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HomeMy WebLinkAbout0049 MAINSAIL LANE - Health 49 Mainsail Lane_ r Hyannis A= 288-187 k i o 1 0 P 4 e d Y 0 K TOWN OF BAR.NSTABLE �Sl to '�. SEWAGE # VILLAGE-W KN iN iA a)CT ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY OC�CJq� LEACHING FACILITY: (type)_ Q�7 (size) (000 2.�1 NO.OF BEDROOMS BUILDER OR OWNER DATE: COMPLIANCE DATE: Separation Distance Between the: t Maximum Adjusted Groundwater Table to the t 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 _c1,C�e' .r ,r � � f C!� CA ` i r ci � r 7,J 3 (� '57- { J G�tS F.P. IFA Z b T- F. - z c r Z 14 U - - - - - d' Fn — AN � � L I � � 'fir Urn n 2L U� 'ci — 1A o� , Ili . 1 bQ i v s r JN X cn PJ X I rj 70 1 p . v+ o i � o I ILi T •' 7-1 r e m Lh Z. c ; N N .� u � c� j O � � n _l z- ` Z "� U ', i� _ � ..`_F Tr- 1n�+---...1�` rn "fl v t`J� V �_`�� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 49 Mainsail Lane Property Address Cynthia Hart Owner Owner's Name information is required for every Hyannisport MA 02647 07/08/11 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 A. General Information filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor-do not Michael Kellett use the return Name of Inspector key. Aardvark Environmental Inspections � Company Name PO Box 896 Company Address East Dennis MA 02641 City/Town State Zip Code 508-385-7608 SI 3742 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 16.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority -(ay 07/09/11 �. Inspector's Signature Date F "i The system inspector shall submit a copy of this inspection report to the Approving Authoritjij(Boa 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 owr% r and copies sent to the buyer, if applicable, and the approving authority. CO I ****This report only describes conditions at the time of inspection and under the conol ons pf 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. I I t5ins•11/10 Me 5 Official Inspection Form Subsur6Sewagosal Syste •Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 49 Mainsail Lane Property Address Cynthia Hart Owner Owner's Name information is p required for every y H annis ort MA 02647 07/08/11 page. CRyrrown 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: 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•11/10 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 49 Mainsail Lane Property Address Cynthia Hart Owner Owner's Name information is required for every Hy p annis ort MA 02647 07/08/11 page. Cityrrown 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 ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 16.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins-11/10 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 a 49 Mainsail Lane Property Address Cynthia Hart Owner Owner's Name information is required for every Hy p annis ort MA 02647 07/08/11 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow t5ins•11/10 Tale 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 49 Mainsail Lane Property Address Cynthia Hart Owner Owner's Name information is required for every Hyannisport MA 02647 07/08/11 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® 'Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails.'l 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•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 49 Mainsail Lane Property Address Cynthia Hart Owner Owner's Name information is required for every Hyannisport MA 02647 07/08/11 page. CityrFown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® El available as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® El approximation in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 t5ins•11/10 Tale 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 49 Mainsail Lane Property Address Cynthia Hart Owner Owner's Name information is Hyannis port MA 02647 07/08/11 required for every p page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® ' No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonaluse? ® Yes ❑ No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No 'Last date of occupancy: 06/11Date 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-11/10 Titre 5 Official Inspection Form: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 49 Mainsail Lane Property Address Cynthia Hart Owner Owner's Name information is H annis ort MA 02647 07/08/11 required for every y p page. Cityrrown State Zip Code Date of Inspection' D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: , Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no)(if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins•11110 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 49 Mainsail Lane Property Address Cynthia Hart Owner Owner's Name information is required for every Hy p annis ort MA 02647 07/08/11 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed(if known)and source of information: 07/19/84 per BOH Were sewage odors detected when