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0023 PERCIVAL DRIVE - Health
23 Percival Dr'ive West Barnstable A= 111-056 J II Apr 01 2019 13:27 HP Fax page 20 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments { 23 Percival Drive Property Address Tara Welsh Owner Owner's Name / ,X informationds West Bamstable t/ MA 02668 3-28-19 �r'I required for every page, City/Town State Zip Code Date of Inspectiori°`` 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. tltit Ii Irrrrrr04 M. Important:out forms A. Inspector Information s/# _04 .• ' sq�'--; tilling out forms �3�'o�' � on the computer, use only the tab James D.Sears I": JA M ES key to move your Name of Inspector U cursor-do not 3* Capewide Enterprises use the return Company Name �� RTl6a� key. 153 Commercial Street %,F 5 INSp�G���`��\ QCompany Address Mashpee MA 02649 City/Town State Zip Code 308-477-8677 31023 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above;the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 3-29-19 spector'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 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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note;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. t5lnsp.doc-rev.7/2fi/2018 Title 5 Official Inspedon Form:Subsurface Sewage Disposal g System•Page 1 of 18 A,pr 01 2019 13:28 HP Fdx Kaye 21 Commonwealth of Massachusetts pw Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 23 Percival Drive Properly Address Tara Welsh Owner Owner's Name information Is required for ovary West Barnstable MA 02668 3-28-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1,2, 3, or 5 and all of 4 and 6. 1) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: The system is a 1000 Gal Tank D Box and two chambers, Note: Old leaching still piped into tank. 2) 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 Complianoo indicating that the tank is loss than 2n year; nlrl is Iivailahle, ❑ Y ❑ N ❑ ND (Explain below): t5insp.dco-rev_?Mf2018 Tide 5 Orfiaar Inspecdon Form:Subsurface Sewage Disposal System•Page 2 at 18 Apr 01 2019 13:29 HP Fax page 22 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments F 23 Percival Drive Property Address Tara Welsh Owner Owners Name Information is e required for every West Barnstable MA 02668 3-28-19 page. CItyrTown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ 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 ❑ NO (Explain below): ❑ The system required pumping more than 4 times a year ril.ie to hrnkPn nr nhstrimted pipe(s).The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ NO (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ NO (Explain below): 3) 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. a. System will pass unless Board of Health determines in accordance with 31D CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc rev.7/26/201 B Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Apr 01 2019 13:29 HP Fax page 23 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 23 Percival Drive Property Address Tara Welsh Owner Owner's Name information is required for every West Bamstable MA 02668 3-28-19 page. CitylTown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 h. System will fail unless the Board of Woalth (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**, Method used to determine distance: This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) 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 t5insp.doc•rev.712612018 Title 5 Official Inspection Form;Subsurface Sewage Disposal System•Pegs 4 of 18 Apr 01 2019 13:30 HP Fax page 24 Commonwealth of Massachusetts Title 5 Official Inspection Form r Subsurface Sewage Disposal System Form - Not for Voluntary Assessments � .' 23 Percival Drive Property Address Tara Welsh Owner Owner's Name information is required for every West Barnstable MA 02668 3-28-19 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in evemperi is less than 6" below invert or available volume is less than%day flow 4 FUMING ❑ ® 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 water supply well. ❑ ® Any portion of a cesspool or privy is vdthin 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 2000 gpd- 10,000 gpd. ❑ ® 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. 5) 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 CA. 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 t5lnsp.doc•rev,T26l2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 18 Apr 01 2019 13:31 HP Fax page 25 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form •Not for Voluntary Assessments 23 Percival Drive Property Address Tara Welsh Owner Owner's Name requir reqtIonuired Is West Barnstable MA 02668 3-28-19 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cant.) If you have answered "yes"to any question in Section C.5 the system is considered a significant threat,or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes"or"no"for each of the following for all inspections: 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 ut'tawt;piuUlu) [310 CMR 15.302(5)] t5insp.cloc•rev.?QG12018 Title 5 Official Inspection Form;Subsurface Sewage Disposal System-Page a of 18 Apr 01 201 c 13:31 HP Fax page 26 ^\ Commonwealth of Massachusetts Title 5 Official Inspection Form ` Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 23 Percival Drive Property Address Tara Welsh Owner Owner's Name requimatior is West Barnstable MA 02668 3-28-19 required to every page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 Description: 1000 Gal. Tank D Box and two chambers. Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes,discharges to: Is laundry on a separate sewage system? (include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d Well Water g ( y 9 (gP ))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Present Date t5insp.doc•rev.726/2013 Title 5 Official Inspection form:Subsurface Sewage Disposal System-Page 7 of 18 Apr 01 2019 13:32 HP Fax page 27 c Commonwealth of Massachusetts Title 5 Official Inspection Form la Subsurface Sewage Disposal System Form •Not for Voluntary Assessments 23 Percival Drive Property Address Tara Welsh Owner Owner's Name information is required for every West Barnstable MA 02668 3-28-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seatslpersonslsq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: 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 below): 3. Pumping Records: Source of information: NA Was system pumped as part of the inspection? ❑ Yes ® No If Y@q.vr9lymp PVMPQO: gills.._ How was quantity pumped determined? Reason for pumping: t5lnsp.dce•rev.712812018 Title 5Official Inspection Form:Subsurlace Sewage Disposal System•Page 8 of 18 Apr 01 201,9 13:32 HP Fax page 28 c Commonwealth of Massachusetts Title 5 Official Inspection Form pSubsurface Sewage Disposal System Form-Not for Voluntary Assessments 23 Percival Drive ZW Property Address Tara Welsh Owner Owner's Name information Is required for every West Barnstable MA 02668 3-28-19 page. City/Town State Zip CDde Dale of Inspection D. System Information (cont.) 4. 