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HomeMy WebLinkAbout0028 GOVERNOR'S WAY - Health 28-,Gover6or�s Barnstable P 258 028002 • Commonwealth of Massachuse#ts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 4 5� ,. 28 Govemor's Way- Property Address Stephen Lawson Owner Owner's Name information is Barnstable 02630 09/08/08 required for every page. Cdyfrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important: A. General Information When filling out forms on the computer,use 1. Inspector: only the tab key to move your Michael Kellett cursor-do not Name of Inspector use the return key- Aardvark Environmental Inspections Company Name P.O. Box 896 ' Company Address East Dennis MA 02641 'dQfO City/Town State Zip Code 508-385-7608 S13742 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and main enance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to S coon ' 5340 of. Title 5(310 CMR 15.000).The system:. ® Passes ❑ Conditionally Passes ❑ F rw ❑ Needs Further Evaluation by the Local Approving Authority 09/10/08 . Inspector's Signature Date t' The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use . at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. �Vv f Commonwealth of Massachusetts `title 5 Official Inspection Forum Subsurface Sewage Disposal System form-Not for Voluntary Assessments 28 Governor's Way Property Address Stephen Lawson Owner Owner's Name information is required for Barnstable MA 02630 09/08/08 - every page. Cityfrown State Zip Code Date of Inspection B. Certification (coat.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Answer yes, no or not determined (Y, N, ND)in the❑for the following statements. If"not determined,"please explain. ❑ The septic tank is metal and over 20 years old'or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent.` System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate . of Compliance indicating that the tank is less than 20 years old is available. ND Explain: ❑ Observation of sewage backup or break out or high static water,level in the distribution box due , to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed Commonwealth of(Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 28 Govemor's Way Property Address Stephen Lawson Owner Owner's Name information is Barnstable required for MA 02630 09/08/08 every page. Cityrrown State Zip Code + Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed ND Explain: C Further Evaluation is Re quired wired b the i q y 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. I. System will pass unless Board of Health determines In accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health land Public Water Supplier,N any) determines that the system Is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 28 Govemor's Way Property Address Stephen Lawson Owner Owner's Name information is required for Barnstable MA 02630 09/08/08 every page. City(Town state Zip Code Date of inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ` ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well'". Method used to determine distance: •*This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You IBM indicate"Yes"or"No"to each of the following for all Inspections: Yes No D Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6"below invert or available volume is less than %day flow ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS,cesspool or privy is below high ground water elevation. ❑ f ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Commonwealth of Massachusetts Title 5 Official Inspection Foy Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 28 Govemor's Way Property Address Stephen Lawson Owner Ownees Name information is required forBarnstable MA 02630 09/08/08 every page. Cityrrown state Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems(cont.): Yes No ` ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratory,for fecal colilform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.) ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system falls. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section.D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply Cl El Area system is located in a nitrogen sensitive area(interim Wellhead Protection Area—IWPA)or a mapped Zone it 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. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 28 Governor's Way Property Address Stephen Lawson Owner Owners Name information is required for Barnstable MA 02630 09/08/08 every page. City/rown State Zip Code Date of inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner,occupant, or Board of Health ❑ Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(if they were not available note as NIA) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components,excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened,and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions,depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information: For example,a plan at the Board of Health. ® ❑ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)(310 CMR 15.302(5)) Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form•Not for Voluntary Assessments 28_Governor's Way Property Address Stephen Lawson Owner Owner's Name information is required for Barnstable MA 02630 09/08/08 every page. Cityrrown state Zip Code Date of Inspection D. System Information 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 Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(if yes separate inspection required) ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: current Date CommercbaUlndustrial flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ .Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): Commonwealth of Massachusetts Title 5 official Onspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 28 Governor's Way Property Address Stephen Lawson Owner Owner's Name information is required for Barnstable MA 02630 09/08/08 every page. City/Town state Zip Code Date of inspection D. System Information (cunt.) General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes,volume pumped: gauons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box,soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system(yes or no)(if yes, attach previous inspection records, if any) ❑ Innovative/Altemative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components,date installed(if known)and source of information: 06/16/04 per BOH 0 Were sewage odors detected when arriving at the site? ❑ Yes ® No Commonwealth of Massachusetts Title 5 official Inspection Foy Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 28 Governor's Way Property Address Stephen Lawson Owner Owner's Name information Is required for Barnstable MA 02630 09/08/08 every page. Cityrrown state Zip Code Date of Inspection D. System Information (cunt.) Building Sewer(locate on site plan): Depth below grade: 2.2 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.): Septic Tank(locate on site plan): Depth below grade: 1.8 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 gallons Sludge depth: 311 Distance from top of sludge to bottom of outlet tee or baffle 29" 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 16" measured How were dimensions determined? Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 28 Governor's Way Property Address Stephen Lawson Owner Owner's Name information is required for Barnstable MA 02630 09/08/08 r every page. Cityfrown State Zip Code Date of Inspection D. System Information (corn.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet Invert,evidence of leakage, etc.): The tank was sound and tight with tees in place and liquid at outlet invert. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑metal []fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑concrete 0 metal ❑fiberglass ❑polyethylene ❑other(explain): Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Forth-Not for Voluntary Assessments 28 Governor's Way Property address ' Stephen Lawson Owner Owner's Name Information is required for Barnstable MA 02630 09/08/08 r every page. cityrrown State Zip Code Date of Inspection . D. System Information (cont.) Tight or Holding Tank(cunt.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑.Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert even 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.): The box was level and tight with no sign of carryover. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: 0 Yes ❑ No Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 28 Govemors Way Property Address Stephen Lawson Owner Owner's Name information is required for Barnstable MA 02630 09/08/08 every page. Cityrrown State Zip Code Date of inspection D. System Information (cont.) Comments(note condition of pump chamber, condition of pumps and appurtenances,etc.): Soil Absorption System(SAS)(locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 3 ❑ 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.): This system has three 500 gallon dry wells surrounded by three feet of stone.There was no sign of ponding or failure. Commonwealth of Massachusetts Title 5 Official Inspection For Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 28 Governor's Way Property Address Stephen Lawson Owner Owner's Name information is Barnstable MA 02630 09/08/08 required for every page Cityrrown state Zip Code Date of inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. s' �.13 3b 3 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 28 Govemor's Way Property Address Stephen Lawson Owner Owner's Name information is Barnstable MA 02630 09/08/08 required for every page. Citylrown state Zip Code Date of Inspection D. System Information (cunt.) Site Exam: ® Check Slope ❑ Surface water ® Check cellar ❑ Shallow wells Estimated depth to ground water: 20.0 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: USGS maps show an elevation of over 20.0 feet. 7' Page. CERTIFICATE OF ANALYSIS V M 39:rs,�c�5tr. Barnstable County Health Laboratory Report Dated: 11/12/2004 Report Prepared For: Order No.: G0428431 , PARCEL - ®Z-%OZ 2Z Herman Woebcke fib.Governors Way L® Barnstable, MA 02630 Laboratory ID#: 0428431-01 Description: Water-Drinking Water Sample#: 28431 Sampling Location 16 Governors Way Barnstable MA Collected: 10/26/2004 Collected by: H Woebcke Received: 10/26/2004 Routine ITEM RESULT UNITS RL MCL Method# Tested LAB: Inorganics Nitrate as Nitrogen 0.7 mg/L 0.1 10 EPA 300.0 10/26/2004 LAB: Metals Copper 0.31 mg/L 0.1 1.3 SM 311113 11d/3/2004 Iron 0.49 mg/L 0.1 0.3 SM 311113 11/3/2004 Sodium 13 mg/L 1.0 20 SM 3111B 11/3/2004 LAB: Microbiology Total Coliform Absent P/A 0 Absent 307 10/26/2004 LAB: Physical Chemistry Conductance 250 umohs/cm 1 EPA 120.1 10/26/2004 pH 7.4 pH-units 0 EPA 150.1 10/26/2004 Based on the results of the parameters tested,the water is suitable for drinking,but may present aesthetic problems(taste, odor,staining)due to Iron. Approved By: , { Directory .art RL = Reporting Limit , MCL=Maximum Contaminant Level ,c� Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6 i05 I . TOWN OF BARNSTABLE :o LOCATION GOVERNORS WAY SEWAGE #2004-240 VILLAGE B A R N S T A B L E ASSESSOR'S MAP & LOT 2 5 8 2 8-2 INSTALLER'S NAME&PHONE NOELLLS BROTHERS CONST . CO . 362-6237 SEPTIC TANK CAPACITY 100 eplika LEACHING FACILITY: (type) b ' �n C ize) NO. OF BEDROOMS BUILDEROROWNER HERMAN & NANCY WOEBKE PERMUDAT-0/ 14/0 4 COMPLIANCE DATE: 7S1 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 l Ce f PS � 3 4 � tJ r V ' FVNo. eeTHE COMMONWEALTH OF MASSACHUSETTS Entered in com PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Rpprtcatton for Mtgpogal bpgtem Congtruction Vermtt Application for a Permit to Construct( . )Repair(X)Upgrade( )Abandon( ) O Complete System ❑Individual Components Location Address or I Q1 G 0 f���� Owner's Name,Address and Tel.No. e�C ��JJ �i4 -e nN� ! nor n 1,� Assessor's Map/Parcel & G G o N.�wrS (,4zz Jri �j..i►rJ'� Y Installer's Name,Address,and Tel.No. 3(o '� (Z 3 7 Designer's Name,Address and Tel.No. I�c<<�7+4�� catisr ac. r.ts�►'�n l� , nt GaS.� Type of Building: Sc� a7 3'O 3 7j Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons 3 Showers( ) Cafeteria( ) Other Fixtures Design Flow 144C2 gallons per day. Calculated daily flow r-$1.0 gallons. Plan Date 7, ul-J-y)-Number of sheets Revision Date 7//9/0,2 Title Size of Septic Tank 1000 r x*`S �-I�1 Type of S.A.S. 3-Soo 5-.0 Chot^/3-0,4 Y-90 Description of Soil,S e e Sbr1 Nature of Repairs or Alterations(Answer when applicable) St t 5�-L O'K I. Date last inspected: Agreement: The undersigned agrees to ensure the nstructio d maintenance of the afore described on-site sewage disposal system in accordance with the provisions of a of the E ;nmrl Code and not to place the system in operation until a Certifi- cate of Compliance has bee iss is Board Sig Date Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued 'rIMAYt`e.,:i. S,-+„, y +ikRl-w,AgR• '.v,.�yy....,•w�,.`�',^�p '-./' �_ �T��bl No. 1 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes p PUBLIC HEALTH DIVISION:' TOWN OF BARNSTABLEs MASSACHUSETTS 2pplication for Mis000l dip terry Con!ari uction Permit Application for a Permit to Construct Repair pp ( ) p ' ( )Upgrade.( )Abandon( ) O Complete System O Individual Components Location Address or Lro� Owner's Name,Address and Tel.No. `x GJ G Assessor's Map/Parcel �yy01Q Installer's Name,Address,and Tel.No. �:�j („ �o 3 -2 Designer's Name,Address and Tel.No. _ r ,� ���llJ :7cG%W.rs rcnSl J,C. F�,�s,•),p�j, �� r nC. G�S3 � . �, r/^"TI.h�, �/�i 9 �t10� !"