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0353 LAKE SHORE DRIVE - Health
353 Lake Shore Drive Marstons Mills I' i TOWN OF BARNSTABLE LOCATION �SEWAGE# QQ VILLAGE M,c�r�'ph& Mr \SASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO.'V-ZAPSI,t�rra Y:i..,c . Sou-8"d S Goss- SEPTIC TANK CAPACITY Q® AD3 -iE2C361 r � LEACHING FACILITY:(type) Lour �w�...�-�h s(size) QS" tc. \l r 9- A l (o 1 NO.OF BEDROOMS 3 'i OWNER e.S—N ` °' C��.c�<<rV� Z -5a A PERMIT DATE: s43 I 1 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility I � 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 .. j FURNISHED BY t � I cu.cr�r i I I Aj = �� a° g t 2 TOWN OF BARNSTABLE LOCATION J I�"� S�0/� SEWAGE # 'VM-1-AGE M• 1Mt S ASSESSOR'S MAP & LOT INSTALLER'S NAME& PHONE NO. SEPTIC TANK CAPACITY I DAD 67A Ole LEACHING FACILITY: (type) J, ,T ' M rAro�&%S (size) —7 X L9 NO. OF BEDROOMS 3 BUILDER OR OWNER CV/T' AI r S7Wo& PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet .Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leacyng facility) Feet Furnished by Qi Iq Aa- 3� P► Finns �,_ �4 r�a-a as AS- !4p 0 � 33- 3;), 'Ay- �lq O O 3 y No. 0 /1— Fee a d THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: a/ PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01pplitation for Misposal 6pstem Construction permit Application for a Permit to Construct( ) Repair(t�grade( ) Abandon( ) ❑Complete System ndividual Components Location Address or Lot No.3. ��'� mho r29 O T Owner's Name,Address,and Tel.No.I'll'. Assessor's Map/Parcel AA, �V1 I�l 44a0 Installer's Name,Address,and T 1.No.����. ®� � fisigner's Name,Address,and Tel.No, 1--•� `4 `� �..o.vz ox 3'7 I s—e%-- �?It7- 6os� Ca.�, �0x Q02 J 5o7-ag-t- 3 a Sd Type of Building: ��{ 'Jed Dwelling No.of Bedrooms Lot Size l �, 0©O sq.ft. Garbage Grinder( ) Other Type of Building �,z"S, No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) �J J gpd Design flow provided J S gpd Plan Date T a S f r Number of sheets Revision Date Title Size of Septic Tank ( fsb`s C,�,S-, O.TypeofS.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in ac-.ordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Sign Date -s i Application Approved by I 1AS Date — l Application Disapproved by Date for the following reasons Permit No. a — U Date Issued 3 % sa,.S 1 No O 0_ I ! Fee d U ` THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ,/" PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes Ap 'l.tatlon for Disposal *pstrm Construction Vermit Application for a Permit to Construct( ) Repair(upgrade( ) Abandon( ) ❑Complete System ndividual Components Location Address or Lot No.3-S3 I-e�`G�- 54�)o r 'Q,r Owner's Name,Address,and Tel.Nol"A' Assessor's Map/Parcel ( � M" All i Q s, V a C� v�n�i.s ov.s MA oa�� Installer's Name,Address,and T 1.No.VL,�-vAa%( Q©S'eT` 1D�s?gner's Name,Address,and Tel.No. p,o,-Q.0X 3? 1 SO$- �'-?e`e- GoS5 Cam IZD R,ok Q03(D 3o)So 4, o z .c�Ge�' NN A B 2S3,L Type of Building: Dwelling No.of Bedrooms 3 - �e LotSizeX e []O O sq.ft. Garbage Grinder( ) Other Type of Building ��S, No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 33 O gpd Design flow provided 3 S gpd Plan Date YZ Q Sul f Number of sheets l Revision Date Title Size of Septic Tank tc o S tAs ck•57'Y�,g,Type of S.A.S. Description of Soil -- i Nature of Repairs or Alterations(Answer when applicable) ,211f c,_� -`�Q C�k b IAC-Q aO ADS C�RC361� C. oc�r 7 <5 "D Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Sign _� Date j Application Approved by S Date _ "- Z l/ r Application Disapproved by CT Date for the following reasons Permit No. 1•.0 I I - i c2 L. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certifirate of Complianre THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(✓) Upgraded( ) Abandoned( )by at -3 S 3 ( ,e��_ s�Ac% .'I— has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.�?D 11 dated S 3 / i Installer G Designer #bedrooms 3 - Ott rej4-t,(_4c1 Approved design flow 3 30 gpd The issuance of this permit shall no a construed as a guarantee that the systern will-f ction esigned. Date Inspecto°r,. uq - Fee ------ No. tO �UO THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal *pstem Construction permit Permission is hereby granted to Construct( ) Repair(--l" Upgrade( ) Abandon( ) System located at 3 3 L-.,A`C-tr— S L,,d T`c _ and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Corns ct.on must be completed within three years of the date of this permit. Date J �( Approved byS c All Nod s r,� �J� f��'/V^ � k .dFP-3 N l�� P f �D Town of Barnstable Regulatory Services Thomas F. Geiler,Director "& 4 Public Health Division s`� Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-46414 Fax: 508-790-6304 Date: `j Va"'O( ( Sewage Permit#20< « Assessor's Map/Parcel Installer& Designer Certification Form Designer: CS M G�� ��.�� Installer: Address: PC)- Go)( 2 o So Address: 7�,d, k 3 7 _2. LU f AA 0 25-3L w 3�MsA a7S'�3 On fZ31.2orl c��-cXL ? " ems,Ste,was issued a permit to install a (da e) (in taller) septic system at 353 LAB 5���D�. KoysS nS Wl,lls based on a design drawn by (address) C,w dated 041'-ght (designer I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Stripout(if req ' ected and the soils were found satisfactory. � tx r,F,W4 LINDA J. PINTO (Installer's ignature) U IL 4 50 � FG/STER�O��' (Designer s Signature) (Affix Desi p Here) 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:\office forms\designercertification form.doc w G'k .25421 Ps288 P231:a9° 05-02--2011 o'S 03 s 12D DEED RESTRt -MON WHEREAS 71 53 (-� . 54,,8�.� O.r �-e ran z;�.�.sPA j '( ) is the owner.of 3 s'3 ..t--:i Y..,e— Sk►.(& located at MA(hereinafter referred to as ; and being show,n�on a-plan entitled"Subdivision of Land in t y ' `�� NIA, Property of M t<_.�✓S�_\ C/'.Or[ l�A.►� l_'��� , .. - et al, LE 3� duly recorded in Barnstable County Registry Of Deeds in Plan Book , Page Or on Land Court Plan:Number WHEREAS; JYl , h��� + �.01,,,,,�, 2 ups the owner of-said lot has agreed with the Town of Barnstable Board of Health to a restriction as to the . number.of-bedrooms which can included in any home.built on said not as a pre-condn to obtaining a disposal works constru ton permit in with 310 CMi715.D00 State Env.Ironmentat Code,Tide V, Minimum Requlr+emi6ts for the Subsurfaceitary Disposal of San Sewage; WHEREAS,the Town of Bamsl~able Board.-of Heaith,'as a pre-oondition-to- granting a disposal works construction permit for a septic:system incompliance. with 310 CMR 15.200, State Environmental Code,.Title V, Mini<nurn Requirements for the Subsurface Disposal of Sanitary Sewage,and authorizing the Issuanoe'of a_building permit for the consti'udddh of a-single family home on this'property, is requiring that the'agreement for the'restriction on ttie number of bedrooms in any house constructed on the lot be put on record with the Barnstable Cou*Registry of Deeds by recording this document, a Bk 25421 Pq 289 #23189 NOW, THEREFORE, (�,& `2.c^Aoes hereby place the (owner's name following restriction on his above-referenced land in accordance with his agreement with hi Town of Samstable Board of HeaW,whiek resfaisue{! run with the-land and be binding upon all,successors in title: 9. may have constructed (address) upon the lot a house containing no more than (3) bedrooms. z3�7 agrees that this shall be.permanent deed (owners ame) restriction affecting L.0 30 located on-",.,-, Sti„�,t. �:�. �M vitAA, and . being shown on the plan recorded in Plan Book a , Paged 1' Or on Land Court Plan For title of seethe following deed: Book s-ol!l , Page Ll 5 . Or Land Court Certificate of Title Number Executed as a sealed instrument 2,91 day of Zvi/ Owner's signature J Owner's signature Owner's signature COMMONWEALTH OF MASSACHUSETTS iws iG� .ss Any ? 20 Then personally appeared the above-named known to me to be the persofi who executed the.foregoing instrument and acknowledged the same to be act and deed, before me, cc � c �� 0 ,,;�, Nota ° 'q 1_ cc Public��°°Q�.'a1SS8 NFaAti'' o '°°��� 'S 9�;; = My commission expires: �� e� G lu A-13 7: (d 1 Mir v x ® = te) z deed[ ''''''�� js pCHUjS���`'�``` BARNSTABLE REGISTRY Vir udo5 TRANS.NO.: CITY/TOWN: APPLICANT: Sh1 �r,c�tnPec,na ADDRESS: &S5 L�l�� Sire. i7r. FWs► ns MAL DESIGN FLOW: ASS gpd REVIEWED BY: DATE: N/A OK NO GENERAL Legal boundaries denoted [310 CMR 15.220(4)(a)] Street,Lot,tax parcel number and lot number noted on plan [310 CMR 15.220(4)(u Locus Provided 310 CMR 15.2204(t)] Plan proper scale? (1"=40' for plot plans, 1"=20' or fewer for components) [310 CMR 15.220(4)] Easements shown 310 CMR 15.220(4)(b)] System located totally on lot served[310 CMR 15.405(1)(a)for upgrades]- if not, a variance is required [310 CMR 15.412(4)] Location of impervious surfaces (driveways,parking areas etc.) / [310 CMR 15.220(4)(d)] Location all buildings existing and proposed 310 CMR 15.220(4)(c)] Location and dimensions of system components and reserve areas. 