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HomeMy WebLinkAbout0039 BAYBERRY LANE - Health 39' BAYBERRY N� y BARNS TABLE .a •n. r A = 355 643 - ail•� o ° 4 _ u , TOWN OF BARNSTABLE a pa LOCATION 6 � ��� 3��z� 6 SEWAGE # deZ2'J A 6)A VILLAGE rj X YtNl,-t-tJ bLOS ASSESSOR'S MAP & LOT 3�n� INSTALLER'S NAME&PHONE NO. Z�tt �i-1 C �� '77/-'7J1 j SEPTIC TANK CAPACITY ?LWP LEACHING FACILITY: (type) V-t e- S (siie) AS' V- I k�X 4.1 NO. OF BEDROOMS BUILDER 0 OWNE CrUJ PERMTTDATE: 1-,JW-Qn COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of.Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) :Feet Furnished by Ail G-'� bC) F w ZAI F' tT do 5 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 39 Bayberry Ln Property Address Kathleen Newman Owner Owner's Name . information is q required for every Cumma uid Ma 02630 7/14/2014 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form: Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, use only the tab 1. Inspector: I y1-1 c J I key to move your cursor-do not Michael DiBuono use the return Name of Inspector key. DiBuono sewer and drain --_ r� Company Name zi 8 Johns path ; Company Address " & ^r't S Yarmouth ma 0266-8' Y City/Town State Zip Code ' 508-364-9587 Si13522 �5 Telephone Number. License Number1 B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority „J 7/16/2014 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 has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. i I t5ins•3/13 Title 5 Official Inspection Form:S u a e Sewage Disposal System Page 1 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 39 Bayberry Ln Property Address Kathleen Newman Owner Owner's Name information is q required for every Cumma uid Ma 02630 7/14/2014 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: This system has a 1500 gallon tank, Pump chamber, and a pressure dosed field that is 45' x 15' x 5' The plans show a zabel filter on the outlet end of the tank. I was unable to remove this cover as it was H2O. The cover on the pump chamber is also H2O and I recommend both covers be swapped for special covers and brought to grade for ease of maintenance. I was able to leverage the cover to the pump chamber to see and hear the pump kick on. I also tested the alarm and probed the field in a few spots to 4 ft the probe came up dry each time B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND) for the following statements._If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not'leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 S 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments. 39 Bayberry Ln Property Address Kathleen Newman Owner Owner's Name information is q required for every Cumma uid Ma 02630 7/14/2014 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System.will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N FIND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins 3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not.for Voluntary Assessments ,M 39 Bayberry Ln Property Address Kathleen Newman Owner Owner's Name information is required for every Cummaquid Ma 02630 7/14/2014 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: "* This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal 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 ❑ E Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form :Not for Voluntary Assessments 39 Bayberry Ln Property Address Kathleen Newman Owner Owner's Name information is q required'for every Cumma uid Ma 02630 7/14/2014 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: a - ❑ f ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. - .❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to'15000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in,Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate „- regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Z 39 Bayberry Ln Property Address Kathleen Newman Owner Owner's Name information is q required for every Cumma uid Ma 02630 7/14/2014 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)] 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 example: 110 gpd x#of bedrooms): 330 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 39 Bayberry Ln Property Address Kathleen Newman Owner Owner's Name information is Cumma uid Ma 02630 7/14/2014 required for every q page. Cityrrown State Zip Code Date of Inspection D. System Information Description: This system has a 1500 gallon tank, Pump chamber, and a pressure dosed field that is 45' x 15'x 5' The plans show a zabel filter on the outlet end of the tank. I was unable to remove this cover as it was H2O. The cover on the pump chamber is also H2O and I recommend both covers be swapped for special covers and brought to grade for ease of maintenance. I was able to leverage the cover to the pump chamber to see and hear the pump kick on. I also'tested the alarm and probed the field in a few spots to 4 ft the probe came up dry each time Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ❑ No Water meter readings, if available last 2 ears usage 2012 56,000 g ( Y g (gpd)) 2013 63,000 Detail: A total of 165 GPD over the last two years. Sump pump? ❑ Yes ® No Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•N13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments o , I w„ 39 Bayberry Ln Property Address Kathleen Newman n Owner Owner's Name information is q required for every Cumma uid Ma 02630 7/14/2014 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Currently Occupied Date Other(describe below): General Information Pumping Records: Source of information: Home owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page B of 17 Commonwealth of Massachusetts = Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 39 Bayberry Ln Property Address Kathleen Newman Owner Owner's Name information