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0112 SCUDDER'S LANE - Health
112 Scudder Lane _ Barnstable A= 259-013 T ' k I I` C ti T O TOWN OF BARNSTABLE LOCATION 112— 5C"&Cr.; GA SEWAGE ff VILLAGE ASSESSOR'S MAP&PARCEL 0/a INSTALLER'S NAME&PHONE NO. � 4��,ff,e�T��C Su�C� ►c�! s��, SEPTIC TANK CAPACITY f��; �, ►j��� <6-wk n LEACHING FACILITY: (type) 2A (size) X 0\ NO.OF BEDROOMS OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) i Feet FURNISHED BY 1 f 1a�X �°- 1 c► ��1 i n,� J fbl4A►n9 `{0US� F q �scmtot N. r O 0 F,� G+QtLpG-C It W c�� PZ 34 No. �d T` Fe) 7 S THE COMMONWEALTH OF MASSACH'USETTS Entered;ncomputer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS es ROplitation for bisposar *pBtem Construction 3permit Application for a Permit to Construct(Repair( ) Upgrade( ) Abandon( ) ❑Complete System PTTndividual Components Location Address or Lot No. I' 2 se e r Z q 4 Q Owner's Name,Address,and Tel.No. / Assessor's Map/Parcel 2- 8 l3 z C' Sa'GQ ri - C>4hOh I/ o Installers Name,Address,and Tel.No. Desig r.s Name Address,and Tel.No. ee!',`�t� Type of Building: t tSC6•���'� �,/ Dwelling No.of Bedrooms ) Lot ize sq.ft. Garbage Grinder( ) Other Type of Building IeeJr` h{,',ql No.of Persons Showers( Cafeteria( ) Other Fixtures Design Flow(mina required YYY0 gpd Design flow provided rv'4�p4r P�r�,t $�u —Y`l��pd Plan Date �112® 20l 7 Number of sheets j Revision Date I t�Z SlL7 Title Size of Septic Tank EK( I Coo 6r,16 n- Type of S.A.S. ��Xif :�1C IGL✓ -)ru5-/ Description of Soil Nature of Repairs or Alterations(Answer when applicable) ✓ r % f Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code-and-not to place the system in operation until a Certificate of Compliance has been issued by this Board ' alth/--- Signedj9v 1 Date ZI-,1'r 7 Application Approved by A Date d Application Disapproved by Date t for the following reasons Permit No. 0 — Date Issued �( 4 >•j r': ryr",;,,, '�1 a} ♦ n "r 'k "Ti .yy.;.4 ..,'t(t}'MM .C. ,,.Z��*'finr,-F•*f% �� .,r.,, , -. X + di,c•' •J l r * =� ,,:.•,.•�<F:-.f,"7rt1, ,.r4.., v. «�+ � „C�° •. tri„( "'•'`+.ra. ... •r . � fir• - �-• •� d / J. 7 No: � ! � �. � "�'!l Fee r THE COMMONWEALTH"'OF MASSACHUSETTS Entered in computer: k:t: L 1es PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE. MASSACHUSETTS ltlYlcatloll for MispoBal *pstrm Construction Permit f Application for a Permit to Construct Repair-( ) Upgrade( ): Abandon( ) ❑Complete System ©"Individual Components r Location Address or Lot No. '' SC uy r 6 q 4 Q Owner's Name,Address,and Tel.No. / Assessor's Map/Parcel 2_S• 9 13 f-t Installer's Name,Address and Tel.No. Designer's Name,Address,and Tel.No. / 3 'a r Uf�h L�J(/�/ Ct'ef YI( a &, S L �(' Sub .J �... `qg ` �` �LC7� 1... Type of Building: Dwelling, No.of Bedrooms -- � Lot Size ��� sq.ft. Garbage GrinderO' Other Type of Building �Fsr'G�e� ,'GtI No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) yy0 gpd Design flow provided S 5/pQr Peru,;f +` Za#-YY6 d Plan Date 1112 L �I 7 Number of sheets Revision Date 1 IIZ 0//73 U A Title Size of Septic Tank EX, Type of S.A.S. E c••r/;h,- ;4uSe/S C&k;c4 &Pa/ Description of Soil Nature of Repairs or Alterations(Answer when applicable)_4 P 1,1 (c 1n.E�/ ��� �^.r Cc;,r(.�a kp .A Y i A" Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code-adM not place the system in operation until a Certificate of Compliance has been issued by this Board f 'ealth Signed Date Application Approved by` Date 7 Application Disapproved by v Date r for the following reasons Permit No. p i — Date Issued /lP( /7 1 i " THE COMMONWEALTH OF MASSACHUSETTS ,fUi Se ' BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( k-j''^ Repaired( ) Upgraded( ) Abandoned( )by- at Z-- ,IG LuE <e- L4h P (/,,rhs--1ad,4 -;-11y'-C�i-has been constructed in-accordance - with the prbvi ioonss of Title 5 and the,,for Disposal System Construction Permit No q11(/dated Installer�r�'' Designer JLi14,114h F #bedrooms `7/ Approved design flow t/V a gpd The issuance of this permit shall not lie construed as a guarantee that the system will`func ton d designed. Date �l`C�4 / Inspector .- . .------.-._-----._--------- -.-.__J•___•_-_•___•-_-•__-•-- -.------.---_---•------•_--•--_•---.----•---.--_---.-_-._•_-.-.------.---------•---•------•---•-•--.-.------------------------------------------------------ .. . No. 3 o / �t Fee `7C THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Misposal 6pstem Construction Permit Permission is hereby granted to Construct ( � Repair( ) Upgrade( ) Abandon -S ( ) System located at / ,✓P'//64r G V rh S�,410 ��/✓S„�Q r and as described in the above Application for Disposal System Construction Permit.+The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit f� Date C (� 1 Approved by v a 12-11—`017 08:41ca DEED RESTRICTION WHEREAS, Elisabeth B, Donohue,Trustee of Elisabeth B.Donohue Trust,of 112 Scudder's Lane,Barnstable,MA is the owner of 112 Scudder's Lane, Barnstable,MA (hereinafter referred to as 112 Scudder's Lane) and described in a deed duly recorded at'Barnstable County Registry of Deeds in Book 27931, Page 297 as Parcel 1 on Plan Book 179,Page 25. WHEREAS,Elisabeth B. Donohue,Trustee,as the owner of said lot has agreed with the Town of Barnstable Board of Health to a restriction on said lot as a pre-condition to obtaining a disposal works construction permit in compliance with 310 CMR j 15.000 State Environmental Code,Title V Minimum Requirements for the Subsurface Disposal of Sanitary Sewage. ' WHEREAS,the Town of Barnstable Board of Health,as a pre-condition to granting a disposal works construction permit for a septic system in compliance with 310 CMR 15.200, State Environmental Code,Title V Minimum Requirements for the Subsurface Disposal of Sanitary Sewage,and authorizing the issuance of a building permit for the construction/renovation of an accessory structure to the main single family home,which presently contains four(4) bedrooms,the Town is requiring that the agreement for the restriction on the number of bedrooms in any house constructed on the lot be put on record with-the Barnstable County Registry of Deeds by recording this document. NOW THEREFORE, Elisabeth B. Donohue,Trustee, does hereby place the following restriction on her above-referenced land in accordance with her agreement with the Town of Barnstable Board of Health,which restriction shall run with the land and be binding upon successors in title:This restriction shall lapse in the event the landowner installs an approved septic system capable of handling flow for the allowance of additional bedrooms or the property is connected to sewer,or if the regulations change allowing additional bedrooms as a matter of right or if the Barnstable Board of Health approves the inclusion of additional bedrooms or other approved relief is granted to the Owner or its successor in interest. 1. 112 Scudder's Lane presently has a home constructed with four bedrooms.- Applicant may construct a game or entertainment space in the accessory structure which shall not be utilized as a bedroom. Elisabeth B. Donohue agrees that this shall be a deed restriction affecting the building located on 112 Scudder's Lane, Barnstable, MA. For title,see deed recorded in Book 27931, Page 297 at the Barnstable County Registry of Deeds and Plan Book 179,Page 25 . P i Executed as sealed instrument this day of �`CC^a%1. •�'i: 2017. Elisabeth B.Donohue,Trustee Elisabeth B.Donohue Trust COMMONWEALTH OF MASSACHUSETTS Barnstable,ss. On this.ith day of 2017 before me,the undersigned notary public,personally appeared and proved to me through satisfactory evidence of identification,,which was [ ] to be the person whose name is signed on the preceding or attached document, and acknowledged to me that he/she/they signed it voluntarily for its stated purpose. Notary Public: My Commission Expires: -z 1 .M i i BARNSTABLE RE61STRY OF DEEDS John F, Meade, Register Poo i I N—Daublehmg wlnCowsbre hmis i - Nme:ThtrdsmallwlnEow uiheadded to lAea:aerhwetlNnB• i GAME ROOM ELEVATIONS NOR:Wlndow.above to beasb _ , EB Nate:Wlndaws above to be caument IrTl LEI-. Note:lNhdows shove tobedoubkhung GYM ELEVATIONS Stanton, David From: ' Stanton, David Sent: Wednesday, November 29, 2017 1:53 PM To: 'Chuck Rowland' Subject: RE: Projects Hi Chuck, Yes, all set with Windswept. Hair salon in Centerville shopping center- For the septic design, they historically only counted the number of chairs going into the septic system (you can exclude counting any chairs that go into the tight tank for the septic design as they do not contribute any flow into the septic system.) I like Johns idea about having the switch to change from going into the septic or tight tank, however, I doubt it would get approved. If you want to look further into the switch,you would need approval from Tom at the very least, but would likely include DEP and the Board as well. You would also need to get approval from the plumbing inspector. Like I said, I like the thought, but I doubt it would get approved, but you are more than welcome to give it a shot and see,who knows. 