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0110 ACORN DRIVE - Health
110 Acorn Drive NNW West Barnstable ' A= 216-013 d 4 t 1 { t e Commonwealth of Massachusetts 013 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 110 Acorn Drive z C: Property Address Kathleen Jeffries tv Owner Owner's Name information is Gary required for every West Barnstable Ma. 02668 10/21/2016 2 page. Citylrown State Zip Code Date of Inspection r.. — — as Inspectidn results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms ,,5� on the computer, 40' 7 use only the tab 1. Inspector: key to move your cursor-do not Michael T Bisienere key the return Name of Inspector Y Cape Septic Inspections Company Name 624 Old Barnstable Road Company Address MA Mashpee Ma. 02649 Cityrrown State Zip Code 508-280-3356 S13938 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 10/23/2016 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ""This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 110 Acorn Drive Property Address Kathleen Jeffries Owner information is Owner's Name required for every West Barnstable Ma. 02668 10/21/2016 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: This home has a H-10 1500 gallon septic tank and a H-10 D-Box with three 500 gallon leaching chambers with appx. four feet of stone around them at the time of the inspection there were no signs of past hydraulic failure. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 110 Acorn Drive Property Address Kathleen Jeffries Owner Owner's Name information is West Barnstable required for every Ma. 02668 10/21/2016 page. Ci frown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ 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•3/13 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 110 Acorn Drive Property Address Kathleen Jeffries Owner Owner's Name information is West Barnstable required for every Ma. 02668 10/21/2016 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 systerr 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 '/day flow t5ins•3/13 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 �e 110 Acorn Drive Property Address Kathleen Jeffries - Owner Owner's Name information is West Barnstable required for every Ma. 02668 10/21/2016 page. Clty/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•3113 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 .•'` 110 Acorn Drive Property Address Kathleen Jeffries Owner Owner's Name information is West Barnstable required for every Ma. 02668 10/21/2016 page. CltylTown 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form ug Subsurface Sewage Disposal System Form -Not for Voluntary Assessments110 Acorn Drive Property Address Kathleen Jeffries Owner Owner's Name information is every West Barnstable re uiredforeve Ma. 02668 10/21/2016 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? (Include laundry system inspection information in this report.) ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): well Detail: Sump pump? ❑ Yes ® No Last date of occupancy: occupied 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? [I 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•3/13 Title 5 office]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 110 Acorn Drive Property Address Kathleen Jeffries Owner Owner's Name information is West Barnstable required for every Ma. 02668 10/21/2016 page. di:yf own 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for or Voluntary Assessments 110 Acorn Drive Property Address Kathleen Jeffries Owner Owner's Name information is required for every West Barnstable Ma. 02668 10/21/2016 page. Clty/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): Depth below grade: 36" 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: 24"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: standard H-10 1500 gallon Sludge depth: 3" t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 110 Acorn Drive Property Address Kathleen Jeffries Owner Owner's Name information is West Barnstable required for every Ma. 02668 10/21/2016 page. Clty/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 apx. 35" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle apx. 5" Distance from bottom of scum to bottom of outlet tee or baffle apx. 12" How were dimensions determined? sludge Judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): I would recommend the new owner put the tank on a maint. plan with a local septic pumping co. based on the future use of the home.The Barnstable Health Dept has a list of local pumping co Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntar y Assessments 110 Acorn Drive Property Address Kathleen Jeffries Owner information is owner's Name required for every West Barnstable Ma. 02668 10/21/2016 page. Citylrown 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts a Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 110 Acorn Drive Property Address Kathleen Jeffries Owner Owner's Name information is required for every West Barnstable Ma. 02668 10/21/2016 page. CltyrFown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): At the time of the inspection there no signs of solids carryover or evidence of past hydraulic failure 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. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins 3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 110 Acorn Drive Property Address Kathleen Jeffries Owner Owner's Name information is required for every West Barnstable Ma. 02668 10/21/2016 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.): At the time of the inspection there were no signs of past hydraulic failure Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 110 Acorn Drive Property Address Kathleen Jeffries Owner Owner's Name information is West Barnstable required for every Ma. 02668 10/21/2016 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.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 _ 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 110 Acorn Drive Property Address Kathleen Jeffries Owner Owner's Name information is West Barnstable required for every Ma. 02668 10/21/2016 page. Cltyfrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately ��- /3 J1 J f" ��v M ��e �nl S�'�•./l e/� o rJ Th c. �v+vx� ���f�. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 II il«�,.��w ww.tuwnvtoamstanle.us�assessmg/HMdisplay.asp?mapper-2. TOWN OFBARNSTABLE LOCATION C. if SEWAGE# 4 . VILLAGE' C b \ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. v SEPTIC TANK CAPACITY LEACHING FACILITY':(ty , i f rap (vpt��y�oin) ! � �r�� NO.OF BEDR t OWNER PERMIT DATE: �/ - ;0 -(3 COMPLIANCE DATE: Separation Distwoe Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility e� Private Water Supply Wgil sad Leaching Facility(If any wills exist an site or within 240 feet of leaching fseitity) —/,�'@ Few Edge of Wetland,and Leaching Facility(If any weflands exist w>dnn 300 feet of leachlag facility) Fee FURNISHED BY l / I '�'EAILOF Na I4��316 b261 � 16'3'a0 �I-. V zq-3$16" N'•51 t$11 t$r c� V 0 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 110 Acorn Drive Property Address Kathleen Jeffries Owner Owner's Name required fo is every West Barnstable required Ma. 02668 10/21/2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 12 plus feet feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: I augered a hole at a lower elevation and shot it with a transit to show five plus feet of seperation Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal system-Page 16 of 17 Commonwealth of Massachusetts vl Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,•'° 110 Acorn Drive Property Address Kathleen Jeffries Owner Owner's Name information is required for every West Barnstable Ma. 02668 10/21/2016 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file - 12 All P/,)S Ceei t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 . TOWN OF BARNSTABLE LOCATION ' D AC O Tzas) ymi O F SEWAGE# �2 o61 VILLAGE SATc0-57MB L ASSESSOR'S MAP&PARCEL �D INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY (' LEACHING FACILITY:(type 3 3 srCo �L tNJ06(size) NO.OF BEDRO MS OWNER a PERMIT DATE: S o — P 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 1 on site or within 200 feet of leaching facility) ftr0 Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY '91EAll-OT- Nov . . � �- y' 6„ �a 19 , 3y vt $a} ao d y e3:3=a0 3Qo Vf�)" IAq •7-1i Crr CLOAK "ta G 11V No. WO fC� Fee THE COMMONWEALTH OF MASSACH SETT '63Entered in computer: s PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ZppYtcatton for �Dte;pogal 6p5tem Con0tructton Permit Application for a Permit to Construct( ) Repair( ) Upgrade(Abandon( ) ❑.Complete System ❑Individual Components Location Address or Lot No. 1 I O AC oizA) D�1 V Owner's Name,Address,and Tel.No cif a 1 e Ah{cc;ro Assessor's Map/Parcel Installe ' ame,Add ess, /el.N� 1� Designer's Name,Address and el.No. i 5AWP K i Type of Building: wellin No.of Bedrooms Lot Size sq. ft. Garbage Grinder,.