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HomeMy WebLinkAbout0023 GOOSE POINT ROAD - Health 23 Goose Point Road - ` Hyannis . .�_..... A= 2 68 o I ° i i a 1 ` o V u 0 i t r o `s Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w John Zappala Property Address 23 Goosepoint Rd. a Owner Owner's Name information is C required for UVANM's Ma. 02632 1/27/2010 every 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 A. General Information forms on the computer,use 1. Inspector: only the tab key to move your Robert Paolini cursor-do not Name of Inspector use the return key. Capewide Enterprises,LLC. Company Name P.O.Box 763 Company Address Centerville Ma. 02632 City/Town State Zip Code (508)428-4028 S14454 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Fur r Evaluation by the Local Approving Authority 1/27/2010 Insp or's Wgn a Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Lo L/ �I O t5ins-09/08 Tide 5 Official Inspection Form:Subsurface age Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments John Zappala Property Address 23 Goosepoint Rd. Owner Owner's Name information is required for Centerville Ma. 02632 1/27/2010 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The septic system is in proper working order at the present time. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments John Zappala Property Address 23 Goosepoint Rd. Owner Owner's Name information is required for Centerville Ma. 02632 1/27/2010 every page. CityrFown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N [IND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t51ns•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments John Zappala Property Address 23 Goosepoint Rd. Owner Owner's Name information is required for Centerville Ma. 02632 1/27/2010 every page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments John Zappala Property Address 23 Goosepoint Rd. Owner Owner's Name information is required for Centerville Ma. 02632 1/27/2010 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems,you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•09/08 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 5 of 17 I Gommonwealth:of'Massachusetts Title 5"Official Inspection Form R — o Subsurface Sewage'Disposal System Form -Not for Voluntary Assessments John Zappala Property`Address 23 Goosepoint Rd. j Owner Owner's Name F information is required-W Centerville' Ma. 02632 1/27./2010. j. St every"page. cityrrown ate Zip code Date-of inspection C. Checklist Check if the followinghave been done. You must indicate"yes"or"no"as to each of the following: Yes No r ® ❑ 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? N ❑ Has the system received normal flows in the previous two week period? �I ❑ ® Have large volumes of water been introduced to the system recently or as part of 4 this inspection? I Were as built plans of the system obtained and examined? (If they were not ❑ available,note as N/A) �! ii ® ❑ Was the facility or dwelling inspected for signs of sewage back up? j ® ❑ Was the site inspected for signs of break out? ED ❑ Were all system components,excluding the SAS, located on site? I ® ❑ 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? i Was the facility owner(and occupants'if different from owner) provided with i! ❑ information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ❑ Existing information. For example, a plan at the Board of Health. Determined in the field (if any of the failure criteria related to Part:C is at issue El N approximation of distance is unacceptable) [310 CMR 15.302(5)] Ij _ i D. System-Information Residential Flow Conditions: j Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 1'10 gpd x#of bedrooms): 330 14 t51ns•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of17 ' I. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments John Zappala Property Address 23 Goosepoint Rd. Owner Owner's Name information is required for Centerville Ma. 02632 1/27/2010 every page. City/Town State Zip Code Date of Inspection D. System Information Description: The septic system consists of a 1000 gallon tank,D-Box and two 500 gallon drywells. Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 2008:88,000 g ( y g (gp ))' 2009:102,000 Detail: 2008:240gpd. 2009:102g pd. Sump pump? ❑ Yes ® No Last date of occupancy: 1/27/2010 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•09108 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments . ' John Zappala Property Address 23 Goosepoint Rd. Owner Owner's Name information is required for Centerville Ma. 02632 1/27/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Capewide Enterprises,LLC. Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Tank pumped 11/18/2009 For maintenance Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t51ns•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments John Zappala Property Address 23 Goosepoint Rd. Owner Owner's Name information is required for Centerville Ma. 02632 1/27/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: New leaching installed 2003 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 4' Depth below grade: feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line. 10'+ feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints appear tight.No evidence of Ieakage.System vented through the house vents. Septic Tank(locate on site plan): Depth below grade: 3.5' 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: 1000 Sludge depth: 1" t5ins•09/08 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments John Zappala Property Address 23 Goosepoint Rd. Owner Owner's Name information is required for Centerville Ma. 02632 1/27/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 31" Scum thickness 0" 8 Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? Measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pump tank every two years.lnlet and outlet tees are in place.No evidence of Ieakage.Tank appears structurally sound. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments John Zappala Property Address 23 Goosepoint Rd. Owner Owner's Name information is required for Centerville Ma. 02632 1/27/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t51ns•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form R — Subsurface Sewage Disposal System Form -Not for Voluntary Assessments John Zappala Property Address 23 Goosepoint Rd. Owner Owner's Name information is required for Centerville Ma. 02632 1/27/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened)(locate on site plan): Depth of liquid level above outlet invert No Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Box is Ievel.Box has one outlet Iateral.No evidence of solids carryover.No evidence of leakage. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts • Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments John Zappala Property Address 23 Goosepoint Rd. Owner Owner's Name information is required for Centerville Ma. 02632 1/27/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 2 ❑ 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.): Sandy dry soil.No signs of hydraulic fa i lure.Drywells water level was 18" below invert.Stain line is 12" below invert. 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 15ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments John Zappala Property Address 23 Goosepoint Rd. Owner Owner's Name information is required for Centerville Ma. 02632 1/27/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t51ns•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Map Page I of 2 Town of Barnstable Geographic Information System Parcel Viewer] Custom Map Abutters Map Size MEN zoom out jjj jjj j JjIn N ft- 30 3 20 Feet Set Scale I" = 20 I Aerial Photos I MAP DISCLAIMER A Tn...n M Q.