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Home My WebLink About0116 SADDLER LANE - Health 'i 1.6 Balkan e' Marstons Mills h= 151 - 054 P w .I I _ � II f TOWN OF BAMSTABLE LOC-."'PN SEW # VILLAGE - S S11 S�& INS"';iLLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY V LEACHING FACILrN: (type � (size) NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: // G3 IO Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facili (If any wAlands exist within 300 feet of leaching facility) Feet Furnished by a � 4.:,;.......:.Y'C:,.1„.,.#._.a.c"Fext... s., �'.•1 E . :1 ,ti-L,.u. .JT...n................ ......-.+ •�r`f.1..# S4� ,!'Ply. Y � ...« ♦. �",KC;.�r�:+','.6w�AK.r:�-:«�',i...,�,.,.%.��n�3�:::,..::..,.,.:.'.. ..,:w:.».�..a-q.:'�r��r,nare;.-:w�L.�t�..a•�.i....r..,*r 'r.f�V,),�.k� .wrsibf......... r4..,:.,.„�..•JF��w......src-..x:...:...tin:«s::.♦w. ..._ ..a..�� al X "Jt.:i..,,.«»..ar_;._.:....m..Lw.m.r.cr:.:...t.z..xR....z..•......-.:c.� .8�.�.. . _TOWN OF BARNSTABLE LOCATION i i o SEWAGE# VILLAGE L�. ('_(IA't"" IESSOR'S MAP&PARCEL {SI-OS4 INSTALLER'SS NAM E&PHONE NO. .L (- 6 ��1- 3_�y6j SEPTIC TANK CAPACITY A:-:-X i f Pr i ctbC7 LEACHING FACILITY: (type) (size) 1 NO.OF BEDROOMS c�' Est- •LE l��c. " OWNER s IJL. PERMIT DATE: 160 COMPLIANCE DATE: Separation Distance Between the: T Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) -& Feet FURNISHED BY S�Jdj�'� 3 I� t t3�l-� �-`Z 6°� • No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - OWN,OF BARNSTABLE� MASSACHUSETTS T ftpliLation for Vspo8al *pstrm Construction Permit Application for a Permit to Construct( ) Repair N) Upgrade( ) Abandon( ) ❑Complete System Individual Components Location Address or Lot No.Jf/, Saddle_r 4n Owner's Name,Address,and Tel.No.CcG$ �;IX°- /: I Assessor's Ma /Parcel ,t'S .}l'%,,,CAeA_ 33 �r�l Qrebf M, P / O T OCP443 Installer's Name,Address,and Tel.No.Sdd=�7J_g 3 Designer's Name,Address,and Qock�i C�v�s�l d'v iCh.tt-vac -15M4)AvC_E-ry Rk_) + (2a ff i�i �1✓�e• �r3Y/ i7�5t• r, oat 6 Type of Building: 2 Dwelling No.of Bedrooms ✓ Lot Size a�� Co (O " sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 33 U gpd Design flow provided g gpd Plan Date j pm. )�j 'a ba I Number of sheets / Revision Date Title!4 f 6 A J-e_ Oet,nz4 1/1, SA r/n, to,Ang"_f/ Pf Size of Septic Tank C°)(i'S4/'P 4 /U/'pOLe Type of S.A.S.49-141G�jn r rS Description of Soil 'k,sE hole Nature of Repairs or Alterations(Answer when applicable) -11 v a _5` X 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 Enviro a Co d not to place the system in operation until a Certificate of Compliance has been issued by this Board o at . Si Date ®� a— Application Approved by Date Application Disapproved by Date for the following reasons Permit No. O Date Issued �t, — l N' S. . f`-. 4 a q � :. •- ,� ti•..A� '1,'ti .:N - :a -, t�.. f= .. J,t w .`yy •... No. Fee kTHE COMMONWEALTH OF.MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION TOWN OF BARNSTABLE, MASSACHUSETTS [pplitatlon for Disposal Apstrm Construction 3permit <" Application for a Permit to Construct( ) Repair d Upgrade( ) Abandon( ) [:]Complete System ©Individual Components Ra. Location Address or Lot No.��U 5a V le r-en Owner's Name,Address,and Tel.No. r f}I1sar�Gv�-122. �33 Cour�.l Ct�S� ,ice• �i Assessor's Map/Parcel/5i �ps ` tI �..�, 07 of,vu 3 I ` Installer's Name,Address,and Tel.No. lei-`7rJ)�-�/3 9 Designer's Name, Address,and Tel.No. QofWatt � 'Sig"vc -iCn,rLi,C '151i uS�►'ifl�C-� tUr? 1 ' �if►�E'�rfxf t1r�t. `i lG //7st' a'�`1ctYS�'n��a i,4!'!i'��c. ��tt� UAW� 1.f`i�n• r>�� ,D ✓^�- utsl f.=� OF,<„ .5' Type of Building: Dwelling No.of Bedrooms ✓ Lot Size :201 to�TC� " sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) .'�•3 3& gpd Design flow provided �j 9 gpd Plan Date- Rr"c'" ) - ),aNumber of sheets / `t: Revision Date Title?:alp _-, -e' r9a,-,,4_ III, SAI&P k 1/' !.t).AJIOAic 41u . 114 Size of Septic Tank C°x�"S /r�^ /!!/�Y� Type of S.A�S.-9-41b xCa•;�,�,G(� mh�/S oZ5 l,x I �13 VJ Description of Soil,")®n �S� Nature of Repairs/or Alterations(Answer when applicable)//- ,- ,�4v- A fk, r V 'y j-��/11) (% /i 1, if/�f/1,tti! `s i✓I 4 dJ`/x� �1) /i/ .dF�AA,6Si.,�ii.A�+"�lc-�(. i y/ieyrfl!'/f//slriJ,�t'fFt1� J,r' t�lr �t t?e fl 4,dn7.de,1 ..96 Date last inspected: f / - 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 Environm_ental C�d and of to`place the system in operation until a Certificate of Compliance has been issued by this Board of ieali Signe ~""'""" Date Application Approved by / Date -7 Pff Application Disapproved by / Date for the following reasons Permit No. O;L f! 0 Date Issued 1 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Cirtifirate of Compliance - THIS IS TO CERTIFY,that th'e On-site Sewage Disposal system Constructed( ) Repaired( s� Upgraded Abandoned ( ) O l � J / b y 1 Y�„�, � rr� at `�(� /��lrl�� r) ltl. /.� has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.` 0?r' '(dated `} / Installer(1� � f.�,sc�✓i_ /_�Ci��i'), _ ,�i( Designer '.4.60),n /_ & #bedrooms Approved design flow r d > gpd The issuance of this permit shall not be construed-as a guarantee that the system will function as designed. Date Inspector .------- _----- -- .-- { No. r, , Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Bisposal 6pstem Construttion Permit Permission is hereby granted to Construct( ) Repair(/) Upgrade( ) Abandon( ) System located at f /Q ,i,nji^I�i°✓ /rt OA/ ,'i� ?� Ale, o _ f 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. �.•-+- _�� Q Date a� `t Approved by � V FEB-27-2021 01:56 From: To:15087906304 Pa9e:1/1 Town of Barnstable Inspectional Services Public Health Division AS Thomas McKean,Director 0 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form Date: Sewage Permit# /•O V/ Assessor's Map\Parcel 15 64 Desi er: Down C �01C. Installer: arkaiao Address: 931 90O f'OA Address: y.Armovt . Pat , NSA �15 A ozo I On a-//- P ,1 was issued a permit to install a (date) (insta ler) I septic system at 11 U Sadd(g tarkt, 1b. egffWJW1based on a design drawn by (address) A. P6 dated I 01•_��' '-L_• (designdr) 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 l 0' lateral relocation of t&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 follo-�. Strip out(if required)was inspected and the soils were found satisfactory. I certify th. he-sy referenced above was constructed in co' plianee with the to rms of the prov etters(if applicable); ��<} I"0F''gsq' , h UANIEL A, 46 OJALA y CIVIi. y (Installer's Signature) x�\p �Nn 40502o O�S CST6 S�UNAL G�1 (Designer's Signature) Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION .CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORMA AS- BUILT ARE RECEIVED BY THE BARNSTAB E PUBLIC HEALTH DIVISION. THANK YOU. WoaldeplANEALTMSEWER eonnec(%sBPTIMesigner cenifica►lon Fann Rev W-13.00c I Town of Barnstable THE Inspectional Services Department ` B"' & MAS& ' Public Health Division 1639. 0 ram" 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4987 8289 December 28, 2020 RICE, RANDALL J & CUTLER, ALISON B 133 LAUREL CREST ROAD MADISON, CT 06443 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 116 Saddler Lane, Marstons Mills, MA was inspected on 12/01/2020 by Frank dunes III, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the s--ptic 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. PER ORDER OF THE BOARD OF HEALTH mas Kean, R.S., CHO �t Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\116 Saddler Lane Marstons 1 Mills.doc ��Try tpjyti BARS M Town of Barnstable 039. ,.