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VILLAGE �, ,zPrj. ASSESSOR'S MAP&PARCEL
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SEPTIC TANK CAPACITY
LEACHING FACILITY.(type) C#_ (size)
NO.OF BEDROOMS
OWNER Zoqn
PERMIT DATE: DATE:m,5� 10110
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, ' t within
300 feet of leaching facility) Feet
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Widgeon Lane
Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
10 Widgeon Drive _
Property Address —---
George Zoto_ -
Owner Owner's Name
information is West Barnstable
required for _-_ MA 02668 March 10;2010 _
every page. City/Town V State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not b p e altered in an
way. y y
Important:
When filling out A. General Information
forms on the
computer,use 1. Inspector:
only the tab key
to move your Patrick M.O'Connell
cursor-do not -------- _-----...
use the return Name of Inspector
key. Septic Inspection_Services Co.
Company Name -- -----....
_
189 Cammett Road
Company Address ---
Marstons Mills MA 02648
'mod City/Town State Zip Code
508-428-1779 _ S1 12855
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
March 10,2010
In pector's Sign at 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 j
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 j
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.
1 D-63 Zoto.tlor.•08,T6
Tide 5 07rciat rsuaelior:Foam.Subsurface Savage Disposal System•Fage 1 of 75 i
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Commonwealth of Massachusetts
--- Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
" 10 Widgeon Drive
Property Address --- �— -
George Zoto
Owner Owner's Name
information is required for West Barnstable MA 02668 March 10,2010
_ —
every page. Cityfrown State Zip Code Date of Inspection
B. Certification (cunt.)
Inspection Summary: Check A,B,C,D or E I always complete all of Section D
A) System Passes:
I
® 1 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 is not in need of pumping at this time, leaching chambers had no standing water or sidewall
stains_.
B) System Conditionally Passes:
❑ One or more system components as described in the"Conditional Pass"section need to be
replaced or repaired. The system, upon completion of the replacement or repair,as approved by
the Board of Health,will pass.
Answer yes, no or not determined(Y, N, ND)in the❑for the following statements. If"not
determined,"please explain.
❑ The septic tank is metal and over 20 years old'or the septic tank(whether metal or not) is
structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent.
System will pass inspection if the existing tank is replaced with a complying septic tank as
approved by the Board of Health.
A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate
of Compliance indicating that the tank is less than 20 years old is available.
ND Explain:
El Observation distribution box due Observation of sewage backup or break out or high static water level I t
to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s)are replaced
❑ obstruction is removed
10-63 Zoto.doc-W06 Title 5 Officiai Inspection form Subsurface sewage Disposal System•Page 2 of 15
�ti II
Commonwealth of Massachusetts
OF
Title 5 Official Inspection Form
Subsurface Sewage Disposal System 'Form -Not for Voluntary Assessments
10 Widgeon Drive
Property Address --._. ------ -- —
George Zoto
Owner ----...---------------------
Owner's Name
information is required for West Barnstable MA 02668 March 10,2010
every page. Cdy/Town State Zip Code Date of Inspection
B. Certification (cont.)
B) System Conditionally Passes(cunt.):
❑ distribution box is leveled or replaced
ND Explain:
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s)are replaced
❑ obstruction is removed
ND Explain:
C) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
2. System will fail unless the Board of Health(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.
10-63 Zoto.doc 08IC6 Td e 5 Official Inspection Form'.Subsurface Sewage Disposal System-Page 3 of 15
t
c Commonwealth of Massachusetts
- - ,— Title 5 official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments.
J
10 Widgeon Drive
Property Address
George Zoto -
Owner Owner's Name
information is required for West Barnstable MA 02668 March 10, 2010
--- -- --
every page. City(fown State-- Zip Code Date of Inspection
B. Certification (cont.)
C) Further Evaluation is Required by the Board of Health (cunt.):
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well".
Method used to determine distance:
**This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform
bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen.is equal to or
less than 5 ppm, provided that no other.failure criteria are triggered.A copy of the analysis must be
attached to this form.
3. Other:
D) System Failure Criteria Applicable to All Systems:
You must indicate"Yes" or"No"to each of the following for all inspections:
Yes No
❑ ® Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
q
Static liquid level in the distribution box above outlet invert due to an overloaded
i
❑ ® or clogged SAS or cesspool
99 p
❑ ® Liquid depth in cesspool is less than 6"below invert or available volume is less
than_ Y da flow
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ ® Any portion of the SAS,cesspool or privy is below high ground water elevation.
❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
10-63 Zoto.doc•08M Tide 5 Off:cia Inspectiri Form:Subsurface Sewage Disposal System•Page 4 of 15
�{
Commonwealth of Massachusetts
- Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
10 Widgeon Drive
Property Address
George Zoto
Owner Owner's Name
information is West Barnstable MA 02668 March 10,2010
required for _ _._..__ -
every page. Cityfrown State Zip Code Date of Inspection
B. Certification (cont.)
D) System Failure Criteria Applicable to All Systems(cont..):
Yes No
❑ ® 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.]
ET ® 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 CM 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 11 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.
10 63 Zoto.doc•08M Title 5 offical lrspeaicn Form:Subsurtne Sewage Disposal System•Pane 5 of IS
Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
10 Widgeon Drive
Property Address
George Zoto
Owner Owner's Name
information is West Barnstable MA 02668 March 10, 2010
required for _._ _..�
every page. Cityfrown 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 NIA)
® ❑ 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)]
10 63 Zolo,doc-08106 TWo 5 Official Inspection Form.Subsurface Sewage Disposal System-Page 6 of 15
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
10_Widgeon Drive
Property Address
George Zoto ------
-_.---
Owner Owner's Name
information is- West Barnstable MA 02668 March 10, 2010
required for
every page. CityrTown State Zip Code Date of Inspection
D. System Information
Residential Flow Conditions:
Number of bedrooms(design): 4 Number of bedrooms(actual): 3
DESIGN flow based on 31'0 CMR 15.203(for example: 110 gpd x#of bedrooms): 440
5
Number of current residents:
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No
Laundry system inspected? ❑ Yes ❑ No
Seasonal use? ❑ Yes 0 No
Water meter readings, if available last 2 ears usage d N/A Well Water
9 ( Y 9 (gpd)):
Sump pump? ❑ Yes ® No
ly
Last date of occupancy: Occu Currerup ed.
