HomeMy WebLinkAbout0068 OAK STREET (CENT./W.BARN) - Health -� - 66' Oak Street
Centerville
173 009
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No. 42101/3 ORA
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
68 Oak Street
u
Property Address
Lindsey Graham
Owner Owner's Name
information is West Barnstable Ma 02668 4-29-2021
required for every
page. City/Town State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
Important:When filling out forms A. Inspector Information S 64t
on the computer,
use only the tab Brett Hickey
key to move your Name of Inspector
cursor-do not B&B Excavation
use the return Company Name
key.
374 Route 130
Company Address
Sandwich Ma 02563
City/Town State Zip Code
fmv (508)477-0653 S113747
Telephone Number License Number
B. Certification
I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 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
I
Brett Hickey Digitally signed by Brett Hickey
'Date:2021.05.D410:43:32.04'00' 4-29-2021
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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 18
c Commonwealth of Massachusetts
6 Title 5 Official Inspection Form
to Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
68 Oak Street
Property Address
Lindsey Graham
Owner Owner's Name
information is West Barnstable Ma 02668 4-29-2021
required for every
page. City/Town 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 system was in working order 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):
15insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18
-
Commonwealth of Massachusetts
d P Title 5 Official Inspection Form
........ Y Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
68 Oak Street
Property Address
Lindsey Graham
Owner Owner's Name
information is West Barnstable Ma 02668 4-29-2021
required for every
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
2 System Conditional) Passes (cont.):
y y
❑ 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:
t5insp.cloc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18
1
Commonwealth of Massachusetts
Title 5 Official Inspection Form
( - Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
68 Oak Street
Property Address
Lindsey Graham
Owner Owner's Name
information is West Barnstable Ma 02668 4-29-2021
required for every
page. City/Town 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
El El clogged
of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ El 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 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18
TOWN OF BARNSTABLE
`LOeATION 66 ®CA16. #,1 Y, �
VILLAGE &TOrL+I Le ASSESSOR'S MAP&PARCEL
Il��'S NAME&PHONE NO." tic U®Iy411 �� �'11'79
SEPTIC TANK CAPACITY l��00 i
LEACHING FACILITY: (typpe)�n, �1�'PcA'`o S (size)
NO.OF BE(DRROOMS /OL
OWNER `�
PERMIT DATE: C I ONREEEME-DATE77,ep, il 1?.
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility(If any wells exist on
site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within
300 feet of leaching facility) Feet
FURNISHED BY
it
tJt/tftft/ - �
4 4 \ 4 \ \ 4 -
'
3 Q
Y
14
2
33
Commonwealth of Massachusetts
n - r Title 5 Official Inspection Form
Jill ...,�' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
68 Oak Street
Property Address
Lindsey Graham
Owner Owner's Name
information is West Barnstable Ma 02668 4-29-2021
required for every
page. City/Town 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
❑ El Liquid depth in cesspool is less than 6"below invert or available volume is less
than 1/day flow
❑ ❑ Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ 0 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
El El tributary to a surface water supply.
❑ O Any portion of a cesspool or privy is within a Zone 1 of a public water supply
well.
❑ El Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ 0 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.]
❑ El 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 15,000 gpd.
For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the
questions in Section 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
t5insp.doc•rev.726/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18
Commonwealth of Massachusetts
R „ - Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
68 Oak Street
Property Address
Lindsey Graham
Owner Owner's Name
information is West Barnstable Ma 02668 4-29-2021
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" m or no for each of the following for all inspections:
Yes No
0 ❑ Pumping information was provided by the owner, occupant, or Board of Health
❑ 0 Were any of the system components pumped out in the previous two weeks?
0 ❑ 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)
❑ 0 Was the facility or dwelling inspected for signs of sewage back up?
0 ❑ Was the site inspected for signs of break out?
0 ❑ Were all system components, excluding the SAS, located on site?
El ❑ 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?
❑ O 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:
El ❑ Existing information.For example, a plan at the Board of Health.
❑ El 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 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18
AN Commonwealth of Massachusetts
Iid =_- Ro Title 5 Official Inspection Form
�. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
68 Oak Street
Property Address
Lindsey Graham
Owner Owner's Name
information is west Barnstable Ma 02668 4-29-2021
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information
1. Residential Flow Conditions:
2 Number of bedrooms(design): Number of bedrooms(actual): 2
331/GPD
DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms):
Description:
3
Number of current residents:
Does residence have a garbage grinder? ❑ Yes No
Does residence have a water treatment unit? ❑ Yes al No
If yes, discharges to:
Is laundry on a separate sewage system? (Include laundry system inspection ® Yes B No
information in this report.)
Laundry system inspected? ❑ Yes 0 No
Seasonaluse? ❑ Yes CE No
Water meter readings, if available(last 2 years usage(gpd)): See below
Detail:
2020- 59,000gallons 2019- 44,000gallons
Sump pump? ❑ Yes ❑■ No
current
Last date of occupancy: 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
68 Oak Street
Property Address
Lindsey Graham
Owner Owner's Name
information is West Barnstable Ma 02668 4-29-2021
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
2. Commercial/Industrial Flow Conditions:
NA
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: Owner- last pumped 3/2021
Was system pumped as part of the inspection? ❑ Yes ❑■ No
If yes, volume pumped: gallons
How was quantity pumped determined?
