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commonwealth of Massachusetts
Title 5 Official Inspection Form r
11. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
76 Headwaters Road
Property Address
Irene Best
r:
Owner Owner's Name
information is required for every Centerville ✓ MA 02632 6-11-19
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 filling out forms A. Inspector Information cS14r 13 e,"101
on the computer, Brett Hickey
use only the tab
key to move your Name of Inspector
cursor-do not B&B Excavation
use the return Company Name
key.
374 Route 130
u� Company Address
Sandwich Ma 02563
City/Town State Zip Code
(508)477-0653 S113747
/ Telephone Number License Number
B. Certification
I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5
(310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address
listed above; the information reported below is true, accurate and complete as of the time of my
inspection; and the inspection was performed based on my training and experience in the proper function
and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined
that the system:
1. ❑■ Passes
2. ❑ Conditionally Passes
3. ❑ Needs Further Evaluation by the Local Approving Authority
4. ❑ Fails
Brett Hickey I,
6-11-19
Oate:ID19.U8.1303:50:A MW
Inspector's Signature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board
of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of
10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate
regional office of the DEP. The original form should be sent to the system owner and copies sent to
the buyer, if applicable, and the approving authority.
Please note: This report only describes conditions at the time of inspection and under the
conditions of use at that time.This inspection does not address how the system will perform
in the future under the same or different conditions of use.
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18
Commonwealth of Massachusetts r Y
,p Title 5 Official Inspection Form
la Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
76 Headwaters Road
V
Property Address
Irene Best
Owner Owner's Name
information is Centerville MA 02632 6-11-19
required for every
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary
Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6.
I
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:
The system was in working order at the time of inspection. Driveway was shortened and blocked with
landscape timber to prevent vehicle traffic from driving over H-10 tank.
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.7/28/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18
I
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
76 Headwaters Road
Property Address
Irene Best
Owner Owners Name
information is Centerville MA 02632 6-11-19
required for every
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
2) System Conditionally Passes (cont.):
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below):
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
3) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
a. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18
c Commonwealth of Massachusetts
�m Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
76 Headwaters Road
Property Address
Irene Best
Owner Owner's Name
information is Centerville MA 02632 6-11-19
required for every
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.
I .
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply I 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
�I
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
❑ 0 Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ El Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 18
i
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
76 Headwaters Road
Property Address
Irene Best
Owner Owner's Name
information is Centerville MA 02632 6-11-19
required for every
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
4) System Failure Criteria Applicable to All Systems: (cont.)
Yes No
❑ El 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
❑ O 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.
❑ a 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 water supply
well.
❑ El Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ El 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.]
❑ Q 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
l5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 18
cam, Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
76 Headwaters Road
Property Address
Irene Best
Owner Owner's Name
information is Centerville MA 02632 6-11-19
required for every
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
Q ❑ Pumping information was provided by the owner, occupant, or Board of Health
❑ El Were any of the system components pumped out in the previous two weeks?
El ❑ 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?
El ❑ 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?
El ❑ Was the site inspected for signs of break out?
El ❑ Were all system components, excluding the SAS, located on site?
El ❑ 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?
P q P 9 P
❑ El 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:
El ❑ Existing information. For example, a plan at the Board of Health.
