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0443 ELLIOTT ROAD - Health
443 Elliott Road A= 227- 112 Centerville ,a r t j'. S M E A D No.2-153LOR UPC 12534 smead.com • Made in USA A910y(O mmmimplo I im OjF1 -_ r Commonwealth of Massachusetts W ip Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments :` 443 Elliott Rd. r Property Address Samira Schumann _' Owner Owner's Name information is =c! required for every Centerville ✓ MA 02632 12/4/2018 page. City/Town State Zip Code Date of Inspection Co 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 g 4 5 A. Inspector Information -1 / 5 AS on the computer, use only the tab Paul C. Martin key to move your Name of Inspector cursor-do not Cape Cod Septic Services Inc. use the return key. Company Name 350 Main St. Company Address West Yarmouth MA 02673 Cityrrown State Zip Code 508-775-2825 S15016 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 16.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs.Further Evaluation by the Local Approving Authority 4. ❑ Fails 12/10/2018 nspector'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. t51nsp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 18 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments _ o I; 443 Elliott Rd. Property Address Samira Schumann Owner Owner's Name information is required for every Centerville MA 02632 12/4/2018 page. Citylrown 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: System in working condition. 2) System Conditionally Passes: ❑ One or more system components as described in the "Conditional.Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 443 Elliott Rd. Property Address Samira Schumann Owner Owner's Name Information Is Centerville MA 02632 12/4/2018 required for every page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts ,A Title 5 Official Inspection Form J. Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ��. 443 Elliott Rd. Property Address Samira Schumann Owner Owner's Name information is required for every Centerville MA 02632 12/4/2018 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 ppm, provided that no other failure criteria are triggered. A copy of the analysis must 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 clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 4 of 18 Commonwealth of Massachusetts 1 IP Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 443 Elliott Rd. Property Address Samira Schumann Owner Owner's Name information is required for every Centerville MA 02632 12/4/2018 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 '/2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. 0 ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 I Commonwealth of Massachusetts x Title 5 Official Inspection Form ah} Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 443 Elliott Rd. Property Address Samira Schumann Owner Owner's Name inormation is required-for every Centerville MA 02632 12/4/2018 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the'system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts i1? Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments .� 443 Elliott Rd. Property Address Samira Schumann Owner Owner's Name information is required for every Centerville MA 02632 12/4/2018 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): 8 Number of bedrooms (actual): 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 110x5= 550gpd Description: Number of current residents: Unknown 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 ears usage 2016=167gpd ( Y 9 (gpd)) 2017=90gpd Detail: Sump pump? ❑ Yes Z No Last date of occupancy: Current Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts pi Title 5 Official Inspection Form la Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 443 Elliott Rd. Property Address Samira Schumann Owner Owner's Name required for is every Centerville required for eve MA 02632 12/4/2018 page. Cityrrown 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: No Records Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 Commonwealth of Massachusetts -- , Title 5 Official Inspection Form to Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 443 Elliott Rd. Property Address Samira Schumann Owner Owner's Name information is required for every Centerville MA 02632 12/4/2018 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: 1990 Per BOH records Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 316"feet Material of construction: ❑cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: +10, feet Comments (on condition of joints, venting, evidence of leakage, etc.): Line checked with sewer camera and was found to be clean properly pitched with no sign of root intrusion. r t5lnsp.doc•rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts I? Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 443 Elliott Rd. Property Address Samira Schumann Owner Owner's Name information is re uired for every Centerville MA 02632 12/4/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank (locate on site plan): Depth below grade: 30"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: 150013al Sludge depth: 3-4" Distance from top of sludge to bottom of outlet tee or baffle Scum thickness 1-2:' Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Estimated Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 1500Gal tank in good condition. PVC tees in place and clean. Tank at normal operating level. Inlet cover at grade with outlet 30" below grade. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 i __ r Commonwealth of Massachusetts Title 5 Official Inspection Form I� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 443 Elliott Rd. Property Address Samira Schumann Owner Owner's Name information is required for every Centerville MA 02632 12/4/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 Commonwealth of Massachusetts p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 443 Elliott Rd. Property Address Samira Schumann Owner Owner's Name information isequired for every Centerville MA 02632 12/4/2018 page. City/Town State Zlp 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 Oil 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.): H-20 DB-3 with 1 line in and 3 lines out in good condition. Box is clean and level with minimal solids carryover. Outlet inverts equal with speed levelers in place. No sign of overloading or hydraulic failure. Cover is at grade. 