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1754 OLD STAGE ROAD - Health
17�4(bid Stage Road West Bamstable 114 11 r �ht L,� Massachusetts Department of Environmental Protection VD r o0 Bureau of Resource Protection Y? Well Completion Reports Well Driller Itk,� Please specify work performed: Address at well location: 01) New Well Street Number: Street Name: 1754 OLD STAGE ROAD Please specify well type: Building Lot#: Assessor's Map#: Domestic 152 H L Assessor's Lot#: ZIP Code: t° fr Number Of Wells: 4-2 02668 City/Town: Well Location BARNSTABLE In public right-of-way: GPS f"Yes No North: West: 41.68845 70.37699 Subdivision/Property/Description: Mailing Address: r click here if same as well location address Property Owner: Street Number: Street Name: PETER GEMEINHARDT 1754 OLD STAGE ROAD City[Town: State: Engineering Firm: BARNSTABLE MASSACHUSETTS ZIP Code: 02668 Board of health permit obtained: 0 Yes r.Not Required Permit Number: Date Issued: W2018 �01/19/2018 Massachusetts Department of Environmental Protection Bureau of Resource Protection-Well Driller Program 'Lill Well Completion Reports(General) ........ .. Well Driller - General Well Form DRILLING METHOD Overburden Bedrock Auger Choose Bedrock- WELL LOG OVERBURDEN LITHOLOGY From(ft) To(ft) Code Color Comment Drop in drill Extra fast or slow Loss or addition stem drill rate of fluid TRACE SILT (` r` 20 Medium Sand P' Brown r Fast r Slow YES ND -� Loss Addition TRACE SILT r. � � r f 20 140 Medium Sand "r Brown ' i`Fast!�Slow - ------- YES NO Loss Addition aMeduTRACE SILT -- [Q1 m Sand (� Brown �" r Fast( Slow Loss Addition _...._._..........:. — TRACE C f'' fa. _ t" t.• i 50 60 Medium Sand—Li Brown i-(7 Fast r Slow o i�^ i --- YES NO Loss Addition _...... 60 €80 [Mdiu em Sand `j� Brown TRACE SILT r { Fast('Slow (" (:' YES NO € ......._.._.._.____......_...._.......__ Loss Addition 80 95 - Fine To Coarse S I Brown ,, r Fast f'Slow YES S NO =Addt,.,, WELL LOG BEDROCK LITHOLOGY Loss or Extra From(ft) To(ft) Code Comment Drop in Extra fast or addition of Visible Rust Large drill stem slow drill rate fluid Staining Chips P i Choose Code Yes' rlYe U -- YES Nt0. [Fast Slow Loss Addition F ADDITIONAL WELL INFORMATION Developed (�7,Yes f"No Disinfected 1:Yes f"No Total Well Depth 95 Depth to Bedrock Surface Seal Type (None racture Enhancement f�Yes - No L._...._..._._.—..._.�__ --- _.— CASING ..Is Casing above ground? From To Type Thickness Diameter Driveshoe 91 Polyvinyl Chloride Schedule 40 r Yes SCREEN r No Screen From To Type Slot Size Diameter _.___._.._.................................-_.,..___.____.____ - 91 95 Stainless Steel Well Point ( 0.012 WATER-BEARING ZONES r D.................._._.. RY WEL ' From To Yield(gpm) l.._......................--__-_.. ___.._----------____ ___..__�----.•--� I Massachusetts Department of Environmental Protection . , Bureau of Resource Protection—Well Driller Program Well Completion Reports(General) 50 95 15 PERMANENT PUMP(IF AVAILABLE) FVIrreConstant SpeePump Description Horsepower rsible 3! Pump Intake Depth(ft) 89 Nominal Pump Capacity(gpm) 10 ANNULAR SEAL/FILTER PACK From To Material 1 Weight Material 2 Weight Water Batches Method Of (gal) (count) Placement ( (...... _._.._. .... ... Choose Material Choose Matenal �� L ! (�J � —Choose One . WELL TEST DATA Date Method Yield(gpm) Time Pumped Pumping Level(ft Time To Recover Recovery(ft (HH:MM) BGS) (HH:MM) BGS) Constant 15 1:i 52-__--_- 0:01 50-____________ 1/11/2018 nt Rate Pump � WATER LEVEL Date Static Depth BGS(ft) Flowing Rate(gpm) Measured COMMENTS WELL DRILLERS STATEMENT This well was drilled or altered under my direct supervision,according to the applicable rules and regulations,and this report is complete and accurate to the best of my knowledge. Supervising Driller DESMOND THOMAS E Monitoring[M] Signature III, DrillerDESMOND III Registration# 764 THOMAS,E DESMOND WELL Date Job Complete Firm DRILLING INC. ' Rig Permit# 023 1H8/2018 ---------------- NOTE:Well Completion Reports must