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HomeMy WebLinkAbout0166 BRALEY JENKINS ROAD - Health 166 Braley Jenkins Road Centerville P A = 172 208 UPC 12534 No.2-153LOR HASTINGS.MN -- Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �^M 166 Braley Jenkins Rd. Property Address Donna Tyndall Owner Owner's Name information is required for Centerville Ma 02632 1/30/07 every page. City/Town State Zip Code Date of Inspection /7,7 Inspection results must be submitted on this form. Inspection forms may not be altered in any way. " Important:When filling out A. General Information forms on the computer,use 1. Inspector: only the tab key to move your Robert Paolini cursor-do not Name of Inspector use the return key. Capewide Enterprises,LLC Company Name r� P.O.Box 763 Company Address Centerville Ma 02632 r� City/Town State Zip Code _N (508)428-4028 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 inspectionjhe 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 too Section-,15.340 of Title 5 (310 CMR 15.000).The system: -n ® Passes ❑ Conditionally Passes ❑ FaliIS -9 +' ❑ Needs Further Evaluation by the Local Approving Authority W M 1/30/07 Inspector's SignattTreV 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. i ****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. 166 Braley jenkins-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 166 Braley Jenkins Rd. Property Address Donna Tyndall Owner Owner's Name information is required for Centerville Ma 02632 1/30/07 every page. City/Town 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: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The septic system is in proper working order at the present time. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need-to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Answer yes, no or not determined (Y, N, ND) in the ❑for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *,A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed 166 Braley jenkins•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 166 Braley Jenkins Rd. Property Address Donna Tyndall Owner Owner's Name information is required for Centerville Ma 02632 1/30/07 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with'approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed ND Explain: C) Further Evaluation is Required by the Board of Health: ❑. Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects.the public 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. 166 Braley Jenkins•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 166 Braley Jenkins Rd. Property Address -Donna Tyndall Owner Owner's Name information is required for Centerville Ma 02632 1/30/07 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You 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 for 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 El ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1h day flow I ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. 166 Braley jenkins•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 15. Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 166 Braley Jenkins Rd: Property Address Donna Tyndall Owner Owner's Name information is required for Centerville Ma 02632 1/30/07 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the,analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D.. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA)or a mapped Zone II of a public water supply-well 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. 166 Braley jenkins•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface,Sewage Disposal System Form - Not for Voluntary Assessments 166 Braley Jenkins Rd. Property Address Donna Tyndall Owner Owner's Name information is required for Centerville Ma 02632 1/30/07 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? El ® 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? i for in f r k t? ® ❑ Was the site inspected o signs s o b ea ,ou ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions;depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ❑ ® Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] 166 Braley jenkins•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °wM 166 