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HomeMy WebLinkAbout0018 CYRUS DRIVE - Health 18 Cyrus Drive Centerville A= 172-147 S M E A D No.2-153LOR UPC 1Z534 smaad c m • *a&In Ysn AM). Vw mmoommam OIFI ��maawaa Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 18 Cyrus Drive Property Address Bart V. Kuimjian Owner Owner's Name Name wqy information is required for every Centerville _ MA 0263_2 3/31/15 _y page. City/Town State Zip Code Date of Inspection Ian �1 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 filling out forms A. General Information � on the computer, use only the tab 1. Inspector: key to move your cursor-do not Michael DiBuono use the return key. Name of Inspector DiBuono Sewer and Drain Company Name 8 Johns path Company Address �w S Yarmouth MA 02664 Cityrrown State Zip Code 508-364-9587 S113522 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-lay-the Local A ing Authority rt� 3/31/15 -inspector's is 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. t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 . Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 18 Cyrus Drive Property Address Bart V. Kuimjian Owner Owner's Name information is required for every Centerville MA 02632 3/31/15 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The system contains a 1,000 gallon tank as well as a concrete Distribution box. All tees and baffles are in place. The Distribution box is level and at normal level. The leaching is made up of two 500 gallon leaching chambers. System is leaching properly and shows no signs of failure. B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. , Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 18 Cyrus Drive Property Address Bart V. Kuimjian Owner Owner's Name information is required for every Centerville MA 02632 3/31/15 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ 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 W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 18 Cyrus Drive Property Address Bart V. Kuimjian Owner Owner's Name information is Centerville MA 02632 3/31/15 required for every _ 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 coliforrh 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 1/2 day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 18 Cyrus Drive Property Address Bart V. Kuimjian Owner Owner's Name information is required for every Centerville MA 02632 3/31/15 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. El ® 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° 18 Cyrus Drive M Property Address Bart V. Kuimjian Owner Owner's Name information is required for every Centerville MA 02632 3/31/15 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® 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 (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 . Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° 18 Cyrus Drive M Property Address Bart V. Kuimjian Owner Owner's Name information is required for every Centerville MA 02632 3/31/15 page. City/Town State Zip Code Date of Inspection D. System Information Description: The system contains a 1,000 gallon tank as well as a concrete Distribution box. All tees and baffles are in place. The Distribution box is level and at normal level. The leaching is made up of two 500 gallon leaching chambers. System is leaching properly and shows no signs of failure: Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No 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 2013 51,000 g ( y g (gp )) 2014 36,000 Detail: 119.5 GPD Sump pump? ❑ Yes ® No Last date of occupancy: OccupiedDate Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available:. t5ins-3/13 Title 5 Official Inspection Form.Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 18 Cyrus Drive Property Address Bart V. Kuimjian Owner Owner's Name information is Centerville MA 02632 3/31/15 required for every 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: 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 _ Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 18 Cyrus Drive Property Address Bart V. Kuimjian Owner Owner's Name information is required for every Centerville MA 02632 3/31/15 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: 3 years Were sewage odors detected when arriving at the site? ❑ Yes ❑ No Building Sewer(locate on site plan): Depth below grade: 18 s 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.): System is vented throught the roof Septic Tank (locate on site plan): Depth below grade: 1 ft feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 1,000 gallon If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 Gallon Sludge depth: 3"s t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 18 Cyrus Drive Property Address Bart V. Kuimjian Owner Owner's Name information is required for every Centerville MA 02632 3/31/15 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 24"s Scum thickness 3"s � Distance from top of scum to top of outlet tee or baffle 42 s Distance from bottom of scum to bottom of outlet tee or baffle "Sludge stick How were dimensions determined? Tape Measure Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): No pumping recommended at time of inspection. Grease Trap (locate on site plan): Depth below grade: NA 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 18 Cyrus Drive Property Address Bart V. Kuimjian Owner Owner's Name information is required for every Centerville MA 02632 3/31/15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tees are in place and levels are normal. 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 W Title 5 Official Inspection Form, Subsurface Sewage Disposal System Form - Not for Voluntary Assessments . 18 Cyrus Drive Property Address Bart V. Kuimjian Owner Owner's Name information is required for every Centerville MA 02632 3/31/15 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 At Normal Level 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.): Distribution Box is level and at normal level with no signs of carry over or decay. 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: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 18 Cyrus Drive H Property Address Bart V. Kuimjian Owner Owner's Name information is required for every Centerville MA 02632 3/31/15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 2-500 Gallon ❑ 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.): No signs of carry over. no signs of hydrualic failure a 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 18 Cyrus Drive Property Address Bart V. Kuimjian Owner Owner's Name information is required for every Centerville MA 02632 3/31/15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): No signs of ponding or hydrualic failure. 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.): 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 ^M 18.Cyrus Drive Property Address Bart V. Kuimjian Owner Owner's Name information is required for every Centerville MA 02632 3/31/15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within.100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t5ins•3l13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 313012015 Assessing As-Built Cards TOWN OFBARNSTABLE LOCATION g' -�. L.Lf- `�5� , SEWAGE# i VII,LAGE L��Lt�-��^ ASSESSOR'S MAP&PARCEL 17-i• i_ 4l— INSTALLER'S NAME&PHONE N,0 .�?ti::cc tv�t"1 t .;t; �-qx l SEPTIC TANK CAPACITY (aoG !gj &-un--t►kf r / r r LEACHING FACILITY:(type) "t e2Lfi(C-14— (size) finer q 1C� NO.OF BEDROOMS y' �- Sco.la�-t_ C.