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HomeMy WebLinkAbout0016 WHITE BIRCH WAY - Health 16' WHITE BIRCH WAY WEST BARNSTABLE A 128• -026 ' i r a8_6c2-� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 16 WHITE BIRCH WAY z Property Address DAMELIO Owner r+ Owner's Name information is required for WEST BARNSTABLE ✓ MA 11-15-16 a every page. Cityrrown State Zip Code Date of Inspection OF V1 Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information When filling out forms on the computer,use 1. Inspector: only the tab key to move your DOUGLAS A BROWN cursor-do not Name of Inspector use the return key. D.A.BROWN INC Company Name P.O. BOX 145 Company Address CENTERVILLE MA 02632 Cityrrown State Zip Code 508-420-4534 S14297 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 11-15-16 or's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page of17 r f1 /Dfd V V Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 16 WHITE BIRCH WAY Property Address DAMELIO Owner Owner's Name information is required for WEST BARNSTABLE MA 11-15-16 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 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: TANK WAS PUMPED AT TIME OF INSPECTION.SYSTEM MET ALL PASSING REQUIREMENTS AT TIME OF INSPECTION. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments yy� 16 WHITE BIRCH WAY Property Address DAMELIO Owner Owner's Name information is required for WEST BARNSTABLE MA 11-15-16 every page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3113 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 3 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 16 WHITE BIRCH WAY Property Address DAMELIO Owner Owner's Name information is required for WEST BARNSTABLE MA 11-15-16 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform!bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters El ® due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow t5ins•3/13 Title 5 Official inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 16 WHITE BIRCH WAY Property Address DAMELIO Owner Owner's Name information is required for WEST BARNSTABLE MA 11-15-16 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water.supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Ie Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 16 WHITE BIRCH WAY Property Address DAMELIO Owner Owner's Name information is required for WEST BARNSTABLE MA 11-15-16 every page. Citylrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(if they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ❑ ® Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner) provided with ® ❑ information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments yy. 16 WHITE BIRCH WAY Property Address DAMELIO Owner Owner's Name information is required for WEST BARNSTABLE MA 11-15-16 every page. City/Town State Zip Code Date of Inspection D. System Information Description: SYSTEM CONSISTS OF A 1500 GALLON TANK D-BOX AND 4 BEDROOM S.A.S WITH 4 FT OF STONE Number of current residents: 1 Does residence have a garbage grinder? ® Yes ❑ No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d WELL 9 ( Y 9 (gP ))� Detail: HOUSE HAS A GARBAGE DISPOSAL---THIS SYSTEM IS NOT DESIGNED FOR USE WITH A GARBAGE DISPOSAL AND IT NEECSTO BE DISCONNECTED. Sump pump? ❑ Yes ❑ No Last date of occupancy: CURRENTLY OCCUPIED Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M ,•�� 16 WHITE BIRCH WAY Property Address DAMELIO Owner Owners Name. information is required for WEST BARNSTABLE MA 11-15-16 every page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: CURRENTLY OCCUPIED Date Other(describe below): General Information Pumping Records: Source of information: DEBARROS SEPTIC Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1500 gallons How was quantity TANK SIZE q y pumped determined? Reason for pumping: MAINTENANCE Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 16 WHITE BIRCH WAY Property Address DAMELIO Owner Owner's Name information is required for WEST BARNSTABLE MA 11-15-16 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 2001 PER AS-BUILT CARD Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 Sludge depth: HEAVY t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 16 WHITE BIRCH WAY Property Address DAMELIO Owner Owner's Name information is required for WEST BARNSTABLE MA 11-15-16 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness HEAVY Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 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.): TANK WAS PUMPED AT TIME OF INSPECTION FOR MAINTENANCE. BEFORE PUMPING THERE WERE HEAVY SOLIDS AND SCUM. TANK DIDNT LOOK LIKE IT HAD BEEN PUMPED IN A WHILE. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 16 WHITE BIRCH WAY Property Address DAMELIO Owner Owner's Name information is required for WEST BARNSTABLE MA 11-15-16 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ElYes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 16 WHITE BIRCH WAY Property Address DAMELIO Owner Owner's Name information is required for WEST BARNSTABLE MA 11-15-16 every page. City/Town State Zip Code Date of Inspection i D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): AT TIME OF INSPECTION BOX HAD A LAYER OF SCUM IN IT PROBABLY DUE TO LACK OF PUMPING AND GARBAGE DISPOSAL. WATER WAS FLOWING FREELY INTO S.A.S FROM D- BOX. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): *If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: DEPTH, AND HEAVILY WOODED GROWTH IN AREA OF S.A.S NO RISERS WERE FOUND CLOSE TO GRADE t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M , 16 WHITE BIRCH WAY Property Address DAMELIO Owner Owner's Name information is required for WEST BARNSTABLE MA 11-15-16 every page. CityrTown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 3 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): CHAMBERS WERE NOT OPENED DUE TO DEPTH AND HEAVILY WOODED GROWTH IN AREA. THERE WERE NO VISIBLE SIGNS OF FAILURE FOUND IN AREA OF S.A.S OR VIEWED IN D- BOX. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 16 WHITE BIRCH WAY Property Address DAMELIO Owner Owner's Name information is required for WEST BARNSTABLE MA 11-15-16 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(rote condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): I Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of_vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 16 WHITE BIRCH WAY Property Address DAMELIO Owner Owner's Name information is required for WEST BARNSTABLE MA 11-15-16 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 16 WHITE BIRCH WAY Property Address DAMELIO Owner Owner's Name information is required for WEST BARNSTABLE MA 11-15-16 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: SEE ATTACHED AS-BUILT feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: i You must describe how you established the high ground water elevation: SEE ATTACHED AS-BUILT Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M s•�'' 16 WHITE BIRCH WAY Property Address DAMELIO Owner Owner's Name information is required for WEST BARNSTABLE MA 11-15-16 every page. Citylrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 TOWN OF BARNSTABLE LOCATION 1 J� f /A SEWAGE # �� J I VILLAGE lax�ati, �, l,O AS3ESSOR'S-MAP& LOT l INSTALLER'S NAME&PHONE NO. tau a SEPTIC-TANK CAPACITY LEACHING FACILITY: (si-(type) �j?