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 IlA system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components,date installed (if known)and source of information: 2013 Permit # 2013-491. Were sewage odors detected when arriving at the site? ❑ Yes ® No 6. Building Sewer(looato on site pion): Depth below grade: 56"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.): Pipeing is 4" PVC SCH -40. 16insp.doc rev.7C1612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 0 of 18 Apr 01 2019 13:33 HP Fax page 29 `x Commonwealth of Massachusetts Ua Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 23 Percival Drive Property Address Tara Welsh Owner Owner's Name information is required ed for every west Barnstable MA 02668 3-28-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 46" feet Material of construction: ®concrete ❑metal ❑ fiberglass ❑polyethylene y El other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 Gal. Precast H-10 Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle 28" Scum thickness 1" Distanoo from top of scum to top of uutlel tee or baMe 8' Distance from bottom of scum to bottom of outlet tee or baffle 17" How were dimensions determined? Asbuilt-Plan-Tape Sludge Judge 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 at working level.Tank at 46" below grade w/both cover's at 10". Inlet tee-Two outlet tee's. No sign of leakage or over loading. l5insp.doc-rev.M41201 8 Title 5 Official Inspedon Form:Subsurface sevraw Disposal System-Pege 10 of 18 f Apr 01 2019 13:33 HP Fax page 30 Commonwealth of Massachusetts Title 5 Official Inspection Form �13 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1�rw 23 Percival Drive Property Address Tara Welsh Owner Owner's Name information is required for every West Barnstable MA 02668 3-28-19 page. City/Town State Zip Code Date of Inspection D. System Information (cons.) 7. 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 Diet3nco 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.): 8. 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 t5insp.doc-rev.7/25/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal system-page 11 of 18 Apr 01 2019 13:33 HP Fax page 31 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 23 Percival Drive Properly Address Tara Welsh Owner Owner's Name information uiredfo is every West Bamstable required for eve MA 02668 3-28-19 page. City/Town State Zlp Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) 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 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert U Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D Box is H-20-22"x22"-5'below grade wlcover at 19". Box is clean and solid w/no sign of over loading cr solid carry over. l5insp.doc•rev.MA=18 Title 5 Official Inspection Form:Subsurface Sewage Dlaposal System•Page 12 of 18 Apr 01 2019 13:34 HP Fax page 32 Commonwealth of Massachusetts ,It Title 5 Official Inspection Form t Subsurface Sewage Disposal System Form -Not for Voluntary Assessments v„ 23 Percival Drive Property Address Tara Welsh Owner Owner's Name information is required for every West Barnstable MA 02668 3-28-19 page. City/Town state Zip Code Date of Inspection D. System Information (Cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances,etc.): * If pumps or alarms are not in working order,system is a conditional pass. 11. Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 2 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number,dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system l Type/name of technology: t5insp.doc rev.7/26/2018 Title 6 OfriNel Inspection Form:Subsurface sewage Disposal System-Page 13 of 18 Apr 01 2019 13:34 HP Fax page 33 Commonwealth of Massachusetts \ Ro Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 23 Percival Drive Property Address Tara Welsh Owner Owner's Name information is -West Barnstable required for every es MA 02668 3-28-19 page. 01yrrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS)(cont.) Comments (note condition of soil,signs of hydraulic failure,level of ponding, damp soil, condition of vegetation, etc.): Leaching is two 500 Gal. dry well chambers w14' stone. Chamber's at 62"below grade w/cover at 18". Level in chamber's at 18" below inlet. 12. 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.): 18insp.doc-rev.7125 018 Title 6 Official Inapecton Form:Subsurface Sewage Disposal System•Page 14 of 18 Apr 01 2019 13:35 HP Fax page 34 Commonwealth of Massachusetts l- Title 5 Official Inspection Form 1� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 23 Percival Drive Property Address Tara Welsh Owner Owner's Name Information is every West Bamstable required toreve MA 02668 3-28-19 page. Cityfrown State Zip Code Date of Inspection D. System Information (cost.) 13. 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.): t5insp.doc•rev.712812018 Title 5 Official Inspection Forth:Subsurface Sewage Dlsposel System•Page 15 of 18 Apr 01 2019 13:35 HP Fax page 35 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments " 23 Percival Drive Property Address Tara Welsh Owner Owner's Name information is required for every West Barnstable MA 02668 3-28-19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cant.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately .B '—D Eck p , y A-r-�°may 13-1= y s- 3 .� 10'V 3 C U S- tSnsp.doc•rev.7/26/2018 Title 5 Oftl ial Inspection Form:Subsurface Sewage Disposal System-Page 16 of 16 i Apr 01 2019 13:35 HP Fax page 36 Commonwealth of Massachusetts Title 5 Official Inspection Form ,S Subsurface Sewage Disposal System Form -Not for voluntary Assessments .v,. 23 Percival Drive Property Address Tara Welsh Owner Owner's Name information is West Barnstable required for every MA 02668 3-28-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. 