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HomeMy WebLinkAbout0361 WOODSIDE ROAD - Health 361 WOODSIDE kVCD A=152-031 J Lk, • �� e , ° v i o � 0 i . 13d.- O8J Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments c 7 C� 361 Woodside Road 1 Property Address Suzy Shur-Thompson Owner Owner's Name information isW required for every West Barnstable MA 02668 11-6 f18 per. City/Town State Zip Code Date of frppection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. OF Af Important:When .• s ., filling out forms A. Inspector Information 51#.Jt3Lf88 q�y, on the computer, JA M ES J'' use only the tab James D.Sears =�; m key tc move your Name of Inspector ; cursor-do not Capewide Enterprises * ' use the return keyCompany Name %,W�YT UF',-- 153 Commercial Street , F Q Company Address Mashpee MA 02649 City/Town State Zip Code 508-477-8877 51623 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above;the information reported below is true, accurate and complete as of the time of my inspection;and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails o� 11-9-18 ;Qfpector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of Inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doe rev-7/M!2018 Title a Official Irspection Form:SubwAace Sewage Disposal system-page 1 of,e i I. abed xeJ did 9£U 9 i3OZ b I. AON f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form •Not for Voluntary Assessments `v 361 Woodside Road Property Address Suzy Shur-Thompson Owner Owners Name information is required for eve West Barnstable MA 02 q every 668 11-6-18 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2. 3, or 5 and all of 4 and 6, 1) System Passes: ® I 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: Note:Outlet Tee has a zable filter. The system is a 1000 Gal Tank D Box and two chamber's 2) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", 'no"or"not determined"(Y,N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is Imminent. System will pass inspection If the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): I t5nsp.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•page 2af 18 Z a6ed xeJ dH 9£:£Z 9l OE t,I, AoN Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments kv�w 361 Woodside Road Property Address Suzy Shur-Thompson Owner Owner's Name information is required for every West Barnstable MA 02668 11-6-18 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes(cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ NO (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ NO (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ NO (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ NO (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines In accordance with 310 CMR 15.3030)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5lnsp.doe-rev.V2612018 Title 5 affidal Inspection Farm;Subsurface Sewage Disposal System•Page 3 of 18 E a6ed xeJ dH KEZ 9 60Z tr l• AoN Commonwealth of Massachusetts Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 361 Woodside Road Property Address Suzy Shur-Thompson Owner Owner's Name inquired for is every required fo West Barnstable MA 02668 11-6-18 page. cityrrown State Zip Code Date of Inspection C. Inspection Summary (cant.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well, ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well'". Method used to determine distance: *"This system passes if the well water analysis,performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No El ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or pond ing of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool 6irrsp.doc.rev.7,r2"018 Title s OMGal inspection Form:Suosurfaoa Sewage Dispose!System•Page 4 of 18 abed xeJ dH K£Z 9 60Z b 6 AoN Commonwealth of Massachusetts Title 5 official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 361 Woodside Road Property Address Suzy Shur-Thompson Owner Owner's Name information is required for every West Barnstable MA 02668 11-6-18 page. City(Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El ® Liquid depth in mamispW is less than 6" below invert or available volume is less than A2 day flow Fi4 eN"�G ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped; ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CM 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 16,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section C.4. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well t5insp.doc rev.7126/2018 Title 5 Offidal Inspection Farm:Subsurface Sewage Disposal System•Page 5 of 18 I g abed xed dH K£Z 960Z b6 ^oN I Commonwealth of Massachusetts Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u 361 Woodside Road Property Address Suzy Shur-Thompson Owner Owner's Name requirtatlon is West Barnstable MA 02668 11-6-18 required for every page_ City/Town State Zip Code Date of Inspection C. Inspection Summary (cost.) If you have answered "yes"to any question in Section C.5 the system is considered a significant threat, or answered"yes"to any question in Section C.4 above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as NIA) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner (and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] f t5insp.doc-rev.7/2612018 Title 5 Otfdal Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 9 abed xe� dH L£:£Z 8l,0Z b 6 AoN I Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments y 361 Woodside Road Property Address Suzy Shur-Thompson Owner Owner's Name information is required for every West Barnstable MA 02668 11-6-18 page. CltyfTown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Description: 1000 Gal.Tank D Box and two chamber's. Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Well Water Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Present Date t5insp.doc-rev.712612018 Tithe 5 0 ficiai Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 a6ed xed dH LUZ 9l,0Z t,I• AoN Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 361 Woodside Road Property Address Suzy Shur-Thompson Owner Owner's Name on is required for every West Bamstable MA 02668 11-6-18 required page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. CommercialAndustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft.,etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): I 3. Pumping Records: Source of information: NA Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc rev.712612018 Tille 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 8 abed xe Ao d dH 8££Z 8 60Z b 6 N Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r 361 Woodside Road Property Address Suzy Shur-Thompson Owne- Owner's Name requiredfo is West Barnstable MA 02668 11-6-18 required for every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank,distribution box,soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no)(if yes, attach previous inspection records,if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components,date installed (if known)and source of information: 2008 Permit 2008-303. Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 38" feet Material of construction: ❑ cast iron ® 40 PVC ❑other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage,etc.): Pipeing is 4" PVC SCH 40. tSinsp doc-rev.7128IM18 Title 5 Official Inspection Form Su�surface Sewage Disposal System-Page 9 of 18 6 a6ed xed dH 8E:EZ 9 LOZ b i, AoN f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 361 Woodside Road Property Address Suzy Shur-Thompson Owner Owner's Name Information is West Barnstable MA 02668 11-6-18 required for every page. City(TDwn State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 28" feet Material of construction: ®concrete ❑metal ❑fiberglass ❑ polyethylene ❑other(explain) If tank is metal,list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dlmensions: 1000 Gal. Precast Sludge depth: 1" Distance from top of sludge to bottom of outlet tee or baffle 29" Scum thickness 1' Distance from top of scum to top of outlet tee or baffle 8" Distance from bottom of scum to bottom of outlet tee or baffle 17" How were dimensions determined? Asbuilt-Plan-Tape Sludge Judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etb.): Tank at working level. Tank at 28"below grade. Inlet cover at 10" w/outlet cover at 18". Inlet baffle and outlet tee w/filter. No sign of leak age or over loading. WrispAoc-rev.712612018 Title 5 Official Inspection Form:Subsurface Sewage Olspossl Syslem-Page 10 of 18 o l, abed xeJ dH BUZ 8 i3OZ IV I, AON I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments F. 361 Woodside Road Property Address Suzy Shur-Thompson Owner Owners Name Information is required for every West Barnstable MA 02668 11-6-18 page. City/Town State Zip Code Date of Inspection D. System Information (coat,) 7. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: i gallons Design Flow: gallons per day t5lnsp.doc•rev.7/261201a Title 5 Mcial Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 i,6 abed xed dH 6£U 8 60Z b l• AoN Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments T 361 Woodside Road Property Address Suzy Shur-Thompson Owner Owner's Name iequi r d for every on is required West Barnstable MA 02668 11-6-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ 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 9. Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D Box Gs 16"x16"-64" below grade wlcover at 10". Box is clean and solid wltwo line's out. No sign of over loading or solid carry over. t5insp.doc-rev.712612018 Title 5 Orfidal Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 Z l, abed xed dH 6EU 9l,0Z b I, AON y Commonwealth of Massachusetts : Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form •Not for Voluntary Assessments 361 Woodside Road Property Address Suzy Shur-Thompson Owner Owners Name Information is required for every West Barnstable MA 02668 11.6-18 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber,condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 2 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: 15insp,doc-rev,712812018 Tide 5 Official Inspection Form,Subsurface Sewage Dlsposai System-Page 13 of 18 £l, a6ed xed dH 6£U 8 60Z b l, AoN Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 361 Woodside Road Property Address Suzy Shur-Thompson Owner Owner's Name information is required for every West Barnstable MA 02668 11-6-18 page. CityfTown State Zip Code Date of Inspection D. System Information (cont.) 11, Soil Absorption System(SAS)(oont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil,condition of vegetation,etc.): Leaching is two 500 Gal.dry well chamber's w/4'stone. Chamber's at 6'below grade w/cover at 10".Chamber's are wet on bottom w/clean like new walls. ; 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materlels of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, e1c.): t5lnsp.doc•rev.7/2612018 Title 5Ofbcial Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 t,6 a6ed xeJ dH K£Z 8l,0Z b L AoN Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 361 Woodside Road Property Address Suzy Shur-Thompson Owner Owner's Name information Is required for every west Barnstable MA 02668 11-6-1 B page. City/Tom State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 15 of 18 56 abed xed dH KEE 8l,0Z bl• AON I , c Commonwealth of Massachusetts { Title 5 Official Inspection Form i; Subsurface Sewage Disposal System Form •Not for Voluntary Assessments 361 Woodside Road Property Address Suzy Shur-Thompson Owner Owner's Name iequiredfo Is West Barnstable MA 02668 11-6-18 required for every page, City(Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System; Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks, Locate all wells within 100 feet. Locate where public water supply enters the buildiing. Check one of the boxes below; ® hand-sketch in the area below ❑ drawing attached separately t5insp.doc•rev.7/26"" Title S Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 9 l, a6ed xed dH 6£U 8 60Z t7 6 AoN , 31 1.8,09;05a. Capewide Enterprises 508-477-4977 p.28 Nnv Page I )IttP;//wwlv,town.barnstable.ma.!js"asseming/-7009/HMdisplay.asp?m.., TOWN OF BARNSTABLE LOCATION (el, W j tG SE`,vAGE N 2-00L'303 ASSESSOR'S\IAp&pARCEL__j.U_j 'a� — INSTALLER'S NAME&PI1ORrr N0. C nt iLP' Yua 1f SErT1C TAVK CAPACITY_ LEACHING FACILITY;(type) f- NO.Of BEDROOMS '— OR'NER c, o..���rlunhnsr`n PERMIT DrtTE: ?-2�-},p� 0 NCE DATE; -2 j-24df Sopsration Diswtoc Bctween the: Maximum Adjuste d Gmundwskr Table to;he Bottom ofleoclune Focility .+o / feet Private W&W Supply Wa and Leaching Faculty(if any wells exist on site orwilhip 200 feet nflem%0Ziaeility) bdga of Weiland and L wetlands .achiog Facility(if my exist feel within 300 feet of l-zel,ing facility). feet FURNISHEDBY �� nz ab•s' a611. Ln 34 9— AY 34 9 `!1 A(0 34•x t 3� o B3 3s•o -- � rt C9��� 3`l 31.0 � g yu 3 3t� 33.3 I of 1 8 23/2009 1 D:01 AM L L a5ed xe� dH Oti:EZ 8 LOZ b L AON I- Commonwealth of Massachusetts Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments E v 361 Woodside Road Property Address Suzy Shur-Thompson Owner Owner's Name requiredfo is West Barnstable MA 02668 11-6-18 required for every page. Qty/Town State Zip Coder Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow welts fV0 Estimated depth t high ground water: 1 feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 6-17-08 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed IJSGS database -explain: You must describe how you established the high ground water elevation: T.H.on Design plan 6-17-08 1 T no G.W.. Bottom of chamber's at 8'-4"below grade. Bottom of chamber's at 2'-8"above T.H. Depth. Before filing this Inspection Report, please see Report Completeness Checklist on next page, 15insp.doc rev.MUM Title b OfBciel Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18 g L a5ed xeA dH Ot?:£Z 9 l,OZ b 6 AoN Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ' 361 Woodside Road Property Address Suzy Shur-Thompson Owner Owner's Name information is required for every West Barnstable MA 02668 11-6-18 page, City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector information:Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4(Failure Criteria)and 6 (Checklist)completed ® D.System Information: For 8:Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included it t5insp.doc-rev.M612018 Title 5 Official Inspection form:Subsurface Sewage Deposal System•Page 16 of 18 61• a5ed xeJ dH OV:EZ 81OZ bI, AoN DATE SCHEDULED: 41 - CALLED BY: K BILLING NAME:5k-z - o JOB LOCATION: DIG SAFE #: ADDRESS: �(01 �13 6 S�& k 3&( Woo(3SoP RCS WATER ❑ VERIZON ❑ W . o�rr�s�~A " o2taoF< w . -R) c-rna ffvk ( )-* GAS ❑ COMCAST ELECTRIC ❑ OTHER ❑ PHONE: 09• t(,'�S• a 3L/3 KEY AVAILABLE: PRIVATE MARKING ❑ /"YlGl i_t reCgAoj4 CLOSEST INTERSECTING STREET: CELL: WATER USAGE: REALTOR: PHONE: HEALTH DEPARTMENT RECORDS EMAIL: PUMPING RECORDS: CELL: AS BUILT: PLAN: HOME OCCUPIED: PRIOR REPORT: # OF OCCUPANTS: WATER RECORDS: # OF BEDROOMS: 3 WELL#: # OF BATHROOMS: 3 ZONE: LEVEL: FULL BASEMENT. Y ADJUSTMENTS =: TOWN WATER: WELL WATER: GARBAGE DISPOSAL: - does ncyy (Ae 3�9 a5":�I��� BY: SUMP PUMP IN BASEMENT: N2 CHECK BY: UNDERGROUND POWER: �I YI `� DATE APPROVED: SPRINKLER SYSTEM: N I'Y�G«ti�5 I'� J BILLED & MAILED: f __________� ______ No.