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Home My WebLink About0082 DEER JUMP HILL - Health f 3.2 Deer Jump Hill West Bamstable A = 133 039 } I Commonwealth of Massachusetts /33-639 ry ,1� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 82 Deer Jump Hill V Property Address Froggy Bog Nominee Trust Owner Owner's Name information is West Barnstable MA 02668 05/25/2021 required or 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:When A. Inspector Information filling out forms � S�� 15 Lt(-4— on the computer, use only the tab Michael T Bisienere key to move your Name of Inspector cursor-do not Cape Septic Inspections use the return Company Name , t key. 52 Rivers End Road rQ Company Address Teaticket Ma. 02536 Cityrrown State Zip Code 508-280-3356 S13938 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 05/25/2021 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 82 Deer Jump Hill Property Address Froggy Bog Nominee Trust Owner Owner's Name information is required for every West Barnstable MA 02668 05/25/2021 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: This 4 bedroom home has an H-10 1500 gallon septic tank with an H-10 D-Box feeding (3) 500 gallon leaching chambers with stone. At the time of the inspection no visible failure criteria was found. The inlet and discharge covers on the septic tank are raised. 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 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 82 Deer Jump Hill Property Address Froggy Bog Nominee Trust Owner Owner's Name information is required for every West Barnstable MA 02668 05/25/2021 page. City/Town 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 El Y F1 N 0 ND (Explain below): ❑ obstruction is removed ❑ Y 0 N El 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 cam, Commonwealth of Massachusetts f. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments c � 82 Deer Jump Hill Property Address Froggy Bog Nominee Trust Owner Owner's Name information is required for every West Barnstable MA 02668 05/25/2021 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: 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 82 Deer Jump Hill Property Address Froggy Bog Nominee Trust Owner Owner's Name informatics is required for every West Barnstable MA 02668 05/25/2021 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 '/z 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. i ❑ ® 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. 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments <, 82 Deer Jump Hill Property Address Froggy Bog Nominee Trust Owner Owner's Name information is required for every West Barnstable MA 02668 05/25/2021 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•ray.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u 82 Deer Jump Hill Property Address Froggy Bog Nominee Trust Owner Owner's Name information is required for every West Barnstable MA 02668 05/25/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 plus GPD Description: Number of current residents: 2 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 ears usage d well water 9 ( Y 9 (gp ))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: occupied Date 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 82 Deer Jump Hill v Property Address Froggy Bog Nominee Trust Owner Owner's Name information is required for every West Barnstable MA 02668 05/25/2021 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): 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: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments c, 82 Deer Jump HIII Property Address Froggy Bog Nominee Trust Owner Owner's Name information is required for every West Barnstable MA 02668 05/25/2021 page. Cityrrown 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: 2006 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): " Depth below grade: 41feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: 10_plus feet feet Comments (on condition of joints, venting, evidence of leakage, etc.): Water was flushed and came freely. t5insp.doc-rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 82 Deer Jump Hill Property Address Froggy Bog Nominee Trust Owner Owner's Name information is required for every West Barnstable MA 02668 05/25/2021 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 32" 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: H-10 1500 gallon Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle 34" Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 5" Distance from bottom of scum to bottom of outlet tee or baffle 13" How were dimensions determined? sludge judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): I recommend the new owner put the septic tank on a maint. plan with a local septic pumping co. based on the future use of the home. At the time of inspection the liquid level was at working level and the tee's were in place. t5insp.doc•rev.7/26/2018 Title E.Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments •�� 82 Deer Jump Hill Property Address Froggy Bog Nominee Trust Owner Owner's Name information is required for every West Barnstable MA 02668 05/25/2021 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•ray.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 ti Commonwealth of Massachusetts -. Title 5 Official Inspection Form �- Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 82 Deer Jump Hill Property Address Froggy Bog Nominee Trust Owner Owner's Name information is required for every West Barnstable MA 02668 05/25/2021 a e. Cityrrown State Zip Code Date of Inspection P9 P P 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.): At the time of the inspection the liquid level was at working level and there were no visible signs of leakage. t5insp.doc-rev.7/2 6120 1 8 Title 5 Official Inspection form:Subsurface Sewage Disposal System-Page 12 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 82 Deer Jump Hill Property Address Froggy Bog Nominee Trust Owner Owner's Name information is required for every West Barnstable MA 02668 05/25/2021 page. City/Town 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 ti Commonwealth of Massachusetts �n Title 5 Official Inspection Form I� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 82 Deer Jump Hill Property Address Froggy Bog Nominee Trust Owner Owner's Name information is required for every west Barnstable MA 02668 05/25/2021 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.): At the time of the inspection no visible failure criteria was found. 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 82 Deer Jump Hill Property Address Froggy Bog Nominee Trust Owner Owner's Name information is required for every West Barnstable MA 02668 05/25/2021 page. CityfTown 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•ray.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 82 Deer Jump Hill Property Address Froggy Bog Nominee Trust Owner Owner's Name information is required for every West Barnstable MA 02668 05/25/2021 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 PrA4� I �r�vcwd►y G I BM�I�oFh•�r� � ; /- o i 2S, 9/ A 01* V��ibSC above i gr"C �J t5insp.doc•rev.7/2612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts p Title 5 Official Inspection Form =1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments !/ 82 Deer Jump Hill v- Property Address Froggy Bog Nominee Trust Owner Owner's Name information is required for every West Barnstable MA 02668 05/25/2021 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: 11 plus feet 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: I augered a hole at a lower elevation and shot it with a transit. 