Commercial1industrial 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:
Last date of occupancy/use: Date
Other(describe):
10-63 Zoto.doc•08t06 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 7 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
-- -.. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
� 10 Widgeon Drive
Property Address
George Zoto
Owner
Owner's Name
information is required for West Barnstable StaMA 02668 March 10, 2010
__-- ---_—.._- — --...__--
every page. Cityrrown te Zip Code Date of Inspection
D. System Information (cont.)
General Information
Pumping Records:
Source of information: Tank pumped 118-24 months ago. _
Was system pumped as part of the inspection? ❑ Yes ® No
If yes,volume pumped: gallons—
How was quantity pumped determined? --
Reason for pumping:
Type of System:
® Septic tank,distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system(yes or no)(if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology.Attach a copy of the current operation and
maintenance contract(to be obtained from system owner)
❑ Tight tank-Attach a copy of the DEP approval. .
❑ Other(describe):
Approximate age of all components, date installed (if known)and source of"information:
Leaching system installed 7/13/99
Were sewage odors detected when arriving at the site? ❑ Yes ® No
10-0 Zoto.doc•08M Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15
Commonwealth of Massachusetts
- Title 5 Official Inspection Form
W- Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
- 10 Widgeon Drive _
Property Address
George Zoto
Owner Owner's Name
information is required for West Barnstable MA 02668 March 10, 2010
every page. Citylrown State Zip Cale Date of Inspection
D. System Information (cont.)
BuildingSewer locate on site plan):
( P )
Depth below grade: 2 -- _
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):
18"
Depth below grade: feet
Material of construction:
®
ex concrete ❑metal El fiberglass Elpolyethylene ❑a#her((explain)
If tank is metal, list age:
years
Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No
----------------------------------------------------------------------------------------------------------------------------
Dimensions: 8.5'Iong_x 5.2'wide-1000 gal.
3„
Sludge depth:
7"
Distance from top of sludge to bottom of outlet tee or baffle 2 2
2'
Scum thickness
6„
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle 12'
How were dimensions determined? Measured
10.63 Zoto.doc-08M Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15
i
Commonwealth of Massachusetts
Title 5. Official Inspection Form
-- Subsurface Sewage Disposal System Farm -Not for Voluntary Assessments
-- °r 10 Widgeon Drive
Property Address --
George Zoto
Owner Owner's Name
information is West Barnstable' MA 02668 March 10, 2010
required for _—__ _
every page. Citylrown 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.):
Tank is not in need of pumping at this time,tees were intact and clear and liquid level was found at
bottom of outlet invert.
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
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):
10-63 Zoto.doc-OPJ05 Title 5 Official Inspection Form.Subsurface Sewage Ossposal System•Page 10 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
- i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
10 Wid eon Drive
Property Address
_George Zoto
Owner Owner's Name
information is West Barnstable MA 02668 March 10,2010
required for — —
every page. Date of Inspection
a e. City/Town State Zip Code
D. System Information cont.
Tight or Holding Tank(cont.)
Dimensions: - ----
Capacity: gallons
Design Flow: aeons per day
-----
9
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
Distribution Box(if present must be opened)(locate on site plan):
011
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.):
No solids or high stains present. Liquid level at bottom of all outlet pipes.
Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No
Alarms in working order: ❑ Yes ❑ No
10-63 Zeto.'doc•0&`06 Title 5 DYic al Inspection Form.Subsurface Sewage Disposal System•Page 11 or 15
r
e\ Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
. 10 Widgeon Drive
Property Address
George Zoto
Owner Owner's Name
information is required for West Barnstable MA 02668 Marc_h10,2010
_ _._.._._._
every page. City/Town State Zip Code Date of Inspection
Q. System Information (cont.)
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
Soil Absorption System (SAS)(locate on site plan, excavation not required):
If SAS not located, explain why:
Type:
❑ leaching pits number:
® leaching chambers number: Three 500 gal
drywells.
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Typelname of technology:
Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil,condition of
vegetation, etc.):
Chambers had no standing water or sidewall stains.
1063 Zoto.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15
Commonwealth of Massachusetts
- Tithe 5 Official Inspection Form
,Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
10 Widgeon Drive
Property Address
George Zoto --
Owner Owners Name
information is West Barnstable MA 02668 March 10,2010
required for -------=— ------- -....-- --...._ .— —..
every page. CityfTown State Zip Code Date of Inspection
D. System Information (cant.)
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
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
Privy(locate on site plan):
Materials of construction:
Dimensions —
Depth of solids
Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,
etc.):
10-63 Zoto.coc-0=6 Title 5 Official Inspection Form:Subswtace Sewage Disposal Systern-Page 13 or 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
10 Widgeon Drive
Property Address
Geor eg Zoto —
Owner Owner's Name
information is required for West Barnstable MA 02668 March 10, 2010
---
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont)
k tch of the sewage disposal s
Sketch Of Sewage Disposal System: Provide a s stem including ties e g P Y
to at least two permanent reference landmarks or benchmarks- Locate all wells within 100 feet.
Locate where public water supply enters the building.
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Widgeon lane
Commonwealth of Massachusetts
Title 5 Official Inspection For
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
10 Widgeon Drive
Property Address
George Zoto
Owner Owner's Name
information is required for West Barnstable _MA 0266_8_ March 10, 2010
every page. City/town State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
® Check Slope
® Surface water
® Check cellar
® Shallow wells
Estimated depth to ground water: 30+
feet
Please indicate all methods used to determine the high ground water elevation:
❑ Obtained from system design plans on record
If checked,date of design plan reviewed: Date --
® Observed site(abutting property/observation hole within 150 feet of SAS)
❑ Checked with local Board of Health-explain.-
Checked with local excavators,installers-(attach documentation)
❑ Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
Pond on opposite side of road is considerably lower than bottom of SAS.
10,63 Zoto.doc-08106 Title 5 Official Inspection form:Subsurface Sewage Disposal System-Page 15 of 15
Commonwealth of Massachusetts ��
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
10 Widgeon Drive
Property Address
George Zoto
Owner Owners Name
information is
required for West Barnstable MA 02668
every page. City/rows March 10, 2010
State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way.
Important
-
When filling out
A. General Information
forms on the
computer,use 1. Inspector:
only the tab key
to move your Patrick M. O'Connell
cursor-do not
use the return Name of Inspector
key. Septic Inspection Services Co
Company Name
rab 189 Cammett Road
Company Address
Marstons Mills MA 02648
City/Town State Zip Code
508-428-1779 SI 12855
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: Y
c, a
® Passes ❑ Conditionally Passes ❑ Fails - ;
❑ Needs Further Evaluation by the Local Approving Authority
t
March 10, 2010 -j a-
In pector's Slgnat 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.
