HomeMy WebLinkAbout0168 BUCKWOOD DRIVE - Health `A68 BuCkwood Drive
`Hyannis F/R
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TOWN OF BARNSTABLE ®,
LOCHT?ON ry t au C k UJ 0 Cd• Z29 SEWAGE #,",W 3 - 2,
VILLAGE WX A A11V/S ASSESSOR'S MAP & LOT '?-It� O
INS'IIA LER'S NAME&PHONE NO. /0 f1 C 0 .M 63 C 14
SEPTIC TANK CAPACITY / Q G D d L b
LEACHING FACILITY:(type) ._ 1W&GL' S (size) /I g-1� R
NO.OF BEDROOMS oZ
BUILDER OR OWNER
PERMIT DATE: 3 COMPLIANCE DATE: S
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
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TOWN OF BARNSTABLE
LOCATION &A66V6dQ A,PrX. SEWAGE #
VILLAGE ��/�i�/,Y:r ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY /000
LEACHING FACILITY: (type) 6X9 (size)
NO.OF BEDROOMS .�
BUILDER OR OWNER
PERMTTDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility 49 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 facil Feet
Furnished by 0.�
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TOWN OF BARNSTABLE
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LOCATION
VILLAGE A ✓1 ' S ASSESSOR'S MAP & LOT
INSTALLER'S NAME & PHONE NO,
SEPTIC TANK CAPACITY
LEACHING FACILITY:{type) (size) ( > i
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER bc,C C n e✓ �� �'n o
DATE PERMIT ISSUED:
DATE COUPLIANCE ISSUED:
`ARI ANCE GRANTED: Yes NO
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Commonwealth of Massachusetts °� !' O
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M 168 Buckwood Dr. r
Property Address 74
Christopher Olson '
Owner Owner's Name
information is required for every y H annis MA 02601 07/10/18
page. City/Town State Zip Code Date of Inspection N1
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 A. General Information
filling out forms
on the computer,
use only the tab 1. Inspector:
key to move your
cursor-do not Richard T. Johnson
use the return Name of Inspector
key.
D &J Environmental Services
re6 Company Name
P.O.Box 1439
Company Address
Plymouth MA 02362
City/Town State Zip Code
508-735-8740 S113545
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:
® Passes ❑ Conditionally Passes ❑ ,Fails
❑ Needs Further Evaluation by the Local Approving Authority
07/10/18
In ector's Signature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board
of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or
has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the
report to the appropriate regional office of the DEP. The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
****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.
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 168 Buckwood Dr.
Property Address
Christopher Olson
Owner Owner's Name
information is Hyannis MA 02601 07/10/18 required for every H y '
page. Citylrown 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:
All system components are within 6"of grade.
i
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
p/ 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17
f
Commonwealth of Massachusetts ,
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 168 Buckwood Dr.
Property Address
Christopher Olson
Owner Owner's Name
information is Hyannis MA 02601 07/10/18.
required for every H y .
page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17
Commonwealth of Massachusetts
v Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
wM 168 Buckwood Dr.
Property Address
Christopher Olson
Owner Owner's Name
information is required for every Hyannis MA 02601 07/10/18
page. City/Town 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
Vjj q� supply
1 - ❑ 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17
f
Commonwealth of Massachusetts
TM Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
�M 168 Buckwood Dr.
Property Address
Christopher Olson
Owner Owner's Name
information is required for every Hyannis MA 02601 07/10/18
page. Cityrrown 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-
1.0,000gpd.
❑ ® 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17
Commonwealth of Massachusetts
G Title 5 Official Inspection Form
rS Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 168 Buckwood Dr.
Property Address
Christopher Olson
Owner Owner's Name
information is required for every Hyannis MA 02601 07/10/18
page. City/Town 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 GPD
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17
f -
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M 168 Buckwood Dr.
