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HomeMy WebLinkAbout0084 RIDGE ROAD - Health p --84 Ridge Road ' t r , ` -I,W:-Barnstable V �I a�G -off Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments XP 84 Ridge Road 2` Property Address NZI Patrick A. Lombardi Owner Owner's Name information is required for every West Barnstable MA 02668 8/2/17 > page. City/Town State Zip Code Date of Inspection Fzt: Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information S-13 on the computer, use only the tab 1. Inspector: key to move your cursor-do not Scott Campbell use the return Name of Inspector key. Cardinal Construction VQ Company Name 32 Ridgetop Rd. Company Address Cotuit MA 02635 City/Town State Zip Code 508.420.1295 S 1388 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: ❑x Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 8/2/17 Inspectors ignatu Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of(17 �V Y Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 84 Ridge Road Property Address Patrick A. Lombardi Owner Owner's Name information is required for every West Barnstable MA 02668 8/2/17 page. Cityrrown 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: 0 I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 84 Ridge Road Property Address Patrick A. Lombardi Owner Owner's Name information is required for every West Barnstable MA 02668 8/2/17 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. 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.doc•rev.6/16 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 84 Ridge Road Property Address Patrick A. Lombardi Owner Owner's Name information is required for every West Barnstable MA 02668 8/2/17 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 fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ 0 Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ R Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ❑x Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ na❑ Liquid depth in cesspool is less than 6" below invert or available volume is less than 'h day flow t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 84 Ridge Road 'M Property Address Patrick A. Lombardi Owner Owner's Name information is required for every West Barnstable MA 02668 8/2/17 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ 0 Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ 0 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. ❑ 0 Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ 0 Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ 0 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.] ❑ 0 The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ 0 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 f . . Commonwealth of Massachusetts w - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 84 Ridge Road Property Address Patrick A. Lombardi Owner Owner's Name information is required for every West Barnstable MA 02668 8/2/17 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 ❑ ❑X Pumping information was provided by the owner, occupant, or Board of Health ❑ ❑X Were any of the system components pumped out in the previous two weeks? ❑X ❑ Has the system received normal flows in the previous two week period? ❑ 0 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 the were not � ❑ Y ( Y available note as N/A) ❑X ❑ Was the facility or dwelling inspected for signs of sewage back up? ❑X ❑ Was the site inspected for signs of break out? 0 ❑ Were all system components, excluding the SAS, located on site? N ❑ 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? ❑X ❑ 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: ❑X ❑ Existing information..For example, a plan at the Board of Health. X❑ ❑ 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.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 84 Ridge Road Property Address Patrick A. Lombardi Owner Owner's Name information is required for every West Barnstable MA 02668 8/2/17 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ❑X No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes 0 No information in this report.) Laundry system inspected? Ana Yes ❑ No Seasonal use? Yes ❑ No Water meter readings, if available (last 2 years usage (gpd)): Detail well Sump pump? ❑ Yes ❑X No Last date of occupancy: 2017 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 84 Ridge Road Property Address Patrick A. Lombardi Owner Owner's Name information is required for every West Barnstable MA 02668 8/2/17 page. Clty own 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 ❑x No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ❑x 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 84 