—O.W. RAG All rinhf.rnenni http://66.203.95.236/arcims/appgeoapp/map.aspx?propertyID=252083H00&mapparback= 2/4/2010 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments John Zappala Property Address 23 Goosepoint Rd. Owner Owner's Name information is required for Centerville Ma. 02632 1/27/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: Bottom of leaching 35' feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: As-Built ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: USED:USGS Observation Well Data.USED:Technical Bulletin 92-0001 plate#2 annual ranges of groundwater elevations. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form R Subsurface Sewage Disposal System Form -Not for Voluntary Assessments John Zappala Property Address 23 Goosepoint Rd. Owner Owner's Name information is required for Centerville Ma. 02632 1/27/2010 every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•09/08 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 O �a TITLE 5 -.` J` OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS . Ty= SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM Z PART A .. CERTIFICATION co rn Property Address: 23 Goose Point Road Centerville Owner's Name: Lloyd Karkos Owner's Address: Date of Inspection: Name of Inspector: lease rint p (p p )Jdilliam E_ • gob inson Sr, Company Name: William E. Robinson Septic Service Mailing Address: P O Box 1089 _Centerville. MA Telephone Number: (5081 775-8776 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. 12111 a DEC approved system inspector.pursuan7tose ion1S340 ofTitle 5(310 CMR 15.000). The system: es Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Sigliature: `" Date: The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health-or DEP)within 30 days of completing this inspection.if the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be seat to the system owner and copies'sent to the buyer,if applicable,and the approving authority. Notes and Comments 6, ""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(lie system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page I L Page 2 of l l ` OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 23 Goose Point Road Centerville Owner: Lloyd Ca kos Date of inspection: '— Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System asses: 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CUR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Co ditionally Passes: One or m re system components as described in the"Conditional Pass"section need to be replaced or repaired.The syst m,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or of determined(Y,N,ND)in the for the following statements.If"not determined"please explain. The septic is metal and over 20 years old"or the septic tank(whether metal or not)is structurally unsound ,exhibits s bstantial infiltration or exfiltration or tank failure is irtuninent.System will pass inspection if the existing tank is rep ced with a complying septic tank as approved by the Board of Health. •A metal septic will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the is less than 20 years old is available. ND explain: Observat' n of sewage backup or break out or Idgh static water level in the distribution box due to-broken or obstructed pipe )or due to a broken,settled or uneven distribution box.System will pass inspection if(with approval of Bo d of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND expl The system required pumping more than 4 times a year due to broken or obsvucted pipe(s).The system will pass in ection if(with approval of the Board of Health): broken pipes)are replaced Obstruction is rcmovod ND explain: UIV Page 3ofII OFFICIAL INSPECTION FORM=NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 23 Goose Point Road Centerville Owner: Llo d .Karkos _ Dale of Inspection: 1 —G' C. Further Evaluation is Required by the Board of Health: onditions 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. S