HomeMy WebLinkAbout0117 GLENEAGLE DRIVE - Health 117 Gleneagie Drive
191-142 Centerville
i
UPC 12534
No.21 3®
HASTINGS,MN
11/19/2004 13:33 5087753397 PHYSIOTHERAPY ASSOC PAGE 01
Town of Barnstable He:dth inspector
("ifficcHours
;;:30—9:30
C.,.-R-egulatqy Services ,
i iABL—
Thomas F.Geiler,Dilrector
MblitHt9th Division
Thomas McKean,Director
�h Inspector
00 Hours
'.30 9.30
_00 2_00
200 Main Street,Hyannis,MA.02601
Flo": 50 MO-6304
Office: :iog-862-4644
AMNESTY PROGRAM APPLICANT— sr4,PTIC QUEST—LINNA11"S'
Size of Pro...)erty
1. Geaeral Information:
AddAddress: map Pal-eel .0
7-
Phone 4:
Name: 7t�-a V
2a. R)w many bedrooms exist at your property now?
2b. Are you planning to add any bedrooms? AN ff yes, 114)w
property(including the arr n.est'1 Mil I? L
2c. How many bedrooms total.are proposed at this
2d.Please include a copy of the floor plans for the�entire Property -SbOw-'!ag t he e ell:isting
rooms in the home plus the proposed amnesty apartment and/or addilioE PICasebabel,
each room clearly on the plans.
3. Is fie dwelling connected to public sewer?, YES or NO
''s.44-througli,40 below.
If.fte 'is-connected to.ptiblic.$cwer,skip question
9
4. Lot:ation of dwelling is INSIDE or OUTSIDE a Zone of Contribul ion,-)put'-ic sul-'Ply wells?
5. Is I he dwelling connected to an ONSITE WELL or to <U�BLIC IVA 71:,,-R?
6. Is a disposal works construction permit on file? J'ES or NO
6a. It'yes,how many bedrooms were approved according to this permit? Bedrooms.
7. W.-re any building permits obtained for construction of additional bedrooms? YES or NO
9, Is there an engineered septic system plan on file at the Health Division? YES or NO
9. Hus the septic system been inspected by a DEP certified inspector within the last rwc yej!I's? TS or NO
FOR OFFICE USE ONLY
The Public Health Division has no objection to bedrooms at tlds -1rOpelt Y.
Special Conditions:
Signed-
Date:
Q:Ihc a1th1Wpf11e.51amna.TVqpp
11/19/2004 13:33 5087753397 PHYSIOTHERAPY ASSOC PAGE 03
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11/19/2004 13:33 5087753397 PHYSIOTHERAPY ASSOC PAGE 04
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No. Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS es
Rpphration for �Digogal 6pgtem Con0truction Permit
Application for a Permit to Construct( ) Repair(;)/ Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. I-e"n<0 5 LL� Owner's Name,Address;and Tel.No.
Assessor's `�Ma /Parcel '
p ,�� �lt�. �� �eU�
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
0 d
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder Va
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) .33o gpd Design flow provided JLf 9 gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank 0—'x S l6 00 Type of S.A.S. rKa �1 Le.tJ�Tn ,r�c-G•• t11—S W/C t ��' 1—ti��
Description of Soil _ a d C,,J ( o�,� C`j. S /(7• �`
Nature of Repairs or Alterations(Answer when applicable) 'Q ace— Q C7n rS
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
Signed Date 9 f / Lo.
Application Approved Date /
Application Disapproved by: Date
for the following reasons
Permit No. e940'7 -�J Date Issued 1 if
........,. r^•�-w�,. �.,',.r.i:+,.., --` ,ti;'�''..4^. ,r�x►'.'y�•.i "."lf i"' ;' ,rak*"C` Y4'?+''-r'F:.t1` 'lur'.�c"*" •.i..t,�+tr�''� JOT y� 7
No. �G J Fee ✓ �o
.- COMM-COMMO WEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH 1�17V,1SIN - TOWN OF BARNSTABE ^MASSACHUSETTS Yes
application for �BiOpoga.Y *pgtem Cougtruction Permit
Application for a Permit to Construct( ) Repair Upgrade( ') Abandon( ) ❑.Complete System ❑Individual Components
Location Address or Lot No. /I? G LeT f w 5 Lp— P O er's Name,Address,and Tel.No.
Assessor'sMap/Parcel �-7 &I<^, Ew k 6 v,W L
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
rnG" -77
Type of Building:
Dwelling No.of Bedrooms `J Lot Size sq. ft. Garbage Grinder,M) I
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 3 3 c) gpd Design flow provided jLf 9 gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank e-r ` S �6 ejQ Type of S.A.S. (Gc, 1�-r-r,,,�t1f S W/o'►k s ���.
Description of Soil — j c,,,.J c?.'q� �K C . C X I• /�
1 r
Nature of Repairs or Alterations(Answer when applicable) $Q k CN 2�— R y� c 5
Fr` K t ,
Date last inspected: _
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of t
Compliance has been issued by this Board of Health. ''
Signed Date ! �-
Application Approve Date
Application Disapproved by: Date
for the following reasons
Permit No. c9A_e2(j'7 5Z= 4 Date Issued I f
r
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
(Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( V/ Upgraded ( )
Abandoned( )by -re,SL
at \ Y Q \,C <' G• \kt, has been constructed in accordance
with the provisions of Title 5 and the or Disposal System Construction Permit No. dated
`Installer Designer t�r .�. �'^ C_ U`~
#bedrooms Approved design flow / / gpd
The issuance of this permit shall dot be co/�stru�e''dfas a guarantee that the system ll f n�Jt on as designed.; /�% p G
Date It / " / Inspector / ]/7"I / /�r.� �l I
ff / `
n a�o -
No. �- d ! Fee
THE-COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS
lwigpogar *p.5tem Con5truction Permit
Permission is hereby granted to Construct ( ) Repair (.,! ) Upgrade ( ) Abandon ( )
System located at N \ C-% Q c, L2. c5r C \l;kl-t
and,as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty
XPcomply with Title 5 and the following local provisions or special conditions.
ovided: Constructio must be completed within three years of the date.of this pe it.
