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HomeMy WebLinkAbout0105 HILLIARD'S HAYWAY - Health 105 Hilliard's Hayway West Barnstable r A = 136-053 ,. E o Commonwealth of Massachusetts ` O Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 105 Hillards Hayway Property Address a+ Howard & Kimberly Reich ; Owner Owner's Name ` information is Ma 02668 8-1-15 required for every West Barnstable page. Cityrrown 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:Wren A. General Information filling out forma on the computer, use only the tag 1. Inspector: v key to move ycur cursor-do not Matthew F. Gilfoy use the return Name of Inspector key. B&B Excavation " Company Name 14 Teaberry Lane Company Address Sandwich Ma. 02644 City/Town State Zip Code (508)477-0653 S113640 Telephone Number License Number B. Certification I certify that.I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 8-1-15 Inspector's Sign ture 7 Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. 2 0 _ VS t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 105 Hillards Hayway Property Address Howard & Kimberly Reich Owner Owner's Name information is required for every West Barnstable Ma 02668 8-1-15 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 105 Hillards Hayway Property Address Howard & Kimberly Reich Owner Owner's Name information is required for every West Barnstable Ma 02668 8-1-15 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 7 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 105 Hillards Hayway Property Address Howard & Kimberly Reich Owner Owner's Name information is required for every West Barnstable Ma 02668 8-1-15 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well"*. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �1M , 105 Hillards Hayway Property Address Howard & Kimberly Reich Owner Owner's Name information is required for every West Barnstable Ma 02668 8-1-15 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 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. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 105 Hillards Hayway Property Address Howard & Kimberly Reich Owner Owner's Name information is required for everyWest Barnstable Ma 02668 8-1-15 page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: 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? P 9 ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner) provided with ❑ ® information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 105 Hillards Hayway Property Address Howard & Kimberly Reich Owner Owner's Name information is required for every West Barnstable Ma 02668 8-1-15 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage d see below 9 ( Y 9 (gp ))� Detail: *well Water* Sump pump? ❑ Yes ® No Last date of occupancy: current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 105 Hillards Hayway Property Address Howard & Kimberly Reich Owner Owner's Name information is. requirec for every West Barnstable Ma 02668 8-1-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 I Commonwealth of Massachusetts N Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 105 Hillards Hayway Property Address Howard & Kimberly Reich Owner Owner's Name information is required for every West Barnstable Ma 02668 8-1-15 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of ail components, date installed (if known) and source of information: 2004 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 12"feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: >100 feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): 6" Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gallon Sludge depth: 6" t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 105 Hillards Hayway Property Address Howard & Kimberly Reich Owner Owner's Name information is required for every West Barnstable Ma 02668 8-1-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 30" Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 15" � How were dimensions determined? measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): At time of inspection septic tank appeared to be in working order with liquid level equal with outlet invert. Tank is not in need of pumping at this time. 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 105 Hillards Hayway Property Address Howard & Kimberly Reich Owner Owner's Name information is required for every west Barnstable Ma 02668 8-1-15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 105 Hillards Hayway Property Address Howard & Kimberly Reich Owner Owner's Name information is required for every West Barnstable Ma 02668 8-1-15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 011 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): At time of inspection D-box is in working order with no sign of back up or carry over. 