HomeMy WebLinkAbout0035 ABEGALE SNOW ROAD - Health 35bi1.Z Snow Road
W. Barnstable
A'.= 088
002001 '
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TOWN OF BARN E
` LOCATIONL5 b (alX Jn STABSEWAGE 4zo[ �,l
VILLAGE 't V ' r ASSESSOR'S MjV & LOT
INSTALLER'S NAME&PHONE NO. V► {
508.833• �
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) 3-.sue C 4 (size) 3 3's-
NO.OF BEDROOMS
BUILDER OR OWNE 1R'- (]f K„�_ � ra I W
PERMITDATE: L^ 1.2—0 1 COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility (If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
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LOCATION , 4�e 0"'I't �(16W - SEWAGE # "ky t —341
-.� VILLAGE Kccn S'�bI C ASSESSOR'S MAP & LOT �8'
INSTALLER'S NAME&PHONE NO. R�.� etr� �( ��.
�`e,1S� Ong
SEPTIC TANK CAPACITY LEACHING FACILITY: (type) 5�0 G�l�� C"J$O (size)(--2o]
NO. OF BEDROOMS
BUILDER OR OWNER nua< 1 A3G
PERMITDATE: �4 tZ 6 L COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility , Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility (If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
35 Abigale Snow rd
Property Address
Owner Owner's Name
information is required for every W Barnstable Ma 11/16/11
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 filling out forms A. General Information
on the computer,
use only the tab 1. Inspector:
key to move your
cursor-do not Chad Hathaway
use the return Name of Inspector
key.
H.P.S.
� Company Name
1 Warwick way
Company Address
Mashpee Me. 02649
City/Town State Zip Code
1 774 274 2581 12866
Telephone Number License Number
B. Certification
I certify that I have personally inspected the sewage disposal system at this address and that the
information reported below is true, accurate and complete as of the time of the inspection. The inspection
G was performed based on my training and experience in the proper function and maintenance of on site
sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of
s..
Title 5(310 CMR 15.000).The system:
C.s_ I •� ��,
® Passes ❑ Conditionally Passes ❑ Fails
a El Needs Further Evaluation by the Local Approving Authority
r�
11/16/11
Inspector's Sign at Date
The system inspector shall su mit a-copy of this inspection report to the Approving Authority(Board
of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or
has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the
report to the appropriate regional office of the DEP. The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
****This report only describes conditions at the time of inspection and under the conditions of use
at that time.This inspection does not address how the system will perform in the future under
the same or different conditions of use.
1
LU
I �3
�i"s �/� Title 5 Official Inspection Form:Subsurface Sewage I System-Page 1 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
35 Abigale Snow rd
Property Address
Owner Owner's Name
information is required for every W Barnstable Ma 11/16/11
page. CitylTown State Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E/always complete all of Section D
A) System Passes:
® I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
1500 gal tank goodcond. is level with tees no signs of leaking Dbox level with speed levelers no leaks
or cracks 500 gal L.0 s are dry staining on side of chambers indicate water was 6"from inlet pipe
Measured from SAS to well 160' of seperation
B) System Conditionally Passes:
❑ One or more system components as described in the"Conditional Pass" section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not
determined," please explain.
The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass
inspection if the existing tank is replaced with a complying septic tank as approved by the Board of
Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND (Explain below):
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17
l
r
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
°r 35 Abigale Snow rd
Property Address
Owner Owner's Name
information is required for every W Barnstable Ma 11/16/11
page. CitylTown State Zip Code Date of Inspection
B. Certification (cont.)
B) System Conditionally Passes(cunt.):
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ ' broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
C) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
,•'r 35 Abigale Snow rd
Property Address
Owner Owner's Name
information is required for every W Barnstable Ma 11/16/11
page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
2. System will fail unless the Board of Health(and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well**.
Method used to determine distance:
**This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform
bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or
less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be
attached to this form.
3. Other:
D) System Failure Criteria Applicable to All Systems:
You must indicate"Yes"or"No"to each of the following for all inspections:
Yes No
❑ ® Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less
than'/2 day flow
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
35 Abigale Snow rd
Property Address
Owner Owner's Name
information is required for every W Barnstable Ma 11/16/11
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Yes No
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered.A copy of the analysis
and chain of custody must be attached to this form.]
❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd.
❑ ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 16,000 gpd.
For large systems, you must indicate either"yes" or"no"to each of the following; in addition to the
questions in Section D.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection
Area—IWPA)or a mapped Zone II of a public water supply well
If you have answered"yes"to any question in Section E the system is considered a significant threat,
or answered"yes" in Section D above the large system has failed. The owner or operator of any large
system considered a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15.304. The system owner should contact the appropriate
regional office of the Department.
t5ins.09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
35 Abigale Snow rd
Property Address
Owner Owner's Name
information is required for every W Barnstable Ma 11/16/11
page. City/Town State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate"yes" or"no" as to each of the following:
Yes No
❑ ® Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
❑ ® Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑ Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
® ❑ Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System(SAS)on the site has
been determined based on:
® ❑ Existing information. For example, a plan at the Board of Health.
❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable)[310 CMR 15.302(5)]
D. System Information
Residential Flow Conditions:
Number of bedrooms (design): 4 Number of bedrooms (actual): 4
DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 440
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17
Commonwealth of Massachusetts
- Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
y 35 Abigale Snow rd
Property Address
Owner Owner's Name
information is W Barnstable Ma 11/16/11
required for every
page. Cityrrown State Zip Code Date of Inspection
D. System Information
Description:
Number of current residents: 0
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No
Laundry system inspected? ® Yes ❑ No
Seasonal use? ❑ Yes ® No
Water meter readings, if available(last 2 years usage(gpd)):
Detail:
well
Sump pump? ❑ Yes ® No
Last date of occupancy: Date
Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 15.203): Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
t5ins-09i08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
35 Abigale Snow rd
Property Address
Owner Owner's Name
information is required for every W Barnstable Ma 11/16/11
page. Cityfrown State Zip Code Date of Inspection
D. System Information (cont.)
Last date of occupancy/use: Date
Other(describe below):
General Information
Pumping Records:
Source of information:
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped: gallons
How was quantity pumped determined?
