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0196 CAP'N CROSBY ROAD - Health
196 Capt'n Crosby , Centerville, MA A= 193 —211 Aff ' UPC 12534 .2-153LA Commonwealth of Massachusetts /93"A// Title 5 Official Inspection Form _ - - _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a �M 196 Ca n Crosby Road —� Property Address ---- ----- ---- --_ .____-_ Diane Cameron Owner Owner's Name------- ----- ---- - --- — - information is required for every Centerville V _ _ —_ MA _ 02632 October 19_, 2016 page. City/Town State Zip Code Date of Inspection N CA — Un 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 f A. General Information - - S� II /-� onn the out forms e computer, .# lL use only the tab 1. Inspector: key to move your cursor-do not Patrick T. Sullivan use the return --- ---- ..--- key. Name of Inspector -- - - --- - Ready Rooter Excavating_ -- ------- „y Company Name ------------ — P.O. Box 89 Company Address Forestdale MA _ 02644 _ Cityrrown State Zip Code 508-888-6055 S112843 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 _ October 25, 2016 _ Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. 1.5ins-3/13 Title 5 Official Inspection Forth:Subsuiface Sewage Disposal System-P'a a 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form I~ = Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 196 Cap''n Crosby Road- Property Address -- Diane Cameron N Owner Owner's ame _ -- - ---- -- - — information is required for every Centerville MA 02632 _ October 19, 2016_ 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: ❑C 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: 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 Tillo 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 196 C p'n Crosby Road Property Address — Diane Cameron Owner Owner's Name --- information is required for every Centerville MA 02632 _ October 19, 2016 page. Cityfrown 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 leveed 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: ❑ 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 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 196 Ca n Crosby Road Property Address - Diane Cameron _ Owner -------- Owner's Name -- information is required for every Centerville _ MA_ 02632 October 19, 2016 page. City/Town 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: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: Yes No ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less - -- than '/2 day flow i!m,s-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments - 196 Cap'n_Crosby Road Property Address — - - Diane Cameron Owner Owner's Name -- - information is required for every Centerville_ — MA 02632 October 19, 2016 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® 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. ❑ ® 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. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts E g Title 5 Official Inspection Form o rm Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w 196 Cap'n Crosby Road Property Address --- Diane Cameron__ Owner Owner's Name — — —_ information is required for every Centerville MA _ 02632 October 19, 2016 page. CityfTown _ 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? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® 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 3 2 (design): Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 338 GPD t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 196 Cap'n Crosby Road _ Property Address -- _ Diane Cameron_ Owner information is Owner's Name —_---- — required for every Centerville __ __ MA 02632 October 19, 2016 page. CitylTown State ZipCode Date of Inspection D. System Information Description.- Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection information in this report.) ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): 2015= 189 GPD' Detail: 2016=212 GPD* Summer water usage higher in summer months due to irrigation. Sump pump? -- ® Yes ❑ No Last date of occupancy: 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/$q.