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HomeMy WebLinkAbout0039 SALT MEADOW LANE - Health 39 Salt Meadow Lane PCB West Barnstable A= 156-045 , �I I d i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 39 Salt Meadow Lane X Property Address Sheila Ware Owner Owner's Name ^_7 information is .. required for every West Barnstable ✓ Ma 02668 3-9-17 page. City/Town State Zip Code Date of Inspection UD a-a 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 a/ on the computer, use only the tab 1. Inspector: key to move your cursor-do not Matthew Gilfoy use the return Name of Inspector key. B&B Excavation reb Company Name 374 Route 130 Company Address few Sandwich Ma 02563 City/Town State Zip Code (508)477-0653 SI 13640 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: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 3-9-17 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent'to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts L u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 39 Salt Meadow Lane M Property Address Sheila Ware Owner Owner's Name information is required for every West Barnstable Ma 02668 3-9-17 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments.- System was in working order at time of inspection. New SAS was installed in 2013. 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-3/13 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 39 Salt Meadow Lane Property Address Sheila Ware Owner Owner's Name information is required for every Nest Barnstable Ma 02668 3-9-17 page. Citylrown 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-3/13 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 39 Salt Meadow Lane Property Address Sheila Ware Owner Owner's Name information is required for every West Barnstable Ma 02668 3-9-17 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 ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 39 Salt Meadow Lane Property Address Sheila Ware Owner Owner's Name information is required for every West Barnstable Ma 02668 3-9-17 page. CityFrown 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 le ss than 100 feet but greater than 50 feet from a private water supplywell with no acceptable water quality analysis. This P q Y Y I system asses if the well water analysis, performed at a DEP certified Y p Y , p 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 39 Salt Meadow Lane M Property Address Sheila Ware Owner Owner's Name information is required for every West Barnstable Ma 02668 3-9-17 page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (Actual) _3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330gpd t5ins•3l13 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 39 Salt Meadow Lane ,M Property Address Sheila Ware Owner Owner's Name information is required for every West Barnstable Ma 02668 3-9-17 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 ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ® Yes ❑ No Water meter readings, if available last 2 ears usage d See below 9 ( Y 9 (gp ))� Detail: ***WELL WATER*** Sump pump? ❑ Yes ® No Last date of occupancy: December 2017Date Commercial/Industrial Flow Conditions: Type of Establishment: NA 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•3/13 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 39 Salt Meadow Lane Property Address Sheila Ware Owner Owner's Name information is required for every West Barnstable Ma 02668 3-9-17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Owner-last pump unknown 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•3/13 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 39 Salt Meadow Lane Property Address Sheila Ware Owner Owner's Name information is required for every West Barnstable Ma 02668 3-9-17 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: New SAS added to existing tank in 2013 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2'feet Material of construction: ❑ cast iron ❑ 40 PVC ❑ other(explain): No basement- unable to determine Distance from private water supply well or suction line: >150' from well to SASfeet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): 1' Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 gallons Sludge depth: 7 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts v Title 5 Official Inspection Form o, Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 39 Salt Meadow Lane Property Address Sheila Ware Owner Owner's Name information is required for every West Barnstable Ma 02668 3-9-17 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 29 Scum thickness 4 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 13" How were dimensions determined? Measured 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 was in working order at time of inspection with liquid level equal to outlet invert. Tank is in need of pumping at this time and should be pumped every two years for maintenance. Grease Trap (locate on site plan): Depth below grade: NAfeet 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 39 Salt Meadow Lane Property Address Sheila Ware Owner Owner's Name information is required for every West Barnstable Ma 02668 3-9-17 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: NA 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-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °wM 39 Salt Meadow Lane Property Address Sheila Ware Owner Owner's Name information is required for every West Barnstable Ma 02668 3-9-17 page. City/Town 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 11 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.): �i D-box was in working order at time of inspection. 