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. Soil Absorption System(SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 105 Hillards Hayway Property Address Howard & Kimberly Reich Owner Owner's Name information is required for every West Barnstable Ma 02668 8-1-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 3 flow diffusers ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): At time of inspection leaching appears to be in working order with no sign of hydraulic failure. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth —top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 105 Hillards Hayway Property Address Howard & Kimberly Reich Owner Owner's Name information is required for every West Barnstable Ma 02668 8-1-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins-3/1:. Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 -Official inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 105 Hillards Hayway Property Address Howard & Kimberly Reich Owner Owner's Name information is required for every West Barnstable Ma 02668 8-1-15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of.the boxes.below: hand-sketch in the area below 0 drawing attached separately Well A O MAIN Y AI . �I � 20t�t► o c3 _22. �a Dz _25 t 0 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts 4 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 105 Hillards Hayway Property Address Howard & Kimberly Reich Owner Owner's Name information is required for every West Barnstable Ma 02668 8-1-15 page. City/Town . State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: No Gw 9'5" feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 7-28-04 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: Plan on file with BOH Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 105 Hillards Hayway Property Address Howard & Kimbehy Reich Owner Owner's Name information is required for every West Barnstable Ma 02668 8-1-15 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 CERTIFICATE OF ANALYSIS Page: 1 of 1 - ' ° h y' M Barnstable County Health Laboratory (M-MA009) ` Report Prepared For: - Report Dated: 8/24/2015 Kathleen Fisher Kathleen Fisher Order No.: G1589801 867 Main St. Osterville, MA Laboratory ID#:. 1589801-01 Description: Water;Drinking Water Sample#: Sample Location: 105 Hilliards Hayway,W.Barnstable Collected: 08/21/2015 Collected by: Customer Received: 08/21/2015 Routine ITEA( RESULT UNITS RL MCL METHOD# ANALYST TESTED NOTE Nitrate as Nitrogen 4.0 mg/L 0.10 10 EPA 300.0 LAP 8/21/2015 Copper ND mg/L 0.10 1.3 EPA 200.8 KK 8/24/2015 Iron ' ND mg/L 0.10 0.3 EPA 200.8 KK 8/24/2015 pH 7.7 PH AT 25C NA 6.5-8.5 SM 4500-H-13 DCB 8/21/2015 Sodium 7.6 mg/L 2.5 20 EPA 200.8 KK 8/24/2015 Total Coliform 0 /100ml 0 0 SM 9222 B RG 8/21/2015 Conductance 130 umohs/cm 2.0 EPA 120.1 DCB 8/21/2015 Water sample meets the recommended limits for drinking water of all the above tested parameters. Attached please find the laboratory certified parameter list. Approved By' __ (Lab Director) r 71-2 ��l r ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph;508-375-6605 '� `�, �s�•. : CERTIFICATE OF ANALYSIS Barnstable County Health Laboratory (M-MA009) �9sr�ctn Recipient: Kathleen Fisher Matrix: Water-Drinking Water Kathleen Fisher Sampled: 08/21/2015 0:00 867 Main St. Received: 08/21/2015 12:53 Osterville; MA Collection Address: 105 Hilliards Hayway,W.Barnstable Order#: G1589801. Sample Location: Description: Real Estate Kit Lab ID: 1589801-01 Date Analyzed: 8/21/2015 @ 14:58 Sample#: Analyst: yn Method: EPA 524.2 Dilution Factor: 1 Comment: Water sample meets the recommended limits for drinking water of all the above tested parameters. EPA 524.2 - Volatile Organics by GC/MS Result MCL MDL Result F-"ug-,L CL MDL Parameter ug/L ug/L ug/L Parameter ug/L ug/L Dichlorodifluoromethane ND 0.50 Chloroform ND 80 0.50 Chloromethane ND 0.50 cis-1,2-Dichloroethene ND 70 0.50 Vinyl chloride ND 2.0 0.50 cis-1,3-Dichloropropene ND 0.50 Bromomethane ND 0.50 Dibromochloromethane ND 0.50 1,1,1,2-Tetrachloroethane ND 0.50 Dibromomethane ND 0.50 1,1,1-Trichloroethane ND 200 0.50 Ethylbenzene ND 700 0.50 1,1,2,2-Tetrachloroethane N ND 0.50 Hexachlorobutadiene ND 0.50 1,1,2-Trichloroethane ND 5,0 0.50 Isopropyl benzene ND 0.50 1,1-Dichloroethane ND 0.50 Methylene chloride ND 5.0 0.50 1,1-Dichlorroethene ND 7.0 0.50 Methyl-tert-butyl ether ND 0.50 1,1-Dichloropropene ND 0.50 Naphthalene ND 0.50 1,2,3-Trichlorobenzene ND 0.50 n-Butylbenzene ND 0.50 1,2,3-Trichloropropane ND 0.50 n-Propylbenzene ND 0.50 1,2,4-Trichlorobenzene ND 70 0.50 p-Isopropyltoluene ND 0.50 1,2,4-Trimethylbenzene ND 0.50 sec-Butylbenzene ND 0.50 1,2-Dibromo-3-chloropropane ND 0.50 Styrene ND 100 0.50 1,2-Dibromoethane(EDB) ND 0.50 tert-Butyl benzene ND 0.50 1,2-Dichlorobenzene ND 600 0.50 Tetrachloroethene ND . 