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HomeMy WebLinkAbout0797 OLD STAGE ROAD - Health 19TO —Stage Road Centerville F/pz� - A = 192 126 U Omrford, NO . 152 1/3 ORA 10 ' • s i TOWN OF BA.RNSTABLE LQCA:'ION --'.97 o d J1i4��'�'O SEWAGE VTLLAf E C ef-,—,;—Gc-t e��'GLf ASSESSOR'S MAP & LOT,"��-Z ,r INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /�®® •�C. CJ��J7'i�� v LEACHING FACILITY: (type) (size) NO. OF BEDROOMS BUILDER OR OWNER 6'�"e ®�J�`" lp PERMITDATE: `� s�'©1 COMPLIANCE DATE: 3 ®3 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 • G� ���oy�. r y UA 3 S41f d No. Fee �V s' y THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIppYfcation for �Ditpogar *pgtem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade Abandon( ) El Complete System ❑Individual Components Location Address or Lot No.;�9;, ®""o 4°e erpo Owner's Name,Address and Tel.No. Assessor's Map/Parcel,,/f j .11,2 16, 0 -O J7,4 6:r4e® 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 dP41-r- No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date —.2 s "®J, Number of sheets Revision Date Title Size of Septic Tank � � �ne'o Type of S.A.S. /�iGA1� /�vtr��7JP.6Jy1' 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 this Bo d of Health. Signed Date 3-.7 ^®f Application Approved by AM&LDYDate 3 Z5'03 Application Disapproved for the following reasons Permit No. ?-O6 �� b Date Issued 2 S 0 �. No. Iµ. G '` Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZippYication for Migpozal 6pttem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade X)Abandon( ) ❑Complete System 0 Individual Components Location Address or Lot No.7� O e.0 ,J>54 e e :�P/J Owner's Name,Address and Tel.No. Assessor's Map/Parcel/9 ./2 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 :e/PFf- No.of Persons Showers( ) Cafeteria( ) Other Fixtures j Design Flow 345sl gallons per day. Calculated daily flow "42 gallons. Plan Date � -a t-O} Number of sheets Revision Date Title Size of Septic Tank Type of S.M7W COk4e f Oi✓F��1.�C!6T���' Description of Soil Nature of Repairs or Alterations(Answer when applicable) - k" Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afol a described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to lace the system in operation until a Certifi- cate of Compliance has been issued by this Board of Health. -03' Signed -ZS Date Application Approved by Date 3 12 S 03 Application Disapproved for the following reasons 1 Permit No. Date Issued 3 2 S ----------------------- ----------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS ' J. Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded Abandoned( )by tP l'^ F'�oEy.F at has been construct d in a cordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 2W 3-I f b dated Installer Designer The issuance o this permit shall not be construed as a guarantee that the syste n'a �°tgned. Date 3 -z( IO3 Inspector w % ---------------------------------------- Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Mtgo$al *p$tem Construction Permit Permission is hereby granted to Construct( )Repair( )Upgrade)Abandon( ) System located at ;>9 O -0 JTi46E ,/PO G e-A17- and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Cons ction must be completed within three years of the date of this pe Date:_ ZS G 3 Approved by TOWN OF BARNSTABLE LOCATION .7.'7 Oed -''O SEWAGE VIi LAGE G �T�"� ASSESSOR'S MAP & LOT/paZ-/�ZE INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY < LEACHING FACILITY: (type) NO.OF BEDROOMS BUILDER OR OWNER PERMIT DATE: °��'`3s COMPLIANCE DATE: : S O�J Separation Distance Between the: Feet Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility / Private Water Supply Well and Leaching Facility (If any wells exist Feet on site or within 200 feet of leaching facility) T— Edge of Wetland and Leaching Facility(If any wetlands exist �L Feet within 300 feet of leaching facility) Furnished by \I Y f� Ore �� '4 COMMONWEALTH OF MASSACHUSETTS. EXECUTIVE OFFICE OF ENVIRONMENTAL.AFFAIRS m DEPARTMENT OF ENVIRONMENTAL PROTECTION Y R MAR 21 2C� 5 4/ TITLE 5 T "EqL h D fNv,3T aLF OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY:ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: A- ,Q MAP Owner's Name: h�21&,ft PARCEL Owner's Address: ,4 b3D LOT Date of Inspection: aoo Name of Inspector: (please rint 0 J Br4olo1 e" Company Name: e FAILED INSPECTION Mailing'Address: 0 , PIAo�y9 Telephone Number: CERTIFICATION STATEMENT 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 Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date. 9 A 3 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. Notes and Comments CL6Z P(j" ****This report