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HomeMy WebLinkAbout0020 MARIE AVENUE - Health 20 Marie Ave. Centerville A = 226 132 No. 42101/3 ORA ESSELTE 10°!0 ® ® o 0 Aa4p- 13a- Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments - 20 Marie Ave. Property Address Catherine Tucke Owner Owner's Name information is Centerville Ma 02632 12/4/2020 required for every page. CityrFown 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 (5/41 S01 on the computer, use only the tab Sean M. Jones key to move your Name of Inspector cursor-do not S.M.Jones Title V Septic Inspection use the return Company Name key. 74 Beldan Lane rab Company Address Centerville Ma 02632 AA Cityrrown State Zip Code 774-248-4850 smjonestitle5@gmail.com, SI4522 sean@smjonestitle5.com 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 12/4/2020 Inspector's Signa re 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 Title 5 Official Inspection Form f Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 20 Marie Ave. Property Address Catherine Tucke Owner Owner's Name information is required for every Centerville Ma 02632 12/4/2020 page. Citylrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The roe located at 20 Marie Ave Centerville is served b a Title V septic stem consisting of a property rtY Y P Y 9 1500 gallon septic tank, distribution box and a 3 lateral perforated pipe leach field. Although the system was found to be in proper working condition at the time of inspection this report does not guarantee future performance under similar or increased usage. 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.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 20 Marie Ave. Property Address Catherine Tucke Owner Owner's Name information is required for every Centerville Ma 02632 12/4/2020 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 20 Marie Ave. Property Address Catherine Tucke Owner Owner's Name information is required for every Centerville Ma 02632 12/4/2020 page. City(rown 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: I 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 c Commonwealth of Massachusetts _ - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 20 Marie Ave. Property Address Catherine Tucke Owner Owner's Name information is required for every Centerville Ma 02632 12/4/2020 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 Y2 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 CM 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 20 Marie Ave. Property Address Catherine Tucke Owner Owner's Name information is required for every Centerville Ma 02632 12/4/2020 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 20 Marie Ave. Property Address Catherine Tucke Owner Owner's Name information is required for every Centerville Ma 02632 12/4/2020 page. Citylrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms(actual): 6 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 gpd Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: unknown Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments . � 20 Marie Ave. Property Address Catherine Tucke Owner Owner's Name information is required for every Centerville Ma 02632 12/4/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Tank was pumped for inspection Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1500 gallons How was quantity pumped determined? size of tank Reason for pumping: routine maintenance 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 20 Marie Ave. Property Address Catherine Tucke Owner Owner's Name information is required for every Centerville Ma 02632 12/4/2020 page. Cityrrown 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: system installed 1999 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 1 feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints in good condition, no leakage, vented through roof. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 20 Marie Ave. Property Address Catherine Tucke Owner Owner's Name information is required for every Centerville Ma 02632 12/4/2020 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: .5 feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 gallons Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Tank pumped for inspection Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): tank was pumped for inspection and should be done again every 2 years for proper maintenance. t5insp.doc•rev.7/26/2018 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 20 Marie Ave. Property Address Catherine Tucke Owner Owner's Name information is required for every Centerville Ma 02632 12/4/2020 page. Cityfrown 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments e 20 Marie Ave. Property Address Catherine Tucke Owner Owner's Name information is required for every Centerville Ma 02632 12/4/2020 page. Cityrrown 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.): Distribution box was replaced at time of inspection, permit#2020-382 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 c Commonwealth of Massachusetts �. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 20 Marie Ave. Property Address Catherine Tucke Owner Owner's Name information is required for every Centerville Ma 02632 12/4/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ® leaching fields number, dimensions: 1 20'x15' ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 20 Marie Ave. Property Address Catherine Tucke Owner Owner's Name information is required for every Centerville Ma 02632 12/4/2020 page. Cityrrown 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.): s.a.s. consists of a 3 lateral perforated pipe leach field. The 3 laterals were video inspected from d- box and found clean with no signs of past overloading. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7/2612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 20 Marie Ave. Property Address Catherine Tucke Owner Owners Name information is required for every Centerville Ma 02632 12/4/2020 page. CityrFown 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.7/2612018 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 e � 20 Marie Ave. Property Address Catherine Tucke Owner Owner's Name information is required for every Centerville Ma 02632 12/4/2020 page. Cityrrown 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 ( `f M. 2 3 5316 A2, 3y '� A3 i t5insp.doc•rev.706/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form �a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments � 20 Marie Ave. u Property Address Catherine Tucke Owner Owner's Name information is required for every Centerville Ma 02632 12/4/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 5+feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: A hand augered test hole to 6' resulted in no observed groundwater, bottom of leach field is 3' below grade. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments .., 20 Marie Ave. Property Address Catherine Tucke Owner Owner's Name information is required for every Centerville Ma 02632 12/4/2020 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 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 L nn TOWN OF BARNSTABLE LOCATION c-A 2 A\�t, SEWAGE# VILLAGE C e, �`L�_ ASSESSOR'S MAP&PARCEL; 6'I,S' r� a, Z. INSTALLER'S NAME&'PHONE NO. S � ��u�vGOF{— a5 N.QC�6 g .: . —SEPTIC TANK.CAPACITY 4 aF i LEACHING FACILITY:(type) (size) NO.OF BEDROOMS �10 © �0)c O� OWNER me-L..) (no-0- l.N^c$ B�ly PERMIT DATE: /A l 0 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 within 300 feet of leaching facility) Feet FURNISHED BY L. C At : 3 � f Aa -- A"3 = � 6 r TOWN OF BARNSTABLE LOCATION o5gt,I e Iq A)A) /er SEWAGE# VILLAGE j '"TerYt//e ASSESSOR'S MAP&PARCEL M199 INSTALLER'S NAME&PHONE NO. �r SEPTIC TANK CAPACITY li ago LEACHING FACILITY: (type) o e/P (size) NO.OF BEDROOMS 7 OWNER PERMIT DATE: COMPLIANCE DATE: j Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility,(If any wetlands exist within 300 feet of leachi facility) Feet FURNISHED BY A � ,p G E 30, I i TOWN OF BARNS T ABLE G \ LDCATIO,N M4 61 C SEWAGE # VILLAGE ASSESSOR'S MAP& LOT 22 a z71, - --INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY j S Q a ,��cLO LEACHING FACILITY: (type) ��� 5 (size) 22 X.ZZ NO.OF BEDROOMS 3 BUILDER OR OWNER PERMTTDATE: . 