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HomeMy WebLinkAbout0047 PATRIOT WAY - Health 47 Patriot Way Centerville F/R A = 192 216 Clll J���c UPC 12534 ' No.2_ 115_R HASTINGS,MN No. dw 5 c3 6 C� li Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS Zfppfication for Miopogal bpotem Conotructfon Permit Application for a Permit to Construct( , j Repair Upgrade( )Abandon( ) ❑Complete System D?I dividual Components Location Address or Lot No. Owner's Name,Address and Tel.No. : D fit/Rio Assessor's Map/Parcel cell nll Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. ©�Z�loi°CD 7 7% 3 �ww Cage Type of Building: , /p Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(' Other 'hype of Building % e No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow D/ gallons. Plan Date_ umber of sheets Revision Date Title TC If D Size of Septic Tank Type o(S.A.S, 2 Description of Soil ��©A-le3,4-Z� 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 b thi Bo d ot Health. Sign Date Application Approved by Date Z/ Application Disapproved for the following reasons Permit No. -,Cr-) 3 —5 3—7 Date Issued P ? d TOWN OF BARNSTABLE LOCATION "77 d' ' 1. SEWAGE # 26C 3 `537 VU AGE C'_Gn� 014E ASSESSOR'S MAP & LOT I92—a 14 INSTALLER'S NAME&PHONE NO. ; Cis-ZA-im TANK CAPACITY ,CXiO gitk -- -- LEACHING FACILITY: (type) C�76,gn 6ar5 (size) -Z f 2 NO.OF BEDROOMS BL-ILDER OR OWNER r ,o ur'�tr PERMITDATE: 11/7/aa COMPLIANCE DATE: -6 D 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 134Le,v, t Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ��.�. , �r•--,�r�ca Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS wficatton for Otgpool &pgtem Congtructton Permit Application for a Permit to Construct( )Repair(V)Upgrade( )Abandon( ) O Complete System 1E/tdividual Components Location Address or Lot No. � Owner's Name,Address and Tel.No. Assessor's Map/Parcel wo o C"ew1en'li A? Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: J Dwelling No.of Bedrooms Lot Size 1,61f7Z sq.ft. Garbage Grinder Other Type of Building We Si TVA/ f No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow ��� gallons per day. Calculated daily flow 3e gallons. Plan Date 11912 e/43 ,dumber of shipets / Revision Date Title 7' Size of Septic Tank 1//>.N�%l�� Type of S.A.S. 7 Description of Soil Nature of Repairs or Alterations(Answer when applicable) i 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 thi Board of Health. SigneU Date // // Application Approved by �. Dated Application Disapproved for the following reasons Permit No. S)-00 3 3 Date Issued 7 U --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CE =,,that the On-sit/,�e Sewage Disposal System Constructed( )Repaired(14Upgraded( ) Abandoned at 7 C� r ,G,,, S f-1.1 V /'t?11�`'/'11 /P has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 2 0-) 'C 3'I dated 1 I •7 Installer Designer The issuance of this pe t shall not be construed as a guarantee that the sy`s`te will functionLasdesigned. Date I I,t Inspector `t �� ------------------------------------� - •�--- No. c7 CK✓ 3 5 3 Fee U THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Moogaf *pgtem Congtruction Permit Permission is hereby granted to Construct( )Repair(V�Jpgrade( )Abandon( ) System located at �' and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this pe 't. Date: / G 3 A pproved by TOWN OF BARNSTABLE LOCATION LA 7 46:m4 SEWAGE # 2 -627 VII,LAGE �'-Gn} ,. ASSESSOR'S MAP& LOT Jop—d l jINSTALLER'S NAME&PHONE NO. � - SEPTIC TANK CAPACITY ,C >Q ekEl- LEACHING FACILITY: (type) (size) { NO.OF BEDROOMS BUILDER OR OWNER i .PERMIT DATE: 11!?