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HomeMy WebLinkAbout0001 GENERAL PATTON DRIVE - Health 1 General Patton DriveY Hyannis F/R - A = 292 095 E ' X a gar Commonwealth of Massachusetts Title 5 Official Inspection Form i; Subsurface Sewage Disposal System Form -Not for Voluntary Assessments , 1 General Patton Drive Property Address Alexander Doxsey 3: Owner Owner's Name information is requited for every Hyannis MA 02601 10-16-2020 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information on the computer, use only the tab Michael T Bisienere key to move your Name of Inspector cursor-do not Cape Septic Inspections use the return key. Company Name 52 Rivers End Road YQ Company Address Teaticket Ma. 02536 _ City/Town State Zip Code 1B�n 508-280-3356 S13938 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: - 1. ® Passes - 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 10 17 2020 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of i 1 10,000 d or greater, the inspector and the system owner shall submit the report to the a ro riate 9P 9 p Y P pp� p� regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection form:Subsurface Sewage Disposal System-Page 1 of 18 f Commonwealth of Massachusetts Title 5 Official Inspection Form I; Subsurface Sewage Disposal System Form - Not for Voluntary Assessments .V 1 General Patton Drive Property Address Alexander Doxsey Owner Owner's Name information is required for every Hyannis MA 02601 10-16-2020 — page. City(rown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: � ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: This 3 bedroom home has a 4 bedroom designed septic system. There is an H-10 1500 gallon septic tank and a D-Box feeing a 10 x 40 leaching trench with infiltrators. At the time of the inspection no visible failure criteria was found. 2) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1 General Patton Drive Property Address Alexander Doxsey Owner Owner's Name information is Hyannis MA 02601 10-16-2020 required for every y page. CityTTown State Zip Code. Date of Inspection C. Inspection Summary (cont.) s' 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced . ❑ Y ❑ N ❑ ND (Explain below):_._... ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below) ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s)-.The system will pass inspection if(with approval of the Board of Health): - ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts �^ Title 5 Official Inspection Form lIa Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1 General Patton Drive IT, v Property Address Alexander Doxsey Owner Owner's Name information is required for every Hyannis MA 02601 10-16-2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water >: ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if 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". y Method used to determine distance: <t�t **This system passes if the well water analysis, performed at a DEP certified laboratory, forrfeeal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen Is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: -rr is 4) 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 El ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18; E t r S-0G YYd Commonwealth of Massachusetts �- Title 5 Official Inspection Form I, Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1 General Patton Drive Property Address Alexander Doxsey Owner Owner's Name information is required for every Hyannis MA 02601 10-16-2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) °r 4) System Failure Criteria Applicable to All Systems: (cont.) "R Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or Fact:*v- 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 s6l ply4 or s„ tributary to a surface water supply. ti Any portion of a cesspool or privy is within a Zone 1 of a public water supply, El ® 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 v t 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 2000-gpd ' 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. r:t fay For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1 General Patton Drive Property Address ; s Alexander Doxsey .f...l. Owner Owner's Name information is required for every Hyannis MA 02601 10-16-2020 page. CityrTown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. . . . . 6. You must indicate "yes" or"no"for each of the following for all inspections: w"aT_' t. t . 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 disposalsystems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: vw;` ® ❑ 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)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts �- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ........... !% 1 General Patton Drive Property Address Alexander Doxsey Owner Owner's Name information is required for every Hyannis MA 02601 10-16-2020 page. Cityrrown State Zip Code Date of Inspection D. System Information , r;E. 1. Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 plus GPD Description: V Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No s information in this report.) Laundry system inspected? ❑ Y:esr[D. No Seasonal use? ❑ Yes, '® No Water meter readings, if available last 2 ears usage Town water 9 ( Y 9 (gPd))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: occupie&-4Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1 General Patton Drive Property Address Alexander Doxsey Owner Owner's Name information is required for every Hyannis MA 02601 10-16-2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. 