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HomeMy WebLinkAbout0291 PERCIVAL DRIVE - Health 291 PERCIVAL DRIVE WEST BARNSTABLE A = 111 061 i Commonwealth of Massachusetts �9 Title 5 Official Inspection Form _} la Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w 291 Percival Drive Property Address p•.b;, Lynne Foster �.. Owner Owner's Name information is -" required for every West Barnstable Ma. 02668 7/30/20$8 page. City/Town State Zip Code Date of I'rispection r'17 11 , Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information l3yglO on the computer, use only the tab 1. Inspector: key to move your cursor-do not Sean M. Jones use the return Name of Inspector key. S.M.Jones Title V Septic Inspection Company Name 74 Beldan Lane Company Address Centerville Ma 02632 Cityrrown State Zip Code 774-248-4850 smjonestitle5@gmail.com S14522 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 7/30/2018 Inspector's Signature l Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 h Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 291 Percival Drive Property Address Lynne Foster Owner Owner's Name information is required for every West Barnstable Ma. 02668 7/30/2018 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The dwelling located at 291 Percival Drive West Barnstable is served by a Title V septic system consisting of a 1500 gallon septic tank, distribution box and a field of biodiffusers. The system was found to be in proper working condition at the time of inspection. B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or -epaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form n ((c Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4' 291 Percival Drive Property Address Lynne Foster Owner Owner's Name information is required for every West Barnstable Ma. 02668 7/30/2018 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observatior of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form M1 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 291 Percival Drive Property Address Lynne Foster Owner Owners Name information is required for every West Barnstable Ma. 02668 7/30/2018 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system nas a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: *"This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form �a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 291 Percival Drive Property Address Lynne Foster Owner Owner's Name information is required for every West Barnstable Ma. 02668 . 7/30/2018 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 291 Percival Drive Property Address Lynne Foster Owner Owner's Name information is required for every West Barnstable Ma. 02668 7/30/2018 page. Cityrrown 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 ❑ Z Pumping information was provided by the owner, occupant, or Board of Health ❑ Z 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? 0 ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 gpd t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 291 Percival Drive u Property Address Lynne Foster Owner Owner's Name information is required for every West Barnstable Ma. 02668 7/30/2018 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form f�' l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 291 Percival Drive Property Address Lynne Foster Owner Owner's Name information is required for every West Barnstable Ma. 02668 7/30/2018 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 291 Percival Drive Property Address Lynne Foster Owner Owner's Name information is required for every West Barnstable Ma. 02668 7/30/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: system repaired 6/11/2010 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2 feet Material of construction: ❑ cast iron I ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints ok, no leaks , vented through roof Septic Tank(locate on site plan): Depth below grade: 1.5 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 gallons Sludge depth: 8" t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 �Officiasl Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments i�vz)- 291 Percival Drive Property Address Lynne Foster Owner Owner's Name informrequired is west Barnstable Ma. 02668 7/30/2018 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 3' 311 Scum thickness Distance from top of scum to top of outlet tee or baffle 611 Distance from bottom of scum to bottom of outlet tee or baffle 10" How were dimensions determined? opened covers and took measurements 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 needs to be cleaned now and again every 2 years for proper maintenance. water level was even with outlet, tank was not leaking and was structurally sound. 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 tIins,doc•rev.6116 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 i i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 291 Percival Drive Property Address Lynne Foster Owner Owner's Name information is required for every West Barnstable Ma. 02668 7/30/2018 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts r� Title 5 Official Inspection Form (' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4' 291 Percival Drive Property Address Lynne Foster Owner Owner's Name information is required for every West Barnstable Ma. 02668 7/30/2018 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Distribution box was in good condition, no rot, water level was even with outlet invert. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form la Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 9 P Y rY 291 Percival Drive Property Address Lynne Foster Owner Owner's Name information is required for every west Barnstable Ma. 02668 7/30/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): leach field was video inspected through vent and was found dry with no signs of past hydraulic overloading. