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0049 SHEEP MEADOW ROAD - Health
49 Sheep Meadow Road, A = 109 - 028 v J • / a 0 v it f l� (N�o/U - Q ��..Q�ciPnC �Q� �� �yv�Q_�o [.S^ No.- --------------- i p` � � .S ( c h 7,1 Fee-------------------- BOARD OF HEALTH TOWN OF BARNSTABLE 01pp[icat ion-for Well Con0truction.Vermit Application is hereby ma a for a ermit to Construct (V), Alter ( ), or Repa' ( )an individual Well at: y --- ► Me� ow �21 — l_o 0 L9 Location — Address Assessors Maps and/Parcel t _—�Q.Q��d �1►_._--._-______ -- •L TQ U X 3�Z �_�-1�l'f(\ l�, c 0 J� I Owner I p Q /� Address 3-__a!J (krS_IVA1 ZZQ--------------- -� Installer — Tiller Address Type of Building Dwelling Other - Type of Building --- No. of Persons--- -•---_--------_--_--- Type of Well 4" SCHyo P�C- — Capacity 10 ky° —_ Purpose of Well--=-M----Si- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until a Certificate .of Compliance has been issued by the Board of Health. Signed ----_--_— - M d — da -------- Application Approved By — ° •- k �- �_L---___--- ate - Application Disapproved for the following reasons: _ date Permit No. UV �-ajo - O - - - — Issued--� - _------- ------ date -- -------- BOARD OF HEALTH TOWN OF BARNSTABLE (C ertif irate ®f (Compliance THIS IS TO� CERTIFY,`Tnh',at'1the Individual Well Constructed (�), Altered ( ), or Repaired ( ) y_1°1 by—1145 L- _ r� .---- �'—Installer Li at__ L ._ - has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. ---------------Dated------ -------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE ------ -- Inspector------_--_____-- -----____-- ;z No. l�v 1 0 ��-U- Vv'G l csP c 7 i� CP►'1n('� `,v� /It -j,i Fee---y� © BOARD OF HEALTH TOWN OF— BARNSTABLE 0(pplicat ion for Veil (ConfitructionPermit 1 Application is hereby�Am_a��e Eor a permit to Construct (✓), Alter ( ), or Repair ( )an individual Well at: oW —_---�-on 1 o28 — Location — Address _ Assessors Map and Parcel _(�)iWQrd , C, 3o537--- Owner Address Installer — EY ller Address Type of Building J Dwelling --- -—-- _---- _- Other - Type of Building No. of Persons--- Type of Well SCNL(o P V c- — Capacity /0 r ( �'m —_,— Purpose of Well P Y----------------- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until a Certificate.of Compliance has been issued by the Board of Health. Signed"A r date Application Approved BY R� �?1� i �l l date Application Disapproved for the following reasons: date Permit No. l N f/l 0 - o — — Issued—!/r 0_ --- —--—-- ------- date BOARD OF HEALTH TOWN OF BARNSTABLE (Certificate ®f (Compliance THIS IS TO CERTIFY, That the Individual Well Constructed V), Altered ( ), or Repaired ( ) by S M p a1�, Q I ��In9. --- ----- -- — - ----------- J Installer at__ Ll S 1\P_R io %LAA0W has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. ------------------Dated---------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE ---—_— __ Inspector ...- --- ------- BOARD OF HEALTH TOWN OF BARNSTABLE Ivell (Con$truct ion Permit No. W � U I 0 -0 ) F ee Permission is hereby granted to Construct (✓ ), Alter ( ), or Repair ( ) an Individual Well at: No. he D (`nod u W �c� t W��� ��-- -- ------------------------------------------ — y __— _street as shown on the application for a Well Construction Permit n No.- — -- Dated-- /-1 --- -- -------------- ----- - - DATE r -� Board of Health I � — F sus ., Page: CERTIFICATE OF ANALYSIS 1 Barnstable County Health Laboratory 4 �yrr_{.ate`•^� Report Prepared- For: Report Dated: 1/14/2010 Sally Desmond Order No.: G1055761 Desmond Well Drilling P O Box 2783 Orleans, MA 02653 Laboratory ID#: 1055761-01 Description: Water-Drinking Water Sample#: Sampling Location: 49 Sheep Meadow Rd.West Barnstable,MA Collected: 1/11/2010 Received: 1/12/2010 Collected by: Customer Routine ITEM RESULT UNITS RL MCL Method# Tested _ mg/L 0.10 10 EPA 300.0 1/12/2010 Nitrate as Nitrogen 2,$ mg/L 0.10 t.3 SM3111B ._ I/12/2010 Copper ND Iron ND mg/L 0.10 0.3 SM 311 I B` 1/12/2010 Sodium 48 mg/L 1.0 20 SM 31 I1B 1/12/2010 Total Coliform Absnet P/A 0 0 SM9923 1/12/2010 380 umohs/cm 2.0 E13A 120.1 1/12/2010 Conductance H 6.6 pH-units 0 SM 4500 H-13 1/12/2010 P Sodium level is above the maximrt contaminant level. Those on a low sodium diet may wish to consult a Physician._ �j' L� Attached please find the laboratory certified parameter list Approved By-,— 1.,� Director) ORIGINAL F ND None Detected Reporting RL = Re ortin Limit MCL=Maximum Contaminant Level = Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 f M Res Page: CERTIFICATE OF ANALYSIS 1 < T.: 9''• J� � 1 Report For: Barnstable County Health Laboratory Sally Desmond Report Dated: 1/14/2010 Order No.: G1055761 Desmond Well Drilling P O Box 2783 Orleans, MA 02653 La'boratory ID#: 1055761-01 Description: Water-Drinking Water Sample#: Sampling Location: 49 Sheep Meadow Rd.West Barnstable,MA Collected: 1/11/2010 Received: 1/12/2010 Collected by: Customer EPA 524.2- Volatile Organics by GC/MS ITEM RESULT UNITS RL MCL Method# Anal st Tested Note Di chi orodifluororriethane ND ug/L 0.50 EPA 524.2 yn 1/12/2010 Chloromethane ND ug/L 0.50 EPA 524.2 yn Il12/2010 Vinyl chloride ND ug/L 0.50 2.0 EPA 524:2 yn I/12/2010 Bromomethane ND ug/L 0.50 EPA 524.2 yn 1/12/2010 1,1,1,2-Tetrachloroethane ND ug/l, 0.50 EPA 524.2 yn 1/12/2010 1,1,1-Trichloroethane ND ug/L 0.50 200 EPA 524.2 yn 1/12/2010 1,I,2,2-Tetrachloroethane ND ug/L 0.50 EPA 524.2 yn 1/12/2010 1,1,2-Trichloroethane ND- ug/L 0.50 5.0 EPA 524.2 yn 1/12/2010 1,1-Dichloroethane ND ug/L 0.50 EPA 524.2 yn 1/12/2010 1,1-Dichloroethenc ND ug/L 0.50 7.0 EPA 524.2 yn 1/1212010 ND ug/L 0.50 EPA 524.2 yn 1/12/2010 1,1-Dichloropropene 1,2,3-Trichlorobenzene ND ug/L 0.50 EPA 524.2 yn I/12/2010 ND uglL 0.50 EPA 524.2 yn I/12/2010 1,2,3-Trichloropropane ug/L o.so 70 EPA 524.2 yn 1/12/20101,2,4-Trichlorobenzene ND ND ug/L 0.50 EPA 524.2 yn 1/12/2010 1,2,4-Trimethylbenzene ug/L 0.50 EPA 524.2 yn 1/12(2010 1,2-Dibromo-3-chloropropane ND' EPA 524.2 yn 1/12/2010 1,2-Dibromoethane(EDB) ND ug/l- o.so 1,2-Dichlorobenzene ND ug/L 0.50 600 EPA 524.2 yn 1/12/2010 ug/L o.5o s.o EPA 524.2 yn t/tz/zolo 1,2-Dichloroethane ND ug/L 0.50 EPA 524.2 yn 1/12/2010 1,2-Dichloropropane ND. ND ug/L 0.50 EPA 524.2 yn 1/12/2010 1,3,5-Trimethylbenzene ND ug/L 0.50 EPA 524.2 yn 1/12/2010 1,3-Dichlorobenzene ND ug/L 0.50 EPA 524.2 yn I/12/2010 1,3-Dichloropropane ug/L o.50 5.0 EPA 524.2 yn 1/12/20101,4-Dichlorobenzene ND ND ug/L 0.50 EPA 524.2 yn 1/12/2010 2,2-Dichloropropane ug1L 0.50 EPA 524.2 yn 1/12/2010 2-Chlor6toluene ND - 4-Chlorotoluene ND ug/L 0.50 EPA 524.2 yn 1/12/2010 ND ug/L 0.50 5.0 EPA 524.2 yn 1/12/2010 Benzene Bramobenzene ND ug/L 0.50 EPA 524.2 yn 1/12/20►0 Bramochloromethane ND ug/L 0.50 EPA 524.2 yn 1/12/2010 Bromodichloromethane ND ug/l. 0.50 EPA 524.2 yn 1/12/2010 Bromoform ND ug/L 0.50 EPA 524.2 yn 1/12/2010 ug/L 0.50 s.o EPA 524.2 yn 1/12/2010Carbon tetrachloride ND ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level Ph: 508-375-6605 cainerior Court House, PO.Box 427, Barnstable, MA 02630 r Page: 2 CERTIFICATE OF ANALYSIS Report For: Barnstable County Health Laboratory Sally Desmond Report Dated: 1/14/2010 G1055761 Desmond Well Drilling Order No.: P 0 Box 2783 Orleans, MA 02653 Laboratory ID#: 1055761-01 Description: Water-Drinking Water Sample#: Sampling Location: 49 Sheep Meadow Rd.West Barnstable,MA Collected: 1/11/2010 Received: 1/12/2010 Collected by: Customer EPA 524.2 Volatile Organics by GUMS RESULT UNITS RL MCL Method# Analyst Tested Note ITEM 2/2010 Chlorc-benzene ND ug/L 0.50 too EPA 524.2 yn 1/1 Chloroethane _ . ND ug/L 0.50 EPA 524.2 yn 1l12/2010 Chloroform ND ug/L 0.50 80 EPA 524.2 yn 1/12/2010 cis-1,2-Dichloroethene ND ug/L 0.50 70 EPA 524.2- yn 1/12/2010 cis-1,3-Dichloropropene ND ug/L 0.50 EPA 524.2 yn 1/12/2010 Dibromochloromethane ND ug/L 0.50 EPA 524.2 yn 1/12/2010 Dibromomethane ND ug/L 0.50 EPA 524.2 yn 1/12/2010 Ethylbenzene ND ug/L 0.50 700 EPA 5247,2- yn 1/12/2010 Hexachlorobutadiene ND ug/L 0.50 EPA 524.2 yn 1/12/2010 Isopropylbenzene ND ug/L 0.50 EPA 524.2 yn 1/12/2010 Methylene chloride. ND ug/L 0.50 5.0 EPA 524.2 yn 1/12/2010 Methyl-tert-butyl ether ND ug/L 0.50 EPA 524.2 yn 1/12/2010 Naphthalene ND ug/L 0.50 EPA 524.2 yn 1/12/2010 n-Butylbenzene ND ug/L 0.50 EPA 524.2 yn 1/12/2010 n-Propylbenzene. ND ugfL 0.50 1-IPA 524.2 yn 1/12/2010 p-Isopropyltoluene ND ug/L' 0.50 EPA 524.2 yn 1/12/2010 sec-Butylbenzene ND ug/L 0.50 EPA 524.2 yn 1/12/2010 Styrene ND ug/L 0.50 too EPA 524.2 yn 1/12/2010 tert-Butylbenzene ND ug[L 0.50 EPA 524.2 yn 1/12/2010 Tetrachloroethene ND ug/L 0.50 5.0 EPA 524.2 yn, 1/12/2010 Toluene ND ug/L 0.50 1000 EPA 524.2 yn 1/12/2010 Total xylenes ND ug/L 0.50 10000 EPA 524.2 yn 1/12/2010 trans-1,2-Dichloroethene ND ug/L 0.50 100 EPA 524.2 yn 1/12/2010 trans-1,3-Dichloropropene ND ug/L 0.50 EPA 524:2 yn. 1/12/2010 Trichloroethene ND ug/L 0.50 5.0 EPA 524.2 yn 1/12/2010 Trichlorofluoromethane ND ug/L 0.50 EPA 524.2 yn 1/12/2010 Sodipm level is above the ntaxium contaminant level. Those on a low sodium diet may wish to consult a physician. Attached please find the laboratory certified parameter list. Approved By. b Director)i ORIGINAL . 