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HomeMy WebLinkAbout0147 MAPLE STREET - Health 147 MAPLE STREET,W. i . 132037 T WN OF BARNSTABLE LOCATION/ r' -T SEWAGE# :JyZ( — VILLAGE ale-St" �,c��Qj1/.S`riJ,�L.l ASSESSOR'S MAP&PARCEL 13 2- D 17 INSTALLER'S NAME&PHONE NO.IL t�vl S E,4 V-L< SEPTIC TANK CAPACITY I S O 0 JAL p LEACHING FACILITY:(type) ' �1 ��"a'�S (size) ,NO..OF BEDROOMS OWNER COW&AP e>ti i I PERMIT DATE: I S COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY E to 1 3 rd�2 b lug 3A >� �i' � d o 1ti � J No , Fee Qa THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: / PUBLIC HEALTH DIVISION - TOWN OF'BARNSTABLE, MASSACHUSETTS Yes 2pplitation for ]Disposal 6pstem Construction Permit Application for a Permit to Construct( ) Repair�) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.JJ 4 72 C- 677- Owner's Name,Address,and Tel.No. / Assessor's Map/Parcel —a 3 2 [..�j1ij/ oftl J' Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. 1�nn�S 642L-�` N2 k`F6/ s4X1,01&1446 l',✓14 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank /'000 T let MoVe22 Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Ans r when app'cable) CM041te Svo M2!, ' Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of th Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of ealt . Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. Date Issued q+: Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: - �,• a ;k �€ - += Yes PUBLIC HEALTH DIVISION - TOWN-OBARNSTABLE, MASSACHUSETTS wb ,zk 01pplication for Bisposal 6pstem Construction Permit Application for a Permit to Construct( ) Repair 0() Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. x1flez ' Al, 4 Owner's Name,Address,and Tel.No., �} Assessor's Map/Parcel PwI 7 c Installer's Name,Address,and Tel.No. `', ;f w'` Designer's Name,Address;and Tel.No. :�L'i'1 ri.t5 '��.•-�� ��L r��'r,� ��N�'�Lt«l�-•r;,i Type of Building:`' Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank la c) i ?tl eY 01.'Vtf n Type of S.A.S. Description of Soil _ Nature of Repairs orAlterations(Answer when,applicable) 4­1 �d AMC A'C h /' -OL.;:L 1 f_.rl l n?r Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of th_e.Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of! lealthn ? / Si$��` e ` ed Date /..;/,r'C� Application Approved by _ Date Application Disapproved by Date for the following reasons Permit No. e / '� / Date Issued /, f r)- I �. - - - - -°----------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(1--< Upgraded( ) Abandoned( )by 1 411 ?;;j /9[,Q _sn /A/ `at r has been constructed in accordance j F with the provisions of Title 5 and the for Disposal System Construction Permit No_jnf dated Installer —7,),exyk -s dQ rt /•4j, Designer #bedrooms Approved design flow gpd The issuance of this permit shall not be construed as a guarantee that the system will fun -a as designed. C Ai Iffy Date i Inspector -- ------ - -- --- - ----- ---------------------------------------- Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS MispoBal *pstrm.Construction Permit Permission is hereby granted to Construct( ) Repair Upgrade( ) Abandon( ) System located at G .�i!�C a 677 (,,(J !. 7 and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this ermit. Date Approved b _ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments G M 147 MAPS F;ST Property Address LALIBERTE Owner Owner's Name information is W BARNSTABLE MA required for 6/2/12 every 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. portam:When filling out A. General Information W forms on the I computer,use 1. Inspector: only the tab key to move your DOUGLAS A BROWN cursor-do not Name of Inspector use the return p key. DOUGLAS A BROWN INC Company Name tr t� P.O. BOX 145 Company Address I CENTERVILLE MA 02632 City/Town State Zip Code 508-420-4534 S 14297 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 6/2/12 Inspector's ggnature 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. r t5ins•09108 �% _ U Title 5 Official Inspection Form:Subsurface Sewage Disposal Sy •Page 1 of 17 q Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �< 147 MAPLE ST Properly Address LALIBERTE Owner Owner's Name requmation is W BARNSTABLE MA required for 6/2/12 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 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: TANK AND D-BOX WERE BOTH OPENED AND NO SIGNS OF FAILURE WERE FOUND AT TIME OF INSP, S.A.S WAS NOT OPENED BECAUSE NO OBSERVATION PORTS WERE FOUND, LEVEL OF PONDING WERE NOT ABLE TO BE DETERMINED. FUTURE PERFORMANCE UNDER THE SAME OR INCREASED USE CAN NOT BE PREDICTED 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): I t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments '< 147 MAPLE ST Property Address LALIBERTE Owner Owner's Name information is W BARNSTABLE required for MA 6/2/12 every page. Clty/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 147 MAPLE ST Property Address LALIBERTE Owner Owner's Name information is W BARNSTABLI required for MA 6/2/12 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 coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: i D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments "t 147 MAPLE ST Property Address LALIBERTE Owner Owner's Name information wired for is re W BARNSTABLE MA every page. Cdy/Town State Date of 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 custod y 