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HomeMy WebLinkAbout0101 MAPLE STREET - Health 0 I ' aple Street g, We,-,-., Barnstable A 132 029 ti F j Y - r. /302 oa:q Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments , -ter M 101 Maple Street Property Address Wells Fargo Bank Owner Owner's Name + information is West Barnstable Ma 02668 5-16-18 required for every e, page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information sf �3C) on the computer, use only the tab 1. Inspector: key to move your cursor-do not Brett Hickey use the return key. Name of Inspector B&B Excavation rab Company Name 374 Route 130 A If Company Address Sandwich Ma 02563 City/Town State Zip Code (508)477-0653 S113747 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails. ❑ Needs Further Evaluation by the Local Approving Authority 5-16-18 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only'describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal Systemm--Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 101 Maple Street Property Address Wells Fargo Bank - Owner Owner's Name information is required for every West Barnstable Ma 02668 5-16-18 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System was in working order at time of inspection. B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced.with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available.. ❑ Y ❑ N ❑ ND (Explain below): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 101 Maple Street Property Address Wells Fargo Bank _ Owner Owner's Name information is required for every West Barnstable Ma 02668 5-16-18 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to troken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 r 5/23/2018 Assessing As-Built Cards Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 101 Maple Street Property Address Wells Fargo Bank Owner Owner's Name information is West Barnstable Ma 02668 5-16-18 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure,criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ' ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 http://www.townofbarnstable.us/Assessing/HMdisplay.asp?mappar=217045&seq=1 2/2 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 101 Maple Street Property Address Wells Fargo Bank Owner Owner's Name information is required for every West Barnstable Ma 02668 5-16-18 page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system.owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered"yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the.Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 101 Maple Street Property Address Wells Fargo Bank Owner Owner's Name information is required for every West Barnstable Ma 02668 5-16-18 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ❑ ® Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 6 Number of bedrooms (Actual) 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 678/GPD t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 101 Maple Street Property Address Wells Fargo Bank Owner Owner's Name information is required for every West Barnstable Ma 02668 5-16-18 page. Citylrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection El Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d See below 9 ( Y 9 (gP ))� Detail: **WELL WATER** Sump pump? ❑ Yes ® No Last date of occupancy: Unknown Date Commercial/Industrial Flow Conditions: Type of Establishment: NA Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 c Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 101 Maple Street Property Address Wells Fargo Bank Owner Owner's Name information is required for every West Barnstable Ma 02668 5-16-18 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Bank owned-unknown Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ 'Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 101 Maple Street Property Address Wells Fargo Bank Owner Owner's Name information is required for every West Barnstable Ma 02668 5-16-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 2001 per COC Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade:pt be o g ade. feet ` Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: >100' from well to SASfeet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): Depth below grade: 2 - feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500gallons Sludge depth: 4 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 101 Maple Street Property Address Wells Fargo Bank Owner Owner's Name information is required for every West Barnstable Ma 02668 5-16-18 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 32 Scum thickness 0 11 Distance from top of scum to top of outlet tee or baffle NS Distance from bottom of scum to bottom of outlet tee or baffle NS How were dimensions determined? Measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank was in working order at time of inspection with liquid level equal to outlet invert. Tank is not in need of pumping at this time but should be pumped every two years for maintenance. Grease Trap (locate on site plan): Depth below grade: NA feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 101 Maple Street Property Address Wells Fargo Bank Owner Owner's Name information is required for every West Barnstable Ma 02668 5-16-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations,.inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): I I Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: NA Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of bast pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No i t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Y Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments � M 101 Maple Street Property Address Wells Fargo Bank Owner Owner's Name information is required for every West Barnstable Ma 02668 5-16-1,8 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 11 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box is in working order at time of inspection with liquid level equal to outlet invert. D-box did not show signs of back up. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): NA * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: l5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 101 Maple Street Property Address Wells Fargo Bank Owner Owner's Name information is required for every West Barnstable Ma 02668 5-16-18 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: (5) 500 gallon ❑ 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.): Leaching was in working order at time of inspection with no sign of hydraulic failure. Leaching was dry when viewed. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration NA Depth —top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 r Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments � M 101 Maple Street Property Address Wells Fargo Bank Owner Owner's Name information is required for every West Barnstable Ma 02668 5-16-18 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: NA Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ° M 101 Maple Street Property Address Wells Fargo Bank Owner Owner's Name information is required for every West Barnstable Ma 02668 5-16-18 page. CityFrown 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 B @ Al 22.5' B1= 17' A2-2 ' B2.25' 4 A3-45,5' 83=51' 4- 7' 84-45' 5.42' 85.58' 5 5=4 ' B5.55' 5 7.57' B7.51' A8.55' B8-575 7 8 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 101 Maple Street Property Address Wells Fargo Bank Owner Owner's Name information is required for every West Barnstable Ma 02668 5-16-18 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: No GW.@ 13'5" feet .Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: Jan- 11-2001 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: Plan on file with BOH. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 101 Maple Street Property Address Wells Fargo Bank Owner Owner's Name information is required for every West Barnstable Ma 02668 5-16-18 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file I t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 No. ��" t Fee BOARD OF HEALTH TOWN OF BARNSTABLE Zlpprtcattou jfor 19ell Cougtructiou permit Application is hereby made for a permit to Construct(t�Alter( ), or Repair( ) an individual well at: o N A L E 5-s1z r cr k,e a-,I /12-1 Location-Address Assessors Map and Parcyd Owner I Address i`tvan�l 1-�an�ttl��TisI� /A4_LC�.,�� �ll c,. -�6,t e z 34.ews �., w yZ�31 Installer-Driller Address Type of Building Dwelling lf'� �1� ko Other-Type of Building No. of Persons Type of Well l s(�//A�I�Xr� / Capacity Purpose of Well Agreement: The undersigned agrees to install the afore described 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 of Compliance has been issued by the Board of Health. Signed Date Application Approved By �` r D e Application Disapproved for the following reasons: �/' f (� Date Permit No. / [) / Issued ® Date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Compliance THIS IS TO CERTIFY,that the individual well Constructed(,Altered( ), or Repaired( ) by �,i 1�e. L/l1 c i( �� 1 1.n G 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. Dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Date Inspector No. � (�"" # Fee BOARD OF HEALTH TOWN OF BARNSTABLE ZIppricatiou jFor Yell Cou5tructiou Permit Application is hereby made for a permit to Construct(Alter( ), or Repair( ) an individual well at: 11�/ M R a► E !jT L-z r 2 � 1 j /19 7_ Location-Address Assessors Map and Parc Owner c� / Address 'S`c y>•2�� 1T'R rl e r_��_'�� r� ��1 � (1�� �A f o �( �.(1 �cl�C �Z� -�v tw S� �.v 1�-1`A yZ G�' Installer-Driller Address Type of Building Dwelling Other-Type of Building No. of Persons Type of Well �/}�"� ,/ Capacity Q Purpose of Well Agreement: The undersigned agrees to install the afore described 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 of Compliance has been issued by the Board of Health. Signed Date Application Approved By / Da Application Disapproved for the following reasons: Date Permit No. D 3o f �)0 Issued � Do Date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Compliance THIS IS TO CERTIFY,that the individual well Constructed(-,)ZAltered( ), or Repaired( ) by r 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. Dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Date Inspector BOARD OF HEALTH TOWN OF BARNSTABLE Veil Construction Permit No. d -- Fee L �- Permission is hereby granted to ALL C �\i)F 1 A.-) r t. _ Installer v w to Construct( ), Alter( ), or Repair( an individual well at: No. —,T Street as as shown on the application for a Well Construction Permit No. � (/S 4 Dated Date Approved By TOWN OF BARNSTABLE LOCATION MA RL E 5-r SEWAGE # 000/— � VILLAGE ASSESSOR'S MAP & LOT/32 INSTALLER'S NAME&PHONE NO. 6011—,c1,AX4 l'-7rjy 10 r 2 SEPTIC TANK CAPACITY LEACHING FACILITY: (typel�'1— /6® C,4L. 4-6 C. (size)4!Mi � ,� /�2/ NO.OF BEDROOMS BUILDER OR OWNER J—AUkA J— '%/C/� PERMITDATE: ( � z'S�� 1 COMPLIANCE DATE: r� ? ►� 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 y 13-1 �671 A- 62- y - 5 4 s ��_S �� � �,. 7 13-�- 5-1 © A` -in- 13-WT 6-% �� No. v"�' r-0 L1/ f +�- Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zipprication for Oigponl *pgtem Conearuction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. pZ / Owner's Name,Address and Tel.No Assessor's Map/Parcel 1 r1 O Z� Ya`N� tt /6�/� J L (.tt�r Installer's ame, ddress,and Tel.No. 6744 ui +.c o+ e Designer's Name,Address and Tel.No. 7 7/ — 7 /o J/o-rt� j.usv �50 � 00 5 oa6� Type of Buflding: Dwelling No.of Bedrooms Lot Size 5�� 7 F/sq.ft. Garbage Grinder(dv) Other Type of Building W.A . No.of Persons Showers( ) Cafeteria(s19) Other Fixtures Design Flow :3 3 D gallons per day. Calculated daily flow a( ® gallons. Plan Date /a //SK1 DO Number of sheets Revision Date /f2e Title Size of Septic Tank / 5106 Type of S.A.S. — Description of Soff r Nature of Repairs or Alterati ns(Answer when applicable) P--�v rne,,..Btr __ , ��etrnt►nt� ENGINEER Wd4T n...eT.,. INSTALLATION AND CERTIFY IN WRITING Date last inspected: THE SYSTEM WAS INSTALLED IN STR CT Agreement: ACCORDANCE TO PLAN. The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issue 7 Boazd Health. Signed �,�s Date /7 6 Application Approved by Date / v Application Disapproved for the following reasons Permit No. "d Date Issued 1 ZI' O �"_ d C No. Fee J THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes ` PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zipprication for �Mi5po5ar *p!tem Con6truction Vermtt Application for a Permit to Construct( )Repair'( )Upgrade( )Abandon( ) ❑Complete System O Individual Components Location Address or Lot No. t, 6�?, C( Owner alne,Address and Tel.No. Assessor's Map/Parcel / Install 's Name ddress,and Tel.No. w -"C C-O-z� Designer's Name Address and Tel.No. Type of Building: Dwelling No.of Bedrooms ' Lot Size �i 7 g` sq.ft. Garbage Grinder(✓®) Other Type of Building — No. of Persons Showers( ) Cafeteria(✓a) Other Fixtures Design Flow 3 3 L gallons per day. Calculated daily flo , a,6 0 gallons. Plan Date f,I Number of sheets 'evision Date Title Size of Septic Tank © Type of S.A.S. Z5 F©d Description of Soil Nature of Repairs r Alterations(Answer when applicable) � Y-e Date last inspec ed: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board-off Health. Signed .v`�: � -r�.-G .�7 Date D /7 O1. Application Approved by Date zs a Application Disapproved for the following reasons Permit No. zivvDate Issued Zf O/ f --------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate,of,Compliance THIS IS TO CERZIFY at the On-sit /Sewag(.Disposal SystemYCoflstt icted•( )Repaired( )Upgraded Abandone ( )by .. at /0 f` f t4l e- l6--H 3 !�b�` has been cons!1t7Me, rdance with the provisions of Title 5 and the for Disposal System Construction Permit No.z0/'6 dated � Installer Designer The issuance of this rtmmy sh 11 not be construed as a guarantee that the sys e ill fu t' designe Date 7 Y G� Inspector Zt---- /---------------------------- - No. Fee 3 Z —O Z �/' THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS - �Digpo!gaY *pttem Congtru n permit Permission is hereby granted to Co struct , ) ep 'r( )U ade( A.andon ) System located at /0 �' G ��' and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Constructio muust a completed within three years of the date of this t. / Z1 0 � � Date: Approved by v TOWN OF BARNS'TABLE 7V LOCATION lf7 lAPLF S7- SEWAGE# VILLAGE ' ' �= 'D'A ASSESSOR'S MAP &nLOT 'INSTALLER'S NAME:&PHONE NO. �//•)•��� )�(I�6(z I ��S S��O SEPTIC TANK CAPACITY LEACHING FACII.rry: (tyPe 'S O C�4�- �-`C• (size) NO.:OF`BEDROOMS [ j BuiLDER OR.OWNER L �� PERMITDATE. 1 �.L.S v I COMPLIANCE DATE: � . n.the: Separation Distance Betw ee Ivlaximum.Ad uSted Groundwater Table to the Bottom of J..eaching Facility F eet wells exist Private Water Supply Well Leaching Facility (If any Feet on site or within 200 feet of leaching facili,ty.) i Edge:of Wetland and Leaching•Fac�Lry,(If any.wetlands e:ust Feet. . . i within 300 feet of leaching facility) Furnished by .. '�.n: :.... yam. .. -. f i Z �3 YEA 13 3- 6 � l� 4 - �3- f TOWN OF BARNSTABL.E 1HE l OF O,y, OFFICE OF i HARISTAEL i BOARD OF .HEALTH 7 MA81L p� 00 1639• �� 367 MAIN STREET o MAY HYANNIS,MASS.02601 January 10, 2001 Mr. Paul Merithew and Mr.