HomeMy WebLinkAbout0016 COVE ISLAND ROAD - Health 16 COVE ISLAND ROAD, CENTERVILLE
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TOWN OF BARNSTABLE
-LOCATION A0 G Vr SEWAGE
VILLAGE L:17-AZr/=e V l L44—S ASSESSOR'S MAP & LOT ZZ 0,32-
INSTALLER'S NAME&PHONE NO. f/JiAnl-ZA 'I
SEPTIC TANK CAPACITY /D 00
LEACHING FACILITY: (type)
i/UG J�,(.11'd7 (size)
• NO.OF BEDROOMS �"
BUILDER OR OWNER
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge,of Wetland and Leaching Facility(If any wetlands exist
., within300 feet of leaching facility) Feet
Furnished by
D
rn Cam_
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
16 Cove Island Rd.
Property Address
Lisa Beaulieu
Owner Owner's Name
information is Centerville Ma. 02632 1-8-21
required for every
page. City/Town State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
Important:When A. Inspector Information 514P f I CIS
filling out forms
on the computer, Michael Sears
use only the tab
key to move your Name of Inspector
cursor-do not Jim The Inspector Man
use the return Company Name
key.
P.O.Box 784
r� Company Address
West Yarmouth Ma. 02673
City/Town State Zip Code
508-364-4398 SI 14430
Telephone Number License Number
B. Certification
I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5
(310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address
listed above; the information reported below is true, accurate and complete as of the time of my
inspection; and the inspection was performed based on my training and experience in the proper function
and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined
that the system:
1. ® Passes -\NOF"4f
2. ❑ Conditionally Passes .
MICHAEL %,n
SEARS
3. ❑ Needs Further Evaluation by the Local Approving Authority S o. -,
* No.SI14430
4. Fails ' o
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Inspector's Sigpefure 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 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 form should be sent to the system owner and copies sent to
the buyer, if applicable, and the approving authority.
Please note: 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.
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18
cam, Commonwealth of Massachusetts
Title 5 Official Inspection Form
�I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
16 Cove Island Rd.
Property Address
Lisa Beaulieu
Owner Owner's Name
information is ill Centerve
required for every Ma. 02632 1-8-21
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary
Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6.
1) 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:
1500 gal tank, D Box Pit
2) 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 El N ❑ ND (Explain below):
I
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
u
16 Cove Island Rd.
Property Address
Lisa Beaulieu
Owner Owner's Name
information is Centerville Ma. 02632 1-8-21
required for every
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
2) System Conditionally Passes (cont.):
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
3) 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.
a. 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:
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
16 Cove Island Rd.
u Property Address
Lisa Beaulieu
Owner Owner's Name
information is
requiredforevery Centerville Ma. 02632 1-8-21
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
❑ Cesspoo[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
b. 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.
c. Other:
_ R
4) System Failure Criteria Applicable to All Systems:
You must indicate "Yes" or"No"to each of the following for all inspections:
Yes No
El ® 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
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18
c Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
16 Cove Island Rd.
V�
Property Address
Lisa Beaulieu
Owner Owner's Name
information is required for every Centerville Ma. 02632 1-8-21
page. Cityrrown State Zip Code Date of Inspection
C. Inspection Summary (cont.)
4) System Failure Criteria Applicable to All Systems: (cont.)
Yes No
❑ ® 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 '/z 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.
❑ ® 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 water supply
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 2000 gpd-
10,000 gpd.
❑ ® 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.
5) 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 CA.
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
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
u
16 Cove Island Rd.
Property Address
Lisa Beaulieu
Owner Owner's Name
information is required for every Centerville Ma. 02632 1-8-21
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.) _
If you have answered "yes" to any question in Section C.5 the system is considered a significant
threat, or answered "yes"to any question in Section CA above the large system has failed. The
owner or operator of any large system considered a significant threat under Section C.5 or failed
under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner
should contact the appropriate regional office of the Department.
6. You must indicate "yes" or"no"for each of the following for all inspections:
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)]
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
�I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
16 Cove Island Rd.
Property Address
Lisa Beaulieu
Owner Owner's Name
information is Centerville Ma. 02632 1-8-21
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information
1. 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
Description:
2
Number of current residents:
Does residence have a garbage grinder? ❑ Yes ® No
Does residence have a water treatment unit? ❑ Yes ® No
If yes, discharges to:
Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No
information in this report.)
