Loading...
HomeMy WebLinkAbout0134 COUNTRY CLUB DRIVE - Health (2) ��l�r2�'TF4�.✓ qi Ms � a 91,0134 Country Club Drive 50"017 Barnstable i a i I i i Commonwealth of Massachusetts 3 50 - 01 - Title 5 Official Inspection form a Subsurface Sewage Disposal System Form- Not for Voluntary Assessments.- 134 Country Club Drive, CumAaquid"1 M -350• P'- 17-4 Property Address I" Ralph & Kathleen Campanelli Owner Owner's Name information is i 7..a required for every P.O. Box 1977, Duxbury. MA 02331 October 4, 2018_, page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be alteretl,'.in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information on the computer, Troy Williams use only the tab y key to move your Name of Inspector cursor-do not Troy Williams Septic Inspections use the return Company Name - key. 19 Hummel Drive Company Address South Dennis MA 02660 _ Citylrown State Zip Code I (508) 385- 1300 S1682 --- Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 16.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® 'Passes 2. ❑ Conditionally Passes 3. ❑ .Needs Further Evaluation by the Local Approving Authority, 4. ❑ Fails October 4, 2018 _ Inspector's Signatures Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. f e Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/2 61261 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts Title 5 Offi 'a"I Inspection-'Form., la Subsurface Sewage Disposal System Form Not for Voluntary Assessments -�� 134 Country Club Drive, Cummaquid M-350 P- 17 Property Address Ralph & Kathleen Campanelli Owner Owner's Name information is p O. Box 1977 Duxbu MA 02331 October 4, 2018 required for every , ry — page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System meets minimum standards set by Massachusetts DEP at the time of inspection only.This inspection is not a guarantee or warranty on the future working conditions of leaching, pipes, components or the future structural integrity of said components and only represents conditions found at the time of inspection only. 2) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 134 Country Club Drive, Cummaquid M -350 P- 17 Property Address Ralph & Kathleen Campanelli _ Owner Owner's Name information is P.O. Box 1.977, Duxbur MA 02331 October 4, 2018 required for every y _ page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in.the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 5 Commonwealth of Massachusetts :-, Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 134 Country Club Drive, Cummaquid M-350 P- 17 Property Address Ralph & Kathleen Campanelli Owner Owner's Name information is required for every P.O. Box 1977, Duxbury MA_ 02331 October 4, 2018 _-- page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: Ej 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. 1 The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: "*This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts -, Title 5 official Inspection Form la Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 134 Country Club Drive, Cummaquid M -350 P - 17 Property Address Ralph & Kathleen Campanelli Owner Owner's Name information is P.O. Box 1977, Duxbur MA 02331 October 4, 2018 required for every Y page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 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 water supply well. ❑ -® Any portion of a cesspool or privy is within 50 feet of a private water supply well. El ®. 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 chainof custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 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. ' 5) 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. i Forlarge systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. , 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 ❑ O the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well t5insp.doc-rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection, Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 134 Country Club Drive, Cummaquid M - 350 P - 17 Property Address Ralph & Kathleen Campanelli Owner Owner's Name information is required for every P.O. Box 1977, Duxbury MA 02331 October 4, 2018 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes" to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? El ® 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)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 16 Commonwealth of Massachusetts ��- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 134 Country Club Drive, Cummaquid M - 350 P- 17 Property Address Ralph & Kathleen Campanelli _ Owner Owner's Name information is required for everyxy P.O.p O. Box 1977, Dbur MA 02331 October 4, 2018 P9 _ -- a e. City/Town State Zip Code Date of Inspection D. System Information 1. 