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Home My WebLink About0010 LOCUST AVENUE - Health 10 Locust Avenue W. Barnstable mm�q = A 197 033 I i x c 1 I Commonwealth of Massachusetts I Title 5 Official Inspection Fora 1�l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments f? u Property Address Owner Owner'sNam9e / ,A information is 1/ A'/ required for every e l� .e / 4 page. City/Town State Zip Code Date of In ection 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. 5�� 15aia� Imngoutforms A. Inspector Info mation on the computer, filling out forms use only he tab 1154- key to move your Name of Inspector 'EN y1 0 7 Ec14 cursor-do not use the return key. Company Name � Ga�0 t _ l Company Address GsirG _-_ Oa 6 (ld- City/To /'� J V 0 O State / �.0- q Zip Code Telepho NumbeV License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 1.5.000); 1 have personally inspected the sewage disposal system at the property address listed above;the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that;�=asseE 1. 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails ag a Inspectot Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority.(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater,the Inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.726/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page t of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form <I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Z—0 G U S1— Property Address p Owner Owners Name v�� information is required for everyo�- page. City/Town State Zip Code Date of Insrpction C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System sses: I have not found any information which indicates that any of the failure criteria described in 310 CUR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: 2) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass'section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box:for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc•rev.7261M18 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 or 18 Commonwealth of Massachusetts Title 5 Official Inspection Form it Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address fie V Owner Owners Nam information is is /� required for every �s� INS�a'4�I L J 1 6�D(f C oZ page. City/Town State Zip Code Date of Insbection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed j!�-j Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1 (b)that the system is not functioning in a manner which will protect public health, safety and the environment: II t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Ic Subsurface Sewage Disposal System Form -Not for Voluntary Assessments /0 Z-0 C(4 Property Address Owner Owners Name el/ /� ,p information is les� lids 4 0.)G G Zf � of O required for every 11 page. City/Town State Zip Code Date of In pecti C. Inspection Summary (cunt.) ❑ 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 i b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided.that no other failure criteria are triggered.A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No Elackup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ i Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u Property Address err Owner Owner's Name / information is required for every Vy TTT //'1s7 G6/e, page. CitylTown State Zip Code Date of Ins ction C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ElStatic 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 � an h day flow ❑ ;,," Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ � Any portion of cesspool or privy is within 100 feet of a surface water supply or i utary to a surface water supply. ❑ Any portion of a cesspool or privy is within a Zone 1 of a public water supply ❑ AAny* ny portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ l=f 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.] ❑ he system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems,you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section C.4. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply El ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well t5insp.doc-rev.7125/2018 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts �w 6o Title 5 Official Inspection Form it Subsurface Sewage Disposal System Form -Not for Voluntary Assessments O LOGc�S Tl/ L V Property Address n Owner Owner's Name g information is eS� &1-6,44- required for every i,/f page. City/Town State Zip Code Date of Ins ection C. Inspection Summary (cont.) If you have answered"yes"to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed.The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section C.4 shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: Yes .0 ❑ umping information was provided by the owner, occupant, or Board of Health ❑ Were any of the system