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•09/08 Title 5 Official Insp ection Form:Subsurface Sewage Disposal System•Page 5 of 17 L I Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 147 MAPLE ST Property Address LALIBERTE Owner Owner's Name information is required for W BARNSTABLE MA 6/2/12 every page. Cl mown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any.of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential,Flow Conditions: Number of bedrooms (design): 4 PERMIT Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 t5ins-09to6 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for VoluntaryAssessments sments 147 MAPLE ST Properly Address LALIBERTE Owner Owner's Name information is W BARNSTABLE MA required for 6/2/12 every page. City mown State Zip Code Date of Inspection D. System Information Description: ACCORDING TO AS-BUILT CARD SYSTEM CONSISTS OF A SEPTIC TANK D-BOX AND INFILTRATORS FOR THE S.A.S Number of current residents: Does residence have a garbage grinder? ❑ Yes ❑ No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ❑ No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ❑ No Water meter readings, if available (last 2 years usage (gpd)): WELL Detail: Sump pump? ❑ Yes ❑ No Last date of occupancy: CURRENT Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments '( 147 MAPLE ST Property Address LALIBERTE Owner Owner's Name informationfiredr W BARNSTABLE MA required for every page. City/Town 6/2/12 YIP D. System Information (cont.) State p Code Date of Inspection Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 147 MAPLE ST Property Address LALIBERTE Owner Owner's Name information is W BARNSTABLE required for MA 6/2/12 every page. Cdyrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: S.A.S INSTALLED IN 1998 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 1 feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene El other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 GALLON OFF AS-BUILT Sludge depth: t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments � 147 MAPLE ST Property Address LALIBERTE Owner Owner's Name information is W BARNSTABLE required for MA 6/2112 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 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 How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): TANK LOOKS LIKE IT COULD USE PUMPING Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 I Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 't 147 MAPLE ST Property Address LALIBERTE Owner Owners Name information is W BARNSTABLE required for MA 6/2/12 every page. Crty/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•09/08 Tithe 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 I ' Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Se _wage Disposal System Form Not for Voluntary Assessments r( 147 MAPLE ST Property Address LALIBERTE Owner Owner's Name information is W BARNSTABLE required for MA 6/2/12 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): LOCATED AND OPENED BOX NO SIGNS OF LEAKAGE OR FAILURE 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.): Soil Absorption System(SAS) (locate on site plan, excavation not required): If SAS not located, explain why: NO OBSERVATION PORTS FOUND t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments r( 147 MAPLE ST Property Address LALIBERTE Owner Owner's Name information is required or W BARNSTABLE MA 6/2/12 f every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ -leaching pits number: ® leaching chambers number: INFILTRATORS ❑ 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.): NO OBSERVATION PORTS FOUND Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer scum Depth of p m layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•09108 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 147 MAPLE ST Property Address LALIBERTE Owner Owner's Name information is W BARNSTABLE required for MA 6/2/12 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 1 l Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 147 MAPLE ST Property Address LALIBERTE Owner Owner's Name information is W BARNSTABLE required for MA 6/2/12 every page. Clty/Town State Zip Code Date of Inspection D. System Information (cunt.) 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 t5ins-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 147 MAPLE ST Property Address LALIBERTE Owner Owner's Name information is W BARNSTABLE MA required for 6/2/12 every page. Cdyfrown State Zip Code Date of Inspection D. System Information (cunt.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: GREATER THAN 4 FT feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: OBTAINED FROM PERC SHEET Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•09/68 Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 147 MAPLE ST Properly Address LALIBERTE Owner Owner's Name information is W BARNSTABLE required for MA 6/2/12 .every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Assessing As-Built Cards Page 1 of 1 TOWN OF BARNSTABLE LOCATION �n��� S 7', SEWAGE#:Del S P. vILLAGE_6 5,.rn, ASSESSOR'S MAP&PARCEL INSTAM,111ta NAME&PHONE NO. �r,c.k �► (1 r� p Ofl s �ilrf r 117 SEPTIC TANK CAPACITY /Oft LEACHING FACILITY:(type)--:37, -rcA von (size) NO.OF BEDROOMS OWNER PERMIT DATE: COl DATE: _J�p1S 07 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 well %.ii;•. ,:¢:;:4:f:,•� ::,"tit?rvY�Kiir. .t ..Rt 23 5 124 tou�on 99 ttp://www.town.bamstable.ma.us/Assessing/HMdisplay.asp?mappar=132037&seq=1 6/6/2012 TOWN OF BARNSTABLE LOCATION iql My& SEWAGE#'47e)SP TILLAGE rn. ASSESSOR'S MAP&PARCEL R#-"1MtT1tS NAME&PHONE NO. 