be filed by the registered well driller within 30 days of well completion. l_ No. W ®1 Fee 45 BOARD OF HEALTH TOWN OF BARNSTABLE 2pplication ifor Yell Coattruction permit Application is hereby made for a permit to Construct(y(j, Alter( ), or Repair( an individual well at: �5 nU Sj!7 y_Z Locatio -Address Assessors Map and Parcel Owner 11PAddress b9sm i�{Al t ®: I���a �nL Z113 . ocbAnx .MA o2.03 Installer-Driller — �— Address Type of Building Dwelling Otherl-Type of Building No. of Persons Type of Well SCIA too PVC. Capacity 10! Cl p Purpose of Well (�c i►ski 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 Cert' to of Compliance has been issued by the Board of Health. Signed /eg Date Application Approve Date Application Disapproved for the following reasons: Date Permit No. W Issued Date -------------------------------------------------------------------------------------------------------- BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Compliance THIS IS TO CERTIFY,that the individual well Constructed k), Altered( ), or Repaired( ) by Installer at `� SLA C)1 � S-o �.. �-�ck Lt- has been installed in accordan with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit NoA,4PO V& ( Dated 4 THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Date Inspector fr� 45 No. Z� 1 c, Fee r BOARD OF HEALTH 1 �� TOWN OF BARNSTABLE 0(ppYication if or V44-,b 5truction Permit Application is hereby made for a permit to Construct(K), Alter( ), or Repair(„) an.individual well at: 115 y. O U 3_ilm9e. K1� w,bamS_a6 52'� 4-Z Location-Address Assessors Map and Parcel Owner Address �sm" V� Qkx o(�1��nG Inc {gyp ax. z113, OclAtNs lA ozb53 Installer-Driller J Address Type of Building Dwelling Other-Type of Building No. of Persons Type of Well t jfIA q0 P VC Capacity 0'a V Purpose of Well �r'Ai m J 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 Cert' to of Compliance has been issued by the Board of Health. ` I p Signed MIL[, 10 �8 Date Application Approved By Date Application Disapproved for the following reasons: r Date Permit No. sued )9 i£ Date e-_--_—e_evo4eemosae—v------omme- ------------- --_se_s_—e--_..--__--------------- --------------. BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Compliance THIS IS TO CERTIFY,that the individual well Constructed k), Altered( ), or Repaired( ) by beS1IIavA -e1� r�1�� I1VN .l Installer at has been installed in accordancd with the provisions of the Town of Barnstable Board of Health Private Well Pr otection s Regulation as described in the application for Well Construction Permit No.AA�18'' � Dated �� THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. -- --Date Inspector -----..----®o—.e.---------------------- r.�..... � � _ es� tee., _ —4--•.---------- BOARD OF HEALTH TOWN OF BARNSTABLE rr }} Yell Con.5truction Permit i No. W DO 1 , Fee Z- 5 Permission is hereby granted to Ns 1'ra" AQ Installer i to Construct(X), Alter( ), or Repair( an individual well at: No. 1-1 5 4 OW S+-Mge l orR , �\j r%4Ck 7 V Street as shown on the application for a Well Construction Permit No ated ` I Date l 1 \ r 1 Approved By k ' CERTIFICATE OF ANALYSIS Page: 1 of 1 t. Barnstable County Health Laboratory (M-MA009) Report Prepared For: Report Dated:, 1/17/2018 Sally Desmond Desmond Well Drilling Order No.: G18104522 P 0 Box 2783 Orleans, MA 02553 Laboratory ID#: 18104522-01 Description: Water-Irrigation Well Sample#: Sample Location: 1754 Old Stage Rd.,N.Barnstable Collected: 01/12/2018 Collected by: DWD Received: 01/12/2018 Routine M ITEM RESULT UNITS RL MCL METHOD# ANALYST TESTED NOTE ,Nitrate as Nitrogen 0.47 mg/L 0.10 10 EPA 300.0 LAP 1/12/2018 Iron ND mg/L 0.10 0.3 SM 3111B LAP 1/17/2018 Manganese ND mg/L 0.025 0.050 SM 3111B LAP 1/17/2018 pH 6.2 PH AT 25C. NA 6.5-8.5 SM 4500-1-1-13 DCB 1/12/2018 Sodium 87 mg/L 2.5 20 SM 3111B LAP 1/17/2018 Total Coliform 0 /100ML 0 0 SM 9222B RG 1/12/2018 Conductance 620 umohs/cm 2.0 SM 2510E DCB 1/12/2018 Sodium level Is above the maxium contaminant level. Those on a low