HomeMy WebLinkAbout1301 SERVICE ROAD - Health 1301,Service Road
West Barnstable
A= 152-003-009
Apr: 30. 2015 9 52AM DP frond W I I Di 111 in I n r N 01 21' P. 2
j3V rr^ f
CERTIFICATE OF ANALYSIS
a 0 ry (M-MA009)
arns a e County ea
Recipient: Sally OPSMond Motrlx; Water- Drinking Water
Desmond Well Drilling sampled.. 04/2412015 MOU
P o Oray 2783 Received-. 04/2412015 11.00
Collection Address: Jj(jj SPrVIC@ Road,W udrnstable
Orleans, MA 02653 g2tta I nrafloh,
jorder#: G1586386 Descriptivn, 2day,1101 Service Rd
Lab 10! 15ft:jtjb_()I Date Ama]Vzed; 4/24/L01s (g) I_,>%it)
Sample#! Analyst! yn
Method; EPA 524.2 Dilution Factor! 1
Comment, Based on the results of the parameters tested,the water is suitable for drinking,but njay present aesthetic problems(taste,
odor,5talolng)due to Iron.
Co"A 524,2 -- 14010NI6 Organics by GCIMS
_Re" 14CIL
Ug/L
Parameter Ug/L ug!L
Parameter ug/L uq/l. up/L I— --——
— — — 1 5.4 00
5d 71o�odffl ��0(neti;;e ND U0 1 Chloroform J� 70 0.50
Ic
O'so c Groe e ND
0,50
e
�Chl,;rrie han' ND
2.0 0150 is-t,3-Dlchloropropene NO
_!�yl.chloride NO
0.50 01brornochloromethane ND ""U
gromomethane ND
1,1,1,2-Tetrach(oroc,thane No 0,50 DIbrornomethane.
o
1,1,1-Trich(oroethane ND 200 0.50 'EthylbLnzene ND
50
I ND 0,50 Hcxachlo�rob0tadlene NO
1,1,2-Trichloroethane ND lsoproptl�zf..ne
y ND 5-0 U0
L'r
1,1-Dichloroethane ND 0.50 Methylene chlotide
llethyl-tert-buY ether NO
1,1 Ulchloroethene NO
1i 6.......-— Naphthalene NO 0.50
J-01chloropropene N 0.50 —.__...r.1.1 '—---
,2,3-Trlcilorop_2,3-Trichiorobenzem Q
0.50
ND 0-50 1 n-Ptopylbenzene
I
1,2,4-Trichlorobenzene NO., 70 _0.50 !1450PMPAoluene
ND U.Sb
NO 1 0150 sec-8utylbenzerle v ND 0.50
ND 100
1,2•Dibromo-3-chloropropana ND 0.50 Sly.Len�
NO 0,50
1,2_01bronioethane(EDB) ND Q'so teti-Butylbenzene n c1*1
1,2-01chlorobomene NO
NO 1000 0.50
1,2.131chloroethano NO S.0 0,50 Toluene —-------
O,M Total�qleoes NO 10000 0150
1,2-Dlchloropropane NO
Pthylbenzene N0__ 0-50 -ttr-ons-1,2-Dichlor0ethene NO 100 0.50
'
NOO
0+50 trans�1.3-Dlchloroorppene ND 0.50
11-Dichlorobcrizenc
J,q:6AjjlQr)benzene . NOS,U 0.50
11,2-Dichloropropane NO 050 Trichlocetlene
4NU 0,50
.50 Triciorofuorone
2.
Recove
red
N 0 .50
P Surrogates '1/Q Recovered I QC Limits(Glo)
Z-Dlchlor ropane o ' e�oRjr_
;Z-Chlorotoluene NO 0
OLO-Mofi tj o rob Fen benzene 9 10/0 0 1 130
or e, 12"/.,
NO 50 1,2 70 130
4 C i;roioluene
5 U
NO 5.0 0.�50
Brorriobenzene ND
oromochloron'ietha.n.e � N D
Bromodichloromethane ND 0.50
Bromoform N D
Carbon.-;�._.ile. ra�cl,lo
Chlarobenzene NO
Chlorone
0.50
ti
Approved By;,.. 'ZZ
Attached please find the laboratory cerfifled paigmeter list, (Lab Director)
ND=None Detected RL = Reporting Limit MU Maximorn Contaminant Level
Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph, 608.375A606 Page 1 of 1
/ -
Commonwealth of Massachusetts �a- 003 oo?
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
1301 Service Road
Property Address
Wayne&Jeremy Cunningham-Allbert
Owner Owner's Name /
information is West Barnstable ✓ Ma 02668 12-8-2020
required for every
page. City/Town State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
Important:When filling out forms A. Inspector Information
6' 4
on the computer, Brett Hickey
use only the tab
key to move your Name of Inspector
cursor-do not B&B Excavation
use the return Company Name
key.
374 Route 130
Company Address
Sandwich Ma 02563
City/Town State Zip Code
rtta (508)477-0653 S113747
Telephone Number License Number
B. Certification
I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5
(310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address
listed above;the information reported below is true, accurate and complete as of the time of my
inspection;and the inspection was performed based on my training and experience in the proper function
and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined
that the system:
1. ❑■ Passes
2. ❑ Conditionally Passes
3. ❑ Needs Further Evaluation by the Local Approving Authority
4. ❑ Fails
Brett Hicke Digitally signed by Brett Hickey
Y Date:2020.12.0915:28:30-05'00' 12-8-2020
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 has a design flow of
10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate
regional office of the DEP. The original form should be sent to the system owner and copies sent to
the buyer, if applicable, and the approving authority.
Please note:This report only describes conditions at the time of inspection and under the
conditions of use at that time.This inspection does not address how the system will perform
in the future under the same or different conditions of use.
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
�f
-- ' 1301 Service Road
Property Address
Wayne&Jeremy Cunningham-Allbert
Owner Owner's Name
information is West Barnstable Ma 02668 12-8-2020
required for every
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary
Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6.
1) System Passes:
Al 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:
The system was in working order at the time of inspection.
2) System Conditionally Passes:
❑ One or more system components as described in the"Conditional Pass"section need to be
replaced or repaired.The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
Check the box for"yes", "no"or"not determined"(Y, N, ND)for the following statements. If"not
determined,"please explain.
The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass
inspection if the existing tank is replaced with a complying septic tank as approved by the Board of
Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND (Explain below):
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18
r
Commonwealth of Massachusetts
�y Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
t l�
1301 Service Road
Property Address
Wayne&Jeremy Cunningham-Allbert
Owner Owner's Name
information is West Barnstable Ma 02668 12-8-2020
required for every
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (Cont.)
2 System Conditionally y Passes(cont.):
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ 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):
3) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
a. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
t5insp.doc•rev.7/26/2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
Y 1301 Service Road
Property Address
Wayne&Jeremy Cunningham-Allbert
Owner Owner's Name
information is West Barnstable Ma 02668 12-8-2020
required for every
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
b. 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.
c. Other:
4) System Failure Criteria Applicable to All Systems:
You must indicate"Yes" or"No"to each of the following for all inspections:
Yes No
❑ Q Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ 0 Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 4 of 18
Commonwealth of Massachusetts
- Title 5 Official Inspection Form
~ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
j 1301 Service Road
Property Address
Wayne&Jeremy Cunningham-Allbert
Owner Owner's Name
information is West Barnstable Ma 02668 12-8-2020
required for every
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary, (cont.)
4) System Failure Criteria Applicable to All Systems: (cont.)
Yes No
❑ ❑ Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ O Liquid depth in cesspool is less than 6"below invert or available volume is less
than Y2 day flow
❑ ❑ Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ R 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.
❑ El Any portion of a cesspool or privy is within a Zone 1 of a public water supply
well.
❑ El Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ n 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 2000 gpd-
10,000 gpd.
❑ E] The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303,therefore the system fails.The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
5) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the
questions in Section CA.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection
Area—IWPA)or a mapped Zone II of a public water supply well
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18
c� Commonwealth of Massachusetts
Title 5 Official Inspection Form
— o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
1301 Service Road
v�
Property Address
Wayne&Jeremy Cunningham-Allbert
Owner Owners Name
information is West Barnstable Ma 02668 12-8-2020
required for every
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
If you have answered"yes"to any question in Section C.5 the system is considered a significant
threat, or answered"yes"to any question in Section CA above the large system has failed. The
owner or operator of any large system considered a significant threat under Section C.5 or failed
under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner
should contact the appropriate regional office of the Department.
6. You must indicate "yes" or"no"for each of the following for all inspections:
Yes No
0 ❑ Pumping information was provided by the owner, occupant, or Board of Health
❑ 0 Were any of the system components pumped out in the previous two weeks?
[D ❑ 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)
❑ El Was the facility or dwelling inspected for signs of sewage back up?
El ❑ Was the site inspected for signs of break out?
E ❑ Were all system components,excluding the SAS, located on site?
El ❑ 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?
❑ a 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:
El ❑ Existing information. For example,a plan at the Board of Health.
❑ 0 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)]
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18
Commonwealth of Massachusetts
b Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
� 1 1� 30 Service Road
Property Address
Wayne&Jeremy Cunningham-Allbert
Owner Owner's Name
information is West Barnstable Ma 02668 12-8-2020
required for every
page. City/Town Satet Zip Code Date of Inspection
D. System Information
1. Residential Flow Conditions:
3 Number of bedrooms(design): Number of bedrooms(actual): 3
DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 353/GPD
Description:
3
Number of current residents:
Does residence have a garbage grinder? ❑ Yes No
Does residence have a water treatment unit? ❑ Yes No
If yes, discharges to:
Is laundry on a separate sewage system? (Include laundry system inspection Yes No
information in this report.)
Laundry system inspected? ❑ Yes '❑ No
Seasonaluse? ❑ Yes No
Water meter readings, if available(last 2 years usage(gpd)): See below
Detail:
***WELL WATER***
Sump pump? ❑■ Yes ❑ No
current
Last date of occupancy: Date
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18
Commonwealth of Massachusetts
- -- Title 5 Official Inspection Form
i; Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
1301 Service Road
v
Property Address
Wayne&Jeremy Cunningham-Allbert
Owner Owner's Name
information is West Barnstable Ma 02668 12-8-2020
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
2. Commercial/Industrial Flow Conditions:
NA
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
Water treatment unit present? ❑ Yes ❑ No
If yes, discharges to:
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
Last date of occupancy/use: Date
Other(describe below):
3. Pumping Records:
Source of information: Owner- last pumped 3 1/2 years ago
Was system pumped as part of the inspection? ❑ Yes ❑■ No
If yes, volume pumped: gallons
How was quantity pumped determined?
Reason for pumping:
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18
Commonwealth of Massachusetts _
- Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
1301 Service Road
Property Address
Wayne&Jeremy Cunningham-Allbert
Owner Owner's Name
information is West Barnstable Ma 02668 12-8-2020
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
4. Type of System:
El 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):
Approximate age of all components, date installed(if known)and source of information:
March 2015 per plans
Were sewage odors detected when arriving at the site? ❑ Yes ❑■ No
5. Building Sewer(locate on site plan):
2'611
Depth below grade: feet
Material of construction:
❑ cast iron 40 PVC ❑other(explain):
>100' from well to SAS
Distance from private water supply well or suction line: feet
Comments (on condition of joints, venting,evidence of leakage, etc.):
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18
Commonwealth of Massachusetts
-(p Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
1301 Service Road
Property Address
Wayne&Jeremy Cunningham-Allbert
Owner Owner's Name
information is West Barnstable Ma 02668 12-8-2020
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
6. Septic Tank(locate on site plan):
1'611
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: -
1500gallons
11"
Sludge depth:
25"
Distance from top of sludge to bottom of outlet tee or baffle
511
Scum thickness
5f�
Distance from top of scum to top of outlet tee or baffle
1211
Distance from bottom of scum to bottom of outlet tee or baffle
measured
How were dimensions determined?
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert,evidence of leakage, etc.):
The tank was,in working order at the time of inspection. The tank is in need of pumping
at this time and should be pumped every two years for maintenance.
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18
Commonwealth of Massachusetts
�m Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
� 1
1301 Service Road
Property Address
Wayne&Jeremy Cunningham-Allbert
Owner Owner's Name
information is West Barnstable Ma 02668 12-8-2020
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
7. Grease Trap(locate on site plan):
NA
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
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
8. Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan):
Depth below grade: NA
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain):
Dimensions:
Capacity:
gallons
Design Flow: gallons per day
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18
c Commonwealth of Massachusetts
. ....I.............. Title 5 Official Inspection Form
+~ - } Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
— � 1301 Service Road
Property Address
Wayne&Jeremy Cunningham-Allbert
Owner Owner's Name
information is West Barnstable Ma 02668 12-8-2020
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
8. Tight or Holding Tank(cont.)
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments (condition of alarm and float switches, etc.):
Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
9. Distribution Box(if present must be opened)-(locate on site plan):
o„
Depth of liquid level above outlet invert
Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
The d-box was in working order at the time of inspection.
l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18
Commonwealth of Massachusetts
-- Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
1301 Service Road
Property Address
Wayne&Jeremy Cunningham-Allbert
Owner Owner's Name
information is West Barnstable Ma 02668 12-8-2020
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
10. Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No*
Alarms in working order: ❑ Yes ❑ No*
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
NA
*If pumps or alarms are not in working order, system is a conditional pass.
11. Soil Absorption System (SAS)(locate on site plan, excavation not required):
If SAS not located,explain why:
Type:
❑ leaching pits number:
(2)500 gallon chambers
El leaching chambers number:
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number,dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
t5lnsp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18
Commonwealth of Massachusetts
=- _= Title 5 Official Inspection Form
r Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
1301 Service Road
Property Address
Wayne&Jeremy Cunningham-Allbert
Owner Owner's Name
information is West Barnstable Ma 02668 12-8-2020
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
11. Soil Absorption System(SAS)(cont.)
Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
The SAS was in working order at the time of inspection. Leaching was dry when viewed.
