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HomeMy WebLinkAbout0087 CARLSON LANE - Health 87 CARLSON LANE, W. BARNSTABLE J o r '! r Commonwealth of Massachusetts 1.1 COP Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments yt 87 Carlson Lane ✓� ).33 Property Address Ray&Dawn Dolan -- Owner Owner's Name information is West Barnstable MA 02668 June 20, 2012 required for every page. Cityrrown state Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information When filling out forms on the computer,use p . Z� 1. Inspector: only the tab key p to move your Patrick T. Sullivan cursor-do not Name of Inspector use the return key, Ready Rooter, Inc Company Name P.O. Box 371 Company Address Sandwich MA 02563 I ream Ci{yRown State Zip Code 508-888-6055 S112843 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 insp lion was performed based on my training and experience in the proper function and riRAtenancePof on sift sewage disposal systems. I am a DEP approved system inspector pursuant to'$ecti 9 on 16.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority June 25, 2012 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. V t5ins-11110 Title 5 Official Ins M.nFVU6--S—geDisj1s'DftWMk1jfY Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments p 87 Carlson Lane Property Address Ray&Dawn Dolan Owner Owner's Name information is West Barnstable MA 02668 June 20, 2012 required for state Zip Code Date of Inspection every page. Cityrrown B. Certification (cunt.) 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: 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 compeeti 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 Id*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial ' filtration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank' replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass ins ection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the nk is less than 20 years old is available. ❑ Y ❑ N ND(Explain below): t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 2 L Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 87 Carlson Lane Property Address Ray&Dawn Dolan Owner Owner's Name information is required for west Barnstable MA 02668 June 20 2012 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with/repla rd of Health): ❑ broken pipe(s) ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is ❑ Y ❑ N ❑ ND(Explain below): distribution boplaced ❑ 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 Re fired by the Board of Health: ❑ Conditions exist which r uire 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•11110 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 3 of 3 I Commonwealth of Massachusetts Title 5 iOfficial Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments '~ 87 Carlson Lane Property Address Ray&Dawn Dolan Owner Owner's Name information is West Barnstable MA 02668 June 20, 2012 required for every page. Cityrrown state Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil a b orption system (SAS) and the SAS is within 100 feet of a surface water supply or t ' utary to a surface water supply. ❑ The system has a septic tank and S and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank an AS and the SAS is within 50 feet of a private water supply well. ❑ The system has aseptic tank and SA and the SAS is less than 100 feet but 50 feet or more from a private water supply w **. Method used to determine distan This system passes if the well ter analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates abse and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 P pm, provide hat 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•11110 Title 5 Official Inspection Forth:SubsuAace Sewage Disposal System•Page 4 of 4 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments rt 87 Carlson Lane Property Address Ray&Dawn Dolan Owner Owner's Name information is required for West Barnstable MA 02668 June 20, 2012 every page. Cityrrown 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 custodymust 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 0 feet of a surface drinking water supply ❑ ❑ the system is wit n 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is I sated in a nitrogen sensitive area (Interim Wellhead Protection Area—IWP or a mapped Zone II of a public water supply well If you have answered "yes"to a question in Section E the system is considered a significant threat, or answered "yes" in Section above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•11/10 Title 5 Official Ins pection Form:Subsurface Sewage Disposal System•Page 5 of 5 II . I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments y 87 Carlson Lane Property Address Ray&Dawn Dolan Owner Owner's Name information is required for West Barnstable MA 02668 June 20, 2012 every page. Cityrrown 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): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 for example: 110 427 GPD ( p gpd x#of bedrooms): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page B of B Il Commonwealth of Massachusetts Title 5 Official Inspection Form UVSubsurface Sewage Disposal System Form-Not for Voluntary Assessments 87 Carlson Lane Property Address Ray&Dawn Dolan Owner Owner's Name information is required for West Barnstable MA 02668 June 20 2012 every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes E No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage(gpd)): Private Well Detail: Well is located 140+'from edge of leach pit. Sump pump? ® Yes ❑ No Last date of occupancy: Current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft. etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank pres t? ❑ Yes ❑ No Non-sanitary waste discharged o the Title 5 system? ❑ Yes ❑ No Water meter readings, if av Table: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 7 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 87 Carlson Lane Property Address Ray&Dawn Dolan Owner Owner's Name information is required for West Barnstable MA 02668 June 20, 2012 