components pumped out in the previous two weeks? ❑ as the system received normal flows in the previous two week period? ❑ Have large volumes of water been introduced to the system recently or as part of this inspection? Were as built plans of the system obtained and examined? (If they were not available note as N/A) Was the facility or dwelling inspected for signs of sewage back up? Was the site inspected for signs of break out? Were ail system components, excluding the SAS, located on site? t �OWere 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? Ih Was the facility owner(and occupants if different from owner)provided with C information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: Existing information. For example, a plan at the Board of Health. ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] t5insp.00c•rev.7126=18 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts �- Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments v/ lo ,L Property Address Owner Owner's informationNaLz/esl infoation is required for every page. City/Town State Zip Code Date of Ins ection D. System Information 1. Residential Flow Conditions: � Number of bedrooms (design): — Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): Description: ' /�� /roh ,Sp �L Gy► (�/ / l� uT�lo-y✓� � S� �w�10n &/ 4a0,144jf♦ w540•r- SC-1 Number of current residents: Does residence have a garbage grinder? ❑ Yes No Does residence have a water treatment unit? ❑ Yes 2 No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes No information in this report.) Laundry system inspected? ❑ Yes Ej No Seasonal use? ❑ Yes No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? Yes ❑ Last date of occupancy: Date t5insp.tloc•rev.7/26/2018 Title 5 01'ricial Inspection Forth:Subsurface Sewage Disposal system.Page 7 of 18 c� Commonwealth of Massachusetts Title 5 Official Inspection Form Ie Subsurface Sewage Disposal S stem Form -Not for Voluntary Assessments u c We- Property Address e(41001 Owner Owner's Nam information is ®® ` Af ►/��Q q required for every `s Gi�i��l �{— 0.: (6 '-' G� o page. City/Town State Zip Code Date of Ins ectio D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describebelow): 1 3. Pumping Records: 0C-✓ Source of information: 41 Was system pumped as part of the inspection? ❑ Yes ❑ No If yes, volume pumped: - gallons How was quantity pumped determined? Reason for pumping: t5insp.doc-rev.7126f2018 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments !r /0 �ocus1 Property Address n L e VT 4 Owner Owner's Nam e5 T /� information is required for every /C� page. City/Town State Zip Code Date of Inspe tion D. System Information (cost.) 4. Type of stem: Septic tank,distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under'contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate a e of all compone ts, date installed (if known)and source of information: 3o00), &0 ,f oI S40 Were sewage odors detected when arriving at the site? ❑ Yes No 5. Building Sewer(locate on site plan): ^ �� Depth below grade: feet �`l' Material of construction: El Gast iron 40 PVC ❑ other(explain): _ la l - Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): t5insp.doc•rev.T/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts p Title 5 official Inspection Fora Subsurface Sewage Disposal System orm -Not for Voluntary Assessments u / 0 o u - Aiw Property Address Owner Owner's Nam �,,� information is S4 �� (� L- 0. required for every '7�' page. City/Town State Zip Code Date of irspec Ion D. System Information (cost.) 6. Septic Tank (Locate on site plan): Depth below grade: feet �e�onstruction: oncrete ❑ 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: /AQ Sludge depth: C� Distance from top of sludge to bottom of outlet tee or baffle 3y/ Scum thickness h Distance from top of scum to top of outlet tee or baffle from, m f m bottom of outlet tee or baffle Distance om bottom o scum to How were dimensions determined? )0-e j Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): tit d►'�19 1 V1 _ 004 // 4_ dcj, 4014, �.�c� 7�es 1✓I -------- --- o C co" �4 Ito" � t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts �n Title 5 official Inspection Form It Subsurface Sewage Disposal System Form -Not for Voluntary Assessments /0 1,106(A-f Property Address ll // Owner Owners / &-44-o- g4('6g Cz � �. information is U e-s l required for every /L page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (ocate on site plan): Depth below grade: feet Material of corstruction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness --- Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 c� Commonwealth of Massachusetts �n Title 5 official Inspection Fora <1� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments v Ape-,- Property Address Owner Owner's Nam s l &OJ44� l information is 4 AUoa,`w C;_ required for