Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0007 EBENEZER ROAD - Health
-- 7 Eberr.�r.�.er Road � Centerville I Immmmll A= 14'1 u7� i i 4 I' 1 S M E A D No.2-153LOR UPC 12534 smead.com • Made in USA OCYC�C S -------------------------------------------------------------------------------------------------------------:------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- NO. 00 THE COMMONWEALTH OF MASSACHUSETTS FF-F. BOARID OF HEALTH 1QW9 OF EARNSTAaLE APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct ( ) Repair ( ) t)pgrade (1/) Abandon ( Complete System Vlnd.ividual Components 7 LB EN -E H UZ Location Zi Owne 6 1-1-ILLER M\ NK Map/Parcel# Addrc,.,,i > TOM DiRittOLL Tclophone# iOA 796-b Telephone It Tcluphonc.#' Type of Building: 1 sWL LL I R G Lot Size (00 Sq.feet Dwelling—No.of Bedrooms Garbage Grinder ( ) Other—Type of Building No.of persons Showers Cafeteria Other fixtures Design Flow(m�tip =radh fl-,.5iD.gpd Calculated design flow-Sarl gpd Design flow provided 34H gpd Plan: Date Number of sheets I Revision Date U Title A? g Df-5(bN i�Soil, LS I6R/AVEL Description of'Soil MED-CWK SAW Soil Evaluator F r 0. f Soil Evaluat'j ULAIL I LRY' Date of Evaluation Evaluator QN PIT DESCRIPTION Al RATIONS ;�s to�in, The upoer-SIOR-0 gorq, A the' dug Sewage so!System In accordance p Difpo with.ft provisions of TITLE 5 and furifw' '" the' sy0en,in "a" Issued by".Board of Health.I . a4r6tion until cat*of Comp liance lance has been Signed Date S- 15- 19 e AA 1 0 C Inspections It' V%4a 01 N\ t FORM 1 - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 I, J 'N0 THEC0.MMONW ALT.Id 01F.�MASSACHUSETTS FEE. . BOA D F�HE 1H.47" T13'W_ OR :4��Aiz _S1 L APPLICATION FORDISPOSAL SYSTEM CONSTRUCTION PERMIT- :Appllcaiion forts°Perftfli 14) ou'roct Qpgrade-( ),ANndi)n ( 0.0,m IcW Systery ndiv dual Components l �:H UD:- j.� tet,7 vmsbwatiosi �a 1-1-ILLER ('"OVErEMNK I MA Map/Parcel N Addrom Telephone# (3 C,,enstall,",N n I"eirr!"v P -a, I S!�Vls , 796 b -1 -7 Ai-' 3 13-C1\Vd%sj Telephone It Telephone Type of Building, -EsWL LL 1 RG Lot Size 510 160 Sq,feet Dwelling 1_1� i 11 w —No.of Bedrooms Garbage Grinder Other—Type of Building No.of persons Showers )..Cafeteria /Other fixtures Desiqp�Flow(min. I aX gpd Calculated design flow 3or gpd Design flow provided34� gpd Plan..7 N 9 Date `J Number of sheets I Revision Date Title RK 5AKX:� SJo �)RAVF_L MED-C Description of oil(s) M Soil Evaluator For 0. Namepf Soil Evaluator L LA K I L'NY Date of Evaluation DESCRIPTION O RE I OR ERATI%s ARARLON PIT PLP LICE , NE-W ,')J16 W ki E t� 10 N L The underslgnedqgrpe_,q to install#W 91;ipyo d*y.ibeo Ind!vidq9!Sewage I)isposal System in accordance with the I=5 and furi* provisions of agrees hot to PIcK0 the system in a.Certificate ,until of Complianco'has been issued bitlie Boaki of Hedifft. Signed Date 1:6 1 -,__I Inspections r All FORM I - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 -——————————————--- - ———————————————————————-- --——————————— No. THE COMMONWEALTH OF MASSACHUSETTS FEE a1kRR5TA12LL8OARD OF HEALTH CERTIFICATE OF COMPLIANCE Description of Work: IM,Individual Component(s) C]Comp lete Syqein The undersigned hereby certify that the Sewage Disposal System,Constructed Repaired(4,Upgraded W).Abandoned by. TaM DPW5MLL at _7 R L R- 3 ifdro. has been installed in accordance with the provisions of 31 CMR 15.00 (Title 5) and the approved desigg lans/as-built 5 / -,pop plans relating to application No.701 dated t'� -1 Approved Design Flow —:r-50 (gpd) Installer T��Rk sC Z L L Designer: EAIWAK k -L-RYP.E'_ —Inspector tj Date__� The issuance of this certificate shall not be construed as a 6u rantee that the system Will function as designed. FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96 --—————————————- -No. THE COMMONWEALTH OF MASSACHUSETTS FEE BARNSTAIaUE BOARD OF HEALTH DISPOSAL SYSTEM CONSTRUCTI