HomeMy WebLinkAbout0248 PINE STREET (HY - Health (2) 248 Pine Street
Centerville
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UPC 12534
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Commonwealth of Massachusetts �d�--
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments C
248 Pine Street I+•.
Property Address
NJ
Howard &Nancy Thomas
Owner Owner's Name
information is 7?
required for every Centerville I/ Ma 02632 1/11/2019
page. City/Town State Zip Code Date of Inspection p�'
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
Imngoutf rms A. Inspector Information filling out forms
on the computer,
use only the tab Sean M. Jones
key to move your Name of Inspector
cursor-do not S.M.Jones Title V Septic Inspection
use the return Company Name
key.
74 Beldan Lane
Company Address
Centerville Ma 02632
City/Town State Zip Code
508-658-3456, 774-248-4850 SI 4522
sean@smjonestitle5.com License Number
B. Certification
I certify that: I am a DEP approved system inspector in full compliance with Section 16.340 of Title 5
(310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address
listed above; the information reported below is true, accurate and complete as of the time of my
inspection; and the inspection was performed based on my training and experience in the proper function
and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined
that the system:
1. ® Passes
2. ❑ Conditionally Passes
3. ❑ Needs Further Evaluation by the Local Approving Authority
4. ❑ Fails
1/11/2019
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 has a design flow of
10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate
regional office of the DEP. The original form should be sent to the system owner and copies sent to
the buyer, if applicable, and the approving authority.
Please note:This report only describes conditions at the time of inspection and under the
conditions of use at that time.This Inspection does not address how the system will perform
In the future under the same or different conditions of use.
t5insp.doc•rev.7/26/201 B Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 16
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
248 Pine Street
Property Address
Howard &Nancy Thomas
Owner owner's Name
information is required for every Centerville Ma 02632 1/11/2019
page. Cityrrown State Zip Code Date of Inspection
C. Inspection Summary
Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6.
1) System Passes:
® I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
The dwelling located at 248 Pine St Centerville is served by a Title V septic system consisting of a
1500 gallon septic tank, 2 distribution boxes and a 40'xl9'x6" leach field with 6 laterals. The system
was found to be in proper working condition at the time of inspection.
2) System Conditionally Passes:
❑ One or more system components as described in the "Conditional Pass"section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not
determined," please explain.
The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass
inspection if the existing tank is replaced with a complying septic tank as approved by the Board of
Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND(Explain below):
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
248 Pine Street
Property Address
Howard & Nancy Thomas
Owner Owner's Name
information is required for every Centerville Ma 02632 1/11/2019
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
2) System Conditionally Passes(cont.):
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
3) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
a. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
t5lnsp.doo•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System.Page 3 of 18
II
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
r 248 Pine Street
Property Address
Howard &Nancy Thomas
Owner Owner's Name
information is required for every Centerville Ma 02632 1/11/2019
page. Cityrrown State Zip Code Date of Inspection
C. Inspection Summary (cont.)
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
b. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well".
Method used to determine distance:
This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal
coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must
be attached to this form.
c. Other:
4) System Failure Criteria Applicable to All Systems:
You must Indicate"Yes" or"No"to each of the following for all inspections:
Yes No
❑ ® Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
t5insp.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of to
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
" 248 Pine Street
Property Address
Howard &Nancy Thomas
Owner Owner's Name
information is required for every Centerville Ma 02632 1/11/2019
page. Cityrrown State Zip Code Date of Inspection
C. Inspection Summary (cont.)
4) System Failure Criteria Applicable to All Systems: (cont.)
Yes No
❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less
than %day flow
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply
well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered. A copy of the analysis:
and chain of custody must be attached to this form.]
® The system is a cesspool serving a facility with a design flow of 2000 gpd-
10,000 gpd.
❑ ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
5) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 16,000 gpd.
For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the
questions in Section CA.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection
Area—IWPA)or a mapped Zone II of a public water supply well
15insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 5 of 18
cam, Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
248 Pine Street
Property Address
Howard &Nancy Thomas
Owner Owner's Name
information is Centerville Ma 02632 1/11/2019
required for every
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
If you have answered"yes"to any question in Section C.5 the system is considered a significant
threat, or answered"yes"to any question in Section CA above the large system has failed. The
owner or operator of any large system considered a significant threat under Section C.5 or failed
under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner
should contact the appropriate regional office of the Department.
