HomeMy WebLinkAbout0235 OLD CRAIGVILLE ROAD - Health 235 Old Craigville Road, Centerville
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Commonwealth of Massachusetts
u Title 5 Official Inspection Form ZW -�Zy
Subsurface Sewage Disposal System Form Not for Voluntary Assessments S• _ (Z2Q'a -�'
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235 Old Craigville rd 01
Property Address
Ellen Conway
Owner Owner's Name xx
information is Ma 02632 8/29/16ill t enerve
required for every C F0
page. City/Town State Zip Code Date of Inspection
`h7
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
Important:When A. General Information
filling out forms
on the computer,
use only the tab 1. Inspector:
key to move your
cursor-do not Michael DiBuono
use the return Name of Inspector
key.
DiBuono Sewer and Drain
rsb Company Name
8 Johns path
Company Address
S Yarmouth Ma 02664
City/Town State Zip Code
508-364-9587 S103522
Telephone Number License Number
B. Certification
I certify that I have personally inspected the sewage disposal system at this address and that the
information reported below is true, accurate and complete as of the time of the inspection. The inspection
was performed based on my training and experience in the proper function and maintenance of on site
sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of
Title 5 (310 CMR 15.000). The system:
® Passes ❑ Conditionally Passes ❑ Fails
❑ Needs Further Evaluation by the Local Approving Authority
9/1/16
Inspector's Signature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board
of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or
has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the
report to the appropriate regional office of the DEP. The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
****This report only describes conditions at the time of inspection and under the conditions of use
at that time.This inspection does not address how the system will perform in the future under
the same or different conditions of use.
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17
L
Commonwealth of Massachusetts {
W Title 5 Official Inspection Form
Subsurface SewageD' -Disposal System Form Not for Voluntary Assessments
235 Old Craigville rd
Property Address
Ellen Conway
Owner Owner's Name
information is required for every Centerville Ma 02632 8/29/16
page. CitylTown State Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E/always complete all of Section D
A) System Passes:
® I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
System contains a 1500 GI septic tank as well as a distribution box and three 500 GI chambers.
System is in proper working order at this time
B) System Conditionally Passes:
❑ One or more system components as described in the "Conditional Pass" section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
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 ears old* or the septic tank whether metal or not is structurally
Y p ( ) Y
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass
inspection if the existing tank is replaced with a complying septic tank as approved by the Board of
Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND (Explain below):
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
235 Old Craigville rd
Property Address
Ellen Conway
Owner Owner's Name
information is required for every Centerville Ma 02632 8/29/16
page. CityrTown State Zip Code Date of Inspection
B. Certification (cont.)
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
B) System Conditionally Passes (cont.):
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
C) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
°M 235 Old Craigville rd
Property Address
Ellen Conway
Owner Owner's Name
information is required for every Centerville Ma 02632 8/29/16
page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
2. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system SAS and the SAS is within
Y P P Y (SAS)
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well".
Method used to determine distance:
*"This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal
coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must
be attached to this form.
3. Other:
D) System Failure Criteria Applicable to All Systems:
You must indicate "Yes" or"No"to each of the following for all inspections:
Yes No
❑ ® 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
❑ ® 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
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
235 Old Craigville rd
Property Address
Ellen Conway
Owner Owner's Name
information is Centerville Ma 02632 8/29/16
required for every
page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
Yes No
❑ ® 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 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 2000gpd-
10,000gpd.
❑ ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection
Area—IWPA)or a mapped Zone II of a public water supply well
If you have answered "yes"to any question in Section E the system is considered a significant threat,
or answered"yes" in Section D above the large system has failed. The owner or operator of any large
system considered a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15.304. The system owner should contact the appropriate
regional office of the Department.
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17
Commonwealth of Massachusetts
- Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -,Not for Voluntary Assessments
G1M , 235 Old Craigville rd
Property Address
Ellen Conway
Owner Owner's Name
information is required for every Centerville Ma 02632 8/29/16
page. Cityrrown State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate"yes" or"no"as to each of the following:
Yes No
❑ ® 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)]
D. System Information
Residential Flow Conditions:
Number of bedrooms (design): 3 Number of bedrooms (actual): 3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of W
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
;M 235 Old Craigville rd
Property Address
Ellen Conway
Owner Owner's Name
information is required for every Centerville Ma 02632 8/29/16
page. Cityrrown State Zip Code Date of Inspection
D. System Information
Description:
System contains a 1500 GI septic tank as well as a distribution box and three 500 GI chambers.
