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Home My WebLink About0620 CEDAR STREET - Health 620 Cedar S1 � West Barnstable A= 109-044 I I No. g I_—3O" Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01ppliLation for Misposal *pstem Construction Permit Application for a Permit to Construct( ) Repair(me'Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.(,�O eada f S f O ne�r's N e A dress,and Assessor's Map/Parcel/O S/ i I staIler's N er Address,and Te.No. S'o�-�� `j399 Designer's Name,Address,and Tel.No. Sa �arl�o�p Cons c�c��r►c • , vat Ca-/, Cr�1n�6,� �1�4[�?ain a v Type of Building:4 Dwelling No.of Bedrooms Lot Size o�0� sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures t' Design Flow(min.required) �,` 3U gpd Design flow provided 3 7 C/ gpd Plan Date Ay o9U,ado— Number of sheets -� Revision Date Title -N,s Size of Septic Tank -IL1Li n� 000 Type of S.A.S. �7'raticr�E•SS.��-A RAQ 1 110 U4115 Description of Soil o aAin tcw Nature of Repairs or Alterations(Answer when applicable) o- e6 ° ' «in1 in SL Sk,r, Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental a and to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed A Date 11 ' Id Application Approved by Date �('— r f1� Application Disapproved by Date for the following reasons r Permit No. f Date Issued F I V No. Z, � 1 / .. .::... � Fee /� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 4 01ptlYication for ]Dt4osal-.pstem Construction permit Application for a Permit to Construct( ) Repair(ael Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.(Ao aac r }-. Owner's N e,Address,and Tel.No. 60S-349 -�p y6/ W, Qarns"ie ��S Sr�le5, GaU <Zr dar L. Assessor's Map/Parcel/p y .c,.{r< A o;;Le.69 Inlstaller's Name,Address,and Tel.No. ,S"OFS-01'7/- `}39p Designer's Name,Address,and Tel.No. .34ml (7or4c>Io1T� eohslrz�-k�or�,�nc • 440n al94 C,�pi.� ��v�r 934�-fain g'�`• ''�* S rr,r� i�i�. a•"F� i% U�Cn a iI a �aG,'7S t Type of Building: Li Dwelling No.of Bedrooms Lot Size y 7 �ga {-- sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) '3?,�.� gpd Design flow provided 3 1- , ' gpd Plan Date Nbur— Qe), a ej I-A-. Number of sheets Revision Date Title . Size of Septic Tank� tfC�;� f U[ Type of S.A.S. �S��rlaleSS. .�.sf��- l4 �laU 1 %fin Description of Soil 6ka r,•{6,�, 1 r a �•J Nature of Repairs or Alterations(Answer when applicable) `{ ,,, 14--(la A;l�-4-r-�rJ non �/�G .j/(0 d aU 14 .k �n. r� llfll(�r 111f11 �S t � 4 U7 .]dl 5hr,ngfoSS II�GC-1 ll0.fnPn. r 1 Date last inspected: ✓ Agreement: The undersigned agrees to ensure the construction and maintenance of the afore=described on-site sewage`disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place'the system in operation until a Certificate of Compliance has been issued by this Board of Health. ` Signed / Date //'/ b-G7 ��- Application Approved by (. Date Application Disapproved by Date for the following reasons Permit No. Date Issued ;? I --------------------------------------------------------------------------------------------------------------------------------------- TH F COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-siteSewage Disposal system Constructed( ) Repaired(.A/) Upgraded( ) Abandoned( )by N r4j, ; ( '� Stc a 'r r-v-% ,L n e- at 62o CF n , C14-, Wye has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. o7a" dated Installer �t .� .n��-R.�c��t c5 n Designer �irt e n ��F Cl o Inc_;n E•t'tc #bedrooms 3 Approved adegign- ow gpd The issuance of this permit shall nott�be c 2strue as a guarantee that the system will functro as e gned. Date `�- �3 �� Inspector\ I 1 ----------------------------------------------------------------------------------------------------------------------------------------- No. go � f— _. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal �ipstem Construction i3ermit Permission is hereby granted to Construct( ) Repair( Upgrade( ) Abandon( ) System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit.Z � - Date f d 1��-4 Approved by ( DEC-04-12012 10:34 From:BORTOLOTTI CONST 5084289399 To:15087906304 P.1/2 FROM down cape engineering ime FAX NO. :150E33629880 Dec. 04 2012 09:13AM P1 ��p_ �r x�y�tlilTp�lpk 51Z 1atiA/L'a,.�"�i1�b>i"P4ranttrl�e�ll l6tl�+;��.� sP r f7 ,P�IV'�C�111- � luwis:.rAA1.��; WAwe. i IU�J�Ii� ��flEhxll��]('Il �l'V lll�1�11<� `�,_.o� � 'i"Cnnt�nit!a II�C��:�ba, ty�ma.•a:9ua ' _ ;Lill N�niu,trwn4, I:�y�rdlark�i�, tbJar�ll. f7$ica�: yAR•Rc�3-+Ib�-# rax: S0�•�JO f�q�4 Y i n•—'J 0-mi mje '�:rrr• N1AIra ti�bam Itr Mae: ��- I Z, %.1pwsgc Pe-rmii1$1 26 -Ammuor"d Maaaol?