Laundry system inspected? ❑ Yes ® No
Seasonaluse? ❑ Yes ® No
Water meter readings, if available last 2 ears usage d NA
9 ( Y 9 (gP ))�
Detail:
Sump pump? ❑ Yes ® No
Present
Last date of occupancy: Date
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18
c Commonwealth of Massachusetts
,� Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
16 Cove Island Rd.
Property Address
Lisa Beaulieu
Owner Owner's Name
information is
required for every Centerville Ma. 02632 1-8-21
page. City(rown State Zip Code Date of Inspection
D. System Information (cont.)
2. Commerciallindustrial 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
Water treatment unit present? ❑ Yes ❑ No
If yes, discharges to:
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 below):
3. Pumping Records:
Source of information: Spring 2020
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped: gallons
How was quantity pumped determined?
Reason for pumping:
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18
Commonwealth of Massachusetts
�v Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
16 Cove Island Rd.
V�
Property Address
Lisa Beaulieu
Owner Owner's Name
information is required for every Centerville Ma. 02632 1-8-21
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
4. 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):
Approximate age of all components, date installed (if known) and source of information:
5-12-86
Were sewage odors detected when arriving at the site? ❑ Yes ® No
5. Building Sewer(locate on site plan):
1001,
Depth belowgrade: feet
Material of construction:
❑ cast iron ®40 PVC ❑ other(explain):
Distance from private water supply well or suction line: feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18
Commonwealth of Massachusetts
�v Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
u—
16 Cove Island Rd.
Property Address
Lisa Beaulieu
Owner Owner's Name
information is required for every Centerville Ma. 02632 1-8-21
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
6. Septic Tank(locate on site plan):
Depth below grade: 90"feet
Material of construction:
® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain)
1500 gal
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
Dimensions: 1500 gal
Sludge depth:
Distance from top of sludge to bottom of outlet tee or baffle
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
How were dimensions determined? Tank too deep to 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.):
1500 gal tank with in and out tees in place, outlet cover 12" below grade
I
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18
c Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
16 Cove Island Rd.
u
Property Address
Lisa Beaulieu
Owner Owner's Name
information is Centerville Ma. 02632 1-8-21
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
7. 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.):
8. 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
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18
c � Commonwealth of Massachusetts
�n ,p Title 5 Official Inspection Form
�15 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
16 Cove Island Rd.
Property Address
Lisa Beaulieu
Owner Owner's Name
information is ill Centerve
required for every Ma. 02632 1-8-21
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
8. Tight or Holding Tank(cont.)
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
9. 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.):
D Box is 16x21 with 1 outlet pipe cover at 18" below grade
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18
cam, Commonwealth of Massachusetts
Title 5 Official Inspection Form
i� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
16 Cove Island Rd.
V
Property Address
Lisa Beaulieu
Owner Owner's Name
information is required for every Centerville Ma. 02632 1-8-21
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
10. 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.
11. 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:
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18
c Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
u
16 Cove Island Rd.
Property Address
Lisa Beaulieu
Owner Owner's Name
information is
required for every Centerville Ma. 02632 1-8-21
page. Citylrown State Zip Code Date of Inspection
D. System Information (cont.)
11. Soil Absorption System (SAS) (cont.)
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
SAS is a 1000 gal pit with 1' of water, walls are clean and shows no sign of failure
12. 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.):
i
t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18
c Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
u
16 Cove Island Rd.
Property Address
Lisa Beaulieu
Owner Owner's Name
information is required for every Centerville Ma. 02632 1-8-21
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
13. 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.):
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
�j� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
16 Cove Island Rd.
u-
Property Address
Lisa Beaulieu
Owner Owner's Name
information is
required for every Centerville Ma. 02632 1-8-21
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
14. 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
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t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18
Commonwealth of Massachusetts
�u Title 5 Official Inspection Form
rj Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
�r
16 Cove Island Rd.
Property Address
Lisa Beaulieu
Owner Owner's Name
information is required for every Centerville Ma. 02632 1-8-21
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
15. Site Exam:
® Check Slope
® Surface water
® Check cellar
® Shallow wells
Estimated depth to high ground water: 20'+
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)
❑ 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:
SAS is up on hill 204 from ground water
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18
Commonwealth of Massachusetts
�v Title 5 Official Inspection Form
is Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
r;
V � 16 Cove Island Rd.
Property Address
Lisa Beaulieu
Owner Owner's Name
information is
required for every Centerville Ma. 02632 1-8-21
page. City/Town State Zip Code Date of Inspection
E. Report Completeness Checklist
Complete all applicable sections of this form inclusive of:
® A. Inspector information: Complete all fields in this section.
® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked
® C. Inspection Summary:
1, 2, 3, or 5 completed as appropriate
4 (Failure Criteria) and 6 (Checklist) completed
® D. System Information:
For 8: Tight/Holding Tank—Pumping contract attached
For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached
For 15: Explanation of estimated depth to high groundwater included
Grade
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t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18
TOWN OF BARNSTABLE
LOCATION �c��. SEWAGE# �r
VILLAGE� ,�� ��;e\l>� ASSESSOR'S
�MMAP&PARCEL Q
�41 VR NAME&PHONE NO.*V--<B-b--Qp
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SEPTIC TANK CAPACITY \Q(Z) \QqCp
LEACHING FACILITY: e L �'
(� ) c�� �%=\c� (size)
NO.OF BEDROOMS
OWNER V��✓� �t"OSS�N�b �,
PERMIT DATE: l COMPLIANCE DATE: Qzx�:,�(
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility S 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) J Feet
FURNISHED BY \ .r��V �
� Y L
Lk
SUBSURFACE SEWAGE DISPOSAL SYSTEM^INSPECTION .FORM
Address of property Lok C.
Owner's name
Date of Inspection "
3 - r�_ qs
PART A
CHECKLIST
Check if the following have been done:
f-�Ipumping information was requested of the owner, occupant, and Board of
Health.
None of the system components have been pumped for at least two weeks
and the system has been receiving normal flow rates during that
period. Large volumes of water have not been introduced into the
system recently or as part of this inspection.
As built plans have been obtained and examined. Note if they are not
available with N/A.
J
The facility or dwelling was inspected for signs of sewage back-up.
The site was inspected for signs 'of. breakout.
All system components',., excluding the SAS, have been .located on the
site.
The septic tank manholes were uncovered, opened, and the interior of
the septic tank was inspected for condition of baffles' or tees,
material of construction, dimensions, depth of liquid, depth of
sludge, depth of scum.
The size and location of the SAS on the site has been determined based
on existing information or approximated by non-intrusive methods.
C.,"The facility owner (and occupants, if different from owner) were
provided with information on the proper maintenance "of SSDS.
y
1
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART .B
SYSTEM INFORMATION
FLOW CONDITIONS
If residential
_ number of bedrooms
9-- number of current residents
garbage grinder, yes or
laundry connected to system, yes or no
seasonal use, yes or no
If nonresidential, calculated flow:
Water meter readings, if available:
6c'u (e Last date of occupancy
GENERAL INFORMATION
Pumping records and sqiiXcd of. in�rmatio: '
System pumped as part of inspection, yes or no
if yes, volume pumped
Reason for pumping:
Type of system Septic tank/distribution .box/soil absorption system
Single cesspool
Overflow cesspool
Privy
J� Shared system (yes or no) (if yes, attach previous inspection
records, if any) "
Other (explain)
Approximate age of all components. Date installed, if known. Source of
information:
IUD Sewage odors detected when arriving at the site, yes or no
J
f
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
SYSTEM INFORMATION continued
SEPTIC TANK: /
(locate on site plan)
depth below grade:_
material of construction:
(-�concrete metal FRP other(explain)
dimensions:
sludge depth
/` distance from top of sludge to bottom of outlet tee or baffle
a- i/1scum thickness
distance from top of scum to top of outlet tee or baffle
G distance from bottom of scum to bottom of outleL tee or baffle
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffles,
depth of liquid level in relation to outlet invert, structural integrity,
evidence of leakage, recommendations for repai s, tc. )
GIJa .e�COeL4 / [-
\
Aa
t'.
DISTRIBUTION BOX: -
(locate on site plan)
depth of liquid level above outlet invert
Comments:
.(note if level and distribution is equal, evidence of solids carryover,
eyden e f leakag or put of box, re ommendation o r airs, eta
P
//
PUMP CHAMBER'
(locate on site p )
pumps in working der, yes or no
Comments:
(note condition of pump chamber_co- iron of+pumps aid appurtenances,
recommendations for m eTrance or repai etc. )
It
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
SYSTEM INFORMATION continued
SOIL ABSORPTION SYSTEM (SAS) : C�
(locate on site plan, if possible; excavation not required, but may be
approximated by non-intrusive methods)
If not determined to be present, explain:
Type..
leaching pits and number _ -�Ub ad L,aar'l oa:rz
leaching chambers and number
leaching galleries and number
leaching trenches, number, length
leaching fields, number, dimensions
overflow cesspool , number
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding,
condition of vegetatio recommejidations formSintenance or repairs,etc. )
CESSPOOLS (locate on--ai\te plan) :
number and configuration �-
depth-top of liquid to inlet inve
depth of solids layer
depth of scum layer
dimensions of cesspool
materials of construction
indication of groundwater
inflow (cesspool m e pumped as
part of inspection)
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding,
condition of vegetat'on, recommendations for maint Hance or re airs,etC. )
- --- a,
PRIVY:
(locate on site plan)
materials of construction
dimensions
depth of solids
Comments: r
(note condition of soil, signs of hydraulic failure, level of ponding,
condition of vegetation, recommendations for maintenance or repairs,etc. ) .