Date., �/ ��/�� Approve by �...�-
Town of Barnstable ,
Regulatory Services
Thomas F.Geiler,Director
Publiceallth DY'itHsiOm
a; Thomas McKean,Director
200 Main Street,Hyannis,Mai 02601
Office:.508-8624644 Fax: 508.790-6304
Installer&Designer Celtfication Form
Date:
D � �� � Installer: �
Designer:
Address: . Address: 0?71 R"t S�
rk 1\,A C� vas 3
�
On �� Lie W. `� � � was issued a permit to install a
Val) (installer) ,,
septic system at �L&44 �t 4- J40(0 based on a design drawn by
(address)
:,, dated
(designer)
,:certify that the septic system referenced above was installed substantially according l)
"die design, which may include minoi approved-changes such as latc4l.Wocatioti of th;
distribution box and/or septic tank.
r. .
_ I certifthat the septic system referenced above was inst ,ed witlz`'.n c
hanges'(Jp.
greater 0' lateral relocatitou of the SAS or any ve�tacal'r&bcaiioa�of any company t
of the.septa"bipystem)but in accordance with State&Local:RegEi�ations.. Plan revisit o�
certified as lsi *by designer to follow.
Y �ID.. ' ' 6.•!
(Installer's Signature) . ISON
sAAfl7—A
er s Signature}
PLEASE I2]C+TURN TO H r T '� I� . B � CERITY , 'y'•,
OF: CDANCENO. . SSI7�D b
BUILT 9WAREREaRED WX19E.RAW9TAIDLE BIM- , g�
THANK YOU.
Q:HealtlAeptic esigner Certification Farm . . :r. !
TOWN OF BARNSTABLE JJ 11``�� ✓
LOu,.NTI'E iV ��� C�� ,f� �� SEWAGE # V W
z: -
VILLAGE tA-- -\4n \ ASSESSOR'S MAP & LOT r
INSTALLER'S NAME&PHONE NO.tt C b� �U' �\/L 51 -7-2S '16 q
SEPTIC TANK CAPACITY to �!T \Obi
LEACHING FACILITY: (type) w. \\ (-"p u6 T�((size
NO. OF BEDROOMS 3 'Zo x \5.
BUILDER OR OWNER `,
PERMPTDATE: Al b / COMPLIANCE DATE: _
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility "� Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) VQ Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) t)-t Feet
Furnished by_ �Q\rn/*
a -
A-0 ��Sqxlxl Loy
63-� sA 2 q
t�� r�3
�ec,V�
TOWN OF BARNSTABLE
L0C-NT1GN \ K l\ SEWAGE #1 " )O
VILLAGE_ `ASSESSOR'S MAP & LOT f
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY ( 4\S4 ' * M'ox
LEACHING FACII.ITY: (type) ,�o k�\ (,e,.;0 T r"(s,ie),z`
NO. OF BEDROOMS ) k f )'-'
BUILDER OR OWNER rr- C ^lC.,
PERMIT DATE: j 1, (b COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility - c 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 _ �. \c;J"
S
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� � /� •�t3 St" �el
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Gtx-�,N� CxX\ SAY a cl',A bb\o
Town of Barnstable P#
Department of Regulatory Services
Public Health Division �:�{: 'Date
ffrABEA
z6 �e$ 200 Main Street,Hyannis MA 02601AA
_.
Time Fee`Pd.
Date Scheduled
Foil Suitability Assessment for Sewtuge Disposal �.
Performed By: Witnessed By:
LOCATION & GENERAL INFORMATION
Location Address �r Owner's Name 3,t 5ic�C.� �4J `
Address ,
Assessor's Map/Pgrcel: ` q- y Engineer's Name
./+�
NEW CONSTRUi[ ITlON REPAIR ✓ } Telephone# - l! .
Land Use G`r ►� " ' ' Slopes(�o) D Surface Stones'
Distances from: Open Water Body ' 'ft' Possible We Area ft Drinking Water Well =ft
Drainage Way ft Property lane O ft Other � ft
SKETCH:($treet name,dimensions of 1 ,exact locations of test holes&perc tests,locate wetlands in proximity to holes)
1 •
CD
4
[..? FTI
T, .
Parent material(geologic) � Depth to Bedrock
Depth to Groundwater. Standing Water in Hole: " l Weeping from Pit Face
Estimated Seasonal 13igh Groundwater
DI ATION FOR SEASONAL HIGH WATER TABLE
Method Used: __. yff In.
Depth OWerved standing m obs.hole: in. Depth to Soil mettles;
in, Groundwater Adjustment fr.