N PERMIT Permission is hereby gra?ted-tQ-(;OP4tFuq U grade Abandon an individual sewage .disposal system at IJ:5 L N as described in the application for Disposal Syitem Construction Permit No.Ob(6)— 15 1 dated 5VIVA2.17 0�d= Provided: Construction shall be completed wifhiniOree years/of the date of this perrift-Al, ocal c itions ust be met. 17 1 . I Date 0 Iq Board of Health,/�_ FORM 2 - DSCP DEP APPROVED FORM 5/96 FORM 1255(REV 5/96) H&W Hoess&WARRENTM PUBLISHERS-BOSTON Town of Barnstable �PvoFt"E r�ti Regulatory Services Thomas F. Geiler, Director .M. 3AEN51'AB i Mom. Public Health Division 41p i63,9. ��� . rEo. ,ia Thomas McKean,Director' 200 Main Street, Hyannis, N A 02601 Office: 508-862=4644 Fax: .508-790-6304 Date: $•2G. 19 Sewage Permit#2o1q Assessor's Ma /Parcel P l4'1 0`]8 Installer:& Designer Certification Form Designer: �, �'� .1G.5 Installer: xg- Address: So�c� ;�hc —MA Address: ly �(c«Sci'1ru --- On 1' 8.kA Ex a.yo,.}�o;n was issued a'permit to install a (date) (installer) septic systern at I ;EQEtJIEf R °R based on:a design drawn by (address) cirl Lk a+ r ;, .dated S• (desig'ne) _ I certify that the septic system referenced above was installed substantially according to the,design, which may include minor approved changes such as lateral relocation of the distribution box and/ septic tank. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic,system referenced above was installed with major, changes (i.e. greater than 1.0' lateral relocation of the SAS or any vertical relocation of.any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built'by designer to follow. StripoutI ff re was inspected and the soils were found satisfactory. -X" OF Mq HARRY yN EARL Instal: is S1 e) 3 LANTERY, iR. H o ,p No.26575 p eT FS'91ONAL ENG\ (Designer i.gnature) (Affix'Designers Stamp Here) PLEASE RETURN TO :BARNST' PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE VVILh, NOT BE UED UNTIL BOTH T BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALOTH DI ISLON. THANK YOU. q:loffce formsWesignercertification.form.doc Town of Barnstable P# Department of Regulatory Services z-" 3 hell I �rWerANiA 9Public Health Division Dater�.. MA93 200 Main Street,Hyannis MA 02601 rEr)fAK1 A Date Scheduled-34�qTime Fee Pd._ Soil Suitability Assessment for S awaQe Disposal .F . Performed By: Witnessed By: C LOCATION&.GENERAL INFORMATION Location Address . 7 ..L O E WE 'T - 1, R D1.1 Owner's Name C ENT E-&�l J LLE Address 3 6 M ]LL F r: D-. Assessor's Map/Parcel: ` 1 6,-1 f Q—1 8 Engineer's Name EARL LANITC HY L ��' M NEW CONSTRUCTION REP ABt / Telephone# J 7 4 113 Land Use• H O U�ecL] Slopes('>6) Ql Surface Stones N A Distances from: Open Water Body I G 5 ft Possible Wet•Area 1-IS ft Drinking Water Well ft Drainage Way i ft Property Line d o t/ ft Other ft SKETCH.'(Street name,dimensions of lot,exact locations of test halos&Pere tests,locate wetlands-in proximity, to holes) Parent material(geologic) G' L Kt Depth to 8erh'oek �•_ Depth to Groundwater. Standing Water in Hole: Weeping from Pit Face- - J4 A Estimated Seasonal High Groundwater 2 DETERMINATION FOR SEASONAL'I(IGH WATER TABLE Method Used: Depth Observed standing in obs.hole: In, Depth to still mottles. Dcilth to weeping firm side of obs.bolo: ln, Oroundwater Adjustment (t. dex Well-# Roading Datw - Index Well Isval Adj,-fhetor AciJ_drauttdwater•Level PERC^vl.A T I IN TEST bate 'l we_____ bservadon Hole# Tlm at 9" —_ - �/! Depth of Pero � Time at 6" . (Start Pro-soak Time @ , d 0:) 0 Time(9"-6") -- 8nd Pro-soak Rate Mlh./Inch Site Suitability Assessment: Slid Passed Sitp Palled: Additional Testing Needed(Y/N) Original: Public Health Division Observd ion Hole Data To Be Completed on Back----------- _ i ***If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conseirvation Division at least one (1)week prior to.beginning. Q:\SEPTICIPERCFORM.DOC DEEP-OBSERVATION HOLE LOG Hole# Depth from Soli Horizon Soil Texture Shcl Color Soil. Other Surface(in.) (USDA) (Munsell) Mottling (Stnucture,Stones;Boulders. Consistency.