HomeMy WebLinkAbout0080 CROCKER ROAD - Health 50 1. U
WEST BARNSTABLE
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TOWN OF BARNSTABLE vUl(P 7V�
LOCATION !0 17b a kr d SEWAGE
VILLAGE La1 �j' ,�(� ,J' ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO. _1/��'/2/i .j .0— v
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type re 6 r—.x- 4i—ze)
i
NO.OF BEDROOMS 3_
BUILDER OR OWNER 0 0'14.t4 _. 1a fe �zr
PERMITDATE: AL ,10 COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200'feet of leaching facility) Feet
Edge of Wetland and Leaching Facility (If any wetlands exist
within 300 feet of c 'ng facility) Feet
Furnished by
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Commonwealth of Massachusetts 90
Title 5 Official Inspection Form
t Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
80 Crocker Rd
Property Address
Owner Borque
information is Owner's Name
required for West Barnstable Ma 7-22-2020
every 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.
Important: A. Inspector Information
When filling out p 67* /q(p-Q.�
forms on the v
computer,use Douglas A Brown
only the tab key Name of Inspector
to mare your D.A.Brown Inc
cursor-do not Company Name
use the return
key. P.o Box 145
Company Address
qRILL�i Centerville Ma 02632
City/Town State Zip Code
5084204534 S14297
Telephone Number License Number
B. Certification
I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title
5(310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property 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 in 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
3. ❑ Needs Further Evaluation by the Local Approving Authority
4. ❑ Fails
7-22-2020
Inspect 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
Commonwealth of Massachusetts
�m Title 5 Official Inspection Form
~ 'IO Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
80 Crocker Rd
Property Address
Owner Borque
information is Owner's Name
required for West Barnstable Ma 7-22-2020
every page. Cityrrown State Zip Code Date of Inspection
C. Inspection Summary
Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6.
1) 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:
At time of inspection this system met all passing requirements all components were opened and
were in working order.This report can not predict the future performance under the same or increased
usage.
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 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):
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18
Commonwealth of Massachusetts
113 Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
80 Crocker Rd
Property Address
Owner Borque
information is Owner's Name
required for West Barnstable Ma 7-22-2020
every page. Cityrrown State Zip Code Date of Inspection
C. Inspection Summary (cont.)
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
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):
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 to protect public health, safety or the environment.
a. 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:
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
80 Crocker Rd
Property Address
Owner Borque
information is Owner's Name
required for West Barnstable Ma 7-22-2020
every page. Cityrrown 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:
4) 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
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
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
80 Crocker Rd
v
Property Address
Owner Borque
information is Owner's Name
required for West Barnstable Ma 7-22-2020
every page. Cityrrown 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 'h day flow
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply
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. [Phis
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 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.
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.
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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 18
Commonwealth of Massachusetts
�v lip Title 5 Official Inspection Form
�. III
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
80 Crocker Rd
Property Address
Owner Borque
information is Owner's Name
required for West Barnstable Ma 7-22-2020
every page. Cityrrown 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
should contact the appropriate regional office of the Department.
6. You must indicate "yes"or"no"for each of the following for all inspections:
Yes No
® ❑ Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
® ❑ Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑ Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
❑ ® Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
❑ ® Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS) on the site has
been determined based on:
® ❑ Existing information. For example, a plan at the Board of Health.
❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18
Commonwealth of Massachusetts
�n Title 5 Official Inspection Form
I' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
I
80 Crocker Rd
Property Address
Owner Borgue
information is Owner's Name
required for West Barnstable Ma 7-22-2020
every page. City/Town State Zip Code Date of Inspection
D. System Information
1. 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
Description:
According to as-built card this system consists of a 1500 gallon septic tank, distribution box, and 3
500 gallon leaching chambers as shown
Number of current residents:
Does residence have a garbage grinder? ❑ 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 ❑ Yes ❑ No
information in this report.)
Laundry system inspected? ❑ Yes ❑ No
Seasonaluse? ❑ Yes ❑ No
Water meter readings, if available (last 2 years usage (gpd)):
Detail:
Well water This system IS NOT designed for usage with a garbage disposal
Sump pump? ❑ Yes ❑ No
Last date of occupancy: currentlyoccupied
t5insp.doc•rev.7/26,2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
,l
80 Crocker Rd
v�
Property Address
Owner Borque
information is Owner's Name
required for West Barnstable Ma 7-22-2020
every page. Cityrrown 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):
Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Water treatment unit present? ❑ Yes ❑ No
If yes, discharges to:
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
Last date of occupancy/use: Date
Other(describe below):
3. Pumping Records:
Source of information: Pumped in June of 2020 per owners info
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped: 1500
gallons
How was quantity pumped determined?
Reason for pumping: for regular maintenance
t5insp.cloc•rev.7/26,12018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18
Commonwealth of Massachusetts
►F Title 5 Official Inspection Form
I° Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
6 � 80 Crocker Rd
L
Property Address
Owner Borgue
information is Owner's Name
required for West Barnstable Ma 7-22-2020
every 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:
11-22-2000
Were sewage odors detected when arriving at the site? ❑ Yes ® No
5. Building Sewer(locate on site plan):
Depth below grade: feet
Material of construction:
❑ cast iron ® 40 PVC ❑ other(explain):
Distance from private water supply well or suction line: feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
t5insp.doc•rev.7/2E/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18
Commonwealth of Massachusetts
w ►9 Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
u
80 Crocker Rd
Property Address
Owner Borque
information is Owner's Name
required for West Barnstable Ma 7-22-2020
every 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: years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
Dimensions: 1500
Sludge depth:
Distance from top of sludge to bottom of outlet tee or baffle
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
How were dimensions determined?