/tea COMPLIANCE DATE: 6 D Separation Distance Between the: ` Maximum Adjusted Groundwater.Table to the Bottom of Leaching Facility Peet. Private Water Supply Well and Leaching Facility (If any wells exist Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) Furnished by 1 I till COMMONWEALTH OF MASSACHUSETTS EXECUTIVE"OFFICE OF ENVIRONMENTAL AFFAIRS U DEPARTMENT OF ENVIRONMENTAL PROTECTION FAILED INSPECTION MAP PARCEL , I TITLE 5 LOT OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: q9 w /. Owner's Name: s �(` RECEI b„ Owner's.Addre U�Co3a Date of Inspection: o MAR 1 2 2003 Name of Inspect (pleas print) '� uPA TOWN OF BARNISTA3LE Company Name: ��" HEALTH DEPT. Mailing Address: 7`1 A 00(.0 d' 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 IT Fails 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. Notes and Comments ****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 I . Page 2 of 11 15 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A . CERTIFICATION (continued) t +,�I . -_Property Address:,; i . - ,6 Owner . . Date of In ection: ZZy( D �a O's Inspection`Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: L 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: 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. 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 lor.t.ank 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 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 obstruction is removed distribution box is leveled or replaced , ND explain: 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 obstruction is removed ND explain: 2 Page 3 of l l OFFICIAL INSPECTION FORM.-.NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE.SEWAGE DISPOSAL SYSTEM.INSPECTION FORM PART A CERTIFICATION(continued) Property Address: Owner: 14j-PAY Date of pection: 0� 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'3IQ'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. System will fail unless the Board of Health (and Public Water Supplier,if any)-determines that the system is functioning in a manner that protects the public health,safety and.environment: _ The system has a septic tank and soil absorption system_(SAS)and the SAS is within 100 feet of 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 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: 3 Page 4 of l l OFFICIAL INSPECTION FORM-:NOT FOR.VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property'Address: ( . Owner: . Date of I ection: _ cP ; �;O 0-_35 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 orsystem 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 Tess than 6"below invert or available volume is less than'/2 day flow i 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 1:00 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. _ l Any portion of a cesspool or privy is within 50 feet of a.private water supply well. ✓ Any portion of a cesspool orprivy 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.] 1J�(Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR'15303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correefthe 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. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no i 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-I WPA)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. 4 Page 5 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: Owner: Date of I ection: �ZZ Pduw c) Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No l/ 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 7 _ ✓ Has the system received normal flows in the previous two week period? V' 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) V11 _ 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 7 _ 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. V _ 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 I 1 OFFICIAL INSPECTION,FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: t =e4 L )atz— cbOwner: Date of. pection: _ o 3 OW CONDITIONS RESIDENTIAL Number of bedrooms(design):- Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 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 . ,[if yes separate inspection required] Laundry system inspected( es or no)- Seasonal use:(yes or no): Water meter readings, if aPlable(last 2 years usage(gpd)):©/- Sump pump(yes or Last date of occupancy: COMMERCIAL/INDUSTRIALA6 Type.of establishment: 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: W, Was system.pumped.as part ofthe inspectio yes or no If yes, volume pumped: gallons--How was quantity pumped determined? Reason'for pumping: TYP F SYSTEM eptic iank, distribution box,soil absorption system Single cesspool _Overflow cesspool _:Privy _Shared system.