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 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form - o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 196 Cap'n Crosby Road Property Address Diane Cameron Owner Owners -- -- information is required for every Centerville __ _ MA 02632 October 19, 2016 page. City/Town _ 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: Ready_Rooter records: Pumped_08/2013 + 10/2015 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments .`�.• 196 Cain Crosb ry Road Property Address -- --- Diane Cameron Owner Owner's Name information is required for every Centerville _ —___ MA 02632 October 19, 2016 _ 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: Tank installed 1978. D-bom replaced prior to inspection. Leach field installed 08/01/2005. Certificates of Compliance on file at Health Dept. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2'6" feet Material of construction.- El cast iron ® 40 PVC ❑ other(explain): -------- -- Distance from private water supply well or suction line: n/a —_ feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): Depth below grade: 1,9„ 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: 8.5' x 4.5' x 5' 1000 gallons Sludge depth: 15ins.3113 Title 5 Official insp ection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments yM =5,.•''• 196 Cap'n Crosby Road Property Address — —Diane Cameron Owner Owner's Name -- — information is required for every Centerville - MA 02632 October 19, 2016 page. City/Town State Zip Code Date of—inspection -- D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 36" Scum thickness `11, 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 14" How were dimensions determined? Tape measure and dip tube. Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.). Inlet and outlet PVC tees in place. Liquid level at outlet invert. Risers bring covers within 6" of grade. Pumping not needed at time of inspection. 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 t51ns•3/13 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 196 Cap'n Crosbv_Road Property Address Diane Cameron Owner O ---- wner's Name - information is Centerville _ _ MA 02632 October 19, 2016 required for every _ _ _ page. Citylrown 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �. •' 196 Ca 'n Crosby Road Property Address -- — Diane Cameron Owner Owner's Name - -- - — — information is required for every Centerville _ MA 02632 October 19, 2016 page. City/Town _ State Zip Code Date of Inspection D. System Information (cont.) - Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 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.): One inlet, one outlet. H-20 D13-3 installed prior to inspection. No staining. Riser brings cover within 6" of grade_ 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.): * 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: ISins•3/13 Title 5 Official Inspection Forth: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 196 Cap'n Crosby Road Property Address Diane Cameron Owner Owner's Name — -- information is Centerville required for every MA_ 02632 October 19, 2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: - ® leaching chambers number: 4 H-20 Hi-cap Infiltrators ❑ 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.): SAS is 4 Infiltrators w/4' of stone. Camera used to locate and inspect 1S1 unit. Wet base with no standing liquid at time of inspection. No sign of past hydraulic failure. 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 t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 'w, ,.•''� 196 Cap'n Crosby Road _ Property Address — — Diane Cameron Owner O — — — wner's Name --- information is required for every Centerville MA 02632 October 19, 2016 _ page. Cityrrown _ 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): Materials of construction: Dimensions -- Depth of solids Comments (note condition of soil, sighs of hydraulic failure, level of ponding, condition of vegetation, etc.),. 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 196 Ca n Crosby Road Property Address Owner Diane Cameron —_ - - --- -- -------_ Owner's Name ---- information is required for every Centerville _ MA 02632 October 19, 2016 page. 6ity/Town State Zip Code Date of Inspection D. System Information (cont.) -- Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: hand-sketch in the area below drawing attached separately T I 1 i ��.