(---�-- Other Type of Building T_ No.of Persons Showers Cafeteria-(--j — Other Fixtures u y Design Flow(min.required) 7 T gpd Design how provided gpd Plan Date 7 r 3 V c.,,-7 Number of sheets Revision Date 0 7 T " Title e U,& Q V, rP,01A fJ e—)r,+A4ff Size of Septic Tank ® royVAR, Type(of S.A.S. "5 Zr Description of Soil Nature of Repairs or Alterations(Answer when applicable) 9),FLt 0 �P EPA O F z ' W/ k -5A raze- cj /.19`o0 02 Ca�ir�, 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 kdde,and not to place the system in operation until a Certificate of Compliance has been issued by t ' Bo Health. Signed 40 ate A 36 0 —7 IV Application Approved by Date Application Disapproved by: Date for the following reasons on din Permit No. Date Issued No. Fee THE COMMONW�EALTHbF MASSACHUSETTS Entered in computer: 1 s PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ZIppYication for �Biopogal �bpotem Conotruction Permit Application for a Permit to Construct( ) Repair( ) Upgrade(Abandon( ) ❑.Complete System ❑Individual Components Location Address or Lot No. / 10 AG 01wV ✓ I V Owner's Name,Address,and Tel.No. Assessor's Map/Parcel �CO oabGB j �b 3-may cl✓ ' Installe ' ame,Add ess,ag5Tel.No. Designer's Name,Address and Tel.No. Rv�s sly" Sae�.Ow�c�lGYI� Y'00ToX 11 Type of Building: Dwellin No.of Bedrooms Lot Size sq. ft. Garbage Grinder_- i Other Type of Building �•j- No.of Persons Showers(�-) Cafeteria.O Other Fixtures ~~ Design Flow(min.required) 7 V gpd Design flow provided .) ✓ gpd Plan Date 3(� • �� Number of sheets Revision Date �_�,��1 -Q 7 { Title `j Ar a c ua e- e !i?'G V, EA/A Z tJ?OC ,4,0 e / / Size of Septic Tank b c Type of S.A.S. �-$GEC) !. '5- y of/ r D w C Description of Soil Nature of Repairs or Alterations(Answer when applicable) ,c1 - uv ''. 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 de and not to place the system in operation until a Certificate of Compliance has been issued by t Bo Health. Signed rb 4 ate -3'0, o Application Approved by Date Application Disapproved by: y Date a for the following reasons Permit No. '"'• Date Issued THE COMMONWEALTH OF MASSACHUSETTS T LE BARNS AB MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, hat the O -site Sewa a Dis osal System Constructed ( ) Repaired ( Upgraded ( ) , Abandoned,(. ')'by !` at / ; as been constructed in ccordance with the provisions of Title 5 and the for Disposal System Construction Permit No. " If t dated 4 Installer Designer #bedrooms Approved design flow �� gpd 1 The issuan e of t s pe it shall not be constt�=ed as a arantee that the system i f nction as desi ned. Date c � e Inspector r , a _ ��� -----�_�rya ------- ' ---- No. Fee—�O!/ .�. �V T14E COMMONWEALTH OF MASSACHUSETTS ' PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS ligool *pftem Con$truction Permit Permission is hereby janted to onstruct ( ) Repair ( / Up rad ( V) !AAbandon ( ) System located at to qa� and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Constru tion m t be completed within three years of the date of this e t Date / Approved by * �` f Town of Barnstable °EVE Regulatory Services �. Thomas F. Geiler, Director (� BaBN"ABLL \ MAS& � Public Health Division 9�a ie3q �0�9 Thomas McKean, Director - - 200 Main Street,Hyannis,MA 02601 Office: 50&862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date:61'2-7'0 Sewage Permit# IU0_7 - ✓Assessor's Map\Parcel a I (I J Desioner �' "' ' `' �'dlr b ) �_ Installer: u,Sv17h� Address: ® ��K ( Address: to_- -5 Ep"Orwit,4( _514AA Wk JN4__0_.A_f-6 3 0n - b -07 60A41 3v;zh r was issued a permit to install a (date) (installer) septic system at I L o rl/�W� p'e,b based on a design drawn, by (address) - I '� t � dated 7 -30 "0'7 7Try iv -- c c� (designer) � x 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 andior septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. OF DA M YER (Installer4Signa re) ` No. 1140 AEGISiE � p� SAN I T0, Q '�� (Designer's Si-nature) (affix Designer's Stamp Here) 0 PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q: Health/Septic/Designer Certification Form 3-26-a.�doe BARN 110 ACORN DR DOC DESCRIPTION TRANS AMT I BARNSTABLE TOWN OF RESTRICTION Surcharge CPA $20.00 20.00 State Fee $40.00 40.00 Document Copy -Man 1.00 Total fees: 76.00 C110 648 Aeo:11-14-2007 11:42:48a uuG hEScH1p|LON |KAmS AMT __ ______ _____ P0STAGE FEE County Postage Fee 1.00 "`" Total charges: 77.00 77.00 Bk 22470 Po241 g665352 1 1-14-2007 & 1 1 =42u NOTICE OF DEED RESTRICTION RESIDENTIAL f The Barnstable Board of Health requires, as a condition of their approval of the variance requested at their October 9, 2007 Board of Healthhearing,the following restrictions: Existing dwelling restricted to four(4)bedrooms. be placed on the property located at 110 Acorn Drive, West Barnstable, MA 02668, Assessors Map: 216, Parcel: 013, As.Deed is recorded at the Barnstable County Registry of Deeds, on the Deed Book 17761 ,Page 217 . As plan of land is recorded at the Barnstable County Registry of Deeds on a subdivision plan titled "Subdivision of Land in West Barnstable Mass Property of Marion A Haniaan, Scale 1" = 60' January 7 1959 Ed Kellogg; Civil Engineer Osterville Mass ", and recorded on the Plan Book 146 Page 081. I, as owner of the referenced above property Acknowledge the deed restriction(s)being,placed on the:property. E,. e Owner's Sign ate lThe person named above: r Acknowledges the foregoing instrument to be his/her free act and deed, before me. A.J4 Notary Publ' Hillary B. Pancoast My Commission Expires: Notary PublicMY Co mission Expires N0� ,. February 19,2010 f . . BARNSTABLE REGISTRY OF DEEDS I b-------------------...... ... ....... ........ ---...... ......- ----- 1 '-0'L, 8"W 1'- ' Be 3M � 5,0„ 6, , 8,_6„ J 0 c 13'-O" i Q �J� U1 Closetco iBathroom \ M rV M rxI, l 3 3 LO Storage Only/Uninhabitable o O N A LO M i ~ 20''O" T THE? Barnstable Town of Barnstable w AFAmerlsaCihr IiARaYSs'fABLE, + SAW A'� Board of HealthI.F 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. JunichiSawayanagi October 16, 2007 Mr. Darren M. Meyer, R.S. P.O. Box 981 E. Sandwich, MA 02537 RE:' 110 Acorn 'Drive, West Barns#able;.,; A= 216=01.3; Dear Mr. Meyer, You are granted a conditional variance on behalf of your client, Kathleen Jeffries, to construct an onsite sewage disposal system at 110 Acorn Drive, West Barnstable. The variance granted is as follows: Section 360-1, Town of Barnstable Code: The soil absorption system will be located 79 feet away from an intermittent stream (wetland), in lieu of the 100 feet minimum separation distance required. This variance is granted with the following conditions: (1) No more than four (4) bedrooms maximum are authorized at this property. Dens, study rooms, offices, finished attics, sleeping lofts, and similar-type rooms are .considered "bedrooms" according to the MA Department of Environmental Protection. (2) The applicant shall record a properly worded deed restriction, signed by the owner of the property, at the Barnstable County Registry of Deeds restricting the property to four (4) bedrooms maximum. A copy of the recorded deed restriction . shall be submitted to the Health Agent prior to obtaining a disposal works construction permit. - (3) The plans shall be revised to show a two compartment septic tank. Q:\WPFILES\MeyerJeffries I I OAcornDrive2007.doc PW (4) The septic system shall be installed in strict accordance with the revised plans. (5) The designing engineer shall supervise the construction of the onsite sewage disposal system and shall certify in writing to the Board of Health that the system was installed in substantial compliance with the revised plans. 'The existing septic system has failed. This variance is granted because the proposed plan appears to meet the maximum feasible design standards contained within the State vironmental Code, Title 5 and local Health Regulations. Sinc el yours, WhKe iller, D. Chairm n I Q:\WPFILES\MeyerJeffries I I OAcomDrive2007.doc SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Signatu item 4 if Restricted Delivery is desired. ❑Agent ■ Print your name and address on the reverse ❑Addressee so that we can return the card to you. o B eceived by(Printed Name) C. a of livery ■ Attach this card to the back of the mailpiece, 3'/ If�� or on the front if space permits. 111 D. Is delivery address different.from item 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑No J. E $ LOU IS VAiJ 06L. 2-5 E1_MCIZOFr WAY 3. Service Type yPVt?M0U7-3-1P0P'-r M* J4 Certified Mail ❑Express Mail ❑Registered ❑ Return Receipt for Merchandise 02L ZJ ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number I (rransfer from service label) PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540_; UNITED STATES POSTAL SERVICE Posstage-&"Fees°#�eid u Ps • Sender: Please print your name, address, and ZIP+4 in this box • D� M/r-, (� �U 66X q01 �v SENDER: COMPLETE NIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Signature item 4 if Restricted Delivery is desired. ❑Agent /Ak/■ Print your name and address on the reverse ❑Addressee so that we can return the card to you. B. Received by(Printed Name) C. Date of D livery ■ Attach this card to the back of the mailpiece, or on the front if space permits. r,tTr( � Nt S �'—1' D. Is delivery address different from item 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑ No KrL-,-ITfl $ [, N-E're DENwis �5 CE-DA-1-K7- ST99E � r 3. Service Type e��� C� V�� (Certified-Mail ❑Express Mail _ ❑Registered ❑ Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number (transfer from service label) PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 i UNITED STATES First-CGISSs"cl WE-! Postage&Fees Paid USPS Permit No.G-10 � I i • Sender: Please print your name, address, and ZIP+4 in this box • it I � a2A557 I COMPLETE • ■ Complete items 1,2,and 3.Also complete item 4 if Restricted Delivery is desired. ❑Agent ■ Print your name and address on the reverse X A dressee so that we can return the card to you. B. Received by(Printed 4Name) C. at f el'very ■ Attach this card to the back of the mailpiece, or on the front if space permits. D.