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION TORM
PART B
SYSTEM INFORMATION continued
SKETCH OF SEWAGE i :SPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100 '
F Ro ti -�-
A A
3 .
o c-
o
�s
-. - 34
DEPTH TO GROUNDWATER
depth to groundwater y
method of dete ination or approximation:
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
FAILURE CRITERIA
Indicate yes, no, or not determined (Y, N, or ND) . Describe basis of
determination in all instances. If "not determined" , explain why not)
l Backup of sewage into facility? (Jc.� � I �- ,.t-
/Vo Discharge or ponding of ceffluent to the, surface. of the ground or
surface waters? U✓L - �
Static liquid level in the distribution box above outlet invert?
/yD Liquid depth in cesspool <6" bel w invert` or available volume< 1/2 da
flow?
vci�
d Required pumping 4 times or more in the last year?
number of times pumped
1
Septic tank is metal? cracked? structurally unsound? substantial
infiltration? substantial exfiltration? tank failure imminent?
Is any portion of the- SAS; cesspool or privy:
O below the high groundwater elevation? US G S MAP �
/y within 50 feet of a surface water?
within 100 feet of a surface water supply or tributary to a surface
water supply?
within a Zone I of a public well?
1"y within 50 feet of a bordering vegetated wetland or, salt marsh-
(cesspools and privies only, not the SAS) ? .
within 50 feet of a private .water supply well?
less than 100. feet but greater than 50 feet from a private .water
supply well with no acceptable water quality analysis? If the -well
has"-been analyzed to be acceptable,- attach copy of well water ana- J
for 'coliform bacteria, volatile organic compounds, ammonia -nitrog
and nitrate nitrogen.
r
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART D
CERTIFICATION
Name of Inspector _ 4v � -
Company Name 9
�,✓l �,►-L. Sn S%�%�
n
Company Address -�J S aX�Z vC � lJ, �' `3 U
Certification Statement
I- certify that I have personally inspected the sewage disposal system at
this address and that the information reported is true, accurate and
complete as of the time of inspection. The inspection was performed and
any recommendations regarding upgrade, maintenance and repair are
consistent with my training and experience in the proper function and
manitenance of on-site sewage disposal systems.
Check_ne:
C/I have not found any information which indicates that the system fails
to adequately protect public health or the environment as defined in
310 CMR 15. 303 . Any failure criteria not evaluated are as stated in
the FAILURE CRITERIA section of this form.
I have determined that the system failshto protect public health and
the environment as defined in 310 CMR 15.303 . The basis for this
determination is provided -in the FAILURE CRITERIA section of this
form.
Inspector's Signature
* 9__111
Date .9 2 ,/ 00.E
Original to system owner
Copies to: -
Buyer (if applicable)
Approving authority
/ TOWN OF BARNSTABLE
LOCATION kv1
VILLAGE ('�'e VIAC Irv' ,�4C <ASSESSOR'S MAP 6z LOT 3�
j, INSTALLER'S NAME,& PHONE NO. F �yS La� l S GG
SEPTIC TANK CAPACITY I Soo
LEACHING FACILITY:(type) (size) Ll X(o
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER ^D.L,\;
BUILDER OR OWNER
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
ao
r �
TOWN OF BARNSTABLE
ATION i COVA. Q�. SEWAGE #OiQOy'
L..p,GE ce4ror/,16, ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY a " t C
LEACHING FACILITY: (type) P/, J
/` (size) a'l X 3 4
NO. OF BEDROOMS -
j BUILDER OR OWNER �JA<f�hAN1
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leachi g facility) .
itu% 3 C Co
Feet
Furnished by ,� ore
3 a '
y � o
13� ao
aa� iy
y a� 11
•�' 3261 Mai!;Street
Route 6A
Barnstable Village MA
02630
S C
December 31, 1986 The BSC-Group
Board of Health 617 362 8133
Town Hall
367 Main Street
Hyannis, MA 02601
Re: Septic System Construction
Lot 6, Cove Island Road
Centerville
Job # 03 .1407 .03
Members of the Board:
This letter is - to inform you that the septic system at the above
referenced location was inspected on December 8, 1986 and
December 31, 1986; and has been constructed in compliance with
the plan.