+ red ►\t // ��taa��►r:f':, yJ�V�r+.rQ ,f/&41 9T4Ff8tGld`B'. J6111 '�f"� hdldlaa�a: 1<dlrr.sm: I 0. px� _ aAr✓ frt► / t / 19�` 1 . I!' J 6 M 00, 0 pt:MattO iLSA.t1 0 ��.--__ C.Plicn sy rtm fit 601U trQO �L ..,.,—... base-d nra a 0:slgu draw.o.'hy �n.diia•nsk) x Mtify tblit.the 5VO) sygm,)i re'fexL+r usi above V1 ms iril+died.'ubl ,truliolly a`QUUTL1i1L, to rl : demip, which T141y i.alclnde muTcar approved changas 91tc.l7. a�3 1ttLLrttl r(°,�Ac.ktinn of Thp. di tribirt'i.rm buu Ad/n'r tiPptin trim. I Certify That t.1i8 "'optic sy►srten re,Cmr:w(A -Ihove wkw installed witty zunj0.1- r,11090 s;i.c. ` I+,raLL r.t4R.Q. 10101001 re)acubm uftlsn SA..; nr:iny vuxti.cal ne uma liau of any(xm'p0rjcx1L 6i=the,ja ptiu tystcrra) but ut}a,CcrrrdEU1Ut; wins St,.re r.& UA lt•r.r1tht,�a�ris_ PIsL.Y0V1!-aua 017 _ mrti �Nk &4R, DANIELA. OJAI.A ( iilcr';a aalatura) CIVIL ' �No,413502 IRT rr 10NAL Y� f ax )c.d4vier"smym 0) . f�fc[ _ 111tEV:y1Jlii�rT4 ,► Jkg ,., AL'r�' C11V. ;, 'rTyF'7C�q'a' � AWE FPUL,A.l P r�'u-QU.pLL-(--ARD AUT seo o o� oar Town of Barnstable P o R'5 Department of Regulatory.Services • r ]Public Health.DivisionMAM Date Tin h1 0200 Main Street,Hyannis MA 02601 Date Scheduled Time Fee Pd. � II ►soil Suitability Assessment for Sew"' Sposal Performed By: —— — --_—. Vritrissed Bye w__J LOCA ION& GENERAL INFORMATION Location Address 6020 Ce- ,/ Owner's Name SD /ellb, Address /` Assessor's Map/Parcel: 0/�/y Enginaer's Name W G t TR NEW CONSTRUCTION REPAIR REPAIR Telephone X • Land Use: 0 5/ g /!� Slopes(96) `/� Surface Stones �,�I/U�i/1DliS Distances from: Open Water Body R Possible Wet Area`17�ft Drinking Water Wellft i a Dcaiirage Way eft Property Linn 7 ra ft Other ft. SKETCH:(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands•fn proximity to holes) r �G ram' C) . w • �97 Parent material(geologic) Depth to Bedrock Depth to Groundwater. Standing Water in Hole:- A 0 Weeping from Pit Fnce Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE II Method Used: Depth Observed standing in obs.hole: / "-�. In, Depth to soli mottles: Itt, Depth to weeping from side of obs.hole: In, Groundwater Adjustment $. Index Well// Reading Date: Index Well leval :_ _ Adj.factor Adj.Groundwater Level Observation PERCOLATION TEST Dote _ Thuo?z� Hole# Tima at 9" Depth of Pere _ Time At 6" Start Pre-soak Time @ /0,'�� Time(V-0) End Pro-soak Q b LAY Rate Min./luch � Site Suitability Assessment: Site Passed Sitp Failed: Addidonal Tcsting Ncedcd(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back---K--- *';'*If percolation test is to be conducted within 100' of wetland,you inust first notify the. Barnstable Conservation Division at least one(I)weep prior to begluDing. Q:'kS EPTICVERCFORM.D OC k DEEP-OBSERVATION HOLE LOG Hole# _ Depth from Soil Horizon Soil Texture .Sdil Color Soil• /- Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. • o i tc w.96'tiravell G L ,oyJLj ro C� ' a -�3 in / y,2gJ — DEEP OBSERVATION HOLE LOG Hole#_� Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. ansis en. %(]ravel) �•- ,q- S L /6 kZ/ y� SG /6 Y& yu -6o c S;L 16 60-1 2_ CZ c MSS /0 ye DEEP OBSERVATION HOLE LOG Hole#. Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. o i to r, ------------ t3 e ry. DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Co si ton y Flood Insurance hate Map: Above 500 year flood boundary No— -Yes .______ Within SOD'year boundary No Yes Within 100 year flood boundary No._ Yes Depth.of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout tho area proposed for the soil absorption system? If not,what is the depth of naturally occurring pervious material? Certification I certify that on (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the requited training,expertise and experience described in 110 CM R 15.017. Signature Datb Q:\SEPTIC\PERCF0RM.D0C i SECTIONSEOER: COMPLETE THIS SECTION COMPLETE THIS . . ■ Complete items 1,2,and 3.Also complete A. Signatu item 4 If Restricted Delivery is desired. X A M ■ Print your name and address on the reverse4' (7 wee A9 so that we can return the card to you. B. Reeo ed b Name) Date of elive ■ Attach this card to the back of the mailpiece, or on the front If space permits. l O / 1. Article Addressed to: D. Is delivery address diflkoft from Item 1? ❑ es If YES,enter delivery address below: 5-No Ms. Elizabeth Rodgers 620 Cedar street West Barnstable, MA 02668 3. Service Type certified Mail ❑Express Mail ❑Registered ❑Retum Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Exha Fee) ❑Yes 2. Article Number (Transfer from service laben 7 0 6 6 0 810 0 0 0 3 5 2 4 6 8 4 0 Ps Form 3811,February 2004 Domestic Return Receipt 102595.02M-11540 •..