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Home My WebLink About0010 FIELD STONE ROAD - Health 10 FIELDSTONE RD. WEST BARNSTABLE A = 111 054 ' i 0 r Commonwealth of Massachusetts r� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 10 Field Stone Road Property Address Emery Owner Owner's Name information is West Barnstable ✓ Ma 02668 8/15/2020 required for 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 67/0 /#60& filling out forms on the computer, use only the tab Sean M. Jones key to move your Name of Inspector cursor-do not S.M.Jones Title V Septic Inspection use the return Company Name key. 74 Company A Lane Co � Company Address Centerville Ma 02632 CityrTown State Zip Code low 774-248-4850 smjonestitle5@gmail.com, S14522 sean@smjonestitle5.com License Number B. Certification I certify that: 1 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 8/15/2020 Inspectors 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 f Commonwealth of Massachusetts Title 5 Official Inspection Form �- Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 10 Field Stone Road Property Address Emery Owner Owner's Name information is West Barnstable Ma 02668 8/15/2020 required for every page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The property located at is served by a Title V septic system consisting of a 1000 gallon septic tank, distribution box and 20 ARC 3616 leaching chambers. Although the system was found to be in proper working condition at the time of inspection this report does not guarantee future performance under similar or increased usage. 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts �e Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 10 Field Stone Road Property Address Emery Owner Owner's Name information is required for every West Barnstable Ma 02668 8/15/2020 page. Citylrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes(cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 I Commonwealth of Massachusetts - Title 5 Official Inspection Form �- Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 10 Field Stone Road Property Address Emery Owner Owner's Name information is required for every West Barnstable Ma 02668 8/15/2020 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 i Commonwealth of Massachusetts +� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 10 Field Stone Road Property Address Emery Owner Owner's Name information is required for every West Barnstable Ma 02668 8/15/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [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 10 Field Stone Road Property Address Emery Owner Owner's Name information is required for every West Barnstable Ma 02668 8/15/2020 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered"yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 f Commonwealth of Massachusetts a Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 10 Field Stone Road v Property Address Emery Owner Owner's Name information is West Barnstable Ma 02668 8/15/2020 required for every page. Cityfrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 gpd Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: unknownDate L15in.p.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 r Commonwealth of Massachusetts Title 5 Official Inspection Form n Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 10 Field Stone Road Property Address Emery Owner Owner's Name information is required for every West Barnstable Ma 02668 8/15/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 2. Commerciallindustrial 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 !n F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u 10 Field Stone Road Property Address Emery Owner Owner's Name information is required for every West Barnstable Ma 02668 8/15/2020 page. Citylrown 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: system repaired 8/2/2010 per town records Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 2.5feet Material of construction: ❑ cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints in good condition, no leakage, vented through roof. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 10 Field Stone Road Property Address Emery Owner Owners Name information is required for every West Barnstable Ma 02668 8/15/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information(cont.) 6. Septic Tank(locate on site plan): Depth below grade: 2 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) El Yes ❑ No Dimensions: 1000 gallons Sludge depth: 5" p Distance from top of sludge to bottom of outlet tee or baffle 3' Scum thickness 2° Distance from top of scum to top of outlet tee or baffle 7" Distance from bottom of scum to bottom of outlet tee or baffle 10" How were dimensions determined? Opened covers and tookmeasurements Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank does not need to be cleaned now but should be done soon and again every 2 years for proper maintenance. water level was even with outlet, tank was not leaking and was structurally sound. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Forth: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 �., 10 Field Stone Road Property Address Emery Owner Owner's Name information is required for every West Barnstable Ma 02668 8/15/2020 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: I Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts rs Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 9 p Y ►Y 4 10 Field Stone Road Property Address iEmery Owner Owner's Name information is required for every West Barnstable Ma 02668 8/15/2020 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments condition of alarm and float switches etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Distribution box was functioning as intended. t5insp.doc•rev.7/2612 01 8 Tdle 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments e 10 Field Stone Road Property Address Emery Owner Owner's Name information is required for every West Barnstable Ma 02668 8/15/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No" Alarms in working order: ❑ Yes ❑ No" Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): " If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 20 ARC 3616 ❑ 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 f Commonwealth of Massachusetts - Title 5 Official Inspection Form �- Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 10 Field Stone Road Property Address Emery Owner Owner's Name information is required for every West Barnstable Ma 02668 8/15/2020 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.): Leaching facility consists of 20 ARC 3616 chambers. s.a.s.was video inspected from vent and was found dry and clean with no signs of past overloading. 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 L� 10 Field Stone Road Property Address Emery Owner Owner's Name information is required for every West Barnstable Ma 02668 8/15/2020 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments ` 10 Field Stone Road Property Address Emery Owner Owner's Name information is required for every West Barnstable Ma 02668 8/15/2020 page. Citylrown 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 J O /L I 2 T3r �g 0a Az OZ 3 A3 27 �3 13 .E I t5insp.doc•rev.7/262018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts r= Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 10 Field Stone Road Property Address Emery Owner Owner's Name information is required for every West Barnstable Ma 02668 8/15/2020 page. Citylrown 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: 12+ feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Groundwater was established by accessing town of Barnstable groundwater contour maps. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 10 Field Stone Road Property Address Emery Owner Owner's Name information is required for every West Barnstable Ma 02668 8/15/2020 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 Idle 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 f CERTIFICATE OF ANALYSIS ;u Barnstable County Health Laboratory (M-MA009) Recipient: Order No.: G20121398 Jane Emery Report Dated: 08/21/2020 3 Pine Ridge Rd. Submitter: Jane Emery Haverhill, MA 01830 Description: rtn Laboratory ID#: 20121398-01 Matrix: Water-Drinking Water Sample#: Sampled: 08/12/2020 10:35 By: JE Collection Address: 10 Fieldstone Rd.,W.Barnstable Received: 08/12/2020 11:03 By: Veronic Sample Location: Turn Around: Standard Routine ITEM RESULT . UNITS RL MCL METHOD# ANALYST TESTED TIME Nitrate as Nitrogen 0.10 mg/t: 0.10 10 EPA300.0 CL, 08113/2020 Copper ND mg/L 0.10 1 EPA 200.8 RS 08/13/2020 12:14 Iron 0.13 mg/L 0.10 0.3 EPA 200.8 RS 08/1312020 12:14 Manganese ND mg1L 0.025 0.050 EPA 200.8 RS 08/13/2020 12:14 Sodium 16 mg/L 2:5 20 EPA 200.8 RS 08/13/2020 12:14 Total Coliform Absent P/A 0 0 SM 922313 RG 08/12/2020 17`.17 Conductance 170 umohs/cm. 2.0 EPA120.1 KB 08/12/2026 11:36 pH 6,2 PH AT 25C NA 6.5-8.5 SM 4500-H-B KB 08/12/2.020 11;36 Based on the results of the parameters tested,the water is suitable for drinking. Attached please find the laboratory certified paramater list. Approved By:. (Lab Manager) ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level R1QG M7in_Cfrnn4 Dr% 12nv A97 RRA nnclIn nt.. eno e-7c cenc Donn• + ..F 4 �. TOWN OF BARNSTABLE, LOCATION to C= eld S"P ac) SEWAGE# 2010 - Z VII LAU r,:,r"j-e ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. i' ,4eWIC/e SEPTIC TANK CAPACITY i o LEACHING FACILITY.