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HomeMy WebLinkAbout0074 COBBLE STONE ROAD - Health 74 COBBLESTONE RD. (BARNSTABLE) A--316-059 i �J Commonwealth of Massachusetts - Title 5 Official Inspection -Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments' - 74 Cobble Stone Rd m Property Address Estate of Dallas Vaughn Owner Owner's Name / n �} information is Bamtable ✓ --_ '+ MA 02630 2-12-16''• required for every p.w - page. City/Town State Zip Code bate 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. , r A. General Information C1# 11.411_7 F, * . 1 Inspector: Shawn Mcelroy Name of Inspector Upper Cape Septic Services r� Company Name P.O. Box 73 Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S 13971 Telephone Number License Number 19 , i .. 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.,)am a DEP approved system inspector pursuant to Section 15.340 of Title.5(310 CMR 15.000).The system: +' ® Passes + ,., .; ❑ Conditionally Passes; n ❑,Fails Needs Further Evaluation y the Local Approving Authority ector's Signature Date The system inspector shall submit a copy of this`in`spection 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. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 I � t, Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 74 Cobble Stone Rd Property Address rt, Estate of Dallas Vaughn Owner , Owner's Name informations required foG very Barntable MA 02630 2-12-16 page. ='r City/Town State Zip Code Date of Inspection a; 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: System is in good working order with no sign of failure. 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 f Commonwealth of Massachusetts '• l Title 5 Official, Inspection, Forni ' Subsurface Sewage Disposal System Form Not forrVoluntary Assessments P 74 Cobble Stone Rd Property Address Estate of Dallas Vaughn Owner Owner's Name information is required for every Bamtable MA 02630 2-12-16 page. City/Town ' State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. Systemwill,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 El 'N ❑ -ND (Explain below): ❑ distribution box is leveled or replaced ❑,Y ❑'N ❑' ND (Explain below): _ yt. f ❑ 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: W I ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet;of ibordering vegetated wetland or a salt marsh t5ins-3/13 P. Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for-Voluntary Assessments 74 Cobble Stone Rd ti Property Address Estate of Dallas Vaughn Owner Owner's Name information is gamtable MA 02630 2-12-16 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2.,System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: r I . ❑ 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 4 ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow t5ins•3f13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection. Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments _. c.. �M sVea 74 Cobble Stone Rd Property Address s Estate of Dallas Vaughn Owner Owner's Name information is required for every Bamtable MA 02630 2-12-16 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) P,Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to dogged or obstructed pipe(s). Number of times pumped: t,.,. ❑,: u ® 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 r - _� 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 �� r ,and chain of custody must be attached to this form j El ® The system isiatcesspool serving a facility with a design flow of 2000gpd- I. 10,000gpd. El ®k 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 _ s 1 ,j necessary.to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to-15,000 gpd. For large systems, you must indicate'either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply I ❑ .❑s , the system is located in a nitrogen sensitive area,(Interim Wellhead Protection Area=IWPA)or a mapped Zone'll 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 u, v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 74 Cobble Stone Rd r Property Address Estate of Dallas Vaughn Owner Owner's Name information is Barntable MA 02630 2-12-16 required for every ' page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ' ❑ . 0 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) ®- ❑ 4 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. ® ❑f 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 Tile 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 i Commonwealth of Massachusetts r 4 r Title 5 Official Inspection' -Form' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments + 74 Cobble Stone Rd Property Address T Estate of Dallas Vaughn Owner Owner's Name information is required for every Barntable t'. MA 02630 2-12-16.1'• page. City/Town State Zip Code Date of Inspection D. System Information Description: ,{ ; Number of current residents: 0 Does residence have a garbage grinder? ' ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection El Yes ® No information in this report.) ` Laundry system inspected? - ❑ Yes ® No Seasonal use? �. .• . ° ' El Yes ® No Water meter readings, if available(last 2 years usage (gpd)): '� •{�` Detail: Sump pump?: ❑ Yes ® No Last date of occupancy: �.; Unknown , Date Commercial/Industrial Flow Conditions: Type of Establishment: f Design flow(based'on 310 CMR 15.203): Gallons per day(gpd) Basis of-design flow(seatstpersons/sq.ft., etc.): Grease trap-present? ❑ Yes El No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system?'. `- • El Yes ❑ No Water meter readings, if available: t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form.-Not for Voluntary Assessments 74 Cobble Stone Rd Property Address Estate of Dallas Vaughn Owner Owner's Name information is required for every garntable MA 02630 2-12-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: N/A 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) (f 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 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments' 11 M , 74 Cobble Stone Rd Property Address Estate of Dallas Vaughn Owner Owner's Name information is Bamtable t MA 02630 2-12-16 i required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) _`a, . : •, Approximate age of all components, date installed (if known) and source of information: 2012 Were sewage odors detected when arriving at the site? r '❑ Yes ® No Building Sewer(locate on site plan):'" { Depth below grade: ' + ' . t 24" feet Material of construction: Cast iron ® 40 PVC ❑ other.