Reason for pumping:
Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system(yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner)and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
35 Abigale Snow rd
Property Address
Owner Owner's Name
information is required for every W Barnstable Ma 11/16/11
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed(if known) and source of information:
1980 origanal plan
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
Depth below grade: 5'feet
Material of construction:
❑ cast iron ®40 PVC ❑ other(explain):
Distance from private water supply well or suction line: feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
Septic Tank(locate on site plan):
Depth below grade: 5'feet
Material of construction:
® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain)
If tank is metal, list age:
years
Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No
Dimensions: 1500 gal
Sludge depth:
3"
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17
Commonwealth of Massachusetts
,p Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
35 Abigale Snow rd
Property Address
Owner Owner's Name
information is required for every W.Barnstable Ma 11/16/11
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Septic Tank(cunt.)
Distance from top of sludge to bottom of outlet tee or baffle 33'
Scum thickness
2"
Distance from top of scum to top of outlet tee or baffle
13"
Distance from bottom of scum to bottom of outlet tee or baffle 711
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.):
pump every other year for maint.
Grease Trap(locate on site plan):
Depth below grade: feet
Material of construction:
❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: Date
t5ins•09,08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17
i
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
35 Abigale Snow rd
Property Address
Owner
Owner's Name
information is required for every W Barnstable Ma 11/16/11
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain):
Dimensions:
Capacity:
gallons
Design Flow: gallons per day
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments(condition of alarm and float switches, etc.):
*Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17
I '
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
35 Abigale Snow rd
Property Address
Owner Owner's Name
information is required for every W Barnstable Ma 11/16/11
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Distribution Box(if present must be opened)(locate on site plan):
Depth of liquid level above outlet invert
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 has no carry overs level with speed levelers no leaks
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.):
Soil Absorption System(SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
500 gal LC s dry but shows Stirling 6"from inlet pipe to chamber
t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
35 Abigale Snow rd
Property Address
Owner Owner's Name
information is required for every W Barnstable Ma 11/16/11
page. Citylrown State Zip Code Date of Inspection
D. System Information (cont.)
Type:
❑ leaching pits number:
® leaching chambers number: 3
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
Cesspools(cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration
Depth—top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
t5ins•09= Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
35 Abigale Snow rd
Property Address
Owner Owner's Name
information is required for every W Barnstable Ma 11/16/11
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
Privylocate on site plan):
( p }
Materials of construction:
Dimensions
Depth of solids
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
g 35 Abigale Snow rd
Property Address
Owner Owner's Name
information is required fo every W Barnstable Ma 11/16/11
r
page. City(Town State Zip Code Date of Inspection
D. System Information (cont.)
Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including t'
g p y g p y g 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
t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17
Commonwealth of Massachusetts
- Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
�. 35 Abigale Snow rd
Property Address
Owner
Owner's Name
information is required for every W Barnstable Ma 11/16/11
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
® Check Slope
® Surface water
® Check cellar
® Shallow wells
Estimated depth to high ground water: N/A
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: 2001
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:
No gw on test log on plan in 2001
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
,a�< 35 Abigale Snow rd
Property Address
Owner Owner's Name
information is required for every W Barnstable Ma 11/16/11
page, Cityrrown State Zip Code Date of Inspection
E. Report Completeness Checklist
® Inspection Summary: A, B, C, D, or E checked
® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed
® System Information—Estimated depth to high groundwater
® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17
-49EC-07-2011 WED 12:30 PM cch radiation therapy FAX NO. 5087904565 P. 03
- a ANALYTICAL Page I of
Bp1#olgllatm In Environmental Boevions
C'FRM I LATE OF ANALYSIS
Envirotech Laboratodes, Inc. Date Received: 1 I122l11
Attu: Mr. Ron'Saari Date Reported: 11129l11
8 Jan Sebastian Drive P.O.#.
Sandwich,MA 02563 Work Carder#: 1111-23205
DESC21PTION: T A MENYTIART
i
i Subject samplo(s)h"'have been analyzed by our Warwick,R.T.laboratory with the attached results.
Referewe: ,A11 parameters were analyzed by U.S.EPA approved methodologies.
The specific methodologies are'listed in the methods column of the CeatiiRcate Of Analysis.
Data qualified(if'present)are explained in full at the end of a given sample's an4lytic41 result.
'ilia Certificate of Analytsis shall not be reproduced except in full,without written approvil-of R.i.Analytical:'
Results relate only To samples submitted to the laboratory for analysis. r
Test results are not blank corrected. a
i
C.' tification#: RI-033,MA-RI015,CT-Pli-0508,ME-RI015
NIi-253700 A&B,USDA S-41944 � r
This Certificate represents all data associated with.the ref=nced work order and is paginated for
completeness. The complete Certificate includes one attachment;the original Chain of Custody.
If you have any questions,regarding this work; or if we may be,of further assistance,please contact
our customer service department.
Approved by:
S on B •er
11OS!Data Reporting Manager
e'no: Chain of Custody
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41 Illlnoia Avenue,Mrs Ick,RI 02688 131 Coclidos 5tmd,Suite 1 Db,Hudson MA 01748
Phone:401,737,6500 Fax;401,738,1970 M Phone:878,5M.0041 Fax;978.558.0078
„ I
*EC-07-2011 WED 12:30 PM cch radiation therapy FAX NO. 5087904565 P. 02
ENEIROTECHLABORATORIES,INC.