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 was recently pumped for maintenance
t5insp.doc-rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18
Commonwealth of Massachusetts
j: Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
80 Crocker Rd
Property Address
Owner Borque
information is Owner's Name
required for West Barnstable Ma 7-22-2020
every 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):
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
Commonwealth of Massachusetts
It? Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
80 Crocker Rd
Property Address
Owner Borque
information is Owner's Name
required for West Barnstable Ma 7-22-2020
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
8. Tight or Holding Tank(cont.)
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments (condition of alarm and float switches, etc.):
*Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
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.):
t5insp.dcc•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
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
v
80 Crocker Rd
Property Address
Owner Borque
information is Owner's Name
required for West Barnstable Ma 7-22-2020
every 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"
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:
Type:
❑ leaching pits number:
® leaching chambers number: 3
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18
L�
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
u
80 Crocker Rd
Property Address
Owner Borque
information is Owner's Name
required for West Barnstable Ma 7-22-2020
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
11. Soil Absorption System (SAS) (cont.)
Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
One chamber was opened and had about 13 inches of standing water with no signs of failure or
surcharge.
12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration
Depth—top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18
Commonwealth of Massachusetts
�v lig Title 5 Official Inspection Form
t Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
80 Crocker Rd
Property Address
Owner Borque
information is Owner's Name
required for West Barnstable Ma 7-22-2020
every 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
P Y 9
Commonwealth of Massachusetts
l Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
80 Crocker Rd
Property Address
Owner Borgue
information is Owner's Name
required for West Barnstable Ma 7-22-2020
every page. Cityrrown 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 publi
c c water supply enters
the building. Check one of the boxes below:
❑ hand-sketch in the area below
® drawing attached separately
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18
Commonwealth of Massachusetts
�. lI Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
�l 80 Crocker Rd
Property Address
Owner Borgue
information is Owner's Name
required for West Barnstable Ma 7-22-2020
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
15. Site Exam:
® Check Slope
® Surface water
® Check cellar
® Shallow wells
Estimated depth to high ground water: greater than 5
feet
Please indicate all methods used to determine the high ground water elevation:
® Obtained from system design plans on record
If checked, date of design plan reviewed: Date
❑ Observed site (abutting property/observation hole within 150 feet of SAS)
❑ Checked with local Board of Health -explain:
❑ Checked with local excavators, installers-(attach documentation)
❑ Accessed USGS database -explain:
You must describe how you established the high ground water elevation:
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5insp.dcc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18
I
Commonwealth of Massachusetts
�m li� Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
V
80 Crocker Rd
Property Address
Owner Borgue
information is Owner's Name
required for West Barnstable Ma 7-22-2020
every 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
„
Assessing As-Built Cards Page 1 of 2
TOWN OF BARNSTABLE
LOCATION R a r— /iaC �e_�_AA. SEWAGE# air=—
VILLAGE L�J f i ( ,e Jet j;',6kc_ASSESSOR'S MAP&LOT r1
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACrrY /.00 o
LEACHING FACILrrY:(rype)t��Et't�/Lt: C//&&b..iu)
NO.OF BEDROOMS 7
BUILDER OR OWNER 00 69 1�;P c�✓.L
PERMITDATE: /J_ZIA c• COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of c ng facili ) Feet
Furnished by e,(�
CA
Al,47
,Z /P
J /8'
https://www.townofbamstable.us/Departments/Assessing/Property_Values/HMdisplay.asp... 7/23/2020
Assessing As-Built Cards Page 2 of 2
https://www.townofbamstable.us/Departments/Assessing/Property_Values/HMdisplay.asp... 7/23/2020
s
CERTIFICATE OF ANALYSIS Page: 1
Barnstable County Health Laboratory
'ryCt�t���ct^ Report Prepared For: Report Dated: 11/20/2009
Jeffrey W.Moore
Old Cape SIR Order No.: G0955330
P O Box 2307
Orleans, MA 02653
Laboratory ID#: 0955330-01 Description: Water-Drinking Water
Sample il: Sampling Location: 99 Crocker Rd.West Barnstable,MA Collected: 11/18/2009
Collected by: Jeff Moore Map 110 Parcel 015-0-0 Received: 11/18/2009
Routine
ITEM RESULT UNITS RL MCL Method# Tested
Nitrate as Nitrogen 2.2 mg/L 0.10 10 EPA 300.0 11/18/2009
Copper 0.15 mg/L 0.10 1.3 SM 3111B 11/20/2009
ND U0 0.3 SM31t;B 1!n012009
Sodium 14 mg/L 1.0 20 SM 311 IB 11/20/2009
Total Coliform Present P/A 0 0 SM9223 11/18/2009
Conductance 170 umohs/cm 2.0 EPA 120.1 11/18/2009
pH 6.8 pH-units 0 SM 4500 H-B 11/18/2009
The recommended maximum contamination level for drinking water exceeded due to Coliform Bacteria Retesting is
recommended.
1 /
Attached please find the laboratory certified parameter list. Approved By: __- __ _______:-__-ll
(Lab Director)
ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level
Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605
I
03 No. HE COMMONWEALTH OF MASSACHUSETTS +FEE -�� —
BOARD OF HEALTH
O &f O F 13*9W57-A? tS.
FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
'&rPPLICATION
lication for a Permit to Construct Repair ( ) Upg C rade ( ) Abandon ( ) - omplete System ❑Individual Components
Loniliun Owner's Name
0/61
Map/Parcel N Address
e
I 'rclephone t
Inslallcr's Name Designer's Name
�D.Bo,; 3�+ l�J Ayxod)IA,Mk
Address Address
Sob- Sd-c2-1733
Telephone It Telephone# '+ i
Type of Building: 12�55i1 W-/-2AL--Dl WfZC1461 Lot Size 3�� 70-7 Sq.feet
Dwelling—No.of Bedrooms 3 Garbage Grinder (/J0JS-
Other—Type of Building No.of persons Showers ( ), Cafeteria ( )
Other fixtures
Design Flow(min.required) 310 gpd Calculated design flow gpd Design flow provided 44 gpd
Plan: Date Zd' Number of sheets Revision Date o 1 0e 00
Title SIT- [AAI i i4 3klnl P«,fAU-- OF
Description of Soil(s) /.,,,,. 0 y J&ALD i AA -axlb ewrf—SAuID
Soil Evaluator Form No. Name of Soil Evaluator 1.&'_"gs-04 Date of Evaluation 2
DESCRIPTION OF REPAIRS OR ALTERATIONS /Pa�/rfiCuGf/ 4 t ,c['f1/Sl_ 1-->l01GL1X16f
A,L D A55oGGA•7--:F1A PVQ-'TUAAIGgk
The undersigned agre to install the above described Individual Sewage Disposal System in accordance with the provisions of
TITLE 5 and further a es of place the system in eration until a Certificate of Compliance has been issued by the Board of Health.
