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Home My WebLink About0149 PERCIVAL DRIVE - Health 149 PERCIVAL DRIVE,1 A= 110 001.014 V TOWN OF BARNSTABLE LOCATION �y9 .�� J0-4, SEWAGE 013nA-. P", ASSESSOR'S MAP&PARCEL �11 VILLAGE � �! INSTALLERS NAME&PHONE NO. C4 4 y 7 SEPTIC TANK CAPACITY X'ltT ' "!, /cvoo LEACHING FACILITY:(type) Cl- iJS` � � �`�(size) /9"; NO.OF BEDROOMS J OWNER ' � ee 4 PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility Feet FURNISHED BY v 74 r P0.4 . No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ISO01pplitation for Disposal 6pstrm Cons"ttion Permit Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Add Lot No. 1 ZC Owner's/Name,Address,and Tel.No. �p� ��v/ f� Assessor's Mrcel 1r /4J Gv �.T��.v�l 1. / KP InTstaller's Name,Address,and Tel.No. jet rrj4 jV?? Designer's N me,Address,and Tel.No. -977 ,,57" �r.V ,-L ✓t�'� C'h.fY ��! "°tdEc�w !A nuu�► e4.r_/!k , Type of Building: . �QYt4�%a'enrf p' P� Dwelling No.of Bedrooms �� Lot Size �J 7 sq.ft. Garbage Grinder( ) Other Type of Building � � No.of Persons Showers( ) Cafeteria( ) Other Fixtures g Design Flow(min.required) �j gpd Design flow provided �r /,6 gpd Plan Date / hc/ /f Number of sheets Revision Date Title Size of Septic Tank Type of S A.S. /� ve �W/c Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Hlealth. i Date 011 Application Approved by Date Application Disapproved by Date for the following reasons Permit No. i Date Issued No. 7T � Enteredm computer: THE COMMONWEALTH OF MASSACHUSETTS P PUBLIC H.E,�ALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2ppl cation for MispoBal 6pstem Construction Permit Application for a Permit to Construct( ) 'Repair Upgrade( ) Abandon( ) ❑Complete System El Individual Components Loc ti Ares dds or Lot No. ��`�� c , oc/r Owner's Name,Address,and Tel.No. /97 4 v f "' Assessor's Map4arcel •j a rauy � 694 C.4 121"11,j Installer's Name,Address;and Tel.No. SQ rf e fi?? Designer's N'� e,Address,and Tel.No. sc� C,,77, J ...-1 r406 1/S �� fly. SC'a,/ t�.� ad r4(i Type of Building: �� J^?v'E ` I. G I rC�C fi�C%�o�C'. 'W9, Dwelling No.of Bedrooms , Lot Size 3 . -0/, sq.ft. Garbage Grinder( ) Other Type of Building 46r"e_ No.of Persons Showers( ) Cafeteria( ) Other Fixtures 4 ..- Design Flow(min.required) �3�) 4 gpdg p 1h gpd Design flow provided Plan Date J//j[`l // ` Number of sheets . Revision Date Title Size of Septic Tank R (.L Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: i Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewagedisposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. i d .s; / ,., c Date all Application Approved by Date Application Disapproved by Date P for the following reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS d BARNSTABLE,MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the On-sue Sewage Dis-o�sal system Constructed( ) Repaired(�) Upgraded( ) Abandoned( )b �l� at #MI�f I Ft, has been cons*P9 ance with the provisions of Title 5 and the for Disposal System Construction Permit No ated Installer Designer i #bedrooms ` Approved design flow gpd The issuance of this permit shall not be gonstrued as a guarantee that the system will fun f on(as\de gne Date / Inspect h, J G• No. f Fee THE COMMONWEALTH OF MASSACHUSETTS l� PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS ]Disposal �ipstrm Construction Permit Permission is hereby gran to onstrpqt ) q ECI Repair( ) U grade( ) Ab o i� System located at K7 and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Constructio mu be co pl t within three years of the date of this permit. Date Approved by / yr 12/15/2011 08:45 5084775313 ENGINEERING WORKS PAGE 01 Town of Bitable Reg-Watery Services Thomas F.Geller,Director Public Heafth DiviMi R Thomas McKean,Director 200 Main street, Hyannis,MA 02601 Of 508-M24644 Fax: 509-790-6304 Date: Sewage Permit# Amemor'c Map?arcel !10- ad I -vt%( stiller&Deslss��er Certli�catloa Form D"iPOr: W o r 4 s- Inc- , Installer: *-�� A J CA Address: 12 W. C�� r ,r 1� j2ai. Addr'ese: 771 ra.s 4�rc MA- Q Z4 4 on. --- c a�r1 3 I was issued a permit to install a (date) (installer) septic system at 14 9 Pe-e�+r ed PrL based on a design drown by (address) P L dated t ► IT) t I2`r I Z) F I 1 esigner T 1(--I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation Woo distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (Le. greater than 10' legal relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State&Local Regulations. Plan revision or certified as-built by designer to follow. Stripout(if required)w and the soils were found sat' OF actory. . / P+MR T. -8 Si McENTEE CIVIL No,35109 L.._.� �IRT (lhstper's Signature) (Affix l?esrgn ) PLEASE RETURN TO BARNSTABLE PUBI<.IC UJUTH I)IVISLON. '�� OF CS�d1ilM ANCE WILD. NQT BE ISSUED UNTIL BOTH THIS AS- BUELT CARD ARE RECEIVED BY THE B MTABLE PUBLIC HEALTH DIVISION. IHAM YVU. q:1offiw 1 W 1 radon fb m.doo DCATION l 0 % 3 3 � cal NO. ILLAGE A/, 3�-4lyU 5 7416 L DAT PPLICANT ST. p !/E!o%',�1��,7- FEE__ _ DDRESS ✓I')I�iOV S. 7 ;1 /n�zl711 TELEPHONE NO. 3 � ZZ6/(Non -refundable) RGINEER �G ��ti-rF N� TELEPHONE NO. "740 44 ATE SCHEDULED (Applica a ' signature) ... • 0-0 . OO : . . . . . O . . . . . . . . . ASSESSORSMAP6 LONO /16 / - .3O 3 SOIL LOG UB-DIVISION NAME lV4LL4L DATE qZ� ��' TIME dl Al XPANS ION AREA: YES NO��`" 2\i L 67 e,hjc_' ENG INEER:N OWN WATER PRIVATE WELL ✓ `�� Adf. lkfJ BOARD OF HEALTH EXCAVATOR KETCH: (Street name,etc. ,dimensions of lot, exact location of test holes and percolation tosts, locate wetlands. in proximity to test holes) NOTES:. T1 01 To 33 u( L6 i 1�,�S'—7 4 ERCOLATION RATE:. M.i N J� U� M'^ �``�d s h� 'EST HOLE NO: i ATION: TEST HOLE NO: Z ELEVATION: 1 LOAM 1 EDAM 2 6DI350 l L 2 SuBSGt 1, 3 � 3 4 4 5 < 5 7 7 . _. . 