'I-C lc- SEPTIC TANK CAPACITY /f?OO �— LEACHING FACILITY:(typeT---ri X-11I Td'cAlot:S (size) NO.OF BEDROOMS OWNER 7?n0kw-f 6(,(- PERMIT DATE: COtRV9ttt*E DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet.of leaching facility) Feet FURNISHED BY Well r i 23 5 a 124 rop in foundation 99 H F COMMONWEALTH OF MASSACHUSETTS w EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS n r d DEPARTMENT OF ENVIRONMENTAL PROTECTION M t W �,y See TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 147 Maple Street West Barnstable MA Owner's Name: Robert Laliberte � Owner's Address: Same ��Jn Date of Inspection: May 25,2007 Job#07-113 s� 7 Name of Inspector: PATRICK M. O'CONNELL Company Name: SEPTIC INSPECTION SERVICES CO. MailingAddress: 18 9 CAMMETT ROAD MARSTONS MILLS MA 02648 Telephone Number: 508-428-1779 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 the inspection.The inspection was performed.based on fii� training and experience in the proper function and maintenance of on site sewage disposal systems c`I>� m a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system;:' � e Passes Conditionally Passes Cn -co Needs Further Evaluation by the Local Approving Authority co rat Fails I Inspector's Signature:2 V ll z...�- ' Date: 5/25/07 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. Notes and Comments: recommend pumping tank,leaching system has no evidence of backup or saturation. ****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. Page 2 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 147 Maple Street,West Barnstable Owner: Robert Laliberte Date of Inspection: May 25,2007 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: _XX_ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND) in the 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. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: 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 obstruction is removed ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 147 Maple Street,West Barnstable Owner: Robert Laliberte Date of Inspection: May 25,2007 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. L System will pass unless Board of Health determines in accordance with 310 CMR 15.303(I)(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 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 147 Maple Street,West Barnstable Owner: Robert Laliberte Date of Inspection: May 25,2007 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No —X— Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool —X_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _X— Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool — _X_ Liquid depth in cesspool is less than 6"below invert or available volume is less than_day flow —X_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _X— Any portion of the SAS,cesspool or privy is below high ground water elevation. —X_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. —X— Any portion of a cesspool or privy is within a Zone I of a public well. —X— Any portion of a cesspool or privy is within 50 feet of a private water supply well. — _X_ 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this forma _No_(Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) 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. Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 147 Maple Street,West Barnstable Owner: Robert Laliberte Date of Inspection: May 25,2007 Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No _X_ — Pumping information was provided by the owner,occupant, or Board of Health _X_ Were any of the system components pumped out in the previous two weeks? _X_ _ Has the system received normal flows in the previous two week period ? _X_ Have large volumes of water been introduced to the system recently or as part of this inspection? _X_ _ Were as built plans of the system obtained and examined?(if they were not available note as N/A) _X_ — Was the facility or dwelling inspected for signs of sewage back up _X_ _ Was the site inspected for signs of break out? _X_ — Were all system components,excluding the SAS, located on site _X_ _ 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 ? X_maintenance of subsurface sewage disposal systems '? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: Yes no _X_ _ Existing information. For example,a plan at the Board of Health. X_ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15..302(3)(b)) Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 147 Maple Street,West Barnstable Owner: Robert Laliberte Date of Inspection: May 25,2007 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Number of current residents:3 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage 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 2 years usage(gpd)): N/A Well Water Sump pump(yes or no): No Last date of occupancy: Currently Occupied COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system (yes or no):_ Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records: None Source of information: Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: gallons-- How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM _X_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) —Tight tank _Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Compliance date for new SAS: 6/5/98 Were sewage odors detected when arriving at the site(yes or no): No Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 147 Maple Street,West Barnstable Owner: Robert Laliberte Date of Inspection: May 25,2007 BUILDING SEWER: XX (locate on site plan) Depth below grade: 1' Materials of construction:_cast iron X-40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: X (locate on site plan) Depth below grade: 8" Material of construction:_X_concrete_metal fiberglass_polyethylene —other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):—(attach a copy of certificate) Dimensions:8.5'long x 5.2' wide—1000 gal. Sludge depth: 8" Distance from top of sludge to bottom of outlet tee or baffle: 22" Scum thickness: 6" 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:8" How were dimensions determined: STICK WITH HINGE FLAP. Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Recommend Pumaine tank.,baffles are intact with liquid level at bottom of outlet invert GREASE TRAP: No (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 last pumping: 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 Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 147 Maple Street,West Barnstable Owner: Robert Laliberte Date of Inspection: May 25,2007 TIGHT or HOLDING TANK: No (tank must be pumped at time of inspection) (locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: Qal'lons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: XX (if present must be opened) (locate on site plan) Depth of liquid level above outlet invert: 0" Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): No solids or hieh stains present PUMP CHAMBER: No (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.): Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 147 Maple Street,West Barnstable Owner: Robert Laliberte Date of Inspection: May 25,2007 SOIL ABSORPTION SYSTEM(SAS): XX (locate on site plan,excavation not required) If SAS not located explain why: Type _leaching pits,number: —X leaching chambers,number: Five Infiltrators. _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.): SAS shows no evidence of backup or saturation CESSPOOLS: No (cesspool must be pumped as part of inspection) (locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): PRIVY: No (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.): Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 147 Maple Street,West Barnstable Owner: Robert Laliberte Date of Inspection: May 25,2007 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch 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. Well a 23 5 124 rop in foundation 99 ms i e Page 1 I of 1 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 147 Maple Street, West Barnstable Owner: Robert Laliberte Date of Inspection: May 25,2007 SITE EXAM Slope None Surface water None Check cellar Dry Shallow wells None Estimated depth to ground water: More than 20 feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record- If checked,date of design plan reviewed: Observed site(abutting propertylobservation hole within 150 feet of SAS Checked with local Board of Health-explain: ) _Checked with local excavators, installers-(attach documentation) _X_Accessed USGS database-explain: USGS topo map and town GIS. You must describe how you established the high ground water elevation: Town groundwater contour map shows water below el. 10 and topo map shows property at or above el.40 I WINDOW/DOOR SCHEDULE 1 Existing 6'0"x 6'8"Steel Insulated French Door 2 Existing 2432 Wood Windows 3 Existing 2817 Basement Hopper Styie Windows A New 5V'x 6'6"Solid core 6 panel double door B New 76"x 6'6"LH Solid core 6 panel door C New 2'8"x 6'6"LH Solid core 6 panel door D New T9'x 6'6" Solid core 6 panel bifold door KNEV W AJ.L f::UL.L WALL f-IT. E New 2'4"x 66"RH Solid core 6 panel door 2 1 F New 2'6"x 6W LH Solid core 6 panel door G New 74"x 66"RH Lovered door F New 1'4"x 66"RH Solid core 6 panel door ELECTRICAL E D 2 2 K NW WAIL_ 3 PANEL 2 8Y?"X 66" WALK OUT HOME GYM CASED OPENING 235 sq.ft. BATH 3 FAMILY ROOM E 115 sq.ft.G C 775 sq.ft. � A 4 b F UNFINISHED STORAG 3 MECHANICAL STORAGE ROOM N F B Scale 1/8"=V OIL W NEW LIVING AREA 1125 sq.ft. H-7 M ABLE 5 K-ET- WBARN TAIOLE5 i xR � t rzX6TIN(-r 'R 30 IW5 f i ELF P `r WALL = x l LALLY i ' I n be 6,£ b,Z LL,0t M a ® N N o_ io I e<< ,L 9,Z 91ti 9z ZZ w N N f7 m FV En ❑ ❑ ❑ ❑ N tV a m � io Z,OZ V,6L Page: CERTIFICATE OF ANALYSIS Barnstable County Health Laboratory Report Prepared.For: Report Dated: 6/3/2003 Order Number: G0319782 Robert LaLiberte 147 Maple Street West Barnstable, MA 02668 Laboratory ID#: 0319782-01 Descrintion: Water-Drinking Water Sample#: 19782 SamMin¢Location: 147 Maple Street, West Barnstable MA Collected 5/16/2003 collected by: R LaLiberte Received 5/16/2003 Routine ITEM RESULT UNITS MCL Method# Tested LAB: IC Lab Nitrates <0.1 mg/L 10 EPA 300.0 5/16/2003 LAB: Metals Copper <0.1 mg/L 1.3 SM 3111E 5/19/2003 Iron 0.2 mg/L 0.3 SM 3111B 5/19/2003 Sodium 8.1 mg/L 20 SM 3111B 5/19/2003 LAB: Microbiology Total Coliform Absent P/A Absent 309 5/16/2003 LAB: Physical Chemistry Conductance 110 umohs/cm EPA 120.1 5/16/2003 pH 6.9 pH-units EPA 150.1 5/16/2003 Note: Water sample meets the recommended limits for drinking water of all