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0198 MOCKINGBIRD LANE - Health
198,MOCKINGBI,, 'L`ANE M:MILLS A= 613 029 f' i �i f Commonwealth of Massachusetts Title 5 Official Inspection _Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 198 MOCKINGBIRD LN Property Address ANDERSON Owner Owner's Name information is required for MARSTONS MILLS MA 02648 12/17/13 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out A. General Information forms on the computer,use 1. Inspector: only the tab key to move your DOUGLAS A BROWN cursor-do not Name of Inspector use the return key. DOUGLAS A BROWN INC Company Name P.O. BOX 145 Company Address CENTERVILLE MA 02632 City/Town State Zip Code 508-420-4534 S14297 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 12/17/13 4ni�rs Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under, the same or different conditions of use. t5ins•3/13 Title 5 Official Inspection Fo :S urface Sewage Disposal System•Page 1 of 17 f - Commonwealth of Massachusetts a Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 198 MOCKINGBIRD LN Property Address ANDERSON Owner Owner's Name information is required for MARSTONS MILLS MA 02648 12/17/13 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: SYSTEM MET ALL PASSING REQUIREMENTS AT TIME OF INSPECTION B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need'to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 198 MOCKINGBIRD LN Property Address ANDERSON Owner Owner's Name information is required for MARSTONS MILLS MA 02648 12/17/13. every page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: .❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection .Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 198 MOCKINGBIRD LN Property Address ANDERSON Owner Owner's Name information is required for MARSTONS MILLS MA 02648 12/17/13 every page. CityrTown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: '*This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 198 MOCKINGBIRD LN Property Address ANDERSON Owner Owner's Name information is required for MARSTONS MILLS MA 02648 12/17/13 every,page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a:-DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. . t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection. Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 198 MOCKINGBIRD LN Property Address ANDERSON Owner Owner's Name information is required for MARSTONS MILLS MA 02648 12/17/13 every page. Cityfrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(if they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ❑ ® Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins-2413 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments GM , 198 MOCKINGBIRD LN Property Address ANDERSON Owner Owner's Name information is required for MARSTONS MILLS MA 02648 12/17/13 every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: SYSTEM CONSISTS OF A 1000 GALLON TANK D-BOX AND 2 500 GALLON CHAMBERS WITH STONE Number of current residents: Does residence have a garbage grinder? ❑ Yes ❑ No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ❑ No information in this report.) Laundry system inspected? ❑ Yes ❑ No I Seasonal use? ❑ Yes ❑ No Water meter readings, if available(last 2 years usage(gpd)): Detail: 2012----424GPD 2013---1276 GPD CHECKED WITH C.O.MM.H2O THEY STATED THERE WAS A LEAKING WATER SERVICE THAT HAS SINCE BEEN REPAIRED HOUSE ALSO HAS POOL AND IRRIGATION SYSTEM. SYSTEM NOT DESIGNED FOR GARBAGE DISPOSAL Sump pump? ❑ Yes ❑ No Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: 15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �M ,•'� 198 MOCKINGBIRD LN Property Address ANDERSON Owner Owner's Hume information is required for MARSTONS MILLS MA 02648 12/17/13 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 l Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments wM 198 MOCKINGBIRD LN Property Address ANDERSON Owner Owner's Name information is required for MARSTONS MILLS MA 02648 12/17/13 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: S.A.S INSTALLED IN 2005 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 1.5 feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 GALLON Sludge depth: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M • 198 MOCKINGBIRD LN Property Address ANDERSON Owner Owner's Name information is required for MARSTONS MILLS MA 02648 12/17/13 every page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): TANK COULD USE PUMPING AT THIS TIME Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date 15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 N Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 198 MOCKINGBIRD LN Property Address ANDERSON Owner Owner's Name information is required for MARSTONS MILLS MA 02648 12/17/13 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal , ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 15ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M �< 198 MOCKINGBIRD LN Property Address ANDERSON Owner Owner's Name information is required for MARSTONS MILLS MA 02648 12/17/13 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" 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.): BOX LEVEL NO SIGNS OF FAILURE AT THIS TIME Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): *If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 L Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 198 MOCKINGBIRD LN Property Address ANDERSON Owner Owner's Name information is required for MAR'STONS MILLS MA 02648 12/17/13 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 2 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): CHAMBERS WERE OPENED AND FOUND TO HAVE ABOUT 8 INCHES OF LIQUID WITH NO STAINING OR SIGNS OF FAILURE Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-:3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 198 MOCKINGBIRD LN Property Address ANDERSON Owner Owner's Name information is required for MARSTONS MILLS MA 02648 12/17/13 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 r Commonwealth of Massachusetts W Title 5 Official Inspection Form- Subsurface Sewage Disposal System Form -Not for Voluntary Assessments GM 5•'r( 198 MOCKINGBIRD LN Property Address ANDERSON Owner Owner's Name information is required for MARSTONS MILLS MA 02648 12/17/13 every page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 198 MOCKINGBIRD LN Property Address ANDERSON Owner Owner's Name information is required for MARSTONS MILLS MA 02648 12/17/13 ,every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: GREATER THAN 5 feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 12/2013 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: DESIGN PLAN Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Assessing As-Built Cards Page 2 of 2 http://www.town.bamstable.ma.us/Assessing/HMdisplay.asp?mappar=013 029&seq=1 12/18/2013 Commonwealth of Massachusetts w u Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M , 198 MOCKINGBIRD LN Property Address ANDERSON Owner Owner's Name information is required for MARSTONS MILLS MA 02648 12/17/13 