HomeMy WebLinkAbout0288 ARROWHEAD DRIVE - Health 288 Arrowhead Drive
Hyannis P
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LOCATION 299 .�ZOf!/ Pli� U` SEWAGE # aU0�7 C)IU
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VILLAGE &4 AM t 6 ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO. It o vt"S EX C gyO.-L,�, 502-4(77 D!7 7
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) 6-�4F,JJ-a- g C 5 " (size) dl.l( 10 u
NO.OF BEDROOMS
BUILDER OR OWNER r , wooed ill ,
PERMITDATE: 31 o D COMPLIANCE DATE:-3 U
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility I oo Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) R Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
c�
w
a s
_ d �
- , V
f%'
N•2 Felts
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
es
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
2pplication for Migoo pztem Construction Permit
Application for a Permit to Construct( . )Repair( , pgrade( Ibandon( ) O Complete System O Individual Components
Location Address or Lot No. y My�� e P2 Owner's Name,Address and Tel.No
Assessor's Map/Parcel
a1l._�
')U — 1 o`Z /J Il s�uu i l E�/a
Installer's Name,Address,and Tel.No. Z O p I S jr CAUl j 1 Designer's Name,Address and Tel.No.
�U go l i(�'� j'►/is S 1i n r"A t-S-e/L �i��w- ,ekir C
Type of Building:
Dwelling No.of Bedrooms Ll Lot Size sq.ft. Garbage Grinder( )
Other 'I�pe of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) 1 ti r�-ia
i
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued by this oaqf-ol)Health.
S'gned �� C Date
Application Approved Date 3 /O O
Application Disapproved for the following reasons
Permit No. Date Issued 3 ho To .
s J� Fe.e
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ¢/
es
PUBLIC HEALTH DIVISION -TOWN OF BARN STABLE, MASSACHUSETTS
ZIppfication for Mfgpoga �pgtem Construction Permit
Application for a Permit to Construct( . j Repair($XUpgrade( 1�4bandon( ) ❑Complete System ' ❑Individual Components
Location Address or Lot No. g (allllOW h e A p2 _Owner's Name,Address and Tel.No
- Assessor's Map/Parcel ^S -�V _ � t../ h
CT 1 /� IIu�UU -P/1
Installer's Name,Address,and Tel.No. o S _1C CA t'14�` Designer's Name,Address and Tel.No.
A S h n-« /'rrlt SC je e -�-S_eft C�HS/w- ,e%ir
G 7D- GY S 02 3 r (�hlepJ �L'J with
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder
Other 'Type of Building No.of Persons Showers( ) Cafeteria( ) I
Other Fixtures «'
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
S
Nature of Repairs or Alterations(Answer when applicable) T ,r is r* I U 6 G 4 AA�<
- f
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued by this oard oftHealth.
Signed Date
Application Approved 8Y _ Date 3 / �G
o Application Disapproved for the following reasons .
Permit No. 7) C�0 `1 _ G 9 a Date Issued -_3 U �/
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded(*.'
Abandoned( )by
atA h A o c.j AW has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No.2 u n tj-U r1 U dated4i 1 ,,�
Installer Designer
The issuance of s permit shall not be construed as a guarantee that the s t wilfunction d signed C
Date linlo Inspector
t .