10-63 Zoto.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary-Assessments
10 Widgeon Drive
Property Address
George Zoto
Owner Owners Name
information is
required for West Barnstable MA 02668 March 10, 2010
every page. Cltyrrown State Zip Code Date of Inspection
B. Certification (cost.)
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 is not in need of pumping at this time, leaching chambers had no standing water or sidewall
stains.
B System Conditionally y ttonally Passes:
❑ One or more system components as described in the"Conditional Pass" section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
Answer yes, no or not determined (Y, N, ND) in the ❑ for the following statements. If"not
determined," please explain.
❑ The septic tank is metal and over 20 years old'or the septic tank (whether metal or not) is
structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent.
System will pass inspection if the existing tank is replaced with a complying septic tank as
approved by the Board of Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate
of Compliance indicating that the tank is less than 20 years old is available.
ND Explain:
❑ Observation of sewage backup or break out or high static water level in the distribution 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
❑ obstruction is removed
10-63 Zoto.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 o1 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
w 10 Widgeon Drive
Property Address
George Zoto
Owner Owners Name
information is
required for West Barnstable MA 02668
every page. Cityrrown March 10, 2010
State Zip Code Date of Inspection
B. Certification (cont.)
B) System Conditionally Passes (cont.):
❑ distribution box is leveled or replaced
ND Explain:
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s) are replaced
❑ obstruction is removed
ND Explain:
C) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
2. System will fail unless the Board of Health (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.
10-63 Zoto.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 0115
i
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
10 Widgeon Drive
Property Address
George Zoto
Owner Owners Name
information is
required for West Barnstable MA 02668 March 10, 2010
every page. City mown State Zip Code Date of Inspection
B. Certification (coot.)
C) Further Evaluation is Required by the Board of Health (cont.):
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well**.
Method used to determine distance:
**This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform
bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or
less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be
attached to this form.
3. Other:
D) System Failure Criteria Applicable to All Systems:
You must indicate "Yes" or"No" to each of the following for all inspections:
Yes No
❑ ® Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less
than_day flow
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
10-63 Zoto.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M 10 Widgeon Drive
Property Address
George Zoto
Owner Owners Name
information is
required for West Barnstable MA 02668 March 1.0, 2010
every page. (5tyfrown State Zip Code Date of Inspection
B. Certification (cont.)
D) System Failure Criteria Applicable to All Systems (cont.):
Yes No
❑ ® 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.
10-63 Zoto.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
10 Widgeon Drive
Property Address
George Zoto
Owner Owners Name
information is
required for West Barnstable MA 02668 March 10, 2010
every page. Cltyrrown 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)]
10-63 Zoto.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15
i
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
10 Widgeon Drive
Property Address
George Zoto
Owner Owners Name
information is
required for West Barnstable MA 02668 March 10, 2010
every page. City/Town State Zip Code Date of Inspection
D. System Information
Residential Flow Conditions:
Number of bedrooms (design): 4 Number of bedrooms (actual): 3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440
Number of current residents: 5
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No
Laundry system inspected? ❑ Yes ❑ No
Seasonal use? ❑ Yes ® No
Water meter readings, if available(last 2 years usage (gpd)): N/A Well Water
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: —
Last date of occupancy/use: Date
Other(describe): _
10-63 Zoto.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M 10 Widgeon Drive
Property Address
George Zoto
Owner Owners Name
information is
required for West Barnstable MA 02668 March 10, 2010
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
General Information
Pumping Records:
Source of information: Tank pumped 118-24 months ago.
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped:
gallons
How was quantity pumped determined?
Reason for pumping:
Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner)
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
Approximate age of all components, date installed (if known) and source of information:
Leaching system installed 7/13/99
Were sewage odors detected when arriving at the site? ❑ Yes ® No
10-63 Zoto.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
10 Widgeon Drive
Property Address
George Zoto
Owner Owners Name
information is
required for West Barnstable MA 02668 March 10, 2010
every page. Citylrown State Zip Code Date of Inspection
D. System Information (cont.)
Building Sewer(locate on site plan):
Depth below grade: 2'
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: 18"
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: 8.5' long x 5.2'wide- 1000 gal.
"
Sludge depth: 3 _
Distance from top of sludge to bottom of outlet tee or baffle 27" —
Scum thickness
2"
Distance from top of scum to top of outlet tee or baffle 6 —
Distance from bottom of scum to bottom of outlet tee or baffle 12 —
How were dimensions determined? Measured —
10-63 Zoto.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15
Commonwealth of Massachusetts
w Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
10 Widgeon Drive
Property Address
George Zoto
Owner Owners Name
information is
required for West Barnstable MA 02668 March 10, 2010
every page. Cltyfrown 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.):
Tank is not in need of pumping at this time, tees were intact and clear and liquid level was found ait
bottom of outlet invert.
Grease Trap (locate on site plan):
Depth below grade:
feet �
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene
El 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.):
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):
10-63 Zoto.doc 08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
10 Widgeon Drive
Property Address
George Zoto
Owner Owners Name
information is
required for West Barnstable MA 02668 March 10, 2010
every page. Cltyrrown State Zip Code Date of Inspection
D. System Information cont.
Tight or Holding Tank(cont.)
Dimensions:
Capacity:
gallons
Design Flow:
gallons per day
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping:
Date
Comments (condition of alarm and float switches, etc.):
Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
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.):
No solids or high stains present. Liquid level at bottom of all outlet pipes
Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No
Alarms in working order: ❑ Yes ❑ No
10-63 Zoto.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 oP 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
10 Widgeon Drive
Property Address
George Zoto
Owner Owners Name
information is
required for West Barnstable MA 02668 March 10, 2010
every page. Cltyrrown State Zip Code Date of Inspection
D. System Information (cont.) 4
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
Type:
❑ leaching pits number:
® leaching chambers number: Three 500 gal
drywells.
❑ 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 had no standing water or sidewall stains
10-63 Zoto.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 or 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -9 p y Not for Voluntary Assessments
10 Widgeon Drive
Property Address
George Zoto
Owner Owners Name
information is
required for West Barnstable MA 02668 March 10, 2010
every page. Cltyrrown State Zip Code Date of Inspection
D. System Information (cont.)
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
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
Privy (locate on site plan):
Materials of construction:
Dimensions _
Depth of solids
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
10-63 Zoto.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-
Page 13 cl 15
MNN Commonwealth of Massachusetts
Title 5 Official Inspection Form
a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
ww 10 Widgeon Drive
Property Address
George Zoto
Owner — - -------------- -— - ---- - —-----
Owner's Name
information is West Barnstable MA _ 02668 _ March 10, 2010
required for _
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties
to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet.