5.0 0.50 1,2-Dichloroethane ND 5.0 0.50 Toluene ND 1000 0.50 1,2-Dichloropropane ND 0.50 Total xylenes ND 10000 0.50 1,3,5-Trimethyl benzene ND 0.50 trans71,2-Dichloroethene ND 100 0.50 1,3-Dichlorobenzene ND 0.50 trans-1,3-Dichloropropene ND 0.50 1,3-Dichloropropane ND 0.50 Trichloroethene ND 5.0 0.50 1,4-Dichlorobenzene ND 5.0 0.50 Trichlorofluoromethane ND 0.50 2,2-Dichloropropane ND 0.50 Surrogates /o Recovered° QC Limits(%) 2-Chlorotoluene ND .0.50 p-Bromofluorobenzene 90% v 70 130 4-Chlorotoluene ND 6.50 1,2-Dichlorobenzene-d4 1120/a 70 130 Benzene ND 5.0 0.50 Bromobenzene ND 0.50 Bromochloromethane ND 0.50 Bromodichloromethane ND 0.50 Bromoform ND 0.50 Carbon tetrachloride ND 5.0 0.50 Chlorobenzene ND 100 0.50 Chloroethane ND 0.50 Attached please find the laboratory certified parameter list. Approved By: . �� (Lab Director) ��2 ���.• ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Lev& Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 Page 1 of 1 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 105 Hilliard's Hayway Property Address Howard & Kimberly Reich Owner Owner's Name information is required for every W. Barnstable MA 02668 6/14/13 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 filling out forms A. Genera! Information on the computer, use only the tab 1. Inspector: �O key to move your cursor-do not Matthew F. Gilfoy use the return Name of Inspector key. B&B Excavation, Inc. Company Name 14 Teaberrr Lane Company Address El-7-1 Forestdale MA 02644 City/Town State Zip Code (508)477-0653 S113640 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 'f 6/14/13 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time..This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Official Inspe on VForm:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 105 Hilliard's Hayway Property Address Howard & Kimberly Reich Owner Owner's Name information is W. Barnstable MA 02668 6/14/13 requiredd for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 105 Hilliard's H.ayway Property Address Howard & Kimberly Reich Owner Owner's Name information is required fcr every W. Barnstable MA 02668 6/14/13 page.. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumpsialarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 105 Hilliard's Hayway Property Address Howard & Kimberly Reich Owner Owner's Name information is required for every W. Barnstable MA 02668 6/14/13 page. CityrFown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: J ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 105 Hilliard's Hayway Property Address Howard & Kimberly Reich Owner Owner's Name information is required for every W. Barnstable MA 02668 6/14/13 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 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. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 105 Hilliard's Hayway Property Address Howard & Kimberly Reich Owner Owner's Name information is required for every W. Barnstable MA 02668 6/14/13 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ ® Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ -Was the site inspected for signs of break out? ❑ ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 440 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 105 Hilliard's Hayway Property Address Howard & Kimberly Reich Owner Owner's Name information is required for every W. Barnstable MA 02668 6/14/13 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No 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 ears usage n/a g ( Y 9 (gPd))� Detail: Sump pump? ❑ Yes ❑ No Last date of occupancy: May 2013Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 105 Hilliard's Hayway Property Address Howard & Kimberly Reich Owner Owner's Name information is W. Barnstable MA 02668 6/14/13 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 I - f , Commonwealth of Massachusetts L u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 105 Hilliard's Hayway Property Address Howard & Kimberly Reich Owner Owner's Name information is required for every W. Barnstable MA 02668 6/14/13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 2004 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 12 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: >100'from