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts 1 Title 5 Official Inspection Form �4 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 291 Percival Drive Property Address Lynne Foster Owner Owner's Name information is required for every West Barnstable Ma. 02668 7/30/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 291 Percival Drive Property Address Lynne Foster Owner Owner's Name information is required for every West Barnstable Ma. 02668 7/30/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately A9" l � A( 3 J nt AZ �l i3Z � ,A3 6 t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form < Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 291 Percival Drive Property Address Lynne Foster Owner Owner's Name information is required for every West Barnstable Ma. 02668 7/30/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 12+ feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: Groundwater elevation was determined by accessing Town of Barnstable groundwater contour map. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 291 Percival Drive Property Address Lynne Foster Owner Owner's Name information is required for every West Barnstable Ma. 02668 7/30/2018 page. Cityrrown State Zip Code Date of Inspection' E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 CERTIFICATE OF ANALYSIS M' Barnstable County Health Laboratory (M-MA009) ` rt \ Recipient: Order No.: G18110702 Lynne H Foster-Welsh Report Dated: 11/01/2018 291 Pervical Drive SubPitter: Lynne H Foster W Barnstable, MA 02668 Description: 5 Day Rush-Rtn Laboratory ID#: 1`8110702-01 Matrix: Water-Drinking Water Sample.#: Sampled: 10/25/2018 11:30 By: Customer I Collection Address: 291 Pervical Drive Vl. Barnstable,MA Received: 10/25/2018 11:30 By: PalmerP Sample Location: Turn Around: 120Hr Rush ; Routine i ITEM RESULT UNITS RL MCL METHOD# ANALYST TESTED TIME Nitrate as Nitrogen 2.7 mg/L 0.10 10 EPA 300.0 LAP 10/25/2018 10:44 Copper ND mg/L 0.10 1.3 EPA 200,8 CL 10/30/2018 12:38 Iron 0.18 mg/L 0.10 0.3 EPA 200.8 CL 10/30/20'18 12:38 pH 6.6 PH AT 25C NA 6.5-8.5 SM 4500-H-B DCB 16/25/2018 16:17 r Sodium 18. mg/L .2.5 20 EPA 200.8. CL 10/30/2018 12:38 t Total Coliform Absent P/A 0 0 SM 9223B RG 10/25/2018 15:16 1 Conductance 180 umohs/cm 2.0 EPA.120.1 DCB 10/25/2018 16:17 Sodium level is above the maxium contaminant level. Those on a low sodium diet may wish to consult a physician. ! Attached please find the laboratory certified parameter list. \ _ Approved By: (Lab Director) - t i ' I I i } d pa f I i ND=None Detected RL _- Reporting Limit MCL=Maximum Contaminant Level 3195,Main Street, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 Page: 1 of 1 f i �ipTIlq �, CERTIFICATE OF ANALYSIS rJ� �1F rI�• ' ` Barnstable County Health Laboratory (NI-MA009) lq�s Recipient: Order No.: G18110715 Lynne H Foster-Welsh Report Dated: 10/26/2018 € 291 Pervical Drive Submitter: Lynne H Foster E W Barnstable, MA 02668 Description: 5 Day Rush-voc ; Laboratory ID#: 18110715-01 Matrix: Water-Drinking Water d Sample#: Sampled: 10/25/2018 11:00 By: Customer Collection Addr: 291 Pervical Drive Received: 10/25/2018 11:30 By: PalmerP Sample Location: Turn Around: 120Hr Rush' ' Analyst: yn Method: EPA 524.2 Dilution: 1 Date Analyzed: 10/25/2018 @ 11:08 t r EPA 524.2 - Volatile Organics,by GCIMS li Result MCL MDL Result MCL MDL. Parameter ug/L ug/L ug/L Parameter ug/L ug/L ug/L Dichlorodifluoromethane ND 0.50 Chloroethane ND 0:50 Chloromethane ND 0.50 Chloroform 1.9 80 0.50 Vinyl chloride ND 2.0 0.50 cis-1,2-Dichloroethene ND 70 . 0.50 Bromomethane ND 0.50 cis-1,3-Dichloropropene ND 0.50 1,1,1,2-Tetrachloroethane ND 0.50 Dibromochloromethane ND 0.50 1,1,1=Trichloroethane ND 200 0'.50 Dibromomethane ND 0.50 1,1,2,2-Tetrachloroethane ND 0.50 Ethylbenzene. ND 700 0.50 1,1,2-Trichloroethane ND 5.0 0.5o Hexachlorobutadiene ND 0.50 , 1,1-Dichloroethane ND 0.50 Isopropyl benzene ND 0.50 1,1-Dichloroethene ND 7.0 0.50 Methylene chloride ND 5.0 0.50 s 1,1-Dichloropropene ND 0.50 Methyl-test-butyl ether, ND 0.50 1,2,3-Trichlorobenzene ND 0.50 Naphthalene ND 0.50 1,2,3-Trichloropropane ND o.5o n-Butylbenzene ND 0.50 ; 1,44-Trichlorobenzene -ND 70 0.50 n-Propylbenzene ND 0.50 1,2,4.Trimethylbenzene ND 0.50 p-Isopropyltoluene ND 0.50 1,2-Dibromo-3-chloropropane ND 0.50 sec-Butyl benzene ND 0.50 r 1,2-Dibromoethane(EDB) ND 0.50 Styrene ND 100 0.50 1,2-Dichiarobenzene ND 600 0.50 tert-Butyl benzene ND 0.50 1,2-Dichloroethane ND 5.0 0.50 Tetrachloroethene ND 5.0 0.50 1,2-Didhloropropane ND 0.50 Toluene ND 1000 0.50 1,3,5-Trimethyibenzene ND 0.50 Total xylenes ND 10000 0.50 1,3-Dichlorobenzene ND 0.50 trans-1,2-Dichloroethene ND 100 0.50 1,3-Dichloropropane ND 0.50 trans-1,3-Dichloropropene ND 0.50 1,4-Dichlorobenzene ND 5.0 0.50 Trichloroethene ND 5.0 0.50 2,2-Dichloropropane ND 0.50 Trichiorofluoromethane ND 0.50 2-Chlorotoluene ND 0.50 Compound %Recovered QC Limits(%) 4-Chlorotoluene ND 0.50 1,2-Dichlorobenzene-d4 108% 70 130 Benzene ND 5.0 0.50 p-Bromofiuorobenzene 96°% 70 130 r Bromobenzene ND 0:50 Bromochloromethane ND 0.50 Brorriodichloromethane ND 0.50 Bromoforrn ND 0.50 Carbon tetrachloride ND 5.0 0.50 Chlorobenzene ND' 100 11.11 a Attached please find the laboratory certified parameter list. Approved By- (Lab, Director) ND= None Detected RL Reporting Limit MCL= Maximu�Cont minant Lev a 3195 Main Street, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 Page 1 of 1 ,A Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ..�' 291 Percival Drive Property Address Ludwig Owner Owner's Name information is west Barnstable MA 02668 November 10, 2009 required for every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important: A. General Information /7 When filling out ht ,forms on the � l� computer,use 1. Inspector: only the tab key to move your Patrick M. O'Connell cursor-do not Name of Inspector use the return key. Septic Inspection Services Co Company Name 189 Cammett Road Company Address Marstons Mills MA 02648 ,aun Citylrown State Zip Code 508-428-1779 SI 12855 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 �-j) —� A( November 10, 2009 :f7-,t lit& ector's Signal Date ure tirR t _ The system inspector shall submit a copy of this inspection report to the Approving Authority-(Boardrt of Health or DEP)within 30 days of completing this inspection. If the system is a shared system o has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit they 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. [IQ ****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. L v 09-235 Ludwig.doc•08106 Title 5 Official Inspection Form:Subsurface Se geisystem•Page 1 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 291 Percival Drive Property Address Ludwig Owner Owner's Name information is required for West Barnstable MA 02668 November 10, 2009 every page. Cityrrown 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 09-235 Ludwig.