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0484 CEDAR STREET - Health
n -- - 484 CEDAR STREET, W. BARNSTABLE A=109-018 r ! l } 3 �I r TOWN OF BARNSTABLE 2 LOCATIONi% ~ SEWAGE# VILLAGE ASSSEESSSOR''S'MAP&P CEL �O INSTALLER'S NAME&PHONE NO. `/!/. //Aiw SEPTIC TANK CAPACITY LEACHING FACILITY: e y NO.OF BE ROO -&)90--WaZSf49a2 OWNER PERMIT DATE: ffi 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) 3t- Feet Edge of Wetland and Leaching Facility(If any wetlands exist Xthin 300 feet of leaching facility) Feet FURNISHED BY .� 1_ �y s� 3 Message Page 1 of 5 McKean, Thomas From: McKean, Thomas Sent: Thursday, May 08, 2014 11:40 AM To: Weil, Ruth; 'Wayne Miller' Cc: McLaughlin, Charles; Houghton, David Subject: RE: PRIVILEGED AND Confidential I'm presently making arrangements to have this particular well retested. We need to first confirm the test result, as suggested by George Heufelder today. Then we we"II go from there, UPDATE - George just called me back as I was typing this e-mail. The customer did a retest on this well and it came back none detected. George recommends we retest ourselves to confirm because we don't know where the most recent sample came from. P..S. Carbon tetrachloride was used as a degreaser to clean car parts for example. This may be an indication of disposal into the septic system or drywell over a period of time (not from a car accident) . -----Original Message----- From: McKean, Thomas On Behalf Of Health Sent: Thursday, May 08, 2014 11:26 AM To: Weil, Ruth; Health; 'Wayne Miller' Cc: McLaughlin, Charles; Houghton, David Subject: RE: PRIVILEGED AND Confidential RE: 484 Cedar Street Hi Ruth, That is a good suggestion- I'll call George Heufelder. The carbon tetrachloride was at 19 me/liter(MCL is 5) and the chloromethane was at 34 (no MCL listed). As we discussed, Gary Lopez called me yesterday. about this and sent me the well test report with the address blacked -out. He stated he believes it is coming from Sandwich because he says they allowed anything to be dumped there at their landfill for years, after refuse loads were rejected in Boston. He wants all the private wells in that area including up on Cape's Trail tested. He contacted Representative Randy Hunt and wrote a letter to Senator Wolf to request funding for testing. The groundwater direction flow is to the north. I pulled the file today and this particular well was installed in 1997 with no VOC's detected at that time- except for a very small amount of chloroform at 1.6 me/liter(the MCL is 80) . Anyhow, I'll gather more information and get back to you.. Talk to you soon- Tom -----Original Message----- From: Weil, Ruth 5/8/2014 Message Page 2 of 5 Sent: Thursday, May 08, 2014 10:56 AM To: Health; 'Wayne Miller' Cc: McLaughlin, Charles; Houghton, David Subject: PRIVILEGED AND Confidential Dear Tom: It's hard for me to discern the significance of the readings in this one sample; whether they show the cataclysmic level of chemical contamination discussed below or whether there is a simple explanation as to why this might be an anomalous result. Have you had a discussion with George Huefelder about this? Should we? Regards, Ruth Ruth J. Wled Town Attorney Town of Barnstable 367 Main Street Hyannis, MA 02601 508-8624620 (telephone) 508-8624724 (fax) The information contained in this electronic transmission ("e-mail"), including any attachment (the "Information"), may be confidential or otherwise exempt from disclosure. It is for the addressee only. This Information may be privileged and confidential attorney work-product or a privileged and confidential attorney-client communication. The Information may also be deliberative and pre-decisional in nature.As such,it is for internal use only. The Information may not be disclosed without the prior written consent of the Town Attorney's Office of the Town of Barnstable. If you have received this e-mail by mistake,please notify the sender and delete it from your system. Please do not copy or forward it.Thank you for your cooperation. -----Original Message----- From: McKean, Thomas On Behalf Of Health Sent: Thursday, May 08, 2014 10:28 AM To: 'Wayne Miller'; Weil, Ruth Subject: FW: -FYI- Letter from Gary Lopez to Senator Wolfe I don't know whether or not you were already cc on this. -----Original Message----- From: Gary Lopez, Sr. [mailto:displacedkanaka@yahoo.com] Sent: Thursday, May 08, 2014 9:44 AM To: Daniel'.Wolf@masenate.gov Subject: Dear Senator Wolf; I have contacted a number of legislators including Chris from Senator Therese Murray's office, who formerly represented West Barnstable. 5/8/2014 Message Page 3 of 5 Chris informed me that Sen. Murray probably would comply with my request the General Court provide a modest amount of money ($ 15,000) for the purpose of mass spectrometer water tests of fifty - sixty private wells. Since West Barnstable does not have a public water supply, neither the DEP nor the EPA regulate maximum contaminant levels (MCL) in these homes. A test, and then a retest, of water samples collected from a West Barnstable property detected 34 ug/liter of chloromethane, 0.57 ug/liter of vinyl chloride, 10 ug/liter of chloroform, 0.52 ug/liter of methylene chloride, 19 ug/liter of carbon tetrachloride. And 84 mg/liter of sodium. Sodium level is four times the EPA MCL of 20 mg/liter The EPA and DEP MCL's for the five other VOC's detected is ZERO. The 1 . 19 ug/liter average level of hexavalent chromium in the groundwater in Hinkley, CA was 33 times LESS than the pollution in West Barnstable, yet Ellen Brockovitch managed to 5/8/2014 Message Page 4 of 5 squeeze $333 million from PG&E To give you a frame of reference the level of dioxin (non-specific VOC) in the groundwater at Love Canal was 53 ug/liter. These levels are far greater than the W.R. Grace levels in Woburn and Acton. West Barnstable homeowners are fortuitous because unlike other contaminated groundwater scores of test wells within a half- mile radius had to be drilled to determine the scope of plumes, there are hundreds of wells already in place which means within a matter of a few days, samples could be collected and analyze and we'll know how wide the plume is. All money appropriated should go directly to the Barnstable County Lab to pay for mass spectrometer water tests that run from $200 - $300 each. This plume is eligible of CERCLA funds to pay for the clean up I have attached a copy of the test. I contacted the Barnstable Board of Health j that will beg George Huefelter for some free tests. The Cape Cod Commission claims that because the groundwater flows into Barnstable Harbor (not crossing town lines) 5/8/2014 L___ r Message Page 5 of 5 the agency cannot get involved. Sen. Murray will not act until she hears from you. Every person living in West Barnstable has an absolute right to know of the pollution so they can take preventive measures such as buy bottled water, digging deeper wells, etc. The VOC's are all known carcinogens and the production of chloromethane has been banned worldwide for at least a dozen years. I plan to handout copies of the test results at the West Barnstable post office this Saturday despite the fact people have been consuming these poisons for more than two decades (I know the dump source). 5/8/2014 _ p 0 TOWN OF BARNSTABLE /�� LOCATION �-� 2 A 1 S� YTY R�SEWAGE # ' 3791 9' VILLAGE Li e LT ASSESSOR'S MAP & LOT101- 612 INSTALLER'S NAME&PHONE NO. R OA 6;x,SPmi �Z2-7 " 43 /? 1 SEPTIC TANK CAPACITY I S y LEACHING FACILITY: (type) .