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Home My WebLink About1845 OLD STAGE ROAD - Health 1845 OLD STAGE RD., W. BARNSTABLE A=152-035.002 ° a I � � o ° TOWN OF BARNSTABLE LOCATION /FyS Old 5ha-e SEWAGE# dOOF- 9*>d VILLAGE Li. ASSESSOR'S MAP&PARCEL 3.S-d INSTALLER'S NAME&PHONE NO. (�A"•Z-Rml,4sai 3'e'17c 58-vtel SEPTIC TANK CAPACITY /S7X 4 /®O� LEACHING FACILITY:(type) SX Sy6. 0�yt--c l (size) /3 X o) NO. OF BEDROOMS LI OWNER rkr Jegqlf- PERMIT DATE: �0�3�.!©r COMPLIANCE DATE: Separation Distance.Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility c3�� 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 L aching Facility(if any wetlands exist within 300 feet of leaching facility). feet FURNISHED BY DES l 1�•.. ��o� r� ReA& Me 00 J� a. - j/WO ®a� �i T/ me Q� ©� SAS r r No. � � .✓ 2-005- (n i 7 7— !1� � �C�d� »„ Fee THE COMMONWEALTH OF MASSA HUSET Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2ppricatiou for Oigpoal *pgtemc Comaructiou Permit Application for a Permit to Construct( ) Repair X Upgrade( Abandon( ) ❑Complete System El Individual Components ocation Address r Lot No. )�L`� O ner's Name, ddres ,and Tel.N � "3 p i 7 lLq Assessor's Map/Parcel a1� �"_a t,02(45 0 508'7 9-7_?� ,5&3c,o 4 Ipsta''l��ler's N,�me ddr ss and Tel.No Desi ner's Name Adliress and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder (09 Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) N L16 gpd Design flow provided y 9. b gpd Plan Date CG-/o• Z0 o L Number of sheets Z-- Revision Date Title Size of Septic Tank *Z 5'00 + 1(00o tiIja Type of S.A.S. 4A4. Description of Soil Q t dUAN SfoNr& Nature of Repairs or^Alt__eratiiojn�ss(Answer when applicable) ._�sQ QQ {/Rf�l t��`�1�'�� 1:S ` 1 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 Code and not to place the system in operation until a Certificate of Compliance has been issued by this oard of H th. !� Signed Date Application Approved by Date (D - Z G — Application Disapproved by-_ Date for the following reasons Permit No. ?,Cog — - 1 2- Date Issued �.:..:#�sa,:J2. '•4's..�.-+...„.,sr. �. ,,,�_,,..� .�... ` 't• :.ti.N,...'K.Drs:.i+,--"" ..i.: .,.+�„i+.ew, +r,w.e.� d a_`, , _• ... ,. x.•u_ • - _ No. ZOO(5 �t Fee (, *TTHE,-C©MMONWE'ALTH.OF MASSACHUSETTS. Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Zipprication for Miopozal 6p,5tem Conotruction'Permit Application for a Permit to Construct O Repair ) Upgrade(1 Abandon O ❑Complete System ❑Individual Components ocation Address or Lot No. O ner's Name,Addre s,and Tel. 50 "'3©1 11 tj Assessor's Map/Parcel ' 4j�� ZJ _ 0� o 5ta � spa-(o /Installer's Sametddress,and Tel.N 50�Y` � Designer's Name Address and Tel.No56F-3(,o q-0 P© 63aX i 0A Cex-�Aexv i l�A, 3 i 4,n I e C;G S , )i G . Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder f Other Type of Building No.of Persons Showers( )( Cafeteria( ) Other Fixtures Design Flow(mina required) y 4/5 t gpd Design flow provided gpd Plan Date Co -/v- Z..o cs Number of sheets Z "� Revision Date Title Size of Septic Tank Z"/S"o0 + /aOa ti Ew """ Type-"of S.A.S. 3 " S"� l+'^ �� /j�c S �"/ 4 I Description of Soil S Lf 0- un,G- ' f 6 Nature of Repairs or Alterations(Answer when applicable10 ) 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 Code and not to place the system in operation until a Certificate of Compliance has been issued by thi Board of H alth. rr t� Signed L.� g Date ,r Application Approved by _ Date (9 " 2 — 05 Application Disapproved by Date for the following reasons Permit No. 2.0 0,5 2 Z Date Issued - 2 c�_ ZOO, THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CE''R,,T11IFY,that the On-site Sewage Disposal System Constructed ( ) Repaired (}C ) Upgraded (!/ ) Abandoned( )by W G W'J��1�CTr �� 1�� L- AU Ll at Icy 5 o1a Czd. l�Q �j1Z' Q has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer P_vfj S o Designer f C-U #bedrooms Approved design flow , / 17WP# ^A god The issuance of this permit s all not be construed as a guarantee that the syste w'll f3 nction as designees Date , �4� Inspector C ` ------------------- No. 20,:�,5 I2 - Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS ligool *pgtem Construction Permit Permission is hereby granted to Construct ( ) Repair (Y Upgrade.( ) Abandon ( ) System located at i y Q� Ca,2 2L'1 (�.� G,�-�S�"�`•bt� and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Constniction must be completed within three years of the date of this pe it. Date Z(vA C', Approved by (1 (n), 1 I� Town of BarnstableWE ; ' Regulatory.Services Thom' T. Geiler,Director # BMWSTABLS • MAW. i639. Publie Health.Division 9� 1 'DrFo rum+° Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-8624644. Fax: 508-790=6304 Installer.&.Designer-Certification Form Date: Sewage Permit#.-e:> 9 Assessor's M*Parcel esigner: �- ) ` Installer: ��i D Address: _ L43 ` h am � Address: i U TSdX LX�V \L�1�V7 CI J .1 Soy as issued:a permit to.install a (date) .......... (installer) ptic system at ��G' Q -� based on a design drawn by se (addressy U_;a5ckT '� C dated� � I (o .:o (designer) `certify that the septic system referenced above was installed:substantially according to :the-design, which may include minor.approved changes such-as lateral relocation of the distribution box and/or-septic tank:: I certify-that the septic system referenced above was installed with major changes (i.e: : 3 greater than,10' lateral relocation.of the SAS or any vertical relocation of any component...... of the septic system)but m-accordance-with--State&Local-Regalations::Plan revision or certified.as built by designer to follow. OF*s�,4 QAVJD o (Installer's Signature) COUGHANOWR CA W 1093 GIsTS� SgAft TAR\Pa (Designer's:Signature) _ {Affix Designe tamp Here} ......... ... PLEASE RETURN TO BARNSTABLE..-_'ktBLIC.- HEALTH- DIVISION.:- : CERTIFICATE . OF . COMPLIANCE WILL.NOT...BE ISSUED UNM BOTH THIS.:FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. - - 0:Health/Septic/Designer Certification Form 3.26-04.doc 1 1 ; _t•!GW �w§�CJ6��Gk I . l I � ' 1 ' .•.,.,,_ �._.+ _r �.-r_� ...._ ._ 1. ..._.-_. . _...__`T'C�01F1 Az- 1 , . 00 -I �- -- - ------- i i ....- -._ ._ ._.. .._ .. _.... - ..._ .... ......_.. _ _ _ 1 6.e Cs,- �A C r �z4c� s r - 1 c.c�o U z?Z -- T CJ own of Barnstable. P# Department of Regulatory Services 2 Public Health Division Date + tbsq. 200 Main Street,Hyannis MA 02601 Y � X Date Scheduled Time ° Fe � e Pd. " i Soil Suitability Assessment for Sewage Disposal ,d Performed By:D 'Lill) b • CD,)&HA-w Witnessed By: UQu A-,R DDES Kr_M LOCATION& GENERAL INFORMATION 1 Location Address f�/I S Old / Si*e k4 Owner's Name 6 `T (G( o P� Aadress _...Assessor's Map/Parcel: Engineer's Name NEW CONSTRUCTION V REPAIR Telephone# ��. 'j�L� ©�Z Land Use 1 ��1 y I i Slopes(g'o) 2 Surface Stones Distances from: Open Water Body IJD� 0 ft Possible Wet Area_ _6+ ft Drinking Water Well jop+ ft Drainage Way ft Property Line Cd f ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands is proximity to holes) ma's \ TP® 7P-2 \ ® O \*% i Cr Q: I, A {t ' y Parent material(geologic) �dG Ua� �v' "t'"�� Depth to Bedrock Alp Depth to Groundwater. Standing Water in Hole: V D w e—_ . Weeping from Pit FoCe I IG T P—C. ll 2 h i w •T P-> Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Q evthed Ii 4i`er- w'ee N w Depth Observed standing in obs.hole: - _ ____ in, Depth to Soil mottles: in, Depth to weeping from side of obs.hole: i16 in, Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adj,factor.,,,,m,4 Adj.Groundwater Level— PERCOLATION PERCOLATION TEST Dgte S S d08Thne tittil #M Observation , Hole# A C_ Time at 4" 0 1'2A Depth of Perc � lh I V Time nt 6" ��'©0 �4 7 ' Start Pre-soak Time @ yO' O Y�'000 Time(V-6") 10 mt n 1 End Pre-soak Rate MinJlnch D N1p 1 m Site Suitability Assessment: Site Passed V Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- -, ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one(1)week prior to beginning. Q:\.SEPTICIPERCFORM.DOC T DATE OF TEST:- MAY 5. 2008APROVED ` 0. COUGHANWR. S 0 I L TES T L 0 G+ WITNESSEDI BYVALUATOR: DONADLD DESSMARA SO HEALTHI DEPT. PERC NUMBER: 121B6 NO I, TEST PIT A PAARENDTUNDWATER MATERIAL: IPROGLAC ALD OUTWASH PERC AT 72 to - 10 MIN/INCH IN C2 SOILS ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER I 73.37 (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING 0-3 0 WOOD LOAM 10 YR 2/1 NONE FRIABLE 3-8 A LOAMY SAND 4 10 YR 3/4 NONE FRIABLE 8-30 T B LOAMY SAND 10 YR 4/4 NONE FRIABLE 6937 30-48 -Cl SILTY SAND 10 YR 5/3 NONE FIRM 63.37 46-120 1 C2 LOAMY MEDIUM SAND 10 YR 5/4 NONE FRIABLE ND-GR TEST PIT B - PARENT MATERIAL: ENCOUNTERED OUTWASH - 10. MIN/INCH,IN C2 SOILS ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER - (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING 74.41 i 0-4_ .' 0 WOOD LOAM -_ z _ _ 10 YR 2/2 NONE FRIABLE 4 4-8 A LOAMY SAND 10 YR 3/4 NONE FRIABLE i _ 8-32-+ `B 'LOAMY SAND `"' 10 YR 4/4 NONE FRIABLE 70.24 32750 C1_ SILTY-SAND _ 10 YR 5/3 NONE FIRM L 50-126 C2 LOAMY MEDIUM SAND 10 YR 5/4 NONE FRIABLE 63.91 _ --- - - _ PERCH WATER WEPING AT 116 in TEST P.I T C _ PARENT-MATERIAL: PROGLACIAL--OUTWASH( 3 MIN/INCH IN C S'OILS ELEVATION USDA SOIL SOIL COLOR SOIL OTHER , ) _ DEPTH SOIL _ __ (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING 73.62 0-4 0 WOOD LOAM f. 10 YR 2/2 NONE FRIABLE i 4-7 E LOAMY-SAND C 10 YR 4/1 NONE FRIABLE 7-12 . A - LOAMY-SAND- - --10 YR-3/3 NONE FRIABLE 12-28 , B LOAMY SAND 10-YR 4/6 NONE FRIABLE 28-46 C1 MEDIUM SAND_ 10 YR 5/4 NONE LOOSE 69.62 46-148 •C2 LOAMY MEDIUM SAND 10 YR 5/4 NONE FRIABLE 61.29 TEST PIT D� PERCHED�WATER WEEPING AT 112 in (el = 63.69) b PARENT MATERIAL: PROGLACIAL OUTWASH 10-MINYINCH-IN C SOILS ELEVATION DEPTH SOIL . :USDA SOIL SOIL COLOR SOIL OTHER 73.02 (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING } 0=6 _ FILL 6-9 _0 P LOAM 10 YR 2/2 NONE FRIABLE " 9-14 A LOAMY.SAND 10 YR 3/3 NONE FRIABLE 70 02 .14-36 B LOAMY SAND 10 YR 4/6 NONE FRIABLE -- -36-120 C- —I'LOAMY MEDIUM-SAND 10 YR 5/4 NONE FRIABLE $a J Flood Insurance Rate Map: Above 500 year flood boundary No— Yes ✓_ -Within 500 year boundary No V, Yes Within 100 year flood boundary No ✓ Yes Depth of Naturally Occurrine Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? Y 25 If not,what is the depth of naturally occurring pervious material? ..� Certification d r I certify that on��`� �� ^ (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis`Was performed by me consistent with, . jN of 4rlss9c the required training,expertise and experience described in 3 10 CMR 15.017. DAVID� Signature SE� Date o D. COUGHANOWR t 410ENS��S�� OQ 6VALOP� Q-.\SEP'mPERCFORM.DOC COMMONWEALTH OF MASSACHUSETTS EXECUTIVE,OFFICE OF„ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESS ME 22 2000 SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART Tc j� A NEti� CERTIFICATION .� Property Address: 1845 Old Stage Rd MAP W Barnstable PARCEL " Z S 0 Owner's Name: Nancy Johnson • Owner's Address: LOT • Date of Inspection: Name of Inspector:(please print) Wi 1 1 jam R Robi nson Sr. Company Name: William E. Robinson Septic Service Mailing Address: P O -Box 1089 Centerville, MA Telephone Number: ( 508) 775-8776 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 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: 'V Passes. Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Sigtsature: e(o 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 appro.ving authority. Notes and Comments ****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. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of l l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS, f SUBSURFACE SEWAGE DISPPOAL T AYSTEM INSPECTI. , O CERTIFICATION (continued): Property Address: 1 8 4 W B - Owner. Nancy .Tnh_nson Date of Inspection: 3 Inspection Summary:;Check A,B,C,D.or E/ALWAYS complete,all of Section D A. System Passes: L/have not found any information which indicates that any of the failure criteria described it 310 Ct.QR 14 A F' 15.303 or in-310CMR>1.5.304,exist.Any failure criteria not evaluated are indicated below. Comments: ,. ..�.... ©.! B. .ystem Conditionally Passes: \One or more system components as described in the"Conditional Pass"section need to be replaced or reps\) The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. N in the for the following statements.if"not determined"please Answer es,no or not determined(YND, ) 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 exftltration or tank failure'Is izturttnenL System will pass inspection if the existing talc 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 expla' Ob ervation 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 f Board of Health):_ broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND a lain: Tlae system required pumping more than 4 times a year due to broken or obstructed pipes) The system will pass inspe tion if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is rcmovcd ND explain: a Page 3 of 11 OFFICIAL INSPECTION FORM:':.NOT FOR VOLUNTARY ASSESSMENTS . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART`A CERTIFICATION(continued) 1845 Old Stage Rd Property Address: w Barnstable - Nancz—J�hn�en - Owner: Date of Inspection: 4 —7— 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 s stem' is iling to protect public health,.safety or the environment. 1. System will pass unless Board of Health determines m'accordauce with:310'.CMR 1.5.303(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.feetof a bordering vegetated wetland or a salt marsh. 