{ds delivery address different from item 17 ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑ No 111 tt1N S P I F TUii-1, cut I H 6 oo y 3. S rvice Type ! Certified Mail ❑Express Mail I JTV jJ /� ❑Registered ❑Return Receipt for Merchandise El Insured Mail ❑C.O.D. � 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number, , (Transfer from service"label) i PS Form 3811,February 2004 Domestic Return Receipt 1o2sss-o2-M-lsa L y'. '!"`;f r UNITED STATES POST LAVI� � � �` ` " >; Class Postage&Fees Paid I I • Sender: Please print your name, address, and ZIP+4 in this box • D� 0MA SECTIONCOMPLETE THIS . . SECTION, COMPLETEiTHIS SEC,rION ON DELIVERY A. Signature to Complete items 1,2,and 3.Also complete iX ❑Agent item 4 if Restricted Delivery is desired. X ❑Agent ❑Addressee - ® Print your name and address on the reverse A dresse B. Received by(Punted Name) C. Date of D livery so that we can return the card to you. B. Received by(Printed Name) C. at f el'ver M Attach this card to the back of the mailpiece, O i or on the front if space permits. . D. Is delivery address different from item 1? ❑Yes D,yIs delivery address different from item 1? ❑Yes 1. Article Addressed to: s If YES,enter delivery address below: ❑No If YES,enter delivery address below: ❑No I N tFl N S P IP-M)A-�, t cu�� Comm Mo M s&j�n M14 ����y 3. Service Type I I ' `�H BU av P FL I oo y 3. S rvice Type )Certified Mail ❑Express Mail 1 Certified Mail ❑Express Mail ❑Registered ❑Return Receipt for Merchandise RoSTO N MA ❑Registered ❑Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. f n ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑y� tJ 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number (ransfer from service label) rn Receipt 102595-02-M-1540 PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-154 SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2;and 3.Also complete A Signatu t item 4 if Restricted Delivery is desired. ❑Agent ■ Print your name and address on the reverse ❑Addressee so that we can return the card to you. B eceived by(Printed Name) : a of live f ■ Attach this card to the back of the mailpiece, . ry # or on the front if space permits. Yf a ; 1. Article Addressed to: D. Is delivery address different from item 1? ❑Yes If YES,enter delivery address below: ❑ No S.E $ Lou!S VAA Peu, 25 E LM ORC FT- WAY { YkkMoun4polp-'r 3. Service Type � JK Certified Mail ❑Express Mail ❑Registered ❑Return Receipt for Merchandise 024 ZS- ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number I{ ansfer born s (Tr ervice laben PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-154a I I jjjj E tO/y DATE: Cj` / •2 ad'1 • FEE: $�S lARN3TABLE MA38. REC. BY---��� — $ �. Town of Barnstable SCHED. DATE:-1(5 --ej"tb0t Board of Health 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Wayne A.Miller,M.D. FAX: 508-790-6304 Paul J.Canniff,D.M.D. VARIANCE REQUEST FORM LOCATION ) 1 Property Address: lit) w f N PIl y e VJ . BP-r"S��� Assessor's Map and Parcel Number: L l I Size of Lot: le- i Z Wetlands Within 300 Ft. Yes X Business Name: t/1A No Subdivision Name: /q JA APPLICANT'S NAME: J�-N Wl • M 5��C/. Phone � � Did the owner of the property authorize you to represent him or her? Yes - No PROPERTY OWNER'S NAME CONTACT PERSON -r• �n� Name: I�AIW�F E .i fFr- Name: D m-,N M— Address: 110 Aco lad De., W . Scat is, Address: 'PO IC q9 C ,j¢�D?vq D cv Phone: VARIANCE FROM REGULATION (List Reg.) REASON FOR VARIANCE(May attach if more space needed) �u. —( � �t 4� .,., NATURE OF WORK: House Addition ❑LJL UULJ House Renovation ❑ Repair of Failed Septic System --� Checklist to be completed by office staff person receiving variance request application) .. � Please submit copies in 4 separate completed sets. Four(4)copies of the completed variance request form Four(4)copies of engineered plan submitted(e.g.septic system plans) Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) Signed letter stating that the property owner authorized you to represent him/her for this request Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense (forTitle V and/or local sewage regulation variances only) Full menu submitted(for grease trap variance requests only) Variance request application fee collected(no fee for lifeguard modification renewals,grease trap variance renewals[same owner/leasee only], outside dining variance renewals [same owner/lessee only],and variances to repair failed sewage disposal systems [only if no expansion to the building proposed]) _ Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Wayne Miller,Chairman NOT APPROVED Paul J.Canniff,D.M.D. q� REASON FOR DISAPPROVAL C:\Documents and Settings\decollik\Local Settings\Temporary Internet Fi1es\0LK1\VARIREQ.D0C 9 � ��,. ap F 26 , x fro 1 �Tl 1l 1 . --hA5E-A461V7- i i i I i I (C�nrr� L VEL i iris• 4•�8' ta'8• rain non r aV2' s @r @ r LTr 8• !�j 29W @r @ir !i i�'i t�• -T10' 0 I O Q raur -� as9• Tr KA 4.. Dora ' o/W I .:.3W•9, W�M. s1- 1@D-1/7• 138 rii• VOW @err rr • I � I sa• s a, Mir @ir or �:7r 11•r 2r rr our 2i• e. l5t Flw epp H161C ` 1MmiorlNv"spaee (FP fj f J l- re- ARP+;MOft 190, Aao a i J lO v Vol i �jD M ` kLqt ZovI IL UP WX i ?f-7W WX 12 , 6F"PT-) k 110 Ac,oPN DQ.wo o � S� � T l Zo � 3 to AcoP-N p� 3 �l,Ob w, bAMSTnbLt 1 UA 14T (0 �9 1 7 September 16,2007 Barnstable Board of Health 200 Main Street Hyannis,MA 02601 Re: Septic System Upgrade Residence— 110 Acorn Drive, W. Barnstable, MA To Whom it may concem: I, Kathleen Jeffries,owner of 110 Acorn Drive, W. Barnstable, MA, authorize Darren M. Meyer, R.S. to represent me before the Barnstable Board of Health in all matters regarding the upgrade of the on-site sewage disposal system at .the above referenced property. Kathleen Jeffries, t../ erty Owner P Bk 22470 Ps241 T65352 ..::` 11-14-20177 o"M 11 =42a NOTICE OF DEED RESTRICTION RESIDENTIAL = i �s. The Barnstable Board of Health requires,as a condition of their approval of the variance requested at their October 9,2007 Board of Health hearing,the following restrictions: ` -e or Existing dwelling restricted to four,(4)bedrooms. n `t � ' ent '. - be placed on the property located at 110 Acorn Drive, West Barnstable, MA 02668, ants }': Assessors Map: 216, Parcel: 013, As Deed is recorded at the Barnstable County Registry of Deeds,on the Deed Book 17761,Page 217. As plan of land is recorded at the Barnstable County Registry of Deeds on a subdivision . ;ealj plan titled "Subdivision of Land in West Barnstable, Mass.. Property of Marion A. ewer Hanigan Scale I"=60' ary Janu 7, 1959,Ed Kellogg,Civil Engineer,Osterville,Mass.", and recorded on the Plan Book 146 Page 081. C `_ rlQS as owner ofthe property referenced above eal) Acknowledge the deed restriction(s)being placed on the property. ;wer _. eal) = `'. Owner's Sign ate wer u The person named above: letew ' Acknowledges the foregoing instrument to be his/her free act and deed,before me. gal) wer 1' fit+0Pwas l01 NotaryPubl' ♦ w' '� Hillary S.Pancoast My Commission Expires: Notary Public : ray COMM1391011 Expires y' February 19,2010 s, f^ I . . . . . . . . . .:- BARNSTABLE REGISTRY OF DEEDS Town of Barnstable. P# y Department of Re� •atory Services ' Public Heal '4 Division Date �e$ 200 Main Street,, '%pnis MA 02601 Date Scheduled A, Time / Fee Pd. Re P6 s/io/oY Soil Suitability Assessrne B1ht for Sewage Disposal Performed Y Witnessed By: LOCATION&GENERAL INFORMATION Location Address r J C3�� �� owner's Name ' 1 , , Address�lt��LD DA2, k/• Assessor's Map/P4tcel: f / Engineer's Name NEW CONSTRU010N REPAIR Telephone# (P8 ,36 2—2�22- E � Io 0 Und Use - HS(D 6AM � Slopes(96) U:"it Surface Stones Distances from: Open Water Body ft Possible W&Area `0 6 ft Drinking Water Well �!S d ft prainageWay T ��b ft. Propertyl-ju r 0 ft Other /VA ft • I SKETCH:($treet name,dimensions of lot,exact locations of to t:hotes&pere,tests,locate wetlands in proximity to holes) SEE . I • 1. ' Parent material(gc ilogic) M•O94,pty,A1 i�_ Depth to Bedrock Depth to Groundwater: Standing Water in Hole:' _ Weeping from Pit Face Estimated Seasonal;"igh Groundwater Dt=EtTION FOR SEASONAL)FIIGH WATER TABLE Method Used: Depth dbperved standingin obs.hole: In. Depth tO Sall mottles; in, Depth toiweeping from side of obs.hale: in, ©roundwnter Adjuslttnent Index Well# Reading Date: index Well level Act.factor _ . AtQ,firgUadWatFt 1.eVei.,,,., PERCOLATION TEST • Date i7 Timp•__e_._. Observation Hole# 3 � Tinte at Sl" Depth of Pere �r' Time at 6" „ „ Start Pre-soak Time.@ � T' Time(9 •6 ) End Pre-soak L hn i tj Rate MinJlnch y L�"t'�-�"'''�1✓1 � Site Suitability Assessment: Site Passed Site Failed; Additional Testing Needed(Y/N) . Original:.Public Health Division Observatiod Hole Data To Be Completed on Back---------- ***If percolation.test is to be conducted within 100' of wetland,you must first notify the Barnstable C4servation Division at least one(1) wedk prior to beginning. DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other ► .Surface(in.) (USDA) I :(Munselp Mottling .