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HomeMy WebLinkAbout0203 SCUDDER'S LANE - Health lr��--203 Scudder Ln. , Barnstable A = 259 007 f a o � 9 n @ ll 1'T-j Yj 1) �{� 6 Commonwealth of Massachusetts Tile 5 Official lnspecti6n Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments '< 203 Scudders Lane, Barnstable r - M-259 , P-7002 Property Address Jane Thompson ` Owner Owner's Name a ..- information is MA 02138 _'' a June 7'2011 required for every 93 Winthop Street, Cambridge page. Citylrown 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 end of,the form., Important:When A. General Information filling out forms [PYon the computer, CO use only the tab 1. Inspector: I key to move your - '�" ' � 2, cursor-do not Troy Williams •' v use the return Name of Inspector key. Troy Williams Septic Inspections ICI Company Name 4. 19 Hummel Drive Company Address ,. South Dennis MA 02660 Cityrrown _ State Zip Code (508)385-1300 S1682 , 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 a�on sewage disposal-systems. I am a DEP approved system inspector pursuant to Section 1"40 Title 5(310 CMR 16.000).The system: ® Passes, a ❑ Conditionally Passes E Falls; 0- ❑ Needs Further Evaluation by the Local Approving Authority ^a � M June 7, 2011 Inspector's Signature f 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, and copies sent to the buyer, if applicable, and°the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. V _ I Title 5 Official Inspection Form:Subsurface Disposal System.•Page 1 of 17 t5ins-11/10 - 1 ° Commonwealth of Massachusetts Title 5 Official inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 203 Scudders Lane, Barnstable M-259 P-7002 Property Address Jane Thompson Owner Owner's Name information is required for every 93 Winthop Street, Cambridge MA 02138 June 7, 2011 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® f 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: Systems meets minimum standards set by Massachusetts DEP at the time of inspection only.This inspection is not a guarantee or warranty on the future working conditions of leaching, pipes, components or the future structural integrity of said components and only represents conditions found at the time of inspection only. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined"(Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old"or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. Y 0 N El ND (Explain below): N/A t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts 4 s Title 5 official inspection orm 4 Subsurface Sewage Disposal System Form Not for Voluntary Assessments °t 203 Scudders Lane, Barnstable M l-259 P 7002 Property Address Jane Thompson Owner Owners Name information is MA 02138 June 7,2011 required for every 93 Winthop Street, Cambridge page. City/Town _ . State Zip Code Date of Inspection B. Certification (cont.) t B) System Conditionally Passes(cost.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health):, ❑ broken pipe(s)'are replaced " ❑ Y ❑ N. ❑ ND,(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or,replaced ❑:Y ..❑ N ❑ :ND(Explain below): N/A ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑' N ❑ ND (Explain below): v N/A 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: El 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 t5ins-11110 Title 5 Official Inspection Fond:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 203 Scudders Lane, Barnstable M-259 P-7002 Property Address • 1 Jane Thompson Owner Owner's Name information is 93 Winthop Street, Cambridge MA 02138 June 7 2011 required for every , page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system Is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well"*. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: N/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 Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6n below invert or available volume is less than %day flow t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts Title 5 Official lnspecti®n orm Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 203 Scudders Lane, Barnstable M-259-P-7002 Property Address Jane Thom son Owner Owner's Name information is 93 Winthop Street, Cambridge' MA 02138 June 7, 2011 required for every page. Cityrrown State Zip Code Date of Inspection B. Certification (cunt.) Yes No , El ® ', 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,f 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 E] ® tributary to a surface water supply. ❑ ®' Any portion ofa cesspool or privy is within a Zone 1::of a public well. 0 ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence `f 'of ammonia.nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] The system is a cesspool serving a facility with a design flow of 2000gpd- 0 ® 10,000gpd.. f The system fails. I have determined,that one or more of the above failure ® criteria exist as described in 310 CMR 15.303, therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system_the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large Systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ El Area system.is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of.a public water supply well If you have answered"yes"to any question in Section E the system;is considered.a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat 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•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form i; Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 203 Scudders Lane, Barnstable M-259 P-7002 Property Address t Jane Thompson Owner owner's Name information is required for every 93 Winthop Street, Cambridge MA 02138 June 7, 2011 page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate es as to each of the following: Y or no g Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® Ei Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 4+ 3 Number of bedrooms(actual): 4+3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440/330 gpd t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection . Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 203 Scudders Lane, Barnstable M 259 - P-7002 Property Address ' Jane Thompson Owner Owner's Name information is 93 Winthop Street, Cambridge MA 02138 June 7, 2011 required for every City/Town State Zip Code Date of Inspection page. D. System Information Description: Property has 2 systems. One for main house that was designed for 4 bdrms/440 gpd and a second' system for the cottage and studio/garage that was designed fo 3 bdrms/330 gpd. Main House system consists of a 1500 tank, d-box and 6 infiltrators. Cottage/Garage system consists of 1500 tank, d-box and 2-500 gallon chambers. 4+ Number of current residents: Does residence have a garbage grinder? El Yes ® No Is laundry on a separate sewage system?