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Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 4040 Main Street
Property Address
Stephen Grande
Owner Owner's Name
information is Cummaguid MA 02637 May 26 2010
required for City(rown State Zip Code Date of Inspection
every page.
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
Important: A. General Information
When filling out
forms on the
computer,use 1, Inspector:
only the tab key
to move your Patrick M. O'Connell
cursor-do not Name of Inspector
use the return
key. Septic Inspection Services Co.
Company Name
189 Cammett Road
Company Address 02648
Marstons Mllls MA
State Zip Code
reran Cityrrown Sl 508.428.1779 Licennsese Number
Telephone Number License
B. Certification
I certify that I have personally inspected the sewage disposal system at this address and that the
information reported below is true, accurate and complete as of the time of the inspection. The inspection
was performed based on my training and experience in the proper function and maintenance of on site
sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of
Title 5(310 CMR 15.000). The system:
7 ~' -4
® Passes ❑ Conditionally Passes ❑ 1 Faflls 5��
f =
❑ Needs Further Evaluation by the Local Approving Authority 3
O, €33
R
May 26, 2010 Job# 10-132
In ector's Si nature Date
The syst
em inspector shall submit a copy of this inspection report to the Approving Authoririj6j(Boarc
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.
rl"Syst/I
1 1 7Title 5 Official Inspection Form:Subsurface Sewage
t5ins•09108
f
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
4040 Main Street
Property Address
Stephen Grande
Owner Owner's Name
information is Cummaquid MA 02637 May 26 2010
required for State Zip Code Date of Inspection
every page. Citylrown
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E%always complete all of Section D
A) System Passes:
® I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
Cesspools were structurally sound overflow pit had 6"of standing water at time of inspection.
B) System Conditionally Passes:
❑ One or more system components as described in the"Conditional Pass" section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
Check the box for"yes", "no"or"not determined" (Y, N. ND)for the following statements. If"not
determined," please.explain.
The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is
structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System
will pass inspection if the existing tank is replaced with a complying septic tank as approved by the
Board of Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND (Explain below):
1,
Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17
(Sins•09/08
Commonwealth of Massachusetts
r Title 5 Official Inspection Form '
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M ..' 4040 Main Street
Property Address
Stephen Grande
Owner Owner's Name
information is CUM maquid MA 02637 May 26 2010
required for State Zip Code Date of Inspection
every page. Cityfrown
B. Certification (cont.)
B) System Conditionally Passes (cont.):
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ 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): }
C) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR
16.303(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
Title 5 Official Inspection Farm:Subsurface Sewage Disposal System-Page 3 of 17
t5ins-09/08
Commonwealth of Massachusetts
r Title 5 Official Inspection Form
a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
4040 Main Street
Property Address
Stephen Grande
Owner Owner's Name
information is Cummaquid MA 02637 May 26, 2010
required for
every page. City/Town State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate"yes" or"no" as to each of the following:
Yes No
® ❑ Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
❑ ® Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
❑ ® Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
❑ ® Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
Was the facility owner(and occupants if different from owner) provided with
® ❑ information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS)on the site has
been determined based on:
❑ ® Existing information. For example, a plan at the Board of Health.
® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) (310 CMR 15.302(5))
D. System Information
Residential Flow Conditions:
Number of bedrooms (design): Unknown Number of bedrooms (actual): 3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): N/A
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17
Commonwealth of Massachusetts
i Title 5 Official Inspection Form
s Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
4040 Main Street
Property Address
Stephen Grande
Owner Owner's Name
information is Cummaquid MA 02637 May 26, 2010
required for
State Zip Code Date of Inspection
every page. Cityrrown
B. Certification (cont.)
2. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well**.
Method used to determine distance:
**This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform
bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or
less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be
attached to this form.
3. Other:
D) System Failure Criteria Applicable to All Systems:
You must indicate "Yes" or"No"to each of the following for all inspections:
Yes No
El ® 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
El or clogged SAS or cesspool
❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less
than_day flow
t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 4040 Main Street
Property Address
Stephen Grande
Owner Owner's Name
information is Cumma uid MA 02637 May 26, 2010
required for q
every page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
Yes No
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ ® 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
tributarylo a surface water supply.
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply
well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered. A copy of the analysis
and chain of custody must be attached to this form.]
❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd.
❑ ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection
Area—IWPA) or a mapped Zone II of a public water supply well
6
If you have answered"yes"to any question in Section E the system is considered a significant threat,
or answered "yes In Section D above the large system has failed. The owner or operator of any large
system considered a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15.304. The system owner should contact the appropriate
regional office of the Department.
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 o117
Commonwealth of Massachusetts
Title 5 Official Inspection Form .
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
4040 Main Street
Property Address
Stephen Grande
Owner Owner's Name
information is Cumma uid MA 02637 May 26, 2010
required for q
every page. Cityrrown State Zip Code Date of Inspection
D. System Information
Description:
0
Number of current residents:
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
N/A one meter
Water meter readings, if available (last 2 years usage (gpd)): for two units.
Detail:
Sump pump? ❑
Yes ® No
Unknown
Last date of occupancy: Date
Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow (based on 310 CMR 15.203): Gallons per day(gpd)
Basis of design flow (seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Industrial waste holding tank present? ❑ Yes El No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17
I I�
f
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
r 4040 Main Street
Property Address
Stephen Grande
Owner Owner's Name
information is required for Cummaq uid MA 02637 May 26, 2010
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Last date of occupancy/use: Date
Other(describe below):
General Information
Pumping Records:
Source of information: None
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped:
gallons
How was quantity pumped determined?
Reason for pumping:
Type of System:
❑ Septic tank, distribution box, soil absorption system
❑ Single cesspool
® Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner) and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
15ins-09/08 Title 5 Official Inspection Form.Subsurface Sewage Disposal System-Page 8 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
R Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
y 4040 Main Street
Property Address
Stephen Grande
Owner Owner's Name
information is required for q Cumma uid MA 02637 May 26 2010
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known) and source of information:
Unknown
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
1'
Depth below grade: 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: 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:
Sludge depth:
l5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17
Commonwealth of Massachusetts
r Title 5 Official Inspection Form
o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
r 4040 Main Street
Property Address
Stephen Grande
Owner Owner's Name
information is Cumma uid MA 02637 May 26, 2010
required for q Y
every page. Citylrown State Zip Code Date of Inspection
D. System Information (cont.)
Septic Tank(cont.)
Distance from top of sludge to bottom of outlet tee or baffle
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
How were dimensions determined?
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Grease Trap (locate on site plan):
Depth below grade: feet
Material of construction:
❑ concrete ❑ metal ❑ fiberglass El 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
15ins-09/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17
Commonwealth of Massachusetts
. Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
4040 Main Street
Property Address
Stephen Grande
Owner Owner's Name
information is Cumma uid MA 02637 May required for q Y 26, 2010
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Capacity:
gallons
Design Flow: gallons per day
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments (condition of alarm and float switches, etc.):
`Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No
15ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 o117
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M 4040 Main Street
Property Address
Stephen Grande
Owner Owner's Name
information is Cumma uid MA 02637 May 26, 2010
required for q y
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Distribution Box (if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert
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.):
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.):
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17
Commonwealth of Massachusetts
r Title 5 Official Inspection Form
o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
4040 Main Street
Property Address
Stephen Grande
Owner Owner's Name
information is Cumma uid MA 02637 May 26, 2010
required for q y
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Type:
❑ leaching pits number:
❑ leaching chambers number:
❑ leaching galleries number:
❑ leaching trenches number, length`.