2. Sy item 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 10.0 feet of a su face water.sup ply 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,. e presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other ailure criteria are triggered.A copy of the analysis must be attached to this form. 3.L(herlhe,: 3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM,INSPECTION FORM .,PART A. CERTIFICATION(continued) Property Address: 1845 Old Stage Rd cy o nson Owner. Date of Inspection: D. System Failure Criteria applicable to all systems:. - Youhnust 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 S-A&or cesspool . t t Discharge'or ponding of effluent to the surface of the ground or surface waters due to an overloa a or clogged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or`: cesspool pth in cesspool is less than 6' below invert or available volume is less than'/:day flow Liquid de 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. is within l00 feet of a surface water supply or tributary to a surface Any portion of cesspool or privy 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 1.100 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 bacteri nd 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.] (Yes/No)The system fails.I have determined that one or more of the above failure criteria exisf 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. L rge Systems: To be nsidered a large system the system must serve.a facility with a design now 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 e system is within 400 feet of a surface drinking water supply e system is within 200 feet of a tributary.to a surface drinking water supply t e system is located in a nitrogen sensitive area(Interim Wellhead Protection Area IWPA)or a mapped one 11 of a public water supply well if you have an wered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Secti n D above the large system has farled.'llte owner ar operator of any large system considered a significant thr at under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The s stem owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 ' OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SE. WAGE DISPOSAL SYSTEM INSPECTION FORM PART R CHECKLIST` Property Address: 1845 Old Stage Rd W Barnstable Owner. Nancy Johnson Date of Inspection: / 'J- 3 Check if the following have been done.You must indicate`yes"or"nW'as to each of the following: Yes o Pumping information was provided by the owner,occupant,or Board of Health V//Were any of the system components pumped out in the previous two weeks? i/ 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 ofsewage backup? Was the site inspected for signs of break out? - — Were all system components,excluding the SAS,located on site? — Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the.condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems:?_ The size and location of the Soil Absorption System(SAS)on the site has been determined based on:. Yes no — /�xisting information.For example,a plan at the Board of Health. i/_ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] 5 . Page 6 of I 1 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART,C. SYSTEM INFORMATION Rd e Property Address: 1845 Old Stage - arns a e Owner. Nancy johnson Date or Inspection: FLOW CONDITIONS RESIDENTIAL. Number of bedrooms(design):. Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x N of bedrooms): Number of current residents: C� Does residence have a garbage grinder(yes or no): /L-:d Is laundry on a separate sewage system(yes or no)-. ?[if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use:(yes or no):f� Water meter readings,if available last 2 ears usa e d g � Y g Bp ))• Sump pump(yes or no): 4- e) Last date of occupancy: COMMERCIA ANDUSTRIAL Type of establis ent: Design flow(bas d on 310 CUR 15.203): avd. Basis of design fl ;w(seats/persons/sgft,etc.): Grease trap prese t(yes or no):_ Industrial waste olding tank present(yes or no):_ Non-sanitary w to discharged to the Title 5 system(yes or no)' Water meter re dings,if available: Last date of oc upancy/use:~ OTHER(de cribe)• GENERAL INFORMATION Pumping Records Source of information: ,ri i0 Was system pumped asp of the inspection(yes or no):�,0 If yes,volume pumped:_gallons--How was quantity pumped determined? Reason for pumping: TYP F SYSTEM — eptic 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 so cc of information: Were sewage odors detected when arriving at the site(yes or no): A- 6 Page 7 of 1 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM:INSPECTION FORM" PART C SYSTEM INFORMATION.(continued), . Property Address: 1845 Old Stage Rd W Barnstable Owner: Nancy Johnson Date or Inspection: BUILDING SEW R(locate on site plan) Depth below grade Materials of cons ctiou _cast iron _40 PVC_other(explain): Distance from pri ate water supply well or suction line: Comments(on c dition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: cate on site plan) c � Depth below grade: I �� Material of construction: oncrete_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) � �� ' 1 b�►'� Dimensions: Sludge depth: ' Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: d Distance from top of scum to top of outlet tee or baffle: , Distance from bottom of scum to bottom o,ffg utlet tee or baffle How were dimensions determined: O-I'cr�-- y+ 1G Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related.to outlet invert,evidence of-leakage,etc.): GR SE TRAP:_(locate on site plan) Depth Blow grade:_ Materia of construction:_concrete_metal_fiberglass_polyethylene_other = (explain Dimensions: Scum thi lcricss: Distancel 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 iast pumping: Conunchts(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): 7 it Page 8 of 1 I , OFFICIAL INSPECTION'FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued). property Address: 1845 Old Stage Rd arnstable Owner: Nancy Johnson Date of Inspection: TIGHT r HOLDING TANK: (tank must be pumped at time of inspection)(locate on.site plan) Depth bd w grade: g ___polyethylene Material o construction: concrete. metal fiberglass other(explam): Dimension Capacity: allons Design Flog, gallons/day Alarm pre ent(yes or no): Alarm lev 1: Alarm in working order(yes or no): Date of la t pumping: Comment (condition of alarm and float switches,etc.): ..,X: V if resent must be opened)(locate on site plan) DISTRIBUTION BOX: ( p , Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence leakage into or out of box,etc.): d PUMP CHAMBER: (locate on site plan) Pumps in working orde (yes or no): Alarms in working orde �ose or no): Comments(note conditi f pump chamber,condition of pumps and appurtenances,etc.): 8 r Page 9 of 11 OFFICIAL INSPECTION FORM-NOT.FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1845 Old Stage Rd arns a e Owner: Nancy Johnson Date of Inspection: /—/7 o 3 SOIL'ABSORPTION SYSTEM(SAS): 1:40ocate on site plan,ezcavation'not required) If SAS not located explain why: Type leaching pits,number: leaching chambers,number. leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system .Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): Z C _ �/ J AI CESSPO OLS: (cesspool must be pumped as part of inspect ion)(locate on site plan) Number and con guration: Depth—top of liq id to inlet invert: Depth of solids la r. Depth of scum laye Dimensions of cess ool: Materials of constru tion: Indication of ground ater inflow(yes or no): Comments(note con ition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: (locate n site plan) Materials of constructi n: Dimensions: Depth of solids: Comments(note cond' ion of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 9 Page 10 of l l t OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESS MEN SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM TS PART C SYSTEM INFORMATION(continued) Property Address: 1845 Old Stage Rd W Barnstable - Nancy rChMMznT— Owner: Date of Inspectlon:l—�—O3 1 I LU SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system includin ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate w ere public water supply enters the building. g 4° � 2 l � � y f • ` 1 10 Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1845 Old Stage Rd Barnstable = Owner. Nancy Johnson Date of Inspection: !"—? 3 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 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: bserved 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: -y 11 Town of Barnstable t EAMSM Department of Health, Safety, and Environmental Services EZ 9�A059. ,0 Public Health Division TED'AP�A P.O. Box 534, Hyannis MA 02601 Office: 508-790-6265 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health RECORD OF VERBAL COMMUNICATION J-0 4, 6r L� Gc" c f'tt G.ad C L e. 7 c— 2 iw:�•ti`�G► J G-S,v to dia 0 l C/,r� Ue Z k', G-r. q- Sot, d WOto 5 46 4- W,, b 2 n S c-� /! u� W a.I /p aC ev, Yo Le w 0— _ CIAA .�C J1�O y� SA a,-? r'� QGL-c c.�v�T '7� i A f.�� verbcomm.doc J FT�ti Town of Barnstable o� STAB Department of Health, Safety, and Environmental Services ' �� Public Health Division pIEO"AA�A P.O. Box 534, Hyannis MA 02601 Office: 508-790-6265 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health RECORD OF VERBAL COMMUNICATION Z `/'e-� � w S raw-t - T'e� `� y►�.�-�.vim, OGc .Sc��.e, cu, /949 Ste. c��a.�►.�,—, ��r r �- �.c f �r c.�o�.�.�..�.�-, verbcomm.doc �OFTHE 1pw� Town of Barnstable BAMSTABL& Department of Health, Safety, and Environmental Services 059. Public Health Division A'FD1A0�A P.O. Box 534, Hyannis MA 02601 Office: 508-790-6265 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health RECORD OF VERBAL COMMUNICATION cam/ fA".Q U D a.�-w-Z.41y 1%1'e-- �flr �p -Wfn .r- 7 j 4-1-e G"II _V .,a L 'e .-,,- JZ- vim. O� &.' kc h.� d,- W►" `/A— G/rr-'— chwo a 4JC.plV/f C/ S""�' � 1.0 (nl F-) Y-'h� UL..L U✓V� A9'V '� lN�" C1r!4w'� ,�VW d'- �P CA., �e �s/� .o vi1 ono G� Go �.vK/, l/:�ev►/� vp CA- wean more® �� if/oa:� 'kan.- tO 4 P w- S�nre L. .f GZ.cg tit `�t1�1`.Q w, l�-eel f @ , / / �t:�►..e �v �C2 G✓ocr�o%c� `�o �.t'it.,-cstn. fn.�Q�In To-P zot.- X1je mac. y`)- ,�aar - Cie L. lac � p o�-l�a►- Gve�1 � ® (,2. so J- s s 4A-J(d, h&C Ct _!;�p OL, a verbcomm.doc Town of Barnstable BAMSTABIE Department of Health, Safety, and Environmental Services 1MASS 639. ,,� Public Health Division p'EDN10�A P.O. Box 534, Hyannis MA 02601 Office: 508-790-6265 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health RECORD OF VERBAL COMMUNICATION yve- uj A cyf Cv d' �,,l 'F l¢O k—, 61, 36..1"d� �oa .La-d�-�ai� Cvvlle J A K11,4��r+ AA verbcomm.doc FEE r Town of Barnstable 0 sAxcvsrns Department of Health, Safety, and Environmental Services 9� ' ,0� Public Health Division P.O. Box 534, Hyannis MA 02601 Office: 508-790-6265 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health RECORD OF VERBAL COMMUNICATION .40 T/2 6KG /'kcaL6r-- C✓c�-S 4 , 7'L i c, .e S �p��-ae� a4� �y-Jv4c-, ( v k�s t,u,,L44 ,,a lam. tF ��.� G.�� 5��02O 917 C&& /r/c cy da 9 v verbcomm.doc Town of Barnstable BAMSfABLE Department of Health, Safety, and Environmental Services 9� 16;q. 10� Public Health Division ATfD"1D�& P.O. Box 534, Hyannis MA 02601 Office: 508-790-6265 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health RECORD OF VERBAL COMMUNICATION Z-2 G-GCe rj *,I 14- N 19� verbcomm.doc Town of Barnstable o� �nB Department of Health, Safety, and Environmental Services 9� MASS. ,�� Public Health Division AlfOtNO�A P.O. Box 534, Hyannis MA 02601 Office: 508-790-6265 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health Gu, (KO"Aj:l*b(0, RECORD OF VERBAL COMMUNICATION e .— �.�`� aL4- dar d�-, �a /�a l �� '7'�L..►.SH,:I a.,d5a-,, U cn aLe n_ L.ra a•� 7 �-ae a r rVa•I er/ QVX c c Ot ,� C,a-N c.O�e -.per L4-9 k1� 'A sa,.� 4,;-,j awn 't1 vP re p L�- ow,� (,✓ram-r-ra.r�.�i� du G� lcrw-i� �-- o�'y/Ln�-�r�� 6P verbcomm.doc 4-1_Zodo lYY.s' 0/d S�oy►� w.R. '�►� Fo y b r 'fo �i'E'G�+6H. G..�_Z,eso /fYs'" Odd •r��C �,, 4i•Q• Yils.S foals. -+ !%.�•�td� +.+! t+•�li�4t.l g r-o✓i- of F•Ya r �i-e t)a. iZw+ I &-r-Z.00 o /Jr4i r o!1 SihK&Q A r:rC- loos c. o�,,,,d c;i t ►N -R,,o�t�. K;��r.•M s�n�c . G.ru1 N�..�.�K��•M 2•S- . i `-I-t000 /TS(s O�dSfs.�G ( , W.Q. « HO) �vw�. �i+c.as•, t� Liviws R-ovw►• kith Mar�i.t�teH� �• S� . I t FAR ANILM I � aid .14404 (r.o�♦" w•i fS PA%d&e"&vj. A/b Sta Gd`« .r�-�Kff �R•S• FoRM30 C,W HOBBS&WARREN Tm THE COMMONWEALTH OF MASSACHUSETTS r BOARD OF HEALTH (�cu-�►1 �a.h le. CITY/TOWN,, a DEPARTMENT 3 G 7A u�P"-J c � SB LIC Ll `�/e q TELEPHONE Address- 0 -S 42,dJ loccupant ae Ait °rd Floor Apartment No. No.of Occupants =� No. of Habitable Rooms No. Sleeping Rooms No.dwelling or rooming units-1 No.Stories �- Name and address of owner �</a-�e� :10 t8 c� _ Remarks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: Roof Gutters, Drains: Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: Li htin : STRUCTURE INT. Hall,Stairway: Fjocr h*(e) IaOJe 6ZA& rOv�t GVr_C&,W - 4/6 2 Sao Obst'n.: @ -e—. w (.e.„t a0 M, 4(.t Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows.- HEATING Chimneys: Central ❑ Y ❑ N Equip. Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line.- H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den Living Room Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas,Oil, Elect.: Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink Stove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: 6v-vvfpllaw ih a 'f 5✓ d n/C. Wash Basin, Shower or Tub: sera do �✓, Infestation Rats, Mice, Roaches or Other.