Locate where public water supply enters the building.
/ / / / / / ! l ! / / ! / f ! r
f / f / f�
\ \ \ \ \ \ \ \ \ \ \ \r\
/ r r / /
r r r /
/ / / / / r ! r / ! J
f r /N / r
42 2
au
44
50 4
32
Widgeon Lane
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
10 Widgeon Drive
Property Address
George Zoto
Owner Owner's Name
information is required for West Barnstable MA 02668 March 10, 2010
every page. CityrTown State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
® Check Slope
® Surface water
® Check cellar
® Shallow wells
Estimated depth to ground water: 30+
feet
Please indicate all methods used to determine the high ground water elevation:
❑ Obtained from system design plans on record
If checked, date of design plan reviewed: Date
® Observed site (abutting property/observation hole within 150 feet of SAS)
❑ Checked with local Board of Health -explain:
❑ Checked with local excavators, installers - (attach documentation)
❑ Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
Pond on opposite side of road is considerably lower than bottom of SAS.
10-63 Zoto.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15
i
jot
c
c11Z
Abb
T
6� f
2 S
"Q. Z �,
150
TQ �y0 �_ o
rA,
t/6/99
NOTICE: This Form Is To Be Used For the Repair Of Failed
Septic Systems Only. -
CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL
WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS)
I, r JQ 20 hereby certify that the application for disposal works
construction permit signed by me dated '!z/(' Ay concerning the
property located at /O d geO;r? XAA Meets all of the
following criteria:
ri I
• The failed system is connected to a residential dwelling only. There are no commercial or business
uses associated with the dwelling.
�• The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch.
There are no wetlands within 100 feet of the proposed septic system
• There are no private wells within 150 feet of the proposed septic system
There is no increase in flow and/or change in use proposed
I,P- There are no variances requested or needed.
The bottom of the proposed leaching facility will not be located less than five feet above the
m&,dmum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor
method when applicable]
If the S.A.S. will be located with 250 feet of any vegetated wetlands, the bottom of the proposed
leaching facility will not be located less than fourteen(14) feet above the maximum adjusted
groundwater table elevation,
Please complete the following:
A) Top of Ground Surface Elevation(using GIS information) )
B) G.W. Elevation +the MAX. High G.W. Adjustment.
DIFFERENCE BETWEEN A and B �7
SIGNED : DATE: l�
[Sketch proposed plan system on back].
q:health folder.cert
., TOWN OF BARNSTABLE
LOCATION SEWAGE #
'MLAGE ASSESSOR'S MAP &LOT
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY /On
LEACHING FACILITY: (type) (size)3 Q SOJA C d_
NO.OF BEDROOMS
BUILDER OR OWNER
PERMPTDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility -AD ' 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 o leacoing f cility) Feet
Furnished by
1 � ���n i
� x/
1
� � �
• y
f
3� �� �.
� �� o
- --- Y— �
_ �
� ��
s� �
� .
r
Fee 13 Ge
rACHUSETTS
THE COMMONWEALTH OF MASSACHUSETTS ';'--"' ntered in computer: Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MAS
21pprication for rigpoal *pmem Comaruction Vermit
Application for a Permit to Construct( VI'Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. /Q Gd�eon L,7, Lv$. Owner's Name,Address and Tel.No.
Assessor's Map/Parcel /3a 020 / �O� Ceo e Zo-/�D 36 Z- 9S59 V
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size Bd sq.ft. Garbage Grinder( )
Other Type of Building -rW o 5' OQ&/ No.of Persons .5 Showers(Pj Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow 330 gallons.
Plan Date Number of sheets Revision Date
Title
9
Size of Septic Tank 400 Type of S.A.S.
Description of Soil 74z) -F)n e
Nature of Repairs or Alterations(Answer when applicable) II&Wja lead 4 6,7`
cy /1'-k- 33 , 1Od AQ_c, GYG{t oZe l`rze S2VS.
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and t to place he syste operation until
cate of Compliance has been issued by this oard of Health.
Signed Date
Application Approved by Date
Application Disapproved for the following reasons
Permit No. " Date Issued
. ,. Fee��
_ THE COMMONWEALTH OF MASSACHUSS ` �~ Entered in computer:
>r Yes
PUBLIC HEALTH DIVISION - TOWN OF`BARNSTABLES MAS 'ACHUSETTS ,
01pprication for -Mtgpo5al *pgtem Construction J)ermit
Application for a Permit to Construct( Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
~, Location Address or Lot No. /O k l d p p� (�j, (.O 8 Owner's Name,Addrew,and Tel.No.
Assessor's Map/Parcel /3A OZ rr / �Of 6eo rf e 2o4D 3 Z_ 9S9
Installer's Name,Address,and Tel.No. Designer's Name Address and Tel.No.
�c �aheaCy �T
Type of Building: `
Dwelling No.of Bedrooms_ 3 Lot Size 44SAffO sq.ft. Garbage Grinder( )
Other Type of Building 7Tj o SYQ&Z No. of Persons S Showers(kj Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow 3 30 gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank ,./DDD , Type of S.A.S.
Description of Soil _G1 eel) rn eWIWP 74V T/')n Pf SG f)
Nature of Repairs or Alterations(Answer when applicable) _../ /)�ll(�2 -X/ST/h�1
r y /- 'A 3 , Sod aQl cam,-► cy G-lc of, —K� s-e rs- .
Date last inspected:
-Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and t to place he syste n operationprtil�� ifr-
cate of Compliance has been issued by this oard of Health. 4//JJ
Signed Date 9/
S - Application Approved a E! Date—
Application Disapproved for the following reasons
Permit No. " Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of (Compliance
THIS IS TO CERTIFY,I that the On-site Sewage Disposal System Constructed( POSRepaired( )Upgraded( )
Abandoned( )by Q 2a(4e of
at has been constructed in accordance
with the provisions of Ti 5 and the for Disposal System Construction Permit No. }' dated
Installer •y�(�,.P �ti� � Designer
The issuance of this pemmi stall of be construed as a guarantee that thei�MAA,
will function Icsig✓ M �y
Date Inspector N
No. "' '�i'�� -------------Fee A5,��'
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS
Zitpogar *p5tem Construction Permit
Permission is hereby granted to Construct( ✓f Repair( )Upgrade( )Abandon( )
System located at Z-aoe
and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
Provided: Construction must be completedwithin three years of the date of thi e I.