CIA CERT.NO.:M MA 063
8 Jan Sebastian DrIm-Writ J2
Sdndwlclr,Alai 02563
(508)888-6460 1-900-3.19-6460
FAX(m)SO&6440
Client Name Menyhurr,Timea Locution 35 Abeaale Snow Rd
Address 46 victoria Strut W.Bametable,Ma
Centaww,Ma 02m
Saa ale Dale 11/17/11
Colleeted By Chant Sample Tine NA
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'Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
° M 35 Abegale Snow Rd.
Property Address
Brian &Christine Matty
Owner Owner's Name
information is required for W Barnstable Ma. 02668 12/28/2010
every page. City/Town State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
Important: A. General Information
When fifling out
forms on the
computer,use 1. Inspector:
only the tab key
to move your Robert Paolini
cursor-do not Name of Inspector
use the return
key. Capewide Enterprises,LLC.
Company Name
IQ P.O.Box 763
Company Address
Centerville Ma. 02632
City/Town State Zip Code
(508)428-4028 S14454
Telephone Number License Number
B. Certification
I certify that I have personally inspected the sewage disposal system at this address and that the
information reported below is true, accurate and complete as of the time of the inspection. The inspection
was performed based on my training and experience in the proper function and maintenance of on site
sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of
Title 5 (310 CMR 15.000). The system:
® Passes ❑ Conditionally Passes ❑ Fails 3 ;
o .. i
❑ Needs Further Evaluation by the Local Approving Authority ,P '
b F
12/28/2010 _t
Insp ctor's§gfi-Aturd Date
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board
of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or
has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the
report to the appropriate regional office of the DEP. The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
****This report only describes conditions at the time of inspection and under the conditions of use
at that time. This inspection does not address how the system will perform in the future under
the same or different conditions of use.
�A
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Dispo I System•/aji 1 17
r
Commonwealth of Massachusetts
F Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
,M 35 Abegale Snow Rd.
Property Address
Brian &Christine Matty
Owner Owner's Name
information is required for W Barnstable Ma. 02668 12/28/2010
i
every page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E/always complete all of Section D
A) System Passes:
® I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
The septic system is in proper working order at the present time.
B) System Conditionally Passes:
❑ One or more system components as described in the"Conditional Pass"section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not
determined," please explain.
The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is
structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System
will pass inspection if the existing tank is replaced with a complying septic tank as approved by the
Board of Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years.old is available.
❑ Y ❑ N ❑ ND (Explain below):
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
,b 35 Abegale Snow Rd.
Property Address
Brian &Christine Matty
Owner Owner's Name
information is required for W Barnstable Ma. 02668 12/28/2010
every page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
B) System Conditionally Passes (cont.):
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s)are replaced ❑ Y ❑ N FIND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below):
El The system required pumping more than 4 tim
es a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
C) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form'-Not for Voluntary Assessments
35 Abegale Snow Rd.
Property Address
Brian & Christine Matty
Owner Owner's Name
information is required for W.Barnstable Ma. 02668 12/28/2010
every page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
2. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ 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.
3. Other:
D) System Failure Criteria Applicable to All Systems:
You must indicate "Yes" or"No"to each of the following for all inspections:
Yes No
❑ ® Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less
than Y2 day flow
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17
Commonwealth of Massachusetts
N W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
<c,G
,M 35 Abegale Snow Rd.
Property Address
P
Brian &Christine Matty
Owner Owner's Name
information is required for W Barnstable Ma. 02668 12/28/2010
every page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Yes No
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
El ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply
well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory, for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered.A copy of the analysis
and chain of custody must be attached to this form.]
❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd.
® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection
Area—IWPA)or a mapped Zone II of a public water supply well
If you have answered "yes"to any question in Section E the system is considered a significant threat,
or answered "yes" in Section D above the large system has failed. The owner or operator of any large
system considered a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15.304. The system owner should contact the appropriate
regional office of the Department.
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
_ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M 35 Abe9 ale Snow Rd.
Property Address
Brian &Christine Matty
Owner Owner's Name
information is required for W Barnstable Ma. 02668 12/28/2010
every page. City/Town State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate"yes"or"no" as to each of the following:
Yes No
® ❑ Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
® ❑ Has the system received normal flows in the previous two week period?
® ❑ Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑ Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
® ❑ Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS) on the site has
been determined based on:
® ❑ Existing information. For example, a plan at the Board of Health.
❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
D. System Information
Residential Flow Conditions:
Number of bedrooms (design): 4 Number of bedrooms (actual): 4
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440
t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17
c Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
35 Abegale Snow Rd.
Property Address
Brian &Christine Matty
Owner Owner's Name
information is required for W Barnstable Ma. 02668 12/28/2010
every page. City/Town State Zip Code Date of Inspection
D. System Information
Description:
Number of current residents: 1
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No
Laundry system inspected? ® Yes ❑ No
Seasonal use? ❑ Yes ® No
Water meter readings, if available last 2 ears usage d Well Water
9 ( Y 9 (gp ))�
Detail:
Sump pump? ❑ Yes ® No
Last date of occupancy: 12/28/2010
Date
Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 15.203): Gallons per day(gpd)
Basis of design flow (seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
^M 35 Abegale Snow Rd.
Property Address
Brian &Christine Matty
Owner Owner's Name
information is required for W Barnstable Ma. 02668 12/28/2010
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Last date of occupancy/use: Date
Other(describe below):
General Information
Pumping Records:
Source of information:
Was system pumped as part of the inspection? ❑ Yes ❑ No
If yes, volume pumped: gallons
How was quantity pumped determined?
Reason for pumping:
Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology.Attach a copy of the current operation and
maintenance contract(to be obtained from system owner) and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
�M 35 Abegale Snow Rd.
Property Address
Brian &Christine Matty
Owner Owner's Name
information is required for W Barnstable Ma. 02668 12/28/2010
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known) and source of information:
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
2'
Depth below grade: feet
Material of construction:
❑ cast iron ® 40 PVC ❑ other(explain):
Distance from private water supply well or suction line: 1 +
fee et
Comments (on condition of joints, venting, evidence of leakage, etc.):
Joints appear tight.No evidence of Ieakage.System vented through the house vents.