{if yes separate inspection required) ❑ Yes ® No Laundry system inspected? ED Yes ❑ No Seasonal use? - ® Yes ❑ No 10=317,000 gals. Water meter readings, if available(last 2 years usage(gpd)): 09=106,000 gals. Detail: , Sump pump? Yes ® No occupied Last date of occupancy: Date CommerciaYindustrial Flow Conditions: N/A Type of Establishment: N/A Design flow(based on 310 CMR 15.203)` Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.):` N/A Grease trap present? Y ❑ Yes ❑ No Industrial waste holding tankpresent? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No N/A Water meter readings, if available: t5ins-11/10 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 203 Scudders Lane, Barnstable M-259 P-7002 Property Address Jane Thompson Owner Owner's Name information is required for every 93 Winthop Street Cambridge MA 02138 June 7, 2011 page. Cityrrown State Zip Code Date of Inspection D. System Information (coot.) Last date of occupancy/user N/A Date Other(describe below): General Information Pumping Records: Source of information: No pumping info was available. Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract. ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection, Form f a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 203 Scudders Lane, Barnstable M 259 P 7002' Property Address Jane Thompson Owner Owner's Name information is 93 Winthop Street, Cambridge MA 02138 -. June T 2011 required for every page Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: Tank, d-box and leaching fo main house were installed on 12/13/96 per compliance. Tank,'d-box and leaching for cottage and garage were installed on 5/20/05 per compliance. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): - - 18"+ Depth below grade: . feet Material of construction: Elcast iron ®40 PVC ❑other(explain): N/A- Distance from private water supply well or suction line: "; feet , Comments(on condition Of joints, venting, evidence of.leakage, etc): Lines were found clear at the time of inspection Septic Tank(locate onsite plan): 1' main 3'with riser to 6"garage Depth below grade: feet Material of construction: M ®concrete ❑ meta( ❑fiberglass. ❑ polyethylene El other(explain) I� If tank is metal,.list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No 1500 gallon both systems Dimensions: 4„ both Sludge depth: t5ins-11/10 Title 5 Official Inspection Foam:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Tile 5 Official Inspection Form i Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 203 Scudders Lane, Barnstable M-259 P-7002 Property Address Jane Thompson Owner Owner's Name information is nthop Street, Cambridge MA 02138 June 7, 2011 required for every 93 Wi page, Cityrrown state Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 2'8" both both Scum thickness None in bo Distance from top of scum to top of outlet tee or baffle 6"both Distance from bottom of scum to bottom of outlet tee or baffle 14" both How were dimensions determined? probe/measured/plan Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pvc inlet and outlet tees were found present and in working order in both tanks. No evidence of leakage or damage was found in either tank. Tanks were not in need of pumping at this time. Grease Trap(locate on site plan): Depth below grade: N/A feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): N/A N/A Dimensions: Scum thickness N/A Distance from top of scum to top of outlet tee or baffle N/A Distance from bottom of scum to bottom of outlet tee or baffle N/A Date of last pumping: N/A Date t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts . . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 203 Scudders Lane, Barnstable. M 259- P-7002 Property Address Jane Thompson Owner Owner's Name information is required for every 93 Winthop Street, Cambridge MA ' 02138 June 7, 2011 page. Cityrrown State , • Zip Code Date of Inspection• D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition; structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): N/A Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): N/A Depth below grade: Material of construction: El concrete ❑metal El fiberglass ❑ polyethylene` other(explain): N/A N/A Dimensions: N/A Capacity, gallons n Flow: N/A- Desi 9 gallons per day Alarm present: « { ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes _ ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.); N/A *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No a t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts upTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 203 Scudders Lane, Barnstable M-259 P-7002 Property Address Jane Thompson Owner owner's Name information is required for every 93 Winthop Street, Cambridge. MA 02138 June 7, 2011 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan):. Depth of liquid level above outlet invert level Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-boxs were found level and in working order. Garage system d-box was found with equal distribution to outlet lines. No evidence of solid carry-over or backup in the past were found at the time of inspection. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments(note condition of pump chamber,condition of pumps and appurtenances, etc.): N/A Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-11110 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts , Title 5 Official Inspection For Subsurface Sewage Disposal System Form-Not for Voluntary Assessments` 203 Scudders Lane; Barnstable M--259. P 7002 Property Address Jane Thompson Owner Owner's Name , information is 93 Winthop Street, Cambridge ., MA 02138 -June 7, 2011 required for every page. C'dyrrown State _Zip Code . Date of Inspection D. System Information-(cont.) Type: ❑ leaching pits number: 2-500 gal. with ® leaching chambers ' number: stone ❑ 25'X 13'X 2' leaching galleries number: ` 6 infiltrators with ® leaching trenches number; length: stone 17"under 9'X43'X2' Elleaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system ' Type/name of technology: Comments(note condition-of soil, signs of�hydraulic failure, level of ponding, damp soil, condition of. vegetation, etc.): Chambers were found with a low water level at the time of inspection.Checked stone for both chambers and infiltrators and found dry and clean. No evidence of hydraulic failure or problems in the past were found at the time of inspection. Chambers.are for cottage&garage. Infiltrators for main house. Cesspools (cesspool must be pumped as part of inspection) (locate.on site plan): N/A Number and configuration N/A Depth—top of liquid to-inlet invert Depth of solids layer N/A N/A Depth of scum layer Dimensions of cesspool N/A N/A Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins,11H 0 Title 5 Official Inspection Form:Subsurface Sewage Disposal system-Page 13 of 17 Commonwealth of Massachusetts Title 5 O fidal-Anspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments °< 203 Scudders Lane, Barnstable M-259 P-7002 Property Address Jane Thompson Owner owner's Name information is g required for every 3 Winthop Street, Cambridge MA 02138 June 7, 2011 