��..; •vi 1/ I 1 ��1/ � l_ ��'1. tf^�I �'t � v r Type of Building: S`&' a 7 3 - 0 3 7 J 1 Dwelling No.of Bedrooms 4 4 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons 3 Showers( . ) Cafeteria( ) Other Fixtures Design Flow U 4 gallons per day. Calculated daily flow gallons. Plan Date a ri 1 `p S 07RNumber of sheets ! I Revision Date 2/o/o.2 r Title s c Size of Septic Tank 1000 /: >< S ?�t`�`.1 ? Type of S.A.S. 3 'S o° u . Description of Soil- See Ste;) L c l r Al. Nature of Repairs or Alterations(Answer when applicable) ST r v x. r Date last inspected: Agreement: The undersigned agrees to ensure the nstructio� maintenance of the afore described on-site sewage disposal system in accordance with the provisions of T-Ve! f the Envuonme.tal Code and not to place theksystem in operation until a Certifi- cate of Compliance has bee i'ssu b oard 6_4 th P Sign/ 10 t, /l .n 'Date 1 oved b Application Appry _ U�r f;� 1 .. D i ate Application Disapproved for the following reasons '�` Permit No. � Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of'Compliance J� THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded( ) Abandoned( )by M P �» q n �'►S t� w r�Ci• r at �bl asX,econstructeed)inDaccordance with theprovisions of Title 5 and the for DispoSystem Construct on Permit No. vaced `� ���/0'1 �to -- ' ?�r Installer �- <<� .r /36�/if,7J C eMCt • e-G Designer Eric !S ��0 r-.—k The issuance of this pe °t shall n6trl�e •onstrued as a guarantee that the system will funet desi�ed. Date �� ( (� Inspector /.�. .. -- FO — --- — No.� 'W—�i�1 "'�"� --------------------- Fee/ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLEs MASSACHUSETTS ;igpogar *pztem Conotruction Permit Permission is hereby gymfed to Construct( )Repair(X)Upgrade( )Abandon( ) Systemlocatedat Gavenc6r5 t,— . Aoint) iA// /h and as described in the above Application for D%osal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction mus Abe/c�o /prl�eJteda within three years of the date of thi �rmit. Date: `7 V% Approved b / . TOWN OF BARNSTABLE LOCATION GOVERNORS WAY SEWAGE #2004-240 VILLAGE B A R N S T A B L E ASSESSOR'S MAP & LOT 258 2 8-2 INSTALLER'S NAME&PHONE NOELL IS BROTHERS CONST . CO . 362-6237 SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO. OF BEDROOMS BUILDERGROWNER HERMAN & NANCY WOEBKE PERMITDATES/ 14/0 4 COMPLIANCE DATE: 7S1 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 !Ce s, r f 4 —T n r r TOWD Of BwOtablo IDgM' 1 R AW RnA DMd= A?J�c SSiA�•�6�4f, ' -14ot lOL7 lDalar �C r�' D ' Apra Mc— ���e�e�o- Nc„ Mks B s + Cc Adbos awl CVO H � Ad1nni �S 6 sf,,g e. a Q' ' Ca - ' L4 15 fie 5 •C'o S(: , Lntad a permit tou low it to uptia qmm zeroed a?m m wombd iam*doto •boMo waa Sint ,l0']awl of to I"at of vatud gdaoxdm Ofby duipmw to a r' MUM ^. a f s •:..,. w� ... �'� e�,�8�( ��" �1�4.;��'`.N �ra.'f� r 1i4 r ! .� 'h"f � : i r ak'j� Jai � i '� � .� .�,,. .,e�,ik;..�. { ,k�..�.e,r._.,� fr ��..K��.€�n,�,�-�.�,�...�,�il�.s,�,�..,,Y.��'•�i`�'�5,,,t�ti�.J�'-,�.�s��a!'� Rl.n il'� ,�r�'it �,�:;M��„ir,��,,�? 7`,x��x,«.. ,,,� ,.. ... .i �'.����� .... -. O TROY WILLIAMS SEPTIC INSPECTIONS Certified by MA Department of Environmental Protection (508) 585-1500 19 Hummel Drive FAILED INSPECTION RECEIVED South Dennis, MA 02660 COMMONWEALTH OF MASSACHUSETTS APR 2 2 2004 EXECUTIVE, OFFICE OF ENVIRONMENTAL AF A>tN OF BARNSTABLE 0 DEPARTMENT OF ENVIRONMENTAL PROT TH DEPT. TITLE 5 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION P41',RC;EL ' LOT I'ropert} Address: Governors Way Barnstable,MA Owner's Name: Herman Woebcke Owner's Address: 16 Governors Way Barnstable, MA 02630 Date of Inspection: April 5;2004 O Name of Inspector: Troy M. Williams Company Name: Troy Williams Septic Inspections Mailing Address: 19 Hummel Drive Telephone Number: South Dennis,MA 02660 (508)385-1300 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 experience in the proper function and maintenance of on site sewage disposal systems. 1 am a DEP approNed system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system- Passes Conditionaliv Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: :: _ r., �_,,�2 Dater The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of I iealth 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. Notes and Comments Although system meets the minimum requirements set forth by the Massachusetts Department of Environmental Protection,certification is not to be construed as a guarantee of future working condition of system,piping or components. This Inspection represents the conditions of the system on the Date of Inspection noted above. ****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. Title 5 Inspection Form 6/15/2000 pace I off' e � Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 16 Governors Way Barnstable,MA Owner: Herman Woebcke Date of Inspection: April 5,2004 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 an f the failure criteria described in 310 CNIR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not aluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need o air,as a t repaired. The system, upon completion of the replacement or re be replaced or p approved by the of Health,will pass. ' Answer yes. no or not determined(Y,N,ND)in the_ for the following explain. statements. If"not d rmined"please The septic tank is metal and over 20 years old" or the septic tank(whether in or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is immine . System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Bo of Health. •A metal septic tank will pass inspection if it is structurally sound,not le tng and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out o gh static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or en distribution box. System will pass inspection if(with approval of Board of Health): . brok pipe(s)are replaced truction is removed distribution box is leveled or replaced ND explain: The syste equired pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspecti if (with approval of the Board of Health): broken pipe(s)are replaced . obstruction is removed ND explain: 2 'Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ' PART A CERTIFICATION(continued) Property Address: , 16 Governors Way Barnstable,MA Owner: Herman Woebcke Date of Inspection: April 5,2004 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. I. 