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0005 CHOPTEAGUE LANE - Health
hoptecague Lame ?V mrstcals Nliil.s A= 028 066 Y h. Town of Barnstable P# -i if 4 — P Department of RegnlatorY SeMe" • Public Health Division Date • 2M Main Sure%Hyannis MA MMI Am Date Scheduled Tune Fee Pd. so r Suitability.Assessment for Sewage Disposal - Performed By. t�-c9w�A�Gr A NI LLA.- � : w- DO Li^1ft tr t�o lZFM1 1 �S LOCATION&GEN UaL INFORMATION Lac: Location Address Ci ownees Name C N't 1 A, i 1 r 0M,0 S C h��;�F�,A J v(tr � y / �P r S-6 us vn l((5 Address S a p�t us t 6 2 8 J6 6 F,nginoa's Name R:J= :p: Assessor's Maw?amd / / _ _ do NEW CONS7RUCflON REPAIR V Tde lMM# J(� " -7 7�— 1 R r ID slopes(%) afi Surfie stones A 0 t , Land Use Water Body !� ft Possible.wet Area Tft �g water wdl _ T Distances from: Open '7 tp OJT/' Dram Way 1 ' ft Property Line ee ft R e SKETCH:(Street name,dnt o exact of test holes&Pere tens,locals wethu ds is pro)wniW to holes) Al s >a� 3 �VA 6rooMd Z 401 Aq r C �O� Parent material(geologic)_L04 W q Depth toBedmdr Depth to Groundwater: Standing Water M Hole weeping from Pit Fie t'1 A t{' VSiuU T`o.T..�, cay-Z. GAht- % 1yt,llel.- EgnnaW Seasonal Wo Gm n►dwater DE' MATION FOR SEASONAL HIGH WATER TABLE 5 Method Used: Sec A our, epth observed sMuftg in ohs.holm R is Depth m and motth ft �l. wowing fmm side of ohs hole hL Groundwater Adjustin nt Depth to we D J Y Adj.&CtDr Adj.Groundwater Level_ T..ao..WAI 9 Readine Date: Index Well h vd is pyl p /. %-"AJ> (M l 4 S ------ - �..�rl7 j�fti- v v .�rrw 11 28 Assessor's Map/Pancel: j�b Eng;noeesName NEw ooNSTRucrlow REPAIR ✓ Tekpborre r 50 ---7 7 J— 00 yA�t3 � no Land Use Slapas(yO) � Srnfacc Stories t t ft -I,o fJ d t h hers 0 14 ft Possible WcL Area—�T S Mmking water wen_ Disloroes frorrc open wfficr Body t Eel Drainagewayf Proputy t�rw ee ft Other $ S K ETCH:(street rim, dimensio ot,mul to iorw of test toles&pem tests,tocaft wdlands in proxinvty to holes) b� S" �j1rR�c5 A-A qj 1 '0 V Z ,^ 6 roJmd WA 950 Z U1+4r- I1 fVj Parent material(geologic) 10 0 W•q DepW to Bedrodx Depth to Groundwater Standing Water in Hots Weeping from Pit tape rl A Estimated Seasonal High Groundwater 50 t± t�S i=�� T�""'v (9yZ G A hK-Att 1, h't,llf" rl�ede DETM*ff ATION FOR SEASONAL HIGH WATER TABLE Mdhod Used: SP-e A O U'G in. Depth to soil mottim kn. Depth observed standing in obs.hole in. GroundwaterAdaslawd ft. Depth to weeping from side ofobs.hole Index well d Read-mg Date index Well level Adj.&cow A-Groundwater LZVd— PERCOLATION TEST Date 6 I'm` f--�"n Observation Tmw at V Hole# �rt Depth ofPerc rune at r Start Pre-soak:Time® rum(r-61 FAd Pre-soak (! ,0 Rate MinAnch __ Site Eaikd:_ — Addeioaal TestU1g Naoded(Y" Site Suitability A � Site Passed original: Public Health Division Observation Hole Data To Be Completed on Back ***If percolation test is to be conducted within 100'of wetland,you mast first notify the Barnstable Conservation Division at least one(1)week prior to beginning. Q-HEALTHMp/PMWMRM Hole# D .Ep OBSERVATION HOLE LOG Other Soil D� _ Mil color Soil Depth from Sol Roraon ) Motd6tg (SWdu�, �Boulders Surly M•) 0_3 St t Imo., J0 3 n0 _ ZS 3 �o Iv nr,P Dip OBSERVATION HOLE LOG Hole# Z Soil Color Sol odw Depth from Soli Horizon Soil Texture Molding P ucmre.Stomas,Boulders. Surface(in.) (USDA) cc ------------------- 1 (e D r) 32•^4Zit t fd ID r s j 6-SAVU Flood Insurance Rate Man: Above Sod year flood boundary No Yes Within 500 year boundary No— Yes Within 100 year food boundary No---- Yes De th Pervious Material Of Natural Oven exist in all areas obsery ed you out the Does at least four fed of�Y owmrmg pemous Ewatenal area proposed for the soil absorption sysftn? ous If not,what is the depth of naUvWIy Occurring lit Certification the�i1 evaluator examination approved by the I certify that on tg V- 144 3(data)1 have passed ro1ed by me consistent with Department of FWvmmm��ou and that the above analysis was 17- ��� "ence described in 310 t:MR 15.017. the required r Da<te b b 0-7 Signature (Y.HFALIWWP/PERCFORM Town of Barnstable P# Department of Regulatory Services Public Health Division Date C/ MAOt 200 Main Street,Hyannis MA 02601 it—Am Fee Pd. t� f Date Scheduled Time Sol Suitability Assessment for Sewage Disposal r 1GS Witnessed BY. )OXJ IV 1PI M 101Z1�Y11�( �S Perfom►ed By: ��fJQ� � ° 1 i4 b 1 Z.L/L.P i_ i LOCATION&GENERAL INFORMATION -�•� Leff rJa Location Address C� / � � Owner's Name i A S hop U& -1 _ Yyt�rS-�pus 1M t S Address Goo p vc, �6 Engincces Name Assessor's Map/Parcel: _ �• v NEW CON577tUGTION REPAIR Telephone# �l9 7 J"— � CO —� I A r,D q—� Surface Stones A 0 � band Use � Slopes(9�0) i ► �►harS ■ � � t ft y W ft ft Possible Wet Area—"ty _ft Drinking Water Well Distances from: Open Water Bod =� c tD�p�✓- Other ft Drainage Way N ft Property Line ee ft e i ,SKETCH:(Street name,dimensio of exact 1 tions of test holes&perc tests,locate wetlands in proximity to holes) �V �b 5- GV A TO LO AJ es ,a� . AJ 6 ro\ t aN Tower o� Ch . Parent material(geologic) V4 W q Depth to Bedrock Depth to Groundwater. Standing Watci in Hole: Weeping from Pit Face t± j( ro.ai.v hr� r Estimated Seasonal High Groundwater VS�J (�lC(Z G f{ ►ode DETERM"UTION FOR SEASONAL HIGH WATER TABLE Method Used: See A 0L,0: Depth to soil mottles: in. Depth Observed standing in obs.hole: n. Depth to weeping from side of obs.hole: in. Groundwater Adjustment ` c..Ac WAI 0 Readine Date: Index Well level Adj.factor Adj.Groundwater Level— 1 1"' r m�p`5't'd IVY U St1. .--.-,-....v Assessor's Map/Parcel: 2 8! t� Engineer's Name R, -ZAv v NEW CONSTRUCTION REPAIR t/ Telephone# 50 " -7 7 5— dt- land Use 1 a r Slopes(%) 1 A� Surface Stones h N�Ift ry ptyL►hnrS N 1� ft Possible Wet Drinking Water Well Distances from: Open Water Body Drainage Way � ft Property Line ee ft Other ft e SKETCH:(Street name,dimensio t,enact 10 tions of test holes&perc tests,locate wetlands in proximity to holes) NGrtq�Fs Pi-A q4 �3 �VA/ � p� 1.O w .I �A l S ,0 s GroOAJ ru m At T 450±: oN TOW'&) 2 C` Co p��e it 4 01 J V c , C�D LA) �' Parent material(geologic) QU�W°� Depth to Bedrock Depth to Groundwater: Standing Water in Hole: 11 A _ Weeping from Pit Face h t vswU T`o,,,•�, (qi7 C,Aht atimated Seasonal High Groundwater �Jd {' 4t' �I'��e►.