page. City/rown 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.): N/A Privy(locate on site plan): Materials of construction: N/A Dimensions N/A Depth of solids N/A Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): N/A t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts ' lugTitle 5 official Inspection'For Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 203 Scudders Lane, Barnstable M,-259 P 7002 Property Address Jane Thompson Owner Owner's Name information is required for every 93 Winthop Street; Cambridge. �` MA 02138 June 7, 2011 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within.100 feet. Locate where public water supply enters the.building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately 'e i . _ �����• V t. Pei O a 1 lj yz, g i _ N14 1,4 t5ins•11/10 Title 5 official Inspection Form:Subsurface Sewage Disposal.System•Page 15 of 17 Commonwealth of Massachusetts Title 5 official inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 203 Scudders Lane, Barnstable M-259 P-7002 Property Address Jane Thompson Owner Owner's Name information is required for every 93 Winthop Street, Cambridge MA 02138 June 7, 2011 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 20.0'+ feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 12/5/95, 6/17/04 Date ® Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: SDW 252 Zone A 46.8' .9'adjustment You must describe how you established the high ground water elevation: Test hole recorded on plan showed no water found at 12.0'. Groundwater adjustment at the time of inspection was.9'. Bottom of deepest part of leaching on property at 6.0'was found not to be located in the high groundwater elevation at the time of inspection. USGS groundwater maps and plan elevations show groundwater to be a minimum of 25.0'. I 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 Commonwealth of Massachusetts Title 5 official inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 203 Scudders Lane, Barnstable M-259 P-7002 Property Address Jane Thompson Owner Owner's Name information is required for every 93 Winthop Street, Cambridge MA 02138 June 7, 2011 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)'completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 ' i 1 T � JUN-09-2005 02 :02 PM DOWN CAPE ENGINEERING 508 362 9880 P. 04 Town of Barnstable Regulatory Services Thomas F. Geiler, Director Public Health Division «w+' Thomas McKean, Director 200 Main Street,Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: Sewage Permit# _ZOO "✓?l Assessor's Ma ff arcel Designer: a , Installer: Address: ��' _ Address: � � � On or 9IO"/W-,; 9 was issued a permit to install a (date) (installer) i n septic system at °2 03 y L" based on a design drawn by (address) / dated (d gner) 1 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. 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. (In er's ignature) ARNE H OJAI.A No. .30792 h �O•`FS���S T E (Designer's Signal), G 9 (A tamp Here) P, RETURN TQ BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WI] L NOT BE I5 U D UNTIL BOTH THIS FORM AND -BUILT C RD ARE RECEIVED By IHE-15ARNSTAPLE PUBLIC HEALTH DIVISION, THANK X U. Q:Health/Septic/Designer certification Form 3-26-04.doc ^ ILA tA V,, CO 2IL G�c�te Lt vv 2 a _ June 11, 2004 �-----�----•---•m---.-� Robert Gatewood JUN 1 4 2004 Barnstable Conservation Commission �A 200 Main Street BARNS T„BLE CONSt=Fr?VATION Hyannis, MA 02601 RE: SE3 4232 Thompson Residence, 203 Scudder Lane, Barnstable Dear Rob, Enclosed is a letter to the Building Department initiating the building permit process. I have not initiated the permit with the Board of Health because Down Cape Engineering is currently designing a second septic system for the garage. Down Cape is going to add the capacity of the two sheds to this new system. I have been assured that the pipe that drains onto the coastal bank will have been cut back and sealed by today. I will check this personally on Monday. I will keep you updated on the progress with both the Building' and Health Departments. Please do not hesitate to call me with any questions or comments. Sinc rely, fickia+m6� . Enclosure Rick Lamb Associates Design Cc: Mrs. Thompson Landscape Architecture 33 Athens Street Cambridge Massachusetts 02138 Telephone 617 868 1939 Fax 617 354 3387 RLAMBASSOC®aol.com June 11, 2004 William Kelly , Building Division Town of Barnstable 200 Main Street Hyannis, MA 02601 RE: Thompson Residence, 203 Scudder Lane, Barnstable Dear Mr. Kelly, I need to ask for your on how to proceed with procuring a building permit after the fact for a neighbor, Mrs. Jane Thompson. Five years ago she built a new house, replacing one that had burned down. Shortly after completing the house, she had three sheds on her adjoining property moved together to provide seasonal bedrooms for her health care personnel. One of the sheds had been a bathroom previously attached to one of the cottages. The old cesspool was' cleaned, filled and collapsed. The bathroom was connected to the new septic system. This winter, as Mrs. Thompson's.Landscape Architect, I filed for Certificate of Compliance with the Conservation Commission. The Certificate was granted, excluding the sheds. I was directed to file a separate Notice of Intent. The Conservation Commission passed the NOI with the conditions that permits are filed with the Building Department and Board of Health. . I have requested that Down Cape Engineers add two"bedrooms"to a second septic system that they are designing for the new garage. Down Cape Is currently proceeding with those plans. I have enclosed a portion of the site.plan showing the current location of the sheds, together with photographs. How does Mrs. Thompson, with me acting as her agent, proceed to procure a building permit after the fact? I would be able to meet you in your office and or on site. I look forward to hearing from you. Sincerely, Rick Lamb Associates Design Landscape Architecture 33 Athens.Street Rick Lamb Cambridge Massachusetts 02138 Enclosures Telephone Cc: Thompson 617 868 1939 Conservation Commission Fax 617 354 3387 RLAMBASSOC@aol.com TOWN OF BARNSTABLE t 1:..;0CAT16N ' 3 SC,,,4t.=5 G CF, SEWAGE vJLI LAG &VJ` i�-� ASSESSOR'S MAP & LOTQ?j, 0d_3 IriSTALLER'S NAME&PHONE NO. ir�s�o i �J1�icctiv✓ . �/.