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0201 CARLSON LANE - Health
201 C SON LN WEST BARNSTABLE A= 110 026 o //'� TOWN OF BARNSTABLE LOCATION �/'4-110,/T®A/ /� le SEWAGE#D7 SSG VILLAGE W. ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. SEPTIC TANX CAPACITYAge LEACHING LEACHING FACILITY:(type) (size) NO.OF BEDROOMS f OWNER 7O i PERMIT DATE: /G';: D 7 COMPLIANCE DATE: O Separation Distance�Retween the: r 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 leac ing faci ) Feet FURNISHED BY /' .d ��•�L It f 3 -ro .j Town of Barnstable 0FZHF T �. regulatory Services Thomas F. Geiler,Director * BARNSTABLE, ' "`ASS Public Health Division Al�Dy_a Thomas McKean,Director 200 Main Street,Hyannis, MA 02601 Fax: 508-790-6304 Office: 508-862-4644 May 22, 2007 C Mr John Milos P O Box 262 West Barnstable The septic system located at 201 Carlson Lane,West Barnstable,MA was last inspected on April 30t',2007,by Donald Klimm, a certified septic inspector for the State of Massachusetts. ptic system showed that the system"Failed"under the guidelines The inspection of the se of 1995 TITLE 5 (310 CMR 15.00) due to the following: Back up of sewage into facility or system component due to overloaded or clogged SAS or cesspool. You have 60 days from the date of the system failure to bring the system into compliance. If there are any questions about this reminder,please feel free to contact the Barnstable Health Department. BARNSTABLE HEAL H DEPARTMENT T ma c ean,R.S., C.H.O. Agent of the Board of Health 4 (, a �d1l1107 AO - ,a) o N Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form Inspection results must be submitted on this form or on the official Title 5 Inspection Form dated 611612000. Inspection forms may not be altered in anyway. 0 to A. Certification Important: When filling out 1. Property Information: forms on the computer,use 201 Carlson Lane only the tab key Property Address cg to move your John Milos cursor-do.not Owner's Name use the return " key. P.O. Box 262 ' Owner's Address r" West Barnstable MA `4668 Cityrrown Stated Code ', Date of Inspection: 4/30/2007 � rimDate C-3 2. Inspector: Donald Klimm Name of Inspector PKM Contractors, Inc. Company Name P.O. Box 775 Company Address East Dennis MA 02641 City/Town State Zip Code 508-385-5993 Telephone Number 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: ❑ Passes ❑ Conditionally Passes ® Fails Ne ds Furt r I by the Local Approving Authority spector's Sig C Date The systema or 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. Title 5,201 Carlson Lane.doc-11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System- Page 1 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments y` Subsurface Sewage Disposal System Form A. Certification cont. 201 Carlson Lane Property Address W. Barnstable MA 02668 City/Town State Zip Code Milos 4/30/2007 Owner's Name Date of Inspection 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 completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the ❑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. ND Explain: Title 5,201 Carlson Lane.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 2 of 16 Commonwealth of Massachusetts = v Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification (cont.) 201 Carlson Road Property Address W. Barnstable MA 02668 Cityrrown State Zip Code Milos 4/30/2007 Owner's Name Date of Inspection 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 ❑ obstruction is removed ❑ distribution box is leveled or replaced ND Explain: ❑ 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 ❑ obstruction is removed ND Explain: 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 Title 5,201 Carlson Lane.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 3 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments ug Subsurface Sewage Disposal System Form A. Certification (cont.) 201 Carlson Lane Property Address W. Barnstable MA 02668 City/Town State Zip Code Milos 4/30/2007 Owner's Name Date of Inspection C) Further Evaluation is Required by the Board of Health (cont.): 2. System will fail unless the Board of Health (and Public Water Supplier,if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that faciliity 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: Title 5,201 Carlson Lane.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 4 of 16 Commonwealth of Massachusetts. Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification (cont.) 201 Carlson Lane Property Address W. Barnstable MA 02668 Cityrrown State ZipCode Milos 4/30/2007 Owner's Name Date of Inspection 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 ❑ ® 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 coliform 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. Title 5,201 Carlson Lane.