every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked-," ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins 3/13 Title 5 Official Inspection Force:Subsurface Sewage Disposal System-Page 17 of 17 Assessing As-Built Cards Nge 2 of 2 htt ://www.town.barnstable.ma.us/Assessin dis la .as .ma ar-013029&se 1 12/18/2013 P g/HM P Y P PP q Assessing As-Built Cards Page 1 of 2 TOWN OF BARNSTABLE LOCATION/Iff /"d,'�& t SEWAGE# S VII.LAGE/�r,/S IVY�I)S ASSESSOR'S MAP&LOT , INSTALLER'S NAME&PHONE NO. � lie S SEPTIC TANK CAPACITY lOeo cam, v LEACHING FACILrrY: (type) g SDA CCAJ 61cm S(size)_I3K_a 7 NO.OF BEDROOMS Z BUILDER OR OWNER_Ank>.fiS h.) PERMrrDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility See pltatJ 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) C Feet Furnished by 3-35`c" 3-vJ'�" http://Www.town.barnstable.ma.us/Assessing/HMdisplay.asp?mappar=013029&seq=1 12/18/2013 DEED RESTRICTION Bk 31314 Po 5o • 084938 r WHEREAS, m of t wne/ nee) `MA (address) Is the owner of (a located: ' aaress) at SOkV�e_ M '06reinafter referred to as c+ ar11,'being shown on a pi�r�46tied "Subdiv�slon of Land �n t •� r `ca�ol� MA, Property of L.,o Po :1 . Pt al, duly.recorded in Barnstable County Registry of Deeds in Plan Book_-- Z, Page Or on Land Court Plan Nu mbe CA" � r WHEREAS, _FLO� , ,li: ,d,,, , as the owner of said lot has (owners name) agreed with the Town of Barnstable Board of Health to a restriction as to the number.of bedrooms which can be In in any home built on said lot as a pre condition to obtaining a disposal works construction permit in compliance w161310'CMR 15.000 State EnVironmental Code, TitIe:V, Minimum Requirements for the Subsurface Disposal of Sanitary SAr ewage, VII sa�ERESte o mb H , donBA i p utl grant► ado sal'works 'to construction permit for a,sept�c system in compliance with`310 CMR 15,200, State.Environmental Code,Title'V Minimum - - Requirements for the Subsurface Disposal of Sanitary Sewage, and authorizing the.,issuance'of a building permit for.the construction of.a single-family:home on this'property Is requiring.that the agreement.forthe•restriction on the number of_ bedrooms In any house constructed on the lot be put on record with the Barnstable County Registry.of Deeds b;recording this document, .-. + o z �T Bk 21314 Pg 51 #54938 4. NOW,THEREFORiit oyfe. A ALAI `does hereby place the (owners name) following restriction on his above-referenced land in accordance with his' agie ot.w fihe Tawa bleat wl�ieiI'-res eLion sbalt run with the-land and hA hindina upon all successors in title:. 9 8. iY�d�k►� bi r L�,� may have constructed (address) ?upon the loft house ytaining no more than 3 (3) bedrooms. agrees that shap,be:.permanent deed (owners name) bird restriction affecting Of locatedis'l on i� j�fs MA, and . being shown on the plan recorded in Plan Book X'Eq , Paged Or on Land Court Plan For title of My"a A'Wk see the following deed: Book 1'�6 ,page Z./A Or Land Court Certificate of Title Number Executed as d instrument _day of Owner's signatur Owes signature Owner's signature COMMONWEALTH-OF MASSACHUSETT$ 20,06 Then personally appeared the above-named fyr, 460 known to me to be the person who executed the.foregoing instrument-and. ackr�owledged _ : a„W the same \be free act and,deed, before me, ��z y m V QM> n o-<r , nouuir m 0•rri �. � Notary�' . A �o0 Public ���Q��IA G �Q'''6; m m0 art,- 6 . 0 me t,• � G� .My commission,.ex Tres �� •t' /oZ 2 o/d M ' (date) - o' -BARNSTABLE REGISTRY OF DEEDS deedr4� /i/p CMUe`"'�```p w 1 TOWN OF BARNSTABLE v LOCATION / lJ SEWAGE # - S:-4 . d LAGE/1401S+WS ASSESSOR'S MAP & LOT4 ,3 65��Lq INSTALLER'S NAME&PHONE NO.QW!i(g 5, I fcu;t1 5c-P ND0-7/Sri SEPTIC TANK CAPACITY 1000 G C4 LEACHING FACILITY: (type) .a SO0 Cat C >r�5(size) ISICcV� NO. OF BEDROOMS BUILDER OR OWNER Ajs r e S01.13 PERMIT DATE: I S COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility "See PICO Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) 1<0Pdory Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) O XQ60 Feet Furnished by r ; l c� cw 1 3-3$`G" 3-q)'GI` o - No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: • Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Application for Miooal *potent Con5truction i3er fit Application for a Permit to Construct( , )Repair(VI"Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 1fi S3 gcCjCt� bvf' Owner's Name,Address and Tel.No. Assessor's Map/Parcel �4 nil Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. \ AA � StcpHco.S � �6Y j C� CocJ e16SOC t�kPS Type of Building: Dwelling No. of Bedrooms 3 Lot Size 2a 1'CPO�i sq.ft. Garbage Grinder(,NO) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3 e/8 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) qkc-p)otr e s . A . S 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 Certifi- cate of Compliance has been issued by this Board of He h. Signe c Date a t ®S- Application Approved by Date Application Disapproved for Ke following reaso Permit No. '� Date Issued fiNo. / L Y Fee s THE COMMONWEALTH OF MASSACHUSETTS- . Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE,, MASSACHUSETTS ' - 2ppiication for Mi.5paa-*raem Con!5truction Permit Application for a Permit to Construct( )Repair(✓)Upgrade( )Abandon( ) EJ Complete System ❑Individual Components Location Address or Lot No.1 C(S �A,�c`c 1/JW c� L }1 Owner's Name,Address and Tel.No. Assessor's Map/Parcel � �/� " Installer's Name,Address,and Tel.No. +� Designer's Name,Address and Tel.No. 5 -Laces-71S�t sva- sy0-as3ti Type of Building: Dwelling No. of Bedrooms I Lot Size D2`I GO{/ sq.ft. Garbage Grinder(Np) Other Type of Building 0110t co. No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow .1 r gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank = C? Type of S.A.S. Description of Soil % Nature of Repairs or Alterations(Answer when applicable)�i� Qlnr C, c 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 Certifi- cate of Compliance has been issued by this Board of Hea h. Signed �,.. ,Oe / ® !t n Date o,?— Application Approved by _ e �,'7 t.l .(Li�' /��,�,1KJ Date Application Disapproved for following rea_so Permit No. "' /7 Date Issued -�-- j ` - THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of Compriance -- THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded ( ) Abandoned( ),by d r;c�''�' at t c, S:� AA_ .,��r,R e�1 Eu_ A r.1 c+ ,3 M, 1 �ha ben constructe in accordance v- - with the provisions of Title 5 and the for Disposal System Construction Permit No. a-'L13 dated q l 'i Installer.11A C—A i�r g��t,� Designer t� ��.1 .� aat F v '- - The issuance of this permit shallaaytno�tt b'e co.strued as a guarantee that the-syst il unction as designed. Date Inspector _ No. �f./f �t —�---------------------------Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE} MASSACHUSETTS Migonl *pgtem C-on!6truction Permit Permission is hereby granted to Construct( )Repair(W-5 Upgrade( )Abandon( ) System located at 19 Fi r tr and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction' must be c, .pleted within three years of the date of this permit:` 1 - :Date:_._ i�� � Approved by I / Notice: This Form Is To Be Used-For the Repair Of Failed Septic Systems Only PERCOLATION TEST AND SOIL EVALUATION.EXEWTION FORM J 1.