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 Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No =" Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: .,_�_ Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 r Commonwealth of Massachusetts , r" Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1 General Patton Drive Property Address Alexander Doxsey Owner Owner's Name information is required for every Hyannis MA 02601 10-16-2020 page' City(rown State Zip Code Date of Inspection D. System Information (cont.) �,.. 4. Type of System: _ •r.= ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 04-27-2005 Were sewage odors detected when arriving at the site? ❑ Yes ED LNo 5. Building Sewer(locate on site plan): 39,E Depth below grade: feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: Town water oauf�' feet Comments (on condition of joints, venting, evidence of leakage, etc.): Water was flushed and came freely. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 Commonwealth of Massachusetts �v Title 5 Official Inspection Form t1 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1 General Patton Drive Property Address Alexander Doxsey Owner . Owner's Name information is required for every Hyannis MA 02601 10-16-2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): 301. Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No _ Dimensions: Standard H-10 1500 gallon Sludge depth: ' Distance from top of sludge to bottom of outlet tee or baffle Scum thickness 1" 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 13" How were dimensions determined? sludge judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural,integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): I recommend the new owner put the septic tank on a maint. plan with a local septic pumping.,co- - ''" based on the future use of the home. At the time of inspection the liquid level was at working-level and the tee's were in place. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of'18'.l Commonwealth of Massachusetts �n Title 5 Official Inspection Form. la Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1 General Patton Drive Property Address Alexander Doxsey Owner Owner's Name �- information is required for every Hyannis MA 02601 10-16-2020 page. Cityrrown State Zip Code Date of Inspection r' D. System Information (cont.) 7. 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 T Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other;(ezplaih)- Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection. Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u.� 1 General Patton Drive Property Address Alexander Doxsey Owner Owner's Name information is required for every Hyannis MA 02601 10-16-2020 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) - 8. Tight or Holding Tank(cont.) _= Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): 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.): At the time of the inspection the liquid level was at working level and there were no visible sig,ns;of; V leakage or solids carryover. t5insp.doc•rev.7/26/2018 Title 5 Oficial Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments V 1 General Patton Drive Property Address Alexander Doxsey Owner Owner's Name information is required for every Hyannis MA 02601 10-16-2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) - 10. Pump Chamber(locate on site plan): Pumps in working order: ElYes ❑ W"fl 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. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: one a x. 10 x 40 ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u!% 1 General Patton Drive Property Address Alexander Doxsey Owner Owner's Name information is required for every Hyannis MA 02601 10-16-2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): At the time of the inspection no visible failure criteria was found. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer ''" Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): M . ram,r t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 ' J Commonwealth of Massachusetts Title 5 Official Inspection Form <I�� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments V 1 General Patton Drive Property Address Alexander Doxsey Owner Owner's Name information is required for every Hyannis MA 02601 10-16-2020 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 13. 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.): er't: �yF=� lJ 7 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1 General Patton Drive Property Address Alexander Doxsey Owner Owner's Name information is required for every Hyannis MA 02601 10-16-2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters- the building. Check one of the boxes below: hand-sketch in the area below ❑ drawing attached separately I s V —----- y�-may- ; 3 - 2t` d t{ ' 36-6" � S`• ya Z, 40' y a' -yg j i — rf t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page%of 18 Commonwealth of Massachusetts n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1 General Patton Drive Property Address Alexander Doxsey Owner Owner's Name information is required for every Hyannis MA 02601 10-16-2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 10 plus feetfeet 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 pro pertyiobservation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database -explain: t You must describe how you established the high ground water elevation: augered a hole at a lower elevation and shot it with a transit. Before filing this Inspection Report, please see Report.Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 i - Commonwealth of Massachusetts �. p Title 5 Official Inspection Form 1 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1 General Patton Drive Property Address Alexander Doxsey Owner Owner's Name information is Hyannis MA 02601 10-16-2020 required for every H y ' page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: ow 1, 2, 3, or 5 completed as appropriate . - p@ 4 (Failure Criteria) and 6 (Checklist)completed ® D. System Information: For 8: Tight/Holding Tank— Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included I'Q�i�D�, • _ rsr - t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 TOWN OF BA.RNSTABLE `l q jCATi01 1 de r �UZ14 SEWAGE #`'0065 VILLAGE Y`�.t'A I ilf- ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. ,��' SEPTIC TANK CAPACITY LEACHING FACILITY: (type) �Na ze) ( NO. OF BEDROOMS BUILDER OR OWNER PERMITDATE: �- ,� "'COMPLIANCE DATE: 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 N �f I cli r3 , I - No. DIl O �� :____ { Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: es PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppricatfon for 30iopoof *p6tem Conotruction Permit Application for a Permit to Construct N)Repair( )Upgrade( )Abandon( ) Complete System ❑Individual Components Location Address or Lot No.4 1 (nA& GA [j,}N'6n t y- Owner's Name,Address and Tel.No. t t�.v�r tS eoo�ros*�i tlsz t U/e- Assessor's Map/Parcel 2 Z ✓ �'� (o Installer's ame Address, d Tel.No. Desi ner's Name,Address and Tel.No. W-6040— N'to �q 81Z Mawr, `;+-1 Os-F--exvt�le-, Type of Building: Dwelling No.of Bedrooms Lot Size 23Zsq.ft. Garbage Grinder(PA Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gadons. Plan Date , o Number of sheets Revision Date c5 Title 171s -_Q Size of Septic Tank L�aCCX� c.�n.� . ) Type o S.A.S. C66TIt�.lnc_w../��2�' Description of Soil �A _C � S�10n. � 41) / sA� Lac ok P fir~ (U�jr/u Ya r Nature of Repairs or Alternations(Answer when applicable) %A41 ter �lS S� dLo Date last inspected: Agreement: The undersigned a r s t e the c nst c ` and maintenance of the afore described on-site sewage disposal system in accordance with the rsion itle E ironmental Cede and not to place the system in operation until a Certifi- cate of Compliance has b e b d alth. Signed Date Application Approved by Date a Application Disapproved for the ollowing reasons Permit No. Date Issued q 1 Fee fl� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: es 'w PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS S:a ZippYication for 3iopoml *p!tem Construction Vermit Application for a Permit to Construct N)Repair( )Upgrade( )Abandon( ) IWomplete System 1:1 Individual Components ` Location Address or Lot No. GkA-4 AO.A Owner's Name,Address and Tel.No. t 4 Assessor's Map/Parcel ,� `AWN t v . Z M � co I o�l-�v►lt� M�'gq. _ O S Installer's, ame Address,Od Tel.No. Designer's Name,Address and Tel.No. / 6 � a�L S*-, o —, M Pr 4 Type of Building: - Dwelling No.of Bedrooms Lot'Size— I Z-3—Zsq.ft. Garbage Grinder(ll1i� Other Type of Building`- �e No. of Persolts Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gaUans. Plan Date A I 105Number of sheets Revision Date 44— Title t S 1-I'ye. v 1 S � Size of Septic Tank lc;&) Q01 . Type of S.A.S. '6o Descri tion of Soil ,, �, ..vt� SCaa l �AKc� su_ IAc,. 0/x�° Y-.01 / .�. , Nature of Repairs or\Alterations(Answer when applicable) )C.i�'I+inc 4)?S zn l I&<I . c.C)►w���� t Date last inspected: O Agreenfenti The undersigned a gees a the c ns c ' and maintenance of the afore described on-site sewage disposal.system in accordance with the vision itle e E ironmental Code and not to place the system in operation until a Certifi- cate of Compliance has b n ' b i d ealth. Signed Date Application Approved by �� Date a Application Disapproved for the ollowing reasons l Permit No. D 00 Date Issued 0 S --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of QCompliance THIS IS TO CE IFY, that the O% S te wage Disposal System Constructed( )Repaired(Upgraded( ) Abandoned( )by � � ru^1 T�c,c at e/ A has been constructed in accordance with the provisio f Title 5 and the for Disposal System onstruction Permit No. o'Z — dated Installer 4 Designer The issuance of this permit sha ont be construed as a guarantee that the sy ern w' as signed. Date Inspector - --------------------------------------- Fee UU — THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS 3MOpoOar *pOtem Construction 3permit Permission is hereby granted to Construct( )Repair(grade( )Abandon( ) System located at �.�dl rn a =` �+ / �, /w wt f 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. r Provided:Cons ll ction/must be completed within three years of the date ofk[i rmit.� Date: �f � / A Approved by -. e l TOWN OF BARNSTABLE CATION Y'�,' / Y�d7'//� � a ✓ SEWAGE #2,265 VII LAGE ( ASSESSOR'S MAP& LOT G� INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY nn LEACHING FACILITY: (type) 1�� 11ze) NO.OF BEDROOMS BUILDER PR OWNER PERMIT DATE: v COMPLIANCE DATE; 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 Furnish-H by I ' Jh Y 9 z� 9/16103 Notice: This Form Is To Be Used For the Repair Of Failed Septic Systems.Only ..PERCOLATION TEST AND-SOIL EVALUATION EXEMPTION FORM I, hereby certify that the engineered plan signed by me' dated ®� concerning the property located at Dlz• r1 I meets all of the following criteria: • This failed system is connected to a residential dwelling only. There are.no commercial or business.uses associated with the.dwelling. • The,soil is classified as.CLASS I and the percolation rate is less than or equal to 5 minutes per inch. The applicant may use historical data to conclude this fact or may conduct deep test holes and percolation tests at the site without a health agent present. • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • The bottom of the lea proposed ching facility w111 be Located rio less than.five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] Please complete the following: A) Top of Ground Surface Elevation(using GIS information l ;B) G.W.Elevation adjustment for high G.W.I.