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: 12-4-13 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: Ynu must describe how you established the high ground wafter elevation: T.H.on Design plan 12-4-13 12' no G.W.. Bottom of chamber's at T-6"below grade. Bottom of chamber's at 4'-6"above T.H. Depth. Note:Rear of lot drops off 20'+ Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•.mv.712612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal g po System-Page 17 of 18 Apr 01 2019 13:36 HP Fax page 37 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form • Not for Voluntary Assessments 23 Percival Drive Propery Address Tara Welsh Owner Owner's Name Information is required for everyWest Bamstable MA 02668 3-28-19 page. Cdy/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4(Failure Criteria)and 6(Checklist)completed ® D. System Information: For 8: Tight/Holding Tank-Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 16: Expl3nation of setim3ted depth to high groundwater included Oro •a kl�M SfR s �f(m, �tr a 15insp.Aoc-rev.7426MI'f3 Title 5 Official Inspection Form:Subsurface Sewage Disposal Sysham-Page 18 of 18 TOWN OF BARNSTABLE LOC ATION o?3 Pe mi Va l Dr( yr, SEWAGE# 2©l 3 q.q f VILLAGE INe54' L n�Sjb� ASSESSOR'S MAP&PARCEL /40 INSTALLER'S NAME&PHONE NO.Crr ,pa&q?c,(r Een4.c/V `fj-,C QC a go& 07—V77 SEPTIC TANK CAPACITY GL I LEACHING FACILITY:(type) (size) `3,d k 9 ) NO.OF BEDROOMS r�e�o OWNER va -c PERMIT DATE: O 13 COMPLIANCE DATE: Separation Distance Between the: Gr®v^rA(xA'k`" Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility ,/4crCd41 i ff Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) M Feet Edge of Wetland and Leaching Facility(If any wetlands exist within / q 300 feet of leaching facility) /U /q Feet FURNISHED BY r � i . AA La r r A- �°X b/ A-3=116` A "4118r , No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftplitatlon for Bisposal *pstrm Construction Permit Application for a Permit to Construct( ) Repair(X Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. X 3 PC-lZCd Wi4L O>Z' •13 Owner's Name,Address,and Tel.No. TAXA WC-L 31-1 Assessor'sMap/Parcel ( � ( ©$ -Z3 PeRcv,4-L R, Weed- PAWSTAbLc- Installer's Name,Address,and Tel.No. .709"�t'I7-g$7`? Designer's Name,Address,and Tel.No.508-q-77-5313 Gwr b 6 Z5NTEP-p2dSC-S ".C—" EfJ�n.�c- Cz 4✓oktC�sue. t C, L-E®&5' cR©S rl RRO �FoV s5rbAtg' Type of Building: �y + Dwelling No.of Bedrooms Lot Size �t [ 3� '" sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(m_n.required) :3 30 gpd Design flow provided 3 57-3 gpd Plan Date i a-17_ L-)(3 Nymber of sheets Revision Date Title .23 pagm ac- C)PJ V G S-&(6C& Size of Septic Tank loco Type of S.A.S. /;L) :500 GA.C".(.l-4CA tLAk C "Y�R� Description of Soil g4+1 To Cie, P Lod,iV Nature of Repairs or Alterations(Answer when applicable) C4 ,6&-) S61tG'ra4l�lf� 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 tae 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 Board of Health. Signed F" Date �,�._ 1 C .Lot-21 Application Approved by Date 0 `ff-1 Application Disapproved by Date for the following reasons r Permit No. y` ( / Date Issued 0 L d o Fee N o. ' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ' PUBLIC HEALTH DIVISION.-TOWN OF BARNSTABLE, MASSACHUSETTS . Yes 1 application for misposal 6pstrut Construction f,ermit Application for a Permit to Construct( ) Repair(Q Upgrade( ) Abandon( ❑Complete System ❑Individual Components Location Address or Lot No.a3 PEQG✓*L CM- 1AJ-(3. Owner's Name,Address,and Tel.No. Assessor's Map/Parcel ta13 egc ov R• (A)e s7K6L C- Installer's Name,Address,and.Tel.No. 'spg-it-7-7-S8 71 Designer's Name,Address,and Tel.No.15 og-477 -5313 <rA sw(b G N7�i �'2tS�S �-�-� Et..�rrJ�z�rlvCz wdRKS�it�, r 1.1 WL S cR F RO �FO Type of Building: Dwelling No.of Bedrooms 3 Lot Size 3 51�33 -" sq.ft. Garbage Grinder( ) Other Type of Building (Z��` _�1, �, No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 30 gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title ,2,3 L�F c- Di 1 U e (r &1 ;, ?A;t ?&(��-- Size of Septic Tank Type of S.A.S. /2 ' $00 GAL-(A "IY,AK 6P�W eAs Description of Soil PA&b, gS;-A Pk 5?4`' To 9l(,!' ESQ P LA 0 Nature of Repairs or Alterations(Answer when applicable) t SE=-W CTjt 6s /[)(XJ V% Op �5_-rplja Date last inspected: Agreement: The undersigned.agrees to ensure the construction and maintenance of the afore described on-site sewage dispasal 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 Board of Health. Signed Date { - I ( -.X0k?� Application Approved by Date 0 `f f-I Application Disapproved by Date for the following reasons Permit No. PO 3 -1 Date Issued TH E COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(x) Upgraded( ) Abandoned( )by at �"� � '�V d C,. �Q �p, f' � �CLs has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.(901 3- II�1 dated Installer G40ELej(TIZ- A(SC%S LZ e, Designer (50GI/JeZ'{Q,-W& (OQKS G, #bedrooms Approved design ow .nctio 11 3© gpd The issuance of thi permit shall not be construed as a guarantee that the system will als designed. Date 1-.7 1 Z Inspector v - ----- --- - - - -------- --------- --------------------- ---------- --------------------------------------------------- ------------------- No. got 3 — �/ lc��J THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal 6pstem Construction germit Permission is hereby granted to Construct( ) Repair(X) Upgrade( ) Abandon( ) System located at x3 P dj✓,4(_ V -- u�T 'ly9T-Aklr �. and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Corns�truction/must be c Date Approved by ompleted within three years of the date of this permit. ; r + ' ' I Town of Barnstable Of lr , Regulatory Services Richard V, Scali, Interim Director BmtNsraaU, MASS. Public Health Division rFa rn�y Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: IZI 6,7 .13 Sewage Permit# 1o13 -14't1 Assessor'sMap\Parcel l 1 ► -05-1 Designer: 15n ne en nc W&&dA.SS Installer; (-0, �d�-e �L✓►ul-e '(�S C Address: t G2,sS pe ICI .( Address: (Kttt-GaA L 610 On l l3 � �►►'� 1F�S�S was issued a permit to install a (date) (installer) septic system at based on a design drawn by (address) dated _ 1 Z Z � l3 (designer) D( I 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. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes ( greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations, Plan revision or certified as-built by designer to follow. Strip out (if required).was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed in compliarth the terms of the IAA approval letters (if applicable) it 01pQ PUER T. McENTL taller's Si ature) civil- �' + � No.36109 n� esiper's Signature) ix Designer's ) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE NII'LIANCE WILL MOT BE ISSUED UNTIL BO OF CO TH THIS FORM AND OF CARD ARE RECEIVED BY THE BARINSTABLE PUBLIC HEALTE DIVISION. BU THANK YOU QASepticzesigner Certification Form Rev 8-14-13.doc qu No.