(type) zo 0 c'C 3(Q 1 u It Zy(size) U, NO.OF BEDROOMS 3 OWNER ;4M s C w�sctit„ PERMIT DATE: '7' Z 3' c "_0 COMPLIANCE DATE: ' ' Z - 7- Separation Distance Between the: LQ Maximum Adjusted Groundwater Table.to the Bottom of Leaching Facility N f 1 Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) , Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY �- t LL 2 A/ It,S - I}3 A4 3t 3y 3R.s R� se 3s yo.s ft� 30 530 11 30. f !/ �-. Commonwealth of Massachusetts N _ 007 Title 5 Official Inspection Form 1. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Fie/V s-�o4.e u Property Address 1`0 .T� vies �=�ee ��$ Owner Owner's Name [' �J "� information is -�'p D�G 6� 9 J O required for every (4/es-� page. City/Town State Zip Code Date of I spectio ' .1—b %y 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 Infor ation S J 3�13 filling out forms n on the computer, use only the tab key to move your Name of Inspector r. cursor-do not j l use the return Company Name �wl(� key. jeO do 7t f c��O Company Address m '�sA Cb City/Town �'0-3 �OV— 77/ v State�D?� Zip Code ri4m Telephone mber 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 s m: 1. Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 9' S Inspectop 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. r -^.... t5insp.doc•rev.712612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 r Commonwealth of Massachusetts ;ip Title 5 Official Inspection Form 3 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 0 Ft G IJ S off_ C Property Address Owner Owner's Name information is required for every page. Cityf town State Zip Code Date of Insp ctio C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System P ses: 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: 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.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 r Commonwealth of Massachusetts p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments L Property Address Ev4ee Owner Owner's Name 9-m-4-44 information is required for every �&54- orv-- o�L b J page. City/Town State Zip Code Date of Insp ction C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑' broken pipe(s) are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.tloc•rev.7/28/2018 Title 5 Offidal Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments /0 �� s�o XQ Property Address �iwJer Owner Owner's Name 1 information is Ues J �nSTa required for every page. Cityrrown State Zip Code Date oft spectio 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 ❑ P 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.00c-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System.Page 4 of 18 r Commonwealth of Massachusetts p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments fV /D Property Address mow►e r Owner Owner's Name information is �eS„� �� { Oil; 69 Q— S.required for every !! T page. City/Town State Zip Code Date of In ection 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 ❑ p Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow ❑ FL-ie� 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. ❑ �ny 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.] ❑ 21-� T 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 C.4. 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.7/26r2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 r c Commonwealth of Massachusetts Id ; Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments /O Flel� lei Property Address vie r Owner Owner's Name information is ( / &,-oQ e /�,4 III required for every page. CitylTown State Zip Code Date of I specdo 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 ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ re any of the system components pumped out in the previous two weeks? ❑ as 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)] I t5insp.doc•rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts :. lip Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address Owner Owner's Name information is 1 1 (� required for every QS / hf7 Qe ��961 / v � page. City/Town State Zip Code Date of I spectio D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): Number of bedrooms (actual): ? DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): Description: / /000 C'-.' ! I0 y tG % 0-Al 's�C0 e� 15 �e Number of current residents: O Does residence have a garbage grinder? ❑ Yes No Does residence have a water treatment unit? ❑ Yes aiNo 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 Seasonal use? ❑ Yes No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yet No Last date of occupancy: D@ t5insp.doc•rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments /0 Property Address Owner Owners NameCs/7q-� / S 41 information is � pr` ��6 6� / required for every page. City/Town State Zip Code Date of spect' n 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 to If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc-rev.7I2EI2018 Title 5 official Inspection Form:Subsurface Sewage Disposal system•Page 8 of 18 f Commonwealth of Massachusetts fi Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address JL�- v'?'e Owner Owner's Name information is S� required for everyAe,4- X Oy]G Cy page. City/Town State Zip Code Date of spectio D. System Information (cont.) 4. Type of S m: 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): Pe 0� Approximate age of all components, date installed (if known) and source of information: -rawL, o jQ wi i ei mL - Y,4-S dofo Were sewage odors detected when arriving at the site? ❑ Yes ❑ No 5. Building Sewer(locate on site plan): Depth below grade: feet Material of constructi;140 El cast iron PVC ❑ other(explain): ! 0 Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): I t5insp.doc-rev.7/26/2018 Title 5 Offidal Inspection Forth:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts p Title 5 Official Inspection Form is Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address Owner Owner's Name information is required for every page. City/Town State Zip Code Date Inspec' n D. System Information (cont.) 6. Septic Tank(locate on site plan): 3 Depth below gra : feet Materia 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 15 C 9 lc� Gam.llw� Dimensions: a 073 ,, Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle A0 —Sc Scum thickness Distance from top of scum to top of outlet tee or baffle �1 Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): T i v7 Wt3-0-d- 00 Cpv►d j77'o.� t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 r Commonwealth of Massachusetts �. Title 5 Official Inspection Form la Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1, 0 Property Address Owner Owner's NameW�,5� &r45 l �� u�6-9information isb required for every page. CityfTown State Zip Code Date of In ection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 11 of 18 f Commonwealth of Massachusetts l Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments . ..... Ft4 IC( t.!�At441!_ Property Address ,AA Owner Owner's Name C,/es 1 1�4s'.�,q,//,/L�/ O information is required for every page. City/Town State Zip Code Date of I pection 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 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.): n� /0d t5insp.doc•rev.7/26/2018 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 /C/ Property Address �M Owner Owner's Name U Q .5W information is (� required for every C94 page. City/Town State Zip Code Date of I pection 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: 0c;10 / J p6 VAG01b?,rf ❑ leaching pits number: ❑ leaching chambers - number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: ---- l5insp.doc•rev.7/26/2018 Title 5 official Inspection Form:Subsurface Sewage Disposal system•Page 13 of 18 r c Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address Owner Owner's Name information is required for every page. CityfTo`^m State Zip Code Date of Ins ction 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.): sO t OeCAI 61 Q✓1 C/ ! elf 074' �✓/'a� 1c- �� 4ee Die 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 u vv�im-ni;er �0 Fig 12J Property Addressj� Owner Owner's Name (A/49—S G6�information is �C/[y_1r— ` / / required for every page. CitylTown State Zip Code Date of Ins ection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: Dimensions - Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.V262018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �% O Fldd /4�: Property Address Owner Owner's Name information is ��s IX !