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HomeMy WebLinkAbout2026 MAIN ST./RTE 6A(W.BARN.) - Health 2026, MAIN.ST/RTE�6A WEST BARNSTABLE A = 217 018 o a o a h Iyy; �4 0 v o 4I v pf � '1,o1wn of isaru-stabie Regulatory Services Thomas F. Geiler,Director MAN. Public Health Division s "Thomas McKean, Director 200 Main Street,Ilyannis, MA 02601 Office: 509-862.4644 Fax: JU'.40-6+04 Ip„�gl�er 8c MAP. er Certification Fo m Date: pesigner: '�-_��+gtr�eectn Tr1c Installer: �iw, Entexpc'tscA,� Address: Z6`1y Crontoerry tti Y1� w-` .Address: _P0 fox -Z b3 `��s} Wnre>h�m NNA d2.53 M db1Y� a2� � t)n_ 11 t`? 2c�� Cce�,c C'L� ,/�ri Sc Was issued a permit to install a (date) (installer) septic system at 2 o 2 (o __-__MG4<dl StyPe..} based on a design drawn by (address) dated . tJ6`ewfpe (designer) I certify that the septic system referenced above was installed substantially according to the desip, which may include minor approved changes such as lateral relocation of the. distribution box and/or septic tank, (mtcoc CnUW16e. ;nCtUA04 444- ren%0,)Ql F 2- t3i44MU�Ata - L�v�h�n� aapetitii Q(djidecl (-i59 .7 ce; � aaeac;Fr ( yyo,ed) Fo, o y be.,At kv► �iwe11tY1�.9t I certify that the septic system referenced above was installed wirh major change.+ (ix, greater than 10' lateral relocation of the SAS or any vertical relocation of any comporerl of the septic system) but in accordance with State & Local Regulations. Plata revision or certified as-built by designer to follow. Sep c;tla4rn�d te,%!3td (Ins l er's Signatur -' , -� :1V1I t - (Designer's Si e) (Affi esigner's tamp Here) PL ' 'T'U TO BU TDIVISIW LATE F CO F ILL BV&T CARD ARE RECELYMPY, ISION, 114ANK YOU, HeahhlSepflc!r)e.9igner certification Form i . 2920 2ZZ 209 nN I Z1�33N I ONAOr Wd ttltl: To 600Z-20-3aa TOWN OF BARNSTABLE OCATION C20,;�(p rXn,+qA f / SEWAGE# Zo©l " 31 4 ILLAGE ASSESSOR'S MAP&PARCEL /-7 INSTALLER'S NAME&PHONE NO. _ Q(,t�(�P � V-IS (A)u SEPTIC TANK CAPACITY LEACHING FACILITY:(type) WO)3(0 ����° (size) /7.zs e% So NO.OF BEDROOMS �{ OWNERp���/ PERMIT DATE: // /'q COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility va / 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 FURNISHEDBY C4p.�ee, 6 v✓p .OM-j LLr- c c, 1�1 , N3 3s, o \33 C3y I)qE o 131 . S . No. t� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:VYes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS fitation for"Ns osai stems Construction�� permit t � p � Application for a Permit to Construct( ) Repair Ot') Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.26 Z(o P-O � �® Owner's Name,Address,and Tel.No.72a 4,,A r fury I Assessor's Map/Parcel Installler's Name,Address,and Tel.No. ��d��,,;,(, y� ®,.lb� Designer's Name,Address,and Tel.No. T<- -7(,3 Type of Building:COIL _50r—3 7 r p Dwelling No.of Bedrooms q Lot Size 3 z,7 W sq.ft. Garbage Grinder( ) Other Type of Building �` rr +% No.of Persons Showers(, ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided d gP Plan Date t'l d�� Number of sheets Revision Date Title U7,(o K444A Size of Septic Tank ,Q00 Type of S.A.S. f 7/�Y Sb �'(ZJLcQ. Js Description of Soil Nature of Repairs or Alterations(Answer when applicable) t [,; rbu�,, 1 R) rw,,j - b S Qa c,) e, (ap A(4_ to�k., Date last inspected: U56 Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issuedIlk b24� s Board of Healthed tl' in Date Application Approved by Date Application Disapproved by j Date for the following reasons Permit No. Date Issued f r ,.. .•_w..�r-t.:.;.p....i'41 r~.m'r..r•.i.lT._,.-... ..__�...... .........�....__......_..« .....�_,. ,. .,_ ._..a.�.-,..r=_,...,.,-•--- -`l�I+A,.a;��(: __ „„ V�x„- No. " Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: 4 PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes �( Yication for IDis osaf stem Construction �� � p tton i9ermtt Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Z 0 Z(o P.6.,rc Owner's Name,Address,and Tel.No. R,(u,r Assessor's Map/Parcel a 1 Z Installer's Name,Address,and Tel.No, C q�.cr.+,c(, �,�t�•s s Designer's Name,Address,and Tel.No, C_nMat(c (�Novc(.,ktiyo yy✓a Type of Building:Cif{.�, 34 ! 0�- � j Dwelling No.of Bedrooms `y Lot Size 37i,?9d�- sq.ft. Garbage Grinder( ) Other Type of Building +�, ,•�r No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date l l'1 l 12Cx4 Number of sheets-1 Revision Date Title UZ(,v M*()/1 Size of Septic Tank U00 E"X., Type of S.A.S. 1 7 A\ S 6 S T&Lug-1 31 ali Description of Soilo Nature of Repairs or Alterations(Answer when applicable) 1i,r s,1,� CYJ�c Z, D x3a� t(? S Date last inspected: 1�7cf7 Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in .. j accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of r Compliance•has been issued by Board of Health. Ak 1 d ! t'1 _ Date - Application Approved by i� p - Date / t Application Disapproved by ! v - Date for the following reasons Permit No. /n// - t Date Issued Le - THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certifitate of COMP ianre THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ;)j Repaired(K) Upgraded( ) Abandoned( at G.c�2Co r(,t1 �o(A L J2 57 VP-44�W�4tc has been cons cted id ce with the provisions of Title 5(yan_d the for Disposal System Construction Permit N y. �,_j ated Installer C.�� t Designer S- C_• Y t t #bedrooms Approved design flow gpd The issuance of this permit shall not bee`.construed>5s a guarantee that the system wi 1 function d signed. Date / / W Inspector v ^N --= o. 11 �7�-��-_-.�:r.--_���_�_ ��. ,-•--- -----____.__ _________--=�_--=_=---°--=-_--=---===Fee 11212�- THE COMMONWEAL TH OF MASSACHUSETTS PUBLIC HEALTH DIVISION BARNSTABLE,MASSACHUSETTS misposal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair Upgrade(�J Abandon( ) System located at �2to �JC (g,A (,�'e 5"� j�y.S �• 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:Construltiog must be�mpleted within three years-of the date of this permit. Date lj I/ l / Approved by oF� Town of Barnstable P 2 ?,9 5� Department of Regulatory Services Public Health Division 200 Main Street,Hyannis MA 02601 Date �AT�D MA'S A Date Scheduled I J U Time 0 t l'4 Fee Pd. j v Soil Suitability Assessment or Sewage ge asposal Performed By: HjC4(,te,l 9CMW .). CLT C5 Witnessed By; v.�f ^ r LOCATION & GENERAL FORMATION Location.Address p / �1 �0�� r/1NlVl bM fF1� Owner's Name �Uner1e rKerlr��r We-r' 6 P%IrA)Ole— Address a 17.26 (M,,n r Assessor's Map/Parcel: +� ff c/ 0 i? 0 13 Engineer's Name CTf""A ee JC atiscoeer rlb Le2c, NEW CONSTRUCTION REPAIR Telephone# 3711-- 61 506-27 -0,3:77 Land Use_ St(kSle Faml(Y / ce;ideo{la( Slopes(9'0) 1" Z Surface Stones ` Distances from: Open Water Body ft Possible Wet.Area ______ft Drinking Water Well 7�._ Y f ft Drainage Way ft Property Line >! 