►I�k:�(} 1Z( OWNER PERMIT DATE: I(- Imo_ COMPLIANCE DATE: ` Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility -4- 4 Feet Private Water Supply Well and Leaching Facility Of any wells,exist on site or within 200 feet of leaching facility) _tA� Feet Edge of Wetland and Leaching Facility Of any wedands exist within / 300 feet of leaching facility) / r`�Feet FURNISHED BY jr sG I�� f R 36' a ' I Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 18 Cyrus Drive Property Address Bart V. Kuimjian Owner Owners Name information is required for every Centerville MA 02632 3/31/15 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: 10+ft 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: 4/9/12 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: Test hole data on plan dated 4/9/12 shows NGE at 10+ft Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 18 Cyrus Drive M Property Address Bart V. Kuimjian Owner Owners Name information is required for every Centerville MA 02632 3/31/15 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 Form:Subsurface Sewage Disposal System•Page 17 of 17 No. 90 12-Oy Fee (t/V THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 0(pplication for -Misposar *pstrm Construction permit Application for a Permit to Construct( ) Repair(11�Upgrade( ) Abandon( ) ❑Complete System Individual Components Location Address or Lot No. j C�ra; �f' C 47krul fle Owner's Name,Address,and Tel.No. Assessor's Map/Parcel / /S/^f Con erukv t`I IQstaljer,'s�yame Address,a d Tel No. Jr'o$' — D signer's arr. Address,and Tel.No. SOS �°o') ">n'Xne. �(S3'r�uSky �1 i» r.` off+ mik o at0�! o s Type of Building: Dwelling No.of Bedrooms 3 Lot Size dsy 4 i 9 sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) `��[} gpd Design flow provided J No gpd Plan Date l a Number of sheets •l Revises Date Title � Size of Septic Tank g(„Sk ng ] � j QOC3Cj� Type of S.A.S. � �yp�Q /4-'to y 0 � y�Ahn n n 1 Description of Soil QSao as r Nature of Repairs or Alterations(Answer when applicable 410 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 Environme Cod and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Healt / s Signed Date Application Approved by Date f 7-Q-, Application Disapproved by Date for the following reasons Permit No. d`� Date Issued f{ •No. UU / i r Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 2pplication fo `Dispo_sal 6pstetn Construction Permit Application for a Permit to Construct( ) Repair( Upgrade( ) Abandon( ) ❑Complete System Individual Components Location Address or Lot No. j Cy rZ;s Zr r , C��n�`,j�e Owner's Name,Address,and Tel.No. S'as- Spa Tr -4//Ft Caor-� 1��►nrLj i a ra -1 Fi�r�.��'�✓•e Assessor's Map/Parcel / /117 Cxn iert t ip AA 4y Installer's Name,Address,and Tel.No. 5408- YJ18• Ef ciaC. Designer's Name,Address,and Tel.No. .508 - S15yl �S'�ruc�d'on,.Tr>c. ysgncluS�ty � ,c�Cz�n i�r-.' r7•� r139i�i.�Sf- i g rs A, U ljk�(a vii Type of Building: - Dwelling No.of Bedrooms 3 Lot Size 1 J Os 9 sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) ' Other Fixtures Design Flow(min.required) .33() gpd Design flow provided—3 gpd Plan Date t1nn4 �1 .,�?bl Number of sheets Revision Date Title ,y J�� �1 Get�e P�#M 61 �`t� &L�, A dQA I . Size of Septic Tank �XiS� n9 d nc�t�c��.0 Type of S.A.S. �v��o,L7 ��-lU �a�r�C, 1 , i Description of Soil 52o I Nature of Repairs or Alterations(Answer when applicable) y n. ,D te) A,' ga � kin 9'Y!e l �r0� j .. i Date last inspected: r' Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-sites age disposal system in I accordance with the provisions of Title 5 of the Environme tail Cod and not to place the system in operation until aCdrrtificate,of__. Compliance has been issued by this Board of Health Signed '-� � Date Application Approved by Date ��- I Application Disapproved by Date i for the following reasons Permit No. Date Issued "{ f 0— THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(41-1/) Upgraded( ) Abandoned( )by at I sC_vrueS 1 ill ' don i• rt)d le has been constructed in accordance with the of Title 5 and the for Disposal System Construction Permit No.0?01d 10f1 dated �"- Installer &(-4-rAot l ( ` nsh r41,10t'1 JDC Designer 11 ,y s,r7,1M #bedrooms Approved design flow gpd 'p The issuance of this permit shall not be coo strued as a guarantee that the system will�fu ct d signed. Date / Inspector._ 1.