1 j�/- ND=None Detected Reporting RL = Re ortin Limit MCL=Maximum Contaminant Level Runerior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 do r Massachusetts Department of Conservation and Recreation Massachusetts Office of Water Resources Well Completion Report 13-JAN-10 09:55:28 WELL LOCATION 269571 GPS North: 410 42.615' GPS West: -700 23.64' Address: 49, Sheep Meadow Lane Property Owner/Client: Lee Royall Subdivision Name: Mailing Address: P.O. Box 352 City/Town: Barnstable City/Town, State:Dillard GA Assessors Map: Assessors Lot #: Permit Number:W2010-01 Board of Health permit obtained: Y Date Issued: 01/11/2010 Work Performed Proposed use Drilling Method Overburden Drilling Method Bedrock New Well Domestic Auger CASING From (ft) To (ft) Type Thickness Diameter 1.00 -80.00 PVC Schedule 40 4.00 SCREEN From (ft) To (ft) Type Slot Size Diameter -80.00 -84..00 Stainless Steel Well .012 4.00 Point WELL SEAL / FILTER PACK / ABANDONMENT MATERIAL From (ft) To (ft) Material Description Purpose WELL TEST DATA (ALL SECTIONS MANDATORY FOR PRODUCTION WELLS) — Date Method Yield Time Pumped Pumping Level Time to Recover Recovery (GPM) (hrs & min) (Ft. BGS) (Hrs & Min) (Ft. BGS) 01/11/2010 Constant Rate Pump 12.0000 1:30 82.0000 0:01 30 STATIC WATER LEVEL (ALL WELLS) PERMANENT PUMP (IF AVAILABLE) Date Depth Below Ground Pump Description:Starite 3/4HP 10GPM composite Measured Surface (ft) Type: 2 Wire Constant Speed Submersible Intake Depth: 84.0000 01/11/2010 30 Nominal Pump Capacity: 10.0000 Horsepower: .7500 WELL DRILLER'S STATEMENT ADDITIONAL WELL INFORMATION Driller: Thomas E Desmond III Developed: Yes Fracture Enhancement:No Supervisor: Thomas Desmond III Rig #: 100 Disinfected: Yes Well Seal Type:None Firm: Desmond Well Drilling Inc. Total Well Depth: 84.000 Depth to Bedrock: Registration #: 764 Date Complete:01/12/2010 Comments: _ - OVERBURDEN __.. From To Description Color Comment Water Loss/Add Drill Drill (ft) (ft) Zone of Fluid Stem Drop Rate .00 75.00 Fine to Coarse Sand Brown tr silt Yes N/A 75.00 84.00 Fine to Coarse Sand Brown Yes N/A BEDROCK From To Code Comment Water Drill Extra Drill Rust Loss/ # of (ft) (ft) Zone Stem Large Rate Stain Add of Frac Dron per ft 1/1 I CERTIFICATE OF ANALYSIS Page: 1 Barnstable County Health Laboratory •,scgCSE," Report Prepared For: Report Dated: 6/5/2008 E.F. Winslow Plumbing&Heating Order No.: G0846333 8 Reardon Circle South Yarmouth, MA 02664 Laboratory ID#: 0846333-01 Description: Water-Drinking Water Sample#: Sampling Location: 49 Sheep-Mcadow Rd:"W.'Barnstable-,-MA� Collected: 5/23/2008 Collected by: J.Clark Received: 5/23/2008 Test Parameters ITEM RESULT UNITS RL MCL Method# Analyst Tested Note Tannin&Lignin ND mg/L 0.20 SM 5550B yn 6/4/2008 Sodium level is above the maximum contaminant level Those on a low sodium diet may wish to consult a physici n. Approved By: (Lab ector)i ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 CERTIFICATE OF ANALYSIS Page: 1 'Q Barnstable County Health Laboratory Report Prepared For: Report Dated: 6/5/2008 E. F. Winslow Plumbing&Heating Order No.: G0846333 8 Reardon Circle South Yarmouth, MA 02664 Laboratory ID#: 0846333-01 Description: Water-Drinking Water, Sample#: Sampling Location:.49-Sheep-Meadow=Rd:W.-Barnstable;P Ate-'-j Collected: 5/23/2008 Collected by: J.Clark Received: 5/23/2008 Test Parameters ITEM RESULT UNITS RL MCL Method# Tested Hardness 45 mg/L as CaCO 0.1 SM 2340B 5/29/2008 Iron ND mg/L 0.1 SM 3111 B 5/29/2008 Mangar_ese 0.01 mg/L 0.01 SM 3111 B 5/29/2008 Sodium 63 mg/L 1 20 SM3111B 5/29/2008 pH 6.5 pH-units 0 SM 4500 H-B 5/23/2008 Sodium level is above the maximum contaminant level. Those on a low sodium diet may wish to consult a physici . Approved B _._ _ . (Lab ector) co cri cV o ca �-- N ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO. Box 427, Barnstable, MA 01630 Ph: 508-375-6605 Town of Barnstable P 0 Department of Regulatory Services t�srrar�►us, � Public Health Division Date MARL 1?4 bsy ��� 200 in Street,Hyannis MA 02601 MJa 0 Date Scheduled Time Fee Pd. Soil Suitability Assessment for Sewage Disposal Performed By: �ccMo e.( el0141`Q,( E-L i CS E 1 1 Witnessed By: Lb1lYl1t }(1©IranC�( LOCATION& GENERAL INFORMATION Location Address o f S h e e p 1Ze-A-,) Owner's Name j q rn eS :-j) 6 S a pj VJeaT 3 •,ar�Q12 Address Lici SkeeP ✓Yte✓�.� f(E1k( / r Assessor's Map/Parcel: lol o 21 Engineer's Name- -L >� kR-0-4<n NEW CONSTRUCTION REPAIR T -Z r_ Telephone# ,SbFS ?J C� Land Use S('n5\� Tr^ : Slopes(%) J'1 0 Surface Stones Distances from: Open Water Body 7 100 ft Possibl- Net Area ft Drinking Water Well 2-i ft Drainage Way 7 100 ft �Pry .y Line —7-[0 ft Other � ft SKETCH:(Street name,dimensions of lot,exact It Y ions of test holes&pero tests,locate wetlands in proximity to holes) ql q Or-,d b r JC L v1�tr'leet-t;� t� Parent material(geologic) Ul; w�Sin. Depth to Bedrock -7 1 y y b�3 h Depth to Groundwater. Standing Water in Hole: -7 ,y 4 b�5 Weeping from Pit Face 7 1 N ii Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: D treGF 01ose.ruo Ftv n Depth Observed standing in obs.hole: 7 14.y In, Depth to soil mottles: 7 (yy In, Depth to weeping from side of obs.hole: 7 (14Y in, Groundwater Adjustment ft. i Index Well# Reading Date: Index Well level Adj,factor„ - Adj.Oroundwater Level..:- PERCOLATION TEST Ditto- Tlmi C Observation - Hole# 'rime at 9" ZQ:3 11 N _ Depth of Perc b-6 y Time at 6' M Start Pre-soak Time @ l0 AX Time(911•6").�J mty5__._____ v End Pre-soak )Q 2 M J Rate MinJlnch Site'Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(YIN) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***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:\SEPT10PERCFORM.D0C \ e^ DEEROBSERVATION HOLE LOG Hole# i Depth from Soil Horizon Soil Texture .Sdil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistencv. Gravel) 6- 3 LlEfe� . 3--7 Fed 7 �- 9 — 56 6-o1 FS /6yr516 sc-et.,e-j 1;'Y6 6 l0-20/' gv-0we-k iowe. 'lilt : 14 DEEP OBSERVATION HOLE LOG Hole# 2 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. ns' o.- 3 Li er 3 - 7 F�l 7- 9 A &S y-tip 3 Ls 10 5/$ - - y4-'58 G-1 Fs 5-i044 9�a�el S@- 8 2• C-2 CS 1. �i i fo/6 10-1014 ca�wP-�lac:5` I .. t32- t Ify C-3 -CS 2.5 i l°I b 4 5 �/t grc.ve-1 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistencv.%Oravell DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. • on Z Flood Insurance Rate Man: Above 500 year flood boundary No— Yes Within 500 year boundary No A Yes Within 100 year flood boundary No-2� Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the o area proposed for the soil absorption system? us material? I If not,what,is the depth of naturally occurring pervio Certification I certify that on /oval (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with t . the required training,expertise nd experience described in 3 10 CMR 15.017. Signature 0 Date j 1-V 0 7 Q:\SEP71L'%PERCFORM.DOC f r-°F HAS CERTIFICATE OF ANALYSIS Page: 1 O Tpsl. Barnstable County Health Laboratory Report Prepared For: Report Dated: 10/5/2007 Joseph Nastasi Order No.: G0743648 P0 Box 913 Barnstable, MA 02630 Laboratory ID#: 0743648-01 Description: Water-Drinking Water Sample#: Sampling Location .Barnstable,MA q �/� � Collected: 10/1/2007 Collected by: J.Nastasi q ` nil eo, /� ,�,,• � C`y'L Received: 10/1/2007 Routine "( I►, vK U"`� ITEM RESULT UNITS RL MCL Method# Tested Nitrate as Nitrogen 3.3 mg/L 0.10 10 EPA 300.0 10/1/2007 Copper ND mg/L 0.10 1.3 SM 311113 10/2/2007 Iron ND mg/L 0.10 0.3 SM 3111 B I^/2/2007 I Sodium 70 mg/L 1.0 20 SM 3111B 10/2/2007 Total Coliform Absent P/A 0 0 SM9223 10/1/2007 Conductance 580 umohs/cm 2.0 EPA 120.1 10/1/2007 pH 6.6 pH-units 0 SM 4500 H-B 10/1/2007 Sodium level is above the maximum contaminant level. Those on a low sodium diet may wish to consult a physic' n. Approved By: (Lab Di ctor) ti 1 ND=None Detected RL = Reporting Limit = p g MCL Maximum Contaminant Level Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 TOWN OF BARNSTABLE LOC,NTION SEWAGE# d 7 Y; VILLAGE V- gcc/vt sh.� le ASSESSOR'S MAP&PARCEL Jb 9 — �b INSTALLERS NAME&PHONE NO. Cat W r A �Cn yo?f 4G d2F SEPTIC TANK CAPACITY LEACHING FACILITY:(type). y ap 5-oo (size) /Z r e2,1r NO.OF BEDROOMS OWNER awe,¢.$ A- V4utv1. 37kk.aSO►n PERMIT DATE: 12-S� — Lco"1 COMPLIANCE DATE: 1 )," C.— ZOO- Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility .yo I Z 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 DG[cJld, FURNISHED BY e �R e/ 1,;eS CJC c q Y r7•S` A , . r 1,1 4q.o ►4S S3•n t A Sfo•o r3 a r, �a 3 ' -4 U•o 8`I 3s•s K V vo J No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: (PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZIpprication for Oioonl *pgtem Cootruction Permit Application for a Permit to Construct( ) Repair(V�Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. y q S�pev Owner's Name,Address,and Tel.No. `YA-m-e S -5 0\e�>o r1 kA3.34.nST.4W-- L145k4_W Ate,OJd..! Assessor's Map/Parcel I Oct •- t J•5/�n 5;-Q-31 e Installer's Name,Address,and Tel.No. 6QP4,.1'G& Pr'SR S Designer's Name,Address and Tel.No. 7 b3S�l C�anbar✓y kyuY y D 1-�S C� H�I e nn Ps La fo3 s 4�oS •2-7 0 3�7 EfFa r w a r e�,q+M srr a Type of Building: Dwelling No.of Bedrooms Lot Size S 0 1 sq.ft. Garbage Grinder ( ) Other Type of Building _ No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 33 D gpd Design flow provided 3 3 S gpd Plan Date I Z-`�-7 0�7 Number of sheets Revision Date Title L4ft 5 ri Size of Septic Tank t000 Type of S.A.S. 2� �00 SW-t, d - La L• e.,�$1t2 Q Description of Soils rp 1+wr+ C ` (p �i — Nature of Repairs or Alterations(Answer when applicable) S i�ti �ln-w. To nQ,,,j -D— 9p X Date last inspected: Agreement: T:he undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signe ate i2 '� Zav� Application Approved by ate IGIL-A�/ !Z Application Disapproved by: Date for the following reasons Permit No. Date Issued ———————————— ————————————————— — — ———————-- No. - �✓ Fee TH,E`COMMPNWt EALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN,OF BARNSTABLE, MASSACHUSETTS Yes Zlppricatton for �hgpo5ar 5tetrt Con!6tructtou Permit 1 Application for a Permit to Construct( ) Repair(V Upgrade( ) Abandon( ❑.Complete System ❑Individual Components Location Address or Lot No. y Q S h eaP M e AAou! R a Owner's Name,+Address,and Tel.No. -TAY.