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HomeMy WebLinkAbout0159 PERCIVAL DRIVE - Health i PERCIVAL DIRJVE (� WestBarnstable f , 023 i c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;t 159 Percival Drive Assessor's Map: 110 Parcel: 1-13 r ? v� Property Address I r,�+ Anthony Laham ;:ry Owner Owner's Name , information fo is every West Barnstable ✓ MA 02668 November 9�2018 require for page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. Inspector Information S/o filling out forms on the computer, use only the tab David D. Coughanowr, R.S. key to move your Name of Inspector cursor-do not Eco-Tech Rapid Response use the return Company Name key. 155 George Ryder Road South raf Company Address Chatham MA 02633 City/Town State Zip Code 508 364-0894 1328 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes - 3. ❑ Needs Furt ,_ S�cyby the Local Approving Authority - s 4. ❑ Falls o DADVID COuG ANOWR N 1 8 �.0 n o P-6 November 9, 2018 Inspector's Signal or FM INspEG 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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: 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. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 i= Commonwealth of Massachusetts - Title 5 Official Inspection Form I; Subsurface Sewage Disposal System Form - Not for Voluntary Assessments v 159 Percival Drive Assessor's Map: 110 Parcel: 1-13 Property Address Anthony Laham Owner Owner's Name information is required for every West Barnstable MA 02668 November 9 2018 page. City/Town State Zip Code Date of Inspection C. Inspection Summary, Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes:, I � � ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: Inspector's Notes==> The septic system described herein is deemed to pass this Real Estate Transfer Inspection if it does not meet any of the failure criteria enumerated in Section D on pages 4- 5, or specified by local regulations. The scope of this inspection is limited to health and environmental compliance and the septic system has been evaluated according to the conditions observed on the day it was inspected. No estimate or guarantee of system longevity is made or implied by a passing determination. 2) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying seiiptic 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 tha6j2_ yeass,oldiisavail ble; ❑ Y ❑ N ❑ ND (Explain'be o t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 159 Percival Drive Assessor's Map: 110 Parcel: 1-13 Property Address Anthony Laham Owner Owner's Name information is required for every West Barnstable MA 02668 November 9, 2018 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ 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): 3) 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. a. 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: t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 18 c Commonwealth of Massachusetts ,p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 159 Percival Drive Assessor's Map: 110 Parcel: 1-13 Property Address Anthony Laham Owner Owner's Name information is required for every West Barnstable MA 02668 November 9, 2018 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) 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 t5insp.doc-rev.7/2 61201 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 159 Percival Drive Assessor's Map: 110 Parcel: 1-13 v Property Address Anthony Laham Owner Owner's'Name information is required for every West Barnstable MA 02668 November 9, 2018 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply 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 2000 gpd- 10,000 gpd. ❑ ® 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. 5) 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 CA. 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 t c Commonwealth of Massachusetts Title 5 Official Inspection Form ±= r Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 159 Percival Drive Assessor's Map: 110 Parcel: 1-13 v� Property Address Anthony Laham Owner Owner's Name information is required for every West Barnstable MA 02668 November 9, 2018 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes" to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes" or"no"for each of the following for all inspections: 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? El ® Have large volumes of water been introduced to the system recently or as part of this inspection? 1.Y.. ® ❑ 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)] t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form ?= w Subsurface Sewage Disposal System Form - Not for Voluntary Assessments j 159 Percival Drive Assessor's Map: 110 Parcel: 1-13 Property Address Anthony Laham Owner Owner's Name information is required for every West Barnstable MA 02668 November 9, 2018 page. City/Town State Zip Code Date of Inspection D. System Information 1. .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 gpd Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d n/a 9 ( Y 9 (gpd)): Detail: unmetered well in use Sump pump? ❑ Yes ® No Last date of occupancy: currentDate t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 c Commonwealth of Massachusetts _ Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �C 159 Percival Drive Assessor's Map: 110 Parcel: 1-13 v Property Address Anthony Laham Owner Owner's Name information is required for every West Barnstable MA 02668 November 9, 2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system?: ;;x .. - . ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form w Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 159 Percival Drive Assessor's Map: 110 Parcel: 1-13 Property Address Anthony Laham Owner Owner's Name information is required for every West Barnstable MA 02668 November 9 2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. 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 A ❑ Tight tank. Attach a.copy of the DEP.approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 4+ years. Certificate of Compliance for a new Soil Absorption system was issued 6/27/14 (Permit# 2014-214 at Health Department). Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer-(locate on site plan): Depth below grade: 2feet 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.): Sewer line appears structurally sound with no evidence of leakage or backup into dwelling. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 L c Commonwealth of Massachusetts i p Title 5 Official Inspection Form T i, Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u 159 Percival Drive Assessor's Map: 110 Parcel: 1-13 Property Address Anthony Laham Owner Owner's Name information is required for every West Barnstable MA 02668 November 9, 2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank (locate on site plan): Depth below grade: 1 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a.copy of certificate). ❑ Yes ❑ No Dimensions: 10.5 ft x 6 ft x 6 ft- 1500 gallons Sludge depth: 6 inches Distance from top of sludge to bottom of outlet tee or baffle 28 inches Scum thickness 4 in - --Distance from-top-of scum to top of outlet tee or baffle _8 inches - -Distance from bottom of scum to bottom of outlet tee or-baffle 12 inches How were dimensions determined? design plan Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumping not required at this time. Maintenance pumping is recommended within 2 years and every 2-4 years thereafter with year round occupation. Tank and tees appear structurally sound and functioning as intended. No evidence of leakage in or out was observed. Pumping access through trap door in deck. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts i= Title 5 Official Inspection Form 15 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 159 Percival Drive Assessor's Map: 110 Parcel: 1-13 Property Address Anthony Laham Owner Owner's Name information is required for every West Barnstable MA 02668 November 9 2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. 