If there are any questions or comments, please do not hesitate
to contact this office.
Very truly yours,
Engineers
Surveyors Stephen A. Wilson, P.E.
Scientists Project Engineer
Architects
Landscape ce: F.E . Mogan
Architectsg
Planners
4SAW10/amc
Cape Cod SurveyConsultants
71,q
No.....................�... F .ps.... _r�........
I THE COMMONWEALTH OF MASSACHUSETTS
-BOAR® OF HEALTH
%-0--W..Q...............oF.. �5.'T ...........................
Appliration for Dhip .oal Workii Tnnitrurtion Frrutit
Application is hereby made for a Permit to Construct X) +or Repair ( ) an Individual Sewage Disposal
System at:
... ........�:�. ........ -. -----------
-.........
------------
--- -----------------•--•-•------------------
......... .......
......cation•Address
y�J _ _ —or Lot No.
W Address
-----------•--- -----
I s a ler Address
Type of Building Size Lot4 3i1Jb q.�,"!..Sq. feet
Dwelling—No. of Bedrooms._.�•--------------••-•--•--•---__--_--•Expansion Attic ( ) Garbage Grinder
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Other fixtures
Design Flow........... .................... allons per erso er day. Total daily dow---__
W g P P $ It ! � 3-3-0.. lons.t
WSeptic Tank—Liquid capacit . _gallons �.engt s.... WidthDiameter--------------- De th %- F ..
••-- Width ?�
x Disposal Trench—No.�?�) Total Length-_�• ........... Total leaching area_ Q.......sq. ft.
3 Seepage Pit No._.._•... .........•• Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
`-' Percolation Test Results Performed by-t �g f�Oe' ...: _Ar- Date.
Test Pit No. 1......�-___.minutes per inch Depth of Test Pit.___-r....______ Depth to ground water__►-5O.T ^04
44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........
a .......................... •-•-•• ''
----
--------•.gin' d.
0 1 , , ten . ...H,
Description of So>1-� ... -!'- - 6.0-- ' YFA13 Cep t>
-- ? ---`- � - �--- �L------- y ?I® 9A—
�`J D T�? n; ` °4�cz _'
-� 2a
W -•--•-----------•--•-•-------------•-•--•--•--...---•-
----
V Nature of a airs or Alterations—Ana• when applicable
2J' -TAN . - ••-
••---• •-
rIN �2.c wtGa a �.avt'� .
�4
Agreement: 1 Nr' c. Z crl-
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System ' ordance wi
the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees of to ace the system n
2±op rati until a Certificate of ComplianC�� d by the bo• d o a t .
�y
SiIned ...... • --•- --.....----•--- -•---••-•-•-•_. v
M ---••--• ................•••--
PPlication Approved BY.................................................... at2 �G--
�Date
Application Disapproved for the following reasons:--•------•••---•-•••------•---•------•--••.............•-----------••-• ........................................
..........................=.............•............._.••-••••..........................................--••••••-•---•••---•---.........•••---.........•------•--••••-•••-----....•---_...----••-•-•---
Date
PermitNo. ... .........=�----.... Issued.......................................................
Date
plan ►' z ?
= C ' • r
�--- a �- a
Nock-°.--:-.......'— FRs.............................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
. ...............OF. .1..1. ;- 15_L -_...-.-.---_-------------•
Appliration for Dhip sal Workii Tjau.� xurtiun jJamit
Application is hereby made for a Permit to Construct ]� ) or Repair ( ) an Individual Sewage Disposal
System t1at: ,
..............1�.�.5.�/ ....... .-----------.....---...-•-------•-.. .........---.....................•--•••..... ....---••••-•-••-••---......-•-•-•-••-----
ocation-Address .........................................
or-Lot No.
.u. . �. ......... .
�'_0!�drl!`:. �t. ................
Installer Address
Type of Building Size Low �.....Sq. feet U
�., Dwelling—No. of Bedrooms___....................................Expansion Attic ( ) Garbage Grinder (y
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Q' Other fixtures .....................................................
W Design Flow= ........IS .....................gallons per pers i per . y. Total .ailly low-----ISO....................... lonst
WSeptic Tank—Liquid capacit gallons engtlfj...f ___._ Wit iII-...._ Diameter________________ De � --
x Disposal Trench—No.Q. ...... Width...'r.__._....... Total Length. t ........... Total leaching area. __._._....sq. ft.
