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0141 POINT HILL ROAD - Health
141 Point T11 Road West Barnstable A= 136 - 022 r j i r No. 1AJ 901 Fee BOARD OF HEALTH TOWN OF BARNSTABLE Zipphration jfor Vern Congtructton Fermat Application is hereby made for a permit to Construct Alter( ), or Repair( ) an individual well at: �A M 0\1 13d 02-�2- Locatio Address Assessors Map and Parcel C1��► ;�,n } c�a� 1D �� �� R�F�1�1\eS"Ie�► j�s�l�IalAo��-1�1 Owner Address SUN 0265 3 Installer-Driller Address Type of Building ,I' Dwelling ��p �Y1�- $c�Y I� pc9�� Other-Type of Building ` , No. of Persons Type of Well Safi �- 4',S��A� $V C Capacity Purpose of Well Agreement: The undersigned agrees to install the afore described individual well in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation-The undersigned further agrees not to place the well in operation until a Certi cate of Compliance has been issued by the Board of Health. Signed /uh Date Application Approved By �^ roG -gT—(C� Date Application Disapproved for the following reasons: Date Permit No. go` ` 03 Issued Date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Compliance THIS IS TO CERTIFY,that the individual well Constructed( Altered( ) or Repaired( ��by 6 f '/ Installer p at ! `� po N% has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No.W,901 y— 03 t Dated, THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Date Inspector r No. 20 I ('I — 651 Fee BOARD OF HEALTH TOWN OF BARNSTABLE 01ppYfcatiou _for lVerr Con5tructiou Permit Application is hereby made for a permit to Construct(✓), Alter( ), or Repair( ) an individual well at: 3�j (z Location-Address Assessors Map and Parcel �'_�6;�r�a n A��►0�� 23 S"k4 o\k Owner ` Address G�11 lY1 0 k 21g3 C�c- �nLPA 4265 3 Installer-Driller Address Type of Building Dwelling f C'eA_MY,\.' S Arnim (14 oc9�+�� Other-Type of Building \ , No. of Persons Type of Well �01��D�, L ��� qcj �V L Capacity T� Purpose of Well bc,r 0 Agreement: The undersigned agrees to install the afore described individual well in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation-The undersigned further agrees not to place the well in operation until a Cert cate of Compliance has been issued by the Board of Health. !4 Signed -1 �^ Date Application Approved By Date Application Disapproved for the following reasons: t Date /�� i q #. Permit No. IJ � V o I � " ' Issued /6 ( - L Date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Compliance THIS IS TO CERTIFY,that the individual well Constructed 0,-_-Altered( ), or Repaired( ) by ® A. Installer 0' at ��� / O i A)i h'/C C ��. W .-67"V �3-Xz.�/ has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No.W,9ON- 05 t Dated - -►� THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Date Inspector 'MiBOARD"OF HEALTH TOWN OF BARNSTABLE Vern �Cougtructiou Permit No. 0 I l _ 6 Fee Permission is hereby granted to '��ax 1l !it/P�/ 2�G c. �•�j .�`y o� Installer to Construct Alter( ), or Repair( an individual well at: No. / y/ �//7— h'/LL �C�� �J FcJet� Street t as shown on the application for a Well Construction Permit No. w 61 Dated o Date / Approved By I CERTIFICATE OF ANALYSIS Page: 1 of 1 4 Barnstable County Health Laboratory (M-MA009) ysstrrttc��f Retort Preuared For: Report Dated: 10/23/2014 Sally Desmond Desmond Well Drilling Order No.: G1484009 P O Box 2783 Orleans, MA 02653 Laboratory ID#: 1484009-01 Description: Water-Irrigation Well Sample#: Sample Location: 2005 Main St. Marstons Mills, MA Collected: 10/20/2014 Collected by: Customer Received: 10/21/2014 j Routine M ITEM RESULT UNITS RL MCL METHOD# TESTED Nitrate as Nitrogen 2.5 mg/L 0.10 10 EPA 300.0 10/21/2014 Iron ND mg/L 0.10 0.3 EPA 200.8 10/2312014 Manganese ND mg/L 0.0030 EPA 200.8 10123/2014 i pH 6.0 PH AT 25C NA 6.5-8.5 SM 4500-1-1-13 1 0/2 1 12 01 4 Sodium 19 mg/L 0.10 20 EPA 200.8 10/23/2014 Total Coliform Absent P/A 0 0 SM 9223 10/21/2014 Conductance 160 umohs/cm 2.0 SM 2510B 10/21/2014 Water sample meets the recommended limits for drinking water of all the above tested parameters. Attached please find the laboratory certified parameter list. Approved By: ` (Lab Director) ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House,. PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 Massachusetts Department of Environmental Protection Bureau of Resource Protection Well Completion Reports Well Driller Please specify work performed: Address at well location: New Well Street Number: Street Name: 2005 MAIN STREET Please specify well type: Building Lot#: Assessor's Map#: Inigation 077 Assessor's Lot#: ZIP Code: Number Of Wells: 028 02648 a CitylTown: Well Location BARNSTABLE In public right-of-way: GPS Yes C No North: West: 41.65255 70.40693 Subdivision/Property/Description: GARDENS BY REBECCA Mailing Address: click here if same as well location addres Property Owner: Street Number: Street Name: REBECCA PERRY 2046 PO BOX City/Town: State: Engineering Firm: BARNSTABLE MASSACHUSETTS ZIP Code: 02634 Board of health permit obtained: f Yes (f Not Required Permit Number: Date Issued: W2014 030 9/25/2014 -� J Massachusetts Department of Environmental Protection Bureau of Resource Protection—Well Driller Program Well Completion Reports(General) Well Driller - General Well Form DRILLING METHOD Overburden Bedrock Auger Choose Bedrock-- WELL LOG OVERBURDEN LITHOLOGY From Drop in drill Extra fast or slow Loss or addition of To(ft) Code Color Comment (ft) stem drill rate fluid 0 20 Fine To Coarse Sand Brown 0 YES 0 NQ GO Fast r Slow fO Loss r Addition 20 40 Fine To Coarse Sand 113rown r YES r NO 0 Fast r Slow fJ Loss r Addition 40 60 ISilty Sand jBrown YES r NO G'Fast 0 Slow r Loss G Addition 60 70 Fine To Coarse Sand Brown r YES 0 NO r Fast 0 Slow 0 Loss r Addition WELL LOG BEDROCK LITHOLOGY , From Drop in drill Extra fast or slow Loss or addition of Visible Extra To(ft) Code Comment ��Rust Large (ft) stem drill rate fluid Staining Chips Choose Code (�S r NO 1 r Fast r Slow r Loss r Addition FrJ Ye b Ye ADDITIONAL WELL INFORMATION Developed Yes t No Disinfected (�i Yes r"a No Total Well Depth 70 Depth to Bedrock Fracture Surface Seal Type INone Enhancement Yes t No CASING I r Is Casing above ground? From: 1 To: 0 From To Type Thickness Diameter Driveshoe 0 66 Polyvinyl Chloride Schedule 40 4 r__J Ye SCREEN No Scree From To Type Slot Size Diameter 66 70 Stainless Steel Well Point 0.012 4 WATER-BEARING ZONES L 1 DRY WEL From To Yield(gpm) 43 70 12 PERMANENT PUMP(IF AVAILABLE) 3 Wire Constant Speed n Pump Description Horsepower Submersible M Massachusetts Department of Environmental Protection Bureau of Resource Protection—Well Driller Program Well Completion Reports(General) Pump Intake Depth(ft) 65 Nominal Pump Capacity(gpm) 20 ANNULAR SEAL/FILTER PACK From To Material 1 Weight Material 2 Weight Water Batches Method Of Placement (gal) Choose Material IChoose Material Choose One-- WELL TEST DATA Time Pumping Time To Recovery (ft Date Method Yield(gpm) Pumped Level (ft Recover BGS) (HH:MM) BGS) (HH:MM) 1 0/2 012 01 4 Constant Rate Pump 12 1:30 48 0:01 43 WATER LEVEL Date Measured Static Depth BGS(ft) Flowing Rate(gpm) 10/20/2014 43 12 COMMENTS WELL DRILLERS STATEMENT This well was drilled or altered under my,direct supervision,according to the applicable rules and regulations,and this report is complete and accurate to the best of my knowledge. DESMON THOMAS E Monitoring[M] Supervising Driller III, Driller DESMOND III Registration# 764 Signature THOMAS, DESMOND WELL Firm DRILLING INC. Rig Permi-# 023 Date Job Complete 11/14/2014 NOTE:Well Completion Reports must be filed by the registered well driller within 30 days of well completion. i ° CERTIFICATE OF ANALYSIS Page: 1 of 1 Barnstable County Health Laboratory (M-MA009) Report, PreDared For: Report Dated: 11/3/2014 Sally Desmond Desmond Well Drilling Order No.: G1484236 P O Box 2783 Orleans, MA 02653 Laboratory ID 0: 1484236-+01 Description: water-Drinking Water Sample#: Sample Location: 6 Dell Avenue Marston Mills,MA Collected: 10/30/2014 Collected by: Customer Received: 10/30/2014 Routine M ITEM RESULT UNITS RL MCL METHOD# TESTED Nitrate as Nitrogen 8.8 mg/L 0.10 10 EPA 300.0 10/31/2014 Iron ND mg& 0.10 0.3 EPA 200.8 1113M14 Manganese 1.1 mg/L 0.003 EPA 200.8 111=014 pH 4.8 PH AT 25C NA 6.5-8.5 SM 4500-H-B 10/31/2014 Sodium 25 mg/L 0.10 20 EPA 200.8 11/3/2014 Total Coliform Absent PIA 0 0 sM 9223 10/30/2014 Conductance 210 umohs/cm 2.0 sM 2510E 10/31/2014 Sodium level is above the maxium contaminant level. These on a low sodium diet may wish to consult a physlclan.pH is low(6.5-8.5),and retesting is recommended. Attached please find the la `boratory certified parameter list. Approved By: •�,� j�;�z� (Lab Director ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 Massachusetts Department of Environmental Protection Bureau of Resource Protection Well Completion Reports Well Driller Please specify work performed: Address at well location: New Well Street Number: Street Name: 6 DELL AVENUE Please specify well type: Building Lot#: Assessor's Map#: Irrigation 47 Assessor's Lot#: ZIP Code: Number Of Wells: 156 02649 a City/Town: Well Location BARNSTABLE In public right-of-way: GPS b Yes r No North: West: 41.68348 70.42814 Subdivision/Property/Description: Mailing Address: r click here if same as well location addres Property Owner: Street Number: Street Name: JEFFERS 6 DELLAVENUE City/Town: State: Engineering Firm: BARNSTABLE MASSACHUSETTS ZIP Code: 02649 Board of health permit obtained: Yes C;Not Required Permit Number: Date Issued: W2014 029 9/18/2014 —� r Massachusetts Department of Environmental Protection / Bureau of Resource Protection—Well Driller Program Well Completion Reports(General) Well Driller - General Well Form DRILLING METHOD Overburden Bedrock ger _ Choose Bdrock Au e -- WELL LOG OVERBURDEN LITHOLOGY From Drop in drill Extra fast or slow Loss or addition of " To(ft) Code Color Comment (ft) stem drill rate fluid 0 20 ISilty Sand And Gravel jBrown r YES 0 NO ty Fast r Slow r Loss r Addition r Fast J YES GO NO r Slow 0 Loss GJ Addition 20 40 Medium'Sand —� Brown ('� 40 60 (medium Sand jBrown r YES fJ NO G Fast 0 Slow fJ Loss Addition WELL LOG BEDROCK LITHOLOGY Visible Extra From Drop in drill Extra fast or slow Loss or addition of To(ft) Code Comment Rust karge (ft) stem drill rate .fluid Staining ;Chips, Choose Code G YES r NO r Fast fit Slow G Loss r Addition d Ye rJ Ye ADDITIONAL WELL INFORMATION Developed Yes r No Disinfected t Yes r`No Total Well Depth 60 Depth to Bedrock Fracture Surface Seal Type INone Enhancement Yes G No CASING U'Is Casing above ground. From To Type Thickness Diameter Driveshoe 0 57 Polyvinyl Chloride ISchedule 40 4 d Ye SCREEN No Scree From To Type Slot Size Diameter 57 60 Stainless Steel Well Point 0.012 4 WATER-BEARING ZONES DRY WEL From To Yield(gpm) 42 60 12 PERMANENT PUMP(IF AVAILABLE) 2 Wire Constant Speed Pump Description Submersible Horsepower 3/ Pump Intake Depth(ft) 55 Nominal Pump Capacity(gpm) 15 {AmMassachusetts Department of Environmental Protection Bureau of Resource Protection—Well Driller Program Well Completion Reports(General) ANNULAR SEAL/FILTER PACK From To Material 1 Weight Material 2 Weight WaterBatches Method Of Placement (gal) Choose Material lChoose Material --Choose One WELL TEST DATA Time Pumping Time To Recovery (ft Date Method Yield(gpm) Pumped Level (ft Recover (HH:MM) BGS) (HH:MM) BGS) Fl—o/-30—/2-014-1 Constant Rate Pump 12 1:30 44 0:01 42 WATER LEVEL Date Measured Static Depth BGS (ft) Flowing Rate(gpm) F10/30/20141 42 12 COMMENTS WELL DRILLERS STATEMENT This well was drilled or altered under my direct supervision,according to the applicable rules and regulations,and this report is complete and accurate to the best of my knowledge. WILLIAM Supervising Driller DESMON Driller URQUART Registration# 299 Monitoring[M] Signature THOMAS, DESMOND WELL Firm DRILLING,INC. Rig Permit# 024 Date Job Complete 11/11/2014 NOTE:Well Completion Reports must be filed by the registered well driller within 30 days of well completion. f Massachusetts Department of Environmental Protection Bureau of Resource Protection a Well Completion Reports Well Driller Please specify work performed: Address at well location: New Well Street Number: Street Name: 141 POINT HILL ROAD Please specify well type: Building Lot#: Assessor's Map#: Domestic 136 Assessor's Lot#: ZIP Code: Number Of Wells: 022 02668 City/Town: Well Location BARNSTABLE In public right-of-way: GPS r Yes r No North: West: 41.73086 70.38998 Subdivision/Property/Description: Mailing Address: r click here if same as well location addres Property Owner: Street Number: Street Name: ATWOOD 141 POINT HILL ROAD City/Town: State: Engineering Firm: BARNSTABLE MASSACHUSETTS ZIP Code: 02668 Board of health permit obtained: r Yes C Not Required Permit Number: Date Issued: W2014 031 10/9/2014 Massachusetts Department of Environmental Protection r Bureau of Resource Protection—Well Driller Program Well Completion Reports(General) Well Driller - General Well Form DRILLING METHOD Overburden Bedrock Auger -Choose Bedrock"-- WELL LOG OVERBURDEN LITHOLOGY From To(ft) Code Color Comment Drop in drill Extra fast or slow Loss or addition of (ft) stem drill rate fluid 0 15 IMediumSand 113rown —� r YES r NC r Fast r Slow r Loss r Addition 15 30 ISilty Sand 113rown —� r YES G NO r Fast r Slow Q Loss r Addition 30 47 lFine Sand 113rown YES r NO r Fast r Slow r Loss r Addition WELL LOG BEDROCK LITHOLOGY From Drop in drill Extra fast or slow Loss or addition of Visible Extra - To(ft) Code Comment .,Rust Large (ft) stem drill rate fluid 'Staining Chips Choose Code 0 YES r NO 0 Fast rd Slow r Loss G Addition O Ye ❑Ye ADDITIONAL WELL INFORMATION Developed r Yes C No Disinfected Yes 0 No Total Well Depth 47 Depth to Bedrock Fracture Surface Seal Type INone Enhancement r Yes G No CASING E Is Casing above ground. From: 1 To: 0 From To Type Thickness Diameter Driveshoe 0 40 Polyvinyl Chloride Schedule 40 4 CJ Ye SCREEN ❑No Scree From To Type Slot Size Diameter 40 47 IStainless Steel Well Point s 0.010 4 WATER-BEARING ZONES r DRY WEL From To Yield(gpm) 32 47 12 PERMANENT PUMP(IF AVAILABLE) 2 Wire Constant Speed Pump Description Horsepower Submersible� 3/ Pump Intake Depth(ft) 42 Nominal Pump Capacity(gpm) 10 Now Massachusetts Department of Environmental Protection Bureau of Resource Protection—Well Driller Program Well Completion Reports(General) ANNULAR SEAL/FILTER PACK From To Material 1 Weight Material 2 Weight Water(gal) Batches Method Of Placement lhoose Material lChoose Material --Choose One WELL TEST DATA Time Pumping Time To Recovery (ft Date Method Yield(gpm) Pumped Level (ft Recover (HH:MM) BGS) (HH:MM) BGS) 10/20/2014 Constant Rate Pump 12 1:30 35 0:01 32 WATER LEVEL Date Measured Static Depth BGS (ft) Flowing Rate(gpm) 10/20/2014 32 12 COMMENTS WELL DRILLERS STATEMENT This well was drilled or altered under my direct supervision,according to the applicable rules and regulations,and this report is complete and accurate to the best of my knowledge. PATRICK Monitorin Supervising Driller DESMON Driller DESMOND Registration# 877 g[M] Signature PATRICK, DESMOND WELL Firm DRILLING INC. Rig Permit# 024 Date Job Complete 10/20/2014 NOTE:Well Completion Reports must be filed by the registered well driller within 30 days of well completion. C _ CERTIFICATE OF ANALYSIS Page: 1 of 1 Barnstable County Health Laboratory (M-MA009) sracta�{` f Report Prepared For: Report Dated: 1 0/2 31201 4 Sally Desmond Desmond Well Drilling Order No.: G1484008 P O Box 2783 Orleans, MA 02653 Laboratory ID#: 1484008-01 Description: Water-Drinking Water Sample#: Sample Location: 141 Point Hill Rd.W. Barnstable,MA Collected: 10/20/2014 Collected by: Customer Received: 10/21/2014 Routine M ITEM RESULT UNITS RL MCL METHOD# TESTED Nitrate as,Nitrogen 3.3 mg/L 0.10 10 EPA 300.0 10/21/2014 Iron ND mg/L 0.10 0.3 EPA 200.8 10/23/2014 Manganese 0.022 mg/L 0.0030 - EPA 200.8 10/23/2014 + pH 5.8 PH AT 25C , NA 6.5.8.5 SM 4500-11-13 10/21/2014 Sodium 19 mg/L 0.10 20 EPA 200.8 10/23/2014 Total Coliform Absent PIA 0 0 SM 9223 10/21/2014 Conductance 180 umohs/cm 2.0 SM 2510B 10/21/2014 Water sample meats the recommended limits for drinking water of all the above tested parameters. Attached please find the laboratory certified parameter list. Approved By: ' (Lab Director) ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 A.lad T CERTIFICATE OF ANALY SIS w Barnstable County Health Laboratory (M-MA009) ��crru Redplent: Sally Desmond - _- Matrix: Water-Drinking Water Desmond Well Drilling Sampled: 10/21/2014 10:15 P 0 Bm c 2783 Received: 10/21/2014 10:35 Orleans, MA 02653 Collection Address: 141 Paint HIII Rd.W.Barnstable,MA Order#: G1484018 Sample Location: Lab ID: 1484018-01 Description: 2day-141 Point Hill Rd voc only Sample#: Date Analyzed: 10/21/2014 @ 9:43 Method: EPA 524.2 Analyst: yn Comment: Dilution Factor: 1 -.._. ... .................... - EPA 524.2- Volatile Organics by GC/MS ............... .............._ - ..._._.. --- Result 1 k�� arameter ug/L ug/L ug/L Parameterug/L ug/L R [t u ethane ND 0.50 Chloroform 0.94 80 0.50 I ND 0.50 cis-1,2-Dichloraethene ND 70 - 0.50-I Vinyl chloride _..............__..._..._.._ ND z.o 0.5o ris-1,3-Dtchloropropene ND 0.50 Bromomethane ND _ 0.50_ Dibromochloromethane_.....--------- ND 0.50 1,1,1,2-Tetrachloroethane ----- ND 0.50 -- Dibromomethane ND -- 0.50 - - -_- --- ----,1,1-Trich1oroethane ND zoo o.s0 Eth benz ene ND 700 0so 1,1,2,2-Tetrachloroethane ND 0.50 Hexachlorobutadiene ND 0.50 11112-Tridhloroethane ND 5.0 o.so isopropylbenzene ND o.50 1,1-Dichtoroethane ND 0.50 Methylene chloride ND 5.0 0.50 1,1-Dlchbroethene ..----T- ND 7.0 0.50 Methyl-tert-butyl ether ND - 0.50 1,1-Dichtoropropene ND 0.50 Naphthalene ND 0.50 1,2,3-Trichlorobenzene NO 0.50 n-Butylbenzene -- -- ------ NO 0.50 ,2,3-TrichloroProPane ND 0.50 n-Propylbenzene NO --o.so 1,2,4-Trichlorobenzene NO 70 0.50 - ------p-lsopropyltoluene Np 0.50 1,2,4-Trtrnetltylbenzene NO oso sec-Butylbenzene NO o.50 _ _ I 1,Z-Dibromo-3-chloropropane.•-_. ....._ ._ ND 0.50 Styrene NO 100 0.50I 1,2-Dibmmoeftm(EDB) NO 0.50 tent-Butylbenzene NO p 50 i 1,2-Dichlorobenzene ND 600 0.50 Tetrachloroethene ND 510 0.50 1,2-Dichloroethane NO 5.0 0.50 Toluene 5.1 O 0.50 1,2-Dk:Woropmpane ND 0.50 Total xylenes - NO 10000 0.50 1,3,5-Tiimethylbenzene ND 0.50 trans-1,2-Dichloroethene ND 100 0.50 1,3-DldUoroberuene ND o... trans-1,3-Dichlompropene NO 0.50 1,3-Dlchloropropane NO 0.50 Trichlomethene NO_ ....__,_ _ 5.0 0.54 1,4-Dlchlorobenzene ND 5.0 0.50 Tdchlorofluoromethane - ND 0.50 -,2-Dlchloro ro one Surrogates %Recovered P P-, .- NO 0.50 2-Chlorobofuene NO -_ _. 0.50 QC Limits(°k) 4-Chlorotoluene ND 0.50 P-Bromofluorobenzene 944�6 70 I30 1,2-DidNorobemzene-d4 85"/(0 70 130 1 Benzene ND 5.0 0.50 Bromobenzene ND 0.50 Bromochioromethane ND 0.50 Bromodlchloromethane ND 0.50 . l3romoformt ND 0.50 Carbon tetrachloride ND 5.0 0.50 Chlorobenzene ND ____10_0_T 0.50 6 Chloroethane ND o.50 Attached please find the laboratory certified parameter list. Approved By (LabDirector) NO=None Detected RL = Reporting Limit MCL= a:amum Contaminant Lve?! Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph:508-375-6606 Page 1 of 1 TOWN OF BARNSTABLE LOCATION t,*1 RIN SEWAGE# )-0V -- 144, VILLAGE J=�zi, ASSESSOR'S MAP&PARCEL 124- INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY (,'X1 f-g7i 1 deU LEACHING FACILITY:(type) 02 Lli4.�,��� (size).1�/,!-J�/�✓'rl J NO.OF BEDROOMS air- OWNER 4. PERMIT DATE: S^- 7�E COMPLIANCE DATE: C�+ 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('f�aciility) � � Feet ` FURNISHED BY JUG l Ll�rr �h��a.�•.