wellfeet Comments (on condition of joints, venting, evidence of leakage, etc.): At time of inspection building sewer appeared to be in good condition with no signs of leakage. Septic Tank(locate on site plan): 6" Depth below grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 5'8"x5'8"x10'6" Sludge depth: no sludge t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 L Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 105 Hilliard's Hayway Property Address Howard & Kimberly Reich Owner Owner's Name information is required for every W. Barnstable MA 02668 6/14/13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle no sludge Scum thickness no scum Distance from top of scum to top of outlet tee or baffle no scum Distance from bottom of scum to bottom of outlet tee or baffle no scum How were dimensions determined? scour stick Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): At time of inspection tank appeared to be in good condition with is present and no evidence of leakage. 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 105 Hilliard's Hayway Property Address Howard & Kimberly Reich Owner Owner's Name informatics is required for every W Barnstable MA 02668 6/14/13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4M , 105 Hilliard's Hayway Property Address Howard & Kimberly Reich Owner Owner's Name information is required for every W. Barnstable MA 02668 6/14/13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): At time of inspection D-Box appeared to be in good condition with no evidence of carryover or leakage. 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. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 i � Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 105 Hilliard's Hayway Property Address Howard & Kimberly Reich Owner Owner's Name information is required for every W. Barnstable MA 02668 6/14/13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ® leaching galleries number: 3 ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): At time of inspection leaching appeared to be in good condition with no sign of hydraulic failure. Cesspools (cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 t Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 105 Hilliard's Hayway Property Address Howard & Kimberly Reich Owner Owner's Name information is required for every W. Barnstable MA 02668 6/14/13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 3 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �•. 105 Hilliard's Hayway Property Address Howard & Kimberly Reich Owner Owners Name information is required for every W. Barnstable MA 02668 6/14/13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately Wei 1 U 7 ��° � �� C!5i b C 2_ Cs 3 2Z' C,t D,Z _ Zb 03 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 105 Hilliard's Hayway Property Address Howard & Kimberly Reich Owner Owner's Name requirafon is W. Barnstable MA 02668 6/14/13 required for every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 9.5 feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 7/8/04 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: Plan obtained from Barnstable Board of Health Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 105 Hilliard's Ha a Yw Y Property Address Howard & Kimberly Reich Owner Owner's Name information is required for every W. Barnstable MA 02668 6/14/13 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 TOWN OF BARNSTABLE J �/ LOCATION ' 0 ,S 44 111 M sl�s 11AY W,9Y SEWAGE VILLAG A 'dIg- ASSESSOR'S MAP & LOT I —Q INSTALLER'S NAME&PHONE NO.Age w 6 ems'% S'a r i 3 e Z SEPTIC TANK CAPACITY y.,. LEACHING FACILITY: (type (size) YNO.OF BEDROOMS_L BUILDER OR OWNER S"TE v,e /:A9 2A g l�i9 PERMTTDATE: S '-3 �d Sr COMPLIANCE DATE: I Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist -on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by L. i ) � a 0 No. U� ,7 Y r Fee ,fTHE'dOMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC'HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 11pprication for ni.5pool 6potem Construction Permit ; Application for a Permit to Construct( )Repair( Upgrade( )Abandon( ) [9 Complete System El Individual Components Location Address or LotNo 1090-A / A R"i Owner's Name,Address and Tel.No. / Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and d Tel.No. �J R_G/y d m�5 f, tr� /I. o u/W C/,/S",✓ S o F 7 j- 13 e,,), So Y_ y s-5- / s Type of Building: � Dwelling No.of Bedrooms� Lot Size sq.ft. Garbage Grinder('A�) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and pot to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of Health. Signed Date s Application Approved by Date Application Disapproved for the llowing reasons Permit No. 2 u a� � 7 ZE Date Issued t i .