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Home My WebLink About0070 SPYGLASS HILL ROAD - Health ® Lot 6 Spyglass Hill Rd. , Barnstable A= 355-001-003 ia a Commonwealth of Massachusetts lql� 996 -401-03 Title 5 official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments d IV) 70 Spyglass Hill Road !7� Property Address Ronald & Noelene Cervin " Owner Owner's Name information is Q1 required for every C"aquid Ma 02637. 8-31-15 page. City/Town State h Zip Code Date of Inspection Y4, 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 on the computer, use only the tab 1. Inspector: key to move your cursor-do not Matthew F. Gilfoy use the return key. Name of Inspector B&B Excavation ab Company Name 14 Teaberry Lane , r Company Address Sandwich Ma. 02644 City/Town State Zip Code (508)477-0653 S113640 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). The system: ® Passes ❑ Conditionally Passes _ ❑ Fails,` "❑ Needs Further Evaluation by the Local Approving Authority 8-31-15 Ins ctor's Signature Date The system inspector shall submit 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. N ****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. �a �salsyst.rnVPaget5ins•3/13 Title 5 Official Inspection Form:Subsurface SewageDis 1 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments t 70 Spyglass Hill Road Property Address Ronald & Noelene Cervin Owner Owner's Name information is Cu-tna uid Ma 02637 8-31-1 5 required for every 4 .. page. City/Town State Zip Code Date of Inspection S. Certification (cont.) ; 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., - comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no or"not determined (Y, N, ND)for the following statements. If"not ' determined," please explain; The septic tank is metal and over.20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is.replaced with a complying septic tank as,approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N. ❑ ND (Explain below): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments. �M 70 Spyglass Hill Road . Property Address Ronald & Noelene Cervin Owner Owner's Name , information is required for every Cunnaquid Ma 02637 8-31-15 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y . ❑ N ❑'ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): [ ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed '❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation,is Required by the Board of Health: ° ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. _ 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health; safety and the environment: 17 ❑ 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•3/13 Title 5 OfficulInspection Form:Subsurface Sewage Disposal System•Page 3 of 17 1 t Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 70 Spyglass Hill Road Property Address Ronald & Noelene Cervin Owner Owner's Name information is Cunna uid Ma 02637 8-31-15 required for every q page. Citylfown 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: r. 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 El E 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 El ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El „ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow wa t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4.of 1741 x .a C Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 70 Spyglass Hill Road Property Address , Ronald & Noelene Cervin Owner Owner's Name information is required for every Cunnaquid Ma 02637 8-31-15 a e. Cit /Town State Zip Code Date of Inspection P Y P 9 B. Certification cont. Yes No 0 ® Required pumping more than 4 times in the last year NOT due to clogged or ' obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. i ❑ ® 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. El ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100'feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd 10,000gpd. ❑ ® The system fails. I have determined that one or more"of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. , Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply El ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well ' 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 . Commonwealth of Massachusetts Title 5 official Inspection Form; Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 70 Spyglass Hill Road , Property Address Ronald & Noelene Cervin Owner Owner's Name information is Cunna uid Ma 02637 8-31-15 required for every q page. Cityrrown State Zip Code Date of Inspection C. Checklist P Check if the following have been done: You must