VLSigned e
O
FORM I - APPLICATION FOR DSCP DEP APPROVED FORM 5/96
"HE COMMONWEALTH OF MASSACHUSETTS"_ ,EE
BOARQ- OF- HEALTH
o &I OF
PPLICAT ION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
V )inpictc SystcnNE]Individual Components Application for�i Permit to Construct Rej)air Upgrade Abandon-)
L
1Z(pi,*_
Localion Owners Namc
Ma Alalcel# Address
Sop 'I cl�phonc ft
hmallci's Name Namc
0.Box 36 Dc,ignDesigners ,,,
+ 1AY_5rtALA0AP%Ak
Address Address
Telephone It Telephone 4
Type of Building: I2f*r-*A111AL4]:)AAL41tJ6i Lot Size s 10-7 Sq.feet
Dwelling—No.of Bedroomy, 3 Garbage Grinder (AIDAif-
Other—Type of Building No.of persons Showers Cafeteria
Other fixtures
Design Flow(min.,required) 330 gpd Calculated design flow gpd Design flow provided gpd
-Plan: Date /Z/715/99 Number of sheets 21 Revision Date 07106100
Title 'Sir b ;;0- -1114AI Bay aF -08D, C&C"r- AAZ)
Description OfSOil(S) /_,WAMV '5/�AIX>
Soil Evaluator Form No. Name of Soil Evaluator.1 Date of Evaluation IZ-117115
DESCRIPTION OF REPAIRS OR ALTERATIONS
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of
TITLE 5 and further rees of place the system hLpperation until a Certificate of Compliance has been issued by the Board of Health.
Signed
V
Ij
I/l/V
UV
FORM I APPLICATION FOR DSCP DEP APPROVED FORM 5/96
7 - -- --
�1 __ 7 1—1------- ----
-
- --
No. THE COMMONWEALTH OF MASSACHUSETTS FEE 14avl
BOARD OF HEALTH
CERTIFICATE OF COMPLIANCE
Description of Work: E] Individual Component(s) E]Complete System
The undersigned hereby certify that the Sewage Disposal System;Constructed Repaired Upgraded Abandoned
by: A/,
at e'er aUAe,4',,
has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built
OA r " 0-' -9* Approved Design Flow
. L�" 00�r
plans relating to applicati dated 1:;� o _(gpd)
Installer
Designer: I n s p e c t o42 . ,4WoOW�D a I e
The issuance of this certificate shall not be construed as a guarantee that the system will function as designed.
FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96
No. PTHE COMM 9NWEALTH OF MASSACHUSETTS FEE
efisgk.1�4�eOARD OF HEALTH
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereb%r ted ty struc Rp,p d fidon an individual sewage
disposal system at aT.A64' ' as described
�4 ,in the application for Disposal System Construction Permit No dated
Provided: Constr ction all be completed within three years of the date ofthis mi Il�
nd s must be met.
Date Board of Health
FORM 2 - DSCP DEP APPROVED FORM 5/96
FORM 1255 (REV 5/96) H&W HOBBS&WARRENTM PUBLISHERS BOSTON
No.-------------------- Fee----- --------------
BOARD OF HEALTH
TOWN OF BARNSTABLE
Application-*rVeil Construction Permit
Application is hereb ade fora hermit to Construct (v), Alter ( ), or Repair ( )an individual Well at:
_--— ^ — Address —Assessors Map and Parcel
Address
---------- ---------------------------------------------------- ---__-_-
Installer — Driller Address
Type of uilding
Dwellin4g --------------
Other - Type of Building No. of Persons.--------------
Type of Well ---------
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 Certificate of Coppfiance s been issued by the Board of Healt .
Signe ZtW
date
a�
Application Approved By
d e
Application Disapproved for the following reasons: --------------------_—______—__—_—
�
date
.
Permit No. --- Issued---------------------------_--_--date
------------------------------
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate Of Compliance
THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( )
by---- --------------- --------------
Installer — —
at----- —
has been installed in accordance with the provisions of the Town of Barnstable Bo d of Health P 'vate Well Protection
Regulation as described in the application for Well Construction Permit No. ated
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE------ _ _ Inspector
.�U. Fee------ -------------- ;
BOARD OF HEALTH t
4
TOWN OF BARNSTABLE
pplication.foruhll=ConotructionPermit
Application is hereb ade for ermit to Construct (✓), Alter ( )_or or Repair ( )an individual Well at:
L 'ation +Address Assessors Map and Parcel 71
—= --- — A� -� ——— —— —-------- __—
. Address —
/'l
$ 7-f- u
--b ---------
Installer — Driller Address
Type ding
Dwelling_ -------------------
0
Other - Type of Building------------_____________ No. of Persons-------------------------___—___—________
v. .
Type of;Well ---
YP - - Capacity-------------------------------------
Purp-se-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 Certificate .of Comp iance s been issued by the Board of Healt .