►;.hereby certify that the engineered plan signed by me dated }1concerning the property located at iq0 �'+\�cti► a,:�a � meets all of the following criteria: • Two soil evaluations excavated for detailed examination(no hand augering)and two percolation tests shall be conducted. • This failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. • The soil is classified as CLASS I and the percolation rate is less than or equal to S minutes per inch. There is no increase in flow and/or change in use proposed There are no variances requested or needed. • The bottom of the proposed leaching facility will be,located no less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] Please complete the following; A) Top of Ground Surface Elevation(using GIS information) l l 1-10 \�\A.-TV r�t. IS,-)r,o �Y-r-q" .P B) G.W.Elevation *adjustment:For hig�G.W. = G j L .c o/ DIFFERENCE BETWEEN A and B SIGNED: DATE: 69 20 — DSO NOTICE Based upon the above information,a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans, -�'138ptic` e_dac � z Town of Barnstable 'moo Regulatory Services * Thomas F. Geiler,Director snaxsTAsIZ. Public Health Division r TFD1"p�A Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form .Date: Designer: Installer: 4)4 5 B;a iJ RITPHE\J.DOYLE AtiD ASSOCIATES Address' 42 CANTERBURY LANE Address: Ro Wnww in, SETTS 02s36 608/640-2634 On _-45 agw'i was issued a permit to install a (d e) (installer) septic system at C�9) ��0 U : -based on a design drawn by (address �soL. dated (desi er) �I c rtify that the septic system referenced above was installed substantially according to design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. 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. s34 ®o ® STE � PHEN in staller's Signature) 4 - J. DOYLE o r37 0 � (Designer' Si e (Affix Design tamp 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:Health/Septic/Designer Certification Form :°overs Note: JI dowa` to UAW gmn (� Are and rgJ ti� ar p o� goy` B9T 99 Proposed SAS Ftw 1500 Gal ` led* ivao 11je • Oor �,,n�tG 198 Yollepbel! j tea° G p��;r'r�"' c dr— ClO� k!F LQ71—h� v q� w' ppgCH '��, ;4 Mk iota .L Its eA)UA)q 1.1 0 t)IJ-OLf �A { suet 109'29"� LASS ModIVGOII { D.E. ' Title 5 e subsurface essible •ts brcueht f +y ga 9AZW 9 r 3'x5' ERGLvSHO R v/GI ENCL SURE A ' r ----- z o " jI I M. BATH sb I " I ® RAIL-M- i ' I I. LI 0 1 T f�7 � T RM. .7 O 9'�IT T-dX� 4_3Yz• u 3' boar eQ � M. BEDROOM VI 1pe. 26-01 lV II l � II T — SECOND FLOOR N SCAI@IM'�1'd - I/�s\�/ � d f� V d V . Hs 91 �e PIRA A3 q.4L s f .. P ` 5��_ � COMMONWEALTH OF MASSACHUSETTS ` EXECUTIVE OFFICE OF ENVIRONMENTA .A FAI* � flVF t r DEPARTMENT OF ENVIRONMENTAL QR'1O' TIT ONE WINTER STREET. BOSTON. MA 02108 617-29 00 1998 , l NOF .� RARN.S701 ark WILLIAM F.WELD v f7'1" f "+ TRUDY COXE Governo: Sccrctary ARGEO PAUL CELLUCCI DAVID B.STRUHS Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissioner PART A CERTIFICATION Property Address: i9.P �/IoCH��vd,r2o '� � �r/J �Ad Address of Owner: Date of Inspection: 1PA/ ' (If different) Name of Inspector: 7-0.1'4FW (o/(&dl 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 1S.000) Company Name: C72)C"d 4e'/4 J'QA1 Mailing Address: jeO, y j f Ho Telephone Number: s-ar—cf1P Polgg 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 inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: _V/Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: Date: 9 is The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (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 Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer,if,applicable, and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: A] SYSTEM PASSES: V I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not"luated are indicated below. - • COMMENTS: 72*4/y i ave Q �S662gj� v."aD C ! ,�'2' �/�o 4,141 P/T tr�O�P �✓lon/in.'?� /N i94�/ /��- Owiv�2 . ��crf�?d!1 tri�/crimul. Ar dr` B] SYSTEM CONDITIONALLY PASSES: One or 1,111 m components as described in the "Conditional Pass" section need to be replaced or re , upon completion of the replacerri eir"I'll proved by the Board of Health w' Indicate yes, no, or not determined (Y, N, or ND). D is of determination to a If"not determined", explain why not. The septic tank is m , ess the owner or operator has provided the system ins o o y of a Certificate of Compli ched) indicating that the tank was installed within twenty (20) years prior to the date o the inspection; or septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 04/25/97) Page 1 of 10 DEP on the World Wide Web: http:/Iwww.magnetstate.ma.usidep 0 Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A + CERTIFICATION (continued) Property Address: Owner: Date of Inspection: B] SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution box ue to broken or obstructed i (s) or due to a broken, settled or uneven distribution box. The system will s inspection if(with approval of the Boar ealth). Describe observations: broken pipe(s) are replaced o ction is removed distributio x is levelled o aced The system required pumping t an four a year due to broken or obstructed pipe(s). The system will pass inspection if(with appr of the Board of Health): roken pipe(s) are replaced obstruction is removed URTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Con ' ' s exist which require further evaluation by the Board of Health in order to determine if the system is failin rotect the public healt ty and the environment. 1) SYSTEM WILL PASS UNLESS D OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUN NING IN A MANNER WHICH WILL PROTECT THE PUBLI LT AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surfs ter Cesspool or privy is within 50 feet of a bordering v ted wetland a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUB SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PRO T S THE PUBLI LTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil sorption system(SAS)and the SAS is within 100 to.a surface water supply or tributary to a surface water sup p . _ The system has a septic tan nd soil absorption system and the SAS is within a Zone I of a public wa supply well. . _ The system has a septi nk and soil absorption system and the SAS is within 50 feet of a private water sup well. The system has a tic tank and soil absorption system and the SAS is.less than 100 feet but 50 feet or more fro a private water pply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well ' ree from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less n 5 ppm. Method used to determine distance (approximation not valid). 