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HomeMy WebLinkAbout0141 THISTLE DRIVE - Health 141 Thistle Drive Centerville F/R A =.149 130033 G/f UPC 10259 o- No. H 163OR M�a. wa• w� NO. Fee SO THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Rpprication for Mir og pgtem Con.5truction Permit Application for a Permit to Construct( )Repair( Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No./y/ Ownef's Name,Addre and Tel.No. C Assessor'sMap/Parcel , t t'0-®33 Installer's Name,AdXskand TCANCo Designer's Name,Address and Tel.No. No. 350 Main Street ' " '� � P 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 ��� gallons per day. Calculated daily flow U gallons. Plan Date t Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. LS_Zra S Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Env'ronme ode and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board o It Signed Date Application Approved by D ate Application Disapproved for the following reasons Permit No. ZOp 2—S t? Date Issued 11- 1 —6'Z— 1Va /�ia/V 4 D Fee -D(,D �x tf THE COMMtfi`NWEALTH OF"MA"SSACHUSETTS­ Entered in computer: PUBLIC HEALTH DIVISION —TOWN OF BARNSTABLE., MASSACHUSETTS Yes,. f r Zipplication for 30ioog -6p5tem Construction Permit Application for a Permit to Construct( )Repair( Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No./W ;s f e 0 ` 0, 's Name,Addre and Tel.No. N_ � Assessor's Map/Parcel ����fC r��� 0A vl L P Te f�, - t30-o33 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. j Type of Building: f Dwelling No.of Bedroomsr Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures ' Design Flow ` y gallons per day. Calculated daily flow r- gallons. Plan Date / Number of sheets / Revision Date Title Size of Septic Tank OnD �i1�i PLC Type of S.A.S. Description of Soil • � I i Nature of Repairs or Alterations(Answer when applicable) 1 1' 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 Env ronmentail Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board o VNY Signed Date Application Approved by Date Application Disapproved for the following reasons Permit No. 2 c n 2-5(g' Date Issued it- ----------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS - Certificate of Compliance THIS IS TO CERTIFY, that the n-site Sewage Disposal System Constructed( )Repaired Upgraded( ) Abandoned( )by at A// /-S / / has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 7.00 2-S►g dated I/- /— 0 2- Installer Designer The issuance of this permit shall not be construed as a guarantee that the sy 'ern w4li/junctio destgne . Date - d - 017 Inspector ���� i --------_--_----------_---------------- i No. Zoo 2—5 lg Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS 33ig;poal bpeum Construction Permit Permission is hereby anted to/Co struct( )Repai ( Upgrade L. )Abandon System located •/ /v,��2 � P 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 e I Date: I - ( — OZ— Approved by _ i Ur't-e,TOWN OF BARNSTABLE LOCATION SEWAGE # VILLAGE/ ��� �o / �J//� trASSESSOR'S MAP 8c LOT �y���3�'033 INSTALLER'S NAME&PHONE NO: 14049 e4w6c) SEPTIC TANK CAPACITY �'� l` � !2.41 00 LEACHING FACII.I'TY: (type) T (size) NO.OF BEDROOMS 3 BUII.,DER OR OWNER PERMIT DATE:.,.. 1.I-I-0 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to;the Bottom of Leaching Facility Feet Private Water Supply Well and Leach*.Facility (If any wells exist E 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 617 73 oir 0�' r ,� 6 � f oV� TROY WILLIAMS SEPTIC INSPECTIONS Certified by MA Department of Environmental Protection CRE19 Hummel Drive South Dennis, MA 02660 1 4 2002COMMONWEALTH OF MASSACHUSEThS BARNS 1 ABUt EXECUTIVE, OFFICE OFENVIRONMENTAL,ATH DEPT. 10 DEPARTMENT OF ENVIRONMENTAL PROTECTION "TITLE 5 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A p, CERTIFICATION c^ILED INSPECTION Propert.N Address: 141 Thistle Drive I-/'1 Centerville,MA Owner's Name: John Barrera Owner's Addres.. 141 Thistle Drive O Centerville,MA 02632 Date of Inspection: August 7,2002 O Name of Inspector: Troy M. Williams Company Name: Troy Williams Septic Inspections Mailing Address: 19 Hummel Drive South Dennis,MA 02660 Telephone Number: (508)385-1300 CERTIFICATION STATEN[ENT 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. 