�' = �:�'. � C��rt titer/ DIFFERENCE'BETWEEN A and B SIGNED : 1�fl - Wes , Aiv,I.�"3) " . DATE: � � ...._.__. S� p� NOTICE 4. Based upon the above information,a repair permit will be issued for bedrooms maximum.. No additional bedrooms are authorized in the future without engineered septic system plans. gASeptic\percexemp.doc I UVV11 UA Uiil1113 LaVIU Y ii Department of Regulatory.Services s 8AFW3rAaLE Public Health Division t Date y MASS. %639. 200 Main Street,Hyannis MA 02601 P�Eo MAy Date Scheduled Time Fee Pd. Soil Suitability Assessment for Sewage Disposal Perfonned By, +(e-5c c,,— Witnessed By: _ LOCATION & GENERAL INFORMATION Location Address Owner's Name 6�- (� D.:+Ccvi Address pSic;Nll�f.' �'✓��Q � 3S 4�ywllj5 ml� ) q �C.3cn of�'67 Assessor's Map/Pureel: P ��c I�ICIrCI� {��GCJT I Engineer's Name NEW CONSTRUCT IONREPAIR Telephone# L� - �:� ' Land Use g ��rY A ACA I Slopes(%) Surface Stones Distances from: Open-Water Body _ff Possible Wet Area t Drinking Water Well /(j ft Drainage Way It . Property Line 3d ft Other_ ft SKETCH:(Street name,dimension_of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) cu rt Q- 0� IN Parent material(geologic)Q0{a:.t c�5h Depth to Bedrock /�► Depth to GrOtlndwater: Standing Water in Hole:� Weeping from Pit lace L2 Estimated Seasonal High Groundwateri^rt) DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: /1) Depth Observed standing in obs.hole: in. Depth to soil mottles: in. Depth to weeping front side of obs.hole: in. Groundwater Adjustment Index Well# Reading Date: Index Well level Adj.factor - Adj.Groundwater Level_ PERCOLATION TEST Date Time Observation Hole# Time at 9" Depth of Pere 55"` Time at 6" Start Pre-soak Time a Cf Time(9"-6") End Pre-soak t"� ''ll a Rate Min./Inch rn rl d�"� q / t,.INd - �?61A&Ils Site Suitability Assessment Site Passed Site Failed: Additional Testing Needed(YIN)—` Original: Public health Division. Observation Hole Data To Be Completed on Back----------- **.*I f percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division.at least one(1)week prior to beginning. Q:HEALTH/WP/PERCFORM " DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon `Soil Texture Soil Color Soil �_ Other Surface(in.) (USDA). (Munsell) Mottling, (Structure,Stones,Boulders. Consistency.%Graven :�GYIL l:861 01 /0 X1 312 TJ\j Sad /�C Vy! /GYJZ`if(� y .�cx� _30""N��oDial �lrtNl( e.�, jr?Y y�//, U•l"!©� �i� :�Cgt1CK. �: � l ���i � r'�'1r�5tJt': �<.: �'-� DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil'T- Other Surface(in,) (USDA) (Munselq Mottling (Structure,Stones,Boulders, Consistency.%Gravel) DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Graver DEEP OBSERVATION HOLE LOG Hole# Depth from. Soil Horizon Soil Texture Soil Color , Soil Other Surface(in.) (USDA), (Munsell) Mottling (Structure,Stones,Boulders. Consistency /°Ci�eveL Flood Insurance Rate Man: Above 500 year flood boundary No— Yes. >C Within 500 year boundary No X Yes Within 1.00 year flood boundary No X Yes Depth of Naturally Occurrine Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed.for the soil absorption system?. ye-S If not,.what is the depth of naturally occurring pervious material? Certification I certify that on tt a(�aa (date)1 have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required n •ning,expertise id experience described in 310 CMIt 15,017. � Signature �? Date I31 f Q:HEALTH/W P/PERCFORM 9116/03 j: Notice: This Form Is To Be Used For the Repair Of Famed Septic Systems.Only PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM I, hereby certify that the engineered plan signed by me dated o r,- concerning the property located at �. �E►�LF.fLP� fh1 [AYAAtmeets all of the following criteria: • This failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the.dwelling. • The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. The applicant may use historical data to conclude this fact or may conduct deep test holes and percolation tests at the site without a health agent presen� • There is no increase in flow and/or change in use proposed • There are no variances requested or needed • The:bottom of the proposed leaching facility will be located no less than five:feet.above the . maximum adjusted groundwater table elevation.[Adjust the groundwater tableIusing the. Frimptor method when applicable] Please complete the following: -.• t:. . A) Top of Ground Surface Elevation(using GIS information). llcn�. t B) G.W.Elevation ` adjustment for high G.W.1. :=. G�r� DIFFERENCE BETWEEN A and B ,eo gr /�� z� SIGNED 1A DATE:,. .j F;'- " ; S pl,arN NOTICE Based upon the above information;a repair permit will be issued for bedrooms maximum No additional bedrooms are authorized in the.future without engineered septic system plans_ 9_\SepacV--cmp.d- AI Own w Darnstault";-� 4�pptHe ro Department of Regulatory Services . Public Health Division Date I v� MASS. `0$ 200 Main Street,Hyannis MA 02601- p�EO MPS� Time Fee Pd. Date Scheduled uitabilit Assessment for Sewag Soil S y e Disposal Performed By,� �`• S�yVCA V64T,5ca— Witnessed By: _ LOCATION & GENERAL INFORMATION Owner's Name t717 Location Address i�i ot:ic.e--r �Pi2P1��� Tct' b�1. Address �rnn,rrl,vla5 fn�T � �A Engineer's Name �K�J f'l� c Assessor's Map/Purcel:•I'�C:t� �93"�t�f.�� �✓����� r'• NEW CONSTRUCTION REPAIR X Telephone Y � Surface Stones Land Use �'Sr( E'i�Ilq Slopes(%) Distances from, Open Water Body u—ft Possible Wet Area j°�it Drinking Water Wcll r It PropertyLine tt Other_ tt Drainage Way SKETCH:(Street name,dimensions.of lot,exact locations of test holes&pare tests,locate wetlands in proximity to holes) "7 ��_ a riOJ COIJ 0— Q*) Parent material(geologic) Q��/t�� Depth to Bedrock >� Depth to Groundwater. Standing Water In Hole: __� Weeping frotfl Pit Face' 64' Estimated Seasonal High Groundwneer DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: In, Depth►o soil mottles: ht Depth Observed standing in obs•hole: _ Groundwater Adjustment it. Depth to weeping from side of obs•hole: Index Well k Reading Date: index Well level Adj.factor Adj.Groundwater Level _ PERCOLATION TEST Date Time Observation Time at 9" Hole# � Time At 6" Depth ofPerc '20 Time(9"G") Start Pre-sonk Time n End Pre-soak a' Rate Min•/inch G.