�. � ':.. d$`f'fit ; ,n " i '. 5 r.. CO • W lr1 K .�. t :s tt d,�A (;e 1 Af.. 'f 11 E ry I'13 �' t '� {a;,': Lei m Postage $ E3 0 Certified Fee E3Return Receipt Fee Postmark (Endorsement Required) Here C3 Restricted Delivery Fee r—i (Endorsement Required) C3 Total Postage&Fees $ 7 ..0 Ms. Elizabeth Rodgers 620 Cedar street West Barnstable, MA 02668 Town of Barnstable Barnstable /�THFTp � I Regulatory Services Department I�'�a�; ;DA MA.",S.. a � public Health Division MASS. �G t6gq. ♦� �f0 MAt a 200 Main Street, Hyannis MA 02601 2C107 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A. McKean,CHO CERTIFIED MAIL# 7006 0810 0000.3524 6840 October 15, 2012 Ms. Elizabeth Rodgers 620 Cedar Street West Barnstable, MA 02668 The septic system located at 620 Cedar Street, West Barnstable, MA was last inspected on 10/8/2012 by Wayne Archambeault, a certified septic inspector for the State of Massachusetts. The Health Division has determined that the system "Fails". 0 System is in hydraulic failure 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 TH OARD OF HEALTH omas McKean, R.S. CHO Agent of the Board of Health ! Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\620 Cedar St.,W.Barn..doc TOWN OF BARNSTABLE z �-- LOCATION {,�-Q C�� SEWAGE# VILLAGE 0..L JZ4. ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO.J�AL.� t I �i(iS�in SEPTIC TANK CAPACITY LEACHING FACILITY:(type) t , (size) -6--t tZ< t1i o (a NO.OF BEDROOMS s asFt L OWNER [� PERMIT DATE: i COMPLIANCE DATE:,A�-1 1_a Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Y—j 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 4wy Ctt/s s�"�w ,. ��` � t �j a: ,• G O s /'b $D ��G �� Cqn.►- vwkc rim Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments -% 620 Cedar Street_ Property Address --- -- Elizabeth Rodgers Owner Owner's Name — '— information is required for West Barnstable — MA 02668 every page. City/Town State Zi— -_ 10/8 o2012 — p 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. ImpoWhen filling A. General Information When filling out forms to the computer,use 1. Inspector: only the tab key to move your Wayne Archabeault _ cursor-do not -use the return Name of Inspector -- --- key. Company Name a6 _Box 914 Company Address — -- — Hyannis MA 02601 "IItl &i fTown 508-775-1362 --�--- State — Zip Code _ _ 355 _ 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 ElConditionally Passes ® Fails cm ❑ Needs Further Evaluation by the L Approving Authority t ' _ 10/8/2012 %lns`pector's t-nature —� ✓= Date ' — — The system inspector shall submit a copy of this inspection report to the Approving � of Health or DEP) within 30 days of completing this inspection. If the system is hared system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•11i10 I 1 Title 5 Official InsW. ,m ace Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form I,r Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 620 Cedar Street _ Property Address — Elizabeth Rodgers Owner Owner's Name — — ---- information is required for West Barnstable MA 02668 _ 10/8/2012 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 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): 15ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Fora is K! Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 620 Cedar Street Property Address ---. Elizabeth Rodgers Owner Owner's Name — -------- information is required for West Barnstable MA _ 02668 10/8/2012 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with 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•11110 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts 53, r Title 5 Official Inspection Form I=I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 620 Cedar Street Property Address — — Elizabeth Rodgers Owner Owner's Name - —. information is required for West Barnstable MA 02668 10/8/2012 every page. City/Town State Zip Code -- Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ® ❑ Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts �_ _ _ _ title 5 Official Inspection Form is- Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 620 Cedar Street Property Address _-- ---- — Elizabeth Rodgers Owner Owner's Name ---� ----- — information is required for West Barnstable MA— 02668 10/8/2012 every page. Cityfrown 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 CM 