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0079 BAYBERRY LANE - Health
79 Bayberry Lane Barnstable A = 335 — 040 J�) i c ;� nl No. 4210 1/3 BLU [Pon dafif, � U 92K 10' Q a o ® m t r- TOWN OF BARNSTABLE ` LOCATION l ✓ry �� SEWAGE # - ---�� VILLAGE ASSESSOR'S.MAP & LOT RiST S NAME&PHONE NO.�/� l12n Sig 253'��3 St3 SEPTIC TANK CAPACITY �L LEACHING FACILITY: (type) Z �. P%fS (size)NO.OF BEDROOMS__ BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: ZZ� .r Q.ncouNitKd / Maximum Adjusted Groundwater Table and Bottom of Leaching Facility 2 660-50 Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) MIA' Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by CeSS�oe( _ A Z 62 = 53'3" $ Ay if 9 5 = 611 It r- (o 00 2 S 3 e.5 r NOT To- 5CA LF Commonwealth of Massachusetts w Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form Inspection results must be submitted on this form. Inspection forms may not be altered in any way. A. General Information ` a�d Important. When filling out 1. Property Information: forms on the computer, use 79 Bayberry Lane Barnstable Ma. 02630 only the tab key Property Address to move your John Damon cursor-do not use the return Owner's Name key. 79 Bayberry Lane Owner's Address f� Barnstable Ma. 02630-1810 Cityrrown State Zip Code Date of Inspection: 11/24/2006 Date 2. Inspector: Brian K. Tilton Name of Inspector The Building Inspector of Cape Cod Company Name P.O. Box 307 Company Address :v Eastham 14Ma. 02642 City/Town State Zip Code = 508-255-9343 c 3 Telephone Number' B. Certification ' certify that I have personally inspected the sewage disposal system at this address nd thata�e information reported below is true, accurate and complete as of the time of the inspection. The)inspre-ction was performed based on my training and experience in the proper function and malnjenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to S ction 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ urther Evalu y the ocal Approving Authority 11/24/2006 ;As,gF ature 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. 79 Bayberry Ln.t5insp.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 1 of 16 I Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form B. Certification (cont.) 79 Bayberry Lane Property Address Barnstable Ma. 02630-1810 City/Town State Zip Code John Damon 11/24/2006 Owner's Name Date of Inspection Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. R 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: 79 Bayberry Ln.t5insp.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 2 of 16 Commonwealth of Massachusetts W Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form GSM B. Certification (cont.) 79 Bayberry Lane Property Address Barnstable Ma. 02630-1810 Cityrrown State Zip Code John Damon 11/24/2006 Owner's Name Date of Inspection 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 ❑ obstruction is removed ❑ 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 79 Bayberry Ln.t5insp.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 3 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form B. Certification (cont.) 79 Bayberry Lane Property Address Barnstable Ma. 02630-1810 City/Town State Zip Code John Damon 11/24/2006 Owner's Name Date of Inspection C) Further Evaluation is Required by the Board of Health (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 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: I 79 Bayberry Ln.t5insp.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 4 of 16 f Commonwealth of Massachusetts Title 5 Official Inspection Form a Not for Voluntary Assessments 4qM Subsurface Sewage Disposal System Form B. Certification (cont.) 79 Bayberry Lane Property Address Barnstable Ma. 02630-1810 City/Town State ZipCode John Damon 11/24/2006 Owner's Name Date of Inspection D)System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No - ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of,the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/day flow, ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® 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.]' El ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. Yes No ❑ ® 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. 79 Bayberry Ln.t5insp.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 5 of 16 I t Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form 'G1M B. Certification (cont.) 79 Bayberry Lane Property Address Barnstable Ma 02630-1810 City/Town State Zip Code John Damon 11/24/2006 Owner's Name Date of Inspection 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. 79 Bayberry Ln.t5insp.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 6 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. Checklist 79 Bayberry Lane Property Address Barnstable Ma. 02630-1810 City/Town State Zip Code John Damon 11/24/2006 Owner's Name Date of Inspection 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)] 79 Bayberry Ln.t5insp.