every page. City/Town state Zip Code Date of Insp ction D. System Information (cont.) 8. Tight or Holding Tank (cont.) I� Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pL mping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): AV a IV, t5insp.doc-rev.W2612018 Title 5 Official inspection Form:Subsurface Serfage Disposal System-Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments /0 ZOC�-- Ave, u Property Address Owner Owner's Name0j� required forinformationlevery V v�s� '✓�1�/1,�� - � _ / page. City/Town State Zip Code Date of nspe tion D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ElYes ❑ No' Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: w Type: ICJ 6�11v., ctllre4f I ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: -------- t5insp.doe•rev.7/26/2018 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address P� Owner Owners Name/ information is /. ,- � N4 required for every �l '1�s alN d�O�d page. City/Town State Zip Code Date of Insp ction D. System Information (cunt.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil,signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): on POO ni Zeclic, V1 alez fir //�• c. A cSolif h AID S-11 ocki C-rco.to,/, 4 lorr-- 1� - 0-1 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of Groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): tSinsp.doc•rev.712612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^ D LO--- Property Address Owner information is J �� required for every ., page. City/Town State Zip Code Date of Ins ection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: - Dimensions Depth of solids Comments (no:e condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.Tf26/2018 TiUe 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System F rm -Not for Voluntary Assessments Property Address �f Owner Owner's Nam I information is �� y C?— a, required for every page. City/Town State Zip Code Date of Inspecti D. System Information (cost.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or c marks. Locate all wells within 100 feet. Locate where public water supply enters the buildi . Cneck one of the boxes below: ❑ and-sketch in the area below drawing attached separately /i t5insp.doc•rev.7262018 Tide 5 Official Inspection Pone:Subsurface Sewage Disposal System•Page 16 of 18 !Q t4p!�U .WN�0MONSTABiE E c LOCATION SEWAGE M 2001—_,c, VILLAGE t<��ar F a.r_crsLl a ASSESSOR'S MAP&LOT t 2—P M INSTALLER'S NAME&PHONE NO. 7Cr�tfL:s3 s'e a 998—o yyN SEPTIC TANK CAPACITY /Soo r.,tL LEACHING FACILTIY:(type) 1z si r,& AcJ,r�(size),s9'x ie.&,x ' NO.OFBEDROOMS BU"ER OR OWNER R,,C Re -ry PERMITDATE:_Z—V—o Z COMPLIANCE DATE: . Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist . on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by (A �Pj, / 1 -r I S�t1-9 fiG9/# ra J Crz—E —z ' Goy A 1 Commonwealth of Massachusetts �d Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u I0 LOGu 5 Property Address r Owner Owner's Name L /7 information is required for every page. City/Town State Zip Code Date of Ins ection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar L ❑ Shallow wellsT Estimated depth to high ground water: fe /� 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 established t e high round water elevation- `0), f 1z Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc-rev.712fil2018 'tie 5 Official Inspection Form:Subsurface Sewage Disposal System-Pape 17 of 18 r s Commonwealth of Massachusetts T= � Title 5 Official Inspection Form i= Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u� - OZOCL4S4- Property Address Owner Owner's Na information is 741654 required for every page. City/Town State Zip Code Date of Insp ction E. Report Completeness Checklist Complete applicable sections of this form inclusive of: �Bertification: spector Information:Complete all fields in this section. Signed& Dated and 1, 2, 3, or 4 checked C. Ins ection Summary: p rY 1, 2, 3, or 5 mpleted as appropriate 4 ilure Criteria)and 6 (Checklist)completed D. System Information: For 8:Tight/Holding Tank-Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Exolanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 18 of 18 CERTIFICATE OF ANALYSIS Palo: 1 .Qp+.y .yr9�+yi U. Barnstable County Health Laboratory \�sAS^r Report Prepared For: Report Dated: 5/20/2009 Ralph Secino William Raveis Real Estate Order No.: G0951465 1284B Main Street Osterville, MA 02655 Laboratory ID#: 0951465-01 Description: Water-Drinking Water Sample#: Sampling Location 10 Locust Ave.West Barnstable,MA Collected: 5/4/2009 Collected by: R.Secino Map 197 Parcel 033 Received: 5/4/2009 Routine ITEM RESULT UNITS RL MCL Method# Tested Nitrate as Nitrogen ND mg/L 0.10 10 EPA 300.0 5/4/2009 -- Copper 0.12 mg/L 0.10 1.3 SM 3111B 5/19/2009 Iron ND mg/L 0.10 0.3 SM 3111B 5/19/2009 Sodium 9.6 mg/L 1.0 20 SM 3111B 5/19/2009 Total Coliform Absent P/A 0 0 SM9223 5/4/2009 Conductance 58 umohs/cm 2.0 EPA 120.1 5/5/2009 pH 6.6 pH-units 0 SM 4500 H-B 5/5/2009 Water sample meets the recommended limits for drinking water of all the above tested parameters. Attached please find the laboratory certified parameter list. Approved �4'Vab Director) ?j ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 10 Locust Ave. Property Address Loraine Wincor Owner Owner's Name information is required for W gaenstable Ma. 02668 5/16/2009 every 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 ❑ drawing attached separately c 3— u y-23,E ?