only describes conditions at:.the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title.5 Inspection Form 6/15/20.00 page 1 Page 2 of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A 10ERTIFICATION (continued) Property Address: 99,7 Owner: Date of Inspection: , Inspection Summary: Check A,B,C;D or E/ALWAYS complete ail 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 3'10 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: '01One or mo e syste m'"components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair;as approved by the Board of Health, will pass. Answer yes,no or not determined (Y,N,ND) in the 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. ND explain: Observation.ofsewage 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 obstruction is removed distribution box is,leveled or replaced ND explain: The system required pumping more than4 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 obstruction is removed ND explain: 2 Page 3 of 11 OFFICIAL INSPECTION FORM-.NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE.SEWAGE.DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property,Address: s� I Owner: Date of Inspection: 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 2;. S.ystetti 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 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to orless than 5 ppm,provided thatl no other failure criteria are triggered.A copy of the analysis must be attached to this form, 3. . Other: 3 Page 4 of 1 1 OFFICIAL INSPECTION FORM=:NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION continued Property Address: Owner: ID Date of Inspection: KE1,in,6a�J? D. System Failure Criteria applicable to all systems: . You must indicate"yes"or"no"to each of the following for all inspections: Yet No �V/ 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�/z 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 a of a:public well. _ Any portion of a cesspool or privy is within 50 feet of 6 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,-provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] 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 correctthe failure. E: Large Systems: To be considered a large system the system must serve atacility-with a`design flow of 10-000 gpd to15,000 gpd. You must indicate either"yes"or"no"to each of the:followiitg: (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a.surface drinking water supply the system is within 200 feet of a tributaryto a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—I WPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any questibn 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. 4 Page 5 of 1] OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: Q Owner Date of inspection: Check if the following have been done.You must indicate"yes"or'no"as to each of the following: Yes No V/_ 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? 1/ 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: Yes no 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(3)(b)) 5 Page 6 of l l OFFICIAL INSPECTIONFORM_ NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE-DISPOSALSYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Ad ress• � Q Owner / Date of Inspection: �� FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 3 10 C1v1 15.203 (for example.: 11.0 gpd x#of bedrooms): Number of current residents: Does residence have a garbage grinder(yes or no): Is laundry on a separate sewage system (yes or"no)/I& [if yes separate'inspertion"required] Laundry system inspected (yes or no)�,(,(q' Seasonal use: es or no (Y )z—A&. Water meter readings, if available(last 2 years usage,(gpd)):61— _fV10 Sump pump.(yes or no :. Last date of occupancy:NallAy. �2L COMMERCIAL/INDUSTRI�/ Type.ofestablishment: Design flow(based on 310 CMR.15.203): gpd " Basis of design flow(seats/persons/sgft,etc.): 'Grease trap present'.(yes or no): Industrial'waste holding tank present(yes or no):— Non-sanitary waste discharged to the Title 5 system (yes or no):_ Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL.INFORMATION Pumping Records Source of information: 9�9 Was system pumped as part of the i spection(yes or no): If yes, volume pumped: gallons--How was qua tity 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) _Tight tank _Attach a copy of the DEP approval _.Other(describe): Ap oximate age of all components,date installed(if known)and source of information: Were s age odors detected when arriving at the site(yes or no): - 6 I • Page 7 of l 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM,-INFORMATION(continued) Property Address: Owner: Date of Inspection: BUILDING SEWER(locate on site plan) Depth below.grade: Materials of construction:_cast iron 40 PVC_other(explain): Distance from private water supply well or suction.line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: locate on site plan) Depth below grade: Material of construction:_concrete_metal_fiberglass_polyethylene other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet,tee.or baffle: Z✓� Scum.thickness:J Distance from top of scum to top of outlet tee or baffle: L�� Distance,from bottom of scum to bottom of outlet tee or baffle: / How were dimensions determined:_,_ ,p i 04211��/�°t Comments.