��„t^. �'" � !r' f1 �.It l�v'r, ��1�' •�- • Site Suitability Assessment: Site Passed • Site Failed: Additlonnl Testine Needed(YIN) Origii,al: Public Health Division. Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one (1) week prior to beginning. Q;HEALTH/W P/PCRCFORM DEEP OBSERVATION HOLE LOG Hole# Olher Depth from Soil Horizon Soil Texture soil color Mottling.. (Structude,Stones,Boulders. Surface(in.) (USDA) (. _ . t�,��. 1s. v C revelL CI l l�,tdtrt ERVATION HOLE LOG Hole #_ __— Soil Color Soil Other DEEP OBS Depth from Soil Horizon Soil Texture Munsell) Mottling (Structure,Stones,.Boulders, Surface(in.) (USDA) ( _ r o�,a,. %aravell DEEP OBSERVATION HOLE LOG Hole # Soil - Other Depth from Soil.Horizon Soil Texture Soil Color_( (Munselq Mottling (Structure,Stones,Boulders. SLlrface(in,) USDA) _ Cnncic(.nry %QraV0I1 DEEP'OBSERVATION HOLE LOG Hole# Soil�olor, Soil Other Depth from Soil Horizon Soil Texture Mottling (Structure,"Stones,Boulders. (USDA) (Munsell) o/[raven Surface(in.) _ Coi`' - --------------- Flood Insurance Rate Man Above 500 year flood boundary No._ Yes.L Within 500 year boundary No_.�L Yes Within 1.00 year flood boundary No Yes De th of Naturnll Occurrin Pervious.Material fet of atu per ous material exist in all areas observed throughout the Does at least four e n rally occurring area proposed.for the soil absorption system? S If not,what is the depth of naturally occurring pervious material? Certification zz� Qdr date I have passed the soil evaluator examination approved by the I certify that on I a" (date) Department of Envi orunental Protection and that the above analysis was performed by me consistent with the required tra'ning,ex ise and experience described In 310 CM.R 15.017. Date �113 Signature t Q;HEALTH/WMERCFO.RM f h'qY. 5.2005 10:25AM BARNSTABLE BOARD OF HEALTH NO.167 P.1i1 4 Town. of Barnstable Regulatory Services Thcrnm F.Geyer,Director Public Health Division Thomas McKeanr Director 200 MWm Street,Hyannis,MA 02601 Office:.508-862-4644 Fix: 508-790-6304 . Install" &Designer Cer{Wcation Foy Date; 45-1 71o� r {� Designer: 4- - ����—�f-�s�� Installer: 4 Address: S f-z- 5C. Address: pn was issued a permit to install a (date) flu tslter} septic system at__.� �a���F.It�e 1 based on a design drawn by. (address) r �NA, dated n 'ios� f designer ' �`IC P`� I certify that-the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. _ I certify that the septic system referenced above was installed with major changes (Le. greater than 10' lateral relocation of the SAS or any vertical relocation of any component o c septic system)but in accordance with State &Local Regulations. Plan revision or ed as--built by designer to follow. OFs o � G fi er's tore} 0 0� Was �Q ONr��G��� � �5 gn s si e} f Af c DesWEVStamp ) PLEASE RETURN TO $ARNg'Y�PUBLIC g�ALTR D &IaN. M M ATE OF C QW L NO I B BU-XK JUH I EA AS- CAItn ARE RECEMD BY BARNnaLE PUBLLC MAL D Irt}N. Q:HedWSeptiWT)esfgner Certification Form J.K. HOLMGREN ENGINEERING, INC. Baxter, Nye &Holmgren Registered Professional Engineers and Land Surveyors 942 W.Chestnut Street,Brockton,MA 02301 Tel:(508)583-2595 Fax(508)588-7518 812 Main Street,Osterville,MA 02655 Tel:(508)428-9131 Fax:(508)428-3750 Toll Free:(800)439-2595 May 4,2005 Mr.Thomas A.McKean,RS,CHO Director Barnstable Health Division 200 Main Street, Hyannis,MA 02601 Phone: (508)862-4644 Fax: (508)790-6304 RE: CIVIL ENGINEER-SEPTIC SYSTEM CONSTRUCTION AS-BUILT CERTIFICATION LOCATION: 1 General Patton Drive,Hyannis,MA-Map 292,Parcel 095 Permit#2005-176 I,Matthew Eddy,P.E.,being a registered Professional Civil Engineer in the Commonwealth of Massachusetts,with the firm of J.K.HOLMGREN ENGINEERING,INC./BAXTER,NYE,&HOLMGREN,Registered Professional Engineers and Land Surveyors,812 Main Street,Osterville,MA 02655,hereby certify that I have reviewed the completed septic system construction,as of the date of this Certification,at the above location and it has been substantially performed,in general accordance with the plan titled"Repair Plan for On-Site Sewage Disposal System",dated 4/14/05 and revised through 04/26/05(Approved Plan),as approved by the Barnstable Public Health Division. Said plan being designed in accordance with 310 CMR 15.00 The State Environmental Code,Title V,and the Barnstable Health Department Regulations. This certification is for the purpose of checking for general compliance with the design plans and with the information given in the Approved Plan. This inspection certification only verifies general component installation and approximate location. It is not to be considered a field control as-built verification of vertical and horizontal information shown on the Approved Plan nor is it to imply daily inspections of the related work. OF ti1gs� S o� �� ti Name Matthew Eddv_P.E. EDDY Registration No. 43183 o W �q04,�$189 �? Seal ot ��w Signature SS�ONAL E� Cc: Mr.James Crocker,East Bay LLC Mr.Randy.Harnois,R&H Construction,Inc. File 0:\2005\2005-033WDMIN\REPORTSX2005-033 Septic As built Affidavitdoc Page 1 Land Surveys • Subdivisions 9 Septic Design 9 Wetland Filings • Site Design - FAILED INSPECTION COMMONWEALTH OF MASSACHUSETTS L EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS ` + DEPARTMENT OF ENVIRONMENTAL PROTEC ION ,C Wa` RECEIVED e Off 2 0 2004 6 TOWN OF BAkNSTABLE HEALTH DEPT. i r TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS` r- SUBSURFACE SEWAGE DISPOSAL SYSTEM FORMS:, -- PART A7 CERTIFICATIO1 ,e•113 --- Property Address: 1 General Patton Drive PAACEI s r� Hyannis MA 02601 44 {" r- 0 Owner's Name: Lilley Davis rn Owner's Address: 40 Rexford Street Mattapan MA 02126 Date of Inspection: August 31,2004 Name of Inspector: PATRICK M.O'CONNELL Company Name: SEPTIC INSPECTION SERVICES CO. Mailing Address: 189 CAMMETT ROAD MARSTONS MILLS MA 02648 Telephone Number: 508-428-1779 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 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 approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system; N OF q�I*�,�'/ Passes ? SS9Cy•. Conditionally Passes AT I K Needs Further Evaluation by the Local Approving Authority _ _X_ Fails 0 N LL Inspector's Signature: Date: 8/31/04 ��''�,,��F•RTI�����o?