- i6 Flro W r- zZ /o--Y,3.5' I 7— ,,5� 4—,ivy t5'ins-09108 Title 5 Official Inspection forth:Subsurface Sewage Disposal System•Page 15 of 17 ` 'Oxr:�T"BAo:S9 �WW , CERTIFICATE OF ANALYSIS-R Page: 1 Barnstable County Health Laboratory Report Prepared For: Report Dated: 9/22/2003 SEP 2 9 2003 Order Number:OWNW22651 Lorraine F.Wincor HEAT-'r, 10 Locust Avenue West Barnstable, MA 02668 Laboratory ID#: 0322651-01 Description: Water-Drinking Water Sample#: 22651 Sampling Location: 10 Locust Avenue,West Barnstable Collected 9/3/2003 Collected by: L.Wincor 197-037 Received 9/3/2003 Routine ITEM 1 RESULT UNITS MCL Method# Tested LAB:IC Lab Nitrates <0.1 mJL 10 EPA 300.0 9/3/2003 LAB: Metals Copper <0.1 mJL 1.3 SM 3111B 9/18/2003 Iron - .._ 0.1 .. .- mJL... -0.3 SM3111B 9/18/2003 .... . Sodium 12 mJL 20 SM 311113 9/18/2003 LAB:Microbiology Total Coliform Absent P/A Absent 307 9/3/2003 LAB:Physical Chemistry Conductance 109 umohs/cm EPA 120.1 9/3/2003 pH 6.2 pH-units EPA 150.1 9/3/2003 Note: Water sample meets the recommended limits for drinking water of all above tested parameters. Approved By: (Lab Director) Z � r•'. <'• '`C `.,",'t'- ':tip h. ` i Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 �� ,"e r L 00 -NOJA —J---- Fee-N----- ---------- BOARD OF HEALTH TOWN[ OF BARNdSTABLE 0(ppricat ion-for Vell Con!5truct ion Permit Application is hereby made for a permit to Construct (l�Alter ( ), or Repair ( )an individual Well at: Location — Address Assessors Map and Parcel Ow r Address Installer — Driller �— Address Type of Bueing 5 Dwelling - ------ Other -- Type of Building—=- -------- No. of Persons--------______—__—_--_____ Type of Well Capacity --,Ld— Purpose of Well-----,��!' �—� Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until rtifi a .of lan has been issued by the Board of Health. Signed Z—— - D daate,� Application Approved By �"� U 72_ date Application Disapproved for the following reasons: - — --------------- - date Permit No. d2U0 2 -0� — Issued--W /0 7 —2- --- ------------- date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( ) by--- — -- --- -----— — ---- Installer at :p- t/0 Lot.Jk /N. g,,Able has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the ap?lication for Well Construction Permit No Dated U/ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE 0 419 Inspector ave 111V -- —------ rr, No.) � 2_ Feel---.�_ .Vil UU BOARD OF HEALTH TOWN[ OF BARNSTABLE ApplicationforlVell Con5truct ion Permit Application is hereby made for a permit to Construct (4-)1,"Alter ( ), or Repair ( )an individual Well at: 1 Locate• - (XWress' �f- Assessors Map and Parcel /Own r Address Installer.— Address Type of Building Dwelling -------- ---- -- Other - Type of Building - No. of Persons-- Type of Well Capacity Capacity----- d-- �' Purpose of Well----�'!—'�l�'—zle — Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a-Certificate WjDrnfan ,' has been issued by the Board of Health. 7 Signed - -- -_ Q — date --- Application Approved By 7- Uz r date Application Disapproved for the following reasons: -------------- -------------------- ,-- � ------------------ date------ Permit No. U4 2 "0 — Issued —�) � �� —� --- ------------ I date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate (Of Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired by--- —' — ---- -- — — -- -- -- --- --- - Installer at--- has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in`the application for Well Construction Permit No e—)QO-0 - —Dated 0/— THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE--Q r�'Z/_a -- Inspector BOARD OF HEALTH TOWN Off' BARNSTABLE Ivell Conoruct ion Permit FJ_ Permission is hereby granted -- -------------- to Construct A, Alter ( ), or Repair ( ) an Individual Well at: _ No. 19 a / a 4r ka, ------------------------------------- Street as shown on the application for a Well Construction Permit No 0(2 d -C/ Dated-- -L�/0?V 2 2 Board of Health DATE � 2 GU 22 E ENVIROTECHLABORATORIES,INC. MA CERT.NO.:M-MA 063 449 Rte.130 Sandwich, MA 02963 908(888-6460) 1-800 339-6460 FAX(908)888-6446 � TU loa CLIENT: Fred Clifford LOCATION: Lot 1 \' NFL' �� ? ADDRESS: PO Box 430 Locust Lane-;-:q<<TyQNsrq So Yarmouth MA 02664 W Barnstable MA�`�pT g<E COLLECTED BY: Fred Clifford SAMPLE DATE: 1/22/2002 SAMPLE TIME: 11:30 WATER SAMPLE TYPE: New Well DATE RECEIVED: 1/22/2002 LAB I.D. #: 0201264 WELL SPECS.: N/A RESULTS OF ANALYSIS: Parameters Units Recommended Results Method Date Analyzed Limits r Coliform bacteria /100ml 0 0 9222 B 1/22/2002 pH pH units 6.5-8.5 6.26 4500 H+ 1/22/2002 Conductance umhos/cm 500 93 120.1 1/22/2002 Nitrate-N mg/L 10.0 0.048 300.0 1/22/2002 Nitrite-N mg/L 1.00 < 0.003 300.0 1/22/2002 Sodium mg/L 28.0 9.8 200.7 1/22/2002 Iron mg/L 0.3 < 0.1 200.7 1/22/2002 Manganese mg/L 0.05 0.014 200.7 1/22/2002 Volatile Organics ug/L See Report None detected.