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0077 CAPES TRAIL - Health
77 CAPES TRAIL,W. BARNSTABLE A= 108 028 i .. TOWN OF BARNSTABLE LOCATION �� r �t+�C l SEWAGE# a��14';L . , � � VILLAGE � C� ASSESSOR'Sg MAP&PARCEL INSTALLER'S NAME&PHONE NO.0 C(e E eiyo LL6. Vp �UN17 SEPTIC TANK CAPACITY I®QO G e i LEACHING FACILITY:(type) ����®�� (size) 16 X 9 NO.OF BEDROOMS �^ 1 �' OWNER U I'C4 Fa alien PERMIT s- PERMIT DATE: r,�4G d 9L5—oL0(L4 COMPLIANCE DATE: Separation Distance Between the: .v brU,r ' exo v�i '�( Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility C-f ®4 Feet Private Water Supply Well and Leaching Facility(If any wells exist on p site or within 200 feet of leaching facility) 156 6 Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) W Feet FURNISHED BY (�A PZw rb E &0TGtFA ISE S LLC Lluf A-4p97` 04 No. k FEE �U i COMMONWEALTH OF MASSAC14US ETTS Board of Health, (3a rr7 s fa b 1 , AIA. APPLICATION FOP, DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repair(14/Upgrade( ) Abandon( ) - ❑Complete System $(Individual Components Location 77 (A Ve 5 Tra I' q/YJ sfgble Owner's Name 3e55 ecci �le✓� Map/Parcel# C?ea/;$ Address 77 CG es T,-*�l W 1iuliyfti t/tP Ud&6i; Lot# Telephone# 771-yytf_gLj& Installer's NameEaOe K)e- Designer's Name��lt�C De i h tegg laeors Address I) 3 CUy-"�►-e, --, S Address P-0-&o x )V 5-1 ic, ,f f 5anda A O a5-('03 Telephone# J '-Z Telephone# $'� —$e6 C6—g'A,6 a Type of Building (fie 5 i GT e n G e Lot Size 14 3.S49ro}/ sq.ft. Dwelling-No.of Bedrooms y Garbage grinder ( ) Other-Type of Building No.of persons Showers ( ),Cafeteria( ) Other Fixtures Design Flow (min.required) 104 0 gpd Calculated design flow 14Ljo Design flow provided Q•4 gpd Plan: Date Stln e 25I RV I L( Number of sheets Revision Date 4///`l Title 5egf-,,c S i.4-e v-/ kerzo l/' ef-o 7 fev- 77 (Ct 5 T/y r'l Description ofSoil(s) /41ediy✓✓7 5cw6 51'It 1,U4rv7 , Lvarny sir, i{ Soil Evaluator Form No. 10 Name of Soil Evaluator 5!v MC GG 4►7 Date of Evaluation MAN l9. alll L/ e r--� DESCRIPTION OF REPAIRS OR ALTERATIONS Q,eM V e i itw 1' 'fr!'bvfim bera"d leachl. Gad --edltiCP wfh i nek,' o�t'Sf�'Ibuf%orl 47�x and 5VX « �` lieacki.-1 hP . The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees to not to ace e m in operation until a Certificate of Compliance has been issued by the Board of Health. Signed Date 7- -7 o o�( �2 g� � Inspections No 1 ! 't ....\ t C 4 p FEE Idu Board of Health, �JG/i15 Lr �> MA APPLICATION FOP, DISPOSAL SYSTEM CONSTRUCTION PERMIT ' . Application for a Permit to Construct() Repair(.(UpgradeO Abandon( - ❑Complete System XIndividual Components Location �7 (cy ioC2 t/[i t�� ti1�5� Iljrir+�S ll,L)I F Owner's Name Map/Parcel# Ci ( a Address 7 7 (cql x` 7r li+�j V. t�('t, Lot# Telephone# Installer's Name ��!!.� Designer's Name /(f(�, �, G ��f`�;�// L�l� 1tiP¢+ Address 3 Address VC, fj X l U S I/ SCE./Cl[v i(f `.,<<( �S 63 Telephone# pp l�-71 $� Z 1 � Telephone# 5 C$ - 5 c6 Type of Building k e 5 t d t << e Lot Size 1/ 3/ S C/& I/- sq.ft. Dwelling-No.of Bedrooms L/ Garbage grinder( ) Other-Type of Building No.of persons Showers ( ),Cafeteria ( ) Other Fixtures Design Flow (min.required) L N O gpd Calculated design flow 41y O Design flow provid&I-zi-I q j� I gpd Plan: Date 3 U`/1F 2 31 2 G 11-1 Number of sheets ) Revision Date N 1A Title 5,,1)4rc Syr7�p.t / CFI/c+ i," /[,./ �c , 77 (r[,01-9y Tle f' / Description of Soil(s) it Evaluator Form No. 7 ( Name of Soil Evaluator 5 w f{ /I1! ( Lr.t.-/ Date of Evaluation i l/C V 1 rl, DESCRIPTION OF REPAIRS OR ALTERATIONS f-e r//G.t/f e X f e7 41,% Gl I e7 4/ t l/!/l l G,/ G>G X 0//,,/ I eci c 1/(r/G t t'+ Clod "( Pf,f r« t., (W1 i•?Fr, The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees to not tp-place a system in operation until a Certificate of Compliance has been issued by the Board of Health. Signed Date K 41 02 C 4r. Inspections / No. FEE C'OMMONWEL OF MASSACHUSETTS Board of Health, /'1/`l T MA. CERTIFICATE OF COMPLIANCE Description of Work: ILA ndividual Component(s) ❑Complete System The undersigned herebyl certify that the Sewage Disposal System; Constructed ( ),Repaired ( ),Upgraded ( ),Abandoned ^ ( ) at 7 / l ✓ 4r l Gto z has been installed in accordance with the r visio s of 310 CMR 15.00 (Title 5) an t- e approved design plans/as-built plans relating to c 1- l ? ll application No. � l � � dated � /� Approved Design Flow 7 d PP PP g �(gP ) Installer t Designer: Inspector: Date: The issuance of this permit shall not be construed as a guarantee that the system will function as designed. No. / FEE COMMONWEALTH Of MASSACHUSETTS Board of Health, P/fir t� MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct( ) Repairpgrade( ) Abandon( ) an individual sewage disposal system at 7 C 1 �r A/'.1>T(..41.O // as described in the application for Disposal System Construction Permit No.,90/ ./X, dated 4b.54 ' Provided: Construction shall be completed `within t ree years of the date of ts, e snit. All local conditions must be met. Form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date (O/ 5 {/t� Board of Health / —Ar �� Town of Barnstable Regulatory Services Richard V.Scab,Interim Director' Public Health.Division Farus" Thomas McKean,Director 200.Main Street,Hyannis,MA 02601 Office: 508-8624644 Fax: 508-790-6304 Installer&:Designer Certification Form° Date: e Pernitt# c t q_AJX Assessor's-Mao T:'arcel Aj-44-+rJ cr Installer: 0-0, e.;:`,. Designers � _ �l �LCOAN5> Ci"c'_;; Address: pv A A Address.* l�x m+►��t c,���� ) AresL r w4 /??r � 3 OA G`tt�,�( j On, 6 nori was issued a permit to install a (date) (installer) septic system at G, $ 7'rL ' based on a design drawn by (address) dated G, 2 3 7. Z 0 t (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. Strip out (if required) was inspected and the soils were found satisfactory: I<certify:than the septic system referenced above was: installed with:major changes (Le. greater than 10' lateral'relocation of the'SAS or,any vertical,relocation tit any component'. ofthe septic system) but in accordance with State& Local Regulations. Plan revision or certified as by designer to follow: Strip gut(if rtquirecf):was inspected'and the soils- were found satisfactory. �}14F&A I certify that the system referenced above was const with the terms of the AA approval letters(if applicable) a,` TABACZYN5KI 'b . U3. CIVIL h1o.337A6�0 �4Ct , e' n, er's>SSignat (17esig s S' nature) (Affix-Clesigner s Stamp Here) PL .ASF RETURN TO BA:RNSTABLE PUBLIC: HEALTH DIVISION: CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL`BOTH THIS FORM AND AS BUILT CARD ARE RECEIVED,BY THE`BARNSTNBL'E PUBLIC HEALTH DIVISION. THANK YOU. W-SeptieDesigner Ceiliiiratian Farm Rev 8-14-13(k)c tla1 1�0�® letter of Transmittal 1�.VAr ENGINEERS&ENVIRONMENTAL SCIENTISTS PO.Ba><1051 •Sandwich,MA 02563.(508)888-9282•Fax 888-5859 www.atlanticcompanies.com To Pedri/t✓ 14 f T�v�.�✓/ of �ti���f��l P . a 00 1q,-1 rrr 7frY Qa- g1/4`i wf `7, �4 OA60( Date 10I a L+Cr We are sending you Project No. 'R 7 70' V O Enclosed ❑ Under separate cover Project via ❑ Direct from printer ❑Taxi Messenger ❑Other the following items Shop Original Prints ❑ Sepias ❑Tracings ❑ Reports ❑ Drawings ❑ Drawings r� ❑ Mylar ❑ Linen ❑ Specifications ❑ Samples ❑Other pi F,m ^�r ,` Description r la.) 5e fI,G 5Y5 fe vl 4e e;,'l 5, 7 7 1,qPS Td<: l�e%f�d 601 1 .y q / vl�f� fins l checli F01- 1(00 Fee ) l"M lltw fa r�//v5�l f yS�P�/ (�✓��f.vc�;�.� �ei..�. a D +...r o ❑ For your information inal Plans ❑ Resubmit copies for approval ❑ Unchecked ❑ Returned for corrections ❑ Return corrected prints ❑ Preliminary ❑ For your review and comment ❑ Submit copies for distribution ❑ Revised ❑ For your approval/signature Remarks Signed r G'"' ���--7 Copy to To 7 If enclosures are not as noted,please contact us immediately ' 'own of BarviN able P aa_ Department of Regulatory Services Public I eaft h Division Date MA&L 200 Main Street,Hyannis MA 02601 r&!1 pAA�A Date scheduled —� D Tiine Fee Pri. Soil Salta ilzo Assessment for Sew is ®s Performed By: Witnessed By: LOCATION dui; GENERA(,]l i ORMATI®N �`� Locat.lon Address 7?Ca�Oe5 TrQ t-I/�t1Pyf. ll���✓Igf�,G/!p Owner's Name 3f 5`7 tCCt F01(/>° Address 7 CAJa'�5 7/G4 i�at/ �n5fyh�P Assessor's Map/Parcel: 8 Engineer's Name R rch Tel ha,(0;?&4 z o5IR NEW CONSTRUC'nON REPAIR CAi1c��i�C Dtl�,p7) Telephone# $d�(i—�6�£S-900'A' Land Use Slopes.(95) Surface Stones _ Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well - ft' Drainage Way ft Property Line - ft Other ft: SIMUCII:(Street frame,dimensions of lot,exact locations of test(toles&pere tests,locate wetlands(n proximity to holes) 0r") Z 5 W Parent material(geologic)5Au�ft St- Depth to Bedrock 31 Depth(o.Groundwater Standing Water in Hole; IQ� Weeping from PI tepee �AIL+f Estimated Seasonal High Groundwater DETERMINATI®N FOR SEASONAL'HIGH WATER TAAL,E Method Used: Depth Observed standing in obs.hole: In, Depth to soil mottles: Depth to weeping from side of obs.hole: 111, Groundwuter Adjustment -- _ Index Well# Reading Date: y�gIn7dyex�Well levvel+1___—V__ Adj.rActorAdj.0 oundwaler Uvel %A�RCOLr.t9.rA I.O rA TES.R DAU Observation Hole It "Clore at 4" Depth of Perc 53 Time At 6" Start Pre-soak Time @ P Time(V-6") �6 End Pre-soak /0.�0 Rate MinJiuch 3 t Site Suitability Assessment:. Site Passed_�. Site Failed: _ Additioaul Tesi),tg i;eeued(Y/N) ,V OdOnal: Public Health Divisio i observation Bole Data To Be Completed on Back----------- 4'**If percolation test is to be conducted within 100' of wetland, you "must first notify the Barnstfable. Conservation 1)Msio❑ at.least one (1) week prior to beginning, Q:sEPTICAPER CFO RM.DOC f r - DEEP.OBSERVA.TION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in,) (USDA) (Munsell Mottling (Stnucture,Stones;boulders. onsistency,To Y3ravel) � _ c a — DEEP OBSERVATION HOLE LOG . Hole# -- Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) o- D i„ q/1 ®'3 DEEP OBSERVATION MOLE LOG Dole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in-) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Co I to cy,%aCdYO 'N, - DEEP OBSERVATION HOLE LOG Mole It Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders, Consistency. a a Flood Insurance][fate Map: Above 500 year flood boundary No— Yes + Witidn 500 year boundary No= Yes Within 100year flood boundary No Yes Depth of Naturally'Occurrina Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? P.S If not, what is the depth of naturally occurring pervious material? Certification I certify that on Oc: 07(b j (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 trainin r,Pxpe ''se and experience described in 10 CMM 15.017. Signature Date V- 1 R E C EEll I E. D 2014 QAS HPTIC�PLRCPORM-DOC Atlantic Design Engineers, LLC Op SHE rod Town of Barnstable Barnstable Regulatory Services Department er1C8C j > BARNSPABLE, •MASS. - 39 m Public Health Division Op i6;q, `� m ATEb MAt b' 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7012 1010 0000 2851 3627 June 12, 2014 Jessica Fallen 77 Capes Trail West Barnstable, MA 02668 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 77 Capes Trail,West Barnstable, MA was last inspected • on 5/24/2014 by James D. Sears, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Failed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Distribution-box needs to be replaced; there is a backup of sewage into ° system component due to overloaded SAS. • Leaching pit needs to be replaced; liquid depth in pit is less than 6" below invert. You are ordered to repair or replace the septic system within sixty(60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF T BOARD OF HEALTH I i i T as McKean, R.S., Cl Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Evl\77 Capes Trail WB Jun2015.doc Parcel Detail http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=6136 VAASA T We, Logged In As: Parcel Detail Tuesday, June 10 2014 Parcel Lookup Parcel Info Parcel Developer ID[108-028 Lot'LOT 33 Location 77 CAPES TRAIL Pri F . _._.m� -__. _.. Frontage� Sec� - _ ____ ___ __.