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 15 XL Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 291 Percival Drive Property Address Ludwig Owner Owner's Name information is required for West Barnstable MA 02668 November 10, 2009 every page. Cityrrown 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 pdoiic 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. 09-235 Ludwig.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form A Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 291 Percival Drive Property Address Ludwig Owner Owner's Name information is required for West Barnstable MA 02668 November 10 2009 every page. Citylrown 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_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. 09-235 Ludwig.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 291 Percival Drive Property Address Ludwig Owner Owner's Name information is required for West Barnstable MA 02668 November 10, 2009 every page. City/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. El ® 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. 09.235 Ludwig.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 291 Percival Drive Property Address Ludwig Owner Owner's Name information is required for West Barnstable MA 02668 November 10 2009 Cit frown State Zip Code Date of Inspection every page. Y P P 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? 0 ® 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)] 09.235 Ludwig.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .."( 291 Percival Drive Property Address Ludwig Owner Owner's Name information is required for West Barnstable MA 02668 November 10, 2009 every page. Cityrrown State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Number of current residents: 4 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage N/A Well Water 9 ( Y 9 (gpd)) Sump pump? ❑ Yes ® No Last date of occupancy: Currently Occupied. 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): 09-235 Ludwig.doc•Oa106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 15 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 291 Percival Drive Property Address Ludwig Owner Owner's Name information is required for West Barnstable MA 02668 November 10, 2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: Tank pumped 10/23/06 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: Compliance date: 8/16/01 Were sewage odors detected when arriving at the site? ❑ Yes ® No 09-235 Ludwig.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 l Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 't 291 Percival Drive Property Address Ludwig Owner Owner's Name information is West Barnstable MA 02668 November 10 2009 required for , every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: if feet Material of construction: ❑cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): Depth below grade: 1 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' long x 5.8'wide- 1500 gal. Sludge depth: 5" Distance from top of sludge to bottom of outlet tee or baffle 28" Scum thickness 3" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 10" How were dimensions determined? Measured 09-235 Ludwig.doc-08106 Title 5 Official Inspection Form.Subsurface Sewage Disposal System-Page 9 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .�' 291 Percival Drive Property Address Ludwig Owner Owner's Name information is required for West Barnstable MA 02668 November 10, 2009 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.): Liquid level was found at bottom of outlet invert tees are intact. 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): 09-235 Ludwig.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 i Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments y 291 Percival Drive Property Address Ludwig Owner Owner's Name information is required for West Barnstable MA 02668 November 10, 2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *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 3" 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.): Liquid level over inlet and outlet inverts, observed staining to top of box. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 09-235 Ludwig.doc•08M Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 291 Percival Drive Property Address Ludwig Owner Owner's Name information is required for West Barnstable MA 02668 November 10, 2009 every page. Cityrrown State Zip Code Date of Inspection D. System Information cont. Y (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: Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: Three 31 foot trenches. ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Tv a/name of technology: .p 9Y Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Trenches have surcharged into d-box, trenches are in hydraulic failure. 09-235 Ludwig.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 291 Percival Drive Property Address Ludwig Owner Owners Name information is required for West Barnstable MA 02668 November 10, 2009 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert 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.): 09-235 Ludwig.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r 291 Percival Drive Property Address Ludwig Owner Owner's Name information is required for West Barnstable MA 02668 November 10, 2009 every page. Citylrown 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. 68 85 51 30 Percival Drive Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 291 Percival Drive Property Address Ludwig Owner Owner's Name information is required for West Barnstable MA 02668 November 10 2009 every page. Citylrown State Zip Code Date of Inspection I D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to ground water: N/Afeet 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: 09-235 Ludwig.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 15 Barnstable Town. of Barnstable 'ca "Regulatory Services Department MSAB t p$ b 9: Public_Health.