arriving at the site? ❑ Yes ® No BuildingSewer locate on site plan): ( P ) Depth below grade: 1.8 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site,plan): Depth below grade: 1.0 p g 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 I Dimensions: 1000 gal I Sludge depth: 3" t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 49 Mainsail Lane Property Address Cynthia Hart Owner Owner's Name information is required for every H annis ort MA 02647 07/08/11 y p page. Cityrrown 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 29" 2" Scum thickness Distance from top of scum to top of outlet tee or baffle 6" - Distance from bottom of scum to bottom of outlet tee or baffle 15" 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.): The tank was sound and tight with tees in place and liquid at outlet invert. 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 t�4 Commonwealth of Massachusetts Title 5 Official Inspection Form . Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 49 Mainsail Lane Property Address Cynthia Hart Owner Owner's Name information is required for every Hyannisport MA 02647 07/08/11 page. Cityfrown 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 co of current pumping contract(required). Is co attached? Yes ❑ No PY P P 9 PY ❑ t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 49 Mainsail Lane Property Address Cynthia Hart Owner Owner's Name information is required for every Hy p annis ort MA 02647 07/08/11 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 even 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.): The box was level and tight with no sign of carryover. 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•11110 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 49 Mainsail Lane Property Address Cynthia Hart Owner Owner's Name information is H annis ort MA 02647 07/08/11 required for every y p page Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ 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.): This system has a 6'x6'precast pit surrounded by afoot of stone.The pit was half full with stainings just above liquid Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert 6 Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•11f10 Tdle 5 Official Inspection forth: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 s ' 49 Mainsail Lane Property Address Cynthia Hart Owner Owner's Name information is H annis ort MA 02647 07/08/11 required for every y p page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): l5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form subsurface Sewage Disposal System Form-Not for Voluntary Assessments 49 Mainsail Lane Pmperty.nddress Cynthia Hart Owner Owner's Name information IsH annisport MA 02647 07/08/11 required for every Stiff Zip Code Date of�pecdion page. Cdy/Town D. System Information (cunt.) Sketch Of Sewage Disposal System:.Provide a view of the sewage disposal system,including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building.Check one of the boxes below. ® hand-sketch in the area below ❑ drawing attached separately a3 d� t5ris•11H0 Tie 5 nffi-l Unp9com FamK&"wjmsmW Dbposd System•Pepa 15 d 17 N Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 49 Mainsail Lane Property Address Cynthia Hart Owner Owner's Name information is required for every Hy p annis ort MA 02647 07/08/11 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: 7.9 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: I augered to 10.0 feet and found no water. I adjusted to 7.9 feet. Bottom of leaching is at 7.4 feet. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11110 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 49 Mainsail Lane Properly Address Cynthia Hart Owner Owner's Name information is Hyannis port MA 02647 07/08/11 required for every p 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•11/10 Tale 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 LWK COO A Date: owner; Prone: *mClors ems: - s 3 Mee dot to-way tabi+f ` I (dqft Is In�fL below,hl ? Date: a?to r. u,0 o S a UM Wat r-Umel Range Zone and 4m Wes Hap-loa".$ke aml deowfte: A)Appiqxiute ; i n'l((�la'5 B)Wafil4vef raw zee 3 mt Water Wesoaes �- - aoWa*depth wster 001 . s mnVW Of of 4 Using Table of Poben"Water Level re for hXIRK Weil(STEP 2A),current depth water , kvd for kmkK won(STD`3),and wator-isviO- mom(STEP 28)determine water-levid 01, 1 adjustrnerrt. 0 St 5 = Estinaft depth to lam Water-by sung no p . E , 1 d� wa (STEP 4)horn nuaeued depifi to water lei at sibs(STEP 1). N Tables i�"Pb Biwa" monNy bb®c wg data:www . . t 7 8 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AF d919 ' 9 DEPARTMENT OF ENVIRONMENTAL PROTEC ONE WINTER STREET, BOSTON MA 02108 (617) 292-5500 j TRUDY CORE WILLIAM F.WELD Secretary Governor DAVID B. STRUHS ARGEO PAUL CELLUCCI Commissioner Lt. Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM IIYSPECTION FORM PART A CERTIFICATION ap �1.