- - Fee BOARD OF HEALTH TOWN OF BARNSTABLE 0pplication-*rVell Con5truct ion Permit � .TOZA C6 Ap lication is hereby made for a permit to Construct (4 ), Alter ( ), or Repair ( )an individual Well at: Location — Address Assessors Map and Parcel — Owner ry Address p� �y Installer Driller 7 —— A dress Type of Building Dwelling------------------------------------------------------- Other - Type of Building----------------------------- No. of Persons-------------------- YP of Well Capacity ----------- - T e ----� �� - �¢�� ----------- -- --------- Purpose of Well---- ��"��—-------- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a Certi ' ate .of Compliance has been issued by the Board of Health. ----- ---------- Signed ---- --���----- /��� date Application Approved By a- — -------- ------- date Application Disapproved for the following reason --------------------- ------- --- ----------- --- ------------------------------ ------- --- —/ date Permit No. )(90 --- Issued----- -- - ------------ dat BOARD OF HEALTH TOWN OF BARNSTABLE (Certificate ®f (Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repairedby ( ) ---------------------- / Installer has been installed in accordance with the provisions of the Town of Barnstable Board of Healt Private Well Protection Regulation as described in the application for Well Construction Permit No. - fj�'Dated--- --- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE—---- -- —- -- Inspector-- - —--- - --- —-----___ No.- - -------------- Fee------ ---- - ----- BOARO.OF HEALTH =¢ TOWN OF BARNSTAB'LE App[icationArlVell Co0truct ion Permit TOLA CE Ap lication is her made for a permit to Construct ( Alter ( ), or Repair ( )an individual Well at: tocathon Address rye+ �AAssessors Map and Parcel Owner, Address rf � — -- — Installer — Driller Address Type of Building Dwelling--------------------------------------------------------- Other - Type of Building --=----------------------- No. of 5 � ------P---er-�s--o�n Cs'---�-—=- '---�------------------- TYPe of Well- Capacity -- -— ---- - - - Purpose of Well Agreement: G' 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 Certifcate .of Compliance has been issued by the Board of Health. Signed date Application Approved By. — - € ----- -— - date - -- Application Disapproved for the following reasons ---------- ------------ ---------- -- -------------- — --- --------------- ----�--- ----- ----- date---- a.� Permit No. IA)00 -! ---- Issued--- ---- ------------- ------- dat ♦4:fE?ia:e:a.S.e:a:l.Y:4.!:ealiY _a'Trsal:f6lieG9i4a•61:+.:+a/isclaece:,eiea�b:ae6sissGeGeGsaeil:ecsi7sstie.!�zsilwweieisafae'GJel:.sarieilssrltilwlaeifa4G.li2ilea..V�ili•:!. BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( ) Installer L athas been installed in accordance with the provisions of the Town of Barnstable Board of Healt rivate Well Protection �1 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—_ ----- ---- —----- .s+G•o�'a•i9alpl:9:9aOLlwellieiVa4aaaeaeiMe1e3461aTSOOPalanala4G9a paea9aBaeiVilieaeC�eaei9iili........... a9i4ilaeieaeae:e:!aes+s9ila949a�i9Gw+i9.i2ie:eitilaealad�y.fg;,Jtla•afze:aa BOARD OF HEALTH TOWN OF BARNSTABLE Well eon!gtruct ion Permit No. ------------% Fee- Permission is hereby granted --------- to ), or Repair ( ) a div'dual e 1 at! NO. Cons�G/( Alt r�(a'e .2 '� 4��-�' Street'� as shown op the a plicatiora for a Well Construction Permit No.- .. — -- Dated -- ^---- Bo rd of'Health r . DATE � __— YHe r Barnstable Town of Barnstable AN-Amedca0~ NWAD MA Board of Health 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawa ana i Y g July 14, 2008 Mr. Michael Pimental JC Engineering, Inc. 2854 Cranberry Highway East Wareham, MA 02538 RE: 361 Woodsltle Road, West Barnstable MA Dear Mr. Pimental, You are granted conditional variances on behalf of your clients, Donald and Susan Shur Thompson, to construct a replacement sewage disposal system at 361 Woodside Road, West Barnstable, Massachusetts. The variances granted are as follows: 310 CMR 15.405: To place six (6) feet of soil cover over the top of the leaching facility, in lieu of the three (3) feet soil cover maximum allowed. 310 CMR 15.405: To place five (5) feet of soil cover over the top of the distribution box, in lieu of the three (3) feet soil cover maximum allowed. Section 397-2, Town of Barnstable Code: To install a leaching facility 102.4 feet away from a neighbor's private well (at 389 Woodside Road), in lieu of the 150 feet minimum setback required. Section 397-2, Town of Barnstable Code: To install a leaching facility 102.4 feet away from an onsite private well (at 361 Woodside Road), in lieu of the 150 feet minimum setback required. These variances are granted with the following conditions: (1) Prior to obtaining a disposal works construction permit, the onsite private well water shall be sampled and tested for conform bacteria, Q:\WPFILES\PimentalJCEngineering361 Woods ideRoadVariance2008.doc �3 nitrate-nitrogen, sodium, pH and other parameters routinely tested at a certified laboratory (2) No more than three (3) bedrooms maximum are authorized at this property. Dens, study rooms, offices, finished attics, sleeping lofts, and similar-type rooms are considered "bedrooms" according to the MA Department of Environmental Protection. (3) The septic system shall be installed in substantial compliance with the engineered plans dated June 23, 2008. (4) The professional engineer shall supervise the construction of the onsite sewage disposal system and shall certify in writing to the Board of Health that the system was installed in substantial. compliance with the engineered plans dated June 23, 2008. (5) These variances expire three (3) years from the date of the variance decision letter. It is the applicant's responsibility to obtain a disposal works construction permit within the three year period. These variances are granted because the physical constraints at the site severely restrict the location of the soil absorption system due to its close proximity to neighboring wells. Sincer yours, W ne iller, M.D. Chair n Q:\WPFILES\PimentalJCEngineering361 WoodsideRoadVariance2008.doc 9 a, SECTIONSENDER- COMPLETE THIS N Complete items 1,2,and 3.Also complete A. Sign 1 item 4 if Restricted Delivery is desired. ❑Agent X ■ Print your name and address on the reverse Addressee 1 so that we can return the card to you. B. a ed by(Printed Name) C. Date'f Del' ery ■ Attach this card to the back of the mailpiece, ` 7 L� or on the front if space permits. D. Is delivery address different from item 1? ❑Yes 1 1. Article Addressed to: If YES,enter delivery address below: ❑No I James F. &Regina R. Hourihan 1 170 The Plains Road 3. Service Type W. Barnstable,MA 02668 ❑Certified Mail ❑ Express Mail 1 ❑Registered ❑Return Receipt for Merchandise 1 ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) p Yes 2. Artil° i ii F •• Ff1 7 i ii ii (r,a ' 700°5 }];7,`60°=0001 '3447ii20889 f} i;w%�'-*H109JA WL PS Form 3811,February 2004 Domestic Return Receipt 102e95-02-M-1540 ' x'nMA -.fy ri4'ri[rtn1p. �, ,yq"': d.M- � r' �iri :'4•ry.._ ,µNeu.. . �� ��, UNITED STATES el Pai 'I M • Sender: Please print your name, address, and ZIP+4 in this box • I - JC Engineering, In . JlaAI 2854 Cranberry Hig East Wareham, MA 02538-f" ` SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Signat item 4 if Restricted Delivery is desired. X ❑Agent ■ Print your name and address on the reverse n Addressee so that we can return the card to you. B. Received by(Printed Name) C to gmit ■ Attach this card to the back of the mailpiece; or on the front if space permits. D. Is delivery address different from item 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑No Anita L. Swanson 389 Woodside Road 3. Service Type W:Barnstable, MA 02668 ❑certified Mail ❑Express Mail ❑Registered ❑Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes j_ ;700511160 i0001i 34.47 2133 i i434_%0" Vogj#NCE PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 UNITED STATEAai M1 e,, cP I I a 4 3LJ.:�INk :�.c�.�t'�, �Fv''E • Sender: Please print your name, address, and ZIP+4 in this box • JC Engineering, g eer0ng, inc. I 2854 Cranberry Highway East Wareham, MA 02538-1314 I I I I SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. rat , S item 4 if Restricted Delivery is desired. Si Agent Pr"` . .,r;:a;:�a and address on the reverse X. ❑Addressee so that we can return the card to you. eiv d by of Nam atf 44f D f ® Attach this card to the back of the mailpiece, vv' C Jw I L�U or on the front if space permits. D. Is delive ddress different from item 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑No I William J. Durken, Jr. 329 Woodside Road 3. Service Type W. Barnstable, MA 02668- ❑Certified Mail ❑ Express Mail ❑Registered ❑Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 12 i 7b05 i 116b bdff s 3447 12t096i Way '80N YgKfANCE. � PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 r a I'.j r Y.`..���`fx ,:< s7t F`MYR•a .a4mnIIn'p r UNITECFS�f'A�Eq^� C �,a'� sS w �" mI'� Y'aa_i µ4,4�{�. I � .�p1 �'e n'A•ynwwfi�`���. .. ,Ydv��L / tilt "'�Kt i3iwilY.'bYe I • Sender: Please print your name, address, a d ZiP+4''rr9r 's box • 7, <�Olqp JC Engineering, Inc. 2854 Cranberry Highway East Wareham, MA 02538-1314 1�'.S Q 'Ff.r..3�3 1 '�lffJFf)}If7J1llt�l?1??1l77f�lf}j1lil111J�F7'17�1177�l1�:717ft1 SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Si F reitem 4 if Restricted Delivery is desired. X ❑Agent ■ Print your name and address on the reverse ❑Addressee so that we can return the card to you. B. FleceiWd y(Pr' ted Name) C. Dat of D livery ■ Attach this card to the back of the mallpiece, , . � or on the front if space permits. 44 ` ff . D. Is delivery address different from Item 17 ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑No I Cornelius W. Andres Loretta J. Andres E 332 Woodside Road s. service Type ❑Certified Mail ❑Express Mail W. Barnstable, MA 02668 ❑Registered ❑Return Receipt for Merchandise � ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2t- { 7005 116011000110447 2102 1 ' I � N�FI-,B.O.H. VRRigNCJE i PS Form 3811,February 2004 Domestic Return Receipt' 102595-02-M-1540 1 I UNITED STAT€ A ' ee jo w� a „ ail • Sender: Please print your name, address, d p this box • � • 26 2p I JC Engineering, Inc.* 08 2854 Cranberry Highway R East Wareham, MA 02538-1314 •�.'�r a.-'fit. - 11-�f it til!'ilf'I�i�__a,��CFllift�I F,I l.11.111�1f l�Ff�f13f'I - SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Signat r item 4 if Restricted Delivery is desired. —" ❑Agent ■ Print your name and address on the reverse ❑Addressee so that we can return the card to you. B eceived by(Print Name) C. Date f Delivery ■ Attach this card to the back of the mailpiece, ��719f. or on the front if space permits. 1. Article Addressed to: D. Is delivery address different fro item 1? 91 Yes If YES,enter delivery address below: ❑No � I Stephen &,Amber S. Crowley 3. Service Type 376 Woodside Road ❑Certified Mau ❑Express Mail W. Barnstable, MA 02668 ❑Registered ❑Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes I r70'05't 1160i+0DOi1 3447i C, I PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 UNITED STAT ; ,.,Q A - w .;• yam :�al , I • Sender: Please print your name, address, and ZIP+4 in this box • I i I I I I JC Engineering, Inc. 2854 Cranberry Highway I East Wareham, MA 02538-1314 •»��i lllfllId-bbliidllibib&ii1hilb,nilbhi7i1 biliddiHfr. - Submlt by Email DATE:—( FEE: o 5 • RARNRrAmE, HARk Town of Barn REC. BY Barnstable � SCHED. DATE: Board of Health 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Wayne A.Miller,M.D. Paul J.Canniff,D.M.D. VARIANCE REQUEST FORM LOCATION Property Address:_361 Woodside Road West Barnstable MA Assessor's Map and Parcel Number: _Map 152 Parcel 31 Size of Lot:_35 284 s.f. ; Wetlands Within 300 Ft. Yes Business Name:_N/A ca No_X_ Subdivision Name: N/A c APPLICANT'S NAME: JC Enaineerin Inc �F "— — 9 Phone 508-273-0377 7 1 N � Did the owner of the property authorize you to represent him or her? Yes _X_ No _Z Cn co CD PROPERTY OWNER'S NAME CONTACT PERSON W 5 Name: Donald W.&Susan Shur Thompson Name: JC En ineerin Inc. co c:) r. o rn Address:_361 Woodside Road West Barnstable MA Address:2854 Cranberry Highway E. Wareham MA Phone: Phone: 508-273-0377 VARIANCE FROM REGULATION (List Reg.) REASON FOR VARIANCE (May attach if more space needed) See Appedix A See Appendix A NATURE OF WORK: House Addition O House Renovation 173 Repair of Failed Septic System X Checklist(to be completed by office staff-person receiving variance request application) Please submit copies in 4 separate completed sets. Four(4)copies of the completed variance request form Four(4)copies of engineered plan submitted(e.g.septic system plans) Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) Signed letter stating that the property owner authorized you to represent him/her for this request Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense (forTitle V and/or local sewage regu]ation variances only) Full menu submitted(for grease trap variance requests only) Variance request application fee collected(no fee for lifeguard modification renewals,grease trap variance renewals[same owner/leasee only], outside dining variance renewals(same owner/leasee only),and variances to repair failed sewage disposal systems[only if no expansion to the building proposed]) Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Wayne Miller,Chairman NOT APPROVED Paul J.Cannifl',D.M.D. REASON FOR DISAPPROVAL C:\\Documents and Settings\\decol1ik\\Local Settings\\Temporary Internet Files\\OLK1\ \VARIREQ.DOC SG,u,l►1 i r �'>h�a JC ENGINEERING, Inc. Civil & Environmental Engineering 2854 Cranberry Highway East Wareham, Massachusetts 02538 4k Ph. 508-273-0377—Fax 508-273-0367 APPENDIX A The following local variances are requested from the town of Barnstable's Chapter 397: Wells Regulations; Section 397-2: (1..) A 47.6' variance (150.0' - 102.4') for the setback from the proposed leaching facility to the existing well located at 389 Woodside Road due to site constraints. (2.) A 47.6' variance (150.0' - 102.4') for the setback from the proposed leaching facility to the existing well located at 361 Woodside Road due to site constraints. In accordance with 310 CMR 15.401 - 15.405, the following local upgrade approvals are requested from 310 CMR 15.221(7): (1.) A 3.0' waiver (3.0 - 6.0') for the maximum cover over the leaching facility due to the deep elevation of the existing septic tank and uphill location of the proposed leaching facility. (2.) A 2.0' waiver (3.0 - 5.0') for the maximum cover over the distribution box due to the deep elevation of the existing septic tank and uphill location of the proposed leaching facility. fo r 'i•own of narnstaDie P# r o\ e7\iir i i Department of Regulatory Services n+< Public Health:Division.