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 within.300 feet of leaching facility) Feet Furnished by D ec� No. O o 6 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Rpplitation for Disposal *pstrm Construction Permit Application for a Permit to Construct( ) Repair('Upgrade( ) Abandon( ) ❑Complete System Individual Components Location Address or Lot No. �� M � Owner's Name,Address,and Tel.No. Assessor's Map/Parcel _1 catt".rovc— T� � Installer's Name,Address,and Tel N p vc-c-, Designer's Name,Address,and Tel.No. Type of uilding: Dwelling No.of Bedrooms Lot.Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Oa uZ _ [� I 0 ` �'r 0`�,U.k-(ti� � V tO ( 1!1 Pi lA L l� l S %Nj L t Cyr 0(S 9C Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signe Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. � � —1�a Date Issued ( 41 C, No. 9'U 3k y Fee ; THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: � !. Yes PUBLIC HEALTH DIVISION-- TOWN OF BARNSTABLE, MASSACHUSETTS r 01pplication for MisposaY 6pstem ConstrUCtion Permit ` Application for a Permit to Construct(h ) Repair(�)�Upgrade-.( ) Abandon( ) El Complete System Q I ndividual Components ' Location Address or Lot No. Owner's Name,Address,and Tel.No. ate.* Assessor's Map/Parcel 1 ev i Cvty !%, t" A-,)C.Xe CXD Installer's Name,Address,and Tel.No.SLO ;r C,✓� Designer's Name,Address,and Tel.No. r �"X'�'! a {v o Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design:Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date " Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) r p 1-1 1 5"r t Ej A-I (t !J !.t-> 14 #Q � l �•t-r l�[a�4\[�r f5�C 4 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed-� ( "'� Date- ( !i V/2 o Application Approved by � � � A (2 , Date m Application Disapproved by r c Date for the following reasons a Permit No. a Date Issued ' h d 6 G -- C. C THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( �Upgraded( ) Abandoned( )by tM ,at 0 (1 to a r i<, Ao -4-0 C`. V has been constructed in accordance j with the provisions of Title 5 and the for Disposal System Construction Permit No, dated Installer <,r 0 � (� �,.���,+�/�„� Designer #bedrooms' Approved design flowfA /�/��' `= gpd The issuance of this permi)shall not be construed as a guarantee that the system will fh ctioyn/as design. Date Z L J Inspector \A cl `No. tf. �Z Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal *pstem Construction permit Permission is hereby granted to Construct( ) Repair(M/ ) Upgrade( ) Abandon( ) System located at 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 must be completed within three years of the date of this permit.Date 1 I .� a /�° Approved by C)) ! V qq No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: - Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS 0[ppYfcation for Di-opoml *proem Con5tructioai Permit Application for a Permit to Construct( )Repair( )Upgra`d/e( )Abandon( ) C� O mplete System Individual Components Y ' Location Address or Lot No. �f 4 Owner's Name,Address and Tel.No. t' Assessor's Map/Parcel i 2 ✓IJ Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms_„� Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3�J V gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 1 Type of S.A.S. Description of Soil �/lf�,PQ S�VO Nature of Repairs or Alterations(Answer when applicable) __��� 1✓ }G—� �''`' Y�hw7` n.,-tc,•�i In 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_be,,en iisssteed-by-t�ti Signed k Date / Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M ^C&L DATA WWI- No. 19 ee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Zizpooal *potem Conotruction Permit Permission is hereby granted to Construct( )Repair )Upgrade Abandon( ) System located at 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. G � Provided:Con tru tion mus/be completed within three years of the date of t" 8 p° t. /� Date: Approved by. 7M� � % t f Fee qq ee THE COMMONWEAkH OF MASSACHUSETTS _ Entered in computer: Yes PUBLIC'HEALTH DIVISION - TOWN OF BARNSTABLE...,,MASSACHUSETTS Zipprication for Migogal *p-5tem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) E7Cbmplete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: ; Dwelling No.of Bedrooms'- Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures -� Design Flow _ �J� gallons per day. Calculated daily flow J gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank" 1`M Type of S.A.S. 1 G l i(_ Description of Soil I�ljl/->•� s�1 y� , Nature of Repairs or Alterations(Answer when applicable) -T r_ Date last inspected: Agreement: _1.