-Bruce Murphy ' Yankee Survey 40 B Industry Road Marstons Mills, MA 02648 Re: 101 Maple Street, West Barnstable Dear Mr. Merithew and Mr. Murphy: You are granted variances on behalf of your clients, William and Laura Lynch, to replace a septic system at the property located at 101 Maple Street, West Barnstable, Massachusetts. The following variances are granted: B.O.H. Private Well Protection Regulation: To install a soil absorption system only 106 feet away from an existing private well located at a neighbor's property (86 Maple Street) in lieu of the minimum setback requirement of 150 feet. B.O.H. Private Well Protection Regulation: To install a soil absorption system only 115 feet away from an existing onsite private well in lieu of the minimum setback requirement of 150 feet. These variances are granted with the following conditions: 1. T he engineered plan shall be revised to include replacement of the septic tank- with ' a 0 gallon capacity septic tank. 150 g p y p 2. The designing sanitarian shall supervise the construction of the onsite sewage disposal system and shall certify in writing to the Board of Health that the system was installed in strict accordance with the revised plans. f li These variances are granted because the existing septic system had"failed" and the proposed replacement system meets the maximum feasible compliance standards contained with the Title V, the State Environmental Code. Sincerely, Susan G. Rask, R.S. Chairman Board of Health Town of Barnstable SGR/lw 101 Maple St. �c�e -}P1M�.St"71�t-e � J GF THE tp DATE: FEE >snatvsrnate. MASS. i639. `0� REC. BY- Town of Barnstable 'SCHED. DATE: Board of Health 367 Main Street, Hyannis MA 02601 Office: 508-8624644 �!- � Susan G.Rask,R.S. FAX: 508-790-6304 ® Sumner Kaufman,M.S.P.H. Ralph A.Murphy,M.D. VARIANCE REQUEST FORM LOCATION :� Property Address: 7 l� f�'1 �1 �'d.0 % d !(��i� (. , Assessor's Map and Parcel Number: 3� x 1 Size of Lot: ur Wetlands Within 300 Ft. Yes L/ Business Name: No Subdivision Name: APPLICANT'S NAME: w���1.4v"�'tr�-a""R'A /t!��I Ig-4 Phone 34c;I -x- Did the owner of the property authorize you to represent him or her? Yes No PROPERTY OWNER'S NAME CONTACT PERSON Name: (/y1 It PtVA*I�av�.a.; �,c� Name:, Xk#LkCC S�%✓e f� Address: a Itr` A; � gr�� W',yrlr 8 J-Address: �b `�' ���'�+ ✓k`yM(S Phone: 3 a — etc, Z Phone: V11-6`1339-S — VA=RhANCEYFR—OM--REGU.IATI.ON-ttiSc�Rog-) REASON FOR VARIANCE(May attach if more space needed) to CL,.v o f ��EIV's 7116, SznY ac Sys iw`' Checklist(to be completed by office staff-person receiving variance request application) t/ r---'-""'"Four(4)copies of engineered plan submitted(e.g. septic system plans) t" �"Fo_ur(4)copies of floor-pla�ubmitted(e.g. house plans or restaurant kitchen plans) f::=-:�::DSigned-'letter-stat.ing that the property owner authorized you to represent him/her for this request C "^4'Pplicant understands that the abu.ctecs must;be:notified-_by-ce_rtified mail at least ten days prior to meeting date at applicant's expense(for Title V and/or local sewage regulation variances only) Full menu submitted(for grease trap variance requests only) is Variance request appIicationyfee:col ected(no fee for lifeguard modification renewals.grease trap variance renewals[same owner/ieasee only).outside dining variance renewals[same ovmertleasee only).and variances to repair failed sewage disposal systems)only if no"pension to the building proposed)) Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Susan G. Rask, R.S., Chairman NOT APPROVED Sumner Kaufman, M.S.P.H. REASON FOR DISAPPROVAL Ralph A. Murphy, M.D. Q:/WP/VARIREQ U.S.Postal Siiiivice CERTIFIED MAIL RECEIPT (Domestic Only; Article Sent To: rti Postage $ :. n— - Certified Fee Postmark i Return Receipt Fee 43 (Endorsement Required) O p Restricted Delivery Fee O (Endorsement Required) 01 Total Postage d Fees �� C. — r; ) ); NName Please Print Clearly)(To be mpleted by mall_e_rt l j m . J..L --AQv 1---� ---------- ea.r.I- Street,Apt No.;or PO Box No. - ----- Er °— �. {s�e----------------------__ O city,S te,LP 4 1 c le PS Form :,, r i i 5,wo v b� okF� r I t G brak-h 4 -- �Gi.szlrw� - - `c� SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C' '1 SYSTEM INFORMATION(continued) ' )w.dvess: •� r •� Owner: 101 Maple Street, West Barnstable,MA y' Dale of Inspection: William Lynch June 27,2000 r SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks # locate all wells within 100'fLocate where public water supply comes into house) ) f- , a ` j,F y3 1S `mar x �N C X F • fy5 } Z s N ` w 10, revised 9/2/98 �e� or►� ; TROY WILLIAMS SEPTIC INSPECTIONS Certified *MA Department of Environmental Protection (508) 385-1300 19 Hummel Drive South Dennis, MA 02660 d, June 28, 2000 Mr. William Lynch 101 Maple Street West Barnstable, MA 02668 Ref: 101 Maple Street, W. Barnstable, MA Dear Mr. Lynch, The original copy of the completed Subsurface Sewage Disposal System Inspection Form and certificate for the above noted address is enclosed. Should you have any additional questions concerning the system or the report, please feel free to call me. Many thanks for doing business with Troy Williams Septic Inspections. Sincerely, Troy M. Williams TROY WILLIAMS SEPTIC INSPECTIONS Certified by MA Department of Environmental Protection (508) 385- 3300 I 19 Hummel Drive South Dennis,MA 02660 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON 1v1A 02108 (617)292-5500 TRUDY CORE Secretary ARGEO PAUL CELLUCCI Governor DAVID B. STRUHS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissioner PART A CERTIFICATION Property Address: Mw�/� ftrcc W . 3rtrr� S fG•�o/[, Name of Owner Address of Owner /0/ Date of Inspection: t: 11 7 /00 - r�— (.�. ,3o.rasja6l�� Mp. o.1068 Name of ;(Please Prirrtl T►ev NRlliwmw I am a DEP approved system inspector pursuant to Sectiat 15.340 of Title 5(310 CMR 15.000) Company Name: Trey VNlllarna Saptle Inaptellons Maing Address: 19 Hummel'Drlve So Dennis life 02860 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 Fells 'k Sew-S..I...J Inspector's Sgna>s,r' e:� �z, G� � Dole: o O 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 the system owner and copies sent to the buyer,it 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. ,glcY sa• C.uw�.��.�5 vw�.� SrS�s,..., b2 2 4, �1n..1 v��7 .♦ Pt.) ) q� Q,.J�+.- .Sr1I t., . ) 60,,<✓ �:..�� A,/ � i't 4Lb 6_ fLi �.l i ti yj, h<✓ � tS.Srti q1' 7^ .L) �7"f tL. it �„� 'flLv..� ti f i ►.)�•c�lu., 4ti.� � � v�o � 4 f,✓.�ro.a�+► O-� ��+r� ✓s � �,� .,k f , SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 101 Maple Street, West Barnstable,MA Owner: William Lynch Date of Inspection: June 27,2000 INSPECTION SUMMARY: Check A, B, C, or A A. SYSTEM PASSES: A11A I have not found an information which indicates s 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: NIA 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 copy 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 9/2/98 race a 11 l f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A M CERTIFICATION(continued) rn 101 Maple Street, West Bastable, A Property Address: William Lynch Ownw: June 27 2000 Date of 4upection: ' C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: A114 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. 11 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 I 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 revise? 9/2/98 SUBSURFACE SEWAGE DISPOSAL SYSTE V INSPECTION FORM PART A CERTIFICATION(continued) 101 Maple Street, West Barnstable,MA William Lynch Property Address: June 27, 2000 Owner: Date of Inspection: D. SYSTEM FAILS: You must indicate either 'Yes' or 'No' to each of the following: _4,0 1 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 Sys},,- is I _ 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. .�L _ �'rl a• R I Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. 57.�- , N I e,+ _ Liquid depth in eeeepeel is less than 6' below invert or available volume is less than 1/2 day flow. ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. Any portion of the 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 then 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: A//n 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 11 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. revised 9/2/98 P.te4ofII SUBSURFACE SEWAGE DISPOSAL SYS71EM INSPECTION FORM PART B CHECKLIST 101 Maple Street, West Barnstable,MA Property address:Own William Lynch Date at z t Inspection: 27,2000 Date o Check if the following have been done: You must indicate either 'Yes' or 'No' as to each of the following: Yes No Pumping information was provided by the owner,occupant,or Board of Health. Y ' _ None of the system components have been pumped-for at least two weeks and-the system has been-receiving rormel flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this Inspection. As built plans have been obtained and examined. Note if they are not available with N/A. Jy�F�n Y _ The facility or dwelling was inspected for signs of sewage back-up. _y_// _ The system does not receive non-sanitary or industrial waste flow. �L _ The site was inspected for signs of breakout. _ All system components, excluding the Soil Absorption System, have been located on the site. �C _ 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: v _ 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)I The facility owner(and occupants,if different from owner) were provided with Information on the proper maintananae.of SubSurface Disposal Systems. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 101 Maple Street, West Barnstable,MA D"rw: William Lynch Date of Inspection: June 27, 2000 FLOW CONDITIONS RESIDENTIAL: Design flow: //O g.p.d./bedroom. Number of bedrooms(design): Number of bedrooms(actual): Total DESIGN flow yyo Number of current residents:--J— Garbage grinder(yes or nol:_&o Laundry(separate system) (yes or no):NO ; If yes. separate inspection required Laundry system inspected (yes or no) Seasonal use(yes or no): No Water meter readings.if available(last two year's usage(gpd): jO.;,j 4 t t J. I I � L k q„ Sump Pump(yes or no): N� Last date of occupancy: 0L�•��..c�/. COMMERCIALANDUSTRIAL: Type of establishment: Design flow: aad ( 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: A/.�=ram s,. « $7 ; ., �£' �..'- System pumped as part of Inspection: (yes or no)l✓� If yes. volume pumped: gallons Reason for pumping: TYPE OF SYSTEM SyS�<..� a.� �.�► S �L.1 �c� a ti ��•�. 1 v7 . V_ Septic tank/distribution box/soil absorption system ( .2 � Single cesspool C 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 s-6 . Syt J. tl .2 .. v w t Sews"odors detected when arriving at the site:(yes or no) A/o SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continied) PrOp°f�Y A Qx= 101 Maple Street, West Barnstable,MA Date ���: William Lynch June 27 2000 BUILDING SEWER: (Locate on site plan) Depth below grade: 49 t/-/- Material of construction: cast iron Z40 PVC /other(explain) Distance from private w ter supply well or suction fine A//11 Diameter y,�, Comments: (condition of joints, venting, evidence of J)leakage.etc.) C /C.4/ 0-4- %5t 1 I."4L SEPTIC TANK:• (locate on site plan) Depth below grade: Ag Material of construction:2oncrete_metal_Fiberglass _Polyethylene_other(explain) If tank is metal,list age_ Wage confirmed by Certificate of Compliance_(Yes/No) Dimensions: $ '.r 5 'k /oo Sludge depth: S:, Distance from top of sludge to bottom of outlet tee or baffle:2/C Scum thickness: y" Distance from top of scum to top of outlet tee or baffle: 6 // Distance from bottom of scum to bottom of outlet tee or baffle: A, How dimensions were determined: Comments: (recommendation for pumpiinn ,condition of role and outlet toes or baffles,depth of liquid level In relation to outlet invert, structural integrity, evidence of leakage.a c.>"1`c S -0-. '-'o .d- • ►rd«. ✓o a .�,Lie GREASE TRAP ,q (locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_Fiberglass _Polyethylene_other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet too 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 9/2/98 Page7of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Prop"Address: 101 Maple Street,West Barnstable,MA Ownw: William Lynch o,ce 'Pec"on` June 27,2000 TIGHT OR HOLDING TANK: M11 (Tank must be pumped prior to, or at time of, inspection) (locate on site plan) Depth below grade:_ Material of con struction: concrete metal_ _ _Fiberglass_Polyethylene_other(ezplain) 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: ( S y yl-e"$ ' (locate on site plan) Depth of liquid level above outlet invert: a bo•r. Comments: (note.if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) c-A "J t�l.v.n tit . .. I 4 .�(, lam, 'f• tf-.!o r ,..ia t t...a+- t}ip J ) A wt ')� } �7•na..a- W [�.✓ '� �t✓a r...•..✓w .Z p.60✓ ♦ i.s..1- ti O.} W f.�•;V .�.i.�! ✓G J .� i74 �y A J c.o- 1 h 4-, '.. _ef b Jac PUMP CHAMBER:-&'Z�l (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.) i I revised 9/2/98 P.e eeu/ll I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 101 Maple Street, West Barnstable,MA Date of Inspection: William Lynch June 27,2000 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: 1 leaching pits,number: 6 XG 'LGG,L% /d.+ .7S-7%h.� leaching 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 h draulic failure, level of ondin dam L P g. p soil, ondition of vegetation, at ) CESSPOOLS: n/ , (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:&11-9 (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) it . rove cor7 0 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(eorrtirarsd) Property Address: 101 Maple Street, West Barnstable,MA Dom"` William Lynch Date of Inspection: June 27,2000 BUILDING SEWER: All,, (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 Diameter Comments:(condition of joints, venting, evidence of leakage,etc.) _ SEPTIC TANK / (locate on site plan) a S� Q Depth below grade: I Material of construction:Zconcreta_metal_Fiberglass _Polyethylene_otherlexplain) If tank Is metal,list age_ Is age confirmed by Certificate of Compliance_(Yes/No) Dimensions: ,rrX9 XG Sludge depth: S'•'� Distance from top of sludge to bottom of outlet tee or baffle: 7�' Scum thickness•/_ Distance from top of scum to top of outlet tee or baffle: 6 �� Distance from bottom of scum to bottom of outlet tee or baffle: / �'• How dimensions were determined: Prb� Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet Inver;, structuraFintogrity, evidence of leakage,etc.) !���s „/c.t �.. � ; u u,—�' wl /�/o c�,"� �� GREASE TRAP._,L//,q (locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_Fiberglass _Polyethylene_other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of lost 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 9/2/98 Page 7ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(coetimm4 Property Address: 101 Maple Street,West Barnstable,MA Own": Dare :Inspection: William Lynch June 27,2000 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: leaching 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 hydra lic failure, level of ponding, damp soil, condition of vegetation, etc.) u //a..f Jl - ... . i ti .� �—. tc t�L. P &Icll CESSPOOLS:L/l'q (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: &/,q (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments; (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) revised 9/2/98 Pop 9ofII ' r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(contimsed) Property address: 101 Maple Street, West Barnstable,MA Owner: William Lynch Date of Inspection: June 27,2000 NRCS Report name /l/1A Soil Type_ Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep SITE EXAM Slope t✓ Surface water ✓ Check Cellar Shallow wells Estimated Depth to Groundwater 18 t Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed Site iAbutting property,observation hole, basement sump etc.) V/ 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)46 y1 .A W y, ..► .L /t/a.�j O ti .cam , ti 7"� '�`��1.