stem will pass unless Board of Health determines in accordance with 310 CM 15.303(1)(b)that the s (cm 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(lie stem 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 froto 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 acteria and volatile organic compounds indicates that the well is Gee from pollution from that facility and e presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other ilure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: b i I 3 i Page 4 of l l OFFICIAL INSPECTION FOIA1-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 23 Goose Point Road Centerville Owner: Llovd -Karkos Date of Inspection: - —Q D. System Failure Criteria applicable to all systems: You must' idicate"yes"or"no"to each of die following for all inspections: Yes No Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ischarge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _ Static liquid level in the distribution box above.outlet invert due to an overloaded or clogged SAS or cesspool Liquid depth in cesspool is less than 6"below invert or.available volume is less than'h day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped _ Any portion of the SAS,cesspool or privy is below high ground water elevation. _ Any portion of cesspool or privy is within 100.feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 1 of a public well. _ Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 Net front a private watrr 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(lie well is free from pollution from that facility and tlhe 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.] (Yes/No)The system fails. I have determined that one or more ofthe 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. arge Systems: To b considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd- You n us(indicate either"yes"or"no"to each of the following: (Tlhe f ]lowing criteria apply to large systems in addition to tlhe criteria above) yes ro 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 syppi r 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 yo have answered"yes'to any question in Section E the system is considered as ignificant ducat,or answered "yc 'in Section D above the large system has failed.The cr%m r or operator of arrY large system considered a st nificant ducat under Section E or failed under Section D shall upgrade the system in accordance with 310 CNIR 304.The system owner should contact the appropriate regional office of the Department. 4 Page S of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 23 Goose Point Road Centerville Owner: Lloyd Karkos Dale of Inspection: 6 Check if the following have been done.You must indicate'yes"or"no"as to each of the following: Yes No/ L/ Pumping information was provided by the owner,occupant,or Board of Health t/ Were any of the system components pumped out in the previous two weeks? Has the system received normal(lows in the previous two week period? ._ Have large volumes of water been introduced to the system recently or as part of this inspection? _ —ZWere 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? v Was the site inspected for signs of break out? v — Were all system components,excluding the SAS,located on site? _� Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the—baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? _ _✓ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no 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)13 10 CMR 15.302(3)(b)) 5 Page 6 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 23 Goose Point Road Centerville Owner: Lloyd Karko's Date of Inspection: —L —d FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x N of bedrooms): '-If 0 Number of current residents: I Does residence have a garbage grinder(yes or no): 6- Is laundry on a separate sewage system(yes or