone Rd Qp Property Address Wendy Higgins .„4 Owner Owner's Name �} information is ✓ v required for every Marstons Mills MA 02648 2-15-16 page. City/Town State Zip Code Date of Inspection ..A7 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. A. General Information 1. Inspector:' Shawri Mcelroy Name of Inspector Upper Cape Septic Services Company Name P.O. Box 73 Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S 13971 Telephone Number License Number B. Certification , I certify that I have personally inspected the sewage disposal system'at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 2-15-16 Inspector'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 is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3113 TMe 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 pw VS Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not.for Voluntary Assessments ae 46 Chippingstone Rd Property Address Wendy Higgins Owner .M': Owner's Name information Marstons Mills MA 02648 2-15-16 required for:e'very page. ;:ill City/Town State Zip Code Date of Inspection B. Certification (cunt.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: , Y ® 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: , System is in good working order with no sign of failure. { 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 f the Board of Health,will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments. 46 Chippingstone Rd Property Address Wendy Higgins Owner Owner's Name information is required for every Marstons Mills MA 02648 2-15-16 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational.System will pass with Board of Health approval if pumps/alarms are repaired: B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑. N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ' ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: 0 ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 46 Chippingstone Rd Property Address Wendy Higgins Owner Owner's Name information is required for every Marstons Mills MA 02648 2-15-16 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System-will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: r ❑ 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. i ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less_than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: , r D) System Failure Criteria Applicable to All Systems: You must indicate "Yes"or"No"to each of the following for all inspections: Yes No ` ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of`effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M Sy0 y 46 Chippingstone Rd Property Address Wendy Higgins Owner Owner's Name information is required for every Marstons Mills MA 02648 2-15-16 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ 1z Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinkingwatersupply ❑ ❑ the system is within 200 feet of�a tributary to a surface drinking water supply ❑ ❑ i, the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the'system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection,,Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 46 Chippingstone Rd Property Address Wendy Higgins Owner Owner's Name information is required for every Marstons Mills MA 02648 2-15-16 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any'of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large avolumes 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) I` ® ❑ 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)] D. System Information. Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for.example: 110 gpd x#of bedrooms): 330 , t5ins•3f13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts w . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 46 Chippingstone Rd Property Address Wendy Higgins Owner Owner's Name information is required for every Marstons Mills MA 02648 2-15-16 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 3 Does residence have a rinder? Yes No garbage 9 ❑ Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): Well Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 2-2016 Date Commercial/industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: 15ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 46 Chippingstone Rd r Property Address Wendy Higgins Owner Owner's Name information is required for every Marstons Mills MA 02648 2-15-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Owner--pumped 1-2016 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Maintenance 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 ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts { Title 5 Official Inspection, Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 46 Chippingstone Rd Property Address Wendy Higgins Owner Owner's Name information is required for every Marstons Mills MA 02648 2-15-16 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 2011 Were sewage g odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): ,. Depth below grace: 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.): Good condition. Septic Tank(locate on site plan): Depth below grade: 14"feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gal Sludge depth: 4" t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts _ I Official -inspection W Title 5 0 c al ect I s o Fo rm p R Subsurface Sewage Disposal System Form -Not for Voluntary Assessments , 46 Chippingstone Rd Property Address Wendy Higgins Owner Owner's Name information is required for every Marstons Mills MA 02648 2-15-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) _. Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 28" Scum thickness 0 F Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? Tape 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 is in good condition with baffles installed and no sign of leakage. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date' t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 46 Chippingstone Rd Property Address Wendy Higgins Owner Owner's Name information is required for every Marstons Mills MA 02648 2-15-16 page. Cfty/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in worldng order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-3/13 Title 5Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M , 46 Chippingstone Rd Property Address Wendy Higgins Owner Owner's Name information is required for every Marstons Mills MA 02648 2-15-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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.): Good condition with water at working level and no sign of back-up from chambers. Pump Chamber(locate on site plan): working in Pumps Yes No* 9 order: ❑ El Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 12 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 'V PP� 9 46 Chi in stone Rd M 5 Property Address Wendy Higgins Owner Owner's Name information is required for every Marstons Mills MA 02648 2-15-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 2-500's ❑ leaching galleries number. ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation,etc.): Leach chambers in good condition and empty at inspection with no visible stain lines. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -.Not for Voluntary Assessments 46 ChiPP 9 in stone Rd Property Address Wendy Higgins Owner Owner's Name information is required for every Marstons Mills MA 02648 2-15-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 1 Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 46 Chippingstone Rd Property Address Wendy Higgins Owner Owner's Name information is required for every Marstons Mills MA 02648 2-15-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately f ^ t 1 �,j Vol 5.3 ' t5ins•W3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official .Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 46 Chippingstone Rd Property Address Wendy Higgins Owner Owner's Name information is required for every Marstons Mills - MA 02648 2-15-16 ' page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 12' feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: ® Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database- explain: You must describe how you established the high ground water elevation: Original design plans show no groundwater at 12'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 46 Chippingstone Rd j Property Address Wendy Higgins Owner Owner's Name information is required for every Marstons Mills MA 02648 2-15-16 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file i t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Town of Barnstable` Barnstable p THE Tp P Regulatory Services Department jmica Ci RAR,NS, BLE,M } ,GS a Public Health Division 9�ATfD 39 t a��� 200 Main Street, Hyannis MA 02601 2007 �! Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 O�T _v�/3 Thomas A.McKean,CHO CERTIFIED MAIL# 7006 0810 0000 3525 5644 July 26, 2011 Carol Sweeney 46 Chippingstone Road Marstons Mills, MA 02648 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at, 46 Chippingstone Street, Marstons Mills,MA. was last inspected on 7/12/2011 by Ricky L. Wright, certified septic inspector for the State of Massachusetts. According to the private septic system inspector, the system "Fails" due to the following: • Back up of sewage into facility or system component due to overloaded or clogged SAS. You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period may result in future enforcement action PER ORDER OF THE BOARD OF HEALTH w o as c ean, R.S., CHO Agent of the Board of Health fly all 1 Q:\SEPTIC\Letters Septic Inspection Failures\1-1 SAMPLE 60 Day Deadline.doc { 9 \, 440 I4 i W Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 46 Chippingstone Road Property Address Carol Sweeney Owner Owner's Name information is Marston Mills Ma 02648 7/12/11 required for every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms on the computer, I use only the tab 1. Inspector: - key to move your cursor-do not Ricky L. Wright use the return Name of Inspector _key. B & B Excavation, Inc. ras Company Name 14 Teaberry Lane Company Address _ u j Sandwich MA 02563 City/Town State Zip Code 508�477-0653 S14595 .� Telephone Number License Number B. Certification o 1,certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority 7/12/11 Inspector'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 is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. f� 1 t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Dispos System-Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 46 Chippingstone Road Property Address Carol Sweeney Owner Owner's Name information is required for every Marston Mills Ma 02648 7/12/11 page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E%always complete all of Section D A) System Passes: ❑ 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: i B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 46 Chippingstone Road Property Address Carol Sweeney Owner Owner's Name information is required for every Marston Mills Ma 02648 7/12/11 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 46 Chippingstone Road Property Address Carol Sweeney Owner Owner's Name information is required for every Marston Mills Ma 02648 7/12/11 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: I ** This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate.nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 46 Chippingstone Road Property Address Carol Sweeney Owner Owner's Name information is required for every Marston Mills Ma 02648 7/12/11 page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 46 Chippingstone Road Property Address Carol Sweeney Owner Owner's Name information is required for every Marston Mills Ma 02648 7/12/11 page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® 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)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 46 Chippingstone Road Property Address Carol Sweeney Owner Owner's Name information is required for every Marston Mills Ma 02648 7/12/11 page. City/Town State Zip Code Date.of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage d n/a 9 ( Y 9 (gP ))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: October 2010 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 46 Chippingstone Road Property Address Carol Sweeney Owner Owners Name information is required for every Marston Mills Ma 02648 7/12/11 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® 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 ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 46 Chippingstone Road Property Address Carol Sweeney Owner Owner's Name information is required for every Marston Mills Ma 02648 7/12/11 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 12/22/1982 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2 feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: >20feet Comments(on condition of joints, venting, evidence of leakage, etc.): At time of inspection building sewer appeared to be in good shape no signs of leakage or blockage. Septic Tank(locate on site plan): Depth below grade: 1 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: 5.2x5.2x8.6 Sludge depth: 6" t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 46 Chippingstone Road Property Address Carol Sweeney Owner Owner's Name information is required for every Marston Mills Ma 02648 7/12/11 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 30" Scum thickness 4„ Distance from top of scum to top of outlet tee or baffle 3" Distance from bottom of scum to bottom of outlet tee or baffle 13" How were dimensions determined? scour stick Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): At time of inspection tank appeared to be in good working order however the concrete baffel was starting to deterate. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 46 Chippingstone Road Property Address Carol Sweeney Owner Owner's Name information is required for every Marston Mills Ma 02648 7/12/11 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for.Voluntary Assessments 46 Chippingstone Road Property Address Carol Sweeney Owner Owner's Name information is Marston Mills Ma 02648 required for every 7/12/11 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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 appeared to be deteriorated .Solid carry over was present in d-box and there were also roots growing in. Pu mp Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: l5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments C4M s 46 Chippingstone Road Property Address Carol Sweeney Owner Owner's Name information is required for every Marston Mills Ma 02648 7/12/11 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): At time of inspection leaching appeared to show sign of solids due to hydraulic failure at on time. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form rS o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 46 Chippingstone Road Property Address Carol Sweeney Owner Owner's Name information is Marston Mills Ma 02648 7/12/11 required for every � page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal.System•Page 14 of 17 Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 46 Chippingstone Road Property Address Carol Sweeney Owner Owners Name information is required for every Marston Mills Ma 02648 7/12/11 page. City[Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 f I enter feet. Locate where public water supply y s the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately i O 2 A 8► _ lktlo U'z= B2; 1g'(a Q3 = 5 / ' a 3 zq '(o i t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 I • Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 46 Chippingstone Road Property Address Carol Sweeney Owner Owner's Name information is required for every Marston Mills Ma 02648 7/12/11 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: >12 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 v Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 46 Chippingstone Road Property Address Carol Sweeney Owner Owner's Name information is required for every Marston Mills Ma 02648 7/12/11 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist Z. Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 TQWWi C B asTABLE Id}trR'tIOI�d SEWAGE# VIU.AGE _ ASSESS.O.WS'NIAPALOT I�iS'Ip,LI.E$Z'S Fd�&THOME N., SEMC T'A-N CAPACITY i.EACFI�AiG.FAC�':(2yp^) NO QF BMmkQoms PE R�T�3ATB. ` _ CC1 PLf C DAM Saparatton ljtstance BL" en tha MaxunumAd ustetlGaour�dv�aW.. afi eto tf eBottom ofLe�cfiing)~aai�ty. fee€ Fnvate Water Supply WeR "d Leg g Fsa�ty apy we, exist bit sate or within 3.E}Q het of ler, ag faci�uty) eet Edgy of W band end Leaching a'?atY(ff SAY Wet' exist within 3Qt}f t f iew ng t Fust:shecI by CfR "z 9 , r i • t� TOWN OF BARNSTABLE LOCATION SEWAGE# 2011 VILLAGE lr1, !na )15 ASSESSOR'S MAP&PARCEL ,�`J - Y3 INSTALLER'S NAME&PHONE NO. B`4, Q L XCc►ycL4 i 0e% Y17-OG S3 SEPTIC TANK CAPACITY 100090.1 LEACHING FACILITY: (type) _SbOgnj zAamS (2)(size) 13 x 2S X 7- NO.OF BEDROOMS 3 OWNER PERMIT DATE: $ 9 -/1 COMPLIANCE DATE: ' I 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 A!- .Bi • �g' AZ• yo,b" 71 sz- 11 8" A3- $I 83• 53' A4• 93' aq-55' 13 © Qz 3 No. e��` THE COMMONWEALTH OF MASSACHUSETTS FEE BOARD OF HEALTH cotip wn— of earf)s fal l - APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct ( ) Repair ( ) Upgrade ( ) Abandon ( ) - [:]Complete System ❑Individual Components ep Ca rra 1eQ)RP17Q1 - Owner'wo e Map/Parcel# 4 I#-` g phone# 1 ` Inst esigndr's e �Qb l Z R`47 7 _ _ Address , Tress Telep one# �1/P J vy Te�lephone# Type of Building: Mf Lot Size Sq.feet Dwelling—No.of Bedrooms Garbage Grinder ( ) Other—Type of Building No.of persons Showers ( ), Cafeteria ( ) Other fixtures Design Flow(m'n.re it d) gpd Calculated design flower gpd Design flow provided 3 gpd Plan: Date T Number of sheets Revision Date Title T1 5 Description of Soil(s) Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of 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. Signed Date —8 Inspections ovxtxAlf- tP �^ , ! FORM t - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 �...,�i.... .r:'= t��..7Ab. � .. �•�'..i..,.7YT'3'�fg 9 .. ...,,',.„y�+�Mr�1:r'„^i•>',..F�MM`�i.`.ra� �e'�r�^in°'-`ro"�A".+..�.�-.'T '1.'v."./''7�,�1C'1r„r -.r=.,�Y r�'1['....r..,,,. \.._ _ - I � p r No. y ©" � � THE COMMONWEALTH OF MASSACHUSETTS FEE ;N BOARD OF HEALTH Cetip .. OF eo(ostcc.��A APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct.( ) Repair ( ) Upgrade ( ) Abandon ( ) - ❑Complete System ❑Individual Components i 6 C lopinc�A5-hone eD -Carol e ' of 2 )epeo I # ✓ 1 ( W,�,A .-D 44 f 1./me_�p ✓'�'�--+ Map/Parcel# �� —/{& lS� _ J , 7 I / +r Q ` (Q r n Sts.g°--Q _ 3 jr�LIns'iIl 7dd ydress l l Telephone# Telephone# i Type of Building: -es ��D(1 Lot Size Sq.feet Dwelling—No.of Bedrooms - Garbage Grinder ( ) Other—Type of Building No.of persons Showers ( ), Cafeteria ( ) Other fixtures -� q Design Flow(m' .,rela rld) a gpd Calculated design flow 1 gpd Design flow provided 3LI7 gpd Plan: Date Number of sheets Revision Date Title Description of Soil(s) , Soil Evaluator Form No. Name of Soil Evaluator k01-P.0 10 10 Date of Evaluation J - DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees not to place the system in operation until a Certificate of Compliance has beren issued by the Board of Health. Signed 0 Date 1 1 Inspections l FORM I - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 r — .-,,v—-------..——-., —— —--——-s,——————r-.