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The sv,;tcm Passes Conditionall\ Passes Needs Further Evaluation by the Local Approving Authority —Z Fails Inspector's Signature: Date: 8 /7 / 0 .2 The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of I lealth 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 Although system meets the minimum requirements set forth by the Massachusetts Department of Environmental Protection,certification is not to be construed as a guarantee of future working condition of system,piping or components. This Inspection represents the conditions of the system on the Date of Inspection noted above. ""This report only describes conditions at the time of inspection and under the conditions of use at that time. phis inspection does not address how the system will perform in the future under the saute or different conditions of use. Title 5 Inspection Form 6/15/2000 pace I Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 141 Thistle Drive Centerville,MA Owner: John Barrera Date of Inspection: August 7,2002 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: I have not found any information which indicates that 96 of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria no valuated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section n@ed to be replaced or repaired. The system, upon completion of the replacement or repair,as approved by the Board of alth, will pass. Answer yes, no or not determined(Y,N,ND)in the_ for the following statements. if- of determined"please explain. The septic tank is metal and over 20 years old* or the septic tank(whet r metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is im nent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by t oard of Ilealth. •A metal septic tank will pass inspection if it is structurally sound,n 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 high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or even distribution box. System will pass inspection if(with approval of Board of Health): bro n pipe(s)are replaced struction is removed distribution box is leveled or replaced ND explain: The syste equired pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspectio (with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: Owner: Date of Inspection: C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. L S)-stem will pass unless Board of Health determines in accordance with 310 CMR 15.303( b)that the system is not functioning in a manner which will protect public health,safety and the •ironment: — 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 arsh 2. System will fail unless the Board of Health(and Public Wa r Supplier,if any,)determines that the system is functioning in a manner that protects t bli he pub h Ith,safety and environment: _ The system has a septic tank and soil absorptio ystem(SAS)and the SAS is within 100 feet of a surface eater supply or tributary to a surface wat supply. — The system has a septic tank and SA d the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic nl:and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply wel . Method used to determine distance •'This system pa s if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and v the organic compounds indicates that the well is free from pollution from that facility and the presen of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure teria are triggered.A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 141 Thistle Drive Centerville,MA Owner: John Barrera Date of inspection: August 7,2002 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for al inspections: Yes No _ Backup of sewage into facility or system component due to overloaded or clo:2ed 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 L-,,,-L,P;} _ Liquid dep6in eessp"is less than 6"below invert or available volume is less than%,day flow _ Required pumping more than 4 times in the last year N,()TT 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. 6uA Any portion of cesspool or privy is,within 100 feet of a surface water supply or tributary to a surface water supply. ,. p PA Any portion of a cesspool or privy is within a Zone I of a public well. h14 Any portion of a cesspool or privy is within 50 feet of a private water supply well. v/A Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this forma JE S (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with ad tgn 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 crite "a above) yes no the system is within 400 feet of a surface drinkin ater supply _ the system is within 200 feet of a tributary a surface drinking water supply the system is located in a nitrogen s sitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone 11 of a public water suppl ell If you have answered"yes"to any estion in.Section E the system is considered a significant threat,or answered "yes"in Section D above the Iar syst to has failed.The owner or operator of any large system considered a significant threat under Secti E or failed under Section D sham upgrade the system in accordance with 310 CMR 15.304.The system owne ould contact the appropriate regional office of the Department. 