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HomeMy WebLinkAbout0037 GENERAL PATTON DRIVE - Health 37�General Patton Drive 1 Hyannis 7. A =`292 134 V 4 ° e o u Commonwealth of Massachusetts Title 5 official Inspection Form sments Subsurface Sewage Disposal System Form -Not for Voluntary Asses Property Address Ss�/A- Owner Owner's Name , /f�� 00601 �p�e information is �j[ n�l s '� Date ction required for State Zip Code every page. CitylTown Inspection results must be submitted on is form.e end Inspec the tionfor forms may not be altered in any way. Please see completeness checklist at Important. A. General Information I When filling out + (� forms on the '/ /l 1-�" computer,use 1 Inspector* Gf�'if be, l only the tab key to move your cursor-do not Name of Inspector ✓ G� ,1 use the return key. /►' �/ l Company N;ar0 lS A l Company Address q a Zip Code State L10 rerm City/Tov�� \ _ License Number Telephone Number B. Certification B sewage disposal system at this7ad'dress and\that thle I certify that I have personally inspected the information reported below is true, accurate and complete as of the time of the.:inspectior%The_inspectlon was erformed based on my training and experience in the tns actor roper function ant t aSect onc15:340 of p roved system p sewage disposal systems. I am a DEP approved Y Title 5,(310 CMR 15.000). The system: I ❑Passes Conditionally Passes ❑ai Fails -� •• ,�, t:s r— NJrr+ j ❑ Needs Further Evaluation by the Local Approving Authority • 3 /y� �l Date Inspect is Signature of this inspection report to the Approving Authority(Board The system inspector shall submit a copy of t this inspection. If the system is a shared system or of Health or DEP) within 30 daydsor g completing has a design flow of 10,000 gp rester, 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. I ****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 differen t conditions of,use. Title 5 official Inspection Form:Subsurface Sewn Dosat S I Iof17 i5ins•09/08 , Commonwealth of Massachusetts Inspection Form Title 5 Official l n sp oluF Assessments Subsurface Sewage Disposal System Form •Not for Voluntary ?�' I Property Address Die v-r f P or Owners Name �- nforrnation is rlrl If State Zip Code Da of nspection equired for CitylTown very page. B. Certification (cont.) ection Summary Check A,B,C,D or E/ always complete all of Section D Insp , A) System Passes: �Ihave not found tlany information which indicates st. that any any offailure theeailure criteria evaluated are in 310 CMR 15.3,03 or in 310 CMR 15.304 indicated below. Comments: I I I i I I i i I B) System Conditionally Passes: I nt air, as approved by of the replacement or rep One or more system components as described i ribed n the"Conditional Pass" section nee o e ❑ replaced or repaired. The system, uponcompletion the Board of Health, will pass. "yes", "no"or"not determined" (Y, N, ND)for the following sta Che ck the box for tements. if"not determined," please explain. etal or not)is. The septic tank is metal and over 20 years old* or or septic tan ton orV tank failhether ure is imminent. System he structurally unsound exhibits substantial infiltration in septic tank as approved by will pass inspection if the existing tank is replaced with a complying P Board of Health. * A meta P I se tic tank)will pass inspection if it is structurally sound, is available. lea Compliance indicating`that t king and if a Certificate of i he tank is less than 20 yea d Y NFj ND (Explain below): i i I i I Title 5 Official Inspection Form:Subsurface Sewage ash Syslem,Page 2 of 17 ISins•09l08 Commonwealth of Massachusetts n Form Title 5 Official Inspection 19Subsurface Sewage Disposal System Form Not for Voluntary Assessments property Address I ss�/ /'�r2K ll 3 Owner owners Name I //�J/ Da6� information is 'T q�f✓l l� �--� Zip bode Dat of I pecGon State required for Cityrrovm every page. B. Certif cation (cont.) B System Conditilonally Passes(cont.): e Y ion of Jewage backup or break out or high staticd oatuneven distribution box Systemr level in the distribution box uwill Observat ior due to a broken, settle to broken or obstructed pipe(s)or of Board of Health): pass inspection if(with app ` ❑ Y ❑ N ❑ ND (Explain below): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below). i ❑ obstruct on is removed distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): El system re I ired pumping more than 4 times a year due to broken or obstructed pipe(s). The ❑ The q' approval of the Board of Health): system will pass Inspection if(with