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Home My WebLink About0050 PLUM STREET - Health 50 Plum Street t "Iw"'8arnhable !� tc; V.(A= 1951---025 v , i i i i ■ Complete items 1,2,and 3. A. Signature ■ Print your name and address on the reverse X Agent so that we can return the card to you. ❑Addressee a Attach this card to the back of the mailpiece, B. Received by(Printed Name) C. Date of Delivery or on the front if space permits. -iddress different from item 1? ❑Yes r delivery address below: ❑ No COHEN,THOMAS S & DOREEN E TRS 50 PLUM STREET WEST BARNSTABLE, MA 02668 S:`SerVTCte"lype ❑Priority Mail Express® II �III�I IDII ICI I III III III I I III I II II�IDII III ❑Adult Signature ❑Registered MailTM ❑ dult Signature Restricted Delivery ❑Registered Mail Restricted) ertified Mail® :livery 9590 9402 5849 0038 3916 93 Certified Mail Restricted Delivery :turn Receipt for ❑Collect on Delivery Merchandise I 2 n.��m_ru ,hor,iTrarLsfer_from_service IabeU ❑Collect on Delivery Restricted Delivery Signature Confirmation rM + ❑Signature Confirmation 7 015 17 3 0 0001 4987 7985— -Restricted Delivery Restricted Delivery PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt , USPS TRACKING# First-Class Mail Postage&Fees Paid USPS Permit No.G-10 9590 9402 5849 0038 3916 93 United States •Sender:Please print your name,address,and ZIP+4®in this box" Postal Service OsTown of Barnstable Health Division ` 200 Main Street I Hyannis,MA 02601 ! I I I I .I i F iHe r owti Town o le o f Barnstable P p Public Health Division U.S.P OS BARNSTARLE. IAGE PITNEY�� BO 9 MASS, g 200 Main Street � WES 6y9. 0 4i"rFD MP+' Hyannis,MA 02601 .`ram ,�- ZIP 02601 7015 1730 0001 4987 7985 � '}i 02 41w $ 006.900 - - - - t 00003.73143 SEP. 1.7. 2020. 1 st Notice y ^x 2nd Notice �- Retumed ,-__-- ---, t' COHEN, THOMAS S & DOREEN E TRS i RETURN TO SENDER NnT t)F1 TVPR Ant F Ag:; ADDRESSED 9 <F g;; '93 33 5 1`0'7 0 tl 3 r 3 C. 02 '0' Fr i"3'Z'Z-10 5 Z 9-1'7 -4 ' �� .•�� a i� R e1 3t��1 0�, I �� 1q 1 I I I I,I �:�,3 I, 61 je1+1� � I . . . . . . . . ... . . . . . . . . .. . .. . . . . . P r �WHE Town of Barnstable Inspectional Services sa MSTABt.E. 9� 6 9 10� Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Thomas A.McKean,CHO FAX: 508-790-6304 CERTIFIED MAIL#7015 1730 0001 4987 7985 September 17, 2020 - - — COHEN, THOMAS S &DOREEN-E TRS - - 50 PLUM STREET WEST BARNSTABLE, MA 02668 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 160 Highland Avenue, Cotuit,MA was inspected on 08/19/2020 by Michael T Bisienere, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Conditionally Passes" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • The distribution box is rotted and needs to be replaced. You are ordered to replace the septic system within one (1)year from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH Thomas McKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Conditionally Passes Letters\160 Highland Ave Cotuit.doc TOWN OF BARNSTABLE LOCATIONS P,� (//�/l S�t' ;Cr�T SEWAGE# VILLAGE ASSESSOR'S MAP&PARCEL JCS=O Xa�� INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 00 759hjr LEACHING FACILITY: (type) (size) NO. OF BEDROOMS 5" OWNER ` 'h&MA 5 e o la e Al PERMIT DATE: COMPLIANCE DATE: ! Separation Distance Between the: Maximum Adjusted Groundwater,Table to the Bottom of Leaching Facility `, Feet Private Water Supply Welland 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/S, `oo 3�� 133 No. v Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pplitation for Die-posal 6pstem ConstrULtiun Permit Application for a Permit to Construct( ) Repair(4Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 3i / ,`/0fjy�i� 5 Owner's Name,Address,and Tel.No. Assessor's Map/Parcel Z— -P/jjIS 'V V Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. #56f, Type of Bu ding: 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) S�O gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank 6 f % G Type of S.A.S. !Y Description of Soil Nature of Repairs or Alterations(Answer when applicable) M S7e4-/l 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 no place the system in operation until a Certificate of Compliance has been issued by this Board of Health. ned Date Application Approved by Date �l / fir Application Disapproved by"' Date for the following reasons Permit No. 2DI 5-, Date Issued �T X YX Idly No. L�" �^ 4 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 4plitatlon for Disposal *pstrm Construction permit Application for a Permit to Construct( ) Repair(/Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components F ation Address or Lot No. � ) /v*15� Owner's Name,Address,and Tel.No. essor's Map/Parcel 1151 Z S -01lje Jfl!pAe� 53) v Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Type of B ding:'.. Dwelling No.of Bedrooms 57 Lot Size sq.ft. Garbage,Grinder( ) Other Type of Building � g�/,o �� No.of Persons Showers( ) Cafeteria( ) Other Fixtures "� Design Flow(min.required) �C/ gpd P "si flow rovided gpd t Plan Date Number of sheet �� Revision Date Title , Size of Septic Tank / 9e) /jwy Type of S-.A.:S. t5 Description of Soil Nature of Repairs or Alterations(Answer /w�hery�apcable Date last inspected: e�l Agreement: - t.U " The undersigned agrees to ensure t9e construc;t}glraAd a14Aiice of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the ELro t 1te t I f de and not place the system in operation until a Certificate of Compliance has been issued by this Board of Hea h. ' i �� S' ed _ Date Application Approved by Date Application Disapproved byool000r Date for the following reasons Permit No. 2C I h 1 �� ,,,Date Issued 41a /-V I! --------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compiia�ie THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( Upgraded( ) Abandoned( )by aehxv at di- has been constructed in accordance with the prov's'OA5 off/Title 5 and the for Disposal System Construction Permit No. /5— 19 2 dated 1(Q1 fi01 q- Installer Designer 4!�tas ,,c��,r,�7`ley #bedrooms Approved desiN\nctias gpd The issuance of t is pe t shall not be construed as a guarantee that the system willesign Date r Inspector / ----------- ---------------------------------------------------- ------------------- No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS Disposal 6pstem Construction 3pPrmlt Permission is hereby granted to Construct( ) Repair( � Upgrade( ) Abandon( ) System located at :F D K2` r-7 S-7- _ (� ��y ,�s-f yq�t 1' 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 must be completed within three years of the date of this permi. Date�'°j /S Approved by Town of Barnstable pP1HE 1pk, Regulatory Services ti Richard V. Scali,Director * MANSTABLE,ASS.MASS' ' Public Health Division 9 M �' Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date: Sewage Permit# Assessor's Map/Parcel ° - ZS, Installer& Designer Certification Form Designer: C—�S s�ae�/F�°t� Installer: 0 4E Address: L e:,�C k 117t7 Address: 44 U R,,dO S LOLccA, MA OZ5�6,3 �I�tcur, 1��, oz:G4!,' On -gyp�E`f �i st-t�2 was issued a permit to install a (date) (installer) septic system at y M ST (,J; based on a design drawn by (address) _T:3sJ Lo T' �¢cV -x-v_ dated - L Co—ZO 15- (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. I certi that the stem referenced above was constructed i liance with the terms of t I/A r v letters (if applicable). �14OF DAVID D. X tl(Instal , isSignature) FLAHERTY,JR. y No. 1211 �sQ/STER21-16./Ill EO ` 7ARlR x (Designer's Signatu (Affix De_s_? s,Stafnp ere) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. gAoffice formsWesignercertification form.doc COMPLETE • 7D. rs'delivery • •■ Complete items 1,2,and 3.Also complete ture item 4 if Restricted Delivery is desired. 0 Agent........ ■ Print your name and address on the reverse Addressee so that we can return the card to you. ived by(Printe am f C. Date of Deh✓ery ■ Attach this card to the back of the mailpiece, or on the front if space permits. address di Brent from item 17 El Yes 1. Article Addressed to: If YES,enter delivery address below: 0 No Doreeia Cohen 50 Plum Street West Barnstable MA 02668 3. Service Type � O Certified Mail° 0 Priority Mail Express- 0 Registered O Return Receipt for Merchandise 0 Insured Mail 0 Collect on Delivery I 4. Restricted Delivery?(Extra Fee) 0 Yes 2. Article Number (Transfer from service label) 7014 i ,120O'i0001+ 0358 3346 Of'j PS Form 3811,July 2013 Domestic Return Receipt I UNITED STATES POSTAL SERVICE Mau. • Sender: Please print your name, address, and ZIP4—Kihis boxe Town ofBarnstable Public Health Division 200 Main Street 'Hyannis, MA 02601 W m to m0r-I Postage $ , Certified Fee w^� 0 �- � Postmark Retum Receipt Fee )I —' M (Endorsement Required) p �� ' Wi�e Restricted Delivery Fee O (Endorsement Required) M Total Postage&Fees U Spy I o Doreen Cohen 50 Plum Street West Barnstable, MA 02668 Certified Mail Provides: a� n A mailing receipt n A unique identifier for your mailpiece o A record of delivery kept by the Postal Service for two years Important Reminders: o Certified Mail may ONLY be combined with First-Class Mail®or Priority Mai6 o Certified Mail is not available for any class of international mail. n NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. a For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. o For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". o 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. - 1 IMPORTANT:Save this receipt and present it when making an mqufry._7 PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 1�4 i `" ' � VEIrd Town of Barnstable Barnstable .