__. _... .W_____.... Sec I Road Frontage' Fire Village[WEST BARNSTABLE W BARNSTABLE District Town sewer exists at this Road No Index�2193 _� address ;- _..; ;q Asbuilt Septic Scan: Interactive ° � - 108028_1 Map -z Owner Info ------ _ _ _ _ . __ Co_ Owner IFALLEN,JESSICA L Owner Streetl j77 CAPES TRAIL I Street2 City;WEST BARNSTABLE State, Zip 02668 Country ��� Land Info Acres Use jSingie Fam MDL-01 _ Zoning IRF Nghbd!0105 Topography Level Road IPaved Utilities Gas,Well,Septic Location i Construction Info _.. . _.....__ __ _ _ Building 1 of 1 Year,---------''-rgg Roof lGable/Hip � � Ext Wood Shingle Built;_ Struct Wall Living�-- _. Roof-- — ___ AC,-', 11712 !Asph/F GIs/Cmp iCentral 1 P Area Cover Type z Int Bed u Style jCape Cod Drywall !4 Bedrooms Wall Rooms ; ._ Model Residential Int Carpet Bath E3 Full Floor Rooms' Heat--------- Total Grade Average: Type 1Hot Air Rooms 18 Rooms Heat___ _ Found _._-- Stories,l 1/2 Stories Fuel'Gas ation'Poured Conc. Gross http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=6136 6/10/2014 box k ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 77 Cape's Trail - Property Address Jessica Fallen Owner Owner's Name information is required for every West Barnstable MA 02668 5-24-14 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 forms A. General Information ``p��N�N►�Ffnui��'G '• on the computer, ,,ZN Mq i� use onl the tab �.�` ,.• key to move your 1. Inspector: �`p2. •;9Pti G cursor-do not =�: JAMES N use the return James D.Sears �3,7 _�: :m y ke Name of Inspector E v: Y• CapewideEnterprises,LLC .,o o Company Name '''�' '�7TiF� 153 Commercial Street '''% ,S/��P0 o``�°� Company Address , MR Mashpee MA 02649 City/Town State Zip Code 508-477-8877 S1623 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: r -. ❑ 'Passes ❑ Conditionally Passes ®Fails - ❑ Needs Further Evaluation by the Local Approving Authority I 4: • 5-24-14 spector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner 'and copies sent to the buyer, if applicable, and the approving authority. "**'This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different'conditions of use. t5ins=3/13 Title 5 Official inspectio orm:Subsurface Sewage Disposal System Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 77 Cape's Trail Property Address Jessica Fallen Owner Owner's Name information required for every West Barnstable MA 02668 5-24-14 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: Failed System 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a ' Subsurface Sewage Disposal System Form-Not for Voluntary Assessments es ' 77 Cape's Trail Property Address Jessica Fallen Owner Owner's Name information is West Barnstable MA 02668 5-24-14 required for every - page. Cityrrown 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): El 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: f El '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 EJ 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 B. Commonwealth of Massachusetts a ° W Title 5 Official Inspection Form �l Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 77 Cape's Trail Property Address , Jessica Fallen Owner Owner's Name information is West Barnstable MA 02668 5-24-14 required for every W • page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ` 2. System will fail unless the Board of Health (and Public Water Supplier, if any) ` 4 #, . 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 . w ' y Backup of sewage into facility or system component due to overloaded or" ,® f 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 El I. Static liquid level in the distribution.box above outlet invert due loan overloaded �� or clogged SAS or cesspool 3 Liquid depth in amompW is less than 6" below invert or available volume is less ` ® ❑ than '/2 day flow /°rT t5ins-3M3.` 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 77 Cape's Trail Property Address Jessica Fallen Owner Owner's Name information is required for every West Barnstable MA 02668 5-24-14 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D., Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system-considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form , F Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M ' 77 Cape's Trail Property Address Jessica Fallen Owner Owner's Name information is required for every West Barnstable MA 02668 5-24-14 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health °' y ❑ ® 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,issue0 El ' approximation of distance is unacceptable)[310 CMR 15.302(5)] D. System Information ti Residential Flow Conditions: Number of bedrooms(design): NA Number of'bedrooms(actual): ' 4 , r , DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 , Commonwealth of Massachusetts Title 5 Official Inspection Form x Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 77 Cape's Trail Property Address Jessica Fallen Owner Owner's Name information is required for every West Barnstable MA 02668 5-24-14 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: The system is a 1000 Gal.Tank D Box and pit. Number of current residents: 3 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage well water 9 ( Y 9 (gPd))� Detail: Sump pump? ❑ Yes Z No Last date of occupancy: Present Date Commercial/Industrial flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of w design fl o (seats/ ersons/s .ft., etc. P 4 Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-3r13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 77 Cape's Trail Property Address Jessica Fallen Owner Owner's Name information is required for every West Barnstable MA 02668 5-24-14 page. Cityrrown 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: NA 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•3/13 Titles Official Inspection form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M y` 77 Cape's Trail Property Address Jessica Fallen Owner Owner's Name information is West Barnstable MA 02668 5-24-14 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 1991 Permit#91 -443. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 18"feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: over 100' feet Comments(on condition of joints, venting, evidence of leakage, etc.): Pipeing is 4" PVC SCH 40. Septic Tank(locate on site plan): Depth below grade: 1 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 Gal. Precast ' Sludge depth: 2" t5ins-3/13 Title 5 Official Inspection Forth: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 77 Cape's Trail Property Address w Jessica Fallen Owner Owners Name information is West Barnstable MA 02668 5-24-14 P required for every page. Citylrown 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 2811 r . Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 12" a°.µ Distance from bottom of scum to bottom of outlet tee or baffle .17" How were dimensions determined? Asbuilt-Tape Sludge-Judge 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 at working level. Tank and cover's at 1' below grade. Inlet tee;outlet baffle. No sign of leakage or over loading. a-Grease Trap(locate on site plan): Depth below grade: feet Material of construction: El concrete ❑ metal ❑fiberglass El polyethylene ❑other(explain): • Dimensions: Scum thickness Distance from top,of scum to top of outlet tee or baffle ;.q Distance from bottom of scum to bottom of outlet tee or baffle Date of last urn in a P P 9 Date .. - t5ins-3/13 �. Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments s M t 77 Cape's Trail Property Address Al Jessica Fallen Owner Owner's Name °. information required for every West Barnstable MA 02668 5-24-14 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; d 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 ' :F Date of last pumping: Date Comments(condition of alarm and float switches, etc.): • * a Attach,copy of current pumping contract(required).Is copy attached? El Yes ❑ No t5ins-3L13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17, °. . Commonwealth of Massachusetts Title 5 official inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 77 Cape's Trail Property Address Jessica Fallen Owner Owner's Name information is West Barnstable MA 02668 5-24-14 required for every ` page. Cityrrown 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, anyR evidence of leakage into or out of box, etc.): = D Box is 18"x18"-27" below grade,w/one line out. wall's are getting old,w/some solid carry over. - k �.g rr, P . 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: x t5ins-3/13 Title Official Inspection Forth:Subsurface Sewage Disposal System-Page 12 of 17 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Sve,� 77 Cape's Trail `4 Property Address Jessica Fallen Owner Owner's Name information required for every West Barnstable MA 02668 5-24-14 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number,length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system w, Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation,etc.): r ' Leaching is a 1000 Gal. Precast pit w/3'stone. Pit at 80" below grade w/cover at 8". Pit is full,not leaching. Need to replace leaching. q. 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 . to Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-3/13 Title 5 Official inspection Form:Subsurface Sewage Disposal System-Page+13 of 17: Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 77 Cape's Trail Property Address Jessica Fallen Owner Owner's Name information is required for every West Barnstable MA 02668 5-24-14 page. City/Town State Zip Code Date of Inspection D. System Information (coot.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form fl Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 77 Cape's Trail - Property Address Jessica Fallen Owner Owner's Name information is required for every West Barnstable MA 02668 5-24-14 page. Cityfrown State Zip Code Date of Inspection . D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to, at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately d A � 71 Al U t5ins•3113 Y 'r axn _ Title 5 Official Inspection Form:Subsurface Sewage Disposal System—Page 15 of 17 ' Commonwealth of Massachusetts X Title 5 Official Inspection Form . Subsurface Sewage Disposal System Form-Not for Voluntary Assessments • x 77 Cape's Trail Property Address Jessica Fallen Owner Owner's Name - information is West Barnstable MA 02668 5-24-14 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells AID p" Estimated depth tofhgh ground water: 50+' -feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ` a ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: Per asbuilt on file. =Y ❑ Checked with local excavators, installers-(attach documentation) ' ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Asbuilt on file 50+'to G.W.. Bottom of pit around 13' below grade. - u Before filing this Inspection Report, please see Report Completeness Checklist on next page t5ins-3113 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 16 of 17 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 77 Cape's Trail Property Address Jessica Fallen Owner Owner's Name information is required for every West Barnstable MA 02668 5-24-14 ` page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 �. `,.R � fit++£ � � Y ik 8�/.