Reason for pumping:
t5insp.doc-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 for Voluntary Assessments
68 Oak Street
Property Address
Lindsey Graham
Owner Owner's Name
information is required for every west Barnstable Ma 02668 4-29-2021
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
4. Type of System:
El Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no)(if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner)and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank.Attach a copy of the DEP approval.
❑ Other(describe):
Approximate age of all components, date installed (if known)and source of information:
2004 per permits
Were sewage odors detected when arriving at the site? ❑ Yes ❑■ No
5. Building Sewer(locate on site plan):
1'6"
Depth below grade: feet
Material of construction:
❑cast iron ■❑40 PVC ❑other(explain):
Distance from private water supply well or suction line: Town waterfeet
Comments (on condition of joints, venting, evidence of leakage, etc.):
t5insp.doc•rev.MUM Tile 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
68 Oak Street
Property Address
Lindsey Graham
Owner Owner's Name
information is west Barnstable Ma 02668 4-29-2021
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
6. Septic Tank(locate on site plan):
611
Depth below grade: 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
1
Dimensions: 500gallons
2"
Sludge depth:
3411
Distance from top of sludge to bottom of outlet tee or baffle
0„
Scum thickness
NS
Distance from top of scum to top of outlet tee or baffle
NS
Distance from bottom of scum to bottom of outlet tee or baffle
measured
How were dimensions determined?
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
The tank was in working order at the time of inspection. The tank is not in need of pumping
at this time but should be pumped every two years for maintenance.
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18
Commonwealth of Massachusetts
a - Title 5 Official Inspection Form
i� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
68 Oak Street
Property Address
Lindsey Graham
Owner Owner's Name
information is West Barnstable Ma 02668 4-29-2021
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
7. Grease Trap(locate on site plan):
Depth below grade: NAfeet
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: NA
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
Title 5 Official Inspection Form
`il Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
68 Oak Street
Property Address
Lindsey Graham
Owner
Owner's Name
information is west Barnstable Ma 02668 4-29-2021
required for every
page. City/Town 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):
orr
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.):
The d-box was in working order at the time of inspection.
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 12 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
i� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
�/� 68 Oak Street
Property Address
Lindsey Graham
Owner Owner's Name
information is West Barnstable Ma 02668 4-29-2021
required for every
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.):
NA
* 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:
(5) infiltrators
El leaching fields number, dimensions:
❑ overflow cesspool number: 37'x10xl'
❑ innovative/alternative system
Type/name of technology:
l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18
Commonwealth of Massachusetts
-- Title 5 Official Inspection Form-
...... . ..
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
68 Oak Street
Property Address
Lindsey Graham
Owner Owner's Name
information is West Barnstable Ma 02668 4-29-2021
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.):
The SAS was in working order at the time of inspection. Leaching was dry when viewed.
12. Cesspools(cesspool must be pumped as part of inspection) (locate on site plan):
NA
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.doc•rev.7262018 Title 5 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
68 Oak Street
Property Address
Lindsey Graham
Owner Owner's Name
information is West Barnstable Ma 02668 4-29-2021
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: NA
Dimensions
Depth of solids
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5insp.doc•rev.7/28/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18
c Commonwealth of Massachusetts
F p Title 5 Official Inspection Form
�o
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
68 Oak Street
Property Address
Lindsey Graham
Owner Owner's Name
information is West Barnstable Ma 02668 4-29-2021
required for every
St
page. City/Town ate 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
TOWN OF BA RNS`I',AD E
LOCA-nail. C? ;- s1 vvAcps
s>rssotz•s lusa�Bt.L(Yr t2 cam►4
INSTALLER`S NAME -PH0. 1VOµ�
SBFTYC TANK CA P^!Q 'r1C
LBA+CHING3 FAC70.IT5'; ( r AM
NO:OF 138DItOOMS _` '
SLIER Olt OWNER:
FBRM=DAT$: . "-�'--.4�-y C0MPL.AN4ts z)A-M_ D -
Segasatio>a Distimncas Between the>
blaximuEa Adjusted Qro4ndwates Tableland Bottotu of Lcnching,Facil ty. : __Esesst`
Fsivaw wate—supply WiWvwd Lilsachins Facility (rf ar►y walls,aatist
F�imet
oo.sfoe:or wiitbisa 2,00 feet of.teachiag" iuty0. __ _...._....
Edge pir Wetland anal tAmching Facility(If any wetlands>exist;
a ithlw;soo r+eef"of leaching facility) Feet_
Pitriti9shee3by"
a- At'
610
0
e.