- Egress Dual and Obst'n: General Building Posted Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR.(See Over) "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES F PERJUR .' INSPECTOR '✓' TITLE DATE ( TIME Z" o A.M. A.M. THE NEXT SCHEDULED REINSPECTION P.M. tw:� Y•6:-•�.-�'*�r;n�•�•`F1C."4./"p!".L�� fi1R'!f•: a� :'�Nl�,�'{��' ,t '�.%dii�d�i�Ut:�i' S' "1t+�+�7r�."wi•":"•F'i"7�Fanl�F�'�^`arM-.:�(•ii�S{W�wY1�?!.ppy�j►�`�a;,�j',id'vi��+d``r:Y"--a+�rs+w-�-:ryw, •i f�:; f 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises, shali be deemed conditions which may endanger or impair the heaith, or safety and well-being of a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B) and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash,which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish,filth or other causes of sickness,which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof,foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2) and 410.150(A)(3)or any defect which renders there inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). - (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105.CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0) shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. 'M THE COMMONWEALTH OF MASSACHUSETTS 21 FORM 30 �1�W HOBBS&WARREN . BOARD OF HEALTH CITYj /TOOWN W -- — DEPARTMENT 36 "7 41 Sf''eert ADDRESS T ff V GqM Z TELEPHONE Address /g�/S d S� oZ d�j W.Ex_kirlOccupant_14a(- 14 Floor _Apartment No. r,: ._ No.of Occupants Q_S No.of Habitable Rooms _ 'No.Sleeping Rooms -J _ No.dwelling or rooming units_1_:` No.Stories 7-- Name and address of owner /y Y�o S __— Remarks Reg. Vio. YARD -Out Bld s.: Fences: Garbage and Rubbish Containers: Drainage i Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: Roof Gutters, Drains: Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: ' Li htin : STRUCTURE IN Hall,Stairway: Floc,, dz'&) triole Cva44 rav,t lvaewr! -f 5�/v S� ObstIn.: @ o Y-e— f- a/ w gn.r,'{c r lky �0 bi, led., Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: , HEATING Chimneys: Central ❑ Y ❑ N E ui . Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen. Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den Living Room Bedroom(1) Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas, Oil, Elect.: Stacks, Flues,Vents,Safeties.- Kitchen Facilities Sink Stove Bathing,Toilet Facil. Vent., Plumb., Sanit'n.: Grv„f � rh a Y+ - u-c fiJt- v l�f` yjo -Py G. Wash Basin, Shower or Tub: �-f p l do Cfy✓, Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General Building Posted Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR. (See Over) "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF PERJUR .' INSPECTOR TITLE 6 / J A.M. DATE r/ TIME Z' ' P.M. i A.M. i THE NEXT SCHEDULED REINSPECTION ova. r I �/ P.M. M� 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises, shall be deemed conditions which may endanger or impair the heaith, or safety and well-being of a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter II, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B)and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash,which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish,filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof, foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any,of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2)and 410.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. T ti Z 273 502 599 US Postal Service Receipt for Certified Mail No Insurance Coverage Provided. Do not use for International Mail(See reverse Seeak — St r /f Po tate,&ZIP Gi 2. Postag $ Certified Fee Special Delivery Fee Restricted Delivery Fee N rn Return Receipt Showing to Whom&Date Delivered n Return Receipt Showing to Whom, Q Date,&Addressee's Address Q TOTAL Postage&Fees $ M 7ostmark or Date LL a Stick postage stamps to article to cover First-Class postage,certified mail fee,and charges for any selected optional services(See front). 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address leaving the receipt attached, and present the article at a post office service window or hand it to your rural carrier(no extra charge). I 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the m return address of the article,date,detach,and retain the receipt,and mail the article. Ln 3. If you want a return receipt,write the certified mail number and your name and address I on a return receipt card,Form 3811,and attach it to the front of the article by means of the it gummed ends if space permits. Otherwise,affix to back of article. Endorse front of article Q RETURN RECEIPT REQUESTED adjacent to the number. Q 4. If you want delivery restricted to the addressee, or to an authorized agent of the C addressee,endorse RESTRICTED DELIVERY on the front of the article. M 5. Enter fees for the services requested in the appropriate spaces on the front of this E receipt. If return receipt is requested,check the applicable blocks in item 1 of Form 3811. o r 6. Save this receipt and present it if you make an inquiry. 102595-99-M-0079 a Town of Barnstable Department of Health, Safety, and Environmental Services � $BARPMIX Public Health Division 1639. �0 � D"AO�A P.O. Box 534, Hyannis MA 02601 Office: 508-8624644 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health March 30, 2000 Nancy L. Johnson P.O. Box 342 Hyannis, MA 02601 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.00, STATE SANITARY CODE II, MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE RENTAL ORDINANCE,ARTICLE 51 The property owned by you located at 1845 Old Stage Road, W. Barnstable, was inspected on March 21, 2000 by Glen Harrington, R.S. Health Inspector for the Town of Barnstable, because of a complaint. The following violations of 105 CMR 410.00, State Sanitary Code H, Minimum Standards of Fitness for Human Habitation were observed: 410.500: The foyer floor tile grout was observed cracked and missing. 410.504C: The bathroom tub was observed not to be sealed to floor. 410.550: Multiple live insects were observed in second floor storage closet. You are directed to correct the above listed violations within seven (7) days of receipt of this notice. You may request a hearing if written petition requesting same is received by the Board of Health within seven (7) days after the date order is received. However, these violations must be corrected regardless of any request for a hearing. Please be advised that failure to comply with an order could result in a fine of not more than $500. Each separate day's failure to comply with an order shall constitute a separate violation. PER ORDER OF THE BOARD OF HEALTH as A. McKean Director of Public Health q/wp/johnson4/ls y pact , l!/lf� °z 6 0 1 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.00, STATE SANITARY CODE H, MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE RENTAL ORDINANCE,ARTICLE 51 The property property owned by you located at/tqS—o ld fleP i fit, , was inspected on 41 a,-p(q 21 , 2000 by Glen Harrington, R.S. Health Inspector for the Town of Barnstable, because of a complaint. The following violations of 105 CMR 410.00, State Sanitary Code H, Minimum Standards of Fitness for Human Habitation were observed: 16S"c An..2 1410, SM T1-4 d-lw,- 0 6 greo 41 CI, So 4 (o �•,. dv b w a d b f e ry c� ti.o dv�a e J=e afi o� YE �i 1U . CA- J� ��J�) (v-o� dbje ,,�� e �.co e�Cov✓ sdw�i—e ar irect o co t th viol c ' t sn You are also directed to correct the above listed violations within seven (7) days of receipt of this notice. You may request a hearing if written petition requesting same is received by the Board of Health within seven (7) days after the date order is received. However, these violations must be corrected regardless of any request for a hearing. Please be advised that failure to comply with an order could result in a fine of not more than $500. Each separate day's failure to comply with an order shall constitute a separate violation. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean Director of Public Health f TOWN OF BARNSTABLE CF?NE raw OFFICE OF = H�ASS alth ComplaintsOtIOARD OF HEALTH pY• 367 MAIN STREET 16-Mar-00 HYANNIS, MASS.02601 Time: 11:00:00 AM Date: 3/16/00 Complaint Number: 2270 Referred To: GLEN HARRINGTON Taken By: LS Complaint Type: CHAPTER II HOUSING Article X Detail: Business Name: O� rQ Number: 1845 Street: OLD STAGE ROAD Village: WEST BARNSTABLE Assessors Map_Parcel: Complaint Description: THERE ARE PARTICLES OF DIRT, p p SAWDUST&WEBBING COMING OUT OF THE DINING ROOM CEILING. THE FLOOR IN THE BATHROOM HAS SHARP PIECES OF TILE ALL AROUND THE BATHTUB. SHE CUTS HER FEET. THE LANDLORD IS NON- RESPONSIVE. Actions Taken/Results: Investigation Date: Investigation Time: S cL C Se+ 4v,-- 1 �t� 152035002 �� 152035002 V 000878 pe#7tt \0000000 1 82AC 1.67 JOHNSON,NANCY L ASS 101� ` '\\\ tpl P O BOX 342 \ � \\ y Beed€fates 03018411892 0 \ so #(� JOHNSON NANCY L YY 4067/288 \ 000058400 Bid#f� 9g. 000072900 I43 0000000000 //s 1845 OLD STAGE ROAD 1174 # 0076 WB \o JUDY S LANE 1 I 0818 Fit 0070 of �\i��\n•� \:.�\ - /� / \u z � a, ` - �� \�� F / l \ '<a` ,cf':''.,<u..w;,:w:?.a'Mf „_��`�1...,�.n..,., �;•,3 .... .... ..a .Ki..,... ..,..,.,, yw•....,,�� _... ' ..,..,.....�.. FORM3o HOBBs&WARREN,INC. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH � ��v►s�a-b 1� CITY/ OWN WMea 104 ` DEPARTMENT �/// e-0`Qe0 jc T 3 LJj 3 to 7 Kti,,,a Chi ADDRESS TELEPHONE Address '5 610(A��/?0' 6/9"14-S?Occupant Dal/QS/4 /j floor Apartment No. No.of Occupants_ l� No.of Habitable Rooms_s No.Sleeping Rooms -� No.dwelling or rooming units / No.Stories Name and address of owner_( 0-4A L,/ TQ 1-tn-S ain Remarks Reg. Vlo. YARD Out Bld s.: Fences: Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: Roof Gutters, Drains: Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: Lighting: STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: l-0- Aill`SSG � Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑Y ❑ N Equip. Repair TYPE: Stacks,Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels,Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT S Ventil. L to . Outlets Walls Ceils. Wind, Doors Floors Locks Kitchen Bathroom Pantry Den Living Room Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas,Oil, Elect.: Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink Stove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: d o a(o r-- /0 Wash Basin,Shower or Tub: Infestation Rats, Mice, Roaches or Other: ' f-�5 c%L, Yle, Egress Dual and Obst'n: General Building Posted Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE 'CODE OR THE AUTHORIZED INSPECTOR.(See Over), "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF PERJURY." INSPECTO 5 ,9!! a TITLE DATE 3�ZI� TIME 2 -FMJ p A.M. THE NEXT SCHEDULED REINSPECTION P.M. a 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises, shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises. This listing is composed of these items which are deemed to always have the potential to endanger or materially impair'the health or safety, and well-being of the occupants or the public. Because Chapter II, 105 CMR 410.000 through 410.499 state minimum requirements of fitness for human habitation, any violation has the potential to fall within this category in any given situation but may not do so in every case and therefore cannot be included in this listing. Failure to include shall in no way be construed as.a determination that other violations may not-be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of the violation(s) pursuant.to 410 CMR 410.830 through 410.813 nor shall it affect the legal obligation of the person to whom the order is r issued to comply with such order. (A) Failure to•provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105. CMR 410.180 and 410A 90 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper ' venting or.use of a space heater or water heater as prohibited by 105 CMR 410.200(B) .and 410.202., (C) Shut-off and/or failure to restore electricity or gas. (D). . Failuie to supply the electrical facilities required by 105 CMR 410.250(B); 410.251(A), 410.253(A), 410.253(B) and the lighting in common area required by 105 CMR 410.254. '(Z) Failure to provide a safe supply of water. (F) _ Failure to provide a toilet and maintain a sewage system in operable '. condition as required by 105 CMR 410.150(A)(1) and 410.300. '(G) Failure to provide,adequate exits, of the obstruction of any exit, passageway or common area caused by an object, including garbage or trash, Which prevents egress in case of an emergency 105 CMR 410.450 and .410.451. (11) Failure to comply with the security requirements of 105 CMR 41D.480(D). (1) . Failure to comply with any provisions of 105 CMR 410.600 through 410.602 =..'which results in any-accumulation of garbage, rubbish, filth or other causes ;of sickness which may provide a food source or harborage for rodents, insects `ior other pests or otherwise contribute to accidents or to the creation or :.spread of disease. (J) The presence of lead-based 'paint on a dwelling or dwelling unit in .violation of -the Massachusetts Department of Public Health Regualtions for Lead Poisoning Prevention and Control 105 CMR 460.000. Hoof,'foundation, or other structural defects that may expose the occupant,or anyone else to fire, burns,+ shock, accident or other dangers or w wpAftftnt to health -or dafety. (1:) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilities as are-required by 105 CMR 410.351 and 410.352 so as to expose the occupant .'