Date: O / Approved by /
r
TOWN OF BARNSTABLE
LOCATION SEWAGE#
VILLAGE ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO. 30 S
d SEPTIC TANK CAPACITI(
LEACHING FACII.ITY: (type) eha (size)3® S�Gl• C _
NO.OF BEDROOMS
BUILDER OR OWNER If
PERMUDATE: 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 /�� Feet
on site or within 200 feet of leaching facility)
Edge of Wedand and Leaching Facility(If any wetlands exist
within 300 feet o leac nMfcifity) Feet
Furnished by
O�
O
10
TOWN OF BARNSTABLE
LOCATION SEWAGE#
VILLAGE ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO. 30 S
SEPTIC TANK CAPACTTY� f jp
LEACHING FACILITY: (type) 6 -- (size)
NO.OF BEDROOMS
BUILDER OR OWNER
PERMTTDATE: COMPLIANCE DATE:
fit I
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) /50 Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feeCTaV! f cility) Feet
Furnished by
i
3�
i
1
-fit' SID
-F Z-
"0 GAtZ-f3AGr-- GR(Qt>r--L
t>,&tU4 FLow _ ito ,c 3 z 33o 6-F.V.
U Ste- L ooX�) GA I_.
t�)ISPCSAL. PIT - L)S6 IOoo Gall.
SU;GW ALL SEA. = (50 S-1-.
50 sue. 1 .o = SO G-P D.
TOTAL 'DESIGw = 425 G•P.D..
ToTA L t7,dt Lam( FL-Ow
PmqGDL&-noQ (ZhTE tail" Smitj oiz IESS.
y
Tom- Iz.,5,-7-7 Tor PWID =,00.o
q.c ..,..,. .. 4
a qin PPS I000 WV
T-AW4
loo INV. IrJV.`�(.�S
4.St 4�'s CAo q�3
I LsAAcH �o� :A
FiT ZC-IA-iVC UU.ZUtj'A(ii.r.
wI rLl MaTL-"R►�L E wA�r✓r-t�`
it/
w.asi+ea �"'IC(-L=7��1 �RuC o e.GQJE;Uc2
�lE�. SToN� Cb
F�E
�•• CEQTtF1ED PLbT PL./Sti
s�o Pizor--i L_i=
LoCATIo�-1 \/V tr�T BA2.11S'TJ�d=�`
SGAL
Ab WA7EX
I G G.iZ T t F-( T 44 A T T N E. 5"C%4J►..I �-A tJ R C.1=c z E V.I G E
L�E�C Z�IJ GCaN1PL�(S �,l/ l TIC Tt-a� 'j I D E..Li►-3tr L.-O T I
.4WC> SETt;ACK S'EQ:JtQE,vlci-tTS. Oi= TNT
-To wLi 01= ?LhJ3 7:7jt?- Umil. 4,Mc'S DATA
DATE B A 7CTC�Z-
QEGIS.i'cRED LA1�1(7 SU2vcYo�'-S
THIS C7LA4-1 I'S UOT LASES C?" 05TEIZVXL,.1L- o SASS•
iWSnJlnEk--iT. SUZ•/ TIaC CI=GS�T�, 61-AOWU2�
�L-:r ear=-- rcl 1_.o-�' 1_1tita5
J
N
3
ZG -
U� t�j .
1c0<--A t.
lo
_
_ SLR f1 G
S-r S TtEll v
{
.r,�? .. .. .. _
1� 19t: L'"3�'.s !G
t
LdcATIO" Wes' Sazo-5TS,(�,LL
-T
i csuTlr-Y THAT' TNT 5u0w►.3 PLAN R��'cIZ�►.IGE
Wr--ZQo COAAPLYS W ITN TI-►E SIDE"�.i►-iE=
AUD 'SETV�AGK VGQvttZEVaWTS ai= TNT SOT I
R,AYE �Z3. 70 C B Q XTE tZ . 1J '(E= 14.1.G_
czEGtscctZLD Lkwcp SUevcYalzs
THI5 VLAW IS WOT BAISE'O U" AN OSTEtZ�/1Lt� o A,tA.SS.
ItJ,�T'IZcJ�tnENT SuQUG`>( � TNt= OF�S�-I"S SI.1oe,�t.a QPPLt CA1�.tT ��ag,GLc ZU"'['v
k,y.y iv.- USEo To DETC-.QMttlt_= Lo-T LINLS
�%%
L0VATIVN >, l SEWAG PERMIT N0.
r9,00-� .577
VILLAGE t1
INS A LLER'S NAME i ADDRESS-
�G✓.Py
BUILDER OR OWNER
G'Pa/rye- ZdTv
Ales T
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED
r _
e _ -�\
,,
.'--- —
"—�
! G�aa�se �
�� � �� �
{
� `�
cro c� -3
1
/�i `\
\� �1`
V
PrJ'/09��s' ���''e'
l� , - FEs.......Q . .0
No. .... ........
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
.......................... . ... .......OF...................................... -----------------------------------------
Jo i iration for Dhipoii ai Works Tnnitrnr#'inn ramit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
Sys em at: ST --------- -------------------
S3 _.............................................. --•- .. i
or Lot
L ' `. .�'4a�.. ocatidn-Address �Q...." .0 eNo._:�LS.....\.
ss
........ ....... -- --- --"-- --- - "---"---)/--............. ..........................................._.....-•-------.....................-----........_._...
�. nstaller Address
Q Type of Building Size Lot.............................Sq. feet
U Dwelling—No. of Bedrooms ...............3.....................Expansion Attic () Garbage Grinder ()
p`'44 Other—Type of Building<_�:1 A:a�.•. No. of persons.._.....�"----______- Showers (�) — Cafeteria
Other fixtures ..................................
W Design Flow...............2----------:.........gallons per person per day. Total daily flow--------5—.5. .__ :fi'_ .._gallons.
WSeptic Tank—Liquid capacttyfO.QO_.gallons Length....__ . Width -.....c`rDiameter....__°-------- Depth....._5....
x Disposal Trench—No. ..... Width........... Total Length_.___....- Total leaching area........__.__..__...sq. ft.
Seepage Pit No.._ Diameter____________________ Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box (�} Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water------------,----------
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------
Ra' --------•---- -----•------"----------•------------------------ ......-------------------------
O Description Soil_... -,' 4o�....... -"----
x 7b
V ........-••••--•-•••••........................... ........._._.-••-•••---_.__•-•••••----•-•-•-•••••••......••-••-......•.....•-• .............-•-••........._...._. ••...--•_.........