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 Title 5 Official Inspection Form In Subsurface Sewage Disposal System Form - Not for Voluntary Assessments >(n 82 Deer Jump Hill Property Address Froggy Bog Nominee Trust Owner Owner's Name information is required for every west Barnstable MA 02668 05/25/2021 page. Cityrrown 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 13a-aa9 Commonwealth of Massachusetts I� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 82 Deer Jump Hill Road,West Barnstable, MA � Property Address Douglas J Bean Owner Owner's Name Or7 information is required for every West Barnstable MA 02668 01/28/2016 '$page. City/Town State Zip Code Date of Inspection ap 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:When filling out forms A. General Information on the computer, use only the tab 1. Inspector: key to move your cursor-do not REID C. ELLIS use the return Name of Inspector key. ELLIS BROTHERS CONSTRUCTION Company Name 23 ENTERPRISE ROAD Company Address YARMOUTH PORT MA 02675 City/Town State Zip Code 508-362-6237 S121891 Telephone Number License Number B. Certification l I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(3 0 CMR 15.000).The system: Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 �o��' vS Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 82 Deer Jump Hill Road, West Barnstable, MA Property Address Owner Douglas J 'Bean Owner'sinformation is Name required for every West Barnstable MA 02668 01/28/2016 page. Ekir own State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: 01 I have not foun ny information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon con pletion 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* r the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltr 3tion or tank failure is imminent. System will pass inspection if the existing tank is replaced with a omplying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is s ructurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 10 years old is available. ❑ Y ❑ N ❑ ND(Explain bel w).- t5ins•3h3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments hM 82 Deer Jump Hill Road,West Barnstable, MA Property Address Douglas J Bean Owner Owner's Name information is required for every West Barnstable MA 02668 01/28/2016 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operatio"na./System will pass with Board of Health approval if pumps/alarms are repaired. I B) System Conditionally Passes(cont): w / /J ❑ 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 bro cen, 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 tim Bs a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluati n by the Board of Health in order to determine if the system is failing to protect public health, s afety or the environment. 1. System will pass unless Board of Healtl determines in accordance with 310 CMR 15.303(1)(b)that the system is not function ng in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3113 �e 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 r <` Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 82 Deer Jump Hill Road, West Barnstable MA Property Address Douglas J Bean Owner Owner's Name information is required for every West Barnstable MA 02668 01/28/2016 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 1O//4 2. System will fail unless the Board of H alth (and Public Water Supplier, if any) determines that the system is functionin 3 in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil a sorption 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 nd 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 prese ice of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other fail 4re criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ t Static liquid level in the distribution box above outlet invert due to an overloaded } or clogged SAS or cesspool ❑ L�J! Liquid depth in cesspool is less than 6"below invert or available volume is less than Y2 day flow t5ins-3/13 Title 5 Official Inspection Forth_Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts AEA Title 5 Official Inspection -Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 82 Deer Jump Hill Road, West Barnstable, MA Property Address Douglas J Bean Owner Owner's Name information is required for every West Barnstable MA 02668 01/28/2016 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ Required pumping more than 4 times in the last year NOT due to clogged or Zobstructed pipe(s). Number of times pumped: ❑ Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ The system is a cesspool serving a facility with a design flow of 2000gpd- > 10,000gpd. ❑ L.y�/ 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 Bo rd of Health to determine what will be necessary to correct the failure E) Large Systems: To be considered a large systenYthie 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"i o"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of surface drinking water supply ❑ ❑ the system is within 200 feet of tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrog n sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zon II of a public water supply well If you have answered"yes"to any question in Section the system is considered a significant threat, or answered"yes" in Section D above the large systen has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The syst m owner should contact the appropriate regional office of the Department. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 5 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 5 82 Deer Jump Hill Road, West Barnstable, MA Property Address Douglas J Bean Owner information is Owner's Name required for every West Barnstable MA 02668 01/28/2016 page. cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Y No Yes ❑ Pumpinginformation was provided p ded by the owner, occupant, or Board of Health V❑ Were an of the y 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? El 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? facility[ Was the and] Y owner( 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: ❑ Existinginformation.ton. For example, Ian at the P a.plan Board of Health. L�"/ ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): Number of bedrooms act( ual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts R a Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 82 Deer Jump Hill Road West Barnstable MA Property Address Douglas J Bean Owner Owner's Name information is required for every West Barnstable MA 02668 01/28/2016 page. Cltyrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: Does residence have a garbage grinder? ❑ Yes VNo Is laundry on a separate sewage system?(Include laundry system inspection information in this report.) ❑ Yes ff/N, Laundry system inspected? [IYes N Seasonal use? [Ell Yes No Water meter readings, if available(last 2 years usage(gpd)): Detail 41 Sump pump? ❑ Yes No Last date of occupancy: m"4a Date Commercial/Industrial Flow Conditions: A V`W Type of Establishment: Design flow i(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 syst m? El El No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �.0 82 Deer Jump Hill Road, West Barnstable, MA Property Address Douglas J Bean Owner Owner's Name information is West Barnstable MA 02668 01/28/2016 required for every page. CityfTown State Zip Code Date of Inspection D. System Information (cont.) Last date ofoccupancy/use: C� `J �' -Aj S T DAV_ Date Other(describe below): General Information Pumping Records: Source of information: — Af Was system pumped as part of the inspection? /Yes ❑ No If yes, volume pumped: 16-®0 gallonsHow was quantity pumped determined? 