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.): 8. 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 t— c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments I; 159 Percival Drive Assessor's Map: 110 Parcel: 1-13 Property Address Anthony Laham Owner Owner's Name information is required for every West Barnstable MA 02668 November 9, 2018 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank (cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: El Yes El No Date of last pumping: Date - Comments (condition of alarm and floc:switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert at 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.): No adverse conditions observed. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts r Title 5 Official Inspection Form r Subsurface Sewage Disposal System Form - Not for Voluntary Assessments l; 159 Percival Drive Assessor's Map: 110 Parcel: 1-13 v Property Address Anthony Laham Owner Owner's Name information is required for every West Barnstable MA 02668 November 9, 2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* - Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: -Type _ ❑ leaching pits number: ❑ leaching chambers number: - ® leaching galleries number: 1 ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 cam, Commonwealth of Massachusetts Title 5 Official Inspection Form - w Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 159 Percival Drive - Assessor's Map: 110 Parcel: 1-13 Property Address Anthony Laham Owner Owner's Name information is required for every West Barnstable MA 02668 November 9, 2018 page. CityTTown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): No evidence of surface ponding, breakout, lush vegetation, or other evidence of hydraulic failure was observed. Flow across distribution box was rapid and unobstructed. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration - Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 159 Percival Drive Assessor's Map: 110 Parcel: 1-13 Property Address Anthony Laham Owner Owner's Name information is required for every West Barnstable MA 02668 November 9, 2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 L Commonwealth of Massachusetts Title 5 Official Inspection Form r Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 159 Percival Drive Assessor's Map: 110 Parcel: 1-13 u Property Address Anthony Laham Owner Owner's Name information is required for every West Barnstable MA 02668 November 9, 2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. 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 a {� �q WOMW }€v a L � V, Z ,1 5 r g Y Al r � � n a t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 c Commonwealth of Massachusetts j Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments I; 159 Percival Drive Assessor's Map: 110 Parcel: 1-13 Property Address Anthony Laham Owner Owner's Name information is required for every West Barnstable MA 02668 November 9, 2018 page, Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 6.4 ft+ 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: 6/25/14Date ❑ 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 howyou established-the high,ground water elevation: Approved design,plan on file with the Board of Health shows bottom of system to be 6.4 feet above the bottom of a witnessed test pit in which no water or groundwater mottling was encountered. mac; Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 L c Commonwealth of Massachusetts - Title 5 Official Inspection Form �= w Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 159 Percival Drive Assessor's Map: 110 Parcel: 1-13 Property Address Anthony Laham Owner Owner's Name information is required for every West Barnstable MA 02668 November 9, 2018 page. CityTTown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included l5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments •''y 159 PERCIVAL DR Property Address KANE Owner Owner's Name information is W BARNSTABLE required for MA 2/7/09 every page. Citylrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important:When filling out A. General Information forms on the computer,use 1. Inspector: only the tab key to move your DOUGLAS A BROWN cursor-do not use the return Name of Inspector key. DOUGLAS A BROWN INC Company Name P.O. BOX 145 Company Address CENTERVILLE MA 02632 CitMy/Town Im n State Zip Code 508-420-4534 S 14297 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 0000z--- — /7/09 I specto' ignature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Ll A Title V Inspection Form.doc•08106 Title 5 Official Inspection Form:Subsurfa ewage Disposal System•Page 1 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 159 PERCIVAL DR Property Address KANE Owner Owner's Name information is W BARNSTABLE required for MA 2/7/09 every page. CitylTown 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: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the ❑for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed Title V Inspection Form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disp osal posal System•Page 2 of 15 1 I Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 159 PERCIVAL DR Property Address KANE Owner Owner's Name information is required for W BARNSTABLE MA City/Town Date of every page. State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ 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 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. Title V Inspection Form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 159 PERCIVAL DR Property Address KANE Owner Owner s Name information is required for W BARNSTABLE MA every page. Ciry/Town Date of 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: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Title V Inspection Form.doc•0&06 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments ` 159 PERCIVAL DR Property Address KANE Owner Owner's Name information is required for W BARNSTABLE MA 2/7/09 every page. Ciiy/Town 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. ❑ ® 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. Title V Inspection Form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts IN Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 159 PERCIVAL DR Property Address KANE Owner Owner's Name information is W BARNSTABLE required for MA 2/7/09 every 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? ® ❑ 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)] Title V Inspection Form.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 15 i Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 159 PERCIVAL DR Property Address KANE Owner Owner's Name information is W BARNSTABLE MA re wired for 217/09 every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms 4 4 (design): Number of bedrooms (actual): 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)): WELL Sump pump? ❑ Yes ® No Last date of occupancy: CURRENT Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): Title V Inspection Form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 159 PERCIVAL DR Property Address KANE Owner Owner's Name information is required for W BARNSTABLE MA 2/7/09 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: INSTALLED MARCH OF 1998 ACCORDING TO AS BUILT CARD Were sewage odors detected when arriving at the site? ❑ Yes ® No Title V Inspection Form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal g po System•Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 159 PERCIVAL DR Property Address KANE Owner Owner's Name information is required for W BARNSTABLE MA every page. Cityrrown 2/7/09 State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain) TANK IS UNDER DECK, REMOVABLE COVER ON DECK FOR ACCESS If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No ------------------------------------------------------------------------------------- Dimensions: 1500 Sludge depth: TRACE,RECENTLY PUMPED Distance from top of sludge to bottom of outlet tee or baffle Scum thickness 0 Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Title V Inspection Form.