0 _ Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pere tests,]ovate wetlands in rozimi P ty to holes) See c. ��lred Plan 'J Parent material(geologic)Ste-CorlVaCi 60�u sn u Depth to Bedrock, 7 i'7(o bss . Depth to Groundwater. Standing Water in Hole:_ 7 1-7 S t. Weeping from Pit Face 7 1-7to �S Estimated Seasonal High Groundwater 7(7G''t5S DETERMINATION FOR SEASONAL HIGH WATER TABLE Used: Dtceck 61o5eryn4rl.n Depth Observed standing in obs.hole: 7 TI(a_ Depth to weeping from side of obs.hole: m. Depth to soli mottles: f76 Index Well# In, Groundwater Adjustment fr. Reading Date: - Index Well level _ft. ---A......._..., Adj.factor�_ AdJ,f3raundwater Observation io-�3-0 PERCOLATION TEST bate 9 Time /a Of Hole# _ Time at 91, Depth of Pere Time at 6" 1:oa eH T Start Pre-soak ime @ /0'26 Alf '"-"- Time (9"-6„) 010017a5 End Pre-soak Rate Min./Inch 2- 'rSar 'j Site Suitability Assessment: Site Passed V Site Failed: Additional Testing Needed(YIN) N Original: Public Health Division Observation Hole Data To Be Completed on Back----------- percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one (1) week prior to beginning, Q:\.S EP'rlC\PERCFO RM.DOC DEE,P-OBSERVATION HOLE LOG Hole# a Depth from Soil Horizon Soil Texture .Soil Color Soil Surface(in.) Other (USDA) (Munsell) Mottling (Structure,Stones;Boulders. r on istency,% ravel 2 - S A LS JO`ir3j3 32-5$ C-1 i-5 2,5 Y 44---------------- - S8 Z LS 2.5 1/t DEEP OBSERVATION HOLE LOG Hole# 2- Depth from Soil Horizon Soil Texture Soil Color Soil Surface(in.) Other (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consiste c `Io ravel) 2- 8 L5 JOY r')3 8 -32 t3 �5 /0Ir -'A% _ 52-58 c-1 1,S 2,5`i 11/b DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Co i to c S' Gravel DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consi ten I • r Flood Insurance Rate Map: Above 500 year flood boundary No_ Yes Within 500 year boundary No ✓ . Yes Within 100 year flood boundary No✓ Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas.observed throughout the area proposed for the soil absorption system? Ye-3 If not,what is the depth of naturally occurring pervious material? Certification - I certify that on io-27-Sq (date)I have passed the soil evaluator examination approved by the Department of.Environmental Protection and that the above analysis was performed by me consistent with the required training,experti e and rience described in 310 CNM 15.017. Signature Date 11-11-6 Q:\SF-PT1C\PERCFORM.DOC TROY WILLIAMS SEPTIC INSPECTIONS Certified by MA Department of Environmental Protection (508) 385-1300 19 Hummel Drive South Dennis, MA 02660 COMMONWEALTH OF MASSACHUSETI'S EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS e DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE llISPOSAL SYSTEM FORM PART A CERTIFICATION RECEIi/ED PropertN Address: 2026 Main Street West Barnstable, MA N O V 0 7 2001 Owner's Name: Bob Pierce Owner's Addres►: 2026 Main Street vvry OF BARNSTABLE West Barnstable, MA 02668 O HEALTH DEPT. Date of Inspection: October 26,2001 O Name of Inspector: Troy M. Williams Company Name: Troy Williams Septic Inspections Mailing Address: 19 Hummel Drive South Dennis,MA 02660 Telephone Number: (508)385-1300 CERTIFICATION STATEMENT I certify that 1 have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The systcm Passes Conditionall c Passes Needs Further Evaluation b) the Local Approving Author t) Fails Inspector's Signature: Date: io/A6 lot The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of I lealth 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. Notes and Comments Although system meets the minimum requirements set forth by the Massachusetts Department of Environmental Protection,certification is not to be construed as a guarantee of future working condition of system,piping or components. This inspection represents the conditions of the system on the Date of Inspection noted above. •••"This report only describes conditions at the time of inspection and under the conditions of use at that time.l his inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 race 1 I Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 2026 Main Street Owner: West Barnstable,MA Date of Inspection: Bob Pierce October 26,2001 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: V/ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to replaced or repaired. The system, upon completion of the replacement or repair,as approved by the Boar of Health,will pass. Answer yes. no or not determined(Y,N,ND)in the for the following statemen . If"not determined"please explain. The septic tank is metal and over 20 years old* or the septic tank( ether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure i mminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved b the Board of Health. •A metal septic tank will pass inspection if it is structurally soun ,not leaking and if a Certificate of Compliance indicatine that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled uneven distribution box. System will pass inspection if(with approval of Board of Health): br en pipe(s)are replaced bstruction is removed distribution box is leveled or replaced ND explain: The syste equired pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass mspectio (with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 i Page 3 of 1 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 2026 Main Street Owner: West Barnstable,MA Date of Inspection: Bob Pierce October 26,2001 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. 3(1)(b)that the system is not functioning in a manner which will protect public health,safety and a 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 t marsh 2. System will fail unless the Board of Health (and Public ater Supplier, if any)determines that the system is functioning in a manner that protects the publi ealth,safety and environment: _ The system has a septic tank and soil absorpt' n system(SAS)and the SAS is within 100 feet of a surface %N ater supply or tributary to a surface • ter supply. The system has a septic tank and S and the SAS is within a Zone 1 of a public water supply. _ The sN stem has a septic tan - nd SAS and the SAS is within 50 feet of a private water supply well. _ The system has a Sept' tank and SAS and the SAS is less than 100 feet but 50 feet or more frorti a private water supply we *. Method used to determine distance **This system p es if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and atile organic compounds indicates that the well is free from pollution from that facility and the prese of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure riteria are triggered.A copy of the analysis must be attached to this form. 3. Other: 3 i Page 4 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 2026 Main Street West Barnstable,MA Owner: Bob Pierce Date of Inspection: October 26,2001 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No _ --v/ 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 y,�j Liquid depth in cesspool is less than 6"below invert or available volume is less than 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. ,vi/4 Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. A,/4 Any portion of a cesspool or privy is within a Zone 1 of a public well. N� Any portion of a cesspool or privy is within 50 feet of a private water supply well. H t4 Anv 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 eater quality analysis. (This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility 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 forma NO (Yes/No)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 de 'gn flow of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criter' above) yes no _ the system is within 400 feet of a surface drinking ater supply _ the system is within 200 feet of a tributary to surface drinking water supply _ the system is located in a nitrogen sen ' the area(Interim.Wellhead Protection Area—IWPA)or a mapped Zone 11 of a public water supply w If you have answered"yes"to any que 'on in Section E the system is considered a significant threat,or answered "yes"in Section D above the large s tern has failed.The owner or operator of any large system considered a significant threat under Section E r failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner sho d contact the appropriate regional office of the Department. 