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.): NA * 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 39 Salt Meadow Lane Property Address Sheila Ware Owner Owner's Name information is required for every West Barnstable Ma 02668 3-9-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: (2) 500gallons 12.5'x25' ❑ 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.): Leaching was in working order at time of inspection. No back up or high staining present. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration NA 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 39 Salt Meadow Lane Property Address Sheila Ware Owner Owner's Name information is required for every West Barnstable Ma 02668 3-9-17 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: NA Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 39 Salt Meadow Lane Property Address Sheila Ware Owner Owner's Name information is required for every West Barnstable Ma 02668 3-9-17 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 FRONT i `EAR 12 IA-23 W1 11 B'.= 2W 1C_8117f] 1®-7 " 1 E0 6"All 2CM 557"' 2d-52' 2E-60 t5ins•3/13 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 39 Salt Meadow Lane Property Address Sheila Ware Owner Owner's Name information is required for every West Barnstable Ma 02668 3-9-17 page. Citylrown 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: >5' below SASfeet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 8-13-13 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: Plan on file with BOH. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 39 Salt Meadow Lane Property Address Sheila Ware Owner Owner's Name information is required for every West Barnstable Ma 02668 3-9-17 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Town of Barnstable �FIMF A Regulatory Services Richard V. Scall,Interim Director safwsrnsLE, Public Health Division sec may" Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Offi-,e: 508-862-4644 Fax: 508-790-6304 Installer &Designer Certification Form r Date: Sewage Permit# ''? Assessor's Map\Parcel Designer: Installer: (, CC�YtJD✓1 i Address: P6 ' C'� Address: I �yYll�' J P X l On /a 13113 ' C ��� � "� �was issued a permit to install a (date) (installer) septic system at S rrLT Me-C141-av"r Eq.VLL based on a design drawn by , (address) r A f,A4 c one dated (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State &Local Regulations. Plan revision or I certified as-built by designer to follow. Strip out(if required)was inspected and the soils j were found satisfac I erti that the ys em referenced above was constructed in compliance with the terms f the appr al etters-(if applicable) �N\� OF o DARNM. ( ler's Signature) y �` 4 No 4 .. STE � (Designer's Signature) ANI TAO PLEASE RETURN TO B TABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:1S�-ptic\Designer Certification Form Rev 8-14-13.doc TOWN OF BARNSTABLE (,LOCATION�. Q _ SEWAGE# VILLAGE ASSESSOR'S MAP&('PARCEL P e CIS' l INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) CRll1MBQR�, (size) Z 500 (AL PM NO.OF BEDROOMS OWNER �P►�c (� ®l>l� PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200.feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY Z3i 1(�� rF6'O of t 12 , No. 041-3— -U l-7 J Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS application for �18 oBAY *pstrm Construction Permit Application for a Permit to Construct Repair Upgrade( ) Bandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.3 G x I � Owner's Name,A dress,and T�1.i L KA Assessor's Map/Parcel trJ(o 1 l'� revs c�JG► -1 — a4_(J staller's Name,Address,and Tel.No. O$ Designer's Name,Address,and Tel.No. AkDL Type of Building: !!����� Dwelling No.of Bedrooms Lot Size 34 '7t�3 sq.ft. Garbage Grinder(M Other Type of Building "S No.of Persons Showers Q Cafeteria( ) Other Fixtures �- Design Flow(min.required) 33D gpd Design flow provided ,7�� gpd Plan Date - I 0 Number of sheets Revision Date AlI-A Title �C, ir1� `1� e 1✓ ✓� Size of Septic Tank 1oO M1IO►') -Type of S.A.S. j)�t &j [PQCk CkaM VS Description of Soil Lco I Nature-of Repairs or Alterptions(Answer when applicable) b ed 1 r1 i Q - 00 Ion lt2dn cf�tarnl�x Date last inspected: Agreement: The undersigned agrees to ensure a cons ction and maintena e o the afore described on-site sewage disposal system in accordance with the provisions of Title 5 f the Env' nmentaI Code an not t ace the system in operation until a Certificate of Compliance has been issued by this B d o Signe Date War u 1 r /3 Application Approved by Date Application Disapproved by Date for the following reasons Permit No. 20l3— 473 Date Issued 1213/7-13 jN No.141—S— -1 7 3 — Fee �Oa.oa THE COMMONWEALTH OF MASSACHUSETTS Entered in computer. PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes ` application for I 08al 6pst m. Construction 3permit Application for a Permit to Construct- Repair-� Upgrade'( ) ban don(' ) ❑Complete System ❑Individual Components Location Address or Lot No.3(� r , 1 Owner's Name,Address,and Tel.No. W ' ' o+ Assessor's Map/Parcel 15� ' /VWL5 b�,cn rev �C I-�rY1Pnc ti Y1 `7�4 - a -15t� nstaller's Name,Address,and Tel.No. 508 - `6' Designer's Name,Address,and Tel.No. t.0 -ConsFrvc c S Mt.)n,T- c . v b �vh ` , �' on N D 1171aOC "'1';1 ' Q S� TAG Type of Building: ` ~ Dwelling No.of Bedrooms 3 / Lot Size 34 Lik3 sq.ft. Garbage Grinder d9) Other Type of Building rJ rrA I P. No.of Persons Showers(j Cafeteria( ) Other Fixtures -A t Design Flow(min.required) gpd Design flow provided ?3 p gpd Plan Date ee l_ Number of sheets CO— Revision Revision Date Title 2''l i� J YV\ k? fa l►e. &A in rr�� Size of Septic Tank i5o6 , a.)lon Type