310 CMR 15.220(4)(e)] System Calculations [310 CMR 15.220(4)( ] daily flow septic tank capacity(required andprovided) soil absorption system(required andprovided) whether system designed for garbage grindei North arrow [310 CMR 15.220 4 Existing and ro osed contours [310 CMR 15.220(4)(g)] Location and log of deep observation holes (existing grade el. on each test) [310 CMR 15.220(4)(h)] Names of soil evaluator and BOH representative [310 CMR 15.220 4 h and i ] Location and date of percolation tests (performed at proper elevation?) [310 CMR 15.220(4)(i)] Percolation test results match loading rate? [310 CMR 15.242] Certification statement by Soil Evaluator [310 CMR 15.220(4 Observed and Adjusted groundwater(method for adjustment given or indicated) [310 CMR 15.103(3)and 310 CMR 15.220(4)(n)] Address 3s� o kt-Sort `�lr. Sheet 1 of 7 N/A OK NO Location of every water supply,public and private, [310 CMR 15.220(4)(k)] within 400 feet of the proposed system location in the case of surface water supplies and gavel packed public water supply within 250 feet of the proposed system location in the case within 150 feet of the proposed system location in the case ✓ of private water supply wells Location of all surface waters and wetlands located up to 100 ft. beyond setbacks listed in 310 CMR 15.211 and any catch basins V/ located within 50 ft. 310 CMR 15.220(4)(1)] Water lines and other subsurface utilities located [310 CMR 15.220(4)(m)] if water line cross see 310 CMR 15.211 1 1 Profile of system showing invert elevations of all system / components and the bottom of the SAS [310 CMR 15.220(4)(o)] V Stamp of designer 310 CMR 15.220 1 and 310 CMR 15.220(2) Stamp of Registered Land Surveyor(required if construction / activities within 5 ft. of lot line) [310 CMR 15.220(3)] Test Holes adequate(two in each of the primary and reserve unless trenches as permitted in 310 CMR 15.102(2)or as a roved'for an upgrade under LUA at 310 CMR 15.405 1 k Test hole adequate to demonstrate four feet of suitable material? / 310 CMR 15.103(4)] Test Holes adequate to confirm adequate groundwater separation? / 310 CMR 15.103 3 Benchmark within 50-75' of system [310 CMR 15.220 4 Materials specifications noted? [various sections of 310 CMR 15.000] System components not>36" deep(unless Local Upgrade Approval or LUA requested) 310 CMR 15.405 1 :address JS 3 L-,kx- �'kO're, Vy' Sheet 2 of 7 N/A OK NO SEPTIC TANK Size OK? [310 CMR 15.223(l)] Inlet tee located ten inches below flow line [310 CMR 15.227(6)] Outlet tee 14" or 14" +5"per foot for increase ft depth [310 CMR / 15.227(6)] Outlet tee with gas baffle or approved filter[310 CMR 15.227(4)] Note regarding installation on stable compacted base [310 CMR 15.228(l)] Separation between inlet and outlet tees (no less than liquid depth) 310 CMR 15.227(2)] Inlet/Outlet elevations at least 12" above high groundwater (except as described 310 CMR 15.227(5)) or permitted for upgrades under LUA 310 CMR 15.405 1 k Minimum cover 9" (Tanks buried more than 9" must have risers on all openings and on the d-box) [310 CMR 15.2228(1)and 310 CMR 15.232(3)(f)] Three access covers (inlet and outlet must be 20" or greater)- middle access at least 8" (b 7/07) 310 CMR 15.228(2)] Access to within 6 " of grade - one port for systems<1 000gpd, / two fors stems>1000 d 310 CMR 15.228(2)] ✓ All at-grade covers secured to unauthorized access? [310 CMR 15.228(2)] > 10 ft from building foundation [310 CMR 15.211 1 Buo anc calculation Required/Done [310 CMR 15.221(8)] H-20 Where appropriate? [310 CMR. 15.226(3)] Setbacks from resources 310 CMR 15.211 Multi-Compartment Tanks Required when other than single-family dwelling or flow>1000 / d[310 CMR 15.223 1 ] J First compartment 200%daily flow; Second compartment 100% / daily flow [310 CMR 15.224(2) and 3 ] V "U"pipe through or over baffle, outlet of each compartment with / as baffle or approved filter[310 CMR 15.224(4)] J Address Sheet 3 of 7 N/A OK NO BUILDING SEWER AND OTHER PIPING Located at least ten feet from any water line? [310 CMR / 15.222(2)] ✓ Disposal piping at least 18" below water line (when water and / sewer cross, see 310 CMR 15.211(1)[1] V Cleanouts required/provided? [310 CMR 15.222(8)] Thrust blocks specified in force mains? 310 CMR 15.221(6)(c)] Slope of sewer line not less than 0.01 (1/8"/ft) 0.02 preferable / [310 CMR 15.222(6)] Proper pitch on all runs? (.005 within gravity-distributed trenches / and beds) [310 CMR 15.251(9)and 310 CMR 15.252(2)(c)] Siphonproblem/ leachfield below pump chamber Endca s or vent manifoldspecified? Size and orientation of discharge holes specified? (not smaller than 3/8" not larger than 5/8") [310 CMR 15.251(8) and 310 CMR 15.252(2)(h)] Materials specified (310 CMR 15.251(5) specifies various pipe types allowed DISTRIBUTION BOX Stable compacted base [310 CMR 15.221(2) and 310 CMR 15.232(2)(a)] Splash plate or baffle tee required on inlet/provided? (when pressure sewer to d-box or steep pitch of gravity sewer) [310 CMR 15.323(3)(a)] Riser if deeper than 9" 310 CMR 15.232 3 Inside minimum dimension 12" [310 CMR 15.232(2)(b)] Minimum sum 6" [310 CMR15.232(3)(e)] Watertight cover if<2000gpd); waterproof manhole if>2000gpd / [310 CMR 15.232(3)(d)] d PUMP CHAMBERS Capacity(emergency storage above working--design flow)? [310 CMR 231 2 ] Proper setbacks [310 CMR 15.211 (same as septic tanks)] Watertight 20-in minium access manhole at least 20" MUST BE / TO GRADE [310 CMR 15.231(5)] V Service components accessible (not too deep with piping, / disconnects accessible) Alarm floats-alarm on circuit separate from pumps specified? Exceeds two units must have two pumps operating in lead-lag mode. [310 CMR 15.231 6 and 8 ] Stable Compacted Base [310 CMR 15.221(2)] Buoyancy calculations needed?Provided? [310 CMR 15.221(8)] Address Y 3 She `�r, Sheet 4 of 7 N/A OK NO SOIL ABSORPTION SYSTEMS (SAS) GENERAL Calculations correct? 4 feet of naturally occurring material demonstrated? [310 CMR 15.240 1 Required separation to groundwater? [310 CMR 15.212)] Aggregate specified as double washed [310 CMR 15.247(2)] System Venting required/provided? (system under driveway or >36" deep) [310 CMR 15.241] Inspection ports specified and within 3"final grade? [310 CMR 15.240 13 Breakout requirements met? (No violation of breakout elevation within 15 ft of SAS unless barrier) [310 CMR 15.211(1)[4] and Guidance Document GALLERIES,PITS,CHAMBERS 310 CMR 15.253 Chambers and Gal. in trench configuration supplied with inlet every 20 ft. [310 CMR 15.253(6)] Each structure with one inspection manhole(if>2000 gpd must / be to grade) [31.0 CMR 15.253(2)] Aggregate 1'minimum-4'maximum. [310 CMR 15.253(1)(b)] 2' sidewall credit maximum 310 CMR 15.253 1 a ] In bed confi ration, inlet every 40 s . ft. 310 CMR 15.253(6)] TRENCHES 310 CMR 15.251 Width T minimum 3'maximum 310 CMR 15.251 1 (b 100 feet-maximum length [310 CMR 15.251 1 a ] Minimum separation 2x effective depth or width whichever / eater 3x if reserve between trenches) [310 CMR 251 1 (d)] Situated along contours 310 CMR 15.251(2)] Breakout OK? [310 CMR 15.211 1 [4] and Guidance Document] BED SAS (Maximum size of bed or field 5000 d) minimum 2 distribution lines 310 CMR 15.252(2)(a)] Maximum separation between lines 6' [310 CM R15.252(2)(d)] Maximum separation between lines and outside of bed 4' [310 CMR 15.252(2)(e)] Aggregate depth below discharge pipes 6" minimum, 12" / maximum. 310 CMR 15.252(2)O] / Separation between beds 10'minimum. [310 CMR 15.252(2)(0] Bottom area used in calculations only [310 CMR 15.252(2)(i)] Address cJS3k-t- 5�s�ve l7►" Sheet 5 of 7 N/A OK NO DID THE PLAN INVOLVE Pressure Dosed System ? Provided pump and piping calculations as required [310 CMR 15.220(4)(r)] Pressure dosing required on all systems>2000gpd or alternative systems under remedial approval [310 CMR 15.254(2) and I/A Remedial Use Approvals] If used in gravelless system-make sure jet is directed as not to scour soil interface [Guidance Document] Inspections once per year(systems<2000 gpd) or quarterly (>2000 dgood to note on plan [310 CMR 15.254(2)(d)] Construction in fill -Did the plan specify that the fill shall meet the specification of 310 CMR 15.255 3 ? Impervious barrier and/or retaining wall? Guidance Document Impervious barrier installation must be supervised by / designer 310 CMR 15.25 5 2 (b)] J Retaining wall must be designed by Registered Professional / Engineer 310 CMR 15.255(2)(a)] d Side slope not exceed 3:1 ? 