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 environ ent: — Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water S plier,if any)determines that the system is functioning in a manner that protects the public health fety and environment: _ The system has a septic tank and soil absorption syst (SAS)and the SAS is within 100 feet of a surface %%ater supple or tributary to a surface water su y. — The system has a septic tank and SAS and e SAS is within a.Zone I of a public water supply. _ The system has a septic tank and S and the SAS is within 50 feet of a private water supply well. _ The system has a septic tan - nd SAS and the SAS is less than 100 feet but 50 feet or more frorh a private water supply well**. thod used to determine distance **This system passes ' e well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volati organic compounds indicates that the well is free from pollution from that facility and the presence o monia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure crit a are triggered.A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) 16 Governors Way Property Address:. Barnstable,MA Herman Woebcke Owner: April 5,2004 Date of Inspection: D: System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No ✓ — Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool Liquid depth in cesspool is less than 6"below invert or available volume is less than''/,day flow Required pumping more than 4 times in the last year Vj_,QLdue to clogged or obstructed pipe(s).Number of times pumped ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 1 of a public well. _ &La Any portion of a cesspool or privy is within 50 feet of a private water supply well. 4//.1 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 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 attached to this form.] YES (Yes/No)The systems fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303. therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system.must serve a facility with a desi flow of 10,000 gpd to 15,000 gpd- You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteri ove) yes no _ — the system is within 400 feet of a surface drinkin ater supply the system is within'200 feet of a tribu o a surface drinking water supply _ - the system is located in a nitroge nsitive area(Interim Wellhead Protection Area—1 WPA)or a mapped Zone 11 of a public water sup well If you have answered"yes"to a question in Section E the system is considered a significant threat,or answered "yes"in Section D above the ge system has failed.The owner or operator of any large system considered a significant threat under S ton E or failed under Section D shall:upgrade the system in accordance with 310 CMR 15304.The system o or should contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 16 Governors Way Barnstable,MA Owner: Herman Woebcke Date of Inspection: April 5,2004 Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No f :,Thing information was provided by.the owner, occupant,or Board of 1 ieahl, Were any of the system components pumped out in the previous two weeks Has the system received normal flows in the previous two week period? / Have large volumes of water been introduced to the system recently or as part of this inspection? ✓ Were as built plans of the system obtained and examined?(If they were not available note as N/A) — Was the facility or dwelling inspected for signs of sewage back up?. Was the site inspected for signs of break out ? ✓ Were all system components,excluding the SAS, located on site iN�4 t Lr�.✓. ✓ — Wo(g 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: Yes no 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(3)(b)j 5 Page 6 of 11 OFFICIAL INSPECTION FORM�-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL,$YSTEM INSPECTION FORM PART f SYSTEM INFORMATION Property Address: 16 Governors Way Barnstable,MA Owner: Herman Woebcke Date of inspection:April 5,2004 RESIDENTIAL FLOW CONDITIONS Number of bedrooms(design):_-A Number of bedrooms(actual): 3+L y DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 Number of current residents: _ Does residence have a garbage grinder(yes or no): AID. Is laundn on a separate sewage system (yes or nol: Laundry systenr- [if yes separate inspection required] m inspected(yes or no):��, Seasonal use: (yes or no): N Water meter readings,if available(last 2 years usage(gpd)): 0-3 =& ,oc,� /�,. o z_ 73,oo- Sump pump(yes or no): ��o Last date of occupancy: COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): ____gpd Basis of design flow(seats/persons/sgft,etc.): _ Grease trap present(yes or no): Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 Sys (yes or no): Water meter readings, if available: Last date of occupancy/use: - OTHER(describe).- GENERAL INFORMATION Pumping Records Source of information: uV., Was system pumped as pan of the inspection(yes or no): o If yes, volume pumped: gallons-- How was quantity determined? Reason for pumping- pumped TYPE OF SYSTEM ✓ Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool _Privy a Shared system(yes or no)(if yes,attach previous inspection records, if any) _Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank —Attach a copy of the DEP approval Other(describe):. Approximate age of all components.date installed.(if known)and source of information: Were sewage odors detected when arriving at the site(yes or no): ,fro 6 Page 7 of 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 16 Governors Way Barnstable,MA Owner: Herman Woebcke Date of Inspection: April 5,2004 BUILDING SEWER(locate on site plan) Depth belo%% grade: L '4 Materials of construction: _cast iron ✓40 PVC , "other(explain): Dictarce front private water supply well or suction line: _ Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 5" h:L+ > Material of construction: concrete_metal_fiberglass_,polyethylene —other(explain) If tank is metal list age:— Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: 5 `x Sludge depth_ Distance from top of sludge to bottom of outlet tee or baffle: 2 ' 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 ffl bae_— _ How were dimensions determined: Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquidlevels as related to outlet invert,evidence of leakage,etc.): _�4 f.a-✓ �.../�-� h/c�S C-..s� '`� i .. y c r i. J.�__�.�I.a..---`G-/t � 1 h 1 t {'.-—��.�a,�- C/ h,�y..i. _f c w t .�.v.�� _Y�_1 S l,.o.i!mil L< o�1'S 4 G[.,S c.i -�•�( S v.�1'CA [elfin lHpr� r:> � of i7 . GREASE TRAP:_(locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_fiberglass_po thylene_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 r baffle: Date of last pumping: Comments(on pumping recommendations,inl and outlet tee or baffle condition,structural integrity,liquid levels as.related to outlet invert,evidence of leak ,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM FART C SYSTEM INFORMATION(continued) Property Address: 16 Governors Way Barnstable,MA Owner: Herman Woebcke Date of Inspection:April 5,2004 TIGHT or HOLDING TANK: (tank must be pumped at time of inspec ' n)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass olyethylene other(explain): Dimensions: Capacity: gallons Design Floe: gallons/day Alarm present(yes or no): Alarm level: Alarm in working er(yes or no): Date of last pumping: Comments(condition of alarm an oat switches,etc.): DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 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.): 13 PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition o umps and appurtenances,etc.): 8 Page 9 of l l OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 16 Governors Way Barnstable,MA Owner: Herman Woebcke Date of Inspection: April S,2004 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why. Type leaching pits,number: leaching chambers,number: leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding,damp soil,condition of vegetation, etc.): .A w.A u . , r ...