no):"[if yes separate inspection required] Laundry system inspected(yes or no):/ Seasonal use:(yes or no):.tle u Water meter readings, if available(last 2 years usage(gpd)): 2004 — 63, 000 Sump pump(yes or no): 0 � — 49, 500 Last date of occupancy: C S COMMERCIAL/IND TRIAL Type of establishment: Design flow(based o 310 CMR 15.203): gpd Basis of design flow seats/persons/sgR,etc.): Grease trap prese (yes or no): Industrial waste Iding tank present(yes or no):_ Non-sanitary w sic discharged to the Title 5 system(yes or no): Water meter r adings,if available: Last date of ccupancy/use: OTHE describe): GENERAL INFORMATION Pumping Records - Source of information: Was system pumped as part of the inspection(yes or no):Ala If yes,volume pumped:_gallons--How was quantity pumped determined? Reason for pumping: TYPk'OF SYSTEM /✓Septic tank,distribution box,soil absorption system _Single cesspool Overflow cesspool Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Altcmative technology.Attach a copy of the current operation and main cnance contract(to be obtained from system owner) _Tigbt tank —Attach a copy of the DEP approval —Other(describe): Approximate age of all components,date installed(if known)and source of information: 9Jli � Were sewage odors detected when arriving at the site(yes or no): U 6 i Pav 7 of I I OFFICIAL INSPECTION FORM —NOT FOR VOLUN-TARY ASSESSIIILNTS SUBSURFACE SELVAGE DISPOSAL, SYSTEM INSPECTION F0101 PART C SYSTEM INFORMATION(continued) Property Address: 23 Goose Point Road Centervi e Owner: Llo d �Kark-o—s Date of Inspection: -6 UUILUING SE'VEIl(lo it on site plan) Dcpdi below grade: Materials of constru lion:_cast iron _40 1'VC_other(explain): Distance from pri ate water supply well or suction line: Conuncnts(on ndition ofjuutts,venting,cvidcncc of leakage,cic.): SEPTIC TANK: (locate on site plait) Depth below grade: I n n Material ofconstructio : ✓EuncrcIc metal fiberglass polyethylene _otlrcr(cxplain) If tank is metal list age:_ Is age confinned•by a Certificate of Cumpliarnce (yes or nu):—(attach a copy of certificate) , Dimensions: Sludge depth: 6—7' Distance from lop of sludge 1u bultonn of outlet Ice or bafllc:_ Scum thickness: /—3 •, Distance from lop of scum to Iup of oullct tee or baffle: , Distance Gom bouum of scum to bottom of outlet Ice or bafllc: % / f low were dimensions docrntincd: _ .t. Cumments(oil pumping(ecununendations,inlet and outlet Ice or bafllc condition, s1luclwal integrity,liquid Ic%•cls as related 10 outlet inver cvidcncc of 1 aka etc.): .> J Ic _ , ry G1t,EASE TRAP:_(locate site plan) Dcpth below grade:_ t Malerial of construction: , concrete metal fiberglass_polycthylene _outer (c).plain): — — Dimensions: Scum Ihickncss: Distancc from lop of um to 1up of oullct Icc or bafllc: Distance Gom bottor of stunt to bottom of oullct ice or bafllc: Dale of last puntpin Conunenls(on pu ping recununendatiults, inlet and oullct tce'Ur bafllc cutnlitiva, structwal integrity,liquid IC\•Cls as rdalcd to oull 111vul,ctidcncc of leakage,ctc.): 7 'age S of OFFICIAL INSPECTION FORM-NOT FOlt VOLUNTARY ASSESSMENTS SULISUIVACE SENYAGE DISPOSAL SYSTEM INSPECTION FORM I PART C SYSTEM INFORMATION(continued) I Properly Address: 23 Goose Point Road CRnterville Owner._L Dale of IDspcctlOD: i TIGIIT or HOLDING TANK: (t must be pumped at tinse of inspection)(locate on site plan) Depth below grade: Material of construction:�conc etc_metal_fiberglass_pulyetltylene other(explaut): Dintcnsions: Capacity: alluns Design Flow. gallons/day Alarm present(yes or no)- Alarm level: ann in working urdcr(ycs or no): Date of last purnping: Conuncnts(conditio of alarm and float switches,ctc.): DISTIUBUTION BOX: Oresent must be opened)(locate on site plan) Depth of liquid level above Outlet invert: Q Conunents(note if box is level and distribution to outlets equal,any evidence of solids carryover, any evidence of leakage into or out of box,ctc.): PUMP