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 7 of 16 i usetts Commonwealth of Massach W Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information 79 Bayberry Lane Property Address Barnstable Ma. 02630-1810 City/Town State Zip Code John Damon 11/24/2006 Owner's Name Date of Inspection Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 1099.4 actual 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 04=107gpd/'05= 9 ( Y 9 (gpd)): 115gpd Sump pump? ❑ Yes ® No Last date of occupancy: Current Date Commercial/Industrial Flow Conditions: Type of Establishment: N/A Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: pate Other(describe): 79 Bayberry Ln.t5insp.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 8 of 16 f - Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form Do System Information (cont:) , 79 Bayberry Lane Property Address Barnstable Ma. 02630-1810 City/Town State Zip Code John Damon 11/24/2006 Owner's Name Date of Inspection General Information Pumping Records: Source of information: 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) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 12/9/1983 Were sewage odors detected when arriving at the site? ❑ Yes ® No 79 Bayberry Ln.t5insp.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 9 of 16 Commonwealth of Massachusetts W Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M D. System Information (cont.) 79 Bayberry Lane Property Address Barnstable Ma. 02630-1810 Cityrrown State Zip Code John Damon 11/24/2006 Owner's Name Date of Inspection Building Sewer(locate on site plan): Depth below grade: 3'6" & 11'9" feet Material of construction: ❑ cast iron ® 40 PVC- ❑ other(explain): Distance from private water supply well or suction line. Town Water feet Comments (on condition of joints, venting, evidence of leakage,etc.): No evidence of leaks Septic Tank(locate on site plan): Depth below grade: 11' 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 ❑ Yes ❑ No certificate) -------------------------------------------------------------------------------------------------------------------------- Dimensions: 5'8"x10'6"x5'8" Sludge depth: 3„ Distance from top of sludge to bottom of outlet tee or baffle 29" Scum thickness 2", 711 Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 18" How were dimensions determined? Dip stick, baffle stick&tape measure 79 Bayberry Ln.t5insp.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 10 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form �M D. System Information (cont.) 79 Bayberry-Lane Property Address Barnstable Ma. 02630-1.810 City/Town State Zip Code John Damon 11/24/2006 Owner's Name Date of Inspection Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Levels normal no evidence of leaks or backup, all components in place. Grease Trap (locate on site plan): Depth below grade: N/A 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.): s Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: N/A Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): 79 Bayberry Ln.t5insp.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 11 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cont.) 79 Bayberry Lane Property Address Barnstable Ma. 02630-1810 City/Town State Zip Code John Damon 11/24/2006 Owner's Name Date of Inspection Tight or Holding Tank(cont.) Dimensions: N/A Capacity: gallons M 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 011 , 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 level with equal flow to 2 pits Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 79 Bayberry Ln.t5insp.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 12 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form } Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cont.) 79 Bayberry Lane Property Address Barnstable Ma. 02630-1810 City/Town State Zip Code John Damon 11/24/2006 Owner's Name Date of Inspection 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: 2 6x6 with2' stone ❑ 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.): Lawn over top no evidence of breakout or hydraulic failure pits both with 5' liquid ponding 79 Bayberry Ln.t5insp.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 13 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form aS Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cont.) 79 Bayberry Lane Property Address Barnstable Ma. 02630-1810 City/Town State Zip Code John Damon 11/24/2006 Owner's Name Date of Inspection Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration 1 cesspool,.disconnected Depth—top of liquid to inlet invert 51. Depth of solids layer 1 g" Depth of scum layer 4" Dimensions of cesspool Materials of construction Block Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): cesspool needs to be abandoned. Plumbing has been tied into current title 5 system. Privy (locate on site plan): Materials of construction: N/A Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t 79 Bayberry Ln.t5insp.