Depth toiweeping from side of obs.hole: pd�,Groundwater Level,
Index Well# Reading Date: Index Well level Rom,.AdJ.factor,
]� PERCOLATION TEST Date .TlMt
it
Observation i rt Time at 9" —.-----
Hole# ;s
Time at 6"
Depth of Perc '
Time(9"-6")
Start Pre-soak Time.@ � /
End Pre-soak
AIIIJ
Rate Min./Inch
Site Failed; A\dditional Testing Needed(Y/N) t�
Site Suitability Assosment:-Site Passed j
Original: Public He;ilth Division ' Observation Hole Data To Be Completed On Back---------
***If percolafiion test is to be conducted within 100' of wetland,you must first notify the
Barnstable Conservation Division at least one(1)week prior to beginning-
Q:\SEPTICAPERC17�itM.DOC
DEEP OBSERVATION HOLE LOG Hole#�,�
Depth from Soil Horizon Soil Texture .Soil Color Soil Other
Surface(in.) (USDA) (Mansell) Mottling (StrucPre,Stones,Boulders.
Cons stenc ravel
2 . to
. G MIL55 2 /o � i Y-,e
?t
W
DEEP OBSERVATION BOLE LOG. Hole# Z.
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell Mottling (Structure,Stones,Boulders.
Consistent %Gravel)
/ 14
PEEP OBSERVATION HOLE LOG Hole#_.,_
Depth from Soil Horizon Soil Texture Soil Color.y ` .,k; Soil Other
Surface(in.) (USDA) (Munsell)iV i Mottling (Structure,Stones,Boulders.
Consistent Gravel
:DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil other
Surface(in.) (USDA) (Munsell) Mottling c (Structure,Stones,Boulders.
onsistenc Gravel)
Flood Insuraniie Rate Map:
- J
Above 5,00 year flood boundary No— Yes .w
Within 100 year boundary No
Within 100 year flood boundary No Yes. .
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pervi tis rial exist in al areas observed throughout the
area proposed fbr the soil absorption system? �.�
If not,what is the depth of naturally occurring pervious material?
Certification �ti,.
I certify that on, (date)I have passed the soil evaluator examination approved by the
Department of tnviron ntal Protection and that the above analysis was performed by Me consistent with .
C* the required training,expe ' e po e perience described in 310 CMR 15.017. '
Signat Date
2Q z x 7
Q:\SEPTIC\PERCf ORM.DOC
\ COMMONVATEALTH OF-NLASSACHUSETTS
'EXECUTIVE OFFICE OF ENVIRONMENTALAFF2URS.
DEPARTM-EI'dT:OF:ENVIR:ONMtIVTA—L PROTECTION
Pecr :.t e�
of o U 1
TITLES
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM.
PART A
CERTIFICATION
Property Address: IJ 7.. rn �
(A
Owner's Name: "� c*-
Owner's Address: ;
r�l�1 7
Date'ofInspection• a607
Name of Inspec (piQase' int) )Company Nam
Mailing Address: ?
4 e-tz,�4f '
Telephone Number:,, Z-7J rzs
CERTIFICATION STATEMEN T
1 certify-that 1-have personally inspected the sewage disposal system at this address and'that the in ormation reported
w ' true accurate and.com lete as of the time of the inspection. The inspection was performed based on my
e o is b ] P
P ,
training and experience.in the proper function and maintenance of on:Site sewage disposal systems.I am a DEP
-approved system inspector pursuant to Section 15.340 of Title 5`(3.10 CMR 15:000). :The systerri:
Passes
Conditionally Passes
Needs Further Evaluation by the.L ocal Approving Authority
Fails
Inspector's Siena#>ire:. Date:. C? ' / 7
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or.
DEP)within'DO days of c.onpletiria 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 serifto the system owner and copies sent to the buyer, if applicable, and the approving .
authority.
Notes and Comments
'-
' ****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.
Title.5 Inspection Form 6/15%2000 page .1
Page 2 of 11 . i
OFFICIAL INS.PECTION:FOR 1-NOT FOR VOLUNTARY ASSESSNSENTS= t
SUBSURFACE SEWA.GE.DISPOSAL SYSTEM INSPECTION FORM
PART A.
CERTIFICATION(continued)
Property Address: e
Owner:
Date of Inspecti. n: -7
Inspection'.Summary: Check- A,B',C,D or E/ALWAYS complete,all of Section D
A. System Passer.
-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 crite.ria.not evaluated are indicated below.
Comments:
B. System Conditionally Passes:
One or more system components:as described in the"Conditional Pass"section need to.be replaced'or
repaired.The system, upon completion of the replacement or repair; as approved by the Board of Health;will pass.
Answer yes,no or not determined (Y,,NjND)in the for the followin-statements. If"not determined"please I
explain.
The septic.tank_is metal and-over 2.0 years:oldY or the septic tank(whether metal or not)is structurally
unsound, exhibits substantial.infiltration or enfiltration or.iank 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. .
ND explain:
Observation of sewage.backup-or break out or high static water level in the distribution box due to broken or.
obstruciedpipe(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
obstruction is-removed
distribution.,box is leveled or replaced
ND explain:
The system required pumping more than:4 times a year due to broken or obstructed pipe(s).The system will
ass'inspection if with.a royal.o t Pf he( P Board of.Health
P
Ilj broken pipe(s),are replaced
obstruction is removed .
ND explain:
i
P'aee of 11
OFFICIAL INSPECTION FORM -.NOT FOR VOLUNTARY*ASSESSMENTS
SUBSURFACE SEWAGE.DI'SPOS' r,SYSTEMINSPECTION'FORM
PART:A
CERTIFICATION(continued)
t ^
Property Address:--/-� �
Owner:
Date of Inspecti n: k5 �/Yit
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; safehl.or the environment.