Property Address
Christopher Olson
Owner Owner's Name
information is required for every Hyannis MA 02601 07/10/18
page. Cityrrown State Zip Code Date of Inspection
D. System Information
Description:
Number of current residents: 0
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system? (Include laundry system inspection El Yes ® No
information in this report.)
Laundry system inspected? ❑ Yes ® No
Seasonal use? ❑ Yes ® No
Water meter readings, if available (last 2 years usage (gpd)):
Detail:
Sump pump? ❑ Yes ® No
Last date of occupancy: unknown
Date -
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? 0 Yes ❑ No
Water meter readings, if available: ---
t5ins•3/13 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
M 168 Buckwood Dr.
Property Address
Christopher Olson
Owner Owner's Name
information is required for every Hyannis MA 02601 07/10/18
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: Owner
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:
® 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):
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17
i
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
°M 168 Buckwood Dr.
Property Address
Christopher Olson
Owner Owner's Name
information is Hyannis MA 02601 07/10/18
required for every y _
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:.
2003 per BOH records
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
Depth below grade: 1.5
feet
Material of construction:
❑.cast iron . ® 40 PVC ❑ other(explain):
Distance from private water supply well or suction line: feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
joints structurally sound, no signs of leakage
Septic Tank (locate on site plan):
Depth below grade: 0.5
feet
Material of construction:
® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain)
Septic Tank Covers tomithin 6 of grade. Fl
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
Dimensions:
1000 Gal
Sludge depth: 511
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17
":3 '
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments.
168 Buckwood Dr.
Property Address
Christopher Olson
Owner Owner's Name
information is required for every Hyannis MA 02601 07/10/18
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
33"
Scum thickness 3"
Distance from top of scum to top of outlet tee.or baffle
5° -
Distance from bottom of scum to bottom of outlet tee or baffle
1311
How were dimensions determined? Field measurement/Mfg. Specs.
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Sanitary tees in good working condition, tank structurally sound, no evidence of leakage. All
components rated at H10 and are not proximate to load bearing conditions. Recommend tank be
pumped to extend life of components.
Grease Trap (locate on site plan):
Depth below grade: feet
Material of construction:
. (( ❑ concrete. [I metal i ❑ fiberglass ❑ polyethylene Elother(explain):
N
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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M 168 Buckwood Dr.
Property Address
Christopher Olson
Owner Owner's Name
information is required for every Hyannis MA 02601 _ 07/10/18
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
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
�M 168 Buckwood Dr.
Property Address
Christopher Olson
Owner Owner's Name
information is required for every Hyannis MA 02601 07/10/18
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"
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.):
Box level, no evidence of solids carryover, no evidence of leakage.
Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No"
Alarms in working order: ❑ Yes ❑ No"
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
" If pumps or alarms are not in working order, system is a conditional pass.
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 168 Buckwood Dr.
Property Address
Christopher Olson
Owner Owner's Name
information is Hyannis MA 02601 07/10/18
required for every y _
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Type:
❑ leaching pits number:
® leaching chambers number:
2 dry wells
❑ 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.):
No evidence of Hydraulic failure, no damp soil, normal vegetation.
Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration
Depth —top of liquid to inlet invert
4
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
t5ins•3/13 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
M 168 Buckwood Dr.
Property Address
Christopher Olson
Owner Owner's Name
information is required for every Hyannis MA 02601 07/10/18
page. City/Town 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.):
_ r
. k
t5ins-3/13 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
168 Buckwood Dr.
Property Address
Christopher Olson
Owner Owner's Name
information is required for every Hyannis MA 02601 07/10/18
page. Cityrrown 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
TO
1X w
t5ins•3113 Title 5 Official Inspection Fond:Subsurface Sewage Disposal System•Page 15 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 168 Buckwood Dr.