-or anyone else to fire, burns, shock, accident or other danger' or impairment ` to..-health or safety. (M) Any of the following conditions which'remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: ('t)' lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack Hof a_stove and oven or any defect that renders either operable. (2) failure•to provide a washbasin and a shower or bathtub as required in 105 CMR 410.150(A)(2) and.410.150(A)(3) and any defect which renders them inoperable. _ (3) any defect in the electrical, plumbing, or heating system which makes _ _such system or any part thereof in violation of generally accepted plumbing heating,, gas-fitting, or electrical.wiring standards that do not create an-immediate hazard. ({)_failure to maintain a safe.handrail or .protective railing for-every stairway, 'porch balcony, roof or similar place as required by 105 CMR 410.503(A) and 410.503(B). (5) failure to -eliminate rodents, cockroaches, insect infestations and other pests is required by 105 CMR 410.550. (N) Amy other violation of Chapter II not enumerated in 105 CMR 410.750(A) through (M)-shall be deemed to be a condition which may endanger or materially iv"$r the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time.so ordered by the board of health. _'J t COMPLETE •N COMPLETE THIS SECTIONON DELIVERY ■ Complete items 1,2,and 3.Also Complete A. Received by(Please Print Clearly) B. Date of Delivery item 4 if Restricted Delivery is desired. ■ Print your name and address on the reverse so that we can return the card to you. L C. j�!ature ❑Agent ■ Attach this card to the back of the mailpiece, or on the front if space permits. � `---❑-Addressee - D. Is dery dre rent from item 1? ❑Yes 1. Article Addressed to: If YES, ter d . ery address below: ❑ No N - 3. Service Type ❑Certified Mail ❑ Express Mail �`�/•/ ❑ Registered ❑ Return Receipt for Merchandise l� ❑ Insured Mail ❑C.O.D. 0 ��/ 4. Restricted Delivery?(Extra Fee) ❑Yes 2 it tilt i!!!i it . i1 i, t!!if i!!i! !!t it! it i ! f! i t !i!!1 it till 4 !1! it it !ltll iitk k Ili M it i PS f j102595.99-M-1789 UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid USPS Permit No.G-10 • Sender: Please print your name, address, and ZIP+4 in this box • Public Health Blviden Town of&Mist" P.O.BOX 534 II kink user 02801 1 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTIO r t ONE WINTER STREET, BOSTON, MA 02108 617-292-5500 Steve B roz � Vb`1LL1AM F.VELDq TR&DY COXE Governor R ` ,�,. ecretan i ARGEO PAUL CELLUCCI 110 t�lyy S r9�AVID TRUHS Lt.Governor SUBSURFACE SEWAGE DISPOSAL INSP FF J Co issioner PA CER I TION Property Address:18 4 Old. Stage a e R d.. ,Cent v p rty 5 g Address o T r 0 Date of Inspection: /'�59 `P (If different) W Yarmouth, Name of Inspector: Wm E Robinson Sr I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) Company Name: Wm E Robinson Septic Service Mailing Address: PO BOX 1089 , Centervi 1 1 e f IAA. 02632 Telephone Number:;, 5 0 8 7 7 5—A 7 7 6 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: Passes ' _ Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: i SYSTE PASSES: 7I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: B] SYSTEM CONDITIONALLY PASSES: One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 04/25/97) Page 1 of 10 DEP on the World Wide Web: http:Uwww.magnet.state.ma.us/dep e'j Printed on Recycled Paper r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: .1845 Old. Stage Rd., Centerville , NSA Owner: Steve Lg Q ron Date of Inspection: ` B] SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system.will pass inspection if(with approval of the Board of Health). Describe observations: .r� broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced _ The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed CJ FUR HER 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 the public health, safety and the environment. SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of 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 APPROPRIATE)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. _ The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER (revised 04/25/97) Page 2 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 1845 Old. Stage Rd.- ,Centerville , MA Owner: Steve LeBaron Date of Inspection: D] SYSTEM FAILS: You must indicate ei;!,er "Yes" or "No" as to each of the following: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. _ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 112 day flow. _ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E] GE SYSTEM FAILS: You ust indicate either "Yes" or "No" as to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area- IWPA) or a mapped Zone II of a public water supply well) The o ner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requir ments of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 04/25/97) Page 3 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 1845 Old. Stage Rd.. , Centerville Owner: Steve LeBaron Date of Inspection: Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No Pumping information was provided by the owner, occupant, or Board of Health. None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or / as part of this inspection. V _ As built plans have been obtained and examined. Note if they are not available with N/A. _ The facility or dwelling was inspected for signs of sewage back-up. J _ The system does not receive non-sanitary or industrial waste flow. _ The site was inspected for signs of breakout. _ All system components, excluding the Soil Absorption System, have been located on the site. _ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: _ The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub-Surface Disposal System. Existing information. Ex. Plan at B.O.H. Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) [15.302(3)(b)] (revised 04/25/97) Page 4 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:1845 Old. Stage Rd.. , Centerville ,. MA Owner: Steve LeBaron Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Design flow: L36- a.p.d./bedroom for S.A.S. Number of bedrooms.3--41 Number of current residents: Garbage grinder (yes or no):_/—o Laundry connected to system (yes or no)�-� Seasonal use (yes or no):,�- 6 Water meter readings, if available (last two (2) year usage (gpd): Sump Pump (yes or no):-,/--d Last date of occupancy: C MERCIAUINDUSTRIAL• Type f establishment: Desig flow: gallons/day Gress trap present: (yes or no)_ Indust al Waste Holding Tank present: (yes or no)_ Non-s itary waste discharged to the Title 5 system: (yes or no)_ Water meter readings, if available: Last ate of occupancy: OTH R: (Describe) Last of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System pu ed,as part of inspection: (yes or nov--d If yes, volume pumped: gallons Reason for pumping: TYPE OOYSTEM V 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) I/A Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known) and source of information: Sewage odors detected when arriving at the site: (yes or no)/L O (revised 04/25/97) Page 5 of 10 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 1845 Old. Stage Rd.. ,. Centerville ,, IVA Owner: Steve LeBaron Date of Inspection: jL Q 7 BU DING SEWER: floc to on site plan) Dept below grade: Mate ial of construction: _cast iron _40 PVC_other (explain) Dista ce from private water supply well or suction line Dia eter Co ments: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK:, (locate on site plan) Depth below grader Material of construction: _4,4oncrete _metal _Fiberglass _Polyethylene _other(explain) If tank is metal, list age — Is age confirmed by Certificate of Compliance —(Yes/No) Dimensions: Sludge depth: O Distance from top of sludge to bottom of outlet tee or baffler Scum thickness:(_ 1. Distance from top of scum to top of outlet tee or baffle: T Distance from bottom of scum to bottom of outlet tee or baffle: How dimensions were determined: �,ti Z✓ �'� Comments: (recommendation for pumping, condition of inlet and ou let tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) %L✓ �� `� d J z GRE E TRAP: (locate n site plan) Depth low grade: Material f construction: _concrete _metal _Fiberglass _Polyethylene —other(explain) Dimensi ns: Scum th' kness Distant from top of scum to top of outlet tee or baffle: Distan from bottom of scum to bottom of outlet tee or baffle: Date f last pumping: Comm nts (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) (revised 04/25/97) Page 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) -Property Address: 1845 Old. Stage Rd.. , Centerville . , MA Owner: Steve LeBaron Date of Inspection: ,�F TI T OR HOLDING TANK: (Tank must be pumped prior to, or at time, of inspection) (Iota a on site plan) Depth below grade: Materi I of construction: _concrete _metal _Fiberglass _Polyethylene _other(explain) Dimensi ns: Capaci gallons Design f ow: gallons/day Alarm I vel: Alarm in working order_Yes; _ No Date of previous pumping: Comm nts: (condi ion of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: L/ (locate on site plan) Depth of liquid level above outlet invert:_ Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) A PU P CHAMBER:_ (lo to on site plan) Pu ps in working order: (Yes or No) Ala ms in working order (Yes or No) Co ments: (n to condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 04/25/97) Page 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 1845 Old. Stage Rd . , Centerville , MA Owner: Steve LeBaron Date of Inspection: / -�-9 % SOIL ABSORPTION SYSTEM (SAS):_ (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number:_ leaching chambers, number:�� leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Alternative system: Name of Technology: Comments: (note condition of soil, sign of hydraulic failure, level of ponding, condition of vegetation, etc.) �16,0 361c—k:-3,t 330 Gal ' S>6ne" C' 6i/'-:5 C��m •t� / CESSP OLS: _ (locate site plan) Number a d configuration: Depth-top f liquid to inlet invert: Depth of so ids layer: Depth of sc m layer: Dimensions f cesspool: Materials of onstruction: Indication of roundwater: infl w (cesspool must be pumped as part of inspection) Comments: (note condi ion of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY:_ (locate on si a plan) Materials ofconstruction: Dimensions: Depth of solids- Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (zevimed 04/25/97) Page 8 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 1845 Old. Stage Rd.. , ' Centerville, MA Owner: teve LeBaron Date of Inspec ion: 1 S_Q 'I SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) a S 1 flP�^ l (revised 04/25/97) Page 9 of 10 t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 1845 Old. Stage Rd.. , Centerville , MA Owner: Steve LeBaron Date of Inspection: l—,r 9 S S+ Depth to Groundwater L Feet Please indicate all the methods used to determine High Groundwater Elevation: /Obtained from Design Plans on record Observation of Site (Abutting property, observation hole, basement sump etc.) Determine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records Check local excavators, installers Use USGS Data Describe in your own words how you established the High Groundwater Elevation. (Must be completed) h < a (revised 04/25/97) Page 10 of 10 TOWN OF BARNSTABLE LOCATION .� vAe" 6" -4 r Yea SE A�0 'r ah syl�, u VILLAGE ASSESSORS MAP & LOT I 03�i-O'a INSTALLER'S NAME&PHONE NO.SEPTIC TANK CAPACITY LEACHING FACILITY: (type) G�—�• � /C�� S(size) .42==�L3�—.2 ` NO.OF BEDROOMS L BUILDER OR OWNER 44" /;O2 d�✓�' PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom/Leaching Facility Feet Private Water Supply Well and Leaching Facili any wells exist on site or within 200 feet of leaching facili Feet Edge of Wetland and Leaching Facility(ff y wetlands exist within 300 feet of leaching facility) 7 Feet Furnished by �`� ° f✓AA 4 • jA. No. Fee Do THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Ztpprication for Mi-4pont *potem Con6truction Permit Application for a Permit to Construct( )Repair(Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 1845 Old Stage Rd Owner's Name,Address and Tel.No. 3 94—8146 W Barnstable Steven LeBaron Assessor's Map/Parcel - 0 3 S --p® Z 54 Trowbridge Pa W Yarmouth Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No. 3 98—8 311 W E Robinson Septic Service C R Short Box 1044 PO Box 1089 Centerville 02632 S Dennis MA 02660 Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder(no) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil sand Nature of Repairs or Alterations(Answer when applicable) Install Title 5 Septic system to the plans of C R Short (plan # 1-838) 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�Heth. de and not to place the system in operation until a Certifi- cate of Compliance has been issued by t 'Signed4 0 Date Application Approved by ® Date Application Disapproved f the following reasons-6L - __ I I / 9- Permit No. Date Issued ———————————————— --------- 1 TOWN OF BARNSTABLE LOCATION 41 Ol� S e �- �- `� �� SE AGE # VILLAGE ASSESSOR'S MAP & LOT 1� ,Z-03S -0-off INSTALLER'S NAME&PHONE NO. '�� SEPTIC TANK CAPACITY ev LEACHING FACELr Y: — 3 3 G Ga� S ( �_ (tYPe) � /L (size) NO.OF BEDROOMS �Z- BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE:1, -`'✓�/—} Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom " Leaching.Facility Feet Private Water Supply Well and Leaching Facili any wells exist on site or within 200 feet of leaching facili Feet Edge of Wetland and Leaching Facility(If y wetlands exist within 300 feet of leaching facility) Feet Furnished by �y K ,n� ��,... _ � -. .. r ,.,,� .... � .