� Inspectional Services Department rfa ru•'�" 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 a driveway due to H-10 components, etc) Leaching 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 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 116 Saddler Ln. Property Address Cutler Owner Owners Name information is required for every West Barnstable Hk MA 02668 12/1/20 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. A. Inspector Information sl l5 0�'3 Frank Nunes III Name of Inspector saa Company Name Box 841 Company Address East Falmouth MA 02536 Cityrrown State Zip Code 508.272.6433 13010 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 12/1/20 Inspecto 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 e Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 116 Saddler Ln. Property Address Cutler Owner Owner's Name information is required for every West Barnstable MA 02668 12/1/20 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.7/26/20111 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts ,ip Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 116 Saddler Ln. Property Address Cutler Owner Owner's Name information is required for every West Barnstable MA 02668 12/1/20 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if 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.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 I Commonwealth of Massachusetts �n (o Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �e u 116 Saddler Ln. Property Address Cutler Owner Owner's Name information is required for every West Barnstable MA 02668 12/1/20 page. Citylrown 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 ® El clogged 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 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 116 Saddler Ln. Property Address Cutler Owner Owner's Name information is required for every West Barnstable MA 02668 12/1/20 page. Cityrrown 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 Y2 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 passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ® ❑ The system 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 16 Commonwealth of Massachusetts (P Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 116 Saddler Ln. Property Address Cutler Owner Owner s Name information is required for every West Barnstable MA 02668 12/1/20 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 116 Saddler Ln. Property Address Cutler Owner Owner's Name information is required for every West Barnstable MA 02668 12/1/20 page. Cityrrown 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 Description: 3 bedroom permit and engineered plan on file Number of current residents: 3 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 Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 160 GPD 9 ( Y 9 (gP ))� Detail 2018 67,000g and 2019 50,000g Sump pump? ❑ Yes ® No Last date of occupancy: occupied Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts 6g Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 116 Saddler Ln. Property Address Cutler Owner Owner's Name information is required for every West Barnstable MA 02668 12/1/20 page. Cityrrown 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: Pumped january 2020 per owner Was system pumped as part of the inspection? ❑ Yes ® No I 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 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 116 Saddler Ln. Property Address Cutler Owner Owner's Name information is required for every West Barnstable MA 02668 12/1/20 page. Cityrrown 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: Existing septic tank new pit 1996 with old pit left in place Were sewage odors detected when arriving at the site? ❑ Yes ❑ No 5. Building Sewer(locate on site plan): Depth below grade: 18"feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: >10'feet Comments (on condition of joints, venting, evidence of leakage, etc.): 15insp.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 u 116 Saddler Ln. Property Address Cutler Owner Owner's Name information is required for every West Barnstable MA 02668 12/1120 page. CityrTown 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) H-10 tank appears to be structurally sound If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000g Sludge depth: 6" Distance from top of sludge to bottom of outlet tee or baffle >12" Scum thickness trace-1/4" Distance from top of scum to top of outlet tee or baffle >2" 1 >2 Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form �- Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u 116 Saddler Ln. Property Address Cutler Owner Owner's Name information is required for every West Barnstable MA 02668 12/1/20 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 ipumping 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 (o Title 5 Official Inspection Form �e Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 116 Saddler Ln. Property Address Cutler Owner Owner's Name information is required for every West Barnstable MA 02668 12/1/20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ 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.): D-box was video inspected and appears structurally sound, it is 20" below grade t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �o 116 Saddler Ln. Property Address Cutler Owner Owner's Name information is required for every West Barnstable MA 02668 12/1/20 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: 2 ❑ 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 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts �a Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 116 Saddler Ln. Property Address Cutler Owner Owner's Name information is required for every West Barnstable MA 02668 12/1/20 page. Cityfrown 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 pit depicted as"C" is the original pit which had failed in 1996 it was not inspected, the pit depicted as"D"was installed in 1996 and it is in a state of hydraulic failure, effluent was up and into the riser 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.