%'drsvel) p-A L Q r441 M aCses '� DEEP OBSERVATION HOLE LOG Hole# Depth from Sol]Horizon Soil Texture Soil Color Soil 'Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. r . Consistency, _ o - Z� L o A m b>e la •� � L, S � � a ZS .d �—• . Mb DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.. Consistency.%Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Sail Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Slopes;Boulders, Co e a Flood Insurance Rat M n•. Above 500 year Mood boundary No Yes Within 500 year boundary No y 1 Yes Within 100 year flood boundary No. - Denth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious ii-Laterial exist in all areas observed thrpughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pervious material? - Certification I cent 1 3O i (date)I have passed the soil evaluator examination approved by the Departme f E t nt tection and that the above analysis was performed by me consistent with . the requi ed tra F erience described in�10 CMR 15.017. A Y ::v Datb • Signature , .. R� y; . � SERY 1R: No Z6575�0 w Q: EPTIC\PERCPORM. FFSS10NA1- � TOWN OF BARNSTABLE LOCATION 'I E5cnc2cr DV- SEWAGE# 20Iq- IS 1 VILLAGE Ccn4crU►1 I r ASSESSOR'S MAP&PARCEL i4`1 .O`18 INSTALLER'S NAME&PHONE NO. Q�- E7lcauo.� �Ot1 y'1�1 O G53 SEPTIC TANK CAPACITY 1000 LEACHING FACILITY:(type) !4 C ('Z> (size) I31t25A 2 NO.OF BEDROOMS 3 OWNER xo1� PERMIT DATE: 1 y-/ COMPLIANCE DATE: $• ZL- f 4 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY A�- A2 ys'(4 32 ' 40 ' A3- Sy ' Z 3 63 Ay- REAR y 1 ' Town of Barnstable Barnstable s� F r Regulatory Services Department ►WlmericaCiiyy BAltN5TA81.� 9 MAn Public Health Division i6gq• �Q' 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas A.McKean,CHO FAX: 508-790-6304 CERTIFIED MAIL#7015 1730 0001 4987 9286 November 7, 2018 ALDEN, SELMA 451 7TH ST SW WASHINGTON, DC 20410 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 7 Ebenezer Road, Centerville, MA was inspected on 11/01/2018 by Shawn Mcelroy, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. You are ordered to repair or replace the septic system within one (1) year from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH Thomas McKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\7 Ebenezer Road Centerville.doc Town of Barnstable • ILAJWsr"LF 9� " N. Regulatory Services Department PrEb MA'S Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A-McKean,CHO Feb 6, 2007 Rev. 5/11/16 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An"x"marked in the ❑is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool NE 1 YEAR DEADLINE CRITERIA tic liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑ Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2) YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any"conditionally passed systems" (broken cover, relocation of a pipe,relocation of a driveway due to H-10 components, etc) ❑ Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER Repair deadline: Q:ISEPTICZEADLINES TO REPAIR'FAILED SYSTEMS.doc Commonwealth of Massachusetts Title 5 Official Inspection Form A Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r !r 7 Ebenezer Rd °} Property Address -; Selma Alden Owner Owner's N e W-J information is required for every MA 02655 11-1-18 page. City/Town State Zip Code Date of Inspection a 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. A. Inspector Information 99' OL133 Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name P.O. Box 73 Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S13971 Telephone Number License Number B. Certification I certify that:l 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 theproperfy 