67 Reason for pumping: Type of System: Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3113 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title -5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 82 Deer Jump Hill Road, West Barnstable, MA Property Address Douglas J Bean Owner Owner's Name information is West Barnstable MA 02668 01/28/2016 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: Were sewage odors detected when arriving at the site? ❑ Yes [R/No Building Sewer(locate on site plan): Depth below grade: feet Material of constructioV- 40 []cast iron PVC ❑ other :ex lain ( p ) Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of-leakage,etc..): iv Aee'& �� c.a �D Septic Tank(locate on site plan): FA* --� ._-. --'�� p Depth below grade: � et^` � :te ri of construction: �N�� :✓<<- �'j '� concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain) ftank is metal, lis ge: years /N age confi d by a Certificate of Co/pliance? (attach a copy of certifi te) ❑ Yes ��No Dimensions: x S Sludge depth: t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System.Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 82 Deer Jump Hill Road, West Barnstable MA Property Address Douglas J Bean Owner Owners Name information is required fcr every West Barnstable MA 02668 01/28/2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness 62 CJ Distance from top of scum to top of outlet tee or baffle cv 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, 9truc r I integrity, liquid levels as re ted tooutlet invert, evidence of leakage, etc.) cam✓ �� / 1 , 0 Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑f,berglass ❑ polyethylene El other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee baffle Distance from bottom of scum to bottom of outl at tee or baffle Date of last pumping: Date t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments .. 82 Deer Jump Hifl Road, West Barnstable, MA Property Address Douglas J Bean Owner Owners Name information is required for every West Barnstable MA 02668 01/28/201-6 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) �� Comments(on pumping recommendations, inlet nd outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence o leakage, etc.): Tight or Holding Tank(tank must be pumped t time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fibe glass ❑_polyethylene ❑ other.(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Officia-I Inspection p on Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments °w. 82 Deer Jump Hill Road,West Barnstable, MA Property Address Douglas J Bean Owner Owners Name information is every West Barnstable required for eve MA 02668 01/28/2016 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on�ft plan): Depth of liquid level above outlet invertUs Comments(note if box is level and distribution to outlets a ual, an evidence ofrq Ycarryover, any evidence of leakage into or out of box, etc.): DiALS ,,I/ �W C LL_ Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of-pump chamber, cond tion of-pumps and appurtenances,-etc.): *If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: C_ �V/ t5ins•3/13 Tide 5 Official inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 82 Deer Jump Hill Road,West Barnstable, MA Property Address Douglas J Bean Owner Owner's Name on is required for oe every West Barnstable required foreve MA 02668 01/28/2016 page. citylTown State Zip Code Date of Inspection D. System Information (cont.) ' , Type" L L 4-r2o? ❑ leaching pits number: leaching chambers number: `7 ❑ leaching galleries number.- El leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation etE" f 9 rc9/any 67 ,vs -� �� "did✓ Cesspools (cesspool must be pumped as 411fpection) (locate on site plan): Number and configuration -Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3l13 Title 5 Offi ial Inspection Forth:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 82 Deer Jump Hill Road, West Barnstable, MA Property Address Douglas J Bean Owner Owner's Name required fra is every West Barnstable required for eve MA 02668 01/28/2016 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hyd aulic failure, level of ponding, condition of vegetation, etc.)-. t5ins•3113 Title 5 Official tnspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts , Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 82 Deer Jump Hill Road West Barnstable, MA Property Address Douglas J Bean. Owner Owner's Name information is every West Barnstable required for eve MA 02668 01/28/2016 page. City/Town state Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: and-sketch in the area below ❑ drawing attached separately Vote,�jY I � I lk4 t �I a� / � 2-0 Lt5imt3113 Me 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form m Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 82 Deer Jump Hill Road, West Barnstable MA Property Address Douglas J Bean Owner Owner's Name information is West Barnstable required for every MA 02668 01/28/2016 page. Cftyrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope -�✓�� ❑ Surface water /fJJ� ❑ Check cellar �� lf,�► d !� ❑ Shallow wells Estimated depth to high ground water: 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: WEJ Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: �1 Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 'wM 82 Deer Jump Hill Road, West Barnstable, MA Property Address Douglas J Bean Owner Owner's Name information is required for every West Barnstable MA 02668 01/28/2016 page. City(rown State Zip Code Date of Inspection E. Report Completeness Checklist Inspection Summary:A, B, C, D, or E checked LI Inspection Summary D(System Failure Criteria Applicable to All Systems)completed f System Information—Estimated depth to high groundwater VSketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-3113 Title 5 Official Inspection Form.Subsurface Sewage Disposal System-Page 17 of 17 CERTIFICATE OF ANALYSIS Page: 1 of 1 Barnstable County Health Laboratory- rYM-MA009� Report Prepared For: Report Dated: 9/17/2015 Reid C. Ellis Ellis Brothers Construction Order No.: G1690348 23 Enterprise Road, P O Box 59 Yarmouthport; MA 02675 i Laboratory ID#: 1590348-01 Description: Water-Drinking Water i l Sample#: sample Location: 82 Deer Jump Hill Road,W Barnstable Collected: 09/16/2015 Collected by: Reid Map 133 Parcel 039 Received: 09/15/2015 Routine i ITEM RESULT UNITS RL MCL METHOD# ANALYST TESTED NOTE Nitrate as Nitrogen 3.4 mg/L 0.10 10 EPA 300.0 LAP 9/15/2015 Copper 0.25 mg/L 0.10 1.3 SM 3111B LAP 9/16/2015 � iron ND mg/L 0.10 0.3 SM 3111E LAP 9/16/2015 pH 6.4 PH AT 25C NA 6.5-8.5 SM 4500-H-B DCB 9/15/2015 i Sodium 7.6 mg/L 2.5 20 SM 3111B LAP 9/16/2015 i l Total Coliform Absent PIA o 0 SM 9223 RG 9/15/2015 Conductance 200 umohs/cm 2.0 EPA 120.1 DCB 9/15/2015 I Water sample meets the recommended limits for drinking water of all the above tested parameters. Attached please find the laboratory certified parameter list. Approved By: (Lab Director) -V ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court'House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 •�jE t1AR:l. CERTIFICATE OF ANALYSIS Barnstable County Health Laboratory (M-MA009) Recipient: Reid C.Ellis Matrix: Water-Drinking Water Ellis Brothers Construction Sampled: 09/15/2015 13:45 23 Enterprise Road, P O Box 59 Received: 09/15/2015 14:59 Yarmouthport, MA 02675 Collection Address: 82 Deer Jump Hill Road,W Barnstable ;Order#: G1590348 Sample Location: Map 133 Parcel 039 Description: 82 Deer lump Hill Road Lab ID: 1590348 Ol Date Analyzed: 9/16/2015 @ 15:35 I Sample#: Analyst: yn Method: EPA 524.2 Dilution Factor: 1 Comment: Water sample meets the recommended limits for drinking water of all the above tested parameters. i EPA 524.2- Volatile Organics by GC/MS Result MCL ! MDL Result MCL I MDL Parameter ug/L i ug/L j ug/L j Parameter ug/L ug/L ug/L 'Dichlorodifluoromethane ND ! 