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 l Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 116 Saddler Ln. Property Address Cutler Owner Owner's Name information is required for every West Barnstable MA 02668 12/1/20 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.7/2612 01 8 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 116 Saddler Ln. Property Address Cutler Owner Owner's Name information is required for every West Barnstable MA 02668 12/1/20 page. Cityrrown 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 1 C'-2,C t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments •t,: 116 Saddler Ln. Property Address Cutler Owner Owners Name information is required for every West Barnstable MA 02668 12/1/20 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: >156"feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 1996 NGW 156" 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: See above 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 116 Saddler Ln. Property Address Cutler Owner Owners Name information is required for every West Barnstable MA 02668 12/1/20 page. Cityfrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 ZVI ~ BORTOLOTTI CONSTRUCTION,INC. A,Y 1996 765 WAKEBY ROAD,MARSTONS MILLS,MA 02648 � A 508-771-9399 508-428-8926 FAX:.508-428-9399 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property'Address: z0ower-, GcJ�S'oL .FJk Date of Inspection: —.25--9 Inspector's Name: &:v4 C/. ' Owner's N and Address: / � wive e4 CERTIFICATION STATEMENT, I certify that I have personally inspected the sewage disposal system at this address and tharthe informs- lion reported below is true`,:accurate and complete as of the time of inspection.The inspection was per- formed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The System: '` Passes MOORS a �- Conditionally Passes PARC7.N(k ,olNeeds Further Ev tion Local Aproving Authority Fails Inspector's'Signature: Date: f � r, The System Inspector shall submit a copy of this inspection report to the Approving.authori_ty within thin ty(30)'days of completing this.inspections:If the system is a shared system or has a'design flow of 10,000 gpd or'greater;:the inspector and the system owner shall submit the report to the appropriate regional office of the Department.of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer;if applicable and the approving authority. . INSPECTION SUMMARY: A)SYSTEM.-PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. I .fit B)SYSTEM CONDITIONALLY.PASSES; One or more system components need to be replaced or repaired. The system;-upon comple- tion of the.replacement or repair,passes inspection. Indicate yes,nor,or•not determined(Y,N,OR ND).Describe basis of determination in all instances. If "not determined",explain why not. R`•\ The'septic tank is'metal,°cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent. The system will pass inspection if,the existing sep tic tank<isreplaced with a conforming septic tank as approved by The Board of Health.' Sewage backkup or breakout or high static water level observed in the distribution box is due to broken or'obstructed pipe(s)or due to a broken,settled or uneven distribution box. The system will pass inspection if(with approval of The Board of Health): -1 - I .— SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Broken pipe(s)replaced Obstruction is removed Distribution Box is levelled or replaced The System required pumping more than four 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 Qbstruction is:removed 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 t the public health safe .and the environment, o rotec ty is.failin t ,;< <�the system. g P. P '1)SYSTEM WILLTASS'UNLESS BOARD OF HEALTH DETERMINES THAT THE -.:SYSTEM IS NOT,FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC,HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 Feet of a surface water •Cesspool or privy is within 50 Feet of a bordering vegetated wetland or a salt marsh. 2)SYSTEM WILL FAIL UNLESS.THE BOARD OF HEALTH (AND,PUBLIC WATER tt SUPPLIER,IF APPROPRIATE)DETERMINES THA T THE SYSTEM IS FUN CTION- ING IN A MANNER`THAT PROTECT THE PUBLIC HEALTH AND SAFETYAND THE; ENVIRONMENT: . L The system has.a septic tank and soil absorption system and`is,. ithin.100 Feet to asurfacerx "K �' water supply or tributary to a surface water supply.. The system has a septic tank and soil absorption system and is with a,Zone I of a publicf wateusupply well. The system has a septic tank and soil absorption system and is within 50 Feet of a private 4 water supply well. The system has a septic tank and soil absorption system and is less than 100 Feet but 50> <.t Feet or more from a private water supply well,unless a well water analysis for coliformrw bacteria and volatile organic compounds indicates that the well is free from°pollution'from the facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, D)I M FAILS: �{ r'. I have determined that the system violates one or more of the following failure criteria as defined,- x b in 310 CMR 15.303. The basis for this determination is identified below4,,T.he,Board'of'Health'41b 5 shou,0116C contacted to determine what will be necessary to.correct the failure. of sewage into facility or stem component due to an overloaded or clogged SAS Backup g h' system P or cesspool. D' charge or ponding of efluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid.level in the distribution box above outlet invert due to an overloaded or clog- ".i lged.SAS,or cesspool. Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 8 day flow.. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s): Number of times pumped -2 , 5'fi:, 4i .J SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a 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 I of a public well. Any portion of a cesspool or privy is within 50 Feet of a private water supply well. Any portion of a cesspool or privy is less than 100 Feet but greater than 50 Feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E)LARGE SYSTEM FAILS: The following criteria apply to a large system in addition to the criteria above:. The design flow of a system is 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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. The.owner or o rator of an.such stem shall bring the stem and.facili mtolulL com hance with the .. Pe. -Y sY g system h'� P groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Check if the following have been done: _i/Pumping information was.requested of the owner,occupant,and Board of-Health. _L/None of the system components have been pumped for atleast two weeks and the.system has,, .been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. _"As-built plans have been obtained and examined. Note if they are not available with N/A. I/The facility or dwelling was inspected for signs of sewage back-up. _ The system does not receive non-sanitary or industrial waste flow. /The site was inspected for signs of breakout. t_All system components,excluding the Soil Absorption System,have been located on site. r/The septic tank manholes were uncovered,opened,and the interior of the septic tank was,m spected for condition of battles or tees,material of construction,dimensions,depth otliquid, depth of sludge,depth of scum. __jZrhe size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. -3- - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST(continued) V The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Subsurface Disposal System SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ' PART C SYSTEM INFORMATION FLOW CONDITIONS RESIDENTIAL- Design Flow: nllons.:Number of Bedrooms: � Num�be�r of Current Residents: Garbage Grinder:• Laundry Connected To System: Veeg Seasonal Use: Water Meter Readings,if a •lable: Last Date of Occupancy: �- COMMERCLAIJINDUSTRIAL: Typed Establishment: Design Flow: gallons/day Grease Trap Present: (yes or no) f: Industrial Waste Holding Tank Present: Non-Sanitary Waste Discharged To The Title V System: Water Meter Readings,If Available: Last Date of Occupancy: OTHER: Describe) Last Date of Occupancy: GENE NFORMATION PUMPING RECORDS and source of informatio /yi 7 Cal �8 System Pumped as part of inspection: If yes,volume pumped: ' >;alions Reason for pumping: TYPE O YSTEM: eptic Tank/Distribution Box/Soil Absorption System Single Cesspool Overflow Cesspool Privy Shared System(If yes,attach previous inspection records,if any) Other(explain): k AI) P OXIMA E AGE of all components,date irSstalled(if known) d source of information:. ewage odors�detec ed when arriving at the site: d -4- ;I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C GENERAL INFORMATION (continued) SEPTIC TANK: Depth below grade: / Material of Construction: concrete metal FRP Other (explain) - Dimisions: Sludge Depth: Scum Thickness: ZP Distance from top of sludge to bottom of outlet tee or baffle: 3 Distance from bottom of scum to bottom of outlet tee or baffle: 2 '. Comments:(recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid . level inflation to outlet invert,ktfqctural integrity,evidence of leakage,etc.) //017, tL 66M e4'A z2o .L. .