- Date Rb 200 Main Slreet,'Hyannis MA 02601 A ' VW_ SIX s ,aiq. Date Scheduled Time Fee Pd.. aa x Soil uitobility Assessment for Se age Disposal, o y, If t Performed By: 361A L• G�vr+C�n t 1I 'SC P•E. Witnessed B ! I Loc don Address jL`b W9S Owner's Name 'L�o� T�w+�S� ?. ln)t S r t�A,rvr)faCil e Address 3 co 1 t,,�-�,�r9S��1•�vc�o� _ Assessor's Map/Parccl: I SZ!d Engineer's Name 04P0�j.* u, e"Ar)o's- /J.C. t `/ NEW CONSTRUCTTION. REPAIR Telephone N Land Use Rdgit. Fcariil /c+5rdenl/a 1 Slopes( 5"/5°lam i Surface Stones Distances from: Open Water Body 7150 fl Possible Wet Area ft Drinking Water Well /00 ft L Drainage Way PIA It Property Line >/O It Other It SKETCH.(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes). l sw at+a d P' aaka wuoe 23, Zao �cee'o�ed by SL Ett cerctig v S✓1 ut4iikta } spiter t ue5r f I. 1 Parent material(geologic) Depth to Bedrock 7 132 a bs S Depth to Groundwater: Standing Water in Hole: 7 13 Z. S Weeping from Pit Face 713 2 OS5 i Estimated Seasonal High Groundwater ;:Method Used Cxe.cE(lesecuekWn .. ° . � + 17epih Obsei ed standing in obs.hole 32 In. Depth to soil mottles: 7132 in. ;Depth to Weepi0.g from srde of obs hole 7 t'12— In. Groundwater Adjustment ft. e Index Well H 'ReaEnrg Date "' Index Well level — Adj,factor:: ..A!.j.Groundwater Level 1 rl�ln�yy � i�. . (p�ME �,,. I� - ire i w 1 01111 i,. d'99d a`� 'a �l11 ,N AR UR�1 4w PL4V , AD :�en IW �. � I• � i 11�i�wJd � G rYrl,�Wi. Observation i Hole I Time at9" /l:50An Depth of Perc 03 y� Time it ti Y Stan Pre-soek Time(g 30Ry Tune(9"fi") Smr'�f 5 End Pie-soak h;YS_ Rate Min./Inch 42 P Site Suitability Assessment: Site Passed ;Site Fatldd Additional TestingrNeeded(Y/N) N ; Original: Public Health Division iObservation Hole Data To Be Completed on Back- ---•-- Q HP.Al.TH%WPMtkCFORM r Sly ;�,< <�,< .....:...<..........:.>....:..............:..tn....r:. i: �ti., ..o.,:.,..:>.:..Kf:>i.:...:.M.:::...:.: :':i 'fi w:.»::::... .::.:........:....n...........rn...............:tR..t•,£.tp•:vn:,::.: Depth from Soll Horizon Soll Texture $oil Color ': Soli Olhtr 111+444 Surface(In:) (USDA). (Munsell) Mottling (Structure,Stones,Boulderes. i 0-8u Pr LS 10Yf3/2 - 6--2 Y 6 1-5 10 yr S/y 2Y-40 C-� t fr+e-Had S 7.5Yr'`/B - b0.132• G- 2 crave-)4ed. 10:.5 Yr 5/y yX £ i t 1.. ?: < .:...:.....:..........r.,. Depth from Soil Horizon Soil Texture, Soil Color Soil Other a' Surface(In.) ,(USDA) (Munsell) Mottling (Structure,$tones,Boulderes. 3/2 13-2 Ls 10Yrs/y 1 ? 2Y-6U L-1 Fire-H S,,A -7.5Yt -/ - s I (,U-137- G-Z n=-µed.&M lO.-rYr 51 l si c y•� j Y�/� /�' .' t�i'? �.X✓:: 1,4 ::.:.::.:...: ... Depth-from Soil Horizon Soil Textura Sol l Color Sol, Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. %t Consistency. 0- O 3IL 8-2Y L 5 . 0 ur s/ - ^ 21I-b0 fine•Hcd.Scrt -7..5 Yrs/ ^ s t: :. ...: X.:..« N.E F': Mr.. ta,Depth from Soli Horizon Soll Tpxplrc Soil Color Soi101hcr Surface(In.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. p Graych pt Ii • i f f Flood Insurance Rate Man: Above 500 year flood boundary No_ Yes ^ Within 500 year boundary No Yes'_ ' Within 100 year flood boundary No.V- Yes_ i t f Depth of Naturally Occurring pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the 4 M area proposed for the soil absorption system? Y{S t t If not,what is the depth of naturally occurring.pervious material7 , r Certification tt s I certify that on 1 (date)I have passed the soil evaluator examination approved by the Department of Env'ir nmentai Prote P ction and thatahe above analysis was performed by me consistent with the required training,expertise and a pert ce.described in.3.1.0 CMR 15.017. Q /2 S ����� 'iRnah:re Date Donald W. & Susan Shur Thompson 361 Woodside Road B West Barnstable,MA June 23, 2008 Board of Health Town of Barnstable 200 Main Street Hyannis, MA 02601 Re: Declaration of Authorization Dear Members of the Board: Let it be known that we, Donald W. & Susan Shur Thompson, do hereby authorize JC Engineering, Inc. of East Wareham, MA 02538 to represent the our interests regarding the upgrade of the sewage disposal system located at 361 Woodside Road, West Barnstable, MA in meetings both public and private. Sincerely, Donald W. & Susan Shur Thompson, • l A fi Town of Barnstable Barnstable Regulatory Services Department j ericaCh + BARN WABLF- 7 MASS. 16g q. Public Health Division Q, ,� AJED NSD�A 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 50E 790-6304 Thomas A.McKean,CHO June 4, 2008 Suzy Shur-Thompson 361 Woodside Road West Barnstable, MA 02668 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 361 Woodside Road, West Barnstable, MA was last inspected on May 20, 2008,by Robert Paolini, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Failed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: 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 't/2 day flow. You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. NR T BOARD OF HEALTH cKean S., C O Agent of the Board of Health CERTIFIED MAIL #7006 2150 0002 1041 9730 Q:\SEPTIC\Letters Septic Inspection Failures\361 Woodside Road.doc Commonwealth of Massachusetts W Title 5. Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Q 361 Woodside Rd. Q U� Property Address Suzy Shur-Thompson a U Owner Owner's Name iequ. ti is requ�red for W Barnstable Ma. 02668 5/20/2008 for eve page.. / City/Town State Zip Code Date of Inspection iV Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important: A. General Information When filling out forms on tl-e computer,use 1. Inspector: only the tab key to move yojr Robert Paolini cursor-do not Name of Inspector use the return key. Capewide Enterprises,LLC. Company Name P.O.Box 763 Company Address Centerville Ma. 02632 rerom City/Town State Zip Code (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 ❑ Needs Further Evaluation by the Local Approving Authority 5/20/2008 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or J has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the ca wport to the appropriate regional office of the DEP. The original should be sent to the system owner d copies sent to the buyer, if applicable, and the approving authority. c y � C� **** report only describes conditions at the time of inspection and under the conditions of use that time.This different conditions of useddress how the system will perform in the future under t same or d'fferen 361 Woodside Rd.•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 2 i , Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ° 361 Woodside Rd. M Property Address Suzy Shur-Thompson Owner Owner's Name information is required for W Barnstable Ma. 02668 5/20/2008 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 and needs to be upgraded. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Answer yes, no or not determined (Y, N, ND) in the ❑for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying.septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed 361 Woodside Rd.•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 2 i I -Commnwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 361 Woodside Rd. Property Address Suzy Shur-Thompson Owner Owner's Name information is required for W Barnstable Ma. 02668 5/20/2008 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: 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. 361 Woodside Rd.•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 3 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 361 Woodside Rd. Property Address Suzy Shur-Thompson Owner Owner's Name information is required for W Barnstable Ma. 02668 5/20/2008 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". J 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 ® El than depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. El ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. 361 Woodside Rd.•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 4 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 361 Woodside Rd. Property Address Suzy Shur-Thompson Owner Owner's Name information is required for W Barnstable Ma. 02668 5/20/2008 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® 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. ® E] criteria 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. 361 Woodside Rd.•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 5 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 361 Woodside Rd. Property Address Suzy Shur-Thompson Owner Owner's Name information is required for W Barnstable Ma. 02668 5/20/2008 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ . Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ❑ ® Existing information. For example, a plan at the Board of Health. ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of.distance is unacceptable) [310 CMR 15.302(5)] I 361 Woodside Rd.-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 6 f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 361 Woodside Rd. Property Address Suzy Shur-Thompson Owner Owner's Name information is required fo- W Barnstable Ma. 02668 5/20/2008 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): 3 DESIGN flow based on 310 CMR 15.203 (for e)6mple: 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 d Well Water 9 ( Y 9 (gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: 5/20/2008Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.2013): 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): 361 Woodside Rd •03/08 Title 5 O Disposal S Official Inspection Form:Subsurface Sewage g p osal System•Page 7 of 7 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° 361 Woodside Rd. M' Property Address Suzy Shur-Thompson Owner Owner's Name information is required for W Barnstable Ma. 02668 5/20/2008 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 i ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components,date installed (if known) and source of information: 1975 Were sewage odors detected when arriving at the site? ❑ Yes ® No 361 Woodside Rd.•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 8 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 361 Woodside Rd. Property Address Suzy Shur-Thompson Owner Owner's Name information is required for W Barnstable Ma. 02668 5/20/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 33"feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line. 10+ feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints appeat tight.No evidence of Ieakage.System vented through the house vents. Septic Tank (locate on site plan): 25" Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No ------------------------------------------------------------------------------------------------------------------------- Dimensions: 10001, Sludge depth: 2" � Distance from top of sludge to bottom of outlet tee or baffle 30" Scum thickness Distance from top of scum to top of outlet tee or baffle 7" Distance from bottom of scum to bottom of outlet tee or baffle 13" How were dimensions determined? measured 361 Woodside Rd.•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 9 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 361 Woodside Rd. Property Address Suzy Shur-Thompson Owner Owner's Name information,is W Barnstable Ma. 02668 5/20/2008 required for 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 years.lnlet and outlet tees are in place.No evidence of Ieakage.Tank appears to be structurally sound. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date 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): 361 Woodside Rd.•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 10 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 361 Woodside Rd. Property Address Suzy Shur-Thompson Owner Owner's Name information is required for W Barnstable Ma. 02668 5/20/2008 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.): Box is Ievel.Box has one outlet Iateral.No evidence of solids carryover.No signs of leakage. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No M Alarms in working order: ❑ Yes ❑ No a g 361 Woodside Rc.-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 11 .. 1 r Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° 361 Woodside Rd. M Property Address Suzy Shur-Thompson Owner Owner's Name informations required for W Barnstable Ma. 02668 5/20/2008 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.): Damp soil.Leaching Pit is in hydraulic failure.Pit was full at time of inspection. 361 Woodside Rc.•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 12 i f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 361 Woodside Rd. Property Address Suzy Shur-Thompson Owner Owner's Name information is required for W Barnstable Ma. 02668 5/20/2008 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.): 361 Woodside Rd.•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 13 Map Page 1 of 2 Town of Barnstable Geographic Information System y Parcel Viewer Custom Map Abutters Map Size ® Zoom Out J J JJj In �g� L rtC R P -- --- --- -- � - ' I Y ' X M 1i `l � r : I ! , 4. � k � r � � 1 t 1.< r, �c r J Re t �t f � r e S 2O Feet Set Scale 1" = 20 I Aerial Photos !'—Mv hf WOR-000A T--nf'R-0n VJo hAA All rinhfc roconn httn://www.town.bamstable.ma.us/arcims/appgeoapp/map.aspx?propertyID=152031&map... 5/28/2008 Commonwealth of Massachusetts L W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;b 361 Woodside Rd. Property Address Suzy Shur-Thompson Owner Owner's Name information is required for W Barnstable Ma. 02668 5/20/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: Bottom of LP 55' 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:USGS Observation Well Data.USED:Technical Bulletin 92-000-01 plate#2 annual ranges of groundwater elevations. 361 Woodside Rd.•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 . . own of Rar nsta le 1 P� o .regulatory ,Services :I BARNBTABLE, : Thomas F. Geiler, Director v 199.� ���'°TEnkuy1. Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 REGARDING SEPTIC INSPECTIONS BY PRIVATE CONTRACTORS DISCLAIMER 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 or copy of the report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observations 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 Works Construction Permit". If you should have any questions regarding this report, please contact the certified Septic System Inspector who conducted the inspection. Q:ISEPTICTisclaimer Private Septic Inspect ions.DOC I' .r-r a. .. \mil ^ti ../A. '� � r �. .+s. ..'