0.50 !Chloroform _ ND 80 ; 0.50 - ._ . --- - ... _ - _....... l.. - Chloromethane ND O.Sa as-1,2-Dichloroethene ND j 70 j 0.50 j 'Vinyl chloride p ND z.o 0.50 cis-1,3-Dichloropropene ND - i 0.50 i 'Bromorreethane ND i 0.50 Dibromochloromethane ND 0.50 1,1,1,2-Tetrachloroethane ND 0.50 Dibromomethane ND i 0.50 j1,1,1-Trichloroethane ND zoo 0.50 Ethlbenzene ND 700 i 0.50 1,1,2,2-Tetrachloroethane I ND 0.50 Hexachlorobutadiene i ND 0.50 1,1,2-Tdchloroethane ND j 5.0 0.50 :,Isopropylbenzene0.50 1,1 Dichloroethane - i ND ` 0.50 jMethylenechloride _ I ND I 5.0 0.50 .1,1-Dichloroethene ! ND 7.0 0.50 •.;Methyl-tert-butyl ether ! ND i 0.50 1,1-Dichlor ro ene ND 0.5o •r op p ( j;Naphthalene ND i - 0.50 1 1,2,3-Trichlorobenzene j ND I 0_50 In-Butylbenzene ND 0.50 i 1,2,3-Trichloropropane j ND 0.50 n-Propylbenzene ! ND 0.50 i 1,2,4 Trichlorobenzene ND I 70 0.50 �p-Isopropyltoiuene i--- ND 1 0.50 1 4,2,4-Trirnethylbenzene ND 0-so j:sec- IBu benzene ND 0.50 1 '1,2-Dibromo-3-chloropropane ! ND 0.50 Styrene 1 ND 100 0.50 i1,2-Dibromoethane(EDB) i ND i j 0.50 tert-Butylbenzene ND ; 0.50 1,2-Dichlorobenzene ND 600 - 0.50 Tetrachloroethene j ND 5.0 s 0.50 11,2-Dichloroethane ND 5.0 0.50 Toluene ND 1000 ` 0.50 11,2-Dichloropropane ND 0.50 Total xylenes ! ND 10000 0.50 11,3,5-Trimethylbenzene ND 0.50 trans-1,2-Dichloroethene ND 100 0.50 ?1,3-Dichlorobenzene ND I ! 0.50 1 trans-1,3-Dichloropropene ND 0.50 .1,3-Dichloropropane ND 0.5o Trichloroethene ND 5.0 0.5o 1,4-Dichlorobenzene i ND t. 5.0 1 0.50 ;jTrichlorofluoromethane ND 0.50 -- - -- -- 2,2-Dichloropropane ND 1 j 0.50 ; �..-.- _........- : Q --- o �... ._..._. Surrogates s !o Recovered ! QC Limits !o)i 2-Chlorotoluene ! ND I 0.500 1 p Bromofluorobenzene 71% 70-30 .4-Chlorotoluene ND ! -- - 0'Sa 11,2-Dichlorobenzene-d4 82% ;70 130 Benzene ND 1 5.0 0.50 i '.Bromobenzene ND ; ti.so iBromochloromethane j ND 0.50 al jBromodichloromethane ND j 0.50 •.Bromoform ND 0.50 Carbon tetrachloride , ND j 5.0 0.50 I !Chlorobenzene ND 100 0.50 Chloroethane ND 0.50 Attached please find the laboratory certified parameter list. Approved By' _ . (Lab Director) _ �7/Z��` S ND=None Detected RL = Reporting Limit MCL=Max:i m Con amrnant e Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6606 Page 1 of 1 Page: 1 of 1 CERTIFICATE OF ANALYSIS Barnstable County Health Laboratory (M-MA009) yssncx s~� Report Prepared For: Report Dated: 9/17/2015 I Reid C. Ellis Ellis Brothers Construction Order No.: G1590348 23 Enterprise Road, P O Box 59 Yarmouthport, MA 02675 Laboratory ID#: 1.590348-01 Description: Water-Drinking Water Sample#: Sample Location: 82 Deer Jump Hill Road,W Barnstable Collected: 09/15/2015 Collected by: Reid Map 133 Parcel 039 Received: 09/15/2015 Routine ITEM RESULT UNITS RL MCL METHOD# ANALYST TESTED NOTE Nitrate as Nitrogen 3.4 mg/L 0.10 10 EPA 300.0 LAP 9/15/2015 Copper 0.25 mg/L 0.10 1.3 SM 3111B LAP 9/16/2015 Iron ND mg/L 0.10 0.3 SM 3111E LAP 9/16/2015 pH 6.4 PH AT 25C NA 6.5-8.5 SM 4500-H-13 DCB 9/15/2015 Sodium 7.6 mg/L 2.5 20 SM 311113 LAP 9/16/2015 Total Coliform Absent P/A 0 0 SM 9223 RG 9/15/2015 Conductance 200 umohs/cm 2.0 EPA 120.1 DCB 9/15/2015 Water sample meets the recommended limits for drinking water of all the above tested parameters. Attached please find the laboratory certified parameter list. Approved By: (Lab Director)' q12-I�/� ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House,. PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 pF,'92A CERTIFICATE OF ANALYSIS CG I+1 -Y` Barnstable County Health Laboratory (M-MA009) Recipient: Reid C. Ellis Matrix: Water-Drinking Water Ellis Brothers Construction Sampled: 09/15/2015 13:45 23 Enterprise Road,P 0 Box 59 Received: 09/15/2015 14:59 Yarmouthport, MA 02675 Collection Address: 82 Deer Jump Hill Road,W Barnstable Order#: G1590346 Sample Location: Map 133 Parcel 039 Description: 82 Deer Jump Hill Road Lab.ID: 1590348-01 Date Analyzed: 9/16/2015 @ 15:35 Sample#: Analyst: yn Method: EPA 524.2 Dilution Factor: 1 Comment: Water sample meets the recommended limits for drinking water of all the above tested parameters. EPA 524.2 - Volatile Organics by GC/MS Result,' MCL MI ., Result MCL MDL Parameter ug/ ug/L ug'/ Parameter ug/L ug/L ug/L Dichlorodifluaromethane ND 0.50 Chloroform ND 80 0.50 lChloromethane ND 0.50 cis-1,2-Dichloroethene ND 70 0.50 Vinyl chloride ND 2.0 0.50 cis-1,3-Dichloropropene ND 0.50 . Bromomethane ND 0.50 Dibromochloromethane ND 0.50 1,1,1,2-Tetrachloroethane ND 0.50 Dibromomethane ND 0.50 1,1,1-Trichloroethane ND 200 0.50 Ethylbenzene ND 700 0.50 1,1,2,2-Tetrachloroethane ND 0.50 Hexachlorobutadiene ND 0.50 1,1,2-Trichloroethane ND 5.0 0.50 Isopropylbenzene ND 0.50 11,1-Dichloroethane ND 0.50 Methylene chloride ND 5.0 0.50 '1,1-Dichloroethene _ ND 7.0 0.50 Methyl-tert-butyl ether ND 0.50 I1,1-Dichloropropene ND 0.50 Naphthalene ND 0.50 11,2,3-Trichlorobenzene ND 0.50 . n-Butylbenzene ND 0.50 !1,2,3-Trichloropropane ND 0.50 n-Propylbenzene ND 0.50 1,2,4-Trichlorobenzene ND 70 0.50 p-Isopropyltoluene ND 0.50 11,2,4-Trimethylbenzene ND 0.50 sec-Butylbenzene ND 0.50 1,2-Dibromo-3-chloropropane ND 0.50, Styrene ND 100 0.50 1,2-Dibromoethane(EDB) ND 0.50 tent-Butylbenzene ND 0.50 1,2-Dichlorobenzene ND 600 0.50 Tetrachloroethene ND 5.0 0.50 1,2-Dichloroethane ND 5.0 0.50 Toluene ND 1000 0.50 1,2-Dichloropropane ND 0.50 Total xylenes ND 10000 0.50 1,3,5-Tri methyl benzene ND 0.50 trans-1,2-Dichloroethene ND 100 0.50 1,3-Dichlorobenzene ND 0.50 trans-1,3-Dichloropropene ND 0.50 1,3-Dichloropropane ND 0.50 Trichloroethene ND 5.0 0.50 �1,4-Dichlorobenzene ND 5.0 0.50 ITrichlorofluoromethane I ND 1 0.50 2,2-Dichloropropane ND 0.50 Surrogates %Recovered QC Limits(%) -- 12-Chlorotoluerte ND 0.50 p-Bromofluorobenzene 71% 70 130 4-Chlorotoluene ND 0.50 1,2-Dichlorobenzene-d4 82% 70 130 Benzene ND 5.0 0.50 Bromobenzene ND 0.50 jBromochloromethane ND 0.50 Bromodichloromethane ND 0.50 Bromoform ND 0.50 Carbon tetrachloride ND 5.0 0.50 �Chlorobenzene ND 100 0.50 hloroethane ND 0.50 Attached please find the laboratory certified parameter list. Approved B (Lab Director) 9�-��y ��-- ND=None Detected RL = Reporting Limit MCL=Maximumt/ ntle'�f Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 Page 1 of 1 ib._ TOWN OF BARNS�TABLE LOCATION �//r19lO SEWAGE # —2ad • 2�3 VILLAGE 2Z, 15A/i't�l r� 41A ASSESSOR'S MAP & LOT "43� INSTALLER'S NAME&PHONE NO.SOF-y20—q' jg 45,f SEPTIC TANK CAPACITY 1,fD0 // LEACHING FACILITY: (type)3'S44 a--WL5` (size) NO. OF BEDROOMS BUILDER OR OWNER 006,a 13Fdgf9 PERMIT DATE: 04 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) 00 Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) cl�% Feet Furnished by -� v r - -POW- I 6p .. I Q . _' s No. 4 cocp t7—� r •• i, Fee /CJ THE COMMONWEAkTH OF MASSACHUSE TTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZIPPYication o5al 6p.5tern Con.5truction Permit Application for a Permit to Construct(for Repair( ) Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. <;Z -Jv,Ynp1A Owner's Name,Address,and Tel.No. -�4 Z -S;oq2 ' p —DoU61PCO A - v Assessor'sMap/Parcel 3 CU �� w �e 34 — �C� VI n u1r Z(,Q/w6- Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. SO$_sve L4 %I/ Type of Building: Dwelling No.of Bedrooms Lot Size l. 1 S sq. ft. Garbage Grinder (AA Other Type of Building S,.ug•ee No.of Persons 3 Showers(3 ) Cafeteria(1U) Other Fixtures / Design Flow(min.required) / TO gpd Design flow provided y gpd Plan Date - / �P Number of sheets Revision Date Title Size of Septic Tank /�v® ® Type of S.A.S. 'S "500:9 c, Description of Soil Nature of Repairs or Alterations(Answer when applicable) A)L0,J —S Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of He�Ithh.. d �i(.� ✓ Date � — Application ApproveCby Date 5 T1 Application Disapproved by: Date for the following reasons Permit No. c�lD1!�t4)- Date Issued i I�Fo- +��J . "• Fee 10000, THE COMMOI,�ILII�� TH'OF MASSACH*65:. SETTS Entered in computer: 5 PUBLIC HEALTH DIVISION - TOWN F BAFRNSTABLE, ,MASSACHUSETTS Yes 21pp ication for ogaY p�terrt Cottgtructior� Permit Application for a Permit to Construct( Repair O Upgrade( ) Abandon O ❑ Complete System ❑Individual Components Location Address or Lot No. SZ Owner's Name,Address,and Tel.No. ,j ps--�4 T�Poj Assessor'sMap/Parcel 13 3 U 39 -90. ?_-Q\ �C,l\ pQ��;�� 12� Wp- r ' z�!�� ' Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Jr`O`b gg y °tS G71�: P70,l5v ;Lg i,,cc.& S t GZ 54 Z Type of Building: DwellingNo.of Bedrooms Lot-Size ..s r � �,, �. 15 sq. ft. Garbage Grinder (AJ) t Other Type of Building S,aq�e Fa✓v.. No.of Persons -j.- ,Showers(' ) Cafeteria(/V) Other Fixtures Design Flow(min.required) 7-�` gpd Design flow.•provided,. +�J �'7 r gpd Plan Date 3�a� Cv Number of sheets ; Revision Date Title 4 s Size of Septic Tank /'jC7 d ,Type of S'A:S. � FtaI Owe,, s n'S Description of Soil 5 Q Q- 1a (\ Nature of Repairs or Alterations(Answer when applicable) _ Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afdrr 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. S' ed Date _ Application Approv4 by Date Application Disapproved by: Date for the following reasons Permit No. 1_400'G 411o� Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( Repaired ( ) Upgraded ( ) Abandoned( �bey - G p. w V at �L.� _if" \ _ has been constructed in accordance �V with the provisiio—nrs of Title 5 and the for Disposal System Construction Permit No. "_W(O dated Installer `\G� S' ��Q, e Designer V1 rl.�Q #bedrooms \j Approved design flow �L� gpd The issuance of this permit sshallyl not abbe ccoonstr e�as a guarantee that the system will(funccti a`s\d'si:n d. _ Date "1' {C/1't Inspector ------------------------------------------- r� , No. Cy Fee THE COMMONWEALTH OF MASSACHUSETTS, PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS 1=i!5Po!9a1 i§pgtem Cougtrurtion Permit Permission is hereby granted to Construct ( Repair ( ) Upgrad ) Abandon ) System located at a— N J�`Qt� ym _ � and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Construc ion must be completed within three years of the date of thi 7 Date 1.1 97Uorn Approved by. G1N, _ S I � ��,� - ( 3 3 03 r Town of Barnstable t Regulatory Services Thomas F. Geiler,Director s BAR;'STABLL MA&S. .a Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508'-790-6304 Installer& Designer Certification Form Date: / ZS a ='Permit#Sewage Z.z 3 Assessor's Map\Parcel /33 3 7. . Designer: ��N� 3'� 4�ni� �/ti Installer: Jd4y S s �G Address: Po Z? -7 Address: 1170,60 N 71719 tto oZ562 On -Iq-06 C-- was issued a permit to install a (date) (installer) septic system at y �0 64,1_ based on a design drawn by (address) t,,c. dated 3/Z 1 l'-�V- 3/900G / (designer) V I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State & Local Regulation . Plan revision or certified as-built by designer to follow. 07 IL (Installer's Signature) u� (Desi er's Signature) (Affix Designers tamp Here) PLEASE RETURN TO BARNSTABLE PT'MiC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED,UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUMLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Fo in 3-26-04.doc Alk ENVIROTECH LABORATORIES, INC. MA CERT. NO.:M-MA 063 8 Jan Sebastian Drive Unit 12 Sandwich,MA 02563 (508)888-6460 1-800-339-6460 FAX(508)888-6446 Client Name Bean,Douglas Loeatio ]05/04/06 an,82 Deer Jump Hill Rd. Address PO Box #345 .Barnstable,MA West Barnstable M 02668 Sample(Date Collected By Fred Clifford Well Drilling Sample Time 1:40 Sample Type New Well Date Received 05/04/06 Lab Order Number DW-2006-1456 Well Specs NA '` F Location Bourse'alf Ddte Collected + #Time Cvlleefed k xs mvr r _- .,. ,-a^[ >, v.t:s.az u.ao- .d,f.,:,w•#..._. :..�. ,t�,G. ..i a.,.. x:_ ... ,.,.., `ip;n fJ,;., u;-a� „'�r„7r _ _ r r Analysis Requested Units Recommended Limits AnalysisResultl Method iDateAnalyzedl Analyzed By Total Coliforrn /100 ml 0 0 9222 B 5/4/2006 MC pH pH units 6.5-8.5 6.03 4500-H-B 5/4/2006 LL Specific Conductance umhos/cm 500 65 120.1 5/4/2006 LL Nitrite-N mg/L 1.00 <0.004 300.0 5/4/2006 LL Nitrate-N mg/L 10.0 0.05 300.0 5/4/2006 LL Sodium mg/L 20.0 8.3 200.7 5/5/2006 MC Tctal Iron mg/L 0.3 <0.1 200.7 5/5/2006 MC Manganese mg/L 0.05 <0.008 200.7 5/5/2006 MC te We'+..f 1Loeatr4nSottree �� yti Y� Da Col�cted4TYme Collected; r ,,;m,a tY C'otiimets � � ; 4 s F�.�,rr.�. •�rxri^ S7 .:•`-1`-3�� r� r a:2 �L+ , .X�., ..in ��-r"F'`n /� F; `'k5`3' ' SAp x5 r`z "Y,•�a yai" .�x y'. 3E v j y..�-.+.,sk t �,. „'f'r. f;�.,,q:rv, ..SNi' '..2•+�+ 3° "t n5t{r:.Nr,r,r., .-?>,, Vl!{/QY7s ,rv,�ti;ry-,,�k,�,,.:,.F: 40 `-,F, ¢uvM Analysis Requested Units Recommended Limits Analysis Result I Method IDateAnalyzedFAnalyzedBy Volatile Organic Compounds* ug/L See comment. ND'* • 524.2 5/9/2006 Groundwater Comments: pH is below recommended limit and may have corrosive characteristics. "ND=None Detezted. Water meets ERA standards and is steitab/e fo drinkin J for parameters tested.Pa , Date S'll, v[ Ronald J.Saari Laboratory Dire i BRL=Below Reportable Limits Page 1 of 1 'See Attached q; GROUNDWATER ANALYTICAL May 9, 2006 Mr. 'Ron Saari Envi-otech Laboratories, Inc. 8 Jan Sebastian Drive Unit#12 Sandwich, MA 02563 LABORATORY REPORT Project: Douglas Bean I.a h ID: 94349 Received: 05-05-06 Dear'Ron: Enclo3ed are the analytical results for the above referenced project. The project was processed for Rush 48 Hour turnaround. This letter authorizes the release of the analytical results, and should be considered a part of this report- This report contains a sample receipt report detailing the samples received, a project narrative indicating project changes and non-conformances, a quality control report, and a statement of our state certifications. The analytical results contained in this report meet all applicable NELAC standards, except as may be specifically noted, or described in the project narrative. This report may only be used or reproduced in its entirely. I attest under the pains and penalties of perjury that, based upon my inquiry of those individuals immediately responsible for obtaining the information, the material contained in this report is, to the best of my knowledge and belief, accurate and complete. Should you have any questions concerning this report, please do not hesitate to contact me. Sinc6re'y, Eric H. Je sen s Ma ger Operatio Vr EHJ/jlI Enclosures Page 1 of 12 r GROUNDWATER . ANALYTICAL EPA Method 524.2 Volatile Organics by GC/MS Field ID: DW-2006-14560 Matrix: Aqueous Project: Douglas Bean Container: 40 mL VOA Vial Client: Envirotech Laboratories,Inc. Preservation: HCl/Cool Laboratory ID: 94349-01 QC Batch ID: VM7-2133-W Sampled: 05-04-06 13:40 Instrument ID: MS-7 Agilent 6090 Received: 05-05-06 10:00 Sample Volume: 25 FnL Analyzed: 05-09-06 06:54 Dilution Factor: 1 Analyst: LG Page: t of 2 (Ah Nvmher..:; Analyte (nncPr►t:ratlnn ;. Nrtte :;; Unite keportlrlgumn :; 75-71-8 DichlorodiFluoromethane BRL ug/L 0.5 74-87-3 Chloromethane BRL ug/L 0.5 75-01-4 Vinyl Chloride BRL ug/L 0.5 74 03 9 Bromomethane BRL ug/L 0.5 75-00-3 Chloroethane BRL ug/L 0.5 75-69-4 TrichIorofluoromethane BRL ug/L 0.5 75-35-4 I,I-Dichloroethene BRL ug/L 0.5 75-09-2 Methylene Chloride BRL ug/L 0.5 156 60-5 trans-1,2-Dictlloroethene BRL ug/L 0.5 1634-04-4 Methyl tert butyl Ether(MTBE) BRL ug/L 0.5 75-34-3 1,1-Dichloroethane BRL ug/L 0.5 594-20-7 2,2-Dichloropropane BRL ug/L 0.5 156-59-2 cis-1,2-Dichloroethene BRL ug/L 0.5 74-97-5 Bromochloromethane BRL ug(L 0.5 67-66-3 Chloroform BRL ug(L 0.5 71-55-6 1,1,1-Trichloroethane BRL ug(L 0.5 56-23-5 Carbon TetracWoride BRL ug/L 0.5 563-58-6 1,N)ichlompraffene KKI ug/I 0..5 71-43-2 Benzene BRL ug/L 0.5 107-06 2 1,2-Dichloroethane BRL ug/L 0.5 79-01-6 Trichloroethene BRL ug/L 0.5 78-87-5 1,2-Dichloropropane BURL ug/L 0.5 74-95-3 Dibromomethane BRL ug/L 0.5 75-27-4 Bromodichloromethane BRL ug(L 0.5 10061'-01-5 cis-1,3-Dichloropropene BRL ug/L 0.5 108 88 3 Toluene BRL ug(L 0.5 10061-02-6 trans-1,3-Dichloropropene RRI ug/I 0.5 79-00-5 1,1,2-Trichloroethane BRL ug/L 0.5 1.27-18-4 Tetrachloroethene BRL ug/L 0.5 142-28-9 1,3-Dichloropropane BRL ug/L 0.5 124-48-1 Dibromochloromethane BRL ug/L 0.5 106-93-4 1,2-Dibromoethane BRL ug/L 100-90-7 Chlorobenzene BRL ug/L 0.5 630-20-6 1,1,1,2-Tetrach I oroeth a ne BRL ug/L 0.5 100 41-4 Ethylbenzelfe BRL ug/L 0.5 tuts sa�iifx