--,V '71-tcU n r:.. Ors Q 'i) ee°a�—�/�iiJ i/! GREASE TRAP:AeA Depth Below Gra e. Material of Construction:_concrete_metal_FRP_Other (explain) Dimensions: Scum Thickness: Distance from top of scum to top of outlet tee or baffle: Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage,etc.) „ < TIGHT OR HOLDING TANK: Depth Below Grade: Material of Construction:_concrete_metal_FRP_Other(explain) Dimensions: Capacity: gallons Design Flow: gallons/day Alarm Level: y, Comments: (condition of inlet tee,condition of alarm and float switches,etc.) `R t . i i,. DISTRIBUTION BOX: Depth of liquid level above outlet invert: Comments: (note' evel and dist 'button is equal vidence of solids carryover,evidence 9f leakage into or out of etc. /)Actc�/"' ® x PUMP CHAMBER: Pump is in working order: Comments: (notp condition of pump chamber,condition of pumps and appurtenances,etc.) -5- V SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) SOIL ABSORPTION SYSTEM(SAS): —Z (Locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present,explain: Type: . Leaching.pits,number:Leaching chambers; number: Leaching galleries,number: Leaching trenches,number,length: .Leaching;fields,number,dimensions: :, '�Overflow cesspool,number Comm is (note condition ofsoil; si o hydraulic f 'lur le of ponding,conditio of vege on, CESSPOOLS: 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(cesspool must be pumped as part of inspection) Comments: (note condition of soilk, signs of hydraulic failure, level of ponding,condition of vegetation, , ; etc.) f,.. r PRIVY: ri Materialstt*construction: Dimensions: Depth of Solids: ; Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.) s r k -6- J SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) SKETCH OF SEWAGE DISPOSAL SYSTEM: Include ties to atleast two permanent references, landmarks or benchmarks. Locate all wells within 100 Feet. C3 1 7v' C i DEPTH TO GROUNDWATER: Depth to groundwater: 3 Z Feet Me od of etermination or Apppro 'mation: -7- Commonwealth of Massachusetts Executive Office of Environmental Affairs Dept. of Environmental Protection • One winter Street,Boston,Ma. 02108 John GrAd D.E.P. Title V Septic Inspector P.O. Box 2119 Teaticket, MA 02536 WILLIAM F.WELD 64-6813 Governor ARGEO PAUL CELLUCCI Lt.Governor Pn6_4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM'o f J+c r0 PART A o'by� L CERTIFICATION NOV 1 3 Property Address: 116 SADDLER LANE WARAWASTABLE MAP 151 PAR 054 L55Address of Owner: TM20FBMNSTABLE Date of Inspection: 9/23198 (If different) - NWHDEPT. Name of Inspector: JOHN GRAM SANDRA PILNICK;14 SHIRLEY POINT CENTERVILLE MA.02632 I am a DEP approved system inspector pursuant to Section 15.340 of Title%(310 CMR 15.000) r Company Name,Address and Telephone Number: E CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: x Passes This Inspection le based on criteria defined In This V Conditio a Passes code 310 CMR 16.303.My findings are of how the system Is performing at the time of the Inspection.My inspection does — Needs ,ta er Evaluation By the Local Approving Authority not Imply enywarrantyor guarantee ofthe longevity ofthe Fails septic system and any of its components useful fife. Inspector's Signature: Date: 1016/98 The System Inspector shai submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspections. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer,if applicable and the approving authority. INSPECTION SUMMARY: Check A, B, C,or D: A] SYSTEM PASSES: x I have not found any information which indicates that the system violates any of the failure criteria defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: B] SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair,passes inspection. Indicate yes•no, or not determined(Y. N,or ND). Describe basis of determination in all instances. If "not determined",explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Co7hpiiance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,whether or not metal, is cracked,structurally unsound, shows substantial infiltration or Fxfiltration, or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 007)97) One Winter Street • Boston,Massachusetts 0210E a FAX(617)556-1049 • Telephone(617)2925500 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 116 SADDLER LANE W.BARNSTABLE MAP 151 PAR 054 L55 Owner: SANDRAPILNICK;14 SHIRLEY POINT RD.CENTERVILLE MA.02632 Date of Inspection:9123198 — Sewage backup or,hreakout or high.static water level observed.in.the distribution box is due to a broken. or obstructed pipe(s)or due to broken,settled or uneven distribution box.The system will pass inspection if (with approval of the Board of Health). Describe observations: broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced —The system required pumping more than four 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 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 the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: — The system has a septic tank and soil absorption system and is within 100 feet to a surface of water supply or tributary to a surface water supply. — The system has a septic tank and soil absorption system and is within a Zone 1 of a public watersupply well. — The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. — The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presense of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method usedto determine distance (approximation not valid) 3)Other D] SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage in facility or system component due to an 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 resspool, SAS is in hydraulic failure. (revleed 04R7197) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 116 SADDLER LANE W.BARNSTABLE MAP 151 PAR 054 L55 Owner: SANDRA PILNICK;14 SHIRLEY POINT RD.CENTERVILLE MA.02632 Date of Inspection:9/23198 D]SYSTEM FAILS(continued) 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). Numbers of times pumped Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 1 of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: The following criteria apply to large systems in addition to the criteria: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 04127)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECLIST Property Address: 116 SADDLER LANE W.BARNSTABLE MAP 151 PAR 054 L55 Owner: SANDRA PILNICK;14 SHIRLEY POINT RD.CENTERVILLE MA.02632 Date of Inspection:9123199 Check if the following have been done:YOu must indicate either"Yes"or"No"as to each of the following: _c_ — Pumping information was requested of the owner, occupant,and Board