----- •------
No. ------ -
�C) q.�G 6 Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS
li5pooal *p5tem Congtruction Permit
Permission is hereby granted to Construct( )Repair( )nUpgrade A
AbandonSystem located at 456 � r-.^Ci LA.) � a� mot' a nn 1
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 dat -of-this`peZEDate: kO1
Approved b
TOWN OF BARNSTABLE � _ U
LOCATION SEWAGE #
VII,LAGE YdYu�l�5 ASSESSOR'S MAP & LOT a70- q
jP
INSTALLER'S NA &PH
ME ONE NO. —ovt5 1^XCce�ra
' SEPTIC TANK CAPACITY 15O o
LEACHING FACILITY: (type) �- �0` s 5 (size) �8 Ll X O u
NO.OF BEDROOMS /
BUILDER OR OWNER � Lclo obi'✓
PERMITDATE: a D COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility !oo Feet
Private Water Supply Well and Leaching Facility (If any wells exist Feet
on site or within 200 feet of leaching facility)
Edge of Wetland and Leaching Facility (If any wetlands exist Feet
within 300 feet of leaching facility)
Furnished by
J /
2 vZ 0
5
�� 7/ - S
03-18-2004 11:56AM FROM SWEETSER ENGINEERING TO 15084770177 P.01
?own of Barnstable
Regulatory,Services
Thoum F.Geller,Dbvcwr
Public Health Division
ThONBS McKeM Director
200 Maid Sam.Hyannis.MA OZ601
Fax 5oti-780-M
Otte: 50'"52.4644
,
Date: March 15, 2004
DWpu. Sweetser Engineering irrstal1er: Ron's Excavating
Address: P.O. Box 713 Addrvw: 20
South Dennie, MA 02660
on . a-, C� a�u�S �k'C_ ' (jas issued a permit to install a
(date) (ia�taller)
scptiC system at 288 Arrowhead Drive, Hyannis based on a deMp drawn by
( M5S)
Tana Daigneault� _ ___ dated March 4, 2004
_., I cftfy that the septic system meferedeed above was installed subsmtially accordingto
the des4a,whieb atsy include minor approved changes such as lateral relocation othe
distribution box and/or septic wk.
I certify that the septic system referenced above was installed with ma'or changes (i.e.
greater than 10'lateral relomfian of the SAS or any vertkel relocation of any component
of the septic system but in arcerdance with State&Local plan revision of — -
certified as
by deOgter to follow.
TAR'YA
OASG-NEA li_T
IJ (Installer's Si ure) No. 1C85 _... .
M -elk
e�
w
r Si ) (A x Designer's Stamp Here)
PLIAA U C T'1E = .- .... ..
l7r E UNTIL _
N. o •= =::..::•::.•.::
TOTAL P.01
�S
Com*MONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAI ( 131
DEPARTMENT OF EN PRO TTION ' '�,
ONE WINTER STREET. BOSTON. NtA 02105 bl?-=9.•5:a0
NO 2.S 199
W'ILLIAM F.WELD 0 OWNOF A TR17Dn ,C0\T
GovCrnr _ _ �. y�(Hfl pITAB(f lL Sc:rctar\
ARGEO PAUL CELLUCCI STRUHS .
Lt.Govcmor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM 9 o`mrnissionr,
PART A
CERTIFICATION - -
p28� � )W`�91 . $AWN1_r'NAddress of Owner:Property Address; bC � .
Date of Inspection: �`�� `� (If different)
Name of Inspector: orc> ` n
am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) S t�V-s�-\.)C_)-T1
Company Name: EA rr'rcl 01 #"P
Mailing Address: 20 Acnx e_33?!�j H/99a,02tz H 09-p 2C4_C/
Telephone Number. rSG21�2 �o=51 2— /Ltc Zco
CERTIFICATION STATEMENT
I certify that I have personally inspected the sevvage disposal system at this address and tha: the information reported beloN- is true, accurate
and complete as of the time of inspec;oo7. The inspection was performed bases on my training and experience in the proper.function and
maintenance of on-site sewage disposa; systems. The system:
Passes -
Concioonaiiv Passes
Neecs Further Evaluation By the Local Approving Authority
Fa.!s
AInspector's Signature: Date: 1Z
f;,e Sys;e^ Ins`e:,or sha!' submit a copy of this inspection repor, to the Approving Authority within thirty (30) days of completing this
inspection. If the systern is a shared system o, has a design flow of 10,000 god or greater, the inspector and the system owner shall submit
the report to the appropriate regional orrice of the Department of Environmenta' Protection.. The original should be sent to the system owner
and copies [ iz to the buyer, if applicable, and the approving authorir\.
INSPECTION SUMMARY: Check A, B, C, or D:
A] SYSTEM PASSES. -
I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303.
Any failure criteria not evaluated are indicated below .
COMMENTS:
B] SYSTEM CONDITIONALLY PASSES:
One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon
completion of the replacement or repair, as approved by the Board of Health, will pass.