CHAMBER:_(luc c on site plan) Pumps in working order(yc or no): Alanns in working order( s or no): _ Conunenls(note eondili t of pump chambe(,condition of pumps and appurtenances, etc.): 6, I Page 9 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 23 Goose Point Road Centerville Owner: Lloyd Karkos Date of Inspection: -Ed,s SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why. TKcharnbcrs, ._ pits,number:_number:2 leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions: overflow cesspool,number: innovative/altemative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): _ 4- Cam, CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and cone oration: Depth—top of li uid to inlet invert: Depth of solids ayer: Depth of scu aver: Dimensions cesspool: Materials o construction: Indication f groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): PRIVY: (loc a on site plan) Materials of con truction: Dimensions: Depth of soli s: Comments ote condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): I 9 Page 10 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address• 23 Goose Point Road Centerville owner:--Lloyd Karkos Date of Inspection: G 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. l l� to -Page 11 of I l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 23 Goose Point Road Centerville Owner. Lloyd Karkos Date of Inspection: — -.r> SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water�P-(5�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 ISO 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 yo established the high groundwater elevation: r— / o�e p-s 1 ' 11 TOWN OF BARNSTABLE LOCATION Cnn„5t70irJt Rosa f) SEWAGE # a6o3"3i? VILLAGE ASSESSOR'S MAP& LOT ?2 -®23 INSTALLER'S NAME&PHONE N . R66crJ4,6i:1 S�Qhic 50�'-7 Z5=9-7](, SEPTIC TANK CAPACITY 1 O O 6 LEACHING FACILITY: (type) —(size)' X 13 a S NO.OF BEDROOMS BUILDER OR OWNER Lit#D PERMIT DATE: aT�3 COMPLIANCE DATE: Ct f 1 0'3 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 :1 y � CJ- C—n ' Ik. �tn� TOWN OF BARNSTABLE LOCATION "� V4 � ZQc-P SEWAGE # 093 V"tL,LAGE C ASSESSOR'S MAP & LOT` / INSTALLER'S NAME&PHONE NO.�� G • SEPTIC TANK CAPACITY , LEACHING FACILITY: (type) (size) NO. OF BEDROOMS 3QQ !�OWNER 4 --, OCy !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 J within 300 feet of leaching facility) Feet r Furnished by Page 10 of 11 -- - -- - . OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Properly Addren: 23 Goo9e Point Road Centerville Owner. Llo d Kar o� Datcofl sPectloo: SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benduharks.Locate all wells within 100 feet.Locate where public water supply enters the building. 7' 1 ri ._. _ _...._.. ._. _ r l t r 'IA No. Fee 5 0.0 0 ' 1 " THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Z(ppYication for Migpogar *p$tem Cow5tructiou Vermtt Application for a Permit to Construct( )Repair(x)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 23 Goosepoint Rd, Centerville Lloyd Karkos Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. W.E. Robinson Septic Service C.R. Short P.O. Box 1089 Centerville P.O. Box 1044, S. Dennis Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq. ft. Garbage Grinder(no) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date 11 Title Size of Septic Tank Type of S.A.S. Description of Soil f Nature of Repairs or Alterations(Answer when applicable) We will install a new Title 5 leach system to plans of C.R. Date last inspected: t Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this ar Health. Date C Signed Application Approved by Date 7 U Application Disapproved for the following reasons Permit No-- =3(pieDate Issued ------ R,r •..�• '� *, r-`.t'•y :,�. _..- ._.f ' r; .:-.i, �,. ., . +.•- c-.:s.r.a+r.r.,'aaq� ti'•ra.,K 's^''" ri i' FW'kti'ap � .:' • t t , t'f � -00 f,...A 'No.