12. Cesspools (cesspool must be pumped as part of inspection)(locate on site plan):
NA
Number and configuration
Depth—top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,
etc.):
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18
Commonwealth of Massachusetts
- Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
1301 Service Road
Property Address
Wayne&Jeremy Cunningham-Allbert
Owner Owner's Name
information is West Barnstable Ma 02668 12-8-2020
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
13. 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.):
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18
Commonwealth of Massachusetts
- Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
1301 Service Road
Property Address
Wayne&Jeremy Cunningham-Allbert
Owner Owner's Name
information is required for every West Barnstable Ma 02668 12-8-2020
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
14. Sketch Of Sewage Disposal System:
Provide a view of the sewage disposal system, including ties to at least two permanent reference
landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters
the building. Check one of the boxes below:
❑■ hand-sketch in the area below
❑ drawing attached separately
`TOWN OF .ARNSTABGE:.
)CA�P'tG1N��-. L .�[GY��at"— __SEWAQEEE
l:t.AGfz 44.ASSES5f.1R S MAP be PARCEL
STALLERIS NAME.&P140HEiNO.
-PTtG TANK CAPACITY
a
ACM.NG FACILITY.(type) � ^� �p1► L�� (sizo)
).E)F t3G't�RGlQMS _.�
VNFK fJ0 Ili
RMITDATE; _ COMPUANcuDATE.
motion Distance Between t1ic:
Alm.untAtUotcd Growtilwulcr Tothic to the Bottom ofX,cachini Facility Fcvtt
vote Witter Supply Well and teaching Facility{tf any wells exW on.
site or within 200:11oas of leachina tociNtyj .Foci
sd go of Wctlu and Leachi ft Facility(If any wetlands exist within
300 foci of lcacltlrtg t'acltltyy) Fc t
Rtv'tSFtL?D FtY�
C
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18
Commonwealth of Massachusetts
_ Title 5 Official Inspection Form
tj P. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
1301 Service Road
Property Address
Wayne&Jeremy Cunningham-Allbert
Owner Owner's Name
information is Nest Barnstable Ma 02668 12-8-2020
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
15. Site Exam:
❑■ Check Slope
❑■ Surface water
❑■ Check cellar
❑■ Shallow wells
No GW @ 120"
Estimated depth to high ground water: feet
Please indicate all methods used to determine the high ground water elevation:
El Obtained from system design plans on record
3-4-2015
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:
A plan on file at the local Board of Health was used to determine high groundwater.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5insp.doc•rev.7/2612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
-- i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
1301 Service Road
Property Address
Wayne&Jeremy Cunningham-Allbert
Owner Owner's Name
information is West Barnstable Ma 02668 12-8-2020
required for every
St
page. City/Town ate Zip Code Date of Inspection
E. Report Completeness Checklist
Complete all applicable sections of this form inclusive of:
0 A. Inspector Information: Complete all fields in this section.
❑� B. Certification: Signed& Dated and 1,2, 3,or.4 checked
❑■ C. Inspection Summary:
1, 2, 3, or 5 completed as appropriate
4(Failure Criteria)and 6(Checklist)completed
❑■ D. System Information:
For 8: Tight/Holding Tank—Pumping contract attached
For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached
For 15: Explanation of estimated depth to high groundwater included
t5insp.doc.-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18
Town of Barnstable
Regulatory Services
a
Richard V.Scan,Interim Director i
j� Public Health Division
6)A
ad Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Fax: 508-790-6304
Office: 508-862-4644
Installer&Designer Certification Form
Date:09-0?-2cAP Sewage Permit# _ Assessor's Map\Parcel
Designer: Lee e-,Y- ASSoG Installer: 77 bd? IScoLC'
Address: � �` Y `f-1'� _ Address: 7 �
o /�toU
' L
On d � � �S�'!j as issued a permit to install a
(date) (installer)
septic system at 1301 S%W,)4CZ W, WES' 1r, -used on a design drawn by
(address)
, Q. -A 930C y>mS dated el-V4- ZoKl '
(desi er) -
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
certified as-built by designer to follow. Strip out(if required)was inspected and the soils
were found satisfactory.
I certify tha a syste erenced above was cons liance with the terms
o e RA a val le e. (if applicable)
RR
Walieeisature . 1140
es 'st�hYrtli' (A x Stamp H ree
PLEAS RETURN TO BARNSTABLE 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:1Scptic\Designer Certification Form Rev 8-14.13.doc
T V. z V 1 1) L)P s m o n a I I Uri i r i n g. C v i 0 Z I
bf A A
CER"TIFICATE OF ANALYSIS Page: I of I
Barnstable County Health Laboratory (M-MA009)
Retort Prepared For, Report Dated: 4128/2015
Sally 4P,31nond
Desmond Well Drilling Order No,:
P 0 Box 2783
Orleans, MA 02653
Laboratory lu#: 1586386-01 04serlption: Water-prinking Water
sample ft: Sample Lqcatlom! 1301 Service Road.W Barnstable Collected: 04/24/201$
Collected by: customer Received: 04124/2015
Routine 1W
ITEM y RESULT UNITI RL MCL METHOD if TESTED
Nitrate as Nitrogen 2.3 mglL eta 10 EPA 300,0 V2Q015
Iron 0.48 mg& 0.10 0.3 sm 3111 Is 412812015
Manganese ND wil. 0.025 0,060 sm 3111 a 412612015
pH 613 PH AT 250 NA 5,5-8.5 SM 4500-1-1,13 412412015
Sodium 16 mg/L Z5 20 SM 31118 412$f2015
Total Colifoym 0 1100MI 0 0 5M 9222S 412412015
Conduc,lance 190 Umohs!cm 12.0 $M 25i0B 412412015
Based on tho results of the parameters tested, the wateris,5u;table fbt'ddnking,but may present aesthetic problams
(taste, odor, staining)duok)lrot7.
Attached pioase fled the laboratory coriffied parameter list. Approvod B
Z4
(Lab 01rector)
ND=None Ntocted RL = Reporting Llmit tv4Cl v hdaklmum Conlarninant Level
Stoporlor C rikirt Hmma, P0. FAny 421, Barnstable, MA 02630 Ph, 608-375.6605
6'
No. l Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
appliLation for Misposal �&pBtrm Construction Permit
Application for a Permit to ConstructW Repair( ) Upgrade( ) a on( ) A Complete System ❑Individual Components
Location Address or Lot No./.;O/ SQL 6'i C.0 A Name,Address,and Tel.No.
Assessor's Map/Parcel s L d0 m9 &6ewsermw G
Instal r' amR,Address,and Tel.No Designer's Name,Address,and Tel.No.
- ft tC C)L.c� ,? a 32>:- YG 92.
Type of Building: //
Dwelling No.of Bedrooms d�j Lot Size 77, sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers(-,2) Cafeteria( )
Other Fixtures
Design Flow(min.required) 3 a d gpd Design flow provided ��_ gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil '_C.p-,v
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmenta ode and not to place the system in operation until a Certificate of
Compliance has been issued by this B and o t .
Signed Date 7 e
Application Approved by Date S P 7a5_
Application Disapprov y Date
for the following reasons
Permit No.&6-Ne Date Issued
4 ;
No. I/ Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered;ncompute:
��PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE MASSACHUSETTS Yes
r
ItJ,Ylcati0lP'fDr 1£4t111; AY)�pBtPltt`��Dn�trUctIDII VPrmit
Application for a Permifto Construct' Repair,( ) Upgrade( ) A an on( ) Complete System El Individual Components
' Location Address or Lot No. /30/ Sck s Name,Address,and Tel.No.
'✓
` Assessor's Map/Parcel IS
Installer's ame,Address,and Tel.No - Designer's Name,Address,and Tel.No.
32Y- YG9L
C3oX V17 .` 4
Type of Building:
Yw n' Dwelling No.of Bedrooms !j Lot Size 7 y` sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers(,2) Cafeteria( )
Other Fixtures `
Design Flow(min.required) 3 SO gpd Design flow provided 35-3 gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil 'Ft--at .v
. t
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
r
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system 4 <
accordance with the provisions of Title 5 of the Environmenta ode and not to place the system in operation until a Certificate of
Compliance has been issued by this B d o alt .
Sigied Date ,,
_ Application Approved by �— Date
s
Application Disapprov y Date
for the following reasons
Permit No.Zp6 /161 Date Issued S ��
---------------------------------------------------------------------------------------------------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed ) Repaired( ) Upgraded( )
t.
Abandoned( )by T �. ('e) L
}at lJoi 5Lje VI(-E ►o 3 t,E has been constructed in accordance
Witt)the p.o'lions of Title 5/ d he for D' System Construction Permit No: � dated
Installer (\/ Designer
k'bedroo s V 3; Approved design flow A gpd
The issuance of this permib sha; not be construed as a guarantee that the system wi nctio desi d.
Date ' Inspector
='-----------------------------------------------------------------------------------------------------------------------J-----
No. f r Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Mispo8al �6psteln Construction Permit
Permission is hereby granted to Construct(r%) Repair( ') Upgrade( ) Abandon( )
System located at 4 ,3Q/
r -r
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:C ns ction must be-completed within three years of the date of this permit.
D' /� Approved by
e
12/1/2020 ShowAsbuilt(1653x2338)
TOWN OF PARNSTABLE
)CATION J loi it _SEWAGE
LLAGF,_( --, e At- ASSI SSQR'S MAY&;PARCEL:
STALLFR'S NAME&PITONE NO. 1 olomi t z
.PTIC TANK.CAPACITY
:ACITING FACILITY:(typc) -jeo ,C<_(size)
I OF BEDRO�OMSS l
J✓NER��_ ���� —.
,[umIT DATE:O ^_ `. COMPLIANCE DATE: S�
aaration Distance.Between:the; ..
eximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
vate Water Supply Well.and Leaching Facility'(If any wells exist on
site or within 200 feet of leaching.facitity) Feet
;e of Weiland andLeaching-Facility(if any wetlands exist within
300 feet of leaching facility)
RNISHFD BY
s4 C ty
;3S
3
1;t, �
a
zf
�Z
https://itsgldb.town.barnstable.ma.us:8431/Home/ShowAsbuilt?mp=152003009&sq=1 1/1
No.' �i5— ( 1p Fee �J
BOARD OF HEALTH
TOWN OF BARNSTABLE
Z(ppricattou _for lVell Cou.5tructiou Vermtt
Application is hereby made for a permit to Construct(�), Alter( ), or Repair( ) an individual well at:
Location-Address Assessors Map and Parcel
Owner Address
QS � ��A �1\�ir�911�1nL I� U Pax 2^l�3, ()iuAw MN 0-&53
Installer-Driller Address
Type of Building
Dwelling
Other-Type of Building\' No. of Persons
Type of Well �1 ��� V Capacity I y 9p, I
Purpose of Well
Agreement:
The undersigned agrees to install the afore described individual well in accordance with the provisions of the
Town of Barnstable Board of Health Private Well Protection Regulation-The undersigned further agrees not to place the
well in operation until a Cert' c to o Compliance has been issued by the Board of Health.
SCBy
d _ Z5
) -4 — . Date
Application Approved
Date
Application Disapproved for the following reasons:
Date
Permit No. '� —� Issued �J 1_5
Date
---------------------------------------------------------------------------------------------------------
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate of Compliance
THIS IS TO CERTIFY,that the individual well Constructed , Altered( ), or Repaired( )
by
Installer
at
has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Prot c '°n
Regulation as described in the application for Well Construction Permit No.�1 -�Od (p Dated 3 1�6 li/
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORILY.
Date Inspector
No Fee L—�
BOARD OF HEALTH
TOWN OF BARNSTABLE {
2pplication _for Yell Con.5truction Permit
Application is hereby made for a permit to Construct V), Alter( ), or Repair( ) an individual well at:
003 C,0�
Location-Address Assessors.Map and Parcel
Owner r Address
Installer-Driller Address
Type of Building /
Dwelling �1
Other-Type of Building No. of Persons
Type of Well q i .sc�qr-) Capacity I
Purpose of Well b�GII( g
Agreement:
The undersigned agrees to install the afore described individual well in accordance with the provisions of the
Town of Barnstable Board of Health Private Well Protection Regulation-The undersigned further agrees not to place the
well in operation until a Certificate of Compliance has been issued by the Board of Health.
Si ned k u I �e. -,,-.A : (Z-5 I In
V Date'
Application Approved B r
Date
APlication Disapproved for the following reasons:
Date
Permit No. Issued ?J � s
r
Date
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate of (Compliance
THIS IS TO CERTIFY,that the individual well Constructed&��Altered( ), or Repaired,( )
by
Installer ,,,
at
has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Prot ct'on
Regulation as described in the application for Well Construction Permit No.1��G 15 —GC Dated 3 1�E
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORILY.