`r �- -t'�'�♦ v .- _ .. - ... _.ppp //No. c.�c� .. ,�/� V i " r Fee THE COMMONWEALTH OF MASSACHUSETTS� Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01ppYtcatton for 3tgpooal *p!tem Con5tructton Vermtt Application for a Permit to Construct( ) Repair k Upgrade( Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 3(o l w ooa S�� pp O 'mod Owner's Name,Address,and Tel.No. We.!5- 13A-111-3TA-3Ve 3Gi �s� (s: .2� Assessor'sMap/Parce 15,�R —B 3� w, �.��,., ,.•vE� Installer's Name,Address,and Tel.No. 4�4,pzw,.dA Designer's Name,Address and Tel.No. ?63 Z G i E7C r(Ce �'1//dl "273-- o3-7-7 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 3 o gpd Design flow provided 3 J 1 • d gP Plan Date L 'beef Number of sheets Revision Date Title 3 w&,Q A 5,. Size of Septic Tank 100 Ck Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) r�� � (+� �j A" kf'2o �_Oo< Date last inspected: Z 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. Sig d Date 7" 2 I Application Approved by Date 2 Application Disapproved by: Date for the following reasons Permit No. Date Issued / CP ——————— ._.... . :.tir .,. .y,,.,4, •�.' c-....,,r._-N°"'Y.;.,s.�..:;ii-:::.:,=r+M•7.vsT......- .1.+...*'' '.. _ is e..:a^'.r-�y7 +�:r-.:r..:..._t ;:,+..y-a... r.�.r a. a.. � ......,rY... ,,,e:.s.-k V.'s:,q., .ax No. 30 1Fee' THE COMM'JNWEALTH•OF MASSACHUSETT `�Entered in computer: V PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pprication for �i5pont.6p5tem (Congtruction Permit Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. 3(,( w o-a s,Jw Q.,�-4 d Owner's Name,Address,and Tel.No. j,j Z�'/ Uj A✓rna(AC3iC. *3C.1 Woad S:ch 2t) Assessor'sMap/Parce /5a (0 3 j Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. SC 6' �. ddk _lC,5YY C<l17W1' r /4. Type of Building: Dwelling No.of Bedrooms Lot Size 35,48�� sq. ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) '3 3 o - gpd Design flow provided gpd Plan Date (,r ! Le�� Number of sheets f /' Revision Date Title 3(.:> .9aA 5 Size of Septic Tank /000 U,y I�k Type of S.A.S. �Z ') }va tP [,. C. 0^Z� Description of Soil a Nature of Repairs or Alterations(Answer when applicable) ` o `2) 1{ -Lo 5'� L.C.. . 1 a Date last inspected: =2 u - Zo o S6 Agreement: i 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. C Sig ed p Date '— Z �0`36 Application Approved by •, Date Application Disapproved by: ` Date for the following reasons Permit No: Date Issued / U THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (certificate of Compliance THIS IS TO CERTIFY,that the.On-site Sewage Disposal System Constructed ( ) Repaired (V— Upgraded ( �) Abandoned( )by e LA 02 u3i CU G n 4-,; Of �- at _3(a) (,)o o A 5 s )..,a. "AA has been constructed in accordance J with the provisions of Title 5 and the for Disposal System Construction Permit No. �-- 03 dated Installer rknec.�;�, &?,,4Z /, C� (�,C.0 Designer -T C• ��, /2,¢R„ ,t t s #bedrooms I Approved d &1go flow // \\ '3 gpd The issuance of this permit cotsshall,not be strued as a guarantee that the system ill functi as�dds ned Date �/ / o ; c�'$ Inspector No.,Qco > Fee /OG THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS 1igpogal i§pgtem Congtruction Permit Permission is hereby granted to Construct ) Repair (b ) Upgrade ( ) Abandon ( ) System located at and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction/O rust be completedwithin three years of thedat' to of is perfn- . Date ��d tl Approved Tiowi DI lii >rl st t318 Regulatory Services Thomas F.Geilcr,Director. a I'tlbhe Health Division y Thomas McKean,Director 2,00 Main.litrect,Hyannis,MA 02601 Office: 509-862-4644 Fax; 508490-4304 Installer&'Desi.-Per r Certifies ' a Fornn Date: 7. 26 -0 Desigtrer•: .J fl fi 6 e e c Installer; 4-C c "5(--,L Address: x ,� L to ,. �.��Y-_ Address:' n)c -7 3 C7 oil Zcoo�S � `, l l — — was issued a perTr it to install a al—e) ini�taller ( ) septic system at 3r~1 Wcv1stcle goocl. }used on a design.drawn by (address) C: t rl�t(1eer i _, C dated ui'e x 3 2eo —.�._...� (designer) 1/ I certify that the septic system referenced above was installed substantially according to the design, which play include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was irxstal$ed with major changes (i.c, greater than 10' lateral relocation of the SAS or any vertical relocation of any component of tilt; septic system) but in accordanCC with State'& Local,Regulations. Plate revision or certified as-built by designer to follow": stallces Si atture} " a 3 -� (Designer's Sig c) _ ^ (Affi esigtler's tamp Isere) P EAS "I U TO BARNST LE P IJIC TH DIVISION.v, CE IRU'A„ 1 o COMPLIANCE WILL Na E Tie Th ;i aN A& B RECEIVED BY THI+: ►3T P LI EAL'T NISI , TIIAN>I��'Q U: Health/SepticLDesiper Certification Form 1 "d L9£0 £LZ 80S DNI833NIDN33r Wd Z£: Z0 800Z—sz—inr Town of Barnstable THE ip� Barnstable Board of Health * EARNSTABLE, ► 200 Main Street,Hyannis MA 02601 9a MASS. 3o i639. �0 TFD MA't a 2007 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi RESULTS OF THE BOARD.OF HEALTH MEETING Tuesday, July 8, 2008 at 3:00 PM Town Hall, Hearing Room 367 Main Street, Hyannis, MA I. Show-Cause Hearing — Housing (New): DEADLINE Marilyn Higgins and Cindy Gold at 92 County Seat, Hyannis — GIVEN Housing Violations. The Board voted to institute a deadline of Friday, July 11, 2008 at 4 p.m. to have all trash removed from the house and if it is not removed, a contractor will be hired at the owner's expense. II. Hearing — Housing: CONTINUED TO Sheila McNamara, owner— 294 Tobey Way, Hyannis, NOV 18, 2008 BOH removal of one bedroom and upgrade the septic system. The applicants will review their options and come back on Nov 18, 2008. III. Septic Variances (Cont): POSTPONED A. Joe Henderson, Horsley Witten Group, representing Mark UNTIL AUG 26, 2008 Ellis, owner— 239 lyannough Road, Hyannis, Map/Parcel BOH MEETING 328-206, 0.66 acre lot, 5 variances requested. III. n Septic Variances (New): p a aces ( :e ) GRANTED A. Michael Pimentel, J.C. Engineering representing Donald WITH and Susan Shur Thompson, owner— 361 Woodside, West CONDITIONS Barnstable, Map/Parcel 152-031, 35,300 square feet lot, four variances requested for a septic repair. The Board voted to approve the plan with the following condition: the drinking well must have a standard Title V well test performed and if one has been done in the past year and is normal, that will be accepted. If the water test does not pass, the well will have to be relocated. (No Deed Restriction is required as the regulations do not allow an increase to four bedrooms due to the lot size.) Page 1 of 2 CONTINUED B. Rich Capen, Capewide Enterprise, representing Grazina UNTIL Pileika, owner— 200 Horseshoe Lane, Centerville, Map/Parcel SEP 9, 2008 BOH 207/133, 10,637 square feet lot, two variances for house addition. David Flaherty will bring the green cards-abutter notices to Mr. McKean and will review options with owner. The Board voted to Continue to Sep 9, 2008 Meeting. GRANTED C. John Schnaible, Coastal Engineering, representing Pamela WITH and George Christodoulo, owner— 271 Pleasant Pines Avenue, CONDITIONS Centerville, Map/Parcel 214-04.1-002, 0.57 acre parcel, four variances requested for house addition. The plan is a new type of an I/A system known as Perc Rite System. The system provides environmental protection and the leaching tubing is only 6 inches to grade. It will remain a three-bedroom system. The Board voted to approve the I/Aseptic plan with the following conditions: 1) a three-bedroom Deed Restriction must be properly recorded, 2) a copy of the Deed Restriction must be submitted to the Public Health Division, 3) the plan needs to be installed in accordance to the DEP approval requirements, 4) a maintenance agreement must be submitted, 5) it must be conveyed to each new owner that the maintenance agreement must be maintained and is the responsibility of the owner, and 6) a monolithic tank will be used and 7) the irrigation well will be noted on the plan. IV. Variance— Food (New): GRANTED A. Dean Walton for Little Sandwich Shop, 223 (a.k.a. 263) WITH CONDITION Stevens Street, Hyannis, grease trap variance. Dr. Miller said they must keep a log of Big Dipper and Dean will see Mr. McKean for the sample document to be used for tracking the grease removal. The Board voted to approve the grease variance. V. Body Art License: APPROVED Heather Sequeira, Plymouth, MA. The Board voted to approve Heather Sequeira as a Body Artist. (She will.be working at PinCushion.) VI. Updates: Dr. Miller mentioned the Discussion for the Commercial portion of the Estuary Regulation will be held during the September 9, 2008 Board of Health meeting. Page 2 of 2 Y Y � . �`0F CERTIFICATE OF ANALYSIS; Page: , M' Barnstable County Health Laboratory Report Prepared For: Report Dated: 7/15/2008 Rich Capen Capewide Enterprises,LLC Order No.: G0847781 P.O.Box 763 Centerville, MA 02632 Laboratory ID#: 0847781-01 Description: Water-Drinking Water Sample#: Sampling Location: 361 Woodside Rd.W.Barnstable,MA Collected: 7/14/2008 Collected by:* C.B. - 12eceivedi`7Trd/2�08'--�- - EPA 524.2- Volatile Organics by GUMS ITEM RESULT UNITS RL MCL Method# Analyst Tested Note Dichlorodifluoromethane ND ug/L 0.50 EPA 524.2 yn 7/14/2008 Chloromethane ND ug/L 0.50 EPA 524.2 yn 7/14/2008 Vinyl chloride ND ug/L 0.50 2.0 EPA 524.2 yn 7/14/2008 Bromornethane ND ug/L 0.50 EPA 524.2 yn 7/14/2008 1;-) 1,2-Tetrachloroethane ND ug/L 0.50 EPA 524.2 yn 7/14/2008' 1,1,17Trchloroethane ND ug/L 0.50 200 EPA 524.2 yn 7/14/2008 1,1,2,2-Tetrachloroethane ND ug/L 0.50 EPA 524.2 yn 7/14/2008 1,1,2-TrichIoroethane ND ug/L 0.50 5.0 EPA 524.2 yn 7/14/2008 1,1-Dichloroethdne ND ug/L 0.50 EPA 524.2 yn 7/14/2008 1,1-Dichloroethene ND ug/L 0.50 7.0 EPA 524.2 yn 7/14/2008 1,1-Dichloropropene ND ug/L 0.50 EPA 524.2 yn 7i14/2008 1,2,3-Trichlorobenzene ND ug/L .0.50 EPA 524.2 yn 7/14/2008 1;2,3-Trichloropropane ND ug/L 0.50 EPA 524.2 yn 7/14/2008 1,2,4-Trichlorobenzene ND ug/L 0.50 70 EPA 524.2 yn 7/14/2008 1,2,4-Trimethylbenzene ND ug/L 0.50 EPA 524.2 yn 7/14/2008 1,2-Dibromo-3-chloropropane ND ug/L 0.50 EPA 524.2 yn 7/14/2008 1,2-Dibromoethane(EDB) ND ug/L .0.50 EPA 524.2 yn 7/14/2008 1,2-Dichlorobenzene ND ug/L 0.50 600 EPA 524.2 yn 7/14/2008 1,2-Dichloroethane ND ug/L 0.50 5.0 EPA 524.2 yn 7/14/2009 1,2-Dichloropropane ND ug/L 0.50 EPA 524.2 yn 7/14/2008 13,5-Trimethylbenzene ND ug/L 0.50 EPA 524.2 yn 7/14/2008 1,3-Dichlorobenzene ND ug/L 0.50 EPA 524.2 yn 7/14/2008 1,3-Dichloropropane ND ug/L 0.50 EPA 524.2 yn 7/14/2008 1,4-Dichlorobenzene ND ug/L 0.50 5.0 EPA 524.2 yn 7/14/2008 2,2-Dichloropropane ND ug/L 0.50 EPA 524.2 yn 7/14/2008 2-Chlorotoluene ND ug/L 0.50 EPA 524.2 yn 7/14/2008 4-Chlorofoluene _---. ND --- --:ug/L, --- 0.50---i- - - EPA 524.2 yn 7/14/2008 Benzene ND. ug/L 0.50 5.0 EPA 524.2 yn 7/14/2008 Bromobenzene ND ug/L 0.50 EPA 524.2 yn 7/14/2008 Bromochloromethane ND ug/L 0.50 EPA 524.2 yn 7/14/2008 Bromodichloromethane ND ug/L 0.50 EPA 524.2 yn -7/14/2008 Bromoform ND ug/L 0.50 EPA 524.2 yn 7/14/2008 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: 2 -'r � tea; • Barnstable County Health.Laboratory <�irsaCH��S Report Prepared For: Report Dated: 7/15/2008 Rich Capen Capewide Enterprises,LLC Order No.: G0847781 P.O. Box 763 Centerville, MA 02632 Laboratory ID#: 0847781-01 Description: Water-Drinking Water Sample#: Sampling Location: 361 Woodside Rd.W.Barnstable,MA Collected: 7/14/2008 Collected b C.B. - - -- ---- - - ----- -- .. ._... ._-- y Received: 7/14/2008 EPA 524.2- Volatile Organics by GUMS ITEM RESULT UNITS RL MCL Method# Analyst Tested . Note Carbon tetrachloride ND ug/L 0.50 5.0 EPA 524.2 yn 7/14/2008 Chlorobenzene ND ug/L 0.50 100 EPA 524.2 yn 7/14/2008 Chloroethane ND ug/L 0.50 EPA 524.2 yn 7/14/2008 Chloroform 6.0 ug/L 0.50 80 EPA 524.2 yn 7/14/2008 cis-1,2-Dichloroethene ND ug/L 0.50 70 EPA 524.2 yn 7/14/2008 cis-1,3-Dichloropropene ND ug/L 0.50 EPA 524.2 yn 7/14/2008 Dibromochloromethane ND ug/L 0.50 EPA 524.2 yn 7/14/2008 Dibromomethane ND ug/L 0.50 EPA 524.2 yn 7/14/2008 Ethylbenzene ND ug/L 0.50 700 EPA 524.2 yn 7/14/2008 Hexachlorobutadiene ND ug/L 0.50 EPA 524.2 yn 7/14/2008 Isopropylbenzene ND ug/L 0.50. EPA 524.2 yn 7/14/2008 Methylene chloride ND ug/L 0.50 5.0 EPA 524.2 yn 7/14/2008 Methyl-tert-butyl ether ND ug/L 0.50 EPA 5.24.2 yn 7/..14/2008 Naphthalene ND ug/L 0.50 EPA 524.2 yn 7/14/2008 n-Butylbenzene ND ug/L 0.50 EPA 524.2 yn 7/14/2008 n-Propylbenzene ND ug/L 0.50 EPA 524.2 yn 7/14/2008 p-Isopropyltoluene ND ug/L 0.50 EPA 524.2 yn 7/14/2008 sec-Butylbenzene ND ug/L 0.50 EPA 524.2 yn 7/14/2008 Styrene ND ug/L 0.50 100 EPA 524.2 yn 7/14/2008 tert-Butylbenzene ND ug/L 0.50 EPA 524.2 yn 7/14/2008 Tetrachloroethene ND r ug/L 0.50 5.0 EPA 524.2 yn 7/14/2008 Toluene ND ug/L. 0.50 1000 EPA 524.2 yn 7/14/2008 Total xylenes ND ug/L 0.50 10000 EPA 524.2 yn 7/14/2008 trans-1,2-Dichloroethene ND ug/L 0.50 100 EPA 524.2 yn 7/14/2008 trans-1,3-Dichloropropene ND ug/L 0.50 EPA 524.2 yn 7/14/2008 Trichloroethene ND ug/L 0.50 5.0 EPA 524.2 yn 7/14/2008 Trichlorofluoromethane ND ug/L 0.50 EPA 524.2 yn 7/14/2008 Water sample meets the recommended limits for drinking water of all the above tested parameters. 4-el 1 • - Approved By: /rTs� (Lab irector)i 7�� 6�� 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 Barnstable County Health Laboratory Report Prepared For: Report Dated: 7/17/2008 Rich Capen Capewide Enterprises,LLC Order No.: G0847785 P.O.Box 763 Centerville, MA 02632 Laboratory ID#: 0847785-01 Description: ;Water-Drinking Water i Sample#: Sampling Location: 361 Woodside Rd.W.Barnstable,MA Collected: 7/14/2008 Collected by: C.B. f Received: 7/15/2008 Routine +Ammonia ITEM RESULT UNITS RL MCL Method# Tested Ammonia ND mg/L 0.20 EPA 350.1 M 7/16/2008 Nitrate as Nitrogen 1.3 mg/L 0.10 10 EPA 300.0 7/15/2008 Copper 0.27 mg/L 0.10 1.3 SM 3111 B 7/15/2008 Iron ND mg/L 0.10 0.3 SM 3111B 7/15/2008 Sodium 15 mg/L 1.0 20 SM 31 1 1 B 7/15/2008 Total Coliform Absent P/A 0 0 SM9223 7/15/2008 Conductance 150 umohs/cm 2.0 EPA 120.1 7/15/2008 pH 6.6 pH-units 0 SM 4500 H-B 7/15/2008 Water sample meets the recommended limits for drinking water of all the above tested parameters. Approved By (Lab rector) 7/� / © t < C3 .� X �7 w v� M1 m ND="done Detected R.L = Reporting Limit MCL._Maxirnum Contaminant Level Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375.-6605 CERTIFICATE OF ANALYSIS :..