sodium diet may wish to consult a physician. Attached please find the laboratory certified parameter list. Approved By: (Lab Director) 122 ND=None Detected RL = Reporting Limit MCL Maximum Contaminant Level 3195 Main Street, Po. Box 427, Barnstable, MA 02630 Ph:508-375-6605 CERTIFICATE OF ANALYSIS Barnstable County Health Laboratory (M-MA009) �ss�CF{l5an•' Reclpient: Sally Desmond Order No.: G18104522 Desmond Well Drilling. Report Dated: 01/18/2018 P O Box 2783 Submilter. Well Driller Orleans, MA 02653 s Description: 2 Day Rush-Rtn_M Laboratory ID#- 18104522-01 Matrix: Water-Irrigation Well Sample#: . Sampled: 01/12/2018 12:00 By: DWD Collection Address: 1754 Old Stage Rd„N.Barnstabie Received: 01/12/2018 16:04 By: Veronic Sample Location: Turn Around: 48 Hr Rush Analyst: yn Method: EPA 524.2 Dilution: 1 Date Analyzed: 01/18/2018 @ 14:18 EPA 524.2- Volatile Organics by GUMS Result MCL MDL Result MCL MDL Parameter ug/L ug/L ug/L Parameter ug/L ug/L ug/L Dichiorodifiuoromethane NO 0.60 cisA,2-Dichloroethene ND 70 0.50 Chloromethane NO 0.60 cls-1,3-Dichloropropene ND 0.60 Vinyl chloride NO 2.0 0.50 Dibromochloromethane ND 0.60 Bromomethane NO 0.50 Dibromomethane ND 0.60 1,1,1,2-Tetrachloroethane ND 0.50 Ethylbenzene NO 700 0.60 1,1,1-Trlchloroethane ND 200 0.50 Hexachlorobutediene ND 0.60 1,1,2,2-Tetrachloroethane ND 0.60 Isopropyl benzene ND 0.60 1,1,2-Trichloroethane ND 5.0 0.50 Methylene chloride ND 5.0 0.60 1,1-Dichloroethane ND 0.50 Methyl-tert-butyl ether ND 0.60 1,1-Dichloroethene ND 7.0 0.50 Naphthalene ND 0.60 1,1-Dichloropropene ND 0.60 n-Butylbenzene ND 0.50 1,2,3-Trichic robe nzene. ND 0.60 n-Propylbenzene ND 0.60 1,2,3-Ticchloropropane NO 0.50 p4sopropyltoluene ND 0.60 1,2,4-Trlchiorobenzene-- NO 70 0.60 sec-Butylbenzene ND 0.50 1,2,4-Trimethylbenzene ND 0.60 Styrene ND 100 0.60 1,2-Dibromo-3-chloropropane NO 0.50 tart-Butylbenzene ND 0.60 1,2-Dibromoelhane(EDB) ND 0.60 Tetrachloroethane ND 6.0 0.50 1,2-Dichlorobenzene ND 600 0.60 Toluene NO 1000 0.60 1,2-Dichloroethene ND 6,0 0.60. Total xylenes NO 10000 0.60 1,2-Dichloropropane ND 0.60 trans-1,2-Dichloroethene NO 100 0.50 1,3,5-Trimethylbenzene ND 0.60 trans-1,3-Dichloropropene ND 0.60 1,3-Dichlorobenzene ND 0.50 Trlchloroethene ND 6.0 0.60 1,3-Dichloropropene ND 0.50 Trlchlorofluoromethane ND 0.60 1,4-Dichlorobenzene ND 6.0 0.60 Surrogates %Recovered QC limits(%) 2,2-Dichloropropane ND 0.60 -Bromofluorobenzene 96% 70 130 2-Chlorotoluene ND 0.60 1,2-Dichlorobenzene-d4 95% 70 13o 4-Chlorotoluene ND 0.50 II Benzene ND 6.0 0.60 Bromobenzene ND 0.60 Bromochioromethans NO 0.60 Bromodlchloromethane NO 0.50 Bromoform ND 0.60 Carbon tetrachloride NO 5.0 0.50 Chlorobenzene ND 100 0.50 Chloroethane ND 0.50 Chloroform 2.5 80 0.60 Attached please find the laboratory certified parameter list. Approved B -- (Lab Director) _ ) d ) {7 ND=None Detected RL = Reporting Limit MCL-Maximum.Contaminant Level 3195 Main Street, P0,Box 427, Barnstable, MA 02630 Ph: 508-375-6605 Page 1 of 1 Commonwealth of Massachusetts D. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1754 Old Stage Road Property Address Gary&Carolyn Wood w Owner Owner's Name information is ;tiT} required for every West Barnstable ,� Ma 02668 9/19/2016 p page. City/Town State Zip Code Date of Inspection "E-► m ►a1 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 A. General Information '(� 9C2 filling out forms V�� I I on the computer, use only the tab key to move your 1. Inspector: cursor-do not Sean M. Jones use the return Name of Inspector key. S.M.Jones Title V Septic Inspection Company Name 74 Beldan Ln. Centerville Ma 02632 Cityrrown State Zip Code 774-248-4850 smjonestitle5@gmail.com SI4522 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 9/19/2016 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 System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments G M 1754 Old Stage Road Property Address Gary&Carolyn Wood Owner Owner's Name information is required for every West Barnstable Ma 02668 9/19/2016 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: The dwelling located at 1754 Old Stage Rd West Barnstable is served by a Title V septic system consisting of a 1000 gallon septic tank, distribution box and a 1000 gallon precast leaching pit. The system was found to be in proper working condition at the time of inspection. 