112 Scudder- If they do not have the second septic system that our records show they have,then yes, a deed restriction for 4 bedrooms would be required and they would also need a permit for the septic line from the garage to the septic tank. The permit would require a rough sketch of the septic line that is existing, as well as the water supply lines for the house and the garage. If either or both of the water supply lines are within 10' of the septic line,they will need to resolve that (typically with a sleeve.) As for the inspection,Tom is asking that Donny checks the points of it,the beginning, middle and end (inlet into septic tank) or if there is a water line issue (i.e. needing a sleeve) that area can be used for the "middle" part inspection. Hope this helps, any questions, let me know. Thanks, Dave From: Chuck Rowland [mailto:chuck@sullivanengin.com] Sent: Wednesday, November 29, 2017 10:09 AM To: Stanton, David Subject: Projects Dave, I have a few projects that I need some guidance on. First offjohn asked if you were happy with Windswept? I am getting asked a lot of questions by the client at the hair salon at the Centerville shopping center.They want to know if I should design for the two wash sinks or the 6 chairs.They worry that in the future someone could inspect it and say that it is too small and needs to be bigger if I design for two chairs.John had a thought that we could connect the chairs to both the septic and the tight tank and put a switch in to connect it to the tight tank when they are coloring hair and the septic when washing hair. Lastly, 112 scudder is rearing its ugly head again. I just want to confirm that you will approve that septic line if it is inspected and confirmed to have proper pitch as well as a deed restriction on the property limiting the bedrooms. 1 Thanks, Chuck Chuck Rowland, P.E. Sullivan Engineering& Consulting, Inc. P.O. Box 659 7 Parker Road Osterville, MA 02655 508-428-3344 508-428-9617 (fax) Engineering R Sulfivancomiti.g,.Inc. z Stanton, David From: Stanton, David Sent: Friday, September 22,�2017 4:05 PM' To: 'John O'Dea' Subject: 112 Scudderi Lane Barnstable ` Hi John, Sorry to bother you on this one, it looks like I might be the final inspector to review.it (according to the file,Tim, Donny & Donna have all dealt with this one) I am.not sure if you are still involved with this one or,not, if you are, we will need the following: -Confirmation that two septic systems are present(one in the rear and one in the front of the main house) I am assuming there might be two, but the records people submitted to us are not consistent. -A septic permit for the plumbing line from this garage\outbuilding to wherever it goes. The builder said the line is already there, however, we have no permits for it. We don't need "engineered" plans but will at least need a good. sketch showing where the building sewer goes frorn'the garage\outbuilding to which ever septic it goes to. Will also need to see where the potable water lines are for tihe'house and garage\outbuilding are to ensure they are 10' apart or }will need to resolve with either the code &pressure testing, or sleeve the line within 10' ,-It looks like we have good floor plans for the main house, but we will need full plans of the garage\outbuilding as the records we have on,file don't seem to match up exactly with the footprint\shape shown on the plot plan. The building might be able to come in and piece together the records we have, it is just-confusing as some of our records show a garage and attached sheds to it, etc. 'Thank S, . Dave 1 .i :4 4, 1 f , Miorandi, Donna { From: Miorandi, Donna Sent: Tuesday, August 08, 2017 4:22 PM To: 'John O'Dea' ' Subject: RE: 112 Scudder Lane-Barnstable Hi John: From what I remember I needed a licensed installer to take out a septic permit for the line and a plumbing - permit. Donna -----Original Message----- >. From: John O'Dea [mailto:john@sullivanengin.com] Sent: Tuesday, August 08, 2017 9:58 AM To: Miorandi, Donna Cc: chuck@sullivanengin.cbm Subject: 112 Scudder Lane - Barnstable Donna, I guess Jaxtimer was in trying to get a building permit to renovate above a garage last week.. We had meet with Donny and Tim before hand to confirm that the existing system was large enough per plan and permit: + Do they need an engineered plan, or do they just need an installer to pull a permit in order for you to sign off on building permit? We thought that a line could just be handled by'an,installer. We have looked at the inverts from the septic plan and see that there is sufficient pitch. John O'Dea, P.E. Sullivan Engineering& Consulting, Inc , P.O. Box 659 , Osterville, MA 02655 508-428-3344 508-428-9617 (fax) 1 T Doe o o�a7 . N . LOCATION: . ; !9/ZNST l�G M/�: U✓"� SCALE.. DATE �1!at% PLAN .REFERENCE,.BNF. `T' l!��.. . ,L¢f - /79 �8 r _� moo,\ �� �• -'` � � \� `\ ���Q'C -�` �'� ZE "11(( o � 0 'X65r/.�fg 5r A1e S Pnlec-L 72MT D,e�c.l.1.vc / �JV J f 'I �Sop �T 0�' sw3-Saic.. �F1WC c/eldsY 1�RiLG/.vG �'z O'! �L" CoArs t' / 94 "i`'7" HE��S.lxia loll ( f LLrY ACT '2 3 2008 N OF BAR � • H�S IC Pon"--TABIr d'ue } , P' * Y Commonwealth of Massachusetts ` Title 5 Official Inspection Fora x Subsurface Sewage Disposal System Form-.Not for Voluntary Assessments 112 Scudder Lane Property rt Address a Thomas Moran. Owner Owners Name _ r information is Barnstable ' ' MA 02630 12/06/13 = required for every page. City/Town State Zip Code Date of Inspection - Inspection results must be submitted on this form.Inspection.forms may not be altered in any way.Please see completeness checklist at the and of the form. - Important:When A. General Information ` filling out forms x, 14 on the computer, LR use only the tab 1. Inspector: key to move your 41 4 U tang cursor-do not Kevin Cochran use the return Name of Inspector �. . t key. Aardvark Environmental Inspections co Company Name t PO Box 896 �A Company Address ', x a no East-Dennis Im 0 641t �- City/Town n State Zip Code lJ1 508-385-7608 .. 'SI`13356 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 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).7he system: ® Passes " ❑`Conditionally„Passes, " ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority ` 12/10/13 J Ins s ignature ..Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the..• report to the appropriate regional office of the DEP.The original should be sent to the system owner r' and copies•sentto the.buyer,if applicable,and the approving authority: ' q. 3 ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•11/10 ' Title 5Official Inspedion FoJuTce Sewage Disposal System•Page 1 of 17 e f Commonwealth of Massachusetts = ` Title 5 Official Inspection' Form h Subsurface Sewage Disposal System Form-Not for Voluntary Assessments - 112 Scudder Lane Property Address Thomas Moran Owner Owner's Name , information is required for every Barnstable MA q 02630' 12/06/13 page. CitylTown State Zip code Date of Inspection B. Certification (cunt.) r Inspection Summary:Check A,B,C,D or E/always complete,all of Section D A) System Passes: ® 1 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. w Comments: • f- Y i_; , t . . a .. ., I . 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"no_t determined"(Y,N;ND)for the a following statements.If"not determined,"please explain. x• ` The septic tank is metal and aver 20 years old*or the septic tank(whether metal or not)is structurally, unsound,exhibits substantial infiltration or ex filtration 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) t t5ins•11/10. 4 1 - Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts f ; , Title 5 Official Inspection Form. i Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ` •" - ti -F Yee,_ a i 112 Scudder Lane w Property Address Ilk Thomas Moran Owner Owner's Name information is required for every Barnstable _ MA 02630 12/06/13' page. Cityfrown State Zip Code t Date of Inspection B. Certification (cont.) ts. 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): El 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 ❑yN ❑ ND(Explain below): • .. f 4., . - to - A � - - C) Further Evaluation is Required by the Board of Health:: Conditions exist which require further evaluation b`the Board of Health in order to determine if, ' .❑ q Y the system is failing to protect public health,safety or the,erivironmerif 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 Y ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh i5ins•'i 1fiC - - Tige 5Official Inspection Fww Subsurface Suffrage Disposal System•Page 3 of]i f Commonwealth of Massachusetts Title 5 Official .Inspection Form , t Subsurface Sewage Disposal System Form=Not for Voluntary Assessments 112 Scudder Lane f ' ' f • t i Property Address Thomas Moran - Owner Owner's Name• information is required for every Barnstable MA 02630 12/06/13 - , page. Cityfrown State Zip Code Date of Inspection x B. Certification (po'nt.) 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 aseptic 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-1.00 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 atM1a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure.criteria are triggered.,A copy of the analysis must d be attached to this form_ d 3. Other. }. "',� ,. ' _'. � , A• ,...,, ` O a , D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No".to each of the following for all inspections: Yes No _ t .. >' • : . . . _, . J • p g y - gg p component d.ue to overloaded or, ;Backup of sewage into facili or stem ® clo ed SAS or cesspool Discharge orponding of effluent to the surface of the ground or surface waters r ❑ ®, ' due to an overloadedI 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 Y2 day flow 6i9s;11/10 ' _ Trde 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 , Commonwealth of Massachusetts, Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments } , 112 Scudder Lane Property Address f , Thomas Moran Owner c Owner's Name information is Barnstable MA 02630 12/06/13 �- required for every ' page. Cltyrrown 'State: Zip Code Date of Inspection B. Certification (cont) Yes No E '®- 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 groundwater elevation: y 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.' 3 ® Ariy 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.] 0 ® 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, necessaryjo correct the failure. t ` •' _ w 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.