•j; -J j\e 5 Q r1 uJ 3 4+�5 T cti-3)� `,,•:s,{�s�-•.�a.p ,ryr e�do,.J Assessor's Map/Parcel I pq Z 3��n 5 r'n G e Installer's Name,Address,and Tel.No. G�(� '�` t°'`'°s Designer's Name,Address and Tel.No. w�Cr• E"'J i�a CC;�1G -74-3 ZFSS`4 G�a�bu��. 0 �Ols y 2� 11D112 C� ,rr.r,ate r�A o2b3i- �oh - 2-73- 03"77 rer rs Type of Building: Dwelling No.of Bedrooms Lot Size 3 s, U 1 �� sq.ft. Garbage Grinder ( ) Other Type of Building S6,4 h 6» No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 3 i7 gpd Design flow provided 3 3 1 gpd Plan Date I Number of sheets Revision Date.. Title L-15 5 Size of Septic Tank /000 Type of S.A.S. (2) �-v0 YkL 14 ' Zo t ate Description of Soil y Nature of Repairs or Alterations(Answer when applicable) E;Z 51)toy T)s,t — 72a Y'4. 'b—)7 D A ` 4 Date last inspected: Agreement: ` The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signe n ate ao Application Approved by i _ ?� �'� Date 49— o Application Disapproved by- v y Date for the following reasons s 1` Permit No. '.> - L .,,Date Issued°THE COMMONWEALTH OF MASSACHUSETTS , BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that�the On-site Sewage Disposal System Constructed.( ').R Repaired (t4 Upgraded ( ) Abandoned( )by 4n• (� 0 i✓'1ti`I•e��' >`�j l,l C at y5 5L-91 SAC AJ*, J has been co strutted in a(;;�jjordance with the provisions of Title 5 and the for Disposal System Construction Permit No. ��CZdated Installer G�RQw�J�ke &I' U Qrl S•C S. L-k-e_ Designer 5 •c-. 6) 14,QAAI , #bedrooms i Approved desig owAl gpd The issuance of this permit shall not b c n4rued a a guarantee that the system wi un•do as design /J 1 // Date Inspector ] � j `S ---- — ---- -----' ———— v -- No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS lwt.gpo.gar 6potem Co tructton Permit Permission is herebyanted to Construct Repair 1�U rade Abandon ,�' � ) P � ) pg � ) � ) System located at (4 4 d ` W1!�Xv r8 arc h�^!3 lti M - and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Const ctio must a completed within three years of the date of thi i 4� Date r r Approved by 5 a '` oftow .sarnstabt� regulatory Services ( pass Thomas F.Geller, Director , {d� „ ' Public Health Division - �` Tathas McKean,birectar I 200 Main Street,Hyannis,MA 260 Office: 508-862.4644 Fax: 508.790.6304 Installer & Designer Certification Form Date: t Z 7 ? Desigoer: ECG Cn c riee c �,'� r Installer: GOaew,der 6.+ter case s Address: �a 5 y CcQv►tinecc H .�.b Address:. -Z( �S . e�`2 "L On bet S Zoo L j 1 L'vl �.a� was issued a permit to install a ( ate) (installer) j septic system at y9 Slf . hQctaaw w ensFab►e. bated on s design drawn-by {address) dated Of m\vcc 'l� 2uo7 .(designer) X I certifythat the septic stem referenced p ab ove ew Y as installed sub stantially according to the design,; which may include minorapproved changes ;such lateral relocation of the distribuition'box and/or septic tank. j I certify that the septic system referenced above was instal fed 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& Loeal i eguladons. Plan revision or certified as�built by designer to follow: j' taller.'s Sign e,) j esi er s ia if esigner' S p Here LEASE RE U ; O B S, E P B LT TI N.MILL N .OF L E TETIL RECEIVE TH O . T UN. Q:Healtiv'Septic/D6ignor Certification Potm 10 •d 1 9i0 tiLZ 80S !)N I N33N I`J' N33l+ Wd LS: Z0 L00Z-L0-33Q ,Comnionwealth of Massachusetts q.RW Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 49 Sheep Meadow Rd. Property Address James& Kevin J. Juleson Owner Owner's Name information is required for W Barnstable Ma. 02668 11/01/2007 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. r Important: A. General Information When filling,out Lk forms on the computer,use 1. Inspector, only the tab key to move your Robert Paolini 1 0 l s cursor-do not use the return Name of Inspector I key. Capewide Enterprises,LLC .Company Name raa P.O.Box 763 Company Address y" Centerville Ma. 02632 co City/Town State Zip Code L; �ri (508)428-4028 S14454 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training.and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Nee Further Evaluation by the Local Approving Authority 11/01/2007 Inspector's Signature Date The system inspector'shail 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. 49 sheep meadow rd.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 I �.<L'\ ,Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 'M 49 Sheep Meadow Rd. Property Address James& Kevin J. Juleson Owner Owner's Name information is required for W Barnstable Ma. 02668 11/01/2007 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The leaching pit is in hydraulic failure.Title Five upgrade is needed. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Answer yes, no or not determined (Y, N, ND) in the ❑ for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: 1 ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed 49 sheep meadow rd.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 49 Sheep Meadow Rd. Property Address James & Kevin J. Juleson Owner Owner's Name information is required for W Barnstable Ma. 02668 11/01/2007 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed ND Explain: 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 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. 49 sheep meadow rd.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 49 Sheep Meadow Rd. Property Address James& Kevin J. Juleson Owner Owner's Name information is required for W Barnstable Ma. 02668 11/01/2007 every page. City/Town State Zip Code Date of Inspection B. Certification (cost.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: Yes No ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ® ❑ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ® ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool P, ElLiquid depth in cesspool is less than 6" below invert or available volume is less than %day flow Required pumping more than 4 times in the last year NOT due to clogged or El ® obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high groundwater elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. 49 sheep meadow rd.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts - Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 49 Sheep Meadow Rd. Property Address James & Kevin J. Juleson Owner Owner's Name information is required for W Barnstable Ma. 02668 11/01/2007 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): 1 Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. � ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you-must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of.any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 49 sheep meadow rd.•06/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 -Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 49 Sheep Meadow Rd. Property Address James& Kevin.J:Juleson Owner Owner's Name information is required for W.Barnstable Ma. 02668 11/01/2007 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done.You must indicate"yes"or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® El available as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ❑ ® Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] 49 sheep meadow rd.-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 49 Sheep Meadow Rd. Property Address James & Kevin J. Juleson Owner Owner's Name information is required for W Barnstable Ma. ` 02668 11/01/2007 every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage (gpd)): Well Water 9 ( Y 9 Sump pump? ❑ Yes ® No Last date of occupancy: Date 2007 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): 49 sheep meadow rd.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 r Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° M 49 Sheep Meadow Rd. Property Address James & Kevin J. Juleson Owner Owner's Name information is required for W Barnstable Ma. 02668 11/01/2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: • gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution.box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) i ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) ❑ Tight tank. Attach a copy of the DEP approval. p ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: 1984 Were sewage odors detected when arriving at the site? ❑ Yes ® No 49 sheep meadow rd.