��'- ��/,� r SEPTIC TANK CAPACITY G,G fil�o 4LEACHING FACILITY: (type)5-eig CQl 64,w4 y (size) /3�>4.2S 'X2/ NO,OF BEDROO �- BUILDER OR PERMITDATE: 6,1W-et 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) /Qo Feet Furnished by 1 b -O br f f� a No. � ' � Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIpplication for io o.5ar Stem Con.5truction Permit Application for a Permit to Construct Repair( )Upgrade( )Abandon( ) /complete System ❑Individual Components Location Address or Lot No. L-Z Owner's Name,Address and Tel.No. Assessor's Map/Parcel �T n 145 / _7 Oo 70�� Installer's Name,Address,and Tel.No. Designer's Name,Address an Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size l' sq.ft. Garbage Grinder( ) Other Ty of Building �)No. of Persons Showers( Cafeteri�j( ) Other Fixtures 4 Design Flow .3 0 gallons per day. Calculated daily flow �3 cr gallons. Plan Date C " cy— "% Number of sheets Revision Date C '—C7 3 "�' `J Title Size of Septic Tanker l".SG U Type of S.A.S. Description of Soil d `c' ,�� 11 Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued b 6 Board of FY3,A. Sign Date Application Approved by Date G y Application Disapproved for the following reasons Permit No. __Gco v ' /y Date Issued (0 cf- 1 � ,.raj—��� /�/ — No. 7 / M ate' Fee A`� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: _T a I Yes ' = PUBLIC HEALTH DIVISION -TOWN OF,BARNSTABLES MASSACHUSETTS 2pplication for �Digpogar *pgtem Congtruction Permit Application for a Permit to Construct( vj)Repair( )Upgrade( )Abandon( ) Complete System' ❑Individual Components Location Address or Lot No.0 C`� 2 Owner's Name,Address and Tel.No. Assessor's Map/Parcel C9,5 O O Oo—'j // "7 -? I,Uc I? , r Installer's Name,Address,and Tel.No. Designer's Name,Address an;No. Type of Building: c Dwelling No.of Bedrooms 041 Lot Size l' o sq. ft. Garbage Grinder( ) Other Ty of Building 4: No. of Perso s Showers(a) Cafeteria( ) --� J Other Fixtures y G r S C Gc�i .T��� f SS�"G S %� /� 4— ! oq Qo H^ Design Flow 0 gallons per day. Calculated daily flow g' gallons. Plan Date _ a a�o `/ Number of sheets Revision Date —o `l Title { l Size of Septic Tank /,S'G 0 Type of S.A.S. .Description of Soil (r, 1::::214 y Nature of Repairs or Alterations(Answer when applicable) Date last inspected: . Agreement: --,The undersigned agrees to ensure the construction and maintenance;of the;fore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmenfµal�Code and not to place the system in operation until a Certifi- cate of Compliance has been issued b Boar of, ` t Sign d Date C `G Application Approved by Date G Application Disapproved for the following reasons t i Permit No. `� Y Date Issued a U THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERVFY, that the On-site SewagetiDisposal System Constructed (✓) Repaired ( )Upgraded( ) Abandoned( )by at L/ /` 4l , al'4, v/ f,0 has been constructed 'n accordance with the provisions o Title 5 and thepr Disposal System Construction Permit No.� 3/`r dated Installer ����`� Designer The issuance of th s pe it shall not be construed as a guarantee that 6e system c 'on s designed. Date , Inspector Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS lwigpogat *pgtem Congtruction Permit Permission is hereby granted to Constru ( atr( Upgrade( )Ab don( ) System located at c9 ,� n"Q _ 4� '�le and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Cons cti n must a completed within three years of th date o�his n t. Date: �p / Approvec'l by er Massachusetts Department of Environmental Protection Provided by DER Bureau of Resource Protection -Wetlands DEP Fire Number s . MARS. WPA Form 3 _ Notice of Intent saso. Document Transaction Number Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Barnstable And Town of Barnstable Ordinances Article XXVII Town A. General Information 1. Project Location (Note: electronic filers will click on button for GIS locator): _7 .,__ . ____ ,_— _ _ __ 203 Scudder Lane Barnstable elel / 02630 a;Street Address—— b.Town/Village c.Zip Code Latitude and Longitude, if Known: d.Latitude e.Longitude 259 007-002 f.Assessors Map Number g.Assessors Parcel Number Important: When filling out 2. Applicant: forms on the computer,use Jane Thompson only the tab a.First Name _ b.Last Name c.Company . key to move One Winthrop Square, 6A your cursor- d.Mailing Address do not use the Cambridge MA 02138 return key. e.City/Town f.State g.Zip Code 617 542 2702 617 542 2704 h.Phone Number i.Fax Number j.Email address 3. Property owner(if different from applicant): ❑ Check if more a.First Name b.Last Name c:Company. d.Mailing Address Note: ` Al Before e.City/town f.State g.Zip Code completing this form consult h.Phone Number i.Fax Number j.Email address �n Barnstable ® �J Conservation 4. Representative(if any):. Division Rick Lamb Associates regarding local a.Firm wetland Rick Lamb Ordinance. b.Contact Person First Name c.Contact Person Las Nam 33 Athens Street BARNSTABLE CONSERVATION d.Mailing Address Barnstable { MA 02138 e.City/Town + f.State 617 868 1939 617 354 3387 rlambassoc@aol.com h.Phone Number i.Fax Number j.Email address ❑ Select if 5.- Total WPA Fee Paid (from Appendix A, Wetland Fee Transmittal Form): you want to see , Wetland Fee $180.00 $55.00 $125.00 Transmittal a.Total Fee Paid b.State Fee,Paid c.Town Fee Paid Form. 6 —GeneralP_roject Descriptio _'cDuring the completion of the site work under SE3-3020, Mrs. Thompson organized various m II �. buildings to provide seasonal health personal places to spend the night.�One-building.serves as a bathroom which ties into the septic system. The"cottages!'.are set south of the 50'setback and the northern facade of the residence. The cottages were placed-in an existing lawn area. woaformldoc•rev.06103 Peas 1 of 8 TOWN OF BARNSTABLE j • Ci-s se �* ATION � r SEWAGE #�°G Y- LARGE � y�v S S'4 -- ASSESSOR'S MAP &LOT20 07000 INSTALLER'S NAME&PHONE NO. �•�o> i C®�+J7'�icttio✓ . y�gs9lo SEPTIC TANK CAPACITY LEACHING FACIIZTY:(type)Iry 6-1 -rlww4 J (size) /3 X Xs ;cam e NO. OF BEDROO ' BUILDER OR � akJ PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) 1490 4 Feet Furnished by ,+•,ram Tom/e r � �P ' � l Aey- ,�� �.r/Naa�C ✓ f,e t SE3-4232 Thompson { / Approved Plan=December 31,2003 Site Plan by Arne Ojala,PLS Special Conditions of Approval I. Preface Caution: Failure to comply with all Conditions of this Order of Conditions can have serious consequences. The consequence may include issuance of a stop work order,fines,requirement to remove unpermitted structures, requirement to re-landscape to original condition,inability to obtain a certificate of compliance,and more. The General Conditions of this Order begin on page 2 and continue on pages 3 and 4. The Special Conditions are contained on pages 4.1,4.2 and 4.3 if necessary.All conditions require your compliance. II. Prior to the start of work,the.following conditions shall be satisfied: 1. Within one month of receipt of this Order of Conditions and prior to the commencement of any work approved herein, General Condition number 8(recording requirement)on page 3 shall be complied with. III. The following additional conditions shall govern the project once work begins. 2. General conditions No. 12 and No. 13(changes in plan)on page 3 shall be complied with. 3. The Conservation Commission,its employees,and its agents shall have a right of entry to inspect for compliance with the provisions of this Order of Conditions. 