indicate"yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in',the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? t ® ❑ Were all system components, excluding the SAS, located on site? 0 ❑ 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: s ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information ; Residential Flow Conditions:; Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example:,110 gpd x#of bedrooms): 440 t5ins•3/13 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 70 Spyglass Hill Road Property Address Ronald & Noelene Cervin Owner Owner's Name ` information is q required for every Cunna uid Ma- 02637 '8-31-15 page. City/Town State Zip Code Date of Inspection D. System Information - Description: Number of current residents: Does residence have a garbage grinder? ° ❑ Yes 0 No Is laundry on a separate sewage system? (Include laundry system inspection Yes ® No information in this report.) . Laundry system inspected? r ❑ Yes ® No .S. Seasonal use? A •❑ Yes ® No Water meter readings, if available last 2 ears usage see below 9 ( X 9 (gpd)): - Detail: 2013- 52GPD 2014-52 GPD • g Sump pump? El Yes N No Last date ofioccupancy: current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on+310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ° ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page Tof 17 f Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 70 Spyglass Hill Road Property Address Ronald & Noelene Cervin ' Owner Owner's Name information is Cunna uid Ma 02637 8-31-15 required for every q page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: date Other(describe below): , General Information Pumping Records: Source of information: " 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 M ❑ 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17, _ s I Commonwealth of Massachusetts W Title 5 Official Inspection Forte Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 70 Spyglass Hill Road Property Address Ronald & Noelene Cervin Owner Owner's Name information is Cunna uid - Ma 02637 8-31-15 required for every q page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1996 Were sewage odors detected when arriving at the site? ❑ Yes E No Building Sewer(locate on site plan): Depth below grade: feet Material of construction: , ❑ cast iron Z 40 PVC ❑ other(explain); ' Y Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): Depth below grade: 18„feet Material of construction: ® concrete 0 metal ❑ fiberglass ❑ polyethylene ❑ other'(explain) If tank is metal, list age: years • r Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes .❑ No ' Dimensions: 1500 gallon A 12" Sludge depth: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 y ,` i Commonwealth of Massachusetts t Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 70 Spyglass Hill Road Property Address Ronald & Noelene Cervin Owner Owner's Name information is Cunna uid Ma 02637 8-31-15 required for every q page. City/Town State Zip Code Date.of Inspection D. System Information (cont.)Y ( Septic Tank(cont.) - Distance from top of sludge to bottom of outlet tee or baffle • 24" .. ' . 4" 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 13" 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.): At time of inspection septic tank appeared to be in working order with liquid level equal with outlet invert. Tank is in.need of pumping at this time and should be pumped every 2 years for maintenance. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness p Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last.pumping; Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 ;, Commonwealth of Massachusetts W Title 5 official Inspection 1=orrn Subsurface Sewage Disposal System Form -Not for Voluntary Assessments . 7 °^M 0 Spyglass Hill Road Property Address Ronald & Noelene Cervin Owner Owner's Name information is Cunna uid Ma 02637 x 8-31-15 required for every q page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.):' *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3H 3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 f Commonwealth of Massachusetts - Title 5 official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 70 Spyglass Hill Road Property Address Ronald & Noelene Cervin Owner Owner's Name information is Cunna uid Ma 02637, 8-31-15 required for every q page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): 0, Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): At time of inspection D-box is in working order with no sign of back up or carry over. . 