-Division m 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790 6304 Thomas A.McKean,CHO CERTIFIED MAIL# 70081830000205008918 January 14, 2010 Clinton&Lynne Ludwig 291 Percival Drive West Barnstable, MA 02668 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 291 Percival Drive,West Barnstable MA was inspected on November 10, 2009 by Patrick M. O'Connell, certified Title V Septic Inspector for the State of Massachusetts. The inspection.of the septic system showed that the system FAILED under the ^ guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: - - - Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool You are ordered to repair or replace the septic system within Sixty (60) days from the date you receive this notification. Failure to repair/replace the septic,system within the deadline period will result in future enforcement action. N S PER ORDER OF THE B ARD OF HEALTH SCOPW o as cKean, R.S., CHO Agent of the Board.of Health Q:\SEPTIC\Letters Septic Inspection Failures\291 Percival Drive.doc TOWN OF BARNSTABLE y LOCATION jW SEWAGE#. ,Z0/0 VILLAGE /�Q✓n s f"�d/e ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. le- /3a CohS .SEPTIC TANK CAPACITY LEACHING FACILITY:(type) f1-�p `size) 307 9/0 NO.OF BEDROOMS L� OWNER 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 r within 300 feet of leaching facility). feet FURNISHED BY r i � V ail .�� t No. / Fee b THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01ppricatiou for Tigpool *pztem Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address No. r Owner's Name,Address,and Tel.No. d 9/ /,Or,v� Assessor's Map/Parcel Installer's Name,Address,and Tel.No.{ Designer's Name,Address and Tel.No. J,`-• l7 r �fo Cow 57ka c/,( ��i4CCY Hf �or/(f �^ W. c vv55'r, /o/R Y77- Type of Building: rog 5'a8 RS�'Ssfd4/�,�l� oaG 5'Sz Dwelling No.of Bedrooms `"/ Lot Size sq. ft. Garbage Grinder ( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) yy® gpd Design flow provided 4/Vy S- gpd Plan Date / Number of sheets Revision Date Title ,'rZ h'T/4ede / ,�14h it eq& _ 9!t jM V P R17 Size of Septic Tank Type of S.A.S. Description of Soil S« Nature of Repairs or Alterations(Answer when applicable) _ ��/4cr �2-/,vX1. ;, /Z er✓-e L e�c�. Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Boar Heal 11 Signed 7V Date —o? Application Approved by Date Application Disapproved by: Date for the following reasons Permit No. Date Issued No. s t. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes'` PUBLIC HEALTH DIVISION'- TOWN OF BARNSTABLE, MASSACHUSETTS = . Application for Migpoal �&potem Cottgtruction Vermit Application for Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address r Lot No. a�� �YCi�/li �Y/�/� Owner's Name,Address,and Tel.No. Assessor's Map/Parcel /a / " `1/ /r we s/ r-e lnstaller�Name,Address,and Tel.No. Designer's Name,Address and Tel.No. «r,ti3 w,.rfI-<. 1/77-�3/3 Type of Building: Sod �/ak y5`5'S fcr.r/�4/ �'A p�G yy Dwelling No..of Bedrooms �/ Lot Size sq. ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) %Lra� gpd Design flow provided yyy gpd Plan Date Number of sheets Revision Date Title ,Sep �7�r{��rc1 .O/C�h �T 9 sFW e' v7 Size of Septic Tank Type of S.A.S. Description of Soil l 7/ Jl, f%rrv, Nature of Repairs or Alterations(Answer when applicable) �P„/„c �-/S'o�( %r /� r Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board Health, Signed _ �p Date �'o? Application Approved by Date Application Disapproved by: / Date v for the following reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded ( ) Abandoned( )by T/: at 6791 F','e,'vy/ /fir r(i has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. V 1 dated Installer T C, 4)y /5�/y Designer `S #bedrooms qApproved design flow y`/p gpd The issuance of this permit shall not be construed as a guarantee that the system will functio des g, ed. Date c f !�J 1 0 Inspector l —�-_-- — --------------- -- ----------- No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS I Digoal *p!5tem Construction permit Permission is hereby granted to Construct ( ) Repair ( Upgrade �bpdon System located at `y/ �P✓C,'ya !��-,-ve �/� and as described in.the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Constructi n must be'com leted within three years of the date of this pe Date Approved by _ ,, '; f_\". r , Town of Barnstable d Regulatory Services Thomas F. Geller,Director s Public Health Division Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 a Office:. 508-862-4644 Fax: 508-790-6304 Date: 0 tO Sewage Permit#d Olo~ I _7 Assessor's Map/Parcel I L 1 Installer&Designer Certification Form Designer: v��q��•2.-er6-t., W , IYj C . Installer: Address: n- W. C&4 M OA Address: 13vX 3 3 J On �`�'� was issued a permit to install a (date) (installer) septic system at 1 ��J�` ��, Vr. based on a design drawn by (address) dated (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Stripout(if required) was inspected and the soils were found satisfactory. VjH OF44Ass�yG 9 PETER T. (Instal er's Signature) c NI c E N T E E L " CIVIL No.35109 esigner's Signature) (Affix De PL ASE, TURN TO BARNSTAB E PUBLIC HEALTH DIMS N. CERTIFI ATE O C. L NOT B I3S . UNTIL B. TH TM FO g ..BY ARN T LE PUBLIC IC D _ -Y gAoffice fomimesipercertification form.doc Engineering Works, Inc. Reserve Area Alternate 12 W. Crossfleld Road 191 Percival Dr., APN 111 -061 Forestdale, MA 02644 HIGH CAPACITY BIODIFFDSER 4 BEDROOM DESIGN CONFIGURATION (508) 477-5313 FOR STONELESS SYSTEM Page 1 of 3 / ,7 }— ORIGINAL STRIPOUT BOUNDARY i KEEP PROPOSED ALTERNATE S.A.S. 5 FT. (MIN.) WITHIN STRIPOUT BOUNDARIES. ;y / D—BOX AND S.A.S. LOCATIONS TAKEN RECORD AS—BUILT & FIELD VERIFIED. `\ / NOTE: WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS / IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND INSTALL NEW D—BOX & SA.S. REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). (D-BOX W/ 4 OUTLETS) r 0 0 BACK OF HOUSE s o PETER McENTEE o CIVIL No. 35109 �- �_ __�_ � d ����� 9 '� ��4 G � �z� i } Engineering Works, Inc. Reserve Area Alternate 12 W. Crossfield Road 191 Percival Dr. , APN 111 -061 Forestdale, MA 02644 HIGH CAPACITY BIODIFFUSER 4 BEDROOM DESIGN CONFIGURATION (508) 477-5313 FOR STONELESS SYSTEM Page 2 of 3 MAINTAIN 2% GRADE (MIN.) OVER S.A.S. INSPECTION PORT 11.3" TO INVERT E - I- - - - - - - - - - - - - f (4 ROWS OF 5 UNITS AT 6.25'/UNIT) + 0.7' WEDGE = 32.0' v PLACE WEDGE BETWEEN 1st & 2nd UNITS SOIL ABSORPTION SYSTEM PROFILE ESTABLISH VEGETATIVE COVER BACKFILL WITH CLEAN NATIVE OR PERC SAND TO TOP OF CHAMBERS � II ill�lllll�l 2.83' EFFECTIVE