13) 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments G M , 1754 Old Stage Road Property Address Gary&Carolyn Wood Owner Owner's Name information is required for every West Barnstable Ma 02668 9/19/2016 page. Cityrrown 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 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•3/13 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 , 1754 Old Stage Road Property Address Gary&Carolyn Wood Owner Owner's Name information is required for every West Barnstable Ma 02668 9/19/2016 page. Cityrrown 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 El ® 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 Y day flow t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments wM 1754 Old Stage Road Property Address Gary& Carolyn Wood Owner Owner's Name information is required for every West Barnstable Ma 02668 9/19/2016 page. CityrFown 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 16,000 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 W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 5 1754 Old Stage Road Property Address Gary&Carolyn Wood Owner Owner's Name information is required for every West Barnstable Ma 02668 9/19/2016 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): 3 Number of bedrooms (actual). 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 gpd t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts x Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1754 Old Stage Road Property Address Gary&Carolyn Wood Owner Owner's Name information is required for every West Barnstable Ma 02668 9/19/2016 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: currentDate 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-3/13 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 M 1754 Old Stage Road Property Address Gary&Carolyn Wood Owner Owner's Name information is required for every West Barnstable. Ma 02668 9/19/2016 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: 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 1754 Old Stage Road Property Address Gary&Carolyn Wood Owner Owner's Name information is required for every West Barnstable Ma 02668 9/19/2016 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: system installed 10-11-84 per town records Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2 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.): Joint were ok, no leaks, vented through the roof Septic Tank(locate on site plan): Depth below grade: 1.5 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gallons Sludge depth: 611 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 1754 Old Stage Road Property Address Gary&Carolyn Wood Owner Owner's Name information is required for every West Barnstable Ma 02668 9/19/2016 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 3" Scum thickness 3" 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 10" How were dimensions determined? opened covers, took measurements 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 structurally sound, water level even with outlet. Tank was not leaking. Tank should be cleaned soon and again every 2 years for proper maintenance. 