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Home My WebLink About0234 BUCKSKIN PATH - Health 234 Buckskin Path Centerville F/R = A 171 032 u No. 4210 1/3 ORA ndl ° 10% F No. 3 G Fee cJ THE COMMONWEALTH OF MASSACHUSETTS Entereti in computer. Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZippYication for Migogar 6p5tem Construction Permit Application for a Pen-nit to Construct( )Repair(grade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.o`3 y pe_1q rye A* ^owner's Name,Addrtss and Tel..No. o Pc a elt Assessor's Map/Parcel Installer's Name,Address,Ad&15io10ANC0 Design s N�,Ad�s�d Tel.No. 350 Main Street n/( Y ? W. Yarmouth, MA 02673 o&T3 Type of Building: Dwelling No.of Bedrooms .> Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 330 gallons per day. Calculated daily flow 3 s , gallons. Plan Date 7 3 Number of sheets ( Revision Date Title �><c . �c✓ c Size of Septic Tank 100o r Type of S.A.S. Description of Soil 1){/` P44) Nature of Repairs or Alterations(Answer when applicable) pr t- �GQ.AJ Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Env' onmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this d He lth. _ Signed � �1 Date 3 Application Approved by Date '9 1 5 03 Application Disapproved for the following reasons Permit No. _ C Date Issued g 39 14), ! Fee �V �THE�C,OMMONWEA;LTH OF MASSACHUSETTS '+'Ent re in computer: eV. PUBLIC HEALTH� IVISION -TOWN OF BARNSTABLES MASSACHUSETTS � 0[pprication,for Oigpo al 6pgtem Congtruction Permit Application for a Permit to Construct )Repair air(,, U rade( )Abandon( ❑Complete System ❑Individual Components PP�. ( P Pg ( ) P Y Po Location Address or Lot No. ;)3 y ue_1 r- ( N.4'Y L1 wner's Name,Add,ss and Tel.No. Assessor's Map/Parcel 171 Installer's Name,Address,and Tel.No. Desi ner's Name,Add ss and Tel.No. {V r' n a Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3 3 U gallons per day. Calculated daily flow 3 s c3 gallons. { Plan Date 7 S L3 Number of sheets / Revision Date Title Size of Septic Tank /000 lt%�sf; Type of S.A.S. Description of Soil /)r/' A14J Nature of Repairs or Alterations(Answer when applicable) ��r Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Env' onmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Bp d He lth. // Signed Date 1911 -3 If Application Approved b Date 9 l 1 S O rr rr Y _ 3 Application Disapproved for the following reasons Permit No. p'2 -i Date Issued --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (fertif icate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired( t.-)-Upgraded( ) Abandoned at C23I/ cr ��"1 Jr4f� t'c end ' _ has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.2403— N 2 dated Installer Designer The issuance of this p mut hall not be construed as a guarantee that the system will tto a si Date 9 S �3 Inspector r — 0 f No. "�— ----------- 00 3 39 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS lwigpogar *pgtem (Construction Permit Permission is hereby granted to Construct( 1 Repair rade( bando ( ) System located at c� 9 ./�«c b S u rt k*t� and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the datfv � ji,—,e_, it. Date: � I � 'O Approved ��, QQ �TOW/�N,OF BARNSTABLE LOCATION 43q ULX �&r q SEWAGE # Q 3%— VILLAGE C �E�yILL� ASSESSOR'S MAP &LOT t'Z l_Q3 2 - INSTALLER'S NAME&PHONE NO. A+80 -7 7S o16 M SEPTIC TANK CAPACITYkt��4 LEACHING FACILITY: (size) , NO.OF BEDROOMS BUILDER OR OWNER !"1 ®'eCDM PERMTTDATE: 2"f 5`O3 COMPLIANCE. DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility{If any wetlands exist within 300 feet of leaching facility) Feet Furnished by OL VP 22 ;��,TOWN OF BARNSTABLE LOCATION J� C�a� S 1J&rq SEWAGE # Q 0. 