❑ a 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
i
Commonwealth of Massachusetts
�n Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
I
76 Headwaters Road
Property Address
Irene Best
Owner Owners Name
information is Centerville MA 02632 6-11-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information
1. Residential Flow Conditions:
3 Number of bedrooms(design): Number of bedrooms (actual): 3
DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330/GPD
Description:
Number of current residents: 2
Does residence have a garbage grinder? ❑ Yes No
Does residence have a water treatment unit? ❑ Yes Q 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 E] No
Seasonal use? ❑ Yes [. No
Water meter readings, if available(last 2 years usage(gpd)): See below
Detail:
2017=123 gpd 2018=77 gpd
Sump pump? ❑ Yes ❑■ No
Last date of Y
occu anc Current
occupancy: Date
l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18
c Commonwealth of Massachusetts
,p Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
76 Headwaters Road
L
Property Address
Irene Best
Owner Owner's Name
information is Centerville MA 02632 6-11-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
2. Commercial/Industrial Flow Conditions:
NA
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: Owner- pumped 2 years ago
Was system pumped as part of the inspection? ❑ Yes ❑U 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
f
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
76 Headwaters Road
v�
Property Address
Irene Best
Owner Owner's Name
information is Centerville MA 02632 6-11-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
4. Type of System:
El 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:
2017
Were sewage odors detected when arriving at the site? ❑ Yes ❑■ No
5. Building Sewer(locate on site plan):
3'
Depth below grade: feet
Material of construction:
❑ cast iron X 40 PVC ❑other(explain):
Town water
Distance from private water supply well or suction line: feet
Comments(on condition of joints, venting, evidence of leakage, etc.):
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18
f
c Commonwealth of Massachusetts
,9 Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
76 Headwaters Road
Property Address
Irene Best
Owner Owner's Name
information is Centerville MA 02632 6-11-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
6. Septic Tank(locate on site plan):
2'
Depth below grade: feet
Material of construction:
M 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 gallons
211
Sludge depth:
34if
Distance from top of sludge to bottom of outlet tee or baffle
1"
Scum thickness
6"
Distance from top of scum to top of outlet tee or baffle
1619
Distance from bottom of scum to bottom of outlet tee or baffle
measured
How were dimensions determined?
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
The tank was in working order at the time of inspection. The tank is not in need of pumping
at this time but should be pumped every two years for maintenance.
t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18
i
Commonwealth of Massachusetts
,lp Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
76 Headwaters Road
Property Address
Irene Best
Owner Owner's Name
information is Centerville MA 02632 6-11-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
7. Grease Trap (locate on site plan):
NA
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):
NA
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Capacity: gallons
Design Flow:
gallons per day
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18
c� Commonwealth of Massachusetts
,/a Title 5 Official Inspection Form
~ ; Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
76 Headwaters Road
LJ�
Property Address
Irene Best
Owner Owner's Name
information is Centerville MA 02632 6-11-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
8. Tight or Holding Tank(cont.)
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments (condition of alarm and float switches, etc.):
*Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
9. Distribution Box if resent must be opened) locate on site plan):
( P P ) ( P )
0"
Depth of liquid level above outlet invert
Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
The d-box was in working order at the time of inspection.
t5insp.doc•rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18
cam, Commonwealth of Massachusetts
�n Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
r
76 Headwaters Road
Property Address
Irene Best
Owner Owner's Name
information is Centerville MA 02632 6-11-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
10. Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No*
Alarms in working order: ❑ Yes ❑ No*
Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.):
NA
* 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:
❑ leaching chambers number: (2) 500 gal.
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
I
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
�n ,�p Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
I;
76 Headwaters Road
u—
Property Address
Irene Best
Owner Owner's Name
information is Centerville MA 02632 6-11-19
required for every
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.):
The SAS was in working order at the time of inspection. Chambers were dry when viewed.
12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
NA
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 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18
Commonwealth of Massachusetts
p Title 5 Official Inspection Form
15 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
76 Headwaters Road
u-
Property Address
Irene Best
Owner Owner's Name
information is Centerville MA 02632 6-11-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
13. Privy (locate on site plan):
Materials of construction: NA
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 I�
Commonwealth of Massachusetts
p Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
76 Headwaters Road
v
Property Address
Irene Best
Owner Owner's Name
information is Centerville MA 02632 6-11-19
required for every
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:
N hand-sketch in the area below
❑ drawing attached separately
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t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18
i
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
I
76 Headwaters Road
u-
Property Address
Irene Best
Owner Owner's Name
information is Centerville MA 02632 6-11-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
15. Site Exam:
0 Check Slope
0 Surface water
0 Check cellar
❑■ Shallow wells
GW > 4' below SAS
Estimated depth to high ground water: feet
Please indicate all methods used to determine the high ground water elevation:
❑ Obtained from system design plans on record
4-20-19
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:
A plan on file at the local Board of Health was used to determine high groundwater.