� t d�� DETERMg4A.TION FOR SEASONAL HIGH WATER TABLE Method Used: SP-C A C1 L06- in. Depth Observed standing in obs.hole: ' n. Depth to stet mottles ft. Depth to weeping from side of obs.hole: in. Groundwater Adjustment Index Well# Rcading Date: Index Well level Adj.factor Adj.Groundwater level_ PERCOLATION TEST Date 6 6 O rrme I l m Observation Time at 9" Hole# Time at 6" Depth of Perc Start Pre-soak Time® l D Sb Time(9"-6") End Pre-soak _L_'_-0Z + Rate MinAnch Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) t" original: Public Health Division Observation Hole Data To Be Completed on Back ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one(1)week prior to beginning. Q:HEALTWWP/PERCFORM f DEEP OBSERVATION HOLE LOG Hole# 2 Soil Color Soil Other Depth from Soil Horizon Soil Texture Mottling (Structur%Stones;Boulders. Surf=(in.) (USDA) (Mansell) ca IStGn- wad el . 0-3" a j� 0 �'' LtZI' 4 [�� St l� ie�-► toYr5�6 ry �' cos� nc 11 25,E �3 no tv c,��� DEEP OBSERVATION HOLE LOG Hole# z- Soil Color Soil Other ° � Depth from Soil Horizon Soil Texture Mottling (Structure,Stones,Boulders. Surface(in.) (USDA) Consisten %Gravel I D=3Z" B1 t h d Y1 11 � if 32 _ PZ Z.Sv 4+ rn e) At Flood Insurance Rate Map: Above 500 year flood boundary No_ Yes Within 500 year boundary No_ Yes ' Within 100 year flood boundary No_ Yes De th of Natural) Occarrin Pervious Material in all areas observed throughout the Does at least four feet of naturally occurring pervious material exist area proposed for the soil absorption system? ervious material? If not,what is the depth of naturally occurring p Certification C� date I have passed the soil evaluator examination approved by the I certify that on �9v' t I)3(date) the above analYsis was me consistent with Department of Environmental� O rience�desribed in 3 0 CMR IS Old by the required tecti experh t� b 0. Date Signature Q.HEAL'17i/WP/PERCFORM TOWN OF BARNSTABLE LOCATION UA SEWAGE# VILLAGEA0�" SSESSOR'S M , &PARCEL IDS NAME&PHONE NO. mo .0 SEPTIC TANK CAPACITY LEACHING FACILITY:(type) NO.OF BEDROO S OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between .Maximum Adjusted Groundwar 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 TOWN OF BARNSTABLE ',OCATION ��C /1 O/� j�ei1A 7 JP A-j SEWAGE#p�'�tr?'3� VILLAGE ��S �J"��"�'l(rASSESSOR'S'MAP&�PARCEL 6 G INSTALLERS NAME&PHONE NO. �I.�i SEPTIC TANK CAPACITY ®6(� LEACHING FACILITY:(type) o? r���) (size) NO.OF BEDROOMS OWNER LA PERMIT DATE: ��ig�d 7 COMPLIANCE DATE: /Q 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) /190Z Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) ��e Feet FURNISHED BY h 4C-I( OLD 4 d-� b � 3 7 g f.03 � A a6 QC3? e363 �30LE A 13 33 � No. r _ ' V � Fee WTHE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Ye pphrattou for Zigonl bpztem Con%ructton Vermtt Application for a Permit to Construct( ) Repair( Upgrade ) Abandon( ) ❑.Complete System ❑Individual Components Location Vr s or Lot Ny- I q r� Owner's Name,Address;and Tel.No. 0 ek J r s ap arce t4 ov1J j yi I stal is e,Addr ss,and Tel.No. Desi er's Name,Address and Tel.No. C Type of Building: Dwelling No.of Bedrooms Lot Size d1b t sq.ft. Garbage Grinder Other Type of Building C No.of Persons Showers( ) Cafeteria( ) Other Fixtures . � Design Flow(min.required) 3.3 gpd Design flow provided _��S gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alt ration (Answer yjien applicable) z c Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 oft4e Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by t is B ar Lolle/&_"._ /SigneDate -)( 8/P 7 Application Approved by Date Application Disapproved by: Date for the following reasons Permit No. Date Issued No. a; ) rl Fee 4 1 Entered in computer: THE COMMONWEALTH OF MASSACHUSETTS p Ye � F PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Application for 0t.5pogar 6pgtem Con0tructton Permit Repair( UApplication for a Permit to Construct pgrade ) Abandon O ❑.Complete System ❑Individual Components Location qre s or Lot No. .. (Gf� Owner's Name,Address,and Tel.No. S /jo PQ J� r s ap are 11 1 t l l^ok A S �e i a Instal is Na e,Addr^ss,and Tel.No. Designer' Name,Add s and Tel.No. 6 C! Type of Building: ? 0 Q Dwelling No.of Bedrooms V Lot Size C;Lb t V sq. ft. Garbage Grinder ( � Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 3 y gpd Design flow provided �S, S gpd Plan Date— Number of sheets Revision Date i Title i Size of Septic Tank Type of S.A.S. Description of Soil ( /Nature of Repairs or Alt rations(Answer)yhen applicable) S i Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of a Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued=e/& �....—Signe Date - V 7 Application Approved by Date v Application Disapproved by: Date for the following reasons Permit No. AM7 Date Issued ——————————— — ———————-——————— ——————————— fl V f ��j THE COMMONWEALTH OF MASSACHUSETTS (� LV J (� BARNSTABLE, MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY that 100n-sitp Sewage Disposal System Constructed ( ) Repaired ( Upgraded ( ) Abandoned( )by I (, f at E'Q 0 Q r ( U—Sas been constructed in a cordance with the provisions of Title 5 and the for Disposal ystem Construction Permit No. dated Installer Designer #bedrooms Approved design flow gpd The issuance of this permit shall not b str d s a u�arantee that the system wi fun do as designed.ff Date Inspector p 1 r — T— WW -------------- -- -------------- --------\\ — No. . Fee�K J HE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION"L BARNSTABLE, MASSACHUSETTS J Oiooml *pgtem Con.5truction Permit Permission is hereby granted to Con truct ( ) Repair ( 1,4-`011Up rade ( A } System located at and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. r Provided: Construction must a completed within three years of the date of thi @rmrt. Date U� Approved by r Town of Barnstable IMElOi+tio Regulatory Services t Thomas F. Geiler, Director * saxxsens[.e• 9 MASS. $ Public Health Division i639• p'Eo n�r►'�" Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office:. 