-o 6-04 CG,*� (size) P-1— NO.OF BEDROOMS 3 BUILDER OR OWNER 7'f, e ti c rt-2 S7� PERMTTDATE: 7 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 d-6 ` P-0 B- oq TGWN O BARNST '-- Si WAGE LOCAVON 777. // ,, e' VILLAGE 0' t7�'n S -v t ,�.s51✓55mR'S MAl'&LOT INSTALLEIa.'S NAME dt Ptil NO 'SEPUC 'TANK CAPACI'C a�ft-Mes s (size) ,Jr� c;�itrr MbLI Y' t Q� 4. No .OF ROOMS. B. .I�FrI�.6k2{�Vfhllalt l COt1irSATf AAT , SPER IAXTD epoxatDon oD�wde Betvres�a tl�e Maxulnu► l rljWW, dW d di-po ker Table to did B61t0m of Aac PrDva6e i;t4D Ju irly'tPIA.v�Dcl�ea��hi¢ag 1?acilit�►:f�asay�vF:tis exist fee &e ae wl¢hin 2QQ felt of lofts t I f e:-ity P:ci�a cif wediDad t id iLeac6ai¢ag Facili¢y` any wet ands exDs¢ IP c t+�D4l3acD:�(tt!fc.ea pt ea�.Ilii�a�.fuci�arya U � �' � ��" Furulsbci.bY � d F o —e-09� 6 -C- 396, o A -p— ill, A -�= 316 CERTIFICATE OF ANALYSIS Barnstable County Health Laboratory (M-MA009) Recipient: -Kar us Matrix: Water-Drinking Water Barnstable Health Dept. Sampled: 05/08/2014 15`:00 200 Main St. Received: 05/08/2014 12:45 Hyannis, MA 02601 Collection Address: 484 Cedar.St,West Barnstable,MA Order#: G1479746 Sample Location: Description: VOC Carbon Tetrachloride Lab ID: 1479746-01 Date Analyzed: @ Sample#: Analyst: yn Method: EPA 524.2 Dilution Factor: 1 Comment: EPA 524.2- Volatile Organics by GC/MS Result MCL MDL Result MCL MDL Parameter ug/L ug/L ug/L F Parameter ug/L ug/L ug/L Dichlorodifluoromethane 0.50 Chloroform 80 0.50 Chloromethane 0.50 cis-1,2-Dichloroethene 70 0.50 Vinyl chloride 2.0 0.50 cis-1,3-Dichloropropene 0.50 Bromomethane 0.50 Dibromochloromethane 0.50 1,1,1,2-Tetrachloroethane 0.50 Dibromomethane 0.50 1,1,1-Trichloroethane 200 0.50 Ethylbenzene 700 0.50 1,1,2,2-Tetrachloroethane 0.50 Hexachlorobutadiene 0.50 1,1,2-Trichloroethane 5.0 0.50 Isopropyl benzene 0.50 1,1-Dichloroethane 0.50 Methylene chloride 5.0 0.50 1,1-Dichloroethene 7.0 0.50 Methyl-tert-butyl ether 0.50 1,1-Dichloropropene 0.50 Naphthalene 0.50 1,2,3-Tdchlorobenzene 0.50 n-Butylbenzene 0.50 1,2,3-Trichloropropane 0.50 n-Propylbenzene 0.50 1,2,4-Trichlorobenzene 70 0.50 . �p-Isopropyltoluene _ _ 0.50 � 1,2,4-Tri methyl benzene 0.50 sec-Butyl benzene 0.50 1,2-Dibromo-3-chloropropane 0.50 Styrene 100 0.50 1,2-Dibromoethane(EDB) o.so tert-Butyl benzene 0.50 1,2-Dichlorobenzene 600 0.50 Tetrachloroethene 5.0 0.50 1,2-Dichloroethane 5.0 0.50 Toluene 1000 0.50 1,2-Dichloropropane 0.50 Total xylenes 10000 0.50 1,3,5-Trimethylbenzene 0.50 trans-1,2-Dichloroethene 100 0.50 1,3-Dichlorobenzene 0.50 trans-1,3-Dichloropropene 0.50 1,3-Dichloropropane 0.50 Trichloroethene +--5.0 0.50 1,4-Dichlorobenzene 5.0 0.50 Trichlorofluoromethane 0.50 2,2-Dichloropropane 0.50 2-Chlorotoluene 0.50 Surrogates %Recovered QC Limits(%) p-Bromofluorobenzene 112% 70 1 130 4-Chlorotoluene 0.50 1,2-Dichlorobenzene-d4 1 120% 70 130 Benzene 5.0 0.50 Bromobenzene 0.50 Bromochloromethane 0.50 Bromodichloromethane 0.50 Bromoform 0.50 !Carbon tetrachloride_ _ _ ND 5.0 0.50 Chlorobenzene 100 0.50 Chloroethane 0.50 Approved B Attached p laboratory lease find the laborato certified parameter list. (L y -LQ- - (Lab Director) ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 Page 1 of 1 w COMMONWEALTH OF MASSACHUSETTS j' DEPARTMENT OF ENVIRONMENTAL PROTECTION Certified Paramefer List as of.01 Jul 2013 M-MA008 BARNSTABLE COUNTY HEALTH&ENV DEPT,BARNSTABLE,MA Anal es Methods for NON-Potable Water Methods forPotable Water ' ALUMINUM EPA 200.8 ANTIMONY 7 EPA 200.8PA 20D,8 ! ARSENIC,..; EPA200,8 r EPA 20D_8 ' _ BARIUM • EPA 200:8 BERYLLIUM EPA 200.8 EPA 2D0.8 CADMIUM EPA 200.8 EPA 200.8 CHROMIUM EPA 200.8 EPA 200.8' COBALT f=PA 200.8 COPPER EPA 200.8;SM 31113 EPA 200.8;SM 3111B IRON SM 3111B LEAD EPA 200.8 EPA 200.8 MANGANESE EPA 200.8;SM 3111 B MERCURY EPA 200.8 NICKEL EPA200.8;SM 3111B EPA 200•.8;SM 3111B SELENIUM EPA 200.8 EPA200.8 SILVER EPA 200,8 EPA 200,8 THALLIUM EPA 200'8 EPA 200.8 VANADIUM EPA 200.8 Z]NC EPA200,8;SM 3111B PH SM 4500-H-B SM 4500-H-B SPECIFIC CONDUCTIVITY EPA 120.1;SM 2510B HARDINESS(DAC03h TOTAL SM 2340B CALCIUM SM 3111 B SM 3111 B MAGNESIUM SM 3111B SODIUM SM 3111B SM 3111 B POTASSIUM SM 3111 B ALKANILI7Y,TOAL SM 2320B SM 232013 CHLORIDE EPA 300.0 FLUORIDE EPA 300.0 SULFATE EPA 300.0 EPA 300.0 NITRATE-N EPA 300.0 EPA 3'OD.0 NITRITE-N EPA 300.0 TURBIDITY EPA 180.1 TOTAL DISSOLVED SOLIDS SM 2540C SM 2540C NON-FILTERABLE RESIDUE(fSS) SM 2540D TOTAL ORGANIC CARBON __SM 5310E CHEMICAL OXYGEN DEMAND HACH METHOD 8000 BIOCHEMICAL OXYGEN DEMAND SM 5210B TRIHALOMETHANES EPA 524.2 VOLATILE HALOCARBONS EPA 624 . VOLATILEAROMATICS EPA 624 VOLATILE ORGANIC COMPOUNDS 'EPA 524.2 1,2-DIBR-OMOEFHANE EPA 564.1 1,2-DI-BROMO-3-CHLOROPROPANE EPA 304.1 PERCHLORATE EPA 314,0 HETEROTROPHIC PLATE COUNT SM 9215B TOTAL COLIFORM N!F SM 9222E TOTAL COLIFORM EPA 1604 TOTAL COLIFORM EN2.SUB.SM 9223 ' FECAL COLIFORM MF SM 9222D MF•SM.9222D E.COLf EPA 1603 EPA 1604 E.GOLI• EPA 1103.1 NA-MUG-SM0222G . E.COLI MF-SM 9213D EN2.SUB.SM 9223 ENTEROCOCCI EPA 1600 EPA 1600 ARv,E CERTIFI ITE OF ANALYSIS Page: 1 of 1 Barnstable Cou � Health Laboratory (M-MA009) /.;s Report Prepared For. spd Dated: 04114/2014 Sample 0: Sample Location: fffCedar St.W. Barnstable.MA Collected: 04/09/2014 Collected by: Customer Received: 04/09/2014 Routine ITEM RESULT UNITS Rh MCA METHOD a ANALY$ eT STE NOTE Nitrate as Nitrogen 1.2 mgfL 0.10 10 EPA 300.0 LAP 041MO14 Copper 0.012 matt. 0.003 1-3 EPA 200.7 LAP 04/10/2014 Iron 0.07 mg/L 0.01 0.3 EPA 2001 LAP 0411W2014 pH 7.9 PH AT 25C NA 6.5.8.5 SM 450D-H-8 DCB 0410WO14 Sodium '. -81: 1.0 20 EPA 200.7 LAP 0411012014 Total Conform Absent PIA 0 0 SM 9223 RG 041OW014 Conductance 740 umons/cm 2.o EPA 120.1 DCs 04/09/2014 Sodium level above the maxium contaminant level. Those on a low sodium diet may wish to consult a physician.Carlton Result , MGL MU .Result. lig, �s Parameter uglt i u9fL ug/L Parameter ug{t ; ug/t uq/t. D chtorodifluoromethane NO, 0.50 ; Momfcum - 10 60 0.50 ChIETrOrttethiine 34 __ 5.0 cis-1,2-Diditroetheoe NO 70 0.50 Vinyl chloride 0.57 2.0 0.50 `cis-1,3-Di&oropr0pene NO 0-sR Brornomethane NO 0.50 i Dlbrocnochloromethane - NO— - 0.90 1,1,1,2-fe—iachtoroeGtarte NO R.so Dlbrroncornethane NO o-so 1,1,1•Tdchtoroethane NO 200 0.50 -Ethyibenzene NO �700 1,1,2,240"chtoroethane NO 0.50 Nexachlorobutad ene ND R.SR 1,1,2-Trichloroethane NO s.0 o.so 1,'hopropyQwuene NO R.so 1,1-Dichloroethane NO 0.50 ',Methytenedttaride _ -_ 0.52 s.R o:so 1,1-Dichloroedwe NO 7.0 0.50 Methyl-tert•butyl edw ND o.50 • • ns�s�������� �sr• A CA • ,„., _ e. _ ._.-. ... .. _. .._. 'M Kecoverm urn6 t'4b) 2•Chmmtoluene NO 0.50 — —._— — p-&omofluoroberuene 110% 70 130 4 totuene NO P.50 t,2-Ofchlormwnzene-dot 116% 70 130 Benzene ND 5.0 O.SO Brcxrrruene NO O.so BranochtarorneWrte ND i 0.so BrornoGh4orantrhane ND 0 s0 ND 0S0 Mom Carbon tetraclslonde 19 s.a o.so ++r ChWmberuene ND too 0so UloroeUwane _ ND 0.50 w Town of Barnstable Geographic Information System May 7, 2014 109084 �109034� • #650 �►109043 109057 • #114 109025 #7 R #131 . 109033 #100 _ 109056 rj#98 109014003 A109 #113 #675 �.,1#620 109026 109024 109083 109055 iiilll s #85 - e #629 • #97 109032 C 109045 #82 tY 109023 • 4 1#586 1090544 T. O #66 • 132007 109082 #81 t11 109027 14 #60 11jila 109047 � 09031 #71 132049 #572 e #66 i� �5 Q #33 109053 109077 109081 109048 #65 44, p #90 #595 s o .6 13 #558 109030 109028 ri w 1#16 � 0 O #52 #49 y 1.09022 9052 #50 132036001 109078 Id6 1#631 y #57 . 132036002 #74 #251 109029 109064 64 109049 #15 109021 109079 #551 #642 #34 #58'109073 �5 O� 109051 ''#75 � 109065 O� #510 #27 • 'p 09020 • 109072 1#531 �� 1090 9 #20 132047* 132004 Q #59 109066 • A Q#16 , � #279 t#241 #,32 ♦ 109062 #10920711� O 109067 #515 109018 r #41 O V 16 `#484 V 1 #0 1 r�✓ ��i C-V • �O� 109061 Q 109089 132003 • 109070 #501 #468. 9l #27 �O 109068 vYr 109017 #285 91 .r� 108015 #460 .� 1090691#306h �� `#475 131056 1#2892 #11 #430 • 131010 108016 #303 Q� #25 108014 131061 �Q 108025 #455 ♦#410 #48 ~ 131009 ♦ 108017 108613 131007001 #321 #45) #435' #390 O 131011 108024 108018 Q • #282 108004 #6 #77 i #0 108019 ♦ 131008 131012 108007002 #349 #320 108022 �'�. #415 108023 #62 �J 131007002 131055 �#7 ... 108012 108021 #370 #332 #0 #78 — 131062 • 108005001 1080020 #375 131013001 131013007 0 148 Feet #0 # 108027 #330 131013004 #36 #431 #23 DISCLAIMERS:This map is for planning purposes only. It is not adequate for legal Map:109 Parcel:018 boundary determination or regulatory interpretation. Enlargements beyond a scale of Owner:WELLS FARGO BANK,NA Total Assessed Value:$386200 Selected Parcel 1"=100'may not meet established map accuracy standards. The parcel lines on this map W are only graphic representations of Assessors tax parcels. They are not We property Co-Owner: Acreage:0.81 acres Abutters boundaries and do not represent accurate relationships to physical features on the map Location:484 CEDAR STREET ! such as building locations. Buffer / .. No. ` s t Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS es 01pplication for Mi,5po,5 1 ,6p6tem Con5tructiun Permit Application for a Permit to Construct( ) Repair(l pgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. ?Y 42F��R -5-T Owner's Name,Address,and Tel.No. 6t Y_ Assessor's Map/Parcel �o Installer's Name ddress and Tel N41/��li D ner's Name,Address and Tel.No.