� r 4`y w o� 6 ,✓ . wr,-2__� �rat.✓t ` _�' �,ice.c w f 7 ti.� �j w.-`. c�� " /h( v�. ate' •�. CESSPOOLS: (cesspool must be pumped as part of inspection)(lo a on site plan) Number and configuration: Depth—top of liquid to inlet invert: _ Depth of solids layer: _ Depth ofscum laNer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or n Comments(note condition of soil,sign hydraulic failure, level of ponding,condition of vegetation,etc.): PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraul' ilure, level of ponding,condition of vegetation,etc.): 9 Page.10 of I 1 OFFICIAL INSPECTION FORM--NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PARS' C SYSTEM INFORMATION(continued) 16 Governors Way Property Address: Barnstable,MA Herman Woebcke Owner: April 5,2004 Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. I I O � I /q L'= z�. tie = 3� � r�F= 3 2' Y. 5 3r 3� S O I � i -Page I I of 1 OFFICIAL INSPECTION FORM— NOT FOR VOLUNTARY ASSESSMENTS . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 16 Governors Way Barnstable,MA Owner: Herman Woebcke Date of Inspection: April 5,2004 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water.i;o "► feet --- Adjusted high ground wafer elevation _ _feel Please indicate(check)all methods used to determine the high giuund %cater elevation: ✓ Obtained from system design plans on record- If checked,date of design plan reviewed: Observed site(abutting property/observation hole within. 150 feet of SAS) Checked with local Board of Ifealth-explain: Checked with local excavators, installers-(attach documentation) _V Accessed USGS database-explain: You must describe how you established the high ground water elevation: �. ° This report has been prepared and the system Inspected as of the date of inspection. This report is not a. warranty or guarantee that the system will function properly In the future. There have been no warranties or guarantees,either expressed,written or Implied,relating to the system,the Inspection and/or this report. 11 1LOCATION _ , SEWAGE PERMIT NO. VILLAGE 14 0 l 1-1a . �h'/9 Se i ivG / l I N S T A LLER'S NAME & ' ADDRESS -+[,? Helfyl-V P�c.Y RcC� ��/v�,c 4 raa ASS I U I L 0 E R OR OWNER DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED __ —� !� �._____._�. ----- .__. ..� d � - •. _ ..�\� ` � ..._ _. ��-,-_ i fQ Y� � � 'i .�. � � � ._a `e_ t. � o 0! C �_� V ocn ...................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........731/'//L/.........OF. ....... ............................_7.......I.................................................... Appliration for Uhiposal Works Tonstrurtion ramit Application is hereby made for a Permit to Construct (/,�or Repair an Individual Sewage Disposal System at: 8/4-7Z/V 6 &.70 V&7Z,_,d, .... ............................ ..........*---------*-------- -------------­'"------------- ----------------------­.......................................Location-Address or Lot No.4 V ...................../ ... ....... ...... Owner --------rddres's------------------------------------------- ............................................ ....................................... 2 ................................... .... ............ Installer Address Type of Building Size Lot-AZ-_7-7­4........Sq. feet Dwelling—No. of Be drooms...........3.....................-----------Expansion Attic Garbage Grinder ( Other—Type of Building ............................ No. of persons....................._.._.._ Showers ( ) — Cafeteria ( Otherfixtures ..................................................................................................................................................... Design Flow......_.... ..............gallons per person per day. Total daily flow__._....... ... ..................gallons. .................... ...... Septic Tank—Liquid capacity.Z.e gallons Length_&/A Diameter________________ Depth.. Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No......../---------- Diameter---- Depth below inlet...... Total leaching area.',AC,�.....sq. f t. Z Other Distribution box Dosing tank ( ) 0-4 .. ... ----------------- Percolation Test Results Performed by.A ......... ----------------- Date r Test Pit No. 1................minutes per inch Depth of Test Pit---Z... ....... Depth to ground water-___--_____,__,.-______- (i Test Pit No. ...minutes per inch Depth of Test Pit----- Depth to ground water........................ --------------------------------- 3—Soy 6 0 Description of Soil...... 4 -- --------------------*------------------"--------------*------------------------------------------------------------ /,V"77-1 A,/&--s Z4 0/-- _:5?y-V,1V6rz. 6?4- 1V U ........................................................................................I...... -------T---------------------------------------------------e��- ................................ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- U Nature of R6pairs or Alterations—Answer when applicable............................................................................................... ...................................................................................................................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of-T'L- 5 of the State Sanitary Code—The undersign h;A'9!irter Lai es not to place the system 1 operation until a Certificate of Compliance has been d he boarqX441ealth. Signed- ................ ... ...... ..... 16.... ... */ D Date Application Approved By......... ---- ---- ..... .. .... .................... ... . Date' ... Application Disapproved for the following reasons:............................................................................................................... ......................................................................................................................................................................................................... Date- PermitNo......................................................... Issued........................................................ Date I& v THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ApplirFation for 14spooal Workfi Tonfitrnrtion Frrutit Application is hereby made for a Permit to Construct (4-ror Repair ( ) an Individual Sewage Disposal System at: C9L 1/L7�JQ/Z S I�� /.t...............................................�� /1�J` /'7I3 4-6— ...............• ............................ -..--•--•---------------•-•-•---••---------------_ ----•?'