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HomeMy WebLinkAbout0141 PERCIVAL DRIVE - Health 141 Percival Drive a W. Barnstable 110 001015 r f Y 1h yJ r k No• 4210 1/3 BLU ESSELTE 10% to O Cf 0 B Commonwealth of Massachusetts Tj 3 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments I..,: fr' 141 Percival Dr p� Property Address Donna Krell ' Owner Owner's Name information is : required for every W. Barnstable ✓ MA 02668 7-19-18 , 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. A. General Information 1. Inspector: Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name P.O. Box 73 Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S13971 Telephone Number License Number B. Certification , I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Furth lua 'on by the Local Approving Authority 7-19-18 I 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 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.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts r� Title 5 Official Inspection Form` ail Subsurface Sewage Disposal System Form Not for Voluntary Assessments T. >' 141 Percival Dr Property Address Donna Krell Owner Owner's Name information is required for every W. Barnstable MA 02668 7-19-18 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summai : Check A,B,C,D+or' E/always complete all of'Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System is in good working order with no sign of failure. F '! M1 , L 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. f 1 t 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 , ON ❑ ND (Explain below): t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 t I R f r Commonwealth of Massachusetts Title 5 Official Inspection Form i�i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 141 Percival Dr Property Address Donna Krell Owner Owner's Name information is required for every W. Barnstable MA 02668 7-19-18 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑N ❑ •ND (Explain below): ❑ obstruction is removed ❑ Y ❑N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑Y ❑N ❑ ND (Explain below): ❑ obstruction is removed ❑Y ❑N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or'privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 1 Commonwealth of Massachusetts Title 5 Official Inspection Form V� Y," l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 141 Percival Dr Property Address Donna Krell Owner Owner's Name information is W. Barnstable 4 MA 02668 7-19-18 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public,Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: :~ , ❑The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water.supply or tributary to a surface water supply. ❑The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: _ I . ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes"or"No"to each of the following for all inspections: : Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool F ' Discharge or ponding of effluerit.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 El or clogged SAS or cesspool Liquid depth in cesspool is less than 6" below invert or available volume is less El ® '► than 1/2 day flow t5ins.doc-rev.6/16 - Title 5 Official Inspection Form:Subsurface Sewage Disposfll System-Page 4 of 11 f Commonwealth of Massachusetts 3 Title 5 Official Inspection Form ' C,�i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments . 141 Percival Dr Property Address Donna Krell Owner Owner's Name information is required for every W. Barnstable MA 02668 7-19-18 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS,,cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems:To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection form li Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 3 141 Percival Dr Property Address Donna Krell Owner Owner's Name information is required for every W. Barnstable MA 02668 7-19-18 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No - ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were,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? ® ❑ Wasthe facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design)' 4 Number of bedrooms (actual): 4 DESIGN flowbased on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 i Commonwealth of Massachusetts ,� ,w Title 5 Official Inspection Form �16D Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 141 Percival Dr Property Address Donna Krell Owner Owner's Name information is required for every W. Barnstable MA 02668 7-19-18 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 3 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection El 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 ® No Last date of occupancy: , 7-2018 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): r 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form ! r► Subsurface Sewage Disposal System Form,-Not for Voluntary Assessments _��, 141 Percival Dr Property Address Donna Krell Owner Owner's Name information is required for every W. Barnstable MA 02668 7-19-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Owner--pumped 3-4 yrs ago ` Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: ' gallons How was quantity pumped determined? Reason for pumping: Maintenance Type of System: Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy ofthe current operation and maintenance contract (to be obtained from system owner) and a copy of latest .i inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): 1 t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts 3 Title 5 Official Inspection Form } %I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 141 Percival Dr Property Address Donna Krell Owner Owner's Name information is required for every W. Barnstable MA 0.2668 7-19-18 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: 2004 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1211 feet Material of construction: ❑ cast iron ® 40 PVC ❑'other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Good condition. Septic Tank (locate on site plan): Depth below grade: 4"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: 1500 gal Sludge depth: 12" t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 c Commonwealth of Massachusetts pit' Title 5 Official Inspection Form �i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 141 Percival Dr Property Address Donna Krell Owner Owner's Name information is required for every W. Barnstable MA 02668 7-19118 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) s Septic,Tank (cont:) Distance from top of sludge to bottom of outlet tee or baffle 20" - Scum thickness 1 r 6" Distance from top of scum to flop of outlet tee or baffle - Distance from bottom of scum to bottom of outlet tee or baffle 15" , How were dimensions determined? Tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed and no sign of leakage. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ; ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum.to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts 1� Title 5 Official Inspection Fora i�l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ' 141 Percival Dr Property Address Donna Krell Owner Owner's Name information is required for every W. Barnstable MA 02668 7-19-18 page. City/Town , State Zip Code Date of Inspection D. System Information (cont.) . Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts -M Title 5 Official Inspection Form „ 4 Subsurface Sewage Disposal System Form -'Not for.Voluntary Assessments ,> 141 Percival Dr Property Address Donna Krell Owner Owner's Name information is required for every W. Barnstable " MA 02668 7-19-18 r . page. City/Town State Zip Code Date of Inspection D. System Information (cont.) - Distribution Boz(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Good condition with water at working level and no sign of back-up from field. 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.): � R * If pumps or alarms are not in working order, system is a conditional pass. I Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 141 Percival Dr Property Address Donna Krell Owner Owner's Name information is required for every W. Barnstable MA 02668 7-19=18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 3-500's ❑ 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.): Leach chambers in good condition and holding 3" of water with stain line at 6" off bottom of chamber. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts 011, Title 5 Official Inspection Form + r► Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4. 141 Percival Dr Property Address Donna Krell Owner Owner's Name information is required for every W. Barnstable MA 02668 7-19-18 page. City/Town - State Zip Code Date of Inspection D. System Information (cont.) It . Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): I M i Privy (locate on site plan): Materials of construction: Dimensions t _ Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 f Commonwealth of Massachusetts r� 3 Title 5 Official Inspection Form YI I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 141 Percival Dr Property Address Donna Krell Owner Owner's Name information is required for every W. Barnstable MA 02668 7-19-18 page. City/Town 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 C 6k { ua ¢ t 1 � 1. Ire, 1 r 1 . eo - - r ' e t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts r� Title 5 Official, Inspection Form r1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments >" 141 Percival Dr Property Address Donna Krell Owner Owner's Name information is required for every W. Barnstable MA 02668 7-19-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) t Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 12 feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: ® Checked with local excavators, installers- (attach documentation) •� ❑ Accessed USGS database- explain: You must describe how you established the high ground water elevation: Original design plans show no groundwater at 12'. Before filing this Inspection Report,please see Report Completeness Checklist on next page. t5ins.doc-rev.6/16 Title 5 Official Inspecton Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts f Title 5 Official Inspection Form II 16 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 141 Percival Dr Property Address Donna Krell Owner Owner's Name information is required for every W. Barnstable MA 02668 7-19-18 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file I I t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 • I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 141 Percival Dr Property Address Hollis �Dwner's Name West Barnstable MA 02668 11/21/11 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. A. General Information 1. Inspector: J'14 C� I u Frank Nunes III Name of Inspector saa Company Name Box 841 Company Address East Falmouth MA 02536 City/Town State Zip Code 508.272.6433 Telephone Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 11/21/11 InspectoH tignat 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 thesystem will perform in the future under the same or different conditions of use. 6 _ /' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 141 Percival Dr Property Address Hollis Owner's Name West Barnstable MA 02668 11/21/11 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: Pumping suggested every 3 yrs to prolong the life of the 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. 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: n/a ❑ 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 7 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 141 Percival Dr Property Address Hollis Owner's Name West Barnstable MA 02668 11/21/11 Cityrrown State Zip Code Date of Inspection B. Certification cont. B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: n/a ❑ 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: n/a C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation b the Board of Health in order to determine if q Y the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 141 Percival Dr Property Address Hollis Owner's Name West Barnstable MA 02668 11/21/11 City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: "*This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: n/a i D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed i e 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 El ® tributary to a surface water supply. r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 141 Percival Dr Property Address Hollis Owners Name West Barnstable MA 02668 11/21/11 Cityrrown State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ Z 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. ❑ Z 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. r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 141 Percival Dr Property Address Hollis Owner's Name West Barnstable MA 02668 11/21/11 City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 141 Percival Dr Property Address Hollis Owners Name West Barnstable MA 02668 11/21/11 Cityrrown State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Number of current residents: 4 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: Occupied Date Commercial/Industrial Flow Conditions: Type of Establishment: n/a 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): n/a Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,M 141 Percival Dr Property Address Hollis Owner's Name West Barnstable MA 02668 11/21/11 City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: Pumped March 2010 per 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, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 8/23/04 per as built Were sewage odors detected when arriving at the site? ❑ Yes ® No r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 141 Percival Dr Property Address Hollis Owner's Name West Barnstable MA 02668 11/21/11 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 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: >100' feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): 6" Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years .1 Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No -------------------------------------------------------------------------------------------------------------------------- Dimensions: 1500g Sludge depth: V. 11 Distance from top of sludge to bottom of outlet tee or baffle >12 Scum thickness 1/2' Distance from top of scum to top of outlet tee or baffle >211 Distance from bottom of scum to bottom of outlet tee or baffle >2° How were dimensions determined? measured f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 141 Percival Dr Property Address Hollis Owner's Name West Barnstable MA 02668 11/21/11 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumping suggested every 3 yrs to prolong the life of the system Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): n/a 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.): n/a 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): n/a Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 141 Percival Dr Property Address Hollis Owner's Name West Barnstable MA 02668 11/21/11 City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): n/a *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box(if present must be opened) (locate on site plan): Depth of liquid)level above outlet invert level w/the bottom of the pipe 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.): D-Box 2' below grade w/riser to 6"of grade. No adverse conditions. No indication of backup Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in work-ng order: ❑ Yes ❑ No Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,M 141 Percival Dr Property Address Hollis Owner's Name West Barnstable MA 02668 11/21/11 Cityrrown State Zip Code Date of Inspection D. System Information (cont.), Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): n/a Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 3 ❑ 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.): Leach Chambers were video inspected and are dry at this time. No indication of backup. Top of chambers approximately 2'6" below grade Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments � 141 Percival Dr Property Address Hollis Owner's Name West Barnstable MA 02668 11/21/11 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert I 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.): n/a Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 141 Percival Dr Property Address Hollis Owner's Name West Barnstable MA 02668 11/21/11 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least twc permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. t �cn"CL- 2 Ca � a 2 � I � Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 141 Percival Dr Property Address Hollis Owner's Name West Barnstable MA 02668 11/21/11 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: >144" 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: 2004 NGW 144"& NGW 156" Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: see above Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form Inspection results must be submitted on this form.Inspection forms may not be altered in any way. A. General Information I/D —oD/ - ois Important: When filling out 1. Property Information: forms on the computer,use 141 PERCIVAL DRIVE only the tab key Property Address to move your MARY STERGIS cursor-do not Owner's Name use the return key. SAME Owner's Address WEST BARNSTABLE MA 02668 Zit/Town State Zip Code 11-24-06 Date of Inspection: Date 2. Inspector: MICHAEL A. BURNIE Name of Inspector DAVID J. BURNIE&SONS SEPTIC SERVICES Company Name 307A COMMERCE PARK NO. Company Address .SO. CHATHAM MA 02659 CityRown State Zip Code 508-432-7420 Telephone Number B. Certification I certify that 1,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 Evalu n the Local Approving Authority a 11-27-06 4' r � Inspectors Signature date The system inspector shall submit a copy of this inspection report to the Approl g Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a hared system-er has a design flow of 10,000 gpd or greater,the inspector and the system owner hall submit then report to the appropriate regional office of the DEP.The original should be sent t the system o!idler 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. BLANK T-5 USE SAVE AS ONLY!!!.doc-03/2006 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 