HomeMy WebLinkAbout0105 HORSESHOE LANE - Health 105 Horseshoe Lane
Centerville
A = 207 100
r
Om. ord, NO. 1521/3 ORA
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` Commonwealth of Massachusetts 020:7 - 10v
r Title 5 Official Inspection Form
('a
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
105 Horseshoe Lane
Property Address
Dangelo
Owner Owner's Name
information is required for every Centerville Ma 02632 7/16/2020
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 5 LlQ(Q�'
on the computer,
use only the tab Chad hathaway
key to move your Name of Inspector
cursor-do not Hathaway Septic Inspections
use the return Company Name
key.
P.O.Box
151
11b Company Address
Forestdale Ma 02644
City/Town State Zip Code
ra(wn 774 274 2581 12866
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 b the Local Approving Authority
❑ y pp g
4. ❑ Fails
7/16/2020
In ector's Signatur Date
The syste nspector shall.submit a cop of this i pection report to the Approving Authority (Board
of Health r DEP)within 30 days of co pleting thi inspection. If the system has a design flow of
10,000 gpd or greater, the inspector nd the s em owner shall submit the report to the appropriate
regional office of the DEP. The origin hould 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
cam, Commonwealth of Massachusetts
t i= Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
105 Horseshoe Lane
Property Address
Dangelo
Owner Owner's Name
information is required for every Centerville Ma 02632 7/16/2020
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary
Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6.
1) System Passes:
® I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
This inspection is not a guaranteeand applies no warrantyof the described septic components in this
report including but not limited to piping structual intergrity of components and life exspectancy of
leaching and described components. This inspection is to describe conditions witnessed at time of
inspection only. Regular tank maintenance and water conservation can prolong life of septic systems
Information on care and do's and don't's can be found at town health dept or mass.gov
2) System Conditionally Passes:
❑ One or more system components as described in the"Conditional Pass section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not
determined," please explain.
The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass
inspection if the existing tank is replaced with a complying septic tank as approved by the Board of
Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND (Explain below):
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18
Commonwealth of Massachusetts
- - Title 5 Official Inspection Form
� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
105 Horseshoe Lane
Property Address
Dangelo
Owner Owner's Name
information is required for every Centerville Ma 02632 7/16/2020
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:
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18
cam, Commonwealth of Massachusetts
Title 5 Official Inspection Form
I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
105 Horseshoe Lane
Property Address
Dangelo
Owner Owner's Name
information is required for every Centerville Ma 02632 7/16/2020
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
b. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well".
Method used to determine distance:
**This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal
coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must
be attached to this form.
c. Other:
4) System Failure Criteria Applicable to All Systems:
You must indicate"Yes" or"No"to each of the following for all inspections:
Yes No
❑ ® Backup of sewage into facility or system component due to overloaded or.
clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18
Commonwealth of Massachusetts
r - Title 5 Official Inspection Form
�a
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
105 Horseshoe Lane
Property Address
Dangelo
Owner Owner's Name
information is required for every Centerville Ma 02632 7/16/2020
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
4) System Failure Criteria Applicable to All Systems: (cont.)
Yes No
❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less
than '/2 day flow
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply
well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered.A copy of the analysis
and chain of custody must be attached to this form.]
❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd-
10,000 gpd.
❑ ® 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 11 of a public water supply well
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18
c Commonwealth of Massachusetts
�n Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
105 Horseshoe Lane
Property Address
Dangelo
Owner Owner's Name
information is required for every Centerville Ma 02632 7/16/2020
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
If you have answered "yes" to any question in Section C.5 the system is considered a significant
threat, or answered "yes"to any question in Section CA above the large system has failed. The
owner or operator of any large system considered a significant threat under Section C.5 or failed
under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner
should contact the appropriate regional office of the Department.
6. You must indicate"yes" or"no"for each of the following for all inspections:
Yes No
® ❑ Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
® ❑ Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑ Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
® ❑ Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS) on the site has
been determined based on:
® ❑ Existing information. For example, a plan at the Board of Health.
❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18
Commonwealth of Massachusetts
- Title 5 Official Inspection Form
� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
105 Horseshoe Lane
Property Address
Dangelo
Owner Owner's Name
information is required for every Centerville Ma 02632 7/16/2020
page. Cityrrown State Zip Code Date of Inspection
D. System Information
1. Residential Flow Conditions:
Number of bedrooms (design): 3 Number of bedrooms (actual): 2
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330
Description:
Number of current residents:
1
Does residence have a garbage grinder? ❑ Yes ® No
Does residence have a water treatment unit? ❑ Yes ® No
If yes, discharges to: .
Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No
information in this report.)
Laundry system inspected? ❑ Yes ® No
Seasonal use? ❑ Yes ® No
Water meter readings, if available (last 2 years usage (gpd)):
Detail:
Sump pump? ❑ Yes ® No
Last date of occupancy: current
Date
t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18
it
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
� � 105 Horseshoe Lane
Property Address
Dangelo
Owner Owner's Name
information is
required for every Centerville Ma 02632 7/16/2020
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
2. Commercialllndustrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 15.203): Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Water treatment unit present? ❑ Yes ❑ No
If yes, discharges to:
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
Last date of occupancy/use: Date
Other(describe below):
3. Pumping Records:
Source of information:
none
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped: gallons
How was quantity pumped determined?
Reason for pumping:
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18
c Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
105 Horseshoe Lane
Property Address
Dangelo
Owner Owner's Name
information is required for every Centerville Ma 02632 7/16/2020
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
4. Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner) and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
Approximate age of all components, date installed if known and source of information:
2005
Were sewage odors detected when arriving at the site? ❑ Yes ® No
5. Building Sewer(locate on site plan):
Depth below grade: 1.5'
feet
Material of construction:
❑ cast iron ®40 PVC ❑ other(explain):
Distance from private water supply well or suction line: 10+
feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
none
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18
Commonwealth of Massachusetts
�n Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
105 Horseshoe Lane
Property Address
Dangelo
Owner Owner's Name
information is required for every Centerville Ma 02632 7/16/2020
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
6. Septic Tank(locate on site plan):
Depth below grade: 1feet
Material of construction:
® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain)
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
Dimensions:
1500 gal
Sludge depth:
4"
Distance from top of sludge to bottom of outlet tee or baffle
26"
Scum thickness
Distance from top of scum to top of outlet tee or baffle
5"
Distance from bottom of scum to bottom of outlet tee or baffle
18"
How were dimensions determined? tape and sludge judge
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
pump tank in 1 year with normal use. tees in place no decay or visable cracks or leaks
t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18
c Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
105 Horseshoe Lane
Property Address
Dangelo
Owner Owner's Name
information is required for every Centerville Ma 02632 7/16/2020
page. CityrTown State Zip Code Date of Inspection
D. System Information (cont.)
7. Grease Trap(locate on site plan):
Depth below grade: feet
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping:
Date
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Capacity:
gallons
Design Flow: gallons per day
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18
Commonwealth of Massachusetts
i
�d Title 5 Official Inspection Form
I." Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
e 105 Horseshoe Lane
Property Address
Dangelo
Owner Owner's Name
information is required for every Centerville Ma 02632 7/16/2020
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
8. Tight or Holding Tank(cont.)
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last,pumping: Date
Comments (condition of alarm and float switches, etc.):
*Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
9. Distribution Box(if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert 0
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.):
Dbox level and solid no major decay or cracks. no carry overs
i
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18
Commonwealth of Massachusetts
jm Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
105 Horseshoe Lane
Property Address
Dangelo
Owner Owner's Name
information is required for every Centerville Ma 02632 7/16/2020
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
10. Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No*
Alarms in working order: ❑ Yes ❑ No*
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
* If pumps or alarms are not in working order, system is a conditional pass.
11. Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
probed stone around chambers clean and dry no signs of hydraulic failure stone bed 36'x11'x1'
Type:
❑ leaching pits number:
® leaching chambers number: hi Cap
infultrators
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
I
❑ innovative/alternative system
Type/name of technology:
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18
cam, Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
105 Horseshoe Lane
Property Address
Dangelo
Owner Owner's Name
information is required for every Centerville Ma 02632 7/16/2020
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.):
12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration
Depth—top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
1' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
105 Horseshoe Lane
Property Address
Dangelo
Owner Owner's Name
information is required for every Centerville Ma 02632 7/16/2020
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
13. Privy (locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5insp.doc.rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18
Commonwealth of Massachusetts
- Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
�u—
105 Horseshoe Lane
Property Address
Dangelo
Owner Owner's Name
information is required for every Centerville Ma 02632 7/16/2020
page. CityTrown State Zip Code Date of Inspection
D. System Information (cont.)
14. Sketch Of Sewage Disposal System:
Provide a view of the sewage disposal system, including ties to at least two permanent reference
landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters
the building. Check one of the boxes below:
® hand-sketch in the area below
❑ drawing attached separately
A I
Pa
1
37
0
0
3
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page t6 of 18
c Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
105 Horseshoe Lane
Property Address
Dangelo
Owner Owner's Name
information is required for every Centerville Ma 02632 7/16/2020
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
15. Site Exam:
❑ Check Slope
❑ Surface water
❑ Check cellar
❑ Shallow wells
Estimated depth to high ground water: high adjusted G/W at 126"feet
Please indicate all methods used to determine the high ground water elevation:
® Obtained from system design plans on record
If checked, date of design plan reviewed: Date
❑ Observed site (abutting property/observation hole within 150 feet of SAS)
® Checked with local Board of Health -explain:
design plan on file
❑ Checked with local excavators, installers (attach documentation)
❑ Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
G/W with adjustment 126" bottom of SAS 48" leaving greater then 48" of seperation between bottom
of SAS and ground water
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
. �v Title 5 Official Inspection Form
w Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
105 Horseshoe Lane
Property Address
Dangelo
Owner Owner's Name
information is required for every Centerville Ma 02632 7/16/2020
page. Cityrrown 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
I TOWN OF BARNSTABLE
LOCATION los SEWAGE # r O C/0
VILLAGE ASSESSOR'S MAP &LOT �— Gfc
INSTALLER'S NAME&PHONE NO. r\
SEPTIC TANK CAPACITY
' a
LEACHING FACILITY: (ty (size)_ ZC _
NO.OF BEDROOMS
BUILDER OR OWNER ("C\X.
PERMITDATE: 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
1!
a �
No. 21 iv. (i_l !! /U i, _. , Fee hi Q
THE COMMONWEALTH OF MASSACF.USETTS Entered in computer: 9/
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
ZIppYication for ]h9pool *patent Con5truction Permit
Application for a Permit to Construct( , )RepairXUpgrade( )Abandon( ) Complete System El Individual Components
Location Address or Lot No. iQ�Sj�,�` NDc Ljqtji& Owner's
�Name,Address and Tel.No. �Q
Assessor's Map/Parcel ' "v L_LT_ 1v`t���"` fl�V -�b
oo
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
{� S `"C. ► ��� C U1 Ott M�/1` �craeg
55S —T9 Cep
Type of Building:
Dwelling No.of Bedrooms .........
Lot Size 1(Q O sq.ft. Garbage Grinder(�
Other Type of Building NL'nQ n No.of Persons Showers( ✓Cafeteria( t�
Other Fixtures Lra s�(3� �,�. ��-}�C.o ��jn�, LA���.f Ogle
Design Flower _ gallons per day. Calculated daily flown [ ' gallons.
Plan Date , Number of sheets / Revision Date
Title ('f3
Size of Septic Tank iEQ rxCZ'Jk Type of S.A.S. tf 41-
t
Description of Soil '
Nature of Repairs or Alterations(Answer when applicable)
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 Certifi-
cate of Compliance has been issncd_jbv this B -aftfq$th.