Indicate yes, no, or not determined (Y, N, or NDi. Describe basis of determination in all instances. If"not determined", explain why not.
The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of
Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection; or
the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank -
failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank
as approved by the Board of Health. Y -
(sa.iaad D�/25!97) Page 1 of 10
DEo on the World Woe Weo htto lnvww nwgnet save ma usv0er
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Addws:
Owner:
Date of Inspection:
B) SYSTEM CONDITIONALLY PASSES tcontinued'
Sewage backup or'breakout or high static water level observed in the distributio box is due to broken or obstructed
pipes) or due to a broken, settled or uneven distribution box. The system will ass inspection if(with approval of the
Board of Health).. Describe observations:
broken'pipe(s) are replaced
obstruction is removed
distribution box is levelled or replaced
The system required pumping more than four times a year due to bro n or obstructed pipe(s). The system w•"ill pass
inspection if(with approval of the Board of Health): -
broken pipets) are replacer
obstruction is removed
c
C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
Conditions exist which require further evaluation by the Board of ealth in order to determine if the system is failing to protect the
public health• safe-y and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETER
NES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER
WHICH WILL PROTECT THE PUBLIC HEALTH AND SAF AND THE ENVIRONMENT:
Cesspool or priv�, is within 50 feet of a surface ater
Cesspoo? or pn"- is within 50 feet of a border ng vegetated wetland or a salt marsh.
2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEAL (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT
THE SYSTEM IS FUNCTIONING IN A MANNER TH T PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE
ENVIRONMENT:
The syste-n has a septic tank and soil ab orption system (SAS) and the SAS is within 100 feet to a surface water supply or
tributary to a surface water supply.
The system has a septic tank and soil sorption system and the SAS is within a Zone I of a public water supn)y well.
The system has a septic tank and soil bsorption system and the SAS is within 50 feet of a private water supply well.
The system has a septic tank and soi absorption system and the SAS is less than 100 feet but 50 feet or more from a
private water supply well, unless a tell water analysis for coliform bacteria and volatile organic compounds indicates that
the well is free from pollution frony that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or
less than 5 ppm. Method used to determine distance (approximation not valid).
3) OTHER
Z'T Z-
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j-c�
L--�47IM14 Z-11;`-I:i�,;,�
(revised 04;25/9') Page 2 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
`PART A
CERTIFICATION'(continued)
Property Address:
Owner:
Date of Inspection:
DJ SYSTEM FAILS:
You must indicate either "Yes" or "N-o" as to each of the following:
1 have determined that the system violates one or more of the following failure criteria as d fined in 310 CMR 15.303. The basis
for this determination is identified below. The Board of Health should be contacted to d ermine what will be necessary to Correa
the failure.
Yes Nd.
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.surfac waters due to an overloaded or clogged SAS or
cesspool.
Static I;ou;d level in the distribution boa above outlet invert due t an overloaded or clogged SAS or cesspoo!.
Liquid depth in cesspool is less than 6" below invert or availab volume is less than 1/2 day flov..
Required pumping more than 4 times in the last year NOT ue'to clogged or obstructed pipes..
Number o'times pumped _.
Any portion o`the Soil Absorption System, cesspool or priv,)• is below the high groundwater eievation
_ An por,;on of a cesspool or privy is within 100 f of a surface water supph• or tributary to a surface water supply.
Any portion of a cesspoo' or prnti• is wrth;r, a Z e I of a public well.
An,. person o'a cesspoo! or pn%ti• is within 5 feet of a private water supple we[!
Any per, or: a a cesspool or pricy is less t n 100 feet but greater than 50 feet from a private water supply well with no
acceptable water qual;n analysis. If the el! has been analyzed to be acceptable, attach cope of well water anaiysis for
col;form bacteria. volatile organic comp o nds, ammonia nitrogen and nitrate nitrogen.