�A J r✓ I I I � 1A -LhP5.4T��1✓1 � I / � / i / / oLil 1- 4- t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts _ - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -P Y Not for Voluntary Assessments ,... 196 Cap'n Crosby Road Property Address Diane Cameron Owner --------- — - - Owner's Name — — information is required for every Centerville _ _MA 02632 _ October 19, 2016 page. City/Town State Zip Code Date of Inspection _ D. System Information (cont.) — Site Exam: ® Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: >25 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: 06/14/2005 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: maps.massg is.state.ma.us/oliver.ph p You must describe how you established the high ground water elevation: Test hole and ground water evaluation form from 2005 show adjusted high ground water at elv= 37. Base of SAS at elv=66.58 per engineered plans. Slope to rear of Property drops below base of SAS. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t51ns•3113 Title 5 Official Inspection form.Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 196 Cap'n Crosby Road Property Address — - Diane Cameron Owner Owners Name ---- — — information is required for every Centerville MA_ _02632 October 19, 2_016 page. City/Town _ State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Pone:Subsurface Sewage Disposal System•Page 17 of 17 No Fee Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes NpliLatlon for Misposal *pStem Construction Permit Application for a Permit to Construct( ) Repair(✓jUpgrade( ) Abandon( ) ❑Complete System &4ndiidual Components Location Address or Lot No. v�6 +,A C �� q Owner's Name,Address,and Tel.No.17"(—al(_-:;L V-S-4 Assessor's Map/Parcel rv� C. c .nr�� � Installer's Name,Address,and Tel. Designer's Name,Address,and Te.No. rtic l din © 6' Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building !J No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank (C)C=C:�j Type of S.A.S.—_7.,1' S.73-A t, Description of Soil Nature of Repairs or Alterations(Answer when applicable) 1 _o t`v Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Si ed Date /d Application Approved by Date Application Disapproved by Date for the following reasons Permit No. 7 Date Issued NoQo/l> Fee 7,5" THE COMMONWEALTH OF MASSACHUSETTS Entered incomputer:�� PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pplitation for Disposal 6pstem Construction permit Application for a Permit to Construct( ) Repair(.Upgrade( ) Abandon( ) ❑Complete System ndividual Components Location Address or Lot No. \,q\c C�pA j.Q_- ` Owner's Name,Address,and Tel.No. Assessor's Map/Parcel60 Installer's Name,Address,and Tel. o.�S- Z E3�5 Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building S No.of Persons Showers( ) Cafeteria( ) -ether Fixtures Design Flow(min.required) gpd Design flow provided f gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) �� o rz_ _ ,x� v,c r t2 � - d ® SlR- 3 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Si ed Date /O Application Approved by Date 6 Application Disapproved by Date for the following reasons Permit No. — 7 Date Issued --------------------------------------------------------------------------------------------------------------------------------------. THE COMMONWEALTH OF MASSACHUSETTS 0* y BARNSTABLE,MASSACHUSETTS Q � Certificate of CotnplCame THIS IS TOO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( � Upgraded( ) Abandoned( )by `tom'r,v a o e1�. J�' lc C�n✓A�� ,�{ at \ C C.a,p ry .1 c�,S 6,, �,c� has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit Nw2 U dated Installer o� , �p��r �1 1�y�-A� Designer #bedrooms �� —� Approved design flo gpd The issuance of this permij shall not be construed as a guarantee that the system w' ction as desi ed. Date U .2 0 b Inspector ..L� ------------------------------------------------------------------------------------------------------------------------------- No 3 2J Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal 6pstem Construction 13ermit Permission is hereby pted to Construct( ) Repair Upgrade( ) Abandon( ) System located at C �p�� >` Sl c� and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction mrt be coleted within three