❑ leaching fields number, dimensions:
® overflow cesspool number: One 6x6 precast
pit.
❑ 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.):
Pit had 6"of standing water with no definite high stains. No evidence of surcharge found.
Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration Two with overflow pit.
Depth—top of liquid to inlet invert
5'
Depth of solids layer 011
011 Depth of scum layer
Dimensions of cesspool 6x6
Materials of construction Block
Indication of groundwater inflow ❑ Yes ® No
l5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
4040 Main Street
Property Address
Stephen Grande
Owner Owner's Name
information is Cumma uid MA 02637 Ma 26, 2010
required for a Y
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
Cesspools were found empty with stain lines at overflow pipes. Cesspools were structurally sound.
Privy (locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
15ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17
Commonwealth of Massachusetts
w r Tizfiie 5 Offic a Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
o
4040 Main Street -
Prop6ty Address
Stephen Grande
Owner Owners Name
information is Cum,maguid _ _ MA 02637 May 26 2010
required for Gitylrown State Zip Code Date of Inspection
every page.
D. system Information (cont.)
Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to
at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate
-ter-suDDIV.e.nte-rs the_buiIding...Check one of the boxes below:
Main S met Route 6A:
Water Service
31 ,
67 . 8
24
44
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
w„ 4040 Main Street
Property Address
Stephen Grande
Owner Owner's Name
information is Cumma uid MA 02637 _ May 26, 2010
required for q Y
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
® Check Slope
® Surface water
® Check cellar
® Shallow wells
Estimated depth to high ground water: 12+
feet
Please indicate all methods used to determine the high ground water elevation:
❑ Obtained from system design plans on record
If checked, date of design plan reviewed: Date
® Observed site (abutting property/observation hole within 150 feet of SAS)
❑ Checked with local Board of Health -explain:
❑ Checked with local excavators, installers - (attach documentation)
❑ Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
Observation hole to 12'found-no water.
F
}
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
15ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
4040 Main Street
Property Address
Stephen Grande
Owner Owner's Name
information is required for q Cumma uid MA 02637 May 26, 2010
every page. City/Town State Zip Code Date of Inspection
E. Report Completeness Checklist
® Inspection Summary: A, B, C, D, or E checked
® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed
® System Information—Estimated depth to high groundwater
® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17
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TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
MAP 351—PARC 044
Property Address: 4400 Main Street—Route 6A
CummNuid,MA 02637
Owner's Name: Fox,Greg
Owner's Address: 12 Vesper Lane
Yarmouth Port,MA 02675
Date of Inspection March 25,2005
Name of Inspector:(please print) James D.-Sears
Company Name: A&B Canco
Mailing Address: 350 Main Street
West Yarmouth,MA 02673
Telephone Number: 508-775-2800
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. I am a DEP
approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system:
Passes
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
Fails q
Inspector's Signature: Date:
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or
DEP)within 30 days of completing this inspection. If the system is a shared systein 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 tot he buyer,if applicable,and the approving authority.
Notes and Comments
'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 Fonn 6/15,'2WO,{ 1
Page 2 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 4400 Main Street,Route 6A
Cummaquid,MA 02637
Owner: Fox,Greg
Date of Inspection: March 25,2005
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: N/A
One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.
The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass.
Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined'
please explain.
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 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
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)" o
broken pipe(s)are replaced
obstruction is removed
ND explain:
X
Title 5 Inspection Form 6/15/2000 2
Y
Page 3 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE,SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(CONTINUED)
Property Address: 4400.Main Street
Cummaquid,MA 02637
Owner: Fox, Greg
Date of Inspection: March 25,2005
C. Further Evaluation is Required by the Board of Health:N/A
Conditions exist which require further evaluation by the Board of Health in order to determine if the system is
failing to protect public health,safety,or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the
system is not functioning in a manner which will protect public health safety and the environment:
Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or salt marsh
2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the
system is functioning in a manner that protects the public health,safety and environment:
The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a
surface water supply or tributary to a surface water supply.
The system has a septic tank and SAS and the SAS is within a Zone 1 of public water supply.
The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well.
The system has a septic tank and SAS and the.SAS is less than 100 feet but 50 feet or more from a
private water supply well". Method used to determine distance
** This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform
bacteria 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.
3. Other:
Title 5 Inspection Form 6/15/2000 3
Y
Page 4 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(CONTINUED)
4
Property Address: 4400 Main Street
Cummaquid,MA 02637
Owner: Fox, Greg
Date of Inspection: March 25,2005
D. System Failure Criteria applicable to all systems: N/A
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 pits is less than 6"below invert or available volume is less than%day flow
vl— 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
N/A Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a
surface water supply
N/A Any portion of a cesspool or privy is within a Zone 1 of a public well
N/A Any portion of a cesspool or privy is within 50 feet of a private water supply well
N/A 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 or less than 5 ppm,provided that no other
failure criteria are triggered. A copy of the analysis must be attached to this form.)
NO (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as
described in 310 CMR 15.303,therefore the system fails. The system owner should contact
the Board of Health to determine what will be necessary to correct the failure.
E. Large Systems: N/A
To be considered a large system the system must service a facility with a design flow of 10,000 gpd to
15,000 gpd.
You must indicate either"yes" or"no to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
Yes No
the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—.IWPA)or a
mapped Zone H 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 is 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.
Title 5 Inspection Form 6/15/2000 4
i
Page 5 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 4400 Main Street
Cummaquid,MA 02637
Owner: Fox,Greg
Date of Inspection: March 25,2005
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
if 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)
if Was the facility or dwelling inspected for signs of sewage back up?
If Was the site inspected for signs of break out?
if Were all system components,excluding the SAS,located on site?
If 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)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(3Xb)]
Title 5 Inspection Form 6/15/2000 5
,�r
Page 6 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 4400 Main Street
Cummaquid,MA 02637
Owner: Fox, Greg
Date of Inspection: March 25,2005
FLOW CONDITIONS
RESIDENTIAL✓
Number of Bedrooms(design): 5 Number of bedrooms(actual): 5
DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms: 550
Number of current residents: 4
Does residence have a garbage grinder(yes or no): YES
Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required]
Laundry system inspected(yes or no): YES
Seasonal use(yes or no): NO
Water meter readings,if available(last 2 years usage(gpd)): WELL
Sump pump(yes or no) NO
Last date of occupancy: PRESENT
COMMERCIAL/INDUSTRIAL
Type of establishment:
Design flow(based on 310 CMR 15.203):
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 system(yes or no):
Water meter readings,if available:
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information: N/A _
Was system pumped as part of the inspection(yes or no): NO
If yes,volume pumped: gallons—How was quantity pumped deteianined?