above tested parameters. Approved By: (Lab Director) rJUREC : � d _ - N 1 1 2003TW r TOWN OF REAL; 1 Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 TOWN OF BA.RNSTABLE LOCATION 14 NA h SEWAGE # VILLAOE 13ARAIS&& , ASSESSOR'S MAP & LOT I INSTAXLER'S NAME & PHONE NO. /rllA G4A �pT,f� L . SEPTIC:.'TANK CAPACITY LEACHING FACILITY: (type) 4/. FILL _ - (size) NO. 01:=.:'WROOMS BUILDER OR OWNER PERMT-t;DATE: 2 COMPLIANCE DATE:-- 1�;�_ _ Separation Distance Between'the: Maxim u.M.Dusted Groundwater Table to the Bottom of Leaching Facility ,r 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 i Furnished:by. . ... ........... Ii I . f i41 Z30 9 I Q3 . : a TOWN OF BARNSTABLE �P LOCATION 147 /PI/k 2 Ca 1� SEWAGE # V.kLLAGE RA0S/r. &/ - ASSESSOR'S MAP & LOTS-3 INSTALLER'S NAME&PHONE.NO. /rI/p C.44,6 og f i C-' SEPTIC TANK CAPACITY -/Ordo LEACHING FACEL=: (type) -S- /A/. &t_� -a (size) f t 1 it NO.OF BEDROOMS'",-' "BUILDER OR OWNER_W ctev PERMTTDATE: COMPLIANCE DATE: 4 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility` Feet Private Water Supply Well and Leaching Facility,(1f,ahy wells exist on site or within 200 feet of leaching facility) Feet Edge of Wedand and Leaching Facility(If an w. e[lands:exist ,�.. . ti- within 300 feet of leaching facility) ti Feet Furnished by 1 .5 AI �32 & q3LA Q3 No. ` t/✓ Fee c�5® THE COMMONWEALTH OF%MASSACHUSETTS Entered in computer ' Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., SSACHUSETTS 2pplication for MigogaY *pgtem Con!Oru tton permit Application for a Permit to Construct( )Repair(14upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. `Lk_7 N&A01`n(_ 5"V Owner's Name,Address and Tel.No. Assessor'sMap/Parcel C�c`` �c+� RD- 0 Z 7 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow %A A0 gallons per day. Calculated daily flow Lk 1� gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank la4`1 E!^ 1 06v 5V4 c-.v Type of S.A.S. Description of Soil S awn Nature of Repairs or Alterations(Answer when applicable) =y-91-*A-k\ U�� 1(J— y0 y - '✓ F�`�� CK Y --Vtn.P La�e.�u!?S t�l�� $rp_.O Qt.- Sr r7ef Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental C e and not to place the system in operation until a Certifi- cate of Compliance ha Signed Date.. S J'F '�F Application Approved b - Date Application Disapproved for the following reasons OR Permit No. Date Issued 02 No. � Fee �� t ' THE COMMONWEALTH OF MASSACHUSETTK ed in computers Yes F ETTS PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., 't 01pprication for Oig�pogar *pgte " Congtructton Permit Application for a Permit to Construct( )Repair(Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. l 14� �� C� 5= Owner's Name,Address and Tel.No. l{J��cvGlS�Sb� JVil.l7c`o� Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. M00-cq( -';,cC kt.- ac-' &o XT c v <20 }+ i Type of Building: Dwelling No.of Bedrooms_ Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow kA y1 O gallons per day. Calculated daily flow y\4,111 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank t rns ) SvA1cw Type of S.A.S. Description of Soil G V\ t Nature of Repairs or Alterations(Answer when applicable) v-5 T t4 k` a r- �a_a ���� C�� '�y t���L-� ,�.Z�n S wl��� S�y r2 ow- c,,th�,' Iq,I volt Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal:system in accordance with the provisions of Title 5 of the Environmental Co4e and not to place the system in operation until a Certifi- cate of Compliance has �y-a: 'Signed � Date7"�� Application Approved b ��2 Date _ Application Disapproved for the following reasons Permit No. Date Issued .7lapq - :5' Y, - - .. THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY,that,the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded Abandoned( )by i tD-C ►z1 PC- S t-OT t c- at 1 '--` k sT' (N__J�'i4(2#v-5\�� has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No ,_ dated -0-0-F jw-r OW . Installer Designer The issuance of this permit shall not be construed as a guarantee that the system w function as designed. Date Inspector L� Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS lwigogal *pgtem Congtruction Vermit Permission is hereby granted to Construct( )Repair 0�pUpgrade( )Abandon( ) System located at l c 7 " r7- i.�... 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:Construction must be completed within three years of the date of th1y9e t. Date: .>? '`' Approvedd r i 101941 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS) hereby certify that the application for disposal works construction permit signed by me dated 5--0T-5T- , concerning the property located at meets all of the following criteria: L"• There are no wetlands located within 100 feet of the proposed leaching facility P P g !/• There are no private wells within 150 feet of the proposed septic system O' There is no increase in flow and/or change in use proposed There are no variances requested or needed. • If the proposed leaching facility will be located within 250 feet of any wetlands,the bottom of the proposed leaching facility will not be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation. Please complete the following: �+ A)Top of Ground Elevation(according to the Engineering Division G.I.S.man) O o B)Observed Groundwater Table Elevation(according to Health Division well map) 3-3- SIGNED : DATE: LICENSED SEPTIC SYSTEM INS ALLER IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system.Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. 1 q:health folder:cert i 1 d f,�� VC, No.' .L. Fss...... 00,..' THE COMMONWEALTH OF MASSAC:HUSETTS ' < BOARD OF HEALTH �/ .--•---------------OF.. /3 '-.-...:=•-darn...;...._.._.... ... P R O V E JDstably, C Appliration flax Disposal Works To r P�n Co�m�s�ton Application is hereby made for a Permit to Construct ( or Repair ( ) g i Se e �� System _ bat --.... . . ..C.�. f.._........... _••-•-IV' �. �1..:.f_ .�.- ....................... -•- ��� tion-Address or Lot No. .t;1-,r�. ............................. ............................................. -•-.......................................... ....Owner ........... ................. Rddress Installer Address JJ d Type of Building Size Lot_.7._P.,. ?....Sq. feet aDwelling—No. of Bedrooms.......//��.. . .........:.........Expansion Attic ( Garbage Grinder p, Other—Type of Building ------.tC e............ No. of persons............................ Showers ( ) — Cafeteria ( ) aOther fixtures ----------------------------------------------•-------....--------------------------------.......----------------------.........------•-----.....----• d W Design Flow.......... -----•--------------gallons per persona per day. Total daily flow.....�0...=...................gallons. WSeptic Tank—Liquid'capacity/ ..gallons Length Clt:a..... Width=.�..... Diameter................ Depth...6,10. x Disposal Trench—N .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.... �--- Diameter...,l ..... Depth below inlet....L10< ... Total leaching areaXO.9�...t...sq. ft. Z Other Distribution box ( L?/ Dosini�tank ( ) Percolation Test Results Performed by.......l,J.... t ....................... 2 . Test Pit No. l..... ..minutes per inch Depth of Test Pit...i lf:�...... Depth to ground water..,.A/ ........... Test Pit No. 2................minutes per inch Depth of Test Pit.../_3......... Depth to ground water....ef-0.......... ---------------------------------------------------------------......................................................... ODescription of Soil-------- -------- �1 .�.......-------------•---•-----------....------------------------------....-----------------------------------•-----------.. x V ..........Fterations ..•--- -•• -------••-.-•--• -----...---•-----•---•-_.._....- --- -- --........_..... .....----- -•-------------------------- ... `--------.� ...--•---------•................-----------•-------------------•-------•----------------------.............-----........------------. V Nature of Repairs or —Answer when applicable............................................................................................... -------------------------------------------------------------------------------------------------------------------------•----------------•---.......------------...........-••------...........-•-••--- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed..... . �j to Application Approved By.-_ --- ----------------------- D e---�. Application Disapproved for the following reasons:............................................................................................................._ • ------•--------•-•--• -• - ----•- --Date Permit No.._.... ... ` r --_.._ Issued.------• -- . -•-- --[.. . D -- — W..W---�---- �_ ---------------------- ------------ 1 � No.:. � �,� FEB....... . 'lS ....' THE COMMONWEALTH OF MASSACHUSETTS r BOARD OF HEALTH I F to i f � S ApplirFatiun for DiupuuFat Works, Tonotratr#iuit Prratit Application is hereby made for a Permit to Construct (..: or Repair ( ) an Individual Sewage Disposal Systat:..... T----—-------- ................. •.......... .... •...... ... .... . ...... 7-•------- •_• Loc tioj •l, dd ss or Lot No. - .. �...:` .. � �P.................... ......................:... .:........... ....................•--..............••........__ Owner Address nstaller Address Type of Building ize Lot__farbage QQ Sq. fee r ............. Dwelling—No. of Bedrooms___._._ . ..........................Expansion Attic ( ✓ Grinder. Other—T e of Building a —Type g ...... _ ------ No. of persons____________________________ Showers ( ) — Cafeteria ( ' ) Otherfixtu es ------•---------------------•-.._.._._..._..-•----..__._....•---•---•-------•-•--------•---•----••-•-• :............. = WDesign Flow............... ...................gallons per perso�Per;day. Total.,d^aily flow__..._:_ _ _._.:__._.____.____.___ ions. WSeptic Tank—Liquid capacity�006gallons Lengthy:_ .__ Width_:�=_�P:-__.. Diameter________________ Depth__ d= xDisposal Trench—No.. __________________ Width.................... Total Length.___:______ ... Total leaching area................:...sq. ft. Seepage Pit No. _ ---- D• eter-__.�: __:____ Depth below inlet...GA Q::.. Total leaching area: 5�:� ....sq. ft. z Other Distribution box ( Dosing : /nk� ( ) - Percolation Test Results Performed by...° 6.1___.... _r. �r�� __________________________ Date__�____z_zA-V a 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_:__I, Depth to round water----__ 0_______ P P �--------- P g Q+' . O Description of Soil..................... ......................................... V .......................................... ..... - x -•---•......--- •--------------------•-•-- •-•_._...• .--�-�: ---------------------------------•------------•-----------------•-------------------::::::----------------------•------- V Nature of Repairs or A erations—Answer when applicable............................................................................................... ..