of S.A.S. P►-e V1(- C+n-1�XV S` d— Description of Soil Ll JC AYtU A t 11Q. �(.111 Nature f Repairs /nor^i f I, Alterations(Answer when applicable) 1 / f � 3 I- ^ kg-ck dirnmUys- Date last inspected: Agreement: r The undersigned agreAo . tion and maintena ce o the afore described on-site sewage disposal system in accordance with the provisions mental Code an not to .lace the system in operation until a Certificate of Compliance has been issued by w 1Si Date Nov 9 1 s r /3 Application Approved by Date Application Disapproved by Date for the following reasons Permit No. 70 hj` 9'7 3 Date Issued 12(3/20,3 I THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO C .T Y,that On-si Sewage DDiJsp seal system Co�structed( ) aRepaired( u Upgraded( ) Abandoned( )by d, d O //Cl ( at sA(,r r� W . STiflWhas been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No?D3- 473 dated P-/3,�'3 Installer Designer #bedrooms Approved design flow gpd The issuance of this je&tall not Pe construed as a guarantee that the system wi ct o as,designed. p t7 C Date Inspector V No. Zpl�j �I 3 v Feed/co".) THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal *pstrm Construction Permit Permission is hereby granted to Construct( ) Repair( ) Upgrade(#*'-) Abandon( ) System located at'31 514LT A40TP&tJ LAIn/67 W . 'U'S`TA81.6 , AMA 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 12. 3 Zo -s Approved by Town of BaIMStable. r# °F Department of Regulatory Services ' Agra Public Health Division Bate MASS 6$ 200 Main Street,Hyannis MA 02601 P -1tF Date Scheduled Time Fee Pd. So " ,5Urtability Assessment for Sewage Disposal Performed By: � � cr ' Witnessed B,rt� i LOCATION & GENERIAL INFORMATION Location Address'...,� l ft- �Q Owner's Name ' 1 AddressV14 CA Assessor's Map/P4rcel: �� (� I Engineer's Na,in f gvv, _ i• p NEW CON51RU�1ION REPAiIt Telephone# � 1( Land Use t Li`'l � Slopes(TO) ' �.�S Surface Stones Distances from: Open Water Body ©� Et Possible Wee Area ? 00 ft Drinking Water Well >�S ft i l y® ft Property Line �� ft Other ft breinage Way j SKETCH:(Street name,dimensiods%f 104 exact locations of test holes&Pere tests,locate wetlands in proximity to holes) -ig . 1� ' I 4; ! _ c I it . Parent material(gecilogic) lA d � 4 ( ���� 1 ' Depth to Bedrock Depth to Groundwater. Standing Water in Hole: /,7 , i Weeping from Pit Face Estimated Seasonal Nigh Groundwater i — TE TION FOR SEASONAL HIGH'WATI♦J�TOLE Method Used:. in. Depth 10 Sall mottles; Jn. Depth db erved standingin obs.hole: I in Groundwater Adjustment / Depth toiweeping from side of obs.hole: , •Actor G v Adj.Groundwater Level Ind Well#� Reading Dajtye Adj. Index Well level - 14 PERCOLATION TEST Dide______ Time' - -- Observation r Time at 9:'. Hole# Time at fi" -- . Depth of Perc Start Pre-soak Time.@ End Pre-soak " 'Rate MinJInch ! Additional Testing Needed(Y/N) Site Suitability Assessment Site Passed Site Failed; - Observation Hole Data To Be Completed on Back Original:.Public I;e$ith Division — ***If percolaAibn test is to be conducted within 1.00' of wetland,you must first notify the Barnstable Conservation Dizzsion at least one(1) wedk Prior to beginning. i,? DEEP OBSERVATION HOLE LOG Hole# I Depth from Soil Horizon Soil Texture Soil Color Soil Other .Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistenc %Gravel Iy1 11— 1' 14,4 0 •(` f� DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistenc %Gravel) 14" COS r� 3 4 tL 32 1� .+ S DEEP OBSERVATION HOLE LOG Hole# IV Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) DA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%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. ra I ti Flood Insurance Rate May: _ Above 500 year flood boundary No_ Yes Within 500 year boundary No V Yes Within 100 year flood boundary No J 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? 'e If not,what is the depth of naturally occurring pery ous material? Certification I certify that on b (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required fratn' ,expep and experience described in all CMR 15.017. Signature Date Q:\.SEPTIC\PERCFORM.DOC ' l down cape engineering, incSIEVE SOILS ANALYSIS 39 SALT MEADOW LN W. BARNSTABLE, MA DATE OF REPORT: 8/1/13 .JOB : GRAIN SIZE ANALYSIS-SIEVE TEST SITE: 39 SALT MEADOW LANE W. BARNSTABLE, MA !LOCATION: DCE TEST HOLE SIEVE ANALYSIS Weight Sample(Grams): 228.0 SIZE :WEIGHT RETAINED % RETAINED € %PASSED --------------:.............(sum..)....... ..................:---------------------:..................................... 1" 0.0: 0.0%: 100.0% ............... 3/4" 0.0: 0.0%: 100.0% -------------:.......................................................---------------------------------------- 1l2" 0.0: 0.0%: 100.0% -------------...................................................... 3/8" 0.0: 0.0%: 100.0% ------------ ....................................................... --- 0.0: 0.0%: 100.0% •-------------i......................................................r---------------------....................... .............. 10 7.31 3.2%: 96.8% -------------:......................................................:------------------o-:.................................... #20 38.5� 16.9/o! 83.1/o --------------......................................................s--------------------y..................................... #40 104.61 45.9%: 54.1% ....................................................... #50 € 145.9: 64.0%: 36.0% -------_•__-__.....................................................•t--------------------y........I............................ #80 .......................................199;9 -------------87.7........................12:3% #100 211.7: 92.9W 7.1% -------------...................................................... ,--------------------->------------------ #200 223.71 98.1%: 1.9% PAN: 225.2: 100.0%: 0.0% ------------ ------- -- SAMPLE: 228.0`: NOTE:TEST ON PASSING#4 ONLY, 1%RETAINED ON#4<45%O.K. i RESULTS: SOIL CLASSIFIED AS AASHTO A-3(FINE SAND) (UNCOMPACTED) PERCENTAGE OF MATERIAL PASSING#4 SIEVE : #4 100% (TEST ONLY MATERIAL PASSING#4) OK #5010%-100% OK #100 0%-20% OK #200 0%-5% OK SAMPLE MEETS TITLE 5 FILL SPECIFICATION >98%SAND RESULTS: PERMEABLE MATERIAL-CLASS 1<2 MINJIN. MATERIAL NONCOMPACTED SOIL DESCRIPTION: FINE SAND j \� V Jr -- � E RECEIVED CEO N O v 0 4 2000 TOWN OF BARNSTABLE HEALTH DEPT. COMMONWEALTH OF MASACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET BOSTON MA 02108(617)292-3500 TRUDY COXE Secretary ARGEO PAUL CELLUCCI DAVID B.STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 39 SALT MEADOW LANE WEST BARNSTABLE, MA 02668 Name of Owner TOM AND JACKIE CRAFT Address of Owner: BOX 172 W.BARNSTABLE MA.02668 Date of Inspection: 10/24/00 Name of Inspector: JOHN GRACI 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) Company Name: SEPTIC INSPECTIONS Mailing Address: P.O.BOX 2119 TEATICKET,MA.02536 Telephone Number: 508-564-6813 FAX 508-564-7270 � f CERTIFICATION STATEMENT I certify that I have personally inspected,th'e sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection'The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.The system: X Passes _ Conditionally Passes _ Needs Further Evaluatio By the Local Approving Authority Fails Inspector's Signature: Date:10/24/00 The System Inspector shall sle mit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(30)days of completing this inspection.If 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 Department of Environmental Protection.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. NOTES AND COMMENTS "The inspection is based on criteria defined in Title V code 310 CMR 15.303.My findings are of how the system is performing at the time of inspection.M,. inspection does not imply any warranty or guarantee of the longevity of the septic system and any of its component's useful life." THE SYSTEM PASSES TITLE V INPECTION.RECOMMEND PUMPING THE EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. Xf say a��.l noin.R pane 1 of 11 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 39 SALT MEADOW LANE WEST BARNSTABLE, MA 02668 Name of Owner TOM AND JACKIE CRAFT Date of Inspection: 10/24/00 INSPECTION SUMMARY: Check A, B, C, or D: A. SYSTEM PASSES: X I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not evaluated are indicated below. B. SYSTEM CONDITIONALLY PASSES: One orimore system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion o the replacement or repair,as approved by the Board of Health,will pass. Indicate yes,no,or not determined(Y,N,or ND).Describe basis of determination in all instances. If"not determined",explain why not. n/a The septic tank pis metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,whethi or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. nIa Sewage backup or'b'reakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)o due to a broken,settled or uneven distribution box.The system will pass inspection if(with approval of the Board of Health). _broken pipe(s)are replaced _obstruction is removed _distribution box is levelled or replaced n(a The system required pumping more than four times a year due to broken or obstructed pipe(s).The system will pass inspection if(wilh approval of the Board of Health): _broken pipe(s)are replaced _obstruction is removed . c r.t V revised 9/2/98 Paoe 2 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 39 SALT MEADOW LANE WEST BARNSTABLE, MA 02668 Name of Owner TOM AND JACKIE CRAFT Date of Inspection: 10/24/00 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 the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303(1)(b)THAT THE SYSTEM I: NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT ThE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER.IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE 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 aseptic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well, Y!f The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis 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,Method used to determine distance nLa (approximation not valid). 3) OTHER nla revised 9/2/98 Paae 3 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 39 SALT MEADOW LANE WEST BARNSTABLE, MA 02668 Name of Owner TOM AND JACKIE CRAFT Date of Inspection: 10/24/00 D. SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303.The basis for this determination is identified below.The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No - X Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. _ X 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. - X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow, - X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped n/a. - X Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. - X Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. - X Any portion of a cesspool or privy is within a Zone I of a public well. - X Any portion of a cesspool or privy is within 50 feet of a private water supply well, - X 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.If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS: 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: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No - X the system is within 400 feet of a surface drinking water supply - X the system is within 200 feet of a