4. The applicant shall obtain septic system and building permits for the as=built structures and facilities. These permit shall be applied for.within 60 days of the issuance of this Order ^f 5. The old pipe on the coastal bank shall be cut and capped,using care not to disturb,the bank. 6. Herbicide,pesticide and fertilizer use is discouraged on lawns within Conservation Commission jurisdiction. If fertilizer is used,only slow-release low-nitrogen fertilizer shall be applied. Over-fertilizing shall be avoided. IV. After all work is completed,the following condition shall be promptly met: 7. At the completion of work,or by the expiration of this Order,the applicant shall request in writing a Certificate of Compliance for the work herein permitted. Barnstable Conservation Commission Form C shall be completed and returned with the request for a Certificate of Compliance. Where a project has been completed in accordance with plans stamped by a registered professional engineer,architect,landscape architect or land surveyor,a written statement by such a professional person certifying substantial compliance with the plans and setting forth what deviation,if any, exists with the record plans approved in the Order shall accompany the request for a Certificate of Compliance.At the time of the request for a Certificate of Compliance,an updated sequence of color photographs of the undisturbed buffer zone shall be also submitted. p.4.1 ^� U TOWN OF BARNSTABLE SEWAGE# �� V)a.,LAGE'' SESSOR'S MAP & LOT ^GU Y INSTALLER'S NAME&PHONE NO. `.SEPTIC TANK CAPACITY I;I:ACHING FACILITY: (type) G O s (size) NO.OF BEDROOMS - , BUILDER OR OWNER /Vn; r C-2s%1/ ✓�' - PERMITDATE: �� I COMPLIANCE DATE: ! as Separation Distance Between the: Maximum Adjusted.Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells eiusf V; �/ ' on site.or within 200 feet of leaching facility) Feet,. � � _ , Edge of Weiland and Leaching Facility(If any wetlands exist t t.. within 300 feet of leaching facility) Feet''; f`Furnished,by y` .IT , t ; `J 2 r � e T�p i t ASS ESSORS MAP MO° a� f No. 4 PARCEL NO: QO / Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIppYication for Migooai bpotem Construction permit Application is hereby made for a Permit to Construct or Repair( )an On-site Sewage Disposal System at: Location Address or Lot No. Ot)_g A,)j)DC (��, Owner's N,gme,Ad ress and Tel.No. 77tW®s6 Assessor's Map/Parcel c 00 3 (�,r//L.AP—D S> Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. , 3� A41N s s Type of Building: Dwelling No.of Bedrooms Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: , The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued d o ealth. Signed Date ,r Application Approved b - ��� Date e— Application Disapproved for the following reasons Permit No. Date Issued No. " DO 7 J Fee 7�HS' dMMONWEALTH OF MASSACHUSETTS ; PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS 2ppiication for Zigpogar *pgtem .Congtruction Permit Application is hereby made for a Permit to Construct(/or Repair( )an On-site Sewage Disposal System at: Location Address or Lot No. 3V�3 n! L Owner's Name,Address and Tel.No. Assessor's Map/Parcel DO Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. , /4e-rV? 2 aim S Type of Building: .. �> Dwelling No.of Bedrooms 4-: ` Garbage Grinder( I/Q Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures 1 Design Flow O gallons per day. Calculated daily flow gallons. Plan Date -�&1 Number of sheets / Revision Date Title %Description of Soil rKe/ SS / 5 dl� Nature of Repairs or Alterations(Answer when applicable) Date last inspected:- Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until,a Certifi- cate of,Compliance has been issued this 'o d o 4ealth. tY Signed Date j Application Approved by Date -- Application Disapproved for the following reasons Permit No. �6 " �lf� Date Issued ——— ————-———.—————-„—------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage,Disposal System installed( )or repaired/replaced( )on by Installer at &C-4 4 j �(�J^ 1,� has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 6 dated Date + Inspector THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYS- TEM WILL FUNCTION SATISFACTORY. --------------------------------------- No. Fee -./ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLES MASSACHUSETTS Migool bpgtem Congtruction Permit Permission is he3eby granted to to construct( )repair( )an On-site Sewage System located at No.# W.�n Sveet and as described in the above Application for Disposal System Construction Permit. NO.' Date 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 three years of the date below. Date: ;��— c� ^ 9� Approved by ��`� Board of Health n K •.ram ;-` �1,..�--r. w 9 - R� No.. S•-•`- Fes$... ......_......_ , THE COMMONWEALTH OF MASSACHUSETTS /0D2� .�-- B®AEA®_- .- HEAL.. ..... OF.......... .. .. .. L ........... Appliratinn for Disposal Warks Tonstrurtiun Vamit Application is hereby made for a Permit to Constr ct ( ) or Repair ( ) an Individual Sewage Disposal S sT at ao� ' . s e ti :.. .......:.............. .......:...........:...•-----...... .....--.•..•-----.--•.......................................... f.._.. Loca' ddress or Lot No. .. ..... n S�C/���Q �����jj. ... •- ��_/J� ............:. .................................... --•--.....................................---••--- ...... [_l/l.►.`�......Arb-L.�..5-_�..`r�.................. ............................................Address....._........._.. Installer Address . Type of Building / Size Lot............................Sq. feet ,., Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( } Other—Type of Building ..... No. of persons............................. Showers — Cafeteria Other fixtures -------------------'----------------- W Design Flow,-..... .................:............gallons per person per day. Total daily`flow..._..__.. __. allons. WSeptic Tank'=Liquid capacity/.gallons Length................ Width---------------- Diameter................ Depth................ x Disposal Trench—No.... ............... Width.................... Total Length..................... Total leaching area....................sq. ft. 3 Seepage Pit No. Diameter Diameter...:................ Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution bo7c ( ) Dosing tank ( ) Percolation Test Results Performed b Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ r14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-___:______-_•---__-_-_. ----•-•.. 1---------•...... ... ....•------- O Description of Soil.--- ...,.1� .. G�._......� �Qe------_91.0 ..... . ...-•----............ W .............................................-•••-••----•--------------.......------•------•-------.....--•-----...-•------•---••---•---•-••-•---••----•---•--••••--••---••-•••......---•--............ UNature of Re a- s or Alterations— nswer w a pli le.___________________•___.__.._.__..._._..__ ._._.....__ ... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—Th tiers- d further agrees not to place the system in operation until a Certificate of Compliance has b ed b e lth. ate ApplicationApproved By.................................................................................................. Date Application Disapproved for the following reasons--------------•--------------•----------------------------...