� "�'�� �� .}-,f per. C°:.✓ At Iti I. • " nj m r.-I 1 0 F F I U CO ti Postage $ ���S A4,q O Certified Fee Q. O Retum.Recelpt Fee Postmark O p (Endorsement Required) C ,Restricted Delivery Fee O (Endorsement Required) rR O Total Postage&Fees $ U S P S ru o Jessica Fallen 77 Capes Trail West Barnstable, MA 02668 i Certified Mail Provides: o A mailing receipt o A unique identifier for your mailpiece e A record of delivery kept by the Postal Service for two years Important Reminders: n Certified Mail may ONLY be combined with First-Class Maile or Priority Mail®. n Certified Mail is not available for any class of international mail. a NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. o For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt.(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. o For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". ® If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 I sE`NbER- 60MPLETiETHISSECTION THIS SECTION ON DELIVERY' ■ Complete items 1,2,and 3.Also complete A. ' nature I item 4 if Restricted Delivery is desired. ❑Agent ■ Print your name and address on the reverse X ❑Addressee so that we can return the card to you. B Re eiv ted a C. Date of Delivery ® Attach this card to the back of the mailpiece, �f or on the front if space permits. \.J D. Is del' ery a ere from item 1`? ❑Yes 1, Article Addressed to: If Y� .ter delivery Ee s below: ElNo I �-- _ — - --— - -- —- - N N 4 Jessica F,a'11,6n �y 77 Capes„Trap 3. service West Barnstable, MA 02668 ❑Certified Mail ❑Express Mail ❑Registered ❑Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) O Yes 2. Article Number - (IYansfer from service label] , ':7 t]`12 1'010 0 0 0: 2 8 51 3 6 2 7 ?S Form 3811.February 2004 Domestic Return Receipt +02595-02-M-1540' i UNITED STATES POSTAL SERVICE First-Class Mail I Postage&Fees Paid USPS I Permit No.G-10 • Sender: Please print your name, address, and ZIP+4 in this box • I I I I _ I I Town of Barnstable � jRegulatory Services Department l M i Public Health Division I 1 200 Main Street Hyannis, MA 02601 I i 1 1��} 1 I/111 �fililllt �8}II IS } SI�• 1 � ! 11' I j71f;'= i 7Aftach items 1,2,and 3.Also complete A. ' nature estricted Delivery is desired. X ❑Agent name and address on the reverse ❑Addressee can return the card to you. g R eiv ted a C. Date of Delivery card to the back of the mailpiece, front if space permits. 1, Article Addressed to: D. Is de' ry a ere from em 1? Yes If Y Sa ter delivery tE s below: ❑No CV Jessica F�a>Flen 77 Capes Trail 3. Service West Barnstable, MA 02668 ❑Certified Mail ❑Express Mail I ❑Registered ❑Return Receipt for Merchandise - -- Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) p Yes 2. Article Number . —i (transfer from service(adeo 7 012 1010 0000 2851 3 6 2 7 ?S Form 3811. February 2004 Domestic Return Receipt 102595-02-M 1540 t © fY,V.V11 17�- rLJ rn ram. .. .;; L cE3 Postage $ r t ru Certified Fee C3 Postmark C3 Retum.Receipt Fee C3 (Endorsement Required) , fe9(@t1A Restricted Delivery Fee I �YiY C3 (Endorsement Required) r=1 p Total Postage&Fees SS r:1 ru Y o 1 Jessica Fallen 77 Capes Trail West Barnstable, MA 02668 P -yq3 r t., s Commonwealth of Massachusetts Title 5 Official Inspection Form o Not for Voluntary Assessments ,M Subsurface Sewage Disposal System Form Inspection results must be submitted on this form or on the official Title 5 Inspection Form dated 6/15/2000. Inspection forms may not be altered in any way. A. Certification Important: �� When filling out 1. Property Information: forms on the T= computer,use 77 Capes Trail- West Barnstable, MA r only the tab key Property Address to move your William and Suzanne Powers cursor-do not Owner's Name '? use the return key. 77 Capes Trail ` Owner's Address rQ West Barnstable MA 02668 SR n City/Town State Zip Code Date of Inspection: April 14, 2006 er rn Date 2. Inspector: David D. Coughanowr, R.S. Name of Inspector Eco-Tech Environmental Company Name 43 Triangle Circle Company Address Sandwich MA 02563 City/Town State Zip Code 508 364 0894 Telephone Number 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 ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 6-1/� Q -A%• — Vim- S April 14, 2006 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5-2302.doc• 11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 1 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments ;M Subsurface Sewage Disposal System Form A. Certification (cont.) 77 Capes Trail Property Address West Barnstable MA 02668 City/Town State Zip Code William and Suzanne Powers April 14, 2006 Owner's Name Date of Inspection 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: Inspector's Note==> A septic system is deemed to pass this Real Estate Transfer Inspection if it does not trigger any of the failure criteria listed below. The septic system has been evaluated according to the conditions observed on the day it was inspected. No estimate or guarantee of system longevity is made or implied by a passing determination. 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: t5-2302.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 2 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification (cont.) 77 Capes Trail Property Address West Barnstable MA 02668 City/Town State Zip Code William and Suzanne Powers April 14, 2006 Owner's Name Date of Inspection 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 ❑ 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: 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 1:5-2302.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 3 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments iG^M Subsurface Sewage Disposal System Form A. Certification (cont.) 77 Capes Trail Property Address West Barnstable MA 02668 City/Town State Zip Code William and Suzanne Powers April 14, 2006 Owner's Name Date of Inspection C) Further Evaluation is Required by the Board of Health (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 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: t5-2302.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 4 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments ;M Subsurface Sewage Disposal System Form A. Certification (cont.) 77 Capes Trail Property Address West Barnstable MA 02668 City/Town State Zip Code William and Suzanne Powers April 14, 2006 Owner's Name Date of Inspection 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 '/2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] Yes 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. t5-2302.doc•11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 5of16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments M y Subsurface Sewage Disposal System Form A. Certification (cont.) 77 Capes Trail Property Address West Barnstable MA 02668 City/Town State Zip Code William and Suzanne Powers April 14, 2006 Owner's Name Date of Inspection 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. t5-2302.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 6of16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form B. Checklist 77 Capes Trail Property Address West Barnstable MA 02668 City/Town State Zip Code William and Suzanne Powers April 14, 2006 Owner's Name Date of Inspection 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, including 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(3)(b)] t5-2302.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 7 of 16 Commonwealth of Massachusetts W Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information 77 Capes Trail Property Address West Barnstable MA 02668 City/Town State Zip Code William and Suzanne Powers April 14, 2006 Owner's Name Date of Inspection Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 gpd Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d n/a-well in use 9 ( Y 9 (gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: 2 weeks agoDate Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): t5-2302.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 8of16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form /GSM C. System Information (cont.) 77 Capes Trail Property Address West Barnstable MA 02668 City/Town State Zip Code William and Suzanne Powers April 14, 2006 Owner's Name Date of Inspection General Information Pumping Records: Source of information: owner 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, 0161.4rih-tien bex, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: Age: 14+years. Certificate of Compliance issued 12/91 (Board of Health permit#91-443) Were sewage odors detected when arriving at the site? ❑ Yes ® No t5-2302.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 9 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form GSM C. System Information (cont.) 77 Capes Trail Property Address West Barnstable MA 02668 City/Town State Zip Code William and Suzanne Powers April 14, 2006 Owner's Name Date of Inspection Building Sewer(locate on site plan): Depth below grade: 1 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: 20+feet Comments (on condition of joints, venting, evidence of leakage, etc.): Sewer appears structurally sound with no evidence of backup or leakage into dwelling Septic Tank (locate on site plan): Depth below grade: 1feet 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 ❑ Yes ❑ No certificate) Dimensions: 8.5 ft x 5 ft x 5 ft(1000 gallon) Sludge depth: 4 inches Distance from top of sludge to bottom of outlet tee or baffle 30 inches Scum thickness 1 inch Distance from top of scum to top of outlet tee or baffle 9 inches Distance from bottom of scum to bottom of outlet tee or baffle 14 inches How were dimensions determined? Design Plan t5-2302.doc• 11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 10 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) 77 Capes Trail Property Address West Barnstable MA 02668 City/Town State Zip Code William and Suzanne Powers April 14, 2006 Owner's Name Date of Inspection Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumping not required at this time but maintenance pumping is recommended within and every two years. Tank and tees appear structurally sound and functioning as intended. No evidence of leakage in or out was observed. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): t5-2302.doc•11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 11 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments iG^M Subsurface Sewage Disposal System Form C. System Information (cont.) 77 Capes Trail Property Address West Barnstable MA 02668 City/Town State Zip Code William and Suzanne Powers April 14, 2006 Owner's Name Date of Inspection Tight or Holding Tank (cont.