Signe
date
! Application Approved By
J d to
Application Disapproved for the following reasons:
date
J
r
Permit No. -- Issued------ -- ------ -- — -
date
t' il:a:��►r.:lw?el.�.•.Kt:4Genraed!saez9a?dtu!aea9:1.r*6!w^w3.9a!l..fweesYaearaaMaeraRasesaaisrer9ve6B'a`Iri2.!umaSedere:rwatasssi:enlaaiiTrnTiodawar9Lssre7r.!Rs.•oleCa:GaaRssae:ea�c�:
BOARD OF HEALTH
TOWN OF BARNSTABLE
C ertif i ate ®f. � -omphance -
THIS IS TO CERTIFY, That the:Individual Well Constructed ( ), Altered ( ), or Repaired ( )
by---- ----- -----==- -------------------------------
�" Installer
at—has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection
Regulation�as''des cfibed<in t�h`e,.Ap�'1'iZ-atibn for Well Construction Permit No. —Z ated---- ----
V F
THE I55UANCEtOF THI 'CERTtFIL�ATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE—=------- _Inspector-------_�___ —_ —_I
2eltl�s Seld9d Roes�los:aw9.:s.4B4aviwe.eVi•�iTieaa�Sstrse:.}Iai!aMaYASasifeeeaezp�fr:i:.oa�rtp'a�r+!ae6lae:ltilesw..ssiraeb'cl"'�i rasareoee.ye6?nwaaaa4waear+:ee}s:.�r�:E.er:®eS.srs�aec+:�.r!3�i+
BOARD OF HEALTH
TOWN OF BARNSTABLE
Iverl Con5tructionAermit
No. -l_-- a _ _
Fee—
Permission i hereby granted to Const t ( 6�t ); 'or e a' ( ) I vidualYell a : -- —
greet
No
as shown on eeZOO
lication for V�felI Construction Permit
No.--- T � )__ Dated
--_— -
__ ---— ------..-..-----
K and of Health
DATE —_ (
07/18/2000 TUE 16:23 FAX 508 888 6446 ENVIROTECH LABS Z 002/005
RNV R07ECHLABORATORIES,INC.
MA CERT.NO_:M-MA W
1' 449 Rw.ZV
Sandwich, MA 02541
508{888.d460) I.800-339-6d60
FAX(908)88S-6446
CLIENT: L Wile LOCA7I0N. Lot 80
ADDRESS: (John Bouigue) Crocker Rd
W Barnstable MA
COLLECTED BY L Wile SAMPLE DATE: 7/11/2000
SAMPLE 77ME: NIA
WATER SAMPLE TYPE. New Well DATE RECEIVED: 7/1/2000
LAB I.D.N. 0007176
WELL SPECS.: 120 4"PVC 70'Tto Water
RESULTS OF ANALYSIS:
Parameters Units Recommended Results Method Date Analyzed
Limits
Colfform bacteria /100mi 0 0 92228 7/11/2000
pH pH units 6.".5 6.61 4500 H+ 7/11/2000
Conductance umhos/cm 500 101 120.1 7/11/2000
Nftte-N mg/L 10.0 0.873 300.0 7/11/2000
Nib te-N mg/L 1.00 <0.003 300.0 7/11/2000
Sodium mg/L 28.0 10.7 200.7 7/13/2000
iron mg/L 0.3 0.022 200.7 7/13/2000
Manganese mg/L 0.05 0.003 200.7 7/13/2000
Volatile Organics
Toluene ppb 1,000 0.9 EPA 524.2 07/17/2000
WATER MEETS EPA STANDARDS AND IS SUITABLE FOR DRINKING PURPOSES
FOR PARAMETERS TESTED.
<=less than
>=greaterthan RbnaldI A4d
TNTC--too numerous to count Laborat rector
07/18/2000 TUE 16:23 FAX 508 888 6446 ENVIROTEGH LABS ..._g 003/005
Page. 4
rxr, ICATE OF AN tiLVCTC
LAPUCK 1,ABORATORIE6139 INC.
1102ort Propured FAr'
Kahort Ontoa: +nl182n00
t:uviroceell,Laboratories,Inc. Order _Number: Y 0066699
Ron Saari
449 Rtc. 130
Sandwich, Ma 02163
1.atbOt'ator rn 0066699-02 �•� ,� t..L 80 Crocttcr
timnpiC N: Itvcnived: 0711212000
(:u11c4ud toy: �u9tncaer
Test Parameters till
ITTM .13T .�IT.S— T= eUto+ #
LAB: Chemistry
90 .,� rpns2n.z 07,11W20110
Sitrrobm:tc-1,2-Dicittorobenze 07t 1772noa
Surrogate-4-Hromofluu rob e 100
,y„ 17rAs24.2
EPA 524.2- Volat&Org%ffics by GC/MS MDL MQ 1 Qll10 �� o
I'M RESULT.
LAB: Orbrenic:s
1,1,1,2-Tetrachlorocthanc ND phn ck.s ►_t'A 5�a.z n7t17lanao
ND Spl' 0.5 L'Pn 52a.2 07rt7>~uuq
1.,1,l-'Trichioroetharte 1.1,2,24etr2chlorueth ane
ND I)plt _ (,,t fl`A$24.2 07117/2000
N U ppb 0.5 EPA sea z 07n 7n_o0+t
1,1,2-'Triclilorocthane u7n7n_oao
»D Opt, 05 CPA$24.2 1,1-Dichlorcthatic o7l+7nuuo
1,1-1)tchloroothene ND ppb 0.5 EPA 524.2
l,l-Dlchloropropene
ND pan 0.5 a;rn 524.2 0711712000
1,2,3-Trlchlurobcrizene
ND ppb us EPA S24.2 0/117l3000
1,2,3-'1'richloro propane
ND ppb 0.5 ttPn 534.2 0711712000
ND ppb u.s 1-P/.$24.2 ogn7r2U0o
1,Z,4-Trlchlurobcttcenc � , c,7tl7t,ato
1,2,4-Trimethylbenxene ND ppb o.s liCA s_4._
ut,b
NA 0.5 crn sza� n7n 7t2nnu
1,2-Ulhrumo-3•Chlol'opropu o7r17Y3u<xa
1,2-Dibromocthanr(ED11)
ND pp0 0.5 I:Pn 5_4.2
ND ppb 0..' I'WA5242 07/172000
1,2-Dichlorobenccne
ND ppb u,; kiNA 524:+ o7n7rzul+n
1,2-01chloroethane l,�rtyr':o1)0
n s_;..