� .. .. .. . , _ ... •... f. w � .,.. ..... .olr.lam^ + � '.^. ^h�.Y. Fee �0, THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Y Yes Q PUBLIC HEALTH DIVISION - TOWN OF BARNSTABL-E., MASSACHUSETTS 2pprication for Digozal *p6tem Cowaruction Permit Application for a Permit to Construct( )Repair(Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 1845 Old Stage Rd Owner's Name,Address and Tel.No. 3 94-8146 W Barnstable Steven LeBaron Assessor's Map/Parcel 15-1 - 0 3 S O0 Z 54 Trowbridge Pa W Yarmouth Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No. 3 98—8 311 W E Robinson Septic Service C R Short Box 1044 PO Box 1089 Centerville 02632 S Dennis MA 02660 Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder P0) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title_ Size'of Septic Tank Type of S.A.S. sand. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Install Title 5 septic system to the plans of C R Short (plan # 1- 3 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the;afore described on-site sewage disposal system 11 in accordance with the provisions of Title 5 of the vironmenta Code and'no[to pl Eace the system in operation until a Certifi- cate of Compliance has been issued by Bo ofHelth. oSigned Date Application Approved by 7 Date Application Disapproved fo the following reasons_6� Permit No. ^' / 0 Date Issued THE CO'MMO)N 'EALTH OF MASSACHUSETTS LeBaron �/ RNSAL ,-MASSACHUSETTS s'` "-/ ' Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded( ) abandgge Old. age Rd. W Barnstable s b en constructed in accordance with the iSrov'sions f Tide 5 and the forDisposal Systpm Construction Permit No. dated Installer Robinson Sepic Service Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date �. _ I t� Inspector r — ————————————————————————————— — No. THE COMMONWEALTH OF MASSACHUSETTS LeBAron PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS lwioozal *pztem Construction Permit Permission is hereby gl Ied o Con uctageRKd.r( )Upgrade( )Abandon( ) 5 Old System located at t5 Barnstable Installeri W E Robinson Septic Service 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: Constructi,n mustOR co pleted within three years of the date oft 's petnitDate: A roved b /��f l�,. PP Y L t 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) I, William E, Robinson, Sr. ,hereby certify that the application for disposal works construction permit signed by me dated concerning the property located at 1845 Old Stage Rd,W Barnstable, meets all of the following criteria: * There are no wetlands within 100 feet of the proposed leaching facility. * There are no private wells within 150 feet of the proposed septic system. * 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 with 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. map) B)Observed Groundwater Table Evaluation(according to Health Division well map) SIGNED: DATE LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER 20-1998 (Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted). .. ,( �i t � ��. v t. No.--V_gS=-- Fee- BOARD OF HEALTH TOWN OF BARNSTABLE Zipptication-*rVell CongtructionA3ermit Application is hereby made for a permit to onstruct ( ), Alter ( ), or Repair ( )an individual Well at: 1��5 D/� S,) e ` 0 ! � 035' 007- — o — � — — -- — — — — -- — --- — P — -- —Location — Address Assessors Ma and Parcel - z'------------jg 0 er Address v9- �el Ic!'I�PL T-- eio /3c� mpsh. Q ---- -m ----------------------------- ---�--m-A- ----------------------------- Installer — Driller AWjress Type of Building / DwellingO�±i�o®/n -------------------- di Other - Type of Building---------------------------------- No. of Persons------------------------------------------------------- Typeof Well— -—------------------------------------ ---- Capacity ------------------------------ Purpose of Well---------—----------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a Certificate .of Compliance has been issued by the Board of Health. Signed---------- -- - -- - --- --- 00 V, --------------------------------- date Application Approved By -------------------- date Application Disapproved for the following reasons:-------------------------------------------------------------------------------------------------_-- --------------------------------------------------------- --------------------------------------------------------------- ------------------------------------------------- date Permit No. -- cra,-' -------- --------- ----------- Issued — -- ------------------ - --- --------------—------------------ ----- date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate ®f Comphante THIS IS TO CERTIFY, That the Individual Well Constructed ( >-), Altered ( ), or Repaired ( ) bY------- --- ---Z-7 --------— - -----------------I---nstall-----er ------------------------------------------------------------------- ----------------------- at------— '` Z C _ - - ---------------------------------------------------------------------------------------------------- has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No.W-1-15-=51)-Dated-------------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATEInspector----------------------------------------------------------------------------- q $ `•No. - -- � � Fee---- BOARD OF HEALTH 1 TOWN OF BARNSTABLE A.pplicat ion-*rMelt CootructionPermit Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair ( )an individual Well at: Location — Address t 4 —Assessors Map and Parcel, 1/ V11U S k/ ------------ ----- A- - - - --- -—— - — 9 _ Owner I y►, Address 3C'I — Install er Driller — -- — — —�3d —�`!lqs�q{�d�dr-s ------ , - ► m - --------------------------------- Type of Building Dwelling i Other - Type of Building--------------------------------- No. of Persons-------------------------------------------------------- Type of Well— - -- —- ------------------------- ----- Capacity -------------------------- Purposeof Well------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a Certificate .of Compliance has been issued by the Board of Health. Signed -- —- ---------------------------------------------------- ----------No V date Application Approved By —-- -— -- r -"- -1 date Application Disapproved for the following reasons:------------------------------------------------------------------------------------------------------ ------------------------------------------------- ---------- - - - - ---- ---------------------------------------------------------- date PermitNo. -- -= — -— - Issued-----------------------------------------------—---------------------- date i BOARD OF HEALTH TOWN OF BARNSTABLE , Certificate (of Compliance ~' THIS IS TO CERTIFY, That the Individual Well Constructed (y), Altered ( ), or Repaired ( ) by----- - -- -- = ---------------------- ----------------------------------- Installer at- -- "' C�-, .----------------------------------------------- has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No\V----fl'`-TO---Dated------------------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE------------------— ——-- — - --- — - Inspector------------------------------------------------------------------------------ sour ams�.s.eacv�r mm es�srame arm�sn m�amca�:sss�> c+emer .+ies�"" .BOARD OF HEALTH TOWN OF BARNSTABLE Melt (Contruct ion Permit No. ---- � Fee Permission is hereby granted---- - - ------- ----A4-- ,fi r - --------------------------------------- to Construct (tir), Alter ( ), or Repair ( ) an Individual Well at: R No. ----—-----------------------— ---- -- - - - ------------------------------------------------------------------------------------------------------------------ Street as shown on the application for a Well Construction Permit No. - — --- --- --- - - Dated -—------------------------------ -------------------------------- ------------------------------------ (-,Board of Health DATE------1L~40 - -- EN VI MA C'CH ABO M-NUA 63, INC. ��JOJ �oI✓ 44 130 Sandwich, h,, MA 02563 508(888-6460) 1-800-339-6460 PAX(508) 888-6446 CLIENT. Aqua Jet of Today LOCATION: 1845 Old Stage Rd ADDRESS: 135 Route 130 Barnstable MA Mashpee MA 02649 COLLECTED BY. Aqua Jet of Today SAMPLE DATE: 1-12-99 SAMPLE TIME: N/A WATER SAMPLE TYPE: New Well DATE RECEIVED:1-12-99 LAB I.D. #: 991120 WELL SPECS.: N/A RESULTS OF ANALYSIS: Parameters Units Recommended Results Method Date Analyzed Limits Volatile Organics ug/L See Report None Detected. EPA 524.2 1/19/99 WATER MEETS EPA STANDARDS AND IS SUITABLE FOR DRINKING PURPOSES FOR PARAMETERS TESTED. -"q-'11 . Date4j%� Ronalb J. Saari Laboratory Direc r <=less than >=greater than TNTC=too numerous to count _ - -------------- - ------------------------ '01Y22'99� FRI 11:11 FAX 401 738 1970_ R- I ANALYTICAL_ [� R.I. Analytical Specialists in Envirorrmcntal Services CERTIFICATE OF ANALYSIS Envuotech Laboratories, Inc. Date Received: li 12/99 Attn: Mr. Ron Saari Date Reported: lr 20/99 449 Rte. 130 P.O. #: l n: Sandwich, MA 02563 Work Order 99'11-002Q( I DESCRIPTION: ONE DRINKING WATER SAMPLE f - i i - i subject sample(s) has/have been analyzed by our laboratory with the attached results. ]reference: All parameters were analyzed by U.S. EPA approved methodologies. The specific methodologies are listed in the methods column of the Certificate Of Analysis. i i if you hav y estio s regarding this work, or if we may be of further assistance, please contact U. Appr ved Jame . Mi ae zl . Hobi Quality Control C oordinat Vice eside enc: C in o Custody ,I i ---- ------------- - - ----_____- 01:22/99 FRI 11:12 FAX 401 738 1970 R I ANALYTICAL-. - - - -• - - - - fit: Page 2 of 3 R.I. Analytical Laboratories, Inc, CERTIFICATE OF ANALYSIS t Envirotecll Laboratories, Inc. Date Received: 1/12/99 Approved by: Work Order# 9901-00289 R. Analytical Sample#: 001 SAMPLE DESCRIPTION: #991120 1945 OLD STAGE RD 1/12/99 SAMPLE DET. ANALYZED PARAMETER RESXILTS LIMIT UNITS 1V]ETHOD DATE/T VIE ANALYST I l i Voladle Organic Compounds EPA 524? I/19199 19:26 JAH ugll Bromodichloromcdian C0.5 0.5 e EPA 52 <0 5 0.5 ug/1 EPA 524,2 4.2 1/t9199 19:26 JAH Bromoform <0.5 0.5 ug 1/19/99 19:26 JAH Dibrontochloromethane <0.5 0.5 ug/l EPA 524.2 1/19/99 19:26 JAH Chloroform EPA 524.2 1119/99 19:26 JAH 1,2-0ibromoedlane(EDB) <0.5 0.5 ugrl <0.5 0.5 6� u 11 EPA 524.2 1119/99 19:26 ]AB I Benzene <0.5 U.5 ug!I EPA 524.2 1!19199 19:26 JAH Carbon Tetrachloride EPA 524.2 1/19/99 1926 JAH <U.5 0.5 ug/1 JAH 1 Dichk�roethane trPA 524.2 Triebloruedicne 1119/99 l9`l6 <0.5 0.5 us/l 1119/99 19:26 JAH <0.5 0.5 ug!1 EPA 524,2 1,4-Dichlorobenzcne EPA 524.2 1119199 19:26 JAH <0.5 0.5 ug/1 1,1-Dichloroethane EPA 524.2 1/19199 1926 JAB � <0.5 0.5 u1;/1 1,1,1-Triehloroethane 1/19/99 19:26 JAH <0.5 0.5 ug/1 EPA 524.2 vinyl Chloride 11 EPA 524.2 it19!99 19:26 JAH Bromobenzene <0•G. Q 5 u€ .4.- 2 1/19/99 19.20 JAH <lU 10 ug/l EPA 5 Bromomethane EPA 524.1 1/19;99 15•=b 3AH <0.5 0.5 ag/I Chlorubenzene <5 5 ug/l EPA 524.2 1119!99 19:2o JAH Chtoroethane <5 5 ug/1 EPA 524.2 1!19/99 19:26 J.414 C.hloromethane f1 EPA 524.2 1!19/99 19:26 JAH 2-Chlorotoluenc <0.5 0'S ug EPA $24.2 1/19199 19:26 JAH a-Chlorotoluene <0.5 ()'5 ug/l , 1119199 19:26 JAH 2< 2 ug/1 EPA 524.. Dibrornomethana 0.5<O,S uFll EPA 524,2 1/19/99 19:26 JA14 1.3-Dichlorobenzene EPA 524 2 V19199 19,26 JAl-I 1.2-Dichlorobenzenc <0.5 0 < ug/1 1119/99 19:26 JAH <0.5 0.5 ug/l EPA 524.2 trans-1,2-Dichloroethene <0.5 0.5 ugll EPA 524.2 1/19/99 19:26 JAH cis•1,2-Dichlorocthenc 1 5 ug/1 EPA 524.2 1119/99 19:26 JAH ASethylene Chloride <0.5 t JAH <0 5 0.5 ugh EPA 524.2 1119199 19:26 i j-Dichloroethenc EPA 524.2 1/19/99 19:26 JAH l.l-Dichloropropene <0.5 0.5 ugll J/19199 19:26 JAH <0.5 0.5 ug/1 EPA 524.2 1,2-Dichloropropanc F..PA 524. 1/19/99 19:26 JAH <U.5 0.5 us11 2 1,3-Dichloropropane EPA 524.2 111999 19:26 JAH 1.3-Dichioropropene a 0.5 up<0.5 11.5 US/ug! 1119199 19.26 JAHJAH<0,5 l EPA 524.2 2.2•Dichloropropane 0 5 ug/1 EPA 524.2 1119/99 19:26 1AH Ethytbenzene <0.5 1119/99 19:26 JAH <0.5 0.5 ug/1 EPA 524.2 Styrene EPA 524.2 1119/99 19:26 JAM 1,1,2-Trichloroethane <0,5 0.5 ug/1 r Page 3 of 3 RA. Analytical Laboratories, Inc. CERTIFICATE OF ANALYSIS i Envirotech Laboratories, Inc. A roved b Date Received; 1/12/99 pp y' Work Order-# 9901-00289 R.I. alytical Sample#: 001 #991.120 1845 OLD STAGE RD 1/12/99 SAMPLE PET. ANALYZED pARAMETER RESULTS LIMIT UNITS METHOD DATE/TEAE ANALYST 1,1,1,2-Terrarylomethane <0.5 0.5 ug/1 CPA 524.2 1119/99 19:26 1,1,2,2-Tetrachloroerhane <0.5 O.S uglt EPA 524.2 1119/99 19:26 JAH <0.5 0.5 ugll EPA 524,2 1/19/99 19:26 JAH Tarrachlomedlcne 1i19i99 19:26 JAH 1.2,3-Trichloropropane <0.5 0.5 USA EPA 524.2 <0.5 0.5 ug/l EPA 524.2 U19199 19:26 JAH Toluene EPA 524.2 1119/99 19:26 JAH <0.5 0.5 ugll 7:ylencs EPA 524,2 1/19199 19:26 JAH 1,2.Dibromo•3-C.hloropropane <10 10 ug/l 1/19/ <l ] ugll EPA 524,2 99 19:26 JAH an Bromoehloromedle 1/19'99 19:26 1 AR n-butylbenzcue <0,5 0.5 ug/I EPA 524.2 <0.5 0.5 ug/1 EPA 524.2 li19/99 19:26 JAH Dicttlotodifluoromethant EPA 524.2 11,19/99 19:26 JAH 7'richlorofluoromc.dlane <0.5 .5 ug/t <(L5 0 0.5 ug/l EPA 524.2 1i19/99 19:26 JAH I•IexachlorobutadienC EPA 524.2 lil9/99 19:26 JAH lsopropylbenzanc <0.5 0.5 uglt JAH <0.5 U.5 ug/l EPA 524.2 1/19/99 19;26 p-Isop ropy Ito'iucne 0 5 ub11 EPA 524.2 1/19/99 19:26 JAH Naphthalene <0.5 JAH 0.5 ug/l EPA 524.2 1/19199 19:26 ]A n-Propylbcrtzene 1/19/99 19:26 JAH sec-Butylbenzcne. <0.5 0.5 ug/l EPA 524.E2 tert-Burylbenzeue <0.5 0.5 ugll EPA 524.2 1119/99 19:26 ]� Epp 924,E 1/19199 19;26 JAH 1.2,3-Trichlorobcrtzenc <0 5 0.5 ug't JAH 1,2.4-Trichlcrobenune <0.5 U.S ugll EPA 52a.2 1119199 19:26 <0,5 0,5 ug/l EPA 524.2 1/19/99 1926 JAR 1 2,4•Trimethylbcnzenc EPA 52a.2 1/19/99 19:26 JAH 1,3.5-Trunedlylbenzene <O.S 0.5 ug/l 1 1 ugll EPA 524.2 1119/49 19;26 JAH N4cthvl Ternary Buthyl Edier <10 ]0 ugll EPA 524 2 1!19;99 19 2C1 JAH n Hexane a; IAII RANGE EPA 51-4 ' 1.19 .. SURROGATES 2 1A9%99 i9:36 l•h 4-Bromofluc:mbeuzeae 1.06 RU-l20"k EPA 524._ R0.1209C EPA 524.2 1/19/99 19:26 JAH 1,2-Dichlombetvcne-d4 95 Town of Barnstable Department of Health,Safety,and Environmental Services Public Health Division Date t 5 Q, 367 Main Street,I lyannis MA.02601 4 RARMABIA r 7�f- �e1'SUM f� t otail+& Date.Scheduled Time Fee 1'd. Soil Suitability Assessneitt fog• Sewage Disposal ._.Performed By: /C `7 Witnessed By NC LOCA'TION:& G 1tAL INFORMATION Location Address It LIS C514 5 G WU Owner's Name s4 Address mil. y 44 H o Z 673 t Assessor's Map/Parcel•, !)S" 'j Z, Engineer's Name C_Yra,-,q NEW CONSTRUCTION ' `X REPAIR Telephone HO g) 3 96 —lea i{ Land Use eS t�d�.