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No t5-2302.doc• 11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 12 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) 77 Capes Trail Property Address West Barnstable MA 02668 City/Town State Zip Code William and Suzanne Powers April 14, 2006 Owner's Name Date of Inspection Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Soils above leaching pit appeared unsaturated. No evidence of surface ponding, breakout, lush vegetation, or other evidence of hydraulic failure was observed. Leach pit was uncovered and found to be dry. t5-2302.doc• 11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 13 of 16 Commonwealth of Massachusetts 4 Title 5 Official Inspection Form Not for Voluntary Assessments ;M Subsurface Sewage Disposal System Form C. System Information (cont.) 77 Capes Trail Property Address West Barnstable MA 02668 City/Town State Zip Code William and Suzanne Powers April 14, 2006 Owner's Name Date of Inspection Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth —top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5-2302.doc• 11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 14 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) 77 Capes Trail Property Address West Barnstable MA 02668 City/Town State Zip Code William and Suzanne Powers April 14, 2006 Owner's Name Date of Inspection 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. O LEACH 3 LOCATIONS A B 1 17 FE 55.5 FE 2 2 22.5 FE 58 Ft SEPTIC 3 71 FE 69.5 FE TANK a A EXISTING a DWELLING # �7 F-1- A WELL CAPES TRAIL NOT TO SCALE t5-2302.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 15 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) 77 Capes Trail Property Address West Barnstable MA 02668 City/Town State Zip Code William and Suzanne Powers April 14, 2006 Owner's Name Date of Inspection Site Exam: Slope Surface water Check cellar Shallow wells Estimated depth to ground water: 50+feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers- (attach documentation) ® Accessed USGS database- explain: USGS topography maps You must describe how you established the high ground water elevation: USGS topography maps indicate property is over 50 feet above water table. t5-2302.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 16 of 16 ar MAP ECO-TECH P r 1� � PARCEL O 2 Environmental AT www.eco-tech.us THIS FORM IS A FACSIMILE OF THE STANDARD SEPTIC INSPECTION FORM ISSUED BY THE MASSACHUSETTS DEPARTMENT OF ENVIRONMENTAL PROTECTION(revised 6/15/2000) TITLE 5 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 77 Canes Trail West Barnstable Owner's Name: Eileen Conway Owner's Address: 77 Canes Trail RECENF01 West Barnstable Date of Inspection: April 17, 2003 20�3 OR 2 9 Name of Inspector: (Please Print) David D. Coughanowr,R.S. Company Name: Eco-Tech Environmental N OF BARNSTABLE Mailing Address: 43 Triangle Circle fOWHEALTH DEPT. Sandwich MA 02563 Telephone Number: (508)364-0894 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: X Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature �S Date: �p�► I ?� �d�' The System Inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design'flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority NOTES AND COMMENTS Inspector's Note==> A septic system is deemed to pass this Real Estate Transfer Inspection if it does not trigger any of the failure criteria listed below. The septic system has been evaluated according to the conditions observed on the day it was inspected. No estimate or guarantee of system longevity is made or implied by a passing determination. ****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: 77 Capes Trail West Barnstable Owner: Eileen Conway Date of Inspection: April 17, 2003 INSPECTION SUMMARY: Check A,B,C,D or E/ALWAYS complete all of section D: A] System Passes: X I have not found any information which indicates that any of the failure criteria described in 310 CMR 5.303 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,or 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 breakout or high static water level in the distribution box is due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. The 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 four 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 a Page 3 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 77 Capes Trail West Barnstable Owner: Eileen Conway Date of Inspection: April 17, 2003 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 and environment. 1 System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2) System will fail unless the Board of Health (and public water supplier,if any) determines that the system is functioning in a manner that protects the public health,safety,and environment The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance **This system passes if the well water analysis,performed by a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form 3) OTHER 3 Page 4 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 77 Capes Trail West Barnstable Owner: Eileen Conway_ Date of Inspection: April 17,2003 D)System Failure Criteria applicable to all systems: You must indicate either"yes" or"no" to each of the following for all inspections: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. yes no X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool. X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow. X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped X Any portion of the SAS,cesspool or privy is below high groundwater elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone 1 of a public well X Any portion of a cesspool or privy is within 50 feet of a private water supply well X 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 by 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 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 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: 77 Capes Trail West Barnstable Owner: Eileen Conway_ Date of Inspection: April 17, 2003 Check if the following have been done: You must indicate either"Yes" or"No"as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant or Board of Health. X Were any of the system components pumped out in the last two weeks? X _ Has the system received normal flows in the previous two week period? X Have large volumes of water been introduced to the system recently or as part of this inspection? n/a _ Were as built plans of the system obtained and examined?(If they were not available as N/A) X _ Was the facility or dwelling inspected for signs of sewage back-up? X _ Was the site inspected for signs of breakout? including X _ Were all system components,exeluding the SAS located on site? X Were the septic tank manholes uncovered,opened,and the interior of the septic tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid, depth of sludge and depth of scum.? X _ Was the facility owner(and occupants,if different from owner) provided with information on the proper maintenance of subsurface disposal systems? For information on the proper maintenance of subsurface disposal systems please go to: WWW.ECO-TECH.US The size and location of the Soil Absorption System(SAS)on the site has been determined based on: X _ Existing information. For example,Plan at the Board of Health. X _ 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: 77 Capes Trail West Barnstable Owner: Eileen Conway Date of Inspection: April 17, 2003 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 gpd Number of current residents 3 Does the 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): n/a Seasonal use(yes or no): no Water meter readings,if available(last two year's usage(gpd): n/a—well in use Sump Pump(yes or no): no Last date of occupancy: current 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: System not pumped in recent past(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: X Septic tank,distfibutien-box, soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no)(if yes, attach previous inspection records,if any) Innovative/Alternate technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight Tank Attach a copy of the DEP approval Other(describe) APPROXIMATE AGE of all components,date installed(if known)and source of information: Age: I I+years Design plan dated 9/30/91 (BOH files) Were sewage odors detected when arriving at the site: (yes or no) no 6 Page 7 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 77 Capes Trail West Barnstable Owner: Eileen Conway Date of Inspection: April 17, 2003 BUILDING SEWER_(Locate on site plan) Depth below grade: 1 ft Material of construction:_cast iron X 40 PVC_other(explain) Distance from private water supply well or suction line 20+ Comments: (on condition of joints,venting, evidence of leakage,etc.) Sewer is vented through roof and appears structurally sound with no evidence of leakage or backup into dwelling_ SEPTIC TANK: X (locate on site plan) Depth below grade: 6 inches Material of construction: X concrete_metal_fiberglass_polyethylene _other(explain) If tank is metal,list age_ Is age confirmed by Certificate of Compliance_(yes or no):_(attach a copy of certificate) Dimensions: 8.5 ft x 5 ft x 5 ft(1000 gallon) Sludge depth: 8 in Distance from top of sludge to bottom of outlet tee or baffle: 26 in Scum thickness: 8 in Distance from top of scum to top of outlet tee or baffle: 6 in Distance from bottom of scum to bottom of outlet tee or baffle: 10 in How dimensions were determined: Probe to top of tank Comments: (on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Pumping recommended at this time and maintenance pumping is recommended every 2 years Liquid level at outlet invert.Tank and tees appear structurally sound and functioning as intended. No evidence of leakage in or out 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: 77 Capes Trail West Barnstable Owner: Eileen Conway Date of Inspection: April 17, 2003 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):_ pumping:Date of last Comments:(condition of inlet tee,condition of alarm and float switches,etc.) DISTRIBUTION BOX: none (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments:(note if box is level and distribution to outlets is equal,any evidence of solids carryover,any evidence of leakage into or out of box, etc.) No D-box was found in spite of probing and snaking the pipe System has been evaluated by inspecting leach pit. 