Property Address
Christopher Olson
Owner Owner's Name
information is required for every Hyannis MA 02601 07/10/18
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
® Check Slope
® Surface water
® Check cellar
❑ Shallow wells
NGWE at 144" (12 ft)
Estimated depth to high ground water: feet
Please indicate all methods used to determine the high ground water elevation:
❑ Obtained from system design plans on record
If checked, date of design plan reviewed: Date
® Observed site (abutting property/observation hole within 150 feet of SAS)
❑ Checked with local Board of Health -explain:
❑ Checked with local excavators, installers-(attach documentation)
❑ Accessed USGS database -explain:
You must describe how you established the high ground water elevation:
Obtained from site observation, visual elevation, data on file with BOH for abutting property.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17
i .
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
�M 168 Buckwood Dr.
Property Address
Christopher Olson
Owner Owner's Name
information is required for every Hyannis MA 02601 07/10/18
page. City/Town 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
�I System Information—Estimated depth to high groundwater
® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
y
}
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17
S
No.
2`f ( Fee $5 0. 0 0
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MA�SACHUSETTS
21ppfication for Migaar *Vztem Congtruction Permit
Application fora Permit to Construct( )RepairkX)Upgrade( )Abandon( ) El Complete System 0 Individual Components
Location Addressor Lot No.16 8 B is c k w o o d D 2 i v e Owner's Name,Address and Tel.No. 5 0 8—3 6 0—8 5 2 5
11yann.i.6, Nas,3. 02601 kalzen Veznen
AssessorsMapRarcel 168 Buckwood Dz iveRyann ih, 17a. 02601
71-110
Installer's Name,Address,and Tel.No. 5 0 8-7 7 5-3 3 3 8 Designer's Name,Address and Tel.No.5 0 8—2 7 3—0 3 7 7
a. P. (7acomFe2 & Son Inc. aC, Cny.inee2.iny, Inc.
13ox 66 Cente2v.i.e.ee, �la��. 02632 lulalm-Itain2854 C2an�e22y Highway Ca�.t
'Type of Building:
DwellingXXXNo.of Bedrooms 2 Lot Size sq.ft. Garbage Grinderl0 )
Other 'Ilype of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 3 5 0. 9 gallons per day. Calculated daily flow2X 110=22 0 gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic TankCxi,3i---ny 1000 Type of S.A.S. 2-500' ,s 25 'X 1 3'X2'
Description of Soil Sandy .eoam .t`o /.ine medu.im sand
No g2ound wa.ten 120"
Nature of Repairs or Alterations(Answer when applicable)I n,3. a i i i n g t w o 500 g a e i o n
ieach.ing chamle2.6 2oaked .in 4 ' ne 9�"Atnng with ss 2" 318" 440gp
cap. 25 'X13'X2'
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 Bo dA 1
Signed Date 6121031
Application Approved by Date
Application Disapproved fo the following reasons
Permit No. 2 003 2 Date Issued .�
.; ,
No:7 y 1 e - t`' G' -'q Fee. 5 0. 0 0
TM�HE`COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
' -PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
01ppYication for Mizpaar *pgtem Congtruction Permit
Application for a Permit to Construct( a{)RepairXX)Upgrade( )Abandon( ) ❑Complete System X Individual Components
Location Address or Lot No.16 8 B u C k w o O d D7 i Z*v e Owner's Name,Address and Tel.,No. 5 0 8—3 6 0—8 5 2 5
Kyann.iz, 17ae.s. 02601 kdaen Veanen
Assessor'sMap/Parcel 168 Buekwood 172.iveRyann.ib, Na. 02601
71-110
Installer's Name,Address,and Tel.No. 5 0 8—7 7 51—3 3 3 8�, '°�'�- Designer's Name,Address and Tel.No.5 0 8—2 7 3-0 3 7 7
a• l. NacomgE4 R Son Inc.4 ;C, Cng.ine_e.¢.ing, Inc.
Box 66 Cente�tv.iiie, (7a-ss.02632' 2854 Czan�en2y Kighway fast
Type of Building: z.