— No. go N d 7o E COMMONWEALTH OF MASSACHUSETTS FEE a«isiab(V- BOARD OF HEALTH CERTIFICATE OF COMPLIANCE Description of Work: Individual Com onent s p ❑ p ( ) ❑Complete System The undersigned hereby certify that the Sewage Disposal System,Constructed( ),Repaired ),Upgraded( ),Abandoned( ) 1i�y: 1-l R, l ( _ V o i v has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to(application No.&«-91 dated -`1' f Approved Design Flow _(gpd) 3 9 IL InstallehP.�z.T Designer:' bu) Q_ `n Inspector ate y The issuance of this certificate shall not be construed as a guarantee that the system will function as designed. FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96 No," _ THE COMMONWEALTH OF MASSACHUSETTS FEE 1 v v BOARD OF HEALTH DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to Construct ) Repair ( ) Upgrade ( ) Abandon ( ) an individual sewage disposal system at 'i & C h I C)Di n ss ,/T h P as described in the application for Disposal System Construction Permit No. 1 � dated g- (q"'l Provided: Construction shall be completed within three years of the date of this permit. local conditio' s mu t be met. Date 1 1 Board of Health (.,`� <\ P 9 \ � FORM 2 - DSCP DEP APPROVED FORM 5/96 V FORM 1255 (REV 5/96) H&W HOBBS&WARREN'" PUBLISHERS- BOSTON FROM :down cape engineering inc FAX NO. :15083629880 Aug. 16 2011 10:49AM P1 -, is�TK,11( a1 Ir w ° ��� ��,� H `�'1s��r�n.;�g ilr', ��,c.aY�.�,�'ILR'cF.n„liuli�• 'Thomas as Wx can, tlhll iL.G.".Il:a y _ '.Qb�i�'if�ov��6�,4n•�t?0:.,,r-1l�;,nimi�nnra,tYII.,�QII'➢rfuQV� Of'inP: .508 Vb`!-4644 �uaat.a�l<ila:r< ��r Nay,®,r7runa:a� �..�.�9.ui(�ll��Ullll�37U�..11+'�uu��rn ]t�aa�.�: � �� j� �yw.�r�����'��'iw�ia�:ir' ������� ...�„��:gcaau�•"ra I�,�i:v��IIF';����-mi!_�1 r , gQ �} II➢�c:�n;�uur�il•� � 0vt1v� _ � °P_.,�� l�nnwtt�n�.11a�u:: VJ�� ����i/a. (�'"`� .�.ail�ln•�;�5: c� _-A.J'1 t. ._ ,'�c#l�dE>I�a�wgp: I/ �•P.,A.U�`n _ Ot.t __ ws i;;;;uwd a permit Lo Wll segata.c�sysf.c:aa. �.�..'. . -t .-.. eased r»} a dr-. gn d WNU l�ty (dc.$'civt—S) , r (deli,ic;r) l r..erti.iq' Lit the S(.P& ;ysta:M referelictd above was W.'%allod. s-tab3t,T)6.i11.y itr•c'oi'a�;i17.IJ tag vvlucs:L't.iiiay inolud4.LuiuorapgcoyEci G`fiange,s Midi as la'OMI relocation of-the distribot.4)n box alic9/ol'^eptic ladle. I. certi..(y that the abov_, was 1Lrtralltd witli l:nnjor chari.gus giea:tl;a- tllaij. IV, .latual r:,,luratioaa of t1it-, .r; ol- ably nrtical.rcl«utvfiou of a.l_ry cc'anr uv.tnt of thc septic iiy;-Acc.Lu) belt i-n.,.uscordanuc with ` tafP & Local Rc-gulrstion.s. Plaa r:,vi;:ioii u.r cel ific r].as bu.Jt by tit si^IJ(:L to fol.lnw. DANIRLA. QJALA N . (.4)1;1.ctll�iT'S J:i(';Jlrl'LI.IYr'�) CIVIL No,46502 w S/ONAL ([➢E;si�;.L?ea'a ( luu `,i. iiafcli'e) f)c,.,cgaxei „ttutt�.l Hti.r:;) ° �r�; ; C —T_a� 1��AILF fiUF�L�a� .1Jj A.��1 1fi _.D1`�II;f:'s C ICI._ - -- --way,- ti,4yTWFQ��1-,Ta='>r Vaal,i:, 1`JfA7iii ij_Nt, r�4D>r9m CIAD ATa nn--UL III.A,��l"T7�TAXL.u_ll°1fM7>fLj7.,ALrR'H ANE."�211... (} iir.,llli7°,ni,t1.C/Llnstu�r.,r Cc-iilt1C3tioa Fora, Towu of Barnstable P#— • �iRE rbr IDepartznMit of Regulatory Services Public Health Division ]date 9 200 Idlain Street,Hyannis MA 02601 • �PtU p,4A'1� Date Scheduled_ Tune_ [+te Pd. vv' Soil Suitability Assessmentfor S S-e �Di=ost - 11crYonned➢y; Witnessed By: LO CA 7CIO & ]GNEI RJG INFORMATION Location Address /// 1 Owner's Name fA Address Assessor's Map/Parcel: '�!�/[l� Engineer's Namc JQ (A) fd_. LL�CrLD�J� NEW CONSTRUCTION 7 REPAIR Telephone It (�}� 2� Land.Use Ate lrl-dei Slopes(4'0) Surface stones ,✓a "�C. Distance's from: Open Water Body Al R Possible Wel Areq /�� fl Drinking Water Well tt Drainage Way Ft Property Line / ft Other " ft � SKETCH, (Street name,dlmensi s of lot,exact locatio ns off lest holes&pert sts, locate wetlunds'I d n proninuly to holes) y� �X V WN � Sal v C Parent malcdal(geologic)_// �y/7 '�Atrl '�3/Depthtq➢eclioel �® ' Depth to Groundwalcr: Standing Water in Hole;�/ / Weeplltg Pram -f�tlee vA!e!" -� Estimated seasonal High Gioundwater A,4 DJ TEBJ IU iAATION FOR SEASONAL HIGH WATER TABLE Method used: Depth Observed sLznding in obs.hole: In, Depth IU Soil nloltiml; Depth to weeping from side of obs.hole: � lia, OrL ulidwate'Adjusiment,r-- Index fC. Index Well✓# Reading Dalc: lndex Well IeYtil —_-„ AdJ,factor_-,__.••�r A41.0lVLl1ldwtlter Level_W JC'JCICd.COLATION TEST k3ale 'll'dalttl -- -� Observation [-Jolt# Tinge lit 9" Depth of Perc r' Mine at 61' �- 5tatl Pre-soak Tillie;@ lA s _ r7 Tim()''-6") End Prc-soak Rate Min./Intl[ AV Silc Suilabillty Assessment: Site)'assed_ Silg'-Failed: Addiliouil Testing Necded(YIN) Original: Public 1-1callh Division Observation Hole Data To Be Completed on Back--- --- -- ' **q'It percolation test is to be conciuctecfl within 100' of Wettand, you must first notify stile Barnstable Conservation D.ivlsioll at least one (1) Weelc PrdOr to bebdnning. QAS EPTIC\PLRC t'ORM.DOC ID11E]EP,O]�,�1(+']ftV.,�TION FTOL1E] OG Dcplh from Soil Horizon Texture ]Dole #�_ Surface(in.) soil - `Soil Color t (USDA).. �+ (Munsell) mottling Other w D g (Structure,Stones;Qoulders, Con ill"nry %' ra el 154-1 ON HOLE'LOG Depth from Soil Horizon Hole #Surface(in.) Soil Texture soil Color (USDA) Soil (Mansell) Mottling (St ructurOther Stones, Qottlders. Consis enc %Cravel y Depth from Soil Horizon ®G ][Mole# Surface(in), Soil Texture USDA Soil Color. Soil (USDA) (Munsgll) M Other Mottling (,structure,Stones,Boulders. Co siste c t7 veil DEEP Q7�J1,SE,_fRVA7['][ON 1- OLE Depth fiom ' Soil.Horizon � ®�' Hole# SurrFice(in.) Soil Texture Soil Color (USDA) .• _ (M °ll Other ansell) Mottling (Structure,Stones;Boulders, % Consi2tency� %praly-c . ,k Mood Insua-ante](Pate Mangy Above 500 year(food boundary No Ycs 4 Within 500 year boundary No Yes ' Within 100 year flood boundary No yp5 � IDlcptiu oa_�l�ra��ntr RY Occurring Povi�ateriai Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? ><f not, what is the depth of Naturally occurring ire vious material' �'e>ctll�'ecauaon , A certify that on (date)I have passed the soil evaluator examination approved by the 1Depa nvironmet tal.PrOtMdDi and that the above analysis,was performed by me consistent with the redltired training, expertise and experience described in AID CMR 15.017, Signature D a tb ?✓' �/ Q:1s.C?F`TrCTERCC0aM.DOC L o - ;41�� f LOCATION SEWAGE PERMIT N0. VILLAGE / / Awls INSTALLER'S NAME i ADDRESS 0 U I L D E R OR OWNER in's e,OLI P© l CA9,po DA T E P ERMIT ISSU E D DATE COMPLIANCE ISSUED �� � � � J� ��l �� /� ® -T 1'v ��m �1 No.... z. .5:01 Fizs........3 .... `THE COMMONWEALTH OF MASSACHUSETTS T BOAR® OF HEALTH 0-P `................ ..oF................................. ................................................... Application for Disposal 19orks Tonstrnrtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) .an Individual Sewage Disposal System at: ��(P A14 • -•-• ........LA..x.................................................... ` -Locatio -Address or N .....,tQ.� .. a .r..�. ,sb ..-----= --------------- ........._ �..� ... ------.....----....----------........-.....---- Owner d (� --------------------- YAMA;A!.�is--•---.........._............... Installer Address ZT Type of Building 11�� Size Lot..-��J__i./_'_..Sq.feet aDwelling—No. of Bedrooms..............Ca ........_.____--•-__•_..Expansion Attic (A'S Garbage Grinder ( ) Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ..---••-•----------------------•----------------------------------------...--------------------------------•- P� Design Flow.._.._._�2 4...•....................gallons per person er dy. Total dailyflow..........__ W >m - g P P ��_ r / � `�--••----�--•-•----------•-gallons. WSeptic Tank—Liquid'capa�ci�3' 0Q.gallons Length.. ...._0--_. Width.�_.�`®_. Diameter..... Depth.__IV I-.. x Disposal Trench—No...../!,l .. .. Width................... Total Length.......�___r.......Total leaching area-___•`••__:.........sq. ft. If Seepage Pit No-------�----------- Diameter.......to...... Depth below inlet............... Total leaching area...16..(&...sq. ft. Z Other Distribution box (V Dosing tank ( ) aPercolation Test Results Performed by..................................................... Date....................................... Test Pit No. 1......?!.._._minutes per inch Depth of Test Pit........ . .... Depth to ground water.._&_A1r.. 44 Test Pit No. 2........2.....minutes per inch Depth of Test Pit......LQ....... Depth to ground water._._lr✓-.OAIX ..................O.............................................................•-------•-. Description of Soil_-_._1__.-_.. _' _ _ ...._.L.4.�1h(._..S'(��4.1' l�r_ : _f:.J(P�_ ra S __.I ___.__.Cf11¢¢�.S' ... ,#AI,4 V ---- - -&F.--`......_V-I.Q.-..---Co�RS'� . UNature.of Repairs or Alterations—Answer when applicable................................................................................................ ----•-----------------------•-----------.....------•-------------------•------------------•--•---------......--------•--------------------------------------------I----------•••••-••---...:._......---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TI LPLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the boarWo'k-LICA'A'.6 f h th. Signed-•- ••• •• •• ...�1-'•• . . /3 Dat Application Approved By......... ---•---------•--------------•- ............ I Date Application Disapproved for the following reasons:.........................................................--------------------•---------.._.. ................................•----•----------.....------...---•--.......----•-------......-----------•-••••••••--•--•.....---•••-----•-•-----••••--•-------••-•••••....----•-•-------•-••---••-•_.... Date PermitNo......................................................... Issued....................................................... Date No.... FEic.............................. `THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........... ........... OF_....................................................................................... Appliration for Uhipoiial Workii Tomitrurtion Vamit Application is hereby made for a'Permit to Construct or Repair an Individual Sewage Disposal System at: Ile Locat*o Address or ZWRo.......................................... ............................... ............ R-14,H-6.4 . ......7........... ....... ........................................................ a. Owner A4drgas X.C.A 41&71-0.V...,.fit ................................... Installer Address Size Lot..alJj...LLk Type of Building ...Sq—feet U Dwelling—No. of Bedrooms..............(A............._-..___---_Expansion Attic (A-1 Garbage Grinder Other—Type of Building ............................ No. of persons............................ .Showers Cafeteria Otherfixtures ....................................................................................................... Design Flow___.___.Zr.........................gallons per person per -day. Total daily flpw............ ............gal ....0..................gallons.,, —Liquid capacit I........gallons 4 01 0 9 Septic Tank Length. -4--- Width ... 7 Diameter....... --- Depth... .......... Disposal Trench No. .... ..1... ... Width.................... Total Length..... ------- Total leaching area......... ..........sq. ft. iSeepage Pit No,,',',,/,.......... Diameter..... ..0........ Depth below' inlet....----.-..........&* Total leaching area.44_4...sq. f t. Z Other Distribution box Dosing tank Percolation Test Results Performed by................................................... -1................. .Date.......--........_...___ �.-4 ------------ Test Pit No. I......;?�.....minutes per inch Depth of Test Pit........L�.....Depth to ground water... 44 Test-Pit No. 2.......ZC.'..minutesper inch Depth of Test Pit-----J.2!.... Depth to ground water_-__ ..................I.......;..................................................#` 7....................r................................................. . j9A .. ...S4..& .... ........C AZC. .A 0 Description of Soil!��._/. ........ #a.....(i-Az z—a-X i.S 22 ArpV.&W.A.7..t. zhn,.r..•......... ....................... ----------- ....... ...... ............................................... U Nature of Repairs or.Alterations—2G''sWer when 'applicable................................................................................................. ....................................................................................................................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board pf lie4ith. Signed---........ I. . .......... ......... . ---/�,../ A;_ Application Approved By...............1 - - ------------------------------------- Z4?1�&............ Date Application. Disapproved for the following reasons:.............................................................................................................. ................................................................................. ........................................................................z............................................. Date PermitNo..*...................