� Regulatory Services Department AtftaicaC'j BARNSfABIE, 9� "�: ,0� Public Health Division m '°ran AA0�A 200 Main Street, Hyannis MA 02601- 2007 Office: 508 862 4644 Richard V.Scali Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7014 1200 0001 0358 3346 May 14 2015 Doreen Cohen 50 Plum Street West Barnstable;MA 02668 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 • The septic system located at 50 Plum Street, West Barnstable,MA was last inspected on 4/27/2015,by James D. Sears, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Failed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Leaching pit or.cesspool with high liquid level,<12"below pit (per Town Code 360-9.1) You are ordered to repair or replace the septic system within two (2) years from the date you receive this notification. 4 Failure to repair/replace the septic system within the deadline period will result in future enforcement action. ORDER OF THE BOARD OF HEALTH o>asMc&ean, R.S., CHO Agent of the Board of Health QASEPTIC\Letters Septic Inspection Failures or Future Ev1\.50 Plum St W.Bam May 2015.doc ��rgyti Town of Barnstable : BARNM � 059. ,�� Regulatory Services Department �fD MA'S # I Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-8624644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 4/28/15 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An"x"marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE (1) YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑ Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2) YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any "conditionally passed systems" (broken cover, relocation of a pipe, relocation of a driveway due to H-10 components, etc) Leaching pit or cesspool with high liquid level, <12"below pit (per Town Code §360-9.1) OTHER Repair deadline: Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc kpr 28 15 09:53p p"1 SIP I9s�� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r 50 Plum Street PropeRy Address Doreen Cohen ; Owner Owner's Neme — information is required for every West Barnstable MA 02668 4-27-15 page. Cltyfrown 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. Importarfilling outA. General Information filling out forms � \,�gtuuflupq�r on the computer, �� OFuse fy �i,�� key to ohe tab ve your 1 Inspector: �� s9ey cursor-do not James D.Sears JAMES use the return Name of Inspector =c�: key. � Cl)�*: : CapewideEnterprises,LLC_ ��.o �o•:"� ,ay Company Name 153 Commercial Street Company Address Mashpee MA 02649 City/Town State Zip Code 508-477-8877 S1623 Telephone Number License Number B. Certification 1 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 C6AR 15,000).The system: ❑ Passes Q Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority 4-28-15 nspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. ***`This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. 15ins•3113 Title 5 Official Inspection Form:Suburfaoe Sewage Disposal System-page 1 of 17 Apr 28 15 09:53p p.2 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 50 Plum Street Property Address Doreen Cohen Owner Owner's Name information is required for every West Barnstable MA 02668 4-27-15 page. Cilyfrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E I always complete all of Section D A) System Passes: ❑ 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: System Failed. The system is a 1500 Gal.Tank D. Box and two pits B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired.The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined"(Y, N, ND)for the following statements. If'not determined,"please explain. The septic tank is metal and over 20 years old"or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. "A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): 15ins 3113 TWe 5 Official Inspection Farm:Subsurface Seweoe Disposal System-Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 50 Plum Street Property Address Doreen Cohen Owner Owners Name information is West Barnstable required for every MA 02668 4-27-15 page. Cltylrown 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(cant.): ❑ 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): i i 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•3113 title 5 Offfdal Inspection Form:Subsurface Sewage Disposal system•Page 3 of 17 I apt 28 15 09:55p p.1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 50 Plum Street Property Address Doreen Cohen Owner Owner's Name information is required forevery West Barnstable MA 02668 4-27-15 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: *"This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coJiform 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 ammoM is less than 6"below invert or available volume is less than'/day flow 15ins•3113 Mlle 5 Official Inspection Form:subsurface Sewage Disposal system•Page 4 of 17 Apr 28 15 09:56p p.2 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 50 Plum Street Property Address Doreen Cohen Owner information is Owner's Name required for every West Bamstable MA 02668 page. Cityrrown 4- State Zip Code Datee of 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 fleet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes'or'no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes°to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15,304. The system owner should contact the appropriate regional office of the Department. t5ins-3/13 Title 5 Baal Inspection Form:Subsurrace Sewage Disposal Systom-Page 5 of 17 Apr 28.15 09:56p p.3 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments y 50 Plum Street Property Address Doreen Cohen Owner Owner's Nerve information is required for every West Barnstable MA 02668 4-27-15 page. C1tyfrown 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 NIA) ® ❑ 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): Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 550 15ins•M 3 Idle 5 Oft---1 Inspection Form Subsurface Sewage OiSpo581$ystem•Page 6 of 17 Apr 28 15 09:56p p.4 Commonwealth of Massachusetts _ . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 50 Plum Street Property Address Doreen Cohen Owner Owners Name information is required for every West Bamstable MA 02668 4-27-15 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: The system is a 1500 Gal Tank D Box and two pits.. Number of current residents: 4 Does residence have a garbage grinder? ❑ Yes 0 No Is laundry on a separate sewage system? (Include laundry system inspection El Yes No information in this report.) Laundry system inspected? ❑ Yes 0 No Seasonaluse? ❑ Yes CK No Water meter readings, if available last 2 ears usage Well Water 9 ( Y 9 (gPd))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Present Date Commerciallindustrial Flow Conditions: Type of Establishment Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/personstsq.ft.,etc.): Grease trap present? ❑ Yes Q No Industrial waste holding tank present? ❑ Yes ❑ No i Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available. l5ins-3113 Idle 5 Orriclal Inspection Farts:StAsurtace Sewage Dispcsa;System-Page 7 or 17 Apr 28 15 09:57p p,5 Commonwealth of Massachusetts �a Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments yc 50 Plum Street Property Address Doreen Cohen Owner Owners Name information is required for every West Barnstable MA 02668 4-27-15 page. cityJrown State Zip Code bate of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: 2011 Was system pumped as part of the inspection? ❑ Yes 9 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): t5tns•3113 Tdo 5 Official hspecion Form:Sttsurfam Sewage Disposal System-Page B of 17 Apr 28 15 09:57p p.6 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4 50 Plum Street Property Address Doreen Cohen Owner Owner's game information is required for every West Barnstable MA 02668 4-27-15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 1995 Permit#95- 1513. Were sewage odors detected when arriving at the site? ❑ Yes ® No 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.): Pipeing is 4" PVC SCH 40. Septic Tank(locate on site plan): Depth below grade: 3' feet Material of construction: ®concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 Gal. Precast H-10 i Sludge depth: 21, Sins-3113 Tifle 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Apr 28 15 09:57p p.7 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 50 Plum Street Property Address Doreen Cohen Owner Owners Name informaban is required for every Wyes Barnstable MA 02668 4-27-15 rrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cunt.) Distance from top of sludge to bottom of outlet fee or baffle 28" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 12" Distance from bottom of scum to bottom of outlet tee or baffle 17" How were dimensions determined? Asbuilt- Plan-Tape _ Sludge Judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to ouffet invert, evidence of leakage, etc.): Tank at working level. Tank-inlet and outlet cover's at 3' below grade wlcenter cover at grade_ Inlet tee, outlet baffle_ No sign of leakage. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑metal ❑fiberglass ❑ polyethylene El 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: Dale 6ins.3113 Twe 5 ORcial impedion Form:Subsurface sewage Disposo System-Page to of 17 Apr 28,15 09:58p p•8 � Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 50 Plum Street Property Address Doreen Cohen Owner Owner's Name information is required for every West Barnstable MA 02668 4-27-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene y ❑other(explain): Dimensions: Capacity: gallons Design Clow: 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 15ins•3113 Title 5 Otlicial Inspection Form Subs rface Sewage Disposal Systom•Page 11 of 17 Apr 28 15 09:58p p.g Commonwealth of Massachusetts AM Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 50 Plum Street Property Address Doreen Cohen Owner Owner's Name information is required for every West Barnstable MA 02668 4-27-15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) Distribution Box (if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 1 1/2 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.): over. D Box is 16"x16"-4' below grade w/two line's out. Level in box in to fine's w/some solid carry 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: 15ins•3r13 Title 5 Official Impaction form:Subsurface Sewage Disposal System-Page 12of 17 Apr 2.8 15 09:58p p.10 Commonwealth of Massachusetts UTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 50 Plum Street Property Address Doreen Cohen Owner Owner's Name information is required for every west Barnstable MA 02668 4-27-15 page. CNyfrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 2 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovativelalternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching is two 1000 Gal. Precast Pits. Pits are 8'below grade, piped into risor. Pit#3 cover at 28", pit#4 cover at 41". Both pit's are full up into risors. Need to replace leaching 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 15ins-3113 Title 5 Official Inspection Form;Subsurface Sewage Disposal System•Page 13 of 17 Apr 28 15 09:59p p.11 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 50 Plum Street Property Address Doreen Cohen Owner Owners Name information is required for every West Barnstable NIA 0266B 4-27-15 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 iApr28 15 09:59p p.12 Commonwealth of Massachusetts P -�. Title 5 Official Inspection Form f Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 50 Plum Street Property Address Doreen Cohen Owner Owner's Name information is required for every West Barnstable MA 02668 4-27-15 page_ CityfTown State Zip Code Date of Inspection D. System Information (cost.) 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 f ` 5V4 A GARC r, C r e-3 = 13,2'-3 � c � 3 Mine-3l13 Tifte 5 Oftidae Inspection Form:Subsurface sewage Disposal System•Page 15 of 17 Apr 28 15 09:59p p.13 Commonwealth of Massachusetts IN Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 50 Plum Street Property Address Doreen Cohen Owner Owner's Name information is West Barnstable required for every a MA 02668 4-27-15 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 t high ground water. 15' 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: 1-5-93 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: T.H.on Design Plan 1-5-93 No G.W. at 15'. Before filing this Inspection Report,please see Report Completeness Checklist on next page, ISins-3113 Tab 5 Dlriclal Inspection Forth:SLbsurlece Sewage 171sposal system•Page 16 or 17 Apr 28 1510:00p p.14 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 50 Plum Street Property Address Doreen Cohen Owner Owner's Name information is required for every West Barnstable MA 02668 4-27-15 page. Cityfrown 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 t t5ins•3/13 Tille 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 TROY WILLIAMS P - �S &A SEPTIC INSPECTIONS t_ i�2so (. Certified by MA Department of Environmental Protection (508) 585-1500 19 Hummel Drive South Dennis, MA 02660 COMMONWEALTH OF MASSACNUSE'1"I'S EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL. PROTEurION 'ITTLE 5 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A 4� CERTIFICATION Proper() Address: 50 Plum Street West Barnstable, MA O O%iner's Name: Stephen Roland Owner's Address: 50 Plum Street West Barnstable, MA O Date of Inspection: June 1,2006 O I Name of Inspector: Troy M. Williams Company Name: Troy Williams Septic Inspections Mailing Address: 19 Hummel Drive South Dennis,MA 02660 Telephone Number: (508)385-1300 CERTIFICATION STATEMENT r -- 1 certify that I have personally inspected the sewage disposal system at this address and that the infor6pation reported f ': below is true, accurate and complete as of the time of the inspection. The inspection was performed based on m:'y ' training and experience in the proper function and maintenance of on site sewage disposal systems. 1 m a DF pr i approN cd system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The systcm� r7 Passes Conditionall\- Passes Needs Further Evaluation by the Local Approving Authurn) Fails Inspector's Signature: A,,:4��j Date: 6 /1 /06 The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of I lealth or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Notes and Comments Although system meets the minimum requirements set forth by the Massachusetts Department of Environmental Protection,certification is not to be construed as a guarantee of future working condition of system,piping or components. This inspection represents the conditions of the system on the Date of Inspection noted above. •'•"This report only describes conditions at the time of inspection and under the conditions of use at that time. phis inspection does not address how the system will perform in the future under the saute or different conditions of use. Title 5 Inspection Form 6/15/2000 paee I of II Page 2 ol, I l OFFICIAL INSPECTION DORM - NOT POP 'VOLUNTARY ASSI?SSMLNTS SUIZSlJ1iliACli SI WA(yIi� DISPOSAL SYSTEM INSPECTION VORM I'AIi`I' A CERTIFICATION (conlinucd) 50 Plum Street Properly Address: W. Barnstable,,MA Stephen Roland Owner: June 1,2006 Dale of Lnspectiou: 11Ispcctiou Summary; Check A,11,C,I) or C! ALWAYS couplelc all of Seclion 1) A. Syslciu Passes: 1 have not lililnd ally information which indicates that itny of the failure critciia described in 310 CMR 15.303 of in 3 it)CMR 15.304 exist. Ally failure criteria not evaluated are indicated below. Coululculs: li. Sysleu►Condtlionally Passes: — - One of more system components as described in life "C'ouditional Pass"sec(ion it d to be replaced or repaired.The syslclrl, uporl Completion of (lne replacement of repair, as approved by lh oard offealth, will pass. i Answer yes, no of not (jelefuliocd(Y,N,Nl)) in the lilt(he lollowiug still llcnls. if"not timciauned"please explain. septic tank is metal and over 20 years old,, or the septic la (whether fnelal or not) is structurally unsound,exhibits substantial iolilualion of exlillration of lank faili is innniuent. System will pass inspection if the existing lank is ieplaccd with a coolplyi.ng septic lank as approv by the lloafd tit'Ifealth. *A metal septic lank will pass inspection if it is stiuclufally s lid, no( leaking and if a Ceililicale of Coulphince indicating that the lank is less than 20 years old is availabl ND explain: Observalion of sewage backup of brca- lit nr high slalic water level iu the distribution box due to broken or obstructed pipe(s)or due to a brokcu, settler lr uneven distribution box. Sys(eln will pass inspection if(with approval of Board of N lealth): _-- 1' :eu pipe(s)are replaced _ obstruction is removed distribution box is leveled of replaced ND explain: `rile system i uired puruping more than 4 limes it year due to broken or obstructed pipe(s).The system will Pass inspection if ifh approval of the Board of,Ifealth): brokcu pipe(s)are replaced obstiu:�tion is removed ND explain: 2 I Page 3 of 011TICIAL INSPECTION 1'011M - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE Sl?WACE DISPOSAI, SYSTEM INSPECTION 1i`012N1 PA RT A CA1.112'IFICA`I'ION (continued) Properly Address: 50 Plum Street W.Barnstable,MA Owner: Stephen Roland Dale of Inspeclioll: June I,2006 C. Further Lvaltuk iou is Itctluired by fllc lioarcl of Ileallh: _ Coodilioos exist which iquire fuilher evalualinn by the Board of Health ill order to delernline if the system is failing to protect public health,Safety of the coviiannlent. 1. Sysleul will ps►ss unless 110al(I of Ilcallb delerilliues lIl accordance Willi 310 CMI2 15.303(1 b) Ihal the System is uol l"unclioning ilk nllllu►tr which will prolecl public health,safely and the en rouule at Cesspool of privy is within 50 lect of a stlilace wales _ Cesspool or privy is within 50 feel of a boide ing vegetated wetland or a salt rni 1 2. Sysleiu will fail unless the lloau,d of!leallh(and I'ublic Water pplicr,if any) delel•nliues that flit system is funclioniub ilk a Illallller Thal lu'oltcfs like public hcallh 'afety and euvironll►cpl, _ IAhe System has a septic lank and soil absorption sysl 1(SAS) and the SAS is within 100 feel of a surface water supply or Iiibulary to a surface walci still y. The system has a septic lank and SAS and I SAS is within a "Lone I of a public water supply. The Sysleiu has it septic lank aril SAS nd the SAS is wilhiu 50 IeCI of a private wafer supply well The system has a septic lank all SAS and the SAS is less Than 100 legit bill 50 feet of more horn a private wales supply well**. MCI cl used to determine clislance **'phis syslcm passes if Ih- ell water analysis,peilornled at a DLP ceilified laboratory, for colifor►n bacleiia anti volatile of— lic conleoullds indicates (flat file well Is lice Il'0111 pollnllon fioul that facility and tilC pl'CSCIICe Ol'alllll Ilia nilrogenand niliate pilrogen is equal to or less than 5 ppm,provided that no other lailure criteria ar riggeied. A copy of the analysis must be attached In this forum. 