• + t.J` i revised 9/2/98 Pate 11 of 11 O�THE Tpf,. DATE: FEE: 65r i • BARNSPABM s3SS ��� REC. BY Town of Barnstable SCHED. DATE: Board of Health 367 Main Street, Hyannis MA 02601 Office: 508-8624644 Susan G.Rask,R.S. FAX: 508-790-6304 Sumner.Kaufman,M.S.P.H. Ralph A.Murphy,M.D. VARIANCE REQUEST FORM LOCATION Property Address: 1 0 a tp (2. - -,4y Qef' Assessor's Map and Parcel Number: 3o a Size of Lot: E It Wetlands Within 300 Ft. Yes Business Name: No Subdivision Name: APPLICANT'S NAME: (,( )t7( t 6 m - Lawn Lfnch Phone Did the owner of the property authorize you to represent him or her? Yes _� No PROPERTY OWNER'S NAME CONTACT PERSON Name: (A i I Gi to 4-LcwCQA- l//, I/ACh Name: (k-n SU�VPT Address: Address: 40 a nca QcA , P P(i I W. (3�✓ns 1e � Phone: (v Phone: g— VARIANCE FROM REGULATION(List Reg.) REASON FOR VARIANCE(May attach if more space needed) t!) r ezz( a S 1'Yl Chec list(to be completed by office staff- receiving variance request application) Four(4)copies of engineered plan submitted(e.g. septic system plans) c/ Four(4)copies of floor plan submitted(e.g. house plans or restaurant kitchen plans) _ Signed letter stating that the property owner authorized you to represent him/her for this request Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense(for Title V and/or local sewage regulation variances only) menu d-(for grease trap variance requests only) / Variance request application fee collected(no fee for lifeguard modification renewals.grove trap variance renewal,(same owner,leasm only(.outside dining variance renewals(fame owner/leasee only 1.and variances to repair failed sewage disposal systems(only d no expansion to the building proposedp Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Susan G. Rask, R.S.. Chairman NOT APPROVED Sumner Kaufman, M.S.P.H. REASON FOR DISAPPR AL Ralph A. Murphy, M.D. Q:/WP/VARIREQ Fps f ' E c�G e C-CLr,sa�'� `` I v _ f { 4A Lj br Town of Barnstable P# Department of Health,Safety,and Environmental Services �IHE, .Public Health Division Date O„ 367 Main Street,Hyannis MA 02601 BAnxsrAer.e, mass. Date Scheduled OG`U e.tnv�- tj- 1-1 A000 Time 101AVA Fee Pd. Soil Suitability Assessment for Sewage Disposal Performed By: 1 SCQC-2 �- ul-yot � J "> • Witnessed By: I JUn;J 0— {' '10&14 Nb LOCATII.ON & GENERAL INFORMATION Location Address ]U/ A e�� le �`�y,�� — Owner's Name Address Assessor's Map/Parcel: �3c�-lc Cc Engineer's Name �� ee�urveU NEW CONSTRUCTION REPAIR Telephone# �15F . I Land Use eX I sy 1�, 15-� Slopes(%) Surface Stones Distances from: Open Water Body 100 R Possible Wet Area R Drinking Water Well /0� R t� Drainage Way R Property Line 1 S� R Other R SKETCH:(Street name,dimensions of lot a ct locations of test holes&pert tests,locate wetlands in proximity to holes) ��o\6m f �. �GQ ��. ��� e r Parent material(geologic) C Vkf W e►"' Depth to Bedrock Depth to Groundwater: Standing Water in Hole: Weeping from Pit Face Estimated Seasonal High Groundwater P ,A- ................ TENATTONI. 'OIt SEASONAL IIIGT WATER TABLE _. Method Used: Depth Observed standing in obs.hole: in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment R. Index Well#_ ----- _.._. Readine Date: In ex Well level. _ _ _ Adj.factor._____ Adj.Groundwater Level I'ERCOf.ATIOIV TEST `Adte f2> 4�:Time Observation Hole# Time at 9" t Depth of Perc`^�P C p Time at 6" Start Pre-soak Time @ 0-18 Time(9"-6") End Pre-soak 15 OA4 vA 10. 1�t e e F��'��u'�• �}Fl C r 15 lam• "l Rate Min./Inch Z °� Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back j Copy: Applicant t: I DEEP OBSERVATION HOLE LOG Hole# 1 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulderes. Consistency,° 'r e l o--ka t l F n 10YA7- OD-evif To� I o T)EEP OB�ER ATION HOLE LOG Hole . Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munseii) Mottling (Structure,Stones,Boulderes. Consistency.° ravel E. OBSERVATION HOLE LOG Hole# < . Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency.%Gravel DEEP OBSERVATION HOLE LOG Hole Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistenc %Gravel r I 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? V S' If not,what is the depth of naturally occurring pervious material? Certification I certify that on N6V R cl` (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,expertis nd experience d cribed in 310 CMR 15.017. Signature Date CERTIFICATE OF ANALYSIS Page. 1 Barnstable County Health Laboratory Report Prepared For: Report Dated: 06/19/2000 Order Number: G0006190 Laura Lynch 101 Maple Street West Barnstable, MA 02668 Laboratory ID#: 0006190-01 Description: Water-Drinking Water Sample#: 06190 B169 160 Sampling Location: 101 Maple Street West Barnstable MA Collected: 06/07/2000 ollected b L L 132/029 Y� Lynch Received: 06/07/2000 Routine+Ammonia ITEM RESULT UNITS MDL MCL Method# Tested LAB: IC Lab Ammonia <0.1 mg/L 0.1 EPA 350.1 06/07/2000 Nitrates <0.1 mg/L 0.1 10 EPA 300.0 06/08/2000 LAB: Metals Copper <0.1 mg/L 0.1 1.3 SM 311113 06/09/2000 Iron <0.1 mg/L 0.1 0.3 SM 3111B 06/09/2000 Sodium 24 mg/L 1.0 20 SM 311113 06/09/2600 LAB: Microbiology Total Coliform Absent P/A 0 Absent P/A 06/07/2000 LAB: Physical Chemistry Conductance 151 umohs/cm 1 EPA 120.1 06/07/2000 pH 5.4 pH-units 0 EPA 150.1 06/07/2000 EPA 502.2- Volatile Organics by PIDIECLD ITEM RESULT UNITS MDL MCL Method# Tested LAB: CC LAB 1,1,1,2-Tetrachloroethane BRL ug/L 0.5 EPA 502.2 06/14/2000 1,1,1-Trichloroethane BRL ug/L 0.5 200 EPA 502.2 06/14/2000 1,1,2,2-Tetrachloroethane BRL ug/L 0.5 EPA 502.2 06/14/2000 1 J,2-Trichlo ro ethane BRL ug/L 0.5 5.0 EPA 502.2 06/14/2000 1,1-Dichloro ethane BRL ug/L 0.5 EPA 502.2 06/14/2000 1,1-Dichloroethene BRL ug/L 0.5 7.0 EPA 502.2 06/14/2000 1,1-Dichloropropene BRL ug/L 0.5 EPA 502.2 06/14/2000 1,2,3-Trichlorobenzene BRL ug/L 0.5 EPA 502.2 06/14/2000 1,2,3-Trichloropropane BRL ug/L 0.5 EPA 502.2 06/14/2000 Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 i r 'Sy OF 6 "J CERTIFICATE OF ANALYSIS Page. 2 Barnstable County Health Laboratory Resort Prepared For: Report Dated: 06/19/2000 Order Number: G0006190 Laura Lynch 101 Maple Street West Barnstable, MA 02668 Laboratory ID#: 0006190-01 Description: Water-Drinking Water Sample#: 06190 B169 160 Sampling Location: 101 Maple Street West Barnstable MA Collected: 06/07/2000 ollected by: L Lynch 132/029 Received: 06/07/2000 1,2,4-Trichlorobenzene BRL ug/L 0.5 70 EPA 502.2 06/14/2000 1,2,4-Trimethylbenzene BRL ug/L 0.5 EPA 502.2 06/14/2000 1,2-Dibromo-3-chloropropan BRL ug/L 0.5 EPA 502.2 06/14/2000 1,2-Dibromoethane(EDB) BRL ug/L 0.5 EPA 502.2 06/14/2000 1,2-Dichlorobenzene BRL ug/L 0.5 600 EPA 502.2 06/14/2000 1,2-Dichloroethane BRL ug/L 0.5 5.0 EPA 502.2 06/14/2000 1,2-Dichloropropane BRL ug/L 0.5 EPA 502.2 06/14/2000 1,3,5-Trimethylbenzene BRL ug/L 0.5 EPA 502.2 06/14/2000 1,3-Dichlorobenzene BRL ug/L 0.5 EPA 502.2 06/14/2000 1,3-Dichloropropane BRL ug/L 0.5 EPA 502.2 06/14/2000 1,4-Dichlorobenzene BRL ug/L 0.5 5.0 EPA 502.2 06/14/2000 2,2-Dichloropropane BRL ug/L 0.5 EPA 502.2 06/14/2000 2-Chlorotoluene BRL ug/L 0.5 EPA 502.2 06/14/2000 4-Chlorotoluene BRL ug/L 0.5 EPA 502.2 06/14/2000 Benzene BRL ug/L 0.5 5.0 EPA 502.2 06/14/2000 Bromobenzene BRL ug/L 0.5 EPA 502.2 06/14/2000 Bromochloromethane BRL ug/L 0.5 EPA 502.2 06/14/2000 Bromodichloromethane BRL ug/L 0.5 EPA 502.2 06/14/2000 Bromoform BRL ug/L 0.5 EPA 502.2 06/14/2000 Bromomethane BRL ug/L 0.5 EPA 502.2 06/14/2000 Carbon tetrachloride BRL ug/L 0.5 5.0 EPA 502.2 06/14/2000 Chlorobenzene BRL ug/L 0.5 100 EPA 502.2 06/14/2000 Chloroethane BRL ug/L 0.5 EPA 502.2 06/14/2000 Chloroform BRL ug/L 0.5 EPA 502.2 06/14/2000 Chloromethane BRL ug/L 0.5 EPA 502.2 06/14/2000 cis-1,2-Dichloroethene BRL ug/L 0.5 70 EPA 502.2 06/14/2000 cis-1,3-Dichloropropene BRL ug/L 0.5 EPA 502.2 06/14/2000 Superior Court House, PO.Box 427 Barnstable MA 02630 Ph: 508-37 -P 5 6605 r `f OF a tp,. CERTIFICATE OF ANALYSIS page. 3 `4 Barnstable County Health Laboratory Report Prepared For: Report Dated: 06/19/2000 Order Number: G0006190 Laura Lynch 101 Maple Street West Barnstable, MA 02668 I Laboratory ID#: 0006190-01 Description: Water-Drinking Water Sample#: 06190 B169 160 Sampling Location: 101 Maple Street West Barnstable MA Collected: 06/07/2000 ollected b L Lynch 132/029 Y� Y