�� fG�G�/AK f _� �'i 4__ Lj —lOG�7 —Uri " Type of Building: _ c�• 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 � 1. � gpd Plan Date Number of sheets Revision Date Title /-� f /�� Size of Septic Tank , p66U Type of S.A.S. :: 0 r4l/ Cl Description of Soil Nature of Repairs or Alterations(Answer when applicable) A C9 > 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 He th. Sign Date �.��! Application Approved by Date J Application Disapproved by: Date for the following reasons Permit No. S-C) ) -3 `— 9 Date Issued �— _AJ ` No. r, 7 / �• 'y t Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS es 01pprication for Cougtructiou Permit Application for a Permit to Construct( ) Repair.( Upgrade( ) Abandon( ) ❑Complete System ❑'Individual Components Location Address or Lot No.. ? Sr Owner's Name,Address,and Tel.NoD , Ile (�E.C.�/j�4-Y C4-) 5ferlfa�l* Assessor's Map/Parcel I 0 1 Installer's Name,.Address,and Tel.No / p�YJ (/`YLf,c�ir Designer's Name,Address and Tel.No.//l�f may/ t/YID Type of Building: Dwelling No.of Bedrooms Lot Size OQ sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) U gpd Design flow provided �'S� gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank � '�� /1000 Type of S.A.S. � ra Description of Soil 1 Nature of Repairs or Alterations(Answer when applicable) i Date last inspected: r- Agreement: 1 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. Signedd� �f� Date Application Approved by Date Application Disapproved by: Date for the following reasons Permit No. C J `'f 41 Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-sit�wag Disptsal System Constructed ( ) Repaired (Upgraded ( ) Abandoned( )by- � ❑ at has been constructed in accordance with the provisions of Title 5 and tth for-Disposal�System Construction Permit No. QO) _.] '-1 dated / / a .L3 Installer � �,� ��,fp Designer #bedrooms -� Approved design flow\ gpd The issuance of this e it sh 1 n ybe construed as a guarantee that the system will function as¢c signed- ;/ J Date Inspector .: -f� 5 1 J /G✓t b? % f 1( ' No. `� � 11� .� Cf� Fee jr'C) THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS 3fgpo,01 i§pgtem Congtruction Permit Permission is hereby granted to Construct ) Repair (� _U grade ( ) Aga don ( ) System located at ��/� � and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be corrtpleted within three years of the date of this pews ---- Date �"�� ��- Approved b� �---� Y l JAN/0 7/201 LAUE :0:37 AM FAX No. P. 001 Town of Barnstable Regulatory Senices Richalyd''V'. Scan,Interim Director ' AM �& Public Health Division S65o►9.4 Thomas McKean,Director 200 Main Street,Hyannis,M4 02601 Of'ice; 508-862-4644 pax: 50&-790-6304 Installer &Designer Certification Form J Date: C 'I Sewage Permit# � Assessor's MaplParcel ( 01 Ci Designer: Y vl5 Installer: Address, Address: « — Onf / as issued a permit to install a ( ate) 1 (installer) p r, styptic system at ` q'q G'r�V� T- V4, �i 'N 5based on a design drawn by I�} (address) IWG dated d . (designer) I certify that the septic system referenced above was installed substantially according to the design, which may ixiclude minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of auy Component of the septic system)but in accordance with State&Local regulations. Plan revision or certified as-built by designer to follow. Strip out(if required)was inspected and the soils were found satisfactory. Z certify that the system referenced above was constructed in complianQe with the terms of the PA approval letters (if applicable) ��N�1'6 Or ��9 CAR N �, Installer's Signature) 14 resignere's Signature) NlTWi� PLEASE RETURN TO BA11ABLE PUBLIC IIEA.LTH DIVISION. CERTIFICATE OF COMPLIANCE Vy LL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTA BLE PUBLIC HEALTH DIVISION. TRANR YOU. Q,1Septio\Designer Certification Form ltev 8.14-13.doc f I UNIT I EO.ST'T* POSTAL;SERVIGE I First-Class Maif tl I PostSPS age LI &Fees Paid I - Permit No.G-10 i Send Please print your name, address, and I ZIP 4 in this box• t I I Town of Barnstable Public Health Division I 200 Main Street Hyannis, MA 02601 / - _ 4 t ff'!7lli}' L s I , /.� i t ! ! Iiiil Fllillf ilililll ii Ff iil if ii?Fi.'i} . m Complete items 1,2,and 3. • • • item 4 if Restricted Delive Also complete 0 Print your name and n address on the verse X S a re ' so that we can return the card to® Attach this card to the back of the you. Agent or on the front if s mailpiece, B• Rec a by(printed Name) C O Addressee ' pace permits. Date of Delivery 1 Article Addressed to: 1 ` D. Is aeliv address different from item 1? ❑YesfJ iA If YES, ter delivery address below *.. David Holt ❑No,. i. Today Real Estate 1533 FalMOUth R a -s Centerville, MA 02632 ervice ' oad/Rte 28 Type - ,❑Certified Mail ❑Express Mail ❑Registered ❑Return Receipt for Merchandise ' Insured Mail ❑C.O.D. 2. Article Number =i ' 'i 'f 4.1 Restricted Deli (Transfer from service/abet)"2004 1p1Q! ry, (�mFee) 0 Yes 70Z2 PS Form 3811.Februa 'JLJU0 28$Z • �. h t —� Qomestic Return Receipt_ l]g 2 3 ! ■ e — 1�2595 02-M-1540: rn .. r . C3 . l L i 1 CO ni Postage $ r-3 Certified Fee w C3 Retum Receipt Fee (Endorsement Required) ioy.��POstma Here,,; I Restricted Delivery Fee �y i 0 (Endorsement Required) Or Total Postage&Fees rU r David Holt Today Real EstateV 1533 Falmouth Road/Rte 28 a T'cntcnrilla nnn (17RQ7 ' f OF TF4E T Town of Barnstable Barnstable Regulatory Services Department 4 f BARNSCABLE, ,M' Public Health Division m pTED"AP�� 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7012 1010 0000 2851 0923 October2, 2013 David Holt Today Real Estate 1533 Falmouth Road/Rte 28 Centerville, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 • The septic system located at 484 Cedar Street, West Barnstable, MA was last inspected on 9/06/2013, by Shawn Mcelroy, 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: • Backup of sewage into facility or system component due to overloaded or clogged SAS. • Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS. You are ordered to repair or replace the septic system within Sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH i i Thomas McKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\484 Cedar St W.Bam Oct 2013.doc Parcel Detail http://issgl2/intranet/propdata/ParceiDetail.aspx?ID=6181 �d St76S�5. o Logged In As: Parcel Detail Tuesday, October 1 2013 Parcel Lookup Parcel Info Parcel,109-018 ' Developer SLOT 3A I D Lot Location 1484 CEDAR STREET v- I Pri122 Frontage Sec�KETTLEHOLE ROAD ! Sec 32 Road Frontage Village rWEST BARNSTABLE ) Fire I;n"' BARNSTABLE District °� Town sewer exists at this Road !No Index,026� 0 address, } Interactive , t Map Owner Info {{ Co- Owner iWELLS FARGO BANK, NA 1 Owner 1 Streetl 4101 WISEMAN BOULEVARD I Street2 F � City'SAN ANTONIO ^� State�Tfl Zip78251 Country Land Info Acres 10.81� UseJSing ZoningRF Nghbd0106 � Topography Level j Road Paved , Utilities I Gas,Well,Septic Location Construction Info Building 1 of 1 Year �� —� Roof Ext �� 11997 Gable/Hip CI baCl oard Built Struct Wall' p Living 833 Roof( sph/F GIs/Cmp AC Area' Cover 1FA Type Style lColonial �� Int fDrywall Bed i3 Bedrooms — Wall Rooms` �24 Int Bath��—�--���— � � Model iResidential Floor Carpet Rooms 12 Full+ 1 H 1 FAT r �, s Heat _ Wj Total r-- Grade Average Plus Type Hot Water Rooms'7 ' Heat, �__._ ��._. Found Stories 2 Stories4��) Fuel(Gas ation Poured Conc. Gross http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=6181 10/1/2013 ���� ��n Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 484 Cedar St Property Address Bank Owned (Contact David Holt @ Today Real Estate 1800-966-2448) Owner' Owner's Name information is required for every W. Barnstable MA 02668 9-6-13 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. A. General Information I �` L3,I� 1. Inspector: . Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name P.O. Box 73 Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S13971 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluatio the Local Approving Authority 9-6-13 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. 1016 t5ins•3/13 Title 5 OfficiajInsp ' rm:Subsurface Sewage Disposal System•Page 1 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 484 Cedar St Property Address Bank Owned (Contact David Holt @ Today Real Estate 1800-966-2448) Owner Owner's Name information is required for every W. Barnstable MA 02668 9-6-13 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) • • 5 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. Check the box for"yes", "no"or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): 1 t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 484 Cedar St Property Address Bank Owned (Contact David Holt @ Today Real Estate 1800-966-2448) Owner Owner's Name information is required for every W. Barnstable MA 02668 9-6-13 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditional) Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 I J Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 484 Cedar St Property Address Bank Owned (Contact David Holt @ Today Real Estate 1800-966-2448) Owner Owner's Name information is required for every W. Barnstable MA 02668 9-6-13 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic.tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP y , p certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes"or"No"to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ® ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 484 Cedar St Property Address Bank Owned (Contact David Holt @ Today Real Estate 1800-966-2448) Owner Owner's Name information is required for every W. Barnstable MA 02668 9-6-13 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 484 Cedar St Property Address Bank Owned (Contact David Holt @ Today Real Estate 1800-966-2448) Owner Owner's Name information is required for every W. Barnstable MA 02668 9-6-13 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? . ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. Determined in the field (if any of the failure criteria related to Part C is at issue ® ❑ approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form m Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 484 Cedar St Property Address Bank Owned (Contact David Holt @ Today Real Estate 1800-966-2448) Owner Owner's Name information is required for every W. Barnstable MA 02668 9-6-13 page. CityFrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage Well 9 ( Y 9 (gPd))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 8-2013 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 484 Cedar St Property Address Bank Owned (Contact David Holt @ Today Real Estate 1800-966-2448) Owner Owner's Name information is required for every W. Barnstable MA 02668 9-6-13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: N/A Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons i 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 484 Cedar St Property Address Bank Owned (Contact David Holt @ Today Real Estate 1800-966-2448) Owner Owner's Name information is required for every W. Barnstable MA 02668 9-6-13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1997 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 18"feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Good condition. Septic Tank(locate on site plan): Depth below grade 12"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 gal Sludge depth: 12" t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 484 Cedar St Property Address Bank Owned (Contact David Holt @ Today Real Estate 1800-966-2448) Owner Owner's Name information is W. Barnstable MA 02668 9-6-13 required for every � page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 20" Scum thickness 2" 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 14" How were dimensions determined? Tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed and no sign leakage. I Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form 0 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 484 Cedar St Property Address Bank Owned (Contact David Holt @ Today Real Estate 1800-966-2448) Owner Owner's Name information is required for every W. Barnstable MA 02668 9-6-13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface'Sevrage Disposal System-Page 11 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 484 Cedar St Property Address Bank Owned (Contact David Holt @ Today Real Estate 1800-966-2448) Owner Owner's Name information is required for every W. Barnstable MA 02668 9-6-13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Good condition with water at working level and stain.a.above inlet invert. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * if pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System(SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M s 484 Cedar St Property Address Bank Owned (Contact David Holt @ Today Real Estate 1800-966-2448) Owner Owner's Name information is required for every W. Barnstable MA 02668 9-6-13 page. City(Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 2-500's ❑ 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.): Leach chambers were filled to capacity at inspection. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 i i Commonwealth of Massachusetts W Title 5 Official Inspection' Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 484 Cedar St Property Address Bank Owned (Contact David Holt @ Today Real Estate 1800-966-2448) Owner Owner's Name information is required for every W. Barnstable MA 02668 9-6-13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 I _ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 484 Cedar St Property Address Bank Owned (Contact David Holt @ Today Real Estate 1800-966-2448) Owner Owner's Name information is required for every W. Barnstable MA 02668 9-6-13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including 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 �'r..C k �y Well t 13 - - 9t- � a A - a 7 r 7 F g f F � 1��•' l� a s�- 3 e d a t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 i Commonwealth of Massachusetts v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 484 Cedar St Property Address Bank Owned (Contact David Holt @ Today Real Estate 1800-966-2448) Owner Owner's Name information is W. Barnstable MA 02668 9-6-13 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 12 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health - explain: ® Checked with local excavators, installers- (attach documentation) ® Accessed USGS database- explain: You must describe how you established the high ground water elevation: USGS and town maps show no groundwater at 12'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 484 Cedar St Property Address Bank Owned (Contact David Holt @ Today Real Estate 1800-966-2448) Owner Owner's Name information is required for every W. Barnstable MA 02668 9-6-13 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 i No.- --�7='---;-L� Fee------ -C - - BOARD OF HEALTH TOWN OF BARNSTABLE 0(pp[icat ion-*rVe[[ Con5tructioni3ermit Applicatio is hereby made for a permit to Construct ( ), Alter ( ), or Repair ( )an individual Well at: Location — Address Assessors Map and Parcel - J�"u S- -------------'"'``�—- ------------------- �— Owner Address l� CUti�.o � �6 6SG M------_-------------------------------------- ' o -------------lam" - Installer Driller Address Type of Building i Dwelling---------------------------------------------------------------- Other - Type of Building ---------- No. of Persons----------------------------------------------------- r Typeof Well Capacity---------------------------------------------— — — ----— Purpose of Well---- c i[_ic- "—Q /--------- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a Certificate . Co pliance has been issued by the Board of Health. s/f 7 Signed �'I!L--- - - — - -- - ------- --- ---- - -- date QQ Application Approved By — =--�. �'-1 r1 V �+ date Application Disapproved for the following reasons:--------------------------------—--------------------------------------------- ------------------------------- ------------------------------------------------------------------ date Permit No. ------- 2=- -- - Issued-------------------------------------------------------------------------- date BOARD OF HEALTH TOWN OF BARNSTABLE C ertif sate ®f Compliance THIS IS TO C R IFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( ) � ----------------------------------------------------------- /1 Installer at- -`o j 3 A - e l—�� �_ LJ`---/J° "�----------- - ------ — has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection f Regulation as described in the application for Well Construction Permit No. 1-- = ---Dated----------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE----------------------------- ------ Inspector----------------------------------------- ------------------------------ No.