Subsurface Sewage Disposal System Form B. Certification (cont.) 141 PERCIVAL DRIVE Property Address W. BARNSTABLE MA 02668 kjr own State Zip Code MARY STERGIS 11 24-06 Owner's Name Date of inspection Inspection Summary: Check A,B,C,D or E 1 always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. I Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined(Y, N, ND)in the ❑for the following statements. If"not determined," please explain. ❑, The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: BLANK T-5 USE SAVE AS ONLY!!!.doc•0312006 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 B. Certif Cation (cunt.) 141 PERCIVAL DRIVE Property Address W. BARNSTA'BLE MA 02668 City/Town State Zip Code MARY STERGIS 11 24-06 Owner's Name Date of Inspection B) System Conditionally Passes(coot.): ❑ 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 BLANK T-5 USE SAVE AS ONLY!11_doc•0312006 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 Subsurface Sewage Disposal System Form B. Certification (cunt.) 141 PERCIVAL DRIVE Property Address W. BARNSTABLE MA 02668 City/Town State Zip Code MARY STERGIS 11-24-06 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. and SAS and the SAS is within a Zone 1 of a public water ❑ The system has a septic tank a 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 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: BLANK T-5 USE SAVE AS ONLY!!!.doc-03/2006 5 Official Irispect ion Form:Subsurface Sewage Disposal System- �� T � Page 4 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary V lunta Assessments Subsurface Sewage Disposal System Form B. Certification (cunt.) 141 PERCIVAL DRIVE Property Address W. BARNSTABLE MA 02668 City/Town State rpCode MARY STERGIS 11 24-06 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 El ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool El ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool El ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6"below invert or available volume is less than%day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: I ❑ ® 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 of 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. 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. BLANK T-5 USE SAVE AS ONLYM.doc•03f2006 Tithe 5 Official Inspection Form:Subsurface Sewage Disposal System. Page 5 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form B. Certification (cont.) 141 PERCIVAL DRIVE Property Address W. BARNSTABLE MA 02668 cityrrown State Zip Code MARY STERGIS 11-24-06 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. BLANK T-5 USE SAVE AS ONLY!II.doc•03t2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 6 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. Checklist 141 PERCIVAL DRIVE Property Address W. BARNSTABLE rylA 02668 City/Town State Zip Code MARY STERGiS 11 24-06 Owners 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 El ® this inspection? ? If h were not obtained and examined they® ❑ Were as built plans of the system ( y available note as NIA) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? S ® ❑ Were all system components, fthe SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid,depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] BLANK T-5 USE SAVE AS ONLYM.doc•03/2006 Official Inspection Form:Subsurface Sewage Disposal System �� ^�� Page 7 of 16 r Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information 141 PERCIVAL DRIVE' Property Address W. BARNSTABLE MA 02668 City/Town State Zip Code MARY STERGIS 11-24-06 Owner's Name Date of Inspection Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms(actual)_ 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms):, 455 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(gpd)): WELL WATER 9 ( y 9 Sump pump? ❑ Yes ® No Last date of occupancy: CURRENTDate - Commerciallindustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/personstsq.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): BLANK T-5 USE SAVE AS ONLYM.doc•0312006 We 5 Official Inspection Form:Subsurface Sewage Disposal System Page 8 of 16 L f Commonwealth of Massachusetts 0% Title 5e official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cont.) 141 PERCIVAL DRIVE Property Address W. BARNSTABLE MA 02668 City/Town State Zip Code MARY STERGIS 11-24-06 Owner's Name Date of inspection General Information Pumping Records: Source of information: NONE PER BOH. 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 Li Overflow cesspool ❑ Privy ❑ Shared system(yes or no)(if yes,attach previous inspection records, if any) ❑ Innovative/Aitemative 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: 3 YEARS+ PER ORIGINAL PLAN DATED 5-1-03 Were sewage odors detected when arriving at the site? ❑ Yes ® No BLANK T-5 USE SAVE AS ONLYM—doc 03/2006 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 D. System Information (cunt.) 141 PERCIVAL DRIVE Property Address W. BARNSTABLE MA 02668 Cityrrown State Zip Code MARY STERGIS 11-24-06 Owner's Name Date of Inspection Building Sewer(locate on site plan): 9" Depth below grade: feet Material of construction: ❑cast iron ®40 PVC L J other(explain): Distance from private water supply well or suction line_ feet Comments(on condition of joints,venting, evidence of leakage, etc.): THE MAIN LINE WAS IN PROPER WORKING CONDITION. Septic Tank(locate on site plan): X Depth below grade: 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 ❑ Yes ❑ No certificate) --- ---------------------------------------------------------------------------------------------------------------------- Dimensions: 2000 GALLONS PER ORIGINAL PLAN DATED MAY 1, 2003 Sludge depth: 6" Distance from top of sludge to bottom of outlet tee or baffle 26" Scum thickness 4" Distance from top of scum to top of outlet tee or baffle 4" Distance from bottom of scum to bottom of outlet tee or baffle 14,E How were dimensions determined? SLUDGE JUDGE MARY STERGIS.doc.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System �� y `_ Page 10 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cont.) 141 PERCIVAL DRIVE Property Aooress W. BARNSTABLE MA 02668 City/Town State Zip Code MARY STERGIS 11-24-06 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.): 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): MARY STERGIS.doc.doc•03/2006 dte 5 Official Inspection Form:Subsurface Sewage Disposal System Page 11 of 16 f Commonwealth of Massachusetts Tide 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cunt.) 141 PERCIVAL DRIVE Property Address W. BARNSTABLE MA 02668 Cityrrown State Zip Code MARY STERGIS 11 24-06 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.): ' Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box,etc.): THE D-BOX WAS IN PROPER WORKING CONDITION AND DID NOT SHOW ANY EVIDENCE OF SOLIDS CARRYOVER. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order. ❑ Yes ❑ No MARY STERGIS.doc.doc•03/2006 Title 5 OfficiW Inspection Form:Subsurface Sewage Disposal System 4 Page 12 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cont.) 141 PERCIVAL DRIVE Property Address W. BARNSTABLE MA 02668 City/Town State Zip Code MARY STERGIS 11-24-06 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: ® leaching chambers number: 3 ❑ 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.): THE LEACHING CHAMBERS WERE DRY AND SHOWED NO SIGNS OF PONDING OR HYDRAULIC FAILURE. MARY STERGIS.doc.doc•0312006 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System Page 13 of 16 Commonwealth of Massachusetts . Title 5 Official Inspection Form. Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System information (cost.) 141 PERCIVA.L DRIVE Property Address K BARNSTABLE MA 02668 City[Town State Zip Code MARY STERGIS 11 24-06 Owner's Name Date of inspection Cesspools(cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top o-liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of o:)nstruction 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.): MARY STERGIS.doc.doc•0312006 Tiiffe 5 Official Inspection Form:Subsurface Sewage Disposal System �o Page 14 of 16 /�' Commonwealth of Massachusetts Y: Title 5 official. Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form Q{y D. System Information (corn.) 141 PERCIVAL:DRIVE Property Adaress W. BARNSTABLE MA 02668 City/Town State Zip Code MARY STERGIS 11 24-06 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. 