HomeMy WebLinkAbout0008 FOREST GLEN ROAD - Health 8 FOREST GLEN ROAD
Hyannis. y �,
A - 290 a;`012
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
8 Forest Glen Road 70
t.
' Property Address
Mark&Constance Vages i
Owner* Owner's Name
information is Hyannis Ma 02601 3/2/2017
required for every
page, Cityrrown 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 A. General Information
filling out forms ��
on the computer,
use only the tab 1. Inspector: -
key to move your
cursor-do not Sean M. Jones
use the return Name of Inspector
key.
S.M.Jones Title V Septic Inspection
"II=SI Company Name
74 Beldan Ln.
Centerville Ma 02632
City/Town State Zip Code
774-248-4850 smjonestitle5@gmail.com SI4522
Telephone Number License Number
B. Certification
I certify that 1 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
�3/2/2017
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 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 hupection 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
8 Forest Glen Road
Property Address
Mark&Constance Vages
Owner Owner's Name
information is required for every Hyannis Ma 02601 3/2/2017
page. Cityrrown 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:
® 1 have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
The dwelling located at 8 Forest Glen Rd Hyannis is served by a Title V septic system consisting of a
1500 gallon septic tank, distribution box and 6 Infiltrators. The system was found to be in proper
9 P Y P P
working condition at the time of inspection.
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•3113 Title 5 Offidal Inspection Form:Subsinface Sewer Disposal System•Page 2 of 17
Commonwealth of Massachusetts
. Title 5 Official Inspection Form
b Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
8 Forest Glen Road
Property Address
Mark&Constance Vages
Owner Owner's Name
information is required for every Hyannis Ma 02601 3/2/2017
page. City/rown 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-3113 Title 5 Offinal hispedon Fonm Svbswfaae Sewage Disposal System•Page 3 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
r 8 Forest Glen Road
Property Address
Mark&Constance Vages
Owner Owner's Name
information is required for every Hyannis Ma 02601 3/2/2017
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
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 Yi day flow
t5ins-3/13 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 4 of 17
I
Commonwealth of Massachusetts
ffi i I Inspection Form
Title Official p
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
a
8 Forest Glen Road
Property Address
Mark&Constance Vages
Owner owner's Name
information is required for every Hyannis Ma 02601 3/2/2017
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-
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 16,000 gpd.
For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the
questions in Section 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
f
Commonwealth of Massachusetts
a Title 5 Official Inspection Form
i Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
8 Forest Glen Road
Property Address
Mark&Constance Vages
Owner Owners Name
information is required for every Hyannis Ma 02601 3/2/2017
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): 4 Number of bedrooms(actual): 4
DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 440 gpd
t5ins•W3 TO 5 Offbal Yispectim Fonrc Sibstrfaoe sewage Dim system•Page 6 or 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
e 8 Forest Glen Road
Property Address
Mark&Constance Vages
Owner Owners Name
information is Hyannis Ma 02601 3/2/2017
required for every
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 ❑ Yes ® No
information in this report.)
Laundry system inspected? ❑ Yes ® No
Seasonaluse? ❑ Yes ® No
Water meter readings, if available(last 2 years usage(gpd)):
Detail:
Sum pump?
p p p ❑ Yes ® No
Last date of occupancy: vacant
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? ❑ Yes ❑ No
Water meter readings, if available:
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17
N Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
8 Forest Glen Road
Property Address
Mark&Constance Vages
Owner Owner's Name
information is Hyannis Ma 02601 3/2/2017
required for every
page. Cityrrown 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:
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•3113 TOa 5 offi W kgmcgan Fam&bmftw Sewage Disposal System•Page 8 of 17
Commonwealth of Massachusetts
lugTitle 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
8 Forest Glen Road
Property Address
Mark&Constance Vages
Owner Owner's Name
information Is required for every Hyannis Ma 02601 3/2/2017
page. cttyRown State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known)and source of information:
system installed 5/12/97 per town records
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
Depth below grade: 2.5feet
Material of construction:
❑ cast iron 2]40 PVC ❑ other(explain):
Distance from private water supply well or suction line: feet
Comments(on condition of joints, venting, evidence of leakage, etc.):
Joint were ok, no leaks,vented through the roof
Septic Tank(locate on site plan):
Depth below grade: 2
feet
Material of construction:
®concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain)
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
Dimensions: 1500 gallons
Sludge depth:
6"
t5ins•3113 Title 5 Official heron Form:Subsurface Sewage Disposal System•Page 9 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
8 Forest Glen Road
Property Address
Mark&Constance Vages
Owner Owner's Name
information is required for every Hyannis Ma 02601 3/2/2017
page. C4rrown 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
3"
Scum thickness
3"
Distance from top of scum to top of outlet tee or baffle 611
Distance from bottom of scum to bottom of outlet tee or baffle
10"
How were dimensions determined? opened covers,took
measurements
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Water level even with outlet invert, tank was structurally sound and not leaking. Tank should be
cleaned soon and again every 2 years for proper maintenance.