� 6� 9/sp-ection ! / required for evey tom,/ J 7" t�C Vd� / J page. Cityrrown State Zip Code Date of I D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view f the sewage disposal system, including ties to at least two permanent reference landmarks enchmarks. Locate all wells within 100 feet. Locate where public water supply enters the bui ' g. Check one of the boxes below: hand-sketch in the area below ❑ drawing attached separately C"r -3 tips � h 1- '4 5 Gt tS�S a o - 30 L// S t5insp.doc-rev.7126r2018 Title 5 Officiai Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage DisposalSystem Form -Not for Voluntary Assessments Property Address information is Owner Owner's Name required for everyT r page. City/Town State Zip Code Date of Insg6ction D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ` ^ /W ❑ Shallow wells 1-4t Estimated depth to high ground water: feet 7� 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 wit cal Board of Health - explain: �C, wSni- 17-owel ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database- explain: You must de 'be how you stablished the high grcund water elevation: n 0 akw�w� Before filing this Inspection Report, please see Report Completeness Checklist on next page. t6insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address Owner Owner's Name information is 4— required for every page. City/Town State Zip Code Date of I pecti / E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: A. I spector Information: Complete all fields in this section. B. Certification: Signed & Dated and 1, 2, 3, or checked C Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (F �ure 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.7126/2018 Title 5 official inspection Form!subsurface sewage Disposai system-Page 18 of 18 --ofc mA 6mo n� > 1 No. f . Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: UBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2ppticatiou for Disposal 6pstem Coustructiou permit :oApplication for a Permit t Construct( ) Repair(>0 IV( ) Abandon( ) ❑Complete System ❑Individual Components �} /n Location Address or Lot No. 10;4aS4ol-._ i3iw►y 1. Owner's Name, ddress,and Tel.No. TAIfn�e5 CyP"-r--j �p Assessor's Map/Parcel l S �mGO� S Installer's Name,Address,and Tel.No. f o ®.� -I b 3 Designer's Name,Address,and Tel.No. C-AfZUJi(d L ,Irpr,) 9 �.:\\T '� 2�5�`(C.0��+4v� (� rr 1-T oz, t- vita Type of Building: _ Dwelling No.of Bedrooms e Lot Size �� ) sq.ft. Garbage Grinder( ) Other_ Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) '3 gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title (`D f�-r Size of Septic Tank l onO Type of S.A.S. SjuV,4,eA WU- Description of Soil 2� Nature of Repairs or Alterations(Answer when applicable) K)t.-J �-�1ax Date last inspected: (0 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 is Board of Health. d Date�• Z3- Z .tom Application Approved by O Date Application Disapproved by Date for the following reasons Permit No. lr-,l-0 Date Issued WAIM ell " Cn •�F �''' A V OT et}� v✓ fflo /VY No; Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computPUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ! ltlYlcatlon for Disposal *pstrm Construction permit d.SApplication for a Permit to Construct( ) Repair( pgrade( ) Abandon`( ) ❑Complete System ❑Individual Components �{ Location Address or Lot No. 10 {',t l vl S t`v-- ?a�� ,M�4 Owneyrys�Naym�e,Address,and Tel.No. �"�e� C�you �o Assessor's Map/Parcel I C1 d!E!�' 'a Installer's Name,Address,and Tel.No. f o ,?�a,,, � �3 Designer's Name,Address,and Tel.No. Type of Building: r Dwelling No.of Bedrooms 'lk' ( Lot Size J �,.�3 sq.ft. Garbage Grinder( ) Other Type of Building �j "t\0- No.of Persons Showers( ) Cafeteria( ) Other.Fixtures Design Flow(min.requi ed) 7473 ,o gpd Design flow provided S ��, "1 gpd Plan Date �— Z,-°1.p l J Number of sheets Revision Date Title I 0 {-� �(1 S Size of Septic Tank Type of S.A.S. S-t7{� �� ,�J � l�L 3(al�,• I��' Description of Soil r I �- - Za t 1 Nature of Repairs or Alterations(Answer'when'applicable) ,F 2.. ---------- Date last inspected: rr 1� Agreement: The undersigned agrees to ensure th construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of.Tifle 5 of thenvironmental Code and not to place tine system in operation until a Certificate of Compliance has�.been issued by this Board of Health. d o a Date - .Z o Application Appro en�d by O Date D Application Disapproa�e�d by Date for the following reasons Permit No. "� Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site nqvq\l ge Disposal system Constructed( ) Repaired(� Upgraded( ) Abandoned( )by��,Z�Q , 1, j L.K-C- at C,' cQ) tye_. - has been con ucted in acco . ce with the provisions of Title 5 and the for Disposal System Construction Permit No ,� r dated Installer �l,Jg A fni, ,C) LC,,. Designer L. ol, #bedrooms Approved design flow gpd The issuance of0th' permit shall not be construed as a guarantee that the system wil ffun)A)1)n'as design d.Date Inspector • _ S ------------------------ ----- --- ---------------------------------------(�-------------------- ------------------ ------ ------ No. �l� / / Fee ��"'` THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE, MASSACHUSETTS Disposal 6pstem Construction J)Prmlt Permission is hereby granted to Construct( ) Repair VI-) Upgrade( ) Abandon( )J System located at 10 I-'* t 14 � �� 1 e ST. ��1,r U�; and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construct ust be mpleted within three years of the date of this permit. Date Approved by 1 1 Town .of Barnstable Regulatory Services Thomas F. Geiler, Director -ARNSTABLE, Public Health Division \ MAW, 619. � Thomas McKean,Director 200 Main Street, Hyannis, MA. 02601 Office: S08-861,4641 Fax: �08•:''i, ,. .;. Sewage PermitO 1010+,Z1 Assessor's Maly/Parcel Installer & Desl>ner Certification Forth ttt��.Cirlc� Installer: Address: 1'_ `/_..._Cto��C�; c ��t >nwr _.._.._.._ Address: 1- o i3®< ?� 3 E��st klo;C�Ii,vYt t H,�........... -e,-, V�vnl�{ 1 �y 7 3� .. e�,c� der), yes was issued a errrtit to install a (:)n Z - 10 o e.l (inst��ller septic system :at I C� 1=i �Id S tc�1e (Ze�<:�:( based on a design drawn by -.........._..................._.._....-- .._.__.................................._..- ---- .._._...._..----- (;tddress) l�l�e�tdlc +nG, elated col 1.1.i1..c1c (dcsigner) I certify chat the septic system referenced above was installed substantially according io �- - the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the Soils \\cre Found satisfactory. I ccrtiFj that the septic system referenced above was installed with major changes (i-c- greater than 10' lateral reloc ition of the SAS or any vertical relocatio of any compom!rlt of the septic system) but in accordance with State & Local Regulations. Plan revision or certified us-built by designer to follow, Stripout (if req nspected and the soils vverc found satisfactory. jt;) N 1. ` "r. w JIZ (Inr.. ::111er'ti Sisntat r�) �o s,ar7 k )csigner s Signature (Affixesif. er s 4' ri�l�1-IGrt�jW PLEASE RETURN ' () BARNSTABLE PUBLIC I ff AQ79 DIVISION, CERT.IFIC'AJ-1, C)M?Ct)MI'I,IANC'1 WILL NUY 13E ISSUED UNTIL BOTH THIS 1�(,,,�RN. A►ND AS- I3UlI,;,,"1.C'AARI) ARE RECEIVED I3V THE BARNSTABLE P'!j LIC HEALTH DIVISION. T 0 .d L920 ELZ 809 DN I a33N I DN38f Wd t,2: 20 e T 0Z-02--inr TRANS. NO.: CITY/TOWN: West Barnstable APPLICANT: ADDRESS: 10 Field Stone Road, West Barnstable, MA DESIGN FLOW: 330 gpd REVIEWED BY: DATE: N/A OK NO GENERAL y .. �f Legal boundaries denoted [310 CMR.15.220(4)(a)] X Street, Lot, tax parcel number and lot number noted on plan [310 CMR 15.220(4)(u)] X Locus Provided [310 CMR 15.2204(t)] X Plan proper scale? (1"=40' for plot plans, 1"=20' or fewer for components) [310 CMR 15.220(4)] X Easements shown [310 CMR 15.220(4)(b)] X System located totally on lot served [310 CMR 15.405(1)(a) for upgrades]- if not, a variance is required [310 CMR 15.412(4)] X Location of impervious surfaces (driveways,parking areas etc.) [310 CMR 15.220(4)(d)] X Location all buildings existing and proposed 310 CMR 15.220(4)(c)] X Location and dimensions of system components and reserve areas. [310 CMR 15.220(4)(e)] X System Calculations [310 CMR 15.220(4)(f)] X daily flow X septic tank capacity (required and provided) X soil absorption system (required and provided) X whether system designed for garbage grinder X North arrow [310 CMR 15.220(4)(g)] X Existing and proposed contours [310 CMR 15.220(4)(g)] X Location and log of deep observation holes (existing grade el. on each test) [310 CMR 15.220(4)(h)] X Names of soil evaluator and BOH representative [310 CMR 