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0100 RED OAK LANE - Health
100 RED OAK LANE Marstons Mills A = 127 - 042 i i i I h., r No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: L� PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes application for Disposal 6pstrm Construction permit Application for a Permit to Construct( ) Repair W Upgrade( ) Abandon( ) ❑Complete System W Individual Components Location Address or Lot No.`06A�il Owner's Name,Address,and Tel.No. '?Y f -q0'3•-.,/j f Assessor's Map/Parcel Installer's Name,Address,and el.No. Sc)78.170J-9.�� Designer's Name,Address,and Tel.No. &r' q6 �,2»L y/�--►x�1g51 r'/Jee✓i' L( o KS, is e7esF�re,�. rr R� is oxewg P 4614 vay,if Type of Building: Dwelling No.of Bedrooms 3 Lot Size Y9$9 sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) _ ( gpd Design flow providedy ,7 gpd Plan Date OO��149 U Number of sheets aZ Revision Date Titlelpp000w Size of Septic Tank - Type of S.A.S. Description of Soil lekL U4 Nature of Repairs or Alterations(Answer when applicable) a •�Gl nnnOLS�,Q.D� ��� Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmen l-eo and not to place the system in operation until a Certificate of Compliance has been issued by this Boar f l gned Date l`Z-f ` Application Approved by Date Application Disapproved by Date for the following reasons Permit No. Date Issued IC3) C�_J t s No.r- Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: 1. PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ltlrlcatiDn fOri8tJ08ap8t"eIn Construction Permit Application for a Permit to Construct( ) Repair(, ) Upgrade( ) Abandon( ) ❑Complete System ®Individual Components } Location Address or Lot No.106 641\ 61 , Owner's Name,Address,and Tel.No. �y g -q©-3--a j I( �flwsic ly Assessor's Map/Parcel IA*-fj,"LJ,d �- yt ��r? {.6a a 0 A 9-7[1 2 z ` Installer's Name,Address,and Tel.No. SvS- W?( 1.3�/ Designer's Name,Address,and Tel.No. i� �", �d'X /2 4,2F5{'t'Pv5+r5: �4tr✓5�a�anall"I/6 , M4 c)XV09 a'-vc��sFrf�!�, _ K1A4 V41 Type of Building: o Dwelling No.of Bedrooms ✓ Lot Size V9 S 9 Q sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3-qo gpd Design flow provided �y�, gpd Plan Date /p/d// C? Number ofsheets i Revision Date Title,— Size of Septic Tank!p x;. �r,ry l St:r��13.r tt Type of S.A.S. A(N;t U )fioA Y. 15 Description of Soil 'L,y.,k Lp� • r. , Nature of Repairs or Alterations(Answer when applicable) h�e,��',!'�/!f.111�L�.t� c��n ,�.`"i�� � l�7� ©Gt i�.k�FN A�'r, � d�F'[�1""`• 1.e i( r y>�d ru ./aP��`i'ta�11 1 R ��/'.MP.?'11,J A''1�" � - Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental-�a and not to place the system in operation until a Certificate of Compliance has been issued by this Board of HealtFl~.-- S'griied Date /ZZZ �'� Application Approved by ��. - � " Date / Application Disapproved by Date for the following reasons Permit No. Date Issued /C3) XC* `3J - THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFFY,that the On--site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned )bey - ol- at /D(a � -���i�75'lt�•��s .��-.- . �'rt iF} �GP9 `Y r ,��.,�' l has been constructed in accordance u y„ �` with the provisions of Title 5/and the for Disposal System Construction Permit No}�.�:rrK a.---'��dated J'/c�I,�� Installerl/'�'4 j171 ��nn /—fi s_`ZPt A_a. Lr)(_ Designer�A*II vrnn l>r • �11)1_1>` _4_) ✓_141A'_ - r _ � #bedrooms w e Approved.desgn flow ,s. gpd The issuance of this permit shall not be construed as a guarantee,"that the sys m will functio�'°de) Date /t Inspector`'.�►_.,./ I r ; No�� �t " fir Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal *pste Construction Permit 1-11 Permission is hereby granted to Construct Repair Repair(' ) Upgrade( ) Abandon( ) System located at f�f/ - Z and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. / Date f _/��� �° j Approved by f JAN-25-2021 23:55 From: To:15087906304 Pa9e:1/1 Town of Barnstable Regulatory Services g Richnrd V.Scan,Interim Director � tutswsrnstr. e Public Health Division Thomas McKean,Director 200 Mnin,Strect,Hyannis,NA 02601 Office- 508-862-4644 Fox: SOS-790.6304 Installer&Designer Certification Form Date: - Zz�Zl Sews a Permit# 070 d0-'7O6 Assessor's Mapftrcel I Z -7 ' D q Z K4,_ M C IE-- Designer: — „��e�-. Inc, installer: !/-c��a�6f Address: JZ Wi Cis-P�,ld 1ZA Address: S In dt1.S+ry 12V cJt2�Y� On 4 �d (. ��cS�-- was issued a permit to install a (date) /� (installer) septic system at 6 0 12p- do U &Ale based on a design drawn by (address) �I►9i rt t3¢rr�c� dVojA,&,lk( dated • . � (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. Strip out (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. Strip out(if required)was inspected and the soils were found satisfactory. I certify-thri—th—e-Tyitern referenced above was constructed mi with the terms fthe IAA pproCal letters(if applicable) N �y nstaller's Sipature) NO V L� 0 • ate`.' I"" .. '�atszE�` (Designer's Signature) (Affix Desi'p ere) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILT- NOT BE ISSUED UNTIL Warm H THIS FORM AND As_ BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. tl:'Septi:tuesigner Certification Form Rey 8.14-13.doe Engineors note:This certification is limited to an ae•buUt inspection of system component;as Installed prior to backfill.The enpineer did not supeMse construction of the system.The installer assumes responsibility for all materials,workmanship,baddiIGng to specified grades with proper compaction and setting deerslcovere as shown on the deelgn plan Town of Barnstable Inspectional Services Department � MAS& � Public Health Division 6:59- o " 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4988 1746 June 12, 2020 CAMPBELL, LYNNE ANTHONY 4506 WAYNE ROAD CORONA DEL MAR, CA 92625 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 100 Red Oak Lane, Marstons Mills, MA was inspected on 05/14/2020 by Michael T Bisienere, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Leaching facility with standing liquid level at or above the invert pipe (per Town Code 360-20 h). You are ordered to repair or replace the septic system within two (2)years from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. das RDER OF TH BOARD OF HEALTH c ean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\100 Red Oak Lane Marstons Mills.doc tMf T Town of Barnstable BARNSrmim 6 9. ,�� Inspectional Services Department Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 4/26/19 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An "x" marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ❑ Structurally unsound septic tank or SAS ONE (1) YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box is above the outlet invert due to an overloaded or clogged SAS or cesspool ❑ A portion of the SAS, cesspool, or privy is below the high groundwater elevation ❑ A portion of the cesspool is located within a Zone 1 to a public well ❑ A portion of the cesspool is located within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2) YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any "conditionally passed systems" (broken cover, relocation of a pipe, relocation of driveway due to H-10 components, etc) eaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER Repair deadline: Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc ; S C i vp c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments • 100 Red Oak Lane f&II-7-© Y-2 Property Address Lynne Campbell Owner Owner's Name information is A� Q required for every 3 O N es ry 1 v[1& MA 02668 05/14/2020 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. Inspector Information filling out forms p on the computer, use only the tab Michael T Bisienere key to move your Name of Inspector cursor-do not Cape Septic Inspections use the return Company Name key. Rivers End Road Co � Company Address Teaticket Ma. 02536 City/Town State Zip Code 508-280-3356 S13938 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ❑ Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ® Fails 05-14-2020 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 has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments . 100 Red Oak Lane Property Address Lynne Campbell Owner Owner's Name information is required for every West Barnstable MA 02668 05/14/2020 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 2) 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): t5insp.doc-rev.7/2 61201 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 100 Red Oak Lane Property Address Lynne Campbell Owner Owner's Name information is required for every West Barnstable MA 02668 05/14/2020 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 100 Red Oak Lane Property Address Lynne Campbell Owner Owner's Name information is West Barnstable MA 02668 05/14/2020 required for every i page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 18 Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 100 Red Oak Lane Property Address Lynne Campbell Owner Owner's Name information is required for every West Barnstable MA 02668 05/14/2020 page. CitylTown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® 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 1/2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system asses if the well water analysis, performed at a DEP certified Y P Y laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ® ❑ The system 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. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of.a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 100 Red Oak Lane Property Address Lynne Campbell Owner Owner's Name information is required for every West Barnstable MA 02668 05/14/2020 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered"yes"to any question in Section C.5 the system is considered a significant threat, or answered"yes" to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form ` Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 100 Red Oak Lane Property Address Lynne Campbell Owner Owner's Name information is required for every West Barnstable MA 02668 05/14/2020 page. City/Town State Zip Code Date of Inspection D. System Information 1. 