�, Address of Owner: Property Address: t l 1 d" A%N) s - Lt,3, d t l\`(�1(,"Qi Date of Inspection- v,<\�C- \ (I!different) i(o� Name of Inspector: C- Q) I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) Company Name: T Mailing Address i7 i'� c�r k a,��,�y AcSY�t�r < t t— 1k Ul--'yk Telephone Number:. �C,�r•- '11 l �� �1 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true. accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: Passes Conditionally Passes _ Needs Further Evaluat' n B t Local Approving Authority Fails CC Inspector's Signature V`F� ,�� Date: Le t 1- The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUNLINIARY: Check A, B, C, or D: AJ SYSTEM PASSES: 1 have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CN1R 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: B] SYSTEM CONDITIONALLY PASSES: One or more system components as described in the 'Conditional Pass' section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Indicate yes, no, or not determined (Y. N, or ND). Describe basis of determination in all instances. If'not determined', explain why not. _ °The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection: or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. hrt na^�'n-i PIvr 1 or 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) . Property Address: Owner: Date of Inspection: B) SYSTEM CONDITIONALLY PASSES (continued) _ Sewage backup or breakout or high static water level observed in the distribution box is due broken or obstructed pipe(s) or due to a broken. settled or uneven distribution box. The system will pass inspection if(wi approval of the Board of Health). Describe observations: broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced _ The system required pumping more than four times a year due to broken obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF ALTH: Conditions exist which require further evaluation by the Boa of Health in order to determine if the system is failing to protect the public health. safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERM NES THAT THE SYSTEM IS NOT FUNCTIONING IN A M A..\'NER WIUCH WILL PROTECT THE PUBLIC HEALTH A.N`D 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 N1TLL FAIL UNLESS THE�OARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEy IS FUNCTIONLNG IN A MAN, THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRON1 TENT: The system has/stic k and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or tributary to a s supply. _ The system hask and soil absorption system and the SAS is within a Zone I of a public water supply well. The system hask and soil absorption system and the SAS is within 50 feet of a private water supply well. Thesystemhask and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply ell, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from p lution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method u d to determine distance (approximation not valid). 3) OTHER (revised 04/25/97) Pnge 2 of 10 IJ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) n Property Address: Owner: Date of Inspection: D] SYSTEM FAILS: You must indicate either "Yes" or "No" as to each of the following: I have determined that the system violates one or more of the following failure criter as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to etenrine what will be necessary to correct the failure. Yes No Backup of sewage into facility or system component due to an over aded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or urface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above o/ofa inverte to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invertle volume is less than I/2 day flow. Required pumping more than 4 times in the last to clogged or obstructed pipe(s). Number of times pumped _. Any portion of the Soil Absorption System. ccssis below' the high groundwater elevation. Any portion of a cesspool or privy is within 100ace water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a one I of a public well. Any portion of a cesspool or privy is/thcwell 50 feet of a private water supply well. Any portion of a cesspool or privy isn 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria. volatile organic cos. ammonia nitrogen and nitrate nitrogen. E) LARGE SYSTEM FAILS: You must indicate either "Yes or "No" as to each of/he following: The following criteria apply to large syste s to addition to the criteria above: The system serves a facility with a desig flow of 10.000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment b cause one or more of the following conditions exist: Yes No .the system is within 400 trt of a surface drinking water supply the system is within 200;Cct of a tributary to a surface drinking water supply the system is located iy nitrogen sensitive area (Interim Wellhead Protection Area - IWPA) or a trapped Zone U of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirernents of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. ,.l. 