-..-•----.:..The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system' R in'acccidance with the provisions of Title 5 of the Environmental C de and not to place the system in operation until a Certifi- cate of Compliance has b'eeen iiss=ed-by-thi f-Health. - 1 Signe— d r - J % Date �f Application Approved by / .�I .�.--' Date A--pplication Disapproved for the following reasons Permit No.Ll ff Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired{ )Upgraded Abandoned( )by CftU S k l� at ,- .v°+-� LQ, U,fDL _ has n constructed in accordance with the provisions of Title 5 and the for Disposal,System Construction Permit No. -dated, Installer Designer f < I •-- The issuance of this permit shall not be construed as a guarantee that the system will function=as designed. Date 1 . . + qq Inspector ----7%71 ------------ -—————————— 4661 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. - CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANSI I hereby certify that the application for disposal works construction permit signed by me dated l j�j�= concerning the property located at �D jr, _ meets all of the following criteria: V- The failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. J• The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. �• There are no wetlands within 100 feet of the proposed septic system (/• There are no private wells within 150 feet of the proposed septic system • There is no increase in flow and/or p use change in pr oposed oposed ere are no variances requested or needed. • The bottom of the proposed leaching facility will not be located less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor ethod when applicable] • If the S.A.S. will be located with 250 feet of any vegetated wetlands, the bottom of the proposed leaching facility will not be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(using GIS information) ] B) G.W.Elevation 6,0+the MAX.High G.W. Adjustment.—Li = 6 DIFFERENCE BETWEEN A and B 1�— SIGNED : DATE: [Sketch proposed pl of system on back]. q:health folder.cert ti ;�___, C� r YI NOTICE:,This Form Is To Be Used For the Repair Of Failed Septic Systems Only. ' CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS) I, hereby certify that the application for disposal works i n �construction permit signed by me dated — 7 concerning the property located at aQ v - _ meets all of the following criteria: c% There are no wetlands located within 100 feet of the proposed leaching facility There are no private wells within 150 feet of the proposed septic system d V. There is no increase in flow and/or change in use proposed (� There are no variances requested or needed. If the proposed leaching facility will be located within 250 feet of any wetlands,the bottom of the proposed leaching facility will am be located less than fourteen(14) feet above the maximum adjusted : A. I groundwater table elevation. i _ Please complete the following: A)Top of Ground Elevation(accordingto the Engineering Division G.I.S.map) B)Observed Groundwater Table Elevation(according to Health Division well map) b I � �.M �.� DATE: SIGNED: LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER (Attach a sketch plan of the proposed system.Also if the licensed installer posesses a eeitifled plot plan, this plan should be submitted]. - 4:beeIU"der.am 0• O c� i TOWN OF BA INSTABLE LOCATION SEWAGE # - VILLAGE - ASSESSOR'S MAP & LOT -a2 I t INSTALLER'S NAME&PHONE NO. /)1%o C (%e o , b SEPTIC TANK CAPACITY /S a o LEACHING FACILITY: (type) ,••e �NS S� .;) (size) a X;Z2 NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE: /- -),,T- r1`I 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 within 300 feet of leaching facility) Feet Furnished by N fy7 Fjms..... . ? ..... THE COMMONWEALTH OF MASSACHUSETTS BOAR® 9F HEALTH pplirFa#ion for Diipniital Works Tnnitr.urtinn Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ...... 