© si - ie) a NO.OF BEDROOMS BUILDER OR OWNER A PERMITDATE: �7 U _COMPLIANCE�&T`E: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leachitg Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist- on site or within 200 feet of leaching facility) 1y Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) ra. Feet , Furnished by I. a II Y " 2 z 76 � ' f i TOWN OF BAP NSTABLE LOCATION ' SEWAGE VILLAGE_ ar I I� ASSESSOR'S MAP & LOT / INSTALLER'S NAME&PHONE NO. kpom-i �Q per t��'"�Z SEPTIC TANK CAPACITY LEACHING FACILITY: (type) n k<V0 (siie) '�S NO. OF BEDROOMS BUILDER OR OWNER/ PERMITDATE:_ �I/a�I� COMPLIANCE DATE: �} ° Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) °� Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) ' k Feet , Furnished by 131 i6 , f L_o T 1 J TOWN OF BARNSTA.BLE LOCATION _ ,:i-# 4l SEWAGE # -Z 1 VILLAGE //�� ASSESSOR'S-MAP & LOT IC INSTALLER'S NAME&PHONE NO. RnPL SEPTIC TANK CAPACITY 11pO LEACHING FACILITY: (type) t - NO. OF BEDROOMS 5 BUILDER OR OWNER fMAO PERMITDATE: �7/ab/CS COMPLIANCE'PATE: ZZE t Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any-wells exist ` on site or within 200 feet of leaching facility) Y �: Y= Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) k Feet Furnished by "K s � , No �` `�� FEE �4 co�i.K NWEALT ®F MASSACHUSUTTS Board of Health,_I J A(N aP1 j%C•6--,-, MA. APPLICATION FOP, DISPOSAL SYSHM CONSTRUCTION PERMIT Application for a Permit to Construct(�epair( ) Upgrade( ) Abandon( ) - Doe—complete System ❑Individual Components Location (S NA/ , i3(RC H WAY Owner's Name -t-06/�A A —04 M6:L l(� Map/Parcel# ;118 Address Lot# AG Telephone# Installer's Name 1 Designer's Name So/Vc CC,41 UC,T W hJ—tS Address Address E/0 g .LjA--,),JSTP- 9-0rip /h,A asjtwd All) LS Telephone# E—0 Telephone# Type of Building Lot Size �? / sq.ft. Dwelling-No.of Bedrooms 41 Garbage grindeA/0 Other-Type of Building No.of persons Showers ( ),Cafeteria ( ) Other Fixtures G` p 410 Design Flow (min.required) /� gpd Calculated design flow Design flow provided y-���gpd Plan: Date,/ Number of sheets Revision Date Title S/ ie '1 S'e w &A M Description of Soil(s) -e 0 L-04 f" Soil Evaluator Form No.� 30 Name of Soil Evaluator Y`•� (3�NkS Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS wl� �GE1 dJ� K I The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees to not to place the system in operation until a Certificate of Compliance has been issued by the Board of Health. Signed Date 6 FEE yLJ WPA . t ` (�1 i RA Tot, L /Board of Hea h, W v �l , M. 9N FOP, DISPOSAL SYSTEM CONSTRUCTION PERMIT APPLICATIt Application for a Permit to Construct(V)'Repair( Upgrade( Abandon( ®'Complete System ❑Individual Components t, t Location j 6 W H WAY Owner's Name M AS 0,4 y-VfL 10 Map/Parcel# �� Address Lot# - fp t ( 1" Telephone# Installer's Name dam:;L_, ei ; -* Designer's Name XAA)[te Su/VP- Ca-4sUCTcHju-ft Address Address yo 1� T AJ'o ST)v 90 A,>MO tZ S Jb r Telephone# �(�� �"�� 1�'� f> Telephone# S Q& 4-//A8-00 S y� 7. Type of Building Lot Size /9 q.ft. Dwelling-No.of Bedrooms Garbage grinde Other-Type of Building No.of persons Showers ( ),Cafeteria ( ) Other Fixtures Design Flow (min.required) ��� gpd Calculated design flow Design flow provided 'y7q gpd Plan: Date �U-� Number of sheets Revision Date Title V"CA N Description of Soil(s) 5"p pe-j4 I-" Soil Evaluator Form No. 0 Name of Soil Evaluator RO CA+R(3ANkS ate of Evaluation �!f `DESCRIPTION OF REPAIRS OR ALTERATIONS ✓ S. Gn / 4~ cao j t The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE'5 and further agrees to not to place the.sysem in operation until a Certificate of Compliance has been issued by the Board of Health.il r Signed . Date Pt�Gica�Fs S � �-+-.• Vti•'L. � f 1 FEE O Board of Health, I,A R N a A a L6= MA. CERTIFICATE OF COMPLIANCE / Description of Work: ❑Individual Component(s) W*Complete System ` ,� The undersi pJ d hereby certify that the Sewage Disposal System; Constructed Jt/),Repaired ( ),Upgraded ( ),Abandoned O by: t/�`l ' j.AC A vilT l l k.) , at 1 tD \tV f 11 t fi" t� I RC WAX has been installed in accordance with the p ovisions of 310 CMR 15.00 (Title 5) a d/the approved design plans/as-built plans relating to application No.