4 f Page 5 of I 1 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B .CHECKLIST Property Address: 141 Thistle Drive Owner: Centerville,MA Date of Inspection: John Barrera August 7,2002 Check if the following have been done. You must indicate"yes"or"no"as to each of the followine: Y No 7 _ P..; ping information was provided by the owner. occupant, or Board of I i:ahl, 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: Yes no _ Existing information. For example,a plan at the Board of Health. _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)13 10 CMR 15.302(3)(b)] 5 r Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 141 Thistle Drive Owner: Centerville,MA Date of inspection: John Barrera August 7,2002FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x k of bedrooms): ,33 D Number of current residents: S Does residence have a garbage grinder(yes or no):Y 3 Is laundn on a separate sewage system(yes or no): N& (if yes separate inspection required) Laundry system inspected(yes or no):_AILq Seasonal use:(yes or no): )L/v Water meter readings,if available(last 2 years Usage(gpd)): Q r _ 61,00 //, > a o Sump pump(yes or no): Ago Last date of occupancy:_6c[.l,21-a COMMERCIAL/INDUSTRIAL 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 ( s or no):_ Water meter readings, if available: _ Last date of occupancy/u,se: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: ,' _ Mu;� , , ��� , r� �, �• ., ����,. Wass stem pumped as part inspection lion— Y p p p p (yes or no): ^1 If yes,volume pumped: gallons-- How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM ✓Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool Privy _Shared system(yes or no)(if yes,attach previous inspection records, if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _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 1�V-4--d /o /z' /a t e - b_,.( � Were swage odors detected when arriving at the site(yes or no): N6 6 f Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 141 Thistle Drive Owner: Centerville,MA Date of Inspection: John Barrera August 7,2002 BUILDING SEWER(locate on site plan) Depth belo%N grade: Materials of construction: _cast iron _,/40 PVC_✓other(explain): /;5 t, I (,,1, Dktance fron• prnate water supply well or suction line: �-i(,, Comments(on condition of joints,venting,evidence o► leakage,etc.): SEPTIC TANK: (locate on site plan) Depth below grade: I 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 nor"_(anach a copy of certificate) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or battle: c) Scum thickness: 3', Distance from top of scum to top of outlet tee or baffle: (," Distance from bottom of scum to bottom of outlet tee or battle: //'' How were dimensions determined: ?P. Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): p fj—��tit �. W O✓.k•a^ S D rK•c�.. J o e,. GREASE TRAP:_(locate on site plan) Depth below grade: Material of construction:_concrete_metal_fiberglass olyethylene other (explain): _ Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or b e: Distance from bottom of scum to bottom of o et tee or baffle: Date of lust pumping: Comments(on pumping recommendat' s,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: 141 Thistle Drive Date of Inspection: Centerville,MAJohn Barrera August 7,2002 TIGHT or HOLDING TANK: (tank must be pumped at time of insp ton)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass olyethylene other(explain): Dimensions: Capacity: gallons Design Flo%%: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order es or no): Date of last pumping: Comments(condition of alarm and floa itches,etc.): DISTRIBUTION BOX: ✓(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 outlets equal,any evidence of solids carryover, any evidence of leakage into or out of box,etc.): _ "(l.3 ...,,�_ cli�a �L,� l..J u.L,�✓ I c.J s..L._s_7'2a•� J � Two.. �.c c...n c( �. 