"
t5insp.doc-rev.7262018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18
f
Commonwealth of Massachusetts
qA Title 5 Official Inspection Form
- — Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
68 Oak Street
Property Address
Lindsey Graham
Owner Owner's Name
information is West Barnstable Ma 02668 4-29-2021
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
15. Site Exam:
Check Slope
Surface water
❑■ Check cellar
❑■ Shallow wells
Estimated depth to high ground water: No GW @ 132"
feet
Please indicate all methods used to determine the high ground water elevation:
0 Obtained from system design plans on record
If checked, date of design plan 7-5-2004 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:
A plan on file at the local Board of Health was used to determine high groundwater.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5insp.doc•rev.7262018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
(" le Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
68 Oak Street
Property Address
Lindsey Graham
Owner Owner's Name
information is West Barnstable Ma 02668 4-29-2021
required for every
page. City/Town 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.7/260018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18
Commonwealth of Massachusetts
4
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
68 Oak Street
Property Address
Ryan Graham
Owner Owner's Name
information is required for Centerville MA 02632 September 11, 2012
every page. City/Town State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
Important:When filling out A. General Information
s
forms on the
computer,use 1. Inspector:
only the tab key
to move your Patrick M. O'Connell
cursor-do not Name of Inspector
use the return
key. Septic Inspection Services Co.
Company Name
18189 Cammett Road
Company Address
Marstons Mills MA 02648
City/Town State Zip Code
508-428-1779 S1 12855
Telephone Number License Number
B. Certification
I certify that I have personally inspected the sewage disposal system at this address and that the
information reported below is true, accurate and complete as of the time of the inspection. The inspection
was performed based on my training and experience in the proper function and maintenance of on site
sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of
` Title 5 (310 CMR 15.000). The system: 771 _ ') —i
01,
< 1
® Passes -❑ Conditionally Passes ❑ Fails i C—
❑ Needs Further Evaluation by the Local Approving Authority
September 11, 2012 Job# 12-1°38 a
I pector's gnature Date t c`
The system inspector shall submit a copy of this inspection report to the Approving Authority (Board
of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or
has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the
report to the appropriate regional office of the DEP. The original.should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
****This report only describes conditions at the time of inspection and under the conditions of use
at that time. This inspection does not address'how the system will perform in the future under
the same or different conditions of use.
l5ins•11110 WOffi.alection Form.Subsurface Sewage Disposal System•Page 1 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
�M 68 Oak Street
Property Address
Ryan Graham
Owner Owner's Name
information is Centerville MA 02632 September 11, 2012
required for
every page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E/always complete all of Section D
A) System Passes:
® I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
Tank was not in ned of pumping at time of inspection leaching system showed no signs of saturation
B) System Conditionally Passes:
❑ One or more system components as described in the"Conditional Pass" section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
Check the box for"yes", "no"or"not'determined" (Y, N, ND) for the following statements. If"not
determined," please explain.
The septic tank is metal and over 20 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):
t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
68 Oak Street
Property Address
Ryan Graham
Owner Owner's Name
information is p
required for Centerville MA 02632 September 11, 2012
every page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
B) System Conditionally Passes (cont.):
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
C) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
t5ins•11110 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 3 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
w� 68 Oak Street
Property Address
Ryan Graham _
Owner Owner's Name
information is Centerville MA 02632 September 11, 2012
required for ------ -
every page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
2. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well**.
Method used to determine distance.-
This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal
coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must
be attached to this form.
3. Other:
D) System Failure Criteria Applicable to All Systems:
You must indicate "Yes" or "No" to each of the following for all inspections:
Yes No
❑ ® Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less
than_day flow
t5ins-11110 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 4 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
i; Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
68 Oak Street
Property Address
Ryan Graham
Owner Owners Name
information is
required for Centerville MA 02632 September 11, 2012
every page. Cltyrrown State Zip Code
Date of Inspection
B. Certification (cont.)
Yes No
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply
well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory, for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered. A copy of the analysis
and chain of custody must be attached to this form.]
❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd.
❑ ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection
Area—IWPA) or a mapped Zone II of a public water supply well
If you have answered "yes" to any question in Section E the system is considered a significant threat,
or answered "yes" in Section D above the large system has failed. The owner or operator of any large
system considered a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15.304. The system owner should contact the appropriate
regional office of the Department.
t5ins-11/10 Title 5 Official Inspection form.Subsurface Sewage Disposal System•Page 5 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
68 Oak Street
Property Address
Ryan Graham
Owner Owner's Name
information is required for CentervilleP
MA 02632 September 11, 2012
every page. CityrTown State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate"yes" or"no" as to each of the following:
Yes No
® ❑ Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
® ❑ Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑ Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
® ❑ Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS) on the site has
been determined based on:
® ❑ Existing information. For example, a plan at the Board of Health.
® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5))
D. System Information
Residential Flow Conditions:
Number of bedrooms (design): 2 Number of bedrooms (actual): 2
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 220
t5ins-11/10 Title 5 Official Inspection Form Subsurface Sewage Disposal System-Page 6 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
68 Oak Street
Property Address
Ryan Graham
Owner Owner's Name
information is,required for Centerville MA 02632 September 11, 2012
every page. City/Town State Zip Code Date of Inspection
D. System Information
Description:
Number of current residents: 2
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system? [if yes separate inspection required) ❑ Yes ® No
Laundry system inspected? ❑ Yes ❑ No
Seasonaluse? ❑ Yes ® No
Water meter readings, if available (last 2 years usage (gpd)):
Detail:
f
Sump pump? ❑ Yes ® No
Last date of occupancy: CurrentlyOccupied.
Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow (based on 310 CMR 15.203): Gallons per day(gpd)
Basis of design flow (seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
15ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17
i
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
68 Oak Street
Property Address
Ryan Graham
Owner Owner's Name
information is p required for Centerville MA 02632 September 11, 2012
_.