`yee or"no."to each of the following,in addition to the questions in Section D. ; .. Yes ' No El J,[T the system is within 400 feet of a surface drinking water supply. i'.e. ❑ ., ❑. the•system is within 200 feet of a tributary'to a surface drinking water supply ` ❑ Ei the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)ora mapped Zone II of a public water supply well,. If you have answered °yes to any question in Section E the system is considered a significant threat, r 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-11/10 - - - Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 " ` ,S Commonwealth of Massachusetts ' ,E Title 5 Official Inspection Form r . . Subsurface Sewage Disposal System Form-Not foryoluntary Assessments , 112 Scudder Lane a , Property Address p . . Thomas Moran r , Owner Owner's Name information is /0 required for eve Barnstable MA 02630 12 6/13 - page. every Cityrrown 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 foll6vind: Yes No , s ® - <❑ -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? ; ' ® 'El ' Has the system received normal flows in the previous two week penod? Have large volumes of water been introduced to the system recently or as part of ❑ ® this inspection? r. A uce Were as built plans of the system obtained and examined?(if they were not ` ❑ available note as NhA) ' 1 ® ❑ Was the facility or dwelling inspected,for signs of sewage back up? ' IT ❑; Was the site inspected for signs of break out? - - r . t ' ® ❑ Were all system com pone nts,.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? 1 , Was the facility`owner(and occupants if different from owner) provided with ` ® .infomiationon the proper maintenance of subsurface sewage disposal systems? ' The 'size and location of the Soil Absorption System(SAS)on the site has 4 been determined based on: ¢` ®. ❑' r Existing information: For example,.a+plan at the Board of Health Determined inthe field (f any of the failure criteria related to Part C is at issue ® ❑ s,approximation`,&distance is unacceptable) [310 CMR,15.302(5)) • D. System Information Residential Flow Conditions. ; Number'of bedrooms(design): 4• Number of bedrooms(actual): 4 440 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd''x#of bedrooms): t5ins-11/10 _n - .. .- _ - , Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts ; Title 5 official Inspection Fora Subsurface Sewage Disposal System Form-Not for Voluntary Assessments - 112 Scudder Lane r Property Address , Thomas Moran f Owner Owner's Name , information is required for every Barnstable MA 02630 12/06/13 . page. City/Town State Zip Code. Date of Inspection - D. System Information ° . Description: f a.y _ 2 v y Number of current residents: r Does residence have a garbage grinder?, El Yes ®' No , Is laundrybn a'separate sewage system. if yes separate ins pection`required] ., ❑; Yes-® No Laundry system inspected? _ `f ❑ Yes ® No Seasonal use? p ❑ Yes ® No Water meter readings, available(last 2 years usage(gpd)): Detail: S Sump pump? T, r„ ❑ Yes ®-,No 1 •;�;Last date of occupancy: Current r + i Date Commerciallindustrial Flow Conditions:. t 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? E 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: t5ins-11116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 a Commonwealth of Massachusetts Title 5 Official Inspecti®n. Form. s Subsurface Sewage DisposalSystem Form-Not for Voluntary Assessments w 112 Scudder Lane 4 Property Address Thomas Moran i Owner Owner's Name information is required for every Barnstable N% 4, . 02630 12/06/13 ` page. Cityrrown State r 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: .Was system pumped as part of the inspection?' ❑ Yes "® No If yes,volume pumped: l ' gallons How was quantity pumped determined? Reason for pumping; ; Type of System: Septic tank,distribution'box,soil absorption system , . x ❑ Single cesspool; ; ❑ Overflow-cesspool El Privy a `R ❑ Shared.system(yes or no)(f yes,attach previous inspection records,,if any) 3❑ Innovativ ' Altemative 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 , j❑ Tight tank.Attach a copy of the DEP approval,'; , .Other(describe) t5ins-11/10 x Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Fort-Not for Voluntary Assessments 112 Scudder Lane r I Property Address N Thomas Moran Owner Owner's Name F information is required for every Barnstable MA 'i ' 02630 ' 12/06/:13 page. City(rown State Zip Code Date of Inspection D. System Information}(cont.) Approximate age of all components,date installed (if known)and source of information: 10/30/08 per BOH Were sewage odors detected when.arriving at the site? 0 .Yes ® No Building Sewer,(locate on site'plan): 1.8 Depth below grade: i feet Material of construction: El cast iron 040 PVC •. , . ❑ other(explain):,. t , Distance from private water supply well orsuction line: . , feet } Comments(on condition of joints,venting,evidence of leakage,etc.): Septic Tank(locate on site plan): ' Depth below grade: f 0.8 feet Material of construction: s ® concrete ❑ metal ❑fiberglass El polyethylene' []"other(explain) If tank is metal,list age: years Is age confirmed by a Certificate.of Compliance?(attach 6 copy of certificate), 0 Yes ❑ No . Dimensions: 1,500 gal k 3" Sludge depth: ' t5ins•11/10 Trite 5Offcial Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts r Title 5 Official Inspection .Form s Subsurface Sewage Disposal System Form,-Not for Voluntary Assessments 112 Scudder Lane ` Property Address Thomas Moran < ' Owner Owner's Name _ information is required for every Barnstable t' MA 02630 -12/06/131 ' page. City/Town a State Zip Code Date of Inspection, • tr. D. System Information (cent.) Septic Tank(cunt.) ` F. 28" . Distance from top of sludge to bottom of outlet tee or baffle Scum thickness - .1. 211 Distance from top of scum to top'of outlet tee or baffle 6 t Distance from bottom of scum tti bottom of outlet tee or baffle x . .. _ . .� � .• ;. How were dimensions determined?.' measured Comments(on pumping recommendations,inlet and.outlet:tee or baffle condition,structural`integrity;` - liquid levels as related to outlet invert,evidence of leakage,,etc.): The tank was sound and tight with tees in place and liquid at outlet invert. 1 - .$if _ .- Grease Trap(locate on site plan):. `' t Depth below grade: }` feet Material of construction: ❑ concrete ❑metal ❑ fiberglass, [:1 polyethylene -f ❑ other(explain): Dimensions:: ; ; y SCUM thickness r Distance from.top of scum to top of outlWtee or baffle,_. Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping:, . a Date t5ins 11/10 ' r r - Title 5'Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 . s - Commonwealth of Massachusetts Title 5 Official Inspection Fora.. Subsurface Sewage Disposal System Form-Not for Voluntary Assessments w 112 Scudder Lane - Property Address Thomas Moran" ' Owner Owner's Name informationi s l Barnstable 8 table MA-�' 02630 .12/06/13 required for every - , page. CityfFown State Zip Code Date of Inspection; D. System:Information (cont.),' .Comments(on pumping recommendations,inlet and outi'et tee or baffle condition,structural integrity, ' liquid levels as related to outlet invert,evidence of leakage, etc.): t ' Tight or Holding Tank(tank must be pumped at time of inspection)(locate pin site plan): Depth below grade: y , Material of construction: -❑ concrete ❑ metal ❑fiberglass,' ❑ polyethylene `❑ other(explain): Dimensions: Capacity: _ s� gallons Design Flow: gallons per day. s Alarm present: r� ❑",Yes El No 1 Alarm level: Alarm in working order: ' ❑ Yes . 1: ❑ No . Date of last pumping: Date ` s J z Comments(condition of alarm'and`float switches,etc.): r ` Attach;copy of current pumping contract(required): Is copy attached? El Yes ❑ No t5ins•11/.10 - _ :e Title 5 Official Inspec6cn Form:Subsurface Sewage Disposal System-Page 11 of 17 r e t Commonwealth of Massachusetts Title 5' Official: Inspection',Form , Subsurface Sewage Disposal System Form-Not for Voluntary Assessments , 112 Scudder Lane F - Property Address ►, Thomas Moran , ; ' s Owner Owner's Name Y information is required for every Barnstable MA'. 02630 12/06/13' , page. City[Town ''State Zip Code Date of Inspection D. System Information(cont.) Distribution Box(if,present must be opened)(locate on site plan): Depth of liquid level above outlet invert ' even Comments(note if box is level and distribution to outlets equal,any evidence'of solids carryover,any9 - evidence of leakage into or out of box,etc.):_ t The box was level and tight with no sign of carryover. Pump Chamber(locate on site plan). , -♦ ' Pumps in working order": , Yes ❑ No r' = < Alarms in workin y w r g.order: r ❑ Yes. ❑ No Comments(note condition of pump chamber,condition of pumps and appurtenances, etc.). Soil Absorption System (SAS)^(IOcate On.Site plan, exca'Vati!6n`not required) r -If SAS not located,explain why e 4 .j. .. t5ins-11/10�• ' ' - - Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17' Commonwealth of Massachusetts Title 5 Official Inspection ,Forte 's . Subsurface Sewage Disposal System Form-Not for Voluntary Assessments - a 112 Scudder Lane Property Address _ Thomas Moran Owner Owner's Name , information is t required for every Barnstable MA 02630 12/06/13 page. Cityrrown State Zip Code Date of Inspection' a D. System Information,(cont.) , Type ❑ leaching pits e i •number 21 leaching chambers `number- ' ❑ leaching galleries number: ` leachingtrenches, , numbe r length: 9 ❑' leaching fields number,dimensions: ❑ .overflow cesspool number: . x•r `❑ innovative/aftemative 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 21 infiltrators in an 1 1'x44'stone field.There was no sign of ponding or.failure y Cesspools (cesspool rnust be pumped as part of inspection) (locate,on site plan): A Number:and configuration Depth—,top of liquid to inlet invert,: Depth of solids layer 4 Depth ofscum'layer `. Dimensions of cesspool ' Materials of construction 'u Indication of groundwater inflow ❑ Yes ❑ No t5ins-11/10 Tdle 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 - G - Commonwealth of Massachusetts ' Title 5 Official InspectionForm y• Y Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 112 Scudder Lane • ` Property Address Thomas Moran Owner Owner's Name information is ' required for every Barnstable MA' 02630 12/06/13 ' 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.): Yic • r .f �r 9 t tl .e .. • Privy(locate on site plan): Materials of coristruction: ^ Dimensions •Depth of solids � � {', '• • ! Comments(note condition of soil,signs of hydraulic failure;level of ponding,condition of,vegetation, etc.): Y A Y .:t • "a=. `' ' 1p .. .. .. ° �IS ». -" a • .