6. You must indicate"yes"or"no"for each of the following for all inspections:
Yes No
® ❑ Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
® ❑ Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑ Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
® ❑ Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System(SAS)on the site has
been determined based on:
® ❑ Existing information. For example, a plan at the Board of Health.
® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
t5insp.doc•rev.7/26/2018 Tine 5 Official Impaction Form:Subsurface Sewage Disposal System•Page 6 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
248 Pine Street
Property Address
Howard & Nancy Thomas
Owner Owners Name
information is Centerville Ma 02632 1/11/2019
required for every
page. Cityrrown State Zip Code Date of Inspection
D. System Information
1. Residential Flow Conditions:
Number of bedrooms (design). 5 Number of bedrooms(actual): 5
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 gpd
Description:
Number of current residents: 2
Does residence have a garbage grinder? ❑ Yes ® No
Does residence have a water treatment unit? ❑ Yes ® No
If yes, discharges to:
Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No
information in this report.)
Laundry system inspected? ❑ Yes ® NoL-
Seasonal use? ❑ Yes ® No
Water meter readings, if available(last 2 years usage(gpd)):
Detail:
Sump pump? ❑ Yes ® No
Last date of occupancy: current
Date
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
248 Pine Street
Property Address
Howard &Nancy Thomas
Owner Owner's Name
information is required for every Centerville Ma 02632 1/11/2019
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
2. Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 15.203): Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Water treatment unit present? ❑ Yes ❑ No
If yes, discharges to:
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
Last date of occupancy/use: Date
Other(describe below):
3. Pumping Records:
Source of information:
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped: gallons
How was quantity pumped determined?
Reason for pumping:
t5insp.doe•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not forVoluntary Assessments
" 248 Pine Street
Property Address
Howard & Nancy Thomas
Owner owner's Name
is
information Centerville Ma 02632 1/11/2019
required for every
page. City/rown State Zip Code Date of Inspection
D. System Information (cont.)
4. Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract fto be obtained from system owner)and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank.Attach a copy of the DEP approval.
❑ Other(describe):
Approximate age of all components, date installed (if known) and source of information:
s.a.s. installed 5/16/2006
Were sewage odors detected when arriving at the site? ❑ Yes ® No
5. Building Sewer(locate on site plan):
Depth below grade: 1.5
feet
Material of construction:
❑ cast iron ®40 PVC ❑ other(explain):
Distance from private water supply well or suction line: feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
Joints ok, no leaks or blockages. Vented through roof
t5insp.doc•rev.7/26/2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18
Commonwealth of Massachusetts
u
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
248 Pine Street
Property Address
Howard &Nancy Thomas
Owner Owner's Name
required don is
r for every Centerville Ma 02632 1/11/2019
requir
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
6. Septic Tank(locate on site plan):
Depth below grade: 1
feet
Material of construction:
® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain)
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No
Dimensions: 1500 gallons
Sludge depth:
6"
Distance from top of sludge to bottom of outlet tee or baffle
3'
Scum thickness
211
Distance from top of scum to top of outlet tee or baffle
5"
Distance from bottom of scum to bottom of outlet tee or baffle
11"
How were dimensions determined? opened covers and took
measurements
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tank does not need to be cleaned now but should be done soon and again every 2 years for proper
maintenance. water level was even with outlet, tank was not leaking and was structurally sound.
t5insp.doc•rev.7/28/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18
c Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -'Not for Voluntary Assessments
248 Pine Street
Property Address
Howard &Nancy Thomas
Owner owner's Name
information is required for every Centerville Ma 02632 1/11/2019
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
7. Grease Trap(locate on site plan):
Depth below grade: feet
Material of construction:
❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: Date
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Capacity:
gallons
Design Flow: gallons per day
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18
Commonwealth of Massachusetts
UTitle 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for'Voluntary Assessments
248 Pine Street
Property Address
Howard&Nancy Thomas
Owner Owners Name
information is Centerville Ma - 02632 1/11/2019
required for every
page. Cityfrown State Zip Code Date of Inspection
D. System Information (cont.)
8. Tight or Holding Tank(cont.)
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments(condition of alarm and float switches, etc.):
"Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
9. Distribution Box(if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert
0"
Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
System has 2 distribution boxes, both were in good condition with no signs of past hydraulic
overloading.
