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Home My WebLink About1671 OST.-W.BARN. RD - Health 1671 O ST.-W.BARN.ROAD West Barnstable ' A = 128 - 038 — WOO o � IS APR-22-2013 16:11 TodagRE Yarmouth 5083980684 P.002 V Jz' IJ/LVVI IV.LI r A A [a UUZ/VU4 "vM0MCMLdB0JUT0R=1NC- MA CERZ Na:M-MA 063 0 IM JW41111=Dadva Unk 12 SdMdW4^MA 02SM (S011)8O&M" 1.000,i 044 0 FAX(in)as&6e" Client Name Aq-a S* Location /971 oeteIv ile//I/. 8,4rn:14- Addrags 111 E Falmouth Highway CatenMa,MA E Feltimaulh.MA 0253E SonllpleDate W3H4 CoAected Sy Gant S4nwk Am NA Sample I)p Well DmRecdwd 07 ivis Lab Drder Number aw.1302E7 Well sPca NA 9i�t"��l'} °• ��. ..�•'r�•��. a t7�` b° " " �I. ° i •ry:� } 1�•• Y� ��.qq., .t r`a si�+ '.yy1: :rF,�'+ •i7��jt� 'wii�A-"� 'q-'.�'�.,').a :Yi9 41• r.Y. +� 'y'.d' ^ .x +t.� �:4?i�+1��' �b' .r.1 !`e•'n I� `k � Y M1 .11�rrastad Unftr adlluN�4eALduletA/leRatudl M�hod AhoQ7�By Total Collferm /100m1 0 0 611611M 2/1412013 IRS pH _ PH UnRe a."s 5.66 SM4600•14a 7Nd/2013 LL Spec&CMwUd ww- umhoulam 500 388 EPA 120.1 2/14/2M3 LL NHY" mg/L 1.00 40.004 EMMA 2A4/2013 LL Nltrd" MWL 10.0 2.61 EPA 300.0 W412013 LL BW*" "WL 20.0 bo's FPA 200.7 2/21/2012 _ MG Total IMM mgA, 0.3 0.06 EPA 2D0.7 M 8*013 K9 Mangatduleo mg/L ales 0019 EPA 200.7 2nWM 3 KB Polpaaklmn tna/L 20.0 2.1 EPA 200.7 2l1t1R013 98 Gelahan MOIL NlA 6.2 EPA200.7 2118/2013 K9 MG/L NIA 4.2 >6PA 200.7 2l18=3 KB 710181 ma/L so-no 30.3 EPA 200.7 2/18M3 KB Alkdlnity mp/L 200 17.E 8M2M08 W1412013 LL gM fM � mg/L � 250 11.0 EPA 3 0 2J1412M 3 LL Chlotld61, MOIL 250 108 EPAWO.0 2ftVAI3 LL TUMdpy _ NTU U <1.0 SM2130 6 2nSW 3 LL Calms APO unlro 16 46,0 SMM20 8 2 ISM3 LL Fm*G02 mall so 38.E Calcination 2/14M 3 LL Corarne�fa: i Lim pH Ihlllmtm high CrWM Owns tedifts. 21*ium Iaw is,not s h hazard,bi!if an a low eodulm did,ooneull a phyeWM befam*Inking , Water dicta EPA and 1R MdfA2k a iar Cf"tng 11or ParsmatM ts3led.' v . : Dave LL- N k;-Ronald A Saari O C%: 4`It4l►aROOMCL- Dlt'eN � C O BAL •SwAaocked Pmf e 1 oft nCen"an Is xw mwilOMo fer Ah aea bo-for n—pamh fa wour nmPlar.. Total P.002 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments o , 1671 Osterville W. Barnstable Road 0 �✓ vim' Property Address ° Desmond Keogh Owner wner's Name information is ;✓West Barnstable MA 02668 6/1/12 required for every page. City/Town State Zip Code Date of Inspection Inspection results must:be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, _�- use only the tab 1. Inspector: key to move your cursor-do not Ricky Wright use the return Name of Inspector key. B & B Excavation,lnc. raa Company Name 14 Teaberry Lane Company Address Forestdale MA 02644 Cityrrown State Zip Code 508-477-0653 S14595 Telephone Number License Number ° �'""""•� q:•� .mar B. Certification certify that I have personally inspected the sewage disposal system at this address`and that=tfe 4�, information reported below is true, accurate and complete as of the time of the inspection. The'inspecfion was performed based on my training and experience in the proper function and maintenance of,-.on sjte sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 6/4/12 nspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. L L t5ins•11/10 Title 5 Official a ion Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1671 Osterville W. Barnstable Road Property Address Desmond Keogh Owner Owner's Name information is required for every West Barnstable MA 02668 6/1/12 page. CityTrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 1671 Osterville W. Barnstable Road Property Address Desmond Keogh Owner Owner's Name information is required for every West Barnstable MA 02668 6/1/12 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 1671 Osterville W. Barnstable Road Property Address Desmond Keogh Owner Owner's Name information is West Barnstable MA 02668 6/1/12 required for every � page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system asses if the well water analysis, performed at a DEP certified laboratory, f r Y p y , p o fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/day flow t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments G1M , 1671 Osterville W. Barnstable Road Property Address Desmond Keogh Owner Owner's Name information is required for every West Barnstable MA 02668 6/1/12 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1671 Osterville W. Barnstable Road Property Address Desmond Keogh Owner Owner's Name information is required for every West Barnstable MA 02668 6/1/12 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ ® Were as built plans of the system obtained and examined? (if they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms actual 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 l5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1671 Osterville W. Barnstable Road Property