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .................................OF.................................................I.................................. (9rdifirair of Toutpliatta THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired by------------- 4..................................................................................I.......................................................... 10 Installer A at................4::� --------- -------- pro isions ................h ............... has been installed in accordance with the pr of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No------ ........... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............................................................................... Inspector..................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............................................................................... No...,8 ............................OF...... FEE........................ Raposal Vorki5 TD11mitrurtion "amit Permission is bereby granted.........4�;�. ..t!......45;e� I _j .... .. ... ........................................................................................... to Construct (,$ or Repair an Individual Se;ga ,.e Disposal System at No._- .......Ile------.. 4...................... Street as shown on the application for Disposal Works Construction Permit No................... D,,,ged.......................................... Bo of ieai........................................... th DATE..........................................Z.2--/9—fL ............ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS Log Number: Date: 9/10/82 s� BAR.NS?'AiBLE COUNTY HEALTH DEPARTMENT 5 f SUPERIOR COURT HOUSE BARNSTABLE, MASSACHUSETTS 02630 r *HONE; 362-2511 DRINKING WATER LABORATORY ANALYSIS EXT. 331 Client: R & S Wells Collector: SA Mailing Address: OS 301 Affiliation: worker E. Falmouth, MA. 02536 Time & Date of Collection: 9/8/82, 7:00 a.m. Telephone: 548-8476 Type of Supply: well water Sample Location: hot 48 Date of Analysis: 9/8/82 Chipping Stone Rd. Marstons Mills Parameter Sample Result Recommended Limits Coliform bacteria (organisms/100 ml) 0 0 pH 6.15 Conductivity 88. 500.0 Iron (ppm) .42 0.3 Nitrate-Nitrogen (ppm) < .04 10.0 Water sample meets the recommended limits of all above tested parameters. Water sample is drinkable but has higher than average levels of This does not represent a health hazard but future monitoring is recommended (2-3 times per year). We will test for Sodium. xx Water sample is drinkable but may present aesthetic problems to users (staining, odor or taste). due to high iron. Water sample is of poor quality and is not recommended for human consumption. Resampling and retesting is suggested. Results only. REMARKS: cc: Barnstable Board of Health cc: Analyst: xnl.Gt C .6 ..c 11/18/81 k Explanation of Test Results Total Coliform Bacterria Coliform bacteria are an indicator of the sanitary quality of a water supply.Water supplies may become contaminated from malfunctioning septic systems, cesspools and surface runoff. A total coliform count of zero indicates that your water supply is safe and approved for human consumption. A total coliform count of greater than zero is most often the result of accidental contamination of the sample bottle through improper sampling methods. For this'reason,-it would be advisable to retest any well water that is not approved. pH pH is the measure of acidity or alkalinity of the water, On the pH scale, the number 7 is neutral, less than 7 is acidic and more than 7 is alkaline. The pH of water on Cape Cod tends to be acidic in the range of 5.0 to 6.5 Conductivity - Conductivity is a measure of the dissolved salt.5 in solution. Amounts in excess of.500 micromhos/cm are generally considered unacceptable and may have a laxative effect upon users. Iron y The presence of iron in water in concentration of .3 ppm or greater may: give the water a bittersweet g astringent taste, cause an unpleasant odor, often gives the water a brownish color and cause staining of laundry and porcelain. The average concentration of iron in Cape Cod's water is .2 - .6 ppm, Although the presence of iron in water may cause the problems listed above, it is not considered deleterious to health. Iron may be removed by use of an iron removal system. Nitrate-nitrogen F The Massachusetts Drinking Water Regulations have set a maximum contaminant level for nitrates at 10 a ppm. Excessive concentrations may cause methemoglobinemia (an infant disease) and have been suggested to form potentially carcinogenic nitrosamines. Contamination sources include fertilizers, cesspools and industrial wastes. Copper Due to the acidic nature of the water on Cape Cod, copper tends to leach from pipes. This normally does not present a health hazard; however, concentrations in excess of 1.0 ppm may cause a metallic taste and/or a bluish green stain on porcelain fixtures. Sodium A concentration of sodium over 20 ppm is only of concern to people who are on a low sodium diet. If the water supply has more than 20 ppm sodium, P people it is u to the eo le who are on such a diet to find another source _ of drinking water or contact their doctor to determine if.consuming the-water is advisable. Concentrations exceeding 50 ppm indicate that there may be ocean water or road salt runoff water getting into the well. 1 O�BAgh� s- JO r. RECEIPT ; N9 0879 M�Be Environmental -Heath Services From: c"' S C®x 30 For:(specify servi e) �I�� Ci✓ Amount: g,0V Signed: o Date: — , a Oz Barnstable County Health Department Telephone Superior Court House 362-2511 Barnstable,Mass.02630 Ext.331 No '- -�-- - --- Fee------1--1-12----------- BOARD OF HEALTH TOWN OF BARNSTABLE Application-*rVell Con0ructionPermit Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair (,-,*"')an individual Well at: Location - Address f Assessors Maly and Parcel _ GJ cJL___ Lr2¢..e - - ------ Y`--c^Mtd9✓to.., Al —Owner --- _ - Address �- _ --`----c" -.c Installer - Driller Address 'Type of Building Dwelling --'tL--L�—----------------------------------------------- Other - Type of Building No. of Persons-------------------------__—_____ 1 Type of Well_��/V C ---- -- ----- -- Capacity--------------------——--- ——— Purpose of Well -----_--_-- Agreement: The undersigned agrees to install the aforedescribed 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 Ce tifi ate .of Compliance has been issued by the Board of Health. Signed date Application Approved By-7 z1Ae ___ . -------—— date Application Disapproved for\the following reasons: J---------------------------- - ---------------------------------------------- -------------------------- date Permit No. L--- ----- Issued--- -- - - - - -- - -- ----------- ----- ----------------- ------------------------------------- ----------------------------- -------`----------____-- date - ------------- -`----- -'-----------------'-'I BOARD OF HEALTH TOWN OF BARNSTABLE Certificate ®f Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired (&-- b 0 A 9ca ----------------------- -------------------------------=------ ---- Installer . L '!.r/ S'P��e j F +M-*emit----- 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 SATISFACTORY. DATE-------- - — Inspector-- ----- - - --- —------- a W ... No.