Reason for pumping:
TYPE OF SYSTEM
✓ Septic tank,distribution box,soil absorption system
Single cesspool
Overflow cesspool
Privy
Shared system(yes or no)(if yes,attach previous inspection records,if any)
Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be
obtained from system owner)
Tight tank Attach copy of the DEP approval
Other(describe):
Approximate age of all component!.,date installed(if known)and source of information:
1998—PERMIT#95-106
Were sewage odors detected when arriving at the site(yes or no): NO
Title 5 Inspection Forni 6/15/2000 6
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 4400 Main Street
Cummaquid,MA 02637
Owner: Fox, Greg
Date of Inspection: March 25,2005
BUILDING SEWER(locate eon.site plan): ✓
Depth below grade: 12"
Materials of construction: Cast iron ✓ 40 PVC _ other(explain)
Distance from private water supply well or suction line:
Comments(on condition of joints,venting,evidence of leakage,etc.):
SEPTIC TANK(locate onsite plan): ✓
Depth below grade: 12"
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: 1500-GALLON PRE CAST
Sludge depth: 2"
Distance from top of sludge to the bottom of outlet tee or baffle: 28"
Scum thickness: 2"
Distance from top of scum to top of outlet tee or baffle: 8"
Distance from bottom of scum to bottom of outlet tee or baffle: 16"
How were dimensions determined: ASBUILT&TAPE
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as
related to outlet invert,evidence of leakage,etc.):
MAIN TANK AT WORKING LEVEL,INLET TEE,OULET TEE.
NO SIGN OF LEAKAGE OR OVERLOADING.
GREASE TRAP(located on site plan) N/A
Y
Depth below grade:
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:
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as
related to outlet invert,evidence of leakage,etc.):
Title 5 Inspection Form 6/15/2000 7
' E
Page 8 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 4400 Main Street
Cummaquid,MA 02637
Owner: Fox, Greg
Date of Inspection: March 25,2005
TIGHT or HOLDING TANK: N/A (tank must be pumped at time of inspection)(locate on site plan)
Depth below grade:
Material of construction: concrete metal fiberglass polyethylene other(explain)
Dimensions:
Capacity: gallons
Design Flow: gallons/day
Alarm present(yes or no)
Alarm level: Alarm in working order(yes or no):
Date of last pumping
Comments(condition of alarm and float switches,etc.):
DISTRIBUTION BOX: (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: 0
Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of
leakage into or out of box,etc.,):.
D-BOX IS CLEAN&SOLID,NO SIGN OF OVER LOADING OR SOLID CARRY OVER.BOX IS LOCATED IN
WALK WAY UNDER CEMENT SLAB.BOX WAS INSPECTED W/CAMERA. 1 LINE IN—2 LINES OUT.
PUMP CHAMBER: N/A (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 of pumps and appurtenances,etc.):
Title 5 Inspection Form 6/15/2000 8
I
Page 9 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 4400 Main Street
Cummaquid,MA 02637
Owner: Fox, Greg
Date of Inspection: March 25,2005
SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required)
If SAS not located explain why:
Type
•/ leaching pits,number: 2
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.)
LEACHING IS 2 PRE CAST PITS,PITS ARE 44"BELOW GRADE W/H-20 COVERS AT 16"X 16".WATER
STAIN LINE AT 20".NO SIGN OF OVER LOADING OR SOLID CARRY OVER.
CESSPOOLS: N/A (cesspool must be pumped as part of inspectionX locate on site plan)
Number and configuration:
Depth—top of liquid to inlet invert:
Depth of solids layer:
Depth of scum layer:
Dimensions of cesspool:
Materials of construction:
Indication of groundwater inflow(yes or no):
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation etc.):
PRIVY: N/A (locate on site plan)
Materials of Construction:
Dimensions:
Depth of solids:
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.)
Title 5 Inspection Form 6/15/2000 9
i
Page 10 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
: SYSTEM INFORMATION(continued)
Property Address: 4406 Main Street
Cummaquid,MA 02637
Owner: Fox, Greg
Date of Inspection: March.25,2005
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 gllnnl,,
1
LA
� K
A -/
ter`.
Title 5 Inspection Form 6/1 5/2000 10
Page 11 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 4400 Main Street
Cummaquid,MA 02637
Owner: Fox, Greg
Date of Inspection: March 25,2005
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to groundwater 21 feet
P
Please indicate(check)all methods used to determine the high ground water elevation:
Obtained from system design plans on record-If checked,date of design plan reviewed:
-7— Observation site(abutting proyertv/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:.
BOTTOM OF PIT AT 11'
AREA HILL ABUTTING PROPERTY DROPS OFF 10'.
r-
LET
7
Tide 5 Inspection Form.6/15/200O 1 1
i f. �✓
No.—4=------- Fee
BOARDOF HEALTH
TOWN OF BARNSTABLE
Apprication-*rVe[I ContructionPermit
Application is hereby made for a permit to Construct (7!), Alter ( ), or Repair ( )an individual Well at:
Location — Address Assessors Map and Parcel
Owner Address
-Ab
------ -------------
Installer — Driller _ — Address
Type of Building
Dwelling------------------------------------------------------------
Other,.- Type of Building--------------—------------------- No. of Persons--------------------------------__--
Type of Well _9a�U ------ Capacity-- =%5- 4-s --—
Purpose of Well--= PSi j€'Vl �---1 m T(-e _PQ
Agreement:
The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The
Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to
place the well in operation until a Certifica of Compliance has been issued by the Board of Health.
Signed - - - - ----— — - /�S`, ---
date
Application Approved By � -- ------------ date
Application Disapproved for the following reasons:---------------.---___—_________________-________________—__—___—__________
---------------------- ---
date
Permit No. __ g�_ --- ---- Issued-------------------------—-- ---— -----------
date
BOARD OF HEALTH
TOWN OF BARNSTABLE
(Certifitate ®f (Compliance
THIS IS TO CERTIFY, That the Individual Well Constructed ()), Altered ( ), or Repaired ( )
by------------— ------
Installer
at---------q`ice--ac_ =a�— --- — -- - -
has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection
Regulation as described in the application for Well Construction Permit No.GJ-7-- ---Dated-----------------=
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE-----------------—-- —-- -- Inspector-------------------------------------------- =- ------------
s
Fee----
BOARD OF HEALTH J`
TOWN OF BARN.STAE�L'E
0(oplicat ton ArWell Con5tructiou'Vermit
Application is,hereby made for a permit to Construct (7f), Alter ( ), or Repair ( )an individual Well at:
Location Address A41P,s3ors Map and Parcel
Owner Address
� � ►n n lU _�c,c o�/ _-_�_ /!lL--------- __----- - ay UiPl.E.4�s
- -- ------ -- -
Installer - Driller _ Address
Type of Building
Dwelling-------------------------------------------- ---------------
Other - Type of Building --- --- ------- No. of Persons-----=------------------- -
c1 -4 1. Type of Well--------3---�---o---�U�----------_---- Capacity--- - -
Purpose of Well--
Agreement:
The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The
Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to
place the well in operation until a Certificate .of Compliance has been issued by the Board of Health.