is q required for every Cumma uid Ma 02630 7/14/2014 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 14 years old Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 12"feet Material of construction: ❑ cast iron ® 40 PVC ® other(explain): Distance from private water supply well or suction line: NA feet Comments (on condition of joints, venting, evidence of leakage, etc.): No evidence of leaking, Vented through the roof Septic Tank(locate on site plan): Depth below grade: 6"sfeet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 1500 gallons If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 Gallon Sludge depth: 3"s t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° 39 Bayberry Ln �M Property Address Kathleen Newman Owner Owner's Name information is q required for every Cumma uid Ma 02630 7/14/2014 page. City/Town State Zip Code Date of Inspection D. Systern Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 24"s Scum thickness 3"s Distance from top of scum to top of outlet tee or baffle 42"s Distance from bottom of scum to bottom of outlet tee or baffle "Sludge stick How were dimensions determined? Tape Measure Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Inlet tee is in place could not inspect outlet tee. Tank level is normal.Very little solids Grease Trap (locate on site plan): Depth below grader 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 t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ° 39 Bayberry Ln Property Address Kathleen Newman Owner Owner's Name information isequired or every Cumma uid Ma 02630 7/14/2014 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): System is in good working order all the way around. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments c,M 39 Bayberry Ln Property Address Kathleen Newman Owner Owner's Name information is q required for every Cumma uid Ma 02630 7/14/2014 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert No D Box 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.): Pressure dosing system, Field is in good working order, No signs of breakout or ponding Pump Chamber(locate on site plan): Pumps in working order: Z Yes ❑ No" Alarms in working order: ® Yes ❑ No" Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Was able to hear and see pump working. Checked alarm at Box.l recommend replacing both inlet and outlet covers with steel ring and covers. * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: pressure dosing system t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 r v Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 39 Bayberry Ln Property Address Kathleen Newman Owner Owner's Name information is required for every CummaQ uid Ma 02630 7/14/2014. page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: press ur edosing 45x15x5' Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): . No signs of hydrualic failure. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 39 Bayberry Ln Property Address Kathleen Newman Owner Owner's Name information is 4 required for every Cumma uid Ma 02630 7/14/2014 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): No signs of failure, ponding or break out Privy(locate on site plan): Materials of construction: Dimensions I Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.),. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 � Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 39 Bayberry Ln M Property Address Kathleen Newman Owner Owner's Name information is q required for every Cumma uid Ma 02630 7/14/2014 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 h � X t O � a`a-�� •�`.1,v Q �{' Fed 7 �a u,y2 r�� s a i!,A6 G� tip f•k3n R� ��s tr8.17' s � Fn A Td- nt OValVA f s' MW mod coo c C5&,�l� 3gI t !i 'an oozy" JAM +''�:,t'.•2� q� c'� '�t tr� v. v V VJ ,. "� 1--i o ` '''&•*ist ( '.�# F1A.�'x1�'Ai� yMSiJ.rs�r. ,. .,r `: k k .y 1�A � �, � -•6 Q' �' O' {O�.c. _y riKOMI- � -.,>. � i,a.. .....}.�s� .v�...F��a :Yw,= �^` .ta '�`i'�::. '.. t --'� _ 1 .B' - �U' \ .:�•- _ '' _k�: �."',}i.�i--r`-s.F� �- _ .� ..._fir a -a�.+f.` I :. t ._-. C "V �q `'Ls�,.t q _ •s. T -x t .,....r.; - ' S._,8 uY;k•�Y } � 3r«•k+y L.,�, 'i-. xa'� �1�}tr :+�" +'".. >4t�f F�;"e _ - - �r.. •�:� ay_ - �A��- .>�?.S .s v5.. -:.ex.- '��5"� sr. k �-�i; Z.. e ,a 7 - -.�. �b.- 3z,.t.. _'.i � � x •: ri ..'�.e �,'°��'_.- ��rsp -;5r'. ss � � -n ,,-T4' -v �•' $..�----r� r � � < �a� .-r..i zra''.rOr:���'�.ra;�=Q.�7�'��','da���;�� .:ssi- �5 _ ^k� r`�, _ --'�az "'„yt �-'rh�'--• x&�. ,,:�' -.t-.3-,'. t �hr-�. 3. �x... r r;e' r ��,�� � r�� '.�.�z g - �`f- _ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 39 Bayberry Ln Property Address Kathleen Newman Owner Owner's Name information is q required for every Cumma uid Ma 02630 7/14/2014 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: 8+ft' feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 12/19/2000 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: Plan on file shows request for variance from ground water and wetlands was granted. ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Site plan dated 12/20/1999 shows ground water to be high and variance was granted by the town of Barnstable. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts u W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4 39 Bayberry Ln Property Address Kathleen Newman Owner Owner's Name information is q required for every Cumma uid Ma 02630 7/14/2014 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ❑ Inspection Summary: A, B, C, D, or E checked ❑ Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ❑ System Information—Estimated depth to high groundwater ❑ Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 -i TOWN OF BARNSTABLE OF THE T�w OFFICE OF i HAWSTABL$ : BOARD OF HEALTH y Mp86. � 1639• ��� 367 MAIN STREET 'eaMnY�`' HYANNIS, MASS.02601 September 20, 2000 Daniel Johnson 63 Captain Aldens Lane Osterville, MA 02655 RE: 39 Bayberry Road, Cummaquid Dear Mr. Johnson: You are granted variances, on behalf of your client Dennis Quinn, to install a replacement onsite sewage disposal system at 39 Bayberry Road, Cummaquid. The variances are as follows: 310 CMR 405(1) (1): To reduce the minimum vertical separation distance between the bottom of the proposed leaching facility to the estimated seasonal groundwater table from four (4) feet to three (3) feet. 310 CMR 405 (F) (b): To reduce the minimum separation distance between the pump chamber and the wetland, from 25 feet to 20 feet. B.O.H. Regulation Part Vlll, SECTION 10.0: . To install a soil absorption system 65 feet and 67 feet away from wetlands, in Lieu of the minimum 100 feet separation. distance required. The variances are granted with the following conditions: (1) Percolation test(s) shall be performed prior to the installation of a soil absorption system. The percolation test shall be witnessed by a health inspector, employed by the Town of Barnstable Health Division. quinn (2) After the percolation test(s) is/are performed, the results of the percolation test shall be shown on a revised engineered plan for this project. (3) If the percolation test results are not between two (2) and five (5) minutes per inch, construction of the onsite sewage disposal system shall cease immediately and the designing engineer shall file a revised plan to the Board of Health for future review at a public meeting of the Board of Health. The variances are granted because the existing cesspools "failed," are located with 25 feet of wetlands, and are in all probability sitting in the groundwater table. The proposed new replacement septic system meets the maximum feasible compliance standards contained in Title 5, the State Environmental Code. Sincerely yours, 4usan4k, R.S. Chairman Board of Health Town of Barnstable SGR/bcs quinn 01/29/1992 23:53 5084201904 DANIEL J,OHNSON PAGE 01 I)CbMSTIC SEPTIc DzsIcx, INC. 63 CAPTAIN ALDENr8 LANz 'OSTMFILLIC, Imo► 02655 (SOS) 420-1904 December 14, 2000 Barnstable Board of Health Town Hall Main Street Hyannis, MA 02601 RR: 39 Bayberry Road, Cummaquid Dear Board of Health Members: I hereby certify that the subsurface sewage disposal septic system was installed as shown on the "As-Built Septic Plan" as approved by the Board of Health. This certification does not guarantee the longevity of the SAS. If you have any questions, please do not hesitate .to call. Sincerely yours, Daniel B6 Johnson, R.S. , C.S.E. t f AsBuilt Page 1 of 1 TOWN OF BARNSTABLE � LOCATION -I,--!&pQ4z14 (�_il SEWAGE it !40 A63 viLLAGE L-LA,(A ULs4L-4 tk, ASSESSOR MA P��AP&LOT-3.=r �n INSTALLER'S NAME&PHONE NO. `�cn2 TUZ1ri`T R'/ t C.�S-4" ?7/ ` 311 SEPTIC TANK CAPACITY IAGd1 -44L l onol-skL i�ceM? !'f Cr4,tG7�' LEACHING FACIIM:(type) V I e- (size) -4,6'-L 1C !S�J X 4.y� NO.OF BEDROOMS BUILDER 0 OWNE cz%. l PERMITDATE: /:AL COMPLIANCE DATE: 00 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility). Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by i g c-4 bo/ 1 � - r,Zem e F 4OLaC ' 1 3-+ 34 1 to�G #a ttot o A-L -1+ { O� +( 6/ N $-�- { 7AscL,tr L rE.R_ r http://issgl2/iritranet/propdata/prebuilt.aspx?mappar=335043&seq=1 8/13/2014 01129/1992 23:53 5084201904 DANIEL JOHNSON PAGE 02 LfAewN F/ELp "P ASS uR 4 o10j ,� q�` 4S G x rS iv it o.sN Q P�+� .2"SIN da _ MANI�OCD � ~ r� L? D�tk M � SCrI 40 E - T/ES To SEMI ('C'"ponlFiv71 ¢ N �- A+c - aa' „ iDoo �RCLor! /5'0o d.accvnl Bu " •A4,6 of - a v..5„ z/�Bc F�47i� de-c d w If LA al ��- qrf I e-,T - 3r PLIlLC TE-ST PER�oaa►1E0: D..��eFN.ce�u � �Y1�� R war vis1e,n ; A.PtlOR-4HADo .4;� 1 y �pf}D sr��r io: 5 IEL ` AS BUILT OF SEPTIC DESIGN EntO /o;9S rz" �o:9S f0�7 39 �A�l6�RR-Y �.4Q, ���+nr�RQura 6'` /o:ss 9SJEL DOMESTrCSEpTIC DESIGN INC '63 CAPTAIN'ALDEN'S LANE �riN rz�gc ` t}-l'��°� OSTERVJLI E,JWA 026SS (508) 420. 1904 ref •App'tovEo. �G/Fw �,�, rMr/f � .,e.,r DATE: A/11A0 SCALE: /Kanf � po 3 o m � y o 0 3 1 =- ~ own of Barnstable P# / Department of Health,Safety,and Environmental Services moIME% Public Health Division Date 3 �® n, 367 Main Street,Hyannis MA 02601 BARNSTABM mass. T tFpMptA Date Scheduled Time Fee Pd. Soil Suitability Assessment for Sewage Disposal Performed By: a4AJ I e7L D "So Witnessed By: 00f'Al /V"Q(L-4 vD LOCATION& GENERAL INFORMATIO�t Location Address Owners Name Address J.9 49,*1tJe-AA_'l A-12 `�"`^'►`�9(� /r! Assessor's Map/Parcel: �3S/� Engineer's Name �A"�t J�'b?r 0 4J NEW CONSTRUCTION REPAIR 7C Telephone# _OS)4�k_0--1901 Land Use ��" t�9"Q��''�S Slopes(%) S' Surface Stones J7Z vC' L,4L L Distances from: Open Water Body ft Possible Wet Area g-� ft .Drinking Water Well ft Drainage Way ft Property Line 30 �- ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) 33 es f7 � Parent material(geologic) Depth to Bedrock /'� /E Depth to Groundwater: Standing Water in Hole: N' s 4 f Weeping from Pit Face p 91 Estimated Seasonal High Groundwater .. .. DETE INATtON 'Ott SEASC)1�Ei O t?VA` EYZ'Y'" Method Used: — Depth Observed standing in obs.hole: /NOT a 9J in. Depth to soil mottles: /g in. I Depth to weeping from side of obs.hole: N-T a$J in. Groundwater Adjustment ft. Index Well#_ .Reading Date:____.___ Index Well level.,.. Adi.factor_ Adj.Groundwater Level ._ PERCOLATION TEST D ata ...A : ..............: y Observation Mel Time at 9" Depth of Perc Time at 6" Start Pre-soak Time @ Time(9"-6") End Pre-soak Rate Min./inch Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back j Copy: Applicant t �0 9G� PLJtl�nw`��i O �- ,:DEEP ®.BSER7-VATION HOLE LA G Holy:# . . . . . . Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency,%Gravel 8 " /6� f3V4 6 44Lr /b"- 9N t C/' zsY S-0 1.8 lob 46 C, fit"- !yx" C -S X,sY > 3 L,%Q jC . _ _............. . ......._ ._. DEEP OB E Q1 OLE.L Hoe Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency,%Gravel) _. ..... ... DEEP fJBSERVATLO.N HULE..LUG Mole . . Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency,%Gravel _....._......_................................ _._.................._............................_....................... ................................. ............................... ......................... .... ..... . _.._..._.. ....................................._......................................_..............................._.................................._...................................._._........._............ ................ ...... ..... ..... .. DEEP OBSERVATION HOLE LOG Hflle Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency.%Gravel Flood Insurance Rate Mau: Above 500 year flood boundary No_ Yes Within 500 year boundary No_ Yes 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? YE ) If not,what is the depth of naturally occurring pervious material? Certification I certify that on (t 9S (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training,expertise and experience described in 310 CMR 15.017. Signature ?' Date f t � i� -1(�No. 7 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in corriputer: es PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIpprication for Otopool *pgtem Construction Permit Application for a Permit to Construct( )Repair(' )Upgrade(V)Abandon( ) LJ Complete System ❑Individual Components Location Address or Lot No. i7 Z D al fell,/ AV Owner's Name,Address and Tel.No. Assessor's Map/Parcel (�UN V,?Q/�� �ell�j R I/;W, Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 0-717l�s®r� 7 7/`� Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder(11�0 Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow �5 JQ gallons. Plan Date 7 24 4 Number of sheets Revision Date Title Size of Septic Tank Z1 e* ype of S.A.S. Description of Soil DESIGNING ENGINEER MUST SUPE^L'i^E MON AND liq VIM5lYi.:u THE SYSTEM INNS IhI 1 ED YN G�'2'R A R ACCORDANCE TO PLC. / Nature of Repairs or Alterations(Answer when applicable) 7L/) i;7l � el d11�.� Date last inspected: Pe Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued b is Bo d of 1jealth. Signed Date Application Approved by — Date 11 Z Z Application Disapproved for a following reasons Permit No. 2 a Date Issued C Z ZY 6D fo 10- No. 2 b J Fee ¢.. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer. Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pprication for Mi�pogal *p�tent`Congtruction ertnit Application for a Permit to Construct( )Repair(' )Upgrade Abandon( ) U Complete System ❑Individual Components Location Address or Lot No. Q , Owner's Name,Address and Tel.No. �' Lv G//ill F i E Assessor's Map/Parcel Installer's Name,Address,and Tel.No. ? Desig er's Name,Address and Tel.No l 77l`�3q� ,' t L�ZDID Type of Building: . Dwelling - No.of-Bedrooms Lot Size r .F'F -s4 ft. Garbage Grinder(�d Other Type of Building / e PNo. of Person "t"( Showers(,.-- ),'Cafeteria'( ) Other Fixtures Design Flow �� gallons per day. Calculated daily flow �. � gallons. y 1. Plan Date Number of sheets Revision Date F r Title yr Size of Septic'Tank 5370 %'� /df�0 JG1�/DC �� ype of S.A.S. V 15_/ 11,L' * • S`- + Description of Soil h Nature of Repairs or Alterations(Answer when applicable) r Date last inspected: Agreement: _ f. The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system yin accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued b his Bo d of Health. r Signed / _. a: S x DateZ<!DD Application Approved by _ ` Date // Z Z 2� Application Disapproved for the following reasons ,� --Permit No. -- —�-------- Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,tthat the On-site.Sewage Disposal System Constructed( )Repaired (Upgraded Abandoned( )by L1_a e,5 atQ ���` r �' e has been constructed in accordance with the provisions of Title 5 an the for Disposal System Construction Permit No. dated Installer Designer The issuance of this permit shalt not be construed as a guarantee that the°system will function as des/ignedy 'Date ,t r ///? !/`� l Inspect4 . 1A S' 8 ���—( -------------------------Fee �� 10. THE COMMONWEALTH OF MASSACHUS9 NINT ENGINEER!MUST SUPERVISE IT PUBLIC HEALTH DIVISION - BARNSTABLES M �° CERTIFY IN WRITING ACCORDANCE TO LNSNTALLFD 1IvI STRICT Miopoar *pttem onotruction Permit Permission is hereby anted to onstruct( )Re air( ))Upgrade( Abandon( ) -System located at 3�W17Z 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:Con truction must be completed within three years of the date of this permit. Date: 1/ 2 2/2 wJ Approved by ���/�. CSC O�l� ©AJ 1� I i r I ��✓II IJw.��t� I ,+-- ,cam DATE: 7 FEE ({ REC.EIntEO : ` + WA ASUB MASSS. 'I t. , REC. HY i AUG 20CG tED MA't �7(� pWHE04DEPTABIETown of Barnstable SCHED. DATE: < /� � HEALTH DEFT, •� Board of Health 67 Main Street, Hyannis NIA 02601 ®+ _`� r �t Office: 508-862-Y644 v Susn-G. ask,R.S. FAX: 508-790-6304 Sumnef Kaufman,M.S.'9- Ralph A.Murphy,b ���� VARIANCE REQUEST FORM AUG 7 ?000 LOCATION inn,4 epvio -A- ' ��B ft—p'r to Property Address: 39 lgft`1,661LA-1 '¢� Assessor's Map and Parcel Number: J3.5/0 43 Size of Lot: J// SDvsij T Wetlands Within 300 Ft. Yes __2� Business Name: h No Subdivision Name: -APPLICANT'S NAME: DEN N l S Q��"�^� Phone ��a3� 3 6 d -/3s•3 Did the owner of the property authorize you to represent him or her? Yes _ No PROPERTY OWNER'S NAME CONTACT PERSON Name: DC'J'- 'S GQ•JoNi✓ Name: Address: 3 9 /t-a9/J G✓ G j/A Address: 6 3 6A-"T-I+tN ACOCA14 t-.j cas�g�e v�Cl� Phone: 3 Phone: � � �.