7 _ ►^.!�-t,..., PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,con on of pumps and appurtenances,etc.): 8 Page 9 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 141 Thistle Drive Owner: Centerville,M.A Date of inspection: John Barrera August 7,2002 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why.. Type leaching pits, number: I — (-'X�-G• t_�.�mot„ yo,'t 2• y}v., . leaching chambers,number: leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions: overflow cesspool,number: innovative/altemative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding, damp soil,Undition of vegetation, etc.): 7 4— // n �l V�.�- _i J'� i b 5��...c -"� o.., c.+� /`. W�+ .F1�' t y c � ! S c✓ _.�. I. f ��ti� CESSPOOLS: (cesspool must be pumped as part of inspectio ocate on site plan) Number and configuration: Depth—top of liquid to inlet invert: ---- -- Depth of solids layer: Depth of scum la\er. _ Dimensions of cesspool: Materials of construction: _ Indication of groundwater inflow(yes or n Comments(note condition of soil,sign f hydraulic failure, level of ponding,condition of vegetation,etc.): PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulXf * e, level of ponding,condition of vegetation,etc.): 9 Page 10 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 141 Thistle Drive Centerville,MA Owner: John Barrera Date of inspection: August 7,2002 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. A ' r � COL—710— �4h lit . LID A F = zr 'G '' 3F = sY ' �o Page 1 I of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 141 Thistle Drive Owner: Centerville,MA Date of Inspection: John Barrera August 7,2002 SITE EXAM Slope Surface water Check cellar ✓ Shallow wells Estimated depth to ground water 12 feet Adjusted high ground water elevation feet Please indicate(check)all methods used to determine the high ground %%ater 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: y�P�;- i h t,e A , Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: ��'�-S_i• fi� .�- �e It 5-�1- i �" _h o �o-}_ ,7`�'—a��,(_ c�. 11 i TROY WILLIAMS SEPTIC INSPECTIONS �� Certified by MA Department of Environmental Protection MAR 2 6 1997 & (508) 385-1300 tt9 19 Hummel Drive South Dennis, MA 02660 HE�ALTBH DEPTh Ll "d Q 8 � Commonweafth of Massachusetts ��L! Executive Office of Environmental Affairs Department of Environmental Protection VA111 m F.Weld G- Trudy Coxe / Argoo Psui Celluccl S"rebuy LL co"aw David B.Struhs 3 OY d j ? C4"n6'ionsr SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A _ ' CERTIFICATION Property Address: 1411 ��, S�'L" 0r. Address of Owner. J L_'_ �a-✓c<<rc. Date of Inspection: 3 /t'� /y] (If different) Name of Inspeetorfoyy w, (1, w,K. 5 Sc..r►�c. Company Name,Address arld 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 inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: ,Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature. Date-- The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: A) SYSTEM PASSES: VI have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. III SYSTEM CONDITIONALLY PASSES: 'V�'y One or more system components need to be replaced or repaired The system,upon completion of the replacement or repair, passes inspection. Indicate yes, no,or not determined(Y, N, or ND). Describe basis of determination in all instances. If"not determined",explain why not) The septic tank is metal,cracked,structurally unsound,shows substantial infiltration or exfiltration,.or tank failure is in+m rent. The system will pass inspection if the existing septic tank is replaced with a ponforming septic tank as approved by the Board of Health. (revised 11/03/95) 1 I . y SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Addrear. / S �(� Or. Owner. 13 C, Date of Inspection: B)SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken,settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): broken pipe(@)are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed 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 the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: / _ Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic 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. 9) OTHER (revised 11/03/95) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A I /�CERTIFICATION(continued) Property Address 7 v/ �!� ; S ?