Braley Jenkins Rd. Property Address - Donna Tyndall Owner Owner's Name information is required for Centerville Ma 02632 1/30/07 every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No 000 ,:151 Water meter readings, if available (last 2 years usage (gpd)): 2002005:15100 Sump pump? ❑ Yes ® No Last date of occupancy: 1/30/07 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: Last date of occupancy/use: Date Other(describe): 166 Braley jenkins-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 166 Braley Jenkins Rd. Property Address Donna Tyndall Owner Owner's Name information is required for Centerville Ma 02632 1/30/07 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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 ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: 1986 Were sewage odors detected when arriving at the site? ❑ Yes ® No 166 Braley jenkins-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 166 Braley Jenkins Rd. Property Address Donna Tyndall Owner Owner's Name information is required for Centerville Ma 02632 1/30/07 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 18"feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: 10+ feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints appear tight.No evidence of Ieakage.System vented through the house vents. Septic Tank(locate on site plan): Depth below grade: 20"feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No -------------------------------------------------------------------------------------------------------------------------- Dimensions: 8'6"X4'10"X57' Sludge depth: 4" Distance from top of sludge to bottom of outlet tee or baffle 32" Scum thickness 0 Distance from top of scum to top of outlet tee or baffle 18 Distance from bottom of scum to bottom of outlet tee or baffle 18" How were dimensions determined? measured 166 Braley jenkins•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for.Voluntary Assessments ,M 166 Braley Jenkins Rd. Property Address Donna Tyndall Owner Owner's Name information is required for Centerville Ma 02632 1/30/07 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pump tank every 2-3 years.lnlet and outlet tees are in place.Tank is structurally sound.No evidence of leakage. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): 166 Braley jenkins•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �^M 166 Braley Jenkins Rd. Property Address Donna Tyndall Owner Owner's Name information is required for Centerville Ma 02632 1/30/07 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank (cont.) 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.): I *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes r❑ No Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms,in working order: ❑ Yes ❑ No 166 Braley jenkins•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 166 Braley Jenkins Rd. Property Address Donna Tyndall Owner Owner's Name information is required for Centerville Ma 02632 1/30/07 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 1 ❑ leaching chambers - number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Medium sandy soil.No signs of hydraulic failure.Vegetation appears normal.Note:Leaching pit is under the deck. 166 Braley jenkins-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 166 Braley Jenkins Rd. Property Address Donna Tyndall Owner Owner's Name information is required for Centerville Ma 02632 1/30/07 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Cesspools (cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, . etc.): 166 Braley jenkins-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 166 Braley Jenkins Rd. Property Address Donna Tyndall Owner Owner's Name information is required for Centerville Ma 02632 1/30/07 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. r i i 166 Braley jenkins•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 166 Braley Jenkins Rd. Property Address Donna Tyndall Owner Owner's Name information is required for Centerville Ma 02632 1/30/07 every page. City/Town State Zip Code Date of Inspection .D. System Information (cont.) Site Exam: ❑ Check Slope ® Surface water ® Check cellar r ❑ Shallow wells Estimated depth to ground water: 50' feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) J ® Checked with local Board of Health-explain: as-built card ® Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Used:Gaherty& Miller Model 12/16/94 Groundwater elevation above sea Ievel.Used:USGS Observation well data June 1992.Used:USGS Annual ranges of groundwater elevations for Cape Cod 92-000-01 Plate#2 166 Braley jenkins•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION MAP .