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HomeMy WebLinkAbout0067 RED OAK LANE - Health v • West Bamostable No. 0 a a �� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftpYication for Vsposal *pstrm (Construction Permit Application for a Permit to Construct( ) Repair/Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Rea, ZAAI.- Owner's Nam Addres ,and Tel N9. Sp8-�{ojQ Gtr• tsT�r ��n Pon�t me cl(;s It r Assessor's S- Map/Parcel / a 3 6? Og I.[.•�• [v$efl sT�S Installer's Na e,Add{'ess,and Tel.No. Sa8_y�g Desigper's Nan Address,and Tel.No. 'a l wte t( C_ Ti r �- 9 S�rnen F1ejer 'Box Q$l L.SAr�w.c� Oa53 Type of Building: Dwelling No.of Bedrooms Lot Size L4�j sq.ft. Garbage Grinder Wd) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) CA4 0 gpd Design flow provided Li Lf&•U3 gpd Plan Date c�7,ao(3 Number of sheets a Revision Date Title I Size of Septic Tank I SCE W. Cex,�,« Type of S.A.S. +T-EC) et, t,Ctfr41K ^ 3 Description of Soil 14s P« PIAw Nature of Repairs or Alterations(Answer when applicable)�� -V( t 's(c A eA& nre 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 f Health. Signed Date O %�0?.6 Application Approved by c Date 6 —� Application Disapproved by Date for the following reasons Permit No. 01 J Date Issued —ro --------------------- ---------------------------------------------------------------------------`-------------- -- --------------- No. �C r J ;�` Fee vv TH_ E'COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01pplitation for Disposal *pstem Construction Permit Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.6 Pe ty U.-1 Owner's Name,Address,and Tel.No. ?��•�✓,?O Assessor's Map/Parcel 1. �' �� �-) �1�.y / r C,1 f 1 f.,� , t,, %JG ,i 37G Installer's Name,Address,and Tel.No. ` a Designer's Name,Address,and Tel.No. 1�� s!_ T , It j,; , .lr �c',`re,� (`ir�rr a "r ,U,t,( Si c ..,Ilwv T,L� ct�1 Type of Building: I ' Dwelling No.of Bedrooms �-� Lot Size J'i, `i 1( sq.ft. Garbage Grinder(N() r Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) LII L{p gpd Design flow provided L4 L-1 t, G.3 gpd r' Plan Date ��-` Eti �_ i 3 Number of sheets Revision Date Title \ Size of Septic Tank I Siac�<,�(. v i�T,.,c 1 Type of S.A.S. Description,of Soil ( �. Nature of Repairs or Alterations(Answer when applicable) (� s��,/1 t. ,a e*t•-1 .'r �AA, 6,IS 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 W Compliance has been issued by this Board of Health. 4 Signed ur Date Application Approved by Date Application Disapproved by 1 Date for the following reasons Permit No... got Date Issued THE COMMONWEALTH OF MASSACHUSETTS k BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(V") Upgraded( ) Abandoned( )by S 4(,,rn , w Cc,h� r at A) '?I �j U,-1 K L,44(= L,i, '<)�,,., T')It— has been constructed in accordance--' with the provisions of Title 5 and the for Disposal System Construction Permit No,�2013 a5 3 dated Installer x cc L}`1c.ec c Designer r• e r-,, #bedrooms i( Approved de�.igri flow L/ gpd+ ( � /1a The issuance of this permit shall n-t be on rued as� guarantee that the system functio as designed Date /,/ Inspector ,�p - - - -- - -- --- No v r 90../ Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Misposal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair((/ Upgrade( ) Abandon( ) System located at e ( ),I A I•g N F 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:Construction must be completed within three years of the date of this permit Date V —f 3 Approved by ((�� 1] TOWN OF BARNSTABLE LC �TInN �`� ICGC0�4k /�AL SEWAGE # VULAGE W &M ST/.WS ASSESSOR'S MAP & LOT 1 a8 Oa3 INSTALLER'S NAME&PHONE NO. SEPTIC-TANK CAPACITY /SOD LEACHING FACILITY: (type) - P,•IrS (size) GX(�` 3 S,ro NO. OF BEDROOMS BUILDER OR OWNER Sk0 CZU1e k PERMITDATE: 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 / •f- on site or within 200 feet of leaching facility) S� Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leachingfa:51SAYC Feet Furnished by J. IF&2 ::Cl mod doe\ Fro^ --L—GAr 8 Al - �H oa- 3 e 3 a � AS' W7 a 8g,- a$ 'Alq !3y • y o , y TOWN OF BARNSTABLE LOCATION O ;iir, 0 /ZS',V/% SEWAGE# VILLAGE /G/JlaAP 7H7 � _ASSESSOR'S MAf P&PARCEL 1�8 _023 INSTALLER'S NAME&PHONE NO. • 1 l C�c t l l S 1 -5�7 f SEPTIC TANK CAPACITY k 00 G-il. CF X(S (1#1 1Z _ d� r r LEACHING FACILITY:(type) 3" 6 00 6�-C41y r4/ / (size) /a.S X 33 S NO.OF BEDROOMS II OWNER �V f tCA J4 36&KJ PERMIT DATE: COMPLIANCE DATE: 13 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY GANG c . a 0 0 b a8 3Sf 3- 38'1 �g�64 08/29/2013 08:27AM 17744139468 MEYER AND SONS PAGE 01/01 Town of Barnstable Regulatory Services • Thomas F. Geiler, Director stia�r,�t,Y, �9, Public Health Division M0 Thomas McKean,Director 200 Nfain Street,Hyannis,jNLA D2601 Office: 503-362-4644 Fax: 50$-790-6304 Installer& Designer Cerfificatlon Farm Date: 5 L Sewage hermit# Assessar's 1IaplParce] 2-3 Designer: e ylj �Vl(,. In Address: C7 li( Address. © ��• _ >3 On f was issued a permit to install a (date) (installer) septic yystern attil Pm 0 (,A1J 14„ 8W5 based on a design drawn by Jj (address) dated � �7 I� �( (desidrrer) ,` I certify that the septic system referenced above was installed