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1754 Old Stage Road Property Address Gary&Carolyn Wood Owner Owner's Name information is required for every West Barnstable Ma 02668 9/19/2016 page. Cityrrown 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1754 Old Stage Road Property Address Gary&Carolyn Wood Owner Owner's Name information is required for every West Barnstable Ma 02668 9/19/2016 page. Cityrrown 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.): Distribution box was functioning as intended Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No" Alarms in working order: ❑ Yes ❑ No" Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): *If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 f Commonwealth of Massachusetts M Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 1754 Old Stage Road Property Address Gary&Carolyn Wood Owner Owners Name information is required for every West Barnstable Ma 02668 9/19/2016 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: '® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leach pit was dry with no sign of past hydraulic overloading Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts 41 Title 5 Official Inspection Form of Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 1754 Old Stage Road Property Address Gary&Carolyn Wood Owner Owner's Name information is West Barnstable Ma 02668 9/19/2016 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M , 1754 Old Stage Road Property Address Gary&Carolyn Wood Owner Owner's Name information is every West Barnstable required for eve Ma 02668 9/19/2016 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately 1 Q r�3 T �g{1 O/d JTd d� t5ins•3/13 Title 5 Official Inspection form:Subsu;ace Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts u W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 1754 Old Stage Road Property Address Gary&Carolyn Wood Owner Owner's Name information is required for every West Barnstable Ma 02668 9/19/2016 page. Cityrrown 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: 12+ 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: Groundwater elevation was determined by accessing Town of Barnstable groundwater contour map. 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1754 Old Stage Road Property Address Gary& Carolyn Wood Owner Owner's Name information is required for every West Barnstable Ma 02668 9/19/2016 page. CityrFown 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 ��° flAas� CERTIFICATE OF ANALYSIS Page: 1 of 1 $. Barnstable County Health Laboratory (M-MA009) Report Prepared For: Report Dated: 9/16/2016 Gary Wood Order No.: G1696731 P.O. Box 872 W. Barnstable, MA 02668 Laboratory lQ#: 1696731-01 Description: Water-Drinking Water Sample#: Sample Location: 1754 Old Stage Rd.W. Barnstable Collected: 09/15/2016 Collected by: Customer Y Received: 09/15/2016 Test Parameters ITEM RESULT UNITS RL MCL METHOD# ANALYST TESTED NOTE I Total Coliform Absent P/A 0 0 SM9223 RG 9/15/2016 Water sample meets the recommended limits for drinking water of all the above tested parameters. 'r Attached please find the laboratory certified parameter list. Approved By: (Lab Director) 011 NO=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level 3195 Main Street, PO. Boz 427; Barnstable MA 02630 Ph: 508-375-6605 t Massachusetts Water Resources Commission/Division of Water Resources WATER WELL COMPLETION REPORT WELL LOCATION Address_ City/Town 1� Y�/?�S j7q e2,C t"rl vas G.S.Quadrangle Map Grid Location Owner 1V eiy Address l-,:t Yqegm✓w i'f YA LL'USE CONSOLIDATED WELL Domestic Public ❑ Industrial❑ Type of Water-bearing Rock Other .' Water-bearing Zones METHOD DRILLED 1) From To - Rotary(type) 5EZd. . Cable ❑ 2) From To Other 3) From To 4) From To CASING Depth to Bedrock Length��Diameter Type `-- UNCONSOLIDATED WELL STATIC WATER LEVEL Water-bearing Materials Feet below land surface 4;,2 Sand: fine❑ medium coarse Date measured Gravel: fine❑ medium pK coarse❑ Screen: GRAVEL PACK WELL Slot* length from to Yes ❑ No Split Screen(or 2nd screen) WATER QUALITY TESTS MADE Slot# . length from to Chemical ❑ Biological ❑ Depth To Bedrock PUMP TEST Drawdown feet after pumping days hours at GPM. How measured Recovery feet after hours. LOG of FORMATIONS COMMENTS: (On well or water) Materials From To 0 DRILLER Firm Address o®, city Registration No. `�G' _ erator s3igneture Please print lrm y 1 OM-8181.164843 L O CAT ION /7JV SEWAGE PERMIT NO. _ LoT 13 4 Id Si t 2d .F I -a51 VILLAGE, W• ►�. ,k au s`rA 61 INSTALLER'S NAME A ADDRESS r'''1eIU�,+�lu ® U I L D E R OR OWNER 7 DATE PERMIT ISSUED DATE COMPLIANCE ISSUED ��� �/ �9 3y 3 qi �3 THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M A� L' DATA .............. .�• THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH . o�. ...................OF... �? 1. 467_0 L .........-----...................••-- ���� Appliratiou for Uhivaaa1 Workii Tomitrurtuatt Prrutit Application is hereby made for a Permit to Construct ) or Repair ( )-an Individual Sewage Disposal System at: -0...................................... ......................--....-----------•-----.........------------------....................----- (y� �f �r Location-Addr ss or Lot No. ....1.:!,a.! �Q ..d!/1 � --C.� � 1' Ab4. ... Cla/1'�1L:�.................... Owner Address a ... . ........... ........:............. c Installer Address Type of Building Size Lot.,5_'. -0-1....Sq. feet Dwelling—No. of Bedrooms--..._. ...........................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons..... Showers / — Cafeteria Q' Other fixtures ------------------------•------• . W Design Flow................1../.... ....0 ................... per person per day. Total daily flow.......... .3..a...................gallons. WSeptic Tank—Liquid capacity.1.000.gallons Length Width.._i1't.�... Diameter................ Depth.&-_-"( x Disposal Trench—No..................... Width........ ........ Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No........1........... Diameter.........6.._...._ Depth below inlet......6.1......... Total leaching area..................sq. ft. Z Other Distribution box ( () Dosing tank ( ) � Percolation Test Results Performed by..............•--•------•••......---•---•-• ` -------••----•------- Date........................................ Test Pit No. I-----�--_-_minutes per inch Depth of Test Pit....F. _....... Depth to ground water....Mv_^---_-. Test Pit No. 2................minutes per inch Depth of Test Pit-----------_........ Depth to ground water........................ a -•--------•----- 0 Description of Soil.---M d•�!!n '---•---•.......................•------------------------------------ -------•-- ------.----- •-----.......---•---- x c., W ---------------......................................................................................................................................................................................... UNature of Repairs or Alterations—Answer when applicable............................................................................................:... Agreement: undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with m-. 5 of the State Sanitary Code—The undersigned further agrees not to place the system in mpliance has been issued by the board of health. -A5v. CCJ�I'Q e. o Y� C+� 7/ ............................................................. .......C.......-- _ ............... Date -------------------------------•---•-----•----------------------------------------- .•------------ Date Issue(L....................................................... Date No ��: ' �...--- Fxs.. 'L............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH `�'o t^,�•, (?�A art 1v 5"l' q�'�L t: ........ .. ..........................OF...........................-.................._.-....._.. 11 At firation for UhiVoaa1 Works Tonstrurtion Permit Application is hereby made for a Permit to Construct ()� or Repair ( ) an Individual Sewage Disposal SystT'8'STR61 T?060 -..mac...- .. ..... ; .. ----------•--•-- --......-•-- -------- --• ......................................... .. ��� �!�LocatttlddFe � je� � `}l�-ur e - = -••• -••-------------•-----•---------•-----•- --------- ........-.-......__._.... �� C 1 LQ !IJ N1G1 ar �i`j" Addr�ssf`!_r a ..................................•------•--------------------------- - -- • .......--- ---------------------------------------------- --- �'W . --- --1 ...