(ye's 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): proximate age of all c mp n , date installed(if known)and source of information: 5 v Were sewage odors detected when arriving at the site(yes or no): 6 O . Page 7 of 1 1 OFFICIAL.INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM..INFORMATION(continued) Property Address: Gci Owner:(:�6 IXe.,4- /Y - Date of I ection: BUILDING SEWER(locate on site plane- . Depth below.grade: Materials of construction:_cast iron _40 PVC,—other(explain): Distance from privatemater 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:��`S�X 6.0 k i Sludge depth: Distance from top sludge to bottom of outlet.tee:or baffle: Scum thickness: V Distance from top of scum to top of outlet tee or baffle: --- Distance,from bottom of scum to bottom of outlet tee_or baffle: How were dimensions determined: Comments.(on pumping recommencfations, i let and outlet tee or baffle condition,structural integrity, liquid levels . s related to outlet inv , evi ence of leakage' etc.): 0 li A GREASE TRAP. 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 8ofI1 OFFICIAL INSPECTION FORM—NOT FOR.VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION.(continued) Property Address: Y _ Owner. _ !� Date of pection: �J TIGHT or HOLDING TAN (tank must be pumped at time of inspection)(locate on site plan) Depth below grade:' Material of construction: concrete metal fiberglass__2olyethvlene other(explain): Dimensions Capacity: gallons Design Flow: eallons/&v 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(if present must be'opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution,to outle equal, any evidence of solids carryover, any evidence of eakage into or out of box ete.): _ Yi PUMP CHAMBER:j%&(locate on site plan) Pumps in working o✓✓rde��r(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:, 14 A Owner: Date of spection: '- SOIL.ABSORPTION SYSTEM (SAS): V (locate on site plan,excavation not required) If SAS not located explain why: TYPe V. leaching pits,number:L 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, tc' / n n C/Xel ,,Qo CESSPOOLS:/'kjk7(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 or no): Comments(note condition of soil,signs of hydraulic failure, level of ponding;condition of vegetation,etc.): PRIV (locate on site plan) Materials of construction:. Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition.of vegetation,etc.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: �CZ( V Owner• Date of I ection: 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 nters the building. .10 Page 11 of.11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: Date.of I s ection: i SITE EXAM Slope Surface water Check cellar Shallow wells Estimated.depth to ground water f 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: © ll i 11 Permit Number: Date: Completed by: �J!f�- HIGH GROUND-WATER LEVEL COMPUTATION Site Location: 7 �7 / �7` 141 L2S/ Lot No. Owner: ��1 y/,q Address: Contractor: Address: Notes: STEP 1 Measure depth to water table J tonearest 1/10 ft............... ..................................... ......................... .Date month/day/year STEP 2 Using Water-Level Range Zone _ and Index Well'Map locate site and determine: OAppropriate index well........:.................. `� Z1.5r Z © Water-level range zone ................... P STEP 3 Using monthly report"Current Water Resources Conditions" determine current depth to y water level for index well ....... ........... month/year STEP 4 Using Table of Water-level Adjustments for index well (STEP 2A),.cur.ent depth to water level for index well (STEP 3)., and water-level zone(STEP 2B) determine water level adjustment .............:..... . • z ..................................................................... STEP 5 . Estimate depth to high water by subtracting the water- level adjustment (STEP 4) from measured depth to water level at site (STEP 1) ....................................:......•:::. ...................... Figure 13.