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 plus GPD Description: Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail Sump pump? ❑ Yes ® No Last date of occupancy: occupied Date t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 'v 100 Red Oak Lane Property Address Lynne Campbell Owner Owner's Name information is required for every West Barnstable MA 02668 05/14/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. 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 Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: 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: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 100 Red Oak Lane Property Address Lynne Campbell Owner Owner's Name information is required for every West Barnstable MA 02668 05/14/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 24"feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line. 100 plus feet Comments (on condition of joints, venting, evidence of leakage, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 100 Red Oak Lane Property Address Lynne Campbell Owner Owner's Name information is required for every West Barnstable MA 02668 05/14/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank (locate on site plan): Depth below grade: 12 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: H-10 1500 gallon Sludge depth: 4" Distance from top of sludge to bottom of outlet tee or baffle 32" Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 5" Distance from bottom of scum to bottom of outlet tee or baffle 13" How were dimensions determined? sludge judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): I recommend the new owner put the septic tank on a maint. plan with a local septic pumping co. based on the future use of the home. At the time of inspection the liquid level was at working level and the baffle was in place. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form < Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 100 Red Oak Lane Property Address Lynne Campbell Owner Owner's Name information is West Barnstable MA 02668 05/14/2020 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 100 Red Oak Lane Property Address Lynne Campbell Owner Owner's Name information is required for every west Barnstable MA 02668 05/14/2020 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): At the time of the inspection the liquid level was at working level and there were no visible signs of leakage. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 100 Red Oak Lane Property Address Lynne Campbell) Owner Owner's Name information is required for every West Barnstable MA 02668 05/14/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 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: t5insp.doc-rev.7/26/2018 I Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 100 Red Oak Lane Property Address Lynne Campbell Owner Owner's Name information is required for every West Barnstable MA 02668 05/14/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): The leaching pit was full at the time of inspection. 12. 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 Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 100 Red Oak Lane u� Property Address Lynne Campbell Owner Owner's Name information is required for every West Barnstable MA 02668 05/14/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 13. 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form < Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 100 Red Oak Lane Property Address Lynne Campbell Owner Owner's Name information is required for every West Barnstable MA 02668 05/14/2020 page. Citylfown State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately C)'j t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Well D C Driv ewa Y } A B O O A B C D 1 27'9" 42' 2 32'10" 47'6" 3 397' 5712„ 3 4 7716" 106'6" Well 67'2" 78'4" 4 i Commonwealth of Massachusetts Title 5 Official Inspection Form t Subsurface Sewage Disposal System Form - Not for Voluntary Assessments - 100 Red Oak Lane Property Address Lynne Campbell Owner Owner's Name information is required for every West Barnstable MA 02668 05/14/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 10 plus feetfeet 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: I augered a hole at a lower elevation and shot it with a transit, Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwea'Ith of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 100 Red Oak Lane Property Address Lynne Campbell Owner Owner's Name information is required for every West Barnstable MA 02668 05/14/2020 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspe.,tion Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist)completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 No. W .U•� ��j �a�j Fee ' BOARD OF HEALTH TOWN OF BARNSTABLE 01ppricatiou jFor Veft Cow5truction Permit Application is hereby made for a permit to Construct Alter( ), or Repair( ) an individual well at: r.. Location-Address Assessors