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.): a If pumps or alarms are not in working order, system is a-conditional pass. Soil Absorption System (SAS)(locate on site plan, excavation not required): . . If SAS not located, explain why; 4 t5ins-3/13 Tile 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments M 70 Spyglass Hill Road Property Address Ronald & Noelene Cervin Owner Owner's Name information is required for every Cunnaguid Ma 02637 8-31-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) : .. Type: ❑ leaching pits number ® leaching chambers, number: , 6 infiltrators w/3' of stone ❑ leaching galleries number: ❑ leaching trenches number, length: " ❑ leaching fields number, dimensions: ❑ overflow cesspool, number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): At time of inspection leaching appears to be in working order with no sign of hydraulic failure. No lush vegetation or damp soils present. Cess ools cess I m m 0o ust be u ed as art of inspection) locate on siteplan): p P P P P P ) ( _ Number and configuration' Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17, Commonwealth of Massachusetts 5 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments. GSM , 70 Spyglass Hill Road - - - Property Address Ronald & Noelene Cervin Owner Owner's Name information is every unna re C uid Ma 02637 8-31-15 wired for eve q 9 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.): Privy (locate on site plan): i Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure,.level of ponding, condition of vegetation, etc.): t t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 70 Spyglass Hill Road Property Address Ronald & Noelene Cervin Owner Owner's Name information is required for every Cunnaguid Ma 02637 8-31-15 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 thb building. Check one of the boxes below: hand-sketch in the area below E drawing attached separately Lj_ ear A Z Hi 6`° 62- is' ., b3 n r , t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts M W Title 5 official Inspection Form , Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 70 Spyglass Hill Road Property Address Ronald & Noelene Cervin Owner Owner's Name information is Cunna uid -Ma 02637 8-31-15 required for every a page. City/Town State • Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water . f ® Check cellar ® Shallow wells ° Estimated depth to high ground water: No Gw 144" feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record 4 If checked, date of design plan reviewed: June-11-1996 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS), ❑ Checked with local Board of Health -explain: - ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: Plan on file with BOH " Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts W Title 5 official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 70 Spyglass Hill Road Property Address Ronald & Noelene Cervin Owner Owner's Name information is Cunna uid Ma 02637 8-31-155. required for every 4 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 _t ins•3/13 • ` , 5 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Pa a 17.of 17 9 P9 s 9" Imo , s RECEIVED M 3 S TROY WILLIAMS NOV 0 3 1999 9 — bbI .. C)a eoQK TOWN OF BARNSTABLE SEPTIC INSPECTIONS HEALTH DEPT. Certified by MA.Department of Environmental Protection (508) 385-1500 19 Hummel Drive South Dennis, MA 02660 -- - — , COMMON«'EALTH OF n SSACHUSETTS U ii EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON MA 02108 (617) 292-5500 TRUDY CORE Secretary AR GEO PAUL CELLUCCI DAVID B. STRUHS Governor Comnussioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Pr Address: 70 S tot/ i v-s 5 /-4� 1 ) /2 J. /! Property / Name of Owner C u.r 0 r i t r N L y ran w� a c( Address of Owner ,�p P/e-.c.y 4 ► 5 f Date of Inspection: /O / f, y C. o. S c /mac+ Name of Inspector:(Please Print) Troy Williams am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) 0 2.02-1' Company Name: TroX lliams Septic Inspections Mailing Address: 19 Hummel Drive, So. Dennis, MA 02660 Telephone Number: (508) 385-1300 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: Passes . Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signaturt� S�,y� �.tt�G✓r,,a Date: /0 The System Inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within thirty(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 Department of Environmental Protection. The original should be sent to ttte system owner and copies sent to the buyer,if applicable,and the approving authority. NOTES AND COMMENTS Although system meets the minimum requirements set forth by the Massachusetts Department of Environmental Protection,certification is not to be construed as a guarantee of future working condition of system,piping or components. This inspection represents the conditions of the system on the Date of Inspection noted above. revised 9/2 /98 p.