17 RecL,VO„I�r,xjltAA 37 d MARY STERGIS.doc doc•0312006 11111e 5 Official Inspection Form.Subsurface Sewage Disposal System Page 15 of 16 I_ Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cont.) 141 PERCIVAL DRIVE Property Address W. CHATHAM MA 02668 Cityrrown state Zip Code MARY STERGIS 11-24-06 Owner's Name Date of Inspection Site Exam: Slopes Surface water Check cellar 1)r� Shallow wells 11,0 IQe- Estimated depth to groundwater: 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: MAY 1, 2003 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: SDW-252 ZONE A 0-2 LEVEL 47.3 ADJUSTMENT 1.4- You must describe how you established the high ground water elevation: SEE ATTACHED MARY STERGIS.doc.doc•030006 Idle 5 Official Inspection Form:Subsurface Sewage Disposal System Page 16 of 16 ox- 'a -RAJa i i PJ t9a� IA . V7 -3 Z)T -'� ° g CERTIFICATE OF ANALYSIS Page: 1 Barnstable County Health Laboratory ysFtct30" Report Prepared For: Report Dated: 11/29/2006 Darroll Gustamachio Kinlin Grover RE Order No.: G0638862 1990 Main Street Brewster, MA 02631 Laboratory 1D#: 0638862-01 Description: Water-Drinking Water Sample#: Sampling Location 141 crcival_Dr.W.;Ba_e6stable NW A Collected: 11/27/2006 Collected by: D.G. Map 110 Parcel 001-015 Received: 11/27/2006 Routine ITEM RESULT UNITS RL MCL Method# Tested Nitrate as Nitrogen 0.29 mg/L 0.10 10 EPA 300.0 11/27/2006 Copper 0.20 mg/L 0.10 1.3 SM3111B 11/29/2006 Iron BRL mg/L 0.10 0.3 SM 3111E 11/29/2006 Sodium 9.5 mg/L 1.0 20 SM 3111B 11/29/2006 Total Coliform Absent P/A 0 0 SM9223 11/27/2006 Conductance 100 umohs/cm 2.0 EPA 120.1 11/27/2006 pH 6.6 pH-units 0 EPA 150.1 11/27/2006 Water sample meets the recommended limits for drinking water of all the above tested parameters. Approved By: (L Director) ta.1 r.1 I' 7/-z,— —eS 6 i ;'s tf3 _.. t.a..t MCL=Maximum Contaminant Level RL = Reporting Limit Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 l � 11/29/2006 WED 16: 01 FAX 5083627103 Barnstable CTY HealthLab --- BARNSTABLE HEALTH 0001/001 i CERTIFICATE OF ANALYSIS Page: 1 Barnstable County Health Laboratory * snCgv` Report Preaared For: Report Dated: 11/29/2006 Darroll Gustamachio Kinlin Grover RE Order No.: G0638862 1990 Main Street Brewster, MA 02631 Laboratory ID#: 0638862-01 Description: Water-Drinking Water Sample#: Sampling Location 141 Percival Dr.W.Barnstable,MA Collected: 11/27/2006 L Collected by: D.G. Map 110 Parcel 001-015 Received: 11/27/2006 Routine ITEM RESULT UNITS RL MCL Method# Tested Nitrate as Nitrogen 0.29 mg/L. 0.10 10 EPA 300.0 11/27/2006 Copper 0.20 mg/L. 0.10 1.3 SM 3111B 11/29/2006 Iron BRL mg/L 0.10 0.3 SM 3111B 11/29/2006 Sodium 9.5 mg/L 1.0 20 SM 3111B 11/29/2006 Total Coliform Absent P/A 0 0 SM9223 11/27/2006 Conductance 100 umohs/cm 2.0 EPA 120.1 11/27/2006 pH 6.6 pH-units 0 EPA 150.1 11/27/2006 Water sample meets the recommended limits for drinking water of all the above tested parameters. Approved By: (L irector) f t 1 1 i i i i i I MCL=Maximum Contaminant Level Ii RL = Reporting Limit Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 4 --------------- -- - .....................................-----------------------. . - ...................,.........---...... --- - - --._.... ......................_................. ----- TC?WN OF$ STABLE LOCAMON ASSESSOWS MAP&LOT INS.T'A�L1~R S NAUE&P146NB NO SEI C:TAN. CA RA r 3�3 T6 S Buu.D .0R m et {i 3 tT1 A'Yti• Cpl UANCE AAM, _.... .:,._......�... .,. I Separatic 19bW*ce Between id: " I �MaXlmum�)uatetl,.Grau�idwateiTabletatpeBmiamofLssac;hln,�k?�u;ility. Prly qc,vVatirr Sup ly J411 tiw d�eaa6�ing Paciu (if any vlslls exist ap►elt�s ac wlthan 2OO feet o�lenebirt�facllity) Feel Btlgi•cyf`�letlat�td aad Lea+0 as�4001 y{U eny woloii exist M03100 kid`f aabiog Pacitibrj sae ftnIA d.by G `'z Le� t T 2 0 o f r r &( -,S7` 0 4- 6n TOWN OF BARNSTABLE lL 6CATION .,.1 �i('C.['vG: ���. SEWAGE # '�Gg03'605' VILLAGE 1J e& Le ASSESSOR'S MAP & LOT 0"T —0 INSTALLER'S NAME&PHONE NO. ."JuAl. ��- SEPTIC TANK CAPACITY C,III LEACHING FACILITY: (type sb Ctw.M (size), NO.OF BEDROOMS BUILDER OR OWNER + PERMTTDATE: wx d ` COMPLIANCE DATE:—, a Sep*ation Distance Between the: Maximum:Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by f #tyr 17ec c-\va` -Or, Jrl It 37,10 to 51`io L, ._- . �Yr No. � � Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: gi Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 2pplication for Oiopool bpgtem Conotruction Permit Application for a Permit to Construct)Repair( )Upgrade( )Abandon( ) O Complete System ❑Individual Components Loc o A ss or Lo N . Owner's Name,Address and Tel.No. - _1�l e 1 o �� IlU -��i�-aIS u�n�s T `Designer's Name,Address and Tel.No.- 1L"L "`tOx (sns� r776p O Dwelling No.of Bedrooms Lot SizeeG '�"_ sq. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow q* gallons. Plan Date Number of sheets ` Revision Date ' 1 Title Size of Septic Tank Type of S.A.S. Soo U Description of Soil JCP Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the truction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Tid a Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued and of Health. d' Si gne Date Application Approved by �' Date Application Disapproved or the following reaso Permit No. Date Issued -Ir . �4, No. , l/ U• t hZ'� V!�J Fee �� h -THE'COMMONWEALTH'OF MASSACHUSETTS Entered in computer:' Yes , .� PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS fl 2pprication for Mood *pgtem Construction Permit Application for a Permit to Construcctt Repair( ),Upgrade( )Abandon( ) ❑Complete System ❑Individual Components r; Location Addtess.or,Lot No. ' �J Owner's Name,Address and Tel.No. `5 _�U.' ' ` I_qY ralt%l.i�t� �i'1 -�1S �r- rc� �S {` Assess/ s Map/Parcel TNI n �. •l ��S Name,Addre V ,... Qo : . . ss;and el _q signer's Name,Address and Tel.No. rA5 5 ur tea 7 Type of Building'` 5: C A t l (Vp0 Dwelling No.of Bedrooms Lot Size )Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures _ qI/� Design'Flow gallons per day. Calculated daily flow �1 gallons. Plan Date Number of sheets 1 Revision Date d3 Title Size of Septic Tank \ ::N M� Type of S.A.S. —3 X .SOD 00ya oy,) �/ Y �. Description of Soil �E�(='_ � ( 04tO Nature of Repairs or Alterations(Answer when applicable) Date last inspected: r , Agreement: f The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Titlef5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by'thiis d of Health. ZF,f' '^� ` Signed ;- ,-,-- - Date UY-7 Application Approved by .'!l .�t�`� '.? ' f ,�`�, > , c /�(� � Date Application Disapproved for the following reasons ,. Permit No. /�� /7 Date Issued r .. THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the O -site Sewage Disposal System Constructed(x)Repaired( )Upgraded( ). Abandoned( )by at y i n lr r 1 t , ! 1V�,,e has been constructed in ac.erdance with the provisions of Title 5 and the for Disposal System Construction Permit No. 0 0 -to US dated f a 1) - Installer P r (FrWi "A' Designer 1� � The issuance o�j this ptern it shall not be construed as a guarantee that the system will function as d signed. `{ Date "f Inspector ),� Vj1.-�' \_ --------------------------------------- No. / (r l/ ` / Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Migogar *pgtem Con.5truction Permit Permission is hereby granted to Construct( )Repair( )Upgrade( )Abandon( ) System located at and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions.or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date: Approved by q v � " i i CD O 1 _ CL C7) N CA M r— Kd CIQ O ffi-t r -0 litW-M v -f f!D 9� —_17(T_._-- O �— X } ` +4 I I I I 111 f1R5T FLOOR : .:. ..;;:: FIRST FLOOR ea ow ;.... ESON GARAGE .... ONLY QELYt00Y 3 Te'i—.D= r4�r 2ND FL OF' GARAGE IS COVPLETM b i ® ON SITL- BY OTHERS N r i f { i ' I e 3442mcb i e �. 0 Daa m o IWASIN C: 12/ca/03 rufG- C Cum Xw: 7t26a3 m a rlmmtc '�t CAR �1^�M.Mm=LVM- l2 DM Ss-M m as a' c a o ta4r�a�a ' rmr f mix s.. � raa.awir ratirsr- swela r—MR FLxY s O r rua es.-ra r rm-aira r ewara i "FEf! Noners r$ n►av CIO O U Ls7 0 I` . L L LO CD a CD LL) N v 03 C) LO r— O �d N $r-t 3/4. d_�t/r tr-s ateu-o- �-- tr-s t/P Il9eWIN rno r.a.w Z ................ i R w .............. X tts•twa�t® ►';' VIR: LL_ :...9 ... . i ......................... i:s A BEDRC � 1 r E .. s ';`::`:;' — . r � «onc -- - 13c: • : �:.�. ...fir_=:::•:;�::�::::;;•::::•:::::::.�:::::•::::::::::::: @ s �- a.: ......................... ..:........ ...... Jill il. I GARAGE Ong 3 UVNI'G RG0V kw yy � LA 1 tt V:`ilVs iLw� in in -CD L CD F--M=t1 C: 12.1MI v 44 0 j OI � �0 L3NAi Kuo: `F.REM H a Pa[GF�k ! •m Cox Ditt 5-6-05 �I M STft ow p y p�, n.tawtrtr.+s�v>sr' �- rxa F'.stl N imp y.'9r• -ama�^o i NI:.B�`4?i ! .6 O I U Q Fee------- BOARD OF HEALTH TOWN OF BARNSTABLE Application-*rVel[ CootructionVermit Application is hereby ��?c Y made for a permit to Construct., Alter ( ), or Repair ( )an individual Well at: Location — Address Assessors Map and Parcel Owner Add — - --_— ___—--- -----__- — _— ----------— - - —------------------------------------ Installer — Driller Address Type of Building Dwelling — ------ Other - Type of Building— No. of Persons----------------------__—__________ Type of Well _ Capacity----------------- Purpose of Well--- -- �� 4 — 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 until a Certifica a of Compliance has been issued by the Board of Health. Signed — — _—= `���� -- Pate Application Approved By �4 — — 2(16, date Application Disapproved for the following reasons: --------------------------------------- -------- -- date o. � ----- -�---�_ 2------------- Permit N date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance THIS IS TO CERTIFY, That the Individual Well Constructed_V), Altered ( ), or Repaired ( ) by--- ---- ---- ------------- Installer at-- IL � ��2 gk_m A kZ1 S1 ------- 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.�? >_ Aated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE----- - —- Inspector---------------------- -._ _. .. T S�awy. :,��t..