3. Other. 3 Page 4 of I I OFFICIAL INSPECTION IeORM — NOT VOR V01 UNTARY ASSESSMENTS SUBSUIiVACI SEWAGE DISPOSAI. SYSTEeM INSPECTION FORM I,A JOI A C AIT11i'iCATION (continued) 50 Plum Street Properly Address: W. Barnstable,MA Stephen Roland Owner: June 1,2006 Dale of Inspection: 1). Sysleu► Failure Criteria applicable to all systeu►s: You most indicate"yes"or"no" to each of [lie following for 'lII InSptCIIOnS: Yes No ✓ Backup of sewage into facility or system coruponelll dot to ovtlluadtd or clogged SAS or cesspool J Discharge or podding of effluent to Ibe surface of the ground or surface wafers clue to an overloaded or clogged SAS or cesspool ______ ✓ Slalic liquid level in the distribulion box above outlet invert due to an overloaded or clogged SAS or cesspool ___ ✓ liquid depth ill cesspool is less than 6"below Invert or available volume is less than '/.day flow __. Rtquilcd pumping Inure than 11 limes in the last year NOT due to clogged or obstructed pipc(s). Nunkbcr of limes pumped --. ____ ✓ Any portion of the SAS, cesspool or privy is below lligh ground water elevilUon. Any portion o f cesspool or privy is within 100 feel of a surface water supply or tributary Ill a surface water supply. Any portioo of a cesspool or privy is will till a `Lone I of a public well. Any portion of a cesspool ar privy is within 50 Icel of a private water supply well. Any porlion of it cesspool or privy is less Than 100 li:el bill greater than 50 feet from a private water supply well with uo acceptable water quality analysis. [This systeuk passes if like well water analysis, performed at a 010, certified laboralpry, li►r californ►bacltrii► and volalilt organic con►pouu(Is indicates thal like well is fi-te frolu pglluliofl fropk 111a1 facility and file presence of am'l►orkia nitrogen and nitrate wilrogen is equal (o or less than 5 ppn►,provided that Ila alller failure Criteria are triggered. A copy of lilt analysis nwksl be allached to this f,nrw►.l _W- _(Yes/No)'l'he systew► fails. I have delernkined lhal one or more of the above failure criteria exist as described ill 310 ClAli 15.303, theretore the syslern fails.1,11e system owner should contact the Board of f lealth to docrmiwe what will be necessary ill correct the failure. 1:. J'arge Syslenks: '1'0 be considef•ell a large syslen► the systew► iwusl serve a facility with a esigw flow of 10,060 gild to 15,000 gild. You must indicate either"yes"or"uo"to each of the Billowing: (The following criteria apply to large sysleu►s in addifion to lilt cril is above) Yes no the system is within'100 Iett of a suilace drluktk Willer supply the system is within 200 feel of a l6bulary a surface drinking water supply lilt system is located in a nitrogen se 'live area(Inlerin►Wellhead Proleclion Area— IWPA)or a mapped Lone 11 of a public water supply l If you have answered"yes"to any(lilt loll in Section 1= the sysler)is considered it significant thrcal, or answered "yes" in Section l)above the large • stem has failed.Tile ownef.of operator of any large system considered a sibnU►carkt threat un(ler Stcfinn r r faile4 un(le4 Secliyq t)shall upgrade llle system in accordance Willi 310 CMR 15.304.The systtn)owner sill .d contact like apprgerwe fegigtial office of the nepaitmenl. Page 5 of I 01147(_'IAL. INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURF ACE SI WAGNE DISiI"OSAL SYS'1'1?IYI 1NSI'L C'I'ION I�O12M Y'ART It cr�x?cic�.rs,�. Properly Address: 50 Plum Street W. Barnstable, MA ()W11e1 Stephen Roland Dale of Inspection; June 1,2006 Check- if the fikllowiug have been done. You rrnisl indicate"yes"or"no"as to each of the following: Yes No _ Pumping iulornialiou was provided by the owner,occupant, or Board 01,1 feallh _-- -✓ Were any of the system canipoucrits put gierl Out in the pievious two weeks '? _ Ilas the syslcuk received normal flows in the previous two wcck peiioil ? Have large volunkes of wulci bcco ioiroduced to the sysleok receolly or as pall of lhis inspection'? , / ._ Wcre as built plaits Lit'the sysicnk obtained and examined'?(II'lhcy were not available note as.N/A) _ Was the lacilily or dwelling inspeeleil fur signs of sewage back up'? -_-- Was the site inspected lilt signs of break nut'? Weie all sysicuk components, excluding the SAS, located on silt '? _ Weie like septic lank manholes uncovered, opened, and the inteiior of the lank inspected for like condition of the baftics of lees, material of construction, dimensions, depth of liquid,depth of sludge and depth of scum'? ✓ _ Was the facility owocr(and occupants ifdidticot itokrk owner)provided Willi inlurrnalion on the proptr maintenance of subsurface sewage disposal syslems ? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no "I" _ Existing tiifoiniation. Foi example, it plan al the Board of Ileallh- Ueleiminetj in the field(it'any of'tile failure criteria related to Part C is at issue approximation of distance is unacceptable) (310 CMR 15.302(3)(1))l 5 Page 6 of I I 0I1i'ICIAL INSI'l?CI'ION VORM — NO'1' FOR VOLUNTARY ASSI?SSMr+MFS SUBSUIWACC SI 'WAC Ii: DISPOSAL SYSTEM INSPECTION F6RM I'A WV C SYSTEM INFORMATION Properly Address; 50 Plum Street W. Barnstable,MA Owt►e►; Stephen Roland Dale of luspeclio►►; June 1,2006 VVOW CONI)ITIONS HESIDEATIAL Nunlbcr of bcdrooms(design): S_ Number of bedrooms(acitial): DESIGN Ilow based on 316 CMR 15.203 (fi), example: 110 gptl x 1/of bedrooins): SS'o Nunlbcr of current residents: 1 _ -- Does residence have a garbage grinder(yes or no):wO Is lauutiq on a sepaialc sewage systeut(yes or uo): A)O Iif yes separate inspection required] f-auodiy system iuspecled(yes or no): .v1A Seasonal use: (yes or nil): Alt) -- Water nlcler readings, if available(last 2 years usage(gpd)): 1'•-;,,�� i-� tl-160 yaw-y SUMP putup(yes ur no): N.Q Last slate ofoccupaucy COMM 1-RCIAI./1NDUS•1•RIA1. I'Y1ic of eslablisbnleut: _. .------_-----__--- Design flow(based on 310 CMR 15.203):— ------- gpd Basis i►f design flow(seals/persons/sglt,etc.): Grease trap present(yes or oo): - --------------- --- luduslrial waste holding lank present(yes or no):_ Non-saoitary waste discharged to the Title 5 syst n(yes or no): Water►nctei readings,ifavaidablc: - - Last slate of,occupancy/use: --------- ------ O 1'IIl R (describe): GI'NP RAI. INVORMATION 1'ur►Ipiob Records Souice of ioltwil alioll: Pv.•,.R{ll___-Qc=1---t)�l__�z�r._�_�_�_s11,_ s�,�t-1 . Was system puny)ed its pall of 111e insficcllon(yes or no): If yes, volilnle 1.xuuped: —_galluus flow was quantity putilped deterlflined? Reason foi punnping: — --- -- ----- -------- TYPE, Ole S'YS'l'l?Ivii , Septic lank,distribution box,soil absorption syslem —Single cesspool —Overflow cesspool --Privy Shared systern(yes or no)(if yes,allach previous inspection lecords, ifany) Innovative/Alternative lechnollgy. Attach it copy of the cufrenl operation and I naiulenalice contract(to be obtained lion►system owner) .—Tight lank _Attach a copy of the Dl3l approval —Other(describe):—_ —— --- Approximate age of all components,date installed(il htlown)antl source of information: Were sewage odors detected when arriving at the site(yes or no): ,up 6 Page / of 1 1 011, ICIAL INSITeCTION DORM — NOT POR VOLUNTARY ASSE'SSMEWFS SIMSURFACE SEWAGV 11ASPOSAL SYSTEM INSITCI'ION DORM I'A1ZT C SYSTEM 1NVOI21Y1ATION (coutiuued) Property Address: 50 Plum Street W. Barnstable, MA Owner; Stephen Roland Dale of luspt cliou: June 1,2006 BUILDINC, SI?Wlat(locale on site plan) Depth below grade: —a ' Materials of conslt"llclitln: —_cast llon ,ZQO PVC_other(explain): Distance from pr ivale water supply well orsuction line: ---- Corunlenls(on condition of joints, veining, evidence of leakage, etc.): SLPTIC'I'ANK: (locale on site plan) Depth below grade: Material ofconstnlctloll: ,/concrcli uncial_fiberglass_-polyclbyleoe ----olher(cxplain)--------------- — If lank is Metal list age: .— Is age confirrued by a Cerlificale of Cornpliaucc(yes or no): _—(atlacL a copy of ee!"llhCille) Sludge depth' ----Y=---- - --- -- --- Distance frotll lop of sludge to billion)of Outlet Ilse of balile: Scunl thickness: —..— Distance front lop of scum to lop ol'outlet Ice or baffle: 6 _ Distance f1Orn bottol-11 mf sctl,ll IO bollolll oI outlet tee of baffle: low were dill,cosions dclerolined: -- Conitrlents(on puulping reconllllcotlalions, inlet and outlet (cc or baffle condition, structural integrity, litluid levels as related to mullet invert, evidcuce of leakage,etc.): , r.Ll, --- l GIW ASI�.TRAI':—(locate on site plan) Depth below grade:— Malerial of construction: concrcle —metal_fiberglass polyethylene_other Dinlensioos: Shull thickness: ------ Dislance lions top of scum to lop of nutlet lee or b" 1le: _ Distance fiord bottom of scum to bottom of oil I lee or baffle:--- Dale ol'lasl pumping: -- -- -- -- Conlnlenls(oil pumping recoluruendalio inlet and mutict Ice or baffle condition, structural integrity, liquid levels as relaletl to outlet invvil,evidence o' eakage, etc.): Page 8 (it'I OFFICIAL INSITCTION VORM — NOT I4O11t VOI UN'1'ARV ASS1!