- --i- --- �1 Fee-- ^ BOARD OF HEALTH TOWN OF BARNSTABLE ; ���rication,�"or�eCY �on�truttion�ermit A li Pc ion is hewV made for a permit to Construct (,,0, Alter ( ), or Repair ( )an individual Well at: / Location — Address / Assessors Map and Parcel t, Ad 5L- -- -------------- - wner Address Installer — Driller Address Type of Building e 7 Dwelling _vim-_-+t��--^-7---------------------------- Other - Type of Building--------------------------------- No. of Persons-------------------------------------- /cs Type of Well--� --S "-• ------------------------ Capacity-----f--------------/`-----,------------- 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 u Certific of Compliance has been issued by the Board of Health. Signed - ------- - - of - C�- te Application Approved By- '°= `, date Application Disapproved for the following reasons:---------------------------------------------------------------------- - —-- _---- -- — --- - - ------- — — - - -------—---------- - �+ 1 date Permit No. ---- -L-Z= ----------- Issued--- -- - ----- - ---- ----------------- date ----------- — t BOARD OF HEALTH TOWN OF BARNSTABLE (tertif sate ®f (Compliance THIS IS TO CERTIFY, That the Individual Well Constructed (,�d, Altered ( ), or Repaired ( ) r by------------- '-- " ----------------------------------------------------------------------------------------------------- Installer has been installed in accordance with the provisions of the Town of Barnstable Board gof Health Private Well Protection LJ Uri Regulation as described in the application for Well Construction Permit No.V/ -- --Dated------------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE- --- --- — - -- -- - -- Inspector----------------------------------------------------------------------- <cgx Ca'� jp {tS.aY9+p'iR J} "�fyr �°/"rw. Jej ,r�—«( ,� jiY.. j �� sJiK/✓4 s'Y+ sY7 ►r'1MfTzsYa�r.aa{'�5�t+1+�.trt"t r. No:- - --- d�-' l> Fee ---- - ---- s" = BOARD OF HEALTH y ,TOWN O`.F� .rBARNSTABLE. } � tsYication for- erCon�tructonermit A he ion is he y made for a permit°to Construct ( } Alter ( ), or Re air ( )an individual Well at Location Address ^— Assessors Map and Parcel ---N caner ; Address i - - Installer Driller � Address i Type of Building 1 Dwelling1 ---------------------------- Other - Type of Building -- - - ,' No. of Persons---------------------------------------- r Type of Wellr'P! - Capacity. - -- - - Purpose of 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 u Certific of Compliance has been issued by the Board of Health. Signed -- - - _------ — -- ---- - d to r. Application Approved B — -- - --- - ----=- PP PP Y - = r� date , I Application Disapproved for the following reasons:------------------- ------------------------------:----------- ----__-_-- ---- ��---- - -- - - ---— -- - - —------------- i. date Permit.No. --- - — --' ----- Issued------------------ -------------------- — --=----------- date BOARD OF HEALTH l TOWN : OF BARNSTABLE Certificate Of compliance - al Well Constructed (4, Altered ( ) or.Repaired ( )THIS IS TO CERTIFY; That the Indrvidu � by - - - -__—-- -------- -- ---- -------- - -- - -—- - — — - ——- _ck� — Installer' g r� - -- —-- - - .�' ------------------------------- at has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection . , . 1 Regulation as described in the application for Well Construction Permit No. &-q d- ---- --Dated'---------------------- THE ISSUANCE:OFTHIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE -----------—-—-- - -- — — -- Inspector--------------------------------------—- ---- BOARD OF HEALTH TOWN OF BARNSTABLE Veil Cootruct ion Permit Fee- —`�'�---=='- Permission is hereby granted - -- — ----- - - — =- to Construct O, Alter ( ), or Repair( ) an Individual Well at: No. - — ------------------------—--------- ------------------------ Street as shown on the, application for a Well Construction Permit No. - - d2 '� t'- =--_-- ---- ---=- - Dated--- - - ------- --- ---- ------------—---------- -- z -�---------------------------------- Board of Health .DATE----� --'��`_--�LE------_ Town of Barnstable P# ' Department of Regulatory Services txnrternaru T9.hda. Public Health Division Date � t �,� arap gig 200 Main Street,Hyannis MA 02.601 Date Scheduled -- �t 2 Time_ --- Fee Pd. OL w Sep l Suitability Assessmentfor Se a ®s�'l f m l Performed.B del Q'1 - � y �°1�� �y +�� Wtmessed By: Loci LOCATION& GENERAL EV i ORMATION �� r +at�on Address Owner's Name -TAiL W 6 sO Address ,RAJ �C—Q 0—iVA(` OR— Assessor's Map/Parcel: f 0. (v Engineer's Name C�i��wta� �-�tt.7c2► q Lk: NEW CONSTRUCTION REPAIR _ Telephone# ,.,'Frfs *1 . Land Use �C iir a� Slopes(96) '^L Surface Stones "Qn-A,- Distances from: Open Water Body2 3C4 ft Possible Wet Area ��' ft Drinking Water Well 7f ft Drainage Way 2 16 O ft Property Line 6��— ft Other ft SIMTCTI:(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands 311 proximity to holes) 2� C VkW 1` Parent material(geologic) U� '�I Depth to Bedrock, Depth to Groundwater. Standing Water in Hole: N w Weeping from Pit Face `v/, Estimated Seasonal High Groundwater DETERARNATION FOR SEASONAL HIGH WATER TABLE, Method Used: Depth Observed standing in obs.hole: In. Depth to soil mottles. In. Depth to weeping from side of obs.hole: In. Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adj.factor— Adj.Groundwater Level PE RCOLATI.ON TEST bete__�_ Thne Observation Hole# re E ;r Lp_ Time at 4" Depth of Pere L, tw' h Time at V Start Pre-soak Time @ �ar✓1 Time 9"6") 1� GEt2�i K End Pre-soak J ' Rate Min./lnch Site Suitability Assessment; Site Passed _ Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation IIole 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:\s EPTIC\PERCFORM.DOC I DEEP-OBSERVATION ROLE LOG Hole# Depth from Soil Horizon Soil Texture .Sdil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Stnucture,Stones;Boulders. onsistency 4fo l3ravel) �- A �Z -a& c CO (� to- cl- DEEP OBSERVATION DOLE LOG Mole#�-2, Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. onsisten % ravel SQ /Z �s C L M5 1 DEEP OBSERVATION BOLE LOG Mole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(iu.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,To Oraycl) DEEP OBSERVATION BOLE LOG Mole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders, Consistency, 6 a a } y Flood Insurance hate Ma : Above 500 year flood boundary No— Yes Within 500 year boundary No S. Yes Within 1.00 year flood boundary No Yes„ Depth of Naturatly Occurring Pervious Material Does at least four feet of naturally occurring pervio s material exist in all areas observed throughout the area proposed for the soil absorption system? 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 10 CW,15.017. Signature 1 C Date (3 Q:\SEPTit\PERCPORM.DOC DP lglcdq�l Z tp TOWN of II Location {ZG v A V C ry cr.