10T1) 8 S l LT` 8 Sf9NT 9 9 10 10 � �l"�H ��A�` 11 • 11 � 12 12 13 13 m o G ° 14 I uJF11 Gtz 14 15 C�.rou�Te>' � 15 o I 16 16 IUITABLE FOR SUB-SURFACE SEWAGE: - LEACHING FIELD LEACHING PITS LEACHING TRENCHES__ fNSUITABLE FOR SUB-SURFACE SEWAGE. REASONS: TOTE: ENGINEEIRING PLANS MUST SHOW NUMBER ASSIGNED -ON PERC TEST APPLICATION )RIGINAL: COMPLETED IN ENTIRETY BY P. E. AND RETURNED TO BOARD OF HEALTH ;OPY: RETAINED BY APPLICANT Engineering Works, Inc. S. A. S. LAYOUT 12 W. Crossfield Road 149 PERCIVAL DRIVE Forestdale, MA 02644 Job No. 241 -11 , Date: 11 /15/11 (508) 477-5313 Page 1 of 1 PORCH /EXISTING / HOUSE(#149)� 9.9t1 GARAGE WALKOUT DECK SPIKE 53,64 O p Ln LO PROP. S.A.S. . TOWN OF BARNSTABLE NSA' LOCATION I LI �c►-_C��_J�.. 1 J)r� SEWAGE# 9 y _.l_ VILLAGE LJ ASSESSOR'S MAP&LOT INSTALLER'S NAME&PHONE NO. o• -I=y , ( (b 6 01 D 14- SEPTIC TANK CAPACITY (004.) LEACHING FACILITY: (type) j D.oJ (size) NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE .5 514 OMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 leachin facility) Feet Furnished by �;u r, 1 3h7 1' I P 3 I r Town of Barnstable P# s $ Department of Regulatory Services i ,, Public Health Division Date 200 Main Street,Hyannis MA 02601 t NIIK Date Scheduled � /` � Time�— Fee rd. 1 Gar /ci Soil Su�i/tfabili/ty_Assessment for Sewo e isposal Performed By: l-Lf / "� t�I-�. Witnessed By LOCATION&GENERAL INFORMATION. Location Address 1 Y9 %P/G ✓q l ,�17✓`� Owner's Name 10. e?l 5-Az 6 L2 0-pp Address ��? e/'C> Yei �. Lt1 Zoo 6 Assessor's Map/Parcel: 116 Q _ //Y Engineer's Name NEW CONSTRUCTION REPAIR Y` Telephone 73-7 —Y 7 6 Land Use 1a5 `de"" q I Slopes(%) .S 4-` Surface Stones N 10e1A Distances from: Open Water Body 7 z a-cj ft Possible Wet Area 7 Z11w ft Drinking Water Well 7 ft Drainage Way r^J/4 ft Property Line _36'�_/'--' ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) !�C/2C(VA zl uU C 4 601 2 , ®a 0 ---I Parent material(geologic) /J/:t i (g gic) Depth to Bedrock nr/� Depth to Groundwater: Standing Water in Hole: /"//�f Weeping from Pit Face Estimated Seasonal High Groundwater (SQ DETERMINATION FOR SEASONAL HIGH WATER TAB'�E. Method Used: 4dt 9 Depth Observed standing in obs.hole: in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater,Adiustment_ -- _ ..Index`VeLl#- - Reading Date: ' Index Well level Adj.factor Adj.Groundwater Level PERCOLATION TEST Date Observation Hole# Time at 9" Depth of Perc Time at 6" Start Pre-soak Time @ Time(9"-6") End Pre-soak '1 Rate Arich M-ail/1' Qkq fei, fjw ve S tp.. C, So. s coo, 4Nr4_1, s�,/s q-Jo-8.6 e< Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division C Observation Hole Dataa To Be Completed on Back----------- /V0 d 4 ' (e 'ILO LL¢ SA t/ .,, 1, , t t c✓i?Ova ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one(1)week prior to beginning. Q:\SEP,nC\PERCFORM.DOC DEEP OBSERVATION HOLE LOG- , Hole# Depth from Soil Horizon Soil Texture . Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistenc %Gravel A ( (o Y2Y/z rd ''-yS �r 5c SL.f S4kC� CZ Sa,j n DEEP OBSERVATION HOLE LOG: Hole# Z r Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface in. ` ( ) (USDA) (Munsell), Mottlin g (Structure,Stones,Boulders. Consistenc %Gravel Z L ldyizV/Z �1 s to y/t qZe=q6 " ( o nest Sanc( 2 .5' Y513 CZ. /41-C skKdt IVY2�S y M I'ye, DEEP OBSERVATION HOLE LOG _ Hale#. Depth from Soil Horizon Soil Texture Soil Color Soi] Other Surface(in.) - -(USDA) - .'(Munsell) Mottling (Structure,Stones,Boulders. Consistency %Gravel) } e DEEP OBSERVATION HOLE LOG Hole Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) - (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) ], u Flood Insurance Rate Mao: Above 500 year flood boundary No_ Yes Oe Within 500 year boundary No /I Yes Within 100 yeji flood boundary No—Q�, Yes Death of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? ye—r--t If not,what is the depth of naturally occurring pervious material? Certification . I certify that on 1 `a S (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that-the"above analysis was performed by me consistent with the.required,training,expertise and experience,described in.310.CMR.15.017. Signature - Date-((' Go fa _ Q:\SEPTIC\PERCFORM.DOC I f TROY WILLIAMS SEPTIC INSPECTIONS -. 0 RFrE��,F� w h so Certified by MA Department of Environmental Protection TowNOF W (508) 585-1300 19 Hummel Drive H�HOEprr4 South Dennis, MA 02660 COMMONWEALTH OF MASSAC S EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS . DO ,Py DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE HINTER STREET, BOSTON, MA 02108 617.292.5500 WILLIAM F.WELD TRUDY CORE Govcmor Sccrctuv ARGEO PAUL CELLUCCI DAVID B.STRUHS Lt.Govcmor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissioncr PART A CERTIFICATION Prop"Address: //9 Pes-c , V c,� �' i J• t3��q s 4v,b p m Address of Owner. Date of Inspection: `o 13 /y ' Of different) Name of Inspector: Troy W i 11 i a m s P.O.13 o,r -?S S- I am a DEP approved stem inspector pursuant to Section 1S.340 of Title S (310 CMR 1S.000) Company Name: Troy .Wifliams Septic I.nsDections ( �•-„sh�s /c MF , Mailing Address: _19 HLlmmel Drive- South Dennis, MA 02660 ' Telephone Number: _(5 0 8) 38 5-13 0 0 6.2, 6 6 V CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection: The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: Passes _ Conditionally Passes Needs Further Evaluation By the Local Approvirg Authority _ Fails Inspector's Signature: ----'; /1.0�. G✓.