15.220(4)(h) and (i)] X Location and date of percolation tests (performed at proper elevation?) [310 CMR 15.220(4)(i)] X Percolation test results match loading rate? [310 CMR 15.242] X Certification statement by Soil Evaluator [310 CMR 15.220(4)0)] X Observed and Adjusted groundwater (method for adjustment given or indicated) [310 CMR 15.103(3) and 310 CMR 15.220(4)(n)] X Address 10 Field Stone Road, West Barnstable MA Sheet 1 of 7 N/A OK NO Location of every water supply,public and private, [310 CMR 15.220(4)(k)] X within 400 feet of the proposed system location in the case of surface water supplies and gravel packed public water supply X within 250 feet of the proposed system location in the case X within 150 feet of the proposed system location in the case of private water supply wells X Location of all surface waters and wetlands located up to 100 ft. beyond setbacks listed in 310 CMR 15.211 and any catch basins located within 50 ft. [310 CMR 15.220(4)(1)] X Water lines and other subsurface utilities located [310 CMR 15.220(4)(m)] (if water line cross see 310 CMR 15.211(1)[1]) X Profile of system showing invert elevations of all system components and the bottom of the SAS [310 CMR15.220(4)(o)] X Stamp of designer [310 CMR 15.220(1) and 310 CMR 15.220(2)] X Stamp of Registered Land Surveyor(required if construction activities within 5 ft. of lot line) [310 CMR 15.220(3)] X Test Holes adequate (two in each of the primary and reserve unless trenches as permitted in 310 CMR 15.102(2) or as approved for an upgrade under LUA at 310 CMR 15.405(1)(k)] X Test hole adequate to demonstrate four feet of suitable material? [310 CMR 15.103(4)] X Test Holes adequate to confirm adequate groundwater separation? [310 CMR 15.103(3)] X Benchmark within 50-75' of system [310 CMR 15.220(4)(q)] X Materials specifications noted? [various sections of 310 CMR 15.000] X System components not> 36" deep (unless Local Upgrade Approval or LUA requested) [310 CMR 15.405(l(b)] X Address 10 Field Stone Road,West Barnstable,MA Sheet 2 of 7 r— _ N/A OK NO SEPTC Size OK? [310 CMR 15.223(1)] X Inlet tee located ten inches below flow line [3 10 CMR 15.227(6)] X Outlet tee 14" or 14" + 5" per foot for increase ft depth [3 10 CMR 15.227(6)] X Outlet tee with gas baffle or approved filter [3 10 CMR 15.227(4)] X Note regarding installation on stable compacted base [3 10 CMR 15.228(1)] X Separation between inlet and outlet tees (no less than liquid depth) [3 10 CMR 15.227(2)] X Inlet/Outlet elevations at least 12" above high groundwater (except as described 310 CMR 15.227(5)) or permitted for upgrades under LUA [3 10 CMR 15.405(1)(k)] X Minimum cover 9" (Tanks buried more than 9" must have risers on all openings and on the d-box) [3 10 CMR 15.2228(1) and 310 CMR 15.232(3)(0] X Three access covers (inlet and outlet must be 20" or greater) - middle access at least 8" (by 7/07) [3 10 CMR 15.228(2)] X Access to within 6 " of grade - one port for systems<I 000gpd, two for systems >1000 gpd [3 10 CMR 15.228(2)] X All at-grade covers secured to unauthorized access? [310 CMR 15.228(2)] X > 10 ft from building foundation [3 10 CMR 15.211 1)] X Buoyancy calculation Required/Done [3 10 CMR 15.221(8)] X H-20 Where appropriate? [3 10 CMR 15.226(3)] X Setbacks from resources [3 10 CMR 15.211] X Multiompartmentf Tariks r n Required when other than single-family dwelling or flow>1000 gpd [310 CMR 15.223(1)(b)] X First compartment 200% daily flow; Second compartment 100% daily flow [3 10 CMR 15.224(2) and(3)] X "U" pipe through or over baffle, outlet of each compartment with gas baffle or approved filter [3 10 CMR 15.224(4)] X Address 10 Field Stone Road,West Barnstable, MA Sheet 3 of 7 r N/A OK NO `BUILLDING SEWER ANDS®THER PIING Located at least ten feet from any water line? [310 CMR 15.222(2)] X Disposal piping at least 18" below water line (when water and sewer cross, see 310 CMR 15.211(1)[1]) X Cleanouts required/provided ? [310 CMR 15.222(8)] X Thrust blocks specified in force mains? 310 CMR 15.221(6)(c)] X Slope of sewer line not less than 0.01 (1/8"/ft) 0.02 preferable [310 CMR 15.222(6)] X Proper pitch on all runs? (.005 within gravity-distributed trenches and beds) [310 CMR 15.251(9) and 310 CMR 15.252(2)(c)] X Siphon problem/ (leachfield below pump chamber) X Endca s or vent manifold specified? X Size and orientation of discharge holes specified? (not smaller than 3/8" not larger than 5/8") [310 CMR 15.251(8) and 310 CMR 15.252(2)(h)] X Materials specified (310 CMR 15.251(5) specifies various pipe types allowed) X DISTRIBUTION BOX " Stable compacted base [310 CMR 15.221(2) and 310 CMR 15.232(2)(a)] X Splash plate or baffle tee required on inlet/provided? (when pressure sewer to d-box or steep pitch of gravity sewer) [310 CMR 15.323(3)(a)] X Riser if deeper than 9" [310 CMR 15.232(3)(f)] X Inside minimum dimension 12" [310 CMR 15.232(2)(b)] X Minimum sump 6" [310 CMR15.232(3)(e)] X Watertight cover if<2000gpd); waterproof manhole if>2000gpd [310 CMR 15.232(3)(d)] X JUMPCH>AIVIBERS Capacity(emergency storage above working=design flow)? [310 CMR 231(2)] X Proper setbacks [310 CMR 15.211 (same as septic tanks)] X Watertight 20-in minium access manhole at least 20" MUST BE TO GRADE [310 CMR 15.231(5)] X Service components accessible (not too deep with piping, disconnects accessible) X Alarm floats - alarm on circuit separate from pumps specified? X Exceeds two units must have two pumps operating in lead-lag mode. [310 CMR 15.231(6) and(8)] X Stable Compacted Base [310 CMR 15.221(2)] X Buoyancy calculations needed ?Provided? [310 CMR 15.221(8)] X Address 10 Field Stone Road, West Barnstable,MA Sheet 4 of 7 r N/A OK NO Calculations correct? X 4 feet of naturally occurring material demonstrated? [310 CMR 15.240(1)] X Required separation to groundwater? [310 CMR 15.212)] X Aggregates edified as double washed [310 CMR 15.247(2)] X System Venting required/provided? (system under driveway or >36" deep) [310 CMR 15.241] X Inspection ports specified and within 3"final grade? [310 CMR 15.240(13)] X Breakout requirements met? (No violation of breakout elevation within 15 ft of SAS unless barrier) [310 CMR 15.211(1)[4] and Guidance Document] X GALLERI So PITSCHAlYIBERS Chambers and Gal. in trench configuration supplied with inlet every 20 ft. [310 CMR 15.253(6)] X Each structure with one inspection manhole (if>2000 gpd must be to grade) [310 CMR 15.253(2)] X Aggregate 1' minimum- 4' maximum. [310 CMR 15.253(1)(b)] X 2' sidewall credit maximum [310 CMR 15.253(1)(a)] X In bed configuration, inlet every 40 sq. ft. [310 CMR 15.253(6)] X �'TRENCHES1/3�10C1VIR 15.251 Width T minimum T maximum [310 CMR 15.251(1)(b)] X 100 feet-maximum length [310 CMR 15.251(1)(a)] X Minimum separation 2x effective depth or width whichever greater(3x if reserve between trenches) [310 CMR 251(1)(d)] X Situated along contours [310 CMR 15.251(2)] X Breakout OK? [310 CMR 15.211(1)[4] and Guidance Document] X BEAD SAS y(Maximums,izo�f�bed�nor�fi�e,1d,5000 gpd) minimum 2 distribution lines [310 CMR 15.252(2)(a)] X Maximum separation between lines 6' [310 CM R15.252(2)(d)] X Maximum separation between lines and outside of bed 4' [310 CMR 15.252(2)(e)] X Aggregate depth below discharge pipes 6" minimum, 12" maximum. [310 CMR 15.252(2)(g)] X Separation between beds 10' minimum. [310 CMR 15.252(2)(f)] X Bottom area used in calculations only [310 CMR 15.252(2)(i)] X Address 10 Field Stone Road,West Barnstable, MA Sheet 5 of 7 N/A OK NO Pressure Dosed Systems ? Provided pump and piping calculations as required [310 CMR 15.220(4)(r)] X Pressure dosing required on all systems>2000gpd or alternative systems under remedial approval [310 CMR 15.254(2) and I/A Remedial Use Approvals] X If used in gravelless system -make sure jet is directed as not to scour soil interface [Guidance Document] X Inspections once per year(systems<2000 gpd) or quarterly (>2000 d) good to note on plan [310 CMR 15.254(2)(d)] X Construction in fill - Did the plan specify that the fill shall meet the specification of 310 CMR 15.255(3)? X Impervious barrier and/or retaining wall ? [Guidance Document] X Impervious barrier installation must be supervised by designer [310 CMR 15.255(2)(b)] X Retaining wall must be designed by Registered Professional Engineer [310 CMR 15.255(2)(a)] X Side slope not exceed 3:1 ? [310 CMR 15.255(2)] X Breakout requirements met? [310 CMR 15.252(2) and Guidance Document] X At least 5 ft. from impervious barrier to edge of SAS (10 ft. recommended) [310 CMR 15.255 (2)(e)] X Graveness Ste 'A I/Ai r ovalLette'r r Y =PP, Check DEP Approval letters for credits and design conditions X If used with pressure dosing do not allow pressure discharge to scour soil interface X Vn Alternative Se tcc:S stem I/A A' royal Letters y 7l Was DEP Approval Letter provided and/or have you reviewed the letter for conditions? X Is the technology being properly applied and does it meet all DEP Approval Conditions? X Is there a note on the plan regarding the requirement for perpetual maintenance agreement? X Any alarms involved on separate circuits X Did the applicant submit an operation and maintenance manual? X Has applicant submitted a copy of a maintenance . X .t ,..