* EPA 524.2 2/5/2002 COMMENTS: pH is below recommended limit and may have corrosive characteristics. *See comment on page 3. WATER MEETS EPA STANDARDS AND IS SUITABLE FOR DRINKING PURPOSES FOR PARAMETERS TESTED. <=less than Date >=greater than A nald J. ri TNTC=too numerous to count Laborato irector Page 2 of 3 R.I. Analytical Laboratories, Inc. CERTIFICATE OF ANALYSIS Envirotech Laboratories, Inc. Date Received: 1/24/02 Approved by: Work Order# 0201-00981 R.I. alytic Sainple#: 001 i SAMPLE DESCRIPTION: 0201264 LOT 10 LOCUST GRAB 01/22/02 all t-"/��NALYZED SAMPLE DET. PARAMETER RESULTS LD41T UNITS METHOD DATE/TIME 'ANALYST Volatile Organic Compounds Bromodichloromethane <0.5 0.5 ug/l EPA 524.2 2/05/02 1:51 NPV Bromoform <0.5 0.5 ug/l EPA 524.2 2/05/02 1:51 NPV Dibromochloromethane <0.5 0.5 ug/l EPA 524.2 2/05/02 1:51 NPV Chloroform <0.5 _ 0.5 ug/I EPA 524.2 2/05/02 1:51 NPV 1,2-Dibromoethane(EDB) <0.5 0.5 ug/l EPA 524.2 2/05/02 1:51 NPV Benzene <0.5 0.5 ug/l EPA 524.2 2/05/02 1:51 NPV Carbon Tetrachloride <0.5 0.5 ug/l EPA 524.2 2/05/02 1:51 NPV 1,2-Dichloroethane <0.5 0.5 ug/1 EPA 524.2 2/05/02 1:51 NPV Trichloroethene <0.5 0.5 ug/1 EPA 524.2 2/05/02 1:51 NPV 1,4-Dichlorobenzene <0.5 0.5 ug/I EPA 524.2 2/05/02 1:51 NPV 1,1-Dichloroethane <0.5 0.5 ug/l EPA 524.2 2/05/02 1:51 NPV 1,1,1-Trichloroethane <0.5 0.5 ug/l EPA 524.2 2/05/02 1:51 NPV Vinyl Chloride <0.5 0.5 ug/l EPA 524.2 2/05/02 1:51 NPV Bromobenzene <0.5 0.5 ug/l EPA 524.2 2/05/02 1:51 NPV Bromomethane <0.5 0.5 ug/l EPA 524.2 2/05/02 1:51 NPV Chlorobenzene <0.5 0.5 ug/1 EPA 524.2 2/05/02 1:51 NPV Chloroethane <0.5 0.5 ugh EPA 524.2 2/05/02 1:51 NPV Chloromethane <0.5 0.5 ug/l EPA 524.2 2/05/02 1:51 NPV 2-Chlorotoluene <0.5 0.5 ug/I EPA 524.2 2/05/02 1:51 NPV 4-Chlorotoluene <0.5 0.5 ug/l EPA 524.2 2/05/02 1:51 NPV Dibromomethane <0.5 0.5 ug/l EPA 524.2 2/05/02 1:51 NPV 1,3-Dichlorobenzene <0.5 0.5 ug/l EPA 524.2 2/05/02 1:51 NPV 1,2-Dichlorobenzene <0.5 0.5 ug/1 EPA 524.2 2/05/02 1:51 NPV trans-1,2-Dichloroethene <0.5 0.5 ug/l EPA 524.2 2/05/02 1:51 NPV cis-1,2-Dichloroethene <0.5 0.5 ug/1 EPA 524.2 2/05/02 1:51 NPV Methylene Chloride 1.4B 0.5 ug/l EPA 524.2 2/05/02 1:51 NPV 1,1-Dichloroethene <0.5 0.5 ug/l EPA 524.2 2/05/02 1:51 NPV 1,1-Dichloropropene <0.5 0.5 ug/1 EPA 524.2 2/05/02 1:51 NPV 1,2-Dichloropropane <0.5 0.5 ug/1 EPA 524.2 2/05/02 1:51 NPV 1,3-Dichloropropane <0.5 0.5 ug/l EPA 524.2 2/05/02 1:51 NPV cis-1,3-Dichloropropene <0.5 0.5 ug/1 EPA 524.2 2/05/02 1:51 NPV tran-1,3-Dichloropropene, <0.5 0.5 ug/I EPA 524.2 2/05/02 1:51 NPV 2,2-Dichloropropane <0.5 0.5 ug/l EPA 524.2 2/05/02 1:51 NPV Ethylbenzene <0.5 0.5 ug/1 EPA 524.2 2/05/02 1:51 NPV Styrene <0.5 0.5 ug/1 EPA 524.2 2/05/02 1:51 NPV 1,1,2-Trichloroethane <0.5 0.5 ug/l EPA 524.2 2/05/02 1:51 NPV 1,1,1,2-Tetrachloroethane <0.5 0.5 ug/l EPA 524.2 2/05/02 1:51 NPV 1,1,2,2-Tetrachloroethane <0.5 0.5 ug/l EPA 524.2 2/05/02 1:51 NPV Page 3 of 3 R.I. Analytical Laboratories, Inc. CERTIFICATE OF ANALYSIS Envirotech Laboratories, Inc. Date Received: 1/24/02 Approved by: Work Order# 0201-00981 R.I. alytical' Sample#: 001 0201264 LOT 10 LOCUST GRAB 01/22/02 c@1 30 SAMPLE DET. ANALYZED PARAMETER RESULTS LEMH UNITS METHOD DATE/TIME ANALYST Tetrachloroethene <0.5 0.5 ug/1 EPA 524.2 2/05/02 1:51 NPV 1,2,3-Trichloropropane <0.5 0.5 ug/I EPA 524.2 2/05/02 1:51 NPV Toluene <0.5 0.5 ug/1 EPA 524.2 2/05/02 1:51 NPV Xylenes <0.5 0.5 ug/I EPA 524.2 2/05/02 1:51 NPV 1,2-Dibromo-3-Chloropropane <0.5 0.5 ug/1 EPA 524.2 2/05/02 1:51 NPV Bromochloromethane <0.5 0.5 ug/1 EPA 524.2 2/05/02 1:51 NPV n-Butylbenzene <0.5 0.5 ug/1 EPA 524.2 2/05/02 1:51 NPV Dichlorodifluoromethane <0.5 0.5 ug/1 EPA 524.2 2/05/02 1:51 NPV Trichlorofluoromethane <0.5 0.5 ugh EPA 524.2 2/05/02 1:51 NPV Hexachlorobutadiene <0.5 0.5 ug/1 EPA 524.2 2/05/02 1:51 NPV Isopropylbenzene <0.5 0.5 ug/l EPA 524.2 2/05/02 1:51 NPV p-Isopropyltoluene <0.5 0.5 ug/l EPA 524.2 2/05/02 1:51 NPV Naphthalene <0.5 0.5 ug/1 EPA 524.2 2/05/02 1:51 NPV n-Propylbenzene <0.5 0.5 ug/l EPA 524.2 2/05/02 1:51 NPV sec-Butylbenzene <0.5 0.5 ug/I EPA 524.2 2/05/02 1:51 NPV tert-Butylbenzene <0.5 0.5 ug/1 EPA 524.2 2/05/02 1:51 NPV 1,2,3-Trichlorobenzene <0.5 0.5 ug/l EPA 524.2 2/05/02 1:51 NPV 1,2,4-Trichlorobenzene <0.5 0.5 ug/l EPA 524.2 2/05/02 1:51 NPV 