Ridge Road Property Address Patrick A. Lombardi Owner Owner's Name information is required for every West Barnstable MA 02668 8/2/17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: permit date 12/3/86 Certificate of compliance date 12/30/86 Were sewage odors detected when arriving at the site? ❑ Yes x❑ No Building Sewer(locate on site plan): Depth below grade: 2 feet Material of construction: ❑ cast iron ❑x 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Properly vented no visual leaks. Septic Tank (locate on site plan): Depth below grade: 2.5 feet Material of construction: ❑x concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 84 Ridge Road Property Address Patrick A. Lombardi Owner Owner's Name information is required for every West Barnstable MA 02668 8/2/17 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 32" Scum thickness 0 Distance from top of scum to top of outlet tee or baffle na Distance from bottom of scum to bottom of outlet tee or baffle na How were dimensions determined? sludge judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank does not need to be pumped at this time. Both inlet and outlet tees in place at time of inspection. Structural integrity of tank is good. Liquid level at proper working height bottom of oulet invert. No vegetation. (gravel Driveway) 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.doc•rev.6/16 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 �M 84 Ridge Road Property Address Patrick A. Lombardi Owner Owner's Name information is required for every West Barnstable MA 02668 8/2/17 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts H W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 84 Ridge Road Property Address Patrick A. Lombardi Owner Owners Name information is required for every West Barnstable MA 02668 8/2/17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): box is set level. No evidence of solids carryover. No evidence of leakage into or out of box. Pump Chamber (locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 84 Ridge Road Property Address Patrick A. Lombardi Owner Owner's Name information is required for every West Barnstable MA 02668 8/2/17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑x leaching trenches number, length: 2, 25'+2'+2' ❑ 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.): No signs of hydraulic failure. No ponding or damp soil. No vegetation. (gravel driveway) 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 84 Ridge Road Property Address Patrick A. Lombardi Owner Owner's Name information is required for every West Barnstable MA 02668 8/2/17 page. CitylTown 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.): l5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 84 Ridge Road Property Address Patrick A. Lombardi Owner Owner's Name information is required for every West Barnstable MA 02668 8/2/17 _ page. cityrrown 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 1 so' i t5ins.doc•rev.W16 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 r Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 84 Ridge Road Property Address Patrick A. Lombardi Owner Owner's Name information is required for every West Barnstable MA 02668 8/2/17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑x Check Slope ❑ Surface water Check cellar ❑ Shallow wells Estimated depth to high ground water: 10+feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: Excavation at time of inspection. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 r Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 84 Ridge Road Property Address Patrick A. Lombardi Owner Owner's Name information is required for every West Barnstable MA 02668 8/2/17 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ❑x Inspection Summary: A, B, C, D, or E checked ❑x Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ❑x System Information —Estimated depth to high groundwater Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 Commonwealth of Massachusetts Title 5 official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments #84 Ridge Rd. Property Address Estate of mark Guest c/o William Guest Owner Owner's Name information is West Barnstable Ma 02668 9/7/2012 required for every page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information When filling out forms on the computer,use 1. Inspector: only the tab key to move your P. Scott Campbell cursor-do not Name of Inspector use the return key. Cardinal Construction _:'*'• Company Name 32 Ridgetop Rd. Company Address ;a Cr Ma 02635 City/tyrToown State Zip Code 508-420-1295 S 1388 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 16.