app ❑ Y ❑ N ❑ ND (Explain below): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): obstruction is removed I I i I Further Evalu�tion is Required by the Board of Health: order to determine if C) ' of ❑ Conditions exist which require�bh�rhealthasafety oon by rlthe env onmenth in the system is falling to pro P ce with l 1. system wild pass unless Board of Health determes mannnr which will prof ct accordan publlichealth, 15.303(1)(b)that the system is not functioning in a safety and thelenvironment: I ❑ Cesspool or privy is within 50 feet of a surface water privy is within 50 feet of a bordering vegetated wetland or a salt marsh ❑ Cesspool or p Y g 3d,7 System •Page Title 5 Official Inspection Form:Subsurface Sewage DW Isins•OWN I i Commonwealth of Massachusetts n Form •6,, pectin Title 5 of f i jai Ins' �, .Not for Voluntary Assessments osal System Fo Subsurface Sewage Dis►p �I � 2 Property Address Owner Owner's Name 0-5 6 /�ate f I pection / information is 5;�✓� State Zip Code D required for city/Town every page. t. B. Certification (con ) Supplier, if any) in a manner that protects the public health, Z, System will ail unless the Boa pu of blic ngalth (and Public Water ctst determines that the system is fu safety and enviironment: (SAS)and the SAS is within ❑ The system a surface water supply has a septic tank and soil absorption system 100 feet of a sur�ace water supply or tributary to system has a septic tank and SAS and the SAS is within a Zone 1 of a public water ❑ The sys, private water supply. The system has a septic tank and SAS and the SAS is within 50 feet o a ❑ supply I well. Istem has a septic tank and SAS and the SAS is less than 100 feet but 50 fee or ❑ The sY ri ate water supply well**- more from a p Method used toldetermine distance: ► EP for coliform .. asses if the well water analysis, peon a ntrogen at a Dand nitrate nitrogen is equal to or This system p presence of a of the analysis must be bacteria indicates absent and the p less than 5 ppm, provided that no other failure criteria are triggered• A copy attached to this fO4. 3. Other: ' i I D) System Failure C�lteria Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: i Yes No Backup of sewage into facility or system component due to overloaded or ❑ L1v clogged SAS or cesspool round or surface waters Discharge or ponding of effluent to the surface of the g ❑ u j due to an overloaded or clogged SAS or cesspool • tic liquid level in the distribution box above outlet invert due to an overloaded Sta❑ or clogged SAS or cesspool Liquid depth in cesspool is less than 6" below invert or available volume is less ❑ than '/2 day flow F Subsunace Sewage Uso�She"' Page a G1 t7 7tle 5 official inspection °fn' is ns•OWN ! Commonwealth of Massachusetts Orl'YI T• OffiiIial Inspection F itle 5 Assessments Subsurface Sewage Disposal System Form Not for Voluntary �'N>✓ �V r Property Address I„o,^���� S -el Owner owner's Name Da of nspection information is G✓ITS State Zip Code required for City/Town I ont. every page. B. Certification (c Yes No ed or � Required pumping more than 4 times in the last year NOT due to clogg ❑ i obstructed pipe(s). Number of times pumped: ❑ i Any portion of the SAS, cesspool or privy is below high ground water elevation. r supply or Any portion of cesspool or privy is within 100 feet of a surface wate ❑ tributary to a surface water supp y Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ � j Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ Is less than 100 feet but greater than 50 feet ❑ ; Any portion of a cesspool or privy his I well with no acceptable water quality analysis. [T from a private water supply performed at a DEP certified system passes if the well water analysis, p laboratory,for fecal coliform bacteria Indicates absent and the presence Bred. A copy of the analysis of ammonia nitrogen and nitrate nitrogen Is equal to or less than ppm+ provided that no other failure criteria are triggered. and chain of custody must be attached to this form.] I The system is a cesspool serving a facility with a design flow of 20009pd- ❑ u " 10,000gpd. the above lure j The system fails. I have determined CMR 15.303,�hereforefthe system fails The ❑ criteria exist as described in 3 ould contactehe Board of Health to determine what will be system owner sh necessary to correct the fa e Systems- To be considered a large system the system must serve a facility with a E) Large Y design flow of 10,000 gpd to 15,000 gpd• systems, I ou must indicate either"yes"or"no"to each of the following, in addition