Map and Parcel Vtl AI CLI M avlo-e 44. Owne / �7c e� � (� oel- Installer-Driller Z— Address Type of Building Dwelling f Other-Type of Building No. of Persons Type of Well u Capacity Iv 4At' Purpose of Well 3119"19-4z- Agreement: The undersigned agrees to install the afore described individual well in accordance with the provisions of the Town of Barnstable Board of H r' to Well Protection Regulation-The undersigned further agrees not to place the well in operation until a Ce 'ficate Co an as been issued by the Board of Health. Signed Date Application Approved By c _ 3^11-1-114& IQ S Date Application Disapproved for the following reasons: �,� C Date J Permit No. "" °2�� — 60- Issued -3 Date ------------------------------------------------------------------------------------------------------- BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Compliance THIS IS TO CERTIFY,that the individual well Constructed( ), Altered( ), or Repaired l by at tuo ^ n 6 "A K `9- ,^Installer has been installed in accordance with the provisions of the Town of Barnstable Board of H altb Private Well Protection Regulation as described in the application for Well Construction Permit No. Dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Date Inspector ` No. Fee I�? � BOARD OF HEALTH 01,p.i 6 TOWN OF BAR-NSTABLE 2pplicatiou -for Yell Cou0tructiou Permit Application is hereby made for a permit to Construct, Alter( ), or Repair( ) an individual well at: 19pic -7 �2— Location-Address z Assessors Map and Parcel nl k1 r? 1'77,Q Al1C`�•tilA Owner Address v —r�, /��Z�:� �/1 c �c��I/G �tr, 01 �DK -��.3�i ,�1.t: l` 1. y26� Installer-Driller ( Address Type of Building / Dwelling ✓ y Other-Type of Building No. of Persons 0 Type of Well �6 I i Capacity A) Cy/.,tif Purpose of Well^12/11�� Agreement: The undersigned agrees to install the afore described individual well in accordance with the provisions of the Town of Barnstable Board of Health-Prrvge Well Protection Regulation-The undersigned further agrees not to place the well in operation until a Certificate of Compliance has been issued by the Board of Health. Signed Date Application Approved By c I (�—•S ^�� • (6 Date Application Disapproved for the following reasons: �_ ) Date Permit No. �'v °i Ol ( — 6 0.5 Issued 3 " Date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Compliance THIS IS TO CERTIFY,that the individual well Constructed( ), Altered( ), or Repaired(� by _ Installer at I f� �l �., yl has been installed in accordance with the provisions of the Town of Barnstable Board of H alth Private Well Protection Regulation as described in the application for Well Construction Permit No. Dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Date Inspector BOARD OF HEALTH TOWN OF BARNSTABLE Derr �Cou�tructiou PermitNo. �a0��D�'b�"� Fee L/5 Permission is hereby granted to Installer to Construct( ), Alt.r( ), or Repair ) an individual well at: No. //J� Street �� ) a0'/b_ 06 57 as shown on the application for a Well Construction Permit No. '"' ated Date "" 'L�`� Approved By 7�r E r may. T ofiPS. VA 7P0,v �•,��- /CrO/r. S� 'G9 MAI o /✓gyp i z , I g FV III `o - o CA 7" ASSESSORS MAP NO: PARCEL K 2__ r. No................_....... Fps........ .................... THE COMMONWEALTH OF MASSACHUSETTS ----BOARD OF HEALTH / N� --•.... ............... ............... .OF......-....................-.......... �...... Appliration for Uiipoo�i1 Works onitrur#inn rrmit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System atA ------------------------------�� ------------..........------------------------------ ... .... Location•Address ® . Lot N ......................-...-- -- ................................................ ....................40. o caner Ars .fd -•--•-•..A .... .......A .. � .......................a Installer Address dType of Building Size Lot...1:.._���?�_ST. feet Dwelling—No. of Bedrooms.......................................Expansion Attic ( ) Garbage Grinder Other—Type of Building ..k)D.-0'�-!_-n.___...... No. of persons............................ Showers ( ) — Cafeteria ( ) a Other fin tur s • •-•-••--•-----••••-------•----••-•••......---•- . --- W Design Flow....... .... ••• -......••••--gallons per person per day. Total daily flow_..._ • ..................gallons. W Septic Tank—Liquid capacity.I _._.. . Length................ Width---------------- Diameter---------------- Depth................ x Disposal Trench—No. ................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.__.. .tC(,0 Dia ter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date---------------------------------------- aTest Pit No. 1_ '_ -minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ .................................. ••--------•-•- . ..................-•••----••-•--••-•--.....-•---••......................••- O Description of Soil ! _ ,C_- ........ -- ... T ................................. �— U --------------------------------------- ----------------•---------•-•------------•-------....--------...