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 1 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments. !% 443 Elliott Rd. Property Address Samira Schumann Owner Owner's Name information is required for every Centerville MA 02632 12/4/2018 page. Citylrown 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: 3-6x4 ❑ 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 :- ,p Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 443 Elliott Rd. Property Address Samira Schumann Owner Owner's Name information is required for every Centerville MA 02632 12/4/2018 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.): 3-6x4 Pits with 3' of stone. No more than 2' of effluent in any of the pits. No evident staining. No sign of overloading or hydraulic failure. Covers at grade. 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.): t5insp.doc•rev.7/26/2018 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts IF, Title 5 Official Inspection Form �o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 443 Elliott Rd. Property Address Samira Schumann Owner Owner's Name information is required for every Centerville MA 02632 12/4/2018 page. Cityrrown 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 p Title 5 Official Inspection Form <� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 443 Elliott Rd. Property Address Samira Schumann Owner Owner's Name information isequired for every very Centerville MA 02632 12/4/2018 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 l5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts ,lp Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 443 Elliott Rd. Property Address Samira Schumann Owner Owner's Name information is required for every Centerville MA 02632 12/4/2018 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: +12' 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: Hand auger did not encounter water at 12'. Max bottom of pits is 8'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts 1`� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �u °y 443 Elliott Rd. Property Address Samira Schumann Owner Owner's Name information is Centerville required for every MA 02632 12/4/2018 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 l5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 Page 1 of 2 TOWN OF BARNSTABLE �` G LOCATION_:y4 3 gE4"77` 0SO S nW_AGE 1 � O VILLAGE— d)mff U ILL- ASSESSOR'S MAP A LOT �!la. INSTALLER'S NAME;A PHONE NO. �,�•��JCI�`� 1 SEPTIC TANK CAPACITY_/-j�O p ( 6'r i ' 2— _ LEACHING PACILITY:(type)3 ��iT� S (stye) `fir GF ScCr� NO.OF BEDROOMS _ff_PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNERn��t '/ �� DATE PERMIT ISSUED:__ DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No f2vw� " Ot- �av�i B A ° Q A 1 30 ® 2 *0 o �a Q7' 9�r vc P� • http://www.townofbarnstable.us/Assessing/HMdisplay.asv?maDDar=2271 17�cP�=1 4/-,/1)n1 a Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 443 Elliot Rd. Property Address SCHUMANN, SAMIRA Owner Owner's Name information is required for every Centerville MA 02632 7/30/13 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms on the computer, I use only the tab 1. Inspector: key to move your cursor-do not Robert Paolini use the return key. Name of Inspector Robert Paolini Septic Service Company Name 17 Playground Lane Company Address Yarmouthport MA 02675 City/Town State Zip Code 508 362-3555 S 14454 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 ftpction. Tf�t$ insp,!Ption was performed based on my training and experience in the proper function and W ntenancWbf on, tte sewage disposal systems. I am a DEP approved system inspector pursuantla ection t5.340- Title 5(310 CMR 15.000).The system: .` ❑ Passes ❑ Conditionally Passes ❑ Fai s ZZ ❑ Needs Further Evaluation by the Local Approving Authority00.~ a0 M 7/30/13 Inspectors SignaMr6 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•3/13 Title 5 is spection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 443 Elliot Rd. Property Address SCHUMANN, SAMIRA Owner owner's Name information is required for every Centerville MA 02632 7/30/13 page. City/Town State Zip Code Date of Inspection B. Certification (cost.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: 1 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: 13) 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 443 Elliot Rd. Property Address SCHUMANN SAMIRA Owner Owner's Name information is required for every Centerville MA 02632 7/30/13 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 443 Elliot Rd. Properly Address SCHUMANN SAMIRA Owner Owner's Name information is required for every Centerville MA 02632 7/30/13 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ FRI Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ n Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ❑x Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ❑x Liquid depth in cesspool is less than 6" below invert or available volume is less than day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 443 Elliot Rd. Property Address SCHUMANN, SAMIRA Owner Owner's Name information is required for every Centerville MA 02632 7/30/13 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ 0 Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ❑x 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. ❑ 0 Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ❑x Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ❑x 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.) ❑ 0 The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ❑x The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 443 Elliot Rd. Property Address SCHUMANN, SAMIRA Owner Owner's Name information is required for every Centerville MA 02632 7/30/13 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 ❑x ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ❑x Were any of the system components pumped out in the previous two weeks? ❑ ❑x 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? 