(explain):'Ir r , Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Good condition. Septic Tank(locate on site plan): 16, Depth below grade: feet Material of construction: > , ® concrete ❑ metal ❑fiberglass ❑ polyethylene • ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate)' ❑ Yes ❑ No Dimensions: + _ 1000 gal .12n Sludge depth: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage-Disposal System Form -Not for Voluntary Assessments 74 Cobble Stone Rd ; Property Address Estate of Dallas Vaughn Owner Owner's Name information is required for every Barntable MA 02630 2-12-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 20" Scum thickness 1" 6" Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 15" How were dimensions determined? Tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed and no sign of leakage. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle , Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts t ° ' u Title 5 Official Inspection Form := Subsurface Sewage Disposal System Form'-Not for Voluntary Assessments 74 Cobble Stone Rd Property Address Estate of Dallas Vaughn ;�f Owner Owner's Name F - ., information is garntable r `� MA 02630 2-12-16,T- required for every ' page. City/Town Z. 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.): " d it 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: 4 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.): r � i •w.._ n *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection form . Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 74 Cobble Stone Rd Property Address Estate of Dallas Vaughn Owner Owner's Name information is required for every Barntable MA 02630 2-12-16 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 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Good condition with water at working level and no sign of back-up from chambers. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and-appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 f Commonwealth of Massachusetts W Title 5 Official Inspection Ford Subsurface Sewage Disposal System Form -Not for Voluntary Assessments"I • = '1 74 Cobble Stone Rd 9t+ Property Address Estate of Dallas Vaughn Owner Owner's Name information is gamtable` MA 02630 2-12-16 required for every � page. City/Town - State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® Teaching chambers number: 4-cultec 330's ❑ 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.): I . Cultec chamber leach field in good working order and empty at inspection with no sign of back-up into d-box or surrounding stone. 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•3/13 j Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 74 Cobble Stone Rd Property Address Estate of Dallas Vaughn Owner Owner's Name information is required for every garntable MA 02630 2-12-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) •, R Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): ,a Materials of construction: Dimensions 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 Y Subsurface Sewage Disposal System Form -Not for Voluntary Assessments , M 74 Cobble Stone Rd 7 Property Address Estate of Dallas Vaughn t x 'f- Owner Owner's Name information is required for every Bamtable MA 02630 2-12-16> page. City/Town 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 Rack r' i t y • IeY ,.' `F'r. . '1 - + ,� 1. f�►iL 1 .b, r�^ r iJA --0 z,3- C r 7 Y t5ins-3/13 - - Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 74 Cobble Stone Rd .' Property Address Estate of Dallas Vaughn Owner Owner's Name information is required for every Bamtable MA 02630 2-12-16 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: 12 feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: ® Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Original design plans show no groundwater at 12'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M , 74 Cobble Stone Rd Property Address Estate of Dallas Vaughn Owner Owner's Name information is required for every Bamtable MA 02630, 2-12-16 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 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 /02 ` .��� �o✓� Vauq�� 1DepartmWit of Regulatory Services nnw+ernate 4 ]P't_blic'Heafth Division D ate �d 200 Main Street,Hyanuis MA 02601 9 Tate Scheduled_ Tinie FLe Pd.. 6 OV Foil Suitability Assessmteritfor Se) D 'sposal Perfamcd By: �� �'� ��� C Witnessed By: _ 1 ILO CATI ON' & GIEN ERA L INl ORIVI[AT ION / Location Address (2&bj/e' Owner's Name Address Assessor's Map/Parcel: 3/61 9 Cngiueer's Naulc �U w e\ a/e NEW CONSTRUCTION REPAIR Telephone It (J C4) 3601 - I��o �r� Land Use' �C(� Slopes(%) Surface dunes / Distance's from: Open Water Body ✓/ It Possible Wel Areq�'y/�'/__R Drinking Water Well 6�l// . Fl Drainage Way It Properly Una T ' ft Otlier �"T—tt a dimensions of lot,exact locations of lest holes Bc p oleert tests,locate we(lands'1 pronlnUly to Boles))''1<CH, (sheet name, ZZ e CD 70 U -- --^-Pvrcni nia tan a'I"(geo'rog'tc)--_ ( Depth to Groundwater: Standing Water In Hole: Weep11113 fl'um Pit Fliiov Estimated Seasonal High Gioundwater DE T EPJ�UNA7['J[ON I[t OR S EASONA L 1J[][I(E1 WATER TABLE, E, Method Used: Depth Observed standing in obs. (tale: In, Depth l0 5QII izlulllss;,Tr_ IIL Depth to weeping,from side of obs.hole: tll, UrOU11dwltterAdjusiment„_� Index Well 7F Reading Date: Index Well level _ _ Ac�j,flletbP_ AcJ.drt?ulttJwutet'L)�Vul IFERCOLATION TES ball:. A'!u'Im _ V Observation 9J ��1G� 1lolc 1P Tiny nt 4'110� s7 l Depth of Perc 60 Tlu'Ip at U" Start Pre-soak Time @ � Time(9"-6") End Prc-soak Rate Min./Inch 0 x, f Silt Suitability Assessmr:nt: Site Passed_lam