WIDTH=11.3' EXISTING SUITABLE MATERIAL USE 4 ROWS OF 5-16"(H-20) ADS BIODUFUSER UNITS WITH NO SEPARATION BETWEEN EACH ROW & NO STONE TYPICAL SECTION USE 4 ROWS OF 5-16" (H-20) ADS BIODIFUSER UNITS W/NO STONE AND EXTENED 0.7' W/ CONTOURED WEDGE BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.70 SF/LF OF UNIT) (BIODIFFUSERS) 20 UNITS x 6.25 LF x 4.70 SF/LF = 587.5 SF (CONTOURED WEDGE) 4 ROWS x 0.7' x 4.70 SF/LF = 13.2 SF TOTAL AREA = 600.7 SF DESIGN FLOW PROVIDED: 0.74(600.7 S.F.) = 444.5 G.P.D. w Engineering Works, Inc. Reserve Area Alternate 12 W. Crossfield Road 191 Percival Dr., APN 111 -061 Forestdale, MA 02644 HIGH CAPACITY BIODIFFUSER 508 477-5313 4 BEDROOM DESIGN CONFIGURATION FOR STONELESS SYSTEM Page 3 of 3 75" I 76" _ PROFILE 16" 11 34" �1 SECTION END CAP 16" HIGH CAPACITY (H-20) BIODIFFUSER UNIT MODEL 16" HICAP LENGTH 76" NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT EFFECTIVE LENGTH 75" TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE. SIDE WALL HEIGHT 11.2" OVERALL HEIGHT 16 - OVERALL WIDTH 34" 4640 TRUEMAN BLVD CAPACITY , 1 .6 Cr r HILLIARD, OHlO 43026 V �� .. I I (101.7 GAL) ADVANCED DRAINAGE SYSTEMS, INC. I � 1 TOWN OF BARNSTABLE LOCATION l 2 91 t 1,'Q v,4 L .D2 i dE v v - SEWAGE # VILLAGE Vj Z11 4 ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. L5Oyf r 1-9 ��'�T SEPTIC TANK CAPACITY 1s�» �rrc (Finn) LEACHING FACILITY: (type) 5rnAJx 31.7a Z' Z' (size) NO. OF BEDROOMS ` BUILDER OR OWNER c PERMIT DATE: Z — COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well arid Leaching Facility (If any wells exist on site or;within 200 feet of leaching facility) _ /S(;� Feet Edge of Wetland.and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by f,\ -54-� d ; I I� 7rri�i� t.. q- -� 'r,/irlc f,.F f1oii'r r i TOWN OF BARNSTABLE �� a LOCATION 29 i Pr V,Ac D2r1/ SEWAGE # 1.00 VILLAGE �4t' t`"�3 �t.r ASSESSOR'S MAP & LOT el-ls INSTALLER'S NAME&,,PHONE NO. t S OYr�'r')< Mir r i 'SEPTIC TANK CAPACITY 625- LEACHING FACILITY: (type) 5'rO T2 W2n I- P1Gf' -3 (size) 3- Zr NO. OF BEDROOMS__ / ' BUILDER OR OWNER �/� S�s � I,,G PERMIT DATE: COMPLIANCE DATE: —G y 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) JI-0 Feet Edge of Wetland.and LeachinFacility(If any wetlands exist within 300 f t'7of leaching,facility).. Feet Furnished by _. M Nil � I yi. T jerk 6- d�F ?• ,No. 6� T r Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZippYication for IDigpool *p5tem Con!truction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. IN ?WAVAL Q P. . Owner's Name Address and Tel.No. Assessor's Map/Parcel�,y�1`� a D^-' p•©• �j0 taerl (�'YI T �G M5_24 11 Installer's Name,Address,and Tel.No. % Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms_� Lot Size�sq. ft. Garbage Grinder(40) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow /!O gallons per day. Calculated daily flow 440 gallons. Plan Date # 4ml Number of sheets 'L- Revision Date O / 00 Title A+-4 S & Size of Septic Tank 15D0 Type of S.A.S. Description of Soil s ns r LObS Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been iss by this o Health. 'i> Signed Date J71 dl Application Approved by Date 2` n Application Disapproved for the following reasonr Permit No. Date Issued 0 f No y� Fee a V - THE COMMONWEALTH OF MASSACHUSETTS'. Entered in computer: Yes PU0,LIC+HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS application for Mioont *raem Con,5truction Vermtt Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System O Individual Components Location Address or Lot No. 2 rlq 1 A . F Na 'V Owner's me, ddress and Tel.No. kl ,_r F�a�l lsrx -�.. 6A co`�.ovi 11 Assessor's Map/Parcel P'O� QJ�X R orl MAe i k ;5 4N JUJl 5 �3 1 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. TO�A(TI COt jsmLuGTt.O� ��l�I M Y�T�(Z. L.6N �A k��5 , Ml�- �l-a3a g qk t 104, Sr��/ ►a 6��4c,64 M�- f Type of Building: Dwelling V No.of Bedrooms `7 Lot Size sq. ft. Garbage Grinder(�o Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow //O gallons per day. Calculated daily flow 4410 gallons. Plan Date R I Number of sheets 2- Revision Date /0/l I00 Title 1Tl✓ A+J'10 SF-PT1d, t Size of Septic Tank (500 Type of S.A.S. 'T4& t+ Description of Soil '56P- 7-KS r 1.6toS Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: ' {- The undersigned agrees to ensure the const ulction;and maintenance of the afore described on-site sewage disposal system in accordance with the.provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been is*b&o Heal h.� ,'f �. Signed e, , Date �7101 Application Approved by Date Z 0 Application Disapproved for the following reasons Permit No. 9/ Date Issued 2 �o THE COMMONWEALTH OF MASSACHUSETTS ///-0(D/ BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CE , that th On ite,/�e age Disposal System Constructed( Repaired( )Upgraded( ) Abandoned( )b 7�'X/e / at 7i 9/ (U-c ela Dr. N J6-" has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.TO(-0 1 dated 2 l w 0/ Installer Designer The issuance of this permits all o construed as a guarantee that the s ined. Date (� yst ill fuo . desig Inspector ——————————————————————————————————————— No. "° l— U ! / Fee /�— THE COMMONWEALTH OF MASSACHUSETTS O6 PUBLIC HEALTH DIVISION - BARNSTABLEi MASSACHUSETTS 1=i!5po!5a1 � $tem Con.5truction Vermit Permission is hereby granted/to Colt ct ,/�epair� Up d� )Abandon( ) System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction/must be completed within three years of the date of this permit. Date: ?