�r Permit No ` Village Installer's Name A Addrew �` ao t - V14�'N Builder or Ow m E2� Lod- / O Date Permit leased �'�`' � to Complipso Issued. e � i I�cl R - e21t THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiutt for Diripuual Wi urku Tuttutriartiurt ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ,0 11 . !0-Q�CIIi/-1L�1give, l S' SSO -S.. 1°.t�1...- �� 54 ------------------------------ or Y_l.o QJF.6XYlJt;„n•� ji/p CD!/° .......................... �0. L�__.•._l N s__l.ltil .s..........--•--- _ Owner d r ss 116 WAli �............ .....•........--•- Installer Address Type of Building Size Lot.3,4�.__..._..Sq. feet a Dwelling—No. of Bedrooms.........................................__Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ----------------------------------- w Design Flow............ .............................gallons per person pier day. Total daj� flow.......A ®........_._..............gallons. 1:4 Septic Tank—Liquid capacity!*?.galIons Length P--`Z----_ WidthA..L-__ Diameter_............. Depth.. .... w Disposal Trench—No. .................... Width.................... 'Total Length............. Total leaching area....... ....-....sq. ft. 3 Seepage Pit No...496........ Diameter-----/Q.......... Depth below inlet..__............ Total leaching areaf4---_.��.`Usq-fe z Other Distribution box ( ) Dosing tWa k ( ) Percolation Test Results Performed by.-DP ..................... Date..... ..�� 96....... Test Pit No. 1...._..Z._..minutes per inch Depth of Test Pit...�' ._.1..... Depth to ground water... a ...... Li, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ R+ •-- --O Descriptio of Soil.... ..A!tI/ � 1� - .. - ...... --------------------••---•-------------------------------------------------•---•---------------------------------------------------------------------------------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 Environmental Code—The u dersigned further agrees not to place the system in operation until a Certificate of Compliance has ee sue he board of health. Signed .. .. . . .. . .-- ...... 4�. ....... . Due Application Approved By .....'�..e �...... ........................ ......._............ - .^. ..-.. .:. ---- Dace Application Disapproved for the following reasons: . ......................................... ..................................................... ..................... .................... ................................................................... ........... ................ -- -- ............................... ............ ........................................ Permit No. ..... ..L--Y...:-......... .Y`:-_�� ------------- Issued ......................_.. ....._................. Dare .... ..-.�- .^-•_—•rtA -7,....� '.....-- d....y.•.._.a.-- _r...., wWw�...ti�L.�-+.`.....«.�.:i-��-`.-.. -"` ....'_.- n..�.L,�w- w�•...^+i.:---.� -...<J+:;,.+.....r l�� F.Eic //- ............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiun for Eli!ipllsa " lVnrlt' Tb r� rtiun Errant Application is hereby made for a Permit to Construct ( ) or Repair—( ) an Individual Sewage Disposal System at: " 9 PM C r v1-7L.- Zb-n,..a �l l 10.....c�G�A.G b121 U ......•••-•-•-••.................... S ASS t S ��w' j°-�1pkr�...�r.�?.......------------ Loc;Ilion-:� dr D SE j yOLQ�(�I(5 i.A,�- ................. ................ Owner dk a � � : nlS----•-. :-.. 0r ,.. .. -----•--- PQ Installer Address U3 Type of Building Size Lot____-4�.._.___..Sq. feet ., Dwelling—No. of Bedrooms.__......�...............................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) - Cafeteria ( ) QOther fixtures --------------------------------------------------------------------------------------- ---------•--•-•----------•-•--------•---...-••---•-•-----•••- w Design Flow.._.......,l�_��..............................gallons per person per day. Total daily flow.__.....93o..........................gallons. � Septic Tank—Liquid capacity!600 gallons Length_S_fL..... Width_4 Y .. Diameter................ Depth,.64::. .-� w Disposal Trench--:fro. .................... Width___`_.____--_-_-_._ Total Length___._......_...... Total leaching area.................... ft. x - Seepage Pit No_.M.6........ Diameter._...�Q..._._.___ Depth below inlet......!.......... Total leaching area-Jao.�/Dsf-.fr. Z Other Distribution box ( ) Dosing tank a P dY 7 PercolationTest Rlsults lD _( ) llM ' Date..... ppl- -- �.-�b-----•-- Test Pi \oZnnutes per inch Depth ofTt Pt Depth to ground water..... .._--. fi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ --------------------------------------------------------------•------------�---;-•••••-•............................----.....--•- ........ O Description of Soil... _y �i..-p.��..SUgSDiL.........74-_tj 4 ��A?�/---1�!1 rs,0(GI.... sf .... ----------------- �r. --------------------------•••-•-- --• . 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 Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has beenr' sued by the board of health. . f;1 r Signed �l✓f� ....................:......�-....it.. ........................ `��� �f� �V ........f....`Date. ........:...... Application Approved By ...... :,.< .......-,c-r-+. '..,.(\'�►/-------------------------------------------------------------- .....h.� .r ...tj•..... Date Application Disapproved for the following reasons: .... . ................. . .................................................................--.--.................... .............. ....................................................................... ..... ..................................................................--.---....................... ........................................ Permit No. ---5 �-�............... ..... ........ Issued .................Dace......................... Date...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE (fezttf rate of Tontyliunce THIS IS TO CERTIFY`,DThat the Individual Sewage Disposal System constructed ( 1/ ) or Repaired (` ) �.�. by _.... R :.......r ----------------------- --............ -- . --............ .. ...... ....... ma:�uet ' ._... . . - .... ............at . f T...... ......... __...._ has been installed in accorda ce with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ........__-- _.------....._....__........ dated _----........:..... .......... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATTIIS . SATISFACTORY. DATE..... . ` _... '....._ `;� ..... _... Inspector-a--- ... � THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Cr � TOWN OF BARNSTABLE No /- , FEE..... .Q iu us�t1 urlt£i Tunitrurtiun '"erntit Permission is hereby granted--------_..N!l••cd .......1�n... c----------------------------------------------------- ----------------------------- to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at No.