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 5 of 16 4 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification (cont.) 201 Carlson Lane Property Address W. Barnstable MA 02668 Cityrrown State Zip Code Milos 4/30/2007 Owner's Name Date of Inspection E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems,you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. YES NO ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. Title 5,201 Carlson Lane.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System- Page 6 of 16 ICI I Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form B. Checklist 201 Carlson Lane Property Address W. Barnstable MA 02668 Cityrrown State Zip Code Milos 4/30/2007 Owner's Name Date of Inspection 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(3)(b)] Title 5,201 Carlson Lane.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 7 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M C. System Information 201 Carlson Lane Property Address W. Barnstable MA 02668 Cityrrown State Zip Code Milos 4/30/2007 Owner's Name Date of Inspection Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms(actual): 4(per owner) DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 3 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d N/A private 9 ( y 9 (gpd)): 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 present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): Title 5,201 Carlson Lane.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 8 of 16 f Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments r` Subsurface Sewage Disposal System Form C. System Information (cont.) 201 Carlson Lane Property Address W. Barnstable MA 02668 Cityrrown State Zip Code Milos 4/30/2007 Owner's Name Date of Inspection General Information Pumping Records: Source of information: N/A Barnstable Water Pollution Control Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1500 gallons-septic tank only gallons How was quantity pumped determined? Site tube estimation Reason for pumping: Maintenance 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) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: Installed 1999 Were sewage odors detected when arriving at the site? ❑ Yes ® No Title 5,201 Carlson Lane.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 9 of 16 Commonwealth of Massachusetts Mum, Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) 201 Carlson Lane Property Address W. Barnstable MA 02668 Citylrown State Zip Code Milos 4/30/2007 Owner's Name Date of Inspection Building Sewer(locate on site plan): Depth below grade: 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: 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 ❑ Yes ❑ No certificate) Dimensions: 1500 gal. Sludge depth: pumped at inspection Distance from top of sludge to bottom of outlet tee or baffle 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 How were dimensions determined? Title 5,201 Carlson Lane.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 10 of 16 Commonwealth of Massachusetts ugTitle 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form l C. System Information (cont.) 201 Carlson Lane Property Address W. Barnstable MA 02668 Cityrrown State Zip Code Milos 4/30/2007 Owner's Name Date of Inspection Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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): Title 5,201 Carlson Lane.doc-11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 11 of 16 Commonwealth of Massachusetts . Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information cont. Y (cont.) 201 Carlson Lane Property Address W. Barnstable MA 02668 City/Town State Zip Code Milos 4/30/2007 Owner's Name Date of Inspection Tight or Holding Tank(cont.) 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.): Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Liquid above inverts 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.): SAS overfull and liquid backed up into d-box Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Title 5,201 Carlson Lane.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 12 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) 201 Carlson Lane Property Address • W. Barnstable MA 02668 Cityrrown State Zip Code Milos 4/30/2007 Owner's Name Date of Inspection Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: 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.): SAS buried deep. Added 6' riser to first inspection port. Chambers found to be overfull, 1'over invert Title 5,201 Carlson Lane.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 13 of 16 Commonwealth of Massachusetts 4 Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) 201 Carlson Lane Property Address • W. Brnstable MA 02668 City/Town State Zip Code Milos 4/30/2007 Owner's Name Date of Inspection Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No 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.): Title 5,201 Carlson Lane.