System is in proper working order at this time.
Number of current residents: Vacant
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No
information in this report.)
Laundry system inspected? ® Yes ❑ No
Seasonal use? ❑ Yes ® No
Water meter readings, if available last 2 ears usage 201 GPD
9 ( Y 9 (gpd))�
Detail:
Sump pump? ❑ Yes ❑ No
Last date of occupancy: Date
Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 15.203): Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 235 Old Craigville rd
Property Address
Ellen Conway
Owner Owner's Name
information is required for every Centerville Ma 02632 8/29/16
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Last date of occupancy/use: Date
Other(describe below):
General Information
Pumping Records:
Source of information: None provided
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped:
gallons
How was quantity pumped determined?
Reason for pumping:
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):
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17
i
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
235 Old Craigville rd
Property Address
Ellen Conway
Owner Owner's Name
information is required for every Centerville Ma 02632 8/29/16
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known) and source of information:
13 Years
Were sewage odors detected when arriving at the site? ❑ Yes ❑ No
Building Sewer(locate on site plan):
Depth below grade: 1.5feet
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.):
Septic Tank(locate on site plan):
Depth below grade: 1
feet
Material of construction:
® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain)
1500
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
Dimensions:
Sludge depth:
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
235 Old Craigville rd
Property Address
Ellen Conway
Owner Owner's Name
information is required for every Centerville Ma 02632 8/29/16
page. Citylrown State Zip Code Date of Inspection
D. System Information (cont.)
Septic Tank(cont.)
Distance from top of sludge to bottom of outlet tee or baffle
24"
Scum thickness
3"
Distance from top of scum to top of outlet tee or baffle
42"
Distance from bottom of scum to bottom of outlet tee or baffle 1" Sludge stick
How were dimensions determined? Tape Measure
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
No evidence of Ieaking,Tees and or baffles in place at time of inspection.
Grease Trap (locate on site plan):
Depth below grade: feet
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: Date
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17
I
Commonwealth of Massachusetts
. Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
0
235 Old Craigville rd
Property Address
Ellen Conway
Owner Owner's Name
information is required for every Centerville Ma 02632 8/29/16
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tees are in place and levels are normal.
Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Capacity: gallons
Design Flow: gallons per day
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments (condition of alarm and float switches, etc.):
*Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17
Commonwealth of Massachusetts
- Title 5 Official Inspection Form
a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M 235 Old Craigville rd
Property Address
Ellen Conway
Owner Owner's Name
information is required for every Centerville Ma 02632 8/29/16
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Distribution Box(if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert
Level and at normal level
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.):
Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No*
Alarms in working order: ❑ Yes ❑ No*
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
*If pumps or alarms are not in working order, system is a conditional pass.
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17
Commonwealth of Massachusetts
U Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
°M 235 Old Craigville rd
Property Address
Ellen Conway
Owner Owner's Name
information is required for every Centerville Ma 02632 8/29/16
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Type:
❑ leaching pits number:
® leaching chambers number: 3
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
Chambers were dry at time of inspection
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
9 ❑ ❑
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17
Commonwealth of Massachusetts
„ t
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
235 Old Craigville rd
Property Address
Ellen Conway
Owner Owner's Name
information is
Centerville Ma
required for eve 02632 8/29/16
4 every
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
No ponding no break out
Privy (locate on site plan):
Materials of construction:
