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0196 CHURCH STREET - Health
196 CHURCH ST. 1 ' WEST BARNSTABLE } A = 153 006 i 41 I No. 4210 1/3 BLU ESSELTE 10% p 0 O N OF 'EARN, �r a�•� ,dorm { iBT �NIB�c �B NrO. NO:oF�sSDROOMs . CIR WNSR AN `S�par�dmu 1Ra'$etVl��xxi, > ilgnu�audtt�fwp�r'Ct��aysBpotnpfLehtn� aciiity ,�.. Prlva9�1�'p�r Sir Wssl1'�wd �� .cif sny�ls Ica�p w1 �R�c of ttuo�fhyl : �d�a c��� Leacb�� itY t� wetlantl�ei[iat ��:lc.G Q vg.tiaC a U(03 ,\ t �{3 TOWN OF BARNSTABLE LOCATION / C76 (� 4 U vC4 Sr SEWAGE # VIL-LAGE tou 6A N N S ASSESSOR'S MAP Cz LOT INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) �°�o O L (size) 6 X NO. OF BEDROOMS —3 PRIVATE WELL OR PUBLIC WATER t,�YCL BUILDER OR OWNER -PAU( DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No `�v(2vtsjJTD qq - vim rr-v2 pa-a-w y� �'� ii e 57 � 3�. , �5 � vus � Commonwealth of Massachusetts f Tile 5 official_ Inspection Fdrnf ? m Subsurface Sewage Disposal System Form -Not for Voluntary,Assessments s 196 Church St Property Address Jane Ferguson , Owner Owner's Name information is required for every W. Barnstable MA 02668 2-24721,- 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. Inspector Information 61* 1S , Shawn Mcelroy Name of Inspector Upper Cape Septic Services ' Company Name " P.O. Box 73 , Company Address East Falmouth MA + < 02536 City/Town State Zip Code 508-495-0905 S13971 Telephone Number License Number B. Certification I certify that:l am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR I6.000);I have personally inspected the sewage disposal system at theproperty address listed above;the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience)n the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: '1.' ®Passes ° 2. ❑. Conditionally Passes , I ❑ Needs:Further Evaluation by the Local Approving Authority , 4. ❑ Fails 2-24-21 in ector'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 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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: 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. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 i ' , Commonwealth of Massachusetts ►' � 3a tp Title 5 Official, Inspection Form M Subsurface Sewage Disposal System Form -Not for Voluntary Assessments � u Ivy s fl 196 Church St Property Address Jane Ferguson Owner Owner's Name - information is W. Barnstable / MA 02668 2-24-21 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary , Inspection Summary: Complete 1, 2,3, or 5 and all of4 and 1) System Passes: k '' ' •' ® 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. Anylfailure criteria not evaluated are indicated below. Comments: System is in good working order with no sign of failure. J, }} 9 2) 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 a re_ placement;or repair, as approved by the Board of Health,will pass. i 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): d r r 4 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts eta Title 5 Official Inspection' Foft _ r _ 'gyp �nl Subsurface Sewage Disposal System Form Not for Voluntary Assessments 196 Church St Property Address Jane Ferguson Owner Owner's Name information is W Barnstable MA 02668 2-24-21 required for every page. Cityrrown . State Zip Code Date of Inspection C. Inspection Summary (cont.) r 2) System Conditionally Passes (cont.): . ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ 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 r 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): t , ❑ 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 ON ❑ ND (Explain below): ❑ obstruction is removed ❑Y ON ❑ ND (Explain below): 3) 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 io protect public health, safety or the environment. s '' a. System will pass unless Board of Health determines in accordance with 310 CMR 16.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.W26/2018 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 18 Commonwealth of Massachusetts f `• 3r Title 5 Official Inspection Form + psi Subsurface Sewage'Dis Disposal System Form=Not for Assessments p Y �+ ^ 196 Church St Property Address Jane Ferguson Owner Owner's Name information is W Barnstable MA 02668 2-24=21 , required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. 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. c. Other: • L ' 4) System Failure Criteria Applicable to All'Systems:' g ' ° 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 t5insp.doc•rev.7/26/2018° Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts :► _ � ; ;, Title 5 Official Inspection Form p Subsurface Sewage.Disposal System Form -Not for Voluntary Assessments . 196 Church St ° Property Address Jane Ferguson r.t Owner Owner's Name information is required for every W. Barnstable MA 02668 2-24-21 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No 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 '/2'day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: �r ❑ ® -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 water supply ❑ ® , well. r. ' ❑ ® 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 2000 gpd- ` 10,000 gpd. 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. .; 5) 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. r , For large systems, you must indicate either"yes" or'°no"to each of the following, in addition to the questions in Section CA. 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 t5insp.doc•rev.7/2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 18 6e`,, Commonwealth of Massachusetts ,'. Title 5 Official Inspection fofti PSI Subsurface Sewage'Disposal System Form -Not for Voluntary Assessments 196 Church St Property Address Jane Ferguson f Owner Owner's Name information is W Barnstable L + s� MA 02668 2-24-21 - required for every page. City/Town State Zip Code Date of Inspection C. Inspection summary (cont.) If you have answered"yes"to any question in"Section C.5 the system is'considered'a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner «' *sh`ould contact the'appropriate regional office of the Department. '. 