���- dated cl 1�30 10 1 . ApprovZDesign Flow / 7� (gpd) Installer `} p Designer VA kY-e uJVL' didU lS(J(TA I pector: /L "r C \'$t A Date: 1C C��/C 2_ The issuance of this permit shall not be construed as a guarantee that the system will function as designed. No.;)Ct� FEE COMMONWEALTH OF MASSAC14USETTS Board of Health, -�AA/U 57-09 6 Z 6: , MA. ➢ ISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct(L)- Repair( ) Upgrade( ) Abandon( ) an individual sewage disposal system at 16 W A) 116 R I RC f4 wAy l as described in the application for Disposal System Construction Permit No.cDW\- ((�, dated Ci 1 ,:30 1 Provided: Construction shall be completed within Tree years of the date of this permit. All local conditions must b me . Form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date VV Board of Health EAM7ROTECII LABORATORIES,INC. {,MA CEAT.NO.:M-MA 063 449 Rte.130 Sandwich, MA 02563 508(888-5460) 1-800 339-6460 FAX(508)888-6446 CLIENT: All Cape Wells LOCATION: 16 White Birch Way ADDRESS: (Tom Damelio) West Barnstable MA COLLECTED BY. All Cape Wells SAMPLE DATE: - 9/4/2001 SAMPLE TIME: N/A WATER SAMPLE TYPE: New Well DATE RECEIVED: 9/4/2001 LAB I.D. #: 0109033 WELL SPECS.: 80/ 125 RESULTS OF ANALYSIS: Parameters Units Recommended Results Method Date Analyzed Limits Coliform bacteria /100ml 0 0 9222 B 9/4/2001 pH pH units 6.5-8.5 6.09 4500 H+ 9/4/2001 Conductance umhos/cm 500 127 120.1 9/4/2001 Nitrate-N mg/L 10.0 0.224 300.0 9/4/2001 Nitrite-N mg/L 1.00 < 0.003 300.0 9/4/2001 Sodium mg/L 28.0 14.5 200.7 9/5/2001 Iron mg/L 0.3 0.2 200.7 9/5/2001 Manganese mg/L 0.05 0.283 200.7 9/5/2001 Volatile Organics ug/L See Report *Chloroform ug/L 1.1 EPA 524.2 917/01 *Dibromochloromethane ug/L 0.84 EPA 524.2 9/7/01 Toluene ug/L 1,000 1.4 EPA 524.2 9/7/01 *Total trihalomethanes can not exceed 100. COMMENTS: pH is below recommended limit and may have corrosive characteristics. Manganese is not a health hazard, but may cause aesthetic problems. WATER MEETS EPA STANDARDS AND IS SUITABLE FOR DRINKING PURPOSES FOR PARAMETERS TESTED. <=less than Date 91 1 >=greater than `R nald J. S n TNTC=too numerous to count Laboratory Director i CERTIFICATE OF ANALYSIS Page: 1 LAPUCK LABORATORIES, INC. Report Prepared For: Report Dated: 09/11/2001 Envirotech Laboratories Order Number: L0170207 Ron Saari 449 Route 130 Sandwich, MA 02563 Laboratory ID#: 0170207-01 Description: 0109033-Damelin 16 White Birch Way Sample#: Sampling Location: Collected: Collected by: Customer Received: 09/06/2001 Test Parameters ITEM RESULT UNITS MDL Method# Tested LAB: Organics MTBE ND ug/L 1.0 EPA 524.2 09/07/2001 EPA 524.2- Volatile Organics by GC/MS ITEM RESULT UNITS MDL Method# Tested LAB: Organics 1,1,1,2-Tetrachloroethane ND ug/L 0.5 EPA 524.2 09/07/2001 1,1,1-Trichloroethane ND ug/L 0.5 EPA 524.2 09/07/2001 1,1,2,2-Tetrachloroethane ND ug/L 0.5 EPA 524.2 09/07/2001 1,1,2-Trichloroethane ND ug/L 0.5 EPA 524.2 09/07/2001 1,1-Dichlorethane ND ug/L 0.5 EPA 524.2 09/07/2001 1,1-Dichloroethene ND ug/L 0.5 EPA 524.2 09/07/2001 1,1-Dichloropropene ND ug/L 0.5 EPA 524.2 09/07/2001 1,2,3-Trichlorobenzene ND ug/L 0.5 EPA 524.2 09/07/2001 1,2,3-Trichloropropane ND ug/L 0.5 EPA 524.2 09/07/2001 1,2,4-Trichlorobenzene ND ug/L 0.5 EPA 524.2 09/07/2001 1,2,4-Trimethylbenzene ND ug/L 0.5 EPA 524.2 09/07/2001 1,2-Dibromo-3-Chloropropa ND ug/L 0.5 EPA 524.2 09/07/2001 1,2-Dibromoethane(EDB) ND ug/L 0.5 EPA 524.2 09/07/2001 1,2-Dichlorobenzene ND ug/L 0.5 EPA 524.2 09/07/2001 1,2-Dichloroethane ND ug/L 0.5 EPA 524.2 09/07/2001 1,2-Dichloropropane ND ug/L 0.5 EPA 524.2 09/07/2001 1,3,5-Trimethylbenzene ND ug/L 0.5 EPA 524.2 09/07/2001 1,3-Dichlorobenzene ND ug/L 0.5 EPA 524.2 09/07/2001 1,3-Dichloropropane ND ug/L 0.5 EPA 524.2 09/07/2001 1,4-Dichlorobenzene ND ug/L 0.5 EPA 524.2 09/07/2001 f CERTIFICATE OF ANALYSIS Page. 2 LAPUCK LABORATORIES, INC. Report Prepared