/ /6 O Approved by r � R.I. Analytical Specialists in Environmental Services CERTIFICATE OF ANALYSIS Envirotech Laboratories, Inc. Date Received: 5/26/99 Mr. Ron Saari 449 Rte. 130 Date Reported: 6/03/99 449 Sandwich, MA 02563 P.O. #:Work Order #f: 9905-04715 DESCRIPTION: MAINE POST & BEAM (ONE DRINKING WATER SAMPLE) Subject sample(s) has/have been analyzed by our laboratory with the attached results. Reference: All parameters were analyzed by U.S. EPA approved methodologies. The specific methodologies are listed in the N methods column of the Certificate Of Analysis. If you hav a uestio s regarding this work, or if we may be of further assistance, please contact us. Appro ed y 1 / ' James Vice Pr id t ichael J. H i Quality Co rol Coordinator enc: Chan f Custody 41 Illinois Avenue, Warwick, RI 02888 950 Boylston Street, Unit 102, Newton Highlands, MA 02461 Tel: (401) 737-8500 fax: (401) 738-1970 Tel: (617) 965.5133 Fax: (617) 965-5624 Page 2 of 3 R.I. Analytical Laboratories, Inc. CERTIFICATE OF ANALYSIS Envirotech Laboratories, Inca Date Received: 5/26/99 Approved by: Wnrk OrrlPr 1f oon5-n.471 G Sample N: 001 SAMPLE DESCRIPTION: 995396 PERCIVAL RD 5/24/99 SAMPLE DET. ANALYZED PARAMETER RESULTS . LIMIT UNITS METHOD DATE/TI�LEE ANALYST Volatile Organic Compounds Bromodichloromethane <0.5 0.5 ug/l EPA 524.2 6/02/99 21:03 RAM Bromoform <0.5 0.5 ug/1 EPA 524.2 6/02/99 21:03 RAM Dibroinochloromethane <0;5 0.5 ug/1 EPA 524.2 6/02/99 21:03 RAM Chloroform 1.0 0.5 ug/I EPA 524.2 6/02/99 21:03 RAM 1,2-Dibromoethane(EDB) <0.5 0'.5 ug/I EPA 524.2 6/02/99 21:03 RAM Benzene <0.5 0.5 ug/I EPA 524.2 6/02/99 21:03, RAM Carbon Tetrachluride <0.5 0.5 ug/I EPA 524.2 6/02/99 21:03 RAM 1,2-Dichloroethane <0.5 0.5 ug/l EPA 524.2 6/02/99 21:03 RAM Trichloroethene <0.5 0.5 ug/l EPA 524.2 6/02/99 21:03 RAM 1,4-Dichlorobenzene <0.5 0.5 ug/I EPA 524.2 6/02/99 21:03 RAM I,I-Dichloroethane <0.5 0.5 ug/I EPA 524.2 6/02/99 21:03 RAM 1,1,1-Trichloroethane <0.5 0.5 ug/1 EPA 524.2 6/02/99 21:03 RAM Vinyl Chloride <0.5 0.5 ug/I EPA 524.2 6/02/99 21:03 RAM Bromobenzene <0.5 0.5 ug/I EPA 524.2 6/02/99 21:03 RAM Bromomethane <10 10 ug/l EPA 524.2 6/02/99 21:03 RAM Chlorobenzene <0.5 0.5 ug/l EPA 524.2 6/02/99 21:03 RAM Chloroethane <5 5 ug/I EPA 524.2 6/02/99 21:03 RAM Chloromethane <5 5 ug/1 EPA 524.2. 6/02/99 21:03 RAM. . 2-Chlorotoluene <0.5 0.5 ug/1 EPA 524.2 6/02/99 21:03 RAM 4-Chlorotoluene <0.5 0.5 ug/I EPA 524.2 6/02/99 21:03 RAM Dibromomethane <2 2 ug/I F.PA 524.2 6/02/99 21:03 RAM 1,3-Dichlorobenzene <0.5 0.5 ug/I EPA 524.2 6/02/99 21:03 RAM 1,2-Dichlorobenzene <0.5 0.5 ug/I EPA 524.2 6/02/99 21:03 RAM trans-1,2-Dichloroethene <0.5 0.5 ug/1 EPA 524.2 6/02/99 21:03 RAM cis-1,2-Dichloroe:hene <0.5 0.5 ug/l EPA 524.2 6/02/99 21:03 RA Methylene Chloride <0.5 0.5 ug/l EPA 524.2 6/02/99 21:03 RAM 1,1-Dichloroethene <0.5 0.5 ug/I EPA 524.2 6/02/99 21:03 RAM 1,1-Dichloropropene <0.5 0.5 ug/I EPA 524.2 6/02/99 21:03 RAM 1,2-Dichloropropane <0.5 0.5 ug/I EPA 524.2 6/02/99 21:03 RAM 1,3-Dichloropropane <0.5 0.5 ug/I EPA 524.2 6/02/99 21:03 RAM 1.3-Dichloropropene <0.5 0.5 ug/l EPA 524.2 6/02/99- 21:03 RAM 2;2-Dichloropropane <0.5 0.5 ug/I EPA 524.2 6/02/99 21:03 RAM Ethylbenzene <0.5 0.5 ug/1 EPA 524.2 6/02/99 21:03 RAM Styrene <0.5 0.5 ug/1 EPA 524.2 6/02/99 21:03 RAM 1,1,2-Trichloroethane <0.5 0.5 ug/l EPA 524.2 6/02/99 21:03 RAM 1,1,1,2-Tetrachloroethane <0.5 0.5 ug/1 EPA 524.2 6/02/99 21:03 RAM 1.1,2,2-Tetrachloroeihaile <0.5 0.5 ug/I EPA 524.2 6/02/99 21:03 RAM Tetrachloroethene <0.5 0.5 ug/I EPA 524.2 6/02/99 21:03 RAM . Page 3 of 3 R.I. Analytical Laboratories, Inc. CERTIFICATE OF ANALYSIS Envirotech Laboratories, Inc. Date Received: 5/26/99 Approved by: Work Order# 9905-047 1 5 R.1. Anal Sample#: 001 995396 PERCIVAL RD 5/24/99 SAMPLE DET. ANALYZED PARAMETER RESULTS LIMIT UNITS METHOD DATE/TIME ANALYST 1,2,3-T rich toropropane <0.5 0.5 ug/I EPA 524.2 6/02/99 21:03 RAM Toluene 0.6 0.5 ug/I EPA 524.2 6/02/99 21:03 RAM Xylenes <0.5 0.5 ug/I EPA 524.2 6/02/99 21:03 RAM 1,2-Dibromo-3-Chloropropane <10 t0 ug/I EPA 524.2 6/02/99 21:03 RAM Bromochloromethane <1 1 ug/I EPA 524.2 6/02/99 21:03 RAM n-Burylbenzene <0.5 0.5 ug/I EPA 524.2 6/02/99 21:03 RAM Dichlorodifluoromethane <0.5 0.5 ug/l EPA 524.2 6/02/99 21:03 RAM Trichlorofluoromethane <0.5 0.5 ug/I EPA 524.2 6/02/99 21:03 RAM Hexachlorobutadiene <0.5 0.5 ug/l EPA 524.2 6/02/99 21:03 RAM Isopropylbenzene <0.5 0.5 ug/l EPA 524.2 6/02/99 21:03 RAM p-Isopropyltoluene <0.5 0.5 ug/I EPA 524.2 6/02/99 21:03 RAM Naphthalene <0.5 0.5 ug/l EPA 524.2 6/02/99 21:03 RAM n-Propylbenzene <0.5 0.5 ug/I EPA 524.2 6/02/99 21:03 RAM sec-Butylbenzene <0.5 0.5 ug/l EPA 524.2 6/02/99 21:03 RAM ten-Burylbenzene <0.5 0.5 ug/I EPA 524.2 6/02/99 21:03 RAM 1,2,3-Trichlorobenzene <0.5 0.5 ug/I EPA 524.2 6/02/99 21:03 RAM 1,2,4-Trichlorobenzene <0.5 0.5 ug/I EPA 524.2 6/02/99 21:03 RAM 1,2,4-Trimethylbenzene <0.5 0.5 ug/I EPA 524.2 6/02/99 21:03 RAM 1,3,5-Trimethylbenzene <0.5 0.5 ug/l EPA 524.2 6/02199 21:03 RAM Methyl Tertiary Buthyl Ether <I I ug/I EPA 524.2 6/02/99 21:03 RAM n-Hexane <10 10 ug/l EPA 524.2 6/02/99 21:03 RAM SURROGATES RANGE EPA 524.2 6/02199 2.1:03 RAM 4-Bromofluorobenzene 113 80-120% EPA 524.2 6/02/99 21:03 RAM 1,2-Dichlorobenzene-d4 115 80-120% EPA 524.2 6/02/99 21:03 RAM • ENVIROTECHLABORATORIES,INC. MA CERT. NO.:M-MA 063 449 Rte. 130 Sandwich, MA 02563 508(888-6460) 1-800-339-6460 FAX(508)888-6446 CLIENT. Pilgrim Well & Pump LOCATION: 29 1'Percival Rd ADDRESS: Maine Post & Beam Barnstable MA Cn� � cnrr_n nv. o,. riigrim vveii t rump SAMPLE DATE. 5-24-9 WATER SAMPLE TYPE: New Well SAMPLE TIME: N/ADATE RECEIVED: 5-24-99 LAB I.D. #: 995396 WELL SPECS.: N/A RESULTS OFANALYSIS: Parameters Units Recommended Results Method Date Analyzed Limits Collform bacteria /100ml , 0 0 9222 B 5/24/99 PH pH units 6.5-8.5 6.26 4500 H+ 5/24/99 Conductance umhos/cm 500 89 120.1 5/24/99 Nitrate-N mg/L 10.0 0.90 300.0 5/24/99 Sodium mg/L 28.0 9.4 200.7 5/24/99 Iron mg/L 0.3 < 0.02 200.7 5/24/99 Manganese mg/L 0.05 < 0.002 200.7 5/24/99 Potassium mg/L 20.0 0.3 200.7 5/24/99 Calcium mg/L N/A 4.5 200.7 5/24/99 Magnesium mg/L N/A 2.0 200.7 5/24/99 Hardness(as CaCO3) mg/L 500 19.4 200.7 5/24/99 Alkalinity mg/L 200 14.2 2320 B 5/24/99 Sulfate mg/L 250 5.6 300.0 5/24/99 Chloride mg/L 250 13.3 300.0 5/24/99 Color APC units 15.0 < 5.0 2120 B 5/24/99 Turbidity NTU 5.0 0.72 21306 5/24/99 Volatile Organics Chloroform ug/L 100 1.0 EPA 524.2 6/2/99 Toluene ug/L 1,000 0.6 EPA 524.2 6/2/99 COMMENTS: pH is below recommended limit and may have corrosive characteristics. WATER MEETS.EPA STANDARDS AND IS SUITABLE FOR DRINKING PURPOSES FOR PARAMETERS TESTED. Date ( /O�C Ro aid J. Sa r Laboratory ctor <=less than >=greater than TNTC=too numerous to count E No.-- ------ Fee---.---- ----------- BOARD OF HEALTH TOWN OF BARNSTABLE Application-*rVell Conotructionpermit Application is hereby made for ap rmit to Construct ( ), Alter ( ), or Repair ( )an individual Well at: ` I v��� �PCi✓ce _dr <n�l�a��c ��'-1'0---�, .