of Health. x None of the system components have been pumped for at least two weeks and the and the system has been receiving normal flow rates during that period. Large volumes of water have not been Introduced into the system recently or as part of this inspection. x — As built plans have been obtained and examined. Note if they are not available with N/A. x — The facility or dwelling was inspected for signs of sewage back-up. x — The system does not receive non-sanitary or industrial waste flow. -x— — The site was inspected for signs of breakout. x — All system components, excluding the Soil Absorption System, have been located on the site. x The septic tank manholes were uncovered, opened,and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid,depth of sludge,depth of scum. x — The size and location of the Soil Absorption System on the site has been determined based on The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal Systens. x Existing information. Ex. Plan at B.O.H. x Determined in the field(if any failure criteria related to Part C is at issue, approximation of distance is — — unacceptable)[15.302(3)(b)) (revised WNW) l SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 116 SADDLER LANE W.BARNSTABLE MAP 151 PAR 054 L55 Owner: SANDRA PILNICK;14 SHIRLEY POINT RD.CENTERVILLE MA.02632 Date of Inspection:9123198 FLOW CONDITIONS RESIDENTIAL: Design flow: 3w g•p•d./bedroom for S.A.S. Number of bedrooms: 3 Number of current residents: U Garbage grinder(yes or no): No Laundry connected to system(yes or no): Yee Seasonal use(yes or no): No Water meter readings,if available:(last two(2)year usage(gpd): rda Sump Pump(yes or no): No Last date of occupancy:JANUARY1998 COMMERCIAL/INDUSTRIAL: Type of establishment: nla Design flow:U gallons/day Grease trap present: (yes or no) No Industrial Waste Holding Tank present:(yes or no) No Non-sanitary waste discharged to the Title 5 system:(yes or no) No Water meter readings,if available: n!a Last date of occupancy: nla OTHER:(Describe) rda Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: rda System pumped as part of inspection: (yes or no)No If yes,volume pumped:0 gallons Reason for pumping: rda TYPE OF SYSTEM x Septic tank/distribution box/soil absorptions system Single cesspool Overflow cesspool Privy Shared system(yes or no) ( if yes, attach previous inspection records, if any) I/A Technology etc.Copy of up to date contract? Other: APPROXIMATE AGE of all components, date installed(if known)and source information: ORIGINAL SYSTEM 131986 WITH NEW PIT INSTALLED IN 1996 Sewage odors detected when arriving at the site: (yes or no) No (revised MUST) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 116 SADDLER LANE W.BARNSTABLE MAP 151 PAR 054 L55 Owner: SANDRA PILNICK;14 SHIRLEY POINT RD.CENTERVILLE MA.02632 Date of Inspection:9123198 SEPTIC TANK: x (locate on site plan) Depth below grade: 8" Material of construction:x concreate metal FRP Polyethylene_other(explain) If tank is metal, list age ria . Is age confirmed by Certificate of Compliance No (Yes/No) Dimensions: L8'6"H5.7"w4'10" Sludge depth:3" Distance from top of sludge to bottom of outlet tee or baffle: 3V Scum thickness:3" Distance from top of scum to top of outlet tee or baffle:5" Distance form bottom of scum to bottom of outlet tee or baffle: 15" How dimensions were determined: MEASURED Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND.RECOMMEND PUMPING EVERY TWO YEARS. GREASE TRAP:_ (locate on site plan) Depth below grade: Na Material of construction: concrete metal FRP Polyethylene_other(explain) Dimensions: rda Scum thickness:rda Distance from top of scum to top of outlet tee or baffle:rda Distance from bottom of scum to bottom of outlet tee or baffle: ria Date of last pumpingn- Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles,depth of liquid level iri relation to outlet invert, structural integrity, evidence of leakage, etc.) rda BUILDING SEWER: (Locate on site plan) Depth below grade: 14° Material of construction:_cast iron x 40 PVC_other(explain) Distance from private water supply well or suction IineYOWN Diameter: Na r,amments: (conditions of joints,venting,evidence of leakage, etc.) (revised 0Q7)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 116 SADDLER LANE W.BARNSTABLE MAP 151 PAR 054 L55 Owner: SANDRA PILNICK;14 SHIRLEY POINT RD.CENTERVILLE MA.02632 Date of Inspection:9123198 TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade: rda Material of construction:_concrete_metal_FRP_Polyethylene_other(explain) Dimensions: we Capacity: rya gallons Design flow: Na gallons/day Alarm level:_4 Alarm in working order?_Yes_No Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) Na DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: Na Comments: (note if level and distribution is equal, evidence of solids carryover,evidence of leakage into or out of box etc.) Na PUMP CHAMBER: (locate on site plan) Pumps in working order:(yes or no)No Alarms in working order(yes or no)Ye: Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) Na (ravleed 04127)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 116 SADDLER LANE W.BARNSTABLE MAP 151 PAR 054 L55 Owner: SANDRA PILNICK;14 SHIRLEY POINT RD.CENTERVILLE MA.02632 Date of Inspection:9123199 SOIL ABSORPTION SYSTEM (SAS):x (locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present,explain: rda Type: leaching pits,number: 2.1000 GALLON LEACH PITS leaching chambers, number:We leaching galleries, number: nla leaching trenches, number,length: n!a leaching fields,number, dimensions:nla overflow cesspool, number:nla Alternate system: rda Name of Technology._rda Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) THE LEACH PITS ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY.THE LEACH PITS WERE EMPTY AT THE TIME OF THE INSEPCTION,NEW PIT HAS NOT HAD MORE THAN V OF WATER IN IT. CESSPOOLS: (locate on site plan) Number and configuration: rda Depth-top of liquid to inlet invert: nla Depth of solids layer: Na Depth of scum layer: Ma Dimensions of cesspool: r0a Materials of construction: Ma Indication of groundwater: rda inflow(cesspool must be pumped as part of inspection) rda Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) Ma PRIVY:_ (locate on site plan) Materials of construction: rda Dimensions: Na Depth of solids: rda Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) rds (revised 04127)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 116 SADDLER LANE W.BARNSTABLE MAP 151 PAR 054 L55 SANDRA PILNICK;14 SHIRLEY POINT RD.CENTERVILLE MA.02632 9123198 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references, landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) C Q 111 V> 3 L0 J f� �4 11 37 (revised04)27197) Paya ! of 10 I F SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 116 SADDLER LANE W.BARNSTABLE MAP 151 PAR 054 L55 SANDRA PILNICK;14 SHIRLEY POINT RD.CENTERVILLE MA.02632 9123199 Depth of groundwater 12. Please indicate all the methods used to determine High Groundwater Elevation: Obtained from design plans on record. Observation of Site(Abutting property, observation hole, basement sump etc.) Determine it from local conditions Check with local Board of Health Check FEMA Maps Check pumping records Check local excavators, installers X Use USGS Data Describe in your own words how you established the High Groundwater Elevation.