Signed Date
Application Approved by Date_1^-2(r_OS—
Application Disapproved for t e following reasons
Permit No. ' .CPJ_S—0 1 o Date Issued 1—.2 US
Fee�=
4 ._ THE COflAMONWEALTH OF MASSAChi`iS`Er Entered in computer:
/ . Yes
PUBLIC'HEALTH DIVISION - TOWN OF BARNSTABLE,,MASSACHUSETTS
4(pplication for �Nopooal *potem Con4ruction Permit
Application for a Permit to Construct(,".' )Repair Upgrade( )Abandon( ) Complete System O Individual Components
q
Location Address or Lot No. JOS ��"��11QE Lv,�06 Owner's Name,Address and Tel.No.
Assessor'sMap/Parcel CCN— fe V L_t_E t A M t Ch0.2.t V0
aD-4 I ,00
Installer's Name, ddress,and Tel.No. Designer's Name,Address and Tel.No.
" c S
Type of Building:
Dwelling No.of Bedrooms a Lot Size 1Pb sq.ft. Garbage G er(W�
Other Type of Building No.of Persons c�. Showers( ) Cafeteria( +�
Other Fixtures L.G 6c._�.%A k i+C t� Slf� LA j,3 be?
` Design Flow 3 , o gallons per day. Calculated daily,,flow )3t�� gallons.
Plan Date Number of sheets j Revision Date
Title (C. 5Li .5-\em 9DCZ �-cx of Sepiic Tank 101a4 1GU0 SSS-\ Type of S.A.S. v r,-q, T G S {
Description of SoilO' rC fl b. 1x
V
Nature of Repairs or Alterations(Answer when applicable) pier
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 Certifi-
cate of Compliance has been issu-e_d by this Bo .d-of- e °th.
Signed "Date
* t Application Approved by V Date
Application Disapproved forte following reasons
Permit No. Go S _ 4 q Date Issued /` OS
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
' (Certificate of Compliance
THIS IS TO CERTIE,,t at the Sewage Disposal System Constructed ( ) Repaired( )Upgraded
Abandoneu( )by K�) _,� C-_
at \ 0f;_ FI d v 4 c S�nr n. �,, P l-�v�t��v���r- has been construc ed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. 2 00.5 dated a G
Installer`�___,:.\v,. Designer S 1-\ca- --
The issuance of this permit shall`knot be construed as a guarantee that the syse. wtil'function as designed.
Date �' F 9'710 5 Inspectors--�1---
No. S "n�0 Fee / U—
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
li!6poal *p5tem Construction Permit
Permission is hereby granted to Construct( )Repair )Upgrade(t-,)'abandon( )
System located at 1 0 5- 0-0,r -c S e-4._
and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
Provided:Cons uction mustbe completed within three years of the date of this pe
Date: �t t� Approved by OAl i - I__V .
f � v
TOWN OF BARNSTABLE •
LOC!.,1.1'10N I D J �/�f ��6� SEWAGE # 42g" D yD
VILLAGE ASSESSOR'S MAP& LOT,-26 7— i co
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY 15A��1
a
LEIACHING FACILITY: (ty ) ` � o° �— (size) � 1
NO.OF BEDROOMS F
Nv V-0 BUILDER OR OWNER
PERMITDATE: ,-- 2 � 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
II �
o�
st_ G o�c
Town of Barnstable
OF IME Tn_
Regulatory Services
Thomas F. Geiler, Director
BARNSTABLE,
A 9 Public Health Division
16
Thomas McKean, Director
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Installer & Designer Certification Form
Date: � .
Designer: j:!�BY , �� _ Installer: —C
Address: ', ' ?)6}G �g3 _ Address: S-
F" KGtMMA:t R yR zvr'Cnlw-t MIA
On �6_�M- �'c was issued a permit to install a
(date) (installer)
septic system at L� a be i 1 based on a design drawn by
(address)
dated
designer)
.-Nn I certify that the septic system referenced above was installed substantially according to
the design, which may include minor approve
d changes such as lateral relo
cation of the
distribution box and/or septic tank.
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.
ZN„Of IITq
(Inst er's Signature CAR. Ef\l cyG
SFIe4Y C
No. 1181
(Designer's Signature) (Affix De ��, ere)
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVIS N. 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:Health/Septic/Designer Certification Form
.......`..........