------------------- --- ------------------------- ------••-•----•----------------------- W ••-•-••-•-------------------••-----•--------------•------•--------••••--•--•-----._....--•-••-••-••--••-------•-----•--••--------•--•-•-•--••-••--••-•••-••••-•-----------....---••-••-•-•--•-.....--•- UNature of Repairs or Alterations—Answer when applicable............................................................................................... .-•------•-•••-------------••------••-•••-•••---•••-••••-•...•---•-•-•-••--•- -•._.......-•---•-••••••....._....-----•--•••-••-------•-••-•••••••--••-•••----•-•--•-•••---•--•••-•-••-............•--••- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITIZ 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance ha een ' ed y the board of health. S ..................•-•.-•-•..�•-"`�•�- -2••-_•••. ig - --•-- i�� -- Date/_ Application Approved BY --•------/ '6 °°'... Date Application Disapproved for the following reasons:----•-----------•-•----•------------•---------------------------------------•---•-•------•-••--••••••.....•..... -------------•-•--------•--•------•------------•-•--•---••-•...-•------------•--------...•..--------------••••--••---•-••••-----•---•-••••••---...-----•------•-••------•-----•-----------•--••-•---•-- Date PermitNo......................................................... Issued....................................................... Date ) 2— No `20( Fps.....'.�... ... THE COMMONWEALTH OF MASSACHUSETTS .--B•OA R D OF HEALTH ...OF............. ...............------------------------------------------------------= Appliration for B44poii al or"or omitrnrtinn anti# Application is hereby made for a Permit to Construct ( ) Repair ( ) an Individual Sewage Disposal System i�j 1.KE7 0 5.........ene -e................................... Location.Address p ��°°�r Lot Nlo,�a .... . . ..... _..Z as 0 N ........./ OOC E 1.l.�!4 .....Y.1.fgCY/dn/ !!L�!SS..... e,. �tt �wner ddress ............................. •.................. ......................................................... Installer Address d Type of Building Size Lot_./_:_.�:�`:.:.s{:._:Sq-feet U Dwelling—No. of Bedrooms.__..�?.....................................Expansion Attic ( ) Garbage Grinder per, Other—Type of Building .i;!) ............ No. of persons............................ Showers ( ) — Cafeteria ( ) PaOther fixtures --------------- -•--•-------... ----------------------------------------- ------- Desi n Flow........... .... W g Z.. ..............gallons per person per day. Total daily flow------- >, . gallons. WSeptic Tank—Liquid capacityf_k _gallons Length................ Width---------------- Diameter---------------- Depth................ x� Disposal Trench—No. .................... Width.................... Total Length_............._..... Total leachingarea....................sq. ft. Seepage Pit No Diameter.................... Depth below let................... Total leachigarea..................sq. ft. Z Other Distribution box Dosing tank1-4 ( ) Percolation Test Results Performed by.......................................................................... Date........................................ ,aj Test Pit No. 1:15;- -minutes per inch Depth of Test Pit.................... Depth to ground water........................ 14, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a .............................•--•-•------------•----------•----•-----------.--- O Description of Soil tN�j-- � j- 1 = --�-�......'.... -� -----••-------------------=•---- x � . . .. c, W ••---------------------------------••---•--------------•---=--------•--•-------•-•-•---•••-•-------•----••----•----------------------••--•-----•---------------------•------------•------------•-------- UNature of Repairs or Alterations—Answer when applicable------------------------------------------------------------ ..---------•-----------------------------------------------•------------------------....................-•....----------•--------•---•-•--••-••-----•--••-•--••--• .................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in.accordance with, the provisions of T I T .;,;. y g g p y 5 of the State Sanitary Code—The undersigned further agrees not to lace the system in of health.operation untila Certificate o ComplianceXha. een s�e - y the board - Date ApplicationApproved BY..................................-------- ----------" --........................... - bat e f Application Disapproved for the following 'reasons-...........................-•--•--------------------------------------------------......-•-------•--------••--- -------•--•..........................•-........---....---•----r•-- • ---------•-----•----•.................••---•--------•------••--•------•••--•••-------------•--------•----•----------------•-•-.-•--- ' E • Date 2 . .. PermitNo.................