3 VILLAGE aNIERN L9 ASSESSOR'S MAP& LOT INSTALLER'S NAME&PHONE NO. 46 COCO 7 75--d-8 66 SEPTIC TANK CAPACITY LEACHING FACILITY: (type)e '- (size) s X 13'Xa2' c NO. OF BEDROOMS BUILDER OR OWNER PERMITDATE: (S—03 COMPLIANCE DATE: S�03 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet. Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) = Feet Furnished by 1- Y� )eMR of N6US 33 � 3s 3vsl� FAILED_ INSPECTION COMMONWEALTH OF MASSACHUSETTS z w EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS s d DEPARTMENT OF ENVIRONMENTAL PROTECTION o,�M See 350 MAIN STREET WEST YARMOUT 508-775-2800 -CEiVEL) TITLE 5 JUN 112003i OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY SSESSMENTq SUBSURFACE SEWAGE DISPOSAL SYSTEM F WN OF BA F NSTABLE PART A HEALTH DEPT. CERTIFICATION MAP 171 PAR 032 Property Address: 234 BUCKSKIN PATH CENTERVILLE,MA 02632 F Owner's Name: MORCOM,DOROTHY MAR 1 f Owner's Address: 234 BUCKSKIN PATH CENTERVILLE,MA 02632 PARCEL Date of Inspection MAY 20,2003 LrT Name of Inspector: (please print) JAMES D. SEARS Company Name: A&B Canco Mailing Address: 350 Main Street West Yarmouth,MA 02673 Telephone Number: 508-775-2800 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was perfonned based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: s 3 G " 0-3 The system inspector shall su?initopy 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 tot he buyer,if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 1 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 234 BUCKSKIN PATH CENTERVILLE,MA 02632 Owner: MORCOM,DOROTHY Date of Inspection: MAY 20,2003 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: N/A _ I have not found any infonnation which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: N/A One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined" please explain. _ The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health)" broken pipe(s)are replaced obstruction is removed ND explain: Title 5 Inspection Form 6/15/2000 2 Page 3 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 234 BUCKSKIN PATH CENTERVILLE,MA 02632 Owner: MORCOM,DOROTHY Date of Inspection: MAY 14,2003 C. Further Evaluation is Required by the Board of Health: N/A Conditions exist which require further evaluation by the Board of Health in order to detennine if the system is failing to protect public health,safety,or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to detennine distance **This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: Title 5 Inspection Form 6/15/2000 3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 234 BUCKSKIN PATH CENTERVILLE,MA 02632 Owner: MORCOM,DOROTHY Date of Inspection: MAY 20,2003 D. System Failure Criteria applicable to all systems: ✓ You must indicate"yes"or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool N/A Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in pit 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 of times pumped ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation N/A Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply N/A Any portion of a cesspool or privy is within a Zone 1 of a public well N/A Any portion of a cesspool or privy is within 50 feet of a private water supply well N/A Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. (This system passes if the well water analysis performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.) YES (Yes/No)The system fails. I have detennined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: N/A To be considered a large system the system must service a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone 11 of a public water supply well. If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system is failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. Title 5 Inspection Form 6/15/2000 4 Page 5 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 234 BUCKSKIN PATH CENTERVILLE,MA 02632 Owner: MORCOM,DOROTHY Date of Inspection: MAY 20,2003 Check if the following have been done. You must indicate"yes"or"no"as to each of the following Yes No ✓ Pumping infonnation 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? N/A Were as built plans of the system obtained and examined?