Date Inspector
BOARD OF HEALTH
TOWN OF BARNSTABLE
ell Construction permit
No. ���- 1� �^} � Fee
Permission is hereby granted to T")_Q c w,n Q� fkj�f>1 q L
Installer
to Construct Alter( ), or Repair( an individual well at:
No. I "' O CJ (� _ -60a nS� �-�-
Street *�
as shown on the application for a Well Construction Permit No. �X,1,5 Dated
Date J�� Approved B;y
y°E"^R," CERTIFICATE OF ANALYSIS Page: 1 of 1
r Barnstable County Health Laboratory (M-MA009)
... .{��SE�' Report Prepared For: Report Dated: 4/28l2015
Sally Desmond
Desmond Well Drilling Order No.: G1586386
P O Box 2783
Orleans, MA 02653
Laboratory lD#: 1586386-01 Description: Water-Drinking Water
Sample#: Sample Location: 1301 Service Road,W Barnstable Collected: 04124/2015
Collected by: customer Received:" 04/24/2015
Routine_M
ITEM RESULT UNITS RL MCL METHOD tt TESTED
Nitrate as Nitrogen 2.3 mg/L 0.10 10 EPA 300.0 4/24/2015
Iron 0.48 mg/L 0.10 0.3 SM 31118 4/26/2015
Manganese ND mg/L 0.025 0.050 SM 3111B 4/2 812 0 1 6
pH 6.3 PH AT 25C NA 6.5-8.5 SM 4500-H-13 4/24/2015
Sodium 16 mg/L 2,5 20 SM 3111E 4/28/2015
Total Coliform 0 /100ml 0 0 SM 9222B 4/24/2015
onductance 190, umohs/cm 2.0 SM 2510E 4/2412015
Based on the results of the parameters tested, the water is suitable for drinking, but may present aesthetic problems
(taste,odor, staining)due to Iron.
Attached please find the laboratory certified parameter list. Approved By:
(Lab Director) �
ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level
Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605
+;
'`vp4 rat,` CERTIFICATE OF ANALYSIS
Barnstable County Health Laboratory (M-MA009)
Nsrrc'�tvst^
Recipient: Sally Desmond Matrix: Water-Drinking Water
Desmond Well Drilling Sampled: 04/24/2015 10:00
De
P Box Well
Received: 04/24/2015 11:00
Collection Address: 1301 Service Road,W Barnstable
Orleans, MA 02653 Sample Location:
j Order#: G1586386 Description: 2day-1301 Service Rd
Lab 10: 1586386-01 Date Analyzed: 4/24/2015 @ 15:36
Sample#: Analyst: yn
Method: EPA 524.2 Dilution Factor: 1
Comment: eased on the results of the parameters tested,the water is suitable for drinking,but may present aesthetic problems(taste,
odor,staining)due to Iron. --
L.....
- -......- - -...-...-....-.._.-._,-..-..- - -.....- - -
EPA 524.2- Vo/adle Organics by GC/MS
es I MCL MDL
su LlCIL MDL ��
Parameter ug/L ug/L ug/L Parameter ug/L ug/L ug/L
80 0.50
Dichlorodifluoromethane ND o.5o Chloroform 5.4
_- -.... -- - - .
_ - - 70 0.50
-- 0.5o cis 1,2 Dichloroethene ND
Chloromethane _ __ N_p_ -
- - - - - -- - 2.0 0.50 cis-1 3 Dlchloropro ene 0.50
Vinyl chloride -. ..-. .-... ND _F-200-
�- pND 0.50 Dibromochloromethane NDBromomethane ND ND 0.50
1,1,1,2-Tetrachloroethane ND 0.5D Dibromomethane
ND 0.50 Ethylbenzene
Np 700 0.50
1 1 1-Tdchloroethane -
ND 0.50
oeth._ 0.50 Hexachlorobutadiene
I112,2-Tetrachloroethane ND` =------- -- --
ND 0.50
1,1,2-Tdchloroethane ND 5.0 0.50 Isopropylbenzene - - - - --_-__-,
-... _ - - -- - NO 5.0
_.. ._.. _... _-...._ - - - - 50
0,5o Methylene chloride
1,1-Dichloroethane ND -
1,1 7.0 0.50 Methyl tent butyl ether NO
0.50
-Dlchloroethene ND
..-.....-_... ND 0.50
1,1-Dichloro ro ene ND 0.50 _ Naphthalene -- -_-.-
- - -
-- - -- ND
D.sa n Butylbenzene ND 0.50
1 2 3-Trichlorobenzene ----- --- --
- - -. - 0.50
_.. -- ._._... -..- - - -- -- Np
1,2,3-Trichloropropane--� _ ND 0.50 n-Propylbenzene
ND 0.50
F11,2,41-Trimethy.lbenzene
2,4-Trichlorobenzene - ND 70^ 0.50 p Isopropyitoluene _
ND 0.50 sec-Butylbenzene ND 0.50
- 100 0.50
p
1,2-Dibromo-3-chloro ropane ND - { oso_ Styrene -ND .. -.._-._.-...
- - - -- - - ND 0.50 tent Butylbenzene ND 0.50
,1,2-Dibromoethane(EDB)
ND 6o0 0.50 Tetrachloroethene ND 5.0 0.50
1,2 Dichlorobenzene ND 1000 0.50
5,D 0.50 Toluene
1,2-Dichloroethane NO _ ---
f 000 0.50
1,2 Dichloropropane --- ND- 0.50 r.trans-1,2-Dlchlora
al xylenes ND 1000 0.50
- - ND o.50 ethene ND11,3,5-Trimethylbenzene 0.50
----
1 3 D obenzene _ ND 0,50 trans 1,3_Dichloropropene - - -.--„-
- -- - -- -- -- _ _ ___ -I- -.....-..
ND 0.50 Trlchioroethene NO 5.0 0.50
1,3-Didhloropropane _ _-�-- - -- 0.50
1,4 Dichlorobenzene -^ i ND 5.0 0.50 Trichlorofluoromethane - - - - ND- -
----
2 2-Dkcrloropro ane ND 0s0 Surrogates %Recovered QC Limits(%)
2-Chlorotoluene ND o.50 p-Bromofluorobenzene 910 70 130
--- - -..-.._-.-._.
4-Chlorotoluene ND o.50 1,2 Dichlorobenzene-d4 112% 70 130
Benzene ND 5.0 0.50 - - -- --
Bromobenzene - - - ND - - 0.50
Bromochloromethane ND D.So
Bromodichloromethane N D 0.50
-_.
Bromoform ND 0.50
-...-..-...-,.
Carbon tetrachloride ND 5.0 0.50
Chlorobenzene -_-_ 100- _ -
Chloroethane ND 0.50
Approved B
Attached please find the laboratory certified parameter list. (Lab Director) YZ`Oyl
NO=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level
Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph:508-375-6605 Page 1 of 1
:,mom
Massachusetts Department of Environmental Protection
�� ~ • r Bureau of Resource Protection
Well Completion Reports
Well Driller
Please specify work performed: CBuin�-ot#-Aisessoes
at well location:
New Well ' umber: Street Name:
SERVICE ROAD
Please specify well type: Map#:
`Domestic -- �M 152 _
Assessor's Lot#: ZIP Code: �A
Y"l
Number
!i Of Wells: 003009 02666
L�
City/Town:
Well Location BARNSTABLE
In public right-of-way: GPS
Yes C` Pb North: West:
41.68899 70.37436
Subdivision/Property/Description:
Mailing Address:
r click here if same as well location addres
Property Owner: Street Number: Street Name:
SEGOLINI CONSTRUCTION 117 MINTON LANE
City/Town: State:
Engineering Firm: BARNSTABLE MASSACHUSETTS
ZIP Code:
02668
Board of health permit obtained:
Yes �`% Not Required
Permit Number: Date Issued:
W2015 006 03/16/2015
i
r
4
Massachusetts Department of Environmental Protection
4
Bureau of Resource Protection—Well Driller Program
Well Completion Reports(General)
(fir
Well Driller - General Well Form
DRILLING METHOD
Overburden Bedrock
Auger I-Choose Bedrock--
WELL LOG OVERBURDEN LITHOLOGY
From(ft) To(ft) Code Color Comment Drop in drill Extra fast or Loss or addition
stem slow drill rate fluid
0 20 Silty Sand And Gr Brown (}YES C NO f fast C>Slow - Loss ( Add,
i
20 25 Silty Sand And Gr Brown C` Fast C) Slow t, Loss f' Addi
25 ((45 Medwm Sand Brown C YES ND r Fast C'Slow C; Loss r Addi
45 65 Fine To Coarse S Brown r ry f=YES ' NO f- Fast r' Slow (', Loss C Addi
65 85 Fine To Coarse S,�3 Brown C =YESr (° Fast r Slow ( Loss C,Add,
85 96 Fine To Coarse S . Brown • i YES (7 ND Fast f'Slow r- Loss 'Addi
L
WELL LOG BEDROCK LITHOLOGY
Drop in drill Extra fast or Loss or addition of Visible Extra
From(ft) To(ft) Code Comment Rust Large
stem slow drill rate fluid
Staining Chips
�� Choose Code aL—A,
C YES r' NO C Fast C Slow r Loss r Addition LLYe Ye
ADDITIONAL WELL INFORMATION
Developed Yes C- No Disinfected Yes ` No
Total Well Depth 96 Depth to Bedrock
Fracture _.._...........
Surface Seal Type None Enhancement r'Yes No
CASING (C Is Casing above ground? From: 1 To: 0
From To Type Thickness Diameter Driveshoe
0 92 Polyvinyl Chloride , Schedule 4 11 0 V► �4I r Ye
SCREEN J No Scre
' L Massachusetts Department of Environmental Protection
Bureau of Resource Protection—Well Driller Program
Well Completion Reports(General)
... ..
From To Type Slot Size Diameter
92 96 Stainless Steel Well Point 0.012 4
WATER-BEARING ZONES r DRY WE
From To Yield(gpm)
45 112
PERMANENT PUMP(IF AVAILABLE)
--Choose Pump -Choose
Pump Description Horsepower
Description--- Horsepower---
Pump Intake Depth(ft) Nominal Pump Capacity(gpm)
ANNULAR SEAL/FILTER PACK
Water Batches Method Of
From To Material Weight Material Weight
(gal) (count) Placement
Choose Material .I (Choose Material �"''''�'� i --Choose One
WELL TEST DATA
Date Method Yield(gpm) Time Pumped Pumping Level(ft Time To Recover Recovery(ft
(HH:MM) BGS) (HH:MM) BGS)
04/24/2015 Constant Rate Pump 12�� 1:30 47 0:01 45
WATER LEVEL ,
Date Static Depth BGS(ft) Flowing Rate(gpm)
Measured
04/24/2015 45 12 '
COMMENTS
Massachusetts Department of Environmental Protection N
yb W" Bureau of Resource Protection—Well Driller Program
Well Completion Reports(General)
i .
WELL DRILLERS STATEMENT
This well was drilled or altered under my direct supervision,according to the applicable rules and regulations, and this report is complete
and accurate to the best of my knowledge.
DESMON
THOMAS E Monitoring[M] Supervising Driller III,
Driller DESMOND III Registration# 764 Signature THOMAS,
DESMOND WELL
Date Job Complete
Firm DRILLING INC. Rig Permit# 023 04/24/2015
NOTE:Well Completion Reports must be filed by the registered well driller within 30 days of well completion.
' r ,
•4
Commonwealth of Massachusetts
City/Town of Barnstable
Percolation Test
Form 12
.4^M
Percolation test results must be submitted with the Soil Suitability Assessment for On-site Sewage
Disposal. DEP has provided this form for use by local Boards of Health. Other forms may be used, but
the information must be substantially the same as that provided here. Before using this form, check with
the local Board of Health to determine the form they use.
Important:When filling out forms A. Site Information
on the computer„ A
use only the tab dilson Segolini
key to move your Owner Name
cursor-do not 1301 Service Road/Map 152, Lot 009
use the return Street Address or Lot#
key.
West Barnstable MA 02668
r� Cityrrown State Zip Code
C: 774-836-6895
Contact Person(if different from Owner) Telephone Number.
B. Test Results
10/17/14 11:13 10/17/14 11:40
Date Time Date Time
Observation Hole# TP-1 /P-1 TP-3/ P-2
.,
Depth of Perc 48-66 ---_ _._._ 72-90 _...----- -
Start Pre-Soak 11:13 11:40
End Pre-Soak 11:26 -24 g water 11:47 -24 g water
Time at 12" 11:26 11:47
Time at 9" 11:30 11:49
Time at 6" 11:36 11:52
Time (9"-6") 6 min 3 min
Rate (Min./Inch) 2 min/in 1 min/in.
Test Passed: ® Test Passed:
Test Failed: ❑ Test Failed: ❑
Ronald F. Bukoski
Test Performed By:
Ms Donna Z. Miorandi, R.S., Health Inspector,Town of Barnstable
Witnessed By:
Comments:
r
J
t5form1.2.doc-06/03 Perc Test-.Page 1 of 1
,r
Commonwealth of Massachusetts
City/Town of Barnstable
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
A. Facility Information
Adilson Segolini
Owner Name
1301 Service Road. 152/009
Street Address Map/Lot#
West Barnstable MA 02668
City State Zip Code
w -
B. Site Information -
1. (Check one) ® New Construction ❑ Upgrade ❑ Repair
)t
2. Soil Survey Available? ® Yes ❑ No If yes: USDA Barnstable County BfC
Source Soil Map Unit
Barnstable-Plymouth-Nantucket Complex Poor Filter
Soil Name Soil Limitations
Glacial Moraine Sandwich Moraine-Terraced Slope
Geologic/Parent Material Landform
3. Surficial Geological Report Available? ® Yes ❑ No If yes: 1993/USDA Soil Survey BfC
Year Published/Source Publication Map Unit
4. Flood Rate Insurance Map
Above the 500-year flood boundary? ® Yes ❑ No Within the 500-year flood boundary? ❑ Yes ® No
If Yes,continue to#5.