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: 0 7 Sewage Permit# Assessor's Map\Parcel 2$ !o Designer: J19,4iCX,.� CA 1�) L LQt�__�S Installer: Address: r, Lot �jx,ZL5 B Address: ' Y,a rm®yt� ! , a '7�©Z673 On was issued a permit to install a (date) (installer) septic system at 5 C k o G 6!, based on a design drawn by (addre s) . CA D t L LA,'— � aL-S jZS dated & 6 D (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Stripout (if required) was inspected and the soils were found satisfactory. ' ,�N OFMgss9 RONALD cya (In ller's S atuye) JAMES CADUAC 1060 p y gNI T 0, (Designer's g ature) ce�J (Affix Designers Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\Septic\Designer Certification Form Rev 03-09-06.doc RONALD J. CADILLAC, PLS, RS Professional Land Surveyor Registered Sanitarian P.O. Box 258, West Yarmouth, MA 02673 (508) 775-9700 July 19, 2007 Donna Miorandi, RS Public Health Division 200 Main Street Hyannis, A4, 02601 Re: 5 Chopteaque Lane, Marstons Mills Dear Donna Miorandi: We have inspected the septic system at 5 Chopteaque Lane, Marstons Mills installed by Bill Harvey on 7/19/2007, and found it to be in significant compliance with Title 5, and the design plan. The removal was less than proposed with extra stone encroaching on the removal. The leaching area was afor slightly above design elevation. Please feel'free to call with any � h concerns. r Thank you. il" ly, r t Ronald J. Ca ' lac No.--Who�___ Fee BOARD OF HEALTH O TOWN OF 6a BAR T B Application,for lVell ertnit Application is ereby made for a permi o Con truct ( ), Alter ( ) o , epair ( a dividu 1 Well t: �1 -----s-—7_ -!- - — �A d C— —-- —�---— ='-C D — L.c s Asse5i s&�Map and Parcel - = �1 -(k.4-- ------ - - -� --= - ` ' d - '- - -- wner Ad ress i -------- ----- - �� - - ------- -- - ' - - Installer — D' er Address Type of Building ,/� Dwelling..... -- --------------------------------------- Other - Type of Building--------------------------- No. of Persons---------------------- Type ----__ __ ofWell- ---- -- ---- , - - - - ----------- - - - - C pac>ty------------------ ] ii ss 44 Purpose of Well-------------l- --------- --------------- -- - will) Agreement: V 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 Certificate omp 'ance has been issued by the Board of Health. Signe -- -- -- ---- - ------ -date ------- Application Approved By — -- date — Application Disapproved for the following reasons:------------------------------------- ----_-------- ----- -- - -- --- _------- - ------- - T__ -------- - --------- -------------- ------ - date Permit No. _-`IO V — -- - Issued--- - - - -— -- date BOARD OF HEALTH QP z TOWN OF BARNSTABLE Certifitate ®f Compliance THIS IS O CER � at the I 'vidual Well Constructed ( ), Altered ( ), or Repaired _---------------------------------------------------------------—- - - ---------------- Installer v___ 0-4 ------------------------------------------------------------------------------------------- has been installed in accordance with the provisions of the Town of Barnstable Board o Healt rivate Well Protection Regulation as described in the application for Well Construction Permit NoQ�! -- __ 1�-Dated----------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE---------------—- -- - - -- -- Inspector------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------- BOARD OF HEALTH TOWN Z2!NrWrMt E �well �. V_J_ 1- 04 �6No. - -ka7 Fee------------- Permission is hereby granted--- ---- ----------_-----__---- -------_-- __— --------------____-- to Const tW011p( ) Re i ) a divl W 1No. -- - � �-1 - - - . ----------------------------------------------- - - ------------- Street as shown on thenap 1'cation for, ell Construction Permit III ------ - Dated--- -- No. - = - - -- - -- �7 - /�"] - Board of Health DATE� -- —�� 6 {_ No.-- --- --- Fee--------------------- BOARD OF HEALTH O ` Q TOWN OF BAR T ol V GO [itation for eCiX ermit Application is reby made for a permit o truct ( ), Alter ( ) o Repair (i, a dived, Wellj,�,�t: oP "' � ,C e S v- — oca ion - Al s AssessASS_Map and Parcel �N� caner .� � � rs,�.-Address Y -------- - ------- -- ---- --- ------------- '�-- ---;1; r {�---�- ( - -- ------ ---- —___----------------- Installer - D' er � . t'"" Address Type of Building Dwelling ----------------------------------- Other - Type of Building------------ ------------------ No. of Persons-------------------------------___________ Type of Well------- ---- --- - C paclty---- - - - -- - 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 Certi icate omp 'ance has been issued by the Board of Health. Signed- - -- �1- - - --- - ------- ---- ------- 1 date Application Approved By - _ �� ---- � 7 date --T APPlication Disapproved —for_the _following reason-s:-------------------- - -------- -------------------- __-_-__--_-------__--_-_--_-d_a_t_e—-_--____-_-_--_--_-Permit No. ---------- Issued--- - r � -------- — ------------- date --; --------------------------------------------------------- ------ - -- j BOARD OF HEALTH C.2 (� TOWN OF BARNSTABLE Certifaate ®f Compliance THIS IS O ER at the I idual Well Constructed ( ), Altered ( ) for.Repaired ( �) _ /� /// by-----=--- !"� -------------- - --------------------------------------------------------------------------------------------- - -- Installer ,. t =- - �A — ' --- - --- ---- --- - ------------------ ------------- -- a f 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 Nc,.Z-M�_ VDated------------------------ .'� _; r THE ISSUANCE OF THIS CERTIFICATE�SHAi1i^L'L'NOT-BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE------------------- - --------------------------- - -- Inspector------------------------- .'_ ,w I C BOARD OF HEALTH r TOWN OF B. S � -L E e[I Co� �rt- ermtt No. 0 ul-al Fee--------------- Permission is hereby granted----—_—__ --- —-------- -------------- - ------------- to Con it (n ) Alte�j(( ), 7 Repair ( )`any individual W I axI J No,- -` - !