t5insp.doc•rev.7W2018 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage'Disposal System Form-Not for'Voluntary Assessments
248 Pine Street
Property Address
Howard 8t Nancy Thomas
Owner Owners Name
information is required for every Centerville Ma 02632 1/11/2019
page. City/Town state Zip Code Date of Inspection
D. System Information (cont.)
10. Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No*
Alarms in working order: ❑ Yes ❑ No*
Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.):
*If pumps or alarms are not in working order, system is a conditional pass.
11. Soil Absorption System(SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
Type:
❑ leaching pits number:
❑ leaching chambers number:
❑ leaching galleries number:
❑ leaching trenches number, length:
® leaching fields number, dimensions: 40'x1'9'z6"
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
t5lnsp.doc•rev.7/20/2018 Title 5 Official Inspection Form:subsurface Sewage Disposal System-Page 13 of 1e
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -'Not for Voluntary Assessments
z
�r 248 Pine Street
Property Address
Howard &Nancy Thomas
Owner Owner's Name
information is Centerville Ma 02632 1/11/2019
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
11. Soil Absorption System (SAS) (cont.)
Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
s.a.s. is a 40'x19'xT 6 lateral perforated pipe leach field. Soil and stone within leaching field was dry
with no signs of past saturation.
12. Cesspools (cesspool must be.pumped as part of inspection) (locate on site.plan):
Number and configuration
Depth—top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5insp.doo•rev.7126/2018 Title 6 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
248 Pine Street
Property Address
Howard &Nancy Thomas
Owner owner's Name
information is Centerville Ma 02632 1/11/2019
required for every
page. City/town state Zip Code Date of Inspection
D. System Information (cont.)
13. Privy(locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
.*rkv.dos•rev.70/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18
4\_ , Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
248 Pine Street
Property Address
Howard &Nancy Thomas
Owner owner's Name
information is required for every Centerville Ma 02632 1/11/2019
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
14. Sketch Of Sewage Disposal System:
Provide a view of the sewage disposal system, including ties to at least two permanent reference
landmarks or benchmarks. Locate all wells within 100 feet Locate where public water supply enters
the building. Check one of the boxes below:
❑ hand-sketch in the area below
❑ drawing attached separately
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KrW.doc•rev.7/28/2M 8 TO 5 OMCW Ion Farts:Subsurface lrrspeal Sewage Disposal System•Page 16 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
248 Pine Street
Property Address
Howard &Nancy Thomas
Owner Owner's Name
information is required for every Centerville Ma 02632 1/11/2019
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
15. Site Exam:
❑ Check Slope
❑ Surface water
❑ Check cellar
❑ Shallow wells
12'+
Estimated depth to high ground water: feet
Please indicate all methods used to determine the high ground water elevation:
❑ Obtained from system design plans on record
If checked, date of design plan reviewed: Date
❑ Observed site(abutting property/observation hole within 150 feet of SAS)
❑ Checked with local Board of Health -explain:
❑ Checked with local excavators, installers-(attach documentation)
❑ Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
Groundwater elevation was established by accessing Town of Barnstable groundwater contour maps.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Pape 17 of 18
Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
248 Pine Street
Property Address
Howard &Nancy Thomas
Owner Owner's Name
information is required for every Centerville Ma 02632 1/11/2019
page. Cityrrown State Zip Code Date of Inspection
E. Report Completeness Checklist
Complete all applicable sections of this form Inclusive of:
® A. Inspector Information: Complete all fields in this section.