� .. , 1' { `. a k n • ' �F .. .. ,. .. • e ° • 1.. , t5ins-11/10 r Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 i k Commonwealth of Massachusetts d r Title 5 Official Ins ection foem Subsurface Sewage Disposal System Forth-Not for Volunta 9 P Y ry Assessments 112 Scudder Lane ~ Property Address Tho mas Moran Owner Owner's Name .. information is MA' 0263Q /13 required for every Barnstable 12/06 page. City/Town state Zip Code Date of Inspection D. System Information (cont.) 4k Sketch Of Sewage Disposal System:Provide a view.of the sewage disposal system,including ties to at least two permanent reference landmarks or benchmarks.Locate`all wells within 100 feet.Locate where public water supply enters the building.Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately y ' r 25 , 14 t5ins•11i i0 Title 5 Official Inspection Form:Subsurface Sewage Disposai System•Page 15 of 17 ♦ .} •.to` Commonwealth of Massachusetts . Title 5 Official Inspection Fora f Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1 112 Scudder Lane , Property Address , Thomas Moran a Owner Owner's Name information is required for every Barnstable MA ' 02630. �" 12/06/13 " page. City/TownState Zip Code Date of inspection D. System Information (cont.) - Site Exam: r Check e SloP El Surface water Check cellar t ❑ Shallow wells Estimated depth to high ground water. �^ 8 3 g� r N feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design`plans on record a ". 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 aocal excavators,installer§-(attach documentation)" ❑ Accessed USGS database-explain: _ K - You must describe.how'ydu established the high ground water elevation`. augered to 10.0-feet and.found no water.`. • 'I adjusted to 8.3 feet. 'Bottom of leaching is at 3.5 feet.- Before filing this inspection Report,please see Report Completeness Checklist on next page. t5ins•11/10 '.. - Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 t , Commonwealth of Massachusetts a husetts Title 5 Official Inspection' Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments° 112 Scudder Lane ' Property Address ` Thomas Moran- Owner Owner's Name information is Barnstable MA 02630' 12/06/13 required for every k Clty/Town State 'Zip Code Date of Inspection page. , E. Report Completeness Checklist ® Inspection Summary:A,B,C,D,or E checked , w ® 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 „a a 15 or attached in separate file ' t • r , t5ins-11/10 . - '. Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 TOWN OF.BARNSTABLEP UDCATION 1 f .�{ -L,4 QQ � SEWAGE# VILLAGE VVC71 (O ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) T,1 "AjZk size) NO.OF BEDROOMS_ . BUILDER OR OWNER c� PERMITDATE: COIV�LIANCE DATE: 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 r - �i Y7 No. �� O v� Fee `� d THE COMMONWEALTH OF MASSACHUSETTS Entered in computer PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftPhrItion for Mis osar 6potem Construction 30ermit Application for a Permit to Construct( ) Repair( ) Upgrade( ) ) Pl�omplete System El Individual Components Location Address or Lot No.(1 1-4ve ,Address,and Tel.No. . 2 a��e: Assessor's Map/Parcel �,'� a 2 �J _ / �UM / 6�13, i 1."2 .e Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. UP Mop I jU is- Type of Building: Dwelling No.of Bedrooms Lot Size S-ULO slyv sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) VO gpd Design flow provided �� gpd Plan Date / - Number of sheets Revision Date Title Size of Septic Tank G T e of S.A.S. U/C - L / yP 1 X �!� )7 -�n Description of Soil Nature of Repairs or Alterations(Answer when applicable) IU L&I J Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Boar od f—H h. Si i /vlZ + Date O Application Approved by Date 02- �' 3 t a Application Disapproved by Date for the following reasons Permit No. <900a �' Ll 7 Date Issued "3 ^�.'... ..«. _.. __• .. ..- .r�,...�.-ti.._..�.-•.:,..., -..,�-_.Lti,.-n-rs•......Fti +1-^.r;.',,•w•^- """._�."..r_=.-•„n,r i'Y'k� „. ,.F. i+..:..^..,.... _ -...s- -J.. _ w No: �.W L/f�� t f,_.�.•: Y i - �� /jd Fee / d 'THE COMMONWEALTH OF MASSACHUSETTS+ Entered in computer: Yes f- PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE,,MASSACHUSETTS ` . � -_-�.,,_s fication for his osaY � stelri �On�trUrtiOn X�Prltlt Application foc a Permit to Construct( ) Repair( ) Upgrade( ) A•b�ndon( ) ©'Complete System El Individual Components �. in �J J/_ Location Address or Lot No /Z Vd�� �j Z/�/ Ow�ri e,Address,and Tel.No. 1 ' 21 Assessor's Map/Parcel' 2!j _ / �U � / el Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Type of Building: U Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures / Design Flow(min required) y0 gpd Design flow provided gpd r Plan Date �!�- 2/ P"= Number of sheets Revision Date Title t. Size of Septic Tank t c::� Type of S.A.S. �6 Description of Soil Nature of Repairs orAlItgations(Answer when applicable) ww. M :? Date last inspected: < Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system iir.- accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board,of H alth. Date Application Approved by Date Q' /-P Application Disapproved by Date ' for the following reasons Permit No. ' C9000c� L��/�i Date Issued �" 5 3`Q '' • s' i�t„-----------------------------------------------'--------------------------------- ---=_--_-------------_---- ------ THE COMMONWEALTH OF MASSACHUSETTS ! BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed Repaired( ) Upgraded( ) Abandoned( )by r2 m n/2 r vtJ at 4t iy<O has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.,Qcc'�-49 1 dated - 2 fN• Installer G,r'i-�-N Designer c*' j Ay�o #bedrooms Approved designflow �{ / _/ gpd The issuance of this permit shall ndbe construed as a guarantee that the system72�1' ion.as des'g ed Date �j�/ Inspector / tl c� t I ,C� - --- - - - - - -�/- -- - - - C- -- - No. �/ �l " IL `l 1 Fee �✓ G THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION BARNSTABLE,MASSACHUSETTS Zisposal bpstem Construrtion permit Permission is hereby granted to Construct((ir Repair( ) Upgrade( ) Abandon( ) System located at / /2 < <,`,/��lL 3 tzlo-CU and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction ust be c mp-leted within three years of the date of tCd—by is t. Date ,��G7 0 Appro �'=� r �. Town of Barnstable oFVE r Regulatory Services Thomas F. Geiler, Director BARNSTABLE• " Public Health Division 9 Mass. se.39 �0 ATFpIA Thomas McKean, Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date: '-e�G �. Sewage Permit# Assessor's Map/Parcel �S / Installer& DesiLyner Certification Form Designer: e—Z)w1,9nn Installer: Address: 13aX S Address: S4 17L �T On J P >'l�ai27 ru was issued a permit to install a (date) (installer) septic system at %2 }�U based on a design drawn by (address) dated- oCT` 7 (designer) -- I certify that the septic system referenced above was installed substantially according to the design, which may include.minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral.relocation of the SAS or any vertical relocation of any component of the--septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Stripout (if required) was inspected and the soils were-found satisfactory: (In ster'�sSgnature) " a b E RD signerLs,Skgnatu'rKe) (Affix.Designer's Stamp Here), PLEASES TU"RNA_O B STABLE PUBLIC HEALTH DIVISION CERTIFICATE OF COMPIAWN-CE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. q:\oMce forms\designercer ifica,ion form:doc t e C rb4e 15.220: Preparation of Plans and Specifications E ��`��, yLl�rt�, I'mS The plans and specifications fbr every on-site system shall be prepared as follows: (1) Every system shall be designed by a Massachusetts Registered Professional Engineer or a Massachusetts Registered Sanitarian provided that such Sanitarian shall not design a system to discharge more than 2,000 gallons per day pursuant to 310 CMR 15.203. Any other agent of the owner may prepare plans for the repair of a system designed to discharge not more than 2,000 gallons per day pursuant to 310 CMR 15.203 provided they are reviewed by a Massachusetts Registered Sanitarian or Massachusetts Registered Professional Engineer and approved by the Approving Authority; ,lL 2 Eve plan submitted Every p d for approval must be dated and bear the stamp and signature of the _ designer. At least one copy submitted shall bear the original stamp and signature of the designer. (3). Every plan for a new system or plan for the'upgrade or expansion of an existing system which requires a variance to a property line setback''distance,must also reference a plan which bears the stamp and signature of a Massachusetts Licensed Land Surveyor in accordance with M.G.L.c. 112.