Silq,Failed: Additional Testing Needed(YIN) Original; Public Health Divisian Observation Hole Data To Be Completed on Back---- ***If>percolatiou test is to be comiductert vviLiiin 100' of vvelltand, you ➢1➢uYst f➢rslt UOUIFy ltt➢e Mirrist;:able Conservatioll I1j9v1S1411 at least olle (1) Weelc prior to begil➢0.IlQug, QASGPT10PGRCPORM.DOC r, LOG Depth from Soil Horizon ]bole # Surface(in.) Sail Texture Soil Color (USDA).. Soil Other (Munsell) Mottling (Structure,Stones;Boulders, Con iste cY. % ra el DREP Depth from OBERRVATIO HOLD LOG Surface Soil Horizon Soil Hole # (in.) l Texture Soil Color (USDA Soil -- ) (Mttnsetl) Mottling (Ser trucWr0e,l5tones � Consis enc ' •-°tilde,;. `�Qrflve) Gd - REPOBSERVATIONITOLE LOG Depth from Sojl7-loriznn Surface(in.). Soil Texhire Soil Color (USDA) (M Soil unsgil) Mottling (,;tructurOetSlones,boulders. ConsistengY 4a 0 velr�_ -------------- - ._ ------------ ._. .. IIJI]EIE110]?,SIEI[�VAl7C.�0N 1-10 E Depth n. Soil Horizon LOG (I Hole# _ Surface(n.) Soil Tex Soil Color S (USDA)) all., (M Other unsell ) Mottling (Structure,Stones Boulders, — — Consi lenGy °�Orav�11 --_ loll®�d InSauu•ance][date IVgnp. Above 500 year•flood boundary No yes -1Vithin 500 year boundary No With in lwyearnood boundary No� '" ll��p�lt➢>I ®_�'P+la�enfi�l9-y�__e�ufl><a-�_n ][n���iotes P�aterta� Does at beast four feet of naturally occurring pervious material exist in all areas observed thl•oughout the area proposed for the soil absorption system? 8t not, Ja hat is the depth of naturally occurring lervious malarial? �efitll�9��f1ll0n I certify that on (date)I have passed the soil evaluator examination approved by the Department ofEnvlronmental.PI'otection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 3f0 CA0t 15.017, Signature Date Q:1SVTfC�PERCI'ORM.DOC %O OF B STAB L{?C�iQPdU/flb l SEWAGE�# .77 DMTALLER'S N &P$Ioi�E ltitfl s rrc T k CAPACITY - LEAc�m No.:OPBEDPIOOP1I� �BUIL DER QR OWNER PERMITI3.dTE: C{iIi!€FL�AIYC,E I?A�E. arWon DistanccB. ech tbe: Maximum Ad5usted C�ondviraterTatIe to the Borior of Leaching Facility.` feet -Pxivate S�tat�r Supply del}and LeaKl�atg�acdity (�€asty�re�s exist ote s�Ea oc within, t 6 :i"ng fac ic ty) met: Edge of V%�lEtiand and I.eac€ ng#" a'ity((If any st%etiands exist witl is 30o€eet'o Ieiblang rZeet Pti# shed,by s" �, ✓�' �� .e�z_ .D Ul G If ELOf ,r �4 ovi _C 33� .e .3V tom ` TOWN OF BARNSTABLE OCATION 'tl 6no % _ o t�SEWAGE# ILLAGE aidlz-wc ASSESSOR'S MAP&PARCEL INSTALLER'S N E&PHONE NO. —, Jt "nGe On-e 'r SEPTIC TANK CAPACITY LEACHING FACILITY: ) M•4Fk(type;�tz,L�CCir�— (size) NO.OF BEDROOMS ``� — �I P�ro L� '�(� OWNER PERMIT DATE: COMPLIANCE DATE. Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility eet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) N r$— Feet FURNISHED BY �y - _ ��� � ,- „ � p !�a ` ar �G� s f, Tr -- . -;, ,. .. i No. V I Fee V�/ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOW,N OF;BARNSTABLE, MASSACHUSETTS Yes ZippliCatlon for Misposal 6pstem Construction permit 1 Application for a Permit to Construct( ) Repair(W Upgrade( ) Abandon( ) ❑Complete System individual Components Location Address or Lot No. Owner's Name,Address,and Tel.No. cer'r7si-� (+e ®a! cis V,Cu fkn Assessor's Map/Parcel & 66�e y S k (jam 3210 Installer's//Name,Adl�dress,and'T,el..LNo. JrUg �.��/ J� Designer's Name,Address,and Tel. o. 6;-* �E"'�lo°�"q �Qr+s'�'fi�'t'etcl �S-�.r¢[(l�'�ice• .C�C7WE7 � GY�iI?E'�t1'/� 9��1�'/2�12�i�" Type of Building: �- Dwelling No.of Bedrooms 3 Lot Size .`I 3 J6 42� '/ sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures l Design Flow(min.required) ,330 gpd Design flow provided J q{ gpd Plan Date L, )a- Number of sheets 1 Revision Date Title _ ' d?h/ e 1f/� Size of Septic Tank ' ' Type of S.A.S. -pb zk5o Description of Soil Nature of Repairs or Alterations(Answer when applicable) k)e-W i y Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental a and not place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date Application Approved by Date ''2 '�j C— 1 Application Disapproved by Date for the following reasons Permit No. �'( Date Issued r ^f No. C)V . , f Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OFBARNSTABLE, MASSACHUSETTS Yes RppYication for Disposal p tern Construction 3pernut Application for a Permit to Construct( ) Repair(to'Upgrade( ) Abandon( ) Complete System ('Individual Components Location Address or Lot No. /7 CV&bbje Owner's Name,Address,and Tel.No. j Q$-3 QG-- oS,j 9 Vuvji-n3cr 7 0-0 '&SVAssessor's Map/Pazcel � �( (� ©a ta s c �rn CJ�lo Installer's Name,Address,and Tel.No. 5U�^ i9y)/—g3 f Designer's Name,Address,and Tel.No. 60r' a/o�l ear?s-4-ri�w,\ 044 c nn 4 Type of Building: I Dwelling No.of Bedrooms 3 Lot Size (/3 5(A sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 9 3U gpd Design flow provided / gpd Plan Date ap Number of sheets ! Revision Date Size of Septic Tank a Type of S.A.S.&I i4-a, Description of Soil �16 Nature of Repairs or Alterations(Answer when applicable) _ S t Ylcz : C . , 411 Date last inspected: Agreement: ! 1 { The undersigned agrees to ensure the construction and maintenance of the afore desc i d on-site.sewage-di`sp sal,system in accordance with the provisions of Title 5 of the Environmental Code`and not to-place the system in operation until a Certificate of Compliance has been issued by this Board of Health. r Signed Date •��.. Application Approved by Date f:7 Application Disapproved by Date for the following reasons Permit No. CDC) •� o�'`1 Date Issued '30 ~ f 1-- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ), Repaired(� Upgraded( nn ) Abandoned( )by ✓'Y C �� �C 4_ jl� at � Lt), /� ,,o � f/y W� has been constructed iri accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.,,�o Installer t--4,01,0it2 C Designer e Lv-, #bedrooms 2 Approved design flow �'� gpd The issuance of this permit shall not be construed as a guarantee that the syste will function d s ned. Date Inspect Ou No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS s osal 6pstem Construction permit Permission is hereby granted to Construct( ) Repair(W Upgrade( ) Abandon( ) System located at �O n ro and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. � f � /2 l Date � '3 y` 1�--- Approved by AUG-09-2012 10:11 From:BORTOLOTTI CONST 5084289399 To:15087906304 P.1/1 FROM :down cape engineering ir1G FAX NO. :15 629980 Aug. 09 2K2 10:11AM P1 r` as�r +noses. Phui tfk Readdh NvilliOlu �;•x4;76;rAll� Y 20U 1i9rizt St8'�ct,1�1 y"uwt�9, 1r+'b 4 02601 ^a-,c SUR-190-6"IN IpTa��n�lEr� Ili ran m�; _tts3d a�' l �6 okm- ][D;U�e: ' ,�tieea��a�; !I'r�'atnn4 (�l � �� ' /6Jt�i� @c{1V•'A ld�sal�rlk'�3�K.il. �� J[Dr.5n;anlen t� D�!.