0 ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A ❑x ❑ Was the facility or dwelling inspected for signs of sewage back up? ❑x ❑ Was the site inspected for signs of break out? ❑x ❑ Were all system components, excluding the SAS, located on site? 0 ❑ 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? ❑x ❑ 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: ❑ ❑x Existing information. For example, a plan at the Board of Health. ❑ 0 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): 6 Number of bedrooms (actual): 6 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 660 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 443 Elliot Rd. Property Address SCHUMANN, SAMIRA Owner Owner's Name information is required for every Centerville MA 02632 7/30/13 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ❑x No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ❑x No information in this report.) Laundry system inspected? ❑x Yes ❑ No Seasonal use? ❑ Yes Z No Water meter readings, if available last 2 ears usage d na 8 ( Y 9 (gp ))� Detail: Sump pump? ❑ Yes 0 No Last date of occupancy: 7/25/13 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 443 Elliot Rd. Properly Address SCHUMANN SAMIRA Owner Owner's Name information is required for every Centerville MA 02632 7/30/13 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 0 No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: R 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 443 Elliot Rd. Property Address SCHUMANN SAMIRA Owner Owner's Name information is required for every Centerville MA 02632 7/30/13 C' /Town State Zip Code Date of Inspection page. �Y P P D. System Information (cont.) Approximate age of all components, date installed(if known)and source of information: Were sewage odors detected when arriving at the site? ❑ Yes ❑X No Building Sewer(locate on site plan): Depth below grade: 2.5' feet Material of construction: ❑ cast iron ❑X 40 PVC ❑ other(explain): Distance from private water supply well or suction line: 10+ feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints appear tight.No evidence of Ieakage.System vented through the building vents. Septic Tank(locate on site plan): Depth below grade: 2' feet Material of construction: Z 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: 1500 gl. Sludge depth: 3" t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 443 Elliot Rd. Property Address SCHUMANN, SAMIRA Owner owner's Name information is required for every Centerville MA 02632 7/30/13 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 33" Scum thickness 4" Distance from top of scum to top of outlet tee or baffle 4" Distance from bottom of scum to bottom of outlet tee or baffle 11" How were dimensions determined? Measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pump tank every 2 years.Inlet and outlet tees are in place.No evidence of Ieakage.Tank appears structurally sound. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 443 Elliot Rd. Property Address SCHUMANN SAMIRA Owner owner's Name information is required for every Centerville MA 02632 7/30/13 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.): 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments rY 443 Elliot Rd. Property Address SCHUMANN SAMIRA Owner Owner's Name information is required for every Centerville MA 02632 7130/13 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 No 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.): Box is level.Box has three outlet laterals.No evidence of leakage. 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 443 Elliot Rd. Property Address SCHUMANN, SAMIRA Owner Owner's Name information is required for every Centerville MA 02632 7/30/13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑x leaching pits number: 3 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): sandy dry soil.No signs of hydraulic failure.No ponding or damp soil.Two pits were dry at time of inspection.Third pit water level was 26"below invert.No stain line higher. 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 443 Elliot Rd. Property Address SCHUMANN, SAMIRA Owner Owner's Name information is required for every Centerville MA 02632 7/30/13 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.): 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 R Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 443 Elliot Rd. Property Address SCHUMANN SAMIRA Owner Owner's Name information is required for every Centerville MA 02632 7/30/13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ❑ drawing attached separately �_...-.I I i I v,R ) .i "Y t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 443 Elliot Rd. Property Address SCHUMANN SAMIRA Owner Owner's Name information is required for every Centerville MA 02632 7/30/13 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: 5' 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: As-Built ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: USED:USGS observation well data.USED:Technical bulletin 92-0001 annual ranges of groundwater elevations. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form A a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 443 Elliot Rd. Property Address SCHUMANN SAMIRA Owner Owner's Name information is required for very Centerville MA 02632 7/30/13 e page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist 0 Inspection Summary: A, B, C, D, or E checked 0 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 No.... � tU� /100.......... J U THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH � —7— ` /--..a.I IN..........OF.... N....5.T CSC. .............................. F. firFatiou for Uiipusal Works Toustrurtion ramit - Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal /!o_ . Location- ddress or Lot N Owner e Address -_.