&81D: V (4) Every plan for a system shall be-of suitable scale(one inch=40 feet or fewer for plot plans ,anA phe inch=20 feet or fewer for details of system components)`and shall include depiction of: l0 (a) the legal boundaries of the facility to be served; (b) the holder and location of any easements appurtenant to or which could impact the �ystem; V (c) the location of all dwelling(s)and building(s)existing and proposed on the facility and identification of those to be served by the system; /::—_(d) the location of existing or proposed impervious areas,including driveways and parking V as; (e) ovation and dimensions of the system(including reserve area); system design calculations,including design daily sewage flow,septic tank capacity (required and provided); soil absorption system capacity (required and provided); and y�hether system is designed for garbage grinder; �/(a) North arrow and existing and proposed contours; (h) location and log of deep observation hole tests including the date of test,existing grade elevations marked on each test, and the names of the representative of the Approving iAuthority and soil evaluator, (t) location and results of percolation tests including the date of test and the names of the ,representative of the Approving Authority and soil evaluator, (j) name and approval date-of the Soil Evaluator of record; _�(k) location of every water supply,public and private, 1. within 400 feet of the proposed system location in the case of surface water supplies and gravel packed public water supply wells, 2. within 250 feet of the proposed system location in the case of tubular public water supply wells,and 3. within 150 feet of the proposed system location in the case of private water supply wells; any surface waters of the Commonwealth,Zone As,rivers,bordering vegetated wetlands, salt marshes, inland or coastal banks, regulatory floodway,velocity zone, surface water supplies,tributaries to surface water supplies,certified vernal pools,private water supplies or suction lines,gravel packed or tubular public water supply wells,and subsurface drains. located up to 100 feet beyond the setback distances in 310 CMR 15.211,any leaching catch basins and dry wells located up to 25 feet beyond the setback distances in 310 CMR 15.211; and the location of any nitrogen sensitive area identified in 310 CMR 15.215 within which ,any portion of the facility or the proposed system is located as well as any nitrogen sensitive ,,, a ea up to 100.feet beyond any property line of the facility. (in) location of water lines and other subsurface utilities on the facility; ✓�p)'observed and adjusted ground-water elevation in the vicinity of the system; 1,,--O'(o) a complete profile of the system; RZA (p) a note on the plan listing all variances to the provisions of 310 CMR 15.000 sought in , conjunction with the plan; " in 0 to 75 feet of the system k with 5 Y (q) the locat ion and elevation of one be nchmark chmar components which is not subject to dislocation or W10loss during construction on the facility; (r) when pressure distribution or dosing is proposed,complete design and specifications of the distribution system proposed including but not limited to dosing chamber capacity (required and provided),pump curves and specifications,number of dosing cycles and depth per cycle; (s) when a Recirculating Sand Filter or equivalent alternative technology is required or proposed,a complete plan and specifications for the system,including a hydraulic profile; (t) a locus plan to show the location of the facility including the nearest existing street; ✓(u) the street number and lot number,if any,and the tax map number and lot number,if any, of the facility;and I- .�__ -,.,..,.r,.,,..,trt t;,,,, o.,,t thP.cnrcificatinns of the system. Town of B ><nstab►le. Department of Regulatory Services ' - Public Health Division Hate ( uuvaresraw prAs& 200 Main Streek Hyannis MA 02601 Date Scheduled i Ti Rm I+ee Pd: e Sot Suitability Assessment for Sewage Dis osar M 00i IMIK Performed By: Witnessed By: / i LOCATION & GENERAL INTORMATION Location Address qP: ner's Name .�0 VA �G �1lizi Sc oDP-C4, dress Assessor's Map/P4rcel: g Engineer's Name �' �� V{1 NEW CONSIRULjON REPAIR Telephone# Land Use Slopes(%) Surface Stones Distances from: Open Water Body - ft Possible Wet.Area _ft Drinking Water Well ft i ft ft Drainage Way ft. . Property Lin _ ._._:_-_. Other . SKETCH:(Street name,dimensioris of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) Y 1 . Parent material(guilogicj2L � '�-s'� Depth to aectrovk.�--- ` u dwa ter Standing Water in Hole: �✓o/� '-- Weeping from Pit Face Depth to Gco n 1 . . g I . Estimated Seasonal i"igh Groundwater ! DtTERMrN TION FOR:SEASONAL 11IGH WATE9 TAD,LE Method Used: P in, Depth to sail tnOld", Depth Observed stand ing!in obs.hole: Depth toiweeping from sidc of obs.hole: ! in, oroundwhter AdJuetmrnt Index Well# Reading Date Index Well ieY�l ! Aq►,factor,,,,_.°- AdJ,OraundwnterLevei,,,;,, PERCOLATION TC4 ST . pate Time Observation I Time at 9" _._.. �.- -- Hole# I - -- Time at G" .i Depth of'Perc Time(911-0) Start Pre-soak Time.@ 1 End Pre-soak .✓j/✓I>.�✓ r Rate Min./Inch 1 / Additional Testing N,O0(Ym) Site Suitability Assessment: Site Passed Site Failed: Original:.Public Hehith Division Observation}Hole Data To Be Completed on Back---------- ***If percolaibn testis to be conducted within 100' of wetland,-You must first notify the -,.nct-nb1P. C'Ariservation Division at least one(1)wedk prxox to beginning. n DEEP OBSERVATION HOLE''LOG Hole#.. Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) " Mottling ,(Structure,Stones,Boulders. C nsis end o Or vel f. / �� / L �mJ's/ sr IO DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture. Soil Color Soil Other Surface (USDA) (Munsell) Mottling (Structure,Stones,Boulders. C nsi to c o Ora 1 —� �, DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. o siste c '%O vel - DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color then Soil O Mottling Structure,Stones,Boulders. Surface(in.) (USDA) (Munsell) g ( I on isten Flood Insurance Rate Map: Above 500 year flood boundary No— Yes Within 500 year boundary . No_ Yes Within 100 year flood boundary No— Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist.in all areas observed throughout the area proposed for the soil absorption system? -- If not, what is the depth of naturally occurring pervious material? Certification I certify that on (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training,expertise and experience described in 3.10 CMR 15.017. Date Signature Q:GS F"lC\PER CFORM.DOC THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed Repaired( ) Upgraded( ) Abandoned( )by mo 2 r✓tJ at 1( 7 Sc,u-la!'e 4,f Lu> has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.Z)m%'qq�dated /1�13--2%— Ci Installer Designer 5•¢2f__560 #bedrooms Approved desi n flow gpd The issuance of thi perm shall no a trued as a guarantee that the system w n/ e/gned v Date �� Inspector d' (/ COMMONWEALTH OF MASSACHUSETTS. r EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM. NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 112 Scudder Lane 013 Barnstable. MA 02630 Owner's Name: John Curtin Owner's-Address: Date of Inspection: November 10 2006 Name of Inspectorc,(Please Print) James M. Ford - Company Name: James M. Ford ' Mailing Address: P.O.Box 49 Osterville,MA 02655-0049 Telephone Number: (508)862-9400" CERTIFICATION STATEMENT, I certify that I have personally inspected the sewage disposal system at this address and that the`infdnnatton ieporteZl t below is true,accurate and complete as of the time of the inspection. The inspection was perfon eO based onmy training and experience in the proper function and maintenance of on`site sewage disposal systems. I am "EP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The s3�gq,em: ' Passes Conditionally Passes Needs Further Evaluation by the Local Approving.A thority r. Fails ' Inspector's Signature: Date. Novem ber_21, 2006 The system inspector shall sub 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,' •authority. and the approving x Notes and Comments G ****This report only describes conditions at the time,of inspection and under the conditions of use at that Gtime. This inspection does not address haw the system,will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 S Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 112 Scudder Lane Barnstable, MA Owner: John Curtin Date of Inspection: November 10, 2006 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below.' Comments: System 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 distribution box is leveled or replaced' t 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: 2 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION_ FORM PART A CERTIFICATION (continued) Property Address: 112 Scudder Lane' Barnstable. MA Owner: John Curtin Date of Inspection: November 10, 2006 C. Further Evaluation is Required by the Board of Health:. Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 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 c health safety and environm ent: went: _ 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 systemmhas aseptic 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: ' . 3 Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSES SMENTS NTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 112 Scudder Lane Barnstable MA Owner: John Curtin Date of Inspection: November 10 2006 D. System Failure Criteria applicable to all systems: You must indicate either"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 podding 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 gg ✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than 'h day flow ✓ Required pumping more than 4 times in the last year NOT due to clog of times pumped ged or obstructed pipe(s). .Number ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ✓ Any portion of a cesspool or privy is within a Zone 1 of a public well. ✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ✓ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic g �c 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.] 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 System: ~ To be considered a large system the system must serve a facility,with a design flow of 10 gpd• ,000 gpd to 15;000. ` 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 206 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 ZonelI of a public`water supply well If you have answered" Y 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. 