�. Page: 1 Barnstable County Health Laboratory Report Prepared For: Report Dated: 7/15/2008 Rich Capen Capewide Enterprises,LLC Order No.: G0847781 P.O. Box 763 Centerville, MA 02632 Laboratory ID#: 0847781-01 Description: Water-Drinking Water Sample#: Sampling Location: 361 Woodside Rd.W.Barnstable,MA Collected: 7/14/2008 Collected by: C.B. Received: 7/14/2008 EPA 524.2 - Volatile Organics by GUMS ITEM RESULT UNITS RL MCL Method# Analyst Tested Note Dichlorodifluoromethane ND ug/L 0.50 EPA 524.2 yn 7/14/2008 Chloromethane ND ug/L 0.50 EPA 524.2 yn 7/14/2008 Vinyl chloride ND ug/L 0.50 2.0 EPA 524.2 yn 7/14/2008 Bromomethane ND ug/L 0.50 EPA 524.2 yn 7/14/2008 1,1,1,2-Tetrachloroethane ND ug/L 0.50 EPA 524.2 yn 7/14/2008 1,1,1-Trichloroethane ND ug/L 0.50 200 EPA 524.2 yn 7/14/2008 1,1,2,2-Tetrachloroethane ND ug/L 0.50 EPA 524.2 yn 7/14/2008 1,1,2-Trichloroethane ND ug/L 0.50 5.0 EPA 524.2 yn 7/14/2008 1,1-Dichloroethane ' ND ug/L 0.50 EPA 524.2 yn 7/14/2008 1,1-Dichloroethene ND ug/L 0.50 7.0 EPA 524.2 yn 7/14/2008 l,l-Dichloropropane ND ug/L 0.50 EPA 524.2 yn 7/14/2008 ..t.3 •fir,: -•i` ., 1,2,3-TnchIorobenzene ND ug/L 0.50 EPA 524.2 yn 7/14/2008 1,2,')-Trlchloropropane ND ug/L 0.50 -EPA 524.2 yn 7/14/2008 1,2,4-Trichlorobenzene ND ug/L 0.50 70 EPA 524.2 yn 7/14/20`08 1,2,4-Trimethylbenzene ND ug/L 0.50 EPA 524.2 yn 7/14/2008 1,27Dibrorno-3-chloropropane ND ug/L 0.50 EPA 524.2 yn 7/14/2008 1,2-Dibrornoethane(EDB) ND ug/L 0.50 EPA 524.2 yn 7/14/2008 1,2-Dichlorobenzene ND ug/L 0.50 600 EPA 524.2 yn 7/14/2008 1,2-Dichloroethane ND ug/L 0.50 5.0 EPA 524.2 yn 7/14/2008 1,2-Dichloropropane ND ug/L 0.50 EPA 524.2 yn 7/14/2008 1,3,5-Trimethylbenzene ND ug/L 0.50 EPA 524.2 yn 7/14/2008 1,3-Dichlorobenzene ND ug/L 0.50 EPA 524.2 yn 7/14/2008 1,3-Dichloropropane ND ug/L .0.50 EPA 524.2 yn 7/14/2008 1,4-Dichlorobenzene ND ug/L 0.50 5.0 EPA 524.2 yn 7/14/2008 2,2-Dichloropropane ND ug/L 0.50 EPA 524.2 yn 7/14/2008 2-Chlorotoluene ND ug/L 0.50 EPA 524.2 yn 7/14/2008 4-Chlorotoluene ND ug/L 0.50 EPA 524.2 yn 7/14/2008 Benzene ND ug/L 0.50 5.0 EPA 524.2 yn 7/14/2008 Bromobenzene. ND ug/L 0.50 EPA 524.2 yn 7/14/2008 Bromochloromethane , ND ug/L 0.50 EPA 524.2 yn 7/14/2008 Bromodichloromethane ND ug/L 0.50 EPA 524.2 yn 7/14/2008 Bromoform ND ug/L 6.50 EPA 524.2 yn 7/14/2008 ND=None Detected RL = Reporting Limit MCL=[Aaximum Contaminant L6e] Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 I °F'''R' CERTIFICATE OF ANALYSIS Page: 2 iQ . Barnstable Count Health Laboratory Y Y Report Prepared For: Report Dated: 7/15/2008 Rich Capen Capewide Enterprises,LLC Order No.: G0847781 P.O. Box 763 Centerville, MA 02632 Laboratory ID#: 0847781-01 Description: Water-Drinking Water Sample#: Sampling Location: 361 Woodside Rd.W.Barnstable,MA Collected: 7/14/2008 Collected by: C.B. Received: 7/14/2008 EPA 524.2 - Volatile Organics by GUMS ITEM RESULT UNITS RL MCL Method# Analyst Tested Note Carbon tetrachloride ND ug/L 0.50 5.0 EPA 524.2 yn 7/14/2008 Chlorobenzene ND ug/L 0.50 100 EPA 524.2 yn 7/14/2008 Chloroethane ND ug/L 0.50 EPA 524.2 yn 7/I4/N08 Chloroform 6.0 ug/L 0.50 80 EPA 524.2 yn 7/14/2008 cis-1,2-Dichloroethene ND ug/L 0.50 70 EPA 524.2 yn 7/14/2008 cis-1,3-Dichloropropene ND ug/L 0.50 EPA 524.2 yn 7/14/2008 Dibromochloromethane ND ug/L 0.50 EPA 524.2 yn 7/14/2008 Dibromomethane ND ug/L 0.50 EPA 524.2 yn 7/14/2008 Ethylbenzene ND ug/L 0.50 700 EPA 524.2 yn 7/14/2008 Hexachlorobutadiene ND ug/L 0.50 EPA 524.2 yn 7/14/2008 Isopropylbenzene ND ug/L 0.50 EPA 524.2 yn 7/14/2008 Methylene chloride ND ug/L 0.50 5.0 EPA 524.2 yn 7/14/2008 Methyl-tert-butyl ether ND ug/L 0.50 EPA 524.2 yn 7/14/2008 Naphthalene ND ug/L 0.50 EPA 524.2 yn 7/14/2008 n-Butylbenzene ND ug/L 0.50 EPA 524.2 yn 7/14/2008 n-Propylbenzene ND ug/L 0.50 EPA 524.2 yn 7/14/2008 p-Isopropyltoluene ND ug/L 0.50 EPA 524.2 yn 7/14/2008 sec-Butylbenzene ND ug/L 0.50 EPA 524.2 yn 7/14/2008 Styrene ND ug/L 0.50 100 EPA 524.2 yn 7/14/2008 tert-Butylbenzene ND ug/L 0.56 EPA 524.2 yn 7/14/2008 Tetrachloroethene ND ug/L 0.50 5.0 EPA 524.2 yn 7/14/2008 Toluene ND ug/L 0.50 1000 EPA 524.2 yn 7/14/2008 Total xylem�s ND ug/L 0.50 10000 EPA 524.2 yn 7/14/2009 trans-1,2-Dichloroethene ND ug/1' 0.50 100 EPA 524.2 yn 7/14/2008 trans-1,3-Dechloropropene ND ug/L, 0.50 EPA 524.2 yn 7/14/2008 Trichlaroethene ND ug/L 0.50 5.0 EPA 524.2 yn 7/14/2008 Trichlorofluoromethane ND ug/L 0.50 EPA 524.2 yn 7/14/2008 Punter samj.n'e ineets the reconinteiaded thnits for drinking water of all the above tested parainelers. t Approved By:..77ire(L.abctor)i 7�� �� ND=None Detected Rl. = Reporting Limit MCI,==Maximum Contaminant Level Superior Court House, PO. Box 427, Barnstable, MA, 026.30 Ph: 508--37.5-660 Town of Barnstable P# Department of Regulatory Services �FIKE r Public Health Division Date /"b/a 200 Main Street,Hyannis MA 02601 ^ BAMSTABM MAM Ai 1679.►� Date Scheduled "Time Fee Pd.k__ p Eo utA+ (� Soil uitability Assessment for Sewage DisposaAl,)WA A l�� c L. Ch D Performed By: �O�MI u 11 �C. ` �. Witnessed B �. .... :::a :: ' .....L.... ,..,.... ... ............. .....r....,.. .:,...........y....,..... ..:...:.., ......... ...:... mom: ...... .. ... !.,:,,.,: it Location Address "3 S, Owner's Name Ttw��5 l ti j ST i3cAdve)t- 1 a Address Assessor's Map/Parcel: sZ/� i Engineer's Name e�p �h��)o'�5��J J •C•16,11) NEW CONSTRUCTION REPAIR Telephone# 07 'h Land Use SnSlt f cbv►* I CSIA teat Slopes(%) 5'�5®lv Surface Stones I Distances from: Open Water Body '7 f 50 ft Possible Wet Area y 1-5'0 ft Drinking Water Well /00 ft t j Drainage Way N 1 4 ft Property Line 10 ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) ac" -XLxne 23, ZOO P �rf O,e-a by znAi AtCA t `` QcAQosec� SCe h-c S13�,-m ue5racle- Parent material(geologic) Depth to Bedrock >t 3.2 b s S Depth to Groundwater: Standing Water in Hole: 7 IS 2 Ss Weeping from Pit Face 7 13 2 Estimated Seasonal High Groundwater >, 1'3 2 bg.3 ...._ ........ r.r..i.,.,__....,.r..r.a,,....�:.,.:r...:......::..:-..._.:...=::r..._::?::,..:.......r.=,....;.......;,..[;.....::;.,..r!......:;::,;..,:....-y:,,,.,_.:.:,:...i,;...r:,........._:.. .:.::.r�..,>:...:..__..:....:...... .... ,..:i::.: .. ...... ':::�:::'!::.:.:.: - ... .......................�.v,n, ::..:. : ..::.�::.:. I ,. ,1,... ._. v .. .. ... ..':::: is:' �I...F..........,.... c. .c.J��.�tL�..���FS_��it .I::,.._......�.Y......._.v....r............ ..................:�.............'.i.._._,..,r.__._.,._....._,cr__it-,!:F;;!ic! ................vl..,._ .......n...._..................._........._......c:..:!u:c:::__..........r_::-::::::.:........_.. �_.._.�_v....v.....__._...:._...:._..._.............r.._.............u..__•_____.w...s......o-..a.,......,..a.,:_•___........c_....._..._....._..._....___.:........_- Method Used: preek- Maseruckton Depth Observed standing in obs.hole: t 32 in. Depth to soil mottles: 7 t 32 in. Depth to weeping from side of obs.hole: '7 t 32- in. Groundwater Adjustment — ft. Index Well# Reading Date: Index Well level — Adj.factor Adj.Groundwater Level ........._..........................:....:....... .. :................L.t..._......_..........,.......................L....... ... ,.. .. ...y�.:, ................................. ...a .....,..............!..........,.!..I..,..!..a.....:.i.i,!,!.:.:. .. ..... ......r.,...:..................r.......a........ ....... ...... .,........,......,..,.,.... r,: ,.: ....::::::.:.. ......:........... .. :.,._�.:.::::::,::...::.: y ......:....::...r.......,.......,..._...... ..... .r ..... ...... '.:...: ............::....r.,.,:.::v:.:,.,,:_;!.:,:,,,:!.,!r:•,+r,i.,,,•,,._...,,....r„r.,,...i....r.r..i.,..r,r.r...:..i..r.......r.....,.:-,::.:,.:tl:�:..r.............,._.,.,.:::::.:..,....: :::::::::::::c.�............,.....::....,....,...............r..,, r,r„ Observation Hole# Time at 9" n Depth of Perc 30"�b 4 Time at 6" Il SS A�7 Start Pre-soak Time(Qa W 30 Time(9"-6') �m End Pre-soak 1,Y.5 01 Rate Min./Inch 2 Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) IV'_ Original: Public Health Division Observation Hole Data To Be Completed on Back-----�-- Q:HEALTH/WP/PERCFORM Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Mnnsell) Mottling (Structure,Stones,Boulderes. Consistency % ZY _ too C— C Fne-HQd S ' _5Yr 5/e — 60 2. 1wie.-).(ed_ 10-5-Yrno i1i ....... .. ................ .:; ::::::::::::::::::.: . ..:....... .......................... Depth from Soil Horizon Soil Texture. Soil Color Soil Other Surface(it (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. ° b 'g a" A LS " 1®Y,r3/,2 10Yr5/Y — — 24-(00 5/i3 — �aoe-NQrI.Sartc 10,5�Yr-5 f . Depth from Soil Horizon Soil Texture Soil Color" Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. 0 - 8 ys 0ye 8-2V 1O yr 51 — 2-4-1100 6- Floe-Neel.Sate 75 fSI (00-1 2 —2 Ktoe4W-5 ® 5 Yr s/ — " ATIO HOLE oil'Iexlure"`>::;:: "Soil"Color::::•::. Soil t e Depth from Soil"tlorlion " S o I 0 h r Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency.° Gravel) Flood Insurance Rate Map: Above 500 year flood boundary, No_ Yes r r Within 500 year boundary No ✓ Yes r Within 100 year flood boundary No ✓- Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? •jt e,S If not,what is the depth of naturally occurring pervious material? Certification I certify that on i (date)I have passed the soil evaluator examination approved by the Department of Envir mmental Protection"and that the above analysis was performed by me consistent with the required training,expertise and*e peri "ce described in 310 CMR 15.0117.. Si*gnature Date 6/ 2 4110 f i ' Page. CERTIFICATE OF ANALYSIS �9 Barnstable County Health Laboratory Report Dated: 2/13/2006 Report Prepared For: Order No.: G0634476 Susan Shur-Thompson 361 Woodside Road �� W Barnstable, MA 02668 Alf fj Laboratory ID#: 0634476-01 Description: Water-Drinking Water Sample#: 34476 Sampling Location 361 Woodside Rd.W.Barnstable,MA Collected: 2/6/2006 Collected by: S.Shur-Thom Received: 2/6/2006 Routine +Ammonia ITEM RESULT UNITS RL MCL Method# Tested LAB: IC Lab Ammonia BRL mg/L 0.20 EPA350.3 2/7/2006 LAB: Inorganics Nitrate as Nitrogen 0.14 mg/L 0.10 10 EPA 300.0 2/6/2006 LAB: Metals Copper 0.27 mg/L 0.10 1.3 SM 311113 2/8/2006 Iron BRL mg/L 0:10 0.3 SM 3111B 2/8/2006 Sodium 10 mg/L 1.0 20 SM 3111B 2/8/2006 LAB: Microbiology Total Coliform Absent P/A 0 0 309 2/6/2006 LAB: Physical Chemistry Conductance 81 umohs/cm 2.0 EPA 120.1 2/6/2006 pH 6.4 pH-units 0 EPA 150.1 2/6/2006 EPA 524.2- Volatile Organics by GUMS ITEM RESULT UNITS RL MCL Method# Tested LAB: GUMS 1,1,1,2-Tetrachloroethane BRL ug/L 0.5 EPA 524.2 2/6/2006 1,1,1-Trichloroethane BRL ug/L 0.5 200 EPA 524.2 2/6/2006 1,1,2,2-Tetrachloroethane BRL ug/L 0.5 EPA 524.2 2/6/2006 1,1,2-Trichloroethane BRL ug/L 0.5 5;0 EPA 524.2 2/6/2006 1,1-Dichloroethane BRL ug/L 0.5 EPA 524.2 2/6/2006 1,1-Dichloroethene BRL ug/L 0.5 7.0 EPA 524.2 2/6/2006 RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 i J •:j rat pF AA�,v�` Page. z CERTIFICATE OF ANALYSIS 0 g, R Barnstable County Health Laboratory Report Dated: 2/13/2006 Report Prepared For: Order No.: G0634476 Susan Shur-Thompson 361 Woodside Road W Barnstable, MA 02668 1,1-Dichloropropene BRL ug/L 0.5 EPA 524.2 2/6/2006 1,2,3-Trichlorobenzene BRL ug/L 0.5 EPA 524.2 2/6/2006 1,2,3-Trichloropropane BRL ug/L 0.5 EPA 524.2 2/6/2006 1,2,4-Trichlorobenzene BRL ug/L 0.5 70 EPA 524.2 2/6/2006 1,2,4-Trimethylbenzene BRL ug/L 0.5 EPA 524.2 2/6/2006 1,2-Dibromo-3-chloropropa BRL ug/L 0.5 EPA 524.2 2/6/2006 1,2-Dibromoethane(EDB) BRL ug/L 0.5 EPA 524.2 2/6/2006 1,2-Dichlorobenzene BRL ug/L 0.5 600 EPA 524.2 2/6/2006 1,2-Dichloroethane BRL ug/L 0.5 5.0 EPA 524.2 2/6/2006 1,2-Dichloropropane BRL ug/L 0.5 EPA 524.2 2/6/2006 1,3,5-Trimethylbenzene BRL ug/L 0.5 EPA 524.2 2/6/2006 1,3-Dichlorobenzene BRL ug/L 0.5 EPA 524.2 2/6/2006 1,3-Dichloropropane BRL ug/L 0.5 EPA 524.2 2/6/2006 1,4-Dichlorobenzene BRL ug/L 0.5 5.0 EPA 524.2 2/6/2006 2,2-Dichloropropane BRL ug/L 0.5 EPA 524.2 2/6/2006 2-Chlorotoluene BRL ug/L 0.5 EPA 524.2 2/6/2006 4-Chlorotoluene BRL ug/L 0.5 EPA 524.2 2/6/2006 Benzene BRL ug/L 0.5 5.0 EPA 524.2 2/6/2006 Bromobenzene BRL ug/L 0.5 EPA 524.2 2/6/2006 Bromochloromethane BRL ug/L 0.5 EPA 524.2 2/6/2006 Bromodichloromethane BRL ug/L 0.5 EPA 524.2 2/6/2006 Bromoform BRL ug/L 0.5 EPA 524.2 2/6/2006 Bromomethane BRL ug/L 0.5 EPA 524.2 2/6/2006 Carbon tetrachloride BRL ug/L 0.5 5.0 EPA 524.2 2/6/2006 Chlorobenzene BRL ug/L 0.5 100 EPA 524.2 2/6/2006 Chloroethane BRL ug/L 0.5 EPA 524.2 2/6/2006 Chloroform 1.3 ug/L 0.5 EPA 524.2 2/6/2006 Chloromethane BRL ug/L 0.5 EPA 524.2 2/6/2006 cis-1,2-Dichloroethene BRL ug/L 0.5 70 EPA 524.2 2/6/2006 RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 f OF H� i�v at Page. 3 CERTIFICATE OF ANALYSIS Barnstable County Health Laboratory 9SSgC�}�G^/ Report Dated: 2/13/2006 Report Prepared For: Order No.: G0634476 Susan Shur-Thompson 361 Woodside Road W Barnstable, MA 02668 cis-1,3-Dichloropropene BRL ug/L 0.5 EPA 524.2 2/6/2006 Dibromochloromethane BRL ug/L 0.5 EPA 524.2 2/6/2006 Dibromomethane BRL ug/L 0.5 EPA 524.2 2/6/2006 Dichlorodifluoromethane BRL ug/L 0.5 EPA 524.2 2/6/2006 Ethylbenzene BRL ug/L 0.5 700 EPA 524.2 2/6/2006 Hexachlorobutadiene BRL ug/L 0.5 EPA 524.2 2/6/2006 Isopropylbenzene BRL ug/L 0.5 EPA 524.2 2/6/2006 Methyl-tert-butyl ether BRL ug/L 0.5 EPA 524.2 2/6/2006 Methylene chloride BRL ug/L 0.5 5.0 EPA 524.2 2/6/2006 n-Butylbenzene BRL ug/L 0.5 EPA 524.2 2/6/2006 n-Propylbenzene BRL ug/L 0.5 EPA 524.2 2/6/2006 Naphthalene BRL ug/L 0.5 EPA 524.2 2/6/2006 p-Isopropyltoluene BRL ug/L 0.5 EPA 524.2 2/6/2006 sec-Butylbenzene BRL ug/L 0.5 EPA 524.2 2/6/2006 Styrene BRL ug/L 0.5 100 EPA 524.2 2/6/2006 tert-Butylbenzene BRL ug/L 0.5 EPA 524.2 2/6/2006 Tetrachloroethene BRL ug/L 0.5 5.0 EPA 524.2 2/6/2006 Toluene BRL ug/L 0.5 1000 EPA 524.2 2/6/2006 Total xylenes BRL ug/L 0.5 10000 EPA 524.2 2/6/2006 trans-I.2-Dichloroethene BRL ug/L 0.5 100 EPA 524.2 2/6/2006 trans-1,3-Dichloropropene BRL ug/L 0.5 EPA 524.2 2/6/2006 Trichloroethene BRL ug/L 0.5 5.0 EPA 524.2 2/6/2006 Trichlorofluoromethane BRL ug/L 0.5 EPA 524.2 2/6/2006 Vinyl chloride BRL ug/L 0.5 2.0 EPA 524.2 2/6/2006 Water sample meets the recommended limits for drinking water of all the above tested parameters. 1 Approved By- (Lab ctor) RL = Reporting Limit MCL=Maximum Contaminant a t Level Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 r„ DATE:_ 6/1 4/99 —_— PROPERTY ADDRESS:----___________________ 361 Woodside Drive ------------------------ West Barnstable ------------------------ O,n the above date, I Inspected the septic system at the above address. This system consists of the following: 1 . 1 -1000 gallon Septic tank 2 . 1 -1000 gallon leaching pit 3. 1 -Distribution Box Based on my Inspection, I certify the following conditions: 4 . This is a title Five Septic System. ( 78 Code ) �, 5 . The septic system is in proper working order �j J at the present time . 6 . The waste water is 59" below the invert pipe of the leaching pit . SIGNATURE:1 Name:_,�L�L Macomber .Jr------- Company: Jose_2h_P. Maco.mber_& Son , Inc . Address: Box 66 Centerville , Ma . 