� A;���x►�Aa`a': adda 21t�a�i9ip �,, &U A.ddrW: , /* (awa11C7T) st;Pbo xy'tifx`1i? ('gams) deei T m f if r [but Hari mpL-O VS'M-M re-rerQu(,r:ct eDnve way x�ust�l1ar.1 ;u sCr�.nri.a111y e.cnordlrK t0 IhQ d,esip, Wlkh May i7,r:l11d�e MblO lipprovtd, changes ulloll Ev, lwti,r;'rw,l a:el()r, t ur1.0 fihe di,ciTibiLhkrzc box Fa Blur sel tic tack. I er•,Ltify Cli+t the ,:, aixr. ,gyotam 7k.[l c' Lt'r ri ,'Hive; wu:� it M,lled viri h .:PAiOr c:,h-ma;;r,9 s�t�r titian lU'-iFtet`81 ri110WHOn of the 5,AZ gr.lny ve'rtiCr(r-elur,;ALun Ofally e.-u4lonviit of tktr s_ �►ri� sy �.r ) huL ix�arna:rdrlr�cv .nth Stan r T.c��;tl R�( 1lvtioxis. ?Intl 7"V,440.ui, rr1 ' ie�l�s bijiI,L by daaif;uw to t IOW UJALl� (IuSt .JCr's u1,17riL ra.) CMI. A No.4T'02 N �ae� t� ir%.TA►1�r" ' a( ,', Ba„ t >7 1`) TJT7�jF�, rt TM8 1,1�AN),) T1L]' Q' It � AL��! n u 1>�¢.,' 1RAXPETf,D T.UC i�u�,� y, vr. (AZ�i. ; 4 1M YQIT- Fr` , COMMONWEALTH OF MASSACHUSETTS ` EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS . DEPARTMENT OF ENVIRONMENTAL PROTECTION j F i tC� t•.P� f 11� `` r „I •.sr TITLE 5 IfrOFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS *F SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM �5 ' PART A CERTIFICATION ~ x i Property Address: 74 COBBLESTONE RD BARNSTABLE,MA 02630 �ku-0S Owner's Name: MR.HERBERT tr. Owner's Address: 74 COBBLESTONE RD BARNSTABLE,MA 02630 Date of Inspection:3/2/01 t �51,r Name of Inspector: (please print) JOHN GRACI .€ SEPTIC INSPECTIONS ``( Company Name: : Mailing Address: i.igtP.O..BOX 2119 TEATICKET,MA.02536 a E L Telephone Number: 508-564 6813!FAX 508-564-7270 t ��•.i CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and . , t' experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system 4,•;' i inspector pursuant to Section 15.340_of Title 5(310 CMR 15.000). The system: , X Passes h _ Conditionally Passes _ Needs Furth :Evaluation by the Local Approving Authority Fails Inspector's Signature: ' Date: 3/2/01 The system inspector shall submi copy of this inspection report to the Approving Authority(Board of Health or DEP)within,, ,;� ,i. , 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments `, • -KI THE SYSTEM PASSES TITLE V INPECTION.RECOMMEND PUMPING SYSTEM NOW AND EVERY ONE YEAR ; TO PROLONG THE SYSTEM'S,USEFULL LIFE. f ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This ,e inspection does not address how the system will perform in the future under the same or different conditions of use. .i.t5 75 a. (i •Ct`< ss Page 2 of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A }` 'f< CERTIFICATION(continued) Property Address: 74 COBBLESTONERD BARNSTABLE,MA 02630 ;'< Owner: MR.HERBERT Date of Inspection: 3/2/01 .., Inspection Summary: Check A,B,C,D or.E/ALWAYS complete all of Section D �•`; ti tt A. System Passes: . X I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 • •.4;:1 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. F y Comments: THE SYSTEM PASSES TITLE V INPECTION.RECOMMEND PUMPING SYSTEM NOW AND EVERY ONE YEAR TO PROLONG THE SYSTEM'S USEFULL LIFE. B. System Conditionally Passes: A _ One or more system components'as described in the"Conditional Pass"section need to be replaced or repaired.The system, upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND) in the for the following statements. If"not determined"please explain. n/a The septic tank is metal and over 20 y°°ears old* or the septic tank(whether metal or not)is structurally unsound,exhibits s substantial infiltration or exfiltration or tack failure is imminent. System will ass inspection if the existing tank is replaced Y P P g P �•,,.f`l i 4 3 i 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: n/a '± x.a n/a Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed t'# 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: n/a n/a 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 Boara of Health): _broken pipes)are replaced _obstruction is removed x 4 { x ND explain: n/a 7 Page 3 of 11 f OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM r PART A CERTIFICATION(continued) Property Address: 74 COBBLESTONE RD BARNSTABLE,MA 02630 Owner: MR.HERBERT Date of Inspection: 3/2/01 " e 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 oft°Health determines in accordance with 310 CMR 15.303(l)(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 41 , v t. 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the :'2 system is functioning in a manner that protects the public health,safety and environment: "3 _ 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 sur'faee water supply. _ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. t _ The system has a septic tank'an'd 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 n/a "*This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and ��{ volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equa!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. 