—Reproducible computation form, 15 „ i r, i 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Address of property owner i s name SAvr-o Date of Inspection i PART A c�ECRLsT • Check if the following have been done: Pumping information was requested of the owner, occupant, and Board of Health. ___�/None of the system'components• haiie '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 t 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. _Z The facility or dwelling was inspected for signs of sewage back-up. V The site was inspected for signs of breakout. ' ��,+ ',•, f F'y t, 1;"�` �I" , i? ;t. F,i? ri ". ;�o'j ,, - �, f i A11 system ;.comppnents, excludincq' the SAS, have been located on thei site. The septic tank manholes were uncovered opened, and the interior of q,k the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge# Aepth of,, scum. The size and location of the SAS on the site has been determined ba sed on existing information or approximated by non-intrusive methods. The facility owner (and occupants, if different from owner) were' provided with information on the proper maintenance of SSDS.' , � .5d* y. t a•t i i ��€ ... � a »��'`..•`f `.e ` Y' t 3'��:i. .> �.'t_'d; S �'f" fff.)'{>, ,',-• j"� ,. �` x ,...P,�,..Y ;' '4). ,1• t:'M'f °w.t yA `"4r "€ fIf3 .°;•,'i' a , nt. ,f," ?:+ t 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM . INSPECTION FORM PART B INFORMATION ` FLOW CONDITIONS, If residential number of bedrooms A number of current residents ,. ; .: s•. ., ,L..> r F > r'; ;� , garbage grinder, yes ,.or no' laundry 'connected •to' system;' ,yes or `no _ A/ seasonal -use, yes or no if nonresidential, calculated- flow:- 1993; r ,f,• < ( a Water meter readings, if available: G�ur.ec' Lt.« s• Last date of occupancy s Rf Aaldcc-ss g :.,' Y+y �. # 1rSt::.;, 'i4 "a.'-F t ' r ''c s +� .%"tH3; �t'^'},IF..,• i . . .r, f . o-^t}..: t s 'r R w I i ,.. w.'t... ro, ` GENERAL INFORMATION Pumping records and source of inlIformations �nLT:•�" o F ;afzC�Ab�Y_ 'TreAt!nl\2 r1-��A _ I e,��" o[i.�o ,j s� dV: /lo' system pumped as �part+""of. ingpection;!.yes or'`no if yes;�.volume 'pumped Reason i fCOr` pumping:' „e , ; _. t �• ti Typ of_,system i :_,., Septic tank/distribution box/so1il absorption system, �' Single, cesspool:, r� , over flow,=cesspool t Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) ' # Other (explain)' r Approximate age of all components. Date installed, if known. S.ource of information: I t lib Sewage odors detected when arriving at the site, yes or no i SUBSURFACE SEWAGE DISPOSAL BY$TE}� YNS$ECTION 'ORt¢ f I- 6YS�'E�• INFQR�'��0� oo�jtiAuyd .i SEPTIC TANK:POO p i (locate on site plan) depth below grade: .. ' . material of construction: concrete metal FRP other(explain) i dimensions: Nl x 8 ' n sludge depth distance from top of sludge to bottom of outlet tee or baffle 1'. scum thickness V distance from 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, recommendations for repairs, etc. ) 'n Q^gA .s R0 , ro.Qtj �V%YA3ilidioTt ever avre DISTRIBUTION Box:", (locate on site , plan) , de th of level above outlet invert P Tiqui Comments: i .(note if level and distribution 'is equal, evidence of solids carryover, evidence of leakage into or out of box, recommendation for repairs, etc. ) '-Bcy CI e,o a,f,of i �, g n ac) t,��a rk O rd e_r'- - -- ----- -- i _. I x ,.• .. a ..rz :i'.t - .. .. 3. .�.; ._, .. t._, . } V V . PUMP CHAMBER: (locate on site plan) pumps in working order, yes or no Comments: (note condition of pump chamber, condition of pumps and appurtenances, . recommendations for maintenance o repairs,etc. ) i - r SUBSURFACE 89 ,WAGE DIBP004Xa OVOT/EX INSPECTION FOAL -� 4R ;1 '�•+5�` � �5�6! bN-�i'.a.:`.F 6 a .1 F.. OMEN IN$ORMATION Conti ued 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 and number leaching chambers and number leaching galleries and number leaching trenches, number, length. leaching fields, number, dimensions ' overflow cesspool, number Comments: (note condition of soil, signs of.,hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs,etc. ) CESSPOOLS (locate on site plan) : 1 number and configuration depth-top of liquid to inlet invert depth of solids layer i depth of scum layer dimensions of cesspool materials of construction indication of groundwater inflow (cesspool must be pumped as I part of inspection) Comments: I (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs,etc. ) PRIVY: (locate on site plan) materials of construction dimensions _ t .. depth of solids Y � Comments: ' (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs,etc. ) ,e,t; �� � •`� r ^ _' �� 'ear : .