® B. Certification: Signed & Dated and 1, 2, 3, or checked
® C. Inspection Summary:
1, 2, 3, or 5 completed as appropriate
4(Failure Criteria)and 6 (Checklist)completed
® D. System Information:
For 8: Tight/Holding Tank—Pumping contract attached
For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached
For 15: Explanation of estimated depth to high groundwater included
t5insp.doc•rev.7/26/2018 Title 5 Official inspection Form:Subsume Sewage Disposal System•Page 18 of 18
Town of Barnstable Health Inspector
OFZHe r Regulatory.Services office Hours
8:30—9:30
Thomas F.Geiler,Director 3:30—4:30
BAM
STAB Public Health Division
f1639. g Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
AMNESTY PROGRAM APPLICANT SEPTIC QUESTIONNAIRE
Date:May 30,2012
- 1. General Information: Size of Property.75 acre
Address: 248 Pine Street Centerville,MA 02632 Map 228 Parcel 040
Name: Howard A. and Nany J.Thomas Phone#: 508-776-1022 �� ,Q. ApG►✓1 rYv h1i.
LA mouse S be C r1 G`
2a. How many bedrooms exist at your property now? _ Ki-rnpy4
2b. Are you planning to add any bedrooms?NO V If yes,how.many? 0 ill�
2c. How many bedrooms total are proposed at this property(including the amnesty unit)? 1 SIP G10 t pC r m k 4
2d.Please include a copy of the floor plans for the entire property. Neatly use astraight-edge. Show all existing rooms in.the
home and the proposed amnesty apartment. Provide width measurements of any open doorways. Please label each'room
clearly. .
3. Is the dwelling connected to public sewer? NO -,,,.
r
If the dwelling is connected to public sewer,skip questions#4 through#9 below:
4. Location of dwelling is INSIDE a Saltwater Estuary Protection Zone?
5 Location of dwelling is INSIDE a Zone of Contribution to public supply wells?
6..Is the dwelling connected to an PUBLIC WATER?
7. Is a disposal works construction permit on file? YES or NO
8. If yes,how many bedrooms were approved according to this permit? Bedrooms.
9. Were any building permits obtained for construction of additional bedrooms? YES.- or . NO
10. ,Is there gineered septic system plan on file at the Health Division? YES or NO.
11: as a se i ystem been inspected by a DEP certified inspector within the last_two,years? YES or NO
-----------------------------------------------------
FOR OFFICE USE ONLY
T ealth Division has,no objection to bedrooms at this property.
Special Conditions:
3
Sign Date.
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TOWN OF BARNSTABLE //����f
CATION —p��� �� SEWAGE#9(X6-W4
V:iI,LAGE ASSESSOR'S MAP&PARCEL
INSTALLERS NAME&PHONE NO. GG 1�7rt ^V( Sot-
SEPTIC TANK CAPACITY S�U (r cal, Lx e: , k f X
LEACHING FACILITY:(type) -Pl.�Cr�.� Q((� (size) ! x 0 X (o
NO.OF BEDROOMS
OWNER c.S d \an.G G.-S
PERMIT DATE:�� q I t�(o COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility �KZ �kC'**NFeet
Private Water Supply Well and Leaching Facility(If any wells exist ee__ aa `
on site or within 200 feet of leaching facility) l��-� 1� Feet
Edge of Wetland and Leaching Facility(If any wetlands exist ��aa ,,{{��
, within 300 feet of leachin facility) AA 1�"`C\/"Feet
FURNISHED BY
A Oro'�� ��LL exns� O t3bx, a
AA-0
A �-
ex�� �� a �ro�� � � a s s•s
Cox exis'�3'I•S'
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NO. . CUW ��� " t - Fee loo
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
apphratton for Mtgozal �§pztem Conztructiou. Verrait
Application for a Permit to Construct( ) Repair(,Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel
Dalf
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
Scc�� r, i L 0j6-3 �G� 30\n.c�5�3,-\ ,5 OY `7 7 W
Li
Type of Building:
Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder ( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) ® gpd Design flow provided 17-lpv . _ gpd
Plan Date Number of sheets Revision Date
Title Size of Septic Tank ISO
0 GI Type of S.A.S. C�
Description of Soil me.Astn �`
Nature of Repairs or Alterations(Answer when applicable) A J J yq YU U )C U. L-e G to c t j
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
Sign Date
Application Approved by Date
Application Disapproved b . Date
for the following reasons
Permit No. �(y(��ii � � Date Issued �_
No. U� .- � Fee /
! 1 THE COMMONWEALTH OF'MASSACHUSETTS Entered in computer: N°
PUBLIC7HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
ZIpprication for Migozal �&pgtern Construction Permit
Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components
Location Address or Lot No. Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel C'`^k_13 's`R_ >"G ?i (} -� r/
� Y
Installer's Name,S Address,and Tel.No. De�signer` '�s Name,Address and Tel.No.cats n �Vv� �C��t��(�/1 ,f0y 7 7 �! q
Type of Building: s
Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder ( )
Other Type of Building No.of Persons Showers( ) Cafeteria`( )
Other Fixtures Design Flow(min.required) ��0 gpd Design flow provided Mo), gpd
Plan Date Number of sheets J Revision Date 6
Title .{� r
Size of Septic Tank ISO 0 G11�_ Ty e of S.A.S. r �-
Description of Soil M f oW <<i ckjr-
r
f
Nature of Repairs or Alterations(Answer when applicable) Ad J 1 el L1 U u 0,5" L C.x yx
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal-system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of '
Compliance has been issued by this Board of Health.