Septic Tank (locate on site plan):
Depth below grade: 18"feet
Material of construction:
® concrete ❑ metal. ❑fiberglass ❑ polyethylene ❑ other(explain)
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
Dimensions: 1500 gallon
Sludge depth:
4"
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
°M 35 Abegale Snow Rd.
Property Address
Brian &Christine Matty
Owner Owner's Name
information is required for W Barnstable Ma. 02668 12/28/2010
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Septic Tank(cont.)
Distance from top of sludge to bottom of outlet tee or baffle
28"
Scum thickness
3"
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
9"
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.):
Pump tank every two years.lnlet and outlet tees are in place.No evidence of Ieakage.Tank appears
structurally sound.
Grease Trap (locate on site plan):
Depth below grade: feet
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: Date
t5ins•1 V10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
^M 35 Abegale Snow Rd.
Property Address
Brian & Christine Matty
Owner Owner's Name
information is required for W.Barnstable Ma. 02668 12/28/2010
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Capacity: gallons
Design Flow:
gallons per day
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments (condition of alarm and float switches, etc.):
*Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
t5ins-11i 10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
�M 35 Abegale Snow Rd.
Property Address
Brian &Christine Matty
Owner Owner's Name
information is required for W.garnstable Ma. 02668 12/28/2010
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Distribution Box (if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert No
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.):
Box is Ievel.Box has two outlet Iaterals.No evidence of solids carryover.No evidence of leakage.
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.):
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17
Commonwealth of Massachusetts
L Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
�M 35 Abegale Snow Rd.
Property Address
Brian &Christine Matty
Owner Owner's Name
information is W Barnstable Ma. 02668 12/28/2010
required for
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Type:
❑ leaching pits number:
® leaching chambers number: 3
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
Sandy dry soil.No signs of hydraulic failure.Leaching chambers had 1" of water on bottom at time of
inspection.
Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration
Depth—top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
t5ins•11;10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M, 35 Abegale Snow Rd.
Property Address
Brian & Christine Matty
Owner Owner's Name
information is required for W Barnstable Ma. 02668 12/28/2010
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
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.):
l5ins•1110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17
Map Page 1 of 2
Town of Barnstable Geographic Information System
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
wM 35 Abegale Snow Rd.
Property Address
Brian &Christine Matty
Owner Owner's Name
information is required for W Barnstable Ma. 02668 12/28/2010
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
® Check Slope
® Surface water
® Check cellar
❑ Shallow wells
Estimated depth to high ground water: Bottom of LC 100'
feet
Please indicate all methods used to determine the high ground water elevation:
❑ Obtained from system design plans on record
If checked, date of design plan reviewed: Date
❑ Observed site (abutting property/observation hole within 150 feet of SAS)
® Checked with local Board of Health -explain:
As-Built
❑ Checked with local excavators, installers- (attach documentation)
❑ Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
USED:USGS Observation.Well Data.USED:Technical Bulletin 92-0001 plate#2 annual ranges of
groundwater elevations.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins•1110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17
Commonwealth of Massachusetts
F F Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
35 Abegale Snow Rd.
Property Address
Brian & Christine Matty
Owner Owner's Name
information is required for W Barnstable Ma. 02668 12/28/2010
every page. City/Town State Zip Code Date of Inspection
E. Report Completeness Checklist
® Inspection Summary: A, B, C, D, or E checked
® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed
® System Information—Estimated depth to high groundwater N,
® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17
m
No. `� r Fee
THE COMMONWEALTH OF MA99ACHUSETT Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS
o
01ppYication for Migooar braem Construction Vermit
L Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Locatio ddre t No. v t ".) 2Ownery'sName,Address and Tel. o 77�01,T�Assessor's Map/Parcelff.2 /O �� r
35 Install e;'sNa e dress,and Tel.No. Designer's Name Address Tel.No. yr/��
Type of Building:
Dwelling No.of Bedrooms Lot Size US sq. ft. Garbage Grinder(A)L?
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures
J
Design Flow gallons per day. Calculated daily flow � gallons.
Plan Date y- •C7/ N ber f eets R vision Date
Title T c G r Se o7 V . V. � t� /67 Gad
Size of Septic Tank Type of S.A.S.
Description of Soil GG U7 1 3� Ila, I vt :u
�
t
Nature of Repairs or Alterations(Answer when applica e) i'
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been iLsue0yjhis Board of ealth. /
Signedp Date
Application Approved by Date
IF
Application Disapproved or the following reaso
Permit No. r Date Issued MCI 6)
Fee 1
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION`-TOWN OF BARNSTABLE., MASSACHUSETTS✓`; Y
rtcatton for Mtzpoal * Stem Congtructton Permit
Application for a Permit to Construct(x)Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location ddress mb&No. o? �'�� it Jffo Owner's Name,Address and Tel.NQ A 7
As ssor s,Map/Parcel (h It 4l P r o_PGl
-Installer's Name,A,ddre s,and Tel.No. �1 Desi ner's Name.-Address and Tel.No. 361) WHI
Type of Building: p
Dwelling No. of Bedrooms L/ Lot Sizes sq. ft. Garbage Grinder(0?
Other Type of Building No.of Persons Showers( ) Cafeteria( ) >
Other Fixtures
Design Flow NI /O gallons per day. Calculated daily flow gallons.
Plan Date N•r)'(>! Number of s eets Revision Date P
Title if S' S G Ln L o�2, -- 1 I' I- (r
tit ,Y t. ,7 b U�S`✓ Gv� !
Size of Septic Tank AZP.) Type of S.A.S. �i ✓?