1. System will pass unless Board of Health determines in accordance with 31*0 CMR 15.303(1)(b) that the
system is not functioning in a manner which will proteet: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 saft'marsh
Z. System will fail unless the Board of Health Viand Public.,Wate'r ,Supplier,if ally).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 SASiis.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 withina`Zone lof a.public water supply.
The system has aseptic 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 M 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 coliform
bacteria and volatile organic compounds indicates that the well is.free from pollution from that facility and
the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided'thatno other
failure criteria are t iagered. A copy of the analysis:must be.attached to this.form.
3. Other:
i
i
' a
Page 4 of.I 1
OFFICIAL INSPECTION FORM=.NOT F.OR VOIfJUNTARYASSESSMENTS
SUBSURFA:CE'SE'WAGE DISPOSAL.SYSTEM-IN"
�SPECTION FORM
PART A
CERTIFICATION(continued)
Property.Address.-
Owner: /
Date of Inspectio
400
D. System Fail ure'Criteria- applicable to allsyste=
You must indicate"yes" or"no"to each•.of the-following for all inspections:
Yes No
_✓ Backup of sewaCe.into.facility,or system component due to overloaded or clogged SAS or..cesspool
Discharge'or p.onding of effluent to the.surface of the ground.or surface waters due to an overloaded or
/ clogged SAS or cesspool
v ' Static liquid-LeveIJn 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 %day flow
Required pumping more.'than 4'times in.the last year NOT due to clogged or obstructed i e s. .Number 'Y pp O
of times pumped
Any Any portion of the.SAS,cesspool or ri p p vy is..below high ground water elevation.
Any:portion.o cesspool or privy is within 100-feet of a surface.water supply or tribtitaryyto.a.surface
water.supply.:
_ Any portion of a ce_�spool.or.privy.is within a Zone 1 of a:public well.
_ Any portion of:a cesspool..or privy is within 50 feet of'a.private water supply well.:
Any: ortion of a cesspool or privy is.less than 1.00 feet but than.50=feet.from a private water
supply well with no acceptable-water quality analysis:.[This system passes-if.the.well water analysis,
performed ati.a DEP certified laboratory,for coliform.ba.cteria and:volatile organic'compounds
indicates that;the.wellis free from pollution from-that.facility'and the:presence of ammonia
nitrogen and;nitra.te nitrogen is equal.to or less than 5 ppm,.pravided that no other failure criteria
pp are triggered!,A..copy-of the analys8.must:be attached to this form.]
(Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as
described in 310 CTIAR 15303,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 consideredlarge: -
� asste m the system must serve.a facili� � - 't a g
Y 3' wt h design IIo� of 10 000 d to. I.� 000
Y g � bP
5Pd
You must indicate either".yes" or"no"to each of the following:
(The following criteria apply to large stems.in addition to the criteria above PPY s b .Y )
yes no
the system is within 4.00 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 signif cant.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.
Page 5 of I
OFFICIAL INSPECTION FORM=NOT FOR VOLUNTARY A_. SSESSIVIEivT S
SUBSURFACE'SEWAGt DI.SP.OSA.L,SYS'TE-M INSPECTION FORM
TART B
CHECKLIST
Property-Address:
A
Owner: t De
Date of Tnspectia:' ) j 7
Check if the followine have.been done..-You must indicate dies"or"no" as to each of the following:
Yes No
Pumping.information was.provided by the owner,•occupant, or Board of Health
Were any of the system components pumped out in the previous two weeks
(/ Has the system received normal flows in the previous two week period?
7 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)
V. _ Was the facility or dwelling inspected for signs.of sewage back up? '
Was the site inspected for signs of breakout?
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 affles or tees; material of construction, dimensions, depth-of liquid,.depth of,sludgeand 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 Absorpfion.System (SAS) omthe site has been'determined'based on:
Yes- .no
Existing information.For example, a plan at the Board of Health.
Determined in the field.(ifany of the failure criteria related to Part C is at issue approximation of distance
is unacceptable) [310 CMR 15.302(3)(b)]
,
Page 6 of 11.
OFFICIAL INSPECTION FORM I'�OT.FOR VOLUI�T RY:ASSESSMEiVTS =
SUBSURFACE-SEWAGE DISPOSAL SYSTEIM I1�i.SPEC`I'IOl`�FOPM
PART.C
SYSTEM:INF.OPUMATI ON
Property
l A ddrescs
Owner: ct' :Date,of Inspe n A
10.7 _
"
RES / FLOW CONDITIONS
IDENTIAL v
Number of bedrooms(design):. Number of bedrooms (actual),:��
DESIGN flow based on`310 CMR 15.203 (for example: 11.0 apd x n of bedrooms): 3d
Number of current residents:. � /
Does residence have a garbage grinder(yes or no):ND
Is laundry on.a.separate:sewase system(yV or no): .[if yes separate inspection required]
Laundry system inspected(y�.or no): v
�/ z
Seasonal use: (yes or na). .
Water meter read 45— �I d ings, if av ilable(last 2 years usaZ a gp d)):�t
Sump-pump(yes.or no): n
Last date of occupancy:: '/
COMMERCIALIINDUSTRIAL A
Type
of establishment: ;
Design flow(based on.310 CMR'15.203): Qpd
Basis of-design flow(s eats/persons/sqft,etc.):
.Grease trap present(yes:orno);
Industrial waste holding tank present(yes or no):_
Non-Sanitary waste discharged to the.Title 5°system(yes or no):
.Water meter readings, if available:
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source-of information:
Was system pumped as part Lofthej specti n(yes or no):
If yes,volume pumped: gallons -How was quantity pumped determined?