1 6. You must indicate"yes"or"no"for each of thefollovving for all inspections: r Yes No ns r J ., , ❑ 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? y "N ® ❑ 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) 1® ❑ Was the facility or dweiling inspected for signs of sewage back up? ®� ❑ r' Was the'site inspected fo"r signs of break out? ®"' 1 ❑ I'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? ' It Wasthe facility owner(and occupants if different from owner) provided with Z El 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 exampie,•a plan at the Board of Health. {. ®• ,',r ❑; 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)] 1=4', t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 f Commonwealth of Massachusetts , Title 5 Official Inspection Form �I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments , 196 Church St Property address Jane Ferguson Owner Owner's Name information is required for every W. Barnstable MA 02668 2-24-21„ page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms(actual): 4 DESIGN flowbased on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Description: Number of current residents: , 1 Does residence have a garbage grinder? r • ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection El 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 water 9 ( Y 9 (gl�))� Detail: Sump pump? t ❑ Yes ® No r Last date of occupancy: a 2-2021 Date t5insp.doc-rev.7/2612018 . Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 Commonwealth of Massachusetts ' pit. Title 5 Official Inspection Form' o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 196 Church St Property Address Jane Ferguson } Owner Owner's Name information is W. Barnstable - MA 02668 2'24-21 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type"of Establishment: ' Design flow(based on 310 CMR 15.203): f " Gallons per day(gpd) t Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: i Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes El No Water meter readings, if available: r ' Last date of occupancy/use: ` pate Other(describe below): 3. Pumping Records: Source of information: Owner----pumped 5-6yrs ago Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Maintenance t5insp.doc•rev.'7/28/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 Commonwealth of Massachusetts usetts Title 5 Official Inspection Form MI Subsurface Sewage Disposal System,Form-Not for.Voluntary Assessments . 196 Church St Property Address Jane Ferguson Owner Owner's Name information is required for every W. Barnstable MA 02668 2-24-21 ' page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. 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): Approximate age of all components, date installed (if known) and source of information: 2009 Were sewage odors detected when arriving at the site? ;. ❑ Yes ® No 5. Building Sewer(locate on site plan): , ., Depth below g 18"rade: feet Material of cofistruction: ® cast iron ® 40 PVC -❑ ot66r(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Good condition. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection .-Eio n Q Subsurface Sewage Disposal System Form --Not for Voluntary Assessments'• 196 Church St Property Address Jane Ferguson Owner Owner's Name information is , required for every W. Barnstable MA 02668 2-24=21 page. City/Town = State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: feet Material of construction: - ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal; list age: t, '` '. ' ' '`` ' years Is age confirmed by a Certificate of Compliance? (attach`a'copy of certificate) ❑ Yes ❑ No Dimensions: �.;. ,-; 1000 gal - Sludge depth: 12" .20" •Distance from top of sludge to bottom of outlet tee or'baffle . Scum thickness 211 w Distance from top of scum'to top of outlet tee or baffle ' 6n , - Distance from bottom of scum to bottom of outlet tee or baffle '15" ' 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 of leakage.. t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts _ , , ;. f Title 5 Official Inspection Foltm. ICI Subsurface Sewage:Disposal System Form -Not for Voluntary Assessments r'+ 196 Church St Property Address Jane Ferguson - Owner Owner's Name information is required for every W. Barnstable MA 02668 2-24-21 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): FA Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle_condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. 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 t5insp.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 s~ Commonwealth of Massachusetts r r . � ot13 Title 5 Official Inspection Forte i w: r.l Subsurface Sewage Disposal System Form -Not for-:Voluntary Assessments 196 Church St Property Address Jane Ferguson Owner Owner's Name information is r r required for every W. Barnstable '- MA 02668 2-24-21 page. City/Town -• State Zip Code Date of Inspection D. System Information (cont.) ' 8. Tight or Holding Tank (cont.) f r Alarm present; ❑ Yes "❑ No ' Alarm level: Alarm in working order: ' ` ❑ Yes ❑ No Date of last pumping: 4 'f' - Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract (required). Is copy attached? '❑ Yes ❑ No 9. 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 no sign of back-up from field. r ti r r t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts .� Title 5 Official Inspection Form , M Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 196 Church St _ Property Address Jane Ferguson - Owner Owner's Name information is required for every W. Barnstable MA 02668 2-24-21 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) , 10. Pump Chamber(locate on site plan): Pumps in working order: ' ❑ Yes ❑ No* r ' 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. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required):. If SAS not located, explain why: t Type: ❑ leaching pits ' - number: ® leaching chambers number: ARCchambers10x41x2 Elleaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts - ,'a Title 5 Official. l nOection Form �> :%i Subsurface Sewage Disposal System Form -Not-for Voluntary Assessments 1 t 196 Church St Property Address P Y Jane Ferguson r ' Owner Owner's Name ; information is required for every W. Barnstable - MA 02668 2-24-21 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) I ' Comments (note condition of soil, signs of hydraulic failure, level of ponding,,damp soil, condition of vegetation, etc.): Leach field in good working order with no sign of back-up into d-box or surrounding stone. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration `' r Depth=top of liquid`to inlet invert Depth of solids layer layer 'Depth of scum la p Y Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure,,level of ponding, condition of vegetation, etc.): r ./ r. .. t5insp.doc-rev.7/26/2018' Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts p Title 5 Official Inspection Form cI Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 196 Church St Property Address Jane Ferguson Owner Owner's Name information is required for every W. Barnstable MA 02668 2-24-21 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. 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.): t5insp.doc-rev.7/26/2018. Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 - 4e`" Commonwealth of Massachusetts ` ,w. Title 5 Official Inspecti®n Form ,i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments + x 196 Church St Property Address Jane Ferguson t Owner Owner's Name information is required for every W Barnstable _ MA 02668 2-24-21' page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. 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 6 � � �6 r C- � `?fi r t5insp.doc-rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Forums, ' r�l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 196 Church St Property Address Jane Ferguson Owner Owner's Name information is W. Barnstable i ., MA 02668 2=24-21 required for every ' page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope r ; ❑ 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 Li 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: Original design plans show no groundwater at 12'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18 - .:� Commonwealth of Massachusetts (,P Title 5 Official Inspecti®n Form :r�1 Subsurface Sewage Disposal System Form -Not•for Vol untary'Assessments•, 196 Church St r' Property Address " Jane Ferguson' Owner Owner's Name information is -.•t required for every W. Barnstable MA 02668 2-24--21 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ' ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6 (Checklist) completed ` ® D System Information For 8: Tight/Holding Tank=Pumping contract attached For 14: Sketch of Sewage Disposal•System drawn on pg. 16 or attached ' For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 \ NEW WELL. ` \ OLD WELLHSE X _ ,C {. EMSTING POOL 54 :X k I ec k 10009 SUv,rooti., x GAS i METER oas nNG j EXISTING GARAGE DWEL UNG r TOP FtRlNDA n0N ELEV. - 51.4' 1 c� lo, oe . STANK -icy oNs, e t / C+ON: GASU ,\ _ \ TH 2 Sf PAVE3 DMYE TH MAPLE '� a \ j DIRT h TOWN OF BARNSTABLE L&ATION SEWAGE# ,geq,0�-�1(� VILLAGE ft/- / j,,.r�y���/� ASSESSOR'S MAP&PARCEL /5-7 -ee[� INSTALLER'S NAME&PHONE NO. V.7 Y' Moe SEPTIC TANK CAPACITY LEACHING FACILITY.(type) & a eAa-v�,/ Cie,)(size) loa jc Yl ;tz f NO.OF BEDROOMS -OWNER PERMIT DATE: COMPLIANCE DATE: 10 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) /SZ7 Feet Edge of Wetland and Leaching Facility(If any.wetlands exist within 300 feet of leaching facility) C '� Feet FURNISHED BY Crr�t G ex�wz�rr�iT e1 sv � + Y J c, ,r No. . t Fee THE COMMONWEALTH OP MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN bF BARNSTABLE, MASSACHUSETTS Yes � �ppgtcatton for �tgponY �p!Aem Corlq;tructton 'Permit Application for a Permit to Construct( ) Repair(/ Upgrade( ) Abandon( ) ❑ Complete System 2 Individual Components )Looccattiion Address or Lot No. /®/c-har ,� Owner's Name,Address,and Tel.No. 6Assessor's o s Ma/Parcel 6 Gl.4G �L �a C� / ��f 4 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size X 4�3 eq—ft. Garbage Grinder (SIP Other Type of Building e.41C, No.of Persons Showers( ) Cafeteria( ) Other Fixtures ®J�j Design Flow(min.r/equired) 7,.L/ gpd Design flow provided 41 5-3 gpd Plan Date !Z ` Number of sheets Revision Date Ze Title 's / ® /yC ,t Size of Septic Tank Type of S.A.S. Description of Soil lai Z.57x Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Boa d of Hea . Signed ® Date ?A /v�l t-9 Application Approved by Date to Application Disapproved by: Date for the following reasons Permit No. Date Issued T F No. Fee / THE COMMONWEAL'+tH Or`„MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN Ic F BARNSTABLE, MASSACHUSETTS Yes A ppgicatton for 33t!5pogaf *p!5tem Congtructton permit , Application for a Permit to Construct( ) Repair(V/) Upgrade( ) Abandon( ) ❑ Complete System V Individual Components Location Address or Lot No. V/ /" J! �' 0-nner's Name,Address,and Tel.No. lAss s or'sMMap/Parcel 17f.!/ /t. r v�o4 A u /� 4} Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. /oaf Cosy 7 r/��.�Pf tooke ''doe �5VO Type of Building: X,, Dwelling No.of Bedrooms Lot Size 7— �/t i2' sy-eft. Garbage Grinder (V� Other Type of Building /t P�il�yP�9C�' No.of Persons Showers( ) Cafeteria( ) Other Fixtures /J Design Flow(min.required) �N0 gpd Design flow provided gpd Plan Date 7i /04^ (Number of sheens++ / Revision Date Title / 9 0 O / 1 ?A /� (1 7— Size of Septic Tank ©(/�� L�l/' Type of S.A.S. — ��� . t�I1� i Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed � / vA Date �ir� Application Approved by /�-� _ Date f r - l y ( ` ` w v Application Disapproved by: \_ r Date for the following reasons Permit No. d Date Issued Al� Lay THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS s Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage DisposalSystem Constructed ( ) Repaired ( {/) Upgraded ( ) Abandoned( )by A r 1' 'P at ,/// /c Q' has bee/ con trticted in aj/Ecordance with th04 e provisi s of Title and the for Dis osal System Construction Permit No. (/ � //J dated �.L 9 Installer Designer #bedrooms _ Approved design floe 1 � � gpd The issuance.of this permit shall not be construed as a guarantee that the system 1 fu ct on as designed. Date 1U MI ) f Ol Inspector P 1,1fjf�X( . _ Fee HE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS Di!gpo.5at &p,tem Cow5truction Permit Permission is hereby granted to Construct ( )/ Repair ( ice) Upgrade,`( ) Abandon ( ) 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 musIbe e mpleted within three years of the date of this i_ermlit roved b / isDate A�/ �" / /�, Pp y r , r TRANS'. iN*0.: CJ<']CY1'1C(PA'N: r.1:�'.')ry --_.p...."1:•, ____,J.. _ —___ _ :l'. ', .r' Ye�:'•!'1� 3�?_:. ,:;�'1�1,1a�':.wi `�?!:o:.�„l:Lf.a'..d4;• ,:v7ic��n;i'..n:fi:7J`I''lc.: :r��:. .i.>t,r, ...d.S.�lf�A.�!(�'flhbl��iYL..t�IJ ..r?{,.�;1..., ..k.,.r.. ,.