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 112 Scudder Lane Barnstable, MA Owner: John Curtin Date of Inspection: November 10 2006 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 nonnal 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? 2 ✓ 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 f 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)]. 5 Page 6 of 11 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTI ON FOR M PART C SYSTEM INFORMATION Property Address: 112 Scudder Lane Barnstable MA Owner: John Curtin Date of Inspection: November 10 2006 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: 0 Does residence have a garbage grinder(yes or no): n1a Is laundry on a separate sewage system(yes or no): n1a [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No = Water meter readings, if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No r Last date of occupancy: Unknown COMMERCIAL/INDUSTRIAL Type of establishment: # Design flow(based on 310 CMR 15.203): .Qpd 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: t OTHER(describe): . GENERAL INFORMATION - Pumping Records Source of information: _Pumped last year Was system pumped as part of the inspection;(yes or no): No If yes,volume pumped: gallons'=-How,was quantity pumped determined? Reason for pumping: TYPE .OF SYSTEM 1(2) Septic tank,distribution box,soil absorption,system Single cesspool' e ' Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records,if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be` obtained from system owner) . Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date'installed(if known)and source of information: System #1 (back yard) installed on 414196 and System #2(front yard) installed on 10128188 per as built cards Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 112 Scudder Lane ` Barnstable. MA Owner: John Curtin r Date of Inspection: November 10 2006 BUILDING SEWER(locate on site plan) . Depth below grade: 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 on site plan) Depth below grade: S stem #1 -2" of S stem #2-6" concrete 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 gal. ; 1000'gal Sludge depth: Both 2,, Distance from top of sludge to bottom of.outlet tee onbaffle: Both 30" k Scum thickness: 0" : 3" Distance from top of scum to top of outlet tee or baffle: Both 6" Distance from bottom of scum to bottom of outlet tee or baffle: Both 10 How were dimensions determined: Measuring stick Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels. as related to outlet invert,evidence of leakage',etc.). Tees were present.' The liquid level was even with the outlet invert There did not aB 2ear to'be any sijzns_o le aka Pe in either tank. GREASE TRAP: None (locate on site plan) .r , Depth below grade; f. 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.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 112 Scudder Lane Barnstable MA Owner: John Curtin - Date of Inspection: November 10 2006 TIGHT or HO LDING IN G TANK: None (tank ank must be( pumped d at time of in spection)ns ,P pect�on)(locate on site plan) Depth below grade: Material of construction: _concrete _metal —fiberglass -_polyethylene ._other(explain): Dimensions: Capacity: allons 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: 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 D-boxes were level and clean. No solids were' resent in either one. PUMP CHAMBER: None (locate on site plan). l Pumps in working order(yes or no): Alarns in working order(yes or no): - Convnents(note condition of pump chamber;condition of pumps and appurtenances,etc.): Page 9 of 11 OFFICIAL INSPECTION FORM-' NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 112 Scudder Lane , Barnstable MA Owner: John Curtin Date of Inspection: November 10 2006 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) ' If SAS not located explain why: Type ✓ leaching pits,number: System #2: 1 -6'x 6'(1000 gal) ✓ leaching chambers,number: _.System #1: 2-Cultec 330s(10 3'x 219 Per as built card leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: ' r overflow ces spool,p ool 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.): The Cultecs were dry and clean. The leach pit was dry. The scur�z line was 6"a from the bottom. The cover was to grade. There did not appear to be any si ns o ailure in'either s stem. CESSPOOLS: None (cesspool must be�pumped as part of inspection)(locate on site plan) Number and configuration: , Depth-top of liquid to inlet invert: - a Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: 4 Indication of groundwater inflow(yes or no) Commnents (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):. PRIVY: None (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.): 9 Page 10 of 11 ' OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 112 Scudder Lane Barnstable MA Owner: John Curtin Date of Inspection: November 10 2006. 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. } U\ F c6 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: 112 Scudder Lane ` Barnstable MA Owner: John Curtin Date of Inspection: November 10 2006 SITE EXAM Slope Surface water Check cellar a Shallow wells Estimated depth to ground water 25 +/- feet 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: i" Observed site(abutting properly/observation hole within 150 feet of SAS) Checked with local Board of Health-explain:_ tonogranhic and water contours mans Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using Barnstable to o ra hic and water contours tna ` ,ns the mans were showing approxtmately 25 +/ t site. o groundwater at this This report has been prepared only for the septic system and components described herein. This septic system has been inspected and passed 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 septic system, the inspection, this report andlor any components of the septic system which have not been located and inspected.- - ' 11 r W/ w,4�/C s` '�' TOWN OF BARNSTABLE LOCATION J �c��E 2 [•4 AlP SEWAGE # VMLAGE KA6r- (IZ ASSESSOR'S MAP&LOT26 INSTALLER'S NAME&PHONE NO. Q. (A 4cZ(91 SEPTIC TANK CAPACITY Q / ' �. LEACHING FACILITY. (type) "—4-3 Cc, IC (size) f NO.OF BEDROOMS BUILDER OR OWNER C U/� �!J G� 2�,/�-��1 6p/l0 S , PERMI TDATE: COMPLIANCE DATE: 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 --------------------- gory ` IV TAW R �.s d 70 ASSESSORS MAP N�' s T -No. PARCEL 1013 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01pplication for MizpaaY bpgtem Cow5truction Permit Application is hereby made for a Permit to Construct( )or Repair(Xan On-site Sewage Disposal System at: Location Address or Lot No. �A72C�- of-//Z Owner's Name,Address and Tel.No. ,S�DOLs72 's L -i✓Gr 13/*2f1V.s7-11YeGG .ToAhV %• Cvlz-r7.v, JlZ_ Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. DC� Nam'/1J� Co SST. �'7J k1,j7z,13 G= Ae62- Z ---/ Type of Building: Dwelling No.of Bedrooms Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow �` ;7 gallons per day. Calculated daily flow Z Z-0 gallons. Plan Date Nov ia, 19,1 !' Number of sheets / Revision Date Title s>� BAizsv3-l"V-Gr .Tos101n'%T C'c..,,277,0- J7e— Description of Soil O '-36" 44,-7 V/ sv --re,, c. 3��=/44 � �lG��i��•�/� �'/a-�v� Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system p in accordance with the provisions of Title 5 of the Environme tal Code and not to place the system in operation until a Certifi- cate of Compliance has been iss d by thi B id of H Signed Date ��10 Application Approved by Application Disapproved for the following reasons Permit No. `'/'7/ �n Date Issued ���. / '7j:,��;;.3.,•�'''•,m'�� ;-. ..:,a. ,. ., (,"°*�ftr�.�`.+tC.::��'Y^ '�^� c ,�.::�,-�... ... `y .. `qa�•'.�r. ..c.:`-., �Y. _ + .. .. 13 Fee c ' AxTHE MONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ,Awlitation for Mi000I *p!tem Con!6truction Vertu • 'Applicatidn is hereby made for a Permit to'Construct( )or Repair(L.,,�an On-site Sewage Disposal System at: Location Address or Lot No. P/YlZGd2 / t✓�/Z Owner's Name,Address and Tel.No. .Sc<.oDL-�z �s G�-,vL� i3,q�,�rsr�z3L[-= .7p�hv J'• Cvr✓r7�; �`2 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. r x' 3GZ- ,51)7 f ' Type of Building: / Dwelling No.of Bddrooms 2 Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow arse 7 - gallons per day. Calculated daily flow Z Z-a gallons. Plan Date No v ids i94 1— Number of sheets / Revision Date Title s�r� !'L�� �s'�iz�.s�.nr�t� �To ,.'J: c:v�z r�s�• .7-ic Description.of Soil O "=3G" 4,3 -7 V/ Jvr3=la c. ��'�=144 { ,-'Nature of Repairs or Alterations(Answer when applicable)z Date last inspected;# r j� Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of'the Environme tal Code and not,to place the system in operation until a Certifi- cate of Compliance has been iss d by this Bo d of H *X{ Signed /` Date .7� Application Approved by Application Disapproved for the following reasons Permit No Q'r�► a, �^+/ 'Y ✓ _= F Af Date Issued THE COMMONWEALTH OF MASSACHUSETTS r PUBLIC HEALTH DIVISION -BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System installed( )or repaired/replaced(L__I�on �aAis7-- for y'o%hAI 7': C.v,&w y 72 as has been constructe in accordance, with the provisions of Title 5 and the for Disposal System Construction Permit No. 9S-/83a dated- Use of this system is conditioned on compliance with the provisions set forth below: 9 .—r— No. ✓� � ✓�� Fee '50-G'1l— --- THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS li5po.qat *pgtem Construction Vermit Permission is hereby grantedgo Mto construct( )repair(✓)an On-site Sewage System located at //Z SCvpDL-n 's 4�-n��� and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. All construction must be completed within two years of the date below. Date: " •�' A roved !