tributary to a surface drinking water supply - X 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) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.30412).Please consult the local regional office of the Department for further information. revised 912/98 Pape 4 of 11 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 39 SALT MEADOW LANE WEST BARNSTABLE, MA 02668 Name of Owner: TOM AND JACKIE CRAFT Date of Inspection: 10/24/00 Check if the following have been done:You must indicate either"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 _ None of the system components have been pumped for at least two weeks and-the system has been receiving normal flow rates during that period.Large volumes of water have not been introduced into the system recently or as part of this inspection. X As built plans have been obtained and examined.Note if they are not available with NIA. X _ The facility or dwelling was inspected for signs of sewage back-up. X - The system does not receive non-sanitary or industrial waste flow. X _ The site was inspected for signs of breakout. X _ All system components,excluding the Soil Absorption System,have been located on the site. X _ The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum.The size and location of the Soil Absorption System on the site has been determined based on: X _ Existing information,For example,Plan at B4O,H, X _ Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable)1 5.302(3)(b)) ,y , :e X _ The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of SubSurface Disposal Systems. i, or revised 9/2/qA Page 5 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 39 SALT MEADOW LANE WEST BARNSTABLE, MA 02668 Name of Owner TOM AND JACKIE CRAFT Date of Inspection: 10/24/00 FLOW CONDITIONS RESIDENTIA Design flow: 110 g.p.d./bedroom Number of bedrooms(design): 3 Number of bedrooms(actual):n/a Total DESIGN flow: 330 gpd Number of current residents:1 Garbage grinder(yes or no):NO Laundry(separate 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 two year's usage): n/a gpd Sump Pump(yes or no): NO Last date of occupancy: n/a COM M ERCIAIJINDLISTRIAL Type of establishment: n/a Design flow: n/a gpd(Based on 15.203) Basis of design flow:n/a i+. Grease trap present:(yes or no): NO Industrial Waste Holding Tank present:(yes or no): NO Non-sanitary waste discharged to the Title 5 system:(yes or no):NO Water meter readings.if available: n/a Last date of occupancy:n/a OTHER: (Describe) n/a GENERAL INFORMATION PUMPING RECORDS and source of information: n/a System pumped as part of inspection:(yes or no):NO If yes,volume pumped n/a gallons Reason for pumping:n/a 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) _ I/A Technology etc.Attach copy of up to date operation and maintenance contract _ Tight Tank Copy of DEP Approval Other:n/a APPROXIMATE AGE of all components,date;installed(if known)and source of information: 4110191 Sewage odors detected when arriving at the site:(yes or no): NO revised 9/2/98 Page 6 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 39 SALT MEADOW LANE WEST BARNSTABLE, MA 02668 Name of Owner TOM AND JACKIE CRAFT Date of Inspection: 10/24/00 BUILDING SEWER:X (Locate on site plan) Depth below grade: 30" Material of construction: _ cast iron X 40 Pvc _ other(explain) Distance from private water supply well or suction line: nla Diameter: n/a Comments: (condition of joints,venting,evidence of leakage,etc.) TWO INLETS;ISO FEET TO WELL SEPTIC TANK: X (locate on site plan) Depth below grade: 24" Material of construction: X concrete_ metal_ Fiberglass_ Polyethylene_ other explain: n/a If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): NO Age: n/a Dimensions: 1000G L 8'6"H S'7"W 4'10"" Sludge depth: 1" Distance from top of sludge to bottom of outlet tee or baffle: 33" Scum thickness: 0" 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: n/a How dimensions were determined: MEASURED Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage,etc.) THE SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND.RECOMMEND PUMPING EVERY TWO YEARS. GREASE TRAP: _ (locate on site plan) Depth below grade: n/a Material of construction: _concrete_ metal_ Fiberglass _ Polyethylene_other Explain: n/a Dimensions:n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle n/a Date of last pumping: n/a Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage,etc.) n/a ' revised 9/2/98 Paoe 7 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 39 SALT MEADOW LANE WEST BARNSTABLE, MA 02668 Name of Owner TOM AND JACKIE CRAFT Date of Inspection: 10/24/00 TIGHT OR HOLDING TANK: _ (Tank must be pumped prior to,or at time of,inspection) (locate on site plan) Depth below grade: n/a Material of construction: _concrete_ metal Fiberglass _Polyethylene _other Explain: n/a Dimensions: n/a Capacity: n/a gallons Design flow: n/a gallons/day Alarm present: NO Alarm level:N/A Alarm in working order:NO Date of previous pumping: n/a Comments: (condition of inlet tee,condition of alarm and float switches,etc.) n/a I DISTRIBUTION BOX:X (locate on site plan) Depth of liquid level above outlet invert: LEVEL WITH BOTTOM OF PIPE Comments: (note if level and distribution is equal,evidence;of solids carryover,evidence of leakage into or out of box,etc.) THE DISTRIBUTION BOX IS STRUCTURALLY SOUND. i PUMP CHAMBER: _ (locate on site plan) Pumps in working order:(Yes or No): NO Alarms in working order(Yes or No): NO Comments: (note condition of pump chamber,condition of pumps and appurtenances.etc.) n/a V revised 912/98 Paae 8 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 39 SALT MEADOW LANE WEST BARNSTABLE, MA 02668 Name of Owner TOM