•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 49 Sheep Meadow Rd. Property Address James & Kevin J. Juleson Owner Owner's Name information is required for W Barnstable Ma. 02668 11/01/2007 every page. City/Town State Zip Code Date of Inspection D. System Information-(cont.) Building Sewer(locate on site plan): 1' Depth below grade: feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: 20+ feet Comments (on condition of joints, venting, evidence of leakage, etc.): r Joints appear tight.No evidence of Ieakage.System vented through the house vents. Septic Tank(locate on site plan): 1, Depth below grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) l If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No -------------------------------------------------------------------------------------------------------------------------- Dimensions: 8,6"x4'10"x57' Sludge depth: 10" Distance from top of sludge to bottom of outlet tee or baffle 20" 14" Scum thickness Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 8„ How were dimensions determined? measured 49 sheep meadow rd.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 f -Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 49 Sheep Meadow Rd. Property Address James & Kevin J. Juleson Owner Owner's Name information is required for W.garnstable Ma. 02668 11/01/2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pump septic tank every 2-3 years.lnlet and outlet tees are in place.Tank appears structurally sound.No evidence of leakage. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): it 49 sheep meadow rd.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 i f -Commonwealth of Massachusetts - Title 5 Official, Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 49 Sheep Meadow Rd. Property Address James& Kevin J. Juleson Owner Owner's Name information is required for W Barnstable Ma. 02668 11/01/2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank (cont.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.):. *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Yes Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-Box is level.Box has one outlet lateral.Evidence of solids carryover.Evidence of leakage out of box. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 49 sheep meadow rd.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 r -Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 49 Sheep Meadow Rd. Property Address James & Kevin J. Juleson Owner Owner's Name information is required for W Barnstable Ma. 02668 11/01/2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 1-1000 gallon ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Sandy soil.Pit is in hydraulic failure.Leaching pit was full at time of inspection. 49 sheep meadow rd.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 r -Commonwealth of Massachusetts W Title 5 Official Inspection Form , Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 49 Sheep Meadow Rd. Property Address James &Kevin J. Juleson Owner Owner's Name information is required for W Barnstable Ma. 02668 11/01/2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): ` Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 49 sheep meadow rd.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 I Map ' a Page 1 of 2 Town of Barnstable Geographic Information System Parcel Viewer Custom Map Abutters Map Size ® Zoom Out J J J J In ' y T +- r t a' , 4 ♦` r. i i` �. G 0 Feet Set Scale 1" = 20 I Aerial Photos (nn.irinhf')r)nr_')On7 Tnuin of Rornefohln hAA All rinhke--1, http://www.town.bamstable.ma.us/arcims/appgeoapp/map.aspx?propertyID=109028&map... 11/1/2007 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 49 Sheep Meadow Rd. Property Address James& Kevin J. Juleson Owner Owner's Name information!isW.garnstable Ma. 02668 11/01/2007 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate.where public water supply enters the building. 49 sheep meadow rd.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 49 Sheep Meadow Rd. Property Address James & Kevin J. Juleson Owner Owner's Name information is required for W Barnstable Ma. 02668 11/01/2007 every Rage. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope . ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to ground water: Bottom of leach pit 35' feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: As-Built Card ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: USED:Gaherty& Miller model 12/16/94 ground water elevations. USED:USGS Observation Well Data June 1992. USED:Technical Bulletin 92-000-01 plate#2 Annual ranges of ground water elevations. 49 sheep meadow rd.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 r Town of Barnstable • OF tHE 1p� yP� ti� Regulatory Services -snRtvsrnate, Thomas F. Geiler�Director • • 9�A �� •�� Public Health .Division TFD MA'S A Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 This septic system inspection report was completed by a private inspector who is certified b the State of Massachuset ts,tts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original/copy of this report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observation s and interpretations contained within this report. In addition, by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would-be listed on the "Disposal Work Construction Permit". If you should have any questions regarding this report,please contact the certified Septic System Inspector who conducted the inspection. 1HE Town of Barnstable • OF 1p� Regulatory Services BAMSUBLE Thomas F. Geiler,Director y MASS. g $p 019. Public Health .Division TFD MA'S A Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-8624644 Fax: 508-790-6304 This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original/copy of this report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observation s and interpretations contained within this report. In addition, by receiving this report the Town of Barnstable Health Division does not aut omatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would-be listed on the "Disposal Work Construction Permit". If you should have any questions regarding this report,please contact the certified Septic System Inspector who conducted the inspection. Town of Barnstable �p 1HE Tp� Regulatory Services BARNSUBLE Thomas F. Geiler,Director MAM ,erED �p Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original/copy of this report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observation s and interpretations contained within this report. In addition,by receiving this report the Town of Barnstable Health Division does not automatically approv3 the number of bedrooms listed within this report. The actual .number of bedrooms.approved at a particular property would-be listed on the "Disposal 'Work Construction Permit'. If you should have any questions regarding this report,please contact the certified Septic System Inspector who conducted the inspection. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C y ( SYSTEM INFORMATION (continued) Property.Address: T11 61449®W Owner:, RFG Marcy Date of Inspection:l��i_y'7 l 11 Depth to Groundwater5� Feet f" Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observation of Site (Abutting property, observation hole, basement sump etc.) Determine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records. Check local excavators, installers Use USGS Data Describe in your own words how you established the High oundwater Elevation. Must be completed) 2 C)Quu�ubw�+ 2jP , PAP ' I (revised 04/25/97) Page 10 of 10 ti, SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM • PART C SYSTEM INFORMATION (continued) Property �j P Y Address: "I S PEG P EA ®w � Owner: Date of Inspection: ' SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) BEAR nil" .�11 r •� +nof (revised 04/25/97) Page 9 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: SNEEi"/HE,�oOw` Owner: PfG MASS C'Y Date of Inspection: /0,_/_y7 SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) LDCAI-E(3 f AJ (•v00(JS , b t O Ivor EXCA V ATO% If not determined to be present, explain: Type: &16 So(F00.1- CE/ttc H Pfr' leaching pits, number: leaching chambers, number.__ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) CESSPOOLS: (locate on site plan) Number and configuration: Depth-top:of liquid to inlet invert: Depth of solids layer: Depth of sr-um layer: Dimensions of cesspool: Materials cf construction: Indication of groundwater: inflow (cesspool must be pumped as part of inspection) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY: (locate on site plan) Dimensions: Materials of construction: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) I (revised 04/25/97) Page 8 of 10 vkY':'lYM'kpgSKi.�.MON•w.,.w.w^}.w. �•+..,nMo*•r,.t�s+vk..wn...MN'+'.�_s.+16�M.<y...+n...www.r..n.rw.w *mr ..x.s.,.wrs-r N.e.a» . _. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: I q 97CF1 /i'iCt�Qu/ Owner: PIEG nI ASP46 y Date of Inspection: 10-1_17 TIGHT OR HOLDING TANK: (Tank must be pumped prior to, or at time, of inspection) (locate on site plan) Depth below grade: Material of construction: _concrete —metal _Fiberglass _Polyethylene —other(explain) Dimensions: Capacity: gallons Design flow: galions/day Alarm level: Alarm in working order— Yes; _ No Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) ' V DISTRIBOTION BOX: (locate on site plan) Depth of liquid level above outlet invert: 1q7, ,6gMM OF PiPF Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) _ ,No ccuo5 ONE Pi PE i/Lr�• ORJCs Pier OL 7- , VERY 6000 SYA E PUMP CHAMBER: (locate on site plan) Pumps in working order: (Yes or No) Alarms in working order (Yes or No) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 04/25/97) Pagi 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: q SNEf PrVIMO,J P _/ Owner: PGG M/fSTE TtJ Dale of Inspection: BUILDING SEWER: (Locate on ;ite plan) Depth below grade: Material of construction: _cast iron _40 PVC other (explain) Distance from private water supply well or suction line• Diameter Comments: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK:' (locate on site plan) Depth billow grade: 6" Material of construction: 'K concrete _metal _Fiberglass _Polyethylene _other(explain) Se�'T c LA If tank is +petal, list age _, Is age confirmed by Certificate of Compliance _(Yes,/No) Dimensions:116(-X'1:'1/0rrL1'1 Sludge depth: �� Distance from top of sludge to bottom of outlet tee or baffler�NCi-1$ Scum thickness: p Distance from top of scum to top of outlet tee or baffle: / riveN, Distance fium bottom of scum to bottom of outlet tee or bfle: a rAcNS How dimensions were determined: TAIOETE'ASoke Comments: (recomrnendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural � VCRV Ulrt SDu115 . tS i/t! VE2Y integrity, evidence of leakage, etc.) E / ��� SNIP E /lJ RE' c Q f I- lrL) L!Cr GREASE 'f F:AP: (locate on site plan) Depth ( -low grade: Material of construction: _concrete _metal _Fiberglass _Polyethylene _other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) (zmvinnd C'4/45/97) Page 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C. SYSTEM INFORMATION Property Address:q9'Sy6rCb InL AOaw Owner: /-n(G In4 S7FY Date of Inspection:!D-/_9 7 i FLOW CONDITIONS RESIDENTIAL: Design flow: 3.3Q g. d./bedroom for S.A.S. Number of bedrooms: Number of current residents:,LRhPr*V SINCE in o0.SGP7r Garbage ghnder (yes off:L\10 Laundry connected to system(aor no):�S Seasonal use (yes or(Oy NO _ Water meter readings, if available (last two (2) year usage (gpd): PRIi1q7L;:: uLI C-u-. Sump Pump (yes oK0):L0 Last date of occupant},: III I SEPT. COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow:_gallons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings, if available: Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and so ce of infor ation: rnewy /{il�1i u COCA LY 1 LAST PurnP ;�-irk-% , owrucR System pumped as part of inspection: (yes or&y—vo If yes, volume pumped: gallons 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) I/A Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known) and source of information: lq PPROX is Y2S Ot-D Sewage odors detected when arriving at the site: (yes or��0 (revised 04/25/97) Page 5 of 10 I r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: yC( Owner: PL rads'Tuy Date of Inspection:�D.!_C�� Check if the following have been done You must indicate either "Yes" or "No" as to each of the following: Yes No Pumping information was provided by the owner, occupant, or Board of Health. X x _ None of the system:components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water hayse�o��n introduced into the system recently or as part of this inspection.H[O�E 61nPTY SINCE M I D As built plans have been obtained and examined. Note if they are not available with N/A. The facility or dwel ing was inspected for signs of sewage back-up. The system does nct receive non-sanitary or industrial waste flow. The site was inspected for signs of breakout. All system components, excluding the Soil Absorption System, have been located on the site. The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of ns, depth of liquid, depth of sludge, depth of scum. baffles or tees, material of construction, dimensio The size and location of.the Soil Absorption System on the site has been determined based on: _ The facility owner ;and occupants, if different from owner) were provided with information on the proper maintenance of Sub-Surface Disposal System. Existing information. Ex. Plan at B.O.H. ^ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) [15.302(3)(b)) Page 4 of 10 (revived 04/25/97) i I ' > SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A • s CERTIFICATION (continued) Property Address: ygSiaECP m(ilOdcO Owner: Pe6fild9STEv Date of Inspection: r��/•,p I i D] SYSTEM FAILS: You must indicate either "Yes" or "No" as to each of the following: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to corre< the failure. Yes No _ Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 112 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _. Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with nc acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. El LARGE SYSTEM FAILS: You must indicate either "Yes" or "No" as to each of the following: The following criteria-apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one.or.more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area- IWPA) or a mapped Zone 11 of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 04/25/97) Page 3 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address, ;a 1 5j45TTc EY ��� Gam Owner: PC14 . Date of Inspection: /0-1—q 7 45,ti BJ SYSTEM CONDITIONALLY PASSES (continued) r IA Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). Describe observations: broken pipe(s) are replaced ,obstruction is removed distribution box is levelled or replaced _ The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed CJ 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 the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. T) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. I well. _ The system has.a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply _ The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER Page 2 of 20 (revised 04/25/97) • V rI \ COMMONWEALTH OF MASSACHUSETTS 7 EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE HINTER STREET. BOSTON. NIA 02108 61;-292-55.PD,® 11 (. 1, /' COXE , TRUDYWILLIANI F.WELD Secretary Govemo: O1'4 /_ DAVIDB.STRUHS ARGEO PAUL CELLUCCI Commissioner Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTPART A CERTIFICATION Property Address:Fig5Nerg-PMEA00viAddress of OwnDate of Inspedion:.t0"t"y7 (If different) Y1'!I, C33C I Name of Inspector: COWARDC,13c'USFIEep I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) Company Name: EDWARD C 1900S'FIQ�0 Mailing Address: 62 W00 AVE' S�31VOW 15-q I' Telephone Number: $$b3 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: _ Passes _ Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority _ Fails Inspector's Signature:/-''C Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this inspection. If the system is a shared system of has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit office of the Department of Environmental Protection. The original should be sent to the system owner regional o ce p h appropriate the report toteg and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Checl�� A/ B, C, or D: A] SYSTEM PASSES: �. I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any.failure criteria not evaluated are indicated below. OOD G�l?lJlrf o/l) vCR�' Gi1kTL COMMENTS: LI,DIU PII A IN V�� - (alas , G L/1�'�i� CZ IC U .S r S ��ti v 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. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not. _ The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (ravixad 04/25/97) ?age 1 of 10 DEP on the World Wide Web' http:l/www.magnet.state.ma.us/dep 0 Printed on Recycled Paper Z� CATION �. � ` ' SEWAGE PERMIT NO. ti' 1.3 - 5,4030 �t"oow Raj. 84- 90 VILLAGE j !U EST lQ4+2ct5T ,�LE �` l ® y I N S T A LLER'S NAME & ADDRESS w _ &8Mr B. 0114 Cd 1AC c. ADD iW4 SS R U I L D E R OR OWNER RpAw er JY s-5Sac . • ff;%,u�Jrs, MQ ss_ DATE PERMIT ISSUED O DATE COMPLIANCE ISSUED �� J' lot i 16 0�' No...&0 .-....I F Fss........... ................... YHE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �O;L� OF................................ ©� . Appliration for Uhip sal l rk nnstrnr#iun rrntit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewa a Disposal System at: �( .........:.... ...No --•...--•-•... Location-Address - or Lot No. ................_....Jeffery•,&..Lisa Johnson ..4&..Maixi..S .... Y....�.�4 is NA--.0266CL--••••• - •-•-.....--•--.n..----....._ oWn Great Western Rd:d 00. T577 N. Harwich a Robert Our Inc. ..---••-•--•........................•-----•--................-•-•---•------...................... .........------••---------............----.....---...........................------........ Installer Address Type of Building Size Lot.... 5� - q. fe. Dwelling—No. of Bedrooms..........S.............................Expansion Attic ( ) Garbage Gri er Other—T e of Building .------- No. of persons............................ Showers ( ) Cafet d Other fixture„s --------------------- w Design Flow...............!F? ....................... per person per day. Total daily flow........... ........... t� Septic Tank—Liquid ca.pacit/ ?b.gallons Length.._. .... Width...,/......... Diameter____---- _--_- Depth...X....... Disposal Trench—No..................... Width.................... Total Length...........:........ Total leaching area....................sq. ft. Seepage Pit No.......1........... Diameter.Z ... Depth below ... Total leaching area_.:. ���ys . ft. Z ( '� Dosingank Other Distribution box Percolation Test Results Performed by...Z=.. nl._.._. .. ... Date.:...'