For: Report Dated: 09/11/2001 Envirotech Laboratories Order Number: L0170207 Ron Saari 449 Route 130 Sandwich, MA 02563 Laboratory ID#: 0170207-01 Description: 0109033-Damelin 16 White Birch Way Sample#: Sampling Location: Collected: Collected by: Customer Received: 09/06/2001 2,2-Dichloropropane ND ug/L 0.5 EPA 524.2 09/07/2001 2-Chlorotoluene ND ug/L 0.5 EPA 524.2 09/07/2001 4-Chlorotoluene ND ug/L 0.5 EPA 524.2 09/07/2001 4-Isopropyltoluene ND ug/L 0.5 EPA 524.2 09/07/2001 Benzene ND ug/L 0.5 EPA 524.2 09/07/2001 Bromobenzene ND ug/L 0.5 EPA 524.2 09/07/2001 Bromochloromethane ND ug/L 0.5 EPA 524.2 09/07/2001 Bromodichloroethane ND ug/L 0.5 EPA 524.2 09/07/2001 Bromoform ND ug/L 0.5 EPA 524.2 09/07/2001 Bromomethane ND ug/L 0.5 EPA 524.2 09/07/2001 CarbonTetrachloride ND ug/L 0.5 EPA 524.2 09/07/2001 Chlorobenzene ND ug/L 0.5 EPA 524.2 09/07/2001 Chloroethane ND ug/L 0.5 EPA 524.2 09/07/2001 Chloroform 1.1 ug/L 0.5 EPA 524.2 09/07/2001 Chloromethane ND ug/L 0.5 EPA 524.2 09/07/2001 cis-1,2-Dichlorethene ND ug/L 0.5 EPA 524.2 09/07/2001 cis-1,3-Dichloropropene ND ug/L 0.5 EPA 524.2 09/07/2001 Dibromochloromethane 0.84 ug/L 0.5 EPA 524.2 09/07/2001 Dibromomethane ND ug/L 0.5 EPA 524.2 09/07/2001 Dichlorodifluoromethane ND ug/L 0.5 EPA 524.2 09/07/2001 Ethylbenzene ND ug/L 0.5 EPA 524.2 09/07/2001 Hexachlorobetadiene ND ug/L 0.5 EPA 524.2 09/07/2001 Isopropylbenzene ND ug/L 0.5 EPA 524.2 09/07/2001 MethyleneChloride ND ug/L 0.5 EPA 524.2 09/07/2001 III n-Butylbenzene ND ug/L 0.5 EPA 524.2 09/07/2001 n-Propylbenzene ND ug/L 0.5 EPA 524.2 09/07/2001 Naphthalene ND ug/L 0.5 EPA 524.2 09/07/2001 sec-Butylbenzene ND ug/L 0.5 EPA 524.2 09/07/2001 CERTIFICATE OF ANALYSIS Page: 3 LAPUCK LABORATORIES, INC. Report Prepared For: Report Dated: 09/11/2001 Envirotech Laboratories Order Number' L0170207 Ron Saari 449 Route 130 Sandwich, MA 02563 Laboratory ID#: 0170207-01 Description: 0109033-Damelin 16 White Birch Way Sample#: Samplin¢Location: Collected: Collected by: Customer Received: 09/06/2001 Styrene ND ug/L 0.5 EPA 524.2 09/07/2001 tert-Butylbenzene ND ug/L 0.5 EPA 524.2 09/07/2001 Tetrachloroethene ND ug/L 0.5 EPA 524.2 09/07/2001 Toluene 1.4 ug/L 0.5 EPA 524.2 09/07/2001 trans-1,2-Dichloroethene ND ug/L 0.5 EPA 524.2 09/07/2001 trans-1,3-Dichloropropene ND ug/L 0.5 EPA 524.2 09/07/2001 Trichloroethene ND ug/L 0.5 EPA 524.2 09/07/2001 Trichlorofluoromethane ND ug/L 0.5 EPA 524.2 09/07/2001 VinylChloride ND ug/L 0.5 EPA 524.2 09/07/2001 Xylene ND ug/L 0.5 EPA 524.2 09/07/2001 Approved By: (Lab Manager) This report is rendered upon the condition that it is not to be reproduced wholly or in part for advertising or other purposes over our signature or in connection w/ our name without special written permission.Total liability is limited to the invoiced amount.The results listed refer only to tested samples and/or applicable ASSESSORS MAP N0. 'l PARCEL NO �' -------- l -----_- -No.__—___ � `�"1--- Fee— BOARD OF HEALTH TOWN OF BARNSTABLE Application forVefi Con5truct ion Permit Application its hereb de for a pe it Jto Construct ( ), Alter ( ), or Repoa>irrp( )an individual Well at: Location — ddress Assessors Map an Parcel O er Addre tj Installer — Driller Address Type of Building Dwelling ` -- --- —- Other - Type of Building--------------- No. of Persons— Type of Well�/ `U C1 — — -- Capacity---------------—---- ----— Purpose of Well--- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a Certificate .of Compliance has been issued by the Board of Health. date Application Approved B __— date Application Disapproved for the following reasons: --------------- --------------- date Permit No. r" " �`�" — Issued--- �-- `--- - ----- date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance THIS IS TO CERTIFY, That the Individual Well Constructed (t4-,'Xitered ( ), or Repaired ( ) by— ------ ——__- --_--- - - -- —— --- --------- Installer at A 4 --- has been installed in accordance with the provisi o s the Town of Barnstable Board of Health Private Well Pro ection Regulation as described in the application for Well Construction Permit Nod- - '` aEed -------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE -— _ — Inspector—------------- ----- —----—- � ;- ., .