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System- Page 14 of 16. Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) 201 Carlson Lane Property Address • W. Barnstable MA 02668 Cityrrown State Zip Code Milos 4/30/2007 Owner's Name Date of Inspection 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. 0 r — I(o Title 5,201 Carlson Lane.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System _. . .. _ Page 15 of 16 r y Commonwealth of Massachusetts . Title 5 Official Inspection Form Not for Voluntary Assessments ` Subsurface Sewage Disposal System Form C. System Information (cont.) • 201 Carlson Lane Property Address • West Barnstable MA 02668 Cityrrown State Zip Code Milos 4/30/2007 Owner's Name Date of Inspection Site Exam: Slope Surface water Check cellar Shallow wells Estimated depth to ground water: 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: Ground water levels not comploeted due to failed system. Title 5,201 Carlson Lane.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 16 of 16_ No. :2 UP 0 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes application for �Digogal 6p5tem Con0truction Permit Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ❑Complete System lXndividual Components Location Address or Lot No. I G� A)J qAJ OLqAe Owner's Name,Addressr and Tel.No. Ass s f(R Mapgarcel vv, ® /a 0 4 g O/�C apt"a a, Inst ller's Name,Address,and Tel.No. ��a' O Designer's Name,Address and Tel.No. Co. Type of Building: Dwelling No.of Bedrooms Lot Size. sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank C) �.gi� � Type of S.A.S. Cti—b,aw k Description of Soil /a_ � 53 Nature of Repairs or Alterations(Answer when applicable) Q V cisl/ �' CA J 7,et NS�iG� Nee✓ o�'��cG�l jCS /��AF4 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. n Signed . OCAI^ 6a 4 - Date 7 y� '0 7 Application Approved byP____L9Date JG—// _0 7 Application Disapproved by: Date for the following reasons Permit No.-,.`) p()-7 (p 0 Date Issued 1 U // — U'7 h ] _ Z• ... RM �} =v^ .,�l ''ti' `-: '..'.e,r^.'. y..... r - •*�E`., •-....��f;,"u. ...�,`-1r J 1f ' No. ppr�CC110i Fee fl(� •VO � . 'THE COMMONWEALTH OF MASSACHUSETTS Enteredr computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE,'MASSACHUSETTS Yes ZIPPYication for, WooeaY;ffi- p4tem Cous;truction Permit Application for a Permit to Construct J Repair( Upgrade( Abandon O ❑.Complete System ridividual Components t k 3 1 Location Address or Lot No. 4/��p ,1 Owner's Name,Address and Tek No. ii//-�-� CO , iFM :s2J, M/log AssessoR MapRarcel 4 Jib q/<< X 0 r Inst ller's Name,Address,and Tel.No. 7✓'' o 0 Designer's Name,Address and Tel.No. Q 6Y11 r7' 13� ev/',cu. .i p-'� j t. 9 a.3_._OeolrE' l A ay e�-r Alfs 7,w,� vetch Type of Building: 1 Dwelling No.of Bedrooms �{ -'`ter Lot Size ql,f b sq.ft. Garbage Grinder ( ) Other Type of Buildin " No.of Persons Showers yp t.g ( ) Cafeteria( ) Other Fixtures Design Flow(min.required) / (� gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title 0 Size of Septic Tank d/ �V y&/.., Type of S.A.S.13f & e(—h,e N- L/ r . o- Description of Soil /a. p+ ���C' ' 2 I ) Nature of Repairs or Alterations(Answer when applicable) &4n;0urV 4e4 G4 /l'el Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. r Signed ZIA CZ64& R . 00e CC.X Date 5� G -U 7 Application Approved by i4AZ IPJC7 Date l U-// -U 7 Application Disapproved by:' #r Date for the following reasons Permit,No: GU - (p(] Date Issued J U- I 1 - 7 -------------------------- THE..COMMONWEALTH OF MASSACIJUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY,that the O ite Sewage Disposal S ystem Constructed ( ) Repaired Upgraded ( ) Abandoned( )by (� 1! O at 20 1 JS u cn \./, CIr-n I kkt has been constructed in accordance with the provisi s/o�f Title 5 and the JQhe for Disposal System Construction Permit No. DC)07- �{�G dated Installer //6 �..! (2 Designer #bedrooms Approved design flow Ll7 U Al gpd The issuance of this permit sha R not b cons;Wed as a guarantee that the system will f Itil s designed.Cli Date Inspector No. 2 6o-7- l d Fee l bo THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS ltgpoal 6p5tem `conotruction permit Permission is herebyranted to Construct Re Upgrade Abandon g air � � U� ) P pg � ) � ) System located at U I C r Ict., `Gn o _ 1AL 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: Const ctio must be completed within three years of the date of this p. it. i Date 0 )( I 4 Approved by LIV. t1�S Town of Barnstable ,THE tqy, Regulatory Services yvP ti� t Thomas F. Geiler, Director • BARNSfABLE 9 MASS. 039. Public Health Division �� ArFDMA'tA Thomas McKean, Director 200.Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: z za Sewage Permit#A07- Vok Assessor's Map\Parcel 11 b1 o 2- 6, Designer: Installer: Address: Address: oze,-.5' On 0 1 0T a LA— -6'0.27--c-was issued a permit to install a ( at ) (installer) _ _ .7 septic system at 20 i e A,t-c Sam c-, c-= based on a design drawn by (address) dated oe-r, 2, 2-,---7 (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. 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. o� S�PHEN y mi �r' / ocv,^ cc� �_'� � A. (InstaSignature) Cv� H IVo.35461 TE��� 6i (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. QASeptic\Designer Certification Form Revised.doc -ru ®'nOM- 2 MEN- 117 I� 1 . C3CerM Postage $ jHere tified FeeRetum Receipt Fee O (Endorsement Requlred) /3�O RestrictedDeliveryFee —D (Endorsement Raquired) rq r-q Total Postage&Fees Is f•p� r p Sent T [` t,w -- ----- OS..................................... or PO Box No. (�� � te z, rn �. oa,�6� Certified Mail Provides: (esaeney)ZooZeunr'ooeEgjjod Sd o A mailing receipt o A unique identifier for your mailpiece o A record of delivery kept by the Postal Service for two years Important Reminders: n Certified Mail may ONLY be combined with First-Class Mail®or Priority Maile. o Certified Mail is not available for any class of international mail. n NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. e For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain ReturnReceipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPSe postmark on your Certified Mail receipt is required. a For an additional fee, delivery may be restricted to the addressee or addressee's authorized aggent.Advise the clerk or mark the mailpiece with the endorsement"Restricted-Delivery" o If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. Internet access to delivery information is not available on mail addressed to APOs and FPOs. 4 SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Signature item 4 if Restricted Delivery is desired. ❑Agent ■ Print your name and address on the reverse X ❑Addressee so that we can return the card to you. 13.=Received by(Printed Name) C. Date of Delivery ■Attach this card to the back of the mailpiece, or on the front if space permits. D. Is delivery address different from item 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑No �r 7ro Korde..& Assoc 321 Billerica Road#210 3. Service Type Chelmsford, MA 01824 ❑certified Mail ❑Express Mail ❑Registered ❑Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number . t (Transfer from service labeq , t 7 0 g 5 1116'0 0 0 0 0 4 0111 3226 PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 UNITED STATES POAW§wY pp X--qqIE.�3t.`�^arq *r n to S « I • Sender. Please print your name, address, and ZIP+ n h box PUBLIC HEALTH DEPARTMENT TOWN OF BARNSTABLE 200 MAN STREET HYANNIS, MA, 02601 I � llL�t��I►l�iL,�If�����III�,11,i�f��li�"I��I,If�l�tll�„f„II SENDER: 7SIgn ■ Complete items 1,Zand 3.Also complete Item 4 if Restricted Delivery Is desired. Agent' e Print your name and address on the reverse so that we can return the card to you. ❑Addressee ®•Attach this card to the back of the mailpiece, by(Printed Name) C. Date of Delivery or on the front if space permits. 1. Article Addressed to: D. Is delivery address different from Item 1? ❑Yes If YES,enter delivery address below: ❑No Korde.&Assoc 321 Billerica Road#210 Chelmsford, MA 01824 3 ®Certified Service d Mail Express Mali ❑Registered ❑Retum Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) O Yes' 2. Article Number ' " (nansteifrom serWce tebeo 7 0 0 5 1160 0000 0191 3226 PS Form 3811,°F'b aryt2004 Domestic Return Receipt "'' 10259"2-M-154o fU lv D 1►1t71 . • ruLn U lWJ�t� O 117 Postage $ 1,'C , r3 O Certified Fee postmark V C3 RetumrR eipt•Fee 1 Here (EndorsementRequrred) /y,: ,, C3 Restricted Dernrery Fee ,a (Endorsement Required) rq Total Postage d:Fees �,/•p• U1 p Sent T l•' - [ Sfi t Apt. / or PO BoxNo.�Q, �Otli... _ -P ..-- -- t Cif�i State, (J(J �R �T b Town of Barnstable OFtME Tp Regulatory Services anxNseAB[E Thomas F. Geiler, Director MASS.: •� Public Health Division rEp Mp'lp Thomas McKean,Director • 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 May 22, 2007 Mr John Milos P O Box 262 West Barnstable The septic system located at 201 Carlson Lane,West Barnstable,MA was last inspected on April 30th,2007,by Donald Klimm, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Failed"under the guidelines of 1995 TITLE 5 ( 310 CMR 15.00) due to the following: Back up of sewage into facility or system component due to overloaded or clogged SAS or cesspool. You have 60 days from the date of the system failure to bring the system into compliance. If there are any questions about this reminder,please feel free to contact the Barnstable Health Department. &ma BLE HE H DEPARTMENT c ean,R.S., C.H.O. Agent of the Board of Health No.-W-?