04, 5:, { +;t 3. Other: ; s n/a 3 . a. `?s; .1 f '� e Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS ` SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) + Property Address: 74 COBBLESTONE RD BARNSTABLE MA 02630 Owner: MR.HERBERT ft# . Date of Inspection: 3/2/01 >x�; D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all-inspections: , Yes No }Nt,'; 4 X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ondin of effluent to the surface of the round or surface waters due to an overloaded or clogged a, - g P g g gg SAS or cesspool x - X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool Y' - X Liquid depth in cesspool is less than 6"below invert or available volume is less than''/2 day flow - X Required pumping more than 4 times in the last year N LT due to clogged or obstructed pipe(s).Number of times pumped SUMMER 00., - X Any portion of the SAS,cesspool or privy is below high ground water elevation. - X Any portion of cesspool or'privy is within 100 feet of a surface water supply or tributary to a surface water supply. s - X Any portion of a cesspool%privy is within a Zone I of a public well. M1; - X Any portion of a cesspool or`privy is within 50 feet of a private water supply well. ' - X 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 coliform bacteria and volatile organic compounds indicates that the well is free 3 from pollution from that facility 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 'k attached to this form.] V n. (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 3 to =u 1 CMR 15.303,therefore the system fails.Th"(system owner should contact the Board of Health to determine what will be necessary to correct the failure. ls� . E. Large Systems: f' To be considered a large system.the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: i (The following criteria apply to large systems in addition to the criteria above) 4 { yes no - X the system is within 400 feet of a surface drinking water supply ;t X the system is within 200 feet of a tributary to a surface drinking water supply 4? k{ u - X 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 f 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. d Page,5 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS :. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Y y. Property Address: 74 COBBLESTONE RD BARNSTABLE,MA 02630 Owner: MR.HERBERT Date of Inspection: 3/2/01 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health _ X Were any of the system components pumped out in the previous two weeks? X _ Has the system received'normal flows in the previous two week period? z. X Have large volumes of water been introduced to the system recently or as part of this inspection? 1 . 4' _ X Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up? X _ Was the site inspected for signs of break out? s X _ Were all system components,excluding the SAS, located on site? X _ 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? ry � , l X _ 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: Yes no _ X Existing information. For:example,a plan at the Board of Health. : { X _ 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(3)(b)] ± ? i v a 4 ' ♦'l 5 Page 6 of 11 4 . OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 74 COBBLESTONE RD BARNSTABLE,MA 02630 Owner: MR.HERBERT Date of Inspection: 3/2/01 FLOW CONDITIONS RESIDENTIAL Y .. 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 Number of current residents:3 Does residence have a garbage grinder(yes°or no): NO '6 Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no): NOt,, Seasonal use: (yes or no): NO ;r,' 'j Water meter readings,if available(last 2 years usage(gpd)): n/a j Sump pump(yes or no): NO Last date of occupancy: n/a COMMERCIALANDUSTRIAL K :1. Type of establishment: n/a Design flow(based on 310 CMR 15.203): n/agpd Basis of design flow(seats/persons/sgft,etc.): n/a Grease trap present(yes or no): NO Industrial waste holding tank present(yes or no): NO Non-sanitary waste discharged to the Title 5 system(yes or no): NO Water meter readings, if available: n/a Last date of occupancy/use: n/a R OTHER(describe): n/a GENERAL INFORMATION s°} Pumping Records '' Source of information: SUMMER 00 ."'t Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: n/agallons--How was quantity pumped determined?n/a Reason for pumping: n/a li TYPE OF SYSTEM X Septic tank,distribution box,soil absorption system . , _Single cesspool _Overflow cesspool _Privy F :i 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 ".},t system owner) _Tight tank Attach a copy of the`DEP approval Other(describe): n/a f Approximate age of all components,date installed(if known)and source of information: 1985 i t Were sewage odors detected when arriving at the site(yes or no): NO e Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS r= SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) t Property Address: 74 COBBLESTONE RD BARNSTABLE,MA 02630 Owner: MR.HERBERT Date of Inspection: 3/2/01 BUILDING SEWER(locate on site plan) Depth below grade: 18" { ={ Materials of construction:_cast iron;_40 PVC Xother(explain):20 PVC Distance from private water supply well or suction line: n/a Comments(on condition of joints,venting,evidence of leakage,etc.): TOWN WATER - r SEPTIC TANK: X(locate on site plan) Depth below grade: 12" ' Material of construction: Xconcrete_metal_fiberglass polyethylene other(explain)n/a ytJ� If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes:or no): NO(attach a copy of certificate) Dimensions: 1000G L 8'6" H 5' 7"W 4',.10"" Sludge depth: 1" ail Distance from top of sludge to bottom of outlet tee or baffle:33" Scum thickness:0" - r ary : . ,u� Distance from top of scum to top of outlet tee,or baffle:6" ;t.Y4 Distance from bottom of scum to bottom of'outlet tee or baffle: n/a How were dimensions determined: MEASURED Comments on pumping recommendations inlet and outlet tee or baffle condition structural integrity, li uid levels as related ( P p g q „ 1-6. to outlet invert,evidence of leakage,etc.): THE SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND.RECOMMEND PUMPING rift .':1'.:+4•a NOW EVERY TWO YEAR TO PROLONG THE SYSTEM'S USEFULL LIFE ' . i yt`lku 3 GREASE TRAP:_(locate on site plan) Depth below grade: n/a, Material of construction: concrete metal fiberglass_polyethylene_other(explain): n/a _ Dimensions: n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a `s Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping: n/a �Y E Comments(on pumping recommendations`,,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.) n/a t �f f is Page 8 of 11 i OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(contirued) Property Address: 