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•3113 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17
e Commonwealth of Massachusetts
Title 5 Official Inspection Form
i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
8 Forest Glen Road
Property Address
Mark&Constance Vages
Owner Owner's Name
information is Hyannis Ma 02601 3/2/2017
required for every y
page. Cityrrown 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.3/1 g Title 5 offidal hvection 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
8 Forest Glen Road
Property Address
Mark&Constance Vages
Owner Owner's Name
information is Hyannis Ma 02601 3/2/2017
required for every
page. City/Town 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.):
Distribution box was video inspected and found to be in good condition, no rot, water level was even
with outlet invert.
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•3113 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
8 Forest Glen Road
Property Address
Mark&Constance Vages
Owner Owner's Name
information is required for every Hyannis Ma 02601 3/2/2017
page Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Type:
❑ leaching pits number:
® leaching chambers number:
6 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.):
s.a.s. consists of 2 rows of 3 Infiltrators. No sign of past hydraulic overloading.
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
I
Indication of groundwater inflow ❑ Yes ❑ No
t5ins•3113 Title 5 Offidal hupeaion Form:Subsw1we Sewage Disposal System-Page 13 of 17
i
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
8 Forest Glen Road
Property Address
Mark&Constance Vages
Owner Owner's Name
information is Hyannis Ma 02601 3/2/2017
required for 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.):
15ins-3113 Title 5 Official Inspection Forth: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
8 Forest Glen Road
Property Address
Mark&Constance Vages
Owner owner's Name
information is required for every Hyannis Ma 02601 3/2/2017
page. 041'rown 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
i
N1�
A 7'�
�( SS
.A 3 2
A3 Kf
B3 �l'6
tsins•3113 rule 5 OFfCal 6nspediai Form:Subsxface Sewage Disposal System•Page 15 of 17 i
41
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
8 Forest Glen Road
Property Address
Mark&Constance Vages
Owner Owner's Name
information is Hyannis Ma 02601 3/2/2017
required for every
page. Cityrrown 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: 12'+
feet
Please indicate all methods used to determine the high ground water elevation:
❑ Obtained from system design plans on record
If checked, date of design plan reviewed: Date
❑ Observed site(abutting property/observation hole within 150 feet of SAS)
❑ Checked with local Board of Health-explain:
❑ Checked with local excavators, installers-(attach documentation)
❑ Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
Groundwater elevation was determined by accessing Town of Barnstable groundwater contour map.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins-3113 7i1le 5 Official hspedion form:SOaface Sewage Disposal System•Page 16 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
8 Forest Glen Road
Property Address
Mark&Constance Vages
Owner Owners Name
information Is
required for every Hyannis Ma 02601 3/2/2017
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-3l13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17
TOWN OF BARNSTABLE
LOCATION , CYkJe.N 1t-C1 SEWAGE # 7
VILLAGE! nMiS ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO.&O t,/\ a agL
SEPTIC TANK CAPACITY
LEACHING FACEL=: (type) (size) j!�)
NO.OF BEDROOMS
BUELDER OR OWNER
PERMITDATE: jCOMPLIANCE DATE:n/-2 If 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) �/�'f)�..QV Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) QvIk Feet
Furnished by
Q to � �
�� � � � �
� � ° `�
X � X �
oC w
� O
O
_ �
II
r
Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
01pp[ication for ]Df5po0ar by.5tem Construction 3dermit
Application for a Permit to Construct( )Repair(V)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. � Owner's N e,Address and Tel.No.
f,,,��r�
Assessor's Map/Parcel � 1 �- `�f Vk,A_ Z0Y1Sb J\ (I(A.