/-IQ- A ,-. Owner. Date of Inspection: ��r✓��� . ,3/1S- /y7 D1 SYSTEM FAILS: I have determined that the system violates one or more of the folio this determination is identified below. The Board of Health should be conttacted to determinilure criteria as defined w �a ill b��necessary 15.303. The basis fOr failure. — Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. _, Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. — Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. — Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow. — Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped — Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. — Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. — Any portion of a cesspool or privy is within a Zone I of a public well. — Any portion of a cesspool or privy is within 50 feet of a private water supply well. — Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. El LARGE SYSTEM FAILS: IVI-9 The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: — the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply — the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area (TJVPA) or a mapped Zone II of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 6.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 11/03/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: Owner. ? Date of Inspeotlon: Check if the following have been done: Pumping information was requested of the owner,occupant, and Board of Health. V None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. V As built plans have been obtained and examined. Note if they are not available with N/A. Ze facility or dwelling was inspected for signs of sewage back-up. ZThe system does not receive non-sanitary or industrial waste flow The site was inspected for sigh of breakout. V All system components, excluding the Soil Absorption System, have been located on the site. The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or /tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. V The size and location of the Soil Absorption System on the site has been determined based 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 Sub- Surface Disposal System. (revised 11/03/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 5 4-/-e- I�. Owner. Date of Inapeotion: RESIDENTUL- FLOW CONDITIONS Design flow:336 pjlozw Number of bedrooms: 3 Number of current residents: 2 Garbage grinder(yes or no):,S Laundry connected to system(yes or no):�ES Seasonal use(yes or ho):—Y'r S Water meter readings, if available: / C�b iU Uy Su �loH Last date of occupancy: ALP t cJ S C Cj COMMERCIAL/INDUSTRIAi, Type of establishment: Design flow:�jeallons/day Grease trap present: (yea or no)_ Industrial Waste Holding Tank present: (yea or no)_ Non-sanitary waste discharged to the Title 5 system: (yea or no) Water meter readings, if available: Last date of occupancy: OTHER. (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: L,ws System pumped as part of inspection. (yes or no) /N c, If yea, volume pumped: ______gallons — Reason for pumping: '1'YPF,-OF SYSTEM Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yea, attach previous inspection records, if any) Other (explain) APPROJQMATE AGE of all components, date installed (if known) and source of information: 1--t' Sewage odors detected when arriving at the site: (yes or no) AlU (revised 11/03/95) b I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(oontlnued) Property Address Owner. Date of Inspection: SEPTIC TANK (locate on site plan) Depth below grado: Material of constriction: ncrete_metal_FRP—other(explain) Dimensions: S ' X '7 i x 6 Sludge depth: / 11 Distance from top of sludge to bottom of outlet tee or baffle: 17 Scum thickness: A10 All Distance from top of scum to top of outlet tee or baffler S C-v P1, Distance from bottom of scum to bottom of outlet tee or baffle: A/- S Comments: (recommendation for pumping, ndition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage, .tea R.) /fz-_ S W c t, 74,n� �..�or• 1.. 5 v-/�<r /10 p.3 fi GAS - Ere t3 c� a(�r►..�y .�. 1 G�. L. W 4 � h a� 7'L , t.. G.t G K ' T i GREASE TRAP:_ (locate on site plan) Depth below grade: Material of construction:_concrete_metal_FRP—other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Comments: (recommendation for pumping, condition of inlet and outlet tees or baIDes, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(oonttnued) Property Address: �yl %5�l e— 0,-. Owner. 