AND JACKIE CRAFT Date of Inspection: 10/24/00 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: nla Type: leaching pits,number:(n/a)n/a leaching chambers,number: (3)FLOW DIFFUSERS leaching galleries,number: (n/a).n/a leaching trenches,number,length: (n/a)n/a leaching fields,number,dimensions: (nla)n/a overfow cesspool,number: (n/a)n/a Alternative system: n/a Name of Technology: nla Comments: (note condition,of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) THE FLOW DIFFUSERS ARE STRUCTURALLY SOUND AND APPEAR TO BE FUNCTIONING PROPERLY.SOIL PROBE DRY IN LEACH AREA. CESSPOOLS: _ (locate on site plan) Number and configuration: n/a Depth-top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer. n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater: n/a inflow(cesspool must be pumped as part of inspection)NO . IL Comments: i (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) n/a PRIVY: (locate on site plan) Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Comments: (note condition of soil;signs of hydraulic failure,level of ponding,condition of vegetation,etc.) n/a revised 9/2/96 �.,$ Paae 9 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(contiiwed) Property Address: 39 SALT MEADOW LANE WEST BARNSTABLE, MA 02668 Name of Owner TOM AND JACKIE CRAFT Date of Inspection: 10/24/00 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) n 4 � AA a3 e C A� 28 r� l3 d� r I revised 9/2/98 Paoe 10 of 11 v SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 39 SALT MEADOW LANE WEST BARNSTABLE, MA 02668 Name of Owner TOM AND JACKIE CRAFT Date of Inspec�:ion: 10/24/00 NRCS Report name: nla Soil Type: n/a Typical depth to groundwater: nla USGS Date website visited: n/a Observation Wells checked: NO Groundwater depth: Shallow_ Moderate_ Deep_ SITE EXAM _ Slope _ Surface water _ Check Cellar _ Shallow wells Estimated Depth to Groundwater 10 Feet+ Please indicate all the methods used to determine High Groundwater Elevation: Obtaied from Design Plans on record Observed Site(Abutting property,observation hole,basement sump etc.) Determined from local conditions _ Checked with local Board of health _ Checked FEMA Maps Checked pumping records Checked local excavators,installers X Used USGS Data 'G Describe how you established the High Groundwater Elevation.(Must be completed) USGS MAPS AND CHARTS-10+FEET •,r't revised 9/2/98 Paoe 11 of 11 TO OF BARNST LE 'LOCATION L��SEWAGE # VMLAGE a r 1 ASSESSOR'S MAP S&LOT S INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO. OF BEDROOMS BUILDER OR OWNER 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 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 D �-� n � ', ' C�^.. -- ' `A{ �. � I1 � �3 eo AD$► � r3 � �C � � �� D �c � ® � ��`( t TOWN OF BARNSTABLE L(?C1l;'IION �jp� !' SEWAGE VILLAGE -/° i ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. (, - SEPTIC TANK CAPACITY `6O �Jo ' LEACHING FACILITY:(type) (size) 3—Yxa NO. OF BEDROOMS RIVATE WE OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: ,Yes Io1 j 13' .�o _ i e 4 \ No.....!__l.'. .J.�./ Fxs...3 ....F- _ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH '�� KOO TOWN OF BARNSTABLE 1 fir #ion for Disp.aiial Workii Tomitrnrtion Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal �ys qt .. =-------------- -- `... �70;ocati Ad - ess ._. ..... :. ...... --'•-- -•--•--••----•--- "------•-----'_...••-•----------• --•--•---- �i G ....... '---- --- -----'--.._....- nstaller Address U "Iof Building Size Lot............................Sq. feet �.. Dwelling—No. of Bedrooms____________________________----------------Expansion Attic ( ) Garbage Grinder ( ) '4 Other—T e of Building No. of persons____________________________ Showers — Cafeteria P4 Other fixtures ..................................... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1________________minutes per inch Depth of Test Pit.................... Depth to ground water........................ (i, 'Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 0 Description of Soil_____ _____ �_ UW -•-•••-----•--------------------•--•---•------------------------•--•---•-•-•-•----•------•-------------•-•---------•-----•- ------•-----------•------•---•--- --- -- --------------------- Nature of Repairs or Alterations—Answer when applicable.............. ..........................................I.............................................................. ------------ -------t_ .................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmen al Code—The undersigned further agrees not to place the system in operation until a Certificate of Complian as been ssued by t oard of alth. Sig ' . . . ..... ........ ... ---------------------- ---- ........... -e� o �-9l._ ---------------------- - Date Application Approved By ------------------------ -- . . ------ - ...--- _1te----71 Application Disapproved for the following easons --------- ------------------------------------------------------------------------------------------------- -- ----------------------------------------------------------------------------------------------------------------- --....-----------.................-----------------------............. --------------------- --------------- Due PermitNo. ..........C�'.... 13.1.................... Issued ---- --- -------------------------------------------------- Date ------------ -- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE (fer#tft.ctt#e of Tantylianve THIS IS T CERTIFY T at the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by-------------------- ----- ............. . I -----•--------nst----all---e r-..............-----------------------------------------........