(MUST be completed) USGS MAPS AND CHARTS (revlced0412T197) page 10 of 10 L 7 Wu E / GLLST�fZ •'DEVELOQ, 7 l`� l yI ,5 � 9v �� I�EfJLSc,T�nN �! t -7, C-5 I fa�j Ic / S !a+TFA ( r1 S l rsuH•,Jtrr ��j/. ?>lzEAK00-r 6= Or0923 41 SITE PLAN LOCUS: I'v Il REF: down cope e/!�'ineerin� }, PREPARED FOR: { 1. fd f CIVIL ENGINEERS :�1 fir ' ,��` E✓, �� -�1 ��_ LAND SURVEYORS R ."14D Son main M W �+t��"4l IA�D '-. 1 SCALES r yu �)l '"►� DgTE .� OF BARNSTABLE LOCATION � v ll� LQ //1 , SEWAGE # VILLAGE R'S MAP & LOT INSTALLER'S NAME&PHONE NO.1�i"7�'�d i�8��s 7ZZ—e- SEPTIC TANK CAPACITY 4.400 e-k� LEACHING FACILITY: (type) �/f �hJ�� (size) 4, /o NO. OF BEDROOMS 3 BUILDER OR OWNER Gorr! / PERMIT DATE: 7 —/7`"&� COMPLIANCE DATE: Separation Disi.nce Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility S^r 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 S t�� 11/23/2020 ShowAsbuilt(1700x2800) t TOWN OF BARNSTABLE L;�ATION Z d SEW N .L VBAGE �� i S R'S9&LOTS INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY dV LEACHAIO FACILITY:(type dos /(size) /QOU NO.OF BEDROOMS BUILDER OR OWNER Q d cc, bVicr PERMITDATE: COMPLIANCE DATE: �3 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leeching Facility(If and as exist within 300 feet of leaching facility) //��'- Feet Ftrnishedby .�6V)Q 'tQC! oa C O� 42- - M1 ) IA �3.,G https://itsgIdb.town.barnstable.ma.us:8431/Home/ShowAsbuilt?mp=151054&sq=1 1/1 OF BARNSTABLE LOCATION s b 4 Ja �� . SEWAGE # fl` ®� VILLAG-E ASSESS R'S MAP & LOT iS/_�✓� 'INST,'kLLER'S NAME&PHONE NO. _9ef 7°' ZZZ 3 SEPTIC TANK CAPACITY 1000 e-u L LEACHING FACILITY: (type) �/ k1 �� (size) NO. OF BEDROOMS -3 BUILDER OR OWN�ER Gk0d-1d / "-PERMITDATE: 7 /7—?t/ COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility s1� 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 e 1 ti 'b w/7/9& Fee _ THE COMMONWEALTH OF MASSACHUSETTS . PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MAS ACHUSETTS 01pprication for Mi5po5al bp5tem Construction permit Application is hereby made for a Permit to Construct( )or Repair( i')an On-site Sewage Disposal System at: a' Location Address or Lot No. /` 0 �/ �� Owner's Nam ,Address and Tg No Assessor's Map/Parcel .��,p�rs�Ah/e �b'd Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. ,Bor�ol��> CD�I'67�-/llG�-r�rl ddc�h c�� /- Type of Building: Dwelling No.of Bedrooms Garbage Grinder(*e Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow ,77 er gallons. Plan Date Number of sheets Revision Date Title Description of Soil ✓��ll//I Nature of,Repairs or.Al rations(Answer when applicable) 7"� O S 0�1c� /' ✓� Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued thi B o th. a Signed " Date Application Approved by a Date Application Disapproved for the following reasons t Permit No. �' Date Issued �� l Fee �d THE COMMONWEALTH OF MASSACHUSETTS `'� L PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MAS ACHUSETTS Zipphration for Mtgogal *pgtem Construction Permit Application is hereby made for a Permit to.Construct( )or Repair( M)an On-site Sewage Disposal System at: Location Address or Lot No. f` eI H� Owner's Name,Address and TelfNo. Assessor's Map/ParcelQ/f+yB Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms 3 Garbage Grinder(*e Other Type of Building f�P�ee No. of Persons Showers( ) Cafeteria( ) Other Fixtures r, r Design Flow gallons per day Calculated daily flow ,�,�� gallons. Plan Date Number of sheets . " f Revision Date . •'� Title E Description of Soil 15�co' Nature of Repairs or Alterationsnswer when applicable) %DI k//rh 0 7S y©6te S /'we 3" ,iA Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued b this BAard of ealth. Signed > A i 4 Date ?17h r Application Approved by / E�t�-- o / kX2MZ Date Application Disapproved for the following reasons L Permit No. ''" Date Issued 62--------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System installed )or repaired/replaced(�/)on by Installer t1� 1�Lo / c©ll57: at / (�, e—l- f!/ ''' hasbeen constructed in acco anc with the provisions of Title 5 and the fo Dis osal System Constructi ermit No. " ated Date / /( � /�� Inspector12 _�- �' o `- , THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT HE`SYS- TEM WILL FUNCTION SATISFACTORY. -- � ----------------- No. ( I 5—I OS7 Fee _ t e THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Migogat *pg/tQem Congtruction permit Permission is hereby granted o to construct( )repair( 0n On-site Sewage System located at No.# sweet and as described in the above Application for Disposal System Construction Permit. t �/N o ,p !� cm 11 The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or specia{condi All construction must be c ple ed within three years of the date below. Date: 1 Approved by Board of Hea} / GLIsST�S� �'DEVEI.OQ, 3o'I-7,tt)f 1 '• ��r'�� i9 zo' --- -- 1��2.. 14 'f• r IN Vy _ ) j SITE PLAN LOCUS: y 14,•�.r ' : .•. c \y REF. down cape engineering - PREPARED FOR: CIVIL ENGINEERS � �. y /0 LAND SURVEYORS —R NOS on Main SL SCALE Y!wwi.W "+ iql U�� ' D TE, q SECTION - SEWAGE () —SEPTIC TANK— S —"b"BOX — 1 —LEACH FI ! TOP OF FON 1�C VO (MSL)& "2"OFI►e tR" STONE WASHED STONE rnin Ir ve(- II IN• OUT• IN• OUT• IN• L - Cp pG SEPTIC 157•C� /5/or(p TANK ELEV. ELEV. ELEV. ELEV. ELEV. ELEV. OF�1"•I%" WASHED STONE ele�� 1 6.Ov TEST HOLE LOG �, 6C 1` TEST BY �l�C,✓>K J, i_oy1 or TEST DATE I� I �� WITNESS DESIGN - BEDROOM HOUSE T.H: o 1 T.H. +► 2 LF�E v!_R ELEV. � '2---MIN/IN. DISPOS PERC RATEER DISPOSER Lam/-�►'(;�"! � j> JLA FLOW RATE Z9� (GAL/DAY) 3 0 SEPTIC TANK 3Z�o (1.5)= q'- REO'D SEPTIC TANK SIZE 1 �= n� LEACH FACILITY SIDE WALL' = 15�s?12•> 1 v G/D. BOTTOM (_�(r� tr _ 5�.2.( I•r.7) . ` G/D. .D -Irl-.S TOTAL USE: =�� LEACHING WATER ENCOUNTERED NOTES: (UNLESS OTHERWISE NOTED) 1.DATUM(MSL) TAKEN FROM S�.V `•`�i �_" QUADRANGLE MAP 2.MUNICIPAL WATER ~AVAILABLE 3.PIPE PITCH:w"PER FOOT E •44 tea. 4.DESIGN LOADING FOR ALL PRE-CAST UNITS'AASHO• - �I .r, i�, y� S.MIN.GROUND COVER OVER ALL SEWAGE FACILITIESs(1)FT. �� - t.. .�(, 6.PIPE JOINTS SHALL BE MADE WATER TIGHT / `t 7.CONSTRUCTION DETAILS TO BE ACCORDANCE WITH COMM.OF MASS. STATE ENVIRONMENTAL CODE TITLE S f /C/'!,� 8. Ty�S pLA�.J F=o�. p'irY�7 �1dClL Cyr L-•`r aL._�d 7+••4�cJ�..0 8 �i. /-.�_a� J�.1� ..T�•,v,i..l� 1`/`6;(F.TJ lades�n r_E �".�t•'OVr..� ��t.•. — E '..-E.' r. R i F. �.)rt (• ! �`.; j .`t r.,i ''7 F.�f•'(:7{_`� 1 !i••,+ .. - A (p INE� 1,� R ti. BOARD OF HEALTH CONTOURS (EXISTING)•.•.••••••"' APPROVED DATE MA IPROPOSED)-O-O-O-O'- c CERTIFICATION OF SKETCH AND ArrLICATION FOR A DiSrOSAL WORKS (;ONS'TKUC:TION PERMIT OVI"THOUT DESIGNED rLANSI ?�,O� j; hereby certify that the application for disposal works construction permit signed by me dated 9Z//7/91 , concerning the p B property located at //��jD �/'� !i9 . �/�� meets all of the P Y � following criteria: T icre arc no wctiands within 30o feet of the proposed septic system icre arc no private tivciis within 150 i'ccl of the proposed septic system "lie observed groundwater fable is 14 fcc! or getter below the bottom of the Ienching facility Ihere is no increase in (tow and/or chanee in use proposed /Therev ne ted or nccded. are no variances� s SIGNED : DATE: LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER (Attach a sketch plan of the proposed system. Also If the licensed installer posesses a certified plot plan, this plan should be submittedl. r yy. � _ -:�.. $ Zj E�3 '`. .