1,2-lltshloropropnne NU rl►!, n,s la
I;i1n 524.2
1,3,E'Trimethylbenzene
ND t,ph p.o 07t172Uo0
N,D ppb 0,5 l;pn<'.4.2 U7t1N3dax1
1,3-Dialiloroben2CRC 2 u7n7rauu0
1,3-Dichluropropane ND ppb 0.5 EPA 124,2
07/18/2000 TUE 16:24 FAX 508 888 6446 ENVIROT'ECH LABS _Q004/005
C:L.KL IFICATE Or ANAL VSIs
LAPt1C.K LABORATORIES, INC.
Itatwn Dowd. O7/IK/20110
Ail
Urder Number: L,0066699
1s0
Ma 025611.,tb )ti:. 0066699-UZ J,►,..,Indnn; (,nt90Croclu:r
unmllne•Lim t_ I��n:- (:IfilccicU:
ti11 R1(11C B: IZCCCIYI•({: 0 711 212 0 0 0
Gullcr•�cd by: ('uslnlncr
1,4-Dichlorohanzcne
ND PVh (0 BPn$24.2 nv17nJ1uo
2,2-1)lchloropropune
ND I),,n 0.5r:Yn saa.: 07117/2000
ND Plin b 5 I:Pn 324.2 0711711201x,
2-Chlorot0luV110
ND ppq 11 5 I WA 524.2 07117121,o0
4-Chlorotoluenc
4-lsnpropyttoluene
NOpPb 0.5 kNn S2n z 01l172noo
ND pl,b q,s lil'A 524.2 071171:(K,t!
Halizeae
ND PNb 0,5 Vrn sza z 07717/1600
Bromobenzenc
ND nnu
i1romochioromethane
0.5 I'sYA s24.2 6 7/l'+f:U4n
ND pVt' n.c hrnS2a: 071{'r12110U
Bromudichloroelhane
ND rrl' 0.5 FPn 534.: n 712 lr( o
nrorrlotorm 00 NO Nab 03 I.1'n sea 20711720e1)
liromott)ethane
' N D Pl,b l;s Iil>n:24.3 o7n]r2nt,n
CurbonTetrachloride
ND nrb 0.5 EI'n 324•: 07I1713000
Cbiorobe))xane u77i]r_uu+)
Chtarocthane
ND Cl,h 0.5 I;1 n 524.2
0.7 al 1, 0.5 ia'n$24 2 07/17n.i1O(1
C'irloroforsil
ND PFv 0.5 F.YA';24.3 07117!2000
Chloromethuue
cis-1,2-Dichloret hene
ND NN(, 0.5 1;1'n 524.2 o7r,)Ro(x)
NU Ilnb 11.5 1--'VA$24.2 W81 N;Uoo
cis-1.3-Dichloropropcne
ppb o.5 I-Yn 524.2 071i712U0n
Dibromochloromethanc ND ppil
ND Pl► o•s ,;I'n s-aa t u7117nugo
Dibromomethane
ND nvb os L:)'n Szc.2 01 r 7,2n(,1)
1)ichlo roil ittuormlittIlane M1►7r2600
ND ppb 0.5 (-*.PA 5242
h thy111011 le (17lt712000
ND nl+h 0-5 I:1 n Sza..,
lIexachtorobctttdiene ND t1Vb 05 I.I A 524._, 0711712000
Isopropylberizene
ND nnh t).$ ern 524,2 07117/200
MethyleneC:hloridt: ND PNh 0-5 IEYn 5.,a 2 01117/20uo
n-Butylbentene
n-pl-opylbenzene
NO rIl)b 0.5 0]II
liNn j2A.3 71200n
Naphlhalene
NO I,�,L t1.s Isrn S:a? 07n7,2uoo
07/18/2000 TVE 16:24 FAX 508 888 6446 ENVIROTECH LABS a 005/005
CERTIFICATE OF ANALYSIS Page: 6
LAPUCK LABORATORIES, INC.
Renorl 1'&M1441 FAU Itcpurt NMI; 0911lu20110
Envirotecb I,aborstorics,lue• Order Number: 1,0066699
rion Sited
449 Ric, 130
Sandwich, Mit 0236.1
1,aboratovy 11 tx: 0066699-02 Dgecrilo(fam Lut 90 Crot:kcr
\umple 11; S`161y ta)Qti0fl;_ Cotlecwd:
Cullumd byl Cu.tumcr Hrreivud: 07/IZ/jfl00
sec-Butylbenzene ND pl,b 0.5 CPA 5242 07/17nlltlll
Styrene ND ppb 0.5 EVA 524.2 a7r17121N00
tent-l3utyihelizene ND pph 0.5 PPA524.2 fill i7r2u00
Tetrachloroethene NO pPb 0.5 crA 524.2 0711 7MOU
Toluene 0.9 rAi, 0.1 1J'A 51142 a7/t7/2tu10
trans-1,2-hichle rued ienc NO ppb 0.5 FTA 524.2 07n7r000
trans-l.3-I)ichlaropropenc NO pph 03 I:I'A 524.2) 0-1117/1.0W1
Trichloroodiene ND pov 0.5 1;PA 324.2 0711W2000
Trieldoratluormilahanc ND ppb 0.9 EPA 5241 07117/2000
VinylMlorlde NO pph 0s h:PA U4.2 07117110txl
Xylene NO I,pt, 05 t:rA sza.a 0711%Mall
Nov-22-00 11 !46A JACK LANDERS-CAULEY 508-540-3344 P._01
FAX TRANSMITTAL COVER SHEET
J. E. LANDERS-CAULEY, P.E.
civil-environmental engineering
P.O.Box 364
West Falmouth. MA 02574
(509) 540-7733- (509) 540-3022
(508) 540-3344 fax
Attention:
Regarding:
G
Number of pages including cover shect
From: Date:
cc:
If you have any questions, plcase contact us. Thank: you.
jack\FAXCVR01 jlc (1)
Nov-22-00 11 :47A JACK LANDERS-CAULEY 508-540-3344 P.05
F.F. ELEV.=111.00
20'MIN.