� . - No. 0 f Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS n Disposal *pstem Construction j3ermit Permission is hereby granted to Construct( ) Repair ) Upgrade( ) Abandon( ) System located at ! t�( rt)S ax) I P 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 must be completed within three years of the date of this permit} " Date •— / 7] Approved by i MAY-02-2012 11:27 From:BDRTOLOTTI CONST 5084289399 To:15087906304 P.1/1 FROM :dawn Cape engineering inc FRX-NO. :150836291e0 May. 02 2012 11:22AM P1 �a ~ 3 �� .'.-�. �l �IJU�CAktf�'. QritllkZ4'l'r itllt'C�Y19,' NANO+ fS W9�� T, � nnhtic 7e nith �PiivJ si ►zi "r'hc' N,-Kaian, ]lDarovlaA 200wwlahl lqt-erkl., "Y:OnnW,r0.b.(O"IPlll Of5r,n: 5t1$•VD-464 1'tix: 5U�-i'Jl1•'i��lrl 7.�fit«l1��4i,�Cp�RD�ae�r(:erfi�t4.es��ieam �'�utrrtn Onto: ��� l3rwfa��Fa»littl �OId —01� Awbvn4Or'fi PAsjt1R'%r�cl U?a:Opkcr: (60► r 0'1►'ztrt 1lls8ta1lIQir: P/0 t (, 111.01�K6I1 u`, I`7J 1, 7l- 11 _(�e,1.1M'NM,istg L d=1 permit tQ hontall.B:r) lllgtli eT /" '� ac�,tl�c �+,;tcu�rit � b(.d D'"r ✓e ., uCisCii oi�,a rewl;�i d-�wn by T rwru-'y tltict t e 9P.MJr, 9,3,,1,en -efts°enu.,d ubov� 'wus mr-alleri nai,�,�tsla'ac11y accoxrel�Dff,to th.a design, wldch way ir,clude miner aprffnved chnngcst uante u lmml -elowaua of The dinribuii.cm bux Rurllol;iefr6c.tank. _ 1 ae Ory Cud the septic rygtcm mFerviccd abuvc, was ii:btlglled with rns.jor chraig,s �5it;ATP1'tbAP. 10' lubm-al rdjOrarion Gf the SAS or arty vemcul r�lGtrti4St o��v;.nt�lFt�tnct�r :s'Ft}tt:SVPtV,Mfr.t;t)b'ELI in acuurc ulw wit1,i S.11C A.,Local ReK lutious, P1813 rcvi9ic-,n (.,.r .,erNFV.',I cu•built'b^q de^i,w,ner m fnlli)w. OOOA CIF At4 DANIEL M1 U.1ALA (Trsytatll.xt�;athTr>r} CIVIL Nol40502 a ` . )7w (n,u .iP.M.L'$ +� 1?Y}7HGlI�J1C1'7 IErlly 7SdP+5� A' r5NRTAuwc VU24 TflS7JKD UNTIL W'>U��� Z�rt�werik ;awD A$-ALV,'.t' t:.�)) .AR HEALTH DtVISIPN. '-An}, INYell!; e1 II��Ifhl"MmlirJl7+u,r.��M(Xr91$rnlimFumi a 2644.dru I TOWN OF BARNSTABLE LOCATION 1 9- SEWAGE# DSO i VILLAGE r� L-%Z-Q1LL(— ASSESSOR'S MAP&PARCEL r%,5-• r"*7 ;r INSTALLER'S NAME&PHONE !} SEPTIC TANK CAPACITY I&CO 4/*L Is 1-1 ".C-A r LEACHING FACILITY:(type) _��C— (size) 364 4 NO.OF BEDROOMS /4:�S*L- C &1. OWNER �6 PERMIT DATE: • i!- Imo_ COMPLIANCE DATE: Separation Distance Between the: n 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) iC Feet Edge of Wetland and Leaching Facility,(If any wetlands exist within 300 feet of leaching facility) 1q1aA-- Feet FURNISHED BY VGwJ Ln�r L�i9rl .•s rlr — AL -- . _ ,,/__ ram;.�, �� Lw<✓ "- _ , i f'� �' r.. ��;�, a��� /�6 3�o o a ., o r � � /� - 0-�3 T owu off°B ar ustablO P#_ /3 &0--- , ;RE Ie, Deparkzrlt;rat oF!Regulatory Services Public HpIth Division Date Ml 200 Main Street,Hyanuis MA 02601 �'Pig, a Date Scheduled Tinie Fee Pd. �/00. D� Foil Suitability Assessnzentfior S � ��b��osal i'crYonn J By: Witnessed dy.: ]LO CA7 ION4 GENE'Rk L I[NI[+ORNU' ION Location Address !S- Owner's Name CeVA�P�VI le Address 6\ Assessor's Map/Parcel: '( 9 1) /!�� Engineer's Namc ,)UW v� 12,y e NEW CONSTRUCTION ((( REPAIR Telephone It �J Land Use \1 `^11 Slopes(%) 0— Surface Stones Di5Lances From: Open Water Body fl Possibie Wet Area IUIVIL Drinking Water Well `1` �f[ Drainage Way /Y Lam_ Ft Properly Llne —ft 0[hrr Ct )E JN�'7I C]E�: (5lreet came,dimensions of lot,exact locations of lest holes 8c pert less,locale wellands'in prouun lj to holes) v-,.) o—s N ..q ..