to the y For large questions in Section D. Yes No I ❑ ❑ the system is within 400 feet of a surface drinking water supply I ❑ + to a surf the system is within 200 feet of a tributary ace 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 have answered"yes" to any question in Section E the system is considered a significant y large If you ha , rade the ner or operato or answered "yes" in Section D above the large system or failed undereSect on D shall upg f any � appropriate system considered Ja significant threat under Section system in accordance with 310 CMR 15.304. The system owner should contact the app P regional office of the Department. Title 5 Official inspection Form:Subsurface Sewage Disposal System 5°�17 t5ins•09,08 Commonwealth of Massachusetts � Inspection Form Title 5 Of ficia� �nsp .Not for Voluntary Assessments Subsurface Sewage Disposal Systemy Form . �vIP,✓'� I l"a Ova ✓!v� Property Address I �e�,e v � Owner Owner's Name "--�— 0"�I information is N i State Zip Code Date f I action required for every page. Cityrrown i C. Checklist You must indicate"yes" or"no" as to each of the following: Chec k if the following have been done. Yes No ❑ Ipumping information was provided by the owner, occupant, or Board of Health ' system components pumped out in the previous two weeks? Were any of the ❑ ((„� IHas the system received normal flows in the previous two week ecently or as part of ❑ !Have large volumes of water been introduced to the system ❑. this inspection? Were as built plans of the system obtained and examined? (If they were not ❑ f available note as N/A) I [] s of sewage back up IWas the facility or dwelling inspected for sign . LJ ' ❑ Was the site inspected for signs of break out? �❑ Were all system components, excluding the SAS, located on site? I ❑ Were the septic tank manholes uncovered, or tees, the construction, one tank i : :ected for the condition of the I inspected dimensions, depth of liquid, depth of sludge and depth of scum?provided with Ii Was the facility owner(and occupants if different bsurfac �❑ i information on the proper maintenance of subsurface sewage disposal systems? tem SAS)on the site has The size and location of the Soil Absorption Sys been determined based on: � Existing information. For example, a plan at the Board of Health. Determined in the field (if any of cceftable)criteria 15.302(5)J C is at issue ❑ ! approximation of distance is una p D. System Information Residential Flow Conditions: Number of bedrooms (actual): O Number of bedrooms (design): = 5.203 (for example: 110 gpd x#of bedrooms): DESIGN flow based on 310 CMR 1 i I Title 5 Official inspection Form:Subsurface Sewage UsDosal System Page 6 of 17 t5ins•09/09 Commonwealth of Massachusetts ion Form Title 5 �����a� Inspect or Voluntary Assessments Subsurface Sewage Disposal System Form -Not Property Address er owner's Name 6 Date f I pection nformation is n state Zip Cod equired for Cityrrown very page- tlOn D. System Informa Description: 00 (T ` /60 Number of current residents: (] Yes J No Does residence have a garbage grinder? e sewage system? [if yes separate inspection required] Yet Ly' �� is laundry on a separate ❑ Yes No Laundry system inspected? ❑ Yes a o Seasonal use? Water meter readings, if available (last 2 years usage (gpd)): Detail: ❑ Yes No Sump pump? Date Last date of occupancy: Commercial/industrial Flow Conditions' Type of Establishment: Design flow (based on 310 cMR 15.203): Gallons per day(9Pd) Basis of design flow (seatslpersonslsq.ft., etc.): ❑ Yes ❑ No Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? Water meter readings, if available: System.Page 7 of V Title 5 Official U+sO�°^Form:Subsurface Sewage Disposal t5ins-09" Commonwealth of Massachusetts FOrI'Y1 5 Official Inspection Title sessments Subsurface Sewage Disposal System Form -Not for Voluntary o� d1 /,l 2� er19 Uty PropAddress owner Owners Name /� on information is / state Zip Code Date f I pecti required for city/Town very page. D. System nforMation (cont. Last date of occupancy/use: Date Other(describe below): General Information Pumping Records:. Source of information: ❑ Yes ❑ No Was system pumped as pad of the inspection? If yes,volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of Sy m: Septic tank, distribution box, soil absorption system ❑ Single cesspool Overflow cesspool 0 Privy or no) (if yes, attach previous inspection records, if any) Shared system (yes ❑ of the current operation and ❑ innovative/Alternative technology. Attach a copy of latest maintenance contraacs(s em obtained from by system under contrraystem owner) anc a copy t inspection of the Y Tight tank. Attach a copy of the DEP approval. ❑ Other (describe): Titre 5 Official Inspection Form:subsurface se"V Disposal system-Page 8 of 17 t6ins-owe r Commonwealth of Massachusetts ion Form Form N Title 5 official Inspection for t Voluntary Assessments stem Subsurface Sewage Disposal S y J11V � property Address er owner's Name ��//J 00 ? / nforrnadon is G!