Dimensions
Depth o solids
li ds
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
�M 235 Old Craigville rd
Property Address
Ellen Conway
Owner Owner's Name
information is required for every Centerville Ma 02632 8/29/16
page. City(rown State Zip Code Date of Inspection
D. System Information (cont.)
Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to
at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate
where public water supply enters the building. Check one of the boxes below:
❑ hand-sketch in the area below
® drawing attached separately
� . 2 CT
i n
a
.z
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17
Commo
nwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M , 235 Old Craigville rd
Property Address
Ellen Conway
Owner Owner's Name
information is Centerville Ma 02632 8/29/16
required for every
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
❑ Check Slope
❑ Surface water
❑ Check cellar
❑ Shallow wells
Estimated depth to high ground water: 10+ ftfeet
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: 2003
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:
Test hole data on file
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
�M 235 Old Craigville rd
Property Address
Ellen Conway
Owner Owner's Name
information is required for every Centerville Ma 02632 8/29/16
page. Cityrrown State Zip Code Date of Inspection
E. Report Completeness Checklist
❑ Inspection Summary: A, B, C, D, or E checked
❑ Inspection Summary D (System Failure Criteria Applicable to All Systems) completed
❑ System Information— Estimated depth to high groundwater
❑ Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17
No. �,, j Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
Yicatiou for ;Di. og Y * Stem Congtruction Permit
Application for a Permit to Construct( )Repair( Upgrade( )Abandon( ) ED Complete System O Individual Components
Location Addressor jt�io� C Owner's/Naame,Address and Tel.No.
11 Assessor's Map/ParcelCC, �il1 �irVv D�,V4/�j
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
k4\�e.k e1 Cow sc- L 1_7
Type of Building:
Dwelling No. of Bedr ms Lot Size v r,2 ft. Garbage Grinder( AO
Other Type of B ilding No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S. r
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 issued by this Board of Health.
Signe Date - f. - ^
Application Approved by Date
Application-Disapproved for the following reas s
A
Permit No. Date Issued
No. r .. } - Fee O
3 TI COMMOhWftALT:H OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
Replication for Mfgogar *pztem Construction Permit
Application for a Permit to Construct( )Repair( Upgrade( )_Abandon( ) O Complete System El Individual Components
Location Address or Lot No. 1 Owner's Name,Address and Tel.No.
3. Assessor's Map/Parcel 61L
b 2 � t
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
L.�Z
7') 1 - \-1 \,Z St t
Type of Building:
Dwelling No.of Bedlyoms Lot Size 24A,,Wsq.ft. Garbage Grinder
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
t__. Title '
Size of Septic Tank Type of§.A.S.
i
.Description of Soil: t L
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 EnvironmeniatCode and not to place the system in operation until a Certifi-
cate of Compliance has been issued by this Board of Health
Signe - Date
Application Approved by r, ' Date
Application"Disapproved or the following reas s
Permit No. 4 Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( t/ieupgraded( )
Abandoned( )by nI_
at &S hasOated
onstructed in accordance
with the provisio s o Titl 5 and the for Disposal System Construction Permit No.
Installer t Lsi i�7'" Designer rA
The issuance of this permit shaalll,�ot be construed as a guarantee that the system wil urzct'o a designed
Date `� Inspector
No.
---— ——————— ——————————— —————— - --`_
Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
mig ont stem�Q• gtruction Permit
p
Permission is hereby granted to Construct( )Repair( grad
e( )Abandon( )
System located at _23 M— D ►2A r��,l��_ 2 _. r� �—'
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: Constructio must be completed within three years of the date of t 's t?
Date: 9 D Approved by
r
Town of Barnstable
Regulatory Services
g rY
A
Thomas F. Geiler,Director
RAM
Public Health Division
Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Installer& Designer Certification Form
Date: Nuv bS
Designer: Installer: h7p,
Address: W• Y Address: 3o &&a..,-u faiLo
M 62-601 MA 6 2-4,o S
On t' `"i LV x_ was issued a permit to install a
(date) (installer)
septic system at r ®\L _ ,�� based on a design drawn by
(addreS
C- b dated
(desi
V I certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic twik.
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 an: component
of the septic system)but in accordance with State & Local $�i��ns. P1 revises or
certified as-built by designer to follow. ♦���P��H o. MASS,4.��I
��� ►IAA t. ;`��� �
L o a ►COMA � u'� � �
9-'�'%A,v '" ' . f�14A'
(ffico
;;caller's Signature) ;l 1 C ? 0 x,
i�9��••,�FGI Sf E^���•Q�Q�� :X U)
-FIE DIH ♦ N W
r-�
L(D
eslgner's Kign e) ( Designer's Stamp here)
PLEASE RETURN TO BARNSTADLE ]PUBLIC HEALTH D SIGN. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOT THIS FORM AND AS-
BUILT CARD ARE RECEIVED BY THE BARNSTADLE P IC HEALTH DIVISION.