� •;�; t dp,,-t Kt'.haw.: ., � P 0 Fee— -- No --- -------- --- � BOARD OF HEALTH TOWN OF BARNSTABLE ►1J r Appricat ion,forlVell Cootruct ion Permit E Application is hereb de for a pe it to Construct ( ), Alter ( ), or Repair ( )an individual Well at: Location — Ad�drewss Assessors Macel /Of`�^er Addddree Installer.— Driller Address Type of Building Dwelling ---- ---- - —- — Other - Type o`f/Building----- ----- No. of Persons---------------------- Type of Well 7 "IR1, c Capacity------------------- Purpose of Well �`2——— ---__ — Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a Certificate .of Compliance has been issued by the Board of Health. date Application Approved B -- -- date Application Disapproved for the following reasons: ----------- --— — - �� — ------ — ---- --date Permit No. - --- Issued-- ---�=�-�' ---------- date BOARD OF HEALTH TOWN OF BARNSTABLE a Certificate ®f (Compliance THIS IS T ERTIFY, That the Individual Well Constructed (4- Altered ( ), or Repaired ( ) by�)% �_ ----- ------- —--------- =------- --- Installer at has been installed in accordance with the provisir s of the Town of Barnstable Board of Health Private Well Protection ' '° Regulation as described in the application for Well Construction Permit No = -�!f Dated—L -------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE Inspector ------__--- BOARD OF HEALTH TOWN OF BARNSTABLE Yell Con$truct ion Aermit No. --- Fee ----- Permission is hereby granted A) — to Corlstruct (l. lter ( ), or epair ( ) an Individual 1 at: --------------------------- street as shown n the application for a Well fonstruction Permit No._ ' i Dated— _` Board of Health f� DATE / ,. — t 6- 4 .._ WEST BARNSTABLE A.M. 12811,? LOT 3 i - m �p , WELL IN FRONT 4 EXlr 5 .� A.M 128/13 p� -.SEPTIC IN .4EAF'^ (VACANT) $ # 94 r96 96 LOCUS �1 BRUCE �� y 1 MURPiiY �� � v� � s O. TP \ O� O o ® No.749 � \ _ _ act,_•____:.` � 1,,,. � '��`C to a bs i ----- - \ \ •4ryITA-1100 p� ' ►� 5� l02 \ , �� � A.M. 128/27 (� \ LOT 2 LOCUS MAP 4 \ WELL IN FRONT 1 C¢ 0% \ ' 1 SEPTIC IN REAR HOUSE \ 1os \\ 6, \ o ` - 1 1 i v48 PLAN REF. 4.06/9 �1 ems- ° 14•0� ' ASSESSORS MAP.- 128/26 0' ZONING: »RI,,, (� fie -- s 3:0. �� �`�- - , t� "` i GROUNDWATER OVERLAY ' "GP" a - UPOLE 10.0� _ 0 0 ...36.4.;::;:;: j70.1' '.'...'.,"....., 1 '+... +"..,..::..,.+...., wit NOTE. GRADING & GRADING WALLS :: ;;. r. PAN POSED BY OTHERS. p� �`... ..........` ..... 0 „� 1 ... ...........4-� OM11 RO .., N , .... ........ $ ` T.O 105.5 �. A.M 128/26 o':::�:: 2� � ., 1;0T 1 �' �' SITE AND , SEWAGE PLAN _ \ ... 24 0' \ PORN 16 0' \ REA=44,.190t S.F. HOUSE-_�16 o PROJECT LOCATION ' NO Tt�' NO JrFLLS WITHIN #16 WHITE BIRCH WA Y 150' ;OF ,_>'EPTIC WEST BARNSl ABLE,•' �1A�. : c , APPLICANT.- I SB LP �� o I U — J THOMAS DAMELIO l ► `- �l (PROPOSE, , _ _IN 100 — .y I WELL / _ _ _- 0 UTILITY,_- vANKEE SURVEY'CONSUL TANTS ►� I ( 67,(q' ;/� -- - 102 - - -- _ P.O. BOX 265 �89•� '3 �' BENCHMARK ' - /NIT 5, 408 INDUSTRY ROAD 104 B NCHMAI�L7 K MARSTONS MILLS, MA. 02648_ 53 TOP OF CATCH BASIN PH.(508)428-0055 FAX(508)420 55to — J s _�NQ '' 1tWAY ELL�'V. =100. 0' » , e o t f. I ;,S f., � SCALE.• 1 =30 DA TE.• 7/18/01 110 _ , 13 ✓ l�?' -CB/DH /�/ �" r=P, REV. REV. Wf4fTE A.M. 128/34 Job NO. 52806 SHEET 1 OF 2 (VACANT) ----- - :« TOP OF 1�YIUNDANON l , cLc_ , « 20' MIN. --- 10'IWIN. - i I CONCRETE COVERS •* SCWR0t),E 40 P V.C. MIN. PI TCH`''/8 PER FT. 21 A YER OF 101, CONCRETE COVER WASHED STONE - 6"MAX. / 6i"MAX., . . / / / / . EL.