---- lam• r,T -•----�--fta"n �"^ ....... .!+street as shown on the application for Disposal Works Construction' egrmit No._�_�- 3, -_ Dated.......................................... ...... ........ -- f �� Board of Health DATE -------7---- FORM 36508 HOBBS&WARREN.INC..PUBLISHERS ENVIROTECH LABORATORIES, INC. MA Cert. No.: M-MA 063 449 Rte. 130 . Sandwich,MA 02563 (508)888-6460 . 1-800-339-6460 FAX(508)888-6446 i CLIENT: Reef Realty LOCATION: Lot 10 ADDRESS: School Street Percival Ave. West Dennis, MA 02670 West Barnstable, MA SAMPLE DATE: 7-26-94 COLLECTED BY: Clifford Well DATE RECEIVED: 7-26-94 TIME: 3:OOPM SAMPLE I.D. : lop JOB TYPE: New Well WELL DEPTH: 94' li RESULTS OF ANALYSIS: Parameters Units Recommended Limit Result Coliform bacteria/100ml (MF Method) 0 0 pH pH units 6.0-8.5 6.03 Conductance umhos/cm 500 101 Sodium mg/L 28.0 8.70 Nitrate-N mg/L 10.0 0.07 Iron mg/L 0.3 0.05 Volatile Organics EPA 601/602* ug/L N.D. COMMENTS: * See report attached. N.D. = None detected Yes 110 WATER IS SUITABLE FOR DRINKING POSES F PARAMETERS TESTED. xxx Date 3 Ron ld J. Sairi Laboratory Director LT = Less Than i ANALrTIC:.L .. 503 759 z17=.# i SR13UN13WATER } ANALYTICAL EPA METHODS 601 and 602 Volatile Organics (GC/PID/ELCD) Field ID: lop Lab ID: 8321-01 Project: Reef Realty/Lot 10 Percival Batch ID: VG2-0428-W Client: Envirotech Sampled: 07-26-94 Cont/Prsv: 40mL VOA Vial/NaHSO4 Cool Received: 07-27-94 Matrix: Aqueous Analyzed: 08-01-94 PARAMETER CONCENTRATION REPORTING LIMIT (ug/L) (ug/L) Dichlorodifluoromethane BRL 5 Chloromethane BRL 5 V-inyl Chloride BRL 5 Bromomethane BRL 5 Chloroethane BRL 5 Trichlorofluoromethane BRL 1 1,1-Dichloroethene BRL 1 Methylere Chloride BRL 1 trans=1,2-Dichloroethene BRL 1,1-Dichloroethane BRL 1 cis-1,2-Dichloroethene * BRL 1 Chloroform BRL I 1,1,1-Trichloroethane BRRL 1 Carbon Tetrachloride Benzene BRL 1 1,2-Dichloroethane BRL 1 Trichloroethene BRL I 1,2-Dichloropropane BRL 1 Bromodichloromethane BRL 1 2-Chloroethyyl Vinyl Ether BRL 5 cis-1,3-Dichloropropene BRL 1 Toluene BRL 1 trans-1 ,3-Dichloropropene BRL 1 1,1 ,2-Trichloroethane BRL 1 Tetrachloroethene BRL I Di bromochl ordinethane BRL i Chlorobenzene BRL Ethylbenzene BRL I meta-and Para-Xylene * BRL 1 ortho-Xylene * BRL 1 Bromoferm BRL 1 1,1 ,2,2-Tetrachloroethane BRI BRL 1 1,3-Dichlorobenzene ' 1,4-Dichlorobenzene BRL 1 1,2-Dichlorobenzene _ BRL l QC SURROGATE COMPOUND SPIKED MEASURED RECOVERY QC LIMITS a,a,a-Trifluorotoluene 30 29 97 % 87 - 113 1,2-Dichloroethane-d4 30 29 95 % 83 - 117 BRL = Below Reporting Limit. * Non-target compound. Method References: Method 601 - Purgeable Halocarbois and Method 602 - Purgeable Aromatics, 40 C.F.R. 136, Appendix A (1986). " 141 LEGEND N cc ° 98 --EXISTING CONTOUR ® =o x 100.98 EXISTING SPOT GRADE ♦ EXISTING WELL o/d Coy"t Ra y/9h k'it/off, s U UNDERGROUND WIRES G EXISTING GAS SERVICE �y TEST PIT BENCHMARK OCUS Irons de gg �� P� BK' 413 P0. � m zz m LOCUS MAP NOT TO SCALE N 10'19'58" E 19P.00, / x 91.12 OK Nn / l / ! LOT 10 i Ir /� -�� VENT // STRIPOUT BENCHIt�ARK ` '� �L�' 1 1 '05 'Q x 92.B3 SEE NOTE 11 :-..:: 1 Rt. cor./Stoop / / 90.4p W ' I / EL.=94.61 t 135,433±S.F.1 0 � 1 1 I I i '- ��� • i i i 92. >o DTP-2 / 9 co 0D I / Lu 89.911 Fes: "'•'. // / �, x 1 4• / tq to I I I i 1 I x 90.831 // 95.23 xLA t-3 / ul 1- � rx-94.3 x 9464 �'� / 11 � W pia, !C1 I to \ �` x�9.70 1 t1 / 2 x 18 I 96.70 I � LO 1 I /' 9272 4. 1 1 x 4� 80.53 --� x 8 l l NE 1 1 N (0 97.00 92.44 / 75 � I 89.95 ! / 9 x 9553 C I X8.86 EXISTING LEACH PIT ' /� // �94.57 DE K CP TO 8E PUMPED & REMAIN AS �/ '/ 91.7b T M2 1 93.90 .07 1 A DRAINAGE DRYWELL //� x 90,78 x��, x ; o 91.90 92.06. / �.'/fir_:..: . 9 .25 97.�2 + .00 1 91.53 J AC 1 sue,, PAVED.: �Q EXISTING DRIVEWAY:- - Q 2 HOUSE(#23) 92.95 T.O.F.=99.8-+ E ING? x .0e EXISTING SEPTIC TANK \�S 9218 (TO REMAIN) x 92.71 .:.. . \\ 94.52 99.05 TOP OF TANK, EL.=91.26+ s.6 INV.(OUT)=89.93t \ 94.64 \ x 98.59 x 98. 98.83 OF AMP S EXIST � m4ss' �03.66 10.04 \ =102. �`� ExIST. PETER T. y I l00.23 / McENTEE EMH ( ELE BO` WELL o CIVIL 97.00 x 9�3 c� 104.62 Edge of 'Povement 99. 4 981 No. 35109 1 G/S1E�```�S�S__ �� PERCIVAL DRIVE 94.85 SS E\ OWNER OF RECORD WELCH, TARA MARIE 39 PERCIVAL DRIVE PLAN REFERENCE: PLAN BK 419 - PG 99 (LOT 10) WEST BARNSTABLE, MA 02668 Engineering by: SCALE DRAWN JOB. ND* PROPOSED SEPTIC SYSTEM UPGRADE PLAN Engineering Works, Inc. 1 =30 P.T.M. 258-13 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET No. 23 PERCIVAL DRIVE WEST BARNSTABLE MA (508) 477-5313 12/7/13 P.T.M. 1 Of 2 Prepared for: Capewide Enterprises, 153 Commercial St., Mashpee, MA 02649 NOTE: TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE < EL:87.5 SEPTIC TANK FOR A DISTANCE OF 15' AROUND THE INSTALL RISERS & COVERS OVER INLET PERIMETER OF THE S.A.S. AND SET TO 6" OF FINISH GRADE. PROPOSED S .S. PROVIDE ACCESS TO GRADE OVER OUTLET COVER PROPOSED D-BOX .A INSTALL WATERTIGHT RISER & PROVIDE TWO ACCESS MANHOLES TO WITHIN 3" ( ►T) COVER SET TO 6" OF GRADE OF FINISH GRADE FOR INSPECTIONCHARCOAL VENT T.O.F.=99.8t FRO F.G. EL.=91.5 to 93.5f MANIFOLD ALL F.G. EL.=95.0t F.G. EL.=94.6t F.G. EL.=95.0t CHAMBERS MAINTAIN 2% GRADE (MIN.) OVER S.A.S. L = 91' L = 13'(MAX.) 0 S=1% (MIN.) ® S=1% (MIN.) 6" 4"SCH40 PVC 4"SCH40 PVC oo 10"I 6 8Ba6aBB 14" BaHaaaa EXISTING 48' LIQUID Baaaaaa LEVEL ADD 4' 5.2' 4' GAS ADD INV.=88.17 PROPOSED INV.=88.00 INV.=89.93t D-BOX EFFECTIVE WIDTH = 13.2' EXISTING INV.=87.50 EXISTING SEPTIC TANK 2-500 GALLON LEACHING CHAMBERS SURROUNDED WITH STONE AS SHOWN H-20 RATED TOP CONC. ELEV.=88.6t BREAKOUT ELEV.=88.0 NOTES: INV. ELEV.=87.50 ease ease Baaaa 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE BOTTOM ELEV.=85.50 fie ease eases INVERTS, PRIOR TO INSTALLATION. 4' 3 X 8.5'=17.0' 4' 2) D-BOX SHALL BE SET LEVEL AND TRUE TO GRADE 4' OF NATURALLY OCCURRING EFFECTIVE LENGTH ON A MECHANICALLY COMPACTED SIX INCH CRUSHED PERVIOUS MATERIAL STONE BASE, AS SPECIFIED IN 310 CMR 15.221(2). 5' MIN. SEPARATION TO G.W. LEACHING SYSTEM SECTION 3) INSTALL INLET & OUTLET TEES AS REQUIRED. NO G.W., TP-2, EL.=81.4 - 4) CONTRACTOR SHALL INSTALL AN APPROVED GAS ESTIMATED HIGH G.W. BELOW EL.=71.0 3/4" TO 1-1/2" DOUBLE BAFFLE ON THE OUTLET TEE. SOIL EVAL. 9/30/86 (SAME VERTICAL DATUM)] WASHED STONE SEPTIC SYSTEM PROFILE 3- LAYER aF DOUBLE WASHEDED STONE N.T.S. (OR APPROVED FILTER FABRIC) GENERAL NOTES: 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL SOIL LOG BOARD OF HEALTH AND THE DESIGN ENGINEER. 