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: 77 Capes Trail West Barnstable Owner: Eileen Conway Date of Inspection: April 17, 2003 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan;excavation not required) If SAS not located, explain why: Type: X leaching pits,number 1 _leaching chambers,number _leaching galleries,number _leaching trenches,number,length _leaching fields,number,dimensions _overflow cesspool,number —innovative/alternate system Type/name of Technology Comments: (note condition of soil, signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.) Soils above leach pit appeared unsaturated. No evidence of surface ponding breakout lush vegetation, or other evidence of hydraulic failure was observed. Leach pit contained 5 feet of effluent in a 6 foot pit CESSPOOLS: none (cesspool must be pumped at time 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: 77 Capes Trail West Barnstable Owner: Eileen Conway_ Date of Inspection: April 17,2003 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'(Locate where public water supply enters the building) LOCATIONS LEACH SPIT A B 1 17 ft 26 ft 2 22.5 f t 23.5 ft 3 71 ft 49 ft 2 B SEPTIC a SHED TANK o I A EXISTING DWELLING # 77 CAPES TRAIL NOT TO SCALE 10 Page 11 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 77 Canes Trail West Barnstable Owner: Eileen Conway Date of Inspection: April 17, 2003 SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to ground water: 90+ feet Please indicate(check)all methods used to determine 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: _ Checked local excavators,installers-attach documentation) X Accessed USGS database You must describe how you established the high ground water elevation. Comparison of USGS topography mans and groundwater contour may indicates that the groundwater table lies over 90 feet below the surface of the lot. 11 CK �► L�`� 33 TROY WILLIAMS �♦ SEPTIC INSPECTIONS °Ito Certified by MA Department of Environmental Protection �w 08) 385-1300 19 Hummel Drive South Dennis, MA 02660 \ COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS �DEPARTMENT OF ENVIRONMENTAL PROTECTION Op� ONE WINTER STREET. BOSTON, MA 02108 617.292.5500 WILLIAM F.WELD TRUDY CORE Govemor Sccretary ARGEO PAUL CELLUCCI DAVID B.STRUHS Lt.Govemor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissioner PART A CERTIFICATION Property Address: 77 ��f�S ��"` �� ✓hs ti�-6�� Address of Owner: Date of Inspection: I/ ��� �`�� (If different) Name of Inspector: Troy Williams /��. $ax s�l I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) Company Name: Troy .Wi 11 iams Septic Inspections Mailing Address: 19 Hummel Drive, SauYh Dennis , MA 02660 Telephone Number: (508) 385-1300 0.24C30 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: asses ` — Conditionally Passes — Needs Further Evaluation By the Local Approving Authority Fails cC Inspector's Signature: V L✓� Date: 1I Az /�s 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 1S.303. Any failure criteria not evaluated are indicated below. COMMENTS: 61 SYSTEM CONDITIONALLY PASSES: 1V/1 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. Indicate yes,no, or not determined (Y, N,or ND). Describe basis of determination in all instances. If'not determined',explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty(20)years prior to the date of the inspection; or the 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. (—i—d 04/25/97) Paq• 1 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) 77 Cape's Trail, West Barnstable,MA Property Address: Tony Distefano Owner: November 12, 1998 Date of Inspection: BI SYSTEM CONDITIONALLY PASSES (continued)�/ � Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). Describe observations: broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four 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 C) FURTHER EVALUATION 15 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 the public health, safety and the environment.. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND 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, I'F APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. _ The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis 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. Method used to determine distance (approximation not valid). 3) OTHER SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 77 Cape's Trail, West Barnstable,MA Owner: Tony Distefano Date of Inspection: November 12, 1998 D) SYSTEM FAILS: A//i? You must indicate ei;,.er "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 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage into facility or system component due to an 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 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. _ Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E) LARGE SYSTEM FAILS: N/A You must indicate either "Yes" or "No" as to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater (large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (r—i.•d 04/25/97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST 77 Cape's Trail, West Barnstable,MA Property Address: Tony Distefano Owner: November 12, 1998 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 normalc flow rates during that period. Large volumes of water have not been introduced into the system recently or / as part of this inspection. Y _ 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. .Y _ The system does not receive non-sanitary or industrial waste flow. �L _ The site was inspected for signs of breakout. _ All system components, excluding the Soil Absorption System, have been located on the site. �L _ The septic tank manholes %Wuncovered, 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) 115.302(3)(b)J (r.vl...d 04/25/97) . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 77 Cape's Trail, West Barnstable,MA Owner: Tony Distefano Date of Inspection: November 12, 1998 RESIDENTIAL: FLOW CONDITIONS Design flow:, g.P.d./bedroom for S.A.S. Number of bedrooms: .3 Number of current residents: O Garbage grinder (yes or no): No Laundry connected to system (yes or no):yFS Seasonal use (yes or no): /Vo Water meter readings, if available (last two (2) year usage (gpd): / Y ✓� f'� (�t//. Sump Pump (yes or no): A/O Last date of occupancy: u.�„ ✓d,t S . COMMERCIAUINDUSTRIAL: A Type of establishment: Design flow: gallons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)— Non-sanitary waste discharged to the Title S system: (yes or no) Water meter readings, if.available: Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: /�/�7`d .,1+�1oh¢�„ � 44V �i✓S'�- TTG/ 1/4 c. System pumped as part of lnspectlon. (yes or no) A/o If yes, volume pumped: gallons Reason for pumping: TYPE QF SYSTEM _� Septic lank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) VA Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known) and source of information: 16116 �✓ CJ.g , Ei u 0- Sewage odors detected when arriving at the site: (yes or no) �D I r.v.i•.0 04/25/971 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 77 Cape's Trail,West Barnstable,MA Owner: Tony Distefano Date of Inspection: jNlovember 12, 1998 Jv BUILDING SEWER: 119 (Locate on site plan) Depth below grade: Material of construction: _cast iron _40 PVC _other (explain) Distance from private water supply well or suction line Diameter Comments: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK: V (locate on site plan) Depth below grade: /D�r Material of construction: Vconcrete _metal _Fiberglass _Polyethylene —other(explain) If tank is metal, list age _ Is age confirmed by Certificate of Compliance _(Yes/No) Dimensions: S sC q x- ' /666 Sludge depth: T Distance from top of sludge to bottom of outlet tee or baffle:y Scum thickness: a NL- Distance from top of scum to top of outlet tee or baffle:No Sc- Distance from bottom of scum to bottom f outlet tee or baffle: V6 S z-✓+1, How dimensions were determined: 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.) P/ C. "r /a LJ GREASE TRAP: /V 119 (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: (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:) (—vis.d 04/25/97) ,,, _ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 77 Cape's Trail, West Barnstable,MA Owner: Tony Distefano Date of Inspection: November 12, 1998 TIGHT OR HOLDING TANK:AA(Tank must be pumped prior to, or 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 level: Alarm in working order Yes; No Date of previous pumping: — _ Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: t/ (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.)_A—�3, .. O W Ji WCrr Jf.�.� .4 k A h O h f �4+ 4A, ; � �I—boX 0- 8z.x Wa, PUMP CHAMBER: (locate on site plan_,i�) 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.) (r-i-d 04/25/91) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 77 Cape's Trail, West Barnstable,MA Owner: Tony Distefano Date of Inspection: November 12, 1998 SOIL ABSORPTION SYSTEM (SAS): (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. OHS c L et 1' 3 '5)o 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,Si ns of hydraulic failure, level of ponding, condition of vegetation, etc.) o r 1 S ✓h >LC 6 L S c...11 a-s �i r.� rd y s 1. /� >< dt 5, r . CESSPOOLS: A114 (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(cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY:�fjl (locate on site plan) Materials of construction: Depth of solids: Dimensions. Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (—v1e.d 04/7S/97) ' P�q• ! or 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C w,l SYSTEM INFORMATION (continued) Property Address: 77 Cape's Trail,West Barnstable,MA Owner: Tony Distefano Date of Inspection: November 12, 1998 SKETCH OF SEWAGE DISPOSAL SYSTEM: 143 t include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) I G.-r I 3 � 59 8�. f /aoa y0.f(a yy,� vQ 86 T UN A (r.vi..e 04/25/97) ..' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 77 Cape's Trail, West Barnstable,MA Owner: Tony Distefano Date of Inspection: November 12, 1998 Depth to Groundwater _ Feet adjusted high groundwater level Please indicate all the methods used to determine High Groundwater Elevation: V✓ Obtained from Design Plans on record Observation of Site (Abutting property, observation hole, basement sump etc.) V/ Determine it from local conditions 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) ll � - i5 h a�-► � ry.r�,� �..%c��"cv � �a o. �.. r, � i-,,,u�•.., U /c' 'Pj�S� � .. t600t, . �. ✓� ./ �` r/p r .nc� vti �- �r /¢ :Jell, �� � l.'J!�S o..�S o c�✓cf �n .,,y�.p c.c_�e �. �5 � 'Ter t� Iravi—d 01/75/97) t' Page 10 or 10 ,�1 v wN RNSTABLE LQ.:.,ATION � ��,.g�-f-�S �L SEWAGE # ��— PY3 �. VIL*LAGE_ M. f-4�(,�' ASSESSOR'S MAP & LOT INSTALLER'S NAME PHONE NO. X3W7ZrZ6'"7 C' NK7— SEPTIC TANK CAPACITY O f LEACHING FACILITY:(type) (size) 61)C AI NO. OF BEDROOMS RIVATE WEL R PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes Ss�D v P/ 0 cJ' ® So Y W Ficz THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF H (°H / ---------...............OF,...- ... ................. - Appliratiun for Disposal Works nutrixrtiun jrrmit r Application is hereb made for a Perim* o Construct ( or Repair ( ) an Individual Sewage Disposal System at: .. / .. ..- • .......................•--_.... ..........------•------------............... ..------...------.._....---••--••-----•-- .---- ess ..........--...........................................or Lot No. ner Address W ,-a .....................................•-•_....------•---•---- ....._........ ................ ..-••-••••••.........._..-•--••-••-•-•-------••••.................•••-•........••---•---•------_.. Installer Address Type of Building Lo _ __Q 1 ----- der ( ) per, Other—Type of Building .._ No. of persons............................ Showers ( } — Cafeteria ( ) a' Ot es ----•-----------•-------------•------•--•-------... d Design Flow... ..................................gallons per person per day. Total daily flow__:_..__ gal W r ----•----•..............L._/_ Ions. WSeptic Tank—Liquid capacity/M.P__gallons Length :L:0.__ Width. rP__._ Diameter________________ Depth _,-.0.._.-- x Disposal Trench—No..................... Width.................... Total Length.... ....... Total leaching area....................sq. ft. Seepage Pit No.-PA./A.------- •ameter..../2 ........ Depth below inlet_. .!- ..... Total leaching areaa.,3J?:_.sq. ft. z Other Distribution box (.o/ Dosing tank Percolation ( ) '-' Percolation Test Results Performed ��........................... Date__/!__ !.�_ ............. minutes per inch Depth of Test Pit... Depth to ground water..- -0.-.____---. Test Pit No. 1.._.__<_�d_�___. _________. � (� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ -_••-•• ----------------------•-•--•---------•----------.......----.......----•---------------------------••-•-------------------------------------•-••- ODescription of Soil........................................................................................................................................................................ W (� -------------•----------_________--------------------___----------------------•---_... --------- ..._.....------------- -------------------------- •------------------- •-----------•-------------------- 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 the system in operation until a Certificate of Compliance has been su by th o of health. Signed.... .... t� ,l.9z_._ Date Application Approved By.. _.......:. - � ~ ��-------...... Date Application Disapproved for the following reasons:.............................................................................................................. --..._...-•---•---------------•----.....-----•----------.........-------------........_.......................--•-------••--------•----------•---...-.------------•--••••--•-•••-•••-•-•••-•••-•--------- Date PermitNo........ -------------------- _ Issued._.....-------------------••--•-•-••----•-7.L-,- ----•- No.--!t'- F�s.....�it�Q......... THE COMMONWEALTH OF MASSACHUSETTS - BOARDS JF H H ...�132.i4r.........................OFF ...................... App iration for Disposal Works ustrurfuart ramit Application is hereb . made for a Perm i -.to Construct ( C. or Repair ( ) an Individual Sewage Disposal System at: . .. =, :...-------------------------- .................................................................................................. C,. +dd,ress or Lot No. l 4 ner Address W ..................°�..... .. --•---••------•----------- --- -----.......------------•--------•_........ ,.� � Installer........ Address _,� UType of Building ,,Size Lott E_.�%`. .......Sq. feet I—I Dwelling—No. of Bedrooms._ _ _ ___________________Expansion Attic O Garbage Grinder ( ) PL4 Other—Type of Building --:�,:. ' No. of persons Showers ( ) — Cafeteria ( ) a . Otl,1gyfytures . W Design Flow... ;> �...............................gallons per person per day. Total daily flow-.-,.! -. __......._...._.______..__�lons. WSeptic Tank—Liquid capacityA,,!.�_..gallons Length/ _ ___ Width..-.L._'r�._. Diameter________________ Depths-t ...... x Disposal Trench—No..................... Width................... Total Length...... Total leaching area....................sq. ft. Seepage Pit No._Z4?An4`...... iameter.._. �, .-........ Depth below inlet........i. .._.. Total leaching area,13._�:...sq. ft. z Other Distribution box ( .,le Dosing tank ( ,) Percolation Test Results Performed by__, �}� �::: ``.,, �. __•- Date.. -` ! r O ------P ground Test Pit No. 1....... minutes per inch Depth of Test Pit... y _......... Depth to water... _ -__---_-__. Gr. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ R.4 ....------•-•-••--------------•-------•---•---------------•----•-•--•------------------------------•....................................................... 0 Description of Soil........................................................................................................................................................................ W U ••---•---••--•-•••-•-------•---••------•--••----------------------------••-----•---•------.....-••-------------•----••-------•••-----•---------•-----•-----..........-----........------------•---.-•--- W •------------------------------------------•-------------------------------•-----•----...-•••......---•-••---•-----------••--••-•----•---••...•--•--------....-•-----•-•-----••-............._......... 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 TITIS 5,of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate-of'- ertificate of'-Compliance has been /ssuk'd by L e roam of-health.- Signed....------------------------------------•-...---r....--- Date Application Approved By............. .._.�?_� . ....... ._g_�_Q'tf Date Application Disapproved for the following reasons:----•-----•-------•--------•-------•----•-•-----•--•--------•-------------------•--............................ ....-•-•------•-------------••---...................-•---------•---•--.....--------..........------•-•---•--------------------------•-----•-•---.......----------------•-------....--•-••---••••----•--- Date PermitNo........�•---'-----V --)--------------•__ Issued_..................•.................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALTH ...'..... ..!........................OF .. '~ .....' `.. ........... THIS IS TO CERTIF, Y :hat the Individual Sewage Disposal System constructed ( or Repaired( •^) ✓"`� Ins 'taller has been installed in accorda4ce with the provisions of TITIFp� of The State Sanitary Code as described in the application for Disposal Works Construction Permit No._. ... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION Tl FACTORY. DATE................................ =N --------------------------- Inspector................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............ L............OF....:' . ....... ... ............•----._................................. f9G� No. ..... FEE..... .......... Permission is hereby granted.......... 1_. .....................� ................................... to Construct ( " or Repair 1' an Individual Se rage Disposal System atNo............. d --- --------....t-- ...............I. /---•-- Street CA as shown on the applica ion for Disposal Works Construction e-rmltt No. I��> _ _ � ated---_-•--____ ...................... - ' t f Board of Health DATE. , -•.------- ................................ FORM 1255 A. M. SULKIN, INC., BOSTON y «®. .. az 2 • , ` z Tiff? 't t„r„r m ,t r , . . E��ROTECH LABORATORIES§ \ ® Mass. Cert.+MA063 § 449 Route 130 Sandwich,Mw053 . 7o\ R8R-40 \ / \ \ \_ . / CLIENT: Dick Schrader 22222g§� tot SJ Capes Trail, Berkshire ) ADDRESS: £ai s, ar sta e - � W. - \ / COLLECTED BY: L Wile SAMPLE DATE-9-19-91 TIME 8am § . DATE RECEIVED. SAMPLE ID: § / JOB New Well 147 to Water j / WELL DEPTH: g r . G RESULTS OF ANALYSIS: E - r . R Parameter Units Recommended limit Ra<! k / Cdlf m b deea/10 ml (MF Method) O O E / pH pH units 6.0-$5 - 6.7& / Conductance u m hmZem 500 \ / . 7& / § Sodium ' mgZE/ .0 - 8.3 _ / RR@EN mgZE 10.0 <0 03 : . E _ j Ron . . _ mgZE $3 0.52 § Manganese mgZE ¢05 / 0.08 Hardness mgZE as CaCOJ . 5 O 11 .2 \ Sulfate mgZE 22 \ - 11.4 r Potassium mgZE 2¢O . E O.5 / Alkalinity mg/[ --- —- QQ - - 7 4.4 \ E Chloride mgZE 25 c . . / 15.0 J % Turbidity NTU 5.0 20 \ K Color . APC unitsI&O ¥ . , 18 A _ . a Background bacteria . • - \ %� COMMENT:. Iron level is not a health h 2 hazard. % _&R EPA 601/602 =R/E Below Reporting Limit# \ See attached report 4 k � E � E Ye No WATER S SUITABLE FOR DRINKING PURPOSES FOR PARAMETE ESTED. \ _ G � DATE g i►� 1 Li!!! ! !!!!! w!!it! i!! ! i i i i� ! ! ! ! i GLEE! s. GROUNDWATER / ANALYTICAL EPA METHODS 601 and 602 . Volatile Organics (GC/PID/ELCD) Field ID: Z-387 Lab ID: 1987-01 Project: Shrader Lot 33 QC Batch: VGA-847 Client: Envirotech Laboratories Sampled: 09-19-91 Cont/Prsv: 4Oml VOA Vial/NaHSO4 Cool Received: 09-20-91 Matrix: Aqueous Analyzed: 09-24-91 PARAMETER CONCENTRATION REPORTING LIMIT (ug/L) (ug/L) Dichlorodifluoromethane BRL 5 Chlor.omethane BRL I Vinyl Chloride BRL 1 Bromomethane BRL 5 Chloroethane BRL 1 Trichlorofluoromethane BRL I 1,1-Dichloroethene BRL I Methylene Chloride BRL I trans-1,2-Dichloroethene BRL 1 1, 1-Dichloroethane BRL I cis-1,2-Dichloroethene * BRL 1 Chloroform BRL I 1, 1, 1-Trichloroethane BRL I Carbon Tetrachloride BRL I Benzene BRL I 1,2-Dichloroethane BRL I Trichloroethene BRL I 1,2-Dichloropropane BRL I Bromodichloromethane BRL 1 2-Chloroethylvinyl Ether BRL I trans-1,3-Dichloropropene BRL I Toluene BRL 1 cis-1,3-Dichloropropene BRL I 1, 1,2-Trichloroethane BRL I Tetrachloroethene BRL I Dibromochloromethane BRL I Chlorobenzene BRL I Ethylbenzene BRL 1 m+MPylene * BRL I o-Xylene * BRL 1 Bromoform BRL I 1,1,2,2-Tetrachloroethane BRL I 1,3-Dichlorobenzene BRL I 1,4-Dichlorobenzene BRL I 1,2-Dichlorobenzene, BRL I QC SURROGATE COMPOUND SPIKED MEASURED RECOVERY QC LIMITS Bromochloromethane 30 31 103 % 83 - 117 % Fluorobenzene 30 30 100 % 87 - 113 % BRL = Below Reporting Limit. * Non-target compound. "Trace" indicates probable presence below listed Reporting Limit. Method References: Method 601 - Purgeable Halocarbons and Method 602 - Purgeable Aromatics, 40 C.F.R. 136, Appendix A (1986). i 3 r Department of Environmental Management/Division of Water Resourges WATER WELL COMPLETION REPORT r WELL LOCAT ON GEOGRAPHIC DESCRIPTION Address 0 s /� 0 S E W of C Il� ee,rl (circle) City/Town /`�Z 5//���9 IfId Well owner 'C ♦ (road) Address G F• 0 N(3 E W of S5 (mi.in tenths) (circle) Board of Health permit: yes no ❑ intersect. w/ (road) WELL USE WELL DATA Domestic Public❑ Industrial ❑ Total well depth ft. Monitoring❑ Other Depth to bedrock ft. Water-bearing roc lunconsolidated material: Method drilled o Description DateBrilled Water-bearing zones: Type ype y 1) From�To / d pp� r 2) From To LengthZa� ft. Dia(l.D. 4 in. 3) From To Length into bedrock ft. /[ Gravel pack well:/VQ dia._, Protective well seal: try( C) Screen:Grout-0 Other Slotd1_� length Saa.fro —to l PUMP TEST f� Static water level below land surface f�ft. Date/ / DrawdowilF�ft. alter pumping '� hr.-30 min/at_,gpm 'How measured '— Recovery 1411L ft. after--,/—hr.�min. o LOG of FORMATIONS COMMENTS Materials From To - Drille P I f Q. Mass. egistrati '..Fir � r" t�• �d Address / y� CitylTo n � W / .!/4 si nature.ol.su ervising.re istered well drl!!er ' Please Print firmly BOARD OF HEALTH COPY BOARD OF HEALTH TOWN OF BARNSTABLE ZippYitation-*rVefi Con5tructionpermit Application is hereby made for permit to Construct ( ), Alter ( ), or Repair ( )an individual Well at: � � ?'�----- --- -- -- ---- ----------__-_-_-- - Location — Address Assessors Map and Parcel caner — — -----------------------------Address,____—_—_ - —------ Installer — Driller Address Type of Building Dwelling -- - --- -- ---------------- Other - Type of Building ---------- No. of Persons--------------------------------------- �t Type of Well- - V- ------ -------- Capacity ----Purpose of Well — --- ------------------ Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation The undersigned further agrees not to place the well in operation unti a Certificate of Compliance has been issued by the Board of Health. �p, f Signe - -- - !