�L bI:@'.:'Ni.M:i�Plg �. Lo:,,alboan(ia:iies denoted[310 CMR_,l5;')20(4j(a):� `•street, Lot, LmX paTOA uAulllrr a,nrl lot numher noted on plan[310 l,ocus Provided �310 CMR 15,2.2.04(t)] ✓ 1'12111 prc-pur s(;itlt:? (11'" 401 :J-.Zq' 1)Ims, 1 n_21T ur fcwur lom:' c,cympoll.ents) [:310 CMIL 17,220(4)] Easrrrlcrats sllow:n [310(AfR 15.220(4)(b)] ✓~ Systcm located,-ota Vy on lu1 e,ervud[310 CMR_ 15.405(1.)(a):Fur f` u.pgades] if not, a var'iOn.r..e is required [310 C`:MK. 1.5.h'12('4)„1 Location of impernou.; surfacts (dnvetAr,,tys, paxkiag aeeaq etc.) ' — [310 ( 1Vf;lZ-15.220(4')(d)] Location::ill btiildiuf s Oxistitl.p all prcy.posed 310 CI AR Locai iuu and rliaLf-,:Si.ot-Ls of System coinponenls aIld icsi:rve areas. [31_0(I'MR 15.220(4)(u)] Syst(rll CnInIl.latio.n•s ( 1.10.("Mlt 15.220(`I)(�] dal ly flow se ':iu tailic cap a-ui- re mired al id n)-ovided � ��I so:i:1 absorptian sysfieln(reyuircd aud.piovidod).__...c --........ .. n whether systom dosir uod Rt'glsdxi c guk-nAer. North afrow [:3 10 ( M R 1.5.220(4)(g)) Existing and proposed coutuurs 1310 CMR 15X40(4)(9)] - Lot-ation and [og of dt.�,p obsurvatiUu holes (cxistillQ glade el oil ua.c ll test) [3 10 CJAR 1.5.220(4)(h)] Nalhos of go-I I.ev a]MIor and'13nH 1.310 CMR. and(1)] -----.. _..... -Lncatio;z.at)d elate: o:I7pacohillo tests (perlDrrued.at ptope7- uluvatiuli?) [310 C:.11!1.1�. 1-.5.220(�I)(i)] .... ...-.--- _... ... --- --....... - - Petc'ol.atior, test-,esulL,ini:Ich loadliigiatu? 13 0 CMR Certification 4-:tatummt by Suil E-vala'ter 13 1,10 CMR_ 15.,7.20k/ ] -- _ _ --- _ Ol�s(;r;Ted and AAi»stecl pmurltE.wl:tea (ni.ei-hoci f«r arljusLn:le it i rr n or ill;_lica':�d) [310 CIS. 15..103(3) ,3-ad 310 CMR 15.22(;(4)(rl)l Aderess 1 of'/ Ed Wdb(2:80 600E 8Z 'daS 088SE9280ST: 'ON Xtid out 6utaaaut6ua adeo umop: WOdd UK ()f uvoly Pply', public: u-nd-priv'Ab, 131C wi-thirl 400 fetl :)f the p-'lopQSQA qystulll loc"Ition 1:1 the u of S).11-face supplius, and g T, �cvcl packed p- -b tic w atur I I Y w '2SC) fc(,T of thu-prc m louttloi 1-w c,(-lse)pmed syste witldll 1.�0 of Jpror system locat;n.ra ITI 10 rage of privau, water supply WC-I.J.'s I ocaLlun ul all up to iG0 ft. b(;youd sff(back.s.1 IsItA In 310 CND.15.211 aad ml-Y catch basins j.()caijs,d wittlin.50 it.. 0 C.'MR- Lb L IVT c-,�r gi. suffane,atilitin Js)wt(J [310 C (if�w 1 c:r line cruss,see 310 C-M R I 5,2.)EM) Pl-ofib; Of vffrL ck.-witions of systul-Ti. 1:2 UV I ("O.M.porlunt's and t1le. boftoill of the '91�s [3 10 CM.R.J.5.220( )(c.) I . _ . . I .. .......... .... �IL /I Slamjj of dusiga5i- [310 CMR 15220(1) arid 31.0 15.220(2)] Larjjp of kugisve).-ed Land. S'L1TVU'y0f (.required if uunstni.dJon ac'tivihui within 5 It, of Jot [-'M CAR 15.220(3)L—. Pest Hull s adUCJ'URl:e,(IWO il) eaeachOf t'le Pl"LL"-'-Y titalea LlulchEs as p(amitted in 510 CMR. 15.102(2) or its 'N IR15.405( a p:ru -Pgt'aClved fogy'aD LL uiid.(;r 1,[J'A at 3 1() C. T8FA huhl adequitu to dem- oustraLe four feel of suitgM-rn a Test 11 oLesadequato o c01i mieqaat _i-otmdwg:t,r sup a,6I—.0TI? &ndma.-Irk within.50-75' of system [3[0 CM-l? 1.5.220(4)(g) puA;jja(7,af.ioTi.,- noted.? rValioll. 8 utio-1, 0 f-110 C-2YR 15.0( System compoli nits nut> 3 6" deep (unlicm,Local(.1pgado Approvai ur LUA ruiposted) [310(,Na 15. 605(1(b)).'_. of 7 2d WUV2:80 600E 8E daS 0886F-9280ST: ON XlJJ out 6uTuaaui6ua adeo unop: wodd ............. S'I,,:, OK? PIC) Ch/fft 1 5..,.!23(I i(d i t, flow IlaC. 1310 ChCK 15,227(6A Outict t(--,u 14" or 14" + �" -.Dc-.r loot 'or It di-I.Pth L3 10('M R OLLUb-L Lee,with g.L,; hfflb 01-Ul).1-TUVUJ. flltrr 1310 (-.',MR*155.227(4)] Noteregai-ding installation on.stable uoinpacledbasm, [310 CIOR .......... Sel.-ja-i'ati,m,betweei.i. and outlet tees(i)olesF tbaiiliquld dEpth) L310 CD/LR. 15,227(2)1 uct)outict 01(watiolls at lcast 12" 9",)ove biEja P.nYiud-waf.fw as (.J escfibud 3.10 CMLR .1.5.227(.5)) or peaullmd to 1- UpgTade-H undtr T IUA [3 10 CMR I5.4�05(.!A )] Minifnarn.uovtr 9" (Tanks l c'iricd-iiiorc than 9" ufast have risers on all opcnings and ontlic d,,'box) [310 CMR 15,2229(l) amd'W Thrcc,acclICSIS cf-Alf;rS (ii1w.,t and.outlet mT.ist b(.,,2011 or greater)- mi(idle access, at leapt 8" (1)y 710T) F31.0 Ovflt 1.5.229(2)1 - one pL)A for sys1eui.s<1000Lrpcj, two thr systems---1000 gpdJ3 10(MR. 15.229(?—)] ........... A11, Lit-p,i-adtcov,-.:i-F; F;eciii.-td-toLiiiai.itlic)Ti7,edacces.q'? [.110(..'M It 10 ft fro-m biii.tdirg tnuMationi3l 0 (_MR. 1.5,21 1.(J.) ;B-uc)yaiie.y calculation Ruqi�drc:d/Dotic L3 10 MM 15.221(8)] 11.20 Wlicrc appicy.ptiatO [310 Ova 15.226(3)1 Sp,tbacks f1-01-n TCS011CCeq [310 CMIR 0 vn "I 0M Reqi,idteci wlien other tliaa siLgle.-f&ruily d-w-t.11in,", or flow>1000 ETA,L3.10..C.MR.. ............. .first cornpaitmeiit d,9,1:ly flow; Scc.oud uumpai-tincrit 10T/, daily flow 1.310 CWR 15.224.(2) and "17" 1)1.11e 1131_0L1g1_.t OT ovei.- baffle, onticA:of ea.c.h compaitiLic4it with gas b�Elu ur app-ro-yod filter[310 CMft IS -22/1.('d.)l ShtA3 ot'7 Vd WUV2:80 600E BE 'daS 088SE9280ST: 'ON XUd QUIT 6U1UaaU16Ua adleo UM0p: Wodj f l d/rL (YX 1V(-) .,... ,..,.. .--�-:,:a;.,..::—,,:.—,—;r..— ...,• - _ -at,. - - a•:•y......,:" ;i`�y is r.:r. +: •ac`-t , cA tjr._ :e.� ��;;' ,.,1(,7J', 'fe,,S:7r' ,;.Y..a,iR,i �;IC°'' ,-:�. + II.11111 nn �I' ., ali)O .i' .t •.�3��r.. lxt::'.6�.^{ •Ra. d.?�i � :IhfV;t r.Ci tl, '?Ar{•: ::r. ;3i•r.:.�.'.Ai ,...a.::n,. ...L . .<!I:_•t,,.. �:,M... ,...7..:'i y, I.r,cated at least tf-a fee[:fruii1 ally v"a:te:r line? [310 C,M li Disposal pi-ping at jcast 1 K" below ;eater lute(whu'i water and scrwex l.:r[i5t;, sou 310 (::MR - Cle�a rn:ets rCilllLe(ta'j�rovidcd'l 1.310 CNl-1:L 1'.LuuSt 111ii ;kS speaificiJ ix1 [ +tr.,e n7aius? 31.0 (_:MIL sk). of sewc::r liui:.ont. less Ih:n 0.01- 0.0:1 j.i:eferahli: Lilo CMR 15.222(6)J P.J.-ope.1-pilul1 Oil all 111u.s? (.005 �vitl:rir.� Ql avi�y-J.i�txibni:erl `.rent:hcs al-id bc;d.$) [31.0 (-N K 15.251(9) an+l 310 CMR:15.25'2(2)(c)J .. _ Siphcui.prnbLen7l(1�:�ich7:i.cl.d._heacwp+�tzip.charnber} _ _ .. - . - -. ..---' hn.lcaps or wnt.(n.am-old spec-ified? `.iize ar,d ori.eutatiou ofd:ischargc holes specifitd?(:trot smallur / •than 3/8" not Larger tnaa 5/9") (310 CMR 15,251(8) and 310 ✓ (_"M'R 15.252(2)(11)J Ma.tc_rials specified (310 CMR. 15.251(5) Specifics various jApe t,ylie a-ow( _--.. Stablu cotnpa-ctec?base; [310 CAR- and 310 CM-R 15.237..(2) a 1 Splash plate or baffle tee regUircd on knIel:/p.r.ov`idcd? (when pressll:re sewer tU J-bOX Or,-t-el.)pi.fch of gravity sewer) [310 CUR 15.32"3(3) a)) — .. _...... Riser if detpCr thaaa 9" (310 C'M.15,232(3)(f)J 11151C1C tl]LI111171ir11 d117]t'•I1S1UI1 12" �310('-M 1..15.23'7_('7.)