------------------------------------------------......... at ---------------3 ..........5006-----... ( ------- ..-------------------------------- has been installed in accordance with the provisions of TITLE 5 of�he State Environmental Code as described in the application for Disposal Works Construction Permit No. ............ ./,..../-3./..... dated ....................._.......................... THE ISSUANCE OF THIS CERTIFICATE SHALL'NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................- ------------------------------------------ -------------------- Inspector .................................................................................--------------. lNo .............................. THE COMMONWEALTH`OF MASSACHUSETTS BOARD OF HEALTH ✓�� TOWN OF BARNSTABLE 'i Apt utttinn for Disposal Works Tonstrurtinn frrmit �nf Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at* �- - .*p ................. .................................. 1.�"" Locati}o -Address ` or Lot No. o'p 7� - ....................................... ............... ..•...........----..........--^---•--......--_..................... Oner Address w rInstaller Address dTyp(/of Building / Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) 'PL4-1 Other—Type of Building No. of persons............................ Showers — Cafeteria Otherfixtures .------••--•---------------------------•--------•----.....---••---•---•-----------------------......'..------......--------•-------------------------• W Design Flow............................................gallons per person per day. Total daily flow" _._____.____...........................gallons. 94 Septic Tank—Liquid capacity........_._.gallons Length................ Width...............JDiameter................ Depth................ Disposal Trench—No..................'-Width.................... Total Length..............Total leaching area....................sq. ft. Seepage Pit No--- ---------------- Diameter.................... Depth below inlet.........!......... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) N-I Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. I................minutes per inch Depth of Test Pit---................. Depth to ground water...................---.. fT4 Test Pit No. 2................minutes per inch Depth of Test Pit.......:............ Depth to ground water...---.................. Description of Soil........... -------/ = w -----•------------------------------------------------- �-------------�--------------------------------...._... -------------.----...---------------- __.-------------- Nature ----- ----- ----- "Ye U of Repairs or Alterations—Answer when applicable--------------- . 4Y �_ _._______.__.: ., ............................................................................................................................. � �/.%�--••-----------.._.. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the-State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliant .as been issued by thewboardofealt_ �r� . - .. ---------`---- ---- / Signed ----------�... ... . .... �....... .. �U Dare A lication Approved B 0. �. l /...'�....�.. ` ......hr.... ..-..�r/. PP PP y ...... ............... �.. ,.x . ... a - Application Disapproved for the fol-owing�sons: ---------------------------------------- ----------------------------------------------------------------------------------------- ----- - D are '41 PermitNo. ........... ..—....1..v : ------------------ Issued .----------------------o�e Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Cfe>r#tftra e of Toraylinnu r THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (,�) • (r..^... �> ------------------------------------------------- .................. f... "�" i r n Installer o �._. �.-�.- T------------------------------------ has been installed in accordance with the provisions of ITLE 5 of iIhe State Environmental Code as described in the application for Disposal Works Construction Permit No. ............a`f.........�1.��s..... dated .....................................---------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE --------------------- ---------------------------------:..................----.................... �' Inspector ...--------........-----------------........--•------------------................................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Disposal Works Tunstrudion rrrmit Permission is hereby granted.------.....�..:...........�ti! .... :__-�:.:....................... to Construct ( ) or Repair (�)° an Individual Sewage Disposal.System �. n ..... ),_.:at No.........._ ...�..._. ...... ........--� a. ...L .:..__:... .........................; � Street as shown on the application for Disposal Works Construction Permit No.0 :_ Dated.......................................... ......................................•-•----•---------------..................._...........------------. DATE A�� Board of Health ---------•----------•-------------------- FORM 38E08 HOBBS h WARREN.INC..PUBLISHERS 1 r LEGEND WCST BARNSTABLE PROPOSED CONTOUR CB/DH 9® PROPOSED SPOT GRADE -- 98 -- EXISTING CONTOUR yv O + 96.52 EXISTING SPOT GRADE W— EXISTING WATER SERVICE '� t9 LOCUS TEST PIT PARCEL ID- QD N Rogo 156/045 PARCEL ID: Rod AREA=35,590t S.F. SO-/ 156/046 6q �iti 'III V1�• 1 O�� � N �'� GF� 0 ,,, LOCUS MAP WELL LOCUS INFORMATION 36" �Q PLAN REF: 202/121 , TITLE REF: 26120/238,fro EXIST. C'F PARCEL ID: MAP 156 PAR. 45 ZONING: "RF" TBM: T #39 �p ; FLOOD ZONE: "C" iSPIKE: 8.5 G 3,J c COMMUNITY PANEL: 250001-0011—D DATED:07/02/92 PARCEL ID: O 3 BEDROOM 156/018 \` DWELLING 012" off' SEPTIC SYSTEM —T--UTILs REPAIR PLAN �� ; EXIST '1,,000G' pp LOCATED AT: SEPTIC TANK 31 CB/DH — UTILS urlLs 39 SALT MEADOW LANE EL=27.7 TBM: 'TOP,Q ,o _ ,, ,�F WEST BARNSTABLE, MA. WELL ; SPIKE: 29.0 .