_--------......................... Location-Address _ ......................................./// nr e/. �/G--ZChi � wit/S27 42s'G e f?S S:...-. ............ or t Owner _ xddress Jcr..f G'7 A//5 .45 S r............ :.... Installer Address dType of Building Size Lot_ ........Sq. feet - Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) P14 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Ga Other fixtures -----------••................... .d W Design Flow........... ..........................gallons per person per day. Total daily flow_______..._ ......................gallons. WSeptic Tank—Liquid capacity_ 4 .gallons Length. `4.".... Width..f!?._Z '.. Diameter________________ Depth..-?=_:a. x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No......../..--------- Diameter.._....�0 fir_ Depth below inlet...... Total leaching area..V7......sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '-' Percolation Test Results Performed C/?SNyz• Date_..SLpT__Z `J�! J................ aTest Pit No. _minutes per inch Depth of Test Pit Depth to ground water "------^'•--..__ Test Pit No. 2.�L._-5-7....minutes per inch Depth of Test Pit..... 3T...... Depth to ground water---- ............ ------•-••-'-------------------------------- •'---......---•--•--------------•-----•-•--•---........................ �DDescription of Soil.....b3G� ` � �---- _. - ---------------- ................................. �------- ' / � L � � +__. --- . ---- _-----.._-*------ .-__ ! ................ ..._ w ..._....: . ............................ ____________________________________________•.....____......___.._....._._________._................___..._._...___....__.________..............................._..............._.__....._.__._.._..... V Nature of Repairs or Alterations—Answer when applicable._.............................................................................................. •----------------•'-------------••••------------......--------------------•-••-•----..........------••••••'-••"--------•.•------------••---••-•••-•---•...•-•-'-'----•'•'-'"-•--•----•----•--•--•••-•. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of .: I.,. S of the State Sanitabe: Co - The undersigned further a reel not to place the system in operation until a Certificate of Compliance has s .e y the board iealth. �. .Signed -- --•- ._.....• . ---•-"- ._. ... ate Application Approved By.....---- -•- A * ---------- Application Disapproved for the following reasons:---•--••---- ••••-••-----...'••------•--•••-•-----•-----••--••••-'..............•--•=------...._.------.....----•--••-...------•--•---•-•-------'•••'-•------••---------•-•--'•'------'------...-•--...-••-----•-•--- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �lfl/ !...........OF........e _ ST >il........`..—.......................... CIrrtifiratr of TI-Implianrr THIS IS. TO CERTIFY, That the Individual Sewage Disposal System constructed (/�or Repaired ( ) by.............. r ----•--.-- ._+----------------------• -------•--•-•--...------........------••--........----•-.............----------•-...._............---•-- Installer at................... '"'" has been installed in accordance with the provisions of T � of The State Sanitary Code as described in the application for Disposal Works Construction Permit No...�_ .. ...S7.1-------- dated.....::......................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................lr� � i��� .. Inspector-••--...� .._ ............................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No. FEE FEE......... ............ Disposal Workii Tongtr ion amit Permission hereby granted........... _ ----•. 'er -"......---'- •------••---.....•-••••------•--••••----•-•......................... to Construct or Repair ( an Individual Sewage Dispos System at No................. " Street as shown on the.application for D ction Per it Noo.�..................... D_ted.......................................... --....................................... / Bo o Health DATE....................................... ---------------- /!/---� �-- FORM 1255 HOBBS & WARREN, INC., PUBLISHERS u LoT'�� 4z.^ 7o r . . ht"DJla.v ICw � _ A►pGJrD • bo„ s• r.D 34 7 0 76 o ,, zo•• w,r>! ttoas ez,49.7a. , Noloo bYrdj'd� �T�tJ.t,iT�61'�j , 411 Z�c, Fr-j ez. ' 4o,1 / 36" Svti-Serit. �.v..S k (,'l t; E.�' HfFry W�Awes bl aT c v . 70 Z. - _ �' Jeri- uu oc Ar*0vs �• ZZ -Sri wt71 ! lao'ro Z6'Y I,/J gyp? AAD. W,"v 6+vcocJ 6K�er'r� �7 /�3J�nlJ9 6: r�i4+S�yr. G�• 6. yC. I MMMUM 6JILCV46i 5 SG�tI.� _..._ �g ^.._.3o J _._ -30" �Q�I'i' �-�' S1�• �-s' SEAR TKO 4V p 0A ! /V AN M O L 7-0D o FI f�O E aLEA µ�.d. 2% -- — — W,TwW ONE. Foc T OF ,JISM GRAGE AREA 2r1 of PGA STo►JE FM , (101Mi 2Arrp,A. CoVFA p�h8X .1BVttoN AMP RVtOv S CDY'P-�► -ro 5T P E lJ T' rimscal FROM aft�.4D� '�/ Ov-7 Z"NE t_ TC,H iQ M1N. �44u4/Ff / FGb cv v t 50 ii V d ll ; o oo o I,EACi4 'o WA 6 N F O ` 58,76 �/ 1 STONE P+�t' CAA GON 4rMi� ►NVERT a I' -- ,. � _! +� ' � RGLi1r�D sIEt .it AW V. fi�a . ., c. A VV4+SAI I pim .58.Zr po jvo GAR13AO GR+i�lR > aoo I ,s4. o � ;5 5EPTI•G 5Y5T�M CoNS'i'RUGf`I�N ��- � ALL. CONFOR/lA, -r 7HE MASS. NuM o �V-0-90OMS: VffZ©1NMENTAL CORE -r Tt.E g °. -- -- :.V t S D 7- 1-77 TttE 'MW1 t CJ) gtal f4 P-1.QVt/ . OAAfZo OF MtAL41-! 1Z&4UI.A-T)0 4ep S � — � ' AND L ACK I G, PAT -r'o t3 of , RSQ 1?. I. AGW G�PA '�� �Elt�1�'of��7 GoN��T'� s "��' fo�.tc.6tr'('E ST NcaT1-�3ua�F5► PRaPe � .EAek CAPAc1TY 20000 P51 rr'4s N 10 LOADirdq Ili Cif ORt-IE�AY No'r To aE LOCAISO � L EM U1 J Lea 1- 2p �� c:,,�° , QV 194 W �ti ; fat GaN 1.0 Qa� LA .jo.",r4D _ AL-L FI P�-ro ae W�AT�'fiG µT ,r _ SyS'feM lb �S � F1 �$E . R ► aee- 0AI31�. Rea:of vEEvs , _ CA5r /9I sLelt .T Aft ENGINEERING DESIGNING BUILDING INC. NA►1.'t'14 Ala � APPOVAl- DENNIS, MASS. 3052831 PROVIDE PRECAST CONCRETE EXTENSION 5"DIA. OUTLET(S) FINISH GRADE OVER CHAMBERS= 101 .0' - 102.0' GENERAL NOTES RISER WITH CONCRETE COVER TO WITHIN o 1. UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION TOP OF FOUNDATION 6"OF FINISH GRADE OVER OUTLET COVER. REMOVABLE COVER SLOPE @ 2!o MIN. OVER SYSTEM METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ELEV.= 106.E FINISH GRADE OVER D-BOX= 102.0' 4"SCHEDULE 40 PVC MIN SLOPE 1% 3/4"TO 1-1/2" DOUBLE WASHED STONE TO CROWN OF PIPE ENVIRONMENTAL CODE AND ANY APPLICABLE LOCAL RULES. FINISH GRADE @ FND. EL.= 104,3' FINISH GRADE OVER TANK EL.= 104.0' - 104.3' 2"OF 1/8"TO 1/2"DOUBLE WASHED STONE 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD 20"MIN.ACCESS COVER g"MIN , PLACE RISERS ON ALL CHAMBERS OF HEALTH AND THE DESIGN ENGINEER. /- (TYPICAL FOR 3) 36 MAX 36"MAX. 9"MIN. TOP OF SAS= 99.0$ TO 6"OF FINISHED GRADE 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL PROPOSED 4" 98.25' 36"MAX. BREAKOUT EL = 98.75' (99.15') BE USED IN DISPOSAL SYSTEM UNLESS OTHERWISE NOTED. SCHEDULE 40 PVC (98.32') ( )98,82' 4. TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE LESS MIN.SLOPE@2% - E 6" 3" 2"DROP MIN. PROVIDE WATERTIGHT THAN ELEVATION =98.82' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. 