Loading...
HomeMy WebLinkAbout0053 KETTLEHOLE ROAD - Health 53 Kettlehole Road West Barnstable A= 109-052 i I t d } _ TOWN OF BARNSTABLE LOCATIbNc \ _ SEWAGE VILLAGE ASSESSOR'S MAP&PARCEL Q INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY (�b LEACHING FACILITY.(type)?rjC�S (size) NO.OF BED ROOMS OWNER v\ PERMIT DATE: ' � ) I"J 1 j COMPLIANCE DATE: 72h D Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom 40eaching Facility tits�j Feet A." Q��Cav n Cf c Private Water Supply Well and Leaching Facility(If any wells exist on site or.within 200 feet of leaching facility) l7(� ` Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) r' �- NA Feet FURNISHED BY. k i � �t t1 � ------, _ ��f "a5�� �y 3 � , G a v� - r - . -�- � � .� �- � � �_� ao: � �, G� � .. . . .�� ��. � fi No. 0 — o� I Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Zipplitation for Disposal 6pstem Construction Permit Application for a Permit to Construct(' ) Repair( ) Upgrade(Abandon( ) complete System ❑Individual Components Location Address or Lot No.j'3 k e 7-1z #&Ie R./ Owner's Name,Address,and Tel.No. Assessor's Map/Parcel / f 5-A Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. 4a Ali C—,4,1'7_f'A,1v e 4 Type of Building: Dwelling -No.of Bedrooms Lot Size 119 sq.ft. Garbage Grinder( ) �� Other "type of Building /1 2 r No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) .J c?0 gpd Design flow provided 1 gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank /O0G t_�'A/J'/o y Type of S.A.S. 0—X4'. �✓�' Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensur he constr tion and a to ce of the afore described on-site sewage disposal system in accordance with the provisions of Title of th Env' tal ode an not o place the system in operation until a Certificate of Compliance has been issued by this Bo d of 7� Signed. Date Application Approved by Date 6 Application Disapproved by Date for the following reasons Permit No. l — Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTI Y,that the On-site Sewage Disposal system Constructed(✓� Repaired( ) Upgraded( ) Abandoned( )by=i <at �� has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. a °� O dated — Installer Designer #bedrooms _3 Approved design flow 3 U gpd The issuance of this permi shall of be construed as a guarantee that the system w' s de ' e Date /' �� � J Inspector No. O 019 d Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes ,,PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 2pplication for Disposal *pstem Construction j3ermit Application for a Permit to Construct(• ) Repair( ) Upgrade Abandon( ) Complete System ❑Individual Components Location Address or Lot No.S'.3 k e 7`t a le R./ / ,Owner's Name,Address,and Tel.No. Assessor's Map/Parcel- V',Q�j,/J/r RA ,t Installer's Name,Address,and Tel.No. Designer's Name;Address,and Tef No. of Q//C kle.-JG,4/ /GO �i//f<i//l N��' >f Tiy C-.4,r7_s4.-Aw+,4 Type of Buflding Dwelling o.of Bedrooms -j Lot Size 7 r//� sq.ft. Garbage Grinder( ) T Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3,?� gpd Design flow provided y 9 gpd Plan Date Number of sheets / Revision Date Title Size of Septic Tank 1 ooe Yx/r Type of S.A.S. n�n hprr Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: // x The undersigned agrees to ensure the construction and maintendrice of the afore described on-site sewage disposal system in ! accordance with the provisions of Title 5'of the Env / ental Ci ode an• not o place the system in operation until a Certificate of .Compliance has been issued by this Board of Tea , X Signed / A / Date Application Approved by l �.. Date Application Disapproved by 1 P Date for the following reasons \ 1/ p, ti Permit No. 4 b 1 a Date Issued ►3 t 1 --------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed(,rj Repaired( ) Upgraded( ) Abandoned( )by7-f C� �C �YtCfiY1 at �3 �/ _/� ��/1� has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. a Oil a! i5 dated - - Installer . Designer #bedrooms Z Approved design flow �j C gpd The issuance of this permi shall pot be construed as a guarantee that the system will-ftitnstio i n Date --7 11b )be Inspector r/------------------------------------- ----------- ------------------------- ------------------- No.�G/9 b Fee / THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE, MASSACHUSETTS Disposal &pstem (Construction Vermit Permission is hereby granted to Construct Repair( ) Upgrade( ) Abandon( ) System located at 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:Construction must be completed within�three years of the date of this permit. `/� Date �— 1 ,3 / Approved bytj Town of Barnstable �`!tE ,. Inspectional Services • �: Public Health Division ;y • SARNSI'ASLE, • r v� MASS � Thomas McKean, Director AlF�ww�°619. 200 Main Street,Hyannis,MA 02601 � R Office: 508-8624644 Fax: 508-790-6304 r Cr Installer& Designer Certification Form Date:` %Z / Sewage Permit# o?0J9-2)S Assessor's Map\Parcel Designer: All f2j TE 17E516 . /_t e— Installer: %6e& 4)f1GCf� 44WJ � )&— Address: W M07-14&) PAV6, Address: 511 vPPE'Z CWr47' POAD SoLM4 T)&NV(IS uwQ 02660 5�c9E Gc�1,2 K On 13 ]IT 77.0 1CX9 � as issued a permit to install a ( te) (installer) septic system at 53 KE-tTLEAc-E ?oZ9D. 14), 81OP441 based on a design drawn by (address) ' AR .51 7f, pg5/&-/�4 C cc dated 5 ZU 1 (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed in c ce with the to rms of the M approval letters (if applicable) OF M4Ssq ASA J.MINTZ nstaller's Signature ° clvlLCn NO.52659 ��SFG/sTERNG��� S�ONAL E (Designers Signature) (Affix Desig Wmip Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. WoWeptAHEALTMSEWER conneeMEPTICOesigner Certification Form Rev&14-13,DOC 1I Lv 'I�jo r ul 061,1510:24p p.1 Commonwealth of Massachusetts Title 5 Official Inspection Form I° Subsurface Sewage Disposal System Form-Not for Voluntary Assessments - 9 P y ry ` 53 Kettlehole Road Property Address Lewis Taloumis Trust Owner Owner's Name information is required for every West Barnstable MA 02668 6-29-15 1-- page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. tnspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the 2 ``��tttlttllttlf►pr��� use only he F A4AS tab �/ter, �3, YtH� s9C'���%. 