-----------•----........-••--•.....-•-•-------•----- --•-•-•-•................•---•......-----•--•....--------•-••-•--•------------•--•----•--••----..._....-........----•----••-•----•--••------•----------------------------•----............_--•-•-........ Date PermitNo........................................................ Issued........................................................ Date No... - Fi@3& -..............._ THE COMMONWEALTH OF MASSACHUSETTS BOARD 9 HEA _w 41,1... . ......o F._....... - ......••-- . pphration for 9hiposal Workii Cnonstrurttutt Vautit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal SysWi n at: 1 �•c a:'.Cd � --....... .......... " t �%.�_.: _. ............................................. ...............--......................... �yt p Loca' ddress p� I _Z :Nra-s-� 14-e.... tl: _'�'�f._a..................... ..... or t Ao-----•----•-......................--••--•. r o� er Address a ......(�,�. .. �.. >r 2(. .................. .............. Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.........................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons......................._.... Showers ( ) — Cafeteria ( ) W Other fixtures --------••-••-•-••••.........--- - ................••------------------ W Design Flow.......,'`-o.............................gallons per person per day. Total daily flow._..._..... 1 ?�%__._..._______._.___gallons. USeptic Tank—Liquid capacity/,,'� (..gallon Length................ Width................ Diameter................ Depth............... xDisposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..A6't*k,;,_1... Diameter.................... Depth below inlet.................... Total leaching area............_.....sq. ft. Z Other Distribution box` ( ) Dosing tank ( ) aPercolation Test Results Performed by.....•-••--••.......--••--••--•-•-•••-••---••-•••. •--•••-•...._•..... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ �14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water....................... a' -••-•-•-•--• ..--- --i....................... O Description of Soil � �} '' p'1 s :� sd �!- ...................... V .......-•••-•••-•--••-•--•••-•--••••••-••-••--•••-••••-•-••••---..---••----•-•-•---------------------••--•-----••--•-- Y t t W U Nature of Repairs or Alterations—Answer wljen applicable.......................................... ._. ........................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersi ed further agrees not to place the system in operation until a Certificate of Compliance has bee by,Zl ;.QLhealth. Sign d� ¢ '•-'��-4..t-. � t ?t ....................... , ate ApplicationApproved By.................................................................................................. ........................................ Date . Application Disapproved for the following reasons:..............................---------••--•-------••-•----••---•---•-•----------......._...._......•-•........ ...................••-••••-•--•---...........----••••.........---••••--•-••-••-•...........••--•-•••--•...-••••-••-•--•................--•••-•-•-••••----•••••-•••......--••------••...........•---...... Date Permit.No..........................................:.............. Issued................. :_......................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF MEAL f.-.41..fly. .....................OF....` ?/w3r!�...� {:.: ................ T '4JS TO CERTIFj That th jndividual Sewage Disposal System constructed ( ) or Repaired ( ) by ,r = , , :..r 'F '. ,>..� f ..... r f at.- � qJ [ 6 has been installed in accordand� with the provisions of Article XI The State Sanitary C d„ ej�s d ctibed in the Is application for Disposal Works Construction Permit No............... ... . ...... dated , pry.W.' ... ..................... t THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUA4ANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE...................•----•---------........................... ........ Ins ector..._/;;Zn,k_.' ' %f ��`..fJ e V THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH "l C t ........... O F........ .....1! jt., /. '.J!-•�' ................................. y �1j fj .. ....... Noy .:..,:... .......... FEE. a•• :....... rrut # Permission is hereby granted........... ................................. a..........�:..�'.... ................•--•--.........:...:.....:................:.-•----- to Construct ( ) or Ike ( ) an Individual Sewage Disposal System ?\ `i r at No........ .: .......... ......- �............... Street as shown on the application for Disposal Works'Construction Permit No.-",A .:.:;...Y.. Dated.................. _ .......................................... - .e •."< .._.J _.�,9�M.7�-' •i........................ ....a Board of Health DATE............ "._. t�^� ' 1 '''....----••........ FORM 1255 HOBSS a WARREN. INC., PU31_I3HEnS t ' Barnstable Jane Thompson May 16, 2003 4' f 1 2 3 • . , 8' A 5'-5 ' up f w f n N t -1 �P ) 1 m9: / I, f 1 r-...�.. Vie.-. .-. n � V--n- -+.w�,..— .+. y�..•-� «-+-...M.: n --r .r— ..v.— +- ._ / �__- _ _ ___ _'"" _- ._. _ �++-_ _ .„. .@.+..era o- - -� -.'�' - -— - M' 2. 24 ;Illy MAME 9 1 - ,1 L \ � _ 1" r Barnstable Gara e w, t� ��� f� s�o� � - 3 9 �' , ° - Ground Floor Plan 203 Scudder Lane,Bamst616,MA 02360 c Scale 1/4 U I Jane Thompson o ; s ,o 1 2 3 26' - • - - - , - C-01 24' Storage/Studio n _ C-02 Barnstable Garage SecondrFloor PlanW. 203 Scudder Lane,Barnstable,MA 02360 - Scale 1/44 Jane Thompson . o r s 1011 , V _. a C' 1 24' i t u i y ♦..... <\ • -.................................... ................ .................................... ..................................... .. ...... _........ • / t �_ ....... ........... ........ ..... ... ...... ...... 1 7 .. ....., .. _ ..... ................. ....... ............ ....................................... ...._. ... .. _ ... .. ....... ......... .. .. .._ ...... - i • t • r , •\ .................. ........................... , ♦ \ \ i / // \ / .\ iY 7 i ........ .......... _ ....... \ t ; ........................ .................................................... ! Barnstable Garage 9 _ 1 w: _� North elevation, facing House/ Harbor_ 203 Scudder Lane,Bamstable',MA 023M Scale 1/4". B - 01 Jane Thom son _ ' o r s 1o. 26' 8' I I ' .... ............ . ............... ......................... .. ................................................................................... ......:..._....... ._......................................................................................................................................_..............................,.................................................._... S,-6w ' ......... ....... ....... ......................................................................................................................._...................................................................................... - . ..............................................................................................