Seepage Pit No---------------_---- Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. tt.
Z Other Distribution box ( ) Dosing tank )
'-' Percolation Test Results Performed by "Depth'
,. y' .� _ Date_. . ._6��..........
a -./
Test Pit No. 1__....�a____minutes per inchof Test Pit___ Z.......... Depth to ground water..& _
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water......... �� `�Fk� t�Fln4Aq
...................•----• ..................... ....................__................_............_.....___._._.._ ...... F
O ♦t �w of �7�5e+� RbGER .y
Description of SoiL0-_-`"'. _...._...�-,. _.. .3 ..._.._.16. _ 430- _ ...•. ...._..�i_'y r
----•---------------------------------------•-------•---•------------------••--------------- -------------- -:•-------- ---------...------..................._•........... a' . I
- i3
Nature of Repairs or Alterations—Answer when applicable /�)il.J6 .....!
1
Agreement V /�"
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System i . cordanc
the provisions of iiTg, 5 of the State Sanitary Code—The undersigned further agrees t to place the sy em in
op rati n until a Certificate of Complia ei the bo- d of i
Signed �7•-
'c'^_'.'.._ ate
tio1> nPPca Approved By...................................................... ---'--�--`-- " -_ _ -•-----•----
— ...........
Date
Application Disapproved for the following reasons--------------------------------------------------------------Z................................................
•-••-•---...-••--------•---...•••----------------------•••••----------•••-•---•-•............••-•-----•••-•••••-•`•--•--•-•---......................... .........................................
Date
Permit No.---------- -= - .14.2 Issued
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.............. Nt*.1 .O F..........�i,.-�` r2 N�f"o`t•B�.
...... ............. .............................
...................................
Trrtifirate of Tomptiaurr
THIS IS-TO CERTIFY.That the Individual Sewage Disposal System constructed ( �-- or Repaired ( )
by... .......--- -•....--
l r Installer_
has been installed in accordance with the provisions of "'1T j of Tile State Sanitary Code as de•cribed in the
application for Disposai Works Construction Permit No........................_.. dated-------/_l_.� —-------------------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTIO S TI�j ACTORY. r
2 v� A4
DATE..._.,.• .... Inspector...........f -------------------------------------------•------------•--•-•----.
THE COMMONWEALTH OF MASSACHUSETTSNI(`��
tiG
-_ -^ BOARD OF {HEALTH
� � JOF rCT6.'T u : Ur_ i/;i.7'
.....................1 1-.
.......? C Csy
FEE........................
� �r5 M 1 S t )v-'�-r/V �3
iiiposa1 orkii Twniitr ion amii r<, 4
Permission is hereby granted................ iv C�.......-••--1....v..... g`�.............................................✓a N
..........................
to Construct ( 'l��Repair ( ) an Individual Sewage Disposal System
W.
Svc.
Street _ f
as shown on the application for Disposal Works Construction Permit Dated... =� �• :.i..`''......
__
Board of Health
DATE Z S 6......-- -
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS -
TOWN OF BARNSTABLE ��
.LOCATION _ yU �, SEWAGE #
VILLAGE ASSESSOR'S MAP & LOT/ 4- p
INSTALLER'S-NAME & PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type)_��'r� (size)T j--
a
NO. OF BEDROOMS. PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER
DATE PERMIT ISSUED: .,• c
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
,�, t,
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Lp g D lT�o�►e0• ,n a1 , .1\�
0 �
l •�4 �p� i y Iz-
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4
61 \4
n
N 53 0 .� 3o •C .
•� r�
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TOWN OF BARNSTABLE ZONING
OF Mq �- o� BY-LAWS DATED JAN 23 1985
��9�y�s R4. ��� N w �, ZONE: RD- 1
0 0
FRq.Ni(
WHI Tll G b _ o SETBACKS
�'. o
po No. 2036s FRONT 30'
s 9�)ISTf5���
s SIDE 10'
\ REAR 10'
d
PROPERTY LINES SHOWN HEREON WERE COMPILED
FROM PLANS OF RECORD AND DO NOT REPRESENT PROJECT NO. 3-007-01
AN ACTUAL SURVEY ON THE GROUND.
THE STRUCTURE DEPICTED ON THIS PLAN WAS LOCATED PLOT PLAN
ON THE GROUND BY SURVEY ON JULY 11 1986 in
AND EXISTS AS SHOWN AS OF THE DATE OF LOCATION. BARNSTABLE MASS .