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 14 of 16 Commonwealth of Massachusetts f : �A. e 5 �ff�coal in� e� �®n Form Not for Voluntary Assessmen--t Subsurface Sewage Disposal System Form D. System Information (coat.) 79 Bayberry Lane Property Address Barnstable Ma 02630-1810 Citylrown State Zip Code John Damon 11/24/2006 Owner's Name Date of Inspection Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. ' At = 13r ?Vol A 9V/ 13 try S ?2 75 0 1� 79 Bayberry Ln.t5insp.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 15 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cont.) 79 Bayberry Lane Property Address Barnstable Ma. 02630-1810 City/Town State Zip Code John Damon 11/24/2006 . Owner's Name Date of Inspection Site Exam: Slope Surface water Check cellar Shallow wells Estimated depth to ground water: ?-C, 4- 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: 9/21/1983 Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database -explain: USGS Test well Near Property at same elevation You must describe how you established the high ground water elevation: . Design plans on file and hand augered test hole 4" diameter 12' no water encountered Corrected to estimated high ground water level using Frimpter Method.No perched water encountered. 79 Bayberry Ln.t5insp.doc•03/2006 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 16 of 16 +5,49C) in It N Goc `� Y3. ,�� mac• �� �� 8- �c3 . t ACID �J `\ ` �s.8, �t Sri F�i's ���.�,�-tea S�•`'� 6 i J,n. -fro.,►.. � Edward E. E mwr • \ lotM11% SITE FLAN OF ,ygcy Locus: �•F. c�ycrrcie ARNE �, Gu mm�x.9.vi c� a55 H. v � H REF: Uo pi. down ca.Pe eftfineeren 3 O PREPARED FOR: 3or1 Sr i O[1 CIVIL ENGINEERS s LAND SURVEYORS � LZ � -_ V{J�n �• ��MC��� ^�r3, r YOR I erraServer Image Courtesy of the USGS Page I of I Send To Printer Back To TerraServer Change to 11x17 Print Size Show Grid Lines Change to Landscape MUSGS 2 km SW of Yarmouth Port, Massachusetts, United States 01 Jul IV7 ---V_ ;7 tx- ir x .) �. :�-, '� `1` .� f..' • ■ ,� r_t,.8� a-Y� �. . `rYsfl i' � ��3 s..+� .,.�. =_� - _-S _�x�.� s• �„ `�■ ai.■ �' ww• ��1�/ � l''� �..,,■ -' '- ■ .r *..1, i ..r/",...f i! �4j 10 :� ,� �P ,./"+tip;,� C.,,,ter•'' `I j � i , .. '_,e•�., > -e +' .- ,+•i Ste' �-a+.= 1,,,'_ �'6� `.�. _ �S f=S f � i' 'l .' ;�4 `i{A° �} $ £ 4r• .. t. .� _ '`'� `,W,c-fir :1»" l. ter ip d 1 i "�y"`,.1,''i-r�.ip 'r^-�`.�►,�5• �`'' i�l�,�*5���°.�'��`,A1�`g�.yii "" +`'..f��� �,�t�"�4 �'�t'Av:. q,��..,W�"'�� "•'"gti,"��' . ....... '.5Km 0` `.25Mi Image courtesy of the U.S. Geological Survey 2004 Microsoft Corporation. Terms of Use Privacy Statement ITCH: (Street name,etc- ,dimensions of lot, exact location of test holes and percolation tests, locate wetlands in proximity to test Boles) COTES. i - t�tee%d i tt1Cr- oe 11 Cue,I a iRCOLATION RATE: 25CAr �;, fsi�++-••C2�+r+•�.��•<<�-. 17ST HOLE NO: ELEVATION: TEST HOLE NO: *.+ ELEVATION: I 1,va y 2 t 2 ` '�- 3 3 eA ea w? 4 C eUO 4 ems 5 5 6 a 77 7. � 7 C+ts 8 8 t� 9 ?aav 9 4.0 u, 10 10 12 12 -- 13 13 14 14 15 15 16 16 UITABLE FOR SUB—SURFACE SEWAGE: LEACHING FIELD EACHING PITS LEACHING TRENCHES °---" NSUITABLE FOR SUB—SURFACE SEWAGE. REASONS: flTE: ENGINEERING PLANS MUST SHOW NUMBER ASSIGNED ON PER EST APPLICATION( RIGINAL: COMPLETED IN ENTIRETY BY P. E. AND RETURNED TO BOARD OF HEALTH TerraServer Image Courtesy of the USGS Page 1 of 1 Send To Printer Back To Terra5erver Change to 11x17 Print Size Remove Grid lines Change to landscape MUSGS Barnstable, Massachusetts. United States 1.0 Mar 199,. JOW 16'52" i70W 16'44" 'e7OW 16'3F'''' 70.2811$ 1-70.27877 !-70.27637. i393,400.0 393,6O0.Q i393,SMO IN 42'05" 41,7012S -1.70130 4,617,400.Q 617,4Q0,0 41.69945 : e 41.69950 4,617,200.0 ,617,20010 �I �}pprbx.wc(� � � �:, ��P✓ax- toca�-cam LOCa� u, 7 rt 41N 41'S2" 41N 41'52" 41.6976 .. 1169770 4,617,000.0 r.: ,617,000.0 - • 41N 41'45"70W 16'52" :7OW 16'43" 4IN 41.69585i-70.28107 i-70.27867 A1.69590 4,616,800,0;393,400,0 393,600.0 4,616,800.0 i70W 16'35" 70.27626 •393,800.0 01 iloom 01 '100yd Image courtesy of the U.S. Geological Survey 2004 Microsoft Corporation. Terms of Use Privacy Statement VfOP OF Fr s, l �8 -.SEPTIC TANK _ sOPOFFDN — P)_ - X - 13 LEACH t _GO.p'!- (MSL)x "2"OF 118TO 112.1 WASHED STONE IN OUT» IN- 1" OUT 53.32 � SQG -- IN- SEPTIC ELEV. TANK 52.47 ELEV. ELEV. Si•GaOt 5�.4� 519c� ELEV. ELEV. ELEV. 6 ELEV. WASHED STONE EST HOLE LOG _STsY9__5A rba�P.E_ John JcAco6; a o t4. p-Z55G sT DATE Z7 83 WITNESS T.H. 3. 5z Z T H. g. DESIGN _BEDROOM HOUSE oa" ELEV. 53.G O.0 ELEV. xrr NO PERC RATE C 2 MIN/IN. DISPOSER DISPOSER Z4a Sd Z 24„ r Sl.6 FLOW RATE 440(GAL./DAY) L�Q 49 2 SEPTIC TANK 4-4 0 ().S)= (~G o �a REO'D SEPTIC TANK SIZE 1040o W USE 1250 GAL.TA"k FoR 4 B Dk`ioo PEf� BRA=NSTRBLE 47G LEACH FACII_fTY F_eGUt.a�lo*: SIDE WALL %Olt-G -1 i•2 G/D. BOTTOM /T1 10)z=`)S S ( 1_,01 G/D. TOTAL _ . -..-. • G D. 84 45.a Z6�.o j USE: M- Vkjo LEACHING PITS ���• ENCOUNTERED )TES.: (UNLESS OTHERWISE NOTED) ATUM(MSLJ+TAKEN FROM_ 1YAt�tlJ 1� UNICIPAL WATER 1S �" QUADRANGLE MAP __ PE PITCH:14"PER FOOT nVgtt.ABLE � ESIGN LOADING FOR ALL PRE-CAST UNITS:AASHO 44 -_ j D IN.GROUND COVER OVER ALL SEWAGE FACILITIES.(1)FT. hFi�ff:H. PE JOINTS SHALL BE MADE WATER TIGHT . )NSTRUCTION DETAILS TO BE ACCORDANCE WITH COMM.OF MASS. �,��CIVIL . 