0..___..�_1�4. .�c°--------.�.....U�..: ��,�- ��r................ .... .............................................. �-------------Location-Address .- •.------•- --•--or.Lot No. 1 G1..G ---•-- � ._. .... ...---•--•------•--- ................ .......•--•-••.... --------------•-----------*............_..... O ner ...... ress ...... 1r✓G,df�'l >P .. 0.. �/�. •----------.........................Add -•-----------------------------•------..... Installer Address VType of Building Size Lot............................Sq. feet � Dwelling- Ko. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—T e of Building No. of persons............................ Showers — Cafeteria a' Other fixtures ------------•---------------------------------d -----------------------------------------•-- 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.l.................. Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '-� Percolation Test Results Performed by----------------------•----------•---•••------•-------•------------------- Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth toground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ -------•---•------------ -----• --------------------- O Description of Soil---------- .� ._..------•--------•------------------------------------•-----------....--•-----...:....--------•-----------------._._...---•-•------------- x ----------- ------------ ---------------------•----...------------------..-----------------...........--------............. V .........................................----.--.-...-..--------•--•---•-------•-------------------------•--------....--�---- ---------- ........................................................ U Natur f Repairs or terat• ns—Answer when applicable.----- .-/ Sd ll t;>>.r�'_�A.. ' ------------------- --T ......•-----------------------------•--------.............------------------------------------------------------------------.-•----...............--. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITL U 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the WAard health. ........../ Date Application Approved By............ .... . : G ...................................... ----•-•--- Date Application Disapproved for the following reasons:................................................................................................................ ---------------------------------------------------------- -------------------- ----------------------•---'------------------------------------------------------•--------------------------••-------- — ' Date Permit No....... ......... ------- Issued--------------------------- Date THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M ^C&L DATA �p THE COMMONWEALT O iVIA A n BOARD OF HEALTH / ....... f �r!'r� ' ...........OF..... . ,4.�r ,�;217".`.IcfaLl ........... Trrtifiratr of Tuntplianrr TES L TO CERTIFY, That the Individual Sewage Dispos lstem constructed ( ) or Repairedby ..... I....._•___.... .a: 04 Install at.._.. / ..__� �A - .!'c �'-' �r +'e` ' .... ---------- has been installed in accordance with the provisions of TITLE j of The State Sanitary Code as described in the application for Disposal Works Construction Permit Ndi� „_-t 2*7---------.- dated.......... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. - n PATE------------------.1'L..�.-'j_,j .................................. Inspector:.... J.� r'� ..... - THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . .+ OF...... -t•! . .......... ................................... F ;. ' 11 ,'`r Permission is hereby granted........' =----- ... ~ = _ -: .......... to Construct ( ) or Repair (f yF)"`an Individual Sewage Disposal System at No. `°� , f* o . .......................... Street as shown on the application for Disposal Works Construction Permit Dated....f. ./f- 0 ............ sc'`a�ot� a>i _ DATE-•--••---�2---'=--!