DwellingXXX No.of Bedrooms 2 Lot Size sq.ft. Garbage Grinder/(0 )
Other Type of Building No. of Persons Showers( ) Cafeteria( )
-Other Fixtures
Design Flow 3 5 0.''9 gallons per day. Calculated daily flow2X 110=22 0 gallons.
Plan Date Number of sheets Revison,Date,I
Title
Size of Septic TankN i 6 t.in9 1000 Type of S.A.S. 2-5 00'.s 25'X 1 3'X2,
Description of Soil Sandy .foam to eine medu.im .sand
No gaound watea 120"
Nature of Repairs or Alterations(Answer when applicable)In.b t aT$. -i n 9 two 500 ga i i o n
te-aching chamge16.6 iPaekQd in 4' n,,P 1' 0 .ttnno ,J''fi n 2" 3,18 4tg.,g
cap. 25'X 13'X21,41- 11 -
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 y this Bo 7o7e
Signed Date 612103
Application Approved by .� Date G3
Application Disapp over fo the following reasons
�i
Permit No. T 3 —2 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 KX )Upgraded( )
Abandoned( )by 2. /0 m
at 168 Buekwood b1t.ive livann i s. l7a s.s. has be n constructed Ana ordance
with the provisions of Title 5 and the for Disposal System Construction Permit No.ZC�D3—2�?dated 3
Installer 7. %. Nacom9e2 R Son. Tar. Designer K, Fng.inee/t.ing, .Tnc.
The issuance of this pe t {tall not be construed as a guarantee that the system 1 /�\
Date 3 Inspector
—-----——————————— —-----— ----------------
No.2�3'Z Fee 50. 00
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
x1i6po.5ar %pgtem Construction Permit
Permission is hereby granted to Construct( )Repair( )Upgrade..KX)Abandon
Systemlocatedat 168 Buekwood Dzive Xyandih, l7a z.
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: Constructio must be completed within three years of the date of this pe i
Date:_ �0/ �. Approved by "
7
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION,FORM
:Address of property C4.-,tee hlyr�nn.� ►n� c1�c j
owner's name ; �i
Date of Inspection `�
PART A
CHECKLIST
Check if the following have been done:
✓ Pumping information was requested of the owner, occupant, and Hoard of
Health.
_V None of the system components have been pumped for at least two weeks
and the system has been receiving normal flow . rates during that
period. Large volumes of water have not been introduced into the
" system recently or as part of this inspection.
' rl,i As built plans have been obtained and examined. Note if they are not
available -with N/A.
The facility or dwelling was inspected for signs of sewage back-up.
The site was inspected for signs of breakout.
✓ All system components, excluding the SAS, have been located on the
site.
✓ The septic tank manholes were uncovered, opened, and the interior of
the septic tank was inspected for condition of baffles or tees,
material of construction, dimensions, depth of liquid, depth of
sludge, depth of scum.
The size and location of the SAS on the site has been determined based
on existing information or approximated-,by non-intrusive methods.
The facility owner '(and occupants, if different from owner) were
provided with information on the proper maintenance of SSDS.
2
JUL
T 1995
� m
5
F
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
SYSTEM INFORMATION
FLOW CONDITIONS
If residential
3 number of bedrooms
a number of current residents
uo garbage grinder, yes or no
y6 laundry connected to system, yes or no
seasonal use, yes or no
If nonresidential , calculated flow.:
Water meter readings, if available:
ti8sco ��•
Last date of occupancy
GENEiRAL INFORMATION
Pumping records and source of information:
a
System pumped as part of inspection, yes or no
if yes, volume pumped
Reason for pumping:
Type of system jVC o
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)
Other (explain)
Approximate age of all components. Date installed, if known. Source of
information:
Sewage odors detected when arriving at the site, yes or no
a
-.;
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
SYSTEM INFORMATION continued
SEPTIC TANK:_
(locate on site plan)
. depth below grade:
material of construction: concrete metal FRP other(explain)
dimensions:
ri sludge depth
�`distance from top of sludge to bottom of outlet tee or baffle
' scum thickness
distance from top of scum to top of outlet tee or baffle
distance from bottom of scum to bottom of outlet tee or baffle
: Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffles,
depth of liquid level in relation to outlet invert, structural integrity,
. evidence of .leakage, recommendations for repairs, etc. )
DISTRIBUTION BOX: N�
(locate on site plan)
depth of liquid level above outlet invert
Comments:
(note if level and,'distribution is equal, evidence of solids carryover,
evidence of leakage into or out of box, recommendation for repairs, etc. )
PUMP CHAMBER:
(locate on site plan)
pumps in working order, yes or
Comments:
(note condition of pump cha r, condition of pumps and appurtenances,
recommendations for mai nance or repairs,etc. )
e
i
r.