years of the date of this it. Date �G/ /, G Approved by - ' !!C� / TOWN OF BARNSTABLE LOCATION 1 l (s o,per �,/�� WAGE# U 16 - 7 S✓ VILLAGE C ri t J� V� ( i ASSESSOR'S MAP&PARCEL ( 3 INSTALLER'S NAME&PHONE NO. CR gS�-rT' SEPTIC TANK CAPACITY `Q C:)U �- 7 Y� 6 0-$ LEACHING FACILITY:(type) T, rt.!H en',j (size) 33 �A NO.OF BEDROOMS OWNER �4 C�,iv"cle r 0�n PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility �41( 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��A�- o n= r 4114 cF J1 ll Cr°Sby �k _ I .513 i a 3= 3-3 09 A, j PERCOLATION TEST AND SOIL EVALUATION E r .TON FORM hereby certify that the engineered plan signed by mo dated 6 Z8 ,concerning the property located at Cf 4p r-G,J Ct20:5a meets all of the following criteria: • This failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. ` • The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. The applicant may use historical data to conclude this fact or may conduct preliminary tests at the site without a health agent present • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching facility will be located no less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] Please complete the following: A) Top of Ground Surface Elevation(using GIS information) ,7�1 8) G.W.Elevation +adjustment for high G.W. d 1S = 37 vS DIFFERENCE BETWEEN A and B 3 ' 5- SIGN v ' CSC^' DATE: Z �S NOTICE Based upon the above information,a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the fiiture without engineered septic system plans. q;licshh folder.puccxmp Town of B,arnstable OF1HE 1p� Regulatory Services P� ~ Thomas F. Geiler,Director * BARNSTABLE, MASS- Public Health Division ATF°Mafia Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: 0 Designer: 1 'J A" SO^] Installer: Address: ,�I �v� l per► �� Address: -t,KKtc5 �, ��► rJwIG� u�W �zs�] _ J Or, b5 _ was issued a permit to install a (da ) // (installer) septic system at )gsed on a design drawn by (address) 0 S , dated 5 (designer) VZ I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. (In er's Si turn Y ri Jib si er's Signature) (Affix Designet•'s Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form J 1 ' oc �1 No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS (� 3pplication for MigozaY *p6tem Cow5tructiun Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components 1 Location Address or Lot N� e,Address and Tel.No. 1!5, Assessor's Map/Parcel /—7 3 l l / Installer's Name,Address,and Tel. o. Designer's Name,Address and Tel.No. /P & -// e C�D /?fJ 4--b' /,)v aS'd ter/ a 7 -,> �) / _7 s— a P3__3 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 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank r r eX Tf---5 6 d Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and no to place the system in operation until a Certifi- cate of Compliance has been issu d b is Board ofMialth. Signg"d : Date d Application Approvet_by Date 00, Application Disapproved for the following reaso Permit No. --&. Date Issued v Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Application for Dizpaal *p$tem Congtruction permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No �e,Address and Tel.No. Assessor's Map/Parcel / 3 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 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 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank T' x s 'r t5 d Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: ' The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and notto place the system in operation until a Certifi- cate of Compliance has been issued by this Board of Health. ✓1-- Signed r-.. a Date Application Approved by i d Date 01 Application Disapproved for the following reaso 1 Permit No. r► Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( ) Repaired ( )Upgraded ( ) Abandoned( )by >ti at has been,constructed ip acco ance with the provisions of Tit e 5 and the for Disposal System Construction Permi No.o � `� 3 G I dated_ ` Installer /4/2</Y Designer / The issuance of this permit shall note toltr}�ed as a guarantee that the s tem lion as designed. Date f � Inspector No. MY_l� r------------------------Fee-- — ...r" THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Mi.5pog;af *p5tem Construction permit Permission is hereby granted to Construct( )Repair( Upgrade( )Abandon( ) System located at GZ 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 m st bec pleted within three years of the date of thi Date:__ Approved by LOCATION SEWAGE PERMIT NO. �.