�� -fs 'a a y Test Pit No. 1.¢4.z..minutes per inch Depth.of Test Pit..l...__y..._. Depth to ground water........................ f� Test Pit No. 2.t5�.Zr...minutes per inch Depth of Test Pit--- y`l 4. Depth to ground water............ ....... Description of Soil........ -----------•- ------------------------ x . w .........................••---- ------------•............................................................ V Nature of Repairs or Alterations—Answer when applicable..............................:................................................................ ----------------------------•------...--•--.....-----------•-•--------------•----------............--------•-•--------------•--•-•---------•-----------•--•---•-----•--•---------....---•----••••------- Agreement: The undersigned agrees to install the a scribed I ivi al Sew ge Disposal System in accordance with the provisions of A.'ITT• 5 of the State S rtary-C e— "The u i igned urther agrees not to place the system in operation until a Certificate of Complianc has been i su by oard iealth. ign .... .. .... ..... ..................... . .........:-......_.... Application Approved By----- ---- --------------------• a ........ -•-•---••-••......••......... ........... Application Disapproved r e following,reasons:--•- ...............................................>.. .--------------•-•••.-•----..._..Date.............. ............................................................... .••.......................... \ Date PermitNo...................................................-•-.. Issued....................................................... Date No...�.y::. L'' .... ............................. THE COMMONWEALTH OF MASSACHUSETTS, BOO-A RD OF YH EALTH' M r IQ Appliration for Dwposal Workii Tonstiurtion .crab ;, ,A f ^ ' ,u Application is hereby made for a Permit to Construct ( ' ) or Repair ( ) an Individual Sewage Disposal ! fi . system at ..............__...``W 3?. uT7. a Mtn, ROAD..--•--- - #13 _ ... _ ......... ___ __ Location-Address r Lot No. - --jeffP,rV a �_1Sa Johnson ��` 7iLtR T1+ia�r� Ck � �T� i c >�A �'Dr ................_ .....--•-•-.... ...• .___.•---- r. . ;:Treat ���lestern Rd.ddFss0- 577 N. .Harwich •Y- aRobert 'Ownert... Inc.................................. .................................................... ....._............. Installer - Address . . � . Type of Building Size Lot..._ �_ aia Dwellin No. of Bedrooms.___.__.__��................ _..Ex ansion Attic g— p ( ) Garbage GriOther—T e of Buildin ................a yp g _........... No. of persons............................ Showers ( ) — Cafet d Other fixtures a ................F `.... ... W Design Flow.................`a_��...................:.gallons per person per days Total daily flow............ `-�__.._: ............gallons. G: Septic Tank—Liquid capacity, .gallons ' Length...: �'r. Width...�._.... Diameter................ .Depth... ...... Disposal Trench—No..................... Width.................... Total,,Length.................... Total leaching area-___-----__----._-:sq. ft. Seepage Pit No........ ---------- Diameter_.h?._-� ... Depth below inlet.�::.2 ��-.... Total leaching area.... .�!?. .sq. ft. Z Other Distribution box ( —Y1� Dosing tank ( - ) , 5�1. � Percolation 'rest Results Performed by._-C_. 42 / � "-.-. �?��•jZ -_,.• Date...._�� a .._ r r-, ,.a Test Pit No. L:e!vi5' ..minutes per inch Depth of Test Pit ..._. Depth to ground water..'r -c?...^` . ." (= Test Pit No. 2. .."l-..minutes per inch .Depth of Test Pit... Depth to ground water.................... C4 .----------•-------••------------••-•---••---•••.................................... O Description of'Soil........ '. x ......................... ---------...----•--•-••-•---••---•-----------•----------..........__...------ V ......----•---------------------•--•----•-------......----------•---.....-----.............._.•-----.......------............-------•----•----......................... U Nature of Repairs or Alterations—Answer when applicable-,...................................................................................::...... x 'i --------------------------------••------------•------------•--......------.:.------.....-----•....-•-------....-----------...-•----------•--•-•••-•- Agreement: The undersigned agrees to install the aforedescribed 'Individualge Disposal System in accordance with the provisions of TITL:, 5 of the State Sanitary Code— The ultd�csigned)urther.agrees not to place the system in operation until a Certificate of Compliance"has been issued by th e_oard of Health. . .. .......... Application Approved By....... --=� ••. �Zp/- ---•--- 1 Date Application Disapproved r �e f ollowingreasons:.................................. ..............................A............................................... ..••••....---•-•-•--••..............•-•-----••--•-•-----•---•----•--••------......--•---•-----------.......--------••-•_................ _:: --------------------- Date PermitNo......................................................... Issued-: -----------••---•---•---•-•-•-......•--••-...••---- Date -THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH" - OF... �._----' (Irrtif utttt' of Tompliatta T 'IS TO CERTIFY hat the Individual Sewage Dis osal 'stem constructed ,�or Repaired g � P �' � 1 ( by.....0�° ----------•----•................................................ �� Instal ev r has been installed in accordance #i the provisions of TIT ' 5 he State SanitaryCod s escribed in the application for Disposal Works nstruction Permit No._-. ��../� � '�/ dated_ _f -' Z --.-- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE.THAT THE SYSTEM WILL FUNCTION SATISFACTORY. Inspector s A/ 4 DATE - ----------------•----------•----------•--•-•-••.......----••---............:..... ---------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH N o..;1!_.../............ FEE..J................... i �roo 1 rks Tonstrur#foiv kin it Permission is he granted... " . 1 ................. to Construct ( o r__(,.- ) an ir. idual SewageXDposal System 7,17 at No.. :. '� om' :u .....................•------.....-•--------.....---•--•-------- ---•--•- Street r as shown on the application for Disposal Wo - Construction Permit No, ....._............................. ........................... - ............................................... DATE...-------- � ard of Health 1 1� 07 X. , - o.� 1(� -7 LAV. dn BATH 'E BEDROOM DINING RM. KITCHEN 0 MASTER B/R O p LT N HALL dn. n. N -Clos Clos. LIVING RM. (open) ENTRY (crawl space) 1 p . I 30'-011 30'-O" SECOND FLOOR FIRST FLOOR LARRY'GORDON ARC-hITECTURAL DESIGN ROyali Residence REV. DATE: 3/24/10 Centerville, MA OR2 3,2 -i 508-730- 1246 49 Sheep Meadow, W. Barnstable EXIST. FLOOR PLANS rev. date: SCALE: A- 1 y r l; 24'-0" o WORKROOM _ F 40'-0" EAV In Feem _ p o Oo b Q — DINING RM. KITCHEN Pantry/ Coats` c� N C-05• GARAGE T W ASK' 1 1 1 k 1 11 1 11 I LIVING RM. 1 1 _ D. I I ENTRY . 1 ` 1 - 1 1 1 30'-0" EXIST. HOUSE p 10'-0" 24'-0" 1 0'-52" 6-4" NOTE: dimen5ion5 are to face of framing, or foundation 4 Ro all Residence DATE: LARRY GORDON ARCHITECTURAL DESIGN Y REV.: 3/24/10 Centerville MA 02G32 508-790- 1 24G 49 Sheep Meadow, W.Barnstable REFERENCE FIRST FLOOR rev. date: SCALE: AN3 'i 24'-0" 5'-0" 7'-0" �� 71_011 5'-0- in i WORKROOM (EL. 57.5) i1 EXIST. HOUSE 5'-0" 5'-0" C\j m 2 0 o � 0' cp m up ►� coats / Pantry v, ch - 68 remove door, replace 3' 3° 3'-7" 3'-2"U with arched opening ol N GARAGE (EL. 57.5) NOTE: Dimensions are to FACE of framing or to CENTER of walls, — - - - - - - - doors, windows. d MUD ROOM CL steel bm. above 0 N O d (EL. GO) r- — — — — — (EL. GO) le 5'-0" A. _ x A-9 10'-0" 6'-G" 5'-6" 5'-6" G'-G" I up 1�7 9'x7 overhead door 9'x7' overhead door 24-0 Residence all I.ARRY GORDON ARCHITECTURAL DESIGN Ro y REV.: DATE: 3/24/10 Aw4 Centerville, MA 02G32 508-790- 124G GARAGE-MUDR49 Sheep Meadow, w. Barnstable OOM PLAN rev. date: SCALE: „ , b 1 4 =1 -0 , r\. FAMPA i WINDOW SCHEDULE ! WINDOW UNIT R.O. REMARKS 344G doub. huncl 42 x 57.5 Harvey Indust. Vicon Classic 344G-2 doub. hunci 82 x 57.5 Harvey Indust. Vicon Classic 284G doub. huncl 34 x 57.5 Harvey Indust. Vicon Classic 343 10 doub. hun 42 x 49.5 Harve Indust. Vicon Classic m 0 — DIN. RM. 2„ w 6'_6 6'_6 Gv0S. / 1 cp - 1 38i 45 25 1 1 1 11 w 1 11 11 1 4 Al 1 1 1 1 - (z W. �� I 0 1 LIV. RM. NI e\9' h 1 1 i pled D. L U N D. I ` peer par ) „1 ee�1�n� 1 � 1 ,1 1 1 1 0 1 1 1 4'-8" A 1 - 10 -1 2 1 � 11 1 1 11 21 X�2 vanity o EXIST. HOUSE O 1 1 - - O 1 NOTE: Dimensions are to FACE 2 of framing or to CENTER of walls, - doors, windows. all Residence LARRY GORDON ARCHITECTURAL DESIGN Ro Y REV: DATE: 3/24/10 �®� Centerville, MA 02G32 508-790- 1 24G 49 Sheep Meadow, W. Barnstable MASTER SUITE PLAN rev. date: SCALE: J ` 1 4"=1 '-0" 1 Azek trim, t p. 12 10� A2ek trim, typ. HH® OOH O OO O OOHO OHO O 0 0 1 = 1 0 uI O - 0 0 00 00 —— — 344G-2 3446 3446 GxG col. 3446 00 �� 00 00 7.5x7.5 col. 0000 0000 I 8'-4" platform �00 Oa 00 k- - 9'x7 gar.dr., typ. 3G"-O" MASTER B/R ADDITION 30'-0" EXISTING HOUSE 34'-0" GARAGE ADDITION Ro all Residence DATE: LARRY GORDON ARCHITECTURAL DESIGN Y � � REV.: 3/24/10 An6 Centerville, MA 02G32 508-790- 124G 49 Sheep Meadow, w. Barnstable SOUTH ELEVATION rev. date: SCALE: 0 i 2 12 1 12 4 Azek trim, typ. 12 31-011 01 o � ® a I -- — — — — — I I 3446-2 — — — — —Azek trim, typ. N I Azek trim, typ. Azek trim, t I I II II — ———————— — 1111111111194 EU 3446 _ II 254G II — — — — — — — — — — — — — — — — — — — — — — I - - - - - - - - - - - - - - - - - - -1 I 5- " ,- - - - - - - - - — - - - - - - E I I- - - - - - -26'51dram—dim.