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
SYSTEM INFORMATION continued
SOIL ABSORPTION SYSTEM (SAS) :
(locate on site plan, if possible; excavation not required, but may be
approximated by non-intrusive methods) ;
If not determined to be present, explain:
Type.
leaching pits and number ►- ` P i Ct,
leaching chambers and number
leaching galleries and number
leaching trenches, number, length
leaching fields, number, dimensions
overflow cesspool , number
Comments:
(note condition of soil , signs of hydraulic failure, level of ponding,
condition of vegetation, recommendations for maintenance or repairs,etc. )
1_S
CESSPOOLS (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 groundwate
inflow (cesspool mu a pumped as
part of inspecti
Comments:
(note condition of soil , signs of hydraulic failure, level of ponding,
condition of vegetation, recommendations for maintenance or repairs,etc. )
PRIVY:
(locate on site plan)
materials of construction
dimensions
depth of solids
Comments:
(note Condit ' n of soil , signs of hydraulic failure, level of ponding,
condition of vegetation, recommendations for maintenance or repairs,etc. )
I
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
SYSTEM INFORMATION continued
'SKETCH OF SEWAGE L=SPOSAL SYSTEM:
•.: include ties to at least two permanent references landmarks or benchmarks
, locate all wells within 100 '
iicK CC
�aiic� I
I
i
,. DEPTH TO GROUNDWATER
a i depth to groundwater
method of determination or approximation:
Q2 c i tc,r Ode
12
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
FAILURE CRITERIA
Indicate yes., :no, or not determined (Y, N, or ND) . Describe basis of
determination in all instances. If "not determined" , explain why not)
N' Backup of sewage into facility?
Discharge or ponding of effluent to the surface of the ground or
surface waters?
• yA
Static liquid level in the distribution box above outlet invert?
Liquid depth in cesspool <6" below invert or available volume< 1/2 da;
flow?
N Required pumping 4 times or more in the last year?
number of times pumped
Septic tank is metal? cracked? structurally unsound? substantial
infiltration? substantial exfiltration? tank failure imminent?
Is any portion of, the SAS, cesspool or privy:
N below the high groundwater elevation?
�✓ within 50 feet of a surface water?
within 100 feet of a surface water supply or tributary to a surface
water supply?
N within a Zone I of a public well?
f✓ within 50 feet of a bordering vegetated wetland or salt marsh
(cesspools and privies only, not the SAS) ?
within 50 feet of a private water supply well?
less than 100 feet but greater than 50 feet from a private. water
supply well with no acceptable water quality analysis? If the well
has been analyzed to be acceptable, attach copy of well water analys-,_
for coliform bacteria, volatile organic compounds, ammonia nitrogen
and nitrate nitrogen.
13
E
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART D
CERTIFICATION
.Name of Inspector UJ� It�.�m E ►�����cn t2•
Company Name W(n, i5c
Company Address 41 �.A.'+ E� �.:�• ��yr�n,�s M•a
Certification Statement
' I certify that .I have personally inspected the , sewage disposal system at
this address and that the information reported .is true, accurate and
complete as of the time of inspection. The inspection was performed and
. any recommendations regarding upgrade, maintenance and repair aro
, cons-istent with my training and experience in the proper function and
manitenance of on-site sewage disposal systems.