--..........................................................................................._............................................................---......................................................__........................................ .. - .. .. ......... .................. ...... . ....................:...... • ,- ........:-. ..................... ........................ .. ................................................................................................._........... .. ................................. 111 - - ....:....... ...................................... ........................................... . ....................................................................... ........_..................... .............................:...............:....:: ...... ................................. .. .. :............... ......... .................................................................................................................... _._.. _. _ ___ _ ___. 24' r. - ......... .......... ......__._.. ...... a.., sr�w .�; ................................................................................................................................................... - r _-.u...._..._.._._....._.._......._.. ._____w..._..._;.._:..,_...�.__.__....__._... .....................: .._ .... .... - ............. ........................................... ............................ Ell F._...__., ,._,.,...:.M_____�___...�_.___...W..._:.._......,.�.._........_ r :. . ..... r . .. .................. ...... ...... ............................................ ............................................ .......... ................. ................ .......... .................. ............................... ...................................................... ................................................... ............... ..................................... ....................... .............--............... ....... ................................ ......... .......... 100) Barnstable Garage West elevation, facing Drive 203 Scudder Lane,Barnstable,MA 02360 Scale 1/4" - Jane Thompson - o 1 s ,o 26' r. '- .....:..............._.................'.......................................-........................................................................................:............:......_.................. ..............................-.................................._............._......_........................................................................................................................ ...."-_........ _ w �.... - _ ........... - .. ........: ............. ..................................._............. .........._...... ............ .............. .......... .... ............ ............................. ................................................ ...... .......... ............................. ... .. ... .. \.......'.... .. a..s •'-- - . 'V .._ ... .......... v 24' .......................... y ,:: �` i y ...... ........ rw� _ .. - ....... Y 1 i............. ....... :a.... 1._.. _ _ ...................... ... .i.,..i...: .......... ...........................,.... Y .... ......... ...i..L,. - ........ Bpi.......... ................. ...{ ..................... i .............................................. _...� p...{�,. ............. 1 /y jb -._ \ �, ...... ....... ........ ....J..... t..................................... \t .............. ............. v .. .. .. ............. it \........................................... ..n F� \ .' ............ ................._ .. .. ............ ..........a .......{............................................... i;,..; ...y ...................... � ............ ......... 1,,.i,,..... •" ,1 .. ........................................... - .. �. .......................................::'t'`y ... ....................................................i:``_. „j..................... ..\. �i , �_..._.._ _l .. :x {zs :.> ... vz.. y .... 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"........... .. , - -t ... r r ....._._.. /............. , ,M�, ' .r K- i [ t ... ........ .. ... ................ - __.. - Y t elevation facin Gooch Barnstable Garage _ — --------_ --- - -_ - — — - 203 Scudder Lane,Barnstable,MA 02360 � � - _ , Scale 1/4w B — Oa- Jane Thompson e ' I. : T _ ..:.... : 3' . 24, ... .. ...... .... .............. .. 1 ........ .......... . ........ ........ .:::::....-... ......................::::..:::. ........................................................_...................................... .. 9''6w .. .i._, ..... ...................... ......................... ..... .... .... ... ....._ ... .............. .. ............... .... .. ... ............�..._..,„,,.......... �____. ..,_,._ .. _ .............. ...... ....................................................................-.........................................................................,................................................................................................................... ......................................_......._.:._..........................:..........._..............:......................................................................._...........................:......................................._.........-...._..............._.........:..................................................... r Barnstable- Garage _ Y _ _. _ - _ _ - �_ South elevation. facing_Road c9htofwayy 203 Scudder Lane,Barnstable,MA 02360 - Scale 1/4" ` = B 04 Jane Thompson u 1. s �a 26• i 1 S 11' 8' g1-6• , 3' 24' MUM _ --- _�Barnstable Garage __North-south-Sec on-1 --- 203 Scudder Lane,Barnstable,MA 02360 Scale 1/4" Cj 01 Jane Thompson 24' 6' : �i Ig{ 24' 24' s TI t , 81�6w 0 - 0 r _ -Barnstable:Gar-age -- -.w-_--_ ._East WestSeEtion 203 Scudder Lane,Barnstable,MA 02360 Scale 1/IV C 02 . Jane Thompson o 1 s ,a j i L SYSTEM PROFILE (FOR GARAGE) TEST HOLE LOGS GAR. SLAB FNDN. AT E . 38.1 ' BARNSTABLE HARBOR C.I. ACCESS COVER TO FIN. GRADE (NOT TO SCALE) PROVIDE INSPECTION PORT TO FINISH ACCESS COVER (WATERTIGHT) TO GRADE ENGINEER: A.H. OJALA, PE _ MINIMUM .75' OF COVER OVER PRECAST /` FIN. GRADE % PE REQUIRED OVER SYSTEM LOCUS 2 slo Q 39.0' WITNESS: E. BARRY (BOH) RUN PIPE LEVEL 2" DOUBLE WA HED DEASTONE DATE: 12/5/95 • 36.4 FOR FIRST 2' 3' MAX. PERC. RATE _ < 2 MIN/INCH (EXIST) PROPOSED 1500 �35.70 GALLON SEPTIC 35.45' H-2o 36.0' CLASS 1 SOILS P# 8613 Z ••- TANK (H- 2O ) GAS - S W _ 35.26' maCOC3 0 MmmE] �_ 0 5 ~ BAFFLE 35:43' �� 0 35.1 7' CJ CJ C7 a C] 0 0 C7 C] 2 C7 = C7 C7 C7 C7 Cl N ( % SLOPE) �6" CRUSHED STONE & MECHANICAL go < MIN COMPACTION. (15.221 [2)) g 2 O C7 C7 C7 O C7 O C] o� 33.17' ELEV. DEPTH OF FLOW = 4 1 % SLOPE ( 1 % SLOPE) " WASHED S Q" � 40.8' �" � 40.5' RTE sA ( ) 3/4 TO 1 1/2 DOUBLE W S ED .NONE TEE SIZES: 6.17' Ap AP INLET DEPTH = 10rr H-20 500 GAL. CHAMBERS LOAM LOAM OUTLET DEPTH = 14" 12" 7.5YR 3/2 12" 7.5YR 3/2 LOCATION MAP NTS 27.0' FOUNDATION 22' SEPTIC TANK 2' --- D' BOX 11 LEACHING B B SILT LOAM SILT LOAM FACILIT'( ASSESSORS MAP 259 PARCEL 7-1 v� �\ UNWITNESSED HOLE 1791 2.5Y 6/4 17" 2.5Y 6/4 \ O 6/17/04 BSFR�F A.OJ4, PE Cl Cl 0" 39.0' z cy TpF FILL SILT LOAM SILT LOAM 12* A/B 10YR 6/2 10YR 6/2 o \ \'L0�9 SL 51" 36.55, 60 35.5' \ 'P 1 OYR 2/1 24" c 2C2 2C2 N O F Cl ,Q• \ IVIED SAND IVIED SAND OG,t \ '9•AS SILT LOAM 1OYR 6/3 10YR 6/6 10YR 6/6 126" �. w •Bg�� � __ _ 1 � 72" 33.0' 120 NO WATOER ENCOUNTERED 30.0 NOTES: CONNECT BUILDING SEWER C' \ C2 TO PROPOSED SEPTIC 4. TANK AT MIN. 2% PITCH �o D K 09ti \\ CMS 1. DATUM IS NGVD I SLEEVE LINE WHERE/IF WITHIN 10'-OF WATERLINE 2.5Y 6/4 EXISTING L"NDING AND STAIRS _ �.