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): 440 gpd Description: , Number of current residents: 0------ Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: N/A Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ 'No Seasonaluse? ® Yes ❑ No Water meter readings, if available last 2 ears usage d '17=58,000 gals. g ( y g (gpd)): 16=51,000 gals. Detail: i--- Sump pump? ❑ Yes ® No Last date of occupancy: occasional use Date t5insp.doc-rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 Commonwealth of Massachusetts _-- Title 5 Official Inspection Form �- i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 134 Country Club Drive, Cummaquid _ M-350 P- 17 Property Address Ralph & Kathleen Campanelli Owner Owner's Name information is P.O. Box 1977, Duxbury MA 02331 October 4, 2018 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: N/A _ Design flow(based on 310 CMR 15.203): N/AGallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): N/A Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: N/A Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: N/A _ Last date of occupancy/use: N/ADate Other(describe below): N/A 3. Pumping Records: Source of information: No pumping info available. i Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? - Reason for pumping: - -------------�-- t5insp.doc•rev.7/26/2016 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 Commonwealth of Massachusetts p �a Title 5 Official Inspection 0=orrn Subsurface Sewage Disposal System Form -Not for Voluntary Assessments: 134 Country Club Drive, Cummaquid M - 350 P- 17 Property Address Ralph & Kathleen Campanelli Owner Owner's Name information is required for every Box uxy p O. B 1977, Dbur MA 02331 October 4, 2018- — page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: Tank, d-box and leaching were installed on 9/12/06 per'compliance. Were sewage odors detected when arriving at the site? ,❑ Yes ❑ No 5. Building Sewer(locate on site plan): - Depth below grade: 18„feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): ---- Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Lines were found clear at the time of inspection. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 c Commonwealth of Massachusetts q- Title 5 Official Inspection -dorm Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 134 Country Club Drive, Cummaquid _ M - 350 P - 17 _ Property Address Ralph & Kathleen Campan_elli Owner Owner's Name information is required for every P.O. Box 1977, Duxbury MA 02331 October 4, 2018 - - page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank (locate on site plan): Depth below grade: 19"with riser to 6" 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: 6'X10.5'X6' 1500 gallon _ Sludge depth: 4" -- Distance from top of sludge to bottom of outlet tee or baffle 2' 8"— ------- --- Scum thickness thin layer Distance from top of scum to top of outlet tee or baffle 6"-- - Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? probe/measured —_ Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pvc inlet and outlet tees were found present and in working order. No evidence of leakage or damage was found. Tank was not in need of pumping at this time. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts �n Title 5 Official . Inspection Form Subsurface Sewage Disposal System.Form -Not for Voluntary Assessments 134.Country Club Drive, Cummaquid M.