02632-0066 Phone:___508_775_3338_____ THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY � II JOSEPH P. MACOMBER & SON, INC. Tanks-Cesspools-Leachflelds Rft Pumped Installed ?1VE0 t� Town Sewer Connections �0 P.O. Box 66 Centerville, MA 02632-0066 JUL 1 3 1999 775-3333 775-6412 too OF b A E �' COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON MA 02108 (617) 292.5500 TRLTDY COX Secrete ARCEO PAUL CELLUCCI DAVID B. STRI**-: Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM WSPECTION FORM PART A CERTIFICATION Property Address: 361 Woodside Drive N.,T,o of owne,<Jean Sullivan West Barnstable Address of owrser: 11 Robbins-Hill Road Dau of kupection. d Brewster, Ma. Na me of kupector:(Pla" nIA/J�eph P. Macomber Jr. 1 am a DEP approved system Inspector pur&u&M to Section 15.340 of Title 5 (310 CMR 15.000) CorrxmnyNarns: Joseph P. Macomber & Son, Inc. M&rag Addis": Box 66, Centervillp., Mai - 02632-0066 T d*visor.N umber:5 0 R-7 7 5-3 3_j R CERTIFICATION STATEMENT I certity that I have personally Inspected the &swage disposal system at this address and that the Information (sported 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 hrnction end maintenance of on•ske sewage disposal systems. The system: Passes Conditionally Passes Needs Further Eval stion By the Local Fails pproving Authority Inspector's Signature: Data: The System Inspect shall submit a copy of this Inspection report to the Approving Authority (Board of Health or DEP)wiihin thirty (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 Mail submit the report to the appropriate regional office of the Department oKnvkonmerual Protection. The original should be s ant to tru system owns(.and copies sent to the buyer, If applicable, and the approving authority. NOTES AND COMMENTS revised 9/2/98 Pasc I of 11 `J PrIM,d on It"Ied Piper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) PropertyAddre::: 361 Woodside Drive, West Barnstable Owner: Jean Sullivan Date of Inspection: 6/14/9 9 INSPECTION SUMMARY: Check A, B, C, or A A. SYSTEM PASSES: I have not found any information which Indicates that any of the failure conditions described in 310 CMR 1fi.303 exist. Any failure criteria not evaluated are Indicated below. COMMENTS: S. 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,_Do. 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 complying septic tank es approved by the Board of Health. Sewage backup or breakout or high static water level observed In the distribution box is due to broken or obstructed pipe($) or due to a broken, settled or uneven distribution box. The system will pass Inspection if(with approval of the Board of Health). broken pipe(s)are replaced obstruction is removed distribution box is levelled or replaced - The system required pumpirtg-rnore than—four—times is yeardue to broken or obstructed pipe(s). The system wiihpess— inspection if(with approval of the Board of Health): - broken pipes)are replaced obstruction is removed i revised 9/2/98 Page 2ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION F0RM PART A CERTIFICATION (contirxsad) Pyclip yAdcrol 361 Woodside Drive, West Barnstable Owns: Jean Sullivan. Dal, of 4up.c Hors 6/1 4/9 9 C. FURTHER EVALUATION LS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by-this Board of Health In order to determine If the system Is falling to protect lzs public health, safety and the environment. 1) SYSTE3a WILL•PASS UNLESS BOARD OF KFALTH DErDWINES IN ACCORDANCE WITH 310 CI.IR 16.3-03 (1)(b) THAT THE SYS IS NOT FUNCTIONING IN A Wkg)LFR WI{1CJiyaLPRQ1ECT THE PUBUC ULkLTIiAND SAFETY AND THE at:BOxUd Cesspool or privy Is within 60 footvf surface water r-' Cesspool or privy Is within 60 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEU WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER, IF ANY) DETUWLNES THAT THE SYSM FUNCTIONING W A WANNER THAT PROTECTS THE PUBLIC HFALRi AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system(SAS) and the SAS Is within 100 feet of a surface water sil tributary to a aurface water supply. The system has a aeptic tank and soli absorption system and the SAS Is within a Zone I of a public water supply weu. The system has a septic tank and soil absorption system and the SAS Is wlttiln 60 foot of • private wear euDWY wau. The system has a sspdc tank and soil absorption system and the SAS Is Isss than 100 foot but 60 feet or more from a private water supply will, unless a well water ►n►lysis for coUform bacteria and volatile org►rJc compounds in6catas vu wall Is free hom pollution from that facility and the e nce of Immonla nitrogen and nJvato nlvogon Is rQual to or If sr than 6 ppm. Method used to determine distanceA�'�-- (approximation not valid).• 31 OTHER revised 9/2/98 Page 3ofIt SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Pro,,-. MAd&—: 361 Woodside Drive, West Barnstable Owrw: Jean Sullivan Data of lrupection: 6/1 4/9.9 D. SYSTEM FAILS: You !Dust Indicate either 'Yes' or 'No' to each of the following: I have determined that one or more of the following failure conditions exist as described In 310 CMR 15.303. The basis for this determination Is Identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No .•ism/ Backup oFtrowage into compone^CdueKo an overloaded orcbgged-SASor,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 i the dis ibution box above outlet invert due to an overloaded or clogged SAS or cesspool. X/ Liquid depth in o.e**p"I 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•wlthin a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for •coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS: You must indicate either 'Yes' or 'No' to each of the following: ,// The following criteria apply to large systems In addition to the criteria above: N16 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 lest of a surface drinking water supply the system•is-within 200 (aetof• t#"t&rY•toa curfaoadrink+rsg watercupf�Y _ _41"— the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area -IWPA) or a mapped Zone II of a public water supply well) The owner or operator of any such system shall upgrade the system In accordance with 310 CMR 15.304(2). Please consult the local regional otfics of the Department for further Infor,tnation. revised 9/2/98 Page 4of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Propeny Ad&*": 361 Woodside Drive, West Barnstable Owr' : Jean Sullivan Date of Inspection: 6/1 4/9 9 Check if the following have been done: You must Indicate either "Yes" or 'No' as to each of the following: Yes No / Pumping information was provided by the owner, occupant, or Board of Health. -None of the systemcompasvnts.i%&w&baon puaVaduf°GatJeast Twoweaiu aad the'system has "Da mcaiQi vM.W.A1 flog rates during that period. Large volumes of water have not been introduced Into the system recently or as part of this inspection. As built plans have been obtained and examined. Note If they are not available with NIA. The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non•sanitary or Industrial waste flow. _ The site was inspected for signs of breakout. _ 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 baffl or teas, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System orr the site has been determined based on: Existing information. For example, 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)1 The facility owner.land.oc 1panu.it diHaraa2 from_nsunarl.weraproyidad.wiihIntnimatioafln?h°�;—° �a+n °^"' ^t SubSurface Disposal Systems. Paersortt revised 9/2/98 l SUBSI1aFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION PropertyAd&—: 361 Woodside Drive, , West Barnstable Owrw: Jean Sullivan Date of Inspection: 6/1 4/9 9 Flow CONDITIONS RESIDENTIAL: Design flow: 1149 g.p•d./badro n Number of bedrooms ( asi 1: Number of 'oadrooms (actuaq:� Total DESIGN flow4,l Number of current residents: Garbage grinder(yes or no):AA Laundry(separate syste ) (yes or� ; I1 y.rs, separata Inspection,required Laundry system Inspected ye or no) Seasonal use (yes or no)" Water motor readings,it a�,va}}}`,able (last two ye r:'s usage(gpd): �� Q9/fts�'-I" If t s.a well has Sump Pump(yes or no):� not been tested in the past Last date of occupancy:tl ^ 12 months . It should be done now. COMMERCIAUINDUSTIIIAL: Type of establishment: _ ____ Design flow: 4f,-Vopd ( Based on 15.'03) E•asis of design flow______� Grease trap present: (yes or no)� Industrial Waste Holding Tank present: (yes or nao A_ 09 Non-sanitary waste disehargej to the Title 5 systorn: (yes or no)-el Water meter readings, If available: Last date of occupancy:-.19/A— OTHER:(Describe)__V4! _.__ Last date of occupancy:___�_�— GENERAL INFORMATION PUMPING RECORDS and sou:ce of information: System pumped es ?art of in pection: O es or no) If yes, volume purnrad: _ ct.rns Reason for puinpir. : TYPE OF SYSTEM Septic tank/distribu:ion box/soil absor;;;ion system Single cesspool Overflow cesspool Privy Shared system (y,�s or no) (if yes, art..-h previous Inspection records,If any) I/A Technology a: Attach copy copy of ul, t r date operation and maintenance contract Tight Tank Technology of D=P At p:oval Other APP�i BATE AGE of all c ),npunonts, data i s.,:t Ned-W known)-and source,o44oformation: �ZLV, Sewage odors detected whan•ar;iving at the s:t::: (yes or no) e6of11 Pa revised 9/2/98 e SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (corttinuad) Pso9*MAd,&o": 361 Woodside Drive, West Barnstable Owner: Jean Sullivan, Dou of"P*cdoa: 6/1 4/9 9 BUILDLNG SEWER: (Locate on slts plan) Depth below grade:,,,_ Material of c nsv ctlon, cgs Iron PV other (explain) Distance from � vets water supply wall or suction line Diamster _ Comments:(condition of Joints, venting, ovidenca of leakage,-etc.) vent . S T (locate on site plan) Depth below grade: Matoriai of construction: s' oncretemetel / FlberglnslOPolyethyleneother(explain) It tank la metal,Ilst ego__ Js.age.conAtmed by Certificate of Compliance 11,W (Yes/No) Dimensions: Sludge depth:_ 24 / Distance from top of,41udge to bottom of outlet tee orbefflat 5Z Scum wcknsss: / Distance from top of scum to top of outiot too or baHls:_ Distance from bonom of scum to bono of outlet t e r bafflo: How dimonslons wars determined: Comments: toes or•baf (recommendation for pumping, condition of Inlet and outlet fles, depth of liquid level In relation to outlet n+art, cvucture:.r,ts�r ty evidence of leakage, etc.) are o evidence o ea age . GREASE TRAP• (locate on sits plan) Depth below grade:to 1h otherlexplain) sMaPol Material of consvuction�concrot�mota,r Fiberglas yethylene+ Dimensions: Scum Wcknsaa: Distance from top of scum to top of outlet too or baffle: Distance from bottom of s m to bottom of outlet tee or baffle Date of last pumping: Comments: Irscommandstion for pumping,condition of Inist and outlet tees or baffles, depth of liquid level In relation to outlet invert. structural int.gnt� evidence of leakage, etc.) revised 9/2/98 Page 7of11 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) PropertyAddress: 361 Woodside Drive, West Barnstable Owner: Jean Sullivan Data of Irupection: 6/1 4/9 9 TIGHT OR HOLDING TANK161A(Tank must be pumped prior to, or at time of, inspection) (locate on site plan) Depth below grade-a Materiel of cons truction;f?L4,roncrste42imetal,FiberglassZAPolyethylene44?other(explainl Dimensions: Capacity:_ gallons Design flow: gallons/day Alarm presentj jig Alarm level: Alarm In working order:Yes. No&V Date of previous pumping: _ Comments: (condition of Inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: !� (locate on site plan) Depth of liquid level above outlet Invert:_ Comments: (note if level and distribution is equal, evidenoe of solids carryover, evidence of leakage Into or out of box, etc.) — solfns e into or out ot the box . PUMP CHAMBEA:—.,&Vei (locate on site plan) Pumps in working order:(Yes or No) Of Alarms In working order(Yes or No) Comments: (note condition of pump chamber,condition of pumps and appurtenances, etc.) P revised 9/2/98 Page 8of11 I II', SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Aches': 361 Woodside Drive, West Barnstable Owner: Jean Sullivan . Data of inspection: 6/1 4/9 9��R ��'-'��i�i At SOIL ABSORPTION SYSTEM(SAS)' roximated by non-Intrusive methods) (locate on site plan, If possible: excavation not required,location may be app 11 not located, explain: Type: leaching pits, number:___ leaching chambers,number: leaching galleries,number: leaching trenches, number,length: leaching fields, number, dime slons: A__ overflow cesspool,number: Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure,level of ponding, damp $oil, condition of vegetation.,etc. y mix to y rau i 1 is r CESSPOOLS: (locate on site plan) pp�� Number and configuration: U Depth-top of liquid to Inlet Invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: Inflow (cesspool must be pumped as part of Inspection) CeITT E.S , Comments: failure,level of ponding,condition of vegetation, etc.) (note condition of soil, signs of hydraulic sen PRIVY:2'jivQ' (locate on site plan) 160" Dimensions: Mate(jals of construct! n: Depth of solids: Comments: ic failure,level of ponding, condition of vegetation; etc.) (note condition of soil, signs of hydraulPri Page 9 of 11 revised 9/2/98 SUBSURFACE SEWAGE DtSPOSAI.SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (condmj4d) PropMAddr&&4:361 Woodside Drive, West Barnstable Owrw; Jean Sullivan o fu of kup+coon: 6/1 4/9 9 SKETCH OF SEWAGE DISPOSAL SYSTEM: Include Iles to +t7e+st two permanent re(arence landmarks or benchmarks locale all wells wlWn 100' (locate white public water supply comes Into house) � sC> �we1cJ revised 9/2/98 Pall 10of It SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) PropattyAddress: 361 Woodside Drive, West Barnstable Owner: Jean Sullivan Date of 4upection: 6/1 4/9 9 NRCS Report name Soil Type_ Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep _ S1TE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to Groundwater_Feet Please indicate all the methods used to determine High Groundwater Elevation: 0 tained from Design Plans on record Observed.Site (Abutting property, bservation hole, basement sump etc.) Determined from local conditions Checked with local Board of health ed FEMA Maps hocked pumping records _ZChecked local excavators, Installers Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) I Usedwwater contours map . Gahrety & Miller Model 12/ revised 9/2/98 Page 11orit �r � •r•�nr�.-n T►.•+Tr••..nrmr•nrwR•art.•...+T.nn�.+i.�r►.•r.�.T.•..r.,mnwli ti..'v,T,�,sT+ .. .r�.-+•T-r-a^rr-'.%..- I TOWN OFBARNSTABLE LlOARD OF HEALTH i SU[1SU[tFACR 9F.Wnc;F DISPOSAL ,SY3TF.M INSPECTION FORM - PART D •- CERTIFICATION A-•T., T•'.'t:.-7..111�.RTT\mf.'..1'If.1T1 T4 KIfT1f TTT1T.'r-t•1-'IR.RII R.IAl�T1'r1�'I�I.TIAI�R�'II."� T1t I1•'ItiK1R7iT`TTT��•.�r T'r.1r -..� -TYPO OR PRINT CLEARLY- PROPERTY INSPECTED STREET ADDRESS _361 Woodside Drive, West Barnstable ASSESSORS MAP , BLOCK AND PARCEL # OWNER' s NAME Jean Sullivan PART D - CERTIFICATION NAME OF INSPECTOR Joseph P. Macomber� Jr. COMPANY NAME Joseph P. Macomber & Son, Inc. COMPANY ADDRESS Box 66, Centerville, Ma. 0263.2-0066 Strvat Town or City 5 t a t 0 COMPANY TELEPHONE (508 )775 -3338 FAX ( 508 )790 -1578 a CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true , accurate , and complete as of the time of.