Description of Soil C C (/j ( �l D 0 ,, f vA4�f3
All
Nature of Repairs or Alterations(Answer when applicab ee
Date last inspected:
d
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described o6zsite 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 �y s Board of , alth. /�
Signed }} /I A a Date
Application Approved by l� t � Date .01
Application Disapproved for the following reason
J
Permit No. 1 Date Issued
-- ——————————— -------- ----------_--
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
(Certificate of (Compliance
THIS IS TO CERTIFY, that the On-site Sewage Dispo al System Constructed( )Repaired ( )Upgraded( )
Abandoned( )by 3 57- A b,Q G^I f Soo,A, 9[""rr_6�
,
at hasUhted
constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. 0 _
Installer Designer
The issuance of this permit shall not be construed as a guarantee that the system willrfunction as designed.
Date 3' / b 1 Inspector �� 41m)
------------------------------------
No. Fee
c 9e -36o
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
Mt!5pogat *pztem (Con.5truction Permit
Permission is hereby granted to Construct( )Repair( )Upgrade( )Abandon( )
System located at
and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
Provided:Construction must be completed within three years of the date of this permit.
Date': Approved by
i
i
TOWN OF BARNSTAB E
5 Sy C SEWAGE #
LOCATION a _
VII.LAG : r ASSESSOR'S & LOT
E 'n
INSTALLER'S NAME&PHONE NO—J - r {.
$• 3•
SO S3
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) 3"5,C110 C a- (size) 33•s k 13 e,)-
NO.OF BEDROOMS �
BUILDER OR OWNER ;:+Ir
PERMIT DATE: r j COMPLIANCE DATE: ��� J
Separation Distance Between the:
Feet
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility
Private Water upply Well and.Leaching Facility (If any wells exist
Feet
on site or w 'n 200 feet of leaching facility)
Edge of Wetland and Lea hing Facility(If any wetlands exist
within 300 Fet of lea v� �H i
F� bye__ Feet
$moo✓
2-
o
0
3
�l
i
ENVIROTECHLA.BORATORIES,INC.
MA CERT.NO.:M-MA 063
449 Rte.130
Sandwich, MA 02563
508(888-6460) 1-800-339-6460
FAX(908)888-6446
CLIENT: Markwood Corporation LOCATION: Lot 2
ADDRESS: 110 Breeds Hill Rd Abigale Snow Rd
Unit 10 W Barnstable ma 02668
Hyannis MA 02601
COLLECTED BY: D Pennini/DA Scannell SAMPLE DATE: 5/2/2001
SAMPLE TIME. 4:00
WATER SAMPLE TYPE: New Well DATE RECEIVED: 5/2/2001
LAB I.D. #. 0105060
WELL SPECS.: 115,
RESULTS OF ANALYSIS:
Parameters Units Recommended Results Method Date Analyzed
Limits
Coliform bacteria /100ml 0 0 9222 B 5/2/2001
pH pH units 6.5-8.5 6.18 4500 H+ 5/2/2001
Conductance umhos/cm 500 64 120.1 5/2/2001
Nitrate-N mg/L 10.0 < 0.005 300.0 5/2/2001
Nitrite-N mg/L 1.00 < 0.003 300.0 5/2/2001
Sodium mg/L 28.0 6.8 200.7 5/3/2001
Iron mg/L 0.3 < 0.1 200.7 5/3/2001
Manganese mg/L 0.05 < 0.008 200.7 5/3/2001
Volatile Organics See Report
Chloroform ug/L 100 5 EPA 524.2 5/11/01
Trichloroethene ug/L 5 1.8 EPA 524.2 5/11/01
COMMENTS: pH is below recommended limit and may have corrosive characteristics.
WATER MEETS EPA STANDARDS AND IS SUITABLE FOR DRINKING PURPOSES
FOR PARAMETERS TESTED.
<=less than Date S 3/Ur
>=greater than n ld J. Saar
TNTC=too numerous to count Lab tory Ditor
Page 8 of 9
R.I. Analytical Laboratories, Inc.
CERTIFICATE OF ANALYSIS
Envirotech Laboratories, Inc.
/
Date Received: 5/03/01 Approved bY�
Work Order# 0105-04991 R.I. Analytical
Sample#: 004 _�
SAMPLE DESCRIPTION: 0105060 LOT 2 GRAB 05/02/01 @1600 `
SAMPLE DET. ANALYZED
PARAMETER RESULTS LI IIT UNITS METHOD DATE/TIME ANALYST
Volatile Organic Compounds
Bromodichloromethane <0.5 0.5 ug/1 EPA 524.2 5111101 15:29 JL
Bromoform <0.5 0.5 ug/I EPA 524.2 5/11/01 15:29 JL
Dibromochloromethane <0.5 0.5 ug/1 EPA 524.2 5111101 15:29 JL
Chloroform 5.0 0.5 ug/l EPA 524.2 5/11/01 15:29 JL
1,2-Dibromoethane(EDB) <0.5 0.5 ug/1 EPA 524.2 5/11/01 15:29 JL