--- Installer Address UQ _ . S feet Type of Building „Q S y Size Lot._.y...................... q. Dwelling—No. of Bedroomsl ..........................................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—T e of Building No. of persons............................ Showers p•l Other—Type g ---------------------------- P ( ) Cafeteria ( ) dOther fixftu�rees ------------------------------•------•---••-••----•---------------•--•---••-••-•-•--•...-----•------. X f W Design Flow.................................y gallons per person4pe%day. Total daily flow............................................gallohk WSeptic Tank—Liquid capacity............gallons 6,jength................ Width................ Diameter---------------- Depth................ x Disposal Trench—No..................... Width---4..s............ Total Length..........i_...... Total leaching area....................sq. ft. Seepage Pit No-----------_------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box (V) Dosing tank ( ) aPercolation Test Result Performed by............................................: �'a�------------------------ Date..................... ,.a Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water......................... G14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.................. a � t............................................................................................................................. M '44iy,n --'\. Descriptionof Soil---------•.......................................................•-•----------------------------------•-----------------•----•--•----------....----•-------------------. x W UNature of Repairs or Alterations—Answer when applicable................................................................................................ --------••-------------------------•--------------•---------------------------------........-•-•---------•--------------------------••------•--....................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITI1 5 of the Stat amitary Code— The undersigned further agrees not to place the...systm in operation until a Certificate of Com Ke has b n ism-bi th b6a0d"of`liealth �/fw. o/ .,.. Signed Ptfa tom: E �r 1 .. i=v ---------------- ---•- ----------................ v Date ApplicationApproved $y- --------------------------------------•'-•-•---•----•--------•-----..................---•- Date Application Disapproved for the following reasons:................................................................................................................ --------------•--•-...........---•-------------------------•-•---------------------..........----------....•-----_....._..------_....._..•••--•••...-----------------•-----••----••--------••--------•--- Date PermitNo......................................................... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............ ........O F...................................................................................... � 6 , 'irate of Tiamplianre THIS IS TO CERTIFY, That e Individual Sewage Disposal System constructed ( ) or Repaired ( ) by---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Installer at....................................................................................................................................................................................................... has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated................................................ x THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE...................................... i .............. Inspector..................................................................................... / THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............................ ...... ..O F. ........................................................................ No-------- --------------- ` .��Y �/ r� FEE........................ �-- t "aTV rk 1 ° ' tr tum ermit Permission is i e "gr ted. .._... _...`:?�`-�.� �.