ELEV=I-08-5
4' CAST IRON OR CONCRffE COVERS
SCHEDULE 40 P V.C.
4' CAST
SCHEDUI
SLP.=0.02
FLOES LINE INVERT DIST.=16.6' CONCRETE CC
ELEV.= 1--- ELEV.= 102.5 - - SLP.=0.0.1_ INVERT
- 10' MIN. 19' 102.31
ELEV.= ELEV.= 102.I5 —
D `scHecAST eR:o P°v.c. DISTRIBUT
LIQUID eaatx or
nu TANK ussD.
(S M CHART AT RIGHT)
1500 GALLON SEPTIC TANK ,�QQl1LD OUTLET T TO BE WET
TO BE PLACED ON DE�'Thl BELOW FLOW 11ME MORE THAN
6" OF STONE OR 4 FEET.......14 INCHES TO BE PLACE
MECHANICALLY COMPACTED SOIL F 5 EET.......19 iNcHEs 6" OF' STONE
B FEET........24 INCHES
USE A TANK WITH THREE COVERS.. SEE 310, CUR SOIL
L
WITH
PER(
TEST HOLE 1 I
PROFILE OF DEPTH HORI2
SEWAGE DISPOSAL SYSTEM
NOT TO SCALE 0"-8" 0/A/
8"-30" B
GENERAL NOTES:
30"-72" cl
I. THIS PLAN IS FOR THE CONSTRUCTION OF A NEW SEWAGE DISPOSAL SYSTEM.
2. PLAN REFERENCE Elk 301 Pg 99 LOT 93 BARNSTABLE REG. OF DEEDS.
3. THIS PLAN IS FOR THE INSTALLATION /REPAIR OF SEPTIC SYSTEM 72"-120" C2
AND NOT TO BE USED FOR SURVEYING AND ZONING PURPOSES.
4. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P.
TITLE 5 AND THE TOWN OF BARNSTABLE RULES AND REGULATIONS
FOR THE SUBSURFACE DISPOSAL OF SEWAGE, TEST HOLE 2 c
5. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO WITHIN —
1Z" OF THE FINISHED GRADE. DEPTH HORI2
6. EXISTING AND FINAL GRADES SHALL REMAIN ESSENTIALLY THE
SAME, UNLESS NOTED BY FINAL CONTOURS. 0"-lo" O/A/l
7. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE
OF WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR
WITHIN 10' OF. DRIVES OR PARKING AREAS. H-20 LOADING io"-30" B
SHALL BE USED UNDER OR WITHIN 10' OF DRIVES OR PARKING
AREAS UNLESS NOTED.
8. ANY MASONARY UNITS USED TO BRING COVERS TO GRADE SHALL
BE MORTARED IN PLACE. c1
9. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH
DEEDED OR ZONING REGULATIONS. OWNER/APPLICANT IS TO
OBTAIN SUCH DETERMINATION FROM APPROPIATE AUTHORITY. 72"-126' C2
10. THE EXCAVATOR/CONTRACTOR SHALL VERIFY THE LOCATION OF
ALL UNDERGROUND UTILITIES PRIOR TO ANY EXCAVATION.
Nov-22-00 11 :47A JACK LANDERS-CAULEY 508-540-3344 P_04
ELEV.=1Q4-L
AST IRON OR 3' �.
EDULE 40 P.V.C. 3' --�- 12" IN. 3' LAYER OF
e COVER DlST.= 1.O__ aq. MASHED STONE
� p o" " " " "o" " "o"o"o"o"oo"o"
EL,EV.=101.�8 °p0°pppp°p°ppppQp°p°pOp00°p .. °0OQ°0°Q°°°Q°0°00000O0c
o_o_o_o_o_0_0_0_0_0_0_ 0_ 0_ 0 0. 0 0.0.0.
6a6® O ®aaa O o 0 0 0$o a 0 00
o`24' LAYER OF
'� ELEV.= 301s9� �00
Moo,
O"O"O`�O`�O"O B®®06®6®®®® O 0 0 0 0 0 /4" TO 1-1/�
0 0 0 O O qq ®a®68B6a O O O O Q O C WASHED STONE
000000000p0 B��Lal76®®®a® O�p00000O0 0. ELEV.=99.85
USE STONE 3 0 500 GALLON
'T TESTED IF TO LEVEL THE LEACHING CHAMBERS
kN ONE OUTLET. BED AS NEEDED. 8.9
,ACED ON i�^
)NE OR — — — — — —
ALLY COMPACTED SOIL. BOTTOM OF TEST HOLE OR U$03 PROBABLE WATER TABLE ELEV -21, ..
OIL TEST DONE BY: J.E. LANDERS-CAULEY P.E. ELEVATION 91.0 EXISTS ON THE SITE
RTNESSED BY. DONNA_M_____„___________ WITH NO GROUNDWATER PRESENT.
'ERCOLATION RATE: _3---MIN/INCH P# 9640
DATE: L2`1ZZA9_ ELEV.
)RIZON TEXTURE COLON MOTT- OTHER
/A/E O
I HEREBY ATTEST THAT I AM A
CERTIFIED SOIL EVALUATOR IN THE
B. LOAMY SAND 7.5Y 5/6 COMMONWEALTH OF MASSACHUSETTS,
AND THAT i WAS PRESENT FOR THE
SOIL TEST AND EVALUATION,
CI MED..SAND 7.5Y 5/6
--------- --
DATE NAME
C2 COARSE SAN 10YR 6/4 30% GRAVEL DESIGN DATA:
No H2O
' ENC'D
NUMBER OF BEDROOMS TIAM L3)___
DATE: L?,/17199_ ELEV.