��`�� 1s i NSPE`����� The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health III or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments: Cesspool with three overflows. First overflow pit has bottom two rows of blocks missing and entire pit will soon collapse. ****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 undertthe same or different conditions of use. Title 5 Inspection Form 6/15/2000 page I ' Page 2 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 1 General Patton Drive,Hyannis Owner: Lilley Davis Date of Inspection: August 31,2004 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: 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. Answer yes,no or not determined(Y,N,ND)in the 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. ND explain: 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 obstruction is removed distribution box is leveled or replaced ND explain: 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 obstruction is removed ND explain: Titlo Iq Inen—tin. F'nrm All ri')nnn 2 Page 3 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 1 General Patton Drive, Hyannis Owner: Lilley Davis Date of Inspection: August 31,2004 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 2. System will fail unless the Board f Y o 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: TIt1a C lnenantirm 17nrm 411 Vln(ln 3 I Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 1 General Patton Drive,Hyannis Owner: Lilley Davis Date of Inspection: August 31,2004 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No —X_ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool —X_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool —X— Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool —X— Liquid depth in cesspool is less than 6"below invert or available volume is less than '/z day flow —X— Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _X_ Any portion of the SAS, cesspool or privy is below high ground water elevation. —X— Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _X_ Any portion of a cesspool or privy is within a Zone 1 of a public well. _X_ Any portion of a cesspool or privy is within 50 feet of a private water supply well. —X— Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this forma **Collapsing cesspool caused failure** _Yes_(Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) 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 11 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. Titla C Tncnortinn Gnrm A/I cMnnn 4 Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 1 General Patton Drive,Hyannis Owner: Lilley Davis Date of Inspection: August 31,2004 Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No _, _X_ Pumping information was provided by the owner,occupant,or Board of Health _X_ Were any of the system components pumped out in the previous two weeks? — _X_ Has the system received normal flows in the previous two week period? _X_ Have large volumes of water been introduced to the system recently or as part of this inspection? N/A Were as built plans of the system obtained and examined?(If they were not available note as N/A) _X_ Was the facility or dwelling inspected for signs of sewage back up? _X_ — Was the site inspected for signs of break out? _X_ _ Were all system components,excluding the SAS, located on site? _X_ _ 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? _X_ _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: Yes no _X_ Existing information. For example, a plan at the Board of Health. _X_ _ 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(3)(b)] Titles i 1n0MAMt1^n 17 rm 411 5 Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 1 General Patton Drive,Hyannis Owner: Lilley Davis Date of Inspection: August 31,2004 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): n/a Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 1 10 gpd x#of bedrooms): n/a Number of current residents: 0 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use: (yes or no): No Water meter readings, if available(last 2 years usage(gpd)): 2002—2,250 gal.2003—7,500 gal.=13 gpd Sump pump(yes or no): No Last date of occupancy: unknown COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records: None Source of information: - Was system pumped as part of the inspection(yes or no): 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 _X_Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records, if any) _Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank _Attach a copy of the DEP approval _Other(describe): Approximate age of all components,date installed (if known)and source of information: Unknown Were sewage odors detected when arriving at the site(yes or no): No i Titla Q Inenartinn I7nrm All cnnnn 6 Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1 General Patton Drive,Hyannis Owner: Lilley Davis Date of Inspection: August 31,2004 BUILDING SEWER: X (locate on site plan) Depth below grade: 6" Materials of construction:_X_cast iron _40 PVC_other(explain): Distance from private water supply well or suction line: n/a Comments(on condition of joints, venting,evidence of leakage,etc.): SEPTIC TANK: No (locate on site plan) Depth below grade: - Material of construction: concrete_metal_fiberglass_polyethylene —other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: - 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: - How were dimensions determined: STICK WITH HINGE FLAP. Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): GREASE TRAP: No (locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): Titles 1;inenorLinn [?nrm 9/1,;nnnn 7 Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1 General Patton Drive,Hyannis Owner: Lilley Davis Date of Inspection: August 31,2004 TIGHT or HOLDING TANK: No (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/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches, etc.): DISTRIBUTION BOX: No (if present must be opened) (locate on site plan) Depth of liquid level above outlet invert: - Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): PUMP CHAMBER: No (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber, condition of pumps and appurtenances,etc.): Title G Tnenartinn Rnrm 8 i Page 9 of i l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1 General Patton Drive, Hyannis Owner: Lilley Davis Date of Inspection: August 31,2004 SOIL ABSORPTION SYSTEM (SAS): XX (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits, number: leaching chambers,number: leaching galleries,number: leaching trenches,number, length: leaching fields,number, dimensions: _X_overflow cesspool,number: Three 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.): two pits branching from first overflow which is bordering on complete collapse bottom two courses of blocks are missing and sand is caving in from under blocks CESSPOOLS: XX (cesspool must be pumped as part of inspection) (locate on site plan) Number and configuration: One with three overflows Depth—top of liquid to inlet invert: 4" Depth of solids layer: 8" Depth of scum layer: 1" Dimensions of cesspool: 5x5 Materials of construction: Block Indication of groundwater inflow(yes or no): N/D Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.): Liquid level at bottom of outlet pipe. PRIVY: No (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.): I Tifia f Tncnartinn l:nr—All ci')nno 9 Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1 General Patton Drive,Hyannis Owner: Lilley Davis Date of Inspection: August 31,2004 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. General Patton Drive 09 Cesspool with three overflows Titlo S Inenartinn 17-- Ail;rmno 10 Page I 1 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1 General Patton Drive, Hyannis Owner: Lilley Davis Date of Inspection: August 31,2004 SITE EXAM Slope None Surface water None Check cellar Dry Shallow wells None Estimated depth to ground water : More than 20 feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record- If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators, installers-(attach documentation) _X_Accessed USGS database-explain: USGS topo map and town GIS You must describe how you established the high ground water elevation: Topo map shows property at el 50 and town groundwater contour map shows water at el.25. Tit1P G Incnontinn Rn�m 4/1 vinno 1 I QEI�ERAL NOTES 1) THE INTENT OF THIS PLAN IS TO DESIGN A SEPTIC SYSTEM REPAIR AT LOCUS. THIS PLAN IS NOT TO BE �.` �• _ CONSTRUED AS A PROPERTY LINE OR EXISTING CONDITIONS SURVEY. 2) LOCUS AREA IS COMPRISED OF. ZONE RB WfTH AP OVERLAY ASSESSOR'S MAP 292 PARCEL 095 'M I THE PROPERTY LINE INFORMATION IS AS SHOWN PER THE PUT RECORDED AT THE BARNSTABLE COUNTY REGISTRY p \ I OF DEEDS IN PLAN BOOK 225 PAGE 109 TITLED "SUBDIVISION PLAN OF LAND IN EIARNSTABLE, MASS' DATED MARCH 28, 1968. AS PREPARED BY CHARLES N. SAVERY INC. 3) OWNER/APPLICANT DEED BOOK 19654 PAGE 103 (03/25/05) EAST BAY OSTERVN.L& LLC, PO BOX 496, OSTERMLLE, MA Sr `. i 508-428-M a, T MAP 292/020 'o 4) PROJECT BENCHMARK : #349 BEARSES WAY FROM BARNSTABLE GIS Q CENTER OF GENERAL PATTON DR. - GIS ELEVATION - 46.6 5) ALL EXISTING CONDITION INFORMATION IS SHOWN FROM GIS INFORMATION OBTAINED FROM THE TOWN OF BARNSTABLE GIS DEPARTMENT. THIS INFORMATION IS APPDXIMATE IF ANY EXISTING INFORMATION SHOWN IS 5 DETERMINED TO BE INACCURATE OR IN CONFLICT WITH THE DESIGN, THE CONTRACTOR SHALL CONTACT THE It DBOX I ENGINEER IMMEDIATELY FOR REVIEW AND POSSIBLE REDESIGN. MILL s I 9 p5 6) COMMUNITY PANEL NUMBER. 250001 0005 C OF THE FLOOD INSURANCE RATE MAP DEFINES THIS AREA AS 0 �: ZONE C, AREA OF MINIMAL FLOODING. vJ M ( O L a' U) co I 7) QMROffiIEN7AL INFORMATION r Ww:T a 1500 GAL G lm 00 �? I SITE IS NOT WITHIN A ZONE p (waLHEAD ZONE OF CONTRIBUTION) / :: . N LOCUS MAP Scale: �" ��� SEPTIC TANK n0 s C _ �I I 8) UTILITY INFORMA11Oy; N -EXISTING SEPTIC SYSTEM INFORMATION OBTAINED FROM THE 'SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION t \ - FORM. AS PREPARED BY PATRICK M. O'CONNELL. DATED) 8131104 -WATER LINE INFORMATION IS EIASED ON THE WATER SERVICE CONNECTION PION AS RECEIVED FROM THE BARNSTABLE WATER COMPANY ON APRIL 11, 2005. r 4/ \ �► CONSTRUCTION NOTES, CLEANOUT 1. ALL SYSTEM COMPONENTS SHALL BE INSTALLED IN ACCORDANCE WITH TITLE V OF THE STATE SANITARY CODE DATED MARCH 31, 1995, AS AMENDED THROUGH THE DATE OF THIS PLAN, do ANY LOCAL RULES & REGULATIONS APPLICABLE. 