-irc� h m o � yror► 19r-UZ,,l i Cam 1 O> I i i No0D j`7 9� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Zippficatiou for Disposal i6pstrut Construction 3permit Application for a Permit to Construct(kill"Repair( ) Upgrade( ) Abandon( ) ❑Complete System L Individual Components Location Address or Lot No. /y/ #4;n4 f¢y( R Owner's Name,Address,and Tel No. W. 64^044-61e CtiC;Jf�`Qa /¢�wo�o� Assessor's Map/Parcel /3 CIA Z2 Instal 's Name Address and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other.Fixtures Design Flow(min.required) �0 gpd Design flow provided S-e-e- Pel m,� :*'2CL'7/7-2_37 gpd Plan Date May Number of sheets / Revision Date Title err S .T/k o vClb en�S / �/�+ l/ Size of Septic Tank K: ,i� Type of S.A.S. Xr in SdV&/'�d4AA"51%4 S64t T:t/01 Description of Soil Nature of Repairs or Alterations(Answer when applicable) ✓ltd J1 in( 0�,6r• PrmoSc°d Pool 00Y -e 4a F_ "S-d,A "K4 h k. 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 Environmenta and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Date Application Approved by Date 7 Application Disapproved by Date for the following reasons Permit No. / — Date Issued ---------------------------------------------------------------------------------------------------------------------------------- No �% / Y Fee ! �`+✓ i THE COMMONW\XAI OF MASSACHUSETTS Entered in computer: r Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 9ppYitation for MisposaY"&pstem Construction 3permit Application for a Permit to Construct(v<Repair( ) Upgrade,( ) Abandon( ) .❑Complete System Individual Components Location Address or Lot No. /V Owner's Name,Address,and Tel.No. L✓. �G/'nft�4G�E (r,dlt,_';�, Gh .�f worm Assessor's Map/Parcel / 36/8 Z'Z t` Install �'sy Name,Address and Tel.No. ._ ` _-f-�1 _ Designer's Name,Address,and Tel.No. —���viT/� AA. AAtLDS /3 Type of Building: Dwelling No.of Bedrooms 3 Lot Size 3; zOG sq.ft. Garbage Grinder( ) Other Type of Building ��%,OPh f G t' No.of Persons Showers( ) Cafeteria( ) Other Fixtures G Design Flow(min.required) 530 gpd Design flow provided Pr/ro. ZG��7— gpd Plan Date M Gr y Number of sheets / Revision Date Title Size of Septic Tank JF-)(, ,n t /! +/oil Type of S.A.S. Description of Soil -- Nature of Repairs or Alterations(Answer when applicable) '40/y Poo/ 40vf�- -�a .. 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 Environmentaw and not to place the system in operation until a Certificate of Compliance hh been issued by this Board of Health.r , ` !' i e d� Date i �> ' Application Approved by Date Application Disapproved by Date for the following reasons t Permit No. �C-'/L/ ��fo Date Issued 6 ��Y // THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned( )by I L11 �o, /��� �o�� �CS/�'U W C�u Ili 5T,_. i - at has been constructed in accordance J�a with the provisions of Title 5 and the for Disposal System Construction Permit Noe9( i y& dated 5 r 44 Installer Designer Sv1/,VaA #bedrooms 3 Approved design flow gpd The issuance of this permit shall not be nc'onsttrued as a guarantee that the system wi gned. Date '6� �`-� Inspector ------------------------------------------------------------------------------------------------------------------------------/--1�------- No. 'I L I f�' Fee LJ -- - THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE, MASSACHUSETTS Misposal *pstem Construction permit - Permission is hereby granted to Construct()() Repairs( ) Upgrade( ) Abandon( ) V /4 jPOi n System located at /� 4H 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:Constructions musl be •omplete�d(within three years of the date of thi permit. Date f, � `1 Approved b � _ - - - - -- - - - - - - - - - - - - - -� I � . I Storage I — - - - - - - - - - — — — — —-- — — — — — — I�Oft Plan i 7' O,Y 18,_60' REF. UNDE m an KITCHNETTE [, GAS FIREPLACE D RAISED HEARTH Cabana t , 1' 1 Chang SHIPS LADDER TO .LOFT ABOVE W m FOLDING GLASS DOOR - Cabana Floor Plan Storage ,: 16'-10" x - 12'-4 Lower Level I s ` Commonwealth of Massachusetts Title 5 Official Inspection Form p Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 141 Point Hill Road, West Barnstable, MA / Property Address Jim Kelliher Owner Owner's Name information is ry West Barnstable MA 02668 February 22 2012 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 A. General Information filling out forms on the computer, use only the tab 1. Inspector: key to move your 1.65 cursor-do not David B. Mason use the return key. Name of Inspector David B. Mason � Company Name Company Address East Sandwich MA 02537 City/Town State Zip Code 508-833-2177 S1287 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: f C=) ® Passes ❑ Conditionally Passes ❑ Fails Needs Further 4aluation y the Local Approving Authority C.s -; C•' February 22, 2012 i�- Inspector's Signature Date CD C t. 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. tslns-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 141 Point Hill Road, West Barnstable, MA Property Address Jim Kelliher Owner Owner's Name information is West Barnstable MA 02668 February 22, 2012 required for every rY page. Citylrown 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: System is operable at this time. Increase in occupancy or increase water useage may result in hydraulic failure. The information in this report is only indicative of the status of the system on February 22, 2012 @ 1 pm. 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-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 141 Point Hill Road, West Barnstable, MA Property Address Jim Kelliher Owner Owner's Name information is ry West Barnstable MA 02668 February 22 2012 required for every , 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•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 41M , 141 Point Hill Road, West Barnstable, MA Property Address Jim Kelliher Owner Owner's Name information is required for every West Barnstable MA 02668 February 22, 2012 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M ,•''r 141 Point Hill Road, West Barnstable, MA Property Address Jim Kelliher Owner Owner's Name information is West Barnstable MA 02668 Februa 22, 2012 required for every ry page. Cityrrown 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 .l questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped.Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•09/08 Title 5 Official 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 °M 141 Point Hill Road, West Barnstable, MA Property Address Jim Kelliher Owner Owner's Name information is West Barnstable MA 02668 February 22, 2012 required for every ry 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)] D. System Information 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 t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments G1M , 141 Point Hill Road, West Barnstable, MA Property Address Jim Kelliher Owner Owner's Name information is ry West Barnstable MA 02668 February 22 2012 required for every , page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Garbage grinder is not permitted with this design. Number of current residents: 2 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 No 9 ( Y 9 (gpd))� Detail: Water meter readings not available due to the dwelling being serviced by a private well. Sump pump? ❑ Yes ® No Last date of occupancy: Current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 141 Point Hill Road, West Barnstable, MA Property Address Jim Kelliher Owner Owner's Name information is ry West Barnstable MA 02668 February 22 2012 required for every , 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 141 Point Hill Road, West Barnstable, MA Property Address Jim Kelliher Owner Owner's Name information is ry West Barnstable MA 02668 February 22 2012 required for every , page. Citylfown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: System installed June 14, 2007 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: Approx. 30 inches feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: 150 feet Comments (on condition of joints, venting, evidence of leakage, etc.): Appears to be operable Septic Tank(locate on site plan): Depth below grade: 14 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 1500 gallon tank If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 141 Point Hill Road, West Barnstable, MA Property Address Jim Kelliher Owner Owner's Name information is rY West Barnstable MA 02668 February 22 2012 required for every , page. Cityrrown 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 30 Scum thickness 2 Distance from top of scum to top of outlet tee or baffle 3 Distance from bottom of scum to bottom of outlet tee or baffle 11 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.): tank appears in good condition. Tees as observed in place. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 141 Point Hill Road, West Barnstable, MA Property Address Jim Kelliher Owner Owner's Name information is ry West Barnstable MA 02668 February 22 2012 required for every , 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•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 141 Point Hill Road, West Barnstable, MA Property Address Jim Kelliher Owner Owner's Name information is ry West Barnstable MA 02668 February 22 2012 required for every , page. Cityfrown 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 even with outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): No indication of solids carryover. Effluent level with outlet invert pipes. 