�-� ' Date: �6 A? 2 The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspection. I(the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Check A, 8, C, or D: A) SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 1S.303. Any failure criteria not evaluated are indicated below. COMMENTS: BI 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. Indicate yes, no,or not determined (Y, N,or ND). Describe basis of determination in all instances. If'not determined', explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty(20)years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. _ (r—im.d 04/2S/97) Pago 1 or 10 ~ nr o __ _ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: Date of Inspection: av 7 B] SYSTEM CONDITIONALLY PASSES (continued) Al(',9 Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). Describe observations: broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed Cl FURTHER EVALUATION 15 REQUIRED BY THE BOARD OF HEALTH: W14 Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, 11F APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER • y (revised 04/25/97) Page 2 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: �ycJ P,r c r U Owner: (3p A y Date of Inspection: D] SYSTEM FAILS: IJ 119 You must indicate ei;•.er "Yes" or "No" as to each of the following: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _. Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: IVI-9 You must indicate either "Yes" or "No" as to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area - IWPA) or a mapped Zone II of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 04/25/97) 7 Page 3 of 10 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: / ��✓ �- v a S f. Owner:Date of Inspection: io% �9 7 Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No _, Pumping information was provided by the owner, occupant, or Board of Health. _, None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as pan of this inspection. — As built plans have been obtained and examined. Note if they are not available with N/A. ✓ _ The facility or dwelling was inspected for signs of sewage back-up. ✓ . _ The system does not receive non-sanitary or industrial waste flow. The site was inspected for signs of breakout. i� _ All system components, excluding the Soil Absorption System, have been located on the site. _ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material-of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: The facility owner(and occupants, if different from owner) were provided with information on the proper maintenance of Sub-Surface Disposal System. _ Existing information. Ex. Plan at B.O.H. ✓ _ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) ]15.302(3)(b)] (revised 04/25/97) P Paga 4 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C 7 SYSTEM INFORMATION Property Address: y /ezr C 1 Sf. Owner: Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Design flow: 330 R.p.d./bedroom for S.A.S. Number of bedrooms:_ Number of current residents: 3 Garbage grinder (yes or no):_, N a Laundry connected to system (yes or no):_y S Seasonal use (yes or no): A/0 n Water meter readings, if available (last two (2) year usage (gpd): r+ -e— e- Sump Pump (yes or no): A/J Last date of occupancy: yc� COMMERCIAUINDUSTRIAL• Type of establishment: Design flow:_gallons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings, if available: Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source.of information: s_� t0✓K. .O i c 9'� o'✓o . If C' is ecn r, s L. 1< "Fi-e ) rt.V t_f / Gi h-f. System pumped as part of inspection: (yes or no) Nd If yes, volume pumped: gallons Reason for pumping: TYPE 9f 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) VA Technology etc. Copy of up to date contracts' Other APPROXIMATE AGE of all components, date installed (if known) and source of information: 4, �(� ,-1— L /,2 Sewage odors detected when arriving at the site: (yes or no) NO (revised 04/25/97) Page S of 10 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: ly-/ Re- 711-; Owner: r3V u (S Date of Inspection: BUILDING SEWER: (Locate on site plan) Depth below grade: Material of construction: _cast iron _40 PVC _other (explain) Distance from private water supply well or suction line Diameter Comments: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK:- (locate on site plan) Depth below grade: �� s r-S 4b t^' : Material of construction: _zconcrete _metal _Fiberglass _Polyethylene —other(explain) If tank is metal, list age _ Is age confirmed by Certificate of Compliance —(Yes/No) Dimensions: S X 5 ix 6 /UUU si0./�� ti Sludge depth:_ Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: "! 6 it Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: /•� How dimensions were determined: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) --�-r+ /c;� G r.J D v 4—I + "S l./ v Ao, „l w O b,- vrd c r /Vc; S i c .