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 an question in Section Y y q ct on 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 CM 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form h' -1 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 620 Cedar Street Property Address -- Elizabeth Rodgers Owner Owner's Name _ information is required foc West Barnstable MA 02668 10/8/2012 every page. CltylTown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) El 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•11/to Title 5 Official Inspection Four:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts rp Title 5 Official ection Form Ins �)-- =, p 'm — Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 620 Cedar Street Property Address - — - Elizabeth Rodgers Owner Owner's Name information is required for West Barnstable MA 02668 10/8/2012 every page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? . ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): na — Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 10/8/2012 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•11110 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 620 Cedar Street Property Address _ Elizabeth Rodgers Owner Owner's Name information is required for West Barnstable MA 02668 10/8/2012 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: -- gallons How was quantity pumped determined? ---- Reason for pumping: _ Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts r� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 620 Cedar Street eet Property Address --- --- Elizabeth Rodgers Owner Owner's Name - information is required for West Barnstable MA 02668 10/8/2012 every page. Cityrrown State Yip Datenspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: installed 6/9/1976 permit# 16-76 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1.5' feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): — — — Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): Depth below grade: 2' feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene El other (explain) tank is structurally sound and tees and liquid at proper heights tank needs maintaince pumping soon If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 8.5,x5'x5, Sludge depth: 6 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 620 Cedar Street Property Address — Elizabeth Rodgers Owner Owner's Name information is required for West Barnstable _ MA 02668 10/8/2012 every page. City/Town State Zip Code Date of Inspection D. System Information (cost.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 31" Scum thickness 5" Distance from top of scum to top of outlet tee or baffle 4 Distance from bottom of scum to bottom of outlet tee or baffle 101, _ How were dimensions determined? measuring rod 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 structurally sound tees and liquid at proper levels tank needs maitainance pumping soon Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene El 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•11/1 o Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts �� Title 5 Official Inspection Form f 11 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments a=v 620 Cedar Street Property Address ^--� — Elizabeth Rodgers Owner — — — information is Owner's Name required for West Barnstable __ MA 02668 10/8/2012 every page. CityFrown 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.): I Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No . f ;Sins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 {I I Commonwealth of Massachusetts Title 5 Official Inspection Form Im 1i Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 620 Cedar Street Property Address - — Elizabeth Rodgers Owner Owner's Name information is required for West Barnstable MA 02668 10/8/2012 every page. CitylTown 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 none 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.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 i Commonwealth of Massachusetts wa Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 620 Cedar Street Property Address -- ------- Elizabeth Rodgers _ Owner Owner's Name information is required for West Barnstable MA 02668 10/8/2012 _ every page. CitylTown _ State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: leaching trenches number, length: — ❑ leaching fields number, dimensions.