'ATE ENVIRONMENTAL CODE TITLE 5 flto. 92 REG,- NAL ENGINEER NTOURS (EXISTING)------------- BOARD OF HEALTH (PROPOSED)-O-O-O-p— APPROVED DATE ,.. TerraServer Image Courtesy of the USGS Page 1 of 1 Send To Printer Back To TerraServer change to 11x17 Print Size Snow Grid Lines Change to Landscape Ii MR Barnstable, Massachusetts. United States 01 Jul :197� 5V T � , 40 w in �i rr} ?? T S 1� R . a. r t, d p ( l r'L /y OL 'zoom 01, 1,.4 200yd Image courtesy of the U.S. Geological Survey C) 2004 Microsoft Corporation. Terms of Use Privacy Statement USGS Ground water for USA: Water Levels-- 1 sites Page 1 of 2 ° aYG' National Water Inf01"matIon Data Category: Geographic Aree: Ground Water United States Resources System: Web Interface GO Ground-water levels for the Nation Search Results -- :I sites found Search Criteria site no Est= e 41415407016500111 Saw.f.%le_of selected sites to local disk for future upload USGS 414154070165001 MA-A1W 247 BARNSTABL.E, MA. Available data for this site Ground-water: Field measurements : 7 L6O Barnstable County, Massachusetts Hydrologic Unit Code 01090002 Output formats Latitude 41041154",Longitude 70°16'50"NAD27 r Land-surface elevation 44.52 feet above sea level NGVD29 ITable of data The depth of the well is 52.0 feet below land surface. The depth of the hole is 52.0 feet below land surface. Tab-separated data This well is completed in the Sand and gravel aquifers(glaciated regions) IGraph of data (N100GLCIAL)national aquifer. Reselect_period This well is completed in the OUTWASH DEPOSITS (I120TSH) local aquifer.. �� i `� `"T �f .ate + e E1• �Y • � ��( `a� "y'° 14 e ,`S� r` j, fi { •U �1T i - � •� �. t rF,' E�� � s ��,``•.��"N' IlC,� !� '�`7r�►I ,:.',•r�fi .. G�./"1ry��\i t!, yS�i .7f„i+i1Lf�'i� R`� •fir ++ '�`` 11 ems°!.. 3 •.In t; �1 .rtF�. �l•: �` .., � •ts. 1 �� '�" ,! ♦<�" �r +'1�y 1, "'' w�.� S c w'4 •<'-d .�.,.�' �:�....q [y,�r l_ .'� Lr < � � �� .Q�.'�ti♦ %,. G'f .� reR�.'. I� l4 '9. •e t-:+ {� •� lf! "•r . --<,., q•1�v FVR. 1!jFI- „`'��'•- i s I c,$r � .?a, ^•+.t -� a'�r..�.a ! l <�1}�,rv. � �7r t �•+..�'�� �+► — t a.+ .Y� �e�it � bz ..f'e`�`'?�o�`. ti " �i<' g``,t'fi I`+"- r��P•!�-r r:c'FdilNiil►'�.;r� i9 ,-ys $:4s �4`r `�i� �f•�tF�"' �a� �R .. �.�_i. � �'" ,4 e�e� „t �2!`eiJ'bY" a"s t+lf� i �`, "�� t `,••�-+� ': ��t Fls<.r g �.e�. yam-. �. > � {.. t.. ,d,. f\'s� 4'.am'.,j'�:d '^.. g � $r ._• ` i t"av'$. •,..4..y �'� �� p�+�'e, ,ram v''� '�`�.,GL�itk8l. T' ..�a...' 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'a'6 K7%,,�(yc..a �b`F� +m v Y•e./��' ,' e - ,�', 7h•.vt ��& ��t���i3� IN VA va- •4�� ��.�$a����"` � ''�� �� Wip �P � �"�a� s ,� :�a� q � •.• � f�..� g �. `,}-```>'� }� & a�A • i a ys •'`i �f sly '¢ ` � �� � t �[t a i�• ,. see'��' ���.'�` -.�' ���,y..g'. �- - �- r: �ta.<�7��`�!� !�i�� ti• 4 ������kra..���tiY v'�._. s ; jY .as`sra S1`:ro'4s. z�'., '^ ✓ �' "� t/INV. 7� ~r art � • T d i 3 !iYV�'/4 � 44"RR• .� �'te•<-�sC �` 5'�- 8'�q Ott i �.,� ` �(� n w lk , "r ' .. `` 7. ti++a.- �A.i(♦��i/y d�' �.a. �;,, t u t ryiit;w" y . r4y� L*1R ��.... � 4 '` 11 �;'� t - +,r•, ate+r 4�` t. � �.r S 9 \ i- i l Y ' ,y t Ili RN " 'W. c<i Vs rb Ila . Itl ! ! =a,—al—w—mil—ems a _:pe od Commission: USGS Well Data September 2006 Page. 1 of 2 ,J United States Geological Survey Observation With, As a service to Cape officials,engineers and other interested parties,the Cape Cod Commission Yuolishes monthly groundwater data gathered by its Water Resources Office. The water level measurements shown below are taken monthly from United States Geological Survey (USGS) observation wells and compiled during the last week of each month. They are published as soon as possible then e. Listed below are nine out of the 61 wells measured across Cape Cod by the Commission's Water Resources Office. These nine are employed as index wells to be used with Technical Bulletin 92-001 to predict high groundwater levels. For your convenience, we've also provided links to USGS national and state data. See the last c€alumit in the table and the footnotes below. To see what's happening in real time at a separate well in Brewster,visit the USGS site: t,fSUS 41463007001,4901 MA-BMW 22 BREWS'TER,__MA =A record high wasbroken in June 2006. For further information about any of the data or links on this page,please contact 1-1}jdrologist Gabrielle: fie lFit at the Commission offices(508-362-3828). September 2006 i k SCS Site Water Record Record Departure from Number' °= Location Well No. Level* Highs Low* Average" (links to t.J.SGS Monthly Overall national water=level IL ' database) Barnstable 230 23.4 2Q.5 26.6 0.9 0.2 41 9560701 fib 01 Barnstable 24W 22.6 20.5 28.6 2.2 1.8 4,1.4.1.54070.1.65.00.1 Brewster BMW 21 8.1 6.9 13.6 2.1 2.0 4145180.70020301 Chatham CGW138 23.8 2fl.9 26.6 0.6 fl.0 4.1._4.10007001:.:1.1.01 Mashpee MIW 29 8.1 5.6 10.0 1.0 0.4 41 3525070291904 Sandwich SDZ 47.0 45.8 48.2 0.5 Q.2 4.1.441.8U7024.1.60.1 Sandwich SDW 47.8 45.8 55:1 2.4 2.3 11 4.1:4.1?407(}2.659011 Truro TSW 89 12.0 10.2 13.0 0.4 0.0 420206070045901 t Completed by: HIGH GROUND-IATER LEVELCfJsVPUTATIO?i Site Location: T �. Lot No, Owner: .1oEw. Address: tvl Contractor: aui�Mati ZMgp. �C_T Address: -a, 40�f �'t�S{�,�tr� �4 Notes: Ni> coa,6¢.