� , . � ., s SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM _',PART° H SYSTEM 'INFORMATION continued ?t t f '. i SKETCH 'OF SEWAOtz L't1,SP08At"SYSTEM:., I � • include ties to at least two permanent references landmarks or benchmarks' " locate all wells within 1001 I "C,"3 i .� s e"ff� •i'';rs t. ,x .. , � �d�, {'4- . .:l?' ., f ,.. !'... � 4 ''� 4" � aJ� « g. .. } ' ft,•.. V t� !.6.•+,,: �1,� `t•,, "i ? ,• ,F_ke �J.:+ ( i"^" t,_i3t{, - Cy '".c'roit JK . ".{.. 3 .v.`k.`�.,:. .IS ;1 � .�4 �t � '; .. r't, y,:. �'+ f. Y ,..r.. •t y •i'.{'t i ,4 I't� 1 '�+•� ..r t.. ,.�: r�5 €;'� 3 �Rx�"1�"'t 2'-. � Q t* to;.r' „}(�'tg rE( ","�*. tI t^i,�� '@ ti',�• '7�ti .�e.,t� `�'.F`�k._ �i`,q'.�t.{ + t i`•,. '' � W 1: g'.., �.'Y! .,.� ... ; .� .. , � f:i� t. i; i 'i, ^yt !fi - s s •S DEPTH TO GkOUNDWAirER '�+ p :`` + '' �x e };:i l:} ! 3 t'i ' ,I , depth to groundwater ^ v�3 ,"Tay i#$s r j method of determination or approxiinationi `To.w�, ` oF' Alervs A feec-a rzAc !1 A r Z "e n Ar s SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM i :PART, C,. �., FAILURECRITERIA Indicate yes, no, or not determined (Y, N, .or ND) . Describe basis of determination in all instances. If "not determined", explain why not) Backup'.,.pf :sewage into - facility? Discharge or ponding of effluent to the surface of the ground or surface waters? Static liquid level in the distribution box above outlet invert? Liquid depth in cesspool <6" bellow invert or available volume< 1/2 day flow? k I N . Required pumping 4 times or morein the last year? k number of times pumped Septic tank is metal? cracked? structurally unsound? substantial infiltration? substantial exfiltration? tank failure imminent? I Is any portion of the SAS, cesspool or privy ,1 below the high groundwater elevation? withih '50 feet of a surfade water? within 100 feet of ' a surface water supply or tributary to a surface water supply? Within a Zone I of a public well? within 50 feet "of a bordering vegetated wetland or salt-.marsh j (cesspools and privies only, not the SAS) ? within '50 feet of a private water supply well? A/ 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 analysi . for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. i , 13 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART D CERTIFICATION Name of InspectorT,r„," y E. C,4s�, Company. Name C,vs��s SPp�i� 1,�s�.rc�io n-s' Company Address N��reek.wo� 12d la�n�►wi P .�A.. Od6G jl . . Certification Statement I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true, accurate and complete as of the time of inspection. The inspection was performed and any recommendations regarding upgrade, maintenance and repair are consistent with my training and experience in the proper function and manitenance of on-site sewage disposal systems. Che one, I. have not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15. 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. , I have determined that the system fails to protect public health and the environment as defined in 310 CMR 15.303 . The basis for this determination is provided in the FAILURE CRITERIA section of this form. I Inspector's Signature l bate i� original to system owner Copies to i, , Buyer (if applicable) Approving authority ; I t LOCATION S E W A G P RMIT NO. V14:LAGE :'I o� y 0 INS A LLER'S NAME i ADDRESS 9 U ! L —�E R OR ss OWNER �tJ Je q DA T E P ERMIT I S S U E D Z2,f DAT E COMPLIANCE ISSUED _79' �1 F/Z 114 No............. THE COMMONWEALTH OF MASSACHUSE77S BOARD OF H ALTH ........0F...... .. ..................... Appliration for Uhipoiial Worhi Tonstrurtion ramit Application is hereby made for a Permit-to Construct (� or Repair an Individual Sewage Disposal ys at L4 ..................................... Locate-' Address or Lo No. .. . .... 4n. ......L S................. ------------ Installer/ Address I " Type of Building Size Lot-_-----r------ ---Sq. feet U orns7!��45E.4.:f...............Expansion Garbage Grinder Dwelling—No. of Bedrooms.___._.___.. ion Attic Other—Type of Building ---------_--_------------ No. of persons............_...........