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HomeMy WebLinkAbout0088 HOLDER LANE - Health 88-Hold.er Lane ` - M.arstons Mills A= 174-001 - 0.17 TOWN OF BARNSTABLE LOCATIONc5 SEWAGE# VILLAGE SSESSOR'S MAP&PARCEL INl; L S NAME&PHONE NO. SEPTIC TANK CAPACITY (OC)0) LEACHING FACILITY: NO.OF BEDROOMS OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY� a I - f�. 3 LA At O O yV , �« ��� act ���� TOWN OF BARNSTABLE 5-i5-o4 Fc. LOCATION " 101� % SEWAGE # )W- 0q:Z_ VILLAGE ASSESSOR'S MAP & LOT 17 -UU/ !7 INSTALLER'S NAME&PHONE NOAQS?J' f cfxaash- on Ioc- SEPTIC TANK CAPACITY O0 -500 6al101'l (-,hct rr-Nber5 LEACHING FACILITY: (type) (size) NO. OF BEDROOMS BUILDER OR OWNER kohel'f SchafZi°2 PERMITDATE: 3 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by A a L4� pf 1 149 -- 6q 3� 110 , oa � O - Commonwealth of Massachusetts Title 5 official Inspection Form ' Subsurface Sewage Disposal System Form-Not for Voluntary Assessments l 88 Holder Lane, Marstons Mills r Property Address , Nina Zaretsky ' Owner Owner's Name information is 13203 Custom House Court Fairfax VA 22033 3/17/2021 required for every . . page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. Inspector Information filling out forms on the computer, use only the tab Jorge Miguel Chavez key to move your Name of Inspector cursor-do not Speakman Excavating LLC use the return Company Name key. Speak Way � Company Address Harwich MA 02645 City/Town State Zip Code raucn 508-432-5565 S 114294 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector In full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection 1 have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails InspectoPs Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. 15insp.doc•rev.712 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts Title 5 official Inspection Form ~ Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 88 Holder Lane, Marstons Mills Property Address Nina Zaretsky Owner Owner's Name information is required for every 13203 Custom House Court, Fairfax VA 22033 3/17/2021 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® 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: 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined"(Y, N, ND)for the following statements. If"not determined,"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. "A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): l5insp.doc•rev.712&2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts P Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments k 88 Holder Lane, Marstons Mills Property Address Nina Zaretsky Owner Owner's Name information is 13203 Custom House Court Fairfax VA 22033 3/17/2021 required for every , page. Cltylrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes(cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5lnsp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface P Sewage Disposal System Page 3 of 18 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 'r 88 Holder Lane, Marstons Mills Property Address Nina Zaretsky Owner Owner's Name information is 13203 Custom House Court, Fairfax VA 22033 3/17l2021 required for every page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® 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 t5insp.doc•rev.7P262018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts 111.F)61 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 88 Holder Lane, Marstons Mills Property Address Nina Zaretsky Owner Owner's Name information is 13 required for every 203 Custom House Court Fairfax VA 22033 3/17/2021 page. Cltyrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 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. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ Z 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 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply pp y ❑ ❑ 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 t5insp.doc•rev.7/26/2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts 1901 Title 5 Official Inspection Form ktv Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 88 Holder Lane, Marstons Mills Property Address Nina Zaretsky Owner Owner's Name information is required for every 13203 Custom House Court, Fairfax VA 22033 3/17/2021 page. Citylrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered"yes"to any question in Section C.5 the system is considered a significant threat, or answered"yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: Yes No ❑ ® 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)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 ' Commonwealth of Massachusetts Title 5 Official inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 88 Holder Lane, Marstons Mills Property Address Nina Zaretsky Owner Owner's Name information is required for every 13203 Custom House Court, Fairfax VA 22033 3/17/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system?(Include laundry system inspection El Yes ® No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: 2019: 114,000 2020: 85,000 Sump pump? ❑ Yes ® No Last date of occupancy: 3/1/21+/- Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Forrn:Subsurface Sewage Disposal System•Page 7 of 18 _<\, Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 88 Holder Lane, Marstons Mills Property Address Nina Zaretsky Owner Owner's Name information is required for every 13203 Custom House Court, Fairfax VA 22033 3/17/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 2. 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 Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form!Subsurface Sewage Disposal System-Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form OP Subsurface Sewage Disposal System Form-Not for Voluntary Assessments � 88 Holder Lane, Marstons Mills Property Address Nina Zaretsky Owner Owner's Name information is required for every 13203 Custom House Court, Fairfax VA 22033 3/17/2021 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. 