• r a �t. LK r-A c- w e GREASE TRAP: /`/1^ (locate on site plan) Depth below grade: Material of construction: _concrete _metal _Fiberglass _Polyethylene _other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) J o- (revised 04/25/97) F Page 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: /4 `� P'r►� v S f Owner: 86 v f Date of Inspection: /J /3 /S 7 TIGHT OR HOLDING TANK:N//9 (Tank must be pumped prior to, or at time, of inspection) (locate on site plan) Depth below grade: Material of construction: _concrete _metal _Fiberglass _Polyethylene _other(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm level: Alarm in working order_Yes; _ No Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:_V (locate on site plan) Depth of liquid level above outlet invert: c v t. / Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) !7" /3.W. .wc.- c/t ,� h W b r i h c. O Y(J C✓ r + L v` b. 'o 'e PUMP CHAMBER: (locate on site plan) Pumps in working order: (Yes or No) Alarms in working order(Yes or No) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) F (revised 04/25/97) Page 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 01 /9`0-C Owner: so j ( G y Date of Inspection: /c' �3 -7 SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number: ON,c- leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) 46 G.J f.✓�t r L c t -! w 7� rti o CESSPOOLS: (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: inflow (cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY: (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.) (=...t..e 04 2s � /s ) }" a.ye a of io P SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) 0,11 ; s 17S Property Address: r` A ®' �i^t,1, Owner. i� Date of Inspection: 90v lc�y SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) �° 53 I00 0 yvf��w 4r -79 ' 57v (raviaad O4/25/97) x' Page 9 of 10 P SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: f 7 `, Pe , / S74 Owner: Date of Inspection: Depth to Groundwater ! Feet adjusted high groundwater level Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observation of Site (Abutting property, observation hole, basement sump etc.) Determine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records Check local excavators, installers Use USGS Data Describe in your own words how you established the High Groundwater Elevation. (Must be completed) lJS G S G vo.� F+�- {.w r+zo. s �,. a.ra s o w 1.6 /a C-C, 'e Gt r ' (revised 04/25/97) r, Peg* 10 of 10 TOWN OF BARNSTABLEvS� LOTION `/ 5 IDc s-C,, aw 0 i-. SEWAGE # VILLAGE (-,J ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. I-�a I -I-� , I 01 I4 SEPTIC TANK CAPACITY LEACHING FACILITY: (type) /D w 1� (size) NO.OF BEDROOMS__ BUILDER OR OWNER PERMITDATE: 314 /y I COMPLIANCE DATE: 6 I Zo /7 N Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 leachin facility) Feet Furnished by f l�u r`►, C'. � /?S f3� D - THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiutt for Diupuuttl Work Tomitrnrtiun Vrrntit Application is hereby made for a Permit to Corrs •-uct ( ) or Repair ( ) an Individual Sewage Disposal Syst EN ;*0 ... 11� . ,gips 9 //�► . lion ss/� ,j ------------------------------------•-•--... Let No: -----—----- --- -- —��... ._/14... ._...... qN e Address a •• /� -----------------••-•••••••--•---•-•-•••-- Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms________ ___............................Expansion Attic ( ) Garbage Grinder ( ) A4 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a Other fixtures ----------- -------------------- - -------------------------------------------- ------------------------------•--•------•---------------•--- W Design Flow............................................gallons per person per day. Total daily flow........----.-------..-----._.----_...__....gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width............--.. Diameter.........----.-- Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------__--------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ fZ4 Test Pit No. 2................minutes per inch Depth of Test it................... Depth to ground water.....-.................. a ----•---•--------------------•-•---•. -• •-------- .... . •-----•-.......• ••-••• ......................................................... 0 Description of Soil...................•• --- •-•••••••••-• ••. -• _- •-•••• ---• ••-- -- . -- --- -- --•--...----------••----•-------------------•----•-••••••-••-•-••--- x w ------------------------------------------------- ---------------------- -----------•--• •--- -••-----•-----------------------...--------••-------••-------------•-----------•-•-----••.....-----•--- V Nature of Repairs or Alterations—Anse r when app cable................................................................................................ ----••--•••-...__...-•--..-••---••••••-•••••••--••-•-------•-----------••---•---•-----•••---------------•----•--...-----------------••-•----•-•--....---------------------------•-••---•.........---••-. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Complia e s e n issued by the boar of health. Signed ----- Application Approved By ..... .... .. ..... ce Application Disapproved for the following re s: ......................................................................................... .............. ...................................................... ............ Dace Permit No. ........... Issued ...... ..... .. . Da,e.... ...... ......................... 4/ THE COMMONWEALTH OF MASSACHUSETTS ' w -' BOARD OF HEALTH TOWN OF BARNSTABLE Avoratiou for Bi-tiv ,ittl Work Towitrurtion trrmit Application is hereby made for a Permit to Cons �uct�(( ) or Repair ( ) an Individual Sewage Disposal ti Syst a o ...., '�..