=- ',, ��`� r -------------------------------------------------- ' / street i �, w. 1 as shown on tithee a pplication for ell Construction Permit No. _T----------- Dated - - - - - ----------------------— - - -------- -------------------------- .. A Board of Health S Town of Barnstable �F'THE y� tio� Regulatory Services = sAxivsrns Thomas.F. Geiler,Director Public Health Division ArFp�a . . Thomas.McKean, Director 200 Main Street, Hyannis,MA 02601 Office: 508-8624644 Fax: 508-790-6304 October 4, 2006 .. F N Mr and Mrs Thomas Lee c/o Chase Forclosure 3415 Vision Drive Columbus, OH 43219 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, Title 5 .The septic system owned by you located at 5 Chopteague Lane,Marstons.Mills, MA was last inspected July 121h by, Robert J. Bortolotti, a certified septic inspector for the State of Massachusetts. The inspection of your septic system showed that your system"Failed"under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: Backup of sewage into facility due to overloaded SAS. You have 2 years from the date of the system failure to bring the system into compliance. If there are any questions about this reminder,please feel free to contact the Barnstable Health Department. B E TH P TMENT G Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health Page 9 of I I OFFICIAL INSPECTION FOR-M.—NOT FOR VOLUNTARY ASSE SMENT SUBSURFACE SEW.Ai, DISPOSAL SYSTEM INSPECTION FORM PART C ,SYSTEM INFORYIATION (continued) Property Address: Owner: Date of Inspection: SOIL ABSORPTIOi SYSTEM (SAS): (locate on site plan, excavation not required) -jjSAS*notj,ocated ex lain vrhy: L' 4 � e YP leaching pits,number:_ leaching chambers;number: leaching.galleries, number: leaching trenches, number; length: leaching fields,nunber, 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.): CESSPOOLS: (cesspool must be pumped, as part of inspection)(locate on site plan) Number and con figuration: ' �3 Depth—top of liquid to inlet invert: =' Depth of solids laver: yi Depth of scum layer: Dimensions of cesspool` Materials of construction: +1 Indication of.groundwater inflow(yes or no): . Comments (note condition of soil_, signs of hydraulic failure,level of ponding, condition of vegetat on, etc:)' PRIVY: (locate or_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):. 9 Page 10 of 1.1 OFFICIAL IiVSPEC'TION FORM—NOT FOR VOLUIN'FARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYS'TEIM INSPECTION FORM PART C' SYSTEM INFORIMATION(continued) Property Address: (�Q Owner: Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM `Provide a`ske'tch'of the.sewaze.disposal system includins ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 1.00 feet.Locate where public water supply enters the building. a� r5A _ -- �� cc,►ton COAfLMON WEALTH A OF M S SAC HUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS. > DEPARTIYIENT OF.ENVIRONMENTAI: PROTECTION _ TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR YOLUNT_ARY ASSESSMENTS SUBST-IRFACE SEWAGE DISPOSAL SYSTEMTORM' PART A CERTIFICATION c ro Property Address: Z Owner's Name: Owner's Address: Date of Inspection: Name of Inspect pleas print) 4' CompanyNe am Mailing Address: Telephone Number: >s -'`� CERTIFICATION STATEMENT 1 certify that I have personally inspected the sewage disposa•l'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 +,F -approved system inspector pursuant to Section 15.340 of Title 5.,--(3.10 CMR 15.000).. The system; Passes Conditionally Passes; Needs Further Evaluation by the Local Approving Authority Fails i Inspector's Signature:. Date:. � '6 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 desig?flow of I0,000 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. o Notes and Comments \ + _ I ****This report only describes.conditions at the time of inspection,and.under.th. conditions;of use at that time.-This inspection does not address"how the system will perform in the future ndeAiAGs"•me or df?fere t conditions of use. TO,;; Title_5 Inspection Form 6/15%2000 page .1 Page 2 of 11_ OFFICIAL INSPECTION FORM NOT FOR 3rO .UNT'AR ASSESSMENTS ° - SUBSURFACE SEWAGE`DISPOSAL SYSTEM INSPECTION FORM` .` PART A CERTIFICATION. (continued) Property Address: Owner Date:of Inspection: . _ )0(0 Inspection Summary: Check A,B,C,D or E/ALWAYS complete.all of Section D A. System Passes: I have not found any information whicli.indicates that any of the failure criteria described in 310:CMR 15.303 or in 310 CMR 15.304 exist.Anv failure criteria.notevaluated are indicated below. Comments:. B. System Conditionally Passes: One or more system components.as described in the`'Conditional Pass"section need to.be replaced or repaired.The system, upon completion of the replacement or repair;.as approved by the Board of Health;will pass. ?. swer yes,no.or not determined(Y,N;ND)in the: for the following statements. If"not determined"please explain. The septic tank is metal and over 20:years old*or.:the.septic tank(whether metal or not)is structurally unsound,exhibits substantial'infiltration or exfiftration or.tank failure is imminent System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the.Board of Health. *A metal septic tank will pass inspection if it is structurally.sound,not leaking and if a Certificate of Compliance . indicating that the tank is less than 20 years old.is available. . ND explain: Observation.of sewage.backup or break out or high static.water,level in the distribution box due to broken or obstruciedpipe(s)or due to a.broken,settled or uneven.distribution box. System will pass inspection if(with. approval of Board;of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than'4 times a year due to broken or obstructed pipe(s).The system will pass inspection if,(.with.approval of the Board of Health): broken.pipe(s),are replaced obstruction ;is removed" ND explain: 3 Pa e of� � it OFFICIAL.INSPECTION FORM-.NOT FOR VOLUNTARY ASSESSMENTS SUBSU]RFACE:'SEWAGE DISPOSAL;SYSTEM INSPECTION FORM PART.A CERTIFICATION(continued) Property Address: Owner• - .,. - o Date of Inspection: , 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 f et of a bordering vegetated wetland or a salt marsh 2. . System will fail unless.the Board,of Health land P.ublic,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 withu%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 of more from a private water supply.well**'Method used to determine:distance "*This system passes if the well water analysis;performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is.free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided thatno other failure criteria are triaaered.A copy of the analysis must be attached to this form. i i 3. Other: i 3 Page 4 of l i QFFICIAL lNSPECTION FORM-NOT FOR VOL IUNTARY.ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM PART CERTIFICATION continued Property.Address: ' 'Owner: Date of Ins ection: P �j D. System Failure Criteria applicable to all`systemsc. 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 c1med 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 Stat1c.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 Required pumping,more than 4 times in.the last year NOT due to closed or obstructed i e s .Number — ..� P P ( ) of times pumped _I/ An onion of the SAS cesspool Q y p spool or privy is below high ground water elevation. J Any portion.of cesspool or. ri , is within 100..feet of a surface water su. l .or tributary to a.surface P v PP y ry water supply. Any portion.ofa cesspool or.privy is within a.Zone 1 ofa.public well. t9 Any portion of a cesspool:or privy is;within 50 feet of a:private water.supply'well:' An portion o. a cesspool or privy is:less than l00 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 a.t..a.DEP certified:laborato y,for colifor.m bacteria and Volatile organic compounds indicates that the.wellis free from pollution from that.facility-and the.presence of ammonia nitrogen and:nitrate nitrogen.is equal.to'or less than 5 ppm,.provided that no..other failure criteria are triggered..A.copy-of.the analysis.must be attached to this form.] }'u/(Yes/No)The system fails.I'have.determined that one or more of the above failure criteria exist as described in3I0 CMR 15:303,therefbre the system.fails.The.system ownershould contact the Board of Health to determine what will be necessary to correct the failure. E. Large:Systems: To be considered.a large system the system must serve:a.facility with.a design flow of 10;000 gpd to 15,000 gPd You must indicate,either"yes" or"no"to each of the following: (The following criteria apply to large-systems in addition to the criteria above) yes no 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 systern is considered a significant threat,.or answered "Yes"in Section D above:the large system*has failed. The owner or operator of an large t g y p . y C system. a significant threat.under Section.E,or failed under Section D`shall upgrade the system in accordance with 3..10 CMR 15.304.The system owner should contact the appropriate regional office of the Department. 4. Page 5 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE�SEWAGE DISPOSAL,>SYSTEM INSPECTION FORM PART B. CHECKLIST r j. Property Address: Owner: Date of inspections i Check if the followine have.been done...You must indicate`yes!or"no'.. as-to each of the followm2. Yes./Na 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 breakout? 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 ofsludge and depth of scum? - C Was the facility owner(and occupants if different from owner)provided with.information.on the proper maintenance of subsurface sewage disposal systems ? F i The size and location of the Soil Absorption System(SAS)on the site has been detertnined based on: Yes nor Existins information.For example, plan at the Board of Health. 7- Determined_ P 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(3)(b)] Page 6 of l I. OFFICIAL INSPECTION FORM. NOT.FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART.C SYSTEM-INFORMATION Property Addessc Owner: Date:of Inspection: FLOW CO ITIONS RESIDENTIAL Number of bedrooms(design). Number of bedrooms(actual)..- DESIGN flow based'on 310 CMR 15 203'(for ample: 11:0 epd'x n of bedrooms): . Number of current residents: , Does residence have a garbage grinder or no): Is laundry on.a;separate sewage system (yes or no);_ .[if yes separate inspection required]' ' Laundry system inspected(y s.or no): Seasonal use: (yes orno): . Water meter readings,if av`ilable(last 2 years usage:(gpd)): Sump Pump(yes or no): ,t Last date of occupancy: COMMERCIAL/IND USTRIAL: U Type of establishment-, . Desigr.flow(based.on310 CN1R 15.203) Qpd Basis ofdesizh'flow(seats/persons/sgft,etc.): Grease,trap present(yes orno);_ Industrial waste:holding tank present(yes or.no):_ Non-sanitary waste discharged to the Title 5 system,(yes or no): Water 'et'r.re'adinas: if available: Last date of occupancy/use: OTHER(describe):. GENERAL.INFORMATION . .Pumping Records.. Source of information: Was system pumped as part of the:inspectio es or no): V If yes,volume pumped: allons—How ,vas quantity pumped determined. Reason`for pumping: ' TYP 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) _Tight tank; Attach a copy of the DEP.approval —Other(describe): i oxim to atue of all components, date installed(if known)w.d source of information:. Were sewage_odors:detected when arriving (Y at the site es or no :. U F 6 Raze 7 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE:DISPOSAL SYSTEM INSPECTION FORM. PART C: SYSTEM INFORMATION(continued) Property Address:p-) 1 ✓ Owner. Date of Inspection: j BUILDING SEWER(locate on site plan) /\A Depth below grade: Materials of construction: cast ion _40 PVC_other(explain): Distance-from private water supply well or suction line: r Comments(on condition of oihts,venting;evidence of leakage, etc.): SEPTIC TANK: (locate on site plan) I� Depth below wade: Material of construction: concrete_metal_fiberglass Polyethylene _other(explain) If tank is metal list age:_ Is age:confumed by a Certificate of Compliance(yes.or no)'._(attach.a copy of certificate) Dimensions: Sludge depth: Cf �+ rr y Distance from top o.f sludge to bottom of out tee or,baffle: r Scum thickness: _ Distance from top of scum to top of outlet tee or baffle`. O!