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Last date of occupancy/use: Date
Other(describe below):
General Information
Pumping Records:
Source of information:
Tank pumped one month prior to inspection.
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped: gallons
How was quantity pumped determined?
Reason for pumping:
Type of System: t
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract (to be obtained from system owner) and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other (describe):
15ins-11/10 Title 5 Official Inspection Form.Subsurface Sewage Disposal System-Page 8 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
68 Oak Street
Property Address
Ryan Graham
Owner Owner's Name
information is p
required for Centerville MA 02632 September 11, 2012
every page. City/Town State Zip Code .Date of Inspection
D. System Information (cont.) '
Approximate age of all components, date installed (if known) and source of information:
2004
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
Depth below grade: 1
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.):
Septic Tank (locate on site plan):
� pn I
Depth below grade: 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: 10.5' long x 5.8'wide- 1500 gal.
Sludge depth:
0"
f5ins•11l10 Title 5 Official Inspection Form,Subsurface Sewage Disposal System•Page 9 0l 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
ww 68 Oak Street
Property Address
Ryan Graham
Owner Owner's Name
information is p
required for Centerville MA 02632 September 11, 2012
- _ -
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Septic Tank (cont.)
Distance from top of sludge to bottom of outlet tee or baffle
Scum thickness 0
11
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
How were dimensions determined? Measured
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 had liquid only no solids. Liquid level was at bottom of outlet invert and tees were intact.
Grease Trap (locate on site plan):
Depth below grade: feet
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: Date
t5ins-11/10 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 10 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
68 Oak Street
Property Address
Ryan Graham
Owner Owner's Name
information is Centerville MA 02632 September 11, 2012
required for p
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Capacity:
gallons
Design Flow: gallons per day
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments (condition of alarm and float switches, etc.):
Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No
15ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
68 Oak Street
Property Address
Ryan Graham
Owner Owner's Name
information is Centerville MA 02632 September 11, 2012
required for P
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Distribution Box (if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert 0
1.
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.):
No solids or high stains present. Liquid level was at bottom of outlet pipes.
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.):
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
t5ins•111110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17
i
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
68 Oak Street
Property Address
Ryan Graham
Owner Owners Name
information is Centerville required for _MA 02632 September 11, 2012
every page. Citylrown State Zip Code Date of Inspection
D. System Information (cont.)
Type:
❑ leaching pits number:
® leaching chambers number:
Infiltrators
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
Stone and soils surrounding SAS were probed with no evidence of saturation found.
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
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
68 Oak Street
Property Address
Ryan Graham
Owner Owner's Name
information is Centerville MA 02632 September 11, 2012
required for p
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
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.):
I
v
15ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
68 Oak Street
--- __.. -------
Property Address �Owner -
Ryan Graham
—— --- ---- — --..._.._.__._...---.-........_.__.._....__.—_.. ............... ---Owner's Name
information is Centerville
required for _.....-._._.._...__....___.._..._.._._._........._.-__ ...... ........_-.........._.__. MA 02632 September 11, 2012
St
every page. ity/Town
State Zip Code Date of Inspection
D. System Information (Cont.)
Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to
at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate
where public water supply enters the building. Check one of the boxes below:
® hand-sketch in the area below
❑ drawing attached separately
30
14
2 33
..... ..............
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
w 68 Oak Street _
Property Address
Ryan Graham _
Owner Owner's Name
information is Centerville MA 02632 September 11, 2012
required for P
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
® Check Slope
® Surface water
® Check cellar
® Shallow wells
Estimated depth to high ground water: 10,
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:
Pond on opposite side of road is lower than SAS.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
68 Oak Street
Property Address
Ryan Graham
Owner Owner's Name
information is P
required for Centerville MA 02632 September 11, 2012
every page. Cityrrown State Zip Code Date of Inspection
E. Report Completeness Checklist
® Inspection Summary: A, B, C, D, or E checked
® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed
® System Information— Estimated depth to high groundwater
® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17
_ f
No. Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
Zipprication for Mtgozal *pgtem Con6tructton Verntit
Application for a Permit to Construct( )Repair )Upgrade( )Abandon( ) omplete System ❑Individual Components
Location Address or Lot No. C' Q�)k ST Owner's`Name,Address and Tel.No.
Assessor's Map/Parcel
Installer's Name,Address,and Tel.No. ���P S3 10 Designer's Name,Address and Tel.No.
'�,)b,�s C �;cnoiG2_ -5+vAq
Type of Building:
Dwelling No.of Bedrooms Lot Size B 00sq. ft. Garbage Grit3der( N�
Other Type of Building Mom No.of Persons I Showers( ) Cafeteria(IX
Other Fixtures 1_CcIJ
Design Flow �7 gallons per day. Calculated daily flow o gallons.
Plan Date N�®�, Number of sheets � Revision Date
Title N V P
Size of Septic Tank Ne ( .`no c�n k Type of S. .S. O x S
Description of Soils ��C1
Nature of Repairs or Alterations(Answer when applicable) n 4q,_ ^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 rron ntal Code and not to place the system in operation until a Certifi-
cate of Compliance has y thi o of Heal
" "
Signe Z Date -
Application Approved by Date
Application Disapproved for the following reason
Permit No. Date Issued
———————————--——————— I
3
No. ,✓� Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS
3pprication for Migool *pgtem Construction Permit
Application for a Permit to Construct( )Repair,Upgrade( )Abandon( ) Complete System ❑Individual Components
Location Address or Lot No. Ow is Name,Address and el.No.