W -- ------------------- ------------------------------------------------------------------------------------------------ -------•-----•-•------------•-------•••--•••-••••-••••-••-••......•_....__--••--
VNature of Repairs or Alterations—Answer when applicable--------------------".-_.____.--------------------------------_................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of iI'i I-E 5 of the State Sanit*Co — e undersigned further agrees not to place the system in
operation until a Certificate of Compliance hat of health:Signed- ..• •.-- ..... ...... . --- ..._._............. -. . .. / .......6.--
._._. .__ e
Application Approved By....
Date
Application Disapproved for the following reasons-...............................................................................................................
..................................................... ...............................................................:..............................................................................
Date
Permit No........... y -__.... Issued__., _.�L.. --------•-•--------....._......
--....----•---•--•............. Date
No:........ ...... Fmc..............................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.......... ..... ..... ..................OF...........................--•--..._...----------._.....---•---
Appliratiun for DWposai Works Tunitratitun "pr- r- Wit
Application is hereby made for a Permit to Construct (b ) or. Repair ) aI Individual Sewage Disposal
Syst „ at
{1 ..
do •Address r Lot No. ••••-•-
O -er Address
`Installer Address........ ...
UType of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms.............. Expa Att nsion ic°''( )"'a Garbage Grinder,_(- )
aOther—Type of Building ,_c c_c 4:... No. of persons___..____._........... Showers (z) — Cafeteria (—)
d Other fixtures
Design Flow..............:J._J__________....._____gallons per person per day. Total daily flow____. G_._.._.______.._._.___..____gallons.
W _
WSeptic Tank—Liquid capacity/vA�_e�_gallons Length_�:5___ Width__._y_S___. Diameter________________ Depth......5......
x Disposal Trench—No..................... Width............ Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No.... ..`_"..:_._.. Diameter____________________ Depth below inlet.................... Total leaching area..................sq. ft.
z Other Distribution box ( ) Dosing tank ( )
1.4 Percolation Test Results Performed by......................................................................... Date........................................
Test Pit No. 1.................minutes per inch Depth of Test Pit.................... Depth to ground water........................
(T4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
--- -----------------------•-T•----;;-•-••-------r-----. ---••-------•--•••--------------------------------------------------------------
D Description of Soil--------./-o........ E_ .....-- - `'-' - ........ .............. ... ---• .
W
UNature of Repairs or Alterations—Answer when applicable...............................................................................................
---------------------•------•----._....----•---_....•••---••-••---•-•__.. .--------..__.........-•----_-___-•-•-----•-----•-•------••--••----•••--•----•-••--•-•••-••••••--•------•--....-•-•-••--•--•••
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITL Es 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issue by the board health.
Signe ..........
�....
"/I j Dat
Application Approved By....... -----------------------•-------••------•--•---------.....-•-------•-
Date
Application Disapproved for the following reasons--------------------------------•------------------------------•-----------------•----------•---••---•...•-----•-
..---•--...--•................•••••-••••__•-•- --•••-•••••....-•-•-•-•...•-•---___•---•••-•-•----•••-•--
�ir Date
PermitNo......................................................... Issued-.......................................................
Date
_ TKE, COMMONWEALTH OF MASSACHUSETTS
' BOARD OF HEALTH
Its by...........O F........,cthl/,...rho e
................ ..........................
......................_................._._.......
Tntgfiratr of Tompliattrr
T S IS TO CERT Y, VTt,,.'..,,e Individual Sewage Disposal System constructed ( orRepairedby-••- ------- -------
Instal
/e G l /rc C .ti i f
at.. - .�.-•----••••••-•-----_..•-•--•___•-•••-----•- .._-•----•--_-•-•------•..•--•••-•--•--••••••-••••-•••--•--••-•------•••••-------•--••-•-••-••-•-----••---•------••-
has been installe in accordance with the provisions of TLE 5 of The State Sanitary Code as de)c 'bed in the
application for Disposal Works'Construction Pei'mit'N .___
� � da.ted --.
- ---------------------------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE..... .. .................................................. Inspector--____, --------------------------------------------
'THE COMMONWEALTH.~OF MASSACHUSETTS
BOARfy OF ` HEALTH
Xl dIt�- +.6 �Sr.iLc �
..........................................OF.....
No...... .... ......._....•__... (
Rovo 1 Work, ni ion rruttt
Permission is hereby granted•-•- .6 ------•- Gt. �� •--------------------------•------•-•--................
nstruct (. ) or Repair ( /an Individual Sewage Disposal System
--
__._:------ - ----------fir^ yY .......... L,P"Tc- - �"rY''T i'tld'' Stree�------�. r+: ....1•r,/.._ ..._•--•...._.........
l � p:4.
n the al(plication for Disposal Works Cor structioii Per it No-----------���__ Dated ____,_ _.��._,_�1-..��..-..
Board of Health
ffx -------------------------------------------
OBBS & WARREN. INC., PUBLISHERS
1
J
� 3 .
3Z1 `
?Pop N
ti ,E $pc
t
sys D
• i _- - Ti C-
weLL.,
L.
CEtZTtF1�L� PLoT F>I-
LoCATIO" WEaT BA OV WS L.
5CALC _ � , L7ATl= 3 •Z5 •-1
t C.F-tZTIl=-( THAT TNc-. 5u0%AJw
%4r-Z E oj_i CoAAPLVG W I TN TWG 51 DS t_ "E:
Awr-> SETE3AGtC REWU19ZEMe►. Tg; OF TNe �C�T
"(n W U oIr �2�tJ 5't�• Leo DP-rev F�T3 �, ►°t -,-7
B Q.XTC�Z � 1JYE I4JG.
tZEGtS I'C-3Z�D LA►-lp 5U2vEYotzS
TNt5 pL,A.W IS LIOT SASE' 0►4 As.J OSTEQVII_t.� o A�CaSS.
ttJS`�tJMEt.IT' SUczv�Y � T11t= oF�S�YS 51�b*ut-a A{�Pt_I GA.ti.iT_ .GCar-'rt✓' Zc>TU
KtIT EEC USCb -rc, pIrr--v-m1%4& LoT' LI1.1a S -
1+ t- e— mF= C—
A
�U 6> 2KAG� C,R1 QRoF--�
F LAW z 1 t o V- = 33 o
—f--v=7-tc = 3` .t 1r7G % _
USA- l oOC:) SAL-
,�jISPo�AL PtT �5a= loco jai. .
z(y�WALL Ae = (SD sF.