�- --- PARCEL O LOT j . TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: EkRA J.A:-� d�—'1y;128— Owner's Name: jrtFA,,.i r-r Owner's Address: !Z Z /Q�2i92tAf---/ 2 ; �~ Date of Inspection: �/.�L d Name of Inspector: (please print) T�jy,A/ C'v l Li�Ctc'ii� N of Company Name: lAvek> ZX e'er 'SDwNEP�-� Mailing Address: 7 v� w 4!r° ' Phlr d Telephone Number: �S-d8 71?7 1-1tf'9 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The System: :.. 4fiPasses Conditionally Passes Needs Further Evaluation by the Local Authority Fails Inspector's Signature. Date: Z.2-16;z The system inspector shall s mit 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. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. s Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) rty'Aaaress: f 6G AAgm . XS 12,[� 1 iu weer: O/ Date of Inspection: Inspection Summary:Check A,B,C,D or E/ALWAYS complete all of Section D CSystem Passes: � �I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR IS.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as dqscribed in the"Conditional"Pass"section need to be replaced or repaired.The system,upon completion of the eplacement or repair,as'approved by the Board of Health,will pass. Answer yes,no or not determined (Y,N,ND)in The for the following statements.If"not determined"please explain. The septic tank is metal and over 20 years old! or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration.or tank"failure is imminent.System will pass inspection if the existing tank is replaced with a complying septic tank as.approved by the Board of Health. 'A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 yedrs old is available.,,. ND explain: Observation of sewage backup or eak out or'high static water evel in the distribution box due to broken or obstructed pipe(s)or due to a broken,setged or uneven distribution box. ystem will pass inspection if(with approval of Board of Health): �;bro n pipe(s)are replaced --pbstruction is removed ibution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) pperty Address: Owner: Date of Inspection: C. Further Evaluation is Required by the Board of Health: I /r Conditions exist which require further evaluation by the Board of Iiralth in order to determine if the system is failing to protect public health,safety or a environment. r' 1. System will pass unless Board of ealth determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a man r which will protect ppiblic health,safety and the environment: _Cesspool or privy is within 50 feet f a surface water _Cesspool or privy is within 50 feet f a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Heal*(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects tlae public health,safety and environment: _The system has a septic tank.and soil absor\\\lion system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface wat supply. _The system has a septic tank and SAS and the S is within a Zone 1 of a public water supply. _The system has a septic tank and SAS and"the SA is within 50 feet of a private water supply well. i The system has a septic tank and SAS end the SAS is ess than 100 feet but 50 feet or more from a private water supply well**. N(�thod usec�to determine dis ce **This system passes if the welt;water alysis,performed at a EP certified laboratory,for coliform bacteria and volatile organic compoti►ds in 'c ates that the we11 is from pollution from that facility and the presence of ammonia nitrogen and n' nitrogen is equal to or 1 than 5 ppm,provided that no other failure criteria are triggered.A copy of the alysis must be attached to is form. 3. Other: i Page 4 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: � S 1;, Owner: v of Date of Inspection: Q46 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No / a kup of sewage into facility or system component due to overloaded or clogged SAS or cesspool t/ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or �gged SAS or cesspool Static liquid level in the distribution box above outlet invert due to and overloaded or clogged SAS or id depth in cesspool is less than 6"below invert or available volume is less than '/:day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number 9"es pumped _ G/ rtion of the SAS,cesspool or privy is below high ground water elevation. r/Any,ppoortion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface Jr supply. y AA .' rtion of a cesspool or privy is within a Zone 1 of a public well. _ JAp�rtion of a cesspool or privy is 50 feet of a private water supply well. _ ny portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A.,copy of the analysis most be attached to this form.] (Yes/No)The system4a i have determined that one or more of the above 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 now of 10,000 gpd to 15,000 You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition the criteria above) yes no _the system is within 400 feet of a s (JAnking water supply — —the system is within 200 fat of a t ib to a surface drinking water supply the system is located in a nitrog ensiti a area(Interim Wellhead Protection Area—IWPA)or a mapped Zone H of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes^in Section D above the large system 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. Page 5 of l l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Irrty Address: 1" gV4LLL/ iVki�yS 42 d owner: Z;' S Date of Inspection: Check if the following have been done. You must indicate"yes"or"no"as to each of the following: YesilQo ,,_/ ;'-<ere umping information was provided by the owner,occupant,or Board of Health any of the system components pumped out in the previous two weeks? Has the system received normal flows in the previous two week period? 4, Have large volumes of water been introduced to the system recently or as part of this inspection? e/ — 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? �Y — Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the bafDes or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? Was the facility owner..(and occupants if different than owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes o E ' 'ng information.For example,a plan at the Board of Health. /K /3- iA--/ _ Determined in the Held(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)P 10 CMR 15.302(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property,Address: :Owner: e/ Date of Inspection: FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): I Number of bedrooms(actual):_ DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 3,,30 Number of current residents: �1, Does residence have a garbage grinder(yes or no):&0 Is laundry on a separate sewage system(yes or no):A6a[if yes separate inspection required] Laundry system inspected(yes or no):*5 Seasonal use:(yes or no): Water meter readings,if available(last 2 years usage(gpd)): Sump Pump(yes or no): V Last date of occupancy. COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based-on 0 CMR 15. 3): gpd Basis of design flow( persons/ gft,etc.): Grease trap present(yes o): Industrial waste holding pr t(yes or no):_ Non-sanitary waste disch g /to the Title 5 system (yes or no):_ Water meter readings,if le: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: OLerA;­642 Zwr v 3 Was system pumped as part of the inspection(yes or no): If yes,volume pumped: Dl °d Sallons—How was quantity pumped determined? ilk �i�t�4So i % Reason for pumping: M►4lN%l9►�CNC�.�- TYPF�SYSTEM Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank _Attach a copy of the DEP approval _Other(describe): Approximate a�ge 9ff 1nm pnents,date installed(if known)and source of information: Were sewage odors detected when arriving at the site(yes or no):1-0 Page 7 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property,Address: lt5ly .