)RIZON TEXTURE COLOR MOTT. OTHER GARBAGE DISPOSAL
TOTAL ESTIMATED FLOW ..33.D----- GPD
/A/E ( 110-__ GAL/BR./DAY X 3 BR. )
SEPTIC TANK CAPACITY
B LOAMY SAND 7.5Y 5/8
LEACHING AREA REQUIREMENTS
cl MED. SAND 7.5Y 5/6 SIDEWALL AREA 1$;L__ GAL/S.F.
BOTTOM AREA GAL/S.F.
C2 COARSE SAND IOYR 8/4 LEACHING CAP.(BOT. & SIDEWALL)_ 4a3_ GAL
NO H2O RESERVE LEACHING CAPACITY _443 GAL
£NC'D
APPLICANT: JOHN BOURQUE DATE: 12/28/99
REVISED-. 11/22/00 JDR SHEET 2 OF 2 IJOB 884
i
Nov-_22-00 11 :47A JACK LANDERS-CAULEY 508-540-3344 P_03
LOT 94
IL
y cis` kz/
/�� /' ' •� /� 7 - -.1
If I
If
If
If /e
If
' / If • / A `r
If
If f
If If
// /( P OPOSED 3
If C BEDROOM DOUSE
/�/l FIRST FLOOR
' If , ELEVATION 112.00
LEACH BED AS DE 1CTED
ON AS BUILT F ARED SIrp•. `;`
BY LANTERY AS C. ON 4-
06/26/79.
LOT 93
j 37.7071 S.F. +
2 9f W XISTING
WELL
LOT 92 O
` l
W �
Nov-22-00 11 :47A JACK LANDERS-CAULEY 508-540-3344 P_02
ow .NOTES:
LOT 93 IS IN THE -C- FLOOD ZONE,
LOT 98 LOT 93 IS IN THE 'RF' ZONING DISTRICT.
LOT 99 ,gyp N
,
\ BENCHMARK:
PK NAIL AT INTERSECTIO
\ OF CENTERLINES
ELEVATION: 100,86
� r
APPROXIMATE LOCAT N `;�4 ± _
OF SEPTIC SYST
' AS SHOWN BY 0 ER_
O
•� <) SITE PLAN
1 ,/ PREPARED FOR 611*
^� 1 JOHN BOURQUE
1G •� LOT 27 of
``-- #80 CROCKER ROAD
' �V BARNSTABLE,. MA
J.E. LANDERS-CAULEY, P.E_
CIVIL ENVIRONMENTAL ENGINEERING
P.O. BOX 364 WEST FALMOUTH, MA 025774
(508) 540-7733 ph. (508) 640-3022 ph-
508) 540 3344 faX
ASS.#110-01 f DATE: 12128199
LOT 28 REV.11 22 00 JDR SCALE: V =30' DRAWN BY: JD
REV.07 08 00 JDR JOB NO. 8d4 SHEET: I OF 2
L
1.
\ ow NOTES:
91 \' LOT 93 IS IN THE "C" FLOOD ZONE.
rn 9� O LOT 98 LOT 93 IS IN THE "RF" ZONING DISTRICT.
LOT 94 5 H
96
co
Uri 98
IN
041
°-
0 o ro LOT 99 P .
/ /�� , /// i / i/ �' , // \ �Q \ \\ gyp•
BENCHMARK:
' PK NAIL AT INTERSECTIO
17.3`.. \\ \ OF CENTERLINES
\
ELEVATION: 100.86
PROPOSED 3
BEDROOM HOUSE
FIRST FLOOR '
ELEVATION 112.00IN
IN IN
. APPROXIMATE LOCAT N
r►rQ�. / •' l . �/ OF SEPTIC SYSTN t
EY
LEACH BED AS DEPICTED s6,1 ` I - 1�1 p / f I / AS SHOWN BY 0 ER.
ON AS BUILT PR ARED Ap,, 1� 9 - - „/ - No.35101
BY LANTERY AS C.. ON 1 off' ' ; �, O
06/26/79.
SITE PLAN
LOT .93 Off' PREPARED FOR
O� 37,707t S.F. 178
JOHN BOURQUE.
82 8 t9I W XISTING '� LOT 27 OF
� #80 CROCKER ROAD
WELL �� BARNSTABLE, MA
LOT 92 \ � j O
J. E. LANDERS-CAULEY, P. E.
Q., CIVIL ENVIRONMENTAL ENGINEERING
a �y P.O. BOX 364 WEST FALMOUTH, MA 02574
a / (508) 540-7733 ph. (508) 540-3022 ph.
508 540 3344 fax
o�
ASS.#110-016 DATE: 12128199
o / LOT 28 SCALE: 1" = 30' DRAWN BY: JDR
REV.07 08 00 JDR JOB NO. 884 SHEET: 1 OF 2
F.F. ELEV.=111.00
20'min.
ELEV.= 109.5
ELEV= 105_0
4" CAST IRON OR CONCRETE COVERS
SCHEDULE 40 P.V.C. 4" CAST IRON OR 4" DIA. SCHEDULE 40 PERFORATED PLASTIC PIPE
SCHEDULE 40 P.V.C. END CAPS ON ALL PIPES
DIST.=14.3' 5' ON CENTER 12" in. A 3" LAYER OF
SLP.= 0.02 . SLP .005
77; INVERT CONCRETE COVER,DIST 1___ v v v .v v v v WASHED STONE
ELEV.- 103_00 Flow LINE DIST. 4.3__ SLP.= 0.01
-- ELEV.= 102.7 •19^ - _ INVERT ELEV.= .104.6 ,00000000 0000000000000000000000000000000J00000000000 000000-000000000000e1
10" MIN,
THE La+cTH of ELEV. 102.71
_ 102.6 " s.. LAYER OFOUTLET TEE IS e -- < v ,. 0 0 /4" TO 1-1/2'
ELEV.-__-- ELEV.= 102.50 c.> � o o � � o c DETERMINED BY THE 4" CAST IRON.OR O O O O O O O O O O O O O O 0 o O O 0 O WASHED STONE
EITANKK USED - � ,o„a O o 0 0,.0 ��o�ono�o� � Or,o 0-0-0-0-0 o ELEV.- 101.7
DEPTH SCHEDULE do P.v.c. DISTRIBUTION BUX
(SEE CHART AT.RIGHT). ----
.