- I _r„ ,s SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (corAirxwd) Property Address: Owncf: 70 Spy Glass Hill Road,Cummaquid,MA Date of k pec _: Carol Tierney INSPECTION SUMMARRY:tOber Check A, B, C, or D: A. SYSTEM PASSES: I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist. Any failure criteria not evaluated are indicated below. COMMENTS: B. SYSTEM CONDITIONALLY PASSES: N/� 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. Indicate yes, no, or not determined(Y, N, or ND). Describe basis of determination in all instances. If "not determined", explain why not. The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached)indicating that the tank was installed within twenty(20) years prior to the date of the inspection: or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. i Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four 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 " revised 9/2/98 Page 2oru �. A SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Prope.ty Address: 70 Spy Glass Hill Road,Cummagtud,MA DWnw: Carol Tiemey Date of Inspection: October 19 19W 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 the public health, safety and the environment. 11 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 THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of surface water — Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. t 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 AND SAFETY AND THE ENVIRONMENT: i — 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 soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis 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. Method used to determine distance (approximation not valid). 3) OTHER revised 9/2/98 PuReJofll SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) 70 Spy Glass Hill Road,Cummaquid,MA Property address: Carol Tiemey Owner: October 19, 1999 Date of Inspection: ,/ D. SYSTEM FAILS: /v//9 You must indicate either "Yes" or "No" to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No r Backup of sewage into facility or system component due'to an overloaded.or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_ Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a 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 I 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS: /V//9 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: The system serves a facility with a design flow of 10,000 gpd or greater(Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area=IWPA) or a mapped Zone II of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further information. N revised 9/2/98 Page 4ofII 1 . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 70 Spy Glass Hill Road,Cummaquid,MA D"'"ef: Carol Tierney Date of kupecti_: October 19, 1999 Check if the following have been.done: You must indicate either "Yes" or "No_ as to each of the followin : 9 Yes, No _ Pumping information was provided by the owner, occupant, or Board of Health. _ None of the system components have been pumped-for at least two weeks and-the system has been-receiving i rmaf flow-* rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. _ As built plans have been obtained and examined. Note if they are not available with NIA. The facility or dwelling was inspected for signs of sewage back-up. Y _ The system does not receive non-sanitary or industrial waste flow. _ The site was inspected for signs of breakout. V _ All system components, excluding the Soil Absorption System, have been located on the site. The septic tank manholes.were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: _ Existing information. For example, Plan at B.O.H. _ Determined in the field(if any of the failure criteria related to Part C is at issue,approximation pproximation of distance is unacceptable) The facility owner (and occupants,if different from owner) were.provided with information on the.propermaintanance of SubSurface Disposal Systems. i M N revised 9/2/98 Page 5ofII P SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: Owner: 70 Spy Glass Hill Road,Cummagtud,MA Date of Inspection: Carol Tiemey October 19, 1999 RESIDENTIAL: FLOW CONDMONS Design flow: (/0 g,p,d./bedroom. Number of bedrooms(design): Number of bedrooms(actual): Total DESIGN flow yyo Number of current residents: 0 Garbage grinder(yes or no): Ivo Laundry(separate system) (yes or no):iVa; If yes, separate inspection required Laundry system inspected (yes or no) Seasonal use(yes or no):A10 r�G Water meter readings, it available(last two year's usage(gpol: / ( : y6 a� a u ��o h S �c9 _ (;U� 16 ci Sump Pump(yes or no): A/o ey Last date of occupancy:2�2,, 98 i J; o c c. f%a 1 u s 0. tom. COMMERCIALIINDUSTRIAL: rl/11,9 Type of establishment: Design flow:_ qpd ( Based on 15.203) Basis of design flow 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: + i OTHER:(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: 2 System pumded as part of inspection: (yes or no)ALv `'"� o�✓hL.