__�— -�-- VARIANCE FROM REGULATION(List Res.) REASON FOR VARIANCE(May attach if more space.neeced) y . J.aGFrC�€r't oOt�,j 5I-4 c e, o P vCaa / TO ,vyq/N 7*/.tt0 f J it r-r d Ia if/�i' � mn Sr 4 oS,S . t 6 mo d• U------------ Check!!st(to be completed by office staff-person receiving variance request application) Four(4)copies of engineered plan submitted(e.g. septic system plans) 1 Four(4)copies of floor plan submitted(e.g.house plans or restaurant kitchen plans) Signed letter sating that the property owner authorized you to represent himiber 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(for Title V and/or local sewage regulation variances only Full menu submitted(for grease trap variance requests only) l-- t Variance request application fee coPeeted tno rat For lifegttard mOd:rtcation re ewala,grease tap variance renewals[same owrerlleasce onfyj,outside fining variAnte renewals[same ownerileaset only),and variances to repair tailed sewage disposal systems{only if no expansion to the building Proposed)) Variance request submitted at least 15 days prior to meeting date Susan G. Rask,R,S.,Chairman VARIANCE APPROVED_� Sumner Kaufman,M.S.P.H. NOT APPROVED Raioh.A, Murphy,M.D. REASON FOR DISAPPROVAL r e ' FORM 9A - APPLICATION FOR LOCAL UPGRADE APPROVAL PAGE 1 OF 5 Commonwealth of Massachusetts SAAlu 5i�s LE , Massachusetts Application for c I Dgrade Approval Title 5, 310 CMR 15.000 DEP Approved form required by 310 CMR 15.403(1) To be submitted to Local Approving Authority/Board of Health: For the upgrade of a failed or nonconforming system with a design flow of <10 000 gpd where full compliance, as defined in 310 CMR 15.404(1), is not feasible. ' To be submitted to DEP: For the upgrade of a failed or nonconforming system with a design flow of 10,000 up to 15,000 gpd and/or for upgrade of a state or federal facility, where full compliance, as defined in 310 CMR 15.404(1), is not feasible. NOTE: Local upgrade approval shall not be granted for an upgrade proposal that includes the addition of new design flow to a cesspool or privy or the addition of new design flow above the existing approved capacity of a system constructed in accordance with either the 1978 Code or 310 CMR 15.000. 1) Facility/system owner Name LiX iv I s U/ej N Address H Phone # __L r�l '1 /6 1 - 3,1 3 Address of facility 2) Applicant (if different from above) Name Address Phone 3) Type of facility residential _commercial school institutional — (specify) DEP APPROVED FORM:UW19S FORM 9A - APPLICATION FOR LOCAL-UPGRADE APPROVAL PAGE 2 OF 5 4) Type of existing system _privy L cesspool(s) conventional system Other (describe) Type of soil absorption system (trenches, chambers, pits,etc.) 5) Design flow based on 310 CMR 15.203 a) Design flow of existing system gpd Approved? yes approval date no why? b) Design flow of proposed upgraded system 33,9 gpd c) Design flow of facility gpd 6) Proposed upgrade of existing system is a) Voluntary Required by order, letter, etc. (attach copy) _ Q Required following inspection required by 310 CMR 15.301 (provide date inspection form was submitted to the approving authority) (date) b) Describe the proposed upgrade to the system _ /L�P��o-Ce Ce�j�o��l .•�-7y /J�a 6:+LLa.� S e'P�C 73ys�.�C, y'�' t 0 o y (�}LLoIJ ,oa—tP /"�L2 .� •r4 9S L I Sou✓ t°2�rs✓oLL 0 S e L15fcf �"lr /��. c) Which of the following are applicable to the proposed upgrade? . J Reduction of setback(s) (list setbacks to be reduced with proposed setback distances) 14-4 Percolation rate of 30-60 minutes per.inch (state actual perc rate) DEP APPROVED FORM•1210719S FORM 9A - APPLICATION FOR LOCAL UPGRADE APPROVAL PAGE 3 OF 5 N� Up to 25% reduction in subsurface disposal area design requirements (state required & proposed size) Relocation of water supply well (identify well, describe relocation) Ll Reduction of required separation between bottom of SAS & high groundwater. (specify proposed reduction & perc rate) Other requirements of 310 CMR 15.000 that cannot be met (specify sections of the Code) System upgrades that cannot be performed in accordance with 310 CMR 15.404 & 15.405, or in full compliance with the requirements of 310 CMR 15.0009-require a variance pursuant to 310 CMR 15.410-15.417. 7) If the proposed upgrade involves a reduction in the required separation between the bottom of the soil absorption system and the-high groundwater elevation, an Approved Soil Evaluator must determine the.high ground water elevation pursuant to 310 CMR 15.405(l)(i)(1). The evaluator must be a member or agent of the local approving authority: Distance from.soil absorption system to high groundwater feet As determined by: Evaluator's.name Evaluator's signature Date of evaluation FORM 9A - APPLICATION FOR LOCAL UPGRADE APPROVAL PAGE 4 OF 5 8) Notice to Abutters No application for upgrade approval in which-the setback from property lines or a private water supply well is reduced shall be complete until the applicant has notified all abutters whose property or well is affected by certified mail at least ten days before the Board of Health meeting at which the upgrade approval will be on the agenda. Such notice shall include the date, time and place where the upgrade approval will be discussed. If the Department is the approving authority, then such notice to abutters must be completed prior to the date of submission of the application to the Department. : The notices to abutters shall include a copy of the completed application form and shall reference the standards set forth in 310 CMR 15.402 through 15.405. List of affected Abutters: Abutter Name Date notified Address Abutter Name Date notified Address Abutter Name Address Date notified Abutter Name Address Date notified 9) Explain why full compliance, as defined in 310 CMR 15.404(1), is not feasible (each section must be completed): a) an upgraded system in full compliance with 310 CMR 15.000 is not feasible: /^'J�r61f_1e- r OPLTti ,SR4_Ce- o 4rjll - S*j Y C —PrA mew Mq .P-7i o�GlLT7T+ t.-�'Tc.4w-�!j A ...4 717 ftid'.rC—T C J CJ" �1���+) J lr vw�s..p�� .sif-r f!l•M 4 a4 �f�trl�(r- (.fj�i.