� ........... ,..3� :.. ......., n.... Installer Address d Type of Building Size Lot_ -----Sq. feet Dwelling—No. of Bedrooms... ---__--Expansion Attic ( ) Garbage Grinder ( ) p., Other—Type of Building ____________________________ No. of persons............................ Showers ( ).— Cafeteria ( ) dOther. fixtures --------------------------------- ------------------------------------------------------------------------------------------------------ <� Design Flow..........M2 M2.......................... per per-so per day. Total daily flow................ .... gallons. 9 Septic Tank—Liquid capacitylSQagallons Length._/Q=_,6.~Width.S'_4.:. Diameter................ Depth...Cz.- 3 . Disposal Trench—No.---_------------- Width._ ,._____... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No....._..F---------- Diameter-/Z..lz.. . Depth below inlet...... ........ Total leaching area.55 Asq. ft. Z Other Distribution box ( d)' Dosing tank ( ) '-' Percolation Test Results Performed by/ OlZ�Y1.e5EK__�f�Q.5,5YrJ�41N_r_.. _ .___ Date.......130/8�........ Test Pit No. I....4 2._..minutes per inch Depth of Test Pit----1.4-1'._.._ Depth to ground water........................ 44 Test Pit No. 2...L.Z.....minutes per inch Depth of Test Pit-----1¢#..... Depth to ground water..................... a •------- - - O Description of Soil Z. .-_. N...._4. !�-- .SUQso�................•---- U --------------- •------- •---------------------------------------------7 ...1.4. /1!I�Pl.t�t ... Slier_o.-----------•-----------•----.....--------•---•. .................................................................................................... W UNature of Repairs or Alterations—Answer when applicable.........................................................:...................................... ----------------------------•---•--•-----------------------•---------------•----._..............--------•----------------------------------------------------•------------------------------•-----.•---- . :Agreement: 'The undersigned agrees to install the afor edescribed Individual Sewage Disposal System in accordance with the provisions of L-1::_.i: 14 of the State Sanitary Code—Th un •gned further agrees lace the system in operation until a Certificate of Compliance has been 'soue o- f h th Signed----- /% f �� Date Application Approved By............ .._... ..... /.t_-44_.^.. Date Application Disapproved for the ollowing reasons:-------•------------------------•--•--------•----------•-------------------------------------------------------- ..........-.....................------------------------------------•----------........---------•._.........---...------------------------------------------------------------------------------. ('� Date PermitNo.------. 0-----.�0-5 ............... Issued----------------------................................ Date No.....!L?:-5O S Fim......l o-n..... _ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............. !.1N '..........OF...../..-- ..�:: ry..STr7�3Lr. .............._......._. Appliration for Disposal Works Tonstrurtion truth Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at zt �'_<_ C_ 1 ti % /c� C� L 1? .. _------•-••----------•-•---•.............•------•-• - ------------- .. ...- ...... -- - ......_....... ....... Location- ddress t N -- ......... --....................................... -•---•--•------.._..------••--•----•••-------------•-...........------------------.............•-- �— Owner c Address ............................... Installer Address d Type of Building Size Lot__:%% .__s S?---- feet Dwelling—No. of Bedrooms...52.....................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures .................................. • Y F fi!d f;Zi-,_- •--------------------------------------^_._............••••-•--•----_..__...•---'^-• W Design Flow..........A0.........................gallons per person per,day. Total daily flow................ ................gallons. WSeptic Tank—Liquid'capacity_,/.:Sl�-'gallons Length__- !_ Width..:r.__ Diameter________________ Depth___f x Disposal Trench—No_ ____________________ Width.................... Total Length..................... Total leaching area....................sq. ft. Seepage Pit No-------25:�-----_---- Diameter... _-7._ _.__ Depth below inlet___.._`__...___. Total leaching area___J_5~'_.�sq. ft. Z Other Distribution box ( -r Dosing tank ( ) Percolation Test Results Performed byf--rlrm,^N__....... 2�s_;, !J Date_______ `::.�:f_�:`.____.... Test Pit No. 1..... _. ____.minutes per inch Depth of Test Pit_.-__�. 4.____ Depth to ground water________________________ 44 Test Pit No. 2.... :'_____minutes per inch Depth of Test Pit..... ._._ Depth to ground water............:':........ a' -•- x •-- ••----------------••••-••••-••••••••••--•-•-•---_.` .....---•-._.........----------`---•-•--•.._._._....-•-•-....••-•--....•---••---•--•-•._..._._.ODescription of Soil-••� ' 0 T � sr _' ._ -----------•-----------------------------•--•--••••••--•••-•-•••-•-•••-•-• ••••••••-••-•-•----•••-••..._...-_-•- •••.._.__...••-•---••••••-•••••-••----•-••---•--•-••---•--•-•-•-•-..-= G - / `- ' -•---- ------ ---------= ni--------------------------------------•-•-•--•---..j . 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 TITLE 5 of the State Sanitary Code—T un gned further agrees lace the system in operation until a Certificate of Compliance has been • e y e-b`o'a d-ef 1 lth, Signed- :: -•ara2•�---...-•--'--.`...__ ........../l .3 ... 9U Date Application Approved By........... -- ----� `""'`- --••-•--••••-••-•---•------ --- ..........f/_-___3 -- fG� Date Application Disapproved for theOolloMngeasons_________________________________________________________________________________________________________________ ---•---•-•-•-•----••----••...•--------•••--•••-••-----•--••-•-••-•--•••----•--._.._..--•.................._..•-•-•-••-•......----•...••----••----...••-•••••-•••-•••-••••••--•••-----•-•-••••--------..._ Date Permit No.........90----_--Sc,•.C.2---•............. Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..............................................................I...................... Trrtifiratr of Tomptiatta THIS IS TO CE TIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by....................k.........-••- .............. .. ...._._.._...-----•--...-• •--.._.....---------...-----....-----------------------------------......_......---------------- C Installer (� at.............L--�"••7-...l•-2------�� .: .__._.1R-� C 2- _ �V .......................................................... has been installed in accordance with the provisions of TI TIE 5 nf—The State Sanitary Code as described in the application for Disposal Works Construction Permit No.___ __.!�_:___ _tea_ ______. dated________________________________________________ THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF f.. .._ -__ J . FEE..... Roposal orkg on w ion rruti# G e �+ Permission is hereby granted_.. I -°.=-.==•- =c:!�............... s ------•.................................•--------•--- to Construct ( ) or Repair ( an I dividual Sewage Disposal Sys atNo. G c'.7' /._...�._.:..� C` °-- ...................................................... Street as shown on the application for Disposal Works Construction Permit N d_ Dated.......................................... l Board of Health DATE................................................................................ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS `` r. LAND USE TECHNOLOGY, INC. =4 (Formerly R. J. O'Hearn, Inc.) Engineers/Sanitarians/Land Surveyors SWAN RIVER PLAZA UNIT 3 P.O. BOX 237. 35 ROUTE 134 SOUTH DENNIS, MA 02660 (617) 394-1265 Marsh 9, 1ED90 Dave Whalen _Whalen Contracting. 3 Trudy Circle East Dennis, MA 02641 Re: Lot #10 Elliot Road Centerville Dear Mr . Whalen : After reviewing the proposed plans and the installers sketch of the above referenced project , it appears this system when installed, conformed to the requirements of Title V, for an 8 bedroom dwelling, if the following assumptions can be made: 1 . That both leaching pits were 10', diameter and 6' deep - total capacity would be 1100 gal/day vs: required 800 for an C' bedroom house without a garbage disposal . 2. That the adjusted water table would be at leas*_ 4 feet below .the bottom of the leaching facility . It must be pointed out that the Town of Barnstable has its own supplementary requirements, and that the design for any house over . 6 bedroom--is subject-ed 'to the "discretion" of the Board of- Healt-ha They could require a larger system for an O bedroom building. However , it appears fr.orn the Flans that there would be sufficient room on this lot to meet additional requirements. Very truly yours, LAN T P• OLOG`�' INC. Rich r J. O'Hearn , President �;I'.4.1 i�4 jfv�q, j" INN 50 psi, 1� took] i�v P, Z4 . . ; , ; . . . .�, I r . � 1,":: \mob' .; ,.,:I : 76 ri COa —ell 0 fn K T1 tj ria 1 J C.1 Al 0 C,4- JI +^ TOWN OF BARNSTABLE d' OFFICE OF IDAMSTAEL MA66. i BOARD OF HEALTH .� �p 1639. 00� MAY,,� 367 MAIN STREET HYANNIS, MASS.02601 April. 12, 1990 David Whalen Whalen Contracting 8 Trudy Circle East Dennis MA 02641 Re: House #443, Lot. 10 Elliot Road, Centerville Dear Mr. Whalen: I am in receipt of the letter addressed to you from Richard J. O'Hearn, President of Land Use Technology, dated March 9, 1990. This letter does not conclude (without assumption) whether or not , the existing septic system conforms to Title V for an eight (8) bedroom dwelling. You telephoned me today and stated you are interested in installing a third leaching pit. Please submit plans designed by a Professional Engineer or a Registered Sanitarian of such a proposal. Sincerely yours, 711-bia;�sTCt. A. McKean~ Director of Public Health TM:cst TOWN OF BARNSTABLE ��-- C-- LG -ATION �f�f, -&Lj6-r7— 90 SEWAGE # VILLAGE ")—, a ee- v I LLB ASSESSOR'S MAP 6z LOT INSTALLER'S NAME & PHONE NO. 1 SEPTIC TANK CAPACITY f- P 00 Co T J � LEACHING FACILITY:(type),- - - /� f i S (size) S G 5�rr NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: // 113-9(i DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No or �� y 13 >� AF' � A 30 r Z 20' © Q7' 7 x a evil o T T*10s Iy1o/t�h/ JOAtF p��r�,• ' Ise 3 y,8/ L�0CAT10li SEWAGE PERMIT NO. VILLAGE L',eN'�"y• INSTA LLER'S NAME i ADDRESS i U I L D E R OR OWNER + Sc X) . �j DATE P`E.RM'1T ISSUED DATE COMPLIANCE ISSUED F O A) Goa R,4 e at. z< � I fit 9 b N 0.®....j),'. ' w FES.. D. ....... LTH " ,� r ••�-' THE BOAF�DAOf F MASALTI-� T�-' `r�- • G T ..................OF........4 .4. ��......------. --------------------------------��- VSTq�LE APp� , m, Appliration for Elhivoiia1 orkfi Tomitrurtion r t��►aSS�®�S�01 Application is hereby made for a Permit to Construct (V/ or Repair ( ) an Individual Sewage Disposal stem at, � y A•s='4� ✓11 ICE P�J "r'r CLo)catio(n�-Address or Lot No. t...._ad�s -----•--...-- --- ---..... .......��}�llseTit, y.. �. S j ................................................. �c �y�er Address Installer Address Type of Building Size Lot__--�___:--�2'_Sq. feet V Dwelling No. of Bedrooms............. ...........................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ____________________________ No. of persons______�_______.__.___.. Showers (°M — Cafeteria ( ) a � Other fixtures --------------------------------------------------------------------------------------------------- -----------------------------------•--------- W Design Flow______________SY,....................gallons per person per day. Total daily flow.....t?_�w__.____ lons. ------------ ii WSeptic Tank l-Liquid capacity__1�4Q'._gallons Length_6a-'. ,'..___ Width______________ Diameter-__6__________ Depth._ __-. x Disposal Trench—No_ ____________________ Width,_..__._.____._.._. Total Length.................... Total leaching area....................sq. ft. Seepage Pit No----------/--------- Diameter__ ___ __ _ Depth below inlet.___r-_........... Total leaching area___2.79..sq. ft. Z Other Distribution box ( A Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I!__I.......minutes per inch Depth of Test Pit---_l�--------- Depth to ground water________________________ (s, Test Pit No. 2__<._/-------minutes per inch Depth of Test Pit._.f_. . Depth to ground water________________________ Ra' - .............. ...._.