Signed Date �� 411 (o
Application Approved by �Cv J. �(' Date Sr �/le li
Application Disapproved b\. Date
for the following reasons
Permit No. 2 Gl)4 a% Date Issued C/y A4
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired V) Upgraded ( )
Abandoned( )by \.\( i)�l in, zM,A i_:�i
at a VHF n 9 S l - -�.;,S Z\\P has been constructed in accordance l
with the provisions of Title 5 and the for Disposal System Construction Permit No. 2 G1)6 — 26V dated S/
Installer �i—,C�7 M (c`r.����. Designer �- oyy 5r,G
#bedrooms �_� C'" Approved design flow �" (( gpd
The issuance of his permit shall not/be cpnstrued as a guarantee that the system il l f n ti on as designed.
Date inspector
--------------------------------------------
No. ?r'Xa(n d Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS
=i!5Po!5a1 ,pgtem Construction Permit
Permission is hereby granted to Construct ( ) Repair ( Upgrade ( ) Abandon ( )
System located at CI (��,-Q
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty
to comply with Title S and the following local provisions or special conditions.
Provided: Construction must be completed within three years of the date oft s pert./
Date '/ �1// Approved by !
MA1•- 2 -2006 08 : 13 PM DANIEL JOHNSON 508 420 9316 P. 01
Town of Barnstable
Regulatory Services
Thomas F.Geiler,Director
te'*' Public Health Dividoo.
Thomas McKm,Director
200 Main Street,Hyannis,MA 02601
Fax: 5o8-7904304
office: 508-862-WA4
DWpe Certi£icAIWOR IS rm
Date:
Desiper: A*e4/ec. J u tf�S o nJ
A,dalress: .
on 6 was issued a permit to install a
(date) (installer)
,septic system at 3-41 $ 1 F S T Gev reA—`"«d based on a design I drew,
(address)
dated
I certify that the septic system referenced above was installed substantially
according to the design.
I cerify that the septic system referenced above was installed with changes but in
accordance with State do Local Regulations, Revision or certified as-built by
desilpwr to follow.
c
(Des'per' Signature) (Affix Stannp Here)
WT501
ST E LI HE D N.
WIL TB I STE C B D I YO .
Q:Ha:alWep deJD.memer Cwificadoa Form
- 6•
Notice: This Form Is To Be Used For the Repair Of Failed
Septic Systems Only
PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM
I, b/?lq /CL &-J P HN5�� ,hereby certify that the engineered plan signed by me
dated -5-Z/Z 0 b ,concerning the property located at
'Z 4 8 P/N S'1 GEKTe-A J,C L E meets all of the
following criteria:
• Two soil evaluations excavated for detailed examination(no hand augering) and two
percolation tests shall be conducted.
• This failed system is connected to a residential dwelling only. There are no commercial or
business uses associated with the dwelling.
• The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes
per inch.
• There is no increase in flow and/or change in use proposed
• There are no variances requested or needed.