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Ready Rooter records: Pumped Feb 2009 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•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 8 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for.Voluntary Assessments 87 Carison Lane Property Address Ray&Dawn Dolan Owner Owner's Name information is required for West Barnstable MA 02668 June 20, 2012 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: System installed 05/30/1989. Certificate of Compliance on file at Board of Health Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1.2 feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: >100 feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 5"feet Material of construction: ®concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 8.5 X 4.5'X 4.5' 1000 gallons Sludge depth: 1" t5ins•11110 Title 5 Official Insp ection Form:Subsurface Sewage Disposal System•Page 9 of 9 44 Commonwealth of Massachusetts Title 5 Official Inspection .Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °< 87 Carlson Lane Property Address Ray&Dawn Dolan Owner Owner's Name information is required for West Barnstable MA 02668 June 20, 2012 every page. cityrrown 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 34" Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 711 Distance from bottom of scum to bottom of outlet tee or baffle 12" How were dimensions determined? Tape measure and dip tube. Comments (on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Inlet and outlet concrete baffles in place. Liquid level at outlet invert. Light solids in tank at time of inspection. Pump not need at this time. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal fiberglass El polyethylene El other(explain): Dimensions: Scum thickness Distance from top of scum/toptlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-11/10 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 10of 10 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments "< 87 Carlson Lane Property Address Ray&Dawn Dolan Owner Owner's Name information is required for West Barnstable MA 02668 June 20, 2012 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal fiberglass El polyethylene El 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•11110 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 11 of 11 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 87 Carlson Lane Property Address Ray&Dawn Dolan Owner Owner's Name information is required for West Barnstable MA 02668 June 20, 2012 every page. Cityrrown 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 oil 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.): One in let,nlet, one outlet. 4.5 below fade in bushes. Located and inspected with camera. No sign o 9 p g of high water staining over outlet invert. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments(note condition of pump chamb r, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 12 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 87 Carlson Lane Property Address Ray&Dawn Dolan Owner Owner's Name information is required for West Barnstable MA 02668 June 20 2012 every page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Type: ® leaching pits number: 1-6'X 6'w/1'of stone. ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/altemative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leach pit is 5' below grade with riser within 6"of grade. Liquid level 5'5"below invert at time of inspection. 3"of liquid in pit. No sign 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•11/10 Title 5 Official Insp ection Form:Subsurface Sewage Disposal System•Page 13 of 13 f I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 87 Carlson Lane Property Address Ray&Dawn Dolan Owner Owner's Name information is West Barnstable MA 02668 June 20,2012 required for State Zip Code Date of Inspection every page. Cityrrown 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, /ofh:vdra:ulic failure, level of ponding, condition of vegetation, etc.): t5ins•1 V10 Title 5 Official Inspection Fomr.Subsurface Sewage Disposal System•Page 14 of 14 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 87 Carlson Lane PmpeAyAddress Ray&Dawn Dolan owner OwWs Nameftftnudio — 'is West Barnstable MWIredtor MA 02668 June 20,2012 every Pqp• CKYRown State zipCode Date of Inspetron D. System Information (cunt.) 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 0 Peut, IV 41 i __�.. Aa^ '43= Aq= loo' o �3 ;41 . �C7 3 9 TM95 Form: MspmW system-Page,sa,s f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 87 Carlson Lane Property Address Ray&Dawn Dolan Owner Owner's Name information is required for West Barnstable MA 02668 June 20,2012 every page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Site Exam: ® Check Slope ❑ Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: >4feet 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 1989 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: ma.water.usgs.gov terraserver-usa.com You must describe how you established the high ground water elevation: Test hole to elv= 33.8 found no ground water(1989). Base of leach pit at elv= 37.8.Accessed local ground water contours and topo mapping. No high ground water in area of system. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 't 87 Carlson Lane Property Address Ray&Dawn Dolan Owner Owner's Name information is required for West Barnstable MA 02668 June 20 2012 every page. Cityrrown state Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 16 or attached in separate file t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 TOWN OF BARNSTABLE LOCATION �r�5�v� ���� SEWAGE# VIIXAGE Cam, ASSESSOR'S MAP&PARCEL \j_J 07 -���—cn.r;3 S'o ' NAME&PHONE SEPTIC TANK CAPACITY LEACHING FACILITY.(type) (size) K 60 NO.OF BEDROOMS OWNER ;�v� PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility > �'( Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) , Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY � S LI'� �J aL� O�d= CVOC�S'� �,l/'to�� ��c��- r .