$SIVILNTS SUBSUIZ- ACE SMAGE OISPOSAL SYS'CLIVI INS1"ECTION m1w I'ART C SYSTEM INFORMATION (continued) Property Address: 50 Plum Street W. Barnstable, MA (honer: Stephen Roland Daic of Inspection: June 1,2006 f'I(.Il'I'or II01.1)ING'I'ANIC: (lank teusl be puulped at tinle of ii eclion)(locale on site plan) Depth below grade: _-- Material of conslr tic lion: _--concrete metal_—(ibergla _polyethylene_--other(explaill): - Capacity: — — ---gallons Design Flow: --_-- — —gallons/day Alarm present(yes or no) _ Alainl ICVCI: - Alarin ill working o er(yes or oo): — Dale of last pumping: -- Coolnuellls(condition of alarm and at switches, etc.): DISTRIBUTION BOX: ✓ (ifpresent must be opencd)(locate on site plan) Depth of liquid level above outlet invert: Conunerlls(note if box is level and(listribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or oul of box, etc.): J ------'-'-�'�..__�1�__�`—,'----�--�-�_r r�_o✓-c.�_sir �u,c,Lc_J�__�s Wtr� ✓n 71 �k c ITNII'CIIAM11I!it: (locate on site plan) Pumps in working orrlei(yes or to): _ Alarms in working order(yes or no): _ Conluteuls(note Condition of pmnp chanlbel', col Boil of pumps and apporteuances, etc.): 8 Page 9 of OFFICIAL INSPECTION DORM - NOI` fi Olt 'VOIAJNTAIIV ASSESSIYII NTS SUBSURFACI? SEWAGE DISI'OSAI., SYSTEM INSPECTION F611M I'A ll'1' C SVS` CM INFOUMA'T'ION (continued) Property Address: 50 Plum Street W._Barnstable,MA Owner: Stephen Roland Dale of Inspection: June 1,2006 SOIL ABSORPTION SYS'I'I:IVI (SAS): i/ (loc;►Ic oft site Wall,excavaliall not required) ICSAS not located explain why: 'Type ✓ leaching pits, nunlher:-a ' -- leaching chambers, nuniber: -- leaching gallcrics, nun,bcr: ---- __-- (caching Benches, number, length: --,-------- - __ leaching fields, nombci, dimensions: _ overflow cesspool, number: ----- inaovalivc/allerr,ative systcn► Type/lame of'lechl In logy: - Comments(mile condition of soil,signs of hydraulic lidluie, level of,poudiug, damp soil,condition of vcgelalion, etc. O w z c► cam.,�c ✓U c �a I-JG �1—�-�2-=�.�-)- L17 3 c�ti✓ 1. c- � l✓.- U✓ fo w 4.i a.. f 1 ll't r c1 1 CI SS1,00LS: _(cesspool must be pumped as pail of iuspeclion)(I alc on site plan) Numbci and cunliguration: 1)cplll lop of liquid to inlet rover l: Depth of solids layer.- —_ -- - DCpt►,of scup,layer. --- --- -- - Dimensions of cesspool:-- - --- Mutcrials of construction: Indication ol-groundwater inflow(yes or n - - -------- Couuneuls(Holt condition of soil,sign f hytliaulie IuihBe, level ufponiling, eonililioi,of vegetation, etc.): . PRIVY; (locale on site plan) Materials of construction: Dimensions: _ Zt-1,Y - Iailme,Depd,ofsolids: of ponding, condition of vegetation, etc.): 9 Page Ill of 01?1�1CIAl, INSI'E C'I'ION I�OItIVI— NOT I�OR VOI,UN'I'AltV ASSL SSM WI'S SMISURFACL SEWAGN DISPOSAL SYSf1 M INSPECTION FORM PART C SYSTEM INVOIMIA'I'ION (continued) � 50 Plum Street Prollerly Address: W. Barnstable,MA Stephen Roland Olvner: June 1,2006 Dale of Inspection: SKETCH OF SEWAGE DISPOSAL SYS'I'1![VI Provide it sketch of lilt sewage disposal system Including tits to at least Iwo permanent reference landmarks or benchmarks. Locate all wells within 100 feel. Locale where public water supply enters the building. f A �ro►v�. q = b 2'6'' n S`I '�•, v e (r 1b7' (�= 10V 1 b0� 0 G !1 10 Page I I of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL. SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 50 Plum Street W. Barnstable, MA Owner: Stephen Roland Dale of lusper:tionn: June 1,2006 SITE EXAM Slope Surface waler Check cellar r/ Shallow wells Adjuslcd high ground water cicvalicin — feel Estimated depth to ground wale, 3DF feet Please indicate(check)all methods used to determine the high ground wale,elevation: Obtained lioni system design plans on,ecord - 11'checked, dale of design plan reviewed: i 15 3 / Observed site(abutting propel ty/obse,va(ion hole wilhin 150 lect of SAS) -- Checked with local load ol'ilealth-explain: _ --Checked with local excavators, installers- (allach docunienlalion)-- ----'--— Accessed 11SGS database-explain: _So�S=2-_t°��._1�_yb.�, _b'.�—�.. You must describe how you establisher) (he high ground waler elevation: D o� y 3. 2 ------------- t3�I-W.t �f ��n� l•,1��.. ,..n H o Ww�✓ I"�-•.-„fit.• This report has been prepared and the system Inspected as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed,written or Implied, relating to the system, the inspection and/or this report. ll �li� Town of Barnstable la / � , ' Departinent of Regulatory Services NAMPublic Health Division Date xe79.a 200 Main Street,Hyannis WM601 Date Scheduled Z Ti'tne Fee Pd. C Sail Suitability Assessment for Sew e. D spos l Performed By:. (' Witnessed By: H V 1!� W' Locallon Address _ LOCATION&GENERAL INFoRMA.TION 5 f LV/,q S%, Owner's Name %�1o/h�kS t jo G�7VC� Addresb Sp �L U21 �J-- CcJ,.�3ir'RN5TA�3 Assessor's Map/parcel., S / 46 Engineer's Name �-v s'7U�IJL= • NEW CONSTRUCTION REPAIR G�hl°iC EMI So S-Ole • �'}rfQNo 'Gal Telephbno# Land Use ecitz c513 Slopes(96) c3 J Surface Stones .. • �-Q, Distances f}om: Open Water Body N 4 ft 'Possible Wet Area 'y14 Z2's It DrinkingWaferWell . ft P DWhage Way //¢ fi roperty Line 90• ---_._R other_ Cd ,Z ft SHE CHI(Street name,dimensions of lot,exact lodnt�n0 of teat holes&pare testa,locate wetlands in proximity to holes) W L.p.r;A A_Q� ( � PVZW POOtb r4-r).r,.s "T 2 Parent material(geologic) y$�C vtJQt. ' �( Depth to Bedrock �L] Depth to Oroundwater. Standing Water in Hole:_ /1`lJilO Weeping fl'otn Pit Fnae Estimated Seasonal High Oroundwater Method Used: DETERMINATION FOR SEASONAL•HmIR WATER TABLE Depth Observed standing in obs.hole: Iv, Depth 10 still mottles: Vlo�Dellth to weepin from side of obs.hole: wl' - I:1, Index Well#f— 'ding Dato:�G Index Well levol��• dj,faC d�star At�ustment , T� A _ ,. Adj,( )unctwtiterLeval PERCOLATION TEST Date Observation / Hole# Z X el Time at 4" Depth of Pero �p 2 f ._.Time at G" �r 3) Start Pre-soak Time @ _v% Time(911.610) End Pre-soak �� !2 Rate Min./lueh , ¢ L •1)4 O,7�_ Site Suitability Assessment: Site Passed ✓ -Sitp Failed: Additional Testing Needed(Y/N) 4/0 Original: Public Health Division Observiition Hole Data To Be Completed on Back— V ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one(1)week prior to beginning, Q:\SEPTlC\PERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole#--L--X Cl 22,7, . Depth from Soil Horizon Soil Texture Sdil Color Soil• Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. • ei to cy 96't3rayell • ✓ � 2ll�G) GiL �v� ' . • DEEP OBSERVATION HOLE LOG Hole# Z X /70 ,751 . Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistchov.%oravell 36) IX 4 v J1vs-yd S /` sC ' 7.Z•s 6/¢ Ps /ate al,2 C, . DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency. DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Crlor soil Other. Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistency. i Flood Insurance Rate Map: Above 500 year f loud boundary No— Yes Within 500 year boundary No Yes ' Within 100 year flood boundary No,.,— Yee . Depth of Naturally Occurring Pervious Matertal Does at least four feet of naturally occurring perviou mtiterial exist in all areas observed thrpughout thei area proposed for the soil absorption system? If not,what is the depth of naturally occurring per sous materlail Certification I certify that on 0 (date)I have passed the soil evaluator examination approved by the CP Department of Environmental Protection and that the above analysis was performed by me consistent with . the required trainin a er. e and a erie a described in 110 CUR 15.017. Signature - Dat� Ul3 Q:\SL-PTIC\PBRCPORM.DOC - q- ------ 1 �s� ® z� No. Fee------- ------------ BOARD OF HEALTH TOWN OF BARNSTABLE w 0[pp[icationArlVell Con5tructionpermit Application is hereby made fora ermit to Construct ( ), Alter ( ), or Repair (�an individual Well at: SD- P)uw� � S7'• � �'Jc� Location — Address Assessors Map and Parcel A (' J ST - Owner Address -- ---------- Installer — Driller Address Type of Building Dwelling------------------------------------------------------- Other - Type of Building------------------------------ No. of Persons---__________________—__—__—_______ 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 Certificat .of Compliance has been issued by the Board of Health. Signed date Application Approved By ----------------------_-- _ date Application Disapproved for the following reasons:---------------------------------___________—__—___--------- ------------- - --- ---------------------------------------------------- date V Permit No.a - -- Issued---- -- ----- ---- -- ------- date BOARD OF HEALTH TOWN OF BARNSTABLE Certifitate ®f Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( ✓� 2 Installer K M at -�� P/ Lo— �ta� ..� -------------------------------------- has been installed in accordance with the provisions of the Town of Barnstable BoarcLof Health.Private Well Protection Regulation as described in the application for Well Construction Permit No.+ -'� Dated---- --- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE----- --- --- Inspector-- --- - -- ---- ----- _ -- - - - - it \ C �.- O Wool No.-------- -- ----;- Fee-------- ------------ BOARD OF HEALTH . TOWN OF BA,RNSTABL'E T 2pplication for Well Cootruct ion permit , Application is hereby made for a ermit to Construct ( ), Alter ( ), or Repair (Olin individual Well at:, n Location Address ,Assessors Map and Parcel PILA PIA/3 Owner n Address Installer Driller, Address Type of Building lDwelling--,,-- ----------------------------- ----------- r Other - Type of Building ---- — ------, No. of Persons----- -------------------------- - -- `` ^ T e of Well"�(�_�>G —_ r - 1 - Ca acit yp P y-- -- - ---=---= =— - �.