=96 EEL. 97 / r i 4" SCH 40 PVC PIPE RISER RISER 6"MAX. (OR EQUAL) MINIMUM „ PIYrH 1/4 PER FT. 36 RISER. CLE<.1V 3 SAND MAX. EL=98 FLOW LINE RISER INVERT -�l. ——_-_'___- EL.=94 A.f1N. 14" •T„ 0000 O o000 EL.= 99.0' INVERT Eli— 2.0' o o c o o n o 0 0 0 0 0 0 0 og '" ° °o 0oMo000000o g ----- BAFFLE - 98.25' 6. SUMP LEVEL o o°°o o 0 0 0 0 0 0 0 0 0 0°00°° INVERT E/,_ INVERT INVERT o o =91.2 EL.= 98.5' EL.= 93.75 �r EL:= 9_3.5"_ 4• a (TO BE'PLACED ON FIRM BASE) DISTRIBUTION (3) 500 GAL. LEACHING CHAMBERS MECHANICALLY COMPACTED OR 6" OF STONE BOX W/ T EL.__9 3 2 1500--GALLONS N Z TO BE WATER TESTED / 12.8•X 35.5* TRENCH FORMA AON SEPTIC TANK IF MORE THAN ONE OUTLET � _ ,LACE ON 6" STONE SOIL A BS ORP TION 3/4" 719 1-1/2" DOUBLE WASHED STONE YS TEM ( , SA S) i—PROFILE O F USGS ADJUSTED ELEV.= ------ SEWAGE DISPOSAL SYSTEM BOTTOM 'OF TEST HOLE ELEV.=_ 84.5' a NOT TO SCALE t 97.5' < OBSER VA T/ON HOL E 1 -f ' . PERCOLA T/ON_ RA TE 2 _ MIN./ INCH rt D_EPTH TEXTURE SOIL TEST ~ 0 ?v" LEA VES &_ SUBSOIL DATE.• JAN 14, 1985 i GENERAL NOTES - 36".-60 SIL TY SOIL ENGINEER. R. FAIRBANK. P.E. 60"-156" CLEAN MEDIUM SAND BOARD OF HEALTH. J. CONLON 1) ALL WORKMANSHIP AND MA TER/AL S SHALL CONFORM TO D.E.P. EXCAVATOR D. SPEAKMAN TITLE 5 AND THE TOWN OF ___6AR&57jA&F RULES AND NO WATER ENCOUNTERED REGUL A TIONS FOR THE SUBSURFACE DISPOSAL OF SEWA GE. , P# �880 2) ONE COVER ON SEPTIC TANK SHALL BE BROUGHT TO W/THIN 6' ,OF FIN/SHED GRADE, 0 THERS W/THIN 12" INSTALL: 3) ALL COMPONENTS OF THE SA NI TAR Y SYSTEM SHALL BE CAPABLE OF WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN (3) 500tiGA'L LEACHING CHAMBERS 10 FT. , OF'DRIVES OR PARKING AREAS. H-20 LOADING SHALL BE SPACED 1' APART CONNECTED BY DESIGN CALCULA TIONS' USED UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS. PIPE WITH 4 STONE ALL AROUND 4) ANY MASONAR Y UNITS USED TO BRING COVERS TO GRADE SHALL 12.8' X 35.5' " NUMBER OF BEDROOMS . . . . . . 4 BE MOR TERED IN PLACE. l GARBAGE- DISPOSAL . . . . . . . . . NO 5) NO DETERM/NA TION HAS BEEN MADE AS TO COMP NIC 11 E W/TH 5' OVERD/G DOWN TO ,APPROX. 60" TOTAL -ES TIMA TED FLOIL' GAL DA Y DEEDED OR ZONING REGULATIONS. OWNER/APPLICANT IS TO TO CLEAN MEDIUM SAIVJ, REPLACE ( _ 0—_GAL./BR.IDA Y x 4_ BR.) 440 _ OBTAIN SUCH DE TERM/NA T/ON FROM A PPROPRMA TE AUTHORITY. W/IH CLEAN MEDIUM SAND PER TITLE 5 REOU/RED SEPTIC TANK CAPA C/TY 1500-GAL 6) U TILT TIES SHOWN ARE APPROXIMA TE ONL Y, EXCA VA T/ON CON TRA CTOR ,(�/L CLASS/FICA T/ON . 1 IS TO CALL "DIG— SAFE" A T 1-800-322—4844 AT LEAST 72 HOURS DESIGN PERCOLATION RA TE 5 MIN.//N. 7 PR/OR TO COMMENCING WORK ON SITE EPEE DENT LOADING RA, TE . ., . 74 GALIDA Y/S.F. ) CONTRACTOR IS TO VERIFY GRADES AND EL EVA TONS AS WELL AS L EA CHIiYG CA PA CrT Y (AREA X RA TE) 479 GAL/PA Y SITE CONDITIONS PR/OR TO COMMENCING WORK ON S/;TE. - ' - 479 GAL DA Y 8) PARCEL IS IN FL 00D ZONE __ 'C ' - RE VE L EA CH/NG'�a CA PA CI T Y . 9) LOT /S SHOWN ON ASSESSORS MAP _ 128 AS PARCEL' _26 (35.5X12.8X.74)+(35.5+35.5+12.8+12.8)X2X.74) �. --- ~� � SdEET 2 F JOB NUMBER __52 O ------ -- WEST BARNSTABLE \ A.M. 128128 - � � �s LOT 3 EXIT 5 WELL IN FRONT ?� A.M.VAC2 8113 / / �� SEPTIC IN REAR ) 94 d ti 9 ,Q��3sLOCUS q 96 - - o\s� g6 ter+ _ o \ �••::__: MURPHY == • ti:::=:::- No.749 10Az \ A.M. 128127 gNap, LOT 2 LOCUS MAP WELL IN FRONT I�4 SEPTIC IN REAR HOUSE 106 \ 6, o o ° i \, #48 PLAN REF.- 40619 14•0 ASSESSORS MAP- 128126 \ I ZONING: "RF" 1 � g,0' � o .per ca - Cr � joo \ -- N s:o ��- i , GROUNDWATER OVERLAY "GP" -��� On UPOLE 10.0' ,,..,... 0 0. 36•�.;:::::: 0 70.1 IINII IM1�1 ca ' NOTE.- GRADING & GRADING WALLS ................. 1.. ...,.,....,,,,...,,, y \N". .................. .................... �y o f'�o \ . ::::: :::::::::::::P POSED:..... 2 0"�" '4-B ROOM""' N \ ' BY OTHERS. ° \7%0' �,� 4... ... ..... ' ice• ...••6.0 .•T.O.F. 10. ........ A.M. 128126 o i ' P.z �•. 