(�.":.�.........--••-•------------••--- x�i FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS t:r LOCATION a- ' SEWAGE 'PERMIT NO. VILLAGE ' INSTA L L E 'S NAME a ADDRESS S U I L D E R OR OWNER Tuc,1< DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED I.Z - 3y ��3S w �? ECAR 6 p�� 9 yo, e -- -- i V' TOWN OF BARNSTABLE LJCATION q10 411 Or Q SEWAGE � VILLAGE cf vZlerJ I /`P ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. 1,1160eo + % SEPTIC TANK CAPACITY LEACHING FACILITY:(ty ) (sue) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER GC `G l d tJr �+A DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes ro(W,'�l1 No I i � f v f� I, THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .......OF........ �. ....................... Aptiration for Uhipuii al Marks Tonstrurtion ami# Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Systems at: .............. ` .� r -------•.............................................................. Location-Address or Lot No. .._...�.f:T.. ....................................................... ..........--.................................--- ............................................... r Address a !�f.. � E ' iP41, .-.--.r�. `); - �: '�:',.--•----------------------•••---.............. ......_.._... ..................... Installer Address Type of Building Size Lot............................Sq. feet Dwelling:;;11o. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building No. of persons............................ Showers — Cafeteria Q, 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-------------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water......................... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-____-_____--•--.__-__.. -----------,- ODescription of Soil---------.-- ./.N -----------------------------------------------------------------•----------------.-.--._----_----------------------•-------- r.. ------•--------------------------•---------- --------------------•---•---------•------ .... ---- ----- ---.-- �----- .......------•••--_•--•-....... U Nature R airs or Alterations—Answer when applicable ................... --- --f ..... : ----------•----••----•-----•..................... ... ....•----. --- ------. •. ---- --------- --• --------------.............--- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TI'i T1E 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. np Date Application Approved Datt ~` . Application Disapproved for the following reasons------------------------------------------------------------------------------------------------••-----.._....... ............................................•------•----. ............................................................................................................................................. Date Permit No......�_ "' 11 Issued•---------------------- r TOP OF STANDARD .NOTES MUNDATI ' 1) THIS P&AN L5 FOR THE INSTALLATION OR REPAIR OF A SEPTIC SYS'IAU AND ZS' NOT INTENDED FOR SURVEYING OR ZONING EL /0/• / ► PURPOSES. GROUND SURFACE EL_ O t 2) ALL INSTALLATION PROCEDURES' ANDnSI�A647ZPRMkS SHALL CONFORM TO 310 AMR 15.000, THE STATE ENVIRONMENTAL COVE, GROUND SURFACE Ems/ TfTLE' 5, AND THE TOWN OF , 13" 116 SUBSURFACE DISPOSAL REGULATIONS. » MIN 3) NO DF.'TERMINATION HAS BEEN MADE AS TO COMPLIANCE OF AVAILABLE PROPERTY INFORMA-TON WITH RECORDED DFFDS OUTLET PIPE LEVEL OR ZONING REGULATIONS. FIRST TWO FEET �, f�" ,J o VENT REQUIRED I ct , 4) TOWN WATER SERVICES THIS PROPERTY. TOP EL LI UM LEVEL Mnv'� LAYS nausLe wAsr n 5) THEM ARE' NO l�NO-IN PRTV i 3�E1 LS ON TfLtS PROPERTY OR WITHIN 100' OF �'fE PROPOSED SOIL ABSORPTION SYSTEM. D—BOX ue•- ue• warn: 8) ALL C"OVER`q OF SYSTEM COMPONENTS SHALL BE BROUGF f rO WITHIN 1,2" OF T'INISHED GRADE, WITH ONE COVER OF"THE INVERT EL 10 14" q ,2 ' �` �``� �' , , `� '� f '` �► " SEPTIC TANK BROUGHT N?TMV 6" OF GRADE. / ___- Ck,Q '6 ^ " r . '~ . ` `,. ` . . �'r �, << EFFL'CTBT ALL SYSTEM COMPONENTS SHALL REMAIN ACCESSIBLE FOR 1NSFECTION. NO STRUCTURES' 5zpLL BE LOCATED DIRECT2Y C(� •x1 GAS BAFFLE AT OUTLET INVERT EL r SWEWALL 7) INVERT EL INVERT EL + , UPON OR ABOVE THE COMPONENT ACCESS LOCATIONS, WHICH WOULD INTERFERE WITH THEP'ERF'ORMANCE ACCESS, INSPECTION °I': Z s - Z' C. I C"t J�1G -0 PU"BVG OR REPAIR �� t 3/4'- 1 1/2' DOUBLE INVERT EL INVERT EL (�ical) WASHED STONE 8) NO DRIVEWAY, PARKING OR TURNING AREA, OR OMR IMPERVIOUS AREA SHALL BE LOCATED ABOVE A SOIL ABSORPTION 8 STONE BASE r SYSTEM, EXCEPT WHEN VEYTWG IIAS BEEN PROVIDED. 