-----C---0 --- Fee------!- -----r------ BOARD OF HEALTH it TOWN OF hBARNSTABLE AppricationjorWrIl Con5tructionl3per-mit t, Application is hereby made for a permit to Construct ( ), Alter ( ), or-Repair (-�an individual Well at: / n Location.—•Address Assessors Map and Parcel yt ---------------------- - -------------------------- ------------------- -- Owner Address ,//�� I'Y C� 60 �4c-C Installer Driller AddGl/:e c� — — _ — —---- — — -f ---------------- —--- ------------------ re�s Type of Building �4t Dwelling ---------------------------- Other - Type of Building---------------------------- No. of Persons------------------------------ Type of Well-���_ w c---- - ------ Capacity--- - --------- ---— Purpose of Well--AD"`"�_��`,c----w�-�"r------ -------- Ei'� Agreement: w vT z The undersigned agrees to install the of redescriberdial well in accordance with the provisions of The Town of Barnstable Board of Health Private a roteg,I ation - The undersigned further agrees not to place the well in operation until a Ce tifi ate .of Compliance has been issued by the Board of Health. ne S' d . a /1$ ---------- --- date Application Approved By— 4A-AA.- ---- date Application Disapproved for the followin rea =-------- -- -------- -, date------- _. �Y- S l Permit No.� - --- Issued---------------=------------------ ------- date �e.3G.Tesituls�b434W1�?39b4�o96MeR�9�4JN2�9t.�4�{e?oio�i2i�!iSwfJiT.i4ilitiSi9i4p`s!e!itGl+itL4iK9iTiAiGoih4�.litiA?�4�liAi.lGtfltK?i!`s'li4Lf7QilGlN�lG1L131L4�1GI!i4i?4oGSi23iilFr}34�!+ BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance THIS IS TO CERTIFY, That the Individual Well Constructed (- ), 'Altered ( ), or Repaired (J:4 by------- 0 A Sc, ---------------- --------------------- --------------------- -----------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 SATISFACTORY. DATE----- -- -- —_ Inspector-- ----- --- --- —- ay4GSiTilulBlLYilitofitGsilitiiPG4NLliti4Geilil/iwiRiliAiTi"IiTGlititi�IGl34`tiliAlwlLef.444i1i4G4ilititafi!itWLVi9ilititi?sou!i�i+i�.�Ri!iti�i!�lYrli.?i�ili!4�i!a.Ti•Nsi4eK�ilo BOARD OF HEALTH TOWN OF BARNSTABLE Well Construct ion3permit No. ��- -L- Fee- ------ Permission is hereby granted ,O A S(._6to Construct ( ), Alter ( ), or Repair (✓) an Individual Well at: - Street ------------ ---- as shown on the application for a Well Construction Permit p No.__^ - -- - Dated--- 1 �J Board of Health DATE =P" it sh grade above and adjacent shall slope a min.of 2%away from system n 4 diam. cast iron or Schedule40PVC pipe (tight joints). 20'min. distance ( building to edge of leaching system)—� L o7- I/ IO'min.dirt. I 0q.99 L.C.Pion 34846 C so, LOT 4 8 a s'9 29,Ile- S.F. y Access manhole cover First Floor Elev.=88.50 prop sed set at finish grade. D, o , Finish Grade sr�3 0 3!99 a zl- \�\� S=0.10� / .-Removable covers 12 max./ \ / 2.5- / _ / h 00ry Removable ' , __� \ "s_,02 cover 2 S=0.02 :i;, Clean backfiH level - �"� r 6t� TEST HOLE#I Liquid level 2"layer ofV"tot/2� Qp yea TEST p0 -- oYa ° washed stone. p S __ ___ e o o o 0 0 0 0 0 ,`, \\ HOLES 2 O O — -- DIST. e,bo' o 0 o 0 o,u y ca Q(��e 13 , 6'diam.x6 'depth - o O O ----- -- -- ; BOx, v7 c~ o 0 00 0 .� o o ` 84 - _ _ 0 LEACHING CHINGedls with Uci 4 — SEPTIC TANK — ,� oni b � yof aD OD — — rn .2 of o , Effective b oll around! 1000—GAL. — ao co �,t s n o, uo` Depth o o oDt v -- -- > r > t c 4b \ / \ RESERVE Q>� e-I cj — — q y N N o N o o� o c o 0 0 0 Precast concrete LEACHING PIT a 76:8 LOT ti Pp PROFILE �. 2ft. 6 ft. diameter 2 ft ' 2 ft.of /4 to I/2 washed stone Not to scale oTf around precast pit providing an '± 3 p� 0 / DESIGN CRITERIA effective diameter of loft. 30 I H h0 � e �� ci NUMBER OF BEDROOMS 3�equivolent to 330 gals/day). Water Table L O T NONE GENERAL NOTES — — _ �' ,9 �e o GARBAGE DISPOSAL UNIT � ,�. Jp � I LEACHING AREA—CAPACITY REQUIRED 330 GALS/DAY. 1)NO CHANGE TO THIS SYSTEM SHALL BE MADE UNLESS �,r Q '= SIDE AREA PROPOSED 188 SQ. FT. APPROVED IN WRITING BY HOLMESand McGRATH, INC. LOT Oro # 2)SUBJECT TO INSPECTION DURING CONSTRUCTION BY kO BOTTOM AREA PROPOSED-�578 SQ. FT. THE BOARD OF HEALTH AND HOLMES and MCGRATH,INC. p PROPOSED LEACHfNG CAPACITY .48 GALLONS/DAY. 3)HEAVY CONSTRUCTION EQUIPMENT SHALL NOT TRAR C TI OVER DISPOSAL SYSTEM DURING OR AFTER CONST LO 0N.WATER SUPPLY WELL 4)DISPOSAL SYSTEM TO BE CONSTRUCTED IN ACCORDANCE PRECAST CONCRETE UNITS, H-10LOADING. WITH TITLE 5 OF THE STATE ENVIRONMENTAL CODE. L -r 4 7 5)A COPY OF THESE PLANS MUST BE KEPT ON THE SI T E G 3 0 BENCH MARK Spike in NET 9Tpole'#_462 Ele_v.-=88.05 NGV Datum. DURING THE TIME OF CONSTRUCTION. ; I 6)A COPY OF THESE PLANS MUST BE FURNISHED TO 11 kE SOIL LOG CONTRACTOR CONSTRUCTING THE DISPOSAL SYSTEM. ?) BEFORE BACKFILLING THE CONTRACTOR SHALL NOTIFY N I N, 2 HOLMES and McGRAN INC. AND THE BOARD OF HEALTH ;�) AGENT TO INSPECT THt SYSTEM AS CONSTRUCTED. Depth Soils Elev. De th Soils Elev. 8) FLOOD PLAIN HAZARD ZONE C 0 86.5 0 83.6 9)ZONING DISTRICT R D — 2 } ' In foundotio ------- — DATE DESCRIPTION Drawn by Checked by RM i LOAM, ex covat ion. 10) THE NORTH ARROW IS DERIVED FROM RECORDED PLANS REVISIONS OR DEEDS. THE NORTH ARROW SHALL NOT BE USED SUBSOIL Coarse FOR ORIENTATION FOR SOLAR HEATING PURPOSES. _ . 3.5' 83.0 PLOT P L Q OF PROPOSED SEWAGE DISPOSAL SYSTEM SAND SOIL TEST TITLE REFERENCE .- FOR JOSEPH POLCARO C o a r se DATE OF SOIL TEST J U L, Y 23. 1981 . L.C. 34846c- LOT 48 CHIPPINGSTON E ROAD S A N D TEST TAKEN BY PH I L I P D.,r HOLMES MARSTONS-MILLS° BARNSTABLE 'MASS.. r ,.IpL,tzg RESULTS WITNESSED BY RON GI FFOR D SCALE: I ' 40 DATE AUG. 2/1 198-1 12' .6 PERCOLATION RATE 2 MIN./ INCH. hdlmes:and�mcgrath;�rnc.. 12 74.5 71 civil'engineers and land surveyors t i GROUNDWATER NOT ENCOUNTERED 220main street folmouth, ma.02540 fChiicked b /�Vl-,/, CIVIL 548—3564 awns,,y TB.,R 5 N' 81175 DWG. N� A I107 -- -- j SHEET .I OF 2 'I 8' - 6" y Al I outlet pipes from the d)stribution box shaI I K o ko Outlet beset level for at least 2 from the box. _ All access Manhole covers for Septic Tank N I II �- �''� _ I N L E T —�- OUTLET T--p-- ��� � � o Distribution fox and/or Leaching Pits set _ INLET .