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): Approximate age of all components, date installed (if known)and source of information: 3/15/04 per COC Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 2.11' feet Material of construction: ❑cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line: 101+ feet Comments(on condition of joints, venting, evidence of leakage, etc.): Building sewer in good condition, there is no evidence of leakage. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 1s Commonwealth of Massachusetts u, 5 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 88 Holder Lane, Marstons Mills Property Address Nina Zaretsky Owner Owner's Name information is 13203 Custom House Court, Fairfax VA 22033 3/17/2021 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 24"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: 1000gal Sludge depth: 4" Distance from top of sludge to bottom of outlet tee or baffle 30" 1" Scum thickness Distance from top of scum to top of outlet tee or baffle 5" Distance from bottom of scum to bottom of outlet tee or baffle 13" How were dimensions determined? Measured+/- Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in ok condition, structurally sound, PVC tee on inlet and outlet in place, liquid level is at outlet invert, there.is no evidence of leakage or backup. t5insp.doc•rev.726/2018 Idle 5 Official Inspection Fort:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form ► Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 88 Holder Lane, Marstons Mills Property Address Nina Zaretsky Owner Owner's Name information is required for every 13203 Custom House Court Fairfax VA 22033 3/17/2021 page. City/Town state Zip Code Date of Inspection D. System Information (cont.) 7. 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.): 8. 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts kvTitle 5 Official Inspection Form �--Wotlzl Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 88 Holder Lane, Marstons Mills Property Address Nina Zaretsky Owner Owner's Name information is required for every 13203 Custom House Court, Fairfax VA 22033 3/17/2021 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): 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.): Dbox is in good condition, watertight, there is no evidence of leakage or backup, 2 outlets with speed levelers. l5insp.doc•rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts 9 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 88 Holder Lane, Marstons Mills Property Address Nina Zaretsky Owner Owner's Name information is required for every 13203 Custom House Court, Fairfax VA 22033 3/17/2021 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No` Alarms in working order: ❑ Yes ❑ No" Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 2 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 13 of 18 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 88 Holder Lane, Marstons Mills Property Address Nina Zaretsky Owner Owner's Name information is required for every 13203 Custom House Court Fairfax VA 22033 3/17/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS)(cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching with 14"of liquid, there is 7"to 8"of separation between liquid level and pipe invert, no visible stain line above liquid level and no evidence of backup or failure. 12. 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts -. p Title 5 Official Inspection Form '- Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 88 Holder Lane, Marstons Mills Property Address Nina Zaretsky Owner Owner's Name information is required for every 13203 Custom House Court, Fairfax VA 22033 3/17/2021 page. Citylfown State Zip Code Date of Inspection D. System Information (cont.) 13. 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection .Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 88 Holder Lane, Marstons Mills Property Address Nina Zaretsky Owner Owner's Name information is required for every 13203 Custom House Court Fairfax VA 22033 3/17/2021 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters . the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately 1 1 A J i At 7t 2, ro o '3: 33 ` https://town.bamstable.ma.us/Departments/Assessing/Property_Values/HMdisplay.asp?mappar=174001017&seq=2 1/2 l5insp.doc.rev.7/26/2018 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 88 Holder Lane, Marstons Mills Property Address Nina Zaretsky Owner Owner's Name information is required for every 13203 Custom House Court, Fairfax VA 22033 3/17/2021 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 6.6' below the bottom of leaching.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:' 3/3/04 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: Engineer letter on file certifying the installation dated 3/18/04 Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 88 Holder Lane, Marstons Mills Property Address Nina Zaretsky Owner Owner's Name information is required for every 13203 Custom House Court, Fairfax VA 22033 3/17/2021 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed& Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6(Checklist)completed ® D. System Information: For 8:Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•page 18 of 18 Commonwealth of Massachusetts 11/� /7y"040,1—Ll 7 Title 5 Official Inspection Form /� �. Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w„ 88 Holder Lane _ Property Address Chris McGowan Owner Owner's Name information is required for every Wegrnstable MA 02668 June 2, 2015 page. Cltylrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, < I j- / O 3� use only the tab 1. Inspector: V I key to move your cursor-do not _Patrick T. Sullivan use the return Name of Inspector key. Ready Rooter Excavating „b Company Name P.O. Box 89 Company Address Forestdale MA 02644 City/Town State Zip Code 508-888-6055 S112843 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 ��� June 2, 2015 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. 