Address Desmond Keogh Owner Owner's Name information is required for every West Barnstable MA 02668 6/1/12 page. Citylrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d n/a 9 ( Y 9 (gP ))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: never occupied Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments c,M 1671 Osterville W. Barnstable Road Property Address Desmond Keogh Owner Owner's Name information is required for every West Barnstable MA 02668 6/1/12 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ❑ No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts u W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 1671 Osterville W. Barnstable Road Property Address Desmond Keogh Owner Owner's Name information is required for every West Barnstable MA 02668 6/1/12 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 2000 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1 1/2' feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: >150feet Comments (on condition of joints, venting, evidence of leakage, etc.): At time of inspection building sewer appeared to be in good working order. Septic Tank(locate on site plan): Depth below grade: 2' feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ® No Dimensions: 5'8"x5'8"x10'6" Sludge depth: no sludge t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 1671 Osterville W. Barnstable Road Property Address Desmond Keogh Owner Owner's Name information is required for every West Barnstable MA 02668 6/1/12 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle no sludge Scum thickness no scum Distance from top of scum to top of outlet tee or baffle no scum Distance from bottom of scum to bottom of outlet tee or baffle no scum How were dimensions determined? scour stick Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): At time of inspection septic tank appears to be structurally sound. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or.baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date l5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4'M , 1671 Osterville W. Barnstable Road Property Address Desmond Keogh Owner Owner's Name information is required for every West Barnstable MA 02668 6/1/12 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 1671 Osterville W. Barnstable Road Property Address Desmond Keogh Owner Owner's Name information is required for every West Barnstable MA 02668 6/1/12 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): At time of inspection d-box appears to be in good condition. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1671 Osterville W. Barnstable Road Property Address P Y Desmond Keogh Owner Owner's Name information is required for every West Barnstable MA 02668 6/1/12 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 4 ❑ 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.): At time of inspection leaching was dry and appears to be in good condition. No sign of hydraulic failure Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 1671 Osterville W. Barnstable Road Property Address Desmond Keogh Owner Owner's Name information is required for every West Barnstable MA 02668 6/1/12 page. Cityrrown State Zip Code Date of Inspection D. System Information cont. Y (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 1671 Osterville W. Barnstable Road Property Address - Desmond Keogh Owner Owners Name — information is required for every West Barnstable MA 02668 6/1/12 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately fi 4 d. a 10 0(2) _ R3= U5I 5 B5 = ` t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 1671 Osterville W. Barnstable Road Property Address Desmond Keogh Owner Owner's Name information is required for every West Barnstable MA 02668 6/1/12 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: >12 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 1671 Osterville W. Barnstable Road Property Address Desmond Keogh Owner Owner's Name information is required for every West Barnstable MA 02668 6/1/12 page. Citylrown State Zip Code Date of Inspection E. Report Completeness Checklist Inspection Summary: A B C D, or E checked p rY ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 L f Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposat System Form-Not for Voluntary Assessments (� M s. °'t o 1671 OSTERVILLE RD. Property Address N.E. PROPERTY SOL. BRAINTREE, MA. I- ' G?