4 i Page 5 of 1 I OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 2026 Main Street Owner: West Barnstable,MA Date of Inspection: Bob Pierce October 26,2001 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yet No information was provided by the owner. occupant. or Board of 1 Laid, Were any of the system components pumped out in the previous two weeks? Has the system received normal flows in the previous two week period ? Have large volumes of water been introduced to the system recently or as part of this inspection? Were as built plans of the system obtained and examined?(If they were not available note as N/A) Was the facility or dwelling inspected for signs of sewage back up? _ Was the site inspected for signs of break out? Were all system components,excluding the SAS, located on site '? Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions, depth of liquid,depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems ? The size and location of the Soil Absorption System(SAS)on.the site has been determined based on: Yes no v _ Existing information. For example,p 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(3)(b)] 5 I Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 2026 Main Street Owner: West Barnstable,MA Date of inspection: Bob Pierce October 26,20pioW CONDITIONS RESIDENTIAL 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): 3 3 G Number of current residents: S Does residence have a garbage grinder(yes or no): AN Is laundn on a separate sewage system (yes or no) ,ro (if yes separate inspection required) Laundry system inspected(yes or no): A11,9 Seasonal use: (yes or no): Aro Water meter readings,if available(last 2 yearslusage(gpd)): p/= 1224 �/, 5 ®0= dr. Sump pump(yes or no): kib boo Last date of occupancy: 0«uy,; j COMM ERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no): — Non-sanitary waste discharged to the Title 5 syste -es or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information:P ',�j Ll ,�_;„ Was system pumped as part of the ins ection(yes or no): my If yes, volume pumped: gallons-- How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM _✓Septic tank,hex,soil absorptiop 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) _Tight tank _Attach a copy of the DEP approval Other(describe):. Approximate age of all components. date installed(if known)and source of information: N It 4-A 11.A J-��...� Were sewage odors detected when arriving at the site(yes or no): Nv 6 Page 7 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 2026 Main Street Owner: West Barnstable,MA Date of Inspection: Bob Pierce October 26,2001 BUILDING SEWER(locate on site plan) Depth belo�� grade: /8" Materials of construction: cast iron Z40 PVC_other(explain): Di,tanc:• fron-. private water supply well or suction line: ,v//q Comments(on condition of joints,venting, evidence of leakage,etc.): �!�y_ �✓c�c �....,..( c.(cam-.. �a, r.< to-�.cam'o... . SEPTIC TANK: 'Z(locate on site plan) Depth below grade: /o" Material of construction: v/concrete_metal_fiberglass__polyethylene —other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no): _(attach a copy of certificate) Dimensions: 5'X g 'X c ` /a o o Sludge depth: y" _ Distance from top of sludge to bottom of outlet tee or baffle:of Scum thickness: --n-, IG.r Distance from top of scum to top of outlet tee or baffle: " Distance from bottom of scum to bottom of outlet tee or b e: /7' Hoye were dimensions determined: Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): !'✓c T- 's -(hl�t_ 'I.c 7<. �Lc.,�. �o Ji�w s - ► t—✓ �r���t -^f �!_.i...0 w<-.*KV. 1t-/c � w.. I ��.../t -7z, �.� � Adr.. K C�v�/c'l� �r,vci�' ti ,r ti o,•c� w �p I°���.:; �� 7i.��l }, �.. c4✓1�c/ s sL P Yvh�.�5 Slry(� R ✓�l.:ll otiA �o r✓. fv /o% t � / �l2 1 j1 w.cw GREASE TRAP:_(locate on site plan) L 1 > /: w' ,k '. ._ A ell 1-4- Depth below grade: .-7C, Material of construction:_concrete_metal_fiberglass_polyethylene_other a-* fk.- is, (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet.tee orb e: Distance from bottom of scum to bottom of ou t tee or baffle: Date of last pumping: Comments(on pumping recomm/peakage, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidenc etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 2026 Main Street Owner: West Barnstable,MA Date of Inspection: Bob Pierce October 26,2001 TIGHT or HOLDING TANK: (tank must be pumped at/inspen)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglane other(expiain): Dimensions: Capacity: ga>order Design Flo%N. ga Alarm present(yes or no):_ X Alarm level: Alarm in wors or no): Date of last pumping: Comments(condition of alarm and fl etc.): DISTRIBUTION BOX: (if present must be opened)(locate on to plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets a al,any evidence of solids carryover, any evidence of leakage into or out of box,etc.): PUMP CHAMBER: (locate on site plan) Pumps in working.order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chambe condition of pumps and appurtenances,etc.): 8 Page 9 of 1 1 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 2026 Main Street Owner: West Barnstable,MA Date of Inspection: Bob Pierce October 26,2001 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why Type leaching pits, number: L' �� '` y' 5h,. - ( Al, leaching chambers,number: leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil,condition of vegetation, etc.): e � w�y [•�K y ti ��e K �-e... L. !P # � I w c.� �...< �,.�� �e-or•`�---.,. ✓S w S 1 ...✓.�`. � w.L. [.� L . y GF �i t.r c.� . s ..A c. l /o �J�w*f�v. c� r 1'•►.� t�! �S�o moo+. b w�I(f �Lv..J` G_/ ���, C4-6e r- &W—)L.rr lwv� l�/v .Gu,� c o,�' �7 �ra (: (✓�z o.� t, 1j_ CESSPOOLS: (cesspool must be pumped as part of inspection) Cate on site plan) # Number and configuration: _ _ �' 02 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 or no): Comments(note condition of soil,signs of raulic 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 hydraul/ure, el of ponding,condition of vegetation,etc.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 2026 Main Street West Barnstable,MA Owner: Bob Pierce Date of Inspection: October 26,2001 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketc sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. a Its within 100 feet. Locate where public water supply enters the building. Sy„G„ sy l3�k qpt �oW y.ad. Ins' lz3, 10 Page I I of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 2026 Main Street Owner: West Barnstable,MA Date of Inspection: Bob Pierce October 26,2001 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to groundwater 404' feet Adjusted high ground water elevation feel Please indicate(check)all methods used to determine the high ground %pater elevation: Obtained from system design plans on record- If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: iaks�- ,,� Checked with local excavators, installers-(attach documentation) _,z-Accessed USGS database-explain: A,,,,, 2w-7 te&z [3 23 Z You must describe how you established the high ground water elevation: �/'1L L..0 1-_ rI`t-W'Iti T /7 /'7W/9 (- G-✓ 6�- �.0 y f d J-1 v p t h �.V Gl M •!t '_d ti9 l Q /� 1� S/�C� �V✓� D " 6v 17 � 3 � 1�✓A !�•f G !J tyo n 07C' / ?.a ' 11 TROY WILLIAMS SEPTIC INSPECTIONS Certified by MA Department of Environmental Protection �� � 08) 385-1300 19 Hummel Drive N South Dennis, MA 02660 'gr ® 'r'999 k o Opp COMMONWEALTH OF MASSACHUSE S �' EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION UV ONE WINTER STREET, BOSTON MA 02108 (617) 292-5500 TRUDY CORE Secretary ARGEO PAUL CELLUCCI DAVID B. STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address °C�O�6 R V+e 6 A Name of Owner e p bt r f" P r<r C.t w e s f Qh✓n S I t Address of Owner: Date of 4sspection: S/a b /9 9 /..