__..._ Description of Soil �1 '......... '^ `ta --. 5 `--•--------............................................. U --•-•••-••-• ---••••--•---••--•--••••-------••--•---•--------•-------•--------•-••--•---•._.......-•--•••--•-•-••-••-•••----•------------••------•••----•-•-•----•-••--•-•-•-•-•-----•---•-••-••---•---- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------•----------•-•-......... V 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,I:L p 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been iss ed by the boar of health. Si ned______. �1.. �... j__...._ ------- -------------------------------*.............. Date Application Approved By------- ------(✓ L. .............................. `-y f......... Date Application Disapproved for the following reasons--------------------------------------------------------------•---------------•--------------------------...---- ---------------------•-------•---...---------------•--------------- -------.•..--.--•------•-------------...-------------•----------------------------------------------------------------•---••-•------- Date PermitNo......................................................... Issued_....................................................... Date �`. No.. ... :.... FRs....30:':""-...... r THE COMMONWEALTH OF MASSACHUSETTS .,6 BOAR® ;ALTH ' `�'F ' 3- / 7� , W" OF..:.....1.......:. -------------------------------------------------•-•--•---.....--- ` Application is hereby made for a'Permit to Construct J-V: or Repair ( ) an Individual-Sewage Disposal System at .. f !a ...--------•--• � :: ._ . ....................•-•.... •---•• -------------•---... ......•. •-----. Location Address or Lot No. t1 rat /� la��,w�•,............................ ... ..... Address ... � 9S iF - S"!.L?_"�_" •------------------^------•---....................................... -- - Installer Address Type of Build i Size Lot___3 G........... '.Sq. feet U Dwelling YNo. of Bedrooms.............. ..........................Expansion Attic ( ) Garbage Grinder ( ) pa, Other—Type of Building ____.._.. No. of persons-------- _______________ Showers ('k — Cafeteria ( ) Q' Other fixtures ----------------------------••--- W Design Flow...............s.�_.�._t_......._.•.....f__gallons per person per day. Total daily flow----- _4f + ............._gallon WSeptic Tank-4L Liquid capacity_.150Q gallons Length.1Rl...V'.. Width----�-------- Diameter__._- -__---•--- Depth_.6_.._�__.. x Disposal Trench 2,No. ----•-•---_ ----_.- Widtly.......... _ ........sq. ft. ........ Total Length............. Total leaching area___--_. _.. Seepage Pit No.:__..J-- _-._____- Diameter.._(_______________ Depth below inlet.....6.........__ Total leaching area.._.�.� .sq. ft. +° Z Other Distribution bok ( ✓S Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test'Pit No. 1. ;-J------minutes per,inch, Depth of Test Pit...tZ""'-........ Depth to ground water........................ Test.Pit No. 2...14.1'_.....minutes per'inch , Depth of Test Pit___1_1!!'"...... Depth to ground water........................ -„•-•-•--- ....... Description of Soil------------e-j lij �" �^ �` �.kt'"�" ---- --- ........................................... x 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 i s LL y g g p y 5 of the State Sanitary Code— The undersigned further agrees not to lace the system in operation until a Certificate of Compliance has been Iss Wedbyho > of iealth. Sied ---- - ---- ------•-------------- 'By -----•------------------ Application A py&By----- f Application-Disapproved for the following reasons:............:... y`: Date ..-•----------•-•••••-•-••-----------••-•••----••--'---•-----•..............•-------.................................•........---••- Date Permit No::.. .. •......:.......... Issued._.. :._..._ Date THE COMMONWEALTH OF MASSACHUSETTS' -BOARD OF HEALT ......... b 1:........O. ....... ............................................................................ %lorrtifiratr of Tomphaurr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( �r Repaired ( o) by ........................................A . r Installer P at.......... ............................................. --....................................................................................... has been installed in accordance with the provisions of T T s j of The State Sanitary Code as described in the ;application for Disposal Works Construction Permit No.._�_....._C _�.............. dated....1_ `.-'f_ -._�_l__................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............................................. Z2n !....... Inspector---_ z TttkCOMMONWEALTH OF MASSACHUSETTS ^1 Bq.4R.D OF HEALTH ::. Ile7 ........................................... ..... oF.....4FEE ...N � Permission is hereby granted_................................................................. to Const uct (�or Repair ( an ndividualjge go at No.. c �� ........... �..-/�, `f C 'evy, '. Street � � (^ / as shown on the application for Disposal `'Forks Construction PerfIiit No. ___. _ __./Z . Dated................. /....................... - _!1r V .[ D Board of Health ' DATE........................................ '6 - Z..................... FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS L 0 C A T 10N SEWAGE PERMIT NO. (2 VILLAGE I N S T A LLER'S NAME i ADDRESS J 1�1 a air✓ 6UILDER OR -OWN ER � eRf Scbtu mt+ A� DATE PERMIT ISSUED y t MPLIANCE ISSUED r- G DATE C 0 J ,J I sa ;% .. �:a b as .w ^'rr.Nt v%.r .;ts� �S,fritr' ydF'�d-." .."r", �i-n• 10 160— MA, ' '`{�'•. ��..fa#6N'F�r y�1t ay` '�- )t� � �. r'�dot@I'� b 5 49tg �ry �LI �,,}�y/..u�t'.- �3 i^ '!17�,1, �-�?.', T�,•1.,�`>` ell I i f, MR pit 15d�"}n LfA'. �. �}-"'y'C:{�,s �yi��; e4�1;(j�7�') 4�` �I' -')!1,, ,��•� 2 N J a o � a tj a NN 3 Ira I � S lo m d I � N � N Iw � �6 1V � 1 9 9 o,tl �ry MM ' Y a vN�M"��, ° N"ad'"°��i y _� ° ARM!,` tt-- x All 1 yrN A � } �f 0 W c- a q � 9 'b auJda14-m # � °Jo d I d I I I I I 1 I I I I u Ij� Ulnln�+dpJ '� • w a. R � � � 1 � � k 8 MUM 1 u;133 Jz Q to Rig s e f, i !,�av .