Reason,for pumping:
7TY E OF SYSTEM
Septic tank, distribution box,soil absorption system
_Sinale 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)
—Tiaht tank _Attach a copyof the DEP approval
_.Other.(describe):
roximate age of all componen , date insta led if known) and source of information: ,
Were sewage odo.rs:detected when'.afriving at the site(yes or no)
6
Page 7 of I 1
OFFICIAL INSPECTION FORM=NOT FOR' VOLUNTARY ASSESSMENTS
SUBSURFACE SE'WAGED.ISPOSAL`SYSTEM-INSPECTION TORM.
PART':C . .
SYS` FM.IINFORMATION (continued)
Property Address:
Owner. J /
Date of Inspection
BUILDING SEWER(locate on site plan)
Depth below grade:
Materials of construction:_cast iron _40 PVC other(explain):
Distance-from private water supply well or suction line:
Comments (on'condition`ofjoints,venting, evidence of leakage, etc.):
SEPTIC TANK: (locate'on site plan)
Depth below Grade:
Materiel of construction:. oncrete metal_fiberglass . Polyethylene'
_other(explain)_
If tank is metal list age:— .Is age:confu-med by a Certificate of.Compliance(yes or no).` (attach..a copy of
• Dimensions:
Sludge depth:
Distance from top of sludge to bottom of outlet tee or baffle:. .
Scum thickness:
Distance from top of scum to top:of outlet tee or baffle:.
Distance from bottom of scum to bottom of outlet tee or baffler
How were dimensions.determined: , 4A-1 Kl-,�.eam -I6/h.�
Comments(on pumping recommefidatio s, inlet and outlet tee or baffle condition, structural integrity, liquid levels
related to outlet invert,evi ence of leakage, etc.):
s
rAlf,
—
e.�A) a4le
GREASE TRAP/.IZD(locate on site plan)
Depth below grade:_
Material of construction:_concrete_metal._fiberglass Polyethylene_other .
(explain):
Dimensions:
Scum thickness:
Distance from top of scurn to top of outlet tee or baffle:
Distance from bottom of scum to bottom,of outlet tee or baffle:
Date of last pumping:
Comments(on' pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet invert, evidence of leakage, etc.):
7
Page 8 of 11
OFFICIAL;.INSPECTION FbRM NC!TTOR.-VOLUNTARYASSESSMENTS
SUBSURFACE-SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C.
SYSTEMINFOR-MA.TION(continued)_
Property Address:
Own err% y
Date of Inspecti r�GU
TIGHT or HOLDING TANK: /t/O(tank must be pumped at time ofinspection)(locate on.site plan)
Depth,below grade:
Material of construction: concrete metal fiberglass_polyethylene other(explain);.
Dimensions:
Capacity: gallons
Design Flow: gallons/day
Alain present.(yes.or no):.
Alarm level: Alarm in working order(yes'or no):
Date of last pumping:
Comm ents�(condition of alarm and float switches,etc.):
DISTRIBUTION BOX: (if present must be'opened)(locate on site.plan)
Depth of liquid Ieve!above outlet invert: � �f=�GP�'/ j
Comments (note if box is..level and distributionto outl6* equal,.any evidence of solids carryover, any evidence of
leakage into or out of box, etc e 642-el
PUMP CHAMBER:.(locate on site plan):
Pumps in working.order(yes of no):
Alarms in working order(yes or no):
Comments (note condition of.pump chamber, condition of pumps and appurtenances, etc.):
Page 9 of I I
OFFICIAL INSPECTION FORM.—NOT.FOR.YOLUNTAAY ASSESSMENTS
.SUBSUAFACE-SEV/AGE::DISPOS-�kL.SI'S:TEM INSPECTION FORIM,
PART C
SYSTEM INFO'RMATION(continued)
Property Address:
Owner:
Date of Inspecti Q'j 7
SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, excavation not required)
If SAS.= located explain why:
Type
ching pits,number:
le aching'chambers,number:
leaching.galleries,-number:
leaching trenches, number,length:
leaching fields,.nunber, dimensions:
overflow cesspool,number:
innovative/alternati.ve system- Type/name of technology:
Comments (note condition of soil,signs of hydraulic failure, level of pondinQ, damp soil;condition of vegetation,
_
CESSPOOLS:)6/L(cesspool must be pumped as part of inspection)(]ocate 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 or no):
Comments (note condition of soil, signs of hydraulic failure,.level of ponding, condition of vegetation, etc:):
PRIVY: (locate on site plan)
Materials of constriction:
Dimensions.
Depth of solids:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.):.
. 9 Ili
Page 10 of 11
OFFICIAL;INSPECTIONTORIYI 1:-OT. FOIRNOI:UIXTAIRY ASSESSMENTS .
SUBSURFACE SEWAGE:DISPOSAL SYSTEM-INSPECTION FORM.
PANT-C.
SYSTEKIi`1:.FORMATION(continued).
1 �
Property Address:
Owner
Date of Inspecti r ddd'�
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the:sewase disposal system includins ties to at least two permanent reference landmarks or
benchmarks. Locate all:wells within 100 feet:Locate.where public water supply enters the buildin1g.
r
a
� ova N
one
� 1 0
Q00
' id
Page.11 of I]
OFFICIAL INSPECTION FORIM —NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM.INSPECTION FORM
PART C
-SYSTEM-INFORMATION(continued)
Property Address: '/
Owner:
Date of Inspectio : ��yj-7
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells l
Estimated.depth to 6 ground water Meet -
Please.indicate (check)all methods used to determine the high ground water elevation:
Obtained from-system design plans on record -If checked, date of design plan'reviewed:
Observed site (abuttinc,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 groundwater elevation:
,
r
11
I
Permit Number: Date:
Completed by:
HIGH GROUND-WATER LEVEL COMPUTATION
Site Location: / 7 lei- <G� �� �� /,/,` Lot No.