Signedl
t date
Application Approved By—
`� ----------—— date
Application Disapproved for the following reasons:'— --------------------------------------------------------__—_
---------------------- --
----- --------------------------------------------------------
date
Permit No. -- = ?� -. _ Issued-- -- - - ----- - --------
date
BOARD`6F EALTH% - tI
T-OWN OF' BARNSTABLE
- Certificate Of Compliance K
THIS IS TO CERTIFY, That the Individual Well Constructed (4,), Altered ( ), or Repaired ( )
- a
bY-------- =� --—--- -
Installer
at -----—------------------- - ---
has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection
Regulation as described in the application for,Well Construction Permit No. - - -= �--Dated ------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE-- - -= __,: �= -- '' . 'Inspector--------------------------------------—— - ------------
BOARD OF HEALTH
TOWN OF BARNSTAB`LE
{ .Well Construct ion permit
t
No. Fee-- L/ - ==
fPermission is hereby granted —------- -
to Construct ( Alter ( ), or Repair ( ) an Individual Well at:
No. - — -- ------= ---— - ---- --_—-- -—— --— —- -------------------------------
Streec
as shown on the application for"'a Well Construction Permit
No. - _—--_ ---- —-------- --- --
-- Dated----�"----�--�=--�--� ---------------------------------
------------- -----------------------
I�
Board of Health
DATE_--- ——--- -- --
I
Mq t
Department of Environmental Management/Division of Water Resources
' WELL COMPLETION REPORT
WELL LOCATION GEOGRAPHIC DESCRIPTION
Address "Yy00 / -11A1
p ��� �C� N S E W of,
(leaf) (circle)
City/Town ///1
Well owner +��lwrA.t1 (road)
Address /715 hse T,CAI. N S E W of
/(7L�QNSTi,kgG� /1- a O��CJ (mi.in tenths) (circle)
Board„5f Health permit obtained: yes 9-11 no ❑ intersect. w/
(road)
WELL USE WELL DATA
Domestic Public❑ Industrial ❑ Total well depth ft.
Monitoring❑ Other Depth to bedrock ft.
Water-bearing rock/unconsol!dated material:
Method drilled ee
�O_3 Description
Date drilled Water-bearing zones:
CASING ��// 1) From To
Type ��7 70 PUC" 2) From To
Length 61 ft. Dia(I.D.) in. 3) From To
Length into bedrock ft. Gravel pack well: dia.
Protective well seal: dia.
Screen:
Grout ❑ Other Slot# Zo? length 4IL—from to +'
STATIC WATER LEVEL (all wells)
Staticwater level below land surfaced ft. Date—
WELL TEST(production wells)
Drawdown /D ft. after pumping � r.o,�D min. at—Xgpm
How measured � ecovery�t1111"`raft&__1_yAr. min.
LOO;';of FORMATIONS COMMENTS
Materials From To
Cb
O
Driller—
Firm (/ CGC iGf i/r
All Address ylQl/6Pit �-'
City/Town
Supervising Driller Reg.# 9/E
Signature o supervising registered well driller '
Please print firmly
BOARD OF HEALTH COPY
II ` TOWN OF BARNSTABLE , G
LOCATIONy`,/PPS' /f�i�/yICJI 5T� SEWAGE #
VILLAGE G 404-An- a Y-,f 2 ASSESSOR'S MAP & LOT -
INSTALLER'S NAME&PHONE NO. &ef rltle, lj
SEPTIC TANK CAPACITY /.�—csn -�,A- --
LEACHING FACILITY: (type) f' ZA— (size) 4-
NO.OF BEDROOMS °r
BUILDER OR
PERMIT COMPLIANCE DATE: i-
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
I
I
k
1-
�lqo
i �
ENVIROTECH LABORATORIES, INC.
-- _'-- VIA-Cert. No.: M-MA 063 -- - --- _
449 Rte.130
-Sandwich, MA 02563 -
(508) 888-6460 1800-339-6460
FAX(508) 888-6446
z
CLIENT: Greg&Susan Fox :LOCATION: 440 Main St.
.ADDRESS: -17.8unset Lane Map 351 Pcl 65
Barnstable, MA 02630 Cummaquid, MA
COLLECTED BY: Desmond Wells SAMPLE DATE: 10-3-97
SAMPLE TIME: 8:30AM
WATER SAMPLE TYPE: New Well DATE RECEIVED: 10-3-97
LAB I.D.#: 9710081
WELL SPECS.: 4"/657 32'
,RESULTS OF ANALYSIS:
1�
Parameters Units Recommended Results Method
Limits
Coliform bacteria /100ml 0 0 9222 B
pH pH units 6.5-8.5 5.80 4500 H+
Conductance umhos/cm '500 - 184 120.1
Sodium,., mg/L' 28.0 22.7- , 200.7.'L'..;
Nitrate-N/Nitrite-N mg/L° ` 10`0` 2.15 4500-NO3 E
Iron mg/L 0.3 0.12 200.7
Manganese mg/L 0.05 0.024 200.7
COMMENTS: Low pH indicates high corrosive characteristics.
YES WATER IS SUITABLE FOR DRINKING PURPOSES FOR PARAMETERS TESTED.
Date* -)-
Ro ald J. Saa
Laboratory Di ctor
<=less than
>=greater than
TNTC=too numerous to count
DEC-09-97 TUE 16:08 ENVIROTECH LABS 508 888 6446 P. 03
Page 3 of 5._
R.I. AxWyt ical LaboratOries, lnC-
CRRTI ICATE OF ANALYS)!S
Envirotech Laboratories, Inc.
Date Received: 10/06/97
Work Order# 9710-04424
Sample#: 1
440 MAIN ST 10/3/97
SAMPLE ANALYZED
PARAMETER RESULTS/UNITS METHOD DATE/TIlAE ANALYST
1,1,1,2-Tetrachloroethane <0.5 ug/1 EPA 524.2 10/10/9710:14 MED
1,1,2,2-Tetrachloroethane <0.5 ug/1 EPA 524.2 10/10/9710:14 MED
Tetrachloroethene <0.5 ug/1 EPA 524.2 10/10/9710:14 MED
1,2,3-Tdchloropropane <0.5 ug/1 EPA 524.2 10/10/9710:14 MED
Toluene <0.5 ug/i EPA 524.2 10/10/97 10,14 MED
Xyienes <0.5 ug/1 EPA 524.2 10/10/97 10:14 MED
1,20bromo-3-Chloropropane <10 ug/1 EPA 524.2 10/10/97 10.14 MED
Bromochloromethwe <1 u9/1 EPA 524.2 10/10/9710:14 MED
n-Butylbenzene <0.5 ug/l EPA 524.2 10/10/9710:14 MED
Dichlorodifluoromethane <0.5 ug/1 EPA 524.2 10/10/9710:14 MED
Tricblorot]uoromethane <0.5 ug/l EPA 524.2 10/10/97 10:14 MED
Hexachlorobutadiene <0.5 U911 EPA 524.2 10/10/97 10:14 MED
Isopropylbenzene <0.5 ug/l EPA 524.2 10/10/97 10:14 MED
p-Isopropyltoluene <0.5 ug/1 EPA 524.2 10/10/9710:14 MED
Naphthalene <0.5 ug/l EPA 524.2 10/10/97 10:14 MED
a-Propylbenzene <0.5 us/1 EPA 524.2 10/10197 10:14 MED
sec-Butylbenzene <0.5 U94 EPA 524.2 10/10/97 10:14 MED
text-Butylbenzene <0.5 ug/1 EPA 524.2 10/10/97 10:14 MED
1,2,3-T ichlorobenzene <0.5 ug/1 EPA 524.2 10/10/97 10:14 MED
1,2,4-Ttichlorobenzene <0.5 ugll EPA 524.2 10/10/97 10,14 MED
1,2,4-Trimethylbenzene <0.5 ug/1 EPA 524.2 10110/9710:14 MED
1,3,5 Trimethylbenzene <0.5 u911 EPA 524.2 10/1019710:14 MED
Methyl Tertiary Buthyl Ether <1 ug/I EPA 524.2 10/10/97 10:14 MED
Hexane <10 ug/I EPA 524.2 10/10/97 10:14 MED
4-Bromotluorobenzene(SUR) 94 % EPA 524.2 10/10/97 10:14 MED
1,2-Dichlorobenzene-&(SUR) 93 % EPA 524.2 10/10/97 10:14 MED
DEC-09-97 TUE 16 :07 ENVIROTECH LABS 508 888 6446 P. 02
Page 2 of 5
R.I. Analytical Laboratories, Inc.