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE DATE: DECEMBER 4, 2013 (REF. P#14,232) LOCAL RULES AND REGULATIONS, EXCEPT AS REQUASTED BELOW: SOIL EVALUATOR: PETER McENTEE PE, (SE#1542) 310 CMR 15.405(1)(b) CONTENTS OF LOCAL UPGRADE APPROVAL- WITNESS: DAVID STANTON R.S. 1) A 3' varia-ice to maximum cover requirement of 3', for 6' of HEALTH AGENT cover, maximum. S.A.S. shall be vented. S.A.S. shall be vented. 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR ELEV. TP- 1 DEPTH ELEV. TP-2 DEPTH TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE 93.4 0" 92.7 0" -DESIGN-ENGINEER _ SANDY LOAM SANDY LOAM 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING 93 1 10YR 4 2 4" 92 4 10YR 4 2 4» FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN ENGINEER BEFORE CONSTRUCTION CONTINUES. B B 5. ALL ELEVATIONS BASED ON ASSUMED DATUM (SAME AS PLAN OF RECORD). SANDY LOAM SANDY LOAM 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF 90.7 10YR 5/8 10YR 5/8 36" THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF C1 32 89 7 C1 HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. SANDY LOAM SANDY LOAM 7. WATER SUPPLY PROVIDED BY PRIVATE WELL. 10YR 5/8 10YR 5/8 B. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S. 85.4 96" 85.7 84" 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS C2 C2 AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE DIRECTED BY THE APPROVING AUTHORITIES. MED. SAND MED. SAND 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY 2.5Y 6/6 2.5Y 6/6 THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING CONSTRUCTION. 81.4 1 144" 81.7 132" 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS NO GROUNDWATER IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). PERC RATE: <2 MIN./IN. (OF FILE 9/30/86) 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE SANDY "C2" SOILS ARE CONSISTENT WITH PERC INSPECTED BY HEALTH DEPARTMENT PRIOR TO BACKFILL. 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY. DESIGN CRITERIA - ®®®® ® qE NUMBER OF E EDROOMS: 3 ®®® 37" SOIL TEXTURAL CLASS: CLASS I N ® DESIGN PERCOLATION RATE: <2 MIN/IN z ®1�® E3 E3 Ea Ea Ea Ea E3 Ea (0.74 GPD/SF LOADING RATE) - DAILY FLOW: 330 GPD 102" DESIGN FLOW: 330 GPD - GARBAGE GRINDER: NO 4" KNOCKOUT LEACHING AREA REQUIRED: (330 GPD) = 445.9 SF .74 GPD/SF 20" DIA. COVER EXISTING SEPTIC TANK: 1000 GALLON CAPACITY 4" KNOCKOUT / 4" KNOCKOUT 62" PROPOSED DISTRIBUTION BOX: 1 INLET, 3 OUTLETS USE 2-500 GALLON LEACHING CHAMBERS IN SERIES 0 SURROUNDED BY DOUBLE WASHED STONE ON ALL SIDES 4" KNOCKOUT SIDEWALL AREA: 2(13.2' + 25.0') X 2 = 152.8 S.F. BOTTOM AREA: 13.2' x 25.0' = 330.0 S.F. TOTAL AREA:............. ........ .. 500 GALLON CAPACITY, H-20 LOADING .....................................482.8 S.F. DESIGN FLOW 'PROVIDED: 0.74 GPD/SF(482.8 SF) = 357.3 GPD CHAMBERS Engineering by: SCALE DRAWN JOB. No. PROPOSED SEPTIC SYSTEM UPGRADE PLAN Engineering Works, Inc. N.T.S. P.T.M. 258-13 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET No. 23 PERCIVAL DRIVE WEST BARNSTABLE MA (508) 477-5313 12/7/13 P.T.M. 2 of 2 Prepared for: Capewide Enterprises, 153 Commercial St., Mashpee, MA 02649 r i LEGEND N -- 98 --EXISTING CONTOUR ® 0 x 100.98 EXISTING SPOT GRADE %, Rd � y, EXISTING WELL Count 9h s U UNDERGROUND WIRES E G EXISTING GAS SERVICE :2 e° v TEST PIT v S� BENCHMARK ` CU st ,rOnsrde O gg �� PE BK' 413 pG. � /� Q` 0 m � mQ LOCUS MAP NOT TO SCALE N 10*19'58" E 19 00' r r x 91.12 �£ P / // / x 91.19 / , LOT 0 i r /� 3/� VENT / SMIPOUT BENCHMARK r .�� x 92.83 , SEE NOTE 11 I �LL� 111 / 05 , Rt. cor./Stoop / r 90.4� EL.=94.61 \ 1 i35,43,3tS.F.I 1 ► 0 -- I , I ' 1 0 92.� DTP-2 �! dJ / 11 11 I , 89.911 W �f :o"`•'! / plp co � x r` / Z Il I 9a I I � 00 N I i i j / /� c0 � l x 90.831 // 95.23 x / r94.3 x 94 54 ��/ / 1 1 Lu Cy I a? coi i 0 1 n x�9.70 II / x .18 1 96.70 I if) 1 1 � 9h2 4. 1 '1-'1 x '1 40 80.53 __ _ - x 8 / 1 94.02 97.00x / 92.44 75 I '89.95 / ��/ 9 x 95b3 I 98.86 EXISTING LEACH PIT i� i� 91 b �94.57 DE K 0 m TO BE PUMPED & REMAIN AS '� .7 T M2 I 93.90 .07 1 A DRAINAGE DRYWELL �� x 9o.7e X x I U, o � 91.9D' .. '.; ' 06. / J + .00 PAVED p EXISnNG AC "--DRIVEWAY.'-.: �.j HOUSE(#23) 92.9s -:' T.O.F.=99.8f E NG? x 08 EXIS77NG SEP77C TANK x \GS 9.21s (TO REMAIN) 92.i1 .:; \ 94.52 \\\ 99.05 TOP OF TANK, EL.=91.26t x 8.6 INV.(OUT)=89.93f \\ \ 94.64 x 98.59 x 98. x 98.83 �F M AMP \ EXIST \ q SS \ OELL 03.6E 103.04 100.23 PETER T. E H 1 - - Exlsr McENTEE ELE BO) WELL o 97.00 x 9�3 CIVIL 104.62 Edge 0f 'Pavement 99G4 No. 35109 I 9e.o'� .---- O R£G/STE�`� PERCIVAL DRIVE 94.85 FS I OWNER OF RECORD WELCH, TARA MARIE 39 PERCIVAL DRIVE PLAN REFERENCE: PLAN BK 419 - PG 99 (LOT 10) WEST BARNSTABLE, MA 02668 Engineering by: SCALE DRAWN JOB. No. PROPOSED SEPTIC SYSTEM UPGRADE PLAN Engineering Works, Inc. 1"=30' P.T.M. 258-13 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET No. 23 PERCIVAL DRIVE WEST BARNSTABLE MA (508) 477-5313 12/7/13 P.T.M. 1 Of 2 Prepared for: Copewide Enterprises, 153 Commercial St., Mashpee, MA 02649 3 1 NOTE: TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE < EL:87.5 SEPTIC TANK FOR A DISTANCE OF 15' AROUND THE INSTALL RISERS & COVERS OVER INLET PERIMETER OF THE S.A.S. AND SET TO 6" OF FINISH GRADE. PROPOSED S.A.S. PROVIDE ACCESS TO GRADE OVER OUTLET COVER PROPOSED BOX INSTALL WATERTIGHT RISER & PROVIDE TWO ACCESS MANHOLES TO WITHIN 3" COVER SET TO 6" OF GRADE OF FINISH GRADE FOR INSPECTION PURPOSES T.O.F.=99.8t(FRONT) CHARCOAL VENT F.G. EL.=91.5 to 93.5t MANIFOLD ALL F.G. EL.=95.0t F.G. EL.=94.6t F.G. EL.=95.Of CHAMBERS MAINTAIN 2% GRADE (MIN.) OVER S.A.S. t L = 91' L = 13'(MAX.) ® S=1% (MIN.) ® S=1% (MIN_) 4"SCH40 PVC 4"SCH40 PVC 6" if 11 10-1 • as as 4" 6 BaBaBBa EXISTING 48" LIQUID ®aaaaaB LEVEL GAS�WYLE INV.=88.17 PROPOSED INV.=88.00 "EFFECTIVE S.ID 4' INV.=89.93t D-BOX WIDTH = 13.2' EXISTING INV.=87.50 EXISTING SEPTIC TANK 2-500 GALLON LEACHING CHAMBERS SURROUNDED WITH STONE AS SHOWN H-20 RATED TOP CONC. ELEV.=88.6t BREAKOUT ELEV.=88.0 mmmm NOTES: INV. ELEV.=87.50 aaea ease aaaaa 1 CONTRACTOR SHALL VERIFY ALL EXISTING PIPE aBaa Baaaa ) BOTTOM ELEV.=85.50 INVERTS, PRIOR TO INSTALLATION. 4' 3 X 8.5'=17.0' 4' 2 D-BOX SHALL BE SET LEVEL AND TRUE TO GRADE 4' OF NATURALLY OCCURRING ON A MECHANICALLY COMPACTED SIX INCH CRUSHED PERVIOUS MATERIAL EFFECTIVE LENGTH = 25.0' STONE BASE, AS SPECIFIED IN 310 CMR 15.221(2). 5' MIN. SEPARATION TO G.W. LEACHING SYSTEM SECTION 3) INSTALL INLET & OUTLET TEES AS REQUIRED. NO G.W., TP-2, EL=81.4 - 4) CONTRACTOR SHALL INSTALL AN APPROVED GAS ESTIMATED HIGH G.W. BELOW EL.=71.0 3/4" TO 1-1/2' DOUBLE BAFFLE ON THE OUTLET TEE. SOIL EVAL. 9/30/86 (SAME VERTICAL DATUM)] WASHED STONE SEPTIC SYSTEM PROFILE 3- LAYER OF DOUBLE WASHHEDEED STONE N.T.S. (OR APPROVED FILTER FABRIC) GENERAL NOTES: 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL SOIL LOG BOARD OF HEALTH AND THE DESIGN ENGINEER. 