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..: .ti.............OF.............. ' ��L ...................._.............. �rrtif�rtt#r oaf f�unt�li�anrr THIS IS R,TIFY, That the Individual Sewage Disposal System constru-te ) or Repaired ( ) I L' :{C's /� •--------------------•-•--------------•---------•----•-•-----------------------•----•-----•-••----•-•----•-- Installer has been installed in accordance with the provisions o / if The State Sanitary Code as described in the- application for Disposal Works Construction Permit No_______________�_____-2........... dated _,.(�_{ ''�____..._.......... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.....................�..._._Y..:...... 7...-----•----.._..... Inspector------ ......................... =''7 _ — a - ---- Z THE COMMONWEALTH OF MASSACHUSETTS ------ • BOARD OF HEALTH ........ .......OF..................1� .................... NoNo...................I...... FEE..._:... �......... d - �i���a��t1- � k� �an��rnr�ilan .erutit P o �`c: f�` Q C.n Yg to C br�pair (, tkdivi L ge Dise System _ atNo......................................................................................................... w.��.'..!d! ! s t as shown on the application for Disposal Works Construction Perm o.-?.C�............. Date �.% � ................ —� is ---------------- `-� _ Board of Health -�`"" DATE.......6 " = FORM 1255 HOBBS & WARREN. INC.. 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Department of Environmental Management/Division of Water Resources WATER WELL COMPLETION REPORT WELL LOCATION Address IdTl3 City/Town / sJ/T?7L�- G.S.Quadrangle Map Grid Location Owne[ Address WELL USE CONSOLIDATED WELL Domestic Public❑ Industrial❑ Type of Waterbearing Rock Other /�� Water-bearing Zones Method D � 11 From To rilled 4 - 21 From To Date Drilled Zl 3) From To -- 4) From To CASING a Depth to Bedrock Length ,7, / Diameter Typo. _ �" UNCONSOLIDATED WELL STATIC WATER LEVEL Waterbearind Materials Feet below land surface ®� Sand: fine❑ medium❑ coarse❑ Date measured L �' Gravel: fine❑ medium❑ coarse❑ GRAVEL PACK WELL Screen: r SIot*/O length,"from to�� Yes ❑ No ❑ Split Screen for 2nd screen! WATER UALITY TESTS MADE Slot it length from to Chemical Biological Depth To Bedrock PUMP TEST Drawdown feet after pumping days hours at GPM. How measured Recovery feet after hours, LOG of FORMATIONS COMMENTS:(On well or water! Materials From To �r ®r DRI LER ,c«s l Firm L Address-!I, City To> Registrati No. ILI 727 �. perator'sSignature { Ceaseprint firmly ^ f 15M-2 84-176471 i i OFFICE LABORATORY '%1498 HIGH STREET 176 PLYMOUTH STREET BRIDGEWATER, MA 02324 BRIDGEWATER, MA 02324 OLIVEIRA ENVIRONMENTAL LABORATORIES, INC. FOOD- DAIRY PRODUCTS-WATER-WASTEWATER CHEMICAL Er BACTERIOLOGICAL ANALYSES 697-26W April 28, 1987 Pioneer Pump Company 21 Spinnaker Drive Plymouth, Mass. 02360 Source: Well Water - Drilled Well - (4 inch PVC Well) - 130 feet deep —producing 8 gals/min. Located on the property of Mr. Don Schutte - Lot 13 - West Barnstable, Mass. Coliform Count /100 ml @ 35 C 0 Membrane Filter S.P.C./ml @35C L 1 Color (APC units) 0.00 Sediment none Turbidity (NTU) 0.33. Odor none Taste satisfactory pH 5.50 Specific Conductance micromhos/cm 95.0 mg /liter Total Alkalinity (CaCO3) 7.00 Free CO, 43.3 Total Hardness (CACO,) 18.0 Calcium (Cal 5.60 Magnesium (Mg) 0.98 Sodium (Na) 9.90 Potassium (K). 2.14 Total Iron (Fe) 0.07 Manganese (Mn) 0.10 Silica (SiO,) 7,20. Sulfate (SO,,) 9.00 Chloride (Cl) 20.0 Nitrogen - Ammonia 0.18 Nitrogen - Nitrite 0.00.7. Nitrogen - Nitrate 3.25 Copper (Cu) On site collection made by the Pioneer Pump Co.- 4/21/87 at 3:00 P.M. Sample delivered to laboratory by Mr. David Klein of the Pioneer Pump Co. - 4/22/87 at 7:15 A.M. Bacteriologically, this well water. is of a satisfactory sanitary standard and is suitable. for drinking and domestic purposes. Chemically, this well water is high in manganese content. All other chemicals tested meet the standards. - . Director L 1 Y The Standard-Plate Count indicated the general bacterial population of the well at the time of collection. Coliform Group Bacteria: Significance The coliform group bacteria includes organisms found in the intestinal tracts of warm blooded animals, birds,decaying organic matter(hay, leaves, wood, etc.), the top 2 to 3 feet of the soil, lakes, ponds, brooks, rivers, drainage and types of vegetation. Because the organisms can cause some illness; because the presence of coliform organisms in the water suggests that other more harmful organisms may be present, water containing one or more coliform group bacteria per 100 ml of sample should not be used for drinking or cooking purposes unless boiled 5 minutes or disinfected by other means. This bacteria is of animal origin(intestinal tract)and may be considered as closely associated with disease causing organisms. On this factor, none should be present. Color — APC Units- Ground water ought to be practically free from color. For attractive water - color should not exceed 15 units. Turbidity — NT Units- Recommended limit not to exceed 5 units. Odor Et Taste — For water to be of high quality, the water should be odor free and taste good. _H — The pH value defines the concentration of free hydrogen ions in solution. Expressed on a scale extending from 