►, Qo-r vr) p 6 c A4 a. Name of Inspector(Please Pnnt1 Tray wlliams 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) O 'Z6 6-8 Company Name: TroyIliams Se tic Inspections Mailing Address: tg Hummel Drive, So. Dennis, MA 02660 Telephone Number: (508) 385-1300 CERTIFICATION STATEMENT 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 inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails / �f� � eo 1 " Inspector's Signature: �(/'J�t.�GG Date: .1 .2 The System Inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within thirty (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 Department of Environmental Protection. The original should be sent to ttte system owner and copies sent to the buyer, if applicable, and the approving authority. NOTES AND COMMENTS Although system meets the minimum requirements set forth by the Massachusetts Department of Environmental Protection,certification is not to be construed as a guarantee of future working condition of system, piping or components. This inspection represents the conditions of the system on the Date of Inspection noted above. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Owner:Property A 2026 Route 6A, West Barnstable,MA Dace of lmpection: Robert J. Pierce May 26, 1999 INSPECTION SUMMARY: Check A, B, C, or D: A. SYSTEM PASSES: 1 have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist. Any failure criteria not evaluated are indicated below. COMMENTS: B. SYSTEM CONDITIONALLY PASSES: One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health, will pass. Indicate yes,no,or not determined(Y, N, or ND). Describe basis of determination in all instances. If "not determined", explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a cop y of a Certificate of Compliance(attached) indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank, whether or not metal, is cracked,structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of" Health). broken pipe(s)are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four 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 obstruction is removed revised 9/2,/9G Page 2ofII I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Prop"Address: 2026 Route 6A, West Barnstable,MA Owner: Robert J. Pierce Date of Inspection: May 26, 1999 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Al 119 Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and 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 THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 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 AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone 1 of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a Private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER SUBSURFACE SEWAGE DISPOSAL SYSTEPA INSPECTION FORM PART A CERTIFICATION (corronued) 2026 Route 6A, West Barnstable,MA Prop"Address: Robert J. Pierce owner: May 26, 1999 Date of Inspection: D. SYSTEM FAILS: NIA You must indicate either "Yes" or 'No" to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this determination Is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage into facility or system component due-to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume Is less than 112 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 Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a 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 I 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS:Al Al You must indicate either"Yes" or 'No" to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further information. r -wised 9/2/98 1,,,. 4 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST P,operty s. 2026 Route 6A,West Barnstable,MA Add.eS -Owner: Robert J. Pierce Date of Inspection: May 26, 1999 Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yet No Pumping information was provided by the owner, occupant, or Board of Health. None of the system components have been pumped•forat least two weeks and-the system has been-receiving rates during that period. Large volumes of water have not been introduced into the system recently or as prt othis flow inspection. _ As built plans have been obtained and examined. Note if they are not available with N/A. _ The facility or dwelling was inspected for signs of sewage back-up. ✓ _ The system does not receive non-sanitary or industrial waste flow. JC _ The site was inspected for signs of breakout. �/ _ All system components, excluding the Soil Absorption System, have been located on the site. J _ The septic tank manholes.were uncovered,opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction,dimensions,depth of liquid,depth of sludge, depth of scum. / The size and location of the Soil Absorption System on the site has been determined based on: Y _ Existing information. For example, Plan at B.O.H. _ Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance Is unacceptable( / 115.302(3)(b)] JL - — The facility owner(and occupants,if different from owner) were provided with information P nforma'on on the.proper mairtter►anceof Subsurface Disposal Systems. rev i sec"! '? Page 5 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: Owner: 2026 Route 6A,West Barnstable,MA Date of Inspection: Robert J. Pierce May 26, 1999 FLOW CONDITIONSRESIDENTIAL: Design flow: J/U g,p,d./bedroom. 7 Number of bedrooms(design): Number of bedrooms(actual):J Total DESIGN flower 3 0 — Number of current residents: Garbage grinder(yes or no): Vo Laundry(separate system) (yes or no):A/O; If yes, separate inspection required Laundry system inspected (yes or no) Seasonal use(yes or no)— Water meter readings,if available(last two year's usage(gpd): 7 S/yy 7 .0o 1 �/ 7��fg = /�u0o tu)/ea s Sump Pump(yes or no). o Last date of occupancy: 6(,C—v I. COMMERCIAL/INDUSTRIAL. P I A Type of establishment: Design flow:_ ppd (Based on 15.203) Basis of design flow Grease trap present:(yes or no)_ Industrial Waste Holding Tank present: (yes or no)— Non-sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings,if available: Last date of occupancy: OTHER:(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of Information: P�►++y��� �Lrt Arils +✓ N eblA.'�c fteH, �o .ht C na.i System pumped as part ofr spection: (yes or no)_/[o If yes, volume pumped: gallons Reason for pumping: 7YPf;OF SYSTEM Septic tank/die44byiie*4W*/soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes, attach previous inspection records,if any) I/A Technology etc.Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components, date installed(if known) and source of information: ..A++ .op h OA /7/,8 Sewage odors detected when arriving at the site: (yes or no) Nd '-et, ; sed 9/2/98 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: 2026 Route 6A, West Barnstable,MA Date of Inspection: Robert J. Pierce BUILDING SEWER: May 26, 1999 (Locate on site plan) Depth below grade: Material of construction: cast iron 40 PVC_other(explain) Distance from private water supply well or suction line A/M Diameter 91, Comments: (condition of joints, venting, evidence of leakage,etc.) .1c SEPTIC TANK: (locate on site plan) Depth below grade: /a Material of construction: V'concrete_metal_Fiberglass _Polyethylene_other(explain) If tank is metal,list age Is.age confirmed by Certificate of Compliance_(Yes/No) Dimensions: .S X 9 ' k 6 /000 gc,llo�. Sludge depth:, f— Distance from top of sludge to bottom of outlet tee or baffle:.4-7 r�0 Scum thickness: AIDNr- Distance from top of scum to top of outlet tee or baffle: Ald S G'i Distance from bottom of scum to bottom of outlet tee or baffle: NG.