Benzene <0.5 0.5 ug/l EPA 524.2 5111101 15:29 JL
Carbon Tetrachloride <0.5 0.5 ug/I EPA 524.2 5/11/01 15:29 JL
1,2-Dichloroethane <0.5 0.5 ug/1 EPA 524.2 5/11/01 15:29 JL
Trichloroethene 1.8 0.5 ug/l EPA 524.2 5111101 15:29 JL
1,4-Dichlorobenzene <0.5 0.5 ug/1 EPA 524.2 5/11/01 15:29 JL
1,1-Dichloroethene <0.5 0.5 ug/l EPA 524.2 5/11/01 15:29 JL
1,1,1-Trichloroethane <0.5 0.5 ug/1 EPA 524.2 5/11/01 15:29 JL
Vinyl Chloride <0.5 0.5 ug/I EPA 524.2 5/11/01 15:29 JL
Bromobenzene <0.5 0.5 ug/l EPA 524.2 5/11/01 15:29 JL
Bromomethane <0.5 0.5 ug/1 EPA 524.2 5/11/01 15:29 JL
Chlorobenzene <0.5 0.5 ug/l EPA 524.2 5/11/01 15:29 JL
Chloroethane <0.5 0.5 ug/1 EPA 524.2 5/11/01 15:29 JL
Chloromethane <0.5 0.5 ug/1 EPA 524.2 5/11/01 15:29 JL
2-Chlorotoluene <0.5 0.5 ug/I EPA 524.2 5/11/01 15:29 JL
4-Chlorotoluene <0.5 0.5 ug/I EPA 524.2 5/11/01 15:29 JL
Dibromomethane <0.5 0.5 ug/I EPA 524.2 5/11/01 15:29 JL
1,3-Dichlorobenzene <0.5 0.5 ug/1 EPA 524.2 5111101 15:29 JL
1,2-Dichlorobenzene <0.5 0.5 ug/l EPA 524.2 5/11/01 15:29 JL
trans-1,2-Dichloroethene <0.5 0.5 ug/1 EPA 524.2 5/11/01 15:29 JL
cis-1,2-Dichloroethene <0.5 0.5 ug/1 EPA 524.2 5111101 15:29 JL
Methylene Chloride <0.5 0.5 ug/1 . EPA 524.2 5111101 15:29 JL
1,1-Dichloroethene <0.5 0.5 ug/l EPA 524.2 5/11/01 15:29 JL
1,1-Dichloropropene <0.5 0.5 ug/I EPA 524.2 5/11/01 15:29 JL
1,2-Dichloropropane <0.5 0.5 ug/I EPA 524.2 5/11/01 15:29 JL
1,3-Dichloropropane <0.5 0.5 ug/I EPA 524.2 5111101 15:29 JL
cis-1,3-Dichloropropene <0.5 0.5 ug/I EPA 524.2 5/11/01 15:29 JL
tran-1,3-Dichloropropene <0.5 0.5 ug/1 EPA 524.2 5/11/01 15:29 JL
2,2-Dichloropropane <0.5 0.5 ug/l EPA 524.2 5111101 15:29 JL
Ethylbenzene <0.5 0.5 ug/1 EPA 524.2 5/11/01 15:29 JL
g
Styrene <0.5 0.5 u /1 EPA 524.2 5/11/01 15:29 JL
1,1,2-Trichloroethane <0.5 0.5 ug/1 EPA 524.2 5/11/01 15:29 JL
1,1,1,2-Tetrachloroethane <0.5 0.5 ug/I EPA 524.2 5/11/01 15:29 JL
1,1,2,2-Tetrachloroethane <0.5 0.5 ug/1 EPA 524.2 5/11/01 15:29 JL
} r ,
Page 9 of 9
R.I. Analytical Laboratories, Inc.
CERTIFICATE OF ANALYSIS
Envirotech Laboratories, Inc.
Date Received: 5/03/01 Approved by:
Work Order# 0105-04991 R/I. Analytical
Sample#: 004
0105060 LOT 2 GRAB 05/02/01 @1600
SAMPLE DET. ANALYZED
PARAMETER RESULTS LIMIT UNITS METHOD DATE/TIME ANALYST
Tetrachloroethene <0.5 0.5 ug/l EPA 524.2 5111101 15:29 JL
1,2,3-Trichloropropane <0.5 0.5 ug/1 EPA 524.2 5/11/01 15:29 JL
Toluene <0.5 0.5 ug/1 EPA 524.2 5/11/01 15:29 JL
Xylenes <0.5 0.5 ug/l EPA 524.2 5/11/01 15:29 JL
1,2-Dibromo-3-Chloropropane <0.5 0.5 ug/l EPA 524.2 5/11/01 15:29 JL
Bromochloromethane <0.5 0.5 ug/l EPA 524.2 5/11/01 15:29 JL
n-Butylbmene <0.5 0.5 ug/1 EPA 524.2 5/11/01 15:29 JL
Dichlorodifluoromethane <0.5 0.5 ug/l EPA 524.2 5111101 15:29 JL
Trichlorofluoromethane <0.5 0.5 ug/l EPA 524.2 5/11/01 15:29 JL
Hexachlorobutadiene <0.5 0.5 ug/l EPA 524.2 5/11/01 15:29 JL
Isopropylbenzene <0.5 0.5 ug/1 EPA 524.2 5111101 15:29 JL
p-Isopropyltoluene <0.5 0.5 ug/I EPA 524.2 5111101 15:29 JL
Naphthalene <0.5 0.5 ug/l EPA 524.2 5/11/01 15:29 JL
n-Propylbenzene <0.5 0.5 ug/l EPA 524.2 5/11/01 15:29 JL
sec-Butylbenzene <0.5 0.5 ug/l EPA 524.2 5111101 15:29 JL
tert-Burylbenzene <0.5 0.5 ug/l EPA 524.2 5111101 15:29 JL
1,2,3-Trichlorobenzene <0.5 0.5 ug/l EPA 524.2 5111101 15:29 JL
1,2,4-Trichlorobenzene <0.5 0.5 ug/l EPA 524.2 5/11/01 15:29 JL
1,2,4-Trimethylbenzene <0.5 0.5 ug/l EPA 524.2 5/11/01 15:29 JL
1,3,5-Trimethylbenzene <0.5 0.5 ug/l EPA 524.2 5111101 15:29 JL
Methyl Tertiary Butyl Ether <1 1 ug/l EPA 524.2 5/11/01 15:29 JL
n-Hexane <10 10 ug/l EPA 524.2 5/11/01 15:29 JL
SURROGATES RANGE EPA 524.2 5/11/01 15:29 JL
4-Bromofluorobenzene 110 80-120% EPA 524.2 5/11/01 15:29 JL
1,2-Dichlorobenzene-d4 103 80-120% EPA 524.2 5111101 15:29 JL
EXISTING
JAI
EXISTING
EXISTING
tl?. Ix8/pc9
NEW RAKE BRDB.
BOO
NEW' EE
o TYP.IX5/IX6
GNR.BRDS.