��- 2 .1.� ..��. �� .............. ----- --- .-----------.....---- ... t,oti-: dss .. or Lot No. = --------------------- --•-•-------------•---___----.....----.--------_-................................................I.._- - /)�,l wne Address W ----.•----- ..i l.L.1I .......4.4 -- 0--•-•--•------•-•----*-------- ----•---•-------------------•------•------ / ------------ IIIstaller Address Type of Building Size Lot............................Sq. feet Dwelling 04 Ot er—Type of Building on 1S Expansion Attic Garbage Grinder -_---_`---------------- No. of persons (-----)Showers ( Cafeteria ( ) � I Q' Other fixtures ...................................................... W Design Flow--------------------------------------------gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity------------gallons Length................ Width---------------- Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No_____________________ Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '-• Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit---------------..... Depth to ground water......................... L% Test Pit No. 2................minutes per inch Depth of Test it.................. Depth to ground water........................ 9 1 ------------------------------------ -- ----•-. . DDescription of Soil•---------------- -- ........... --- ---.. •-•-••= • • -- . • -- ----•--- ----•••-•-••-••--•••-•--••••---•-------------------•---- x c, ................................................ . ------------------------------•---------------------------------------.. ...---------------- U Nature of Repairs .or Alterations—Anse r when applr cable----------------------------__-----------.-.----.-__--_--_-___.-.--_-__-_---------.-----..-----. ---------------------•---•--•-•-.-------•----------•••----••••••-------------------•--•-------•---•---------------------------------------••---••--•---•----------------•-•--•--•----•................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Complia ce has been issued by the board of health. Signed ...... Application Approved By ..... ...... �'� t i:..-.�%........._.................. ......L} / / Application Disapproved for the following re s: ......................................................................................... ................................................ ..... ................................................................. ...--................... .... ............ . .................................. Date Permit No. ..:r .... Issued .. /�D THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE 01'er#ifira e of (111omplianre T ISVER... ,F , Individual Sewage Disposal System constructed ( ) or Repaired---. --- ------ - ----- /..r ........... - --------------------------------------------------- bytau�t / j f ...-. ... /.- .... at .......... . ........ � I !`...l_-...- B-�..... � ... " `-'> 1'd"(} '- .-............. - .................._-..-.-....... has been installed in-accordance with the provisions of TIfL of he Sta n lronmental Code as described in the application for Disposal Works Construction Permit No. -..- ._---- dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT E ONSTR E AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..... ::77...... -. ....w...--.. .ter F.................. . Inspector -.. � .................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH q4� TOWN OF BARNSTABLE �- No........I.............. FEE---••-•-•--•- -•-•--• !nt!d."\,.ffl_ � ' �u. ¢ e irin �rrntitPermissio hereb -- �Y -• - - -----------------•---•--•--..........._...-----.....................•...-•- to Construct or R air /� n di ' al ern Iar osal s at No.---- � �f ��.'�!V-� �r="6V "�' .�- � C`�f Street as shown on the application for Disposal Works Construction Perrnit�No�^...___.._ ._`Dated ._.___.....?.....�..*+�............ iLp .................... . -. Board of�Health DATE.......................N------ j FORM 36508 HOBBS&WARREN.INC.,PUBLISHERS r MAR-16-94 WED 09 :06 EN5I�IROTECH LABS 508 888 6446 P. 01 r ENVIROTECH -TABORATORIES, INC. 449 Rte. 130 • S&udm4ch,MA 02563 (508) SM-6460 - 1-800.339-64G0 FAX(506)888-8457 F A X M E S S A G E S TO: FAX#-. FROM: DATE: lql NUMBER OF PAGES INCLUDING COV R PAGE: ADDITIONAL COMMENTS : ANY QUESTIONS PLEASE CALL: (508) 888-6460 i MAR-16-94 WED 09 :06 ENVIROTECH LABS 508 688 6446 P. 02 Y P 0MROMCH LABORATORIES f Mass. Cert.#:MA063 449 Route 130 Sandwich,MA 02563 • (508) 888-6460 CLIENT: ----Mr. Bnoulay LOCATION: 33 Percival Drive ,ADDRESS: P.O. Box 355 W. Barnstable, MA W. Barnstable MA COLLECTED BY: D, L. Scannelj-- SAMPLE DATE: 1-24-94 TIME: 12.00PM DATE RECEIVED: 1-24-94 SAMPLE ID: 33 JOB#: xeli WELL DEPTH: 64' . RESULTS OF ANALYSIS: Parameter Units Recommended limit Result Coliform bacteria/100 ml (MF Method) 0 0 H pH units 6.0.8.5 6.60 Conductance urnhos/cm 500 102 Sodium L 28.0 9.1 Nitrate-N m 10.0 0.05 Iron mg/L 0.3 0.26 Man anese m /L 0.05 Hardness m /L as CaCO 500 Sulfate m /L 250 Potassium m /L 20.0 Allmlini m /L 200 Chloride m /L 250 Turbidity NTU 5.0 Color APC units 15.0 Background bacteria/100 ml (MF method) 200 EPA 601/602 * ug/L COMMENT: N.D. * See report attached. YES NO Ux ❑ WATER IS SUITABLE FOR DRINKING PURPOS R F R.S TESTED. DATE i MAR-16-94 WED 09 :07 ENVIROTECH LABS 508 888 6446 P. 03 2- 1-94 -.16 PM :�P.C::PtD�jlA� i nN.4LY=:CAL ENVI,RO:E. ? SQ3 "rb3 * �+i: 'i.' ANALYTIAL ER CA EPA METHODS 601 