3"DROP MAX. 3" 9„ JOINTS (TYP.) oca ), o o UNLESS A 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE 10" 4" PVC IN FROM � OT= � TOP OF THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. (102.65 ) 14" (101 .60') SEPTIC TANK 4"PVC OUT TO O o 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. ' LEACHING FACILITY T T � 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. 101 .82 ( ,) � op0 � � 0 0 0 0 00( 12" 9$•95 0 00 7. LOCAL BOARD OF HEALTH TO BE NOTIFIED PRIOR TO BACK 48„ OUTLET TEE 9$.67' MIN. 98.50' 00 FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY (99.12') 6"CRUSHED STONE 0 0 0 0 0 pp � pp FOR INSPECTION. SYSTEM IS NOT TO BE BACK FILLED 22"ZABEL FILTER OVER MECHANICALLY �L� o WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF 11.9' MODEL#A1801 HIP(GAS COMPACTED BASE 4' _ I HEALTH. BAFFLE ON BOTTOM) 8•5' 4' 4' 4.9' 8. ELEVATIONS BASED ON ASSUMED DATUM OF 100.0'MSL OBTAINED 6" CRUSHED STONE 5 OUTLET DISTRIBUTION BOX 33.5 < 91 .50 (2 9.) FROM THE TOP OF A CONCRETE BOUND AS SHOWN ON PLAN. OVER MECHANICALLY TO BE INSTALLED ON A LEVEL STABLE GROUND WATER ELEV.= COMPACTED BASE BASE. FIRST TWO FEET OF OUTLET /C96.2519. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION PIPES TO BE LAID LEVEL. ' 3 - 500 GAL. CHAMBERS H-20 4'MIN. DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE PROPOSED 1500 GALLON CON& ETE SEPTIC0�, N (96.32 ) ( ) 4 MIN. AT 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY LENGTH 10.5' WIDTH 5.66' DEPTH 5.58' CROSS SECTION VIEW TYPICAL CHAMBER PROFILE CHAMBER DETAILS CHAMBER END VIEW 10. ALLJODISCRENTSWHEREPANCIES O THE DESIGN PIPEENTERSANDtEXTSCONCRETE SEPTIC TANK PROFILE DISTRIBUTION BOX DETAIL NOT TO SCALE NOT TO SCALE NOT TO SCALE STRUCTURES SHALL BE MADE WATERTIGHT. 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR _ TEST PIT DATAZONING REGULATIONS. OWNER/APPLICANT IS TO OBTAIN • 5 SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. INSPECTOR: 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS ' ?# LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH ' � ` SOIL EVALUATOR: John L. Churchill Jr. CASE THEY SHALL WITHSTAND H-20 LOADING. DATE: June 25, 2002 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND '� °_ , '•• � TEST PIT#: 1 FINES. 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND • k '1 . ELEV TOP= 102.50' UNSUITABLE MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES •' ELEV WATER= >1 V BGS OF LEACHING FACILITY. REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN • p COARSE SAND FREE FROM CLAY, FINES OR OTHER UNSUITABLE MATERIAL IN •'�. ' v A= � - •' �y' . PERC RATE= 3.3 MIN/IN ACCORDANCE WITH 310 CMR 15.255(3). • .. - tQ '� t DEPTH OF PERC= 54"-72" 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES • ll f _.�,;r. FOUND IN SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. ' • �I 50 TEXTURAL CLASS: 1 ( �{� , � � �, ♦ � �^� 16. PROPOSED PROJECT IS LOCATED WITHIN: t r • ! :F�` '+ ---� i 0 102.50' ASSESORS MAP 258 LOT 28-2 w. E ♦ • i ' t Top Soil ' `r i" • �•! '• " ;'j` A 10YR 3/2 17. OWNER OF RECORD: Herman N& Nancy L Woebcke 8" Sandy Loam 101.84' ADDRESS: 16 Governors Way • ;�, ' • - � `•<< a ' o Barnstable, MA 02630 1 ��� • , , ^�! B 10/o Boulder 20%Stone 10%Clay Content 18. PLAN REFERENCE: . ' Firm 1. "SUBDIVISION PLAN OF LAND IN BARNSTABLE, MASS. PROPERTY OF \ ( �° p • 50" 98.34' MARY HINCKLEY CRANE"JANUARY 16 1961 WHICH SAID PLAN IS DULY FILED IN THE BARNSTABLE COUNTY REGISTRY OF DEEDS IN 10tta 54" 98.50' PLAN BOOK 160, PAGE 13. S�3"53, 'Ile Q 0 _ -7 Perc 2. "SUBDIVISION PLAN LAND IN BARNSTABLE, MASS. KNOWN AS 13 45� Q 72" 97 GREENE ACRES" MMARCH14,1967, WHICH SAID PLAN IS DULY ° Ci lP a Loamy Sand .00 FILED IN THE BARNSTABLE COUNTY REGISTRY OF DEEDS IN PLAN C BOOK 214, PAGE 77. B.M. f? 3. " PLAN OF LAND IN BARNSTABLE, MASS. SURVEYED FOR TOP OF CONCRETE �2 t= ° ° 4 MARY H. CRANE"JULY 1971,WHICH SAID PLAN IS DULY BOUND �� ,1ti� - ! FILED BOOK IN THE PAGE 90STABLE COUNTY REGISTRY OF DEEDS IN PLAN ELEV. = 100.00'ASSUMED Q o \, -• _--_ __ t _ a No Groundwater PROPOSED 3-500 GALLON H-20 19. DEED REFERENCE:Encountered <p O005 LEACIING CHAMBERS LOCUS PLAN 132" 91.50' 1. "DEED FOR HERMAN N. WOEBCKE" MAY 11, 1983,WHICH SAID DEED \ IS DULY FILED IN THE BARNSTABLE COUNTY REGISTRY OF DEEDS IN CONC. BOUND 44QI PAGE 305.BOOK 3738, _ (FND) IV r SCALE: 1" = 1000' 20. ALL DISTURBED AREAS TO BE LOAM AND SEEDED. o / ROPOSED 1500 GALLON TANK DESIGN DATA LEGEND D 4 NUMBER OF BEDROOMS 4 (96.87') ACTUAL ELEVATION "AS-BUILT" 0. , o CONC. BOUND G�S "i ^ NUMBER OF PERSONS 3 -- - - -- EXISTING CONTOUR o ^' GAS r_ `n DESIGN FLOW 110 GAUDAY/BEDROOM co G t , �, i' T # 2) -A. TOTAL DESIGN FLOW 440 GAUDAY ® PROPOSED SPOT GRADES O ` 1 X O HC 2 EXISTING MAP 258 0 880 RNO -� DESIGN FLOW X 200 !o = GAUDAY PROPOSED CONTOUR (40 R-S ( (1 119, 4-BEDROOM LOT 28-2 USE PROPOSED 1500 GALLON SEPTIC TANK �/�,'D DWELLING �y yy W EXISTING WATERLINE �) 000 TOF= 106.6 AREA = 22,212 SQ.FT.± \ 5) HC 1 GAS GAS EXISTING GASLINE \ INSTALL 3- 500 GAL. CHAMBERS --- E/T/C EXISTING ELEC/TELEPHONE/CABLE(OVERHEAD) I \� CO A/C A/C GARAGE SIDEWALL CAPACITY TEST PIT LOCATION q l- \�- ON SLAB ' (LENGTH + WIDTH) (2 SIDES) (2' HIGH) (.74 GPD/S.F.) = GAUDAY _- LOTHROP (33.5'+ 12.9')(2 ) (2' ) ( .74 GPD/S.F.) = 137.3 GAUDAY Q Q Q PROPOSED 1500 GALLON SEPTIC TANK CONC. BOUND C (-✓T - HILL (FND) CEMETERY 4"SOLID SCHEDULE 40 PVC PIPE ' EXISTING 1000 GALLON SEPTIC TANK, BOTTOM CAPACITY DISTRIBUTION BOX 1 \ TO BE PUMPED, CRUSHED, AND BOTTOM 3 (LENGTH x WIDTH) (.74 GPD/S.F.) = GAUDAY \ TO BE PUNCTURED IN ACCORDANCE WITH o (33.5'x 12.9') (.74 GPD/S.F.) - 319.8 GAUDAY ' TITLE V Q 500 GAL. LEACHING CHAMBER Cd PROPOSED"D" BOX TOTALS: co ALL DISTURBED PAVEMENT TOTAL NUMBER OF CHAMBERS 3 O BE REPAVED TOTAL LEACHING AREA 617.7 SQ.FT. TOTAL LEACHING CAPACITY 457.1 GAL./DAY REV. DATE BY APP'D. DESCRIPTION ";4�39'S5~�, "AS-BUILT" SEPTIC SYSTEM EXISTING LEACHINGPIT TO BE 8�2' PREPARED FOR: FILLED WITH CLEADN SAND / HERMAN N & NANCY L WOEBCKE Ok k- (� ,'/ ' LOCATED AT 41 O� Q DESCRIPTION HC 1 HC 2 16 GOVERNORS WAY SEPTIC COVER IN (1) 17.1' 17.3' RESERVED FOR BOARD OF HEALTH USE BARNSTABLE, MA 02630 SEPTIC COVER OUT(2) 23.8' 23.7' V" SCALE: 1 INCH = 20 FT. DATE: JUNE 24, 2004 0 10 20 40 80 FEET D-BOX (3) 26.5' 30.9' „AS BUILT„ oF / r^O CHAMBER COVER(4) 36.4' 34.8' �°� JOHN L. CHUHtLL � PREPARED BY: �+ RC CHAMBER COVER(5) 34.1' 42.4' U CML . JC ENGINEERING, INC. PLAN No 41807 2854 CRANBERRY HIGHWAY --- ----- -- EAST WAREHAM, MA 02538 SITE PLAN 508.273.0377 SCALE: 1"=20' ��/1'� Drawn By: DS Designed By: JLC Checked By:JLC JOB No.242 TOP OF FOUNDATION PROVIDE PRECAST CONCRETE EXTENSION 5"DIA. OUTLET(S) FINISH GRADE OVER CHAMBERS= 101 .0' - 102.0' GENERAL NOTES ELEV. 106.6' RISER WITH CONCRETE COVER TO WITHIN ° 1. UNLESS OTHERWISE NOTED,ALL SYSTEM COMPONENTS AND CONSTRUCTION REMOVABLE COVER SLOPE @ 2/°MIN. OVER SYSTEM METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE 6"OF FINISH GRADE ABOVE OUTLET COVER FINISH GRADE OVER D-BOX= 102.0 4"SCHEDULE 40 PVC MIN SLOPE 1% 3/4"TO 1-1/2" DOUBLE WASHED STONE TO CROWN OF PIPE ENVIRONMENTAL CODE AND ANY APPLICABLE LOCAL RULES. FINISH GRADE OVER TANK EL.