Owner: Address: y �t
Contractor: r"71 Address:
Notes:
STEP 1 Measure depth to water table
to nearest 1/10 ft. ............................................ .................... .Date L�7
month day/year
STEP 2 Using Water-Level Range Zone
.and Index Well Map locate
site and determine:
Appropriate.index well.................................................... Z
OB Water-level range zone .....................................................
STEP 3 Using monthly report"Current
Water Resources Conditions"
determine current depth to
1
water level for index well .:......................... P q7,y
month/year
STEP 4 Using Table of Water-level Adjustments
for index well.(STEP 2A),current depth
to water level for index well (STEP 3),
and water-level zone (STEP 213)
determine water-level adjustment ................................:....:....................................................
STEP 5 Estimate depth`to:'high water
by subtracting the water
level adjustment (STEP 4)
from measured depth to water
level at site (STEP.1) .......... j
Figure 13.--Reproducible computation form.
t 15
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- - -
� - - .
.� ='i
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TOWN OF BARNSTABLE LOCATIOA J 7 61 eyi 6 U SEWAGE #�L7�A 7
VILLAGE ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) / (size)
NO.OF BEDROOMS ,, JJar`''^``�
BUILDER OR OWNER 1 n 1`DS ��PhT►`oi
PERMTTDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) - Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
( ASSESSORS MAP NO: j q j
No.!Z.'/Z 7.. PARCEL NO.: 1 a FiQ7 7..............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH NY
e -l
...................oF...��►.rL.r�1:�'1:.�r�!�...-----.CerTcrv-�-�-i-- --- ----
Appliration -for Mipoiial Works Tonotrurtiun Prrutit
Applicatio is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal
System at: fIT4047
-..:_�dr. ........... l ea:�P ���. �� r�,v .----....... —�a.� ------------------------------------------- ----
Location Address or Lot No.
.......C�3 R �-T`t 'zysT (til�i�.. :..---..Ct�!�o�o.�?..-... .°.:..ga x .!:1....--
............... •---••-•-------•--
'C Z Owner Address
Installer Address
PQ
Type of Building p Size Lot..1.�g4l.............Sq. feet
U Dwelling—No. of Bedrooms.__......... t 1? ?S�rm_..._...Expansion Attic e) Garbage Grinder ()Uo)
P4 Other—Type of Building MXA_4`"S E_ No: of persons____________________________ Showers ( ) — Cafeteria ( )
WDesign Flow_3 X i U P)u )_5...........gallons per person per day. Total daily flow...................-. �� .�P�.gallons.
WSeptic Tank—Liquid capacity!W..0..gallons Length__.&........ Width.*P...... Diameter________________ Depth.S...).L__-
x Disposal Trench-No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No.�.._0o' .__.. Diameter.....id......... Depth below inlet......._?/------- Total leaching area...2(Q_�._.._sq. ft.
Z Other Distribution box N ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
aTest Pit No. 1.L.. ....... per inch Depth of Test Pit----!R:: ..... Depth to ground water...t.)lfi1C,.........
Test Pit No. 2.L.Z ......minutes per inch Depth of Test Pit....?a:.0...... Depth to ground water----ricm6E.......
•---•....................................................•-•_-----------•----•-••-••-•--•-------•......................................]a..................
O Description of Soil... ....... ?.�...... EY�Ii4r .......� SP.t �' 1 .�----•- -�a T ......�Z
u1 � 5 .........� �9 ==`...........................•-..*----------------•------*-----------------------------•-----
---------------------- ------------------------------- ................................................................................................................................................
U Nature of Repairs or Mterations—Answer when applicable................................................................................................
-------•-------------------•---•_-----------_--_---•---_•••------------.--...-•---••--••-_•_•-•--------•_---------------------.------------•••-------_---------------------_---_-_---_•---_-....------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of iITLi: 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in
operation until a Certi- to of Complian issued by the board of health.
Signed lL .................. .�J.... .... ..-------
ate
Application Approved By........ -
Date
Application Disapproved for the following reasons:...............................................................................................................
--•--•-•-••---•---------•----•..................•--•-•---_-------_--------...-•-•-------•--•---.....--------•--------------------_--------------••------_-------_--------•-----_--------•---_--••---.._
Date
Permit No.... ... -: i.L.. Issued.......................................................
Date
No..�7.-�. 7 Pan C—Q 4 I-f 2 Fss7�-- ....._.
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
` r epI11......................oF.... C?Jl .....--�, r!tFc.c?��If?......
Appliratiun for Disposal Works Tonstrurtiun rrrm t
Application is hereby made for a Permit to Construct (X ) or Repair ( ) an Individual Sewage Disposal
System at:
kcj ..!!.......Qe!v.---:..- � •--�� 2tc ..................... ......•---..._._...................-----.._...---_..--•-.......---...................._..........
Locatr .Address or t No.
._....G'+g F}L_.. ! St :v:_ �a: ...!. ._.. i2gl�n?�:9%tr
- ---- ........ ..
owner Address
W ... i�(C 9?n 5T-- --•-----•-C'eri 1 P r��t(e.......&—Is...................................
Installer Address
Type of Building Size Lot....