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments y� 159 PERCIVAL DR Property Address KANE Owner Owner's Name information is required for W BARNSTABLE MA 2/7/09 every 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.): TANK IS CLEAN AND WAS RECENTLY PUMPED ACCORDING TO OWNER 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): Title V Inspection Form.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 L - Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 159 PERCIVAL DR Property Address KANE Owner Owner's Name information is required for W BARNSTABLE MA l every page. City/Town State Zip Code Dateate of 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.): *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 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.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Tide V Inspection Form.doc•08/06 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 I_ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments '< 159 PERCIVAL DR Property Address KANE Owner Owner's Name information is W BARNSTABLE MA re wired for 2/7/09 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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: NOT OPENED DUE TO DEPTH Type: ❑ leaching pits number: ® leaching chambers number: 4 FLOW DIFFS ❑ 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.): NOT OPENED DUE TO DEPTH NO SIGNS OF HYDRAULIC FAILURE ON SURFACE, UNABLE TO DETERMINE LEVEL OF PONDING Tide V Inspection Form.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 15 Commonwealth of Mass achusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 159 PERCIVAL DR Property Address KANE Owner Owner's Name information is W BARNSTABLE required for MA 2/7/09 every page. city/Town 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 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.): Title V Inspection Form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 15 I_ ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 159 PERCIVAL DR Property Address KANE Owner Owner's Name information is W BARNSTABLE required for MA 2/7/09 every page. City(rown 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 two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. A A D- X4 �PecAL- A F , y -b L- SI F- 70 .F Title V Inspection Form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 Commonwealth of Massachusetts U9Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 159 PERCIVAL DR Property Address KANE Owner Owner's Name information is W BARNSTABLE required for MA 2/7/09 every page. rty/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to ground water: ' re-�'�'� oetr-j S , 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: OFF SYSTEM AS �.a AS BUILT SEWAGE#95-722 M a c �1(yr.,Oag-r. " 'Q l7 a �AS V 0+P d� r�jM OA � r'+ Title V Inspection Form.doc•0&06 Tide 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 15 of 15 THE COMMONWEALTH OF MASSACHUSETTS 3 A TOWN OF BARNSTABLE Board of Health Fee: w $75.00 Permit To Operate A Swimming Pool In accordance with the provisions of Chapter 111,Section 127A of the General Laws,and Regulations established by the Massachusetts Deparment of Public Health( 105 CMR 435.00)permit is hereby issued to Y.M.C.A. corporation or individual for the operation of INDOOR POOL (Public,Semi-Public,or Special Purpose Pool) at PO BOX 188 WEST BARNSTABLE, MA address Method of water treatment is chlorine-automatically fed Bathing load not to exceed 75 bathers. QUALIFIED LIFEGUARD MUST BE AT POOL SITE ALL TIMES POOL IS OPEN.The smaller pool is a This permit is valid until December 31, 2009 Wayne Miller, M.D., Chairman Board Paul J. Canniff, D.M.D. of January 1, 2009 Junichi Sawayanagi Health POST CONSPICUOUSLY By Thomas A. McKean RS, CHO, Health Agent THE COMMONWEALTH OF MASSACHUSETTS A TOWN OF BARNSTABLE Fee: >� Board of Health $75.00 Permit To Operate A Swimming Pool In accordance with the provisions of Chapter 111,Section 127A of the General Laws,and Regulations established by the Massachusetts Deparment of Public Health( 105 CMR 435.00)permit is hereby issued to Y.M.C.A. corporation or individual for the operation of INDOOR POOL (Public,Semi-Public,or Special Purpose Pool) at PO BOX 188 WEST BARNSTABLE, MA address Method of water treatment is chlorine-automatically fed Bathing load not to exceed 75 bathers. QUALIFIED LIFEGUARD MUST BE AT POOL SITE ALL TIMES POOL IS OPEN.The smaller pool is a This permit is valid until December 31, 2009 Wayne Miller, M.D., Chairman Board Paul J. Canniff, D.M.D. of January 1, 2009 Junichi Sawayanagi Health POST CONSPICUOUSLY By Thomas A. McKean RS, CHO, Health Agent TOWN OF BARNSTABLE `'yr LOCATION /,���.�,%Cl��� SEWAGE# ��� i VILLAGE ����,��T��,��ASSESSOR'S MAP.&PARCEL I %� INSTALLER'S NAME&PHONE NO. /F'lw S/�?/9/� C.F�✓TU/`Y J��✓!/!� SEPTIC TANK CAPACITY 150o T LEACHING FACILITY.(type) .3�Sdd C�/ (size) NO.OF BEDROOMS - OWNER PERMIT DATE: 1�' Z 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` c site or within 200 feet of leaching facility) J Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY AqF O�Wf�/ IC •.t 5 �Nd-Cl2 �Lam- , L3IedI 13 i h spe hUN1 TOWN OF BARNSTABLE 1 LOCATION j 5'9 F�A6G�3C�� SEWAGE# VILI`kGE W BA RA) ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY f 5-()0 rr LEACHING FACILITY:(type) __4 Flo c)o (size) 40 11 X1-- NO.OF BEDROOMS Ll OWNERc,�J°� 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 `I cic A 0 - 32 A F -11 3 13 5-1 0 d F `70 -001 -0- 13 No. _ Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in comp ter: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ftplication for Bisposal 6pstent Construction Permit Application for a Permit to Construct( ) Repair, Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 45 f/01ew-*- fe- Owner's Name,Address,and Tel.No. Assessor's Map/Parcel � L ®. ,f✓� Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. C�TU/�Y ��vG''Co_ QOG�2✓ Cam 05rVG�<v -�4'i�✓!r .✓ Ste'cr/ S i, av Type of Building: Dwelling No.of Bedrooms Lot Size .3`' sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) ym® gpd Design flow provided ��$� gpd Plan Date 17 /6, /yNumber of sheets / Revision Date Title .�S Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) lKe4l ,e9 edx Date last inspected: fi✓O 117lez 441#1771 Gc Agreement: �p�vN.r`,i�/% .SNP /S'R,�pY/�i►�'� f '� The undersigned agrees to ensure con'sfr o and r�ifaintenance of�e afore descri ed oi�t e��ag"e"lispos�� �'� � 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 o ealth. igne Date- Application Approved by Date Application Disapproved by Date for the following reasons Permit No. r Date Issued ~ ` i L( No., f t R r �f Fee Act/CJ t 1 j THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes s PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Spplication for Misposal A57k-in Construction 'Permit Application for a Permit to Construct Re air` Upgrade( Abandon ar Complete System Individual Components PP ( ) P Pg ( ) ( )` ❑ P Y ❑ P Location Address or Lot No. 4519 11 . 5f- /el%a �r Owner's Name,Address,and Tel.No. ! �,, �/✓S/ Ly� Assessor's Map/Parcel Installer's Name,Address,and Tel.No. �1y�^/ •T,�/ Designer's Name,Address,and Tel.No. T`�iw'Y' f'/r?fi'4T moo. Qol.-04-1«Gii/Grn��-yP/�✓G— s Type of Building: 5Vg•,�6,Z _.rr� Dwelling No.of Bedrooms Lot Size ?4' 3 sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons / Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided � '�"�" gpd Plan Date ��"//�•�/ j� Number of sheets / Revision Date Title Size of Septic Tank r/ Type of S.A.S. Description of Soil 40, Nature of Repairs or Alterations(Answer when applicable) ,F_.,!5�',,r./.ieyl� �.c�f✓/ht1f 1 /�a�r�.cc �.%/,��e5/� sTn.v �a/ems/' h/fT"i9.4L -�/1,�As,�/,/a .�✓�_,r_�_".!_,4.��" r.7".,y,�..��.�.�_,�.G G .�,�'�.I T/�V lr �.�'A�/�ei✓6 :.�,;Qc-/�./THY/gii Date last inspected: _. h'n/Q /.cG Gu/Ty C Z,:59/y .Sti'iV.D, Agreement: ` . 3 s a'?iV ��' d r�i t�'�i7'l .