3) OTH (revised 04/25/97) Page 2 of 10 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: Date of Inspection: D) SYSTEM FAILS: You must indicate either "Yes" or"No" as to each of the following: I have determined that the system violates one or more of the following failure criteria as defined in 310 R 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine w will be necessary to correct th ilure. Yes No Backu f sewage into facility or system component due to an overloaded r clogged SAS or cesspool. Discharge or p ing of effluent to the surface of the ground or ace waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distr tion box above outl invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than " bel invert or available volume is less than 1/2 day flow. Required pumping more than 4 ti in the year NOT due to clogged or obstructed pipe(s). Number of times pumped Any portion of the Soil sorption System, cesspool or p i is below the high groundwater elevation. Any portion of cesspool or privy is within 100 feet of a surface ater supply or tributary to a surface water supply. Any po n of a cesspool or privy is within a Zone I of a public well. y portion of a cesspool or privy is within 50 feet of a private water supply wel . _ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a p i ate water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach co of well water analysis for coldorm bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: You mus ' icate either"Yes" or"No"as to each of the following: The fo criteria apply to large systems in addition to the criteria above: The system serves a a ' 'ty with a design flow of 10,000 gpd or greater (Large System) and the syste s a significant threat to public health and safety an a environment because one or more of the following conditions ist: Yes No the system is within 400 feet of a surface drin ' water su the system is within 200 feet of a tributary to ce drin i ater supply the system is located in a nitr sensitive area(Interim Wellhead Prot Area-IWPA) or a mapped Zone II of a public water supply we The owner or operator o such system shall bring the system and facility into full compliance with the ground ter treatment program F requ irements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 04/25/97) Page 3 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: Owner: Date of Inspection: Check if the following have been done: You must indicate either "Yes" or"No" as to each of the following: Yes No, �( Pumping information was provided by the owner, occupant, or Board of Health. _ None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. J _ As built plans have been obtained and examined. Note if they are not available with N/A. _ The facility or dwelling was inspected for signs of sewage back-up. _ The system does not receive non-sanitary or industrial waste flow. _ The site was inspected for signs of breakout. J _ All system components, excluding the Soil Absorption System, have been located on the site. �. The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub-Surface Disposal System. _ 'Existing information. Ex. Plan at B.O.H. Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) [t 5.302(3)(b)] 3 (revised 04/25/97) Page 4 of 10 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: Owner: Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Design flow: W4 e.p.d./bedroom for S.A.S. Number of bedrooms:: 3 Number of current residents: Garbage grinder (yes or no):� Laundry connected to system (yes or no):S— Seasonal use (yes or no):K/ Water meter readings, if available (last two (2)year usage (gpd): Sump Pump (yes or no):�L Last date of occupancy:�,ru COMMERCIAUINDUSTRIAL• Type of establishment: Del3ig w: allons/day Grease trap prese s nt-Lo) Industrial Waste Holding Tank presen . r no)_ Non-sanitary waste discharged to the Title 5 system- Water meter readings, if available: Last date of occupancy: OTHER: (D i ) Las a of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: N. System pumped as part of inspection: (yes or no)./b If yes, volume pumped: gallons Reason for pumping: TYPE SYSTEM Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Sham system (yes or no) (if yes, attach previous inspection records, if any) I/A Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known)and source of information: Sewage odors detected when arriving at the site: (yes or no)AO (revised 04/25/97) Page 5 of 10 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C , SYSTEM INFORMATION (continued) Property Address: Owner: Date of Inspection: BUILDING SEWER: (Locate on site plan) Depth below Material of construction: iron 40 PVC_other in Distance from private ate supply water I r suction lire Diameter Comments: (con ' ' of joints, venting, evidence of leakage, etc.) . SEPTIC TANK: (locate on site plan) Depth below grade: Material of construction: concrete _metal _Fiberglass _Polyethylene —other(explain) If tank is metal, list age _ Is age confirmed by Certificate of Compliance _(Yes/No) Dimensions: /ooa 644Z414 Sludge depth: a Distance from top of sludge to bottom of outlet tee or baffle: .3� Scum thidrness:=3„ Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffie:�) How dimensions were determined: , 5/S©9�L�f Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth,of liquid level in relation to outlet invert,.structural integrity, evidence of leakage, etc.) u:-4 j 4Qa" .(/ A?L(Ap,1j4 t. JQL,J A141— rb i a'bA GREASE TRAP: (Iota on site plan) Depth below grade: Material of construction: �cmoncre 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 outl r e: Date of last pumping: Comments: (recomme ion for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural in , evidence of leakage, etc.) (revised 04/25/97) Page 6 of 10 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: Date of Inspection: TI T OR HOLDING TANK: (Tank must be pumped prior to, or at time, of inspection) (locate o " plan) Depth below grade: Material of construction: �crete _metal _Fiberglass _Polyethylene _other( iN Dimensions: Capacity: gallons Design flow: gallons/ Alarm level: A in working order_Yes; _ No Date of previous pu ing: Comments: (conditi of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:- (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) PUMP CHAMBER:_ to on site plan) Pumps in working order: o Alarms in working order (Yes or No) Comments: (note condition of pump chamber, conditi ps and appurtenances, e . (revised 04/25/97) Page 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: Date of Inspection: SOIL ABSORPTION SYSTEM (SAS): V (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number.- leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) CESSPOOLS: _ (locate on site plan) Number nfiguration: Depth-top of liquid to rt: Depth of solids layer- Depth of scum layer: Dimensions of cesspool: .Materials of construction: Indication of groundwater: inflow (cesspool pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) P (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil, signs of au is failure, level of ponding, condition of vegetation, etc.) (ravia�d 04/2S/97) Page 8 of 10 r - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM • PART C SYSTEM INFORMATION (continued) Property Address: Owner: Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) �� OG f1v�JE (revised 04/2S/97) Page 9 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: Date of Inspection: Depth to Groundwater oz 3 Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observation of Site (Abutting property, observation hole, basement sump etc.) /Determine it from local conditions �1/ Check with local Board of health Check FEMA Maps Check pumping records Check local excavators, installers Use USGS Data Describe in your own words how you established the High Groundwater Elevation. Must be completed) /�/6!1 6Qaa.v� cc��9i'�i2 4 " 64'rAS'4'PhW -'�,y /,3a/1. ,vjlg-PP, This information is available in alternate format upon request by contacting DEP's ADA Coordinator at 617-574-6872 (revised 04/25/97) Page 10 of 10 . C TOWN OF BARNSTABLE i LOCATION�gR"j�1�C65i/>��,%�/ Zaoe, SEWAGE # VILLAGE/u/01226jn-3 /11�1S ASSESSOR'S MAP 6t LOT 41/2- 02 INSTALLER'S NAME & PHONE NO.l&k1()W1- �.yr�cSJ� �/O)do _ I SEPTIC TANK CAPACITY Aoz7o a&/ LEACHING FACILITY:(type) �`y� �� � (size) NO. OF BEDROOMS PRIVATE WELL O �UBLICWATE—� BUILDER OR(OWNER ' Lu r-)o Ll DATE PERMIT ISSUED: �/,00/q y DATE COMPLIANCE ISSUER: C _ Ty VARIANCE GRANTED: Yes No _ ���g K �, �� - _ 3�, y6 ! ��. / s�, �� 1 ��� � �'�a6l�y THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Apphratiou for DioVoml Works Touitrurtion Prrutit Application is hereby made for a Permit to Construct ( ) or Repair Pl.� an Individual Sewage Disposal System at: ........./1 .. ........C.e.1 was u,.5 /y/ /-----.-..........,-,---------------------------------------...----...------.....---•--•-----•--------•-- t� w ...... o�i-i\dc�rrss ,--•---•--•---[--.1__ ---1_ �".`�V/��/V-4�_ � ..or. v ................. ._...... V!/�fQWC Owner G Address .... ............ -•-----------•-•----••••..---------•--•---- ....... ............. Installer� r Address UType of Building �� Size Lot............................Sq. feet Dwelling—No. of Bedrooms----------------_---------------------------Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures ------------------------------- -- W Design Flow...............J� ................gallons per person per day. Total daily flow_._.-___-__� a__.................gallons. WSeptic Tank—Liquid capacity/A 4...gallons Length________________ Width---------------- Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. c�- Diameter....... ............ Depth below inlet..__..k.......... Total leaching area.._._.__....._....s ft. � Seepage Pit No----- -------------- �� P g q• Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit_________________... Depth to ground water...................... fZ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ M ...-----•--------------------------•-----•--------•----•••-••---------------------••••-•••-•._............................................................... ODescription of Soil------------------------------------------------------------------------------------------------------------------------------------------------------------------------ x U .....-----•-------------•---•----------......-----•----•--•-----•----••-••-•-----•-•---.........-----••-•-•--------------------------•-----•-----•••-----•--•. .......................................... ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------- UNature of epairs or Alterations—Answer when applicable----------�.0............11 '--------- ---------�_-�-..-. 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 be n is ued t4o board of health. --- ter/ Signed ........... .... ....... ........ ....... .. .. ................. Dace Application Approved B s ----EA'e � j - - - -"";r� " Dace Application Disapproved for the following reasons- ------------------ ---------------------- ----------- ................... . .................................. ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- . .... ................... Dare Permit No. �' ------------ Issued ------.. r-.`--;? � .Y...� " /�j/�� Dace No..�....7' � FEBF .................... ....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratinn for Uhripi ial Works Tomitrnr#inn Prrmi# Application is hereby made for a Permit to Construct ( ) or Repair (X) an Individual Sewage Disposal System at: t ...............-------_---+-..._..----------...._....-----------------------------------�--.......�/J,.-------------------/------3-----n---/-�-----...-------------.........-------------/-�-.....--------- .....--!�.. ..... VAddr^; i-•----•--..... 1�......... .... A�/ b.--------!/LD....,�t j A,4 / Y t It k Owner r.._...-- ,c-._.-- Address ------------- .•. •••- ----------- Installer Address UType of Building �? Size Lot............................Sq. feet �. Dwelling— No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons_________________._________- Showers ( ) — Cafeteria ( ) Otherfixtures ..................................................................................................................................................... W Design Flow................ ............................ per person per day. Total daily flow............-. ..................... WSeptic Tank—Liquid capacity/ q.._gallons Length________________ Width................ Diameter---.------------ Depth................ x Disposal Trench—No_ ____________________ Width-------------------- Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..._c-.......... Diameter-------e�....... Depth below inlet______-�R_r_.____._ 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........................ Gi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 94 ----------------------------•-••---••--•-----•-•••--•-•-----------•-------------•-----••-••••-•-----•-•-•---•-••-...__.......---•-•---...... -•-.... _--------- 0 Description of Soil-------------------------------•-----•----------------..._..--------------------...--------------------------------------------------------------•-•------••------_----. U ---.....---•------------------------------------------------------------------------------------------------------------•-----------------............................................................. W x --••••---•-----------------•---•----------•-----••---.....•---------------•-....------------•-••-•----------------.._..----•---•-----•---------------••--••--•------•------- ... U Nature oepairs or Alterations—Answer when applicable------------ _ ► ----------- ........... U�_f? ._.._....._.!�__'_!......... 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 h-.s been isred�.y tth board of health. Signed / Y .G�+%7' 1/ (-. • �.� Date /! Application Approved B -- .. -r G'"'.- r ✓. ..... -=.............................. .....-Z ', T i Date Application Disapproved for the following reasons- -------------------- -------- -----------------........................ .... .............. ........-............ ... ........... ........................................... ------------------------------ - ---------------------- ------------- .....�.. �....... ... � ........ Issued � ..`.. - I Date Permit No. Daze THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE k"Ller#ifira e of C�omplianre THIS IS TO CERTIFY, Th-a-t-the.Individual Sewage Disposal System constructed ( )or Repaired ( �) by ------ --------------- ---------- -----.--.-------------.-------- ---------------------------------------------------- 1waller ---------- --- ----- -- .. 