sub=ntially according to the design, which may i4clude minor approved chases such as lateral reloo-t:on of the distribution boN and/or septic tark. I certify that rk a septic system referenced above wa3 installed with major changes (i.C, greater than 107 lateral relocation of the SAS or ar,y verticaI relocation of any compenent Of the septic system) but in accordance with.State & Local Regulations_ Flan revision or Certified as-built by designer to follow, DA (installer's Signature) � llq, / NITA%\ (Designer's Signature) Designer's Stamp Here) FL ',,SSE RETURN TO 8A,RNSTABLJ' PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS PDRVI AND AS-BUILT CARD ARE RECEIVED BY THE BAD N9T.A ALE 1*11IB .IC HEALTIJ DIVISION. THANK YOU. Q:.Healtf/5eptic,Designa Certification Form.3-76- -doc I I Town of Ba Mstable.. P#—L aL Department of Regulatory Services ' ' Public Health Division Date Bur. ' ib3Mq 200 Main Street:Hy#nnis MA 02601 Fn��ti Date Scheduled ._ ll' y •- 1 L }� `�f 'Time Fee Pd. Soil Suitability Assessment for Sewage Disposal Performed By: T)6_,C r 9_ ' "A Me,, F— ! Witnessed By: f)o 1J r • i LOCATION &:"GENERAL INFORMATION Lncation Address („'7 r�1,,L\� p � Owner's Name ��( -$ 1Y W - �� I Address Name En user's Q Yd Assessor's Map/P4tcel: ����(?.2•.3 � gt . I NEW CONS1RUd"i ION REPAIR Teiephone# S Land Use Slopes(%' Surface Stones Distances from: Open Water Body 2po ft Possible Wee AreaZ O'O? ft Drinking Water Well >t v v ft i)rainage,Way > too ft Property Line l y ft Other ft SKETCH:(Street name,dimcnsiods of lot,exact locations of test holes&perc tests,locate wetlands in proxitnity to holes) I ! 'TOWN OF BARNSTABLE I ant? a 94 to rtf 12: 27 I i Parent material(geologic) I act a,� - - `V-45� Depth t0 Bedrock 1 • Depth to Groundwa(dr. Standing Water in Hole: ' Weeping from Plt Ftiee Estimated SeasonaliIigh Groundwater q .:A DtT- EMI NATION FOR SEASONAL HIGH WATER TADLE Method Used: Depth observed standing in obs.hole: in. Depth td Sall mottles: Depth tolweeping from side of obs.hole ! in. Groundwater Adjustment ft.-- ! _ A .Actor.,.�� Adj•droundwaterl evel.,,�,e, Index Well# _ � Reading Date: Index Well levdl -- df PERCOLATION TEST Date __ Tliue Cl Observation I Time at 9" ®L_....._.. Hole# t` Time at 61' Depth of Perc n �w_ ® Time(V-V) ---- -------- Start Pre-soak Time.C� ® I �- PP End Pre-soak 4 Rate MinJInch Site Failed: Site Suitability Assessment: Site Passed _ Additional Testing Needcd(YIN) Original:,Public Iie'plth Division Observation Hole Data To Be Completed on Back— ***If pereolafiiOn test is to be conducted within 100, of wetland,.you must first notify the least one 1 wedk prior to beginning. Barnstable Cdriservation Division at ( ) • DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other .Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistent %Gravel Oil -rqq ovd,G 2: DEEP OBSERVATION HOLE LOG Hole#' Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistent %Gra el b''- Z'� D .�- N 14L1Z / DEEP OBSERVATION HOLE LOG Hole# NA Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistent %Gravel DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency. Gravel) Flood Insurance Rate Mau: 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 per ious material? Certification C I certify that on (date)I have passed the soil evaluator examination approved by the Department o nvironm ntal Protection and that the above analysis was performed by me consistent with the requir traini xpertis and x erience described in 3:10 CMR 15.017. Signature Date QASEPTICIPERCFORM.DOC .ter ' CERT'IFICAT'E OF ANALYSIS Page: 1 ' `- Barnstable County Health Laboratory tfv`4 . Report Pre pared For: Report Dated: 07/13/2001 RECEIVED n MacAllister,Joan&Duncan Order Number: G0110 72 6 2001 Joan MacAllister nY 8 Redbe Lane TpWN OF BARNSTABLE Marstons Mills, MA 02648 HEALTH DEPT. Laboratory ID#: 0110575-01 Description: Water-Drinldng Water Sample#: 10575 Sampling Location: 67 Red Oak Lane,West Barnstable Collected: 07/082001 Collected Joan MacAllis 128-023 bY� Received: 07/092001 Routine rrEM RESULT UNITS MCL Method# Tested LAB: IC Lab Nitrates 2.5 mg/L 10 EPA 300.0 07/09/2001 LAB:Metals Copper 0.1 mg/L 1.3 SM 3111B 07/10/2001 Iron <0.1 mg/L 0.3 SM 3111B 07/10/2001 Sodium 18 mg/L 20 SM 3111B 07/10/2001 LAB: Microbiology Total Coliform Absent P/A Absent P/A 07/09/2001 LAB: Physical Chemistry Conductance 147 umohs/cm EPA 120.1 07/09/2001 pH 6.0 PH-units EPA 150.1 07/09/2001 Note: Water sample meets the recommended limits for drinking water of all above tested parameters. Approved By: (Lab Director) -7 3lzool Superior Court House, PO.Boa 427, Barnstable, MA 02630 Ph: 508-375-6605 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 67 Red Oak Lane West Barnstable, MA 02668 Owner's Name: Bob Skoczulek Owner's Address: Same RECEIVED Date of Inspection: July 11, 2001 Name of Inspector:(Please Print) James M Ford J U L 19 2001 Company Name: James M. Ford Mailing Address: P.O. Box 49 TOWN OF BARNSTABLE Osterville,MA 02655-0049 Map: 12 HEALTH DEPT. Telephone Number: (508) 862-9400 Lot: 023 CERTIFICATION STATEMENT I certifythat I have personally inspected the sewage disposal system at this address and that the information reported P Y P g P Y P 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: ✓ Passes Conditionally Passes Neqds Further Evaluation by the Local Approving Authority aii Inspector's Signature: Date: July 14, 2001 The system inspector shall sub t 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. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page I Page 2 of l 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 67 Red Oak Lane West Barnstable. M.4 Owner: Bob Skoczulek Date of Inspection: July 11, 2001 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired: The-system,.upon completion of the replacement or repair,as approved by the.Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined",please explain:.-n r The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution boxdue to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 1 Page 3 of 1 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 67 Red Oak Lane West Barnstable, MA Owner: Bob Skoczulek Date of Inspection: July 11, 2001 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 2. System will fail unless the Board of Health(add 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 and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 _h Page 4 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 67 Red Oak Lane r ;} ,r West Barnstable, AM Owner: Bob Skoczulek Date of Inspection: July 11, 2001 D. System Failure Criteria applicable to all systems: You must indicate either"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 '/z day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _ ✓ Any portion of a cesspool or privy is within a Zorie_Fof 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 ifeet,but.greater than 5.0,feet from a private water supply well with no acceptable water quality analysis. (This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform;bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.) No (Yes/No)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 System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No 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 1I 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. 4 f Page 5 of 1 I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 67 Red Oak Lane West Barnstable, MA Owner: Bob Skoczulek Date of Inspection: July 11, 2001 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 7 Was^the site-inspected for.signs of break out"? ; ✓ Were all system components,excluding the SAS,located on site? ✓ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum ? ✓ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes No ✓ 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 CNM 15.302(3)(b)]. 5 Page 6 of I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ',':SYSTEM INFORMATION Property Address: 67 Red Oak Lane :. West Barnstable, AM Owner: Bob Skoczulek Date of Inspection: July 11, 2001 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Number of current residents: 4 Does residence have a garbage grinder(yes or no): Yes Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): Private well s Sump Pump(yes or no): No Last date of occupancy: Currently occupied COMMERCIALANDUSTRIAL Type of establishment: Design flow.(based on 310 CMR 15.203): gpd Basis-of design flow_(seats/persons/sgft'6tc) Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Pumped in 2000-per owner Was system pumped as part of the inspection(yes or no): 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) Tight Tank Attach a copy of the DEP approval Other(describe)-' r _..._ .__Approximate age of all.components,..date installed(if-known)and source of.information: Original in 1986.-New pit added in 1996(per as built card) Were sewage odors detected when arriving at the site(yes or no): No 6 b- s Page 7 of 1 I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 67 Red Oak Lane West Barnstable, MA - Owner: Bob Skoczulek Date of Inspection: July 11, 2001 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron _40 PVC _other(explain): Distance from private water supply well or suction line: _ Comments(on condition of joints, venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 4' Material of construction: ✓ concrete _metal _fiberglass _polyethylene _other(explain) If tank is metal list age: -. Is.age.confirmed by_a Certificate-of Compliance(yes or no): (attach a copy.of certificate) Dimensions: 1500 gal. Sludge depth: 1„ r _ 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: 10" Distance from bottom of scum to bottom of outlet tee or baffle: 12" How were dimensions determined: Measuring 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.): The tees were present. The liquid level was even with the outlet invert. There were no signs ofleakage. The inlet cover was 3" below grade. GREASE TRAP: None (locate on site plan) Depth below grade: 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: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of 1 I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM-INSPECTION FORM PART C $YSTEM INFORMATION (continued) Property Address: 67 Red Oak Lane ,- West Barnstable, W