-_. to Construct ( ) or Repair ( ) an Individual S e Disposal Syst ' r� at No.-•-•--•----•-•-------------••....----•-------'--•- -------------- ----.........•-•--......-•••---_----= ------ -----------•----•--•--........._..------------....----.............. , Stre t as shown on the application for Disposal Works Construction/P/py�rt; o..................... Dated.................................. h+t . A +�� ►d yl Board of Health DATE................................................................................ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS Rood I orker I Chinch P Locus f� 6 � (`✓ Q(• Q°l e�y d1I r Lane �° o son Road o Joe _ 4 p.0 2, a 1 90 2' C� LOCUS MAP SCALE 1"=2000'f ASSESSORS MAP 152 PARCEL 4-2 \ N 8 \\\ LOCUS IS WITHIN FEMA FLOOD ZONE X (AREA OF MINIMAL FLOOD HAZARD) AS SHOWN ON COMMUNITY PANEL #25001 CO543J 82 8� DATED 7/16/2014 0 \ ZONING SUMMARY _ �N i ZONING DISTRICT: RF DISTRICT So MIN. LOT SIZE 43,560 S.F. 1 MIN. LOT FRONTAGE 150 \� MIN. FRONT SETBACK 30' MIN. SIDE SETBACK 15' �. MIN. REAR SETBACK 15' MAX. BUILDING HEIGHT 30' SITE IS LOCATED WITHIN THE RESOURCE PROTECTION OVERLAY DISTRICT SITE IS LOCATED WITHIN THE AQUIFER GRAVEL } PROTECTION OVERLAY DISTRICT PARKING I - ` OWNER OF, RECORD ` JOHN P. GEMEINHARDT 4 UNION BRAIDING ROAD SANDWICH, MA 02563 REFERENCES < � _ DEED BOOK 30850 PAGE 143 oRwE 5g$ rJ - PLAN BOOK 371 PAGE 97 vE� PLAN BOOK 290 PAGE 78 EXISTING DWELLING N 000 O 8 �p � \ GR VEL o \PAR ING \ 81 82 83 1 84 d�- O 87 8> vC� to UI EXISTING WELL S / S l T E P L A N TO BE C REPLACED IN 150.0 OF i AME LOCATION v 1754 OLD STAGE ROAD NOTE: NO ABUTTING WEST BARNSTABLE� MA WEL SEPTIC SYSTEMS WITHIN 150' TO WELL PREPARED FOR J PETER GEMEINHARDT `. DATE: DECEMBER 26 2017 6.65' Scale: 1"= 20' 0 10 20 30 40 50 FEET OF tilgs i jA OF AAq �L a� S�cy\a SS9c Q'fc` DA!`�IEI_ �P\� oc' DANIELA. yG< A �` S r �m off 508-362-4541 Ito OJp,.lA UJAL+ I fax 508-362-9880 o` � .� r CIVIL No.46502 �, downcape.com _ C O CAP �:4". PO 'Q� _ • • • FFgS 4 tiF G STER down cape en ineerml Inc. civil engineers ( 1 Ion d surveyors DATE DANIEL A. OJALA, P.E., P.L.S. 939 Main Street ( Rte 6A) YARMOUTHPORT MA 02675 WE > 7-442 r SOIL LOG w N0. 1 O N0. 2 SITE PLANS-,�=�r.io y- 7-�.ram �° ,. ; i �.a s a li. 2 } C, 3 o � 4 TOP OF FOUNDATION EL.: 88.1 5 • o, 6 L 'q 8 T/G//TLY a a • _`' ' a � a 10 V@ pro ego• • ,- . - •• -e IN.EL. © EL. IN. 8z• :6 ` V 2 COVER 1/8 3/8 WASHED STONE ►moo �, - a IN.EL. e �-,� • c�.3 _ p p q e• L °` I N.E L -, G C a i a .E/YC'CX�Y✓✓1 EO 12 �� IN. EL. D/B- W/ 6 SUMP °a n°o -- 3/4`= 1 1/2" WASHED STONE . 13 ° 4 LIQUID LEVEL ° 14 Oe O . b Do ei b oC o p �aoo��b : 6"EFF. DEPTH , 00� � h 15 e �D m �< n •i • •s o PERC TEST RESULTS o � �' • I j e o � �' PRECAST SEPTIC TANK WITH °o aoe p r'o PERC , RATE : Mew/ivc. v o PRECAST LEACHING PITS CAST IN ` PLACE INLET AND EL, �� o �' e �' �/,9. ,� �s",;%�,v WHITNESSED BY: h' ,gco.e�r �� NO.. _. — SIZE. OUTLET T "S PER TITLEsA�zry�sT��. BOARD ` OF HEALTH � of D I A . ,. SIZE . ���:o�/ � AFL �R�� DATE L 8. 11-54 moo'D I A . 4 �8 G L On�G x .q /O 1✓/L7� x S8 �.EEP> � ``. ��„ ol a PROFILE OF PROPOSED SEWAGE SYSTEM SYSTEM .. DESIGNED BY THE TOWN Of B,gRrYST �sLE' REGULATIONS ANt� STATE TITLE V FOR SUBSURFACE DISPOSAL OF SEWAGE . SCALE : 1/4 0 J v . N . B . , 1. ALL PIPES SHALL BE SCHEDULE 40 P.V.C. SEWER PIPE gI' 2. ALL PIPES SHALL BE SLOPED 1/4" PER FOOT EXCEPT FOR THE FIRST 2 FEET OUT Of THE D / B WHICH SHALL BE LEVEL 3. DESIGN FLOW -3 BEDROOMS AT 110 GALDAY PER BR. . .3o GAL/DAY .-'cry /. 5-_. SEPTIC TANK SIZE X 49S GAL• a i _ /Q GLUT USE ov GAL. W/ GARBAGE DISPOSAL z E if LEACHING SYSTEM. USE 1 EFFECTIVE AREA . SIDEP� BOTTOM - - � TOTAL FLOW TOTAL REQ'O FLOW -5,30 X v — 53 W/e�•--GARBAGE DISPOSAL t RESERVE FLOW 3 �' - 330 GAL/DAY REFERENCE PLANS APPROVED . BY -. �3 B O A fZ� OF HEALTH 87.3� G. N DATE SITE AND SEWAGE PLAN PROPERTY OWNER : o OF FOR : , BEDROOM SINGLE ROB .. .. . �'.�. N FAMILY DWELLING 577 o ,.,. . DATE . /`�ARC� /39 n. 24500 � > . OF GISTE� ��S f NAI ENG DOYLE ASSOCIATES FALMOUTH , MASS. c