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluati by the Local Approving Authority ,'IdV49/7/2012 Inspecto s Ignature Date C� F. 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•11/10 Tide 5 Offiaal Inspection Fonn:Subsurface Sewage Disposal System•Page 1 of 17 F Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M y #84 Ridge Rd. Property Address Estate of mark Guest c/o William Guest Owner Owner's Name information is required for West Barnstable Ma 02668 9/7/2012 every 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: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old"or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M , #84 Ridge Rd. Property Address Estate of mark Guest c/o William Guest Owner Owner's Name information is required for West Barnstable Ma 02668 9/7/2012 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-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M , #84 Ridge Rd. Property Address Estate of mark Guest c/o William Guest Owner Owner's Name: information is required for West Barnstable Ma 02668 9/7/2012 every 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 fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: ti 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 Sins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 r Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments "< #84 Ridge Rd. Property Address Estate of mark Guest c/o William Guest Owner Owner's Name information is required for West Barnstable Ma 02668 9/7/2012 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- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is'within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•11/10 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 #84 Ridge Rd. Property Address Estate of mark Guest c/o William Guest Owner owner's Name information is required for West Barnstable Ma 02668 9/7/2012 every page. Citylrown 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-11/10 Title 5 Official Inspection Forth: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 #84 Ridge Rd. Property Address Estate of mark Guest Go William Guest Owner Owner's Name information is required for West Barnstable Ma 02668 9/7/2012 every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: Well water Sump pump? ❑ Yes ® No 2012 Last date of occupancy: Date Date Commercial/industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M #84 Ridge Rd. Property Address Estate of mark Guest c/o William Guest Owner Owner's Name information is required for West Barnstable Ma 02668 9/7/2012 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: 2012 Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments #84 Ridge Rd. Property Address Estate of mark Guest c/o William Guest Owner Owner's Name information is required for West Barnstable Ma 02668 9/7/2012 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: Compliance issued 12/30/1986 Permit issued 12/3/1986 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron ❑40 PVC ❑other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 2 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments #84 Ridge Rd. Property Address Estate of mark Guest c/o William Guest Owner Owner's Name information is required for West Barnstable Ma 02668 9/7/2012 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 3' Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? sludge stick, tape measure Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): system should be pumped every 2 to 3 years. Both inlet and outlet tees in place at time of inspection. Structural integrity of tank is good. Liquid level at proper working height at time of inspection. No evidence of leakage into or out of tank at time of inspection. 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•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments #84 Ridge Rd. Property Address Estate of mark Guest c/o William Guest Owner Owner's Name information is required for West Barnstable Ma 02668 9/7/2012 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cost.) 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 um in : p p g Date Comments(condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M #84 Ridge Rd. Property Address Estate of mark Guest c/o William Guest Owner Owner's Name information is required for West Barnstable Ma 02668 9/7/2012 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 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Box is set level. single line out of distribution box. No evidence of solids carryover at time of inspection. No leakage into or out of box. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System(SAS)(locate on site plan, excavation not required): If SAS not located, explain.why: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M #84 Ridge Rd. Property Address Estate of mark Guest c/o William Guest Owner Owner's Name information is required for West Barnstable Ma 02668 9/7/2012 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: (2)25'&2'&2' ❑ 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.): Course sand, no signs of hydraulic failure, no ponding or damp soil. No vegetation present. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M y e < #84 Ridge Rd. Property Address Estate of mark Guest c/o William Guest Owner Owners Name information is required for west Barnstable Ma 02668 9/7/2012 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.): t5ins-11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 14 of 17 44- Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ..y< #84 Ridge Rd.. Property Address Estate of mark Guest c/o William Guest Owner owner's Name information is required for West Barnstable Ma 02668 9/7/2012 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 zo' • 2 , , t5ins•11110 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 M . #84 Ridge Rd. Property Address Estate of mark Guest c/o William Guest Owner Owners Name information is required for West Barnstable Ma 02668 9/7/2012 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells � Estimated depth to high ground water: 12+feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Excavation at time of inspection. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M #84 Ridge Rd. Property Address Estate of mark Guest c/o William Guest Owner Owner's Name information is required for West Barnstable Ma 02668 9/7/2012 every 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 0/ O/C3 0. N A ---------- - - BOARD OF HEALTH Fee- 0_5----- �j OWN OF BARNSTABLE ��- ZippCicat ion,forVell CongtructionVermit � Appl' i n is her y made for a permit to Construct ( ), Alter ( ), or Repair an`individual Well at: L ation�Address — — —� Assessors Map and Parcel wne Addressr- - AAAA, ---------!� 4j-L-------- — Installe — riller Address Type of Building Dwelling -- -- — -- - --- -- Other - Type of Building- —__---____— No. of Persons-- ---- Lt t 1 Type of Well —_—. Capacity---------------------------- Purpose of Well--$) Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until a Certificate.of Compliance has been issued by the Board of Health. Sign �— Application Approved By — _ ZV/V date' Application Disapproved for the following r ns:---------_-_-_-_ ------— I --_— — — date Permit No. —�___- -- Issued--- --- - ----------_____--------- --- --- - - -- - - - - - -- - -- - - - - - - date BOARD OF HEALTH TOWN OF BARNSTABLE (Certificate Of Compliance THIS IS T CERTIFY, That the In ividual Well Co truct d ( i), Altered ( ), or Re4 dd Installer at__ has been installed in accordance wit the provisions of the Town of Barnstable Board-of Health Private Well Protection Regulation as described in the application for Well Construction Permit Nol ,< ated---- --------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE -- -- Inspector------- -- -- ---------- 41 - -- _ No.:"� `- ------ - Fee----- _ ---------- BOARD OF HEALTH »� / = OWN OF BARNSTABLE - J- 0(pplicati'an,for Well Con4truction Permit Applic tion is here y made for a permit to Construct ( ), Alter ( ), or Repair (A )an individual Well at: L aeon — Address Assessors Map and Parcel CU7- - - - -- — �`.-- care - - -I S�r owner InstalleF — Driller '" V Address Type,of Building Dwelling— —_--- -----— ------ Other - Type of Building--___—__--____ No. of Persons----.--_-_---------_—__—__—___ _ Type of Well Ll 11 V t L - Capacity-------- --—---- ---- Purpose of Well- ' _�--- r Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until a Certificate.of Compliance has been issued by the Board of Health. Sign- C) -- '-_ Application Approved By U dat o Application Disapproved for the following r ns: �U). date - / / _Permit No. - --�--------- Issued---- p---- - ---�------ -------- date BOARD OF HEALTH TOWN OF BARNSTABLE R Certificate Of Compliance ''e Q �;L� l�n� ' THIS IS T CERTIFY, That the In ividual Well Co strutted ( ), Altered ( ), or Repdrij( )" a-----� -------- --- -- --- r � installer at 4z has been installed in accordance wit�e provisions of the Town of Barnstable Board of Health Private Well Protection i Regulation as described in the application for Well Construction Permit No - /H�/��ated-----—--------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE- - -- Inspector---------------- --- -------- - - ------------------------------------ -----.._ . . -----------•---------------------------- -- - . . . BOARD OF HEALTH TOWN OF BARNSTABLE l f ell Congtructionpermit No. 6 CFee-f -- - Permission is hereby granted to Constru t {/ ) Alter dy , or'Repair (/�) Individu l W 11 at No. —_ �-*" � j` ' /T o 1�-=RA�t ------------------------------------ - street as shown on�tie pinc lion for a We' Construction Permit No.