THANK YOU.
Q:Health/Septic/Designer Certification Form
TOWN OF BARNSTABLE
LOCATION,i3r 2:b: CRA(gVl"I�- Ze— SEWAGE #
VI LAGF - ASSESSOR'S MAP & LO')rJY.? 124
INSTALLER'S NAME&PHONE NO. e".h r
T
SEPTIC TANK CAPACITY i o.
LEACHING FACILITY: (type) AYg,-,U 5DO (size) jl .49-J
NO.OF BEDROOMS
BUILDER 0 WNEE
PERMTTDATE: `10 —Cy'd6— COMPLIANCE DATE:
a i
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 1 ility) Feet
4
Furnished by CZ"k
OIL
'06�\
14
Hsi �
;fir
TOWN OF 8ARNSTABLE �®
?.00ATION o?3r Ro SEWAGE #
.VILJ,A.GE ASSESSOR'S MAP & LOT C - R Y
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY C IL5A EL /mod C w e-
LEACHING FACILITY: (type) (size)
NO.OF BEDROOMS .3 '
F440
BUILDER OR-O%T ER A,4. V_?91`Y¢s Cr. c�•yu��Y—Fs�T/�Cit
PERMTTDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility /® Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by �� =�
-,
.<:r.; ''
P.,po,�5�� ,
i f�:00r,��
����
i
�S, i� �Kr� I!
_\ �I �4 L
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a c��sce�cs.
i
1
commonweoM of Mossochusetts
Executive Office of Environmental Affairs ASSESSORS MAPNL—R
epartment ®f PARcallo•
' Environmental Protection
WNW F.weld TnWy Cox
ae�na s.mewy '
Atgeo Paul Celluoci DoW 0.SWuha
Lt.GWAK•ta comm�bbMt
f
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION
Pn�pertyAddresw ;?3S pL0 C/�AOCN! G/ i1� Address of Owner.
DO"of i opasua : .s'/a// cif diffe,aAt) ,y��,v " ��. 4*;r-,::29>
Nano of r. �-1/L e,
Inspects /,4/2D
Company Name,Address and Telephone Number. rp p -'do X a SO
i-i�4-S op o.2 C31
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported below i.true,accurate ;M;`r
and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-ate sewage disposal systems. The system:
-�—"Passea
_ .Conditionally Passes
Needs Further Evaluation By the Local Approving Authority
Faila
Inapector's Signatwm�e: Date: 6�a 7��{ •?a�, : '
The System Inspector shall submit a copy of this inspectionreport to the Approving Authority within thirty(30)days of completing this
inspection. If the system is a shared system or has a design flow of 10,000 gpd or gmatar,the inspector and the system owner$ball submit the
report to the appropriate regional office of the Department of Environmental Protection.
The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority.
INSPECTION SUMMARY:
Chscl ,C,or D: t
A] SYSTEM PASSES:
_IzI have not Bound any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303,
Any failure criteria not evaluated are indicated below.
Bl 9YBM CONDITIONALLY PASSES:
One or mots system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes
Indicate Tss,no,or not determined(Y, N, or ND). Describe basis of determination in all instances. If"not determined",explain why not)
The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or extlltration,.or.anit failure is
imminent. The system will pass inspection if the existing septic tank is replaced with a ponforming septic tank as approved
by the Board of Health.