- F�!cOvw �d . .STET' 1 Measure depth to water table r _ N tonearest 1 ........................................................................ .Date �. rnonxn,cia�•Ivear i _ STEP 2 Using W14-ter-Lever Range gone �____._..............w.. ._. and Index Well Map locate site and determine: Rit�f L I rA Appropriate index well......................................:............ Water-level range zone ................... -------------................. --�-- ' 1 STEP 3 Using monthly report"Current j y Vtater Resources Conditions- 1 ' deta=rn;ne current tfeptcs.a p water level#ir index well____-_------------------- STET' 4 Using Tabie of Water-level Adjustments for index weii (S T EP 2A),current dtptir 1 to water te-el for index well (STEP 3), � 1 and water-leml zone(STEP 28) determine smaer level adjustreant ........_.............._........................_...... -_..........,............ i STEP S Estimate deaf+to high router I by subtracting the water- ? level adjustrrent(STEP 41 from measured depth to water levelat site (STEP 1) ....-...............--................—................................... ............ ..............:. �D. Figure U.--Reproduc€ele coaaaPut don forma, t1 J}'i1 11_l3V l)i; t' ,r`.._ L, tii1 V_v I�.J.i ti i.'+1J VL ttiyi _ Y _t.lJ iv �I LOCATION __f � --• --- - __.,� - - ------ NO.�- `•3� -VILLAGE DATE . Z _ APPLICANT ., o 41 ki 71�ZK4oyi ( Sot1 '�5?_1 lam,,,) FEE -Z}' ADDRESS TELEPHONE NO. (Non-refundabl.e)/ ENGINEER TELEPHONE NO. DATE SCHEDULED 3 (Applicant'.s signature) . . . . . . . . . . . . . . . . . . . : . . . . . . . . . . . . o . . . . . . . . o . . . . . o . . . . o . . . . . . . . . . a . . . . . o . . . . . . . . . SOIL LOG SUB-DIVISION NAME DATE_ , {p �9 TIME � EXPANSION AREA: YES ENGINEER::: TOWN WATER PRIVATE WELL BOARD OF HEALTH Ice EXCAVATOR SKETCH: (Street name, etc. ,dimensions of lot, exact location of test holes and percolation tests, locate wetlands in proximity to test holes ) NOTES: a • te", 3 f ! r I 7 ii . � o � t r ! 41 - I e5T° ale N- I POac4 PA 1� CVO 3 t PERCOLATION RATE: 25CAt,- S t�,,�•G2ti++ �.��k�� ' TEST HOLE NO: 3 ELEVATION: TEST HOLE NO: 04 ELEVATION: 1 1 l,va - �y • 2 2 SV4 -t. -aa 3 Sv" 36� 3 e"v t 4 Cr- in1 4 COA e- i 6 72 7 7 CU,0 8ae 8 kotA 9 vu,v 9 10 10 11 11 12 12 4_ 13 13 14 14 15 15 16 16 SUITABLE FOR SUB-SURFACE SEWAGE: LEACHING FIELD EACHING PITS LEACHING TRENCHES " . UNSUITABLE FOR SUB-SURFACE SEWAGE. REASONS: NOTE: ENGINEERING PLANS .MUST SHOW NUMBER ASSIGNED ON PER EST APPLICATION ORIGINAL: COMPLETED IN ENTIRETY BY P . E AND RETURNED TO BOARD OF HEALTH COPY: RETAINED BY APPLICANT T) THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................... ....................OF.........................................------------------.......-..--.-........:... Appliration for Diapaiial Works Tonstrnrtiun Frrafit Application is hereby made f a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Syst • ... b(o ................................... '� S.. .. . Lo tion Address or Lot No. ..... ._ ---• -- ... ..................................... -................. __....--•-••-•-...... ............................................... . caner / Address ........... . ..................... staller Address UType of Building Size Lot=XA_K.la��_____...Sq. feet Dwelling—.No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) a1� Other—Type of Building No. of ersons____________________________ Showers YP g -------------------••---•--• ---_P•_.- ( ) — Cafeteria ( ) dOther fixtures ------------------------------------------•-•-••-------------_-____---------------••---•••--- W Design Flow............................................gallons per person per day. Total daily flow..._._.__._.._.____...__..._.___......__.___gallons. WSeptic Tank—Liquid capacity------------gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No_____________________ Width.................... Total Length...-................ Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed bY.......................................................................... Date........................................ as Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ t%, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a -•------••••--------•----•---•....................................................................•--.........---...••----••--•-........................... 0 Description of Soil.....................................•-•--------•--••--•-----•---..:---------...--------------------------------•-----........-----••---------..._....--•••...._---••••- x U ••••••••••---•-•--------•--------------•••-•••••••-••••••••••••••-•-•-••-•-••••...-----••••••---••••-•-••-••-•...-•----------------••--•••--•------•••••---...----•--.....•------•......•---••--••••-••- W ------------------------------------------------ ----------------------------------------------------•-----•---------------•----------------------...------------------------.._..