CERTIFICATE OF ANALYSIS
Envirotech Laboratories, Inc.
Date Received; 10/06/97
Work Order# 9710-04424
Sample#: 1
SAMPLE DESCRIPTION: 440 MAIN ST 10/3/97
4
SAMPLE ANALYZED
PARAMETER RESULTS/UNITS METHOD DATE/TME ANALYST
Volatile Organic Compounds
Bromodichloromethane <0.5 ug/l EPA 524.2 l0/10/97 10:14 MED
Bromgjgrm <0.5 ug/l EPA 524.2 10110/9710:14 MED
Dibromochloromethane <0.5 ug/l EPA 524.2 10/10/9710:14 MED
Chloroform <0.5 ugA EPA 524.2 10/1019710:14 MED
1,2-Dibromoethane <0.5 ug/1 EPA 524.2 10110/9710:14 MED
Benzene <0.5 ugll EPA 524.2 10/10/9710:14 MED
Carbon Tetrachloride <0.5 ag/1 EPA 524.2 10/10/9710:14 MED
1,2-Dichloroethane <0.5 ug/l EPA 524.2 10/10/9710:14 MED
Trichloroethene <0.5 ug/1 EPA 524.2 10/10/9710:14 MED
1,4-Dichlorobeanne <0.5 u911 EPA 524.2 10/10/9710:14 MED
1,106bloroethane <0.5 ugA EPA 524.2 10/10/9710:14 MED
1,1,i-Trichloroethane <0.5 USA EPA 524.2 10/10/97 10.14 MED
Vinyl Chloride <0.5 u9/1 EPA 524.2 10/10/9710:14 MED
Bromobemne <0.5 ug/1 EPA 524.2 10/10/9710:14 MED
Bromomethane <10 ug/1 EPA 524.2 10/10/97 10:14 MED
Chlorobenzene <0.5 ug/I EPA 524.2 10/10/97 10:14 MED
Chlomethane <5 ug/1 EPA 524.2 10/10/97 10:14 MED
Chloromethane <5 u9/1 EPA,524.2 10/10/91 10:14 MED
2-Cblorotoluene <0.5 ag/1 EPA 524.2 10/10/9710:14 MED
4-Chlorotoluene <0.5 U911 EPA 524.2 10/10/9710:14 MED
Dibromomethane <2 U94 EPA 524.2 10110/9710:14 MED
0-Dichlorobenzene <0.5 ug/l EPA 524.2 10/10/97 10:14 MED
1,2-Dichlorobenzene <0,5 ug/1 EPA 524.2 10/10/97 10:14 MED
trans-1,2-DicMoroed=e <0.5 ugll EPA 524.2 0!I 10t971i:14 MED
cis-1,2-Dichloroethene <0.5 ugli EPA 524.2 10/10/9710:14 MED
Methylene Chloride <0.5 ug/1 EPA 524.2 10/10/9710:14 MED
1,1-Dichloroethene <0.5 ug/1 EPA 524.2 10/10/9710:14 MED
1,1-Dichloropropene <0.5 ' ugA EPA 524.2 10/10/97 10:14 MED
1,2-Dichloropropane <0.5 US/I EPA 524.2 10/10/9710:14 MED
1,3-Dichloropropane <0.5 ug/1 EPA 524.2 10/10/97 10:14 MED
1.3-Dichloropropene <0.5 ug/1 EPA 524.2 10/10/97 10:14 MED
2,2-Dichloropropane <0.5 ugA EPA 524,2 10/10/97 10:14 MED
Ethylbenzene <0.5 ugn EPA 524.2 10/10/9710:14 MED
Squat <0.5 u9/1 EPA 524.2 10/10/97 10:14 MED
13,2-Trichloroethane <0.5 ng/1 EPA 524.2 10/10/97 10:14 MED
DEC-09-97 TUE 16 :05 ENVIROTECH LABS 508 888 6446 P. 01
' ENVIROTECH LABORATORIES, INC.
- -MA Cert_NQ,,M-MA 063 - -
449 Rte.130
- Sandwich; MA 02563 -
(508)888-$4601800-339-6460
FAX(508)888-6446
CLIENT: Greg&Susan Fox LOCATION: 440 Maln St.
ADDRESS: 17 Sunset Lane Map 351 Pcl 65
Barnstable,MA 02M Cummaquid, MA
;COLLECTED BY: Desmond Wells SAMPLE DATE: 10-3-97
SAMPLE TIME: 8:30AM
.1 WATER SAMPLE TYPE: New Well DATE RECEIVED: 10-3-97
LAB I.D.#: 9710081
WELL SPECS.: 4"/657 32'
RESULTS OF ANALYSIS:
Parameters Units Recommended Results Method
Limits
Coliform bacteria /100ml 0 0 9M B
PH PH units 6.".5 6.80 4500 H+
Conductance umhos/cm 6W 184 120.1
Sodium mg/L 28.0 22.7 200.7
Nitrate-N/Nitrite-N mg/L. 10.0 2.16 4500,NO3 E
Iron mg/L 0.3 0.12 200.7
Manganese M91L 0.05 0.024 200.7
Volatile Organics ug/L See attached report. ND EPA 524.2
ND=None Detected.
COMMENTS: Low PH indicates high comosive characteristics.
YES WATER IS SUITABLE FOR DRINKING PURPOSES FOR PARAMETERS TESTED.
DEC-09-97 TUE 16 :07 ENVIROTECH LABS 508 888 6446 P. 01
ENVIROTECH LABQRATORIES, INC.
—
449 Rte.130
Sandwictr, MA 02563
(508)888-6460 1800-339-646a
FAX(508)888-6446
CLIENT: Greg S Susan Fox LOCATION: 440 Main St.