Owner: Bob Skoczulek Date of Inspection: July 11, 2001 TIGHT or HOLDING TANK: None (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: j Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): > c DISTRIBUTION BOX:! ✓ (if present must,_be opened)(locate on site plan) Depth of liquid level-above.outlet invert: Even 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.): The D-box was level. There were no signs of leakage or solids. Speed levelers were present. The D-box was approximately Y below grade. Recommend installing risers. PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no): F Alarms in working order(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 67 Red Oak Lane West Barnstable, MA . Owner: Bob Skoczulek Date of Inspection: July 11, 2001 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: 2-6'x 6'w/3'stone(per as built card) leaching chambers,number: leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions: overflow cesspool,number: Innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): One pit 03)had 4'of water on the bottom.' The scum dine was at the'dme level. There were no signs offailure:•The cover was 36"below grade. The other pit(#4)had 1'6"of water on the bottom. The scum line was at the same level. There were no signs offailure. The cover was S"below grade. The bottom of both pits to grade was approximately 10'6". CESSPOOLS: None (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 or no): Comments (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: None (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.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENtS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 67 Red Oak Lane West Barnstable, AM Owner: Bob Skoczulek Date of Inspection: July 11, 2001 Map: 128 Lot. 023 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. F�OnT /a(*AGc ` v Aa- 3a 3a- 3� 3 AS- y� A'4 - "1 9 13H - y d y 10 Page 1 I of 1 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 67 Red Oak Lane West Barnstable, MA Owner: Bob Skoczulek Date of Inspection: July 11, 2001 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record- If checked, date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: topographic and water contours maps Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: The bottom ofthe leach pits to grade was approximately 40'6.". Using the Barnstable topographic map-and the Cape Cod Commission water contours may, the maps were showing approximately 100'+/-to groundwater at that site. This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied, relating to the system, the inspection and/or this report. I1 TOWN OF BARNSTABLE LOCATIbN to' 0A'1-, SEWAGE# �° Z VILLAGE - R ��} �.�- ASSESSOR'S MAP & LOT/ , `� INSTALLER'S NAME&PHONE'NO. MID ID C6 4C SEAI L SEPTIC TANK CAPACITY LEACHING FACII,PTY: (type) a �` (size) f ad O 671 NO. OF BEDROOMS OR OWNER $ / d PERMUDATE: 4 He COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of le c 'ng f i�zc li Feet Furnished by l r _ IJ s a 0- Two , 1-Y d P� 1-2 -2 ' t Fee No. � ,y THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS 2pplication for Migogal *pztem Construction i3ermit Application is hereby made for a Permit to Construct pp y ( )or Repair(L-15n On-site Sewage Disposal System at: I Location Address or Lot No. Owner's Name,Address and Tel.No. Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. "IZO `ti w�t./S Type of Building: Dwelling No.of Bedrooms Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Description of Soil Nature of Pepairs or Alterations(Answer when applicable) 0k Tr 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 Cod and not to place the system in operation until a Certifi- cate of Compliance has been issued rB o . Sign Date Application Approved by Application Disapproved for the following reasons Permit No. Date Issued ——————————————————————————————————————— JCS-6,,13 - No. / 6 -� 7 / r Fee . C/ Q THE COMMONWEALTH OF MASSACHUSETTS-- I .PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS 2pplication for Migaar *V!5tern Con.5fruction Permit Application is hereby made for a Permit to Construct( )or Repair(L")an On-site Sewage Disposal System at: Location Address or Lot No. ��T Owner's Name,Address and Tel.No. Installer's Name,Address,and Tel.No. �� ✓ Designer's Name,Address and Tel.No. }} G E'V Type of Building: �F Dwelling No.of Bedrooms_ Garbage Grinder( ) Other Type of Building No. of Persons Showers( "")Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date -Number of sheets Revision Date Title - r "Description of Soil tin/7 1 'ti .