��{ (3 Slopes(%) /V::.` .Surface Stones Ye S „ Distnnces from: Open Water Body ti '`r €' R" Possible Wct Area R Drinking Water Well DSO R m h Drainage Way ti '44 i R ,`Propeity Line s.lS R t Other i SKETCH:,(Street name,dimensions'of to(,exact locations of test holes&perc tests,locate wetlands in proximity to holes) Sw�s rem -33 9 Al x �< Itfi'x,.s r`/Aw C, ' a s rrt%-�rw rr v It� O /o, S eft/c 0 9 �. < - v t �2 Parent material�(geologic) �o Depth to bedrock P!I'M�r� .VV ro47�� r. t Dc th to Groundwater: Standing-Water Water in Hole: `p - g" N�'q .Weeping from Face' Estimated Seasonal Iligh Groundwater ! /j r)I�;TERMINAT101V'r(�R`SLASONAL IXGI-1 WATER TABLE Method Used:. .r—,0-st elrzc C& s fi Depth Observed standing in obs.hole: in. Depth to soil mollies: Depth to weeping i"rom side of ohs.hole: in. Groundwater Adjustment _ — It. Index Well N Reading Date: Index Well level Adj.factor Adj.Groundwater Level P ttCOLATION TEST idle le.30 Tillie /0. DO r Observation Bole N Z Time at 9" 0 O Depth of Pere 4 e—4,0 Time at 6" Start Pre-soak Time t ® /O Ste. a V 'rime(9"-6") 4 l2 n•i r.� 1 End Pre-soak /1 /O : 3 4 i Rate Min./Inch 'L 4" iZi :.., Site Suitability Assessment: Site Passed Site Failed: Additional Tcsling Needed()/N) Original: Public Ilcahh Division Observation Dole DaWTo Be Completed on Back j Copy: Applicant, �, r DEEP013SERVATION LIOLL LOG',' llolc# c. + Depth front Soil I lorizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Mansell) Mollling (Slructotc,Stones,Iloulderes. c.Es a4-H S 3 O y r 3 -Sat.,CA 4 �g .S`"G C % r,v a 34� 2 .So-let b ' lv . , DEEk,TOBSERVATION HOLE LOG.' 1101le # 2, Depth front Soil I lorizon Soil Texture Soil Color Soil Other 'l. Surftiec(in.). _i t e (USDA) (Mansell)' - Motlliug (Siraclure,Stones,Iloulderes. ►) • 8 A'a is•..y i o y r r ) t a ewe-,rcri;4 •fir. aI. �_ _ r: lJrt.i W� e a..»r ra- ..a.gyp 44. 18a C3 Sonr�t �lRed-< it llCCI':OBSCRYVATION MOLL LOG" I10lc i# 3 f Depth front Soil Ilorizon Soil'fcxture Soil Color Soil Olhcr Surface(in.) (USDA) (Munscll) Mottling` (Strodure,Slopes,Iloulderes. Coasislcli�y,°�(4rm•cl 8 't CL /o Y)?- Aj o w n?—c4-i >h a Jan rXz,,SY 4' _— . _ ; ....y sDte-p ro 'DROP OBSERVATION I-IOEE LOG Hole # Depth from Soil Ilorizon Soil` c4t,ire., Soil Color —Soil Other Surface(in.) (USDAjy"))_ (Munsell) Mottling (Structure,Stones,Iloulderes. '�II515(CIICV•io(iI:IVC� I .• /� San C11 /Oy1t �O Ur►Svr�` w//Z• A. v 4— �X, a ScL►t 7;�:,►rL� z.sy % . 9 � C2 `, U�1V� . aaa.,.y 7ba .D,-c)p to 32 " c4 rrF;4t�o.Kr ��.sv•C_ Flood Insurance Rate Map: Above 500 year flood boundary No_ Yes ✓ Within 500 year boundary No_ Yes Within 100 year flood boundary No_ Yes ,Veplh of Nat irally Occurring Pervious Matet ial Does at least four feet of naturally occurring pervious material exist in all areas observed Ihrolighoul the area proposed for the soil absorption system? YES If not,what is the depth of naturally occurring pervious material?.. . , i Certification I 1 certify that on AJo� t S ¢ (date) I have passed the sciil'e'valuator examination altprovecl by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training,expertise and experience described in 310 CMR 15.017. Signature t/` Date 11/V98 No................ .... Fss............................. THE COMMONWEALTH OF MASSACHUSETTS _ ob-L BOARD OF HEALTH GWIN...................OF......... Apliftratiou for Diopos al Works Tour rurtioat Frrutit Application is hereby made for a Permit to Construct (�() or Repair ( ) an Individual Sewage Disposal taE),n ( -- -"Address or Lot No P:l`j a'� ......1.... c - !.:----.•....W....(&enP- ----........... _ - Owner. Address c F" a •.... .. ... � :....-•----..._..-••--------------- ••----•---•--••-•••-•------••----••----•--•--•----.....---•-••-••-....._ 1 `t 71_. Installer Address Type of Building Size Lot---- b?,_ 1C....Sq. feet U Dwelling—No. of Bedrooms.........................................Expansion Attic ( ) Garbage Grinder ( ) 134 Other—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a Other fixtures .----•-••----......-•••••-••-••.d W Design Flow............1.l0........................gallons per person per day. Total daily flow___..__..& ........................gallons. WSeptic Tank—Liquid capacity.1..........gallons Length................ Width................ Diameter-______--____-_ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-------a.......... Diameter-___-___--$ _...... Depth below inlet.......�?.._....... Total leaching area..A ...... ft. Z Other Distribution box Dosing tank ( ) Percolation Test Results Performed by..._..el-ta£-q-_ _ s1,2._.___.�._....•__--••---•-----•- Date.....q `$.�.._.Ssi.............. Test Pit No. l sS_minutes per inch Depth of Test �t.____l�_I.___..__ Depth to ground water_.D_C> a&5tZ fs, Test Pit No. 2aP9�,:z_minutes per inch Depth of Test Pit......)a..._.___.. Depth to ground water___]\a..1s;m-It- --•----------------------------------------•--•••.••••-••.......••--••-•--........•--..._..---............••----•-•--•-------•••--•••.............---.--••- D Description of Soil----•--•-�_aam....••.... _•...a ............ ....... IQ•--------•--•-------•-•--- x V ------------ -------------------------- •-------- •------------------ --•----•-•-------------•--------•-------•---•-•---•-•---------•--•---••-------•-----_----------------•----•-•-•-------•------- 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 TITI,I 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. Application Approved By................... -•-••-•--•••••-••••••--•-•-•---•-•---•••--•-----••--- Y --- -- ------------------------------ Date Application Disapproved for the olio ng reasons-----------------------------------------------------------------...........................Da.t.L......-•------ .................•-•---•--------••---•••..........----••••-••................-••----•-••-...••--------._...••--•••••-•••--•••.--•-•------------•--•-•-••••-----••••••---•-•--••--••---•••--••••-........ Date PermitNo......................................................... Issued....................................................... Date N.as...-ta.-.....O.at......d...l....................•...........................................t........f...........a..t.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..............................................I...................................... Trrfifiratr of ToutpliFatta T S.•L8 TO RT , That the Individual Se , �o e isposal System constructed ( r Repaired ( ) by -. .-•--.•.... z •-•----•----•--•----•------------------•--.......--------••-•---•--................._..__.... at'.----------- -------- -----•---•............. -••••-•••-•••••-••---...--••-••-•••••••-•••••-•--•-•.._...•-••--•-••-•-••--•.................•. has been installed in accordance with the rovisions of TIT Fy 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No--------Y.-_2-z .......•_Z .. dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... 30-60 0000.0..86...66600.06.040000000000.e0066686100.9.041W69...........•98.10.0000000.0.0..664.0..00000904..................0 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...............................OF..................................................................................... (Z No. FEE.....0 tul .LkIrk onotrttrttion rrutit Permission is h rante ............. . . ... ......... ..... ................. to Construct ( air ( ) ual Se al t atNo.............. -•••••-•-•-. ........,••-...... - ..... ••••-•••-•-•••••••-••••••--•••-••-••••••-••••-•--•-••--••-•---••-•-•--...... Street as shown on the application for Disposal Works Constr tion Permit o--------_....... .. ated.......................................... ...................................... .......................................................... oard of Health DATE................................................................................ FORM 1255 A. M. SULKIN, INC., BOSTON NLf-.x.2 FizsC ................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................0 F......................... Appliration for Disposal Works Tonstrurtion Vrrnti# Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ................_................................................................................ .................................................................................................. Location-Address , or Lot No. ..............•-------------------------•----•--......-----•--......._........................... ..........-----•------.......------............................•••......-----•----............---- Owner Address W Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers a YP g ---•--•-•------------•-•---- P ( ) — Cafeteria ( ) Otherfixtures .........................................-••---------.---------------•--•--••--------•----•-•--•-•--•-•-•------•----------•---•..............-•-•--•- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.........._......... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date---------------------------------------- 0-] Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water......................... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ......... ---------------------------------......... ---------------- --------------- •--- ---------•---------------------- •-•---•.................. 0 Description of Soil........................................................................................................................................................................ W U --------------•--•-•---........---------•--•-•--•--------------•---•--•--•-------.....---------•--•--•----•---...-------•---------.........-------•--------------------------•••---••------•---------•-- 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 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 . �M D e Application Approved By................... ----- f � Da e Application Disapproved for the JX1'_ow' g reasons-----------------------•--------•-----•-•--...-------•---------------------------•--------..Da .............. •--•-----------------------•-•-•-----•--..........------•---••-------•--------------................----.._...........----•----------------•-----...------------------------------------------.....•-•--- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... (9rrtifiratr of Tontpliatta THINS-TO CZRTIF That the Individual Sewage ]sposal System constructed ( ,,Kor Repaired ( ) by - ------•---------••------.-----•---------------------------------------•-•----------------- - n at--- scan, has been cost lied accordance with e P�� v� isions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works ConstruckTon Permit No.__-.PY_.-,_,n�_�.,`�.... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... No..rI j. ._�. � - -- FEE....J 1.......... Dist Works nstrnr�ion rntit Permission is herebygranted..: g f� �.�•''� ---------- ----••-•-•---••-••--••. ...-••---•--------- .............- ----•-------.... to Construct ( ) e it ( ) an nd' fdxf r�ar'> al ea a sposal Syst atNo.................. �. -- �'�'...-_---- --_.. .. . �' �' —'Stre t as shown on t e application for Disposal Works Construc ' n Permit N ..................... ed........_........................_........ -- .... ��,,,/// d of Health DATE................................................................. FORM 1255 A. M. SULKIN, INC., BOSTON d 1 ., . j •rf..c.es` � } —r79PA �S 71f+V.1 �-ncl , *)OR '1SiC1 C� •JO78 i 416; ha/ 5'Lb t' //C-Lb d � i f. �tL1l�t;� Fti�Mtl.�! 3 F3t- tZ,o0N& r �dlL�( Ft..,ow �. 1to +t 3 • �?o G•P•D I 57CS . t� oN.. aca� Ear SPOSeL PtT - t.�SE toc>o GA.r_, : 2. . •OLA "7T�1�(o �� So TOT1&L 'L7ESIGLt c 4ZS 6-.RD. 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LOCUS PfNE (FND) `sue �l LOT I A.M. 152-035-001AWE O a y O � ,O G 8' W (FND) 4 3 ' CENTER VILLE W 'Oo 57 9 99 S83¢3 " 8 r` LOCUS MAP (A'v 89.47) 366•33 !i PLAN REF• 364-19 o DEED REF 18664-158 Q,' w ZONING: "RF" LOT 2 SETBACKS: 30'-15'-15' A.M. 152-035-002 i FLOOD ZONE: "C" AREA 72, 774�S.F. ; PANEL NUMBER.- 250001 0015 C ice, �j DATED.