>�6' woo Owner Owner's Name information is required for W.BARNSTABLE MA 02668 8/22/08 - - every page. Cityrrown State Zip Code Date of Inspection Inspection-results must be submitted on this form.Inspection forms may not be altered in any way. Im nr anfilt: out A. General Information 1 forms on the computer,use 1. Inspector: only the tab key to move your VANCE STEVE YOUNG cursor-do not Name of Inspector use the return key. Company Name BOX 1592 Company Address MANOMET MA 02345 rain City/Town State Zip Code 508 759 5603 S1686 , Telephone Number License Number v B. Certifications 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 it section.the inspection was performed based on my training and experience in the proper function and ma'ntenance of on�site sewage disposal systems. lam a DEP approved system inspector pursuant to ection 1.5.34p=of Title 5(310 CMR 15.000).The system: co ® Passes ElConditionally Passes ElFails ❑ Needs Further Evaluation by the Local Approving Authority e i $/22/08 Inspector's Sig na ure Date 1 The system inspector shall Z4a 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 DER The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. ****This report only describes conditions at the time+of rnspection 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. OSTERVILLE RD.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System form-Not for Voluntary Assessments 1671 OSTERVILLE RC). Property Address N.E. PROPERTY SOL. BRAINTREE, MA. Owner Owner's Name information is required for W. BARNSTABLE MA 02668 8/22/08 every page. City/Town State Zip Code Date of inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/aftays complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Answer yes, no or not determined (Y,N, ND)in the❑for the following statements. If"not determined,"please explain. ❑ The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available: ND Explain: ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed OSTERVILLE RD.•08106 Me5Officiat Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 • , 1 Commonwealth of Massachusetts w Title 5 Official Inspection Form a Subsurface Sewage Disposal Systern.Form-Not for Voluntary Assessments 1671 OSTERVILLE_RD. Property Address N.E. PROPERTY SOL. BRAINTREE, MA. Owner Owner's Name information is required for W BARNSTABLE MA 02668 8/22108 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cunt.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if - the system is failing to protect public-health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a mariner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the"Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. El The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. OSTERVILLE RD.•08/06 T"Rle 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts H Title 5 Official Inspection Form a Subsurface Sewage Disposal Systerm Form Not for Voluntary Assessments 1671 OSTERVILLE RD. Property Address N.E. PROPERTY SOL. BRAINTREE, MA. Owner Owner's Name information is required for W BARNSTABLE MA 02668 8f22l08 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well*". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: Any portion of the SAS,cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. OSTERV ILLE RD.-08/06 Title 5 Official Inspeclion Forth:Subsurface Sewage Disposal System-Page 4 of 15 Commonwealth of Massachusetts Title 5 Official inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1671 OSTERVILLE RD. s Property Address N.E. PROPERTY SOL:. BRAINTREE, MA. Owner Ownef's Name information is required for W BARNSTABLE MA 02668 8/22/08 every page. City/Town State Zp Code Date of Inspection B. Certification (coat:) D) System Failure Criteria Applicable to All Systems(cunt.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no otherfailure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (interim Wellhead Protection Area—IWPA)or a mapped Zone 11 of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. OSTERVILLE RD.-08/W TNe 5 Official Inspection form:Subsurface Sewage Disposal System-Page 5 of 15 Commonwealth of Massachusetts _ Title 5 official Inspection Form Subsurface Sewage Disposal System form-Not for Voluntary Assessments 1671 OSTERVILLE RD. Property Address N.E. PROPERTY SOL.BRAINTREE, MA. Owner Owner's Name information is required for W. BARNSTABLE MA 02668 8/22/08 every page. Cityrrown state Zip Code Date of Inspection C. Checklist Check if the following have been done.You must indicate`yes'or"no"as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered,opened, and the interior of the tank inspected for the condition of the baffles or tees,material of construction, dimensions,depth of liquid,depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information.For example, a plan at the Board of Health. ❑ ® Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] OSTERV ILLE RD.-08/06 Title 5 Official Inspection Porm:Subsurface Sewage Disposal System-Page 6 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1671 OSTERVILLE RD. Property Address N.E. PROPERTY SOL. BRAINTREE, MA. Owner Owner's Name information is required for W BARNSTABLE MA 02668 8/22/08 every page. Citylrown State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available ast 2 ears usage N/A 9 � Y 9 (gPd))� Sump pump? ❑ Yes ® No Last date of occupancy: UNKNOWNDate Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): OSTERVILLE RD.