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
�m Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
76 Headwaters Road
u—
Property Address
Irene Best
Owner Owner's Name
information is Centerville MA 02632 6-11-19
required for every
page. City/Town State Zip Code Date of Inspection
E. Report Completeness Checklist
Complete all applicable sections of this form inclusive of:
❑■ A. Inspector Information: Complete all fields in this section.
❑■ B. Certification: Signed & Dated and 1, 2, 3, or 4 checked
■❑ C. Inspection Summary:
1, 2, 3, or 5 completed as appropriate
4 (Failure Criteria)and 6 (Checklist)completed
❑■ D. System Information:
For 8: Tight/Holding Tank—Pumping contract attached
For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached
For 15: Explanation of estimated depth to high groundwater included
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18
TOWN OF BARNSTABLE
LOCATION SEWAGE # C90/ — /-3
l,VILLAGE ��n t/t--�1t-�-! �1 ASSESSOR'S MAP & LOT C9 TY;�L
INSTALLER'S NAME&PHONE NO. ln�n �c�cr y --(lw�° @
SEPTIC TANK CAPACITY A5(50ngWn
L ACHNG FACILITY: (type) C� Ck&b62C5 (size)I is
NO. OF BEDROOMS
BUILDER OR OWNER
PERMIT DATE: ! f "aOI9 COMPLIANCE DATE:
Separation Distance Between the:,
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet !
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility (If any wetlands exist
%ithin 300 feet of leaching facility) N Feet
t}r shed by
f
� 5
7 I
Fee 166
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
2ppliLAtlon for Disposal 6pstrm Const union Permit
Application for a Permit to Construct( ) Repair( ) Upgrade,) Abandon( ) ,Complete System ❑Individual Components
Locitin ddr or Lot No. } �� �Q� Te ��'�I e Owner's Name,Address,and Tel.No. �8f, q' �,8S t 74,4o��Assr's Map/Parcel 2 [(�g(� 2 tU Klr 1 D ^bit �(
Installer's Name,Address,and Tel.No. ��,13 bq 6VOO Z 'Delsig�nner's Name,Address,and Tel.No.
J
eo-* -rorrz Jl r-Llw:e� V J S�QC i K 5d , l J 3 j f�b7
Type of Building:
Dwelling No.of Bedrooms Lot Size / �'� sq.ft. Garbage Grinder ),N.�•
Other Type of Building S'f-J t e_ Ro4ou No.of Persons Showers( ) Cafeteria( )
Other Fixtures Design Flow(min.required) 3 30 gpd Design flow provided 0-3 1 1 3 gpd
Plan Date 3o -11 Number of sheets OF— Revision Date L,
Title G b #0110"kfl P 216
Size of Septic Tank / S-o (l/ Type of S.A.S.
Description of Soil .2Q_P !gip ct
Nature of Repairs or Alterations(Answer when applicable) �d�n�/J�Q 1Q X� S.,T"e✓1
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 Healt
gne Date 492. 1:�2
Application Approved by Date
Application Disapproved by Date
for the following reasons
Permit No. 7 /1 Date Issued
c„
Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
Zipplication for Disposal 6pstem Construction Vermit
Application for a Permit to Construct( ) Repair;( )J,�Jpgrade ) Abandon( ) 'Complete System ❑Individual Components
�w -+w
Location l dj' [,v </r'w
6 dress or Lot No. Ones Name,Address,and Tel.No. $ Q G�
407 HIVA0try }�S R(J C'e�-�pr�i
Asses or's Map/Parcel /amg 10 R I't1 L,r A r. b V x6arj M A
Installer's Name,Address,and Tel.No. �" ,3 toq 6g00 Z Designer's Name,Address,and Tel.No.
0rr4E . Sid- ..G�-. V Es t des 6-09. 93.00`f!