� 1 � �` 3`` �c, ry UJ� � �� c `�� � 68 3l .. o � TOWN OF BARNSTABLE t LOCATION i CQu ksco - SEWAGE # VILLAGE w LY�� �LI2 ASSESSOR'S MAP & LOT /33 r 0-he INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 660 LEACHING FACILITY: (type) �;",k D! (size) 1, 5 CL) NO.OF BEDROOMS BUILDER OR OWNER LC-4 O %0e-r PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by (Q C Oct R w o p a �$ 31 p►c g� 3S Lt Uj COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS i DEPARTMENT OF ENVIRONMENTAL PROTECTION R t �y TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE,SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 87 CARLSON LANE WEST BARNSTABLE,MA 02668 M133 P76 Owner's Name: SELLARS Owner's Address: 87 CARLSON LANE WEST BARNSTABLE,MA 02668 RECEIVE® Date of Inspection: 12/1/00 Name of Inspector:(please print) I;,:,, JOHN GRACI Dt� 0 Company Name: SEPTIC INSPECTIONS TOWN OF BARNSTABLE Mailing Address: P.O.BOX 2119 TEATICKET,MA.02536 HEALTH DEPT. Telephone Number: 508-564-6813 FAX 508-564-7270 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of 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: X Passes _'•: _ Conditionally Passes _ Needs FurPY Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: 12/1/00 The system inspector shall submi 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. Notes and Comments ; THE SYSTEM PASSES TITLE V INPECTION.RECOMMEND PUMPING SYSTEM NOW AND EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. ****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. Title 5 Incnnrtinn Fnrm ril si?nnn 1 Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 87 CARLSON LANE WEST BARNSTABLE,MA 02668 M133 P76 Owner: SELLARS Date of Inspection: 12/1/00 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 fl. CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: THE SYSTEM PASSES TITLE V INPECTION.RECOMMEND PUMPING SYSTEM NOW AND EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. 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. Answer yes,no or not determined(Y,N,ND)Pin the for the following statements.If"not determined"please explain. n/a 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. ND explain: n/a n/a Observation of sewage backup or breakout 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): L _ broken pipe(s)are replaced _ obstruction is removed _ distribution box is leveled or replaced ND explain: n/a n/a 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 Bodil of Health): _broken pipes)are replaced _obstruction is removed ND explain: n/a Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 87 CARLSON LANE WEST BARNSTABLE,MA 02668 M133 P76 Owner: SELLARS Date of Inspection: 12/1/00 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 2. System will fail unless the Board of Health(and Public Water Supp:ier,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 I of a public water supply. _ The system has a septic tank°z nd SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank"and SAS and the SAS is less than 100 fee,:but 50 feet or more from a private water supply well". Method used to determine distance n/a "This system passes if the well'water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ummonia 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: n/a Page 4 of 1 I i OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 87 CARLSON LANE-WEST BARNSTABLE,MA 02668 M133 P76 Owner: SELLARS Date of Inspection: 12/1/00 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all-inspections: Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _ X Liquid depth in cesspool,is less than 6"below invert or available volume is less than '/2 day flow _ X Required pumping more than 4 times in the last year NnT due to clogged or obstructed pipe(s).Number of times pumped nLa. X Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone I of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. X 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 roliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] (Yes/No)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: i To be considered a large system'the'system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or`ono"to each of the following: (The following criteria apply to large systems in addition to the criteria above) (-0, yes no X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply X 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 syste(J,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. a Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 87 CARLSON.,LANE WEST BARNSTABLE,MA 02668 M133 P76 Owner: SELLARS Date of Inspection: 12/1/00 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health X Were any of the system components pumped out in the previous two weeks? X _ Has the system received normal flows in the previous two week period? X Have large volumes of water been introduced to the system recently or as part of this inspection? X _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up? , X _ Was the site inspected for signs of break out? X _ Were all system components,excluding the SAS, located on site? X _ Were the septic tank manhbles 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? X _ 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: Yes no X _ Existing information.For example,a plan at the Board of Health. X _ Determined in the field(if any o?the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] { P 3 . 