(Structure,Stones,Boulders. nsis e c ravel) 0`!l2'' fo l� to ,e 3/ N Esc LoAm 116yS�8 An VV to tit LO lo:Yk��4 DEEP OBSERVATION HOLE LOG Hole#_ �2, Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, Gravel) ��► l2„ ,� �A�b Co doy/� 3/�, N A ��e ��� lee -2�8 t(,r Lo die lL DEEP OBSERVATION HOLE LOG Hole#__ Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Oravel 0 1.2�t A aw i!v l a R- w A s 2fs 33�" C Nlirp. 2.S 71� DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soit'Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency. r Flood Insurance Rate Mau: Above 500 year flood boundary No— Yes ` Within 500 year boundary No Yes Within 100 year flood boundary No x Yes Depth of Naturaliv Occurring Pervious Material. Does at least four feet of naturally occurring pervious:-material exist.in all areas observed throughout the area proposed for the soil absorption system? - If not,what is the depth of naturally occurring pervious material? Certification I certify that on ( (date)I have.,pqss 4the'sbit evaluator examination approved by the Department of Environ ental Protection and that the°:above analysis was performed by me consistent with the requireft ' ingjexpeertise and experience described in 310'0MR 15,017. Signature G' ✓ Date °I 11 D7 down cape engineering, inc. SIEVE SOILS ANALYSIS_JEFFRIES.xis DATE OF REPORT: 5/15107 .JOB : GRAIN SIZE ANALYSIS-SIEVE TEST FOR DARREN MEYER SITE: 110 ACORN DR. BARNSTABLE, MA LOCATION: SIEVE ANALYSIS Weight Sample(Grams): 453.2 SIZE RETAINED WT. RET. % RETAINED: % PASSED __________ ind_sieve) (sum) 1" 0.0 0.0 100.0% ----- - ------------ --------- -L--------------- 3/4" 21.5 215 4.7%: 95.3% 1/2" 37.5 59.0 13.0% 87.0% 3/8" 25.6 84.6 18.7/o: 81.3% -------------- ------------------- ----------------------------------------- #4 24.7 109.3 24.1%: 75.9% #10------- -�--------------31.9 141.2---------31.2%:----------------68.8% --------------L------------------- -----------------L----------------------- #20 88.4 229.6 50.7%: 49.3% #40 117.9 347.5 76.7%; 23_3% #80 85.0 432.5_ 95.4%: 4.6% #200 -------;--------------17.5 450.0 ------ 99.3%;------------------0.7% -L-------------- -L---------------- PAN: 3.2 453.2 100.0%:_________________ 0_0% SAMPLE: 453.2 NOTE: TEST ON PASSING#4 ONLY RESULTS: SOIL CLASSIFIED AS AASHTO A-3 (GRANULAR, SAND) (UNCOMPACTED) PERCENTAGE OF MATERIAL PASSING#4 SIEVE MEETS : #4 100% (TEST ONLY MATERIAL PASSING#4) #6010%-100% , #100 0%-20% #200 0%-5% REQUIREMENT FOR"FILL" IN TITLE 5. <5% PASSING#200 SIEVE RESULTS: PERMEABLE MATERIAL-CLASS 1<5 MINJIN. MATERIAL NONCOMPACTED SOIL DESCRIPTION: MEDIUM COURSE SAND I ---©5 00 9 Fee—-----4_5------ BOARD OF HEALTH TOWN OF BARNSTABLE ZippricationArVeil Con0truct ion Permit Application is hereby ade for a permit to Construct ( ), Alter ( ), or Repair NYndividual Well at: Location — Address AssessorAbp and Parcel v Owner Address 1 _ 1 �Y�'v O t_ '/L�/ Installer — Driller Address Type of Building Dwelling -------- --—-- — Other - Type of Building--------- - No. of Persons-- ------- --- /t Type of Well -- Purpose of Well------ -- --'-1��-�—`�— — Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a Certificate of Compliance has been issued by the Board of Health. — ®5 s2 Signed — — -- ---— — _ _ at --- date Application Approved By __—_ __—___- - - date Application Disapproved for the following reasons:----------— --- ---- - ------ ---------—--- -- -- --—_------ - —--____— date Permit No. — Issued----- -— - ------ ---- — - date BOARD OF HEALTH TOWN OF BARNSTABLE (Certificate ®f (Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired by (� °�� '�'^------ ---- ---- -- --- - -- - ------- ---- -- —__-__ stallers� 6��� ] has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. ------------------Dated-------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE------- —- — Inspector------ - -- -----—--------- .R N6 �S �� Fee----- - ----- _� BOARD OF HEALTH ' - ' TOWN OF BARNSTABLE 21pplicat ion Ar Well Con5tructionPermit Application is hereby- fnade for a permit to Construct ( ), Alter ( ), or Repair an individual Well at: _116 A a a kAl lot', W. (3a tr-.tl Location — Address _-- AssessorsOrMap and Parcel -- -------- --- - / 'y Owner Address i !✓ iN f" Installer — Driller Address Type of Building Dwelling --- -- --—- -- I, Other - Type of Building---------- No. of Persons------------------ i y /t ( Type of Well - -—-- �1A pacity--- ---------- -- Purpose of Well Agreement: f The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until Certificate .of Compliance has been issued by the Board of Health. SignedOS- date f Application Approved By — --------—-— - ---- date I` Application Disapproved for the following reasons:------------ - —---— - -------- '� ---- -- --- -----------��.� --- date Permit No. -— --- Issued---— --- ---------- ----- date BOARD OF HEALTH i TOWN OF BARNSTABLE Certificate Of (Compliance THIS IS TO CERTIFY, That-the Individual Well Constructed ( ), Altered ( ), or Repaired (� ' { { ttaller 1' f cc has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. ------------------Dated--------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. Inspector-- --- - - - - ----- --- DATE--------------- --- -- -- BOARD OF HEALTH i TOWN OF BARNSTABLE ! Melt Con5truct ion Permit 5 oa % _ No. Fee- i Permission is hereby granted --- - — ------- ' to Construct ( ), Alter ), or Repair-( n Individual W 1 at: No. -- �_��— CCJ r-n — t street as shown on the applicationn�a Well Construction Permit No._ — ed-- -- --- - f ' Board of Health ' DATE—___`�-�f!D I I _ m �: _ �� � � `� ,,� � --- - . - - -- --- -.-.-- - - __ , __ - _ ._ __ _-�-_ .______t --����-� �.____�.� _ __ __.__ _ _- ---- s - - —_ _ �. ___ _ �__ __.�_ � _ . _ �.�-- ------------- -�---- ----..-� - - � __ -- _ gip__ -� �___._. _ _� . £. ��..� �-+- - -rrY�� _ C �r �� ..� ��..- � � .ram ��� � ��� _ �� .. ...�� _._. �,�_ ��_ �.�. � J �.�+-mow-� e.. � —.—' — - � � a� ��__ Y..�a�� - � _ --- - - .�-.--�-:� � w- ___ _ _- -�_ _.�-�L - - .- ------- -- - - --- - - _ -.�- 4 - - _�: � _.___ ���- r -Z. .. _ � —_.#,.'„`,.._..._,. _`.."' ;" �— -'--'---' _---. R�..,... - ,. _--�._ mow•..._,.—... ._ — _ —_—,.�._— .... .—�—.._-_ — - --- s � x �. _� f ��._ _ ,�—__.tea__ � �_�� -• _.._ - - _ ���...�_-�__.._.�_..--.- �. _- _ ..—.-.__.�_ +_-..�._.--•--- _..-._.. _� _-. �_� 4.-+;-s.. x ,_--.�� —-.__�_.._..._ .ter_� __�._�_ - - -�.-s+_�.;-•'--..-_ � _— _ ._ ! F _ter•._-.2..___._-. �-+_�_a.—- ��—V.__ _s-.. �___�_--._. .r ' _ t _ ,gig � "`�>„� ''��• s S N' TOWN OF BARNSTABLE LOCATION SEWAGE VILLAGE a6L 124 SSESSOR'S MAP 6z LOT INSTALLER'S NAME 6� PHONE NO. Its( I(,t SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) NO. OF BEDROOMS PRIVATE WELL PUBLIC WATER BUILDER OR OWNERIE��� �LJ` DATE PERMIT ISSUED: DATE- COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No eWSA'41/ 6-f-ppe- 1 W L` W 8 ,275No... ............. Fxx 2Z.!:...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 0 F.............. ... .................................. Appliration for Disposal Works Tonstrurtion Frimit Application is hereby made for a Permit to Construct or Repair (�an Individual Sewage Disposal System at: ..................................... ............ .....................14,� ......Oeo .............. ---Y�.� .... K7-------------------------------------------- L ion-A4dress or E; o. ............. . ........ ................. .......................................................... Owner Address V.ZiDx........................... ......... ....U.(L(o..........A.k*A.. ............... Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms___.3 ___._Expansion Attic Garbage Grinder P4 Other—Type of Building ............................ No. of persons............................ Showers Cafeteria .(...:_) Otherfixtures ............................................z............................I......... .... ....... Design Flow........&!S...........i...............gallons per person per day. Total daily flow-----------................................gallons. 9, Septic Tank—Liquid capacity............gallons Length________________ Width..______.__.__._ Diameter_________-______ Depth_______.._...._. Disposal Trench 'No....................... Width.................... Total Length.................... Total leaching area....................sq. f t. Seepage Pit No......./............ Diameter.......kt*?.1.... Depth below inlet____.-......._. Total leaching area...................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date.............................;.......... Test Pit No. I................minutesperinch Depth of Test Pit_.__..._._._______.. Depth to ground water_._._..._.._____..____-. 44 Test Pit No. 2................minutes per inch Depth of Test Pit._._...._.____._._.. Depth to ground water___.___...._.._.___..._. ............................................................................................................................................................. 0 Description of Soil..............................................................................................................