------•--•---•-••-•- 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 iITLL 5 of the State Sanitary C de— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b issued by the and of ealt . Sig -•--• ••-•• ..... __.. .... . ..... ._ --•• ------ ----- -------••-•__.... e ApplicationAPP •-••••_ ....-- .......................................... - 3•• -�••---•-........ Application Disappro he follow in r ons_____________________•__...-...__...----------------••----•••• -------•-•-•••--•--•-•-- Date • -..-••-•........................••-•-_•--_.__._._....---••-•-•--•--••--•••-----•••-•---.......__..._••••--••_...._...._...._..---•--------•-••-•••••••••-----------••••••-•--•-------••••••••---...--•--- Date PermitNo.......................................................... Issued........................................................ Daze <.f THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...... ................OF......................................-.... ...... Appliration for Uhipoiial Workii Ton,itrnrt"ton amit Application is hereby made fob a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal SysteM at -' .E r 11 fC{�TA( ti'9� .: (............................................ . .. . � i --.--•• --------••-----•-••--------------------- ... ...... .ion-Address �� o. Lot No.......................................... ner /' Address ==••..... ..........-............. - '1�:��P� l4 --•--......... It staller Address Type of Building Size Lot•33- ��0_'.....Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............... No. of ersons.....................__.._.. Showers a YP g ------------- P ( ) — Cafeteria ( ) QI Other fixtures ...................................................... W Design_ Flow............................................gallons per person per day. Total daily flow......................................_.gallons. P4 Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................Depth................ Disposal Trench--No..................... Width.................... Total Length.................... Total leaching area.................... sq. ft. Seepage Pit No.---.--..-_-_-____- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation.Test Results Performed bY.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ --------------------------------- •--------------------------------------------------------- -------- -------------------------------------- .------ -............ 0 Description of Soil........................................................................................................................................................................ U -----------------------------------------------•--•-•----------•--------------------•----.....------.......-•---------------------------....----------.........---...---.......-•-----•••-••-----•--•--. W UNature 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 TITLE 5 of the State Sanitary C de— The undersigned further a rees not to place the system in operation until a Certificate of Compliance has be issued by the and of ealt . e, -'Sig d_. .- - ----- --- c ate ApplicationAPPr. Y •••••• .. ........ .... ............... .......................................... /..?-��•---........... d Date Application Disappro�vLd f br the following reasons:............................................................. .............................................. -•--•-.........._••••-••-•--•-•••------•--•-•-------•--•••••....•••.......-•••-••••--.--••-••------•-......._•-•-••---•-••------•----•.•--•..............•------•...---•-•--•••.....--••-•-••---•-•-••--- Date PermitNo...............................................:......... Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... Tntif iratr of TOmplinurr S S TO,CERTIFY, That the Indio i al Sewage Disposal System constructed ( ) or Repaired ( ) t fJ by ..... ...... ......•-;..... ------- • f i� Installer -•••-• •-••••.._...il)�osal ........................••••......._ has been installcco d ce with the provisions of T T F 5 f he State Sanitary Code a�es I d in the � ,r application for Works Construction Permit No .'--=_- °r.�.................. dated_ /._� ;<...__ ......_.._._... THE ISSUANC OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WIV FACTION SATISFACTORY. DATE../z..: f..... •..................•---••-••....----...--•---..•... Inspector---- --- -----••••......_........_.............._.........••---.......-•-•-.... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF/HEALTH .: N ..........`�......... FEE..... ............... Permission is he,eb �ntedr.�.l�_..:_..i :_-� �Dtn,��'�tton rrmtt yg f-- .............................................. to Construct (" .. f Repair ( , fan idual $,eage Disposal System at No..... .. .................. -•••-•-••----•--------...-•.--••• -----------•----•-•----•--•------••-......••••-•••••••••-•------•-•-••••....--•--.••.... Street as shown on the ap licati for Dos 1 orks Construction Permi ..................... Dated.......................................... Board of-Heilth DATE..../ . .............................................. li°r FORM 1255 A. M. SULKIN, INC., BOSTON r` ...... Fua................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..