310 CMR 15.255(2)] Breakout requirements met? [310 CMR 15.252(2) and ` Guidance Document] At least 5 ft. from impervious barrier to edge of SAS (10 ft. recommended) [310 CMR 15.255 2 e Gravelless System[EA Approval Letters] Check DEP Approval letters for credits and design conditions If used with pressure dosing do not allow pressure discharge / to scour soil interface J Alternative Septic System[UA Approval Letters] Was DEP Approval Letter provided and/or have you / reviewed the letter for conditions? Is the technology being properly applied and does it meet all / DEP Approval Conditions? J Is there a note on the plan regarding the requirement for / perpetual maintenance agreement? ✓ Any alarms involved on separate circuits Did the applicant submit an operation and maintenance / manual? Has applicant submitted a copy of a maintenance Variances Are the variances listed on the plan? [310 CMR 15.220 (4)( ] RLS Stamp necessary on plan if a component is within five feet of property line [310 CMR 15.412(4)] New construction or increased flow proposed- [Refer to 310 CMR 15.414 Address 3s3 La S�-ofe l�r. Sheet 6 of 7 N/A OK NO Nitrogen Sensitive Areas Is the system in a Designated Nitrogen Sensitive Area(Zone II for a public supply well)? [310 CMR 15.214, 310 CMR 15.215 and j 310 CMR 15.216 -also refer to Policy regarding upgrades of such ✓ existing systems] Is the system proposed on the same lot as served by private well ? / 310 CMR 15.214(2)] Are the nitrogen loads proposed in compliance? [310 CMR 15.216(1)] Miscellaneous Pumping to septic tank? [ 310 CMR 15.229] Shared System 310 CMR 15.290] Address 365 Sheet 7 of 7 rf Town of Barnstable P# / ?2P Department of Regulatory Services ' Public Health Division Date 3 / ILes Getl�tt"�� 200 Main Street,Hyannis MA 02601 Date Scheduled I Time Fee Pd. ! , Soil Suitability Assessment for Sewage Disposal Performed By: CsN rl�lnn�(i a�� Witnessed By:f t�j `7 4�_ky LOCATION& GENERAL INFORMATIO �rol- Location Address Owner's Name JS5;Lc.kc.Sko,'z D'r, Zen}- �/L Address /� Assessor's Map/Parcel: 01 T/O O Z Engineer's Name Lvi1 —J 1 A e4 NEW CONSTRUCTION REPAIR Telephone# h 0�- ��{ 1 3 4 1 Land Use l C'S Slopes(35) 0 -- ©�., Surface Stones lV O Distances from: Open Water Body k A ft Possible Wet Area IJ ft Drinking Water Well I�t I L ft Drainage Way hl / ft Property Line Cr ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&.perc tests,locate wetlands Sn proximity to holes) Ca- s Parent material(geologic) ack i �- o sin Depth to Bedrock Ol Depth to Groundwater. Standing Water in Hole: N 1 A Weeping from Pit Fpee d i1 Estimated Seasonal High Groundwater N/PI DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: In, Depth to soil mottles: in. Depth to weeping from side of obs.hole: in, Groundwater Adjustment f[. Index Well# Reading Date: Index Well level Adj.factor. � Adj,Groundwater Level,,,e PERCOLATION TEST Date 4140, Time 1 Z Joo�M Observation Hole# Time at 9" Depth of Perc nG Time at 6" Start Pre-soak Time @ Time:(9"4") End Pre-soak Rate MinJlnch Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back---------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conservation Division at least one(1)week prior to beginning. Q:\SEPTICIPERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole#-a Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface in. ( ) (USDA)A) (Munsell Mot tling mg (Structure,Stones;Boulders. o item y.96 Gravel) dJLID `�° n —S L O 3ta C, I�1-CLS . o DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other ~.. Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. onsi en % rave s CSL o CI m�c�s a s16 '01 _ ��f C3 M-(-Said 1.216L S)y oo , DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistencv.%Oravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stories;Boulders. Consistency. Flood Insurance Rate Map: Above 500 year flood boundary No..,_/ Yes Within 500 year boundary No Yes Within 100 year flood boundary No Yes,:. ._ Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervio s material exist in all areas observed throughout the area proposed for the soil absorption system? ----tLI If not,what is the depth of naturally occurring pervious materia17 Certification I certify that on m. (date)I have passed the soil evaluator examination approved by the Department of Environmental'Protection and that the above analysis was performed by me consistent with . the required traini g,expertise and experience described in 310 CUR 15.017. Signature �Ur Date Q:\.S.EPTICIPERCFORM.DOC 8 BENNETT ENVIRONMENTAL ASSOCIATES, INC. LICENSED SITE PROFESSIONALS,ENVIRONMENTAL SCIENTISTS,GEOLOGISTS,ENGINEERS 1573 Main Street (508) 896-1706 P.O. Box 1743 fax (508) 896-5109 Brewster, MA 02631 SIEVE ANALYSIS DATA AND COMPUTATION SHEET Date: 04/28/2011 Sheet 1 of 1 Job Name: CSN Engineering Job Number: BEA11,-10327 Sample Number: Lake Shore Drive 4/21/11 Sample Collected By: Linda Pinto Sample Tested By: Brian Clarke Notes: Class I Soil-Clean Medium Sand (0.74 gpd/SF<5 minutes/inch)[David Bennett,LPG.,RS] PAN=299.4 g,Pan w/Sand=537.7 wet,535.3 dry SIEVE OPENING WEIGHT RETAINED PERCENT CUMULATIVE SIEVE IN GRAMS RETAINED PERCENT PROJECT MANUAL IN SIEVE MILLIMETERS MESH (Cumulative) (Cumulative) FINER USDA 4.76 4 4.2 4.2 1.8 1.8 98.2 Pebble-Fine Gravel j 0.295 50 214.2 218.4 90.8 92.6 7.4 Medium Sand 1 0.147 100 15.3 233.7 6.5 99.1 0.9 Fine Sand 0.075 200 1.7 235.4 0.7 99.8 0.2 Very Fine Sand <0.075 PAN 0.4 235.8 0.2 100 Silt-Clay I 1 l' PASSED MESH SIEVE TOTAL 235.8 100 Sample Weight Wet: 238.3 g Sample Weight Dry: 235.9 g Percent Moisture: 1.0 Sample Weight Passed Through Sieves: 235.8 • l COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION RECEIVED MAR 2 5 2002 TOWN OF BARNSTABLE HEALTH DEPT. TITLE 5 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 353 Lake Shore Drive Marston Mills, MA 02648 Owner's Name: Curt Ainsworth Owner's Address: Same Date of Inspection: March 11, 2002 Name of Inspector: (Please Print) James M. Ford Company Name: James M. Ford Mailing Address: P.O. Box 49 Map: 014 Osterville,MA 02655-0049 Parcel: 002 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 Need urther Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: March 11, 2002 The system inspector shall subm 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 1 Page 2 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 353 Lake Shore Drive Marston Mills, MA Owner: Curt Ainsworth Date of Inspection: March 11, 2002 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 i l OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 353 Lake Shore Drive _ Marston Mills. AM Owner: Curt Ainsworth Date of Inspection: March 11, 2002 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. Th.-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 I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 353 Lake Shore Drive _ Marston Mills, MA Owner: Curt Ainsworth Date of Inspection: March 11, 2002 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 '/z 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 I 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.] No (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: 353 Lake Shore Drive Marston Mills. AM Owner: Curt Ainsworth Date of Inspection: March 11, 2002 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: 353 Lake Shore Drive Marston Mills, MA Owner: Curt Ainsworth Date of Inspection: March 11, 2002 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: 4 Does residence have a garbage grinder(yes or no): No 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): No Water meter readings, if available(last 2 years usage(gpd)): 2001- 70,000 gals.; 2000-85 000 gals. Sump Pump(yes or no): No Last date of occupancy: Currently occupied COMMERCIALANDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd 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 March 2001 -per owner Was system pumped as part of the inspection (yes or no): No If yes, volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM ✓ Septic tank,distribution box,soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight Tank Attach a copy of the DEP approval Other(describe): I Approximate age of all components, date installed(if known)and source of information: New leach field March 27195-per as built card Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 353 Lake Shore Drive Marston Mills, MA Owner: Curt Ainsworth Date of Inspection: March 11, 2002 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: 1" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 10" Distance from top of scum to top of outlet tee or baffle: 9" Distance from bottom of scum to bottom of outlet tee or baffle: 6" 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 even with the outlet invert There were no signs ofleakage Recommend pumping every three years. 