• ` ' No. f Fee 1 U nterea m.com HE COMMONWEALTH OF'i MASSACHUSETTS.. t"� p uter: ✓ Yes 1PULIC�HEALTH DIVISION =TOWNdOF,BARNSTABLE SSACHUSETTS ZIP cation for Migozaf 6petem Con!5truction Permit Application for a Permit to Construct( )Repair( KUpgrade( )Abandon( ) El Complete System ❑Individual,'Components Location Address or of No. 5 A� � Owner's Name,Address and Tel.No. 10 5 l-�;!/.Iq K ��Y .� Sr �- e i'f •z r, f /ice Assessor's Map/Parcel / 3 Listaller's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms y Lot Size sq.ft. Garbage Grinder(�) -, Other Type of Building No. of Persons Showers( ) Cafeteria( ) -Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date / Title Size of Septic Tank , Type of S.A.S. Description of Soil y- Nature of Repairs or Alterations(Answer when applicable - / R Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place,the system in operation until a Certifi- cate of Compliance has been issued by this Board.of Health.. 1� _ Signed Date ' I Application Approved by `� t4 S Date l 3 u�J Application Disapproved for the following reasons Permit No. U o`� _ Date Issued 4 / 1310 Y r THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CER IFY, that the On-site Sewage Disposal System Constructed( ) Repaired ( )Upgraded( ) 'Abandoned.-( )b - t /_/ at has beyen construct d in ccordance with the provisions of Title 5 and the for Disposal System Construction Permit No. VO y 7 dated 01/13 0 Installer s Designer Fn I— ov 7 A/ 15:_ "''3 I " IT issuance of thi pe t hall not be construed as a guarantee that the system wall fu don as des ed. n Date 1 Inspector /JV. (C No,. -7�--------® � a.. --.------.---Fee /dU-- d THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS �i6paal *p!5tem Con.9truction Permit Permission is hereby granted to Construct-( )Repair( )Upgrade( )Abandon,(.....) System located at ! '/�i r� and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construct ion must be completed within three years of the date of th s �rn' . Date:_ 1 Approved by � ) - TOWN OF BARNSTABLE foci# LOCATION f �' �� (� s IIAY"49Y SEWAGE#o?c:'4P S/v VILLAGE ��Si �A�t.✓s`?9 �% ASSESSOR'S MAP & LOT M -V U INSTALLER'S NAME&PHONE NOAeeW ee—'s'i se €' 7 7-s' 3 e� SEPTIC TANK CAPACITY F x o s r. ' /m 0 A LEACHING FACILITY: (type )/'/a 00 fc c s t-4s' (size) NO.OF BEDROOMS BUILDER OR OWNER S'TE vr' �•9 eA or 1�:q PERMIT DATE: FZ ��'� COMPLIANCE DATE: I�F ,Separa7tion;Distance Between the: Maximum Adjusted Groundwater able to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnlshed by - 1 J � � ®, P. ' Town of Barnstable a Regulatory Services Thomas F.Geder,Dim:tor Public Health Division Al Thomas McKean,Director 200 Main Street,Hyanal%M.t 02601 Fax; -03-790.6304 f3ftice: 508-962-4644 installer&Desisner Cer'tiCcatior Form Date: 9/2 4 04 Sewage Petmit# __.—Ass Ass�ssor's IW apiPareel 13 6/0 5 3 igner: Des Falmouth Engineering Znc. Installer: Address: 101 Ton k{all square Address: •(. =— Falmouth >Ih 02940 �Lmus Has iss-ied a permit to install a On i atenstaller) �� used on a design drawn by septic system at�05 H' ' 4d�dress) Falmouth En ineering, Inc. dated ?!8/04 RE.I. 8 6/04 (designer) �( 1 certify that the septic system referenced above was installed substantially according to the design,which may include minor approved charzl;es such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above wal. installed with major changes (Le, greater than lo' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State&Lora) Regulations. Plan revision or certified as-built by designer to follow. SORSELLI j A, ` _ CIVIL J {Installer's lgnature} ?Vo.35�r4 l (Desi t (AN r' 's Signatwe) :Designer's Stamp Here? 1 CERTIFICATE OF gyp, RE'1gIRN O 18AICYSTABLE �UAi rc HBALTH�DIYt IOl` AND AS-BUILT CA$ I $ COMPLI CE WILL 7' BE ISSUED '111 IL SOTS T1 Ilp TIAANK TM R.ECEIr cD BY THE N BAQSI'ABLE PUBLIC AEALTH_DIV O HtalthiSapt c.'Desipet Certificatien Form 3.26-04.doc R. A. Bousfield Backhoe Service 17 Burbank Street ! Sandwich, Massachusetts 02563 ` lD I Sewer Permit No. Location: U 7 S A 21 A 2 Builder,s Name and Address Date Permit Issued: Date Compliance Issued: f 1� o ,� { _ 3 .2. r Fsz�...� No.�- .................. �• t THE COMMONWEALTH OF MASSACHUSETTS CS BOARD F HEA TH ....OF........ ... ... . .. Apphrutinn -for Bhipagal Workii Tontrnrtinn Vrrm t �� Y 1\(g� Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: o�nCl'.1 r l/........�1. .2. 1�5?' .................4,.aT... .7-----------------------------------------------•--- Loc •Address --••........................................ Lot No. O r Address ,Wa �1��4•-•�dUf#..r 4JJ ---........ Installer Address pp UType of Buildi Size Lot_2�G•_1!!----------Sq. feet Dwelling—No. of�Bedrooms--.---_--/_________________________________Expansion Attic ( � Garbage Grinder (fk Other—Type of Building ____________________________ No. of persons........I------------------ Showers Cafeteria ( ) Other fixtures ------------------------------------------------------ W Design Flow.......s .................................gallons per person per day. Total daily.flow-------/d_4----______-__-__.-.__-._--gallons. WSeptic Tank--Liquid capacity/OAgallons Length---------------- Width................ Diameter-----........... Depth........ ....... x Disposal Trench—No..................... Width_______e-------------------- Total Length_.._..._............ Total Teaching area.............._....sq. ft. Seepage Pit No--------I........... Diameter.l�Q4....S)3�i 5�let................... Total leaching area------- ..........sq. ft. Z Other Distribution box ( ) Dosing tan ( )Aest - ~' Percolation Test Results Performed by'� is. �-----------------�` Date._---f, . ........... a Test Pit No. 1----------------minutes per inch Depth ofit._........_...__.... Depth to ground water-..--------------------- r14 Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ Ix . _ -••- y � F .-------- O --- es f SoilD w - ---------------- Y--------------------------------------0- ;----- �3 - _�,. :------ V 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 Article NI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b iss e by the board of health. Signed. -- •••• • - - ------------ Application Approved By---------- --- -• ---... .... ..--- - -- ---� ------lr----- -------------- Z late 14 . Application Disapproved for the following reasons---------------•---........_._..-•--•-.....-•---•--------•-----........_...----------....._--•--•............•--- .............•---•---.....••••--•-••..................----•---_..._.......•••..--•- Date PermitNo......................................................... Issued........................................................ Date i ------------------------------------------------------------------------------------------------------ ----- .� + THE COMMONWEALTH OF MASSACHUSETTS BOARD F HE TH ----OF........ .... ... - - - --- ---- ---------- ---.._._---------- ppliratiuu -fur Disposal Worka Touotrurtion Vautit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: ---------------------------•--•---•--------------•--•-•-......-•---•• ........................ _...................................... Location-Address or Lot No. W owner Address , Installer Address UType of Building Size Lot...............:`-----------Sq. feet Dwelling—No. of Bedrooms--------Z________________________________Expansion Attic O Garbage Grinder ( r) 44 Other—Type of Building ............................ No. of persons-------1................... Showers Cafeteria ( ) PaOther fixtures ------------------------------------•-----•--•-•-- ---------•-••---•-•-------------------•••-••------•---•----------•-- -•-••---- W Design Flow--------- ............................gallons per person per day. Total daily flow_______ .._ _.._._-._-___--..-_.._--gallons. P4 Septic Tank L Liquid capacity/.........gallons Length---------------- Width................ Diameter................ Depth---------------- W Disposal Trench—No. .................... Width-------------------- Total Length_------------------ Total leaching area--------------------sq. ft. x Seepage Pit No-------- ........... Diameter_----------------- Depth below inlet.................... Total leaching area-_._.--_-._____-.sq. ft. z Other Distribution box ( ) Dosing tan ( ) — �1 /�GOt , Gl , • %(o . aPercolation Test Results Performed by:"" .�,`./�►._._. _ .. Date.---� -_�_-n7�_-__----.... Test Pit No. 1----------------minutes per inch Depth of ' est Pit-.-_--__•--_--__-_-_ Depth to ground water-------..-.------------- fXq Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water--.--._--___-_-----_.._. P4 .---•-----•----- G 1 1 _ y T�'4412 L �jr �._..Descri ti of Soil-- ---------a- -•....#....... -- = at ja ---------------------_- x x ------------------------------------------------------------------ ----------------------------------------------- &--/V.......�- : �-v-;--- ----- d-L,4-....- --�'-�-�.=ate:------ V Nature of Repairs or Alterations—Answer when applicable--------------------------------_y_-_---.______-__•--_--____-_.------.-...