1. Inspector. key to move your cursor-do not James D.Sears JAMES use the return Name of Inspector SEARS -4 key CapewideEnterprises,LLC Company Name To IF �a 153 Commercial Street Company Address Mashpee MA 02649 City/Town State Zip Code 508477-8877 S1623 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. 1 am a DEP approved system inspector pursuant to Section 16.340 of Title 5 (310 CMR 15.000).The system: ❑ Passes ❑ Conditionally Passes Fails i i ❑ Needs Further Evaluation by the Local Approving Authority I f S9� 7-6-15 j <rrrspector's Signature Date The system inspector shall si_,bmit 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. i i ****This report only describes conditions at the time of inspection and under the conditions of use i at that time. This inspectioni does not address how the system WE perform in the future under the same or different conditions of use. t5inr:•3113 Title 5 Offidal Inspection Fonn:Subwrfaw Sew np Mpn.W System-Pape 1 of 17 r Jul 06 15 10:25p p.2 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 53 Kettlehole Road Property Address Lewis Taloumis Trust Owner Owner's Name information is West Barnstable AAA 02668 6-29-15 required for every i page. Citylrown 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: Failed System. The system is a 1000 Gal.Tank-D Box and Pit. j 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. i Q Y Q IV Q Na(Explain belowj: I i 151ns-3113 Titles 0%dal Inspecdon Form:Subsurface Sewage Disposal Syslem-Page 2 of 17 i I r; Jul 06 11510:25p p.3 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 53 Kettlehole Road Property Address Lewis Taloumis Trust Owner Owner's Name information is required for every West 6amstable MA 02668 6-29-15 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 pumpslalarms 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: II 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 tsins Title 6 Official Inspection Form:Subsurface Sewage Ussposel System•Page 3 of 17 I Jul06 1510:25p p.4 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 53 Kettlehole Road Property Address Lewis Taloumis Trust Owner Owner's Name information is West Bamstabte AAA 02668 6-29-f 5 required for every page. Citylrown 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 i 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 i A' i/f E Pd 57— ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ 0 Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Liquid depth in t is less than 6"below invert or available volume is less than day flow PST f,�- 7-11 E P,4527 15ins-3113 Title 5 Official Inspection Fort Subsurface Sewage Disposed System•Page 4 of 17 I j I i Jul06 1510:26p p.5 Commonwealth of Massachusetts Title 5 Official Inspection Form ;i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments k 53 Kettlehole Road _ Property Address - Lewis Taloumis Trust i Owner owner's Name information is West Barnstable MA 02668 6-29-15 required for every Zip Code Date of Inspection page. City/Town State 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. ❑ 0 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. a ❑ ® 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 20009pd- 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 11 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. t5ine•3M 3 TRIe 5 official Inspeclion Form:Subsurface Sewage Disposal System-Page 5 of 11 iI i f Jul06 1510:26p p.6 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System.Form - Not for Voluntary Assessments 53 Kettlehole Road Property Address Lewis Taloumis Trust Owner Owner's Name information is West Barnstable MA 02668 6-29.15 required For every 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) t ❑ Was the fat itifty 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? El M 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 approximafion of distance is unacceptable)131 D CMR 15.302(5)) D. System Information 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 t5ins-3M3 Title 5 offi6a:inspedon Fonn:Subsurface Sewage Disposal System-Page 6 of f 7 Jul 06 15 10:26p p.7 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r 53 Kettlehole Road Property Address Lewis Taloumis Trust Owner Owner's Name information is required for every West Bamstabre MA 02668 6-29-15 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: The system is a 1000 Gal.Tank D Box and Pit. 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 d Well Water g ( y 9 (gP ))� Detail: Sump pump? ❑ Yes N No NA Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15203): Gallons per day(gpr!) Basis of design flow(seats/personslsq.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: Sires•3113 Title 5Offldel Inspection Forth:Subsurface Sewage Disposal System•Page 7 of 17 Jul 06 15 10:27p p.8 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 53 Kettlehole Road Propeny Address Lewis Taloumis Trust Owner Owners Name information is required for every West Barnstable MA 02668 6-29-15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancyluse: Date Other(describe below): General Information Pumping Records: NA Source of information: Was system pumped as part of the inspection? ❑ Yes ® No i If yes,volume pumped: gallons How was quantity pumped determined? -- Reason for pumping: -- i 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) i ❑ Innovative/Alternative technology_ Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest i inspection of the I/A system by system operator under contract ❑ 'fight tank.Attach a copy of the DEP approval_ ❑ Other(describe): t5ins•3113 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 8 of 17 i i i i i i Jul06 1510:27p p.9 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments y 53 Kettlehole Road Property Address Lewis Taloumis Trust Owner Owner's Name information is West Barnstable MA 02668 6-29-15 required for every page City/Town StateZip Code Date of inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1989 Permit # 89- 128. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 3' Depth below grade: feel 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.): Pipeing is 4" PVC SCH 40. Septic Tank(locate on site plan): 27" Depth below grade. feet Material of construction: ® concrete ❑metal ❑fiberglass ❑ polyethylene ❑other(explain) i i If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No 1000 Gal.Precast H-10 Dimensions: 3" Sludge depth: I i5ins•W3 Tine s ommai inspection Forth:subsudece Sewage Disposal System•Page 9 of 17 I t Jul06 1510:27p p.10. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 53 Kettlehole Road Property Address Lewis Taloumis Trust _ Owner Owner's Name informationis required for every West Barnstable MA 02666 6-29-15 page. Cityfrown 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 27" 1" Scum thickness 12" Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 17' Asbuilt-Tape How were dimensions determined? Sludge Jude 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 at working level.Tank at 27" below grade w/inlet cover at 4". In and out let baffles. No sign of leakage Tank shows signs of being over full (solid's on top of both baffles). Grease Trap(locate on site plan): I 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17. Jul06 1510:28p p.11 Commonwealth of Massachusetts Title 5 official Inspection Form .I Subsurface Sewage Disposal System Form-Not for Voluntary Assessments p ` 53 Kettlehole Road Property Address Lewis Taloumis Trust Owner Owner's Name information is MA 02668 6-29-15 West Barnstable required for every State Zip Code Date of Inspection page. City/Town D. System Information (cunt.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): j 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 Faun:Subsurface Sewage Disposal system-Page 11 or 17 Jul06 1510:28p p.12 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 53 Kettlehole Road Property Address Lewis Taloumis Trust Owner Owner's Name information required for every West Barnstable MA 02668 6-29-15 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 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.): D Box is 12"x16"-3' below grade w/one line out. 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. i Soil Absorption System(SAS)(locate on site plan, excavation not required): If SAS not located, explain why: l5ins•3113 Title 5 Offlrla Inspegion Form Subsurface Sawage Disposal System•Page 12 of 17 i I l i Jul06 1510:28p p.13 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r 53 Kettlehole Road Property Address Lewis Taloumis Trust Owner owner's Name reformation is required for every West Bamstable MA 02668 6-29-15 page. CityrFown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number 1 -- ❑ leaching chambers number ❑ leaching galleries number: 4 ❑ 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.): Leaching is a 4'x6'pit w/3'stone. Pit at 42"below grade w/cover at 22". Pit is dry. Pit shows signs of being over full and not leaching. Solids on top of inlet line w/paper and solids stuck on wall at inlet level. 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-3113 - Tille 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 0117 Jul06 1510:29p p.14 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 53 Kettlehole Road Property Address Lewis Taloumis Trust Owner Owner's Name informationis required for every West Barnstable MA 02668 6-29-15 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•3113 Title 5 Official Inspedion Fonrx Subsurface Sewage Disposal System•Page 14 of 17 Jul06 1510:29p p.15 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments G 53 Kettlehole Road Property Address Lewis Taloumis Trust Owner Owner's Name _ information required for every West 8amstable MA 02668 6-29-15 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 aft 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 b a PPS A� 1J� L,t_ I �qy^� i 13-3 13 15ins-N13 Tide 5 OKdal hspedion Fonm subsurtace&we"oispoui system•Page 15 of 11 J J Jul06 15 10:29p p.16 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 53 Kettlehole Road Property Address Lewis Taloumis Trust Owner Owner's Name inquired foon r West Barnstable MA 02668 6-29-15 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar i ❑ Shallow wells a N 20' Estimated depth to high ground water: feet F 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: pate ® Observed site(abutting propertylobservation 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: System is in rear, Lot high from RD. some 20'. Bottom of pit at 8' below grade. i Before Fling this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3113 Title 5 Ofridal Inspection Fom¢Stbsurface sewage Disposal System•Page 16 of 17 I i r Jul 06 15 10:30p p.17 Commonwealth of Massachusetts • Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 53 Kettlehole Road Property Address Lewis Taloumis Trust Owner Owner's Name information required for every West Samstable MA 02668 6-29-15 page. Citylrown 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 15ins•3013 Title 5 MIMI inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Aug 041510:15p p.1 g ' Er/ / $ i` 17 li'� F'aR / Commonwealth of Massachusetts Title 5 Official Inspection Form 7 Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 53 Kettlehole Road " Property Address Lewis Taloumis Trust Owner Owner's Name f 1 information is 3`- t3te MA 02668 8-1-45 required for every West Bamst'a page. CityrTown 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. Impfling out f When A. Genera) Information tununrrp filling out forms i� ������,• OF r�r'�ii on the computer, /' //v c// use only the tab 1. Inspector: off". �csG key to move your cursor-do not James D.Sears _~g; JAMES use the return Name of Inspector key. CapewideEnterprises,LLC V I-I Company Name 153 Commercial Street Company Address Mashpee _ ____ MA _ _ 02649 Cityfrown State Zip Code 508-477-8877 _ S1623 Telephone Number license Number B. Certification I certify that i have personally inspected the sewage disposal system at this address and that the irtformatiort reported below is true, accurate and cortTfrtete as of the time of the inspection. The inspectbn 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 CM 16.