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 Page 8 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 353 Lake Shore Drive Marston Mills, MA Owner: Curt Ainsworth Date of Inspection: March 11, 2002 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: Even 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 level. There were no signs of leakage or solids There were no signs of backup or failure in the infiltrators "newer leach field." The bottom to grade was approximately 6' 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 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 353 Lake Shore Drive Marstons Mills, MA Owner: Curt Ainsworth Date of Inspection: March 11, 2002 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: 1 leaching chambers,number: ✓ leaching galleries,number: 4 infiltrators with 2'stone- Tx 29'x 2' 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.): The infiltrators were not dug up. There were no signs offailure in the D-box The bottom to grade was approximately 6' The old pit had signs of failure. 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 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 353 Lake Shore Drive Marstons Mills. MA Owner: Curt Ainsworth Date of Inspection: March 11, 2002 Map: 014 Parcel: 002 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. A i - ace Qi - Iq A Fr•dn�' 4 rya- as A3- y6 0 (33- 3;L ALI - �q O O 3 y 10 I Page 1 I of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 353 Lake Shore Drive Marston Mills. MA Owner: Curt Ainsworth Date of Inspection: March 11, 2002 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: The bottom of the leach field to grade was approximately 6' Using the Barnstable topographic map and the Cape Cod Commission water contours map, the maps were showing approximately 50'+/-to ground water at this site This report has been prepared and the system inspected and passed 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 I I 1 i`4a, r. _ - _.. 7" //-7"'1 Ir - d i It 341 01 Sal Cobs b uouOac ssol-1 i — I I - I I I , I I T I I I I _ I ' i I I I j I I I , I I -�— I T 4 I I I , i _ I - ..._ .I _._ _.... ... I 1 I I I , t - - - •-- . -._ _ - --- .......... I : I - I ; , I I + I i f. _ � �r I y r 1 , I _ I I I li I r ' rr- nA 1 I i i T : 1�. —t - I ;I 4 j 150,00 1,10 J�� LOT 29 o LOT 30 =-=_= HSE N, DECK 00 o \A 15p. o_ � 561 I RES. ZONE RF" This MORTGAGE INSPECTION Plan is For FLOOD ZONE.- "C" T WNW -11- -R -—LV MILLS____ Bank Use Only --- REGISTRY 0 OWNER: CURT_R.. JOANNEC._AINSWORTH DEED REF: 4--244 __—___-BUYER: MICHAEL_&�AROLYIV ZENT __ DATE: _4 � %D�____ - PLAN REF: _249/79 __________ SCALE:1"= _30 ___FT. I HEREBY CERTIFY TO NATIONAL CITY_MORTGAGE____ _C_OM_P_A_NYC_0_M_NI_0_N_W_EL_T_HU_N_I_TE. AT THE BUILDING YANKEE SURVEY SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS �ta_�� � SHOWN AND THAT ITS POSITION DOES CONFORM PAUI CONSULTANTS TO THE ZONING LAW SETBACK REQUIREMENTS OF THE A. 40B (SUITE 1) TOWN OF _BARNSTARLE ________AND THAT '��{ �` INDUSTRY ROAD f hdq. 13 IT DOES__-OT _ LIE WITHIN THE SPECIAL FLOOD HAZARD ,\ MARSTONS MILLS, MA. 02648 AREA AS SHOWN ON THE H.U.D. MAP DATED_a 19 B5 _ ,,� 'STE�'�• Comm ,�tV—Pang 150001 0015 C }��d�,. TEL: 428-0055 v ► r� FAX: 420-5553 a ' THIS PLAN NOT MADE FROM A RUMENT PAUL Iv:ERITHE ' -------- SURVEY, NOT TO BE USED FOR FENCES, ET- 33090 LM .APR-23-2002 TUE 01 : 35 PM TODAY REAL ESTATE 15087901388 P, 02 -� COMMONWEALTH OF MASSAC"HUSETTS EXECUTIVE I E OFF ICE OF ENVIRONMENTAL N ENTAL AFFAIRS F IRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 353 Lake Shore Drive Marston Mills, MA 02648 Owner's Name: Curr Ainsworth Owner's Address: game Date of Inspection: March 11, 2002 Name of Inspector: (Please Print) James M. Fiord ' Company Name: Janes Af. Ford Nailing Address: P.O. Box 49 Map: 014 . _ Osterville, MA 026S5-0049 Parcel: 002 Telephone Number: (508) 862-9400 CERTIFICATION STATEMENT I cert.ify that I have personally inspected the sewage disposal system at this address and that the i.nformat.ion reported b,_low 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(31.0 CMR 15.000). The system: Passes Conditionally Passes Need rather Evaluation by the Local Approving Authority Faits i i Inspector's Signature: Date: March 11, 2002 'I he system inspector shall subm 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 CEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving, j a-.ithority. Dotes and Comments I i i I "***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. i Titic 5 Inspection Form 6/15/2000 page I I I i 2002 TUE 01 :35 PM TODAY REAL ESTATE 1508I901385 i Page 2 of 1 1 OFFICIAL .INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE. SEWAGE DISPOSAL SYSTEM INSPECTI ON FORM PART A CERTIFICATION (continued) Property Address: 353 Lake Shore Drive Marstons.Mills MA Owner: Curt Abtrivorth Date of Inspection: March 11 .2002 Inspection Summary: Check A B,C,D or E/ALWAYS complete all of Section D i A. System Passes: 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 13.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are.indicated below. Comments: I I i 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 rep.l.acement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined(Y,N,ND) in the for rho foll explain. owing statem ents. if"not dcKertnined",.please 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 oxfiltration or tank failure is imminent. System will pass inspection if the ex: stin.g tank is replaced with a complying septic tank as approved-by the.Board of.Heal.th. 'A.metal septic tan.k 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. i ND explain: Observation of sewage backup or braak 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: i 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 obstructicsn is.removed ND explain: I 2 i r -2002 TUE 01 :35 PH TODAY REAL ESTATE 15087901388 P. 04 Page 3 of 1.1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SURSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM. PART A CERTIFICATION (continued) Property Address: 353 Luke Shore Drive Marston Mills, HA Owner: Curt Ainsworth 'Date of Inspection: March 11 2002 C. Further Evaluation is Required by the Board of Health: Conditions exist which require fitrther evaluation by the Board of Health in order to determine if the system is failing to protect public health; safety or the enviromment. 1. System will pass unless Board of Health determines in accordance with 3.10 CMR 1.5.303 (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 syst(Tn passes if the well water analysis, performed at a DEP certified laboratory, for colifonn 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: i I_ 3 J� ,,-2002 TUE 01 :36 PM TODAY REAL ESTATE 15087901388 P. 05 Page 4 of .l 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATTON (continued) Property Address: 353 Lake Shore Drive Marston M11Lc. .MA Owner: Curt Ainsworrh Date of Inspection: Murch 11, 2002 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 sow-dge into facility or system component due to overloaded or clogged SAS or cesspool T ✓ Discharge or pending of.effluent to the surface of the ground or surface waters due to an overloaded or c.lobged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _ ✓ Any portion of the SAS. cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet of a'surfaeeiwater supply or tributary to a surface water supply. '/ ✓ Any portion of a cesspool or privy is within a Zone .I 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.] a. No (Ycs/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 yf Health to determine what will be necessary to correct the failure. i 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`ho"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,(lnterim Wellhead Protection.Area- 1WPA) or a mapped MZone 11 of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered `yes"in Section D above the large system.has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shal.l upgrade the system in accordance with 310 CMR 15.304, The system owner should contact the appropriate regional office of the Department. 4 /-2002 TUE 01 :36 PM TODAY REAL ESTATE 15087901388 P. 06 r Page 5 of 1 I _J OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 353 Lake,Shore Drive Marstnns Mills, AM Owner: Cart Ain,4*)rth Date of Inspection: March 11, 2002 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 ? 9 ✓ Were as built plans of the system obtained and examined?