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-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 141 Point Hill Road, West Barnstable, MA Property Address Jim Kelliher Owner Owner's Name information is West Barnstable MA 02668 February 22, 2012 required for every rY page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 2 ❑ 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.): 2 500 gallon leaching chambers. No signs of hydraulic failure no ponding or damp soil on system 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-09/08 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 141 Point Hill Road, West Barnstable, MA Property Address Jim Kelliher Owner Owner's Name information is ry West Barnstable MA 02668 Februa 22 2012 required for every , page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 141 Point Hill Road, West Barnstable, MA Property Address Jim Kelliher Owner Owner's Name information is ry West Barnstable MA 02668 February 22 2012 required for every , 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 t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 141 Point Hill Road, West Barnstable, MA Property Address Jim Kelliher Owner Owner's Name information is ry West Barnstable MA 02668 February 22 2012 required for every , page. Cityfrown 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: 25 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: Groundwater contour maps ® Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Based on Town of Barnstable groundwater contour maps. Before filing this Inspection Report, please see Report Completeness Ch ecklist on next page. t5ins-09/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 141 Point Hill Road, West Barnstable, MA Property Address Jim Kelliher Owner Owner's Name information is West Barnstable MA 02668 February 22 2012 required for every ry , page. Citylrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 f Assessing As-Built Cards Page 1 of 1 TOWN OF BARNSTABLE LOCATION �'y� �OrI�T �[� R��4(� SEWAGE a1XI-e23`1 "MLAGE /✓ARN ASSESSOR'S MAP&PARCEL 134-,?, INSTALLERS NAME&PHONE NO. o h o SH f O -7 � G 77� � g� A tt< S f �S �_ SEPVC'- ANK CAPACITY 1060 'I: 1;CHING FACILITY:(type) C 6.4 (size) .2q. 5'A NO.OF BEDROOMS 3 OWNER r^r- AID :t SAPJ0t2A Sf*.64-f PERMIT DATE:��-/—6 '� COMPLIANCE DATE: L-/ •c�7 Separation Distoice Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Iteet j Private Water Supply Well and Leaching Facility(If any wells exist oa site.or within 200 feet of leaching facility) Feet Edge of Wetland and Teaching Faci4ty(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED t 2 63' g`( o if � Ll El0 f 66 r � COWS http://www.town.barnstable.ma.us/Assessing/HMdisplay.asp?mappar=136022&seq=1 2/27/2012 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M s 141 Point Hill Road, West Barnstable, MA Property Address Jim Kelliher Owner Owner's Name information is West Barnstable MA 02668 May 20 2010 required for Y 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 A. General Information forms on the an computer,use 1. Inspector: only the tab key to move your David B. Mason 5 cursor-do not Name of Inspector use the return key. David B. Mason Company Name tab Company Address East Sandwich MA 02537 rem City/Town State Zip Code 508-833-2177 S 1287 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the in The,insp,ec�tion was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to;Section 1:5;340 0f Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails LL° �a ❑ Needs Further Evaluation by the Local Approving Authority u is a M May 20, 2010 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 l ' Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 141 Point Hill Road, West Barnstable, MA Property Address Jim Kelliher Owner Owner's Name information is y West Barnstable MA 02668 May 20 2010 required for , every page. CitylTown 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: System is operable at this time. Increase in occupancy or increase water useage may result in hydraulic failure. The information in this report is only indicative of the status of the system on May 20, 2010 at 1 PM. 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 141 Point Hill Road, West Barnstable, MA Property Address Jim Kelliher Owner Owner's Name information is West Barnstable MA 02668 May 20 2010 required for Y every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 141 Point Hill Road, West Barnstable, MA Property Address Jim Kelliher Owner Owner's Name information is West Barnstable MA 02668 May 20, 2010 required for Y every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 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 Y2 day flow t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments c�M 141 Point Hill Road, West Barnstable, MA Property Address Jim Kelliher Owner Owner's Name information is West Barnstable MA 02668 May 20, 2010 required for Y every page. Cityrrown 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- 1 0,000g pd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 - _ i Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 141 Point Hill Road, West Barnstable, MA Property Address Jim Kelliher Owner Owner's Name information is West Barnstable MA 02668 May 20, 2010 required for Y every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 141 Point Hill Road, West Barnstable, MA Property Address Jim Kelliher Owner Owner's Name information is West Barnstable MA 02668 May 20, 2010 required for Y every page. Citylrown State Zip Code Date of Inspection D. System Information Description: Garbage grinder is not permitted with this design. Number of current residents: 2 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 No 9 ( Y g (gP ))� Detail: Water meter readings not available due to the dwelling being serviced by a private well. Sump pump? ❑ Yes ® No Last date of occupancy: Current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CM 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 i I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 141 Point Hill Road, West Barnstable, MA Property Address Jim Kelliher Owner Owner's Name information is West Barnstable MA 02668 May 20, 2010 required for y every page. City/Town 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 141 Point Hill Road, West Barnstable, MA Property Address Jim Kelliher Owner Owner's Name information is West Barnstable MA 02668 May 20, 2010 required for y every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: System installed June 14, 2007 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: Approx. 30 inchesfeet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: 150 feet Comments (on condition of joints, venting, evidence of leakage, etc.): Appears to be operable Septic Tank(locate on site plan): Depth below grade: 14feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 1500 gallon tank If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 __ I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 141 Point Hill Road, West Barnstable, MA Property Address Jim Kelliher Owner Owner's Name information is West Barnstable MA 02668 May 20, 2010 required for Y every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 30 Scum thickness 2 Distance from top of scum to top of outlet tee or baffle 3 Distance from bottom of scum to bottom of outlet tee or baffle 11 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.): tank appears in good condition. Tees as observed in place. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments GSM , 141 Point Hill Road, West Barnstable, MA Property Address Jim Kelliher Owner Owner's Name information is West Barnstable MA 02668 May 20 2010 required for y , 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.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 141 Point Hill Road, West Barnstable, MA Property Address Jim Kelliher Owner Owner's Name information is Y West Barnstable MA 02668 May 20 2010 required for , every 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 even with outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): No indication of solids carryover. Effluent level with outlet invert pipes. 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-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 f Commonwealth of Massachusetts L W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 141 Point Hill Road, West Barnstable, MA Property Address Jim Kelliher Owner Owner's Name information is West Barnstable MA 02668 May 20, 2010 required for Y every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 2 ❑ 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.): 2 500 gallon leaching chambers. No signs of hydraulic failure, no ponding or damp soil on system 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 141 Point Hill Road, West Barnstable, MA Property Address Jim Kelliher Owner Owner's Name information is West Barnstable MA 02668 May 20 2010 required for Y every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): tsins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 14 of 17 L Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 141 Point Hill Road, West Barnstable, MA Property Address Jim Kelliher Owner Owner's Name information is West Barnstable MA 02668 May 20, 2010 required for Y every 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 t5ins•09/08 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 141 Point Hill Road, West Barnstable, MA Property Address Jim Kelliher Owner Owner's Name information is West Barnstable MA 02668 May 20, 2010 required for Y every 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: 25 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: Groundwater contour maps ® Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Based on Town of Barnstable groundwater contour maps. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•09/08 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 G1M 141 Point Hill Road, West Barnstable, MA Property Address Jim Kelliher Owner Owner's Name information is West Barnstable MA 02668 May 20, 2010 required for Y every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 TOWN OFBARMABL$ LdCATB3N r•••`� I�+%l �eACl SEWAGE# %.t.ac, 4sfsass°�'e agar 8�pe�.c�t. 3� Z2 M- ONB NO, jCGgpACTTSC d6b y :3 (oizcl + tZ h5�— r%OF'BF.DXOOW3 f caw CLU1rtC'BAATB •fie�twoeathe; M • (�pdwa�et'ibbk to tbe8otta�t oLLeaomaB Fac�Y "veto VON Eifw wem no Feet -•�i g� n 1Q4 feet of�hie�' ,. . Edge cioid adaad PROW Of ay , a �ri9ua3WlxtoFlosed�6 ) "' t 4 2 b3' gr� o 3 t ' a�! aa; ; 2, Ss r� 1601 Town of Barnstable T Regulatory Services Thomas F. Geiler,Director &AMNsrasu � KAM: ���� Public Health Division 1639 T�fl Thomas McKean,Director 200 Main Street,Hyannis,MA 02601. Office: 508-862-4644 Fax: 508-790-6304 installer:&Designer Certification Form Date: ` 'f `�� Sewage Permit# Assessor's Map\Parcel 13 6/2 2 Designer: Eco-Tech Installer' Wm E Robinson Sr Septic Address: 43 Triangle Circle_ Address: po Rc)x 1 nSa Sandwich Cpntcryi1-_1e On '( ( 7 Wm E Robinson Sr , Sept-lq issued a permit to.install a (date) (installer) septic system at 141 :Point Hill Rd, W. Barnstahalgedon a design drawn by (address) Eeo-Tech dated - 05-27-07 (designer). V l certify.that the septic system referenced above was installed substantially according to the design, which may include minor.approved.changes such.as lateral relocation of the distribution box and/or septic tank. . .I certify that the septic system. referenced above was installed .with major changes (i.e. 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 Flab revision or certified as-built by designer to follow. N OF MASSgctiG DAV10 D. (Installers Signature) COUGHANU RCn No. 1093 �S G/S 7S�aO �NI TARP (Designer's Signature) (Affix Designer's Stamp Here) PUASE RETURN TO B_AR STABLE PUBLIC HEALTH. DIVISION. . CERTIFICATE OF COMPLLANCE WILL.NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BIUT CARD ARE RECEIVED BY THE BARINSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification.Form 346-04.doc a i�210 hijparanon of flans ane Jnect?�canu,a� u: + • . . .�, c - , - Tne plans and specifications`for every on-site system shall be prepared as follows: (lj Ev`ery system shall be designed by a Massachusetts Registered Professional Engineer or a Massachusetts Registered 5anitasian provided that such Sanitarian shall nnt-design a- system designed to discharge more than 2,000 gallons per day pu.=suant to 314 CMR 15.203. ny other agent of the owner..may prepare'plans for the repair of a systerrt.designed to discharge not rnorz.than than 2,000 gallons per day pursuant to 310 CMR 1S.203 provided t'r�y are reviewed by:a Massachusetts Registerzd Sanitarian and approved by the approving authority; (2). .Every:plan submitted for approval must be dated and bear the stamp and signer re of the designer, (3) Every plan for a new systern or plan for the upgrade or expansion of an wdsting•systern "• - which requires a variance to a property line setback distance,:must.-also reference a plan which bears the stamp and signature Of a Massachidsctts. Licensed Land Surveyor in accordance with M.t.L. c: 112, § 81D; Mans £very plan for a system shall be of suitable scale(oae inch =40 feet or fewer for plot and one inch Z0 feet or fewer for details of system ccmpanens), fLid shah include. : delActian of: !to- ' (a) the legal boundaries of the facilitysemen�usaNutdtenanL to or which could impact the (b) the holder and location of any a pp system; " (c) the locatiori-of the all dwelling(s)or building(i)existing and proposed on the fac ity and Identifieatia of those to be served by the system; d) zhe`Iacarion of ekistir g of proposed irnpertious azcas, inchi ng: driveways and kin - g areas; .. _ ._... . system-- - (e) location and dimcrsions of the (including reserve area); yste system design calculations, including design daily sewage flow, septic rank capacity �c4uircd and provided); soil absorptionsm capacity (required and provided); and --��✓" w ther system is designed for garbage grinder; t North arrow and existing and proposed contours; Iodation and'log of deep,observation hole tests including the date of test, existing cd on each test, and he naives of the rcpresentztvc of the grade elevations mark a "oving authority and soil evaluator (i) locafion and zcsults of percolation-tests including the are-of test and the names of representative of the approving authority and soil evaluator, . (j) name and cetrficat on numixr-of-thL-Sor7 Evaluator-of record-. (k) locarion -of.every water supply,public and"private, 1. within 400 feet of the proposed system location in the case of surface water supplies and gravel packed public water supply wells, 2. within 250 feet of the proposed system location in the case;of tubular public ater supply wells, and 3. within 130 feet•of the ,proposed system,location in the case of private water supply wells; _.. 1) location of-azip surface waters of the Camrnoawealth rivers, bordering-vegetated wetlands, salt marshes, inland or coastal banks, regulatory flaodway, velocity zone, surface water supplies, tributaries to surface water supplies,certified vernal pools,private water supplies or-suction lines, gravel packed or tubular public water supply wells, subsurface drains, leaching catch basins, or dry wells; and the location of any nitrogen sensitive area identified'in 310 CNS 25.215 WrthL1 which pardons of the proposed 0 stem are located. • location of water lines and-other subsurface utilidcs on the facility; obseried and adjusted ground=water elevation in the vicinity of the system; a) a complete profile of the system; • �ry (0 a note on the plan Iistin9 all variances to the provisions of 310 CMFt IS.000 sought } lJ` in conjunction with the plan; :::Z�' the location and elevation of one benchrlark-within50 to7S feet of the facility hich is not subject to dislocation or loss during canstmcdch on the facility; (r) when dosing is"proposed, 'camplcte design $n� specification of the.dosing system proposed including.but not limited to dosing chamber capacity (required and'proyided),' ump curves and.specifieations, number .of d•osinD cycles and depth per cycle; s) when a Recirculating Sand Filter or equivalent alternative technology is required or oposed, a complete plan and spcci�cation for the syste ,including a hydraulic profile; (t a Locus pIan,to show he location of the facility including the nearest existing street; the street number and lot number, if any, of the facility; and _�v_) the materals of constuuctien.and the specifications of the system. Town of Barnstable P# Department of Regulatory Services Public Health Division �~ MAU Date to 1200 � 200 Main Street,Hyannis MA 02601 Date Scheduled _ ime /` Fee Pd.— Soil Suitability Assessmentfr Sewage Disposal Performed By: 11 6d G h Nb ill Z, t. � Witnessed By: LOCATION& GENERAL FORMATION Location Address Owner's Name GE21}LJ� Address t41 POINT 44 ILt Assessor's MapA areel: wgV 7 R_.4 7?�jq-4 On cc Engineer's Name NEW CONSTRUCTION REPAIR Telephone# 5_0q NOD D. C6066A 3 Land Use _ C'Ci I � I—/n__ Slopes(R'o) Surface Stones mo tl e- Distances from: Open Water Bodyt 0V"t _pt possible Wet Area too f , —�_ft Drinking Water Well Drainage Way ft Property Line --�_ft Other ft i SKETCH:(Street name,dimensions of lot,exact locations of test holes&Pere tests,locate wetlands- n proximity to holes) 22000 Q j i iP,2 I I � GROUNDWATER ADJUSTMENT m I I J I m m J EXISTING GROUNDWATER LEVEL BASED ON LACK OF GROUNDWATER 1 = OBSERVED IN TEST _PIT 2.-� - —#- dBSD WELL RVED W NONE AT 16.90 -I I ZONE SDW-252 A Q READING READING DATE APR46.7 2007 46.E \ I ADJUSTMENT 0.e ADJUSTED GW B ! ELOW 17.70 220.00 - - Parent material(geologic)"toGCl"G>+ Depth to Bedrock Depth to Groundwater. Standing Water in Hole: / ],,— Weeping from Pit Fnee S Estimated Seasonal High Groundwater ?e gboy c C-M DETE QNATION FOR SEASONAL HIGH WATER TABLE � Method Used.- 0 Depth Observed standing in obs.hole: _ 3. Depth to weeping from side of obs,hole: in. Depth to sell mottles: Index Well# in, Groundwater AdJustment ►n., `` . Reading Date: Index Well level ._ AdJ•factor Adj.Groundwater Level PERCOLATION TEST bate Observation xYnie Hole# r 1 ---� Time at 9" c rs Depth of Perc qD t ,-- h 1 Time at 6" of Start Pre-soak Time @ C` j Time(9"6") t . �3 ----�-+-- l End Pre-soak ("e'1 'h Rate Min./Inch Z m o Site Suitability Assessment: Site Passed- Site Failed: �Sj-____ Additional Testing Needed(Y/N) Original:Public Health Division AL Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100'of wetland,you must first notify the Barnstable Conservation Division at least one(1)week prior to beginning. Q:ISEPTICIPERCFORM.DOC I I i L , ATE TEST: MAY 22. 007 S O I TEST O G SOIL EOVALUATOR: DAVID D.2C000HANOWR. R.S. r�4,r WITNESSED BY: DONNA MIORANDI. HEALTH DEPT. 1 PERC NUMBER: 11763 TER NCOUNTERED TEST PIT PARENOTUMATER MATERIAL:1 PROGLACIAL OUTWASH ' PERC AT 60 in - 2 MIN/INCH IN C SOILS ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING 30.60 0-16 -FILL 16-26 AP _ -. LOAMY SAND 10 YR 3/3 NONE FRIABLE 28-62 B LOAMY SAND 10 YR 5/6 NONE FRIABLE 25.63 62-132 C MEDUIM SAND 10 YR 5/4 NONE LOOSE 19.60 _ TEST PIT NO GROUNDWATER PAARENTU ENCOUNTERED MATERIAL: L OUTWASH 2 MIN/INCH IN C1 & C3 SOILS ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL - OTHER (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING 28.90 1 Y 0-22 Alp LOAMY SAND 10 YR 3/3 NONE FRIABLE 22-52 B LOAMY SAND 10 YR 4/6 NONE FRIABLE 52-74 C1 MEDUIM SAND 10 YR 5/4 NONE , LOOSE 74-62 C2 SILTY SAND 10 YR 5/3 NONE FIRM k � 22.07 82-144 C3 MEDUIM SAND 10 YR 6/4 NONE LOOSE DEEP OBSERVATION HOLE LOG Hole# Depth from. Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munseli) Mottling (Structure,Stones,Boulders. Consiste c G vel DEEP OBSERVATION HOLE LOG Hole# Soil Other Depth from Soil Horizon Soil Texture Soil Color S Mottling (Structure,Stones;Boulders. Surface(in.) (USDA) (Munselq g Consi ten ° C". tit Flood Insurance Rate Man: y ` Above 500 year flood boundary No_ Yes Within 500 year boundary No Yes Within 100 year flood boundary No✓ Yes Depth of Naturally 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. If not,what is the depth of naturally occurring pervious material? Jf� f Certification I certify that on � ' �' (date)I have passed the soil evaluator examination approved by the n and that the above analysis was performed by me consisted tN of Mg Department of Environmental Protectio ss9c the required training,expertise and experience described in 310 CNIR 15.017. o� 'DAVID Date V'IuTI 207 0� D. Signature " COUGHANOWR �O /CENSER pQ- '� FVAL 3 Q:�SEPTICgPERCFORM.DOC ,} H CERTIFICATE OF ANALYSIS t . Page: 1 m' Barnstable County Health Laboratory Report Prepared For Report Dated: 6/13/2007 Gerald Street Order No.: G0740876 141 Point Hill Road West Barnstable, MA 02668 Laboratory ID#: 0740876-01 Description: Water-Drinking Water Sample N: Sampling Location: 141 Point Hill Rd.West Barnstable,MA Collected: 6/11/2007 Collected by: G.Street Received: 6/11/2007 Routine ITEM RESULT UNITS RL MCL Method# Tested Nitrate as Nitrogen 3•5 mg/L 0.10 10 EPA 300.0 6/11/2007 Copper 0.36 mg/L 0.10 1.3 SM3111B 6/13/2007 Iron ND mg/L 0.10 0.3 SM 311 IB 6/13/2007 Sodium 11 mg/L 1.0 20 SM 3111B 6/13/2007 Total Coliform Absent P/A 0 0 SM9223 6/11/2007 Conductance 150 umohs/cm 2.0 EPA 120.1 6/11/2007 pH 6.1 pH-units 0 SM 4500 H-B 6/11/2007 Plater sample meets the recommended limits for drinking water of till the above tested parameters. Approved By: ✓.+/--'�"�� ( ab ector) a w •• w -- r w rn d ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 L TOWN OF BARNSTABLE LOCATION �' / J9OlJA All 201q0 SEWAGE# dool -023-7 VILLAGE (3,49/Ws gk/PASSESSOR'S MAP&PARCEL 1'3G-.?.') INSTALLERS NAME&PHONE NO. Sepht Sod-)7 S'3 2% SEPTIC'TANK CAPACITY 1 060 -LEACHING FACILITY:(type) i e ACkt" G4/6-(2� (size) .1y S A i-Z,S)e Z NO.OF BEDROOMS 3 OWNER &l RA17) -F SANoc2Vq StW f PERMIT DATE: 6—%—6 7 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 siteor`within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of.leaching facy) Feet FURNISHED BY,. . 166 f ��M WC45 r � No. he1 00 .00 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes application for Di5pogar *p5tem Cow5truction Permit Application for a Permit to Construct( ) Repair(?� Upgrade( ) Abandon( ) ❑ Complete System,I�J I dividual Components Location Address or Lot No. Owner's Name,Address,and Tel.No. 3 6 2—33 5 3 4 141 Point Hill Rd Gerald & Sandra Street Assessor'sMap/Parcel 136/22 141 Point Hill Rd, W. Barnstable Installer's Name,Address,and Tel.No. 7 7 5—$7 7 6 Designer's Name,Address and Tel.No. 3 6 4—0 8 9 4 Wm E Robinson Sr Septic Eco-Tech PO Box 1089., Centerville 1 43 Triangle Cir, Sandwich Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder (ng Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) INstal l a new Title 5 leach system to plans of Eco- ec , #ETE-2604 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed y Date Application Approved by _�, Date 6``l—a7 Application Disapproved by: Date for the following reasons Permit No. ;-00-7- —�3 Date Issued 6 — I—O 7 f..,-. ; ,i vF Fee 0 0.0 0 —/ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF-BARNSTABLE, MASSACHUSETTS Yes 21pprication for �DIO.Oal *p5tem Construction Permit ; Application for a Permit to Construct O Repair(;X) Upgrade O Abandon O ❑Complete System.[�]3'ndividual Components Location Address or Lot No. Owner's Name,Address,and Tel.No. 3 6 2—3 5 3 4 141 Point Hill Rd Gerald & Sandra Street Assessor'sMap/Parcel 136/22 141 Point Hill Rd, W. Barnstable Installer's Name,Address,and Tel:No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No. 3 6 4—0 8 9 4 Wm E Robinson Sr Septic Eco—Tech PO Box 1089 Centerville 1 43 Trian le Cir, Sandwich Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder (nq Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date 1 Number of sheets Revision Date Title d Size of Septic Tank GIA10 Type of S.A.S. Description of Soil Nature of~Repairs or Alterations(Answer when applicable INstall a new Title 5 leach , {I system to plans of . Eco- Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in '}accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has.been issued by this Board of Health. Signed ��' t I ...�, Date Application Approved by 1�!^ �_6` Date ©� Application Disapproved by: U Date for)the following reasons V Permit No. 02007- —07-3 Date Issued (9 — t- 0 T ———————————————————————————————————————————- - THE COMMONWEALTH OF MASSACHUSETTS �M1 o�I 4 of/l ovt�r3PP,,P) BARNSTABLE, MASSACHUSETTS C(� Stre�t (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired (X ) Upgraded ( ) Abandoned( )b��yY Wm E Robinson Sr Seiblbic at 141 Point Hill Road, W. Barnstable has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 007 — 137 dated G Installer Designer #bedrooms 3 Approved design flow j gpd The issuance of this permit shall not be construed as a guarantee that the system Wil`I-f1urct o' as desi g• ed. Date fn_ ' U 77- Inspector /r� �� (C --------------------------------------------- No. a" -023 7- F410 0.0 0 Street THE COMMONWEALTH OF MASSACHUSETTS - PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS Xigpo!6at *p5tem Construction Permit Permission is hereby granted to Construct ( ) Repair (X ) Upgrade ( ) Abandon ( ) System located at 141 Point Hill Road, W. Barnstable and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this permit. Date _. 6" b Approved by 4- 6a 2, LOCATION ?��_ �" SEWAGE PERMIT NO. co VILLAGE 13 INSTA LLER'S NAME & ADDRESS OWNER IN, % DATE PEItMIT- ISSUED i ) .DATE COIII tsIIANCE ISSUED -7t U �� � �� r� f�E 3� s% �� rd .:t L, � _�� _. �� ,` .�. 136 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Twee...........OF.... ......................................... Appliratilan for Uiipnsal Warkii Ton rar#iun ramit Application is hereby made for a Permit to Construct (v) or Repair ( ) an Individual rage Disposal System at: Oj, # _FO/nr T AiGG /ZD �1&5T 84'2�l5TGJ'BG - z6T 7 1 4 -....G....S...tio Address ..._.._.... ._... ���-...�l�G�................................................. D Location A�ddres's /'� 1, or Lot No. /t-��1 ..........-^9/t"�""^•.................!9[:W`.........-•---........................... . ........br_4r..... .....---•--Y.........-----J--..._.C.11_:ro�i..1�........................... Owner Address . .............................. ..........------......•-•--•---..............-- Installer Address d Type of Building Size Lot..-3s Z®v Sq. feet aDwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) p., Other—Type of Building ............................ No, of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures --------------•--------•-- W Design Flow............... 3- n_ ------------.--...__gallons per person per day. Total daily flow.._........_- ____...._._..__._._..gallons. WSeptic Tank—Liquid capacity-/000.gallons Length._g..'6...... Width-_- Diameter---------------- Depth................ x Disposal Trench—No. .................... Width.............._..... Total Length.............:...... Total leaching area....................sq. ft. 3 Seepage Pit No......./........... Diameter....../0 Depth below inlet:.... ......... Total leaching area...z47....sq. ft. Other Distribution box ( ) Dosing tank ( ) / -� — Z Percolation Test Results Performed b ...4 1PW = ..._l:.L�u-n.................... Date.�`�'T__�� ��8S Y r-•--•••............ ,tea Test Pit No. 1....t..3c..minutes per inch Depth of Test,Pit.....�__...._: Depth to ground water........................ (i Test Pit No. 2....5 'Z'...minutes per inch Depth of Test Pit.....f� . Depth to ground water-----............... a •---••-••••---------------------•--•-------•--•------------------------..........:::.:------......--......................................................... 0 Description of Soil.........g2 - .......W ..... —Sod-c'.......... -----. ¢8/-/,0-,4...... C (xj .....................................-•---------------------•----------•---...-----•------•--......--•-•-•-•---...---------•---•--........------------.........----....-------- 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 TLITAIE 5 of the State Sanitary Code—.ju, ndersigned further agrees not to place the system in operation until a ertifi of Com ' nce has b u lth. Signe •------- -- ----•--- -------•-••••-•---------------•........._. t Date PPlication Approved By.......... ........ ..... .•---- •. . ....... l g LAIN Date Application Disapproved for th 11owing reasons:------•-------••--------------------------•--------------•---•--------------•--------------------............._ ..............•-•---•---...--•---...----.........----•---•--••-------------------•--------••---------•------------------•----------•-------------------•••-•---•••--------------•--••••.....--------•-•- Date PermitNo......................................................... Issued--------------•---••----.......---------•------•----•-- Date --- -- - - -- --- -- - - - No................»...... Fitz_....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............7i�/.i�.. ----.....OF.....��G? ✓, i, i%GG"......................................... Appliratiun for Disposal Works Tonu#.rurtion Frrmi# Application is hereby made for a Permit to Construct (,--) or Repair ( ) an Individual Sewage Disposal System at: Location-Address •--•or LotNo. .R...»».»..•»........ ...................- --•• `. ............•-- Owner Address ................................ ........................•--............................................------...-•---..........--- Installer Address Type of Building Size Lot--3�»"--0._.v.....Sq. feet =� Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) a4 Other—Type e of Building No. of persons............................ Showers a yP g .............•---........... p ( ) — Cafeteria ( ) 04 Other fixtures ........................•---..........••---••_--•- ........ WW Design Flow...........................................gallons per person per day. Total daily flow............. �!�....................gallons. WSeptic Tank—Liquid capacity..legagallons Length..a. ...... Width...'`_b Diameter................ Depth........g.. , x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area...................sq. ft. J. Seepage Pit No........I.......... Diameter....... 