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 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the.Local Approving Authority 4. ® Fails 11-1-18 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system 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 s Commonwealth of Massachusetts j� Title 5 Official Inspection Form ! iolI Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .:; 7 Ebenezer Rd Property Address Selma Alden Owner Owner's Name information is required for every Osterville MA 02655 11-1-18 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: 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 exfrltration 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): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 f Commonwealth of Massachusetts Title 5 Official Inspection Form - IQ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments f,!N r lam:! 7 Ebenezer Rd Property Address Selma Alden Owner Owner's Name information is required for every Osterville MA 02655 11-1-18 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 El ❑ 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 s Commonwealth of Massachusetts r� ,w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments f +r+ 7 Ebenezer Rd Property Address Selma Alden Owner Owner's Name information is required for every Osterville MA 02655 11-1-18 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 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 m provided that no other failure criteria are triggered. A co of the analysis must PP + P 99 PY Y be attached to this form. c. Other: 4) 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 cloggedP 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 3 Title 5 Official Inspection Form bl Subsurface Sewage Disposal System Form -Not for Voluntary Assessments rti•.:Jif? 7 Ebenezer Rd Property Address Selma Alden Owner Owner's Name information is required for every Osterville MA 02655 11-1-18 page. City/Town 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 El ® 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. l 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 r� p Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Irl >' 7 Ebenezer Rd Property Address Selma Alden Owner Owner's Name information is required for every Osterville MA 02655 11-1-18 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 b the owner, occupant, or Board of Health P 9 P Y � P I ❑ ® 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? Wasthe facility owner(and occupants if different from owner) provided with information on the maintenance of subsurface sewage disposal systems? proper 9 P Y 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 ra Title 5 Official Inspection Form i�l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 7 Ebenezer Rd Property Address Selma Alden Owner Owner's Name information is required for every Osterville MA 02655 11-1-18 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 2 Number of bedrooms (actual): 2 DESIGN flowbased on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 220 Description: Number of current residents: 0 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 Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Unknown Date t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form w: iat Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 7 Ebenezer Rd Property Address Selma Alden Owner Owner's Name information is required for every Osterville MA 02655 11-1-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. 