az-� meta-Xylene and para-Xylene BRL ug(L 0.5 95-47-6 ortho-Xylene BRL ug/L 0.5 100-42-5 Styrene BRL ug/L 0.5 75-25-2 Bromoform BRL ug/L 0.5 98-82-8 Isopropyl benzene BRL ug/L 0.5 108-86-1 Bromobenzene BRL ug/L 0.5 79-34-5 1,1,2,2-Tetrachloroethane BRL ug/L 0.5 96-18-4 1,2,3-Tri chi oropropane BRL ug(L 0.5 103-65-1 n-Propylbenzene BRL uWL 0.5 95-49-8 2-Chlorotoluene BRL ug(L 0.5 108-67-8 '1,3,5-Tri methyl benzene BRL ug/L 0.5 Page 3 of 12 Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 GROUNDWATER - ANALYTICAL EPA Method 524.2 (Continued) Volatile Organics by GC/MS Field ID: DW-2006-14566 Matrix: Aqueous ?roject: Douglas Bean Container: 40 mL VOA Vial Client: Envirotech Laboratories,Inc. Preservation: HCl/Cool La bo rato ry.I D: 94349-01 QC Batch ID: VM7-2133-W Sampled: 05-04-06 13:40 Instrument ID: MS-7 Agilent 6890 Received: 05-05-06 10:00 Sample Volume: 25 ntL Analyzed: 05-09-06 06:54 Dilution Factor: 1 Analyst: LG Page: 2 of 2 EAh Numher :: Anal..i� YF.. . .: .;iEnnCPI)t:rattt9f) .:: :; NfktPCi: ,:::UnttS -:' ReporttrtgLtmF4.;:: 106-43-4 4-Chlorotolojene BRL ug/L 0.5 98-06-6 tort-ButyIbcnzonc BRL ug/L 0.5 S•5-63-6 1,2,4-Trimethylbenzene BRL ug/L 0.5 1.35-98-8 sec-Butylbenzene BRL ug/L 0.5 541-73-1 1,3-Dichlorobenzene BRL ug/L 0.5 99-87-6 4-Isopropyltoluene BRL ug/L 0.5 106-46-7 1,4-Dichlorobenzene BRL ug/L 0.5 95-50-1 1,2-Dichlorobenzene BRL ug/L 0.5 104-51-8 n-Butyl benzene BRL ug/L 0-5 SIC-1 2-8 1,2-Dibromo-3-chloropropane BRL ug/L 0.5 120-82-1 1,2,4-Trichlorobenzene BRL ug/L 0.5 87-68-3 Hcxachlorobutadicne BRL ug/L 0.5 91-20-3 Naphthalene BRL ug/L 0.5 67-61-6 1,2 3-Trichlorobenzene BRL ug/L 0.5 QC Suriu[afe Gim}nrunil: 5Ntkeil Meeured Recivery a 1,2-Dichloro ben zene-d 10 9.2 92 % 80 120 /' 4-Bromofluorobenzene 10 8.7 87 % 80-120% Method Reference: Methods for the Determination of Organic Compounds in Drinking Water,Supplement III,US EPA, EPA-600/R-95/131 (1995). Mediod Revisiun 4.1. Report.Notations: BRL Indicates concentration,if any,is below reporting limit for analyte. Reporting limit is the lowest concentration that can be reliahly quantified under routine lahoratory operating ronditiom. Reporting limits are adjusted for sampla si7P and dilution. Page 4 of 12 Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 L No.--_—__---------- Fee-------- - BOARD OF HEALTH TOWN OF BARNSTABLE Application,forlVell Con5tructionpermit Appli ation is hereby made for a permit to Construct (l-<Alter ( ), or Repair ( )an individual Well at: Location — ddress Assessors Map and P c Zk —_ Owner Address — Installer — Driller AddXs� Type of Building Dwelling — � — ---...... — Other - Type of Building-------_----______ No. of Persons----�------.--- Type of Well rAS,le— _ Ca acit Purpose of Well---,P0 ��___ Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Heal Private Well Protection Regulation — The undersigned further agrees not to place the well in operation unt'1`a ea r ' 'c to f nce has been issued by the Board of Health. dat i Application Approved By __ ______--__—___— 5// 74 date Application Disapproved for the following reasons: ' -------_._.-------date----__. Permit No. . 0 _ Issued----`S - date BOARD OF HEALTH TOWN OF BARNSTABLE (Certificate ®f (Compliance THIS IS T T t the In 'vidual Well Constructed (bl_'Al tered ( ), or Repaired ( ) by— N, - * Installer at-0� �'� T7i L�—_------- --- -------------------------------------------------------- has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well P ote tion Regulation as described in the application for Well Construction Permit No. -�0—��-1 q Dated-5- --f ---4--- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE ---- — Inspector___----------------------- w tJ 9<�c -l1to.------------------ Fee--------------- --- BOARD OF HEALTH TOWN OF BARNSTABLE , IIIIII s 1 01pplication-*rVell Con0ructiouPermit Ap I' ation is hereby made for a perm t to Construct (l�Alter ( ), or Repair ( )an individual Well at: -- ,Icz f2 .�_v_�-�L/J �l�,�c C 05 r; Location — Address —-- -- -�--��----�—��! _------ /� Assessors Map and P c I Ow'ne/ L �� ------------------------ -------------------- - -------------- Installer - Driller Add s Type of Building — - Dwelling-- ____------ ____ Other - Type of Building No. of _ Type of Well Cos_-,C�-�- _-------- --- Capacity----------- A) 6AX�fL--------- Purpose of Well---- Agreement: ; Y- The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The a Town of Barnstable Board of Health Private Well Protection Regulation,- The undersigned further agrees not'to place the well in operation until'a Cer to om fiance has been issued by the Board of Health. ' Sr ne Application Approved B� — Cam/ a._._____ date _ Application Disapproved for the following reasons: _ date _ / Permit No. �S'�O_f9 _ O Q ---- Issued--_`-�� /�! (p -- - -— ------------ date --------- -----------.--.---.----------- ------------- -'----i----.--------1r-------- .---------- BOARD OF HEALTH TOWN OF BARNSTABLE Certificate ®f compliance THIS IS -L T FY,�T,at the In dvidual Well Constructed (�ltered ( ), or Repaired ( ) G'rort�� —__ .---------------- - --- - - -- ------- ---- ------ �, Installer � -- e 2 -/,LG --------------- at---- -------------------------------------------------------------------- has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well P ote•tion Regulation as described in the application for Well Construction Permit No.�-�--�-�°roDated—Jam------1 ---------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE--_-- --- - - -- Inspector-- - --------- ------------------------------------ftw------------ -------------------------------sloc��aassaae BOARD OF HEALTH TOWN_. OF BARNSTABLE ` Well Conoruct ion Permit Fee- C�F��d Permission is hereby granted to Cons c _ f(1-Ater ( ), or Repair ( ) a �div'dual�!VeJI at: Street _____ as shown on the application,for a Well Construction Permit No.- (9 0=.: � - ------------- are --- - -- ---------------------------------------------------- �t - — — -- -- - --------7-----------------------. ..------- �� Board of Health DATE j ..__—_.. :...,�.. .. 6�®» ..:.......... ..._T•.O'._____._. A1T'. �.,..'.4`•0' 2:6'..I e.6. .. 13�1`. .. _.._:a,p. 6-0'..__, _ � , Q.2 } 8 f (,, Q\v Lh _ 19 f' i P �:Or 4�ii �.. ,� _ '� 11 O» �. � 1l:pY �� g.p°; ('1.0`:�. • i � � i 2 �^\ ' � � '' �. �..BA.__ _._._.;,.e-0.. .....:. .�,b.. 6.O" 9.6» -1.1." � O,G_ � ..n.`. .4..0- .. .1.z:0- •. 6.O_`n:. ;. .. � - -- ' Ic o' 3a'o» .•:' - 2A:a" .. /'S A . '�iJME QfFICE _ . . ul Iz .O T6 I' L _Ng 0 i - , 0 � - ,� ..� � � '~ �� I •"" a .. ` I 4.6_ 4.b• i Zo: l aurauC4 — F � but- f i OD O� I • ,i Ir Y (, 14 , -- _-- . .� `�Tl�-5o6_�E[[tL1Y=oV-ICzSrs4l�� '_. .' '. .a••• ,.-. � 6 - - ... a�orcic _ I { ---- -- r -r---- F -.--_- 0 ..............-...... .. "AMRY o_zsrz erAr_:::_ - peA9 d C CIA.CONC.FILLED EOMO V6*" i ON:O x to x lr il0.FILL 24 Pit — m O I I i I 2��x-Qr�uh—envc r.e. - I. I I r i F. rls_� L•—n-t-•� D I 10 °s . n 4 v .9p . I I .•a �, ' --o,,--- -- A Cp"Q SLAB I — o I ' - I.. a � P D!0`I;UNC.F0.LE0:Os10lyses .. � . �,rn lo1 LLLS Lw_n_EtLg ins lo•O' 4l• s.ir - 6.3. .. q:o" _ 6:$"... .s.11. _ 4` I • q"- { IN . ...L-77T n-,11 �eoveo o� ww�r i.. i l v - rr J;L4 Lu - .. .. 1 IF loll Ste- 6%r. Nuun\ 1 x+• 0l Q i� a y, 1 t u its EE� L LL 1 'II , ` 1 _ r 1 i _F►R�TrCOC3R-'FiL7CJar*��r-- II I � € i l ' DESIGN CALCULATIONS LOT 23 LOT 22 LOT 21 GAP �`� CAPACITY REQUIRED - RESIDENTIAL N F N/F /_113 N/F o DESIGN FLOW: / LAURANCE AND MATHEW W. AND Q 4 BDRMS ® 110GPD/BDRM = 440 GPD R T APAUL A. RODLIFF ROSEMARY JOSEPH HIGH STPATRICIA LYN LAMBERT CAPACITY PROVIDED: SEPTIC TANK: N3631'39"E DH FND EXISTING ROCKWALL N36'11'25"E DH FND N3628'21"E EXISTING ROCKWJALL DESIGN FLOW = 440 Gal/Day r 21.291 O 4. __- �237.30' 127.44' -� �P�G �� X 880 Gal/Day N Q�\� P��O� SIZE UPROVIDED = 1,500 Gal/Day 90 " LOCUS J� HILL LEACHING FACILITY: -�- , N 'l - SETBACK LINE (TYP) �- SOIL DESIGTEXTURAL CLASSN PERCOLATION RCLASS 21 MPI / 9 CfVER�G..