�, , cF ; PREPARED FOR 150' oos � 9 24 KAREN ANN KOLB 83 �� �' WELL AUGUST 13, 2013 ! 7.2 i 57 O ' O 150, �� 0 F MqS ,' ��F�'�/?y �S-. tao•S� , ,�h l '�TH-� �PDA N M. s,( , f^ . : °1`1os moo. PARCEL ID: 4 TH \ 156/024-002 y v AIL7.0 `� 0 28.4 � �` e� ,�� ; SgNI TAR�p� .�Q �tx 5 FOOT 501L REMOVAL PARCEL ID: Ak 65 ' (SEE NOTE 16) ;r 156/023 27.3 MEYER & SONS, INC. (WELL MORE THAN , 150' AWAY) 28 3 GRAPHIC SCALE P.O. BOX 981 P� 30 0 15 30 s° 'Z° EAST SANDWICH, MA. 02537 P (508)362- 2922 IN FEET ) 1 inch = 30 ft. SHEET 1 OF 2 J#1563 NOTE: MAGNETIC TAPE TO BE PLACED OVER ALL COVERS NOTE: PLACE RISERS OVER ALL COVERS W/IN 6" OF GRADE FINISHED GRADE (29.50) F.G.EL: 31.0 F.G.EL: 30.50 F.G. EL: 29.50 •a MAINTAIN 2% MIN SLOPE OVER LEACHING AREA a• .D :Q 2" OF 3/8" DOUBLE WASHED 3/4" - 1-1/2" TOP TANK=EL. 29.54 STONE OR FILTER FABRIC DOUBLE WASHED STONE 71 A 6' 77777 4" SCH 40 PVC LLit0"1 ®®®®. O ®®®® 14' 6 @ S= 1% (MIN.) ®®®®®®®®®®® T4"E SCHRE TO 40 PVC BE INV.27.65 F 2 E F. DEPTH ®®®®®®®®®®® INV.28.25 INV.27.45 4' 2 X 8.5' 4' EXISTING OUTLET BAFFLE�E PROPOSED DB-3 EFFECTIVE LENGTH = 25' :..... •„ ..;..•. . DISTRIBUTION BOX --e- / ------------ INV. 28.50 I NV. ELEV.= 25.5 EXISTING 1 ,500 GALLON SEPTIC TANK GAS BAFFLE TO BE INSTALLED ON ���� �F MAPIP BREAKOUT OUTLET TEE AS MANUFACTURED BY oZ DAR N M. Gn ELEV.= 26.50 TUF-TITE, ZABEL, OR EQUAL M� TOP CONC. ELEV.= 26.5 NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING No 1140 INV. ELEV= 25.5 ®Ea ®:E3 ®® . PIPE INVERTS PRIOR TO CONSTRUCTION ®®®E 2) D-BOX SHALL BE SET LEVEL AND TRUE TO 'AEG/S1E ®®0E3 GRADE ON A MECHANICALL COMPACTED SIX QNITAR\P� BOTTOM EL.= 23.5 3.75' S FT. 3.75' INCH CRUSHED STONE BASE, AS SPECIFIED IN } 310 CMR 15.221(2) � 3) REPLACE EXISTING 1,500 GALLON SEPTIC TANK SEPARATION 12.90 FT. EFFECTIVE WIDTH = 12.5' WITH GALLON SEPTIC TANK IF FAILED, SEPTIC SYSTEM PROFILE DAMAGEDED,, NOT H2O LOADING, OR UNDERSIZED. SOIL ABSORPTION SYSTEM (SECTION) 4) INSTALL INLET & OUTLET TEES W/ ADJUST. GRNDWATER EL: 10.6 GAS BAFFLE AS REQUIRED (500 GALLON LEACH CHAMBER) GENERAL NOTES: 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL SOIL. LOGS P#: 14059 DESIGN CRITERIA BOARD OF HEALTH AND THE DESIGN ENGINEER. NUMBER OF BEDROOMS: 3 BEDROOMM DESIGN 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS SOIL TEXTURAL CLASS: CLASS 1 (0.74 GPD/SF) OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE DATE: JULY 10, 2013 LOCAL RULES AND REGULATIONS. SOIL EVALUATOR: DARREN MEYER, CSE 1614 DESIGN PERCOLATION RATE: <2 MIN/IN DESIGN FLOW: 330 G.P.D. 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR WITNESS: DONALD DESMARAIS, BARNSTABLE HEALTH DAILY FLOW: 110 G.P.D. X 3 BR = TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE GARBAGE GRINDER: NO (not designed for garbage grinder) DESIGN ENGINEER. 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING SEPTIC TANK: 330 gpd x 200% = 660 gpd, USE EXIST. 1,000 GAL. SEPTIC TANK FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN Elev. TP-1 Depth Elev. TP-2 Depth ENGINEER BEFORE CONSTRUCTION CONTINUES. i 0" (330) = 445.94 S.F. 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. 28.60 A 0" 28.60 LOAMY SAND A LEACHING AREA REQUIRED: 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF tAYR SAND LOAMY SAND 74 THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF - 10YR 3/2 , HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. 27.44 B 14 27.44 14" USE TWO (2) 500 GALLON PRECAST LEACH CHAMBERS W/ 4 7. WATER SUPPLY PROVIDED BY PRIVATE DRINKING WATER WELL. S 0YRR 6�8 B SANDDY10YR LOAM STONEON ENDS & 3.75' STONE ON SIDES: 25' L X 12.5' W X 2'D 8.ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED 25.44 38" TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. C SILT 25.44 C 6/8 38" BOTTOM AREA: 25' x 12.5'= 312.50 SF 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE SILT THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING LOAM LOAM SIDE AREA: (25 + 12.5) X 2 X 2 = 150 SF 10YR 6/6 CONSTRUCTION. 10YR 6/6 10. EXISTING LEACHING TO BE PUMPED, CRUSHED AND FILLED PER TITLE 5. (location unknown) 11.60 204" 11.60 204" TOTAL SQUARE FEET PROVIDED = 462.50 vs. 445.94 REQ'D 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION SIEVE ® EL 10.0 FINE FINE DESIGN FLOW PROVIDED: 0.74(462.50 S.F.) = 342.25 G.P.D. vs. 330 G.P.D. req'd 12, THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY SAND SAND AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY 2.5Y 7/4 25Y 7/4 PROPOSED SEPTIC SYSTEM UPGRADE PLAN 13. NO ABUTTING PRIVATE WELLS WITHIN 150' OF PROPOSED LEACHING. 7.60 252" 7.60 252" 39 SALT MEADOW LANE, WEST BARNSTABLE, MA 14. NO WETLANDS WITHIN 100' OF PROPOSED LEACHING. PERC RATE <2 MIN/IN. ("C2- HORIZON) PER SIEVE ANALYSIS 15. ALL PIPING TO BE 4" SCH 40 0 1/8-/FT (UNLESS SPECIFIED) GROUNDWATER OBSERVED AT 204' (EL. 11.60) Prepared for: Kolb 16. REMOVE ALL UNSUITABLE MATERIALS 5 FT. AROUND LEACHING WELL: SOW-252, ZONE: A. LEVEL 46.4. ADJUSTMENT 0.5 - USE ADJ. GROUNDWATER EL 12.10 Engineering by: Surveying by: SCALE DRAWN TO ELEV. 11.60 TOP OF "C2" AND REPLACE WITH CLEAN MEDIUM MEYER&SONS,INC. DMM • I, Darren M. Meyer, R.S., CSE, hereby certify that I am currently approved by MADEP pursuant to 310 CMR 15.017 �faoDouB811 Survey N.T.S. SAND PER TITLE 5. to conduct soil evaluations and that the above anal POBOX961 analysis has been performed by me consistent with the (508) 419-1086 DATE CHECKED SHEET NO. 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 08/13/13 DMM 2 of 2