___. Showers Cafeteria P-1 Other fixtures ...................................................................................................................................................... Design Flow............................................gallons per person per day. Total daily flow---------5,30....................gallons. 9 Septic Tank—Liquid capacit/OMgallons Length................ Width.............._. Diameter.._..........._. Depth............._.. Disposal Trench—No..................... Width....--------_--.___ Total Length.................... Total leaching area....................Sq. ft. Seepage Pit No..._.... ----------- Diameter......I.D.-JO.. Depth below inlet....6...... 'Tot lea ing area_.Z.47 6--sq. ft. Z Other Distribution box Dosing to I -1 Percolation Test Results Performed by.._-_.. ..2r!, ............. Date....... ...... t it X"-.C�... Depth to ground water_.__ Test Pit No. I.....Z.....minutes per inch Depth of test itA.- 44 Test Pit No. 2................minutes per inch Depth of Test Pit_................_.. Depth to ground water........................ 04 ........ --------- ------------------ ------------------------------------------------------------------------- 0 Description of Soil..........0. ......... ........................................................... ................2- ------------ ........... -- ..........................................................................-------------------------------------------------------------------------------- ------------------------------------------6......I-2L-----le.7&4? U Nature 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 TITLE LE 5 of the State Sanitary Code— The undersigned fu her agrees not to place the system in If M 1"t operation until a Certificate of Compliance has bee * s d by hardSign ........ ... —----- ------_--_-- ........................... X -L—Date 7 Application Approved By....... .................... ... e.. 42 // .2-77 Date Application Disapproved for the following reasons:......................f -...................... ................................................................... ......................................................................................................................................................................................................... Permit No. Issued-J—— ..Id — 7'7 Date ....................... ....................... Date f r� No............. ...1�.. Fimz............... ........... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HE LTH Appliratiun for Dispoii al urkg Tonotrurtiun ramit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal Sys at, •-•- - Locati Address or Lol No O ner A dyes Installer Address. Type of Building Size Lot....... a._ -......Sq. feet `4 Dwelling—No. of Bedrooms______________ .............Expansion Attic (,, Garbage Grinder ( ) Other—Type T e of Building - p-, yp g ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ..-- -•-•----------------•---.•••---•••••••-•----••••---•-----•---•----•-••• W Design Flow............................ gallons per person per day. Total daily flow___.._. .___.....___gallons. Septic Tank—Liquid capact} gallons Length................... Width____..___._.._._ Diameter _. ______, Depth................ *: Disposal Trench—No. .......:............. Widt # _._-___Total Length...... � Total leachin area__:_ sq. It Seepage Pit No........k........... Diameter Q" _ Depth below inlet..... 6„}.. Tota lea hing area_ sq. ft. Z Other Distribution box Dosing t '-' Percolation Test Results Performed by _ + _'_ a ---• - -- - --•- -- -- � `"�'�--------•--- Date__ �---- Test Pit No. 1...... .....minutes per inch Depth of Test it..}_' '_. £ ___ Depth to ground water_-_ ., :,_. rzq Test Pit No. 2................minutes per inch Depth of Test`'Pit___.__._____________ Depth to ground water_______.._._:..:'`P P P -------- a ...--•..............•---••---•-------••-.----------••--_---•-- Description of Soil-----_...Q l �.t11'I!\... .� L -----•-•--•.._..•••-••-•--...-•- . ------------------------------------------ � - m . -- •-. W •-•-•••----•---------------------•-----•-• fF' -- . -------•- V Nature of Repairs or Alterations-Answer''when applicable-------:'_________________________________________________________________________.............. •-----------••--•----•---•----------•--....