« Are the variances listed on the plan ? [310 CMR 15.220 (4)(q)] X RLS Stamp necessary on plan if a component is within five feet of property line [310 CMR 15.412(4)] x New construction or increased flow proposed- [Refer to 310 CMR 15.414] X /� Address 10 Field Stone Road, West Barnstable MA Sheet 6 of 7 Nitro en,Sensrt velre"ars v..N/A OK Jor Is the system in a Designated Nitrogen Sensitive Area(Zone 11 for a public supply well)? [310 CMR 15.214, 310 CMR 15.215 and 310 CMR 15.216 - also refer to Policy regarding upgrades of such existing systems] X Is the system proposed on the same lot as served by private well ? [310 CMR 15.214(2)] X Are the nitrogen loads proposed in compliance? [310 CMR 15.216(1)] X Pumping to septic tank ? [ 310 CMR 15.229] X Shared System [310 CMR 15.290] X Address 10 Field Stone Road,West Barnstable MA Sheet 7 of 7 I Town of Barnstable. P# ,2 Department.ofRegtilatory Services Public Health Division Date 'r lzr� s 1e$ 2W Main Street,Hyannis MA 02601 Date Scheduled Time_ -- Fee Pd. ! Foil Suitability Assessment for Sewage Disposer Performed By. glad I eq 11. 6VW0 E 17, L.S V 'Witnessed By: i i LOCATION&GENERAL INFORMATION I Owner's Name M e r Location Address j �(�s ✓r e �� Address 5 am e Wa . bnrns-{rn�2. • Engineer's Name � Assessor's Map/P4Md: ' + 0 S� • 213-6 3-7 7 NEW CONSTRU�I70N REPAIR Telephone# i Land Use 5S�e- Corn`1 r d elIt�.j Slopes(%)_! S Surface Stones - O i f Distances from: 'Open Water Body _ ft Possible Wet Area ,ft Drinking Water Well ft Drainage Way '_ ft Property Lin t ft Other ft SKETCH:($treet name,dimensiod6f lot.exact locations of ts�t holes&pert tests,locate wetlands in proxittuty to holes) 5-ce- • i , , j 7 1 3 2` �S t 6UYU,a5�! Depth to Bedrock Parent material(gaiidgic) 7 t 32"hS S Depth to Groundwater: Standing Water in Hole: 7 t 3 2`�gS Weeping from Pit Pace Estirrrated Seasonal high Groundwater 7 D�TERMIN TION FOR SEASONAL HIGH WATERS TADLE Method Used: D t 2S V absecv o ti z t 3 2 i ln. Depth t0 sell tnattles: 132 in, Depth Cibperved standing!in obs.hole - $. Depth toiweeping from side of obs.hole: !3 2 I {n. tro Actor er At�Wlt Adj. !� Adj.factor,�..�-..•- A�I�dtrwndwatff tav41..,�., Index Well# Reading Date: - Index Well level .... PERCOLATION TEST Dante 7 'yl W 6 A!4. Observation I 11inle at W, .--- Hole# I - 7!o`•-9y`r Tinuat6" .. .....•.-- ..•.------- Depth of Pere l D;o o All ! lime(9"•6") Start Pre-soak Time.a - /0;jO AN i End Presoak Rate MinJlnch - Site Suitability Assessment: Site Passed �25 Site Failed; Additional Testing Needed(YIN)T� OrigrnaL,Public Health Division Observation Hole Data TO Be Completed on'Back------=- i ! -you must first notify the ***If percola#6u,test is to be conducted within 100 of wetland, Barnstable C44servation Division at least one(1)week prior to beginning. _ _ 1 DEEP OBSERVATION ROLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling .(Structure,Stones,Boulders. onsis enc Gravel) -8 a Ls JOW 312 g.-5 2- 0 5Z-'32 C- !'1 S 2:5 Y 6/v - i 5% �r've'! Huh C es.) socvve �000kus is 72 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Grav b S A LS toir 312 5 2. 5/5 52-i3 z G NS 2.5 Y 6 i5% 5rouel w>✓ny cebl e..5 sa✓�ebov7de�� AD 7Z" 1 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Cons iste c Oravell DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color (loll Other Surface(in.) (USDA) (Munsell) Mottling (Structure,States.Boulders. Consistency,% m Flood Insurance Rate May: Above 500 year flood boundary No_ Yes _ Within 500 year boundary No'/ Yes a Within 100 year flood boundary No Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist.in all areas observed throughout the proposed for the soil absorption system? _er If not,what is the depth of naturally occurring pervious material? .._. . Certification 5v1 ti9 Zoo3 I certify that on y_ (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the,required training,expertise and experience described in M CMR 15.017. Signature Date 7.2 2-i o Q:SBPTIOPBRC14011M.DOC f �a No.--�---1- _=2�7 Fee--- � ----- BOARD OF HEALTH TOWN OF BARNSTABLE Applicat ion for Vell Cootruct ion Permit ApBp lic tion is her by mad .for a permi to Construct ( , Alter ( ), or Repair ( )an individual Well at: `r -- 1?<— ------------------- Location — Address Assessors Map and Parcel O ner Address C__-- �4�----4 _�"&_Z -- ---------- -��--�6'-----��34� d -------` zK - --- - /� Installer Driller — Address Type of Building Dwelling -� - --------------------------------- Other - Type of Building -------- No. of Persons--------------------------------- -- -------------- Type of Well---�if5<--` � --------- - ---— - Capacity-— - —— ---- Purpose of Well---� ------- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation u a Ce if' Vfo ce has been issued by the Board of Health.* Signed --- — - - ------ — --6Q-h - date Application Approved By— - --------------- — �� date Application Disapproved for the following reasons:-----—---------------—---------------------------- ----------------------- -- --------------------------------------------- p , date Permit No. Issued--- -- - - - --- - ----------------------- date BOARD OF HEALTH TOWN OF BARNSTABLE C ertif irate ®f Compliance THIS IS TO CERTIFY.., That the Individual Well Constructed ( ), Altered ( ), or Repaired ( ) bY------------ ------------✓�-- --------------------------- Insta er at-----------LzT, _--- '&— I:�__� ----- ------------------------ has been installed in accordance with the provisions of the Town of Barnstable Board of Healt�h7 Private Well Protection Regulation as described in the application for Well Construction Permit No. - y= l--Dated----------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE------------------------— — - — — -- Inspector------------------------------------ —--- ---- ;No.-��J-- = � - - Fee------ -- ------ , BOARD OF HEALTH TOWN OF BARNSTABLE� Application-*rIVe[c CootructionAermit Alt- ApBli tiis h;erxpmace for p i� tons ( , Alter ( ),-or Repair ( -)an individual Well at: Location— Address �• Assessors Map and Parcel' O ner < Address Installer — Driller ' ; Address ' Type of Building i I Dwelling ----------------------------------------�- --- i Other - Type of Building ------------- No. of Persons------------------------------ Type of Well Capacity--Purpose of Well - +� ----�-�---��4�------------------------ i Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable.Board of Health Private Well Protection Regulation - The undersigned further agrees,not to place the well in operation uptil a Ce 'f' a e f o ace has been issued by the Board of Health. Signed — --- -- --- -------- — date ' — -- _Application Approved By— ��-��-=-�-- ---------------- ---� �i date Application Disapproved for the following reasons:--------------------------------------------------------------------------- date Permit No. --- - = -¢— ------- Issued--- -- - -- -— - - - — ----- date w:coa.,.�ara.®.�.�...��arnr�....e.o..re®�.�w��sa o..o�.us.oas�.�:�e..•..we.p�ws..•rn�.w.w.�r�.w....:.•i.:mcs rww.sn,n wa.e^a.�.r..w+ BOARD OF HEALTH TOWN OF BARNSTABLE Certificate (Of Compriance THIS IS T CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( ) - - ------------------------------------------------------- - - -—- --- - - --- ....��a � Installer at -- L�� -—- --- — _!�L_ -------------------------------— ---- has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in therapplication for Well Construction Permit No. -V qy=)-Z Dated------------------------- ' THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE---------- ------ —-- ----- Inspector----------------------------------------—--- - --- BOARD OF HEALTH TOWN OF BARNSTABLE �e[C �on�truction�ermit, No ,---- ` Fee---g�== ---- Permission is hereby granted ------ - ------------------------------------------------------------- to Construct N, Alter ( ), or Re air ( ) an Individual Well at: N o. ---f '' — --- � - — weer L{/_�_�_d 4.xd �- — --- - as shown on the application for a Well Construction Permit No. - - - - U J ---- Dated--- � -=- -�l - --------------- --- - - - -------------------T-- —¢-' -�' r3-------------------------------- ---. ......_...