7 0 V t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments A. 88 Holder Lane Property Address Chris McGowan Owner Owner's Name information is West Barnstable required for every MA 02668 June 2, 2015 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments •y'" 88 Holder Lane Property Address Chris McGowan __ Owner Owner's Name information is required for every West Barnstable MA 02668 June 2, 2015 page. City/Town 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 Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 88 Holder Lane Property Address Chris McGowan Owner Owner's Name information is required for every West Barnstable MA 02668 June 2, 2015 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 D P e y , p E certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 'h day flow t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 88 Holder Lane_ Property Address Chris McGowan Owner Owner's Name information is required for every West Barnstable MA 02668 June 2, 2015 - page. City/Town 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- 1 0,000g pd. ❑ ® 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. l5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 88 Holder Lane Property Address -- Chris McGowan Owner Owner's Name information is required for every West Barnstable MA 02668 June 2, 2015 _ page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were an of the system components pumped out in the previous two weeks? Y Y P P P ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 - Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 335.8 GPD t5ins-3/13 Title 5 Official Inspection Form.Subsurface Sewage Disposal System-Page 6 of 17 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 88 Holder Lane _ Property Address Chris McGowan Owner Owner's Name information is West Barnstable MA_ 02668 June 2, 2015 required for every _ page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 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 Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 2013= 236 GPD g ( y g (gp ))' 2014= 197 GPD Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 88 Holder Lane Property Address Chris McGowan Owner Owner's Name information is West Barnstable MA 02668 June 2, 2015 required for every _ page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Ready Rooter records: Pumped Sept. 2014 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 88 Holder Lane _ Property Address Chris McGowan Owner Owner's Name information is required for every West Barnstable MA 02668 June 2, 2015 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: Tank installed 1987. D-box and SAS installed 03/15/2004. Certificate of Compliance on file at Health Dept. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2 8 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: n/afeet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): Depth below grade: 2 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 8.6'X 4.5'X 4.5' 1000 gallons Sludge depth: 2 t5ins•3113 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 ,. 88 Holder Lane Property Address Chris McGowan Owner Owner's Name information is required for every West Barnstable MA 02668 June 2, 2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 32" Scum thickness 2"at inlet 1"at outlet _ Distance from top of scum to top of outlet tee or baffle 6 Distance from bottom of scum to bottom of outlet tee or baffle 13" How were dimensions determined? Tape measure and dip tube. Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Inlet and outlet PVC tees in place. Liquid level at outlet invert. Risers bring covers within 6" of grade. Old outlet line capped outside of tank. 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 Commonwealth of Massachusetts Title 5 Official Inspection Form _ — Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 88 Holder Lane_ Property Address Chris McGowan Owner Owner's Name information is every West Barnstable re wired for eve MA 02668 June 2, 2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.).- Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: — gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•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 'w.. 88 Holder Lane Property Address Chris McGowan Owner Owner's Name information is required for every West Barnstable MA 02668 _ June 2, 2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 11 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): One inlet, two outlets w/speed levelers in place. Equal flow. No solids carryover present. D-box is H- 10, 3.5' below grade. Riser brings cover within 2" of grade. Recommend removal of Cypress bush near d-box cover to avoid root intrusion in future. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3113 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 88 Holder Lane _ Property Address Chris McGowan Owner Owner's Name information is required for every west Barnstable MA 02668 June 2, 2015 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: — ® leaching chambers number: 2- 500 gal ea. w/ 4' of stone. ❑ 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.): Chamber located and inspected with camera. Liquid level >1' from invert at time of inspection. No sign of past hydraulic failure. Clean stone visible in sidewall. 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 layer Depth of scum la P Y Dimensions of cesspool Materials of construction - -- Indication of groundwater inflow ❑ Yes ❑ No t5ins•3113 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 88 Holder Lane Property Address Chris McGowan Owner Owner's Name information is required for every West Barnstable MA 02668 June 2, 2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)-. Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•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 88 Holder Lane Property Address Chris McGowan Owner Owner's Name information is West Barnstable required for every MA 02668 June 2, 2015 page. Cityfrown 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 i I � l k 'D 01 1 _ - 3z ` 33 r t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 88 Holder Lane Property Address -- Chris McGowan Owner Owner's Name information is every West Barnstable required for eve MA 02668 June 2, 2015 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: '5 ---- 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. 