(If it ey 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'1 ✓ 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 Pan C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)]. 5 2002 TUE 01 :36 PM TODAY REAL ESTATE 15087901388 P. 07AV { ti I Page 6 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS �I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 353 Luke Shore Drive Marstons Mills, A14 Owner: Curt Ainsworth Date of Inspection: March 11, 2002 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: 4 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system (yes or.no): .Nn (if yes separate inspection required] Laundry system inspected(yes or no): No. Seasonal use(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): 2001- 70,000 gals.; 2000,-85,000 gals. Sump Pump(yes or no): No Last date of occupancy: Currently occupied 1 COMMERCIAL/INDUSTRIAL Type of establishment:- Design flow(based on 310 CMR 15.203): gpd 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 March 2001 -per owner Was system pumped as part of the inspection (yes or no): Nn 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 ofthe 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: New lecich field March 27195-per as built card Were sewage odors detected when arriving at the site(yes or no): No 6 I .4, o`02 TUE 01 :37 PM TODAY REAL ESTATE 15087901388 P, 08 Page 7 of 11 OFFICIAL INSPECTION FORM - HOT FOR VOLUNTARY ASSESSMENTS I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property.Address: 353 Lake Shore Drive Marsrons Mills, MA Owner: Curt Ainsworth Date of Inspection: March.11, 2002 BUILDING SEWER(.locate an 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 ofJoints, venting, evidence of leakage, etc.): SFMC TANK: ✓ (locate on site plan) Depth below grade: 20" Material of construction: ✓ concrete _metal fiberglass,' --polyethylene _ocher(explain) If tank is metal list age: Is age confirmed by a.Certifcate of Compliance(yes or no): (attach a copy of certificate) Dimensions: _ 1000 gal, Sludge depth: :1" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 10" Distance from top of scum to top of outlet tee or baffle: J" Distance from bottom of scum to bottom of outlet tee or baffle: 16" How were dimensions determined: Measurinc 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 even with the outlet invert There Ywre no cix=ns ofleakogc Recommend pumping every three years. 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 0IF- -2002 TUE 01 .37 PM TODAY REAL ESTATE 15087901388 P. 09 F✓ Page 8 of 1 1 A OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SU13SURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) i Property Address: . 353 Lake Shore Drive Maroons Mills, MA. Owner: Curt Aim worth Date of Inspection: March 11, 2002 TIGHT or.ROLDING 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 pc): 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: Even 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 T1-box was level. There were nn fiZris of leakage or solids.:/There were no signs of backup or fpllure in the infltrarnrs "newer leach field. " The bottom to trade was approximately 8. 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 =2002 T U E 01 ,37 PM TODAY REAL ESTATE 15087901388 P' 10 Page 9 of I l OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 353 Lake Shore Drive Marston Mills. MA Owner: Curt Ainsworth Date of Inspection: March 11, 2002 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits, number: 1 leaching chambers,number: ✓ leaching galleries, number: 4 infiltrators with 2'stone- 7'x 29'x 2' - leaching trenches, number,length: , leaching fields,number, dimensions: overflow cesspool,number: ' Innovative/alternative system T�ypc/name of technology: Comments (note condition of soil, signs of hydraulic.failure, level of ponding, damp soil, condition of vegetation, etc.): The infiltrators were not dug up There were no signs offailure in the D-box. The bottom to grade was approximateh,6'. The old nit had signs offailure _ 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 ofponding, 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 /2002 TUE 01 :37 PN TODAY REAL ESTATE 15087901388 P, 11 Page 10 of l.l OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 353 Lake.Shore Drive Marstnns Mills MA Owner: Curt Ainstiwjrth Date of Inspection: March 11, 2002 Map: 014 Purcel. 002 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 rho building. A i — ace A , 4 3a- as (33- 3a. Qy- yq of O O 3 y 10 ,. }UE 01 ;37 PM TODAY REAL ESTATE 15087901388 P. 12 Pale l ] of 11 } L OFFICIAL INSPECTION FORM - NOT FOR 'VOLUNTARY ASSESSMENTS s ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM 'I PART C SYSTEM INFORMATION (continued) i Property Address: 353 Lake Shore Drive Marsions Mills AL4 _ Owner: Curr Ainsworth I Date of Inspection: March I1 2002 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/obse�rvati.on hole within 150 feet-of SAS ✓ Checked with local Board of Health-explain: topographic and water contours maps i Checked with local excavators, installers- (attach documentation) i Accessed USGS database-explain: You must describe how you established the high ground water elevation: The bottom of the leach,meld to grade was approximately 6' Usinz the Barnstable topographic map and the Cape Cod _ Commission waxer conururs map the maps were showing approximately 50' I./-to ground water at This site. This report has been prepared and the system inspected and passed as of the!late 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. l.l Y 2002 TUE 01 :38 PM TODAY REAL ESTATE 15087901388 P. 1 ate: Date &Time of Inspection: r'3�1 o Commonwealth of Nlassachusetts, Executive Office of Public SafetyDepartment o1Fire Prevention P.O. Box 1025, State Road, Stow, MA 01775 Issued By: Centerville-Osterville-Marstons Mills Fire/Rescuc and Emergency Services CERTIFICATE OF COMPLIANCE - M.G.L. CHAPTER 148, SECTION 26F Application is hereby made to install approved smoke detectors as required byMGL Chapter 148, Section 26F. and to have same tested .by the C-O-MM Fire/Rescue and Emergency-Services. Location of Property; rs � py Owner of Property4i'lease Print): Date Contact Person �: �..,... Phone: - �? a' '7 Date Built (Mo./Yr.)_. _e/ ■ • ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■.■ ■ mi ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ n ■ ■ r ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ r a ■ ■ ■ ■ ■ ■ • This certifies that the property located above has been equipped with approved smoke detectors and was found to be in compliance with M.G.L. Chapter 148, Section 26F, on the date tested. The above location was inspected and tested on; 20Q�"and found to consist of: Dwelling Uhit(s), with 3__Primary Power.Detectors it r Pow r D tectors John M. Farrington, Head of Department Inspector:_ Notice: This certificate expires sixty (60)days after date of issue. �. ....... , This form mtets the requirements for F.P.`7 ;is revised l 1/84. Form Distribution: White Copy -I-lomeowner, Yellow Copy-Fire Dcpt. i i i i i i i I TOWN OF BARNSTABLE LOCATION �� o ® �f� SEWAGE # VILLAGE In. 1141 LLS ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY Ato a0 LEACHING FACILITY:(type � t) ��+- � (size) `7 �yv 9 f NO. OF BEDROOMS PRIVATE WELL PUBLIC WAT BUILDER O WNER �¢in/<S�nl t —"a4 DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes Now 1 4q 4 c�( qq3, No...75--_21.17 THE COMMONWEALTH OF MASSACHUSETTS /F iEL:jBi.............................. BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Dbip t ial Wor1w Towitrurtinn Urrmit Application is hereby made for a Permit to Construct ( ) or Repair (� an Individual Sewage Disposal System at: /.:`� i'J�:"- eAddress---------•---- ----- -Il.T�..��c�!�`f/ D1 Lo� 1 V ( f Al /LA_. .._...... _ �I�l .........._ .__... Owner _� n-n Address Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms._.............tea.. -. ---..- _- lixpansion Attic ( ) Garbage Grinder aOther—Type of Building ---------------------------- No. of persons--------------------.------- Showers ( ) — Cafeteria ( ) Other fixtures ---------------_-------- ----- . . W Design Flow.................-��..........:..gallons per person per day. Total daily flow............... —7d.................gallons. WSeptic Tank—Liquid capacity/ --gallons Length---------------- Width....------------ Diameter...------------- Depth................ x Disposal Trench—No. ...........�...---- Width...... ..--.-.--. Total Length..-- ..... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter..............-:.... Depth below inlet...,/ Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by-------------------------------------------------------------------------- Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.