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
Type of Building:
Dwelling No.of Bedrooms _ Lot Size sq. ft. Garbage Grinder( -
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank/170 0 Type of S.A.S. 4IN +c-&y.krl.Y
Description of Soil zg& pti��
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 Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued by this Board o<ealt !��
Signed Date /
Application Approved Dater
Application Disapproved for the following reasons
Permit No. q2 Date Issued '—
No. / Fee
J
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
4
Application for i.5pogal *pgtem Congtructton Permit
Application for a Permit to Construct( )Repair(V)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. 1 Owner's N e,Address and TQ1.No.
Assessor's Map/Parcel ��Q V �^i `a � 0� '�O'f ^ lA
Installer's Name,Address,and Tel �Io. -, � Designer's Name,Address and Tel.No.
3c.0� M �-r,^ � 61 F, l l \
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(�J -
Other Type of Building No.of Persons Showers( ) Cafeteria( )
•a
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
t Title
Size of Septic Tank ITO —Type of S.A.S. /r"R.
4 V/ _
Description of Soil
1
Nature of Repairs or Alterations(Answe whenjapplicable)
v G c.1. '�c.�/�l/� 1.S C�?C .SCE S O czr
Co / 3'-S" P4 s
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 issuied by this Board o ealt
Signed Date /
Application Approved Date` `
Application Disapproved for the following reasons
v
Permit No. Date Issued
---------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of (Compliance
THIS IS TO C TIFY,that the On-site Sewage Disposal System Constructed( )Repaired(Upgraded( )
Abandoned )by L V`_ S
at C6 �{S has been constructed in accordance
with the provisions of Tid 5 and the for Disposal System Construction Permit N dated - —Y—9 7
Installer 5C6 MG.S S C a f&- Designer S�t� ���5 e cx G1 Lt-.
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
Date 2 7 Inspector
.a_ 1
------------------------------------------
No� -- � Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
Mtgpogar Opgtem Congtruction Permit
Permission is hereby granted to Construct( )Repair( Upgrade( )Abandon( )
System located r-euS-V C=rt C'^ O-r) S
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: Cons on must be com leted within three years of the date of 't. -
Date: r Approved
�f /c
/
TOWN OF BARNSTABLE ^�a
;LOCATION � 5� Apr SEWAGE # J
VELLAGE S c ^^"s ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY
IsEACHING FACILITY: (type) b �f\�r���cc��(1f 3 (size) f o) �• S�U'<�
NO.;OF BEDROOMS
.::-M'MDER OR OWNER
PERMITDATE: _�f COMPLIANCE DATE: /Z If 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) ,/��U..� Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
.within 300 feet of leaching facility) �c��� Feet
Furnished by
d
oo ` �cojC .0ia
n�
ASSE,S50PS MAP N6 „
TROY WILLIAMS PMCB.Na -=�
SEPTIC INSPECTIONS
fy,-`
Certified by MA Department of Environmental Protection (508) 760-1815
40 Old Bass River Road
South Dennis,MA 02660
J
Cof monweatih of MCWOChwem h V
Executive Office of Envkorm ild Affairs BAN Cfj -D
Department of .� 3 ,1
Environmental Protection 1996
Oavldtruhaowninwilioner
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION �o S� Ft�IN Gh c S
Property Address: 8 Fos -S f �i le h Rd Address of owner."/o/Vt V G S
Date of Inspection; i �1S/y (If different) /
Name of Inspecton-o yy� !rl i 1; "r, S /a
Company Name,Address atSd Telephone Number.. MCA u ss, o / $ d S y
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate
and complete as of the time of inspection..The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewage disposal systems. The system:
Passes
Conditionally Passes
Needs Further Evaluation By the Local Approving Authority
Fails
Inspector's Signature. Date:
/a
The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this
inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit
the report to the appropriate regional office of the Department of Environmental Protection.
The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority.
INSPECTION SUMMARY:
Check A, B,C, or D:
Al SYSTEM PASSES: n/11_9
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 criteri�olr>evaluated are indicated below.
61 SYSTEM CONDITIONALLY PASSES: /c/%
One or more system components need to be replaced or repaired. The system, upon coompletion of the replacement or repair,
passes inspection.
tnd�cate yes, no, or not determined (Y. N, a ND). Describe basis of determination in all instances. If'not determined', explain why noc)
The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or exflltration, 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.