------*------------------------------ ..................................................................................................................................................................................................... ..................................................................................................................................................................................................... U Nature of Repairs or Alterations—Answer when applicable--...A-10.0.....0_1.—.e—------ ...................................................................... Agreement: I The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE Ti LE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of healt Sign _;L.... .. . ......................... ....... Date .................................................. ............... ------------ Application Approved By......==Z_14_0- Date Application Disapproved for the following reasons:..............................................................................................................- ....................................................................................................................................................................................................... 7 Date PermitNo.._.. ........................... Issued_......:................................................. Date No.._.oY2 75- C 'F-- l "t 3 a e� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �C N...--...OF....... S!2k S1C•t,�1. .,................................. Appliration for Disposal Works Tonstrur#inn Prrutit Application is hereby made for a Permit to Construct ( ) or Repair (\)San Individual Sewage Disposal System at: . ..........�-/S S e_r c9 2 .. .-. ......- _......_..... .....................--.e!z.. -d4----........---------------•--............------ �p � Location-Address or Lot No. ' F;'�? l K.:_.......�5 ?:`: ---......•............................ ......................... ............................................................ Owner Address a ...:...... ..�:>•, ...s- .......... ..... ??c�=.... � L ' ........... A. jil .............. Installer Address UType of Building Size Lot.................... ......Sq. feet Dwelling—No. of Bedrooms.....3..................................Expansion Attic ( ) Garbage Grinder ( ) P4 Other—Type of Building/1_....Z................... No. 'of persons........................... Showers ( ) — Cafeteria ( ) dOthei!fi tures,l.-- r-•---•---•-•-••--•--•-•-•-••-••••-•---.......-•--•-......•--•••-•--•----------•-•--...- W Design Flow........ .:�..........................gallons per person per day. Total daily flow......... _ ___._..._____.......gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No.......1............ Diameter....... Depth below inlet....... ..... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) a Percolation Test Results Performed bY.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit..........._........ Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ LYi -------------•-------------...----•-•----•---------.......--------.........-•--..........._....--••-......................................................... ODescription of Soil........................................................................................................................................................................ ---------•------------------------•---------------------------.....----------------- --.----------------- •------------------ --.-------- ---------------------- ......__... .-------------- W UNature of Repairs or Alterations=Answer when applicable.....P.-0.Y).__...0Vt- ..... =------------------•-•----•----...----......_...._------......-•----:....-•---• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TILE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by he board of health ------•--•- ........ _..5---- Date Application Approved B ,- i 6 i Z.,F4 ..ate Application Disapproved for the following reasons-..................................t--•-•••---•----------••••-•••-•--•--•---••-••------•••-- ....._..... l Date Permit No...... -�•� ................... i-----•.._......--•---.._.. Issued-......:................................................ Date ----------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......... �......OF.... ................................. (Irrtifiratr of Toutplittnrle THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( �)� y............................... .......................... Installer at - �!_.__.._. ..__....Q. l yiz.......v4�*- ------------41.Y u.kt_:ie:_..S_'-,o --------------------------------------- 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._,!�V2:72 !2�r------------- dated...s� -All. __.......__..._._...... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.. --jl!. k ------------------- Inspector................ =� -............................................. - - - -- -..--- ... ----------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No......................... FEE.....z. .......... Disposal Works CDoristrurtion Hermit Permission is hereby granted.....1_.l!!?!1 ._ .b? -! _.. .`E'.� T.+�� .................. ......�.._. to Construct ( ) or Repair )—an—Individual Sewage Disposal System = ..................................................... Strcet � as shown on the application for Disposal Works Construction Permit No.�....`.�5._ Dated.._?r�i3? 'p� .. ...........••-•--_.... lyy DATE.......-----------•-- ................................................. Board of•Ilealth / No. .... ... � l Fxs.. ..�.. THE COMMONWEALTH OF MASSACHUSE17S BOARD OF HEALTH Appliratinn for Disposal Works Tonstrur#iun 1hruti# Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: QY�.ru....,orz .......................... ....................... .................. ` Location-Address or Lot No. ...........0 5�.`r" -"^ •- 1 b e+rz,�------•------------------- -•--....-----.........4s_:!4^_^�-4....................................................... Address ...., .._.........G. ? ,.......................... . ................ Installer Address Type of Building Size Lot............................Sq. feet �-, Dwelling—No. of Bedrooms......��................................Expansion Attic ( ) Garbage Grinder ( ) aa Other—T e of Building Other—Type g ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) d Other fixtures W Design Flow.........! .................gallons per person per day. Total daily flow........ ..........gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width..................... Total Length.................... Total leaching area.............:......sq. ft. 3 Seepage Pit No........I.......... Diameter...../..a`-- -- P. . De th below inlet.......(_....... Total leaching area..................sq. ft.- - Z Other Distribution box ( ) Dosing tank ( ) 1.4 Percolation Test Results Performed by.......................................................................... Date............:........................... Test Pit No. (................minutes per inch Depth of Test Pit.................... Depth to ground water..............-. L>~ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ x -----s -------------------- •-----------------------------------------•-•--------------.........•---------------- 0 Description of Soil............�_.!4.*...�..._:'T..............� y. ----•----••--•--•---•--...----•--•----•----•-•---.....•••--•........---•--••..... U .............••.........-•-•-••............---•-•.........----------------......................------.......---------•-----....---•------•-------. W UNature o Repairs or Alterations—Answer when applicable..... .t�°a�►9_� ....62 X.&....p. Ems:-.�ws�=.._��. C - Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'I'LL 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by Pe board of healtlik Signed.......: /` -------- Application Approved By__......... _ � -- Date Application Disapproved for the following reasons:----•-------•-------•--•------••----••------------------------------------•-•-•-----...........-••--•-•--•---- .....-•--------------•---.......-•----................------------------------•---•-----••••......--•--•••••-••------•---•......----••......-- �,� l qy Date Permit No...-- ��. ..................... Issued...:. �� 1............ Date No.! ... D. !c ! THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........OF Wn2w ......................................... Appliration for Disposal Works Toutrurtion Prrutit Application is hereby made for a Permit to Construct ( ~) or Repair ( ) an Individual Sewage Disposal System at: --->�:�.�? .!�.a....1��`........................... z_�,YZ-,�............ ..........•- .......-•u---.---.-w---.._ssS..:Pr`!w.4'.-----•--------........-----�---•---...............-..„............ .... 1:J � Location.Address 4orLNo. ...... 1 � ` ,Y ....;:�e* Owner . ----•--• Address a G 1AY?c Lt.;0_ ctvQ � -._...... .......... 4 \lS.... - M Installer Address U Type of Building �'�------`^'- -- .� Size Lot.._..______ .............Sq.(feet Under OtherDwell—Type T eoof Buildingooms........ .................. P Expansion Attic ( )Showers (Garbage) Cafeteria ( ) { 04 Other fixtures . --------------------------••-• No. ofersons----------•-•••• ------ d Deign Flow.........<,-:§=..................gallons per person per day. Total daily flow--------�.IC)...................gallons. Septic Tank—Liquid capacity............gallons Length................ Width._..._..._...... Diameter................ Depth................ xDisposal Trench—No..................... Width..................... Total Length..................... Total leaching area.................:..sq. ft. 3 . .......... Diameter .. Depth below inlet.....I".,�--/- Seepage Pit No......... .�'..... ....... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water.............._......... fZ4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ O ---•--------------------•---------••---.......------------•----..............--•------....-•---......-•-------•--. - 0 Description of Soil............. .. :!!� _...'�_...... ~•--+. .................................... ............--------•-•.................•••-----•-........----------------.........-•----.........-•-------------....---------......._..---------........_.......•----------------......._..........------...... W U Nature of Repairs or Alterations—Answer when applicable_....-/"~'r- .......... -----•--------------- Agreement J The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'Al TL: 5 of the State Sanitary Code—The undersigned further agrees not to place the system in ,operation until a Certificate of Compliance has been issued by the board of hea_It & Application Approved By -� Date Application Disapproved for the following reasons:................................................................................................................ .......----•.............•---••-•---......-•-•-----•-----...-•-------•--.....-------•-------•--..........._.....--•------•-------•------------------•-------------------.....------•-•---------.......... ¢ / - ----.Date -- Permit No......tz!. �- 9•---•-------------- Issued_....... ....�-7/-��--'' 111 ........... Date ------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �� "......oF ?. YzwS` .............................. Tertifirate of Toutpliattrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (L)� by................ Installer at.................(-.1.0..... 4C_c.%e. ..... ............................. .......... ......................................................... has been installed in accordance with the provisions of TI 'LE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.....�6G`^._ ..... dated_...- ......... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION lSATISFACTORY. DATE.........................�/!!. .t_ ......................... Inspector......-----.�R�]..'... � V THE COMMONWEALTH OF MASSACHUSETTS L BOARD OF HEALTH �' '.?.�G Op`-��.�P.Y�visa= ?�Q ..................... .................. ........._. ................................ r No.......�................. FEE....... ... . Disposal Works Tonstrurtion "prntit Permission is hereby granted------C n_ -• - --._ � to Construct ( ) or Repair ,( ) an Individual Sewage Disposal System atNo.......Al.a..-••-1 -,:......................t_�----- ---f a rA-dr.W.5.--------------------------------------------•---•--..... Street as shown on the application for Disposal Works Construction Perm No.... ..:..........^XI D'ated�_____.L�..._,��_...�P�..___. DATE-------- ............................. .....--•—.................. Board of Flealth -----------1' --''`-----�-- _ T I' SYSTEM PROFILE . DATUM . - C.O. SWEEP ELBOWS TO GRADE sA - C.o NOT TO SCALE VERTICAL DATUM MSLf WITH SCREW CAP ACCESS. BENCH MARK SET. COR, 2 1 /2 x3 13RICK TOP OF FOUNDATION RAISE COVERS TO WITHIN 6 OF FINISH GRADE - SYSTEM DESIGN SPRUCE ST. STOOP ELEV - ;9.11 LOCUS ELEV. 78.00 CENTER CHAMBER RISER FINISH GRADE RAISE TO WITHIN 6" FINISH GRADE FINISH GRADE ACORN DR. OF FINISH GRADE GROUND ELEVATION 79.0 N FLOW ELEV. 73.3 ELEV. 78.0 ELEV, 78.5 DESIGN L0 4 11 0 4 ///,.� ..� � \\j //\ �� ///�� /�� /��///�� -- BEDROOMS AT GPB/Q ��L GPD 1 MIN.-3 MAX. COVER �:� 4 BAND STAINLESS - 024 ST L CONNE OR GARRETT 5 EXISTING PLLMBING TO EE 132 - TOP ELEV 76.00 ,. „ ;. REQUIRED PTI TANK „ _ SEPTIC tN5![.E RESIDENCE 2 MIN 1 8 1 4 DOUBLE WASHED PEA ST�)ItiE POND REMAIN 18 _ � „ / / 2 MIN 3 MAX 21 < 40' O O O o c� O O O 4 PVC SCH 9 O O ,0 . 0 0 SCH 40 INV. ---440 x 2_- - -----880 GAL.. „ c= o „ C7 O O O -, r XI IN 76.30 ,. 14 TE 75.60 „ 'SEPTIC EXIST. V. 0 O SEPT.0 TANK PROVIDED 1500 GAL. 2 COMP. RE . 75.94 10 TEE O O N 0 ------ ( Q ) O O 0 O O O 3/4 DOOUBLE WASHED STONE 6 p p o 0 0 O GAS O O O O O 5 -g BAFFLE 3 OUTLET " , , ;` � 1 „ CHAMBERSSIZE OF LEACHING FACILITY REQUIRED GAR. SLAB 4 -8 ,. ,� THREE 4 -10 x8 -6 x3 -0 > /2 - 4 -1 D-BOX �. 4 3 ,. H-20 0 ELEV 83.70 _ LI UID LEVEL 4 4 - 27 _ DESIGN PERC RATE ___<2_ -MIN./INCH PER SIEVE ANALYSIS Q INV. 75. 75.00 T (POUT ABOUND SYSTEM TO C 3 HORIZON M N DEPTH / 4 BAN[ STAINLESS .., a .� INV.=75.10 - ON TER APP . RAT 0.74 GPD S.F. STEEL ',ONNECTOR 1000 500 p LONG M L E_____ / 6 �t•�t. ELEV S.A.S. (12.83 x 33.50 ) +I w 73.00 '- � ` •. GALLONS GAL.. , mot. STRIPOUT 23 t x 43.5 �r 11 F PIPE 71:27 ( } • •- . SIZE OF LEACHING SYSTEM PROVIDED. N to INV = 20 6 BASE OF CRUSHED STONE PLUMBING TO 440 - 0.74 SF/GPD = _596 S.F. MIN. REQUIRED EXISTING ,,= OR MECHANICALLY COMPACTED TEST PIT 3 ELEV. 51.60 INO GROUNDWATER ENCOUNTERED REMAIN INSIDE .GARAGE _ # LOCUS MAP �t�: 1,500 GALLON PRECAST - NOT TO SCALE. CONCRETE SEPTIC TANK USING 3 CHAMBERS WITH 4' STONE AROUND (2 COMPARTMENT) D.T:H. 3 SIDEWALL 2(12.83+33.5) x 2 = 185.3S.F. D.T.H. #1 � D.T.H. #2 �' # _ ,` _ : DATE: 5 10 07 DATE: 5/10/07 BOTTOM - 12.83 x 33.5 - 429.8S.F: DATE. 12/OS/06 / / GROUND ELEV 80.0 GROUND ELEV 79.8 GROM ELEV 79.6 TOTAL LEACHING AREA = 615S.F. NO GROUNDWATER N0, GROUN DWATER NO GROUNDWATER 6 '-, � 615 S.F x 0.74 = 455 GPD i EL 80.0 EL 79. 8 EL 79.6 455 GPD PROVIDED > ,440 GPD REQUIRED = 15 GPD RESERVE A A q (216 58) SANDY LOAM SANDY LOAM SANDY LOAM BARBARA M. WHITE NO (GARBAGE DISPOSAL / GRINDER ALLOWED) 1'3YR 3/2 10YR 3 2 _ 10YR 3/2 ,� _ EL 78.8 12 EL 78.6 12 EL 79 .0 12 B B SANDY LOAM SANDY LOAM 10YR 5/8 1�YR 5/8 Y LOAM I SANDY L " LOCUS INFORMATION EL 75.8 48 EL 75.6 48 _ CORRAL 10YR 5/8 C=1 C 1 , EL 76.0 48 SANDY LOAM SANDY LOAM -1 10YR 6/6 1�YR 6/6 C , SANDY LOAM EL 66.3 162 EL 66.1 .62 ! SAN , CURRENT OWNER KATHLEEN E. JEFFRIES 10YR 6 6 C-2 C-2 SILY LOAM SLY LOAM r , ADDRESS #110 ACORN DRIVE EL 66.5 162" 1�YR 6 4 ' 10YR 6/4 „ / i �� WEST BARNSTABLE EL 55.8 288 EL 55.6 288 ,i 150.00 _ MA 02668 C 2 _ C-3 r TO WELL C 3 ,, ; SILT LOAM MEDIUM SAND i �. PLAN REFERENCE 146/81 MEDIUM 'SAND. 10YR 6/4 Y 7 3 r' j 2.5Y,7 3 �.•5 / " i WELL �. 51.8 / 336 EL 51.6 336AL EL 64.0 192 EL r ' / , i i TITLE REFERENCE 1 7761/21 7 B.O.H. B.O.H. B.O.H. DON DESMARAIS DON QESMA RAIS DON DESMARAIS ! SHED / b ! �►!4 ,� ZONING DISTRICT RF SOIL EVALUATOR. SOIL EVALUATOR: SOI L EVALUATOR. ti s / ! _ i YER + ---r - a-WF \ �_ ' FLOOD ZONE "C" 8/18/95 D. MEYER D. MEYER D: ,ME - I 65 1 OPERATOR. PROBE OPERATOR. w 0• 4 - 250001--5C BACKHOE OPERATOR. PROBE 0 1 \ I i \ . ., � NOTE. •� �. N WELL DRILLING al TABLE 6� < IIII BRUCE MCALLISTER D FS 1�IVU V�tLL DRILLING DESMO D o , _.�-- , ABANDON EXISTING SEPTIC o o o I 1 84 � � •,-t � • : � \ , ASSESSORS MAP 216 1 ^� \ 1 sa L_ Y � ACCORDANCE � . . TYPE. __ //^^A�IL .-. .. MIN.. .. s 3 T _ _' _ SOIL .TYPE. __. .:. r � . ` �. I 1 _ � �.px ! c ;.. H o I <2 PE Ii�C � MIN. F'I:K IN C PEF� A L __ rr+ --'" PERC .:.RATE. :. _� � RATE: UBABLE TO PERCWITH TITLE 5, a G PERC RA / l VIA SIEVE ANALYSIS r to Cl OR C2 .v �- (VIA .SIEVE ANALYSIS) ( ) , (h T \ _ i • 4 GAL/SF/MIN IP] RATE. 0:74 GAL/SF/MIN Z WF , LOT AREA 54,278t S.F. I LOADING' RATE. LOAD G ---- � t \ \, ..�a � ,.�y _07 _ .... WF ZONE 11 NOT A ZONE II INDICATES DEEP 0-BOX TO BE USED s� \ TH 4 EXISTING GARAGE \ \ / (IN A' NITROGEN SENSITIVE D # TEST HOLE �► 25 INDICATES MOTTLING AS CLEAN OUT. CONCRETE \ S �` WITH ONE BEDROOM / ,. -_.,� • . / �•. :-' TYP. 7.5YR 5 6 FILL BASE AND CREATE .10 h ,/' WF a, x,.� AREA DUE TO PRIVATE WELLS LOFT ABOVE o �. / ti , IN NEIGHBORHOOD.) CHANNEL FOR FLOW. \ co ,� DISTINCT / COMMON �\ \' JJ h \ \ \ I> i OVERLAY DISTRICT AP INDICATES N t 1 ' AL .. " _ P RC TEST 108 INDICATES WEEPING ' P 5 44 E D.T.H. #1 - / i /� WF AL CLEAN OUT ! 1 OHW D.T.H. #2 �' AL ,� AL D.T.H. #3 �SWF NOTE: P TIC " _ , \ \ 1 WF REMOVE EXISTING SE "D-BOX" 1., \ ... ,•, ; NOTES: SYSTEN IN ACCORDANCE - i GENERAL 0 _- _-- • ' M 0 30 45 60 90 150 WTH TITLE 5. -- - ;.. - - 7, .� \y i!.�1 h c}' / 1 WF (� 1. ALL WORKMANSH IP AND MATERIALS SHALL CONFORM TO D.E.P. BEN CHMARK �� ' �• / \ J I TITLE V AND THE TOWN OF BARNSTABLE RULES AND REGULATIONS CORNER OF CONCRETE ;:... .,,�' i / \ �. �! o ` W ` iSTOOP/ ELEV 79.11 �•., \ N 4 � •�. FOR SUBSURFACE DISPOSAL OF SEWERAGE: 196- ( ,r \ \ `� l �. .� GRAPHIC SCALE: 1 INCH = 30 FEET 2. AT LEAST ONE ACCESS POINT OVER TANK TEES SHALL BE IN LAN SPIRIT AND---- ----- f „ THE 0 ' / �?✓ ACCESSIBLE WITHIN 6 OF FINISH GRADE, WITH- ANY REMAINING CULTURAL TRAINING COUNCIL, INC. / ACCESS PORTS BROUGHT TO WITHIN 12" OF FINISH GRADE. y .VACANT. /,�Op, I 3. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE AND O CAPABLE OF WITHSTANDING H-10 LOADING UNLESS THEY ARE L - UNDER OR WITHIN 10 OF DRIVES OR PARKING AREAS THEY F r _ MUST WITHSTAND H-20 LOADING. 'J'O ,1 79 ---- ��P \ 150.00 4. THE EXCAVATION CONTRACTOR SHALL VERIFY THE LOCATION // ,g ! �� ,� - 75 I ,��` T ANY, EXCAVATION: _ _ I WELL TO WELL OF. ALL UTILITIES PRIOR 0 / / � J 110 RY NITS USED TO BRING COVERS TO GRADE / / / ••, 5. ANY MASON U / / ) (3) " ARE 1N PLACE OR WITHIN 6 OF GRADE SHALL BE MORTARED S� .