�. -1 ) / Nature of step airs or Alterations(Answer when applicable) l �l —6(,K 51 S 5-T, 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 Cod and not to place the system in operation until a Certifi- cate of Compliance has been issued B d o Sign ,-- Date - Application Approved by Application Disapproved for the following reasons Permit No. Date ——————-- -- ._-------------- THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Certificate of Compliance , / THIS IS TO C that the._O.n_ ' e ewa a Disposal System installed S )or repaired/replaced(w )on Sit � v �� for A/��c..c as E b C� 1--A/• eS i has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Use of this system is conditioned on compliance with the proviswjis set forth below: No. / Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Migogal *p.5tem Construction Permit Permission is hereby granted to to construct( )repair(�n On-site Sewage System located at (a -7 lE10 n a le Lc- u—e L tJ c�,r-` I<0 b Le and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. All construction must/be completed within two years of the date below. Date: eT d / Approved by � , CERTIFICATION OF SKETCH AND APPLICATION FOR A bISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS) I hereby certify that the application for disposal works construction permit signed by me dated concerning the property located at 7 OD O L�` �1 a�z�S' meet$all of the following criteria: • Thereire no wetlands within 300 feet of the proposed septic systettt • There are no private wells within 150 feet of the proposed septic system The observed groundwater table Is 14 feet or greater below the bottom of the leaching fbcility • There is no increase in flow and/or change in use proposed o There are no variances requested or needed. SIGNED: DATE: ' LICENSED SEPTIC SYSTEM INSTALLER;N TIE TOWN OF BAMSTA13LE NUMBER [Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. ' a x o r C New prr, TOW. N OF BARNSTABLE LOCATION GG-f /� y( U U� S SEWAGE # VILLAGE l!/, ASSESSOR'S MAP & LOT Gc/ /G C�INSTALLER'S NAME & PHONE NO. 39F 6-119 1 SEPTIC TANK CAPACITY /So 0 .Q LEACHING FACILITYAtype) GegGG� to/ /1 (size) 4 %NO.fOF BEDROOMS G/PRIVATE WELL OR PUBLIC WATER rev. BUILDER OR OWNER G'�.t�iv Ji/,An ©DATE PERMIT ISSUED: �/�Jf-I 9 DATE .COUPLIANCE ISSUED: �/23 VARIANCE GRANTED: Yes -- - No /J = 69 G =32r�rr ac w t ASSESSORS MAP NO: 3 ..2-3.7 PARCEL NO: /i c� Fes$.. .THE COMMONW-ALTH OF MASSACHUSETTS BOAR® OF HEALTH --------------------- ------------------OF...................................................................................................... ApphrFation for Elh4pos al Works Toustrnrtiun ramit Application is hereby made for a Permit to Construct (/ or Repair ( ) an Individual Sewage Disposal System at: /J ......T..J.._.�..•.R.4 v.N.�...........0._ .-...I .............1J[l./�/._................... ..C..�.._.-_..... ..... Location-A ss or Lot No. 7.� �h.._....J h.e...... ,/l_�:s!eti.: ------•-•---------------------•------.....---._...........•......................-------•--•----- / Q ner Address / a CQ.......... -fJ7 1�1 ...............•••-•-----•---.............................••••-•-•......•...................••... Installer Address �{ C/ U Type of Building Size Lot..._?�j.11.7.7_•___••Sq. feet Dwelling—No. of Bedrooms............. ............................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ..................................6;di vh-----------------------------------------------------------------------•-- ............. ••••...... -------..._-.--------- Design Flow .! '_ •_________gallons per �sen per _____day. Total daily flow-_._-._.. _ _....I ......gallons. W W Septic Tank—Liquid capacity.f-S-'W---gallons Length----/__0..'__�i-Width. "6 a_.... Diameter................ Depth................ x Disposal Trench—:\To. .................... Width.........._......... Total Length..._............_--- Total leaching area....................sq. ft. Seepage Pit No.-.___-c�---------- Diameter-----ISO--------- Depth below inlet.....6............. Total leaching area...,53y_....sq. ft. Z Other Distribution box (VI) Dosing tank ( ) '�:a?l-/ Y � Percolation Test Results Performed by...........� ._____ .. _.. _•_..__ ........ Date....... .......... Test Pit No. 1........6-----minutes per inch Depth of Test Pit......Ay . Depth to ground water...�/[rn_,�--_---__--. (z, Test Pit No. 2.2._.51.minutes per inch Depth of Test Pit....... ...._..... Depth to ground water 1 ----_--. / . . .. - ----•-------------------•-•---••---•------ Description of Soil..ei------4f-fJ_-A ya Y.AA.._5� -----�Q Y_me ---S6...`�......... w --------------------------------•------------------------•------ --•-----•-----------------.._._...-----------•-------------------------•--------------•-------------•--------------•--............... U Nature 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'Til._.L 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been iss ed by the board of hgalth ,t R 7 -�• �y7 Signed------... .....� ..�.7---- ! D t Application Approved B ....................................................... •a-�` . -7� . Date Application Disapproved for the following reasons:---------•-••--------------•--------•--••----•--•----------•-•---------=---•----------------------•••-••......-- ...•••••-••-••••--•-••-••••••------__...••-•••-••--•••---••-----••-••••••--•---••---••---•---••........_..-•-•--•••----•--•••--•-•-•-•--•••-•••-•••----•--•---.....•••-•-•------•••------•--••••••.....•. Date PermitNo. '.. - ----------•-•---•--•••-•. Issued....................................................... Date �a No...............-....... Fps............._............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF........... ......................