$c-4"+ How dimensions were determined: Pro be .Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structuraHntegrity, evidence of leakage,etc.) JOV c- j t, .may ; ,, /`f r N V L �—« C G a �• ti wor k r 4 DY^cRt✓ Nu i StiS d 7� �Gw ko4e c. S 1✓✓C-�✓I t -7LtJ1� I .. e. r•.,i.� .r+.,.t CrK✓ S<C', ✓✓v.p.i.. yl N<✓ �7i4- r•�"n.i.< I/.S4 .�I R SE TRAP:N/�g v�ti: I/ . rZ`... wu f c r ro +j /� ��, /c �O P'/r t� i�o v I j a w t,, r (locate on site plan) P 1, rA 7 .0 fv f�i t ��o Sw c % fP k Cv 4ti J, /cDepth below grade: � o w�sP tw as rc.! e� Material of construction:_concrete_metal_Fiberglass _Polyethylene_other(explain) Ruti fs P,'� 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: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) revised 9/2/Q8 Page 7ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: 2026 Route 6A,West Barnstable,MA Dace of Inspection: Robert J. Pierce May 26, 1999 TIGHT OR HOLDING TANK:A1119 (Tank must be pumped prior to, or 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/day Alarm present Alarm level: Alarm in working order:Yes_ No Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches,etc.) DISTRIBUTION BOX: Al/A (locate on site plan) Depth of liquid level above outlet invert: Comments: (note-if level and distribution is equal,evidence of solids carryover, evidence of leakage into or out of box;etc.) -- PUMP CHAMBER:—��/'q (locate on site plan) Pumps in working order:(Yes or No) Alarms in working order(Yes or No) Comments: (note condition of pump chamber,condition of pumps and appurtenances, etc.) ­v sed 9/2/98 ., !''Qe 8 of 1 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: 2026 Route 6A,West Barnstable,MA Date of Inspection: Robert J. Pierce May 26, 1999 SOIL ABSORPTION SYSTEM(SAS):--,/- (locate on site plan, if possible;excavation not required, location may be approximated by non-intrusive methods) If not located,explain: Type: leaching pits, number:(�rX� Pr w , /(, rS/Dkc , /- /JAG ' P•) w r( �/'slaH� leeching chambers,number:_ leaching galleries,number:_ leaching trenches,number, length: leaching fields, number, dimensions: overflow cesspool,number:_ Alternative system: Name of Technology: Comments: (`note condition of soil, signs of hydraulic failure, level of ponding, damp soil condition of vegetation etc.) W G. - r .A 3 HGL NGWt 7 tr ; HO s • h O c sPooLS:�/A (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(cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY: ///19 (locate on site plan) Materials of construction: Depth of solids: Dimensions: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) revised 9/2/98 1,gr9ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Prop"Address: Owner: 2026 Route 6A, West Barnstable,MA Date of inspection: Robert J. Pierce May 26, 1999 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least tw nt reference landmarks or benchmarks locate all wells within p' a ere public water supply comes into house) �� ,�; ► 5t�b" OCA 150 wok.. yo 3g e �oo0 y C- �N�^ K- O 1 105- JI (z rev 1 :,? 9/2,19 8 Page 10 of SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(cori6nued) Prop"Address:Owner: 2026 Route 6A, West Barnstable,MA o Data of Inspection: Robert J. Pierce May 26, 1999 NRCS Report name Soil Type_ Typical depth to groundwater USGS Date website visited Observation Wells checked -La."67 Groundwater depth: Shallow Moderate Deep ✓ SITE EXAM Slope ✓ Surface water Check Cellar Shallow wells rr�� Estimated Depth to Groundwater 926f Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed Site 1Abutting property, observation hole, basement sump etc.) Determined from local conditions Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators,installers Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) Qry gals 1�0 �•� �'ai- S at �c�l .+� wa c� �v+MCA w�- � c�tp �rcc, t.Jw S �•y �. 13°1'�'�, o c/.e.ch� I , j revised 9/2/98 ,,age 11 of 11 '! + A G L fL `erl__� D A T IS U E D l it 1 r v� M s J ASSESSORS MAP NO: —Xi, ` PARCEL NO.: D f r1 �0 Fxs1 ,. r THE COMMONWEALTH OF MASSACHUSETTS ___---BOARD OF HEALTH 11�/........o 1� Z.. .................................. Appliratiun for Uiupuuttl Marks Tunutrnrtiun Permit Application is hereby made for a Permit to Construct ( ) or Repair ( Individual Sewage Disposal System at: ? ........................................... ...............�........_..... -----------------........................ Location-Address �— 6 or Lot No ... . ......_. L- .. .. - ..... .............................. ......................._. Owner. Address .....4.r ... ............54. ._ Y .:............................----•-•--•-------•-----••-----....... Installer Address � f Type of Building � S Size Lot.......................... q. eet U g— .Expansion Attic ( ) Garbage Grinder ( )Dwelling No. of Bedrooms___________________________________________ '4 Other—T e of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures .................................. W Design Flow............................................gallons per person per day. Total d*ly flow............................................gallons. WSeptic Tank—Liquid capacity). . allons Length.....5.7__-..... Width----- - -------- Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length ... Total leaching area....................sq. ft. Seepage Pit No----------/------- Diameter.._......_...... Depth below inlet._.._..._..... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ 1.4 Test Pit No. L...............minutes per inch Depth of Test Pit.................... Depth to ground water..................... fi Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ R+' .................................................. ••--- --..----------•---•------------...-......................................................... 0 Description of Soil......�i..... . C� . ✓ -----------------------•---------------•---------------------------••-......_---•--•-••---- V ••--•--••••-•••--••--•-••--•-•-•----------------•---••-••----•-••-•-•-•---•--•••-•...---•-...---•--.._.....••••--•••-•--•--•----------•--•-•-•••-----......••••-•-••-••--•---•-•-------••......•--•----- W UNature of Repairs or Alterations—An when applicable........... ` �. ..:117 1f?.r�e................ -----------------------------------••-•--•----- r ` --------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITL 1E 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 by the board of health. ` ig Signed. :r 1.�-x-- ------------------ -----y 7L Application Approved .............................................................. ate teD at Application Disapproved for the following reasons:---•----------------------------------------------•---------------------------------------------------..------ --•-•-•-•-•-••---•........---•------......•-••........•-••-• ......•-••••............................._...........................--••••..............................-•----.....Date ......._..:. „3 > PermitNo............ .......... Issued-....................................................... Date - a f�......... Fps u : ._....... ... THE COMMONWEALTH OF MASSACHUSETTS ,_ BOARD OF HEALTH f..............S �' )��........OF.. ; '1 - w7 i.... ......._........._....._........... Appliration for Bispuittl Warks Tontrnr#inn Permit Application is hereby made for a Permit to Construct ( ) or Repair ( 410'Ln Individual Sewage Disposal System at ...... »»......