• Purpose of'Well--��_ciT1`— ,-)c` °�--_—=— .Agreement: ` The undersigned agrees to install the aforedescribe.d 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 k place the.well in operation until a Certificat .of Compliance has been issued by the Board of Health II a Signed date -------- . j. Application Approved By --- -- - -----—— Gate ---- r Application Disapproved for the following,reasons: ______�______ date - vgq Permit No. Issued ----- -— ----- --- ---------- ` R, date `.-7`a'h=`a!AfrSNTi riai��a,._.i•a+�•',R+�a!t�n+.WS!<� !rti:iFp?`i.9�#3?i�Ai3+�aAiRhfa4iRiSiRi�RAai'AC6eea1t8R�TibElta!&.4i:9+1e30.uMd9iRa9Ge:Mauliw4X.:%aC4RA4iwnwi9'n�6beKlitill/iT�YRilwi3a4i'�i•'!b'Ga; ? BOARD"OF HEALTH TOWN OF . BARNSTABLE Certificate Of Compliance THIS IS TO CE TIFY That the Individual Well Constructed ( ), Alteredby ( ), or Repaired (.✓j Installer ------------------- ti .' d P/14 M 13 ' J61 PJ l has been installed in accordance with the provisions of the Town of Barnstable Boa of Healt rivate Well Protection j Regulatio1-7 n as described"in.the application for Well Construction Permit No. g' Dated---- ------. . _ . T THE.ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY: 1 DATE------ — - =- Inspector-----—- ---�-- —-=---- :�' �Nk..iriwi�i'.'a+'i9ro�o!s?8p25ta�ps T3+i�Yti'li�i ............sA8i439o9i'987i PY4ASOT�FieAgl.tfMi90�8@il1Si4AS�RBf6f3i4- r4e�7'T !bpi?iG4s46�M4G!i§d4B4G4i� !iPi?i�ii,i.w4iTi?il!s'�si` f BOARD OF HEALTH TOWN OF BARNSTABLE rr '' ll Well Con5tructionpermit No.— t Fee--�------ Permission is hereby granted D S e6,��•c /� y --_to Construct ( ), Alter ( ), or Repair (+ej an Individual Well at: �O NIA i street as shown on t o p 'cation f r a Well Construction Permit LA No.= Dated-- -- =- A— = -- - s /------.---- j --�- Board of a th DATE� --- --- .• - i TOWN OF BARNSTABLE Of 311/1/ 6 LOCATION AUM 5-f Loy` Aq SEWAGE # C/S '/3 VILLAGE U✓, Aurh 5li-O K ASSESSOR'S MAP & LOTZ2,2 � ✓ INSTALLER'S NAME&PHONE NO. 504-7 4/40 5'�� ✓ SEPTIC TANK CAPACITY `.S00 5, LEACHING FACILITY: (type) l0059 (size) l X 0 NO.OF BEDROOMS ,B :I DE OR OWNER /I/, c k L,7c,4 d,'-i of PERMITDATE: ::X_-;?,' -- 9�h' COMPLIANCE DATE: /Iel/ilor_-;Zv' -" Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by I 'I . INSPECTION DATE/TIME: -� '+M/P # 10 No.... :5... �C� f61VD1NCs1_ W�aU, � ��U��S Fss......... ........�.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........TOWN..................OF........................... � 5 lPC-el' Appliratiun fur Disposal arks Tonstrurtiun Prrmit Application is hereby made for a Permit to Construct ( C_ ) or Upgrade ( ) an Individual Sewage Disposal System at: W,� ��• ..._..___S T".---\Li atio an2A d e.s.s.z/��^ ''"Q/` f' •................................................................- ........................................ � C....o... .T....�. .../...T...� fT - ......................-................... - 2o /6sTt ... Owner Address .9-......................... a ............................•-----•---------------•--------------••-----------•.. Addresse dType of Building Size Lot...... ...._.._._. t Dwelling—No. of Bedrooms.............. ----------------_---_.Expansion Attic ( ) Garbage Grinder Other—Type of Building No. of persons........................... Showers — Cafeteria .< Other fixtures .----••-•------------------- t F� �`+� Design Flow......... rZ gallons per day. Total da}1 how .-.-----�5�... .. o WSeptic Tank—Liquid capacity.��agallons Length../!../rd... Width.�. ..... Diameter................ Depth. x Disposal Trench—No..................... Width.................... Total Length........... Total leaching area....................sq. ft. Seepage Pit No.......��._.. iameter........ De th below inlet........-_��........_ �.3.�..s ft. r p _ Total leaching area.... _ q. Z Other Distribution box ( " Dosing Conk( ) ``�� '" Percolation Test Resul Performed by.....____.__J� _..✓..' D__.__1.�.............�Y_.............. Date..._. 1.../_/...._ �.,r.. Test Pit No. 1._ ..minutes per inch Depth of Test Pit....�tx �...- Depth to ground water............ (i Test Pit No. 2__G_ .....minutes per inch Depth of Test Pit..,,-,,........ Depth to ground water...e.7'71 �.... a, ........... . ........ ......................................... ..----...... O Des-ri tion f oil _- � ._ _. s� fa.�L 6'?z �s�S� / * P 7Lu,Gv �uK gyp Kf /�`3 6 - o ` 7bd.. .Sd�Sv/C �!l�r �•� lD 72'!.ta 3 ------------- 3� /.... U --....... -- �.............. „•---..........-------- F............ (=1 "'r- �� c r�•l6S- ,*-?&._,/'rn�G fJ'�'�� ? R r� 'q W- --•----- �,,y�sy.Jp -iig//GL.�X- (D /��. ..lSi U ��Qitre o��iWer�ofis ———— Answer whin apphcalsle:.-•-•----•---••••-•---•-•--•---•-------------•------------ ----••....-----•---------• ................-....................................................................................................................................................................................... Agreement: The undersigned agrees to install the afor es ibed Individual Sewage Disposal System in ` nce with the provisions of TITLE 5 of the State Enviro tal Co n ersigned further a t�tb a he system in operation until a Certificate of Comp ' e is boar f h 2 Signed^ ............... .........a..................... Application Approved By ......... ....... .. .®.... . .-. ..... ........................:... Application Disapproved for the followin axons: MAR 2 `+ `e1995 to - - -- -------------------------------------------------------- -------------------.------------------.-----------------..-...........................-- ......... ........... Permit No. �` l'� --------- -------------------------------------- Issued .... -- Dace e V J fi1,'..7-t']INSF.ECTION DATEMME: A, P # on-r PC'�4fls-Fim 61V N(� Wgu, No... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN.................OF... .................................................................... ------------------ --- - ................... Appliration for Disposal Works Tonstrurtion frrmit Application is hereby made for a Permit to Construct ( (40i,Upgrade ( /,) an Individual Sewage Disposal 5'OSystem at: r? -'qL I ) - -. 30 1? 7- 7------------•------------- ........ Address It No*,4,>,Lo • --------------——--------------------------------- ................ ................................................................ Owner / Address . ..... -------................**..... .*.................................................................................... LaWler Address Type of Building -- U __5__ Size Lot-----.....................eSkF-_--:%et Dwelling—No. of Bedrooms............... ..........................Expansion Attic Garbage Grinder (�0 -.4 04 Other—Type of Building ............................ No. of persons............................ Showers Cafeteria P4Other fixtures .................................. IV, wa-;----------------------------------------------------------------------------------------------- < -Ovs Design Ffow.................ll.e).................gallons per person peer d4y. Total dail fl W 'Y ' ow........................:'�......ga4lom" 1:4 Septic Tank—Liquid capacity.Z-��%allons Length..!L��... Width_.6..?2..... Diameter................ Depth..6.2..".. Disposal Trench—No..................... Width.._................. Total Length..........._....... Total leaching area...................sq. ft. Seepage Pit No...................... Diameter........A�-�_...... Depth below inlet......... .... Total leaching area. ..sq. ft. Z Other Distribution box ( __r Dosing tank ( Percolation Test Results 5L Performed by...... J Ar7�—p ................................................................... Date---- 2..... Test Pit No. 1 minutes per inch Depth of Test Pit..... ..... Depth to ground water ... 1� e;l I ....... .. Test Pit No. .....minutes per inch Depth of Test Pit../ ' Depth to ground water.. ..............................4............7�5-5................................................ ......... . ...... r, 4�, ;7 Z_ /C , 0 Description of Soil.P.--,3(........................................................................Pe . C.,.....0...."..=..._....Z.....1..-..7..6..V............. ---------.- ---- P-7Z-'-- to U .......................................................... ..............................................5............... /........ZC). . e�t / ?/ j . I"-----)........ .. ;D ... C"`"w4vure of(AWerAons — — Answer whe5n app icable...................................................................................•............ ........................................................................................................................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmenta Code he-undersigned further agrees not to place the system in operation until a Certificate of Compliance u t boar�;of hpaf5h. Z _N1 Signed .................. ......--..a--------------------................ ... .......................!...... IN, Application Approved By .&�k/' -1....................................... ................................... Date Application Disapproved for the followin asons: ................................................................................................ ............................ ....................ti.....................:..... .................I.................................................................. .... ..........I.... .. ..............I.............. � _ Dae5 . S7 ? ...........V.7a.Y_77q .........Permit No ........ ..... ........... . l9d Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...............TOWN..............I OF ..................7 ...... (fiertifirate of Tontyliance THIS IS TO CERTIFY, That the IndividuaI)S7age Disposal System constructed or upgraded by.......................;.J.... -e -+-^ ................................_.................................I....................... .................................................... Installer at ............. �0...........10/0..... ......................................... has been installed in accordance with the provisions of TITLE 5 of The State Enviionmental Code as described in the application for Disposal Works Construction Permit No. .............. dated .... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. ,/-4 z:DATE../�......7 ........;ZF -----4.�....... -................... Inspector .. ... ----------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEAL H TOWN .........................................OF....... Df��NTS ...............................7............................................. No......................... FEE........ Disposal Works Tons ttVrrmit I at Permission is hereby granted....................... ----------------- --------- ............................................................... spos st in��vi�u �e E fi� to Construct or UVrade an Individual Sewa6p S st... ........ .. ----- atNo............ .. ...... W...... ---------------------- ,,--Street /P e � ':�3 "d2......q............. as shown on the applicatio for Disposal Works Construction e mi, Noy I) 'i ...-.,2Y, 'o P .............. ....... .......... /-if --------�"_74 ---------- DATE...................... ...... .1L J5.... .......................... Board o- Revised 7.20.94 7 . ... a .. ..p. V ^tl 4 APPLICATION FOR PERCOLATION TEST AND OBSERVATION PITS LOCATION 197/2C-GrL B RZei�-1 .STVEZ''T NO. VILLAGE 1^/&_57- !ei)72/VS771-346- DATE APPLICANT 0&,e FEE_�D(� ADDRESS TELEPHONE NO. (Non-refundable) ENGINEER CZ>k,e4� G /C&zz 4!x TELEPHONE NO. &l2-zz6 G DATE SCHEDULED `T/a�V. / y 9.S (Applicant' s signat re) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . • . . . . . . . . . . . . . . . . . . . . . . • . . . . . . . . . O . . 0.0 . . O . O . . . . . . ESS ASSOR'S MAP & LOT NO: SOIL LOG SUB-DIVISION NAME Pi9 A?C6-2 B PL, a 36r -Jy 93 DATE 9W, TIME /o:yo A-r�Y EXPANSION AREA: YES ✓ NO / 6•y, j?,9 �, /��TG�y ENGINEER TOWN WATER PRIVATE WELL ✓ _ , BOARD OF HEALTH U 6L47Z EXCAVATOR SKETCH: (Street name,etc. ,dimensions of lot, exact location of test holes and percolation tests, locate wetlands in proximity to test holes ) NOTES : or / i2Gd"Z t3 r w i / .� 7W .3 ri /�/ 7Z-'3T f/aL45 3 d "36"k/o.o4149-7 $S✓d_Soic- � Q,S, .3G'= 90" F.,vt�• s�.io w.rt� •F.��-s Dwsc4 AAc_-IG4 Fiw� -T4W2> ¢CZAy /D5 �/sz L /erns off' Frn/16 sR-ovD� DZI Cf A9C_&X� ��&- SA+vo Cd4y r,.x Igo 1.14 S"R-2vZ PERCOLATION RATE: LES.s 77h9--✓ EST HOLE NO: f ELEVATION: TEST HOLE NO: Z ELEVATION: 1 Woo �v�,�j 1 Won6>41,Av4 . 2 Svo,SoiL 2 Se,/3-So�G 3 -30'l 3 4 4 MG9v�j�i,v� 5 s4v,.$D wo 7x 5 S9�a ►w/�7�/ 7z" 6 ,` ..\' ; ti.vea 7Z,, 7 7 8 AMP. 9 s,wa 9 s 10 In//ram' /lv'' 10 . 11 g 11 12 so-v 12 13 AlAles 13 -sia�ra /68" 14 /68" •14 15 15 16 16 UITABLE FOR SUB-SURFACE SEWAGE: LEACHING FIELD_L,/-LEACHING PITSi/ LEACHING TRENCHES/ NSUITABLE FOR SUB-SURFACE SEWAGE. REASONS: OTE: ENGINEERING PLANS MUST SHOW NUMBER .ASSIGNED ON PERC TEST APPLICATION RIGINAL: COMPLETED TN rNTTRFTY T1Y P . F . AND RETURNED TO BOARD OF HEALTH ,OPY: RETAINED BY APP-LICANT No.- .----- -- ------ Fee------ ---------- BOARD OF HEALTH TOWN OF BARNSTABLE ZIpplicat ion for Veil Con5truction3permit Application is hereby made for a permit to Construct ), Alter ( ), or Repair ( )an individual Well at: �� -- ------ 5 d�4 - � � -•�' --- - -------- --- --—- ------- Location — Address Assessors Map and Parcel �tju-, � o ��'`- - -- ----- ------- ---------------------------------------------------------------------------- Owner Address AX—t-t c&A.,�----- -' - ----------------------- ------------------------------------------- taller — Driller Address Type of Building Dwelling Other - TVe of Building------------------------------ No. of Persons-------------------------------------- ---- Type of Well -- - Capacity---------------------------------------- — Purpose of Well--------— - - ----- - h Agreement: The undersigned agrees to install the aforedescribed individual well in accordance ith 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 rtificate .of -ep fiance has been issued by the Board of Health. 4 � Signe -- �p d date Application Approved By — ® - date Application Disapproved for the following reasons:-------------------------—-------------------------------------------____________ --157 ---------- v( �_ date Permit No. - ----- Issued--- — - - —------ - - - ---_-- d to BOARD OF HEALTH TOWN OF BARNSTABLE (Certificate ®f Compliance THIS IS TO TIFY, Tha e Indiyr��,ual Well Constructed ( ), Altered ( ) or Repaired ( ) by------------ a - - - lF ------------------------ lust ne 0 at- — — -- — ------ —� — -- — ------------- has been installe in accordance with the provisions of the Town of garnstable BoarclDf Health Private Well Protection Regulation as described in the application for Well Construction Permit No.U3aated--------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE------------------- — -- -- --- Inspector-------------------------------------------------------------- i , a . Jo 1 �� (�`� .r, ; 1 - .._ s•.�rev o ``. � � 2 \ 1 i -7O 'k �\ ' i- ... 6446 P. 02 r w ENVIROTECH LABORATORIES, INC, MA Cert. No.: M-MA 063 449 Rto. 130 4 Sandwich,MA 02663 (508)888-6460 • 1-800-339-6460 K-3 0 FAX(SU)888-6446 CLIENT: ,Aqua-Jet LOCATION: Lot B ADDRESS: 135 Rte 130 Plum Street Hashpee, MA 02649 W. Barnstable, MA SMIPLE DATE: 4-4-95 COLLEMED EY: Aqua-Jet DATE RECEIVED: 4-4-95 TIME: 2:0OPM LAB I.D. NO. : E4-33 JOB TYPE: New Well WIPLE I.D.M. 13AS1i 166 WELL SPECS.: 82' lit RESULTSiOF,,ANALYSIS: Parameters �i Units Recommended Limit Result Coliform bacteria/100m1 (MF Method) 0 0 pf1 PH units 6.0-8.5 5.69 Conductance umhos/cm 500 98 Sodium mg/L 28.0 13.4 Nitrate-N mg/L 10.0 0.19 Iron , mg/L' 0.3 0.18 Manganese mg/L 0.05 0.018 Volatile Organics ug/L See enclosed report. EPA riethod 601/602 None detected. i 4'.s COMMUS: Low PH indicates high corrosive characteristics. Yes No WATER IS SUITABLE FOR DRINKING P SES FOR MTERS TESTS . XK ate �,f ona d J. Saayy Laboratory Diefector LT = Less Than i GROUNDWATER ANALYTICAL EPA METHODS 601 and 602 Volatile organics (6C/P1D/ELCD) Field ID: E433 Lab ID: 10353-01 Project: Aqua Jet/Lot B Plume Batch ID: 04-04-9 Sampled: 04 Client: Envirotech 96 Cont/Prsv: 40mL VOA Vial/HC1 Cool Received: 04- -95 Matrix: Aqueous Analyzed: 04,13-95 PARAMETER CONCENTRATION REPORTING(LIM`T (ug/L) Dichlorodifluoromethane 5 /BRL 5 Chloromethane 5 Vinyl Chloride BRLBRL 5 Bromomethane BRL 5 Chloroethane BRL 1 Trichlorofluoromethane 1 1,1-Dichloroethene BRL 1 Methylene Chloride 1 trans-1,2-Dichloroethene BRL 1 1,1^Dichloroethene 1 cis-�1,2-Dichloroethene * gRL 1 Chloroform I 1,1, 1-Trichloroethane BRL I Carbon Tetrachloride BRL 1 Benzene I 12-Dichloroethane BRL 1 T;ichioroethene RL 1 11 2-Dichloropropane BRL 1 Bromodichloromethane BRL 5 2-Chloroethyl Vinyl Ether SAL I cl -1,3-Dichloropropene SAL 1 To uene BRL I trans-1I 3-Dichloropropene BRL 1 11 1',2-�Trichl oroethane 1 Tetrachloroethene BRL BRL 1 Ribromochloromethane BRL 1 Chlorobenzene 1 Ethylbenzene BRL 1 meta-and Para-Xylene * 1 ortho-Xylene * BRL 1 Bromoform 1 1,1,2 2-Tetrachloroethane BRLBRL 1 1,3-Dichlorobenzene BRL _ 1,4-Dichlorobenzene BRL 1, 1,2-Dichlorobenzene QC SURROGATE COMPOUND SPIKED MEASURED RECOVERY QC LIMITS a,a,a-Trifluorotoluene 30 32 107 % 87 - 113 % 1,2-0ichloroethane-0 30 31 102 % 83 - 117 Y BRL - Below Reporting limit. * Non-targot compound. Method AefarQ�9: Method 601 - Pur9eabie Halocarboos and Method 602 - Purgeable Arcmratics, 40 C.F,R. 136, Appor;dix A (1986)• LOCUS DATA 3 .� 6A / j N -7.5 CURRENT OWNER COHEN PLUM / LOCUS 1, N � s � STREET R.T. lb / FAO off, 132 PLAN REFERENCE 610-20 DEED REFERENCE 24590-255 1 3`" 6 . ! , � LOT �, ZONING DISTRICT RF I :: 102,693f S.F.. 2.36t S.F. I LOCUS MAP NOT TO SCALE: FLOOD ZONE X I WELL L�A.�, ASSESSORS MAP 195 150' I o 15-0117 PARCEL 25 (o j I \\ F N' OVERLAY DISTRICT NOT A ZONE II xlsT. POTABLE WELLS / I OOL �, DIG SAFE REQUIRED PRIOR v ! ! i ,j �� r , EXIST. N v TO INSTALLATION OF SEPTIC LOT AREA 2.36t ACRES SYSTEM COMPONENTS ! ! / EXIST. \ \�� ( ,DWELLING / SITE 8c SEWAGE ( `� , / �, o / � BARN �\ �\ ��.\�\ / EXIST. �. \\\� / GARAGE REPAIR PLAN a IV'�;,' PLUM S TREE --- o �. �`\ , ,��,,, �, `L '`aoL l N I I 0 ZjLn -- aw ol � � 0 p � i I i \) �� J EXIST. ) u, W. BARNSTABLE, MA � % l % ; ;; ,� ;' ' ; ; ;� DRIVEWAY DATE: JUNE 16, 2015 ► �� _ ; OWNER/APPLICANT: (1�1��\\ \ �� ice; l';' i �I • // fir/ ��` \ THOMAS COHEN - 5 0 PLUM STREET �\ �\ �_�, SEE 20 SCALE `zN OF ass \ \i �\\\ ,\>,i� ; , ( /// DETAIL ON �' N ; k? 9p i /' o i �( I ( SHEET 2 h WEST BARNSTABLE moo? EDWARD ��, \ � ��'��_ _�. ,% ' ��/ `\ clv MA 02668 STONEA. ink SHEET 1 OF 3 0 . No. 28980 0 '',•_ ,\ T` / /If , LA,PREPARED BY: �G EAS SURVEY, INC. _ i P . O. B O X 1729 :�� }0�. 3,. 5°�6 • ; BENCHMARK SET"P.K. NAIL AT � 0 50 75 100 SANDWICH , MA 02563 6 - / Clay/TS�oF,C, 3,` DRIVEWAY & STREET �` C . PLUM PH. (508) 888-3619 CELL (508) 527-3600 INTERSECTION 126.34 Ka 52'•�6,30�� W f'y£NT GRAPHIC SCALE: EAS.SURVEY�YAHOO.COM -S `i5.4 . a, 1 INCH = 50 FEET - k , SYSTEM DESIGN ,r EXISTING CENTER RISER ELEV. 125.6 TOP OF FOUNDATION RAISE COVERS TO.WITHIN 6" OF FINISH GRADE 4i ' `, ( (2) CHAMBERS DESIGN FLOW , ELEV. 130.92 FINISH GRADE FINISH GRADE RAISE .TO WITHIN 6" 5 BEDROOMS AT 110 GPB/D 2`S2 GPD ,129.6 ELEV. 125.8 ELEV. 125.3 FINISH GRADE OF FINISH GRADE ELEV 123.8 , ELEV. 119.7 ELEV. 120.0 120.2 /-�� -\ REQUIRED SEPTIC TANK EXISTING iv TOP ELEV 117.20 !