- - - - - - --� I, I 33-O fram. dim. WEST ELEVATION EAST ELEVATION Ro all Residence DATE: LARRY GORDON ARCHITECTURAL DESIGN y EAST & W ELEVATIONS REV.: 3/24/10 Am7 49 Shee Meadow, w. Barnstable EST ELEVA rev. date: SCALE: Centerville, MA 02G32 508-790- 1 24G p 3 16"=1 '-0" i exist. dormer roof Vellux FCM3030 343 ® ® ® ® ® ® Webb OWV 2-0 LLLU 344G-2 in 84G 2846 -- --------- ---- ------ — 34'-0" GARAGE / MUD RM. ADDITION 30'-0" EXISTING HOUSE MASTER B/R ADDITION Ro all Residence DATE: LARRY GORDON ARCHITECTURAL DESIGN y NORTH ON Rom" 3/24/10 Am8 o, Centerville, MA 02G32 508-790- 1 24G 49 Sheep Meadow, W. Barnstable ELEVATION rev. date: SCALE: cont. ridge vent 2x I O 2x8@ I G" rafters, typ. 12 8" ZIP plywd. sheathing, 2xG@ I G" collar ties 14 asphalt roof shingles, — Vellux 3434VCM skylight 2x8@ I G" rafters, typ. — — 8" Zip piywd. sheathing, asphalt roof shingles, typ. 12 raised 2-2x8 header II A7e.k trim, gyp, Harvey Indust. 343 10 Vicon m Classic D.H. window m fir. of connector beyond Unfinished � lead flashing — —— — — — — — — — — — — — — — — — — — — — — rake bd. beyond _ 12 4 2x 10 @ I G" O.C. 2x8@ I G" rafters 3'-O" I O' 2-2x4 top pl., typ. 5/8" Fire ode GWB on strap mg 3 2 x l l 4" paralam W 12x45 stl. bm. 2x4@ I G" wall, 2 lywd. sheath " Zip "I �' p ., 5/8" Firecode GWB cedar shingles I I E00 J'w.x7'h. gar. dr. ,4- - GARAGE WORK RM. 2 2'-8" 1 O'-4" i fin. fir. EL. 57.5 8" conc. frost wall, typ. G" cons. slab I O"x 12" conc. footing I ON I G" conc. footing, typ. LARRY GORDON ARCHITECTURAL DESIGN Royall Residence DATE: REV.: 3/24/10 A-9 Centerville, MA 02G32 508-790- 1 24 , 49 Sheep Meadow, W. Barnstable CROSS SECTION A-A rev. date: SCALE: 3 8'=V-0" cont. ri ven Velux FCM 3030 skylight 2xG@ I G" collars L � 8" Zip plywd. sheathing, ening framed & asphalt roof shingles, 12 lor 28GG door 12 2x8@ I G" rafters, typ. II � II U Connector 3/4" CDX (glue t nail) N (no finish) Ln 2x4 raised plate, typ. 2x8 rim Joist, typ. 2x8@ i G", R-30 high dens. FG insul. 2-2x4 top plate, typ. Azek fasaa bd. I O° Azek soffit w/ cont. bee vent 1/2" GWB, typ. Azek freeze bd. Jzi 2x4 @ I G" wall, R- 15 FG insul., MUDROOM t 2" ZIP plywd. sheath. (install vertically from rim Joist to top 01 1 9'-3° `� plate); cedar shingles, typ. 1 4'-7" fin. fir. (elev. GO) garage slab (eiev. 57.5) N 4'-0" P.T. 2x4 plate, typ. 2x 1 0@ 1 G", R-30 FG insul. =III=III=III=1 I=III- N 4" rough conc. slab I— 1 1=1 11=1 11=1 I F=l 1 V II—III=—III III—III— 8" conc. frost wall, t Illi cq II1= II1-1I1-�' typ. CO I 0"x I G" conc. footing, typ. LARRY GORDON ARCHITECTURAL DESIGN Royall Residence REV.: °ATE` O8_79 _ 49 Sheep Meadow W. Barnstable CROSS SECTION B-B rev. date: SCALE: AmIO o, Centerville, MA 02632 5 O 1246 3 8 -1 -0 24'-0" 10'-0" 48" M.O.le 10'-0" —_— 5 . IF- — — — — — — - - - - - - - - - - - - o I I o I :' ► I I I 8x 12 conc. ftcg. I I MASTER SUITE FOUNDATION line of exist. _ .._ - - - - - - - - - - - - - - - - - - I house o N I I o � 6'- L O" I - 1N G" concrete slab I I 2'7 O„ 3, 6 — — — 1 3'-2" (EL. 57.5) I I O L — I 1 1 m 3_6 — — _ — — 13 - I 8" pour. conc. I I frost wall, typ. I — — ' ent, tyP — — — — — — = 3" rough slab I I W16.V — — — (EL. appr. 56.5) 1 I 8x 16 pour. conc. I 1 1 1 footing, typ. 1 1 1 0 lq I 1 - - I 1 1 P .r r p05t N I I I 1 � � 2 �t9• � — I I � . 1 11 Z�XZAx 3„ ro�9Y► 51ab 1 1 - - - - - - - - � frost wall below5lab 1 1 10'-0" 0 1 —_— — — — ----"----- I� , 1 1 - - - - - - I0'-5 2u I '-G" - - - �9-6" - - - - - -�0T-9fttT�- - - - 1 g 1 1 I _0 I '-0" line of exist. house MUDROOM-GARAGE FOUNDATION — 8x I G pour. conc. 8" pour. conc. footing, typ. a' frost wall, typ. LARRY GORDON ARCHITECTURAL DESIGN Royall Residence REV.: DATE: 3/24/10 Centerville MA 02G32 508-790- 1 24G 49 Sheep Meadow, W. Barnstable FOUNDATION PLAN rev. date: SCALE: �■ br 24'-O" 2x 1 O@ 1 2" O.C., typ. 2-2x 10 I 2'-O" Ilk I O'-O" 2x 10 rim Joist, typ. o edge of slab 2 2x 10 2-2x4 top plate, typ. G'- 1 O" R.Q. for pill 2x 10 wind bracing -1 o n tai @48" O.C., typ. N 00 m m 2x 1 O@ 1 G" O.C. C.L. steel beam o -1 ( 1 2W45) 3/4" CDX subfloor (glue nail) 2x 1 O@ 1 G" O.C., typ. O L J N r � P.T.2x4 plate 2x ) O rim J015 2x 10 ledger (lag into house) 1 O'-O" MUDROOM FLOOR FRAMING GARAGE CEILING FRAMING i LARRY GORDON ARCHITECTURAL DESIGN Royall Residence REV.: DATE: 3/24/10 Centerville MA 02G32 508-790- 1 24G 49 Sheep Meadow, W. Barnstable FLOOR / CEILING FRAMIN rev. date: SCALE: Sm2 ° 3 16 -1 -0 i 2x 10 rim joist, typ. P.T. plate, typ. 3 1 nSXg 2x 1 O@ 1 6" floor J015t5, typ. XZ N 05� dn. 6x6 P. ' p 3/4" CDX 5ubfloor Z 1 �5X9 5 V: (glue nail) N d'_ O 2x 1 O@ 1 6" floor Joists, typ. 2x 1 O@45" wind brac., typ. P.T. 2x4 plate, typ. 2x 10 rim Joist, typ. MASTER SUITE FLOOR FRAMING LARRY GORDON ARCHITECTURAL DESIGN Royall Residence REV.: DATE: 3/24/10 FLOOR FRAMING Sw3 49 Sheep Meadow, W. Barnstable rev. date: SCALE: Centerville, MA 02632 508-790- 1246 p I 24'-0" 4'-0" 1 G'-0" 4'-0" 0 m 2-2x4 top plate, typ. N N 4' G" Vellux 2-2x8 hurricane tie ea. 3434 typ, rafter, typ. 2-2x4 top plate, typ. - - R.O. - — — Ln O" O' O" sh d o me 2' 01 5/8" Zip plywd. sheath. typ. 2-2x8 rafters 2x8 rafters, typ. -1N 2-2x8 rafters Vellux 5/8" Zip plywd. p R.O. sheath. typ. E 2x 10 ridge bm. m 2x 10 ridge bm. n� E ` e stra s Ca.� ridg ride straps ea. g p N rafter, typ. rafter, typ. a o� _ -� 2x8 rafters @ I G", typ. , crm 2x8@48" wind t bracing, typ. hurricane tie ea. 2x8@ I G" rafters, typ. rafter, typ. 1 0'-0" O F.P SIC MUDROOM ROOF FRAMING GARAGE ROOF FRAMING id ll Residence a IJ-�RRY GORDON ARCHITECTURAL DESIGN Ro y REV.: DATE: 3/24/10 � Centerville MA 02G32 508-790- 1 24 49 Sheep Meadow, W. Barnstable ROOF FRAMING rev. date: SCALE: „ S 4 G @.1 c r I 2'7 O„ 2-2x4 top plate, typ. 2x 10 ridge bm. O ridge straps ea. rafter, typ. 5/8" Zip plywd. sheath. typ. Y 0 O " � N p� 2x8@ I G" rafter, typ, hurricane tie ea. 2 I ri e m. rafter, typ. N O CP O Q 2-2x4 top plate, typ. hurricane tie ea. rafter, typ. 5/8" Zip plywd. 5heath.,typ. 2x8@ I G" rafter, typ. 2x8@48" wind brac., typ. MASTER SUITE ROOF FRAMING LARRY GORDON ARCHITECTURAL DESIGN Royall Residence REV.: DATE: 3/24/10 Centerville, MA 02G32 508-790- 1 24G 49 Sheep Meadow, W. Barnstable ROOF FRAMING rev. date: SCALE: 1 3 16 -1 -0 Benchmark �� 55.7' 55.0' ��. G` �� ` SWINGS-TIES PLAT? Nail in Oak Tree \ ; ��G/ F �� I /�, SCALE: 1 =20' Elev. =59.00' \ 56 �Z�"O� --; �.` _ Approx. M.S.L. / a _ V� Q /� '0�``o ow Q`" SWING-TIES - ' 12.0' \\ 8N GRAVEL : ��` N �rn / O/ DESCRIPTION \ / ro DRIVEWAY \ / LEACHING CORNER(1) 20.7' 39.4' \ #49 �_ w��` LEACHING CORNER(2) 43.2' 47.3' w EXISTING00 - o a LEACHING CORNER (3). 48.2' 57.7' MAP 109 CO 2-BEDROOM, v 1 DWELLING / LEACHING CORNER(4) 29.7' 51.4' PARCEL 30 0 / TOF = 59.0 ± /. Z � j / Q 1 / O .10 411 Q / TREELINE EL_ / -, MAP 109 PARCEL 29 / pq f'(Cwt- f1'i,11r2/a C„�j"fin I�iCi1P� co MAP 109 s.T -7 S'Sa PARCEL 22 aolo-0 WELL �50� I / rbA / ,�`�• off. . 50'x 50' DRAINAGE EASEMENT ' /h1b MAP 109 ' , . PARCEL 21 N6102 WELL � g6• NOTE: 1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG EDGE OF EACtfi SEPTIC SYSTEM COMPONENT. :.qITF PI _AN:,-, 2.) ALL NEIGHBORING WELLS ARE GREATER THAN 150' 1 FINISHED GRADE OVER TANK EL. _ �j�7,3'-1- PROVIDE PRECAST CONCRETE FINISH GRADE OVER D-BOX= 56.5�+ , - PROPOSED VENT WITH CHARCOAL EXTENSION RISER WITH CONCRETE FINISH GRADE OVER CHAMBERS= jrj,Q 57.Q FILTER TO ABOVE GRADE GENERAL NOTES TOP OF FOUNDATION SLOPE 2% MIN. OVER SYSTEM ELEV- ' ± COVER TO WITHIN 6"OF FINISH GRADE @ rJ9.0 _ CONCRETE RISER AND COVER 3/4"TO 1-1/2"DOUBLE WASHED STONE TO 1. UNLESS OTHERWISE NOTED,ALL SYSTEM COMPONENTS AND CONSTRUCTION OVER INLET AND OUTLET COVERS. TO WITHIN 6"OF FINISHED GRADE 4"SCHEDULE 40 PVC MIN SLOPE 1% ACCESS BOX WITH COVER TO GRADE CROWN OF PIPE METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL FINISH GRADE 5" DIA. OUTLET(S) (SEE NOTE#21) @ FND. EL.= VARIES 2'"OF 1/8"TO 1/2"DOUBLE WASHED STONE CODE AND ANY APPLICABLE LOCAL RULES. PLACE RISERS ON ALL 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE TOP OF SAS= 52,00' CHAMBERS WITH DESIGN ENGINEER. SEWER „ PROPOSED 4" 9"MIN. INLET PIPES TO 6"OF 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL PIPE PVC SEWER PIPE 51 .00' 36"MAX. BREAKOUT EL = 51.50� FINISHED GRADE SYSTEM UNLESS OTHERWISE NOTED. - _-- 6" 3" 3"DROP MAX " " PROVIDE WATERTIGHT 4. TO PREVENT BREAKOUT,THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN - - 3 9 0 0 2" DROP MIN MIN.SLOPE @1% JOINTS (TYP.) o ELEVATION=51.50' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS A 4 PVC IN FROM " ��� 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE TOP OF 14" `55 Q' SEPTIC TANK 4"PVC OUT TO 0 O 0 0 0 0 0 0 0 O 0 C THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. O LEACHING FACILITY � r . 12 Ts!R9, 0 0 o o 0 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. CONTRACTOR CONTRACTOR SHALL 53.50� MIN. 53.33� 2' o 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. SHALL VERIFY SIZE 48" VERIFY CONDITION OF OUTLET TEE 0 0 0 0 0 0 0 0 0 EXISTING TEES " _ .. 