(revised 11/03/95)
One Winter Street o Boston,Massachusetts 02108 a FAX(617)556-1049 a Telephone(617)292.666
A
}Pnnt•d en RrrvN,d Paper
PAR Real Estate System - General Property Inquiry Help
Parcel Id: 248 124- - Account No: 155147 Parent :
Location: 235 OLD CRAIGVILLE RD Neighborhood: 55DC Fire Dist : CO
Devel Lot : 1 Lot Size : . 23 Acres
Current Own: SIMON, FREDERICK L & State Class : 101
SIMON, CORINNE T No. Bldgs : 1 Area: 1632
23 AVONSIDE Year Added:
AVON CT 6001
Deed Date : 120188 Reference : 6540/168
January 1st : SIMON, FREDERICK L & Deed MMDD: 1288 Deed Ref : 6540/168
Comments :
Values : Land: 24800 Buildings : 57200 Extra Features :
Road System: 235 Index: 1145 (OLD CRAIGVILLE ROAD ) Frntg: 75
Index: 1926 (EDGEWOOD ROAD ) Frntg: 84
Control Info: Last Auto Upd: 050695 Status : C Last TACS Update : 090889
Land Reviewed By: Date: 0000 Bldgs Reviewed By: Date : 0000
Tax Title : Account : Taken: Account Status : Hold Status :
Cancel
Press XMT for more data
Next screen PAR Action
Owners Name
Road Index Road Name
Parcel Number 248 125
RCV F (GE) 1
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (oontinued)
PrvPerty Address: ;3 oGO G i?.R/6(/lGGe� !PO C�e'.vexl&e-
Owner. H 4".
Date of Impaction:
s1a y/y�
131 SYSTEM CONDMONALLY PASSES (continued)
Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)
or due to a broken,settled or uneven distribution box. The system will pass inspection if(with approval of the Board of
Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is levelled or replaced
The system required Pumping more than four times a year due to broken or obstructed pipe(e). The eyetem will pass
inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
C1 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 the
Public health,safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A
MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
Cesspool or privy is within 60 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh.
2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER,IF APPROPRIATE)
DLTERN04M THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND
SAFETY AND THE ENVIRONMENT:
The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a
surface water supply.
The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well.
The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well.
The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water
supply well,unless a well water analysis for coliform bacteria and volatile organic oompounds indicates that the well is See
from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or lass than 6 ppm.
9) OTHER
(revised 11/03/95) 2
,
4
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (oontinued)
Prroperty Addreee: Ro G/ZA r4f l/IGG.0
Owner.
Date of Inspection:
DI SYSTEM FAIL:
I bow determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for' '
this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the
failure.
41 ,
Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool.
Diacbarge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or
cesspool.
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 112 day flow.
_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). V- '.
Number of times pumped .711
Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation.
Any portion of a 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 I of a public 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 thaw 100 feet but greater than 50 feet from a private water supply well with no
acceptable water quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis for
oWorm bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen.
E1 LARGE SYSTEM FAILS:
The following criteria apply to large systems in addition to the criteria above:
The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public
health and safety and the environment because one or more of the following conditions exist:
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 n of a public
water supply well)
The owass or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program
regniremeats of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information..
(revised 11/03/95) 3
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
PnMrty Address: ?
Owner.Da r�fir,/1 GAO• L.. S/�,p� .
te of.inspection:
'Cbsck if the following have been done:
Pumping information was requested of the owner, occupant, and Board of Health.
None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates
during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection,
As built plant have been obtained and examined. Note if they are not available with N/A.
(C The facility or dwelling was inspected for signs of sewage back-up.
vThe.system does not receive non-sanitary or industrial waste flow
vThe site was inspected for signs of breakout.
1;::::All system components,/#Kclu&ng the Soil Absorption System, have been located on the site.
!/The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of ba®es or
tan, material of construction, dimensions,depth of liquid, depth of sludge,depth of scum.
1-- h size and location of the Soil Absorption System on the site has been determined based on edsting information or
approzimated by non-intrusive methods.
The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub-
Surface Disposal System.
(revised 11/03/95) 4
\ f
r
i
SUBSURFACE SEWAGE DISPOSAL SYSTEM-INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Addreae: C�.v�,(�fdIGGC
Owner- h/l, �/9�lis �, Gv,�/wj9Y - G�llyz X.