E7 LARGE SYSTEM FAILS:
You must indicate either "Yes' or "..No" as to each of th following:
The folio\,%;ng criteria app'%-to !arse systems n.addition to the criteria above:
The system serves a facilit\ with a design f ow of 10,000 gpd or greater (Large System; and the system is a significant threat to
public hea!th and saferr and the environ ent because one or more of the following conditions exist:
Yes No .
the system is within 400 f t of a surface drinking water supply
the system is within 200 eet of a tributary to a surface drinking water supply
the system is located i a nitrogen sensitive area (Interim Wellhead Protection Area• IWPA) or a mapped Zone ll of a
public water supply ell)
The owner or operator of any such s tem shall bring the system and facility into full compliance with the groundwater treatment program
requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.
(revised 04125/97) yPage l 0i 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
- - CHECKLIST�:
Properiv Address:
Owner:�U�� 1
Date of Inspection:'11`�Z��~l
Check if the following have been done: You must indicate either Yes" or "No as to each of the following:
-f-'� -o '
Pumping information was provided by the owner, occupant, or Board of Health.
— None of the system components have been pumped for at least two weeks and the system has been receiving normal
flow rates during that period. Large volumes of water have not been introduced into the system recentl. or
as pan of this inspection.
As bull: plans have been obtained and examined. Note if they are not available with N/A.
— The fac:lit\, or dwelling was inspected for signs of sewage back-up.
— The system does not receive non-sanitary or industrial waste flow. -
The site vas inspected for signs of breakout.
All system cornponenis. excluding the So!l 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. materia'- o`construction, dimensions, depth of liquid, depth of sludge, depth of scum.
The size and location of the Soil Absorption System on the site has been determined based on:
— The fac,lin ovine, iano occupants. if difieren: from owner were provided with information on the proper maintenance of
Sub•Suriace Disposal System.
Existing information. Ea. Plan at B.O.H.
— Determined in the field :if am of the failure criteria related to Pan C is at issue, approximation of distance is
unaccep:abie [15.30231til
a t: oz
(revised 04/25/97) Page 4 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR..M
PART C
SYSTEM INFORMATION
Properh Address:
Owner: t.
Date of Ihspectionl 1
1•\` 2`51
FLOW CONDITIONS
RESIDENTIAL-
Design floN o.dJbedroom for S.A.S
Number of bedrooms
Number o'current residents- •
Garbage g,:--der (yes or no!:�_
Laundry co-:^ected to system (yes or no)
Seasonal use Ives or no!:_111
Water meter readings, if available (last two (2 year usage igpd): (�
Sump Pump Ives or no): (Q __
Lac: date o`occupancy � nU �
COMMER' P412INDUSTRIAL:
Type of establishment.
Design fiow_ a!ionsida,.
Grease trap present. tees or no'_
Industrial \'taste holding Tani; present. Ives or no, -
:on-sanitar% Haste discharged to the T!toe 5 system. ivies or no_
\%ater meter readings. if availabie
Las:Pxe o: o ;;:pane.
OTHER: .De_cnbe
Last cafe of occuoanc.
GENERAL INFORMATION
PUMPING RECORDS and so rce of for ation.
1� Q G CW
System pumped as par, of inspection: tves or no. ;
If yes, volume pumped eallons _
Reason for pumping
TYPE OF SYSTEM
Septic tank/distri ution box/soil absorption syste
Single cesspool I Ok}Z&T JoW QA-" e6G
Overflow cesspool d
Shared system (yes or no) (if yes, attach previous inspection records, if any)
I/A Technologv etc. Copy of up to date contract?
Other r
APPROXIMATE AGE of all components, date installed (if known) and source of information: 1,�+ T.i•� \i I:f
' d
Sewage odors detected when arriving at the site. (yes or not
(revised 04/25/91) Page 5 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address:
Owner:
Date of Inspection:
BUILDING SEWER:
(Locate on site plan)
Depth below grade. f r =
Material of construction: _cast iron _40 PVC _other (explain)
Distance from private water supply well or suction Ir-e
Diameter 3'. -
Comments: (condition of joints, venting, evidence of leakage. etc.)M
SEPTIC TANK:_ _
(locate on site plan
Depth below grade-
Material of construction: _concrete _meta _Fioerglast _Pol lethviene _othenexplain _
If tank is metal. Iis: age _ Is age con.irmee b%-Ce^:fica;e of ompiiance _(l es'No
Dimensions
Sludge depth
Disiance from top o: s!udge to bororn'of outie:iee o, ba-le
Scum thickness:
Distance from top of scum to top of outlet tee or ba"ie _ -
Distance from bottom of scum to boco-n of out et tee or •a-.e
How dimensions were determined
Comments.
trecommendat on for pumping. tondit ono inlet and outle, tees or baffles. depth of liquid level in relation to outlet invert, structural
integrity, evidence of leakage, e:c.)