Che k one:
I have not found any information which indicates that the system fails
to adequately protect public health or the environment as defined in
310 CMR 15 . 303 . Any failure criteria not evaluated are as stated in
the FAILURE CRITERIA section of this form.
I have determined that the system fails to protect public health and
the environment as defined. in 310 CMR 15. 303 . The basis for this
determination is provided in the FAILURE CRITERIA section of this
form.
Inspector ' s Signature GOctf:���Lh�o-9
Date S-13
original to system owner
Copies to:
Buyer (if applicable)
Approving authority
0
PROVIDE PRECAST CONCRETE 5" DIA. OUTLET(S) FINISH GRADE OVER CHAMBERS = 98,8' - 98.3' GENERAL NOTES
CONCRETE TOP OF FOUNDATION ELEV. = 101 .2' EXTENSION RISER WITH
E COVER TO WITHIN 6" REMOVABLE COVER SLOPE @ 2% MIN. OVER SYSTEM
OF CRETE[7 GRADE ABOVE FINISH GRADE OVER D-BOX= 98.6' 4" SCHEDULE 40 PVC MIN SLOPE 1% 3/4" TO 1-1/2" DOUBLE WASHED STONE TO CROWN OF PIPE 1. UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION
FINISH GRADE , FINISH GRADE OUTLET COS/ER METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE
@ FND. EL.= OVER TANK EL.= 99.2' 2" OF 1/8" TO 1/2" DOUBLE WASHED STONE
99.5 ENVIRONMENTAL CODE AND ANY APPLICABLE LOCAL RULES.
PLACE RISERS ON ALL CHAMBERS 2• ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD
20' MIN. ACCESS COVER TOP OF SAS = 97.33 TO C R FINISHED GRADE OF HEALTH AND THE DESIGN ENGINEER.
(TYPICAL FOR 2) 36"MAX. 9"MIN. 3. 4" SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL
EX1IS1'IrvG 4" 96.50 36"MAX. BREAKOUT EL = 97.00' BE USED IN DISPOSAL SYSTEM UNLESS OTHERWISE NOTED.
PVC PII'E - r---
- -- -- - - ----=- -u`- 4. TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE LESS THAN
_
_.___ __� _.__ 1 �� I PROVIDE WATERTIGHT ELEVATION = 97.00' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS
JOINTS (TYP.)
-___ ------ ------------- 2" DROP MIN. 3' 9' o oow� oo�� �:>
110„ 3" DROP MAX. , 4" PVC IN FROM O �� oo O o THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION.
SEPTIC TANK 4' PVC OUT TO o0 000 00 00 5. SLOPE ALL SOLID PIPE AT 1.0 % MINIMUM.
98.70'± -� 14 LEACHING FACILITY Too C�
\' 9S 07'-� o0 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL.
98.28'± -� _.-_.___.-_ , 12" 2' I�1 00 0 00 7. LOCAL BOARD OF HEALTH TO BE NOTIFIED PRIOR TO BACK FILLING WHEN
i � ,,. ,�rr�Acf��l� i�� 97.00 MIN. 96.83 I-� cx� c� cx,
'CONTRACTOR TO CONTRACTOR SHALL VERIFY SIZE 48" i ;; 1. o SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS NOT TO
VERIFY AND CONDITION OF TANK AND TEES I 6" CRUSHED STONE o 0 I� 0 0 00 0 0 0 C� o BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH.