-inspection , The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . Chec one System PASSED The Inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15 . 303 , Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. System FAILED# The inspection which I have conalicted has found that the system fails to protect the }-)ublic health and the environment in accordance with Title 5 , 310 CMR 15 . 303, and as specifically noted on PART C -- FAILURE CRITERIA of this insp'ec io form . Inspector Signature Date One copy of this ertification must be provided to the OWNER, the BUYER ( where applicable ) and the BOARD OF 112AL'1'll. • 'I f the inspection FAILED, th'e owner or'"oporator shall u ha ate within one year of the date of the inspection, unless allowed dortrequirredm otherwise as provided in 3.10 CMR 16 . 306 . partd • doc TOWN OF BARNSTABLE LOCATION Apt, t"JOW31&e SEWAGE# VILLAGE W, qeA, 3�c,6U ASSESSOR'S MAP&PARCEL tZS - .26_ INSTALLER'S NAME&PHONE NO. (4 28 q u")Fl SEPTIC TANK CAPACITY ''.E rsV 100 U Qa } 1 U LEACHING FACILITY:(type) (o?) dU H 7 L> (size) 1 Z X NO. OF BEDROOMS OWNER �c,ra-� UWr��5oY1 PERMIT DATE: _ - �� V COMPLIANCE DATE: -7-U `Z®car Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility :A 0 feet Private Water Supply Well and Leaching Facility(if any wells exist on site or within 200 feet of leaching facility) i 0U feet Edge of Wetland and Leaching Facility(if any wetlands exist within 300 feet of leaching facility). feet FURNISHED BY `t f,0f,�GS L LC, 6�' � ���� � hs � � .0 cry NIP a TOWN OF ARNSTABLE LOCATION s 0_ SEWAGE # 14 VILLAGE &QST �,, il ASSESSOR'S MA.P & LOT INSTALLER'S NAME& PHONE NO. SEPTIC TANK CAPACITY LEACHING FACII.ITY: (type)J-'/40y Ald,1141 (size) /Q) NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (Lf any wetlands exist within 300 feet of leaching fa il' ) 0 Feet Furnishedor b i � `CAP O bT t t�O . V foi- S . Fix.... : .......... No._._4y THE COMMONWEALTH OF MASSACHUSETTS � I BOARD OF HEALTH �'0 �Oww - oF... 3n�sTi�d Appliratiou for DifiVasal Warko (fntui#rudiou ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: B 407- �O0 /�� �LO�• GULST �/rwST�P6GG .............................. . .........----- .._......:_................ ..�......_..__...... ....... ......Location!/L C SG................................. .............................Z/1....off`;016. .._ 't OSTC�'U/Gc� �l, ... .... ............................ ner . .............................Address Insta ller Address UType of Building Size Lot. 1f,A0A0_._.._..Sq. feet `-� Dwelling—No. of Bedrooms___.....................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons____________________________ Showers — Cafeteria Q' Other fixtures ___________________________________ W Design Flow......_t�o.._......__.� gallons per person per day. Total daily flow.-.__._3 C o'_________________________gallons. &...-- 04 Septic Tank—Liquid capacity............gallons Length................ Width....___......... Diameter................ Depth................ HDisposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit NoZod—_-�-----Diameter.................... Depth below inlet____...____......._. Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) • aPercolation Test Results Performed by.......................................................................... Date......................................... Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water................._...... (1 Test Pit No. 2................minutes per inch Depth of Test Pit...._............... Depth to ground water____:__________________. P4 ....-........................................................................................................................................................ O Description of Soil................................ xm V ........•••---•------------••---•--••---•-•-•-•---'S-�••••••-==----------------------------•-----------•--------------..-----------------------------------------------........................... ------------------..._....-----------------------•---•-----------._.-------..-.._._.__...._..--•--------- 0----------------------------------•---•-•-•••••••. .........-......................... V Nature of Repairs or Alterations—Answer when applicable................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to'place the system in operation until a Certificate of Compliance has been issue by the boa of h lth. ��// Signed...f�... ............ .... ...................... ...••--------------- Applicat on Approved BY 1-- ------------- ' Date __________________ Date Application Disapproved for the following re sons--------------------------------•------------------ ........................................................... ----------------------•------------------------...----------••----•--•-------•-•-----.......------------•...•-••-••-•----••-•-----••---:............................................................... Date PermitNo..VT _______________•--.......-.............. Issued...................-.................................... Date THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M ^C&L DATA J i� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ter, -• }�,,r,7'•.?,t,"d.. �'> ��f"'!•r,W ......--..-.. .................. Q:=.......:..:...:..........................._............................................. Appli.vatiagt for Biriipoiial Worka Tontitrurtion Vernfit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an•Individual' Sewage Disposal System at: ........................ - !� ':,:.: ....... ::c.t....... ......... y............................................. Lecatton., es Addrs- ,f ?kotJNv r i '— .,...,:..e.........:......................................................:....................... .................................................................................................. r~NOwner`p Address ......;...:f.....:................. 'Installer......,.........,.....,,...,....,.....,.. ..,...........Address........ ............................. GA Type of Building Size :...............Sq. feet I-+ Dwelling—No. of Bedrooms... ......................................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—Type of BuildingNo. of persons...:........................ Showers — Cafeteria Q' Other fixtures .---•-----...-•------------•-•-••-•--....-•---••-• . 10 W Design Flow,._.:_.''...........:___.._._ . ..........gallons per person per day. Total daily flow------ .....................................ga llons. 04 Septic Tank—Liquid.,capacity............gallons Length................ Width......---------- Diameter................ Depth................ xDisposal Trench—No. ................... Width.................... Total Length.._.........._...... Total leaching area....................sq. ft. Seepage Pit Nd;-'%rj_.._:' .:_ Diameter.................... Depth below inlet................._.. Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by-•....:.............••------...-----•------------------•-----•-•-•-_..... Date......................................... Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water_..____-___-__--_-_----- fz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.........:............. . -----•---------------------------------•-•------...--,.-.--•---------------------------..........---.......................................................... ODescription of Soil----------------------------- •------------------------•---------•-•-••----------------------------------------------•-•----------------------------------...----•----- ..,. W U Nature of Repairs or Alterations—Answer when applicable................................................................................................ .......----•---------------------•-•--•------••--------------......---------...............---•.............................................................-......................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed-l _..t .. ....................... 11-- .-. :.,___--•. r, f ' Date Application Approved By....... {._._.. ...�`` fff Date Application Disapproved for the following rtrfsonr:--.............................................................................................................. ......-•-•-----•--•----------••-•----•-•--.-•..................•----------....---.._......_....---........_..-----------•-•-..._..----...------•--•-.........-------•-..._..........--••-.......... .... Date PermitNo. ...........................................--•• Issued........................................................ Date ;p THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH "rriifiratr of Toutpliattrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (IV) or Repaired ( ) b -------------•-----•----•-------•--•----•-----------..........---•--.............._........--••_...-- - t r • ].11�TS11CC lat C' = A ... . l_ --..... ..........: fF w has been installed in accordance with the provisions of Article XI of The State Sanitary Code as d scribed in the application for Disposal Works Construction Permit No.....'=;=: �____________________..__. dated-... _. _ _ _' _..._._._..... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS GU, A TEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE------- � .:. °,c ••-_.. Inspector-:---•----•- J--.•...� •��.r!�. '�! $.. �... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF.. f:f _.. .� (� No. FEE._... wigvniial lgorbi %Tamitrurtion "**Writ Permission is hereby granted:.::='_u � ._.; r =r == -•--------•--••-•-•----•--•..................•-............_....................... to .Construct '(r ) or Repair ( ) an Individual Sewage Disposal System atNo...................................... _ Z, �' . `r ••• •-.--=•__.. ............ Street as shown on the application for Disposal Works Construction t i No., _ Dated--------M.44 Ve... and of Health DATE --��----...........----------------- =- FORD 1255 HOBBS & WARREN, INC.. PUBLISHERS FINISHED GRADE OVER TANK EL. = 84•8'± PROVIDE PRECAST CONCRETE FINISH GRADE OVER D-BOX= 86.6'± PROPOSED VENT WITH CHARCOAL GENERAL NOTES .' TOP OF FOUNDATION EXTENSION RISER WITH CONCRETE SLOPE @ 2%MIN. OVER SYSTEM FINISH GRADE OVER CHAMBERS= $7.T - $6.2' FILTER TO ABOVE GRADE CO H-20 CONCRETE RISER AND COVER ELEV= $5. COVER TO WITHIN 6"OF FINISH GRADE OVER INLET AND OUTLET COVERS. TO WITHIN 6"OF FINISHED GRADE 4"SCHEDULE 40 PVC MIN SLOPE 1% 3/4"TO 1-1/2"DOUBLE WASHED STONE TO 1. UNLESS OTHERWISE NOTED ALL SYSTEM COMPONENTS AND CONSTRUCTION ' ACCESS BOX WITH COVER TO GRADE CROWN OF PIPE METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL FINISH GRADE 5"DIA. OUTLET(S) (SEE NOTE#21) @ FND. EL, 8'4•0�'�" 2"OF"I/8"TO 1/2"DOUBLE WASHED STONE CODE AND ANY APPLICABLE LOCAL RULES. ALI CE SERS ON ALL 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE PLA RI DESIGN ENGINEER. TOP OF SAS= 81.70' CHAMBERS WITH PROPOSED 4" 9"MIN. INLET PIPES TO 6"OF 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL SEWER PIPE EXISTING " PVC SEWER PIPE 80.70' 36"MAX. BREAKOUT EL 81.20' FINISHED GRADE SYSTEM UNLESS OTHERWISE NOTED. = -- -- - 6 3 3"DROP MAX " " PROVIDE WATERTIGHT 4. TO PREVENT BREAKOUT,THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN " " ELEVATION=81.20 FOR A DISTANCE OF 15 AROUND THE PERIMETER OF THE SAS. UNLESS A 2"DROP MIN 3 9 MIN.SLOPE 1% JOINTS(Tl(P.) " 4"PVC IN FROM a ��� 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE TOP OF - 14" *$'� 4' SEPTIC TANK 4"PVC OUT TO o 0 0 O 0 0 0 0 0 o o �b O THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. O LEACHING FACILITY o00 00 0 5. SLOPE ALL SOLID PIPE AT 1.0%MINIMUM. CONTRACTOR CONTRACTOR SHALL 81.00' MIN. 80.83' 2' oo o 0 0 = = = 0 o� 6. THIS SYSTEM 1S NOT DESIGNED FOR A GARBAGE DISPOSAL. SHALL VERIFY SIZE 48" VERIFY CONDITION OF OUTLET TEE 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK AND CONDITION OF EXISTING TEES 22^ZABEL FILTER 6"CRUSHED STONE o �' a o 'oC) o FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION.SYSTEM IS EXISTING SEPTIC AND REPLACE AS MODEL#A1801-4x22 OVER MECHANICALLY co NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH TANK NECESSARY COMPACTED BASE T AND DESIGN ENGINEER. 5 4.0' 8.5'(lYP) _ - -( 4.0 3.55' 4.9' 3.55' 8 OUTLET DISTRIBUTION BOX ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM OF 88.00'ESTABLISHED TO BE INSTALLED ON A LEVEL STABLE 25.0' ' (NP') ON A NAIL SET IN AN OAK TREE AS SHOWN ON PLAN. BASE. FIRST TWO FEET OF OUTLET /778.70GROUND WATER ELEV= 73.70 EXISTING 1000 GALLON CONCRETE SEPTIC TANK PIPES TO BE LAID LEVEL. *39,+ 12.0' 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION 2 - 500 GALLON H-20 CHAMBERS CHAMBER END VIEW THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT CROSS SECTION VIEW 5'MIN. 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES SEPTIC TANK PROFILE TYPICAL CHAMBER PROFILE TO THE DESIGN ENGINEER. "CONTRACTOR TO VERIFY EXISTING ELEVATION PRIOR NOT TO SCALE I DISTRIBUTION BOX (H-20) DETAIL H-20 CHAMBER DETAILS *9roundwaterelevationpertownofbamstable's NOT TO SCALE 1992 groundwater contours ma 10• ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC.STRUCTURES SHALL BE MADE WATERTIGHT. TO ANY WORK& NOTIFY ENGINEER IF DIFFERENT. NOT TO SCAL 9 p 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING ,o REGULATIONS. OWNERIAPPLICANT IS TO OBTAIN SUCH DETERMINATION FROM x TEST PIT DATA TEST PIT DATA APPROPRIATE AUTHORITY. 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS ' 5,T �' s INSPECTOR: Donna Miiorandi INSPECTOR: Donna Miorandi LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE • � � - .��k, ' 0 THEY SHALL WITHSTAND H-20 LOADING. frY EVALUATOR: John L. Churrchill,Jr.,P.E. EVALUATOR: John L. Churchill,Jr., P.E. June 17 20)08 June 17 2008 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. ��„ • DATE: DATE: TEST PIT#: 1 (Perc.M 12267) TEST PIT#: 2(Perc. 12267) 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM,SUBSOIL AND UNSUITABLE MATERIAL IN AREA BENEATH AND FOR 5 FT.ON ALL SIDES OF LEACHING FACILITY. ELEV TOP= �84.70' ELEV TOP= 87.00' REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, 187.40' '° ELEV WATER= <73.70' ELEV WATER= <76.00' FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). R=138-40 ; PERC RATE_ <2 NAin/In PERC RATE= 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN a I ° ,. - SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. OO���� ; DEPTH OF PERC= 310"-48" DEPTH OF PERC= 16. PROPOSED PROJECT IS LOCATED WITHIN: N �JO `po � � � '`\ ,TEXTURAL CLASS: 1 TEXTURAL CLASS: 1 ASSESSORS MAP 109 PARCEL 28 a MAP 152 \�v PARCEL 31 �- OWNER OF RECORD: DONALD W.&SUSAN SHUR THOMPSON t7 ._, ADDRESS:: 361 WOODSIDE ROAD 35,284 S.F. t � � � / � ��O „ � � - �< �`" �z- �,. 