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Propert Address- �� S t�, , Owner: `��`N Date of Inspection: (5�� Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No _ Pumping information was provided by the owner, occupant, or Board of Health. None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. — As built plans have been obtained and examined. Note if they are not available with N/A. — The facility or dwelling was inspected for signs of sewage back-up. — The system does not receive non-sanitary or industrial waste flow. — The site was inspected for signs of breakout. — All system components. excluding,the Soil Absorption System, have been located on the site. — The septic tank manholes were uncovered, opened, and the interior of the septic tank uas inspected for condition of baffles or tees. naterial of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: The facility owner (and occupants,11if different from owner) were provided with information on the proper maintenance of Sub- Surface Disposal System. Existing information. Ex. Plan at B.O.H. Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) [15.302(3)(b)] t , (rc.ised 0V25/97) Pige 4 or to SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Propert Address: Owner: AVA vJ Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Design flow:-�'2, e.p.d./bedroom for S.A.S. Number of bedrooms: 2� Number of current residents: 6 Garbage grinder (yes or no):� Laundry connected to system (yes or no): Seasonal use (yes or no):_&:� Water meter readings. if available (last two (2) year usage (gpd): Sump Pump (yes or no): Last date of occupancy: CONENfERCIAL/INDL'ST RIAL: Type of establishment: Design flow: eallons/day 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: OTHER: (Describe) Last date of occupancy: GEN-ER.A-L INTORALATION PUN PL\G RECORDS and source of information: t�Y QC O C' C System pumped as part of inspection: (yes or no)_$S a If yes, volume pumped: gallons Reason for pumping: TYPE OF SYSTEM Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) I/A Technology etc. Copy of up to date contract? Other APPROXINLXTE AGE of all components, date installed (if known) and source of information: Sewage odors detected when arriving at the site: (yes or no) Irr'iiyl M'_t'0'1 l' PAV'o 4 or 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SySTEb1 INFORMATION (continued) l • PropertyA .1 Owner: p Date of Inspection: BUILDING SEWER: tid t, (Locate on site plan) Depth below grade: Material of construction: _cast iron _40 PVC _other (explain) Distance from private water supply well or suction line Diameter Comments: (condition of joints. venting. evidence of leakage, etc.) SEPTIC TAI K:*S (locate on site plan) t� Depth below grade: Material of construction: concrete _metal _Fiberglass _Polyethylene _other(explain) If tank is metal. list a-ve _ Is age confirmed by Certificate of Compliance_(Yes/No) Dimensions: l ("w'�'0 n Sludge depth _ r t Distance from top of sludi:e to bottom of outlet tee or baffle: 30 Scum thickness: '�_ tt Distance from top of scum to top of outlet tee or baffle: cl Distance from bottom of scum to bottom of outlet tee or baffle:_\V How dimensions were determined: tRt,C t1,tS� Comments: (recommendation for pumping. condition of inlet and outlet tees or baffles. depth of liquid level in relation to�utic: invert. tructCural rote uy. evidence of leakage. etc.) <<e 1 l fi ( T GREASE -P: (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: Contents: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert. structural integrity. evidence'of leakage, etc:) (reristd 04/25/97) Page 6 of t0 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Ad ess � Owner: Iv Date of Inspection: W4 TIGHT OR HOLDING TANK: (Tank must be pumped prior to, or at time, of inspection) (locate on site plan) Depth below grade: Material of construction: _concrete _metal _Fiberglass _Polyethylene _other(explain) Dimensions: Capacity: gallons Desien flow: gallons/day Alarm level: Alarm in workinc order _ Yes: _ No Date of previous pumping: Comments: (condition of inlet tee. condition of alarm and float switches, etc.) tISTRIBUTION BOX: S (locate on site plan) Depth of liquid level above outlet invert:J4_3 W� OUST - Comments: (note if level and istributi is eq - ell � idence f solids carryover, evidenff of leakage into or out o�box, etc.) c �, �1��� �,�.�c- �'�,rzc2 PUMP CHAAIBER:vjn (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.) 