-....t.�l`�.I.........Sq. feet
U Dwelling—No. of Bedrooms.S...&JI'29�m-t.............Expansion Attic (W) Garbage Grinder (OG)
Other—T e of Building r0M1E No. of persons............................ Showers
Q•I Other—Type g �-�--------- P ( ) Cafeteria ( )
Q' Other fixtures ------------------------------------------------------------•--•...
W Design Flow.3`l.1►4?.0 _x�. .............gallons per person per day. Total daily flow_.._.........s�---2---------......._.._.gallons. ia �,t'D
WSeptic Tank—Liquid capacity.1W.....gallons Length.b."6�.._.. Width.�L'-!��`_._ Diameter................ Depth.....t....
W Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
3 Seepage Pit No....6�-���-•- Diameter..._.�9........... Depth below inlet....'........... Total leaching area-_..Zit.,.�-....sq. ft.
Z Other Distribution box (K ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
14 Test Pit No. I..L z.......minutes per inch Depth of Test Pit....!?.: ...i, Test Pit No. 2..��._....minutes per inch Depth of Test Pit... _. ...•.. Depth to ground water..toms...........
--•---••.........................•------•-•--•--•---•-----
......
LL
O Description of Soil--- �:. .......s iuD...X---..�i� l....... --- L .. 7 .. ........................
MAE-6-------- 1 fit....C�tz r9 e
U -•---•----••--•-------•- -- ---------------------------------------------------------•-----
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 Sanit Code—.The undersigned further agrees not to place the system in
operation until C--tiqcate of Compliance has be sued by the board of h th.
~ \\, ,,
_../ nn
Signed....... . ......�..1.�...---- --•- --• ------------------------ ......��.�:..........:.-7__
Date
Application Approved By---..... .. .......... _ ..._.......
Application Disapproved for 0 0--o vin reasons:............................................................................................... ..........-_-
.......................•-•---•-------....-•-•---•-----•-•-•------.......---------•---••-----........---•---•--•----•-•---•-.....•---........------•._......-•-••-------.......... .D�............_
PermitNo...... .. ._... .._.... Issued----------------------------••---••-.................
...
- / (� 7 Hate
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
................OF................
.................... ...
krrtifiratr u " unta tttnrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
ff .._... ....--Installer....................:.....................•..............C.................................
at... . •.... t ----- . -•-------------------•----•----------.........----•-•-------...--•---....... ---...------......_
has been ii � .- in 'a cor n ltl'' ovis s'of TITIE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No....... .. .............. ...._....... dated...............r.................................
THE ISSUANCE OF THIS CERTIFICATE SHALL I BE iONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY. —_
DATE............................ Ss' ......__ Inspector......... j---------- .........................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
No.. .7 � (?.`.(..�.. ....-.....OF. _M*e-..../..( •.:... �. ................ ... Fn...
C?-�c.c�
Disposal Works Tunu#rixrtiun Prrntit 7 ....
Permission is hereby granted.... II.,�..... . -•--•-•-- .......__--_
to Construct ( ) or Repair ( ) ann'diwir3a� 1ewg�Dtisa1 System
at No..- --
............................:.... ............................ . ............-----.......... .................................................
, ? G i r Street,_._,,e / �
as shown on the application for D>sposal WorW Construction Permit No..:,:.. ... Dated............. ... ........ .......
.
�.
DATE...........
-•--- .•---•- ---------•-•................ 1
FORM 1255 A. M. SULKIN, INC., BOSTON
r
TOWN OF BARNSTABLE
LOCATION v �� �� (' ` _� ��� t ,SEWAGE #
yILLAGE ASSESSOR'S MAP
4j & LOT ��
VNSTALUER'S NAME & PHONE NO.
SEPTIC TANK CAPACITY
s
EACHING FACILITY:(type) (size) 0 0 O
NO. OF BEDROOMS PRIVATE WELL OR UBLIC WAT
BUILDER OR OWNER
DATE PERMIT ISSUED: _ 7
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No �/
U
a -
1 `� b
DESIGN DATA
STRUCTURE SINGS-F_ F \ILy PWEL-L'
- ..' DESIGN FLOW 38•DRM No GRIND .
►S's... 3 A 110 G•PD/23•DRAN
i" G lR 5
F) cII w�D� 33o �+�Drls = �q
$ G'Di7
K LOT
12. 0. SEPTIC TANK SSE' 1000 GAL,
LEACHING RATES SIDE AREA..!?-S GPD/SF
BOTTOM AREA /OGPD/SF
LEACHING FACILITY
^t O
0
Of x
o Q p S/PCA)ZEA : 10n6n -& - ���
I ( n a� S C�sr. ART AI : S= " Zr = 7,?
F N� 0.99,x ,$)tl72-x /,
PLAN REFERENCE: ?6
i►y O''z�o c 1 � x� ?LZ3K �lo
o o-
\ 7.7
LIP ASSESSORS LOT NO. /V\A I°II I-dT 142-
NOTE-
I. ALL MATERIALS AND CONSTRUCTION METHODS
N/F TO CONFORM WITH COMM. OF MASS. TITLE M:
J ENVIRONMENTAL CODE
a� /� '/a V/ 3. ALL, A'[�. TrIIVG LOTS 14AVE
�� ?'O wN WA Tc R
` p / fit► = �P3t.0'POS�D �aRAb �
E.X%ST, "PAVE'P1MNT
BENCH IV\A-,
1-0'r 1 p H.YDRA►`lT TAG.Bok.-T
—
N �Jf�
o 14,
JO
1: PLAN is ►,' w
o. vy7 IS
G/ SCALE �° 4�� ( Z A / 29374 =�
TEST PIT NO. TEST PIT .NO. ,l1 4f �E`�
ELEV. IOOe ELEV. 1 01 . fGlTE•
gam.