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 8-4-15 spector'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 wff[perform In the future under the same or different conditions of use. csms•3113 Tile 5 Official Inspection Form:Subsurface Sewage Disposal System-Page I of 17 �� - VS Aug 04 1510:15p p,19 Commonwealth of Massachusetts Title 5 Official Inspection Form b Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 53 Kettlehole Road Property Address Lewis Taloumis Trust Owner Owner's Name information required for every West Bamstable MA 02668 8-1-15 page. Cityrrown 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: ® 1 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: Revised Report Note: System is 25 years old_ Pit show's sign's its been over full in the past. After review W180H system passes. 8) System Conditmaily 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 it 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 We 5 Official twection Form Subsurface Sewage Disposal System-Page 2 of 17 1 Aug 04 15 10:1 tip p,20 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments -- 53 Kettlehole Road Property Address Lewis Taloumis Trust Owner Owner's Name information is required for every West Barnstable MA 02668 8-1-15 page. Cityrrown state Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumpslalarms not operational. System will pass with Board of Health approval if pumpstalarms 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 ❑ NO (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 t5hs•311a Title5 0frdal Inspedion Form:Subsurface Sewage Disposal System•Page 3 of 17 i� I Aug 041510:16p p.21 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 53 Kettlehole Road Property Address Lewis Taloumis Trust Owner Owner's Name information is required for every URlest Bamstabte MA 02668 8-1-15 page. Cityrrown State Zip Code Date of Inspection B. Certification (coat.) 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 aseptic tank and SAS and the SAS is less than 100 feet but 50 feeter 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: i 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 eesepeet is less than 6" below invert or available volume is less than day flow e°.•r 15ire.3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 4 of 17 i I j Aug 041510:17p p.22 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments r 53 Kettlehole Road Property Address Lewis Taloumis Trust _ Owner Owner's Name information is West Bamstable MA 02668 8-1-15 required for every page. Citylrown 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 arm wnie 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 20009pd- 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 faits. 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•3113 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 5 of 17 Aug 041510:18p p.23 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 53 Kettlehole Road Property Address Lewis Taloumis Trust --- Owner Owner's Name information is required for every West Barnstable VA 02668 8-1-1 5 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 NIA) ❑ 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): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 15ns-V a Title 5 Official Inspection Form:Subsurface sewage Disposal system-Page 6 of 17 I Aug 041510:18p p.24 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 53 Kettlehole Road Property Address Lewis Taloumis Trust Owner Owner's Name information required for every West Bamstable MA 02668 8-1-15 page. City/Town State Zip Code Date of Inspection D. System Information Description: The system is a 1000 Gal. Tank D Box and Pit Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes f ]C No Is laundry on a separate sewage system? (Include laundry system inspection El Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaiuse? ❑ Yes ® No Water meter readings, if available (last 2 years usage(gpd)): Well Water Detail: Sump pump? ❑ 'Yes ® No Last date of occupancy: NA Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(go) Basis of design flow(seats/personslsq.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-W13 Title 5 Ofridal Inspeclior,Forth:Subsurface Sewage Disposal System•Page 7 cf 17 Aug 041510:18p p.25 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 63 Kettlehole Road _ Property Address Lewis Taloumis Trust Owner Owners Name information required for every West Barnstable MA 02668 8-1-15 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: NA 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): ISim•3113 Title 5 Official Inspection Form;Su:surface Sewage Disposal Syslem•Page 8 of 17 Aug 041510:19p p.26 Commonwealth of Massachusetts Title 5 Official Inspection Form a' o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 53 Kettlehole Road Property Address Lewis Taloumis Trust Owner Owner's Name information is West Barnstable MA 02666 8-1-16 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed(if known) and source of information: 1989 Permit # 89- 128. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 3' Depth below grade: feet Material of construction: ❑cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Pipeing is 4" PVC SCH 40. Septic Tank(locate on site plan): 27" 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 Gal.Precast H-10 Sludge depth: T. t6ira-3113 Titia 5 Official Inspadion Fctm Subsur(ara Sewage nisposal Syslem-Pape 9 of 17 I I Aug 041510:19p p.27 Commonwealth of Massachusetts Title 5 Official Inspection Form f) Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 53 Kettlehole Road Property Address Lewis Taloumis Trust Owner Owner's Name information required for every Wiest 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 27" 1" Scum thickness Distance from top of scum to top of outlet tee or baffle 12" Distance from bottom of scum to bottom of outlet tee or baffle 17" How were dimensions determined? Asburlt-Tape Sludge Juge 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 at working level.Tank at 27" below grade w/inlet cover at 4". In and out let baffles. No sign of leakage Tank shows signs of being over full (solid's on top of both baffles). 