•----•---.........----------..._................. Apli irFatiun for BiupuuFal Works Tomitrurtfun ranfit Application is hereby made for a Permit to Construct (1A) or Repair ( ) an Individual Sewage Disposal System at: �,p� �j�,,- //' ^� 4,.Y/i- ?.1.�!.✓..:......7d::L4L°_•....................... ..............................`...�..! 6........ .}.....�G ;Y7%ti7Cad.�+ '¢•- y ocation-Addre / 6. .... �_�l i �s��4r.............. ....•----•----------.......-----------------...----.............................................. Ow er ...............................Address � Installer Address //� ¢ �� S feet Type of Building Size Lot_...-7_.,_______________ q. Dwelling—No. of Bedrooms....................................-------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures ................................. .. W Design Flow............./Z.0_......................gallons per n per day. Total daily flow-__.-----�`10......._.................gallons. 9 Septic Tank—Liquid capacity.l.SO_gallons Length._&k....... Width.Y11-___- Diameter________________ Depth................ Disposal Trench—No. .................... Width.................... Total Length.......... ........ Total leaching area....................sq. ft. Seepage Pit No---------a........ Diameter........ Depth below inlet................ Total leaching area---ff!Y_....sq. ft. Z Other Distribution box (v-1 Dosing tank ( ) ,+ a Percolation Test Results Performed by........3n......_. ............. Date..... = y_-------- .- Test Pit No. 1.....6________minutes per inch Depth of Test Pit.......�y........ epth to ground water....ti0>�-_....--- f=, Test Pit No. 2..1S_....minutes per inch Depth of Test Pit.......1!_....._.. Depth to ground water.....11Jdre........ P4 ------------------------------4u,Y .3�/o._..g� .S >_ghh. r-rvc�?S___ -�Q !Y.---- - {<..5 ..__...._.. x r 0-va...... _P_t-. s aI'l_fir.....ek'4 13�t.....m iA'` 5 � .5z"lf 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 TITL is 14 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued)W the board of health. / ,. ' Signed �........ .. Date ApplicationApproved By-----.......................................... ..................-------------- at7 Application Disapproved for the following reasons:....... .................................................................................................... ...-•-----•--------------------------•-....•..---------------.....----------------........-----......-•-------------------------------•------------------------•---•---•••-•-••-------------•-•••-•---•- ® Date PermitNo........................................................./ Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...............:.f. ......................OF......... ... C......................... .............. / n'Trdifiratr of &-impffFanrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( >kor Repaired ( ) by.. V -�-t------f' J------•----------------------------------ia5caii�------------ -----..----------..._...............--------------.---------•----------- at ---• / - --�- -- e ------------•---•-•-•-------------------------------------•----------....---•-•---•------•-------------------. has been�fn�'tahec�ii�accdre'7�an�e I he p"ro'�[sions of iiii,ia: j of The State Sanitary Code as described in the application for Disposal Works Construction Permit No-----F__ ._..__._� e��` dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NO BE CO STRUED AS A GUARANTEE THAT YHE SYSTEM WILL FUNCTION SATISFACTORY. DATE �. a" ............................ Inspector �-- ......................•.... ---�� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......OF............. �................._ y. No...... •�_. G C. -��-. lC r FEE.....� .s. Din u�aa Nor wunofriun until Permission is hereby granted........ '•.....-f`_"C• - ........................................................------------------........... ------- to Construct ( or Repair ( ) an Individual Sewage Disposal System at No.............. ---•-- GU� / & 1 -;i�- O 'IC-- r Street as shown on the application for Disposal Works Construction Permit No..... ------------•---••--•--- -a� V------------------ar �t DATE------- .... n........................................... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS fill 111 1 R t a & - ENVIROTECH LABORATORIES ` — 66 Lewis Bay Road - Massachusetts 061 . 61777t725 . 7 & : F — k E CLIENT: G1Pn Mi 11iken . LOCATION: tot 16 Red Oak lane kADDRESS 7990 ]_,th Rd Q. B rnatahl@�A 3 % . rantarAri11P NA 02632 - k COLLECTED BY: Rd Npph,n SAMPLE DATE 7126/87 TIME: 3.45 Pm g . % . DATE RECEIVED: 2/2/87 SAMPLE ID: D432 q 140 £t — JOB New Well . WELL DEPTH: . F . - k RESULTS OF ANALYSIS: k F � k Parameter Units Recommended hmR Result EF Co WIm b de a/10 m (F Method) O O q . q pH � pH units � 6 0ƒ5 6.99 = % Conductance umh scm 0 170 F mg/L 2.0 . Sodium 31.1 k N#@eN mg L 10.0 .05 ^Iron mg/L 0. .32 EF kManganese mg% 0.05 k Hardness mg/L as CaCO a 5O k Sulfate mg/L 2 O . m k Potassium mg/L 20.0 k Alkalinity mg/L 200 Chloride . mg/L 250 7 . . kCOMMENT: Sodium and Iron levels do not constitute a healthhazards. E k kWater is suitable for drinking purposes for parameters tested. 