06/1987 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: maps.massgis.state.ma.us/oliver.php You must describe how you established the high ground water elevation: Test hole in 1987 found no ground water at 180" (elv= 111.5) Base of SAS at elv= 118.10 per engineered plans. Accessed local ground water contours and topo mapping. No high ground water in area of system. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3113 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 88 Holder Lane Property Address Chris McGowan Owner Owner's Name information is West Barnstable required for every MA _ 02668 June 2, 2015 page. CitylTown 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 r E.k 22977 P's 283 -:3'7t740 06-13-2008 a`1 10= 25ax DEED RESTRICTION WHEREAS, 4c: SA'! -c HMrl OGaejAd of - (owners name) (addmss) is the owner of ffau)r-,/L L ( I located (address) at VJ66T l3 VAJ Salt N4 , MA (hereinafter referred to as OR- 411-166-2 L.n) and being shown on a plan entitled "Subdivision of Land in Dl1►W S t E MA, Properly of CN7R kmvo�*A G { c�J -n�� �L� � et al, duly recorded in Barnstable County Registry Of blpFcs Deeds in Plan Book a` q , Page 114 -a o ; Or on Land Court Plan Number WHEREAS, HAfit} M cc-,: aw � as the owner of said lot has (owner's name) agreed with the Town of Bamstable Board of Health to a restriction as to the number of bedrooms which can be included in any home built on said lot as a pre-condition to obtaining a disposal works construction permit in compliance with 310 CMR 15.000 StateL Environmental Code,Title.V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage; WHEREAS, the Town of Barnstable Board of.Health, as a pre-condition to granting a disposal works:construction permit fora septic system in compliance with 310 CMR 15.200, State Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage, and authorizing the issuance of a building permit for the.construction of a single family home on this property, is requiring that the agreement for the restriction on the number of bedrooms in any house constructed on the lot be put on record with the Barnstable County Registry of Deeds by recording this document, aee& ct,�l� tfi>sYV1U; 14'W AU AM 40 H aA£dfNw eh i l F S13a.;ti ta..rk ,.. key I 'F ., moo;. �dr>a`-��aa�.c:.•�..:- �" .. � NOW, THEREFORE, IYA-91 r can/ �(cC,���� (does hereby place the (owner's name) following restriction on his above-referenced land in accordance with his agreement with the Town of Barnstable Board of Health, which restriction shall run with the land and be binding upon all successors in title: may have constructed (address) upon the lot a house containing no more than C _ _( ) bedrooms. cfi�rs-rvPrrt��, f(� , � agrees that this shall be permanent deed e na ) restriction affecting A�VAP.n located on oUn1i-TA-per MA, and being shown on the plan recorded in Plan Book�_ , pages _fit, Or on Land Court Plan For title of_a�av� ►k,p see the following deed: Book l8'q_oa , Page i . Or Land Court Certificate of Title Number Executed as a sealed instrumen „ff-l- day of � C Owner's sign re Owner's sig ature Owner's signature COMMONWEALTH OF MASSACHUSETTS ss is 20cz� Then personally aFpeared the above-named known to me to be the person who executed the foregoing instrument and acknowledged the same to be free act and deed, before me, Public Notary My commission expires: Y C i deedrOLTM O i �'h' AW 11,2014 1. COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION FAILED INSPECTION MAP PARCEL , OO\CO) EAT TITLE 5 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 88 Holder Lane West Barnstable, MA 02668 Owner's Name: Constance Schaffer Owner's Address: - RECEIVED Date of Inspection: February 11, 2004 FEB 2 6 2004 Name of Inspector: (Please Print) James M. Ford Company Name: James M. Ford TOWN OF BARNSTABLE Mailing Address: P.O. Box 49 HEALTH DEFT, Osterville,MA 02655-0049 Telephone Number: (508) 862-9400 CERTIFICATION STATEMENT 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 Needs Further Evaluation by the Local Approving Authority ✓ FailA Inspector's Signature: Date: February 14, 2004 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. _ Notes and Comments ****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. Title 5 Inspection Form 6/15/2000 page I Page 2 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 88 Holder Lane West Barnstable, MA Owner: _ Constance Schaffer Date of Inspection: February 11, 2004 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. 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 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: 2 Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 88 Holder Lane West Barnstable, MA Owner: Constance Schaffer J Date of Inspection: February 11, 2004 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. _ 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 and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 88 Holder Lane West Barnstable, MA Owner: Constance Schaffer Date of Inspection: February 11, 2004 D. System Failure Criteria applicable to all systems: You must indicate either`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 '/2 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. ✓ 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] Yes (Yes/No)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 System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd- You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) 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. 4 Page 5 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 88 Holder Lane West Barnstable, MA Owner: Constance Schaffer Date of Inspection: February 11, 2004 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: Yes No ✓ 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(3)(b)]. 