GREASE TRAP:
(locate on site plan; = .
Depth below grade:
Material of construction: _concrete _metal Fiberglass _Polyethylene _other(explain)
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle: �� ___•-_,
Distance from bonom-of scum to bottom- f outlet-fee'or baffie:-- •_..
Date of last pumping:
..__e
(recommendation for pumping, condit"on of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural��
integrity, evidence of leakage, etc.)
I
(revimed 04/25:97) Page 6 of 10 nsr%..,
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTIO FORM
PART C
SYSTEM INFORMATION (continued)
Propem Address:
Owner:
Date of Inspection:
TIGHT OR HOLDING TANK: :Tank must be pumped prior to, or at time, of i pectioni
(locate on site plan,
Depth below grade:
Material of construction. _concrete _metal _Fiberglass _Polyethylene _ot er(explain)
Dimensions:
Capacity: gallons
Design flow galionssda,
Alarm level Alarm in working order _ Yes: _ No
Date of previous pu'nping
Comments
(condition of inlet tee. condition of a!arm and float switches. etc.)
DISTRIBUTION BOX:_
(locate on site par.
Depth of liquid level above outie: in%e
Comments-
mote if leve! a-:d distribution. is eaua'. evidence of solids rryover, evidence of leakage into or out of box, etc.)
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, condition of pumps and appurtenances, etc.)
(revised 04/25/97) Page 7 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR.-1
SYSTEM INFORMATION (continued)
Property Addr-ss: ;L1313U� +d 4 '
Owner:
Date of Inspection:
I11�LI�� _
SOIL ABSORPTION SYSTEM (SAS):
(locate on site-pian, if possible; exca,. tion not required, but may be approximated by non-intrusive methods;
If not determined to be present, explain:
Type
leaching pits. number. ___ _.__ __. _ _ - _--_---•------- __r __. __......�__�..
leaching chambers, number:_
leaching galleries, number:
leaching trenches, humber,iength: --
leaching fleids, number, dirnension.s. _
overfiow cesspool, number
Alternative s%,stem _
Name of Technoiog\•:
Comments.
in to condition of oii, signs of hydraulic failure, level of pon ng, dit of vegetation, tc.1 _ t
re ...... t�.-�, on
_cqfA
CESSPOOLS: QS T
(locate on site plar.
Numbe, and configura:.or ik
Depth-top of liquid to inlet urver
Depth of solids lave--_ 1) U
Depth of scum laver._
Dimensions of cesspool--(v
Materials of construaior.
Indication of groundwater
inflow icesspool must be pumpeC as par, of inspection) IJC�- S� •� V1M 1_y!,►{',r
Comments:
(note condition of soil, signs of hydraulic failure, level of pon ing, co ition of gets n, etc.)
Q.
6
� -PRIVY:
(locate on site plan)
-Materials'of construction:___ - - --_______ . .,__ __ __.____ __w -----•-- - Dimensions: + _
Depth of solids:
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
(reva..d 04;2S/97) Page 8 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
:PART C
SYSTEM INFORMATION (continued
Prope , Address: ��� 1\K�!(�w• I
Owner:
Date of Inbpection.
tf«��
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100' (locate where public water supply comes into house)
Oar,
1
(revised 04!35/57) Page 9 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ,
PART C _.
SYSTEM INFORMATION (continued)
n ��
Property ddres�,dUT� ��!W �%�cJ�•/
Owner:
In i Date of s en on.
P
1 .