�" ------ !� date Application Approved By - ----- -!' `'_�__ __�___ 00'o-� � date Application Disapproved for the following reasons:---------- ---- -- - --------------------------------------------------- --- -- ---- - --------------------- _ date le- Permit No. -�`='— -�J -1—�- -- - — Issued-- - -- —Ir - date BOARD OF HEALTH TOWN OF BARNSTABLE Certifirate ®f Compliance THIS Ili T RTIFY, T at the Individual Well Constructed Alter ( ), or Repaired ( ) - ------------------- - - A- -- ----p-- — ---- —— - I�nst Iler, -------------_---- has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. THE ISSUANCE'OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE----------------------------------------------------------- ----------------------- Inspector- -- - - --_- ---- - --_-- - - V�c ------ -- - ----- No. Fee-2-6 BOARD OF HEALTH TOWN OF BARNSTABLE Application-*r Well Con0ructionprrmit Application is hereby made for a permit to Construct Alter or Repair ( )an individual Well at: -------- -------<; I- 1\ ------------------------------------------------------------------------- loca ion Address — Assessors Map and Parcel jPh- �h ft -ner4 --Address ---—--- —-—----------- ---------------------------------------------------------------------------------- 7--- -----------ee------------------------ -------------------------------------------- ------------------------------------------------------- Installer 7 Driller Address Type of Building Dwelling----------------------------------------- Other - Type of Building-------------------------------- No. of Persons----------------------------------------------------- Typeof Well- -------------------- Capacity-------------------------------------------------------------------------------- Purpose of Well- --------------------------------- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation unti a Certificate of Compliance has been issued by the Board of Health. Signe, - ---------—------------ ----------------------------------- date Application Approved By --------- -I-�- ...... --- ---------------date Application Disapproved for the following reasons:----------------------------- -------------------------------- -------------------------------------------——------------------------------------------------------------------------------------------------------------------------------------------------------- -V ."�— //,,- R- ,-'l date PermitNo. ------------------------I----------------------- Issued--------------------------------- date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate (Of (Compliance THIS IDS T� CERTIFY, Tat the Individual Well Constructed Itered- or Repaired VN ------ ---------------------------'T----------------------------------------------------------------------- Instler N ----------- it �4,T- z - - -----A�,- V--------------- -------- t --------------------------- has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. *A�gA-A:Xa*t(ed----- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE------------------------------------------------------------------------------------- Inspector—----------------------------------------------------------------------------- BOARD OF HEALTH TOWN OF BARNSTABLE Well (Cow5truct ion Akrmit No. V-V---------------- Fee------------------- Permission is hereby granted'to Construct O/Alter or Repair an Indivoual ®ellfat: No. - ) r --- ---- --------------------- --------R 0-------5,h-1- --- ---h AflA, Street as shown on the application/four- pplication for a Well Construction Permit No.---------- -------------------- -------- ------------------------------- Dated--------------- Jo ----------- Board of Health DATE------------- 00 y gtitliliT?ditrr,rtiiitTPr?tS????TTTtTTT'tin???TTtTTiitiitnrt,T1?nt?Tj??T?Tn?Tt.T?T?TTTt?i?TTTTTT(T?iTTT1?t?i?ni1TTF?t, nrT+f,�nITrr„rt! trtfn+Tnr�r:f n,rtr n tr,nni!itn+ttr ntt+r,ni n t t tnt tngt ,. i . :: T ENVIROTECH LABORATORIES BE Mass. Cert.#:MA063 449 Route 130 Sandwich,MA 02563 (508) 888-6460 _- -- CLIENT: Dick Schrader LOCATION: Lot 33 Capes Trail, Berkshire _= Trails, W. Barns--t-aTIe ADDRESS: COLLECTED BY: L Wile SAMPLE DATE:9-19-91 TIME: Sam DATE RECEIVED:9�T - SAMPLE ID. New Well 147 to Water JOB x: _ WELL DEPTH: RESULTS OF ANALYSIS: c. Parameter Units Recommended limit Result z Coiiform bacteria/100.ml (MF Method) 0 0 pH pH units -- 6.0-8 5 6.74 E: Conductance umhos/cm 500 74 = ` Sodium mg/L 20.0 8.3 ;r Nitrate-N mg/L 10.0 <0.03 Iron mg/L 0.3 0.52 Manganese mg/L 0.05 0.08 Hardness mg/L as CaCO 500 3 11.2 c BE. mg/L 250 11.4 .i Potassium rng/L 20.0 0.5Hi Alkalinity mg/L 200 4.4 - Chloride mg/L 250 15.0 Turbidity NTU 5.0 20 Color APC units 15.0 18 3 Background bacteria - COMMENT: Iron level is not a health hazard. EPA 601/602 ug/L Below Reporting Limit See attached report '= YES No WATER IS SUITABLE FOR DRINKING PURPOSES FOR PARAMETE ESTED. _ c. DATE c. '1' ili lliil 11U111!!liilllilldl I,ll1!!lllUllitl11U111111111!l1111U!lilllUl!!lU 11!lUu1111Uu111111U111111Uulidt11111uult,t!�!!t llUliiiii 1141 r GROUNDWATER ANALYTICAL EPA METHODS 601 and 602 Volatile Organics (GC/PID/ELCD) Field ID: Z-387 Lab ID: 1987-01 Project: Shrader Lot 33 QC Batch: VGA-847 Client: Envirotech Laboratories Sampled: 09-19-91 Cont/Prsv: 40m1 VOA Vial/NaHSO4 Cool Received: 09-20-91 Matrix: Aqueous Analyzed: 09-24-91 PARAMETER CONCENTRATION REPORTING LIMIT (ug/L) (ug/L) Dichlorodifluoromethane BRL 5 Chloromethane BRL 1 Vinyl Chloride BRL 1 Bromomethane BRL 5 Chloroethane BRL 1 Trichlorofluoromethane BRL 1 1, 1-Dichloroethene BRL 1 Methylene Chloride BRL 1 trans-1,2-Dichloroethene BRL 1 1,1-Dichloroethane BRL 1 cis-1,2-Dichloroethene * BRL 1 Chloroform BRL 1 1,1, 1-Trichloroethane BRL 1 Carbon Tetrachloride BRL 1 Benzene BRL 1 1,2-Dichloroethane BRL 1 Trichloroethene BRL 1 1,2-Dichloropropane BRL 1 Bromodichloromethane BRL 1 2=Chloroethylvinyl Ether BRL 1 trans-1,3-Dichloropropene BRL 1 Toluene BRL 1 cis-1,3-Dichloropropene BRL 1 1, 1,2-Trichloroethane BRL 1 Tetrachloroethene BRL 1 Dibromochloromethane BRL 1 Chlorobenzene BRL 1 Ethyl benzene BRL 1 «np-M ene * BRL 1 o-Xylene * BRL 1 B•romoform BRL 1 1,1;2,2-Tetrachloroethane BRL 1 1,3-Dichlorobenzene BRL 1 1,4-Dichlorobenzene BRL 1 1,2-Dichlorobenzene BRL 1 F QC_�SURROGATE COMPOUND. SPIKED MEASURED RECOVERY QC LIMITS _r Bromochloromethane 30 31 103 %. 83 - 117 Fluorobenzene 30 30 100 % 87 - 113 BRL = Below Reporting Limit. * Non-target compound. "Trace" indicates probable presence below listed Reporting Limit. Method References: Method 601 - Purgeable Halocarbons and Method 602 - Purgeable Aromatics, 40 C.F.R. 136, Appendix A (1986). LOCATION 77 Cap s Tm, I SEWAGE k VILLAGE la.1EST g&kk4Lk&-C ASSESSOR'S MAP&LOT1Uk' 7 INSTALLER'S NAME PHONE NO. R000tDi4f COWS 1- SEPTIC TANK CAPACITY LEACHING FACILITY: (type) Q l f (size)G XG w 3 4 510,1 f NO.OF BEDROOMS + BUILDER OR OWNER S0'taanr PiwerS PERMITDATE: 10/1 G��1 I COMPLIANCE DATE: l2/R 1 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Sy } Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 700 feet of leaching facility) too+ Feet Edge of Wetland and Leaching Facility(If any wetlands exist 10)f Feet within 300 feet of leaching facility) Furnished by_ECo^ 'taH F-Ijt WINIENTAL LEACH PIT LOCATIONS A 8 1 17 FL 55.5 FL ! 2 22.5 FL 58 FL SEPTInc® 3 71 FL 89.5 FL A EXISTING ° OWELLING ` # 77 . o WELL-OvER 100 FEET TO LEACH PIT. CAPES TRAIL NOT TO SCALE 1 a O F' //3l/,�— W N0 RNSTABLE LOCATION Gd]Rf3, SEWAGE VILLAGE &J. �,AeA .�fG1GF ASSESSOR'S MAP & LOT �08 oa�U INSTALLER'S NAME & PHONE NO. W ZZe)V C41.,J ,— SEPTIC TANK CAPACITY ,-&V LEACHING FACILITY:(type) ,7" &J (size) 6DC/02 NO. OF BEDROOMS RIVATE ' EL R PUBLIC WATER BUILDER OR OWNER /96,5,3 RU/aEPS DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTI}D: Yes N R P►L 1 �a _ TOWN OF BARNSTABLE L'y7CAnON 77 rajo es 'm, I SEWAGE # VILLAGE WEST � 1' ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. g000t®"Il' 1 C0115f l- SEPTIC TANK CAPACITY t 000 v LEACHING FACILITY: (type) (size) G x6 6J 34 S7�i�t P NO.OF BEDROOMS BUILDER OR OWNER S024hhr D2+Vetr PERMTTDATE: 10t16 COMPLIANCE DATE: 0,14 I Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility TO f Feet Private Water Supply Well and Leaching Facility (If any wells exist ®O on site or within 200 feet of leaching facility) + Feet Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) Furnished by 60~ T-ec H E yo RDb NEWTAL LEA C PITH LOCATIONS +' 3 A B 1 17 FE 55.5 FL 2 2 22.5 FE 58 FE SEPTIC 3 71 FE 89.5 FE TANK o A g EXISTING DWELLING # WELL - OVER 100 FEET TO LEACH PIT. CAPES TRAIL NOT TO SCALE i a . gajr - . :.'i...-. ....:. _.:..aFi�a-. , C' •_-..x. _. .- < ... - • F s. ......n v4. tlw. - M�n - rr a. _. L d ti Z ry) i J 000r ! E el cp i 1 i i P I Floor — 1 ,n -JIaC� c � Z9 i ! "ao , 1 c a I � 4 �;_ �'IN s,. � - ,.,.�x- ai�s=.�a��mi:''✓'�' �:3. :1_a"�'�'.?.'.',�'x..^,-' h �,:,•.,Y .�..�..�b"k...,.,,,...y?e ...a.#..�a�,'� xe.�P;�i" �t �*�«+;c? kP, x!. ..g ,�a. _tom"' x,�..e - . 555 Y �i T i Cr y tr I ! I �' _ O • I � i if • R -Hq3 j 7TJP OF Ft omilwN 2 LAYS OF cower covaxs �. 4 RISER MS D GROUND EL=�4 <. WAS7 STOW INVERT'INTO '7Tl CIONO TE G10 1pnw 12�fIXORSCf18DULd' 40 R V-G P1PL i 1/4` rr p�SCJMVLS 40 P.V. p Fmw LINE P11Y7Sf 1 4 'Pale Fl air EL = 45.87 "pa, PRiCAST • 11VY6RT14 :i �� LBIG�IDI� I aR EL.= 52 0 r CRV.%=a i I7lYILSIVT E 51. 78 sm�. .i:a:::: wtaler �o 11vvtRf L= - 3 Ea. o 51- 6.0 s 4 1ti 1 _ . . , EL. .51. 72 `��, o . 20' 1000 GALLONS 30 „,, , o c; . . el --- 39.87 �---- D A. . . 6.D I r_.. LthAQY P1T - 12.0 CA P.�,S' TRAI .._�_..... L s O R PROBABLE WA TABLE' 9L- " BOTTOM D ,TEST H LE O USGS ?�R GE ` F �'LE .M.H.�o . _ AS ELEC. TRANS PROFILE _ OF TEL s : CABLE' - CABLE _ W G ISPOSAL SYSTEM _ .� � -- ELEC _ SE A E WELL ; ~ DESIGN DAT . , TEL. r D.E' I A : ` TC� SCALE -NOT q >, 3 g , NUMBIKR OF BEDROOMS : o VATIONS ALL ELE ASSUMEDNONE . GE DISPOSAL '` ALL ,., _ 39. D r 3.4!� REFE,RE1!CE NAIL .SET 1 - - 330 GPD s TOTAI ESTIMATED FLOW 24 o N o IN RTREE' T.B.M., EL— 54. 0 , • 3 ~PROPOSED _ 110 GAL, .R DAY g, BR. GARAGE - ..� 18 c4 USL' 9 .; 00 b 1 0 GAL . TANK 74 SEPTIC .TANK. CAPACITY O A 'REQUIREMENTS ' o - � LEACHING .ARE 2 / 25 ': 28. 'SOIL IL LOG �. �.NZ�EWALL .AREA ..:.:.— . GAL �F DAY _ / �' DATE B -0.61 BOTTOM AREA -71 , ' GAL S F. DAY h O P7816 .911 353 GAL WITNESSED .BY.DONNA Z.- hii ORAIVDI LEA CJYWG CAPACNI'Y BOTTOM & SIDEII'ALL . — x -. 1 .P r $ h v 5.„p ,_ TOWN OF BARN,STABLE"HEAL TN Off10ER 8.28(BXB) 226-X 1.2 . 11 0 _ O_ 3.14 36 =113 X PERFORMED BY. _ _ ,, � , 5 G CAPACITY __ GAL DAY 6 E ENGINEERING RESERVE,LEACHIN UPPER' CAP h 0 ; 1 2 09 150 = 13.6 = EL 52.80 0 _ PERCOLATION RATE' _MIV cH IN •SLOPE 1 11 = � ,.. LOT ")�/] ]may 7 ] OLE TEST H 1 ; 3� o w. a REMOVE ALL IMPERVIOUS MATERIALS FOR .,_ . . . . C M t A , 4 >�a , S r P 53.B7 ': 10 ALL :AROUND AND REP.L.4CE yPITH. CLEANLOT ,,.., ./ COURSE SAND BELOW INVERT TO EL 45.87o �A� T S,�rPIT S - A 3 EL 5 .8 .1 .. NEW MEFi17 _..._ . , : osm co vRs No.32098 e PROP IVT O '. 9 O o TILL` CLAY o d 5 _ F � ,- . COBBLES �fSTE e / s , Is'X15T7NG!CONTO�3RS , s✓ s 6 o q © 3 8 EL 5 ,� � �•,.r ra 45.87 4 33 , 9 ! b . . _ PACKED - ti , SAND , 6 n FLOOD ZON.