-----•--•••-•••_.._.•--•-------•-------•--------•--•-•---••--••••--••-•--••---•••----••-------------•-•--------------•--•••---•-•••---••••----•••----••------••-•-•-•••-••••....--••------•-•---...._. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT1E 5 of the State Sanitary Code— The undersigned further agrees not to place the system in. operation until a Certificate of Compliance has been issued b the board of health. e.. ...._ A lication Approved B ' �/1 _ ��.... .. ... .............. ¢ - PP PP Y ��. a e ---- Application.Disapproved for the f ollowing reasons:------•--------------------- ----------------------...-----------._.........-•-...-•••••......--••-- .-_................................................_._...._.. ..-•-•- -- ------•------•-------__-------•-----.....-- --- ------------••--- / Da Permit No..... 1'. -••-•••-----••--- Issued------ Date .............. THE COMMONWEALTH OF MASSACHUSETTS r BOARD 17 HEALTH ................OF.....: /'. ........ ... .................. C�rdifiratr of Toutplia ttv THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ` .�-or Repaired ( ) by...j -------•----•----- ---------•-- _-_-....._-' -__-----•-•- .Installer ------•-•-' has been installAd in accordance with the provisions of TIT 'r 5 of ijej to Sanitary C e as s ' e in the application for Disposal Works Construction Permit No___________ -- dated_._.--_ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A G RA EE THATT,HE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS OARD OF HE LT .OF.........1 ... -1a........ ........... No......... ........... FEE.... A� Bilivoll a IV r u rztr$iun rruti� Permissionis/hereby granted ---- -----------•-•-•---------------••-----•--••-----•--•--------•---•--------___-----__---__------.-- to Constru o Re a'}�+'/(� ) / di ual Se , isposal+J/`vV� (/JAL'/^// atNo......... f .... .. ----Street ..... .............r"I ._.. ... as shown on the application or Di al Works Construction Permit o.. . ...... _. ate _ ......................... --- ............ ---•. -- ` -----••-- ...... Board of Health DATE........................ ---•- FORM 1255 A. M. SULKIN, INC., BOSTON .,1C111Sd1*iliiiifiiflliflr!fi+itinfIM 1.trftrinTfit+!tr�rrrrntrtnlmfrTttflrttt�tt+nsrrtnnrmfi+ri�r�tinfif�tttrtt+rnntt+tt+m�ftf�trfttrfexff�n+m Tt+tt to tt ru n++rtr nt+rt+n n n+rr o f t nrttnn+ �. :. :.::...:..: : . :.:.. :L:,1.al::a:at::a.•:•::a•::,::L••it::tfi':::,:t::lt:ttL•1 :�r ENVIROTECH LABORATORIES . Mass. Cert.#:MA063 449 Route 130 Sandwich,MA 02563 (508) 888-6460 = a CLIENT: Pilgrim Pump & Well LOCATION: P4a le Street _ P. Sunderland _ _ ADDRESS: _ � � Barnstable. MA COLLECTED BY: Pilgrim Pump SAMPLE DATE: 8-22-91 TIME: 12:30p _ DATE RECEIVED:8-22-91 SAMPLE ID: Z365 = JOB New Well WELL DEPTH: 40,129 z RESULTS OF ANALYSIS: 4 Parameter Units Recommended limit Result Coliform bacteria/100 ml (MF Method) 0 pH pH units 6.0-8.5 x 5.48 >» Conductance umhos/cm 500 4 9 Sodium mg/L 20.0 z 9.0 Nitrate-N mg/L 10.0 _ 0.11 Iron mg/L 0.3 0.14 Manganese mg/L 0.05 r; 0.04 �_ =^` Hardness mg/L as CaCO 500 _ 3 16.8 _ B Sulfate mg/L 250 ' 7.9 Potassium mg/L 20.0 = 0.06 -4 Alkalinity mg/L 200 — -- 8.4 _; Chloride mg/L 250 16.3 _z Turbidity NTU 5.0 2.7 -, Color APC units 15.0 <1.0 Background bacteria COMMENT: =x Low pH indicates high corrosive characteristics. EPA 601/602 ug/1 Below Reportimg Limit See attached report E YES No WATER IS SUITABLE FOR DRINKING PURPOSES FOR PARAMETERS S 9 TED. DATE . . . �fiwli!!U!!!il!!U!I!ititiiilitiUillititiltlillUlillii!!iti11!!llilIllUllli111ilit still liiillutiii!lUllIlli+iiiiiili+iii;itiir+uiiiiiiiiiitiiiiilHiiiiiiiiil ,o_ i i6: i2 C Cu: �wr==- �N.-.�YTIC?L ENVI :.OT r- o,)o i - - - c- _ - ` GROUNDWATER ANALYTICAL EPA METHODS 601 and 602 Volatile Organics (GC/PID/ELCD) Field ID: Z-365 Lab ID: 1865-01 Project: Sunderland Maple St QC Batch: VGA-833 Client: Envirotech Sampled: 08-22-91 Cont/Prsv: 40ml VOA Vial/NaHSO4 Cool Received: 08-23-91 Matrix: Aqueous Analyzed: 08-27-91 PARAMETER CONCENTRATION REPORTING LIMIT (ug/L) (ug/L) Di chl orodi f 1 uoromethane BRL 5 Chloromethane BRL 1 Vinyl Chloride BRL I Bromomethane BRL 5 BRL Chloroethane 1 1 Trichlorofluoromethane BRL 1 1,1-Dichloroethene BRL 1 Methylene Chloride BRL 1 trans-1,2-Dichloroethene BRL BRL 1 1,1-Dichloroethane BRL I cis-1,2-Dichloroethene * BRL 1 Chloroform BRL 1 1,1 1-Trichloroethane Caron Tetrachloride BRL 1 Benzene BRL 1 BRL 1 1,2-Dichloroethane BRL 1 Trichloroethene BRL 1 1,2-Dichloropropane BRL 1 Bromodichloromethane 2-Chloroethylvinyl Ether BRL ' 1 BRL 1 trans-1,3-Dichloropropene BRL 1 Toluene cis-1' 3-Dichloropropene BRL 1 1,1,2-Trichloroethane' BRL 1 Tetrachloroethene BRL I Dibromochloromethane BRL 1 Chuorobenzene BRL 1 Ethylbenzene 1 BRL m+pp-Xylene * o-Xylene * BRL Bromoform BRL 1 1,I,2,2-Tetrachloroethane BRL 1 1,3-Dichlorobenzene BRL 1 1,4-Dichlorobenzene BRL 1 1,2-Dichlorobenzene BRL 1 QC SURROGATE COMPOUND SPIKED MEASURED RECOVERY QC LIMITS P Bromochloromethane 30 32 107 % 83 - 111 Fluorobenzene 30 30 100 % 87 - 113 % BRL - Below Reporting Limit, * Non-target compound. "Trace" indicates probable presence below listed Reporting Limit. Method References: Method 601 - Purgeable Halocarbons and Method 602 - Purgeable Aromatics, 40 C.F.R. 136, Appendix A (1986), yi> ,I.uww.,...,,.., ,.,,;.....