2 U / J411DATE . . ' 1 , — Department of Environmental Management/Division of Water Resources WATER WELL COMPILETION REPORT WELL LOCATION. Address J 1)4 // � 4 On k /(? City/Town //). 6o rn,-, f 61 G.S.Quadrangle Map Grid Location / Owner Address•?,-,?..J,i l PA4 olil P. 222�/�42kl,� Sv a WELL USE CONSOLIDATED WELL Domestic!❑ Public ❑ Industrial ❑ Type of Water-bearing Rock Other Water-bearing Zones Method Drilled o Alt F-U 1) From To 2) From To Date Drilled —a 3) From To 4) From To CASING Depth to Bedrock Length �Q / Diameter Type P/RS T AC UNCONSOLIDATED WELL STATIC WATER LEVEL Water-bearing Materials Feet below.land surface /00 Sand: fine❑ medium rcoarse'® Date measured .,�- — '7 Gravel: fine ❑ medium❑ coarse El g Screen: GRAVEL PACK WELL / Slot# ./() length from to Yes ❑ No Q Split Screen (or 2nd screen) WATER QUALITY TESTS MADE Slog lenqth . from to Chemical I Biological ❑ Depth To Bedrock PUMP TEST L/ Drawdown feet after pumping days " hours at n2 0 GPM! How measured.e?2 I r gr rri Recovery feet after hours. LOG of FORMATIONS COMMENTS: (On well or water) Materials From To _ o C m �Y?f d. DRILLER / m &f Firm &tO� /)(zlp/I Coarse Address A)6x S166 � l�n City F'nre-s4c-0ko Registration No. i qg operator's ignature Please Print rrm y BOARD OF HEALTH COPY 25M-10•95•807101 for ,,ffi i T i I q)21 � i 1 u :08. 0 SETP�/aGLS ' F2oL1T� 'hog . . SI pe 15 ' SITE iN Oi y�sf LOCUS: ::l T/� ARNE ti H. 1 �' AL �, REF: OGE t�ok3 �l �4 down cape a#gineeriag � CIVIL ENGINEERS PREPARED FOR: LAND SURVEYORS 02Q NtI/1 St. RE ,-,may rV fL1t�YOR YawMs ! ' SCALE � -� T I_�LL Nt;W_WI/J]�ptn15 -U 3E_.A/��inso� --TILT vvASH• ---_ _ yI-oIt yI-OrCc J J S 1V _ t3E Roor•t `�`-' hlT- 8E = .GicEvt /ZED ovE2 WALE �COvd ' �I �jp LIvtN_�./32EF3 -� I � T t3A i1-I 3A 7-1/1 — _ GD !�lioPoS� SN_-LAlN.�3PAC+71'1tNT 1 NEW 5?ACE i r868 tX 7-D t 6 +c - - r�. W -L- ru aw ' { S� 23E Rfr+ot ED 3aTL_ a'' t wWilCb ow_ .3t -1�ECMooI F Cm_ _ ) ?A/JC1�Y � t y?tn �oe,tTns?1�C�E>>. CLOSE• ,i'J'/92 1 t i -I tAik ? • � aY a IQ b 1 . j P. .[_1/-is j_ER j3E�RoofrJ - j i o r f r o u Dl�ttnl TO �F�oW S� i SIB„ >D i i iotj Fa -W SJOM M c LLIsrrA. SCAT : +,+ram -11 APPROVED DY: DRAWN BY M REVISED SECON Looms PILAO ' ORAWINfi NUMBER Wa A4E4 3 `� 4 Q Q EX�STJNG r/2si �LpvR ?�q�/ ' q 0 t�- N_1:W_ -SA LAublb. &L��-s,AlSLS iU s-,v-LAYJ J�3ts.EJf�oo��.�EN__ • 0 0 , r /d r P.- I-,vJAiG ooN1 C•b • 1• a. b rrl oLOAN MLAU-V:�1�69 SCALE: I �• 6,� APPROVED SY. DRAWN BY MAM DATE: REVISED FIRST Fib R ' � DRAWING NUMBER '� SECTION - SEWAGE 1 I -SEPTIC TANK- D BOX— PI rs 1/d - �- s� i �/ L4 " " I� —LEACH �. /Z . .' Ak .TOP OF FON - �i '12"OF 116T0 W" x WASHEO STONE ' � � -moo• . � � ; I`co_ yE,e�t! OJ Ig Ql�rr. " . IN• Q�lO�elsEe G�' ToP OUT• IN• - 512�G OUT• I� IN• __ O- _ 1 i '-`• / % t7 7� .� C//AMC�� di I(p I D SEPTIC ELEV. TANK �'�I ►o / , / ✓ W i ( �o ` �� `` Ic n I J ELEV: ELEV. ELEV. .0c-p1 -14 ELEV. ELEV. I4,0 WASHED STONE QQ i TEST HOLE LOG TEST BY T� �R WITNESS J BEDROOM HOUSE ' TEST GATE DESIGN � � �" � I � • T.H. � 1 T.H. « 2 Q�t 2j°�� �\ / � �t -I1 ELEV. £ To DISPOSER OISPO ER _� l 5uP PERC RATE MIN/IN. y`- 3 Fes, /09.8't oS,S FLOW RATE I I O (GALJDAY)/fzi� AA �l \ iG 4z`` SEPTIC TANK 44o ri,,)a REn'!?SEPTIC TANK SIZE \ 1 LEACH FACILITY SIDE WALL q G/D. I �`�5_ .. ✓q �/ 1�- Sim ( � C- �G. /OZ.S-'e Mlnl l BOTTOM `li�z)Z'r = 'IS , (v.'II ) �;5, �� G/D. �( ('� 1. �o (�3�5 /�J TOTAL Z61 , 0 a 3�0� •-( �j ,� ` '/✓/`� •qv IZ 4f6.(7 -- 2 PITS 534.0 `l��•4 G�� �i �� /. - J 2 neE�a�T USE: LEACHING PI T /j/U ---Ip1 E�FFLI�yE T7iAP 1 x C� PFFEC,[�V T7EPT� V \ �.` "J •' - . . : .. . WATER ENCOUNTERED NOTES: (UNLESS OTHERWISE NOTED) Q 1.DATUM(MSL)�TAKEN FROM-,.-1'',���:.��;_���- _ -„,-QUADRANGLE MAP 2.FiJii1CIFNL WATER 1 al ,IQ'C-. --.-----_.AVAILABLE — 3.PIPE PITCH:VG"PER FOOT , t, Slk OF / y a —I(7 \ , 4.DESIGN LOADING FOR ALL PRECAST kJNIT7:AASHO- � -44 �' • 5.MIN.GROUND COVER OVER ALL SEWAGE FACILITIES:(1) FT. 6.PIPE JOINTS SHALL BE WADE WATER TIGHT � A ALq SITE PLAN' 7.CONSTRUCTION DETAILS TO BE ACCORDANCE WITH COMM.OF MASS. �, STATE ENVIRONMENTAL CODE TITLE 5 c� VI �+ f K PPO�SI;D OM 01�11.Y Aj jp SHOD�I�pp VW. LOCUS: Kvf � U SQ:;l FOFt LI►JE �• e(t _ q � ���iH�oF ��ssy�. /7/�ST ARNE REG.PR I GINEER y-\., pGE I o H. I REF: .J/�� 4 36, WOW cape engifteeriag 26 ' %v ;r�/,u�' � PREPARED FOR: CIVIL ENGINEERS I' �,,• 2��7 LAND SURVEYORS BOARD OF HEALTH RE 'N It1tEYOR i_ , CONTOURS (EXISTING)............. 02a iAtlrf 8t. ''� ._ SCALE_ � Z_ / .j (PROPOSED)-O-O-O-O- APPROVED DATE rjAP_1 I�TA(�L� MA Yatl�1„Ir6q _ DATE 8�'`O/9 WEST BARNSTABLE �{ WELL b 00 `` �v <G "§5 Iv �v st• J v °6•• �. oQ� �.o LOT 17 a h� { Op Ilero LOCUS MAP O , °� 3-CAR espy 146.7 LOCUS INFORMATION GAR. IN, PLAN REF: 398/64 ,.