-W-12 Fee------ - `�' BOARD OF HEALTH ks TOWN OF BARNSTABLE Applicat ion,forWell Contruct ion Permit "Applicatio is hereby made for a permit to Construct ( ); Alter ( ), or Repair ( )an individual Well at: Location — Address Assessors Map and Parcel ow -- - — - --- ----------------- ---------- I"'Vic- - -- ------------------- -= -- ------------------ Ifi Address • n --- - - = - Installer — Driller Address Type of Building Dwelling Other - Type of Building ----------- No. of Persons---------------------==-- c . Type-of Well—�f / — -- - Capacity ----— — - ----— Purpose of Well----Q©—^''____S 11[ - [.�4 F I Agreement: ry 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 tertificate . Co pliance has been issued by the Board of Health.`�.. Signed --- -- -- - -- date Application Approved By --2- date Application Disapproved for the following reasons:---------------------------—-------------—---------------------------------- ---------- 1 , ----------- "` -___ __-_--__------_____-___-_____-_______________________-_______-_________-_____-_-___________________ date t � ' iPermit No. -- -------------- Issued-------------------------------------------------- --- ----- ------------- date BOARD OF HEALTH TOWN OF BARNSTABLE t t e Certificate Of Compliance THIS IS TO C R IFY, That the Individual Well Constructed ( );Altered ( ), or Repaired ( ) ,. I� a 1,►vP - -------- Installer at at-----1 oT 3 --C P O b S W'— --/J r - -M ----- has been installed in accordance with the provisions of`the Town of Barnstable Board of Health Private Well Pr9ltection Regulation as described in the application for Well Construction Permit No.V'u--.`�--'-�--11- ------Dated-------------------------- 1 THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE------------------- --- ---- — -- Inspector------------------------------------------------- ------------ BOARD OF HEALTH TOWN OF BARNSTABLE Ivell Con5truct ion Permit i No. Fee-- -- ,Q _ ��U-w r+ -c / -------------------------------- Permission is hereby granted---�'- --�------------------------------------------------------------ to Construct (—), Alter ( ), or Repair ( ) an Individual Well at: No. _ o -- -- ��/>G -- 5'r----------------------------- Street as shown on the application for a Well Construction Permit No.--------------- ---- ---- --- -------- - Dated - ---- ' -------------- - - ----------------------------------- - Board of Health DATE----�=--�-,�—�'=�� _______ b Town of BAr nstable P# — l �t►tt Department of Regulatory Services eraetA Public Health Division Date— ;1(21011 MAsa 200 Main Street;Hyannis MA 02601 f*b N Date Scheduled r 'Time Fee Pd. hV I <• > o ,5itabili Assessment or Se e Disp s �, Witnessed By: Performed By: LOCATION & GENERAL INFORMATION Location Address fl {Z i owner's Name �I (j,5., ^y I Pj V V 9"- 5Tf v -LS `"r'1 Address s t T- Assessor's Map/P4reel: 0 `/® l g I Engineer's Name e;,�Q,�js ,� 1'' NEW CONS IRU!tION REPAIR �Telephone# i G Land Use , Slopes Surface Stones 1 Distances from: Open Water Body ft Possible Wee Area�" "� ft Drinking Water Well ft .�,� a �ll ft Other ft prainage Way ft Proprrty Line w i SKETCH:(Street name,dimensio65 of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) I r t i ro I . . I f Depth to Bedrock ' Parent material(geglogie) I0 Depth to Groundwatdr. Standing Water in Hole: Weeping from Pit Face Estimated Seasonal�jigh Groundwater DtTERMINATION FOR SEASONAL HICK VVATE TALE �. � ln. Method Used: in. Depth to soil mottles: Depth dbserved standing in obs.hole: j ln. Groundwater Adjusttrlent tk. Depth toVeeping from side of obs.hole: i A ,{aetOC.,,, Adj.()roundwater Level Index Well# Reading Date Index Well 1evd - I PERCOLATION TEST . Date T4n't -- Observation + I Time at 9" - Hole# L1 e Time at 6" .-» -- Depth of Perc 7_�� j� Time(9"-6") -- Start Pre-soak Time.@ L--— End Pre-soak T— Rate Minjlnch �-- Additional Testing Needed(Y/N) — Site Suitability Asse$smeot: Site Passed__— Site Failed;; original:.Public I'4lth Division Observation Hole Data To Be Completed on Back-- ** If percola you must jibn test is to be conducted within 100' of wilo o'btzginning first notify the Barnstable C44servation Division at least one(1) week p DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistenc %Gravel G(� Zvi✓131 wiq'smL DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistenc %Gravel) - tl Quid,, GAM DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Hori Soil Texture Soil Color Soul Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistenc %Gravel DEEP OBSERVATION HOLE LOG NHole# Depth from Soil Ho' on Soil Texture Soil Color Soll Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consisten ra I Flood Insurance Rate Map: Above 500 year flood boundary No Yes Within 500 year boundary No y Yes, Within 100 year flood boundary No v Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring perviohs material? Certification I certify that on (date)I have passed the soil evaluator examination approved by the Department of Environ ental Protection and that the above analysis was performed by me consistent with the required Mr * g,expertise and experience described in 3.10 CMR 15.017. Signature Date Q:\SEPTICVERCFORM.DOC + t.dVIROTECN LABORATORIES, INC. r a r MA Cer. No.: M-MA 063 449 Rte.130 Sandwich, MA 02563 (508) 888-6460 1800-339-6460 FAX (508) 888-6446 CLIENT: Don Priestley/ Irene Trust LOCATION: 484 Lot 3A ADDRESS: PO Box 599 Cedar Street Mashpee, MA 02649 W. Barnstable, MA COLLECTED BY: DA Scannell SAMPLE DATE: 6-26-97/7-7-97* SAMPLE TIME: 3:00 WATER SAMPLE TYPE: New Well DATE RECEIVED: 6-26-97/7-7-97* LAB I.D. #: 976-707977-110* WELL SPECS.: 90, RESULTS OF ANALYSIS: Parameters Units Recommended Results Method Limits Coliform bacteria /100m1 0 0 9222 B Volatile Organics See attached report. Chloroform ug/L 100 1.6 502.2 * Retest performed. YES WATER IS SUITABLE FOR DRINKING PURPOSES FOR PARAMETERS TESTED. Date Ronald J. Sa#1 *q Laboratory Director <=less than >=greater than TNTC=too numerous to count FROP'I' : TO" 11Ohl F'HOl.1E lJO. E172 r 11.135 _ JU 1. t�13 1997 03:2 F'I`1 F Page 2 TOXIKON CORP. REPORT Work Order # 97-07-005 Received: 07/O1/97 Results by Sample SAMPLE 10 9767U7 FRACTION 0� TEST CODE 50 _ NAME VOC IN flZQ BY' PURGE T P Date & Time Collected WEIRCategory LATER Dichlorodifluoromethane ND 0.50 1,1,1,2-Tetrachtoroethane ND 0.50 Chloromethane ____.PD _ 0.50 10-01oh(oropropehe ND 0.50 Vinyl Chloride ND __0.50 Bromoform ND 0,50 Bromomethane N 0.50 1,1,2,2-Tetrachloroethane ND 0.50 Chtoroethane ND O.CO 1,2,3-Trichtoropropane NI) . 