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. _.t....: .... ..'... dated THE ISSUANCE OF THIS CERTIFICATE SHALL NO E CONSTRUED AS A GUARANTEE THAT THrE SYSTEM WILL FUNCTION SATISFACTORY. � DATE-------------- _------ -------------------------------- Inspector ....... V .1_---------------------- :. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �� TOWN OF BARNSTABLE No.......... --9 lJ FEE--- ............ nrk� �nn�#rnr#inn �rrnti# Permissionis hereby granted------------------ ----- ---•---•------.------•---------------------------------•---------...._.....-------------------------..._...---..... to Construct ( ) or Repair an Individual Sewage Disposal System qL� 11 i� � � �/Y 1113� ..... ..------- -- - "-------- ._at No. � Street as shown on the application for Disposal Works Construction Permit V Board of Health / DATE......'`e'-,....... ..--------_-`�` ......................... f/ FORM 36508 HOBBS&WARREN.INC..PUBLISHERS LYN LfJC14ION SEWAGE PERMIT NO. VILLACE I N S I A LLER S NAME & ADDRESS BUILDER DR OWNER DATE P ERNIT ISSUED DATE COMPLIANCE ISSUED . _ r• ,�� j �� � ® �� �� ��A ��. .. . . . ��� `i � tip, � R V 4 ` No Fizz THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH .?.1�.W.N.----..OF........�•�A...F).N..S.MA...5--L-�------•-----. Appliration for Disposal Works Tonstrurtiun Prrutit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: .............. of:.............. . 1.......... !N f3.1.�..._ N..F� -•-.4.- . y,�.Y3/�N..�s.},:C� (j:--�- = ............... ......�� ".�1v.� n •Location:Ad�res�_ -f1-�'•............•�® �If/C..s�...7!/ /! �/.oCS�/!T.. .... .:©� ® y L.. V F/ S' w 't Lt"' C"�t S Fte / ( /1/; FSTr Ad 9� SA 9 Installer Address 6,0 � Type of Building Size Lot_�...Z...4.................Sq. feet Dwelling—No. of Bedrooms..........-3............................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria a' Other fixtures d . w Design Flow.............../--.1.10.................gallons per peRa per dal. Total dailyow.............................. _...........gallon. WSeptic Tank—Liquid capacity/4UQgallons Length_--6__n�_- Width.1.:_/•._... Diameter................ Depthd..- .. x Disposal Trench—No..................... Width.................... Total Length.....................Total leaching area....................sq. ft. Seepage Pit No........../........ Diameter..../42/-r Depth below inlet..... Total leaching area..21a.7....sq. ft. Z Other Distribution box (X ) Dosing tank (,. ) ~" Percolation Test Results Performed by......... .................. Date....G/,.ZV. .2 ...__.. a Test Pit No. 1.-<-.._.minutes per inch Depth of Test- Pit.... ._�..�..... Depth to ground water........................ Gi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ go ............................................... .. ...._.......................... .....- ....... O Description of Soil............. 4$�. e�•'4��,��tly P_.... '1 .. �.. ........._. . D. x48 ............................ w UNature of Repairs or Alterations—Answer when applicable............................................................................................... ......-•.................•-•••...-----•---•--....----•-•---...........--•-•---.................•-•••--•••--•----......... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place th a sy tern in operation until a Certificate of Compliance has beeZiued by oard of health. Si -• --•- ....................•-•---------•.....------•............... --•- �'�. Application Approved BY- -..-"• --•--- •-•--••....:........•-----------------..._..._..._........-•-•---------- ------•--------------- ----------- Date Application Disap v qr� he f ollouring reasons:...........................................................•-------.---•--------.........................._.._ ............................. ....... ...........................................................................................................................................................^ Date PermitNo..................................................._.... Issued........................................................ Date No ..�... It .......... THE COMMONWEALTH OFMASS/�ACHUSETTS f� AR B D OF HEALTH .i....W/.. _.....OF....... J.A..!�1.Ay..-�}.. ..�h..��. Appliration for Disposal Works Tontrudion remit Application is hereby made for a Permit to Construct ( ✓) or Repair ( ) an Individual Sewage Disposal System at: ----•............ ... .. .__... Location•Ater, jo r o 41A.1 ............................. w it - �5�T i2. � c v C - ..........:. p� Installer Address U Type of Building Size Lot. °U..._.Sq. feet Dwelling—No. of Bedrooms..........Air.............................Expansion Attic ( ) Garbage Grinder ( ) aa Other—Type of Building No. of persons............................ Showers YP g ............................ P ( ) — Cafeteria ( ) Otherfixtures . --•------•----------•------------------••----•--------•----...... ---------- Design ' ...... C �Iit�G71*'/ w Flow...............LIAO.................gallons per-peen per day. Total daily flow........................................................gallon. WSeptic Tank—Liquid capacityAa gallons Length....' .. Width.'...:�U... Diameter................ Depth-K --4... x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area...................sq. ft. Seepage Pit No.......... ........ Diameter...: a-ZFr. Depth below inlet..... Total leaching area_.R(1.1....sq. ft. Z Other Distribution box (X ) Dosing tank ( ) ~" Percolation Test Results Performed by........ .:.tr,.. ?'! ! .. .................. Date....G,1.G� ....... Test Pit No. 1..<:.. -...minutes per inch Depth of Test Pit.... ..e. ...... Depth to ground water........................ f=, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P� .....--•-...-•••-•-•-•-••••.................A`_............ - .._......... ....... .. O Description of Soil............j52�---21................ - .......................... W .........•..........--•--•- ........_..`��..'.---- ---•.__..---- t,�t 1'-2-:r.p..... ... J.e!,N.5----5.&N.p............................ ----------------------------••----------.......---•-•-•-------•------------........-•------......-•--------•-••-------------------••---........------......--••--.......-----._.._......-••..._......_.. U "-.Nature 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 T I T U 5 of the State Sanitary Code-The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the-board of health. qoZAr /� •• Dabv Application Approved/By,�._ .-. ._...: Date ApplicationDisapovwing reasons----------------•-•-•--•-----------•-----.....----------•---•----•----------.........•--•••............----•.. ---••-•------•-•----------•--•---------_..-----•-•--------••••••....................................................Date......------ PermitNo......................................... ........... Issued................. ........................ 1 THE COMMONWEALTH OF MASSACHUSETTS BOAR OF HFzAILTH �.,..........................O'F�/. ................�L'' .. ................................................. (Irrtgfiratr of Toutpliana w THIS IS TO IF , Th Wthe Individual Sewage Disposal System constructed or Repaired ( ) •-.