� 20 7 - ViLLAGE INSTALLER'S NAME i ADDRESS ctvlty H/ClCLO.' ? C Cy Ag 9/4C7j-- CA' 34it tl BUILDER OR OWNER SV r-,yaox IZ r' t"n ot 'i I Lt DATE PERMIT ISSUED c{_Z0 , 7� DAT E COMPLIANCE ISSUED �� r �c:�4— ^L� �,�z �3 'ram jJ4�i `'�l� �,� ,, � �� J�� I THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .. ............OF......d4 j!: �........................... Appliratiou for Disposal Works Tonstrurtiou Famit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: - ...................................................................................%............. Z''o'c lion,Ad Or LID. . . ..... .....e.. ...6: . . 0 or .........Address .... .. . .. .......... ........................................ ................................... ...................................................... Inst r Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.................C Attic (W4 Garbage Grinder (MO U ..R.....................Expansion �-j P4 Other—Type of Building Aa... ............ No. of persons...._..._f............... Showers Cafeteria Wo Otherfixtures ...................................................................................................................................................... Design Flow............ZJ4T-------------------gallons per person per day. Total daily flow....... ......................gallon —L Je.... - 0� Septic Tank—Liquid capacity/#0.470.gallons Length.Af�.�6..... Width....7.... Diameter------5....... Depth-.S-/...... Disposal Trench—No. .................... Width ........... Total Length.._..._..__.... ... Total leaching area....................sq. f t. 7' Seepage Pit No...../------------ Diameter.................... Depth below inlet.....]........_... Total leaching area../.Oojl ..sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by-------------- t4/,a/...&... ....... ...... Date____I as Test Pit No. I......;Z.....minutes per inch Depth of Test Pit......c&........ Depth to ground water.-JY0Ar....... Test Pit No. 2................minutes per inch Depth of Test Pit.__................. Depth to ground water.___-_..........._...... 0 -------- -----------------------------. *---------------------------*--------...... ...... ----"-----------*--------- ------------------Description of Soil....................... C .............. ...5.(4 .... ---- - ------------------------------------- 41.................................................. M . ...........#,X4..... ---------------*................*--------- I ------------------------------------------------------------------------------------------------------ ................................................................................................ 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 TL I Ti 1E 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the bo of/health. Signed ....... ... . . ....... . ...... ............................ .... Date_ Application Approved By....... .......... ----- ... ...... '"/**---- ............7....... .......:? Da'te Application Disapproved for the following reasons:............................................................................................................... Date Permit No. _ Issued----4, .................................................. Date NA�� e -��L I THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH _..... ...__....__.............._...OF..........................`...;?:.... ._. . . , , Appliration for Diopnwttl Works Tunotrnrtion Vnmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ...............—f-r-•c............��....... i......�/.7/7 -•, ............................................Lot .................... ".-^.............._. JeK...... .... - •- aii f, ................................. -----•------------------------•-----------•--•---------------------------------------------------- �z 4�y{ Address T�pe'of Builchiig Size Lot............................Sq. feet p,,, Other—Type of Building .................... g T ..� -Expansion Attic ( ) Garbage Grinder ( �' Dwelling No. of Bedrooms......................W No. of persons.............