(If they were not available note as N/A) ✓ Was the facility or dwelling inspected for signs of sewage back up? ✓ Was the site inspected for signs of break out? ✓ Were all system components,excluding the SAS,located on site? ✓ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum ✓ Was the facility owner(and occupants if different from owner)provided with infonnation on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)has been determined based on: Yes No N/A Existing infonnation. For example,a plan at the Board of Health. ✓ Detennined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] Title 5 Inspection Form 6/15/2000 5 Page 6 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 234 BUCKSKIN PATH CENTERVILLE,MA 02632 Owner: MORCOM,DOROTHY Date of Inspection: MAY 20,2003 FLOW CONDITIONS RESIDENTIAL Number of Bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 1 10 gpd x#of bedrooms: 330 Number of current residents: I Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no): YES Seasonal use(yes or no): N/A Water meter readings,if available(last 2 years usage(gpd)): NO Sump purnp(yes or no) NO Last date of occupancy: PRESENT COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CM 15.203): Basis of design flow(seats/persons/sqft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: N/A Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: gallons—How was quantity pumped detennined? Reason for pumping: TYPE OF SYSTEM ./ Septic tank,soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no)(if yes,attach previous inspection records,if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank Attach copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: AROUND 1975 Were sewage odors detected when arriving at the site(yes or no): NO Title 5 Inspection Form 6/15/2000 6 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 234 BUCKSKIN PATH CENTERVILLE,MA 02632 Owner: MORCOM,DOROTHY Date of Inspection: MAY 20,2003 BUILDING SEWER(locate on site plan): ✓ Depth below grade: 20" Materials of construction: Cast iron P/ 40 PVC _ other(explain) Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK(locate onsite plan): ✓ Depth below grade: 16" Material of construction: ✓ concrete metal fiberglass polyethylene other(explain) If tank is metal list age: Is age continued by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1,000 GALLON PRE CAST Sludge depth: 3" Distance from top of sludge to the bottom of outlet tee or baffle: 27" Scum thickness: 1" Distance from top of scum to top of outlet tee or baffle: 12" Distance from bottom of scum to bottom of outlet tee or baffle: 17" How were dimensions determined: TAPE AND PROBE Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): MAIN TANK AT WORKING LEVEL. INLET BAFFLE,OUTLET BAFFLE.TANK AND COVERS 16"BELOW GRADE. GREASE TRAP(located on site plan) N/A Depth below grade: Material of construction: concrete metal fiberglass _ polyethylene other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Title 5 Inspection Form 6/15/2000 7 r Page 8 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 234 BUCKSKIN PATH CENTERVILLE,MA 02632 Owner: MORCOM,DOROTHY Date of Inspection: MAY 20,2003 TIGHT or HOLDING TANK: N/A (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass polyethylene