� Distance from bottom of scum to bottom o outlet tee.-or baffle: Z How were dimensions.determined: Comments(on.pumping recommend tions, ' et and outlet tee or baffle condition,structural integrity, liquid levels elated to outlet invert, evi ce ofleakage, etc.): All C) + GREASE TRAP:41ocate on site plan) . Depth below grade:_ Material-of construction:_concrete metal_fiberglass_polyethylene_other (explain):. Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments (on pumping recommendations,inlet and outlet tee or baffle.condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 7 Page 8 of I OFFICIAL INSPECTTON FORM-:NOT FORVOEUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C. SYSTEM INFORMATION(continued) Property Address: Owner• Date of Inspection: . TIGHT or. HOLDING TANK:/1G tank must be pumped at time of ins ection)(locate.on.site plan) ( P P P Depth,below grade: Material.of construction: concrete metal. f berglass_polyethylene 'other(explain)*�, • . k Dimensions: Capacity: Gallons Design Flow:. gallons/day, Alarm present.(yes or no):. Alarm level:. Alarm in working order(yes or no): Date of last pumping: Comments(condition,of alarm and float switches;etc.): DISTRIBUTION BOX:jZif present must be opened)(locate on site.plan) Depth of liquid level above outlet invert:. Comments note if box is level and distributionto..outlet l.an. .evidence of solids carryover,an evidence of ( q Y �' Y age�into or ut o box,etc)° ' PUMP CHAMBERAL_(locate on site plan) Pumps in working.order(yes or no): Alarms in working.order(yes or no):` ~ Comments(note condition of pump chamber,condition of pumps and appurtenances, etc.): Page 9 of 11 .OFFICIAL INSPECTION FORM:—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE`SEW.AOE DISPOSAL SYSTEM I?NTSPECTION FORM PART C. SYSTEM.INFO IMATION(continued) Property Address: Owner Date of Inspection: SOIL ABSORPTIO SY M (SAS): (locate on site plan,.excavation not required) I ASS n t located pl why: Type leaching pits,number:_ leaching chambers,number: leaching.galleries, number: leaching trenches,number. length: leaching fields,-number, dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: E to C is c Comments (no condition of soil, s o�hydraulic failure, level of ponding.v�; damp soil; condition of veagetation; etc.): CESSPOOLS: (cesspool must be pumped as parr of inspection)(locate on site plan) Number and confieuration: Depth--top of liquid to inlet invert: Depth of solids laver: Depth of scum layer: Dimensions of cesspool: Materials of construction: A. Indication of.groundwater inflow(yes or no): . 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.)-- 9 '. r Page 10 of 1.I OFFICIAL INSPECTION FORM-.:NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE'DISPOSAL SYSTEM INSPECTION FORM PART S17STP-TVI INFORMATION(continued) Property Address: Owner: Date of Inspection:: SKETCH OF,SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks..Locate all wells within 100 feet.Locate.where public water supply enters the building. VO & I WO I® epu s c co .10 Page 1 I of 11 OFFIC-IAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM.INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:Q 4 !� Owner: Date of Inspection: . SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to groundwater �� feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of.SAS) Checked with local Board of-Health-explain: Checked with-local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you.established the high groundwater elevation: 're 751/` o u f Date: Permit Number: Completed by: HIGH GROUND-WATER LEVEL,COMPUTATION. Site Location: � r� A /�- Lot No. Owner: Address: Contractor: Address: z/ Notes: STEP 1 Measure depth to water table ffii to nearest 1/10 ft. ...........................................:........I........................... .Date "7 A month/day/year STEP 2 Using Water-Level Range Zone: and Index Well Mapaocate.::_:; site and determine: OA ..,Appropriate index well' .. ..................................... OB Water level range zone.......................................................... rt STEP 3 Using monthly repom Current Water Resources Conditions determine curxent deptkt water.level fDr_mdex�+uelJ_ ....._................... month/year T. STEP 4 UsingTable::of Wafer-level-Adjustments for index:vueII-_(STEP_2A);:current depth to water-le.vel.for-index=well-(STEP 3), and water-level zone (STEP 26) determine.-water-level.:adjustment ........................................................................................:. STEP 5 Estimate depth to high water by subtracting the water- level adjustment (STEP 4) from measured depth to water �u levelat site (STEP 1) ................................................................................................:............ / i j I Figure 13.7Reproducible computation form. 15 I _. _.... s� LOCATION o�EWAGE ,, PERMIT NO. �/ VILLAGE INST l E ,'S NAME i ADDRESS (,t,4- e UILDER \. NER t / DATE PERMIT ISSUED l _,Z' z _ 77 DAT E COMPLIANCE ISSUED CAI Z I� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH S Apphration -fur Biiipwial Works Tomitrurtion Vrrntit Application is hereby made for a Permit to Construct (14 or Repair ( ) an Individual Sewage Disposal System at: ..../ -.r ', .4 "..Ch P._rr!} t.,}/Y�.t.4&1?m(JV �jWe .��4l) I S7 N4'1V4(s Location• ddress or Lot No. 4orY141. --------.Z.adz-�................ .... 3.r_tR_K.c E)...}.. /....................................... W O fh Address ------------ . . . . --- •-•- �' f .h1-- ...,7 .S S . Installer Address a Q Type of Building Size Lot_Sj�.390_Sq. feet UDwelling JC No. of Bedroom's--------- ----------------------_-----Expansion Attic (� Garbage Grinder aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ----- ................................................................................................................................................. W Design Flow............170....................gallons per person per day. Total daily flow...........�3.._d..&._..........gallons. WSeptic Tank—Liquid capacity_ 00_0gallons Length................ Width---------------- Diameter................ Depth_--.-------.---- x Disposal Trench—No..................... Width.................... Total Length.............. ._.. Total leaching area.......-------------sq. ft. Seepage Pit No......./---------- Diameter..........SP....._ Depth below ink et_----- _.__. Total leachil �_.�_. k �} trea.____ sc. it. i Z Other Distribution box ( I ) Dosing tank ( ) 10P_ V � a�C Percolation Test Results Performed by..Q0.!NAl.4_ 1.. .._.__E/y�11y,G', �c'l!f1G Date........................................ Test Pit No. 1................minutes per inch Depth of "Pest Pit.................... Depth to ground water_.---..-_--._-----.--- fZA Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-_._---.._-.__.-_.-.---. 9 ---------------- -----------•------------•------------•-..........•---•------...................--••......................................................... 0 Description of Soil =_ ................................... -------------------------------------------------------------------------------------- U ----------------------------- ....... .... ...--------- ----- -------------------------------------------- W V Nature of Repairs or Alterations—2nsw�er when applicable...------------------------------------------ --•------------------•-••---------------------•-•-----••----•-•-•----•-----------------•--------------•-----------•--•------.-----•---•---•------------------------------•--- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issue by the board o. hea th G Signed......_..... .................. .. . . . . Date Application Approved By----------- / -------------- .p...... ---• = 4---_----- Date Application Disapproved for the following reasons:-------•----------•--------------------•-----------------•-•-•-----------•-••-•---•----------------------------- .........--•----•._.......•-----------------•-------•---...----••---....--•-•-----........_....._._..................-------•--------------•------- ------------•------------••-----------•-------------- / � Date Permit No. Issued. L -�`......----••---•---•-•-- „��� Date No._-- - ,a-- Fs�.... ,�. —� ..... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OP Appliratiun -fur M,npuntt1 Workii Tunntrnrtiun .pant t Applicatiowis hereby made for a Permit to Construct (ko�or Repair ( ) an Individual 'Sewage Disposal System at Location- dress or Lot No - v -------S-'0►-- -,o ..................... ....��- /+ __ '.�", .'e. /� _ _._........ lt n Address ,+ Installer ` Address U Type of Building Size Lot.. 1._, .t_4P Sq. feet Dwelling No. of Bedrooms---------- ............................Expansion Attic (� Garbage Grinder (IV6 aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) w g Other fixtures , gallons- ---- ---------- -------- --------_----- - ----.... ................ W Design Flow........._. AQ ........ ...... allons per person 'per day. Total dailyflow---------- )4 .0......_......gallons' WSeptic Tank—Liquid capacity��pCltons Length................ Width................ Diameter_..._............ Depth------ x Disposal Trench 5 N _ Width } Total Length__________ ____ ___ Total leaching area..-.- sq ft. Seepage Pit No , _ Diameter ........ Depth below inlet___. Total leachil ire......, sq ft. y..,v rr'' z Other. Distribution box ( �) DosinQ tank ( ) �+� r ItSi t� a Percolation Test Results Performed by. 4 w�i�' A1° '.... f ,�' '�et/ Date.......... ._._.... ............... :.. a Test�NPit No. I__F.__:_---------minutes per inch Depth of TestvPit ............... Deptl-io ground water------------- ........... (� Test Pit No. 2..............'.minutes per inch Depth of Test'Pit__________________• Depth to ground water--------------- ------------------------- •..••• ---•-------- O Description of Soil-------- ------ -- -- n R x ----- -------- ------------------------------ U -- ---- ---- •••••- W U "Nature of Repairs or Alteration§' nswer when applicable-------------.-_-----------------------------=----------- ------------------------------------ t, ---------------------------------------- - --=-------------------------------------.---------------------------------------------- Agreement The undersigned agrees.to install the aforedescribed 4ndividual Sewage Disposal System in accordance with the provisions of Article XI of the State-Sanitary Code'-The`:,undersigned further-agrees not to.place the system in . operation until a Certificate of Compliance hasbeentissti by&.board o hea h Signed „ ' +► - ------ _// + •. •• . ----- •-• - Date Application Approved BY • s ......•-•- I Date Application Disapproved for the followin9.,reasons:---:------------------------------------------- ............ =-------------------------------------------------- --- ----------------------------------------------------------------------------------------------- ---------- ;. Date PermitNo......................................................... _ Issued......................`-............................... Date a THE COMMONWEALTH OF MASSACHUSETTS' BOARD OF HEALTH f ` 1 ...........O F. / )..G rp,•, . ........................... .......... V.1.1erfif irittr of 1ToMV1ittnrr THIS I)TP CE IFY, Tha the Individual Sewage Disposal System constructed ( • or Repaired ( ) at 000, has been-installed in accor ance with the provisions of Ark XI of the State Sanitary Code as described in the application for Disposal Works Construction Permit No... _._____� _�....._..__. dated------ .n7............ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM, WILL FUNCTION SATISFACTORY.- DATE --------- Inspector......41-----•--------------------------------•----------------------......:_...._. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . 2 .•... — Bitivn6ttri r �undrnrfion Vamit Permission -s ereby granted_.------ ------ ��e;7ag --------•-----------------------•-----•--•-----------•---------•--------•:.. to Construct . or Re air`( n Individ ral Syst�/�7 ,(�at No.. '`-- y-= =�'-�----N:;,.R•� �- -- ...j - ---- -�1�✓!<-�'-- - --- - '--'�� 2-_.l"----- ---- 40, Sire as shown on the application for Disposal Works Construction Permio.