• 08-19-85 �o I � �' PLOT PLAN OF LAND s SHED O I LOCATED AT 1845 OLD STAGE ROAD WELL WEST BARNS'TABLE, MA. THE SEPTIC SYSTEM ® O � 60' I WAS DRAWN FROM THE ' EXIS37NC: ,O 9 TOWN OF BARNSTABLE 'HQ. E SSfi. 0 SEPTIC INSTALLERS CARD �'j L`� �O• j <<" 161.6 PREPARED FOR: GRAVEL / DRIVEWAY KENNETH & NANCY THIBEA ULT DON O ��®� DRY WELLS 0 ®®��!�or !Aa� DECEMBER 27 2007 k �. GAS-Eq� �, - c v LOT 3 REV- A. �, IV STEP QSTEFt1E�J F� ; RE A.M. 152-035-003 ,1� , o J. N 0 ® " DOYLE REV.• ® � REV.• S U F�v�y�� YANKEE LAND SURVEYORS ON ` ve"o IRV & CONSULTANTS GRAPHIC SCALE P. O. BOX 265 50 0 25 50 100 UNIT 1, 40 INDUSTRY ROAD MARSTONS MILLS, MA 02648 TM 508—428—0055 FAX 508—420—5553 1 inch = 50 ft. SHEET I OF 1 JOB #• 54301 JF WEST BARBSTABLE. MA CONTOURSLL Ro�T 00} 41.5 Ft x 12.83 Ft x 2 F E _ - _ - - - - F'QVfcF C'�AF h F?� \ 73 LEACHING GALLERY EXISTING 50 Rojo �cyw�Y H U J m \ \ `1 FINAL 50 WO < `~ m a 4OD_ 74 RESERVEmJo m ran 14-0 76 LOCUS AREA or0�Ns". \ o w a< • ir _ \ �s -- _- \ GARBAGE GRINDER N m ' m � N IS NOT ALLOWED ACHMAN o sa:s: \ Bon / CO ovuF m w < _w \®SOIL Tag /60 ��\ �` WITH THIS DESIGN. LANE o a:s•s:s:xs: w a�, :S.rssroa>s:. m X o REMOVAL W J oxnaaass:• �p X < Q0- 14-0 \ 0 aoo c CD,,,.,., w °wz <o va AREA oos-0 \ `�`��s LOCUS M A P J=o H J Z w ua E� \ rpz71 m `•. _Juz<l U)I j 1-4 w z ww u_o \ p ' / EO ; \\ NOT TO SCALE v3 - W � o a3 w0 W�- U J m m Ln �X aoQJ � � N �6; Ns"`� m mF J W w CD o In '�'xs`st w \ is ` m a;sssmry aa:>ssst � X s'i�ri`s y °a z i -. a u) d O 0 Ir (30 wu 0 \ / 0 O - Z z « c o Ld co �s \ W .. (t) J N \ \ Ow z N cD co m LEGEND ` k m 3 '� STONE DRIVEWAY W 2 O =G 1000 GALLON ; W l lc_)W 10 � SEPTIC TANK J f-~ C3 UT- O m �` EXISTING W Z J w< m R p 1500 GALLON z O I / SEPTIC TANK �e _ J � � W w O J UTILITY POLE194 $ ADDITION w w z P lQ W Z Z TEST PIT® D-BOX 0 \ / ® \ OI O w w \ LL m 0 HYDRANT DRAIN ® 4 / LOT 2 W Z W N m+L F- U TO 3 << W —J ~ DECIDUOUS CONIFEROUS 80 \ �^ p 0 c�m z TREE TREE / v aw ow o L , o0 12� / AREA = 1.67 cc +- w x m ( ) \ / .' -NUMBER REFERS TO DIAMETER IN \ �` �� Q N U U m m INCHES.LETTER DENOTES TYPE. h (U O O-OAK M-MAPLE P-PINE C-CEDAR / U z d z �' W \ 194 Ft FROM WELL WELL / 'k QP W m m m U) / �� o W= 60 CD BENCH MARK \ _—J /00 WO P zF" i m TOP CORNER OF STEP* W � O3 Ln z N 4 ELEVATION = 81.13 ....... V a W > °' N BARNSTABLE GIS DATUM J __ X w \ � 225. t e w NOTES \ ®_ ��, SEWAGE DISPOSAL SYSTEM PLAN W < `--� �y -TO SERVE EXISTING DWELLING Z INSTALL SECOND 1000 GALLON I Y THIBEAIJ T I w w z I EST. KENNETH & NANC L H J _j CD OJ Q SEPTIC TANK IN SERIES AS SHOWN PL/�N OWNERS OF RECORD —1 EXISTING SOIL ABSORPTION a o c)m F- SYSTEM IS TO BE REMOVED. SCALE 1 ,� = s0 Ft -�' oFMgSs tNOFMgs 1845 OLD STAGE ROAD O ° J (n CD U 30 0 30 60 �� DAVID �cyG� o�� DAVID sq�yG� ��® 1995 �' WEST BARNSTABLE, MA o ° w I� m '~ � ALL UNSUITABLE SOILS i m W a ENCOUNTERED WITHIN THE , -+ n 0 le 20 3G� o D. o D. ®N� PROPERTY ADDRESS n e I LLJ SOIL REMOVAL AREA ARE TO V COUGHANOWR CA c, W I + LC Q. COUGHANOWR ASSESSORS MAP 15 2 PARCEL 3 5-2 Z - �, (f) BE REMOVED DOWN TO THE NO OTHER WELLS WITHIN I50 f't OF No. 1093 43 TRIANGLE CIRCLE tj m C2 LOAMY MEDIUM SAND THE PROPOSED LEACHING GALLERY ,p o SANDWICH MA 02563 PLAN BOOK 364 PAGE 19 3 N STRATUM AND REPLACED FcrsTE�` sp �ICFNs�� 4 w ++ ow q \�� L ��P ,LVA DATE, JUNE 10. 2006 0 w WITH CLEAN MEDIUM SAND s �0 506 364-m894 o �, W NK U. PER TITLE 5. --' (��' W -1 a z w (mm J ' 7(i JOB #E T E-2 8 4 7 PAGE 1 OF 2 VERSION: O W Q1 �? N w v w SLOPE BACKFILL SO AS � THIS PLAN IS BASED ON AN INSTRUMENT SURVEY AND IS INTENDED �- o- o_j N z TO PREVENT PONDING @� e SOLELY FOR INSTALLATION OF THE PROPOSED SEPTIC SYSTEM OF RAINWATER OVER e(I S f DEPICTED HEREON. FOR ANY OTHER CHANGES TO PROPERTY INCLUDING LEACHING GALLERY. PLACEMENT OF ADDITIONS. SHEDS. FENCES OR SWIMMING POOLS. OWNER SHOULD CONSULT WITH A MASSACHUSETTS REGISTERED LAND SURVEYOR. APPROVED DAVID D. COUGHANOWR. DATE OF TEST: MAY S. 2008 DESIGN CALCULATIONS SOIL TEST L 0 G WIITNESSEDI BYVALUATOR; DONALD DESMAR IS EALTHI DEPT. PERC NUMBER: 12186 DESIGN FLOW: 4 BEDROOMS X 110 GPD = 440 GPD NO TEST PIT A PAARENDTU MATERIAL: PROGLAC ALD OUTWASH SEPTIC TANK: 440 GPD X 2 DAYS = 880 GALLONS PERC AT 72 in - 10 MIN/INCH IN C2 SOILS USE EXISTING 1500 GALLON SEPTIC TANK IF IN SOUND STRUCTURAL CONDITION. ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER IF NOT INSTALL A NEW 1500 GALLON SEPTIC TANK I(MINIMUM ALLOWED) (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING DISTRIBUTION BOX: USE 3 OUTLET D-BOX. 73.37 0-3 O WOOD LOAM 10 YR 2/1 NONE FRIABLE SOIL ABSORBTION SYSTEM: A 41.5 FL x 12.B3 FL x 2 f E LEACHING GALLERY CAN LEACH 3-8 A LOAMY SAND 10 YR 3/4 NONE FRIABLE Abot = ( 41.5 x 12.83 l = 532.45 sf 8-30 B LOAMY SAND 10 YR 4/4 NONE FRIABLE Asdw = ( 4 1.5 + 41.5 + 12.83 + 12.83 ) x 2 = 21'7.32 sf At-ot = 749.77 sf 69.37 30-48 Cl SILTY SAND 10 YR 5/3 NONE FIRM Vt 0.60 x 749.77 = 449.8 GPD 63,37 46-120 C2 LOAMY MEDIUM SAND 1 10 YR 5/4 1 NONE FRIABLE USE A 41.5 f"t x 12.83 Ft x 2 Ft- GALLERY. Vt. = 449.8 GPD > 440 GPD REQUIRED NO TEST PIT B PAARENOTU MATERIAL: PROGLAC ALD OUTWASH 10 MIN/INCH IN C2 SOILS ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER L EA CHI NG GA L L ER Y 1000 GALLON SEPTIC TAW (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING DIMENSIONS AND DETAIL NOT TO 74.41 USE SHOREY PRECAST 500 GALLON NOT TO USE H-10 (NIT SCALE 0-4 0 WOOD LOAM 10 YR 2/2 NONE FRIABLE LEACHING DRYWELL (H-10 LOADING) SCALE 4-8 A LOAMY SAND 10 YR 3/4 NONE FRIABLE 8-32 B LOAMY SAND 10 YR 4/4 NONE FRIABLE CONSTRUCTION DETAIL 1 in 70.24 32-50 Cl SILTY SAND 10 YR 5/3 NONE FIRM TAPER 50-126 C2 LOAMY MEDIUM SAND 10 YR 5/4 NONE FRIABLE DRYWELL UNIT STO 63.91 PERCHE � C TEST PIT C PARENT DMATERIAL: PROGLACIAL OUTWASH WATER WEPING AT 116 in (al = 63.951 41.5 ft. N m� o �o 3 MIN/INCH IN C SOILS 4 j C ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER m� N Lo (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING co 1 73.62 0-4 O WOOD LOAM 10 YR 2/2 NONE FRIABLE 4=Z E _ LOAMY SAND 10 YR 4/1 NONE FRIABLE 4 �t 8.5 f t1.4 f t 8.5 f t 1.4 f't1. 8.5 ft 4 ft 6 f'�-6 t� A k� 7-12 A LOAMY SAND 10 YR 3/3 NONE FRIABLE 4 1.5 Ft 12-28 B LOAMY SAND 10 YR 4/6 NONE FRIABLE NLET COVER COVER 69.62 26-48 Cl MEDIUM SAND 10 YR 5/4 NONE LOOSE 61.29 48-146 C2 LOAMY MEDIUM SAND 10 YR 5/4 NONE FRIABLE 500 GALLON DRYWELL -> 141, 3 IN DROFLOW LINE DIMENSIONS AND DETAIL FROM = PERCHEBUILDING 10 ir, = 14 - BOX TEST PIT D PARENTDMATERIAL: PROGLACIAL OUTWASHWATER WEPING AT 112 in (el = 63.69) USE H-10 UNIT INSTALL ONE INSPECTION in To 10 MIN/INCH IN C SOILS RISER TO WITHIN THREE 48 in INCHES OF FINAL GRADE GAS LEVEL ELEVATION AND INDICATE LOCATION BAFFLE DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER ON AS-BUILT PLAN 73.02 (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING 0-6 FILL ......................_,,.,,..,.,..,.,..._,.....,..,.,......... 6-9 O LOAM 10 YR 2/2 NONE FRIABLE 00 33 CROSS SECTION VIEW 9-14 A LOAMY SAND 10 YR 3/3 NONE FRIABLE oc::Dr 00o �p in 63.02 36-1120 C LOAMY MEDIUM SAND 10 YR 5/4 NONE FRIABLE 70.02 14-36 B LOAMY SAND 10 YR 4/6 NONE FRIABLE aOo��oo 102 !n NOTES CROSS SECTION VIEW GROUNDWATER ADJUSTMENT 1) INSTALLER TO OBTAIN DISPOSAL WORKS PERMIT BEFORE STARTING WORK. EXISTING GROUNDWATER LEVEL in PEASTONE SEWAGE DISPOSAL SYSTEM PLAN 2) ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM REOUIREMENTS BASED'ON TOWN OF BARNSTABLE OF MASSACHUSETTS TITLE 5 SEPTIC CODE (310 CMR 15). GIS DEPARTMENT RECORDS. -TO SERVE EXISTING DWELLING 3) INSTALLER TO VERIFY LOCATIONS OF ALL UNDERGROUND UTILITIES 28it(7Ab EFFECTIVE /4 u, TO 2KENNETH & NANCY THI13AULT BEFORE EXCAVATING FOR SYSTEM. INDICATED GW 38.00 '^OR^VEL in 4) ALL STONE TO BE DOUBLE WASHED AND FREE OF IRON. FINES INDEX WELL SDW-253 AND DUST IN PLACE. ZONE B 1849 OLD STAGE ROAD WEST BARNSTABLE. MA `READING DATE MAY. 2006 48 in 58 in 48 in 5) EC TECH:. ENVIRONMENTAL RECOMMENDS THE INSTALLATIBN OF LOW READING 48.5 ECO-TECH ENVIRONMENTAL FLOW FIXTURES AND APPLIANCES. AND BIANNUAL PUMPING OF THE � ADJUSTMENT 2.7 154 in XTILE SEPTIC TANK. ADJUSTED GW 40.E 6) SYSTEM IS NOT DESIGNED TO WITHSTAND VEHICULAR LOADING. DO NOT FABRIC LINRPLACE O MAY BFSTHE 2 n. PEASTTONE LAYER TITUTE AN APPROVED ESPECIFIED. 43 TRIANGLE CIRCLE SANDWICH MA 02563 PARK OR DRIVE VEHICLES OVER SEPTIC SYSTEM. ETE-28591 DUNE 10. 2008 1 2/2 SOIL TES r 1cs r H o i.e f3 ov-- AWe .7 20 FT.� MIMMUM FROM CELLAR DATE OF SO4L TEST - OF m" 10 FT. MINIMUM FROM SLAB OR CRAY& SPACE SOIL 'TEST DONE BY I , i CLEAN SAND "w' !0040-1 101PT. WITNESSED BY ElE TION HO E ELEN.m OBSERVAMON HOLE 2 LOAM AND SEED ELEV.- 9� ,' ObSLRVA 40 SCHEDULE 40 PVC PIPE Tl� RATE _T PERCOLA11ON RATE FERCpL MIN./INCH AT, Ci4ES MIN. PITCH 1/11- PER F 2" LAYER OF < MIN./INCH AT 49-1-4 kl*ES 1/8- TO 1/2- DEP TEXTUREL OTHER COLOR MOTT. OTHER TH HORIZ COLOR MOTT DEPTH NORiZ TEXTURE SHED STONE a 4 6 VENT ST ON NOT REQUIRED Ty 4w CA IR PIPE of Ale. JOR EQU�L) MINIMUM cw "IN 1 CU. FT. OF PIT04 1/4 PER FT. a m ;n-&-®r CONCRETE Y/z, f ANCHOR je B Fl.OW LINE r 6F.,6"'* -% 7 167-0 10' cl 17.100 F, 614 Cq ve TMIN. 0 0 0 0� . U#Voujr7 ELEV. 3 10 7 SZ"400 jo. Ko.I I 7,,r y r o4 .j 96.2,5 L)A-,juj7. — . ELEV. — awl ELEV. 6- SU PLO, dO 02 0" DISTRIBUTION 4 'y ELEV. C UZ rEC C 0 IV r,q C TO e 3 30 Loa My' op C3 "r J w j 17PI STONE IN AN -Tv" TLET BOX JTO BE PLACED ON Fl RM BASE) /60 0 az 4 14 OWN S TO BE WATER TESTED Z.3 E'DEEP TRENCH FORMATION x x J9�IN IF MORE THAN ONE OUTLET -0 4 04 S 1500 GALLON I WELL 140 WATER ENCOUNTERED AT 162 ELEV. WATER ENCOUNTERED' AT ELEV. ' IN SOIL ABSORPTION N S ZONE INM S TI C TANK (To BE PLACED ON FIRM BASE 4 SEP 3/4- TO 1 1/201 SYSTEM (SAS) INDEX WASHED Sl`ONE ADJUST 4 ,0 in.-"/ fl) vz) eLly". LEGEND: DESIGN CALCULATIONS 71 e,o44 7' USGS PROBABLE WATER TABLE EEMILIEV. NUMBER OF BEDROOMS EXISTING,SPOT ELEVATION 00.0 SEWAGE -DISPOSAL SYSTEM PROFILE OBSERVED WATER TABLE ELEV. EXISTING CONTOUR ----00---- GARBAGE DISPOSAL UNIT NO NOT TO SCALE BOTTOM OF TE ST HOLE ELEV. FINAL SPOT ELEVATION TOTAL ESTIMATED FLOW FINAL CONTOUR 110 GAL/9R./DAY X BR.) 330 GAL/DAY REQUIRED SEPTIC TANK CAPACITY GAL- SOIL TEST LOCATION 1�1-1 AJ C- 4FA C/4 P/;P UTILITY POLE ACTUAL SIZE OF SEPTIC TANK GAL SOIL CLASSIFICATION TOWN WATER —W DESIGN PERCOLATION RATE MIN./IN. CATCH BASIN EFFLUENT LOADING RATE GAL./DAY/S.F. GAS LINE cyo x e ) , .4 SQ.,PT. -O- _____ LEACHING AREA 0,2xl CLEAN OU' -1 CESSPOOL C.P. 0 LEACHING CAPACITY (AREA X RAIT) 04.�D�' -74 X -1) 9 RESERVE LEACHING CAPACITY 4 24 !,GALI* DAY NOTE& le. 3,31 1. ALL woRKmANskP AN6 MATERjAfi SMALL CONFdRM,10 D.E.P. TITLE 5 AND THE'tOWN OF 8 RULES,AND 94 REGULATIONS,FOR THE,SUBSLIRFAbE* DISPO§A�, �--SEWAGE- 2- ALL COVERS-TO SANITARY UNM 'SHALL.'BE, BROUGHT TO WITHIN�6"-OF FINISHED,GRADE. 3. ALL COMPONENTS OF''THE SANIT#.RY SYSTEM SHALLSE ZAPABLE'l bF - WI7ljStANblf4GM-10 LIRADING UNLESt THEY-ARE UNDO'OR "Two 0 10 'FT OFDRIVES PR-PARKING-6R6S.*H-2. 'LOADIN10 SMALL. BE ' USED UNDER OR WITHIN 10 OR PARKING AREAS. FT.� OF DRIVE u Tl L. b 4. ANY MASONARY UNITS4 USED TO BRING COVERS TO GRADE SHALL BE MORTARb IN PLACE. Tfi op 5. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WI DEEDED OR ZOMNG REGULATIONS. OWNER / APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. 6. UTILITIES SHOWN ARE APPROXIMATE ONLY, EXCAVATION CONTRACTOR IS TO CALL *DIG-SAFE" AT 1-OW-344-7233 AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON �SITE 7. CONTRACTOR IS TO VERIFY GRADES AND ELEVATIONS AS 'WELL AS SITE COND11IONS PRIOR TO COMMENCING WORK ON SITE. ANY VARIATION 7- ..................... IS TO BE BROUGHT TO THE ATTENTION OF THE DESIGN ENGINEER 0 7 -- IMMEDIATELY. S. PARCEL IS IN FLOOD ZO NE T, 4 9. LOT IS SHOWN'ON'ASSESSORS MAP'. 1 LL NSUITAKE MATERIAL SHALL X REMOVtD FROM UNDER AND FOR 0, A U 109 A MINIMUM OF 5" AROUND LEACHINO FACILITY AND BE REPLACED WITH MATERIAL AS SPECIFIED IN 310 CMR 15.255.(3). 44 IN tv IN %n:, (y? PAZOP05 ----------4- 0. p �p "o 11011 910 NAO /vorE �1/0 's Al 113 SHOPKT OIL CIVILL 183 011- APPROVED: BOARD OF HEALTH v?i 0 DATE AGENT PROPOSED SEPTIC 'DESIqN FOR ' EA S TEV, Lr,8A �OA/' ' PROJECT LOCA'PON xf, cc CRAIG R ';SHORT PROFESSIONXL GNGINEER P-O-� ,BOX 1044, 906 i - - SOUTH 'DENNIS,. MAtS .3913-8311 02660 [SCALE j DATE 11Z) REVISED NO. REVISED SHEET OF LOCATION MAP L A'"o" E ' llu 0 W p1l 0 1998 CRAIG:R, SHORT, ------i- I I --- ------------"-,-------,�------------- _______ - ------�,_.,__--_ ,--- ___- ____.___ '______�,____`,_ - - --,---- -- --- - -- ____ -111_____1----- I I I -�..------------ -,-------,-, � . I I �I . I I I I I . I - I . 1 I,- I - � ", I - _ I � 1, 1. .I. % I I -- .11,11 I�.I� - .-. .1, . �, ml I I -1 1 � I 1 �� I li,11 I , --f, - I I . I �I � I I I � I I , , I'� e \ . I I . , I I -� - .,_".b��_ I � I . . I I I . I I I I . I I � I I I I 1, � ��_ 1, 11 . . . I I . � . � I I I I I , ,. , 11, , _ ., I I. I I . I � I I I , . 1 k � . � I � � - � I I �I , , I � , �! ,:, , ,-,: 11 "� . ,�. _ I I I I I - I I I I � 11 �_-� I�� , "I , 11 , � I , � I � I 11 I � I I . 1. �I 1. � I� I � I � I I� I- _�_�, I ____ . � I "� t, I - I � I . --- -_ � & I'i 11 ,,1 .,�,," ,,� , I . I I�I " I I ,� . v� . : I� I � � I� I I I ; . I � . _____ , I I �1\ _____ . � I , , �,�� _', �� " � :, ,-, ;, �;''t. .� .. . 11 - 11 -, I I., I . � , � I I I I �, b � , �.4 �- �, �,�. I ..'_ , I I , �� , . ,,, I � � I I - ZV r-�^ � I .1 .A, � 1 -I- I � I . � I I = 'FU17A ,4 SO I L TE S --,,, � ,�,`:' i,3� '. 1 , I n6 j r H a i- , j e 3 4,.,,,v- p -?.;7 4 7 1 1 � 1 � ,�, "� ll I 11 . ! - I - I � I I . . � I I : . . ", , . 