- � -- -- Dated--- — -!a---- - 3-------------- ( Bpard of Health DATE �_ L/ - WN OF BARNSTABLE LOT 5 - RIDGE ROAD 86-1279 LOCATION SEWAGE # vlt- l3S VILLAGE W. BARNSTABLE ASSESSOR'S MAP Cz LOT 5 INSTALLER'S NAME & PHONE NO. BCK 776-0444 SEPTIC TANK CAPACITY 1000 GST (H-20) LEACHING FACILITY:(type) (2) L:TRENCHES (size) 25x2z2 NO. OF BEDROOMS 3 PRIVATE WELL OR PUBLIC WATER WELL BUILDER OR OWNER HARK GUEST (OWNER) Crested) DATE PERMIT ISSUED: 12/3/86 DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes X No A 1 � �A I �k �w �� 20� .� �� a'� y 3�' �i• o , �;� �� � BCD e � i"�- �*• No:.......... .........._ r t f J r „ Fsz .r..-`�T.._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH (zl1`,��............OF:................. iS"I � .l.r ............:. liratilatt flax . �n _ o���� �tspnstt1 Works C�oatstrixr#uari rrrmtt R i 6 ` Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal System at: ?... ...... n...�.....=? .... ---.... - = -•-•-•.................................... -Location-Address or Lot No. ...........-•_. .. :.. ...... 4-1T------------------•--_-- ------------------------................................................................_........ W Owner Address ...... .......••--...•-•-•..................................... ............ Installer Address Type of Building Size Lot... ���C).Sq. feet �-. Dwelling—No. of Bedrooms.......... .....................Expansion Attic ( ) Garbage Grinder ( ) ` Other—Type T 4 e of Building persons............................ Showers 4 yp g .......•.................... No. of p ( ) — Cafeteria Ga ( ) Q Other fixtures .................................................._................................................... ... ....... ._.............................. W Design Flow...............�_1.Q__...._...........gallons per person per day. Total daily flaw.;_.........._ 3U..........gallons. WSeptic Tank—Liquid capacit J. gallons Length...JC� p__. Width:... . $. Diameter................ D th.��, ?_.. x Disposal Trench—No._ .... Width.. Z...... Total Length..._4-J....... Total leaching area.3�....sq. ft. 3 Seepage Pit No. ... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( `4 Dosing tank ( ) - Percolation Test Results Performed by....................0........._...................--. .. Date.........--......................_...... M Test Pit No. 1...._.�..__.minutes per inch Depth of Test Pit.......2r.i..... Depth to ground water.....A&U/A" ------ Test Pit No. 2.......e...minutes per inch Depth of Test Pit.......I.Q..... Depth to ground water......�]A...... Tm .�� ....._. . Description of Soil .l:`. .LPAL��I._. ..Sl..a ?.}--` -_---•--£P lt�.``A..51 'l'�--.z..._....._.......F _A-P__AI? � ►�'' Z..7.�.. .t. .. .1�!' CP' St?+i+JL?..�M..r—�L�..T...' �.�.4' 1i'•�L�y4rla.l............................ ....CV_..G1.-�.�4r1�1:._..�!t. ►- ... 4...`�?.:D 5' U Nature of Repairs or Alterations—Answer when applicable..__.-_.!!�!� tC��t�IC.. NGINEER t�iUST ..."_........-." .. .........................................................................hISTA1�L_ATION-AND CERTIFY iT�i'" Agreement: THE SYSTEM WAS 1NSTALLl=iy W•��y�{��-""- The undersigned agrees to install the aforedescribed Individu1QeQ§ � §ispgsPa14ysstem in accordance with the provisions of AITL: 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued byte board of health. Signed........1.1 SQL .. ..�.�,1 ....................... .l._21-,q ......... Application Approved B .......................................................... .••-.........._••-•- Date Application Disapproved for the following reasons:--""............................"---............_........................---._..........._...................... .....................................................................................-...............................................................................................................Date a -- PermitNo.... ...... ........ Issued...•............................_......._.. u...... Date I THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) I A , m / �C(�"-J LI DATA Now No....................._ -- ; Fzz........ F THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -: .............OF..................:7R:4.W C-A�"�.t:,. .... ....... Appl ration for Disposal Workg Tontrurtion jlrrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ........... .G...., `* ;......aT`A . t =�•�,��-�: ................... ................... Location-Address or Lot No. ...................... ......