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Propert Ad ress:"N\!,P Owner: (')o Date of Inspection: 1 S lG SOIL ABSORPTION SYSTEM (SAS): t4'L9N (locate on site plan, if possible: excavation not required, but may be approximated by non-intrusive methods) If not determined to be present. explain: Type: leaching pits, number:1 b&kD leaching chambers, number:_ leaching galleries, number: leaching trenches. number.length: leaching fields. number• dimensions: overflow cesspool, number: Altemative system: Name of Technology: Comments: (note condition of soil. signs of hydraulicfailure, level of ponding, condition of vegetation ��� CESSPOOLS: (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids laver: Depth of scum layer: Dimensions of cesspool Materials of construction: Indication of groundwater: inflow (cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY: L_v (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: ' (note condition of soil• signs of hydraulic failure, level of ponding, condition of vegetation, etc.) i t Page E o!10 (revised a(25/97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Pro pert Address: Owner:Z j II Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) owQ � L t r✓�_ -II ; I 1 M � SUBSURFACE SEWAGE DISPOSAL SYSTEM (INSPECTION FORM PART C SYSTEM INFOFMATION (continued) Property Address: Owner: V� Date of Inspection: Q 1 S(G C 1 r\ l Ll Depth to Groundwater{ Feet Please indicate all the methods used to determine High Groundwater Elevation: / Obtained from Design Plans on record X Observation of Site (Abutting property, observation hole. basement sump etc.) --�"--CCCDetermine it from locai conditions Check with local Board of health Check FEMA Maps Check pumping records Check iocai excavators. Installers Use USGS Data .Desc.ib, i❑ your o�%-n words hoµ you established the Hich Groundwater Elevation (jjust be comp;e'—iC t 1 (rr�iscd 01:25i97) Page 10 of 10 -LOCATION ! SEWAGE PERMIT NO. VILLAG INSTA LLER'S NAME & ADDRESS B U I L D E R OR OWNER I .\ DATE PERMIT ISSUED 171317 DATE COMPLIANCE ISSUED \ 1 Q' ,rf .s1 O No... ?=....tlgy Fxs,3 r ......._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OE HEALTH ......................�-�...................OF......... .................... ........................................ Appliration for Bispvo al Work.5 Tomitrurtinn rnwit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at �i Location-Address Ir Lot No. -• ---------•----- j-----•.................................................... � F...__........... ......------ --....... Owner Address W a ---------------------------------'----------Inst --••...-----...----.--_.--'--................ --------------------------------------------.-------•-----------------........... Installer Address dType of Building Size Lot...l 7$ .......Sq. feet V Dwelling—No. of Bedrooms...._..�............................Expansion Attic ( ) Garbage Grinder lt'�j Other—T e of Building No. of persons............................ Showers — Cafeteria p' Other fixtures - ....................•. l F .� � W Design Flow.............. ------------------ gallons Length .....Width. f ar Diameter................ Depth ---_. x Disposal Trench—No..................... Width.................. Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.....1/a_®... Depth below inlet....... d.. Total leaching area .sq. ft. Z Other Distribution box 00 Dosing nk, ) i W Percolation Test Result Performed by__ _.._..___.� ...............( .......... Date �, ...... Test Pit No. 1................minutes per inch Depth of Test Pit...er .._..._.... Depth to ground water-----:--------------- __. �r4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a - ------------------------------------•-••------'----------------------------•......--------------------•--------... O Description of Soil..-��-•--.-c!.K_..• '''' f �1f®� ..__.._.__._/-Z--111 ...e x ---•---•--•........••-•-•-------------------•--•'-'•-.----•- V .....-•--•-•-••••-•••---••••----•--.........-•..............•••••-------------------•......-"---•-------•-•••--.------------------ W VNature of Repairs or Alterations—Answer when applicable................................................................................................ ..--------•----------•----------•-•-•.............•--------•------------------------................•••---••--•-••••--...•••--•-•••---•-••••--•...._..••••••-••-•-••••-••-••-•--•••..........__.....--•- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITLL 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Application Approved By......... r ------ ..........•----------•------- C� . Date Application Disapproved for the following reasons--------------------------------------------------•-----•--------•---------------------------------...........-" ...................•..-•-•-----------------------------------•--••------=-------------------••--•-------_.....--••---••--•--••-••----•-•-----•-•-----------•-•-•-••-----•--•-•-•......-•......••'"'-'--- Date PermitNo......................................................... Issued--•------------......-•---.....-----------•---•--...... Date a .....::..�.�.......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Allptiration for Uiipusal Workfi Cnnnstrnrtiun rnmit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at Location-Address .._..-•------•••.....................•----- --••------------•••..........._................ ..........--.........../...........-•--- c ..................�---........................ Owner Address W Installer Address dType of Building Size Lot__........