-Cf----��---- Fee--------�--- ---- BOARD OF HEALTH TOWN OF BARNSTABLE Zipplication-*r Veil Con0ructionPermit Application is hereby made for a permit to Construct ( Alter ( ), or Repair ( )an individual Well at: -�M-A -- � �'ce i_ a� Location — Address Assessors Map and Parcel __Pcw t-----���-�n—_P����.—a�i8__-��'►_�s�,J��--Pa sty-_L"'1�_����-�s Owner Address Installer — Driller Address Type of Building Dwelling --------------- -- Other - Type of Building ------ No. of Persons----------------------_—______ , Type of Well—�- l�——- ----- Capacity------------------------— Purpose of Well----�4' !1_1�t-Z .---------- — 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 tificpte .o m iance has been issued by the Board of Health. p Signe date Application Approved By -------------- C/ Ili date Application Disapproved for the following reasons:---------------------_—______—__________—_ ----- --- ------------------------------------------------------ 00 date Permit No. W — .7 — Issued----- --- - ---- ---— - ------- date BOARD OF HEALTH TOWN OF BARNSTABLE (Certificate Of Compliance THIS IS TO CERTIFY, That the Individual Well Constructed (-/), Altered ( ), or Repaired ( ) by 4staller — at—_COI ('�S�n La n����_�-chas 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. V--=Jd�---Dated----- ------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE---- --_ — Inspector E W. No.- - --- { : . Fee—!, ------ ----- i -. BOARD OF HEALTH i ' TOWN, rOF BA'RNSTABLE c ; ."110 f atfou'ArVell C,onarurtion ermit t: ` !a rApplication is hereby made for,a permit to Construct (el--Alter ( );. or Repair( )an in i�idualWell at;� LO 'J -` U 1 - o�c !SrJ r1• 1 _ (aJ_ a rr,S-rc�k p l�l A __r`'� f 1. .i .--- - ---------- - `— �^--T----- 0- y ----- i 1 E• � .Location- Address, Assessois Map and Parcel .1 r p - -- - Owner Address tl Installer — Driller Address Type of Building d uJ; Other =Type of Building---------=---------= No. of Peisons------------=--------- --- ------_ Type of Well —�!-- — --- =-- 'Ca acit P, Y—= ' -- -=--------------------------- i Purpose of Well---.7 , n_1'C ,_n --- --- 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 Ce tificate .of C m liance has been issued by.the Board.of Health. %/ %Z . �. c p Signe — -- L---- date Application Approved By date Application Disapproved for the following.,reasons: _ _ -- — — -- -- -- 77 ~ date Permit'No. Issued — — — --- Fdate rs�aiasxrsarrs aaxrsass4c�rs:s.!taoralA�a�wasss:.w:lG�sTe+a:gra..asse3r*�uspsswasr�apltisiFs�otsawaws3a'4aar'sqa+m�tti,atais:zZis.wmrersi3res3ieutw:era.wry+4=se�s�e.�ea^sae.¢asrfsas+t+ BOARD OF'HEALTH k TOWN OF BARNSTABLE &rtifirate 0f Compliance . THIS IS TO CERTIFY That, he,Individua-1 W 11 Constructed-(, ) t 'tered )"l or Repaired ( ) by M �=ate----- _ � �_ — --—maw t � nstalle C�( °?, �' 6 , •" r 'arl, d ! t C1 C ` i� { � AQ I at t}a -- ' - - --has been installed in accordancwithalie provisions of theTown of Barnstable Board of Health Private Well Protection f Regulation as:.d seribM 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 BOARD OF HEALTH TOWN OF - BARNSTABLE lodl Cootruct ion Permit � p No. / -�j ____ Fee71> — �© Permission is hereby granted _L(10 Kaw to.Connsstru; (�C ter �', or Repair; ( ') an Individual Well 'at: No. s« as shown on the application'for a Well Construction Permit No.- Dated -2 " ----- - - Board of Health DATE 1� . TOWN OF BARNSTABLE LOCATION oZ U I C l)9 L, S o AJ C 6 NC SEWAGE # VILLAGE k)61 13R2A/�i!" �LE ASSESSOR'S MAP & LOT /40 ` -b INSTALLER'S NAME&PHONE NO. 14WefIve- 2)0,v0v0,&1 5-0k 2f'1-1,PJ 7 SEPTIC TANK CAPACITY DSO 0 ("9 L L G MS LEACHING FACILITY: (type) - C�,P%ook�)P25 (size) Gt4/ 'Pea- NO.OF BEDROOMS J BUILDER OR OWNER _1 A') S PERMTTDATE: LCOMPLIANCE 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 L I � l l TOWN OF BARNSTABLE UMIS F ATION oZ U I C 1912 L S O�J ( �N SEWAGE #LAGE WEST 13R9AJJr d1f ASSESSOR'SMAP&LOTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY �Sa'O g L L GMS LEACHING FACILITY: (type) C�l v4ut P/Z S —(size) �l �ai4 Ppc� N OOF BEDROOMS J -BUILDER OR OWNER T A')1 0 s 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 � -� 307 37'`�`� (� 77 6 b T 1 No. 7 � �-- �.. Fee THE COMMONWEALTH OF MASSACHI4SETTV f Entered in computer: Q PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE,. MASSACHUSETTS Yes �� Yication fo Zigogar *pgtem Cons ruction 30ermit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) Complete System El Individual Components Location Address or Lot No. A0 I GAf2L//��S��6 AJ Owner's Name,Address and Tpl.No. O�/ 7S We,MQ��� �GE 4 � Ik6S' b G Assessor's Map/Parcel // �) J ROX aZO AA n%0 L4-r Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. LAW12CjVC6 3)Odor//�;'✓ /7fl /fll'. D's^ S /' , Type of Building: Dwelling No.of Bedrooms_ Lot Size Y3 566 sq.ft. Garbage Grinder( ) � Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued this Board of Heal . Signed ® Date 7 Application Approved by ti4az Date Application Disapproved for the following reasons Permit No. Date Issued No. �� t 9 t. .A AA �c�_✓ 'Fie THE COMMONWE H F-iMA�SACHVS:ET*T9` Entered in computer: Yes PUBLIC HEALTH DIVISION'- TOWN OF BARNSTABLE., MASSACHUSETTS 0(pplicati6n for &Opogaf *p!tem Con!tructi'n Permit Vv Application for a Permit to Construct(./ )Repair( )Upgrade( )Abandon( ) WComplete System El Individual Components Location Address or Lot No.