(b)] _• _ _ _ M 1,31MUn151ui11f) (i" (310 (N11.15.)37.(3)(�) _ Watcrtight cover if<2000gpd.); watarpz:cmof 1-nar1holu if>?000gpti L31.0 (,'NIR 15-232(3)(cl')]_....__.... - 'alrx:�+,.a.>..,.r, N�.,nv%>.c::•-, iJ7b� �d3� .... ....... .... ...__ l�i` Capp+city(emergency sloragt;abutr(:wozk.in.g--clesigl7 i:icw)? [:3:10 F'for+e:r Selbacics [3 10 CMS_ 15.2 1.1 (sc117 5 Ew s'.Utjc..tank.$)j Watel-tiglet 20-•ill lilll7i',1CQ Zccess Manhole at least 20"M.US't.'13L i'() GI LAM 310 CMR. 1.5.231(.5)1 Service uct;tpot>c:tr::s acr..Pssib;e(:1ot IOU duce with p:ipilig, �_... Ial.).).).floats alarttl oti rircii t se.)arat+,. fiuYzi Tri'_i.)s s)ecT�ied? }' seeds twO units r_ii+.st IR'M.two 1i11111ps(,pra-atizlg itl 1Cacl l.a? mode. (:31.0 ('Ma 15,231(6) and(8)1 Stabl(;C`•o�nli:zct:ed'I3a;;e[:310 CMR 1`.7,'7_l(?,)I " Buoyaltcy calcillalions rl.ued.uil '? P.i'ovi(ied`.j (31() (.`l'y13-. 1.5,1'),1( )l `i i,ttt 4 of 7 Sd Wdt72:80 600Z 8Z -daS 088SE9280SL: ON XHd out 6uzaaaut6ua adeo umop: WOdd FROM :doom cape engineering inc FAX NO. :15083629880 Sep. 28 2009 08:35AM P6 __—'-- �(�)(Z)7,S7,.S[ ?:CWJ OT£J rijt7o snvT}��tL��Tr.,L'ii pasT1 ra_Lr. Lu�ij,Li� 'TTRITITM111T 4f1T sp*q T:TaaA�:I.aq iLui:I['_CT'c'la uZ I, `UMLLLLLTLCLi„q s,)did 7.if-mT.j,)ST[).Mi p(I1j;)('Io L''`rj).T?d (){4 ,,7 P@Cj J0 ap'Es,111 a PTT,? ;;oTrTT TT6T1Ti, udgs C17ELTri 1.xe IN soTrrTTl rEdas uii�zzrTxt;,W • Wp1**, [F(L.)(Z)Z,S7-, S[ ?iWJ UT�.I salrTT TT..,r1n.gjT..1srP TTILITI)TLrTTSL �'''.�.'"Mt '. ____ __— 1�� ml`� �3; _ igr' 4T.. —+};. �7{y 4 1 4r^•. AO a. ..._ _... 1 !•...�'1.is'l...d,Resl 07k1Aril�rdMYfk�;ri1CA'_. ,��� _ . .LraLun.aa(l aaur..Pmx)FMA WI(T1TTZ'ST. N,)U El 470Itto��aaf.l [(Z)I. Z-S[ ?I_Vd=) O L`�:J S111.01.LE00�TUOTI. P^1T ljl.S . �{P ([ .[�Z2WI=) OTf:� (SeTToTza�Li22Ma.aclatiLaS'a_tJLx�:)-iaT,?ai_`i _t9naCj--+[4M LI)P'EM_10 TI)&)I] XZ T1011E TfsdaS X[TCLi iT:�1C[/� [SZ ST 0T£J L5RTi�T Tutlr-mRfrT.TI 00-1' LlL[)([)[SZ ST?TJi1T OT�I IIITI,TIITyvul, TTICRI7T. pll ,Z T{1T�i h� --- - - i.�' �'�' . ......... . . ......... ....... . . �(y)f S� S k �I l ;_l ()[f•� l� Its (]��CzaAa 1aTLT'I°LIai,1?_LT1 IT7IC,:� [ln TTT TlLlL1lC[I�P.LCL]:1P2_E] ITP.YIaFIIS ,7., --- � -- 2TW,;) OTf.] "LTTCLLCC[XLLGT 4t -otTCLCCCCL1mlj a{T:,2e:Z13y f(z)4:SG'ST 211N,� OTC! (2Utf 4)1 aq ;SILLIT.piT'd ()�)()L<j!) a�ULIUI?LCL LLULT.-)QJSLLt auo glim,a T1, _E,s Lj-)P3 —............ . .. — +7T]-'--' - 101M TI,T.M.P:)TTd.l W U.0LJP-11081 LI.00 LIJLIa)'4 LU "I r`.)PLLP', S_La(ILCInT.,) PTT.t,' ll'l(T)TTZ'S'T �YW,� ()-[f {.Tarr)•E:;c[SSOFRI SN .Tc) 5T T.TT-ga.tnn 110E SAa'a 1103;1?:lC .O TIOTJ)31 0T,).C, P'irrj TrTr{i?ffi.prU?P,)T7T.,xods �1rc,ci.TTOTJ_,acls(r( {TbZ.'ST. -TyT_) nTrJ { �:r:? „qi< _La Ku'makup_L-,)PTIT-. LLL:')js.is) e p'—:PTAC,Sd/p1)xin.h'")-T',TT7_)TIr1A TTI04;,�.17 rcz.)ibG S[ 21.1R'F_) 01�•J aJLlnop sr pa_ji,)-)d^a,T? aT1gg J L T 7,'ST)M,) OTi.I i,.TJ��tY1.pT.T[1p7� 01 TT0Qe.TUd;)S Pa.i:TELba�i ?TY1Ti) ()�Ar.J �T)7)1?11STICITIT:I):, T);TS:a1'}?Ti.T.;T1Z_LI1:7;1C1�TT13.it4T T J() ,�` Iad ., . : ��l')l`.:9,01 :fl,.......,....n..:.3.v..v.i. ,. .r::.,..�.-.:'M1!':1...;,y.1�,,,t: . ;titH..l_.. _L'i aa� �•: �' :....4.�._�,. .i,r t. �, .Y�•..yS �i6•j •'�, .i ^Y' 'nt',r''"4.:.a,. t,�:�i.'e �.SI,`.,,y,.{6.1: .,r.,?'.�"Yf,••y',>hT ..7.: �.• 0� 7 7 '�(y{,, ti. :,i:'•.:?jr; �;I. .a��'�;. i::•..rt.. `V/�13 V �':'7:�.. '���I�•q,.h.a.,; "?, '. ' .q�.^,%�t:,ti.i+�nnr::r(- :,.oc�.k, llress'ur Posed S)-Wfelm, provitl(°:(l.puarlp (anc:l.T,.1:01g salad atluus 3 ):P.C�LL11 eCl i 310 f_:PJfI:�i 5.?.2O(�}i•1).� Pressm:�duSa�a.g rcgaa.:ta:e(i on tell �.�stenzS���).(}!}O�;ixi ur a.lte:rnaiiv'r j ;;ySlctliS a�iicSer a e;.ncdiisl a.l)l)rr,v�tl [310(:1 TR 15.254(2) mud V.A. f lZ.em�:dial i_I.;e.A�)ru��a.1S} :fl c Ec:d.in grave:lleSS System -nial e slii.e,36L is cl.irectecl av 11r-;t in srei.n s(iil. itlti riace f(ruifiitla(e i')cacurtlrtlt! - _ 1tlsprrii.nns utlre pea }'en 2000 gpd) c>rc(IMAC ly (..--ZOOOgpd) good tea note oll p.i.a)i `310 CY R 15.Z�4(7)(d)} f.`e)itstraaf1h)n in fill -Did tkie ptau s7»ri,fy that tl i(fill sThtil Inset the soecificatio-a Of ?10 C MR l-5.255(3)'? Icta.tsEFVLouS baiiJer and/orrct,f:i.uin9w"1.11? F7'911dancc 1]ocluucllt] Tna.pervira.is han-ier iu0,911,:tion Blum,be supervised by c1.cs:iFner `310 CIvR 1.5.2E5(2)(b)� .. llllrlj'wa.11.1)11:iSt b u,designed by ItfsnisteredI'rofe.Signal Kngillccx �31.0 C.MR 15,7.55(2)(aj] Side dopt;not i;xceed 3:1 ? [310 CM:R.15.25{(2)7 BfC,9 c(-)Ut meat? [31()(:NIR 15,252(2) and NI/ l luidancc Uocumentl At lca.st 5 A- f i.ia iraxl)e2vi.nus biurioz tc) e(lge of SAS (10 tt. rc0(.)L0.men.dud) 1310 CVR, 15.255 (2)(e)J l' » fdYY Ik. i (_',Beck UEP App�rovLd le tt:t:rs-".'Or mdit.s and desikni coll,ditions Tf LWC4 wi.f(-k preSst(rc,dosing flu uOt 5.1.1ow pressure discharge to soow sail.iTlt_rfacc 7AFWky� � fyLth1Yi677a'7{�Y .` C —......\Yas UEP Approval lzttcrprovided and/or}have yott revic:�wi-cl tYae le{_ter fur cotid;itif)ns? _ 1:s th.e tu�'lrlliali-�nyl)eing piupc%rly applitA and does it Iur.,et a1:1 - DEP Approval Couditiong? Ts ii x(ote Oil the plaua regarding tiac;rcg7lixemenC[f i.c piTzjx- ml nlaixttc;tl;j.tic•e,a.preemellt? ATly alartt13;iuvoli ed ou scpamte cirujits 1)i(I tlic applicant Sabi lit all o'pe}:anrna mid.mamic-miucc. Has app.h(;c�Mt subm--ttod i copy yfLtulii�uS,en,ancc _ Are•the vadgnces listed ou t'ho plan.? ['.i 10 CMK1.5-2'20 Rf,� �taTlzprtcccssca.tyt�n p1aTiif<�i.:_)a_n.jaoiaent 11; within five feel:of Tnupr;P7.little[310 CMR 15-41.')� )1 N6W c:011stmcti.em m-iucrcasc;d tlnw pro,)osc_:ci [Refer to 310 15.414] — 5be.et.5 of 7 Ld WHS2:80 600E 8E -daS 088SE9280ST: 'ON Xdd out 6uiaaaut6ua adeo umo•p: WOdd c VA 0 1%. N 0 FYI ll*l'iID(flA P.14t.dNitioguil S(.,.il8ltinA-tca(ZODC 'Ilfff it public 6LIP-;Dly WC11)? [310 CMR L-5. 14, 310 CMR 1.5.2.11 and 310 CMl 15.216 - also rdcr to Policy rugatding-�i-pgade-s of quc:l,)1 ("Xisting Is thf;syst.;m I*)rupos(.-.d t--untlic sallir.lot as ,clvcd by pl-iva wel.l. ? 3 1+) C1111F. 1.5.2.1.E(.2) , re tlie- n'i'lrogen loads joroposod,in wnpliancu? [310 C.M.R. 1.5.2 1 6(t)] Dimping to septic,tank ?