�.,0 Sri". � t •o = Sd C�•P D.
TOTAL 't'�ESIG►.I = 425 G•RD.
ToTQ�. b,cst�-�( FLaw = 33p 6.P.D•
G�fLGDL�T1O t,J RATE C'Ll 'LM"'J 02 1B6S•
I
1
Tor F"w0 =1oo.o
-rr-ST -7-7
[t C \\ ///\\ / \:Y 11.0
C9/)'I
p,P� VKT
4 'Boy, Sepr;c I o �.
Su3�D/c utV. IJ To�K
I DOO (�wV• t►N•q(.5
Q4 S
4,5 GAS.. `o, c�G,-3 `A
t L.sArN ;
G p,T }�cGvE UUSc�,�At?r~E e.
wire
i WAiWED
,yam, STOwe- qo,
F�E /o�f �o � �L... l.•bT 'L /�.�.i
-I I CEV-TtF1ED P �_
s�wv. PRo'F•I L_
LoC.ATIo" \NC~ST �iA�t•�'Tfi�a�
aO XNt,,E
A.ro WA n-:fZ-
c�IZTI1=�
2 c►mil G&
T F••(A T T N� 5 t••1o�►J PL to 1�1 R i_h�.
t-�f_4?L=L�t�3 G lPL�(S W ITFA TI-!iE: �jIDE Ll►-�E= L �"T'
A►vt7 `:ETL.ACIC EMcuTs DF T► e
Tow off= P�Pcl.1 F 2. 0 E�•1.
I RCGtSrc=��D LANG SU2v�=Yoc:.S
Ut•...i A�.J oSTE.�VtL..LG o I�CrLSS,
-r 1-t l•s h t�A� t� ►-t o-r 1✓AS eo � a.T�
rc,
LEGEND Locus-' _M
Wid °�S.Coos=°I Roil
rood ®
- -- 98 --- -_ EXISTING CONTOUR �O9e° nnn
and
�,
.x 100.98 EXISTING SPOT GRADE
for.
A EXISTING WELL y° q °�1p
BENCHMARK Benchmark Set `,/, �F
Top Con c./B.H. Corner ;o Cedar ,3
2 EL.=100.77 (Assumed)
A,
(D ee �
Sp 64, W CP J
/ x 97.19 a---x-9a.96-_ N 52'45'10° W x 97.18
252.77' -; LOCUoS SCALE
� , , NOT
rn x 97.18 3
In
FO
Sri LO
05 (30
Xz�)v ' r10
[) 0)
` LOT 1 _
_. NEN(
/r i �� x 100.4 ( rw, C 49
APN 132-028 DECK
EXISITN _
1 ACRE
G/
N PROPOSED
!' at ADDITION %/HOUSE(#10)/ 150'
f T.O.F.=1001.44t /
30
P op. .PORCH �ii,�/ L� x looao 70.9 �\ c11 97.26 ;
b 100.4 1\ cV--. G�t 99A1�x 91„18 G) 4 100A co
II y
120' WALK F f7 EXIS77NG �. tr1
W . 9s2 100.1 SEP77C TANK M
100.37
917B
r / --- ., -- 1 EXIST. D-BOX
�O d'
°' -C 99,92 r#99,61
- -"i EXIST. S.A.S. CB/Jh fnd. 9850
\929,5� , m :A- --- 99.0 OF Mq
0.00 .x .18 S��P CyG
X y - ,\\' _ h� o PETER T.
C-g8 x 1oo.9s / D �,�� 99.18 U McENTEE
6g. ` 99.s1 o CIVIL
92 R_24g 0 j'`95 _ .97' �`l� o. 35109
CB/dh fnd S 52*4510 E 9 •32
_
�
FO
o. tr-a.uelLed_.1v9Y---
--- ---_-__._ ----Edge-
WIDGEON LANE 1 �;)
o so
FLOOD PLAIN DESIGNATION
Community-Panel No. 250001 0011 D )3O�
Map Revised: July 2, 1992
Zone C CB/seal fnd.
WIND EXPOSURE CATAGORY: Exposure B �j2 SITE PLAN OF PROPOSED ADDITION
ZONING CLASSIFICATION: RIF , 10 WIDGEON LANE, WEST 6ARNSTABLE, MA
BUILDING SETBACKS: Prepared for: George Zoto, 10 Widgeon Lane, West Barnstable, MA 02668
FRONT = 30'
SIDE = 15' Engineering by: SCALE DRAWN JOB. NO.
t 1"=30' P.T.M. 116-10
REAR = 15' Engineering Works, Inc.
BUILDING HEIGHT = 30' 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET.NO.
(508) 477-5313 3/15/10 P.T.M. 1 Of 2
ti
r
(3) 5" DIA.OUTLETS
15.5" 16" 2"
T.O.F.
)35f(MAX EL:' 92. .
EXISTING � F.G. EL.=99.82t � F.G. EL: 99.78E F.G. � ' �•,
1
jg ;r 15.5" 8 12
Ba A ®a
B 6E OE H-10 LOADING 2
INV.=96.77t 48" LIQUID INV.=96.74E aaaaaaa
INV.=97.3t LEVEL INV.=96.70t D BOX INV.=96.53E 4,EFF. WIDTH 5 1,3't(RECORD) D-BOX
INV.=91.60E N.T.S.
EXISTING SEPTIC TANK 3-500 GALLON LEACHING CHAMBERS
SURROUNDED WITH STONE AS SHOWN
H-10 RATED
TOP CONC. ELEV.=92.35
BREAKOUT ELEV.=92.10t
INV. ELEV.=91.60E ease ®®' ® ®®®
aaaa
Baaaa aoaaa33"
BOTTOM ELEV.=89.60E - ®EE ®®® ® ®®®
4't 3 X 8.5'=25.5' 4'f N > ® ®®®® ® ® U® ®
5' MIN. ABOVE BOTTOM OF EFFECTIVE LENGTH = 33' (RECORD) Z ® ®®®
T.P. EXCAVATION OR G.W.
LEACHING SYSTEM SECTION
NO GROUNDWATER, EL.=84.60 = 102"
EXISTING SEPTIC SYSTEM PROFILE
N.T.S.