(on pumping recommendations, inlet and outlet tee or'baffle condition,structural integrity, liquid levels a elated to outlet invert,evidence of leakage,etc.): /` Giles 62 tcl)7V- ' GREASE TRAP/JU(locate on site plan) Depth below grade: 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:. Comments(on pumping recommendations, inlet and outlet tee or'baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FORVOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C . SYSTEM-INFORMAITION(continued) Property Address: Q � Q Owner:. Date of Inspection: 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/day Alarm present(yes or no): Alarm level: Alarm in working order(yes'or no): Date of last pumping: Comments(condition of alarm and float switches, etc.): DISTRIBUTION BOX:_Z(ifpresent must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover,any evidence of leakage into or out of box,et .):, PUMP CHAMB R• (f9' (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber-,condition of pumps and'appurtenances, etc.): 8 i Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: A _/ f"7 4 Date of Inspection: C��L /ti /7i o?OU3 SOIL.ABSORPTION SYSTEM (SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type _... �eaching pits,number: / leaching chambers,number: 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, CESSPOOLS_k(cesspool must be pumped as part of inspect ion)(locate on site plan) Number and configuration: 'Depth'—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cessp.00l:. Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition-of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY U)*cate 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.): 9 Page 10 of l 1 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM.INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 262 NO' Owner: Date of Inspection: 7,0003 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch 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. a� o . 70 n _ Page 11 of 11 OFFICIAL INSPECTION FORM--NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 7C Owner:. Date.of Inspection: / a)o2 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated.depth to ground water feet Please indicate(check).all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked, date of design plan reviewed:. Observed site(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: ,. L 11 Permit Number: Date: Completed by: 5f d'2 HIGH GROUND-WATER LEVEL COMPUTATION Site Location: 47 7 0&1 ��� e T� Celllt/`G'f/tot No. Ile Owner: ��/ I��/f Address: Contractor: �Df 7OJ�j G'D911,:5Z Address: Notes: �/� ��"l �� STEP 1 Measure depth to water table to nearest 1/10 ft. ............................... Date AzX3 month/day/year STEP 2 Using Water-Level Range Zone _ and Index Well'Map locate site and determine: OAppropriate.index well....................................1�.�. CJB Water-level range zone ..............................................:..:... STEP 3 Using monthly report"Current Water Resources Conditions" determine current depth to nZ�73 j water level for index well ........................... f� !(� `7 month/year STEP, 4 Using Table of Water-level Adjustments for index well (STEP 2A), current depth to water level for index.well (STEP 3)., and water-level zone (STEP 26) determine water-level adjustment.............. . ..................... STEP 5 .. Estimate depth to high water by subtracting the water- level adjustment (STEP 4) J levelat site (STEP 1) ....................................:......•.... .......................................... from measured depth to water ............ `�` Figure 13.