(re�1•cd a/is/95) 1
I
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: Tp,.L S� Icti
Owner.
Fev eA s
Date of In
spection: I /.? A9 S`
61 SYSTEM CONDITIONALLY PASSES (continued)
— Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed
pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the
Board of Health):
broken pipe(s) are replaced
obstruction is removed
distribution box is levelled or replaced
The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass
inspection if(with approval of the Board of Health):
broken pipe(s) are replaced
obstruction is removed
CI FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:N//9
Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the
Public health, safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER
WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh.
2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT
THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE
ENVIRONMENT:
T he system has a septic lank ano son absorption system and is within 100 feet to a surface writer supply or tributary ;c, a
surface water supply.
The s\•stem has a septic tank and soil absorption system and is within a Zone I of a public water supply well.
The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well.
The systen, has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water
supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is
free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than S
ppm.
SYSTEM FAILS:
_z I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis
for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct
the failure.
N Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool
Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or
cesspool
seo 6/15/5Si
y
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM t '
PART A
CERTIFICATION (continued)
Property Address: 8 F,,,,t 5
Owner. FGM HGa-kd L
Date of Inspection: f 42 r/�6
DI SYSTEM FAILS (continued):
/yq Static liquid level in the distribution box above outlet invert due to an overloaded or dogged SAS or cesspool.
Liquid depth in cesspool is less than 6' below invert or available volume is less than 1/2 day flow.
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Number of times pumped
Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation.
C.t-, 01S -4✓�u1 ,4--b .S<. wafer✓ -)zr-b).< .
N Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
N Any portion of a cesspool or privy is within a Zone I of.a public well.
�( Any portion of a cesspool or privy is within 50 feet of a private water supply well.
�r Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no
acceptable water quality analysis. If the well has been analyzed to be acceptable,.attach copy of well water analysis for
coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen.
EI LARGE SYSTEM FAILS: N//3
The following criteria apply to large systems in addition to the criteria above:
The design flow of system is 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety
and the environment because one or more of the following conditions exist:
the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area (IWPA) or a mapped Zone it of a
public water supply well)
I he owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program
Nuirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.
:�� 6�a B/1S/951 3
f
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM `''`
PART B ,.
CHECKLIST
Property Address:
Owner.
Date of Inspection:
I
Check if the following have been done:
Pumping information was requested of the owner, occupant, and 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 recently or as part of this inspection.
N41 As built plans have been obtained and examined. Note if they are not available with WA.
The facility or dwelling was inspected for signs of sewage back-up.
✓The system does not receive non-sanitary or industrial waste flow
ZThe site was inspected for signs of breakout.
JL"'AII system components, excluding the Soil Absorption System, have been located on the site.
MIA 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.
fThe size and location of the Soil Absorption System on the site has been determined based on existing information or
approximated by non-intrusive methods.
_ The facility ONN---• to-d oc(-urants, if different from owner) were provided with information on the proper maintenance of Sub-
Surface Disposal System.
:cviaed 8/1S/9Si 4
xti,
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM }
PART C .
SYSTEM INFORMATION
Property Address: C/ Foe 6 Leh
Owner. s
Date of Inspection:
/ /ar/5c
FLOW CONDITIONS
RESIDENTIAL:
Design flow: yo gallons
Number of bedrooms:
Number of current residents: 3
Garbage grinder(yes or no): A/o
aundry connected to system (yes or no): 5
seasonal use (yes or no): HO
Water meter readings, if available:
ast date of occupancy: ec.c-vim: --.d .
COMMERCIAUINDUSTRIAL•,X1(//?
ype of establishment:
)esign flow: aallons/day
rease trap present: (yes or no)_
ndustrial Waste Holding Tank present: (yes or no)_
von-sanitary waste discharged to the Title S system: (yes or no)_
.eater meter readings, if available:
ast date of occupancy:
OTHER: (Describe)
ast date of occupancy:
GENERAL INFORMATION
"UMPING RECORDS and source of information:
Q ✓.�.�' tidt �yif �r� r .c✓ i...� o � h c J- �•-M �.o�*..� � v�Jh Cv.