5 Page 6 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 88 Holder Lane West Barnstable, AM Owner: Constance Schaffer Date of Inspection: February 11, 2004 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 2 Does residence have a garbage grinder(yes or no): Yes Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): n/a Water meter readings, if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Currently occupied COMMERCLUANDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): and Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system (yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Pumped in September 2003-per owner Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: Qallons--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: Installed on Oct. 15193-per as built card Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 88 Holder Lane West Barnstable, AM Owner: Constance Schaffer Date of Inspection: February]], 2004 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron 40 PVC other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 20" Material of construction: ✓ concrete _metal _fiberglass _polyethylene _other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1000 gal. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 2" Distance from top of scum to top of outlet tee or baffle: 8" Distance from bottom of scum to bottom of outlet tee or baffle: 10" How were dimensions determined: Measuring stick Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Tees were present. The liquid level was above the outlet pipe and backing up from the leach pit GREASE TRAP: None (locate on site plan) Depth below grade: 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: Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): 7 r Page 8 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 88 Holder Lane West Barnstable, AM Owner: Constance Schaffer Date of Inspection: February 11, 2004 TIGHT or HOLDING TANK: None (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/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Above Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): The D-box was under water. PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 Page 9 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 88 Holder Lane West Barnstable, MA Owner: Constance Schafer Date of Inspection: February 11, 2004 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: 1 -4'x 6' 600 gal. (per as built card) leaching chambers,number: 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.): I dug down to the leach pit. Liquid was filling the hole Liquid was approximately 6"above the top of the leach pit The leach pit was in hydraulic failure. The bottom to grade was 8'. The cover was 4'below grade CESSPOOLS: None (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 or no): Comments (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.): PRIVY: None (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.): 9 Page 10 of 1 I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 88 Holder Lane West Barnstable, MA Owner: Constance Schaffer Date of Inspection: February 11, 2004 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. C l3A�k A B r--, 0 , i a 13 3 /� ay a r p l y �- 3 a S 31 e 10 Page 11 of 1 I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 88 Holder Lane West Barnstable AM Owner: Constance Schaffer Date of Inspection: February 11, 2004 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water feet Please indicate (check)all methods used to determine the high ground water elevation: Obtained from system design plans on record- If checked, date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: topographic and water contours maps Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using the Barnstable topographic map and water contours map, the maps were showing approximately 50'+1-to ground water at this site. This report has been prepared and the system inspected and failed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied relating to the system, the inspection and/or this report. 11 'No. �_ � FEE`�% COMMONWEALTH OF MASSACHUSETTS — l�l Board of Health, T3 Af►^ 5 yob i� , MA. �,� APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repair( Upgrade( Abandon( ❑Complete System Individual Components Location p He W.- Ca v\- Owner's Name I'ro��fi' Map/Parcel# M 17LJ ()' zt,e Address 5� Lot# Telephone# Installer'spName P�-5+-0 V-e- gu CC\�C'+tCj Designer's Name �e�1�A (fig �S Address 11-(3 ?i}c I•Z-vg �U�`eS�` l KA' Address i2 �l�S$- ',-e-\8, �� �al� Telephone# •(5b9)+2 ---g300 Telephone# �S�d� 't l-S�jl� 'MA- q:z7 Type of Building Tze S`Ak'A'-� co J Lot Size sq.ft. Dwelling-No.of Bedrooms 3 Garbage grinder ( ). Other-Type of Building /V No.of persons Showers ( ),Cafeteria ( ) Other Fixtures Aj 14 Design Flow (min.(required) �J3 O gpd Calculated design flow 317 0 Design flow provided ��5, gpd Plan: Date 25 1 Z�.tl A- Number of sheets 2 Revision Date Title 1 �b511o'C 5�P U A A z3Ctt �/ L[•1 l�U 1�0.!.�S�v�jLe . MA Description of Soil(s -4Z0A u1.,3a. Soil Evaluator Form No. Name of Soil Evaluator Cr a A (�� Date of Evaluation DESIGNING ENGINEER MW WPERM DESCRIPTION OF REPAIRS OR ALTERATIONS INSTALLATION AM C$YM IN WRITO IM M SYSTEM WAS P TO RM. 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 plane lie system m operation until a Certificate of Compliance has been issued by the Board of Health. Signed �^,f'i Date 2)-V - 0 166 H d Inspections lalln� .kipr 'No. FEE�•//` �.�"� e A' ��. �" i�� 4I � t ti Board of Health, c?�f►'► �q \' MA. APPLICATION FOP DISPOSAL Application for a Permit to Construct( ) Repair( Upgrade( ) Abandon( ) - ❑Complete System VIndividual Components Location 88 H G ' ( P,ti Re (Owner's Name Map/Parcel# M ke )-7 t-1 Pq�e( a '� Address Lot# C Telephone# Installer's Name d Designer's Name ; (��^ f Address J1•0, Go* 12?J9 �re S�' 1 MA Address ,-Z W, �raS$t . `a ( a Telephone# Telephone# Type of Building s 5� '�► c.� "°" S Lot Size sq.0' �' Dwelling-No. of Bedrooms 3 Garbage grinder s- rp r. Other-Type of Building r NA No.of persons Showers ( ),Cafeteria ( ) ,t Other Fixtures N/4 Design Flow,(min. required) 3 O gpd Calculated design flow �d 0 Design flow provided gpd 1 Plan: Date\ Z v Number.of sheets 2 q Revision Date Title 1 sO�eg,5-�U' S*-0 4h C 6J 4 S�-Cs/"� V A q ro j t j �� S CAAW U-l Description of Soils ,,. �+`� .