/1 d11� State Zip Code Da of I pection uired for City/Town very page. D. System Information (cont.) Approximate age of all com onents, date installed (if kr�w� and source of information: Q D Yes Were sewage odors detected when arriving at the site? ❑ No Building Sewer(locate on site plan): feet Depth below grade: Material onstruction: 40 PVC ❑ other (explain): / cast iron l I Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Sep tic Tank(locate on site plan): C2U l feet Depth below grade: Material construction: ❑other(explain) lass ❑ polyethylene concrete ❑ metal ❑fiberglass If tank is metal, list age: years � of certificate) oyes ❑ No i Is age confirmed by a Certificate of Compliance? (attach a copy v / Dimensions: a — Sludge depth: s tom,Page 9 of 17 Title s Official InspeeGon form:Subsurface Sewage Disposal � isms•Me .� Commonwealth of Massachusetts FOI"1'Y1 Official Inspection Title Not for Voluntary As essments osal System Form - Subsurface Sewage Disp 3 v property Address er Owners Name —� pa of I pection nformation is �'� �s State Zip Code equired for Cityrrown very page D. System Informstlon (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle / // Qell Scum thickness v Distance from top of scum to top of outlet tee or baffle - Distance from bottom of scum to bottom of outlet tee or baffle Y How were dimensions determined? Comments (on pumping rec ommendations, inlet and outlet tee or baffle condition, structural integrity. liquid levels as related to outlet invert, evidence of leakage, etc. : _ (A t/"I I"' ✓�O� , _ l / �vl Oo N av, 4 �4� 6 01,^ lJ Grease Trap (locate on site plan): feet Depth below grade: Material of construction: ❑other(explain): ❑ concrete ❑ metal fiberglass ❑ polyethylene Dimensions: Scum thickness to top of outlet tee or baffle Distance from top of scum to bottom of outlet tee or baffle Distance from bottom;of scum — — Date Date of last pumping: on Form:Subsurface Se"39e DiSpOSai System'Page 10 of 17 T�Ue 5 Oifidat�^SDec� t5ins•09108 ' Commonwealth of hAassachuSetts Form Title 5 Official Inspection for Voluntary Assessments Subsurface Sewage Disposal System /I/ owl Property Address Owner owners Name Q 60 information is Cj t�Y.f1 State Zip Code Da of I p ction required for cityrrown every page. � (cont.) D. System Information recommendations, inlet and outlet tee orbaffle condition, structural integrity, Comments (on pumping p 9 liquid levels as related to outlet invert, evidence of leakage, Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: fiberglass polyethylene other(explain): ❑ concrete ❑ metal ❑ ❑ ❑ Dimensions, gallons Capacity: Design Flow: gallons per day ❑ Yes ❑ No Alarm present: ❑ Yes ❑ No Alarm in working order: Alarm level: Date of last pumping: Date Comments (condition of alarm and float switches, etc.): in contract(required). Is copy attached? ❑ Yes ❑ No ' Attach copy of current pumping Title 5 Official Inspection Form:Subsurface Sege Disposal System Page 11 of 17 t5ins•OWS Commonwealth of Massachusetts Form Title 5 official Inspection Subsurface Sewage Disposal System Form •Not for Voluntary Assessments 32 Properly Address Owner Owners Name ( _ &1pe=cb0n - requiredinformation is CA viol state Zip Code oat for Cityfrown every page. D. System Information (cunt.) Distribution Box (if present must be opened) (locate on site���:� Depth of liquid level above outlet invert L-- 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.): a 2e a �s GS �C !�✓G�P✓� Pump Chamber (locate on site plan): ❑ Yes ❑ No Pumps in working order: ❑ Yes ❑ No Alarms in working order: amber, condition of pumps and appurtenances,etc.): Comments (note condition of pump ch ' Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Title 5 Official inspection Forth:Subsurface Sewage Disposal System•Page t 2 of 17 t5ins•OW08 � Commonwea lth of Massachusetts 5 Offi*ial Inspection Form Tale Not for Voluntary Assessments Subsurface Sewage Disposal System Form • Property Addressvllter �Se Owner owners Name L�y a 6— W information is Q+n✓ 1'r State Zip Code D of Inspection required for city/Town every page D. System Information (Cont.) Type: UL�- ,..