�kDom Fee 50. Entered in computer: THE COMMONWEALTH OF MASSACHUSETTS Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS =y ;= 01pplication for 3Di5pogal &p.5tem Construction Permit Application for a Permit to Construct( )Repair(x)Upgrade( )Abandon( ) O Complete System El Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 23 Goosepoint Rd, Centerville Lloyd Karkos Assessor's Map/Pa&el Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. W.E. Robinson Septic Service C.R. Short P.O. Box 1080 Centerville P.O. Box :.1.044, S. Dennis Type of Building: Dwelling No.of Bedrooms' . 3 Lot Size sq^ft. Garbage Grinder(Ao)+ i• Other Type of Building T No.of Persons Showers( ) Cafeteria( ) Other Fixtures A Design Flow gallons per day. Calculated daily.flow' gallons. Plan Date Number of sheets Revision Date � i Title 1I ,Y Size of Septic Tank Type of S.A:S. �✓.. Description of Soil Nature of Repairs or Alterations(Answer when applicable) We Will install a. new Title 5 leach system to plans of C.R. " 'r 1 -982 Date last inspected: w Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of,Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this E oar f Health. Signed Date ,Application Approved Approved by Date . t Application Disapproved for the following reasons Permit No. c,,C�ID Date Issued 7 U `. ----- — --- _— x-- —————— —--- . Lloyd THE COMMONWEALTH OF MASSACHUSETTS R BARNSTABLE, MASSACHUSETTS Certificate of Compliance t. THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed ( ) Repaired( x)Upgraded ( ) Abandoned( )by W.E. Robinson Septic Service at 23 Goose Point Rd , rPntory111p has been constructed in accordance = with the provisions of Title 5 and the for Disposal System Construction Permit No.2-00 3` 31og dated ?` ?-0 3 Installer Designer The issuance of this pe Ushall not be construed as a guarantee that the.system W 'bn�d�li�Xne - Date t/ D.S Inspector i No. Lloyd Fee 50.00 aco.3—3 Co THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS r &.5pont bpztem Construction Permit Permission is hereby granted to Construct( )Repair( X)Upgrade( )Abandon( ) System located at 23 Goose Point Rd Centerville 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 o this pe Date:_ 17 O - Approved by TOWN OF BARNSTABLE LOCATION O iQE" SEWAGE# r2w3 3t,'• VILLAGE ASSESSOR'S MAP& LOT :3 " INSTALLER'S NAME&PHONE NO. (cb�irlcrslJ S�n�rc 5a -7?S-�7?ro SEPTIC TANK CAPACITY ( 00C) LEACFENG FACILITY: (type) (size) 2X 13 aRa'� NO.OF BEDROOMS BUILDER OR OWNER LI-YI) PERMIT DATE: ____,.,-- COMPLIANCE DATE: CY I�'1 I©'� Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility . Feet f Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet II Edge of Wetland and Leaching Facility(If any wetlands exist { within 300 feet of leaching facility) Feet Furnished by -- ------ _J I/ i • ii i I w a • _ , T - - a - - » t u NC - $E HI�ARI - SOIL TESL' .. . ...' TOP OF FOUNDATION 20 FT.,MINIMUM FROM CELLAR DATE OF SOfL'TES7103 410 FT, MINIMUM FROM SLAB OR CRAWL SPACE .:100.00 I0 fT. MINIMUM SOIL TEST DONE 8Y ELEV. CLEAN SAND WITNESSED 8Y _Mil. E. RNSOt�L _ (ASSUMED) CONCRETE VERS _ CO LOAM AND SEED PVC IP OBSERVATION HOLE":,l E�EV.� 4 SCHEDULE 40 P E MIN. PITCH 1/8 R PER- FT: " PERCOLATION' ATE < �� 1A1N./INCH A7 2 "4 (NGNES 2 LAYER OF 1 8 TO f/2 LEGEND: DEPTH HORIZ TEXTURE - COLOR MOTT. [OTHER, , f N/A 99.0 MAX. WASHED.STONT EXISTING SPOT ELEVATION OOXO• Y 4 CAST IRON `PIPE 98.4 MIN. EXISTING CONTOUR ----DO---- ' A F (OR EQUAL) MINIMUM FINAL,SPOTELEVATION PITCH 1/4" PER FT. FINAL CONTOUR 6" A LOAMY SAND 10YR3 2 NO 8 4.75' ZABEL FILTER MAX. SOIL TEST LOCATION !� FLOW LINE 94.25 in UTILITY POLE -0 ELEV. = N A ❑ ❑ O Cl ❑O ❑ ❑ p O O TOWN WATER -�WW�= 30' 6 LOAMY SAND 10YR5/ 6 N „'• h L� - MIN. ° o ° CATCH BASIN ,®i ELEV. _ 94_25_ 2.p..