��. if Soil Evaluitor Form No. r Name of Soil Evaljavtot, ,c Date of Evaluation �4 Z C DESCRIPTION OF REPAIRS OR ALTERATIONS 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 fhe system in o ation until a Certificate of Compliance has been issued by the Board of Health. Signed Date — _ O v Inspections / { No. FEE� v COMMONWEALTH MASSACHUSETTS Board oblealth MA. ° 6110' FICATE OF COMPLIANCE Description of Work: individual Component(s) ❑Complete System The unde gnjd hereby.cerfify that the Sewage Disposal System; Constructed ( ),Repaired P,Upgraded ( ),Abandoned ( by: G!J'()(e at !4 - rYt M has been installed in accordance with the rolsiolns of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No. a� (J7 , dated 3� rl�Y A proved Des• n Flow (gpd) Installer ` Designer: Inspecr: Date: �� d The issuance of this permit shall not be construed as a guarantee that the system will function as designed. No. �eQ (/ FEE �`V Board of Health, MA. ➢ ISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct( ) Repair( ) Upgrade( ) Abandon( ) an indi-,ridual sewage disposal system at as described in the application for Disposal System Construction Permit NoOTO dated Provided: Construction shall be completed wit in t ree years of the date of is perAmf. AR local co it•ons must be met. Form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA_, Date Zl�/WBoard of Health JJ// TOWN OF BARNSTABLE �f --� �- LOCATION 1O`� SEWAGE # �w VILLAGE iV ASSESSOR'S MAP & LOT j 7l—OO wr7 INSTALLER'S NAME& PHONE NO.PQS?J' f Tr)C- i SEPTIC TANK CAPACITY —500 6cdk YI �t1R t�er'S LEACHING FACILITY: (type) (size) NO. OF BEDROOMS BUILDER OR OWNER her-I- .S'(hQr"f PERMITDATE: COMPLIANCE DATE: 3 S D L Separation Distance Between the: Maximum Adjusted Groundwater Tab e 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 (dany wetlands exist within 300 feet of leaching facility) Feet Furnished by � 3 a� A • 6q 3 ® a °FtHE Tph, Town of Barnstable Regulatory Services anxxsrnsLe, 9 Mass, Thomas F. Geiler,Director �A 039. �0 °i Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Designer Certification Form Date: t-Qs O 4— Designer: _;.`� .—A— k)-e-A Address: 1 Z C 'a S S-R'V& t u On �Ic �XGi4�> �was issued a permit to install a (date) (installer) septic system at H tCU, -C,:k, W based on a design I drew, (address) dated Z G I certify that the septic system referenced above was installed substantially according to the designs ���� � ►�a v,�v orc oL �, I certify that the septic system referenced above was installed with changes but in accordance with State & Local Regulations. Revision or certified as-built by designer to follow. N\\ OF MgSsq��G o PETER T. f McENTEE o CIVIL ' j No. 35109 �EG/STER``� �� F�WL E � (Designer's Signature) (Affix Stamp ere) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form y - " TOWN OF BARNSTABLE LOCATION L, J f�c�L1��,� ZA� SEWAGE # 2,� VILLAGE w�""„" "��">-i'' � ASSESSOR'S MAP & LOT j ]jeo_—&7 INSTALLER'S NAME PHONE NO.33. DV-'5��// /�/e2 SEPTIC TANK CAPACITY JOOO LEACHING FACILITY:(type) 2,- (size) �Z NO. OF BEDROOMS 3 PRIVATE WELL OR pI1Ri Ic WAT BUILDER OR OWNER DATE PERMIT ISSUED: .DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No I, 6 to 3�° ib Zy' i'-► _ p�l �la' 1 -7 No................_....... FEs/�:..f' THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 8b .............row.. l.........oF............fF.�..1.4.11-!t1�T�4.�L��.-...... Apli iration for Wapasal Works Cnnnstrur#inn Permit Applicati hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: ................� _....�o r.. %. ..:. � ._.L .. __........._..... ... ... ...... .. Location.- dres Np. •...•.......__.._....... . - rdL / or --c!/Vr OAd ess r a .......... )-•• . .�. ,...... --•------ ¢ .............•------... Installer Addtess Type of Building Size Lot....I7 S7 ....Sq. feet ..� Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) 04 Other--Type of Building ............................ No. of persons.....................------. Showers ( ) — Cafeteria ( ) a' Other fixtures ................................... 1:31 - ----------------------------••------••------.-.--•---•--•-----•-•----------- W Design Flow................ .J..Q...................gallons per pe>�n pier flay. Total dpily Pow......... 0.................. WSeptic Tank—Liquid capac>ty.� .gallons Length.�'1.-(a...... Width..+,.I O.. Diameter................ Depth.`a.... '... x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area..............r,.sq. ft. 3 Seepage Pit No.........I........... Diameter........... -..__ Depth below inlet..3_,5..... Total leaching area.2n.L�S...sq. ft. Z Other Distribution box ( \>�, Dosing tank ( ) '~ Percolation Test Results Performed by.--......G. .. ................................ Date.... /Z i�.7.......... 0.4 Test Pit No. L.4.2:....minutes per inch Depth of Test Pit...l&f1...._ Depth to ground water..... Jd atlE LT4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 {_'---------------------..............•.................•.....-........-------------------------.--------------------- ODescription of Soil----------- ................................................................................................................................. x 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.:ITLZ 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issJu�d�,by the board of health. 157 Signed------ 4.`�....................................... .... �l.y..�.eC at Application Approved II .._.......__ :_,, Date Application Disapproved for the following reasons:........................................... ............................................................... ................................................--...................................................................................................................................0.................. / Date Permit No...... � / � F -�•-F•---Z-�----------------- Issued..---------•--•-- --•-----------•---�!_.._......._ Date -- 13 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH _............ ..C?�.t. l.........0F............ . 1... ................. .. ..: .......... Appliration for Pispaual Workv Tonotrurtion Permit Applicatiop ss hereby made for a Permit to Construct (� or Repair ( ) an Individual Sewage Disposal System at: 1 ` , /� r ---........- - OT ! ------......A/ Location dres or t N %................_ - GG'-tea-�il/ .. t ................ W .�/ /-��Own�- .� ..