�-- �P�er C9(vf - -------------------------------- Location — Address r� Assess/ors Map and Parcel / M / QOwner Address Installer — Driller Address Type of Building Dwelling-------------------------------------------------------- Other - Type of Building------------------------------ No. of Persons--------------------------------_________ ai Type of Well - -------------------------- 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. Signed— date'_��� _ -------- - --- - Application Approved B date Application Disapproved for the following reasons: -------------------_______-________—__--____—_ ------------- — - --- --------------------------------------------------------- date Permit No. `-`-% -- Issued----- -- ---— --- date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( ) Installer . at 7.sd �"-- / — 4 -- ----- 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 NoAle A--- *Dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE---- - -- Inspector-----— -- ----- —------ 4 }•, ... ' 1, s"M No � f�. __ Fee--- - �--- BOARD OF HEALTH TOWN OF B'ARNSTABLE fication orVell Conwtrurt ion Permit C' (Application is hereby made for a p rmit to Construct ( ) Alter ( ), .or Repair ( )an individual Well at (t a9� �erctYci� -°�r I - Art./ Q(o(. Location—:Address„ t.'Assessors Map and:Parcel + w ,/,� - --- -- --Ik ---— ---- - - - - -- — l--- --------- Owner Address M ��(/Q fCG- t`u 1_�/j/t M t -- ------ — - ---- ------------------ -------- ------------ ------ - - Installer —`Driller Address' Type of Building Dwelling----------------------------------------- Other'-, Type-of Building• --- No. of;Persons---------------- ------------ - - Type of Well- Qcwcs��; vs -- _ - Capacity-------------------- Purpose of Well ------ - -s— -- ---. - 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.agre'es not to place the well in operation until a Certificate .of Compliance has been issued by the Board of Health: l Signed -------------- ----�-��-- f� date'. E Application Approved B date Application Disapproved for:the following.reasons:-------------- -=----------------- - ----- --=== date i yr• Permit No. . r+i = --- Issued-- ----- - r - -— ---— - date . . 1y�n?p!,y}.a4d�dtq¢dt3�o4aPel. Ala!!eYJnNb��wiNe!'owo{!'at?ailA± !4i1fi93±o.1o'@itC'eR�Y.c9y��GbA,RS�i.4mlbT2l6iiM8.0+liili'AcRiM6!•�eKI.STNVi$4�6�6LVii�:iiMh,[e"i0Y@Yi4,�h`d4E!Y8.B6®iORfi�ioil4'illepo?�!'iC4��i9: BOARD OF 'HEALTH TOWN OF BARNSTABLE Certifirate AN'f Complia> ce THIS IS TO CERTIFY, That the Individual Well Constructed.( ), 'Altered ( ), or Repaired (. ) �p /. Installer { p at 1C_// -i M Zf/�j' 4.' PvM (0 v?S"': t%Gibr��o --�I( --1-�j - ---= ---=--= lias been installed in accordance with the provisions of the Town of Barnstable Board of HealthPrivate Well Protection Regulation as described in the application for Well-Construction Permit NoA/e- �,0_SDated THE ISSUANCE OF THIS'CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL-FUNCTION SATISFACTORY. DATE_ =-;--- ----- =-, 'In'spector-- - --= -------------- r.•i-rc:!�Ys :x+,•itare:,�aesr�v �ap�s..tWfa�eax5�+��xtsray.ecec�ee.e�4a7i:aaea!erwYacea.HLi3sali!eiea+eer.e/:aiwa9eraare#miwxeds:!ei•!aaa/r.?vea.Heir.ese�eayir:aa�ss.��!�es�aeo:c+.v..-: BOARD OF HEALTH TOWN, OF BARNSTABLE Well, Congtruct ion Permit No. - Fee Permission is hereby granted d4r.k 66 blo ell:rM Gc%/..1_�✓ to Construct ( ),`Alter ( ), or Repair( . ) an Individual Well at-�--��s du y-�----- No ( 0�rri v� ( .. S - Street - - - — — --- . as show n on he'a li at' f r a Well.Constuction Permit No:- ej - - Dated- _—__ --- -- --- - - -- Board of.Health DATE z __ D CIO .. IrMIR= 03 iMC6 O 0 k1 Y: E O Ln Postage $ O Certified Fee Sid (LI stma p Return Receipt Fee r3 (Endorsement Required) jj I3 Restricted DeliveryFee !X(Endorsement Required) *—m gp Total Postage&Fees Sent To M neo - - orPOBoxNo. L q L.. �V/.�� 1 41��rl City,State,ZIP+4 ----------.--------- llwTav .. Certified Mail Provides: o A mailing receipt e A unique identifier for your mailpiece o A record of delivery kept by the Postal Service for two years Important Reminders: n Certified Mail may ONLY.be combined with First-Class Mail®or Priority Mail®. o Certified Mail is not available for any class of international mail. ■ NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. a For an additional fee,a Retum Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt;a USPS®postmark on your Certified Mail receipt is required. Vv r' r " ® For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted-Delivery. n If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office,for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT.Save this receipt and present it when making an inquiry. . PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 4.1 • _- ... ' • • GENERAL NOTES: AP 11`•PARCEL 061 - 1 ALL CONSTRUCTION SHALL CONFORM T TH - - _ _ ORM O E AREA: •36,539'-SF `L- ` - _ REQUIREMENTS OF THE MOST CURRENT MA DEP 10 MIN.CIEARMIC 1 - � _ ul�� ENVIRONMENTAL CODE TITLE V AND LOCAL BOARD OUTSIDE OVERDI,GI- f _ "` _ _ -�_ OF HEALTH REQUIREMENTS. 2. CONTRACTOR SHALL NOTIFY DIG-SAFE PRIOR TO CONSTRUCTION ,AND BE RESPONSIBLE FOR ALL W E _ UN TILITIES. PROPOSED ~ / \ !`� - - _ 3: EXISTING UTILITIES AS SHOWN ARE APPROXIMATE SANITARY SYSTEM _1 fi'-" :_.��- - �` �O� ` ' 1 � ONLY. ACTUAL LOCATIONS AND ELEVATIONS SHALL. SEE DETAILS SHEET 2 ' i� I �'�. �s - 1 ,`'�.�1 "�` _ BE DETERMINED IN THE FIELD BY THE CONTRACTOR AND/OR OWNERS REPRESENTATIVE PRIOR TO ANY �• � 'J��. CONSTRUCTION. 0. ti T1F1ED AT LEAST DESIGN ENGINEER SHALL BE NO 48 HOURS PRIOR TO REQUIRED INSPECTIONS. S 150.0'R :1 , - - T�. _ - FAILURE LIRE O DO MAY TIN V. L SO Y RESULT R -EXCAVATION E OF INSTALLED COMPONENTS FOR INSPECTION 150.0'R ` �� , ( = � �.� PURPOSES. •� FIELDSTONE RD ` 5. NO CHANGES IN THE FIELD WITHOUT PRIOR 3-1 MAX ~� NOTIFICATION OF THE DESIGN ENGINEER. COIL LIMITS OF P ! :y- 6. ALL TREES WITHIN 10' OF THE SAS SHALL BE 47.4"CLEARING ; REMOVED. ALL ROOTS WITHIN THE SAS SHALL BE REMOVED PRIOR TO INSTALLATION OF THE SYSTEM- . q 7. THE SYSTEM IS NOT DESIGNED TO ACCOMODATE ## GA RBAGE ARBAGE GRINDER. 1 O C 0►G BARE L CUS . WELL r 00 32 i Y zip PERCIVAL ST __' i ! 30,y. t/f� ?R pR � f �� ' 9 e�AOsf' s� 150.0'Rp js li -� - •.� / W IT, T - OAS ,�V/Ci''`L/i�OOM,• `S •� \• - r a ^ i' E o' �l N6` a LOCUS __ , d , E % ps.o r l ti NO SCALE vr 10.0 `�HIMNEY PROFESSIONAL 'tArr WMPa& -; 2' 0' LAND SURVEYOR PROFES =z ENGNE BENCHMARK - — ` �.% j TOP OF CONCRETE_BOU53 �' o �.� \� � Q 30.6'• ��H OF ,yq� ``':tHOFMAss'c�G PROPOSED S' a o \ o�y```4 ROBB 9�4, o�� DANIEL M. WELL Rang a • �e B. " SMIT o SYKES y 0. 