••--•-•--.._....._.....--•-•-•--•--• --............ Owner Address a .....•....." ....................................r a h( -- -----------•-•---.............-----•-••------....--•------•-•-•-•............................... Installer Address Type of Building Size Lot...-Z? -`�-�-.-�Z:'.:l-Sq. feet �., Dwelling—No. of Bedrooms...................--....._......._._...........Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building No. of persons............................ Showers W YP g -•---•--•-•................. p ( ) — Cafeteria ( ) p t Other fixtures W Design Flow............... .I,_ .__..._....._...gallons,.per;person�periday.,Total,wily flow...............7? ...........gallons. WSeptic Tank—Liquid capacity gallons ,Length..---( 1' �Width -,-_,-��•_._ Diameter................ Depth..- '¢--. x Disposal Trench—No. `T?<-�f. _ Width..._-_ . -�__... Total Length.... Total leaching area...• ....sq. ft. 3 Seepage Pit No.._..'� �._. Diameter........ Depth below inlet.................... Total leaching area.................sq. ft. Z Other Distribution box ( X) Dosing tank ( ) aPercolation Test Results Performed by...........................................--••-•--•....................... Date........................................ Test Pit No. I.......�?!.....minutes per inch Depth of _Test'Pit. ._.i_ Depth to ground water...... S �A...... 44 Test Pit No. 2....... ..minutes per inch Depth of`Test Pit.......(.Q__.... Depth to ground.water......4.K.._... 94 'ITGST ?lT dD 'S , " a. r , 0 Description of Soils?4 l L7 �-�I St_\ga 5t�.t\1t 1t '� ��- ..............................................l .�+" :. `_. C'•iyt. \ F\►.1(".. UNature of Repairs or Alterations—Answer when applicable...............:...... .............................. -•.............................................. . .................... Agreement: The undersigned agrees to install the aforedescribed�Indvidual,Sewage�Disposal System in accordance with the provisions of TITLZ 5 of the State Sanitary Code;The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issue��d��by-.the board of health. Signed.. . .....%l....� ) ... k..::.................... ..:.."........:....._.... .... . - _ • �, i Date. Application Approved By.................•............................,.-•-----.........-•••-.'r`....._........ �.:2�� %��........ % � y Date Application Disapproved for the following reasons:.............:................................................................. ................................................................................................. ..................._....................... ..............__ Date PermitNo.......................................:..........I........ Issued-............... ...-•----...--•-•-................ Date Y_,_- -__-- THE COMMONWEALTH OF MASSACHUSETTS -; BOARD OF HEALTH �n 12-1� �N Tntif utttr of Tomplitturr THIS-IS.TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by........ �;�:.�:_...�I 'r , .. ►��..i,`..-. .. /._�C: ..................................••-- ---••-•--•.._...................................... ..... _ Installer at••-•-••--•--•----�.--------...T.� l�t.4A . -�- -- -----••.. ----•-......•• --........ ....---••.......................................................---••...--•••-.............. has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.._..C..�.....�_ _. dated....?,2.3..�:.. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................ e•-t-Q............................... Inspector............ ...............--------...------•-•----•--......................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �- irl) OF. ' .......,4.....:�.:............................................. Oiopwittl-Iforks Tonotrurtion Prrmit Permission is hereby granted.......!. _ ~ ' am5 1C -a.!VC� .......................-- � . .............--•---......................................_............... to Construct ( ) or Repair ( ) an Individual Sewage Disposal,-System atNo...................:. __...=' _•...... •. •............. ..�........................... •-•--•----...................------.... --------•---............ Street - 1 & A as shown on the application for Disposal Works Construction Permit No................. Dated.................... :.:_.. ....... ............. .......... ... Board of HealthDATE..._.. - ► �. of| ti ptm # fmRi| ||tifiilniiR||iy9|| iin ?fifes|nStiim |fi| inni!||||| R �_ g ENVIROTEC H LABORATORIES � ' 2 k 6 Lewis Bay Road ® Massachusetts 02601.o (612�771-2 5 q F . 