�r.� _1"Q.f. aC n- use /� e The undersigned agrees to ensure the codstituction an ain enance of the afore described on-site sewage disposal system m _GAyQ 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 ealth. v gne Date - .4 Application Approved by Date Application Disapproved by Date for the following reasons Permit No. /L. y Date Issued 6 i TITE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO C(J�TIFY,}th biteZSar Dis o1 sy tem Constructed( ) Repaired( UpgradedAbandoned at /S � ��� �(_/�/_ as been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit N y T dated / Installer Designer #bedrooms Approved desigkflow gpd The issuance of this pe it all not 'e construed as a guarantee that the system w func io NX dsig ed. © Q p Inspector Date I p �91 No. l c97"/L`f Fee�tJ r THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS misposaf 6pstem construction permit Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon( ) System located at I 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:Construction in st be completed within three years of the date of this,permit. Date / Approved b� FROM :down cape engineering inc FAX NO. :15083629880 Jun. 26 2014 02:30PM P1 "Town of Barns taJohe, Tt�s�zinas�, dr.'il!�er,�rexto�Y.' sc flki�+isCAtsi�i. WASS. Public MOM rD'C•1Tdfdon ••r��a���� I'h,o>insam 1Vd�cJl�.�wn,�inmd•dax 300 Mmk Strew t.,Hyi Z619,l 07601 Office: 5084,62-4644 Fax 508-.790-6304 . . Ina4�In�r�:%➢�si�.�r�`Rxbifia:a��amaA�!���.'�uut )Date: �c10 g s, �k'e ni4lt 7 1 C� Ass¢s�®rr's 1V�a�n�'arcel.. P '&Tan ��'• 0 e:. _._ ��dlJreae: 7� � 1"�Gt{Y�, `�J (. `... ._ �diin Q.s�. I ��.. �.►�— On _ �'as issued a pt--mdt to iaastaU a (date) (inyttt settle systEm at / _ �� C !/' .. hosed on a.d.eslP;n.drawn by (address) datr..d rj ... dcsign 1 certify that thc: 5eplir; systelr,re.fatmec:d. ah► ve was j.ilsi;iilc'd. s<xb�autially according to the desi.gri,which MAY include .Irzi>>.or approved change:; situh as lateral,e],oc�ition a the cliaffibutim box an.d/or scph.c tauk. w .n � ?..t. I ac�-tily fbat-the- selitia systEm rcfcaericed avow wqs zustaJ.l.ed lfi� .milur rJlml�cs ( ;neater than,10" lateral rclocati.on.of tlu:SAS' oz auy veTticat relou;lion of any compuun:nt oL&selitic system) but in,arc ordaoce with State & Local.Rugulati.uus. P.lau.rk:9i51oJ1.oT re. lied a l7t It by desigaer to-ullaw. OOF � c UANIEL A. yr OAA Or'3 j� -httr=) " CIVIL No.46602 c rO- NAL 15 VC , Si 3t�n.e 1 — Affix llninoe:r.'s Sta��p H�;:rnY ;r1�L�Ag kF;11'()RiY u JJARI fA5 .lr Fti!Lid .ki t9;d�'1'�li ID1VL'3lL¢D.1`i.... C:1v RTT�cIC A 7'>v C]1F v,.1'TCdT : J, JTI�..lT b)�... 0l?'�'Jia TE[T..S t�O 11! . d71 ,4 -kJlla,°l (fiit]Il� AFi; 1�E�;1_1 Y �A2i@TSTA.�PLfu PTJA 7�1 C_tCtr;�+X,'a'�>a1�V XON. I fLAM.YCDTJ. r,-t7�e,�1,1C.,a;rlrl.�.;o+,rr C:eiti2lCetiOp.T�UtU13-2G-O•I_duc ' FROM :down cape engineering inc 'F.4X NO, .115083629880 Jun. 23 2014 02:46PM P2 We. VV IVW-i __ . ,,k� • ArJdrf9ag:15 Perth 'e-'�'''We _ Ba;lnstt�ble s Fie s 3t ZiD o21 .P OWN Wood Na 24.0' b i Fturdly Rom 51 Ming N T:UM Kltahm Room Flrst Floor Lndry. Garage LhArg I&W AaNAtc. pmm 34.0'pvrott F. 6L Second Floor Bedroom Bedroom Bedroom Metr.'Bedroa z5.0' Bath Interior Not to We 19 24.0' 9ke�h by Apex tV WlndoVveTM. GYAri BiYsi Plnor 1300,00 1900.OA BirpB sloop am aammea Max 1334,00 1�3a.d0 9a.D z 24.0 S76,00 1a,4 16.0 le..o x 26...a 44e:oo semmpd F Yti c`'`• t. 1. A• TOTAL UVAKE (rounded) 2s34 '5:Arsap,Tibtw(1,1 lu 2&14 e'£•`'•''-..�,;','�" 'r •• .. .. ;,' _YAhFii;,;vr .`��!;rt'��eS t`'.- .. .•'.L r:',." 4 ,� 4' I "f�Aa q?',•, FPf1M _Ann,in runs- ann i naar,i nn i nrr Pay wn , _l"MA7r,'7gAAA Ti to '77 ':)A1 d G1?:AcWM P1 down cape engineering, inc.SIEVE SOILS ANALYSIS 159 PERCIVAL DRIVE W. BARNSTABLE, MA DATE OF REPORT: 6/23/14 .JOB : GRAIN SIZE ANALYSIS-SIEVE TEST SITE: 159 PERCIVAL DRIVE WEST BARNSTABLE, MA LOCATION: DCE TEST HOLE SIEVE ANALYSIS Weight Sample(Grams): 189.2 SIZE :WEIGHT RETAINED % RETAINED % PASSED (sum ) --------------......................................................:---------------------:..................................... 1" 0.0€ 0.0%€ 100.0% --------------i......................................................t--------------------4------------------- 3/4" 0.0i 0.0%i 100.0% --------------:................:.....................................:---------------------=------------------ 1/2" 0.0€ 0.0%€ 100.0% --------------i......................................................r-------------------- �------------------ 3/8" 0.0i 0.0%i 100.0% ---------- 0....0€..1---------------------------------------- #4 . 0.0%€ 100.0% --------------i......................................................>---------------------,..................................... #10 12.4€ 6.6% 93.4% :---------------------, --------------...................................................... ..................................... #20 47.1€ 24.9%€ 75.1% ---------------i......................................................t-------------- ------,..................................... #40 107.6i 56.9%i 43.1% ........................................................ ..................................... #50 134.0€ 70.8%€ 29.2% --------------i......................................................>-------------------'-+..................................... #80 162.8i 86.0% 14.0% --------------:......................................................:---------------------:..................................... #100 170.2€ 90.0%€ 10.0% --------------i......................................................t---------------------------------------- #200 182.8 96.6% 3.4% --------------:......................................................:---------------------=------------------ PAN: 186.1€ 100.0%€ 0.0% ------------ ------- -- SAMPLE: 189.2i NOTE:TEST ON PASSING#4 ONLY, 7.4% RETAINED ON#4 <45% O.K.. RESULTS: SOIL CLASSIFIED AS AASHTO A-1-b (GRAVEL &SAND) (UNCOMPACTED) PERCENTAGE OF MATERIAL PASSING#4 SIEVE : #4 100% (TEST ONLY MATERIAL PASSING#4) OK #5010%-100% OK #100 0%-20% OK #200 0%-5% OK SAMPLE MEETS TITLE 5 FILL SPECIFICATION H of r�,�ss�cy >96%SAND s° CAMELA. GJ o O.1T!_F, 0 CIVIL cn RESULTS: PERMEABLE MATERIAL-CLASS 1 <2 MINJIN. MATERIAL No.46502 NONCOMPACTED �����c�STE`��°�``� SOIL DESCRIPTION: MEDIUM SANDSSIoNAL ENS Tom•of Barnstable • or ' Department of Regrzlatory.Services �i i Public Health DMsioia Date to 200 Main Street,Hyannis MA 02601 Date Scheduled rr vl%r%/ � �� Time s Fee Pd, .SOULSuatazlity .Assessment,far Suva'a ® L Performea•By `' Witnessed By ✓ LoCAa�roly �nvFORNrAT�0- t Lecacion Address / p2�✓G t u/P_ Owner's Namc Sir �o�a Address Assessor's Map/Parcel: //0/001 O(3 BnginceesName � 0tUrl�- NEW CONSTRUCTION REPAIR TrJe hone# ��� 6 a_7�YY i and Use: L a` SIopes W Smdaca Stones Distance§from: Open Water Body's `'y 0 ft Possible Wet Area ��hY i ft Drinking Water Well ft Drainage Way ft Property Line > =� ft Other ft SEETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,IQcatc wetlands in prnxirnity to holes) ZG""ra% Pi? . 00 -T.4z 7,, I � trrro a� 1 J"J ' • CJ 5�z • � 'u�i,�• .e Parent material(geologic) I�JGi r, t a Depth to li edrack Dcptlr to Groundwater. S[anding Water in Hole: !' r ': Weeping froth Pit FRea• /&r Estimated Seasonal High Groundwater ✓! DETERI RNMON FOR SEASONAL HIGH WATER TABLE Method Used: s.. `f` ✓� Depth Observed standing in obs.ho1e: la. Depth to 5011 mottles. In, Depth to wcep]ng from side of obs,hole: in, Orouadwater Adjustment frr. Index We11# heading Date Index Well]oYal _ Adj,Aabr,,,,,.,•.,_•.^Adj.dtwundwaterLaval,,,,,_, PERCOLATION TEST Dote, Time LP Hole# Time at 9" _ Depth of Perc VG Time at G" Start Pre-soak Timo @ _ TimO(9"-611) Bud Fro-soak Rate i rillnch SitcSultabilltyAssessment: SiteFessed SitpFallcd: Additional Testing NeededCYIN) Original: Public Health Dlvlsiea Observarion Hole,Data ToBe Completed onBack **-*If percolation testis to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one(1)week prior to begianuing. Q:1S P PTICIPERCFO RM.D O C I ]DEEB.