36 UG ; No. Q 1001` UTS , 'tMST ` WELL s C R O �'po gfQ/S FTEaE� �E! !� l LEGEND: - ` /, UT SEPTIC SYSTEM DESIGN PROPERTY LINE - / l�� �� OD ► S MAP 111 PARCEL 061 PROPOSED CONTOURS 15 EXISTING CONTOURS ; / --' 291 PERCIVAL DRIVE — — — — — LIMITS OF OVERDIG i t BARNSTABLE, MA PROPOSED LEACHING TRENCH & D-BOX - RESERVE':! PROPOSED RESERVE AREA PERIMETER ®O PROPOSED SEPTIC TANK ZONING; RF { LAND SERVICES, INC. SETBACKS:- MINIMUMe Lane - . . - P.O.PBox 1188 - 41 Meetinghouse TP-1 TEST PIT, LOCATION & NUMBER FRONT . 30' 0 B g SIDES'. t5' '� '` Sagamore Beach, MA 02562 FF FIRST FLOOR REAR' 15'. PREPARED FOR: DANIEL TROUT LIMITS OF CLEARING ' DATE: APRIL 1999 SCALE: I" 30' t DWG NO.: 99055.DWG SHEET 1 OF 2 GENERAL NOTES: N MAP I11_­PARCEL 06-1 1. ALL CONSTRUCTION SHALL CONFORM TO THE --AREA-: _3f�5,39r�SF. REQUIREMENTS OF THE MOST CURRENT MA DEP ENVIRONMENTAL CODE TITLE V AND LOCAL BOARD 10' MIN.CLEAR4NG OF HEALTH RE QUIREMENTS- OUTSIDE-OVERRkG,­ 2. CONTRACTOR SHALL NOTIFY DIG-SAFE PRIOR TO CONSTRUCTION AND BE RESPONSIBLE FOR ALL UNDERGROUND UTILITIES. W E 3. EXISTING UTILITIES AS SHOWN ARE APPROXIMATE PROPOSED _Oc- ONLY. ACTUAL LOCATIONS AND ELEVATIONS SHALL SANITARY SYSTEM BE DETERMINED IN THE FIELD BY THE CONTRACTOR SEE DETAILS SHEET 2 -0. AND/OR OWNERS REPRESENTATIVE PRIOR TO ANY CONSTRUCTION. 4. DESIGN ENGINEER SHALL BE NOTIFIED AT LEAST 48 HOURS PRIOR TO REQUIRED INSPECTIONS. FAILURE TO DO SO MAY RESULT IN RE-EXCAVATION S 150.0'R OF INSTALLED COMPONENTS FOR INSPECTION PURPOSES. 150.0'R 5. NO CHANGES IN THE FIELD WITHOUT PRIOR FIELDSTONE RD- NOTIFICATION OF THE DESIGN ENGINEER. 3:1 MAX PtD C SIDESLOPE 6. ALL TREES WITHIN 10' OF THE SAS SHALL BE 0 LIMITS OF 7'y REMOVED. ALL ROOTS WITHIN THE SAS SHALL BE CLEARING .41 REMOVED PRIOR TO INSTALLATION OF THE SYSTEM. 7. THE SYSTEM IS NOT DESIGNED TO ACCOMODATE z A GARBAGE GRINDER. O%G 8!� EXIST. Locus WELL 4L, .z 10.0 log J-,Y(.),o PIX PERCIVAL ST ;I u i5,0.0'R Vou -IVC W -0600- LOCUS E -7-74- 'X 2 6 NO SCALE PLAMWT 4CHIMNEY PROFESSIONAL 10. LAND SURVEYOR PROF Ma&JNGINEER BENCHMARK 30. OF EL TOP OF CONCRETE B0 111.53 UND 808 ANIEL = !,.b r3. SMIM PROPOSED SYKES WELL 9 704 C-2 Nolats EXIST �0 r F Q o@a o �� WELL UG UT '-Y�OkAt /Yc/ UG SEPTIC SYSTEM DESIGN LEGEND: ­"Oc Ifealth Ditislon town PROPERTY LINE OOf Barnstable MAP 111, PARCEL 061 PROPOSED CONTOURS lr'rO BOX 534 291 PERCIVAL DRIVE EXISTING CONTOURS z Hyannis, Massachusetft BARNSTABLE, MA '601 LIMITS OF OVERDIG 0,4 PROPOSED LEACHING TRENCH & D-BOX : Fax(508)775-3344 Phone(508)790_6265 PERIMETER RESERVE PROPOSED RESERVE AREA ZONING: RF LAND SERVICES, INC_ PROPOSEDSEPTIC TANK P.O. Box 1188 41 Meetinghouse Lane-s SETBACKS: MINIMUM TEST PIT, LOCATION & NUMBER FRONT 30' I Sagamore Beach, MA 02562 SIDES 15' FF FIRST FLOOR REAR 15' /��� PREPARED FOR: DANIEL TROUT LIMITS OF CLEARING DATE: APRIL 1999 SCALE: 1" =30' DWG NO.: 99055-DWG SHEET 1 OF 2 " FIRST FLOOR I �£ EL=106.00 14" SCH 40 4' SCH 40 (� SOLID WALL PVC PERFORATED PVC BASE 10'10' MINIMUM SLAB � MAN HOLE RISERS AS REQUIRED (TYP) FINISH GRADE TO PROP: LINE 97.5 SEE PLAN FINISH GRADE - SEE PLAN 77 9 MIN =.�_.r. s� u n j w.�_�_ -( ) _ 12" MIN. 2" OF 1./8"-1/2" 36" MAX.:aS= 2.0 % 3 12" S=1.25% 1 D DOUBLE WASHED STONE -:, _:; 4" SCH 40 PERFORATE EL=95.00 - -- ,z -^�,. ;-,-- ---r PVC PIPE EL=93.36 :. .;..:fir i.":_-r 7.': .-.y';-. 'St^ r'-i '1'�.�-'�'S_"'.<'}^ ..`�3�i.." EL=94.43 EL= =,�, .vj� ";�. ;{, =.r,; .; ,., L14' 9 EL :uY 3/4"-1 1/2" DOUBLE WASHED cr Yv' xr CRUSHED STONE (TYP.) EL= "I12" 1K; n t=�� r x >�� r z EEL : .79 94.80 EL=91.36 1500 .GALLON _ 7 , PRECAST CONC. i o I. FIRST 2' TO BE 10, SEPTIC TANK WITH -45 REINFORCED CONC_ DISTRIBUTION INSTALLED LEVEL (10' MINIMUM) 2 - PVC SCH 40 v BOX W/6 OUTLETS TEES AND GAS BAFFLE W/6" COMPACTED GRAVEL \�EL3.62 BASE (NO STONE OVER 2") i 12" 51' 12.4' _.. 5' MIN. FOR PERC. RATE >2MPI -:..,..:. .::c::.'..-:-:;.:..:.:......:�•_:.::..,-..-.:-_.,.-...,...:_ .. - 2.5' - 31.75' 4' MIN. FOR PERC. RATE <2MP1 6" COMPACTED GRAVEL BASE (NO STONE OVER 2") GROUND WATER NONE TO EL 79.0 60' (20' MINIMUM) SOIL TEST LOG SOIL TEST LOG DESIGN SUMMARY: PROFILE TEST PIT NO. 2 TEST PIT NO.. 1 NO SCALE DEPTH(IN) TOP OF HOLE HORIZON TOP OF HOLE DEPTH(IN) TITLE V LONG TERM ACCEPTANCE RATE -ELR (EFFLUENT LOADING RATE). 0' EL=91.0 EL=95.5 0' LOAMY SAND LOAMY SAND PERCOLATION RATE: 3 MIN PER INCH 7.5YR5/3 O/A 7.5YR5/3 SOIL CLASSIFICATION: CLASS I NOTE: FINISH GRADE SHALL HAVE A' MINIMUM SLOPE OF MASSIVE/FRIABLE MASSIVE/FRIABLE 0.02 FT/FT ACROSS THE SOIL ABSORPTION SYSTEM FINISH GRADE 6' 6' DESIGN FLOW: SEE PLAN LOAMY SAND LOAMY SAND 7.5YR5/4 B 7.5YR5/4 N0. OF BEDROOMS:4 ._==� =? � i._is_ <i-'.. <. u ��,�_,,.._.. ..���=_ .f_`S_ ° •"�.t..Y�,,,,a_•';__;�'- MASSIVE/FRIABLE MASSIVE/FRIABLE DESIGN FLOW:, 4 BDRMS X 110 GPD/BDRM= 440GPD t8' 18' 36' MAX 2" OF 1/8--1/2" LOAMY SAND LOAMY SAND ,._REQUIRED EFFLUENT LOADING RATE: 12' MIN DOUBLE WASHED STONE 7.5YR5/3 7.5YR5/3 0.74 CPD PER SF OF LEACHING AREA 4" P.V.C. MASSIVE/FRIABLE MASSIVE/FRIABLE 66' 66' 440 GPD/ 0.74 GPD/SF= 595 SF LEACHING v:J "....... . .. MEDIUM SAND MEDIUM SAND AREA REQUIRED ram- 4r `` V; ""= 3/4"- 1 1/2" 7.5YR6/4 7.5YR6/4 _:?yf ;;� DOUBLE WASHED 1 - SINGLE GRAIN LOOSE SINGLE GRAIN LOOSE 162' r 1`-�" `��'�' STONE PROPOSED SOIL ABSORPTION SYSTEM(SAS) -t 2' `r :.K *NOTES: DATE OF TEST:4/1/99 'j FOR THE ACTIVE AREA: r� YJ 'r _ .K y SOIL EVALUATOR: DANIEL SMITH � �- 3 TRENCHES 31.75' LONG 1 WITNESS: EDWARD BARRY-BARNSTABLE BOARD OF HEALTH 6'---�- 2'---�- 6'---�-- 2'--�- 5' - NQ GROUNDWATER OBSERVED AREA PROVIDED: OVERDIG ACTIVE ACTIVE. ACTIVE OVERDIG TOP OF PERC AT 48" TEST PIT NO 2: PERC' RATE: 3 MPI BOTTOM: 3x(2'x31.75') = 190.5 SF PROFES iq A�- ENGINEER PERIMETER SIDEWALLS: 3x[2x(2'x31.75')+2(2'x2')] = 405.0 SF REMOVE ALL MATERIAL WITHIN OVERDIG LIMITS TO TOP OF < `` c;4^: n4"•,� LAND SERVICES, INC_ TOTAL AREA = 595.5 SF C1 SOIL LAYER(APPROX EL 89.5) OR AS OTHERWISE DIRECTED 1 ,;. . " BY THE BOARD OF HEALTH. REPLACE WITH CLEAN GRANULAR . =` �� . P.O. Box 1 188 - 41 Meetinghouse Lane EACH TRENCH FILL TO TOP OF TRENCH(EL 99.86) IN ACCORDANCE WITH Sagamore Beach, MA 02562 EFFECTIVE LENGTH = 31.75' LONG 310 CMR 15.25 � MIT . � EPARED FOR: DANIEL TROUT EFFECTIVE WIDTH = 2' EFFECTIVE DEPTH = 2' LEACHING TRENCH CROSS SECTION CIVIL NUMBER OF TRENCHES = 3 NO SCALE . + DATE: APRIL 1999 SCALE: 1" = 30' 4�,n, ���iSTE��•9 As ` _� DWG NO.: 99055.DWG SHEET 2 OF 2