��...__......_._..Sq. feet Dwelling—No. of Bedrooms._______.:' ____________________________Expansion Attic ( ) Garbage Grinder aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures ........................................ d W Design Flow................ / -•----...--•____-gallons per penaiT per day. Total da}y flo ______ w_..._._.____.._f�___3 __....._.... ---- R; Septic Tank—Liquid capacity.� ______� Rons Length_ _'r_-_ Width__�-_�r-2 Diameter________________ Depth_________....... Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No____________________ Diameter__-_.. `�'.b-_ Depth below inlet........tom'.. . Total leaching area_�`.7sq. ft. Z Other Distribution box (X) Dosing t ) / Percolation Test Results Performed by ._�- __.______.wr.i_______________ Date_ . !_- z:__.-. Test Pit No. 1____ _______m2- inutes per inch Depth of Test Pit.... �......... Depth to ground water........................ Test Pit No. 2..........__....minutes per inch Depth of Test Pit.................... Depth to ground water........................ R'+ .....................:................................................................................................................................... O Description of Soil..-!?��ry` fir,-�" 'S...............�?!`�� <:/_ 3''`J -'���,� S,_a4p U ------------ •......... -------------------------------------- •------------------- ---------- ------------------ .._.. -------- -•---•-•----••- ---------------•--..._..-----...-•------------.._..._._.__....-.._...--------•---•---------._...-----------------...--•--------._...-----•--•--•-•------....._-•--..._-------•--•---•-•- U Nature of Repairs or Alterations—Answer when applicable . ................................_......._.. -•------------------•---------------•----------------------•---------•--•--•--•----......----•----------•-----------------------------------••---------------.-.-.--•-•--------•--•-••••-•••---•••-•---- Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TiT1: 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been i ued by the board of health. Signed.LA!_ �Z '� -`/� ...........__ -•T"' D h..e. Application Approved By .._..._ _,x _r.d�.--•«.r � �✓���'g..-----••--•-•- Date Application Disapproved for the following reasons:-------------------------•-••---.-.-------------------•-----------------------------•--•-•-•-----------•...._.. ----•..............••--------•-----------....---._...------------------------._._..._._..-----------------•-------•-•-•-•-----------------•-•---•-•--------------------••-•------------•------•------._ Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF.................................................I................................... Owrrtifiratr of Tomplianrr � THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by ---•••-•--• ........................................... staller has been installed in accordance with the provisions of TIT 1 5 of Th State Sanitary Code as desEribed in the application for Disposal Works Construction Permit No-----dI-"" _?_ ____________ dated-............................................... THE ISSUANC OF THIS CERTIFICATE SHALL NOT BE CONSTRUED A GUARANTEE THAT THE SYSTEM WI L F CTION SATISFACTORY. . DATE , _lf.......................:::.......... Inspector THE COMMONWEALTH OF MASSACHUSETTS `a BOARD OF HEALTH �< < ..OF..................................................................................... . No...�_�.:. `�..1.. FEE.... ........... Disposal sal nrkii 0-Pa$nstra inn amit Permission is hereby granted.............................................................................................................................................. to Const u�',( ), ` Reopair ) an_Indivi.ual ewa Disposal Syst at No...../ -. .f.:.. ' � ..Mom. --- -y�'? #005,11raw " d Street Y as shown on the apX1i , n for Disposal Works Construction Permit No..................... Dated.......................................... � y r / Boad of Health DATE.---C... ............................................... FORM 1255 HOBBS & WARREN, INC.. 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DISPOSAL OF: SANITARY SEWAGE LEVATION - T _ OUTLET DISTRIBUTION`, BOX` FT.'. ,. E 98.5� , E.L E VA .ION., - ,. __. , - .. �wL'ET�. LEACHIN'G�. r'i?�' s. BOTTOM LE'ACN N:G PIT: FT.. _w N L DESIG CA CULATIONS DUMBER OF BEDROOMS GARBAGE. DISPOSAL UNIT... _ . . �„ - TOTAL-.ESTIMATED. FLOW' ( /o GAL AR /DAY x— BR.),: GAL:/DAY' , REQUIRED _' SEPTIC TANK: GAL- 'CAPACITY ACTUAL- SIZE-.'OF ''SEPTIC TANK:.`TO RE 'INSTALLED..:: GAL: LEACHING AREA-, REQUIREMENTS ; ' f SIDE WALL, AREA- _ GAL./S.� :Sy '. BOTTOM AREA GAL /S:F. � y _ f ,: _•` LEACHIN CAPAC TY ( BOTTOM� SIOEWA�LL ).::..:. RESERVE LEACHING CAPACITY , . >Y3 ' GAL. :TOP`• OF FO-UN D. r ELEV.=lO� �' /4 �,.✓ CONCRETE . 4 , SCH 40 — t _ _ . , . - C .- . LEAN • SANDY .. - . - `PVC:_ PIPE ;. , . ,- � . :: ., ,: ;. COVERS' ; . .;, u: CONCRETE MIN- PER. 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