*,i+ba ssv�'" ''a�1 {, q'Ls'a a'�'13�\ .A tr "1 � .t , f ' 7�.a "'(t 1 y y r �{i'2 r E�!A ftt�f�!"'{" f a,��"' ��'�`'c��`�"s°��it � 3 ',�}�✓o b"��.h�-.`•Lti,�k Fa�� '�; �iy F�it� �r 4' rT �a33"h� •� tl. *3r r k `�.�.;} k �� _.it �it.? Y 3 � t ''� 8 :` .t k t� a r�h.Y�'��R��"..,gr`a•u T 5 r��� -;h aS,T J P J 4 \ I v \ n \ oa s�aet+ A-L •' 4b I ] woo W H P 9 //�F \\'./ IF iir, lIt— 7 T _V Z y 1 L. Aj g { I 1 6p M L o { _ — Ir -.v� L Assessois office(IstFloor): �eT//) yoFvxc�o` Assessor's map and lot number b�V Oi Board of Health(3rd floor): Sewage Permit number ! 1 DA8D9T�DLE j Engineering Depart?nt jd floor): House number �o r►v e Definitive Plan Approved by Planning Board t9' APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2.00 P.M.only : TOWN OF BARNSTABLE BUILDING /INSPECTOR APPLICATION FOR PERMIT TO /6/tl019EL TYPE OF CONSTRUCTION ,,2weze 19 TO THE INSPECTOR OF BUILDINGS: The undersigned dddhhereby applies for a permit according to the follo information: Location Zl�d 3 Proposed Use Zoning District .`/ Fire District _ o Name of owner Address "� 9� Address�� Name of Builder��//�LL/y �O�/TiPi9�Tiy6'/ti'4' Address i� nX���y Name of Architect) Address A/ Number of Rooms Foundation /` d i�w-'`T�� i Exterior, Roofing y� Floors Interloc Heating Plumbing Fireplace Approximate Cost Z ' Area Diagram of Lot and Building with Dimensions Fee I i OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regar ing the a construction. Name DO e- Z C �J Construction Supervisor's License S � a01 `K",77 '71 -IT M,�"T.7 ----------- 3.5 IF R V/p O&E:, 57 7 &y EX I S 20 FT MIN. P., E.. ........... TOP OF FOUND.A 7- 17 0 L A f5F .- SOIL TEST EL 18, 71 10 ,FT MIN. OBSERVATION OLE I OBSERVATION HOL%/2 OBSERVATION HOLE 3 4 SCH 40 PVC C DATE', OF. �TEST DATE OF 'TEST DATE OF TEST OVERS CLEAN SAND PIPE -MIN. PITCH 0z, covEr" By 12 P_ &d_y WITNESSED WITNESSED ,: A4 ' BY P Af UeP-/9/ WITNESSED BY 70 GZ0V,0_ 1/ 8 PER FT 4 C,V,:PERC.�: RATE COVERS - RE MINI INCH PERC, RATE MINANCH PERC. RATE MINANCH 4!' CAST IRON ( OR covi5de �v 70 G Fv = /3-0 ELEV= EQUAL) PIPE- MIN. 12 MAX EL ELEV. PITCH 1/4" PER F 0 2% MIN. L LEAF A4`ULCA� FLOW LINE EA 7 cli L= E MIN, EL= � 13- 8 EL= EL=. l EL= EL= EX 15�7, EX I EL= DIST 4! 14-4- 144 BOX LO CAT-10 N A P WATER AT — EL= WATER AT E L WATER AT EL GAL PRECAST LEACHING El 9. �3 EGEND SEPTIC BASIN / GALLEY OR EQUAL TANK Eb ' ""00'EXISTING SPOT :: L VATION EXISTING,: CONTOUR FINAL : SPOT� �ELEVATION FINAL ,', CONTOUR,", TABLE EL 61 SOIL TEST, LOCATI N 0 SEWAGE DISROSAL SYSTEM ADJUSTED GROUND WATER TABLE (61-7,9190) EL t5, 2 BA SF-L): NOT TO SCALE A tl GC HYDRANT OWN WATER T 1vv CATCH BASIN ....... . FRAME a COVER SHALL BE r e SET WITH MASONRY UNITS WHICH ARE TO BE MORTARED F3 P 01,'or CLEAN SAND I N PLACE GENERAL", NOTES 1. ALL,:'WORK MAN SHIP 2" LAYER .OF N D MATER I LS T CE 5 tj D Q.E.' N D_':�'�T. H E 1/8 - 1121" WASHED 'CONFORM TO ',: E.Lpr AA T 0 W N �,O F RULES:-. RFGULAT'16NS": STONE IVO 7-,9 -SUBSURFACE : DISPOSAU `OF� FOR, . THE t��46 E 2-ALL , COVERS 'TO SANITARY'', �,,B 0 i HA 0 BROUGHT' ��,�TO I� 0 Al D 4,1 0, TIT F FIN I SHED �:�:ORADjE' WITHIN IL L "REMr JL 3.EXISTING ' AN FINAL, GRAD S %'S H L A IN E t-A, 0 ESSENTIALLY: THE,.,-SAM8 t),,Q 7 WASHED STONE > AS ' BEEN,- 1) ��,�BY �TH 4- bET N H 4. NO ERMINATIO Is y AS , T 0 O� CO MPILIANCE 11 OFFICE:�, ''TOWN OC w uj v u-0 'OWNER /�APPLICANT fs � N S" LL SUCH , �'DETERMINA c C, PRECAST LEACHING \4� Ld BASIN / GALLEY 0 lie PPROPRIAtEI `� AUTHORI A EQUA 70 TY L 24" DIA. COVERS 5.,TH 1 S PLAN :,IS ,�VALID 1F� "SIGNED IN ��,,RED�r THIS OFFICE PLAN VIEW ASSbM, �� NO 5 c 7- 7 T :z�C NTAINEDr' RESPONSIBILITY FOR, ]NF6 N,`� 10 0 :WHICH "DO : NOT HAVE ON COPIES FRAMES COVERS SHALL MASONRY 'AND ISIGNATURES`.�`,;, STAMPS BE SET WITHr UNITS 64 opo WHICH ARE TO BE MORTARED TARY,�,,� S 6.'ALL., COMPONENTS' �'OF THEI� NI -Y,ST IN PLACE - 7-oo c1Aj1,-H ; , SHALL BE CAPABLE OF;:,WITA8TANbIN6 f WITHIN LOADING UNLES�� OF DRIVES A _:`H LEACHING FACILITY INLET ": I OR 10 fT, PARKING ARE�: 3"MIN. NOT TO SCALE �,UND ` 0 H LDISHALL �B E :, USED _R, wit" IN OU 6"MIN. FLOW LINE----,,,,, 10 FT OF DRIVES OR PARKING�, AREAS 2 MIN. �—REMOVEABLE COVER TS WINIM0 _ 14- SETBACK REQUIRIEMEN or UTLET PIPES FRONT . SIDE! REA0� 0 MIN. AS REQUIRED eel' OF : � .BOARD t7 4 FT MIN, , INLET FLOW OUTLET -.10 LIQUID LINE DATE -AGENT�'. .0 u-F �44S. DEPTH a,p Iq nn PROJECT LOCATION 1 2 -LI-1, 0 7- , L 0_7 ' 0 A R-N No. r INLET TEE PROVIDED PER SECTION 15.10.2 APPLICANT: Al 4- TITLE 5 L�5 Al w A CROSS SECTION VIEW OUTLET TEE NO. OF OUTLETS; S RIC ARD LIQUID DEPTH TEE DEPTH ES tA BELOW FLOW LINE OF EARN 694 SEPTI and 4 FT. DIST. BOX DETAIL 14 INCHES 5 F T 19 INCHES NOT TO SCAL E 6 FT 24 INCHES lee Y7 lqg ncd 7 FT 29 INCHES 0i 8 FT 341NCHES A/0 TE F'OR44Z�RLr R _ HEARAI, nal nej�:E rs L n UrVe qnitonpl�,� L 0,7 R11-_Y 7 0 CA 7-/ CA/ IV 0�N/ Sr vF_ 'E'� �E V".e?7 35 ROUFF G �11V DESIGN CALCULATIONS 0 !, 1,34 S 7 _H 7-0 )AIAI NUMBER OF BEDROOMS _ _ __ 0 7 9-'EX '!�77/ G GARBAGE DISPOSAL UN IT.... ........... /V 0 REVISIONS =7/rl 0 ve r_)�C�j /,9 7 E .57 TOTA L ESTIMATED FLOW - (f7-1C)1\j O/C- 7W4 0C_ 7 0 7/-/,F S� 7 �9 GAL BR./DAY x BR. .......... GAL./DAY REQUIRED SEPTIC TANK CAPACITY_ ___- GAL. 1�500 ACTUAL SIZE OF SEPTIC TANK . ....__... GAL. :�O VE 0 LF 7 .,x1Z:: LEACHING AREA REQUIREMENTS 0. F �P 7 I/v/11/ C, Ic- v D f__ SIDEWALL AREA GAL./S.F 7_1_1E7 'g�'E T. D .7,.' F % .7 OX GAL./S.F. BOTTOM AREA Z- 7 r zz L�ACHING),��PACITY ( BOTTOM + SJDEWALL) GAL. 4-x 11-x 7-1-11::- P1 7-7. x 6* f 7 x 1 0 X 4 x P_ SCALE �5 DATE,�:, P 77H 0)= P. 7 T 0 x GAL. RESERVE LEACHING CAPACITY............-....... 0,C7 DR. BY' A PP D.,,,BY _/0"'r 7 C_ /:;Ip 0 �O/ 7-1 �7 7-/- 7 /7/F_ P, L OB NO. ';7- F SC_ VV &H 'ET 0)'_ 7 C C_ 7 S7 L E IE A/3, 1:?019RO,� :0 7- R E,7 0 0A EX 1-5 7- /87 TVPt�,c..t. D► .�T�E�'.�T"t Ohl '��� _ ���� �t� � f oat c.. CJrc� „,��ST t i =rtc�� "� A►�1D Eat '5 st .. '-_• ..Z LAB. .. ...,...". r''•.! .. ... ..'" — 4''. ., 4..J� �' i. ..,_= \ '; y•"""r^� ,.. ,._-_ ,,+° <- . ',. _ ,c.� F_N1 c�1e t", t..�E-:L��'°�T'�1.r x,<C.? �S ;..