`o b) an alternative system approved pursuant to 310 CMR 15.283-15.288 is not feasible: DO�MOV®FORM-iUVigs FORM 9A _ APPLICATION FOR LOCAj, jjpG RAD � APPROVAL . OVAL c) a shared'system is not feasible: PAGE S OF S d) connection to a sewer is not'feasible: 10) An application for a disposal D•g. Plans & s system construction permit, including pecifications, site evaluation forms) ing all required attachments SCP.application attached? , must accompany thus application. Is the _3'e_no 11) Certification the facility owner, certify under Penaltyof attachments, to the best of my knowledge and lawbeli tare document and all complete. I am aware that there may be significant consequences for and false information, including, but not limited to, penalties or fin submitting imprisonment for knowing violations," e and/or - r Fad". owner's signature 7 �O� Date - - Prin �t Name Name of preparer >_I� Date 63 elephone & address of prep er cN �& �v L'LL oars NOTE; Title 5, 310 CMR 15.403(4 u ), requires the sys Department a copy of the local tem owner or operator to submit to th approval upon issuance by the Boat of Health and e t0 Commencement of construc Pgrade upgrade prior . . MWAF VWFOjW•UWVs BUOYANCY CALCULATIONS FO' RMAT Property Location9 ��� L ' Property Owner o e-^wi S Date of-submittal z4 t p��P DNA-rr,l3�rt N-a �: SIZE o a. Constants: ----Gal Ions _Weight-of.Concrete @ 144Lb/Cu/Ft. ..Weight of Water @ 62A Lb/Cu.Ft. Weight of Fill (dry)95 Lb/Cu.Ft. PROFILE OF TANK Fm A Grade Elevation- , Top or Tv*ij — - . Ground Water EI. �'6 0 t7 . Bosom.of Tank EI.90,_, t TOTAL VOLUME OF TANK ,.. INSIDE VOLUME OF TANK VOLUME OF CONCRETE ,,•/lo Fc=Net Volume in cu/ft x(1441b/cu.ft}=doy� d displacement ! VOLUME OF FILL OVER TANKi Tank dimensions in cu/ft F =Tank".x(95)b! Ft.)=DQxn%ard force_ VOLUME OF WATER DISPLACED 13Y TANK.Outside tank dimensions { C uX1 of tank x(6/2.u41b/cu.ft�/V xard force TOTAL DOWNWARD FORCE-WT OF CO:�G TANK+WT,pg FILL = /S S 14 ' IS DOWNII'ARD FORCE GREATER THAN UPWARD K rS FACTOR OF SAFETY- 4 . BUOYANCY CALCULATIONS FORMAT Property Location Property Owner . Date of.Submittal SEPTIC TANK; SIZE ls�a - Constants: -----G�lons _ Weight of.Concrete @ 144Lb/Cu/Ft, -. .Weight of Water @ 62A Lb/Cuyt, .Weight of Fill (dry)95 Lb/Cu.Ft. PROFILE OF TANK ° .Finch Grade Elevation 99,a t TF Top of Tank'EI'J6 . . s Ground Water Ef.24,o �= .� Bottom.of Tank EL 51,At TOTAL VOLUME OF TANK INSIDE VOLUME OF TANK VOLUME OF CONCRETE Fc=Net Volume in cu/ft x(144 lb/cu.ft d ownward displacement i3 /3.i /� P�� .Ihr.4 ca-��. fiaz� VOLUME OF FILL OVER TANKi Tank dimensions in cu/ft f Ff Tank Cu Tt.x(951b/ Ft.�Do%m%%,ard fb=_ 6ar9/1 VOLUME OF WATER DISPLACED BY TANK;Outside tank dimensions Fb=Cuj't Of tank,x(62.4 lb✓cu.ft)r--upp%ard force TOTAL DOWNWARD FORCE=WT OF CO:�C:TANK+WT.OF FI = / s /` IS DOWNYINM FORCE GREATER I'I' f 1 THAN UPWARD YC� FACTOR OF SAFETY � :1 • LE'A�N/n/G F/EoD ' PkESsu2E do.tEe. QS y 4S x /5 P t_ r Ro aOe�+6a qr E d'Jcd 40 MAN�FoC.D A G a r`Sc�{ 40 A fv,Q�EM.trN /-�0 vSc- F E VFS TO SEPTIC CoMPOni�n►TS AC - ;Ca /000 691-CcJ /Sa0 �ALCOnI B C- 26 Efh "�5�6 r p�ihp ak"e 'Q SE/n c 7 Vk 3g.6, N-� 0 N-moo A� � ba rz -3 6'a" MRKifOLF L��E2 "S F6r � 9/66- I 9 e-J - 3/X fJ 3Q . pEILC TEST LPT-�) PFRka.`lFa: b.Jl0H 90AJ 6,4YgE�e_r� DkrE: /z/S/oO >. o �L �`' AS BUILT OF SEPTIC DESIGN 3?. Sr�tiT /o: S 3osEc '� ei to: 11s 1t '! 39 bM6E"i2LY Ao,+D, �JMM�Qv/O 9 DOMESTIC SEPTIC 9SlE DESIGN, INC � 63 CAPTAIN ALDEN'S LANE R.frE . .�ZMrni /zsgc 1�I ���°° OSTER PULE, MA 02655 ` (508) 420- 1904 i�'zef '4Pp'ZaVEa yc•fN FAA F-+aThClt oe�q/cs DATE: /-z/11b0 SCALE: KonIE DOMESTIC wSEPTIC DESIGN, INC. 63 CAPTAIN ALDEN'S LANE OSTERVILLE, BdA 02655 (508) 420-1904 December 14 , 2000 Barnstable Board of Health Town Hall Main Street Hyannis, MA 02601 RE: 39 Bayberry Road, Cummaquid Dear Board of. Health Members: I hereby certify that the subsurface sewage disposal septic system was installed as shown on the "As-Built Septic Plan" as approved by the Board of Health. This certification does not guarantee the longevity of the SAS. If you have any questions, please do not hesitate to call. Sincerely yours, 4' Daniel B6 Johnson, R.S. , C.S.E. 4lC T ION S E 1 AGE PE IMIT p0- 13� Vl_LLAGE &lie IaSTA LL.ER'S 4AME ' 8 ADDRESS 0ItlLDE OR OWNER DA E PERMIT ISSUED DATE C0IAPLIAN--CE ISSUED � � r _� a� O i t �i O � • 1 �� ji r!h.. � �. � ►►ss TOWN OF BARNSTABLE - '�'� �F'TH E Tp 6Q� wo OFFICE OF BafiH9TesL$ i BOARD OF HEALTH 9 MASS. °o 1 639• \gym 367 MAIN STREET Ufa MAY HYANNIS, MASS.02601 September 20, 2000 - Daniel Johnson 63 Captain Aldens Lane Osterville, MA 02655 RE: 39 Bayberry Road, Cummaquid Dear Mr. Johnson: You are granted variances, on behalf of your client Dennis Quinn, to install a replacement onsite.sewage disposal system at 39 Bayberry Road, Cummaquid. The variances are as follows: 310 CMR 405(1) (1): To reduce the minimum vertical separation distance between the bottom-of the proposed leaching facility to the estimated seasonal groundwater table from four (4) feet to three (3) feet. 310 CMR 405 (F) (b): To reduce the minimum separation distance between the pump chamber and the wetland, from 25 feet to 20 feet. B.O.H. Regulation Part Vill, SECTION 10.0: To install a soil absorption system 65 feet and 67 feet away from wetlands, in lieu of the minimum 100 feet separation distance required. I I I C VQIIQIII.CJ ale 91 a11lGU VVtlll UIG IVIIV VV II II,. 