{—""w+lepin•F ., .... ''�,�4.M 1 _ _. y,e --�-� s Feed --- ------- BOARD OF HEALTH .TOWN OF BAR,NStABLE Applicat ion for Vell Con5tructionjoermit Application is hereby made for a permit to Construct.), Alter ( ), or Repair ( )an individual Well at: As,, czcrlvi� 1 �,�- �e�st�\ — Location — Address s Assessors Map and Parcel .. Owner T— Address — — ------------—--------------------— ——--—_ ---— — Installer — Driller _-- Address Type of Building Dwelling '_ — ------- Other - Type of Building— Q No. of Persons.-------------_-__—__—_--_ Type of Well _ Capacity------------------- —� Purpose of Well-- - �C'`` — 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 until a Certific Ix e of Compliance has been issued by the Board of Health. Signed — — — -� date Application Approved By Q4LC �� S/21 it:�i date Application Disapproved for the following reasons: ------ -------- -- date Permit No. "�'-- �� ! a�- -- Issued------------h=1-�2- --------------- date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate (Of (Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ), Altered ( ), or Repaired ( ) by-- — --- --— — —-- -- ---- Installer } _ 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.U__)_1a_C __'hated 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 Ivell Conoruct ion Permit No. W` O Fee— ---- Permission is hereby granted — --------------------- to Construct'O, Alter ( ), or Repair ( ) an Individual Well at: No. �E 2C( yA k �J 2(�5�1�1 (� - — --- ----------------------------- street as shown on the application for a Well Construction Permit c� � � , No.- - — Dated -------------------- --- - — - -- Board of Health DATE / i s 3 ,( Ir 7. O-:Af.HA W53 1:3C CLIENT: Clifford Well Drilling LOCATION: Sturgis ADDRESS: PO Box 430 141 Percival S. Yarmouth, MA 02664.. W. Barnstable, MA COLLECTED BY., Clifford Well Drilling SAMPLE DATE: 11/19/2002 SAMPLE TIME: 12:55 WATER SAMPLE TYPE: Existing Well DATE RECEIVED: 1144 2 LAB I.D. 021127 WELL SPECS.: NA RESULTS OF ANALYSIS: Parameters traits Recommended Resents a etliod Date Analyze Lirr�6ts Coliform Bacteria f 100ml 0 0 9222 B 11/19/2002 PR pH units 6.5-8.5 6.29 4500 H+ 11/19/2002 Conductance umhos/cm 500 94 120.1 11/19/2002 Nitrate-N mg/L 10.0 0.48 300.0 11/19/2002 Nitrite N mg/L 1 AO < O.dd4 300.0 11/19/2002 so f/tier mg/L 20.0 10.4 200.7 11/19/2002 Iron mg/L 0.3 <0.1 200.7 11/19/2002 Manganese mg/L 0.05) 0.012 200.7 11/19/2002 COMMENTS: pH is below recommended limit and may have corrosive characteristics. INA?ER MEETS EPA STANDARDS AND?S SUITABLE FOR DRINKING PURPOSES FOR PARAMETERS TESTED. <=less than Dateh �.. 62 ��4 >=greater than lRi aalcf . SaarTNTC=too numerous to count Watory Director T�Wild d(�$�A�St"Ar8'!+8' �rr �:• Department-of Health,Safety,and Environmental Services 1HE Public Health Division Date 9- 2.8-0l 367 Main Street,Hyannis MA 02601 � UARNSTADLE, � 'y MUSS. $. , r '°l'6�9y��� Date Scheduled �0 ^3y— � 1 d Euna. 1 Time l � A^'� Fee I tf.__� dU v Soil Suitability Assessment for Sewage Disposal Performed By: EPWA.R'P 6). ST'orJG Witnessed By: Ca:- ,C ddr✓VZL L(� ATION`& GI✓NI; AL, INFOIt1YIATION � Location Address Owncr s Name tOCi! �t ll� So�D, C. CtJtr JZOAJ �. 3'j4 Address 13 l F��P aA,�v �•3 - bTl3 Assessor's Map/Parcel: 1 ( Q -» Up 1 - O 1 5 99 Engineer's Name t4�R GA' t3olr t29 Saar✓ NEW CONSTRUCTION REPAIR Telephone N 1G14 A44 .OZS�3 11 V( _6696-36(9 l�C Land Use 7�-916 AAA-4 •e445i t7(4&1A Slopes(%) Surface Stones Af D k4 Le q.Ot&O 'tZF7-- Distances from: Open Water Body �aU It ssi tto� et Area R DrinkingWater Well _R �'+ i1 y�YOrl�� / t/ G R ll�r ES�r _ I.t/ Drainage Way 2Z0 R roperty Line Other R /��26 R'OetdAc- par cam= S Nam`/ 5- holes /. SI�TCH: (Street name,dimensions of lot,exact locations of lest &pert tests,locale wetlands in proximity to holes) }. jeG ( ✓a o 110-00te 1 _OcS v N SHAG • t W ` a ? Q 0 m Z� Of r 3 I , S A Parente ena geo ogtc Depth to OcaroCK Depth to Groundwater: Standing Water in Hole: /�O,V G Weeping from Pit Face !Estimated Seasonal High Groundwater "l�T?!!�• Y DTI�9 y r��!/7 / ' �U N .:.:.:.....:::::..:.;...,. ..:..... ..:....:........,......::..;........:... :.:..: ...:....:...;:;.:.;: D '7'EZtMINATZO�i .O.R SrAi 0NAL;J 'V4/A -t TAB j .. ... ..: . ... ::.. .. "`- Method Used: ; � �n Depth Observed standing in obs.hole: in. Depth to soil mottles: //a/ Depth to weeping from side of obs.hole: in. Groundwater Adjustment, ft�q�� PEA Cor�AT ON TEST °p;i:� �,iifi c Observation .r/�7 II l t 00 Hole N V /' Zr4 Time at 9" Depth of Perc � (�' 40 /�1101 Time at 6" 6 ; 4 s� i3 2d Start Pre-soak Time @ �Q' �'! - ld rr / Time(9"-6") ~r End Pre-soak 7Ut �a �!/ (,tIt y Rate Min./Inch (. Z_ l^2MP� 0 Site Suitability Assessment: Silc.Passed Site Failed: Additional Testing Nceded(Y dt3 l" Original: Public Health Division Observation Hole Data To Be Completed B cic Copy: ApplicantGov V IAJv� • m 1 ll>Cri OL LOC ON Depth Ho1� Depth from Soil Horizon Soil Texture Soil Color Soil Other S. ,. Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Doul deres. i cnc ravel /2- Z¢ 3 s /o yfz d�� 24 — 2 C/ 14r caaftf 6 M.. 2-/� Cz 5 m 5,��✓� �� n rcc�EY a R ble I —T4�° �� l l� 4j W,�' V&7 TDB /4x IV DEEP BSERVATION HOLE LOG Hole#. .Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA). (Munsell) Mottling (Stricture,Stones,Doulderes ' tent ° aye 14. ecfr� � F „2 /0 2 7�¢ �U a t ,Z Y. ,i d SO-/G2 G Z 'O ipYjz 7 ¢ F 7•5YA IIJ ' 03rI2� �'ION IOLI;LOG Iolc. ...Depth from Soil Horizon Soil Texture Soil,Color Soil Other - Surface(in.) (USDA) (Munsell) Motllitjg (Structure,Stones,[3ouldcres. `. n i tcnc °o ravel i F , f DEEP OBSERYf1TI01�1 HOLE LOG Hole# qq Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(it (USDA) (Munscll) Mottling (Structure,Stones,13oulderes. _QQnsistency-° ravel Flood Insurance Rate Maw Above 500 year flood boundary No_ Yes FIR AA 2 er7tQQ r.�� Within 500 year boundary No_ Yes Within 10.0 year flood boundary No= Yes �' Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious lterial exist i 1 areas observed throughout the FA VOee 7Jl area proposed for the soil absorption system. CZ K�fh/d Iq 5 � w /L(S�t 2 eT 2+�2 57RIPe��" D /sus If not,what is the depth of naturally occurring pervious material? �tRc� --- �40 ----� v � icTl .Cel-tification � �9 Rc v (date)I have passed the soil evaluator ex arm nat1on,approved.by,tf fill °.Department 6 f -,11 4ronmental Protection and that the above analysis was-performed'byrn'rcomittent with f tle:regtiired-trai ' .g xpertise ex e described in 310 CMR 15.01 o Signahtre r Date /o .30 a/ �'t ��. �y NOTE: OUTLET PIPE NOT Opp p0 < CONNECTED TO DWELLING ��D gyp' p���0 NSF 'O rn REBAR WEEKES CROSSING���" �•// W LOT 35 SET COMM.ASSESSORS ASS o0,_069 Q 'p s i ERNEST & DEANNA CASALI �p ��,OPEN SPACE p SAS O z #129 PERCIVAL DRIVE DRAINAGE p0 tx O Y ASSESSORS 110-001-016 , EASEMENT� o � (4 BEDROOMS) � m 26.6' EXISTING REBAR j REBAR WELL SET SET 141.5' UTILITY „ gyp• CLUSTER 1,500 GALLON �• N EXISTING SEPTIC TANK 61 �� WELL o LOT 34 °, •°' �' � LOT 33 EBAR 35,216± S.F. ��� 22.7' o N F SET D"B0XO/41.8' �N Pg.� COURTNEY & ELISSA PALMER S`�O REBAR / c�. #149 PERCIVAL DRIVE AS•° SET CC p� ASSESSORS 110-001-014 `161, ® F� (3 BEDROOMS) AF 7 55.4' 12.8x33.5' 38.1' OPEN S.A.S. WITH SPACE S9, A' O ROUND VERDIG "AS- BUILT TIES" tiA,. , ELEV.�9����h TOP FOUNDATION A ass 5"IQ c,�p OUT FOUNDATION 1cy't� REBAR 1 IN SEPTIC TANK52.16 34'-4" 8'- " OPEN SET 2 OUT SEPTIC TANK 51.96 41' 1'-1" GTtis SPACE 3 IN D-BOX " 'f'i�9� 6 OUT D-BOX 4 oy 9� 4 IN CHAMBER3'- , 7'- „ 1 BOTTOM F THE CERTIFY THE TOWN OF BAORNOWING STABLE STATEMENTS TO AS- BUILT HEREBY CERTIFY THAT THE LOT SHOWN AND PLOT PLAN THE BUILDING THEREON CONFORM TO ZONING BY-LAW WITH REGARD TO DIMENSIONAL REQUIREMENTS AND ANR PLAN AS RECORDED. IN THT THE LOT SHOWN DOES FURTHER FALL W THINAA SPECIAL FEDERAL W. B A R N S TA B LE, MASS FLOOD HAZARD AREA AND IS DESIGNATED AS ZONE "C". SCALE: 1"=50' DATE: 8/30/04 PREP. FOR: Mr. JAMES STERGIS THIS PLOT PLAN IS FOR BUILDING PREP. BY: EAS SURVEY, INC. PURPOSES ONLY AND IS THE RESULT OF AN ROUTE 6A; 'PO BOX 1729 ONGROUND TAPE AND INSTRUMENT SURVEY. SANDWICH, MA 02563 508-888-3619 �,JNOF'+ssq REFERENCES: o EDWARD cy� ADDRESS #141 PERCIVAL DRIVE o� A. `v� OWNER JAMES & MARY STERGIS STONE N REGISTRY DEED 5325 / 320 No. 2S980 PLAN 413 / 99 °�'P�G/ , ASSESSORS 110-001-015 ZONING: RF �oHY_ �� B�3D'� SETBACKS FRONT 30' SIDE & REAR 15' EDWARD A. STONE RPLS #28980 rri bw Q', 54�►p -WKILT u P PAST Xp x ir n 3/4" 11'-0' 26'-0' co f-aT.(i1 6' SLIDING GLASS DOOR ' 3(°u ev'+e s by, rn ...........ems.'.':.':::.':.':.'........... 3'-0"x6'-8' AANCE.. i ... `......... OFENIN6. : JC ..:.:..' ........... �>�� lL 6113884 i :_ :.:.:.:.' :::: ,� lo AIE� CPS 121 `J vJnas F I it G/Y� 7'.:.7ey.:..........:.:...:.'...:..._.:.'.:.:.'..:.'.'.'.'.'.':.'.'.'.'.'.'.'.'.'. li IY FIONC•/ l....................'.'...'