43ur/� rw Date of Inspection: TIGHT OR HOLDING TANK: N14 (locate on site plan) Depth below grade: Material of construction:_concrete_metal_FRP_other(ezpLiin) Dimensions: Capacity:- gallons Design flow: gallons/day Alarm level: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) —/3 Uk—C14 a PUMP CHAMBER: (locate on site plan) Pumps in working order:(yes or no) Comments: (note condition of pump chamber,condition of pumps and appurtenances, etc_) (revised 11/03/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C L/ SYSTEM INFORMATION(continued) Property Address: �7 I Owner. Date of Ins ��rrLv peotton: 3/1 S/9 7 SOIL ABSORPTION SYSTEM (SAS): ✓ Goes"an site plan, if possible;excavation not required, but may be aPPraximated by non-intrusive methods) If not determined to be present,explain: Type: leaching pits, number. leaching chambers, number._ leaching galleries, number. leaching trenches, number,length: leaching fields, number,dimensions: overflow cesspool, number: Co nts: (note condition of soil, signs of hydraulic failure, level of Ponding, condition of vegetatio CESSPOOL9: (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(cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,do etc.) , PRIVY: (locate on site plan) Materials of construction: Depth of solids: Dimensions: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (revised 11/03/95) 8 . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner. Da Inspection: 3 /t�r SKETCH OF SEWAGE DISPOSAL SYSTEM: Include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' -4 S `Z r r �b c r iOOU �klla� ( lr 5`1 - b x DEPTH TO GROUNDWATER Depth to groundwater•, feet — adjusted high-groundwater level m / ..method of determination or approximation: P �,, �� Y/ . 6— a w ( 4c- } ,J a w a 1'e Zdt -Ta Yp / ' 9 NoQ..... .THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH 1.ov.�vJ......... .....OF. [ ! ST1P2... Appliratinn for Disposal Marks Tonstrnrtion ramit Application is hereby made for a Permit to Construct ( V1,111,0'r Repair ( ) an Individual Sewage Disposal System at: _ .-Locati dress nn or Lot No. /�j -----------------------------------------•---•---..........-------•-•.._..................----.--- _ /f/y ��j/�� � Address Installer Address Type of Btu Size Lot.................... .....Sq. feet aDwelling—No. of Bedrooms....................3.....................Expansion Attic ( ) Garbage Grinder QW) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures ------------------------------•-•-•------------•--------------•----------•-----------------------------...........-------•-•----•-•---•............. W Design Flow..................`JS-....._.....-----.gallons per person per day. Total daily flow.................. ............gallons. WSeptic Tank—Liquid capacity. gallons Length................ Width................ Diameter__-_____-___.___ Depth................ x Disposal Trench—41L o..................... Width...... ............ Total Length.....................Total leaching area....................sq. ft. Seepage Pit No...... ........... Diameter.........451...... Depth below inlet........ ©......... Total leaching area... ..sq. ft. Z Other Distribution box ( Dosin tank ( ) Percolation Test Results Performed by =XNL..+...OYIE......__.. .: Q1404...P9 Date......-:'..-- --" . Test Pit No. 1.... -.....minutes per inch Depth of Test Pit.......t2!...... Depth to ground water--------.- fZ4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P1 ..•-•--•--••------------•••-----•---•----••-------•--•-•-•-------•-----•.....................•................................................................ Description of Soil............................... t • . x w 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 TITIE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b ued e board of he It igned--• --• . •.... ...........L? Date Application Approved BY 6 .a,u .... ............... Date Ap lieati n isapprcyrcld for the following reasons:-----•----------------------•-----•--------------------•------...--------------•------------•--------.....--.... ............. ................--- . -�------------------------------------------------------------------------------------------------------------------------- Date PermitNo......................................................... Issued_....................................................... Date N0.._ .. %I Fps....... : .. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....................OF...........�1�?.< ..i.. �12��P----------.