Within the 100-year flood boundary? ❑ Yes ® No
5. Within a velocity zone? ❑ Yes ® No
6. Within a Mapped Wetland Area? El Yes ® No MassGIS Wetland Data Layer: N/A
PP Wetland Type
7. Current Water Resource Conditions (USGS): 10/2014 Range: ❑ Above Normal ® Normal ❑ Below Normal
Month/Year
8. Other references reviewed: USGS Topographic Map
• Barnstable GIS Map
t5form11 docx-rev.9/14 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 1 of 8
Commonwealth of Massachusetts
City/Town of Barnstable
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
C. On-Site Review (minimum of two holes required at every proposed primary and reserve disposal area)
Deep Observation Hole Number: TP-1 10/17/14 0900 Hrs Cldy, 60's F
Date Time Weather
1. Location
Ground Elevation at Surface of Hole: +/-70' Latitude/Longitude: /
feet
Description of Location: Northern side of Moraine slope
2. Land Use Wooded, undeveloped. No visible surface stones. 10% N
(e.g.,woodland,agricultural field,vacant lot,etc.) Surface Stones(e.g.,cobbles,stones,boulders,etc.) Slope(%)
Greenbriers, Brush & Mixed Trees Moraine Northern side of terraced slope.
Vegetation Landform Position on Landscape(SU,SH, BS,FS,TS)
3. Distances from: Open Water Body >150 Drainage Way >100 Wetlands >150
feet feet feet
Property Line +/-30 W Drinking Water Well >150 Other
feet feet feet
4. Parent Material: Glacial Unsuitable Materials Present: ❑ Yes ® No
If Yes: ❑ Disturbed Soil ❑ Fill Material ❑ Impervious Layer(s) ❑ Weathered/Fractured Rock ❑ Bedrock
5. Groundwater Observed: ❑ Yes ® No If yes:
Depth Weeping from Pit Depth Standing Water in Hole
Estimated Depth to High Groundwater: 2402 _ +/-50 ft
inches elevation
1 Elevation estimated from Barnstable GIS map.
2. Estimated from USGS map and proximal
surface water elevations.
t5forml l.docx•rev.9/14 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 2 of 8
Commonwealth of Massachusetts
City/Town of Barnstable
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
C. On-Site Review (continued)
Deep Observation Hole Number: TP-1
Redoximorphic Features Coarse FragmentsSoil
a
Soil Horizon/Soil Matrix:Color- Soil Texture �o by Volume
' Depth(in.) Layer Moist(Munsell) (USDA) Cobbles Soil Structure Consistence Other
Depth Color Percent Gravel (Moist)
&Stones
Forest Litter
0 -12 A 10YR2/1 N/A Sandy Loam over Organic Loose Tree Roots
Soil
12 -34 B 10YR5/8 N/A Sandy Loam No Struc. Friable Decreasing
Roots
34-120 C 2.5Y6/6 N/A Loamy Sand '10-20 5-15 Granular Loose
Additional Notes:
Percolation test performed in C Layer.
t5form1l.docx•rev.9/14 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 3 of 8
Commonwealth of Massachusetts
CityrFown of Barnstable
p Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
ram.
C. On-Site Review (continued)
Deep Observation Hole Number: TP-2 10/17/14 0930 Hrs Cidy, 60s F
Date Time Weather
1. Location
Ground Elevation at Surface of Hole: +/-66' Latitude/Longitude: /
feet
2. Land Use Wooded, Undeveloped None visible. Level
(e.g.,woodland,agricultural field,vacant lot,etc.) Surface Stones(e.g.,cobbles,stones,boulders,etc.) Slope(%)
Greenbriers, Brush & Mixed Trees Glacial ice contact Shallow depression.
Vegetation Landform Position on Landscape(SLI,SH,BS,FS,
3. Distances from: Open Water Body >150 Drainage Way >50 N Wetlands >150
feet feet feet
Property Line +1-40 N Drinking Water Well >150 Other
feet feet feet
4. Parent Material: Glacial Unsuitable Materials Present: 0 Yes ❑ No
If Yes: ❑ Disturbed Soil ❑ Fill Material ® Impervious Layer(s) ❑ Weathered/Fractured Rock ❑ Bedrock
5. Groundwater Observed: ❑ Yes ® No If yes: _
Depth Weeping from Pit Depth Standing Water in Hole
Estimated Depth to High Groundwater: 192 +/-50ft
inches elevation
1 Elevation estimated from Barnstable GIS map.
t5form11.docx•rev.9/14 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 4 of 8
Commonwealth of Massachusetts
City/Town of Barnstable
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
C. On-Site Review (continued)
Deep Observation Hole Number: TP-2
Coarse Fragments
o
Soil Horizon/Soil Matrix:Color- Redoximorphic Features Soil Texture /�by Volume Soil
Depth(in.) Layer. Moist(Munsell) (USDA) Cobbles Soil Structure Consistence(Moist)
Other
Depth Color- Percent Gravel
&Stones ( )
0 - 12 A 10Yr2/1 N/A Sandy Loam Forest Litter Loose Roots
over Organic
12 -28 B 2.5Y5/6 N/A Sandy Loam No Loose
Structure
28 -82 C1d 2.5Y6/3 N/A Gravelly 5-10 5 Massive Friable Ablation
Sandy Loam Till
82 -192 C2d 10YR5/6 N/A Gravelly 5-10 5 Massive Friable Interlockin
Sandy am g
Stones
Additional Notes:
1. No suitable soils identified at this location for a SAS.
t5form11.docx•rev.9/14 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 5 of 8
Commonwealth of Massachusetts
d City/Town of Barnstable
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
D. Dete
rmination of High Groundwater Elevation
1. Method Used: Obs. Hole#TP-1 Obs. Hole#TP-2
® Depth observed standing water in observation hole >120 >192
inches inches
® Depth weeping from side of observation hole >120 >192
inches inches
® Depth to soil redoximorphic features (mottles) >120 >192
inches inches
❑ Depth to adjusted seasonal high groundwater(Sh)
(
USGS methodology) inches inches
Index Well Number Reading Date
Sh= Sc—[Sr X (OWE—OWmax)/OWrl
Obs. Hole# Sc Sr OW': OWmax OWr Sh
Obs. Hole# Sc Sr OWc OWmax OWr Sh
E. Depth of Pervious Material
1. Depth of Naturally Occurring Pervious Material
a. Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil
absorption system?
M Yes ❑ No TP-1 &TIP-3 / TP-1 &TP-3
b. If yes, at what depth was it observed? Upper boundary: 34& 84 Lower boundary: Below
inches 120 &
c. If no, at what depth was impervious material observed? Upper boundary: Lower boundary:
inches inches
t5forml l.docx•rev.9/14 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 6 of 8
Commonwealth of Massachusetts
City/Town of Barnstable
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
kv
F. Certification
I certify that I am currently approved by the Department of Environmental Protection pursuant to 310 CMR 15.017 to conduct soil
evaluations and that the above analysis has been performed by me consistent with the required training, expertise and experience
described in 310 CMR 15.017. 1 further certify that the results of my soil evaluation, as indicated in the attached Soil Evaluation Form,
are accurate and in accordance with 310 CMR 15.100 through 15.107.
s a,, 10/17/14
Signature of Soil Evaluator Date
Ronald F. Bukoski/SE 270 6130/16
Typed or Printed Name of Soil Evaluator/License# Expiration Date of License
Ms. Donna Z. Miroandi;R.S. Town of Barnstable
Name of Board of Health Witness Board of Health
Note: in accordance with 310 CMR 15.018(2)this form must be submitted to the approving authority within 60 days of the date of field testing, and
to the designer and the property owner with Percolation Test Form 12.
t5forml l.docx•rev.9/14 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 7 of 8
Commonwealth of Massachusetts
City/Town of Barnstable
p Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
Field Diagrams
Use this sheet for field diagrams: See attached Barnstable GIS map.
t5form1 l.docx•rev.9/14 Form 11 —Soil Suitability Assessment for on-Site Sewage Disposal •Page 8 of 8
Commonwealth of Massachusetts
City/Town of Barnstable
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
C. On-Site Review (minimum of two holes required at every proposed primary and reserve disposal area)
Deep Observation Hole Number: TP-3 10/17/14 1015 Hrs Cldy, 60's F
Date Time Weather
1. Location
Ground Elevation at Surface of Hole: 69' Latitude/Longitude: /
feet
Description of Location: Northern side of terraced slope.
2. Land Use Wooded No surface stones visible. Level
(e.g.,woodland,agricultural field,vacant lot,etc.) Surface Stones(e.g.,cobbles,stones,boulders,etc.) Slope(%)
Greenbriers, brush, &trees. Glacial Morraine Northern edge of terrace.
Vegetation Landform Position on Landscape(SU,SH,BS, FS,TS)
3. Distances from: Open Water Body >150 Drainage Way >100 Wetlands >150
feet feet feet
Property Line 55 E Drinking Water Well >150 Other
feet feet feet
4. Parent Material: Ablation Till over Glacial Outwash Unsuitable Materials Present: ❑ Yes ❑ No
If Yes: ❑ Disturbed Soil ❑ Fill Material ❑ Impervious Layer(s) ❑ Weathered/Fractured Rock ❑ Bedrock
5. Groundwater Observed: ❑ Yes ® No If yes:
Depth Weeping from Pit Depth Standing Water in Hole
Estimated Depth to High Groundwater: >132 Below 58 ft
inches elevation
1 Elevation estimated from Barnstable GIS map.
1 .
t5form11 (4).doc•rev.9/14 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 1 of 4
Commonwealth of Massachusetts
City/Town of Barnstable
F Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
C. On-Site Review (continued)
Deep Observation Hole Number: TP-3
Redoximorphic Features Coarse FragmentsSoil
o
Soil Horizon/Soil Matrix:Color- Soil Texture �o by Volume
Depth(in.) Layer Moist(Munsell) (USDA) Cobbles (Moist)Soil Structure Consistence Other
Depth Color Percent Gravel
8 Stones
0-12 A - 10YR2/1 N/A Sandy Loam No Struc. Loose
12—32 B 10YR5/8 N/A Sandy Loam No Struc. Loose
32—84 C1d 2.5Y6/6 NIA Loamy Sand Massive Friable
84-132 C2 2.5Y6/6 N/A Gravelly 10-20 Granular Loose
Sand
Additional Notes:
t5forml 1 (4).doc•rev.9/14 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 2 of 4
Commonwealth of Massachusetts
City/Town of Barnstable
A Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
C. On-Site Review (continued)
Deep Observation Hole Number: TP-4 10/17/14 1030 Hrs Cldy, 60's F
Date Time Weather
1. Location
Ground Elevation at Surface of Hole: 70' Latitude/Longitude: /.
feet
2. Land Use Wooded -Undeveloped None visible. Level
(e.g.,woodland,agricultural field,vacant lot,etc.) Surface Stones(e.g.,cobbles,stones,boulders,etc.) Slope(%)
Greenbriers, brush, &trees. Glacial Morraine Terraced level
Vegetation Landform Position on Landscape(SU,SH,BS,FS,
3. Distances from: Open Water Body >150 Drainage Way >150 Wetlands >150
feet feet feet
Property Line 50 E Drinking Water Well >150 Other
feet feet feet
4. Parent Material: Glacial Morraine Unsuitable Materials Present: ® Yes ❑ No
If Yes: ❑ Disturbed Soil ❑ Fill Material ® Impervious Layer(s) ❑ Weathered/Fractured Rock ❑ Bedrock
5. Groundwater Observed: ❑ Yes ® No If yes:
Depth Weeping from Pit Depth Standing Water in Hole
Estimated Depth to High Groundwater: >132
inches elevation
1 Elevation estimated from Barnstable GIS map.
t5form1l (4).doc•rev.9/14 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 3 of 4
Commonwealth of Massachusetts
City/Town of Barnstable
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
C. On-Site Review (continued)
Deep Observation Hole Number: TP-4
Coarse Fragments
Redoximorphic Features %by Volume Soil
Depth(in.) Soil Horizon/Soil Matrix:Color- Soil Texture Soil Structure Consistence Other
Layer Moist(Munsell) (USDA) Cobbles (Moist)
Depth Color Percent Gravel &Stones
0—12 A- 10YR2/1 N/A - Sandy Loam No. Struc. Loose
12—32 B 10YR5/8 N/A Sandy Loam No Struc. Loose
t
32 -132 C1d 2.5Y6/6 N/A Loamy Sand 10-20 5-15 Massive Friable
Additional Notes:
C1d most likely unsuitable for SAS.
t5forml 1 (4).doc•rev.9/14 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 4 of 4
Commonwealth of Massachusetts
City/Town of Barnstable
F Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
C. On-Site Review (minimum of two holes required at every proposed primary and reserve disposal area)
Deep Observation Hole Number: TP-5 10/17/14 1200 Hrs Cldy, 60's F
Date Time Weather
1. Location
Ground Elevation at Surface of Hole: 70' Latitude/Longitude: /
feet
Description of Location: Northern side of terraced slope.
2. Land Use Wooded—undeveloped. None visible. Level
(e.g.,woodland,agricultural field,vacant lot,etc.) Surface Stones(e.g.,cobbles,stones,boulders,etc.) Slope(%)
Greenbriers, brush &trees. Glacial Morraine Northern side of terraced slope.