1,2,4-Trimethylbenzene <0.5 0.5 u /I EPA 524.2 g 2/05/02 1:51 NPV 1,3,5-Trimethylbenzene <0.5 0.5 ug/l EPA 524.2 2/05/02 1:51 NPV Methyl Tertiary Butyl Ether <1 1 ug/1 EPA 524.2 2/05/02 1:51 NPV n-Hexane <10 10 ug/l EPA 524.2 2/05/02 1:51 NPV SURROGATES RANGE EPA 524.2 2/05/02 1:51 NPV 4-Bromofluorobenzene 80 80-120% EPA 524.2 2/05/02 1:51 NPV 1,2-Dichlorobenzene-d4 71* 80-120% EPA 524.2 2/05/02 1:51 NPV Method 524.2:B = Aalyte has been detected in the laboratory method blank as well as in an associated field sample. The 'B' flag is used only when the concentration of analyte found in the sample is less than 20 times that found in the associated blank. This flag denotes possible contribution of background laboratory contamination to the concentration or amount of that analyte detected in the field sample. Method 524.2: * Surrogate below acceptable QA/QC limits on initial and reanalysis of sample. '0 TOWN�OFZB 4RNSTABLE � c LOCATION' — - SEWAGE # 2oo l-s-Ca VILLAGE ASSESSOR'S MAP & LOT Z22—P 33 INSTALLER'S NAME&PHONE NO. (3&+,n.) rs4�eG sc 9%��-o yyy SEPTIC TANK CAPACITY I.Sa® G,4L LEACHING FACILITY: (type) ig S*co 6aL Lgjc� c (size) se'x io.j,3 x zf NO.OF BEDROOMS BUILDER OR OWNER G e�aL?Y PERMITDATE: Z- COMPLIANCE DATE: -3 L 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 m A / m y zs'9 7 �s p 9 /a THE COMMONWEALTH OF MASSACHUSETTS FEE BOARD OFF "HEALTH. V/ O F Akl/.4,.4L41 ' PPLIC FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT �� Ap licatio r Permit to on ruct ( ) Repair ( ) Upgrade ( ) Abandon ( ) - ❑Complete System ❑Individual Components I�r �� Location 3� Owner' Na e -� cuw be Map/Pare # Address Lot# Telephone# C k E. 1 Aj e�ALL staAlle�(r¢J��.av-Od �� !e' ner'sr.N�sa//me Telephone# Telephone, Type of Building: 1 Lot Size q5 - Sq.feet Dwelling—No.of Bedrooms Garbage Grinder ( ) Other—Type of Building No.of persons Showers ( ), Cafeteria ( ) Other fixtures Design Flow min.required) gpd Calculated design fl w gpd Design flow provided gpd Plan: Date 1,0 Number of sheets Revision Date Title .7ri 1\ � 6�l=JG Description of Soil(s) Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS r The undersign grees instal the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and fu rees n t la a the system in operation until a Certificate f Compliance has been I p y p p issued by the Board of Health. Signed ate 9 z e"e - lEttspeMons ' �- w S'6 FORM I - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 ....i __.,.�.. ....rL:..y,�»t`:.+r.�•�.--a�"�'.. ,�.r•� tC t _ � v ` _..,,`y„.,4..., .. h.xt '.'•a�,- .. ... ,' e N C':"CAP ."lam' ♦ S..-:R^ - p'`' �..+ :. TH�400*ONWEALTH OF MASSACHUSETTS. FEE BOARD" O F H E A LT H} . ]�/ 3 OF APPLIC . O FOR DISPOSAL SYSTEM CONSTRUCTION:PERMIT '�Applicatio r ermit to Don truct ( ) Repair ( ) Upgrade ( ) Abandon ( ) - ❑Complete,System ❑Individua'%,Qomponents Location Owner'Name' onc, , • Map/Parcp 0Address Lot q Telephone )# Mstall e;s--Narr De' ner's Name i ,uw� i7 Telephone# r Telephone F r Type of Building: we. Lot Size q 3 '3 Sq.feet Dwelling—No.of Bedrooms t" Garbage Grinder ( ) Other—Type of Building No.of persons Showers ( ), Cafeteria ( ) Other fixtures C/ Design Flow in.required) U gpd Calculated design flew T d gpd Design flow provided gpd , ,.....,...,,Y '' Elan: Date D Number of sheets `�,,, Revision Date Tt i S Z'rifle Yfs. ,.. Description of Soil(s) AU-- Soil Evaluator Form No. Name of Soil-Evaluator Date of Evaluation t DESCRIPTION OF REPAIRS OR ALTERATIONS f The undersign 1agrees install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and fu r rees n t to platle the system in operation until a Certificate of Compliance has been issued by the Board of Health. Signed ate U �ZJ 2 " Z. -hispeetrons /J• a_4 S—' 0 1 FORM I - APPLICATION FOR DSCP DEP APPROVEDi FORM 5/96 a - �V�T'[^c- �' No. a THE COMMONWEALTH OF MASSACHUSETTSFEE �vUt � 14(Y BOARD OF HEALTH �. CERTIFICATE-OF COMPLIANCE Description of Work: ❑ Individual Component(s) AComplete System ' The undersl ned hereby certify that the Sewage Disposal System;Constructed( ),Repaired( ),Upgraded( ),Abandoned( ) by: �.,ti.�.rs.�..�1 C• -(ILL, s.K__-P_k at /G 7�/ z*u w, S"—. lit/, has been installed in accordance with the provisions of'3 CMYI 15.00 (Title 5) and the approved design plans/ -built plans relating to application No.a J -_qdated / d/ Approved Design Flow (gpd) Installer A Designer: Inspector t t " /�1'I r c Date CJ The issuance of this certificate shall not be construed as a guarantee that the system will function as designed. t FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96 No.719?) V0 THE COMMONWEALTH OF MASSACHUSETTS FEE z6v �- Ct.�vl BOARD OF HEALTH DISPOSAL SYSTEM STRUCTION PERMIT ` x�* Permission is hereby ranted t,o,AConstruct ( Repair ( ) Upgrade ( ) Abandon ( ) an individual sewage disposal system at - & as described in the application for Disposal System Construction Permit No.