-• �(----�..... hd Bess ................... Vi c�� ff a ................•-•.._...... f. 1.. 1!!� �� pc.�-S......._..._..__..._.._.. Installer Address U Type of Building Size Lot ....17.5: �__..Sq. feet aDwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q Other fixtures . r!I ----------------•---------•----------------•---------------------.---------------------------------- tom; W Design Flow................/1 0.................gallons per person per flay. Total daily flow.......... ?©..................-.gallops. WSeptic Tank—Liquid capacity ....gallons Length.2.lr,�...__. Width:. ..!0... Diameter................ Depth.._.4:.... x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area.__...........�,,.sq. ft. Seepage Pit No---------I........... Diameter.......�_�-..... Depth below inlet...3....... ...... Total leaching area_2n.L/-.�....sq. ft. Z Other Distribution box ( '�'4 Dosing tank ( ) Percolation Test Results Performed b 1.� ..��' ................................. Date...- :Z/�6.7........... a y... ,.a Test Pit No. 1.. _�� ..._minutes per inch Depth of Test Pit....ed.0..... Depth to ground water....N�!v ... 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ �+ ..................................................................................... O Description of Soil... ;-.......... Y� -----------------------------------------------•-•-....---.._..------.....--•-•-..... 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:II LZ 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed Application Approved B _. - ------- - Date Application Disapproved for the following reasons:.....................................------- ---------------• -------------------------•-•- .........-•------•--•-•--•..................•---••---------..... ---•--•-------•-------......------•...............------------.....--------------------- `............................................. y ......... Date Permit No...._.%--/0".- _ ._..... .. Issued-........... '� .7...... 0 ,2 Date ----------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . ...........OF....... or-''�. .. 1b.`���-":... Tntif rate of Tompliattre °. THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (P) or Repaired ( ) bY------------•----------------------•---`---71...:; .....�'7"'! � .tics 1,C.......---....---.....-•---•-•-----•--------------............---.............................. - • - Installer at...................�� jj ---- oi.�-- .,~ , d .. s. ,o.# _' '"" !1 ' `.fl.�vL ' has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No------ 014---------- dated......., ��*��^ ......... THE ISSUANCE OF THIS CERTIFICATE SHALL K B4,41,`O� 5T ED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE...................... .. .._._.. Inspector..- � . --� .. ,_-- --- . -_ -T -. .--. ,.------------ -__--.-m__-----.--.- --------V ... . .m _r„--- - _ - ^- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH NO..r�,...... .f rf.1 ••........ ............... FEE. f/ e!!' Disposal Works Tonotrurtion rrmit Permission is hereby granted---_-------- --t r = �� ._.:. .............................................................. to Construct (fi) or Repair ( ) an Individual Sewage Disposal System at No. !� -... ,! ... �! ! a :,. r.. ............ '� Strcet as shown on the application for Disposal Works Construction Permit No; ----------- Dated._ / _ .t...J,_, •, ----•................................................._ DATE. .. Board of Health •,•- .......................................... s �a EXIST. KITCHEN t a,�3� d33 4' 1111 j � NJ � O —� skylight above F -1 ! ( o 1 alum. screen system in L I x I wht. alum. tubing, typ. L — _ J - P.T. decking 1 3Gx88 Harvey Industr. cell. fan Y "Hollywood" screen door EXIST. FAMILY RM. a `-9 3G"xGO" P.T. step a NEW 5CREEN PORCH 10 railing * balustrades with I r Azek lattice panels inset, tyr. Azek trimmed column k• 1 (appr. 5 2"x 5 -L") z I appr. 7G" appr. 76" �� ' # ,�._ , Re 5 2" tYP• % G0��ij'� p o NO 30638 Cn k BOSTON,NI OF MiP Mc Gowan Resident DATE: LARRY GORDON ARCHITECTURAL DE51GN ��ppy+� REV.: 9-7-10 �� C7®�d�r `�, PORCH FLOOR PLAN rev. date: SCALE: — AA Centerville, MA 02G32 505-790- 1 246 9 ► 1 /4"-1'-c1" ra �� e Velux FCM 3030 skylight (with cellular shade) Azek fascia bd. 4x5 wht. alum. gutter appr. 7G" F- -- °appr. 70 Azek trim, typ. 52 upper scr. sect. upper scr. sect. d I x2 alum. T" channel, typ. FTTT L I lower scr. sect. lower scr. sect. �-4 o�'Si� Azek trim 1 I oy 14NO. 306-a i POR 11 DDITION BOSTON, ®� ® M SS. J��® LJ LJ OFf Mc Gowan Residence r DATE: LARRY GORDON ARCHITECTURAL DE51GN REV.: 9-7-10 Centerville, MA 02G32 508-790- 1 24G 88 Holder Lane, W. Barnstable "NORTH ELEVATION rev. date: SCALE: „ , „ Aw2 11 1 1 1 1 ri Azek fascia bd. 4x5 wht. alum. gutter Azek trim, yp. appr. 70" appr. 70" upper scr. sect. up. 5cr. sect. 30 5cr. 00 door o UM lower 5cr. sect. low. scr. sect. AA�; I G'-G" PO ICHII ADDITION � r m� No.sosss BOSTON, s MA LJ LJ OF Mc Gowan Residence DATE: LARRY GORDON ARCHITECTURAL DESIGN .-- REV.:-- 9-7- 10 WEST ELEVATION �� Holder Lane �. Barnstable , rev. date: SCALE: Centerville, MA 02632 508-7J0- 1246 9 �� � » ------ .._: 1 4 -1 -0 12 exist. 2x8@ I G" rafters 7 . — — exist. a5ph. 5hing. roof 1/2" Zip plywd. deck (pitch (5L" / ft. to the west) OGO EPDM rubber roofing Azek fascia bd. 2x 10 @ 1 2", typ. 2-2x 10 Azek trim, typ. beaded plywd. clg. 51mp5on ACE4 post to bin. connector, typ. exist. 