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture .SM Color Soil. Other Surface(in.) (USDA) (Mungdl) Mottling (Structure,Stones;Boulders, • ,�/' a i ten, 96' rave I 0-ems _ f Jy 4'o--� ,4 Cz bm OB9E1 VATYON HOU LOG- Role# Z Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface Gn) (USDA) (Munsell) Mottling (5tructurn,Stones,Boulders. -Qo-ns!stqnoL clo G ave C DM OBSERVATION HOLE L00 Hole#. Dcpthtom Soil-Horizon SollTexturc Soil Color Soil Other' Surface(in.) (USDA) (Munseln Mottling (Sttuetare,Stones,Boulders. Cn Nlate Gray-81) ti DEEP OBMWA'I'YON HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color SOIL Other Surface(in.) (USDA) (Munscll) Mottling (Structure,Stones,Boulders. o si ton �_ lood Insurance Rate 1VIa-p: Above 500 yearflood boundary No— Yes _ Within 500yrarboundary No 'i.. Y. , _ - i Within 100 ymr flood boundary No.LY1 Yds _ .Y)enth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring per•Aousmaterial exist in all areas observed throughout the area proposed for the soil absorptibn systeml y le 5 7f not,what is the depth of haturally occurring pervious material? Certirication Y certify that on % Z (date)r 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�10 CYM 15.017. l r Signature �.. )date Q:19.LMC11 kCF0RM.DOC L_ >~ol s 15 9 TOWN OF BARNSTABLE LOCATION P�oCCiVA D!L SEWAGE 'VILLAGE �1 �/�'� ASSESSOR'S MAP& LOT 3- lT1STALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY S S - L o cy y' t:Et1CHING FACILITY: (type) � � F S (size) x � NO..OF BEDROOMS BUILDER OR OWNER PERMIT DATE: 3 $ -1�,� COMPLIANCE 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) f tJ Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by ----------------- I i 1 / - 1 M LOT 33 cm ZS Leh•09 p � 0 � , H LOT 32 35,713 + S.F. (OA2 ± AG) N �P P ti0 LOT 31 JOB 94-038-32 CERTIFIED PLOT PLAN PREPARED FOR LOCATION :ASES MAP U0 PAR 1-13 SANDWICH PERCIVAL DRIVE WEST BARNSTABLE CO-OPERATIVE SCALE : V = W BANK REF UNCE : LOT 32 PLAN BOOK 413 PAGE 99 I HEREBY COMFY THAT THE STRUCTURE SHOWN ON THIS t�OF PLAN IS LOCATED ON THE GROUND AS SHOWN HEREON. JOHN STRUCTURE CONFORMS TO SMACK REQUIREMENTS OF THE 2 FO{?OD HAZAWN WHEN RB DUCTED STRUCTURE DOES NOT LIE IN A /EEA�ST.JFL � Rv ft3m cl DBlAREST—McLELLAN ENGINERRMG � SCHOOL STREET P.O. BOX 463 DECEMBER 17, 1997 Wh3`P DENN1% MA. 02670-0463 (508)398-7710 DATE P ONAL LANDSAF OR {- 1311ILDER INFORIVMATluiv �4.97 3 r TOWN OF BARNSTABLE i 1 0 ®®1 i p �s� � 3 LOCATION ��.X C-/11A I' SEWAGE # VILLAGE �� 0� �' ASSESSOR'S MAP & LOT 3 INSTALLER'S NAME&PHONE NO. E61 1 S SEPTIC TANK CAPACITY 1 S 6r'o LEACHING FACILITY: (type) S (size) NO.OF BEDROOMS _ BUILDER OR OWNER e 'er �t y PERMTTDATE: .3 - $ -1f,!r COMPLIANCE DATE: .�5 5'41A 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) .1 PO Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by r .. � JIO 16 No................ a FRs.........Za�... J THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Bi-nVoiittl World, Tomitrnrtion ramit Application is hereby made for a Permit to Construct ((/11"Or Repair ( ) an Individual Sewage Disposal System at: 0/,f C...��2i VE------•---•-•-••----- --'•�.°`F......AAL).---•-� �L.............!..;�>......_ Location-Address r Lot No � 14G�5...ap �C.......-- P°-' x f b.;_�� i }.iM� ..... Owner (� Address a ............... � .l,A� 1 .�a_).�_ AQ,C'iL7J�: �L_ ' ].. r4 ... InstallerC�5- r Address d Type of Building Size Lot---....:..:.....l .-......Sq. feet U Dwelling—No. of Bedrooms..... .....................................Expansion Attic ( ) Garbage Grinder ( ) _a Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures ---------------------------------- W Design Flow..............k4b.......................gallons per person per day. Total daily flow....-- ... gallons. W Septic Tank—Liquid Li uid ca acity.( P 9 PI --gallons Lengtyh._1(_�......... Width.....�f----- Diameter................ Depth----._.�F." x Disposal Trench—No. .................... Width..� � __ Total Length.__....._. Total leaching area..�'$b�l Daq-f �. Seepage Pit No.___�"� ...... Diameter-`�-.... Depth below inlet.................... Total leaching area..-..... _. .._. . Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by...-1�0`1:�- ... ............... Date........ ....................... minutes per inch Depth of Test Pit____�_ o _ Depth to ground water.._.N Test Pit No. 1..-1�-_�-. . P P P Test Pit No. 2.�.. - --minutes per inch Depth of Test Pit----- .`fk..... Depth to ground water....A J�—_-__-. -----------------------------------------•--•---•-•----------_---- --••-----------•------....... ..... O Description of Soil's v .......,.c_-r--------............................................. ......:;'440....1-ro„-��Ne.J.V1 � Nam_ �ll­WE .-. 3��s w �1��� 1`��f........... =1---------------------------------------------------------------------- ................................... UNature of Repairs or Alterations—Answer when applicable...........:.................................................................................... --------••------- .................................................... •----...-•--•-•--•---•.-•---•--•••-•-••-------------•-----••-•-----•--•........_.....-----------------------•••.................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compli has bee ' ed b he board of health. Lw.�. 31' Signed ---. 6�re � ............. ... ............ . ... , .Application Approved B ..... .................. ...... � te Application Disapproved for the following reasons: ............ ............ . ......._...... ...... ..........................--..--... ....... ......... ........................... . ................ ................... . ........... ............ . .......... .......................---------------- Permit No. .............. Issued " as —s2-.. - --- - - -_.... Dre 06, FEz THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Applirtt#ion for Dig oittl Work.6 Toni#rnr#"ton rami# Application is hereby made for a Permit to Construct (dor Repair ( ) an Individual Sewage Disposal System at: i................................... ................ ... .............. Location.Address Lot No. C� OY .: .lL7. .. Owner (� Address Installer l �n�. Address d Type of Building ,! Size Lot...lc:�?j !.............Sq. feet V Dwelling— No. of Bedrooms---_.y--------------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a' Other fixtures ................................... Design Flow.............. . : .......................gallons per person per day. Total daily flow..____ ....._ gallons. WSeptic Tank—Liquid capacity.L.�:0_galIons Lengyi---l-l__.______._ Width-----C�_...... Diameter---------------- Deptl��.� .(' x Disposal Trench— No. .....!.............. Width..... l .. Total Length_..{.__......... Total leaching area-_ Seepage Pit No..4 --._____ Diameter..._..- `'�'I'-..__. Depth below inlet 77i. .......... Total leaching area, -- Z Other Distribution box ( ) Dosing tank ( )_ Percolation Test Results Performed ............... Date........ ............................ __minutes per inch Depth of Test Pit___!_ ��.. Depth to ground water I t=- Test Pit No. 1- �� P P �� P In -------------- (s, Test/Pit No. 2.G_.�'5....minutes per inch Depth of Test Pit----- ` _ ._..... Depth to ground water....}J,e ........ D Description of Soil•---'-.(....p�� T.-��s.Sid gSol -_•• l Fj'':_�'?y_�.'...._ ill ��F��,•S,�rJD..w�.�1�b111� .<<,r�. �5f U .l—r ._..... Z" '.� Tt�Pc Si k�,S��[— . P, &X IVJ_[,-_i)N. _�"?�C�J2ElVEL ).!a e...... �.T.._..._..._1.1.t '� �`l`�. �'m.4'T`_----------•---------••-----.... U Nature of Repairs or Alterations—Answer when applicable________________________________ _________ _________ _________ ___________•--------__. -•----------•------------------------------•----•-----------------------------------••--••-----••---••--------------------------•-•--•----••--•--------•-----•------------••---•----••--..........-•-•-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Complian e has been.iss,}ed by.the board of health. Cc u� �, �' h � c.� Signed ........:. ' L/- ........ -Z�3a-v� i� ...f,........ / i J Date A lication Approved B � ..............._�.