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•W 3 Title 5 Official inspection Farm:Subsurface Sewage Disposal System.Pago 10 of 17 l Aug 041510:20p p.28 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments t 53 Kettlehole Road Property Address Lewis Taloumis Trust Owner Owner's Name information is required for every "kst Barnstable MA 02668 8-4-t 5 page. Cityffovm 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 15im•3113 Title 5 Midst Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Aug 041510:20p p.29 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 53 Kettlehole Road Property Address Lewis Taloumis Trust Owner Owner's Name information required for every test Barnstable MA 02668 8-4-96 page. CitylTown State Zip Cade Date oY Inspection D. System Information (cont.) 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.): D Box is 12"xiT-3' below grade wfone line out 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: 15'ns•3113 Title 5 oiricei inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Aug 041510:20p p.30 Commonwealth of Massachusetts Title 5 Official Inspection Form J — Subsurface Sewage Disposal System Form-Not for Voluntary Assessments y 53 Kettlehole Road Property Address Lewis Taloumis Trust _ Owner Owner's Name information 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: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Typeiname of technology: ---- Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation,etc.): Leaching is a 4'x6'pit w/3' stone. Pit at 42" below grade w/cover at 22". Pit is dry. Pit shows signs of being over full in the past. 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 Ohs•313 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 or 17 Aug 041510:20p p.31 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 53 Kettlehole Road Property Address Lewis Taloumis Trust Owner Owner's Name information is West BarnstaWe MA 02668 8-1-15 required for every page. CitylTown 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.): i Sins-3113 Title 6 Official Inspection Form:Subsurface Sewage DlsFosal System•Page 14 of V I Aug 04 15 10:21 p p,32 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 53 Kettlehole Roar! Property Address Lewis Taloumis Trust _ Oivrte� Owner's Name information is required for every West 8amstabie MA 02658 8-1-13 page Cityffown 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 t -- _4. j -- —-- E >r ' r C; i > { I I i I 15ina-3)t3 Tide 5 MOM t.P- -Form:Su—u S.W Disp.SW.•page%5 0117 Aug 04 15 10:21 p p.33 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 53 Kettlehole Road Property Address Lewis Taloumis Trust Owner Owner's Name information is required for every Vilest 8annstabte MA 02668 8-f-13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells N,J Estimated depth to high ground water: 20 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: System is in rear, Lot high from RD.some 20'. Bottom of pit at 8'below grade. Before filing this Inspection Report, please see Report Completeness Checklist on next page. l5ins-3113 Title 6 Offi6al hspecNon Form:Subsurface Sewage Dispose)System-Page 16 of 17 Y Aug 04 15 10:21 p p.34 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 53 Kettlehole Road Property Address Lewis Taloumis Trust Owner Owner's Name information is required for every West 8amstable MA 02668 8-1-15 page. Cityfrown 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•W13 Tift 5 Official Inspection Form:Subsurface Sevaga Disposal System•Page 1T of 17 i TOWN OF BARNSTABLE LOCATION,. � Al Q& e = SEWAGE VILLAGE tQ 6cua&9q:� ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. 0 t SEPTIC TANK CAPACITY AS'-- 4P LEACHING FACILITY:(type) &iLl (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER &-)01S DATE PERMIT ISSUED: DATE COUPLIANCE ISSUED: - VARIANCE GRANTED: Yes No �. rI,j `f� �� � / 3� f �-�� ��' G�� tNc Fizz... `_......... THE COMMONWEALTH OF MASSACHUSETTS 3 BOARD TH / 'E! li' .....................OF..... .._... ...................................................... Appliration for Disposal Wo:70r Tonotrnr#ion amit Application is herebymade for a Permit to Construct Repair an Individual Sew a a Disposal System at ..._. .Zf40........... ........................................... ._....._......................_.......... Location-Address •--or.Lot No. •- L�:�.L ___..T1... .1!ors......................................... ..........................---•--•----• --.-....--------.............................. Yfngt-.� Address W !� w/mil ..............a .... % ..... •- ----------------------------- Installer Address dType of Building Size Lot.._*�./.............Sq. feet Dwelling—No. of Bedrooms....��......................................Expansion Attic ( Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria a' Other fixtyses s -------------•------.---.---. -.---.--_-----------•-----------------.-- W Design Flow............. ..........................gallons per personer day. Total daily, flow........ZIP.......................gallons. WSeptic Tank—Liquid'capacityt/XV..gallons Length__.x.lP_.... WidthYt: .... Diameter................ Depth...3/........ x Disposal Trench—N ............... Width....................Total Length............„_.Total leaching area......._....v._ sq. ft. Seepage Pit No.Q ems"___.. Diameter....../v... Depth below inlet��t.S........ Total leaching area.. .....sq. ft. Z Other Distribution box ) Dosing tank (_ a `" Percolation Test Resul s Performed by..... ®l' _______________________ Date_ °Z_ _ .... a Test Pit No. 1................minutes per inch Depth of Test Pit..../,........... Depth to ground water../-If0........... f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ •------------------•----...............".-•--•---... --------- -....... •--------------•---------------------- ••----------------------------- Descriptionof Soil ....----------------•--------------------•-----.........-----------.......----..................•-••••-•---- V .....--•-•-----••...................••••--•..............-------•••..._..._....._......_._.........� .......-•----------•----•---•---•------••------......-•---...---...-----....._....---•••---•---- 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 Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued 4Ahe b d of h4lth. Signed.�� r ........ ... 7 Application Approved BY "" ..................... .... -------------•---- .. .... - Date Application Disapproved for the following reasons:.............................................................................................................. .........................•---...------......---.....r•-•-.....-•• --------- -.--•-----•-•---.-----.-------..-------------------- ----------------------------- ------.....Dau-----•---•---- Permit No......U....� - ................ Issued.......................................... Date '<i No.��....... Fss............._............._ THE COMMONWEALTH OF MASSACHUSETTS BOARD E. TH L -.......................oF..... ......: .. Appliration for DWpnual darks Tonstrur#iun Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at `:.....- ........... -•-••••-----------•---•..................... ..........._..........................•... Location-Address or Lot No. .11 e.:�:,`e.'.......................................... Address Installer Address d Type of Building Size Lot.... .................Sq. feet Dwelling—No. of Bedrooms.....` ..................................Expansion Attic ( Jf Garbage Grinder e4p) PL4Other—Type of Building No. of persons........................... Showers — Cafeteria dOther y fixt s -•----•--••--••••-••-••......................................... W Design Flow.............. .............................gallons per person per day. Total daily, -�flow.._..... _3.P_......._.•...........gallons. WSeptic Tank—Liquid capacity4z27 ..gallons Length.K.Ak.... Width`/t. ..... Diameter................ Depth--- -----_-.- x Disposal Trench No..................... Width.._._..._...._.___.. Total Length.................... Total leaching area........-__-__.....sq. ft. 3 Seepage Pit No. _ _ p * g q."P __. Diameter Depth below inlet__.._�..;�".�..... Total leaching area_.�,_ ....s ft. Z Other Distribution box ) Dosing tank a Percolation Test Resul?.S (, Performed by..... ! . : .__:.. f ....................... Date. ......... '__ ............ 04 Test Pit No. I.....:___--•--minutes per inch Depth of Test Pit....//........... Depth to ground water...idO:........... �X4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ x ........ ••------•---•--•---•-•-•----------------•-----•••-•-••-------••-----••----------•-----•--......................................................... 0 Description of Soil........................................................................................................................................................................ W ----------------------------------------------------------------•-----------••-------............-----•------------------------------•----...--------------•--•--•------.............................. M. 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 Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance,has been issuedebbhe board of heajth. SignedV Date ApplicationApproved By--. --------••---------•---.. .......................... ...................... -••----•-•-•••--- Date Application Disapproved for the following reasons:.............................................................................................................. ......................................................... ••...:---- -------------------_-------•-•-------------------------- -••--••---------------------- ----Date-------------- - Permit No.-----11. 1... ............. Issued...........................................Date....... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF LTH .....................oF......... r. �r.�. ... . .. .......................... (Irr#ifirtttr of Tamp iunrr THIS I, XCrf Tha�tJ I•r e)e!l-fs�ge Disposal System constructed ( Repaired ( ) by /` / ` ... /�/ --------- •-------------------------------------------------- --•--------- •--------- - `/ — Installer has been installed in accordance with the provisions of TI F 5 of�T to Sanitary Co e s des -be in the application for Disposal Works Construction Permit No.... __"__!-C? __ dated_._._ ._1,��' _______________ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE HAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............................?-...I.Xil e....................._ Inspector..................................1)........................................ THE COMMONWEALTH OF MASSACHUSETTS OARD F �.•- No..�I / 1%.! ..vV.. ..OF....... ..I ............ .....-..../ ......................... I FEE.-7 ........... Permission hereby granted....................................... to Construct ) epair d Se�� a Di oral System at No.- ��---•• Street as shown on the application for Disposal Works Construction Permit N. ... ..../ Dated_.__: __1. .._�S ........... •---•-----••---•••------•...... ......................................................... = ---------------------------------------------------------- e, v Board of Health ---•-....•.................. DATE................