5 Page 6 of 11 t, OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 87 CARLSON LANE WEST BARNSTABLE,MA 02668 M133 P76 Owner: SELLARS Date of Inspection: 12/1/00 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):330 Number of current residents:2 Does residence have a garbage grinder(yes or no):NO Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no):NO Seasonal use:(yes or no):NO Water meter readings,if available(last 2 years usage(gpd)): n/a Sump pump(yes or no): NO , Last date of occupancy: n/a COMMERCIAL/INDUSTRIAL Type of establishment: n/a i Design flow(based on 310 CMR 15..203):.n/agpd Basis of design flow(seats/persons/sqft,etc.): n/a Grease trap present(yes or no): NO Industrial waste holding tank present(yes or no):NO Non-sanitary waste discharged to the Title 5 system(yes or no):NO Water meter readings,if available: n/a Last date of occupancy/use: n/a OTHER(describe): n/a GE NERAL INFORMATION Pumping Records Source of information: n/a Was system pumped as part of the inspectitih(yes or no): NO If yes,volume pumped: n/agallons--How was quantity pumped determined?n/a Reason for pumping: n/a TYPE OF SYSTEM X Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes,.attach previous inspection records, if any) Innovative/Alternative technology.,Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank Attach a copy of the`UEP approval Other(describe): n/a Approximate age of all components,date installed(if known)and source of information: 1989 Were sewage odors detected when arriving at the site(yes or no): NO Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 87 CARLSON LANE WEST BARNSTABLE,MA 02668 M133 P76 Owner: SELLARS Date of Inspection: 12/1/00 BUILDING SEWER(locate on site plan) Depth below grade: 14" t Materials of construction:_cast iron X40 PVC_other(explain): n/a Distance from private water supply well or suction line: n/a Comments(on condition of joints,venting,evidence of leakage,etc.): TWO INLETS--WELL WATER SEPTIC TANK: X(locate on site plan) Depth below grade: 8" Material of construction:Xconcrete_metal_fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: 1000G L 8' 6" H 5' 7"W 4' toil" Sludge depth: 4" Distance from top of sludge to bottom of outlet tee or baffle:30" Scum thickness:3" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: n/a How were dimensions determined: MEASURED Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): THE SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND.RECOMMEND PUMPING NOW AND EVERY TWO YEARS`TO PROLONG THE SYSTEM'S USEFULL LIFE. GREASE TRAP:_(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene other(explain): n/a Dimensions: n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping: n/a , Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.):" n/a lt, r ti' t 7 f Page 8 of 11. OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 87 CAR.LSON LANE WEST BARNSTABLE,MA 02668 M133 P76 Owner: SELLARS Date of Inspection: 12/1/001 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Capacity: n/a gallons Design Flow:n/a gallons/day Alarm present(yes or no): N/A Alarm level:N/A Alarm in working order(yes or no): NO Date of last pumping: n/a Comments(condition of alarm and float switches,etc.): n/a DISTRIBUTION BOX:_(if present,must be opened)(locate on site plan) Depth of liquid level above outlet invert: n/a 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.): n/a PUMP CHAMBER:_(locate on site plan) Pumps in working order(yes or no):NO ` Alarms in working order(yes or no):NO Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): n/a , Y: l R Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(cont inued) ) Property Address: 87 CARLSON LANE WEST BARNSTABLE,MA 02668 M133 P76 Owner: SELLARS Date of Inspection: 12/1/00 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: n/a Type 1000 GAL 6' X 6' leaching pits, number: 1 n/a leaching chambers, number: n/a n/a leaching galleries, number: n/a n/a leaching trenches, number, length: n/a n/a leaching fields, number: n/a n/a overflow cesspool, number: n/a n/a in system Type/name of technology: n/a Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.): THE LEACH PIT IS STRUCTURALLY SOUND AND APPEARS TO BE FUNCTIONING PROPERLY.THE PIT HAD Y OF WATER IN IT AT THE TIME OF THE INSPECTION.THE SYSTEM SHOWS NO SIGNS OF FAILURE. CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: n/a Depth—top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer: n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater inflow(yes or no):NO Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a PRIVY: (locate on site plan) Materials of construction: n/a Dimensions: n/a ' Depth of solids: n/a Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): n/a r 4 Page 10 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 87 CARLSON LANE WEST BARNSTABLE,MA 02668 M133 P76 Owner: SELLARS Date of Inspection: 12/1/00 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet.Locate where public water supply enters the building. to y " ca D b C . i Ar6 3-7& Ac q9 8A 33 cc Say Page I 1 of$I M OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 87 CARLSON LANE WEST BARNSTABLE,MA 02668 M133 P76 Owner: SELLARS Date of Inspection: 12/1/00 SITE EXAM _Slope _Surface water _Check cellar Shallow wells Estimated depth to ground water 12+feet Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record-If checked,date of design plan reviewed: n/a NO Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a NO Checked with local excavators;}installers-(attach documentation) YES Accessed USGS database-explain: n/a You must describe how you established the high ground water elevation: USGS MAPS AND CHARTS- 12+FEET fi ,e,l 7 ,i ,�)1.1 Ilk THE COMMONWEALTH OF MASSACHUSE17S BOA R® OF HEALTH L.®w ................OF.... ......................... ApplirFation for Uispooal Works Tonotrurtion ramit Application is hereby made for a Permit to Construct ( ✓5 or Repair ( ) an Individual Sewage Disposal System at: 8? Lc',f s C-" L Ova. .LET.z']--... ... ...............•- .... ..................................AV S T' �� 1�95.5�............................................................. ------------ Location:Address or Lot No. .............................................. .............••••.....•... --............-----•.........-•-...------------ wner � ddr ss --•........................••-•....------••--.......... .......---•-•-••---•-•-•-..........- ......��`...... Installer Address ir Type of Building Size Lot-1611-Qz-......Sq. feet Dwelling—No. of Bedrooms............ ...........................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons-_--•_--_-_______•---__-___- Showers — Cafeteria Q' Other fixtures __________________________________ Design Flow...........