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
' }c0\.i OF. JF....tiE��..... -..Ct
Appliratiuu fur Diupuuaf Works Tows rurtiun Prrutit
Application is hereby made for a Permit to Construct 1( ) or Repair (4-) an Individual Sewage Disposal
System ate�^^
...........a..------. 0_c S�...��.��.......................... --•-••---•--- ..................................` ' i - ----
Location-Address or Lot No.
Address
Installer Address
Type of Building Size Lot-----------------_-----_-•Sq. feet
Dwelling—No. of Bedrooms____.................................Expansion Attic ( ) Garbage Grinder ( )
04 Other—Type of Building ............................ No. of persons---•...__-__-__.--_--__-____ Showers ( ) — Cafeteria ( )
a Other fixtures -------------------------------- -
W Design Flow............. -..................gallons per person per day. Total daily flow-___-___..................gallons.
WSeptic Tank`Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No.--.____�._-__..... Diameter_____.Z) ...... Depth below inlet.....C t__...._... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water----__--____--__-----_-.
(s, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a •-•-•-•---•-•-••---•---•------------------•---•-...------------••--•-------.........-----•-•---•••••......-----...•--.......................................O Description of Soil........................................................................................................................................................................
U --•--•--------•-------•--••--------•••••-------------•-•--•-•-•--•-•••-••-•--------•---........-----._...-----•--••••--.._...--------••-•-•-•------•••-----•-------------------------•••--•----------...
W
x ------------------------------------------------------------------- -----------------•----------------•--•-----•.....---•-------•......---- ----•---•------•••......-----------•--•--•...
U Nature of Repairs or Alte ions—Answer when applicable......�42....... X ......__ ....'�.__.��.....`�c
-
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TIT E 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Complian b the bo of heal
Signed...�,................. .. ....... __ )_l_....
Application Approved B
ate
Application Disapproved for the following reasons---------------------•--------•---••-------------------------...................................................
-----------------------------------------------------------------••••----------•-•------•----••---------------------------•-••••-------------------•-••-----------•------•-----•----••------------------
Date
PermitNo............... ......_-- -- Issued.......................................................
Date
�-- Iav
No. .._.:...! F ...........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........OF.. �!.w�:��.5 s �-Q ---------------------------------
Appliration for Ui-qposal Works Tonitrurtion 1hrutit
Application is hereby made for a Permit to Construct ( ) or Repair (c -fin Individual Sewage Disposal
System at:
Location-Address or Lot No.
---•-..ac` ... ..------p�►r���� ......................... ................... ..�=-.........................................................
a /" Owner _ Address .-.•-.•........
_...Y..._ �G/......... L.. w�/ 5. .......................... _� . mil_'= e.._ i.
Pq Installer Address
Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms___-�.................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ____________________________ No. of persons........_................... Showers ( ) — Cafeteria ( )
Otherfixtures ..--•-•----•------------•-•--------•--•--•----•-•------•-••••-•-•-•-••---•---•-••••---------•----•
W Design Flow........... ...................gallons per person per day. Total daily flow--------- .................gallons.
WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth___--___-__--_--
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No--------- .......... Diameter-----/�....... Depth below inlet....�,/......... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water--__--____--_-_-______.
fs, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
P4 •-••-•••-----••-----•--•--•--•-••-•-•-••--••-•---••----•----••......•-•............................•........................................
ODescription of Soil........................................................................................................................................................................
x
W
U Nature of Repairs or Alterations—Answer when applicable_..__ 1t1' ....... ........ j ..__TU_____ _C
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of T i T L
p 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of ComplianeZ4ms+eeI1-*'&S1jgd by the bo of health.
Signed-........ ' - -- -•-----• �C
- �.
Application Approved
r. . -------- --------------
Date
Application Disapproved for the following reasons---------------•-----------•----•-------••---------------------••----------------•--------------------.....--''--
--------------••-----------------•----------•---...----•-----'------•------••--------•-•----'----........-----•--•------------------------------•--------------•-------------------------------.--------
Date
PermitNo.............. _ '-------•--� Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........................................O F.........1. .................... ... \: .................................