2 F m CLIENT: Nark Guest LOCATION: tot 5 k ADDRESS 37 Ridge R Ridge «d W. Ba£nstable,MA k W. B Instable.:A 02668 k 2 COLLECTED BY: Ed Meehan SAMPLE DATE: 12/16/86 TIME: 55555 P d k DATE RECEIVED:12 1 686 SAMPLE ID: 771 g k JOB t New _A]] WELL DEPTH: 97 ft 2 k � k RESULTS OF ANALYSIS k k 2 Parameter . Units Recommended limit Result 2 . Co br b deIa/l0 m . (MF Method) O O d ' & pH . pH units 6ƒ&S 5.85 K � 2 Conductance umh sZcm 500 75 2 F q k Sodium mg L 20.0 9.3 Nitrate- . mg L 10.0 .19 2 k . � & Iron mg L . 0.3 ,IO �_ F Manganese mg L . 0.05 d A : 7 Hardness mg L as CaCO3 500 q � 7 7 Sulfate . . mg/E 250 Q � � . kPotassium mg/1- 20.0 E - % � Alkalinity mg E 200 Chloride mg/L 250 : k & � R � � 9 . COMMENT Water is suitable for drinking purposes for all parameters tested. k ; & % E d k DATE g k EE ' .. . . U k 362-4541 926 main street rt 6A yarmouthport mass. 02675 down cape eftgineehftg civil engineers& land surveyors structural design Arne H.0ja1a P.E.,R.L.S. land court Richard R.Fairbank P.E. surveys site planning sewage system designs December 23, 1986 inspections Board of Health permits Town of Barnstable South Street Hyannis, MA Gentlemen: On December 20, 1986 Down Cape Engineering inspected the septic system on Lot #5 Ridge Road, W. Barnstable. The construction complies with the Massachusetts Environ- mental Code Title V, the Barnstable Health Regulations and conforms to Down Cape Engineering plan #83-157 rev, date June 16, 1986, prepared for 12ark Guest. Ver truly yours l Richard R. Fairbanks, P.E. Inspected by: R. R. Fairbanks RRF/amp I (LIN s Massachusetts Water Resources Commission/Diviiion of Water Resources WATER WELL COMPLETION REPORT WELL L/�CX��OCHj ION Address Z63y - I— IC ,C l� City/Town �� �1r'�' F LLto G.S.Quadrangle Map Grid Location Owner T Address r Ge' N es WEB L USE CONSOLIDATED WELL Domestic 2/Public ❑ Industrial❑ Type of Water-bearing Rock Other Water-bearing Zones METHOD DRILLED 1) From To Rotary(type) Cable ❑ 2) From To Other 3) From To 4) From To CASING Depth to Bedrock Length ` Diameter, Type UNCONSOLIDATED WELL STATIC WATER LEVEL Water-bearing Materials Feet below land surface j Sand: fine medium❑' coarse(] Date measured Z /S�` �'r/ Gravel: fine❑ medium❑ coarse❑ GRAVEL PACK WELL Screen:- ElSlot#��length��from to Yes U No Split Screen(or 2nd screen) WATER QUALITY TESTS MADE' Slot# length from to Chemical 0' Biological ❑ Depth To Bedrock PUMP TEST Drawdown -" feet after pumping days hours at.. .-4— GPM. How measured 04 r 1 Recovery feet after hours. LOG of FORMATIONS COMMENTS: (On well or water) Materials From To 0 M /DRILLER Firm A1415�/7At/- Address_ Y4419 \ City , "' S 1,0f,L Aff Registration No. j perator'ss—S gnature Please pnn[ irm y 10M-8/81.184843 y SECTION SEWAGE —SEPTIC TANK — _ "D"BOX — — LEACH -TZtl�r GN V. TOP OF FDN � -� (MSL)# EEMOVE_ A lIx-e ur tnt ltTASbL� MA��IAL pctZ Al11211 OF118TO V2" / A�•� �ISTfir.l�=. OF, to 'F-C A2 oUtrO TrJ.!-1•rpl. ` n.__il WASHED STONE I I M t TPyuca-IS A.r..tn r�*� •,-k.e, wi�-1 �•�AL�.ce�►it.SG ��A+�D. 76 i S ` to I N• ��rr OUT• IN. �.�]rJ+V ZF 1 O I \ IN• \` -7 .�o�- I SEPTIC G ) 1 TANK — 1C/ l ro E I ELEV. ELEV. ELEV. C — — � Gr'� / w //. ELEV. 40 ELEV. ELEV. `l l .Co2 ) .Sv 1' ��•) u'`K 40 V. OF WASHED STONELI TEST HOLE LOG t o TEST BY �A.c.oi3`( -t. WITNESS \ x u TEST DATE P22>1% DESIGN BEDROOM HOUSE i1 1 T.H. T.H. # 2 Z t:` r' (9 ELEV. pp" ELEV. S ` 1� NO � =LL? I r7i�, i DISPOSER DISPOSER PERC RATE MIN/IN. z4 -13.Q FLOW RATE "33v (GAL./DAY) 33v 4 AC21` Q. SEPTIC TANK 0 s e sl SPa+o wi " REQ'D SEPTIC.TANK SIZE �O4 5 e S t T �. LEACH FACILITY to.o SIDE WALL (���z�(LS� = too'i' ((.�G) = 1loCo_ G/D. BOTTOM 'Z.•(�.•S� = 54 � .'l l ) = 3 S'•`� G/D D. f+ oo/ar.i TOTAL X Z = 3 00 1� � •�, P�\ ,:��-\ �Z Gl.4Y I-Foazq Af-� `IZ.1" (o$.9z. XZ = 4-03 USE: i wo LEACHING r.►C�-4 S 14�•• �5,v No -Zr�' �o�tG x Z� vv��e, x 2.' 'D>=GP � G � ��;_ _ WATER ENCOUNTERED \ � r NOTES: (UNLESS OTHERWISE NOTED) �'� 1. DATUM (MSL)+TAKEN FROM YA �_S QUADRANGLE MAP / uF 2. MUNICIPAL WATER _—N�T- JaVAILABLE � �QsiSq -- - -- -- 3. PIPE PITCH: r/a"PER FOOT C+y r �� Co�3 8-N1. tit All_ 4. DESIGN LOADING FOR ALL PRE-CAST UNITS: AASHO- t� -Z -44 O= ARNE G` � ARNE H. I(,+ 5. MIN.GROUND COVER OVER ALL SEWAGE FACILITIES: (1) FT. Fi. �`t - OVA -'-. D--DISTANCE AS CERTIFIED 6. PIPE JOINTS SHALL BE MADE WATER TIGHT o OjALA cn .� a CIVIL 7.CONSTRUCTION DETAILS TO BE ACCORDANCE WITH COMM.OF MASS. c� g26348 pa No. 3G782 :' r i SITE PLAN STATE ENVI RONMENTAL CODE TITLE 5 1 i LOCUS: l.o-t' S _..._. 3AZt�tSTA31_ P�Pdss7 t� ituG Pzin� -rn ---- ��- _...... t Gprr.�T?ucTtors HouSt.- �' u` REG. PRO ES T+fA1t`tNGINEER {r-- REF: 14.1 � 7 9 u3Au C �•E• down cabe engmeerlrrg PREPARED FOR: N►P.21= GuG-4s 1 �• r dW- '� r I r'n . CIVIL ENGINEERS I N N o wATGit✓ FOI!rl:l. ,�, ——————————— I LAND SURVEYORS 4- M � BOARD OF HEALTH REG. LAND SURVEYOR CONTOURS (EXISTING)------------- -� � ) ` J ►3AZh1S1 c].13�G SCALE (PROPOSED)-O-O-0-O- APPROVED DATE MA Yarmouth MA / �. _ _ _ _ _ nATF !