�H�"r /o,�v�s �J l'�� number: leaching pits leaching chambers number: Cl leaching galleries number: leaching trenches • number, length: 0 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.): , �e� o o V7e :Q:�- A o S n� 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 � Yes ❑ No , Indication of groundwater inflow t]d 17 Tine 5 Orfid ct ai Inspeor+Form:SubwAace Sevr39e Disposai System•?age l5ins•09" Commonwealth of Massachusetts 5 Official Inspection Form Title Not for oluntary As ssments Sewage Dis Subsurface posal System Form ` �f r�e��► j � � rig'-� Property Address �v✓1 t�r� Owner Owner's Name information is G H i Zip Code Date Ins on required for State every page Ciry/Town D. System Information (cont.) level of ponding, condition of vegetation, Comments (note condition of soil, signs of hydraulic failure, etc.): i privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comm ents note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Title 5 Official Inspection Form:Subsurface Sewage Disposal Systern page 14 o1 V t5ins•0908 r Commonwealth of Massachusetts l Inspection Form Title 5 officia I ace Sewage Disposal System Form -Not for Voluntary Assessments i Subsurface 9 I Property Address Owner Owners Name - 1'_'L_ information is q✓10 ft Dat oft spection tequired for State ZP Code very page. cityrrown D. System Information (cont.) to Sketch Of Sewage Disposal System:d rarkse a view of or benchmarks. Locate ale sewage l l system wellswithin 100 feet inces luding at least two permanent reference la where p water supply enters the building. Check one of the boxes below: i hand-sketch in the area below ❑ drawing attached separately i i i I ; G,-cle Cover r 0-f U-s � �o✓P� d�� �e�o t,✓ Title 5 Official Inspection Form:Subsurface Sewage Disposal System'Page t5 of 17 (sins•09" Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address ��r V"71e` u,p Owner Owner's Name of ulred ford `7 c-,ki`?�s � 0,�6 0 very page. City/Town State Zip Code Da of I pection D. System Information (cont.) j Site Exam: ❑ Check Slope 3� ❑ Surface water 0% a ❑ Check cellar (0jA ❑ Shallow wells Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record f 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: j ❑ Checked with local excavators, installers- (attach documentation) I ❑ Accessed USGS database-explain: 1 I i You must describe how you established the high ground water elevation: i I j Before filing this Inspection Report, please see Report Completeness Checklist on next page. 115ins•09M Title 5 official Inspection forth:Subsurface Sewage Disposal System-Page 16 of 17 I II \ Commonwealth of Massachusetts Title 5 Official Inspection Form • Subsurface Sewage Disposal System Form -Not for Voluntary Assessments o �r l/�— Property Address er owner's Name formation is C! 101 j Oo�60 uired for State tip Code Date Ins ction very page. Cityfrown E. Report Completeness Checklist inspection Summary: A, B, C, D, or E checked Q' 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 I I i I i i I I f I , II i i i i it ; I i j i l A5ins.pgpg Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION 6s �C TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Z l Property Address: 37 GENERAL PATTON DR HYANNIS Owners Name: CLAUDIO/AUGUSTO NETTO Owner's Address: Date of Inspection:2/22/07 n -,z Name of Inspector: (please print) Douglas A.Brown 4 Company Name: Douglas A.Brown Septic Inspections C-1 Mailing Address:P.0 Box 145 Centerville,MA 02632 Telephone Number: 508-420-4534 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 a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: X Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Sign ature• Date: 2/22/07 ,2 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. Notes and Comments SYSTEM APPEARS TO MEET MINIMUM PASSING REQUIRMENTS.OPENED OBSERVATION PORT,SOIL IS DAMP WITH NO STANDING WATER. ****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. Title 5 Inspection Form 6/15/2000 page 1 Revised on 10/31/2000 )gage 2 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 37 GENERAL PATTON DR HYANNIS Owner's Name: CLAUDIO/AUGUSTO NETTO Owner's Address: SAME Date of Inspection: 2/22/07 inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X 'I have not found any information winch indicates that any of the failure criteria described in 3 10 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: OBSERVATION PORT OPENED,CHAMBERS WERE DAMP WITH NO STANDING WATER B. System Conditionally Passes: one or more system components as described