Date of Inspection:
/ FLOW CONDITIONS
RESIDENTIAL
Design flow:______pllons
Plumber of bedrooms: 3
Humber of current residents:
Garbage grinder(yes or no):_d�g
Lm mdry oomneeted to system(yes or no): NV
Seasonal use(yes or no): nod
®`Dater meter readings, if available: /�S - �/`�po0 Gi°G /�'!`.� �S p��D C/f � /`9�j ' 7/dl� G✓/<
G,y
Last date of oocupancy: /2/PSSd v7L y
COMME3WIAL/INDUSTRIAL:
Type of.establishment:
Daaign flow:_ _Sallone/day
Grease trap present: (yea or no)_
Industrial Waste Holding Tank present: (yes or no)_
Hon4 anitary waste discharged to the Title 5 system: (yes or no)_
Water,meter.readings, if available:
Last date of occupancy:
OTHER:(Describe)
Last data of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of information:
System pumped as part of inspection: (yes or no)_LZS
If yes,volume pumped. g&Uo'
Reason for pumping ,C T/ .v
TYP&OF SYSTEM
Septic tankAistrDnrtion boa/soil absorption system
Sin&Cesspool
7 Overflow Cesspool
Privy
Shared system(yes or no) (if yea, attach previous inspection records, if any)
Other(explain)
APPROMUTZ AGE of all components,date installed(if known)and source of information:
Ss4a`e odors detected when arriving at the site: (yes or no)
(revised 11/03/95) 6
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address
Owner.
Date of Inspection
SEPTIC TANK
(locate on site p4)
Depth below grade:
]dial of const;m c on:_concrete_metal_FRP_ether(e:plain)
Dima%sions:
Sludge depth:
Distance fPom top of sludge to bottom of outlet tee or baffle:
Scum thickness:
Distance f m1n top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert,structural integrity,
evidence of leakage, au.)
QREASE TRAP
(locate on Bite p
Depth below grade:
Material of construction:_concrete_metal_FRP_other(explain)
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance film bottom of scum to bottom of outlet tee or baffle:
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert,stnrctural integrity,,
evidence of leakage,etc.)
(revised 11/03/95) 6
. i
I
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Addm : .2 3�- 640 �5'�9:�GU r_GEC X V C
Orin er. f�/1li�LGnE t
Date of Inspection:
TIGHT OR HOLDING TANK1
(locate an site plan) !!
Depth below grade:
Materiel of construction:_concrete_metal_FRP---other(explain)
Dimensions:
Capacity: gallons
Design flow: eallons/day
Alarm level:
Comments:
(condition of inlet tee, condition of alarm and float switches, etc.)
DISTRIBUTION BOX L
(locate on site plan)
Depth of liquid level above outlet invert:
—
Cam
(Dots if level and distribution is equal,evidence of solids carryover, evidence of leakage into or out of box,etc.)
PUMP CHAMBEIL
(locate on site plan)
Pumps in working order-(yes or no) .
Camnawnts:
(no ti,condition of pump chamber,condition of pumps and appurtenances, etc.)
(revised 11/03/95) 7
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: o?3 �✓� G/P�`/G c//GGrt /1.0 G2,Ul)'Owner. ✓�.d!/i G-, GU.licv� /� �d�GG�
Date of InsImmAion.
SOU.ABSORPTION SYSTEM (SAS):_
(locate on sift plan, if possible;excavation not required,but may be approximated by non-intrusive methods)
If not do4rmiaed to be present,explain:
Type:
leaching pits, number:_
leaching chambers,number:_
leaching galleries, number:
leaching trenches, number,length:
eaching fields, number,dimensions:
overflow cesspool, number:
Comments:(note condition of soil, s' of hydraulic failure, level of g
signs y ponding, of ve tatioa,etc.) G
CESSPOOLS:_
(locate on site plan)
Number and configuration:
Depth-top of liquid to inlet invert: S '�
Depth of solids layer.
Depth of sarm layer:
Dimensions of casspool: G' or� G
Materials of construction: 41116
Iadintioa of groundwater:_
inflow(oasspool must be pumped as part of inspection) 7'&Z,'//z /ijk/
GPI f3C/T .C./O
Comments:(note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation,etc.)
(locate as srtt plan)
Material of construction: Dimensions:
,Depth of solids:
.0 mments:(note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation,etc.)