------- by - . r Installer at...t ...... .. ---- ----------------- -L` �x •---•............................................... has been installed in accorda ith the provisions of T;'IZ 5 of The State Sanitary Coe described in the application for Disposal Wo Construction Permit Not)_(._?.'.. ............... dated. ..ae/ THE ISSUANCE O THIS CERTIFICATE SHALL 7SACHUSETTS E® AS GUARANTEE THAT THE SYSTEM WILL FU . ION SATISFACTORY. DATE.......Zl z './..:':.lf.. ........................................... I .. - .................................................... THE COMMONWEALTH r BOARD 0F HE LTF�i G .y . No..$ Y1 L.................I........OF...Y��e................ 3J .......... .... FEE............. ......... i o ttl Porft �11 ,x� . ion " Mit Permissioni hereby granted .. ......... -----------•-•-------------------..........---...--•--••.......----......---- to Constrpct P4 )� r Repair" ( ) an Individual Sewage Disposal System at No..X6. 7..I.•. G!��p!�...�I���'J-----_4-dam••---•-•---•--•---- Street �•• as shown on the apph tion f Disposal Works Construction Permit/No� _' ted......Z...............................�' . .. -• .;y, a , �1 J / / Board of Health DATE. .�..:',,. ././....--- .......................... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS o t' - , '• r HR F A Q p r T- F L S01 IDc7 U/A LEA 7 l k'aT ioo ti ^r . T.. XC? �.. S s, i � /3 .0 'v NoT ,S 1) E'X)ST7NGJAN„D r 1A%A , t= . 2� Qti�yL1ANC 'r - H L,! � �\ 71.t:�tsi { ; G 1 '� 1: S>3 AL I3 D E 7 F R P�f i E y F ;�, B`f L:� 0 ` 3� 5 r j. c��! P �'. 1._1__ D F V't= A ti l y a OF J �. .',,;l' RICH��RD ' RICNp.6D JA' ' O`HEARN � . U O'HEARN r�o. eyt ti LEGEND` <r f c/sT� �o 1 .`l SUR EXISTING SPOT ELEVATIONS O,A EXISTING CONTOUR — — - 0 - — — — FINISHED SPOT ELEVATIONS 0.0 FINISHED CONTOUR 0 PROPOSED PLOT PLAN APPROVED: BOARD OF HEALTH MASS DATE AGENT 407 -" 1� �dr >,NG E )., D L.AN�' R. ✓ 0WEARN, INC., RL S, RS 1348 ROUTE 134 EAST DENNIS, MASS. DATE /G SCALE: JOB NO. .a - 159� CLIENT l UN .DY DR BY SHEET OF ,_P r l Z h SOIL TEST INVERT ELEVATIONS NOTES= i DATE OF .SOIL TEST ' INVERT AT BUILDING `'K'' 3 FT. ALL WORKMANSHIP .AND MATERIAL WITNESSED BY �`� "� INLET SEPTIC' TANK. gg,0 FT.. SHALL CONFORM TO DE.Q.E. TILE . PERCOLATION RATE ? OUTLET SEPTIC .TANK 28.8. FT. AND THE TOWN OF BA.RNSTABI� RULES MIN./INCH g AND REGULATIONS' _ FOR SUBSURFACE INLET `DISTRIBUTION BOX 6 FT. OBSERVATION HOLE I OBSERVATION HOLE • 2 DISPOSAL OF SANITARY SEWAGE ELEVATION = �,4- ELEVATION= OUTLET DISTRIBUTION BOX FT. v INLET LEACHING PIT - FT. J -- BOTTOM LEACHING . PIT . 9),4 FT ' DESIGNS CALCULATIONS -3 NUMBER OF BEDROOMS .. . . . . . . . . . . . . . . . . . . . . GARBAGE DISPOSAL UNIT... . ... . . . . N O i CJ.r 1?N I- T >> T�� TOTAL. ESTIMATED FLOW :( O GAL./BR./DAY x 3'SR.),.. 3 3 GAL./DAY ., ,� c� �,^� /� ;r�:� REQUIRED SEPTIC TANK CAPACITY 4 5'- GAL. ACTUAL SIZE` OF SEPTIC TANK TO BE INSTALLED... . > �� GAL:_ LEACHING AREA REQUIREMENTS �?�, 4 > ,.� SIDE WALL AREA 2•-fGAL.%S.F. —)4-4 �_ - - ..BOTTOM . 'AREA LO GAL./S.F TEACHING CAPACITY ( BOTTOM SIDEWALL )...... . . . GAL C3.14-.x SZ xJ., O) t 0, 14 X /Q.x;�o x2; 5� RESERVE LEACHING CAPACITY. . . . . . . . . . . . . . . . . . . . : . . S 49. 7 GAL. , i �/ S�FT ( 20FTI�)N1 TOP OF FOUND. :ELEV.= �.U.rr > CONCRETE 4" SCH. 40 CLEAN SAND COVERS PVC PIPE CONCRETE MIN, PITCH 1 COVER �— 1/8 PER. FT. �F _ 2% MIN. PITCH �V00 OF� e• f y J IZ MAX. _ +P RI CHARD `� RiCHARD JAME JA:M�� N 2�� LAYER OF 1/8"= I/2', o OHEARN m z O'HEARN Ill FLOW LINE WASHED STONE rb s�a�� " 9 No:694 r J± �oz �g o 4 CAST IRON WASHED STONE PIPE- MIN. PITCH o k >_ ," A SU.RNJ. 1/4 PER FT. DIET o _ PRECAST LEACHING i gyp"' , �9 vC n o `BASIN OR EQUIV. W0 n . voo GAL � n LL �' ja /� ws , ,�` . - MASS. SEPTIC FT _ Fr HEARN fNC. RLS, RS TANK ) OFT MiN ROUTE 3 R J. 0, - 1348 R0 E L. .4 :EAST. _DEN'N'IS.,'MASS „ - PROFILE OF GROUND WATER TABLE h . . DISPOSAL ,►08 No gz 1Sy CLIENT. f SEWAGE DIS NOT TO SCALE TE (- 2 3 �Z ;. 3 DA SHEET 20F Z - _ I STAMP: a UP C A - x 20'x1 ' . - .1x4 MAH ANY DEC NG 3 a P GAS F/ - :o - - - 0 © z U _ - Q z z D \ '` POWDER DW O RM. PANTR' K1TCI+E E n FAMIL RM. a CVN PREP SINK 20'-2. 0 REF ------------- ,a L11 GARAGE 5'-10 a 71 L1J / , Z ___ ___ z STOR. C/) CL. I.D. LW V G N CL. 81 FIBGL. AI C n N 1 18,� C7. 2�_4.1 i �TYOLP' LIVING . _ Q G 9070 OR DR. i 9070 OH DR. i - I alLu .'�/12' H. 14 LT i w/12'H. 14 LT I I i O RM. Z U _ m TRANSOM i i TRANSOM 0 COVERED o m I PORCH TRLE: 1x MAHOGANY DECK NG 10'DIA FIRST FLOOR FIBGL. PLAN # 5 �•, 10'_4' 4,-6, 6�_p. 6�_p. 4-_6' 10'-4' y$. COL. TYP. y�. 2_6. g_6. _ 2 514' 2O'6' 11 O' 20'6' 7'_6. _ - 53'-p' DATE ISSUED: 09/11/Gq - REVISIONS: FIRST FLOOR PLAN DRNWN BY: - - _ PROJECT#: _ - .. - DRAWING NO.:A31 s .AllA STAMP: r.--- ---- ———— ——— ——————— — ——— - oa II I II Yx5' F1 EP.GL SHOW R w/GLASS . LI ENCL SURE 1 3• -. �I OO I' N h N II c o s6 VAC P 1 f. BA"I H BATH 19 6 i i 7 W p RAILING- Z~ vi Q ^^ LI EQ BEDROOM #2 I o w LI Eh �4 ® T 1O' I - co U o m O s I 3¢ 003 GREAT I I �(�! 3'-11• T-4Yi 9'-3Y' 3'-I0 — HALL a -- - II - m N 36. L DN.STAIRS CL. I Q - I LiJ LL z g � M. BEDROOM m Lu c BEDROOM # T `n O ^ 0 LA IyDRY Q Z Y z C I-- i s s ® II Lu Q Z 01) Q Cs 11/ II 10'-4' 4'-6- 61-01 6'-0' 4.6' 10'-4' 5'-9• . 3'-0• - 20'-O• - 20-6' 12'-0•. 20'-6' TITLE: 2o-Cl - 53'-0' _ - SOCOND FLOOR PLAN SECOND FLOOR PLAN ' - -DATE ISSUED: SC1LLE:1/4•=1'-0' _ _ 09/11/04 _ REVISIONS: - - - - DRAWN BY: , - - PROJECT#: DRAWING NO.: a3 A4 -- - : STAMP: . CON'T RIDGE VENT - - - 2x12 RIDGE BD. .. - 12 TYPICAL ROOF CONSTRUCTION - ASPHALT SHINGLES ON _ CONT RIDGE-VENT . 10 / 2x6 O IG'O.G. - \ 1/2°COX PLYWD W. RIDGE BD. BUILDING FELT ON BUILT OVER ROOF . \ I/2 / 2 10 RAFTERS O 16'G.G. w/ � OIM1-301.1 W2.5 CLIPS O In JC. 9(R-30) FIBERGLASS GATT / - - 12 m KRAFT FACED INSUL. .. 42 / \ \ 4 / n 2xe O 16'O.C. - TYPICAL NALL CONSTRUCTION _ // 2x10 O 16'O.C. .. UR -W.C. SHINGLES 5'E1P05 E A(l v'FC" Y7 C ALUM.GUTTERS ON rJt._r, ,-'/Y=J i�:,X: `) J_:):Y �'_::. .J_,Y� X�.:J..:(.-Y_iA./); _ .x-Y_�_'(.'S .. TYVEK HOUSEWRAP '• J hf „Cx1/1' JY�` ' ,•l :X�C�•P v I/2'COX PLYWOOD Ix8 FASCIA BDS. T x 3 STRAPPING 4T 16"O.C. 3 STRAPPING AT 16-O.C�\\\\ Zzb STUDS O 16^OC. COAT. T. SOFFIT i/2'G.W.H-PAINTED - - / / 1/2'G.W.B.-PAINTED 5 I/Z'RI9 UNPAGED FIBERGLASS GATT \ \ - w/CONT.VINYL VENT INSULATION - //// 9(R-30)FIBERGLASS HATT M. BEDRM_ M. BATH POLY VAPOR BARRIER CONT.AT -" / / KRAFT FACED INSUL \\\\ ASPHALT SHINGLES ON - - INSIDE FACE / / 154 BUILDING FELT ON - I/Z'BUILDING PLYWD. io _ I/2'G.W.B--PAINTED _ GREAT \\\ \ 2x5 RAFTERS O Ib'O.G.w/ TYP.2n4 FLOOR CONSTRUCTION - \ - SIMPSON H2.5 CLIPS O IB'O.C. 1'j --___. ,12 - / MOOR CONSTRUCTION \ \ 3/4'TOG PLYWD SUBFLOOR //-/ 3/4'TOG PLYWD SUSFLOOR \\\\ ^ Z N 2. GLUED t NAILED OVER i 3 - / _ GLUED 4 NAILED OVER \ LD p rl 16'TJI'e AT ib°O.C. ASPHALT SHINGLES ON / I6'TJI's AT 16'O.G. \ 1/2 BUILDING FELT ON / CD 2.8 X PLYWD. ;d'6SiSFVSbY SSE€i5• SS lKSY7�NfG7"v'L 4tF.5Y:.�76"t1dt76N, S^PY2F'77�h'fi?�Rfi�'.SffG`81:1'3N`£-; w z9 RAFTERS 1 Ib' 2-1 3/4'x4 1/4^LVL BPI. SIMPSON H2.5 CLIPS O 16'O.C. - Z U N w en? FURRED OUT -� — I 3 STRAPPING 4T I6"O.C. 5 1/2'RI9 UNPAGED FIBERGLASS BATT 0~ m T _ i!2'G.W.B x .