�� o dated Provided: Construction shall be completed within three years of the date of this per .it.All local conditions must be met. Date Board of Healtkt, (� ,�2� > hY✓ FORM 2 - DSCP DEP APPROVED FORM 5/96 t FORM 1255 (REV 5/96) f H&W HOBBSB WARREN rm PUBLISHERS- BOSTON Y I • f ��.�� TOWN OF BARNSTABLE I .LOCATION SEWAGE # 2o01-5-ca VILLAGE ti]agrr- Ei�gt+.�sy'ALf_p_ ASSESSOR'S MAP & LOT-1 22-P 3.3 INSTALLER'S NAME&PHONE NO. a R i,u K! lee --O I 'I,Iff-o*1f/M SEPTIC TANK CAPACITY /.Sao G,tL LEACHING FACILITY: (type) 9 s®n caL Lad., c1/e (size) ! NO. OF BEDROOMS I BUILDER OR OWNER R" 1: &e*kry PERMITDATE: Z- 8- 0 2 COMPLIANCE DATE: -3 04 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 ' b _Z rLa - 1 eJ_ I A; S/- e I/4" 11'-4 I/5" I'-9" f'-10" - ]'-O"rj 1 p "ZZ0 0 0 0 Z Q o nr a9@�Sa"en d ` <0 d 5 d v t <n4 }. �o II V Wood Peak > d � - 2 O'•O"X f 4'O" i d -_bilco"G" A �" V 1 cA�P�\ _ e bulkhewd 1/4" / WOOd Peck . d' 7 1 O'•O"X f O'•O" �. L of 0 - ow----- f3a+h �i� .. c 4 ..2'!e f/B"%4'•9 1/4'w � ^` q�"- ,^ 5/B" erode 9YP.bd.` O b I A- L _ a `o - I ' +h'�wwll wnd ce ding.bove �� i ... - ` i I I I I 5 r (�'O��X( 2�.0�� And!9 4 4G Y I • , i_____own I I� Li --F---------- 2 ra 1/e %4 9 1/4 red � 2 9'8„X 2%'8" vN� � rro«• � •J , � I I \,I i Living F-oom - •'•• PJedroom"2 - - .. ' - \`; 2 1 •!o X I %.wJ _Ir .Z N I c r up\I t �NOm y 03 \ t f m Go - 2rc Cv ID Farmer's Porch I Q 17 I Q I 1 I I ewced In 9/4"pine}o pwin+ 0 3 - t No aS 9 a J ou g` 9 0 U ' _ v pPmoVot �J r1 p Q P Q P P P P Q Q N � C •d 5 d o d 5 d DRAWING TYPE: tl N U 0 0 0 N t t t First Fioor plan I I I I I FLOOD PLAN SHEET NUMBER: Gale: ( /4" = f '-O" A IP 0 t i i . � � • ` c4Eyyyy 4 • 2&'-2 1/4" 2,_O" < .. dormer < m -�L"o33ks d a`5M6� $ E\ E\ i �.. @ .. Q Y P— P— �y `T� .al 1v, W�^^ l = jW v ___________ L 01 L d 0 -- ----- - - ------------ - I c FUkUre 4 7 L- Sk .I II I II I� 14` r�edro om-4 ...........rx-ro And.-2 4 46' W F•' open to below (� O I r.o.•2'!o I/6"x 4'9 1/4" O it ______ _ __ r ------------------------------------------------------- --------------------------------- /I i i I i _________ _______ S \ - _ _ _____________ f I II it S S }'i(V O II II L' I -1 _tr � I ---------- . I p -------------------- - ri ,,II NN e4, 0_ryDBOi _'� a�--ps- 4 -� _ I I A ` Nrl c��oW 3 J m o U n z r r r l� r DRAWING TYPE: 9�7e6ond Floor Plan �� GJEGOi.�r� FLOOD pLJs.h1 SHEET NUMBER: A 4 OO v cis 4v-e— �3 l 1 f LEA' / 100.0 PROPOSED SPOT ELEVATION ASSESSORS MAP 197 PARCEL 33 / 100x0 EXISTING SPOT ELEVATION FLOOD ZONE: C 1. DATUM IS APPROXIMATED FROM QUAD MAP 100 PROPOSED CONTOUR/ NOT AVAILABLE FOUNDATION DRAINS MAY BE � 2. MUNICIPAL WATER'IS 100 EXISTING CONTOUR / REQUIRED DUE TO IMPERVIOUS 3. MINIMUM PIPE PITCH.TO BE 1/8' PER FOOT. Focus NATURE OF SOILS / 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO H— 10 / S. PIPE JOINTS TO BE MADE WATERTIGHT. / 5' REMOVAL OF UNSUITABLE SOIL 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS. ENVIRONMENTAL CODE TITLE V. Q `/ e�REQUIRED AROUND PERIMETER OF 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO BE LEACHING FACILITY, DOWN TO SUITAELE USED FOR LOT LINE STAKING. SOIL LAYER. REPLACE WITH CLEAN MED. 3 SAND. ENGINEER TO INSPECT AND 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4 PVC. CERTIFY REMOVAL. 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITH❑UT INSPECTI❑N BY BOARD OF HEALTH AND PERMISSI❑N ❑BTAINED I b 28 FROM BOARD OF HEALTH. , VJ 11 T 10. WATER—TEST O'BOX FOR LEVELNESS O / O LOCATION MAP NOT TO SCALE car C� RES E AREA = � _ V. . Z 903 F % /Sp' / PROP. DWELL. / N1 TOP FNDN = 33.0' / p• / j / / $� " BENBRBCFOUND / / 8• %/ //TH 1 EL. 32.2' LOT E U w / 43,634 SF PROP. TELL HOARD OF HMTA TH 2 / MA APPROVED DATE ' PROP. CRAWLSPACE (FLOOR ELEVATION \ �\ TO BE 28.0' OR HIGHER) 1 / / SHEET 1 OF 2 TITLE 5 SITE PLAN \ raw TH 3 / OF LOT 6 MAIN STREET (RTE 6A) IN THE TOWN OF: l (WEST) BARNSTABLE PREPARED FOR: REEF REALTY LUTHERAN 60 90 CHURCH ,°�;, 0' / 30 30 _ WELL Uf down cape engineering, inc. �� AUF �' , _, _ , H. = — SCALE: 1 = 30 DATE: AUGUST 8, 2001 CIVIL ENGINEERS OJA No. LAND SURVEYORS f — _ 939 main st. parmouth, ma 02675 DCE OF qVE. ~1 _ 00 040 P.R.. P.L.S. iuT1s TOP FNDN AT EL. 33.o' SYSTEM PROFILE ACCESS COVER TO WITHIN 6' OF FIN. GRADE (NOT TO SCALE) ACCESS COVER (WATERTIGHT) TO 32.0' MUM .75' OF COVER OVER PRECAST WITHIN 6° OF' FIN. GRADE MINI •� 2% SLOPE REQUIRED OVER SYSTEM RUN PIPE LEVEL 2° DOUBLE WASHED PEASTON }• 28.5 FOR FIRST 2' 3' MAX. PROPOSED 100 28.25' GALLON SEPTIC 28.0' r 28.0' TANK (H- 10 ) GAS L— BAFFLE 27.62' �� 27.45' 0 o � 00 o o o o og IF 27.17 � C� 0 0 0 l� c 3.5' AT ENDS_ o�ooc�O000c �- 6° CRUSHED STONE OR MECHANICAL g 00 = 0 0 3' ® SIDES (2.3 SLOPE) 2'COMPACTION. (15.221 [2]) $ C7 0 0 0a o a o o� 25.17' DEPTH OF FLOW = 4' ( 5 X SLOPE) 3/4" TO 1 1/2" DOUBLE WASHED STONE TEE SIZES: H I INLET DEPTH = 10 