Depth to Groundwater{ �S Feet
Please indicate all the methods used to determine High GroundN46r Elevation:`
Obtained irom Design Plans on record
Observation of Site (Abutting property, obsen-ation hole, basement sump etc.)
Determine it from local conditions
Cnec*K with loca! Board o! nea!t
Chec'K FE.NIA Maps
Check pumping record--
Check loca! excavators. installers
Use LKS Da--a
Describe in voir.own %%oronno•.+ you established t`he High Groundwater Elevation. (Must be completed:
V.S. yo lo�jiccSSuv)�-41 .
� 3.l
(sav-zed 0412"5" Page 10 of 10
I
��� SOL TEST
1 FT. MINIMUM FROM CEL_AR __ DATE OF SOIL TEST
TOP CF FOUN4t.±ION MAr3�n �,�QQ4
( 10 FT. MINIMUM FROM SI AB OR ;PAWL SPACE SOIL TEST DONE BY SWEET �)YQJN�E_RING
ELLV. = 100•0_ 10 FT. MINIMUM CLEAN SAND WITNESSED BY --------__---__--_
(ASSUMED) i ''ONCRETE INSPECTION, PORT
-- COVER" LOAM AND SEED 08SERYA110N HOLE I ELEV.-_ 99.30
4" SCHEDULE 40 PVC PIPE PERCOLATION RATE _15, _- MIN./INCH AT __ 6_0___ INCHES
-.--- MIN. PITCH 1/8" PER FT. 2" LAYER OP
1 � � \ t/8" TO 1 j2" DEPTH HORIZ TEXTURE COLOR MOTT. OTHER
+ W
�� a" CAST IRON PIPE - �•� MAX. 9T.25 W.ASHED STONE J NON REQUIRED
0-12 A SANDY LOAM 10YR4/2 NO ROOTS
(OR EQUAL) M;NIMIiM
-r7CH 1/4" PER �T. _.�_ _ \ � 12-24 B LOAMY SAND 10YR6/6 ROOTS &
5% COBBLES
\ t 24-39 Cl MEDIUM SAND 2.5Y7/4
'- ---- l FLOW LINE
�- ELEV. _ �QQ_ 10" i 7� -„--� - o o I ' ' �`0 39-45 C2 COARSE SAND 10YR5/4 5% COBBLES
lPLflAIB1N; TD BE �•�'.4/S�� ! -THIN.
20
L ELEV. 96.35- LEVEL o 10 ° >I1b.17
RE B1' UCENS�D ELEV. _ ______ 45-132 C2 MEDIUM SAND 2.5Y7/4
PrUG/BER AS NEEDED. I ELEV. _ _ _ BA AS E ELEV. 6" SUMP -ELEV. _ _9d.1'Lf_
_ _ _�--�` FL DISTRI9UTION ELEV. _
p
a HIGH CAPACTY INFILTRATORS
IrL!U!D OUTLET (- BOX -�- WITH STONE IN AN � z
--T- (TO BE PLACED ON FIRM BASE) TO BE WATER TESTED I �-87
4 T 14 INCNE I 11 X 4a' X 1Or TRENCH FO MA,,ON
5 F T 19 IN EES (` jF MORE THAN ONE OUTLET ---"t ;n ' NO WATER ENCOUNTERED AT --J"- ELEV.
' 6 FEET �4 IN is ; �Al-�-J� (TO BE PLACED ON FIRM BASE) SOIL ABSORPTION i ONE NIA
8 FEET 34 INCHES SEPIt.' TANK 3 4" TO 1 t 2" CLEAN � INDEX
-- SYSTEM (SAS)
DOUBLE WASHED FRE OFFINES & SILT ADJUST DESIGN CALCULATIONS
USGS PROBABLE WATE TABLE ELEV. - NUMBER OF BEDROOMS '�_
SEWAGE DISPOSAL SYSTEM PROFlLE OBSERVED WATER TABLE ( / / ) EL_ . = _-__-_ GARBAGE DISPOSAL UNIT
NOT TO SCALE BOTTOM OF TrST HOLE ELEV. = -_$ „�Q_ TOTAL ESTIMATED FLOW
( 110 GAL/BR./DAY X ,�_ 8R.) _A44_ GAL./DAY
REQUIRED SEPTIC TANK CAPACITY _ GAL.