�' [/�(ZLS d 1. Owner's Name,Address and TFI.No. ' Assessor's Map[Paz o 91,t.cel .' x /ire D Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. nwR c-'c c ])-O �AH/ 4 4c,Cr S kIyYym/s� /7flt N a76Nni1S Ad, _ p/2S®�-3yy�-1 'Sr'� y/�Rs?ac,��yt/�6A --- ' Type of Building: Dwelling No.of Bedrooms �f Lot Size 3 566 sq.ft. Garbage Grinder s Other ' Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets + Revision Date Title '' Size of Septic Tank >- Type of S.A.S. Description of Soil f41 Nature of Repairs or Alterations(Answer when applicable) r "� Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the'.system in operation until a Certifi- cate of Compliance has been issued this Board of Heal . Signed .' G Date 7 Application Approved by -Date Application Disapproved for the following reasons Permit No. ' Date Issued ---------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY, t Wh VQ * Sew ge Di osgl ys m Constructed(J( )Repaired ( )Upgraded( ) Aband ned( ) y / at s n constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit�io. dated Installer Designer A The issuance of this e t s Aa/l t be construed as a guarantee that the sy le ,will function as.designe/d. v G Date I.�� Inspector M _//4,� (�f l) —— - -————————————————————————— —— No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Diopooar 6potem (Construction Permit Permission is hereby g anted to Cons ct( Repair( U gr de( )Aband n System located at / (. and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construc_wn-Mst be completg�within three years of the date of this it. , Date: ` / / Approved by, ( f i s ACCESS COVERS MUST BE WITHIN GENERAL 9 MINIMUM. l N� � R T EL E VA T I ONS DES / GN CR 1 TER IA : GEN " ERAL NO TES 6' OF FINISH GRADE 3' MAXIMUM COVER ~ INVERT AT BUILDING: 122.7 DESIGN FLOW: 132.0 FIRST 2' TO cn 1. THIS PLAN /S FOR THE DESIGN AND CONSTRUCT/ON BE LEVEL MIN 2' OF PEASTONE INVERT IN SEPTIC TANK 122.0 4 BEDROOMS AT 110 G.P.D. PER OF THE SEWAGE DISPOSAL SYSTEM ONLY, - �. INVERT OUT SEPTIC TANK: 121.75_ BEDROOM EQUALS 440 G•P.D. t11 INVERT IN DIST. BOX: 116. 17 4• Dlau�pE 3/4' - I l/2' DIA. �, wo t--� O 2, VERTICAL DATUM IS ASSUMED. FOR BENCH MARKS -� 7 _ l22 0 T2' WASHED STONE i\�J INVERT OUT DI ST, BOX: 118.0 N GARBAGE GRINDER SET. SEE SITE PLAN. GASF _ ,� $ !l5.5 Cr1 l INVERT /N LEACH CHAMBER: 117,5 2 0 BAFFLE 6 5 VM BOTTOM OF LEACH CHAMBER: 115.5 SEPTIC TANK REQUIRED: J. ALL CONSTRUCTION METHODS AND MATERIALS AND 3 OUTLET 3-500 GAL LEACHING CHAMBERS 440 G.P.D. X 200V - 880 GAL. MAINTENANCE OF THE SEPTIC SYSTEM SHALL D-BOX W/4' STONE AROUND, 12.8'X 33.5'X 2' ADJUSTED GROUND WATER: N/A 1500 GAL � OBSERVED GROUND WATER: N/A SEPTIC TANK PROVIDED: 1500 GAL. MIN. CONFORM TO MASS, D.E.P. TITLE 5 AND LOCAL ---- SEPTIC TANK 6' CRUSHED STONE BASE Z BOTTOM OF TEST HOLE #1: 104.0 SOIL ABSORPTION SYSTEM REQUIRED: BOARD OF HEALTH REGULATIONS, DESIGN PERC RATE ( 5 MIN/INCH 4. ALL SEPTIC SYSTEM COMPONENTS LOCATED UNDER PROF I L E NOT TO SCALE SOIL TEXTURAL CLASS - I AREAS SUBJECT TO VEHICULAR TRAFFIC OR GREATER Z THAN 3' IN DEPTH SHALL' BE CAPABLE OF WITH- m I EFFLUENT LOADING RATE - 0.74 GPD/SF q 440 GPD / 0. 74 GPD/SF - 595 S.F. REQUIRED STANDING H-20 WHEEL LOADS. -° c m , PROVIDED: 3-500 GAL LEACHING CHAMBERS 5. ALL SEWER PIPE SHALL BE SCHEDULE 40 OR ' r W/4' STONE AROUND, A-614 S.F. ni n 614 S.F. x 0.74 - 454 G.P.D. APPROVED EQUAL. • rn I t 6. SEPTIC TANK AND D-BOX SHALL BE REINFORCED SOIL PRECAST CONCRETE AND WATERTIGHT. TEST PIT DQ TQ 7. BEFORE CONSTRUCTION CALL 'DIG-SAFE'. O 1 ND I CA TES IND ERVEICATDES PERCOLATION BS TEST GROUNDWATER I-888-DIG-SAFE AND THE LOCAL WATER DEPT. L O T FOR LOCATION OF UNDERGROUND UTILITIES, P-8336 43566 + S.F. TP f I TP f2 8. NO DETERMINATION HAS BEEN MADE AS TO DESCRIPTION DESCRIPTION 0' - I20,0 0' - 122.6 COMPLIANCE WITH DEED RESTRICTIONS OR ZONING TOPSOIL TOPSOIL REGULATIONS. IT SHALL REMAIN THE CLIENTS SUBSOIL SUBSOIL RESPONSIBILITY TO OBTAIN ALL PERMITS. SPECIAL 2.5 •.................. 117.5 2.5 ................... I20._I PERMITS. VARIANCES ETC. FOR THIS PROJECT. .FINE FINE SAND SAND 9. IT SHALL REMAIN THE CLIENT'S RESPONSIBILITY , - SIZT SILT TO HAVE THE PROPOSED BUILDING FOUNDATION DESIGNED TO ACCOUNT.FOR THE EXISTING GRADE AND SOIL CONDITIONS AT THE LOCATION OF THE \� 1� 2.9 MEDIUM PROPOSED BUILDING. Aah phi TP•2 �Fr�, SAND •. ➢` F '•., '•. _ 10• ..................... 