= 13° 2"OF 1/8"TO 1/2" DOUBLE WASHED STONE 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD - - - - - -- - - OF HEALTH AND THE DESIGN ENGINEER. TOP OF SAS= 99.08' TO 6" RISERS ON ALL CHAMBERS 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL 36"MAX• 9"MIN. TO 6 OF FINISHED GRADE BE USED IN DISPOSAL SYSTEM UNLESS OTHERWISE NOTED. 98.25' 36"MAX. BREAKOUT EL = 98.75 4. TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE LESS 2"DROP MIN. PROVIDE WATERTIGHT THAN ELEVATION=98.75' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. _ 6" 3" 3"DROP MAX. 3" 9 JOINTS (T�,P ) o S UNLESS A 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE Il 10' 4"PVC IN FROM " Q 0 0 0 0rc> 14" 100.75' SEPTIC TANK 4 PVC OUT TO o0 LEACHING FACILITY oo 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. . LOCAL BOARD OF _CD " VRIFY ONDIITOOF OUTLET TEE CONTRACTOR TO 198.67' MIN. 98,50'12" 2' o 00 o00 7 FIILLNG WHEN SYSTM IS NEARLY COMPLETETH TO BE NOTIFIED IAND READY TEES AND REPLACE " 000 oo FOR INSPECTION. SYSTEM IS NOT TO BE BACK FILLED 6 CRUSHED STONE 1 0 0 WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF I AS NECESSARY 22"ZABEL FILTER -L- o OVER MECHANICALLY MODEL#A1801 HIP(GAS COMPACTED BASE HEALTH. BAFFLE ON BOTTOM) 4 8.5' - I 4' 4.9' 4' 8. ELEVATIONS BASED ON ASSUMED DATUM OF 100.0'MSL OBTAINED v 5 OUTLET DISTRIBUTION BOX 33.5' (TYP.) FROM THE TOP OF A CONCRETE BOUND AS SHOWN ON PLAN. _ TO BE INSTALLED ON A LEVEL STABLE GROUND WATER ELEV.= < 91 •50' 12.9' 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION EXISTING 1000 GALLON CONCRETE SEPTIC TANK BASE. FIRST TWO FEET OF OUTLET 96.25 THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE LENGTH 8 -6 WIDTH 4 10 DEPTH PIPES TO BE LAID LEVEL. 3 - 500 GAL. CHAMBERS(H-20) 4'MIN. AT D SC REPANC ES TO THE DESIGN ENG NE RABLE AGENCIES. REPORT ANY �� CROSS SECTION VIEW SEPTIC TANK PROFILE DISTRIBUTION BOX DETAIL TYPICAL CHAMBER PROFILE CHAMBER DETAILS CHAMBER END VIEW 10. ALL JOINTS WHERE PIPE ENTERS ANDtJCITSCONCRETE NOT TO SCALE NOT TO SCALE NOT TO SCALE STRUCTURES SHALL BE MADE WATERTIGHT. 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR i j. 5 � • s' , „ ` � `�c='• TEST P IT DATA ZONING REGULATIONS. OWNER/APPLICANT IS TO OBTAIN l�Si "r� " • i' t ;��_ SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS = INSPECTOR: LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH �� •' �' f SOIL EVALUATOR: John L. Churchill Jr. CASE THEY SHALL WITHSTAND H-20 LOADING. •r ? ;'r• .ti..�.•�. :.�• �s ,*': . Jwe 25,2002 • •;ra �=r;t;':' ••; •N.z�rr�;; t.o ;, .� � • _ DATE: 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND TEST PIT#: 1 FINES. • -" ' 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND . . ELEV TOP= 102.50' UNSUITABLE MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES u ELEV WATER >11'BGS OF LEACHING FACILITY. REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN � • = i • COARSE SAND FREE FROM CLAY, FINES OR OTHER UNSUITABLE MATERIAL IN i • ti PERC RATE= 3.3 MIN/IN ACCORDANCE WITH 310 CMR 15.255(3). !j • ' ,p R • DEPTH OF PERC=_ 54"-72" 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. M TEXTURAL CLASS:_ 1 16. PROPOSED PROJECT IS LOCATED WITHIN: • 0 102.50' ASSESORS MAP 258 LOT 28-2 r. E � � • Top Soil• ' • y A 17. OWNER OF RECORD: Herman N & Nancy L Woebcke • � •a 10YR 3/?. 8 Sandy Loam 101.84' ADDRESS: 16 Governors Way B 10% Boulder Barnstable, MA 02630 , ^ I� 20%Stone 18. PLAN REFERENCE: • V 1 10%Clay Content 4wa Firm 1. "SUBDIVISION PLAN OF LAND IN BARNSTABLE, MASS. PROPERTY OF p 50" 98.34' MARY HINCKLEY CRANE"JANUARY 16, 1961, WHICH SAID PLAN IS DULY s * FILED IN THE BARNSTABLE COUNTY REGISTRY OF DEEDS IN 54" - 98.50 PLAN BOOK 160 PAGE 13. a� S73° q Perc 2. "SUBDIVISION PLAN LAND IN BARNSTABLE, MASS. KNOWN AS 5350"F 97.00' GREENE ACRES"MARCH 14,1967,WHICH SAIn PLAN IS DULY 4 13j4S ' 72" Loamy Sand FILED IN THE BARNSTABLE COUNTY REGISTRY OF DEEDS IN PLAN \ ,� C BOOK 214, PAGE 77. 3. "PLAN OF p LAND IN BARN 1 r dLE, MhSa. 5L RVEYLIJ FL)R B.M. TOP OF CONCRETE MARY H. CRANE"JULY 1971, WHICH SAID PLAN IS DULY +1 ` FILED IN THE BARNSTABLE COUNTY REGISTR OF DEEDS IN PLAN BOUND =w \ ELEV. = 100.00 ASSUMED � � -' BOOK 252, PAGE 90.No Groundwater 19. DEED REFERENCE: Q 4 in Q 1 3-500 GALLON H-20 I Encountered p A LEAQHING CHAMBERS 132" 91.50' 1. " DEED FOR HERMAN N.WOEBCKE" MAY 11, 1983,WHICH SAID DEED Q = I LOCUS PLAN IS DULY FILED IN THE BARNSTABLE COUNTY REGISTRY OF DEEDS IN CONC. BOUND ' Ao �, / ISTRUBUTION BOX BOOK 3738, PAGE 305. (FND) SCALE: 1"= 1000' 20. ALL DISTURBED AREAS TO BE LOAM AND SEEDED. GG 10 DESIGN DATA LEGEND o NUMBER OF BEDROOMS 4 - - 50 - - EXISTING CONTOUR �, GgIS 2�0' " %' ro CONC. BOUND \ o / / °i v NUMBER OF PERSONS 3 V_ 4 S� � `e' DESIGN FLOW 110 GAUDAY/BEDROOM 50 PROPOSED SPOT GRADES _ T # / �' v TOTAL DESIGN FLOW 440 GAUDAY `` .� 50 PROPOSED CONTOUR I O�� 1 8 s o �4 0' MAP 258 DESIGN FLOW X 200 % = 880 GAUDAY RNOR, f ( � EXISTING LOT 28-2 USE EXISTING 1000 GALLON SEPTIC TANK W w EXISTING WATERLINE S 140� �^ ` _ ( N 4-BEDROOM 80• �'1 r DWELLING co AREA = 22,212 SQ.FT.f GAS GAS EXISTING GASLINE TOF= 106.6 0 8.0, E/7/C r EXISTING ELEC/TELEPHONE/CABLE(OVERHEAD) 12 _ 1S s e'r 1 s INSTALL 3- 500 GAL. CHAMBERS TEST PIT LOCATION I �/ � ,/,q Y GARAGE SIDEWALL CAPACITY t�� 0 N ( Cj `j ` EXISTING 1000 GALLON SEPTIC TANK ON SLAB o I (LENGTH + WIDTH) (2 SIDES) (2'HIGH) (.74 GPD/S.F.) = GAUDAY I 1 ' ry LOTHROP (33.5'+ 12.9')(2 ) (2' ) ( .74 GPD/S.F.) = 137.3 GAUDAY HILL 4"SOLID SCHEDULE 40 PVC PIPE CON FND UND E/T/C E/T C / - E/T/ �E/ E/T/C 220. CEMETERY X ( ) .1 �- BOTTOM CAPACITY 0 DISTRIBUTION BO / (LENGTH x WIDTH) (.74 GPD/S.F.) = GAUDAY 0 500 GAL. LEACHING CHAMBER l / ALL DISTURBED PAVEMENT o - (33.5'x 12.9') (.74 GPD/S.F.) = 319.8 GAUDAY TO BE REPAVED co i TOTALS: 1 co TOTAL NUMBER OF CHAMBERS 3 1 7-19-02 BMB JLC RELOCATE CHAMBERS TOTAL LEACHING AREA 617.7 SQ.FT. TOTAL LEACHING CAPACITY 457.1 GAL./DAY REV. DATE BY APP'D. DESCRIPTION "'3°39s5 PROPOSED SITE PLAN-ALT 1 148.02' / PREPARED FOR: HERMAN N & NANCY L WOEBCKE 0 LOCATED AT 40 Q� `� 16 GOVERNORS WAY ZO - _ - - - _ - ---- _.__---- ------- ----- - -- --- -- BARNSTABLE, MA 02630 RESERVED FOR BOARD OF HEALTH USE SCALE: 1 INCH = 20 FT. DATE: JULY 5, 2002 0 10 20 40 80 FEET Of JOHN L `w^ PREPARED BY: CHURCHILL JR. JC ENGINEERING, INC. � CIVIL 41 No 41807 5 ROUNDHILL BLVD. - A EAST WAREHAM, MA 02538 SITE PLAN ------ _ 508.273.0377----__._ -- - SCALE: 1" =20' 7-/'�-o2 Drawn By. DS Designed By: JLC Checked By:JLC JOB No.242