THIS PLAN IS FOR PLOT PLAN PURPOSES ONLY AND SCALE: 1" - 40' JULY 14 19B6
SHOULD NOT BE,USED FOR NY OTHER PURPOSE.
BSC / CAPE COD SURVEY CONSULTANTS
-7 1¢ �� / 3261 MAIN STREET
DATE PROFESSIONAL LAND SURVEYOR BARNSTABLE VILLAGE, MA. 02630 (617) 362-8133
.h
IrF #'l : PERC TEST APPLICATION NO. .a-2 n�. REVISIONS:
TEST PIT DATA DATE o,� rEsriNc _r,9��% _ � , 'ERA` TEST CAA DATA : SEPTIC TANK DET. / . s;zE- / GAL. D/ST. BOX DETAIL : LEACHING E ,"'IL /TY DETAIL: NO. DATE
TEST BY _� C ®.�'7A1 — - --- --- - y�{Il �vtS� tL� 5r~tic.
T P r DATE OF TESTING __— _f - $i—__ — TANK TO CONFORM TO TITLE 5 REOU/REMENTS. TO CONFORM TO TITLE 5 REOU/REMENTS i �-r I(� `7
-rE r f T f WITNESSED BY E fret -54 cam?------- •�C�Y f rr1 �
T>~s r �Tz TEST BY., --�Y X,- -�,. .vy _ tlr _._ NO. OF OUTLETS r - -----
��,, M.N. dNa covF -ro ,e�a�
--- -- - �,a- --- WI TNESSED BY: �� ..,' - _ ���i1,., [� a --- - ------ � ,� .,a� �� ; _ 2- s�`�/ �s Revise EPT 1 L s`fsTtr
- --- - --- -- O. TOPU - J r r �i7 T;` i /�/ �/ - �� y �� �� � � EMOVEABL E COVER
EL 3 • /2 _ MANHOLE BROUGHT TO _ I ,1 rRECAsr
:.. ......:.. J FIN/SH GRADE. W► T .. . .. ,. r �. P S'm�J 6 ^ cGNC_ j21 S f R _
3 CLEAR . 3 CLE�R� OUTLET PIPES e r�- 1' o . G;1
2% t �S`!' COA $ ND DEPTH OF TEST: 6"MIN—�-3 M/N 6"MIN. " AS REOUIRED � bt 0 1 � Tz- r
p -- --- -
S' RA rE• INLE, DISr. r.
--- - -- - -- �� L' [1_ 11� 1? _ /O"MIN. i i. i , I
INLET TEE --- OUTLET TEE o �� i / . I t BOX. 4' r I
- __�- ___ __ .� ._ - /5CO `
�L 33.4 _ ._ UT E DEPTN '' � . . GAL..
INLET AND OUTLET 4' 0" MINIM"M 0 LET TE I SEPTIC TANK 1 PR'ECAsr OiC [ --
�k Z TEES TO BE CAST L IOUID OEP:"H /4"AT LIOUID DEPTH OF 4" 0 2 6
- - ----- -- .— — — ----- ----- n 'r /9 5' r; /" `.. CONCRETE 1 SEE"T'AfrC P►r µ • t
DEPTH OF TEST `3� _ �`� /RON, SCHED. 40 ; „
- -� PVC. OR CAST IN 24" 6' • CONSTRUCTION '} , o • t
RA TE: G 7�.._ f'A f�d/ �Z4 ETA L .;A PLACE CONCRETE I : 29" " " " 7 —
.E,p; M bII✓f sN CONCRETE n 34 B' BOTTOM ON LEVEL STABLEBASE f
_-- _ --- __� ------ CONSTRUL TION
N A OQ T� T' (WATERTIGHT/ P [
Tj,q T� D F T 5 7 t NGj- G, 3 ,,••,, z ,. e. INLET TEE PROVIDED WHERE SLOPE FOUNDATION - - -
' .' t_. •'' •` o r +- OF INL E r PIPE EXCEEDS O.OB %-0R I
1. _ .
CaA SA, I N F RMA rAt.1 — '' - ''�! TANK TO BEABLE TO W/THSTANO
� "a T �' C A PL- C_U b S u jC V 6'f A io.i BOTTOM OF TANK ON LEVEL STAB..E BASE H-/0 LOADING UNLESS UNDE!? /2 WASNt D roNE
Y: _ l PAVEMENT OR IN DRIVE. H-2,0
IS �� W ►�N .�-S i �' TG M M ly1 LOAD/NG UNDER PAVEMENTOR
-- ORI VE.