Vegetation Landform Position on Landscape(SU,SH,BS,FS,TS)
3. Distances from: Open Water Body >150 Drainage Way >100 Wetlands >150
feet feet feet
Property Line 80 E Drinking Water Well >150 Other
feet feet feet
4. Parent Material: Glacial Unsuitable Materials Present: ® Yes ❑ No
If Yes: ❑ Disturbed Soil ❑ Fill Material ® Impervious Layer(s) ❑ Weathered/Fractured Rock ❑ Bedrock
5. Groundwater Observed: ❑ Yes ® No If yes:
Depth Weeping from Pit Depth Standing Water in Hole
Estimated Depth to High Groundwater: >132 Below 59 ft
inches elevation
1 Elevation estimated from Barnstable GIS map.
t5forml 1 (5).doc•rev.9114 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 1 of 4
Commonwealth of Massachusetts
City/Town of Barnstable
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
C. On-Site Review (continued)
Deep Observation Hole Number: TP-5
Coarse Fragments
Redoximorphic Features o Soil
Soil Horizon/Soil Matrix:Color- Soil Texture �o by Volume
Depth in. Soil Structure Consistence Other
De
p ( ) Layer Moist(Munsell) (USDA) Cobbles (Moist)
Depth Color Percent Gravel Stones
- 0 -12 A 10YR2/1 N/A Sandy Loam No Struc. Loose
12 -32 B 10YR5/8 N/A Sandy Loam No Struc. Loose
32 -80 C1d 2.5Y6/6 N/A Loamy Sand 10-20 5-10 Massive Firm
80 -132 C2 2.6Y6/6 N/A Gravelly 10-20 Granular Loose
Sand
Additional Notes:
C2 suitable for SAS.
t5form11 (5).doc-rev.9/14 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 2 of 4
Commonwealth of Massachusetts
City/Town of Barnstable
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
C. On-Site Review (continued)
Deep Observation Hole Number: TP-6 10/17/14 1230 Hrs Cldy, 60's F
Date Time Weather
1. Location
Ground Elevation at Surface of Hole: 70' Latitude/Longitude: /
feet
2. Land Use Wooded - undeveloped None visible. Level
(e.g.,woodland,agricultural field,vacant lot,etc.) Surface Stones(e.g.,cobbles,stones, boulders,etc.) Slope(%)
Greenbriers, brush, &trees Glacial Morraine Northern side of terrace.
Vegetation Landform Position on Landscape(SU,SH,BS,FS,
3. Distances from: Open Water Body >150 Drainage Way >100 Wetlands >150
feet feet feet
Property Line 30 W Drinking Water Well >150 Other
feet feet feet
4. Parent Material: Glacial Morraine Unsuitable Materials Present: ❑ Yes ® No
If Yes: ❑ Disturbed Soil ❑ Fill Material ❑ Impervious Layer(s) ❑ Weathered/Fractured Rock ❑ Bedrock
5. Groundwater Observed: ❑ Yes ® No If yes:
Depth Weeping from Pit Depth Standing Water in Hole
Estimated Depth to High Groundwater: >120 Below 60 ft
inches elevation
1 Elevation estimated from Barnstable GIS map.
t5form11 (5).doc•rev.9/14 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 3 of 4
Commonwealth of Massachusetts
City/Town of Barnstable
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
k1pi -
C. On-Site Review (continued)
Deep Observation Hole Number: TP-6
Coarse Fragments
Redoximorphic Features /�o e Soil
Soil Horizon/Soil Matrix:Color- Soil Texture by Volume
Consistence
Depth(in.) Layer Moist(Munsell) (USDA) Cobbles Soil Structure Mo st) Other
Depth Color Percent Gravel &Stones
_ 0.-12 A - 1OYR2/1 N/A. __ . . . Sandy Loam No Struc. Loose
12 -34 B 10YR518 N/A Sandy Loam No Struc. Loose
34-120 C 2.5Y6/6 N/A Loamy Sand 10-20 5-15 No Struc. Friable
Additional Notes:
C Layer suitable for SAS. _
t5forml 1 (5).doc•rev.9/14 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 4 of 4
Town of Barnstable Geographic Information System October 27,2014
X 61.85
X 77:79 U.P.#291
tv Baseline� I
.73
O 78, X 64.3 64. F
CO X
70.15
X 84.38 O TP-21
0
162003001 TP-61 p
101800 TP-1�
70.72 P-1I °
69.08
2 ° P-5) X 't'o
1#0085 7Q �y X 67.44
X 69.29 P-2 TP-3 0
TP-41
X 70.9
162003009
8� #1301
�b
152007
66.55 #630
/Test Pit Locations /
No. Baseline(ft) :Offset,(ft)
TP-1 86.5 6 E /
TP-2 53 10 E
TP-3 95 60 E u 76.87
TP-4 130 60 E 1620W
#1347,
TP-5 95 35 E
TP-6 92 9 W 16220006
84 78
152010
0 =8ee� �#1660
DISCLAIMERS:This map Is for planning purposes only. It Is not adequate for legal Map:152 Parcel:003009 r
boundary determination or regulatory Interpretation. Enlargements beyond a scale of Selected Parcel
1"=100'may not meet established map accuracy standards. The parcel lines on this map Owner:WEST BARNSTABLE DEER CLUB Total Assessed Value:$124000
are only graphic representations of Assessor's tax parcels. They are not true property Co-Owner: Acreage:1.00 acres Abutters E
t, boundaries and do not represent accurate relationships to physical features on the map Location:1301 SERVICE ROAD
such as building locations. Buff' ` }
c
f
CGE Engineering, Inc.
Civil ♦ Geotechnical ♦ Environmental Consulting
Engineers & Scientists
Letter of Transmittal
To: Ms. Donna Z. Miorandi, R.S. Date: December 3, 2014
Town of Barnstable, Public Health Div. File No: 141013
200 Main Street Subject: Soil Evaluation Report
Hyannis, MA 02601 Barnstable, MA
We are sending you: Attached ❑ Under Separate Cover
The Following Items:
Copies Date Description
1 10/17/14 Soil Suitability Assessment for Sewage Disposal, Town of Barnstable
Form, 1301 Service Road, West Barnstable
1 10/17/14 DEP Form t5formI I and t5form 12, 1301 Service Road,
West Barnstable
These are Transmitted as Checked Below:
dFor your information l"For your use ❑ Approved as Noted
0 As Requested O For Approval ❑ For Review
Remarks:
M
Cy to:
CL Signed'7Z,-„A-)
Ronald F. Bukoski, P.E., L.S.P.
21 Hilltop Drive,P.Q.Box 456, Sagamore,MA 02561 (508)833-2250 RFBukoski@aol.com
Town of Barnstable P#
Department of Regulatory Services
rwwernets Public ]Health Division Date 0c
MAss.
163y.A'I 200 Main Street,Hyannis MA 02601
rfD.M A
Date Scheduled v� Time
Fee Pd.
Soil Suitability ,Assessment fog- Sew is o r
Performed By: AL1-) fi -t,,I(os r i B is'8 Witnessed By:
LOCATION& GENERAL INFORMATION
Location Address Owner's Name A014 SOH C rc al4 l
13d.1
S'ef& D Address C:`r771-1) 8366`'68 75'
UV e-S-t 6.0 gj4-6 L;e_
Assessor's Map/Parcel: I 2 6 0
3_Dot Engineer's Name cG �W6 '
NEWCONSTRUCIION JL_�/__ REPAIR Telephone# Sid � f� ZZ
�.
Land Use _tariDMIECej EE1 RE(iDf)J7IR1 Slopes 7&R QAc a
(9h) LEUEA. -* /0/ AI Surface Stones /�,aNr VLC(RLge'
Distances from: Open Water Body >IYO ft Possible Wet Area »_110 ft Drinking Water Well _**[ ft
Drainage Way > IQO ft Property Line 30Ltlj ypn/ ft Other
ft
SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes)
SF� R ArGNc ARiJ,S?AaLC &S MA't F'4a TtfT T�iT l,G aT.�nJSo
S'�F ' A7Y13'TCNLra �N�rrOS f f Z dF TP—/ A,a T%-3
R-
Parent material(geologic) S4t'JQtJ tGM 002A I A)C -.7�QJ?Ae�D pth to Bedrock rl'OT .d�i Ceal jng
Depth to Groundwater. Standing Water in Hole: /'� Erl(&A ) is R E,4Viceping from Pit Pne I�OnI F I �
Estimated Seasonal High Groundwater 77-2 , FucIl+/ 66 &Q
DETERMINATION FOR SEASONAL HIGH WATER TABLE
Method Used: QZ c FRO A ri e Al ST_ 7P .lOG.
Depth Observed standing in obs:hole: TP-Z ? 1jZ In. Depth to soil mottles: V w Z T JIZ in.
Depth to weeping from side of obs,hole:-a-? in. Groundwater Adjustment i9ja ft.
Index Well# Reading Date: Index Well level a._. Adj.factor Adj.Groundwater Level,,,,v,
PERCOLATION TEST bate'tt: J Time
Observation P_1
Hole# Tp-I P-I •TA-3 2 Time at9" _ ►i:�i9
Depth of Pere 4 .6 6 it 72 9�°) Time at G" It 36 W.52
Stair Pre-soak Time @ 'I"ime(9"-6") Mia 3 M4t)
End Pre-soak ll:26 1 i :4 7 2`/9 EAGjI
Rate Min./Inch
-+ Site Suitability Assessment: Site Passed y F.5 Site Failed: Additional Testing Needed(Y/N)
Original: Public Health Division Observation Hole Data To Be Completed on Back-----------
***If percolation test is to be conducted within 100' of wetland,you must first notify the.
Barnstable Conservation Division at least one(1) week prior to beginning.
Q:\SEPTICNPERCF0RM.DOC
� u - C,E V 2.JS ABLE /►'1Ap.
1- 7a' DEEP.OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (Munsell) Mottling (Stnucture,Stones,,Boulders.
onsistency.%Gravel)
Faac-�T L•:rra
t7— 12 X0A toy
2 I iREE• �ohTS
l 2 s 3`l as 0 �" o
Y b 1AcZ� SAS
5 /S°/V Codx3EES �Z
/e-Ze+ fo Akrv'! e
CocA-r�aA t fREt?C. 7a'"; (=rcJEd
�� 66 .DEEP OBSERVATION LE LOG Dole# 7F 2 OF,6
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell Mottling
g (Structure,Stones,Boulders.
onsistem.%Gravel)
0- 12 `AnDO oA 1� Zi' P/orJ� r�onEr,—<.77W-R `
7R 6 Roo-T S 4 !�
12- Z SAaD 1-6A s
i �aAvt ccy I `
2 — C! S �J .f0 I►� Z.s 6/. \ �./OiJ� iMAS` �! RALATie�
CZA GRA��Z �b , ' �loA)l �A.SScsE�
At t TrA 9 Lf LJA7 76,J t ORLAS.
69 ` DEEP OBSERVATION HOLE LOG Dole#'i Pa 3 or-
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency, Gravell
0 Fog r:.Cr l>�';'a
. t oA raj ""'n i /26a
12 - n) M s I'ld d C
CIA LnALAYSA0D Z,S
��ot� (1/ZAA)cxiAl2
8 ' - 132 b RAva t. SA Z,S 6 s
tTA SiX o(2 x..
' x
tl- 70° DEEP OBSERVATION DOLE LOG Hole# —7 P_ ar- 6
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stolim Boulders.
Consistency,
fc1rzcjrr L i?rBQ
-1 '11 �
2 — -,CA 43 .LBA(A 10 S h/,0A)E
n�Adrw E, Fa,Aa`9
` �'Aa 6 Q JC o n CG
a Z.S
CIA
!µ I lC l:L n1 t.% d Z S Ii
Flood Insurance Rate Map:
Above 500 year flood boundary No— Yes .✓__
Within 500 year boundary No Yes
Within 100 year flood boundary No._Ne� 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? DES
If not,what is the depth of naturally occurring pervious material?
Ceftification
I certify that on S (date)I have passed the soil evaluator examination approved by the
Department of Environmental Protection and that the above analysis was performed by me consistent with
the required training,expertise and
experience described in 510 CMR 15.017.
Signature .� Date
S` Z 70
Q:VS EPTIC\PERCPORM.DOC
? cr Z ®�- Z
a _ - �c s rua►t�.
-4F 7B ' DEE]P.O�SER'6�ATYON SOLE LQG ]E�ol # `y ' S : r-
Depth from.' Sot[Horizon Soil Texture . .soil'Col or Soil Other
Surface(mJ,_:: (USDA) (Mansell) Mottling (Stnueture Stones,Boulders
o ls�stency 96'Gravell
o . t inEST L/_
.
� .
►
I.
I.
TRC:E :?2p�s
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-.
. ,.
.
C� E
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/- 70 ' DEEP OBI E I ON H LE LOQ lE�ol # P 6 e>` 6
Depth from Soil Horizon SoR ,,xture k Soil Color . Soil . Other.
�.�I.:�...:�.I I..—:-:.�.:*-II�.1 II..1.-,-���,..�I��.,..L..'.I
,.I..,9.t.I.l...:._..i..d'.I.1.P:--.I":..I*..'-.'..1.�'-.:...:�:...:.:-
Surface(in.)
(USDA) (Mansell Moulin
g (Structure;Stones,Boulders.
. . - .
-.: sten %
o si a
r 6oJo aa'
44me II
K
.. `
O: r? .. .4TimL�
,.
. .
.
7a.�,�
o`- RA
dt`L
. .
— Coh'8LE 47 /S�.:
`. A
)AL —I ..'?rre1z6 .SU f3L:
F
--;: DEEP OBSERVATION HOLE LOG Holo
Depth from 5oi1 Horizon Soil Texture . Soil Color Soil Other
Surface(in.) (USDA) (Munsel) Mottling; :(structure,Stones,Boulders.
.. .
C
. ontte Q
".. ,
. .. .
� .
::"_
RU P.0 3SEIt'VA ION DOLE I,OG Hole# .
Depth from : Soil Horizon :: Soil Texture Soil Color . soil Other
Surface(in) (USDA) (Mansell) Mottling (Structure,Stones;13ouldars.
. . .. .
.
on'tin
..
.
. — .
.
.
. .
I+'lood.Insurance Rate Map.
. Above 500 year flood boundary`.No Yes::_
. _. -
Within 500,year boundary — Yes _ `
. .
No
. .... . .
Within L00 year flood boundary No Yes. .
. -
..
_ Denh,of Naturally Occurring:Pervious.Material -
Does of least four feat of naturally occurring perwlous tnaterial exist to all areas observed throughout the
area proposed.for the soil absorption system? -
.-
If not;what is the depth of naturally occurring pervious material? — :;
Certification �)��
I certify that on `I . (date)I have passed the s..oil evaluator examination approved by the
.