other(explain) Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no) Alann level: Alarm in working order(yes or no): Date of last pumping Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: N/A (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: N/A (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Title 5 Inspection Form 6/15/2000 8 I Page 9 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 234 BUCKSKIN PATH CENTERVILLE,MA 02632 Owner: MORCOM,DOROTHY Date of Inspection: MAY 20,2003 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.) LEACHING IS ONE PRE CAST PIT.PIT 32"BELOW GRADE WITH COVER AT 18".PIT FULL,NO 7- LEACHING. FAILED LEACHING. CESSPOOLS: N/A (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: N/A (locate on site plan) Materials of Construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) Title 5 Inspection Form 6/15/2000 9 P Page 9 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 234 BUCKSKIN PATH CENTEPWILLE,MA 02632 Owner: MORCOM, DOROTHY Date of Inspection: MAY 20,2003 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two pennanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. i } I i Title 5 Inspection Form 6/15/2000 10 Page I I of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 234 BUCKSKIN PATH CENTERVILLE,MA 02632 Owner: MORCOM, DOROTHY Date of Inspection: MAY 20,2003 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to no groundwater 12 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: Observation 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: TEST HOLE BOTTOM OF PIT 9'. TEST HOLE 13' BELOW GRADE,4' BELOW BOTTOM OF PIT. i x/ Title 5 Inspection Form 6/15/2000 11 ASSESSORS MAP AI ICI TEST HOLE LOGS , NOTES: PARCEL : I) THE INSTALLATION MUST BE IN SUBSTANTIAL COMPLIANCE WITH FLOOD ZONE : ' SO I L EVALUATOR : ,VVIeje*.1�S•�C�,� THIS PLAN 1995 MASSACHUSETTS TITLE V & TOWN OF r �jtr W I TNESS; -�UC ?Ui�D ` �-aIS"(1ggL BOARD OF HEALTH REGULATIONS. ' REFERENCE:E �r iL DATE: 2-00 2) THE INSTALLER SHALL VERIFY THE LOCATION OF UTILITIES PERCOLAT►ON RATE � ►��►`1 I�� SEWER INVERTS AND SEPTIC COMPONENTS PRIOR TO '�� d INSTALLATION. cr �.. /` TH I �,L,�(� pu TH-2 3) THIS PLAN SHALL BE USED FOR SEPTIC SYSTEM INSTALLATION �� Yy ONLY, AND SHALL NOT BE USED FOR PROPERTY LINE v �` r A SA►�417 ID�{ f2 DETERMINATION. L,0XK ^J 4) ALL PIPING TO BE 4" SCHEDULE 40 @ 1/8 "/ FOOT. (UNLESS lfl�,es/ r" SPECIFIED OTHERWISE) LOCATION MAP(WTCi ) ,� 1 2S^ 5) THE DESIGN OF THIS SYSTEM DOES NOT ALLOW FOR THE USE OF A 'W � TAP GARBAGE DISPOSAL. �G S� 6) SEPTIC TANKS AND DISTRIBUTION BOXES (WHEN INSTALLED) G MUST BE PLACED ON A MECHANICALLY COMPACTED BASE OR ON A BASE OF 6"OF CRUSHED STONE. c K $1 J'Vo Kr�Own1 Fir vet`� wEl, w ,ry ,eta as i,v �— U +� /V 2U�G5t7 L�"11�1t A5 3.32' I s9.a SEPTIC SYSTEM DESIGN 10' 1�k y4)24� "E S f"A f t,&\l 6A., 84R tj s-/z cc�_ S6 I FA I FLOW ESTI>MATE � 37 or BEDROOMS A IIO GAL/DAY/BEDROOM - 33d GAL/DAY SEPT I C :TANK I 33� GAL/DAY x 2 DAYS - �wD GAL 1 USE ` o GALLON SEPT I C TANK Ey�t, inl� - 9CP(Ace w/f,s 6,9-4, 5ip, TA-Nm-1 "� SOIL ABSORPTION SYSTEM 1 lop S 1.S 0 Pk ch Sr `to f'V y LSLkI� �K Zp rU., SIDE AREA: `25 x o� 7y\N' U ll2• Y� '. BOTTOM AREA: 2-6 x 13 U,7t/ q(), Sv V vv SEPT I SYSTEM SECTION �33v dap refLek), -BA-�_ 'to I3 I� Coves // _ a,VIl -� +1_ I (As 5 v a o� phis Wv'acl�° 9'M�» K/ CoA J 7 / 7 D Z '— UtJBLE WR tlNE -- p X LL.. .._ .. .--- D-BOX y7 33 7-1 Els� GAL ' 7 SEPTIC TANK � " 3�y' 1 DwBc 67 --- 25�(,x M(vwk 21a --�` SITE AND SEWAGE PLAN �ZN OF MAS AR ` � LOCATION 2.3�{,_ '6116rhpll) P" E v, No. 1140 PREPARED FOR o a/TS � 11�'DJeG�,7, 1�o��ryy S'4NirAR\PN jJ3 SCALE: �J� Ot DARREN M. MEYER, R.S. IN � Iz, iLN2 43 VINE STREET DATE: 7 5 Q3 DUXBURY, MA 02332 DATE HEALTH AGENT (781) 585-0293