__.. .........OF. I ..i.......... ............... - Apphration -for Dispagat Workii C omlrurtivu Punift Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at: (���t✓�91,�(d/G� ` ...................... l�c��-...... ...*----------------------- ----------- --------------- ' Address or Lot No. owne _ Address I A- Installer Address Q Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ------------------------------ -. . . W Design Flow............................................gallons per person per.day. Total daily flow--------------------------------------------gallons. WSeptic afik= iquid capacity............gallons Length---------------- Width_-------------- Diameter-------.-------- Depth_____-____._.. x Dispo I rench No. ............- -_- Width-------------------- Total Length---.------.--_ --__. Total leaching area....._-.--_-_--_--sq. ft. Seepa P t _______Fults ___ _ r ter-------------------- Depth below inlet.................... Total leaching area------------------sq. ft. Z Other t buti�b � Dosing tank ( ) aPercolatio -t Re Performed by-------------------------------------------------------------------------- Date--------------------------------------.. a Test Pit No. 1_______________minutes per inch Depth of Test Pit.-.-_--__________-_ Depth to ground water------------------------ ( Test Pit No. 2----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water-----.-.._-_-_._--_--__. M •---------------------------------------•--_----------- ------ 0 Description of Soil-------- 1 -1E ��� hr / ---� i�G��----,f��---- -� C------ x -------------------LL.�'1 W -------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------- 41' V ure of P irs or Alt �pnsd Answer whey applicasile._.. f�ST%?4 ---------o ..`jam----------- __��`°�. Agreement:. The undersigned agrees to install the a re escrt ed 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/systemoperation until a Certificate of Compliance has be ss" t board of health. Signe .... ::® D A lication Approved B .....__._ PP PP y----- Date Application Disapproved for the ollowing reasons:.................................................................... -------------------------•------------- :. ': - .....: - D-t--------------- fiy a e Permit No...........-S•-�- -•---•--------•--••---••----...... Issued ------- �: .. .. Date ,.. No...... ................ ... Fax.... ... ... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 00914 Appliration -for Uiiipaoal 10orks Tonstrnrtion Pumit { 'lication is hereb made for a Permit to Construct or Repair 4/an Individual Sewage Disposal ARP,' Y ( ) P ( '7 a P System at: G��/ U/r a c , I )u Address or Lot No. oj ----•••. ---------•--------.-".................--.._.........-------------._..._..---.._..._..._ ..........v' •9l?°?' _.._..-•-----••---.....---------"--------------------•-•--------". Owne Address a ------------�cJ ------ --"------------------ 1� "1# h� h'+r '�`#,, r' ? S'`....-"--- p Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic-..,( ) Garbage Grinder ( ) p� Other—Type of Building ____________________________ No. of persons............................. Showers ( ) — Cafeteria ( ) P4Other fixtures -------------------------------- -d ------------------- -------------------------------------------------------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic " :Ink quid capacity------------gallons Length................ Width---------....... Diameter................ Depth____--__-_--- x Dispos I rench No_____________�►____ Width-------------------- Total Length.................... Total leaching area--------------------sq. ft. Seepag Pt _ er.................... Depth below inlet.................... Total leaching area._..._____________sq. ft. z Other D tr utit� Dosing tank ( ) ~' Percolation T t Results Performed by............................................ i a ------------------------------ Date------------------------------------- .. Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water..-.---.--_-__-.__------ 1:14 Test Pit No. 2---_............minutes per inch Depth of Test Pit.................... Depth to ground wate......................... P4 ----------- ---------_--- ----------- --- ............- - ------------------ ------- ------ -- ---- D Description of SoilI. �1k /. - !y t -4.. - --"--'�'C.+1: i. x • --•- ------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------- U re of R irs or Alt inns x-Answer whe applica,ale. ... /.LA`.r!_g___..r................. ..."__lQ _....._ c O [c« iV s7- . �,° Agreement The undersigned agrees to install the of re escri ed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary qde—Tho;updersigiie fur�tliei gees 60t-40 place!!#system i operation until a Certiiicat ofrCb ipliance has;l� . " ss t`' boa d d healfh. a Signe _ Da ApplicationApproved BY..........--- ------................................................................... ........................................ Date Application Disapproved for the ollowing reasons:................................................................................................................ --••----•-•------•----•--------••--••------------•------------•-••--•--•-------•------_...