ADDRESS: 17 Sunset Lane Map 351 Pet 65
Barnstable,MA 02630 Cummaquid, MA
COLLECTED BY: Desmond Wells SAMPLE DATE: 10-3-97
SAMPLE TIME: 8:30AM
WATER SAMPLE TYPE: New Well DATE RECEIVED: 10-3-97
LAB I.D.M 9710081
WELL SPECS.: 41657 3Z
RESULTS OF ANALYSIS:
Parameters Units Recommended Results Method
Limits
Coliform bacteria /100MI 0 0 9222 B
PH pH units 6.5-8.5 5.80 4500 H+
Conductance umhos/cm 500 184 120.1
Sodium mg/L 28.0 22.7 200.7
Nitrate-WNitrite-N mg/L 10.0 2.15 4500-NO3 E
Iron mg/L 0.3 0.12 200.7
Manganese mg/L 0.05 0,024 200.7
Volatile Organics ug/L See attached report. ND EPA 624.2
ND=None Detected.
COMMENTS: Low pH indicates high oorrosive characteristics.
YES WATER IS SUITABLE FOR DRINKING PURPOSES FOR PARAMETERS TESTED_
R Wald J.Sd��r
Laboratory
ec=less than
>=greater than
TNTC`too numerous to count
TOWN OF BARNSTABLE
LOCATION 7 7 � SEWAGE #
VILLAGE Q y/IY/&I�OQ o) ASSESSOR'S MAP & LOT y�
J NSPF�-7"e�. nn
'S NAME&PHONE NO.-
SEPTIC TANK CAPACITY -S L A 71,c-
LEACHING FACELrrY: (type) (size)
NO.OF BEDROOMS _
BUILDER OR OWNER ® X ;�r
DATE: 3 ,��_�s 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
$J, INI
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TOWN OF BARNSTABLE ,�•
LOCr1:TI � IYd S SEWAGE #
,VILLAGE ASSESSOR'S MAP & LOT'
STALLER'S NAME&PHONE NO. 4�EPTIC TANK CAPACITY J,
EACHING FACILITY: (type) (size) 4, K IO
NO.OF BEDROOMS _
BUILDER OR R
PERMITDATE: �Z/l,�/�`! COMPLIANCE DATE: ,=J/-,I .
Separation Distance Between.the:
Maximum Adjusted Groundwater Table and 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
(4 J
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AssEss0Rsm&N 3
PARCEL N0:
! I s L THE
BOARD AOF LTH �HEALTH
MAS TS
r
TOWN OF BARNSTABL.E
Appliration for Tutimrurttnn ramit
Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal
System at:
i�.......-. Ha i
------•------------------------------'-"--•----- --
Location dress or Lot No.
---------------------• .... / i .501rhr� � ��0 fSalr 6s"
Owner Address
W
Installer Address
UType of Building Size Lot.13jA...........Sq. feet
0-4 Dwelling— No. of Bedrooms............... ..... --.�-.. ..Expansion Attic ( ) Garbage Grinder
aOther—Type of Building ----------------------- ---- No. ersons---------------------.------ Showers ( ) — Cafeteria ( )
04 s Other fixture ---------- -------------------
d -------------------- -------------------------------------------------------------
W Design Flow............................................gallons per person per day. Total daily flow--------------------------------------------gallons.
WSeptic Tank—Liquid capacity------------gallons Length---------------- Width---------------- Diameter.---_--------- Depth................
x Disposal Trench—No. .................... Width.................... Total Length.._..........._....- Total leaching area....................sq. ft.
Seepage Pit No--------__--------- Diameter-------------------- Depth below inlet----------.......... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
~' Percolation Test Results Performed by...................... .. Date........................................
a �1 -
Test Pit No. l... .7------minutes per inch Depth of Test Pit---- - --------- Depth to ground water...��F_ �!�:1WW40
44 Test Pit No. 2...L 4.....minutes per inch Depth of Test Pit----ZP/--------- Depth .to ground water_.A*�E_EnKcuAMWX6
P4 .................................................----•-------•---"---•-'-----------•-'-----'-'---'........................... ----
0 Description of Soil-art-C...PLRN(---------------------------------------------------------------------•---------------------------------------------------•---...---..........
V .....•------•-------•-----•---------•---'--------------•----------•---------'-------'•-----••-••--'-•-----•---------------------------
W -- --- --- -- --- - ....
-
U Nature of RR air or Alierati s—Answer when applicable...J.. �— ... ... S'...._..
.................... fl4--------------•---•-'---•----•--•-----------------------------------
Agreement:
The undersigned agrees to install,the.aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code —The undersigned further agrees not to place the
system in operation until a Certificate of Compliance has ee is d by the a t .
Signed .......: --- ---- 1 �/-...... ...... ... . ..
ce qq
Application.Approved By ------------ .. --a ........ f
Application Disapproved for the following reasons: ...................
-------------- ------------------------------------------------------------------------------ --------------- ------------- --------------------------------------------------------------------- - ------ -- - -------------
Date
PermitNo. ... -/p--6- ------------------- Issued .............................. ---.................................
Date
t 5U/1
FEB
A
............ ....
THE COMMONWEALTH OF MASSACHUSIETTS
BOARD OF HEALTH
' TOWN OF BARNSTABLE
Apphration for Diti-Viiiial Worits Tomitrnrtinn rrrtnit
Application is hereby made for a Permit to Construct (A ) or Repair ( ) an Individual Sewage Disposal
System at:
94 L 7� 'Z
. ... / / ............ ............• -----------
l w� C�Nral� +---•--- 4Gq C43v /y1,..fivST-------r-----f-•r--�-•--g--.o..i.U........�.../..�.D...•.................
- ddress � r Lot No.ocatio n , CPFC •.5 . N -----
W Owner Address
a
Installer Address
Type of Building � s Size Lot.13Z..��_.._.......Sq. feet
a Dwelling— No. of Bedrooms-------------- �._r ___., __.-_,_Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ---------------------------- No. of persons-----------................. Showers ( ) — Cafeteria ( )
d Other fixtures ----------------------------------------------------------------------- --------------
----------------------------------------------
W Design Flow--------------------------------------------gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity-__---_----gallons Length---------------- Width.--------------- Diameter-------.-------- Depth................
x Disposal Trench—No. .................... Width.................... Total Length-------------------- Total leaching area....................sq. ft.
Seepage Pit No---r L................ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.................................................... Date........................................
�
/ iIiCGVNTtfl'AO
Test Pit No. I---4_.._......minutes per inch Depth of Test Pit----Z Depth to ground water________________________
GZ4 Test Pit No. 2.... .4.....minutes per inch Depth of Test Pit....ZQ----------- Depth to ground water..i✓o .FivcaunTFeC��U
-----------------------------------•----••--------------------------------------------------•--•••--.........................................................
0 Description of Soil.5kf-...PIAAJ - ---------------------------------••----................
W f i
.........................................................................0.......................
W --•-----•----------------------------------------------------------------------• ------------•---------------_-•---- :........ -
__....
U Nature of Repairs or Alterations—Answer when applicable.._N-J---_ �- ................................. r' l ......................S
ilk 1Lr'f 7-c ,
......................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compliance has been Issued by�thehoardof-h`ealih r
b; Sl ned f............ -e-. . : --.
r
Application.Approved BY -------------
Application /b...`.. <�t�
.........-----Dare
Disapproved for the following reasons- ----------------. /.._.V.'._... ----........---------------------------------------..........--------,'...._.............