----- ............. Depth to ground water...--................... G Test Pit No. 2................minutes per inch Depth of Test Pit,-------------..---. Depth to ground water.....----...........--.. ................•• ... ----•----......--••------••-----•--.......--•--•-•---•-•--••-•••••----•----......................................................... 0 Description of Soil.......................................................................................................................................................................... x w ..........=- ---------------------------------------------------- ....................................... UNature of Repairs or Alterations—Answer when applicable...-../ t�.----- ----------------.fN�----- t !� .- ?-c• Z ...-• ir✓ - �5€lTc --A............... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has �issued by he rd of health. Signed ------------.... . ....... ----- . ...._...... --------------v Date Application.Approved By ..--------- ------- --.. ----- -------------- ----------------------------------------------------- ......3--- I---n Date Application Disapproved for the ollowing reafonr: .......... ............... .. ............... .. .. . .. .......................... ..........._..._..... .._.._......_.................... .. .........- ........... .. ..........--..... ................................... ---------------------------------------- Date Permit No. --------- ------------ --------- Issued ---------- ---------11... ..9,5 ................ Date - ZF THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appfiratilan for Uiiipoiial Workg Tomitrnstiun ramit Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal System at: ?S ESQ 01(LE J f'✓� ✓vJ / l[,S . .................... ••�-•----.....--•,0�-----•-------•----•..._... -----•------......------••-••-•-•---•-••....---•----•-------•-_...........--•.......----.....--- Location-Address or Lot No. � , .Sw4 J. - ..._ Z111 S<1d2� .... �_I�.......................vis ......................_.....•• --••-----•-•------•---- --- Owner __ n n Address --- 7`�`�/ CC t»?7 GGry� �ii 7 ivDv_.---- 7l�� --------/-i . ....---•-V.V.7-t---�--1-I...-S............... Installer Address Q Type of Building Size Lot............................Sq. feet U Dwelling— No. of Bedrooms________________ -------------------------Expansion Attic ( ) Garbage Grinder �--� P J� aOther—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a' Other fixtures _______________________________ _ _ W Design Flow.................. gallons per person per day. Total daily flow...._.__....__3d-----______-_____gallons. W Septic Tank—Liquid capacity/A90___gallons Length-______________ Width---------------- Diameter._._.__-._.-___ Depth................ x Disposal Trench—No. .................... Width......_._._......... Total Length----5; ----- Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.._�-t`'.:-... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.................._------------------------------------------------------ Date........................................ Test Pit No. I________________minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ Li, Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ P+ •--•----••-----------------------------------------------------------•-•----•----•-------------•••--......................................................... 0 Description of Soil........................................................................................................................................................................ x V :.. W ............. ----------- --------------------------------------------------------------------------------- ------ --------------------------------------- ------------------------------- UNature of Repairs or Alterations—Answer when applicable._..__ .......4X_._______ __ ....................................` Agreement: The undersigned agrees to install the-aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has/ '°en2 ....issued by h�rd of health. / // -: :=Signed .... .. ��% ...-..... .- Dace Application.Approved By ............<� .- t.. ..................... .................................. ------3_,... II: Application Disapproved for the following reasons: -------------------------------------------------------............-......--..."............---_...........---------. -------"---_-...._--------"---""--"---"--"---"-----"-----------------""-----"---...-....-------"------------._....--------------------------....-----------------`--------"---------- . .. ................... .......... Dare Permit No. ..-....... .- "" - Issued "... ``� 5-"....."............ Dace I4 t — I THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE 1 C�ez#ifi ak of Compliance THIS IS TO CERTIFY,,Tha-t the Individual Sewage Disposal System constructed ( ) or Repaired - Insr,Jler at .....----------------..... .........."... ......... ...."------ -- -- --------"---""---"-....- -- - " " has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in _�.��... the application for Disposal Works Construction Permit No. ..... dated ._...-...............-. . THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED S A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFAC IORY. DATE '....... Ins ect ... ... ...... -.-_----„---_,-,-,-,-,--_,-,-__------.--- --_-- ---------,-,----- -m-_ -----.------ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No... f�.�._.1G`.. �-�.� FEE..... DifiVntsa1 Works Tomtru#inn rantit Permission is hereby granted____________________�/��UL-77 ._---.�N$_�� ---------------------------•---••-------...._.. to Construct ( ) or Repair (\4 an Individual Sewage Disposal System at No.. `�� -... �� ...-`�u��-------��(I�I�.-- ------------------------------------------------------ Street ( lJ � as shown on the application for Disposal Works Construction Permit No. .. __-�/� �' s __- _ Dated__ ._-.. _.."._/cam ..._.... ---------•-•-----•----•-• . of Health DATE----•------------------- -�- - � FORM 36508 HOBBS&WARREN.INC..PUBLISHERS 21 L,O C A>T ION S E W A G'E`, PERMIT NO. VILLAGE N , INSTALLER'S NAME & ADDRESS I3 U I L D E R OR OWNER &.)U ti ��Sf 1'Ne DATE PERMIT ISSUED ODATE COMPLIANCE ISSUID A k Sk�� r' THE COMMONWEALTH OF MASSACHUSETTS Application is hereby made fo-,a Permit to Construct or Repair an Individual Sewage Disposal System t: ?� .......... ........t... ......... .......... ....................... Tess' ---------r o ion owner Y_ Instal'I'e'r Address Type of Building Size .........Sq. feet Dwelling—No. of Bedroom ion Attic Garbage Grinder 416 Seepage Pit No.. Z Other Distribution box Dosing tank The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TI I TL 1Z 5 of the State Sanitary Code—The undersigned further agrees not to place the system in until a Certificate of Compliance h b n issued by the board of health. ne licat Application Disapprov or _— _—._'-------- _ Date Date --------~~--------- No.. `: .y.. - Fmc .......................... THE COMMONWEALTH OF MASSACHUSETTS BOAR® O F H EA H ..................OF.......�.� - ---- •-......................... Appliration for Uiiposal Workii Tonitrnrtion amit Application is hereby made for a Permit to Construct (x ) or Repair ( ) an Individual Sewage Disposal system t ......../..-- 1�....,.--------- ...................... � /. _3..Q............................................ Ir..R.... �.:.._ `k ............................ r Owner 3c �.: AZ1, ss a _.. !!.........:..........:'°"""....................... ........-=••'...�.V-4 -•---. .... ... ................................ faller -•+- Address U Type of Buildi� �' ��F yq_)� ' Size Lot_. /-,.o.pA__......Sq. feet Dwelling—No. of Bedi�c3drks. _;', "== .:..:.........:....Expansion Attic Garbage Grinder iCY& Other—Type of Building _. No. of ersons____________________________ Showers flI YP ng� ------------- ----= P ( ) Cafeteria ( i A4 Other fixtures -----------•--- --•---••-----------•-- - w Design Flow............S3 -----------------------gallons.per person per day. Total daily flow........ y_=.5 _...................gallons. WSeptic Tank—Liquid capacity_//n�2°._gallons Length___. Width..1:4._`:.__ Diameter................ Depth................ x Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No----------�,-_._._. Diarheter....a_:r:........ Depth below inlet__ _:!_........... Total leaching area._/E't:.....sq. ft. Z Other Distribution box ( /) Dosing tank ( ) • • Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. l________________minutes per inch Depth of Test Pit.................... Depth to ground water.......................... f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ----•---------------------------•---_._...