(Fevfied 11/63/95) S
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (oontinued)
Imperty Address
)rawer. �i/l. Tr9.�/'s' �. C.u.,v.m'✓'Y -- l'�TIl�2. L�RJ. L. S/lhU�
)ate of Inspection:
iHEXH OF SEWAGE DISPOSAL SYSTEM:
include ties to at Last two permanent references landmarks or benchmarks
bate all Wells within 100,
PRo�o��o
/4 p,D/T/,w
r
if (o
/S'y 6/r.'r �'vlili/��+ �rMrfiz
/Al .6arN i✓!% �s �r.:%GJr.:v> L O ff�y � /,v j H�`' S/�ih�" /'�.9t'�' T i7'L /�/TG�`L.�
DEPTH TO GROUNDWATER
Dapth to pamd /o -t' &d
Ewthod of detmrminatiom or apprau=tion: l//f :.�?.<>> C/,:=i"•%�� /5 / 5!�' /]/i; "ram 1�i9/�t�y 4L/L
7-0 4r Cc�ds4T /ts': rHg e-1scr
Go.�/li'�✓ion FifGT.e�Z /:� 3.6' l' Fi/[.!/ a9 3cxir G )
(revised 11/03/95) 9
1500 GALLON TANK DISTRIBUTION BOX DRY WELLS CROSS SECTION LOCUS PLAN
NOT TO SCALE NOT TO SCALE NOT TO SCALE NOT TO SCALE NOT TO SCALE
115,64 MW 2° L PE 99.9
COVER TO BE wITIm 1 e"OF ORADE MIN. 12"COVER 2" 1/8"-1/2" WASHED S ONE
MAX. COVER
3 MINBvIUM
=0 -
f\
3
n
11z. w A t-
o' o o =
I
9 0 0 0 0 0 0 0
13
B 11 1
t 11
11 0.3
C�
.9
2.25 �'
a
4 0 � o 0 0 0 0 0 0 0 0
� C C�0 o a � C� C� C� C� � C� �0 � 2
w
3
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•$ o 0 0 0 0 0� o o
111 0 0
.o O C� C�
C� C� O C� C� C� C� C� 2
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........ 1.1
0
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1 3 C�os. C� C�
C� \
C� C� C� C� C� C� C� C� �
11 .8 C� C� �
4.0 0
A
1
J
10.0 �/ \ �/\ �/\ �/\ \ �/\ �/\ �/\ s:\ �/\`�/\:�/\� OLD CRAIG V ILL E RDAD
MIN
2.8' 4.83 2.8'
bn oi�aro ui m raNtc:::: :::.:::::: 28.5' 10.5'
10.5' 3/4"-1 1/2"DOUBLE WASHED STONE
BOTTOM OBS 102.6
SITE SPECIFIC NOTES FT OOR pT A1�T
1. L 1�1 DESIGN CALCULATIONS GENERAL NOTES
CESSPOOLS TO BE PUMPED AND NOT TO SCALE EXISTING BEDROOMS 3 0 110 G.P.D. ALL PIPING TO BE SCHEDULE 40 P.V.C.
FILLED (REMOVE ONE NEAR TANK)
330 G.P.D. ALL LOCATIONS OF UTILITIES SHOWN ARE AS
CONNECT BUILDING SEWER PIPES MARKED BY DIG-SAFE AND ARE To BE
VERIFIED BY INSTALLER PRIOR TOt
NO. OF UNITS 3 CONSTRUCTION 111
BEFORE TANK IF NOT ALREADY DEPTH BELOW INV. 2' THERE ARE NO KNOWN WETLANDS WITHIN
WIDTH 10.5, 150' OF THE PROPOSED LEACHING FACILITY
LENGTH 28.5' UNLESS SHOWN.
INSTALLER TO NOTIFY DESIGNER 24 HOURS FIRST FLOOR THERE ARE NO KNOWN POTABLE WELLS WITHI
PRI❑R TO BEGINNING OF JOB TO COORDINATE M2,4 BOTTOM AREA g P124 SIDEWALL AREA 156 100' OF THE PROPOSED LEACHING FACILITY.
299.3
INSPECTIONS
p# ♦♦ l ♦
11 11 TOTAL SQUARE FEET 464 SF THERE ARE NO KNOWN IRRIGATION WELLS
� WITHIN
THIN 50' OF THE PROPOSED LEACHING
CAPACITY SIDEWALL 00.74 115.4 G.P.D. FACILITY
DINING ROOM CAPACITY BOTTOM 0 0.74 221.4 G.P.D. THIS PROPERTY DOES NOT FALL WITHIN A
ROOM CAPACITY TOTAL 336.8 G.P.D. FLOOD ZONE AS SHOWN ON FIRM MAP
•G AC1<1JS THIS DESIGN DOES NOT REQUIRE VARIANCES
TO TITLE 5 (310 C.M.R. 15.00) OR BARNSTABLE
4 THIS SYSTEM NOT DESIGNED TO SUPPLEMENTAL REGULATIONS.
ACCOMODATE A GARBAGE ALL CONSTRUCTION SHALL BE IN ACCORDANCE
FAMILY WITH TITLE 5 AND BARNSTABLE SUPPLEMENTAL
KITCHEN FB
AMI ROOM DISPOSAL REGULATIONS.