___--___---_-._... ----------------------------- --- ---------- ------- -------------------------•-----------------------------------------------------------------•----------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary 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. Signe �. h S /_ Application Approved B ----------- � ... PP PP Y �' l/ _ .2)., 7 (� Application Disapproved for the following reasons:--•--------•-----------------------------------•---------------------------------------------......--------•---. ` Date PermitNo................................................ ........ Issued........................................................ Date I THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH ? � . ..............OF...... .. ..Cam'` ••` ' '•`C••................... 01.11rtifiratr of Tilutpliana T S IS 0 RTIFY T tXtlVle.In t tdual Sew Dispo 1 System onstructed (�or Repairedby � t • ............................................................... Installer 7� ...�.---- ..._.- has been installed in accordance with the provisions of : £icte XI of The State Sanitary Code as described in the application for Disposal Works Construction ,Permit No.-y.....'..Z_ 6___�_____________ dated.. �-_�__-_.?_�.............. THE ISSUANCE OF THIS CERTIFICATE SHALE, NOT RE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.................... ------------2ir................. Inspector--------------- --•-"--------------•-----•••-- THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH 7 .........o f.... . lc�r<� .. ................................................. No. •--- ............. FEE-/d ...... Dinvoott� rk noutr i at rrmit Permission 's hereby granted �/� G «+�/"----- --------t" ! ` to Cons uct or epair ( ) an Individual Sewage ,is ,. 1 Systein Street 7 6, as shown on the application for Disposal Works Construction Perini No.___�.._.___ ._._. °"ted.... .................................... % lr�:-------------- Board of Health DATE-------------------------------------------------------------------------------- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS _ 110 i CACC LTA BAY 4 � kM0 PROJECT i LOCATION HIWAIRDS � HAYWAY LOT 22 If QWAr (3 l wI � 1 Zvi' } ;✓ H F 1 CB C FOUND � ,\...{ a iL s LOT 21 �-®.CUS` NOT TO SCALE HILLIA S',Rb CATCH 14._ // BASIN 2v / MOE �A' LOT 20 AY WA OF RIStR �A OAT '•A Y CATCH 14.0 EX/SANG CESSPOa BASIN �APPROX/AIATl�'LGI^A11AVJ r�--_--_- N�9'1rJ'E 3 Q13.1 '3.3 PU4f DiP1; AND fXL 3.0 Z (3J,XZOf aFR SMS AWY ce 13.0 FOUND \ S / 4'42r SICW AROU412 BROKEI 2 FOUND 0.4 try 1 5 ? \\ 13.3 -2PM TANK OF i x "{ LOT 31 �� \\ s' "smp aIr m ASO)w r, , 1; S7J/64"A/A117P✓AL HOLY \' \ 13.6 15� f '7/ (SS,tf AW 11EAar SANO �Z EDGE tat 0.8 J \ 70 aF REZOCA Z � � 0 19.2 \ 3.0 \ x `� � \ 7 �� \'� �'��-1_ � �' __ �--�'--'_ ' -'� � � � � � �., x 7.6 J \ �� 1- - \ \ \ w7vr Ito QPAUE - - -0.9 �1 X 6.1 11.8 '%2 1 'w 7.1 2\01 �,kL •, `��0 _ ` - =�- N�� cJ99 16 5 1// f 1�; 17.2 4.l , \ SM101 V203 _ Zap . / SM125 `, CB/D \FCppO ^ \ 13.5 ��\ �I/`.2 ( I�� f 18.4 FOUND \ \ Ce14.6 \ - ' C � _ SM124 N 18 � � 7C �71 \,\ 120.00• \ � D15. OAK z JJ SM123 \ \ ?qR0 \ ` / I 1 20.3 19.5 DRIVE` /�� / �'�� / x 14.5 \\ \ 1 � i x 6.3 J \ \ N N �\ ` � 1 \ L3.3 \�^-2 \�\\ ,.-. /�� 14.3 y- \ 7.8 (TIDAL) J SM102 SALT MARSH \�, \�, I TIDAL ��• \\ \,�0 C \ p ` ` �\Tl7BEREII \� , : S�# ,�I 1, 14 41 CBTV �� `�'_ 'a - PVC �� � t SM121 7.5 - \ .2 PIPE, i JJLeiO S 4 Q SM120 SM119 � ,, °► > \�'� / SM11s� 4 •. --- LOT 37 ,� ,.. �X \�. \ 2.56t ACRES $0 x ,c. 0 7.6 12.1\ ' 1\ J THE GREAT MARSHES i (TIDAL) �\ \lp\ � ..«� ,, . � `=;� \ �`�' X..� •\ J'� 10.0; SM104 I \ i 7.8 \\\� 9.4 " ':9 �73 �\ V302 10:5\ 1 \I/ r SM115 \\ •• / ` SM105 �1 1 \ 1 �x9.9 7.6 x6.6 x8.5 N68'30'10"E I SM11 •.. -' �� I i POST g \, _ .5 yy 50.00' 2 SM108 SM107 R� SM1126.9 LOT 36 THE GREAT MARSHES SMt10 -5 SWCS '+L' (TIDAL) I I 8/6/04 RELOCATE SEPTIC SYSTEM, REMOVE RESERVE AREA. f DATE REVISION x 6.6 PLOT PLAN PREPARED FOR S T EVE PARRELLA IN GENERAL NOTES: ,tHOFIAss WEST BARNSTABLE MA MICHAELJ y`r; p PLAN DATE: JULY 8, 2004 PLAN SCALE: 1" = 20' o BORSELU 1. HOUSE NUMBER: 105 �• M U WETLANDS PERMITTII4G CIVIL ' No.35054 % pVIL ENGINEERING �t 2. ASSESSOR'S NUMBER: MAP 136, PARCEL 053, LOT 37 9U �GIg1E� L ALL � ,� WASTEWATER DESIGN ` - � COASTAL ENGINEERING 3. FLOOD HAZARD ZONES: C do A3 (EL. 11) ' 4. TOPOGRAPHIC INFORMATION COMPILED FROM AN ON THE GROUND SUiaVEY. 11nE s PLOT PLANS P1°� AND G0�*' . l�C�' I 5. ELEVATIONS SHOWN ARE BASED ON NATIONAL GEODETIC VERTICAL DATUM. 