1500 Gal. Septic Tank q 9) SEPTIC TANK5, GREASE TRAPS, DOSING CHAMBERS AND DISTRIBUTION BOXES SHALL BE PLACED ON A 6" STONE BASE zs � EL TO STABILITY AND PREVENTG.SET1LIN I, - _-1- t t 1 �'.f. BOTT M OF TEST HOLE 10) OUTLET DISTRIBUTION LINES SHALL REMAIN LEVELR A MINIMUM OF THE FIRST TWO FEET OF THEIR LENGT�I. 2 t 11) ALL SYSTEM COMPONENTS SHALL BE CAPABLE OF WITHSTANDING H-10 (OADING UNLESS THEY ARE UNDER OR WITHIN 10' OF DRIVEWAYS OR PARKING OR TURNING IN WHICH CASE H-20 COMPONENTS SHALL BE USED 12) ALL BUILDING SEWER LINES SHALL HAVE AN INNER DL4METER OF 4 ' AND SHALL BE CAST—IRON OR SCHEDULE 40 PVC. 13) THE DEPTH OF THE TOP OF ALL SYSTEM COMPONENTS` SHALL NOT EXCEED 36" UNLESS VENTNG HAS BEEN PROVIDED. 14) 1A" ?TIE AREAS OF EXCAVAT7011 EMTIIVG GRADES SHALL BE REEST__BLTSHED UNLESS NOTED AS PROPOSED CONTOURS. T/�T 1 V Q• D0 15) IF SOILS ARE ENCOUNTERED DURING THE EXCA VAIYON OF TILE SOIL ABSORPTION SYSTEM, THAT DIFFER NOTABLY FROM S O2025 • THE DEEP OBSERVATION HOLE LOG, CONTACT THE ENGINEER BEFORE PROCEEDING. i 18) CONTRACTOR ?O VERIFY LOCATION OF ALL UNDERGROUND UTILITIES. MA-HMUM .FEASIBLE COMPLIANCES �CAU T/vn1 � � .) VARIANCE TO THE 5' SEPARATION BETWEEN TEE BOTTOM OF LEACHING FACILITY AND ESTIMATED HIGH GROUND WATER A 4' SEPARATION IS PRO TIDED. (101. 7) (102.1) TITLE 5 SECTION 15.212(B) DEEP OBSERVATION Proposed Leaching Facilit HOLE LAG ' x 23' Leach .Field • (1OD•5) � � � ��, �t�o M �t�� td G t�'c�✓�..D Test Hole 1 Existing 23 . . . . w�th three lines DEL /d f) D---•-Box .. . . : : : . . . . . . . .•.•.•.• . ....•. . . . t' v soil Soil Boil . . . . . . . . . . . . . . . . . . . . . . . . . . . . t l ) Bt Izon xture Color �t1SDA) (Munsell) Existing 1,500 Gal . . . . . . . . . . .:• Q _ A Z6AMy / ' Sep tic Tank 0 4 : :...........:.:...:... . .:...:.....:.....:.:.....:.:: y Shed _-_ /,77 1 -/4 it S, - - - 7 . . . . . _ g�- o c _ . . . . . . . . . . DESIGN DATA ' (100.4) (100.2) ^ Number of Bedrooms: ';'► e Grinder. Garbs Observa tion r: NO Ex�sting In vest ;� ,� � g ET = 99.35 1( N Hole. Design Flow: '? (100 0) (110 Gal/BR/Day z Number or BR) Septic Tank 1,500 rtVIN Dee Obs Hole Date: (Minimum = Design Flow z 2ooz") Soil Evaluator. t??C A4 Al Deck (99.8) Leaching Area: Witnessed Br. . Pere Rate::... (100 2) Sidewalk Soil survey Description: C A-e v (2 side z z ) + Geologle Material: o u rw A S Depth to Standing Water: �''4 = 2 .� (2 Sidevalls z n z n) + Depth to Weeping Water: Pepth to Mottling(Color): 100.1 EXCAVATION NOTES Bottom: ( ) � i y60 sas obee�►t�yen Aaf 1 t� A=VATZ'ALL YAI.RRIAL A90VA' SOIL HORIZON C (S.h'Lr DEEP O.btSERVATION ( z 11't) Date of Last Measurement TBM EL = .100. 0 HO&W LOG) AT APPIdDMIf N BLEYA170Y 93.4 MR A LATMUL DMTANCE OF 5' Long Term Acceptance Rate (LTAR): 0.74 Comments: (/HERE POD) X ALL J9ffl&- M BEI = THE Ot/TL'R PE1WlE= OF THE to (O Leaching :Area Design Capacity: BI d #�� .Top of Con c �� KU MATMUAL s� CVJ=r of Cr.� GRANULAR SANu FREe FMW ORGAI&,', 3�D GP,D. (100. 0) M AND 0TJM DZesTSRr VS 8VWrANCWS; N70M ,1aM T ?B'UVAAL (sidewall Area + Bottom Area) z LTAlt O 3 Bed dlTERIA PUT MRTB M Sal MN 15.255(9) OF TTTZB 3) SCARIFY = BOTMAt BL'RFACR OF IM ZMAVA17ON PRIOR T7 PLdCE1f M' TO. ' EL = 1 D1. 1 - (r00.0> t� c. � Ufa "V UW ff M DRY M --- l PROJECT LOCATION ASSESSORS MAP �' LOT 2-- `, Porch APPII'CANT.• 6EE'o L�o 7,,� Existing , A -20 ' D/YY ' - _ PREPARED BY i i q A & M Land Services 33 Old Main Street i v South Yarmouth, MA 02664 21�1 ) (508) 398-2121 Fax 394-9642 y SCALE j /p r DATE.• I Zq/ f�` N 03'59 '40 " .E' 125. 00 r �� of REV. LOCUS .MAP - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - — N - - - - - - - - - - - - - - - - ��- - - - - - - - - - - -- - (976) ` s„o Mtn/ DWG. NO. `g800? SHEET 1 OF 1 MARIE A VENUE