-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM '� 1671 OSTERVILL:E RD. Property Address N.E. PROPERTY SOL. BRAINTREE, MA. Owner Owner's Name information is required for W BARNSTABLE MA 02668 8/22/08 every page. City/Town state Zip Code Date of Inspection D. System Information (cunt.) General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ❑ No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank,distribution box, soil absorption system El Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 8 YRS PER PLAN DATED 8/10/2000 Were sewage odors detected when arriving at the site? ❑ Yes ® No OSTERVILLE RD.•08/06 Title 5 Oficiall Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System form -Not for Voluntary Assessments 1671 OSTERVILLE RD. Property Address N.E.PROPERTY SOL. BRAINTREE, MA. Owner Owner's Name information is required for W. BARNSTABLE MA 02668 8/22/08 every page. City/Town state Zip Code Date of Inspection D. System Information (cunt:) Building Sewer(locate on site plan): Depth below grade: feet - Material of construction: ❑ cast iron ❑ 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): 'Depth below grade: feet _--- Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No -------------------------------------------------------------------------------------------------------------------------- Dimensions: 10X5X5 Sludge depth: 3" Distance from top of sludge to bottom of outlet tee or baffle 27" Scum thickness 0 Distance from top of scum to top of outlet tee or baffle 8" Distance from bottom of scum to bottom of outlet tee or baffle 18" How were dimensions determined? MEASURE STICK OS T ERVILLE RD.-08/06 Taie 5 Official inspedon Form:Subsurface Sewage Disposal System-Page 9 of 16 Commonwealth of Massachusetts W Title 5 Official Inspection Farm o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments y�< 1671 OSTERVILLE RD. Property Address N.E. PROPERTY SOL. BRAINTREE, MA. Owner Owner's Name information is required for W. BARNSTABLE MA 02668 8/22/08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): TANK INTEGRITY OK INLET AND OUTLET TEES OK .LIQUID IS LEVEL WITH THE OUTLET INVERT DOES NOT NEED PUMPING AT THIS TIME,RECOMMEND PUMPING ANNUALLY Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑metal ❑fiberglass ❑ polyethylene ❑ other(explain): OSTERVILLE RD.•08106 Trtfe 5 Official Inspection Form:Subsurface Swage Disposal System-Page 10 of 15 Commonwealth of Massachusetts Title 5 Official inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 4 M , 1671 OSTERVILLE RD. Property Address N.E. PROPERTY SOL. BRAINTREE, MA. Owner Owner's Name information is required for W BARNSTABLE MA 02668 8/22/08 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) Tight or Holding Tank (cont.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order. ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover, any evidence of leakage into or out of box, etc.): BOX IS LEVEL AND DIST. IS EQUAL.. INTEGRITY OK NO STAINING ON WALLS OF BOX ABOVE THE INVERT LINE AND NO EVIDENCE OF SOLIDS CARRY-OVER Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No OSTERVILLE RD.•Oa/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments y� 1671 OSTERVILLE RD. Property Address N.E. PROPERTY SOL. BRAINTREE, MA. Owner Owner's Name information is required for W BARNSTABLE MA 02668 8/22/08 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cunt.) Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 4 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number,dimensions: ❑ overflow cesspool number: ❑ innovative/altemative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): COVER#4 WAS EXPOSED, NO STANDING EFFLUENT IN CHAMBER INDICATING ACCEPTABLE LEACHING AT THIS TIME CURRENT CONDITIONS DO NOT GUARANTEE FUTURE PERFORMANCE OSTERVILLE RD.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 15 • Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1671 OSTERVILLE RD. Property Address N.E. PROPERTY SOL. BRAINTREE, MA. Owner Owner's(dame information is required for K BARNSTABLE MA 02668 8122/08 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Cesspools (cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): OSTERVILLE RD.•08/06 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 1671 OSTERVILLE RD. Property Address N.E. PROPERTY SOL. BRAINTREE, MA. Owner Owner's Name information is required for W BARNSTABLE MA 02668 8/22/08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. i F0krl OF POOSE � A= y7' o 0 y ' 71 1 f AS-:,71 ' le & &:�y F OSTERVILLE RD.