System pumped as pan of inspection: (yes or o)�: S
If yes, volume pumped SD U gallons
Reason for pumping: CCL,��� �,-n,��� c✓4�-cr r „ >S l�, oh
YPE 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)
Other (explain)
-\PPROXIMATE AGE of all components, date installed (if known) and source of information: i e ; tiu 4 a r. t
r•wage odors detected when arriving at the site (yes or no)
eVlsed eitSrvsj S
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM €�
PART C :_
SYSTEM INFORMATION (continued) t'
Property Address: 8 For 1-5 Icy„
Owner:
Date of Inspection:
. i
SEPTIC TANK:LS//q
(locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _FRP_other(explain)
Dimensions:
S I udge 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'.
,ntegrity, evidence of leakage, etc.)
GREASE TRAP: LV/A
locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _FRP _other(explain)
Dimensions:
,cum thickness.
Distance from top of scum to top of outlet tee or baffle:
li5lance from bottom r%t cram In h0nnm OI OUtIPt tee or banle.
omments:
recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural
n(egrity, evidence of leakage, eio
d 8;IS/9Si
6
,p
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continue
Property Address: $ ro✓,S �c a
Owner. rGv h U h d C S
Date of Inspection:
, /as/7 �
TIGHT OR HOLDING TANK:lyfI9
)locate on site plan)
Depth below grade:
material of construction: _,concrete _metal _FRP--.other(explain)
Dimensions:
-apacity: xallons
Design flow: gallons/day
-\]arm level:
omments:
condition of inlet tee, condition of alarm and float switches, etc.)
DISTRIBUTION BOX:A114
ovate on site plan)
)epth of liquid level above outlet invert:
omments:
tote ii level and distribution is equal, e,.idence of solids carryover, evidence of leakage into or out of box, etc.)
UMP CHAMBER:_,LA///�!
ovate on site plan)
'amps in working order.(yes or no)
omments:
rcoo,.e, ndition of pump chamber, condition of pumps and appurtenances, etc.)
d S/1S/95)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address:
Owner. / cr tia c 5
Date of Inspection:
SOIL ABSORPTION SYSTEM(SAS):—z
(locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods)
f not determined to be present, explain:
T ype:
leaching pits, number:_
leaching chambers, number:_
leaching galleries, number:
leaching trenches, number,length:
leaching fields, number, dimensions:
overflow cesspool, number. O�r•c o /�, cGS oo �. '�ij�� K �.� .
omments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.) o
5a. .-r•- A S�oh� �/U Suss- S o� . �✓tt��• L �.�ri or
0 .is er
CESSPOOLS:
locate on site plan)
4umber and configuration:
)epth-top of liquid to inlet invert: /C>
)epth of solids layer:_ "
)epth of scum layer:_ 1 '
)lmensions of cesspool: '" <,� k S '�(;K ., •�i3•
-1aterials of construction: c s, j,oo 1 0 {�
idication of groundwater: y S. .
inflow (cesspool must be pumped as part of inspection) -c s S n y c� ;�vim, o t d
a
fv�*-cam a
Grovh Jl ./G-� cr
•. -� 1 �-r-�.,fi �., ' �, c•�s s� o ( w u s r_�wn s c.••� 7—
omments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)/
R IVY:
,cafe on site plan)
Materials of construction: Dimensions:
lepth of solids:
omments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
e-ised B/15/951 8
{
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C ?r: },,•.,
R 4L :t
SYSTEM INFORMATION (continued) `
Property Address:
Owner. r-c,—h -s
Date of Inspection;
SKETCH OF SEWAGE DISPOSAL SYSTEM;
Ind4de ties to at least two permanent references landmarks or benchmarks
locate all wells within 100'
15 '
/`•µl�• CCSf�J�ol S ✓ 0 wT lam•
/
L r
11PTH TO GROUNDWATER
,epth to groundwater: fl. S feet /y / adjusted high groundwater level �
Method of determination or approximation:_.-A /Q„ CI 4--h
C•- �f-, ✓Y'� .., a- -lCr L. � L/ , o o ✓ h i1 w�.�--e r ✓t i S 5 o �- S4- Z
�✓ /q 6c �?.� �S��S�t l�✓ 1b Y>roXi v+ T4 U / (�c�� t✓ •-lJvh e / /L1a L,
� 3 L y
S G " bolo j ��JJ -,.A wa.4�� ,
—ised 8/15/951 9
r
Permit Number: Date:
Completed by: fT I-/; . a 06,
HIGH GROUND-WATER LEVEL COMPUTATION f;
Site Location: Forma� G Lot No.