_...... .............................` -• •--•-•---_____-_.....»................ yyLocation-Address . or Lot No. .... .`�_.!._ta.::... ..........a 1' _. ..... .._.,..O_.w.ner . ....... - ... ...................»................................».»..... ---------•_---_---• __....... � 0 Address ! � . � ....-- - ............•...................---......._...--•-•---•-••--....Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedroom s............ .....:....................Expansion Attic ( ) Garbage Grinder ( ) 04 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) aOther fixtures ............................................... Design Flow........................:...................gallons per person per day. Total dly flow............................................gallons. Septic Tank—Liquld'ca.pacity-lUOPWallons Length......7....... Width...... ....... Diameter................ Depth................ W Disposal Trench—No_ ____________________ Width.................... Total Length........ Total leaching area...................sq. ft. x 3 Seepage Pit No._.,,, . ....... Diameter........&...... Depth below inlet.... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ F`Jj Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water....................... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 04 ..............•-•------•---•-...._.....•• ...... .................................... -..._. Pj O Description of Soil...... .!.'^'S` �`*� `'"�� j v� o - • U ----------------- ............... ------------- •............ •----•- -________........ -------------- • -•••-----•••---- W -••...............••-----•-------....---.._.._---••------•--------- ---•---•••-.......•-•-•---.....---........--••---•-•.....•--•-....--•.............•-------------•-•••-......_.�_.. UNature of Repairs or Alterations—Answer when applicable............ I�. .�: �c ~�..... `x' = {:___________•-. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITIS 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 by the board of health. 7. .. ............•-- • / Date Application Approved BY .:.__:: ......: ................. _ -•••---_••_...C ? Datet Application Disapproved for the following reasons_...........................................................-..............................................»__ ...-•-------•--------------------••••------......----...---•-----••------•.............-•--•-------...._.---...--••----•--.......---..........---•---•----------------------.......-----••--..........» Permit No.............��_W....... Daft^2.1..0. _--_ Issued.........--••- -•---••-----......... ...._ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................................ O F. .::;' }t�� a± E3.f � ................................. Trr#ifutt#r of Tomplittnrr THIS IO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by----...-----.......... ..: l t��-ttY.....--•--------..__..._..---•------•----•----•in.iaii«-•----..................................................-•••--........_........ ..._..._ has been installed in accordance with the provisions of TITLE y 5 of The State Sanitary Cod as described in the application for Disposal Works Construction Permit No....... ._..7'.4?4r._..... dated.__.. ° 7� (........................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNC IO S TISFACTORY. DATE...•---•....................7/.P •-•-•--••-----•-••---•-. Inspector...... l ..................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD _O , HEALTH �-•�- - �\ {. ...... ............OF........... � =TFl 'af ................. �.. N FAR .::::........ is Dispaid Works Tonu#.rur#ion Permit Permission is`hereby granted.... of r.ti:F-A"41........................................................................................................._.._ to Construct ( ) or. Repair ( an Individual Sewage_Disposal System at 'No...........'.:?. ?:�.'._t. `�.F :: ....r f�"'r == ...............................•----------•-•----..........----•............... - Street as shown-,on the application for Disposal Works Construction Permit No.?�:..2.5 ? �D,qed...... 7,� ram............... ......................I.:......".-...,.._x:/1 i6,.................................................. -' Board of Health DATE_... 7� .........--•.............................. FORM 1255 A. M. SULKIN• INC.. BOSTON > 'F 9-2 -9 r Llb CAT ION SEWAGE PERMIT NO. VALLAGE INSTA LLER'S NAME & ADDRESS BUILDER OR O WN//E./Q DATE PERMIT ISSUED DATE COMPLIANCE ISSUED ��_�� r I Ta4wic. / l: / Oh I I / Q ICED qA ,� �/ J THE COMMONWEALTH OF MASSACHUSETTS ` S BOAR® OF HEALTH ....................T.own..---......OF........Barnstable .................................................... Appliration fnr Disputial Works Tnntrurthin ramit Application is hereby made for a Permit to Construct ( ) or Repair (x ) an Individual Sewage Disposal System at: 2026 Main St. , West Barnstable __...._.. .......................................... .•-••--•-•-----•-----------•---------•----------..._._.....---••-•---------------...........------ Kenneth Salemino Location•Address 2026 Main St. , Wks'ft]farnstable, 02668 ......................-.......................................................I.................. ..........-----------------•--•--•------------•-•---------------- ---.....-------- W A & B Cesspool Servic"eeT -128 Bishops Terrace, yannis, MA 02601 a ------------------------•---•--•----•----•-•------.............--•-----..........•---------•---... .....•-------------------------•---------------........•-•--•--•..........._.._................... Installer Address � Type of Building Size Lot___________________________S q. feet Dwelling—No. of Bedrooms.................3........................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons.........4................ Showers — Cafeteria a' Other fixtures ............................................... W Design Flow............................................gallons per person per day. Total daily flow.......,....................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter-____-__--_--_._ Depth................ x Disposal Trench—No. -----•-•--------•--- Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.-______-__--_--___- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water----_---___-_-__-__---_. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ----------------------------------------------------••------•---•--•----------•--.-----•----•-•-----•----•----•--------------------------------- O Description of Soil...:____.�asxl__ x V ---------------------------------------------------------------------------------------•----------------------------------------...---------------..................................................... U Nature of Repairs or Alterations—Answer when applicable_._ixlstallatoxl--- f:-a--1,000-_gallon•-septic. tank & .a-.1.0Q0..gallon..gxe_-�a.st,.__ Qn�...pa.Cke-d....ea.Qh..p1t...(.oymrflora)-_.to-_replace_-Caved..in. system. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT f E 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b en issued by the b d health. S' e ,-. = 4 12 82 •---- ------._�...ct ---•... ............1................ ApplicationApproved By................ -------•---- ---'.............................................. ................. • 2/82 Date Application.Disapproved for the oll ing reasons:.............................................................................................................. .........