�_�r_.......................... per person per y. Total y ow____. W ons. R; Septic Tank—Liquid capacityIM..gallons Length.__ t lt;width__....TTt meter________________ Depths._. W Disposal Trench—No..................... Width.................... Total Length.................... Total leaching _area -- ------------sq. ft. x Seepage Pit No._......r------------ Diameter.......?_.fT.. Depth below inlet......�:r..... Total leaching area......U------sq. ft. Z Other Distribution box (• ) Dosing tank ) ~' Percolation Test Results Performed by-_.. ._. ...65� E.................. Date....... '.l�_ L_ _ Test Pit No. 1___.�___-__minutesperinch Depth of Test Pit-___/2._..._... Depth to ground water__-6___ (s, Test Pit No. 2................minutes per inch Depth of Test Pit__._____•---__-_---- Depth to ground waterw%................ �+ --••--------------------------------- ............................................... ODescription of Soil-•----..2,&A1%...•---•-•�.`.... ... � ...C� �•-• ----1.,� ..-- y- '-................................... x - t., .4.....r oA&Sd-------.5.A4,D---------- -----1 ---- ------------------------------------------------•-------.---- 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'TILE 5 of the State Sanitary Code—The undersigns further agrees not to place the system in op on until a Certificate of Compliance has a sued y the boar o health. : Signs _....... .................................. Date Applicatio Approved By...... .... .... ...- - Date rj Application Disapproved for the following reasons:--•-----•------------------------•-••-------------------•.....--•--------------•---------------------........--- •----....--•--------------•-------...---------------------............------------.......-•---•------..__....•----••--------------••---•-•-•--••-•---•-•--••----•-•-••..._----•-•--•---••-•--•-------- Date PermitNo........ Lz�.F................... Issued....................................................... Date .r Qc�• -�.r 77 Fx$....1.. ............ THE COMMONWEALTH OF MASSACHUSETTS BOARD Off` -HEALTH ?'. ...... ......OF...- t --........................ Applirtatinn for Elhipaii of �nrk� ��ta��rarc�iaan �ermi� Application is hereby ):Wade for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ........... .. . ------•-•-------•----- Location-Address or Lot No. to - a �r=er1 ? � R ly� � t....._ ddrpssl . _....----- .............................. ki( --.. Installer Address Type of Building Size Lot_5itA ------Sq. feet �-� Dwelling—No. of Bedrooms.............* ...........................Expansion Attic ( ) Garbage Grinder (44 aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ------------------------------------------------------------------------------'--------------••-..----• W Design Flow.............. : .........................gallons per person�Per- y. Total y flow....... ...........................rons. WSeptic Tank—Liquid capacitytf ..gallons Length___.s'd: IWVidth:. 4 _. Diameter............... Deptr.. x Disposal Trench—No: .................... Width.................... Total Length.................... Total leaching area.................... q. ft. Seepage Pit No.______t__._________ Diameter- 1-'�--T.. Depth below inlet....... '�:(°..... Total leaching area.._...44._._._sq. ft. Z Other Distribution box ( ) Dosing tank ) '-' Percolation Test Results Performed by .` s <. W = �. - Date.. Test Pit No. I....X.......minutes per inch Depth of Test Pit....,�'�........... Depth to ground water.A��---t; ' A Gz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water___-____---.-__- ....'--------•------------------•--'-------' '---'----•-.............---..........-'----. ODescription of Soil........I-A.A. ' ._.:. ` 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 T iTi i� p 5 of the State Sanitary Code— The undersigned further agrees not to place the system in op on until a Certificate of Compliance hasFnssu y the oa d of health.Signed_ ....... Er----------- �-.-6- ......-- Date A licatiiA proved B i Date Application Disapproved for the following reasons:-----•----- •-•-•---------------------------------------------------------------••--••-'--• ............-'-•-- ................•'-----'-----'-'-------•----•-•'-•••---"------•-•----••-•"--"----...-'-'-'--'.........-•-•-••--•-•--.._... Date Permit No....... -------------------- Issued--•-----------------=................................. Lat.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 77/..0 Idem.................OF....., .................................... Trrtif irFatr of T amlrfiFanrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed) or Repaired ( ) Installer at------------ �-7 g--- -- ��L_—�- '� 1-----------------------•----•-•-•---------------. has been installed in accordan with the provisions TIT L 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No---------- �.� ... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............................ - J.v�FS1.........----------......---. Inspector../--...-..........._........ ...................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Ct.: ..............OF..-----...... . ....... ........................ FEE. .............. Disposaa Works Q-111anitrndian Firrmit Permission is hereby granted...........k ----14-�,� -�c�s,� --------------------- to Construct (X) or Repair ) an Individual Sewage Disposal System at No.. �. - .7 ,! .ds •7".......................................... `. Street as shown on the application for Disposal Works Construction Permit No Dated.......................................... Board of Health DATE................................................................................ FORM 1255 HOBBS\& WARREN. INC., PUBLISHERS t� ��mrrmmt►mm►rmnmPIMMMMMI M! mrr^l mm'1 _MMT"rM11_rrmnrl"1 1 ITTMU rnlT m;rmmr;, ttttn rlmmr nrlr�mr�lrxlmnnmmmmtrnmmmmmnmmMM4i` ENVIROTECH LABORATORIES ;~ 449 Route 130 Sandwich, MA 02563 • (508) 888-6460 _ _ Maine Post & Beam of Cape Cod Lot 27 Angela Way = CLIENT: p LOCATION: ADDRESS: Box 276 Rte 6A W. Barnstable -' W. Barnstable, MA 02668 COLLECTED BY: Nick Kapolis SAMPLE DATE: 3/9/89 TIME: 1:30 PM DATE.RECEIVED: 3 9 89 SAMPLE ID: 420. JOB #: New Well WELL DEPTH: 83 ft c RESULTS OF ANALYSIS: Parameter Units Recommended limit Result — Coliform bacteria/100 ml (MF Method) 0 0 c pH pH units 6.0-8.5 5.82 E` Conductance umhos/cm 500 212 Sodium mg/L 20.0 f 20. 