-- Board of Health DATE--- = '- ) -- r ; t w f ENVIROTECH LABORATORIES, INC. MA Cert. No.: M-MA 063 449 Rte. 130 . Sandwich, MA 02563 (508)888-6460 1-800-339-6460 FAX(508)888-6446 CLIENT: Reef Realty LOCATION: Lot 8 Fieldstone Rd. ADDRESS: School St. W. Barnstable, MA W. Dennis, MA SAMPLE DATE: 7-11-94 COLLECTED BY: Fred Clifford DATE RECEIVED: 7-11-94 TIME: 8:OOAM SAMPLE ID: 1-A JOB TYPE: New well WELL DEPTH: 67' RESULTS OF ANALYSIS: Parameters Units Recommended Result Limit Coliform bacteria/100m1 (MF Method) 0 0 PH pH units 6.0-8.5 6.08 Conductance umhos/cm 500 191 Sodium mg/L 28.0 8.58 Nitrate-N mg/L 10.0 0.05 Iron mg/L 0.3 0.68 Volatile Organics EPA 601/602 mg/L N.D. COMMENTS: Iron level is not a health hazard. * See report attached. Yes No WATER IS SUITABLE FOR DRINKING PURPOSES FPR PARAMETERS TESTED. XXX Date Ronald J. S ri LT = Less Than Laboratory Director _-_.. '.:"TUVATER ANALYTICAL SOa 159 --.75:x 2/ f SR13UNDWATER ANALYTICAL EPA METHODS 601 and 602 Volatile Organics (GC/PID/ELCD) Field ID: 1A Lab ID: 8170-01 Project: Reef Realty/Lot 8 Fieldstone Batch ID: V62-0416-W Client: Envirotech Sampled: 07-11-94 Cont/Prsv: 40mL VOA Vial/NaHSO4 Cool Received: 07-12-94 Matrix: Aqueous Analyzed: 07-13-94 PARAMETER CONCENTRATION REPORTING LIMIT Dichlorodifluoromethane BRL 5 Chloromethane BRL 5 BRL 5 Vinyl Chloride BRL 5 Bromomethane BRL 5 Chloroethane BRL 1 Trichlorofluoromethane BRL 1 1,1-Dichloroethene BRL 1 Methylene Chloride BRL 1 trans-1,2-Dichloroethene BRL 1 1,1-Dichloroethane BRL 1 cis-1,2-Dichloroethene * BRL 1 Chloroform BRL 1 1,1,1-Trichloroethane BRL I Carbon Tetrachloride BRL 1 Benzene BRL 1 1,2-Dichloroethane Trichloroethene BRL 1 BRL 1 1,2-Dichloropropane BRL 1 Bromodichloromethane 2-Chloroethyl Vinyl Ether BRL cis-1,3-Dichloropropene BRL 1 1 Toluene BRL i trans-1,3-Dichloropropene BRL 1 1,1,2-Trichloroethane BRL BRL I Tetrachloroethene BRL 1 Dibromochloromethane BRL 1 Chlorobenzene BRL I Ethylbenzene 1 meta-and Para-Xylene * BRL 1 ortho-Xylene * BRL 1 Bromoform BRL 1 1,1 ,2,2-Tetrachloroethene SRL 1 r 1,3-Dichlorobenzene BRL 1 '. 1,4-Dichlorobenzene BRL 1 1,2-Dichlorobenzene QC SURROGATE COMPOUND SPIKED MEASURED RECOVERY QC LIMITS a,a,a-Trifluorotoluene 30 28 94 % 87 - 113 % 1,2-Dichloroethane-d4 30 30 98 7 83 - 117 BRL = Below Reoorting Limit. * Non-target compound. Method References: Method 601 - Purgeable Halocarbons and Method 602 - Purgeable Aromatics, 40 C.F.R. 136, Appendix A (1986). TOWN of H%RVVIM 4-a �lLocation 4rw�e Permit No Village A 2N S4 A b e 11 Installer's Name&Address Builder or Owner ��'�� ` - S/ { r } Date Permit Issued '°' °° te:Comptiasce Issued j '� J!LO •�77R.' i TOWN OF BARNSTABLE LOCATION SEWAGE # VILLAGE U)• ASSESSOR'S MAP & LOT < < ( 5 INSTALLER'S NAME & PHONE NO. 't-l-AlK ( ppLgMA ,l SEPTIC TANK CAPACITY I bb 0 LEACHING FACILITY:(type) LGACt-( t�-iT' (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER U3CL - BUILDER OR OWNER 3M£S �YY1E2_5I DATE PERMIT ISSUED: 15-9 } DATE COMPLIANCE ISSUED:: VARIANCE GRANTED: Yes No _ 1 A I A- C. p - t4l 3- 158` ;: + r--..,,._.-.� _�_�.-.-�___ �.�.... _-,. ��.- f � i /_/yam-� � { err �� ',ag�/�9�iI � <v/ � ��✓ �� i ;� /�/�� i o semi No... .`.� F>r$....... 9v....... LTH THEBOARD AOF FHEALTH Ts TOWN OF BARNSTABLE Appliratinn for Diri.pwml l urk,i Tottstrnrtiun Permit Application is,hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: 1 d s,e 4 1>"rffWe ype ....SOY .... ! ��STd.J�--• AR /'i, IAS ,S ' dap ..._.PAL 54 Loc:uion- t ress or Lot No. ................... . .... • ................................. ............................................... ................................................. Owner Address W _ I Iistal Ier Address 3 �1 UType of Building Size Lot....__.__.�....._]_..__._._Sq. feet ►.� Dwelling—No. of Bedr ------------------------------- Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) 44 Other fixtures -------------------------------- - ----------------------- -------------------..----------------•---------------------•--------- ---------- W Design Flow............ .�5......_..___........__._gallons per person er day. Total,,dLLaily flow......3c3 3,16........................... lon . WSeptic Tank—Liquid capacity.IM-.gallons Length---��3—__ Width._YL... Diameter................ Depth.... x Disposal Trench— No. .................... Width.................... Total Length-------- --- Total leaching area............ ...sq. ft. 3 Seepage Pit No..................... Diameter....1Z.......... Depth below inlet.... ........... Total leaching area`v..�/1?.sq-fit Z Other Distribution box ( ) Dosing tank ( ) '~ Percolation Test Results Performed .......... Date.... .............. aTest Pit No. 1....`z-c.-__minutes per inch Depth of Test Pit.... ! __._.____ Depth to ground water...1✓DN 6..._.. (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ W ........ -------- ----- ------.............................................................................................................................. O Description of Soil---- .'. 2...... F'.. -SUC�50�1_....._`�7--.. 1 �►? b1.v''�'?...t Aw �N'� oUI, E�.�....-•-•--. ----- W ----- -------------------------------------------------------------------------------------•----•••-----------------...------••---------•---•------••----------•-•-•---................................ U Nature of Repairs or Alterations—Answer when applicable...................___.._.__._........................_.__._._._.__..._.__........._.........._. --•-•---•------------------------•-•------•----------------•-------------------•-----------•----------------------------------------------------------------........................................... Agreement: The undersigned agrees to install the aforedescribed Individual .Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compli s has be issued b e board of health. Signed ..�/L ....................................ZZ—�•/�" Date Application Approved By ......... ..... .-..... ................................... �.......... --------------------- Application Disapproved for the following reasons: ...... ......................... . ......................................................................................... ...................................................................................................................................................................................... ........................................ r Permit No. --- ---.-....... f Issued �.. ........................... ........................................................Date....... .. Date ----------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Ce>rtifictt#e of Complianre THIS IS CERTIFY, t�e Individual Sewage Disposal System constructed ( �' ) or Repaired ( ) by .............. �� --�L �_ -In ... . -- - Installa•t at .. ....... L......................... .... . ............................. fort. $......} ...... —r has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. .................._.............._----------- dated ......._.........................._....__ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. �Q DATE.............. .p... .. .. .1 --............... - Inspector ------t✓t-..d - No..... a , Fxs......... ).............. q THE COMMONWEALTH OF MASSACHUSETTS t boo BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiou for Uiripwial Works Tonotrurtion "ermit Application is-hereby made for a Permit to Construct ( ) orRepair ( ) an Individual Sewage Disposal System at: /d ttj e d .sT rvi TZ'�' -• �07 !- L�STUN - ......................... ASS_ 5 ►'? ._.. a ......................."tL�L �� ...... .Location-Address Lot No.ss •-----•-----•-----•----------•-•----•-'•- .. �1 owner J Address Installer Address I I UType of Building Size Lot.___..-...f................Sq. feet Dwelling— No. of Bedrooms........... ..............................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ..--__-_--___-------------- No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures -.---•-------------------------- - - W Design Flow.............55........................gallons per person per day. Totai daily flow------3_ 6_.....__._......_...........gallon . WSeptic Tank—Liquid capacity_006..gallons Length-_- _��Z-.. Width... Diameter----------------- Depth._. x Disposal Trench--No. .................... Width.................... .Total=Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No..GI ........ Diameter-----LZ.......... Depth below inlet.__..-........... Total leaching area`+-7.L&./t1_.sq•-€t. z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by----DO.J_�ne.... J l�.`' �1�1.tr.......... Date...._11:_ .............. �. t r Test Pit No. I___..._Z ....minutes per inch Depth of Test Pit.... ! __._____. Depth to ground water...... _M4 L ...... Lz, Test Pit No. 2................minutes per inch Depth of Test Pit_................. Depth to ground water........................ 9 -•-•-----•---•--------------••-•-••••-••••••-•--•••'--•••-•'•-'-'•'-'........_....--'--..................................................................... 0 Description of Soil.... ...... 5hv!?...A.! ! --- ........... W ••.............-.......-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable............................................................................................... -----------------------•----•---------•--------------------•---•-------------------------------••-----------..._...