-y{ ° o GAS LINE G EXIST. LEVEL e ° ❑ ❑ O ❑❑❑ ❑ ❑ ❑ ❑❑ ELEV. _94 GAS _ 94.0 6" SUMP ELEV. 93.8 ° ° a CLEAN OUT ELEV. - .._____ _ -~_--- ❑ O O f]a a O O D C7 O o 2' e CESSPOOL C.P.Q BAFFLE DISTRIBUTION ° ° a ° ELEV. _ ° ❑ 0= 00❑ ❑ ❑13❑ ° ° ` LIQUID OUTLET -% BOX ��_ ° a ° o o ELEV. _ _91.5 MEDIUM 1^0 DEPTH TEE 4 FEET 14 INCHES {� BE PLACED ON FIRM BASE) TO 8E WATER TESTED 2-500 GALLON DRYWELLS WITH 144' C SAND OYR7 4 , 5 FEET 19 INCHES IF MORE THAN ONE .OUTLET STONE IN AN 6 FEET 24 INCHES 1 000 GALLON 7 FEET 29 INCHS (TO BE PLACED ON FIRM BASE) 13' x 25' x 2' TRENCH FORMATION K 5.3. NZIEIN_E N A NO WATER ENCOUNTERED AT ._12:,.,_ ELEV. _ ,.,.$ .'S'L , e FEET 34 INCHES SEPTIC TANK O -t�t1e-- 3/4" TO 1 1/2- CLEAN SOIL ABSORPTION " v ix�, DESIGN CALCULATIONS' ,' EXISTING DOUBLE WASHED -STONE � 'ADJUST FREE OF FINES & SILT SYSTEM SAS NUMBER OF BEDROOMS " 3 USGS PROBABLE WATER TABLE ELEV. _ A� GARBAGE DISPOSAL UNIT NO! LOWED SEWAGE DISPOSAL SYSTEM PROFILE OBSERVED WATER TABLE ( / f ) ELEV. = A__ TOTAL ESTIMATED FLOW NOT TO SCALE BOTTOM OF TEST HOLE ELEV. .2__ ( 110 GAL:/BR./DAY.•X ....'5.._ BR) ;:.3�51.,.GAL:/DAY REQUIRED SEPTIC TANK CAPACITY :a.1Q1�_ GAL ACTUAL.SIZE OF SEPTIC TANK .«2. GAL. SOIL CLASSIFICATION .. ...1�.: X., DESIGN PERCOLATION-RATE: 5s�_:. MIN./IN. EFFLUENT LOADING_RATE 1� GAL./DAY/S Fl- LEACHING AREA T., 477- SQ..,FT,,' (13'x25')+(76'x2') LEACHING CAPACITY'(AREA X RATE) ' 5 & BARN. B.O.H. VARIANCES .REQUIRED.: x 99.5 477 x 0.74 : SECTION 15.221: RESERVE:LEACHING CAPACITY . S_ GAL. AY r ALLOWS ONLY 3' OF COVER OVER S.`A.S COMPONENTS. A 1.75' VARIANCE REQUESTED 5PVCHIVAR 100.0 NOTES. 1: ALL WORKMANSHIP AND'MATERIALS' SHALL 'CONFORM.TO D.E:P, .r TITLE 5 AND THE TOWN RULES AND REGULATIONS_FOR THE SUBSURt:ACE-�v DISPOSAL 'OF SEWAGE. ;. 2.ALL COVERS TO SANITARY UNITS 'SHALL BE BROUGHT TO x WITHIN 6" "OF'FINISHED GRADE: 100.2 G> 3. ALL COMPONENTS OF THE:SANITARY S'�STEM SHALL 8E CAPABLt 'OF ., 99.4U WITHSTANDING'-H•-10 LOADING'UNLESS--THEY ARE UNDER OR ;WITHIN -- - -- '- - 10 FT. OF DRIVES OR PARKING AREAS. aH-20 LOADING �9 _ . USED'UNDER UNDER OR WITHIN 10 f T. OF DRIVES OR PARKING 'AREAS' . x 100.9 � � _ 4. ANY MASONRY.UNITS USED'TO BRING COVERS TO'GRADE SHALL _ BE MORTARED IN PLACE. _ 5. NO ,DETERMINATION RMINATION HAS BEEN ,MADE AS :TO CQMrUANCE'WiTH 99.8 DEEDED.OR ZONING REGULATIONS.; OWNER / 'APPLICANT IS TO B/T. ORI1�£ o+ OBTAIN 'SUCH DETERMINATION FROM APPROPRIATE' AUTHORITY.- 1I 99.3 .4 00.3 09.4 6."UT1UTIES SHOWN ARE,�APPROXIMATE ONLY, EXCAVATION ,CONTRACTOR : 6.7 IS TO CALL "DIG-SAFE"=AT 1,488"-344-7233 AT LEAST,72,HOURS A PRIOR TO COMMENCING WORK :ON SITE.; 99.3 GARAGE �65� 4 ��������� 7. CONTRACTOR IS TO VERIFY GRADES ANb ELEVATIONS;AS FWEk UNDER ` SITE CONDITIONS 'PRIOR TO COMMENCING WORK ON SITE. ANY-;�IATtIATION 9.3 •799.4 �,�,���� 1S TO.BE BROUGHT TO THE ATTENTION OF THE`.DESIGN ENGINEEF IMMEDIATELY. WALK x 98.8 OUT ���- 8.'PARCEL IS IN FLOOD ZONE .w C.. 2b2. -83 g 9. LOT IS SHOWN ON ASSESSORS f�AP AS PARCEL 99.4 9 6 10. ACL UNSUITABLE MATERIAL SHALL BE REMOVED FROM :UNDER,` AND EXISTING DWELLING FOR A MINIMUM OF.5 FEET FROM AROUND THE;SOIL'ABSORPTION SYSTEM,' EXISTING :AND BE REPLACED WITH SAND AS SPECIFIED 1N 310 .CMR 15.255: (3) 1000 GA a.: i / (I.E. TITLE 5) IF ENCOUNTERED BELOW S.A.S. ,PIPE INVERT; SEPTI - �:OF . ., ��. � 11. EXISTING LEACH PIT TO BE PUMPED AND REMOVED. , TANK - ti .:�.�,;. .�•F> t, _, ,. , --- :_ T .'ILASORPTION"', } 12. PROPOSED CONSTRUCTION IS 'TO REPLACE 'A'FAILED Sb � ,. SYS tFM. " D.B. 18,jlj S.F.f s9.3✓' � CRAIG Irk +6 CH DECK � 97.9 � SHORT I , APPROVED: . BOARD _ OF , HE L�'H . i • ' - -. .. a"�:r,.• j,. �,.5': `� ' - I U CIVIL N _ .yalD.. ,. No. 27493 . _. £GtS Fr s. 2480 o.3 AT AGENT;,.. . L.P. a , PROPOSED -:-SEPTIC . DESIGN _ FOR ROU7E 132 WM. El . ROBINSON, SR:a NARAOS - - V , _ k. � �, ,. . LOG. z:. /SHALLOW 23 _.GOOSE POINT-: ROAD POND • ul CENTERVILE . 0. CRAIG : SHORT, ?E.. _� LOCu9 235 GREAT ;WESTERN '-ROAD z508P. 0. BOX 1044 r : SOUTH DENNIS, :MASS. 398-8311 02660 - ? ` o DATE- SCALE , ,:. 5 AUG. 1 , 003 , 20 71 REV,' :, ` - .JOB N0. �� � 982 R V. E MAP . LOCATION a1 01-0982 Korkos.dwq "02003 CRAIG R. SNORT, P.E.