0...... Depth below inlet.....G.......... Total leaching area......c 7....sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by....G �N! v....E :.�'�?:« .................. Date.. r' .......� yf� _... a Test Pit No. I.....�....Z..minutes per inch Depth of Test Pit.....'`l` .':___. Depth to ground water....... `-......... .... Test Pit No. 2.....G..Z'..minutes per inch Depth of Test Pit......! ._.. Depth to ground water...... ............. O Description of Soil. ' 4___. .......lnio� Gvcr ..... .�?Ut3--_So�.........................................../4� `7 �:..GG6=�.iv V ........... ... ? T ............................................................................................................................................................................ 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 iITLE 5 of the State Sanitary Code—T undersigned further agrees not to place the system in operation until a Certificate of Com 1' nce has b the ard�th. ° G Signed Dat Vel Application Approved By........... . ..... ...... ...... .. .... .......-........................ .....:I J.`.V..................... Date Application Disapproved for the f !lowing reasons:..................................... ...........................................„..........................................................»..............................................................................................» Date PermitNo....................................................».-.. Issued...................................»............... ... Date THE COMMONWEALTH OF MASSACHUSETTS y BOARD OF HEALTH ..........................................+�i.� O F.... G�'' La.�VTi9/.�' .................................. .... Tvortif iratr of Tumplianrr THI IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( for Repaired ( ) by......... ................ ......... .•-----•------ -•-...-----•........_.................................. ....... ....... ..._........ .»»..» -�---� Installer a at•-••-_....1:::`..`......�......................J`. .��....._l� cam.......... ,--)---� `•'•-.1� ...................------------ ........................... has been installed in accordance with the provisions of TITLE 5 of The State Sanitary C 2tdr/as described in the application for Disposal Works Construction Permit No...... . ' !?�-�_Z_ dated............!. f Z�. ' --•-- .--- ................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................. � .• 52� .......................... . Inspector.......... .............................................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH N o. .. .�3 !.+ ..!........OF.......... 1A %� .�� EGG............................ ...»�» oCa Fss. '.^-.. Disposal Works Tuns#rurtiun Frrmit Permission is hereby granted............Ap.:� m......C.0. !TR.uc_"t_!O ............... to Construct ( vr-or Repair ( ) an Individual Sewage Disposal System, at No......................L..:t....#...`1.......... _a!_V).T......»KI- Q'•--•----.w. ....... »2 NSt/4 L t1 --....»... Street as shown on the application for Disposal Works Construction Permit No............... .... Dated.._....__................................. 1 ........................................... ` B o ealth DATE......................: .:! ..... ........ FORM 1255 A. M SULKIN, INC., BOSTON S/T�= 'pL/-3T/ ERisTin/G p LOCATION .WEST L31-9RW-57771,64E SCALE . DATE PLAN REFERENCE . ..4r3.07- 5i�fa VI V o N i NoT�� �2�1/.9�Tlvni.s Bi9.s�`D aN (y� 4 '9PARox S�YvAc6 \ LoT 0 4 I� , •2,Zv, oo I / _ ► � � � piT \� s�:�p V Ab, Pia. \� 0 / 3$• / a Ab` / ------_-p'� o � EXisn NG 71 WasrZ t. a So.FT. .t / /'— 1 7o t I LoT '*8 1$ of etA / So EDWA. G,J p LEY �STi.•/G ,�"� SC-W-4C o. 26100 ey AL.LAiLO -STR& Re--T7 7eo Al6-x 38,o0 TOP OF FOUNDATION CONCRETE COVER CONCRETE COVERS iog• e e 4"CAST IRON 2"MAX. �mrs�lr ��► OR SCHEDULE 4 P.V.C. PIPE � 4��SCHEDULE 40 P.V.C.(ONLY) 12"MAX. e"• PITCH 1/4"PER.FT. PIPE- MIN. LEACH PITCH 1/4"PER.FT. PIT PRECAST � • -� LEACHING INVERT • a ° EL..�7.Za.. INVERT INVERT : . (.; PIT OR SEPTIC TANK ZL DIET. ZL b • tw •c EQUIV. INVERT EL..... .. /. . BOX EL....:.7a. /aoZ�.. .. GAL. INVERT ..� " EL.ZL73 INVERT ww o• •:�► 3/4 TOIV2' EL2G,00 :.• o' WASHED e w �: STONE o /bi � ¢/ •I c2.Za.00 ... e . ., /o' DIA- id a ec "Apn g" — PROR LE OF GROUND WATER TABLE SEWAGE DISPOSAL SYSTEM NO SCALE SOIL LOG WITNESSED BY : DATE ?'r!/ BOARD OF HEALTH I TEST HOLE I TEST HOLE 2 �-UWA? L: ��r? ENGINEER ELEV—70?..Qo . . ELEV. .Z�`-�.q. DESIPN DATA : . wooDLo'q''7 Wooa�oAr� �„ S�Q-Solt. svp.seic. �•Z�•� 51 NUMBER OF BEDROOMS TOTAL ESTIMATED FLOW , . 330 GALLONS/DAY 77"7 ti�v" �iED, BOTTOM LEACHING AREA 78• . . SQ.FT. /PIT167, 2>• ,Sq„�p SAD SIDE LEACHING AREA : . .�88' , . SQ.FT./ PIV47/!P.D. GARBAGE DISPOSAL .YA^19.(50% AREA INCREASE). TOTAL LEACHING AREA , . . Z6� . . SQ.FT PERCOLATION RATE ,8sec Po7Z; Fr/fc / MIN/INCH Al LEACHING AREA PER PERCOLATION RATE .. ...O. .WATER ENCOUNTERED NUMBER OF LEACHING PITS . . . . �!. APPROVED . .. . . . . . . . . . BOARD OF HEALTH • T�'1�o �C -7'. aL" .57av�, owl, /�� DATE . . . . . . . . . AGENT OR INSPECTOR CF lrp 1 N OF ,7 t� EDWA�iD o° __ o 7- .� E L 1 o K' LEY N 2 H Po/ivT !y/GG •'P-o'9�. . . 26100 g O �£CISTLREO�ylv ISTE� siD�AL LAB ronik?�� PETITIONER l' AGD. G',-S7� s�- ✓ SSESS®RS RE�a //� lP - 3 �i �oFn Map 136, Parcel. 022 OVERLAY DISTRICT. °�, �Lj AP — Aquifer Protection District ' ch c6,6 bo �_1V Ss9sce Oio St one ko// Parking r Area I �, Location Map i avey � CD Q i Drive I .Cjo �� , 1 i #141 CZshe�She//prive FLOOD ZONE. '-� 2 Sty w/f Zone C ......................: a° Dwelling Approx septic Community Panel No. Pri Asnunt roosed By ao #250001 0011 D p � Cord ` ��� Enclosure Fence m �: July 2, 1992 4..Vent - .. .; .. i13 ' r Lawn /' ZONE. Lot 7 �� RF ( ) Future shed w/ O co RPOD CBA j Re—location, ed i Fnd ti Pro osed 35,200f SF ; Area (min.) 87,120 SF yo / p �, o Pool & Spa ;' a° Frontage. (min) 150' ..� Future : QL Cabana ,i Setbacks:/ Fron t 30, i q, Side 15' NOTE. Rear 15' �• 1.) The property line information shown was �� o compiled from available record information. chQle/ �� �cS� 2.) The topographic information was obtained �Oc,�°co from an on the ground survey performed on h�// or between 11/MAR/14 and 21/MAR/14. 3.) The datum used is Approximate mean sea level a�� GHAR� Ft. �+ OQ�o � 3 Rt vREVX • based on the Town of Barnstable GIS maps. L HE 34312 0 o NO o �►Q S s / 1 0 15 30 45 60 FEET Sheet # Title: Capetiuw or: Notes Revisions: Scale:Plan Of Proposed Pool , / l„-30 C�/IStIC'�/7 ADO(/ Date: At 141 Point Hill Road 23 West Bay Rd, Suite G �] of Osterville MA 02655 02/MAY�14 IBARNSTASLE (west Samstaible) MASS, (508)420-3994 (505)420-3995 fax wg: capesurvftapecod.net C446_1 g 1 r ... + CONTOURS - NO�'I�'S .. � Y NECK ROAD Z - ��` . SANG w� ° EXISTING - - - - m - - 50 / �\ EXISTING LEACH PIT IS TO BE PUMPED, COLLAPSED AND BURNING NE Wo< m MINIMAL GRADING PROPOSED REMOVED. EXCAVATE ALL ASSOCIATED CONTAMINATED TREE LA m = tL� / _ \ SOILS AND REPLACE WITH CLEAN MEDIUM SAND PER TITLE 5. m _z o z� ww— o 10<w o VARIANCE REQUESTED LOT ��'y PIPE IN AN ALTERNATE LOCATION.INSTALLER MAY ELEC T TO PLACE VENT N W Z O� F-J J MAY BE GRANTED INTEDIATELY BY HEALTH AGENT OR HEALTH INSPECTOR. / AREA 35200 w~ q co m m m 31ld CMR 15.221(7) — COMPONENT / �� 36 QO~O� J u z m m DEPTH TO FINISH GRADE. 36 In / HILLIAROs m �' MAX REQUIRED — VARIANCE TO �\20e LOCUS HA YWA Y w 60 In OF COVER REQUESTED. / I �`�t 36 / 24 f t x 12.5 FL x 2 FL WEST BARNSTABLE. MA ~ / RE7AIAING \� LEACHING GALLERY w 34 LOCUS M A P w<3 �/ hI�LL -WITH CUT CORNER (AOOZ �/ _\ / / SEE DETAIL ON REVERSE NOT T O SCALE O Ul O 32 o N °CO ~�� \ \ \ Z0 P / �.� BENCH MARK L� //r�� ` \ TOP OF DRAIN GRATE LJV ��/ >. % le-P 9 ELEVATION"= 25.06 WZ JO M_I Z-+ I0, - / f�O _ \ �pF'V 30 BARNSTABLE GIS DATUM �Z �u VENT mU3 W .> OLj Z I\I �`�J =� PIPE �\ 28 � / 1 II VVV Z� I W�..lJ J `• J- L(1 / \ e'4ICj� ~)(� , / J lLf O =Z B I+X O N ) f''9TIp k 3 O/M 3r \ 26 ~W O J< m J V O / flu 2 cj 6D ® Fp O\ / W 1 10-D IL / W~ m W 38� W LL / h� 6-O LEGEND D �oJ o C7 m N 36 / ISO f'E F"R ELF— e-° / EXISTING z l Q 6D 0 WELL 7� _— / 1000 GALLON LL U W W _< X To 34 1p . _ �— / SEPTIC TANK z Z r / D-BOX ❑li O o LzmLL _ WELL ��\ TEST PIT J cn w UO_ $ N r� itr II OZ Z Z w W U ��\ ^ i 24 EXISTING O Q �2J / LEACH PIT O m T-O � 4 X Z U J H O(Wf) 32 \\ / w DRAIN m wz _ w W O = O Z ULcJ 30 2 ` / / / Ijz /~2� �(V�� EE NUMBER REFERS TO �//' DIAMETER IN INCHES. _7118-P L W 3 J T_ 20e0\/ v \ / / rSa OOAK LETTER P-RI E DENOTES O-DECIDUOUS w �3z PLAN 28 � � No \/ z o z i N z�` � J X � ~ + SCALE. 1 In = 30 f E �i l�l w m z c� N \ r �O �r GARBAGE GRINDER N N m 30 e 30 60 24 \ J 20 O �� IS NOT ALLOWED o W U m w �\tiF / / << WITH THIS DESIGN. w 0 10 20 30 22 Ln NO OTHER WELLS WITHIN 150 f t �\ / / WELL z OF PROPOSED.LEACHING GALLERY \ z J O Z< 2. ®,� T�� SEWAGE DISPOSAL SYSTEM PLAN O J z —I j \ / t e4 TO SERVE EXISTING DWELLING 3 << a om �- NOT TO \� EST. GERALD & SANDRA STREET O - � (� DISTANCES SCALE i / OWNERS OF RECORD //-"-"�� Z o �- �--+ '—' AL LEACHING GALLERY ^ B - - I41 POINT HILL ROAD LL 0 I�' - m X ALL DISTANCES ARE IN DECIMAL I 53.0 50.3 �-y� lgg5 `t (n V FEET NOT IN FEET AND INCHES. 2 53.0 50.3 , eo + LIJ W 3 �A 59.4 �`�!IIAOFMAss9c ��'j"OFn�g . �� �� WEST BARNSTABLE. MA 1 m ' s 5 59.4 61.9 moo? DAVID yGJ, ��`� DAVID yGN SON PROPERTY ADDRESS O Q Q? D. �+ o D. ASSESSORS MAP 1 6 PARCEL 2 2 43 TRIANGLE CIRCLE I` m 3 COUGHANOWR " COUGHANOWR `� SANDWICH MA 02563 PLAN BOOK 249 PAGE 107 o " z 4 No. 1093 588 364-0694 J N X z �F�1 ��o so�c,�ENs�o �¢ DATE, MAY 27. 