6" BELOW 101' 2. ANY CHANGE TO THIS PLAN MUST BE APPROVED IN WRITING BY THE ENGINEER. ELEVATION BLDG SEWER ` INFORMATION MUST NOT BE CHANGED WITHOUT WRITTEN PRIOR APPROVAL BY THE ENGINEER. GRADE PEP SEPT!C SYSTEM \ I G I 3. WHEN CONSTRUCTION IS COMPLETED, PRIOR TO BACKFlWNG, NOTIFY THE BOARD OF HEALTH !NSPECT!0N REPORT AGENT AND DESIGNING ENGINEER FOR INSPECTION. c MAP 292/096 J 4- \ •��' 4. ALL SANITARY DISPOSAL SYSTEM PIPING TO BE 4" SCHED 40 PVC UNLESS OTHERWISE NOTED #2 GENERAL PATTON DR. I 1" 0 S �' �O( N SF `Z�O \ \ �/� HEREIN. N$' ^ r 5. IF UNSUITABLE MATERIALS ENCOUNTERED BELOW THE SAS INVERT IN, EXCAVATE UNSUITABLE MATERIALS FOR A HORIZ. DISTANCE OF 5' SURROUNDING THE LEACHING FIELD AS NECESSARY, AND REPLACE WITH CLEAN SAND PER 310 CMR 15.255. 6. INSULATE BUILDING CONNECTION PIPES AGAINST FREEZING AS REQUIRED WHEN LESS THAN 3' OF COVER. C\�p�Pc,S 7. THE SEPTIC SYSTEM DESIGN DOES NOT INCLUDE GARBAGE GRINDER DISPOSALS. SAVE EXIST. TREE ti \ 8. THE CONTRACTOR SFWl CONTACT DIG SAFE (AT 1-888-DIG-SAFE) AND UTILITY \, COMPANIES TO LOCATE ALL EXISTING UTILITIES, AT LEAST 72 HOURS BEFORE THE START OF Z IR SHOWN IN AN APPROXIMATE WAY ONLY, MAY NOT BE LIMITED TO THOSE SHOWN HEREON AND S, CONSTRUCTION. THE CONTRACTOR SHALL DETERMINE THE EXACT LOCATION, BOTH HORIZONTALLY AND VERTICALLY, OF ALL EXISTING UTILITIES, LINES AND INFRASTRUCTURE BEFORE THE START OF u �. i ANY WORK. THE LOCATION OF EXISTING UNDERGROUND UTIUTIES, LINES AND INFRASTRUCTURE ARE N M FIVE NOT BEEN INDEPENDENTLY VERIFIED BY THE OWNER OR ITS REPRESENTATIVE. THE CONTRACTOR AGREES TO BE FULLY RESPONSIBLE FOR ANY AND ALL DAMAGES WHICH MIGHT BE : - OCCASIONED BY THE CONTRACTOR'S FAILURE TO LOCATE THE UTILITIES EXACTLY. IF ELEVATION INFORMATION DIFFERS FROM PLAN INFORMATION, THE CONTRACTOR SFWl NOTIFY THE ENGINEER IMMEDIATELY FOR POSSIBLE REDESIGN. AT UTILITY CROSSINGS, VERIFY IN FIELD THE HORIZONTAL L l AND VERTICAL LOCATION OF WATER, ELECTRIC, GAS, TELEPHONE & DATA/COMM AND RELOCATE IF _.--------_-__.__----_-_ ---__---__-_ --- ----1 ` CONFLICTING WITH PROPOSED INVERTS PER THE ENGINEERS DIRFCTION. THE CONTRACTOR SHALL PRESERVE ALL UNDERGROUNV UTILITIES AS REQUIRED. !T Vol I 1 -4 i I dP I S 40'3 i�0 " W MA 92.7 ' eP�� l - I GENERAL .�.. PA TTON DRIVE ASSUMED BENCH MARK SM LOGS - DATE 4/13/05 BARNSTABLE GIS ELEV CENTER OF ROAD = 46.6 (� WNSTABLE BOH AGENT: I p EXEMPTION FORM FILED Project Location: SOIL EVALUATOR: STEV N VENTRESCA, EIT 1 General Patton Drive, Hyannis, MA TEST PIT 1 " G.S.E. = 4 7.5 PREPARED FOR 10' cn 3/4"-1-1/2 A ; 10YR 3/2 ; SANDY LOAM East Bay Osterville LLC FINISHED GRADE M DOUBLE WASHED STONE P.O. BOX 496 . Osterville, MA 02655 36"MAX.-9� ��������COMPACTED\FILL�������� 1 o ao s ~ BaaLE s NG tCHAMBBERS EouAL) 9" ELEV 46.75) 508.428.88W 2" LAYER DOUBLE WASHED TOP OF CHAMBER SBi4NbY100AM /6 T�lE STONE 1/8" TO 1/2" PIPE INVERT M 26" ELEV 45.33 REPAIR PLAN FOR 3/4 TO 1 -1/2- 24 DOUBLE WASHED E DEPTH E 1' 38' 1' C1 1 5E SAND MED. COARS ON-SITE SEWAGE DISPOSAL SYSTEM STONE ^ 40, OA N 84" (ELEV 40.5) J.K. HOLMGREN ENGINEERING, INC. TYPICAL SYSTEM PROFILE I 3.s 2.8 I PLAN VIEW ' ' 3.s'--I z NOT TO SCALE C2 ; 2.5Y 7/3 ; SAND L BAXTER NYE & HOLMGREN NOTES: IVOT TO SCALE SECTION J 120" (ELEV 37.5) Registered Professional 1. ALL MATERIALS SHA'1 MEET H-20 LOADING REQUIREMENTS IF PLACED NOT TO SCALE NO WATER OBSERVED En ineers and Land Surve ors A 4,4 WITHIN 10 Fr of A ROADWAY OR DRIVEWAY. PLASTIC LEACHING CHAMBER DETAIL o PERC 0 37" (ELEV 44.4) 812 Main Street, Osterville, Massachusetts 02655 �� `� RATE= <2 MIN/IN d _ MATTHEW ASSUMED TOP OF FINISH FLOOR ADS-BIODIFFUSER 160OBD (OR EQUAL) CLASS I SOIL Phone - (508) 428-9131 Fax - (508) 428-3750 % LAYUP LENGTH 76" PER UNIT 1 SLAB ON GRADE = 48.0 SET AT LEAST ONE MANHOLE FRAME & LEACHING AREA REQUIREMENTS - ASSUMED EXIST. GRADE = 47.0 COVER To WITHIN 6" OF FINISH GRADE IF REQUIRED. RISERS & COVERS SHALL BE NITROGEN LOADING LIMITA'�' NA ` YZ#3 f WATERTIGHT FINISHED r_JROOMS 10 0 10 20 Aft FINISHED GRADE OVER TANK = 47.7 FINISHED GRADE OVER D. BOX = 48.1 FINISHED GRADE OVER y LEACHING TRENCH = 48.0 TO 47.5 x , __. Gpb BEDROOM `il. .A v+ COMPACTED FILL TOTAL DESIGN FLOW = 44u GPD SCALE IN FEET 4' SCH 40 PVC 9" (min) COver INSTALL ONE INSPECTION PORT IN GARBAGE GRINDER (NOT INCLUDED) = N/A 1"=10' L L ASSUMED EXIST. L- 43' S=1.80X (1.0X MIN ALLOWED) 3" MIN 36• (max) Corer ACCORDANCE WITH MANUFACTURERS INN OUT = 46.0 y r RECOMMENDATIONS CONTRACTOR TO 6' MIN. 4 LF~a" SCH 40 PVC OS-2.0% FIRST 2' (TO BE LEVEL) 2" LAYER 1/810/2- PERC RATE = <5 MIN. / INCH (CLASS 1) VERIFY IN FIELD - ---� 4" SCH. 40 PVC DOUBLE WASHED STONE 6 ~ BIOOIFFUSER 18008D (OR EQUAL) LIAR = 0.74 GPD/S.F. SEE GENERAL NOTE INN IN= 45.24 10' MIN. NV our-44.99 2" TOP LEACHING CHAMBERSMIN. LEACHING AREA OF S.A.S. REQUIRED: PVC INV IN- 44.91 . • 5 Z 6" SUMP Nv ouT- 44.74 CHAMBER i 40 440 GPD/ 0.74 GPD/S.F. = 595 S.F. MIN. DATE: 4/14/05 GAS RIFFLE 14' r:, _ - :.-ter ..�.' - --. -_ PROPOSED SYSTEM: REINFORCED CONCRETE 6" CRUSHED _ BOT. LEACHING CHAMBERS: SAS 40' L x 10' W x 2' D (-STONE BASE 43.47 + 6" CRUSHED) N 0 3/4" TO 1-1/2 DOUBLE WASHED r r �e ■ - CS1 _ .• STONE BASE w STONE SIDEWALL AREA: (40' + 10')2 x 2' DEPTH - 200 SF MVVE 04/26/0 RAISE INVERTS DISTRBUTION BOX LEVEL T. STONE =42. 1 BOTTOM AREA: (40' x 10') = 400 SF NO. BY I DATE I REMARKS t600 GALLON ONE-COMPARTMENT SEPTIC TAW BE INSTALLED ON A LEVEL STABLE BASE GROUNDWATER ADJUSTMENT TOTAL EFFECTIVE LEACHING AREA = 600 SF DRAWN BY: DESIGNED BY: MWE CHECKED E3Y: MWE DRAWING NUMBER 2 OUTLETS REQUIRED MEASURED DEPTH TO WATER TABLE (4/13/05): NONE OBSERVED SYSTEM DESIGN CAPACITY = 600 SF x 0.74 GPD/SF = 444 GPD ROTONDO ST15o0 OR EQUAL INDEX WELL- AIW-230 5' MIN TO BE INSTALLED ON A LEVEL STARTLE BASE DEPTH: (3/05) 22.1 SEPTIC TANK SIZING: 440 GPD x 200% = 880 GAL 0: 2005 2005-033 CIVIL PLOT 2005-033 SEP.DWG SEPTIC TANK TO BE INSPECTED & CLEANED ANNUALLY ZONE: C ADJUSTED HIGH GROUNDWATER ELEV - NONE OBSERVED/ INDEX WELL WATER ADJUSTMENT: 1.6' D AT 27.2 USE 1500 GALLON TANK MIN. ESTIMATED DEPTH TO H W 20.5 2005-033