Type of Building:
Dwelling No.of Bedrooms - Lot Size �, C! sq.ft. Garbage Grinder(�) A
Other Type of Building e '1% No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided '" gpd
Plan Date �3• 30 -7 Number of sheets� 17 Revision Date
,.a� ( .� •
Title t E- #<A0 t,
Size of Septic Tank 0 3 Type of S.A.S. A,,-, beS A
Description of Soil
c
Nature of Repairs or Alterations(Answer when applicable) ', 1-n/Q
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 Healt ---, ,,,,•T' r} I
Sfg ed--, Date
Application Approved by Date
Application Disapproved by Date
w '-for the.following reasons
Nt
Permit No. {�1 — l 1 Date Issued cJC/
- --------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
. : Certificate of Compliante
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( )
Abandoned( )by
at Can has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No: /f—J/3 dated
Installer J Designer
#bedrooms Approved 2es;*gn flow gpd
The issuance of this pe i s allnot aco strued as a guarantee that the system l functawed.
Date
---------------------------/-]-----------------------------------------------------------------------------------------------------------
No. �? '—!/_3 Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE,MASSACHUSETTS
Disposal 6pstem Construrtion J)ermlt
Permission is hereby granted to Construct(�) epair�(/� Upgrade Aband o�4 )
System located at 6 y�{ t �}�JC_(x/ L7 (/
and as described in the above Application for Disposal System Construction;Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions.
Provided:Construction m s}t be comple ed within three years of the date of this permit.
Date / —7 Approved by
Town of Barnstable
`Regulatory Services
Richard V. Scali,Interim Director
• anxxsenats.
M^&9• Public Health Division
FAA Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office: 508-8624644 Fax: 508-790-6304
Installer& Designer Certification Form
Date: -f 2 57 Sewage Permit# )-6/°1_f/� Assessor's Map\Parcel
Designer: 5 Q G/� r Installer: _�e,0 �k�
Address: 61-�-11/Z-.oz/ Address:
On 7 60 Z_�_e. was issued a permit to install a
(date) (installe
septic system at 7 f�+'a S /2 based on a design drawn by
(address)
Vz/ A '"1 leS dated G��7
(designer)
—Z, certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank. Strip out (if required) was inspected and the soils
were found satisfactory.
I certify that the septic system-referenced above was installed with major changes (i.e.
greater than 10' lateral relocation of the SAS or any vertical relocation of any component
of the septic system) but in accordance with State & Local Regulations. Plan revision or
certified as-built by designer to follow. Strip out(if required)was inspected and the soils
were found satisfactory.
I certify that the system referenced above was constructed in compliance with the terms
of the I\A approval letters (if applicable)
,%AOFMgs�yc
AW
c—Kh_staller9s_Signature)
VON HONE -+
#1068 0
sic<ssE�'
(Designer's Signature) (Affix D mp Here)
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-
BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.
THANK YOU.
Q:\Septic\Designer Certification Form Rev 8-14-13.doc
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TOWN OF BARNSTABLE / p
LOCATION Zk Mewal 616 9d SEWAGE
VILLAGE e/:y/fOIJ I/i/f`�f' ASSESSOR'S MAP & LOT
INSTALLER'S NAME & PHONE NO.l/l All
SEPTIC TANK CAPACITYP
LEACHING FACILITY:(type)� ���9 @ ',� si Gf3
1
NO. OF BEDROOMS PRIVAT-E WELL OR PUBLIC WATER
BUILDER OR OWNER
DATE PERMIT ISSUED: /�Az�
DATE , COMPLIANCE ISSUED:/A
VARIANCE GRANTED: Yes No
i
R
r i
THE COMMONWEALTH OF MASSACHUSETTS
OAR® QF HEALTH
..304r3
q......... OF... . ............... ..........
Appliration for Disposal WorkS Tongtr aura Frrmit
Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal
system
.4
.......... .. ........ ............... .............. .. ...... ................ .............. If
...... ------------dreL -
- --------- ---------------------------
caX5_:;1d, r Lot .
.... ..... .... ......I ...0....
..0.... ......................................... ----------------- ...... .........I.......
0
..... ... . ................. ...P.f..r. ................................ .........(.;�. 0061-5...------.......-----------------
Installer Address
Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms.....-3.................................Expansion Attic Garbage Grinder
a
Other—Type of Building ............................ No. of persons._..__.____............._... Showers Cafeteria
Otherfixtures ...............................0................................................................................................