Received: 06/07/2000 �I Dibromochloromethane BRL ug/L 0.5 EPA 502.2 06/14/2000 Dibromomethane BRL ug/L 0.5 EPA 502.2 06/14/2000 Dichlorodifluoromethane BRL ug/L 0.5 EPA 502.2 06/14/2000 Ethylbenzene BRL ug/L 0.5 700 EPA 502.2 06/14/2000 Hexachlorobutadiene BRL ug/L 0.5 EPA 502.2 06/14/2000 Isopropylbenzene BRL ug/L, 0.5 EPA 502.2 06/14/2000 Methyl-tert-butyl ether BRL ug/L 2.0 EPA 502.2 06/14/2000 Methylene chloride BRL ug/L 0.5 5.0 EPA 502.2 06/14/2000 n-Butylbenzene BRL ug/L 0.5 EPA 502.2 06/14/2000 n-Propylbenzene BRL ug/L 0.5 EPA 502.2 06/14/2000 Naphthalene BRL ug/L 0.5 EPA 502.2 06/14/2000 p-Isopropyltoluene BRL ug/L 0.5 EPA 502.2 06/14/2000 sec-Butylbenzene BRL ug/L 0.5 EPA 502.2 06/14/2000 Styrene BRL ug/L 0.5 100 EPA 502.2 06/14/2000 tert-Butylbenzene BRL ug/L 0.5 EPA 502.2 06/14/2000 Tetrachloroethene BRL ug/L 0.5 5.0 EPA 502.2 06/14/2000 Toluene BRL ug/L 0.5 200 EPA 502.2 06/14/2000 Total xylenes BRL ug/L 0.5 10000 EPA 502.2 06/14/2000 trans-1,2-Dichloroethene BRL ug/L 0.5 100 EPA 502.2 06/14/2000 trans-1,3-Dichloropropene BRL ug/L 0.5 EPA 502.2 06/14/2000 Trichloroethene BRL ug/L 0.5 5.0 EPA 502.2 06/14/2000 Trichloroflu oro methane BRL ug/L 0.5 EPA 502.2 06/14/2000 Vinyl chloride BRL ug/L 0.5 2.0 EPA 502.2 06/14/2000 Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 Page: 4 CERTIFICATE OF ANALYSIS Barnstable County Health Laboratory Report Prepared For: Report Dated: 06/19/2000 Order Number: G0006190 Laura Lynch 101 Maple Street West Barnstable, MA 02668 Laboratory ID#: 0006190-01 Description: . Water-Drinking Water Sample#: 06190 B169 160 Sampling Location: 101 Maple Street West Barnstable MA Collected: 06/07/2000 ollected b L Lynch 132/029 Y� Y Received: 06/07/2000 Note: The water has high levels of sodium;persons on a low sodium diet should consult their doctor. Approved By: (Lab Director) 611112000 Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 -_ I `U( !{ Ike",=;�-' I fl 70 i3 �w ch j0,orn -Nty Wu4 nT , 011'e P),-*-e'I f CHARLIE : TAKE MAPLE STREET TO BOARD OF HEALTH FIRST THING TOMMORROW, tv J cQ V .J 5 S C`d r, ,prev-e, 0 cve cAl- � TIJA^ > G Z T;.Ol L,4 , -'s b-a, /p C �c ihsre��1 ion C6 � Sw � ( -s t JLAI w 5 o F i s 7 Fim. . y THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH Appliratinn for Dispuiial Works Tnnitrnrtion umit Application is hereby made fbr a Permit to Construct ( ) or Repair k an Individual Sewage Disposal System at: ........... .........W.. Lac do -A re or .... .. Addre R G .. Instalier Address �1 d Type of Building Size Lot. / C_f__..Sq. feet U Dwelling—No. of Bedrooms___..._____________________________Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures_.-.................................................................................................................................................... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. R; Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................ 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........................................ Test 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........................ -------------------------------------------------------•-....---....------------•------------•----......----------•--------••------------------...-----.-•--- ODescription of Soil........................................................................................................................................................................ x V ....-----•---•---•-•---•--•••-•••-•-•-•--•••---•-•-••-••-••••-•----••--------•--••--•----------•.............•-••••---------•-••--•--••--•--••-••••------•---------•......-•-•---••--•......---•-••_.... W ----•-----------•---------------•---•------••-...-•-----•••--------•-•-••---•--••---••--•--•--•------••-•-•-•-• --••-- ......................U Nature of Re >r r Alterations—Answer when a plicable.____.._ rL_ _____________C .�1�...�........ Agreement: 10--470,_ The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'TILE 5 of the State Sanitary Code— The undersigned further agrees not to plac/thhe stemoperation until a Certificate of Compliance has bee s by thhe bboo rd of health.Signed•• � -__--- Application Appr Y .. ---------IZ?/ -- AS _ Date Application Disapproved for the following reasons:..............................................................................................................._ -----•--------------•--------•--..•..........._..-•--------------•---•----------••---------•----.......----•---------••---•-•--••---•--••-••----...-•--•-••••-•-•-•-•-•••-•--••---•---•------.....•---•- Date Permit No.< 9- -.--.....lrl.<-..7.................... Issued....................................................... Date ' No..��:......./...j FEE....-'�................. + a THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ' ........... -........................OF....... Appliratiou for Disposal Works Tonstrurtiou rprutit Application is hereby made for a Permit to Construct ( ) or Repair k) an Individual Sewage Disposal System at: Z d Locatiop•Ad r s or Lot No. .............�..�1��....................•--------....... ..........................................- �.. .......... . ............................... .... ...--..... .... ...........................7`aaTr Installer� Address Q UType of Building Size Lo ._ ---------Sq. feet 1-1 Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) `-� Other—T e of Building No. of persons____________________________ Showers — Cafeteria Otherfixtures •••-•------•----•••-----•-••-•-----•--••--••-••-----•-------------------------•--•••---•--••-------------------------•--...---------•--....--_------ W Design Flow_.........................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—NTo_ ____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. 3 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. 1________________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.._.___________.___...._ Ix -------------------------------------------•----....._-•--------....._._..------•------------•------............................ - ---•-••---•--•--•----- 0 Description of Soil....................................................................................................................................................................... x W ••-•------•------------------------•-----------------------------------------=••=--==-=•- -A�5­ptoc­6.............. ....... - U Nature of Repairs or Alterations—Answer when i 1 V , �----L��!`L r® X f �o Agreement: � / The undersigned agrees to install the aforedescribed- Individual Sewage Disposal System in accordance with the provisions of T T i'L is j of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has",,65-2stiedbythe boarddff h 1 Signed .f'''` ----£,. ------•-•--- /��••......... .... _ ..._------- ate Application Approved By l.. =---/;�' - ----------------------•----••-----•-•---------•------ l� Dy4e Application Disapproved for the following reasons:............................................................................ - - ------------------------- --------- - ---- -•-----------/•--••-•----------•--•-----•-•---•------•---------------------------------••----__--------------------------------------------------•--- j/ Date i. Permit No.•-•--...:.:== ------------------- Issued------•---------•--•- ............. Date THE COMMONWEALTH OF MASSACHUSETTS BOARDi OF _HEALTH _ �I........................OF..................................................................................... ` . (9rdif irate of Toutpliattrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( } by................................;...--___•------ ------ -----------•-----•-----•--•- •-------...•--------.......----........-----•-•-•---•---•--------....._._..----._...------•---- Installer • -- -............................................ - -------•- has been installed in accordance with the provisions of TT T iE j of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......... ___________ dated....... 1_-___-_-1_j.______________ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT YHE SYSTEM WILL FUNCTION ATIS ACTORY. _w DATE... ... 6..................... .............•----�-2 ....... .--------------_. Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD .._._ 0� ........ ... O ... UF . ,N 1.1-_C-..-�- FEE........................ o._._ Disposal Works Troato#rt iott rrutit Permission is hereby granted- .<-----•I---• --• -`---f f--•--.----=---------•------------------------••--••---••-----•--.....---•---....-•----•--..........-- to Construct ( ) or Repair ( ) an Individual Sewage Disposal System atNo............ _______________ - ' tree 1 St / ' ..�-^. as shown on the application for Disposal Works Construction emit No_____________ 'L. ed .......... Board of Health DATE......................................................:'.__.E.._f._._s:._...---- FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS A.M. 132/ LOT 13-2 THOMAS & SANDI EVERY A.M. MAP. 132 r r '-- ` _ DEED REF27791122 LOCUS A.M. 132/ LOT 12 PLAN REF 270/90 oG I. TOWN CONSERVATION LAND ------- 1 �' 410/59 N. ZONING. "RF" 'Q9r FLOOD ZONE: »C" ,� � ' 4y porgy '•Q WATER PROTECTION AREA: 1 � � _ A.M. 132/ 26-1 WILLIAM H. & LA URA S. LYNCH LOT 29 0 �,� `, ' `� LOCUS MAP AREA=51, 781_:j- Sglft , Gj� \` \� \` ` NOTE-' E"ISTING 1000 GAL TANK MUST BE PUMPED AND 6'cs' �1.�� ��� �o� ��� REPLACE WITH 1500 CAL STANK.D 86 MAPLE / LE STREET ` j •\ `�\ \ ��� IRETON & PEARL BRA DSHA W , t ,,; ,o W LL. �Po sE\ \`� � TS'GNING ENGINEER MUST SUPES .__ (LOCATION'\ \ 6 ION D CERTIFY IN WM a ' \ ELE 100 (ASSf �E as wsr ® IN i 6� PER OWNER ` _ ` �' ` ` ` r TOP OF C.B. " CORD GE TO pLANs G A 115 EXISTING ` `� Rox AA� SEPTIC UPGRA DE 1 ; tp,, ,' PREPARED FOR 1 cam. ,,, oo IP 4. (fnd) LA URA S. LYNCH o 8'h LOCA TED�s o yy , ��r � o I�y�� �� / 101 MAPLE STREET 1 __ 3 3;, BARNST S54 ( . 20. f j E, MA. 70 00' / l L Z \ ;;;..3�;;; 2 i O \ N �, , o� �y. NOVEMPAik BER 17, 2000 "" REVISED. i I ¢ O o -, ,� �ERITMEVd DECEMBER 18, 2000 �w '� ct�';;, „"',;;"� rao. e REVISED.* JANUARY 11, 2001 Xrs 6 . Q REVISED.• JANUARY 18, 2001 ' \ 60. 01 5Uf1 ANKEE -SUR I/EY CONSUL TANTS P.0 BOX 265 ' % � `�� cfl J,% UNIT 5, 408 INDUSTRY ROAD � Pf/ MARSTONS MILLS, MA. 02648 / __ 1�¢ ——— �� 1/ ` ' I � (508)428—0055 — FAX(508)420—5553 y{T - 1 105 69°5 p 41 JOB�`52554 CB �`� ~ A.M. 132/ LOT 13-2 • •--- S3�o THOMAS & SANDI EVERY A.M. MAP. 132 LOCUS ST j1 Q DEED REF 27791122 0 PLAN REF- 270/90 f A.M. 132/ LOT 12 1�'3�O, 410/59 �9 TOWN CONSERVATION LAND —----— `qLL ZONING: "RF" FLOOD ZONE. C . Qy� p0c�9 s WATER PROTECTION AREA: "AP" �' �►1 R 1 A.M. 132/ 26-1 s WILLIAM H. & LA URA S . LYNCH a LOCUS MAP �V LOT 29 l�� r V� `� �� `� \ NOTE: EXSISTINC 1000 CAL TANK A.M 132 21-1 AREA=51, 781 f Sglft i'/ '1� rp Tp MUST BE PUMPED AND REMOVED 86 MAPLE STREET ©� p REPLACE WITH 1500 CAL TANK. IRETON & PEARL BRADSHA W CD bESIGNING ENGINEER MUST SUPERVISE 1 W LL. \PUMP \ �\6� �`\ `` �\ ELEV= 100' (AS S ION D INSTACERTILLED IN �41fF31TI,iC (LOCATION 14(OUSE�--_ \ `� TOP OF C.B. ACCORD GE TO ILAN.�D Ilu. STRICT c p C` PER OWNER G As > 115 E EM \CB e SEPTIC UPGRADE' Ox 97 / \ (fnd), PREPARED FOR �V 'cam App ,%�4N/' rP,�, 4. ti f d LA URA ,S' L YNCH 000 ° , LOCATED ° �\\4 ,'� ,00 S.1 :n:�. \� Cqs ° I �ti ,�; ,'� 101 MAPLE' STREET ti /b of ;� ° ° m�� BARNSTABLE. MA. g s_ i cy NO VEMBER 17, 2000 � 'E ' 30- � 2 , 10 1 ' REVISED: DECEMBER 18 2000 70. 00' / L\\L 18 I q�' r ' REVISED' JANUARY 11, 2001 ° $fi / ,' `� �� REVISED.- JANUARY 18, 2001 6 , , / C> ANKEE SURVEY CONSULTANTS S0- 01 P.O. BOX 265 UNIT 5, 40B INDUSTRY ROAD A T PH. 508428�NS ILLS A 0055F X508 420-5553 G. p, SCALE :1"=30' 61 l03 6 g°5 41 ____----- N JOB#52554 CB s . TYIP OF FOUNDATION (BY SEPTIC TANK) 20' MIN. 10' MIN. CONCRETE COVERS 4" SCHEDULE 40 P. VC MIN. PITCH 1/8 PER FT. 2"LA YER OF EL= 103 CONCRETE COVER 1/B"-1/2" VENT / . . ♦ / / / ♦ ♦ / / / / " MAX ELWASHED SHDSTONE / / / / ♦ / ♦747 ' 04 4" CAST IRON PIPE 12" (OR EQUAL MINIMUM � PI7L^H 1/4 ' PER FT. CLEAN SAND FLO W LINE s �� EL=97 5' EXISTING I N - 101 MIN 14" EG 0 0 0 0 0 0 Cl0 0 0 0° 0 k ADD GAS �6 SUM ° 0 ° O O O O O O O o 0 0 0 ' INVERT BAFFLE FINVER,2 = 10 .5 INVERT IN 0 o EL.= 95 EL.= 100. 75' EL. = 97.25' EL.= 97_5'_ o ' INVERT 4 4 DISTRIBUTION EL.= 97'__ 1500 __GALLONS BOX WITH T EXISTING SEPTIC TANK TO BE WATER TESTED 52.5' X 12.5' TRENCH FORMATIO IF MORE THAN ONE OUTLET tcj TO BE REMOVED AND PLACE ON 6" STONE 3/4•• TO 1-1/2" SOIL ABSORPTION REPLACED WITH 1500 GAL. TANK. WASHED S710NE PROFILE OF SYSTEM (SAS) SEWAGE DISPOSAL SYSTEM #1 BOTTOM OF TEST HOLE OR USGS PROBABLE WATER TABLE ELEV. =_89.5_ NOT TO SCALE MAXIMUM FEASIBLE COMPLIANCE NO OBSERVED WATER TABLE (11/17/00) ELEV. =_89.5_ SEPTIC SYSTEM REPAIR. RESERVE LEACHING NOW BEING INSTALLED VARIANCE FROM LOCAL HEALTH REGULATION LEACHING LESS THAN 150' FROM WELLS OBSERVATION HOLE I ELEV.=_ 103' GENERAL NO TES OWNERS WELL 115',' VARIANCE OF 35' PERCOLATION RATE _�_2_ MIN./ INCH ABUTTERS WELL 106; VARIANCE OF 44 DEPTH HORIZ TEXTURE COLOR MOTT. OTHER 1) ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. 0-12" A SANDY LOAM I0YR3-2 TITLE 5 AND THE TOWN OF _BARNSTABLE RULES AND 12"-5.5' B SILTY LOAM I0YR6-4 REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE. P ,�98 7 i 5.5'-13.5 Cl FINE SAND 10 YR7-3 2) ONE COVER ON SEPTIC TANK SHALL BE BROUGHT TO PERC. WITHIN 6" OF FINISHED GRADE, OTHERS WITHIN 12" TOP 6 3) ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF NO WATER WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN DATE OF SOIL, TEST 11/17/00 SOIL TEST DONE BY BRUCE G. MURPHY , R.S. 10 FT. OF DRIVES OR PARKING AREAS. H-20 LOADING SHALL BE WITNESSED BY: DONNA MIORANDI USED UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS. 7 BEDROOM HOUSE 4) ANY MASONARY UNITS USED TO BRING COVERS TO GRADE SHALL INSTALL FIVE (5) ACME HEALTH AGENT DESIGN CALCULATIONS. BE MORTERED IN PLACE. 500 GALLON LEACHING ' I� (SYSTEM �I) 5) NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH CHAMBERS WITH FOUR FEET NUMBER OF BEDROOMS . . . . . . . . 6 DEEDED OR ZONING REGULATIONS. OWNER/APPLICANT IS TO STONE SIDES AND ENDS GARBAGE DISPOSAL . . . . . . . . . NO OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. SPACED SIX INCHES APART. TOTAL ESTIMA TED FL W 6) UTILITIES SHOWN ARE APPROXIMATE ONLY, EXCA VA TION CONTRACTOR 52.5' X 12 5' ( 110__CAL%BR./DA Y x _s BR.) 660 GAL/DA Y „ IS TO CALL DIG- SAFE AT 1-800-322-4844 AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE. NEW SEPTIC TANK CAPACITY 1500 GAL E. 7) CONTRACTOR IS TO VERIFY GRADES AND ELEVATIONS AS WELL AS PUMP AND REMOVE LEA CHPIT SOIL CLASSIFICA TION . . . . . . . . 1 SITE CONDITIONS PRIOR TO COMMENCING WORK ON SITE. AND SEPTIC TANK AT RIGHT DESIGN. PERCOLATION RATE . . . . . < 2 MIN./IN. 8) PARCEL IS IN FLOOD ZONE___"C SIDE OF HO USE.(S YSTEM /K1) EFFLUENT LOADING RATE . . . . . . . 74 GAL/DA Y/S.F 9) LOT IS SHOWN ON ASSESSORS MAP _13_2 AS PARCEL _29 ___. LEACHING CAPACITY (AREA X RA TE) 678 GAL/DA Y RESERVE LEACHING CAPACITY . . . BEING INSTALLED (52.5 X 12.5 X . 74)+(52.5 + 52.5 +12.5+12.5 X . 74 X 2) s 2 of 2 JOB NUMBER_ A.M. 1321 LOT 13-2 q THOMAS & SANDI EVLRY rk A.M. MAP' 132 II o DEED REF• 27791122 --- FLAN REF. 270190 410159 A.M. 1321 LOT 12 l�3 fig, ,f9 9 TOWN CONSERVATION LAND i-------�--, ZONING: "RF" 'i T FLOOD ZONE. »� » 4 VO 1 Y CRUcE G. MURPHY No.749 , A.M. 1321 26-1 WILLIAM H. & LA URA S. LYNCH (VACANT LOT 29 ��. �� �� A.M. 132121-1 AREA=51, 781f sq/ft �o0 86 MAPLE STREET IRETON & PEARL BRADSHA W BARN ✓ EX pTICG � � �` ti° SEPTIC UPGRADE' / 2 .. SE \ CB ' 97' GAS , ,' \ _ (fnd),' PREPARED FOR J �;;;;.Q ppgQx /,' p tP� 2 h (fn' LA URA S. L YNCH A i ti i c� "✓, i o_ i,' ,' LOCA TED 101 MAPLE STREET _ ----- le BARNSTABLE, MA. TING a, — " le =' """" �� �� leNO VEMBER 17, 2000 S54 0135'E' / le SEP , i 3 ; ^s; 2 �' i O / o • "' 0 - - �� ` 10 '� YA NKEE SUR I/E Y CONSUL TAN TS �',c, „. ,,,,, / 6 i P. O. BOX 265 0- 1 UNIT 5, 40H INDUSTRY ROAD g%1�53� MARSTONS MILLS, MA. 02648 PH. (508)428—0055 — FA X(508)420—5553 ----- Ngg 5 SCALE :1"=30' JOB52554 CB 105'_ TOP OF FOUNDATION (BY SEPTIC TANK) 20' MAN. 10' MIN. CONCRETE COVERS 4" SCHEDULE 40 P. VC MIN. PI7VH 1/8 PER FT. 2"LA YER OF EL= 103 CONCRETE COVER VENT `/ WASHED STONE/ ♦ i ♦ ♦ / / / / / ♦ i i ♦ ♦ / / / ♦6" MAX / / ♦ i i i , EL=103 12"' i ♦ ♦ / / / / ♦ / i i ♦ ♦ / ♦ ♦ ♦ i i ♦ ♦ / 4" CAST IRON PIPE r 2 (OR EQUAL MINIMUM PITCH 1/4 ' PER FT. CLEAN SAND 3 RISERS FLO W LINE EL=97.5' F] EXISTING 11OMIN.' 14" T". EL.