OUTLET DEPTH 14" FOUNDATION 11' SEPTIC TANK 7' — D' BOX 20' LEACHING 7.17' FACILITY TEST HOLE LOGS ENGINEER: RICHARD FAIRSANK, PE WITNESS: N. LEITNER/J. DUNNING (PERC) 18.0, DATE: 8/10/87 & 12/9/87 (PERC) PERC. RATE � 20 MIN/INCH SEPTIC DESIGN: (cARe�cE asPoseR Is NOT ALLOWED � DESIGN FLOW: 4 BEDROOMS ( 110 GPD) = 440 GPD CLASS I & II SOILS P# 6633 & USE A 440 GPD DESIGN FLOW 6803 SEPTIC TANK: 440 GPD ( :?) - 880 iJ ELEV. [� USE A 1500 GALLON SEPTIC TANK 30.0' 0' 32.0 oil 32.5 LEACHING: A & B A & B SIDES: 2 (58 + 10.83) 2 (.53) = 145 12° 12° A & B BOTTOM: 58 X 10.83 (.53) = 332.9 TOTAL: 901.7 S.F. 477.9GPD SHEET 2 OF 2 HARD PAN USE (6) 500 GAL. LEACHING CHAMBERS WITH 3.5' TITLE 5 SITE PLAN 84' 23.0 HARD PAN HARD PAN STONE AT ENDS AND 3' AT SIDES OF LOT 6 MAIN STREET (RTE 6A) cos 10s° so° 60' ►N THE TowN (W EST) BARNSTABLE PERC TIGHT SILTY HARD PACKED SILTY SAND 4f PREPARED FOR: REEF REALTY SAND WITH Mgs�c i SAND SOME SILT W/Occ. o�' ARNE H. �G " AUGUST 8, 2001 occ. POCKETS of OJALA � SCALE: 1 = 30' DATE: POCKETS OF ClVI y CLEAN SAND IN CLEAN SAND 144-1 18.0' 144" 1 20.0' 144° 20.5' SSUAIN ARN P.P:, P.L.S. DATE OQ_040 NO WATER ENCOUNTERED • L L . %. LEAN p• j!_V 4 ASSESSORS MAP 197` PARCEL 33 [t[f / 100.0 PROPOSED SPOT ELEVATION NOTES i 100x0 EXISTING SPOT ELEVATION FLOOD ZONE: C APPROXIMATED FROM QUAD MAP 1. DATUM IS / PROPOSED CONTOUR FOUNDATION DRAINS MAY BE 2. MUNICIPAL WATER IS NOT AVAILABLE / EXISTING CONTOUR REQUIRED DUE TO IMPERVIOUS 3. MINIMUM PIPE PITCH TO-BE 1 e PER FOOT. 100 NATURE OF.SOILS 10 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO,H- -I 5. PIPE JOINTS TO BE MADE VATER11GHT. r 5' REMOVAL OF UNSUITABLE SOIL 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH, MMS. ENVIRONMENTAL CODE TITLE V. / REQUIRED AROUND PERIMETER OF 7 -. THIS PLAN IS..FOR PROPOSED WORK ONLY AND NOT TO BE 3 ,' /. LEACHING FACILITY, DOWN TO SUITABLE USED FOR'LOT LINE STAKING. `G SOIL LAYER. REPLACE WITH CLEAN MED. SAND. ENGINEER TO INSPECT AND 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4' PVC. i / o CERTIFY REMOVAL. 9. COMPONENTS NOT TO DE BACKFILLED OR CONCEALED WITHOUT F' , INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED ' 28 FROM BOARD OF HEALTH, 1 ' \ ; 10. WATER—TEST O'BOX FOR; LEVELNESS o LOCATION MAP NOT TO SCALE / RES AREA 903 F C OF.cIr PROP. DWELL: TOP FNDN = 33.0' + / BENCHMARK: / / //TH 1 / BRB FOUND EL 32.2' LOT f. y \ / 43,634 SF PROP. WEL /�� t' CQ/ Or RMTE DL Amcm DATE \�` \ PROP. CRAWLSPACE (FLOOR ELEVATION / zv TO BE 28.0 OR HIGHER) / / SHEET 1Y .OF 2 TITLE 5 SITE. PLAN to \ \\ \\ V 1' ® TH 3` IN THE TOWN..OF• W ; \ / l NSTAB\ WE BAR LL'WEST) PREPARED FOR: REEF REALTY q / LUTHERAN 30 ;`� 30 66 90 . CHURCH aae°0 i� e�� \ ` ` \��` \ WELL I q�iH UF M down cape engineering, inc. �� ARNE \��\1 �;_a_ \ . AUGUST 8, 2C01 !E H, SCALE: DATE: OJA CIVIL ENGINEERS ` I LAND SURVEYORSP p AV 939 main sL parmouth, ma 02675 3. 00-040 . P.R.. P.I.S. 1LfTB - -- a y ' SYSTEM PROFILE 4.. TOP FNDN. AT EL. 33.0' ' ACCESS COVER TO WITHIN 6' OF FIN. GRADE, (NOT To SCALE) ACCESS COVER (WATERTIGHT) TO WITHIN 6" OF FIN. GRADE 32.0 MINIMUM .75 OF COVER OVER PRECAST, 2% SLOPE REQUIRED OVER SYSTEM 31.0' • :. - DOUBLEWASHED .. .. RUN PIPE LEVEL WAS PEASTON ,t 28.5' FOR FIRST 2' 3' MAX. PROPOSED 1��00 SEPTIC 28.0 GALLON .� . 8. 28.25 2 0 K TANK (H— 10 or GAS . .BAFFLE�'27.62' • . 27.4W 0 O O 00 Cl O'o C� ooc,ca � J c 27.17' 0 � .0 0 0 0 C3 0 0 �' 3.5' AT ENDS ��- 6' CRUSHED STONE OR MECHANICAL- 0 0 0 0 0 0 0 0 O 3' ® SIDES (r2.3 % SLOPE) COMPACTION. (15.221. [2]) 8 2� 0000 � 0000 25.1T DEPTH OF FLOW a 4' _ (5 x SLOPE) 3/4" TO 1 1/2" DOUBLE WASHED STONE _: ...._ TEE SIZES: INLET DEPTH - 10M OUTLET DEPTH - FOUNDATION-- SEPTIC TANK 7 D BOX 20 ' LEACHING 7.17' FACILITY . I TEST HOLE LOGS ENGINEER:' RICHARD FAIRBANK,• PE WITNESS: N. LEITNER/J. DUNNING (PERC) 18.0' ��: 8/10/87 do 12/9/87 (PERC) PERC. RATE 20 MIN/INCH.. SEPTIC DESIGN: (c�ence psaosEft � NOT ALLOWED � DESIGN FLOW: 4 BEDROOMS ( 110 GPD) v 440 GPD CLASS I de II SOILS P{} 6633 & USE A 440 GPD DESIGN FLOW y 6803 SEPTIC TANK: 440 GPD ( 2 ) 880 .8.. Cp..,...M. ....ELEV.3 ' �.� 1p` ;= 32.5' L A 1500 GALLON SEPTIC TANK . 32.0. CHINE: .. q 9 SIDES: 2 (58 + 10.83) 2 (.53) = 145 A k B A & B _ — 3 .9 .. 58 X 10.83 (.53) _ 3 2 BOTTOM:12 12 - ;... . _u TOTAL: 901.7 S.F. 477.9 GPD SHEET 2 OF 2 USE (6) 500 GAL. LEACHING CHAMBERS WITH 3.5' b4 HARD PAN 23 0 HARD PAN STONE AT ENDS AND 3� AT s1DEs 'TITLE 5 SITE PLAN HARD PAN Cos:.. OF LOT 6 MAIN STREET (RTE 6A) 108' 60"., son IN THE TOWN OF. (WEST) BARNSTABLE PREPARED FOR: TIGHT SILTY -� HARD PACKED SILTY SAND pF REEF REALTY. SAND WITH w/occ. • M SOME SILT. _ ARNE H. J, OCC. POCKETS OF s O.u►LI► �`. SC 1" = DATE. AUGUST 8, 2001 ,,,. - POCKETS OF .. H ALE ... ._. CLEAN SAND C VI CLEAN,_SAND Q 144 18.0' 144' 20.0`, 144ml 20.5' N (J ARN RE P.L.S. DAFE �.�A�� •" �9� WATER ENCOUNTERED .. �... �