�, If yes, volume pumped: gallons Reason for pumping: TYPE 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) I/A Technology etc.Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components, date installed{if known) and source of information: Sewage odors detected when arriving at the site: (yes or no)_Z.16 re vised 9 2/ /9 8 Page 6 of 11 , SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(corr6nued) Property Address: Owner: 70 Spy Glass Hill Road,Cummaquid,MA Date of Inspection: Carol Tiemey BUILDING SEWER: October 19, 1999 (Locate on site plan) Depth below grade: oL Material of construction:_cast iron_V40 PVC—other(explain) Distance from private water supply well or suction line A11A Diameter Comments: (condition of joints, venting, evidence of leakage,etc.) SEPTIC TANK:' (locate on site plan) Depth below grade:�8 Material of construction: concrete_metal_Fiberglass _Polyethylene_other(explain) If tank is metal,list age— Is.age confirmed by Certificate of Compliance_(Yes/No) Dimensions: 7 'X W X L /S Sludge depth: A!QNi= Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: O 4F Distance from top of scum to top of outlet tee or baffle: No S C- Distance from bottom of scum to bottom of outlet tee or baffle:Ald t C J v-n How dimensions were determined: .Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structuraHntegrity, evidence of leakage,etc.) PU c-, i c'a �r ,r. ).-4 c,t ( out 1< ,,./Lr� �r'vr:.R � ti 6— AIL ,� 4 e- <1 u c, rS 1 C) /-f uQ Wc.-t f H t GREASE TRAP: (locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_Fiberglass _Polyethylene_other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping; Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of.liquid level in relation to outlet invert, structural integrity, evidence of leakage,etc.) revised 9/2/98 Page 7ofII I� A SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: 70 Spy Glass Hill Road,Cummaquid,MA Data of Inspection: Carol Tierney October 1)9, 1999 TIGHT OR HOLDING TANK: Nl/9 (Tank must be pumped prior to, or at time of, inspection) (locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_Fiberglass_Polyethylene_other(explain) Dimensions Capacity gallons Design flow: gallons/day Alarm present Alarm level: Alarm in working order: Yes_ No Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches,etc.) DISTRIBUTION BOX: J (locate on site plan) Depth of liquid level above outlet invert: Comments: (note-if level and distribution is equal,evidence of solids carryover, evidence of leakage into or out of box; etc.)_ —Qo X rnJLL� I 1 In ,6 �L �✓`�-Gr GLI�i�. E PUMP CHAMBER: /t/119 (locate on site plan) Pumps in working order:(Yes or No) Alarms in working order(Yes or No) Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) s revised 9/2/98 Page 9ofII r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: 70 Spy Glass Hill Road,Cummaquid,MA Date of Inspection: Carol Tierney SOIL ADSORPTION SYSTEM(9d 1:--� (locate on site plan, if possible; excavation not required, location may be approximated by non-intrusive methods) If not located, explain: Type: leaching pits, number:_ leaching chambers,number: ' /vt l��j }v S w . f 3 1 S LU" leaching galleries,number:_ leaching trenches,number, length: leaching fields, number, dimensions: overflow cesspool,number:_ Alternative system: Name of Technology: Comments: (note condition of sal, signs of hydraulic failure, level of pond* g, damp soil, condition of vegetation, etc.) `1 sC✓c�v ` /v ✓t y��AJ�� _ Y 2 I M //1.L t2�r f GVt t -�- 0. .r- )7.. t. h ;G CESSPOOLS: it - (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer.- Depth of scum layer: Dimensions of cesspool• Materials of construction: Indication of groundwater: inflow(cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY: (locate on site plan) Materials of construction: Depth of solids: Dimensions: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) revised 9/2/98 Page 9ofII _ Fr f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(corrtir,ued) Property Address: Oatf Date of f Inspection: m 70 Spy Glass Hill Road,Cumaquid,MA Carol Tierney October 19, 1999 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) 4 ,y � 1 �y n uo� y"(' M revised 9/2/98 Page 10of II SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(confimmd) ProPertY Ad(kess: Owner: 70 Spy Glass Hill Road,Cummaquid,MA Date of Irupection: Carol Tierney October 19, 1999 NRCS Report name A1/19 Soil Type_ Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep_ SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to Groundwater Feet Please indicate all the methods used to determine High Groundwater Elevation: I/ Obtained from Design Plans on record Observed SiteiAbutting property, observation hole, basement sump etc.) Determined from local conditions Checked with local Board of health Checked FEMA Maps h Checked pumping records Checked local excavators,installers Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) -7ts � w �rov.� /� c✓vtc� 11.�.r3 S �oL./, of ,vs' �._ A, wrFfe_ I r J✓%-J G.+G 7 ✓ I c ✓ G�.�7 O t . S revised 9/2/98 Page 11 of 11 TOWN OF BARNSTA/BLE QIx LOCATION Lam`/ G 4,0 V 6AI .s //,// '® SEWAGE # VILLAGE 4 I-11W ASSESSOR'S MAP &LOT b -Q0 INSTALLER'S NAME&PHONE NO. ,Rr`C G �I r4� I�G✓�y�iG,�l .� ;=7�. -I SEPTIC TANK CAPACITY I�d� LEACHING FACILITY: (type X A"F111-14 3 (size) f 0 ,'C NO.OF BEDROOMS BUII,DER OR OWNER PERMUDATE: �" �I/ COMPLIANCE DATE: J 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 Q a � q o CPO C=zw L,) .� 14 ,� sk No. q FcE THE COMMONWEALTH OF MASSACHUSETTS ' PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppYication for Oiopozal *pgtem 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. {/�'—/G� �„�'/�Lg�C't Owner' s Name,Address�►d Tel. o. �na Assessor's Map/Parcel �{'l/t;�� S`s .� / rael�w1- (,((Jo' cm +� 14, Installer's Name,Address,and Tel.No. 0 �of Designer's Name,Address and Tel.No. H+ j7 t pe o wilding: 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 r Nature of Repairs or Alterations(Answer when applicable) /31 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance o the afore described on-site ss age disposal system in accordance with the provisions of Title 5 of the Environmental Coder t o the system' operation until a Certifi- cate of Compliance has been i s d b this Board of Health. Signe Date Application Approved by Date Application Disapproved for the following rea o Permit No. Date Issued ——————————————————————————————————————— `,�+•� wi k -T y 1 T � '.TJ \yf .. .. 'f. i�•\' FpY'1".� .,4P".� ZC' v � � a IA,, _ /� �r . a� �v No i THE COMMONWEALTH F MASSACHYSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS i Ziooriration for Miopogar *P!5tem� Con,Mructton Vgmit Application is hereby made for aPermit to Construct( )or Repair( )an On-site Sewage Disposal System at: !t Address d Tel.No. Location Address or Lot No. Owner's Name, Assessor's Map/Parcel 1�-�> M A ,:CA°—"b''Co Installer's Name,Address,and Tel.No: 0 F-01/0 Designer's'Name,Address and Tel.No: c� U0 pe o uilding: : Dwelling No.of Bedrooms Garbage Grinder( .. ) Other Type of Building No.of Persons Showers( ),Cafeteria( �) Othef,.Fixtures ' i Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Description of Soil Natu\e.of Repairs or Alterations(Answer when applicable) ky Date last inspected: i Agreement: The undersigned agrees to ensure the construction and maintenance of th afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Cod the system' operation until a Certifi- cate of Compliance has been i s d b this Board of Health. Si gne Date ;Application Approved by Date ! 1. 'Application Disapproved for the following re o Permit No. Date Issued &9&9E�a THE COMMONWEALTH OF MASSACHUSETTS L BARNSTABLE, MASSACHUSETTS (Certificate of Conmpfiancelt- THIS IS TO CERTIFY,that the On-site Sewage Disposal System installed( . )or'repaired/,replaced.( )on by '.~ Installer at has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Date 10 r Inspector THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYS- TEM WILL FUNCTION SATISFACTORY. °. -- NO. -��— ,---- -- -- — —Fee �r Y 3 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Di5oo r 6?5 m Ito ngtxuctio%Vprrni Permission is hereby granted to m I' t wo to construct.( ).repair( )anO site ew ge S stem located�a N :# t V Street and as described in the above Application for Disposal System Construction Permit. No. D�te The applicant recognizes his/her duty to comply with Title 5 and the following 1 .oa• rovisions or special dondi ons. All construction must a c n three years of the date below. Date: Approved by .