� TITLE REF: 14153/167 4 PARCEL ID: MAP 128 PAR. 23 ZONING: "RF" YiP 0 \ 32 FLOOD ZONE: "C" COMMUNITY PANEL: 250001-0015-C DATED:08/19/85 '--3�'--� o' SEPTIC SYSTEM #67 0 REPAIR PLAN 0 0 I "e"t�A> LOCATED AT: TOF=149.14 EXIST 1,50OG - SEPTIC TANK _,__ _- --- ----- 67 RED OAK LANE TBM:COR STEP WEST BARNSTABLE, MA. EL=149.0 �p PREPARED FOR DUNCAN & JOAN ,> LOT 16 MACALLISTER G IrIQG AREA=47,874f S.F. JULY 27, 2013 t ' OF M rx L t ti i Ili �t No. 1140 LOT 15 lI t NITAR0Ii 1 ' •h l l O 7ss1> rl hh0 1 s01 MEYER �c SONS, INC. GRAPHIC SCALE �' P.O. BOX 981 30 0 15 30 60 120 WELL Iry / EAST SANDWICH, MA. 02537 ( IN FEET ) h (508)362-2922 i inch = 30 ft. WELL SHEET 1 OF 2 7560 ELEV. TOP FOUNDATION NOTE: MAGNETIC TAPE TO BE PLACED OVER ALL COVERS (Existing) NOTE: PLACE RISERS OVER ALL COVERS W/IN 6" OF GRADE FINISHED GRADE (148.0-147.50) = 149.14---,� �F.G.EL: 149.0 F.G.EL: 148.50 F.G. EL: 148.0 � VENT MAINTAIN 2% MIN SLOPE OVER LEACHING AREA a .b' :Q 2" OF 3/8" DOUBLE WASHED STONE OR FILTER FABRIC DOUBLE - 1-1ED I DOUBLE WASHED STONE 4, 6 4" SCH 40 PVC 10„I jWaE ®®E3 O ®®®®14" s" © S= 1 (MIN. ®®®®®®®®®®TEE'S ARE TO BE ) ®®®®®®®®®®4' scH 4o PvcINV.143.30 2 EFF. DEPTH ®®®®®®®®®® Q...Q.::` INV.143.50 INV.143.10 4' 3 X 8.5' 4' GAS PROPOSED DB-3 EXISTING OUTLET BAFFLE .....,. ..; H2O DISTRIBUTION BOX EFFECTIVE LENGTH = 33.5' INV. 143.7 t INV. ELEV.= 142.8 EXISTING 1 ,500 GALLON SEPTIC TANK GAS BAFFLE TO BE INSTALLED ON �f MgSJ9� BREAKOUT OUTLET TEE AS MANUFACTURED BY yo ELEV.= 143.85 TUF-TITE, ZABEL, OR EQUAL DARRRENM TOP CONC. ELEV.= 143.85 :.. . NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING N . .1140 `�' INV. ELEV.= 142.85 �®®� E3 E3 E3 ED Ea E2 E3® PIPE INVERTS PRIOR TO CONSTRUCTION ®®ame 2) D-BOX SHALL BE SET LEVEL AND TRUE TO G1STE 1 ®®®®®® ala 3.75' 5T. 3.75' E3 GRADE ON A MECHANICALL COMPACTED SIX SANITAR��`� Z� I �3 BOTTOM EL.= 140.85 F INCH CRUSHED STONE BASE, AS SPECIFIED IN �� t 310 CMR 15.221(2) 3) REPLACE EXISTING 1,500 GALLON SEPTIC TANK SEPARATION 5.45 FT. EFFECTIVE WIDTH = 12.5' WITH 1500 GALLON SEPTIC TANK IF FAILED, DAMAGED, NOT H2O LOADING, OR UNDERSIZED. SEPTIC SYSTEM PROFILE BOTTOM OF TESTPIT EL: 135.40 SOIL ABSORPTION SYSTEM (SECTION) 4) INSTALL INLET & OUTLET TEES W/ GAS BAFFLE AS REQUIRED (500 GALLON (H20) LEACH CHAMBER) GENERAL NOTES: DESIGN CRITERIA 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL SOIL LOGS P#: 14058 BOARD OF HEALTH AND THE DESIGN ENGINEER. NUMBER OF BEDROOMS: 4 BEDROOOM DESIGN 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS SOIL TEXTURAL CLASS: CLASS I (0.74 GPD/SF) OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE DATE: JULY 9, 2013 LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW: DESIGN PERCOLATION RATE: <2 MIN/IN - 310 CMR 15.405 1 SOIL EVALUATOR: DARREN MEYER, CSE 1614 ( ) (B)� DAILY FLOW: 110 G.P.D. X 4 BR = DESIGN FLOW: 440 G.P.D. 1) A 1.15 FT. VARIANCE FROM 310CMR15.221(7) TO ALLOW LEACHING WITNESS: DONALD DESMARAIS, BARNSTABLE HEALTH GARBAGE GRINDER: NO (not designed for garbage grinder) TO BE 4.15 FT (MAX) BELOW GRADE VS REQ'D 3 FT. (H20/VENT PROVIDED) SEPTIC TANK: 440 gpd x 200% = 880 gpd, USE EXIST. 1,500 GAL. SEPTIC TANK 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR Elev. TP- 1 Depth Elev. TP-2 Depth TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE 147.40 0" 148.40 0" (440) = 594.59 S.F. DESIGN ENGINEER. A A LOAMY SAND LOAMY SAND LEACHING AREA REQUIRED:4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING 10YR 3/2 10YR 3/2 9" 74 FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN 146.73 8" 147.65 ENGINEER BEFORE CONSTRUCTION CONTINUES. B B USE THREE (3) 500 GALLON (H20) PRECAST LEACH CHAMBERS W/ 4' 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. LOAMY SAND LOAMY SAND STONE ON SIDES & 3.75' STONE ON SIDES: 33.5' L x 12.5' W x 2'D 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF 1OYR 6/8 10YR 6/8 THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF BOTTOM AREA: 33.5' x 12.5'= 418.75 SF HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. 144.24 C 38" 145.24 C 38" SIDE AREA: (33.5 + 12.5) X 2 X 2 = 184 SF 7. WATER SUPPLY PROVIDED BY PRIVATE DRINKING WATER WELL. 8. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED PERC ® EL. 142.82 LOAMY LOAMY TOTAL SQUARE FEET PROVIDED = 602.75 vs. 594.59 REQ'D TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE SAND SAND DESIGN FLOW PROVIDED: 0.74(602.75 S.F.) = 446.03 G.P.D. vs. 440 G.P.D. req'd THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING 2.5Y 6/4 2.5Y 6/4 CONSTRUCTION. PROPOSED SEPTIC SYSTEM UPGRADE PLAN 10. EXISTING LEACHING TO BE PUMPED, CRUSHED AND FILLED PER TITLE 5. 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION 135.40 144" 136.40 144" 67 RED OAK LANE, W. BARNSTABLE, MA 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY PERC RATE <2 MIN/IN. ("Cl" HORIZON) Prepared for: McAllister 13. NO ABUTTING PRIVATE WELLS WITHIN 150' OF PROPOSED LEACHING. NO GROUNDWATER OBSERVED Engineering by: Surveying by: SCALE DRAWN 14. NO WETLANDS WITHIN 100' OF PROPOSED LEACHING. MEYER&SONS, INC. MacDougall Surve N.T.S. DMM • I, Darren M. Meyer, R.S., CSE, hereby certify that I am currently approved by MADEP pursuant to 310 CMR 15.017 � .y 15. ALL PIPING TO BE 4" SCH 40 ® i 8" FT UNLESS SPECIFIED to conduct soil evaluations and that the above analysis has been performed b me consistent with the PO BOX981 ( ) DATE CHECKED SHEET N0. / / ( ) y p y 508 419-1086 requirements of 310 CMR 15.017. 1 further certify that I have passed the Soil Eval. Exam in October, 1999. EAST SANDWICH,MA 02537 508-362-2922 07/27/13 DMM 2 of 2