and 602 Volatile Organics (GC/PID/ELCD) Field ID: 83 Lab ID: 6810^01 Batch ID: V02-0307-W Pro, ect: Boul ay 33 Percival sampled: 01-24-94 Client: Envirotech Received: 01-26-94 Cant/Prsv: 40mL VOA Vial/NaHs44 Cool Analyzed: 01-21-94 Matrix: Aqueous i PARAMETER CONCENTRATION REPORTING LIMIT) 9/L) 5 Dichlorodifluoromethane RRL 5 Chloromethane BRL 5 Vinyl Chloride 5 Bromomethane BRL 5 Chloroethane 1 Trichlorofluoromethane BRLBRL I 1,1-Dichloroethene 1 Methylene Chloride BRL 1 trans-1 2-Dichloroethene BRL I 111-0iWoroethane 1 cis-1,2-Dichloroethene * BRL Chlaroform 1 I,1 1-Trichloroethane BRL 1 Carbon Tetrachloride BRL 1 Benzene BRL 1 1,2-Dichloroethane I Trichloroethene BRL 1 1,2-Dichloropropane BRLBromodichlorome have g 2-Chloroethyyl Vinyl Ether BRL 1 cis-1,3-Dichloroprepene BRL 1 Toluene BRL 1 trans-1,3-Dichloropropene 1 1,1,2-Trichloroethane BRL 1 Tetrachloroethene 1 Dibromochloromethane BRL I Chl orobenzere g2: i Ethyl benzene meta-and Para-Xylene BRLBRL 1 ortho»Xylene * . BRL 1 Bromoform RR� 1 1 AM Twi.�w��l�Mwwii�w-r. t No -- --- --------- Fee ------------- BOARD OF HEALTH TOWN OF BARNSTABLE Applitation fforVell Constructionpermit Application is hereby made for a permit to Construct Alter ( ), or Repair ( )an individual Well at: Z0 — 3. �e<c-i �L ,p� Via• /iv / - /I/ ----------- ----------------------------------- ---tom------------------------ ----------------------- ------------------------------------------------------------------- Location — Address Assessors Map and Parcel D /3ou to/ o_, v 3S- _�—�-=-'�6_"'------------------------------------------------------------------------ - - _ Owner Address -------------------------—------- Installer — Driller Address Type of Building Dwelling �t°u$ Other - Type of Building----------------------------------- No. of Persons----------------------------------------------------- Typeof Well - •------------------------------------------ Capacity------------------------------------ Purpose of Well--�°"'-==-=°-r" --- 1 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 Certifiqof fiance has been issued by the Board of Health. date Application Approved By ---- - - - ----------- - 1�: date Application Disapproved for the following reasons:-==--------------------------------------------------------------- --- ---- ——-- V I/ — �-- --- ——— — -- —— — ——— e -------------------- ----- — dat Permit No.------------- ---------- -------------------------------- Issued L- V- - ------------------------------------- --- ------------ ---- date BOARD OF HEALTH ' TOWN OF BARNSTABLE Certificate Of Compliance THIS IS TO CERTIFY, That the. Individual Well CQ structed (-I, Altered ( ), or Repaired ( ) D �_— �� Instal at------- ---------------------------------- has been installed in accordance with the provisions of the Town of Barnstable Boar o lthtvate Well Protection Regulation as described in the application for Well Construction Permit No. -- -- ------ ated-------------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE------------- --------------------------------------------------------- ----------- Inspector------------------------------------------------------------------------------ ,r No r-�'-- -- --------�--- i Fee- ---------+'------ L r BOARD OF HEALTH TOWN OF BARNSTABLE � Application-for lVell Congtructiouperruit Application is hereby made for a permit to Construct (4`1, Alfer ( ), or Repair ( )an individual Well at: - -- - - - ---- - - ---------------------------------- "Location — Address �! r Assessors Map and Parcel _ - ---------------------------------------------- ---------------------------------- - ----------------------------------------------- j 3 —OwnT r ��r E J Address/ �f /L 61 ' --- — — — — —------------------------------ — —n — - ------------------------------------------ Drl—� Installer -- lle .-w` Address Type of Building ` Dwelling °C' Other - Type of Building------------------------------------- No. of Persons--------------------------------------------------------- Typeof Well 4�/ - - ------------------------------ Capacity ----------------------------------------------------- YP -- P Y -- Purpose of We11-p`-----"-_`__----�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 Certificate of Co iance has been issued by the Board of Health. r % " Signed- e'er --- =-- -0------------- -� — - t . �' -- ---------- I date n Application Approved By F ` � ---s - - - date Application Disapproved for the following reasons:-----------------___-----__----_-__---------------------------------_------------_----_-____________ e ---------------------------- - I 1 — date - --------------------------------------- ------------- ----------------------------------------- PermitNo. - - --f-- --- - - — - --------------- Issued--------- +, -- --------------------------------------- date ` yBOARD OF HEALTH / TOWN ` OF.