1������� ������������ :ZN%IlllI20 �' ., LOT 1 SITE AND SEWAGE PLAN 24 0. N pORCN 16 O' AREA=44,IOOf S.F. p HO USE �16 0 ���� PROJECT T L OCA ON INN- NO NO #rTSLLS WITHIN #16 WHITE BIRCH WAY . / ` \ 150 OF SEPTIC WEST BARNSTABLE, MA APPLICANT.• � SB LP \ ccTc % ►�� o o � �\--,/ \ , THOMAS DAMELIO 1 g8 _- � i \ \ _ Jloo(p'ROPOSED 0 YANKEE SURVEY CONSULTANTS TSLL UTILITY 102 --�- 0 P.O. BOX 265 189.g - �' ®/N/T 5, 40B INDUSTRY ROAD 104 -� , BENCHMARK. MARSTONS MILLS, MA. 02648 ' IN PH. 508 428-0055 FAX 508 420-5553 _ _ � ��; °O 8 ,� WA Y TOP OF CATCH BAS ( ) ( �108 — — fps -�r174 ,,,� t ELEV. -100. 0 SCALE.• 1"-30' DATE.• 7 18101 11p c iB1f REV. REV.• o , �, \ �609' ITE W14A.M. 128134 ✓OB NO. 52806 SHEET 1 OF 2 (VACANT) EL. =_105.5' 719P OF FVUNDATION r� 20' MIN. 10' MIN CONCRETE COVERS 4" SCHEDULE 40 P. VC MIN. PITCH 1/8 PER FT. 21A YER OF / EL=101' 1/8"-1/2" CONCRETE CO VER WASHED STONE l() 6"MAX. 6"MAX / / / i i , ,: / EL.=96 EL.=97 4" SCH 40 PVC PIPE RISER RISER 6"MAX "MAX P017L'H�/4 j PERMINIMUM FT. RISER CLEAN J SAND A6 EL=98 FLOW LINE RISER 17 EL.=94 INVERT 'AAN" f4" 'T" _ o o = = O = = o :C:3 EL. 99.0' 2.0' 000 0000 = 00 = = 0 °8000 --- CAS INVERT LEVEL °o 0 0 = _ _ _ _ _ _ = o o 00 0INVERT BAFFLE EL = g8.2$' INVERT 6 SUMP °o 0 0 0 0 0 0 = _ _ = o 0 0° oINVERT o0 = = = = _ _ _ _ _ _ So EL. 91.2 EL.= 9_8.5 EL.= 9J..755 EL•= 9_J.5__ 01 4 (TO BE PLACED ON FIRM BASE) DISTRIBUTION (3) 500 CAL. LEACH/NC CHAMBERS MECHANICALLY COMPAC7ED OR 6" OF STONE BOXTj�j/�1 T,J EL.=9J .2 1500__GALLONS TO BE WATER TESTED Z SEPTIC TANK /F MORE THAN ONE OUTLET 12.8'x 35.5' 1RENCH FORMATION PLACE ON 6" STONE 3/4" M I-1/2" SOIL A BSORP TION `r) DOUBLE WASHED STONE SYSTEM (SA S� PROFILE OF 845' SEWAGE DISPOSAL SYSTEM USGS ADJUSTED ELEV._ ______ BOTTOM OF TEST HOLE ELEV.=_ 84.5' i NOT TO SCALE ELEV.=_ 97.5' i OBSER VA T/ON HOLE 1 PERCOLA T/ON RA TE _ 2 _ MIN./ INCH DEPTH TEXTURE SOIL TEST GENERA L NO TES 0-J6" LEA VES & SUBSOIL DATE.• JAN 14, 1985 J6"-60" SILTY SOIL ENGINEER. R. FAIRBANK. PE 60"-156" CLEAN MEDIUM SAND BOARD OF HEALTH. J. CONLON 1) ALL WORKMANSHIP AND MA TERIAL S SHALL CONFORM TO D.E.P. EXCA VA TOR. D. SPEAKMAN TITLE 5 AND THE TOWN OF ___RAR&5_TA&f-__ RULES AND NO WATER ENCOUNTERED REGUL A TIONS FOR THE SUBSURFA CE DISPOSAL OF SEWAGE. 38P,O 2) ONE COVER ON SEPTIC TANK SHALL BE BROUGHT TO WITHIN 6" OF FIN/SHED GRADE, OTHERS WITHIN 12" INSTALL: 3) ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF (J) 500 GAL. LEACHING CHAMBERS WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN SPACED I' APART CONNECTED BY 10 FT. OF DRIVES OR PARKING AREAS. H-20 LOADING SHALL BE PIPE W/TH 4' STONE ALL AROUND DESIGN CALCULA TIONS: USED UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS. 12 8' X J5.5' 4) ANY MASONAR Y UNITS USED TO BRING COVERS TO GRADE SHALL NUMBER OF BEDROOMS . . . . . . . . 4 BE MOR TERED /N PLACE. GA RSA GE DISPOSAL . . . . . . . . . NO 5) NO DETERM/NA T/ON HAS BEEN MADE AS TO COMPL/ANCE WI TH 5' OVERDIG DOWN TO APPROX. 60" TOTAL ESTIMA TED FLOW i DEEDED OR ZONING REGULA TIONS. 0WNERIAPPL/CANT /S TO TO CLEAN MEDIUM SAND, REPLACE ( _1.10GAL./BR./DA Y x __4_ BR.) 440 GALIDA Y OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY WITH CLEAN MEDIUM SAND PER TITLE 5 REOU/RED SEPTIC TANK CAPACITY 1500 GAL 6) UT/L/TIES SHOWN ARE APPROXIMA TE ONL Y, EXCA VA T/ON CONTRACTOR IS TO CALL "DIG- SAFE" AT 1-800-J22-4844 AT LEAST 72 HOURS SOIL CLASSIF/CA ION . 1 TE 5 M/N.//N. PR/OR TO COMMENCING WORK ON S/TE. DESIGN PERGOLA T/ON . 7) CONTRACTOR IS TO VERIFY GRADES AND ELEVA TONS AS WELL AS + EFFLUENT LOADING RA TE . . . . . . 74 GALIDA Y/S,F. SI TE CONDI TIONS PRIOR TO COMMENCING WORK ON SI TE. LEACHING CAPACITY (AREA X RATE) 479 GAL/DA Y 8) PARCEL /S IN FLOOD ZONE____'C . RESERVE LEACHING CAPACITY . . . 479 GAL/DA Y 9) LOT IS SHOWN ON ASSESSORS MAP _ 128 AS PARCEL 26_• (J5.5X12.8X.74)+(J5.5+J5.5+12.8+12.8)X2X. 74) y F JOB NUMBER __52806______