Owner: Address:
Contractor: Address:
Notes:
STEP 1 Measure depth to water table
tonearest 1/10 ft. .............................................................................. .Date
month/day/year
STEP 2 Using Water-Level Range Zone
and Index Well Map locate
site and determine:
OAppropriate index well.................................................... M r u 25
OB Water-level range zone ..................................................... C. ?
STEP 3 Using monthly report "Current
Water Resources Conditions"
determine current depth to
water level for index well ...........................
month/year
STEP 4 Using Table of Water-level Adjustments
for index well (STEP 2A),current depth
to water level for index well (STEP 3),
and water-level zone (STEP 26)
determine water-level adjustment ........................ �•
STEP 5 Estimate depth to high water
by subtracting the water-
level adjustment (STEP 4)
from measured depth to water
C
levelat site (STEP 11 ............................................................................................................. �.
TOWN OF BARNSTABLE
LOCATION f C- SEWAGE#
VILLAGE 4 h r ASSESSOR'S MAP&LOT
IN STALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILrrY: (type) (size)
NO.OF BEDROOMS
BUILDER OR OWNER
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility S — ( 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 --'( LJ ' l l -- - -\
S
1�,
1 �.s
� a _
�4
(`= o
��
n
� �-
�.
-� I
� II
GENERAL NOTES : ACCESS COVERS MUST BE WITHIN 9' MINIMUM.6' OF FINISH GRADE INVERT ELEVATIONS : DESIGN CR I TER I A :
I. THIS PLAN /S FOR THE DESIGN AND CONSTRUCTION 101. 7/ 3' MAXIMUM COVER INVERT AT BUILDING */ : _97. 21 DESIGN FLOW:
OF THE SEWAGE DISPOSAL SYSTEM ONLY. FIRST 2' TO INVERT AT BUILDING *2: _ 96. 3/ _4_BEDROOMS AT_L.4 G. P. D. PER
BE LEVEL MIN 2' OF PEASTONE
INVERT /N SEPTIC TANK: 95. 43 _ BEDROOM EQUALS 440G. P. D.
2. ALL CONSTRUCTION METHODS AND MATERIALS AND 4' PVC -"
MAINTENANCE OF THE SEPTIC SYSTEM SHALL SCHEDULE 40 T
. -3/4' - l l/2' D/A. INVERT OUT SEPTIC TANK: 95, l8 _
CONFORM TO MASS. D.E.P. TITLE 5 AND LOCAL `� S /B 9� !3.! WASHED STONE INVERT IN DIST. BOX: 94. 7 NO GARBAGE GRINDER
97.2I cas .
BOARD OF HEALTH REGULATIONS. 96. 31 AOAFFLE 94 7 i° 2 SETS OF 3 STANDARD
95 �---j--- INVERT OUT DJST. BOX: 94. 53 _
OUTLET INFILTRATORS W/3.5' STONE AROUND SEPTIC TANK REQUIRED:
J. ALL SEPTIC SYSTEM COMPONENTS LOCATED UNDER144me3ommum _L INVERT /N LEACH CHAMBER: 94. 48
l0 ' MIN. D-BOX 10'x 26'x 7' EACH
AREAS SUBJECT TO VEHICULAR TRAFFIC OR GREATER ------ 1500 GAL BOTTOM OF LEACH CHAMBER: 93. 9 440 G. P. D, X 200X - 880 GAL .
SEPTIC TANK 6' CRUSHED STONE BASE SEPTIC TANK PROVIDED:_-__1500 GAL .
THAN 3' l N DEPTH SHALL BE CAPABLE OF WITH- _ -
STANDING H-20 WHEEL LOADS. ADJUSTED GROUND WATER: 88_9
4. ALL SEWER PIPE SHALL BE SCHEDULE 40 OR PROFILE : Nor TO SCALE OBSERVED GROUND WATER: 87. 5 SOIL ABSORPTION SYSTEM REQUIRED:
APPROVED EQUAL.