0 or very acid to 14 or very alkaline with 7.0 being neutral. Specific Conductance — Conductivity is a good criterion for measuring the degree of mineralization and assessing the affect of diverse ions on chemical equilibria. Total Alkalinity — The alkalinity of this water represents its content of carbonates and bicarbonates. Free Carbon Dioxide — Well water having a low pH and a Free CO, level in excess of 50. mg/I will be corrosive to iron, bronze, brass and copper tubing and fittings. Total Hardness — Standard not to exceed 50. mg/l. Waters having a hardness level of 50 to 100 are in the medium hardness range, over 100 very hard. Calcium -- Calcium contributes to the total hardness of water.Appreciable amounts of calcium salts break down on heating and form scale in boilers, pipes and cooking utensils. Magnesium — Magnesium is a common constituent of natural water. Magnesium and calcium ions are principal contributors to water hard- ness. Concentrations in excess of 125 mg/I can exert a cathartic and diuretic action. Sodium — Recommended limit not to exceed 20 mg/l. Potassium — Potassium concentrations in drinking water seldom exceed 20. mg/I. Total Iron — Standard not to exceed 0.3 mg/I. Manganese — Standard not to exceed 0.05 mg/I.The principal reason for limiting the concentration of manganese is to reduce esthetic and economic problems. Silica — Silica content of natural water is most commonly in the 1 to 30 mg/I. Silica in water is undesirable because it forms difficult to remove silica scales. Sulfates — Standard not to exceed 250 mg/l. Chloride — Standard not to exceed 250 mg/I. Nitrogen — Ammonia is present in variable concentrations in many surface and ground waters. Its occurrence in ground water is generally a result of natural reduction processes. Nitrogen - Nitrite — Nitrite in water poses a health hazard, but fortunately seldom occurs in high concentrations. Waters with a nitrogen - nitrite concentration over 1 mg/I should not be used for infant feeding. Nitrogen - Nitrate — Standard not to exceed 10. mg/I. Nitrate, in high concentrations can and do cause methemoglobinemia or so-called nitrate poisoning in infants.Water with 10 or more mg/I of nitrate is unsatisfactory and is not considered safe for drinking or cook- ing. It is especially dangerous to children and should never be used in infant formulas. Copper — Standard not to exceed 1.0 mg/l. CERTIFICATE OF ANALYSIS P e: 1 of 1 'ram ti'r•, -1 M; Barnstable County Health Laboratory (M-MA009) iA) 9ss�c��yCc^' Report Prepared For: Report Dated: 7/8/2015 Anne E. Anthony Order No.: G1588034 -� 100 Red Oak Lane m%table, MA 02668 �-- --.. ' Laboratory ID#: 1588034-01 Description: Water-Drinking Water Sample#: Sample Location: 100 Red Oak Lane W. Barnstable, MA Collected: 07/01/2015 Collected by, Received: 07/01/2015 Test Parameters ITEM RESULT UNITS RL MCL METHOD# ANALYST TESTED NOTE Manganese 0.052 mg/L 0.025 0.050 ?# SM 3111 B LAP 7/7/2015 Routine ' ITEM RESULT UNITS RL MCL METHOD# ANALYST TESTED NOTE . Nitrate as Nitrogen ND mg/L 0.10 10 EPA 300.0 LAP 7/1/2015 Copper ND mg/L 0.10 1.3 SM 3111B LAP 7/7/2015 Iron 1.42 mg/L 0.10 0.3 SM 3111E LAP 7/7/2015 pH 7.4 PH AT 25C NA 6.5-8.5 SM 4500-H-B DCB 7/1/2015 Sodium 63 mg/L 2.5 20 SM 3111E LAP 7/7/2015 Total Coliform Absent P/A 0 0 SM 9223 RG 7/1/2015 Conductance 310 umohs/cm 2.0 EPA 120.1 DCB 7/1/2015 Sodium level is above the maximum contaminant level. Those on a low sodium diet may wish to consult a physician. The water may present aesthetic problems(taste, odor, staining)due to Iron. Approved By: Attached please find the laboratory certified parameter list. pp (Lab Director ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605, �.r (n 4 — — N 49'37'41" W -- Lw \I — = - -0* - - - - - 272.09' 4 N L4 o — — - - o 1 0 _ �� _ D — c'� rrl -z-T T— — ITI r— I 1 � � - -- �� � H W 1 ° (z - - - --9 — Zu - -&ubD — N L1 -00 (I ZZI Z — ID Vn- SA •,��' w o �-4 _ Z N I X 0+ •� \ S�, m OD ra 01 + ` _ I >C N — X010ID _ N WZ O 0 ;Ux10 t-T' N 9 I O \ �� N N \� � O X I v Pt = � rri I a�1 it if r-Y-1 U) F- 0€ `c°(o GA T �— -4-34- 01 w o,p :ti; � � I 1 1 N +� + m / r�• bD 01 dw I :j.d � W ' a '� o N / I J CA j A ' ...:-. X O.' A ON I10 X r m -0 m m00 X � I v r7 H/ '' '�` M^ m M Z X ;u X X 01 0 * 0 (n0 c m 0 o z / •O Z r • o r- Z -4 —+ 0 / oc) c X c D X m m o Ww O N m 01 N o 1 I A I I co�uoy�� Z 9�f I occnv _ P 0m I I ocv 0 c,+<m ~ rn r^ Tr n ot; i i I DD� o m-� a mz- m I z S11�5 _z,�w I u o m w ' i D �� I ._., ID D VFW tMte" Cl) LD(p p o N N Engineering by: SCALE DRAWN Job. No. PROPOSED SEPTIC SYSTEM UPGRADE PLAN Engineering Works, Inc. 1~=3o' P.T.M. 294-20 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET No. 100 RED OAK LANE MARSTONS MILLS MA (508) 477-5313 10/21/2 P.T.M. 1 of 2 Prepared for: Lynne Campbell, 4506 Wayne Rd, Corona Del Mar, CA ,. NOTE: TO PREVENT, BREAKOUT, THE PROPOSED Q FINISH GRADE SHALL :NOT BE < EL:122.5 GENERAL NOTES: Z SEPTIC TANK FOR A DISTANCE OF 15' AROUND THE L PERIMETER OF THE S.A.S. Q o INSTALL RISERS & COVERS OVER INLET 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL AND SET TO 6" OF FINISH GRADE. PROPOSED D-BOX PROPOSED S.A.S. I BOARD OF HEALTH AND THE DESIGN ENGINEER. ' PROVIDE ONE ACCESS MANHOLE TO WITHIN 3" 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS a� CELLAR FLOOR EL.