�:..... a_--. --------------- Application pp PP Y ----------------6 ...................r. ................................... Dare Disapproved for the following reasons: ..................................... . ....................... .. . ..... ......................... --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------- Permit No. /� ? a 0 - -5- ..---..- - Issued ............... -- Dare ————--—--—.———.—_.—-- ———— ——.—,————._._.--_. --.—_.--——.-- --— — ———— — ———--.--—— THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE ' Certifirate of Contlatianre THIS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by 1 = ? zr,� � - --.. - 4.<.1..�... -.�� s . ................ _. / �— Insrdler at .............................................. jam? has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. .9-S-7...7�?4..-.............. dated ._ .-. ..`..�`'3.......... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. s . . DATE..........................................r.......... ... .._. ............................... -,---------------------- i----------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE�• FEE.---•.................... Ropusal Works � n #rnr#ion rani# _ Permission is hereby granted. T,-' f/�! :` `-r ,i'7 (<< -ctf��-' = �!� _�L......................o to Construct ( )or Repair ( ) an Individual Sewage Disposal System - atNo. ` �.. / i�� - --- --------------------•-- ----------------� - � --- ._ , Street � ri -2 - -- as shown on the application for Disposal Works Constructione'rmit No..................... ................_ Dated.._._-_____.._._-__-_...._....._..__....... __ �. .� Board of Health DATE----- '� i---`•-•-----... ---•-�-__ 7----------------- FORM 36508 HOBBS&WARREN.INC..PUBLISHERS - r `°F fi/['UalCERTIFICATE OF ANALYSIS Page: 1 a, Barnstable County Health Laboratory Report Prepared For: Report Dated: 3/4/2009 Holly Kane Kane, Holly Order No.: G0950817 101 Willow Street W. Barnstable, MA 02668 Laboratory ID#: 0950817-01 Description: Water-Drinking Water Sample#: Sampling Location: 159 Percival Dr.W.Barnstable,MA Collected: 2/25/2009 Collected by: H.Kane Received: 2/25/2009 Routine ITEM RESULT UNITS RL MCL Method# Tested Nitrate as Nitrogen 0.75 mg/L 0.10 10 EPA 300.0 2/25/2009 Copper ND mg/L 0.10 1.3 SM 31 1 1 B 3/2/2009 Iron ND mg/L 0.10 0.3 SM 31 1 1 B 3/2/2009 Sodium 11 mg/L 1.0 20 SM 31 1 1 B 3/2/2009 Total Coliform Absent P/A 0 0 SM9223 2/25/2009 Conductance 110 umohs/cm 2.0 EPA 120.1 2/25/2009 pH 6.9 pH-units 0 SM 4500 H-B 2/25/2009 Water sample meets the recanntended limits for drinking water of all the above tested parameters. Attached please find the laboratory certified parameter list. Approved By: ,� � (La irector) 1 ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 ENVIROTECH L ORATORIES, INC. MA Cert.`;, �.: M-MA 063 449 Rte. 130 • aandwich,MA 02563 (508)888-6460 • 1-800-339-6460 FAX(508)888-6446 CLIENT: Reef Realty LOCATION: Lot 32 Percival Dr. P.O. Box 186 W. Barnstable, MA W. Dennis, MA 02670 SAMPLE DATE: 3-20-95 COLLECTED BY: Clifford Well Drilling DATE RECEIVED: 3-20-95 TIME: 4:OOPM LAB I.D. NO. : E3-271 JOB TYPE: New well SAMPLE I.D.NO. 32 WELL SPECS. : N/A RESULTS OF ANALYSIS: Parameters Units Recommended Limit Result Coliform bacteria/100ml (MF Method) 0 0 pH pH units 6.0-8.5 6.50 Conductance umhos/cm 500 102 Sodium mg/L 28.0 8.68 Nitrate-N mg/L 10.0 0.03 Iron mg/L 0.3 0.24 Manganese mg/L 0.05 0.006 Volatile Organics See enclosed report. EPA 601/602 ug/L Yes No WATER IS SUITABLE FOR DRINKING',,2VRPOSESFqR PARAMETERS TESTED. XXX /;-.. A Date 3 Z 7 5� Ron ld J. ri Laboratory 'rector IT = Less Than ANALYTICAL EPA METHODS 601 and 602 Volatile Organics (GC/PID/ELCD) Field ID: E3-271 Lab ID: 10222-01 Project: Reef Realty/Lot 32 Percival Batch ID: VG2-0577-W Client: Envirotech Sampled: 03-21-95 Cont/Prsv: 40mL VOA Vial/HCl Cool Received: 03-21-95 Matrix: Aqueous Analyzed: 03-22-95 PARAMETER CONCENTRATION REPORTING LIMIT (ug/L) (ug/L) Dichlorodifluoromethane BRL 5 Chl oromethane 5 Vinyl Chloride BRL 5 Bromomethane BRL 5 Chloroethane BRL 5 Trichlorofluoromethane BRL 1 1,1-Dichloroethene BRL 1 Methylene Chloride BRL 1 trans-1,2-Dichloroethene BRL 1 1,1-Dichloroethane BRL 1 cis-1,2-Dichloroethene * 2 BRL 1 Chloroform 1,1,1-Trichloroethane BRL 1 Carbon Tetrachloride BRL 1 Benzene BRL 1 1,2-Dichloroethane BRL 1 Trichloroethene BRL 1 1,2-Dichloropropane BRL 1 Bromodichloromethane BRL 1 2-Chloroethyl Vinyl Ether BRL 5 cis-1,3-Dichloropropene BRL 1 Toluene BRL 1 trans-1,3-Dichloropropene BRL 1 1,1 ,2-Trichloroethane BRL 1 Tetrachloroethene BRL 1 Dibromochloromethane BRL Chlorobenzene BRL 1 Ethylbenzene BRL 1 meta-and para-Xylene * BRL 1 ortho-Xylene * BRL 1 Br m. oform BRL 1 1,1,2,2-Tetrachloroethane BRL 1 1,3-Dichlorobenzene BRL 1 1,4-Dichlorobenzene BRL 1 1,2-Dichlorobenzene BRL QC SURROGATE COMPOUND SPIKED MEASURED RECOVERY QC LIMITS a,a,a-Trifluorotoluene 30 29 97 Y 87 - 113 % 1,2-Dichloroethane-d4 30 33 109 % 83 - 117 BRL = Below Reporting Limit. * Non-target compound. Method References: Method 601 - Purgeable Halocarbons and Method 602 - Purgeable Aromatics, 40 C.F.R. 136, Appendix A (1986). ---------------------------------------------------------------------------------------------------------- 3-23-95 5: 33 FM ;GROUNDWATER ANALYTICAL ENVIROTECH 508 759 4475;# 3/ 4 o co o 3 No. -- --==---� Fee------- BOARD OF HEALTH l TOWN OF BARNSTABLE Application-*r Well Cootruction Permit APO tion6is her y made,for a permit to ConstructICj, Alter ( ), or Repair ( )an individual Well at: Locati n — Address Assessors Ma and Parc -- — , �� _� � - ------ -- ------------ - - cLs- ---------- Owner Address l FddLc ---------- - e'ldSl ---0--- 6 _- _ -------------- installer — Dril r Address Type of Building Dwelling a ' --------------------------------- Other - Type of Building-------------------------------- No. of Persons------------------------------------------ Type of Well— ,g57 256 - -------— - Capacity-------------------------------------------— — — ---— Purpose of Well - ���`/! �� Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a-Certificate .of Compliance has been issued by the Board of Health. e Signed ,G -- - � -- -- date Application Approved By— ---------=- - — --�= - ------------- date Application Disapproved for the following reasons:----------------------------—------ -------------------------------------------- ---------------------------- q / date Permit No. - --1 `— F — --------- Issued -------------- date BOARD OF HEALTH TOWN OF BARNSTABLE (Certificate ®f Compliance THIS IS TO CERTIFY, That the Individual Well Constructed (>d, Altered ( ), or Repaired ( ) by------------- --- —1 ---------- -------------------------------------------------- Installer at - ` -------------�-:---- - - -------------------------------------------------- has been installed in accordance with the provisions ofthe Town of Barnstable Boa d of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. J))?-S---_ Dated---------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE- --- -- ——--------— - -- -- Inspector---------------------------------—--- - ---- >,,.�r„��•'.,.�'r'fr•��.•*rr •�r.-'.�'s� k+?;r'h•�*w�ri`,.,",�;�'�v� S^ a...-,.,Fj,r..�;,�.�r* i,`�{l•.�4����=��r-rl�h.+rat� 'rt"�--�`�,�``"• �''+� "i't•y�ia'tw`�,r��� ., Oct - o13 >No.°=--;- ------ -t Fee------- ---- BOARD OF HEALTH- TOWN OF BARNSTABLE h ' t . ApplicationArVe[C Con5tructionVermit A he Pion is her y made for a-permit to Construct(�), Alter ( ), or Repair ( )an individual Well at: -Location Address — --— --- � ---'—AssessorsMa and Par -- ���—-- PC _---------------- a Owner Address - Re* o a ---' - - -------- -- - - -� '1 - - Installer.- Dnl r Address Type of Building Dwelling - '"r--------------------------------- t Other - Type of Building----------------------------------- No. of Persons--------------------------------— --- Type of Well----I _ - Capacity Purposeof Well---------- --------------------------- - — - — L. 'i Agreement: t 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 Compliance has.been issued by the Board of Health. Signed i date ! . F r. Application Approved By - ------- --- - -r-�-= .