-350 P 17 V Property Address Ralph & Kathleen Campanelli Owner Owner's Name information is required for everyBox Dux bury P.O.O B 1977, Dbury MA 02331 October 4, 2018 - page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: N/Afee -- Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: N/A Scum thickness 2 N/A Distance from top of scum to top of outlet tee or baffle N/A Distance from bottom of scum to bottom of outlet tee or baffle N/A r N/A 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.): N/A 8. 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): Dimensions: N/A Capacity: N/A gallons Design Flow: N/A gallons per day t5insp.doc•rev.712 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 Commonwealth of Massachusetts Title 5 officinal Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 134 Country Club Drive, Cummaquid M - 350 P - 17 Property Address Ralph & Kathleen Campanelli Owner Owner's Name information is required for every P.O.p O. Box 1977, Duxbur MA 02331 October 4, 2018 _ __- - page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank (cont.) Alarm present: ❑ Yes ❑ No Alarm level: N/A--- Alarm in working order: ❑ Yes ❑ No Date of last pumping: N/A Date Comments (condition of alarm and float switches, etc.): N/A *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert level Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box was found level and in working order with equal distribution to outlet lines through speed levelers. No evidence of solid carry-over or backup in the past was found at the time of inspection. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 Commonwealth of Massachusetts Title 5 official Inspection. Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 134 Country Club Drive, Cummaquid M -350 P- 17 Property Address Ralph & Kathleen Campanelli Owner Owner's Name information is required for everyxury P.O.p O. Box 1977, Db MA 02331 October 4, 2018 _ _.-- page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No` Alarms in working order: ❑ Yes' ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): N/A " If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: - - ® leaching chambers number: 3-500 gallon with 4' stone_ ❑ leaching galleries number: 33.5' X 13.5'X 2' ❑ leaching trenches number, length: ---- ❑ leaching fields number,,dimensions: -- ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: --- -- t5insp.doc•rev.7126/2018. Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 c Commonwealth of Massachusetts �a =- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 134 Country Club Drive, Cummaquid_ _ M -350 P- 17 — Property Address Ralph & Kathleen Campanelli Owner Owner's Name information is P.O. Box 1977 Duxbu MA 02331 October 4 2018 required for every � ry -- � _ page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Soil was sandy. Chambers were dry at the time of inspection. Checked stone and found dry and clean. No evidence of hydraulic failure or problems in the past were found at the time of inspection. 12. 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 ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): N/A t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 134 Country Club Drive, Cummaquid M -350 P - 17 Property Address Ralph & Kathleen Campanelli _ Owner Owner's Name information is required for every p O. Box 1977, Duxbury MA 02331 October 4, 2018 - page. City/Town State Zip Code Date of Inspection D. System Information (cont.) . 13. 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.): N/A r t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts �� - -- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 6 � 134 Country Club Drive, Cummaquid _ M -350 P - 17 Property Address Ralph & Kathleen Campanelli Owner Owner's Name information is P.O. y_Box 1977, Duxbur MA_ 02331 October 4, 2018 required for every _. page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately Fes„ 6 O ® J, QQ ' 10 0 / t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts Title 5 official Inspection Form ie Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 134 Country Club Drive, Cummaquid M - 350 P- 17 _ Property Address Ralph & Kathleen Campanelli Owner Owner's Name information is P.O. Box 1977, Duxbur MA 02331- October 4,2018 required for everyy page. City/Town State Zip Code Date.of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells 11.0'+ Estimated depth to high ground water: 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: 8/29/06/ 10/11/94 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: AIW 247 Zone B^ 23.0' 2.3' adjustment You must describe how you established the high ground water elevation: Test holes recorded on plan showed no water found at 10.5' & 11.0'. Hand augered 5' below bottom of leaching with no water found at a depth of 10.0'. Groundwater adjustment at the time of inspection was 2.3'. Bottom of leaching at 4.0'was found not to be located in the high groundwater elevation at the time of inspection. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts - Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 134 Country Club Drive, Cummaquid M - 350 P 17 Property Address Ralph & Kathleen Campanelli Owner Owner's Name information is ry required for every P.O. Box 1977, Duxbu MA 02331 October 4, 2018 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank— Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ZIpplication for TDi5pozat *pg;tem Construction Permit Application for a Permit to Construct( Repair( ) Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. f 3Y �� /D ` Owner's Name,Address,and Tel.No. Assessor's Map/Parcel t, �� � A.1, Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms I.,ot Size �� sq. ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided y _<5 gpd Plan Date A A \� Zo ItL Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by thi Board of Health. Sig<d Date �0 ..Application Approved by -,Date , Application.Disapproved by: ,-'Date il for.the fol lowing-reasons Permit No. Y Date Issued . N No. es. � . i? x Fee THE COMMONWEALTH'OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS, Rpplication for Digogal �&p.5tem Cowaruction Permit Application for a Permit to Construct( Repair O Upgrade O Abandon O ❑ Complete System ❑Individual Components Location Address or Lot No. 3Y C0& ny Q `b Owner's Name,Address,and Tel.No. Assessor's Map/Parcel YK y,. Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Ate Farr r-,- sod- sX +� C .2� .34 z-y-P r Type of Building: 1 Dwelling No.of Bedrooms "<Lot Size `t ) ` Ot* sq. ft. Garbage Grinder Other Type of Building No.of Persons Showers( �.) Cafeteria( ) Other Fixtures r' s Design Flow(min.required) �`\O gpd Design flow provided y; gpd Plan Date + I\ 2p u. Number of sheets Revision Date Title Size of Septic Tank Type of-S.A.S. Description of Soil Y Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by th'. Board of Health. Si ed /p�.•+ r1 Date 9 0 Application Approved by Date � r�s) r Application Disapproved by: µ V r V M Date r ' ' for the following reasons 1 4, i Permit No. i r Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS'­-.", Certificate of Comp iance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed (" ) Repaired ( ) Upgraded ( ) Abandoned( )by (A demor at l 31-( C��.rw+�r (�� �r � ,, Chas been onstructed i a/�cordance 3, with the provisions of Title 5 and the for Disposal System Construction Permit No. . 1 dated Installer Designer owh C_^ ± #bedrooms Y Approved design flow gpd The issuances oof this pe itt shall not,,be,construed as a guarantee that the sy`em will�cti as designed. Date "i rr��(�1010 Y Inspector -----_��- - l --=-- = ----=--- ----------- ------- No. ���`~ Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS wigpogat *p5tem Construction Permit Permission is,hereby granted to Construct ( Repair ( ) Upgrade ( ) Abandon ( ) System located at 13`I C(ewn r 1" and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions Provided: Cons ctio .must be completed within three years of the date of i permit. _ r'/Date � Approved by •,�: l / TOWN OF BARNS^TTABLE{OCATION 1 `� �O��-�o`y C: /Cx V�, SEWAGE# d(Z6-3 7Q 1 VILLAGE L ,V p 5�iq ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. , e k C;:y 61,2®ow< -271-y/ SEPTIC TANK CAPACITY 11,00 LEACHING FACILITY:(type) , X 9`40 44t4-M. (size) 3 o S" NO.OF BEDROOMS 7 OWNER 6 e,. PERMIT DATE: 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 Llo 3 1� 1�c= FROM :down cape engineering inc FAX NO. :15083629880 Feb. 12 2007 03:09PM P2 ' 'own of Barnstable Regulatory Services Q Thomas F. Geiler, Director EktRVaCrA" Public Health Division +' Thomas McKean, Director 200 Maio Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 509-790-6304 Installer S Designer Certification Form Date: Sewage Permit# Assessor's Map\Parcel Designer: - Installer: Address: �'�-L',— -S Address- n _U On was issued a permit to install a (date) (' ler) septic system at 5 1+ G w CL based on a design drawn by -_-� (adds s) dated c (design } LI eertit, that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box andJor septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance tenth State &. Local Regulations. Plan revision or certified as-built by designer to follow-_ ARNE H (Installer's Signature) oJALA ` { No. 30792 0X,, G15T Affix Desz„ tamp Isere) ( esigrt r'S Signature) (� PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DI(VIS ON. CERTIFICATE- OF `COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTA13 E PUBLIC HEALTH DIVISION. T14ANK YOU. �� �:laealtlUSeptic/Designer C.cnif cation FoyTi1 3-2.6-04.doe P- ��� 3sp P 0/7 / 3,S-0 - 0, 17 No., _�ef Fa$.f.� �... / THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Appliratiult for Dbripatiul Works Towitrnrtiun ramit Application is hereby made for a Permit to Construct (V') or Repair ( ) an Ind' idual Sewage Disposal 0 yst.....a. ..q ..... .. ... .. ..._..Lo_-ction::\daircss ' ......._,or Lot No. ................. .... ........................................... ........ • .................. •••••-••----•-•-•-•-•............................... Ow er /h �! ��eL[�� Address a ;-- ----- ------------- ------ ------..........--- ------..........----•-------------.....------......._. ��ry In tal Address //�� Q Type of Building lam/ ./L(,f4XL Size Lot_._..YYAIv.......Sq.-feet U Dwelling—No. of Bedroom�s._/_.__..._ _ -------------------Expansion Attic (A10) Garbage Grinder QW) per, Other—Type of Building U/P10 _ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) 0.t Other fixtures --------------- ---------------------- Design Flow......_.... g P ... . ... ,,ll W _ _�1�...........gallons per n per day. Total dailyflow..........7..YO.......................gallons. WSeptic Tank—Liquid capacity5Pb__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 tawk ( _ ~' Percolation Test Results C Performed b U --•---------------- Date �..!l• .............. a y. . Test Pit No. 1.... ....minutes per inch Depth of Test Pit.................... Depth to ground water...............__. 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Description of Soil..... I-------------------------------- .----------------- - V ------------------------------- ------------------------ •------------------------------- ...----- ---------------------------------------•----•-------•----------- •--------------------- ..-•---------- W U Nature of Repairs or Alterations—Answer when applicable................................................................................................ ...-----•--•----------------•------•--•--------------------••--------••••---••-••---..........•-••-•••--••-••-••-•---------------••••••....••••-••--•-•••-•--•---•••••••-•--•••---••-••................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with . the provisions of TITLE 5 of the State Env' nmental de — he undersigned further agrees not to place the system in operation until a Certificate of Com iance has en ' s d by t b d of health. Signe 30 O1 ApplicationApproved By ......: ...... /✓''1�--------------- ....... ....... ......'--........................................ ........-.Dace.......... ::.. Application Disapproved for the following reasons: .......................................... . ...................................... ....... ................................. .. ............................................. . ............... . .................................................. . ......................------ ...................-- ....................................... Dace Permit No. `' -.. �----------------- Issued . �.-- ��� . \\ Dare .+'..r,.-_..-'l} -.-.:.,.+.'�.�-p-v—•c�.�,....,r-�-,r,f.,y,w � �I��,.. "�. ..,. P.r:.r. 3 THE COMMONWEALTH OF MASSACHUSETTS b/6A-RD OF HEALTH TOWN OF BARNSTABLE Appliratioit for Dio.poottl Wi ork,i Tomitrnrtion Famit Application is hereby made for a Permit to Construct (t--*") or Repair ( ) an Individual Sewage Disposal stem a ` Location-.