A.
USE STONE
LENGTH.OF TO BE WET TESTED IF .
1500 GALLON SEPTIC TANK" LIQUID OUTLET TEE To LEVEL 'THE
T0. BE PLACED ON
DEPTH BELOW FLAW LINE MORE THAN ONE OUTLET. BED AS NEEDED.
4 FEET .14 INCHES
- 6" OF STONE OR 5 FEET 19 INCHES TO BE `PLACED ON
l
MECHANICALLY COMPACTED - SOIL. s FEET.......zs INCHES 6" OF STONE OR.
1_
SEE. 310 CMR MECHANICALLY COMPACTED SOIL. BOTTOM of TEST HOLE OR USGS PROBABLE WATER TABLE ELEV
USE A TANK WITH THREE COVERS. 15.227 (s) ELEVATION 91.0 EXISTS ON THE SITE
SOIL TEST DONE BY: J.E. LANDERS-CAULEY P.E. WITH NO GROUNDWATER PRESENT.
WITNESSED BY:_DONNA-M.---------
PERCOLATION RATE: __2_--MIN/INCH P# 9640
- ,.DATE: 12 17 _99_ - ;fie" z-oF
YE/
TEST HOLE' .1 _1_/ _ ELEV._] -.9 ..o_o_o_o_o,.o o_o o,.o_o o .1ASHED STONE
PROFILE OF �00�00 OO�OOO 8- VYEROF
DEPTH HORIZON TEXTURE COLOR MOTT. OTHER o 0 0 3/4 �o ,-1/2
WASH ID STONE
SEWAGE DISPOSAL SYSTEM 3 PERFORATED PIPES
NOT TO SCALE 0.:_8.. O/A/E SECTION A-A
I HEREBY ATTEST THAT I AM
CERTIFIED SOILV
i
8"-30" B LOAMY SAN 7.5Y 5/6 COMMONWEALTH OF MAASSOR
r
AND THAT I WAS PRESE HE
GENERAL NOTES: SOIL TEST AND EVALU
l
E N
JO N
30" 72" Cl M D. SAND 7.5Y 5/6 I ------ -
N ULEY
1. THIS PLAN IS FOR THE CONSTRUCTION OF A NEW SEWAGE DISPOSAL SYSTEM: DATE M , 36101,
2. PLAN REFERENCE Bk 301 Pg 99 LOT 93 BARNSTABLE REG. OF. DEEDS. y
3.. THIS PLAN IS FOR THE INSTALLATION /REPAIR OF SEPTIC 'SYSTEM 72 -120" C2 oARSE SAND' lOYR 6/4 30� GRAVELE �
AND NOT TO BE USED FOR SURVEYING AND ZONING PURPOSES. DESIGN DAL
4. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. NO H2O
TITLE 5 AND THE TOWN OF BARNSTABLE RULES AND ' REGULATIONS ENC'D
" FOR THE SUBSURFACE DISPOSAL OF SEWAGE. NUMBER OF BEDROOMS TI3SFX,_.�_
5. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO WITHIN TEST HOLE 2 DATE 12117199_ ELEV:-109_5
12" OF THE FINISHED `GRADE. DEPTH HORIZON TEXTURE COLOR MOTT. OTHER GARBAGE DISPOSAL NONE_(pj_____ :
6. EXISTING. AND FINAL GRADES SHALL REMAIN ESSENTIALLY THE- TOTAL ESTIMATED FLOW ,3Q___-_ GPD
.SAME, UNLESS NOTED BY FINAL CONTOURS: 0"-•10" 0/A%E � ( 11.(L-_ GAL./BR./DAY X �____ BR. )
7. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE
OF WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR SEPTIC TANK CAPACITY 15QQ GAI�__
WITHIN 10' OF DRIVES OR PARKING AREAS. H-20 -LOADING 10"-30" B ' LOAMY SAND 7.5Y 5js
SHALL BE USED UNDER OR WITHIN 10' OF DRIVES` OR PARKING LEACHING AREA REQUIREMENTS
AREAS UNLESS NOTED.
8. ANY MASONARY UNITS USED TO BRING COVERS TO GRADE SHALL SIDEWALL AREA 4____ GAL /S.F:
BE MORTARED IN PLACE. 30"-72 Cl MED. SAND 7.5Y 5/6
9. NO DETERMINATION HAS BEEN. MADE AS TO COMPLIANCE WITH BOTTOM AREA -QQO _-_ GAL.,/S.F.
DEEDED OR ZONING REGULATIONS. OWNER/APPLICANT IS TO
OBTAIN SUCH DETERMINATION FROM APPROPIATE AUTHORITY. ! LEACHING CAP.(BOT. & SIDEWALL)_ 444_ ,GAL.
72"-126" C2,. OARSE SAN lOYR 6/4
10, THE EXCAVATOR/CONTRACTOR SHALL VERIFY THE LOCATION OF r
ALL UNDERGROUND UTILITIES PRIOR TO ANY EXCAVATION. NO H2O RESERVE LEACHING CAPACITY _444 ___ GAL
a -
ENC'D --
APPLICANT: JOHN BOURQUE DATE: 12/28/99
REVISED: 07/18/00 JDR SHEET 2 OF 2 EOB .# 884