>'r _F.,; ,b A�•`-"" ,r�ai`.. _yam.,:• '5i' .w ,;�` fr-..::.L-: .c,,� y a.- - , x n;✓t f _ •€ ham._fit"'1.. . m z+. `;r' h § i. �A s I si - q Fim ar No—.94 . ........... :L THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........-TOW-NL..........OF....... ............................ ppliration for Ubspasal Works Tontitnulion Ilermit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: 11. .......... ......... ......1.40 .....till. .�_ . ....L+.1.1._J.........-...E.". . j. Location-Address or Iot No. f ................ ..LLZ�.. .................. ............................................................................................... Address ........... ......... Installer Address 9 Type of Building Size Lot..Z.0.,..G.10Sq. feet Dwelling—No. of Bedrooms.............. ........................Expansion Attic Garbage Grinder ( ) Other—Type of Building ............................ No. of persons............................ Showers Cafeteria ( ) Otherfixtures ..................................4----�--I........................................................................................................... Design Flow..........A...I.X:.�...................gallons per Ple4arovivt persm , flow.........---!; t6 o...................g- qer day. Total c4il) 10 Septic Tank—Liquid capacityiDJ).O..gallons Length.jY(t.t'.. Width..�5_4'3.... Diameter................ D e p t _0 Disposal Trench—No- -------------------- Width.................... Total Length.............._..... Total leaching area....................sq. ft. Seepage Pit No.....I...... Diameter.......JE!�....... Depth below inlet........Cr ..... Total leaching area:ZP!t.J....sq. f t. Z Other Distribution Dosing tank Percolation Test Results Performed by....... ................... Date......(a_ 0.4 [" Test Pit No. I....!;�.Z..minutes per inch Depth of Test Pit... Depth to ground water NJJE,-_- Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.--..................... ............**......./ .................................................................................. 0 Description of Soil....... b4le.; !F �4 ........ ................... ijSID... = -LP.. AM ----------* Ale;.��................................ ..............................................................................................................................1......................................................................... Nature 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 TL I':LZ 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compjjance has been d b the b d........pu y e rr(I f iealth. Signed... ......................... i. ...... �S. Date Application Approved By................. - I u- -1—�Ks..... .......................... Date Application Disapproved for the fol 'nga reasons:................................................................................................................ ........................................................................................................................................................................................................ Due PermitNo........................................................ Issued...................................................... Daft lie No........ S i ?Il THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Appliration for Ui_gpasal Works Towitrurtion Permit Application is hereby made for a Permit to Construct O or Repair ( ) an Individual Sewage Disposal System at: C 7.......... .. T j7 L :1 --..._ .� ��l E. 14:1 )N t T�:: M .. ...........•- �� •1 { -Location Address or Lot No P ............. ...... .�?E...:- �.l_Fes\7 1`�� ..._......---.......---.............^_.................._.._.... �E V!io Owner Address a ... ..........r...0 y................................:.. .......---------------..............--•---------------......_......._.....................----- Installer Address Type of Building Size Lot..Zq.LaCSq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building No, of persons............................ Showers G.1 YP sg ----• P ( ) Cafeteria ( ) a' Other fixtures d' 1..... 1roaini ...... ............................... Design Flow..........I...a.. ... _...gallons per person pier day. Total d ailyllflow........ f�..................gtallons. Septic Tank—Liquid capacitytl) o..gallons Length._ ._(:6..._.. Width_. '_... Diameter................ Depth.__ t?.... x Disposal Trench—No_ ____________________ Width___-_._____-___-_... Total Length-- -'_.-__...______._ Total leaching area..___._.________....sq. ft. Seepage Pit No.....1.......___:`.: Diameter.......: ........ Depth below inlet .....CR'..... Total leaching area_�9�:..k...sq. ft. Z Other Distribution box O Dosing tank ( ) _ Percolation Test Results Performed by.......'l'':.._= ti r7i: 1�1.!! ................. Date.....(a..ti ._P_a�a'_._.__.... -- 1 1_4Test Pit No. 1....G _minutes per Inch Depth of Test Depth to ground water. r=t Test Pit No. 2..............minutes per inch Depth of Test Pit..................... Depth to ground water............................ P4 '� ..- ,r ....... ........................ ... Description of Soil .... I`... .�.. _l ._ �_t '�l r.1 -1 N( t"si�11 !� r. l� V -------•-•-•-:......... ........ ------- �xary S.... W ............................................................. •-....------ ......•-•. .- -•-•..._ ........... -•---•---••--•---•---_... -----....-•----•-••-----••..........._•---_.... V Nature 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.TITL; 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been i by the b rd ehealth. Application Approved B 10 ' " Date Application Disapproved for the f ollo ing reasons:.............:...:...-•----......-•---------------..........__.......----------.....-----------.........._--- =t •-•••..........................••----..............--•-------•--•----.......-- ................... _...-••--------••-----...--------•...._......--••••.....: _ .. ...... Date PermitNo......................................................... Issued-...................................................... Date .L. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..............OF............................. Trrtif irate of-Tamplittnrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed �) or Repairedby ) .......................................... ! ........... ....................................................................................................... Erb T H,J11� t n6_1' ez C-)t P P L C7VZ- LEA TV CS at....... ------•- -- ___. ..--•• _-- ....:.... : ...... ......•- --- -•- •----.........._•---•--- -•........................ has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTI N SATISFACTORY. DATE.............. .1 r .................................. Inspector. °-`' f_•to Y :r�1 i+i r.d i,a J w.rv�7 r y» .e.....-auv a.y c_..:..y der.::.�::.r-.i a a. m b'J4 .•ri nsO ti..75F ix6 Nsmsu.xww i i.•t u n.r......is A p a THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .......................,;................:OF..................................................................................... NO:.-:::::...�_"��, FEE........................ Diaposal Works 01 natrurtinn Permit Permission is her granted__________ ___ ..... ....•••.t. •...---•-I--------•................••....----•---••............