-.-------------_ ApplirFatiun for 11hipati al Works Tonatratrtiun "truth Application is hereby made for a Permit to Construct ( V or Repair- .( ) an Individual Sewage Disposal System at: ................_.......�f .1: �.. r21. :.. C'Ll .._............ 1..._........._. _............- ._.... Location-Address or Lot No. t — c. 1�`x• } Y L. ��,� .r Z �.�.. � O- Address a ........ .................. Oar`r cwrax—"` •der__: Llr f V .i�gtaller t✓ Address d Type of B ilding Size Lot............................Sq. feet U Dwelling—No. of Bedrooms.................... ......... Expansion ( )Showers g Cafeteria Attic Garbage Grinder Other—Type Te of Building No. of a � Other fixtures --------------------------------------------�-a,----------------------------------------------------------..__..�;...;.......----------........-•---• W Design Flow................. `'?.......:...........gallons per persorr,per day. Total daily flow__:_.............. ...........gallons. WSeptic Tank—Liquid"capacity l ;X,I.gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—. o:.................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------- ----------- Diameter.._............. Depth below inlet........ Total leaching area__._ °"�. ?..sq. ft. Z Other Distribution box ( ' Dosing tank ( ) Percolation Test Results Performed by._'t.�c 4»__s"... !15.......... ..:. Date....__.__. ..........................G W Test Pit No. 1..... ^^.._..minutes per inch Depth of Test Pit.......1 1--__--- Depth to ground water........:!, ......... 44 Test Pit No. 2................minutes per inch Depth of Test Pit..................•. Depth to ground water........................ W ......... •--------------------- - --••.....-----•------------------------•------------------------•---•--------------------------•-•••----------•-------•-•-- Description of Soil _. .. ...._.... ------.....-•-••----- e= -------------------------------------- --------------------------------------- , W V 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 TITi 1Z 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been .ssued `y the board of health. igned. -.- '_ rr,-- -- 1J,- ---------------•-- IDate Y Application Approved BY..... - � :..... ................ ............. App icati r v6 for thw following reasons: -'--------------------------------------•---------------...-----------------.........--_.. _...___.. ....... --- ---------------------.----------------------------------------------------------------------------------------------- i Date Permit No- ------------------------------------- --------------- Issued. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .................OF............f �� .C?:�........................ Trrfif iratr of Tomplianrr THIS IS Y, That the Individual Se ge Dispopl System constructed or Repaired ( ) by--------------------- , . F ...... .... v --•--------------------------------------------------•----------•- y ----------- Installer at............... f --------------� t 1 S--k- -------- �/{ _ =- :,s'Z t --------f� �t i S S has been installed in accordance with the provisions of TITLE j of The State Sanitary Code as described in the application for Disposal Works Construction PerrPlit li w.,,_\--- --I------------------- dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHAD:NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. j n � DATE.............................................................. �?�`? �` � Inspector....................... r THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH i ....... ..... U...................OF. y—. - �v�s >i E L............ Dispou1 Wore NOono#r ion amit J Permission is ereby granted........... •- _ .......... . to Construct ( or Repair ( ) an Individual Sevc�age Disposal System at No. t'.......L......... Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... r -------------------------------------------------------- `'��03>1 of Health DATE............... D.••....V ... FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS L O CATION ,p SEWAGE PERMIT NO• 4-6741 VILLAGE l4/9 - -�33 INSTALLER'S NAME i "ADDRESS Tool US p Aid-kiw GUILDER OR OWNER C a rvi IZ o 04 DATE PERMIT ISSUED a,�8� DATE COMPLIANCE, ISSUED / �, �Lam �� �/ ,� p��t��►.i UQ,TA. I 1 �z •`7�'j Leh t�� F LA�c/ :. 1►� � 3 � ''3?d G.P•D. -� 1��'r'tG 'r�l: = 3�ov (Sc % • ��;ra G.Pr7. � �� ti u5 - t ooc::� 1C./v 5F- )c 2.S Y �7S G.P.D. 4 A. Bc1T`rO,fA 4e t_1A= '0ilf `� TOTAL t7E{,IGN = .125 io , -ro-rA 330PE 2CC)L&T10Q VA["� t��to �LAA 0 02 Ls,,;. µ4 • ... lwL`t ��'�'►.T-!t'�""jam'~* -.