------......--...---'----------•---------------------------......................._.. Agreement: f The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance.has been,issued by the board of health. "7zz - Signed .. ..t...,� . ............. .......................................... ... .....-i�.e.(�..�. Application Approved By ........ --_ — .................................................. ...'.:.. m Application Disapproved for the following reasons: .......................................... .......................................................................................... .......................... ..... . . . . . . ...--....................................................... . ..................................... .....---... ........................................ Date Permit No. ..... ...r.:�....--.. --�---f .................... '-.: -- - Issued ......--......--.....---.. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE t (11'er#tftctt#P of CZomplianre THIS IS TO CERTIFY,,That the Individual Sewage Disposal System constructed ( �' ) or Repaired ( ) by ..... ............ l �. ..' '. ✓..., -----------------------.....-------.----. ......................................................................................... tnaantt at ...........J .-- has been installed In accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit Nu. .............._...-......................... dated ............................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE... ...............-.44...e7..........---. -.4.0. ... ............. Inspector s 1/t---7..- - THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ` (� TOWN OF BARNSTABLE No....I._ ~. d/ FEE...;15................. Disposal 19orkii Tonotrudiort "prrntit Permissionis hereby granted-------------t '--..-----------•--------------------------------------------.------•-------------------••---------•----.--•-----..___-_._-_ to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at No......... ---------- * " s -- .. , ,��P-ht Street c� as shown on the application for Disposal Works Construction Permit No._i- Dated........................................... �� Board of Health DATE... o ff'_••�......... ............•----•-••--•.....''-' FORM 36508 HOBBS♦!t WARREN,INC..PUBLISHERS - r � ` ENVIROTECH LABORATORIES, INC. MA Cert. No.: M-MA 063 449 Rte. 130 . Sandwich, MA 02563 (508)888-6460 • 1-800-339-6460 FAX(508) 888-6446 CLIENT: Reef Realty LOCATION: Lot 8 Fieldstone Rd. ADDRESS: School St. W. Barnstable, MA W. Dennis, MA SAMPLE DATE: 7-11-94 COLLECTED BY: Fred Clifford DATE RECEIVED: 7-11-94 TIME: 8:OOAM SAMPLE ID: 1-A JOB TYPE: New well WELL DEPTH: 67' RESULTS OF ANALYSIS: Parameters Units Recommended Result Limit Coliform bacteria/100ml (MF Method) 0 0 PH pH units 6.0-8.5 6.08 Conductance umhos/cm 500 191 Sodium mg/L 28.0 8.58 Nitrate-N mg/L 10.0 0.05 Iron mg/L 0.3 0.68 Volatile Organics EPA 601/602 mg/L N.D. COMMENTS: Iron level is not a health hazard. * See report attached. Yes No WATER IS SUITABLE FOR DRINKING PURPOSES FOR PARAMETERS TESTED. Xxx -Al '`�` Date onald J. S ri LT = Less Than Laboratory Director ;GROUNDWATER AN=L.YTI CAL c -41 ,- _! r � SROUNDWATER ANALYTICAL EPA METHODS 601 and 602 Volatile Organics (GC/PID/ELCO) Field-ID: 1A Lab ID: 8170-01 Project: Reef Realty/Lot S Fieldstone Batch ID: VG2-0416-W Client:. Envirotech Sampled: 07-11-94 Cont/Prsv: 40mL VOA Vial/NaHSO4 Cool Received: 07-12-94 Matrix: Aqueous Analyzed: 07-13-94 PARAMETER CONCENTRATION � REPORTING LIMIT ug Dichlorodifluoromethune. BRL 5 Chloromethane BRL 5 Vinyl Chloride BRL 5 BRL 5 Bromomethane BRL 5 Chloroethane Trichlorofluoromethane BRL 1 1,1-Dichloroethene BRL 1 Methylene Chloride BRL 1 trans-1,2-Dichloroethene BRL 1 1,1-Dichloroethane BRL 1 cis-1,2-Dichloroethene * BRL 1 Chloroform BRL 1 1,1,1-Trichloroethane BRL 1 Carbon Tetrachloride BRL 1 Benzene BRL 1 1,2-Dichloroethane BRL 1 Trichloroethene BRL I 1,2-Dichloropropane BRL 1 Bromodichloromethane BRL I 2-Chloroethyl Vinyl Ether BRL 5 cis-1,3-Dichloropropene BRL 1 Toluene BRL I trans-1,3-Dichloropropene BRL I 1,1,2-Trichloroethane BRL 1 Tetrachloroethene BRL 1 Dibromochloromethane BRL 1 Chlorobenzene BRL 1 Ethylbenzene BRL 1 meta-and para-Xylene * BRL I ortho-Xylene * BRL 1 Bromoform BRL 1 1,1,2,2-Tetrachloroethane BRL 1 1,3-Dichlorobenzene SRL 1 1,4-Dichlorobenzene BRL 1 1,2-Dichlorobenzene BRL 1 QC SURROGATE COMPOUND SPIKED MEASURED RECOVERY QC LIMITS a,a,a-Trifluorotoluene 30 28 94 % 87 - 113 .1,2-Dichloroethane-d4 30 30 98 % 83 - 117 BRL = Below Reporting Limit. * Non-target compound. Method References: Method 601 - Purgeable Halocarbons and Method 602 - Purgeable Aromatics, 40 C.F.R. 136, Appendix A (1986). DEMAREST-McLELLAN ENGINEERING September 19, 1994 Jerry Dunning Barnstable Health Agent 367 Main Street Hyannis, MA 02601 RE: Soil inspection Lot 8 Fieldstone Drive West Barnstable, MA Dear Jerry. On September 19, 1994, Demarest-McLellan Engineering inspected the soil conditions at the above referenced site. The soils consisted of a clean medium sand to a depth of four feet below the proposed leach pit. No groundwater was encountered. If you have any questions or require any additional information, please call me at 398-7710. Sincerely, TIM Thomas cLellan, P.E. cc: Reef Realty to �c 65 24 School St. P.O. Box 463 West Dennis, MA 02670 (5081 398-7710 T.O.F. EL.= 75.2'+ r 4"SCHEDULE 40 PVC MIN.SLOPE 1% PROPOSED PVC VENT FINISHED GRADE OVER BIODIFFUSERS= 74.5' - 76.5' GENERAL NOTES PROVIDE EXTENSION RISER WISH GRADE OVER D-BOX= 74.5 SLOPE @ 2%MIN. WITH COVER OVER INLET& REMOVABLE WATER-TIGHT COVER OVER INSPECTION PORT WITH 1. UNLESS OTHERWISE NOTED,ALL SYSTEM COMPONENTS AND CONSTRUCTION OUTLET TO WITHIN 6"OF F.G. RISER TO WITHIN 6"OF FINISHED GRADE ACCESS BOX TO WITHIN METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL FINISH GRADE 3"OF F.G. (ONE PER ROW) @ FND. EL, 74.2± F.G. OVER TANK EL. = 74.0�- 5"DIA. OUTLET(S) CODE AND ANY APPLICABLE LOCAL RULES. } 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE f I DESIGN ENGINEER. PROPOSED 4" 9"MIN. SEE NOTE 21 EXISTING 4" 36"MAX. 72"MAX. TOP OF SAS/B.O. = 70•53' 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL SEWER PIPE _ - PVC SEWER PIPE _ Gn SYSTEM UNLESS OTHERWISE NOTED. �- ----- -_-- 6" " 3"DROP MAX „ PROVIDE WATERTIGHT 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN - --= 3 - 2"DROP MIN 3 9 ELEVATION =70.53' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS A MIN.SLOPE 1% JOINTS(TYP.) 10" 4"PVC IN FROM 1.33' n7 (rYP) 16„ 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE TOP OF 14" *70.7'± SEPTIC TANK 4"PVC OUT TO (TYPhA= .) THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. LEACHING FACILITY 4nl o 5. SLOPE ALL SOLID PIPE AT 1.0 /o MINIMUM. CONTRACTOR CONTRACTOR SHALL 70,rjQ' MIN. 6" ' 70. . 69.20' //laid flat 2.875'(34.5")� 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. SHALL VERIFY SIZE 48" VERIFY CONDITION OF OUTLET TEE 70.33l ) AND CONDITION OF EXISTING TEES 9 5.0' (TYP.) 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK I GAS BAFFLE 6"CRUSHED STONE FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION.SYSTEM IS OVER MECHANICALLY EXISTING SEPTIC AND REPLACE AS (TYP-) 5'MIN. 14.375' NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH TANK NECESSARY COMPACTED BASE REQ'D 20.0' AND DESIGN ENGINEER. 5 OUTLET DISTRIBUTION BOX (NP•) 8. ELEVATIONS BASED ON APPROXIMATE MEAN SEA LEVEL DATUM OF 74.42' _T TO BE INSTALLED ON A LEVEL STABLE GROUND WATER ELEV.= < 63.00' BIODIFFUSERS (END VIEW) ESTABLISHED ON TOP OF A CONCRETE STEP AS SHOWN ON PLAN. BASE. FIRST TWO FEET OF OUTLET 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION EXISTING 1,000 GALLON CONCRETE SEPTIC TANK PIPES TO BE LAID LEVEL. 20 - BIODIFFUSER E (PROFILE) THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT DRAINAGE CROSS SECTION VIEW (BY ADVANCED RA AG S E S, INC.) 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES *CONTRACTOR TO VERIFY EXISTING ELEVATION PRIOR SEPTIC TANK PROFILE DISTRIBUTION BOX DETAIL 20 - ARC 36HC (#3616BD) H-20 BIODIFFUSERS TO THE DESIGN ENGINEER.TO ANY WORT; & NOTIFY ENGINEER IF DIFFERENT. NOT TO SCALE 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC.STRUCTURES SHALL BE MADE WATERTIGHT. NOT TO SCALE NOT TO SCAL 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING -- TEST PIT DATA REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. PERC NO.t !4- ♦ m INSPECTOR: David W.Stanton,R.S. 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS 4 .w ;, - • '� LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE -- ' _ - - EVALUATOR: Bradley M.Bertolo, E.I.T. #10 �• • ► ---�- THEY SHALL WITHSTAND H-20 LOADING. � 3 C.S.E.APPROVAL DATE; July 29,2003 - - '"- E A B E OF ALL DIRT, DUST AND FINES. EXISTING • x ,;c. 