Trrtifiratr of Tomph anrr
THIS IS-ZOCERT14ZYThat the Individual Sewage Disposal System constructed ( ) or Repaired 6-4-
by------------------------ .......... ---------------•-------------------'------------------.......------------------------------........----•---'...------....--
Installer `
at------- --- t ------- -- .... t c-C.------------ _ ..1= ................................•c
has been installed in accordance with the provisions of TiTIE 5 ' The State Sanitary Code as d�scribed in the
application for Disposal Works Construction Permit No.-S... ._ _��_(� dated-- --
_-S_�'..............
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A IG � RANTEE THAT THE
SYSTEM WILL F NCTION SATISFACTORY.
DATE.............7.AYe.$t�' ------------------------------------•---' Inspector------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........0 F..... ......... S`� _`... _............................
w
Mips �_. o � i rnit
L. �� .-. .! SPermission is hereby granted----c ....��
a'
to Construct ( ) or/1e�pair (L�n Individual Sewage Disposal System _
at NO........--0-�......( ?_!C '� ^h x.. �. - c`- •%•.................C / ...
Street ,��,
as shown on the application for Disposal Works Construction Permit Nbf�..- Dated......... _/_.7_ ...........
�^DATE.. Board of Health
�. .. .....-`--••-•-•-•---...'•••-----•--•--------
FORM 1255 HOBBS WARREN. INC., PUBLISHERSy
ASSESSOR'S MAP NO. PARCEL
L6CATION - SEWAGE PERMIT NO.
VILLAGE
"IN-STA LLER'S NAME i ADDRESS
d c� Q._
e U I L D E R OR OWNER
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED
r
Y�
10
T)a
�R 631VM IqAAa—L
*NOTE: ALL PIPES ARE TO BE 4" SCHEDULE 40 P.V.C. SECTION A -A
10' min. from PROFILE VIEW OF ADDITION TO LEACHING SYSTEM a"ist BUT'�iON BOX PIPES FROM THE
Existing Foundation house to septic tank SET LEVEL FOR AT SHALL BE LEAST 2 FT. 12' CONCRETE COVER -�
TOP OF FOUNDATION ELEV. 100.00 Assumed Septic tank covers must be D-BOX cover mwt be 3' of t/8" - 1 2` Washed Peastone
(Assumed) within 6 In. of finished grade within 6 in. of finished grade n,r-•.
Oraae ever Septic Tank - 9900 Grade ow D-Box - 9E-00 ow SAS - 97.75 3/4' to 1 1/2 Washed Crushed Stone / � � 3 - S'OUTLET ' •s�..r ..�•' 2
� KNOCKOUTS
A\ -- --------- i
4' PVC(CAPPED)INSPECTION PORT TO BE -- 5.5' r I TLET ' 12- INLET
S 0.02 3 HOLE H-10 WSTAILO AND TO BE NTHN 6'OF GRADE
T. BOX 3' Maximum Cowr 8' F 49• T
ts NEW S-0.01 or Greats Top OF S)wtsm- Elev. -9&75 I R
NEv CITE g N 1,500 GAL. s- o.ot'PN foot 10 EHeetM Depth t.73'
r N 30' 4" - SCH. 40 7
F1<DN EXIST. PDIsiDATIDN / � SEPTIC TANK 8
e H-10 0.soft h 20 a Units a bPs = 2s PLAN SECTION CROSS-SECTION \ -
CONCRETE FULL FOUNM -� V h. 4' 3' STONE IN BETWEEN 4' °+
u e i Iri 0)rn o 0.83 (10 inches) B,
SYSTEM PROFILE 6 1n.of 3/4--t t/2' 36' 3 HOLE H-10 DISTRIBUTION BOX
compacted stuns i 'o Effective Length NOT TO SCALE �'�" a '•.