74 COBBLESTONE RD BARNSTABLE,MA 02630 Owner: MR.HERBERT Date of Inspection: 3/2/01 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) I; Depth below grade: n/a Material of construction: concrete metal. fiberglass_polyethylene_other(explain): n/a b ". Dimensions: n/a Capacity: n/a gallons Design Flow: n/a gallons/day ar Alarm present(yes or no): N/A i. Alarm level: N/A Alarm in working order(yes or no): NO Date of last pumping: n/a Comments(condition of alarm and float switches,etc.): n/a DISTRIBUTION BOX:_(if present must be opened)(locate on site plan) I i Depth of liquid level above outlet invert: n/a 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.): n/a PUMP CHAMBER:_(locate on site plan) Pumps in working order(yes or no): NO `+ Alarms in working order(yes or no):NO "r Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): ;.K n/a q1F. i. r4L 1e[{1•3 { r 1 n Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS , SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) l Property Address: 74 COBBLESTONE RD BARNSTABLE,MA 02630 ai< Owner: MR.HERBERT Date of Inspection: 3/2/01 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: n/a y Type 1000 GAL 6' X 6' leaching pits, number: 1 n/a leaching chambers, number: n/a n/a leaching galleries, number: n/a n/a leaching trenches, number, length: n/a n/a leaching fields, number: nla n/a overflow cesspool, number: n/a n/a ;t-innovative/alternative system }..; ,.,Type/name of technology: nla • ��:Y v'Sid ";A Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.): THE LEACH PIT IS STRUCTURALLY SOUND AND APPEARS TO BE FUNCTIONING PROPERLY.THE PIT HAD 611OF LEACHING LEFT AT THE TIME OF THE INSPECTION. CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) '}. Number and configuration: n/a Depth—top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer: n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater inflow(yes or no): NO Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a PRIVY: (locate on site plan) Materials of construction: n/a '. Dimensions: n/a Depth of solids: n/a Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): } i n/a '� t 2 g. Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS x. . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) ' Property Address: 74 COBBLESTONE RD BARNSTABLE,MA 02630 Owner: MR.HERBERT F Date of Inspection: 312/01 SKETCH OF SEWAGE DISPOSAL SYSTEM Y 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. i� }r± A 61x t f lar p b rT � • 'jj¢i •'•�, _ A AC BA :k� z ,fk �n Page l l of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 74 COBBLESTONE,RD BARNSTABLE,MA 02630 Owner: MR. HERBERT t; . Date of Inspection: 3/2/01 • i, SITE EXAM , _Slope _Surface water _Check cellar _Shallow wells { Estimated depth to ground water 12+feet Please indicate(check)all methods used to determine the high ground water elevation NO Obtained from system design plans on record-If checked,date of design plan reviewed: n/a NO Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a NO Checked with local excavators, installers-(attach.documentation) YES Accessed USGS database-explain: n/a You must describe how you established the high ground water elevation: USGS MAPS AND CHARTS- 12+FEET , ' d - r "V; fr , ,l1 s F { t i ; TOWN OF BARNST LE II ,, o L6? ATION qQ SEWAGE # VILLAGE ASSESSOR'S MAP& LOT 1' c/' F�- INSTALLER'S NAME&PHONE NO. ' SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: 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 r /+ C PA Ml `- ' � t e -7y 8' 10N SEWAGE P W LA C.A.T PERMIT NO. C'o�QCc I ayc 'o VILLAGE �fJ.M /�►oa 4�s� I N S T A LLER'S NAME & ADDRESS �b���l �19 e./O i9/j t� �f 9 ��- � �X C A y•3T�e�l G ,S R UILDER OR OWNER N C�- 'C o s r v.o C g9 r 7'e 1� I ��.d►;�s 40 .. DATE PERMIT ISSUED DATE CO-MPLIANCE ISSUED g r - C v Q( e S TO ®� y6 tr 4 PST 3,3 Fi i THE COMMONWEALTH OF MASSACHUSETTS f BOARD OF HEALTH W.t"1................OF....... ,J0.c'Y�50.bI e Appliratio' n__for Disposal Works Tonstrurtiun Vrrntit Application is hereby made for a Permit to Construct (X) or ;Repair ( ) an Individual Sewage Disposal System at: - i e. Sine,_ Lot 82 Pl. t31�, 3G-1 ... -.fib --• --•-- ...... �:�•-•--------------•....•-----...... ----...----•-•-----...._.�_..._........ Location-Address or t No. WA�.Q. .�_ C....---•-•• ............................................... ...... �`v nt.s. QQR -- .................... W Owner ¢ Address a .............................•-•-...._.........-•---......•-•-•----._..._._.........------..... --••••---•------•--••---......._.......-------------•------••---••----••-••--•:..---•-............ • Installer Address Type of Building Size Lot.. ?a5 �.i Sq. feet , .-� Dwelling—No. of Bedrooms......�................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building ............. ...... No. of ersons__.........._............... Showers --Cafeteria a YP g .-...---- Cafeteria ( ) Other,fixtures . ----------------------•----... = --....----•---......---.....-•-•-•-- ............................................................. W Design Flow.......... 5..........................gallons per person per-day. Total da lyZ�iow.._.....�.30-.......................gallons. WSeptic Tank—Liquid'capacity.I o0o gallons Length---.....�:_--.. Width;A..._..... Diameter................ Depth.... .......... Disposal Trench—No..................... Width......---.--_ Total Length Total leachingarea.................... ft. x o e g �3-� q• 3 Seepage Pit No.......t.....:... Diameter...............Depth below inlet-....-..---: J:.. Total leaching area.S4'a:ri.n._4. C7'D Z Other Distribution box (X) Dosin tank ( ) a Percolation Test Results Performed by... -:..Fal !?a!'� ._,j._ :.e..... ....._. Date...S l"1 e2- ..._.�....... ...--•-•-•---•---..... Test Pit No. 1....:!�%�..minutes per inch Depth of Test Pit...).56._r�._. Depth to ground water.... ...y�.ati„S� M-i Lj. Test Pit No. 2................minutes per inch Depth of Test Pit-..AC.8.�... Depth to ground water..... ...1Z.tnCQ.Q Tere� x 1�03 '= 1a : -- ....-•----.. .. ..:"......................................................... Description of Soil.....