-••---------••-----••---•--•-•••-------•-••----------•-•-----•••------•---•---------------•••---•-•--------- 3S f :.7Y� Date PermitNo......................................................... Issued......... - ��/ --,................. Date TH'E COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .......................O F........ ....................................................................... r�bP Qrr#if irafle of f�umplianrr THIS IS TO CERTIFY, That the Individual Se'a e.Disposal System constructed ( ) or Repaired. ( ) by = ............... lj,*' 4 e'e/ Installer �] f . at----------=---- ---- ....... _.._-•---�-- •--------------------------•-----•------------------•-------•-----••--------------------------•-•-----•-••------•--••------------------------------- ='has 'been,installed in accordance with the provisions of :Article of The State Sanitary Code as described in the 6,. �:"application for Disposal Works otlstruction,Permit^No,.�_� __________________ dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BECONSTRUED AS A GUARANTEE THAT THE SYSTEM. WILL FUNCTION SATISFACTORY. DATE;------"- .................................................. •-•---- Inspector..................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF, HEALTH b 1'Q't�'x' OF............. awtt�'6:.................................................. .. No.•---- ,3S '� = ;. FEE........................ Di-ivalial ivorkii � n�#rnr inat rrntif :' Permission is hereby granted______ __,-._ ---------------6bk „ G•!KI/�iy�i. to Construct ( ) or Repair ,( ) an�lIndividual Sewage Disposal System as shown on the application fo`r'Di posal Works Coristruct ota I�'ermit 1�To-_�fA "��.�� :-.. ,,�,�s . Dated---- as . ...............•----. fiat?v f _... r Board f Health- ._ _r________________ .._ _.. FORM 1255 HOBBS & WARREN. INC.. PUBL•,ISJµi.ERS j r- a�`,! .r�*w"�v'i'"� ,''F-•.'•�'I%^M`�''�A���'7+ -�v cxs�,&. ,.`-'-:1, �'ti �e Great Western Road Sor Lis Harwich, Massachusetts Dear You a:"€guest for LI variance-ianc 1--o inisl al two (2) 1000 gallon pre— cyc 9:9 �a± aya , d�:. �-Y; o �.�� Wiz, stone �.�.n"nrj �..ghteen ��S) f et deep an .. he 9�.�'Y��'e.��''.6.� �� .d�c. ��'lr�.� i�erJo 53�me3 p1uv�..d.�,d:1� Bal�.�'�r.J�i.'y ..�,.kr�.�aA�:�, -ast be remo-ved and re-placed As i�otedin your recpiest, all clay m. sJ3.e'.1 y os ) �� m _ 0�n�, � � d :ti '- 3 � 3�. % ?x2 - - :%o ? �h of leaching'-pit a3 e' C.'V'ent e�'a'� I€: a4. bAn ::pjt rcoula''be_ a.'+:`,'3`:ua-ed. the leaching G' %.:aa �':.3far3.( , ' `�:�»v's'' ��3'�� �«1� 'Ls1�3 .� ����b.??t'e-��:t"�::alu�-1s:::'�'�':�`"� ious m-ate gel e the 9 would not- he reVired Prior 6iJ �thv- l'S.J r7, ria;g, lJ 6r.jYt'.a -}p..3i t or�_',keplacelmanti lay .t.,..�.--.. wit"� cleanfill, �'n'Hea.l'Ca2 ET�l:S"'Pect-O %USI ObSe.ZVe E."-':�>°Z:s3lratz--.d cari' �3 QgI Gaza .d ` / . a d s m D. oO.l�iP/L3L� � �� � �z �� �����- � �� �_ � � SECTION - SEWAGE .- _ @ A �''g o p E Z8' -SEPTIC TANK - Z i / - "D" BOX - 13/ - LEACH PIT -- TOP OF FDN 6q.C? (MSL);* ••2•"OF veTO lb" WASHED STONE t e � �,-r .• Co + I +5,4`Z I N- ci 0 OUT I OUT• IN- �D`�cl0 -�- S•f �C 1_Z.1 G �` -r r�3.3Z SEPTIC �1 �/ P �\ S2.7Z TANK 52.4? 5) O ELEV. ELEV. ELEV. t ELEV. / • , 52.0"7/ 51.90 L+ I k9 vi ELEV. ELEV. Q I-- -2.o'O F 314" / N WASHED STONE ' N :76 TEST HOLE LOG TEST BY p_.1F0.lr oo ny.:,P."E' n 101co TEST DATE2"? $3 ` WITNESS DESIGN BEDROOM HOUSE T.H. # 3 T.H. 4 on 53i6 �� OQ�i ELEV. O.O ELEV. NO o° PERC RATE C 2 MIN/IN. DISPOSER DISPOSER Z41r �4.y Q(GAL./DAY ) 4 Q �` \ I a ` 51.6 FLOW RATE 44 . �I 3+; �- =z c� 24 �jc.2 r SEPTIC TANK 49 © (1.5)= �G o s�z? \I 5 { 59 RE'Q'p SEPTIC TANK SIZE W USE IZ50 GAL.-TA"K FoR 4 B. 02o'orn '"—� \ o SAC• �`, -... PEf� BAR•NSTABI.E 2EGVLA` 100 :>r/4 --.�� �� -''�Sal -- LEACH EA61 LITY Q p A `?2 4'7.: SIDE WALL ►o'iY Gi = 1 $1. �(2♦S) = 411.2 G/D. >=Np , 0 rPc BOTTOM 1 ���`�g( 1•0 ) _ 8.5 G/D. .p \ s', r +u _ G M TOTAL ZG,-j.o �..�.2._ � Q � \ � x 2 = 534,o FoP_ 1099.4 84 45;2 `' TWco P 1 T S G'D• oa.cb�e.kyKp_<" USE: LEACHING 144 414 �Matatmytvll ���ff d�p �1 x ►b )DO WATER ENCOUNTERED � � Mct1-i'I�h IoIMIru �` -'(�. ��`,¢, mod• NOTES: (UNLESS OTHERWISE NOTED) EU LA./ atO' �4 , 1. DATUM (MSL)+ TAKEN FROM ....�}YAt�t�.J 1' --------•-QUADRANGLE MAP � OF „MUNICIPAL WATER.... � AVAILABLE - •••_ �. 3. PIPE PITCH: 1/4""PER FORT 4.DESIGN,LOAOtNG FOR ALL PRECA$T UNITS: AAS'HO - )0 •44/ ARNE H' S:MIN.GROUryb COVER OVERALL SEWAGE FACILITIES:.(1) FT., a•,IALA "I 6.PIPE JOINTS SHALL BE MADE WATER MIGHT- v CIVIL /� 7.CONSTRUCTION DETAILS TO BE ACCORDANCE ©LA•WITH COMM.OF MASS. Np "�► SITE f N TATE ENVIRONMENTAL CODE TI.TLE 5 S 'A Of•,y,�Ss LOCUS �-•o"F r 'Q die--t ARNE R' REG.P NALENGINEER• � ' � ^ ��• I 1IALA F0. �- a 48 dowa cape engineering 30 -sr', a:n PREPARED FOR: I } -CI.V,(L ENGNdEERS �$ LAND S(dRVEYORS y z t30ARD OF HEALTH _ '� YOR ExISTING) `•- - A Varmouth:&'Orleans,PLIIa' SCALE _ DATE . I CONTOURS M _ p-0-0 r0—. APPR{JVED ^DATE_ • , - .K ♦ .. ' ♦ `. • r r 1 r ) 1 '4• ''.±W v t a� I'; • ww j