in the"Conditional Pase'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 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 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 1 • Page 3 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 37 GENERAL PATTON DR HYANNIS Owner's Name: CLAUDIO/AUGUSTO NETTO Owner's Address: Date of Inspection: 2/22/07 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 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 I 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: Page 4 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 37 GENERAL PATTON DR HYANNIS Owner's Name: CLAUDIO/AUGUSTONETTO Owner's Address: Date of Inspection:2/22/07 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 1/2 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 form.] NO (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 3 10 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 ye$'m 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 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 37 GENERAL PATTON DR HYANNIS Owner: CLAUDIO/AUGUSTONETTO Date of Inspection: 2/22/07 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? X _ 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. _ _ 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)] 5 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:37 GENERAL PATTON DR HYANNIS Owner's Name: CLAUDIO/AUGUSTO NETTO Owner's Address: Date of Inspection. 2/22/07 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 2 DESIGN How based on 3 10 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 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): NA Seasonal use: (yes or no): NO Water meter readings,if available(last 2 years usage(gpd)): Sump pump(yes or no): NO Last date of occupancy: NA 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 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 X 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) _Tight tank _Attach a copy of the DEP approval _Other(describe): Approximate age of all components,date installed(if known)and source of information: 2001 JIM LEBOEUF Were sewage odors detected when arriving at the site (yes or no)? NO Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) 'Property Address: 37 GENERAL PATTON DR HYANNIS Owner's Name: ' CLAUDIO/AUGUSTO NETTO Owner's Address: Date of Inspection: 2/22/07 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: cast iron _40 PVC other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: (locate on site plan) Depth below grade: 12" Material of construction: X 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: 1500 gal Sludge depth: 6° Distance from top of sludge to bottom of outlet tee or baffle: 28" Scum thickness: 0 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: WOODEN POLE Comments(on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.)- TANK LOOKS STRUCTUALLY SOUND AT THIS TIME IT HAS ONE RISER TO GRADE INLET TEE WAS CLOGGED AT TIME OF INSPECTION,COULD USE PUMPING! GREASE TRAP:_(locate on site plan) Depth.below grade: Material of construction: concrete metal_fiberglass—polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from 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.): 'Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 37 GENERAL PATTON DR HYANMS Owner's Name: CLAUDIO/AUGUSTO NETTO Owner's Address: Date of Inspection: 2/22/07 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/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: (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.): PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Page 9 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 37 GENERAL PATTON DR HYANNIS Owner's Name: CLAUDIO/AUGUSTO NETTO Owner's Address: Date of Inspection: 2/22/07 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: 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.): 4 infiltrators in a FIELD 1 IX36 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 or no): 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.): Page 10 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 37I'GA NERAL PATTON DR NIS Owner's Name: CLAUDIO/AUGUSTO NETTO Owner's Address: Date of Inspection: 2/22/07 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. s 3� Page l l of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM ] INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 37 GENERAL PATTON DR i HYANNIS Owner's Name: CLAUDIO/AUGUSTO NETTO Owner's Address: Date of Inspection:2/22/07 SITE EXAM Slope: Surface water: Check cellar: Shallow wells Estimated depth to ground water 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) Accessed USGS database-explain: You must describe how you established the high ground water elevation: TOWN OF BARNSTABLE LOCATION �%�� ✓c �L WAr2>1-- A'e, SEWAGE # 77J VI LACE i4/�E'✓.(' ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. _17,i� C_ c`.�©Gb"/� SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO. OF BEDROOMS BUILDER OR OWNER �F�'.ey 'F�,t'E.V . '` Je PERMIT DATE: COMPLIANCE DATE: 0 Separation Distance Between the: f Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility // Feet f Private Water Supply Well and Leaching Facility (If any wells exist 1 a on site or within 200 feet of leaching facility) s� Feet' Edge of Wetland and Leaching Facility (If any wetlands exist , within 300 feet o aching facility / Feet Furnished by r C � .� r � . ��r t � r + m i i � � /� � �� �. � � � . �� �� �n r c �I 9 °� � ( � 7 1 � r � �w \, .� � _ � � •A� ��� r n �' `'� � , Z � � �� � O � a �� ��`� � ` No.,:,> Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Rpplication for Migpool *p-5tem Congarurtton Permit Application for a Permit to Construct Repair Upgrade Abandon El Complete System Individual Components Location Addy or Lot No. 5,;� Owner's Name,Address and Tel.No. Assessor's Map/Parcel -*OW / -Z Installer's Name,Address,and Tel.No. &1, ;;j D Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size 9'1'Y'6r_sq.ft. Garbage Grinder Other Type of Building 4e<lf No. of Persons Showers Ifteria Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank ---Type of S.A.S. Description of Soil: Nature of Repairs or Alterations(Answer when applicable) 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 issue bythis Board of Health. Signed Date Application Approved by 6:::� Date Application Disapproved for the following reasons Permit No. _9/�Fa 71111�l Date Issued . -•� �—r �. � yiw � ..w,'�,,d`A:j,..,,rs-.r `7rr..:.�:.,-„ - ..;ti:: C.:w�, r.a r' �.w,�� .�- � �� .:- .. - . -r•�,.r—,-..--+-.r...w .,.ua.,-..r+c � Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION-TOWN OF BARNSTABLE., MASSACHUSETT$ 2. 0(poYication for ;Bigo0al *pgtem Construction 3permit Application for a Permit to Construct( . )Repair( )Upgrade Abandon( ) El Complete System ❑Individual Components Location Ad dre s or Lot No.-5:�G Owner's Name,Address and Tel.No. Assessor's Map/Parcel �'9a \\A Installer's Name,Address,and Tel.No. �. ,ems''p p J D Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size 9/J 6 sq.ft. Garbage Grinder Other Type of Building QFr No.of Person Showers( ) Cafeteria( ) Other Fixtures Design Flow i r. gallons per day. Calculated daily flow gallons. Plan Date Number of sheets / Revision Date , r Title Size of Septic Tank /1'o0 -941 J �Ni� Type of S.A.S: Description of Soil r, Nature of Repai or Alterations(Answer when applicable) Date last inspected: Agreement: < ,.' 'Ttie,undersigned agrees to ensure the construction=and`iiiaintenance 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 issue by this Board of Health. Signed Date Application Approved by Dafe Application Disapproved for the following reasons ° Permit No. Date Issued Zw THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance T THIS IS TO CERTIFY, that the;On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded ) Abandoned( )by 2, Z e'!-�or y,` at 7 G�ti t/P� d �� O ,� ,hl�has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit N go,e!2 '1 ated 49 2,- V/. Installer C-i A4 -Designer The issuance of this permit shall not be construed as a guarantee that the syst- willAfu ct*n a�a s_i�d. Date 0 �0-z 2����z Inspector 0 ' v I i No. THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION a BARNSTABLE., MASSACHUSETTS 1witpoe al OpMem Construction 30ermit Permission is hereby granted to Construct( )Repair( )Upgrade Abandon( ) System located at 3 7 GC/YF�/i /'���70�✓ �� �y + and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this,pe�r tit. Date: / .-! �/ �� Approve ,by, i TOWN OF BA.RNSTA.BLE C LOCATION SEWAGE # .(14.71 VILLAGE Xi�6�t"'.(� ASSESSOR'S MAP & LOT O INSTALLER'S NAME& PHONE NO. !J`�,i,K 7 SEPTIC TANK CAPACITY LEACHING FACILITY: (type) 4 %��it(/i,•g /r7E'Ep — (size) // )C34rx Ile- I'- ' NO. OF BEDROOMS 'BUILDER OR OWNER 1/ � PERMITDATE: COMPLIANCE DATE: — —© Separation Distance Between the:. I 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 Wedand and.Leaching Facility (If any wetlands exist , within 300 fee Feet Furnished by cat/% / 6oP 0 HINCiHMARK TOP OF SLAB 20 FT, MINIMUM FROM CELLAR ..SOIL TEST 10 FT. MINIMUM FROM SLAB OR CRAWL SPACE DATE OF SOIL TEST D�Cz.,S. 2001_____' ELEV. = 1----- 10 FL MINIMUM CLEAN SAND SOIL TEST DONE BY �V. I FLL[�1N�$1C�G (ASSUMED) CONCRETE WITNESSED BY ----------- COVERS ---- LOAM AND SEED 4" SCHEDULE 4o PVC PIPE OBSERVATION HOLE 1 ELEV,- 96.20 MIN. PITCH 1/8" PER FT. PERCOLATION RATE .