• The bottom of the proposed leaching facility will be located no less than five feet above the
maximum adjusted groundwater table elevation. [Adjust the groundwater table using the
Frimptor method when applicable]
Please complete the following:
A) Top of Ground Surface Elevation(using GIS information) S 0
B) G.W. Elevation 2 0 +adjustment for high G.W. 3(A4 = �'
DIFFERENCE BETWEEN and B
SIGNED : 0 DATE:
NOTICE
Based upon the above information, a repair permit will be issued for bedrooms
maximum. No additional bedrooms are authorized in the future without engineered septic system
plans.
gASeptic\percexemp.doc
i� TOWN OF BARNSTABLE
LOCATION-M64 Rwy�-- �� SEWAGE # 9 —SPY
VILLAGE 0-tlJT'e Ui Lx ASSESSOR'S MAP & LOTZAS 0,VQ
INSTALLER'S NAME & PHONE NO. 1A1c - cctvsT
SEPTIC TANK CAPACITY (,T 0 flfl
LEACHING FACILITY:(type) TV,,.-Tb 0 (size) 1�
NO. OF BEDROOMS 5, PRIVATE WELL UBLIC WATER
BUILDER O OWNER
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED: C/ -3 6 -
VARIANCE GRANTED: Yes No �,�
1.
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No— Fmic
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliratiuii for Divi-Vuutt1 urlt� Cnu$t triirttun Pruitt
Appli on is"ereby made for a Permit to Construct ( ) or Repair (X.1 an Individual Sewage Disposal
System at: 2 a—o Y
...... --•--•-----•----------------------------------------
Location-Address or Lot No.
caner Address
W ...K5.°L_. ... C` �Q.s. �"......•---� ��. ..........SA............... .A" ...............
Installer Address
UType of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms��
...........___________________________Expansion Attic ( ) Garbage Grinder ( )
aOther—Type
of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
dOther 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........................................
.a Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................
(i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
9 ----•----••----------------------------------------------•-•-•-•----------••••-•--------------...•---..._....-••--------------------------------------------
0 Description of Soil......................................... -------------••-•---•--•--------------------_.....------------------------------------•-----.................................
w
UNature of Repairs or Alterations—Answer when applicable.-- `. ........ ------- t._.-j...... (.g f•" _._-- �
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental 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 -.,. .... ................................................ 1p�---------------- -------Y... ..
Application Approved By . -
Application Disapproved for the following reasons. .................. . . .. . . ... . . . ............................ . ..........................
..................................................................................... .. .............
Permit No. ------- L� �y�+�
/ Dare
M z2 g a"AU
No... Fss...... .I:•........ ...
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Apphration for Bi5pi13Fil nrlts'Tnnstrnrtinn 1rrmit
Application is ,I�ereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal
System at: 0
.. .Y... ... .d�iN s.r����-----------------�' "'--i......'z v.// --------------------------..........----....---.......---------.....---
Location-Address or Lot No.
--•---- --------------------------
Owner Address '
---•--------
Installer Address
UType of Building Size Lot............................Sq. feet
..� Dwelling— No. of Bedrooms_��_...------------------------------------Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( )
d Other fixtures .
W Design Flow--------------------------------------------gallons per person per day. Total daily flow................_...........................gallons.
WSeptic Tank—Liquid capacitv------------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. 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 ------•-•---------------------•-•-•---•-•••---•----•-----•-•-------•------•---......---...--•-------.........................................................
0 Description of Soil........................................................................................................................................................................
x
U -----•----------•---•------•----•--•------------••-••••--------•--•-•-•--------------•-••------•-•-------••-----•-••-----•--•-----•-----•------•-----....•-•---•-•-•-•-••--•---------••--•-----------...
W
-----------•-•----------------------------•--------------------------------------------...._......•----------------------------------------------
U Nature of Repairs or Alterations—Answer when applicable.-- (--.--.� ___._T'r��__...J."?._...``�1_S�/�-`.....��
Agreement: /
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental 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 .: G-- �5�� S ...... 9
R ------
Application A roved B �. , ....�..,..:-x.. -1 ---- --------------------------------------------------------................ -----..�-----1� ..-..---V L
PP Y —AA-__
Dale
Application Disapproved for the following reasonr- ----------------------------------- .------------.........................---------------------------------------
. ...................................... .............................................. ....... -- .... .................................................. .......................................
ice
Permit No. ............R..��....-..>>!)-...---
-----
.------
.- Issued ..........................._................ . ......