1+U11UlUVI10. - (1) Percolation test(s) shall be performed prior to the installation of a soil absorption system. The percolation test shall be witnessed by a health inspector, employed by the Town of Barnstable Health Division.. quinn OWN After the percolation test(s) is/are performed, the results of the percolation test shall be shown on a revised engineered plan for this �.; project. (3) If the percolation test results are not between two (2) and five (5) minutes per inch, construction of the onsite sewage disposal system shall cease immediately and the designing engineer shall file a revised plan to the Board of Health for future review at a public meeting of the Board of Health. I The variances are granted because the existing cesspools "failed," are located with 25 feet of wetlands, and are in all probability sitting in the groundwater table. The proposed new replacement septic system meets the maximum feasible compliance standards contained in Title 5, the State Environmental Code. Sincerely yours, eusan.G. Zk, R.S. Chairman Board of Health Town of Barnstable SGR/bcs quinn _— D F S Cr" T< L S Y TE M I �El'1' PIT D]1T1► YCE: VIA LOCAL UPGRADE APPROVAL .•, " -. 1500 GALLON SEPTIC TANK U,o,�� Performed B: Daniel B. Johnson 1 Request variance to reduce the offset of the Estimated /vIAP . 33S ( aT; q3 0� I Seasonal High Groundwater Table to the bottom of the MODEL TK 1500(SHEACONCRETE) (OREQUN4LENT) \ ` Witnessed By: Donna Morandi proposed leaching field frcxt 4 feet to 3 feet, 310 CMR FINISHED GRADE \obi o t\ reao��,v(r int. 94,1,t � i5. 905 ( 1 ) ( i ) • _ �•• �� sE, h�-F I Date: June 13, 2000 _ 24"DIA I 24"DIA 9"(MIN) 24"DIA / \c� { 2 . Request variance to reduce the offset of the pump chamber -- ---- P,cEssv�F cosEa c-�`� TP-1 (EL. = 101 .5) from the wetland from 2.5 feet to 20 feet, 310 CMR 3" 3" H 20 45'� �c�5'w xm,S N YJo a++ ► °' 1.5. 405 ( 1 ) (b) . Note the septic tank is only specified. c . 61: 6" o� 0" - 8" A, 10YR4/3 Fine sandy loam 4"SCH 40 5 ld�+b 0► \ 8" - 16" Bw, 10YR5/8 Fine sandy loam 4"SCH 40� 10 FLO'vk/LINE 14" / ► 16" - 54" Cl , 2 . 5Y5/3 Clay loarn ZABEL FILTER A 300 �� r',: "' �:> .y`. _SEPTIC TANK TO MEET 54�� - 66" C2, 2. . 5Y7/3 Fi ne sand 4"SCH 40 TEE 4'LIOUID LEVEL REQUIREMENTS OF �Er`AcE SXb / �� �•� �i j ` 100 P(tatoSE/1 66 108 C3, 2 . 5Y5/3 Clay loam ; • - _ -.__ ._._.-..____.�_ ._._ _ �-__ .. ._..._..._•_•___. 4 SCH 0 ATT R TIGHTNESS, GAS BAFFLE 310 R 15 226 OR 108" -126" C4, 2 . 5Y7/3 Fine sand a w F GHTNESS - h / .r N�TBALf S CALCULATIONS I TEE ETC Sr�KES \ 126" -138" C5, 2 . 5Y5/3 Clay loam f �`.. PAR 6AiL '• f 138 -392" C6, 2. . 5Y7/3 F'i r,e sand ---- - - - - -:__ _- 9 �� I 3 Bedroom9 (Existing) o g' (MIN ) o -- MECHANICED 18" ObservF_d F.SHWT (7 . 5YR5/8, 2 . 5Y6/1 ) -Perched „ o ti ^`,'� No Observed [�r�„rndw��t.gt" 110 Gi D/Aedrogm X 3 Bedrooms � 330 GPD C' o COMPACTED ;yea Pereolat icon Rate - - pI - 5TABlE LEVEL8A8F CRUSHED 5TUNF 2 5 M ('�P 1 ) __. /4 DIA �BEruir►,4RK �° etfb t ! irl�OOLATION Tt3T DMA - ';oil Class : Cl tas>� 7 (0. 54 G/SF') 1p3 n nTt J sLP D iv ft L k %vlH Rrr�-'�� _ 1 ' Used for design s _____ _ ____ __ -_ __.___.__._ - - ______�__M--_ __. _-- _-. _ "• __... _.. -- Nl:Y�/iK � � r"w x �k �,- � g per >8artlstapin H.C) N Req , due. ao ; DE i 6ovr.lAA 1 er Date: ,Juno 13, 2UUU i reduction in offset Of SAS tc, E';SMN'1' from 4' to :�• . 1000 GALLON PUMP CHAMBER ToP o F [o uiB rf oa �,/ 1 ` w rT'4,,+Na1 CGLRT) FaonTcArrory �' ► � 1 SOi 1 Clej,98: Class 1 0.74 G/;;F' Used � - ----- ( ) , U* .d q• �i G/l F PROPOSICD LEACHIM AREA: MODEL TK 10001SHEA CONCRETE I .-- oa,q'• ' Porc Rate : 2 - 5 MPI (TP-1 ) ---- --- FINISHED GRADE ►ol FfE + Ate•) (rA�t t � 1.rF,�Chi n�1 F'ie1d2 dC)' 1. x lhr W X d. !a' )i o 1`� V� <`�A ,� SP �P` q- Depth of 1[?AL"C Test: 13�" I oti : 660 SF' X 0. 50 Q/SE' �' Tr T1T se * Nc�k t.cam /1 r ���� � 24"UTA 24"DIA g• (MIN) 74"DIA Oil °� t E P 156 �l' .4a) I,,•,r '+ i ns2 .OjsA(;i ty c SEE "PUMP CALCULATIONS"AND ---- - - _ -T- 1 "FLOAT SWITCHES 'FUR ` Actual Pero I .•o will be performed at t I mw FURTHER DETAILS � FLOAT RAIL---- - �. 4'SCH 40 6„ b loot \\ a9*' 9 ? ? Of R4MK7VO and 1tt:;p1#0e (Assumed 2 Mr I for [erg ign , , >rLtaA'� t1�1ITClR>R! PUMP CHAMBER TO MEE 1 „►p `Srr�V 9 ` ~r-� -- -- -- ---- ______.-----•-- _ . 1I ? 5( i 10 FORCEMAIN et r,&L ' II1rllr W itor- Alarm: 2711 wATEIiTIGFTTNESr I HIGH 4 Sf SCBZDVLE Of ELEVATIOV8 AND PUMP TO HAVE OVERLOAD LLL 10 c� 1/8"pIA WEEP HOLE PROTFFTmN - WATER 9 � gsco4° t� � Inv . Out Four►dat icon (existing) y`) , r, ! i�llmp C)tT : 211 , 4"SCH 40 TEE - - CHECK VALVE a''ick ao g�9 I riv. Its Septic Tank 95.80 PUMP CHAMBER TO I rump Oft : b PUMP ON MEET REQUIREMENTS fo iN 9 9 � �r1 1 0� \ ;� Inv. Out Septic Tank 145. ah OF310 CMR 157.11 �7� \ $ - rSoo SAL► K I t nv .. In Pump Chamber 95. ! PUMP OFF cr I. 1.0,N A 50 f + Distances referenced from hottonk of pump chamber- , H 20 5 PT 2c I r,v.. Out Pump Chamber 95.25 ic� g" (MIN) _ - �' �'Q MECHANICALLY .cam Co a COMPACTED go�vR�y of � � 3 �. , lnv . Fiegir, Manifold 102 . 50 I ?„� TrP; i 24 Hr st rrago volu»: •4S3 gAl1+�•rt4s UF11NG CHAIN SECURED TO -- WF774, NDS I ri V, F;T7d Manifold 102 . 55 FLOAT RAIL AND PUMP•f ACCESS _ ____ CRUSHED STONE STABLE LEVEL BASE )l4"[11A •° lnv. HEyir► of Lrvachiny F'iE�lci 103.73 FROM MAN1111t.1 ) At I VALVES lnv. End of beaching Field 1.03. 50 -- - __.______,---__ __---�__----.___ ___---•-.-------.-_--_----_ _--_ _ - -----.--. - OUTFITTED 1t-i RL PFMij\A () TIGHT TANK DIMENSIOINS 8'LXF7'WX5'B"H 99rS NArBALES N \� F"lMPSHALL BF INSTALLED IN STRICT CONFORMANCE WITH 'FLOAT SWITCHES REF \ IooO yA,.,.D ) Bottom at beaching F'ielci 103.U0 zv '�' I ,L'SHWT (TP-1 ) 100. 00 MANUFAC1 Ofil `, SPf:CIF'IEA1ION` AND SHALL BE F QUIPPPF D ,P j PUMP CAI.CCTLATIONS FROM ETf1 17 OM OF \� PEA Bf►YtE N'� t',5 e - --------- 1 Doses per day (330 Gallons AN L WAD U✓�R HIIN B�tkb fiHC1M \ .!!L � / ` � ` i _.__.___ P Y Per ll�se) FM IMP(►u►MHF N .L LEA \ � 2 y Total Friction Loss: . lJ•s o o u P a t�f L, ` 4 MANWMD d Existing Contour - - - 98 - - - static Loss: 103.73 - 91 .25 = 12.48' Proposed Contour --, 98 network Loss: 1 . '31 X 2 .5 = 3.3' 1 1/4"PVC 5 -- -1 1/a"scH 40 RISERS ELBOW Test Pit Force Mair; Loss: 95' X 3,55 X 49.5 aom 1 . HS 4 .41 2"SCH 40 FOR MAIN 1 1/4' SCH 40 ' 150 X 2" 2 f' IN - THREADED R -- � Finished Floor_ Elevation FFE � T---- - COUPLING (OR EQUIV Total Dynamic head - 20.2' at 49.5 GPM SCH 40 PVC MANIFOLD • �- _----- ------------- 12 ----- -------------� \�'�?"SCH F'Vf f-AP \ Basement Floor Elevation BFE I Pump Model: Hydromatic Model: sP 5OM2 (or equivalent) Water Line W_�_ 112 Hp, 230 volt, 1 Phase! 