. .
Department of Environmental Protection and thatthe above analysis was performed by me,consistent with .
11.
1.
I.
- the reyuired.training,expertise and experience described in 10 CMR 15A17.
Signature: aTg� Date
. . .
Q:ISEFTI VERCFORM.DOC .
Town of Barnstable Geographic Information System October 27,2014
X 61.85
X 7719 U.P.#29_I
ly 1��---�Ba e it ne I .73 -'
.78 X 64.3 X 64. F ! XCO 29
70.15
t
X .38 O TP-21
.# i
162003001 TP-6I \
t 160o TP-1
70.7a� Phi l sF�`
69.08 �t`F
¢ 162003008 X 67.44
7� TP-5� � X
I
X 69.29 TP-31
TP-4]
i X 70.9
162003009
8� #1301
152007
_ 66.55 #630
Test Pit Locations
No. Baseline:00 Offset';(ft)-
T04 86.5 6 E
TP-2 53 10 E a
TP-3 95 60 E u 76.87
TP-4 130 60 E 162008
#1347
TP-6 92 9 W 1 2006
P
` 84,78 Q 152010
\ CC
Me 162 Parcel:DISCLAIMERS:This map is for planning purposes only. It Is not adequate for legal p� Selected Parcel N
boundary determination or regulatory Interpretatlon. Enlargements beyond a scale of Owner:WEST BARNSTABLE DEER CLUB Total Assessed Value:$124000
1"=100'may not meet established map accuracy standards. The parcel lines on this map E
ere only graphic representations of Assessor's tax parcels. They are not true property Co-Owner: Acreage:1.00 acres Abutters ::;:;;:; w
boundaries and do not represent accurate relationships to physical features on the map Locatlon:1301 SERVICE ROAD �✓
such as building locations. Buffer '/ /
1301 Service Road October 17,2014
West Barnstable,MA Page 1
VW
.�
"{ "~'4 *s yam�y(f `i• a... - •`e!•- 1y,e
IF
°�;•'� � ~'�x r� "i"�"++,ems' r��`s �'
n -77
0 ti f
Photo 1: TP-1 as viewed from the east/northeast end of the test pit.
Excavated C layer soil(Loamy Sand)stockpiled on left side of
photograph. Percolation test performed in C layer from 48-66 inches
below grade with a percolation rate of 2 min/in.
,
:hut '� 1. ''feY�� , �F"�+;y .i•'�.9 tR�' > S -
s.I
Y1i• e;r- �"r- Y ._
�, . { e.- _ -.`" ��,{ .mac•�
• f.'J ,x
t cep;� r• .�'. e .
i s +�• r
In l C qq..
Photo 2: TP-3 location as viewed from eastern end of test pit. Stockpiled soil on
right side of photograph from C2 layer, 84 to 132 inches below grade.
Percolation rate 1 min/in.from 72 to 90 inches below izrade.
CGE Engineering,Inc.
Commonwealth of Massachusetts
City/Town of Barnstable
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
A. Facility Information
Adilson Segolini
Owner Name
1301 Service Road 152/009
Street Address Map/Lot#
West Barnstable MA 02668
City State Zip Code
B. Site Information
1. (Check one) ® New Construction ❑ Upgrade ❑ Repair
2. Soil Survey Available? ® Yes ❑ No If yes: USDA Barnstable County BfC
Source Soil Map Unit
Barnstable-Plymouth-Nantucket Complex Poor Filter
Soil Name Soil Limitations
Glacial Moraine Sandwich Moraine -Terraced Slope
Geologic/Parent Material Landform
3. Surficial Geological Report Available? ® Yes ❑ No If yes:' 1993/USDA Soil Survey BfC
Year Published/Source Publication Map Unit
4. Flood Rate Insurance Map
Above the 500-year flood boundary? ® Yes ❑ No Within the 500-year flood boundary? ❑ Yes ® No
If Yes,continue to#5.
Within the 100-year flood boundary? ❑ Yes ® No
5. Within a velocity zone? ❑ Yes ® No
MassGIS Wetland Data Layer: N/A
6. Within a Mapped Wetland Area? ❑ Yes ® No Wetland Type
7. Current Water Resource Conditions(USGS): 10/2014 Range: ❑ Above Normal ® Normal ❑ Below Normal
Month/Year
8. Other references reviewed: USGS Topographic Map
Barnstable GIS Map
t5forml l.docx•rev.9/14 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 1 of 8
Commonwealth of Massachusetts
City/Town of Barnstable
r Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
C. On-Site Review (minimum of two holes required at every proposed primary and reserve disposal area)
Deep Observation Hole Number: TP-1 10/17/14 0900 Hrs Cldy, 60's F
Date Time Weather
1. Location
Ground Elevation at Surface of Hole: +/-70' Latitude/Longitude: /
feet
Description of Location: Northern side of Moraine slope
2. .Land Use Wooded, undeveloped. No visible surface stones. 10% N
(e.g.,woodland,agricultural field,vacant lot,etc.) Surface Stones(e.g.,cobbles,stones,boulders,etc.) Slope(%)
Greenbriers, Brush & Mixed Trees Moraine Northern side of terraced slope.
Vegetation Landform Position on Landscape(SU,SH, BS, FS,TS)
>150 Drainage Wa
3. Distances from: Open Water Body 9 Y >100 Wetlands >150
feet feet feet
Property Line +/-30 W Drinking Water Well >150 Other
feet feet feet
4. Parent Material: Glacial Unsuitable Materials Present: ❑ Yes ® No
If Yes: ❑ Disturbed Soil ❑ Fill Material ❑ Impervious Layer(s) ❑ Weathered/Fractured Rock ❑ Bedrock
5. Groundwater Observed: ❑ Yes ® No If yes:
Depth Weeping from Pit Depth Standing Water in Hole
Estimated Depth to High Groundwater: 2402 50 ft
inches elevation
1 Elevation estimated from Barnstable GIS map.
2. Estimated from USGS map and proximal
surface water elevations.
t5form11.docx•rev.9/1.4 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 2 of 8
Commonwealth of Massachusetts
City/Town of Barnstable
r Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
C. On-Site Review (continued)
Deep Observation Hole Number: TP-1
Redoximorphic Features Coarse Fragments Soil
Soil Horizon/Soil Matrix:Color- Soil Texture /o by Volume
Depth(in.) Layer Moist(Munsell) (USDA) Cobbles Soil Structure Consistence Other
Depth Color Percent Gravel &Stones
Forest Litter
0 - 12 A 10YR2/1 NIA Sandy Loam over Organic Loose Tree Roots
Soil
12 -34 B 10YR5/8 N/A Sandy Loam No Struc. Friable Decreasing
Roots
34 - 120 C 2.5Y6/6 N/A Loamy Sand 10-20 5-15 Granular Loose
Additional Notes:
Percolation test performed in C Layer.
t5forml l.docx•rev.9/14 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 3 of 8
Commonwealth of Massachusetts
City/Town of Barnstable
p Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
yI
C. On-Site Review (continued)
Deep Observation Hole Number: TP-2 10117/14 0930 Hrs Cldy, 60s F
Date Time Weather
1. Location
Ground Elevation at Surface of Hole: +/-66' Latitude/Longitude: /
feet
2. Land Use Wooded, Undeveloped None visible. Level
(e.g.,woodland,agricultural field,vacant lot,etc.) Surface Stones(e.g.,cobbles,stones,boulders,etc.) Slope(%)
Greenbriers, Brush & Mixed Trees Glacial ice contact Shallow depression.
Vegetation Landform Position on Landscape(SU,SH, BS,FS,
3. Distances from: Open Water Body >150 Drainage Way >50 N Wetlands >150
feet feet feet
Property Line +/-40 N Drinking Water Well >150 Other
feet feet feet
4. Parent Material: Glacial Unsuitable Materials Present: ® Yes ❑ No
If Yes: ❑ Disturbed Soil ❑ Fill Material ® Impervious Layer(s) ❑ Weathered/Fractured Rock ❑ Bedrock
5. Groundwater Observed: ❑ Yes ® No If yes:
Depth Weeping from Pit Depth Standing Water in Hole
Estimated Depth to High Groundwater: 192 +/-50ft
inches elevation
1 Elevation estimated from Barnstable GIS map.
t5form11.docx-rev. 9/14 Form 11 —Soil Suitability Assessmentr n- •for O Site Sewage Disposal Pa ge4of8
Commonwealth of Massachusetts
City/Town of Barnstable
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
C. On-Site Review (continued)
Deep Observation Hole Number: TP-2
Coarse Fragments
o
Soil Horizon/Soil Matrix:Color- Redoximorphic Features Soil Texture /�by Volume Soil
Depth m. Soil Structure Consistence Other
p ( ) Layer Moist(Munsell) (USDA) Cobbles (Moist)
Depth Color Percent Gravel g Stones
0 -12 A 10Yr2/1 N/A Sandy Loam Forest Litter Loose Roots
over Organic
No
12 -28 B 2.5Y5/6 N/A Sandy Loam Structure Loose
28 -82 C1d 2.5Y6/3 N/A Gravelly 5-10 5 Massive Friable Ablation
Sandy Loam Till
82 -192 C2d 10YR5/6 N/A San Grad v Loam 5-10 5 Massive Friable Ingterlockin Stones
y
Additional Notes:
1. No suitable soils identified at this location for a SAS.
t5forml l.docx•rev.9/14 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 5 of 8
Commonwealth of Massachusetts
City/Town of Barnstable
r Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
D. Determination of High Groundwater Elevation
1. Method Used: Obs. Hole#TP-1 Obs. Hole#TP-2
® Depth observed standing water in observation hole >120 >192
inches inches
® Depth weeping from side of observation hole >120 >192
inches inches
® Depth to soil redoximorphic features (mottles) >120 >192
inches inches
❑ Depth to adjusted seasonal high groundwater(Sh)
(USGS methodology) inches inches
Index Well Number Reading Date
Sh= Sc—[Sr X(OWc—OWmax)/OWrl
Obs. Hole# Sc Sr OW, OWmax OWr %
Obs. Hole# Sc Sr OWc OWmax OWr Sh
E. Depth of Pervious Material
1. Depth of Naturally Occurring Pervious Material
a. Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil
absorption system?
Z Yes ❑ No TP-1 &TP-3 / TP-1 &TP-3
b. If yes, at what depth was it observed? Upper boundary: 34& 84 Lower boundary: Below
inches 120 &
c. If no, at what depth was impervious material observed? Upper boundary: Lower boundary:
inches inches
t5form1l.docx-rev.9/14 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal -Page 6 of 8
Commonwealth of Massachusetts
City/Town of Barnstable
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
F. Certification
I certify that I am currently approved by the Department of Environmental Protection pursuant to 310 CMR 15.017 to conduct soil
evaluations and that the above analysis has been performed by me consistent with the required training, expertise and experience
described in 310 CMR 15.017. 1 further certify that the results of my soil evaluation, as indicated in the attached Soil Evaluation Form,
are accurate and in accordance with 310 CMR 15.100 through 15.107.
_ �t 10/17/14
Signature of Soil Evaluator Date
Ronald F. Bukoski/ SE 270 6130/16
Typed or Printed Name of Soil Evaluator/License# Expiration Date of License
Ms. Donna Z. Miroandi, R.S. Town of Barnstable
Name of Board of Health Witness Board of Health
Note: In accordance with 310 CMR 15.018(2)this form must be submitted to the approving authority within 60 days of the date of field testing, and
to the designer and the property owner with Percolation Test Form 12.
t5form1l.docx•rev.9/14 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 7 of 8
Commonwealth of Massachusetts
City/Town of Barnstable
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
Field Diagrams
Use this sheet for field diagrams: See attached Barnstable GIS map.
t5form11.docx•rev.9/14 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 8 of 8
Town of Barnstable Geographic Information System October 27, 2014y
X 61,85 !
X 77:7"s U.P.#29�
g05`ne"I, 7 .73
CID .78, X 64.3 X 64. X b
70.15
OX 4.3s O �,TP-2)
162003001 � TP r
#1600 TP-1I
70.72�' P-1I �F'prr
69.08 �CF
162003008 TP-51y X 's'o
01265 X 67.44
X 69.a9 2 TP-3j
P-21'�...r=-70
TP-41
X 70.9
162003009
�0 #1301
�b
162007
66.55 #630
Test Pit Locations
No. ' $aseline(ft) Offset'.(ft)'
TP-1 86.5 6 E e
TP-2 53 10 E
TP-3 95 60 E Y 76.87
#1347
TP-5 95 35 E 10,
TP-6 92 9 W 1 25 00
\ P
\ 84.., Q 162010
0 �Fe e� �! �#1660
DISCLAIMERS:This map Is for planning purposes only. It is not adequate for legal Map:152 Parcel:003009 ® N
boundary determination or regulatory Interpretation. Enlargements beyond a scale of Cwner:WEST BARNSTABLE DEER CLUB Total Assessed Value:$124000 Selected Parcel
1"-100'may not meet established map accuracy standards. The parcel lines on this map E
are only graphic represenlatlons.of Assescor'o tax parcels. They are not true property Co-owner: Acreage:1.00 acres Abutters
boundaries and do not represent accurate reletionshipts to physical features on the map Location:1301 SERVICE ROAD f /
such as building locations. Buffer j/�/
Commonwealth of Massachusetts
City/Town of Barnstable
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
C. On-Site Review (minimum of two holes required at every proposed primary and reserve disposal area)
Deep Observation Hole Number: TP-3 10/17/14 1015 Hrs Cidy, 60's F
Date Time Weather
1. Location
Ground Elevation at Surface of Hole: 69' Latitude/Longitude: /
feet
Description of Location: Northern side of terraced slope.