00 00 Ll 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK AND CONDITIONubF 22 ZABEL FILTER 6 CRUSHED STONE o 0o FILLING WHENSYSTEM o Q 0 0 : 0 0 0 0 0 0 o IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS EXISTING SEPTIC '"`°-' AND REPLACE AS TVIODEL-#A1801-4x22 -° _ OVER MECHANICALLY o NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH TANK NECESSARY COMPACTED BASE I AND DESIGN ENGINEER. 5 4.0' 8.5'(TYP) 4.0' 3.55' 4 9' 3.55' a OUTLET DISTRIBUTION BOX 25 0' Y_ (TYP.) 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM OF 59.00'ESTABLISHED TO BE INSTALLED ON A LEVEL STABLE < 43.00' ON A NAIL SET IN AN OAK TREE AS SHOWN ON PLAN. BASE. FIRST TWO FEET OF OUTLET 49.00� GROUND WATER ELEv.= 12.0' 9 CONTRACTOR SHALL SAFE VERIFY EAST 72 HOURS CATIONS PRIOR TO CONSTRUCTION EXISTING 1000 GALLON CONCRETE SEPTIC TANK PIPES TO BE LAID LEVEL. PRIORO COMMENCING WORK ON SITE AT 2 - 500 H-20 GALLON CHAMBERS 5' MIN. CHAMBER END VIEW 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES SEPTIC TANK PROFILE CROSS SECTION VIEW TYPICAL CHAMBER PROFILE �+ "CONTRACTOR TO VERIFY EXISTING ELEVATION PRIOR NOT TO SCALE DISTRIBUTION BOX DETAIL H-20 CHAMBER DETAILS TO THE DESIGN ENGINEER. TO ANY WORK& NOTIFY ENGINEER IF DIFFERENT. NOT TO SCALE NOT TO SCALE 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONCRETE STRUCTURES SHALL BE MADE WATERTIGHT. " 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING -. �` TEST PIT DATA MAP 1 O9 � �,�, REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM PARCEL 31 APPROXIMATE LOCATION OF EXISTING LEACHING PIT TO ' _1 APPROPRIATE AUTHORITY. MAP 109 BE PUMPED AND FILLED WITH CLEAN, COARSE SAND ,... '' '' +k INSPECTOR: Donna Miorandi 12• ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS PARCEL 27 / g " EVALUATOR: LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE ALU R: Michael Pimentel, E.I.T. APPROXIMATE LOCATION OF ris C► THEY SHALL WITHSTAND H-20 LOADING. z December 4 2007 j� EXISTING DISTRIBUTION BOX (3) (2) of ;. -�+ DATE: 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. - - , � TEST PIT#: 1 (Perc # 12050) EXISTING 1(�0{3 GALLON _ 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE u g ELEV TOP- 55.70' SEPTIC TANK TO BE UTILIZED MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. AS PART OF THIS DESIGN - �, . ELEV WATER= "<43.70' REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, o , k FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). S7g"35'34"E / O _- o M ►� *' � . ., PERC RATE = 5 Min/In a 174.30� 15. ND IN _ ••- CONTRACTOR S PROPOSED PVC VENT PIPE - : o HC 2 DEPTH OF PERC= 46"-64" T HALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND o °' = I CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK FINAL LOCATION PER OWNER) `X-X-X X- SITE C NS OM a ( / 1 X� (4) (1) � ' •` TEXTURAL CLASS: 1 16. PROPOSED PROJECT IS LOCATED WITHIN: ASSESSOR'S MAP 109 PARCEL 28 PROPOSED 2-500 GALLON OWNER OF RECORD: JAMES E. &KEVIN J.JULESON H-20 LEACHING CHAMBERS LP / HC 1 •- �► " +� 0" 55.70' f EXISTING r-.» J � �' � ` Litter ADDRESS: C/O KEVIN J. &CHRISTINE L.JULESON �I / MAP 109 DWELLING f/ i f ,o �, 3" Fill 55.45 49 SHEEP MEADOW ROAD !/ .. PARCEL 28 7 Loamy Sand 55.12 WEST BARNSTABLE, MA 02668 PROPOSED DISTRIBUTION BOX A / 35,015 S.F. ± / ., .- ,- 10 Yr 311 ° '� 9" 54.95' FEMA FLOOD ZONE C �52 h ?� ♦ B Loam Sand COMMUNITY PANEL# 250001 0011 D Y 10 Yr 5/8 E REFER 46 51.8T 7. D REFERENCE: �� �� BOOK 21510, PAGE 280 Perc Fine Sand � -54- P ARC E L 2 8 , _ - OY O F F S E T�--- -� - ��~� C 1 -�--- PLANREFERENCE- `. 5 10%Gravel .PLAN BOOK 301, PAGE 99 ' P W E �` ..,,. . �... 58 50.87 _ 55 2 /p -� • 1 2-�� Q � .�:. �;� � _ . �.-.. � <-� �� � _ ` 19. L DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. rn ._ =_-i 55.0 ;< 2 _ ,>; .. :. , ..,� 64" 50.37 Benchmark o TP 1 -:- �, �� ,� SWING .TEES PLAN >�< ,., _� . . Coarse Sand 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY Nail in Oak Tree 55.T "� "._�G�F �f, SCALE: 1 =20 � 2.5Y 6/6 , 6______ 0� �,� �� Z , � C-2 ° FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WALL NOT ASSUME ANY LIABILITY' Elev. -59.00 '- 5 .r w r _ (10-20/°Gravel) -° FOR USES OF THIS PLAN OTHER'THAN ITS INTENDED'PURPOSE. Approx. M.S.L. cP O O p �•� \ ���` ptu _S SWING-TIES 82" 48.87' 21. A 4"PERFORATED SCH.40 PVC PIPE SHALL BE PLACED IN A VERTICAL POSITION TO A LO DEPTH OF THE BOTTOM OF THE SAS AND EXTEND TO WITHIN 3"OF FINISH GRADE. A N _ o �P O \ / ;� Q Med.-Coarse Sand o � DESCRIPTION HG,1 HC 2 LOCUS PLAN 2.5Y REMOVABLE THREADED CAP SHALL BE PLACED ON THE TOP TO ALLOW FOR INSPECTIONS. j \ 12.0' �� GRAVEL ���` �o C-3 (<5%Gravel,Loose) 22.` IN ACCORDANCE WITH 310 CMR 15.401 - 15.405 THE FOLLOWING LOCAL UPGRADE / DRIVEWAY I LEACHING CORNER(1) 20.7l 39.4' SCALE: 1"= 1000' 144" 43.70' APPROVAL IS REQUESTED FROM 310 CMR 15.221(7): a 6' �`/ LEACHING CORNER 2 43.2' 47.3' (1.) A 2.00'VARIANCE(3.0-5.0')FOR THE MAXIMUM COVER OVER THE LEACHING FACILITY. #49 � O No Mottling, Standing or Weeping Observed w EXISTING o a / -�' `� LEACHING CORNER(3) 48.2' 57.7' 2-BEDROOM MAP 109 6 DWELLING �� LEACHING CORNER(4) 29.7: T 51.4' DESIGN DATA LEGEND j PARCEL 30 Z / 1 TOF=59.0 ± / TEST PIT DATA 50 - - EXISTING CONTOUR NUMBER OF BEDROOMS (ASSESSOR) 2 ZA / NUMBER OF BEDROOMS (DESIGN) 3* INSPECTOR: Donna Miorandi 50 PROPOSED CONTOUR i ��°J Q DESIGN FLOW 110 GAUDAY/BEDROOM EVALUATOR: Michael Pimentel, E.I.T. / Qp�O `� E/T/C EXISTING UNDERGROUND UTILITIES DATE: _. O December 4 2007 W ,,t►� TOTAL DESIGN FLOW 330 GAUDAY I '/�1�G 76 t►c � _. ' � o _ 660 TEST PIT#: 2 W W EXISTING WATER LINE Q �1 �► �/ J DESIGN FLOW X 200 /o - GAUDAY _ �$T�O ' Q ELEV TOP- 55.00 I \ USE EXISTING 1000 GALLON SEPTIC TANK EXISTING FENCELINE __u_Y_u_Y_Y - ELEV WATER= <43.00' „` ,„` ,„` ,„` //`` Proposed septic system design was based on 3 bedrooms per plan / TREELINE WELL s� entitled, "SITE SEWAGE PLAN", prepared by Low&Weller, Inc.,dated PERC RATE= N/A' TEST PIT LOCATION MAP 109 I �- -56- / Q December 27, 1983(revised January 3, 1984) / 4 �- DEPTH OF PERC= N/A LP EXISTING LEACHING PIT PARCEL 29 , INSTALL 2 - 500 GALLON H-20 CHAMBERS TEXTURAL CLASS: 1 / MAP 109 SIDEWALL CAPACITY FO q EXISTING 1000 GALLON SEPTIC TANK PARCEL 22 (LENGTH + WIDTH) (2 SIDES) (2'HIGH) (0.74 GPD/S).F.) = GAUDAY w , (25'+ 12')(2) (2') (0.74 GPD/S.F.) = 109.5 GAUDAY 3 Litter 5475 PROPOSED 4"SOLID SCHEDULE 40 PVC PIPE I BOTTOM CAPACITY 7" LoamyFill 54.42' PROPOSED DISTRIBUTION BOX i (LENGTH x WIDTH) (0.74 GPD/S.F.) = GAUDAIY A 10 Yr 3/1 / - , _ g" 54.25' 0 PROPOSED 500 GAL. H-20 LEACHING CHAMBER (25 x 12) (0.74 GPD/S.F.) - 222.0 GAUDAW ' B Loamy Sand WELL 10 Yr 5/8 -50- ___-- - TOTALS: 46" 51.1T REV. DATE BY APP'D. DESCRIPTION / Fine Sand / _ o PROPOSED SEPTIC SYSTEM UPGRADE TOTAL NUMBER OF CHAMBERS 2 � C-1 10Yr 5/6 58" 10/o Gr�'vel) 50 17' PREPARED FOR: TOTAL LEACHING AREA 448.0 SQ FT (5 50'ic 50' �`� TOTAL LEACHING CAPACITY 331.5 GAL./DAY DRAINAGE ' _ Coarse Sand CAPEWIDE ENTERPRISES EASEMENT ' 2.5Y 6/6 /.�g�-- MAP 109 c-2 / PARCEL 21 (10-20%Gravel) , LOCATED AT I -� 82" 48.17' 49 SHEEP MEADOW ROAD Med.-Coarse'sand WEST BARNSTABLE, MA C-3 <5%Gravel/Loose) ) " SCALE: 1 INCH = 20 FT. DATE: DECEMBER 4, 2007 6 0 / 144 43.00 0 10 20 40 80 FEET Ng'l°3 ��• WELL No Mottling, Standing or Weeping Observed �"`� "' c cHu�,,�iLL a PREPARED BY: JOHN L. RESERVED FOR BOARD OF HEALTH USE J,L JC ENGINEERING, INC. NOTE: 1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP N ' 017 2854 CRANBERRY HIGHWAY EDGE OF EACH SEPTIC SYSTEM COMPONENT. EAST WAREHAM, MA 02538 SITE PLAN 2.)ALL NEIGHBORING WELLS ARE GREATER THAN 150' FROM 508.273.0377 THE PROPOSED LEACHING FACILITY. Drawn By: BSM Designed By:MCP Checked By:JLC JOB No.1345 SCALE: 1"=20' i a (o 3 ? y�o Q D -7 Locu (� 174 �30' o`� s,:P �o5y� `° eo6 � � Qe�e �r� z \e Mt71 LOT 13 35,018 sff p<�S —S3------------------------------ Wpow N � r' I EXISTING 3 BR LEACHING FACILITY cv'n CAT / / LOCUS MAP 0 54 RISER / / � SCALE 1"=2000'f �u-¢dc (o ASSESSORS MAP 109 PARCEL 28 r--- —� 55 LOCUS IS WITHIN FEMA FLOOD ZONE C ZONING SUMMARY ZONING DISTRICT. RF � ST � O O. / // � MIN. LOT SIZE 43,560 S.F.* MIN. LOT FRONTAGE 150' PROP. GARAGE MIN. FRONT SETBACK 30' \ / / MIN. SIDE SETBACK 15' S8 BLOCK \ BH , � // MIN. REAR SETBACK 15 \ PATIO *SITE IS LOCATED WITHIN RESOURCE EXISTING o \ �r; / PROTECTION 'OVERLAY DISTRICT o DWELLING �o \ �f(-,-i / SITE IS LOCATED WITHIN AP DISTRICT a' TOP FNDN. 59.1• FIRST FL 60.0' \\ STO E \ / / // o OWNER OF RECORD VELMA LEE ROYALL P.O. BOX 352 DILLARD, GA 30537 PROP. ADD'N. REFERENCES �+ ti W 57 m, NEW /\ DEED BOOK 22529 PAGE 305 WELL PLAN BOOK 301 PAGE 99 / SEPTIC AS—BUILT CARD 7-552 56 �� (COMPLIANCE DATE: 12/6/07) NOTES: 1. DATUM: APPROX. NGVD 2. EXIST. 2 BR DWELLING, ADDING 1 BEDROOM w 57 / 4010' 400, 1 48 % �° SITE PLAN DRAIN � � �,�%�� EASEMENT ' / / SHOWING PROPOSED ADDITIONS AT 49 SHEEP MEADOW ROAD DMH� WEST BARNSTABLE TEL RISER i ELEC. PREPARED FOR FAD fax 508-362-$so ��NOF�gs 1,��tHOFMgsS9C V. LEE ROYALL CATV I downcope.com © � sq°y �o�' DANIEL o DANIELA. G� o A. RISER �_;,- down cope engineering iac o OJALA OJALA CAJANUARY 15, 2010 a No.46 o 1L �' �No.40980 civil en ineers SN land su9 eyors -3v�S—I b °F� sTe����``� �Na uR o Scale: 1 = 20 939 Main Street ( Rte 6A) YARMOUTHPORT MA 02675 DATE DA A. 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