2xG wall a 5 1/2" s ppr. upper screen Section 2x4 cedar railing ' L EXIST. FAMILY RM. SCREENED PORCH I 2x2 cedar balustrades w/ Azek lattice panels— I x2 alum. "h" channel, typ. o I lower screen section I " P.T. decking, typ. w/ `y) I x I alum. tube in alum 'If" channel, typ. insect Screening below I `n 51mp5on ABU44 p05t to P.T.2x8 @ I G", typ. 5onotube connector, typ. I IIII—III—III—III—III III=1 I I-1 11=1 I I—I I I 14-OI fra .dim. III=1 I I—III—III—I Ilift EXISt. B5m t. 1 2" dia, 5onotube footing, typ. L - J L - J ® �, NO,30-'38 BQSTQP�, Mc Gowan Residence -` DATE: LARRY GORDON ARCHITECTURAL DESIGN REV.: 9-7-10At 88 Holder Ln., W. Barnstable, MA PORCH CROSS SECTION rev. date: SCALE: AMCV Centerville, MA 02632 508-790- 1246 3/8"=1'-0" P.T. 2x6 ledger, lag into house - 3-P.T. 2x8 bm. Simpson ACE4 post to R.O. for skylight bm. connector, typ. (locate in field) a ' 2-P.T.2x8 2x 10 cr} 2-2x 10 typ. 2-2x 10 bm. below P.T.2x8 @ 16", typ. 2-P.T. 2x8 12" dia. Sonotube, typ. 2x 10 @ 1 2" typ. P.T. decking, typ. 1/2" Zip plywd. deck cross tle5, typ. hurricane ties ea. rafter, typ. c� P.T. 2x8 @48" 2x 10 @48" wind. brac., typ. -P.T. 2x8 wind brac., typ. 2-2x 10 bm. below 7'-0" 1 I 11 7'-0" 1 4'-0" 7" FLOOR FRAMING PLAN ROOF FRAMING PLAN �- ® , o No. 306358 `� ► a� so ,o z �P Fyc CF k'k � 40 Mc Gowan Residence DATE: LARRY GORDON ARCHITECTURAL DE51GN REV.: 9-7-10 Centerville, MA 02G32 508-790- 1 246 88 Holder Ln., W. GarnStable, MA PORCH FRAMING PLANS rev. date: SCALE: ---- - 1 /4 =1 -0 LEGEND g LOCUS�o 9g PROPOSED CONTOUR o a y9 PROPOSED SPOT GRADE joe ThomPsor` Holder Lo ---- 40 ----- EXISTING CONTOUR "y ® f +107,9 EXISTING SPOT GRADE � A TEST PIT Fzd '7 10 —W— EXISTING WATER SERVICE �� goo Grace 7• 44' S5. i32 Race Lane J 99'64' r� ""'" ..130•- 13A r' LOCUS MAP N.T.S. ' ✓ 124,3 EXIST, S,A,S, 1, - _�6 � �~ --- --- ., + 2S,9 A PUMP a FILL W/SAND 'ry 130 •6• �22 EXIST, SEPTIC TANK ,- •+123,0 GENERAL NOTES: TOP OF TANK EL1 121,83 . ' • • °\ Cu +1 32 INV,(OUT)=120.5t 1�4,6 ` '. '' 121,1 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL � � r' y , 12 ,0 BOARD OF HEALTH AND THE DESIGN ENGINEER. c w 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS \o OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE BENCHMARKI DECK LOCAL RULES AND REGULATIONS. TOP OF F❑UNDATI❑N 1iJ 124.9 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR r� AT CHIMNEY �.� +123.8\ TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE ELF 125,00 (ASSUMED) N i c� + _2,5 m DESIGN ENGINEER. EXISTING: � 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING 3 m 3 BEDROOM FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN a HOUSE (# ENGINEER BEFORE CONSTRUCTION CONTINUES. ro � 88) z TEF-125 0 0 Un 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. M I 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF yr THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. S� OF& r 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. SV �e w 3 8. THERE ARE NO PRIVATE WELLS LOCATED WITHIN 100' OF THE S.A.S.¢> 9. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED a TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. kk , ,R3• LOT 114 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE »' 10 THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING PARCEL 1 CONSTRUCTION. 17,578±9.F 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS IN THE AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF THE S.A.S. AND REPLACE WITH CLEAN FILL AS SPECIFIED IN 310 CMR 255(3). 3 .00' �F N 86. 1 33" W 56.77, ��\\ M4j, HOUSE LOCATION TAKEN FROM CERTIFIED PLOT PLAN BY BAXTER & NYE, INC. __ ____� �- R_425 00 3c�F r REGISTERED LAND SURVEYORS, OSTERVILLE, MA, DATED OCTOBER 4, 1993 o PETER T. -____ McENTEE PROPOSED SEPTIC SYSTEM UPGRADE y�LDE/� LANE U No I35109 N gg HOLDER LANE, WEST BARNSTABLE, MA AoF �£G/SjE�F����� Prepared for: Robert Schaffer, 88 Holder Lane, West Barnstable, MA F5510NA1 E��\ Engineering by: SCALE DRAWN JOB. NO. Engineering Works 1°=30' P.T.M. 19-04 12 West Crossfoeld Rd, Forestdale, MA 02644 DATE CHECKED SHEET NO. (508) 477-5313 3/2/04 P.T.M. 1 of 2 • r r ,, s NOTE: TO PREVENT BREAKOUT, THE PROPOSED F.G. EL: 124.5t FINISH GRADE SHALL NOT BE < EL:120.6 F�EL: FOUNDATION VENT FOR A DISTANCE OF 15' AROUND THE, t EXISTING F.G. EL: 123.3t(EXISTING) F.G. EL: 123.9f(EXISTING) PERIMETER OF THE S.A.S. MAINTAIN 2% MIN SLOPE OVER S.A.S. INSTALL RISERS OVER INLET & OUTLET INSTALL RISER OVER D-BOX T❑ 2-500 GALLON LEACHING CHAMBERS INSTALL RISER OVER CHAMBER/S TO WITHIN 6" OF FINISH GRADE WITHIN 6" ❑F FINISH GRADE IN SERIES WITH STONE ALL SIDES SH❑WN ON PLAN AND SET C❑VER/S a; WITHIN 6' OF FINISH GRADE L =9' L =13'(MAX) 4" SCH 40 PVC 4" SCH 40 PVC 2' LAYER OF 1/8' TO 1/2' �. tD t4• @ S= 1X (MIN.) 6' @ S= 1% (MIN.) ®®®��®� DOUBLE WASHED STONE EXISTING < EXISTING 1000 GALLON INV. ELEV.=120.40 INV. ELEV.=120.23 2' EFF, DEPTH ®®®®®®® a... '. SEPTIC TANK 3.5 5,2' 3.5' 3 1/2' EXISTING DOUBLE WASHED FFECTIVE WIDTH = 12,2' STONE INSTALL INLET & OUTLET TEES GAS BAFFLE TO BE INSTALLED ON NV.EL: 120.50t INV. ELEV.=120.10 OUTLET TEE AS MANUFACTURED BY TUF—TITE, ZABEL, OR EQUAL .TOP CONC. ELEV.=121.1 0-BOX SHALL 8E SET LEVEL AND TRUE TO GRADE —BREAKOUT ELEV.=120.6 ON A MECHANICALLY COMPACTED SIX INCH CRUSHED INV. ELEV.=120.10 STONE BASE, AS SPECIFIED IN 310 CMR 15.221(2). ®® BOTTOM ELEV.=118.10 4' I 2 x 8,5' = 17,0' I� 4' SEPTIC SYSTEM PROFILE 5' MINIMUM ABOVE MAXIMUM � EFFECTIVE LENGTH = 25' SEASONAL HIGH GROUNDWATER LEACHING SYSTEM SECTION NO G.W, ENCOUNTERED N.T.S. BOTTOM OF TP EL, 111.5 (3) 5" DIA.OUTLETS 15.51 10 -16' --�2° DESIGN CRITERIA Q� M�J�q�yG o PETER T. L NUMBER OF BEDROOMS: 3 BEDROOMS ZE McENTEE 15.5' 6' 6, SOIL LOG CIVIL • SOIL TYPE: CLASS I No 35109 2' DESIGN PERCOLATION RATE: 2 MIN JIN. R EG/S1 H-10 LOADING DATE: JUNE 26, 1987 DAILY FLOW: 330 G.P.D. FSS G D-BOX SOIL EVALUATOR: CRAIG SHORT DESIGN FLOW: 330 G.P.D Krs PSI_------ INSPECTOR: JERRY DUNNING-BOH AGENT GARBAGE GRINDER: NO PROP, S.A.S. '__-_-_ Elev._- ' TP- 1 De th LEACHING AREA REQUIRED: (330) = 445.9 S.F. I ---P— .74 126.5 A& B 0" ®®E ® ® ®®®® EXISTING SEPTIC TANK: 1000 GALLON CAPACITY ®®®®®®®®®®® 39„ LOAM & ®®®®®®®®®®® p N SUBSOIL N ®off®® a®®Ea®® ; USE 2-500 GALLON LEACHING CHAMBERS IN SERIES t�ECr{ 122.8 C 42' SIDEWALL AREA: 2(12.2' + 25') X 2 = 148.8 S.F. 102" BOTTOM AREA: 12.2' x 25' = 305.0 S.F. TOTAL AREA: 453.8 S.F. 4" KNOCKOUT EXISTING 20" DIA. COVER 3 BEDROOM DESIGN FLOW PROVIDED: 0.74(453.8) = 335.8 G.P.D. 4" KNOCKOUT /4" KNOCKOUT 62 lJ HOUSE �#$8� FINE SAND TOF=125,0 QQPROPOSED SEPTIC SYSTEM UPGRADE 4" KNOCKOUT 88 HOLDER LANE, WEST BARNSTABLE, MA 111.5 180" Prepared for: Robert Schaffer, 88 Holder Lane, West Barnstable, MA 500 GALLON CAPACITY, H-20 LOADING NO G.W. ENCOUNTERED Engineering by: SCALE DRAWN JOB. NO. CHAMBERS SAS, LAYOUT PERC RATE: <2 MIN/IN. ("C" HORIZON) Engineering Works NTS P.T.M. 19-04 Hcs. Kr.s 12 West Crossfoeld Rd, Forestdale, MA 02644 DATE CHECKED SHEET N0. 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