--Reproducible computation form. 15 i 677 + F p ._ y 541,3, COMMONWEALTH OF MASSACHUSETTS F EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON._ MA 02108 617-292-5500 V WILLIAM F.WELD RUDY CO Governor Mildred. Ho aY, �� �/�/� Secre ARGEO PAUL CELLUCCI DA 11.STRUH Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM rjir Commissiorie PART A 4, CERTIFICATION � s � Property Address: 797 Old. Stage Rd.. 797 Ol 5 ,. e Rd.. P rh Address of Owner: �- Date of Inspection: /—�^ ' Centerville , MA (If different) Centervi ,'`dV(` `. y Name of Inspector: Wm E Robinson Sr I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) Company Name: Wm E Robinson Septic Servi .A Mailing Address: PO BOX 1 089, CPnf-Pr m 1 1 e,r LvjA 02632 Telephone Numbery 5 0 8` 7 7 5_A 7'7 6 CERTIFICATION STATEMENT 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 inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewa disposal systems. The system: _ asses Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Q Inspector's Signature: z,� k L. Date: / The System Inspector shall submit a copy of this inspection report 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 greater, the inspector and the system owner shall 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: Check A, 8, C, or D: A] SYSTE PASSES: I have not found 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. COMMENTS: B SYSTEM CONDITIONALLY PASSES: One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Ind cate yes, 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, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 04/25/97) Page 1 of 20 DEP on the World Wide Web: http:/twww.magnet.state.ma.ustdep e'j Printed on Recycled Paper r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 797 Old. Stage Rd.. , Centerville , MA Owner: Mildred. Hollahan Date of Inspection:/- F4 3 B SYSTEM CONDITIONALLY 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). Describe observations: broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year dde'to broken or`.-obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed C] URTHER 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 50 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) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system (SAS) and the SAS 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 the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS 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 compounds indicates that the well is free from pollution from that facility and the presence of ammonia.nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3 OTHER (revised 04/25/97) Page 2 of 10 y SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 797 old. Stage Rd.. , Centerville , MA Owner: Mildred. Hollahan Date of Inspection: D] SYSTEM FAILS: Yo must indicate ei;-,er "Yes" or "No" as to each of the following: I have 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. Yes No Backup of sewage into facility or system component due to an 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 112 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 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 than 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 coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E] RGE SYSTEM FAILS: Yo must indicate either "Yes" or "No" as to each of the following: 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: 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) Th owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program req irements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 04/25/97) Page 3 of 10 SUBSURFACE SEW AGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 797 Old. Stage Rd.. , Centerville , MA Owner: Mildred. Hollahan Date of Inspection: Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No Pumping information was provided by the owner, occupant, or 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 plans have been obtained and examined. Note if they are not available with N/A. The facility or dwelling was inspected for signs of sewage back-up. ✓ The system does not receive non-sanitary or industrial waste flow. _ The site was inspected for signs of breakout. All system components, excluding 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 baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge,depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of / Sub-Surface Disposal System. Existing information. Ex. Plan at B.O.H. Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) (15.302(3)(b)] (revised 04/25/97) Page 4 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 797 Old. Stage Rd.. , Centerville , MA Owner: Mildred. ollahan Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Design flow:L13 0 .p.d./bedroom for S.A.S. Number of bedrooms:_ Number of current residents: Garbage grinder (yes or no): ti o . Laundry connected to system (yes or no):W Seasonal use (yes or no):A,d 1998 20 , 000 gal. Water meter readings, if available (last two (2)year usage (gpd): Sump Pump (yes or no): 4., o 1996 22,000 gal. Last date of occupancy: CO MERCIAUINDUSTRIAL: Type of establishment: Desig flow: gallons/day Grease trap present: (yes or no)_ Industri I Waste Holding Tank present: (yes or no)_ Non-sa nary waste discharged to the Title 5 system: (yes or no)_ Water eter readings, if available: Last ate of occupancy: OTH R: (Describe) Last f occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System pumped as part of inspection: (yes or no) If yes, volume pumped: eallons Reason for pumping: TYPE 0 SYSTEM I/ 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) I/A Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known) and source of information: _7'3! .a Sewage odors detected when arriving at the site: (yes or no) d (revised 04/25/97) Page 5 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 797 Old. Stage Rd.. , Centerville , MA Owner: Mildred. Hollahan Date of Inspection: B DING SEWER: (Locake on site plan) Depth below grade: Materi I of construction: _cast iron _40 PVC_other (explain) Distan a from private water supply well or suction line Diam ter Corn ents: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK:_ (locate on site plan) Depth below grader / .Material of construction: —concrete _metal_Fiberglass _Polyethylene _other(explain) If tank is metal, list age _ Is age confirmed by Certificate of Compliance _(Yes/No) Dimensions: Sludge depth: ��,• Distance from top of sludge to bottom of outlet tee or baffler Scum thickness: /--3 Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffler How dimensions were determined: atPisn�T +� Comments: (recommendation for pumping, condition of inlet and outlet tees or ba les, dep h of li id level in relation to outlet invert, structural. integrity, evidence of leakage, etc. 6 t" t� � � �- a Y �.0 7� C � dIV GR E TRAP: (locate on site plan) Depth elow grade: Materia of construction: _concrete _metal _Fiberglass _Polyethylene —other(explain) Dimen ions: Scum t ickness: Distan a from top of scum to top of outlet tee or baffle: Dista a from bottom of scum to bottom of outlet tee or baffle: Date f last pumping: Co ments: (re ommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural inte rity, evidence of leakage, etc.) (revised 04/25/97) Page 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 797 Old. Stage Rd.. , 'Centerville ,. .MA Owner: Mildred Hollahan Date of Inspection: T GHT OR HOLDING TANK: (Tank must be pumped prior to, or at time, of inspection) do to on site plan) Dep below grade: Mate ial of construction: _concrete _metal _Fiberglass _Polyethylene._other(explain) Dime sions: Capa ity: gallons Desi n flow: gallons/day Alar level: Alarm in working order_Yes; _ No Dat of previous pumping: Com ents: (cond tion of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert _ Comments: (note if level and distribution is equal, evidence ,ef solids carryover, evidence of leakage into or out of box, etc.) .PUM CHAMBER: (locate n site plan) Pumps n working order: (Yes or No) Alarms in working order (Yes or No) Comm nts: (note ondition of pump chamber, condition of pumps and appurtenances, etc.) (revised 04/25/97) Page 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 797 Old. Stage Rd. ,. Centerville , MA Owner: Mildred. Hollahan Date of Inspection: —9 g / SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number: l leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure, pl ellof Qonding, condition of vegetatiq�t, etc.)/ �G f CESSP Ol _ (locate n site plan) Number and configuration: Depth-to of liquid to inlet invert: Depth of olids layer: Depth of cum layer: Dimensio s of cesspool: Materials of construction: Indication of groundwater: i iflow (cesspool must be pumped as part of inspection) Comme ts: (note ndition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY: (locate on site plan) Materials f construction: Dimensions: Depth of olids- Comment (note con ition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (revised 04/25/97) Page 8 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 797 Old. Stage Rd.. , Centerville , .MA Owner: Mildred. Hollahan Date of Inspection: Depth to Groundwater Feet Please indicate all the methods used to determine High Groundwater Elevation: /Obtained from Design Plans on record V Observation of Site (Abutting property, observation hole, basement sump etc.) Determine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records Check local excavators, installers Use USGS Data Describe your own words how you established the High Groundwater Elevation. (Must be completed) (revised 04/25/97) Page 10 of 10 - a I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 797 Old. Stage Rd.. ; Centerville , MA Owner: Mildred. Hollahan Date of Inspection: o, SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) U� a ao�- c ` S` 3 5 r (revised 04/25/97) Page 9 of 10 00CATION SEWAGE PERMIT NO. f `7 cD C. ::C VILLAGE I N S T A LLER'S NAME A ADDRESS 11 r e U i L D E R OR- - OWNE R DATE PERMIT ISSUED � �-�� DAT E COMPLIANCE ISSUED x .. � ,: . .: �:.