-....1---�-��-�-�•� FORrvt 1255 A. M. SULKIN, INC., BOSTON inrtffi?ititttnitffiiintrntittiittttnrfttt(r►tfttflniiititittiiliillnintiitiitilitfttttttttit(1(ntinrtf tint(fittititiitiiflrilttit(fititilifit111iHntittititiitlif(Itiltttittli(tllttlitit(ili(tititflt(>ttttl(iltit(wftnl� TE H LABORATORIES ENVIRO C O ` IES 449 Route 130 Sandwich, MA 02563 • (508) 888-6460 r= CLIENT: Mr. Taloumis LOCATION: Lot 41 Kettlehole Rd. ADDRESS: Box 398 W. Barnstable Dennisport, MA 02639 COLLECTED BY: Meehan SAMPLE DATE: 3/6/89 TIME: 3 PM DATE RECEIVED: 3 76/89 SAMPLE ID: ET 423 E JOB #. New Well WELL DEPTH: 106 ft RESULTS OF ANALYSIS: EE Parameter Units Recommended limit Result Coliform bacteria/100 ml (MF Method) 0 0 c ;~ pH pH units 6.0-8.5 7.20 Conductance umhos/cm 500 138. Sodium mg/L 20.0 13.5 Nitrate-N mg/L 10.0 1.25 i= Iron mg/L 0.3 <.05 Manganese mg/L 0.05 F Hardness mg/L as CaCO 3 500 £' _ Sulfate mg/L 250 E_ Potassium mg/L 20.0 Alkalinity mg/L 200 tt- e_ z` Chloride mg/L 250 Turbidity NTU 5.0 Color APC units 15.0 Background bacteria COMMENT: YES No WATER IS SUITABLE FOR DRINKING PURPOSES FOR PARAMETERS STED. XNX ❑ DATE witIlutllttititttlllUlUlt!llttttlttl►ltlllUlillllUlllltlUlUltttt�` ' Department of Environmental Management/Division of Water Resources ' WATER WELL COMPLETION REPORT L WELL LOCATION/ Address T LC h'2 I� �•� City/Town �' PI �n L �� rin G.S.Quadrangle Map Grid Location \ Owner Q\C � Address ). A -LL USE CONSOLIDATED WELL Domestic 9 Public ❑ Industrial ❑ E Type of'Water-bearing Rock Other Water-bearing Zones Method Drilled 1) From To tip��-� - -� 2) From To Date Drilled �' ! 3) From To ,14) From To CASING Depth to Bedrock Length f )_Diameter 7^'Type -1": y- C-- UNCONSOLIDATED WELL STATIC WATER LEVEL Water-bearing Materials Feet below land surface t7 j4 Sand: fine❑ medium©coarse❑ Date measured �I/;,J N Gravel: fine❑ medium❑ coarse❑ GRAVEL PACK WELL Screen:Slot# )� length-/ from to Yes El No 0� Split Screen (or 2nd screen) WATER QU LITY TESTS MADE Slot4 length from to Chemical [V� Biological,� Depth To Bedrock PUMP TEST Drawdown /"*.) feet m D �t after pu ping days hours at ,-) GPM. How measured cJr< Recovery feet after hours. LOG of FORMATIONS COMMENTS:(On well or water) Materials From To ' m Ohl �M.r�P C DRILLER S'r lb/ �,.,Firm 1'/1r9O t,1+� �A/,o !-7 Address PA A,) ✓ of ') / \ City Registration No._�C/ 1, perator-s Signature ease print rrm y 25M-10-85.807101 BOARD OF HEALTH COPY AsBuilt Page 1 of 1 TOWN OF BARNSTABLE 4S3 LOCATION /. SEWAGE VILLAGE C,)C(,)t? ASSESSORS MAP & LOT INSTALLER'S NAME & PHONE NO. Eam" SEPTIC TANK CAPACITY LEACHING FACILITY:(type) ice' (sue) NO. OF BEDROOMS 3 PRIVATIE WELL OR PUBLIC WATER BUILDER OR OWNER(.FCC-Y 2 �( bU0U CJ % DATE PERMIT ISSUED: 11610 DATE COMPLIANCE ISSUED; VARIANCE GRANTED: Yes No ✓ w� 35 1 3` CT� .� http://issgl2/intranet/propdata/prebuilt.aspx?mappar=109052&seq=1 5/13/2019 r CO I-- I I o OL Lu EXI5TING FOUNDATION I I EXISTIN(. FOUNDATION 1I 516 FOOT 5F24 FOOTING 60 12" :.: LLEC5rN0TJBBOVE OVER I 4 N cri BEAM 188 v I BEAM TO DOUBLE J015T (2)PT 2 x 10's USE JOIST HANGER THI5 �y — — — — — — — — — — \ � � G1 w / p --PT 2 x 10 JOISTS P I6"O.G: PT(�) 2 x 1 p's BEAM'1151 4 � / UJ L DROFFED BBArA C 4 FLUSH BEAM IIE—:-DOUBLE END.'-GIST(JC4�) / U u� 14"x 49"GONGRETp FILIED -ONO CUBES(TYP) / z DOUBLE:RIMBOAf�'D TO CAR"ANGLE DECK LOAD L N�l 51 DROPPED BEAM (2)PT 2 x 10'9 Bi:AM Ll B2 - z — — — — — — — 7 Lu 7BIGFOOl BF24 FOOTING w!12" !ram /"�� "' CONGRMTE PII.LED SONO TUBE OVER \ j g, DATE: Lu Ile ti flan - 5/16 _ 1 � � DRAi^IM B SHEET # cv w l la EXISTING RISER ON Da BOX TO SITE INFORMATION DWELLING EXISTING CONCRETE BAFFLE SHALL BE REMOVED RISERS To BE BROUGHT TO BE BROUGHT To WITHIN � WITHIN 6" OF GRADE 6" OF GRADE RISER ON CHAMBERS TO ADDRESS: 53 KETTLEHOLE ROAD, WEST BARNSTABLE BE BROUGHT TO WITHIN MA s�F/��iR'�ctrr�f'/J,J�/1/•«fi, .�„sr.i,,,h//N"4�;�i�:� PROVIDE SPEED LEVELERS ON OUTLETS 6„ OF GRADE Z 109/52 - - vo 'Ce,. , ,{Ar DEED REFERENCE: 29658/257 30 9 �:•C,r{� ��{✓,,��>1t�,r��<av`r�i e�ff�s .(�r.ir rr r� �.<.�r �, {(�rer (f1r ryrcr�/ ,ir,�<f it ur f" n J!.!/fir� rFli rr ' i✓<1 f t F .[Ir/ - :=° --- �---=- i ,w;,u�Gvl.. . .,v• ,.� �r;SL✓,., a��/ icur f.�; PLAN REFERENCE: 1 9 4._S✓,. . , :1��5��4 ELEV.=120.34 MAX 9" MIN. COVER 2" OF J" PEASTONE OR DESIGN CALCULCATIONS 36" MAX. COVER 8 OZ. NON WOVEN 23' OF 4,. GEOTEXTILE DESIGN FLOW PROVIDE ZABER PVC, S- SCH 40 110 GALLONS/DAY/BEDROOM X 3 BEDROOMS = 330 GALLONS/DAY A1800 FILTER O.Oi0 MIN. 13' OF 4" SCH 40 (LONGER RUt±) ELEV.=117.34 7EXISTINGEXISTING 1,000 GALLON 14" PVC, S=0.010 MIN. - __ _ _ _ __ TANK CAPACITY REINFORCED CONCRETE fl � Cl m f� 0 200% DAILY FLOW = 660 GALLONS; USE EXISTING 1.000 GALLON TANK � ., CIDQ © � � ' SEPTIC TANK INV.-117.12 ~� M Q I= ; c .. � E DESIGN PERC RATE _ < 2 MIN/INCH - INV.=116.72 - - - 2' DEPTH OF 1 DOUBLEWASHED STONEINV.=116.89 c 330 GPD / 0.74 GALLONS PER DAY PER SQ. FT. = 445.95 SO. FT. TEE WITH GAS BAFFLE L A A INV.=116.59Ml (� ( `+ ELEV.=114.59 CONSISTING TO 6" LACHING CAPACITY CENTERED IN TANK OPENING) CRUSHED STONE � 4' 4.83 X 8.5' LEACHING CHAMBER 4 BOTTOM AREA = 25.00' X 12.83' = 320.75 SQ. Ft'. PROPOSED 3-OUTLET {SEE SITE PLAN FOR ORIENTATION) 5' MINIMUM SEPARATION TO SIDE AREA = 75.66' X 2.00' = 151.32 SO. FT. DISTRIBUTION BOX (H20) (2)-500 GALLON H-10 LEACHING CHAMBERS SEASONAL HIGH GROUNDWATER ✓ SYSTEM PROFILE EXISTING PROPOSED PROPOSED 472.07 SO, FT, SEPTIC TANK DISTRIBUTION BOX SOIL ABSORPTION SYSTEM GPD PROVIDED = 349.29 GPD NOT TO SCALE = NO WATER WAS OBSERVED DURING THE TEST HOLE EXCAVATIONS. BOTTOM OF DEEPEST HOLE ELEV=109.47 GENERAL NOTES: TP- 1 1. NONE OF THE SUBJECT PROPERTY IS WITHIN THE LIMITS OF A FEMA FLOOD HAZARD ZONE AS SHOWN ON PANEL NO. 25001 CO534J, EFFECTIVE DATE JULY 0 A SANDY LOAM 120.47 16, 2014. 0 10YR 3/3 LEGEND. DINING KITCHEN UTIL CL BATH BATH BDRM 12" 119.47 2. THE SITE IS NOT LOCATED WITHIN A ZONE 11 AREA. THE SITE IS LOCATED a $ O. 1 FAMILY WITHIN AN AQUIFER PROTECTION DISTRICT PER THE TOWN OF BARNSTABLE � SANDY LOAM LIVING RM ROOM IOYR 5/6 PROPERTY LINE SUN RM ZONING MAP. BATH BDRM 3. THERE ARE NO STREAMS OR WETLANDS WITHIN 100-FEET OF THE PROPOSED m 36" C1 117.47 ________104 ________ -EXISTING CONTOUR o FINE SAND OFFICE BDRM � SUBSURFACE SEWAGE DISPOSAL SYSTEM. 