-•'ice :,•BEDROOM 6. FINISH GRADE SHALL HAVE A MINIMUM OF 0.02 FEET PER 1 \ OWELLING ' s 4� 19� _ -� %� SITE AND SEWAGE PLAN FOOT OVER THE S.A.S. AND DISTRIBUTION BOX. , K SANITARY TEE'S SHALL BE CONSTRUCTED OF 7. SEPTIC TAN S ��-� � , SCHEDULE 40 PVC AND SHALL EXTEND A MINIMUM OF 6 ABOVE 4 \\ ,� � ._•. .� ��,,,., .�� _ REPAIR / `UPGRADE THE FLOW LINE AND SHALL BE ON THE CENTERLINE AND \6'\ \� \\ \ / �i/ EXISTING LOCATED DIRECTLY UNDER THE CLEAN OUT MANHOLES. \ \ -"1. \ \\ \ 1 DWELLING #110 ACORN DRIVE 8. THE INLET PIPE INVERT ELEVATION SHALL BE NO LESS THAN \\ \\ R THAN 3 INCHES ABOVETHE INVERT \ \\ �\ \v-r�-� ; !. !, �� _ IN 2 INCHES NOR MORE \ \6O \ '� ELEVATION OF THE OUTLET PIPE:` .'' \� \\\\\\ \. .�• -- �. T SEPTIC TANK SHALL HAVE A MINIMUM COVER OF 9 INCHES 26-.12) WEST BARNSTABLE, MASSACHUSETTS 1 HE E �. \ '�- �5�,- �-! ITH &(L'VNETTE DENNIS , 10. THE OUTLET SANITARY TEE SHALL BE EQUIPPED WITH A GAS BAFFLE, 4 INCHES IN DIAMETER AND CONSTRUCTED OF, 4 PVC \cs \\ 1 �\J �. SCALE 1 - 30 DATE. 7/30/07 SEWER PIPE AND �;\\` 7 "`V 11. ALL PIPES SHALL BE SCHEDULE 40 PVC REV: 10/19/07 SHALL BE SLOPED 1 4 INCH PER FOOT MIN. EXCEPT FOR THE ����� �/ \� \\//N '''� .��; /„ EXISTING / ��� � SEP. PIT PREPARED FOR: FIRST TWO FEET OUT OF THE DISTRIBUTION BOX WHICH SHALL BE LEVEL \ K ATH LEEN E. JEFFRI ES NOTIFICATION ,�. ✓��`•��,i\����.i������!55�� 12. CHANGES OR REVISIONS" TO SEPTIC DESIGN REQUIRE 0 Y INC. FOR B.O.H. AND DESIGN ENGINEERS REVIEW To EAS SURVEY N 110 ACORN DRIVE ` AND APPROVAL. 00 `�•,,���.�,��� WEST BARNSTABLE MA 02668 CONSTRUCTION NOTES: 1. CONTRACTORS INSTALLERS SHALL VERIFY GRADES AND / PREPARED BY: ELEVATIONS AND SITE CONDITIONS PRIOR TO COMMENCING / .0 �� U %, IE f �`jtA of hagSS � MEYER WORK ON THE SITE., D A R R E N M . b� EDV1�Afi�D T COMPLIANCE XXEI A. 2. NO DETERMINATION HAS .BEEN MADE AS 0 C WITH DEEDED OR ZONING REGULATIONS. OWNER APPLICANT . b. 1140 P. O. BOX 981 d sTol�r / WETLAND DELINEATION IS TO OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. BY Mr. BRAD HALL 3. VEHICULAR TRAFFIC, PARKING OF VEHICLES AND PLACING /O ����s� E. SANDWICH BOX AND oh D a MATERIALS OVER THE SEPTIC TANK, DISTRIBUTIONO S��,T� �P�' M A 02537 /s S.A.S. AREA IS PROHIBITED LL r.:� lG 'jq -��) PH. 508 3fi2-2922 \�'u Q C ) \0 �'' , i 1 DATUM : SYSTEM PROFILE : 6A NOT TO SCALE VERTICAL DATUM: MSLf BENCH MARK SET: COR 2 1 /2x3' BRICK TOP OF FOUNDATION SPRUCE ST, _ ELEV. 78.00 RAISE COVERS TO WITHIN 6" OF FINISH GRADE LOCUS STOOP ELEV 79.11 SYSTEM DESIGN ACORN DR. CENTER CHAMBER RISER FINISH GRADE FINISH GRADE RAISE TO WITHIN 6" FINISH OF FINISH GRADE SI- GRADE V ELEV. DE ELEV. 73.3 SIGN FLOW DE /r-- , ELEV. 79.2 GROUND ELEVATION 79.0 4_ BEDROOMS AT 110 GPB/D 440 GPD G AR R ETT'S N TOP = 77.61 ///�� /.�� e�///�� / //\� , 132 REPLUMB SOIL PIPE 5" 1 MIN,-3 MAX. COVER TOP ELEV 76,70 POND TO MEET FLOP. OUTLET ELEV. 4" PVC 1Q' ; 2" MIN 1/8"-1/4" DOUBLE WASHED PEA S''ONE REQUIRED SEPTIC TANK 31 4 PVC SCH 40 9 O O 0 0 o O 0 0 SLEEVE SCH 40 INV. 2 MIN-3 MAX O 0 0 0 ---440 x_2_ _ -.---880 GAL. GASKET EXIST, iNV,= 76.30 76.53 10"TEE 14"TEE INV:=76.33 p p O p p a 0 0000 O 0 i 1, SEPTIC TANK PROVIDED = 1000 _GAL. EXISTING PROP. INV.= 76.75 6„ O 0O 00 0 0 0 O O 3/4 DOUBLE WASHED STONE - _ 5 -7 O 0 0 O O „ GAS BAFFLE 3 OUTLET „ SIZE OF LEACHING FACILITY REQUIRED GAR. SLAB 41_6 1/ „ THREE 4 -10 x8 -6 x3 -0 CHAMBERS ELEV 83,70 2 4 -1 LIQUID LEVEL 4'-4" D-BOX INV•=76.00 INV.=75.70 0 DESIGN PERC RATE _ _<_? MIN./INCH PER SIEVE ANALYSIS . - STRIPOUT AROUND SYSTEM TO C-3 HORIZON MIN DEPTH st. ��� L ,, ,, INV.-75.80 LONG TERM APPL, RATE_0.74_GPD/S.F. 6 � ' ��.�.�,-t ELEV S.A.S. (12.83 x 33.50 ) © V. 73.70 122 OF PIPE ` ' 72.0 STRIPOUT (23'f x 43.5') :H � LEACHING SYSTEM PROVIDED: I OF LEAC G S S o S ZE 0 0 o n o o N . a a N i )OV-zil.20 6" BASE OF CRUSHED STONE 440 _ 0.74 SF/GPD _596 S.F. MIN. REQUIRED OR MECHANICALLY COMPACTED TEST PIT #3 ELEV. 51.60 NO GROUNDWATER ENCOUNTERED LOCUS MAP . t . NOT TO SCALE: 1,000 GALLON PRECAST USING 3 CHAMBERS WITH 4' STONE AROUND CONCRETE SEPTIC TANK D.T,H. #1 L I I7b D.T.H. #2 0 D•T_H #3 TO REMAIN SIDEWALL = 2(12.83+33.5) x 2 = 185.3S.F. DATE: 12/08/06 DATE: 5/10/07 DA'E 5/10/07 GROUND ELEV 80,0 GROUND ELEV 79,8 GROUND ELEV 79.6 BOTTOM 1NG x 33.5' = 615S.F.F, TOTAL LEACHING AREA 615S.F. 6 - - 4 5 GPD NO GROUNDWATER N0 GROUNDWATER NO GROUNDWATER 615 S.F x 0.74 5 • 19 6s 0'� EL 80.0 EL 79.8 EL 79.6 - 455 GPD PROVIDED > 440 GPD REQUIRED = 15 GPD RESERVE A A q (216-58) c ARBARA M. WHITE NO (GARBAGE DISPOSAL / GRINDER ALLOWED) _ A NDY LOAM B SANDY 3/2M SANDY 3/1M S10YR 3/2 EL 78.8 12 EL 78.6 - 12" EL 79.0 12" B B B SANDY LOAM S�.NDY LOAM SANDY LOAM 10YR 5/8 10YR 5/8 10YR 5/8 EL 75.8 48 EL 75.6 C-1 48 Z CORRAL LOCUSINFORMATION EL 76.0 48„ C_1 � SANDY LOAM SANDY LOAM i C-1 10YR 6/6 10YR 6/6 SANDY LOAM EL 66.3 162" EL 66.1 - 162" 10YR 6/6 C-2 C-.2 CURRENT OWNER KATHLEEN E. JEFFRIES EL 66.5 162" SILY LOAM SILY LOAM f ° ADDRESS #110 ACORN DRIVE i iOYR 6 4 WEST BARNSTABLE 10YR 6/4 / ,i C-2 EL 55.8 288 EL 55.6 288 ES C_3 C-3 % � 1 MA 02668 AM i � SILT LOAM MEDIUM SAND MEDIUM SAND 10YR 6/4 2.5Y 7 3 �:•5Y 7/3 PLAN REFERENCE 146/81 EL 64.0 192„ EL 51.8 1 336„ EL 51.6 - 336" 1 ` i j / � �AIL , WELL 1` TITLE REFERENCE 1 7761/21 7 B.O.H. B4O.H. B.0.H, i DON DESMARAIS DON DESMARAIS DON DESMARAIS � SHED / � i� AL k � �� �\ \ \ ZONING DISTRICT RIF SOIL EVALUATOR. SOIL EVALUATOR. S01_ EVALUATOR. y D. MEYER D. MEYER D. MEYER I - -r - �. WF AL AL 65 , 4 90 ' FLOOD ZONE „C" 8/18/95 BACKHOE OPERATOR. PROBE OPERATOR. PROBf� OPERATOR, I i I o _ _ �g0 , AL , �4 _- _ 250001-5C BRUCE MCALLISTER DESMOND WELL DRILLING DI SMOND WELL DRILLING NOTE: a o of \ STABLE I '�` 6_$ SOIL TYPE: _3 SOIL TYPE: 1_ SOIL F'YPE: _ ABANDON EXISTING SEPTIC o o ! o I I I �8 �� • (' -�" - 1 ASSESSORS MAP 216 - - SYSTEM IN ACCORDANCE cs`�� �111� f' _ aIllc. ----t_- P iN H .•. 1 <2 MIN. PER INCH PERC ,SATE. <2 MIN. PER C COw o• P C R A E.PER •� \ PERC RATE. -- -- WITH TITLE. 5, ,�_G ,--�----"• .•- C1 OR C2 (VIA SIEVE ANALYSIS) (VIA SIEVE ANAi,.YSIS) LOADING RATE: 0_74 GAL/SF/MIN LOADI�G RATE: 0.74 GAL/SF/MIN Z�� \ \ ��` WF / \\ ; LOT AREA 54,278f S.F. WF % ZONE II NOT A ZONE II INDICATES DEEP „ „ \ / ` \ , D-BOX TO BE USED 4 �DTH ,� e IN A NITROGEN SENSITIVE # EXISTING GARAGE / ( T HOLE E TES 0 E 25 INDICATES MOTTLING \ / e e• �� AS CLEAN OUT, CONCRETE AREA DUE TO PRIVATE WELLS TYP. 7,5YR 5/6 WITH ONE BEDROOM / `S ` WF ��•�:''� FILL BASE AND CREATE LOFT ABOVE o/c.0. ��' � `� � � CHANNEL FOR FLOW. o \ �e / `\' , i� IN NEIGHBORHOOD.) DISTINCT / COMMON \ �• • 9lk INDICATES \ h `K ;i AL AL P-5 44" PERC .TEST � 108" INDICATES WEEPING ;� � 1 - � OVERLAY DISTRICT AP / ; D.T.H• #1 / i WF � � CLEAN OUT l OHW D.T.H. #2 i11 AL al{k i D.T.H. #3 � WF . � a NOTE: \ \ i \ 2 �..•�,�,� REMOVE EXISTING SEPTIC „D-BOX„ GENERAL NOTES: SYSTEN IN ACCORDANCE WITH TITLE 5. i \ ��r h`O �a, / l� WF 0 30 45 60 90 150 CONFORM TO D.E.P. �p K ANSHIP " AND MATERIALS SHALL COi 1. ALL WORMi p �.••. i o TITLE V AND ,THE TOWN OF BARNSTABLE RULES AND REGULATIONS FOR SUBSURFACE DISPOSAL OF SEWERAGE. 196-6 2. AT LEAST ONE ACCESS POINT OVER TANK TEES SHALL BE THE INDIAN SPIRITUAL AND : '% i ;%' \ \ \ , •� GRAPHIC SCALE: 1 !.NCH = 30 FEET ACCESSIBLE WITHIN 6" OF FINISH GRADE, WITH ANY REMAINING i ✓ \ - _'\ \ / e,� C;-LTURAL TRAINING COUNCIL, INC. ACCESS PORTS BROUGHT TO WITH 12" OF FINISH GRADE. „VACANT" �O 3. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE T O \ CAPABLE OF WITHSTANDING H-10. LOADING UNLESS THEY ARE LAND 0���� \ .�j/ �8 R PARK ING .AREAS E _ _ -9- i 1 OF DR IVES 0 P ce- NDER OR WIT HIN 0 - MUST WITHSTAND H-20 LOADING, ,9,Lof'�/ /1 / /� - E EXCAVATION CONTRACTOR SHALL VERIFY THE LOCATION - - - 4. THE / • " I /� 75 �' / // II c� 4WELL OF ALL UTILITIES PRIOR TO ANY EXCAVATION. / // �"�`J / #110 _ W 5. ANY MASONRY UNITS USED TO BRING COVERS TO GRADE / / / OR WITHIN 6" OF GRADE SHALL BE MORTARED IN PLACE. / / / 3 BED 6• FINISH GRADE SHALL HAVE A MINIMUM OF 0.02 FEET PER `SO• �� \ ' DWELLING FOOT OVER THE S.A.S. AND, DISTRIBUTION BOX. TRUCTED OF �G'`'`F, 1 `�'�•�i ��� ;�� SITE AND SEWAGE PLAN 7. SEPTIC TANK SANITARY TEES SHALL BE CONS V AND SHALL EXTEND A MINIMUM OF 6" ABOVE ��• � ii - /./i/i%`��� SCHEDULE 4o PVC / REPAIR / UPGRADE THE FLOW LINE AND SHALL BE ON THE CENTERLINE AND \ \\\ \� \\\ EXISTING OUT MANHOLES. - . LOCATED DIRECTLY UNDER THE CLEAN � 11 0 ACORN � CO DRIVE 8. THE INLET PIPE INVERT ELEVATION SHALL BE NO LESS THAN \\ '�\\� \ r D`VELL ING E 2 INCHES NOR MORE THAN 3 INCHES ABOVE THE INVERT �' \ \\\6 \``> v��'� ;' �'� �� '" ,� ELEVATION OF THE OUTLET PIPE. IN 9. THE SEPTIC TANK SHALL HAVE A MINIMUM COVER OF 9 INCHES \ \\\\ss ��\\�\\� 5� --�� '� (216-12) WEST BARNSTABLE, MASSACHUSETTS 10. THE OUTLET SANITARY TEE SHALL BE EQUIPPED WITH A GAS \ \ \ \ �� - .-/65� e \\\s\ \ \\\ .,/� BAFFLE, 4 INCHES IN DIAMETER AND CONSTRUCTED OF 4" PVC ,t!►��. \�S \\\off\\\� ,f �o KEITH 8c LYNETTE DENNIS SCALE 1 " = 30' DATE: 7/30/07 11. ALL PIPES SHALL BE SCHEDULE 40 PVC SEWER PIPE AND ���\ \\\\\\\ SHALL- BE SLOPED 1 4 INCH PER. FOOT MIN. EXCEPT FOR THE •\�\\\ ��� �\\\ �`�� /�\\\�\\�'' ' � � / � \�\\��y / \J/\ ��-r EXISTING FIRST TWO FEET OUT OF THE DISTRIBUTION BOX WHICH SHALL t\ �\�✓���\✓�V ` SEP. PIT PREPARED FOR: BE LEVEL '- \�� ^��\ �`^ �� g 12. CHANGES OR REVISIONS TO SEPTIC DESIGN REQUIRE NOTIFICATION � -'S�_ �� KATHLEEN E. JEFFRIES TO EAS SURVEY INC. FOR B.O.H. AND DESIGN ENGINEERS REVIEW v '' �, �` ������ ; �;�; -� 110 ACORN DRIVE AND APPROVAL. i0 ��� 6 , Fo ��� VA dANCE: WEST BARNSTABLE CONSTRUCTION NOTES: MA 02668 gTFR VARIANCE TO ALLOW LEACHING TO BE 79' FROM WETLAND VS. 1, CONTRACTORS / INSTALLERS SHALL VERIFY GRADES AND REQUIRED 100' y_ c ELEVATIONS AND SITE CONDITIONS PRIOR TO COMMENCING --__ - _ _--_-_ __ _ - ----- -- _--- _ : `"` � �----; PREPARED BY: � �� 38 0 a Dril�i?