...................... O N CHASE ST�,LR 61 0JiA)b Uo 4 PANTRY 'x24' 10' 1`iQ,SL F>�oR GL�EL, ROOM 9-0" 9-0 1 ---------- ------- 3861 '-0 1/4" REVISION C: 12/05/03 *LMC* & EPC (12/8/03) SIZE/STYLE 28'z38/65' FIN CAPE FILE NO:.STURGIS RESIDENCE DATE: 3-8-03 24' X 26' GARAGE TITLE: FIRST FLOOR PLAN DRAWN BY: EPG STATE: MASS aoo 3 ��� -o I/2• 10'-0" 26'-0' WIEG ----------------------- 3861SG 388 A13 FIRST FLOOR BELOW GARAGE BROOM-Z i 24'X32' ACCESS M aJ 6 w T 2ND FL OF GARAGE IS COMPLETED b ON SITE BY OTHERS ' C4 ----------------------- — -� r� 1o'-a' !C�►E6 �A�L DORMER 3442 A " RMER j AX � ---------------------------------------------------- ------ �l) l LT 142 -------------------! REVISION—D: M.I WINDOW LOCATIONS ..12-9-03 REVISION C: 12/05/03 *LMG* & EPG (12/08/03) SIZE/STYIE 28'x38/65' FIN CAPE FILE No:.STURGLS RESIDENCE DATE: 3-8-03 24' X 26' GARAGE TITLE: SECOND FLOOR PLAN DRAIN BY: EPG STATE: MASS �. T �/ ! ��� h rcv tM ; k e V a I � 1 g �I V � = 9 �� hru I Fir Cw � O TOWN OF BARNSTABLE 15C LOCATION �I �'CCr�'' I Dryi� SEWAGE# 20v3��a�" VILLAGE l e,�- ASSESSO 'S MAP&LOT 015 INS-TALLER'S NAME&PHONE NO A&A SEPTIC TANK CAPACITY c, LEACHING FACILITY: (type)' C w+ (size) NO.OF BEDROOMS ` BUILDER OR OWNER /' PERMPTDATE: X 0 COMPLIANCE DATE: a Section Distance Between the: Maximus* Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 2b0 feet of leaching facilityl Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by CA t I 1L o, (b -B I L � I C 4- i I I G� NE o SYSTEM PROFILE :SPNO RO NOT TO SCALE SYSTEM DESIGN 6 A -1 O TOP OF FOUNDATION DESIGN FLOW 4 / -- ELEV. 64.0 __ BEDROOMS AT 110 GPB D 440- GPD HIGH ST. RAISE COVERS TO WITHIN 6" OF FINISH GRADE CENTER CHAMBER RISER RAISE TO WITHIN 6„ OF FINISH GRADE REQUIRED SEPTIC TANK BASEMENT SLAB 56.0' `�> FINISH GRADE FINISH GRADE A ELEV = 55.8E ELEV = 54'f FINISH GRADE FINISH GRADE ' ELEV = 52.5E FINISH GRADE ELEV = 52.3t ELEV = 52.0E - GAL. 440 x-2-- - __ 880_ SEPTIC TANK REQUIRED = _1500 _GAL. TOP 53.17 -- 1 MIN 3 MAX COVER ON S.A.S. _ -- ------ 24' ®S=0.041 SEPTIC TANK PROVIDED H2O 2000 GAL. < � 21 CAS=0.093 2x9 CAS=0.01 TOP ELEV. 50.25 PER CLIENT N 4 PVC 2 MIN 1/8 1/4 DOUBLE WASHED PEA STONE k\ O� - 4 PVC SCH 40 0 00 00 0 0 00 00 SIZE OF LEACHING FACILITY REQUIRED SCH 40 O INV.= 2 MIN 3 MAX7 - INV.=51.75 INV.= 53.0 52.0 10 TEE 14 TEE O 00 00 0 0 0 00 00 �, „ DESIGN PERC RATE ___<2 ----MIN./INCH O 0 O 00000 O 3/4 DOUBLE WASHED STONE LOCUS LOCUS 6" 00 00 0 0 0 0 LONG TERM APPL. RATE_0.74_GPD/S.F. 5'-8 GAS BAFFLE 5 OUTLET ., �O 4,_6 THREE 4 -10 x8 -6 x2 -9 _ 4 -1 LIQUID LEVEL D-BOX R SIZE OF LEACHING SYSTEM PROVIDED. 4' �� LINV.=49.50 500 GALLON CHAMBE S ,z TRIPOUT' AROUND SYSTEM TO "C-2" HORIZON MIN DEPTH3 49.79 596 INV.=49.59 N 440 - 0.74 SF/GPD = ----S.F. MIN. REQUIRED ELEV- S.A.S. 12.83' x 33.50 EL V. 47.50 LOCUS MAP. NOT TO SCALE ( ), �n o - 47.50 - STRIPOUT (23 f x 43.5 ) USING 3 CHAMBERS WITH 4' STONE AROUND 100 0. ° TO MEDIUM SAND" C-2" HORIZON `n T 6„ BASE OF CRUSHED STONE D A T U M . SIDEWALL 2(12.83+33.5') x 2 185.3S.F OR MECHANICALLY COMPACTED BASE TEST PIT #2, MOTTLES AT ELEVATION. 42,.3 - i H-10 1,500 GALLON BOTTOM 12.83 x 33.5 - 429.8S.F. VERTICAL DATUM. ASSUMED TOTAL LEACHING AREA 615S.F. PRECAST CONCRETE SEPTIC TANK = • 4 BENCH ON FILE � 615 S.F x 0.74 455 GPD BENCH MARK USED. TOP OF CONCRETE BOUND. ELEVATION 7 .60. BE C T AN F 455 GPD PROVIDED > 440 GPD REQUIRED = 15 GPD RESERVE AT THE BOARD OF HEALTH OFFICE, SEE SITE/SEPTIC IC PLAN 0 I Y R T & McLELELLAN ENGINEERING 4 BEDROOM DESIGN B DEME ES NO GARBAGE GRINDER,_./ DISPOSAL ALLOWED OF ABUTTING LOT 35, # 129 PERCVAL DRIVE. TEST HOLE 2 _ TEST 1 DEEP E DEEP ES # # DATE. 10 30 01 DATE: 10 30 01 EXISTING X MARK �\ LOT 51 / SE T IN GROUND ELEV 51.0 GROUND ELEV 52.1 WE LL .UTILITY PAD ��� N/F , INFORMATION c T I NO GROUNDWATER NO GROUNDWATER ` THOMA & MADELINEs MA DEN LOCUS I N I OR M A I I ON NO REFUSAL NO REFUSAL 0 S Q • `� � `. #140 PERCIVAL DRIVE ASSESSORS 110-001-028 LOAMY SAND �\ � CB � 4 BEDROOMS LOAMY SAND O 10YR 3 2 �L '�� � ) CURRENT OWNER DAMES & MARY STERGIS 10YR 3/2 „ / 12 B 14 N F 'jT �\ B / CB ADDRESS 47 OAKMONT ROAD LOAMY SAND LOAMY SAND ' BENCHMARK # OF, WEEKES CROSSING � �®��\ `.\ TOP OF -CUMMAQUID 10YR 4/6 10YR 4/6 �`L COMM. ASSOC. \� MA 02637 24 32„ �1E�\' •gyp ASSESSORS 111-001-069R�\ 00 ��� CONCRETE C-1 C-1 G 5� � -- � � `�cp '0 .\ BOUND FOUND \N . O cP- DEED REFERENCE: DEED BOOK 5325, PAGE 320 COMP. SILT/LOAM COMP. SILT/LOAMY\S \ \ \ �\ /� ELEV = 74 t 10YR 6/6 10YR 6/6 „ 42 60 50 � REBAR � �/� ' ` � � PLAN REFERENCE: PLAN BOOK 413, .PAGE 99 C-2 1 A C-2 2A EAPROX, LOCATION OF \ 1 SET _ - - \�` \\ . ELEV = 47.5 „® OPEN SPACE MEDIUM SAND 66" COARSE SAND 66 N SEPTIC SYSTEM �� \\ ZONING DISTRICT RF 10YR 7 4 10YR 7 4 / 0 / / „ � � DRAINAGE � , � � �` 108" 90 , - SETBACKS FRONT 30' C-3 C 3 ,o- SIDE... 15 118 (ELE ) EASEMENT REAR 15 COMP. SILT CLAY COMP. SILT/CLAY / s - S ' MOTTLES 7.5YR 4 6 10YR 6 2 10YR 6/2 / 6' .- � /' •� i 9� O , 150 DISTINCT & MANY � � � -- _ 116 116 \ .�. �- � .\ - \ FLOOD ZONE C , DATED \ - i 2. O O C F` . , C 2 i � � O PANEL Y 4 6 A EL 7 R O MOT TLES .5 � � -_ T 3 5 .. - R SAND ._t ._ r COARSE .� .� _ � � 6 MEDIUM .SAND _ a� - _ \_ - _ DISTINCT & MANY � � -•` . D I S ...- 1 1 YR 7 4 _. � � 0 4 � �. G 10YR 7 / / 0 A AP 11 0 \ ASSESSORS M 0 16 2 / F. / S � �. \ "I _ ELEV - 38.g c� \ - � �. � � - / PARCEL 001 015 ELEV 39.0 ERNEST & DEANNA CASALI \ / 6 �' 129 PERCIVAL DRIVE \' .p \ p B.O.H. B.O.H. I � ASSESSORS 110-001=016 � \ � � 68 � � / \ r� w \ � � . EXISTING \ LEE M. McCONNELL D. STANTON > J LEE M. McCONNELL/D STANTON / - � > \ LOT AREA 35,216E S.F. CALCULATED AREA (4 BEDROOMS) \ -- ��, �'• � O� WELL \ c� SOIL EVALUATOR. SOIL EVALUATOR `t \ \ \ / 9 \ - - - - \ REBAR D. STONE Y 0 \ \ „ ED. STONE E o � � \ ET, �/ / � \ \� OVERLAY DISTRICT. A.P.. BACKHOE OPERATOR. REBAR SEAN ENRIGHT / SET AREA OF NEIGHBORHOOD PRIVATE WELLS SOIL TYPE: NCH 0, "Ix _ _\ � t / ) PERC RATE. <2 MIN. PER I d LOADING RATE: 0_74 GAL/SF/MIN UTILITY GENERAL NOTES. _ / CLUSTER 1. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. S TA E RULES AND REGULATIONS lb TITLE V AND THE TOWN OF BARNS BL FOR SUBSURFACE DISPOSAL OF SEWERAGE. 2. AT LEAST ONE ACCESS POINT OVER TANK TEES SHALL BE ' REMAINING ACCESSIBLE WITHIN 6 OF FINISH GRADE, WITH ANY REMA N O / \ \ / �6 \, 0 20 30 40 60 10 BROUGHT TO WITHIN 12 OF FINISH GRADE. O 55 • O �0 yakf V" ACCESS PORTS B >' / EXISTING ,, , A COMPONENTS OF THE SANITARY SYSTEM SHALL BE `'� / 1 500 GALLON O- r 6 - ` 3. ALL \J g0 3� \� WELL , ,.�; c'nr,^; "�• UNLESS THEY ARE i CAPABLE OF WITHSTANDING H 10 LOADING U SEPTIC TANKrn \ PARKING AREAS THEY UNDER OR WITHIN 10 OF DRIVES OR -'S4 / -' - - - - - - - - - - - MUST WITHSTAND H-20 LOADING. / ` < �O o t�, , GRAPHIC SCALE. 1 INCH - 20 FEET / � � � / � ST;�"v�= �� �� MflLL1AM �� 4. THE EXCAVATION CONTRACTOR SHALL VERIFY THE LOCATION / ` S' All _ 2A - o .. o. S� � � / ,,� 5P po ,� a �,� DATE. DECEMBER 5, 2001 � �� OF ALL UTILITIES PRIOR TO ANY EXCAVATION. 90 TO GRADE - - _ , ,,5-J p�` 5. ANY MASONRY UNITS USED TO BRING COVERS53- . LOT 33 ss`°Nqs�EOS`'� REV. NOVEMBER 12, 2002Q`� �Q PLACE. - _ F �, 9 I S OR WITHIN 6 OF GRADE SHALL BE MORTARED IN L / - - � S \ - � � O �� 5� �� - �FFSStOMA, `NG� 6. FINISH GRADE SHALL HAVE A MINIMUM OF 0.02 FEET PER / „ „ N/F REV. MAY 1 , 2003 FOOT OVER THE S.A.S. AND DISTRIBUTION BOX. / DTH#2 D ROX 0 �� / T 34 ...... ... :' . � \ / 8 � COURTNEY & MELISSA P)ALMER "LOT �.. 7. SEPTIC TANK SANITARY TEE 5 SHALL BE CONSTRUCTED OF i ;•.� \ '1 S #149 PERCIVAL DRIV/E REBAR ......:.: :.... . , SCHEDULE 40 PVC AND SH ALL EXTEND A_MINIMUM OF 6 ABOVE - / ' ASSESSORS 110-001-1014 SET � S. F. � : : . .... .....:-.•.•. \ SITE ..AND SEWAGE PLAN N THE CENTERLINE AND 35, 216 - - _ i „ :::: 38 6 �� ROOMS THE FLOW LINE AND SHALL BE 0 1A :;:: � \ � (3 BEDROOMS) LOCATED DIRECTLY UNDER THE CLEAN OUT MANHOLES. s �/ o V RI INVERT ELEVATION SHALL BE NO LESS THAN S• - .::: :::• � � � 141 PERCI AL DRIVE 8. THE INLET PIPE E O �- Q 0. O• - - -52 12.8x33.5 . . DTH 1 / S INCHES NOR MORE THAN 3 INCHES ABOVE THE INVERT \ .......::,:: .. ...... # �.� O 2 .:::::-....�::......::::: �. S.A.S.- WITH ... ......:::: ......::. � � WEEKES CROSSING ELEVATION OF THE OUTLET PIPE. F \ INCHES 5' OVERDID 9. THE SEPTIC TANK SHALL HAVE A MINIMUM COVER OF 9 INC A \ ALL AROUN \ \ ,� I N 10. THE OUTLET SANITARY TEE SHALL BE EQUIPPED WITH A G S REBAR / �' CONSTRUCTED OF 4' PVC \ / Sc'� ��� BAFFLE, 4 INCHES IN DIAMETER AND C T \ , �, ( W. BARNSTABLE, MASSACHUSETTS SET 11. ALL PIPES SHALL BE SCHEDULE 40 PVC SEWER PIPE AND \ 61.o FOR THE �� \ SHALL BE SLOPED 1/4 INCH PER FOOT MIN. EXCEPT .� 63.0 DISTRIBUTION BOX WHICH SHALL s9. \ O FIRST TWO FEET .OUT OF THE D S OPEN \ ,�g BE LEVEL. SPACE LEGEND N TO SYSTEM DESIGN REQUIRE NOTIFICATION \ 12. CHANGES OR REVISIONS 12.8x34.5 \ SURVEY INC. FOR BOARD OF HEALTH AND DESIGN ENGINEERS \ / D�` TO EAS RESERVE AREA PREPARED FOR: AND APPROVAL.. \ / O�• • N/F NOW OR FORMERLY REVIEW \ // `L W PROPOSED WATER LINE JAMES - & MARY STERGIS \ / BENCHMARK Fri PROPOSED COUNTOUR 47 OAK M ON T ROAD . \ / SPIKE SET CONSTRUCTION NOTES. \ � // IN TRIPLE --62- - EXISTING CONTOUR CUMMAOUID, ` MA 02637 CEDAR .AND ,� g0 \ / 1. CONTRACTORS INSTALLERS SHALL VERIFY GRADES S, / / \ / ELEV = 5d.00 E (508) 362-6595 u O EXISTING ELECTRIC MANHOLE ELEVATIONS AND SITE CONDITIONS PRIOR TO COMMENCING 9• \ / �y .. NOTE: WORK ON THE SITE. TOTAL SUBDIVISION OPEN SPACE AREA _ 933,571t S.F. Cg EXISTING CATCH BASIN . NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE - 2 TOTAL NUMBER OF .LOTS IN SUBDIVISION _ 51 LOTS WITH DEEDED OR ZONING REGULATIONS. OWNER / APPLICANT OPEN SPACE AREA PER LOT = 18,305E S.F. FROM APPROPRIATE AUTHORITY. IS TO OBTAIN SUCH DETERMINATION TOTAL LOT AREA + ALLOCATED \ ' PREPARED BY: VEHICULAR TRAFFIC PARKING OF VEHICLES AND PLACING N/F 3 / OPEN SPACE AREA = 53;521 f S.F. E AS SURVEY INC. MATERIALS OVER THE SEPTIC TANK, DISTRIBUTION BOX AND MASSACHUSETTS BAY REBAR \ � 53,521 S.F. / 10;000 S.F PER BEDROOM = 5 BEDROOMS S.A.S. AREA IS PROHIBITED TRANSPORTATION SET 141 RT. 6A P. O. BOX 1729 \ , INSPECT BOTTOM OF LEACHING AUT HORITY 4. B.O.H AND DESIGN ENGINEER TO INS OPEN EXISTING LOT AREA _ . 