= —n A/ 'n o �5Z J N 1� .. ` �zo P y8, i w Parent material(geologic)_�V' e� Depth to QOdroclt Depth to Groundwater: Standing Water in Hole: YV v' 1 Weeplhg Il'on1 Pit ROB Estimated Seasonal High Groundwater >C➢E,T ERIMNt�.7CJLON FOR SEA 'O.NA L HIGH WATER TABLE lYlelhoJ Used: Depth Observed standing in obs. Bole: In, Depth 10 Sall muld.n;. IV111-17- Dcplh to weeping from side of obs.halt: _ hl, dYtlullrlWuteY AdJuslnlent _ _ ft. htJcx Well It Reading Datc: Index Well I¢vnI � � AdjI,rl.wtov ,A41,0l-(Aindwater UVeI Observatimi _ IPERCO� ATI..ONTJCS".� PJuit ll'1it1b��—� Holc It ' 'Chile at.h" Depth of Perc .7 TIn1p al 6" [/, Star[Pre-soak Time @ fAVvLO Time(9''4") End Prc-soak Irate Min./lncll �� ' . Sltc Suilabillty Assessment: Site Passed_ Sile,,Failed: Additional Tesling Needed(Y/111) A/ Original; Public Health Diviaion Observation Holr:,Data To Be Colnpleterl on Back---v----- **g'It percolation test is to be conducted vviLidn 100' og vvefla nd, you ¢a➢west firslt Uoti y the -Barnstable Conse�vatioil Division at least one (I) wee1G prior to begouA0.➢hig. QAS EPTIG1PLIZC FORM.00C 1))E' ',P'.OBS>-Rl7ATION ii—o , + ]LOB I•� Depth from Soil Horizon ]Dole # Surface(in) Soil Texture ', USDA Sdi)Color '-9-- ' ( )' Soil nsell) Mottling Other / (Mu g (Structure,Stones..� Boulders,J C� Con iste c , rhyrn 1 D-Er-iP OBS-R-R �A'aIONHOLE ]LOG Depth from Soil Horizon H le f Surraee(in.) Soil Texture Soil Color (USDA) Soil Other -- (fv',unseilj Moltlin g (Structure,Stones, Boulders, C nsis e ❑ % C ave) Yt /aYxs// De th prom Soil Horizon Soil Siirrace(in..) Soil Texture Sail Color -' (USDA) Soil Other (MunsGll) Mottling Mtructu e.Stones,Boulders. " ('•o siste cy,%Omvel) ------------ Depth fiam ]]DIIEE,P O]IS]ERVAl7['ION]fIOLE L®G Soil Horizon Hole# Surface(in) Soil Texture Soil Color ) _ Soil (USDA) (Munsell Other Motlling (Structure,Stones; Boulders, Consistent_ v, %—Qmxt 1 El19od Insurance)Gate Maw Above Soo year flood boundary No Yes Within 500 year boundary No Yes ' within 100year flood boundary No y�5 � Deplth o_ Q Nalturally oc_ c�arring r0vl�aterfal Does at least four fcOt of naturally occurring pervious material exist in all areas Observed thl'oughout the al-ea proposed for the soil absorption system? If not, what is the depth of naturally occurring pervious mar8ribW CeHmeafion 1 cert� i', / that on (date)' have passed the soil evaluator examination approved by the Department of Environmental.Protection and that the above analysis•was performed by me consistent with t(ae required training, expertise and experience described in V'D CIAR 15.017, Signature Data % Q:1Sl?.PTIC RRCd;ORM.DOC i �10---`Q ....... Ficim :......................... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH - IAII,%................OF...... � '..............._.......... Apphrativat for Bhipmal 19orkii Tnngtrur#ion Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at .. . ...................................................... J �Locatio Ad ress (� Lot ..............1 ._ .. ................................. ........�<. .... �rY._ l.Y ..... ..... TInstallerl dress � Address U T Dwelling in No. ..........................Expansion Attic ( ) Size Lot-Ga�bagte`Ginderfe YP g q.a Other—Type of ....... No. of persons.................C....... Showers ( ) — Cafeteria ( ) dOther fixtures -------------------------------------------------------•-••••••---------•--••••-••--•-•---•-•----••-•----•••••-••-•-•••-••-•----•----•-••-•-•-•••-•-- W Design Flow................3.V_.....__....-_..gallons per person per day. Total daily flow..__....-ev ...... WSeptic Tank—Liquid capacity.W...gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width_____.__......... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No__________________•-- DiameterCi(� e th below inlet.................... Total leaching area. O3— ft. �. Sing P g �------•------sq•Other Distribution box ( ) - tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 ••-• •)•-•-•• ------------ • 0 Description of Soil............. x j� !yG/. ... .________________________________________________________________ __r ....................................................................................I................ W -_-_-___-_••............................................................................................................................................................................................ U Nature of Repairs or Alterations—Answer when applicable................................................................................................ --------------------------------•--••---•-•--------------•-•---•--------------------....••••-_--•••.••--••--•••••--•-•----•.......••--------•••-••••---•----•••-••-••••---------•--•••-••••-••.....•---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanit6aode he un sig a further agrees not to place the system in operation until a Certificate of Compliance haiss y th r he�lth. Signed . --•---......•................... ..........---•-•-•-•----.....-- DApplication Approved By----••-••-•-• -•-•... .. --•.......... .1...•... -•------••----•--•-•-••------•-••-•----•-•-••--•--• Date Application Disapproved for the ollowing reasons:---------------------•-----------.._..---------••---•••.--•..------ ......................--•----•-----..._... .............................................---....----•-••••-•----•---•--•-----•••••••••---•••--••-•••..•••-•••••••-....--••--••-••-•-•--••-----.................................................... �> 3 . Date Permit No........ ..................................... Issued. �< — /' Date ....... Fmc.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD ' OF HEALTH ....................OF....--��-, pfiration for Biapusal orkii (2 onstrur inu rruti ri _ { Application is hereby made for a Kermit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ............�. ---}-- „r='"-- 5 erw V t...................... .......�d two �'L.......... ......................................... L_ocatt/g Address _� or L ot o / ............ a: ;..;:: :.7:""p, ... ?: .................. .............. r g.:.•.-�fk ^t.4:�1.* ..... ..3: 3C.. F}: :t:::... 1 01vnet i `, ddress ry ' J^^-•-.•• a .•............... ...... :" ?:C.r " `v ......_ V�:....... • • .Y • . •.• Installer � Address • U Type of B lding Size Lot____/r _! `.i_..___Sq. feet Dwelling—No. of Bedrooms..........___-._.___._._..___.____..._._..Expansion Attic ( ) Garbage Grinder ( ) p`4 Other—Type of Building .............. No. of persons.......................... Showers ( ) — Cafeteria ( ) P4 Other fixtures __________________________________ • ` W Pg Liquid --�__� g P person P Y Y � ..........................g Desi n Flow..................:.....................gallons per erson per day. Total daily flow__....._;,._.___,_ WSeptic Tank—Li uid ca acit D___.gallons Length_______________ Width............._. Diameter................ Depth--_----------- Disposal "Trench—No..................... Width....__....__.____,__ Total Length_._._.__.________._ Total leaching area.... ft. x '.v3�r a b q Seepage Pit No..................... Diameter_::.~ .____.. Depth below inlet.................... Total leaching area3`_p�-__...,sq. ft. f�. Z Other Distribution box ( ) D.6sing tank ,( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ tl� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 3 s a_ .....'-.......... 't._..._.... 1 O Description of Soil............ x •--------------------------=--------------•-----••------••---•-••-----------------._.......-------•-----------------------------------•-----•-•--------------••-----------•-----------•---------------- U Nature of Repairs or Alterations—Answer when applicable................................................................................................ -------------------------•---•--...----•-----•-•-----•----------------------------•----•-.....---.