�� date Application Disapproved for the following reasons:=----------------—----___:____—__-________________--____________________ I. - j - —-- —--==--------- ---------------------- �� date I{ s �r J Permit No. - `- } ----— -- Issued date a..�o'ar..r�w.m.sns aam'�iw�.wwvo..�mwr'w.�•w.u��si�r�'...�.�r�wor-a.r�.�.�anR.�.>..w...i..wm.�..r.ter.w..r.r.r..a..r...r....io«rr wwr,..i�ts�®ee�we....arr■r.a.+1 BOARD OF HEALTH TOWN OF BARNSTABLE Certifirate ®f Compliance THIS IS TO CERTIFY, That the.Individual Well Constructed ()d,•-Altered ( ), or Repaired ( ) b --- --------------------------------- -------------------------- --=------------- Instal ler -----' ----- ------------------------, --- ._ w: 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. Dated-------------------------- r THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL i. SYSTEM WILL FUNCTION SATISFACTORY. DATE------------------=------------------------------------------- Inspector-------=---------------------------- ----------- t 4 BOARD OF HEALTH TOWN OF BARNSTABLE k Veil Con5truct ion Permit No. A �V_4 Fee--- �--- Permission is hereby granted- s•• � — - —--------- -- —------—-------- —- - i to Construct ; Alter ( ), or Repair ( ) an Individual Well at: fN o: - -- -� -- i ce? -- ------------h� tr�, 2---—-----=-------------------------- Str as shown on the application.for a Well Construction Permit No. }— -r ------------------------ Dated- =—� — —------------------= ---------------------------------- - 'c Board of Health DATE — f - - f AA(fkA z _ +' T x Z�tJfi Of- � 1 • I � j l 1,r2 l ------------ 2,107 t to it Of 40 ,r W10 .P, 010 C O I Imo- .. a. �!►r iYL E ....... >IT ostyL j K r �G '- � _ '� _. _ .._.. �� �•,` i. !�.Gam.' ` ... .._ .. ._ � I (t� _ __. 15) Corot Notes 10, 0 � 0 y,-loll 5�CONP FOOP, PLAN 12 0 W WOW 5G1f171U 2' 1 31-yll y, n 0 8'-211 Q 2452 P.H. © e d'_BII 0 24510 t7,N, MU,I, LAUNI�ZY 'N 0 10'-91, DOOR 50 U : ® 2'8" X 6'6" RN%P r*a © �I'011�1611 81-�Ol,n tzP115�t7 pAN�I, 12�'�11 12'-6" 0 V O" X 6'6" PAI%V PAWL B�t�Z00M I �, �Dtz00M 2 �v.oz as 05 No. Revision/Issue Date we.em sW Ad*— 2y' M Kft W5, AWITION MAN W. PARWAM &e , °d. �oi�sio� I OF 10 Genwcd Notes UJ%IN6 LAVP 6' 9'-211 Flk5f FOR, PVAN WWOW 5GIf17l IQ 2446 DPHP �XI511NG BEAM I,ALI,Y GOI,UNW POOR 50tI U.- 241 HM12 TO WLT OF FOI WDAAON LVAM LAW CaL MN cLO5ff vo" X 6'8" 9 um gm POOR MIN WA A,, ON FOLN12AIlON UJ%N6 FIR5f FLOOR aAM r 6' 9' 9' WV.os os No. ReNeia�/Iseus Date 2'-611 2' 1 Kft W5, F AnnmoN VLM W. 6AIZWAM - 6 OF 10 P _ K i N ASSESSORS MAP. 110 � _ PARCEL: 1-13 TEST HOLE LOGS NOTES: 'y 1. VERTICAL DATUM. ASSUMED FROM AUAD NGVD + - �, CURRENT ZONING: RF ENGINEER. DOYLE ENGINEERING 2. MUNICAPAL WATER IS NOT AVAILABLE. ' a BUILDING SETBACKS: WITNESS. THOMAS McKEAN R.S. 3. SCHEDULE 40 4 PVC PIPE TO BE USED THROUGHOUT SEPTIC SYSTEM. ".� L P �a 1YJ F. _ S. 15 R. )5 DATE: 11-18-86 4. ALL PRECAST UNITS TO CONFORM WITH AASHTD PERCOLATION RATE: 5 MIN/IN LOADING SPECIFICATIONS. _ FLOOD ZONE: C 5. PIPE PITCH = " PER FOOT UNLESS NOTED OTHERWISE). _2 1,� �( ) 77 7 TH 1 TH 6. 'FIRST 2'-OF PIPE OUT OF D-BOX TO BE LAID LEVEL. � EXISTING 75 76 77 -}�C 63.0 6fS ' WELL 74 y ` ` �s+ ELEV ELEV 7. THE SEPTIC SYSTEM HAS NOT BEEN DESIGNED TO ACCOMODATE THE CO�' LOCUS TOP dt TOP & .�+�- ♦73 ��, SUBSOIL SUBSOIL USE OF A GARBAGE DISPOSAL. z a ` ` ` ` \ o 4e 59.0 36, 58.5 a1 7z . . ` \ 8. ALL CONSTRUCTION DETAILS ARE TO BE IN CONFORMANCE WITH THE LOCATION MAP \ ` ` ` ` ` 9G FINE- nEICTM IP- ME IIUx STATE OF MASS. ENVIRONMENTAL CODE (TITLE FIVE) AND LOCAL g 71 . . • . SAND SAND HEALTH REGULATIONS. ' ` -} � � WITH WITH ' LOT 32 PROPOSED ` . \ d GRAVEL GRAVEL 9. CONTRACTOR TO VERIFY LOCATIONS OF ALL UTILITIES PRIOR COBBLES 35,713 ± S.F. �raLz 70, � � �' �. � coeBLas TO`CONSTRUCTION. 185' TO LEACH AREA ` 77.4 f AND AND (0.82 + AC.) ` ` ` ` MINOR MINOR SILT 10. PROPOSED SEPTIC SYSTEM AND WELL LOCATION IS IN ACCORDANCE WITH SILT 1f0" 523 MASTER PLAN ON FILE WITH BARNSTABLE HEALTH DEPT. 69 \, 7?. z SILT 11. D-BOX TO BE WATER TESTED TO ENSURE LEVELNESS AND EQUAL FLOW.UTILITY CLUSTER 138" 151.5 144" 49.5 68 \ _ NO GROUNDWATER ENCOUNTERED 67 BENCHMARK AT CATCH BASIN ELEV. - 76.7 �k \ ` SEPTIC SYSTEM DESIGN 6s y t -65 € gam : 64 ` \6 \ \ r FLOW ESTIMATE: 4 BEDROOMS AT 110 GAL DAY BEDROOM = 440 GAL DAY r / / / WALK--OUT 62 \ \ \ SEPTIC TANK: DECK w" 61 :` 6� �40 GAL/DAY * 1.5 DAYS = 660 GAL ,� 72 73 74 USE 1500 GALLON SEPTIC TANK � .• ,,.- \ \ PROPOSED 60 24' 4 BEDROOM s ► 65 , ; ; t DWELLING Q ......_ , t LEACHING AREA. F 65S , TH-1 t 18' 71 GARAGE - ' s1 PROPOSED GARAGE r ` ` USE 4 FLOWDIFFUSORS WITH 4' OF STONE ALL AROUND 24' 4 BEDROOM i t t t \ 36' 5s DWELLING ` ` \ AND 1' UNDER (40' x 12' x 2' DEEP) T,F.= 66.0 7o PROPOSED DWELLING SIDE AREA: (40 + 12)2 x 2 = 208 SF(1.66) = 345 GAL/DAY 58 i j DECK t ` BOTTOM AREA: 40 x 12 480 SF (.71) = 341_ GAL/DAY t t.....\............:.'. .... GALjDAY 57 , i i .. �. S. .. T ,•'• j t � t t SEPTIC SYSTEM SECTION 2 PEASTONE _ 56 69 t t 4' OF 3/4" - 1 1/2" t \ t t , t COVERS WITHIN 12" 55 \ t i c t 66.0 -OF FINISHED GRADE WASHED STONE RESERVE t co 1 TOP OF FOUNDATION t t t t 68 t , ` - s7 59.36 58.77 0 ' t \ / \ - ELEV. 59.02 ELEV. D-BOX 1.a \ � � • � 1500 GAL 56.3 ` \ TH-z . ss ELEV. 58 54 ss \ 58.71 E-� E-Y ELEV. � _ SEPTIC TANK ELEV. 4. 4• - 49 \ 65 ELEV. \ \ . TEE SIZES. 58.3 INLET: 6" UP 10" DOWN ' 64 ' ELEV. 4 FLOWDIFFUSORS WITH 4 OF STONE 57 ` \ sz OUTLET. 6" UP, 19 DOWN ALL AROUND AND 1.O' UNDER (40' x 12' x 2' DEEP (H-20) 60 61 BREAKOUT CALC.: (59 - 55)/65 x 150 = 9' 58 59 KEY: EXISTING CONTOUR: _ PROPOSED CONTOUR: •........................ SITE AND SEWAGE PLAN EXISTING SPOT ELEVATION: 25.5 PROPOSED SPOT ELEVATION: 25 0 TEST HOLE: L 0CA TION.. UTILITY POLE •-a r : LOT 32 PERCIVAL DRIVE FENCE LINE: HYDRANT. •-b- .° .r T _ WEST BARNSTABLE MA RETAINING WALL: ;. PREPARED FOR: s, (, REEF .REALTY 0 DEMAREST-McLELLAN ENGINEERING lib i SCALE: r = 31Y DATE: 3-2-95 24 SCHOOL STREET P.O. BOX 463 (�f?r WEST DENNIS, MASSACHUSETTS 02670 REFERENCE: PLAN BOOK 413 PAGE 99 DM # �!LS_32 THOMAS McLELLAN, P.E. JOHN Z. DEMAREST JR., P.L.S. I / N ASSESSORS MAP: 110 PARCEL 1-13 T T"ST HOLE LOGS NOTES: 1. VERTICAL DATUM.=ASSUMED FROM QUAD (NGVD �! •�„ CURRENT ZONING:•� ENGINI ER: DOYLE ENGINEERING 2. 3[UNICAPAL WATER 7S NOT AVAILABLE. BUILDING SETBACKS: WITNESS: THOMAS McKEAN, R.S. 3. SCHEDULE 40 - 4n PVC PIPE TO BE USED THROUGHOUT SEPTIC SYSTEM. 6 - 8 rfc$ F. 30' S• 15 DATE: 1'R. 15' —� 1 --86 4. ALL PRECAST.UNITS TO CONFORM WITH AASHTO _H-10 & H-20 - ,q�� PERCOLATION RATE: 5 MIN/IN LOADING SPECIFICATIONS. q FLOOD ZONE: C TH-1 TH-2 5. PIPE PITCH = 1 Z4" PER FOOT,(UNLESS NOTED OTHERWISE). . EXISTING 75 7s 77, " 63D els 6. FIRST 2' OF PIPE OUT OF D-BOX TO BE LAID LEVEL. WELL �� 74 ` 77 7 164 TOP k ELEV TOP & ELEV 7. THE SEPTIC SYSTEM HAS NOT BEEN DESIGNED TO ACCOMODATE THE Locus ♦73 `\ `` `\ `. 4�, �� SUB:;OIL SUBSOIL USE OF A GARBAGE DISPOSAL. 72` \ ` \ �\ o�,, fL, 48' S9A 3�' SBS 8. ALL CONSTRUCTION DETAILS ARE TO BE IN CONFORMANCE WITH THE t \ ` ` ` • �,� yLIUM MEDIUM STATE OF MASS. ENVIRONMENTAL CODE (TITLE FIVE) AND LOCAL LOCATION ,MAP � `` `` ` \ � \ ` ` `*' SAND SAND HEALTH REGULATIONS. WITH LOT 32 pRosaD `♦ • '� GRA EL GRAVEL 9. CONTRACTOR TO VERIFY LOCATIONS OF ALL UTILITIES PRIOR 35,713 f S.F. WELL 70 . • . COBBLES � � � � ` 77. 4 '�1' �D'LEs AND TO CONSTRUCTION. (0.82 ± AC.) (feo' To LEACH AREA) ` \ G► MINOR SILT 10. PROPOSED SEPTIC SYSTEM! AND WELL LOCATION IS IN ACCORDANCE WITH SILT -- 1f0" SILT 5,3.3 MASTER PLAN ON FILE WITH BARNSTABLE HEALTH DEPT. 69 \ \ \ X SILT 11. D-BOX TO BE WATER TESTED TO ENSURE LEVELNESS AND EQUAL FLOW. \N7 . 2 UTILITY CLUSTER Ise Sf 5 144" 49.5 6e r \ \ \,�V \ t KO GROUNDWATER ENCOUNTERED r \ \ \ \ BENCHMARK AT CATCH BASIN \ \ \ \ \ # ELEV. - 76.7 w, r SEPTIC SYSTEM DESIGN \ r 9g ` 78 64 6 \ 75 FLOW .wSTIMATE 74 4 BEDROOMS AT_'110 GAL/DAYIBEDROOM = 440 GAL/DAY ` • \ ` EXISTING WELL 82 . .... ` '�.. r ` \ r `\ \ (15z TO PROPOSED ` \' .