NO TES 5 ti - � �. -/ VER T EL E VA TONS:
LAN VIEW
I. THIS PLAN/S FOR THE DESIGN AND CONSTRUCT/ON OF THE SEWAGE
DISPOSAL FACILITY ONLY. SCALE : ✓ _
r % I V . S OF
AT BUILDING
2. ALL CONSTRUCT/ON METHODS AND MATERIALS SHALL 091VFORM TO � \ ti _INV. AT SEPTIC TANK(IN) _ Z g �J �ai� �� SrCPH N �
MASS. D.E.O.E. TITLE 5 AND THE \ /-
HEALTH REGULATIONS. Wit'` --- ----- BOARD OF � _
EGUL TIONS. ray 4k �T a� .vr�
,'N V. A T SEPTIC TANK(Gi1T) _Z�._�� �� / ,«
�t� i Yeti«F1;�IG „•�,, Ers
: 4 Nu. 298691a H NO 34 [5 d
3. IN FRONT OF HOUSE FINISH GRADE TO SLOPE Ai'f�WH, /.�r ' 1 ° ;� •a�o'A�GIST�Pfs
LEAST 314 FOR 15' \ , r �� {, ,g, Fr`,^HAXA
IN V. AT DIST. BOX(/N) Z g c s ... i
� ' 1 \ -INV. AT DIST BOVOUTl 2 . ` .z C �•^ /� c vi c.-
4. DRIVEWAY TO PITCH TOWARDS STREET FOR THE /RST t
/O ' FROM BUILDING.
$UTrcm 0� LEAcwW4
7, � ?r'%nlr" _;s//94L /3f. c: ^1.5`T /,Kc'c1A,✓ 4c,' .�C j t/' 't/tg
L 7E-Ty 0AJ rye 7R..,A Ve f_!_E•U v/,�A
(Bf se t) ON MAx I�tj,(A
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loo
, , \ , \ , , �, \� �ilvla & Silvia
, / w, �� 1 1 1 1� t \� N.�LOW: SSG 11C.
1
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�' ' r �, I ! °, I ` f 4 1 r r� `' - -- - - -- -- -- - - — - G19 Main Street �J_1 -� 2
w/G7 aT.{7
r '' rr' / l o >°x 1 l r '� `� 1 _ Centerville, NIA
I'MREQUIRED SEPTIC TANK
I , / ,'?•.9 /. } am^. „ C' 7 f 1. 1 1 1 , , �jk 1 - \\ y` / = '
1 �w � � ti `r .� o x •z o c� �Q %�� Q _ GAL.
w 1 7 SEPTIC TANK PROVIDED = 1 ' C3 t� GAL. CAPE COD SURVEY
,,. SLY-T L TA&jK —� LTA
CONS NTS
�� ro � )° ,� ,, 4 REOVIRED SIZE LEACHING FACILITY: in treat Route 6A
�- .-.T� -...�� � �l � �` � -r'lT !' s-ronlc - -- ---- Ma
-- _ 3261 S
I{ ,�v ; ' / �, [ A.. 5ta� Barnstable Village, MassaG"�usetts C2630
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_Q Number: 617 62-8133
kkK A - - DIVISION OF
( / ( EVE 3 _ �� !f r ( \ \� 4• \, '� .', 5 '� ` 1 ��;IN £?9 BOSTON SURVEY CONSULTANTS INC.
\ ` "„•,- \ `` \ \ \ \ � �. ` �` k �•.y �L �,,'� � � SIZE OF LEACHING FACIL/rY PROVIDED: _,ENGINEERING • SURVEYING PLANNING
" r _ - 1�0 �` \\ \ \ \ �`` �' "" p TYPE OF SYSTEM: z,5AcEJ/Nq PIT
r �� _, -- - - TITLE:
`
i .• I I ro F �: - 4 �, ,, \ \ \ 51bCUJALLS 161 x 2.5
- 40� �. D_
— SEWAGE DISPOSAL SYSTEM
i - , -- _,_. _. -------- -= _..__-- - ___ ;_� a �L i I � �� ~ � �\\\��\ � ``�„_ +�\ `` ``°` � � •��`8 �� ... $y?Tp11«t, �.- i 5¢
_ _ , -- _ - DESIGN
-LOT 6
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METERS
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DATE: i/4/fry
COMP./DESIGN: A
CHECK: P
DA TUM' DRAWN:
FIELD: t�,,L_CP / t x-P
FILE NO:
DWG. NO: 82 9 JOB NO: 03
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