__<__2_- MIN,/INCH IN C HORIZON 2" LAYER OF TO 1/2' �+ LEGEND: DEPTH HORIZ TEXTURE- COLOR MOTT. OTHER 6 A 96.00 MAX. WASHED STONE VENT GVG 3.00 4" CAST IRON PIPE 83.75 MiN. NOT REQUIRED EXISTING SPOT ELEVATION 00,,0 0-40 FILL (OR EQUAL) MINIMUM �--..- EXISTING CONTOUR ----00---- �- _ FINAL SPOT ELEVATION 0 PITCH 1/4" PER FT. Z 1 CU. FT, OF � 40-50 A LOAMY SAND 10YR5/4 NO ROOTS TEE CONCRETE FINAL CONTOUR ANCHOR SOIL TEST LOCATION 50-82 B LOAMY SAND 10YR5 8 FLOW LINE 93.00 0' UTILITY POLE -0- / ELEV. 97.00_ 10" TOWN WATER -=W -_-- W- '[ MIN. 94.45 2'0" ° ° I ° / \ 82-138 C1 MEDIUM SAND 10YR6 8 20% COBBLES ELEV. _ ------ LEVEL o 10. ° ®/ CATCH BASIN / 1.6? G ELEV. = _�4.7Q_ GAS ELEV. 6" SUMP _93.00_ ° ELEV.._ ------ GAS LINE) _ _ 93.17^ ELEV. _ = - BAFFLE --- CLEAN 0 T CESSPOOL C.P. DISTRIBUTION . ELEV. .:. 4 HIGH CAPACITY INFILTRATORS WITH t LIQUID OUTLET �� m:-, BOX _�2,�4-J STONE IN AN DEPTH TEE I (TO BE PLACED ON FIRM BASE} ) z } 4 FEET 14 INCHES - TO BE WATER TESTED M b 5 FEET 19 INCHES 11 X 38 X 10 TRENCH FORMATION S7 ' i IF MORE THAN ONE OUTLET �� 6 FEET 24 INCHES 5OO GALLON c r 7 FEET 29 INCHES C (TO BE PLACED ON FIRM BASE) SOIL ABSORPTION I - WELL N/A NO WATER ENCOUNTERED AT 138 ELEV. 8 FEET 34 INCHES SEPTIC TANKZONE 3/4.. TO i 1/2.. CLEAN STEM SAS I INDEXDOUBLE WASHED STONE ADJUST FREE of FINES SILT DESIGN CALCULATIONS SEWAGE DISPOSAL SYSTEM PROFILE OBSERVED PROBABLE WATER TABLE ELEV. ------ NUMBER OF BEDROOMS -3-- OBSERVED WATER TABLE ( / } ELEV. _ GARBAGE DISPOSAL UNIT NOT TO SCALE BOTTOM OF TEST 1-0LE ELEV. = _44aZQ_, TOTAL ESTIMATED FLOW ( 110 GAL/SR./DAY X 3 SR.) _�3Q_ GAL./DAY , REQUIRED SEPTIC TANK CAPACITY __f4Q_ GAL. ACTUAL SIZE OF.SEPTIC TANK GAL SOIL CLASSIFICATION DESIGN PERCOLATION RATE <_� MIN./IN. EFFLUENT LOADING RATE ,7-4, GAL./DAY/S.F. LEACHING AREA 4Z444 SQ. FT. (11X36)+(47X2X1O/12) LEACHING CAPACITY (AREA X RATE) -35tQQ GAL./DAY 474.33 X 0.74 RESERVE LEACHING CAPACITY ''LQQ GAL./DAY NOTES: 1. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P, I TITLE 5 AND THE TOWN OF _-_ARNSTAM---- RULES AND REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE. X 98."5 / 2. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO WITHIN 6 OF FINISHED GRADE. 3. -ALL.COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF 98.6 n 8 WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN 98 �. 10 FT. OF DRIVES OR PARKING K G AREAS. H 20 LOADING SHALL BE USED .UNDER OR WITHIN 10 FT F I � 0 DRIVES OR PARKING AREAS: 4. ANY MASONARY IT UN 5 USED TO:BRING COVERS TO GRADE SHALL r o1 PE' MORTARED IN _ A( , , . . .E 1 I vE3-Dl;itRl�Ai'tiATit`JN HAS BEEN MADE A5 TO`COMPLIAN F WITH � C.. DEEDED OR ZONING REGULATIONS. OWNER E j APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM APPROPRIATE RO RIATE AUTHORITY. O (� 9, 15 S. - IS p 6. UTILITIES SHOWN ARE APPROXIMATE ONLY, EXCAVATION CONTRACTOR rJ TO CALL "DIG-SAFE" AT 1-888-344-7233 AT EAST 7 H• L 2 OURS j f PRIOR TO COMMENCING WORK ON SITE. II X 97:5 7. CONTRACTOR IS TO VERIFY GRADES AND ELEVATIONS AS WELL AS I SITE CONDITIONS PRIOR TO COMMENCING WORK ON SITE. ANY VARIATION X 98.0 D. BOX 99.0 W X 97.3 I5 TO BE BROUGHT TO THE ATTENTION OF THE DESIGN ENGINEER 98.5 IMMEDIATELY. 8. PARCEL IS IN FLOOD ZONE ;__c_,�. 99.2 Z 9 i 8 X 97.2 9. LOT IS SHOWN ON ASSESSORS MAP 292Y AS PARCEL _134 x 9� 10. INTERIOR PIPING IS TO BE PLUMBED TO EXIT AS SHOWN. 98.3 11. EXISTING SEPTICS ARE TO BE PUMPED AND REMOVED, EXISTING DWELLING x 98• 12. ALL UNSUITABLE MATERIAL SHALL BE REMOVED FROM UNDER AND FOR tx h 2 BEDROOMS A MINIMUM OF 5' AROUND SOIL ABSORPTION SYSTEM AND BE REPLACED �N 98;6 .; h.. WITH SAND AS SPECIFIED IN 310 CMR 15.255:(3). .P, _> 9� X 9 7.7 f R I ' APPROVED: BOARD OF HEALTH L 1500 GALLON `. X 88.6 T T SEPTIC TANK 6 , ._- •O 98.5 �� DATE AGENT PROPOSED SEPTIC DESIGN FOR 9� LIMIT of Rov�� 2 If ERRY Tro"EY 5' OVERDIG 8 9 O ' LOIDT 40, 37 GENERAL PATTON DRV. 6sr sr9 BARNSTABLE (HYAAWKS> LASS SW EMSER ENGIIITEERING 12 58' ot ` 235 GREAT WESTERN ROAD zD 508- P. 0. BOX 713 SOUTH DENNIS, MASS. 398-3922 02660 - LVCEU DATE ^ SCALE >> I DEC 5, 2001 1 = 20 REVISED dOB N0. 5290-CIO LOCATION MAP REVISED SHEET 1 OF lt: C �S8�PR0✓�5290-00 \dwg�5290-00 DWG 0 2001 SWEETSER ENGINE-ERING