• I � � - OUTLET more than 12 below finished gradeshalf•be p - ' - raised to within 12 of finished grade. Outlet r Metal frame &cover or concrete cover Knockouts over "Ts" where required.,- - Concrete block masonry 2'-0'� 1'-2" STEEL tREINFORCED. PRECAST CONCRETE - or 3„ 3„ _ Brick- masonry Removable covers 'f �'' '� Concrete,".cover''4� , : 2" Conc.`;'cover P >i1''•--3"min.clearancere uired;-' a� ,� Q ��� INLET'Y INLET •-. .;. 8 ;2 min.inlet to outet 6 min. _ 13 INLET—n- \ Outlet ' Outlet Liquid level 14 OUTLET ,1 OUTLET- - Knockouts ,ItS' 10 min. _s 6 2 min F %�, s - min. _ LO a —-�- - -� o. —_ , 6 min. - 6- _ >_ 6 min. ;. . O d' 1 — t _ - TYPICAL DISTRIBUTION BOX ;r " -' SCALE' I If = 1'-0" If x -•----�- 8'- 6 �---- 4' -10 `R 9 y TYPICAL 1000 GALLON SEPTIC TANK { SCALE: 3/8' = 1'- 0" ., ' f QATE DESCRIPTION- Drown.by Checked by ,_• • w ' REVISIONS; PLOT PLAN = DETAIL SHEET` : d OF PROPOSED SEWAGE DISPOSAL SYSTEM FOR JOSEPH POLCAROr,-- ' LOT 48 CHIPPINGSTONE ROAD F MARSTONS MILLS BARNSTABLE, MASS. ( SCALE: as shown DATE: .AUG. 21) 1981 w�v�Mcs N' T holmes and mcgrath,inc. civil engineers and land surveyors 220main street , LOT 48 CHIPPINGSTONE RD. ! taimouth, mo.02540 Checked b "P.o.14 i 548-3564 t [Drown by,R.S.1. JO N281 175 OWG.N° A 1107 SHEET 2 OF 2 �; I I SYSTEM PROFILE ALL DS EMWIT COMPON NTTAPSHALL E OR BE NOTES MARK(NOT TO SCALE) COWARABLE MEANS FOR FUTURE LOCATION. APPROX. NGVD PROVIDE MIN. 20" DIAM. WATERTIGHT 1. DATUM IS ACCESS COVERS TO WITHIN 6" OF FIN. GRADE CONCREI-_ COVERS TO WITHIN 3" GRADE 2" PEASTONE OR GEOTEXTILE 2. MUNICIPAL WATER IS NOT USED \ FILTER FABRIC OVER STONE$$ 1' 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. MINIMUM .75' OF COVER OVER PRECAST 2% SLOFf: REQUIRED OVER SYSTEM 86.0' 2 nd od 4. DESIGN LOADING FOR ALL PROPOSED PRECAST PRECAST H-10 � � BLOCKS OR 3 RISERS (TYP.) PRECAST RISERS UNITS TO BE AASHO H-10 �, �° Wakeby R°ad 2 m 84.1' 4"OS L 0 PVC MOR'AR ALL H-10 0 PIPES LEVEL 1ST 2' COM"ONENTS 5. PIPE JOINTS TO BE MADE WATERTIGHT. ` 4 'TYP.) INV' 1' 4' �r 83.0' c 10" EXISTING 14" Po ENDS o�° oSoDE oo. 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE TEE SEPTIC TANK** TEE oaaa o 000r� oaa�_o -c�ooa 'o°o WITH 310 CMR 15.000 (TITLE V.) *82.7 6" MIN. SUMP '°°°°°°°° ° ° ° ° ° oaaaa00000�� oaaaaaa��oo -0-0° ° ° ° ° ° ° 0000000.00 ° ° 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND 0 0 0 0 12" MIN. INT. DIM. o 'o°o°o°°° o 0 0 0 0 0 0 0 0 0 o o ram- o 0 0 0 o 0 0 ;°GAS BAFFLE::; °o °o°o ° ° ° ° ooaaa00000�� oa�oaao�000 ° °o N °°°°°°°° °°°°° ° NOT TO BE USED FOR LOT LINE STAKING OR ANYLocuP 's> > ° ° ° ° °°° ° ° ' OTHER PURPOSE.82.382.2 °°°°°°°° °°°°°°°° 80.17 Pond p 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. `H-10 500 (;AL. LEACHING CHAMBER BY ACME PRECAST OR EQUAL. 4- 3/4"-1-1/2" DOUBLE WASHED STONE 4' MIN. (2) UNITS REQUIRED 9. COMPONENTS NOT TO BE BACKFILLED OR 4 ALL AROUND PRECAST STRUCTURES CONCEALED WITHOUT INSPECTION BY BOARD OF 104 6" CRUSHED STONE OR MECHANICAL OVERALL DIMENSIONS TO OUTSIDE OF, STONE: 25.0' X 12.83' HEALTH AND PERMISSION OBTAINED FROM BOARD COMPACTION. (15.221 [21) o -H OF HEALTH. 10. CONTRACTOR SHALL BE RESPONSIBLE FOR. ( 1 % SLOPE) SLOPE) CALLING( 1 VERIFYING ITHE LOCATION OF ALL UNDERGROUND & LOCUS MAP ' LEACHING 76.1' BOTTOM TH-1 & 2 OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF FOUNDATION EXIST SEPTIC TANK 33 D' BOX 12' FACILITY No GROUNDWATER FOUND WORK. NOT TO SCALE *THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL 11. ANY UNSUITABLE MATERIAL ENCOUNTERED ASSESSORS MAP 27 PARCEL 43 VARIANCES FOR SEPTIC SYSTEM REPAIRS WHICH MAY BE UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS GROUNDWATER EXPECTED AT SHALL BE REMOVED 5' BENEATH AND AROUND THE PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM ELEVATION 44t PROPOSED LEACHING FACILITY. IMMEDIATELY GRANTED BY THE BOARD OF HEALTH AGENT OR BY HEALTH INSPECTOR 12. EXISTING LEACHING FACILITY SHALL BE PUMPED **INSTALLER SHALL CONFIRM MINIMUM SEPTIC TANK SIZE AT / AND REMOVED OR PUMPED A D FILLED WITH CLEAN 1000 GALLONS AND ITS SUITABILITY FOR RE-USE. REPLACE / SAND. PAPERWORK AND HEARING REDUCTION PROPOSALS APPROVED WITH 1500 GALLON SEPTIC TANK APPROPRIATE TO SITE BY THE BOARD OF HEALTH REVISED DURING A PUBLIC CONDITIONS IF NOT SUITABLE HEARING HELD ON AUG. 4, 2009 1) FAILED SYSTEMS ONLY : SAS TO PRIVATE ONSITE WELL m SEPARATION DISTANCE VARIANCES, IF LOCATED IN THE SAME o GENERAL LOCATION AS THE OLD SAS AND MORE THAN 100 FEET SEPARATION IS PROPOSED BOTH FROM ON-SITE WELL AND SYSTEM DESIGN: ANY AND ALL WELLS ON; ADJACENT AND. :NEIGHBORING PARCELS. WELL 150' TO PROP. GARBAGE DISPOSER IS NOT ALLOWED SAS 86 DESIGN FLOW: 3 BEDROOMS ® 110 GPD 330 GPD USE A 330 GPD DESIGN FLOW _ r,. TA ,�1,___33C ^" '-D (2) 6.5.0 **RE-USE EXISTING 1000 GAL. SEPTIC TANK 1 LEACHING: TEST HOLE LOGS SIDES: 2 (25 + 12.83) 2 (.74) = 112 GPD � BOTTOM 25 x 12.83 (.74) = 237 GPD ENGINEER: ARNE H. OJALA, PE, SE \ X 86.28 WITNESS: DON DESMARAIS, RS 3\9 r�T- T__ TOTAL: 472 S.F. 349 GPD - _ T DATE: AUGUST 3, 2011 \\ - - LOT 48 USE (2) 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL) \\ -T 6.45 29,119 t SF WITH 4' STONE ALL AROUND PERC. RATE _ < 2 MIN/INCH 85.74 88.05 A CLASS I SOILS P# 13370 \\ EXIST. DWELL i \ 0 n ELEV. � ELEV. 4 X 86.56 \\ \� � to0,p `V 86.1 0" `V' 86.1, \\\�4.03 s 2 � 87.0 86.53 APPROVED DATE BOARD OF HEALTH MA FILL FILL \ \ 7 �� x 86'34 6„ 619 \ \ 4.84 ap, 86.2 . 2 TITLE 5 SITE PLAN A/B A/B \\ F 0 .55 - OF 10YRL2/1 10YRL2/1 �\\ 86. 3 e 6) � Scale: 1"'= 20' 8" 8" C% �4.24�, 81�61 6p g6- 46 CHIPPINGSTONE ROAD B B to \\ �� 86.13 7 / 0 1020 30 40 50 FEET MARSTONS MILLS SL SL '� \\\ a 86. b� p X 82.80 j \ \ 8 PREPARED FOR 48" 10YR 5/4 82.1' 48's 10YR 5/4 82.1' Z� \\ 1-1 " 5 .A 84.37 TH ' B&B EXCAVATION/ V` 8 X 4.27 .�► \ #3o SWEENEY C C Q 84.43 8 .iJ7 TOWN WATER PERC �� \\ �s B� / AUGUST 3, 2011 MCS MCS _ _ 4.2 8 �O• _ _N OF Mq fax 508-362-9880 ZH pE u off 508-362-4541 85.84 � gssq Q DANIEL oy� o� DANIfiLA CyG. downcape.com �. . �, 2.5Y 6/4 2.5Y 6/4 #S 53 AND 37 \ 31 �' A. OCIVILL down cape engineering inc. \ ®JALA N \ cos® Na. s50�o�� civil engineers 120" 76.1' 120" 76 1 ' TOWN WATER 4.07 NOTE: SEPTIC SYSTEM IS NOT w DESIGNED FOR VEHICLE LOADING a5 F ," �� land surveyors NO GROUNDWATER ENCOUNTERED �_3_ Aj° _- ON l � 939 Main Street ( Rte 6A) BENCH MARK - HYDRANT ON TAG DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675 - ' 74 BOLT 1834 ELEVATION = 86.3 I