_ lie F rr yY N LOCATION SCALE . , . ./.'f DATE PLAN REFERENCE , E7ivF yo 7"i,•c� a � fie.3'x L I, W/ �oce. lec- A � •:. 7�'�r' Die/cC�,vc /. .u4X 6 3L" eo-4. �e Su3-5c✓t. 16 or E. i �v !ALE�Y 2 iii00 f w� ZrOUAl .... a.1'.:' 4 i._ .g: . _. y �. n . a .. 'x' :. - � .... a .. .�. .. .� � i. .. ., . < . . , . _ F _ y�, •� 1 . r :. - , . . . . _ _ . .�F 5 . _ r. T yy. .. _ _ a ,. t �, s _ . .. �+. m � � ] a. .. .� .- -,y ', y a .a �� .. i. .. ..� ,��, .r t. ��L L k sr''� .. J - � _ � i - .. � .. y _ .. :. �. �. i .. - w. � _ _ _ n .y .. i _ � ... i . _ .-- .. i f � - e. �. .i - _ _ _ - �.ems- � ��� L _ ..: _ -. .. ,.. F �. �. ,, q. " tr r a ��� p �^Y ,k _ . . �, �, a r� •n- - ". — �, . .. � .. - . - . . . _ {� _ r �' TOWN OF BARNSTABLE LOCATION SEWAGE # 00 VILLAGE ASSESSOR'S MAP Cz LOT�� O I INSTALLER'S NAME & PHONE NO. A & B CANCO 775-6264 SEPTIC TANK CAPACITY /Q00 4;�:I LEACHING FACILITY:(type) (size) /pao 4a '.. NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNERAc4 DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No 'i - r� _ - , ,: a , . ,-.. ws ��o Q ' . �� .... a Board of Health Town of Barnstable P.O. BO:c 524Fizic.. ... ........ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ----.._.._.._...................OF............--------------........._............. Appliration for Elh4priiial Work.6 Tonotrurtiura Vamit Application is hereby made for a Permit to Construct ( ) or Repair (✓S an Individual Sewage Disposal System at: �, r ...i/•?� �CU �... :.-----8!91ar Xgg C_..-----•--------•-•---------------------•-------------------------•-•-----._.....---------------- Location:-Address or Lot No. �._..... A --------------------------------- Owner _ Address .._/ -`�_ 1.9•► ?--------------- vv.1a 1 i S�-' _.ltk'__. "FA.! iac�R+a T. �... Installer Address UType of Building Size Lot----------------------------Sq. feet Dwelling—No. of Bedrooms____..}...................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building No. of ersons____________________________ Showers � YP g ---------------------------- P ( ) — Cafeteria ( ) QOther fixtures -------------------------------------------•------•--------•------------------------------------ h 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 Date_---------------•-•••-••--•------------ ,.a Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water_-_-_-_-____-____--_-._. Gi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_--____________-______-. 9 --------•••---••----•-••-••----•-------•---------------•---------•------------••--•-------------•-------•---------._...._...-------•••----------•---------. 0 Description of Soil........................................................................................................................................................................ x U •-------•--------•-----------•------------•-•-------------••-•---•--•-------------------......._._..--••---------------.._...--•-----------••-----------•---••-----•----------••---------•-•------•----- w U Nature of Repairs or Alterations Answer when applicable_-,L N_SrP?��-..__f r' .__f_t_�___.'7 ..NK_�._..__�_' Q . Agreement: The undersigned agrees to stall the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'TTi:, e N p 5 of the tate Sanitary Code— The undersigned further agrees not to place the system in w operation until a Certificate of Compliance has been issued by the board of health. Signed------. ..................................... ... "' . ...._ Date Application Approved By............ --•--------------------------------- ----- 10--1.9-'--g1-----. Date Application Disapproved for the following reasons----------------•----------------•---------------...-----------------------------------------------._...--------- -----------------------•--...------•-----....----••---------...-•-------------------._._.....-------------------------•.._...----••-----•---•--------------.__---------------•--------------•----------- a Date PermitNo._----_V .:Z,,3-V-------•--•----•-----------. Issued_....................................................... Date — �V Fxs .:...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .................. ---------------_OF..................................................---...---...----------•----------------- Appliratiun for Uiupaual Works Tunitratrtinn Prrutit Application is hereby made for a Permit to Construct ( ) or Repair O an Individual Sewage Disposal System at: 11 1- ..S c_U it.CN'.24a`;, ...............•-----------------........--------------------.......-"---'..__..._--.---..._..... ------------------"------------...._.....-----"----'----'...---'---'-----------'-...........-•-- Location-Address or Lot No. ...--- L..G e_ 1 Owner Address .S U I� f tA✓ - e{t-,�4 1�A n JT 'l . N-..A .................................................................................................. .....................................................:............................................ Installer Address dType of Building Size Lot............................Sq. feet f Dwelling—No. of Bedrooms_._._S....................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' 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--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water_-_______-_-____---__-_. fX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ ---------------------------------.------••---------------------.--.--------•---•--•------------------------------------------------------- •----------------- 0 Description of Soil....................................................................................................--------------------.............................................. W U •--••-•--•-•------•------•-•-----------------------•-----------......-•-•--•............'--"------------------.-----•-----•-----•-••----•••--...----•--•-------••----•.....-•----------•-•-••......-- W -------------------------------------------------- •--•- ...............................................----------------------------------------------------------------------------...-•'•--'-•-- UNature of Repairs or Alterations—Answer when applicable.. _ -_ --- ---- ! / ti !hoc as 1 ; A-r ✓+ �roVa: faC �..0-r-ayi� � d1 •-----------•-----------•----••--------•-------•------•-----------------•--•---••---.............-•---•-•--•-••-•---------------•-•----•••-----•----••---•--•......••--••-••--••-•••--................-- t r Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iT'LE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed........Z.....C,_; ^"' �- fU - 1 e '2 `�i . ----------•----------------------------•-----..---' • _. . ........sli _.. Date Application Approved By.............��'. ......- _r4s --<r------------------ -------------- ---------C�?:_/ - Y ....... V Date Application Disapproved for the following reasons----------------------------••---------------------------------------------------•-----•----•--•-••-•---------- '---------•---•--•-•-'------------------•---------•---........--•---........----•-----------------•-•-----------•-........---•------•-------•----•----•••-------•--•------------•-•••-•----•--••-•-•--- �j Date PermitNo....... �a 3- ----------------------------- Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH fi rt ............. ............OF....... ............................................... TarrfifirFati oaf Tautpliatta THIS I TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired><1 by----------------- f � n-L ....---•'-------------------------- -tall ` Installer � has been installed in accordance with the provisions of TIT'V 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No..... �. 2(�.�`�._......... dated________________________________________________ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CON TRUED AS A GUARANTEE THAT THE SYSTEM WILL U C T ON SATISFACTORY. J DATE................ ._. Inspector.................. t 4 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ,�z � .:......OF.............. . eC ........_............-----..._.... 1 No... ._.l FEE... ..---'-----.... Bispao tll urku Tnnitrttrtion rrutit t Permission is hereby granted--------- ! ...69t!=,C..---••-'---------------------------------------------------------------------------------------- to Construct ( ) or Repair an Individual Sewage Disposal Syst atNo............... 1.� c) %� :............U�`„z- r ----------------------'-----------•---•----------••--------------- Street QQ��� as shown on the application for Disposal Works Construction Permit No.6K k .... Dated.......................................... Q�y ............................ ... .••-••••---•---...••-•--------.....--------'-------'-------- /� �� -__V O Board of Health DATE. FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS � 0 ,` ! iiTOWN/OF BARNSTABLE L.JCIiTION I {a S C V C�G✓ /4At SEWAGE# VILLAGE 1241`/1S' AUL ASSESSOR'S MAP&PARCEL aS) - 13 INSTALLERS NAME&PHONE NO. H SEPTIC TANK CAPACITY /5CM Pd' LEACHING FACILITY:(type)Off' 3 C !. 'A , (size) /M P IT NO.OF BEDROOMS OWNER Curml^ PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of,leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY ESh "e lie Ss I O d .1vo�3 d , e A (3Ack � j 107 3 a- A 8 r _ 3 aS yQ, Lo Ci b a up - LIVING U O CL x �] 1 SCREEN r�Tl O O - AND W UCi n GLA55 C6PORCH ENTRY _ . m O CL FP CL 1/2 BATI-I f rt • _ x DINING Q 3 cl F A t c LIVING z, ----- PAWTW �E awrLim o cN , r • � wwneT • , - Itl KITCHEN t U Q Q 1. I ,z —1 ool 0 tu 111 uP EAKF T i s a : W_ cl J ----, I � Q J y Q V rr 9 yr W-s yr t2-y ADDITION FIRST FLOOR %PLAN S14EET 3 OF b . _ SCALE, 114' --p-0•. JOB: 0719 DRAWN BY. KW DATE: 12/11/07 l Mom• U) • Fv-I � 12'-9 1/2' 29'-9• __ Il'-2 V2• 18'-9• 9-,• 11'-0• V L o T 1 - N BED RM #2 U W s.. • rwx � � U o CLowr e _ R • F .: - . :. ON . - BATH FP HIS HERS MASTER $ATH MASTER BED RM2a Q 4 -- 2a , � ulaw - 3 Tn.e CK O BED RM #3 2A 2e BED RM #4 111 Z r f Q —ROOF LOFT DECK ®O' LU W -_ W W J Z. m -------- lam N'-2 I/7 16'-I I/t• '�• II�• ._ e'er• T-I• ' r _ _, _ N 6'-1• 14'-10• 14'i• 94-0- SECOND FLOOR PLAN SCALE, 114° 1'-0' SHEET 4 OF 5 JOB: 0719 DRAWN BY: KN " DATE: 12/11/07 Ln _ W 4 I r 1 1 w,usI-- e I I - :IsSno'coNToaiq a loDTINa TTP. I I U W W i- - fh I I fi'-w 1/2• fi'-10 V2• fi'-10 1/2' fi'-10 VY fi'-lo V2• 5'-10 v2 I cq 2 i rSTM COLUMN , S I I � I .