------ Agreement: The undersigned agrees to install the aforedescrib,"d Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code The undersipne,d further agrees not to place the system in operation until a Certificate of Compli� -Jhaso been is tied;by tl�,e F6oa a d I lth. �. Application Approved B / fI PP PP Y •�L--_,___--_•__- ---__•-----•--•............. Dat'e F a Application Disapproved for the411owing reasons:----------------................................................................................................ --........-•------•---._._...-•-------------------------•--•---•-•--- Date PermitNo.......1 ...................................... Issued........................................................ Date THE'COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .?..... f` r........ - ........OF. t . '1'"x art{" `:......................................... �pI`#t�il�ffP D� ��t�tt�'�ttt1t�P y y THIS IS TO CEjTIFY,, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) - Installer t ....h.-------------- /J j. ............•-------••-.--..__..._......----- at.............................fc .7 ;, `� y -- Ain�' ' <...... • ��-"" _,__-•----•--_-•- ......................................................... has been installed in accordance�,'ith the provisions of Article XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No........ ____________________ dated----------------_................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........ .-'-....1-_L/-Y•---•....................... Inspector.................................................................................... THE COMMONWEALTH 0# MASSACHU�ETTS g BOARD Of 1 KH (,�� ��:" ill.",. // .. f....................OF.ft .. .. ,Ja No..._..3... Y ?: ..._.....f ..................... FEE /d•... i 1arittl War-ks Tinto tr on. Prruttt Permission is hereby granted.......................,�-.............._...T ......."" ....-7).......................................................... to Construct 4 ),or Repair (, ),ari lndivi�%�1' Sewage Dispo ,Syste r r V Street as sh©Noa Qn the application for D°fsposal Works Construction Permit No..S.3.1 3 Dated.._ ....... I/ oar f DATE------ � /_ y,............................... Health FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS ` a a � h� b�/ o,CQT1OP! VT ?ENNQ.(:�E PERMIT UO.�.l. VILLAGE MST LL R S &ME ADDRESIS [� Ty�] � -.I Li, a .LSVI- - 1a i 4 0 �FI�k TOKW2 BUILDER 5 Q &MF- ADDRESS DIATE -PERNA T ISSUED .— DATE COKAPLI W`lCE ISSUED ; Y2,711 4 E �� �. L O C AT 1 O K1 SEW 6,CkE PERMIT 1`I p, IJT1!`1S7 LL. R S. �t�IIE ADDRESS u i .t.�. - s; T.T. u b U 1 L D E R 5 1.1 AVAF- ADDRESS DATE PERNAVT I D ATE COKAPL.14QCE ISSUED hn � i G .. • ✓tom' .. �i 'ti . ALL S YSTE SHALL SYSTEM PROFILE MARKED WITHC MAGNETIC TTAPE OR 8E (NOT TO SCALE) COMPARABLE MEANS FOR FUTURE LOCATION. NOTE)S Three Ponds PROVIDE MIN 20" DIAM. WATERTIGHT R° e Lone ACCESS COVERS TO WITHIN 6" OF FIN. GRADE CONCRETE COVERS TO WITHIN 3" GRADE 1. DATUM IS APPROX. NGVD 2" PEASTONE OR GEOTEXTILE � \ TOP FOUND. EL. 70.9' FILTER FABRIC OVER STONE 2. MUNICIPAL WATER IS EXISTING Locus MINIMUM .75' OF COVER OVER PRECAST 2� SLOPE REQUIRED OVER SYSTEM 69' 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. o \� of PRECAST H-10 BLOCKS OR 4. DESIGN LOADING FOR ALL PROPOSED PRECAST RISERS (rrP.) � r o Z 4"OSCH40 PVC PRECAST RISERS UNITS TO BE AASHO H-1Q o .y: 68.2' MORTa ALL 5. PIPE JOINTS TO BE MADE WATERTIGHT. ry o PIPES LEVEL 1ST 2' C H-10 a o COMP.NENTS �ENDS (TYP.) 7 SIDES EXISTING 66.0' 10" 14" P<° ,�a e a s o a a °o°°0 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE o °°°°o°°° °° ° ° ° °° TEE SEPTIC TANK** TEE * o o o 0 0 oo°ggg o0��:Elf _��QQ Im °°°°°°°° WITH 310 CMR 15.000 (TITLE 5.) d c 66.8 1 0 oaa� °°°°°°°° 0 0 0 0 0 0 °°°°°° ° o�o�o�o0o-o0 °°°°°°°° ° °°GAS BAFFLE:: o 0 0 0 0 0 ° ° ° ° °°°°°° o 0 0 0 0 0 °°°°°°°�_o0,o„o,o,,o_ b o°o°o°o° �DoDo 0��000En®[� °O, ° ®oErn] aa °°°°°°°° 7. THIS PLAN IS FOR PROPOSED WORK ONLY ANO65.49' o 0000 00E �� 00000000 NOT TO BE USED FOR LOT LINE STAKING OR ANY 65.32 ogog0000 . o0000n °o °g 63.17 OTHER PURPOSE. tie 6" MIN SUMP L "12" MIN INT. DIM. - . . 