=130.8t INSTALL WATERTIGHT RISER & OF FINISH GRADE FOR INSPECTION PURPOSES OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE W (n T.O.F.=137.94tt COVER SET TO 6" OF GRADE I CHARCOAL LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW: Q J F.G. EL.=133.Of F.G. EL.=125.Ot VENT -310 CMR 15.405(1)(b): LOCAL UPGRADE APPROVAL Q -_� o F.G. EL.=132.5t F.G. EL.=128.0t TO 127.6f . 1) A 3' variance to the 3' maximum cover requirement, for up to w p 6' of max. cover. S.A.S. shall be H-20 and vented. U MAINTAIN 2� GRADE (MIN.) OVER S.A.S. (' j 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR a Z TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE L = 20' L = 5' DESIGN ENGINEER. SCH4 (MIN.) SCH4 (MIN.) 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING c • a"scHao PVC 4"SCHao PVC FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN a 6., W aB� � a® ENGINEER BEFORE CONSTRUCTION CONTINUES. X y 14" s" aaaaaaa 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. as®a®aa EXISTING 48" LIQUID 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF �- � LEVEL ADD 4' 4.8' 4' THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF W GAS BAFFLE INV.=125.17 PROPOSED INV.=125.00 HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. INV.=130.13t D-BOX EFFECTIVE,WIDTH = 12.8' L�J - INV.=122.00 7. WATER SUPPLY PROVIDED BY PRIVATE WELL. U Z (FIELD VERIFY) H-20 EXISTING SEPTIC TAN 2-500 GALLON WITH CHAMBERS B. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S. g K INSTALL INLET TEE SURROUNDED WI H STONE AS SHOWN 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS V"J 0 AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE H-20 RATED DIRECTED BY THE APPROVING AUTHORITIES. N Q TOP CONC. ELEV.=123.1 t C 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY 0 C BREAKOUT ELEV.=122.50 THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING J INV. ELEV.=122.00 NOTES: ---- CONSTRUCTION. W 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE aroma® aaBaaa 1 1. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS 0 W `o BOTTOM ELEV.=120.00 0 INVERTS, PRIOR TO INSTALLATION. IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND w ��EFFECTIVE 2 X 8.5'=17.0' 4' � -p 2) D-BOX SHALL BE SET LEVEL AND TRUE TO GRADE 4' MIN. OF NATURALLY OCCURRING REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). 0 (D ON A MECHANICALLY COMPACTED SIX INCH CRUSHEDPERVIOUS MATERIAL LENGTH = 25.0' 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE `v 5' MIN. ABOVE GROUNDWATER INSPECTED BY HEALTH DEPARTMENT PRIOR TO BACKFILL. STONE BASE, AS SPECIFIED IN 310 CMR 15.221(2). .LEACHING. SYSTEM SECTION � � � 3) INSTALL INLET & .OUTLET TEES AS REQUIRED. BOTT. OF TP-2, EL.=114.3 - 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND d IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY. 4) CONTRACTOR SHALL INSTALL A GAS BAFFLE ON THE I 3/4" TO 1-1/2" DOUBLE p o N OUTLET TEE. WASHED STONE o cV z z I t o 3-DOUBLE WASHED STONE2" N � `- SEPTIC SYSTEM PROFILE (OR APPROVED FILTER FABRIC) 3 0 D_ U � SOIL LOG EXIS77Nc DESIGN CRITERIA HOUSE(#too) N DATE: OCTOBER 9, 2020 (REF# TPT-20-212) T.O.F.=137.94 NUMBER OF BEDROOMS: 3 SOIL EVALUATOR: PETER McENTEE'PE(SE#1542) ~ N GARAGE SOIL TEXTURAL CLASS: CLASS I WITNESS: DAVID STANTON R.S. .HEALTH AGENT cvi) Z o 0 DESIGN PERCOLATION RATE: <2 MIN/IN ELEV. TP-1 DEPTH ELEy. TP-2 DEPTH r- (0.74 GPD/SF LOADING RATE) DECK 126.0 0" 125.8 0 cv DAILY FLOW: 330 GPD 125.6 FILL 5" 125.4 e FILL 5„ o DESIGN FLOW: 330 GPD A A GARBAGE GRINDER: NO LOAMY SAND LOAMY SAND P. 125.0 10YR 4/2 12" 124.8 10YR 4/2 12" CJ1� ��+ V o LEACHING AREA REQUIRED: (330 GPD) = 445.9 SF L,o 4� B B .74 GPD/SF LOAMY SAND LOAMY SAND EXISTING SEPTIC TANK: 1 500 GALLON CAPACITY 123.2 10YR 5/8 34„ 10YR 5/8 v, ^• � PROPOSED DISTRIBUTION BOX: 1 INLET, 3 OUTLETS C 123.1 32" 36"/54' C k Q v USE 2-500 GALLON LEACHING CHAMBERS IN SERIES P RC SURROUNDED BY DOUBLE WASHED STONE ON ALL SIDES FINE SAND FINE SAND 2.5Y 7/3 2i5Y 7/3 `P. S.A.S. SIDEWALL AREA: 2(12.8' + 25.0') X 2 = 151 .2 S.F. BOTTOM AREA: 12.8' x 25.0' = 320.0 S.F. ��25�� N' o, W o 'n TOTAL AREA:..............................................................471.2 S.F. 114.5 138" 114.3 I 138„ c U n NO GROUNDWATER, PERC RATE: <2 MIN./IN. DESIGN FLOW PROVIDED: 0.74 GPD/SF(471 .2 SF) = 348.7 GPD SOILS IN "C" HORIZON ARE CONSISTENT WITH SEPTIC LAYOUT 00 0 REFERENCE PERC TEST, 12/21/84, (P-3889) w W to ifj I i 2,9 IF 4 ILI a _ ° So.a : R /5-0o (,AZ. 5.77 g�7S 3�.00 _ k✓1 5l��"E%Sf f� .S E' 7"eAc'/t = F=3o S =/5; '2= , , I ? . IP�' IG:�t i `::..� ,4✓ - f i U f'3�c I L L 0 W / © G ',r f'fr y i x' L�'r. " " /°f , -31 s S•' T t r 3 D , � I fir LpT /3 RAJ -- fvl i �• 1 1. S£P i a�S Y.s 7',�'/'? St//�-«.~ .c�"x fi r'a .'�r `�.�'[t - LV/Tf{f"`ifbSS. 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