(3iPN�1r� �,b[k�i�S � N Owner: - N� Date of Inspection: BUILDING SEWER(locate on site plan) Depth below grade: �24 � Materials of construction:_cast iron_40 PVC "other(explain): Distance from private water supply well or suction line: IY o NE /N 0IZ )9 Comments(on condition of'oints,venting,evidence of leakage,etc.): SEPTIC TANK: (locate on site plan) Depth below grade:�_ � Material of construction: sconcrete_metal_fiberglass_polyethylene other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: loco 6,A .l- Sludge depth: > Distance from the top of sludge to bottom of outlet tee or baffle: Scum thickness: fit" ,, Distance from top of scum to top of outlet tee or baffle: 6 , Distance from bottom of scum to bottom of outlet tee or baffle: r t' How were dimensions determined: c- ; /c Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to ou$ invert, e-,o t evidence ofleakage,etc.): 15 i? A� iv,. e yi-l.��,�1 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 toj o utlet tee or baffle: Distance from bottom of scum j6 botto f outlet tee or baffle: Date of last pumping: V Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Page 8 of l l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: Date of Inspection: 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: ons Design Flow: lons/day Alarm present(yes or!AIiyi'ing Alarm level: order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: (i present must be opened)(locate on site plan) Depth of liquid level above o t t invert: Comments(not if box is lcve d distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box, c.): PUMP CHAMBER: (locate on site plan) Pumps in working order a or no): Alarms in working order es or no): Comments(note conditi ump chamber,condition of pumps and appurtenances,etc.): Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFAC E SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: /(7(a P,P 1 4 22,7 r— Jt=>N 5 120 c /q �t�t= /k i Owner: K.1-1 d gt4 PO 80 S Date of Ins 'on: alWad SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type K leaching pits,number: leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Typetname of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): I I Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: j(,�,��, �2ra i 1r�•f J E� �f��� C'c�N i�LiJfbu? � Owner: �p 5 Date of Inspection: !1 0 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. el 0 i t3 , 1' Pool Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: S Cc' Owner: Date of Inspection: I7L O SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground waterr feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record—If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Cbwked with the local Board of Health-explain: ,,/checked with,local excavators,installers-(attach documentation) i3r�✓ii!k"VA <T'4s l Accessed USGS database-explain: You must describe how you established the high ground waterelevation: b,c U_yQ.-6A1 e.A i No � i 9 Fms... -... .. �j THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH � � " OF....... .:' _!_. �_G.4'_...._.... Apli iration for Biopnattl Works Tomil.rnrtiun thrmit Application is hereby made for a Permit to Construct ( �or Repair ( ) an Individual Sewage Disposal System at: Location-Address or Lot N ._ Owner Address .5 .........-•--------- .. ......... Installer Address _ Type of Building Size Lot... feet a Dwelling—No. of Bedrooms......=3....__. - ------- Attu Garbage Grinder(-�—' A4 Other—Type of Building 0�- __---- No. of persons......C:................ Sho�) — Cafeteria, (--T' a Other fixtures -------- ------------•-•-•••---------------------- W Design Flow...........................d a- _Sallons per person per day. Total daily flflow..__._....-_.._ .-��_-_.-.......�lends. �t WSeptic Tank—Liquid capacityi& allons Length----&... . Width.. .. ..... Diameter................ Depth..-_._..._..._.. x Disposal Trench—No. .................... Width..................... Total Length.................... Total leaching area.....................ssq. ft. Seepage Pit No------------ ------- iameter..... - Depth below inlet.......-. Total leaching area.....z. sq. ft. z Other Distribution box ( Dosing tanly '(- '-' Percolation Test Result5 Performed by...... ... ......... . ............... Date.....Z � aTest Pit No. I.. ...`-:minutes per inch Depth of Test Pit..... Depth to ground water.._ ............. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water......................... ................... Description of Soil.............IV2.?;?-_;,-.,....� �-C x x --••-------•----------------••---•-•-•------•--------••••••----------•-•-•-••••••-------•----•-----•-•--•----•-------•--•••---•-•-----•••---......------•-----••••••-•••••-•---------•---------_..... U Nature of Repairs or Alterations—Answer when applicable............................................................................................... •----------------------------------------------------------•-------------------------................----......--------------------------------------------------• .................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITL% 5 of the State Sanitary Code— The undersigned further agrees not to place the system in J operation until a rtificate of Compliance has been issued b the board ot health. Si ned.X------ . _. � .---•-••-_.... ._�.�._-�4.(.. ' Applica ion Approved By.._...� _.....�.---•-------------------•......----•------•---••-..... .......... /D ------ D�te Application Disapproved for the following reasons-------------------------------------•---------------•-----------------------•-----------._...-••---....._....._ ---•-•-------------------------------•---....------•--------...------•---..............---.....----------••-------------•--••••--••---•......•-------•---••-••--•---•••----•-•-----------------•--•----- c Date PermitNo................. 4. ...................... Issued....................................................... Date .r s NoY ft�.�yt 9 Fims......... — -�... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .......... c..`'v'✓.OF...............''..2..ti,/..5;, � �= Appliration for Disposal Works Tonstrnrtiun rnmit Application is hereby made for a Permit to Construct (L) or Repair ( ) an Individual Sewage Disposal System at: %�?—J C— P r"`✓. f L°° ��at .,�Aaa� i ,s ? ✓ �t .3! or Lot,, t--t / . .m...............................................Y. ...� Address ....,... ......-----••-----•-----. ----•----------......_...._.............._. Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms=.a .._t.........................Expansion Attic ( ) Garbage Grinder-(� ) Other—Type of Building �._..•-___-J.------- No. of persons...._�''................. Showers ( ) — Cafeteria' ( ) P4 Other fixtures ........en................. Design Flow.......................... �_=_.__gallons per person per,day. Total daily flow.........._.._._.__.__._.____..__...........gallons. . Septic Tank—Liquid capacity gallons Length___ ___._ Width.y_.' __ Diameter................ Depth.`..... W Disposal Trench—No..................... Width.................... Total Length................_--Total leaching area......_.__.........-sq. ft. Seepage Pit No................u,,Diameter....._..._.......... Depth below inlet......... ......... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank'(--)- ram✓ P /c, S 0" Percolation Test Results 7 Performed by `�: ... 1. �..._.`__........ .................... Date............ .......-/................. aTest Pit No. 1................minutes per inch Depth of Test Pit..............._..._ Depth to ground water----------------_------ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ .�_.` .."..__.. .. .O Description of Soil............. x W -•------------------------------------------•-----•------------------------------------••---........----------------------------------••-----••-••---------•------------------•-----•----------•-------- U Nature of Repairs or Alterations—Answer when applicable................................................................................................ ----------------------------•---•--••--••----------•-----•-•--------•-----•---..._.....--•......---•----•-------------------------•--------------------------•--------------------------••---••----••--- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITI.- 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a. tificate of Compliance has been issued by the board of health. cl/ Signed......`..............•--------------•---............------------..............---•-•--- ................................ --- Date Application Approved BY � � �. �- ..... Application Disapproved for the following reasons:----••-----------------•----------------------------•--------------------------------------•---......••-_-•---- ..-------•-----------•----•..............•------•--------•-•••-------------------._....-•-.....-------•-------•----------------------•----------------------------------•------...•-------••---•-------- Date Permit No............. -: Lf._1 7................ Issued......................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................... .............................................................. (Irrtifiratr of Tuntpliatta THIS IS TO CERTI.�' at the In sposal.S-stem constructed ( ) or Repaired ( ) b ...............................•-- ------•••--•-•••••--- --;-•----•-------•. --- - -•--__ .... ...,..a.+rr . tt..�...�..�-- -__---------•--- Installer a. 2-�1 a/ ✓. / 1 n //b''Jx at----•-----------------------•-----....__...-----.....-------•---••-------�----`�-- ------.....`------==5--...L------ has been installed in accordance with the provisions of TITV�.. .5 of T1�e� tate Sanitary Co d bed in the application for Disposal Works Construction Permit No_____________ ________________________ dated--------- --__________.___._.___...____._. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector..................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH _ <:"^ ............... OF..................................��•.j�.'1.f.............................................--' No... ............ FEE....--n.......... Disposal 30orkg�(gn tr 1liju ; rmit ' Permission is hereby granted...................................................... to Construct ( L)-or Repair ( ); an Individual Sewage Disposal System at No. A / "ci r f / P y ✓ ''� f < 7-s /l " C ,'�' ✓. // r /{�, -- .. ..................................•---.....--.----- ------------ -----------•-- ----....... - ---------- Street as shown on the application for Disposal Works Construction ,Permit._No..__ .......1.GI Dated...... _; _ ................ ------------- .......-•---------••------•----------------------........-----___-------------•••-••- _ --• Board of Health DATE L _ __i�-----•----------•-------- FORM 1255 HOBBS & WARREN. INC., PUBLISHERS Or's rm�p TOWN OF BARNSTABLE LOCA I "� OT \�\\ ��\��- ��� '�SEWAGE # VILLAGE ASSESSOR'S MAP & LOT r INSTALLER'S.NAM:; & PHONE NO. SEPTIC TANK.r�A:!' ,.CITY \ U 0 LEACHING--. .A.tILIT~t:(type) (size) /0 0 0 ��C_ NO. OF BaDROOMS PRIVATE WELL O UB IC WA:CjR BUILDERi0`4 OW:dER; DATE PERM.lT ISSUED:41 DATE COLiPLIAN4CE _VARIANCE GRANTED: Yes No (� b �131 i 1 B E N C H MARK rz0• / r- Z_E .� � CQn� ~ '0 4: e,3. o ass Ar. TEST HOLE RESULTS P4745 DATE : . / 3 .5- n/ ?. WITNESSED BY T o I�1 l�°1 K�o �C3 . /. c �-. r' c TEST H0LE1 E_ / O L M LT 3 Gr � / a c+L ! to e ? LoTI-fl u S O 3G a SOIL EL..S-E3.8 -/ 1 or i OD TzE'S " 5 2 �T l �a 1' V go - i-`— Ds r. VI i ,pox CO 1 E� 4 9.8 CV ± ro 5 p cv 4 /_ NK A r~ 14 14tv a` ce . os W C� i N " 1' o a G OUND WATER N t Y� �.. ENCOUNTERED f r L31- _AR �L tic, G 4 0 MANHOLES AND COVER TO BE BUILT TO ELEV. TOP OF -. WITHIN 12 OF FINISHED GRADE FOUNDATION o FINISHED MI . 2 /o S ,t GRADE N LOPE 8- 4 i 4 D IA. --- -• 4 2 n t _ DIA. PIPE FIRS MI --- � 1 9 o P1 P E MI N. 2 LAYER OF t,. �' _ ,�w. MIN.PITCH FT. LEVE _ � ti 1 `6r , . q Mih �8 �2 PE STONE PITCH i.r n�w 14r -- Q , n�.w 9, z5' .. 4/FT. 1 _ , /� .._ N V R T _. .. ., .:.ens.. ,.. �` . .NV_RT � , �,,7 I N '�ER T +. GALLON S DL� T DIA. EPTIC TAN,. ® , �4 2 - .z, INVERT 3 c� , .. . FOOTING TO 8E. PLACED , . - e0x � © WASHED STONE t�V E-R T ,... INVERT w •. ON A MINIMUM' OF 18 OF ALL AROUND . r _ PLACE ON � . � � . !7 a !L VIRGIN 0 COMPACTED . > ASE ��. 0 R _ FIRM B / , BOTTOM AT ELEV. S+5. C7 �- � ,7-- SAND , : ... O GARBAGE � 3 G ,� .. _ .L1L_ ( 2 0 M L N.) GRINDER „ /2 S. 2 ,t3 ELEV. PROF I, L E OF 7—ROUND WATER TABLE 13040 %- '' SANITARY DISPOSAL SYSTEM NOT TO SCALE D E SIGN DATA . i • - 3 CONSTRUCTION OF SANITARY DISPOSAL BEDROOMS SYSTEM , _A YST M SHALL CONFORM TO THE MASS. - DESIGN FLOW 330 GAL./DAY ENVIRONMENTAL CODE TITLE S (REVISED , 7 I 77 ) AND THE TOWN LEACH RATE - MIN. INCH . REQUIRED LEACHING CAPACITY : 330 HEALTH DEPARTMENT REGULATIONS 0 SEPTIC TANKs DISTRIBUTION BOX AND _ LEACH- ¢•� 3 PROPOSED � r GAL/DAY ING UNIT TO , BE OF " REINFORCED ' CONCRETE ; - _ MIN. CONCRETE ' STRENGTH = 3000PSL REQUIRED SEPTIC ,TANK • /000 GAL. ; MIN. STEEL STRENGTH * 200000 PS. I. MIN. DESIGN LOADING , l' / f000 —•---- PROPOSED SEPTIC TANK: GAL. DRIVEWAYS NOT TO BE LOCATED OVER SYSTEM a . UNLESS H2O DESIGN LOADING IS USED • ALL PIPES . AND FITTINGS TO BE WATERTIGH T AND TO BE of CAST IRON OR APPROVED P.V.C. HEALTH AGENT APPROVAL- DATE SITE PLAN , SHOWING PROPOSED_ CONSTRUCTION , V/ LI_ ZONING DATA LEG_EN D `' LOCATION . B A R N S T A B L E Cc�-.,ire-,e E') .