0.50 trich.lorofluoramsthane ND d 5 n 1,1-Dichloroethene NO 0.50 2-Chlorotoluene No No 0.5u 0.50 Methylene Chloride ND 0.50 4-Chlorotoluene NO 0.50 trans-1,2-Dichtoroethene ND 0.50 1,3-Dichlorobenzene ND 0.50 ill-Dichloroethane ND 0.50 1,4-biehlorobenzene ND 0.5Q eis-1,2-Dichloroethene NO 0.50 1,2-Dichlorobenzene No 0.50 2,2-Dichloropropane NO 0.50 1,2-Dlbromo-3-Chloropropane NO 0.50 Chloroform 1.6 0.50 1,2,4-Trichlorobenzene _ ND 0.50 Bromachloromethane NO 9.50 Nexachtorobutadiene NO 0.50 1,1,1-Trichloroethane ND 0.50 1,2,3-Trichlorobenzene ND 0.50 1,1-Dichloropropane ND 0.50 Benzene ND 0.50 Carbon Tetrachloride NO 0.50 Toluene ND 0,50 1,2-Dichloroethane ND 0.50 Ethylbenzene _ NO 0.50 Trichloroethene NO 0,50 m-Xylene NO 0.50 1,2-Dichloropropane _ No 0.50 p-Xylene � NQ 0.50 Bromodichloromethane NO 0.50 o-Xytene NQ _ 0.50 Dibromomethane No 0.50 styrene NQ 0.50 cis-1,3-Dichlaropropene ND 0.50 Isopropytbenzene ND 0.50 trans-1,3.0ichlOropropene No 0.50 n-Propylbenzene NO 0.50 1,1,2-Trichloroethane _IUD 0.50 1,3,5-Trimethytbenzene RD 0.50 1,3-Dichloropropane No 0.50 tert-Butytbenzene NO 0.50 letrachloroethene NO �0050 1,2,4-Trimethylbenzene _ NO 0.50 0 1 bromoch toromethan,a 4D 0.10 Bec-aUtyibEraccne No 0.5u 1,2-Dibromoethane NO 0-50 p-lsopropyltotuene ND 0.50 Chlorobenzene ND 9.50 n-Butylbenzene No 0150 Nepthatene ND 0.50 Notes and Definitions for this Report! DATE RUN 07/02/97 ANALYST CMD INSTRUMENT G UNITS ug/L DILUTION 1 Nb = NOT DETECTED AT DETECTION LIMITS "fit {- �Fiigr*x COMMONWEALTH OF MASSACHUSETTS t { . EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS ' p `x DEPARTMENT OF ENVIRONMENTAL PROTECTION $ ' a A . ye •. TITLE 5 � OFFICIAL INSPECTION FORM—NOT FORVOLUNTARY ASSESSMENTS ` SUBSURFACE SEWAGE DISPOSAL`SYSTEM FORM 1 d4} PART A CERTIFICATION LC7�i3f) Property Address: 484 CEDAR ST WEST BARNSTABLE,MA 02668 Owner's Name: THOMAS EVANS Owner's Address: 484 CEDAR ST,WEST BARNSTABLE,MA 02668 y Date of Inspection: 11/13/01 RECEIVED Name of Inspector: (please print) JOHN GRACI Company Name: SEPTIC INSPECTIONS '; Mailing Address: P.O. BOX 2119 TEATICKET,MA.02536 NOV 2 n bu l V iytry�4 TOWN OF b,�kRrcti f ABLE { 4444 Telephone Number: 508-564-6813 FAX 508-564-7270 HEALTH D'EPT. � CERTIFICATION STATEMENT `y I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is r true,accurate and complete as of the time of the inspection.The in performed based on my training and spection was experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system 1IRE 44 ' ��'k inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: X Passes _ Conditionally Passes =1" _ Needs Furth valuation by the Local Approving Authority Fails ,. Date: 11/13/01 Inspector's Signature: ,- P'i � lth or DEP)within The system inspector shall submi a copy of this inspection report to the Approving Authority�Board of Hea } 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 w �° inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be '` c sent to the system owner and copies sent to,the buyer,if applicable,and the approving authority. r ` Notes and Comments SYSTEM PASSES TITLE V RECOMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM USEFUL , .� LIFE.RECOMMEND RAISING COVERS TO SYSTEM. 4V hI ****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. „ . f r a m Title S Tnc.�r�tinn T nrm i��5%?nnn '• L. f f Page 2 of 11 {>' OFFICIAL INSPECTION FORM—NOT FOR;VOLUNTARY ASSESSMENTS . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A t�.. CERTIFICATION(continued) ��` f � e Property Address: 484 CEDAR ST WEST BARNSTABLE,MA 02668b Owner: THOMAS EVANS Date of Inspection: 11/13/01 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D .f. , A. System Passes: F X 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: :. SYSTEM PASSES TITLE V RECOMENDIPUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM ;{ USEFUL LIFE.RECOMMEND RAISING COVERS TO SYSTEM. �hA B. System Conditionally Passes: . " _ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system, .5 upon completion of the replacement or repair,as approved by the Board of Health,will pass. f _' Ail Answer yes,no or not determined.(Y,N,ND)in the for the following statements.If"not determined"please explain. a ilhr�; n/a The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits x. 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 '; � F. that the tank is less than 20 yearEM8(is available. ND explain: n/a { n/a Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed inspection if with a royal of Board of 4 . pipe(s)or due to a broken,settled or uneven distribution box. System will pass rasp ( pp R - Health): _ broken pipe(s)are replaced _ obstruction is removed _ distribution box is leveled or replaced r d a y ND explain: n/ar � .. n/a The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass �h � , inspection if(with approval of the Board of Health): _broken pipe(s)are replaced , _obstruction is removed ; F ND explain: n/a « ,„ rt. Y )• Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR'VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ,`^ � PART A CERTIFICATION(continued) 4 ' Property Address: 484 CEDAR ST WEST BARNSTABLE,MA 02668 �� Owner: THOMAS EVANS Date of Inspection: 11/13/01 P'' C. Further Evaluation is Required by the Board of Health: "* kM _ 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(l)(b)that the system 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 z ' _ 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 any)determines that the .'i� v$i 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 h , 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 n/a 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 ammonia4F nitrogen and nitrate nitrogen is equal to or less than 5 m provided that no other failure criteria are triggered.A copy. g ,g, , q PP ,P of the analysis must be attachedio this form. ; is 3. Other: I Y 1k a i as • Z 1`L i Page 4 of I I OFFICIAL INSPECTION FORM—NOT FOR,VOLUNTARY ASSESSMENTS �� SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM { Ids, d PART A CERTIFICATION(continued) 3 Property Address: 484 CEDAR ST WEST BARNSTABLE,MA 02668 Owner: THOMAS EVANS ` f� Date of Inspection: 11/13/01 .a ` L D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for alLinspections: � i{. T Yes No � X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool 4 � X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or cloggedNt ' SAS or cesspool �� K. - 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'/a day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed i e s .Number of times - q P P g Y P� P�P ( ) �t< pumped nLa. ' 4 _ X Any portion of the SAS,cesspool or privy is below high ground water elevation. X An portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water su l - Y P P P �'Y PP Y �' PP Y � - X Any portion of a cesspool or privy is within a Zone 1 of a public well. , i _ X Any portion of a cesspool or privy is within 50 feet of a private water supply well. ,. t _ 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 1 certified laboratory,for coliform bacteria and volatile or 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* g P r less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be -� attached to this form.l G �' F _ )The Y Yes/No 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 If necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. �� °: You must indicate either"yes"or"no"to each of the following: , (The following criteria apply to large systems in addition to the criteria above) I yes no : I _ 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 supplyUr `' " X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped ,�� , { Zone 1I of a public water supply well f. { �P 1 If you have answered"ye's',to any question in Section E the system is considered a significant threat,or answered ` a "yes" in Section D above the large system has failed.The owner or operator of any large system considered a significant thrcat`-"'1,9 � 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. w � 441, i Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS $. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM *4 PART B 5- CHECKLIST ' Property Address: 484 CEDAR ST WEST BARNSTABLE,MA 02668 Owner: THOMAS EVANS r � } Date of Inspection: 11/13/01 x, Check if the following have been done.You must indicate yes or no as to each of the following: f k` 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? t J✓�h X Have large volumes of water been introduced to the system recently or as part of this inspection? iG X _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) hf r X _ Was the facility or dwellin 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 manholes uncovered,opened,and the interior of the tank inspected for the condition of the ryg baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? y X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance 'F of subsurface sewage disposal systems? :;fk 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. - Y X _ 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)]. `4 C y Aa t t s� Page 6 of I 1 _ s OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM r*�' PART C SYSTEM INFORMATION ' h Property Address: 484 CEDAR ST WEST BARNSTABLE,MA 02668 Owner: THOMAS EVANS Date of Inspection: 11/13/01 t ,FLOW CONDITIONS s RESIDENTIAL s Number of bedrooms(design):3 Number of bedrooms(actual): 3 r 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 Ys stem inspected(Yes or no): NO. f Seasonal use: (yes or no): NO tsr Water meter readings, if available last 2 ears usage d n/a g ( Y g (gP ))� Sump pump(yes or no): NO 'h� Last date of occupancy: n/a . Y✓�3'�7[t�.,j4 COMMERCIAL/INDUSTRIAL Type of establishment: n/a Design flow(based on 310 CMR 15.203): n/agpd Basis of design flow(seats/persons/sgft,etc.): n/a - ti.. Grease trap present(yes or no): NO Industrial waste holding tank present(yes or no): NO s Non-sanitary waste discharged to the Title 5 system(yes or no):NO fi Water meter readings, if available:*n/a ,Rrtd Last date of occupancy/use: n/a OTHER(describe): n/a GENERAL INFORMATION �,• ; Pumping Records t Lr Source of information: n/a '' Was system pumped as part of the inspection(yes or no): NO .� . If yes,volume pumped: n/agallons'=-How was quantity pumped determined?n/a Reason for pumping: n/a `K. TYPE OF SYSTEM X Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool L _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): n/a � Approximate age of all components,_date installed(if known)and source of information: :. 1997 ' Were sewage odors detected when arriving at the site(yes or no): NOf r Page 7 of I I t$ -P a OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) F " Property Address: 484 CEDAR ST WEST BARNSTABLE,MA 02668 Owner: THOMAS EVANS Date of Inspection: 11/13/01 BUILDING SEWER(locate on site plan) ; d Depth below grade: 18" Materials of construction:_cast iron X40 PVC_other(explain): n/a Distance from private water supply well or suction line: n/a ;;h Comments(on condition of joints,venting,evidence of leakage,etc.): ''I TOWN WATER sst � SEPTIC TANK: X(locate on site plan) �i• Depth below grade: 0" Material of construction: Xconcrete_metal_fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a Is'age confrmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: 150OG L 10 6 H 5.7 W 5 8 Sludge depth:2" Distance from top of sludge to bottom of outlet tee or baffle:32" ** Scum thickness: 1" ` N�a vti 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:0" 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.): t .a THE SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND AND FUNCTIONING .� PROPERLY. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL 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 4 Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a ft Distance from bottom of scum to bottom of outlet tee or baffle: n/a ; y f Date of last pumping: n/a1 : Comments(on pumping recommendations, in and outlet tee or battle condition,structural integrity,liquid levels as related J�� ; R to outlet invert,evidence of leakage,etc,.): n/a till:" 14 a yl• .� s y��L'y7^i �•R. t �. Page 8 of 11 $x a . s� OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM � n PART C �"T SYSTEM INFORMATION(continued) ` Property Address: 484 CEDAR ST WEST BARNSTABLE,MA 02668 Owner: THOMAS EVANS f y Date of Inspection: 11/13/01 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 N ' Alarm present(yes or no): N/A xt' Alarm level:N/A Alarm in working order(yes or no): NO r x Date of last pumping: n/a �" Comments(condition of alarm and float switches,etc.): n/a Alm20 ' . DISTRIBUTION BOX:X(if present must be+opened)(locate on site plan) k, �4,i Depth of liquid level above outlet invert: LEVEL WITH BOTTOM OF PIPE £s x Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): } BOX IS STRUCTURALLY SOUND. A ' PUMP CHAMBER:_(locate on site plan) �n 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/at: Q Page 9 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS ' ¢' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) �^ Property Address: 484 CEDAR ST WEST BARNSTABLE,MA 02668 Owner: THOMAS EVANS ,�r'; Date of Inspection: 11/13/01 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required)` " gw x ' rah { If SAS not located explain why: n/a �p Type n/a leaching pits, number: n/a 500 GALLON LEACHING leaching chambers, number: 2 "' CHAMBERS leaching galleries, number n/a � F k�Y n/a leaching trenches, number,"length: n/a n/a leaching fields, number: n/a n/a overflow cesspool, number: n/ar � n/a innovative/alternative system n/a Type/name of technology: n/a Continents(note condition of soil,ksigns of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.): LEACH FIELD APPEARS TO BE FUNCTIONING NORMALLY.THERE ARE NO SIGNS OF HYDRAULIC FAILURE.RECOMMEND RAISING COVER TO FIELD:BOTTOM OF FIELD IS 5'6" f L 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/aK PRIVY: (locate on site plan) Materials of construction: n/a + Dimensions: n/at ' Depth of solids: n/a. ` Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): "t n/a +r t 4 Q Page 10 of 11 _. • �y OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM _= PART C ' SYSTEM INFORMATION(continued){ Property Address: 484 CEDAR ST WEST BARNSTABLE,MA 02668 : Owner: THOMAS EVANS 1 Date of Inspection: 11/13/01 SKETCH OF SEWAGE DISPOSAL SYSTEMRk Provide a sketch of the sewage disposal system'including ties to at least two permanent reference landmarks or benchmarks. Y) Locate all wells within 100 feet. Locate where public water supply enters the building. s 01 { y � AA o Ag : n C ACAD 3 y ' 6� Ll b . t A 1 s t in Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS ' ; ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C a SYSTEM INFORMATION(continued) Property Address: 484 CEDAR ST WEST BARNSTABLE,MA 02668 Owner: THOMAS EVANS Date of Inspection: 11/13/01 W SITE EXAM X V 1 _Slope _Surface water ,,•- _Check cellar +` Y Shallow wells b. # Estimated depth to ground water 12+feet Please indicate check all methods used to determine the high ground water elevation: .' " YES 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) t'x NO Checked with local Board of Health-explain: n/a NO Checked with local excavators, installers-(attach documentation) NO Accessed USGS database-explain: n/a You must describe how you established the high ground water elevation: GROUNDWATER DETERMINED FROM ENGINEERED PLANS ; V, ' r X 5 ` '. . 'l J r � t S � 11 No. THE COMMONWEALTH OF MASSACHUSETTS Fee too BOARD OF HEALTH V W l YICAATION OFAP FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct ( ) Repair ( ) //U''pgrade ( ) Abandon ( ) XComplete System ❑Individual Components Z'r-e„/ 09 rr J 7L is uion Owner's Name 3,* Map/Parcel# Address A/7 7 Tcicphon - .e � p Installer~Name Designer's Name Address Address Telephone# Telephone# Type of Building: Lot Size- 08 0 Sq.feet Dwelling—No.of Bedrooms 3 Garbage Grinder ( ) Other=Type of Building No.of persons Showers ( ), Cafeteria ( ) Other fixtures Design Flow(min. required) 3,3 0 gpd Calculated design flow 330 gpd Design flow provided-� 3 gpd Plan: Date ��'* �s f 4 S? Number of sheets / Revision Date Title S�hS/� �G l� 2�s.`ef� Bs. `,e X- esX,o�y Description of Soil(s) s�b �f4..�,/ .�—f !"a// -`,-dI. eve Soil Evaluator Form No. Name of Soil Evaluator 77 rpy s e" Date of Evaluation G 7 DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees not to place the system in operation until a Certificate of Compliance has been issued by the Board of Health. Signed ate FORM I - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 ` N"O. THErCOMMONWeEALTH OF MASSACHUSETT . EE .; BOARDD OF HEALTH � WOF ar `. APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct ( ) Repair{ ) Upgrade ( ) Abandon ( ) -XComplete System ❑Individual Components Locution Owner's Name Map/Parcel# Address 1 7 Telcphony;,�dw a w d w7 Installers Name Designers Name I / . F Address Address �• j 't Telephone# Telephone# � t . Type of Building >_y, ;Lot Size DtP 10 Sq.feet - t_ I)we. 'ng �No:of Bedr-ooms:. Garbage Grinder Other' ype of Buil,01ng No.of-persons ,6 Showers ( ), Cafeteria t � r Other fixtures j, -Design-Flow(min. required) .3.30 gpd Calculated design flow.330 gpd Design flow provided•753. 7gpd Plan: Date Number of sheets / Revision Date - ' u Title S/.. /� j'.c.