• Cafeteria ( Otherfixtures ----------- ---------{! ..-- . ------......................... .---------- ---------•----------------...'...----------................... W Design Flow.............................................gallons per person per day. Total daily flow..............----,,--:....................gallons. W Septic Tank—Liquid m acity............gallons Length................ Width..............,- Diameter-_.-_-_-_-_--_.'Depth........... ,_..� x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area........�........sq. ft. Other Distribution box/( ) Dosing tank ( ) ~' Percolation Tent Resufts Performed by........................y......... �: jr Date....................7... �...�:.ri..:'' ,4 Test Pit No. I................minutes per inch Depth,'of it_..........._...., Depth to ground water------ Test Pit No. 2...........a�.minutes per inch Depth of Test Pit................ Depth to ground water........................ O Description of Soil........................... •. r : r��/�¢r;VW ........ ..................... r......... ..----.....----............•........-.•.-.-....... - a �. 7 -- •-----•...---------•---••---•------------------ ----•••-•••--•---------•-•----••........_.....................---._....----•-•-•-..._.....--•--.....------•---•-.........................-- 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 TITILL 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been;issued by the board of health. Sid.__ Z........-- ...................................•................... •.. -r ..... ...------ Date { �7 -C.... .....APPlication Approved BY - .' . Date Application Disapproved for the o11ow1ng reasons: �. Date 5 zd 7� PermitNo.........................................-........----• Issued.------- . ---------i--•---•-•--....._...._.....---- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ' s....................OF...pl .:r�.::. w'�.....�/.G✓�:�:.". ......... .............. Tntifirtt#r of Tomplianrr THIS-IS TO CERTIFY, That the Individual Sewage Disposal System constructed (,4i) or Repaired ( ) bY...............:. .,�•a ;.�, ••k t-•C', - --........-•--••-•--••------------....------•-•------•-•--...-----•------•---•--•-------...----•---•--•---•-•-----•---------•- ,1 /J Installer a't...... v 1 r x-c----.� ���.l1.y.�ql....(--s r f � .... '^ ....._... has been installed in accordance wilt the provisions dTIT >of The State Sanitary Code a described in the application for Disposal Works Construction Permit NO.. v�',� '... dated_..... -.,� _.-_�,�-...-._...... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE 'SYSTEM WILL FUNCTION SATISFACTORY. / s - GDc� - , DATE::........ '„�.rt. r.'.Z. ...". 7�..•-------------------- Inspector...... . t �� _ .� THE COMMONWEALTH OF MASSACHUSETTS -- BOARD OF HEALTH N .... ,,� � 1......</.c c—4..............OF.. ......................... Disposal Works Tomarlulion rrrmit Permission is hereby granted.../f4_1%,r./.0•-• ���-�----f -�• -ewage'Disposal System to Construct ) or Repair ( ) an Individual S at No..� �' xw__4�... s4 Works y: E�.....( ._ ,fC_�L.�,�f 4--••..............................................••-- Street ��++ as shown on the application for Disposal C struction Per o....... d...... ...... .................._.... .. �._J�7-14F------- -.-- t DATE-_-_ - - ------•--•.-.•--.--------•-- oa d FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS •' /'+ ,qGi TOWN OF BARNSTABLE LOCATIONC—f3.1'7-V C2 O S�Y SEWAGE # a ma's-36 e VILLAGE C `', T B R-&'c���P ASSESSOR'S MAP & LOT f�- �l INSTALLER'S NAME&PHONE NO.Age-°"Y 13 6'2 SEPTIC TANK CAPACITY 1 x s r LEACHING FACILITY: (type) 33 X `size) NO.OF BEDROOMS 3 BUILDER OR OWNER PERMITDATE: :> COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by G1 01 f . _ O 1 LoiC� L0 O D � 97.9 9�'O /00,5" 9 ` boo 88,0 - 7 /9 M Ex/ST 28 p`O '�'c•ivq S�itl D \ 0 ? \ G oT PeoP�000� 2/A o z �0 9� �3, SioN /000y.r,,o TES-7 Ho ,� /eES U TS r07- 2g, 27 PE�2 TO WN /eEC'ORDS 7� , I GoT DATE of TO L.