2. Land Use Wooded No surface stones visible. Level
(e.g.,woodland,agricultural field,vacant lot,etc.) Surface Stones(e.g.,cobbles,stones, boulders,etc.) Slope(%)
Greenbriers, brush, &trees. Glacial Morraine Northern edge of terrace.
Vegetation Landform Position on Landscape(SU,SH,BS, FS,TS)
3. Distances from: Open Water Body >150 Drainage Way >100 Wetlands >150
feet feet feet
Property Line 55 E Drinking Water Well >150 Other
feet feet feet
4. Parent Material: Ablation Till over Glacial Outwash Unsuitable Materials Present: ❑ Yes ❑ No
If Yes: ❑ Disturbed Soil ❑ Fill Material ❑ Impervious Layer(s) ❑ Weathered/Fractured Rock ❑ Bedrock
5. Groundwater Observed: ❑ Yes ® No If yes:
Depth Weeping from Pit Depth Standing Water in Hole
Estimated Depth to High Groundwater: >132 Below 58 ft
inches elevation
1 Elevation estimated from Barnstable GIS map.
t5forml 1 (4).doc•rev.9/14 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 1 of 4
Commonwealth of Massachusetts
City/Town of Barnstable
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
C. On-Site Review (continued)
Deep Observation Hole Number: TP-3
Coarse Fragments
Redoximorphic Features o Soil
Soil Horizon/Soil Matrix:Color- Soil Texture /o by Volume
Depth(in.) Layer Moist(Munsell) Cobbles Soil Structure Consistence Other
(USDA)
Depth Color Percent Gravel (Moist)
&Stones
0 - 12 A 10YR2/1 N/A Sandy Loam No Struc. Loose
12—32 B 10YR5/8 N/A Sandy Loam No Struc. Loose
32—84 C1d 2.5Y6/6 NIA Loamy Sand Massive Friable
84-132 C2 2.5Y6/6 N/A Gravelly Sand 10-20 Granular Loose
Additional Notes:
t5form11 (4).doc•rev.9/14 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 2 of 4
Commonwealth of Massachusetts
City/Town of Barnstable
F Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
C. .On-Site Review (continued)
Deep Observation Hole Number: TP-4 10/17/14 1030 Hrs Cldy, 60's IF
Date Time Weather
1. Location
Ground Elevation at Surface of Hole: 70' Latitude/Longitude: /
feet
2. Land Use Wooded -Undeveloped None visible. Level
(e.g.,woodland,agricultural field,-vacant lot,etc.) Surface Stones(e.g.,cobbles,stones,boulders,etc.) Slope(%)
Greenbriers,brush, &trees. Glacial Morraine Terraced level
Vegetation Landform Position on Landscape(SU,SH, BS, FS,
3. Distances from: Open Water Body >150 Drainage Way >150 Wetlands >150
feet feet feet
Property Line 50 E Drinking Water Well >150 Other
feet feet feet
4. Parent Material: Glacial Morraine Unsuitable Materials Present: ® Yes ❑ No
If Yes: ❑ Disturbed.Soil ❑ fill Material ® Impervious Layer(s) ❑ Weathered/Fractured Rock ❑ Bedrock
5. Groundwater Observed: ❑ Yes ® No If yes:
Depth Weeping from Pit Depth Standing Water in Hole
Estimated Depth to High Groundwater: >132 _
inches elevation
1 Elevation estimated from Barnstable GIS map.
t5form11•(4).doc•rev.9/14 Form 11 —Soil Suitability Assessment for on-Site Sewage Disposal •Page 3 of 4
Commonwealth of Massachusetts
City/Town of Barnstable
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
C. On-Site Review (continued)
Deep Observation Hole Number: TP-4
Redoximorphic Features Coarse Fragments Soil
Soil Horizon/Soil Matrix:Color- Soil Texture /o by Volume
Depth(in.) Layer Moist(Munsell) (USDA) Cobbles Soil Structure Consistence Other
Depth Color Percent Gravel (Moist)
&Stones
0—12 A 10YR2/1 N/A Sandy Loam No. Struc. Loose
12—32 B 10YR5/8 N/A Sandy Loam No Struc. Loose
32 -132 C1d 2.5Y6/6 N/A Loamy Sand 10-20 5-15 Massive Friable
Additional Notes:
C1d most likely unsuitable for SAS.
Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 4 of 4
t5form11 (4).doc-rev.9/14 Y .1 P 9
Commonwealth of Massachusetts ,
TCity/Town of Barnstable
'6 Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
C. On-Site Review (minimum of two holes required at every proposed primary and reserve disposal area)
Deep Observation Hole Number: TP-5 10/17/14 1200 Hrs Cldy, 60's F
Date Time Weather
1. Location
Ground Elevation at Surface of Hole: 70' Latitude/Longitude: /
feet
Description of Location: Northern side of terraced slope.
2. Land Use Wooded—undeveloped. None visible. Level
(e.g.,woodland,agricultural field,vacant lot,etc.) Surface Stones(e.g.,cobbles,stones,boulders,etc.) Slope(%)
Greenbriers, brush &trees. Glacial Morraine Northern side of terraced slope.
Vegetation Landform Position on Landscape(SU,SH,BS,FS,TS)
3. Distances from: Open Water Body >150 Drainage Way >100 Wetlands >150
feet feet feet
Property Line 80 E Drinking Water Well >150 Other
feet feet feet
4. Parent Material: Glacial Unsuitable Materials Present: ® Yes ❑ No
If Yes: ❑ Disturbed Soil ❑ Fill Material ® Impervious Layer(s) ❑ Weathered/Fractured Rock ❑ Bedrock
5. Groundwater Observed: '❑ Yes ® No If yes:
Depth Weeping from Pit Depth Standing Water in Hole
Estimated Depth to High Groundwater: >132 Below 59 ft
inches elevation
1 Elevation estimated from Barnstable GIS map.
t5form11 (5).doc•rev.9/14 Form 11 —Soil Suitability Assessment for on-Site Sewage Disposal •Page 1 of 4
Commonwealth of Massachusetts
lugCity/Town of Barnstable
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
C. On-Site Review (continued)
Deep Observation Hole Number: TP-5
Redoximorphic Features Coarse Fragmentso Soil
Soil Horizon/Soil Matrix:Color- Soil Texture /o by Volume
Depth(in.) Layer Moist(Munsell) (USDA) FCbbles Soil Structure Consistence Other
Depth Color Percent Gravel (Moist)
tones
0 - 12 A - 10YR2/1 N/A Sandy Loam No Struc. Loose
12 -32 B 10YR5/8 NIA Sandy Loam No Struc. Loose
32 -80 C1d 2.5Y6/6 NIA Loamy Sand 10-20 5-10 Massive Firm
80 -132 C2 2.5Y6/6 N/A Gravelly 10-20 Granular Loose
Sand
Additional Notes:
C2 suitable for SAS.
t5forml 1 (5).doc•rev.9/14 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 2 of 4
I
Commonwealth of Massachusetts
City/Town of Barnstable
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
C. On-Site Review (continued)
Deep Observation Hole Number: TP-6 10/17/14 1230 Hrs Cldy, 60's F
Date Time Weather
1. Location
Ground Elevation at Surface of Hole: 70' Latitude/Longitude: /
feet
2. Land Use Wooded - undeveloped None visible. Level
(e.g.,woodland,agricultural field,vacant lot,etc.) Surface Stones(e.g.,cobbles,stones,boulders,etc.) Slope(%)
Greenbriers, brush, &trees Glacial Morraine Northern side of terrace.
Vegetation Landform Position on Landscape(SU,SH, BS, FS,
3. Distances from: Open Water Body >150 Drainage Way >100 Wetlands >150
feet feet feet
Property Line 30 W Drinking Water Well >150 Other
feet feet feet
4. Parent Material: Glacial Morraine Unsuitable Materials Present: ❑ Yes ® No
If Yes: ❑ Disturbed Soil ❑ Fill Material ❑ Impervious Layer(s) ❑ Weathered/Fractured Rock ❑ Bedrock
5. Groundwater Observed: ❑ Yes ® No If yes:
Depth Weeping from Pit Depth Standing Water in Hole
Estimated Depth to High Groundwater: >120 Below 60 ft
inches elevation
1 Elevation estimated from Barnstable GIS map.
t5forml 1 (5).doc•rev.9/14 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal •Page 3 of 4
Commonwealth of Massachusetts
City/Town of Barnstable
Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal
C. On-Site Review (continued)
Deep Observation Hole Number: TP-6
Redoximorphic Features Coarse Fragments�/,b Volume Soil
Depth(in.) Soil Horizon/Soil Matrix:Color- Soil Texture y
Layer Moist(Munsell) (USDA) TCobbles Soil Structure Consistence Other
Depth Color Percent Gravel (Moist)
ones
0 - 12 A 10YR2/1 N/A Sandy Loam No Struc. Loose
12 -34 B 10YR5/8 N/A Sandy Loam No Struc. Loose
34-120 C 2.5Y6/6 N/A Loamy Sand 10-20 5-15 No Struc. Friable
Additional Notes:
C Layer suitable for SAS.
t5forml 1 (5).doc•rev.9/14 Form 11 —Soil Suitability Assessment for On-Site Sewage Disposal Page 4 of 4
i
Commonwealth of Massachusetts
City/Town of Barnstable
Percolation Test
Form 12
4M
Percolation test results must be submitted with the Soil Suitability Assessment for On-site Sewage
Disposal. DEP has provided this form for use by local Boards of Health. Other forms may be used, but
the information must be substantially the same as that provided here. Before using this form, check with
the local Board of Health to determine the form they use.
Important:When A. Site Information
filling out forms
on the computer,
use only the tab Adilson Segolini
key to move your Owner Name
cursor-do not 1301 Service Road/Map 152, Lot 009
use the return Street Address or Lot#
key.
West Barnstable MA 02668
City/Town State Zip Code
C: 774-836-6895
Contact Person(if different from Owner) Telephone Number
B. Test Results
10/17/14 11:13 10/17114 11:40
Date Time Date Tima
Observation Hole# T12-1 /P-1 TP-3/ P-2
Depth of Perc 48-66" 72-90"
Start Pre-Soak _ 11:13 11:40
End Pre-Soak 11:26 -24 g water 11:47 -24 g water
Time at 12" 11:26 11:47
Time at 9" 11:30 11:49
Time at 6" 11:36 11:52
Time (9"-6") 6 min 3 min
Rate (Min./Inch) 2 min/in 1 min/in.
Test Passed: ® Test Passed:
Test Failed: ❑ Test Failed: ❑
Ronald F. Bukoski
Test Performed By:
Ms Donna Z. Miorandi, R.S., Health Inspector,Town of Barnstable
Witnessed By:
Comments:
t5form12.doc•06/03 Perc Test-Page 1 of 1
1301 Service Road October 17,2014
West Barnstable,MA Page 1
:£• bra � ���. } �
MCI _ ,
�
Photo 1: TP-1 as viewed from the east/northeast end of the test pit.
Excavated C layer soil(Loamy Sand)stockpiled on left side of
photograph. Percolation test performed in C layer from 48-66 inches
below grade with a percolation rate of 2 min/in.
ay V
1K r a
S J lywy� '•�1\�'�� t !
Photo 2: TP-3 location as viewed from eastern end of test pit. Stockpiled soil on
right side of photograph from C2 layer, 84 to 132 inches below grade.
Percolation rate 1 min/in.from 72 to 90 inches below Trade.
CGE Engineering,Inc.
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n ' INSTALL RISERS # COVERS TO PIPES TO BE LAID LEVEL FOR 2" LAYER OF DOUBLE WASHED PEA5TONE
I v WITHIN 6" OF FINISH GRADE 2' OUT OF DISTRIBUTION BOX OVER 3/4" - I %2" DOUBLE WASHED STONE
m (SEE PLAN VIEW FOR LOCATIONS) ALL AROUND GENERAL NOTES
w WATER TEST D-BOX FOR
�r \ u LEVELNESS +� FLOW
a' N Q EQUALIZATION I . 5EPTIC SYSTEM 15 TO BE INSTALLED IN ACCORDANCE WITH
CL
3 10 CMR 1 5.00: TITLE V
a N
EL. 72.0 2. THIS SEPTIC SYSTEM IS NOT DESIGNED FOR THE USE OF A
1 `\ 0 a_ T.O.F. @ 4"5CH - - -EL. 70.0 GARBAGE DISPOSAL.
. Om Q EL. 73.0 a"5CH 40 PVC 40 PVC TOP @ EL. 67.2 3. TH15 PLAN 15 NOT TO BE U5ED FOR PROPERTY LINE DETERMINATION.
F°r 4°5CH 4o PVC 4. CONTRACTOR SHALL PROVIDE 48 HOUR NOTICE TO DE51GN
LOCl�S z lo" 14" (2) 500 GAL. PRECAST DRYWELLS
�68.0 67.50 �66.83 BOTTOM @ EL. 64.5 ENGINEER FOR ANY REQUIRED INSPECTIONS.
« x NSTALL GAS BAFFLE `C�/.00
O IN OUTLET TEE 7.25 6G.50 5. CONTRACTOR TO BE RESPONSIBLE FOR THE LOCATION OF ANY
1 DB-G UTILITY, ABOVE OR UNDERGROUND, PRIOR TO ANY EXCAVATION
Ln
NOTE: REMOVE ANY IMPERVIOUS MATERIAL FOR OR CONSTRUCTION.
w (H-20)
�^ ~ 1500 GALLON PRECAST A 5' RADIUS AROUND THE 501L ABSORPTION 5.5'
O Q �� SYSTEM AND REPLACE WITH CLEAN MEDIUM
` SEPTIC TANK INSTALL TANK 4 D-BOX
ON G"LAYER OF CRU5HED SAND.