-•••--....••••--•--•-•--------••-..........-•••-•----••-•-......................................................... 0 Description 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 TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b en issued by the board of health. Ifollowing ned `� `---..... ...------•---------- - -------- e..-----..Application Approved Date Application Disapproved o reasons: •------- ---•--•--••----•---- ••-•-•••------------••--•------------------•••--=--•-----._...__...--••-••------••---•......._..••---•••••--._._............__._....----•-•-----•••---•-•-•--------•----..-----••------•-------•----•--- Date PermitNo......................................................... Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... (Irrtif iratle of Toinpliatta T� !�TO CERTIFY, That the Individual Sewage Disposal System constructed (- or Repaired ( ) f by...�;.. .. C' •. - ---•-•-----------------------------•-----...------._......-----.......---.............-----••••--._..._ _ �,� ,✓ Installer at_•-•-_.. d.r:.....If)----- -. --___----------------•----------------------------------------------•--- ......._ has been installed in accordance with the provisions of TI F 5 of The State Sanitary Cod s d sbed in the application for Disposal Works Construction Permit No.__��hf _-/�___________________ da d_.G- l_f!/._......'__..____....._._...... THE ISSIJ N OF THIS CERTIFICATE SHALT. NOT BE CONST S A GUARANTEE THAT THE SYSTEM WI TION SATISFACTORY. DATE.....t`. ..l ..... Inspector ...... .......... --,,.._.... THE COMMONWEALTH OF 6ACHUSETTS BOARD OF HEALTH No. �f^. FEE... ............. 111-spoll orkii Tonotrnrtion rrmit Permission is herby granted--- -------------- `---------------------------•-----•---..._...._.._.....-----•--........._............... to C,rrstruc o Repair ftnd•v-,u#r.Sewag Disposal System at No. ': f ¢' ``" j '�• r - �Y ' 5 ------------ -------------------------------•---------•-----••-----.......... Street as shown on the application for Disposal Works Construction Permit _________________ Dated.......................................... .................. ..••----.....-•------•-•-•------------•-----•--•---•---•---•---••-••---•••---•---- �jHealth FORM `_�S_:-� -----•----------•-----------•------- Board of FORM 1255 A. M. SULKIN, INC., BOSTON Ord`w. �j11JGLG— FAMI►-`! - :3 BGORaoM uo ,6ACLBAGE (jR�ti1DE2 ,LeDKc-S.U�•e� D,� . �` DM�.Y FLOW a IIU X = = 3OG.PD 5EPT►G T.A►,JK - 330xl50% = A9!;6.Po Us1c %000 GAL. 015PD3AL PIT u6E IvoO GAL. 'TAl. 44;4e,,v ' (50 5.F„ X �•5 r 37�J G.pD � �T 99�p s 50TToM AREA r 0 5 F•- I a �C� x 1• o P o s.F � 5 �-• -ToTA 1- DESIGN : .g-2� G.P. D• � E-rr? •TOTAL. DA I►-Y F'--oV4 'moo- ^ P�2co�AT10N RATE = I''IN 2MiN o12-LE55 A i� OF I C.DAVJQ � ,, U► �. 1HULIN ; 10l"ARU j No. 29976 H A. LI0�-10 q- UAY.TCE3 u;:'.V �/ l�G�� �• TER \ i Yy' �No.2:.:13 AL y4 r at .Qc,nlo✓br,oG�- vai5u T,dac AI 7:9RIA L ,4iysa,ee►� C�4Ce- C-46;4A,1 F/GL FG.e /o A1-c._.su'�ar� TOP FNO= lWv- ^ ' .SvJ�.Sr.Ic._ MST. INS/, SCPT�G Z 0uK PTIC- TANK.lo ca�lP1G7 /Go oI N�/�.• 98 0 LEAcu �' PIT •/ INV. INV. WIT14 y8 z 5�•f< 113/�i•1 vu WASi{GD _�istA/lo 6Tv,NEr " CERTIFIED PLoT Pt•-A-W 10 PRz0FIL� No• SCALE r7GALE � �� ' �AT�c z/�3/�ctL P L-A N RE F E 2E►`I GE `''� CERTIFY THAT 'T14E EXIST �►�� SNowN HERSo1.l C0MPL`(5 WITH-tHE S I V6L1NC. ,G o 7- 30 AWP 5ETeACK R.6Qv12EMEN of -Tµ� 7o W N O F AND I S t�loT /p��✓ C3.C� Z�y /��• 79 LOCI&M D MTNIIJ TH•E GLooD PLAIN DAT 1r BAXTE iz.c W`{E INC. . RED I S�>✓��-v'►.�.0 D 5�ev�Y�es Tu15 PLQN I !$ KIOT 4n5c p oId AN 06TE2VILLlC Iu5T?,uMeN-r Svevey --THE 01=F5E.T5 No'T Ds ,V5EDTO. D'ETEp./^1►�� cT -INES APPLIGA►�IT r 7 t ° 3 _y. .. obo _ N n a�F3 aofsY3 E5 E a �O b b $H E7\ E�. ./P.i••:.e l.'..a.el 'B°mr 9'-O'Pi9foa+.foot'mga L o � 4 r Ada•7/ .. ... — ~— +•a/ --- ---- - .ma a �(�' L o I ,^I°//.UI ON I% Gar e>°>/B• � _ + na .f:,.ar.•>% a o.m � � t- � 'xlll 19rran a 9^ - e rrL. 91 r _ e w , VaWss P9•PoO, i ,� Ls+ £o+�o'>I Po � W a in9 w:% I • I _- ____ c O rp#aal/Loners+s LO(Umn. pGl%I/A°YT 1 >/B' G Var aLnmm ban S ,1•\11. } A�daraanmTw s 9,s oPPIGe Goun+ar wi b.r ainL ° - a+arn9• N I - e.ia+'�nn Pnmilyroom Q r.o.x'-m 1/B••,'_%1/,• , I mro mq.P+. I° ,• C j-� Fyn e L � —® - _\ I Naw oo•.oo°.I Pouroe j j "�"� m .C. 8 I V wra+a focFnq w/q I/s°m I bras,;Loners+a L„wm I /�,� p r.a.no%/e•.oB /x• I I - ----------- _________ d . a c �afrnma for x n Q C O E I I „ � 9.vnna daara. � ��� U _ II41, I I - 4.N .. _ ______ ___ �� 6• _�_____________ .. __ _--____ C� i , 00 Y L .... - - �9 vm#c sd d banrinq � .-d •� �3-- O J 4 E # ....�..o-.�.. o.. .. ....t..'�.E-1�.- JIM ® + .V.O-.Ta.. of o x R C a c v vo 30 4b z m 5�c C No C` a o - < S am E ®a_ I5 ' o" t 12._m. b I S•_m. t O h�� •REPRODUCTION T e ¢ .,-o• ��'• Lt OF THESE PUNS BY•' J m P i0 l o•-%1.,• b r-a• m•-o v/9• ANY MEANS IS PROHIBITED BY FEDERAL LAW VIOLATIONS 0 3 6 V s 9 0• _ -_ - (� • ARE PUNISHABLE BY FINES UP Q • � � AMERICAN/NSTAUTE ' - • � OP BUILDING DEBIQN MF—�-' FLOOD PG—AN CCC333��'000 � � �L . TO S10D,000 PER OFFENSE • G hoGonrl Floor Plan �EGONr� PLOO�1'LN • CALL THE DESIGNER TO •,�Q I n Pam: I Q 11 1-0�1 OBTAIN LEGAL COPIES V oow OF THIS PUN ������ SHEET NUMBER: A200 3'i 7i"c�a FFi nos ynyy DC n�'a < `o . Z "BY Q Z7VIE GOn}inJpUS ridge Ven} - Asphd+shinglez to match existlnq � - Asphal+shingles+,match axis}inq . 2 0 I/2"ApA F=a+cd hhea+hlnq 4� 1�++Fcl+paper w/Ice 1 Wa}er hhield 'Q New 2 xB F=af}cr.e 1 ro"o.c. on ewvcs and valleys. - > Proper vents e 1 co"o.a 1 2"F.G.Insulatio•�• "�B nL 1/2"APAra+edhhea+hinq 7 L P'Ie+al drip edgeL- �� ...... ... I 2 xB Geihnq joists e I fo"o.c. J „\ 0 J' - Gon+inuous s,ffi+vent Q IxB Preprimed pine}rim - 1/2"gypsom board \ \ ,,Q1 1 ei•Fel+paper splines® L all windoww and doors and a w �� � `` 1� �( all Trim - remove rxistinq rwf}ers - v ,\ e 1 a" .c. Tyvek®bousewrwp 9 Proper vents a 2"APA rated sheathing 2 x 4 Wall Muds e B"H.O.Insul w+ion %O - V 1/2°H.O.Insula+wn-F-1 5 0/A APA rw}ad T<G sUi floor lye+wl drip edgelww Exis+inq 2 xB Floor joiyF-s e 1<n"o.c. - - Aluminum qu}tars ; - New 5/B"Type"X"drywall bon+mucus-ff+ven} • - _ 1xB Preprimed pine+rim News 1/%"x 1 1 7/B"poGl Vers-w-Lwmo '^N WG.shingles e'S"}.w. S - -.0. u •9 r m ve0� . e.. New v 1/2"m s+eel/concre+c column y •� •..E .. . Exis+inq 2x4 stud wall ?{ .... $ a-`E.. w/�i/B"TI fr- £ `u New%O"x"J O"x f'Goncre+e foo+lnq - o"Poured concrete slwb W.4 .. '•.\k`,k. k"k• ,,;k` .• ,\ \ fit '+ k'',\ 1 - Exis+inq concrete Foundw+ion \k ME •k oL�uS°�•� IP P \A ��'�'•.��\�; >4. p�UlLI71t.�1��EG"rlOf`l ���,� � �"ta D v s .�v= ° P � o�3��a�� REPROWCTION`• � •, °,m�- E OF THESE PLANS BY ANY MEANS IS PROHIBITED . z o g° m 3 c BY FEDERAL LAW VIOLATWNS r LL' d O AHE runtSHABLE B'f PINES'LIF � Q _~�• A 0 AMECAN INBT(T�{Tt % ON1LOIN0 „AS D e .- - TO$100.000 PER OFFENSE• . - - y• • CALL THE DESIGNER TO, y� .� • OBTAIN LEGAL COPMQ q n� •• OF THjkP, , y¢ �C •• 4��� SHEET NUME3ER, Ej °q m 11ll u a`�§t6�SY'au' \ 4 ® \ f L. Q � 7 l S Z N v � o s — .. .... ... L---------------------------_-------___----'i---~ Q n L F�oHT s;t^E�r�TtoN 00 6 m -m � O J• Q # �..0. ..s�. O o aoo ).......... p ..... ..... . FFMI al o mm�oov iLL • 3 u U ' �OO�J30 CQ i Ll r---- ------ ----- - - - ----- ------- - R`o v K a ------------- ------ ------------------------ REPRODUCTION T S OFTHESE PLANSPROHIBITED B ----� �� ANY MEANS IS PROHIBITED , BY FEDERAL LAW VIOLATIONS m LL: ARE PUNISHABLE BY FINES UP •.O D1�A 1 $YPE: Tto� Q A1dERN:AN INSTTUTE Gale: f /�l" ( o" r r OF BU0.DING DESIGN : W vJ �f•�. TO Sl 00,000 PER OFFENSE .• Effl Q, F N • CALL THE DESIGNER TO SHEET NUMBER: OBTAIN LEGAL COPIES •• /� O O OF THIS PLAN �C ��FGAL�� pats TOP OF FOUNDATION 24"dameter concrete couers 4"PVC VENT TWENTY(20)ADS ARC3G(3G I GBD2) LEACH MARSTONS MILLS, EL=99.3 rased to withm 6"of finish gradet CAP BY"SWEETAIR (or as noted) CHAMBERS IN BED CONFIGURATION FOUR(4) 5YSTEM DESIGN CALCULATIONS MA /nspection Port and cap with magnetic ROWS OF FIVE(5)UNITS EACH marking tape to uathm 3"of grade '( 361MIN 5EWAGEDE5/6N FLOW REQULRED:3 BEDROOM DWL=LLJNG @ Asa Mel s j Existing EL=96.9±- EL=99.0-- EL=99.04- A L O GPD/BEDROOM-330 GPD REQUIRED Rd / Vent .' ;• � 0 ¢ SEWAGE DES/GN FLOW PROUJDED: TWFNTY(20)ADS UN/TS IN BFD �a���h� ��r / \ Y CONFIGURAT/ON/N FOUR(4)RO1+5 OF FIIAL(5)UN/T5 EAi. y Z 97i /+ 18"min Cover for cp Vt=[(330/0.74)/(4.B f7z/FT)/5.0 LF/ sting Ex 96.5t H-20 Loading -, - /9 A05 UN/TS REQU/RED(20 PRO(//DE0) LOCUS - 55,02t Al 355 GPD PROV/D O GPD Shore ED>33 REQU/RED � Existm a 95.9f - SEPTIC TANK CAPACITYREQUIRED. 