� SECTION - SEWAGE —7•Z..'E.1v G ti —SEPTIC TANK — — 'D' BOX — — LEACH TOP OF FON \ v MSL)# pEM4VE Aw�Y U�1�u�TAt?,t� M4�C21A� Foil A Aa ( "2"OF UsTO 4z" w b�STAuGE. 41- !O � A2ou►4o v_wrr%xj ' X= � WASHED STONE "�S I T2cNC-.-15 At-.iD 4 tiv�-�,t,� w�T.t cCFM+�.G[�f+it.SG SA+.+rJ. �0 1 I \ r � I IN♦ OUT. IN- OUT• IN, G o 4 -Co� /' SEPTIC Z\ -7 Z4,` & TANK ?4-)9 �[3.ioZ ELEV. ELEV. ELEV. \ r �// `)3.�2 -l�j.lar ELEV. ZS \ 0 f Vtj �1 ELEV. ELEV. l) .�oZ 1) .r7v7Q) �5 ----- OF3✓a WASHED STONE 125 1 TEST HOLE LOG 'Fb•.t ix.a3AN� 1?>t., J. J A LO3Y 3.4.N _ •/ - '\ - TEST BY �- WITNESS ' ��� r TEST DATE /zol�3 P2338 DESIGN BEDROOM HOUSE 11 , k� / \. - T.H. # 1 -►- T.H. # 2 ELEV. pp" ELEV. NO `` _ -• rJ uol 6. (9 Su so„ f Co DISPOSER DISPOSER I PERC RATE MIN/IN. 3g �" FLOW RATE 33� (GAL./DAY) '33v A� ` 04� 71L,Scop s~. SEPTIC TANK 334 (L51= D w REQ'D SEPTIC.TANK SIZE >✓ sl S Pt•+o w l K S G 51 T u LEACH FACILITY z = tbod' k' �- $[�, SIDE WALL CSC �CLS ((.4.&) _ loCo G/D. BOTTOM '2-Cz S� = 54 ( ."�l ) = 35.5 G/D. c,va-! �, *4 oPAhl TOTAL X 2 GI.Ate( 1-FA2p AN IL1,. �$•9-L X-L - L.(-Q USE: wo LEACHING T2.CrtL1-1 S f.. No 5 WATER ENCOUNTERED � IM NOTES: (UNLESS OTHERWISE NOTED)1. 2. MUNI,CIPALWATERKEN-FN - �AV---- QUADRANGLE MAP / 0t k444AS ` 3. PIPE PITCH:4a"PER FOOT C.y� t�,S3- Col 8.1✓1. NAi� 4.DESIGN LOADING FOR ALL PRE-CAST UNITS:AASHO- -Z 44 O? ARNE G• ti� AR NE H. yfiL % AoJSurn, ELEV. 5. MIN.GROUND COVER OVER ALL SEWAGE FACILITIES: (1) FT. � r{. _ . RNE DISTANCE AS CERTIFIED 6. PIPE JOINTS SHALL BE MADE WATERTIGHT I`o OJALR cn ,. G= Q 7.CONSTRUCTION DETAILS TO BE ACCORDANCE WITH COMM.OF MASS. t o 2`3' V da CIVIL�2 ' ( SITE PLAN STATE ENVIRONMENTAL CODE TITLE 5 1 iA� -o �' I2D JD Q n l �¢ a , �CIST4.R yq, •�c .t�R� 4!' ___ I��^1 LOCUS: \ Ss. . GZt�Y Sail GGND�1 �GtiS Iu a��o. oT- SU . �•�� �\ .�N� � 1 CV.IGST ) 3A�t�lSTAi3l_E. M,a.Sr�. GpN.<3T�+JGT(ON t�F' HouSt.- �! ul REG.PRO E 1.S tbT+171ENGINEER - - �,,, C L.d lr-� - ��. 131G., )Ci 1 � n&. I 33 :Q- TF f'n3-PG"lCoCo I REF: r d1 - 0 j i3 :�anti 5 1 pw�G RE.yl WOW# Cdb el? eeII/Ig PREPARED FOR: B,G r-!. CIVIL ENGINEERS 3`l �t�yL (�Al2�ISTFi?�LG !llo.SS Nowv�t2 �outi,7. "�I LAND SURVEYORS _ M BOARD OF HEALTH REG. LAND SURVEYOR CONTOURS (EXISTING)------------- -• - pJaZh�-jTp.�1�G -O-0-O-'O- APPROVED DATE MA Yarmouth MA SCALE- (PROPOSED) CC 1�Y. 4/G4 Tr. ,a DD - 'sr HOG 1.1a.'3 4 DATE SECTION - SEWAGE -SEPTIC TANK - - "D"BOX - - LEACH V. TOP OF FDN /� M -7$. (MSL)# pel,llOvl=_ .4uY Uuratl�TAt�I� MATFL'1AL 7r o,2 .d "2"OF 118TO lh btSTAtic✓ of 14 �'I' AEauNO El�T,R� SAC r1 WASHED STONE rze1 HS A+"Uj 1=EP«cE. w,Z-►a ct F�u+�cc,R-i Cc, SA+UD. I use. A-u> I \ IN• OUT• IN OUT• / � N• Z4.��o SEPTIC -IQ.Ic1 ro Z \I 1 t7Z TANK 3l02 I }� Tp 1 ELEV. ELEV. ELEV. `13.�2 -13.LaS ELEV:. �(j ELEV. ELEV. 40 q p � �es T:Q OF 3/4"-142" WASHEDSTONE TEST HOLE LOG 1 A w 3Y TEST BY WITNESS TEST DATE DESIGN BEDROOM HOUSE T.H. # 1 -��•Q T.H. ELEV. pcy" N ELEV. NO — _ ` ;10, to,.sn Su so„ t�a.n PERC RATE MIN/IN.�D DISPOSER DISPOSER S I 5 t 1 S" 15.5 z4" -13•cI FLOW RATE 330 (GAL./DAY) ` Q SEPTIC TANK D w REQ'D SEPTIC.TANK SIZE ELzl s P..10 .N� ►� rN ' LEACH FACILITY SIDE WALL �t�Cz��2.5� too� llofo G/D. -, C�1•Q BOTTOM • r ��• 3 TOTAL X -L = 300� = ZO I .s 6/c) S �p�� ` >Z uo,r Nce n,►y IL1" Cn�,FZ XZ = 4-03 USE: i wo LEACHING -r�.Ct,4ci-AS No -ZS L-oti46 x z vv,'C>c x Z u��P , G - WATER ENCOUNTERED r K• ' ff\N} 1 � NOTES: (UNLESS OTHERWISE NOTED) + �YAt ltA 1. DATUM (MSL)_TAKEN FROM---------_--------_----_---------------QUADRANGLE MAP ep OF lvl 2.MUNICIPAL WATER r - - AVAILABLE '43*��N �SS�%\ 3. PIPE PITCH: 4 FOOT PER FOOT +1 -z.� y a 4.DESIGN LOADING FOR ALL PRE-CAST UNITS: AASHO- 44 O ARNIE PNE H_ 5. MIN.GROUND COVER OVER ALL SEWAGE FACILITIES: (1) FT. F;, GJkLA s-+ ;, —0--DISTANCE AS CERTIFIED / � 8 q �o•�o 6.PIPE JOINTS SHALL BE MADE WATER TIGHT q CJNLP: OI�/kL [ '' 7.CONSTRUCTION DETAILS TO BE ACCORDANCE WITH COMM.OF MASS. v ,�'2634t� Ij" €o r 7 �)�' #O, 3v,92 SITE PLAN ~ STATE ENVIRONMENTAL CODE TITLE 5 l " �� l oT S - ��� L� � ^ y /I �4.J'• I LOCUS: ,u Az� SO ,. �_ �k CV\(GST ) 13At�lSYAT�k_..� u REG.PRO ES fb1V7PC NGINEER Gou'�T?ucTtou�Cc�T- F1ouSE - o.l _ �'\C.J�f 5 . T31G I t S 1 , (n + r `` t�� 3-P-Z54,6- REF: c Ii 2 Z 1 3Y: SIC!lAe_v r�17L�Au G t�.E. down Cape engineet ng PREPARED FOR: M P.i2K. Gut.�s"t' r' 1 - - �n " CIVIL ENGINEERS 37 �IbyL (�AR�ISTIi?�'-�-, MASS N� wG.Tt-fG Fouw1 7. --------- _(� LAND SURVEYORS 8 BOARD OF HEALTH � REG. LAND SURVEYOR CONTOURS (EXISTING)------------ 3r'��1�151 p.�at_C SCALE (PROPOSED)-O-O-O-O- APPROVED DATE MA Yarmouth ,MA DATE [� �Y. t Co 84 To � )-1oL.G 1.10.�j