<'. I .. _ �. ��. _ � .. _ � ,�' � �� �.� � � � ASSESSORS MAP NO: F. Ido. y.......---_.... ' �� ��'0.. Fss................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH I . OF....... ...................... Appliration for Bigpoottl Workii Tooutrur#ion ramit Application is hereby made for a Permit to Construct ( ) or Repair ) an Individual Sewage Disposal System at: ....:'7.9... ......�I. :� .........'� v..................•... ................................ - ............................................... Locatio -Address or Lot No. ............................. . ............................................... Owner ...... Address ra P Installer Addr -•-ess UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms_.....k.................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type e� yp of Building ............................ No. of persons____................ Showers (y). — Cafeteria ( ) dOther fixtures ---------------------------------------------------------------------------------------------------------------------••-•---._....----•-••---•----- WDesign Flow.........&.3 ........................gallons per person per day. Total dai17 flow.............................................gallons. WSeptic Tank—Liquid capacitvi,000gallons Length...$.......... Width-_-Lj 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........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 .---•-•----•-------•••--••--•-•.._....-•--------•-------------------•......--..........--•-••-•_.............................................................O Description of Soil........................................................................................................................................................................ v •----•------••---•--•-•-•.......................••-•----------•••-••-•---•---------------••-------------...-•------••------•----••----•-••-•-•-•----•-------•-------------.....................-- ---------------- -------------------------------•--------------------------------------•-•----......---•-•-•-•--....--•--• ---•- U Nature of.Repairs or Alterations—Answer when applicable.._._ s�,CAt''�'1 ........ r_. .p2 -----------------------•----•----....-----------••---------•---•-••------......-----•---......----------------- --------------------••---------•----------------------------------------....._..-•------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in opera 'on until a Certificate of Compliance has been issued by the board of health. Signed......... --••----•--•••--.......••---•-•---•••...-----•......•------•-----•----••- r, I � •--------•-- ••--------•----•-- Application Approved By_ -,---_ ��'�"` _•-•- L.r __a ate Application Disapproved for the following reasons:-----•..............•-•----•--------•--•-•------------.........------------••------------------------........._ --•--•-•-••---•.............••---•--.....---......----•••---...--•---•--••••••-•-----••-•-•--••••--•---•------------------•-----•-•-•-•-----•-•••-----•----...........•............................... ��77 Date PermitNo.... .................................................. Issued.....-.................................................. Date L----- ----- No.. ........... Fitz................: THE COMMONWEALTH OF MASSACHUSETTS \ \BOARD, OF HEALTH jr - ............OF.......71 .`' � ...................... Appliration for Dispoottl Works Tonstrur#inn rrrmd Application is hereby made for a Permit to Construct ( ) or Repair ) an Individual Sewage Disposal' System at: �t /J............A� .q..--.I....'.ion Address ••-.or Lot No•-•-- .............................. ,p Own , Address a .t......-•-•............. . .................................................. ................._:............... ......... Installer Address Type of Building Size Lot................ Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) `4 Other—Type T e of Building� YP g ----------------•-•--------- No. of persons............................ Showers ( ) — Cafeteria ( ) d 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. 3 Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 1.4 (, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a+ .........-..........................................................................•....................................................