� Z alth r. TOWN OF BARNSTABLE LOCATION L�� 6 �,c y G/�� /�� /E'n/ SEWAGE # - .3 VILLAG ASSESSOR'S MAP& LOT b -00 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type (size)_/C1 �p NO.OF BEDROOMS 'el BUILDER OR OWNER PERMTTDATE: O _COMPLIANCE DATE:---'�L �1 - 7 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 lY If rr A� r PT--� 91 ppp.MOTES ' 1:DATUM IS NAVD88 ° THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT 70 BE USED FFOR LOT LNE STAKING OR ANY OTHER " _ - PURPOSE:' � O7l� ICONTRACTOR.SHAUL BE RESPONSIBLE FOR CALLING .- &�` DIGSAFE(T-888-344-7233)AND VERIFYING THE ds .. LOCATION OF ALL UNDERGROUND h OVERHEAD UTUTIES _ a .. -PRIOR TO COMMENCEMENT OF WORK. - c 4- EXISTING SEPTIC LOCATION PER TIE CARD ON FILE 1NIn1 TOwN. G R o&6 a: r�ovth 0 W m' - - v]pp F r, z LOCUS MAP , ^; S 355 PAR 3 SCALE 1' 0't ASSESSOR MAP PARCEL 1 K ' ^� M ZONING SUMMARY • . .••. • `. I ZONING DISTRICT: RF-1 DISTRICT VED H rn 74 16. MIN. LOT SIZE .43,560 S.F. MIN. LOT,FRONTAGE 20' o� qc j76� I f MIN. LOT WIDTH 125' A2 i �o Il8 P OSE Y MIN. FRONT SETBACK 30' N, "0 R 10.1 MIN. SIDE SETBACK 15' �g SION, PROPOSED EXISTING CHsN z:.. MIN. REAR SETBACK 15' �. GARAGE _ Old Klnf BaHighway MAX. BUILDING HEIGHT 30' committee . SITE IS LOCATED WITHIN THE GROUNDWATER * PROTECTION OVERLAY DISTRICT `9 77 1 EXISTING * GRAVEL DRIVE OWNER OF RECORD 6 PETER F & ANN•`� C . RGIN EXISTING 638MAIN STREET UNIT B— _ a 79 DWELLING 3 DENNIS, MA 026380 TOF 78.3' FFLR = 79.5'. D 51 9' ... A 11 01?0y ,, v, . REFERENCES K CERT #208019 5 LCP 41246 B RAINA - EMENT �8 LA o - .. . i 8, 8o T SITE PLAN 0OF #70 SPYGLASS HILL .ROAD CUMMAQU ID MA ES R •� O - PREPARED FOR PETER BERGIN _ DATE: J 016 . �. OA AN 4, 2 off 508 362 4541 fax 508-362-9880 _ : .. o .c - o� p A ti� 02 Dr\ !EL d wncape om '- ANIEL - _ � OJALA �. I !L dow cape engineeriD c. No.401180 civil engineers e Scale:1"=20` yi(- (o S°' a� _ tea' land surveyors / 939 Main Street ( Rte 6A) 0 0 20 3o ao so FEET -DATE ANIEL A. 0 YAR THPO 02675 DICE #IS.-375 m DA D JALA P.E. P L S . MOU RT MA 3 _ 15-375 • r r \ - -- - Ti -- - _ i I . I T I - i f t "Al.1 , - --- - - - - ---. _ - _ At,,C-7 -- - - -- - - - ---- - ' I I -------------------- APPRWED JAN 212016 ' 3 \� Lr— —, -1. _._ �•• Old King's Highway. Com ittee /. y" RECEIVED�E1 �irR,® 'II 1VIANAIj GEMENT r. I + !I! PT I • _.�. �.. e C DATE DONALD I MEYER d' - Professional Bui1&ng Desna P.O$o.Z2 So.Yarmouth,MA M664 ---- (508)3%-5296 --= �.p iva r RECEIVED 1 �b UcC 1020i-5 .! e 1i GROWTH MANAGEMENTED � 1 i PPROV JAN 2 2016 ., ---------ram-- _—-� --�.; Town of B irnstable Old King'E Highway cornr ittee 1; 9 t* 0, IL TO L� _� —70 4- �'Ii lam' i I� DATE DONALD I. MEYER R O �..= . x } Professional Building Designer " P.O.Box 532 • • So.Yarmouth,VIA 02664 (SOB)394-5296 ROFILE TEST HOLE LOGS (NOT TO SCALE) T.O.F. AT EL 10, 5 ACCESS COVER To WITHIN 6* OF FIN. GRADE ACCESS COVER (WATERTIGHT) TO WITHIN 6' OF FIN. GRADE MINIMUM .75' Of COVER OVER PRECAST ENGINEER—— 2X SLOPE REQUIRED OVER SYSTEM WITNESS-. ,rlt�4 12.L RUN PIPE LfVEL FOR FIRST 2' DATE: PROPOSED 'T i7_1 PERC, RATE TAN - ----- GALLON SEPTIC CL-ASS SOILS P # (_X SLOPE) 6" CRUSHED STONE OR MECHANICAL A DEPTH OF FLOW A COMPACTION (15.221 [21) I'Ag TEE SIZES: (--X SLOPE) X SLOPE) L INLET DEPTH - 10 fi� OUTLET DEPTH Tp LOCATI ON MAP ASSESSORS MAP 71 D' BOX X LEACHING PARCEL FOUNDATION 10 SFPTIC TANK FACILITY 1,5 4_3�0 FLOOD ZONE BUILDING ZONE: 6 -5 1 1'21 SETBACKS: FRONT - 4 Z. SIDE — 1E.3 REAR — 1. PLAN REFERENCE: If It. NOTES: G I 1 DATUM IS �` `° . ` �7S r� y \` SEPTIC DESIGN: (GARBAGE [)isposEk is 2 MUNICIPAL WATER IS PITCH TO BE 1 /8" PER FOOT. .4 DESIGN FLOW: BEDROOMS (I ",0 GPD) 14.g GPD 3. MINIMUM PIPE GPD DESIGN FLOW X 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO-4-i- 5. PIPE JOINTS TO BE MADE WATERTIGHT, USE A 'SEPTIC TANK: (;P[) GALLONS 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS. USE A GALLON SEPTIC TANK ENVIRONMENTAL CODE TITLE V, -A - THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO BE JE�CHIN . -1 USED FOR LOT LINE STAKING. 2_J -li: SIDES: GPD lzx, 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. °' �.- , ( ,� _ �; ;a E30TTOM.- 4 - '1 GPD 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT GPD INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED TOTAL: S.F. .4 10C> FROM BOARD OF HEALTH. 0 1"! Q ±.50J L IJ JUN 12 1996 SITE AND SEWAGE�'� / ,� y' PI-AN IN THE TOWN OF: a \ -i��1 ' ( BOARD OF HEALTH 2-1, 0 1-5 I MA PREPARED FOR 4 AA46VE--ID' DATE 'r7l 0 Q-z' t A Fact -7 SCALE: DATE: down cape engineering, ine. APNF CIVIL ENGINEERS 4, LAND SURVEYORS Nq PHONE 508-362---4541 .1` FAX 508-362-9880 939 main st. yarmouth, ma WIJOB& 64 C-1 OJALA, S. DATE