- El 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.): liqud in leaching pit less than 6" from invert pipe pit in hydraulic failure Cesspools (cesspool must be pumped as part of inspection) (locate on site plan).- Number and configuration Depth —top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool J Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 5 620 Cedar Street Property Address Elizabeth Rodgers Owner Owner's Name — — --- — information is required for West Barnstable MA 0_2668 10/8/2012 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: — Dimensions Depth of solids Comments (note condition of soil; signs of hydraulic failure, level of ponding, condition of vegetation, etc.). t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 620 Cedar Street Property Address -- --- -- Elizabeth Rodgers Owner Owner's Name — — information is required for West Barnstable _ MA 02668 10/8/2012 every 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 } t5ins•11/10 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 15 of 17 I Assessing As-Built Cards - 10/8/12 10:22 AM LOC&T1Oty SEWU ::�E PERMIT UO_ 'VILLAGE tV_9_L f__B_jih'_STA'5 INSTALLERS QiWE e 'aDDREsS —1 Z�- rem( — — — — = GUILDER 5 Q&MF- ADDRESS DATE PER" T ISSUED DATE COMPL1 W ACE ISSUED : 6- 9-7G J �a c N ji i http://www.town.barnstable.ma.us/Assessing/HMdisplay.asp?mappar=109044&seq=1 Page 1 of 2 3 t Commonwealth of Massachusetts Title 5 Official Inspection Form � — Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 620 Cedar Street Property Address — Elizabeth Rodgers Owner information is Owner's Name required for West Barnstable MA 02668 _ 10/8/2012 every page. Cityfrown 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: 30' 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: GIS maps on line ❑ Checked with local excavators, installers - (attach documentation) . ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: ground water at 30' bottom of leaching pit at 9' seperation 21' Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 I Commonwealth of Massachusetts Y : Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments a 620 Cedar Street Property Address — Elizabeth Rodgers Owner Owner's Name - --�------ - information is required for _West Barnstable MA '02668 10/8/2012 every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 t LOCL,TIOt�I ' SEW&C,E PERMIT MO. VILLAGE INSTALLER S ► && AE ADDRESS -10 Vw A- E, / - W - Ou - bUILDER 5 Q &MF- ADDRESS — _ e � ` -20 — — — - - - - DNTE PERWT ISSUED DATE COMPL1 &KiCE ISSUED : IV J /000 PIP fd,, r I C. F c.f 0.�.. ... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH k C�. � ` ... . Town.........o F ...Barnstable.:.. .......................... I A��liratinn fur Di,npnnttl nrkfi Ton trnrtion Vanift Application is hereby made: for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal System at: Cedar St.-Weser stable Lot 33 — "TRAILUIEW" .._._�_._�_. -•------------------------------ ••----••-------- ............................................................................... Location.Address or Lot No. SEA—LAKE CORPORATION........................ --.--BUX_.264:,,..Sand ri ch,_..Mass..__Il2a63-----------••------- Owne. Address W Norman Ayotte = Main_-St._,._.San ,ii s.:__42.5� . p Installer Address 44 892 d Type of Building Size Lot......... ..................Sq. feet Dwelling-K No. of Bedrooms.........wee...:.......... ... ._.Expansion' Attic ( ) Garbage Grinder 0.) Other—Type of Building .-_....................... No. of cl son---.-_._.-..._------------------------------ Showers Cafeteria A' Other lixt res __. . wDesign Flow............ .. ................... gallons per person per day. Total daily. flow .....__ .-------- ---_.-. ........ .gallon,. � Septic i-::nkI—Liquid capacit�-..._-____gallons Length_____ __________ Width...... .... . . Diameter ..---_ Depth................ Disposal Trench No. .................... NVidth---------- . Total Length Total leachtng area...::.- sq. it. See a e Pit No...... .............. Diameter__,___...._p g l �.___ Depth below inlet......... ........ Total leaching area. sal. tl z Other Distribution box ( ) Dosing ( ) � A�'a n W Jones 12 18 75 Percolation Test Results Performed by------- - ----------.------- -----.................................... bate-................................. 'rest Pit No. l________________minutes per inch Depth of Test Pit.................... Depth to ground water....... . w Test Pit No. 2................m.inutes per inch Depth of Test Pit........................ Depth to ground water........................ ee at;ndhtc _'-&colat on test report Descriptionof Soil.......................................................I----•--••------•-•--•-- ................................. -:..................................... x W ---•-- --- --- -- -- -------...............................................................----- ---•- . .................... UN;lturc of Repairs or Alterations—Answer when applicable........ .. . ...:.:. .. ..__. ......: . .. . ---- --•---•.............................••----------------------------•------•---------.._.._.._.......--•---•---------•---.._....-------•------•-------.....-•--•------=-------•---•..-•--.. Agreement: e The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article \I of the State Sanitary Code— The undersigned fur agrees not to place the 'system in operation until a Certificate of Compliance has been issued - e a d of a Signed....... -----13 76 •.. . .•. ....... .. ...... .. ---- Pate Date Application Approved By ............... L %. ................. ---------- ------_--------------------------- Date. ••-- Application Disapproved for tit following reasons:.................... -- :' ._......--•--••.................••----•--..-_.._...---..................--_.. •-----• •----...... ...._..._..__.......----- ._._..... Date PermitNo..---�61............................................. Issued........................................................ Date No....... .................. f ,. l...._....Y..: �.'. THE COMMONWEALTH OF MASSACHUSETTS .' ' BOARD OF HEALTH ` TOwn ..... OF.....Barnstab�.e.....'..._... ..:. . t • . pphruiti n "far 11�V.aatt.l Motk!i ToWitrurfion VPrni - I t 4 - ; Application is,hereby made for a Perm�i to Construct (X) or Repair ( ) an Individual 'Sewage Disposal System at: ; Cedar "It.—West Barnstable ,ot 33 - "TRAILUIEW" , !: ....................................1--__.-___-__-__ ...... .............................. ------- .._____.___----------------------------------- „• Location-Address ' or Lot No. . . .....SM-.IAhE.-COPPORATION...---- •. ..................... ."..._.. ''M..264.,...Sand i-ch,...Mass.._.025.63--- ------------- Owner Address - T Erman A otte.........' 1,lain-.St._,....5-.arxdw , ?., .1`? Ss.._.Q2.56 .. -- Installer ,Address c Tvl of Pudding Size Lot...44�892 -Sq. feet :f DwelliT.g—). on. of B'edrooms.........three._...:- _----_-.._.Expansion Attic ( ) Garbage Grinder ( ),� Other--Type of Btu Ing ,........................ No. of person .... Shov,ers (• 1 — Cafeteria ( 7/• Other fixtures ..................... Design Flow...................�7—d---_-_-.•------gal1r, is-per person per dal-. Tota idaily how..........-__&!0!7'y..........------gallon>. a ------ \Vidth - ------..._. .1)iamcte.. . ........ Depth.... - .,... Sclrtic -1"::;71:— l�ic.niti ca1 lacitv...../ lloi s" Length..._...._ _ Disposal Trench— No. .................... \1-idth..........._.._---._�Dial Lel *th.... -. .----..._.. Total ltaching area..............-..-..stl. ft Sce)a-e Pit No•..... I t . i I /-.---.- Diameter Ifr�'fTi below inlet ------------- Total ,eac,ung <tree.....-.......--.-.sn. ' Other Distribution box ( ) Dossing ( ) - 12-18-75 an W. Jones a - Percolation Tea Results Pcrf, rmed by..... ........... ..•------ . Date •----•-• - -•-- ..... Test l'it No. I................ruinutes per inc'n Depth of Test ['It..'_................ Depth to ground waif'__....... ... Test Pit No. '................minutes per inch Depth of "Test Pit.................... Depth to ground water........... ........... --------- > See attacYied percolation test._report----------------------------------------- ..._------" ' Dcsc-ij• I of Soil ..:...... ..............................................................................................................................................----•------ . --........ ----•-------. . •----- ..._....--- . -- ---- -•-- I H ----------- ....................... .............................................._......................._.........._............ -.. j `• ^daftlrc t:f Repairs or Alf, rations—Answer when applicable......._ .... ............ --- ---------- ---------- -------- -•-------•---•-----------------------------------•-------- ----------- --.......-- ------------ ----------.....`--- ---------- .. ............... Agreement:. The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the prb•:isions of i'.rticle \I of the State Sanitary Code — The undersigned fur agrees not to place the system in ' operation until a ('ertific,,te of Compliance has been issued t �af Signed....... ... . . . .. . `_4._......_._....