\ddnss or Lot No. -} Owner Address W ..................................................................................... � -- �V_L �� — In tall er- Address U Type of Building T�Z �— Size Lot.... YVA0U-......Sq. feet . ►., Dwelling—No. of Bedrooms-------------y--_--__------_----_--._---Expansion Attic (A10) Garbage Grinder (X4)), pI Other—Type of Building _Z46Wj_ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a' Other fixtures ------------------------------- -- W Design Flow................. ...........gallons per person per day. Total daily flow----__.-.V�D.......................gallons. W Septic Tank—Liquid capacity45db_.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 tan ( ) Percolation Test Results Performed by._.._...`.. t___y.�l Date........�ll.............................. ,.a Test Pit No. 1----- ,�....minutes per inch Depth of Test Pit-------�1___...... Depth to ground water....:..N .. 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 .—--------- -----------------------------•••---•-------------•--••--.....•-•-------...............---....-•••-•---..................---•-••-- D Description of Soil---�_ r�19—e4-----•-•------------------------------------------------------------- x --• ------------ --------------------- ------------• ----' ----........------......-----------•--•------- ---------•---- --.....--------....------•--•---------•------------------------•--............. 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 =Iiancehas nmental Code—The undersigned further agrees not to place the system in operation until a Certificate of -en i.sued brtb `rd of health.Signed ....::'�. `.. . .......... ......Date.................. Application Approved By ....._ -- ... ,.��......... ....... . .. - ........ - - //'"� i '� Application Disapproved for the following reasons: ........................................... . . ...................................-. ......------.......................... - .................... ....................... ... . . ................ . ..................................... ................... ............................. ..... .. ..I....................... .... Date Permit No. - Issued ........./... !.� �.f/....�r Dare THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE C9e>rtiftrate of Compliarnce THIS IS TO.CER IFY�TThat the Individual Sewage Disposal System constructed ( !/ ) or Repaired ( ) by ..��---I. .........-- -- ...... ...... ... .................................. � ii«._........... ........................... - -- at ....0_�............q..?�.......Co o'U7I-'� ... t%.V �.�.!.. Coo,,.f0..�..6�...U..t._�.._............................- has been installed in accordance with the provisions of TITLE5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. � y dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE'CONSTRULS A GUARANTEE THAT TH SYSTEM WILL FUNCTION SATISFACTORY. .� �DATE .._...._y -..................._..... ..... _ .. Inspector... - THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE �D FEE........................ No......................... �i��oo�tl ork� C�onotritrtion �.erutit T lsc��� Permissionis hereby granted---�J-----!�-G��-- -------------------------------------------------------------------------•-•--------------.._..--•-............ to Construct (0 or Repair ( ) an Individual Sewage Disposal System at No....L I-----qi 3-•--C LQ O NT�`1 a L(A 1 i/-'-- ------ c o m� rl 4.6L(� 1 street ilff � /`` as shown on the application for Disposal �t orks Construction Per `� /fi "���.;..._ 6' ..----••-•................ F!r <------ l �--� d /`� Q Board of Acalth DATE........ - ./----- --------•-• ----•-...e FORM 38508 HOBBS A WARREN-INC..PUBLISHERS ' t 45W6Er 2 a 2 F o-- LoL)tj -p- -----C OBOF �etve 4sd'go PETER yGJ, — a5 8A5�� NYb SRiuA SULLIVAN All q�^, BM• Ec�oo \ No. 29733 `� I 18102 A / FSS70NAL i.