Design Flow............................................gallons per person per day. Total daily flow---------------------------------------------gallons.
1:4 Septic Tank—Liquid capacity............gallons Length................ Width.......______... Diameter_______-________ Depth...._...__..___.
Disposal Trench—No. .................... Width..._.........__..... Total Length.................... Total leaching area....................sq. f t.
Seepage Pit No_____________________ Diameter.._........._._.____ Depth below inlet.............0...... Total leaching area..................sq. f t.
Z Other Distribution box ( ) Dosing tank ( )
1.4 0-4 Percolation Test Results Performed by......................................................0................... Date........................................
Test Pit No. 1................minutes per inch Depth of Test Pit._______........__.. Depth to ground water____----_---_---______-.
P Test Pit No. 2................minutes per inch Depth of Test Pit.___._..........._.. Depth to ground water.......____..._.........
9 .....................................................................................00................................................0...................
0 Description of Soil.............................................0..............0-0........................................................................................................
------------------*----------------------*--------------------------------------0--------------------------------------------------0---------------------------0**--------- -----------
.................................................................................................... ........ /-------------------------------------- ----
----------
--------- --- ...
U Nature of R�p pair s or Altura A 2r when applicable...
....... ��ions
-- - ;.5------ _ --------- 2
Agree ---- ------- .............
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of'L 1'L 1E 5 of the State Sanitary Code— The undersigned f rther-agrees not to place the system in
operation until a Certificate of Compliance has been is djWealth.
Signed---- .. ...... ...0 ................ ................ ®r"
D
roved=g��. . �r!
Application App .. ...... . ... ...... ..................... ......
.............
Date
Application Disapproved for the following reasons:............................................................. ................................................
...............................................................0.0................ ..........................................................................................................
Date
PermitNo.--- . ....... Issued.............................................0.........
Date
Z-)
Fps.......:'...................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
d.............OF...../........4/_//................1'7�'
........................
ApVftration for Disposal Works Totwujartiott Urrutit
4-,�
Application is hereby made for a Permit to Construct or Repair In
dividual ndividual Sewage Disposal
Sy
..... ............................
.................6c,
........................ ........ .......P .................... ---------------
Locatiqg ddrZf, or Lot No.
.12 �L .... .. .....................................................--- L ...... ................................................ ..............................................
. . ........ .....
------ ........ .. ="If............................ .................. ...........................................
Installer Address
U Type of Building Size Lot--------_-----------------Sq. feet
Dwelling—No. of Bedrooms___......:..................................Expansion Attic Garbage Grinder
a
Other—Type of Building ............................ No. of persons............................ Showers Cafeteria Other fixtures .........................
Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
P4 Septic Tank—Liquid capacity............gallons Length................ Width...._........... Diameter_-_------..._-__ Depth_...............
Disposal Trench—No..................... Width.................... Total Length..._................ Total leaching area....................sq. f t.
Seepage Pit No--------------------- Diamet' r.................... Depth below inlet.................... Total leaching area..................sq. f t.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Perfor ed by-------------------------------------------------------------------------- Date........................................
4 (1
Test Pit No. I................minutes er inch Depth of Test Pit_.........._........ Depth to ground water.._....___._.._.........
rZ4 Test Pit No. 2................minutes po r inch Depth of Test Pit.................... Depth to ground water..__._......___....._...
................................
------------ ---------------------------*----------------------------------------------------------
0 Description of Soil.......................................................................................................................................................................
U ........................................................................................................................................................................................................
..................................................................................................................I... .../----------------------------------- ---- ---
:2
Nature of Repairs or A��a ions e,;,
U —Answer when a licable,.... -------------_/............................ . ------ .........
.......................
............
71"�
Agree Zen t:
zedjcribed Individual Sewage Disposal System in accordance with
The undersigned agrees to install the afo I
the provisions of'T'1,14: 5 of the State Sanitary de— The undersigned f}irther agrees not to place the system in
operation until a Certificate of Compliance has beep issupd
Y
-......................... .................. --------
Application App roved -3°-
-------- ......../
Date
Application Disapproved for the following reasons:................................................................................................................