35,216E S.F. SANDWICH , MA 02563 AREA PRIOR TO INSTALLATION OF SYSTEM. SPACE /// OPEN SPACE IN FRONT OF LOT 34 = 4,825E S.F. 4 BEDROOMS PH. 508 888-3619 FAX 508 888-2496 40,041 S.F. / 10,000 S.F PER BEDROOM ( ) . � ) ___ __ I V SYSTEM PROF' 'E : ALL COMPONENTS TO BE H - 20 W NOT TO SCALE 6A SYSTEM DESIGN �a TOP OF FOUNDATION _ DESIGN FLOW BEDROOMS AT 110 GPB fD 440 GPD HIGH ST. RAISE COVERS TO WITHIN 6" OF FINISH 'RADE ELEV. 66.0 CENTER CHAMBER RISER 4 RAISE TO WITHIN 6" q BASEMENT SLAB 56.0 FINISH GRADE FINISH GRADE OF FINISH GRADE REQUIRED SEPTIC TANK ELEV = 55.8t ELEV = 54.5t FINISH GRADE FINISH GRADE //�.� ELEV = 52.5t ELEV = 52.Of ELEFINIVH=GRADE52 Of ----40 x 2 - _ -- 8 0 GAL. 440 x 2 880 A: 3 OS=0.200 ��///, / \� .� �� �� ���///�� SEPTIC TANK REQUIRED _1_500 _GAL. T = //�� , ' 10'OS=0.060 1 MIN- 3 MAX COVER ON S.A,S. SEPTIC TANK PROVIDED - �� Q� -• . 15 CUSS=0.067 - N `� `�. 4„ V 35 c�S=0.017 18 t�S=0.033 TO[, ELEV. 51.3 ,. "_ " PER CLIENT _H2O 2000_GAL. ,+- 4 PVC SCH -40 2 MIN 1/8 1/4 DOUBLE WASHED PEA STONE L, x, p OLO O o o O O O a O SCH 40 INV•= 2 MIN-3-MAX o) O 00000 o SIZE OF LEACHING FACILITY REQUIRED " „ INV.=51.75 O O O o o p 00 O'O i „ LOCUS LOCUS INV.= 53.0 M 52.0 10 TEE 14 TEE - „ 0�0 00 O O O 3 4 DOUBLE WASHED NONE DESIGN PERC RATE <2 � , 6 q. O c� o O O / ---------MIN./INCH 7 -4 GAS BAFFLE O O O O O / 69-i 1 _9 OUTLET THREE 4'-10"x8'-6"x3'-0" LONG TERM APPL. RATE_0.74_GPD S.F. 2 5'-4" LIQUID LEVEL H 20 D BOX 500 GAL. H-20 CHAMBERS SIZE OF LEACHING SYSTEM PROVIDED: 5-10" 51.15 i'V.=50.3 I " „ .u_ z T (POUT AROUND SYSTEM T(0 C-2 HORIZON MIN DEPTH INV.=50.9 • LOCUS MAP: NOT TO SCALE 45 ELEV= S.A•S. (12.83 x 33.50 ) . 48.3 440 - 0.74 SF/GPD = 596 S.F. MIN. REQUIRED „ Lri USING 3 CHAMBERS WITH 4' STONE AROUND _ o 0 0 0 0 0 STRIPOUT (23't x 43.5') o „ TO MEDIUM SAND C-2 HORIZON DATUM : 6 BASE OF CRUSHED STONE OR MECHANICALLY COMPACTED BASE - - H-20 2,000 GALLON TEST PIT #2, MOTTLES AT ELEVATION 42.3 - SIDEWALL = 2(12.83+33.5') x 2 = 185.3S.F. VERTICAL DATUM: ASSUMED BOTTOM = 12.83 x 33.5 = 429.8S.F. ,Q TOTAL LEACHING AREA = 615S.F. j � PRECAST CONCRETE ., BENCH MARK USED: TOP OF CONCRETE BOUND. ELEVATION 74.60. BENCH ON FILE SEPTIC TANK _ 51 U E 615 S.F x 0.74 - 455 GPD SEE SITE/SEPTIC PLAN OF AT THE BOARD OF HEALTH OFFICE, 455 GPD PROVIDED > 440 GPD REQUIRED = 15 GPD RESERVE 4 BEDROOM DESIGN BY DEMEREST & McLELELLAN ENGINEERING OF ABUTTING LOT 35, 129 PERCVAL DRIVE. NO GARBAGE GRINDER f DISPOSAL ALLOWED er4 ` DEEP TEST HOLE #1 DEEP TEST HOLE #2 tw DATE: 10/30/01 DATE: 10/30/01 EXISTING X-MARK �`� LOT 51 .fi SET IN GROUND ELEV 51.0 GROUND ELEV 52.1 WELL 4 NO GROUNDWATER NO GROUNDWATER UTILITY PAD ��� N/F � THOMAS & MADELINE MADDEN LOCUS INFORMATION NO REFUSAL NO REFUSAL E . EN 0 �• `� �• 140 PERCIVAL- DRIVE LOAMY SAND LOAMY SAND ASSESSORS 110-001-028 10YR 3 2 10YR 3/2 I O �`� �j CB (4(4 BEDROOMS) B / 12" B ,4" �O .� CURRENT OWNER JOSEPH TOZZA & MILDRED MASCIOLI LOAMY SAND LOAMY SAND ' N/F CB �� BENCHMARK ADDRESS 6 HASTINGS ROAD 10YR 4/6 10YR 4/6 �. Off' WE COMM. CROSSING < ;®.�� �`� TOP OF WINCHESTER C-1 24 C-1 32 �lE��' •�O� ASSESSORS 111 001-069R�� �� �`� Q �`� CONCRETE MA 01890 COMP. SILT LOAM COMP. SILT LOAM \ ���G ��� �- cA `. `. BOUND FOUND / ��`' ' \ \ a �' �� �� `� ELEV - 74.60 DEED REFERENCE: DEED 800K 5325, PAGE 320 ,OYR 6/6 10YR 6/6 ,�0 E i \ \ \ ` ` ELEV = 47.5 C-2 4210 A C-2 60 Zq APPROX• LOCATION OF \ 150 REBAR A i _ - ` ` � `� PLAN REFERENCE: PLAN BOOK 413, PAGE 99 MEDIUM SAND 66" COARSE SAND 66" ABUTTING SEPTIC SYSTEM SE OPEN SPACE I 10YR 7/4 10YR 7/4 \ / p 108 90 // i DRAINAGE ZONING DISTRICT RF i SETBACKS FRONT 30 C-3 C-3 , • COMP. SILT/CL.AY COMP. SILT/CLAY 118" (ELEV. 42.3) \ '. ,o l �'° s EASEMEN T �,� r SIDE 15 10YR 6/2 10YR 6/2 MOTTLES 7.5YR 4/6 6, I v', �\ �� - - 7,� `� Sp. `� REAR 15 l is e", 116" 150" DISTINCT & MANY 9 �--69, p „ MOTTLES 7.5YR 4/6 \ \ \ 4F, �`� •\ FLOOD ZONE C , DATED I, �IEDiUM SAND, COARSE SAND LOT 35 DISTINCT & MANY - \ 6j \ =%•� -'68 0� \ >1,� 1d e r t� � �� PANEL # 10YR 7/4 10YR 7/4 ♦ � \ _ �� �� � � �\ S� \� ,o `� 14�! 16 2" w _N/F c5' \ _ - \ �. G ELEV = 38.8 \ a i .F, / S • ASSESSORS MAP 110 ERNEST & DEANN.A CASALI \ _ , �6 �� / \ �• \ 1i a #129 PERCIVAL DRIVE �S ,39.1 �-- �� , \ 9.4' 69� 6� / ^' / \`�6•, \ �` C� PARCEL 001-015 B.O.H. M - -F / \ •O / \ `� 'p0 • ASSESSORS 110-001-016 \ F LEE M. MCCONNELL/D STAN'rON LEE M. uMcCONNELL/D. STANTON \ ""'�' "' 68. ��� /PROPOSED \ S �� 90 SOIL EVALUATOR. SOIL EVALUATOR (4 BEDROOMS) \ / �6j` ��, / > Z Y \\ -- - -- --�TL '�� - �►� O \ I WELL \ ��, . LOT AREA 35,216f S.F. CALCULATED AREA ED. STONE ED. STONE 6' \ ♦� -REBAR O -� \ \ I BACKHOE OPERATOR. o _ _.. --- r� �' \ �`♦ ETA �� / \ \\\ OVERLAY DISTRICT: "A.P" � \ :�` v x \ REBAR SEAN ENRIGH7 m �\ // \ ♦ I \ N SOIL TYPE: 1 Q -- j� �\\ ♦♦`� 6s '►♦: ��/ \ \ \ �j SET „AREA OF NEIGHBORHOOD PRIVATE WELLS PERC RATE: <2 MIN. PER INCH �, / '� '4 O ��• \ LOADING RATE: 0�74 GAL/SF/MIN N a ti�1� /^;-/ / \\ \ ♦,� .>0 T♦ \ \ \\ ,��,� '~ \ / UTILITY GENERAL NOTES: I 10, --- _ A . ♦ 101, � � / 68. CLUSTER !' 0o 1. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. _ I // " - _ �-01 \ \ Os .0, TITLE V AND THE TOWN OF BARNSTABLE RULES AND REGULATIONS FOR SUBSURFACE DISPOSAL OF SEWERAGE. ,_ / _. A _ \ 9Sr� 11\ ` 2. AT LEAST ONE ACCESS POINT OVER TANK TEES SHALL BE „ WITH ANY REMAINING O� _-. _ •t,> a' F4 �s \ S Sip \�/ S ACCESSIBLE WITHIN 6 OF FINISH GRADE, A ACCESS PORTS BROUGHT TO WITHIN 12 OF FINISH GRADE. ,p�0�' I 'A� S) \ �� •t 00 Ft0 / 4\ EDWARD A. STONE, PLS. DATE: 3. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE �g'� / „r S� p u'�\\ ' �� S �� ' 6 ��� EXISTING CAPABLE OF WITHSTANDING H-10 LOADING UNLESS THEY ARE / / '9� `S'FO •O \ � �, �� \ 3� QD WELL UNDER OR WITHIN 10' OF DRIVES OR PARKING AREAS THEY -S4'' " - S'` �.G,o c \ \ / \6 �O MUST WITHSTAND H-20 LOADING. -" - -,-9� �F AF y 1 ,� 4. THE EXCAVATION CONTRACTOR SHALL VERIFY THE LOCATION 1 OF ALL UTILITIES PRIOR TO ANY EXCAVATION. / O ,.2A,fi`L ,p •F S ' ''� / l� P�' 5, ANY MASONRY UNITS USED TO BRING COVERS TO GRADE ___S3` `\ .0,��0 OR V�ITHIN 6" OF GRADE SHALL BE MORTARED IN PLACE. �` 1 s �� F� LOT 33 i / 0 �? 0 20 30 40 60 100 6. _FINISH GRADE SHALL HAVE A MINIMUM OF 0.02 FEET PER / �6 0 \ S9 h0 FOOT OVER THE S.A.S. AND DISTRIBUTION BOX. // ♦ 0 TH# 48\\ 0 �v/ `S �' '`� v N/F f 7. SEPTIC TANK SANITARY TEE'S SHALL BE CONSTRUCTED OF , / LOT 34 �... ! \ / 8 3� COURTNEY & MELISSA PALMER REBAR / \� � SCHEDULE 40 PVC AND SHALL .EXTEND A MINIMUM OF 6 ABOVE _ - \ S) O #149 PERCIVAL DRIVE THE FLO',V LINE AND SHALL BE ON THE CENTERLINE AND \ SET < 35, 216 + S. F. �i' // „ M �., \\ 27.0'�� �� ASSESSORS 110-001-014 GRAPHIC SCALE: 1 INCH = 20 FEET t LOCATED DIRECTLY UNDER THE CLEAN OUT MANHOLES. s \ �� 4 / 1A \ /� Sc 2� (3 BEDROOMS) 8. THE INLET PIPE INVERT ELEVATION SHALL BE NO LESS THAN �Sir 0 _ \� ��' � // ��' ' SS �� DATE: DECEMBER 5, 2001 2 INCHES NOR MORE THAN 3 INCHES ABOVE THE INVERT 6 O' r"52 \ / G' TH# 2000 GALLON ELEVATION OF THE OUTLET PIPE. H-20 SEPTIC �� 9. THE SEPTIC TANK SHALL HAVE A MINIMUM COVER OF 9 INCHES \ S� TANK o �� 10. THE OUTLET SANITARY TEE SHALL BE EQUIPPED WITH A,�GAS REBAR �S BAFFLE, 4 INCHES IN DIAMETER AND CONSTRUCTED OF 4 PVC . :\:: ' �� SITE AND SEWAGE PLAN 11. ALL PIPES SHALL BE SCHEDULE 40 PVC SEWER PIPE AND SET ,, \\ / ��31' i \ � �\ SHALL BE SLOPED 1/4 INCH PER FOOT MIN. EXCEPT FOR THE \ 51` „ O�' 141 PERCIVAL DRIVE FIRST TWO FEET OUT OF THE DISTRIBUTION BOX WHICH SHALL OPEN •S9' 1 ,/ H-20 D BOX �� BE LEVEL. SPACE _5 \ .8x33.5' \ WE E K E S CROSSING" 12. CHANGES OR REVISIONS TO SYSTEM DESIGN REQUIRE NOTIFICATION LEGEND TO. EAS SURVEY, INC. FOR BOARD OF HEALTH AND DESIGN ENGINEERS ..• \� / g��`� OVERDIG IN REVIEW AND APPROVAL. \ // ti AROUND N/F' NOW OR FORMERLY W. BARNSTABLE, MASSACHUSETTS / \ W PROPOSED WATER LINE \\ / BENCHMC PREPARED FOR: ON5TrRUCTION NOTES: \\ t' 570 SPIKE SI —z 4.