10YR s/s X X X X EXISTING FENCE FIRST FLOOR SECOND FLOOR 4. VERTICAL DATUM IS ASSUMED 93" 112.72 E/TEL EXISTING UNDERGROUND UTILITIES FLOOR PLAN C2 5. ALL CONSTRUCTION MEANS AND METHODS SHALL CONFORM TO 310 CMR 15.00 COARSE SAND W EXISTING WATER LINE ` STATE REGULATIONS AND LOCAL BOARD OF HEALTH AND BUILDING DEPARTMENT 10YR 6/4 [�jj N NOT TO SCALE REGULATIONS. G EXISTING GAS LINE BENCHMARK eg26 �8,. w N/F ASTRID SIMSARIAN 6. ALL JOINTS IN THE TANK AND DISTRIBUTION BOX SHALL BE MADE WATERTIGHT 14 65 KETTLEHOLE ROAD THROUGH THE USE OF ASPHALT OR SYNTHETIC POLYMER SEALERS OR 132" 109.47 TP-1 LOCATION OF TEST TOP OF WELLHEAD CAP 6'>>' 109/053 HYDRAULIC CEMENT. PIT/PERC TEST ELEVATION 114.54 WELL 7. SYSTEM COMPONENTS SHALL BE H-10 LOADING, EXCEPT WHERE NOTED. 7,P-2 99.76 X EXISTING SPOT ELEVATION �, // / 8. DIGSAFE AND LOCAL UTILITY COMPANIES SHALL BE CONTACTED PRIOR TO ANY 0" 120.47 up-0- EXISTING UTILITY POLE EXCAVATION OCCURRING. A SANDY LOAM IOYR 3/3 ®WELL PRIVATE DRINKING ; > / / ` �, 9. LOCATION OF UTILITIES ON THIS PLAN ARE APPROXIMATE AND SHALL BE w 10" 119.64 WATER WELL / /.., SH£0 ! /' /' ' ! VERIFIED IN THE FIELD. THE ELEVATION OF THE BUILDING SEWER SHALL BE > $ / �.. / ;` �1 !T4 I VERIFIED PRIOR TO THE INSTALL OF ANY S'YSitM COMPONENTS o U�1L EDEStA SANDY LOAM / �4 / / /�/ w 10YR 5/6 rL`L / / i` / ,' �� 10. THE SEPTIC SYSTEM INSTALLER SHALL NOTIFY THE DESIGN ENGINEER 2 DAYS N F O� / �c,� J'•. �2 ;` ./ / Y i PRIOR TO BEGINNING INSTALLATION OF THE SYSTEM TO ALLOW FOR w 34" 117.63 / 0, " / f�O f q, �I 1 v ° I� �� / / o I SCHEDULING OF INSPECTIONS m CZ JOHN AND LAURIE ELLIS / GP / / �1 �. / �, ^ FINE AN 542 CEDAR STREET ti F' / As/ / LIMIT OF r / T / 11. WHERE APPLICABLE, UNSUITABLE MATERIAL A & B HORIZONS ENCOUNTERED 1O9/049 �� /•. ..�•'•� STONE (TYP) / i � / / ,, � ._r f 1 ( ) P OPOSED 2 - 50) GALLO / 111.0' BELOW THE INVERT OF THE INLET TO THE SOIL ABSORPTION SYSTEM SHALL 75" 114.22 p,� LIMIT OF 5' OVERDIG f / ) „ �_�! 1 ' j ,_J LJACHING AMBE,�� � /__ /-�'-� -/`` BE REMOVED TO A DISTANCE 5 AROUND 11-IE SYSTEM AND BROUGHT BACK TO C2 / r / / yyeti THE APPROPRIATE ELEVATION WITH CLEAN SAND PER MASSACHUSETTS 310 COARSE SAND ! / 1'17.99 /l"A / 10YR 6/4 / / j TH-2 /� 1 1 I � / // ( ! / CMR 15.00 REGULATIONS. PROPOSED 3-OUTLET , /ISER (TYF.) r I v� J dR\vS / I (_ _�� 12. EXISTING CONDITIONS GROUND SURVEY PERFORMED BY PAUL E. SWEETSER, (COBBLES) ! / / DISTRIBUTION BOX 120.51 ! I( / / r ! ` PLS. MAY 2019 1. 1 0.27 EXISTING DISTRIBUTION BOX TO 120. 2 �; y t EX\S G - / o 13. THIS DESIGN DOES NOT ALLOW FOR THE USE OF A GARBAGE GRINDER 96" 112.47 �' BE REMOVED. EXISTING PIT TO _� ! !� X� . O ,.; / / //� `' t / I. ' /MAG/NAlll PERC RATE: < 2 MIN/IN. ��' BACKFILLED WITH CLEAN SAND : ,:•� w / l .,1 I / - �'�� >2001 TOP AND ABANDON ! ! I ' �:.,, oF.h�� t i t EI/EVATION 08.16' ! �� (BASED ON RECORD PERC TEST) PRIVATE I I O / \ i / Q AT WELL I� I ;�ui c� \ t / ( ! 4 CRESTVIEW DRIVE DATE: MAY 18, 2019 Q O 542 CEDAR I I�� (120.. t \ f' ) l EAST SANDWICH,MA 02537 STREET I I 120 7 w / ! PERFORMED BY: ASA MINTZ I - :•"'•:`" 20.0 / / WITNESS BY; DAVID STANTON I I I I ` 12 83� 0' MIN• / j 4`,,� \� / ( PHONE: 508 400-2365 SOIL PROFILE LOT 4' / // - -�___4___ / o SITE DESIGN LLC 35,1 19 SQ. FT. f I ! I O O / '� \ \ \ \ � � NOT TO SCALE 0.81 ACRES t I / / \ \ \ \ Residential Site Design and Permitting / N I I121.I3 X / j +� o H j \\ \\ \\ �/ \ 10 q j o \ \\ \\ \\ \ _�' tic = / I w o N to O 121.10 a / w / c \\ \ \ M zo :r ' LOC.4TiaV- I w W c 53 KETTLEHOLE ROAD \ EXI LNG 1,0001 GALLEON �� iw / �, "� j x \\ �\ \\ a� "G 2�a o �•.7 3 I WEST BARNSTABLE, MA 02668 K TO2EMPIN ND j Cam, / w F �' o IBE IREU�ED - 122 '/ w / ��SSioNA���G�? x uz cuLnrr LOCUS ' I \\ p j / G\ fs� o KEITH AND STEPHANIE RAE SCALE 1 =1000 J o ' j w j ' ! �� �!i �-1 4 53 KETTLEHOLE ROAD X 125.75 \cpo0 WEST BARNSTABLE, MA 02668 D X' 3.17 \ / / (N OF Mgs�, j '� OIP.IH7NG AT[E PAU `Y ! SUBSURFACE SEWAGE DISPOSAL SITE PLAN AND PROFILE E. \\� �22 v S ETS SC&E La17Er vRewinrc W. 1 =20 5/20/19 1 _ of 1 _ SITE ---��_ �s Fss%O SuR%vl i REVISIONS �QS � f COUNTER VARIANCE REQUEST: NO. DATE DESCRIPTION I 1. VARIANCE FROM CHAPTER 397-2 OF THE TOWN OF BARNSTABLE REGULATIONS, N/F R S� LOCATION RESTRICTIONS - A VARIANCE OF 33 FEET IS REQUESTED FROM THE 150 RICHARD AND PATRICIA OSSEN i 1 OG Mp,P FOOT REQUIREMENT FROM .A SOIL ABSORPTION SYSTEM TO THE A PRIVATE WATER 510 CEDAR STREET � ,` ! 6' SUPPLY WELL. ;_ 109,/051 SEPTIC SY,S TAM Pc OFILE- /✓OT TO SCAI-,E - f'OP FnUa✓DAT/i%�!✓ LEACH/NCB' PIT = 6 S" 0 VAP/ES 1 V, - .V Q !'✓C OR EGA UN N/N P/TGN r/v'~PER coo T 3~pF Y8 r" 3 /Y 5TJNE_. o o n : 5 Cr r:l C EE.1Y-- �/- /o X E BAS.E�IE�L;T � S'TONE �C' C •_ `�� p �,; �, r C)) C_'�J P.QE^A.ST CONCRETE r.' f Q r`• C p yr r.n G- I O20 REiNFDiPC C � a 5jERT/C TAIVX " f 0 o TN i TI-I 2 G , � . 63,8 _ 3 12 3 a zz14cy11vG .PiT . 70 LOT 33n J: -x c ;0 7.o .o,Es1gA1 CR rERiA s ti'rrr� s:�T1r��iE E s - AURLJBf - Of.l3ECRDD/'f - -• r, `_e_'�_�� O G D/SPOS.t'�,S 3 E: 0 O _ , 7 G _ N — - jT//•1ATED FLOGt1 G'.P 2 • /3/ SF X SGPD I D,8S,�R �14TioA P/Ts \` SOTTO 113 SF x , GPp/ r , i 3 Cr pp �• �� DrCTE `OCT, 2G 188 3 f},�'RFoRIAIEa 15y, --- +��Oi) �a ._,. i / = . ifG u.✓n �!�� Fc. f . OD F LOT 39 f 3b, AR?F_ BAD EG CAI' Y`w {,d�►�eee• f p �A✓G + �+ LO i2 r , cvr T w � T ti �) i/T�, s,' l9iVi�: GCr9G" E'UL�:- TNisT �OPGy �`� KART F r G��. sT�G�cE0,4r 1� .9742 T P�/OiE' TO /SACK. /LL/,1/ ThIE �' iJ ,30A�G , 15NAL�,Ci.E/NOT/�/ELF s/-�A L /t/OT .B.E USA%O f'O PURPOSES4'� lAFa k/ATCR S 13 PROV/OEO� .P y _1N � �rsr; 4 "`•' • .` �--~--- .•GL d. O dE` R LAC !/it/.fd�T.?.O•CE /�ATz-"�c'i.9t f n' TE:t/ FE" •�` ''� •. iiV f�t c .CJ/"QFG Ti o NS J/�g N/'J TrO E•c. L�9GC'Fi�.0 t�'!�!� w ,N, go' C.� W,4v ✓AtV!/ �iV ��/ /�C!/7�YC�: �✓!T/`!� 3!oCnrt�. !.s•oz C/7) . .. sirE PLAIV SEPT/C D.�SlgAl • Jr -GO LOT 41 w WELL 5e .6R/3,oZ- KETTLEHOLE ROAD IGO-00 e 6 W 2ARN57ABL.E MA , �� 54 - KET LEH L-E ROA r { 3O L�; - so. � 30I JJ �.ON E - Lr -t .4.G . 50 E - .._. ._. - - - Yl3 R TZ-- 6 R ox �1 l ,6- S4,V,0VICl/ 111A. 0 -F3 7 '. L O i 15 _ LET 16 �AT�: 2� 13��� ,af-4 wIAI B 111 ELL 1-30 i