110.0 SOME - 122_ FINE _ GRA VEL a-500 Gat MED I UM / LEACHING CHAMBERS .:SAND W/4' STONE AROUND •� 16' No WATER � 104.0 12' NO WATER 110.6 01 Ay 0 I?. \ti 1 121.e + F'B o � Js. DATE: DECEMBER 22. 1994 26 \ \. TEST BY: STEPHEN HAAS \ D-Box WITNESSED BY: ED BARRY PERC RATE: ! 2 MIN/INCH \ \\ 125.o+ \\\ b \\\ i \i \� \\ is +121.0 \ 1500 GAL r 1 \ \\ \\ SEPTIC TANr - \ \ TP•IIQ \\ r , �\+ s \\ /� t��i /,LG.� \\ \ �\ \`•� SEPTIC COVER \ \ O i 128 . ?0. , i" 12e. PROPOSED WELL I \ \ - 125.I+ ti ti S / 7-__ PLA /V OF LANO 20 / CARL SON LANE . MAR / / 0 . PARCEL 26 / 4 \ 0\' ,p OR FAT MARSHES gp PP�g a q e q cAry PEDEsraL I P R ER A R EO FOR / / /h � OH� ✓ � L OCU )"ARA,10UTHP0R T . MA 0267-5 E \ WELL SCALE . / " - 2 O J!� /V UA R Y 1 .2 . / 9 9 9 HH / TEL PED E A O l___ E U F-R E Y 1 N G 1 C 923 Rou t e 6A /p�ti � �" � .I '.� / \\ � Yo r f� po r t MA . 02675 - ( 5O8 ) 362-8 1 32 / \ /' ► w, r I• ...�� �__._ l- ` �..t, /`\�/�1� � � 508 � 432-5333 \ \ \ 0 10 20 40 JOB NO: 94-368 FIELD:CFW/EEK CALC: SAH/CFW CHECK :CFW DRN: SAH LOCUS VAP i i,_ .. . ., ,• .,,... .. +„ .. n #.nee a '..t x ..+Rs..... H _._ - _._ .. -... ,.. ,. . ,<:.. .:WTI+ a .. .. -, : , ,. . ,-. ... :<...... ,A. f- .. . L v- , P. <Y. . , .. K` . ... .. _ �..- a ; .'.i,. :i , - :..., .. .: ., . 7. r .: , .r ., ". .. s .. S C l T ER l A �. ,. ; . -. . -I . I I IN V R T EL E VA T l ONS DE l GN R �I 1I1 I .,!!I,t..I I�III I ��.".,.I..h,..��1.11.�1 1�1.I.,.I,""." �i.,I.�:.1... » . I R 1� I . 7 1'I' I./1 �-1 1 1 I .�I I I II -1.1.2� �--, II ' GENERA L TES , _.. . ., , ..�.,,�1,�.1".;,,Io.I,I,-.-'.:,�,1,.1-,��I�1 I 1,.1�.I1.I 1I,11II I,,,.w11,I"I,�,�,II�I11,,:��11:�.,I.t,...:'�I 1I,".1I i1-*.11.-"I!._'�11,�I$I.,.I..I-'�..1.-.I,,�.�i�-'.1 I.. I " ,"'-I.1 1- .,T_I' ',1�. C*'�'IN'. ,::• -, � ., .:, ' ..� � . DESIGN FLOW: , . N ,:� ACCES COVERS MUST BE'w1 THIN T BOX: -./I6 5 , . r - S ' 19 .MINIMUM. : INVERT OUT DtS 1' .. _ N = 4 BEDROOMS AT I l0 G.P.D. PER -; k CONSTRUCTION 6 OF FiN/SH GRADE 3' MAXIMUM COVER INVERT IN DIST. BOX: I16.27 �.-I II7 I I I II� .�.I"I L..I��-T�I1 1I��I;-I I -- , It -..THIS;PLANIS FOR THE DESIGN AND . I .I 1 . II I 'o--A . .*--A�I, ,II�:_.�1 f-.-I,11,,1_'.1��!IIII1��"_,,1-I'A1"�,I1 I,,I,-,"�II�1_-,I.:.,�,."1 I.--.,�.'c-.�.�1-,��III-�,,1 1�,'-���.;1I,:,"`�_,_II 1�.,I 1�-1".,I.�'1-1-- ,,111�,-,'�,�1��-I�.I-I"'I,,,1"1",,I_.�.�,_',:,1,I1���I.".�,.1l,I,�l�,11_1I-,�.,,.-'�,_�1,,,"�.-.I1..,'1 I._I�,I,1,�I I�,-I�I,i�.,..,�.I,,.-i`,�I-.,_�":.,'_:',-I..�,,,,,"-'I.I`,I:�,,,:,1'.;I�q���,",�I1�.�:Il�.II,.-I,�,-,;.'��.�1%:1,_�"i 1,41,�.�.1,"I"I,1I-..",.-�I,,'�"'.,i�..�.,,.,I:,�:.I.�I�,.-,�,II,.-',,.I,,��-,,�,�,I I,�,:.�1,��.,,1,`�.,,�.�.�-":�-1,.,1,.'1-:.-',,'_.,..I�"1.I,I.�I1,,".I,II,.,,._�',,I,�"�.1.��I 1,I 1'I.'1,,..I I_,I�I�..'�-.I I,�1,1.�-I"-,I I1I�I.,,.'"I�_I-_�,1.-��.I,"__I,I,..11-1j",I I-�A,�..�_,,.""I-"�.-,��"I..II..I"-1�.I",-z-.-,.','"."I,I II I .I1i A. II I. BEDROOM EQUALS 440 G.P.D. , -„1. EWAGE DISPOSAL:,SYSTEM ONLY, I �I II I I - I �� .�' I . I III III I. FIRST-2 TO NVERT OUT D1ST.: BOX. I16. l OF THE S Zh / BELEVEL OF P ASTONE ll5.9 :_ . MIN 2 E INVERT I N i EACH CHAMBER � * 1'-1 . 1, "' . .j I.I I I �.�,. .I � 'I . I II � I 1 .I . � . ll 1 I.1 1 1,. .�.I.. . �'.. �• o NO GARBAGE GRINDER. ,; , . RKS I II AL. DATUM I S ASSUMED,. FOR BENCH MA 2. VER11 . m N BOTTOM OF LEACH CHAMBER: 1t3.9 ` SET. SEE SITE "PLAN. 3/4-,-- ! ,J/2- ,D 1 A, C . - , is , . _ - � ADJUSTED GROUND WATER• N/A SEPTIC TANK REQUIRED• •' . .' Ld e E - - ' 116.5 l!6. 1 4d� 2, // DOUBLE WASH D STONE OBSERVED GROUND WATER• N/A 440 G P 0 X 200x 880 GAL _: 3.f . ALL CONSTRUCTION METHODS AND MATERIALS AND 1/6.27 � „ 115.9 /13'.9 .•-� - .'. 0 OM OF HOLE *I: 104.0 SEPTIC TANK,PROVIDED: I500 GAL. EXISTING : A B TT T , M SH LL_. F H SEPTIC SYSTE d . ,. .MAINTENANCE 0 . T E EXISTING . , .. ;; < 3 500 GAL=LEACHING CHAMBERS 3 OUTL AND LOCAL - c CONFORM TO MASS.`D.E.P.. •TITLE 5 D BOX d SOIL ABSORPTION SYSTEM REQUIRED• ` . ;.'. D-BOX W/4 STONE AROUND. 12.8 r x 33.5 / x 2 Z BOARD OF HEALTH:REGULi(T/ON$. o DESIGN PERC RATE C 5 MIN/INCH . - . ::. . . . ,: ., . 6' .CRUSHED STONf ORmn SOIL TEXTURAL :CLASS - 7 T D UNDER 4. ALL-SEPTIC SYSTEM COMPONENTS LOCA E COMPACTED BASE•, . ,:. ,, z EFFLUENT LOADING RATE - 0.74 GPD/SF . : �, A RAFF!C.OR GREATER • . , R•. -: _ _ AREA S SUBJECT TO VEH/CUL R T : F - URD �„ ;:, „ , u. 0 440 GPD / 0.74 GPD/S 595 S.F. REO ! E , _ 0 W TH . : N E CAPABLE F . I CA THAN,3 . IN DEPTH=SHALL ,B PROFILE NOT TO S LE . _ STANDING H 2O WHEEL LOAD5. . , , , o c PROVIDED: 3-500 GAL LEACHING CHAMBERS - ': ;. u, _ r . _ ` F� ,. : N 5. ' :ALL.SEWER P/PE,SHALL BE SCHEDULE 40 OR W/4' STONE AROUND A-6/4 S F F. - 4 D . , . n 6/4 S x 074 45 GP ... APPROVED EOUAL. < . • r• j m ' ' 6, , 'SEPTIC TANK AND`D-BOX SHALL BE REINFORCED SO l L TEST P / T DA TA ' P*11958 •-'PRECAST CONCRETE AND WATERTIGHT. D-BOX SHALL •='BE,WATER TESTED'TO CHECK FOR LEVEL WHEN 'THERE L Tl DI - INDICATES N \� TESTOAA GROUNDWATER ES ON , . <:' I5.MORE'`:'THAN ONE:OUTLET. -• LOT l i t , \ -' ,. 