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4 PVC. er ho �- H10 500 GAL LEACHING CHAMBER BY ACME PRECAST OR EQUAL. 3/4"-1-1/2" DOUBLE WASHED STONE (2) UNITS REQUIRED 6" CRUSHED STONE OR MECHANICAL 9. COMPONENTS NOT TO BE BACKFILLED OR 9�� COMPACTION. (15.221 [2]) OVERALL DIMENSIONS TO OUTSIDE OF STONE: 30' X 9.8:, •CONCEALED WITHOUT INSPECTION. BY BOARD OF C. ck °rn HEALTH AND PERMISSION OBTAINED FROM BOARD °W e _J (AA y. SLOPE) ( 1 9: SLOPE) co OF HEALTH. LEACHING 10. CONTRACTOR SHALL BE RESPONSIBLE .FOR LOCUS MAP FOUNDATION EXIST. SEPTIC TANK 28' D' BOX 17' FACILITY CALLING DIGSAFE (1-888-344-7233) AND NOT TO SCALE 57.0' BOTTOM TH-1 VERIFYING THE LOCATION OF ALL UNDERGROUND & *THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL **INSTALLER SHALL CONFIRM MINIMUM SEPTIC TANK SIZE AT NO GROUNDWATER FOUND OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS 1000 GALLONS AND ITS SUITABILITY FOR RE-USE. REPLACE 71 WORK. ASSESSORS MAP 172 PARCEL 147 PRIOR TO INSTALLING ANY PORTION OF SEPTIC .SYSTEM WITH 1500 GALLON SEPTIC TANK APPROPRIATE TO SITE CONDITIONS IF NOT SUITABLE 11. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL BE REMOVED 5' BENEATH AND AROUND THE PROPOSED LEACHING FACILITY. ! 12. EXISTING LEACHING FACILITY SHALL BE PUMPED AND REMOVED OR PUMPED AND FILLED WITH CLEAN SAND. VARIANCES FOR SEPTIC SYSTEM REPAIRS WHICH MAY BE o IMMEDIATELY GRANTED BY THE BOARD OF HEALTH AGENT OR \ BY HEALTH INSPECTOR \ PAPERWORK AND HEARING REDUCTION PROPOSALS APPROVED N \ v SYSTEM DESIGN. BY THE BOARD OF HEALTH REVISED DURING A PUBLIC \ GARBAGE DISPOSER IS NOT ALLOWED HEARING HELD ON AUG. 4, 2009 \ \2) FAILED SYSTEMS ONLY : SEPTIC SYSTEM COMPONENT TO �97.83 O /�� DESIGN FLOW: 3 BEDROOMS ® 110 GPD = 330 GPD FOUNDATION SETBACK, IF AN IMPERVIOUS LINER IS DESIGNED 0� / /"69.01 USE A 330 GPD DESIGN FLOW AND INSTALLED (10' OR GREATER ALLOWED). \ �o, / \ �o SEPTIC TANK: 330 GPD (2) 1= 660 �`G // **RE-USE EXISTING 1000 GAL. SEPTIC TANK** O 88 / \ SIDES: 2 (30 + 9.83) 2 (.74) = 118 GPD / s/ .69 \o BOTTOM 30 x 9.83 (.74) = 218 GPD / � c \ TEST HOLE LOGS 69 39 \ TOTAL: 454 S.F. 336 GPD .88 ARNE H. OJALA, PE, SE / s• USE (2) 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL) ENGINEER: / sc73�\ DON DESMARAIS, IRS / x 68 2 6 ' I WITH 2.5' STONE AT SIDES, 4' AT ENDS AND 5' WITNESS: 6 .79 BETWEEN UNITS DATE: 4/9/12 •�. < 3 MIN/INCH / TH 2 ls ENCH MARK - TOP OF PERC. RATE _ 67. 4 D � 6 .1 OTTOM STEP EL. 70,7 i LOT 27 CLASS I SOILS p# 13602 1 11 00 (.4 10' �i 15,057 t SF 00 \67.6 O 7�.06 EXIST. DWELL. 1 4 ELEV. 2 ELEV. ICs7.53�' TH 1 o TOP- NDN. _ MA 4 0.1 69.0' p" 69.2' ST ELEV• _70.9' APPROVED DATE BOARD OF HEALTH O Q SHED A �� SL FILL x\67.49 ��_,�� x U .83 C 5 4 10YR 4/2 A \\ 6907 TITLE 5 SITE PLAN 6 \SL \ 9� 70.09 0 OF B 10YR 4/2 \k 1 o x 011 8 66 18 CYRUS DRIVE SL 66.0 \ 69.60069.74 "69.94 C T 10YR 5/4 B PROVIDE 36' OF 40 MIL LINER AT 5' \ x 82 `''EN 1 ERVILLE 36 SL OFF SAS IN AREA SHOWN. TOP AT \ 4? Q ELEV. 66.0', BOTTOM AT EL. 62.0t. 8.s, PREPARED FOR C 1 34" 10YR 5/4 66.3' \\6� 7 PERK LS FIRM/ L'�- s 8 BORTOLOTTI CONSTRUCTION/ COBBLES as 6 68.51 jj,) 7.5YR 5 8 C 1 �� 1-1 0�oo�MAs , ESN 0�MASS q B. KUIMJIAN " / LS FIRM/ \? 's3, x69.39 �� a�F r DANIEL cti� 108r�a DANIELA. COBBLES Q �s� 67 A OJALA 2012 7.5YR 5/8 \ �� I 1 APRIL 9, C2 108"" '` 6 . 7, 69 11 No.40502 4 Q€i0 \ \ o r* x 69.44 s off 508-362-4541 MS C2 N \6:70 � � � sq �_ sqc`� fax 508-362-9880 � r \ �o DArJIELA DAN{EL �� downcape.com MS \ o OJALA ,o �1� A. � • \ I�'IL " OJALA own cape engineering, /dC• 10YR 6/4 57.0' 120" 10YR 6/4 592' \ No.46 .4098 v 144 . \\ �o� ��T �� °FF s o �- civil engineers D"= �66.50 l c'I z �v�E .N sU land surveyors�zv�y°� NO GROUNDWATER ENCOUNTERED Scale: 1 20' � ' � S � ����----- 939 Main Street ( Rte 6A) o io 20 30 40 50 FEET DATE DANIEL A. OJALA,- P.E., P.L.S. YARMOUTHPORT MA 02675 >2-073