1 Nitrate-N mg/L 10.0 2.14 Iron mg/L 0.3 . 12 Manganese mg/L 0.05 ;= Hardness mg/L as CaCO 3 500 BE Sulfate mg/L 250 -" 0 Potassium mg/L 20.0 c _ Alkalinity mg/L 200 — _ Chloride mg/L 250 Turbidity NTU 5.0 Color APC units 15.0 BE Background bacteria COMMENT: YES No WATER IS SUITABLE FOR DRINKING PURPOSES FOR PARAMETERS TESTED. _ xxX ❑ DATE ��/ iiltl111illuilillli llillltl!l1111itlillll ituitttiliilit illitltliltiiltUi uii i iiu ililiiiuiiiuiitliiilui lliuitiillilllit111111u1111ililllililillitltt illilllllllll!!tlllUllll� r xy� agaarz_f 1W= §s Z T. ,;. ^'x--`�� '... ._'ems"'".-- Y'�"'- r '-° ',', ...r=•,,.-.x..+s-,-.' '....... ''=�.=a a+-,�z -F• -c� ..c" .-` ..�. !3 • "-«- =ice-- ��'G� 1ri - 5 - -G f i3�i e i"J �`. _ �.a+... ..•':' -�.�._ .yam - y John Grace - - = _Exce_mfice of Envlronmeniai Affdrs D.E.P. Title V Septic Inspector art, nt of P;O. Box 2119 Teaticket,MA 02536 al P t of - eM ro e t 3 _ --.T- - r F SUBSURFACE SEWAGE DISPOSAL SYST.EiN INSPECTION FORM APART"A CERTIFICATION Property Address: 87 Carlson t_anew Barnstable Address of'Owner:' Date of Inspection:10109196 di e -(If ffer nt) Box 306 W.Barnstable Name of.Inspector:John Grad Plper. Company Name,Address and Telephone Number _ CERTIFICATION STATEMENT ` ; t oei�ify that I have personally inspectdd'the sewage disposal system.at this address and that the information reported below is true,accurate and,complete as of.the time of-inspection. The inspection was performed based on my training and experience in the proper function and ` maintenance of on-site sewage disposal,systems. The system: . X Passes —_'Conditionally Pas es - Needs Fu er Iuation By the Local Approving Authority IV 0/ .:., Fails . .1 .Inspector's Signature; Date: t 069B � b �l 61 ` - f c mpleting this The System Inspector shall submit a copy of this inspection report to the Approving Authoritywithin thirty(30)day o inspections. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the sys etwner shall submit, the report to the appropriate regional office of the Department of Environmental Protection. a "U The original should be sent to the system owner and copies sent to the:buyer,if applicable and the approving authority. . INSPECTION SUMMARY; Check A, B,C; or D: A] SYSTEM PASSES: X I have not found any information which indicates that the system violates any of the failure criteria defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B] SYSTEM CONDITIONALLY PASSES: . One or more system components.needto be replaced or.repaired. The system,upon completion of the replacement or repair,passes inspection. . . Indicate yes,no, or not determined(Y, N,or ND). Describe basis of determination in all instances.. If "not determined", explain why not.) _ The septic tank is metal, cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health: (revised 11115195) ;..I t One Winter Street' • Boston,Massachusetts 02108..• FAX(61T)556-1049 • Telephone(617)292-5500 . -ate' x Sl18SURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Propertys Add ress:�87 Carlson Lane-W Bamstable `O.vvner Piper.Box 306 W Bamstabte r_. _- . .: -- T - -Sewage ac oG rya"koi o?fl�gl5 statr tr►the dtstrtbuUarbex�s due-to a=brakea: -+� settletl or uneven distribution box The:system vnll pass inspection if(with approval of the Board=of Health) _ _brokep_plpeAS.}.ace replaced obstruction is removed , distribution box is.leveled or replaced The'system required pumping"more than four times•a year due to broken or obstructed pipe(s)..The system will pass inspection if(with approval of the Board of.Health): - broken pipes)"are replaced ,- obstruction is removed: .R - r C] +FURTHER EVALUATION IS,REQUIRED BY THE BOARD OF HEALTH: Conditions:exist which require further evaluation by the.Board of Health in order to.determine if the system is failing to protect the public health,.safety and the environment. T) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN.A MANNER WHICH,WILL PROTECT THE PUBLIC HEALTH AND. SAFETY.AND THE-ENVIRONMENT:' Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. ' 2) SYSTEM WILL FAIL UNLESS`THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER, IF APPROPRIATE)DETERMINES THAT THE SYSTEM IS FUNCTIONING.IN A"MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY.AND THE ENVIRONMENT: The system has a septic tank and.soil absorption system and is within 100 feet to a surface of water supply or tributary.:to a surface water supply. The system has a septic tank,and soil absorption system and is within a Zone 1 of a public water. — supply well.' The system has a septic tank and soil absorption system and is within 50 feet of a private water, supply well. The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform'bacteria Volatile organic compounds indicates thatthe well is .free from pollution for that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal or less than 5 ppm. 3) OTHER D] SYSTEM FAILS: _ I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage in facility or system component due to an overloaded or clogged SAS or cesspool. _ Discharge or,ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged cesspool. SAS is in hydraulic failure. - (revised 11115/95) - z - Awm '. a, .,� Ft �x -t- w"' ,.,,. �•�•�. ""''sr y,�r F T«.. i :-.'