-...._.. 1-13--76 f . ... ...... D tc Application Approved B%............. ... . --------------- ---------...--... 4 ::lpplicariOn Disapproved for the lowing reason ..................................... .......:.........---------- •---------------• .................................... -----•-••----- --•---------•---...-----------•. ---- ................. v D.te PermitNo-------:../6_..._..._.I.......................... ..... Issued.............. •-•--- ---...-----...----- .......... Date eTH. .WEA WEALTH SAS a " r` s. t; •.� iE t_ .' :� r.'-t�• •xa,; �-..,-• -!- :f- a:� E'COMMON ALT OF MAS CHUSETT5� p BOARD OF- HEALTH ` ......OF_. �i(��tt19�s�c!....... irrrtifir�tr' of C imp li�nrle a ' TKIS IS TO CERTIFI , That tht: Individual Sewage isposal System constructed ( or Repaired ( ) by.................................. ---•- ---- - ----- --------------•------------•---------•-•-•---------- -------------------------------- •�.�/[ ✓� / T�. installer t ......................... .. ....... -• - --- ------- -- -------. -..------ - ----- - •- i a, hero installt�Qt zC'corc with ti r vi. ons of Artide o ie Sta e Samta v Code -as described in the application for Disposal Works Constri -tion Permit No.....:..... .. ...... -- -- --- ----- ----- dated. �� rr,am�......... THE ISSUANCE OF THIS CER••'FICATE SHALL NO ' &CONSTRUED A5 A GUAi46EE''TQsl�fi14' 7L SYSTEM WILL FUNCTION SATISFACTOf Y. , i. ,.l'AT -- ------•-- ------.--- Inspector.. : ------ ••---•--•-•- ........ THE COMMONWEALTH OF MASSACHUSETTS 4:, a t BOARD OF HEALTH ,' V, • • • .. .. ......... .... ... .. i.. y r 1 FEE .._ ` irpa-5i Vork.5 AnaiW r4rfivu Vrtmif f ' Pert fission is ht•rebv granted......... % - --:..... .:....... ..... ............... ,i. -0,4-Av*,k-----"-- - y�-�l,Yrrr r" t 7 Coast .uct ( ) or Repair ( ) an individual Sew: re Disp ;al System t - -.--:_3. -•-•- ..s show" 1.1n the application for Disposal \Yorks Constru tion P [lilt No..' , Dated... .------ --- ._................ ••----_--------- -------- • � � � '' nar'd El�alth "--- DATF ........ ,2 .......7. 1 FORM '.'-'S3 HOrJ F..S & WARREN. INC.. PUBL IHER.3"":F. %� -R;rtiaY, � -. r tt t `,. " *a1 r� . .9•� '� � "( t - I <.r*,,._-;:a•14pol',Mrr .,r. :. ;,,,il(+rt t°"f",1":`G,• .r,s,..,,,.w d'H"yj!.x 'cs"i..'" i. .f: ... �.{y,» "d:;:..r"1+. x ,Fy r;!""tfi 4 '�'ia _r _.:f .I i-} i_��.. 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L..' _..tl../C_4 /SE7�- ,5,�•34.�I'7-'.,S" �" ./ { h�.d . 17 :'f 7� er � f,` 'ter- _,.a•+-'- _.:k .�_.:-'- --' .�.".-i.__�._'_-L- I �-'1`'•--- - - - -t--S--�'"a- -('-- 1 '�--i''G -; - - ._ r_s 1, j 1.._ -.5- _i+., t -• -;;t t• 'W� j ,' J. , , r s. ,,� 1 ,,.: ,, , i _-_ t .a ..,,_ ,._, 11 -_..t-;- ?� t r._. �-�-1 ��. ; _� :i: - :r I r♦-1 1 t _F - ._r I t l� I . 1 . , '' ,q ..� 1 , y •I � y I � _�..1_4 k - }--1 ._ I '1 � } '--'I ! ?_ ..__ _ _.-f_. �'.-4..r ._, I t� _ .� r � -,1'1 f�._.7.. fi q;�'k"',. ��'. i t , ' t , I ! ! i .t j k_..a i d t 1 }' y , ._J •_k ' P L_�- � �-.. �- .,...., y---- ..�J �.._ 1_. ��. __ t. I _._____.-1 ,..-_1 ..! I I i d. t , ��' �J,,,d'd, .'+i'yi s.�-)....�s �•,�' a ALAN W. JONES & ASSOCIATES CONSULTING ENGINEERS CARLETON DRIVE EAST SANDWICH, MASS. 02537 TELEPHONE 888-3154 TEST PIT AND PERCOLATION TEST 18 December 1975. To: Sea-Lake Corp. Personnel Present: Paul Murray Route 6A & Tupper Rd. Norman Ayotte Sandwich, Mass. Alan W. Jones, Re: Lot #33 Lot Size: 44,892 s.f. Cedar St. W. Barnstable, Mass. 010" Ground surface Topsoil and sub-soil 2' 6„ Stoney marl and fines, sand Average Percolation Rate : 1" drop in less than 2 min. Varying layers of firm, fine to medium, yellow sand OF P; N \ 12' 0" L i, -Alp No water encountered ES ! N iiGO f _U ,b. `csSIONAt-4�yV V�re� Water levels indicated, if any, .are those observed when test pit was excavated and do not necessarily represent permanent ground water levels. .. . .. . . . . . : SYSTEM P R O FILE ALL SYSTEM COMPONENTS SHALL BE MARKED WITH MAGNETIC TAPE OR PROVIDE MIN. 20" DIAM. WATERPROOF (NOT TO SCALE) COMPARABLE MEANS FOR FUTURE LOCATION. NOTES ACCESS COVERS TO WITHIN 6" OF FIN. GRADE PROVIDE INSPECTION PORTS TO o° WITHIN 3" OF FINISH GRADE 1. DATUM IS APPROX. NGVD f sy \ TOP FOUND. EL. 124.0• 1 2. MUNICIPAL WATER IS NOT AVAILABLE 2% SLOPE REQUIRED OVER SYSTEM 108' - 109.4'MINIMUM .75' OF COVER OVER PRECASTZ rr 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. PRECAST H-10 PROP. TEE RISERS (TYP.) 4. DESIGN LOADING FOR ALL PROPOSED PRECAST 71 2'0 UNITS TO BE AASHO H-].Q ��s 55° a0 t: 4"OSCH40 PVC 0�° c o Leo a 103.4' 5. PIPE JOINTS TO BE MADE WATERTIGHT. z�e� r eQ 10" EXISTING 14" 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE e Locus TEE (R��NEPTIC j TANK TEE 1 2f'* o o'o'o WITH 310 CMR 15.000 TITLE 5. ss o 0 0 0 0 0 6" MIN. SUMP ( ) GAS BAFFLE VERY APPROX. �00000000000 12" MIN. INT. DIM. 103.0 6 o j �. (V.I.F.) 