�- -�, (16 1 T(>t!Jri cj �t £Cj JJ TO- 1 r%h"T IAN. C�cat. I . tNV. X � (000 u L<»Ac N WASN�D (�p 5'1-Ouf�- CJ k1 ' 5f Ao� �e/ J40 t-it.1,c�t�r.1 Gc�v1t�L��S W 1'�'E�2 T1-1;=: 51 Dr'.l_l►-�� 1�,.c�Tr /.�ti.t s,� ";E'�-l-.��C t: C:r-/.�t�1 I`'�N�c 1.1�-s o F T N� �b� �l1"C„ �11c 1~1��t- 1�• G tJ�11.._ r;ATc 1i, 1 �� _� � .�.. '('t-11�=, C7r_At,.l 1'=a t-!OT L��zC� --! /a�•J ��'rE��:�/►t-.L.C. v f���r�Si. 6i4 tit �p,� 1.!> C'.•t tJr,G�`> 1Cj l7wrcIZZMi►4C Ld'1 l_1hti:s ! _ 1.�(�.�v�,.IP'L p 1 1 ARNSTABLE \ OLD sa THIS TL E 1)RI VE roti. 1 �� �� fO'� cb EDGE OF PA VE'MENT $' —� coy N40°46'06"W 140. 00' _ r A.M. 1491130-33 Lo 4� TP LOT 1 Q� 01 LOCUS MAP AREA= '19,206. 0 S.F. / 62X 7 ASSESSORS MAP: 149 �yT p PLAN REF• 326/29 26. 9' Y� FLOODZONING: ' 12.8' 15.0' AM 148_86 ZONE. _ COMM. PANEL f LOT 2 / p 12 8' 250001 0015 C ' _ OVERLA -___�O � � � DATED.- 8/19�85 o � � Y.• "WP' AM 149/130-34 - _ 10.0' ___ Ti \ __--- __-_ - - SEPTIC UPGRADE PLAN HOUSE -- _ - OF LAND 41 O y r BRUCE s CHIM- -- -- - -- -_____-___- -TOP OF FND. 2 LOCATED A T G 6 No. 749 y 6, _ _ --EL=64.3' - / 61 �, 141 THISTLE DRIVE' S �Fcrst�aE , _—_====-60. 3' 50. 0' cn 44/rAR�P 8 1 CENTER VILLE MA. DECK / PREPARED FOR 60 1 JOHN P BARRERA 95 SEPTEMBER 18, 2002 PAUl SCALE 1" = 20' A. 6 � �(,. =? � YANKEE SURVEY CONSULTANTS r 99 5� 140.,28 UNIT 1, 40B INDUSTRY ROAD S3770' e � - P. O. BOX 265 '`°' E MARSTONS MILLS, MASS. 02648 I� N , ` TEL• 428-0055 FAX 420-5553 r J)OF -53238 DCB . S EL. =_64.3 TOP OF FOUNDATION r� 20" MIN. 10' MIN. CONCRETE COVERS 4" SCHEDULE 40 P. VC MIN. PITCH 1/8 PER FT. 2"LAYER OF 1/2" CONCRETE COVER WASHED S70NE 4' CAST IRON PIPE MUM 6 A1AX 6 MAX PnrH /4 PER FT RISER CLEAN o FLOW LINE SAND h 60.0 INVERT 1 0" ��1��J 616 MIN.1 14" —20'— �p rN 6" SUMP 6" SUMP LEVLL ° ° °° o 0 0 0 M 0 °INVERT BAFFLE E� .�0. 75" DISTRIBUTION c 7'jo.. °- EL.__61,0 BOX(EXISTING) DISTRIBUTION 4, BOX(NEW') /NVFM 1000 -GALLONS IFNVMW B0_5 6 25 59_75 INVM EXISTING SEPTIC TANK - ----- -- -- 25' X 12.B' TRENCH FORMATION �a c TO BE WATER TESTED IF MORE THAN ONE OUTLET SOIL ABSORPTION PROFILE 0 F PLACr ON 6" STONE DOUBLE WASHED STONE SYSTEM (SAS) SEWAGE DISPOSAL SYSTEM NO OBSERVED WATER TABLE (09107102) ELEV.= 49. 7 NOT TO SCALE 11. 7 ADJUSTMENT (SDW 253, ZONE C) USGS PROBABLE WATER TABLE ELEV. = 45.4 G.I.S. WATER TABLE ( WEATHER VANE POND) ELEV. = 337 OBSERVATION HOLE I ELEV.= 62. 7_ PERCOLATION RATE _!�L 2 MIN./ INCH AT 36 INCHES DEPTH HORIZ TEXTURE COLOR MOTT. OTHER 0'-4" A SANDY LOAM 10YR 7-1 4"=3' B LOAMY SAND 10 YR 5-6 '- 6' Cl FINE SAND IOYR 7-4 6'-13' C2 FINE TO MEDIUM IOYR 7-3 PERC SAND GENERAL NOTES NO WATER 1) ALL WORKMANSHIP AND MATERIALS SHALL CONFORM 70 D.E.P. TITLE 5 AND THE 70WN OF _BARNS'TABLE_-__ RULES AND SOIL TEST REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE. 2) ONE COVER ON SEPTIC TANK SHALL BE BROUGHT TO DATE OF SOIL TEST 9107102 SOIL TEST DONE BY BRUCE G. MURPHY , R S. WITHIN 6 OF FINISHED GRADE, OTHERS WITHIN 12 3) ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN DESIGN CALCULA TIONS. 10 FT. OF DRIVES OR PARKING AREAS. H-20 LOADING SHALL BE USED UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS. NUMBER OF BEDROOMS . (3 DESIGN) 4) ANY MASONARY UNITS USED TO BRING COVERS TO GRADE SHALL GARBAGE DISPOSAL . NO BE MORTERED IN PLACE. + 5) NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH INSTALL TWO (2) ACME TOTAL ESTIMATED FLOW DEEDED OR ZONING REGULATIONS. OWNER/APPLICANT IS 70 500 GALLON LEACHING CHAMBERS ( 110__GAL/BR1DAY x _3-_ BIB) 330 CAL�DAY OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. WITH FOUR FEET OF DOUBLE PROPOSED SEPTIC TANK CAPACITY 1500 CAL 6) UTILITIES SHOWN ARE APPROXIMATE ONLY, EXCA VAT10N CONTRACTOR WASHED STONE SIDES AND ENDS IS 70 CALL DIG- SAFE" AT 1-800-322-4844 AT LEAST 72 HOURS 25 X 12.8" SOIL CLASSIFICATION . . . . . . . . 1 PRIOR 719 COMMENCING WORK ON SITE. DESIGN PERCOLATION RATE . < 2 MIN.IIN. 7) CONTRACTOR IS TO VERIFY GRADES AND ELEVATIONS AS WELL AS EFFLUENT LOADING RATE . . . . • 74 GAL/DAY/S.F. SITE CONDITIONS PRIOR 70 COMMENCING WORK ON SITE. ti LEACHING CAPACITY (AREA X RATE) 347 8) PARCEL IS IN FLOOD ZONE___lC"_____. CALIDA Y 9) LOT IS SHOWN ON ASSESSORS MAP _149 AS PARCEL _130-33 RESERVE LEACHING CAPACITY . . . 347 CAL/DAY (25 X 12.8 X . 74)+(25 + 25 +12.8+12.8 X . 74 X 2) SHEET 2 OF 2 JOB NUMBER__ 53238 ______