- MA . LEBEL SOLLOWS DEV.FOR CORP. DATE .• ZONE E. T ST HOLE LOCATION EFEREN Ch LOT 14! AS SHOWN - ON REVISIONS . c o o �K o REQUIRED AREA • _- 5• O EXISTING SPOT , ELEVATION 17.6 �� LAN BOOK 44 4 PAGE 82 � o; stia Nam, 2 - . e o .._ o l O � REQUIRED W tATf-� EXISTING CONTOUR I6 _ v o' _ REQUIRED FRONT ,SETBACK . PROPOSED CONTOUR Ig �! _ x� __ 30 S . / } - � GALE REQUIRED SIDE SETBACK, . PROPOSED WATER SERVIC ---W— o,� �ci S E - � p A! REQUIRED • REAR SETBACK . _ / PROPOSED GAS SERVICE G �• .... PROPOSED ELEC a ELE' E a T 6T i A G GRR SHIRT , P. E . { PROFESSIONAL CIVIL E NOINEER BUILD 131 OLD ROUTE 132 � HYANNIS MA. 02601 FILE NO. N G INSPECTOR APPROVAL DATE • TELE. 617 ) 362 - 9411 ) E / F / . ( � :. �. S H E T 0 t i BENCH MARK : rrz 0 N 7W L E C © rt, 0 14-- o Q sue- E L F 3. o 6-9.5 s w i ar4) T E S T H 0 L E R E S U L T S P4,4566 DATE: 0/a/ a WITNESSED BY T H. j P- 7-EX SUL.LIV'A/,1 l34xr�,2 x nl Y., a r" o TEST HOLE1 EL.. O L pM LoTI-!I L. oT 1 A ✓ �� ,.J, lo' 131i 9 N 3(," S u 13 SOIL � ter».'' 1 g 4 8 � or ) 4i ` ME.D.,um E's E12 Vim" 30 � Iti i �r . SAND pox CO (n cV 45't poop D S fP?�G (v ,INK L o a �G c. 19 r , Q IA 44 iT --GROUND WATER fir 2 43 ' ENCOUNTERED ,X3LUy y 1 G,aR Q' MANHOLES AND COVER TO BE BUILT TO Dfl v - - � 1 Z ELEV• TOP OF WITHIN 12� OF FINISHED GRADE / •' ' � FOUNDATION FINISH r -. ED GRADE MIN, 2% SLOPE t 23;_G oT14 1� 440 D IA. 4�� DIA• PIPE FIRS 2"MI � • NIb- •--j-_------ -_ M I N N. PI TC H FT T. LE V E 41 MIN . 2 LAYER OF '- ` , • 1�8'-'�2' PEASTONE Q % �ry� I .' 1 MIN. PITCH • • / i iriv�w. 1 M - / �'�, c +� 1/4/ /POO INVERT .• 39rS4 r GALL ' ,R Y DI INVERT •••® y ��• .� I A % EPTIC TANK INVERT sa. ., g� Q m �q Y2. DI FOOTING TO BE. PLACED : : INVERT - 90X ©• WASHED STONE INVERT `' 3S W • �, ( ON A MINIMUM OF 18 OF PLACE ON �, ;.� °��,` ALL AROUND �o? VIRGIN OR COMPACTED 31 , 17 FIRM BASE a t?it•; 2. IN.)-alBOTTOM AT ELEV, 6'S, © SAND -- 10 M I iVO GARBAGE ( 2 O' MI N.) 3' '— G• 3, GRINDER PR O F I• L E OF GROUND WATER TABLE E3040 %-✓ SANITARY DISPOSAL SYSTEM ( NOT TO SCALE ) DESIGN DATA • CONSTRUCTION OF SANITARY DISPOSAL 3BEDROOMS SYSTEM , SHALL CONFORM TO THE MASS. Sao ENVIRONMENTAL CODE TITLE �' DESIGN FLOW GAL.�DAY (REVISED - 7- I-77 ) AND THE 'TOWN LEACH RATE L MIN. INCH HEALTH DEPARTMENT REGULATIONS REQUIRED LEACHING CAPACITY : 330 • SEPTIC TANK, DISTRIBUTION BOX AND LEACH- PROPOSED 4-4 GAL/DAY ING UNIT TO BE OF REINFORCED CONCRETE : . 2•6 3•S 1, 07(4) _ MIN. CONCRETE STRENGTH 3000PS.I. REQUIRED SEPTIC ,TANK /000 GAL• MIN. STEEL STRENGTH 20,000 P. S. I. MIN. DESIGN LOADING : oY / ra PROPOSED SEPTIC TANK : /000GAL. • DRIVEWAYS NOT TO BE LOCATED OVER SYSTEM UNLESS H2O DESIGN LOADING IS USED • ALL PIPES AND FITTINGS TO BE WATERTIGH-T AND TO BE OF CAST IRON OR APPROVED P.V.C. HEALTH AGENT APPROVAL DATE SITE PLAN SHOWING PROPOSED CONSTRUCTI ON ,ev. � �E ZONING DATA LEGEND � � LO CAT I O N : BARNSTABLEcaov;,e MA . � L-ja OF � " FOR LEBEL— SOLLOWS DEV. CORP. DATE ZONE : _ _ RC TEST HOLE LOCATION �a ' I 4- CRAM REFERENCE I-OT W 0 AS SHOWN ON REVISIONS : � -1�- REQUIRED AREA t5'000 � � EXISTING SPOT ELEVATION 17.6 " -PLAN SOOK 444 PAGE 82 REQUIRED W tDTI-! 100 , EXISTING CONTOUR 16 -- 'r o REQUIRED FRONT SETBACK 20 � lp S/STER DEE'Ds PROPOSED CONTOUR 16 �S/OHALE��'\� SCALE ' REQUIRED SIDE SETBACK, : / o ' PROPOSED WATER . SERVICE --�W- �C• 7—'M A �� � S A 2 .E. �v� �,+ �' a »�� o �/ C)r L-. � T"' � "`�'! f L_/.�1^�;e 3 � 6 �Gi . �- � REQUIRED • REAR SETBACK : - PROPOSED GAS SERVICE --G--- PROPOSED ELEC. a TELE E aT CRAIG , R . SHORT , P. E . PROFESSIONAL IONAL CIVIL E NOINEER BU I L D i NG INSPECTOR APPROVAL DATE 131 OLD ROUTE 132 •, HYANN 189 MA, 02601 FILENO. TELE. (617 ) 362- 9411 ) p.1 SHEET ! OF /