�__. 2. MUNICIPAL WATER IS - _ 'd: -�v'iiNiMl;I,I i'iF'E BITCH-Tv- BL /'r.�,. r,1-c rvv�. , NO WATER ENCOUNTERED 4. ,DESIGN LOADING FOR -ALL PRECAST UNITS TO BE AASHO H- 2 _____ . w� k SEPTIC DESIGN: (GARBAGE DISPOSER IS NOT Al I QWFn ) 5. PIPE JOINTS TO BE MADE *&ERTIGHT. a 110 = 30 6. CONSTRUCTION DETAILS TO 6 IN ACCORDANCE WITH MASS. DESIGN FLOW: _3_-. BEDROOMS ( GPD) 3 GPD E � ENVIRONMENTAL CODE TITLE V. USE A 330 GPD DESIGN FLOW 7. THIS PLAN IS FOR PROPOSED SEPTIC SYSTEM ONLY AND IS NOT \ SEPTIC TANK., 330 GPD ( 2 ) = 660 TO BE USED FOR ANY OTHER PURPOSE. USE A 15.0.0_ GALLON SEPTIC TANK 8. PI E FOR SEPTIC SYSTEM TO SCH. 40 4 PVC. I TH2 wyo 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT LEACHING: 3r� EXIST. DWELL. INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED w SIDES: - - FROM BOARD OF HEALTH. - -- cr- -- TH1 � BOTTOM: 25 x 12.83 (.74) = 237 GARDE A }A� \ BENCHMARK: TOP CB TOTAL: 472 S.F. 349 GPD -ri 4 r S oo - ELEV. 31.37 (NGVD) USE (2) 500 GAL. LEACHING CHAMBERS (ACME OR `7` ,, ; AREA C I/ EQJAL) WITH 4' STONE ALL AROUND TITLE 5 , JTG PLAY 3 _ Al /W I PROP. RESERVE AREA (IF UTILIZED, OF ; RETAINING WALLS REQUIRED - LEGEND 3 E \ ^ CONTACT ENGINEER FOR DESIGN) 203 S C U D D LR LANE SLEEVE S ER � 100.0 PROPOSED SPOT ELEVATION IN THE TOWN OF: - 'j tJW UNE FOR 10' �/ 5' REMOVAL OF UNSUITABLE SOIL REQUIRED Q p^I c /� R I { 1 f a EITHER SIDE OF AROUND PERIMETER OF LEACHING FACILITY, U A I\I V S TA U L E� (VILLAGE) CROSSING WITH �. ,� DOWN TO SUITABLE SOIL LAYER. REPLACE 100x0 EXISTING SPOT ELEVATION j WAT R LINE STONE WITH CLEAN MED. SAND. ENGINEER TO DRIVE INSPECT AND CERTIFY REMOVAL 1 OO PREPARED FOR: JAN E TH O M PSO N ## . �� PROPOSED CONTOUR APPROX. WATERLINE ONLY: MUST BE RE-ROUTED WHERE WITHIN i0' OF SEPTIC COMPONENTS OR SLEEVED 1OO EXISTING CONTOUR � 30 0 30 60 90 EXIST. -- 2 ` GARAGE BOARD OF HEALTH \ O,Q� W/ART STUDIO SCALE: 1„ _ 30' .._.. .__...-.. DATE: DUNE 20, 2004 MA REV 6/23/04\ S �'`/I, � APPROVED -DATE 24 REV 12 04 BV / / off 508-362-4541 NOTE: DWELLING HAS OWN fox 508 382-98e0 -VA OF ��q,(HOF�,rgs�c SYSTEM (INSTALLED 1996) 1 �o� ARNE H oyGN ARNE H. yc� PERMIT #96-403. down cape engineering, inc, OJALA �a OJALA CIVIL , � N y No CIVIL ENGINEERS o. 30792 34` oP LAND SURVEYORS NA 95-331 939 ruin st, yarmouth, ma 02675 AR OJALA, P.E., P.L.S. DATE ij i I 1 i 1 BARNSTABLE \ HARBOR LOCUS i C7 ' \ N CALVES G PASTURE o WAY BARNSTABLE HARBOR RO�'Te sA qoA� LOCUS MAP SCALE 1 "= 2000' ASSESSORS MAP 259 \ PARCELS 7-1, 7-2 r, \ t %\ t JANE THOMPSON i % c0qS\ !A \ PARCEL 2 .((/I ' %'�� •� \ � DECK 1 q B \� T, GUEST i =', LANDING AND STAIRS ' HOUSES f i i f (HATCHES AREA) i C�r ` y / EXISTING ` JOSHUA C. CHASE %> ! i i ', -�, � i . DWELLING , . ,` � ` • :r _.._.~/ FLAG STONE \�; r, ._•-• -/ WALKS STONE \ w w, I �' BENCHMARK:TOP CB DRIVE : GARtJEN ARA� ,az ` \\ ELEV. 31.37 .(NGVD) 9;V -AREA ,.� .` _... STONE �� ! , _... ..... • I - . DRIVE ! .. F. WAYNE GOOCH f ................ SITE PLAN GARAGE ,. 2 n� p IS E V E OF LAND IN `.............. z BARNSTABLE, MA MAR 2 5 2004 \ r PREPARED FOR BARNSTABLE CONSERVATION JANE THOMPSON DATE: DECEMBER 311 2003 `' SCALE: 1 " 30' I i 30 0 30 60 90 Feet i 1 . d• r ( H OF rygss9c OF A(q�C N � rt3" 1 ��o R E �o� ARNE 1 0 � H• ' N OJALA i No.28348 No 26348 92.72' 1 2 \ �oQ, 4 e s\o J SURVE S /Z��/lo 3 �233,23' Lv Z Q 266.48 J SUZANNEFNEWMAN Lu © M 04 4� 0-1 PE. s �If►-tE�: �, '�1 1.��� l �jHQa1 STD-BL.1E {�A2 Bad � 'top FH o t.1 �55 �.r�¢.5 -{b h11 Tr•t I I.I btt Af FI a►5}•( GIRA4� E• 40 0 5E�1'1L DESIea.�; Gfs'e�.b�ucE t�I���E'Q- }b �..Io1`Ab-►.OI.tEO g><o¢oo� PIL Peo P. 1 �A�. 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OJALA ,dr ram. g, No. Na 26348 'e, s 9fCtSiEREooe�� • �` .Z C /t/o v o 3 i AROISTAKE o iocrrs KAROM � � Q CAMS \�\ PAST�� I w�Y \ �\ $A y N� t WILUAM E. do ANTONIA B. COOK CERT.N 126576 y LOCUS MAP SCALE 1 2000' LCP 20950 \ FOR REGISTRY USE ONLY "= a•.`" i0�r\ 4fjZw BARNSTABLE HARBOR ASSESSORS MAP 259 }q� PARCELS 7-1. 7-2 ZONING: RF-1 EXIST. �`� `NF MIN. LOT FRONTAGE - 20 FT •- \ \ MIN. LOT WIDTH 125 FT 2 BARN \ ` Bl*? \ AREA - 43,560 SF SETBACKS: FRONT - 30' `\s? REAR I 155' FLOODIONE C V3(EL15) � YJ• \ F` BARNSTABLE COMMUNITY PANEL f250001 0015 C f AUGUST 19. 1985 i OWNER OF RECORD: 14 STORY STREET rGyo� ` CAMBRIDGE, MA 02138 \°Rp REF: DEED BOOK 1500 PAGE 823 DEED BOOK 11217 PAGE 225 \ epT PLAN BOOK 516 PAGE 33 PARCEL 4 ORIGINAL PARCEL 2 MINUS NEW PARCEL 3 231.834 SFt UPLAND SHAPE - 18.5 .�....... ..�..: ,.. .. _..: . BARNSTABLE PLANNING EXIST. � ' . G BOARD \ v APPROVAL under the SUBDIVISION -----r=• , ... ;�..,, .. _ � tiF CONTROL LAW NOT 0 REQUIRED N , &Zz_:z /j 3 o .gyp. ..,.. t•,�. _ O . , - � _: ,__ � EX�sT. _ . DATE: W BLDG. o ` �. , _.. v ` \ \sp d ikb �, \ o .�,► t N PARCEL 3 Q � �, h EXIST. 10.850 SFt BLDG. 3 UPLAND' PLAN OF LAND IN f A O \ / EXIST. ` NOTE: so BLD S �a N A O ♦ NO DETERMINATION AS TO COMPUMCE WITH THE JOSHUA C CHASE 5.5'# ti 6, �' � �`� HAS BEEN BARNSTABLE, MA CERR o650 9G ?# - EXISTING PARCEL` • EXIST. ORNINTENDED BYING CTHEEREMENTS ABOVE ENDORSEMENT MBE LCPr-.. � 51.774 SFt TOTAL 203 SCUDDER LANE \ BARN i ; / 47.474 SFt UPLAND 5.8'# NOTE: 2 PREPARED FOR ' 6p CB SEE PREVIOUS APPROVAL NOT REQUIRED PLAN OF i W ��' FND THE SAME PARCELS Of LAND ENDORSED BY THE BARNSTABLE SABLE PLANNING JA NE THOMPSON � o RECORD. TO CB FND BOARD ON AUGUST 7. 1995 fD •N} S 13'09'25" E 1.70' NOTE: M SCALE: 1' 40' PARCEL 3 IS TO BE COMBINED WITH PARCEL 1 2 ��•^•.,_,/`ti• SHAPE FACTOR OF PARCEL 3 AND 1 IS 21.7 DATE: OCTOBER 29. 2003 i '.` �i�'w. ; GRAVEL DRIVE Q, 40 0 40 80 120 Feet O 4 - �� l r ~OQ N/F F. WAYNE GOOCH •- �'\��2`� ` �•v� DEED BOOK 10011 PAGE 334 WETLAND2.768 SF* MAR 1 8 004 Na o ;� 2 o 'So.ig WETLAND q► BARNSTA"I_E CONSERVATION �� 2 w LOT ? ON 508-30-4Ml fox 300 341—"80 I CERTIFY THAT THIS PLAN WAS MADE IN CB w 'down cope engineering, Inc. ACCORDANCE WITH THE REGI DEEDS FNDIV 'S0 REGULATIONS EFFECTIVE' F1+ss 6 RECORD TO CB FND 9�20" W 92,7 • CIVIL ENGINEERS AND AS AMENDED JAN o� S 70015'42" E 0.26' N 7g , 2 �- LAND SURVEYORS FND �8 ZO. 4, 44� �Al:�:• ' � ?33.23• � 3 939 main st. ormouth, ma 02675 ,jai R ��•. � N 266.�• s 78-,6, f ;' ,� � y FOSS N/F 80�� w � � �a �a SUZANNE NEWMAN rN 4 DATE AW f+t*K P.L.S. CERT. #157507 .. t: 86 8Sf ODTHC ''••: ..��� LCP 20950--K 2