� IS 0 per:.. T� `1T- n l Z. \ �3 S x C� F 1 6'D ik pir- - a j 1 * -- - - - N V p --- - - - - - i :. e - :. - .. ,., / .. ��.�i r'{t_,_ _ �ice.•.C. ��{�✓� �_ 4. j O t p •ECG '",F * X^., 1_ �-•'�C_!-= ram,:_ •�' /} " o c < I /ya7" /A/ t � -�; t - �C� :,.�_ �• 'C3•�'� �,C� .GcT S,t�oc.�.:N �,'t/ ��r�,v I I IVO TE SFRV,gT/ On/ HOLr LY NO/1M/�N GRO �S�/-�/�,� � /=: t='• — 20 FT. MIN. SOIL T EST TOP OF FOUND. 10 FT MIN. OBSERVATION }TOLE I OBSERVATION HOLE 2 OBSERVATION HOLE 3 CONCRETE- �i GATE OF TEST / / ��' � ' DATE OF TEST —T/-�11�/ DATE OF TEST COVERS 4" SCH 40 PVC CLEAN SAND WITNESSED BY 1. �� �f /' / WITNESSED BY / Mr)F_'Lgy WITNESSED BY PIPE - MIN. PITCH " CONCRETE a ro �,c.4 1/ 8 PER FT PERC. RATE MIN./INCH PERC. RATE MIN./INCH PERC. RATE MIN./ INCH �- --- n• 4 CAST IRON OR COVERS EV = / -' ELEV = r m � �; I act+E/r t EL / - ' '� ELEV.= EQUAL) PIPE- MIN.- 12 MAX / ti` E��'° �P - _ PITCH 1/4 PER Fi. / - , o J -2 /o MIN. MULCH L_EA MULC'N � Sua SOIL � �' �' - � ' LEVEL / _ c .�J �-LGcv s ran f - 36 U8 O/L D c Ef J r FLOW LINE a. .. .a. . -EL= 10 - I IMIN / - - v o • . . o: . a : -EL = EL= - 1 MF_ D/CrN/ MED/UM EL= 4 �,. �... rkAIG v���� gFAC�, l oe� 5F�/v'D EL= 1-I - - EL = F�v�<< � \� EL= DIST - - -- - - /44' - /44 - ---- BOX D 4 I ^✓� WATER AT EL = / r WATER AT EL = WATER AT EL = o LOCATION MAP GAL_ PRECAST LEACHING — SEPTIJ � - TANK BASIN EQUAL/ GALLEY OR „• EL= LEGEND: EXISTING SPOT ELEVATION OOXO i / - -DO- FINAL - i � /•� �, . �XISTING CONTOUR - - SPOT ELEVATION 0.0 t FINAL CONTOUR 0 j PROFILE OF - --- --- --- -- - - - - - SOIL TEST LOCATION --OE ' E9r JL �--- OR OBSERVED WATER TABLE EL = SEWAGE DISPOSAL SYSTEM ADJUSTED GROUND WATER TABLE ( /."/'" ) EL = TELEPHONE POLE -o- NOT TO SCALE '-/, �. - �- / , , , �-_ .; � HYDRANT I TOWN WATER I 2 / CATCH BASIN 3 g! �^ -- -- -- —FRAME d COVER SHALL BE 6 i s F o� R G ',� SET WITH MASONRY UNITS ` OF [3/4 �<<--� CLEAN SAND WHICH ARE TO BE MORTARED TUY Qo t IN PLACE - T� r /,,, ---- - - GENERAL NOTES : } __ I. ALL WORKMANSHIP AND MATERIALS SHALL � � I 2 LAYER OF LET �� 1�I�I�ir I 1/8"- 112" WASHED CONFORM TO D. E.Q.E. TITLE 5 AND THE STONE RULES & REGULATIONS Et I% - N�✓ TF" i I -ao -esaa n � _—_ n . n -a-.orenao�-1 TOWN OFl�f/Kn/,;, 3,6 2 F �� ( �� \� I ago . ed trL-_._p_ ' FOR THE SUBSURFACE DISPOSAL OF SEWAGE 2. ALL COVERS TO SANITARY UNITS SHALL BE j J BROUGHT TO WITHIN 12" OF FINISHED GRADE 3.EXISTING AND FINAL GRADES SHALL REMAIN T0f -1 Jr/I 1 yr� ����c < I 1► ,� ° w — 3/4�- 1 1/2" ESSENTIALLY THE SAME t) '�l 1 I - WASHED STONE 0 4. {NO DETERMINATION HAS BEEN MADE BY THIS FYFA�i T/�!•,y // I r I ww a .'OFFICE AS TO COMPLIANCE WITH TOWN t U f DU COVErr� L - - - �` -- - - - - -- - -- - - � �o � - -- - - TONIOBTAINNG G SUCH ONDETES. RM DETERMINATION ON PFIROMANT IS �Jn, r - BASIN STGALL EYHIOR 1 - r> d ;,� �t1G I - 4 nOliF __ T" F �ti /, O o APPROPRIATE AUTHORITY. l� 1 V 24 DIA. COVERS o p p EQUAL 5. THIS PLAN IS VALID IF IT IS STAMPED AND OT ;; ! �� ! (� a�, FLAN VIEW J SIGNED IN RED. THIS OFFICE ASSUMES NG ^ r� t 0 1 - _ I / f 'h `J1 \ ` ? " J ` ` RESPONSIBILITY FOR INFORMATION CONTAINED ON COPIES WHICH DO NOT HAVE ORIGINAL C�• E' �--FRAMES & COVERS SHALL STAMPS AND SIGNATURES BE SET WITH MASONRY UNITS WHICH ARE TO BE MORTARED IN PLACE 6. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF WITHSTANDING H-10 r E�' LEACHING FACILITY LOADING UNLESS THEY ARE UNDER OR WITHIN 3afi � t\\y � `•F-F. INLET � .�. OUTLET 10 FT, OF DRIVES OR PARKING AREAS. H-20 f 3 MIN ;4,. NOT TO SCALE LOADING SHALL BE USED UNDER OR WITHIN 16 c��J ' --� 6 MIN FLOW LINE 10 FT OF DRIVES OR PARKING AREAS 2 MIN. - - - _} REMOVEABLE COVER a, I y n. 7. SETBACK REQUIREMENTS (MINIMUM) / r 14 e 10 MIN. OUTLET PIPES FRONT SIDE REAR AS REQUIRED t ��, � ���, �..-` , , . �' • — ----- - - - - — ----+-- ---- -- - -° • ,, ,o APPROVED BOARD OF HEALTH /; y \ 4 FT MIN. INLET j OUTLET FLOW -- --------- -- /,I LIQUID �� i 1 LINE -� Q ��A c� 44,a` DATE AGENT 3,0 w- \ DEPTH -Y, LOT / _ �L O 1 2 6 O'HERR PROJECT �OCarION CIA No. r V L E INLET TEE PROVIDED ro PER SECTION 15 10.2 APPLICANT: TITLE 5 ,/ �� - RO ,QERT S C'HCJ/�lANil/ CROSS SECTION VIEW �;� /17 OUTLET TEE NO. OF OUTLETS e CHARp f� P \ \ LIQUID DEPTH TEE DEPTH i / � 1AMES BELOW FLOW LINE �•e9 lam/ r/ U,50� SEPTIC TANK DETAIL �/ . vOHEAR4 w ' \ �Z 4 FT. 14 INCHES D IST. BOX DETA I L NOT TO SCALE 5 FT. 19 INCHES NOT TO SCALE Ic c hnoloqy, IncSANIT6 FT 24 INCHES7 FT 29INCHES ' ✓O /- ( FORMERLY R. J. O'HEARN , /NC. ) j Q 8 FT 34 INCHES v�c�!-�\ \` Jlo�o\ '-1 ,� F1 F_ /-'E""�;'':J/V >i/'c r= TO LOT // Engineers - Land Surveyors - Sonitorivns I DESIGN CALCULATIONS V /F `/ T//E Loc%? T/ G^i ,q/�/,: FLEV,g7-/ GNP 35 ROUTE 134 - UNIT 3 - P O. BOX 237 WNC), �T\•� \ e') EX / ST//�i r' NUMBER OF BEDROOMS - l TO i/"//v VN/.�i TEP , ,4^/G S.9/t//7.9/r 'r' /.(,A// T S. SOUTH DENN/S, W. GARBAGE DISPOSAL- UNIT —1 T/ c ,�;`� ���'� REVISIONS i C, i, _ , CJ/✓E �/�/L7 _ O/�_ TQ MOVEO �. c, � �� TOTAL ESTIMATED FLOW 70 7 NF f" 7/ SF.9 �' T/D n/ OF T/-/ .�c'� G/= •... ----- -- --- ( _ GAL / BR /DAY x =_BR. ) __ _.—GAL /DAY •' ?�� W \ \ NEB/- TN. T/-1E E"X/ ST/,,V G LEACH//'✓:; SAS//�i s�q�• °•, - - --- - ---- REQUIRED SEPTIC TANK CAPACITY __ _ GAL. � Cl,`� \ II MF/ Y ��E .F=E- USED /F U/�./GA:'�!.4<'F.+% ACTUAL SIZE OF SEPTIC TANK / ' GAL. VED /30fa.�'DI1 V` �\ LEACHING AREA REQUIREMENTS /rJ• /''F_ ,U T�'I/V/'.i /PE (°OI�G' jI,/I/ D Ec V/DE//C FD F� Y \ SIDEWALL AREA GAL-./S.F / - , c- r �� �4'•. -- — C �\ BOTTOM AREA / . GAL./S.F. E //� T/-/F LX/ ST. .C/ . . ! ✓X \, \ Tf/Ei2E EX/ ST//✓ ram' !_C/� , . �''•, �iTl< ---- - -- -- - ---- LEACHING CAPACITY ( BOTTOM + SIDEWALL ) __/ GAL. / l� '•1 TNT �/ T (J/'✓ COI/Er• EG N14D .�/" ,Ek/=ECT/ VF \ Gc�• J r _ fJIC/� T/`/ 0� 2. 7 FT ANCJ /3/V /�f��KG>C SCALE: " 71 D�J 4/25 2¢ G 4O � O•/�. RESERVE LEACHING CAPACITY...... . __GAL. { / 3 DATE / / ..... � r'// DR. BY APPD. BY J x r lJ• f>� Tl/r>c� O// TtiE PI�G�D r= D TJF S / CA/ EXCFEL) 7/-/F APE � U/ RF_ MEN T.S OF T•/ TL 7—W/F S/�F JOB No. O1-• TNT SIC- L/V,4 C S y 0 T E/✓ / S D E F T TO TN F SHEET _OF .�D - 45� rJ •• G/ Sc.'2E T/r/V OF TN /V-. R0 OF FORM 9/9 /87 , -A3