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1671 OSTERVILLE RD. Property Address N.E. PROPERTY SOL. BRAINTREE, MA. Owner Owner's Name information is required for W. BARNSTABLE MA 02668 8/22/08 every page. Cityfrown state Zip Code Date of Inspection D. System Information (cant.) Site Exam: ❑ Check Slope ❑ Surface water ® Check cellar ❑ Shallow wells Estimated depth to ground water: 10+feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 8/10/2000 Date ❑ Observed site(abutting{property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: PER PLAN ON FILE OSTERVILLE RD.-08/08 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 f5-- 0 3 No. ~ �� 1�G7" 11 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 0(pprication for Digoar *pgtem Congtruction V__errmit Application for a Permit to Construct( )Repair(/Upgrade( )Abandon( ) ❑Complete System C�7 6ividual Components Location Address or Lot No./i 7/ ecW1 41 111� Owner's Name,Address and Tel.No. Assessor's Map/Parcel �7/ 4/1 �� pole Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Ant#4a 0'Y 71 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building._US. 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 Nature of Repairs orAlte atiops(Answer when applicable) 7iALe inop4ee 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 Certifi- cate of Compliance has been issued by thi o d ealth. ,Q f Signed ' Date Application Approved by Date Ic 1 Application Disapproved for the following reasons — ——Permit No. =OINI(ln\"`Sc6 a——— —� Date Issued No. r l� .� .�;y Fee. L� THE COMMONWEALTH OF MASSACHUSETTS Entered in compute: I Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS Z(pprication for �Mi5pooal *p5temton5truction Permit Application for a Permit to Construct( )Repair(Upgrade( )Abandon( ) ❑Complete System R'Individual Components Location Address or Lot No. / /)S r U J Owner's Name,Address and Tel No. Assessor's Map/Parcel K/, t3 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms � Lot Size sq. ft. Garbage Grinder( )' Other Type of Building �� No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date -Title Size of Septic Tank jS,(,A1.-�('..C \ Type of S.A.S. Description of Soil Nature of Repairs or Alt"tio s(Answer when applicable) ,'L'/aZw e d rode 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 Certifi- cate of Compliance has been issued by this o d o Teal p / Signed Date _ 15l'/zi71 Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued —— —————— ——————— ———— — THE COMMONWEALTH OF MASSACHUSETTS �3$ BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY that the On-site Sewage Disposal System Constructed( )Repaired( A<Upgraded( ) Abandoned( )by LSOr /�7If1 y1�s�� n55w_-7", Zf at , 7Z / -5/V9/`6////,-0 1 44, f�lJ/�15IV lb of has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No._—Qd3\-`5,�dated Installer Designer The issuance of s permit shall not be construed as a guarantee that the syste will function as,designed. Date L� /��i 10 1 Inspector C�t �i • '�Ut \mil`. -^s ———————— ————————————————————— No. X _� — �� ` ! ® 0 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS �Di5po!5ar 6potem Construction Permit Permission is hereby granted to Construct( )Repair v/ upgrade( )Abandon System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to r comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of-this permit. f � Date: Approved by r sYC 4y"s� a Mdu r 5s4n tij 6i�k tNvf F- kfFI2 3 E-� TOWN OF-B E ,C I I r �y �rJ7Sl 1STABL tth e ', 1l SEWAGE # VILLAGE f� ,/S �7 ASSESSOR'S MAP & LOT 39 -kb { .. INSTALLER'S NAME&PHONE NO.AIL (as T�r� 9399 SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size)1 � NO. OFBfDROOMS BUILDER OR OWNER btA e PERMIT COMPLIANCE DATE ID D DATE. � 1 Separation Distance Between the: I4azimum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply..Well and LeachingFacility ty (If any wells exist : on site or within200 feet of leaching.facility,): .Feet Edge of Wetland and Leaching Facility(If any wetlands exist i . Feet within 300 feet of leac,lung fac hty)Furnished by _ I ; 00 A2: Y7 As a A y 71 ---------------- as 7Y 0 1 let 3y `SO '. i No.-------------------- fJ ff t/d 0vSL Y 1-53 VCO 70 •fib it € Fee---------------------- BOARD OF HEALTH TOWN OF BARNSTABLE Applicat ion Ar Vell Con0ructionpermit Application is hereby made for a permit to Construct (4, Alter ( ), or Repair ( )an individual Well at: Location — Address Assessors Map and Parcel Owner . e Address --------,__�_�_-----�_�_�_�--- /_ ? 'i Z -------------Avie - Installer — Driller Address Type of B Dwe ------------------------------------------------------ Other - Type of Building ------ No. of Persons--------------------------__-__—------_—______ Type of Well——Lv�. d,�� - ----— -- - 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- � -- - --=� e'fj --- A lication A roved By '`'� - a e PP PP � " -- -- r =-- - r --- � "B-�---- date Application Disapproved for the following reasons:--------------------------------------------_—_—________ --------------- — -- ------------------------------------- date J �otJ 3�— - ---- Issued— date Permit No.