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EXISTING AND NEW REAR ELEVATION
d
Designs
BRIAN R CNRISTM DATE REVISION DRAWN BTE MATTY �I PROPOSED STUDIO AND MUDROOM. 12-13-O-I N .� PAGE SCALE
� (�
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9 35 ABEGALE SNOW ) T12-13-071 M s • of � v*:+-0" 1 gy _
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g 6 9 35 ABEGALE SNOW �I T 2-13-07 N to cx 4- ut'.i o° lily �v g
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I/2"PLY,BREATHING ASPHALT SHINGLES i� ASPHALT SHINGLES ,
15e ASPHALT PAPER
ASPHALT SHINGLES
2X12's C.J.a 16"O.G. —_ _— 2XI2'e C.J,0 16"O.C.
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AREA 3/4"T/G PLY. BIDING 3/4"T/G PLY,
NAILED t GLUED. _ _ __
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W Q /• }I/2"GONG,FILLED Q Q LOLLY COLUMN, ... -
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I ASSESSORS DATA:
MAP 88 PARCEL 002-001
LOCUS ADDRESS:
#35 ABEGALE SNOW ROAD, WEST BARNSTABLE
0P
ZONING DISTRICT RF
ABEGALE SN�w f , \\\` OVERLAY DISTRICT AP & RPOD
BUILDING SETBACKS.
FRONT - 30'
SIDE & REAR - 15'
Focus I F`., ,'�, REFERENCE DEED. 19551-222
o� �c ` REFERENCE PLAN556-38
FEMA DATA: ZONE »C"
MAP REV AUGUST 19, 1985
PANEL 250001 0015 C
o�
50.3' , �\\ M
O %Qp
Op Fqq U
348�B 4� p 80.4'
w i
LOT 2 263
56,061 fSF 36.W
SEPTIC PER T.O.B. �'. ` • '
1.0 - ,
AS-BUILT CARD
SAS
A .PLOT :PLA1V OF LAND LAD
ARE
PROPOSED Prepared For-
a� 256' p�2$12 ADDITION 35 ABEGALE SNOW ROAD
00 O •� In
8.3 x 10.3 SHED ►►►X ���
NLTHOF�,S �f+ West Barnstable, - Massachusetts
o P�Gisr�a
Scale: 1" = 40' Date: November 21, 2007
o # YL y Prepared By.-
'ag �, Stephen J. Doyle and Associates
S ion . 42 Canterbury Lane, E. Falmouth, MA 02536
40 0 40ll 80 ' s" R E�. Telephone: 5081540-2534
_E3_z
GRAPHIC SCALE 1" 40'
NO. DATE ""~ DESCRIPTION BY
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ASSESSORS MAP, $$ PARCELS. 1 & 2
LEGEND
+ PROPOSED WATER WELL
ZIONING DISTRICT: RF
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MIINIMUM YARD SETBACKS:* c
,
o
-16- EXISTING CONTOUR �a
M
_
T _ x
FRONT 30 R
SITE LOCUS
PGA 4
X 16 EXISTING SPOT GRADE SIDE = 15 show RD
15
o- PROPOSED CONTOUR
REAR =
TH 1 ,� p
F
� K � SOIL TEST HOLE
MAR BARNSTABLE BENCHMARK ZONE: G B S BLE
B E FILOOD ZO E
�c" DFT AGE EA ENT,/ / �
/ ! SEE TEST HOLE LOGSPANEL
(
1 1 2500 000 D
CATCH BASIN /
COMMUNITY c s,.
c
O, � N ,
I Tl ITY P JULY: 2, 1992
F
J U L OLE �
- O
I ELEV 122.�30
I o
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GROUNDWATER -0V�RLAY DISTRICT: AP
�� _) � -� I -' � • CATCH BASIN
3
1 7 PA
PLAN REF: BOOK 558 GE 3
- LOCUS MAP
REF: OK 55E PAGE 38
�5.00 _ PLAN E BOOK
5 \\ wN
��. -^ NOT ALL SYMBOLS MAY APPEAR N DRAWING SC,ALE: N•h'J
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TOWNOFFICIALS� W TH T V*)VERIFY., I 0
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A�,CE'SS CO E
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F FIN, GRADE "COVER TO WITHIN 6 0
/ 6 � ACCESS CO E
a 2 � N F FIN RA p .� � / � ✓� � WITH! 6 0 GRADE
1 4 ,
TOP OF FNDN AT EL. 2 .0 ,
AT 1 0.9 t
GROUND SURFACE EL. 2 1 GROUND SURFACE AT EL. 1 16.5 t
F AT i f GROUND SURFACE L. fi.3 OU D SU CE E
�9 J PF C
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MIN
IMUM M .7 F COVER
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REQUIRED OVER SYSTEM
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"
RUN PIPE L VEL
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FOR FIRST 2
TI I
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114.5 PROPOSED ED 0 S
/
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/ �, CLUST GALLON SEPTIC 117.0
� 17. 5 t
1 2
��� TANK (H-10)
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a4 4 114.0 3.5 o s DEs
p p BAFFLE 114. 1 2 ® ENDS
- 000ca ooco pc�000
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DEPTH OF FLOW _ „
2
�• 1_ � R MECHANIC
-
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7 SIZES:O TEE S Z ��
4 "
-----------------
INLET DEPTH = 10" MIN BELOW FLOW LINE COMPACTION. (15.221 [2]) g 14 o`t3gi o 1 12.0
�� DEPTH = 14" MIN OW FLOW LINE
LOT R"Q �1 � � `�� J OUTLET DEP BEL
i
Er 4 TO 1 1 2 DOUBLE WASHED STONE
, MIN 2% SLOPE MIN 1� SLOPE €dIIN 17, SLOPE)
( )
11 74 D BOX 6 LEACHING FACILITY
6 .