+., !r 2e�xllere.. s.A St.., ,e - Description of Soil(s) pry Jvb �'fs.�d art' ,.� /�;'�/ S%/f, iMta►/• c'c .l t 3q«<%�yr4v.e Soil EvaluatorTorm No. Name of Soil Evaluator P r4. rc.: Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS ` lye ; t The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees not to place the system in operation until'a Certificate of Compliance has been issued by the Board of Health. Signed ate J FORM t - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 No. ✓ THE COMMONWEALTH OF MASSACHUSETTS FEE ~ BOARD OF HEALTH CERTIFICATE OF COMPLIANCE Description of Work: ❑ Individual Component(s) ❑Complete System The undersigned hereby certify that the Sewage Disposal System;Constructed(Repaired( ))Upgraded( /)�Abandoned( ) 6 1 at `4 q 1 C•Pd S 4 lit 1 has been.installed in accordance with-the rovisions of 310 CMR 15.00 (Title,5) and the approved design plans/as-built` plans relating to application No. r dated Approved Design Flow (gpd) - i Installer z Designer: Inspector Date Yr The issuance of this certificate shall not be construed as a guarante CiRat the system will function as designed. / FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96 No. `! `THE COMMONWEALTH OF MASSACHUSETTS tJ FEE -BOARD OF HEALTH i DSPOSAL SYSTEM CONSTRUCTION PERMIT Perm sto is he-rVb ranted to Construct Re air Upgrade Abandon an individual sewage I �y g f ( P ) Pg ( ) g disposal sy'ste at l [n/d5Raoxas.4, as described 11 in the applieatio for Disposal System Construction Permit No. '"� ,dated Provided: Construction shall be completed within three years of the date of this er ' .Al loca c8nditio s must be met. Date "' 4 .�f z G Board of He46-' µ FORM 2 - DSCP ;'DEP APPROVED FORM 5/96 FORM 1255 (REV 5/96) H&W HOBBSB WARREN TM PUBLISHERS- BOSTON i Jos ,h4C TOWN OF BARNSTABLE LOCATION Lo-r. -?A C fVA4 SEWAGE # 3 VILLAGE l-y'e s` b ASSESSOR'S MAP & LO 1n 9_01 zd INSTALLER'S NA ME PHONE NO. IR oN 6;,+AF S'PM/ SEPTIC TANK CAPACITY j r LEACHING FACILITY: (type) So G Pr( C�-yh►vlaA (size) a I NO.OF BEDROOMS BUILDER OR OWNER "T'!, [sr T2 v S 7— . PERMIT DATE:�J 7 COMPLIANCE DATE:_1 n - 7—� 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) Furnished by OLE WEST BARNSTABLE KE�ROP N44°15,�� E WELL LEGEND q,60 PROPOSED CONTOUR rOOO S8S° 9® PROPOSED SPOT GRADE <0 27Sg,, } -- 98 -- EXISTING CONTOUR p� v F + 96.52 EXISTING SPOT GRADE sq ,.92 W— EXISTING WATER SERVICE pF�9,p LOCUS TEST PIT WELL �•,` �� �, ' ,Qp DZ W O /00, 1 00 LOT 4A LOCUS MAP C ' LOCUS INFORMATION 69 PLAN REF: 301/99 m TITLE REF: 26029/215 2-CAR ; ASPHALT DRIVE � � . PARCEL ID: MAP 109 PAR. 18 ITI .GARAGE; BLHD COR. ZONING: "RF" --I N T13M=69.0v- 1N-2 FLOOD ZONE: "C" N = �•�XISI' �, �/_ COMMUNITY PANEL: 250001-0011-D DATED:07/02/92 TANK00 25.- o ; ______- -- SEPTIC SYSTEM ---- -----------C_ ° % #484 o o ------____ - _s 'TOF=69.95; :' b, - w >>° REPAIR PLAN ,;, DECK `SS _,_ � LOCATED A [o SHED 484 CEDAR STREET s - --------- ��-_--- ! WEST BARNSTABL A. - ---J / / ' --- /' / J / 7 -'4 6 PREPARED FOR _ 65 ' WELLS FARGO BANK, NA / -mM4_OAKS NOVEMBER 25, 2013 EXIST. LEACHING �`9S� (see Note 10) L 0 T 3 A - ��� M �V8220. AREA=35,080t S.F. OF gss��� 9�ti $�•e ORIl DARNM. It /� ' eMENT` e0cc�stE ° / �4NITAR�a� /t ZS/ )3 ' 111 LOT 2 ' 3 o ' h 22� �cn 8 , w LOT 5A MEYER & SONS INC. IV (rW GRAPHIC SCALE W P.O. BOX 981 30 U 15 30 60 120 ;' m EAST SANDWICH, MA. 02537 - (508)362- 2922 ( IN FEET ) ) ` WELL 1 inch = 30 ft. SHEET 1 OF 2 J 1608 ELEV. TOP FOUNDATION NOTE: METAL RINGS AND COVERS TO GRADE OVER ALL COMPONENTS (Existing) FINISHED GRADE (68.0) = 69.95 � F.G.EL: 68.0 F.G.EL: 68.0 F.G. EL: 68.0 MAINTAIN 2% MIN SLOPE OVER LEACHING AREA a !!! :c 2" OF 3/8" DOUBLE WASHED 3/4" - 1-1/2" F.G.EL: 67.18 STONE OR FILTER FABRIC DOUBLE WASHED STONE 6" „ 4 SCH 40 PVC A: 14., 6" © S= 1 (MIN.) ®®®®®®®®®®® TEE'S ARE TO BE INV.65.73 2 E F. DEPTH ®®®®®®®®®®® 4' SCH 40 PVC INV.65.93 INV.65.53 'i GAS J • _ 4' 2 X 8.5' 4' EXISTING OUTLET BAFFLE PROPOSED DB 3 t} DISTRIBUTION BOX EFFECTIVE LENGTH = 25' INV. 66.18 INV. ELEV.= 65.30 EXISTING 1 ,000 GALLON SEPTIC TANK GAS BAFFLE TO BE INSTALLED ON P��� �F MAss9 BREAKOUT OUTLET TEE AS MANUFACTURED BY �-� ��` DA M. `-y ELEV.= 66.30 TUF-TITE, ZABEL, OR EQUAL M TOP CONC. ELEV.= 66.30 _ T T A No. INV.N INV. ELEV.= 65.30 •®® •®® NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE INVERTS PRIOR TO CONSTRUCTION ®®®®®®® 2) D-BOX SHALL BE SET LEVEL AND TRUE TO �fG/STE�� ®®®®®tom 3 GRADE ON A MECHANICALLY COMPACTED SIX SgN�TAR�P� BOTTOM EL.= 63.30 INCH CRUSHED STONE BASE, AS SPECIFIED IN .,,/ YrZ 3.75' 5 FT. M,'. 310 CMR 15.221(2) [ > D REPLACE EXISTING 1,000 GALLON SEPTIC TANK SEPARATION 6.80 FT. EFFECTIVE WIDTH = 12.5' WITH 1500 GALLON SEPTIC TANK IF FAILED, SEPTIC SYSTEM PROFILE DAMAGED, NOT H2O LOADING, OR UNDERSIZED. 4) INSTALL INLET & OUTLET TEES W/ BOTTOM OF TESTHOLE EL: 56.50 r SOIL ABSORPTION SYSTEM (SECTION) GAS BAFFLE AS REQUIRED (500 GALLON LEACH CHAMBER) GENERAL NOTES: DESIGN CRITERIA SOIL LOGS p : 14205 1• ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL NUMBER OF BEDROOMS: 3 BEDROOOM BOARD OF HEALTH AND THE DESIGN ENGINEER. 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS DATE: NOVEMBER 13, 2013 SOIL TEXTURAL CLASS: CLASS I (0.74 GPD/SF) OF THE STATE ENVIRONMENTAL CODE, TITLE V. AND ANY APPLICABLE DESIGN PERCOLATION RATE: <2 MIN/IN LOCAL RULES AND REGULATIONS. SOIL EVALUATOR: DARREN MEYER, R.S., CSE #1614 DAILY FLOW: 110 G.P.D. X 3 BR DESIGN FLOW: 330 G.P.D. 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR WITNESS: DONNA MIORANDI, BARNSTABLE B.O.H. = TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE GARBAGE GRINDER: NO (not designed for garbage grinder) DESIGN ENGINEER. 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING SEPTIC TANK: 330 gpd x 200% = 660 gpd, USE EXISTING 1,000 GAL. SEPTIC TANK FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN Elev. TP- 1 Depth Elev. TP-2 Depth ENGINEER BEFORE CONSTRUCTION CONTINUES. 68. 68.00 0" (330) = 445.94 S.F. i.� 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. 50 A 0„LOAMY SAND A LOAMYLEACHING AREA REQUIRED: 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF 67.83 10YR 3/2 8„ D SAND D 74 THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF 67.23 8"HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. E1 SANDY LOAM B SANDY LOAM USE TWO /l2) 500 GALLON PRECAST LEACH CHAMBERS W/ 4' 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. 65.83 10YR 6/6 32„ 10YR 6/6 65.33 32" STONE ON SIDES & 3.75 STONE ON SIDES: 25 L x 12.5 W x 2'D 8.ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED C C BOTTOM AREA: 25 x 12.5= 312.5 SF TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE MEDIUM SAND MEDIUM SAND SIDE AREA: (25 + 12.5) X 2 X 2 = 150 SF THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING 2.5Y 6/4 CONSTRUCTION. 2.5Y 6/4 TOTAL SQUARE FEET PROVIDED = 462 vs. 445.94 REQ'D 10. EXISTING LEACHING TO BE PUMPED, CRUSHED AND REMOVED PER TITLE 5. DESIGN FLOW PROVIDED: 0.74(462 S.F.) = 342.25 G.P.D. vs. 330 G.P.D. req'd REPLACE WITH CLEAN MEDIUM SAND PER TITLE 5 SPECIFICATIONS. 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION PROPOSED SEPTIC SYSTEM UPGRADE PLAN 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY 57.00 138" 56.50 138" AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY 484 CEDAR STREET, WEST BARNSTABLE, MA 13. NO ABUTTING PRIVATE WELLS WITHIN 150' OF PROPOSED LEACHING. 14. NO WETLANDS WITHIN 100' OF PROPOSED LEACHING. PERC RATE <2 MIN/IN. ("C2" HORIZON) Prepared for: Faszewski 15. ALL PIPING TO BE 4" SCH 40 0 1/8"/FT (UNLESS SPECIFIED) NO GROUNDWATER OBSERVED Engineering and Surveying by: SCALE DRAWN I, Darren M. Meyer, R.S.. CSE, hereby certify that I am currently approved by MADEP pursuant to 310 CMR 15.017 MEYER&SONS,INC. N.T.S. DMM to conduct soil evaluations and that the above analysis has been performed by me consistent with the PO BOX 981 requirements of 310 CMR 15.017. I further certify that 1 have passed the Soil Eval. Exam in October, 1999. EAST SANDWICH,MA 02537 DATE CHECKED SHEET N0. „_� 50s,362-2922 1 >t/.25/1._3 DMM 2 Of 2 - f-�'E. ?uR�6E. Ofi'f�i-6S �1..•�11 IS'� t`OG.K. 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