-•--••-----------•--•---•--•----------------------------•---•-----••----•-------------•-•--------•••-•••--•-••----•-•----•----•----------••-----------•--•--•-----•-•--•-••----•-••------------ Date Permit No.....82...-•---.....-•------••--•-•-----•---•----•... Issued.........4,12/82 Date No......82=A.7- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....................T own ..........O F.......Parnstable.... Applirtttion for Klispuiittl Works Totutratrtilatt FarAft Application is hereby made for a Permit to Construct ( ) or Repair (x ) an Individual Sewage Disposal System at: 2026 Nain St. =.. j A Parnstable ................-_....---... ...-----.........------.........-----. ............----- •-----------•--•--.......---.....-------•----•-----.......................---- Location-Address Kenneth Salemin0 2026 R�in St. , Wdi3t°t instable, 02668 ......................__........................................................................ ..................•-------•--............------............-•----•---•-.......................---- Owner W A &. P Cesspool Service 128 Bishops Terrac6;dr Hyannis, VA 02601 Installer Address Pq UType of Building Size Lot.................... ......Sq. feet �-, Dwelling—No. of Bedrooms.................3.........................Expansion Attic ( ) Garbage Grinder ( ) P4 Other—T aype of Buildin g ............................ No. of persons.--•-----4................ Showers ( ) — Cafeteria ( ) dOther fixtures -------------------------------•----------------...----•---•-••-••-•--••-•--•--------•----•--------•...-•••---•-•-.......-•••-..........-•--•-----•-. W Design Flow............................................gallons per person per day. Total daily flow--------------------------------------------gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total.leaching area....................sq. ft. Seepage Pit No...................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ r14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.....-__------------____ 04 ..----•--•-----••------••---•-•...............•-•---•-•-....•-•-.....•--•--.....................•.................-•-•--------•. DDescription of Soil...------..5ADa...••-••-•••-•..............•-•....._.....-------•--•-•----•••-•--•-•-•••-------•••••---••............--•-••......•••. U ••...........................••--••-•-•--....._......-----••--•-••-•-•-••..........----......-----•-•--•-•----....•••------••-•--•---•-•---•••----------••-••---••--...........-••--•--•-•............. W U Nature of Repairs or Alterations—Answer when applicable_.i natallat i on of a 1,000 gallon sent i C tank & - - a--1000--gallon pze-cast, stone packed leach pit (overflow to replace caved in system. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'TiTY-E 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 by the bgard,afihealth. _ �b f/ , ` 4 12 Q2 Si 1.e ._ LGG ct �tl..� - 2x L t 2/f 4 -...... r. Application Approved By............. �......- ` v `...'....... ..--••-----•--•-•�f- -Z/R2------ ♦ Date Application Disapproved for th f ollong reasons---------------------------------------------------------------------------------------------------------------- Date PermitNo............2..........................•.................. Issued.--•------•---12 P..--------------------------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .................T own........O F........Barnstable.......................... �rr�if irtttle laf f�uaat�littatrr TH IS TO CERTIFY That the indi idual ewa e Dis sal S-ste ons d or Repaired �c A do Cesspool Service, 1zn Bishops er ace, I yann, .s, i fl ( ) P ( ) by-A ...........................................•-----.....---.......----------•---•---. •-•-•-•-----•-------•---•-•••-•-••----•-•------•--•._.........._.......--•--•--•-••--•---....._ 2Q.26 Yain St., West Barnstable, 02660n"t-" Kenneth Salemino at .... ."�.------ •---------------------------------------- ------------ -------------------------------------------------------------------------------------------- --------- \ has been installed in accordance with the provisions of '� F, The State Sanitary4ft8Z described in the application for Disposal Works Construction Permit No________ _____________________________ dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. / 3/ 2 Inspector....................� 4.:. ... ............................. THE COMMONWEALTH OF MASSACHUSETTS i BOARD OF HEALTH Town Parnstable 5,00 82_ f OF........:. No. .......... FEE------------------------ ! isposal Workii Taaa otrudivit rrutit Permission is hereby granted.....A & B Cesspool....S.ervice ................. ------•---- to Cons t ( ) or�R epai (X ) n Inc�ivitdal Sb r Di osal st ��6 141ain 5t , Jest rns a e, ` 98 Cenne i alemino #` atNo......................................................................................................... Street / 7 as shown on the application for Disposal Works Construction P�,>riit N r._ .Dated..____ /12`_ ....._•.-..--.•..._.. raver f+ ------- --- 4/13 82 hoard of Health DATE...........•................................................................... ' r FORM 1255/HOBBS & WARREN, INC.. PUBLISHERS ,'\ 4"SCHEDULE 40 PVC MIN.SLOPE 1% PROP.4 VENT WITH CHARCOAL �^+ /� NOTES: - FINISHED GRADE OVER BIODIFFUSERS= - GENERAL NOTES WISH GRADE OVER D-BOX- 71.75 ± FILTER TO ABOVE GRADE 71.20 71.53 SLOPE @ 2%MIN. INSPECTION PORT WITH 1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP EDGE OF REMOVABLE WATER-TIGHT COVER OVER 1. UNLESS OTHERWISE NOTED,ALL SYSTEM COMPONENTS AND CONSTRUCTION RISER TO WITHIN 6"OF FINISHED GRADE ACCESS BOX TO WITHIN METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL 5"DIA. OUTLET(S)EACH SEPTIC SYSTEM COMPONENT. 3"OF F.G. ONE PER ROW)) CODE AND ANY APPLICABLE LOCAL RULES. 2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE LOCATION OF 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE THE PROPOSED LEACHING FACILITY TO ENSURE CONSISTENCY WITH TEST DESIGN ENGINEER. 66"MAX. 72"MAX 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL PIT DATA SHOWN ON THIS PLAN. REPORT TO ENGINEER AND LOCAL SEE NOTE 22 SEE NOTE 22 TOP OF SAS/B.O. = 65,53 SYSTEM UNLESS OTHERWISE NOTED. BOARD OF HEALTH IF SOILS ARE NOT CONSISTENT WITH TEST PIT DATA. PROVIDE WATERTIGHT 4. TO PREVENT BREAKOUT,THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN L=128 JOINTS(TYP.) ELEVATION =65.53' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS A LO 4"PVC IN FROM 1.33' f " 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE TOP OF LO ui MAP 217 MAP 217 SEPTIC TANK 4"PVC OUT TO 0.9�, (TYP.) 10.75"(TYP) 16 THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. a Q LEACHING FACILITY 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. PARCEL 32 PARCEL 20-04 cli 12" 6" , \� , 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. Y 65.50 MIN. 65,33' 65.10 64.20 (laid flat) 2.875 (3�4.5 ) (STONELESS SYSTEM) o (TYP..) 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK m 5.0' z 6"CRUSHED STONE (TYP.) FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS a OVER MECHANICALLY 5'MIN. 17.25' NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH N88°59'40"E COMPACTED BASE 50.0'(TYP FOR ALL 6 ROWS) AND DESIGN ENGINEER. 100.00' 6 OUTLET DISTRIBUTION BOX 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM OF 75.00'ESTABLISHED / TO BE INSTALLED ON A LEVEL STABLE GROUND WATER ELEV.= < 57.53' ON A NAIL SET IN UTILITY POLE#10/S AS SHOWN ON PLAN. fl-x X x X X-x X x-X X X X X XX BASE. FIRST TWO FEET OF OUTLET 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION x x PIPES TO BE LAID LEVEL. 