-- - ---- ------------------ - -------- date BOARD OF HEALTH TOWN OF BARNSTABLE (Certificate Of (Compliance THIS IS TO CERTIFY, That the Individual Well Constructed (�!), Altered ( ), or Repaired ( ) -- --------------------------- ® Installer at has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. ------------------Dated-----THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE- ------- --- Inspector-- --- - - ---- --- -- II U r � S S Q JCI 1 FFA41V �v_33 (� No.—------------------ Tss vt,0 7 .� • G� it E Fee------ ------ BOARD OF HEALTH TOWN OF BARNSTA.BLE Application contruct ion erntit Application is hereby.made fora permit to Construct (/ Alter ( ), or Repair ( )an individual`Well at: - - - - - - - --- - .a 3 F_--w --- - -' Location Address / Assessors,Map and Parcel' A/, r, , w Owner , " r€ GT Address - f e/�__ /J`�� . t✓ _" /'!.�`/,�1,�Tl.�/45i/1 ___�i-�------------------ i Installer — Driller Address Type of B ' Dwelling -- ----- -----= - ------------ Other.- Type of Building''=,-- --' ---------t° No. 0 -Persons-------------- ' ---------- Type of Well Capacity.-— - - - --——-- ----— +` Purpose of Well-------------- ---- --- ---- y t � .,r I k: 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 1 - place the well in operation until a Certificate .of Compliance has been issued by the Board of Health. Signed --'1% — LIJ/`d ---- �da e A lication.A roved B zwo. r, PP PP --------— date - -- ' Application Disapproved for the following re date Permit No.= —.�3 — -- . Issued G-F date a!•A!e*�aiaasi!i!�!L9andt!i9CiYc}d!LCnlilA! N14Ali9ilA°e4B�TiSXdifl.!asilitFliBtil�8rfS9�!Ofl:4 fifLl8�A4-iRii0+9�1g4.)!?9fla9.slA.!#li9iliR4't�to!iSeRGl44A.�648!L4o'�iK►^t9�6twt05L:3-� BOARD"OF•H.EALTH TOWN OF BARNSTABLE t Certificate Of Compliance THIS IS TO CERTIFY, That the.Individual Well Constructed.(/) Altered ( ), or Repaired ( ) Installer �.y has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation. as described in the application for Well Construction Permit No. -----------------Dated----- ------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THA_ T'THE WELL SYSTEM WILL FUNCTION.SATISFACTORY. DATE ------- —= --- -- pector:-- Ins 'Ririi.ii+4R:.�iKi'EaTiKiTS42gW+IaBaYiliRaVia!'.i4+,afa2'c:DAB i*2e48+aaB41`.48.8!Gpi26S.t9G9i.I:RFIriRa4AIii.1Y'4i'BYailoQJ19A!i94lOSD+k'i4iPisbi94?APiWAa`L9.LLmi!4Y+QiDQiY.'A4h2A+AYiRi!a paadTA4341Ta'!.K BOARD OF HEALTH TOWN - OF BARNSTABLE Well Congtructionpermit ,. ------------ Fee 't Permission is hereby granted to Construct (p'"), Alter ( .), or Repair ( ) an Individual Well at:No— A/1 / — - - - - Street as shown on the application for a Well Construction Permit ' ----------- Dated------------ - -----=-- --------------------------------- ; 4 Board of Health DATE j TOWN OF BARNSTABLE LOCATION 4 / -AV, RPSEWAGE# .V+LLAGE ASSESSOR'S MAP&PARCEL 4e—:F, —4V60 IIJSTALLERS NAME&PHONE NO. & 67d� SEPTIC TANK CAPACITY �� Via'l LEACHING FACILITY:(type) eC)55 (size) J NO.OF BEDROOMS `7�' OWNER &1,4 P P&44-�f , ��i�I��l� '�� !✓! PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY 99 �� : . � � .� r - � s � — .�. - � �® D O �1 ��, �/ �� 3 �g 83 "��` � �� . . .�,�� 1 TOWN OF�BAJ STABLE C✓ t�l LOCATION / II Slc1 C J, SEWAGE # _ aQ0- Y7d VI1,LAGE • 1�S C��i,U S�1 SOR'S MAP & LOT /cPS'38 "!Jo INSTALLER'S NAME&PHONE NO. JOB��' 605/; ZZI- 939f SEPTIC TANK CAPACITY A Q4 YL LEACHING FACILITY: (type) ' (�cQ/ Nfh /Nl 1 (size-) NO.OF BEDROOMS BUILDER OR OWNER AA e PERMITDATE: /D hanQ COMPLIANCE DATE: 8 1 Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Ftirnished by r t rPoVr or MOUSE ,4 F Aa- y7 AS . fly -- 71 ' r AS i �y 38 ,No. A�L�'f _ 7g Fee-fib THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE Yes , MASSACHUSETTS 0(ppfication for Migozaf *pgtem Construction Permit Application for a Permit to Construct Y)Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. �� 1 �,Lc Owner's Name,Address and Tel.No. (,U a �r a�e•L�C�.�,, f� 'l l tom. �!!�' Gl Assessor's Ma /Parcel �"3 71 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No,9 j)re,,,,i,I/,( (�/Ai l 4-� Type of Building: Dwelling No.of Bedroo s I. Lot Size sq.ft. Garbage Grinder") Other Type of Building M No.of Persons - Showers(q) Cafeteria(4,4 Other Fixtuyes Design Flow 1 Eg gallons per day. Calculated daily flow gallons. Plan Date = Z-7 2.00e, Number of sheets 2 S+cQa7;S Revision Date Title Q1)Qmeo E�tIC �ISC�u� 4G'1 �� t�LLYt�CG W ��a,2t�S�6c� �C� Size of Septic Tank f y LQ t71V tr Type of S.A.S. Description of Soil: kPI"t p_ y Nature of Repairs or Alterations(Answer when applicable) 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 Certifi- cate of Compliance has been issued by Bo Signed Date Application Approved by Date - Application Disapproved for the following reasons Permit No. Date Issued T' L� 1/ > >e No.. G+!