-.................. . O Description of Soil.........................................................•.......-............................................................................. ...:..._.._.....- U --------•----------------•-- •--------•-------------------------------•----------------•---•--------___------------------------•-•------•------------•----... .......... W VNature of Repairs or Alterations—Answer when applicable............................................................:.................................. ---•----------------------•...........-•----....._........-----....•----••••-----•••-•.....--••-•--•........----•••-••-----•--•-• ....._.._...--••-•••------------...._.....•-•-•----••-•-.....--- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T I IL LE 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. Signed......... �....... . ................ . .•• -_..te ••••••......... --�/� --7 o PPlication Approved By.............. ........ t � .... - ••• ..... Application Disapproved for the following reasons:_ ........... ------------` --• •----------------------- ----••------••-•-------__---- ---•--•-•......... _...... _Date........._.._ gG Permit No--- ------------•----------------••-•-•-•-••-•------•-- Issued.................. ............--••--•......._... Date S A 1 THE COMMONWEALTH OF MASSACHUSETTS e BOARD OF HEALTH (In if iratr of Tomplitttur THIS I TO CERTIFY, at theIndividual Sewage Disposal System constructed ( ) or Repaired�� by...... 'L'� :_ --------N-N--.6 L-nil.�. .......--•---••••-------------------•--..... .....--•••--•--. ....----- �....!-....! v 1.t�J� _ .� O ?- .Install c..L r ft1 a += .........� � �` at..............•- ---..._-••-••..._....... - has been installed-in accordance with the provisions of TITLE 5 of The State Sanitary e s des ribed in the application for Disposal'Works Construction Permit No ___�______________ dated---.:__-__. �-��F __•- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM!_ UNCTION SATISFACTORY. DA --. .��_-.�_�SJ............................................ Inspector_....... TE ...............................................................-- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No.. ... .... .....Tb.•......•................OF....... J .............. Fi .. ,. Ropsal rks ion r ruti� Permission is hereby granted............... =�.:.!4s-. G?.......................... ----------------------•---_-_ to Construct ( ) or Repair ( 'I, an Individual Sew a Disposal System _.--- atNo...--------- 3�Lo ----______ ....................I'�-...._ i------..._..._......_._............. ........ Street �-/��/,� as shown on the application for Disposal Works Constructio ermit N�...__1__�Dated______`9 -•--•-•-;;-• e,DATE........--••----•Z•I--------------------•--•----•-----.........•••••••-•• Board of Health FORM 1255 A. M. SULKIN, INC., BOSTON i f . Q ASSESSORS MAP : TEST HOLE LOGS PARCEL: _.__ # /2_w . ,_ FLOOD ZONE: ��- SO I L EVALUATOR: �j►��11(� �j 1 WITNESS : ' NOTES: REFERENCE - d7��E['� .__ 6DDA - ! 76�� 'f DATE: PERCOLATION RATE: IV 1) The installation shall comply with Title V and Town of Barnstable Board of .- TH- I TH-2 Health Regulations. 2) The installer shall verify the location of utilities, sewer inverts and septic CaU7 8 A ��b� components prior to installation. 12,11461 3) All septic piping to be 4 inch Sch 40 PVC at 1/8"per foot. �00�-1?yI11� 4) Existing leach pit to be pumped and backfilled per Title V abandonment , / fo procedures. LOCAT 1 ON MAP�i.IT6� 5) This plan is not to be utilized for property line determination nor any other � � �I�� ��-t��i - - ---- purpose other than the proposed system installation. 6) All septic components must meet Title V specifications. 7) Parking shall not be constructed over HI septic components. 8) The property is bounded b property corner y p p ert y sand property lines as depicted. ��V-,'; 9) The property owner shall review design considerations to approve of total number '� of bedrooms to be considered ered for design. - SEPTIC SYSTEM DESIGN Lo FLOW ESTIMATE BEDROOMS Al O GAL/DAY/BEDROOM - 22 GAL/DAY 9 i oiD5) , PT I C TANK V,)O GAL/DAY x 2 DAYS - LLD GAL USE. GALLON SEPT I C TANK L4_�� ` SOIL AB%O PTION SYSTEM w`.''�'_" � �� �� : A--1 ,J ' �h� ( � I-�2C� l-�I,�w�. I wl�l/'(►2�'(��25 W SIDE AREA: Z� 30'+ Ip�g �Z, �� - �22 1 P' / GO �Q � BOTTOM AREA: ' I X D PTIC SYSTEM SECTION 5 Q . - � 2 oG u /�-- _ � Ltl MF! 1K,� -mot r✓� _ 3 D-BOX 1'0O GAL S 5 L SEPTIC TANK �j�, � '_ '12,„ _LtQ_�jrp�1 ,^�; U rq ' ` r SITE AND SEWAGE PLAN kA LOCATION : t PREPARED FOR SCALE: DAV I D B . MASON 174j DATE: 3 1 0 DBC ENVIRONMENTAL DESIGNS DATE HEALTH 'AGENT EAST: SANDWICH . MA ( 508 ) 833- 2177