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND 103.18' 103.01 ' 0.92' NOT TO BE USED FOR LOT LINE STAKING OR ANY Meet 102.08 OTHER PURPOSE. Maple S PROP. H-20 D'BOX ( IM H-ON HIGH CAPACITY INFILTRATORS 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. 6" CRUSHED STONE OR MECHANICAL OVERALL DIMENSIONS TO OUTSIDE OF UNITS: 37.5' X 8.5' • ES 9. COMPONENTS NOT TO BE BACKFlLLED OR (NO STONE PROPOSE.,COMPACTION. (15.221 [2]) ) CONCEALED WITHOUT INSPECTION BY BOARD OF ' 5.1 HEALTH AND PERMISSION OBTAINED FROM BOARD +s OF HEALTH. LOCUS MAP (15fy, SLOPE) ( 1 % SLOPE) 10. CONTRACTOR SHALL BE RESPONSIBLE FOR FOUNDATION EXIST SEPTIC TANK 57' D' BOX 3' LEACHING CALLING DIGSAFE (1-888-344-7233) AND NOT TO SCALE -FACILITY VERIFYING THE LOCATION OF ALL UNDERGROUND & * **INSTALLER SHALL CONFIRM MINIMUM SEPTIC TANK SIZE AT BOTTOM TH 1 EL. 97.0' OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL WORK. ASSESSORS MAP 109 PARCEL 44 UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS 1000 GALLONS AND ITS SUITABILITY FOR RE-USE. REPLACE PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM WITH 1500 GALLON SEPTIC TANK APPROPRIATE TO SITE 11. ANY UNSUITABLE MATERIAL ENCOUNTERED CONDITIONS IF NOT SUITABLE SHALL BE REMOVED 5' BENEATH AND AROUND THE PROPOSED LEACHING FACILITY. 12. EXISTING LEACHING FACILITY SHALL BE PUMPED VARIANCES FOR SEPTIC SYSTEM REPAIRS WHICH MAY BE I AND REMOVED OR PUMPED AND FILLED WITH CLEAN SAND. IMMEDIATELY GRANTED BY THE BOARD OF HEALTH AGENT OR BY HEALTH INSPECTOR - 38 13. NO KNOWN POTABLE WELLS WITHIN 150' PAPERWORK AND HEARING REDUCTION PROPOSALS APPROVED 127.88 I BENCH MARK - SLAB AT WALKOUT OF PROPOSED SAS SYSTEM DESIGN: BY THE BOARD OF HEALTH REVISED DURING A PUBLIC I I EXIST. WELLS SLIDER. ELEVATION = 116.5 HEARING HELD ON AUG. 4, 2009 150' GARBAGE DISPOSER IS NOT ALLOWED 3) FAILED SYSTEMS ONLY : SOIL ABSORPTION SYSTEM I ! INSTALLATIONS PROPOSED MORE THAN THREE FEET BELOW I DESIGN FLOW: 3 BEDROOMS 0110 GPD = 330 GPD GRADE WITH PROPER VENTING (PIPED TO THE ATMOSPHERE) I 1 USE A 330 GPD DESIGN FLOW AND WITH H-20 LOADING, BUT IN NO CASE SHALL THE SAS BE LOCATED MORE THAN SIX FEET BELOW GRADE. I x 114.3 / SEPTIC TANK: 330 GPD (2) = 660 I i 11 a x / 375.62' RE-USE EXISTING SEPTIC TANK** aI - 7 7 ,\ \ l I LEACHING: �, HIGH CAP .56 SF PER 1 15.0 CAPACITY INFILTRATOR UNIT I , 129 49 ! �0 'o� 105.99 330' GPD/0.74 GPD/SF = 445.9 SF LEACHING TEST HOLE LOGS READ - 116�' \\ LP I 445.9 SF/29.56 SF/UNIT = 15.1 UNITS ARNE H. OJALA PE, SE y I /� �--x 1 x 1].33 I THEREFORE USE GRAVELLESS SYSTEM OF 16 ENGINEER: I Ex T. sr=* \•\ ( ) D. DESMARAIS, RS I 116.52 x 2.45 1 H-20 HIGHS CAPACITY UNITS IN FIELD WITNESS: I X 123 5 16 011 . 4 I j 12.2 ` CONFIGURATION SHOWN 11/16/12 6 DATE: a PERC. RATE _ < 2 MIN/INCH I j EXIST. DWELL.TOP FNDN. _ � 119 ! 16 UNITS x 29.5 SF = 472 SF > 445.9 SF I J 124.31 - 120 - 0 0 I 472 SF (0.74) = 349 GPD (OK) EL. 124.0 _ 121 121 o- ' CLASS I SOILS P# 13785 i /G - 122 x 12 .47 9 1 o ` ax 100.65 GI 25.51 x 133.15 1 0 7 9 x 1 1 .1 ELEV. ELEV. 108.0' 108.0' 1130.63 � 64 DECK a� I 1 MA 0 0 I rn QG \ APPROVED DATE BOARD OF HEALTH A A I o 2 2 /SL SI- EXIST. WELL x 121. 9 x 119 74 / I 23.60 1 48 I 10YR 2/1 10YR 2/1 I ( 83 I TITLE 5 SITE PLAN 6" 6" *123 48 OF B B I � N i PROP. VENT WITH CHARCOAL FILTER / / I 50 I I I I I AND BUGSCREEN (FINAL PLACEMENT BY /SL SL I PAVED DRIVE 119.32 CONTRACTOR WITH HOMEOWNER 620 CEDAR STREET CONSULTATION) „ 10YR 6/4 10YR /4 I 0.38 T T� 1` .123.14 i 105.0 .40 105.0 WEST BARNSTABLE 36 y71 4. 2 . 9 T T T �1130.64 T2 T .2222.93�C 1 /C 1 1 9.64 *-r 90 PREPARED FOR OAM Si LOAM I 30. �129.49 BORTOLOTTI CONSTRUCTION/ Si L „ 1OYR 5/4 103.0' 60++ 10YR 5/4 103.0' 130.14 44,892f S.F. 3g� 20 SOLES LOT 33 60 I / LOCATION OF EXISTING SEPTIC SYSTEM NOVEMBER 20, 2012 C2 C2 I APPROXIMATE ONLY (AS-BUILT UNCLEAR) PERC I I off 508-362-4541 CMS CMS a �� ` ` +� I fax 508-362-9880 downca e.com 10YR 8 1 10YR 8 1 I �'� 5'-' �; }� � ��r-� ��.�t�7� 132 / / x ` LA ,fJ�. down cape eng/neering, /nc. 97.0 132 97.0 1128.45 o� ' �I _� Ivl �� civil engineers Scale: 1"= 20' �� s Ion surveyors NO GROUNDWATER ENCOUNTERED 939 Main Street ( Rte 6A) 12-277 0 10 20 30 40 50 FEET DATE DANIEL A OJALA, , YARMOUTHPORT MA 02675