•--•--...................... to Construct ( or Repair ( ) an Individual Sewage Disposal System at No.....................' : :. ....... -SAD SAD a t � r✓4 t�'� . -' -----------••----------•-------•----••--------- Street as shown on the application for Disposal Works Construction Permit No----- -------------- Dated.._ ------------------------------_...... .................................. lO " Board of Health DATE......1 . i SECTION - SEWAGE 7C5 9v. l -7, t5 C _-SEPTIC TANK - K -"O"BOX - LEACH- l TOP OF FON /rj -7 r r "2"OF 118TO lh" y WASHED STON nIE i 1"Yl i co v e- N.J IN• OUT• IN- OUT• IN• _ j! 1 �D�- �{_''/�� 57,042 156,rl SEPTIC TANK ELEV. ELEV. ELEV. ELEV. ✓✓ ELEV. ELEV. +x 4> CJ WASHED STONE �` �Y/' �, t t TEST HOLE LOG . TEST BY r. WITNESS 7 ty IS TEST DATE '� f g'^ DESIGN BEDROOM HOUSE T.H.- 1 T.H. 2 %r a _ELFV_ i< ELEV. NO - y I 'j` r� �" 1 J 6 /4,� ' ✓W`. •. w :ar+: � ) DISPOSER DISPOSER tS7.y PERC RATE 2- MIN/IN. i & tl__. FLOW RATE a� (GAL-/DAY) SEPTIC TANK aW:,ol (1-5)- ., 41— REO'D'SEPTIC TANK SIZE 1 rx2 ICu4� At.] LEACH FACILITY SIDE WALL 4 (n = �'��,,c 3 . o BOTTOM ,_.,(21 , a.7�' I .C7) = G/D. TOTAL USE: �r?��c LEACHING ;' Yr t ` I lt, ��F �F�-1`�1`i-1 y, `E3 �r� 1 JJ i:� ' •t i?. .. / �WATER ENCOUNTERED I _ NO•TES:AUNLESS OTHERWISE NOTED) 1.DATUM(MSU*TAKEN FR M SA N:7lfJ 1 GL'• QUADRANGLE MAP 2.MUNICIPAL WATER I� _ AVAILABLE \ 3.PIPE PITCH:W"PER FOOT 4.DESIGN LOADING FOR ALL PRE-CAST UNITS.AASHO- -44 f OVER OVER ALL SEWAGE FACILITIES:(1)FT. S.MIN.GROUND C �••,,,..._„- da „� 6.PIPE JOINTS SHALL BE MADE WATERTIGHT, CONSTRUCTION DETAILS TO BE ACCORDANCE WITH COMM.OF MASS. < . ),. i'• p 7.STATE UC \,.,. ,,'� SITE PLAN STATE ENVIRONMENTAL CODE TITLES `�•t�•f e _ ' 8. T�-�.�5 'PLA`J Po�C. ?�A?r�� t.. IC C. i`C M..�O �+-\ocJ�.0 ��or,'" '...•'I ' - ►-.:a-r �� USED r•a� �iZo.Z'-.-L„f L�.1t= 51-d,�.n._►G. � _ N �' _�� LOCUS' "f? TvE c(' '� 10VC•P L�I..,'�; — 'N %.�f l (.i ¢�\� ` • yr :7 L cFrC>t!.`�rl !,r',.t :_l.) 'C A INE R ER '� c4+i ../fy �lOat h f + s.• REF: k �' �� d®war edge enfineeriraj. „ft PREPARED FOR: CIVIL ENGINEERS " t �' 3 `t' REV, _ LAND SURVEYORS BOARD OF HEALTH R _ 0. S + (EXISTING)._....... m II ain 8Z•., � � w'/ SCALES I I _ Z4-r CONTOURS FPROPOSED)—O-0'Q—p— APPROVED DATE MA •». c, SYSTEM PROFILE ALL SYSTEM COMPONENTS SHALL BE NOTES MARKED WITH MAGNETIC TAPE OR (NOT TO SCALE) COMPARABLE MEANS FOR FUTURE LOCATION. 1. DATUM IS NAVD 88 FFLR EL 164.8' ACCESS COVERS TO WITHIN 6" OF FIN. GRADE CONCRETE COVERS TO WITHIN 3" GRADE 2" PEASTONE OR GEOTEXTILE 2. MUNICIPAL WATER IS EXISTING White \ FILTER FABRIC OVER STONE 3. MINIMUM PIPE PITCH TO BE 1 8 PER FOOT. 162.0 MINIMUM .75' OF COVER OVER PRECAST 2� SLOPE REQUIRED OVER SYSTEM 159.5 � " PRECAST H-10 WATERTEST D'BOX FOR LEVELNESS BLOCKS OR 4. DESIGN LOADING FOR ALL PROPOSED PRECAST �oGf MIN. 2" WALL THICKNESS PRECAST RISERS P 6• RISERS (TYP.) UNITS TO BE AASHO H-10 4"0SCH40 PVC MORTAR ALL � b Derby 1 61•4' PIPES LEVEL 1ST 2' COMPONENTS INVERT IN 155.67' o� `` ENDS (TMP') SIDES 156.5' 5. PIPE JOINTS TO BE MADE WATERTIGHT. Sae G�rt�c ore 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE °a odder L 10" EXISTING 14" °°°°°°°° o0000000 TEE SEPTIC TANK** TEE E °°°°° ° ®®�® o ®®®® ®®®®- ®®� °o°°°o°° S ®®®®®0®®®®® ®®®®®®®®0®� ;°°°°°°°° WITH 310 CMR 15.000 (TITLE 5.) Locus 1 60.07f * 1 o 0 6" MIN. SUMP ° °°°° ° °o°°°° o°o°o.o°o°o° o '°000°o°° o °°° ° o `0 ,�OOU�O�U^ao 12" MIN. INT. DIM. ri ;°°°°°°°° ®®®�®�®®®®® ®®®®®®®®®®® oaoo°°°° 7, THIS PLAN IS FOR PROPOSED WORK ONLY AND ° °°°° ®®®®®a®®®®® ®®®®®®®®a®a °°°°° _ GAS BAFFLE >°o° °° °°°°°° 153.67 _ 156.47' 156.3' °°°°°° °°°°°°°° NOT TO BE USED FOR LOT LINE STAKING OR ANY OTHER PURPOSE. H-10 500 GAL.' LEACHING CHAMBERS BY ACME PRECAST OR EQUAL. " t� ALL AR AROUND DOUBLE WASHED STONE 4' MIN. (2) UNITS REQUIRED 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4 PVC. ALL AROUND PRECAST STRUCTURES Q, Meet 6" CRUSHED STONE OR MECHANICAL OVERALL DIMENSIONS TO,OUTSIDE OF STONE: 25.00' X 12.83' 9. COMPONENTS NOT To BE BACKFILLED OR Oak 5 COMPACTION. (15.221 [2]) r CONCEALED WITHOUT INSPECTION BY BOARD OF SLOPE) (6.3% SLOPE) 4 HEALTH AND PERMISSION OBTAINED FROM BOARD Roce Lone OF HEALTH. FOUNDATION EXIST. SEPTIC TANK 45' - LEACHING D' BOX 12' FACILITY 10. CONTRACTOR SHALL BE RESPONSIBLE FOR CALLING DIGSAFE (1-888-344-7233) AND LOCUS MAP _ VERIFYING THE LOCATION OF ALL UNDERGROUND & 149.5' BOTTOM TH-2 OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF **INSTALLER SHALL CONFIRM MINIMUM NO GROUNDWATER FOUND WORK. SCALE 1"=2000'f LEGEND- *THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL SEPTIC TANK SIZE AT 000 GALLONS 11. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS AND ITS SUITABILITY FOR RE-USE. ASSESSORS MAP 151 PARCEL 054 BE REMOVED BENEATH AND 5' AROUND THE 99- EXISTING CONTOUR PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM REPLACE WITH 1500 GAL LON SEPTIC PROPOSED LEACHING FACILITY. LOCUS IS WITHIN FEMA FLOOD ZONE X X ss r TANK APPROPRIATE TO SITE ExIST. sl=oT ELEv. CONDITIONS IF NOT SUITABLE 12. EXISTING LEACHING FACILITY SHALL BE PUMPED (AREA OF MINIMAL FLOOD HAZARD) AS -[99]-- PROPOSED CONTOUR / AND REMOVED OR PUMPED AND FILLED WITH CLEAN SHOWN ON COMMUNITY PANEL #25001 CO561 J SAND. �-172 DATED 7/16/2014 [98•41 PROPOSED SPOT EL. TH1 TEST HOLE SLOPE OF GROUND 2 171 SYSTEM DESIGN: UTILITY POLE 00 rr, 0 �Q o 'a9 GARBAGE DISPOSER IS NOT ALLOWED_ FIRE HYDRANT , NOTE: NOT ALL SYMBOLS MAY APPEAR IN DRAWING 7 6,6� \:'�67 DESIGN IFLOW: 3 BEDROOMS @ 110 GPD = 330 GPD USE A 330 GPD DESIGN FLOW TEST .1 IOLE LOGS ' ` Are 8 SEPTIC TANK: 330 GPD (2) = 660 ATE P VED � 1 oc **RE-USE EXISTING 1000 GAL. SEPTIC TANK ENGINEER: DANIEL E. GONSALVES, SE #13587 c cgTV DRI E LEACHING: WITNESS: TIM O'CONNELL \c q k SIDES: 2 25 + 12.83) 2 (.74) = 112 GPD DATE: 1/8/21 - BOTTOM 25 x 12.83 (.74) = 237 GPD _ �- < 5 .MIN INCH . PERC. RATE / �5'540 (0 ^ c TOTAL: 472 S.F. 349 GPD 20-278 CLASS ENCHM 'SOILS ' P# coNC. ouND 15 �' c <�� ^� c USE (2) 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL) EL. 152.35' 1�$ �o �� WITH 4' STONE ALL AROUND ELEV. ELEV. O" 4 160.5'. O» 160.5' - DECK - - - / / EXISTING DWELLING MA APPROVED BATE BOARD OF HEALTH r64 FFLR FL = 164.8' 5„ 0 10» 0 LOT 55 c 158 �y 20,690± S.F. / O �� , oQ., TITLE 5 SITE PLAN �6 10" 0 159.7' 16" 0 159.2' �� \\ J' - 167 OF H S� �S� 0 116 SADDLER LANE SEE NOTE 12 �6A i 163 1H2 ° ` - '2-) WE'ST�,BARNST=ABLE, MA 26" 157.8 32" 157.8 ° ��6 �L�, � i-i r t( s I� 6S A i s1/� sb' J � PREPARED FOR 6 \LP, BORTOLOTTI CONST. INC o �o 66" / 155.0' 70' / 54.67' S EMO AL F SUIT B E S01 R Q IRED --- RANDALL RICE & ALISON CUTLER AR D ERI E OF L A IN F Cl ITY, ^� D SUITA S01 A .=1 5.0' . �� , PLACE WITH CLEANM A TO EE ya t cN OF M,n 111 e V' 1 1 C2 C2 SPECIFICATIONS 00 R 1 265( s �THOF/�q�qc DATE: JAN. 13, 2021 PERC UNSUITABLE `� a,t�DA ;o - =� ANIELA. y-�`^ �� - off 508-362-4541 M/FS M/FS SOIL r ..I. i. 1 NPROMO 0' OF 40 IL LI E T �� J98u c JALA �+ fax 508-362-9880 �CiVIL � 2.5Y 7/3 2.5Y 7/3 OFF SAS I sHo P ` ' N,v 46502 p o ,;, � A �- �� ., , downca e.com V. 157.5', BOTTO AT L. 1 3.5 t ':< s Q o down copy eng�n«r1�lg inc. /STERN SUR�� U AL C. ASS/ANAL ENG 7 civil ers 132" 149.5' 120" 150.5 land surveyors Scale: 1 = 20 �- ��-�\ � y 939 Main Street ( Rte 6A) NO GROUNDWATER ENCOUNTERED DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675 D CE #2 0--4 0 0 0 10 20 30 40 50 FEET 20-400 BORTOLOTTI-CUTLER.DWG