0" Loamy Sand 84.70' 0" Loamy Sand 87.00' WEST BARNSTABLE, MA 02668 / --78-7 4 _- ' , A 10 Yr 3/2 A 10 Yr 3/2 \ 8-' g^ 84.03 g^ 86.33 FEMA FLOOD ZONE C B Loamy Sand B Loamy Sand COMMUNITY PANEL# 250001 0015 C O C63w/p j 10 Yr 5/4 10 Yr 5/4 O " r _, 24" 82.70' 24" 85.00' 17. DEED REFERENCE: BOOK 12379, PAGE 332 18. PLAN REFERENCE: PLAN BOOK 239 PAGE 137 30 82.20 F to M Sand F to M Sand 00 Perc C-1 ;"- 7.5 Yr 5/8 C-1 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. 7.5 Yr 5/8 SHED �'a., , 48" 80.70' 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY f / \ x ' r FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY 70' 6 " 8 00' FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. 60 79. 0 2. +� ._�, �>t .� , .. : �,_.: _ 21. A 4 PERFORATED SCH.40 PVC PIPE SHALL:BE PLACED IN A VERTICAL POSITION TO A f \ s :< k \x \ f MAP 52 , a DEPTH OF THE BOTTOM OF THE SAS AND EXTEND TO WITHIN 3"OF FINISH GRADE. A f PARCEL 32 1 < y hx' P TO ALLOW FOR INSPECTIONS. DRIVEWAY � � IN-GROUN ,�� r; � , REMOVABLE THREADED CAP SHALL BE PLACED ON THE TID `# / 389 WOODSIDE RDi «, .`. �. \ �, \ / POOL \ / s G2 F to M Sand C_2 F to M Sand 22- THE FOLLOWING LOCAL VARIANCES ARE REQUESTED FROM THE TOWN OF BARNSTABLE'S Iv) 10.5 Yr 5/4I 10.5 Yr 5/4 CHAPTER 397: WELLS REGULATIONS;SECTION 397-2: `n `--82 \ \ (1.) A 47.6'VARIANCE(150.0'- 102A')FOR THE SETBACK FROM THE PROPOSED LEACHING 150'WEB E RD FACILITY TO THE EXISTING WELL LOCATED AT 389 WOODSIDE ROAD. ` 376 WOODS --APPROXIMATE LOCATION OF LOCUS PLAN_ (2.) A 47.6'VARIANCE(150.0'- 102.4')FOR THE SETBACK FROM THE PROPOSED LEACHING EXISTING DISTRIBUTION BOX FACILITY TO THE EXISTING WELL LOCATED AT 361 WOODSIDE ROAD. / SCALE: 1"= 1000 132" 73.70' 132" 76.00' APPROXIMATE LOCATION OF EXISTING LEACHING PIT TO 23. IN ACCORDANCE WITH 310 CMR 15.401 -15.405,THE FOLLOWING LOCAL UPGRADE '* r town of BamstabWs 1992 groundwater contours ma " ► \ ��� BE PUMPED AND FILLED WITH CLEAN, COARSE SAND per 9 p No Mottling,Standing or Weeping Observed No Mottling, Standing or Weeping Observed APPROVALS ARE REQUESTED FROM 310 CMR 15.221 (7): (1.) A 3.0'WAIVER(3.0-6.0')FOR THE MAXIMUM COVER OVER THE LEACHING FACILITY. DESIGN DATA (2.) A 2.0'WAIVER(3.0-5.0')FOR THE MAXIMUM COVER OVER THE DISTRIBUTION BOX. EXIST.WELL TEST PIT`DATA _ LEGEND #361 � _ `` EXISTING - / '� NUMBER OF BEDROOMS(ASSESSOR) 3 3-BEDROOM LP /$�� 50x0 EXISTING SPOT GRADE \ NUMBER OF BEDROOMS(DESIGN) 3 INSPECTOR: Donna Miorandi DWELLING EVALUATOR: John L.Churchill,Jr., P.E. - - 50 - - EXISTING CONTOUR TOF-85.1'± 4��` k / - � APPROXIMATE LOCATION OF EXISTING 1000 GALLON DESIGN FLOW 110 GAL/DAY/BEDROOM SEPTIC TANK TO BE UTILIZED AS PART OF THIS DESIGN SWING-'TIES TOTAL DESIGN FLOW 330 GALA:) DATE: June 17,2008 AY 50 PROPOSED CONTOUR o ` 2 _ TEST PIT#: 3(Perc.#12267) DESCRIPTION HCA : HC-2 DESIGN FLOW X 200 % = 660 GAL/DAY E/T/C EXISTING UNDERGROUND UTILITIES --- -` 2 � PROPOSED 2-500 GALLON ELEV TOP= _ 88.00 . EXIST.WELL 1024 Sr \ H-20 LEACHING CHAMBERS LEACHING CORNER(1) 26.8' 34.4' USE EXISTING 1000 GALLON SEPTIC TANK ELEV WATER- <77.00 W W EXISTING WATER LINE Bnchrk 1 � LEACHING CORNER(2) 38.1' 47.3' PERC RATE APPROXIMATE ATER SERVICE e ma 20. _ -X-X-X-X-X- EXISTING FENCELINE (CONTRACTOR TO VERIFY) it in Oak Tree y) = LEACHING CORNER(3) 51.1' 55.6' Elev.=88.00' 71 moo' _ - - DEPTH OF PERC= TEST PIT LOCATION r' rox.M.S.L. o '` N� o LEACHING CORNER(4) 43.3' 51.8' INSTALL 2 500 H 20 GALLON CHAMBERS APP `per `LL EXISTING LEACHING PIT � / � � �g8 _ TEXTURAL CLASS: 1 LP � . TP 1, o ` o �� ,.y SIDEWALL CAPACITY � � 84.70 � 4 4W ., O (� 00 v TP 2 (LENGTH + WIDTH) (2 SIDES) (2'HIGH) (0.74 GPD/S.F.) = GAL/DAY 0" 88.00' Q Q EXISTING 1000 GALLON SEPTIC TANK �6/ �.O 87.00 ,: . 88 TP 3�•O�� / (25'+ 12')(2) (2') (0.74 GPD/S.F.) = 109.5 GAUDAY Loamy Sand < 8"A 10 Yr 3/ 87.33' oo �� 88.00' , PROPOSED 4"SOLID SCHEDULE 40 PVC PIPE / co EXISTING#361 BOTTOM CAPACITY Loam Sand �°' /� B y 10 Yr 5/4 (LENGTH x WIDTH) (0.74 GPD/S.F.) = GAUDAY ' ❑ PROPOSED H-20 DISTRIBUTION BOX \ ,`r o ,pa"E 3-BEDROOM (25'x 12') (0.74 GPD/S.F.) = 222.0 GAUDAY 24" 86.00` p `) / N79 Tg / I 50'WELL OFFSET \ DWELLING 32 --- INS RD _ ,+ 0 PROPOSED 500 GAL. H-20 LEACHING CHAMBER �1 1 / 770 THE PLA �- TOF-85.1 _ HC-2 C)o / PROPOSED DISTRIBUTION BOX TOTALS: C-1 F7 5 to iY 6 8d REV.° DATE BY APP'D. DESCRIPTION 0 2 Z PROPOSED INSPECTION PORT TOTAL NUMBER OF CHAMBERS PROPOSED SEPTIC SYSTEM UPGRADE _ MAP 152 TOTAL LEACHING AREA 448.0 SQ.FT. 60" 83.00' PREPARED FOR: m PROPOSED PVC VENT PIPE; PARCEL 30 2 TOTAL LEACHING CAPACITY 331.5 GAL./DAY CAPEWIDE ENTERPRISES o EXACT LOCATION PER OWNER 170 THE PLAINS RD ) HCA " 0v - F to M Sand m (� LOCATED AT y Z =r o C-2 10.5Yr5/4 361 WOODSIDE ROAD o WEST BARNSTABLE, MA -i p w .� 3)0 132"1 1 77.00' SCALE: 1 INCH = 20 FT. DATE: JUNE 23,2008 � SH o�M 0. 0 10 20 40 80 FEET 11 (4 No Mottling,Standing or Weeping Observed �� JOHN L. � CHURCHILL w SWING-TIES PLAN RESERVED FOR BOARD OF HEALTH USE clnL PREPARED BY: SCALE: 1"=20' No. 41507 JC ENGINEERING, INC. 2854 CRANBERRY HIGHWAY NOTE: 1. MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP EAST WAREHAM, MA 02538 SITE PLAN 5os.273.0377 EDGE OF EACH SEPTIC SYSTEM COMPONENT.. SCALE: 1"=20' Drawn By: MCP Designed By:MCP Checked By:JLC JOB No.1434 !IT it FINISHED GRADE OVER TANK EL.= 84.,$'± PROVIDE PRECAST CONCRETE FINISH GRADE OVER D-BOX= 86.6�±' FINISH GRADE OVER CHAMBERS= $7,T - $G,2' PROOPOSED VENT WITH CHARCOAL �j E N E RAL NOTES TOP OF FOUNDATION EXTENSION RISER WITH CONCRETE FILTER TO ABOVE GRADE COVER TO WITHIN 6 OF FINISH GRADE SLOPE 2% MIN.OVER SYSTEM _ H-20 CONCRETE RISER AND COVER ELEv- 85.1 ± OVER INLET AND OUTLET COVERS. TO WITHIN 6"OF FINISHED GRADE 3/4"TO '1-1/2"DOUBLE WASHED STONE TO 1. UNLESS OTHERWISE NOTED,ALL SYSTEM COMPONENTS AND CONSTRUCTION 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) w n n CODE AND ANY APPLICABLE LOCAL RULES. FND. EL.= 84.0 2 OF 1/8 T� 1/2 DOUBLE WASHED STONE PLACE RISIERS ON ALL 2- ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE TOP OF SAS= $1,70' CHAMBERS WITH DESIGN ENGINEER. PROPOSED 4" 9"MIN. INLET PIPIES TO 6"OF n EXISTING 4 I 3. 4 SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL SEWER PIPE PVC SEWER PIPE 8O.70 36"MAX. BREAKOUT EL = 81.20' FINISIHED GRADE SYSTEM UNLESS OTHERWISE NOTED. 6" 3" 3p DROP MAX 3„ 9n PROVIDE WATERTIGHT o 4. TO PREVENT BREAKOUT,THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN 2 DROP MIN JOINTS P. _ , MIN.s�oPe , � ) ELEVATION -81.20 FOR A DISTANCE OF 15 .AROUND THE PERIMETER OF THE.SAS. UNLESS A 10" ( 4 PVC IN FROM " �'� 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE TOP OF 10" 14" *$ ,4'-- SEPTIC TANK 4 PVC OUT TO o O 0 0 0 0 0 0 0 { THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. O LEACHING FACILITY a� 00 2b 5. SLOPE ALL SOLID PIPE AT 1.0%MINIMUM. " oo CONTRACTOR " CONTRACTOR SHALL OUTLET TEE 81.00, MIN. 80.83' 2' oo O o o op 00 6. THIS SYSTEM IS NOT DESIGNED FOR GARBAGE DISPOSAL. SHALL VERIFY SIZE 48 VERIFY CONDITION OF �' 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK 0 0 a i, a AND CONDITION OF EXISTING TEES 22. ZABEL FILTER 6"CRUSHED STONE o L� 0 0 0 00 0 o FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS EXISTING SEPTIC AND REPLACE AS MODEL#A1801-4x22 OVER MECHANICALLY o - NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH TANK NECESSARY COMPACTED BASE 4.0' - 4.0' AND DESIGN ENGINEER. 8.5 P _ � � ) 3.55 3.55 4.9 cJ UT ET DISTRIBUTION BOX 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM OF 88.00 ESTABLISHED O L 25.0 , P. TO BE INSTALLED ON A LEVEL STABLE. ' i ON A NAIL SET IN AN OAK TREE AS SHOWN ON PLAN. BASE. FIRST TWO FEET OF OUTLET I GROUND WATER ELEV.= 73.70 EXISTING 1000 GALLON CONCRETE SEPTIC TANK PIPES TO BE LAID LEVEL. 78.70 *39'± 12.0 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT 2 -`500 GALLON H-20 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 *groundwaterTO THE DESIGN ENGINEER. *CONTRACTOR TO VERIFY EXISTING ELEVATION PRIOR NOT TO SCALE DISTRIBUTION BOX (H-20) DETAIL H-20 CHAMBER DETAILS 1 elercont contours dbamstables TO ANY WORK& NOTIFY ENGINEER IF DIFFERENT. NOT TO SCALE 9 R 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC.STRUCTURES SHALL BE MADE WATERTIGHT. 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM TEST PIT DATA TEST PIT ,DATA APPROPRIATE AUTHORITY. 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS • ` ` INSPECTOR: Donna Miorandi INSPECTOR: Donna Miorandi LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE THEY SHALL WITHSTAND H-20 LOADING. 1 EVALUATOR: John L.Churchill JJr. P.E. EVALUATOR: John L.-Churchill, Jr., P.E. 13. L BE FREE OF ALL DI S AND FINES. - DOUBLE WASHED CRUSHED STONE SHALL DIRT, DUST A ES DATE: June 17,20 DATE: June 17,20 08 08 ill ,I, '" ,r �` �. �•. ,�` � �-,•�r TEST PIT#: 1 (Pere.#1226�7) TEST PIT#: 2(Perk,#12267) 14, WHERE REQUIRED,CONTRACTOR SHALL REMOVE ALL LOAM,SUBSOIL AND UNSUITABLE MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. Q I - - d ELEV TOP= 84.70 ELEV TOP= 87.00 " REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, OP r IN 1 CMR 15.255(3). •, �1 / L=187 40' t ,:" >` ELEV WATER= <73.7(0' ELEV WATER= ' <76.00' FINES OR OTHER UNSUITABLE MATERIAL ACCORDANCE WITH 310 -40 �.ty - 3 8 k r, -1 O R - - �O -t _�: PERC RATE- <2 Mm/In PERC RATE.- 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN k r.+ SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. " DEPTH OF PERC= 30 48 DEPTH OF PERC- 16 PROPOSED PROJECT IS LOCATED WITHIN: V� m TEXTURAL CLASS: 1 TEXTURAL CLASS: 1 ASSESSOR'S MAP 109 PARCEL 28 a MAP 152 - }> OWNER OF RECORD: DONALD W.&SUSAN SHUR THOMPSON �v PARCEL.31 / S90 `�� `� �� ���° ate ADDRESS: 361 WOODSIDE ROAD I , yL 35,284 S.F.± / �����9 0" Loam Sand 84.70' On Loam Sand 87.00' WEST BARNSTABLE MA 02668 i � y y / 3 A A 10 Yr 3/2 10 Yr 3/2 8" 84.03' 8" 86.33' FEMA FLOOD ZONE C 0 �• >_. #� Loam Sand Loam Sand S B y B y a fi �• � �� °- COMMUNITY PANEL# 250001 0015 C 10 Yr 5/4 10 Yr 514 / \ _'O , " n 17. DEED REFERENCE: BOOK 12379, PAGE 332 0 �u 4-- . 24 82.70 24 85 00 0 , i O 3fi / \ 18. PLAN REFERENCE: PLAN BOOK 239,PAGE 137 30" 82.20' ],,,- F to M Sand ORIGINAL CONDITION.' Perk C-1 z C19. ALL DISTURBED AREAS SkiALL.BE RESTORED TO RIGINA ONDIT.5 Yr 5/8 5F to M SandSHED x ` 7.5 Yr /8 ea: 48 80,70 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLANTS TO BE USED ONLY -� �c FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY " " FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. 60 79.70 60 82.00 _ 21. A 4"PERFORATED SCH.40 PVC PIPE SHALL BE PLACED.IN A VERTICAL POSITION TO A .MAP 152 ,.. ... .... DEPTH OF THE BOTTOM OF THE SAS AND EXTEND TO WITHIN 3 OF FINISH GRADE. A \ PARCEL 32 *_ T REMOVABLE THREADED CAP SHALL BE PLACED ON THE TOP TO ALLOW FOR INSPECTIONS. r DRIVEWAY IN-GROUN \ 9 ku ,,., \ 389 WOODSIDE RD 22. THE FOLLOWING LOCAL VARIANCES ARE REQUESTED FROM THE TOWN OF BARNSTABLE'S / F to M Sand F to M Sand POOL / f `:� •" / a C-2 10.5 Yr 5/4 C-2 10.5 Yr 5/4 CHAPTER 397: WELLS REGULATIONS;SECTION 397-2: FSET�- (1.) A 47.6'VARIANCE(=50.0'-`102.4')FOR THE SETBACK FROM THE,PROPOSED LEACHING o \ LL OF --_. \ 150 WE-- -•--- LOCUS PLAN FACILITY TO THE EXISTING WELL LOCATED AT 389 WOODSIDE ROAD. J C /� 8�, 1376 WOODSIDE RD APPROXIMATE LOCATION OF (2.) A 47.6'VARIANCE(150.0'-102.4')FOR THE SETBACK FROM THE PROPOSED LEACHING / \ X EXISTING DISTRIBUTION BOX FACILITY TO THE EXISTING WELL LOCATED AT 361 WOODSIDE ROAD. \ \ / n_ , J SCALE: 1 - 1000 _ � X/ 132 I a 132 73.70 76.00 1 PIT T .,F EXISTING LEACHING O 23. IN X APPROXIMATE LOCATION O ACCORDANCE WITH 310 CMR 15.401 -15.40 THE FOLLOWING LOCAL UPGRADE 5 O O U GRA ' ,-- ** town of Barnstable's 1992 groundwater � ��/� BE PUMPED AND FILLED WITH CLEAN, COARSE SAND I� g undwater contours map No Mottling,Standing or Weeping Observed No Mottling,Standing or Weeping Observed APPROVALS ARE REQUESTED FROM 310 CMR 15.221 (7): 64- �_ / d- � •-: � VX .<v (1.) A 3.0 WAIVER(3.0-6.0)FOR THE MAXIMUM COVER OVER THE LEACHING FACILITY. (2.) A 2.0'WAIVER(3.0-5.0')FOR THE MAXIMUM COVER OVER,THE DISTRIBUTION BOX. C N DATA I, � •_ �- ,o � EXIST.WELL DESIGN I G � TEST PIT 'DATA #361 / �� LEGEND EXISTING 3-BEDROOM / LP % �g4 NUMBER OF BEDROOMS(ASSESSOR) 3 / -- NUMBER OF BEDROOMS(DESIGN) 3 INSPECTOR: Donna Miorandi - - 50x0 - EXISTING SPOT GRADE TOFEL85.1'+_+_ 4> { ac DESIGN FLOW 110 GAUDAYBEDROOM EVALUATOR: John L•Churchill,Jr.,P.E: 50 EXISTING CONTOUR APPROXIMATE LOCATION OF EXISTING 1000 GALLON / DATE: June 17,�008 / ---- Q SEPTIC TANK TO BE UTILIZED AS PART OF THIS DESIGN SWING-TIES TOTAL DESIGN FLOW 330 GAVDAY 50 PROPOSED CONTOUR 102 TEST PIT#: 3(Peril.#12267) HCA HC-2 DESIGN FLOW X 200 % _ 660 GAVDAY E/T/C EXISTING UNDERGROUND UTILITIES DESCRIPTION ELEV TOP= 88.00 PROPOSED 2-500 GALLON EXIST.WELL USE EXISTING 1000 GALLON SEPTIC TANK C'sr \ H-20 LEACHING CHAMBERS LEACHING CORNER(1) 26.8' 34.4' ELEV WATER= r <77.00' W W EXISTING WATER LINE 102.4, •s v i 0 LEACHING CORNER(2) 38.1' 47.3' PERC RATE_ X-X-X-X-X- EXISTING FENCELINE APPROXIMATE W�TER SERVICE Benchmark 12 (CONTRACTOR TO VERIFY) il in Oak Tree y� ' LEACHING CORNER(3) 51.1' 55.6' DEPTH OF PERC 88.00 7 � TEST PIT LOCATION r Approx.`M.S.L. LEACHING CORNER(4) 43.3' 51.8 INSTALL 2 - 500 H-20 GALLON CHAMBERS TEXTURAL CLASS: 1 EXISTING LEACHING PIT TP 1 SIDEWALL CAPACITY / ' 0 0 \ O (LENGTH + WIDTH) (2 SIDES) (2'HIGH) (0.74 GPD/S.F.) = GAIUDAY " , TP 2 :'; :. �O �� _ 0 88.00 O Q EXISTING 1000 GALLON SEPTIC TANK O 87.00 ' : TP 3 F�Fj. (25'+ 12')(2) (2') (0.74 GPD/S.F.) 109.5 GAIUDAY A Loamy Sand �O 88 88.00' .: 87.33' PROPOSED 4 SOLID SCHEDULE 40 PVC PIPE 10 Yr 3/2 k,/ _ s #361 BOTTOM CAPACITY Loam" Sand ., B y /4 ❑ PROPOSED H-20 DISTRIBUTION BOX 8s / / EXISTING - (LENGTH x WIDTH) (0.74 GPD/S.F.) = GAVDAY 10 Yr5/4 \ y nE 3-BEDROOM = n ' \ / a4q08 (25 x 12) (0.74 GPD/S.F.) 222.0 GAL/DAY 24 86.00 O N19 150'WELL OFFSET 0 , \ DWELLING PROPOSED 500 GAL.. H-20 LEACHING CHAMBER 13279 770 THE PLAINS RD �- TOF=85.1'± HG2 00 / PROPOSED DISTRIBUTION BOX TOTALS: C'1 F7 5 to Iy 51Bd REV. DATE BY APP'D. DESCRIPTION �o z PROPOSED INSPECTION PORT TOTAL NUMBER OF CHAMBERS 2 PROPOSED SEPTIC SYSTEM UPGRADE 448. S .FT. --I MAP 152 TOTAL LEACHING AREA 0 Q _ PROPOSED PVC VENT PIPE 60" 83.00' PREPARED FOR. m , PARCEL 30 2) TOTAL LEACHING CAPACITY 331.5 GAL./DAY CAPEWIDE ENTERPRISES o EXACT LOCATION PER OWNER 170 THE PLAINS RD HC-1 o -_ - LOCATED AT (1 D z r o- c-2 io5 rya 361 WOODSIDE ROAD o = =`- WEST BARNSTABLE, MA 0 -`s �~ 132" 1 77.00' SCALE: 1 INCH = 20 FT. DATE: JUNE 23,2008 0 10 20 40 80 FEET (4 No Mottling, Standing orV�eeping Observed oFM o� PREPARED BY: SWING-TIES PLAN RESERVED FOR BOARD OF HEALTH USE �� JURCH �`�� JC ENGINEERING, INC. SCALE: 1"=20' JR. o CiiURCHILL No CIVIL�, 2854 CRANBERRY HIGHWAY (VOTE: � � EAST WAREHAM, MA 02538 SITE E PLAN 1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP 508.273.0377 EDGE OF EACH SEPTIC SYSTEM COMPONENT. Drawn By: MCP Designed By:MCP Checked By:JLC JOB No.1434 SCALE: 1"=20' l I l