� BARNSTABLE A, Certificate Of Compliance THIS IS TO CERTIFY, That the Individual Well Constructed (�, Altered ( ),o'r Repaired ( ) bY---------=------ _ : �_� c `----Q/, /_� n Instal at--- '� /� _ - 1 V -t'c� N` � lD_ - -1 has been installed in accordance with the provisions of the Town of Barnstable Board o- alt ivate Well Protection Regulation as'described in the application for Well Construction Permit No. -- - e------Dated--------------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. ft ;� , , DATE, f ;;, - = - j- - ,`-- Inspector- - ------------------------------------------------------ r BOARD OF HEALTH TOWN OF BARNSTABLE , _ � �eYr �on�tructiou�ermit / No. .r Fee Permission is hereby granted ------------------------------------------------------------------------------------------------ - r to Co 1-17 n truct '�, A1ter� ), or a ai ( �) Individual Well at: (j P 4 f ` Street as shown o the application for a Well Construction Permit No.X ' --- -----�---------------------------------------------------- Dated - #- -----a 6-------------------------- --------- Board of Health DATE ( l7 r ------------------------------------- 110 N Williarl"s path do 0 PERCIVAL DRIVE Or /Qf c99 Count w -C Aj Street PK SET 68.40) edge 68.70 of 68.77 6�8.79 pavement 68,75 L---------- ------------ - - - - Ironside Ln f - - L OC us N 41'53'36" W 76.46 LA 66---------- ------------- 64,99-Ii WELL WELL LOCUS MAP NOT TO SCALE --- LLB------------- ---------6---------- - LEGEND 62.30 98 EXISTING CONTOUR 62.00---------- ---------- ------ fry x 100.98 EXISTING SPOT GRADE WELLA EXISTING WELL 60.21.- 59.96 60.35 .. ........ + edge 0�jown U- UNDERGROUND WIRES TEST PIT 57.91 1�;3 BENCHMARK 57.15 57.52 PA 6 3 DRIVE WA'%)� 5 PORCH x �,5.62 19. 55.0 56.34 IEXIS77NG o f:.8. U-) HOUSE(#149) 53,5 S GARAGE 58.06 TO.F.=59.9±' 51.00 WALKOUT 5511 52.5 (V DECK L53'18 BENCHMARK BM Outside -Cor. Conc. landing 51.84+ -50,33 51.18 3.1 +53.&4 EL.=5347 (Assumed) : 4"51,95 LA toISN --5:2- x LA 3 C 0. lo aj LO cli 49.72 .03 0 z 4a- 47.5 47. 48.77 EXISTING SEPTIC T TANK N1 45.10 (TO REMAIN) x P S T E TOP OF TANK=49.05 45.14 45.6� TIO INV(OUT)=4772± 45, 0 61 d-- EXISTING LEACH PIT TO BE PUMPED, FILLED WITH 6' SAND AND ABANDONED TP-3 x 44.11 i iiN -46-, ri-r-N' .51 , i '1 L.1-1 A - ) STRIPOUT 1±--14,3' SEE NOTE 11, SHEET 2 44 LOT 33 35,047±S.F. APN 110-001 -014 168.00 S 47-35'49" E PLAN REVISION-1 2/8Z1 1 1) REVISE S.A.S. LOCATION, DESIGN & CONFIGURATION DUE TO FIELD CHANGES 2) PERFORM SOIL EVALUATION AT REVISED S.A.S. LOCATION (3 TEST HOLES). PLAN REFERENCE PLAN BOOK 413 - PAGE 99 CERTIFIED PLOT PLAN BY CAPE & ISLANDS ENGINEERING, INC., DATED MARCH 28, 1994 OF PROPOSED SEPTIC SYSTEM UPGRADE PLAN o PETER T. McENTIEE 149 PERCIVAL DRIVE, WEST BARNSTABLE, MA o CIVIL Prepared for: Courtney Palmer. 149 Percival drive, West Barnstable, MA 02668 No. 351090 OWNER OF RECORD Engineering by: SCALE DRAWN JOB. NO. /S1 PALMER, COURTNEY C & MELISSA s Engineering Works, Inc. i If=301 P.T.M. 241-11 149 PERCIVAL DRIVE 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. (7-jil 11 W. BARNSTABLE, MA 02668 1(508) 477-5313 1 11/15/11 1 P.T.M. 1 1 of 2 .r NOTE: TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE < EL.42.3 FOR A DISTANCE OF 15' AROUND THE PERIMETER OF THE S.A.S. SEPTIC TANK PROPOSED S.A.S. PROPOSED D-BOX INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & WATERTIGHT INSTALL INSPECTION PORT OVER END UNIT T.O.F. OUTLET AND SET TO 6" OF FINISH GRADE COVER SET TO 6" OF GRADE EXISTING • � F.G. EL.=51.7t � F.G. EL: 45.5f F.G. 45.33(MAX.) MAINTAIN 2% GRADE (MIN.) OVER S.A.S. ' '• _ INSPECTION ® S=1%5(MIN.) ® SL 1% (MIN.) TOP LOAD ONITS PORT 4'SCH40 PVC 4"SCH40 PVC (1 MINIMUM) 6" 10"I 4" 6 19" TO EXISTING 48" UaUID INVERT LEVEL AD INV.=42.87 PROPOSED INV.=42.7 I - .; INV.=47.72t D-BOX 5 ROWS OF 4 UNITS AT 5.0'/UNIT = 20.0' EXISTING INSTALL INV:=42.59 EXISTING SEPTIC TANK INLET TEE SOIL ABSORPTION SYSTEM (PROFILE) ESTABLISH VEGETATIVE COVER BACKFILL WITH CLEAN NATIVE OR PERC SAND TO TOP OF CHAMBERS NOTES: INV. ELEV.=42.59 1 CONTRACTOR SHALL VERIFY ALL EXISTING PIPE BREAKOUT=TOP "::• ;': ':, + TOP ELEV.=42.33 INVERTS, PRIOR TO INSTALLATION. 2) D-BOX SHALL BE SET LEVEL AND TRUE TO GRADE ON A MECHANICALLY COMPACTED SIX BOTTOM ELEV.=41.00- •, INCH CRUSHED STONE BASE, AS SPECIFIED 2.83' IN 310 CMR 15.221(2). 5' MIN. ABOVE BOTTOM OF 3) INSTALL INLET & OUTLET TEES AS REQUIRED. T.P. EXCAVATION OR G.W. EFFECTIVE WIDTH=14.2' 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE 1 EXISTING SUITABLE AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. NO G.W., EL=33.2 = MATERIAL USE 5 ROWS OF 4-ADS Arc 36HC UNITS WITH NO SEPTIC SYSTEM PROFILE SEPARATION BETWEEN EACH ROW & NO STONE N.T.S. TYPICAL.SECTION SOIL LOG DATE: NOVi=MBER 10, 2011 (REF# P-13,457) ADDITIONAL TEST HOLES DECEMBER 8, 2011 SOIL EVALUATOR: PETER McENTEE (SE#1542) WITNESS: DAVID STANTON-BOH (1 1/10/1 1) Elev. TP-3 Depth EIeV. TP-4 Depth EIeV. TP-5 Depth 45.6 A 0" 45.5 A 0" 44.2 A 0" GENERAL NOTES: SANDY LOAM SANDY LOAM SANDY LOAM - -- -- -- - 1OYR 4/2 „ 10YR"4/2 1OYR 4/2 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL 44.6 B 12 44.5 B 12 43.2 B 12" BOARD OF HEALTH AND THE DESIGN ENGINEER. SANDY LOAM SANDY LOAM SANDY LOAM 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS 1OYR 5/4 10YR 5/4 10YR 5/4 OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE 42.6 36" 42.5 36" 41.2 36" LOCAL RULES AND REGULATIONS. C1 C1 C1 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR FINE FINE FINE TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE SANDY LOAM SANDY LOAM SANDY LOAM DESIGN ENGINEER. AND SAND AND SAND AND SAND 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING 2.5Y 5/3 2.5Y 5/3 2.5Y 5/3 FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN (UNSUITABLE) (UNSUITABLE) (UNSUITABLE) ENGINEER BEFORE CONSTRUCTION CONTINUES. 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. 37.6 96" 38.5 84" 37.7 78" 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF C2 C2 C2 PERC 78"/90" THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF M-C SAND M-C SAND M-C SAND HEALTH FOR PROPER INSPECTIONS DUPING CONSTRUCTION. 