-PAINTED 2-1 J'x9 J' LVL INSULATION - C) O II - U.HEADER O ON DOORSFLU a0 CEN TOG TER BEAD BD ON — - WIOz26 FRAME BM. - GARAGE �'Q Oa 3 2x6 O 16•G.G. LIVING ?`;' 4.4 P T.POST INSIDE ON TYPE'X'G.W.B.. To' DIA.FIBERGLASS COL---- RM. FAMILYRM. m ON wnLLs t cLG. TYP. fST FLOOR CONSTRUCTION f III -3/4'T/G PLYWD SUBFLOOR - - I a• L4 MAHOGANY DECKING GLUED 1 NAILED OVER - -ON 2xb P.T. FRAME - i I - 5 TJI'R AT Ib"O.C. COON.APRON _ 4"CONIC.SLAB w/ 5 I/2" RI9 FIBERGL455 GATT INSULA?ION 6'xb' 10/IO WWM ON 2-2x10 P.T.GIRT e _. .. .z., ... ,. t _ b"COMPACTED GRAVEL - - .12' DIA.CONC. - .: SONOTUBE ON I I_Ili Q L ON S'I CONIC.DAMPPROCFING I.IIi- O� LLJ Lu 24'x24N12"CONIC. FTG. _EXISTING CONC. FOUNDATION -�' FOUNDATION WALL QT . /SLAB ON 16"x10' DEEP KEYED CONC. FOOTING - g 1 Z (---._J . Lu CRAWL SP. FLOOR. J 2'CONC.SLAB OVER 6 MIL POLY VAPOR BARRIER - m ON 6'COMPACTED GRAVEL - Z Z Lu cn A CROSS SECTION CROSS SECTION Y Z U o ^> SCALE:1/4"=1'-0` ^T SCALE:174'=1'4r Q. - O I� z co COPPER PAN FLASHING - - - - AT DOOR LOCATIONS TIRE: FIRST FLOOR - FABRIC FLASHING----------' \� 1 .—^� + SUBFLOOR CROSS SECTIGIM . .. Ix6 COMPOSITE DECKING .ta aI I,4 - - — -- DETAILS . Ix3 ON Ix =�I-!1 - - 1 ;:1 —'[ ----'�------' RED CEDAR- __.. ") .. �— P.T. �2x ® wb O G. ._..-- . 'PAINTED Ii% ' DATE ISSUED: J. J —/ // v; REVISIONS: •-H2.5 CLIPS JOIST HANGERS ,I'. 1 - P.T. 2x GIRT - - P.T.'2x LEDGER -' {{ - w/ 5/5" P.T- SPACER w/ Ia Q - g 5/8" DIA. GALV..LAG BOLTS �. - - I ® 16" O.C. STAGGERED — I - i SIMPSON GB44 i -_GONG SONOTUBE i DRAWN BY: a 1 - i PROJECT#: DRAWII\ NO.: A7 _r r Fin.Floor El. 103.5' S 1 ° FFnish Grade R1 101't F6"111111 1/B" to 1/2•' washed Stone O 3' Thick 6" 6" f �� tfaish Crade 1� 70!t�3 0 Die m RVAR 6„ /8.6' RISEREl. 98. 7p INY EL88INV EL INV EL 1O INV EL 9788' 314' - 1 1/2' meshed stone Below Floir Line , 98.35 -6"Ston 98.95 Add Gas 98. 70 4' 4 ................i Liquid Level 48" ST Betlle 4 HOLE DISTRIBUTION BOX TR ENCH RENCH h EXISTING l000 GALLON SEPTIC TANK PRECAST REINFORCED CONCRETE, DISTRIBUTION BOX PROPOSED Install on a level base 7 Minimum wall thickness = 2» .�� INSPECT EXISTING TANK CONDITIONS AS FOLLOWS: Minimum inside dimension = 12" Bottom of Deep Observation Hole El 90.5' Minimum Construction Materials Per 310CMR 15.226(2) Outlet inverts shall be equal to each other and at Tees shall be constructed of Schedule 40 PVC and shall extend a .2" minimum below inlet invert. High Ground Water El. �60' (Long Pond) � LOW F0'0 minimum of 6" above the flow line of the septic tank and be on The distribution lines from. the distribution box shall all have 12.83 the centerline of the septic tank located directly under the equal inverts as determine'-d by flooding the distribution "box to clean-out manhole. the height of the distribution line invert after all lines have The inlet pipe elevation shall be no less than 2" nor more than 3" been sealed in place. °� e e' 24" above the invert elevation of the outlet pipe. Invert adjustments shall be made by filling with durable and 4 4 X,O C' TT.S MAP Septic tank shall be installed level and true to grade on a level, nondeformable material permanently fastened to the line or -� 5e" �-+- stable base that has been mechanically compacted and on which reconstructing the lines until all inverts are of equal elevation. Number of Trenches - 1 Number of chambers - 2 6" of crushed stone has been placed to ensure stability and PROPOSED LEACH TRENCH - END VIEW N.T.S. to prevent settling. Install Two 500 Gallon Units Septic tank shall have a minimum cover of 9': 101.5 with Four Feet of Stone at Sides and Ends ASSESSORS DATA: Two manholes with readily removable impermeable covers 13 - 29 of durable material shall be rovided with access ports. SAS ABAAWN�,G Note: P P Remove all unsuitable material 5' around.SAS 9" The outlet tee shall be equipped with gas baffle. Reserve 1o1.ts ; S� 4 �, LEACH PITS down to the "Cz layer (EI 4769 and replace with clean granular sand per 310 CAfR 15.255 (3), (4), (5). „ „ and (6). FEMA DATA: ZONE C ,!e r Ref ate 101.8 Ifi'pOp, TPI - El. 101.6 TPI - El 101.E „ ble 0 0 AI ° q SUBDIVISION LOT 99 „A„ ti s ed Q' ZONING DISTRICT RF SL IOyr 6/2 A SL 10yr 6/2 i000 cALLo TANK 4" 4" 1O;s TCJ.REdlA71V LOT 99 too.91 O OVERLAY DISTRICT 22,460.fsq.ft i GP AND RPOD CLEAN FILL CLEAN FILL 101.5 101.5 f - r BUILDING SETBACKS.• OLD A" OLD 'A' l0=5i;;._. ...2b.0� za SL IOyr 3/2 SL yr 3/2 Proposed SAS 7f-ench ::;-. 100.82 q IO , „ 1o1.s r SIDEAND REAR 15 5 ..: e „B» 18 »B 18 ;... u..:: ;;s ue ° roo 9 0 REFERENCE PLAN. IOyr 5/4 LS IOyr 5/4 1 DE K .......... 100.a f'ioo 70 BOOK 2e4 PAGE 91 »r» 30 »�» JO 101.3 i FINE FINE Ise. ° LT�rTG #198 volleyball �' GRAPHIC SCALE SILTY SILTY STING D fiArea W o 15 ao ao 120 2.5y 7/4 2.5y 7/4 EXI M , O SAND (EL 9�62 48 SAND (EL 97 ) 48 w ' ppgCH » „ kzkl »PE 54' „ PERC 5Li" ° �. / IN FEET C2 02 iw 1 inch - 30 ft. MED. 2.5y 6/4 MED. 2 5,v 6/4 SAND SAND r 133 , 133" Denote ev. El. 90.5 El. 90.5 «> o ; No Water Encountered No Water Encountered 9s es 155.87 R�25 U ____0 RV CATCH BASIN Rif[ 100.5' - SLBY. 99.91 v DATUM NGVat Soil Log 0 4s'29"E N8 - - - Performed By.• S. Doyle ! ----' �s.76 99.89 --- S'eptic Repair and Upgrade Plan Date: August 23, 2005 - �r� Prepared For• Pero Rate: G2 Min/Inch �� LAl� ,����s 4 ocKING-B� P1,1 �c'�, "A� ',, 198 MOCKINGBIRD LAND' MSpy i,1q � GENERAL CONSTRUCTION NOTES �° F� �Fo . . si'' -` ss . In f o STEPHEN 1. All the workmanship and materials shall conform to R E.P Title 5 J r. s 4t�'r 0AM N oonE Lr 'CRMAN ,: MarstonS Mills, Massa eh use t is . a o ► and the Town of Barnstable rules and regulations for the subsurface ® �r 7� n ,3,,, , disposal of sewage. _ E O�oQ ' ��, Scale: 1" = 30' Date: August 24, 2005 2. At least one access port over tank tees shall be accessible ��qti su ��a� sFF TF r o Prepared By.• within 6 of finish grade, with any remaining access ports brought _ r{ n r- o 9 Stephen J. Doyle and Associates 1 to within 6 of finish grade. -�� ► 5- 42 Canterbury Lane, E. Falmouth, MA 02536 f" 3. All components is of the sanitary system shall be capable of Design Da ta: 8 p _ p - 1 p y •ys p � Telephone: 508 540-2534 r withstanding H-10 loading unless they are under or within 10 ft Three Bedroom ® 3 X 110 - 330 GPD Required Flow V o�,y R�^ v� a B_z of drives or parking. H--20 loading shall be used under or within No Garbage Disposal 10 ft of drives or parkingunless noted. Plastic equals may berN P WILLIAM used in lieu of all precast units Use: Chamber Trench 251 x 12.83 W x 2 Eff/Depth � LIEBERMAN rn ; i v 4. The exca va for/con tractor shall verify the location of all site j25 + 25 + 12.83 + 12.83J x 2.0 = 151 NO.23971 �; < �',`;• utilities prior to any excavation, and shall be responsible for 25 x 12.83 = 320 � +, all matters relating to electric easements. 471 x 0. 74 348 GPD Total Design Flow s'on►aL rJ' 5. Sewer pipes shall be. 4 Schedule 40 PVC laid at a min. 0.02 slope. ' 6. Any masonry units used to bring covers to grade shall be '\��✓ =�-�2�-hr' � u 1 09/$0/06 1000 GALLON TANK 10 RMAIN mortared in place. 7 Finish grade shall have a minimum slope of 0.02 ft per foot. NO. DATE DESCRIPTION