\ \ \ \ 73 LEACH AREA) SEPTIC TANK: \ �� 'r \` \ ' : \ \ `\ `\ \, 440 GAL/DAY * 1.5 DAYS = sso GAL PROPOSED 4 BEDROOM 26. 72 USE 1500 GALLON SEPTIC TANK' z4' DWELLING t t t � ; � �' r r r r . ` r LEACHING AREA: f4, r t \ PORCH 6' rk72 TH-1 PROPO.Sa } GAR. 1 t t` ,, \ 71 USE 4 FLOWDIFFUSORS WITH 4' OF STONE ALL AROUND 34' D 4 BEDROOM 1 1 1 0s 5' t r r r\ A ND 1' UNDER 40' x 12' x 2' DEEP) / r , TOP FNDA 65,0 70 PROPOSED DWELLING ss , r\ r` FIDE AREA: (40 + 12)2 x 2 = 208 SF(1.66) = 345 , GAL/DAY 5e t 1 1?DTTOM AREA: 40 x 12 480 SF (.71) = 341 GAL/DAY t - ' (20' VfV) .TOTAL, CAPACITY 686 '.GAL/DAY SEPTIC SYSTEM SECTION 2" PEASTONE 56 89 4' OF314" - 1 V2" r r r \ r , ` :. r , COVERS WITHIN 12' ss r r ` r ' ` / c 66.0 OF FINISHED GRADE WASHED STONE .: TOP OF FOUNDATION GAS BAFFLE AT 55 68 OUTLET TEE ELEVr 60.9 r t ` t i -1 1 � •� � � ` $2.0 r \ ` ` . 6,y ELEV. 61.4 e L-l61.65 1500 GAL ELEV. 60.83 D-BOX 1.0 58.43 56 ` ` \ \ TH-z ss ELEV. 61.0 4 4> ELEV. SEPTIC TANK ELEV. ' ` - 65 TEE SIZES: 60.43 � �\ �� , \ � ` � � • ` � . � ` . INLET: 6" UP', f0" DOWN 67 t ` - 62 s3 ` s4 OUTLET: 6" UP, 19" DOWN ELEV. ALL AROUND AND 1.O' UNDERLOWDIFFUSORS WITH 4' F STONE ` (40' x 12' x 2' DEEP) (H-20) `\ so `� BREAKOUT CALC.: (663 - 58)/45 x 150 = 16' se 59 KEY: EXISTING CONTOUR: PROPOSED CONTOUR: ............................. SITE AND SEWAGE PLAN EXISTING SPOT ELEVATION: 2.5.5 PROPOSED SPOT ELEVATION: 25 TEST HOLE:- LOCATION.• UTILITY POLE: -o- •',AOf , �H°f" LOT 32 PERCIVAL DRIVE FENCE LINE: . . .. .. 3�tiiO�lAS d 9c� Z. HYDRANT: � Mid-m � o�a�r,.�. m WEST BARNST ABLE, MA CIVIL RETAINING WALL: 9Na36a_TI Na 'S9 PREPARED FOR: REEF REALTY /1ly� DaMARaST-McLELLAN ENGINEERING /r'( SCALE: 1" =`30' DATE 3-2-95 24 SCHOOL STREET P.O. BOX 463 WEST DENNIS. MASSACHUSETTS 02670 REFERENCE PLAN BOOK 413 PAGE 99 DM # 94-089-s2 (039L32) E�AS l[cLL�'LLAX, P.E. JOHN Z. DEMAREST JR., P.L.S. REVISED: 8-25--97 REVISED: 9-4-97 ALL SYSTEM S SHALL SYSTEM STEM PROFILE ol MARKED WITHCMAGNETICT BE TAPE OR PROVIDE WATERTIGHT MIN. 20" DIAM. (NOT TO SCALE) COMPARABLE MEANS FOR FUTURE LOCATION. NOTES ACCESS COVERS TO WITHIN 6" OF FIN. GRADE 2" PEASTONE OR GEOTEXTILE CONCRETE COVERS TO WITHIN 3" GRADE 1. DATUM IS APPROX. NGVD e \ ----------------- TOP FOUND. EL 66.4' FILTER FABRIC OVER STONE 2. MUNICIPAL WATER IS NOT AVAILABLE ti MINIMUM .75' OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM 64.0' - 65.5' 3. 'MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. ° PRECAST H-10 NOTE: MIN WALL THICKNESS: 2" BLOCKS OR 4. DESIGN LOADING FOR 500 GAL. CHAMBER RISERS (TYP.) PRECAST RISERS , 2'0 4 OSCH40 PVC MORTAR ALL H-q0 UNITS TO BE AASHO H-M 'y9h S PIPES LEVEL 1ST 2' 4' COMPONENTS f .EXISTING ENDS (NP') 3' SIDES 61.43' 5. PIPE JOINTS TO BE MADE WATERTIGHT. 1500 GAL H-10 1>*-o-o- ``'` 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE 00000000�0" 14" ° oTEE SEPTIC TANK TEE ° ° ®® ® ®a® ® ® ���o0 0 00 0 0 6" MIN. SUMP 00° ® ®®®®®®®�®®� �0°°oocoo;q ( )o o ° ° ° tlWITH 310 CMR 15.000 TITLE 5.GAS BAFFLE::; o0 0 o 012" MIN INT. DIM. 0 0®�®�®®®®®� ®�®®®®®���� ,o°o°,°oo f00 0 0 0 0 0 0oC,o�o„o�o_ nj °o0 c°°°o°o o°o 0 °°°°�°°, 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND60.7' 60.53' °°° o ° _,° Locus ° �0�04o4c7 58.43 NOT TO BE USED FOR LOT LINE STAKING OR ANY OTHER PURPOSE. „ L H-20 500 GAL. LEACHING CHAMBER BY ACME PRECAST OR EQUAL. " EXIST. INVERT OUT OF D'BOX 3/4"-1-1/2 DOUBLE WASHED STONE 4' MIN. (3) UNITS REQUIRED 8• PIPE FOR SEPTIC SYSTEM TO SCH. 40-4 PVC. ELEVATION 61.1't ALL AROUND PRECAST STRUCTURES o 6" CRUSHED STONE OR MECHANICAL OVERALL DIMENSIONS TO OUTSIDE OF STONE: 33.5, X 12.83' 9. COMPONENTS NOT TO BE BACKFILLED OR COMPACTION. (15.221 [21) CONCEALED WITHOUT INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED FROM BOARD ( 1 90 SLOPE) ( 1 SLOPE) OF HEALTH. LOCUS MAP LEACHING 10. CONTRACTOR SHALL BE RESPONSIBLE FOR FOUNDATION EXIST SEPTIC TANK 26' D' BOX 12' 52.0' BOTTOM TH-2 CALLING DIGSAFE (1-888-344-7233) AND NOT TO SCALE FACILITY NO ROUNDWATER FOUND If VERIFYING THE LOCATION OF ALL UNDERGROUND & OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF ASSESSORS MAP 110 PARCEL 1-13 *THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL - WORK. UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS EXIST. 11. ANY UNSUITABLE MATERIAL ENCOUNTERED PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM WELL SHALL BE REMOVED 5' BENEATH AND AROUND THE PROPOSED LEACHING FACILITY. 12. EXISTING LEACHING FACILITY SHALL BE PUMPED \ EXIST. AND REMOVED OR PUMPED AND FILLED WITH CLEAN LEGEND �� SAND. VARIANCES FOR SEPTIC SYSTEM REPAIRS WHICH MAY BE WELL\ IMMEDIATELY GRANTED BY THE BOARD OF HEALTH AGENT OR 99- EXISTING CONTOUR -77. 77.63 BY HEALTH INSPECTOR X 99.1 EXIST. SPOT ELEV. k 6 \ \ � °a PAPERWORK AND HEARING REDUCTION PROPOSALS APPROVED 1 d' BY THE BOARD OF HEALTH REVISED DURING -A PUBLIC 99 PROPOSED CONTOUR F� Le \ \ \ n.os HEARING HELD ON AUG. 4, 2009 ���� PROPOSED SPOT EL 3) FAILED SYSTEMS ONLY : SOIL ABSORPTION SYSTEM 99 \ \ 72.97 INSTALLATIONS PROPOSED MORE THAN THREE FEET BELOW TH1 \ Epp 73.0 \ 7684 ANDDE WITH NTH H 2O0PER LOAD NG,nBUTNG (IINPED TO THE NO CASE SHALLOTHEESAS _Q� TEST HOLE \ \ 70.1 QP ��. \ 6.3 76.89 BE LOCATED MORE THAN SIX FEET BELOW GRADE. 2!-- SLOPE OF GROUND � \� \ \ 6 6��\ \. E ST. '76.88 Foo � SYSTEM DESIGN: COL) UTILITY POLE \ 6 .4\ 6b WELL\> 55.12\ \ \ FIRE HYDRANT \\ \ ss.2a GARBAGE DISPOSER IS NOT ALLOWED 77.55 NOTE: NOT ALL SYMBOLS MAY APPEAR IN DnkWM \\ 1 D� 66.09 7� \ ��� J EXISTING 4 BEDROOM DWELLING (REF: PERMIT `#95-722) 65.89 \ USE A 44© GPD DESIGN Si' GN FLOW TEST HOLE LOGS 65�8\ 6689\ SEPTIC TANK: 440 GPD (2) = 880 - MAP 110 �� OPEN DANIEL E. GONSALVES, SE PARCEL 1-14 ' \ 66.7. i I SPACE **RE-USE EXISTING 1000 GAL. SEPTIC TANK ENGINEER: ` PORCH sfrs i DRAINAGE DONNA MIORANDI RS � � - - - EASEMENT LEACHING: WITNESS: , \ EXISTING JUNE 16, 2014 DWELLING #159 ( I 33.5 + 12.83) 2 (.74) = 137 GPD � \ � I I , SIDES:2 DATE: N07E• EXIS77NG j TOP FNO.=66.40 (REAR) I PERC. RATE _ < Z MIN/INCH HATCHWAY IN DECK FOR i _ _ _ BOTTOM 33.5 x 12.83 (.74) = 318 GPD 14399 SEP7/C TANK ACCESS II \ o m 65.73 �15-F° TOTAL: 614 S.F. 455 GPD CLASS I SOILS P# �I� \ 65.60 8 \ 662/ , \ USE (3) 500 GAL. H-20 LEACHING CHAMBERS (ACME OR EQUAL) � ELEV. ELEV. z i ,65 WITH 4' STONE ALL AROUND . . 0" 65.0 0„ 64.0 1, 65.01 DECK L` I 6/,3 MAP .110 � � �. 65.10' A/ / A/ EXISnNG LEACHING\ 4, / i \ ` PARCEL 1-12 >' / \ I XISTING �LS / /LS UNSUIT. FACILITY (SEE Nq7E 12 MA UNSUIT. R 2 �\ � - ';�y �%70 53 66 DWELLING APPROVED DATE BOARD OF HEALTH ' 8» 10YR 3/2 8» 10Y 3/ � /�. yy� o I B B' OP NT WITH HARC FILTER �' / TITLE 5SITE PLAN/ / PR VE C OAL � \ / N . � DECK �LS UNSUIT. �S / UNSUIT. AND BUGSCREEN (FINAL PLACEMtNT BY 65.15 O - CONTRACTOR WITH HOMEOWNER ���s3.,s �� 6g OF 61.0' 4819 10YR 4/3 CONSULTATION) \ 48 10YR 4/3 60.0 6' � � 64.04 / 7 N fi3.2`I 428 PLAY BENCHMARK: TOP 159 PERCIVAL DRIVE \�62.58 AREA - CORNER OF BULKHEAD WEST BARNSTABLE 'Cl UNSUIT. C1 UNSUIT. ��\ 63.10 ' ELEK=65.9' Si LOAM Si LOAM/ s i i i i 57.5' 90" / 56.5' � j - s6 PREPARED FOR 90 2.5Y 6/3 2.5Y 6/3 / slEVE 62 STEPHANIE SHARLET L � �64 _ C2 C2 5' REMOVAL OF UNSUITABLE SOIL REQUIRED JUNE 16, 2014 AROUND PER/ME7ER OF LEACHING FACILITY, DOWN . a �,. n TO SUITABLE SOIL LAYER. REPLACE WITH CLEAN `3 �r/'9a �' Cr+�t4 ` W OF h+ r off 508-362-4541 ,.. 'o � y° s, 'aa fax 508-362-9880 MED. SAND, TO MEET SPECIFICATIONS OF 310 CUR �,Q �� oti ,ro�s D 1„EL �� �. DA.t"EL , MS MS G,.PJ LA. \ � 15.255(3) ,, s o F r 11 c L A � �r z '` _AI1 r lc ' A �1 downcape.com CIVIL " ;'r'c�i ,I -4. " �Jt,i�; <1',b?i GIi,�A 144 10YR 5/4 53.0 144» 10YR 5/4 52.0 MAP 110 No.� �^2 I down cope e/1gi/1�er�ng Inc �. O- PARCEL 1-13 a2�o �F ° ` �, .� . ti w���E \ \�F ^`� 0.82 Ac.t ` ;F c��TER` ��',!. ; �fi F �x �t t ��,� civil engineers Scale:1 = 30 (35,713f SF) �Ip t a,` c E a ,� r *4�rRvt �._ �. , - : land sums veyors NO GROUNDWATER ENCOUNTERED "A '� 7 ! 939 Main Street ( R to 6A) DCE # I �t / 22 0 15 30 45 60 75 FEET DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675 22 SHARLET.DWG 16 i it i T f I