330 GPDX 200% 660 GI D REQU/RED g g 95.6� 95./7 - 95.00 94.60 x. ,. , , ��a� Fxistm _ Existing N SEPT/C TANK CAPACITY PROVIDED: fX/ST/NG /000 GALLON SEPTIC TANK va�' Gat 9 1 Proposed 93.70 A / B e o l n e e ) TWENTY(20)AD5 RC36(36 6 D2) A GARBAGE D/SPOSAL/S NOT PERM/TTED W/Tfi Tff/S DESIGN FLOW Gas Baffle LEACI)Cl)AMBER5 IN BED Wren Long r CONFIGURATION WITI/FOUR(4)ROWS Ln Pond Longest Run 5.6'j- � /2' 9' OF FIVE(5)CHAMBERS Inspection Port(See Note#4) Ewstm EX/ST/NG /000 GALLON (1I-20 Rated) L fA Ch CHAMDfR5 PLAN V 1 E W 5EPTIC TANK D-501V (H-20 Loading) EL=BB./:tBottom of Test Hole SCALE: I" = 10' SITE LOCUS FLOW PROFILE NOT TO SCAM CONSTRUCTION NOTES NOT TO SCALE .) Assessor's Map 14 Parcel 2 I .)ALL WORK SHALL CONFORM TO THE STATE ENVIRONMENTAL CODE,TITLE 5 (31 O CMR 2.) Deed Book 15079 Page 45 1 5.000):STANDARD REQUIREMENTS FOR THE SITING, CONSTRUCTION, INSPECTION, 1 3.) Plan Book 249 Page 79 UPGRADE, AND EXPANSION OF ON-SITE SEWAGE TREATMENT AND DISPOSAL SYSTEMS AND �O� a� 4.) This property is in a Zone II of a Public Water Supply FOR THE TRANSPORT AND DISPOSAL OF SEPTAGE, AND THE LOCAL BOARD OF HEALTH INSTALLER TO VERIFY THE LOCATION OF ALL I and a Groundwater Protection District (Town of Barnstable) REGULATIONS. v 1. UNDERGROUND AND OVERHEAD UTILITIES \�� �Q 5.) Flood Zone: C �� `y? 2.) ANY SEPTIC SYSTEM COMPONENT INSTALLED IN A LOCATION WHERE THERE IS PRIOR TO THE START OF ANY EXCAVATION A0+ \hO. I POTENTIAL FOR VEHICLES OR HEAVY EQUIPMENT TO PASS OVER IT SHALL BE DESIGNED TO ACTIVITIES AND RELOCATE AS NECESSARY WITHSTAND AN H-20 LOADING. IF UNDER AN IMPERVIOUS SURFACE,SYSTEM SHALL BE (SEE NOTE #1 5) Shed VENTED TO THE ATMOSPHERE. 3.)TO MINIMIZE UNEVEN SETTLING, ALL SYSTEM COMPONENTS SHALL BE INSTALLED ON A (o\� �e dL` �� LEGEND STABLE MECHANICALLY-COMPACTED BASE ON SIX INCHES OF CRUSHED STONE. 5'.5odRemoual 6--1 EXISTING SPOT GRADE 4.)COVERS OVER THE INLET AND OUTLET TEES OF THE SEPTIC TANK,THE DISTRIBUTION i� (See Note#20) 0�? m 24x5 PROPOSED SPOT GRADE BOX, AND THE SOIL ABSORPTION SYSTEM SHALL BE RAISED TO WITHIN G"OF FINAL GRADE. ��<,�� Light <1` 24 EXISTING CONTOUR LEACHING FIELDS,TRENCHES, AND OTHER SOIL ABSORPTION SYSTEMS WITHOUT ACCESS MANHOLES SHALL HAVE AT LEAST ONE(1) INSPECTION PORT CONSISTING OF PERFORATED Family �^icy/ 24- PROPOSED CONTOUR 4"PVC PIPE PLACED VERTICALLY TO THE BOTTOM OF THE SOIL ABSORPTION SYSTEM WITH v�� III I I w WATER SERVICE LINE A CAP,TIED WITH MAGNETIC MARKING TAPE, ACCESSIBLE TO WITHIN 3"OF FINAL GRADE. Garage O OVERHEAD UTILITY LINES Sun ' i I �' u UNDERGROUND UTILITY LINES 5.) PIPING SHALL CONSIST OF 4"SCHEDULE 40 PVC OR EQUIVALENT. PIPE SHALL BE LAID \ 35.5 G} ( I ON A MINIMUM CONTINUOUS GRADE OF NOT LESS THAN 2% FROM THE BUILDING TO THE Lrom9 Room Vent / r' O -cam- GAS SE VICE LINE Garage I Q f SEPTIC TANK, AND NOT LESS T`;�jAN I%OTHERW(SE. first Floor y9,�\ � f � 6'' gg,7 m EDGE OF CLEARING I Dining Kitchen qs -\ --- J` I Tp TEST HOLE LOCATION G.) DISTRIBUTION LINES FOR THE SOIL ABSORPTION SYSTEM SHALL BE 4"DIAMETER Bdrm f I I j i i SCHEDULE 40 PVC(OR EQUIVALENT)LAID AT 0.005 FT/FT. UNLESS OTHERWISE NOTED. Btn (I L I I f I ST SEPTIC TANK . �� _ , 1 ► srJ� I I I I I DB DISTRIBUTION BOX LINES SHALL BE CAPPED AT END OR AS NOTED. - J �� i Existm 3 Bedroom Dwelti SAS SOIL ABSORPTION SYSTEM 7.) LINES FROM THE DISTRIBUTION BOX TO BE LEVEL FOR THE FIRST TWO(2) FEET BEFORE I 9 ng PITCHING TO THE SOIL ABSORPTION SYSTEM. DISTRIBUTION BOX SHALL BE WATER TESTED c Foundation EL=99.3:t TO ASSURE EVEN DISTRIBUTE � " �\ f y9 o Top of t. Errstmg Septic Components to G� I VARIANCES REQUESTED 8.)GROUT TO BE USED AT ALL POINTS WHERE PIPES ENTER OR LEAVE ALL CONCRETE be Abandoned(See Note#22) cqs STRUCTURES IN ORDER TO PROVIDE A WATERTIGHT SEAL. Rim Erestmg Septic Tank to be BENCHMARK s j� I I i Local Upgrade Approvals: 310 CMR 15.403 9.) HEAVY EQUIPMENT SHALL NOT BE ALLOWED TO OPERATE OVER THE LIMITS OF THE Utdrzed(See Note#2/) I Variances 3 10 CMR 15.221 (7)General Construction SEWAGE DISPOSAL FIELD DURING THE COURSE OF CONSTRUCTION OF THE SYSTEM. Top Corner Step EL=100.00(Assumed Datum) 10.) IN ACCORDANCE WITH 3 10 CMR 15.22 I,ALL SYSTEM COMPONENTS SHALL BE Deck Requirements for All System Components: Deck f MARKED WITH MAGNETIC MARKING TAPE. Bdrn / I-)Sod Absorption System > 3G"Below Finish Grade Second Floor 1 1.)THERE ARE NO KNOWN WELLS WITHIN 10(7 OF THE PROPOSED SOIL ABSORPTION Bdrm �0 96.2 � 5.111 48"Held 1 2"Variance Requested SYSTEM. 12.) FROM THE DATE OF THE INSTALLATION OF THE SOIL ABSORPTION SYSTEM UNTIL Bth RECEIPT OF THE CERTIFICATE OF COMPLIANCE,THE PERIMETER SHALL BE STAKED AND n FLAGGED TO PREVENT USE OF THE AREA THAT MAY CAUSE DAMAGE TO THE SYSTEM. Q lJ I9�►� y FLOOR PLAN '4 13.) THE DESIGNER WILL NOT BE RESPONSIBLE FOR THE SYSTEM AS DESIGNED UNLESS B-��flA'�• G CONSTRUCTED AS SHOWN ON PLAN. ANY CHANGES SHALL BE APPROVED IN WRITING BY THE DESIGNER. NOT TO SCALE 9' •OO Civet �' 5 14.)THE BOARD OF HEALTH REQUIRES INSPECTION OF ALL CONSTRUCTION BY AN AGENT OF THE BOARD OF HEALTH AND THE DESIGNER. THE DESIGNER SHALL CERTIFY IN WRITING 1� LOT 30 \50 0 A% ��Is'T THAT THE SEWAGE DISPOSAL SYSTEM WAS INSTALLED IN ACCORDANCE WITH THE TERMS Area 1 ,000 S.F.± �IO�A` Surveil Work by: OF THE PERMIT AND THE APPROVED PLANS. 48 HOURS ADVANCE NOTICE IS REQUESTED. TEST HOLE LOGS � 32� L{ A & M Land Services 15.) LOCATION OF UTILITIES IS APPROXIMATE AND CONTRACTOR SHALL BE RESPONSIBLE G\ BIB Route 28, Suite 3 FOR DETERMINING THE LOCATION OF ALL UNDERGROUND AND OVERHEAD UTILITIES PRIOR West Yarmouth, HA 02673 TO COMMENCEMENT OF ANY WORK. THIS INCLUDES, BUT IS NOT LIMITED TO, REQUESTS Test Hole#I (EL=98.8±) P#13250 pn TO DIGSAFE,ANY PRIVATE UTILITY COMPANIES, AND THE LOCAL WATER DEPARTMENT. SITE FLAN Pb.P� (508) 737-19"I'7 Email. aamland®comcestnet Depth Layer Sod Class Sod Color Comments I G.)CONTRACTOR SHALL VERIFY THAT ALL WASTEUNES ARE CONNECTED BY WATER TESTING WITHIN THE DWELLING PRIOR TO INSTALLATION OF ANY SEPTIC COMPONENTS. 0"-G" A Fine Sandy Loam I OYR 3/2 SCALE: 1" = 20' Prepared for: 0-20" B Medium Loamy Sand I OYR 5/G 17.)CONTRACTOR SHALL VERIFY EXISTING INVERT ELEVATIONS PRIOR TO INSTALLATION OF 20"-57" C I M-C Loamy Sand I OYR 5/G This Area is Served Michael * Carolyn Zent ANY SEPTIC SYSTEM COMPONENTS. 57"-80" C2 Very Fine Sandy Loam 2.5Y G/4 Tight by Town Water 353 Lake Shore Drive, Mar5ton5 Mdls, MA 02G48 80"-126" C3 Medium-Coarse Sand I OYR 5/4 Loose 18.) INSTRUMENT SURVEY CONDUCTED FOR PROPOSED WORK ONLY. SITE PLAN SHALL - NOT BE USED FOR STAKING, OR ANY OTHER PURPOSES. Test Hole#2 (EL=98.8�) Proposed Sewage Disposal System 353 Lake Shore Drive, Marstons Mills, MA 19.)TH15 PLAN DOES NOT CERTIFY, GUARANTEE OR WARRANTY COMPLIANCE WITH ZONING Depth Layer Sod Class Sod Color Comments I CERTIFY THAT I AM CURRENTLY APPROVED BY THE BYLAWS, SPECIFICALLY, BUT NOT LIMITED TO, SIDELINE SETBACKS AND BUILDING HEIGHT DEPARTMENT OF ENVIRONMENTAL PROTECTION PURSUANT TO RESTRICTIONS. Prepared b : O"-8" A fine Sandy Loam 1 OYR 3/2 3 I O CMR 15.0 17 TO CONDUCT SOIL EVALUATIONS AND THAT I' y 20.) SOIL REMOVAL: ALL TOPSOIL(A"LAYER), SUBSOIL("B"LAYER), C I AND C2 LAYERS 8"-22' B Medium Loamy Sand I OYR 5/G THE SOIL ANALYSIS HAS BEEN PERFORMED BY ME CONSISTENT INSPECTION NOTE: SHALL 1 REMOVED FOR A DISTANCE OF FIVE(5) FEET LATERALLY FROM THE SOIL 22"-49" C I M-C Loamy Sand I OYR 5/G WITH THE REQUIRED TRAINING, EXPERTISE, AND EXPERIENCE ABSORPTION SYSTEM DOWN TO THE CLEAN SAND LAYER(E LATERALLY I R AREA 5 BE 49"-G7" C2 Very Fine Sandy Loam 2.5Y G/4 Tight DESCRIBED IN 3 10 CMR 15.017. 1 FURTHER CERTIFY THAT THE PRIOR TO FINAL INSPECTION BY THE ENGINEER,5Y5TEM , G7"-1 28" C3 Medium-Coarse Sand I OYR 5/4 Loose RESULTS OF MY SOIL EVALUATION AS INDICATED ON THE NEEDS TO BE COMPLETE INCLUDING BUILDUP FOR COVERS. W-51, BACKFILLED WITH CLEAN SAND MEETING THE SPECIFICATIONS OF 3 10 CMR 15.255(3)AND ATTACHED SOIL EVALUATION FORM, ARE ACCURATE AND IN /►I=' COMPACTED TO MINIMIZE SETTLING. ACCORDANCE WITH 3 10 CMR 15.100 THROUGH 15.107 �ti,� Engineerin DATE OF TESTING: 04121111 III 2 1.) D(15TING 1000 GALLON SEPTIC TANK TO BE UTILIZED. PVC TEES TO BE INSTALLED ON SOIL EVALUATOR: LINDA J. PINTO, P.E., CSN ENGINEERING INLET AND OUTLET PIPES IF NECESSARY,AND A GAS BAFFLE INSTALLED IN THE OUTLET TEE. ;..BOARD OF HEALTH AGENT: DAVE STANTON, BARNSTABLE HEALTH DEPARTMENT O 20 I 6O P.O.Box2030 Phone_(508)299-3250 22.) EXISTING SEPTIC COMPONENTS TO BE LOCATED, PUMPED DRY, FILLED WITH CLEAN PERCOLATION RATE: LESS THAN 2 MIN/INCH IN"C3"LAYER(PER SCALE 1 20' SIEVE ANALYSIS) Teaticket,MA 02536 Fax:(508)548-5478 - - "= SAND AND ABANDONED IN PLACE. AREA TO BE COMPACTED TO MINIMIZE SETTLING. NO GROUNDWATER ENCOUNTERED Linda J. Pinto, Ce ified Soil Evaluator C:\CSN\RR-Lake Shore\RR-Lake Shore-SDS Plan.dwg Date:04/25/1 I 1 scale:As Shown I By:LIP Check:MA Project No.C5N01 GO