//\,/ V,,Q TER i-S A VA / L P 8 ,L E //t/SP. y f M/ N//`-IU/"I 8U/,. DING S,ETl3F9r-fK RE0U/ RE/"7Eti/TS 0A/7- U/2/ VEL✓f� Y ti/o 7- 7-0 L•3,E Lac �TED P,� OPOSED Z3 E p2ooMs 3 I O VE)e sys T'E/ 7 UNLESS DEs/G/V FLO cam/ -: 30 GAL Day H-20 D'ES / G/V L0 ,9D //VG /S USED . P,201=;'OSED LE/9C1-/ "9PE/9 Z 70 SEPT/42 PE/eC OL �T/OA,! TES T C O N F O M 7-0 /eES C/L TS Z ,D ,'9 7-,E-D JUL Y /, /977 F A.12) TOLVAI of I 6,9.FivsTr9,8LE HE L TN 2EG UL AT/ O/VS. SILL ELEV. TO 13E FT /930VE ,eD. PTOP OF e R I L Ge�DE/ '9aovE LEA H FO UNDFIT/on/ -/DO, S /V O S o A /- E F�.eEr9 MA/VHOLE4 0OVE'R To EXTE/,/Z TO. To F'E,eVlOUS CvvEe k/lTH/N OF F/A//SHED 67R,9DE PREVEn/-- F//VES I! FROM /n/-/1-72r97-1NG I M/N/MUM /O'M/A,//MUM 57-0n/E z „zoo %" To 2 jp-�'` Z¢"CoVE�S D/sT. coV�,e Wf/Sf/ED S7oNE I ox z/"W/DE h'L L ,9RO Un/D 1 '4 D/fI. !✓f1TER 1 a .2 � /`'!/A//MUM 6'Minl. �Y 2"H/ti/. iGHT 4 ," o ?� /0 P/TCH �—FLoh/ LIA'E M/N. PITC CttYY FOOT . /,¢„ % Foor XZ,3FooT_ _�j7 �A L L`C�N Perms o n/ED (( /IVVEeT 9 L F�c H e GALLON/ /A/VEReT PIT /A/VER7` �z,7 /NTyf"R,e- o UND SEPT/C TF 9 Wf7-9-R7-/6 HT) /AVEeT 12"/vI/N./N VE.eT , � x. /NVE�eT N'p GF?RBF7GE GRINDER �- A�'EA OF Mqs 4 M / �/. D/ST. TO M19X ' 1 / A ���P sgcy G/e O UN WfJ D TEe, EI-E V. p/. O T PL I / � RONALD o ARTHUR L O (C ,19 T/ O A1: G'L�i��E/t'Y'/L L GIFFORD O' 2),49 TE: No.603 8E/n./G ,L 07- OC>lq le�S 9140WAI SgFGISTERP� ON A P�. A/V /e E C ore D EZD /N 77gE B1,gRA/- N/TARS /9.I3L COC/NT EG / ST�ey 0� DEEDS �( S T E y ,� �!/.,f' F O� SEPT/ C 7"/9 NK To H E /7 MIN- ,..5'v��"4 M v M o F /o' Fie o M F o U/V D om- TL /Eof� C' H /NG P / TSeor✓Q E O (.cJ TS To ;BE- f . /"I/N- Uo FF,e Ro E)2Ty 1 C E R T / FY T N A 7- T f-/ E 1�_W --107W�V L / /V E ,S r9 /`/ D S E P T/ C TF� /V fC l�.ann.11 L, SHoW/V oA,/ 7TH /S PCf3N / S ZOL-W7,FC) =jt%���, aF ; AND zo' F,eO/-1 FOU/VDF97-/ON CA/ T H E G R O U/V ZD 9 S S 14 0 W/V H E R EON n./ D T/-N� 7- / 7- L�oF S C p/v F0�2/`q c�oRCE � D A T T T L E / E — — — — — — o �3 U / ,L D I N 7-G S E B f G'� K �e E Q v �' LOW,:R. TT HE � ' ' 97 d' t>tJ`• G`�' D/,9 rE 8 O i9 /e D O F f-1 E �L TH I D�T E E G. N 5 �E' V E y o �'�°^ ;�`�` F/PP1e oVE D r9 G E N T I 1 !�3 ASSESSORS MAP b TEST HOLE LOGS 1 c�' z// i� a PARCEL - -----_ _ ------- __: _ NOTES. �# SOIL EVALUATOR. ( FLOOD ZONE: W I TNESS•' 1T ! REFERENCE: . 1 ,The installation shall coin l with E DATE: I ) P y t Title V and Town of Barnstable Board of ' PERCOLATION R Health°Re Regulations. 2 The installer shall verifythe location of utilities, sewer inverts and septic components nor to installation and setting base elevations. - TH 1 . TH 2 P g 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8 per foot. P , 4) This plan is not to be utilized for property line determination nor any other 16 r purpose other than the proposed system installation. ,tom 6 -/ 5) All septic components must meet Title V specifications. P ;� �2 6 ) Parking shall not be constructed over H10 septic components. �L Al 7) The property is bounded by roe corners and roe lines. - � - �. --- --- --- property rtY property rty LOCATION MAP 8) The roe owner shall review design considerations to approve property rtY g of total design flow to be considered for design. Receipt of payment for the plan 8 P P Y p a and installation based on the plan shall be deemed approval of the design flow. /lw;r e"?- 9 The existing leach i# s shall be pumped and filled with m f� � � ) g P � ) P P material per Title V abandonment procedures. Those within the proposed SAS shall be removed 2• � P P -- ! along with contaminated soil and replaced with clean washed sand per Title V secs. i -t P 10 System components to be 10 feet from water line. 11 If a garbage grinder exists it is r , � ) g g gr t to be removed and the responsibility of the , �- owner to ensure such. i2)Excavate 5 feet around and under the proposed SAS to a depth of 96" i SEPTSEPY I C SYSTEM DESIGN P � �P /Fne Q Sand and fill with clean washed sand per Title V specs. q 7 P P� 1 FLOW ESTIMATE 1 1 , BEDROOMS-AT/A9 GAL/DAY/BEDR00 - GAL/DAY ti Q _ n� t SEPTIC;,TANK _l Y GAL/DAY x 2 DAYS GAL USE IWO GALLON "'SEPT1 C`TAN ��JTI W n SOIL AE;SORPT I ON SYSTEM 4�Tbk1 VW rye) ��►. '.'. • S i DE AREA. ail BOTTOM AREA: X D X *_� r SEPTIC. SYSTEM SECTION ' d(uwd, W , _: WIC,... ... -- $'� �• '.' �. wa CA to — __ - (Ale b IC0Q GAL i v (p SEPTIC T K �Q -lOJi -�Z (d/ ! i� �0 VV r►� - Cv2 oI SITE AND SEWAGE PLAN ZS PREPARED FOR : a N I.. - O SCALE. owe DAV I D B . MASON f� DATE: DBC ENV I RONMEN�fAL DESIGNS DATE HEALTH AGENT EAST SANDWICH MA � _ ( 508 ) 833- 2177