� 3 7 s , -` _.SUBSURFACI 'SEWAGE DISP.OSAL�SYSTEM INSPECTION FORM PART'A. CERTIFICATION (contlnued) _ Paoperty Address; 87 Carlson Lane W:Bamstable _ - `-- -Owner' Piper.Box 306 W.Barnstable k abate of Inspection:-101W96 SYS'�EM�AItSaartttrrne� r - - � .7, Staticliquid level-I distnbution box above outlet Invert due to an overloaded or clogged. SAS or cesspool Liquid depth in cesspool-is less than 6°below Invert or available volume Is less than 1/2 day flow. :! Required pumping more than 4 times in the last year NOT due to clogged.or obstructed pipes) Numbers of times pumped 7. Any portion of the Soil Absorption.System, cesspool or privy is below the high groundwater -elevation , Any portion of a cesspool or pnvy Is within 100 feet of a surface water supply or.tributary`to a surface water supply.' Any portion of a cesspool or pn' is within a Zone 1 of a public well Any portion of a cesspool or privy Is within 50 feet of a priv,at,water supply well: - Any portion of a cesspool or pnyy is less than 100 feet but greaterthan 50 feet from a private water supply Well with no acceptable water.quality analysis: If the well has been analyzed to be acceptable,attach copy of well water analysis'for coliform bacteria,volatile organic,compounds,.ammonia nitrogen and nitrate nitrogen E] LARGE SYSTEM FAILS: - The following criteria apply to large systems in addition to the criteria: The system serves a facility with a design;flow of 10,000 gpd or greater..(Large System)and the system is a significant threat to public health and safety and the environment because one-or more of the following conditions exist: 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 li of a public water supply well) _ The owner or operator of any such system shall bring the system and.facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00: Please consult the local regional office of the Department for further.information. (revised 11115195) , F'- .•`�"�'�' *-"� r'i� '' ° •--"�"'- -`--`-'i..= >:__.�mac. ---,--- - ��...- �-_ .�.rr�.s..._,N•r�—.. ., �'_ . ._.._.__t�tz^�'�,._. .. .. r_._-r:----,--sus-;s�.•.�-�+„^..;c±n+�srrr-' -, aa^a��, �st.�*,ss-s.. s r `°R VA g WI MOM �,•�- .�..��-- W-�P+vx �,; � :P•r S�-a..- c ...,}Z� :'ter-« ,.��� .T`T^��-;y �.,X �•..,.,..� —sue, `.,,�"+,...}- �',.i � ��..� �e'�`.= r�,� '��-..'�-,, ��'..+,`- � -fiae`t.-_" '„t' -,.y'.�-- �k•2.`�'�:.ar � - t,d' -�, i,a�� _.?*^ v-'"'�', �` y-y-w.'G -S'--.�- '�r'�,,.a .',w z. e'+c a e t fie, z. 4{ : �-"� ,� ��•,5�.m',�-'�z� ,;� '�..,,3'tx�:, 'F'Y---;:. f ,� s•r-Ca+a. '`t" �•rw +:. .� 1"�:-5 ;,- ""� *` � 5�_.;-�-'� _:�'e� -{^- `�-,x=s � ' Y 4 c �..:.,�v f#TMz aA _ ..w ' - --� �'SkJBSf1RF'!X-CE SE�i4GE DIS�OSA�SYSTEM INSPEGTIOtJ FORM ' �' f,'. � x... x-rtl^5" _ s ��- �'�.a' � '`i� PtAR"Tyra"'-y- •�t"-c-'�.t � -�r-i - `y 't- T .ro P'01 Y.;AdCfres_s 82CarlsonLane_W Barnstable Owner - Piper.Box-W& Barnstable s x F Date o gspee ton T Checklfthe following hav"e been done f _ - R` -_ ✓X pumping informationwas requested of the Fawner occupant;and Board:of Health X None of the system components have been pumped for at least two weeks and'the and the system has been receiving normal t flow rates during that penod:,,Large.volumes of water have not been introduced into the system:recently or as part of-this r*. in X As.buil.. t t.plans have been obtained and examined. Note if they are,not,available with N/A v. X The facility or dwelling was.inspected for signs of sewage back-up.. `t a ".x The system does riot receive non sanitary or industrial Waste flow: X The site was inspected for signs'of breakout. x' All system components excluding the Soil Absorption System;have been located on the site interior or of the se tic tank was inspected the X The septic tank manholes were uncovered,,opened,.and P •. for condition of baffles or tees,-mateh I of construction, dimensions; depth of liquid, depth of Judge, depth of scum. 41 X The size and location of the Soil'Absorption System on the site has been determined based on existing or approximated by non-intrusive methods X The facility owner(and occupants;if different from owner)were provided with:information on the proper maintenance of Sub-. Surface Disposal System.' x (revised 11115195) w 10� .-..r,; .r -Y'„° z',, a .'or-s-mac'r�.. �+.> *-•2 �`,� 7�&"",ter +f ":"L ,hr� ems: -.a, G '° 'SUBSItRFACESEWAGE DISPOSAL SYSTEM INSPECTION FORM < - E x_ y v �-'—e=-,°:_ :>✓_:� '_'" .. ,- �;-�--SlFS7�R�tNEEkf�tdA.T - '�, ,.�� � �- _ •._._i:. x. �- .,�.... ,r '- - �—.�-,—.._max, -..:-. _ _"`� _PfopertyAddress 87CarlsonLaneW Bamstabie - -_ - - :;.OWnef Alper.Box 306''.W Barnstable s: - �$algFfts'peCtfi9w�-10198J9ti s- ,�; ELOY1f C NDFFI Oes�gn flow-33a - gallons r _ r +, y T IvUmberoECUI feBfeSfde(rtS k` i = - a,•y ', c Garbef e`.gnndet(yes or.tro) Yes x S� - -= Laundry connected to system(yes or no) Seasonal•use(yes or nqj:'No Water meter readings,ifiavailable Na Last date of occupancy: n!a COMMERCIAL/INDUSTRIAL. , Type of establishment: n1a Design flow:o gallons/day Grease trap present:(yes or no) No Industrial Waste Holding Tank-present: (yes or no) No Non-sanitary waste discharged to the Title 5 system: (yes or.no) No Water meter readings, if available: n1a Last date of occupancy: rya OTHER: (Describe) Wa .Last date of occupancy: ` GENERAL INFORMATION PUMPING RECORDS and source of information;_ System was last pumped 1112 years ago. - System pumped as part of inspection: (yes or no)Yes If yes,volume pumped:1000. gallons Reason for pumping:'Maintenance. TYPE OF SYSTEM X Septic tank/distribution boxisoil absorptions system Single cesspool Overflow cesspool Privy Shared system(yes or no) ('if yes, attach previous inspection records,if any) Other(explain) APPROXIMATE AGE of all components,date installed(if known)and source information_ 1990 Sewage odors detected when arriving at the site:(yes or no) Yes (revised 11115195)._r Mt.'.: *y` S!}t3SCIRF�9SE SE1LIfAGE DISEOSAL'iS:YSTEM tN3PEC.TI0L FORNh y� { t_.e �� �'& .r=�.�"r —�' _ �.� T � a^- - �. ti �xa l` �� �m r �..?��a•M1.t •r^ S .,�. � � ... �.