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 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: N/A 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 r Commonwealth of Massachusetts a Title 5 Official Inspection Form �I• + A Subsurface Sewage Disposal System-Form -Not for Voluntary Assessments �Y r•�,, >°` 7 Ebenezer Rd Property Address Selma Alden Owner Owner's Name information is required for every Osterville MA 02655 11-1-18 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: 1981 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): 18" Depth below grade: 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.): Good condition. t5insp.doc-rev.7/26=18 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 Commonwealth of Massachusetts r� Title 5 Official Inspection Form N Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °J 7 Ebenezer Rd Property Address Selma Alden Owner Owner's Name information is required for every Osterville MA 02655 11-1-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank (locate on site plan): Depth below grade: 12"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gal Sludge depth: 12" Distance from top of sludge to bottom of outlet tee or baffle 20" Scum thickness lot Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 15" How were dimensions determined? Tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed and no sign of leakage. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts ,w Title 5 Official Inspection Form hl. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 7 Ebenezer Rd Property Address Selma Alden Owner Owner's Name information is required for every Osterville MA 02655 11-1-18 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: I - 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 Commonwealth of Massachusetts ,,. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 7 Ebenezer Rd Property Address Selma Alden Owner Owner's Name information is required for every Osterville MA 02655 11-1-18 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 .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 had stain lines above inlet invert from being filled beyond capacity. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form i N Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ' 9 p Y rY 7 Ebenezer Rd Property Address Selma Alden Owner Owner's Name information is required for every Osterville MA 02655 11-1-18 page. City/Town 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: 1-1000 gal ❑ 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 Commonwealth of Massachusetts I Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 7 Ebenezer Rd Property Address Selma Alden Owner Owner's Name information is required for every Osteryille MA 02655 11-1-18 page. City/Town 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.): Leach pit had stain lines above inlet invert. 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.): r t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 I �. Commonwealth of Massachusetts Title 5 Official Inspection Form M Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r , 7 Ebenezer Rd Property Address Selma Alden Owner Owner's Name information is required for every Osterville MA 02655 11-1-18 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 w: i o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 7 Ebenezer Rd Property Address Selma Alden Owner Owner's Name information is required for every Osterville MA 02655 11-1-18 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 t t5insp.doc-rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 i Commonwealth of Massachusetts _ Title 5 Official Inspection Form ! �ti Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a 7 Ebenezer Rd Property Address Selma Alden Owner Owner's Name information is required for every Osterville MA 02655 11-1-18 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: USGS and town maps show groundwater at greater than 20'. 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 c Commonwealth of Massachusetts y Title 5 Official Inspection Form i�i. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments > 7 Ebenezer Rd Property Address Selma Alden Owner Owner's Name information is required for every Osterville MA 02655 11-1-18 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 t5insp.doc•rev.7/28/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 No................_....... Fss... ... ............... THE COMMONWEALTH.OF MASSACHUSETTS BOAR® OF HE TLj �1. OF......... .? .. ............................... Allp irFation iur Bispvii al Works C> omitrurtiun 1hrmit Application is hereby made for a Permit to onstruct X) or Repair ( ) an Individual Sewage Disposal System at: a�w Location,Addr e / o o.. �r ......... . .... ... ---- ..... - ................ e Owner Address wl f� J.... �1 .�� •................................ r ,' ........ ......._..._...... a .... Installer Address // Type of Building Size Lot501-_� --___--Sq. feet Dwelling—No. of Bedrooms........... .......................Expansion Attic ( ) Garbage Grinder ( ) p-, Other—Type of Building ............................ No. of persons............._.............. Showers ( ) — Cafeteria ( ) Other Mures ..._... ................................. Design Flow................7,7-'__4)................gallons per person per day. Total daily flow...... ......_...............gallons. WSeptic Tank—Liquid capacity& ..gahons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No..................... Width.................... Total Length.........___ Total leaching area.........._.,�.. ._sq. ft. Seepage Pit No........./......... Diameter........%P..'._...... Depth below inlet...... Total leaching area. ...sq. ft. Z .Other Distribution box Dosing tank ( ) // y► ~' Percolation Test Results Performed by.......................�� . ....6.._.......... Date.... .................... a Test Pit No. 1&V.....minutes per inch Depth of Test Pit...1.2......... Depth to ground water/�1 &...... tz, Test Pit No. minutes per inch Depth of Test Pit.................... Depth to ground water !!�� O ._..._.....f--�---f-......•-------------••-•--•----- J ----------W-------- c.� -------------------•----------•• ---- w , /•••-••-•-•-••••--- UNature of Repairs or Alterations—Answer when applicable............................................................................................... -•-----------------------------------------•--------------••-----------------•-••--•-•-•----••-•-----.....--------------------------------------------................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with `. the provisions of TL 1IL L� 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance hhas been sued by the bo rd gf health e Application Approved By.... — -•--=-.•..'.l_�- Date Application Disapproved for the following reasons:..----- ........-•.....................•--------•••••---•-•-•-•----•-•-•••-•-•-----•--••••----••---•••-----....._••-•-•--•--••••••-••••••-----•------••---•••-•------•-•••-••••-•-•-------••-••••-•••----.._.... Date PermitNo......................................................... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS • BOARD OF HE T �4# .................OF.......... ... Appliratiun for Uispaa al Works Toustrurtiun 1hrmit Application is hereby made'for a Permit to Construct ,f ) or Repair ( ) an Individual Sewage Disposal System at Fes.... ��, �, , ..... ........___-- ................. - -•---------- --------...._..........---.................................................... �` Location Address• _ - or,Lot No. .. .......................................... Owner Address a . /,. J:r::. � , ...•--- .....•----....•---•••••............................... Installer Address . J Type of Building Size Lot..._..J:_._.____��!._.___Sq. feet pl Other—Type Type of Building ms.....:.:.: :::........::•-_;___.._......Expansion Attic ( ) Garbage Grinder ( ) a g No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fi tures . ... -•-•-.