............................................................................................................................................................................ ............................
Date
PermitNo......... .................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH,/.,
...................................... .................................
Trdifiratr of Toutpliattrr
THIS 19 TO--CE-RTIFY, T t the Individual Sewage Disposal System constructed or Repaired
............... .......I...
by......... .....
---7 7...................-------
T
at . ............. .. ..... . . .._...... ........... AZ.-.
.-.-.-.-.-.-.-.-.-.-.-.-.-.. -
has been installed in accordance with the provisions of TITIE 5 of The State Sanitary (;a(te a5 d ' d in the
application for Disposal Works Construction Permit dated----- �Ft_
.......................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE --- Inspector.......I......I. ..................................................................
.DATE.............. . .... ---------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEAZL7,�'
0 0
......................................... ...... ............................
N FEE.......
.................
Disposal Wor tipMution prrutit
F
Permission is hereby granted.......... . . ......... .... ................................................
e��R _�........ ...M�_! -
................
to Construct or Repair (/ diJ"an In i nal Sewage Disposal-Sy em---------------------- -------------------------------------------------
at: No.
.Street
Permit ...........-.,Date
as shown on the application for Disposal Works Constructiond... ...........
- -----------......... Board of ...............................................
-------- Health
DATE------.
---4r-------------
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
52.66
Approx. Location of Cesspo0\1 GENERAL NOTES:
Vacant �� Locate, Pump and Backfill
VERTICAL DATUM: __NAVD88 _________
Benchmark: Conc. Bnd \ I \ Re-establish area to prohibi parking 2. NTCIPAL WATER _ IS _ AVAILABLE.
at Elev. 44.1' ----
\ \ 52.67 with Loam and Seems simil r 3. SCHEDULE 40 PVC PIPE TO BE USED THROUGHOUT
1 \ ! \ SYSTEM UNLESS OTHERWISE NOTED.
{ 11 4. ALL PRECAST UNITS TO CONFORM TO
-___�52 _� C�g ,
43.94 - "".. \ o� • 5�1.5 Fr1 d / AASH TO:' - I••E20-----
50.5Z 5�\ 1 o \ 1\ 9'09 5. PIPE PITCH-1/4" PER FOOT UNLESS OTHERWISE NOTED.
�'54 4 Ve.n ",..`..: :,: .. 6• ALL CONSTRUCTION DETAILS TO BE IN CONFORMANCE
�� \ \ ,Fer%c.e_ ,: Shed _ .�o:. ,. . 10 TH-: WITH MA ENVIR. CODE (TITLE 5) AND LOCAL
" �5 • 50.06 ( ?'? 0�� 5� 2 83' 0.18
So o.2s a 10 i / REGULATIONS.
87:\W �- 10 / 7 CONTRACTOR TO VERIFY LOCATIONS OF ALL UTILITIES
\ �= w ` 'in e = CO C oo M p 3a, PRIOR TO CONSTRUCTION.
45 0-- ��jj�
=S\ Existing Dwell. 29 j N ! LEGEND:
\ \ \ \ TF El. 50.8' 049.
u, 49 f4� PROPOSED CONTOUR
A FF El. 51.8
\ 9.,81
\ • ,�3�� \ Full Fndn. I ss PROPOSED SPOT GRADE
i 48.; � 4 O6 40 - EXISTING CONTOUR
48.25 _ 1 X 3 0.2 3 EXISTING SPOT GRADE
\ \ i4 Oak � 4�.28_- j d�4s.ss�° ' TEST PIT
,,fi�e, .. �'
\� N�9C - - �� /l� Meets1'.Breakou� �\, ® EXISTING WATER SERVICE
\\� �s „ � 0- �_ �_ .: o `� E X E WORK LIMIT LINE
mm \ �, a�a 45:6 P. c, �' �� ,� : 45:31:. :.:,:a 71 0 i
lv \
8 Oak -� �� / .:. c3
\ i�a-- ss \ � / / FloorAlternateTB Thresholds EL 51 8nchmark: Use First
OF �tj9 Jq�
`� � � i� .Si" 44.98 � A Y L. f yG eS3N7�43 a,-- -.- VON HONE �'
/R \ n
C d Oak .. / -a
\End 1:27" �6 CedarNo. 1068
.