2007 �J X W w I T E < AL P� _ JOB #E T E 2 6 0 4 PAGE 1 OF 2 VERSION: P l� I- w q ! q P A s L THIS PLAN IS BASED ON AN INSTRUMENT SURVEY AND IS INTENDED SOLELY FOR INSTALLATION OF THE PROPOSED SEPTIC SYSTEM DEPICTED FOR ANY CHANGES TO PROPERTY INCLUDING Oc4Y 2,71 2007 PLACEMENT OF HEREON.ADDITIO S. SHEDS..FENCES OR SWIMMIING POOLS. OWNER . SHOULD.CONSULT WITH. A MASSACHUSETTS REGISTERED LAND SURVEYOR. C .e J.E RO C O � - r � • AD N.T„Q 'n_ N O ra} SANpY NECK U EXISTING - - - - - - - 50 / \ EXISTING LEACH PIT IS TO BE PUMPED, COLLAPSED AND BURNINL NE >� / \\\ REMOVED. EXCAVATE ALL ASSOCIATED CONTAMINATED TREE ww� a m MINIMAL GRADING PROPOSED SOILS AND REPLACE WITH CLEAN MEDIUM SAND PER TITLE 5. af w °mT: LN / LOT \ 40 INSTALLER MAY ELECT TO PLACE VENT N v yp z a w~~,, o m w 3 VARIANCE REQUESTED_ ' \\ PIPE IN AN ALTERNATE LOCATION. pR��✓�y w a J 0 w O MAY BE GRANTED IMMEDIATELY BY HEALTH AGENT OR HEALTH INSPECTOR. AREA = 3SG 00 S r +- �\ O 0o\ f-J(n l' J a W~ - m o u L. m 310 CMR 15.221(7) - COMPONENT � i \\ 38 Q��O� J=❑m m DEPTH TO FINISH GRADE. 36 Tn LOCUS J HILLIAROS UZ\ / . MAX REQUIRED - VARIANCE TO I \��'e` HA YWA Y >-i„m 6fd In OF COVER REQUESTED. / / �t . 3s WEST BARNSTABLE. MA � � 24 ft x 125 Ft x 2 Ft_ BETA jA Nc \� 34 LEACHING GALLERY LOCUS MAP OW Q 3 / WALL \ -WITH CUT CORNER H Z❑ 4 j �� / / SEE DETAIL ON REVERSE NOT T O SCALE OD DU)D 32 N ow° ti��� �� _ / 20_F �\ BENCH MARK ff �rr�� \ O r0 V W ENO ` \ \ / IB_P TOP OF DRAIN GRATE w > �O 30 ELEVATION = 25.06 ~ J �y W� / x BARNSTABLE GIS DATUM � W _ LL / \ JZ O I I ^ tiVENT z OU m u 3 W > O '\ I , \ f')O J kc� PIPE \ 28 �O CDWz m _T_ U O J ' V / �RIC� V �IJ O 0 I2-D \ - (Y II �i / A TI C(� 3 O W z =Z 0 [�� �❑ J Z / ) p (U �3 Q I� �ti �26 ti W W m Ln E W w0 40 // ~OW = s-D ® `Fp p\ / LU ❑ J< lJ w 10-D �p V N 38� � 15a [ O LEGEND I— J W m N m 36,/ f E F/? ELF— / \ B-D EXISTING LU O �� WELL /� / 1000 GALLON �) Z m J 34 / �— SEPTIC TANK ..K m /� U lv w LL Z Z X m cD D-BOX O C J 0 ZOLLO = N N WELL \\\\ ' / / v TEST PIT u = UGH \\ / / / 24 �\/ EXISTING z z LEACH PIT � U WNK / ti U Z dwU \ \ ' �• � �w I-LU (n T O ❑ x z z J wFCCE) 32 \ m� DRAIN ►- ` O /iQoll TREE z z 30 / / ,~ -NUMBER REFERS TO Q \ / 22 DIAMETER IN INCHES. 1B-P .1 O=O 2200�\ � P rSa TYPE O-OAK LETTER P-PINES D-DECIDUOUS CO —�� 3 <-z PLAN 28x \ ' ' �LU O �3 u7 \ / T J zoz I , 2 \ A � �, �3 GARBAGE GRINDER (n F-Q + c� SCALE: l In = 30 f t \ ). W w n� ~ N m 30 0 30 60 l\\\ / 20 O �� IS NOT ALLOWED 0 m X 24 \ rl,� Q << WITH THIS DESIGN. WU w 0 10 20 30 22 NO OTHER WELLS WITHIN 150 f t WELL F� z v OF PROPOSED LEACHING GALLERY \ w W 0 z N. / / ®� T�� SEWAGE DISPOSAL SYSTEM PLAN z 0 < -TO SERVE EXISTING DWELLING O \� EST. GERALD & SANDRA STREET o -1 "m ICI U DI S T A NCES NOT TO SCALE T OWNERS OF RECORD O W II X TO LEACHING GALLERY A B co ALL DISTANCES ARE IN DECIMAL 1 52.6 52.5 �/ 141 POINT HILL ROAD FEET NOT IN FEET AND INCHES. 2 53.0 50.3 1995 � e I W ED 3 71.4 59.4 �NOFMgsS ti ��yjNOFl�gss ti ���O�m�� PROPSRTYB DDRNSTABLE, MA 4 77.8 70.0 S1 4c qc Z L '—' 5 59.4 61.9 !! o DAVID G o DAVID e 1 `Pct` �� ASSESSORS MAP 16 6 PARCEL 2 2 O o D. + D. 43 TRIANGLE CIRCLE 0LL cn s COUGHANOWR COUGHANOWR SANDWICH MA 02563 PLAN BOOK 249 PAGE 107 1, Z No. 1093 5�8 364-D894 U J F N N 2 4 ] 'PFGI ��O `s0 410ENS�� p� DATE: MAY 27. 2007 IJ O W x w W I T a /� A L P� JOB #E T E-2 6 0 4 PAGE 1 O 2 VERSION: /.- A e L_ THIS PLAN IS BASED ON AN INSTRUMENT SURVEY AND IS INTENDED SOLELY FOR INSTALLATION OF THE PROPOSED SEPTIC SYSTEM ,,A �� 20�� DEPICTED HEREON. FOR ANY OTHER CHANGES TO PROPERTY INCLUDING PLACEMENT OF ADDITIONS. SHEDS, FENCES OR SWIMMING POOLS. OWNER SHOULD CONSULT WITH A MASSACHUSETTS REGISTERED LAND SURVEYOR. 007 SOIL TEST LOG DO L EVALUATOR: DAVID20.2COUGHANOWR. R.S. O E SIG N C AL C U L A T I O N S WITNESSED BY: DONNA MIORANDI. HEALTH DEPT. PERC NUMBER: H763 DESIGN FLOW: 3 BEDROOMS X 110 GPD = 330 GPD TEST PIT 1 NO GROUNDWATER ENCOUNTERED SEPTIC TANK: 330 GPD X 2 DAYS = 66 GALLONS PARENT MATERIAL: PROGLACIAL OUTWASH USE EXISTING 1000 GALLON SEPTICC TANK IF IN SOUND STRUCTURAL PERC AT 60 In - 2 MIN/INCH IN C SOILS CONDITION. IF NOT. INSTALL 1500 GALLON SEPTIC TANK (MINIMUM ALLOWED) DISTRIBUTION BOX: USE 3 OUTLET D-BOX. ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER SOIL ABSORBTION SYSTEM: THE LEACHING GALLERY DEPICTED BELOW CAN LEACH (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING A6ot = ( 24.5 x 12.5 ) - 0.5 x ( 3 x 3 ) = 3 01.7 5 sF 30.80 Asdw = ( 24.5 + 9.5 + 4.24 + 21.5 + 12.5 ) x 2 = 144.48 sf 0-18 FILL Atot = 446.23 sf Vt 0.74 x 446.23 = 330.2 GPD 18-26 AR LOAMY SAND 10 YR 3/3 NONE FRIABLE USE THE LEACHING GALLERY DEPICTED BELOW. Vt, = 330.2 GPD > 330 GPD REQUIRED 28-62 B LOAMY SAND 10 YR 5/6 NONE FRIABLE 25.63 62-132 C MEDUIM SAND 10 YR 5/4 NONE LOOSE 19.80 L EA CHING GA L L ER Y IPJ00 GALLON SEPTIC TANK DIMENSIONS AND DETAIL NOT TO TEST PIT 2 NO GROUNDWATER ENCOUNTERED USE SHDREY PRECAST 500 GALLON NOT TO USE EXISTING H-10 UNIT SCALE LEACHING DRYWELL (H-20 LOADING) SCALE PARENT MATERIAL: PROGLACIAL OUTWASH 2 MIN/INCH IN C1 & C3 SOILS CONSTRUCTION DETAIL EXISTING SEPTIC TANK IS TO BE PUMPED DRY AT THE TIME OF INSTALLATION AND 7 ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER DRYWELL UNIT STON IS TO BE EXAMINED FOR STRUCTURAL (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING INTEGRITY. INSTALL ANEW PVC OUTLET 28.90 � 21.5 Ft TEE EQUIPPED WITH A GAS BAFFLE. � 0-22 Ap LOAMY SAND 10 YR 3/3 NONE FRIABLE ,LP m 4 4, 22-52 B LOAMY SAND 10 YR 4/6 NONE FRIABLE m LO 52-'�4 Cl MEDUIM SAND 10 YR 5/4 NONE LOOSE � 0 � m� n TAPER j 1 In 74-82 C2 SILTY SAND 10 YR 5/3 NONE FIRM Lq m O 16.90 82-144 C3 MEDUIM SAND 10 YR 6/4 NONE LOOSE "'� 5 f t- 16.90 4.0 ft B.5 Ft B.5 FL .5 ft 81n 24.5 Ft GROUNDWATER ADJUSTMENT EXISTING GROUNDWATER LEVEL 500 GALLON DRYWELL BASED ON IN LACK OT PIT GROUNDWATER DIMENSIONS AND DETAIL 8 USE H-20 UNIT OBSERVED GW NONE AT 16.90 INSTALL ONE INSPECTION INDEX WELL SDW-252 RISER TO WITHIN THREE INLET OUTLET ZONE A INCHES OF FINAL GRADE END END READING DATE APRIL, 200 AND INDICATE LOCATION 'r READING 46.7 ON AS-BUILT PLAN 3 IN DROP ADJUSTMENT 0.8 FLOW LINE ADJUSTED GW BELOW 17.70 FROM 101n = jq TO Q 36 BUILDING 1n D-BOX DO�� O QO�� In O Q QQ 48 1n O O NOTES OpO�opo�ap� LIQUID GAS LEVEL BAFFLE 1) INSTALLER TO OBTAIN DISPOSAL WORKS PERMIT BEFORE STARTING WORK. 2) SEPTIC TANK TO BE PUMPED DRY AT TIME OF SYSTEM REPAIR AND CHECKED 10Z In FOR STRUCTURAL INTEGRITY. INSTALL PVC OUTLET TEE FITTED WITH GAS BAFFLE. 3) ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM REOUIREMENTS CROSS SECTION VIEW OF MASSACHUSETTS TITLE 5 SEPTIC CODE (310 CMR 15). CROSS SECTION VIEW . 4) INSTALLER TO VERIFY LOCATIONS OF ALL UNDERGROUND UTILITIES BEFORE EXCAVATING FOR SYSTEM. _ 2 in PEASTONE 2 1n PEASTONE 7 5) EXISTING LEACH PIT TO BE PUMPED. COLLAPSED. AND REMOVED. ,,.,, SEWAGE DISPOSAL SYSTEM PLAN�. ' �t o 0 6) ALL STONE TO BE DOUBLE WASHED AND FREE OF IRON, FINES ''AND DUST IN =P,LACE. 28 3ia,^ TO EFFECTIVE 3ia ro 26 -TO SERVE EXISTING DWELLING r 1; 1n�� DEPTH 1-112 1 GRAVEL In 71 ECO-TECH ENVIRONMENTAL RECOMMENDS THE INSTALLATION OF, LOW FLOW, F In FIXTURES GERALD AND SANDRA STREET AND APPLIANCES. AND BIANNUAL PUMPING OF THE SEPTIC TANK. , 46 1n 58 In 46 1n 141 POINT HILL ROAD WEST BARNSTABLE. MA 8) .SYSTEM IS NOT DESIGNED TO WITHSTAND VEHICULAR LOADING. `DO NOT PARK OR DRIVE VEHICLES OVER SEPTIC SYSTEM. A* ,- 150 to ECO-TECH ENVIRONMENTAL .: ' ' " + ' �'�}-,5�=•" INSTALLER MAY SUBSTITUTE AN APPROVED GEOTEXTILE 9) SEPTIC TANKS SHALL BE INSTALLED LEVEL AND TRUE '-TO GRADE `ONE-K, LEVEL FABRIC IN PLACE OF THE Z tn. PEASTONE LAYER SPECIFIED. STABLE BASE THAT HAS BEEN MECHANICALLY COMPACTED AND ON TO .WHICH 43 TRIANGLE CIRCLE SANDWICH MA 02563 SIX INCHES OF CRUSHED STONE HAS BEEN PLACED TO MINIMIZE' UNEVEN SETTLING. ETE-26041 MAY 27, 2007 2/2 IP Fnd Proposed Pooliy House c —O / �' t3 / !� F.G. EL. 34.0 F.G. EL 36.0 PROPOSEDw- 1 EL. 32.50 -W '-W +.; Installer To Confirm Prior EL 30.85t Existing .r , To Any Work 1000 Gallon Septic Tank ;. 4' /r ��bb Installer to confirm - ' / w f f f M O O U e'` �s Elevations prier any work _ —a5-- ' ' �' SS9• DEVELOPED PROFILE OF SEPTIC SYSTEM V c / 6, 1 I _. ,.......... �- /.Parking 3� / I /,, 22p 28�, Proposed "��` Area � 1 , NOT TO SCALE \ �/. % Pool Fence �"� --' Sto TT ) ( / I �� �O .. r: + ,; -." ...`V 8.7• 77. r I ,A� � 49.0 .00o Top=40.8• // /• 1 Location Map ove / To 0,2'• Drive \i.r� �l I ', 1 n-2,000t' O j r, Q Top C4S,,e ASSESSORS REF.. d Shell pr/ve J Map 136, Parcel 022 rn #141 __ \` Existing Septic .. 2 Sty w1f Permit 20a7-237 OVERLAY DISTRICT 4 rap=4o.r Existing Lawn AP - Aquifer Protection District I pprox Septic Proposed Pool / / / g Dwellln By BOH Asbullt ' r W x 26• (C,. „lr.+J cord Lawn - FLOOD ZONE: / Proposed POtlo j Elev. 37• ' °nt Zone C Community Panel No. �` •......: #250001 0011 D _... ✓ ~_- Proposed Septic Line _ .. r July 2, 1992 4• TOIL I` Ord Fence'b Lot Login^ w f ~" 35,200±SF ZONE: cB/DH �Fp . _.......Shed d ��2 3- 3 i.30 r _ 2 F tone w„° ..._�.....� 6 � Area F((RP�D87,1 0 S 0 3 2 -..,,- \ Frbn tags (min) 150' �y 123.1 O Setbacks: - " Fron t 30' r - ...._ - Proposed , ,..yj� r ` t v+ Side 15' Pool Fenc� Rear 15' Legend. VQ .O Cedar Tree O � /b/' ,9 Oe�F 22Q 28� Q Holly Tree ,Li. �a •Op, `fah%co O ` Deciduous Tree + Coniferous Tree ® Iron Pipe El CB/DH — Concrete Bound w/Drillhole O Well 4(Z O Vent Pipe OHW— Overhead Wires — 25- Elevation Contour / ..........S.......... Underground Utility Line Title: PREPARED BY.• PREPARED FOR: NotesIlRevision: Pro OSed 1m rOVementSristian Atwood NOTE: p p Sullivan EnggqInc.Engineering,b� Inc 1.) The property line information shown was PO Box 659 23 West Bay Rd, Suite G compiled from available record information. At 141 Point Hili Road Osterville, MA 02655 Osterville MA 02655 (508)428-3344 (508)428-9617 fax (508) 420-3994 / 420-3995fox 2.) The topographic information was obtained Barnstable, (west Barnstable) www.copesurv.com from an on the ground survey performed on ass, o or between 111MAR114 and 21/MAR/14. Field: RRL/KAR Review: RRL/JOD 20 0 10 20 40 80 V 3.) The datum used is Approximate mean sea level Date: Scale: ComplDroft: RRL/CTR Drawing # C446_1 ex1 based on the Town of Barnstable GIS maps. Ma 8, 2014 1'=20' y Project: Atwood-Jaxtimer Project # 9800165_Atwood