2.5Y 6/4 2.5Y 6/4 2.5Y 6/4 7. WATER SUPPLY PROVIDED BY PRIVATE WELL. 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S. 33.6 144" 34.5 132" 33.2 132" > 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE PERC RATE <2 MIN/IN. IN SAND DIRECTED BY THE APPROVING AUTHORITIES. NO GROUNDWATER OBSERVED 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING CONSTRUCTION. -63.25" 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). 16- 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE INSPECTED BY DESIGN ENGINEER PRIOR TO BACKFILL. 34.5" 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY. TOP VIEW DESIGN CRITERIA 60" NUMBER OF BEDROOMS: 3 BEDROOMS END CAP END CAP FRONT VIEW SIDE VIEW SOIL TEXTURAL CLASS: CLASS I END CAP DESIGN PERCOLATION RATE: <2 MIN/IN REAR/TOP VIEW DAILY FLOW: 33O G.P.D. NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT SIDE VIEW TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE. DESIGN FLOW: 330 G.P.D. GARBAGE GRINDER: NO a 4640 T BLVD HILUARD, OHIO HIO 43026 Arc 36HC DETAIL LEACHING AREA REQUIRED: (330) = 445.9 S.F. ADVANCED DRAINAGE SYSTEMS,INC. UNITS MUST BE STAMPED H-20 74 PROPOSED SEPTIC SYSTEM UPGRADE PLAN EXISTIf�G SEPTIC TANK: 1000 GALLON CAPACITY PROPOSED D-BOX:: 1 INLET, 5 OUTLET (MINIMUM) 149 PERCIVAL DRIVE, WEST BARNSTABLE, MA USE 5 ROWS OF 4-ADS Arc 36 UNITS WITH NO Prepared for: Courtney Palmer, 149 Percival drive, West Barnstable, MA 02668 SEPARATION BETWEEN EACH ROW & NO STONE Engineering by: SCALE DRAWN JOB. NO. BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.80 SF/LF OF UNIT) Engineering Works, Inc. n.t,s. P.T.M. 241-11 (Arc36HC Units) 20 UNITS x 5.0 LF x 4.80 SF/LF = 480.0 SF 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. DESIGN FLOW PROVIDED: 0.74(480.0 S.F.) = 355.2 G.P.D. (508) 477-5313 11/15/11 P.T.M. 2 Of 2 S YS T M PROFILE ! NOT TO SCALE TOP FDN. FINISH GRADE OVER FINISH GRADE - EL .---- .e:, ,;►: FINISH SPADE OVER DIST. BOX 2 s a FINISH GRADE OVER SEPTIC TANK z ` Q I LEACHING PIT 22. d e 12" MAX. . w� ,p p� ►,O' °�.°' :o. iJ.d.t: ' p'®•.••e,•'•I:' {1•o:®:r :d;M:;o•�. : d, p'.r; , �7 ~ OF .d/U' 112'v 12" MAX o .d. ,:..., o•;P . ..:• , d.., "j: " PRECAST CONC. OR ASHED PEA STONE e' :p BRICK MORTAR C f e: 3 to *.. OUTLET PIPE LEVEL M TO 12 BELOW GRADE a o a FOP 2 FT. MIN. b.. i "4•'•f .n• A.'n .ii 'o :4:'s 4• � � .Q e .�C. ';o• '• r o w ,r--.-ram -� •.fir•-,.••r.r-r, i D 6 C�• •.�6n �l .5O A L :a 2 /, 2'a I /..5 .�• .:e.a..'s• � '�'•a:�.�'.c.;. :q:o:i a .po "4.;p'i•:D 'o'° . .0:•p 1 0 2 0 9a s �. ' •o. C. I. OR PYC TEES I. .n•,�. .� + a ;.� ,• a' ey DD.°4 'O w0' 1000 ry SMT. F LR. , :e EL . o: t� ,L L.DPI D1,5 UTI S. :a STALL ON LEVEL BASE N _ N I; *^+ e IN 3/� TO 1 .1/2 6p o °'o;• :.e.:o: : o — PRECA�S T 4f.7 CR 'T ��// �� PRECAQ S T •a •0~''0•'.O''0 •O: O .0 _ AASHa�D R �� C uS �D I' [ o . . �'--� 0 RED.N�'CRC 'D :b - S Ta�vv� � CONCRETE c..- • 'e.° •d•o-4:a: o;a:: o :n .•o. .p.. Q: c p ..:;. :. p , '„ o: _ _.._ .b',O:• b;.p.D�.o.QO•,Q,•¢O•. o•,•�' d.�tlp� B,O.4:•,•O:�'Ar . .[n•b�,P,• 1 ,Q ,¢.� ,�} �• •s/ •O` J p.4• ! d-- 6✓ Ri NF w SEP�T C NK ' INSTALL ON LEVEL BASE' a' No rE:• E"XCA VA TE' TO EL EV. �. OR . d•°. 'a:o': o.''. o.4 r ,��, 7' LOYZ"R - TO REMOVE ALL IMPERVIOUS -"- I�;A TERIAL &ENE•A TH Tr�'E' LEACHING AREA `� �^`� a 4 �-O e, RE'PL A CE EXCA VA TED A'A TERIA L l✓I 7'H 6 ._o !! GLEAN° CLA Y l�RE'E SAND 1°� . �0 '! EFFECTI VE DIAME'TER GENERAC T S L EAR CNINC PIT v - % ,1 - INSTALL ON LEVEL' EASE ASSUMEED •-�_ V.�' t�N,'�` �°HO��N ARC BASED ( N ' r .�. ALL E`E TI AC P. AL L P1"PESIN TqF_ SYSTEM HUST BE CAST IRON OR SCHEDULE O PVC. -''—� Q Q • , — .ani/ �� "' `�• -� 3. THE F`t'7PRFID OF HEALTH MUST BE NOTE FIEC� �O E"!GRG, P6165 ':�H�.N CONS TRUC T�"ON Is +:°C'�'�Pi�ETE PRIOR i PERC LA TION RA TE:' TO A C FIL L ING yrI e? :5* .c r B K cd W°e// cr rd P MIN. IN. •4'° ANY CHANGES IN THIS .PLAN MUST BE APPROVED BY THE HEALTH AND CAPE 6 ISLANDS I✓ITNESSED BY.• BOARD O. SURVEYING Co., INC. T.M�KEAN o l I 5. MA TER1'ALS AND INSTALLATION SHALL BE IN BARNS. � COMPLIANCE' Mr TV THE STATE SANITARY 2,�, 1 TH DESIGN D TA ^� DATE.' - - - - � CODE' � TITLE E' V - AND LOCAL APPLICABLE , RULES AND REG1 A TION.�' 3 NUMB F R B RO 2 _ /. � O ED OMS M RECORD PLANS AND ' RR �i' S FROM REC R •--._...._ NORTH A O I O QOi 6. O 2/. T O 5,3.2 IYtJ -- ---�_ ��,�s GARBAGE DISPOSAL _ - IS NO T� TO BE ll�E"D FOR SO1�R PURPOSES Teo.,o, � s b f o, I -- - 7• FLOOD HAZARD ZONE sibs•, i �� DAIL Y FLOWloco- GALL . B. OVA TER SUPPL Yam' a�" SEPTIC TANK REGI 'D. GA AL I GA�L . s SEPTIC TANK PRO VIDED f G/ 2 � 2 8 �.,., i v N •...._ 3 L ACHING CJUIR GP�D. 4 E ED E �R r 4 V e t S SAL L ` A F_ 265 S. F . m N n \ ! S. F. X G/ �F. .. GPD I l7 .a B TOM ARE S.F. i rr P �.54 . 63—""— 97 r>: • � � \. L,.�" '�" D ._. ...5. F. x G/S.F. �8GPD - — / LEACHING PRO VIDEDAW GP t /92 �u \ T Z Pq.1POSED ELEVA TION L a r 3 —-- ---- EXt STING CONTOUR SINGLE FAQ MIL Y RESIDENCE 08.0)ER VA TION PIT .., 7 t. C7 DI,5 TRIBUTION BOX �p PROPOSED SEW, GE SP�p D� �SA LEACHING PIT PREPARED FOR t SEPTIC ' A O ..y TIC TANK t/ LOT 33 ! E d CI VA L D/ f I VF H 9 , ti/ t R p 8 !'Fr�..9L�!"s V l"9 WEST SA RNS TAQ BL E — MASS. PIPE IN✓ERT ELEVATION CAPE cS'o ISLANDS ENGINEERING SWAW . . PLOT PLAN -•,�t•' , p%,`;, '� z SCALE AS NOTED 133 FALMOUTI-1 ROAD -- SUITE 2E "SCALE.' ? �o 3 a F PL-AN NO. -s/2?9.�� MA SHPEE, MA SS. cl M. P SEC PCL LOT HSE - 4xr I I I I I