- L ' - WORK ON THE SITE. (� / ' k DARREN M . MEYER 2. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE v � � WAF�O tiG Cf WITH DEEDED OR ZONING REGULATIONS. OWNER / APPLICANT �, N l AUTHORITY. WETLAND DELINEATION �N 140o P. O. BOX 981 o STONE N IS TO OBTAIN SUCH DETERMINATION FROM APPROPRIATE A A 3. VEHICULAR TRAFFIC, PARKING OF VEHICLES AND PLACING BY Mr. BRAD HALE rST . E. SANDWICH ' �'°' � a° ' S N R1 P�� o AN DISTRIBUTION BOX AND MATERIALS OVER THE SEPTIC TANK, O MA 02537 `"ssoN` T S.A.S. AREA IS PROHIBITED - � A 1�0 J� PH. (508) 362-2922 0! 17 (2 r 3 7 T `,;.. a ' ���� t 4� � O e, � 11Y66 (� � �` � . . G .. a /�� ,7� rf , NO.. /-� F�s...... ...................... THE COMMONWEALTH OF MASSACHUSETTS ' BOARD PF HEALTH 1Y� ----------------OF...... - ---- Aliptiratilan flax 11hipaii a1 xk ayn� rnr iun ernai# ` Application is hereby made for a Permit to Construct ( ` or Repair ( ) an Individual Sewage Disposal System at: ............................4 Qz"........ --------------------------- Locati n- d re s or Lot No. �!_ -• O-ne ddress .............. ..................•--•-----•-- Installer Address Type of Building Size Lot----------------------------Sq. feet Dwelling—No. of Bedrooms........... ...........................Expansion Attic ( ) Garbage Grinder ( ) a Other—Type of BuildingtJdac7¢a X._.___._.. No. of per sons !!�t............... Show s (-2 ) — Cafeteria (� Otherfixtures ............................................. Design Flow.....................oVO..........gallons per person per day. Total daily flow---------Z�_ ..0......._._......_.._gallons. WSeptic Tank—Liquid*capacit}✓d442...gallons LengthLUAO_..... Width-X ,D- ..... Diameter_CIZA0-_- De th=A6.__. x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area... 99- �sq. ft. Seepage Pit No...11a_k g_...... Diameter.................... Depth below inlet.................... Total leaching areaa 7!.•-•_.sq. ft. Z Other Distribution box ( ) Dosing tank / '-' Percolation Test Results Performed by. i_ ,cf_..1�c Q.�i._.. NG�............ Date..,/d,/J/./`7........_.. Test Pit No. 1..0.........minutes per inch Depth of Test Pit.1-0-..._..._... Depth to ground water____-_-4______________ (s. Test Pit No. 2....N?.......minutes per inch Depth of Test Pit----- ..... Depth to ground water.......r................ ---------------------------------------•---......---•-•-•---..-.--------.--. ---. ---- ....---. -".- ••--•.........-••..-•--••------ 0 Description of Soil.a�117?!1�'':(lf1d,.S'd. L.-----L.1.G fIT.fN;�EQ,LfA��--•--•--•-•-----•---•-•................ x U ..................•-•---•-•••-•-••-•-••---•••-•--•--••-•-••••-•-••.................••----•--....._..••.....••---•---••••••-••-•••-•----•-••-•••-•••---•-••-•-•-•-••-•••--•--•-•••••......•-•••-......••. w ----------------------------------------------------------------)-•-•-•----•-......--•••• ........ UNature of Repairs or Alterations—Answer when applicable•__________________............................................................................ -----------------------------------•---------------------------•--•---•--•---••-••••-•-•--•-•--.....-•••••••••--•---------------•----••-•----••-----•-•---•••--••-•-••---••••......-••••-•-•-------•-•. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iIli LE 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 ed by the board of health. ------•---..(/. ..-•--------------------------•---.............Sign ----------- -� _. .../.0�•��/�� Date Application Approved By.. �................ ..... ..'--7.7•... Date .r Application Disapproved for the following reasons-------------•------------------------------- ---.._...--------------------------•-------------------...•••-•_... -----------------------------------------•---------•------------•-------........---...............--------•--•••----•••••-••••••-••--•-•••--•-•-•••--•-------------•---••-----•----•••............••••- Permit No. --. Issued_._a2 "7-Z�" ate D -..................................................ate Date (7 No............. Q s, FEB THE COMMONWEALTH OF MASSACHUSETTS BOAR® F, 14 IYTH. Appliration for Disposal Works Tonstrnrtiun Prrutit - Application is,hereby made for a Permit to Construct .,( .,.) or Repair ( ) an Individual Sewage Disposal System at: .L jet D. ...........G oT / Location- DwHer Ad o W-J Address im . v •- - o 1/ .h!7�f •ccZ'S v>IySS.. -�- . s�d ... Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.............. ........................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building s 4A-:??__lX..... �No. of persons............� ...._... Showers (Z) — Cafeteria ( ) a Other fixtures ?.. _ Z rytl,.� ,$'................ d W Design Flow............41?o9•0.................gallons per person per day. Total daily flow__._._....ca2 55 G.................gallons. WSeptic Tank—Liquid capacity/VidO_-gallons Length.Xra... Width._X VO.. Diameter__UP7 . Depth-__._1�.. x Seepage Tr No.-•-- 1 gth . Total leaching area..................fsq. ft. Disposal PitTrench—j ok - Diameter Width Dept obelowtal ninlet_________________`Total leaching'area_a _7 ...sq. ft. Z Other Distribution fb2ox ( ) Dosing tank �,A ) �+ Percolation Test Results Performed by ....1.0 .._ l lip Date.....,l0 41/7_7:....__. ,.a Test Pit No. I......'......minutes per inch Depth of Test Pit-----14-......... Depth to,ground water.......?............. (s, Test Pit No. 2.......�___minutes per inch Dept of Test Pit..../.0.......... Depth to ground water------2.............. -----------------------------------•------------•--•----............------------••--••---•----......•-----•... ........._.........--------....----.--•-- O Description of Soil: �-a -----�.0�1',SLt. ,t�. '.-,G -FhfT�rl .c.r. /I/C�..----•---------------•----- ",� W ••---------------------------------------------------------------------------•......•.....,--••-......---------•-----------•-•-----------------••••-••----•----•-••----•-•-----•---------...----------- VNature 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 TITLE 5 of the State Sanitary Code— The undersi ned further agrees not to place the system in operation until a Certificate of Compliance has bee ed by the boa o ign = ...... ......` .. _Dew, 77 Application Approved By,•-.' ....... ..... ...... .. . Y............•••... ----•---- 1----------••--•--------- `/ Date Application Disapproved for the following reasons----------------•----•--•------------------------------•-------------=--------------------••------••--........._ --•------•......................•--------•--------------------------------••----._......--••--------......-•---....................................................................................... d. Date PermitNo...................................................... - Issued.....................='---------•---.........._..._...... Date THE COMMONWEALTH OF MASSACHUSETTS. 7.i BOARD O HEALTH ..... ... ......OF..... ... . . f " %6!' z✓" -•.........`......... (Irdifiratr of. �unt41 l anrr r T I TO TI , That hev' '� al ge age sto j d4 or Repaired ( ) by----- -... ... . .... •------------ �'•-- Instal at....."... _ . ..../.....L - .....J .. --A...... --------------- -------- ---------------------------- has been installed in accordance with the prov•',ions of Ti r�f,The State Sanitary Co asd�scsJi in the appllcatlon for Disposal Works Construction Permit No.:'_:_..._..�.__.......'_._..._.._ da.ted__ y.............:..................... THE .ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUYP AS A UARANTEE THAT THE t SYSTEM"WILL FUNCTION SATISFACTORY. �- % r , DATE. ` -------• ••..---_. ................ Inspector.....,. THE COMMONWEALTH OF MASSACHUSETTS BOARD PF HEALTH -' OF... � ........................................ ._.N . ........................... ...... .......... FEE,.._._ .............. Permission i hereby granted -' ' --------------------------------............. to Con u ( or Raw Rawr an Individual qAwage Disposal ystem ;,at No. ...4w -------------•-•-••-•---... ...... ...... reet as�'shown on the application for Disposal Works Construction Permit o........ .. ..... ted.. -- 77........... v ........................ Boa d o eaF 1 ATE.... ............................ •----- 4' FORM 1255 HOBBS & WARREN_;INC.. PUBLISHERS 4 a ..�.,,.��,;,,}r �\-�.,� mod✓ '•J,f"'r' ..�.� �. ,- phiA q7.:� , t 10 Z7 ... ........... R i.� A/f a • C� <f' .cv�,��J�-.ems p'v .yB46E ,�gvtGT' `9' r^• ' f `` R �' i c �a.c.e©•�/s �Np rJ� olsy" � crr -:5.E-10T/G'TAN` .,. -41 ...b, /r✓ / f 4° 1 LEY ddJ►"F"LYs! ,Os 7' sal/A/ /G v S yST-SE Aq s���/c .�'ys Tin•,Cc1.c.�..5-�,�t�c�--�a.,,,,� To ,rYfl7ss. t�49 + ,�`iv'�/.�C d�•..�/y1�hr�'r�L. Co D.�' T1TL� ..� � •-V4' 7 1,Vr_440'0/AIC. g:E.)edOA,.l�f4C>:v• SITE PLAN SHOWING PROPOSED CONSTRUCTION � F0R • A��''� /A:91✓I AP PROVE D 1977 SCALE ` t DATE " - ' C, `�' BOARD OF HEALTH � R E, F E R E ICI C E .: ' r''? ✓ . t y:sue/�✓ ':,��-�` U 4nh.1 f /` ': :- tom-,`J DATE A G E N T f C S ASSOCIATES, INC � r13r `,�4 REGISTERED ENGINEERS Il. LAND SURVEYORS sstyT=L �tti MID-CAPE OFFICE BUILDING - 1Ze5 ROUTE 26 SOUTH YARM OUTHj MASS. 02664 t ,