� • � ��; �V 5 513S. s rn �;� Qw LONG TERM ACCEPTANCE RATE (LTAR): 0.74 BOTTOM AREA: 33 6 x 12-10 = 429 SF -+.. " i �Q�/nu , SIDE AREA: 2'[2(33'-6")+2(12'-10")] =185 TP 2 rU Q Ova ti �.:.. / V N c� TOTAL AREA= 614 SF J LOT`�" Q � PpT2� 1• ,� ° $- s �`'` � �O� cT, � 0�- � ii -- 90---... __ 00 L.O 1 tiJ RESERVE�REA i ter F Kx- f= o C) '� J N --98 r / N w ' OD LOCUS - 000� TOTAL CAPACITY =0 54Gal/Day/SF 47,960f s.f. _ -- _f �p0 CNm � - l ��Ol ®EXISTING 1.10f acres = - WELL SYSTEM IS )!!4I DESIGNED FOR A GARBAGE GRINDER rq E o # 52 DEER JUMP HILL PjRCH ,i �.i, AND BUFFER ROSTERS 'LEGEND ti. rn %% ,, ,�,rt ,, i WEB- ARTHUR E. DES EXISTING -- ` i % ''"'' ,.;.;.�;jii .` ii �� ;, 00 EXISTING CONTOURS / - . . ' D ii �X I HUB/TACK ® PROPOSED 00 WELL o ELEV =88. f HOUSE 03 � i%, Z 5 WELL 0o PROPOSED CONTOURS (155'+ to SAS) �6i / (�SED ` X90 I PRp�P B D 'OOM �� ,, / ��` W (1 + to SAS) 1 F EBAR OOxO CONTOUR SPOT GRADE / 9X0 VVOD FRAME j i - p W / \ SET E UNDERGROUND ELECTRIC / HUB/TACK - \ LpOR= 85U " ' ,�� /;'•y%' `� &1T ` •, ° 'BORDERING WETLAND w EL V =100.00 100 \ \ / BSM� F ��)f ,i,,,/% W Rl E ' 4�Iti ��3.2 _ ,: o. p0 ® PROPOSED WELL � � � %; / c� �� e,. � ° R�252' EXISTING WELL 90 0,�• ` BD H FND --�'" #104 DEER JUMP HILL .-°°"° �� I �1 WETLAND FLAG y ,� , ,/w vEMEN\ ` TP BARBARA A. BEAN I i / 88 �_ �- PP O 0 TEST PIT I ' S / � ►- / EDGE CRUH IpN PT PERC TEST / 10 / �3XoTEMPOR CON ------ ❑ EXISTING CATCH BASIN v;, ` ° �9� TONE / - _ p S NCE 4" SANITARY / / 96 -! W ° °° �•0� ��'� ENTRA� ,,,,,` a PROPOSED OP C.BSEED UNDERGROUND 1/2" HANDLE TEE `1 '� 51 .� / �l� /i OX W PROPOSED WATER LINE W �0 90 �' �a o• GB �86 / ; -'hp \� �� ® REBAR SET 18" FILTER \ l / /�00 `K �� / ° CBDH EXISTING STONE WALL CARTRIDGE \ p� 92 '\ // t // FND PROPOSED HAYBALES 4" SEWER \ / � '�' ` 0� �\ PIPE 10 FN[�CBDH """ � 8 ZONING: RESIDENTIAL RF .--- FILTER R AR 25.00' _ __ 00 38 SETBACKS: GASKET SET L-L-2�O�' R 280 _ �-�� $6 f FRONT - 30' R=120.00 S34 3123W / GAS BAFFLE �- ��_.---" � � P// \H /� SIDE - 15' , __ / 'FER �pG� 8�' REAR - 15 ZABEL A1800 RESIDENTIAL SEPTIC TANK 0 8vF / 6 EFFLUENT FILTER SPECIFICATIONS OF t; i APPLICATION:' SINGLE'FAMILY HOMES. �, i �� WE �� ' "F- _ i' �= I FLOW RATE: 800 GPD. INSTALLATION: THE A1800 EFFLUENT FILTER / r �--�'' /r , 11TMR1�iY ENTIRE SITE IS LQCATED y t CARTRIDGE WILL FIT ANY 4" SANITARY TEE AND C3PtA1� IN FLOOD ZONE C ON SEWAGE PIPE USE AS A SEPTIC TANK OUTLET -'"' °f / � ._____ ____ G � -^ e FLOOD MAP 2500 010 011C BAFFLE. EXTEND THE SEWAGE PIPE AT LEAST - __- / V5 gO ram, ONE INCH BELOW THE BOTTOM OF THE FILTER r - R� '� EFECTIVE DATE: JULY 2, 1992 CARTRIDGE GASKET. /--_ / / �� ` R PNg�R ��N OF M4SJ, G QUESTIONS: CALL 1-800-221-5742 � f- `� C � DONALD F. ZABEL FILTERS a/ ! 0 CI IL MODEL A1800 NOT TO SCALE I �^ <1�T it ...331 ERR, gO�J S EXCAVATION NOTE: 3/30/06 MOVE HOUSE, GARAGE, SAS DLH � 3/28/06 PORCH, WETLAND LINE TRB 0 10 20 I Z CONTRACTOR IS TO REMOVE ALL LOAM, SUBSOIL AND OTHER UNSUITABLE PATE DESCRIPTION INIT. � ��l`1 MATERIAL (TO C2 LAYER) IN THE AREA BENEATH AND FOR 5 FEET ON ALL SIDES REVISIONS E� OF THE LEACHING FACILITY. EXCAVATED MATERIAL IS TO BE REPLACED WITH 0 4o so SoFE I METERS CLEAN COARSE SAND FREE FROM CLAY, FINES, OR OTHER UNSUITABLE DONALD F. BRACKEN JR. 20 BENCHMARK DESCRIPTION GRAPHIC SCALE 1" = 20' MATERIAL,IN ACCORDANCE WITH 310CMR 15.255(3). 110 STATE RD. SAGAMORE BEACH, MA. HUB AND TACK - - 02562 ELEV. = 100.0 (ASSUMED) PLAN OF SEWAGE DISPOSAL SYSTEM TOP NOTES AND SPECIFICATIONS TEST PIT INFORMATION OF FND. ROPOSED INSTALL RISER TO 94.0 INISHED GRADE WITHIN 6" OF INSTALL RISER TO WITHIN 6"OF 1. All risers are t0 be made Watertight. DEEP OBSERVATION HOLE LOG - TEST PIT #1 DEEP OBSERVATION HOLE LOG - TEST PIT #2 PLAN REFERENCE FINISHED GRADE 2. All pipes to be Sched. 40or equivalent. yu�ACE SOIL SOIL 0M(SRXI I� DACE FRW SOIL saL 0M(sacml� 92.5 FINISHED GRADE FINISHED GRADE P P FEET HoS IL Toc�AE (MCOLOR u SELL) MorniNc HORIZON SOIL TEXTURE COLOR PROP. f7vo. 92.0+ 3. All joints are to be made watertight. TOP EL"'.0 LOAMY SET INCHES 1O�Y sw e.X WA% ( ) o01EnCv,x aW�U TOP EL-94.5 ( A) (MUNSELL) MOTTLING puyp) L.C.P. 13 7 8 0 8-B HEIGHT=9.0' INSTALL RISER TO 4. All stone is to be double washed. 1 0-8' A SAND tOYR 3/3 1 o-e° A SANG tOYR 3/3 WITHIN 6" of 5. All components are to have a minimum of 9"and a maximum of 36"of cover. FINISHED GRADE FINISHED GRADE 6. The contractor is to verify all elevations and utility locations prior to construction. Any differences shall be 2 8-32' a SANDLOAMY 7.5YR 5/6 2 8-34' B SANDY 7.5YR 5/6 92.0 IEL=89.3 EL-91.7 EL. = 91.25 brought to the attention of the engineer. 3 3 7. There are no conflicts with Title V, Section 15.220(4)(k) - location of public and private water supplies. PROPosEO ENTIRE 8. There are known sources of water supply, streams or drains within 100' of the proposed system. 4101, 01 LAB 4 SILT CURRENT OWNER aC APPLICANT FLOOR L= 11' FT. 3" MIN. 3" MIN. 2.5' OF PP y, P P Y IS TO BE 32-72" C1 LOAM IDYR 5/4 ELEV. S= .02 FT/FT 1 I L= 10' Fr. COVER 9. There are no wetlands within 100'of the proposed system. 5 SYSTEM OUT 5 DOUGLAS BEAN 85.0 6" SEE NOTE 15 3w S= .02 FT/FT EL. = 89.50 10. The Septic tank and D-box shall be installed level and true to grade on a level stable base that has been 6 32-90" C1 SILT 1DYR 5/4 g EL-88•5 104 DEER JUMP HILL ?� mechanically compacted and on to which six inches of crushed stone has been placed to minimize uneven 72_�. C2 COARSE z sY 7/4 WEST BARNSTABLE, MA. 000 000 000 000 °°,•° ° settling. Sec. 15.228 1 7 7 SAND 02668 �°•e°e•o° 000000a o000000 ° g O Ia-64.5 E<=67.0 - _f12 6w 2Ex...00 o°• ° 000 0 000 4.83 x 8.5 LEACHING CHAMBERS 00000 00 ° ° 11. A Zabel Filter is to be installed at the outlet end of the tank. 14"* °° o 0 o a o 0 0 3 REVD.) (SEE SECTION) 00000 0 0 •° 8 8 4'0" MIN. MIN. 12. The Zabel Filter must be removed at least once a year and cleaned,when the tank is pumped. LIQUID DEPTH 13. Use (3) 500 gal. leaching galleys for the soil absorption system with 4'of stone all around. 9 0-144 C2 COARSE 2.5Y 7/4 9 ON-SITE SEWAGE DISPOSAL SYSTEM CORROSION SAND RESISTANT - DB INLET INV. 14. A 5' stripout around the entire soil absorption system is to be done down to the C2-layer. 10 -10 - GASf BAFFLE -,--*, $9.5 33.5' 15. Strip-out entire C1 layer and replace with clean Title V sand. 11 11 AND SITE PLAN ROP. HOUSE INVER IEL=80.090.2 DB OUTLET INV. BOTTOM CHAMBERS 1212 89.3 87.0 (2% Min.) Finish Grade 13 13 82 DEER JUMP HILL * INSTALL TEES~IN ACCORDANCE WITH TITLE 5 7. INVERT ELEV. Compacted Earth Fill 14 � 14 MAP 133 PARCEL 39 TANK INLET INV. " 90.0 TANK OUT-INV. 89.0 89 7 INVERT ELEV. 12" Min. NO G.W. FOUND NO G.W. FOUND WEST B A R N S TA B L E g9.0 2" SOIL EXAMINATION PERFORMED BY: ED STONE SOIL EXAMINATION PERFORMED BY: ED STONE M A• ' 12/15/2003 12/15/2003 MIN. OF 2" OF o0 0°... o 000 0 0 a o o °o° 4" (0.25') 1/8" TO 1/2" ° ° WASHED STONE. o ° 24" NO GROUNDWATER ENCOUNTERED DOWN TO EL. 80.0 ° o° o o° °oo °°o°°$ 0 0 0 0 °o o °°oo og PERCOLATION TEST DATA BENNETT ENGINEERING NO. DATE ELEV. RATE NOTES LAND SURVEYING,ENGINEERING,&DEVELOPMENT SERVICES PROPOSED 1,500 GALLON PRECAST CONC. 3/4" To 1-1/2" I 1 12 15 03 < 2 M.P.I. TEST PIT #1 PRECAST CONC. SEPTIC TANK DISTRIBUTION BOX SOIL ABSORPTION SYSTEM WASHED STONE. �-4.0 4.8 4.0 PO BOX297 TEL_(508)8884868 H-10 LOADING SAGAMORE BEACH,MA02562 FAx.(508)888,4867 DRAWN BY: BDH DATE: 3/21/06 SYSTEM PROFILE (not to scale) S E C TI ON (not to scale) WIITNESSED BY: D. MIORANDI J0B# 08j9FB SHEET N,O. 10 OF 1 _ --�- _ _ -- --- ---- DESIGN CALCULATIONS LOT 22 LOT 21 d,P �P CAPACITY REQUIRED - RESIDENTIAL LOT 23 N/F � o N/F O DESIGN FLOW: N F h MATHEW W. AND Q 4 BDRMS A 110GPD/BDRM .