Dace
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
(111'ertiftrate of Tomplianee
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( � )
by ......l�� \4=4--------�c►w S�'---------------- -------------..._-----------------
ins r 11
--------------------------------------------------------------------------------------------
has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in
the application for Disposal Works Construction Permit No. ......'� ..------ Q_t (---_ dated .
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE...... - .�.'.., . ..- � --- -------------- -... Inspector ... - - _, l .:..•
--------------------- ---------------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Elispnsttl Workii Tnns#ructinn f rrmit
Permission is hereby granted.._. _..__ bows ........C� . �'�
to Construct l ) ors^Repair (/G�� an Individual Sewage Disposal System
atNo...z ............. ' •----.-•S.. _..�'�..---..........-----. --------------- -------------•-------•--------------•--....--------------•-•--•-.............
Street
as shown on the application for Disposal Works Construction Permit No. y. ! _p._ Dated........ -,..?.:.....�.............
tom .
DATE................�.._". r7.:.��.�/
---•----------------•----------•• Boar f Health
FORM 36508 HOBBS&WARREN.INC..PUBLISHERS
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S Y S rEill _ DISTRIBUTION BOX:
- -- H-10
TEST PIT VA2h MODEL SHOREY DB-9
> r REMOVABLE COVER ;' d, c�CN 40OUTLET �_ATERALS
I = 1 0 --+
UI.TTNQUTION DOX TO MCCT / L HAJ I RF SFT I FV'FI Ff1R A
i I REQUIREMENTS OF 310 CMR MINIMUM OF THE FIRST TWO
2 r - - i 15 232(WATERTIGHTNESS. -- Y i' FEET AND CONNECTED TO
a e : �:: _ _ %� .; CONSTRUCTION. ETCI - _ �I EACH DISTRIBUTION LINE
r
;' '.vlTH S0LID SCH 40 R/C PIPE
j r'
= 99 . 4) i NO OF 3U TLE T5 B 4"SCH 4Q i i
- - - --- - TF-1 (EL.
EL -9650 i EL =36s3
- - o o — CRUSHED STONE <1-3/4„
DIA. STONE TO BE
/C Loamv Sant: 4 STABLE LEVEL BASF M
ECHANICALLY
r ` 0 ACTED
-coarse t
Medium
ed
I NO. OF ACTUAL DISTRIBUTION
TP-2 (EL . = 99 , 4) LINES B
LENGTH OF LEACHING :JNE 4(
LEACHING FIELD
Sandy _Oc ? ThID"CROSS SE'-TION 4fl LX 19'bv"iC05`N
n LEACHING FIELD DIMENSIONS
SCALE - "BONE
FINAL GRADE TO BE S'+ABILIZED
Medium-coarse sand \
s FINISHED GRADE iSLOPE 02)
-EL 99
t 1 PERC OIL► 'ii i T'UST D II � 4' SCH 4G PVC PIPE •� I)!+ i!! # - 12' MIN I' ? _
[ )
LATER Ve" 1/Z'DOUBLE
EL. _96.70 vn —WASHED STONE
fBREAKOLIT)
f � ' EL. =96.G0(END)
i SlS" OF0FACE DW S' 3/4"• I 1/2"DOUBLE WASHE
A _ o 0 o STONE
DEL =95z11
j9 t5 FFE: l a3,1
C-11LEACHING F'.ELD TO MEET
-_ � �8.1 REQUIREMENTS 4�F 310
CMR 15 25'
7t SCHEDULE OF ELEVATIONS ;
,�,-, BFE = 9 4, � T
± I END OF DISTRIBUTION LINES TO 6E i ,'—BOTTOM OF TP-2(EL. _
� I jrr14C, T F _ /aA.o _ _ I -
lS�� (J,p��or�! I { �r. T/ _yp f,C;a=.-�K e; _S_ing �PPE0 NO08SGvr1ESH1++T
p T r T.M�I k v. O'C _ S e>✓
E ` r: L 3 t r 3C?i NOTES
Lj} +I Sow _.. . . �'_ �iSL_ _.� Boy: i
o rg 1e:C$
= :.--Li con5truotiarL rtaeth 5 s 1u-: r.�'0rm tc the T
O 99f +ISr/M(1 J . ?aC _' _e_^_. 96 . •_ I 'MR . 5 , and the FSarnStab;e ;cra Jf !Y$a_td Reg' are
I r�A.� A Bc 'om :.c-ai.}•1_..g e_,1 95 . 5u E ons .
i
�IJ �„:�4y No ,bus . GY'vi .SHWT are no KnGw°r: v e or pu1J c l
i } pri at _� wells within 150
-ee- i400 feet, r?spevt ve, o. _
�(,NCJfMR - -- a .