0— 'ry e.J 1 LL E,M R qe sec)
Assessor's Map/Parcel 1—�r ^�J l pO g 5-A M e
Installer's Nam. ddress,and Tel.No. _ (V Desi ne's Name ddress and Tel.No. 2 (��
�_d�C�cS Sgt��lk �nutcn�manlF�\
s -TT-Q,0Aa--) S*. Y44 oj+ met p4 Va m o u-w, MA o a s3.
Type of Building:
Dwelling No.of Bedrooms a Lot Size sq.ft. Garbage Grip•er
Other Type of Building One No.of Persons " Showers( ` ) Cafeteria( 1/�
Other Fixtures
Design Flow -Jd gallons per day. Calculated daily flow3 ' gallons.
Plan Date Number f sheets Revision Date
Title � osr fiC S�RM �r i
Size of Septic Tank 5100 qG Type of S.A.S. O X .,25 - S S^t Iywk 1-0 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 E virf`'ro mental Code and not to place the system in operation until a Certifi-
cate of Compliance has been iissued'by thi oar of eMO.
f Signed . 1 1 _ h m Y2(-- Date
Application Approved by a ^� ��/ Date
Application Disapproved for the following reason
k Permit No. V Date Issued .12
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of (Compliance
THIS IS TO CER Y, aLth• site Se_a, Di al System Constructed ( ) Repaired ( ) Upgraded( )
Abandoned( )by C) . �—
t at �l°���� E P4 V N13 constructed i�.'arc•ordance
with the pro,isions-o Title 5`nndd the for Disposal System Construction Permits No, �dated 7
16( " 7
Installer .V �j Designer
The issuanc_of Aiiiis lermit shall not be construed as a guarantee that the sy' tem willf- ction as
Date /t "! ! ' Inspector
r
4
No.. � � Fee itz)
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
DiOpo5ar *p5tem Con.5truction Permit
Permission is hereby granted to Construct( )Re�pair /grade( )Abandon( )
System located at CJ r tT _
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: Constdc iot
t e completed within three years of the date of this '�.
Date: Approved b 7
_._ �� PP Y
TOWN OF BARNSTABLE
LOCATION 10( ®�-K��V�� SEWAGE #��� 331-(
VILLAGE t�G ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO��
SEPTIC TANK CAPACITY
EACHING FACILITY: (type) 'H CCA .-rW 4gff(size)
NO.OF BEDROOMS �—
BUILDER OR OWNER
PERMITDATE: —COMPLIANCE DATE: �7
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
�p�c r�c�ss
s
ar
a6
�'cC�
TOWN OF BA.RNSTABLE
LOCATION --- SEWAGE *
VILLAGE � r� ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY
• LEACHING FACILITY: (type) b�fG (size) 2, 2exAD'Kl
NO.OF BEDROOMS,
BUILDER OR OWNER
PERMTT DATE: `G_U q COMPLIANCE DATE: d
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
U
0
�r Zhu
�3t
a�
3 f '
Town of Barnstable
°Ft1HE rp Regulatory Services
Thomas F. Geiler, Director
* BAMSrna[.e.
MASS. Public Health Division
1639. 1% Thomas McKean, Director
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Installer& Designer Certification Form
Date: 7/9/04
Designer: Shay Environmental Services Installer: Roberts Septic Service
Address: 34 Thatchers Lane Address: 5 Trenton Street
East Falmouth, MA 02536 Yarmouth, MA�
On 7/6/04 Roberts Septic Service was issued a permit to install a
(date) (installer)
septic system at 68 Oak Street, Centerville based on a design drawn by
(address)
Shay Environmental Services dated 7/5/04
(designer)
X X I certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank.
I certify that the septic system referenced above was installed with major changes (i.e.
greater than 10' lateral relocation of the SAS or any vertical relocation of any component
of the septic system) but in accordance with State & Local Regulations. Plan revision or
certified as-built by designer to follow.
(Installer's Signature)
Ea
No. 1181
�—`Ll 9FQ 1 ST E� '
(Designer's Signature) (Affix Di ere)
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION: CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-
BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.
THANK YOU. ,
Q:Health/Septic/Designer Certification Form
r
0 CATION S E W A G E PERMIT, NO.
o
VILLAGE
caz �".1U-
INSTALLER'S NAME i ADDRESS
ac
r!
4 U I L D E R 0 OWNER
DATE PERMIT ISSUED
DAT E COMPLI-ANCE ISSUED
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c„r �\ /�
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(ASSESSORS MAP NO: _l
PARCEL NO.:
No. .. Fps.. .
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF. HET
.....OF.......
. .. .. r :.:.L� .....-...
Applira#ion for Dispoiial Works Tonar) an
' n rrutit
Application is ereb ade for a Permit to Construct or Repair Individual 'ewapp y ( ) p ( Sewage Disposal
syt:stem
-•- ....... •-••• -• ___-____-•o..-_--••••-__----•__ --_--•-_--•----•-•-•.....................