Not to Scale - c
' > 4' 4' I SOIL. ABSORPTION SYSTEM (SAS)
i � p
6 in.of 3/4'-1 1/2' 0 11 y ® INFILTATROR HIGH CAPACITY (H-20 LOADING)/ GEORGE O'BRIEN GENERAL NOTES
compacted stone < EFFective Vktth
0 (OR EQUIVALENT) Not to Scale
NOTE: ALL COMPONENTS MUST HAVE RISERS TO WITHIN 6" BELOW GRADE 0 1. Contractor is responsible for Digsafe notification
p m NOTE: OVERALL HEI',HT OF INFILTRATOR IS 18' /EFFECTIVE HEIGHT IS 10" and protection Of all underground utilities and pipes.
i? Bottom of Test Hots t Bev.-85.30 2. The septic tank and distribution box shall be set
Graundratw Observed a t2 - ELEV
�67^50 level on 6" of 3/4"-1 1/2" stone.
v 3. Backfill should be clean sand or gravel with no
stones over 3" in size.
4. This system is subject to inspection during installation
PERCOLATION TEST by Carmen E. Shay - Environmental Services, Inc.
5. The contractor shall install this system in accordance
Date of Percolation Test: JAN. 3, 2004 , with Title V of the Massachusetts state code, the approved plan
Test Performed By. CARMEN E. SHAY, R.S., C.S.E. ,' DO and Local Regulations.
Results Witnessed By. WAIVER(per Barnstable B.O.H.) �' '� 6. If, during installation the contractor encounters any
EXCAVATOR: Shay Environmental Services, Inc. ,/' ,' soil conditions or site conditions that are different
Percolation Rate: Less Than 2 MPI 6 42" ,' from those shown on the soil log or in our design
7- --- - ' ,' installation must halt & immediate notification be
Test Hole \, / _--- ---_-,3 made to Carmen E. Shay - Environmental Services, Inc.
7.
No. 1 %��- No vehicle or heavy machinery shall drive over the
DEPTH SOILS ELEV. ,'� p septic system unless noted as H-20 septic components.
o 98.00 ,�' 4j 8. Install Tuf-Tite gas baffles or equals on all outlet tee ends.
Soamy r �,' 10' 9. All Distribution Lines shall be 4" diameter Schedule 40 NSF PVC pipes.
and
10. All solid piping, tees & fittings shall be 4" diameter
10 TR 3/2 '' Schedule 40 NSF PVC pipes with water tight joints.
11. Municipal Water is Connected to ALL OF The Residence and Abutting
K
j LSar,doamy v�� ' B • Properties Within 150 Feet.
10 TR 5/6 `�\ \1 ------ -�i: _• ,� THE PROPERTY LINES ARE APPROXIMATE AND
II 12" 27' Medium 95.75 l<�� �� t `+NEST HOLE #1 COMPILED FROM THE SURVEY PLAN GENERATED BY
• ` BEARSE & KELLOG, ENGINNERS., ENTITLED
25 Y7/4 �� S ��� ,^\ 1 ; +:- ` ;'`~ ELEV� 98.00 PLAN OF LAND IN CENTERVILLE, MA" PLAN BOOK 97 PAGE 85
�L ' \ I • = `'` ` DATED DATEDFEB. 15, 1951
27 -132" G 87.00 ,/ 1 1 =ate. �:
AND IS NOT INTENDED TO BE A SURVEY PLOT PLAN
' \ IT SHOULD BE USED FOR NO PURPOSE OTHER THAN
THE SEPTIC SYSTEM INSTALLATION.
LOT #6 EXISTING CESSPOOL TO BE PUMPED OUT AND FILLED IN PLACE OR
\� i REMOVED TO FACILITATE NEW SEPTIC SYSTEM INSTALLATION
<'/ O0 NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE
` 1500 GALLON I FROM THE EXISTING CESSPOOL TO BE DISPOSED
SEPTIC TANK // OF AS PER BOARD OF HEALTH SPECIFICATIONS.
PROJECT BENCH MARK --
TOP OF FOUNDATION - - _ - - \ cf /� 96 WETLANDS ARE PRESENT WITHIN 200' OF THE PROPERTY
Perc #1 ELEV. = 100.00 (Assumed) \L �50� /, 9� 9 BUT ARE OVER 100' FROM THE PROPOSED SAS.