11 , ' ' I I I I � � I I I DA7_-GF'§0iL TEST / IC 96 1 1 , 1. � I � I � . I I . . I I - , 1, I , I , I �-. I I I � CELLAR . I I I - /z, I 05 1 1 . . l , , - I . I . ,`; 1� . IMMIUM ': "' I I ��o r-e P. 46. �, I � 1. ' � 1, � 11 � m 11 ,�20 FT. MINIMUM FROM . � - I I � -S6L TEST DONI , " 10 � I I I- � z*.7i 1,1", - ' (::i,,._.__ I � " 1-11 .,TOP, bF' OUNDATION , ,- �'_i --- 1 � -i -- I I `*iiiiiii_._ ___"` #e O.7�z -v 0-f I 01 ; ;0-/^Ir I . . , " , _1 _ . I F � " , I I I " I SLAB OR CRAWL SPACE I I I . I - WITNESSED By vs I - . �c�z ", "I ,�, I" , . . I 10,FT. MINIMUM FROM � CLEAN SAND I I � I I I I ,Im, I fl I ELV 10 -I ,, - 10 FT, MIMWM ., - - I I . 0 *;p - , I � , , � . . I . :, I . � �., I , I . ,0 - � - o I � . 9Z.0 I I 1 11 . 94'.0 so i �'i�ll f � - ' ' . . I � � I ELEv-ps OBSERVATION HOLE -� ELEV. . :-, , I, . :--. �' ---, --(ASSUMM) � I . 1.� I � LOAM AND SEED I OBSERVATION HOLE 2 TE --4 MIN./INCH AT 4 8 ; 6 INCHES ,. - ', ' '. , lz�, I I I .1 I I I 1 I I I I - 4 MIN.PNCH AT 4'9`61- INCHES PERCOLATION R I . , . d '. " '11 - � I I I TiON RATE -- I ,.,'� - WIPIRRS- ATE � -I I " I : � CID � 1 4" SCHEDULE 40 PVC PIPE I PERcoLA I . %1. t , 11 � I I � I I I . I I ;, I I . � I- I � I � I I � � � -_ COLOR -'ff.- . - ,,, - � � 1� 11 11 I I . I I � MIN. PIT04 I/8- PER F-T. 2w LAYER OF I � I TEXTURE COLOR MOTT. 0 - , f . ,� llz� � � ,-, I .. 11 _ � I'll - I I . # THER DEPTH HORIZ I TEXTURE MO OTHER 1 il -%, . . '' "�'7 1 7 I � I ''I . - I I I I 11 I DEPTH HORIZ - I , . �1�I 1 1� ,�, 1, ; 1/8- TO 1/2- 1 . I � . , , 1, .1,",_, I I I I I , I . 11, . � I� . I . I I I .f,r . . �, . , . . - � I , - , , .� I I I . 1� I I I I I 0 1 . � . 4. t . I ., , 11 � "I I ,"I I . .1.I 11 , I I I tl I . -z% ED STONE VENT I I: . I . L ---AL 0 . L .__ I ._ ._1'.1 _ , � ",O!, , I - 0 YA- , 'VIA b-CA-7 i- 1. � I . To.. "d y I , " a �, ,c ; 11 , "I I '� I I. I . I, � I f __* I , -i-09)z .5 -,0'n 4d/ I ;1,,,;; - L fr'L '96.0"m ,t 11 I - I � 11 I - I � 1.,e elob �, I I I I '. ... 1, 11 ; I I ' UAY El- 14.$�vl,V NOT REOUIRED � 1 "�4 -7-a�" " 61 IV 5 U.,7- 1 l, �t I -1 , . I- I I I I I I ON FVE � t, - � '5 L ^J6 V ' 8 .41 - "'"',*, 1. 11 , � � 3 ''I 1 4" CAST IR I I I I � )3 � - - _ __ �� I - ., '. f;, I � � , '. �. I . - I 4,o a r%n . zfl-3 17. .O,Y,Z . ,� " � , I � I - . I (OR EQU�Q M"ul lu � ; 1 Cu. FT. OF I _ .-i - 4o*,,wx ,/ It, 1, " I I �, .1 , ," I I I I - , - Z, I e � 'EL F,?,� , :14' , �,, I'!,, I � _� 1 I . . .". 1� I .i:1 " I 11' '. - .11 , � :, �, PITCH 1/4 P&'ii: / \-.- / X'k /j_ - 2 CONCRETE . I � , j �*42 y.0 >(/Z I 0 ,3Z 5 50.,�:� I - �L 11 . � - � , , 1��;_. - , � : ,, I " L , 7AJ39 -&,ff - I I " e-j 9 2 - . - -_ I - - __-,-- - , T" �, �I I � I � 1, I I ; -4. * "Y I I . . . , I , , , �4 ,I . 1�, �� 11, . � 7 1 ,3 f, 5 �5 0.01 _�, . t�.< & . I I f I., 11 I I I ,I ", � 11 I � I I I I I ANCHOR I � 91 __w- q=.f.,Ae_1r,_ej . , " .4 � , , ,� , , I I 'd., BA' -__�Z_ � 4#.s ,�,� �" .,� :11 . , � �,I, I I � . I I . I -I- 'ro � ml - � , - ' I ,� , I I �� , JF Z. I- .- r, �' I F,-,e -5"c.-.,./ 2's, Y " � - I � 11 I I - . , � - 'I, �, , , , - �1� "kN l I . 11 I *' - _r4!J7 6" . I 1'1� �'�, I I I- 1, I I i FLOW LINE I - - uln F'L*I , 9 6 0 , W r.ret �,-I zt#, ; _ I :�' � I I 1: "' .. 11., !, - I 11 . I � I � I I I . . 1, a I 4 - . 11 I I - , ,4' '� � ,, I � . I I - I I I - - ,J, �. � I . 11 I'.� , . . '� " - "��ELEV. . 92.00 10, , 0 a 0 1 1 's`1 C I flar"ei 'If, 7-j yAr4co . - '$O/r- : " ,,I" ._. I I 11 �i , - -TMIN., I J�� '_ I � I I 1 2� ff " " , � I '?("00 Lii - I ,�.- .ci , Z..-nq - X :. U.&)` � . ,� , , I I I . , , , . s � . � I , I I I . I 1'1�'t I - ,�i ,''., -. *1 �, ,* , - V. = 0 - 73.0 I-I _. ,e 7/14ria4'"y 2.41*y 41 . . I ,- �� I� ., . I I_1, *' " 11.1 I I � ,:�. 1 . - , , I� � 1� , � � ,� 0 ELEV. - � . 3 . OAljuj7-. -_ -1- - � .--i I I � � _ ' 6 af i . I ,,-.��,, � 11 I I I . � I I I � I . � I . 2 _j,-".1( 4 -A I I . 1 " I. I., � ,I li, I . I . I --- I I—- 1. � � __ - -_ __ ] �, ,,� ,1 40 4x.1" I I . , , 4.N , I I I � . " I __ .. , _ELI: - -PA-3-, . I I - - , - , I I ,:', : _ , � 1, , 211, ELEV. m 9f.75' v SU E e,I ,�;, ,.� I . '' I I, - " V. . 96. LEV. - 9 1 16 / . I � �,l � I ,1� . , I� � I ,, I I-_ I ,, I 1, I � tspAt f LL - I � . 440a m I ,e,,,,D&*p ' 'I J.. I 'I I I I , 1� � - ,-, , ' . � . � I , . ,, "I � I 11 if I IV, O., I r 0 P3 I 1. 0 � I � . � # ,, .,l ,' ". '. ,,��,�,�_�.�'�'�� .,, , ;I 11 ,� I - . . . L DISTRIBUTION -4,c UL,rec C 0 IV 77tl�C TO e Z 30 � , I. I � 1. ; :,t :, o , � ,.''. I I � , I , � , � I I 71".1 4�X � - I :, � - . . � - 4 - . , 1 '� 1 . I . 1 11 I I '' I � � I I � ,re 70l-Ac. I ! - -�- . I , - I 'U^J�.TU�l . 1 '# ,-,* I . , ,, I � , , - . i I I .? S . , d _ff:L _1", � 11 �:11 .111 I I 1 .� � � I . I . I - - Box m:_/ w I rpi STONE IN AN 11 - . � I I . /a d 0 1 1 102L 1 , '_ .. . _7 1 " , ''-", � . I I . . .OUTLET - - - . . . . . - . . ! L'. ' - I I I . � . . . . . ff' - . I I I I I " ,� � ," 11 � : , 1= , � m 1 I f x � I I . I I col 0 I , I "% � - ,V ..":� '111, , � ,,, (To�BE PLACED ON FIRM BASE) TO BEWATER TES70 , /a x za, ,F.,nrEp TR 9 T 22 2* �1'ELItV, ;� �e 4�'0 ': . . . I I � I � I . I ,� . ,. I . � I il , � � �,, - " I ' I I I ENCH FORMATION I / t9 0 ELEV. - , "0- , 417 RED A I .'.' , I I . . �� I I I . 11 14 IN AT � WATER ENCOUNTE I IN '.'2i:,� I . � I 11, . , . 4 S IF.MORE THAN ONE OUTLET I 10 WATER ENCOUNTERED - . . . . . � . � � ! I . . . A . . . � , 1 . _� . _ , ,- IN � � � I ., . . . . I, � I �'.,. , :, ,�'�:,," _"� ,� - I N S !� �_ WELL I . . 1. �', . . _ "" � k 1 ?4 NW. , 1500' ' GALLON � I I I � . . I I . . I ., I . �, I I . " , I 11 1 . 1, ' '. 1, I CH a . I (TO BE PLACED ON FIRM BASE) I SOIL ABSORP11ON ZONE � . I . I I . I ... � � . . I � , : �., - � : ,,,, I � I "� , I S I � . � . � � ,"_ , " I I I . I . � I I � ; � � I , � , ' I 1, i � . . 4 . I I .. :, . " , M,I j� �11;I , � � I I - 29 IN& S � I I I . . 1.'. , '' I - . . I . , . , � 41 - . � 11 INDEX- . I . 0 .. , .. . , . - ., : '.� 11 - . , I SEPTIC. TANK 1 3/4- TO 1 1/2-i SYSTEM (SAS) I I . . . # . ' ' , � � , J' ' - I I 11 11 , - I . 1* . . � I - � I ',"I", I - , - � �L_ .. I . I I I 1, . WASHED STONE I ADJUST I I � . I I � . � . *DESIGN * CALCULATIONS - - ' � J-1 � , m 4',,� �';I �I" I�� 11��',11 I., "I I I 11� .� ' 1 . � I �.. I I I I I . 11 I. � I 1, . . . 'r 1/6-07 ,40,C)-o"I -r-47A/Z) C2 ELIV - 0 11 � LEGEND: I 1. 3 , , : .1 �, __ I I � , , - I . I I . _.%," 1, ,__: I I � �. I ,� . , , � I .1 I., . � . I- I - 11 ; � TING SPOT ELEVATION 00,0 NUMBER OF 13EDROOMS . I �$� ' '��".�,�,�_ I" I �.11,I- .11 . �11 � 11 � �I I I I I I i ELEV. tv '-7 I I � . . � .11 . I EXIS GARBAGE'DISPOSAL UNIT � . � . NO I � �V it I I � I I I 1� . 1, , � I , 11 I - � USGS PROBABLE WATER TABLE I I EXISTING CONTOUR ----00---- I � I I - . ; _ I � I 1 . I . I , I " � � t, . � I , I I . : - I I TOTAL ESTIMATED FLOW .1 I q I I,." j _� , � 111 � 1�1 , . ., .� __1. I SEWAOE DISPOSAL SYSTEM PROFILE OBSERVED WATER TABLE ( / /, ) ELEV- I � � . �iINAL SPOT ELEVATION I - 11 , - 11� I � . . , I I _. .-- _1 ; I .5 I 1� � OR.) GAL/DAY , � , . � I 1 I . . L I I . I ( 110 CALAR./bAY X / : �., L� ' I �11, i. , . , .-, " I � I � NOT TO SCALE BOTTOM OF TEST HOLE ELEV. . � FINAL CONTOUR If_ � .,, .,I I 11. , . - � I � I I I - . ,I � t�, �� ,:,: �, : � I I I I / PO, , I f /,\ )I F-,w I-I rpv e- [11111111 � I I � REOUtRED SEP71C TANK CAPACITY I GAL . . v - ll I I � L I � I I I I ; I .I-- /I SOIL TEST LOCATION "GAL 11% 1 . ,-; , , .I . � � . 1 141, - I ACTUAL SIZE OF SEPTIC TANK . � __� 1, 1. � � " 1. � .1 I 11 I . I 11 . . . I -IAJC 1-1 I 1\ 4.0'A CH p.#7 UTILITY POLE -0- . -,, �k I - . . I I I � I � � . I 1� I 11 1. ,� 11 t� 1 . ,� -, 1� � I I 11 � I Y,) ill .- I -_ J � - ,/ TO � -W SOIL CLASSIFICATION I � I � % � ,,� 11 � � I . 1� I I I e, WN W�TER W-�-w DESIGN PERCOLATION .RATE I # I 11 . 1. I I ` ,t ' . 11, I I'll - I � I � , � . (m) 11 �_11 � I . . I 1, 11 � 1 � I 1; � .4p 160, 4 CATCH BASIN I MIN./IN. , � � VI/ I EFFLUENT LOADING RATE ,11 GAL/DAY/S.F. , , � � . .1 . � � � I �m . I I I I � �i I I � GAS LINE -' 'I I 1 : 1 . � 1 87 - I 1. I I 1. I . � E90�K Z 1) I 77Z- SO.�FT. . I 4 1 I I I I I �� I� �1, I. . . I . I I I I . I I I CLEAN OU' . . LEACHING AREA 6,-x Z,3) I- Q � I� . . I , . . I I i I . .I.: I I, I � . l - I I I',, I I .1, I � . � I I I � CESSPOOL C.P. 0 424 4AL/DAY I . � . � . , I � � I I i I LEACHING CAPACITY (AREA X RA I & � � . . I �. I 1 I I i I � � , I I I I - . z l I 4,r'76 X ,7 w I � "._� I��l � I I . I .. I I I � ' 1424 .1. I,� I. . � I �.I- 1� I I I I : .11, I nj I I I �I .9 RESERVE LEACHING CAPACITY . GAL/DAY I � iP, I , _1 I. : 11 I I . i 11 I - I I � AN I - r 11 . . - _," I I � � I 11 I � L . ! L, %J 9 2 1 (7-4=\,v1V /3xJ4'v , 7-rf 33/"' 'f'f1v-zm/) 1 . * ,, I , . � I . I I � . . , .11.1, -.1 � I � : 1 . . � � I I I � I ,I+ G� . 0\ , I NOTES: I I � I � , I . I , I � 1. I . � - Z� _ I I I ; . � . I � I . . t . . , I I � � I �, I I 11 i� I � \ L .E.P. I I 1 , I , � I - ____- I I I I I 1. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D . , . I , 11 . . I � I r � '' I � I . I I I I I I / s.--6. aj � -1 01,93 4 RULES AND 11 I � I . 11 I I I - - I 'I-, TITLE 5 AND THE TOWN OF B0')A^1 I . � I I . I I i � � L I - I I , I . I I I . I I . t. � . I l, 7 � I t � I - I . I L I . I " I I . � I ',�� 4 � - -1 REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE. ,, I " , , � . I � I I � I . I N 1� � � I I - I lwl I � �_ . ;." ,.'' I :" ,, "I I I �I I � _� I � , I 11 11 ,,�� \ � 0� I I - 2. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO � I I . "`I � 11 �, I �� I � I I � 0,� cl off , � . I I WITHIN 6' OF FINISHED GRADE. '. I � I . 4 - I '' I IL-. : ` 11 I .I . . I I I . T I � � . & I \ I � 9L� � I I I I . - � . . .. i . I . r 1 3. ALL, COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF " I �,,, I ,ii� , , ", ,�I . � I I - I � . I I OADING UNLESS THEY ARE UNDER OR WITHIN , 4 ,�.,. , ' ' � I I I � -10 L I 1. �_t ,�-m I " l . � I . � WITHSTANDING H . "- , I � I � ,.,� . . / �4, J, -20 LOADINC-SHIALL BE I f , , . � . � I .1.1 I � ,,i I i � I I � I � I \ \ I I 10 FT. OF DRIVES OR PARKING AREAS. ,H , %: ': �:, "" ' ' I I � / 11 I 0 1 1� I I I I 0" 01 ` '* - 1�� , .. . I , I I � U 7- I I , . " I w. .- ,. " . I I \ �/ I IL. .�. I I d , USED UNDER OR WITHIN 10 FT, OF DRIVES,OR PARKING AREAS* : , . . . I I � � 4' � oel - I NS TO ALL � , #,. - " � 1. I . I � . I I ; I I 4. ANY MASONARY UNITS USED TO BRING COVE tGRADE.SH I �t . � . , -".'��,. 1 1. I L 1�� - �I :` � , � � - I - - - �' 11 . / , pole � �, - . It-1 I .I . � I .�, � I Ie!- I I � . . _- I I I . \ 11\, BE MORTARED IN PLACE. . 1 ,7, 1 1 1 . 11 . - . I � � . . . \ / , 1 . 6 I. . I . I 1� . I I . \ � 48 5. NO DETERMINATION HAS BEEN MADE AS TO COMPLIAkE ,VATH �'. I. - I 11 09,47 \ % I O� I z / i � 1 A.14 ,:"�� . , � ." , . - I � I I I I I . \ 91p .-.it \ I � DEEDED OR ZONING REGULATIONS. O"ER / APPLICANT IS TO ,�_It. �I � L " I I I � I �0 / ,_ - � - - _� q . I I I OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. . T14- 1� ",1. �"I I- I 1� I - . � � 11 I I I . . I I &I _..�.� � r\ /I / _\� \ - �_, I - Iq . 6. U11UTIES SHOWN ARE APPROXIMATE ONLY, EXCAVATION- CONTRACTOR I I ".. ..I ,i , , � . � � .-I '4312 � 1� I . I I 0\ I / ' i l"'. I ; I I � � . � I I 11 11 A - IS TO CALL "DIG-SAFE' AT 1-,895-344-7�33 �T LEAST. 72?HOUhS .11 . I I � . .. ��," ,,b:� �1 � . . I . I \ \ \ I \ 11 ' I I ll I . I � �p , . ., ,, I I I , � ( /,,,,- 3- , , � - - - - -_ � � I PRW TO COMMENCINQ WORK ON SITE , - - 41 I . 4 , - ., . 1.� 1�1'1;"11 I I ,Ilk � . I � .I I I� I \ ,\ , I I \ \ I �_ .-- I � ,\ () 7. CONIRACTOR IS TO VERIFY GR*DES 'AND ELEVA1IONS*,AS'.WELI, A'S � ,, I � I I I I I 1 � I ". I \ I . I I . I I I N, � � O." SITE CONDITIONS PRICA TO COMMENCING WORK ON.Srll� ANY, VARIATION , , - - . 1 . I � I / - 0 �1 � I - m I , ,�'. I .1 � N'11 � � I.. I I I I I I I 1-11 I / 1 4, C 7- Z \ \ � - / '6ROUGHT 1*6 THE ATTENTION a THE:-,DESIGN ENGINEER' � . I . l . -,, � I � l I ________�� L IS TO BE L . I ) , 1I I I I 1.11, I � - w 11 , I I k . . - . - I .1 . , "I. "!, ''I . I I - 1�> 011- ----, -,----' I � . 1 0 I I � I I ., I I :I I I 1 -4 , 1, I I �,,,_ , I I � p . I � � � 11 � � , 'I r ` . . , � , , � \ / /, ,C7 + A ,c2 . Al I mmmqky" * � � 401- I I . I � " ��,,,� j,", ,, ,�11 - , I�, I , . \ \ , ,� I f 8. PARCtL IS IN AOOD *ZONE - p I , ,, _ ', , �,�_ , I I 11 11 I � 1 .3 . : :L, ', , � � . - I I � 1.,� --..� � 1, 11� .. . . � . I /. I 11-1 _- IfZ - --P. -3 -Z I' ��, � , . I \\ 00 / , / ��, � � I I ��;., ; I I I \ I ,/ I � � - iv , - � 9.10T IS SHOWN' ON*ASSESSOR$ MA :,C5 ARM -� - . �,�, .1 1 . _11- � I I 11 I I p I I , - I I � 1� . .1 * ' 1 11 41 1� . ,"�� _ ! I �1, - . I I I� I I . . \ I qA - , - , , I � 11 : I I a ____ ' . ' , . , I . I , I I , - � i / __��, I 6. ALL UNSWTABLE -MAtMAL SHALL Dt IMA04M 'FROM,UNDER"AND FOR' I " , I - I I I � I I . - . �/ , , / . . , ,., I 1''.11 " � I I I , 1: " I I - 1 , - '14 *CED'WITH ,:� . .. I 11 'i - ,: I I - . � I _., , , , � 1 Nq 1 1 ,� / 1. A MINIMUM 'OF 5- AROUND LEA041NO-FACft1TY'AND-BE'REPLA j ' I I , I , I A ' � . , �:-� 111, 1 1. I I� _��,:�.�� ,� , I 1. - I I - � I I I J,q ,' � . MAITJiIAL' * S' SkCIPIED IN 310 CMR i,5 2354i)� '- -..! � I " --"-, L,l� -,� I 11 I I I I � � I \ I I I I . �_� , , , . . * . � , �, '. �_ - :1, � k . I I , . �I ��t, ..� I , � ", 1, � I . � - - a- I , \ \ I .I . . j / N I I I . " I - I . . I .I . 1 ..� I I I I- 7 �, I I , \ - , I , I . � :. . I � v � , � I I I I I I (-�q . I i I I .11 . I . . . I c I 1 . I I . . i 't . l I I 11 . I I , I . - I I I - . � . . . . � . � , - I i o. I � I , I I �, I I � � , I / . I �.......� 1. "__� . . � , � I . I . / I . I � - . 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