IN-LINE ELEVATIONS PROPOSED AS-BUII.T SURVEY INFORMATION
,Q Benchmark se n� 113,52 \ D PROPERTY LINE DATA FROM
Left cor, loot, step DECK NV BH
UP/54/4 INV. ® HOUSE A 112.9/B N3.1
EL=115.31 �Ass4med� INv OUT O OF TANK 1 TANK 112.25 2.5 TERRY WARNERSEPT 30,SURVEYING005
ti
INV INTO D-BOX 111.0 PLAN TO BE USED FOR INSTALLATION
INV OUT OF D-BOX 110.8 OF SEPTIC SYSTEM ONLY
,•__
11 INV INTO CHAMBER 110.3 NOT FOR DETERMINING PROPERTY LINES
1 BOTTOM OF CHA
MBER ER 108.3
:
�C SECOND FLOOR
E' -
BOTTOM nF OR c Hnl F 102.6 BENCH MARK
I WATER TABLE NONE"ENCOUNTERED ORNER OF BULKHEAD 115.64 (ASSUMED)
Dr Ve I 11L07 DATE: OBSERVED BY: WITNESSED BY:a v e BEDROOM 77
BEDROOM SOIL LOGS July 26, 2005 LISA C. LYONS DON DESMARAIS
O SOIL EVALUATOR BOARD OF HEALTH
4' OBS. HOLE #1 OBS. HOLE #2
1 F ELEV. DEPTH ELEV. DEPTH
BEDROOM 113. - 0" 114.1 0"
t r F A
LOAMY SAND A LOAMY SAND
f Q 7B1-
Deck 1 OYR 4/4 1 OYR 4/4
I
Y 113. To 113. 9"
C
B LOAMY SAND LOAMY SAND
ry ` #235 lOYR 5/6 B lOYR 5/6
O TOF=115,64 �. �� ><><>.s 25" 112.1 24"
CAs5umedJ r C MEDIUM SAND MEDNM/COARSE SAND
2.5Y 6/6 39" 2.5Y 6/6
42"
0 v 103.8 5121" 102.E 54
Sh W / 38
Benchmark set l� 0 GROUNDWATER ENCOUNTERS qO GROUNDWATER ENCOUNTERS
Right cor, but khea d ,4 No
E(.=115.64 CAssumedO tr>
Fdn,
T ��
! .! y PERC RATE<2 M WS./INCH PERC RATE<2 M1NS./INCH
_.
- 0 TH 1 ( ,
0 ale
.:_.,.
F __x
x 112,81 x
112.8
112.36 :3 .• r•rem. PLAN SHOWING:
SAS - 4 DRY WELLS �o;• �`�a: .,N G PROPOSED SEPTIC SYSTEM REPAIR IN BARNSTABLE
=Z • r .r FOR: DRAWN BY: LISA C. LYONS
10,51 X 25.5' ZO � �Al ks " �� I STEVEN ONEIL DESIGNED & CHECKED BY:
• �r LISA C. LYONS
•P•11,{i" �•••`.c� LOCATION: VISIONS:DESCRIPTION: DATE:
'�i 9••'••:€C1 '••• �4w 235 OLD CRAIGVILLE RD CENTERVILL
���Fl►+I Ike •• �� LOT#: DATE:OCT 17,2005
e�;fiifri�f�i ��>� M248 P124
R S.
SCALE 1 : 20 I CERTIFY THAT THIS PLAN CONFORMS TO L( S A C. LYONS R . S. (508) 790-9270
TITLE 5 AND BARNSTABLE B.O.H. REGULATIONS , lT]4) 487-1638
(EXCLUDING WAIVERS SPECIFIED) HYANNIS, MA SSACHUSETTS
i