4" KNOCKOUT
20" DIA. COVER
SOIL LOG 4" KNOCKOUT / 4" KNOCKOUT 62"
DESIGN CRITERIA
DATE: DECEMBER 5, 1977 0
NUMBER OF BEDROOMS: 3 BEDROOMS + 1 PROPOSED = 4 TOTAL SOIL EVALUATOR: WILUAM NYE
(TAKEN FROM TOWN RECORD)
SOIL TEXTURAL CLASS: CLASS I DEPTH TIP4" KNOCKOUT
DESIGN PERCOLATION RATE: <2 MIN/IN 0"
DAILY FLOW: 440 G.P.D. LOAM
DESIGN FLOW: 440 G.P.D. 12"
GARBAGE GRINDER: NO 500 GALLON CAPACITY, H-10 LOADING
SUBSOIL
EXISTING SEPTIC TANK: 1000 GALLON CAPACITY (> 200% DAILY FLOW) 54. CHAMBERS
LEACHING AREA REQUIRED: (440) = 594.6 S.F.
.74 N.T.S.
EXISTING S.A.S. HAS 3-500 GALLON LEACHING CHAMBERS IN SERIES CLEAN .MED. SITE PLAN OF PROPOSED ADDITION
SURROUNDED BY DOUBLE WASHED STONE ON ALL SIDES (13' x 33') TO FINE
SIDEWALL AREA: 2(13' + 33') X 2 = 184 S.F. SAND
' 10 WIDGEON LANE, WEST BARNSTABLE, MA
BOTTOM AREA: 13' x 33' = 429 S.F. Prepared for: George Zoto, 10 Widgeon Lane, West Barnstable, MA 02668
TOTAL AREA:................................... ................... 613 S.F. 160" Engineering by: SCALE DRAWN JOB. NO.
C RATE <2 MIN IN. C" HORIZON) Engineering Works, Inc. NTS P.T.M. 116-10
S.A.S. DRY AT TIME OF INSPECTION, 3/10/2010 PER NO GROUNDWATER ENCOUNTERED 12 West Crossfieldd Road, Forestdale, MA 02644 DATE
O.
EXISTING CAPACITY OF S.A.S.: 0.74(613) = 453.6 G.P.D. CHECKED SHEET 3
(508) 477-5313 3�15�10 P.T.M. 3 Of 3
NOTES: ..
1.) CONTRACTOR IS TO VERIFY ALL EXISTING CONDITIONS
9,g 9-s &DIMENSIONS IN THE FIELD
2.) CONTRACTOR TO VERIFY ALL INTERIOR&EXTERIOR MATERIALS,
DETAILS,&FINISHES IN THE FIELD WITH OWNER
A A § 3.) ROUGH OPENING HEAD HEIGHT OF WINDOWS AT
5
B � D FIRST FLOOR TO BE 6'-8"ABOVE SUBFLOOR
4.) ALL CONSTRUCTION TO CONFORM TO 780 CMR MASSACHUSETTS
---� STATE BUILDING CODE,SEVENTH EDITION
O SINK SINK pyy REF b NEW
5.) 110 MPH EXPOSURE B WIND ZONE, 1.25 ASPECT RATIO FOR NEW ADDITION ONLY
O:
NEW 6.) ALL SHEETS OF PLYWOOD WALL•SHEATHING TO BE INSTALLED VERTICALLY
STACK 21'x 66' DECK OR HORIZONTALLY W/BLOCKING AT ALL EDGES
A WID NEW 5, I KITCHEN 9LITE +�
L'.DRY. FI (VERIFY KITCHEN a (AZEK DECKING) 7.) THE NAILING SCHEDULE ON SHEET A9 TO BE FOLLOWED WITH NO EXCEPTIONS.
NEW RANGE LAYOUT WI OWNER) DEVIATION FROM THIS SCHEDULE WILL REQUIRE ADDITIONAL METAL HOLD DOWNS&STRAPS
x3 BATH LIN. (VAULTEDCEIUNG) ry 8.) SEE CERTIFIED PLOT PLAN DEVELOPED BY ENGINEERING WORKS,INC.FORALL
so Cne. d i1'6 v DETAILS ON THE EXISTING PROPERTY
0
I z c I I EXIST.
9.) FOLLOW ALL MANUFACTURER'S SPECIFICATIONS FOR INSTALLATION OF ALL
SIMPSON COMPONENTS
0 I CLOS. I 10.) ALL CONCRETE USED FOR FOUNDATION WALLS,FOOTINGS&SLABS
o I I TO BE 3000 PSI
I is (
2rxSir VERIFY ALL PLUMBING&ELECTRICAL DETAILS W/OWNERS ON THE SITE
CESS I I I FOLDING i I I 11.) .
4 ty I _J I I CLOS. I I DURING FRAMING CONSTRUCTION
PKT.DOOR 12.)THIS ADDITION DESIGNED TO THE FAMILY APARTMENT CRITERIA @240-47.1
2VxSV .2V'x66' 58 I I IN THE TOWN OF BARNSTABLE ZONING BY-LAWS
PKT.DOOR PKT.DOORcc
8 I I
/ xG
NEW io
SITTING 1425
NEW AREA LIVING
BEDROOM Zr
A (VAULTED CEILING) ROOM
12 -
v
)
A A
A
5'-1P 9'•7 9'-2" 3'-10' z{p
a NEW -
COVERED -
PORCH �ee_a
(AZEK DECKING) 12
12 ® �4
P.T.4 x 4 POSTS WI MATCH
EXIST.
1aa 1a-o'
10'd CASING&1 x 6 BASE
3o a
A
FIRST FLOOR PLAN
NEW CORNER BOARDS
LEGEND: TO MATCH EXIST.
u lilt
EXISTING WALLS NEW W.C.SHINGLE SIDING
- CONSTRUCTION TO BE REMOVED TO MATCH EXISTING
t---J
® NEW CONSTRUCTION
AREA CALCULATIONS:
EXISTING HOUSE = 1908 S.F. I 264T ra
NEW FAMILY APARTMENT = 785 S.F.
NEW COVERED PORCH = 210 S.F. LEFT ELEVATION
TIEOESrNERSTIALLBENOTIFIEDIFANY SCALE: DRAWING NO.:
ERRORS OR OMSSOONS AREfCK1NDON - _
COTUIT BAY DESIGN, LLC NEW ADDITION FOR: TL�ORANINGSPLEFOR HECONT 1/4° = 1'-0"
-. } ODNSTRUCRON.THE SURDWG yNfpAGTOa
MALL BE RESPONSIBLE FOR 11E OONTENT
43 BREWSTER ROAD NTHESE DRAMAMIS If OONSTaUCRON
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