�l ' MIN ___550 x_2_- _ --___11_DO GAL. 28'@S=0.05 EXISTING SEPTIC TANK = __�5 GAL'. SCH 40-4 PVC 2 MI-'N 3 AX 4" PVC SCH 40 85'C�S=0.028 14'OS= 0.02 0 p 0 0 0 0 o O 0 0 p 0 0 INV.= i SIZE OF LEACHING FACILITY SQUIRED !' INV.= EXISTING 120.84 10"TEE 14"TEE INV.= ppp0p o o Op0Op0Op TO REMAIN INSTALL 120.64 O 0 00 o c O 0 r � � EXISTING TO REMAIN GAS BAFFLE EXISTING 6•� 0p p 0 0 0 DESIGN PERC RATE _ - = IN./INCH 3 OUTLET 6 OUTLET LONG TERM APPL. RA E 0•74 D/S.F. 4'-1" LIQUID LEVEL REMAIN H-20 DB3 H-20 DB6 FOUR 5'-0"x8'-6"x3'-0" CHAMBERS INV.=119.23 S.A.S. (13.0' x 42.0') H-20 ' SIZE. OF LEACHING SYSTE R VIDED:, INV.=116.65 > W ` EXISTING PROPOSED INV..=116.48 a m .114.2 0 550 0.74.SF/GPD 744 S.F. MIN. REQ. 0 0 0 o INV. to t, in DATUM: EXISTING 1,500 GALLON t09.2 USING H-20 CONCRETE LEACHING CHAMBERS VERTICAL DATUM: SEPTIC TANK TO REMAIN WITH 4' OF STONE ALL AROUND MSL± / BARNSTABLE GIS BOTTOM (13.0' x 42.0') = 546 S.F. BENCH MARK USED: TBM SPIKE ELEV=126.46 Y SIDE WALL (13.0' + 42.0') 2x2 220�,_F TBM NAIL ELEV=126.34.. CONSTRUCTION NOTES: 766 S.F. 15-0117 O0p 00 0 o O 00 00 766 S.F.x 0.74 G/SF = 566 GPD 1..CONTRACTORS / INSTALLERS SHALL VERIFY GRADES AND i • 000p0 0 00000 566 GPD PROV > 550 GPD REQ. = 16 GPD RES 99,^ SEWAGE ELEVATIONS AND SITE CONDITIONS PRIOR TO COMMENCING p 00 00 '= 0 0�0 00 NO (GARBAGE DISPOSAL / GRINDER ALLOWED) SITE WORK ON THE SITE. , J 2. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE �4 0' 5.0- �L..-4;0=---, REPAIR PLAN WITH DEEDED OR ZONING REGULATIONS. OWNER / APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. ". 50 3. VEHICULAR TRAFFIC, PARKING OF VEHICLES AND PLACING 13.0' MATERIALS OVER THE SEPTIC TANK, DISTRIBUTION BOX AND D.T.H. #1 D.T.H. - SIDE VIEW DATE: 6-2-2015 DATE: 6-2-2015 PLUM STREET S.A.S. AREA IS PROHIBITED GROUND ELEV. 122.7 GROUND ELEV. 122.5 GENERAL NOTES: I CERTIFY THAT I AM CURRENTLY APPROVED BY THE NO GROUNDWATER NO GROUNDWATER IN 1. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D•E.P. DEPARTMENT OF ENVIRONMENTAL.PROTECTION TO CONDUCT W. BARNSTABLE, M A " TITLE V AND THE TOWN OF BARNSTABLE RULES AND REGULATIONS SOIL EVALUATIONS AND THAT THE RESULTS OF MY SOIL A FILL FOR SUBSURFACE DISPOSAL OF SEWERAGE. EVALUATION ARE ACCURATE AND IN ACCORDANCE WITH 310 LOAMY SAND 30" 2. AT LEAST ONE ACCESS POINT OVER TANK•TEES'SHALL BE CMR 15.100 THROUGH 1 107 10YR 4 f3 " A DATE: JUNE 16, 2015 ACCESSIBLE WITHIN 3" OF FINISH GRADE, WITH ANY REMAINING 4 LOAMY SAND ACCESS PORTS BROUGHT TO WITHIN 12" OF FINISH GRADE. _.________ _ __ _ _ __ B 10YR 4/3 34" 3. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE EDWARD A. ST 4 CE FIED S IL EVALUATOR LOAMY SAND OWNER APPLICANT: CAPABLE OF WITHSTANDING H-10 LOADING UNLESS 7.5YR 5/6 B OTHERWISE SPECIFIED. ` 34" LOAMY SAND 4. THE EXCAVATION CONTRACTOR SHALL VERIFY THE LOCATION �,� � EL. = 119.9 7:5YR 5/6 , THOMAS COHEN INDICATES DEEP . 46" OF ALL UTILITIES PRIOR TO ANY EXCAVATION. f VID rH #1 � EL. = 1t8.7 I TEST HOLE , 50 PLUM STREET 5. ANY MASONRY UNITS USED TO BRING COVERS TO GRADE ¢- • • ' OR WITHIN 6 OF GRADE SHALL BE MORTARED IN PLACE. R 6. FINISH GRADE SHALL HAVE A MINIMUM OF 0.02 FEET PER , y' 62" WEST BARNSTABLE PERC TEs . FOOT OVER THE S.A.S. AND DISTRIBUTION BOX. M A 02668 7. SEPTIC TANK SANITARY TEE'S .SHALL BE;CONSTRUCTED OF �� 62" PERC TEST C C a SCHEDULE 40 PVC AND SHALL EXTEND A MINIMUM OF 6" ABOVE GIST MEDIUM SAND '' MEDIUM SAND THE FLOW LINE AND SHALL BE ON THE CENTERLINE AND 4 ITSR�A NO MOTTLING 2.5Y 6/4 2.5Y 6/4 SHEET 3 OF 3 LOCATED DIRECTLY UNDER THE CLEAN OUT MANHOLES. NO WEEPING 10% COBBLES 100 COBBLES 8. THE INLET PIPE INVERT ELEVATION SHALL BE NO LESS THAN 10% STONE i. 2 INCHES NOR MORE THAN 3 INCHES ABOVE THE INVERT '. , NO G.WATER 162 NO G.WATER 144° PREPARED BY: ELEVATION OF THE OUTLET PIPE. �� 162 INDICATES ADJ.- GROUNDWATER EL. = 109.2 EL. = 110.5 SURVEY) INC. 9• THE SEPTIC TANK SHALL HAVE A MINIMUM .COVER OF 9 INCHES ' E A S S U R 10. THE OUTLET SANITARY TEE SHALL BE`EQUIPPED WITH `'A GAS NO OBS. GROUNDWATER B.O.H. BAFFLE, 4 INCHES IN DIAMETER AND CONSTRUCTED 'OF' 4" PVC` I. DAVE STANTON P'. O- BOX 1729 11. ALL PIPES SHALL BE SCHEDULE 40 PVC SEWER PIPE AND NO OBSERVED GROUNDWATER SOIL EVALUATOR SHALL BE SLOPED 1/4 INCH PER FOOT MIN. EXCEPT FOR THE + ED. STONE S A N D WI C H M A O 2 5 6 3 FIRST TWO FEET OUT OF THE DISTRIBUTION BOX WHICH: SHALL 1 DEPTH TO BOTTOM OF HOLE ;13.5 • BACKHOE OPERATOR. BE LEVEL �� ROONEY F EX ON (MIKE), , 12. CHANGES OR. REVISIONS TO SEPTIC'DESIGN -REQUIRE NOTIFICATION ! VARIANCES-REQUESTED' SOIL TYPE: ? _ PH. 508 888 3619 VIEW . 4 M PER INCH ( TO EAS SURVEY INC. FOR B.O.H. rAND bESIGN ENGINEERS:RE PERC RAT _ F MIN .' - NONE 74 GALS _ 0 CELL (508) 527 3600 AND APPROVAL , .' • .. � .. - • • LOADING �-- . EAS.SUR.VEYC�?YAHOO,COM 13. MAGNETIC TAPE ON ALL COMPONENTS. i rE 1\ \ / EXISTING GARAGE \170 \ EX TING\\1,5QQ0 \ EXISTING \ J \GAON S1<PTI CENTER TANK\TO KM N \ \ TOVER REMAINER \I LOT- 1 "ISE `i&ET A L O / I 0YTLET11 RIS TO I \ WITHIN �'� - 102,693t S.F. � I 2.36t S.F. I 1 FIN St GR DE.1 EXISTING PARKING AREA / I 1 \ EXISTING PARKING AREA �' EXIPTIN( ��D,�I BOAC 1 TO REMp IN. RISER ) Q • J / / T0� WITWIN 15-0117 / --� FlNISHdD G AD l ` 1 SITE & SEWAGE i REPAIR PLAN #50 EXISANG / PLUM STREET L CHING PATS TO / IN \ \ CRUSHED ;(ND / �- —112— ABANDO�dED IN W. BARNSTABLE, MA /� ATCORDANCE W H 5. // HOF �14 DATE: JUNE 16, 2015 / / / I ��ED RD cy / / / � �o EDWARD �s / OWNER/APPLICANT: �� -, / / �3� /; STONE -o N0: 2898 THOMAS COHEN �6� �. / / / : ate. � .' ��F�FG sTe \ � - / , OPOSED /, / / / � / / /oN P ` 50 PLUM STREET �/ �� PR°D" BOX �� / LLA Iz- WEST BARNSTABLE ,11a- #2 I o _ MA 02668 ! \ \ LEAC�iNG BENCHMARK SET" SHEET 2 OF. 3 �� CHEER S.A.S. / / \ \ SPIKE ON GRADE .42.0, / ADJACENT TO Q / DRIVEWAY. PREPARED BY: NIP / � �� - � ELEV.=126.4s �YOOD D TH / \ EAS SURVEY INC. ' OAR' GROVE P. O. BOX 1729 Q J 0 , � 2 SANDWICH MA 02563 z � M v 0 30 40- 1 / PH. (508) 888-3619 . OAKS 'TO CELL (508) 527-3600 REMAIN \ � �� GRAPHIC SCALE: 1 INCH 20 FEE EAS.SURVEY®YAHOO.COM SOI L' 7E ST 20 FT� MINIMUM TOP OF FOUNDATION soic DATE OF TEST —RAIUMV ��L q .10 FT. MINIMUM CLEAN SAND - 'pa Ju iffm is, WITNESSED BY �zkgkV ;_ tLEV.11 PERCOLATIOWRAIE 44 IN./INCH. ,,., CONCRETE COVERS 4",SCHEOULE ,40 PVC. PIPE �2* LAYER OF OBSERVATION HOLE ,,.,,OBSERVA!1'ON HOLE :_� MIN.",PlTdH 1/8* 'PER FT. 12* ELEV. 1/8" iTO Ij jq ELEV. VATI 0o" off CORCRM � WASHED' STONE COVERS , Top, AND - -MAX. 12m -SUBSOIL- 4* CAST. IRON PIPE so"_ We 1>1 r SUIS$OIL rstor, rr�i some (OR EQUAL) MINIMUM PITCH 1/4" PER FT. 7P E t,I vm, OW LINE FL WIT 10" t>eiJsi_r PACfFD1'Fhwr 14ongve, ple A4 0 9 ZT ELEV. \-ELEV. �ELEV. 0 ELEV.' mlkLrt)'' EL- No ' E V. tel— 7R�0 WA 'AT.!-&_0 0 WATER ,AT-4L L= 1.71, 4r MO .DISTRIBUTION CALC �o 3/4*' TO 1 1/2, DESIGN ULATIONS .00 Alit> A5 BOX , WASHED S E oo NUMBER 6F_ BEOR MS �V EUV.' Ao � GARBAGE DISPOSAL UNIt TO� 8E' WATER TES17ED 0 1500-, GALLON . TOTAL,ESTIMATED FLOW IF MORE 1HAN, ONE OUTLET , L/p �1> AY 2 GA (jd�_GAL/8R-/DAY1.1 .... .. �SEPTFC TANK: , 2 6 :�DIA. 2 REQUIREII SEPTIC'TANk APACITY` GALi PRECAST' LEACHINO -- ki ARM BASIN ',OR EQUIV WELL ACTUAL S1ZE: OF-SEPTIC TANK LEACHING AREA'REQUIREMENTS ZONE 0 14'' INDEX SIDEWAL 1 ARExi, 13 S -SYSTI�M ADJUST,_.�� SEWAGE PIOSAL� PROFILE BOTTOM 'AREA OTTOW + ,SIDEWALJL) �:GA�L AY- LEA [P. NOT TO SCALE, CHING `CAPA 4x 7 RESERVE LEACHING CAPACITY,,' GAL/DAY, BOTTOM 'OF TEST HOLE OR USGS PROBABLF_ WATER TABLE ELEV. TABLE:( 'ELEV. . 013SERVED WATER , NOTES E.P 1.'�ALL WORKMANSHIP AND MATERIALS 'SHALj:.,.COWORM 'TO D' -TITLE 5 ,AND THE ' 0 *r WN OF, 2dLvJs:V*6�_,it RULES,AND SEWAGE.'L 0 LEGEND REGULATtO NS FOR THE,SUBSURFACE..DISPOSAL OF , .00. EXIS'nN SANITARY,L: SPOT ELEVATION ' �O`, 2. ALL:COVERS T UNM SHALL .13E,'BROVGHT �TO;- EXISTING GRADE., WTHIN 12* OF 'FINISHED' ..CONTOUR, FINAL SPOT-ELEVA11OW ro .0 3. EX AD S ISTING AND f1NAL 'GR ='CUMPIAL Z_ 'FINAL' CON-MUP )Nr-gTg o s YSI SHALL.BE CAPABLE OF,, YS, ON SOIL' TEST e LOCATI WITHSTANDING H-1 0',LOADING ��UNLESS,,THEY. ARE UNDER OR iNITHtN 1UTILITY.. POLE, H� 20�LOADING ,:SHALLBE, 10 'PT.,017 DRIVES:. OR- PARKII,40� AREAS. -,UNDER OR -WI 'OF, IVES OR PARKING AREAS. -TOWN WATER USED THIN 10 �FT., DR SIN CATCH BIA -BRING' COVERS.10 GRADE ALL: 5.,ANY'MASONARY UNITS, USED TO SH 7BE MORTAREDAN PLA &Jv 46 6. NO'DETERMINA11ON HAS.�BEEN MADE'AS'TO,� OMPLIANdt NTH<,' OWNER' /,"APPLICANT IS DEEDED OR ZONING REGULATIONS. 70� OBTAIN 'SUCH DETERMINATION FROM�APPROPRIAri�:AUTHORITY.,!;. 0� :t 1094 A ARD � ,OFt�' HEALTH 07�VIT -0 -APPROVED :'�,' B wDA TE AGENT A,14 # LAN '0 _p P ED` P L RQ-0 T 9 ",-FOR A�ip "o �0, PROACTIMAIM 104 A 404,� e57'low, \A� A . C., F 35, ROAO, DA E _0 SCALF. A" 7, A It"m f "j; w ri T' j ,0FR Y L Kit N� Yt A "T" '7 % 7, 7 Y v 3-,;:7� ��Et k� Z, J AZ !A. M 4 iN P", -x,� , r s a G ,r J( 7 , . : y n S t . - F � f a to z . ,/ ° , 2 PROPOSED PLOT01 PLAN /-1-1 FOR ..:.."'N w•-.t{.R � J/j"/jj�J tea..'^. - }/—/ /{''/''''J `-' } j • yr' -, _ PROJECT LOCATION ��- S WEETSER ENGINEERING a5` t i' 235 GREAT WESTERN ROAD Dec%. P. 0. 80X 7 13 ( , �.<. � SOUTH DENNIS, MASS. 398 3922 02660 1 1s SCALE p DATE 1444 l7 , •`- ,. .- -- �i ,, / REVISED REVISED cos No. 0 SHEET 2 OF _ Z