\ �-� Oak42 � o. �
\ \ i 14 Oakes „ Oak
f
in
0.25 40. -�� / 8.38 �, /j,..:: :: �41 �,.rfi \�Cp TA
Dogwood �: <4� \ \1 Uak SAS �/�
1 i / g 4 /
ASSESSOR'S MAP: 228
•3972
PARCEL: 042 1 / \ \� -39� \ NOTE: This plan is to be used for septic
/�''
' system purposes only and is not to be
REFERENCE: PL. BK. 240 PG. 123 / � 0 33.2� ,• _ .: . � ., `�_ Y P P Y
used for an other purpose.
PL. BK. 394 PG. 21 ��$ �' �'�: ;,' '.;�� 's1� � Y P P
X Town of Barnstable �� �Je
FLOOD ZONE: 24 Oaks
25001 C0546J(07 16/14) `� 37.s2
38.06 76 HEADWATERS ROAD
LOCUS a <.
West Main Street 1 :: ::✓.:: < ?.:.;: 36IM" CEN TER VI LLE, MA
Cl
;- �3�
s rn S PREPARED
102 \ associates Torrey Excavation
Q = SEPTIC SYSTEM DESIGNS FOR:
_ r37 4 Rev.04/06/17:Relocate a n d
320 t uit Road
Sandwich, MA 02563 9
Tank,HlO,Parkin J i n i a D r i n k w a t e r
Lot Area: (0) 508.833.0041
0 17,925f sf �6� (c) 508.274.0074
a o a / 3 P.O. Box 1795
Maximum Feasible Com Hance: Su-eying" ej Du xbu ry, MA 02331
�p I ''� 36.7 AH Ojala Surveying
cn / Title 5' 15.405:
Q Arne H. Ojala,P.L.S.
1' variance request, pro 1 sed 4' 211 Maple Sbve DATE REVISED SCALE SHEET NO.
a 68
maximum cover over leach acilty '"°�`�36a-09302C 03/30/17 04/06/17 1" = 20' 1 of 2
LOWS MAP N.T.S.
t II s
Provide Riser over D-box NOTE: All components to be marked with NOTE: To prevent breakout, final
T.O.F. (Full) i
EL. 50.8 to within 6" of final grade magnetic tape or similar prior to final cover. grade of EL. 46.5 to be carried
(Cover to be watertight) out a minimum 15' beyond edge
F.G. EL: 49.8-50.4 F.G. EL: 50.5 F.G. EL: 50.3 Maintain Min. 2% slope over leach facility to of leach facility.(Existing grade
Existin �- i prevent onding F.G. EL: 48.5-50.5 meets breakout.)