�` \ O 1t �� v r gb.ti I og tob 35P Pc� tllo c 12�7.9d \ ¢ 1 I AAAP 35o R I e pro,pos I QBt PETER 9, IN � No. L i,3� ciq \ \ \ 100A SF ..MAP 3C�o PCB . I`1 C=L�C� Cvtii�l to `"`' 3 mac,MAP 35o 21; ZN qOF F R1CHARD r� HARD 3 r�ER R@CA ida Boas BAXTER a" Lam JV ,�40T ,pI—A,c/ � Peopa 5 E� (:'-�'l>.1 A f4 G— �'"�,� SETB.cS Cl-c-- �Ec?4/1.'2E�'lE.t/T.S 0/9- 7��,c' 7`"4�W� 34 R 4 S 7,4-8 e- A1vo /.s A0r t �C,4 TEv fy/Thy/�/ 7-/ �Loa�PG4/y L of 95 i j� 7"v8�•- l�9 /(/ate- ,E3,�XT�.2E B,aSEo �3/v Ait/ .eEG/s7"E-2EO !-�i��o sl�.el�6'ya�/NST,eUiy.��t/T,S'U.2YEY E Tye �,STE.0 1//,C,C.,�a 0�,45ETs sya/,�/,y S.yovG�� ,/-�T z./1t/.�cS. ,4lV a -PATA 51�1 FAMILY 5 $Er,;WW cs� o UA43Ac,E 6JUVE7Z 'PAIL,-( 5E riC TANS 330x 2 dye 6RD lx G 1 GOD &A L- '�; 2i5FMAL PIT i -ivcv�ac. /��sro�l� �AW oN' /sex. b4L-�1.E 0� 5IDEW4iL AREA-.: 22& SF 3 BOTTOM ACEA I I3 SF K o•&3- z CouwrwY . C,)8 'DI?i\lI✓- TOfALAL UU I6NAILYF�--�S • VY" o CL)AA AA A 0U I`I> PRZ/-D .ATI DN ¢A'T'E -j'►U 4 Mi4/Lz5S OF OF �°� (� uF F(ISo,.''• `$" �`SS,� yer gld OF �s . PETER P;:TcR BitfrMd� �v 8 �.'. $ SULLIVAN A. ; U Sul LI�'r�Pd BAXTER DAM No.2aoas Rio. 29733 rn Fla ` U fido. 2r113 Wk Lap LAWSIOP�AL Parr v k-z'7. 9� Tom,r NoLE- F(,.tl TF = 99 P v�c• DKTT. i�J✓ ✓ GQL 4¢ I noU Bo;c 43� �3 SEf�TIC 7- TANL ,wlP 1 I Z° - Sv;n� w,as�i� tom: A� Imcrvzo st.-r sToNE MOLE TMA04 q! •vrZ-F s �" ELsb7 Q4ALL: Ze 14-7.0 i tzrIFI® Per R 4 r`�� L..>= -�-71 amS2G DATI= to , 16 �1¢ Wo clime �rzv�3L�-p PLAN V-C 1s C '12,7.14- 1 CAIFy 74 AT THE Iow�1 NzeoN ezm'fL' � WITA 111 FEQ. Ct- 7DwN OF. 1 �2Aa 5TA+3 �t- AO 6l-04ATVD WI 41d E vxo > p wu' I O SEz i49 pA,`t�' io,i8•�I�i. � _ �dX�'E.1.z � NYE (NC, p�Y(o�JdL L1ilJT7 Su�.V�/oe5 -0S FLAQ l5 Nor F3A41-J v'( AN 1�15'TLC7titE+J1" ���i t_. E�.►Gi N EE�.S Su(zvc`j A14D TN1E OFFSEj1 4 4tiuL.D o or -ae o 5T MvI -a MAS4 , u5 T-D ESTABL15N PrzapEtTvj U N>=5 QPpLI -A NT s S t� to i-b;uc �uG �JESl6N -DATA S6��ST" ( fit= 2 SI�1GL FAMIL-( $EMWM� i�o UA05Ar-E 6Izl1JVEZ- -DAI L-( SE?Fl C TANS 330 4y c GPD 0xe 1Soc) COAL s — '�; 215MAL FIT i -torn6Ae- /S' ro,� ra 0'J --kw 51DEWAlL AWeA .: 2s& 6F BOTTOM A(ZC = 113 s F A 0.b-3 z `id l�D, CouWr2Y C,)8 -DrLrv'i= TOTAL t)E616W 6fP„ TOTAL 'DAILY Fir/ =3 GPz o►L- Ct)AAAAAQvi`t > T�EP�DLATt ON WATE _(,,)U 4 m k4/t a',s OF r f `y � S �� OF acr� � PETER P:3"t at SULLId A. SUL1.1V 6A�NEAXTER � t o.2aIAs �R10. 29733 + �BAXTER 19a No. 29133 ag, O P,v.c SGQT kto T'. q4 C. I voU rtl i^iy �Nc wi 1T i WASF�E3� �l�: Al-L. S'f'QVGTuQES SST A6961; MMOU TuAN 4 DEEP sru/L s,4a� BE -2o 46 ec1b7 -P�VF�P� T�rzoFlc.�-- Cezi"IT--I® Rdf' FLAN Loc.�c'TIoN : �UNt.f�ln(��t� 1 LZ- ' FLAN zers(,L�� M-7-14- I CEJ?-T1F`( 7�AT TI{E aw N I �3 �F4®u1}J ktzecN �M'PL S wl-rA -N SI�EV �r L CZEQ. c c `T'DWN OF. 'i An-45TAf3LE �t- A+TD 1S (--044Ta:'D W l U 1 d E TIZOD .�I t�. I o b EE • (4 9 �A`t�-' l c.i�•`Id-� � � _ �d XY�1Z � N Y6 (NC p�5;fpiJdL LAu� 5u?a/EyatzS -7E41S FLAQ IS NOT ?A-;© C)� AN 1�15T�tJktE+�T' z���� �4 E+j(;l14 EtzS SUIZVE't MD rNF- OFFSET• 44vUQ,) U or 'fa 0 5TrEzIzvILLE MA44 , uSC-1D T'o t=STQ�K� �e�C�1 la rJ'`5 QPPLIcQN-r, 1, Sc� , tokt);06 � �uG srl6�7- 2 of 2 I I F— LOV t.1TRy CLJB ��'lVE a W>b. SPu/Q1 1 ��. PETER yG�".. All q�,v esslu rB.NEI��co SULLIVAN /r No. 29733 181p2 ��6�STfctA<'?``�ke 10 �' �� ,-1 I MAP 3 Ill. 16 q OF '4, �A+O,,pp t \ \ a �iy dB t PIF TE,R awe 9, Cill I'40. 2;7 33 \ deck 1-v' / ti — _ \ 10A SF .MAP 3� PC . i-7 1 vAi44 C GNU�U I \\ \\ 3-_mac.MAP 35D 21; OF I• ' Fate bi. RICHARD 3 " N ®AXTONM 24048 . ti 1 C� 7-i,�%Ev Pao o, E:� ac,a Trd,�i S.�/l�Gr/it/yE,2EO�C/CO�I,oL Y.S W/Th' CUM'�44 d U/D SCA Z- 50 0_ /o -12, 9d � y�� s"/l�E�/.c/� ANU SETB.4 C/G 2�✓. /2,�•94 7-e4/ 84 e N s r`,�8�� ,4,vo /s A07 OC'.4 T,EI� lyi7'y//✓ T//E .�Loaa�G4/y, L of 95 Z.9� o/ i TvB�- l4 9 Cj cam- .._. BAXTE,C?E NYE /,t/C. Tf//S �.GA///S il/aT BASEG� �3,t/,4�f/ �2E"G/STE,eE� ,L.gc•/4 SU.e/iEya�. /N.ST,2U�icit/7-,S'!/,2Y�'Y� Tye �S i TE a OET ,PiLj/�� .�>T /N�.S 1'414'�.L BARNSTABLE LOCATION Z 0� qa> (-QovJ,� G ju� Qc. SEWAGE # VILLAGE-Ct)k'�+nn�C�y► ASSESSOR'S MAP & LOT,,' rd 0/7 INSTALLER'S NAME PHONE NO. -'• Dt;5L61) `7 71-- (610 SEPTIC TANK CAPACITY (, drOU y^t[01A LEACHING FACILITY:(type) (Aa(c,�' -(size) 1, 000 NO. OF BEDROOMS PRIVATE WELL O PUBLIC WATER , BUILDER OR OWNER CO. DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No 1 ' 3y` < S�r�f i SYSTEM PROFILE NOTES Route 6A FTO� N. AT EL 48.7 ACCESS COVER TO,WITHIN V OF FIN. GRADE (NOT M Saml) 1. DATUM' IS APPROXIMATE NGVD ACCESS COVER (WATERTIGHT) TO ACCESS COVER TO WITHIN 3 OF FIN. GRADE WITHIN 6" OF FIN. GRADE 2. MUNICIPAL WATER IS EXISTING 48.0' MINIMUM .75' OF COVER OVER PRECAST 2X SLOPE REQUIRED OVER SYSTEM 2" DOUBLE WASHED PEASTONE,\ 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. � * RUN PIPE LEVEL OR:.GEOTEXTILE .FABRIC *EXISTING 45 5 FOR FIRST 2' a 3' MAX. 