••--•--•------ -•-•---•---•-•- •••-••••--------•-••••-•--•------••---••- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal Srystem in accordance with, TTl1x the provisions of I: ::_..i-,; 5 of the State Sanitary Code— The undersigned fu dI er agrees not to place the system in operation until a Certificate of Compliance has bee s d by t.e and f 1 Im. !�Q Stgn . � G' .f....1 Date Application Approved BY........ . ..4. •--• •-y .................. •Application Disapproved for the following reasons-.......................------..............................................................DatDat.e.............. ---•................•------------•-•----...---------•-----------••---•-•---------•-•-------•--------••----•••...•••--•------•••-••-•---••--•••-•-•--------. -••-----••-----•----••••----••--••-•----- Date PermitNo. ........ Issued....................................................... Date s. THE COMMONWEALTH OF MASSACHUSETTS BOARS. ............ F O F HE LTH Yo ......! .......................................... Grfifiraft of ToutpliFaurr IS IS TO C RTIFY That �tfi e�Inu vidual ew. ' Dis sal Sys in constructed or Repaired ( ) by1! 1 .e'"'Y..r t4° _--- ...:....... .... ................................................ 6r. Installer has been installed in accordance with the,provisions•off The State Sanitary C de as described in the application for Disposal Works Construction Permit No .................................... dated......, •-. . "" "` THE ISSUANCE OF THIS CERTIFICATE SHALL NOT`BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM,"WILL FUNCTION SATISFACTORY. : DATE..... ce} - ......................... Insp'ector.... ---------------------- THE COMMONWEALTH OF MASSACHUSETTS, BOARD' OP HEA TH .. .. ,........0F..... 33 �"�.. L . . ................. . O' ..... ........:...... FEE.. . iu urk un,strnrr#' n anti Permission is hereby ranted_____ - Q _'a t_�:_:� to Construct or R, e air ) a Indivi al..Sewa�(Qispos S ayy/jjx �1 at No. ----�---• YP ljStreet 1• �5.+' �w--•-----•--•-- ..----•-- as shown on the application for Disposal Works Construction Perm- __________ ___ __ ed - ............. _.. ...... .._.._ .* Board of Health DATE...... ............................... _FORM 1255 HOBBS & WARREN, INC., PUBLISHERS • �?, 'r oJ; o� ' olPit + I s '�r awry r , �s Zy I 0 9 - . 3S ry fa C v A T i ` I y J /- i4 rir `t W f . <• YT � J i 1 LEGEND \ s CERTIFIED PLOT PLAN ,EXISTING SPOT ELEVATION Ox0 _I .,EXISTING -CONTOUR 0­ i, f G.G a �-i eta Ltd a y i FINISHED SPOT ELEVATION 0 0� 'FINISHED CONTOUR 0 - �- , a:' I ,APPROVE.D BOARD OF HEALTH - <` • ,., - - •t. •1 i DATE AGENT SCALE : /1�- �/G DATE : T2v � 79 , s ItL-bREDGE ENGINEERING CO. ING C L I E N C �phhPv _-_—'- — I CERTIFY THAT THE PROPOSED:'' rEGISTEREC', "REGISTERED) JOB NO 7F/ 0Y BUILDING SHOWN ON THIS PLAN s ' CIVIL LAND � p� CONFORMS TO THE ZONING LAWS ENGINEERS' I.,SU_ RVEYORS� DR. BY - C)F BARNSTABLE , MASS. �f CH. BY //8 ob 5 ^•i0 1AHMi7�;rHf Mom.' .;. Iir.j;vtv' > MA :_; SHEET -/ - OF DATE REG. LAND SURVEYOR'` 20 FT. P9/N"y /1l07"E /F E/TiYE�'� 7`'I e-5.gp G TANK OR A V.-t MORE Tf/-A.Al /2..SE40-S/ -A`c�4`0v/A/�'ETEE CarYC'RET� COi/ER SNALL OF 9A OUCiA0 f -T°®.61�s4OE.�.4N .EXTRA r/ 9ef,a " CONCRETE /M. P/TCN /4E.4Yy CA5T /RON�COI�L�/P Sf✓.4LL DE USE.IO • e,, COliERS� IB. RFR�r. - r o� _ C3R.9®E CC31�ER CLEAA/ .SAND - _ &AC.+lFILL •� ____ ... L/QUID LEVEL .• - .< . _' . . . •��. • •� .. LAYER 4 CAST !8 3�B ... ,.v. .a o � m m q Q QF �/ +- G. L. ° 0 1 e e o o ® e s / 1 a °4 WA5HFD 5710NE %q'Rem ter. SEPTIC 7A- AIX � c � 1 _ Bt7X p e0 � � 0 0 ® 00 r crop °9 1-• a p EFFECT/VE o a - o ® DEFT!/ ° 01 ' G dV.�1 SHED STONE - a a,e a 1 1 / ® • ® o e / 1 D om y PREC-AST SEEPAGE". F/T OR EQU/V /MVCKT E4Rl1AT/®!VS �� ��rSo /AIYE)?T AT 9011DlNG �' OFT. INLET SEPT/C TANK _ FT. O/AAA. C CsES Ts�BULaT�O�v OUTLET SEPT/C T.aNaC AFT. I/1/4E'T D157RIBU7-/D1d BOX 9-TA 0 FT. SECT/O/V a F GROUND AVA7-E,4!r TABLE OUTLET.&/5TR/B UTI UN BOX I FT. llVLET LEACHING T " FT. SEWAGE UISFPO.TA L .SY..577,6 -��46411-,gTIOAt LEACH !