_1`3 1.0 CNI"R M.2291 ...................... Shai-e(IS-y9lem r31.0 C'- M 15,290] .......... Shed:7 of 8d WUS2:80 600E BE -daS 088SE9280ST: ON XIdJ oui 6uivaaui6ua ad-eo unop: wOdA Q�►-��F�,-yl�w. T®wu of Barnstable Pit_ . „E r� Department of Regulatory Services u aAM917AHLE, Public HealthDivision ][Date � MASS. ,200Main Street,Hyanuis MA 02601 APfD PAPS A R tM Date Scheduled 7 TimeC Fee Pd. Soil Suitability Assesesnzgnt for Se),Pag Isposal Perfonned By: ,' i(,,04 Witnessed By.:,'° ✓(\ �J"� Location Address /!� C� V (/ Ov;ner's Name FPi�g w- yJQN^-e Address Assessor's Map/Parcel: .153/006 Engineer's Nainc Wes ! Telephone It NEW CONSTRUC"1'ION REPAIR � p i [' C Land Use �� Slopes(%) �✓r Surface Stones Ott ) '� S� '11 Distances from: Open Water Body� _ft Possible Wet Area 444 ".ft Drinking Water Well 4$ ft Drainage Way 0/� ft Property Line %7 0 ft Other �^ It 5K'TCH, (Street name,dimensions of lot,exact locations of le holes&pere tests,locate wetlands in prmdlluty to holes) °�PJ �l Parent material(geologic) efOAte OWu 1WO ` Depth to Bedrock 4�� Depth to Groundwater: Standing Water in Hole: Il/O/V WEeplhg from Pit 1'ce �,�o Estimated Seasonal High Groundwater DETERTMNATION FOR SEASONAL HIGH WATER TABLE Method Used: A J t Depth Observed standing in obs.hole: _ __._In. Depth to 5011 lrttORION: Depth to weeping from side of obs.hole: _ i!]. Oroundwuter AdJuSlment _ �,..-�ft. t Index Well# Reading Dale: Index Well level Ad�l,factor- A41.0l`(A1lidwuteY Level Observation Holc# �_ "Chile tit 4" /y' l/ Depth of Pere Time at 6" Start Pre-soak Time @ Time:(9"-6") End Pre-soak / Rate Min./Inch Site Suitability Assessment: Site Passed Sile,Failed: Additional Testing Needed(YIN) Original; Public Health Division Observation Hole Data To Be Coinpleled on Back----------- *-*If percolation test is to be conducted witilln 100' of Wetland, you rllalSt first u0tify tile. Barnstable Conservation Division at least olle (I) week prior to begatA➢. ing. Q:\S EPTIC\PERC FORM.DOC 1 o D EIE]P.GBSERV. . . Depth from Soil Horizon Soil 5oii Texture Sail Color Soil- Surface(in.) (USDA) Other (Munsell) :Mottling -(Structure,Stones;Boulders. 4— L S j Con istenc % ravel C* /G - 34 �s /v Y2 —SN /G Y/ae-/6 _ _ SEEP OBSERVATION HOLE, LOG Depth from Soil Horizon Soil Texture Hole 2 Surface(in.) Soil Color Soil Other r (USDA) (Munsell) Mottling (Structure,Stones, Boulders, Consis ene %Gravel /6-3y DEEP OBSER�'r-�TION HOLE, LOGDepth from Soil Horizon # Surface(in.) Soil Texture Soil Color Soil (USDA) (Munsell) Mottling her (Structure,Stones,Boulders. Co siste cY.TP O vet - - - — DEEP OBSERVATION HOLE, LOG Depth from Soil'Horizon Hole# Surface(in.) Soil Texture Soil Color Sol! (USDA) (M Other (Munsell) Mottling (Structure,Stones; Boulders. Consl ten ° a I ' ,k Flood Insurance Rate Map. k Above 500 year flood boundary No yes /l "Within 500 year boundary No Yes ' Within 100 year nood boundary No yes . Depth of Natu rally �ccn>r�in�Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas Observed throughout the avert proposed for the soil absorption system? If not, what is the depth of naturally occurring Iervious mararial7 CeHiflCation I certify that on 4961 . (date)I have passed the soil evaluator examination approved by*tlie Department of Environmental.Protection and that the above analysis was performed by me consistent:with the required training, expertise and experience described in V0 CDjmM 15.017. Date l 7/7 Q:1SBFTIC\PERCFORM.DOC FROM :down cape engineering inc FAX NO. .'J,508j6213880 Oct. 21 2009 07:16AM Pl ervice ti AA VJA LT, Momm KcKeaanl) Wzectur 200'"Jin StrUlt, HY%'mui--/,,,MA 07,601 Fax: 508-790-6304 justalltt o�&J)Lq Date.- Sewage PeR.-mig# j0z mapTarcc Agldress: AddO-CM: A�1 On issuod a pemift to install a -septic system at...—/. based on a design drawn by (address) I v (Yi CL/,a dated (pia'.'Her) I cutify tbal the, Septic system referenced above was ingtallod substantially accotding to the design, Which 11-lay illojude minot appmved changres such. ai.3 lateral relocaijou, of the di-itlibulion.box and/or sciatic.tank.- 1 certify tat the Septic sysiorn rtffeTence(l above was installed with major changes (1-0. greater than 1W lateral relocation.of the SAS or ally ve.ttical rclocalimi of any component of the Septic sysleni) huff in.accordance with. S-03c & Local RegUlallQnS. Plan revisl0li or certified i-is-builf by dosignor io follow. OF J4WIAAS, DAN I A, Wx 45 02 fax L CD 0 (DCS i gi ior's '311-FTl.aflue) (:affix Eksig,u,er 'A' aniptlerc) C10.1"PrAJOCY, WiLL NUT BE ISS TTEPT) Uj-j'yll, BUTH THT.�-, P'O' -UUULT CAR3. XXI� 1% AND AS RE C'FIWEI D HYTHF,NARKS.I.A.ULE TH .'L'J. Catifiewitm Ft)mj 3-26-04.doc No.61)7.60 t_ Fee----- --�---- BOARD OF HEALTH TOWN OF BARNSTABLE 0[pplicat ion-for Vell Cootruct ion Permit Application is hereby made f r a p it to Construct ( ),. Alter ( ), or Repair ( an in Well at: CIO 6 Location — Address Assessors Map and Parcel owner Address ---------------- ---- ------- ----------- ------------- Installer — Driller Address Type of 'l Dwelling ----- --------- Other - Type of Building-- ------ No. of Persons--------------- ---------- Type of Well �l/�- -- Capacity--------------—--- Purpose of Well- 69a --C1--Sj6'- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a Certificate of Compliance has been issued by the Board of Health. Signed date f U Application Approved By ` ------- G,l--__ ate Application Disapproved for the following reasons: ------------- ----- -- - — ------ —_—_--_------- date----- Permit No. -- Issued--- ---—— ---- ---------------- date BOARD OF HEALTH TOWN OF BARNSTABLE C ertif irate ®f Compliance THIS IS TO CERTIFY, That the Individ�uual Well Constructed ( ), Altered ( ), or Repaired ( ) has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. -------------Dated----THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE---- Inspector---------------= —_ —____ No.r-`�7.?!tI ------- Fee------ '-r---- --- BOARD OF HEALTH TOWN OF BARNSTABLE App[cc"Atto ruction permit Application'is hereby made,'Ep. r a pe it to Construct ( ), Alter ( ), or Repair ( an Individual Well at: Location — Address Assessors Map and Parcel Owner _ Address — Installer — Dnl el r Address Type of ildin Dwelling— ----_-- ----_—______-- "" t Other - Type of Building-- ------ No. of Persons-------------------------_--- .Type of Well�� ��---- Capacity-------------------- Purpose of Well- Agreement: . The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until a Certificate of Compliance has been issued by the Board of Health. .