�° C • ;, 6 _ � _ _ it » JOH1� _ rN.4 R ENCOUNTERED RES. BONE. RF'JpA� .,O t -:. !Y a �{ i .' -. - 7 . . .FLAN a�4EF. 462 _34 S, 56 5S 3 c . AE . ; d,TEC - CATION. . :.. - S _ L -LOT ,33 ,.CAPE TRAI - : _ , O VED. BOARD OF :HE�LTLI. . Roar y WEST B.ARNSTABLE` APPROVED: sA : ,r P C , ,aI E AP LI AIJ DA T NG COMPANY . UILDI A Y ROES:, _ NOTES. _ GENERAL E' _ _ h V.C.. A1VIfEE .SURVEY CONSULTANTS SC ULE' 40 P O 1. ALL WIPE TO BE 4. ,D 4 O UTE 49 , .. P. O. BOX 265 1 3 R 1 ALLATION OF NEW SEPTIC SYSTEM . - 2. THIS PLAN`IS FOR :INST . - , .: MARSTONS...MILLS M�''02648 E S ARY SYST,'M SHALL NEE ..APABLE - D , t 7 ALL COMPONEN75 OF TH ANIT . ST. LPH, 4 0 _ ,¢ _ �` _ 3. TIIIS PLAN IS FOR INSTALI�4TION/ REPAIR OF SEPTIC SYSTEM S PURPOSES. OF WITHSTANDING H--10 LOADING UNLESS "THEY ARE UNDER LOCUS OR ON G PURP ` AND NOT TO,BE USED FOR SURVEYING Z IN ^. S OR PARKING .AREAS. II 20 L ADWG _ 'OR WITHIN 10 OF DRIVE ,:, .- :.. _ ', . TE•r SCALE` ,Y.,:OR A7T1111V i0 OF Dl1'.jE'S ORPARNG. 1 , — 40 0 30 914. ALL iPORIf4fANSHIP AND MATERIALS SHALL CONFORM TO D.E 1? :SHALL:BE• USED UNDER � � [D2 � � _ TITLE 5 A1VD TIC' 'TO AN OF BARNSTABLE RULE'S :AND ''REGULATIONS UNLESS NOTED. MIDCAPE HIG A Y , : SHALL W 8. ,,ANY MASONRY:UNITS USED TO BRING COVERS TO GRADE .DISPOSAL OF SE AGE._ REV. V FOR :THE SUBSURFACERE . 5. ALL COVER 'TO `SANITARY,.UNITS SHALL FIE BROUGHT TO WI7"HIN BE MORTARED`W PLACE. 12" OF FINISHED,:GRADE. 9. NO DETERMINATION HAS.BEEN MADE AS TO CO,AMPLIANCE A7TH _ - � , STD - FS,�WETr OR ZONING: REGULATIONS. O WNER, APPLICANT l JOB NO.ES 'SHALL REM.97N ESSE11rTIALLY- THE DEEDED ,6. EXISTING .AND FINAL GRAD 5�D 711 OF. 1 ` � LOCATION MAP- _ . O I L SAME UNLESS NOTED BY FINAL `COIVTDURS OBTAIN SUCH DETERMINATION:FROM APPROP.AlA TE A UTH R` TY Fti}i�! III 4- vt N/F PAUL C. & R/CHARD CNARLES & GEOR01A CONSTANTINE f MAP 109 PARCEL 1,3--7 HA)VON 'S ' MAP 109 PARCEL 15-8 ij i 1 { gg , ;x Y• a ta# Ac r §a- ,. .> ai t 4 Pn Fi;'. c yt vfr,. c I ro r gl k a.S[ h r p r y C : {;H t{}#f !.4tFt 7 -<_ y. r 5 # ,gs x CAPES TRAILfr • � (P(TBLIc so' WIDE)) ` Y xr ifP rg #�hF v ¢EI€�¢ 'y¢jrYtpppgbi r ' a t 77 - :, i . §' S j gt 3g2 cts tx<Ij' qqIs, i8$ if # r �t f•¢1, t'`F,,* • 2;ti "! yjig!i A�` YL s ,'::r , &1,; 'hK s aF=150. 8 gW _ Ef .3 I I I €! _r:•'k �`` ( pp .0 $ 3 F'; f ,Y.':s [ {,5'.;Y{ i.: (£ :; s.g g e# 31 '..F #T ac [Ihg g!"Ik€#li,. R�025. }{g " - {.?hs.?'i:''. '. ;s ° t y„ , .t. 't a as {, I,..II'. # € c 6 LOAM & SEED IMIN. F.G.= 175.1 ... r; MAX. F.c.=177.1 LOCUS MAP � m 2" LAYER OF CLEA9"MINKFILL TOP OF PEASTONE SCALE: 1"=2,000'f 1/8" TO 1/2" 3' MAX ELEV.=174.3 DOUBLE WASHED GENERAL NOTES. f \ .......... f. PEA STONE :6.4 ::�::11 6 11 :o p 1. RECORD OWNER(S): JESSICA L FALLEN c c a a •a -77 CAPES TRAIL ? as a a ° a° 3/4" WEST BARNSTABLE, MA 02668 DESIGN FORMULA: ° -4 .� ° 4 > ° o TO 1-1/2- BOOK 24820 PAGE 156 N \ NO GARBAGE GRINDER ALLOWED WITH THIS DESIGN 6 INCHES 4 °° Q ° ' .6 a PQ ° DOUBLE JESSICA FALLEN �`, SYSTEM REQUIRED PROVIDED MINIMUM •P .d ° 4 ° ° 4 ° 4 °° WASHED 2, THE PROPERTY IS SHOWN ON THE TOWN OF BARNSTABLE ASSESSOR'S MAP 108, PARCEL 28 { ra Q p p a p a p a STONE MAP 108 PARCEL 8 o p o p p #77 CAPES TRAIL DAILY FLOW: 3. THE PROPERTY LIES WITHIN THE RF (RESIDENTIAL-F) ZONING DISTRICT BASED UPON A REVIEW OF 6.0 TYP AREA=43,896 SF� 4 BEDROOMS ® 110 GDP/BEDROOM 440 GPD 4" PERFORATED THE TOWN OF BARNSTABLE GEOGRAPHIC INFORMATION SYSTEM (GIS). SCH 40 PVC (1.01 ACRES) SEPTIC TANK: LATERAL PIPES N. 4. THE PROPERTY LIES WITHIN THE AQUIFER PROTECTION OVERLAY DISTRICT BASED UPON A REVIEW TERESA A MURRAr `., 440 GPD x 200% (TITLE 5) 880 GAL 1,000 GAL 4' MINIMUM 4.0' MIAX. OF THE TOWN OF BARNSTABLE GEOGRAPHIC INFORMATION SYSTEM (GIS). MAP 69 PARCEL 14 (EXISTING) SEPARATION LEACHING AREA: BorroM of BED LEVEL DISTANCE 5. THE PROPERTY LIES WITHIN THE RESOURCE PROTECTION OVERLAY DISTRICT BASED UPON A REVIEW 16' x 38' LEACHING BED (0.5' DEPTH) FOR ENTIRE LENGTH GROUNDWATER OF THE TOWN OF BARNSTABLE GEOGRAPHIC INFORMATION SYSTEM (GIS). EXISTING RESIDENCE EX. 4" INV. BED: 16' x 38' 608 SF = qBU 1 s0• lLIN FIRST' FLOOR-178.78 �' � N/F ?ps o OUT=175.9t ,L LEACHING CAPACITY: TYPICAL LEACHING BED 6. THE PROPERTY LINES DEPICTED HEREON ARE BASED UPON PLANS AND DEEDS ON RECORD AND �, BASEMENT SLAB-170.73 >' BRUCE ✓. & KATHER/NE ✓. a EItERETT BED: 608 SF x 0.74 GAL/SF 449.9 GPD ARE NOT THE RESULT OF A BOUNDARY SURVEY BY ATLANTIC DESIGN ENGINEERS, INC. CROSS-SECTION a MAP 108 PARCEL 29 TOTAL: 440 GPD 449.9 GPD NOT TO SCALE � 'n N 7. THE PROPERTY LIES WITHIN FLOOD ZONE C (AN AREA OF MINIMAL FLOODING) BASED UPON A o REVIEW OF THE FEDERAL EMERGENCY MANAGEMENT AGENCY (FEMA) FLOOD INSURANCE RATE MAP I EX. 1!000 GA;)-ON < (FIRM) MAP NUMBER 250001 0015 C, DATED AUGUST 19, 1985. S 6C TANS" 0 3 , o REMAI F� TEST PIT 1 -- ELEVATION=179.5 %1� N a # 8. THE PROPERTY IS NOT LOCATED WITHIN A ZONE II BASED UPON A REVIEW OF THE BENCHMARK a MASSACHUSETTS,GEOGRAPHIC INFORMATION SYSTEM. HUB AND TACK DEPTH BOTTOM SOIL SOIL REDOXIMORPHIC EX. DBOX , / , 1 To BE REMOVED Ac SH/dl / ELEVATION = 181.17 FROM OF LAYER SOIL TEXTURE COLOR FEATURES OTHER 9. THE PROPERTY DOES NOT LIE WITHIN AN ESTIMATED OR A PRIORITY HABITAT OF RARE SPECIES .77- - o- �jA1VERTSrOF Tii C' (NAVD88) SURFACE ELEV. HORIZON (USDA) (MUNSELL) (MOTTLES) BASED UPON A REVIEW OF THE NATURAL HERITAGE AND ENDANGERED SPECIES PROGRAM MAPS \ f INCHES FEET ExM 'T sh MM TAN (INCHES) (FEET) SEPTIC SYSTEM MINIMUM SETBACKS OBSERVED ON THE MASSACHUSETTS GEOGRAPHIC INFORMATION SYSTEM. i � ``L1 PRi�t TO l70MMEN 0-10 178.7 A LOAM 10 YR 4 2 NONE PROPOSED � -, � °� -' �` ¢�ONSTRUCT1oN* ,P • / - ,. LEACHING FACILITY SEPTIC TANK r• TREELINE (TYP) i i i / 7 10. THE PROPERTY DOES NOT LIE WITHIN ,AN AREA OF CRITICAL ENVIROr�MENTAL CONCERN ACEC/ - dap 10-32 176.8 B SANDY LOAM 10 YR 5/6 NONE - 10; PROPERTY LINES �10: PROPERTY LINES PR E ( ) i , �" - ^ 3 _ 20, CELLAR WALL 10, (CEL AR WALL BASED UPON A REVIEW OF THE MASSACHUSETTS GEOGRAPHIC INFORMATION SYSTEM. 9 1 - - N LOOSE L - / 4 _,. 32 120 169.5 C MEDIUM SAND _-2.5 Y.6/4_ .._,, ONE 10 SLAB FOUNDATION 10 ` AB FOUNDATION 3 � / TIE �EXISTING ti � --r L . TANK OUTLET ^4' / cD 150 PRIVATE WELL 100 (PRIVATE WELL 11. EXISTING CONDITIONS SHOWN HEREON ARE BASED UPON A FIELD SURVEY BY ATLANTIC DESIGN / \ / / - -'-- / / / o r� _ PERCOLATION TEST BY: SCOTT MCGANN, SOIL EVALUATOR #2761 o ENGINEERS, INC. IN MAY OF 2014. , / / M N e WITNESSED BY: DONNA MIORANDi ' y q • / / / j M DATE: MAY 19, 2014 t N / / '% / N PERCOLATION RATE: 3 MPI IN C LAYER 12. EXISTING WELL LOCATIONS WERE FIELD LOCATED BY ATLANTIC DESIGN ENGINEERS, INC. IN MAY OF ESTIMATED DEPTH TO HIGH GROUNDWATER: >120" 2014. EXISTING SEPTIC SYSTEM INFORMATION WAS COMPILED FROM AS-BUILT INFORMATION ON . PROPOSED / ;� / / / 10o.s RECORD. INSPECTION 7---., X, 6 DIAMETER 1 sN MOUNTED CAW IRON PORJ 1 / / LEACHING PIT / / �/ / a � Ro Box wrTM x �� SEPTIC NOTES: TO eE REMovED ELEVATION=179.8 A �� , °°°a°°°�°0000�bpop0000 FEMALE ADAPTOR / TEST PIT #2 / 1 15.8 ( ,� 1. ALL DIMENSIONS` ARE PERPENDICULAR TO THE PROPERTY LINES. ° O O O / -----__i F NSHED GRADE °° °°°°°° d °'ter°°°°° �� PROPOSED /S-ou7LET e�" DEPTH BOTTOM IL SOIL 2. ALL SYSTEM COMPONENTS SHALL BE INSTALLED IN COMPLIANCE 1MTH THE STATE SANITARY CODE ,0 \ SO REDOXIMORPHIC h �. _. DISTRIBUT01 OX FROM OF LAYER SOIL TEXTURE COLOR FEATURES OTHER `•• :_; •• TITLE V AND THE LOCAL BOARD OF HEALTH REQUIREMENTS. ... SURFACE ELEV. HORIZON (USDA) (MUNSELL) (MOTTLES) :•g-'I ; ? 3. ANY CHANGE TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND DESIGN (INCHES) (FEET) . ' '' ENGINEER. tSMES 0-10 179.0 A LOAM 10 YR 4/2 NONE - ,;: �+N+ a DI") 4. BEFORE BACKFILUNG THE SYSTEM, THE 'CONTRACTOR SHALL NOTIFY THE DESIGN ENGINEER AND 15 s' }61.s \ _ _ '"ram ' ; > '. •' :":.. BOARD OF HEALTH TO INSPECT. j / / \ 10 34 177.0 B SANDY LOAM 10 YR 5/6 NONE 4s BEND `:; / / / / ��a = r. - - \ - 6 2 NONE - 5. HEAVY EQUIPMENT SHALL NOT TRAVEL OVER DISPOSAL SYSTEM DURING OR AFTER CONSTRUCTION. ! r s • / ( \ 34 60 174.8 C1 SILT LOAM 10 YR / / \ '� e- 6. TIGHT JOINT (T.J.) PIPING SHALL CONSIST OF POLYVINYL CHLORIDE (PVC) PIPE, SCHEDULE 40. ALL 60-130 169.0 C2 LOAMY SAND 2.5 Y 6/4 NONE LOOSE 8 0 0•0�,° a .ono , \ \ oro o oag8 00o a PIPES TO BE LAID ON FIRM BASE AND TO BE WATERTIGHT. ALL CONNECTIONS AND JOINTS SHALL PRO�OSED SOIL / \ 1 \ \ ' ° o �aoQ �ro-°�3oeo - LEM BE MECHANICALLY SOUND AND TIGHT. � ABSORPTION SY TE�I f � � \ } ��� t � � PERCOLATION TEST BY: SCOTT MCGANN, SOIL.EVALUATOR #2761 °o' ,ate �� MAIN at i (38'XlW LEACHIN1I BED) } ) I WITNESSED BY: DONNA MIORANDI NOSE: 7. DISTRIBUTION BOX SHALL BE WATER TESTED FOR LEVELNESS. DISTRIBUTION BOX SHALL HAVE AN ? PROPOSED 3�'x16' / j / / \ /j DATE: MAY 19, 2014 � SEC• � 3 4• D°"� INLET TEE EXTENDING TO ONE INCH ABOVE THE OUTLET INVERT ELEVATION. j \ PERCOLATION RATE: N/A RESERVE AREA / j ,� j ( / j TYPICAL SEWER CLEANIOUT DETAIL 8. THE DESIGN ENGINEER SHALL CERTIFY INSTALLATION. / ESTIMATED DEPTH TO HIGH GROUNDWATER: >130 NOT TO SCALE 9. EXISTING LOT SERVED BY PRIVATE WELL. / NOTE: THE FINISH GRADE ABOVE THE SOIL ABSORPTION - j �j \ I� WIGGINS PRECAST DB-3 SYSTEM SHALL HAVE A MINIMUM SLOPE OF 2% TO REDUCE - INFILTRATION AND TO MINIMIZE EROSION. DISTRIBUTION BOX OR APPROVED EQUAL FIRST FLOOR=178.78' PROVIDE RISER AND COVER 4" PERFORATED PVC SCH 40 O TO WITHIN 6" OF FINAL " GRADE 0.5X SLOPE WITH 3/8 MIN. AND EXISTING 1,000 GALLON 38' LONG LEACHING BED 5/8" MAX. PERFORATIONS •' SEPTIC TANK TO REMAIN F.G.=175.1' MIN TO 177.1' MAX -SOIL ABSORPTION SYSTEM- F.G.=175.1' MIN TO 177.1' MAX EXISTING SEWER 0o rn LINE OUT OF - J --13r ` BUILDING 0)UT•_ 6" SUMP I / / ., / MIN. TOP OF STONE 3' MAX. COVER " " " 9 MIN. COVER PROVIDE 2 OF TO PROVIDE ?' OF 11 DOUBLE -1g4 - j / / IN WASHED STONE (TYP)175.9't -.. ELEV.=174.30 WASHED STONE (TYP) TOP OF / I / ELEV. (EX.) OUT-� IN OUT -� - SYSTEM g IN �,: •,• - r k , . '>`, _;;..•. ELEV.-174.11 .i �•, :S,' •.►: ':+::.: :-y;:.:•::•v;:2:►: •.►::Sv; •:r:'='.+•:'y:2 v.: v.:�:''•.►•:'v;: y;:•:•, .v;:•:•;:•v::'v:•.v:'v::•:•:'Z'v.:'v:av:: y;:••✓.••v::r.'� . 6 MIN. ,.- ••� ` I 4 PVC � t•�•tL•.t,� .i• :• Via:•.�••.�a •.,•�u.••i•'!.♦••:�•jam••�• t•L.�.•..a•.�• .t9i.t••.t� �••.tS�.t•.�♦•.tS� .♦•'.� .�♦'.i ':♦••.• i♦d - - f / ° 1.19rt 4" PVC ® "• v ✓.. v, v;: v,. ✓.. 4, �: •N. N• Y• •N• Y• Y• N• N• N- Y• Y• N• �". .1+156.58`1' " �,�,,,.,.. 1X MIN. :.•.. . .' ' (TY , BOTTOM OF BED 4' MINIMUM 173.6 ' ELEV. ELEV. ELEV.=173.11 SEPARATION TO -�`. ::. :.::.:.....•. ...:.:.::.::.::.:•:.: ... 174A0' ELEV ASSUMED 174.75'f* HIGH GROUNDWATER (EXISTING ELEV.) ASSUMED L V. .r 25't (EXISTING ELEV.) L1 2* 38 LONG LEACHING BED L2=12 t ° C f-TWA *CONTRACTOR SHALL VERIFY L3=18't BOTTOM OF BED LEVEL FOR ENTIRE LENGTH ROII'E 6 STATE HI PROVIDE LEVEL 6 . INVERTS OF THE EXISTING (PUBLIC VARIABLE WIDTH) SEPTIC TANK PRIOR TO COMPACTED CRUSHED GW ELEV.=>169.W COMMENCING CONSTRUCTION* STONE BENEATH DISTRIBUTION BOX PROPOSED SEPTIC SYSTEM PROFILE (NIOT TO SCALE) _ OF M� RICHARD FILE: 2770.00-SEPTIC Designed by : SCALE `" PREIPARED FOR: SEPTIC SYSTEM REPAIR PLAN Sheet of Drawn by �, ' 3746o FOR 1 ® SCALE 1 20 1. JESS[ CA FALLEN Checked by : A 77 CAPES TRAIL an IC DESIGN ENGINEERS, INC. 5 10 20 40 77 CAPES TRAIL JOB NUMBER Survey chk. by . WEST BARNSTABLE, MA 02668 �""'� P.O. Box 1051 , Sandwich,- MA 02563 (508) 888 -- 9282 Approved by : DATE NO. BY DATE REVISION WEST BARNSTABLE, MA 02668 JUNE 23, 2014 2770• 00