= 101 �2.0'� ° o 0 0 Cl 0 Cl Cl Cl )0" 0° � ADD GAS INVERT 6 SUM LEVEL ° o ° o 0 0 0 0 0 ° o o ' INVERT BAFFLE EL = IOO.S INVERT /NVERT o o EL.= 95 EL.= 100. 75' EL = 97.25' EL.= 97.5' 4 ° 4' INVERT DISTRIBUTION EL = 97'__ 1000 GALLONS BOX WITH T , EXISTING SEPTIC TANK TO BE WATER TESTED 34.5' X L2.5' TRENCH FORMA TIO ti IF MORE THAN ONE OUTLET SOIL ABSORPTION PLACE ON 6" STONE 3 4" T 9 1-1 h /2"" PROFILE OF A J S7n"E SYSTEM (SAS SEWAGE DISPOSAL SYSTEM BOTTOM OF TEST HOLE OR USGS PROBABLE WATER TABLE ELEV. =_89.5_ NOT TO SCALE MAXIMUM FEASIBLE COMPLIANCE NO OBSERVED WATER TABLE (11/17/00) ELEV. =_89.5_ SEPTIC SYSTEM REPAIR. RESERVE LEACHING NOW BEING INSTALLED VARIANCE FROM LOCAL HEALTH REGULATION LEACHING LESS THAN 150' FROM WELLS OBSERVATION HOLE 1 ELEV.=_ 103' GENERAL NO TES OWNERS WELL 119.5; VARIANCE OF 30.5' PERCOLATION RATE __!!;;j_2_ MIN/ INCH ABUTTERS WELL 110.5; VARIANCE OF 39.5' DEPTH HORIZ TEXTURE COLOR MOTT. OTHER 1) ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. 0-12" A SANDY LOAM 10YR3-2 TITLE 5 AND THE TOWN OF _BAZN�TA$LE____ RULES AND 12"-5.5' B SILTY LOAM I0YR6-4 REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE. 5.5'-13.5 Cl FINE SAND I0YR7-3 PERC. 2) ONE COVER ON SEPTIC TANK SHALL BE BROUGHT TO WITHIN 6- OF FINISHED GRADE, OTHERS WITHIN 12" p 98 7 No WATER TOP 6' 3) ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS. H-20 LOADING SHALL BE DATE OF SOIL TEST 11/I7/00 SOIL TEST DONE BY BRUCE G. MURPHY , R.S. USED UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS. WITN ES S F D BY: DONNA MIORANDI 4) ANY AfASONARY UNITS USED TO BRING CO VER.5' 7'0 GRADE SHALL HEALTH AGENT DESIGN CALCULA TIONS.' BE MORTERED IN PLACE. 5) NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH INSTALL THRF,'E' (3) ACME NUMBER OF BEDROOMS . . . . . . . . 4 DEEDED OR ZONING REGULATIONS. OWNER/APPLICANT IS TO 500 GALLON LEACHING GARBAGE DISPOSAL NO OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. CHAMBERS WITH FOUR FEET TOTAL ESTIMATED FLOW 6 UTILITIES SHOWN ARE APPROXIMATE ONLY, EXCAVATION CONTRACTOR STONE SIDES AND ENDS 440 GAL/DA Y SPACED SIX INCHES APART. ( 110 GAL/BR./DA Y x _4 BR.) IS TO CALL "DIG- SAFE" A T 1-800-322-4844 A T LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE. 34.5' X 12.5' EXISTING SEPTIC TANK CAPACITY 1000 GAL 7) CONTRACTOR IS TO VERIFY GRADES AND ELEVATIONS AS WELL AS SOIL CLASSIFICATION . . . . . . . . 1 SITE CONDITIONS PRIOR TO COMMENCING WORK ON SITE. PUMP AND RITMO VE LEA CHPIT DESIGN PERCOLATION RATE . . . . . < 2 MIN./IN. 8) PARCEL IS IN FLOOD ZONE___"C"_____. AT RIGHT SIDS' OF HO USE EFFLUENT LOADING RATE . . . . . . . 74 GAL/DA Y/S.F. 9) LOT IS SHOWN ON ASSESSORS MAP _132 AS PARCEL _29 . LEACHING CAPACITY (AREA X RATE) 458 GAL/DA Y RESERVE LEACHING CAPACITY . . 458 GAL/DA Y (34.5 X 12.5 X . 74)+(34.5 + 34,5 +12 5+12.5 X . 74 X 2) JOB NUMBER_ �. A.M. 132/ LOT 13-2 ,THOMAS & SANDI EVERY o DEED REF 2779/122 LOCUS .po PLAN REF 270/90 A.M. 132/ LOT 12 1��?��, A. 410/59 0-9 TOWN CONSERVATION LAND ----- ,qll as ZONING: "RF" FLOOD ZONE. C . � 4o�9 WATER PROTECTION AREA. "AP P' 1 A.M. 132/ 26-1 WILLIAM H & LA URA S. LYNCH LOCUS MAP 0 \ \ LOT 29 0� �� \\\ \\ \\\ •� , \ \ ` A.M. 132/21-1 AREA=51, 781.t sq/ft 86 MAPLE STREET ' 8 IRETON & PEARL BRADSHA W UD W�a'LL -o sE� \\\63 \`\ \`\ ��\ ELEV= 100' (ASSUMED) •� �\ (LOCATION \ -___ ` �\ \\ `\ o TOP OF C.B. C_ � \ PER OWNER �- / BAD ✓ AS' 115' r RrfSTING \` \\ , G SEPTIC UPGRADE (rnd), PREPARED FOR Ap ,''04;/' e.1 ,�;;;;. "► 4. (f d) LA URA S. L YNCH \ , "cr•� ,,,,,,,,,,,,,. i ° �/ / LOCA TED `, ' ' \\vr �O 8 1 •- V�. �`�s' ° 101 MAPLE STREET OL o ° �'��� EARNSTAELE, MA. 20. NO VEMBER 17 2000 S54'O1'3 �' '. , a i " 30--%"%%%�% �. '' REVISED. DECEMBER 18, 2000 .... ` .., w 7Q 00. E v, \\, ':n' �Oti ram 18 QQ� ��� 1�1 REVISED: JANUARY 11, 2001 "� ' YANKEE SURVEY CONSUL TAN TS w P.O. BOX 265 / Q j YSTE ...... �A /1 p3 1 UNIT 5, 408 INDUSTRY ROAD ' �' ; ')� MARSTONS MILLS, MA. 02648 �15 � "'�'%# ���. PH.(508)428-0055 — FAX(508)420-5553 ly p'�,- < SCALE-404 03 _ , _--- IV69 r JOBf52554 CB EL. = 105,_ 770P OF FOUNDATION (BY SEPTIC TANK) 20' MIN. 10' MIN. CONCRETE COVERS 4" SCHEDULE 40 P. VC MIN. PI7rH 1/8 PER FT. 2"LAYER OF EL= 103 CONCRETE COVER VENT; ♦ 7 .. . . WASHED S77ONE . 1 / � / , . . . / x or e . EL=103' 4" CAST IRON PIPE 12" ' !2" ' POI7CH114 PERMUM FT CLEAN SAND FLOW LINE a EL=97 5' EXISTING 110" "T" 14" EL.= 101 MIN INVERT `2.0�— ° 00 o 0 0 0 0 0 Cl °° ° ADD CAS �6 SUM LEVEL ° ° °�? 0 o a o 0 0 0 ° = 95' a INVERT BAFFLE' EL.= 100.5 — 9IN VER 25, INVERT ° ° o ° ° ° EL.= 100. 75 EL.—_= EL.= 97 5 4 4' INVERT DISTRIBUTION EL.= 97'__ _-1QQ2__GALLONS BOX WITH "T" EXISTING SEPTIC TANK TO BE WATER TESTED 52.5' X 12.5' TRENCH FORMATIO IF MORE THAN ONE OUTLET ABSORPTION PLACE ON 6" S719NE 3/4" 70 1-1/2" SOIL � PROFILE 0 F WASHED STONE SYSTEM (SAS) SEWAGE DISPOSAL SYSTEM #1 BOTTOM OF TEST HOLE OR USGS PROBABLE WATER TABLE ELEV. =_89.5_ NOT TO SCALE MAXIMUM FEASIBLE COMPLIANCE NO OBSERVED WATER TABLE (11/17/00) ELEV. =_89.5_ SEPTIC SYSTEM REPAIR. RESERVE LEACHING NOW BEING INSTALLED VARIANCE FROM LOCAL HEALTH REGULATION LEACHING LESS THAN 150' FROM WELLS OBSERVATION HOLE I ELEV=_ 103_ GENERAL NOTES OWNERS WELL 115'; VARIANCE OF 35' PERCOLATION RATE —SE— MIN/ INCH ABUTTERS WELL 106; VARIANCE OF 44' DEPTH HORIZ TEXTURE COLOR M07T. OTHER 1) ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. 0-12" A SANDY LOAM I0YR3-2 TITLE 5 AND THE TOWN OF _BARIMSLIBLE____ RULES AND 12"-5.5' B SILTY LOAM I0YR6-4 REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE. 5.5'-13.5 Cl FINE SAND 10 YR7-3 PERC. 2) ONE COVER ON SEPTIC TANK SHALL BE BROUGHT TO WITHIN 6" OF FINISHED GRADE, OTHERS WITHIN 12" TOP 6 3) ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF P #9877 NO WATER WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS. H-20 LOADING SHALL BE DATE OF SOIL TEST 11/17/00 SOIL TEST DONE BY BRUCE C. MURPHY , RS. USED UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS. WITNESSED BY: DONNA MIORANDI 7 BEDROOM HOUSE 4) ANY MASONARY UNITS USED TO BRING COVERS TO GRADE SHALL HEALTH AGENT DESIG CALCULA TIONS: BE MORTERED IN PLACE. SYSTEM W) 5) NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH INSTALL FIVE (5) ACME NUMBER OF BEDROOMS . 6 DEEDED OR ZONING REGULATIONS. OWNER/APPLICANT IS TO 500 CALLON LEACHING CHAMBERS WITH FOUR FEET GARBAGE DISPOSAL NO OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. STONE SIDES AND ENDS TOTAL ESTIMATED FLOW 6) UTILITIES SHOWN ARE APPROXIMATE ONLY, EXCA VA TION CONTRACTOR 1 660 GAL/DA Y SPACED SIX INCHES APART. ( _1_0_—_CAL/BR./DA Y x _6 _ BR) IS TO CALL DIG— SAFE AT 1-800-322-4844 AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE. 52.5' X 12.5' EXISTING SEPTIC TANK CAPACITY 1000 CAL 7) CONTRACTOR IS TO VERIFY GRADES AND ELEVATIONS AS WELL AS SOIL CLASSIFICATION . . . . . . . . 1 SITE CONDITIONS PRIOR TO COMMENCING WORK ON SITE. PUMP AND REMOVE I.EACHPIT DESIGN PERCOLATION RATE . . . . . < 2 MIN./IN. 8) PARCEL IS IN FLOOD ZONE___"C" . AT RICHT SIDE OF HOUSE EFFLUENT LOADING RATE . . . . . . • 74 GAL/DA Y/S.F. 9) LOT IS SHOWN ON ASSESSORS MAP _13_z AS PARCEL _29 _. (SYSTE'M /1) LEACHING CAPACITY (AREA X RATE) 678 CAL/DAY RESERVE LEACHING CAPACITY . . . BEING INSTALLED_ (52.5 X 12.5 X . 74)+(52.5 + 52.5 +L2.5+12.5 X . 74 X 2) JOB NUMBER__ 52554A