TH2 FOUNDAT121,5
ION SEPTIC TANK O
3 D r
1 8
-- - _ '
\
PE OP E 1, 0 A 0 BOTTOM OF TEST HOLE AT EL. 104.5
� SYSTEM PRO
FILE
E
N C E .--
0
TEES � / �� '- NIOT TO SCALE)
)WELLING a } ;
9°l
- 122.57 �t
- _ - DEPTH 1N. TH7 ELEVATION '(FT.) r� �/n In
- '
� � �/ ( ) � DEPTH H (I N.) o: T u 1�,: "�T
SANDY LOAM I SANDY LOAM ,
9 , / 10 YR 2 1 10 YR 2/1
_ _. /
`z `-__ _ _ �'.,-..- ;�-� i '' r $ , 115.53 8 116.23
__
--- - _ /
_�_ ___ �w
6�\ - -_ = w T� ��/ BW M DATE: MARCH 20, 2001 SANDY LOAM
- _ ,^ SANDY LOA �
�`, ----- ----- _-_' -----' ENGINEER: ARNE H. OJALA IPE, PLS 10 YR 6/4
C{ cp " 10 YR 6/4 113.86 N HARRINGTON RS "
2$ C1 WITNESS. GLEN 30 114.40
EXCAVATOR: BORTOLOTTI I
120 �,g �r � � `�� LOAMY SAND
I1LTRATS 8� i �j LOAMY FINE SAND 10 YR 6 3
D 2 TH y11a 46 10 YR 6/3 112.36 �" / 112.9
C2 SOIL CLASS: I C2
\ /C LOAMY FINE SAND MED/COARSE SAND
PERC RATE: <5 MIN./INCH 2.5 Y 8 1
/ 1 zz 12h ,. 2.5 Y 8/1 " 78" / 110.4
56 111.53 TOP PERC: 84
z<< �� t T / C3 C3
LOAMY ND
� SA
VARI AT
LO
G ED
76" 7.5 YR 5/8 109.86 88" / 109.57
°�� G<< � 7.5 YR 5 $
� C4 C4
' MED COARSE SAND
MED/COARSE SAND /
„ 10 YR 7/3 " 10 YR 7/3 NOTES:
140 104.53 TEST HOLE LOGS 144 104.9
(1) 0 (6) HIG ACI FILT T S / '%0i NO WATER FOUND (NOT TO SCALE) NO WATER FOUND 1 . THE LOCATION OF EXISTING UNDERGROUND UTILITIES SHOWN ON
WITH .5' OF STONE AT T�I� SIDES,
` A THE THIS PLAN IS APPROXIMATE. PRIOR TO ANY EXCAVATION ON THIS
ENDS, �ANU 4--BENE ! SITE, THE EXCAVATING CONTRACTOR SHALL MAKE THE REQUIRED 72
HOUR NOTIFICATION TO DIG SAFE (1 -888-344-7233) AND ANY
OTHER UTILITIES WHICH MAY HAVE CABLE, PIPE, OR EQUIPMENT
56 0 1 5F �+ ��1 p I, g IN THE CONSTRUCTION AREA FOR VERIFICATION OF LOCATIONS.
6 1,2 AC t i SEPTIC SYSTEM DESIGN DATA 2. MUNICIPAL WATER IS UNAVAILABLE.
�23 Z.99, / ► i 3. ALL SEPTIC WORK AND MATERIALS TO CONFORM TO 310 CMR
i SEPTIC DESIGN: (GARBAGE DISPOSER IS NOT ALLOWED) 15.00 TITLE 5 AND BARNSTABLE HEALTH REGULATIONS.
DESIGN FLOW: 4 BEDROOMS (1 10 GPD) = 440 GPD 4, MINIMUM PIPE PITCH TO BE 1/8" PER FOOT,
SEPTIC TANK: 440 GPD ( 2 ) := 880 6 1 1 lo 5. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO H-10,
d `� 6. PIPE JOINTS TO BE MADE WATERTIGHT,
USE A 1500 GALLON SEPTIC TANK 1 7• WATER TEST D-BOX FOR LEVELNESS.
LEACHING: •J I
_ , �, 8. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO BE
� BOTTOM: 41.5 X 9.83 = 408 S.F. `1
/ SIDES: 2(41 .5 + 9.83) X 2 = 205 S.F. r '� USED FOR LOT LINE STAKING.
TOTAL: 613 S.F. X 0.74 LTAR = 454 GPD > 440 O.K.
9. PIPE FOR SEPTIC SYSTEM TO BE SCH. 40-4" PVC.
Q 10. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT
USE (1) ROW OF (6) HIGH CAPACITY INFILTRATORS` s 1 INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED
- C WITH 3.5' OF STONE AT THE SIDES„ 2' AT THE ENDS, FROM BOARD OF HEALTH.
AND 14" BENEATH '?� X
11. NO VEHICLES OR CONSTRUCTION EQUIPMENT ALLOWED OVER
PROPOSED SYSTEM,
12, VERTICAL DATUM APPROXIMATED FROM QUAD
SITE PLAN /
SCALE: 1" = 30' �,5�ya r - 3�
TITLE 5 SITE PLAN
off 508-362-4541 OF
fox 508 362-9880 LOT 2 -- ABIGALE SNOW ROAD
IN THE TOWN OF:
down cope engineering, Inc. WEST BARNSTABLE
��$Ali OF PREPARED FOR:
ARNEK �� �«, 0F44 CIVIL ENGINEERS
� c TIM PEARSON/MARKWOOD
OJALA
CIVIL ARNE LAND SLJRVEYORS
fVo.90492
H. 30 0 30 60 90
o OJALA
j w A�����'�►sTla�o tiQ o.2634 4 BOARD OF HEALTH m h ma 02675
939 main st. yar ou
,
At ENG {
MA APRIL 2, 2001
y PLS DATE APPROVED DATE SCALE' 1 = 30' DATE:
OO- 1 O9-L2 ARNE H. OJALA,