�4� — ate Application Approved By --------- '?v Cr ---- ate Application Disapproved for the following reasons:------------------------------— --- _ date Permit No. — Issued-- ----- ----- --------- date --'—. ---- - � � BOARD OF HEALTH TOWN OF BARNSTABLE , Certificate ®f Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( ) by--- �- � _----------- ---------- ----- Koaller �— at has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. ------------Dated-------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE---- - - Inspector BOARD OF HEALTH TOWN OF BARNSTABLE Ivell Con5trutt ion Permit No. (1200l- Fee Permission is hereby grantedto Construct e,, , Alter ( ), or Repair ( ' a/n Individual Well at: No. 41 zf - ------------------------------- - --- Street as shown on the application for a Well Construction Permit No.- C'-) ' Dated-- = -- ---------------- - - ------------------- D i/0/ oard Health ATE + 771 I TOWN OF BARNSTABLE LOCATION A � - .--W ` SEWAGE # F, VILLAGE �� / a�1 /�i.;� ASSESSORS MAP & LOT —004 INSTALLER'S NAME & PHONE NO. Lr� ��ti�- _ NA, SEPTIC TANK CAPACITY /�/'O D 'e.l LEACHING FACILITY:(type) /N.��-; ��+'� � (size) NO. OF BEDROOMS PRIVATE W OR PUBLIC WATER BUILDER O OWN DATE PERMIT ISSUED: '' DATE COMPLIANCE ISSUED: -3 VARIANCE GRANTED: Yes No ..., 3�� �IS'`�, � -�3 I .:� �q No..I�-.._L. Fxs.... ... ... THE COMMONWEALTH OF MASSACHUSETTS APPROVED BOARD OF HEALTH Q"n'table C° 8bW k"rtment TOWN OF BARNSTABLE c./�.�.. r, 1` Date�.� ,1ltrttft>�it for �t� � Sulurk C��gtrxtnrn rruttt Application is hereby made for a Permit to Coristruct ( ) or Repair an Individual Sewage Disposal System at: r / SC.......! .____v.:...:....................... �.. - . alto -:\ddr• s- � No Owner dress •- .................... , ' - . ........... Installer Address U Type of Building Size Lot.... P. 'o .Sq. feet ,., Dwelling— No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) pa Other—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures ................................. . W Design Flow....................�?T_�....__..._gallons per person per day. Total daily flow..............._.... - ....._......_...gallons. WSeptic Tank—Liquid capacity��®__gallons Length---------------- Width__-__.-_--/.... Diameter__._.._...._._.. Depth................ x Disposal Trench--No. ........ ........ Width....... _._____._ Total Length.... 9..... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet-----f........... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ 444 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.........._............. P --------------------------------------------------------------------------•----.......................................-----........•-•---......--••--•....... 0 Description of Soil......................................................................................................................................................................... W V .----------------'--------'-----------"-'-----•---....--------------------------------'---•----------------------------'-'-------'--------------'---------------•------....--'..............---•'..---- W UNature of Repairs or Alterations—Answer when applicable._.�AJ �—__ � -� / ..... ........�,f'..ZZiiIJYL .......-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Complian as een i d by board of health. Signed .... . ........................ ............................. .. . .............. ...... ,; :. e�. •-� i Date Approved By Application ...... ..�� J .•------ ...... .......................... _.............................. ........�f-�73..-. Dce Application Disapproved for the following reasonr: ... ...... ........ . ............................ . .. ......................................... ....................... ....... .... .................................. .... ............................... ........................................... . . ........................................ q Dace PermitNo. ----- ---/--J. I----9-7....................... Issued ............---............ ...................................... Date No..,? -.. .................. ....... THE COMMONWEALTH OF MASSACHUSETTS ..-- BOARD OF HEALTH TOWN OF BARNSTABLE AV.Vliratinn for Diripwial Work.6 Tomitrnr#iun Firmit r + Applicyation is hereby made for a Permit to Construct ( ) or Repair (�) an Individual'Sewage Disposal` System at: - .lN E Location-Addre s or Lot No. Owner Address •-- -------------------- ----- a Installer Address Type Bunk ingNo Size Lot__ of Bedrooms................. ..___._______...Expansion Attic ( ) Oage G q feet Grinder ( ) aOther —Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) QOther fixtures -------------------------------------------------------------------------------------- ---------••------•----------•--- W Design Flow.................... ���_.gallons per person per day. Total daily flow._....._._..____.._.�d-.-•----.-----gallons. --- W Septic Tank—Liquid capacrty.__..___.._gallons Length.....:......... Width / Diameter................ Depth................ x Disposal Trench—No. ........ ........ Width.......`7......... Total Length.... ..... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet-----/........... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) 04 Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 0 Description of Soil.................................................................................................... ----------. -•----•••.--•••- ......_...._...----•-•- W U Nature of Repairs or Alterations—Answer when applicable_- '!J.__.S.. /._f Vic;_,--.-i is ...........Zlvw..� ....................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance'/,has eeenn i�suid My ,booa-rrd�of health. Si ned .....1...l . ' b C_//.....1 ... - .......Z�Z g .. ...... ........ /� Dare Application Approved By .......... o.d ...•t- ------------------------------------------------------------------------------ Daze Application Disapproved for the following reasons: ...... ...................................................................................................................... ........................ ............................................................... . ................. . . ................._........................................... .............. ......I................ Date PermitNo. ..........T-5.....L.?g...7....................... Issued ----.......... .........--..................---........._........ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Qxrtifirate of Compliance THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ! ) be .�..c.�.�1 cam,-.,,rT2 J��p,1 ..._... ....................................... y ......_.........................._.........................._ .... cr at .............................. ....... _.. -G:� ..... 5%12- .` '- . ............�J%�...f... has been installed in accordance with the provisions of TITLE S of he State Environmental Code as described in the application for Disposal Works Construction PermlONo- ------..... .-.....�..�... _._.. dated ............................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE. ..........................(n ...... ......................... Inspector --------------.-s--`-1.,.......................................... i—.—o m—————.���..�.era�.�.��:�ai��.�.�...r.�.a.�ti��.r w��.a>--—-------.v—wa r r--——————tee.-- —----——m m— THE COMMONWEALTH OF MASSACHUSETTS _ BOARD OF HEALTH ((7� / TOWN OF BARNSTABLE No._._.d.. _4 7 FEE..`��.r �t��>an�t1 larks �un��rinn �rrmit Permission is hereby granted------------------.. 1•G f ----_----- .......................................................... to Construct ( ) or Repair ( ",4-an Individual Sewage Disposal System at No........................................ (:cT/= !t../iJ ��= --•--- A- ��'fi f ?-------------....- f t1hCT:......._ Street ¢ { as shown on the application for Disposal Works Construction Permit No.r::M-7_ Dated.......... ................................ 1J Board of Health 1 DATE--------------- z'•- FORM 36508 HOBBS&WARREN.INC..PUBLISHERS LEGEND D SYSTEM PROFILE ALL SYSTEM COMPONENTS SHALL BE NOTES I V MARKED WITH MAGNETIC TAPE OR SYSTEM DESIGN: PROVIDE MIN 20" DIAM. WATERTIGHT (NOT TO SCALE) COMPARABLE MEANS FOR FUTURE LOCATION. 1. DATUM IS APPROX. NGVD Siq eet 99 - EXISTING CONTOUR ACCESS COVERS TO WITHIN 6" OF FIN. GRADE PROVIDE INSPECTION PORT TO WITHIN 3" OF FINAL GRADE 2. MUNICIPAL WATER IS NOT AVAILABLE X 99.1 ExIST, SPOT ELEV. GARBAGE DISPOSER IS NOT ALLOWED TOP FOUND. EL. 51.4' \ - 99 PROPOSED CONTOUR DESIGN FLOW: 4 BEDROOMS ® 110 GPD =440 GPD MINIMUM .75' OF COVER OVER PRECAST 2% SLOPE REQUIRED OVE SYSTEM 47.0' 48.0' 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. ��� �98 4] PROPOSED SPOT EL. USE A 440 GPD DESIGN FLOW CAUTION: GASLINE 4. DESIGN LOADING FOR ALL PROPOSED PRECAST UNITS �a / TO BE AASHO H-1Q " !/ 4"0SCH40 PVC 2" DOUBLE WASHED PEASTONE TH1 .. 4 SCH40 PVC OR GEOTEXTILE FABRIC 5. PIPE JOINTS TO BE MADE WATERTIGHT. TEST HOLE SEPTIC TANK: 440 GPD (2) = 880 PIPES LEVEL 1ST 2 44.5' RE-USE EXISTING SEPTIC TANK ** 10. 14" 0 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH Locu� Roo 2q� SLOPE OF GROUND .�' EXIST. 1000 TEE , or TEE �� 47 2f* " 310 CMR 15.000 (TITLE V.) P ker LEACHING: SEPTIC TANK ° ° 6 MIN. SUMP 44.0 ch 0 000.0000000° oc 12" MIN TNT. DIM. 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO vim% s �Q, UTILITY POLE GAS BAFFLE :•' ° °0°0°0000 00 0° SIDES: 2 (41.5 + 10.25) 1.85 (.74) = 141 GPD ° °o�o�o�o�00- rim, 1.85' BE USED FOR LOT LINE STAKING OR ANY OTHER VFIRE HYDRANT - 44.68' 44.51' 0 42.15 PURPOSE. 0 BOTTOM 41.5 x 10.25 (.74) 312 GPD IN DRA H-20 3050 INFILTRATORS 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. NOTE: NOT ALL SYMBOLS MAY APPEAR WING TOTAL: 613 S.F. 453 GPD 3/4" TO 1 1/2" DOUBLE WASHED STONE 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED 6" CRUSHED STONE OR MECHANICAL WITHOUT INSPECTION BY BOARD OF HEALTH AND USE (5) 3050 INFILTRATOR CHAMBERS COMPACTION. (15.221 [2]) OVERALL DIMENSIONS TO OUTSIDE OF STONE: 41.5' X 10.25' 7.15 PERMISSION OBTAINED FROM BOARD OF HEALTH. *THE INSTALLER SHALL VERIFY THE WITH 3' STONE AT ENDS AND 3' AT SIDES MIN 10. CONTRACTOR SHALL BE RESPONSIBLE FOR CALLING LOCATIONS OF ALL UTILITIES AND ALL DIGSAFE (1-888-344-7233) AND VERIFYING THE BUILDING SEWER OUTLETS AND (2•4% SLOPE) (. 1 % SLOPE) LOCATION OF ALL UNDERGROUND & OVERHEAD UTILITIES LOCUS MAP ELEVATIONS PRIOR TO INSTALLING ANY PRIOR TO COMMENCEMENT OF WORK. NOT TO SCALE PORTION OF SEPTIC SYSTEM ' BOTTOM _ 11. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL BE MA LEACHING NO GROUNDWATER FOUND 35.0' REMOVED 5' BENEATH AND AROUND THE PROPOSED ASSESSORS MAP 153 PARCEL 006 APPROVED DATE BOARD OF HEALTH FOUNDATION EXIST. SEPTIC TANK 107 D' BOX 3' FACILITY LEACHING FACILITY. 12. EXISTING LEACHING FACILITY SHALL BE PUMPED AND NO CONSTRUCTION PROPOSED REMOVED OR PUMPED AND FILLED WITH CLEAN SAND. **INSTALLER SHALL CONFIRM MINIMUM SEPTIC TANK SIZE AT 13. NO KNOWN POTABLE WELLS WITHIN 150' OF PROP. 1000 GALLONS AND ITS SUITABILITY FOR RE-USE. REPLACE SAS WITH 1500 GALLON H-10 SEPTIC TANK IF NOT SUITABLE. \ 3S)� LOT AREA I 2 AC'RES± \ NEW WELL I / TEST HOLE LOGS ENGINEER: ARNE H. OJALA, PE, SE / WITNESS: DAVID W. STANTON, IRS I DATE: AUGUST 27, 2009 f \ y OLD WELLHSE PERC. RATE _ < 2 MIN/INCH v z � \ X / CLASS I SOILS P# 12682 k \ ELEV. ELEV. m X X r 0» 4 47.0' 0" 46.6' `c k EXISTING LS LS POOL _ _ 10/1 10YR 6/2 » IOYR 6/2 10 x� E E I \ MS MS 1OYR 5/2 1OYR 5/2 16" 16" JB B �3 LS ,. LS METER GAS 36 1OYR 5/6 44.0 34 1OYR 5/6 43.8 EXISTING EXISTING GARAGE C DWELLING 1 C 1 �a / >a FMS FMS TOP FOUNDATION ELEV. = 51.4' EXISTI ELL 54" 10YR 6/6 56�, 10YR 6/6 BENCHMARK: USE COR. PAVEMENT ALTERNATE / a, AT GARAGE EL. 46.10' PERC C2 C2 BENCHMARK I i 45 COR CONC. LANDING ELEV. = 51.43 ` I 2.5Y 6/6 2.5Y 6/6 \ EXI T. S.TANK I 144" Ir 35.0 136" 35.2' / 0 4 I -----PROP. VENT WITH CHARCOAL FILTER 1 / AND BUGSCREEN (FINAL PLACEMENT BY NO GROUNDWATER ENCOUNTERED �r----- \ CAI TION: GASLIN CONTR CTOR WITH HOMEOWNER EXIST SAS*----- \ 0 0 i / \ � 150' -i I i 135'f --- -- C/or',j �� �• �' \ �� TH 2 WELL PER OWNER TITLE %E,34 T Em PLAN \ PAVED \ G. MAPLE DRIVE ' TH �S / OF - - _ - J \ / I I \I 49 1 196 CHURCH STREET 1 48 ' 4-950 WEST BARNSTABLE � I / � PREPARED FOR 82.DIRT E 50 CONSTJ BORTOLOTTI \ � \ ALTERNATE � I \ \ SMALL SPA KE $ET C FERGUSON o \ ELEV. = 51.61 / I y T y \ 51 AUGUST 27, 2009 REV. SEPT. 21 , 2009 (3 BR - 4 BR, NOTES) Scale: 1"= 20' 0 10 20 30 40 50 FEET \ 52 �ZN OFM �y�'�oFMgss off 508-362-4541 - - - _ _ gssq fax 508-362-9880 EDGE OF PgMENT - - \ 2 �y �Q DANIEL �� �� DANIELA. G(p A downcape.com o OJALA U A OJALA CIVIVILLNo. 40980 down cope eft INveri08, INC. No.46502 �O ' o F civil engineers OFoISTE��G ! �qti soft E�° ,\ land Surveyors NAL / 939 Main Street ( Rte 6A) DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675 09- 19 > 09-191.DWG (SBO)