............... .. .. ..............._.................. ... .. ....... .. ............ . ..._.....:.................._....................... ........................................
Date
Permit No. /.D &------- ---- --------- , Issued .........................
--........................... ...---- Dace
-- tee. ---_.. ._.---_---------_.-----_.__._.-- __------i
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Gertifi ate of Tompliaare
THIS IS TO CERTIFY, That the:Individual Sewage Disposal System constructed ( ) or Repaired ( )
bya -��.. ......._ .. - ------- - - ......... -
,q,, In-il let
at --------4.P_1.-------- ........M....at,+ - s-T .._.. .:.t u�1 Y -- -
has been installed in accordance with the provisions of TITLE 5 k The State Environmental Code as described in
the application for Disposal Works Construction Permit No. ........ 4......_. dated
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE.... .. ... ..._......__ ----------------------------------...._._..------ Inspector .......-------------------------------------------------------------------------------
1
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
No........:.... l� FEE---.... .n......
Dispoal Work.5 Tonotrudivit rrrntit
Permission is hereby granted...... --._--_- '
to Construct (>;or Repair ( ) an Individual Sewage Disposal System
at No......-- ^ r .w",-•` T-.. ------- '=rj .....
S eet 1l I oCJ 11 )
as shown on the appli tion for Disposal Works Construction Per t— - _- _�_____________ Dads__... _ -----
1
1
Board of ea"lih O
DATE.......... , .-•--- ...... ----•-----�------------------------------
FORM 36508 HOBBS Q WARREN,INC..PUBLISHERS
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V` i 3 CUMMAQUID, MA 02637
o (DEED BOOK 4195 PAGE 86)
STEPHEN D. PORTER &
Existing I I LOUISE G� PORTER
Leach Pit I I P.O., BOX 273
Cesspool I , CUMMAQIIID, MA 02637
Deck ��\ I� .� , I I (DEED BOOK 12303 PAGE 169)
26.1':
REFERENCES
Deck
,#'4040 I , DEED BOOK 4195 PAGE 86
p DEED BOOK 12303 PAGE 169
UnI2 Story y cessp° PLAN BOOK 381 PAGE 37
Dwel/Ing
x
I x
CERTIFIED PLOT PLAN
FOR THE PURPOSE OF OBTAINING A BUILDING PERMIT
I I IN
MHB Fnd a
Back
Center BARNSTABLE CUMMAQUID MA
111.16
S g4'53'10" W
nowPREPARED FOR
1.45.
' STEPHEN E. GRANDE III
to �►
i i� Lo t ` N9de) RO� 6 . •
N � �19(22'f Of POWMenO lylHB Fnd
Ma„� streLead P/ug STEPHEN D. & LOUISE G. PORTER
v -
(BND TO BND) DATE: J U N E 15, 2006
o�� � N84 50'53"E
i 165.26 Scale:1"= 20'
4
MHB Fnd 0 10 20 30 40 50 FEET
Lead Plug
off 60-362-4541
fax 508-362-98M
N OF I
ARNE down cape engineering, Inc.
OJALA CIVIL ENGINEERS
oa.ze3a8.�y : LAND SURVEYORS '
R _
939 nnain st. armouth ort, ma 02675
L y P uJ
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DATE ARNE H. OJALA, P.L.S. Ld
::\Land Projects 2004\05-200 GRANDE\dwg\05-200 plot plan.dwg,18 x 24 Ste,8/16/200610:05:44 AM, o
*_Owner,HP designjet 1050C,Arch C-18 x 24 in.(landscape),1:1 05-200 PLOTPLAN.DWG(AO)
MCMAHAN, GQEa96 E'£J? & MCMANOW, I Barnstable arbor
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S YARMOUTH, MA 02644
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LOCUS . MAP
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zk ASSESSORS MAP 336 PARCEL 072
040
G nit B 37.5 . h LOCUS IS WITHIN FEMA FLOOD ZONE C AS
St o g 50001
SHOWN ON. COMMUNITY PANEL, #2
l ry. '0001 D DATED JULY' 2, 1992
Deck y ZONING SUMMARY
o I I ZONING DISTRICT: RF-2 .RESIDENTIAL DISTRICT
MIN. LOT'SIZE• 43,560 S.E.
TALES GIB CAPE CW 'INC MIN. LOT FRONTAGE 20- -
Deck Ram I P O BOX 41 MIN. LOT WIDTH. 150'-
SARNST MA
026.30
It
MIN FRONT T SE BACK 30
V I 1 MIN. SIDE SETBACK 15
J I I MIN. REAR SETBACK 15'.
HO✓- PO✓ FARM CONDOMINIUM" Existing
AREA /N SO. FT. = 38,020-* Septic Tank I I • SITE IS LOCATED WITHIN THE ,AQUIFER
W l a 9 0.e AREA /N ACRES = 8� `' `�` i PROTECTION OVERLAY DISTRICT
I
,
o Proposed I
2 New Garage
15,45' V' 4'- 0„4.
I
Srww
Existing I OWNER .OF RECORD
Sonotubes. for loe�` f D-Box fj i STEPHEN E. GRANDE .III
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1. D
S PLAN I S.FOR THE DESIGN AND CONSTRUCTION
L II0 P
; G.P.D. PE .,
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.
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,W GEDI SPOSAL SYSTEM AMD WFTL ND
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, SEPTIC TANK REOUIRED
- CONSTRUCTION ETHO S AND'MATERIALS AND
, " � ALL I - LOCUS5550 52 .1: MA INTENAACE'OF�THE SEPT I C SYSTEM SHALL G. P.D. X150% 6AL
� , I
TE5 AND LOCAL 1500 -
CONFORM TO MASS. D.E.P. TIL VED: GAL .
. SEPTIC TANK PROID
� . .t '
O LTHREGULATINS. ftII � I
{ . BOARD IE I . ,1 1 ♦t - . _ '
"I ' SIZE OF LEACHING FACILITY REQUIRED.
''� 4.. ALL SEPTIC SYSTEM COMPONE TS IOCATED UNDER
��� - . RAILROAD ',- -
, t, _ AREAS SUBJECT. TO :VEHICULAR TRAFFIC OR GREATER 550 G. P.D. $M 10 �
- W1 TH-4"J� HAN 3 IN DEPTH SHALLIBE CAPABLE OF ( 4 5.3,1 T DESIGN PERC RATE MINIINCH
, STANDIMGk-20 -WHtEL.LOADS. � _ ," DEAml$
1_
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377 2. 0 - 74APPROVED EOUAL S I DEPALL . S.F.X GPD
0. 83 - 130 .0.
" BOTTOM 157 S.F.X GPD . 3
- X 1 N D-BOX SHALL BE REINFORCED 534 884 I%%/ ATOTAL : S.F. GPD
PRECAST CONCRETE AND wArERTIGHT, 8. COAS ANK I0 .I LOCUS MAP
1 APPROXIMATE I I
\ •
, 7. BEFORE CONSTRUCTION CALL DIG-SAFE LIU/T OF ACEC
SO TEST 1T DATA -orVP" . \ $M.9
, IL
E . t THE LOCAL WATER DEPT. 1
. 57AL BANK % -_ .r
FOR LOCATION OF UNDERGROUND UTIL I TIES. INDICATES V INDICATES . . I * I _,!� .