'F t� ' , - ._ - DATE: June 9,2010 13 DOUBLE WASHED CRUSHED STONE SHALL E FREE / � a 3-BEDROOM , : + DWELLING 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE TEST.PIT#: � 1 C� - .�a " " ,1+� "` MATERIAL IN AREA BENEATH AND FOR 5 FT.ON ALL SIDES OF LEACHING FACILITY. TOF= 75.2't "` x ��,,� � ELEV TOP= 74.00' cj�O �00") /' / cR�lN-11 PC ,� LOCUS _ REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, `'` "" <63.00' FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). s oRCN `� -- ELEV WATER= a." P �` 41 > 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN / PERC RATE_ <2 min./inch / 1� �/ �/ / Q, 2) SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. Egg w DEPTH OF PERC= 76"-94" ��MEN 1 �$ HOxX 16. PROPOSED PROJECT IS LOCATED WITHIN: OF P TEXTURAL CLASS: 1 ASSESSOR'S MAP 111 PARCEL 54 MAP 111 r ..F= 3 v Ow J o OWNER OF RECORD: JAMES P.&MARGARET A. EMERY PARCEL 70 p ap ) `'` !/ ADDRESS: 10 FIELD STONE ROAD r D"2/ o 0a p,? u r �' A Loamy Sand 74.00' WEST BARNSTABLE,MA 02668 o `56"E 't o Z _ , r �4 .- t " 10Yr 3/2 8 73.33 rp 66 / kn I (4 FEMA FLOOD ZONE C Loamy Sand COMMUNITY PANEL# 250001 0015 C LL / x " " 10Yr 5/8 f EXIST. 1,000 GAL. SEPTIC TANK TO BE ,`.' Y 17. DEED REFERENCE: DEED BOOK 9302 PAGE 183 UTILIZED AS PART OF THIS DESIGN SWING-TIES SCALE: 1"=20' � ��t�: � � �``" � � 52" 69.67' ` 18. PLAN REFERENCE: PLAN BOOK 413, PAGE 99 W { �T� DESCRIPTION HC PC C �, 76" 67.67' 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. e W I PROPOSED DISTRI _ eaa Perc BIODIFFUSER CORNER 1 49.1' 16.8' * - .` � : O ,•� :. . �." 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY #10 n / .° ._ r�, r-- .-- � � 94" �� 66.1 T FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY y \ EXISTING PROPOSED TOTAL 20 ARC 36HC(#36166D)H BIODIFFUSER CORNER(2) 60.1' 13.2' eye q FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. ��S• -� 3-BEDROOM BIODIFFUSERS IN A FIELD CONFIGURATION Medium Sand BIODIFFUSER CORNER 3 73.5' 32.9' "C C 21. IN ACCORDANCE WITH 310 CMR 15.401 -15.405,THE FOLLOWING LOCAL UPGRADE DWELLING O � 2.5Y 6/4 TOF= 75.24- PROPOSED INSPECTION PORT WITH ACCESS BIODIFFUSER CORNER(4) 64.8' 34.5' +". ' _ - ! (15%gravel;many APPROVAL IS REQUESTED FROM 310 CMR 15.221 (7): \ c� BOX TO GRADE (TYP OF 5) cobbles; some (1.) A 3.0 WAIVER(6.0 -3.0)FOR THE MAXIMUM COVER OVER THE LEACHING FACILITY. MAP 111 B.H. s poOA a I boulders to 72") 22. THE FOLLOWING LOCAL VARIANCES ARE REQUESTED FROM THE TOWN OF BARNSTABLE'S PARCEL 53 PROP. PVC VENT; EXACT LOCATION PER OWNER LOCUS PLAN CHAPTER 397: WELLS REGULATIONS; SECTION 397-2: (1.) A 32.5'VARIANCE(150.0'- 117.5')FOR THE SETBACK FROM THE PROPOSED LEACHING / SCALE: 1"= 1000 FACILITY TO THE EXISTING WELL LOCATED AT MAP 111, PARCEL 54. \ \ u� 2 --EXISTING XISTING LEACHING PIT TO BE PtlI4RPE0, FILLED „ (2.) A 49.4'VARIANCE(150.0-- 100.6')FOR THE SETBACK FROM THE PROPOSED LEACHING r y' � WITH CLEAN COARSE SAND&ABANDONED 132 63.00 Benchmark �j of Step � / +y No Mottling,Standing or Weeping Observed FACILITY TO THE EXISTING WELL LOCATED AT MAP 111, PARCEL 53. Elev. 7442' �` i4.o' 6 DESIGN DATA TEST PIT DATA Approx. M.S.L. Al ^ CO PERC NO. 12992 LEGEND \ \� 41 TP 1 h / INSPECTOR: David W.Stanton, R.S. C roi- 50x0 EXISTING SPOT GRADE & �4.0' LP) EVALUATOR: Bradley M. Bertolo, NUMBER OF BEDROOMS (DESIGN) E.I.T.82_ C;� ��p / fi"• � � / 110 3 G.S.E.APPROVAL DATE: July 29,2003 - 50 - - EXISTING CONTOUR DESIGN FLOW GAUDAY/BEDROOM DATE. June 9,2010 50 PROPOSED CONTOUR TOTAL DESIGN FLOW 330 GAUDAY 2 PROPOSED RAD TEST PIT#: 50PO SPOT GRADE \ __._7 - /84--- '--� DESIGN FLOW X 200 % = 660 GAUDAY ELEV TOP= 74.00 � _. - E/T/C EXISTING UNDERGROUND UTILITIES USE EXISTING 1,000 GALLON SEPTIC TANK ELEV WATER- <63.00' \ _78 / `� MAP 111 \ GAS EXISTING GAS LINE PERC RATE_ PARCEL 54 W W EXISTING WATER LINE EX.WELL -,-82--- DEPTH OF PERC ._._- --� .--- I 35,173 S.F.t INSTALL 20 - ARC 36HC (#3616BD) H-20 BIODIFFUSERS = _-----84 -86 TEXTURAL CLASS: 1 TEST PIT LOCATION SYSTEM CAPACITY EXISTING 1,000 GALLON SEPTIC TANK (TOTAL L.F. OF BIOS)(4.8 SF/LF)(0.74 GPD/SQ.FT.)=GPD on 74.00' p (100.0')(4.8 SF/LF)(0.74 GAUSQ.FT.)= 355.2 GAL. LEACHING/DAY A Loamy Sand PROPOSED 4"SOLID SCHEDULE 40 PVC PIPE o. 8„ 10Yr 3/2 73.33' TOTALS: B Loamy Sand ❑ PROPOSED DISTRIBUTION BOX TOTAL NUMBER OF BIODIFFUSERS: 20 10Yr 5/8 PROPOSED ARC 36HC(#3616BD)H-20 BIODIFFUSER "'`-9p-� TOTAL NUMBER OF COUPLINGS: 0 52 69.67 � TOTAL LEACHING AREA: 480.0 J g4_ \ �92_ TOTAL LEACHING CAPACITY: 355.2 REV. DATE BY APP'D. DESCRIPTION PROPOSED SEPTIC SYSTEM UPGRADE NOTE: PREPARED FOR: N EFFECTIVE LEACHING AREA OF 4.80 SF/LF OBTAINED FROM THE G CAPEWIDE ENTERPRISES ___- - ____ Medium Sand 96 _96-- _ DEPARTMENT OF ENVIRONMENTAL PROTECTION APPR(0VAL LETTER 2.5Y 6/4 "MODIFIED CERTIFICATION FOR GENERAL USE" ISSUED)TO ADVANCED (15%gravel;many DRAINAGE SYSTEMS, INC. ON OCTOBER 3,2003(LAST NAODIFIED cobbles;some LOCATED AT �g2 4Q FEBRUARY 18, 2010). TRANSMITTAL NUMBER=W000052. boulders to 72") 10 FIELD STONE ROAD WEST BARNSTABLE, MA 02668 NOTES: MAP 111 SCALE: 1 INCH = 20 FT. DATE: JULY 22, 2010 �. 132" 63.00' _ PARCEL 55 ��, 0 10 20 40 80 FEET 1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP EDGE OF No Mottling, Standing or Weeping Observed �w OF&I �/ SOMME EACH SEPTIC SYSTEM COMPONENT. PREPARED BY: r RESERVED FOR BOARD OF HEALTH USE JOHN L. �� CHURCH L JR. N JC ENGINEERING, INC. o. 2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE LOCATION OF THE a 2854 CRANBERRY HIGHWAY PROPOSED LEACHING FACILITY TO ENSURE CONSISTENCY WITH TEST PIT N • o DATA SHOWN ON THIS PLAN. REPORT TO ENGINEER AND LOCAL BOARD OF SITE PLAN�F S . EAST WAREHAM, MA 02538 HEALTH IF SOILS ARE NOT CONSISTENT WITH TEST PIT DATA. 508.273.0377 SCALE: 1"=20' Drawn By: MCP Designed By:MCP Checked By:JLC JOB No.18" _ _ r N ASSESSORS MAP:_11�_ A/ /" ._ � / a TL ST HOLE LOGS NOTES. _ PARCEL: 54 1. VERTICAL DATUM: ASSUMED FROM A 1? (NGVD + -) �- ENGINEER: DOYLE ENGINEERING Qi ._' CURRENT ZONING. -,RF 2. ..hlIUNICAPAL WATER IS NOT AVAILABLE... - BUILDING SETBACKS: 7 WITNESS: THOMAS MCKEAN 3. SCHEDULE 40 - 4" PVC PIPE TO BE USED THROUGHOUT SEPTIC SYSTEM. DATE: 9-23-86' F. 30' S. 1s R. _ 4. ALL PRECAST UNITS TO CONFORM WITH AASHTO H-10 & H-20 PERCOLATION RATE. < 2 MINIIN LOADING SPECIFICATIONS. FLOOD ZONE: C TH'-1 TH-2 5. PIPE PITCH =jf_4" PER FOOT. 5 BENCHMARK AT 8s 0 6. FIRST 2' OF PIPE OUT OF D--BOX TO BE LAID LEVEL. A Locus CATCH ELEV ELEV _=ss BASIN SuR o11: 7. THE SEPTIC SYSTEM HAS NOT BEEN DESIGNED TO ACCOMODATE THE USE OF A GARBAGE DISPOSAL. yG, 8. ALL CONSTRUCTION DETAILS ARE TO BE IN CONFORMANCE WITH THE 65. s � -! AP Y e s MEDIUM STATE OF MASS. ENVIRONMENTAL CODE (TITLE FIVE) AND'LOCAL LOCATION M p�� AND HEALTH REGULATIONS. LOT 8 35,171 ± S.F. 68 84" OUL1.ER 78.0 9. CONTRACTOR TO VERIFY LOCATIONS OF ALL UTILITIES PRIOR (0.81 -- AC.) Q ND l R 70 MEDIUM! TO CONSTRUCTION. ' SANr! 10. DESIGN ENGINEER TO INSPECT AND CERTIFY SUITABLE SOIL CONDITIONS TO A DEPTH OF 4.0' BELOW LEACH PIT AT TIME OF CONSTRUCTION. sT014 _ _ --�s•s� - 144" 7s.o _11. PROPOSED SEPTIC SYSTEM AND WELL LOCATIONS ARE IN ACCORDANCE WITH MASTER PLAN, ON FILE WITH THE BARNSTABLE HEALTH DEPT. /74 w0000p r: _ / NO GROUNDWATER ENCOUNTERED 70 � 68. 9 6s-6� ,. 68 act / 7s SEPTIC SYSTEM DESIGN rGAk- UTILITY 14' .78 FLOW .?ST IMAT E.� BEDROOMS AT 110 GAL/DAY/BEDROOM = 330 GAL/DAY s B B oy24' CLUSTER r 24' DUELLING a . . ' � `�• '�wPROPOSED . .80 SEPTI TANK: TY. _ 764 (( l 330 GAL DAY * 1.5 DAYS - 495 GAL TO LEACH l / � 76 8 � / s6' DECK q / USE 1000 GALLON SEPTIC TANK PIT) 82 LEACHING AREA: 70 PROPOSED'DWELLING (SCALE f so-) 1 gL U;�E ON'E LEACH PIT (6' x 49 WITH 3.0' OF STONE Tg• Da ( :/. (1,r EFFECTIVE DIAMETER x 4' DEEP) ' 1 84 S IDE AREA: 12 x PI x 4 = 151 SF (2.5) - 377 GAL/DAY 72 ' / ...r• S IiPYTTOM AREA: 6 x 6 x PI = 113 SF (1.0) = 113 GAL/DAY / 74 / .. - "t�1.41, GAt'AC1"lY = 4yU GAL/17AY 76 -,..� 1 SEPTIC SYSTEM SECT ION " 78`" _ _ T$ 2 PEASTONE LOT 7 80- r / OF 3/4" - 1 1/2" 82 76.0 WASHED STONE , 84 _ TOP OF FOUNDATION 86 - / / � •- _ � � � •moo, -90 / \ - 72.43 0 0 92_ i �/ - \ _ - 72.68 1000 GAL ELEV. IDI-BOX 72.24 ELEV. SEPTIC TANK 2.3ELEV. 67.98 / 16244' ELEV`: TEE SIZES: ELEV. 71.98 3 ELEV. ` 96- / \ - -9s INLET: 6"_ UP, 10" DOWN ELEV. •— 12' - -> 98 \ OUTLET: 6"-UP, 19" DOWN ONE LEACH PIT (6' x 4') WITH +z9;99. s - 3' OF STONE (12' EFF. DIAM. x 4' DEEP) - - - 9e (H-20) r 100 r ' SITE AND SEWAGE PLAN KEY: LOCATION. EXISTING CONTOUR: LOT 9 .,j.o LOT 8 FIELDSTONE ROAD PROPOSED CONTOUR: .............................. A` ' T, ��, r r EXISTING SPOT ELEVATION: 2s.5 n R ` -- a WEST BA.RNSTABLE, MA PROPOSED SPOT ELEVATION. 25 TEST HOLE:-�- �,i ��.�,„e. :�. t�4 � �.� PREPARED FOR UTILITY POLE. •-<>- FENCE LINE. REEF REALTY SCALE: 1" 30' DATE: 5-13-94 DEMAREST-NcLELLAN ENGINEERING HYDRANT: -6- 24 SCHOOL STREET P.O. BOX 468 WEST DENNIS, MASSACHUSETTS 02670 REFERENCE: PLAN BOOK 413 PAGE 99 DM # THOMAS McLELLAN, P.E. .TO,HN Z. DEMAREST JR., P.L S. d