BOTTOM OF TEST HOLE #1 : 87. 0 DES/GN PERC RATE -_ ( _5_M/N/I NCH
-
INDEX WELL A /W 230. ZONE C SOIL TEXTURAL CLASS - __1_,
5. BEFORE CONSTRUCTION CALL 'DIG-sAFE'. 2/97 READ I NG-2/ . 9. I . 4 ' ADJ. EFFLUENT LOADING RATE - 0. 74 GPD/SF
1-800-322-4844 AND THE LOCAL WATER DEPT. _440 GPD / 0.,7-4 GPD/SF -__59_5__S. F.
FOR L OCA T/ON OF UNDERGROUND UTILITIES.
6. VERTICAL DATUM IS: ASSUMED N PROVIDED:2___�EI_S _OF__3 ARD
INFILTRATORS W/3 5 ST _AROD. _
7. FOR BENCH MARKS SET. SEE SITE PLAN.
A - 604f S. F.
8. EXISTING CESSPOOLS TO BE PUMPED DRY AND ,
BACKF/LLED. / SOIL TEST P I T DA TA
\ / // % PERCOLATION OBSERVED
9. ALL UNSUITABLE MATERIAL (A 6 8 HORIZONS) INDICATES V_ INDICATES
' l -
ENCOUNTERED BELOW THE INVERT OF THE LEACHING ,' / TEST GROUNDWATER
FACILITY TO BE REMOVED FOR A DISTANCE OF 5 . e'/lo' OAK
/
AROUND AND REPLACED WITH SAND IN ACCORDANCE � � , TP#-_f --
/ GRND EL.96. 0_
S 86
WITH TITLE 5. 27'56'W
G. W.EL. 87. 0
/0. WHERE THE SEWER LINE CROSSES THE WATER LINE.
A��
'R. X SETS OF J% Q / HOR/ZON TEXTURE COLOR OTHER 96. 0
THEY SHALL BE CONSTRUCTED IN ACCORDANCE WITH �� - ------------
STATE AND LOCAL REQUIREMENTS. '9� %IWILTRATyas ' -�` /0. 4.��CEU1R / 0
-' ,-' ! II/J.S' ONE ' -� / `A LAND !OYR
��, � -- � -..� hIE'DgE / / SAND
2/2
-96------E�ONC'PAD 12'--r.............................................................195. 0
__-- LOAMY /OYR GRAVEL
•�J�,�•',_ ,�-� _ ,D o o / / D SAND 5/6
SSP00L� ~` I" O. 7�?/�/' // 24' ...194. 0
CLEAOUi- -°- s -'` �,�i �� �I / 1 COARSE /OYR GRAVEL
/500 aft ? /y�v SAND 6/6
//l .- PORCH PATIO `� - T/C TANK ; I/ 48'
�•9� ��i , t _� PATIO 1 , /
,y ,
OARAOf EXISTIN® FOUR BEDROOM
DMELLI)V®. TOF-101.71
/02- 87.5
ol
CLEAMWT' --
-- - -
DR I vEtra r I ,�; / l 08' i87.0
tl Lu ssrooc // // �CBroH FND DATE: FEBRUARY 11 . 1997___
N LOT 30 TEST BY: STEPHEN_HAAS_
WITNESSED BY: JER_RY_ DUNNING
26. 664+ S . F. PERC RATE'-?--__ M/N/INCH
►L� ,\oQ Al•
S EP T / C S YS TEM - S / c�^�
N 87' 16'oo'E CO FND 8 OR E-S T GL E/V R Owl O IWA P 29 O P.4 R
SA R /V S TA S L E . t f-/ Y 4 /V/V / S > MA
„ � PREP,4 REU FOR
E_WE- Y A 1.'E- . B O yL S T O/V . Mil . O / S O S
L S A TT
s /N s O R;TII�a No.35461 S CA L E .a P R / L
.E'14 G.L E' -5 UR trE'YI NG Bi E'NG I NE'E'R I NG . I NC .
} s I
Y
r' YcrrmO u O MA
� I
C5' ® � � 362 - � 1 32
i r 67 0 4 q.? 67 3 3 3
LOCUS MAP �� �! -�- -o !0 20 40 JOB NO: 96-401 FIELD:CFW/EEK CALC: SAH/TAW CHECK: CFW DRN: SAH