60 - BIODIFFUSERS PROFILE BIODIFFUSER END VIEW THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT X x CROSS SECTION VIEW 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES DISTRIBUTION BOX (H-20) DETAIL 60 - ARC 36HC ( 3616BD) H-20 BIODIFFUSERS TO THE DESIGN ENGINEER. 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC.STRUCTURES SHALL BE MADE WATERTIGHT. j __ _- j NOT TO SCALE NOT TO SCALE _ _ _ -- '� 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING _ TEST PIT DATA REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM INGROUND POOL i x PROVIDE PRECAST CONCRETE " -- 'F - _ ' APPROPRIATE AUTHORITY. I i I T.O.F. EL.= VARIES EXTENSION RISER WITH CONCRETE .. _.,�, _ PERC NO. 12725 X i-r x COVER TO WITHIN 6"OF F.G. OVER q - �" - ," INSPECTOR: David W.Stanton, R.S. 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS f - ��. 4i _ _ -- LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE - i I INLET AND OUTLET COVERS. FINISH GRADE _ , .g - . :, - - - wC.S.E. mentel, E.I.T. � �x � - - EVALUATOR: Michael Pi THEY SHALL WITHSTAND H-20 LOADING. - I FND. EL.= VARIES FINISHED GRADE OVER TANK EL. 69.5+ Oct. 1999 @ _ � T C S APPROVAL DATE, 13. DOUBLE WASHED CRUSHED STONE SHALL BE F F-ALL-DIRT-DNST-AND-FJ1ESES.- -x -X-X-X- - x \ � �X-X-X-X- - • ��- � - - ,� . -"" � . ;' �r ,.� DATE: October 15, 2009 \g9 I EXISTING 4°' PROPOSED 4" _W E _, ,� r TEST PIT#: 1 W E REQ CTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE \ �SIr<N�R PIPE PVC SEWER PIPE - MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. ELEV TOP= 72.20' REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, 4 I <57.53' FINES OR OTHER UNSUITABLE-MATERIAL,IN ACCORDANCE WITH 310 CMR 15.255(3): --\ \ _ , ELEV WATER= __.... _ - __ -_� " " 3"DROP MAX „ " - _ _ r..- 2 DROP MIN 3 9 Mir,. _ FOUN o -- " r OR SHAtL-NC�TIIOESttENGtNEER OF1�NY DISCREPANCIES w ( s�oPE�,% LOCUS ' /''" ) PERC RATE 30 min./inch c°D„ �' \ ( 10" ,� _ - SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION O WORK. MAP 217 ti ; 3 _1__ 14" 1, e-w +� ' DEPTH OF PERC- 8" 26" 16. PROPOSED PROJECT IS LOCATED WITHIN: I N `'' O ! i � ��.�a - c - f O . PARCEL 18 _r�► ' ' ' � � � �A,,� q� " �s �` ��� r � TEXTURAL CLASS: 2 ASSESSORS MAP 217 PARCEL 18 32,780 S.F.± � \ j . \ CONTRACTOR CONTRACTOR SHALL OWNER OF RECORD: ROBERT A. &KELLI A. DONEHEY ^� s'' \ o " OUTLET TEE 20 MAIN STREET r. \ o ' \ SHALL VERIFY SIZE 48 VERIFY CONDITION OF EXISTING tl)Tl.1=T TO BE PLUGGED AND CONDITION OF EXISTING TEES " 0 of 0" 72 20, ADDRESS: 26 S EET i I 22 ZABEL FILTER ( a �, °'` Fill WEST BARNSTABLE MA 02668 I ' I EXISTING SEPTIC AND REPLACE AS , t4i x MODEL#Al 801-4x22 ° a " (' I EXISTING 1.000 GALLON � � TANK NECESSARY � �� �� � � � `' °� , � � (�� = � � °� � 2 Loam Sand 72.03 SEPTIC;°TANK TO BE UTILIZED 1 i s# 32 D A 10Yr 3/4 x \ \ AS PART OF THIS DESIGN � � -- - - --�- � � g" 71.53' FEMA FLOOD ZONE. C x \ _ �. � r Perk COMMUNITY PANEL# 2500010003D B Loamy Sand I \ EXISTING 1,000 GALLON CONCRETE SEPTIC TANK "" '= :��' 26" 10Yr 5/6 70.03' 17. DEED REFERENCE: BOOK 14403, PAGE 134 .: x " ' ,�.:�: � 32 69.53 j F0_1=iPC\ CH H \ K PROFILE '" ' ,h ' 18. PLAN REFERENCES: PLAN BOOK 121, PAGE 55 SEPTIC TANK :r r ,a x \ NOT TO SCALE ,� # C-1 Loamy 2 5Y 6/6 d 19. ALL DISTURBED AREAS SHAU-;BE RESTORED TO ORIGINAL CONDITION. I S , CONTRACTOR TO VERIFY E�clTll � ELEVATION PRIOR 1TOF TO ANY WORK& NOTIFY ENGINEER IF DIFFERENT. 58" 67.37' 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY FOR SEPTIC SYST M UPGf�rNDE.°,�ENGINEERING WILL NOT ASSUME ANY IIABUJTY 4. ;�� �,� FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. #2026 .`'� o o - ' ' - � � x o '' w c,w l ;' 21. THE FOLLOWING LOCAL VARIANCEy1S REQUESTED FROM THE TOWN OF BARNSTABLE'S N SWING TIES �, r.fi t '�r ,► ,� o Loamy Sand MAP 217 x EXISTING 1 o , MAP 217 C-2, 2.5Y 7/1 _ CHAPTER 397: WELLS REGULATIONS; SECTION 397-2: 1 4-BEDROOM \ N rn PARCEL 19-W00 DESCRIPTION 1. A 18.9'VARIANCE 150.0'- 131.1' FOR THE SETBACK FROM THE PROPOSED LEACHING w `� HC 1 HC 2 ( ) ( ) PARCEL 54 I DWELLING ATIO m ' FACILITY TO THE EXISTING WELL LOCATED AT MAP 217, PARCEL 54. BIODIFFUSER CORNER(1) 31.8' 23.4' LOCUS PLAN 22. IN ACCORDANCE WITH 310 CMR 15.401 -15.405,THE FOLLOWING LOCAL UPGRADE x BIODIFFUSER CORNER (2) 48.8' 35.4' SCALE: 1"= 1000' APPROVALS ARE REQUESTED FROM 310 CMR 15.221 (7): x 176" 57.53' (1.) A 3.0'WAIVER(3.0-6.0')FOR THE MAXIMUM COVER OVER THE LEACHING FACILITY. DECK I BIODIFFUSER CORNER (3) 74.0' 76.0' No Mottling, Standing or Weeping Observed (2.) A 2.5'WAIVER(3.0-5.5') FOR THE MAXIMUM COVER OVER THE DISTRIBUTION BOX. I \ BIODIFFUSER CORNER (4) 64.0' 71.3' EXIST.WELL TEST PIT DATA DESIGN DATA LEGEND I H h PERC NO. 12725 - / TOF=72.4,± ! Y I INSPECTOR: David W.Stanton, R.S. - 50 - - EXISTING CONTOUR x INV.=6 .8± p Ip EVALUATOR: Michael Pimentel E.I.T. 50 PROPOSED SPOT GRADE >c / „ 1 f y NUMBER OF BEDROOMS (DESIGN) 4 C.S.E.APPROVAL DATE: Oct. 1999 -' ' 0 PROPOSED CONTOUR / I r \ \ - JV �-' DESIGN FLOW 110 GAUDAY/BEDROOM DATE:Lu October 15, 2009 TOTAL DESIGN FLOW 440 GAL/DAY TEST PIT#: 2 ❑/H/W EXISTING OVERHEAD WIRES 2 2# 0 6 - x i / 16.0' o DESIGN FLOW X 200 % = 880 GAL/DAY ELEV TOP- 72.20 -X-X-X-X-X- EXISTING FENCELINE I a W EXISTING ELEV WATER= <57.53' GAS EXISTING GAS LINE x USE EXISTING 1,000 GALLON SEPTIC TANK 3 - - ._ X a / ----`" "+ " `�• PERC RATE --------- -W-W EXISTING WATER LINE x 7 DWELLING / SLEEVE PROP. 4" PVC SEWER LINE A MIN. OF INSTALL 60 - ARC 36HC (#3616BD) H-20 BIODIFFUSERS PTH OF PERC= TEST PIT LOCATION x I H 10 EACH SIDE OF WATER LINE CROSSING ;� I ^ ' __ - ��- TEXTURAL CLASS: 2 LP EXISTING LEACHING PIT i -SYSTEM CAPACITY r EXISTING 1,000 GALLON SEPTIC TANK X C-2 (TOTAL L.F.OF BIODIFFUSERS&COUPLINGS)(4.8 SF/LF)(0.33 GPD/SQ.FT.)= GPD 0" 72 20' i x PROPOSED 6-OUTLET H-20 DISTRIBUTION BOX HC-1 , (300.0)(4.8 SF/LF)(0.33 GAUSQ.FT.)= 475.2 GAL. LEACHING/DAY Fill PROPOSED 4"SOLID SCHEDULE 40 PVC PIPE X I£ A " Loamy Sand 72 03' PROPOSED H-20 DISTRIBUTION BOX 10Yr 3/4 o I 18'2 PROPOSED TOTAL 60 ARC 36HC H-20 (1 TOTALS: g" 71.53' /i � 16.5' PIODIFFUSERS IN FIELD CONFIGURATION B Loamy Sand PROPOSED ARC 36HC(#3616BD)BIODIFFUSER(H-20) \ / < y TOTAL NUMBER OF BIODIFFUSERS: 60 10Yr 5/6 x / TOTAL NUMBER OF COUPLINGS: 0 32" 69.53' i F SE j l- EXISTING LEACHING PIT TO BE PUMPED, TOTAL LEACHING AREA: 1,440 SQ.FT. REV. DATE BY APP'D. DESCRIPTION 1 0 0 OF " j Q I?I�D FILLED WITH CLEAN, COARSE SAND 2) TOTAL LEACHING CAPACITY: 475.2 GAL./DAY C-1 Loamy Sand 2.5Y6/6 PROPOSED SEPTIC SYSTEM UPGRADE X Lu p x �" £ 58" 67.37' PROP. 4"VENT; EXACT I ti Q I Tp �j y PROPOSED INSPECTION PORT WITH _ PREPARED FOR: LOCATION PER OWNER & o- 72.2'` s�`' £ ACCESS BOX TO GRADE (TYP OF G) CAPEWIDE ENTERPRISES \\ NOTE: t y / , x Tj -�, � UYWIRE I Loamy Sand 72.2' EFFECTIVE LEACHING AREA OF 4.80 SF/LF OBTAINED FROM THE C-2 2.5Y 7/1 LOCATED AT / 5 (4 DEPARTMENT OF ENVIRONMENTAL PROTECTION APPROVAL LETTER -x-Xt-x XX x X X X "MODIFIED CERTIFICATION FOR GENERAL USE" lssuED TO 2026 MAIN STREET N ADVANCED DRAINAGE SYSTEMS, INC. ON OCTOBER 3, 2003(LAST WEST BARNSTABLE, MA MODIFIED JUNE 30,2009). TRANSMITTAL NUMBER=W000052. X X-X f 1p000� '�-- / 3) 176" 57.53' SCALE: 1 INCH = 20 FT. DATE. IOVEMBER 11,2009 Benchmark 0 10 20 ao 80 FEET r No Mottling, Standing or Weeping Observed -� 1~ T ROUTE 6A) EElev.=75 U.P. SWING-TIES PLAN pA E MAIN EE � �,.tH oFM ' N a� �*� PREPARED BY: oF�EM M gTR OUT) JC ENGINEERING INC. Approx. SCALE: 1" = 20' o CHURCM� yG� ,GE �Y A rox. M.S.L. RESERVED FOR BOARD OF HEALTH USE �L Y E� GHWA STATE H ��,� 2854 CRANBERRY HIGHWAY 17 EAST WAREHAM, MA 02538 SITE PLAN- Drawn SCALE: 1"=20' Drawn By: MCP Designed By:MCP Checked By:JLC JOB No. 1702 i {