CUTLET TEE WITH o 8. ELEVATIONS BASED ON ASSUMED DATUM OF 100.00'MSL OBTAINED
AND REPLACE AS NECESSARY C,AS BAFFLE � OVER MECHANICALLY
8 p, , COMPACTED BASE 4' 8.5' I ( 4' 4' 4.9' 4' FROM A NAIL IN A TREE AS SHOWN ON PLAN.
l
---------------- ---- I (TYP.) 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION
i 5 OUTLET DISTRIBUTION BOX 25.0 THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE
- __-- ^--_T--- TO BE INSTALLED ON A LEVEL STABLE 88.95'
, GROUND WATER ELEV= 12.9' AT 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT AN
BASE. FIRST TWO FEET OF OUTLET 94.50 DISCREPANCIES TO THE DESIGN ENGINEER.
EXISTING 1000 GALLON CONCRETE SEPTIC TANK PIPES TO BE LAID LEVEL. 2- 500 GAL. CHAMBERS 5'MIN. 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONCRETE
LENGTH 8'-6" WIDTH 4'� DEPTH `�� CROSS SECTION VIEW STRUCTURES SHALL BE MADE WATERTIGHT.
SEPTIC � I PROFILE
g�,r^�,�� C DISTRIBUTION
� �p-5 I �^y ���� �-},r �,r � �- �� TYPICAL CHAMBER PROFILE C HAM B ER DETAILS CHAMBER END VIEW 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR
R / L R C3 NOT TO SCALE NOT TO SCALE ZONING REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH
NOT TO SCALE
DETERMINATION FROM APPROPRIATE AUTHORITY.
- - - --_ �,'*�° V - 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS
• ' r. �: " +�/ « +� « TEST r I T DATA LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE
THEY SHALL WITHSTAND H-20 LOADING.
• "-' .' " TOWN AGENT: N.A. 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND
MAP 2701 * *� �� oc J S ; «. * .,�► SOIL EVALUATOR: Samuel Philos Jensen FINES.
w « " '• tt �.. *t + `�,, DATE: May 30, 2003 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND
• #"`� 1-11 � �`, ~� ,r � • UNSUITABLE MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF
PARCEL 111 « « , r « f TEST PIT#: 1 LEACHING FACILITY. REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN
N/F DIAS « " tl)11C „ y ,y
%"�, ELEV TOP= 98.95' COARSE SAND FREE FROM CLAY, FINES OR OTHER UNSUITABLE MATERIAL IN
w ' • y I} p ' " �^" l.r` ACCORDANCE WITH 310 CMR 15.255(3).
4ra0 `t� ELEV WATER= < 8E.95'
« a - 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN
(oil �a`wr PERC RATE < 2 MIN/IN SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK.
- 16. PROPOSED PROJECT IS LOCATED WITHIN:
DEPTH OF PERC- 26" 44"
ASSESSORS MAP 271 PARCEL 110
/ Q I• �( « « ' TEXTURAL CLASS: 1
B M a ,�� '" -" 17. OWNER OF RECORD: KAREN IRENE VERNEN
/ Nail in Tree Q « '"' • -"�- « '"" "` p gg 95 ADDRESS: 168 BUCKWOOD DRIVE
= w
Elev. 100.00
/ co * �r * „ . « � R � ,�, A Sandy Loam HYANNIS, MA 02601
/ Assumed • :, " . ,� * « . 10YR 3/2
�! , * 4" 98.62' FEMA FLOOD ZONE C
Q, coo
w.4 • « « " +� AS SHOWN ON COMMUNITY PANEL# 250001 0005 C
Sand Loam
ar �" « 0 ' " B y
INSTALL. TWO, 5O9-GAL ------- V M 00 s a a r �, M- 10YR 5/8 18. PLAN REFERENCE:
CHAMBERS J N a " , „
/ ' „ ( 25' 96.87' 1. L.C. PLAN 35404A
C-1 26 f-m-c Sand
/ F 1 , ,w '�- 10YR 6/6 19. DEED REFERENCE:
N� 120 00 �* (3 1'
� � M `� ,. 1. CERTIFICATE 140495
w
48" 94.95' 20. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION.
m-c Sand 21. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY
2.5Y 7/4 FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY
l'C "�. �� i1Ir��E�,, '� • yr „ FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE.