ACTUAL SIZE OF SEPTIC TANK _1____ GAL.
SOIL CLASSIFICATION
DESIGN PERCOLATION RATE S_ __ MIN./IN.
EFFLUENT LOADING RATE Q,.7 GAL./DAY/S.F. '
LEACHING AREA 6.26. - SQ. FT.
(11X48)+(59X2X10/12)
LEACHING CAPACITY (AREA X RATE) GAL./DAY
626.33 X 0.74
RESERVE LEACHING CAPACITY _1 _ GAL./DAY
NOTES:
ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO C.E.P.
TITLE 5 AND THE TOWN'S RULES AND REGULATIONS FOR THE
SUBSURFACE DISPOSAL OF SEWAGE.
2. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO
WITHIN 6" OF FINISHED GRADE.
X 9�'3 3. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF
33 y WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN
J 97 2 911
Z7 10 FT. OF DRIVES OR PARKING AREAS. H-20 LOADING SHALL BE
USED UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS.
J I1_ 4 N PLACE.YI USED TO BRING COVERS TO GRADE SHALL BE
MORTARED
r f 29.j f 5. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH
j DEEDED OR ZONING REGULATIONS. OWNER / APPLICANT IS 70
OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY.
97 5 1 6. UTILITIES SHOWN ARE APPROXIMATE ONLY, EXCAVATION
0 CONTRACTOR IS TO CALL "DIG-SAFE" AT 1-888-344-7233
AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE.
'. 97.6 - 7. CONTRACTOR IS TO VERIFY GRADES .AND ELEVATIONS AS WELL
AS SITE CONDITIONS PRIOR TO COMMENCING WORK ON SITE. i
x 98 7 ANY VARIATION IS TO BE BROUGHT TO THE ATTENTION OF
C� 98.5 THE DESIGN ENGINEER IMMEDIATELY.
Q 99•0 f 8. PARCEL IS IN FLOOD ZONE � _
?0. SHOWN
, S ARE TO BE PUMPED
AND REMOVED ALONG WITH
IS ON ASSESSORS MAP AM_ AS
PARCEL
LOT 36 � ANY POLLUTED SOILS ENCOUNTERED i
8,784 .t S.F � BN. 1100, i
1500 GALLON
SEPTIC TANK SOIL - +
!
98.8 O V O r 9 ' 99.5 , E DAIGNcA'"T
99.3 +
• 97.2 I �� b DECK i ;`, �No. 15
APPROVED: BOARD OF' HEALTH
99.0 -ell
I f D. BOX 936 f'
{ x 97.2 14,
i - 99.2 " 99.7 -
` 1 99.3 , 7s
1 ' ' JA'"t AGENT
• 97 2 98.5 99.3 99.1 PROPOSED SEPTIC -DESIGN �
' l
X 9 .68 ( FOR
28 } BRI N WOODRI
� 99,1 Y 99.5 99.8 R�
h 1,J*OS.
(100)- o LOC. 24949 ARROWHEAD DR�
100 4 ! f ,BAR•NS'TABBLE 0
�A��
� V
235 GF�EAT WESTERN ROAD
I ' BRgL1F j 508- P. 0. BOX 713
1398-3922 SOUTH DENNIS, MASS. 02660
LEGEND: 0
EXISTING SPOT ELEVATION x0.0
i EXISTING CONTOUR ----OO—- q�� j DATE MAR. 4, 2004 SCALE 7 " _ 20'
i FINAL SPOT ELEVATION J I {
FINAL CONTOUR -- 1
Sr'L TEST LOCATION REVISED j JOB N0. 5922_0
UTILITY POLE M..> I I
TOWN WATER -WW-
CATCH BASIN `CIS
GAS LINC --�c� LOCATiQ 1 MAP REVIS i !SHEET 1 OF 1
CESSPOOL \�P
CLEANQUT _-, C.O.
C.• �S8�PROJ,5922-001dwg15922-sos.OwG 02004 SWEETc` ' _!yGJ