� PROPOSED COUNTOUR ti IN TRIPL CARL P. CUERONI 1. CONTRACTORS / INSTALLERS SHALL VERIFY GRADES AND �'�;� , g0 // CEDAR EXISTING CONTOUR 31 FAY ROAD �_LE'VATiOIIS AND SITE CONDITIONS PRIOR TO COMMENCING SA , \ / ELEV = 00 \ ' 9• \ / OE EXISTING ELECTRIC MANHOLE �' FRAMINGHAM MA 01702 r YFjta`nK ON THE SITE, ly �. NOTE: � �•��S� °f"�s � `ZN of 2, NO Cyr TERt,tZINATiOI� HAS BEEN MADE AS TO COMPLIANCE 12.8x34.5' TOTAL SUBDIVISION OPEN SCE AREA = 933,571f S.F. � . CB EXISTING CATCH BASIN WI tH DEtLEC OR ZON{PUG REGULATIONS. OWNER APPLICANT TOTAL NUMBER OF LOTS INIUBDIVISION = 51 LOTS ® �� � (508) 879-9989 � 1 DWARD / RESERVE AREA , \ WILLIAM a TO Os3TA'hl S1;CI-I DETERMINATION FR01�4 APPROPRIATE AUTHORITY. OPEN SPACE AREA PER L0 18,305f S.F. ( LIEBERMAN " STONE H 3. � _HIC'ULAR TRAF'_IC, PARKING OF VEHICLES AND PLACING N/F TOTAL LOT AREA + ALLOC�D \ � A ,� NJ. ray„o PREPARED BY: � � �,� ivI�;TERIAL� OVER THE SEPTIC TANK, DISTRIBUTION BOX AND MASSACHUSETTS BAY \ REBAR OPEN SPACE AR = 53,521t S.F. - ��o`AG�ST£, �,► \ FS c� EAS SURVEY, INC. S.A.S. AREA IS PROHIBITED TRANSPORTATION � SET 53,521 S.F. / 10,000 S.F � BEDROOM = 5 BEDROOMS s�oN�L �•�' ,< <,. , 4: B.O.H AND DESIGN ENGINEER TO INSPECT BOTTOM OF LEACHING AUTHORITY L 141 RT. 6A,• •P.O. BOX 1729 OPEN EXISTING LOT AREA 35,216± S.F. \ Vv p t AREA PRIOR TO INSTALLATION OF SYSTEM. SPACE OPEN SPACE IN FRONT -OF 34 = 4 825f S.F. 1y ' � r . SANDWICH. MA 02563 - 40,041 S.F. / 10,000 S.F P BEDROOM = 4 BEDROOMS AV - ---- v N C� SPNa SYSTEM PROFILE : R z NOT TO SCALE 6 A SYSTEM DESIGN P� �O TOP OF FOUNDATION DESIGN FLOW ELEV. 64.0 4 BEDROOMS AT 110 GPB/D 440 GPD HIGH ST. RAISE COVERS TO WITHIN 6" OF FINISH GRADE CENTER CHAMBER RISER RAISE TO WITHIN 6" BASEMENT SLAB = 56.0 FINISH GRADE FINISH GRADE OF FINISH GRADE REQUIRED SEPTIC TANK ELEV = 55.8t ELEV - 54'f FINISH GRADE FINISH GRADE ELEV = 52.3f FINISH GRADE 440 x 2 = _-_ 880 ELEV = 52.5f ELEV = 52.Ot --- - - -- - GAL. F TOP = 53.17 ///�\ ��� ��///�\ //�\ �\ �\ �\ SEPTIC TANK REQUIRED - 500 _GAL. 3 @S=0.03 `ram 24' ®S=0.041 1' MIN- 3' MAX COVER ON S.A.S. SEPTIC TANK PROVIDED = _H2O 2000_GAL. N � `�` 4" PVC 21'®S=0.093 2x9'@S=0.01 TOP ELEV. 50.25 PER CLIENT O� 2" MIN 1/8"-1/4" DOUBLE WASHED PEA STONE O SCH 40 INV.-_ 2 MIN-3 MAX 4" PVC SCH 40 O DO 00 0 o O 00 00 SIZE OF LEACHING FACILITY REQUIRED LOCUS INV.= 53.0' 52.0' 10"TEE 14"TEE INV.=51.75 M�o O O o Q O O O -1 DESIGN PERC RATE <2 MIN. INCH O LOCUS 00 00 O 00 00 `�' 3/4" DOUBLE WASIHED STONE ------ / �O 5'-8, GAS BAFFLE 6 00 00 0 o O 00 00 LONG TERM APPL. RATE-O•_74_GPD/S.F. 4'-6" 5 OUTLET 4'-1" LIQUID LEVEL D-BOX THREE GALL4'-1ON CHAMBERS SIZE OF LEACHING SYSTEM PROVIDED: 4,-3„ 49.79 LINV.=49.50 500 GALLON CHAMBERS _ INV.=49.59 z \5' TRIPOUT AROUND SYSTfEM TO "C-2" HORIZON MIN DEPTH N 440 _ 0.74 SF/GPD = _596 S.F. MIN. REQUIRED LOCUS MAP NOT TO SCALE ELEV= S.A.S. (12.83' x 33.50 ) L V. 47.50 - 47,50 Sri - STRIPOUT (23' x 43.5') ! USING 3 CHAMBERS WITH 4' STONE AROUND DATUM : 6" BASE OF CRUSHED STONE TO MEDIUM SAND" C-2" HORIZON `n OR MECHANICALLY COMPACTED BASE TEST PIT #2, MOTTLES AT ELEVATION 42.3 SIDEWALL = 2(12.83+33.5') x 2 = 185.3S.F. VERTICAL DATUM: ASSUMED H-10 1,500 GALLON BOTTOM = 12.83' x 33.5" = 429.8S.F. PRECAST CONCRETE TOTAL LEACHING AREA 615S.F. BENCH V ARK • TOP FCONCRETESEPTIC TANK =USED: 0 ED BOUND. ELEVATION 4 0 7 .60. BENCH ON FILE 615 S.F x 0.74 455 GPD AT THE BOARD OF HEALTH OFFICE, SEE SITE/SEPTIC P-AN OF 455 GPD PROVIDED > 440 GPD. REQUIRED 15 GPD RESERVE BEDROOM DESIGN BY DEMEREST & MCLELELLAN ENGINEERING OF ABUTTING LOT 35, # 129 PERCVA.L DRIVE. NO GARBAGE GRINDER_/ DISPOSAL ALLOWED DEEP TEST HOLE �14- DEEP TEST HOLE 42 DATE: 10/30/01 DATE: 10/30/O' { EXISTING X-MARK `. ��j1 GROUND ELEV 51.0 GROUND ELEV 52.1 WELL SET IN LET " NO GROUNDWATER NO GROUNDWATER UTILITY PAD \\ TH MA A/F IN MADDEN LOCUS INFORMATION NO REFUSAL NO REFUSAL A A O `� �. 0 S & M DEL E M DDE �� ��� #140 PERCIVAL DRIVE LOAMY SAND LOAMY SAND \� ��``' - 10YR 3/2 10YR 3 2 ASSESSORS 110-OG1-028 / Op ��� CB®' (4 BEDROOMS) I CURRENT OWNER JAMES & MARY STERGIS B 12 B 14 �O ` L LOAMY SAND LOAMY SAND N/F � CB �` \\�. BENCHMARK ADDRESS #47 OAKMONT ROAD 10YR 4/6 „ 10YR 4/6 ' �F, WEEKES CROSSING ® TOP OF CUMMAQUID 24 32" orL COMM. ASSOC. ,p ��, O CONCRETE MA 02637 C-1 C-1 ASSESSORS 111-001-069R\\ 6' \ `. COMP. SILT/LOAM COMP. SILT/LOAM , ��NG �h - \ O .\ �� BOUND FOUND 10YR6/6 ELEV - 74.60 DEED REFERENCE: DEED BOOK 5325, PAGE 320 10YR O 42 60 / REBAR / I PLAN REFERENCE: PLAN BOOK 413, PAGE 99 ELEV = 47.5 C-2 Q 1 A C-2 ® 2A \ � �/ i �\ �� 66 APPROX. LOCATION ST � - - - OPEN SPACE \ e,\ MEDIUM SAND 66" COARSE SAND SET - 10YR 7/4 10YR 7/4 ABUTTING SEPTIC SYSTEM \ \ / / / DRAINAGE � � \ �` �.\\ ZONING DISTRICT FR FRONT 30' C-3 108„ C-3 90" SETBACKS O COMP. SILT/CLAY COMP. SILT/CLAY � 118" (ELEV. = 42.3) > / \ / 70 ------,EASEMENT \ \ \ \ \� \ \ \`� I SIDE 15' 10YR 6/2 10YR 6:/2 MOTTLES 7.5YR 4/6 _ 6 O s�j• �\ \ - •/ ` �\\ SO.,.. `,\ PEAR 15 C-2 116" 4� 116" C-2 150" DISTINCT �& MANY 9 \ - 69� MOTTLES 7.•J-YR +/6 - - - �- FLOOD ZONE C , DATED MEDIUM SAND COARSE SAND �1 \ \ \ _ - moo. _ _-- LOT � � DISTINCT & -MANY �., .�-, _-- - _��. ..__.. - _\ -_ _ - 10YR 7/4 10YR 7/4 rn \ --.. 68- ELEV = 39.0 ELEV = 38.8 c� . / , 66 \ ,0 \ . .\, G ASSESSORS MAP 110 Q - ERNEST & DEANNA CASALI \ - - - -t \ \ �� tx F' \ /\ \S \ - phi . m O �\ 6g PARCEL 001-015 ti B.O.H. B.O.H. #129 PERCIVAL DRIVE S \ - 1 ASSESSORS 110-001-016 \ F �O LEE M. McCONNELL/D STANTON LEE M. McCONNELL/D. STANTON I � � � 68� �EX:ISTING �O SOIL EVALUATOR. SOIL EVALUATOR 4 BEDROOMS �� \ \ >\ ,9 J z ( ) \ \ \`�� 6�, �' 00 \ / WELL \\ \ �O\ LOT AREA 35,216f S'.F. CALCULATED AREA ED. STONE ED. STONE Y a. - - - - -f- - \ \ .REBAR / \ BACKHOE OPERATOR. o \ \ \ / \ o -- - -- \ ET, /\ \/ \ \� OVERLAY DISTRICT: "A.P" SEAN ENRIGHT m i \ �i \ \ REBAR SOIL TYPE: �_ Qz / - -= \ V� O \ x / \ \ �� N SET „ PERC RATE: <2 MIN. .PER INCH � -�� s0 � � J i AREA OF NEIGHBORHOOD PRIVATE WELLS LOADING RATE: _0_74 GAL/SF/MIN �� 7 - - \ \ \ \ O GENERAL NOTES: _ _ -�/ - �' `� / - - \ // UTILITY 6�. CLUSTER 1. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. TITLE V AND THE TOWN OF BARNSTABLE RULES AND REGULATIONS - - _/ - \ FOR SUBSURFACE DISPOSAL OF SEWERAGE. 2. AT LEAST ONE ACCESS POINT OVER TANK TEES SHALL BE 'O' � ACCESSIBLE WITHIN 6 OF FINISH GRADE, WITH ANY REMAINING ACCESS PORTS BROUGHT TO WITHIN 12" OF FINISH GRADE. ,p00'O SS .� Op \ \61 \\ ,p\\ tT\ \ P \ // �64\ ��' �p3 0 20 30 40 60 10 3. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE �'5 i --� O \"�S rp ` i' D \ /� EXISTING i 1,500 GALLON ` U1 6 CAPABLE OF WITHSTANDING H-10 LOADING UNLESS THEY ARE / \� 3� �\� WELL SEPTIC TANK UNDER OR WITHIN 10' OF DRIVES OR PARKING AREAS THEY - -54 -- - -/ - s y \ / \ ��5 ! ^„f i - - - - - - - - - - mod' G� \ \ 6 '�` rD MUST WITHSTAND H-20 LOADING. O GRAPHIC SCALE: 1 INCH = 20 FEET 4. THE EXCAVATION CONTRACTOR SHALL VERIFY THE LOCATION / / OF ALL UTILITIES PRIOR TO ANY EXCAVATION. 5' `� lLLiAFII y 'Y' i 2A" o \ •o• \s �� 5?' 9 No L. DATE: DECEMBER 5, 2001AlS 5. ANY MASONRY UNITS USED TO BRING COVERS TO GRADE / / `�, - - - - - - - F �` ,�� o 71 = -53_ i \ \�\ \ \/ 6 ,'`�� off` Fs c r s F R �c 1�4D a H OR WITHIN 6 OF GRADE SHALL BE MORTARED IN PLACE. /- - _ - i Q / '1 LOT 33 S'or =� REV. NOVEMBER 12 2002 s / - - �\ ���A+.J�i CEP t� 6. FINISH GRADE SHALL HAVE A MINIMUM OF 0.02 FEET PER / S FOOT OVER THE S.A.S. AND DISTRIBUTION BOX. /LOT 34 ,\ DTH#2 "D,'�X / 8 �� �� N/F REV. MAY 11 2003 7. SEPTIC TANK SANITARY TEES SHALL BE CONSTRUCTED OF , COURTNEY & MELISSA� PALMER REBAR �. , . .:..: SCHEDULE 40 PVC AND SHALL EXTEND A MINIMUM OF 6 ABOVE F. _ - - \ \ ,��� S� a #149 PERCIVAL DRIVE THE FLOW LINE AND SHALL BE ON THE CENTERLINE AND SE,T < 35, 216 S. f _ \ \ / �� ASSESSORS 110-001-014 SITE AND SEWAGE PLAN LOCATED DIRECTLY UNDER THE CLEAN OUT MANHOLES. S \ - - "1A" \ 38 \ 6 QO (3 BEDROOMS)) 8. THE INLET PIPE INVERT ELEVATION SHALL BE NO LESS THAN �S�`'�O �� _ - ' �/ \ \/ O 141 PERCIVAL DRIVE ::: 2 INCHES NOR MORE THAN 3 INCHES ABOVE THE INVERT 6 O -52- \ .8x33.5' DTH#1 \ / �S ¢� y::: 4.\ O >> W >> ELEVATION OF THE OUTLET PIPE. sr �. `' S�A.S. WITH :::: : : ... .. ', EEKES CROSSING 9. THE SEPTIC TANK SHALL HAVE A MINIMUM COVER OF 9 INCHES \ \ 5 OVER DIG ��\y 10. THE OUTLET SANITARY TEE SHALL BE EQUIPPED WITH A GAS \ ALL AROUN IN BAFFLE, 4 INCHES IN DIAMETER AND CONSTRUCTED OF 4" PVC REBAR \\ / /i \S�� \ �\�G 11. ALL PIPES SHALL BE SCHEDULE 40 PVC SEWER PIPE AND W. BARNSTABLE MASSACHUSETTS SHALL BE SLOPED 1/4 INCH PER FOOT MIN. EXCEPT FOR THE ��8 \\ 51 0 ' FIRST TWO FEET OUT OF THE DISTRIBUTION BOX WHICH SHALL OPEN `S9• \ 63.0 12.BE LEVEL.CHAN ES OR REVISIONS TO SYSTEM DESIGN REQUIRE NOTIFICATION SPACE _ \ // \ �h LEGEND TO EAS SURVEY, INC. FOR BOARD OF HEALTH AND DESIGN ENGINEERS 12.8x34.5' REVIEW AND APPROVAL. RESERVE AREA //� ,��� \ ! PREPARED FOR: / N/F NOW OR FORMERLY \ / \ W PROPOSED WATER`LINE J A M E S & MARY S TE R G I S \\\ BENCHMARK Ff d� PROPOSED COUNTQUR 4 CONSTRUCTION NOTES: / SPIKE SET # 7 O A K M O N T ROAD . EXISTING CONTOUR CUMMAQUID, MA 02637 1. CONTRACTORS / ,INSTALLERS SHALL VERIFY GRADES AND ,� , c�0/`\ / CEDAR \ ELEVATIONS AND SITE CONDITIONS PRIOR TO COMMENCING SQ / ELEV = 50.00 O EXISTING ELECTRIC'MANHOLE (508) 362-6595 WORK ON THE SITE. `�!y \�./ NOTE: 2. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE TOTAL SUBDIVISION OPEN SPACE AREA = 933,571f S.F. , WITH DEEDED OR ZONING REGULATIONS. OWNER / APPLICANT TOTAL NUMBER OF LOTS IN SUBDIVISION = 51 LOTS ® CB EXISTING CATCH BASIN IS TO OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. OPEN SPACE AREA PER LOT = 18,305f S.F. \ . 3. VEHICULAR TRAFFIC, PARKING OF VEHICLES AND PLACING N/F TOTAL LOT AREA + ALLOCATED \ PREPARED BY: MATERIALS OVER THE SEPTIC TANK, DISTRIBUTION BOX AND MASSACHUSETTS BAY REBAR OPEN SPACE AREA = 53,521 t S.F. \ EAS SURVEY, INC. S.A.S. AREA IS PROHIBITED TRANSPORTATION SET 53,521 S.F. / 10,000 S.F PER BEDROOM = 5 BEDROOMS 4: B.O.H AND DESIGN ENGINEER TO INSPECT BOTTOM OF LEACHING AUTHORITY. 141 RT. 6A, P. O. BOX 1 729 OPEN EXISTING LOT AREA = 35,216t S.F. AREA PRIOR TO INSTALLATION OF SYSTEM. 825f S.F. \ SANDWICH, MA 02563 SPACE OPEN SPACE IN FRONT OF LOT 34 = 4, 40,041 S.F. / 10,000 S.F PER BEDROOM 87DROOMs PH. (508) 888-3619 FAX (508) 888-2496