/ Fee ' E, Entered in computer:. THE COMMONWEALTH OF MASSACHUSETTS Y s PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIPPriration for Mtoozar *p�tem Cowarurtion Permit ! Application for a Permit to Construct(Y)Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components it i Location Address or Lot No. Owner's Name,Address and Tel.No. Assesso 's p �ce_� 75 �r3 7/ t Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.Nofj ✓ Type of Building: Cf Dwelling No.of Bedroo Lot Size�— sq.ft. Garbage Grinder") q• Other Type of Building / '. No.of Persons / ' 3 Showers(3) Cafeteria(A,a) Other Fixtt#r "� - Design Flow ,� gallons per day. Calculated daily flow / d gallons. Plan Date U�V Z . zoo 6 Number of sheets 2 S}(Eis!T j Revision Date .. Title 'ZVOSEO EfTIG `fS('Ewt �� 1G-71 OgTEPWILca W $42(V5(?e>LE D Size of Septic Tank �0 � ' << Ty�p of S.A.S. fe Descriptio of Soil `r d /�'1 �d°7 / y��/�U < 1 f l 6�✓' �'6 s ,r-r) 7i C �dg r Gl Z tr s, f Nature of Repairs or Alterations(Answer when applicable) 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 Certifi- cate of Compliance has been issuedsb s Signed / Date Appli ation Approved by DateR Application Disapproved for the following reasons r Permit No. �,. Date Issued —————————————————————————————————;—--- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CA Yth t the site/sG g�yspos m Constructed(K )Repaired( )Upgraded( ) Abandoned( by _ _ at 16� ` dS l EZ,,/ k Cl L 05 l NS t�C F, onstructed in accordance with the pr visions of Title 5 and the for Disposal System Construction Pe date '``!l�' Installer n 1`_b<<Ot'V Designer f t dl C✓ �/`' c N� l' The issuance of this pe t all not be construed as a guarantee that the syst tll c ' n as de tgn Dater Z*0 Inspector �'�Yl� f �j -- No. ----------------------Fee/ t� _ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS W6pozar *potem Conetrurtion Permit Permission is hereby granted to onstruct(� )Repair( )Upggk�ade( )Abandon( ) System located at �6_7 �S��Y►�L C— ��ES t5�42cVS (3G� (zoo �� 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:Constructionymustfie completed within three years of the date of thi t.- Date: Approved by A . J . " Le �. i r )s-r i i )TOWN OF BAR/N�ST�ABLE LOCATION ?1r�71 l��/_S�p(-,✓ le 1 � il/JS�?/J/(' /4f' i SEWAGE # VILLAGE1�i1T�t�I), ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE'NO. j SEPTIC TANK CAPACITY LEACHING FACILITY: (type)_V(SZO NO.OF BEDROOMS j BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet .;Edge of Wetland and Leaching Facility.(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by I Y TOWN OF Bj STABLE �jCj LOCATION llD71 d'5kwo ll d ,&ws�aile f l SEWAGE # a�LL"Y7 `I7� VILLAGE A(SkA� AA ASSESSOR'S MAP & LOT -39 40 INSTALLER'S NAME&PHONE NO. c�r�2�oi/ C6�PS� 77I 9399 SEPTIC TANK CAPACITY '' LEACHING.FACILITY: (type) (size) X�� NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: 10 D COMPLIANCE DATE: .. / Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands.exist within 300 feet of leaching facility) Feet Furnished by POOSE Oo As : qy _ 71 " r 133:3y, F G.I 00.0 F.G. 9E.0 ; 70 t 1500 Gallon — 0 98.5 p Septic Tank I 9E.3 /i�;�� Too c mil.9o.p : 95.7 95.5_ Y3-___ t.El.2 3.0 e r-edding as 7' Per Titic 5 Eettom of Test Hole Ei.r.56.o No Ground Water DELVELOPED PROFILE OF PPOPOSED SEPTIC ,Ep. NU Not to scale.. ' '— A 6.UES , � , ��•I.Water Supply FwThis Lot is a Private Wall. p 2 LO=tion of Utilities Shown on This Plan Are Approx. P A;Least 72 Nauss Prior to Any Escsvction FarThis I � � /?•3'� Proje:-t The CcntraciwShali intake The Required --- Notification to Dig Safe(1-800-322-4 VA) F:f w The Controcior is Required to Severe Appropriate t°ormits From Tow, Agencies For Construction er` ''sra-L Lrs e, sdby This Plc . 4• Install Risers as Required to`Jilhin 12°of Finished C.-,;de. c noG "�" ,�,r S.A i Strt ct�:as Buried o";rFeetor�!ore crSsbiect °'-c i=' 1 Cyj«_'ER to Vehicular Traffic to be H-20 Load;;, ;co ra rca�� fi Scrtic System to bs lastelledin Pccordance With r 310 CM11 15.00 Lctest Revision And The Townoi` G_S!GN DATA Barnstable Board of Health Regulation; Z PVC. ,All Piping to be Sch.40 P E"I" 'l -4 Bedre T h no Garbcn.3 G-t:ucr ' G ;iyF:o:=iivx•A=4r,0 G P D ' apiic Toa1t 440 G P D 200%=880GPD s U5 i500 Lclion Scolic Tank LFACNI:dG :'REA O TEST PIT N o. _ K-0 Gi�'°0 T =5° SF Required l l_L v. 9b.p 183 S VC _ ar^Area=12'x35'= 420 S.E. 3" S.F.T.:oi PrcV1d:d MEO, SAND W CO nL LEAC}'ItJG CXAMBERDESIGtd 30 f1 o Y P �6 8� ESt?t Pi;�ES io$e S.t;�dL+te c:0 Use G00 Gai.Leaching Choi rs ino MEp, STRATI /1'-3 12' 3 i Wcch--i Stcna Field as Shown SANG IOYR 7f3 PERCOI-ATI O Pd Y`d.3, j CLASS t MATERtAL 60 iNCHG.S No GROLt p WF"TER D:4TE: p2.