;: PERCOLATION
"1, = avr If11.5 I sm s �-
TEST , GROUNDWATER I " - ,-
6.t, ; THE EXISTING WELL IN THE OLD PUMP HOUSE SHALL r 'c' I 1
P-6154
BE ABANDONED ,IN ACCORDANCE WI TH THE TOWN OF - 10.0
I * 2 , _� CASTALBANK .a I
'. TP# Tp I � vI
BARNSTABLE HEALTH REGULATIONS. 46.9 I 1 - p0 -
GRND EL. 45.2 GRND EL. 1 I -
, � ,t
1 9. 1 I ALL UNSUITABLE MATERIAL (TOPSOIL. SUBSOIL. , G.W.EL. MIA G.W.EL N/A // #.I/ f 5 �
I 112 COASTAL RANK i I 1 0
CLAY. ETC.) SHALL BE REMOVED FOR A DISTANCE OF0 O
U HE EACH PITS DOWN TO THE SAND LAYER I I /� / I ) .I � P<I0 ,,ARONDTL LOAM. LOAM. • I // / D \ 5 VI, 1p
AND REPLACED WITH CLEAN SAND. I \ \ .
CLAY CLAY I 0 1" \\ V," SM 9 * � 0-.X
HARDPAN I \ \
IO. NO DETERMINATION HAS BEEN MADE AS TO HARDPAN fV W Y6.� , \\ 1 � % \ 0
COMPLIANCE WITH DEED RESTRICTIONS OR ZONING .
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REGULATIONS. 17 SHALL REMAIN THE CLIENTS �
11 � I \\ �" �ASYL RANK \- \\ V U
RESPONSIBILITY TO OBTAIN ALL PERMITS. SPECIAL / I\1 N I 1 tn
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PERMITS. VARIANCES ETC. FOR THIS PROJECT. 11 ' 34.2 V.w. �O.3 1\\ \\\ I I gI I 1 m
CLAY 14' I I I 5
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IL IT SHALL REMAIN THE CLIENT'S RESPONSIBILITY \ 1� * I I \ Q
TO HAVE THE PROPOSED BUILDING FOUNDATION 16' ' 29.2 fI I I
DESIGNED TO ACCOUNT FOR THE EXISTING GRADE MEDIFIME I I I \ \ S 4
AND SOIL CONDITIONS AT THE LOCATION OF THE MEDIFINE I I I TAL RAMX 5 N .1
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PROPOSED BUILDING. .. I �\ - eI � 0 / � t\ \
12. STAKED HAYBALES AND SILT FENCE TO BE PLACED 22* NO WATER 20* NO WATER I \ 0I \ %\IF5.9 1
ALONG THE WORK LI41T LINE TO PREVENT SILTATION 00\\ 11 14. �_- " COASTAL BANK
, f OF THEWETLAND DURING CONSTRUCTION. DATE- N '
TEST BY. EDWARD E. KELLEY i.V,r. 1110 2.5 1" l\ _ 1 \1
13. ALL ROOF RUNOFF TO ,BE DIRECTED TO GUTTERS. I I --_ _ 1 * \
WI TNESSED By. JERRY DUNNING I � 1-T V.w. NO.I I $M 2\
B.V.A. NO.8 1.7 -PERC RATE. ( 4 MI NIINCH Zjr -. ! /I- I a G1 4
\ a.V.W. NO.S B.V.W. o.�,0 V.W, ma.12C,�TAL BANK J \7 \
14. REFER TO SEPTIC PERMIT. 95-106 FOR THIS SEPTIC ASSUMED /N MEDIFINE SAND \I . . \
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. " .,f 1 COA L BANK 2 -V \
, 15., SOIL. CONDITIONS IN *THE AREA OF THE PROPOSED 'f _ I 04\.H* % $M 1
4 ; 8.V.,W. NO-�> 0. 10.3 .4
SEPTIC SYSTEM TO BE VERIFIED PRIOR TO ANY c COASTAL BANK I
CONSTRUCTION. C �
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ACCESS COVERS MUST BE WITHIN I h .P. \ .. __ -,
47.00 OF I �A )� �-_ .- )IG.rs
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SCHEDULE I t_ PEASTONE \1 I 0 1 '1 1� , - ,�," � . / /.' Z440
44.00 \ 9 r IU/� OF P. , - ,- ,.� , � ,-
4 SO 43.60 43.40 . % B.V.W. Na.-Lg �
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3 OUTLET ` \%41.2 -r-- , 0 - 11 ,-- _ _,_ _
/O 500 GAL D-ROX \V.0.I,.e0.I .+.W. r 16, " __ - -
SEPTIC TANK \ \ft.V AO 2 ' 1,21 ,�, , .' -�, e ,el 1, 1 .
2-LEACH PITS \ A _1 I vry Av.fl tv " 1
PROF I L E NOT TO SCALE H-20 \ \\ \ \ II // ""- 11 , 1
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INVERT EL EVATIONS \ \ N -' Ill/ // / // / 1 . . � 1 // ,
NVERT AT BUILDING: 44..5 A fir/ / / / / // " 1
II NVER T I N SEPTIC TANK: 44. 25 I I I � l // / / // / // 1-le
INVERT OUT SEPTIC TANK. 44. 00 I I I b1/ / / / / / 1
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INVERT IN DIST. BOX: 43, 60 I ) jj1/ / / / / / / 1
INVERT OUT DIST. BOX: 43. 40 / /ti i _ / / / itI / I
INVERT IN LEACH PI T: 43. 20 / I +�/b/,"-, /// I / bT 2
BOTTOM OF LEACH PIT: 37. 20 / ,r ,; / VrO/A 11�689± FF. 2. 66f AC.
/ ,,y // / E _ANe: �64,P8± ISo F. 0. 38± AC. -ADJUSTED GROUND WATER: NIA / / 4 _
8/.W. NO.k4/Il.V.W._J0.1(4 * // / / J / ± 1T/01 _X
OBSERVED GROUND WATER: NIA / //1//1 __ <. // / / / al6/ .S. F. . . 4y.s
BOTTOM OF TEST HOLE / : 23. 20 --
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EXISTING UTILITY WORK LIMIT\\ .0-, - -, ,0 // / // P/ ED ,�� _ I --
SEE NOTE I .I IML 32- / / / CAI ? --
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"�-' I \, -I 1% . - , ,- .12M41LE I I� " 4d .1 / AVAILABLE PLANS OF RECORD AND NOT BY ANI 6L P PI�E .
0/W-ZL 32.5NI NI % .% % 11 ----/ _ z \_ I 1 " -/ ACTUAL ON THE GROUND SURVEY.
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HOWN .REFER
.LL 11 TO NATIONAL
ATIONAL GEODETIC
/C/ % , I,_%\ //_/ \ L \ I VERTICAL DATUM (N.G. V.D. ). .
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/ 9 4 � l 8* PIPE\\ 04�0 4I / I / I I
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