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE DATE: OCTOBER 10, 2013 (REF. P#14,153) LOCAL RULES AND REGULATIONS, EXCEPT AS REQUASTED BELOW: SOIL EVALUATOR: PETER McENTEE PE, (SE#1542) 310 CMR 15.405(1)(b) CONTENTS OF LOCAL UPGRADE APPROVAL: WITNESS: DAVID STANTON R.S. 1) A 3' variance to maximum cover requirement of 3'. for 6' of HEALTH AGENT cover, maximum. S.A.S. shall be vented. S.A.S. shall be vented. 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR ELEV. TP- 1 DEPTH ELEV. TP-2 DEPTH TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE 93:4 92:7- A 0" _.O"-- - -- - -DESIGN- A ENGINEER. -- - -- - -- ` ' - - SANDY LOAM SANDY LOAM 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING 93 1 10YR 4 2 4" 92 2 10YR 4 2 6,. FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN ENGINEER BE=ORE CONSTRUCTION CONTINUES. B B 5. ALL ELEVATIONS BASED ON ASSUMED DATUM (SAME AS PLAN OF RECORD). SANDY LOAM SANDY LOAM 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF 10YR 5/8 10YR 5/8 THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF 90 6 C1 34" 89.7 C1 36" HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. SANDY LOAM SANDY LOAM 7. WATER SUPPLY PROVIDED BY PRIVATE WELL. 10YR 5/8 10YR 5/8 B. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S. 85.4 96" 85.7 84" 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS C2 C2 AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE DIRECTED BY THE APPROVING AUTHORITIES. MED. SAND MED. SAND 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY 2.5Y 6/6 2.5Y 6/6 THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING CONSTRUCTION. 81.4 144" 81.7 132" 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS NO GROUNDWATER IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND PERC RATE: <Z MIN. D TE FILE 9 30 86 REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). SANDY "C2" SOILS ARE CONSISTENT WITH PERC 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE INSPECTED BY HEALTH DEPARTMENT PRIOR TO BACKFILL. 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY. DESIGN CRITERIA -KEEREE2 ® ® ®®®® NUMBER OF BEDROOMS: 3 ®®® ®®®®® 37SOIL TEXTURAL CLASS: CLASS I N ®®®®®®®® DESIGN PERCOLATION RATE: <2 MIN/IN - (0.74 GPD/SF LOADING RATE) - DAILY FLOW: 330 GPD 102" DESIGN FLOW: 330 GPD - GARBAGE GRINDER: NO 4" KNOCKOUT LEACHING AREA REQUIRED: (330 GPD) = 445.9 SF .74 GPD/SF 20" DIA. COVER EXISTING SEPTIC TANK: 1000 GALLON CAPACITY 4" KNOCKOUT / 4" KNOCKOUT 62" PROPOSED DISTRIBUTION BOX: 1 INLET, 3 OUTLETS USE 2-500 GALLON LEACHING CHAMBERS IN SERIES 0 SURROUNDED BY DOUBLE WASHED STONE ON ALL SIDES 4" KNOCKOUT SIDEWALL AREA: 2(13.2' + 25.0') X 2 = 152.8 S-F. BOTTOM AREA: 13.2' x 25.0' = 330.0 S.F. TOTAL AREA:..............................................................482.8 S.F. 500 GALLON CAPACITY, H-20 LOADING DESIGN FLOW PROVIDED: 0.74 GPD/SF(482.8 SF) = 357.3 GPD CHAMBERS Engineering by: SCALE DRAWN JOB. NO. PROPOSED SEPTIC SYSTEM UPGRADE PLAN Engineering Works, Inc. N.T.S. P.T.M. 258-13 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET No. 23 PERCIVAL DRIVE WEST BARNSTABLE MA (508) 477-5313 12/7/13 P.T.M. 2 of 2 Prepared for: Capewide Enterprises, 153 Commercial St., Mashpee, MA 02649 -N . ASSESSORS AP. .111 T.LA'ST HOLE LOGS NOTES*- � PARCEL 4 V GVD + _ ti} 1. VERTICAL DATUM. ASSUMED FROM QUAD (N f ) �• CURRENT ZONING: RF ENGINEER. DOYLE ENGINEERING2. MUNICAPAL WATER IS NOT AVAILABLE. r WITNESS: THOMAS MCKEAN � a BUILDING SETBACKS: - 3. SCHEDULE '40 - 4" PVC PIPE TO BE USED THROUGHOUT SEPTIC SYSTEM. 9 DATE: - -- F. 3p S. 15 R. 1S 6 Z t 4. ALL PRECAST UNITS TO CONFORM WITH AASHTO H-10 & H-20 �Ytc� PERCOLATION RATE: < 2 MINli LOADING SPECIFICATIONS. TH-1 TH-2 5. PIPE PITCH PER FOOT.' q FLOOD ZONE.. C ,.1�4 -83.0 6. FIRST 2' OF PIPE OUT OF D-BOX TO BE LAID LEVEL. " Top & ELEV CO 0 ATE THE SUBSOIL7. THE SEPTIC SYSTEM HAS NOT BEEN DESIGNED TO AC M D c , LOCUS 24" &.0 USE OF A GARBAGE DISPOSAL. ---- S. ALL CONSTRUCTION DETAILS ARE TO BE IN CONFORMANCE WITH THE __-- CLEAN STATE OF MASS. ENVIRONMENTAL CODE (TITLE FIVE) AND LOCAL LOCATION MAP SAND � HEALTH REGULATIONS. WITH OF ALL UTILITIES PRIOR LOT 10 92 V GRAVEL 9. CONTRACTOR TO VERIFY LOCATIONS 35,434 ± S.F. TO CONSTRUCTION. (0.81 ± AC.) 88 10. PROPOSED SEPTIC SYSTEM AND WELL LOCATIONS ARE IN ACCORDANCE' 86 1 WITH MASTER PLAN ON FILE WITH THE BARNSTABLE HEALTH DEPT. I 84 144" r 0 I � I - 82 1 19�. 7B 80 ' 94 1 ' 1 1 76 1 1 1 I I NO GROUNDWATER ENCOUNTERED 72 74 1 SEPTIC SYSTEM DESIGN 72 t t f 1 i 1 88 LOT 9 FLOAT ESTIMATE: 3 BEDROOMS AT 110 GALIDAY/BEDROOM 330 GAL/DAY WALKOUT t 1 1 \ SEPTIC TANK: DECK 74 7 1 � � ` , � � N 100 �Q GAL/DAY * 1.5 DAYS =`495 GAL ! USE a000 GALLON SEPTIC TANK PROPOSED m 2 3 BEDROOM 26'c DWELLING 1 r l LEACHING AREA: CAR T.E. = 9e.o 1 1 \ \ LP I t USE ONE LEACH PIT (6" x 6') WITH 2' OF STONE 14� 3s, 76 78 \ \ 1 / 10' EFFECTIVE DIAMETER x 6' DEEP) ZGGAR GR 102 PROPOSED DWELLING I 1 SIDE AREA: 10 x PI x 6 188 SF (2.5) = 470 GAL/DAY I '• I T -1 \ \ \ \ \ \ f , , BOTTOM AREA: 5 x 5 x PI = 78 SF (1.0) = 78 GAL/DAY \ \. 1�IN ., �: TOTAL CAPACITY = 4�GAL/DAY 80 19z �cK 94 ` PROPOSED 9a SEPTIC SYSTEM SECTION POSED 2" PEASTONE t D SgD Po 8 O8,. \ P $D ING : UTILITY OF 3/4" -'1 112"' ! / g D$ 1pj 1 I CLUSTER WSTONE O uNDf TF86 \ WASHED ..: \ TOP OF FOUNDATION n • / poSsD '-102 _ 92� 98 94 _ 88.39 oD "- - 9� a102'920 �� 88.64 ELEV. D-BOX 9 d _ A v 93. 7 1000 GAL 88.as .75.0 �,,,_ '- < 10Q _ . •. - 96. s pp o ELEV. SEPTIC TANK 3 ELEV. <----> .—f �.ELEV. "a v per D ELEV. 81.0 102— �. t....... $ 01 ELEV. TEE SIZES: ELEV. . $DG �F� (UNDER ` INLET': 6" UP, 10" DOWN •. � J00. 7 ONE LEACH PIT (6' x 6') WITH o , BASEMENT OUTLET: 6" UP, 19" DOWN 2' OF STONE (10' EFF. DIAM. x 6' DEEP) u LITY c srER �,L FLOOR) (H--20) � BREAKOUT CALC: (81.5 - 74) / 90 x 150 13' 00000 IVA b 15- E SITE . AND SEWAGE PLAN P KEY: ELECTRIC LOCATION.• EXISTING CONTOUR. — MANHOLE PROPOSED CONTOUR. -T � s r ��.. Y; -n-� , ,.-F LOT 10 PERCIVAL DRIVE . ... EXISTING SPOT ELEVATION: 25.5 `=.� , ..�, s PROPOSED SPOT ELEVATION: 25 B cHMARK �_._< ._Lr + Z.THCMACIJ, WEST BARNSTABLE MA a AT NC. BOUND ,, l" ° -1 lgEr X- EST HOLE: c�� c� n T � ELEv ION ffi fozy � . t a.a�7; , .: v rac.s6359 � PREPARED FOR: UTILITY POLE: -0- Q CE LINE: FEN � �� �° REEF REALTY HYDRANT: -6- RETAINING WALL. DMsv , • DEMAREST—YcLELLAN ENGINEERING = SCALE: I" = 30' DATE: 5-20-94 24 SCHOOL STREET P.O. BODY 463 � � YAssACHvsETTs o2s�o REFERENCE: PLAN BOOK 413 PAGE 99 DM # 94-039-10 WEST DENNIS., ' THOMAS McLELLA,N,:P:S:.]l JOHN Z. DEMAREST JR.,'P.L.S.