--- e off- 4 � ..... c.�'Z_... ..... ...........................................•--•-- . U ------------------------------------------- ...------------------------- ......_... ---------- .....---•---•-----•-•-----..... ---.------•-•-•------------•• ---_........ ............. VW ....................................................................................................................................:..............................:.............•---..._.............. 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 LITL; 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b tdob he board of th. t ✓� Y k Si ned.... � �T� Application Approved BY - .. Dace Date Application Disapproved for the following reasons:---...-•.................•-•--•-----................--•--....._._............._....... .............. . ........-•-•--•....................................•-----•...........----•-•--•--•--•--•.......----•••.......••••-•-•--••--.......................-•---.....-----.........•-----......................._ Date PermitNo......................................................... Issued.................................................... Date NO....g lrEs.... ,.. THE COMMONWEALTH OF MASSACHUSETTS �9 BOARD OF HEALTH c�VJ:1...................OF.....::1Jc....".t1S-................. r Applirtttiun for Uiupu,ittl v' rk.5 Tonstrurtiun Permit Application is hereby made for a Permit to Construct (x) or Repair '( ) an Individual Sewage Disposal System at: . Pq.�.No. �- Location-Address oa�rt ...... ...........................•-•-•--.._. . ,� s W Owner Address ,.a ..................................................------------------------------------------------ -•--•••••••----.......•-----..._.._._.......-••--••••••--•----.....----•-•�....+..........•- Installer Address Type of Building Size Lot..` 3��....$._Sq. feet .-� Dwelling—No. of Bedrooms.._._.�� ........................ ............Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Buildi a Other—Type tl=g ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) d Other fixtures WW Design Flow.........S5..........................gallons per person per,day. Total daily flow...... .............gallons. WSeptic Tank-Liquid capacity!ouo gallons Length._�- ?_. Width:.4_r?.. Diameter---------------- Depth.. ........ x Disposal Trench—No. ............... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.......I............ Diameter......1.9..e -Depth below Total leaching area.5A"...sq:-ft. G Q Z Other Distribution box (X) Dosing tank Percolation Test Results Performed by.... Date.__`J!.�� 82 a - --•------•- •........... ,.a Test Pit No. 1....! •:..minutes per inch Depth of Test Pit... -�-'aSP...... Depth to ground water..... . GZ. Test Pit No. 2................minutes per inch Depth of Test Pit.... Depth to ground water....................�....�. p ........................._......---.•_. ............._..: _...._..........._ ... O Description of Soil..... .. 11 V ................. - ---••• •_••-• -.........- -• -•.........................•---................._..................... ....... .....••--- ..... .-- U�l ........--•.............•--•••--•••----•••-•---•---••--•---•-••----••---•-•-----•••-•••...-----•-•••--•••-•-••--•••••-•-..................------••..................................................... 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 TITLZZ 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance ha�.b��b he board of th. >\ Si ned... ,l9 4 --Ill)aw......... .•................. 1 ........... Date, p_l a,,,• Application Approved By... ----------------------------------- -------------------- -••-•-------.------ - Date i Application Disapproved for the j ollmbing reasons:...............................................................•--------.....----•••....._......_............... ...................•---...........------......--••••---••._.......--•----------- •--•-----•--...---•....••---...............................-•----•-••--•...a................................. Date PermitNo......................................................... Issued........................................................ Date —-.,<.—..--..— — .,s..-- .a.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF................................................................................... (Irrtif irat a of Tamplittnrr 15 THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by.................. ....•---••-•••-.................•--•-•....._........---..... .....---•--••••-•••••....•------•-•-----•------------•-----•--••--•••.............--•---.................... Install°er at. �=---------- r s_........._y'.__...._,:rix�- ✓.......................................................................... has been installed in accordance with the provisions of T "'IE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit .............. dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE......... l�.-�I ...... ......- . Inspector.A .......................•-•--•--•--•••---•-----••-......................._. � a F THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF....:................................................................................ . No... ...`�:..�:q. F .......-•--.......... . �is�ru�tt1 ur�u �unu�r�tr#iun r��erutii Permission is hereby granted........................................................... ...................................•---------•-•-------••---................•...... to Construc ( ) or Repair L ) an Individual Sewag Disposal System at No.. lJrs_ cev. •••. .... ................................................. Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... Board of Health DATE F. .SECTION SEWAGE - - -SEPTIC TANK - - "D"BOX - - LEACH PIT }" TOP OF FDN (MSL)x -"2"OF NeTO 1/2" WASHED STONE o tN- OUT r IN- 1000 OUT• IN- G ELEV. S'1.92 TANK //+++ y ! TH• ELEV. ELEV. 60 ELEV. 8'7.4-7 8'7.3a 81.oG� 6 ELEV. ELEV. ELET / 2 Fes-r I 01 Z !p l � — L •.Z . OF 3/4"•14z" k-j r WASHED STONE ! TEST HOLE LOG I ¢ ;,L4 ti! a, TH•#► Zo ,: ��� q2 + 0 m n t, �' 'TEST BY �.Fg►r1n - ,. . Giorc^, B•H-D. O 1,.'a1�47 + _g=�' J.,s.r TEST DATErJ 1 82 WITNESS 3 ' SE'I'V. a DESIGN BEDROOM HOUSE f- j �m31� n,;� oboe \\ q0 T.H. 1 T.H. +� 2 oe 'U �,. —A4 ELEV. ELEV. + __ ___•- , IOaPn _ « 9c.5 lo�m 91.0 PERC RATE C2- MIN/IN. DISPOSER DISPOSER `'.