= 440 GPD / LAURANCE AND R A PAUL A. RODLIFF ROSEMARY JOSEPH \Z PATRICIA LYN LAMBERT IGH sT. CAPACITY PROVIDED: _ SEPTIC TANK: N3631'39"E DH FND EXISTING ROCKWALL N36*11'25"E DH FND N36'28'21"E EXISTING ROCKWALL DESIGN FLOW = 440 Gal/Day 21.29' ! �237.30'% 127.44' -! \P'�G �Q�.o� REQUIRED SIZE X 880X Gal/Day -104 / Iu o LOCUS Q HILL SIZE PROVIDED = 1,500 Gal/Day --102'- J J -' / / / �O 90 J� LEACHING FACILITY: �- � DESIGN PERCOLATION RATE: S2 MPI / S TBACK LINE (TYP) / �Q SOIL TEXTURAL CLASS: CLASS I 5 Sip rn = - O� LONG TERM ACCEPTANCE RATE (LTAR): 0.74 100 ' BOTTOM AREA: 33'6" x 12-10" = 429 SF '„y� ,r- N O ' l SIDE AREA: 2'[2(33'-6")+2(12'-10")] =185 2� 1 ' D`" ^ TOTAL AREA= 614 SF _ o V PT2 1 y O � • O 0 / 9 - 1 C Q � , o / 1 39 O _ 0 Z-V J N Q1 c,, LOCUS 1 »_1 000� x LTAR 0.74Ga1/Oay/SF LOT RESERV ram- ,;rx / N) Q b (V ,,_ 0) f CO w TOTAL CAPACITY = 454 Gal/Day --98 47,960f s.f. I ' - Q O N ®EXISTING 1.10t acres OO -, m {' WELL SYSTEM IS NQI DESIGNED FOR A GARBAGE GRINDER i0 93xO , LO I 1F. �. CK :,:. •� gpRX9 ��% �. -""' # 52 DEER JUMP HILL Q• �' Lfl PR SAND BUFFER \ -�'` ARTHUR E. L7ESROSIERS LEGEND N v / 100 Y� �. \ pp EXISTING CONTOURS EXISTING i �- / - :; !�'' 1 !� �� / HUB/TACK PROPOSED �--PROPOSED CONTOURS / -P o . . ELEV =88. ® 00 WELL ",. -- HOUSE 1J) � 0 5 �� WELL (155 + to SAS) / \ l :; 6 / � / \ 0 /.' PR04 BSDROOME 1 I�m X9 / op� W (1� + to SAS) OOxO CONTOUR SPOT GRADE f . F�EB AR FRA 1 ��/ +� W \ SET E UNDERGROUND ELECTRIC / F = 94 0_ 5 O 1 \P� °�� \ • \ -BORDERING WETLAND cfl HUB TACK 100 \ �; OFt-OOR 8 I �;,�; ;:.!i%' ' �T Rl •' �� .7 c:I EL =100.00 BS �, '` W �' • L�3 o• 0 PROPOSED WELL °' ,: „ a;:-.; is%% ' g Rs252" - --- O EXISTING WELL � \ � � BDH FND \ �� , #104 DEER JUMP HILL �� Ec a, ,P o f � � K � •�'�" � -� i��N� \ ., I �1 WETLAND FLAG i COI 1 w `•� r. /Pp, Mg sa TEST PIT BARBARA A. BEAN / gs �• %E OF � NE(D PT La / 107 5' J 0 / 8� E� ARY CR lJCT10N ----- O PERC TEST � -MpOR CpNSTR I - o EXISTING CATCH BASIN STOOE 6 Vd / TR o PROPOSED UNDERGROUND g • ' -' _" ` p� // ` � EN /�� -•---.-�., ELEC. BOX 1/2" HANDLE 4" SANITARY \ / 4_ � / �/ / ~w •517" // /-TEE �\ / / / 9 // // W PROPOSED WATER LINE ! E 2 / ® REBAR SET W •••� R\M /� R\vP'�E /�� CBDH � EXISTING STONE WALL 18" FILTER FND PROPOSED HAYBALES CARTRIDGE / 000000 4" SEWER \ � �� PIPE `v // wow1 // / J CBDH / Q / FND��/ // "'~' 8 ZONING: RESIDENTIAL RF / - f 7 SETBACKS: FILTER RE 25.00 - - _280.00 //Cg 6�8 T - 30' GASKET \ SET I.-L��O R - ! M�N�� B FRONT � R-120.00 S34 31'23"W 1 ' / P p,�/ SIDE - 15' � _ --' _ Eon/ 8 vW GAS BAFFLE / - ZABEL A1800 RESIDENTIAL SEPTIC TANK / __•___.--- 'r guFFER 6 REAR 15 • EFFLUENT FILTER SPECIFICATIONS / i /�. N� s 1 OF APPLICATION: SINGLE FAMILY HOMES. � i� �O /�j� � P F �'/�, ►�� - FLOOD ZONE: FLOW RATE: 800 GPD. . TaTNY ENTIRE SITE IS LOCATED INSTALLATION: THE A1800 EFFLUENT FILTER' // r r` / R•_= " CARTRIDGE WILL FIT ANY 4" SANITARY TEE AND / / L. .__' -_ C.`•kASC'iT �_.t� ,,.,,. -.J,�;•- � ...,E-�e,l ,.. ... SEWAGE PIPE USE AS A SEPTIC TANK OUTLET $/ _ 0 _ ��'===� °' _ MAP.2500 010 011 C _ FLOOD BAFFLE. EXTEND THE SEWAGE PIPE AT LEAST _� - -'�� 5 R.( BAG `:,ti, OF qs EFECTIVE DATE: JULY 2, 1992 ONE INCH BELOW THE BOTTOM OF THE FILTER -_ % / • B R 1N M CARTRIDGE GASKET. �-- .. � , � CRP �� DONALD F. QUESTIONS: CALL 1-800-221-5742 �' 6/ G•%t� N,J t '� 0 3 � v CI IL ZABEL FILTERS / / 0 r' N 1 f MODEL A1800 NOT TO SCALE 3 BOG � CR ANBERR� 3/30/06 MOVE HOUSE, GARAGE, SAS DLH EXCAVATION NOTE. 0 10 20 � CONTRACTOR IS TO REMOVE ALL LOAM, SUBSOIL AND OTHER UNSUITABLE J� 3/28/06 PORCH, WETLAND LINE TRB DATE DESCRIPTION [NIT. 00 �.r1• MATERIAL (TO C2 LAYER) IN THE AREA BENEATH AND FOR 5 FEET ON ALL SIDES REVISIONS FEE OF THE LEACHING FACILITY. EXCAVATED MATERIAL IS TO BE REPLACED WITH DONALD F. BRACKEN JR. I METERS CLEAN COARSE SAND FREE FROM CLAY, FINES, OR OTHER UNSUITABLE BENCHMARK DESCRIPTION 0 20 4o so so � 110 STATE RD. MATERIAL,IN ACCORDANCE WITH 310CMR 15.255(3). GRAPHIC SCALE 1" = 20' SAGAMORE BEACH, MA. HUB AND TACK j 02562 ELEV. = 100.0 (ASSUMED) PLAN OF SEWAGE DISPOSAL SYSTEM ; TOP NOTES AND SPECIFICATIONS TEST PIT INFORMATION OF FND. ROPOSED INSTALL RISER TO - 1. All risers are to be madewaterti ht. INSTALL RISER TO WITHIN 6 of g DEEP OBSERVATION HOLE LOG - TEST PIT fl DEEP OBSERVATION HOLE LOG - TEST PIT /2 PLAN REFERENCE 94.0 INISHED GRADE WITHIN 6" OF FINISHED GRADE 2. All pipes to be Sched.40 or equivalent. SWAGE SOIL salDEP7"FROM 9M NW"k ' "`E son TE aE COLOR SOIL 92.5 FINISHED GRADE p p sal TEXTURE ca°R sal Sam FINISHED GRADE 3. All Joints are t0 be madewatertight. r� �o HORIZON' (USDA) (MUNSELL) MOTTLING WWO,X 1 FEET M94.5 HORIZON (USDA) (MUNSELL) MOTTLING Y xau L.C.P. 137808-B 07195EIICi x CG1E1) TOP EL-94.5 'I LOAMY PROP. FWD. 92.0+ INSTALL RISER TO 4. All stone is to be double washed. 1 O-r A LOAMY 10YR 3/3 o-a' A SAND10YR 3/3 HEIGHT=9.0' " „ „ 1 WITHIN s of 5. All components are to have a minimum of 9 and a maximum of 36 of cover. LOAMY FINISHED GRADE FINISHED GRADE a-3r 9 LOAMY 7 5YR s e-34- 9 SAND 7.5YR 5/6 92 0 6. The contractor is to verify all elevations and utility locations prior to construction. Any differences shall be 2 SAND 2 brought to the attention of the engineer. a-�3 ELl91.7 EL = 91.25 7. There are no conflicts with Title V, Section 15.220(4)(k) location of public and private water supplies. 3 PROPOSED ENTIRE 3 8. There are known sources of water supply, streams or drains within 100'of the proposed system. 4 Ae�soRPna+ O' LA'R 4 SILT CURRENT OWNER & APPLICANT FLOOR L= 11' FT. 3" MIN. 3" MIN. 2.5' OF p P Y Is TO K 32-72• C1 LOAM 10" 5/4 ELEV. S= .02 FT/FT 12" L= 10' FT. COVER 9.There are no wetlands within 100'of the proposed system. 5 SYSTEM OUT 5 DOUGLAS BEAN 85.0 6" S= .02 FT rT 10. The Septic tank and D-box shall be installed level and true to grade on a level stable base that has been SILT SEE NOTE 15 EL"W.5 104 DEER JUMP HILL 3" / EL. = 89.5D 6 �-90• � LOAM 10YR 5/4 6 2" ............. mechanically compacted and on to which six inches of crushed stone has been placed to minimize uneven 72-W C2 COARSE 2.5Y 7/4 WEST BARNSTABLE, MA. -a 000 000 000 000 „••o e settling. Sec. 15.228 1 7 �_�5 7 EL-87.0 02668 x°•;;.:' 0000000 4.83'x 85' LEACHING CHAMBERS E3000000 . o O 0 g ( ) 12 6" 2 . .o.• . 000 0 000 0000000 11. A Zabel Filter is to be installed at the outlet end of the tank. g 8 14" : ° '• a000000 3 REQb.) (SEE SECTION) 0000000 ••: •.H-L " MIN- 12. The Zabel Filter must be removed at least once a year and cleaned,when the tank is pumped. LIQUID DEPTH _ - 13. Use (3) 500 gal. leaching galleys for the soil absorption system with W of stone all around. 9 144 C2 COARSE 2.5Y 7/4 9 ON-SITE SEWAGE DISPOSAL SYSTEM CORROSION 14. A 5' stripout around the entire soil absorption system is to be done down to the C2-layer. 10 10 RESISTANT DB INLET INV. AND SITE PLAN GAS BAFFLE 89.5 33.5 15. Strip-out entire C1 layerand_replace with clean Title V sand. 11 11 ROP. HOUSE INVER 90.2 ; ' ` B OUTLET IN . BOTTOM CHAMBERS 12 12 $2 DEER JUMP HILL . - - 89.3 87.0 (29� Min.) Finish Grade 13 13 * INSTALL TEES IN ACCORDANCE WITH TITLE 5 7' INVERT ELEv. Compacted Earth Fill 14 14 TANK INLET INV 89.0 _ Ito - MAP � �� PARCEL 3 9 Hi 90.0 TANK OUT-INV. 12' Min. IND G.W. FOUND No G.W. FOUND WEST BARNSTABLE MA. 89.7 INVERT 9 L0 2" 'SOIL EXAMINATION PERFORMED BY: ED STONE SOIL EXAMINATION PERFORMED BY: ED STONE ...••. ..... 112/15/2003 12/15/2003 " o c•�o•000 °o o °• 0 000 4" (0.25') Q MIN. OF 2 OF 00° °o °p o 1/8" TO 1/2" ° 11 WASHED STONE. 0 ° 24" NO GROUNDWATER ENCOUNTERED DOWN TO EL. 80.0 0 00 0 0° Q 0 00 0 00 °o$ PERCOLATION TEST DATA B E N N ETT ENGINEERING 00 00 000 08 ° o NO. DATE ELEV. RATE NOTES LAND SURVEYING,ENGINEERING,&DEVELOPMENT SERVICES PROPOSED 1 500 GALLON PRECAST CONC. 3/4" To 1-1/2" I I I 1 12 1.5 03 < 2 M.P.I. TEST PIT #1 PRECAST CONC. SEPTIC TANK DiSTRIBUTION BOX SOIL ABSORPTION SYSTEM WASHED STONE. I--4.0' 4.8' I -4.0'--I PO BOX297 1000�TEL.(508)888,4868 H-1 O LOADING SAGAMORE BEACH,MA02562 FAx.(508)888,4867 DRAWN BY: BDH DATE: 3/21/06 WITNESSED BY: D. MIORANDI _ CHECK BY: DFB SCALE: 1"=20' SYSTEM PROFILE (not to scale) SECTION (not to scale) JOB # 0879 SHEET NO. 1 OF 1 T