WWWWOMM
Install risers w/covers over inlet and 7 Min. 2" of 1/8" - 3/4" Washed Stone or Ins ection Port within 6" to grade
outlet to within 6" of final grade 1 Geotextile Fabric
L=22' (Access Covers mirr: .20".- diom. per Code) L=12' 3 4" - 1 1 2" Double Washed Stone ~Exist. invert 4" SCT
- 4" H 4 L=15' / /Cast Iron 4". :: ®S=3. SC 0 PVC 4" SCH 40 PVCTop of Peastone or Geotextile Fabric EL. 46.5
EL. 48.47 „• CAS=8.5% 1 TB a as asC@S=6.6% 0.5%MIN 8103 000 24 Eff. Depth
EL. 47.5 asanstall Gas Baffle EL. 46.47EL. 46.3 43.3
EL. PROPOSED DB-3 EL. 45.3 Use 2 - 500 Gallon Precast Chambers
H-20 DISTRIBUTION BOX (H-20) with Double Washed Stone 6.24'
tertest for levelness
Wa 4' Ends, 4' Sides
(Install PVC Inlet & Outlet Tees)PROPOSED 1500 GALLON if more than one SEPTIC SYSTEM PROFILE (25' x 12.83' x 2')
H-10 SEPTIC TANK outlet EL. 37.06
N.T.S. Bottom of TH-2
SOIL LOG ADDITIONAL NOTES DESIGN CRITERIA
SOIL EVALUATOR: AMY VON HONE, R.S. S.E. #2517 Number of Bedrooms:Existing 3 Bedrooms
Contractor to confim soil suitability prior to installation. Contact BOH and
INSPECTOR: DAVID STANTON, R.S., BOH 1• y
DATE: MARCH 29, 2017 10:00 AM Design Sanitarian in the event of varying soils from original soil test. Soil Type: Class I
PERMIT: #15294 Percolation Rate: <2 min/Inch
PERCOLATION RATE:<2 MIN/INCH IN C1 2. Locate, Pump, and backfill Failed Cesspool. Any contaminated materials
within 5' of proposed Leach Facility to, be removed. Replace with clean fill Daily Flow: 110 G.P.D./Bedrm x 3 =330 G.P.D.
TH - 1 TH - 2 per Title 5 specifications. Confirm original cesspool filled. Design Flow: 330 G.P.D. (Min. Required)
EL. 50.18 EL. 49.06 3, Water line to be sleeved at any sewerline crossings and within 10' of any Garbage Grinder: Not Allowed
septic components, as needed, per Water Department requirements.
Fill/Peastone Fill/Peastone Contractor to verify location of water line prior to construction. Leaching Area Required: (330)/0.74 = 445.94 S.F.
11" 49.26 15" 47.81 4. Septic Tank and Distribution Box to be placed on 6" crushed stone or 330 G.P.D. x 200% = 660 G.P.D
B B compacted, level base. Septic Tank Required:
Loamy Sand Loamy Sand p Minimum 1500 Gallon (Proposed)
22" 10YR5/8 48.35 22" 10YR5/8 47.23 Use 2 - 500 Gallon Precast Chambers H-20 with
C1 C1 Double Washed Stone: 25' x 12.83' x 2'
Coarse Sand 0 SEPTIC TIES
2.5Y7/3 Coarse Sand
42" Bottom 2.5Y7/3 i Sidewoll Area: 2(25' + 12.83')2= 151.32 S.F.
Bottom Area: 25' x 12.83'= 320.75 S.F.
Shed Total Area: 472.07 S.F.
Desi n Flow Provided: 0.74(472.07 S.F.)= 349.33 G.P.D.
i 3 2.83'
2' 76 HEADWATERS ROAD
co 0 o V ft CENTERVILLE, MA
" Existing Dwell. 10' k�, 0' N associates PREPARED
120 40.18 144 37.06 TF EI. 50.8 o FOR: Torrey Excavation
SEPTIC SYSTEM DESIGNS
FF El. 51.8' 320 Cotuit Rood Rev.04/06/17:Relocat and
No Groundwater Observed No Groundwater Observed 12 Sandwich, MA 02563 Tank,H10,Parking
Full Fn d n. (0) 508.833.0041 J i n i a D r i n k w a t e r
<9" @ 11: 37 min. PERC RATE: <2 MIN/INCH C1 Horizon (C) 508.274.0074 P,Q, BOX 17
I, Amy L. von Hone, R.S., hereby certify that I am currently approved by ��- 1 Surveying b 95
by: P.O.
0 x b u r M A 9 5
the DEP pursuant to 310 CMR 15.017 to conduct soil evaluations and AHOjala Surveying y,
331
that the above analysis has been performed by me consistent with the ArneH. Ojala,P.L.S.
requirements of 310 CMR 15.017. 1 further certify that I have 211 Maple Street DATE REVISED SCALE SHEET NO.
West Barnstable. MA 02668
successfully passed the Soil Evaluators Exam on November, 1994. 5W-362-0934 03 30 17 04/06/17 1" = 20' 2 of 2
f