- _ _ �. �- 1 YS'GEi�1 t1�'FOfFM�k-TiQhffcorrt+n.ued}-- �—��` �•�� � �`-�T'�� �, Ison Lane W Bamstah le Ad dress: 87 Caz ,. Pro ert _ - P Y Piper.Box 306 W.Bamsta_ble 4Yf7EG: Dale.of Iris pection:10/08/96 w �. (locate ars site plarl� - .as i Depth below grade '.Material of const�uctlon- 'concreaYe metal FR`P- other(exptath- r - — w Dimensions: L 8'6•H 5'7"W 4'10' Sludge depth:2' _ Distance from top of sludge to bottom of'outlet tee or baffle: 25 Scum thickness:0 6 Distance from fop of scum.to top Of outlet tee or baffle 6' fr Distance form bottom of-Scum to:bottom of,outlet tee or baffle, 4 w Comments: (recommendation for pumping, condition of inlet and outlet tees orbaffles,depth of liquid level in relation to outlet Invert structural integnty evidence of leakage,etc:) BeP tic tank and.all components are structurally sound.Recommend pumping system every two years for maintenance. - GREASE TRAP: ; (locate on site plan) f_ Depth below grade:n1a Material of construction: concrete metal_FRP other(explain) Dimensions: n1a Scum thickness:n1a Distance from top of scum to top of outlet tee or baffle:Fda Distance from bottom of scum to bottom of outlet tee or baffle: n1a Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage,etc.) Na (revised 11115195) `. �.- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM u� r PART C,. '-SYS"fEM�INFORMATiON(continued) Property Address: 87 Carlson.Lane W.Barnstable i. Owner' Piper.Box 306 W.Bamstable x :Tate ofrnsp'"pectron'10108f96_-=' ' .: -• � i. TIGH OR FMDING TANK T :' ;'> .+-�.� -t'":" ��- -i+h �`L.i •s'"� ,.� -+x�. a ~ tom+- --t 3 r .sue' _ - -t. a.T>.•.tia-•�z t!" L,e, � � F i Depth below grade Na s °p J Matenarof'construction:=concrete -metal_FRF other(expi`arnj Dimensions-:'Na 1 Capacity. nla:- gallons nfa gallons/day } h Design flow. 9 Y Alarm level: Na Comments: (condition of inlet tee, condition of alarm,and float switches etc ) nla r . DISTRIBUTION BOX!.X (locate on site plan) f- Depth of liquid level aboveyoutlet invert: Liquid leve!wlth bottom ofpipe Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box etc.) D43ox is structurally sound. PUMP CHAMBER: (locate on site plan): Pumps in working order.(yes or no). Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) nla (revised 11115195) 7 RI _14-..a. - z+s y,:kh'� s r �„ .+ r' ,.v,.� as. c^• t-... ���-�;�-��-A.-�-` �.�'"��.,_ "�.sa:�''y,�. �, '�q "w 'e'"';`�— _•:.toss r' x' I : ��,�'"�""�������' � :���is. �„ ,�„�'r--s-�'�-'�'•,c:�sa,�"� �raw..c rx-�"i$� _ ,.��,�- .... � �_�-2-�"{ r'="""'T�`_. e-- �'::� „� .-,-,a^ -a--•€+..-T+„r+..t' ,-' "-A�:,= -'R �c'-x. 'vim'^v°' 6�2 ,�''' `--t --:v-sw ,.�' �- rK .-..mot i.-->.: �V � - ..-:e.- c, .- PFQ. /�tftdf9SS 8�CaTIS6fYl0ne--�lll'BaftlStatlle---�,,,, ,� -_r ...,,,,-+.Q ,, air--Y -t t - "'� —"^• -x�- -,ems i'7`' J. Plpert3ox306'W Bartisfahle N " SOIL ABSORPTION SYSTEM,(SAS) 'X-' r (locate on'siteplan if possible'ezcavation not required, lint maybe approximated by non-intrusive:methods) `�' -1f not'deterinined"to be p�esent''explain.:�`- , � _ - 'TYPe Teaching pits,'number 1,000 gatlen leach pit 74. ;a leaching-chambers,number:nla' leaching galleries,number nia". leaching trenches,number, length nla t leaching fields;'number, dimensions nla M1 R overflow cesspool, lumber:nla ; } Comments(note condition of soil,signs of hydraulic failure level of ponding condition of vegetation etc) The leach it is structUralty'sound and functioning properly. x I ' I CESSPOOLS:_ (locate on site plan) { �.I Number'and configuration: n1a Depth-top of liquid to inlet invert: Depth of solids layer: nla Depth of scum layer: nla Dimensions of cesspool: n1a Materials of construction: Iva Indication of groundwater: -n1a inflow(cesspool must be pumped.as part of inspection) nla .Comments`.(note condition of soil, signs of hydraulic failure;level of..ponding, condition of vegetation, etc.) nla PRIVY: (locate on site plan) Materials of construction; n!a Dimensions:' n1a Depth of solids: n1a Comments:(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.) Privycomments (revised 11115195) �.. _ r- h. - _ -- I. - _¢ - -�-� s r . a ' b ` k f t F l Y z::. F 'a F 5 . SUBSURFACE SEWAGE DISPOSAL`SYSTEM INSPECTION FORM ? 3' { .; ;, PART C + a SYSTEM INFORMATION(continued) K',p - - t.„ _ 1 .�. .,. t =ProperEy AddTe55::87 Carlson Lane W.Barnstable z' I-�1�''--"---�,-4',:;'-,I—,1--'.i�"—:'�4�-''.�.,'�,—�"I"''",.;"I',.����-'�.''—:�.��--".�..,—.�-''.'e-I Ovvner> Piper Box,306 W.Bamstable s ` t Date of Inspect'ran:1a/a8196 - - _ 14 SKETCHI OF SEWAGE DISPOSAL SYSTEM- - i I - -tiesto at least"two permanent refer. ericeslandma'rks or'benchmarks s w locate all wells within 100 ,„ :, ., h s t 1 i� e '° Q „s H r S i _ f v t'n _ I c .'R, c .,k 1. F y ' _ - t j i S F" 11 C, 7 a a Y Y � k k j _� t � y t r :Q Z� ;; r ;. '..�I.�-.-�I\-"1 I"�'�,---.I.-�1 I,-��.I'..L:"I��'.,..-.,-I.I-.,�I.I.�:.L�.-I,.�I..1 I*.I-,.I,�.I�,I.�.1-.:--�.��.�,.�-..-1t..'1�.-,.�...'I�..L.-1,"��.�,".-..',.I.,,.I.i..i, kti , ' : =5 " "fin - II r '•. - i : X,, R H; .�.' y f a; i i O b - y". r C' 9 t' - t )F t i F, ii Y' V _ r. ,..,y ; . t• -.. .- y GovC_St,�i . Ak,aSft x . rt 6 3I q� -Ii 6 - tA 3 M5 . g� . . . I. r . _. . ._ . : ' . . . . k DEPTH TO GROUNDWATER . Depth to groundwater:12•• feet . method of determination or approximation: - USGS Maps and Charts . (revised 11115195) . . I . . 9 . L LEG. 011 Rc-��ac� Ivt 3 c...�n LL s 1 L-eoG c �. cn n f f-�n c/p I � �.l--e 4 G v-I srd (1 egtcace t4er i I-e. 3 . Tc>C3 c:�re►t s . i f 1 Ti L P 3 w A c.LS ►n Tula - ShC22�er c 3 'iL C I 3�''2 l --- , .: 1"-LIF FIT Ju_ r. WHOLESALE CABINETRY CAPE & ISLAND DESIGNED FOR: [�OANGE MICRO D.W. KITCHENS DESIGNED BY:99 State Road,Sagamore Beach,MA 02562 OK TOP H00D REFRIDGShowroom:508-w.cape it s.com 8-833-1442 DATE: APPROVED BY: EN COMPCTR SINK www.capekitchens.com It. is } r � — s��T� c s YS TAM PROF�L.� ti r. ►- 4 4' DDi� A � d t, 10 /PE . 'FORCE 2 0 - - IG --- 50 - i SEf'T/C TAA/K - S 6 7 I 44 - 4 G GO 4G .52 IG7.i-0 / _ �3 8 a SAME ZZ14Cy11VC, f/T ,DES/q/V CRITERIA �. SANG 3 <<. 4.G NG L O T 26 N , _J Li) 330 ;F 47 r �;Ec'Cj!✓Gi/G/l �PAIE 2 N — 151 '�2,5 GPD/SF° .3774,PD T / gq 50 .sf X 1 C, 4�' � ° 5G 4A: / 9/ LOT 28 ,.%ED =•iL 7vFl. A70k •� I c,v ASSUMED DATUM ��� � - L � d Z. ' !E ._ �. � S y_ ./`f S,yifl ti /UE i/v,;T.t� , c. A'''':/.f/J.:N� -,-,• :•, +<<. Of EA L T (03 TA \\� / 46 I ` 4 T!t /��✓/c/" . A-� /�_';kNo. 3i3O5 �FC15Tr WCLL �E � ��•�\ • � �' ' �� • �r �'��/JC c�L f+'ZZ UTiVoJ.✓vs1.T��1.N4WFfo �An'�?T�sd ozFZZ WELL E-4dS,o '9c<1144 w/i �I5 4 � 7. �'�_/1t'_� _ �c,7` moo. � d �- - S/TZ PLAIV �l SEPTIC aCSI�llv =� ' G f� 4G, LOT 2 7 h\ O\'` A N G E LA WAY W, BARNSTAGLE MA , G r 1 l R (= 40 Z. Is 413 RTE GA • WELL GATE. / J fj t+tq wN By