VLocati ` /T —` or Lot No.
Address
aW ------------- - .-------••-•-. .......................................................................................................-••-_--_-_----•_•........................•-------•-•---------•--•---•--_-----••-•...----•__--
Installer Address
� Type of Building ,Size Lot____________________............................Sq. feet
U Dwelling o. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
Other—Type e of Building
� yp g ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
d Other fixtures
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity............gallons Length................ Width....._.......... Diameter.....-.......... Depth................
x Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area___-._______________sq. ft.
Seepage Pit No----------_--------- Diameter.............-...... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by_________________________•____••-----••-------•---------------•---..__._._ Date........................................
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
rT, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
_----- -----•- -- --------------- --------•----------------------------------------------------------
x Description of Soil________________________ ____
U ------------------------------------------•-•--_-------•---•----------•-•---------•------...... --•--•-------------•---_-_---------•-----•-------••------------------------------------------_-_...__._
--------------------------------------------------------------------------------------•--------------------------------- -----
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 i!I I.I;
p 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has be issued by bo d of h th.
. --_- •.... . .X_. _- --•- , ��-._.
D to
Application Approved By............
.
----- --------•----.....••-
Date
Application Disapproved for the following reasons---------------------•----------------------------------•----•-•-------------------------------.................
.......................................--•-------•--•-------•--_---------...-•---_....--_----_...__---_•---•-----_----__--------•-_•--•_-_-----_-------_-----------------------=-----•--------...•-•___
Permit No.._.__- Date
D•.... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEAL
......OF...... .........................
Appliration for Dhipwial Workii Tinuitrurtion Prrutit
Application is hereby Made for a Permit to Construct or Repair an Individual Sewage Disposal
SS,'t t
y
_N cat .... .... ........ . ..................................................................................................
'or Lot"No.
......................... ........... ....................................................................................
Address
.............................................................
/y
....7ZV5 ............... ------------------------ ss
Address
CA
Type of Size Buildin Lot............................Sq. feet
Dw No. of Bedrooms............................................Expansion Attic Garbage Grinder ( )
U ellin g!2
P-4 Other—Type of Building ............................ No. of persons.._..__._.__.........__.____ Showers Cafeteria ( )
04 ..Other fixtures .................................. ..................................................................................................................
< - ;
W .Design Flow............................................gallons per.person per day. Total daily flow.................1
..........................gallons.
04 Septic Tank—Liquid capacity............gallons Length................ Width....__.._._____. Diameter-_-__-_----_'',,. Depth_._.._...._.._..
Disposal Trench—.\To..................... Width.................... Total Length.................... Total leaching are,,a....................sq. ft.
Seepage Pit No--_---------------- Diameter___.._...___.__..... Depth below inlet..............._._.. Total leaching area..................sq. f t.
Z Other Distribution box Dosing tank
Percolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. I----------------minutesperinch Depth of Test Pit.............._..__. Depth to ground water..__................._..
Test Pit No. 2..::............minutes per inch Depth of Test Pit..._............_._. Depth to ground water-._________.___-----___.
.........................................
0 Description of Soil.................. .................................................................................................................
W .:Z:� ---------------
U ......................................................................................................................................................................................................
----------------------------- ........ ----------------------------------------------------------------------------
---------------------7.....
U Nature of Repairs or Alterations—Answer when applicable........_... ... ....
........................................................................................................................................................................................................
Agreement:
The undersigned agrees to install the aio-zedescribed Individual Sewage Disposal System in accordance with
the provisions of'7TTLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has be" issued by Ahe bo'drd f 11 Ith.
-1' 11 11 0 . �ld, OV
............. ....... // ..... . .................. . ........... ..... ...............eeb
ApplicationApproved By................. ......I ..... ...... . ....... ........................ .........................................
Date
Application Disapproved for the following reasons:..............................................................................................................
........................................................................................................................................................................................................
Datz
PermitNo----------------------- —-------------------- Issued--------------------------------------------------------
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD 0 HEAL
.... ... ........... .................................................OF........zl=�
.............*...... ......
I I Y T at the Individual Sewage Disposal System constructed or Repaired 4-},�
bj -- ...
..... ... ...........e......
----------------------------------------------------------------------
6 Ins all
A-- ---- .
at- ................................................................................ --- --------- -------------
---- ----- ------- ------- ----------- ...has been instilled in accordance with the provisions of TITIE.....5-ot'.-The-.St-ate-.S.a-nitar-y--�o�9 escli-l'),ed in the
No- .....& ------- - - ------- ...........
I I dated- ----71 application for Disposal Works Construction Permit
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT YHE
SYSTEM WILL 7CION SATSFACTORY.DATE.................. ............................... Inspecton... ........ ...--------------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD F HEA
..................OF, .......................
FEEO.............
.
Permission is hereby gr ed .............................. .......... ......... . ..A_ .......................................................
to Cons7uc victual wdu I
a i o al
atNo.p.. .......... ... .......................... ....... ..... .......... .........................................................................
Street '26 111 1 CrJ�G
as shown-o the application for Disposal Works Construction Permit .......... Dated.1------ .........................
............
�1� - ..... .........................