1�. _ t •,.• ,, \ * TP *4 TP *5 i1. . BEFORE;CONSTRUCT10N::CALL '`D/G-SAFE., ,'. 43566 t S.F. TP 3 -888-DIG-SAFE'-AND,'THE'LOCAL`WATER DEPT. \ '' ' FOR LOCATION OF;UNDERGROUND UTILITIES 9 22 9 0 122 \ 0- HORIZON TEXTURE COLOR /22 0' HORIZON TEXTURE COLOR / HORIZON TEXTURE COLOR 9 _, -._ ,, . e.. LOAMY IOYR LOAMY. IOYR -,,. : .- SAND 312 SAND 3/2 SEPT C:SYSTEM„INSTALLER SHALL NOTIFY THE . ... ... ,,. 3-500 GAL 121.9 /2 12I.9 � l219 l2 ... .., , ,' /2 G E R TWO`DAYS PR/OR' TO CONSTRUCTION DESIGN EN I N E 'tfacHrNG cHAMeERs , ,_' F .: - W14 -3fON,F AROUND LOAMY IOYR LOAMY IOYR LOAMY IOYR , ., r,OF:.THE.SYSTEM TO ALLOW FOR SCHEDUL I NG OF THE - i "� _� � B SAND 5/8 B SAND 5/8 'Q SAND 3/2 CONSTRUCTION ,INSPECTIONS. ' _ .... ........................................ / ...... ; 1 %. SOIL�IP AL 36 I9. 24 I20.9 8 2/,4 ,f SEE ND _L.� Q '; ,_ Y� LOAMY IOYR t .�, LOAMY 2.SY LOAMY 2.5Y B 9..- ALL `UNSUI TABLE''MATERIAL lA A B HORIZONS. CI LAYERI , TP 3 C / C / - ti � \ SAND AND 6/4 SAND AND 6/4 , n .9 SAND 5/8 , : .h . 2 COUNTERED BELOW THE !NVERT.OF THE;."LEACHING EN p*� ♦ GRAVEL GRAVEL 30' l 20:4 1 :::. \ - :' FACILITY,TO ,BE ;REMOVED FOR A DISTANCE OF 5 :., :: . TP*5 I. h �. + % \ FIRM IN PLACE 48- ..............FIRM••1N PLACE..... 1/8.9 MEDIUM 2.5Y , £ D AROUND `AND REPLACED W1 TH "SAND JN ACCORDANCE '� ah �%TP•2 \ C2 SAND AN 6/4 W/TH TITLE,S. 96 •� :'. + 1 1/4 9 GRAVEL . I r • , , \ REDIUM 2.5Y LOOSE „, . - / .... _. 48 ._ l 18 9 C2 C2 r BM. OF•l?3.8 / T N AND 6 4 r D.ao�r 4 SAD / , , . / � SAND AND 6/ : . > \ LOAMY - , 2.SY . ,,. 111.r / \ GRA VEL GRA VEL .. y -f- / ND AND 6/4 v LOSE , _/ .• GRAVEL \ Ig r `., , ' \ FIRM /N PLACE \ 00 LOOSE . \ 144 9 20 2 9 J . . , \ c�` \ - ->~- ExISTINo sas N0 WATER ` NO WATER NO WATER i \ 0 _s , r .1 y •. ' \ C 0 \ . OCTOBER 1 007 .:' . \ \ E` EXI S tallo,- , --- \ D-eox T STEPHEN HAAS -: : •• • � DATE Z ITN ED B DONNA M/ORAN / \ : �F\ __ „ PE • W ESS Y: DI _ e, ,:, . . - , .. . , � � �`' �'<' � RC RATE: C 2 MIN/INCH 1 \ \ f / I. „., .. : ` . ,..,.. / .,. / _� p ` _ - ,I }. �)` \\ EX/ST1NG / / . V� ., 1 GAL , / �� + a , •- -' ,. - .: ,, ,-. • , i/ ` \\ `PEPTIC TANK I . : � r TP•1 ,/� SOIL TEST PI T L�ATA � . .; 1 / o r -- ---__ � _ , o ;1::,:.; / INDICATES V INDICATES ,. / . .. .. . . - .o PERCOLATION = OBSERVED o / . o � I TEST - GROUNDWATER .; , _ . // 4� . / E . t / I Ito o ! t l �/ . , / 5 / _ _. - - - - -- P*8336 _: . / oQ / / s. ,' I,-,_9E / 129.8 ,�-r / . � , ,r /< ION , .� DESCRIPTION DESCR J PT , e / 0- �-•-- 120.0 0' 122.E '.r . / / \ / , / / I I i / / TOPSOIL TOPSOIL . . Ir / \ .- _ ,_. •' _, ,i , r �.f� \ \\ j/ 2.5' 1/7.5 2.5' 120. t I. SUBSOIL SUBSOIL ^` 1�` . • . <, ,,, I po \ ., FINE SANE - I I / a \ SAND , D r F� 0 SILT SILT \ I I �� �i \ \\ A .. ' . , \ I �LG, D� 1" SEPTIC COVER y: . ,., , . . 5 ", tI I � � � 8 6 116.6 ., , . ,, , i \ \ MEDIUM \ ,, I I ,. , I � ��•".'";•�.� SAND ; ., . ,` \ '�S . . �, �:. l 0 /l 0.0 SOME . r ,_r-� -____ o --- �� y z, FINE GRAVEL l--- i HMS M.. MED I UM ' I S : k SAND �_ , i , , } I \10 Na 35461 . • M • ,:, 1 I E �!` I , NO WATER NO WATER 10.6 a• . . t I 16 .0 . . I . �� l 04 12 1 _ (", - i2e . ( ' . f DATE 4 H- I , C�� / DECEMBER 22, l99 i I `�`' ��- � w/� n TEST BY: STEPHEN HAAS ::. II 12e.5 WI TNESSED BY: ED BARRY . . . ,, ` ,:. , , t, - WELL I PERC RATE l 2 !N !NC . , , 1 r r r I I , I I . . r r , -'+ �y 26 .' r I . • r r 11 / 1 , . 1 125.I''- , -- r _-_ - ` , `» , ; /?9\ . ° - , r i z , , SEPT- / C S ' STEM _ S / G/\/ - r., , ' . p , 7 , - - .. r O M t =,. • I , . ': A , , -' , I. , - ,, rn rn o , 201 CARL S0/V LA11E . MAP / "/ O . PARCEL 26 1 4. i- , , , i i .. - . D. , . EST B,4R /VS .4 E , . , ►�f�' S T 8 +►��p0v .0� GREAT MARSHES : ' + . . , is , 4 . - J, + ; '. SQL' + + , p , , 4 F0 - . w �, + PREPARED R I ,« . 0 , % + x, y % CATV PEDESTAL , H + . 1 c + sT « + � oH� Mimeos h �\ ' \\ �, LEGEND . �' , : Locums _ L 6 22' . �O 026 8 , ' ,: _ P BOX 262 WES T BARIVS TAB E . MA iP -..-1 ■ CB CONCRETE BOUND . ,. '. ��p , . • -�- ,. \ {`Y . \ WELL W WATER LINE SCA L E : / - 20 OC TOBER 2 . 2007 P ., \ ,, �\` HH / TEL ED N`` �\ ® O HYDRANT e \ G GAS LINE EAG � E � UR �/ EY I NG , 1 NC - / 4 �� \ 923 Rou t 6A 4/� A + OHW OVER HEAD W RES o # LIGHT POST ` ,, �o - \ - R 1 L J NE ---�E UNDERGROUND ELECT C ,_ . e \ / �.� 508 " 362 8 1 32 - - .= i I 1 C r ,,, z ,,. ,,, Eo T UNDERGROUND TELEPHONE LINE // 11 I\ II I. #,,, . . ., , \ !_:l /I ► 11 4� ' •- .", - - - LEV1 ON LINE `li - F., d ,., 9 \ l ONB CI UNDERGROUN S I /�\+1 � n z:. s� \ I --�I-;L,.__I___�,_ _I.I_I,,I�.--11-I-I---I--I-�---I-.�'�_I'_I I-�.- I �f-I /f -}-40 4 SPOT ELEVA e.. r. .. ., . _ '. „_--40-._ EX/STING CONTOUR - • { 1 PROPOSED C 0 . . ., . : \ . __. . . > , _ 1. . 0 0. 4 8 F 1 EL D. 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