• • � 1 - n °0'Imo'kt2•GONCRM PAD I - I ------------- L r r>, r ,� r, r/ r fi'11• fi'11 °'II• ------------------- ------- -- ----- 117 _ L �.:1 - - e >�GRDOt I I A T -- -- -- L . ;� FULL BASEMENT - I — — I I _��i•-! ; F�aF-- —i-••=+----i-+��h— ---h+-i-_��1--+•�:a ��,• �1--- -1-•+ .I P I _ I w n ti I i p �6412 GIRD6t Tom° (.,_2• 6'-Y I W °eo a�Ir ONCFtIIM PAD ILI 8050ow COICR M PAD r-•rcaNcaera rwu° I i I Q Z 1t51w•aorttlNuoua FOOTING TTP: ------t-------------- - — — — -- — N L - --- ---------- . -------- --- ------ --= I n fi,'-9 1P2• SHEET 5 OF 6 FOUNDATION PLAN SCALE, va°,. p_p• NOTE: EXISTING STRUCTURE TO BE RAISED G° •`{ rv'—� AND NEW FOUNDATION PLACED UNDER, . EXISTING FRAMING MEMBERS TO BE VERIFIED JOB: 0719 DRAWN BY: KW DATE: 12/11/07 - u1 ............ ----- - --- - ._...-------.._. . C4 _ -- ._ _ ... o _ W sl 9To��r,,IgqGE SHED 0 2g53 N 29 3/4"43 3/4" STORAGE DN. ly 'o to w v-- o tJ 1 _ . ___ -_ 0 __ _.... :_..._. .... N ....... ---- _ _ _ _ W to N r r v ;� x x X cwLn 2 0 2 0 5 0 5 -O 2 -0 -0 . _ 2 _ W Z q'-011 18'-011 _ q'-0" - o .,, II s I- it SCALE 4 1 G :;Alwoll /I II m ( M m m N ry to 3 3 sti 3 m Q N 4 N Q UP f o w -, to WI w 3 AR (n o GARAGE o a I L--- - Z AN 2925 I __ �■ ,n 2q 314' x25 3/4" m WI --` m WI I r--- -- w Daal M q I L------ EXISTING �9 z)3 Q �I3 I j------ S SHEDGE r�__ __ a w ' I LL -- ` J-- r�rllr l nl�r--- l i - AN 2g25 2q 3/4' x25 314" - 1 I - NOTE, CONTRACTOR TO REFER ` �1 �` I I' ` TO WFCM 110 X B AND ° - �.,- ! �' - C1-IECKL15T FOR ADDITIONAL HIGH WIND TECHNIQUES - RELATED TO THIS PLAN 6'x�t' I 8'xq' I t3'xq' SNEET 2 OF 3 (3) 11 7/8' LVL HDR " (3) 11 7J8 LVL WDR (3) it 7/8" LVL WDR 3 FULL WEIGHT STUDS 3 FULL HEIGHT STUDS 3 FULL HEIGHT STUDS SHEAR WALL COMPLIANCE: EA END EA END EA END W= ?,0% OF EACH WALL RUN 2'_s' q'-o" i'-to" qI-oll t'-10" q'-011 2'-6" VERTICAL SHEATHING WITH NAILS 3" EDGE/12" FIELD � o (4)16d NAILS PER FT BOTTOM PLATE C 'p FLAN._ L= 15% OF EACH WALL RUN f f`S� i.�.�./� VERTICAL SHEATHING WITH t',d NAILS 3" EDGE/12" FIELD SCALE: 114" 1'-0" ('4)16d NAILS PER FT BOTTOM PLATE -- JOB: 07f DRAWN BY: KW REVISED- 1/8/09 DATE: 10114/08 A 3 - 36-oil16 0 14-0" Ln Ln - - - - -- - --- - - - — —— — — ——— —— — — .-. .....— _... .^ — ._... -- •s O - - — I' ; O F L V. �' 00 W I TYP. FOUNDATION- _ALL BIL L L ANCHORED I t I n 0 8 x7' - 10a CONCRETE WALL .... EXISTING I ...:. I S. O A G E 10 x6 CONTINUOUS FOOTING SHED .. AG G O- I T S . I ; EXISTING _ DEMOL SH S ED • TORAGED , 3 GA : .�• �� •.- a .. R o GARAGE I . : a cortc 51_A13 • I . PT TI GN OWAR D U w DOOR I W NO •. T : . I 5 8 AN CNO R BOLTS r. : EXTEN D T R AND SO LE E PLATE M E BEDDED " t l SPACED O.C. i a 12 FROM CORNERS " " WASHER 3 S x3 1 x /4n I a D 0 DROP 10 DROP I R DROP O WALL e O e R P T. L 4 DROP W LL 48 , DROP 1 A AT DOOR t A DO OR T DOOR- _ T R ••• I o t.J I . r W - — J n ci- 2 5 q 6 4 q 4 2 5 I ,_ , I O 11 36 0 ` n w V 1 C�UN ION �'L.A N Lt1 Z DA"i. - I " SCALE. 114 - 1 0 Al f _ RIDGE VENT xl RIDGE BOARD 2 2 G 5/8 COX SHEATHING CEDAR BREATHIER RED CEDAR SHINGLES s @ 16 Lu co •�0 p f I -0 -0 Z UNFINISHED o = 2 2 w 12 � o , , i - s-ro>zA�� � 1 HURRICANE CLIP ip _i , Q W U-1 � Ix8 FASCIA / Ix4 SECOND MEMHER FASTENERS AT ALL F 1I I : RAFTER / TOP PLATE , ; CONTINUOUS VENTING SOFFIT, , I JUNCTIONS P. Ix8 FRIEZE BD. W/ BED MOULDING {.� rn T TY V I ! 1 - w w a i I aLOGKINCs 4 o D.C. n, _ IN FIRST TWO JOIST Q L.E-- r e _ n 14 ! J015T5 @ 16 O C. r M ABLE WALL I HAYS FROM G V -.I V! r Z - n I ---� r � 3 it 7/8 LVL 16R r � ) Z n J O.H: DOOR WDR q T �.!r r J L.� a r r 2x6 EXT. STUDS @ 16 O.G. { � - e GARAGE 1 PLYWOOD SHEATHING V r � /2 PLYW Q t --� TYVEK WRAP (OR .EQUAL) t r SHINGLES r W.G. G t PITCH TO DOORS t _ (-1Ti •,•. u v =FII 4 GONG. 5LA 7 O II t 1 . . —: :. .: • : TI-T1 i �I - :.'.11=illi. COMPACT FILL _. _ _I- FOUNDATION ALL TYP_ FDU � 24-0 1L-J P.T. SILL ANCHORED 38 O.G. = 8"0'-10" CONCRETE p o a n ..•. 10 x16 CONTINUOUS FOOTING. SHEET 3 OF 3 a .a _ "All I II ,ram i CROSS SECTION A -- SCALE- 1/4" 1'--D' OB: 07 J 19 DRAWN BY: KW REVISED: 1/8/0cl DATE: 10/14/08 aI.Y�f ASSESSORS REF. : Map 259, Parcel 13 3 ZONE: b rvp,e �i sib,, .. �� • •`wy9", rt- s�-' � X) +• / �Q �� '•. RF_1 ' �� Area min. 87,120 SF RPOD �.u� . . Frontage (min) 20' Setbacks: • IUMIJFron t 30' ` • �' Side 15' � Rear 15' 0 LOCATION MAP: Scale: 1" 2000'f { OVERLAY DISTRICT: GP Groundwater Protection District W2 '~' �l\ 1 \ t`� \ ma m ~ '> \ �� \ ` \ \ is XDm FLOOD ZONE: N �� �' � i \ o � � N o v AE(EL 12), AE(EL 14), X si oho I i li ~�. .\L \ ► CD Based on Map # 25001 CO554J July 16, 2014 i N- j )r L Lawn •\ X, •� L f 6 \ X Q k x5 Brick Patio/77777 ? 9.8' % \ ` #112 f 2 Sty W/F \` 36x4 G Dwelling Wood Deck Lawn � l i / 36x / Entry o+� Lawn S / 1 i Room 9 i 'O- ! r21.5' a r J `---- Lawn r — \ — -- ---- c) ! 45.1' 41 \ 1-112 Sty WIF f �`� Lawn (j Legend \t ` Carriage Ito�eitch Required ........... i 4y House + Pi e`nvert ! Heolthfpe ected y �\ 41 H drant I+ P b Existing Elev. 36.45.t r --� portment \ Tank y Proposed ti To be Confrmed Septic Line' -.�� �? t i Pool Table Room �y�' to be Sleeved ;/ ;�� OO Water Gate (round) o Above Garage v� 10' Past Water v: o See Nolte. '/ \\ '/ i y, -� Guy Anchor Gig �� I [ ` i / o O Utility Pole tiCO 00 1 ties N — Elevation Contour v M; Existing Tank Inlet sjy5°t i i p '25 1 O 40x8 — .\ \ I \ I Wert Efev. 34.45't� j~ �0°4 e Gt�9 G 0 _ .. \.�\ 1\ \. Per ContfNmed Eorvto P be E�Qe�Op$r i (7 \{y '- ` �� \ installatiorl of Additions'Line Deciduous Tree Cia yy t/ Lawn On% U GardBn Wherever Sewer Lines Must Cross Water Supply Lines Both Lines 1 o N \ \ // Lawn r t Shall Be Constructed of Class 150 Pressure Pipe and Shall be Water i (A / Tested to Assure Water tightness. In General,Water Lines Shall be s v ...... / _a // i Constructed in Coordination With Barnstable Water Department,and ! ` // Shall be in Accordance With 248 CMR 1.00-7.00&310 CMR 15.00. ZE Lawn , �( NOTE: LO ;>> ( 1.) The property line information shown was ..� compiled from available record information. � ;' eat � ................ -•`":- ' - � � 1 / ...... ..................... ,.. \ r 2. The topographic information was obtained lr ,, from an on the ground survey performed on or between 25 SEP 06 and 12 SEP 17. '" -..•` e datum used based on N............ --�,�• _ 3.) The da us is A I/D'88. V CO v v Lot 1 58,098f SF z i } Lawn 1.33±AC w R=41.6' • •. 1 ` ....................................... .... ....................:._............... 3 a,RLES ®, R N�82 ao„w o w = 745 87' o. 2 9 cosrE�-°�� Revision: Add Septic Line Notes 1112812017 Title: PREPARED FOR: PREPARED BY: Proposed Septic Line Engineering The Elizabeth 8 Donohue Trust S 11 vauonsultingjnc CapeSury u� 1Plan of Land at e /� (508)428-3344•seci@sullivanengin.com 11 2 Sc d d ers Lane PO Box 65le Parker Road 23 i West Boy Rd, Suite G Osterville MA 02655 y Mass. www.sultivanengin.com Osterville MA 02655 Ba,/''�ct b'e (Barnstable (508) 420-3994 / 420-3995fox of aJ (Village www.copesurv.com 20 0 10 20 40 50 Date: Scale: Field: WHK/ASK Review: RRL November 20, 2017 1 F1=20r Comp/Draft: ASK/RRL Drawing # C688_3gl ex1 BARNSTABLE HARBOR TOHINCKLEPON i LOCUS MAP SCALE I "= 2000, �- n� n' ASSESSORS MAP 259 PARCEL 13 �O SITE PLAN V IN BARN STABLE , MASS . - � FOR. W , _E PARCEL i , O TOM MORA N 561245 SQ. FT. 00 OCTOBER 21 , 2008 SCALE AS NOTED EDWARD E. KELLEY REG. PROFESSIONAL LAND - 4� SURVEYOR HIGH CAPACITY B E D G EXISTIN GRADE „ E L. 39. 50 , 38� N ►rj �� /• \I � 110, N , _� ',i' .' -� HIGH CAPACITY INFILTRATOR",. ,; W E`. TOP 0FD- 40•60 O =,� _ ;'f ; , ; BACK- FILL-�WITH CLEAN SAND, ; S O EX M !rj 25 W co ��O 5� TH ► TH2 �� i pe 61 34„ �I 6`1 34„ 6„ 34„, 6„ s OA _5�, \ pERc \i ST• 80X 9` 101611 ; Q to 1AJ EL.46:88. . . . >' /8' /\ TOP OF FOUNDATION 0 CONCRETE COVERS o z 5 / ti ' EXISTING GRADE / N - EL. 39.0 c j C� 4 CAST IRON 9 , ^ Z� ��(I�1t' j J / ` Z-�8 ti OR SCHEOULE40 4"SCHEDULE 40 P.V.C. (ONLY ) 9"MIN, LEACH BED 36'� MAX V / j / P.V,C. PIPE MIN. PIPE-M IN. �- j / NO '_, PITCH I/4"PER.FT. PITCH 1/4°PER.FT. 2 5n �' -�(8 ,/ '' C„ INFO GAS BAFFLE ' INVERT 6" INVERT I I „ O 43 � ,f� SEPTIC TANK EL.38,30., � �.+•� EL3T88.. L.� /SO0 GAL. INV RT g 48 j �O,q9 33 ,' INVERT 55 DI T. INVERT CLEAN MED-COARSE SAND (p j j :J EL.....:....... EL. ..8.05 60X 37 71 EL.. .:..... cn j HIGH CAPACITY INFILTRATOR `f. 01 OVER 10 cli10 Z D� QZ \ P r 1 I TOTAL OF BED , 0j f � �Ot � I-� - 5 43.T PROF! LIE D�a o�° P— 12 269 SEWAGE DISPOSAL SYSTE M � GROUND WATER TABLE w nJ SOIL LOG U) �Ic DATE -& Lao TIME 5100 1""/ NO SCALE O - M TEST HOLE I TEST HOLE 2 -- ELEV. Z• SO ?o, oo DES 1 GN DATA ELEV. a-e _ "'� NUMBER OF BEDROOMS 4 I'�7 60" „Y2i L�,r•. �JAND LvnHy SAND 440 j %��'- Y Go TOTAL ESTIMATED FLOW ._... . . . . . . .GALLONS/DAY 2 /, Pef,.c. c� EG.s7,So P�nc, te,3S.ee 458.94 BOTTOM LEACHING AREA . . . . . . . . . . . SQ.FT./TRENCH y h D C bCa ioyti /COK �o,, 74 �aZ„ i/3 5,q SIDE LEACHING AREA . .... ....... . .. . . SQ.FT./ TRENCH N 78023, 00„ LrG, 35, 3/.moo GARBAGE DISPOSAL . :NONE 150% AREA INCREASE) 145 87 �'/ CeA2SE Z TOTAL LEACHING AREA 766 . . . . .. SO. FT. Of AtilCZ SAtib C PERCOLATION RATE : ....7, MIN PER. INCH � ''ym lays 559 SQ.FT/GAL . PER. DAY - LEACHING AREA PER PERCOLATION RATE .......... .. ED1liRD o .Alg LLEY H PLAN SCALE I - 3O /C$ EL, 29s; ►6$ APPROVED . . .... .. . . . . . . . .. . . BOARD OF HEALTH No.26100 ---- a p� ...NO :WATER ENCOUNTERED ,��y�",�£�►st � oQ REVISED DATE . . . . . . . : . : . .f AL . __—S��'Gz^,�_Q, 1/�?GL._ �•�� AGENT OR INSPECTOR bO NFI /`N9/0 2 oQ"DI KS, L30Fl2 D o (fit nLTf/ TOM MORAN OWNER PLAN REF. — PL . BK . 179 PG . 25 ASSESSORS MAP 259 PARCEL 13