/ " * C-221
i
e
° MAP 271
/ o PARCEL 110 1�`k_. ,
LOCUS PLAIN
j z / No Groundwater
10,320 S.F.±
: _ ALE. 1 = 1000/ SC 120" Observed 88.95'
O 224, T l DE 1GN DATA LEGEND
o -CV �
/ 0 �, oN - NUMBER OF BEDROOMS: 2
/ w , / (EXISTING SYSTEM CAPACITY: 3 BEDROOMS) - EXISTING CONTOUR
NUMBER OF BEDROOMS: 3 (DESIGN, TITLE V MINIMUM)
DESIGN FLOW: 110 GPD/BDRM 50 PROPOSED SPOT GRADES
v O ! TOTAL DESIGN FLOW: 330 GPD
J #168 / DESIGN FLOW X 200 % = 660 GPD n PROPOSED CONTOUR
EXISTING 2 BEDROOM USE EXISTING 1000 GALLON SEPTIC TANK - -- E/r/C --- EXISTING OVERHEAD UTILITIES
IJ` DWELLING
t. 8'0' _ INSTALL TWO 500-GALLON CHAMBERS EXISTING WATERLINE
- 12.! GAS _ 18.0
/ TOP OF FOUND. EL. - 101.2' � g- I
GAS �-, > SIDEWALL CAPACITY GAS EXISTING GASLINE
GAS
0 L_ _ (LENGTH + WIDTH) (2 SIDES) (EFF. HEIGHT) (.74 GPD/SQ.FT.) = GPD
o� GAS 1
�- TEST PIT LOCATION
Y �'
o (25' + 12.9') (2) (2') (.74 GAUSQ.FT.) = 112.2 GAL. LEACHING/DAY
40
EXISTING 1000 GALLON SEPTIC TANK
00 / c _ I
- �� w BOTTOM CAPACITY ----- -
/ (LENGTH) (WIDTH) (.74 GPD/SQ.FT.) = GPD _-._
\t/ 4" SOLID SCHEDULE 40 PVC PIPE
o l (25') (12.9') (.74 GAL/SQ.FT.) = 238.7 GAL. LEACHING/DAY
`'` ! MAP 271 ❑ DISTRIBUTION BOX
DECK
7 '���J�'i 1 fl J \\
�.,x i TOTALS: _ �
- PARCEL 162
r O 500 GAL. LEACHING CHAMBER
TOTAL LEACHING AREA 474.1 SQ.FT.
DISTRIBUTION BOX I N/F OCONNOR TOTAL LEACHING CAPACITY 350.9 1GPD
w
E /
I „C,E
o TP �, WATER GARDEN WITH
` > u REV. DATE BY APP'D. DESCRIPTION
S _ GEOMEMBRANE LINER
0 BOTTOM EL. = 97.10'
PROPOSED SEPTIC SYSTEM UPGRADE
� '- _ - 98.95 / PREPARED FOR:
co 2
;Y r
I
MAP 2 71 4p,.w
KAREN VERNEN
LOCATED AT
PARCEL 109 `;� _ /
h 168 BUCKWOOD DRIVE
N/F PLOTCZYK �i ..._
�._ HYA N N I S
_ I RESERVED FOR BOARD OF HEALTH USE
0
SCALE: 1 INCH = 10 FT. DATE: JUNE 2, 2003
OF I 0 5 10 20 40 FEET
i
j _...
JOHN
CHURCHILL '" I PREPARED BY:
, ., , . ...ii', JR
CIVIL JC ENGINEERING, INC.
CD o NOTE: PROPERTY LOCATED IN A ZONE II +�eoT
2854 CRANBERRY HIGHWAY
EAST WAREHAM, MA 02538
SITE PLAN
508.273.0377 _
N _ (, Drawn By SPJ Designed By:SPJ Checked By JLC JOB No 460
,� SCALE: 1' - 10' ___-_. -----__.__