____�- ,__ ,. D ----- "_ .?."7.7----.••. "ice{' 44A f�� �'� -- ---•---------'-•...... ........ DATE = =---------------------------------•-- �, Y� �t-t Ile 4� d f Heal h FORM 1.255 HOBBS & 'WARREN., INC..'PUBLISHERS wy �, qd�S� *. ,» �y, wbj • '�: /� ,M .,.:"•sue } � c A,� ��,� " t yv. �} 'i?`tt _I S�'" t: 1 tt' s. �A. �' J' .,a �" � Y,$ x t'- � � ��•t: �Y „�,P"� V�r s�i k: it iIx ' ' � E.. �AIl1 -'\ ..".•..__ `� % A� „jam ` i' .:�. / 4 ,0 a,i, O,gTl k W.49*7 a F._PT<C 7?9.V.A' J/7 . C4MWAWD srK<9 WiV N�?eQa v AQNs TNgT 17- Vo E p" 7.0 lJ,,rr ARN � fiA , �iWt7 C'�570000 k-''�' r �.:: C/V./L l�,t/ /A,! i�f��E�r / `�j�/pg i` F ' � t i`�•c ' �'�,�:� � 04 �Qi. LA3tV0 .SV@#/*YO �v r, A..'m ^ • 4 .. �. / J ,P� err yl{ T / S 3,..�' '/ ;�, ,rr' \� �/ .Y 'I .. - S �:•A'a r/ �4 J� r 71, 1 JOAs®� / = 4O t�14Yl�: t�� ►---- /, !�O Ci)G. SF_GTr'G 7�J�t/!c' +° f GAT /. �, G> t i, ^�• i-Z r ?-ic1/G3 ll -/O f/ F�'O}! e`T C - /"�/"' `.: _• / //, j JX ,j/ /C f,�c// F/%' l // nF $. @�Q®� CDd7"/IPY TNF7T TNT DV/L.Di.6/� '' �9 �1/Ad OM 9'�I/8 BL/a.V /D L®Q.�51TEt� ON Th/E �a g k � sr,ti+o ww N�e'sow./ �Na T'NgT /r ,., oE� co�vao�ma•s �' +0***,*L OQAA1S OX Tsle `•rOAVA/ of�f)f '^J:;Y:f;�!_` 0� ARNE '#z� 7 Y Ou7ne f�IQ^- eMOt�TN, M,?V5. Bfi TE —._ ,gErr.Ri.va ¢c�✓o� ' 4. ALWAYS DIG SAFE PRIOR TO, CONSTRUCTION--UTILITY LOCATIONS SHOWN INCOMPLETE. ( JOB NO. B-07-01 NOT TO ON DISTRICT WATER LEE.dwg akeb SCALE rn N/F I` 94.92 NO GRADE CHANGES 1. LOCUS IS A.M. 28, PARCEL 66. Rd o 2. ELEVATIONS SHOWN ARE TOWN' GIS ±0.3 6 SAJBAN ARE PROPOSED 3. LOCUS IS IN FLOOD ZONE C ON FIRM DATED AUGUST 19, 1985. o_ 95,00 4. ALL PIPES TO BE 4" SCH 40, AND PITCHED AT 1/4" PER FOOT. (UNLESS NOTED) \ 5 MUNICIPAL WATER IS AVAILABLE.. N \ 6. COMPONENTS TO BE AASHTO H-10, UNLESS NOTED. e och; o t \ BENCH MARK--TOP MAG NAIL SET 7. INLET TEE TO PROJECT DOWN 13", OUTLET TEE DOWN 14": IN PAVEMENT=94.18 TOWN GISf0.3' 8. IF TWO OR MORE LINES, WATER TEST D-BOX FOR EQUAL FLOW oQ�e gay 9s�o o \ D-BOX EXIT PIPES- TO BE LEVEL FOR FIRST TWO FEET. G`�` Poi `�0 \ 9. DEPTH OF COMPONENTS NOT TO EXCEED 3', OR VENTING MUST BE PROVIDED. o \ COVERS: BUILD UP COVERS TO 6" BELOW GRADE--1 ON TANK, 1 ON D-BOX, 2 ON LEACHING 10. STONE TO BE DOUBLE WASHED 3/4 TO 1 1/2" WITH 2" MIN. 1/8 TO 1/2" PEA STONE ON TOP. \\ / 11. IF UNSUITABLE SOILS, OR SOILS DIFFERING FROM THE SOIL LOG ARE FOUND, LOCATION MAP \ CONTACT THE BOARD OF HEALTH, OR R.J. CADILLAC. N/F \ 12. IF AN OVERDIG IS GALLED FOR BELOW, FILL MATERIAL FOR 5' AROUND AND UNDER LEACHING x 94' \ //� IS TO BE CLEAN GRANULAR SAND MEETING SPECIFICATIONS OF 310 CMR 15.255(3). TEST HOLE 1 BURKE d 4, (� c LOT 14 x 95.2 P\ 13. PUMP AND FILL ANY EXISTING CESSPOOLS. REMOVE ANY CLOGGED SOIL, BLOCK, AND STONE IN ON DISTRICT WATER •`�� 1 �J. F. "cps LEACH AREA, AND DISPOSE OF AS DIRECTED BY HEALTH AGENT.TION TO MEET TITLE 5 AND LOCAL REGULATIONS DEPTH (Inches) ELEV.(feet) \ 14. ALL CONSTRUC . x 95,2 0 A layer lOyr 3/2 94.6 ��'`$ `r'•�i\ silt loam 0952 4,1 TEST HOLE DATE: June 6, 2007x9 BENCH MARK-TOP, BACK & CENTER PERFORMED BY: Ron Cadillac, Soil Evaluator3" B1 Layer 10yr 5/4 SEPTIC TANK=93.43 TOWN GISt0.3` WITNESSED BY: Donna Mlorondi, RS 9" silt loam 94,34 PERC RATE: <2'-00 /inch (C layer) B2 layer 10yr 5/6 05.9 x 95.4, \ SOIL SURVEY(1993): Enfield silt loam silt loam , e 94,9 \ GEOLOGIC MAP(1986): Mashpee pitted plain deposits o„ 91.1 { �' \ 96.2 L 0i�94,9 � - 3 5 8 � x O ,�, \ Top Foundation Invert 92.14 66"� C layer 2.5y 6/3 4,9 `L , .k 94,2 2 2 DRY WELLS coarse sand J� �'9-4�7 .Use Gas Baffle _ { x 94.5 ,' Off\ , \ Invert 91.33 90% gravel I Proposed 91.8 =Tod Carte. TH 1 � �� ,� 5 �� x 95,1 \\ -----Existing -- 1 S=1"/ft �� 91.5-Top Peastone x,94, _ 94.0 O &.0 /o, 95.0 x 94. 1000 Gal. S=5/8 /f Septic Tank 1 4.6X \ ---------- 24" no w144" ater 94.5 82.6 95.0 I 95.1 \ Invert 91.50 Invert 91.00 89.0 ����, / \ `� 95.0 94 9 \ 6 Stone or compact Proposed Proposed 6'`I Bottom TEST HOLE 2 + .52 5 2,3 \ ' 6--a 94,2 /� ©i �`� :. SX �0 \ i $ I 1 - 1 6' 0 TH (inches) ELEV.(#ei) ���' 94,95,E `� WELL << o x 4 Bottom TH1=82. DEPTH 94.9 4.5 �� , , G•- ` J5 O 95,2 x 95.1 rn a, r� ca A foyer 1Qyr 3/2 95.0 O� �.� C \ DESIGN DATA 10" Ye ye silt loam �-E �+ 11 layer 1 b 6 4 E E 9 E E 62 ` BEDROOMS: 3 32„ silt loam ,4 >c\94,9 / ::951 +5 �0 GARBAGE GRINDER: No B2 layer 10 5 6 _ �� LEACH AREA >n k, silt loam , �� '••:,- -.=' � REQUIRED CAPACITY. 330 GPO DISCONNECT WELL W�--K 93.4 USE 2 DRY WELLS WITH 4' OF STONE 42" 91.4 94,7 �\ :: / EXISTING SEPTIC TANK: 1000 GAL. �� �� 93.3 ALL AROUND TO MAKE A 25' BY 13' BENCH MARK--TOP WOOD STAKE \ BOTTOM LEACHING AREA: 325 SF C layer 2.5y 6/4 SET FLUSH=94.95 TOWN GIS± 0.3' ys `� `�� PROPOSED WAS SERVICE x 94,8 / / 25' X 13' WIDE 8Y 2' D)=EP LEACH AREA. (�'-s" OFF CORNER of DECK) '�„t `�\ S � `� 95.3 UNDER CONTRACT TO BCI [( )] coarse sand 94,0 / SIDE LEACHING AREA: 1'52 SF ry �\ WATER DEPT ACCNT. 12231 10% gravel Sy \ F �� / // 12(13'+ 25') X 2' DEEP)] 1y. 4.0 O� � DESIGN CAPACITY: 352 GPD [(325 SF + 152 SF) X .74 GPD/SF] INSPECTION SCHEDULE x 94.3 // '' CALL R.J. CADILLAC TO INSPECT PRIOR TO BACKFILL. rro water N/F F / 144,� 82.9 DUARTE tK / /93.04 !�O x 93,5x/93.1 / I \� 93.5� /92,99 3.3 Z/' ON DISTRICT WATER o SITE PLAN FOR /92.64 THIS PLAN IS A VALID COPY ONLY IF IT BEARS AN ORIGINAL RED STAMP AND SIGNATURE. CYNTHIA AND THOMAS LEE LEGEND -\�AoFMgs ��� �FMgs LOT 14v 5 CHOPTEAQUE LANE, MARSTONS MILLS, ALA �- TH 1 TEST HOLE LOCATION, NUMBER �� S�cy ��� 01, W WATER LINE MARKINGS ° RO L ems° 1A �s » > -P PROPOSED WATER SERVICE s J E o AM `� JU N E 89 2007 SCALE: 1 =20 E OVERHEAD ELECTRIC WIRES (IF SHOWN) 10 0 x 9.5 ,8.7 EXISTING & PROPOSED ELEVATIONS ('X' MARKS POINT) G/STERQ- �--6-- EXISTING CONTOUR SgN�TAR�PN �"� SUR\J��° RONALD J. CADILLAC, PLS, RS, P.C. PROPOSED CONTOUR$- Z � 16 C PROFESSIONAL LAND SURVEYOR & REGISTERED SANITARIAN 0 UTILITY POLE (IF SHOWN) El EXISTING DRAINAGE CATCH BASIN P.O. BOX 258 x - FENCE (IF.SHOWN, NOT ALL SHOWN) WEST YARMOUTH, MA 02673 TREE (IF SHOWN, NOT ALL SHOWN) (508) 775-9700 REV. 7/16/07--WATER DEPT. ACCOUNT NO. ADDED HEALTH AGENT APPROVAL DATE @C 2007 8Y [R.J. CADILLAC PAGE 1 OF 1 II'I