+.., ..a,...,w...a...w...w.a..._ .........:..M.,.w+.-., ,.,.......... ..-.....:...,w..,..«-:w..w+:,...........•.r.............. .. ...:w.r.a..•d.....+,.....,,,«-.,M...w......i,.....,.,.......dw......ian,...-..,._...:o-.....un,......,.o•...-....._.. ...,. :.....b......,_ ....,.•......«..,e...,.................•...._..,.....r.-.-....,,.-...rr•..a,*,a.,..,..,............,w....:,•w......s.•,..e..........«-.......«,..,............._...-.,....: .,,r...........,...............,r...,.n...»,.,o,..,...-...._...,...:.,...... .....,.:,...... .............,.. ,..._ ... .. , .,, -• ,o....., Mr, ......,.,.m.,ma ..wi...w...,-,,...., ." ..<-,.r,............. .....-.. _...... ... .. ..s.+..r.a,.. r..+....em.....nw.w:.a..aw...•........,...rws+...,.w x } t pt �— SE /jj N It L SEA CH/NG Pl T TOP OF FOUNDATION EL- D F/N/SH GRACE OVER LCACHIN6 P/ ` = O frN/SH TRACE /?. " MAX _:_... '777 . .... :-4 707 ._. ..' 1.1 MIA, Pi rcH //4 " Pl R rO!?T 3`` l/R 'I ? z RISEN r n .. .... i ]C •.,«. WASH-FD P£A 1 T'ONE. 4 a e iN 8y v ,7 � a BASEMEN r' * �' a Q /��GALL01'V PRECAS` ,a i, 0 D Q CONCPE TE H- /o REINFOAieftED j n C) O .-- Etz' ._.._ v n 3 m 3:4" Il,'2" rJ 0 ��,� 0 e r-*?ECAST COr�CgFrE i J4 WASHED C�© �� N- /O RE/NF,7f►'CE✓ i d �0 �} 0 Q a v v.:v-• 4` l f:/ �O t ♦ Er. CnUSMED n � �- �, rrPE .s r- �.• AsE STONE A rop ,3E SET O M A Lf�E,c �'J V E—FCT/VE 42- DIAMETER EL= ri'3 ,�`3z Sf7'GiV A t^ft �._?95z :' �� <� / �o'rorl O.` TN,�A�T /;0 L6VEL es 41 \ '.fr 3" / , ' t 3�s• tiZ,. L - DES CR/Ti�R1A 41 N of NUM6ER OF BE[��C.?M.S- 3 �3 7 4 _._ __ _� _. 64N$4GE• DISPOS4� YES- PVC. _. __ __-- raTAL E^T/MArEt� r�OW=__� �T : F'F:YrOL�4TIGN RATE � ,WV i jCfi Lt VJA•1BER Off' L-E4'HIN,, .4t rS �� -- e •- •e R A A• �° o R ;i/DEi+�3�Ci_L AREA- fi RH= •�` , q1`,�� \ Ito - Z.Z� SFx���v��D/SF. s C. pr # � _ +�' ✓� ---'. 9�' 6'O1'T'OM AREA= T7'"ti = 41 _ \ TC)TAL LEACHING PRO VICE 0= CJED _sA f s 1 _ '_ -- 17 A10 -z v r✓G /yp 3 ' 08SERVAT10Al P1 TS FLOOD PLAN � � 1 ONE - - _ . `�� , DATE S� 1A P r S i REET __ . _ W PERFORMED BY. ,J- rc'Ekt�?' �fEi°.E"_ .ems __ -- RE �.c ,� 6 _Z� �ZaAo 33 r CA A E A 1 BOARD OF HEALTH• --�2� c..,�_ ✓ e 1 EXCAVATOR:�_ Ll ,L i'GEND SEPT I C. r 1 NOTES: I a �, J /°/YOi�vSE� SCOT � ELEVATION ARF_ BASED ON •�► � ,►r rc A)4 rO.r 2 THE SEPTIC SYSTEM SHALL &EINSTA-LED ACCORVING TO f'�'%%�OS.EL� �L!'�U,� nrLE �' f Al1/YLD(:AL RJLES THAT APPLY 7Z T' s s 9 PRIOR TO BACKFIL L ING THE `��!BOARL' OF • c �', _ •. \ � HEALTH SHALL BE NOl!FLED. ry7�� t+i ^y -y. A •.• 4 WATER '�JR°LY l•c PROVIDED & e ° 5 REMOVE ALL UiV SJi TABLE NfATR/AL FOR TEN =EET IN AI_L DIRECT,'ONS AND TC AN EL EV OF BACKF�'�L W/TH ` -•,. -.'. :.A �-, , „�' ,:;*s� �a'i o�y. sy�-$•Yy �sa „� ee ,>. s #s. A J: i , , ,'... a < � CLEAN SAND IN COMPLIANCE Wi TH 3/G CMR.rS 02(l7I i r 6. BLS _P�1dLf� To �,�,E" t �SGf/ -fo /°y.L �qy, T ,a',� ConPoNE��TS df T� S'YS1"F!r • '. \ �'i�°/9.O.C� Of W/Th'.STN.f1.�/VG h'-/O �0�9,0/ VG h,� � ``� x.. UNLESS or,yEZ yv ;E A/o r6'D ' \, / WX,,cA /S ,LOcp re' O �/' OR Eu✓i9Y /T .S*od<,o `` ` ,(3.F /�.l.4GED /N /9 hf:z't L ,'✓,T 7 r :rr,• A.y Ct SITE PLAN 8 SEPTIC DE_S�G'N � 0 37 of M40, UPPER CAPE ENGINEERING PA ' Esc �EED� "'` PGANS cF 2ECo21� ' PC,.. 86")( 616 LOBARON.JR i4V D f+ Pil,� 7/A` FIE L © E,c)��E y": $ � � p-. s F No.30763 :�• ,"�`$��~,~ '• F CANT irVr6H MA- a�,. - 3 o _� ' Y e� f SEPTIC TANK L,E4 CHING Pl T tEL OF FOONDAT/C?N �_� E.c FINISH GRADE OVER LEACHING PIT= 319 SH 6RjRADE GRADE V4R/ES I2" MAX 37. 0 ..,. c. . ..Q- v. 4 PVC OR EOUl� Q - M➢'N P/TCJH /14 "PEP FU '' N u Z RISFR - WASHED PEAS TONE o bC J 3 5ro�� 000 - Q ? / GALLON I PRECAST B4 sE MENT a o• a D r �\ FL. CONC,4ETE H- /o REINFORCED �� n O� O D 0 ��c CONCRETE ► f+ L� l m i/-I H- D %�%NFOVCE�'� s �?'�(� �0 N A n� p:�:o•:e J.4 W SHtO,f�E-r CRUSHED sTONE \ P� oinEivs°o vs �w 6y!f��°A 4 I EFFECTIVE- /z DIAMETER J LOT I 1: �J � / 1 co \ � O o?TD/1 Of Thr 1ADT f•i o L E'vl-L TP" 3__ rf' 3 Z- Z. DESIGN CRl DER/A 3 N , <7 -- ,/,,v �✓ ,Z6,7 ►+ �; + ' 7-1 NUMBtR OF BEDROOMS-:- �-- - — /3 74649846E DI.,PO!S4L• YES__. _ _NO__._ TOTAL F IDTIMAT�D FLOW=_..�_—_(;PO. \ �, PCRCOLARON RATES MIN/INCH _ D„cr l \ NUMBEfe OF LEACHING R TS o,� A•,C SAAFo i SIDE WALL AREA= 2 77 RH= '�r+ so -�• l�l -��� S.FX3S G.PO/Sf= �rGFL1 SOT EOM AREA= fiR = AL LEA N PROVIDE = ap TG�T G . . i 1 G `z O A/0 _ - ,,s _ l z OBSERVATION P/ TS FLOOD PLA;;'�- c ZONE.. ,� .1 1 DATE. 6'1 _8 z (�1 A P L_ F S;R E T 4m Bn �19' _ __�� -- ---- � � PERFORMS^ BY. �3 POW VeLL BOARD OF r�LA�TN D •,,l•v ,� __._ - _ •, s A,e E 3S r� NOTES`. � . < r�ol�oS,ED S/°OT E l ELEVAT'ON ARE BA SED ON �J3 Sri irc Jet Tu n 2 T,yE SEPTIC SYSTEM SHALL BEIN'TALLED ACCORI,'ING TO :�,� , �. Q TIT!E V ANY i0'.AL R'JLES THAT APPLY TEST f/OL E` T ;` '`'`� ? PRIOR TO BACKFILLING rHE�30ARD OF HEALTH SHALL BE NOf'FIED. 4 WATER SUPPLY ISPROVIDED BY w' " - 5REMOVE AL L UNSUI TABLE MArRIAL FUR TEN FEET IN ALL DIRECTIONS AND M AN ELEV OF BACKFiLL WITH 0.EAN .'SAND ,N COMPLIANCE W/TH 310CMR.),0207) \ \ 6. 1—,o,'/°lN6 TD 1 7. dl, g CD/li°oNENT� E SY�Z'_ /r Sfi'i9�,C �,E • C'.9PsJ,B,c� of G✓/Th'sls.s/.D/,t/G h'-/O •Co�9.Oi•�/G U.v�Ess orHE� � ��. $, v✓E.0� To Q� o c i9 T�C �o ��'o� E/�G�' c� rrE o /1v d.�R ll ke 4 x l T,�if/o t/<,O SITE PLAN a SEPTIC DESIGN 37 UPPER CAPE ENGINEERING TN/� YL •1.. i� CoM � [- 4 �iQoti/J 3.v PA'1t SG W�W�44• PC Box /o �rDj " ,�LA.vs o� 2Ecn21� LeBARON, E SANDWICH, MA. No.307s3 tTtrAl P-,4, .V? aw .... . OFFICE