---•------------•----••--••--•--------. ••-•-- W Design Flow............................................ gallons per person per day. Total daily flow........r..................................gallons. WSeptic Tank—Liquid capacit/'A N2._gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No.................... Width.................... Total Length......_.____ Total leaching area............ ._...sq. ft. Seepage Pit No---------/--------- Diameter.......c�� _.._.. Depth below inlet........ Total leaching area. .!�__ ...sq. ft. z Other Distribution box.O Dosing tank ( / a Percolation Test Res,;Its Performed bY-----•---•--•----•---••------`......-•••--••-••---.,--•-•---------------- Date--- -----.. Test Pit No. 1�-�?"_ .....minutes per inch Depth of Test Pit... . .......... Depth to ground water`' ' _----------- ?I '44 Test Pit No. 7/r.KK! .".--minutes per inch Depth of Test Pit.................... Depth to ground water" _�.-...... al Ri ...........`..........................y......................••.. ......... " .. f Description of Soil--------------- ......�. ............44, ... -�- -. -� / ca". 'r' ...---- Wx ----------- ------ -----•-••--•-------•---••• •--------------•-•--- ---•-----•------------•----•----•----------•-••-••----••-----•---------------•. '--y�-'-•--••----•-•----•--�'.....=--- 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 TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been,3ssued by the�bo4rd pf health. r/ '�% / . to Application Approved BY �" _ !� --- ................... ••---._l__'_f. '`-,�r---- Date Application Disapproved for the following reasons:....................._.....•................................................................................ -----------------------------------------------------------------•---------------•-•--••••--•-----•-•-•-- Date PermitNo......................................................... Issued_..................................:......=............. Date THE COMMONWEALTH OF MASSACHUSETTS / 7^ :.BOARD OF HEALTH intifiratt ..........OF..... . ./��' tj�..� wr ................................. of ToutpliFatta THIS IS TO CERTIFY, Th t the Individual Sewage Disposal Slstem construc,ted,,(k )• or Repaired ( ) bY--------------------------a�/J� ----- � '� .................................... ,- •` !f✓1 /, w�/1 a� 1 Instt11 f._ at..................................................... $ . •-• ............................................................... has been installed in accordance with the provisions of T 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit N O�/ 117>............... dated_.............................................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................ 2-y- /.......-•------------------•--------•---- Inspector_- e.x ......................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD y F HEALTH ..........................................OF......:-'� !✓.................................................. .:'•�� N ..... � FEE.......................... �iu�u,�aal urk� �ua�uiriun rruti# . Permission is hereby granted---------- to Construct.( ) or Repair ( ) an Individual Sewage s osal S tein at No................................ !!..... -� !° _Z.Z... j�l Street as shown on the application for 11 Disposal Works Construction Permit No.................+.. Dated.......................................... 00 Board of Health DATE............................................... ,. FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS ZI 'i x as a,itn NLb 4 �a G S M �� c tpr ,ni r s ! 04 i m 0 4 {" r i riuir ol f � /`L.C► 4'�I 6 .. ,,, ��•t •F SAS. y '' ",r. RAli f t Y LEGEND d 1 # .. ' laru� SPOT 'ELEVATION 4 OxO, , F" °� ERTIFIEp PLOT CONTOUR --- 0 — BERT 9F! E® `SPOT ELEVATION A• \ D CONTOUR 0 MOF+SE � 4.."n�TERyrIL� r A 9 'ROVED= BOARD OF HEALTH f TE AGENT SCALES ' i -!oU' DATa r ENGINE'EROAIG'CO. Nil f CLIENT 1 C1 .