• qr- �. m •` 30 ce4h 88.0 31 88•S FLOW RATE 330 (GAL./DAY) 30 I, s f�e SEPTIC TANK 33o x (IS)_ 9S '''`-� �U) / \ �•�\, 6o slit'! 85.5 N Sand 85 5 REQ'D SEPTIC TANK SIZE 1►7 �gGo / �s" ox�a 84 S J �-- � 0 „ hard LEACH FACILIT CD LoT 82 -� JOB 81•S SIDE WALL�I o 1Y�Co = 1a8.5 1.2 Ir \ *I� Sa clean (Z•S ) = 4'� G/D. r oX;t a me BOTTOM la r78:5 I l,o) s '783 G/D. m -__ 132 me� ' '79.5 sand TOTAL CC, USE: ©NE LEACHING P %T a I r ND WATER ENCOUNTERED NOTES: (UNLESS OTHERWISE NOTED) y p 36 - .......... 1. DATUM(MSLY TAKEN FROM.___Y�7:-N��C�.`. QUADRANGLff MAP sal+`� yA" ��ya'� 5�p LO 1J 2.MUNICIPAL WATER..__ _ __.t-',>-_-_________________AVAILABLE SQhd � .ASS � �F 3. PIPE PITCH: N"PER FOOT V 4. DESIGN LOADING FOR ALL PRE-CAST UNITS:AASHO-�_0 -44 act'- E3'I'O � ARNE H. I S..MIN:GROUND COVER OVER ALL SEWAGE FACILITIES: (1) FT. clean � t/' - --Q---DISTANCE AS CERTIFIED ' 6.PfPE JOINTS SHALL BE MADE.WATER TIGHT n+Ed• OJALA fig 7.CONSTRUCTION DETAILS TO BE ACCORDANCE WITH COMM.OF MASS. smnd CIVIL STATE ENVIRONMENTAL CODE TITLE 5 w�t�l No. 30792 -« SITE PLAN �N OF /�� LoT a -}+- GoaeL_e -3TO1,je ' Some (', '�f,�+l 4 �@ ������ LOCUS: �O. f SI•on � a RNF_ ��?�� B A�tl STABLE MASS. ' RE L ENGINEER 14a— ']9•17 I iU 0JALAA �� REF: PLA PJ BK. 3�r7 , PG. '74 • 1 _26348 } down cope evinee�iaff PREPARED FOR: F W A LT E 25 CIVIL ENGINEERS � C/s Eu. LAND SURVEYORS BOARD OF HEALTH 926 Mpin SL R ANOJ R CONTOURS (PROPOSED)-0-0 O-O- APPROVED DATE > MA I F ACLNSTf1B� E SCALE 4 s" i2 S —,-- DATE 8` '- ---- --- _ - _ _ ALLISYSTEM SHALL SYSTEM PROFILE MARKED D WTHCMAGNETICTTAPE OR BE i NOTES PROVIDE AS REQ'D, MIN. 20" DIAM. WATERTIGHT"` (NOT TO SCALE) COMPARABLE MEANS FOR FUTURE LOCATION. ACCESS COVERS TO WITHIN 6" OF FIN. GRADE .1 DATUM IS APPROX. NGVD PROVIDE INSPECTION PORT TO WITHIN 3" OF FINAL GRADE � a TOP FOUND. EL. 89.3' 2. MUNICIPAL WATER IS EXISTING \ MINIMUM .75' OF COVER OVER PRECAST 27o SLOPE EQUIRED OVER SYSTEM 85.0' V oute 6 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. PRECAST H-10 RISERS (TYP.) 4. DESIGN LOADING FOR ALL PROPOSED PRECAST �' m 2* 84.25' 4"OSCH40 PVC 2" DOUB�F WASHED PEASTONE UNITS TO BE AASHO H-JQ *, PIPES LEVEL 1ST 2' OR GEOTIf ILE FABRIC 82.5 5. PIPE JOINTS TO BE MADE WATERTIGHT. Gro 0 '+• '•L' TEE EXISTING10- SEPTIC TANK** TEE \82.85,±* o o00 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE � �o� o Locus 82,0 o WITH 310 CMR 15.000 (TITLE 5.) o �� GAS BAFFLE °og0g�gogo° \c�� gra9g5 y a go 2' 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND Qr 0 .: •.a': 82.17' 82.0' oog'oo 0�8 80.0 NOT TO BE USED FOR LOT LINE STAKING OR ANY OTHER PURPOSE. ;.. ':, ....,:..; .•,j,.. :. :: . .:•.- ::.......: '•: 6" MIN. SUMP H-20 3050 INFILTRATORS a 12" MIN. INT. DIM. 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. 3/4" TO 1 1/2" DOUBLE WASHED STONE 6" CRUSHED STONE OR MECHANICAL 9. COMPONENTS NOT TO BE BACKFILLED OR COMPACTION. (15.221 [2]) _ OVERALL DIMENSIONS TO OUTSIDE OF STONE: 30.4' X 10.25' CONCEALED WITHOUT INSPECTION BY BOARD OF 6.5' HEALTH AND PERMISSION OBTAINED FROM BOARD (ZA_% SLOPE) OF HEALTH. 10. CONTRACTOR SHALL BE' RESPONSIBLE FOR FOUNDATION- EXIST. SEPTIC TANK 20' D' BOX 2' LEACHING CALLING DIGSAFE (1-888-344-7233) AND LOCUS MAP FACILITY VERIFYING THE LOCA11ON OF ALL UNDERGROUND & *THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL ** OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF INSTALLER SHALL CONFIRM MINIMUM SEPTIC TANK SIZE AT BOTTOM TH-1 & TH-2 NOT TO SCALE UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS 1000 GALLONS AND ITS SUITABILITY FOR RE-USE. REPLACE NO GROUNDWATER FOUND 73.5 WORK. PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM WITH 1500 GALLON SEPTIC TANK APPROPRIATE TO SITE 11. ANY UNSUITABLE MATERIAL ENCOUNTERED ASSESSORS MAP 316 PARCEL 59 CONDITIONS IF NOT SUITABLE SHALL BE REMOVED 5' BENEATH AND AROUND THE PROPOSED LEACHING FACILITY. 12. EXISTING LEACHING FACILITY SHALL BE PUMPED AND REMOVED OR PUMPED AND FILLED WITH CLEAN SAND. �,ao SYSTEM DESIGN: GARBAGE DISPOSER IS NOT ALLOWED 4.67 \ DESIGN FLOW: 3 BEDROOMS ® 110 GPD = 330 GPD I cL� USE A 330 GPD DESIGN FLOW 224•90• SEPTIC TANK: 330 GPD (2) = 660 RE-USE EXISTING SEPTIC TANK** " TEST HOLE LOGS _ 85.05 LOT 82 S97 LEACHING: 43,568t S.F. H. OJALA PE, SE / 8g Mas.22 SIDES: 2 (30.4 + 10.25) 1.85 (:74) = 111 GPD ARNE ENGINEER: ' \ BOTTOM 30.4 x 10.25 .74 = 230 GPD WITNESS: DON DESMARAIS, RS /a8cp 84.9910 DATE: 7/20/12 7.42 TOTAL: 462 S.F. 341 GPD GRAVEL 87.45 <5 MIN/INCH Q ' x87.03 PARKING \ 81 x90.57 USE (4) H-20 3050 INFILTRATORS PERC. RATE _ '\S w-- w pAveo DRIV" �F86 9 90� WITH 1' STONE AT ENDS AND 3' AT SIDES CLASS I SOILS p# 13700 Ilk �85.29 53 w 93.s4 x 88.09x ■86.i 5 1i. \w\ s . s i- cP� .as.os 69 `- as. s w\ �� i 6a 86 0 o ELEV. ELEV. h �� 30. 16. OAK 5.90 a8\ 4 s7,a AST. DWE DECK x 8 .69 Q 84.8 Q 84.5 V \ ` °4.25 " 5.31 85.6286 8� A A ' M `\ OP FNDN. 89.27 85 4 2 OULDER 87.04 MA LS LS p 89'3 TM 1 APPROVED DATE BOARD OF HEALTH tt 4„ 10YR 3/2 4„ 10YR 3/2 85.6, 6.e7c\ 84.84.07 4.92 4s5 ry I � �---ass 93. a IRCH � B B N 83.68 -83 �� �6 TITLE 5 SITE PLAN LS LS I u SHED e4.76 9 \ a Q 83.39 oA x 85.89 OF 30" 10YR 6/6 82.3' 30" 10YR 6/6 82.0' 4" 84.56 89 S 185.85 00 0 74 COBBLESTONE ROAD x 84.55 BARNSTABLE (VILLAGE) C C BENCHMARK: USE TOP PERc I FNDN. AT EL 89.3' x84.03 PREPARED FOR 186.30 COMs Ms , BORTOLOTTI CONSTRUCTION/ COMPACT COMPACT /86.15 D. VAUGHN x 82. 4 2.5Y 7/4 2.5Y 7/4 220.40' x84.,2 JULY 24, 2012 ��'6 OF Mgssq N OF M S c off 508-362-4541 132 73.8 132 73.5 q fax 508-362-9880 " " ��` DANIELA. c DANIEL yG� downcape.com o OJALA O ALA NO GROUNDWATER ENCOUNTERED CI 'II- I I�� �8� down c4#*e engineering, INC. i 02 q 61��STE�ti `p°�.SS\ ` � civil engineers Scale: 1 = 30 1s ��,,. ` tr��No,�,� � / -� land surveyors y . 939 Main Street ( Rte 6A) 0 15 30 45 60 75 FEET DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675 2- > 85 z