�22��OOg . No; p-91o8�1 ' t3AXTER, NYC- -J-•HOL,.IGRENr lNC pp WiTNCSS: D. MORANDI TEST P%T r, O a.2 ELEV A2.0 I 3 Lr, SANID — A YR �S/o P�M 9 ' rt�6 @ ,YStK,h S 1 LTY LOAt rywPa �-4 \Jr 60� t LroIl'gl . �n . C S1•'T`1 -TILL r I 10 Y R c2 SILTy SAND lyy'� "TILL_ 2,5YR &�,3 v. r� C� S, EE T 2 o 2 OPdS MILLS,fi�A SAIL!IVA;N ENr,1 'dEEf?!Ee'f j i �'-LE,I'AASS. h rfi . Town of .Barnstable P 4 " Department of Health,Safety,and Environmental Services 0�1 SE Public Health Division Date ,X1y Si 367 Main Street,I Iyannis MA 02601 a rt 30 _ e� rter�er.E, "rfn►nx�" Date Scheduled Time Fee Pd. Soil Suitability Assessment for Sewage Disposal Performed By: „c Lo i I soo, Witnessed By: o��r7a. rYj e rct6,4'4 LOCATION &;GENERAL;INFORMATION Location Address ((,71 OE Ftru i I U. LJc. *. eveI ns.6 121� Owner's Name �'o1�n P. We.b b kl Address d5' Cr„-ptva . Assessor's Map/Parcel: M/Fp 12$l PcL. ST Engineer's Name _ �3c r�lcr, N�c f W ul wi�vtir� NEW CONSTRUCTION ✓ REPAIR Telephone# 4ZS_`it C xt 13, Land Use Slopes(%) Surface Stones ✓� Distances from: Open Water Body 11 Possible Wet Area tt Drinking Water Well ft Drainage Way ft Property Line ft Other ft SKETCH: (Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) t i / v j /�� , :`�.. >�.gas; / `�� •�) 1 136,11 ---�• h Parent material(geologic)��ara/r.[ Depth to Bedrock Depth to Groundwater: Standing Water in Hole: Weeping from Pit Face Estimated Seasonal High Groundwater DETIiJR1YIYNA . ... FOR SEASONAL HIGH WATER'<;TABI,E Method Used Depth Observed standing to obs.hole in. Depth to soil mottles in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment tl. Index Well# _- -_ Reading Date:. . _ Index Well level.. Ad,j.factor Adj.Groundwater Level PERCOLATION TEST vate 2 22 Time - -— Observation Hole# Time at 9" Depth of Perc CoO Time at 6" Start Pre-soak Time C Time(9"-6") End Pre-soak Rate MinAnch Site Suitability Assessment: Site Passed L/ Site Failed: Additional Testing Needed(YIN) Original: Public Health Division Observation Hole Data To Be Completed on Back j Copy: Applicant DEEP OBSER�ATICIN HOLE LOG Hole Depth from Soil Flonzon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Doulderes. Consistency. 1 DEEP OBSERVATION HALE LOG Hole Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsetl) Mottling (Structure,Stones,Doulderes. Consistency.%Gravel) v— d- - t7 f J. 1 i S I I'I'LJ I..A L Y4,1 15 w'� DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Hzon ori Soil"I exture Soil Color Soil Other Surface(inJ (USDA) (Munsetl) Mottling (Structure,Stones,Boulderes. Consistency.%Ciraych i DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsetl) Mottling (Structure,Stones,Boulderes. Consistencv.%Gravel) i Flood Insurance Rate Map: Above 500 year flood boundary No— Yes is Within 500 year boundary No lJ' Yes Within 100 year flood boundary No 101"� Yes Depth of Natural Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? V,., j If not,what is the depth of naturally occurring pervious material? Certification 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 the required training,expertise and experience described in 310 CMR 15.017. Signature Date 3 9 7 crcm l Una1 � / y 1 o o p' U C PA LOT 10 y w„nd A.M 128137 LOT 11 o o < Al A=43,561- S.F. \� 127/ 10 3—X02 / — v zv +�.z ; �� LOCUS PLAN Scale:1 =2000 Assessors Macy 128 Parc--i .33TO0 u, 38 WOO Zoning : RF SO From ' y3, ,:..`_ ps-+� 0 1 / •<,, 3 0 Skis 1 5 / \ RLar 15 TOP OF C3 � A.M 1.28./3,3— WO �� k CB/DH 100 (ASS�J WED T`'�� _ Ot cc SFr -- --� /A`,. Ile 127/3—X01 pop — �� / ,Ot - VACANT � _ r CB DISC' \ \ A 38-Ts'70 o At 0 �� SHEET I or 2 _PI AN VIEW ��' � c�0 � � SITE PLAN _ Scale : I,�_ PROPOSED SEPTIC SYSTEM A.M. 127133 �,;�'� /�, �, I671 OSTERYI LLE- W. BARNSTAB(__E ROAD MARS IONS MILLS, MASS. ° FOR DANIINY DEL0UCFiI SCALE: AS SHOWN DAT JUKE 2r 200c.„ SULLIVArN ENGINEERING INC. T p� . . r-a•..ceaa'.rmsm mrr_s:F,n n.q T rr^P a o ��'S�•'� 10 :X4 LOCUS 46 40 i �•' �$ f i / / . \ , �`'l?,, LOT 10 („'1-C- M. 12837 .10 c LOT 11 L� A 3S A. A A=43,561 t S. I a, yam/ /i / �p � !.� �� 9RY ° • .a�iE 71. ,. goo � -� LOCUS PLAN A.M.127/3-X02 �,� o Scale:1"=2000 n �� Assessors Map 128 C\/b,GAtJT � p i Parcel 38TOO & 1 s o E s. 38 WOO r '1' Zoning: RF \ C\4.. Setbacks : Front 30' rP a Side 1 5, l- ':- \ fa Rear 15 BENCHMARK Ground Waier Protection TOP OF CB. Zone: GP ^— l9'O 1 Ca/DH 100 (ASSUMED) A.M. 128/.�v 1 1 A AI A.M. '�- pro \ °- —` ' �� 1,2713-XOI VACANT A. 3t� NO o a 10� �y O SHEET I of 2 IZJ SITE PLAN PLAN VIEW 03� PROPOSED SEPTIC SYSTEM QAT Scale : i"= 30' I ��<<S�a 1671 OSTERVILLE- W. BARNSTABLE ROAD A.M. . 127/33 ;� �',�- '0' Y MARSTONS MILLS, MASS. 1 0� FOR , r DANNY DELOU.,HE �X\s.T� VVF _ SCALE AS SHOWN DATE: J U N E 27,2000 SULLIVAN ENGINEERING INC. OSTERVILLE MASS, x. zoO2