@RTIEY THAT T'!#E. BIBTERE REGISTERED JOB NO. hll"J BUILDIK9 SWOWN .CDR T CtV L LAND ,�d CO.Nf YQ 'T4�It. DR.®Y= j' _ ._ ,a IMEER RV Y. R `OF Ai��IESTAS E ' 712 AGAIN ST. CH. ®V= ��j"'a / L HYANNIS, MASS. SWEET—L. OF E RA. .` NO z�`�!C!•/f/V6 PiT' ,4R� f-/{iF11��; /V- CONC� rE / h�E.aYY ST/R©,N ccv� S'h+ LL D+E_uS tg� MAN C'G/VC.�E .o ER . A ,C'1•EAN SAN.1' QRADF C U '• , A, . BACXF/LL - ,. L/QU/O•LEVEL 2'LAYER,. -4"CAST /RON P/PE i p o o ^ Poo OF /�$.-'��B MIN.P/TtN < GAL. , 1 • . • . ••. n ThA� `yASHFO STi'JNE " PFR —r < .S�PT/C TA�VEC' D/ST• °_ s 1 • • m o 1 1 • d q • BOX c • � ® e • . e • • �. a°a • b � - �PJ�.e`���i':,� � i �p � 1 1 •EFFECTTVLr � • • �r 3�4"- I �2" bl. a • o • p WASHED. STOiYa 1 �•• .:o• o e 1 1 • • � s •1 1 ' Cp P � .. • ' PRECAST SEEPAGE a o . 1 m • . . • 1 1 e c P/7 OR NV EQU/V / 41A"r ELE✓ T/DH AS /} ► a /NYERT AT OU/LD/NG 9 L.� FT. //V L ET .wRr/C TANK (, S FT /D �. lob M. �i C(SEE T�9BUL.4TlO v� OUTLET SEPT/C TiaNK `' d FT• - /NLET D/STR/B!/T/ON BOX f C --7. GROuNO 044TER TABLE O0;rLETD/STR/Bl/T•/O/H BOX-�-�Y�FT SECT/O/V OF /NLET' LEACH/MG f'/T F SEd'�/�4G� O/3POSAL .SY.ST�M TA&l/LATID/V LEACH//VG 01/7' •. . SCALE %�� /o D" DiMclVS/ON A_T_FT. D�•S/GN CR/TER/�1 D/1•l.E/Vs/®N $ FT. NUMBER OF BEDROOMS 3 D/MENS/ON C t FT. GARBAGE 0/SP05AL UNIT SOIL LOG TOTAL E8T1,WATED FLO*V 3% GAL.I0AY. SO/L TEST / SO/l 71CST 2 .�'O/L TE1T NJMBER OF LL"ACNING �P/TS I ! L�LEY. R7 ��LY• ,DATE.OF SO/L TEST S/AE�AGH/N_G PER P/T �.rQ, FT. I r .t`:•+ � _; :.,{ - d (i.; ; �•, RESlJLTS dV/T/VESSED 8Y "'� _ �i�OTTOM LEi1CN/NG PER P/T $Q, pT. ,a ; f f :K.; PERCCAA WON.RATE At d>- L - !y//Vyl/NCH -r.67 I_ 4eACH/NG AREA 1-tam sip. Fr c E /3 % l ):WNCO4A7•/ON RA7,ff 2 RE5BRVEL654CH/N6ARE,4 % '% SQ. F;r. r 7J0 y� 1 i EfRUCE. F E,L PREASE ENWAI,ER✓� CC INC IS •1 - N , !lrp; E``,' a dp"5 NO G/QOuNh.,:YYi4TBzR 01VCO411V7'REO o HYANN/3, MA$$ RD UA40 d�vATER_Al"-FLE(/ - f< o r •- . .� i2 T M oV t, i �3 , ) M ATE s -RPo11i'� r �15 Tz rA r 0 t- 4 j,,,� C ov��. Z..; �� „ , E _ � 6�f�111J_1!�3`MAX C p+t�r�y�., }I�Q'F"CrJ1 , ! t� t' �i /kcEns f�blq Tyr:x, f ysa�T���c. � ;�� �_—._.� I•_;„ � � � �, � i i4 i, e� �+is f•� _ ,.._..`!�. •..._ '_ .. ._.._�_....... .'- '_. . .. '5VAtr_5ToAt nR t` ACi C.V15 kI'll INS 7 4r r J,I;: , g }�t,'rti� - �o , 1✓3Cl.vv�� ; NOTES — 1. Disposal System to be constructed in strict accordance with _ Commonwealth of Mass. Environmental Code—Title V. 2. This plan is for the sole purpose of construction of a septic system. --__ 3. Contractor to call Dig-Safe 72 hours prior to beginning of excavation. 4. Pump existing pit, fill with sand and abandon. 5. Contractor to field check outlet invert of existing septic tank. f i , �9 � _ ---�--•--�--�------5; 6. Bench mark is teller floor at back of house elev. 43.4. } 7. APN is 147 078 for Town of Barnstable. r 8. Locus is served by Town water. fo 9. The plan view is based on survey by E. Joslin Whitney, PLS. --�zQ-'. j 10. Pump existing 1,000 septic tank and check for Tees and gas baffle JDZV Pic per Title V. 11. Install (H-20) distribut:an box. - ' 12. Use 2- 5 x8 x2 P.C.L.C. wi*h 4' of %" to 1 %" Double washed stone CA15i all around with filter fabric on top. a ' J � f i 13. Grade, loam and seed all disturbed areas. s I I A 4 s 'r HARRY EAR ��Mta lsl rl,l !AN" RY. i iL 0 A MY 5 AN LlSS OVA L) _ wt� 1. K. � t 1 5 f*k'1r : E 1 .rid 1 g "4S-ETIT 5 C ilk,, t' u i f x 1 RL t'S+4'n CI-)J�1�1G I _ g L(' L < CMtz� tl� t is , :� f.,Y :� / F �7 h{ . 'T i NtfJ{ Wl. { _ �1 yt {' ��^� SANE) c.S`I P If : r !-'" "A :, ,;_�.... ty a r tit� C„ i�.q i:� - -.."� - « �':r l..-"' ";'� -r- ,.r 0 �3 PcO -i'm oau.l.l1_z WuAa -. e r s + ✓ ` :f; t`, d L�+ ,f f� s r4 ar f "gig 4 �. f 1 4 '.. � +pip. �=. w`.✓.-� d I�.P,� �`r '..'y..«fmo L"� ,I� iJ`tV � ' 2�} Li .» _ C 0 to SV L MA,, , --- Rt EC� 1� ' -- DATE,:. l �b- i� r� l ��., Sid 19 , w $ IS. •