::ie prG Ose- leaching are :twi', r.5e� lea _ tC are
_ F a is not w 3 100 Leet .;f a
RS�J IJ(I'35 I _�ra.^.C, :+C?' 1$ iait�i" �n.4 Feet �' a r .VF_ _`_ron- .
70 a1c r4 ,41c , q ScN4U�,
`DiA 1 septic tan'. �_, oe pumped and new 4" SiH 40 PVC
SST ;>.5 ----- S" ° 3X I I+t _ -, a* tee and f _tier -c be - a..;
C� �t KEEP Al `AL i f I _ . r:s._a__
I ALA)AI tr/Z _._. 11 Hxist ^a cntour - - - 9 _-'-anges are to be made in the f_e'd ;I-r.-,;t he a ro- -
ZoJTS �i ' \�! +� I I Pp_ a 1
P055 61.b (NALluui4y - - - - - - - 99— ! p ! _ e Boar,-4 of Rea_ _): and the design
�. _ _ �, r pose•: Contour
'
sed eaciting �ie ..: Is not des_Jne;: f _ :se w ti
F-E, -
i r._>_-s^e1 - 1oor
71
1; cP �; -c su �7ev.
99tb 99 *A 9�'` 4ret o�) �; ..--. � __ L _� s~:a_i ve=ify awe piumb_nti frCm existing S:= 1CiUTP..
p°� ` I -- ---- I --- = - - e,^ �c _^e :,ew sG� - _ =•�ste prior tc
is found tt be ffe_er. _ the ;hat Shown on the
s � ,. , pproved Sept_ system plan, Lae contractor shall notify the
A o 5 .�° �,��: yes rer . ?_ ' _nter-:a-
G y t 1 i p e ; e
i at 1 a ` attsre �o L _ ic_l b@ c:onnecteC ? :teW
septa system, unless " r� s s : fl d.
4
0 ,Eq
golLrt►9v+rx0,i q•ScH 4° 10 ( ~' I '9 . t �"~E,v.
L>IL•IJL W Aq I j'.OI E I ( r a - _ �? `N a�►p
LA Mtrt
A.
--------- �__�- - ._ CAT-CULATIONS .
' 4
Y `•
•r ?
pJNA p �
a 7 wF ?edrecros \es�i 5 ling
110 GPD/Bedroom X 5 Bedrooms 550 '=PD
EJ>(rE v1:N�oEMENT � oN\-'✓/ 'Arcoiation Rate < 2 MPI, Class ' • �=, " ,��'
iAP/ICoI+ pv j
901
^' n PROPOSED LEACHING AREA:
c%3 '1C� 1d 4 Ci r L �• 1 9r Wr
p • .,.
�0,�4 1° v �F Y Na�4^R`A RC Q? Bottom Area: 760 SF X 0 . 74
s`JF - 53r1... Y .3.7
T-� z 4,N[ ,a- i -
��( E M ;� l 2 'A r �'ctal eaching Capacity• 56� 4 `=J
i-D
5c,4LE .9S 51go JNI j:p,.)rtm6( (y/LADE
n ( C A a
f a 0 ` 1�O S) J f-L T 1 Q . /T t A
D._
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3 o
96LI 9b5o 6� ►'EER•fi'�� S-.00S �
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F/E I.v
go`t. t 19�w /C0,5N # 12E 510 _I'� sr j� •r.1CNrt�hA ►C S{fov�b jo��GTEST �4.�D �ur�. lass
v I oio Ec.o��4TEo 6C
> 9�
� SEf p�A�t v1E�, I Ec�C v,4n Ar.tS o� PL'4^I / Erg.
,
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