1 1/2 Diameter Solids (LENGTH OF MANIFULDI - - -- - -- ._------ - ---_ ___- ---- ---- -- '• _____. __.,_.,.. ,_...___ ...___ __ _ --- _ _ . __--_-____ .._._-_-_-• __-_-f 'i i T Ai NO O I. F Hj,i S a I / 1 t Ni CALL TION9 f PRESSURE DOSING t,JI.A ;, ' ,`� ,;,�_.r;•=� i�- ' 1 . Lateral length - 4!�' Lateral pipet diameter - 1 1/4" SCH 40 PVC r 2. Drill a 5/16" diameter hole at the end of each lateral, LENGTH OF LEACFN 40 UNE 45• IEACF11t��1G FIELD / F 'END"CROSS SECTION /�S''�o '� - -- � ', � through t;h• caEr, nest the crown tat the ]atrtrsl for venting. Q HP 7 • 3. Perforation diamAter far esrh lateral shall. tea 5/16" FINAL GRADE TO BESTABILQED • ��� rJ ���y I N t FINISHED GRADE(SLOPE = 021 4. A single line o orifices alterris ely plar.•d t. 5 o'clock and 7 o'clock, nq r! o cif o t s • .. evety 5 toot slang each lateral. Perforation hales shall be staggered 4"SCH 40PERF. PVC,\I I- III � I I = 12"(MIN) I I I between laterals so so to Itr. an the vertlr,lLox crf oqualater.al trianglox, VARIANCE : VIA Barnstable Board of Health Regulations �t ° w • N(1 OFACTl1A1 [1I',TFiINI1TIUN �� 2''LAYER 118" 112'' " c " x` ' 5. Perforation 01schotoo Net• (Q) s Q - 11 .79 x d2 X hc,112 -� DOUBLE WASHED STONE 1 . Request variance to reduce the offset of the proposed i IF a 3 0' ' n LINES 3 2'6" 5' S' 2'6" leaching field to the boundary of wetlands from 100 feet to ` " '' «L �' ' rN I 0 * 11 .'7# X 1 .11 1)2 X (?.5) 1/3 1 .A, 5/8" ORIFACEDIA - approximately 6.6 feet (Reg. 1 . 13) . „� � ` I LEACHING - 6" : � :,, .:$r. � 45'LX15'WXOS'II � c'® - �� s oNEt/� C'ou6LE wASHE .,.. ,...;. Lateral 0140hargo t°so p (I,M) � U X N 1 15' --� ice' , LOX 1 .0.1 yVttl X 9 * l�• '� yl.+tn � AIA I IA1 NO OF DISTIBUTIDN PIPFS MAY VAI IY j END OF DISTRIBUTION LINES TO 1 FACHING FIR D TO MEET I r4fDi EO GRaoE Or SEP/ i 5 y s rF 109Z Total Diachorge Wjto (TDR) sr 1,-M X I. �ECAPPED OMABOYEDETAIL REIERENtE NO OF CMRMEMENTSOF310 DI,t iilEtUllf)N LINE5 AND PLAN wEw CMR t�262. /09 i d 4S .Stl,3ten/ / TDA 16, upa X 3 �- 4R.5 gpa, ---- to9 r-- ----------- 4S _ - __j r!t'l�rti•s p - t'rrC.,r t.lor► 1,1act►as w Kate (qpm) IiOTEB �� ►' 4 ScH 10 ?�� jpr, mot. ►i - hiam�:te, of Poxtoratior, Hole (inches) I - - �5�°vs� kld - Minimum nistai Pressure (ft) i . All construction methods shall conform to the Title V (310 CMR 15) and the Sandwich Board of Health Regulations.. I f.Ut(t � l.istdrixl U1eCtLargs Rat• (gpsa) 9 -,i � f/Eta M -�----- per Lator®1 ACr 1�� o Lt I � N Number of Perforations o3.73 g5 'i_ /S'v, X 0,S,4 I I03,00 TL,k - 'tonal Discharge Rate (gpm) 2. There are no known private or public wells within 100 feet 1. Number of Latereile j of the proposed leaching area . 3 " (Obtained from Table 2) -- I L-. Manifold Diameter 2 �ENd� �. Mdnif.old Lrtingth = 12' 3. Existinc cesspool to be pumped and removed prior to - ,�q uiA, ►NiSEAJR,v4 / I 8. Manifold should be sloped (a .005) back Cowards the force4sain, as to � instal.linq the new septic tank. °1M1-�d�, �F. I oo.Q; C o�is TD ..,,T d IAI G, Q drain the manifold after each dr,�linq, � 100 � 6"0F �►vf(To > 6, _ F;�u�T(Ec =loo, ?� 1 4 . NO changers are to be made in the field without. th*,�Appro i W*MXTr bfi r) E_f s //V� / TP- I n �x3 p,c•Po�Eo 6.a.+•oF 1 _ ._ _.__ of the Hoard of Health and the design engineer. ,df \ �`' ti�"°,-► 10"�,- AUG 7 2000 - 6r` r, �� V �' �' r 5. proposed leaching field is not. designed for use with %Kr1�L �0 Tsai' °f (F Adc-IL KQoP,N� o M�'O ( 1k LOOP I garbage disposal . ` TO"OFBApNSTg81E Hrl+i'HDEPT. r v�} ko 1 MEMSIL+/,jE Ar et,r !0.4 � I O ' � � o+ I ,LO` � s �t a � ,. dorn"', of rC�63&R [tooFr,v6r US ,,,+ _ t .O y � c f . Cttrlt r':NC '.Or t � + )t i fy [liq Safi hc7t1!s prior to b K, T� -S M T r QO.. 2 0 . • caris rust icvrt. S ') /VL. +o r ~c A r ,. y ► ` +� _f ' E i °r' I f L w.co � t (��0) 344-7233 . � PCs4nl v,E w tic o CANDY o _ _L° t o MB��n+E _ -� LA - 6 - a - - N� 1 . PrOporty 11no, information taken from Subdivision plan of -7 ES*+,,-r Sri . 96,5') /roc47tvN of r t: ` �. s' i M o S r o v,cKrr • Land i i, C urnin squ id ( Barnst.ab l o) , MA, dated February 10, 1961 FEAr(r { *p by Nalmon hearts" and Richard 1,aw, land Surveyors. AS V IC(110 �D t Cp,-Ts ? I �cr�t` ( o r 9s:8o e►o%��� i 'y t A"�Qirs I`ll' �',�,• `i 8 . KOMOVe 5 feat hcsri zoritally around the proposed leaching area ,LAx .� 4'✓� St w, u and vertically, approximately 2. 5 feet (topsoil and J 9SSS _ •�MO CUMMAGUID �+ P-, s° _ Subsoil. and t:lay I.c,am/fine sand) and replace with Title V }. I fill [Reference .310 CMR 15.255 for specifications of fill o s i +o l oc�5 wH i �' xo ,'„ I (,+Prod) ] . The tot ,,l amount ot� fill required is approximately z ) I.�� °y� a �r oA Duo "���r o• =o * ' ,stoic ye4r'dfs . �C o 1`�I O V E 'ii� C • O �' V �O' `` r A s ,.,�, � i-_._.. ---'------ I•.; f. _ `•1t t Ke F A A cE f A ^�f«cA �► '� ' cis F&I ^ 4 1�. Sep �uDTt i o o �. A• �- SUBSURFACE SEWAGE DISPOSAL SYSTEM 1 � s t I AKA )�IAE lll'000 OAAMONf' OA ` NA&A [�1 ' :,> ` 39 BAYBERRY ROAD, CUMMAQUID (BARNSTABLE) A I /S00 ,4gCl.oN �~ `� (ouAL rAn[) nA f � 5 ( --- u 6 {.�� h SCALE: Shoes APPROVED BY DRAWN BY SEeT', , -r4AtK r rGACC ON M,o [Art N. r f f; ► I DATE: SE T L TANK # r A P f{ s F �o f 7/20/00 Daaiel B Johnson D.H. Johnson wLL' ,► i ��rAav a r . � 1 � 5 rot:Prepared 3�Sayb�zry Roads Quinn , 362-1353 Ctaraoaquid, Y01 02637 t_.__ Z__. ___.__ I ---r_. _. I r__.-__ - r- __�____ ___ a zepsr D SIGN, INC (SO ) 420-1904 DRAWING NUMBER D+7� 90 1'�'60 1+)0 (r�J l+ 90 ,2i00 �►!O ?f�-,g J+;'<a � � J '�} � ��II�01 By 63 (:aptsin A-1dons Ln Ostarvills, NA 02655 � %13 '� 1 i