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO Dennis t*EXISTING 1500 H- 10. a i *EXISTIN GALLON SEPTIC TANK *�55' '4.5' I- Vo Pond o BAFFLE 44.0 43.83 Q 0 Q Q 0 0 0 5. PIPE JOINTS TO BE MADE WATERTIGHT. , 0 43.74' o a m a O 0 C C 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH 4, ( 2.5X SLOPE) 6" CRUSHED STONE OR MECHANICAL p p m p m 0 a C MASS. ENVIRONMENTAL CODE TITLE V. m r COMPACTION. (15.221 [2]) 2' a p p © =I 0 ID CI 41.74. DEPTH OF FLOW = 4' 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO LOCUS TEE SIZES: 3/4" TO 1 1/2" DOUBLE WASHED S BE USED FOR LOT LINE STAKING OR ANY G114ER PURPOSE. Exit 7 INLET DEPTH = 10" Yarmouth Route B OUTLET DEPTH = 14" ( 1 X SLOPE) ( 1 X SLOPE) 8. PIPE FOR SEP11C SYSTEM TO SCH. 40-4" PVC. Campground 1 D14.774'FOUNDATION EXISTING SEPTIC TANK 55' LEACHING D' BOX 11' 23't 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED SCALE: 1" = 2,000't FACILITYWITHOUT INSPECTION BY BOARD OF HEALTH AND PERMISSION- OBTAINED I FROM BOARD OF HEALTH. *THE INSTALLER SHALL VERIFY THE **THE INSTALLER SHALL CONFIRM MIN. LOCATIONS OF ALL UTILITIES AND ALL SEPTIC TANK SIZE AT 1500 GALLONS AND 10. CONTRACTOR SHALL BE RESPONSIBLE FOR CALLING ASSESSORS MAP 350 PARCEL 17 ITS SUITABILITY FOR RE-USE . DIGSAFE (1 888-344-7233) AND VERIFYING THE LOCATION LOCUS IS WITHIN AP OVERLAY DISTRICT BUILDING SEWER OUTLETS AND ELEVATIONS 'BOTTOM. TH-2 EL 37.0' OF ALL UNDERGROUND & OVERHEAD UTILITIES PRIOR TO PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM GROUNDWATER ITT EL 18.0't COMMENCEMENT OF WORK. 9 s (PER TOWN OF BARNSTABLE GROUNDWATER 11. EXISTING LEACH PIT SHALL BE PUMPED AND FILLED WITH ELEVATION CONTOUR MAP) CLEAN SAND OR PUMPED AND REMOVED. LEGEND 12. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL BE 100.0 PROPOSED SPOT ELEVATION ri REMOVED 5' BENEATH AND AROUND THE LEACHING FACILITY. rj (SEE TEST HOLE #1) +100.00 EXISTING SPOT ELEVATION BENCHMARK' �L I 100 PROPOSED CONTOUR TAG BOLT 168T ELEV=50.1' SYS F _ M � Nr { EXISTING CONTOUR ,;r '. , � 100 �� q . GARBAGE DISPOSER IS NOT ALLOWED .... W EXISTING WATER LINE --'� a �,'.....• 4�'"ti�-� 0 110 GPO 440 GPD G EXISTING. GAS. LINE. QPr . /--PAVED r \���� 2�0 USE A 440 GPD DESIGN FLOW DRIVE 23, e _ LP_ EXISTING- LEACH-PIT � _ ��/ oo •r- � SEPTIC TANK: 440 GPD {2) = 880 v - � **RE-USE EXISTING 1500 GAL. SEP11C TANK �4zY/,,/!' ���' ►.`b�ry_. ,aI LEACHING: ARQEN/�! SIDES. 2 33.5 + 12.83 2 .74 E 137 GPD TEST HOLE LOGS EXISTING / BOTTOM 33.5 x 12.83 .74 = 137 GPD DAVID° FLAHERTY R.S. �_ / / S.T. EXISTING TOTAL: 615 S.F. 318 GPD I 4 BR CWELLING ENGINEER: ' / ✓ / o i �, � TOP of aVDN=oar DON DESMARAIS, R.S. APPROXIMATE AREA BENCHMARK I WITNESS: COR BRICK LANDiNc USE` (3} b00 GAL LEACHING CHAMBERS (ACME OR EQUAL) OF EXISTING rj AUGUST 29, 2006 UNDERGROUND r� �\ i ELEV=49.3' I DATE: UTILITIES-USE .� ✓-ate 1 WITH 4 STONE ALL AROUND < 2 MIN/INCH EXTREME.CAUnON! ri ��� �_ DECK PERC. RATE = CLASS I SOILS P# 11411 // 3 / c / $' ,,r •3 E _ / MA ELEV. ELEV. APPROVED DATE BOARD OF HEALTH o" 47.5 on 48.0 .o' FOAL .0 65 TITLE 5 SITE PLAN :.:. . . I A A UTILI OF TY LS LS CLUSTER `t47.42 ELEC, TEL, CATV r r p CLUB » 1OYR 5/2 " 10YR 5/2 +49.78 4kv 134 COUNTRY CLUB DR. 9 46.7 12 47.0 ^�' LOT 93 g g 44,1GO SFf CCUMMAQUID) BARNSTABLE . LS LS 49.25 PREPARED. FOR 31" 10YR 7/4 44.9' 36" 10YR 7/4 45.0' aOH.N GIARDINO PERc C1 MFS C 00' DATE: AUGUST 31 , 2006 ��5 115" 2.5Y 5/3 37.9' I MFS C2 SILT LOAM off 508-362-4541 fax 508 362-9880 r 2.5Y 5/3 123" 2.5Y 6/2 37.2' �.��,of rd,Jss9c t�°F MAs�c� ° E C3 moo` ARNE H yG� o ARNE H. do Wn cope engineering, inc. MFS ° IVIILL N ° OJ En CI VIL ENGINEERS '0 2.5Y 5/3 » , o 30792 No 6 8 LAND SURVEYORS 12637.0 132 37.0 Scale:1 = 30 0 4,Tr S ` s�° 939 Main Street YARMOU THPOR T, MASS. NO GROUNDWATER ENCOUNTERED D �0N4L ARNE H. OJA s .L.S. 0 15 30 45 60 75 FEET 06-188 GIARDINO.DWG (DDF) DCE #06-188 4 i f t