• �vo'rvti^t'� _ •cep
SOIL OBSERVATION PITS
CSP t=M� . _..~''_ 1�. hROPo3L'D <o R�'DE DATE OF TEST Su L_y
_
_ ._.._ — —. o v ENGINEER "DA�/l? T1�ur,.-1 N
• �-— 102:00 ST NG G v I 00 1..0 A M
B O H M E N G O. .A ENT T M 1 A
TANK RISER. LOA 2•o StJ8301�..
a: SUB SO I L .. EXCAVATOR /aY0 T T
o e zs PERC RATE IN T•P.NO. / AT Co FT.= L z MINJIN.
9.0r�-�-7
'sOP t c o° M E'D, SANS � LOT ( 1 , C�L E/�I E A C,L E roR► vE
$o ° ftA1/E L G� ITT CiZ �/1 .MA S5'
TANK. �� MED SANb G
,_ FoR YVA%-A N �S
F7Ew CO'53LES
ELLISo S T v
10 LAND SURVEYORS AND CIVILENGINEERS
.
EAST SANDWIC
H, MAS
S.
.
w
nF T PI
�Ro'p05G'U �L-OT
SCALE OR, I slo VF-R' I".=S. o ; T ,
.�L SECTION THRU.. 'S.EPTIC SYSTEM
tx No "v,/ATE'tR
__ _ .
�i
. ,
ASSESSORS MAP :
- TEST HOLE LOGS NOTES:
PARCEL : / -
-F FLOOD ZONE: ��� f ,�, SO I L EVALUATOR : l IAYlT ,° w Gam.
WITNESS : 1_90ww IMUJQ V491) The installation shall comply with Title V and Town of Barnstable Board of
fa REFERENCE: 8c0L-' DATE: 2G> !r Health Regulations.
~~ PERCOLATION RA,E: '�f�
2 The installer shall verifythe location of utilities sewer inverts and septic
r Z
components prior to installation and setting base elevations.
I
3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8" per foot. The first
0 TH- I TH-2 two feet out of the d-box to the leaching shall be level.
Dt44II C. 4) This plan is not to be utilized for property line determination nor any other.
purpose other than the proposed system installation.
l:p
5) All septic components must meet Title V specifications.
10 �� ��,`j b) Parking shall not be constructed over H1.0 septic components.
LOCATION MAP C4-1 Mkt 11�'1t� 2� meo, �►�k1t 7) The property is bounded by property corners and property lines.
66�i �o%l .t1 Gt lo%p fqV6, 8) The property owner shall review design considerations to approve of total
,
�. l �' 7-6LO H. design flow and number of bedrooms to be considered for design. Receipt of
payment for the plan and installation based on the plan shall be deemed
ram/ approval of the design flow by the owner.
9) The existing leaching or cesspools shall be pumped and filled with material
per Title V abandonment procedures. Those within the proposed SAS shall be
1 � r �j�' � 52° removed along with contaminated soil and replaced with clean washed sand
"�" -•..,., l�, �/ Sc O$ /Z ' _.s�, e,..( �!�Ja b�ti � ' . per Title V specs. i
10)System components to be 10 feet from water line. Sewer lines crossing the
water line sliall be sleeved with 4 inch SCH 40 PVC with ends grouted if
sty` applicable.
I C SYSTEM DES IGN 11) If a garbage grinder exists it is to be removed and is the responsibility of the
I FLOW E5T 1 MATE owner to ensure such.
12)The installer is to take caution in excavation around the as line if applicable.
�� 3 I 13)The installer shall verify the location, quantity and elevation of the sewer lines
BEDROOMS AT GAL/DAY/BEDROOM - GAL/DAY exiting the dwelling prior to the installation.
SEPTIC "TANK
t)� FJ�GAL/DAY x 2 DAYS - GAL
f r
USE IWO GALLON SEPTIC TANKX.! T't
y � �� SOIL. RESORPTION SY�TEM__._.__._
; _j —
F 77=T7
0� CM k/ I t�i 5 �� l 11.4.r� 2:S w 11 Uc X I o Z t�!F
X _113 81%v_'K''. .. _
I � c �{..(.� (� � .,N j_..�p� l�./FiGT�egTb/Z„t y,72 5��1-F FIEL1,� . GOWFIItv�}i70�1 � QIAy1p �, t 4m ,��;
__ c -
09 iwfi�,_ u��t- /-�Wf�!6 a5/x j,7 Z = z , 5" s� uW iT �,
MAS N•? � � ti� "� Nl)�l, LI��- 29 .��1//.1�T-- � vG,o(/T _ G
-tom
x_�7
/S VE `
. . s
S T I C SYSTEM SECTION NWT°S.
g
I b�D�' �1►�D ��Y' . F.G.2%slope over leach facilityto preventponding EL: Ot L���
�'�
� : .• �r 11x1, Ma , ► can Backfill Sand Over Filter Fabric/Min.14"for HD Loading Min.11ns e f n P
i LJFF
4 I b�, i ( �--
Bre
�
Ej 16•
+— `�` � D-BOX ,�jE t���$" ao 10. •Inve
I � GAL �
(��,I �J '�s1-- `� EL
I k ' SEPT I TANK F� . ltcs5:lean TitleVSand Ilse I .High Capacity Infiltrators without Stone
i Rows of 4 Units set W apart(25'x 9.5'x 10.2")
i
H-20Loading
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