........................... -5;
Board of Health
-1till ATE. .......... ... . ... ..... ........... .............
'y FORM—1259 I- BB A IEN INC., PUBLISHERS
SECTION A -A 0 RAND WtXAM' f
NOTE: ALL PIPES ARE TO BE 4" SCHEDULE 40 P.V.C. ALL OUTLET PIPES FROM THE
*
10' min. from VENT PIPE ® Least 24 inches tale PROFILE VIEW OF ADDITION TO LEACHING SYSTEM IBSTROUTM Box SHALL BE
Existing Foundation house to septic tank Schedule 4 PVC w Charcoal Odor Filler 3!
Septic tank covers Rust be i SET LEVEL FOR AT LEAST 2 FT. 12- CONCRETE COVER I
TOP OF FOUNDATION = ELEV. 100.00 (Assumed) 3" of 1/8" - 1/2' Washed Peaston =
t within 6 M. of finished grade ..,�_-.- -��; - w
^- Orode over Septic Tank - 98.00 Grade over D-Box- 98.00 de over SAS.- 98.00 3/4" to 1 1/2 Washed Crushed Stone \ 3 _ 5•OUn,E7 'a*-� •-..c-,, 2 �I
KNOCKOUTS
a
S " 0.02 - &5' ., e I a Ito
3 HOLE H-10 OUTLET
,2' MJLET
DIST. BOX 3' Maximum Cover Top Lood - Elev. -95.25 i \ ° r
,s 14 NEW / _ ' El�tn ttaehla a"
S=O.ot or Greater
25' 4" - SCH. 40 Te
10"Effective Depth 1. 1.75" �� ��,x,ncY:
EXIST, P X N 1,500 GAL S- 0.a1' er foot 1 w' Ra,.-
fRON EXIST. FtxxtnATTON ! w r6 SEPTIC TANK
/J 9 °' ,,,,,,,, m in r2OP
o s uL=�
it a 6,zs' = ao' PLAN SECTION CROSS=SECTIONCONCRETE FU1 fOUNDAl1 ' II H-10 t\ ,y 0.83' (10 inches) 3' 1,25' 3' gLnOIdBap Tarovo t+
SYSTEM PROFILE 6 µ,.of 3/4--1 1/2• -6 v II n 37.25' 3 HOLE H-10 DISTRIBUTION BOX
compacted stone
Not to Scale c o ° . a Effective Length NOT TO SCALE 5�n
' J ew La� N 29aa P.aM!kM•y9Cm.eany®Z�+Navipuan tt � N"k'Mn p r
c a 4' 4' SOIL ABSORPTION SYSTEM (SAS)
_ t 2 5•
6 in.of 3/4'-1 1/2" 10 INFILTATROR HIGH CAPACITY (H-20 LOADING)/ GEORGE ❑'BRIEN GENERAL NOTES
compacted .tons Effective vkttn OR EQUIVALENT Not to Scale
NOTE: ALL COMPONENTS MUST HAVE RISERS TO WITHIN 6" BELOW GRADE o Bottom of rest Hole 1 Elev.=87.00 m ( } 1. Contractor is responsible for Digsafe notification
No Groundwater observed o_ 132' NOTE: OVERALL HEIGHT OF INFILTRATOR IS 18' /EFFECTIVE HEIGHT IS 10" and protection of all underground utilities and pipes.
- - ` - 2. The septic tank anl, distri ution box shall be set
level on 6" of 3/4'-1 1/2" stone.
3. Backfill should be clean sand or gravel with no
stones over 3" in size.
4. This system is subject to inspection during installation
by Carmen E. Shay - Environmental Services, Inc.
5. The contractor shall install this system in accordance
PERCOLATION TEST �o with Title V of the Massachusetts state code, the approved plan
A 66.00' and Local Regulations.
/� 6. If, during installation the contractor encounters any
Date e Percolation Test: E. 5, Y, R. i soil conditions or site conditions that are different
Test Performed By. CARMEN E. SHAY, R.S., C.S-E. \ i from those shown on the soil log or in our design
Results Witnessed By. WAIVER ( per Barnstable B.O.H.) I; installation must halt & immediate notification be
SHAY ENVIRONMENTAL SERVICES, INC. / made to Carmen E. Shay - Environmental Services, Inc.
Percolation Rate: less Than 2 MPI ® 36" ��� � i Y
7. No vehicle or heavy machinery shall drive over the
r. septic system unless noted as H-20 septic components.
{ 8. Install Tuf-rite gas baffles or equals on all outlet tee ends.
9. All Distribution Lines shall be 4" diameter Schedule 40 NSF PVC pipes.
Test Hole 10. All solid piping, tees & fittings shall be 4" diameter
No. 1
Schedule 40 NSF PVC pipes with water tight joints.
DEPTH SOiLS ELEV. 11. Municipal Water is Connected to ALL OF The Residence and Abutting
/
0 9&00 �� /' ,' 1 Properties Within 150 Feet.
Sandy
Loom
10 Y 3/2 ' / %' THE PROPERTY LINES ARE APPROXIMATE AND
0"-12" A 97.00
COMPILED FROM THE DEED DESCRIPTION AND ASSESSORS INFORMATION.