/G// F'/T 3 FT. SCALE : /4 /�- O� /UIME/NS/D/V A DES/Geld CR/TEl�/� D/pJ.EIt�S/oN FT. NUMBER OF BEDROOMS T. D/MENS/ON C F GAR45AGE®/SROSA4 UNIT 1501 L LOB TOTAL Esr1M.4TED FL.O,w 3 3 U G.44.1DAY SOIL. TEST #/ SOIL TES7-*2 lUMBER 0F.4E4CgfJV6 PITS !`L�LEY. 9C' d M 2 791 S/DE LEACHING PER PIT __SQ, FT. !� G !_ g RESULTS 6VI7-/VES5ED BY wh a c' 1`J c007-710MLr7ACH/lVG PFR /olr $Q. pT. / 40E0$C04A7'/OM !f'A7E tS' pr1//V'IINCH TOTAL jjCEACH//YG AREA LGa B S� SQ. FT. `r f' �RCOLAT/O N RATE�2 � M/M./lNCN RESERVEI.EAC/l/1VGAREA SQ. FT. 0F/NQS Z. U /- ROBERT; ti\, P. N g rep' i "- BUNIKIS v,j No 22162�0 Q/ me Pa, EL.0R ED,G&E/9/G �®,/NG.. 71G #"A/N ST.`: 3.3•,N0,MIS//V ST.- `i IVCDUNT�RE© NYsiM/V/5,..MASS:. SD.,Y�fR/+ROt/Tt✓,MASS. 5 TOP FNDN. AT EL. 73.7' SYSTEM PROFILE TEST HOLE LOGS ACCESS COVER TO WITHIN 6" OF FIN. GRADE (NOT TO SCALE) PROVIDE INSPECTION PORT WITHIN 6" OF FINISH GRADE ELDREDGE ENGINEERING CO. INC. Locus ACCESS COVER (WATERTIGHT) TO ENGINEER: I MINIMUM .75' OF COVER OVER PRECAST WITHIN 6" OF FIN. GRADE 2% SLOPE REOUIRED OVER SYSTEM 72.0 WITNESS: TOWN OF BARNSTABLE 3 2" DOUBLE WASHED PEASTONE\ DATE:____L 26/79 f ' EL. 7 RUN PIPE LEVEL FOR FIRST 2' 3' < 2 MIN INCH a ? EXIST _1000 / PERC. RATE _ - / Q GALLON SEPTIC �9 0+* / 69'0' CLASS i SOILS P# TANK (H- 10 ) GAS (RE-USE) BAFFLE 68.48' "� 68.31 ' CI 0 C7 0 0 CI ED C1 CJ a 6 8.17' C1 L� f� C] Cl C] CJ Cl O o 6'° CRUSHED STONE OR MECHANICAL � = � � = 0 = CI Q q„ Q ELEV. °� Q 70.8 L ° COMPACTION, (15.221 [2]) 00�75`� 2' 0 �' 0 CI 0 0 66.17' DEPTH OF FLOW = 4 MIN ( 1 % SLOPE) TEE SIZES: % SLOPE) 3/4" TO 1 1/2" DOUBLE WASHED STONE LOAM ( ' INLET DEPTH = 10" SUBSOIL CIO 68.8' OUTLET DEPTH = 14„ LOCATION MAP NTS FOUNDATION- EXIST. SEPTIC TANK 14' D' BOX 16 LEACHING FACILITY7.37 COARSE SAND ASSESSORS MAP 192 PARCEL 218 *THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL UTILITIES AND ALL 6' 64.8' BUILDING SEWER OUTLETS AND ELEVATIONS PRIOR TO INSTALLING ANY PORTION OF BENCH MARK - CORNER OF CONC, SEPTIC SYSTEM BULKHEAD ELEVATION = 73.7 58 8' MED. SAND + 69. rod3 . OVER HEAD UTILITIES 70.1 12' 5$.8' .24 lb l TH 1 i-73 L-- _ _ _ --f--7 t 6 _ - -- -- -' - --�7�9 / NO WATER ENCOUNTERED + 5.7 � I � -' �`i.$- NOTES �o°' 7Lo I � WATER MTR. PIT _.._ - - ! _ - -+- W, _ GRAVEL DRIVE - - �p W** ' -- -t 71.a 4 - - I �00 1 . DA-UM IS APPROX, NGVD �M 71.8 7 - _ ..:_ - - - ,f" ` 2. OU \IICIPAL WATER 1`,: _ 3. \41":'MUM PIPE PITCH TO PI__ 1/8" Pf=R, 10" P.PINES =.tip EXIST. 7o.i I , DWELL. �r � 0' I � 4. DESIGN LOADING FORA PRECAST UN "S IrJ BE AASHO H- 10 4-7 - 471.0 0_noon, .. N 70.1 5. PI�'E JOINTS TO BE MA-E WATERTIGHT. TF = 1 �`y' 6. CONSTRUCTION DETAILS "TO BE IN ACCORDANCE WITH MASS. + 69. + 73.7' I }� ENVIRONMENTAL CODE TITLE V. PECK 1 69.9 7. THIS PLAN IS FOR PROPOSED SEPTIC SYSTEM ONLY AND IS NOT 3" W.PINE �s, I + 73.1 TO BE USED FOR ANY OTHER PURPOSE. 1 AK o 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. + i' 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT **APPROX. WATERLINE. INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED W.PINE CONFIRM LOCATION PRIOR FROM BOARD OF HEALTH. 10" W.PINE TO EXCAVATION 10. PUMP & REMOVE EXISTING LEACH PIT. REMOVE ANY CONTAMINATED 1� + + 72.6 SOILS WITHIN 5' OF LEACHING FACILITY + 71.3 72.4 + y S D 72.3 14" P.PINES LEGEND. TITLE 5 SI G PL..!'"IOV PROPOSED SPOT ELEVATION OF 47 PATRIOT WAY + 72.4 10OX0 EXISTING SPOT ELEVATION IN THE TOWN OF: 72.0 + 72 10q PROPOSED CONTOUR (CENTERVILLE) BARNSTABLE LOT 5 10o EXISTING CONTOUR 16,972t SO. FT. SEPTIC DESIGN: (GARBAGE DISPOSER IS NOT ALLOWED ) PREPARED FOR: gORTOLOTTI DESIGN FLOW: 3 BEDROOMS ( 110 GPD) = 330 GPD CON STRUCTION/D'AVOLIO USE A 330 GPD DESIGN FLOW + 72.3 20 0 20 40 60 SEPTIC TANK: 330 GPD ( 2 ) = 660 BOARD OF HEALTH + 72.4 USE A 1000 GALLON SEPTIC TANK (RE-USE EXIST.) LEACHING: APPROVED DATE MA SCALE: 1 " = 20' DATE: OCTOBER 29, 2003 o SIDES: 2(30 + 9.83) 2 (.74) = 118 o. BOTTOM: 30 x 9.83 (.74) - 218 off 508-362-4541 fax 508 362-9880 TOTAL: 454 S.F. 336 GPD USE (2) 500 GAL. LEACHING CHAMBERS (ACME OR down Cope engineering, inc. ✓ ' ARNE: � �?� Amj. H. I STONE AT SIDES, 4' AT ENDS AND 5 H. �'t 13 oJv;L EQUAL) WITH 2.5' 5 0 DES, �� CIVIL ENGINEERS 140 26348 1 No. 3CZ92 BETWEEN UNITS �,�� LAND SURVEYORS ".I ,�`' 2yI 939 rein st, yarmouth, ma 02675 -- - + ----- - ---� 03- 299 Al'2NF, H. OJ.1 A, P.T., P.L.S. DATE