Depth to Perc: 42" to 60" \
Perc Rate= Less Than 2 MPI ASSESSORS MAP 207� PARCEL 100
Observed Groundwater = 126" __�- / ,'� , ''
' LEGEND
3,-24' DLAM. ACCESS MANHOLES 104X 1 DENOTES PROPOSED
SPOT GRADE
i EXISTING toDENOTES EXISTING
LOTS #4 & #5 2 BEDROOM /� X 104.46 SPOT GRADE
16,990 Square Feet HOUSE
PL
_ l \-- OU
#10-5" PROPERTY LINE
INLET ` / `/ THE ACCESS COVERS FOR THE SEPTIC TANK, '/ /' PORCH ' 96P PROPOSED CONT011R
DISTRIBUTION BOX AND LEACHING COMPONENT
';�.. �. T ^z.�-�.:`tT.� •' SHALL BE RAISED TO WITHIN 6" OF FINISHED GRADE. - - - - - -97 EXISTING CONTOUR
STEEL REINFORCED PRECAST CONCRETE INSTALL TUF-TITE GAS BAFFLES OR EQUALS 1 g
PLAN VIEW ON ALL OUTLET TEE ENDS .Q DECK ,'
,� DEEP TEST HOLE &
3-24"REMOVABLE 001E`S PERCOLATION TEST LOCATION
6 FOOT STOCKADE FENCE
•mkt'ciewonce
,r,� a=min_j-12• min. boo to outlet e' , I ,r ..n
NU; 1d - t�• _ WTL.ET - 1\ � // / \\\ - 1t �-- - - ---------
0. LIWW depth
( P LOT PLAN
1 4'-0' min. \ / , , �/ \ 1
OF PROPOSED SEPTIC SYSTEM UPGRADL
_ � � '/ t Foiled ( t\ O
,o• o-., ,.. .- - 5 _8. -. - LOT #3 � ,
.CROSS SECTION END-SECTION 96- ,''� ( Failed
tri PREPARED FOR
94-- ``� 1
92 l Fa.3d ,� '1„' MICHAEL & DEBRA G AWIJ
TYPICAL 1500 GALLON SEPTIC TANK Cc spool ---- „ d' ,
# 105 HORSHOE LAME
i'
NOT TO SCALE 90-_
(H- 10 LOADING) __ _ f ' CENTERUIELE NSA
, '\
Desian Calculations \ / ' ------- ------- -- -
i - / P
Garbage Grinder: No L
Number of Bedrooms:2 Equivalent to 220 Gal./Day (330 Gal./Day Min. per Title V) ss qc EPARED BY:
= 75.00 - C R
\ �
Leaching Capacity Proposed: 330 Gol./Day Minimum (Min. Per Title V) 1L 1t 0 �4 R�I�N �'. A ll A l v
Septic Tank : - 2 x 330 Gal./Day = 660 8''� -' 1' 11 " En
SERVICES, INC.
SOIL ABSORPTION AREA: Using percolation rate of G2 min./inch 86 -----; \ No. 1
Bottom Area: 0.74 gal/sq. ft. x 370 sq. ft. = 273.8 gallons -----` Q 10 EAST
BOX 627
Sidewall Area: 0.74 gal./sq. ft. x 78 sq. ft. = 58 gallons 0 20 40 50 �� G/sTE�� EAST FALMOUTH, MA 02536
Providing: = 331.80 gallons PRIVATE DRIVEWAY\`\ SgNITAR�P� TEL/FAX : 508-539-7966
Use: (4) INFILTRATOR HIGH CAPACITY H-20 UNITS, HAVING A 0.83' (10 INCHES) EFFECTIVE DEPTH, SCALE: 1 "=20' DRAWN BY: CES DATE: JANUARY 27, 2005
TO BE USED WITH 4.0' OF WASHED STONE ON THE SIDES, AND 4' OF WASHED STONE
ON THE ENDS, 3' STONE IN BETWEEN. NO STONE UNDER. SCALE: 1"=20' PROJECT#SD679 FILENAME: SD679PP.DWG SHEET 1 OF 1