\\ STONE
BOTTOM OF TH #5
@ EL 59.0
TBM - EL. G8.2
✓� ��`\`y \MAG NAIL IN PAVEMENT DE51GN DATA
DAILY I \\\ / � \\�`.I • \`\\�`\ \ SEPTIC TOANK(3)30 GPD x 200%GP 6G0 GODGPD
70 I +65. I \\ I \J\\ �`\
USE: 1 500 GAL. PRECA5T SEPTIC TANK
DISTRIBUTION BOX: DB-G (H-20)
\ ' 501L ABSORPTION SYSTEM:
USE: (2) 500 GAL. PRECAST DRYWELL5 LINED
\ \\ w/4' OF DOUBLE WASHED STONE ALL AROUND
\ \ TH , \, ; ; .\` CAPACITY:
\\ )k#\ I q\/Sogs , ` 51DEWALL: 7G x 2 x 0.74 = 1 12.5 GPD
BOTTOM: 13 x 25 x 0.74 = 240.5 GPD
\ \ 1 •'°08 � � � TOTAL: 353.0 GPD
DEEP OBSERVATION HOLE LOGS
TH \ /
- �� #I \ / / \ ` DATE: 1 O-1 7-2014
\ � F �®�\ 7O TEST BY: R. BUK05KI, CSE #270
\ ` \\ I WITNESS: D. MIORANDI, HEALTH AGENT
PERC RATE: < 2 MIN. / INCH
72.2+ #6 `(` • TH /� _ - J J // \ DEEP OBSERVATION HOLE#I EL. 70.0
#5 // / DEPTH
SOIL 501L SOIL COLOR 501L OTHER
HORIZON TEXTURE
��IRFACE (MUNSELL) MOTTLING
t ' / �0'- 1 2' A SANDY LOAM I OYR211
jI 70t8 y #3 1 2"_34" B SANDY LOAM !OYR5/8 PER.0 @ 48"-GG
/ � / 34"- !2G" C LO.a!y1Y SAND 2.5Y6/b ii _ 2 (v11N/IN
\ I 1%u ; / 73.G
\ O \ I 6+ DEEP OBSERVATION HOLE#2 EL. GG.0
\ \ \\ \ f DEPTH
\ / / FROM 501L 501L SOIL COLOR 5011- OTHER
SO \ \ \ / SURFACE HORIZON TEXTURE (MUNSELL) MOTTLING
0"- 1 2" A SANDY LOAM I OYR2/I _
1 2'-26" B SANDY LOAM 2.5Y5/G
+/2.G '- \ 28` -82" C I GRAVELLY SANDY LOAM 2.5YG/3
\ I \\ \\ \ .52"- 192" C2 GRAVELLY SANDY LOAM 1 OYR5 6
TH' ' It
\ \
61
11 \\ DEEP 055ERVATION HOLE#3 EL. G9.0
i
DEPTH 501L 501L 501L COLOR 50€L
FROM OTHER
/ L - HORIZON TEXTURE (MUNSIELU MOTTLING
\� I SURFACE
O"- 1 2" A SANDY LOAM I OYR,2/1
1 2"-32" B SANDY LOAM I OYK5/8 PERC @ 72"-90"
\\ +83 1 \\ i`ii \ \\ \ �1 \\ 1 84"- 18 2" C2 GRAVELLY SAND 2.5Y6/6 _ I MIN/IN
-,NOFA4
�+ \I I c RR ya
DEEP OBSERVATION HOLE#4 EL. 70.0 Y R
/ •Z-- \ i o \ \ \ \\ _ ./ I DEPTH No. 114.0
FROM HORIZON TEXTURE BMUNSELOR MOTTLING 5011- OTHER
\ O SURFACE gf$T�
11 Q 0"- 1 2' A SANDY LOAM I OYR2/ �+ `ASl
\ \\ \ I \\ \\ i ` \\ \\ CD -1 32"_ 32" C LOAMY SAND 2 5YG/6 ��/T1lR
\
\ SITE - SEWAGE PLAN
DEEP OBSERVATION HOLE#5 EL. 70.0
\ \ \ \\ V ` 1 FROM SOIL SOIL SOIL COLOR 5011-
GTHER FOR
5URFACE HORIZON TEXTURE (IMUNSELL) MorruNG 1301 SERVICE RD., WE5T BARN5TABLE, MA
\ 1 0"- 1 2" A SANDY LOAM I OYIR2/I
11 1 2"-32" B SANDY LOAM I OYIR5/8 PREPARED FOR
\ \ \ \ \ \ \ ` 1 32 80" G I LOAMY SAND 2.5W6/6
PROPOSEDi 80'- 132" C2 GRAVELLY SAND 2.5 616 5EGOLINI CONSTRUCTION
/ \ � WELL! SCALE: DATE: DRAWN BY:
1 \ '-lb
I " = 30' 03-04-20 1 5 TMW
/ 99.Oe' + EXISTING JOB NUMBER: REVISION: SHEET NUMBER:
WELL DEEP OBSERVATION HOLE#G EL. 70.0 1 5-003 5P-
DEPTH 501E SOIL 501L COLOR 51.1E WELLER * ASSOCIATES
FROM OTHER
� 80 HORIZON TEXTURE (MUNSIELL) MOTTLING
SURFACE _
0"- 12" A 5ANDYLOAM IOYR2/1 I G45 PALMOUTH RD., SUITE F9
1 2"-34" B SANDY LOAM I OYR5/8 P.O. BOX 4 1 7 CENTERVILLE, MA 02G32
`I 34'- 120" C LOAMY SAND 2.5YG/G TELEPHONE: (508) 328-4G92
EMAIL: trl5weller@gmall.com
NOTE: NO GROUNDWATER ENCOUNTERED IN ANY OBSERVATION HOLE REGISTERED LAND SURVEYORS ENVIRONMENTAL CONSULTANTS
Traverse PC
INSTALL RISERS t COVERS TO PIPES TO BE LAID LEVEL FOR 2." LAYER OF DOUBLE WASHED PEA5TONE
N d? WI HIN 6" OF FINISH GRADE 2' OUT OF DISTRIBUTION BOX OVER 3/4"- 1 V2" DOUBLE WASHED STONE
\ m (SEE PLAN VIEW FOR LOCATIONS) ALL AROUND GENERAL NOTES
u� WATER TEST D-BOX FOR
LEVELNESS FLOW
`:etas N Q EQUALIZATION 1 . SEPTIC 5Y5TEM 15 TO BE INSTALLED IN ACCORDANCE WITH
31 O CMR 1 5.00: TITLE V
N 2. TH15 SEPTIC 5Y5TEM 15 NOT DESIGNED FOR THE USE OF A
In
°� 0 - T.O.F. �� - - - EL. 70.0 GA
RBAGE DISPOSAL.
4"5CH
;7
hxF�a O LI 73.0 a°scH 4o PVC Pvc � TOP @ EL. 67.2 3. THI5 PLAN 15 NOT TO BE USED FOR PROPERTY LINE DETERMINATION.
Q 4° 4"scH ao Pvc �2 F: 4. CONTRACTOR SHALL PROVIDE 48 HOUR NOTICE TO DE51GN
LO C US: m I o" I a..
Z �68.0 6'7.50� (2) 500 GAL. PRECAST DRYVVELLS
g INSTALL GAS BAFFLE 7.00 66.83 BOTTOM @ EL. G4.5 ENGINEER FOR ANY REQUIRED INSPECTIONS.
O IN OUTLET TEE 7,25 GG.50 5. CONTRACTOR TO BE RESPONSIBLE FOR THE LOCATION OF ANY
UTILITY, ABOVE OR UNDERGROUND, PRIOR TO ANY EXCAVATION
wDB-6 NOTE: REMOVE ANY IMPERVIOUS MATERIAL FOR OR CONSTRUCTION.
I (H-20) A 5' RADIUS AROUND THE 501L ABSORPTION 5.5'
Ln t� ~ 1500 ON PRECAST SYSTEM AND REPLACE WITH CLEAN MEDIIUM
D O
0 GALL
5EPTIG TANK INSTALL TAN D-BOX
ON G"LAYER OF CRUSHED SAND.
STONE
BOTTOM OF TH #5
@ EL 59.0
TBM = EL. G8.2
\MAG NAIL IN PAVEMENT DESIGN DATA
DAILY FLOW: 3 BD\\ ! \ ( ) RM5 x I 10 GPD = 330 GPD
SEPTIC TANK: 330 GPD x 200% = GGO GPD
7n USE: 1 500 GAL. PRECAST SEPTIC TANK
DISTRIBUTION BOX: DB-G (H-20)
SOIL ABSORPTION SYSTEM:
U5E: (2) 500 GAL. PRECAST DRYWELL5 LINED
w/4' OF DOUBLE WASHED STONE ALL AROUND
\ CAPACITY:
\ \ TH ��� % %� SIDEWALL: 7G x 2 x 0.74 = 1 12.5 GPD
IN, 0f BOTTOM: 13 x 25 x 0.74 = 240.5 GPD
TOTAL: 353.0 GPD
DEEP OBSERVATION HOLE LOGS
TH I O-17-20 14
#I \ / \ DATE:
70 TEST BY: R. BUK05KI, C5E #270
,, \ ,! ; WITNE55: D. MIORANDI, HEALTH AGENT
\ _� ��I \ PERC RATE: < 2 MIN. / INCH
I TH
72.2� I ®#h TH ` _. ! // \ ? DEEP OBSERVATION HOLE#I EL. 70.0
_ DEPTH SOIL SOIL SOIL COLOR SOIL
r #5 `` (MUN
rl SUROA.C:E HORIZON TEXTURE SELL) MOTTLING OTHER
G'-1 2' A SANDY LOAM I OYR21 I
7
ai0.6m ,� _ _,., I I� 34° y PERC 48"-GG"
w - rr3j - w. / E SANDY LOAM I OYR5/6 °C
-_12a. G !oAn.,Yg.enro 2.5YG/G 2 MIN/1N
\ ! _ -
\ o \¢t 1 69.3 / - DF. '055ERVATION HOLE#2 EL. GG.0
\ •�. , p
\ \ \\ \ f DEPTH
SOIL SOIL
.. SOIL COLOR SOIL
\ / HORIZON TEXTURE OTHER
8O \ \\ SURFACE (NAUN5ELL) MOTTLING
�. C. 12" A SANDY LOAM I OYR2/
i 12'-28' B SANDY LOAM
+72 6 S5 --- 215 -82" C I GRAVELLY SANDY LOAM 2.SY6/3
\�
\ G2'- 1 92" C2 GRAVELLY SANDY LOAM 1 OYRS 6
TH
#4 11 \ DEEP 085ERVATION HOLE#3 EL. G9.0
SOIL SOIL S01L COLOR SOIL
FROM OTHER
HORIZON TEXTURE (MUN5ELL) MOTTLING
51JRFACE
0'- 12' A SANDY LOAM I OYR2/1
12'-32' B SANDY LOAM 1 OYR5/8
PERC @ 72"-90"
32"-84" C I LOAMY SAND 2.SY6/6 I MIN/IN
NI \ 1 ll �5 1 \ I 84'- 1 32 C2 GRAVELLY SAND 2.5YG/G
I `\`�� \ \\ \ / ` 1 1 + 1
s' t.
T cl .EVEN
/ Z Grp \.�� ` \ \ \ 1 I I DEEP OBSERVATION HOLE#4 EL. 70.0 35 vakum g1O V A O' 114
/ O \ \ \ 1 �,M SOIL COLOR 501L OTHER G T�
\ 1 / I DEPTr Qi l!
� r SOIL SOIL � A/
{ 4l HORIZON TEXTURE
p ` Si.RFACE (MUNSEI_U MOTTLING aO s'QNJTA�IP
l7 - - / 2' -132" B SANDY LOAM I OYR5/8 roNALV c
C LOAMY SAND 2.5YG/G
3
SITE - SEWAGE PLAN
\ \ \ \\ \ \ \ - -- - - -1-- DE--'P OB5ER1/AT!(71V HOLE#5 EL. 70.0
FOR
\ \ \ \ \ I 1 SOIL SOIL SOIL COLOR SOIL
\ � FROM OTHER -
\ \ i HORIZON TEXTURE (MUN5ELL) MOTTLING
\ \� Stir:;ACE 1 301 SERVICE RD., WEST BARNSTABLE, MA
0'- 12' !) SANDY LOAM I OYR2/1
12"-32' B SANDY LOAM I OYR5/8 PREPARED FOR
O' - 3 CI LOAMY SAND 2.5YG/G SEGOLINI CONSTRUCTION
� \ \ +84.9 PROPOSED` \\ ►It 80'- 132" C2 GRAVELLY SAND 2.5Y6/G
WELL
SCALE: DATE: DRAWN BY:
/ J 9y. 30' 03-04-201 5 TMW
OCR \ 1
/ \\ \ + WELL
LTING JOB NUMBER: 1 5-003 REV1510N: SHEET NUMBER: SP-
/ DEEP 0B5ERVATION HOLE#G EL. 70.0 DEPTH SOIL SOIL S(OILCOLOR SOIL WELLER * ASSOCIATES
\, 8O FROM HORIZON TEXTURE (IMUNSELL) MOTTLING OTHER
SURFACE
0'- 12' A SANDY LOAM I OYR2/1 I G45 FALMOUTH RD., SUITE F9
12.-34" B SANDY LOAM I OYR5/8 P.O. BOX 4 1 7 CENTERVILLE, MA 02G32
34'- 120" C LOAMY SAND 2.5YG/G TELEPHONE: (508) 328-4G92
EMAIL: trlsweller@gmall.com
NOTE: NO GROUNDWATER ENCOUNTERED IN ANY'OBSERVATION HOLE REGISTERED LAND SURVEYORS ENVIRONMENTAL CONSULTANTS
Traverse PC