Sandy N/F HELEN HAZELTON ,�
/ DEED DESCRIPTION ( BOOK 2791 PG 131)
to g� �0p 16,500 Square Feet +/ // 00 IT SHOULD BE USED FOR NO PURPOSE OTHER THAN
B. ------ -''�� i THE SEPTIC SYSTEM INSTALLATION.
Sand Q' t / /
I 7-5 Y 7/6 0 20 40 50 EXISTING LEACH PIT TO BE PUMPED .OUT AND
36"-132" G 87.00 \�� ' �i REMOVED TO FACILITATE NEW SEPTIC SYSTEM INSTALLATION
NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE
i FROM THE EXISTING LEACH PIT TO BE DISPOSED
SCALE: 1 =20 -
Failed 4" PVC �` =-
-- �., � �____ - ---- ._____--- _ OF-AS-PER-BOARD-O�HEAETH-SPECIFICATIONS.
Exist. Cesspool VENT NO WETLANDS ARE PRESENT WITHIN 200' OF THE PROPERTY
7.25 / �i /' ASSESSORS MAP 173, PARCEL 009
Desiun Colculations LEGEND
�, ,z • . .r•r • ti, �:�• , , / Number]of Bedrooms: 2 Equivalent to 220 Gal./Day (330 Gal./Day Min. per Title V)
Perc #1 ,� =�'', ,t ' ,/ / cti Garbage' Grinder: N6
Depth to Perc: 38" to 56" �� �� 10 Q, , Vt Leaching Capacity Proposed: 330 Gal./Day Minimum (Min. Per Title V) DENOTES PROPOSED
Perc Rote= Less Tho 2 MPI
- D-Bow , Septic Tank -.2 x 330 Gal./Day = 660 USE NEW 1,500 GAL. Septic Tank. 104X 1 SPOT GRADE
Groundwater Not Observed ��\ ��' // SOiL ABSORPTION AREA: Using percolation rate of <2 min./inch
No Observed ESHWT `-- TEST HOLE #1 �� Bottom Area: 0.74 gal/sq. ft. x 370 sq. ft. = 273.8 gallons DENOTES EXISTING
ADJUSTED H2O Elev. __ None ELEV.= 98.00 ,' �/ Sidevu all Area: 0.74 gal./sq. ft. x 78 sq, ft. = 58 gallons X 104.46 SPOT GRADE
Providing: = 331.80 gallons
/ PROPERTY LINE
2 Use: (5) INFILTRATOR HIGH CAPACITY H-20 UNITS, HAVING A 0.83' (10 INCHES} EFFECTIVE DEPTH, PL
TO BE USED WITH 4.0' OF WASHED STONE ON THE SIDES, AND 3.5' OF WASHED STONE 96P PROPOSED CONTOUR
ON THE.`,ENDS. NO STONE UNDER.
/ / I
O - - - - - -97 EXISTING CONTOUR
O
I
10" O / ,' 3-24. OnM. ACCESS MANHOLES DEEP TEST HOLE &
PROJECT BENCH MARK NEW 1500 gol / �i ,c36 ,o -e• PERCOLATION TEST LOCATION
TOP OF FOUNDATION EXISTING septic Tank
ELEV. = 100.00 Assumed 6 FOOT STOCKADE FENCE
2 BEDROOM
HOUSE
' INLET 1
#68 / 1
INLETOUT ET
r THE ACCESS COVERS FOR THE SEPTIC TANK. P LOT P LAN
DISTRIBUTION BOX AND LEACHING COMPONENT
`TF T �DP ~- CONCRETE OF PROPOSED SEPTIC SYSTEM UPGRADE
SHALL BE RAISED TO WITHIN 6" OF
�� I j � STEED REINFORCED PRECAST CONCRETE FINISHED GRADE.
96~'' INSTALL TUF-TITS GAS BAFFLES OR EQUALS
PLAN VIEW ON ALL ounEr TEE ENDS PREPARED FOR
J , ; �3_24"REMOVABLE COVERS-\ M S . H E L E N H A Z E LT O N
4'
AT
:..�^3'min r •"Erclearance - - :e
/ ,- , ' • • , / INLET 8 mMT-Jr2' min. kd•t to outlet e.T, ,�Fa OUTLET #68 OAK STREET
CENTERVILLE, MA
r E g 4'-0'min.
6 6.0 0 - / s a-s... Liquid depth
PREPARED BY:
e
-
WARffEY '. ,OSHA Y
//ASPHALT f// ���+�--.,�� 11 to'-o'
/ DRIVEWAY, _ 4 CROSS SECTION END-SECTION N
,' /1 I -` --------- 9 VIRONMENTAL SERVICES, INC.
- ------- - \ �'t
-� _ f r, ' P.O. BOX 627
94------ , TYPICAL 1500 GALLON SEPTIC TANK �Qf EAST FALMOUTH, MA 02536
NOT TO SCALE �M ?AKtP� :TEL/FAX 508
(60 FOOT RIGHT OF WAY) -548-0796
OAK S" TREE 7- H-10 LOADING
SCALE: 1"=20' DRAWN BY: CES DATE: JULY 5, 2004
'
_ I
PROJECT#SD597 FILENAME: SD597PP.DWG SHEET 1 OF 1
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