20 0 10 20 40 WEE COMMERgAI/RESIDENIIAL R LAND USE PLANNING _ - Se,�r�y Gq�s Cad avid SavMsosf�rn ,f/assm�i�isefta SCALE: 1 WCH - 20 FEET y l 101 TOWN HALL S '��ARE - FALMOUTH, MA - 02540 - 508.495.1225 - 508.495.3229 fax PROJECT NUMBER: 04021 CAD FILE NAME: 04021PP DRAWN BY' L.M. SFEET 1 OF 2 t � � FINISH GRADE ;TALL BE 2X M/N/MU0 OILER ALL SEP77C S7S" COMPONEN7.' USA' 4 O/A: SCHEDULE 40 PAC OR CAST IRON PIPE 20'MIN&U M SETBACor FROM EDGE 6F STONE TO CELLAR WALL 1 10'MINIMUM SE F,4Cfl REMOVABLE COVERS SET TO WITHIN 12" OF FINISH GRADE (TOTAL OF 3) SOIL TEST _ - - - - - - _ - - - - - - •: .. - AIL. . - - - - - � � - - _ _ - .. -� = - ... . . T T, I -� Date of soil test: 3/30/04 Test taken by. MICHAEL BORSELLI • • S = . Results witnessed by. DAVID STANTON a , .02 Percolation rate < 2 MIN/IN. d .S\L��� /NkERT ELEK - 14.00 Ground water 10.25', 9.50' 2"LAYER OF 1/8" TO 1/2' OBSERVED AT 10.3' TEST HOLE #1 a JOO` GALLON �i S 'T F7RST SLG�E 1/AR/ES �,4SHE0 STONE OBSERVED AT 9.5 TEST HOLE 2 ,) � 2'LEI2rL S = .01 tit/N. # SEPTIC TANK Cm Cm 0 =on= a �W FLICK = U10 h W h BOX nto 6 H/GH GROUNOW.4TER EL. _ .?O i3 II D/ST. - 9f l� INSTALL .�/4" TO > 1/2" OBSERkF GROUNDWATER EL. S.0 t� WASHED, CRUSHED STONE ALL EL. 4 O SET SEPTIC TANL't' AW 91SZF19Z1)70N 9OX II I AROUND C/1AMNERS AND 0010V K60770t/ OF TEST HOLE TEST HOLE #1 TEST HOLE #1 ON 5 LA YER O)c CRUSHED STONE �, TO 7HE BOTTOM GF 711E CHAMBE.4 SYSIFV.. REFER TO LAYOUTOF on 0" SYSTEM FOR MORE DETAILS ok 6" A 6" A 9 It$ PROFILE. z z LOAMY SAND LOAMY SAND I 36 „ 10 YR s 6 1s" 10 YR s s NOT TO SCALE C1 C1 J - RI -IE 24"D/A. 00kERS REMOOASLE 24" O/A. 00kER LOAMY SAND LOAMY SAND 2.5Y7/4 2.5Y7/4 � . ; • • 4. ti. .. 4 . MC OPEN AT TOP SET 96 102 INLET II'NOC/fOUT 5"M/N. FROM TAN!( CD�£R L/ /D LEl�L OUTLET ICNOCI,BUT I C2 C2 INLET TEE SET OU7ZET TEE SET - 2" COARSE SAND COARSE SAND 10 M/N. BELOW 14"BELOlY 2 OUTLETS 1 3/4" ' : L/QUIlO LEt2rL L/QU/O L£li£L 2.5 Y 7/3 2.5 Y 7/3 O +� OUTLET i," � � INLET 144" 132" '' GAS BAFFLE . �'Ui INLET TrnicaL of 5 '�2 1,-2 0 N G.W. 0 9.50' 4' 8 G.W. 010.25 •� 6 ,I :4 3" 2 - OU TLETS 19.5" 19.5" a. PLAN VIEW CROSS-SECTION r _ _ DiSTRIDUTION t�G t =10 LOADING I FOR 1 0' O" 5'' 2" BASS 0 DESIGN: NOT TO SCALE • TOTAL L.7A/L Y FLOW/S BASED ON 4 BEDROOMS, NO GARBAGE DISPOSAL 10' - 6" 5' - g" TOTAL OAIL Y/Z OW = 110 GPD/SEOROOM X 4 BEDROOMS = 440 GPD 1500 GALLON SEPTIC TANK (H-1 0 LOADING) BOTTON"AREA PROPOSED = 5Z5 S.F. NOT TO SCALE SIDE AREA PROPOSED = 99 S.F. TOTAL LEACH/NG AREA PROPOSED = 515 S.F. B CONSTRU 0 NOTES: APPL/CA77ON RATE = 0.74 GPD/S.F. (' ----------- -------- -- A 1. INSTALLATION Off" THi'PROPOSED SEP770 SYSTEM SHALL 9E/N ACCORDANCE ils7lY A7ZE 5 AND 771E BOARD OF HEAL 7H REGL/LAAON.S DESIGN LEACH/NG CAPA0/7Y = 455 GPD > 440 GPD A I I I 1 SPECIFICATIONS I 1 2. A C6 PY GIF' 771E PLANS _9VALL RE 4 0A/LARLE ON .577E FOR REFERENCE AT ALL 77WE:S' I- - _T - 1.) CONCRETE STRENGTH F'C 4,000 PSI O 28 DAYS. DUR/NC 771E/NS7,44L410k 6F /Wl- SEPAC SYSTEM. - - - + DENSITY 150 PCF. 2.) CEMENT, PORTLANID TYPE I OR III. ASTM C150-81. J. NO CHANGES TO 71E DES✓GN SHALL 8f'PERFORMED ff77la/T WE APPROVAL OF 80771 ' 3.) ADMIXTURES, AIR I& PLASTICIZERS O ASTM C233-81 FALM00Y GNOINEi?19M2 1142 AND THE BOAR OF HEAL Th. I 4.) REINFORCING ASTM A615 FOR WIRE FABRIC, GRADE i I I I 60 BAR. 4 THE SEPAL SYSn I+/ IS SU6',eeT TO /NSPEC770N BY FALMOUAI ENG/NEER/NQ INC I I 5.) DESIGN LOADING AASHTO HS20-44. AND A1E BOARD IN L- -- ------- --------- 5. AhE 001V7RACr6WR HALL NO77FYFALMA%A1 ENG/NEER/Nig INC AND /7/E90AR0 Or HEAL AI TO INSPECT )WE50*1IC SY571W PR/OR TO 9ACA77LL. /N SOHIE/NSTANCESy A&WE 711AN ONE B /NS9°EC)70V MAY 6E NEEDEL'. /HE CONTRACTOR SHALL OWL Y SA016*7LL THE P6W;7aVS Or T71E 8'-0" 2" , SYSTEM THAT HA;,r Saw IN.,SPEC7E0 ND APPR012r0 BY FAL va17H ENGINEERING,, /NG AND 4- PVC VENT PIPE THE BOARD 6F HM7N SCREEN 6" S. /F 771E CD/1/TRACT P Q1/COG/N7ERS AND IiAR/AAONS /N SYT6' CDND/AON,S SUCH AS D/PEER/NC ® ® ® ® ® SGYL.S A0000RAP1+I' N£TZAA-.,2S' 6W 07YER 6VN0/776NS 7H.4T MAY RI-WIRE RE-£I�ALUA77GW Air MIN. ® ® ® ® ® ® TH£DES/A1; A1E .VMACTIW SHALL /MMEO/ATEL Y CANTACT FALMOUTf1 ENG/NE£RINIT INC FINISHED GRADE 30 2" X 5 1 2- OPENINGS 9' KNOCKOUTS FOR / BED INSTALLATION FRONT VIEW SIDE VIEW SEPTIC SYSTEM DETAILS PITCH PREPARED FOR 4" PVC VENT PIPE 2' 8- PLAN: VIA STEVE PARRELLA 41/2' 3/8" SLOTS 21I2 IN VENT PIPE DETAIL WEST BARNSTABLE 4• DIA. MA NOT TO SCALE , 0 � FLOW LINE PLAN ®ATE: JULY 8, 2004 PLAN SCALE: AS SHOWN OF CIVIL ENGINEERING WETLANDS PERMITTING -� MOUT Z 1'{' WASTEWATER DESIGN > COASTAL ENGINEERING SECTION A-A SECTION B-B TITLE PLOT PLANS ��G 1��- PIS AND DOCKS WEER TYPICAL FLOW DIFFUSOR DETAIL a !, LAND USE PLANNING sa- ,.9 C400 Cad me,S'aridtienstavr, ,l/asswdus�.tta NOT TO SCALE 101 TOWN HALL SQUARE -- FALMOUTH. MA - 02540 - 508.495.1225 -- 508.495.3229 fax PROJECT NUMBER: 04021 CAD FILE NAME: 04021PP DRAWN BY L.M.,D.H.M. 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